pharm fin

What are first-generation NSAIDs used for?

Inflammation, mild to moderate pain, fever, and dysmenorrhea. Prototypes: aspirin and ibuprofen.

What other first-generation NSAIDs should you know?

Naproxen, indomethacin, ketorolac, meloxicam, and diclofenac.

What do COX-1 and COX-2 do?

COX-1 protects the stomach and kidneys and helps platelets clot blood. COX-2 causes pain, fever, and inflammation.

What GI and bleeding problems can NSAIDs cause?

Ulcers, stomach pain, black stools, coffee-ground vomit, bruising, petechiae, or excessive bleeding.

How can NSAIDs affect the kidneys?

They can cause renal dysfunction (kidney problems). Monitor urine output, BUN, creatinine, swelling, and weight gain.

What cardiovascular risk can non-aspirin NSAIDs increase?

Heart attack and stroke.

What is salicylism?

Aspirin toxicity. Early signs include tinnitus (ringing in the ears) and decreased hearing.

Why is aspirin avoided in children with viral infections?

It can cause Reye syndrome.

What teaching is important with NSAIDs?

Take with food. Avoid alcohol. Anticoagulants and glucocorticoids can increase bleeding risk.

What is celecoxib used for?

Pain, inflammation, fever, and dysmenorrhea. It mainly blocks COX-2.

What precautions apply to celecoxib?

Check for a sulfa allergy, watch for GI and kidney problems, and separate magnesium/aluminum antacids by about 2 hours.

What is acetaminophen used for?

Mild to moderate pain and fever. It does not reduce inflammation or prevent blood clots.

What are signs of acetaminophen toxicity?

Nausea, vomiting, abdominal discomfort, sweating, diarrhea, and possible liver damage.

What is the antidote for acetaminophen toxicity?

Acetylcysteine (NAC).

What teaching is important with acetaminophen?

Avoid excess alcohol and check cold/flu medicines because they may also contain acetaminophen.

What is tramadol used for and how does it work?

It treats moderate to severe pain by acting on opioid receptors and affecting norepinephrine and serotonin.

What serious effects can tramadol cause?

Seizures, serotonin syndrome, sedation, and respiratory depression (slow breathing).

What teaching is important with tramadol?

Take with food if nauseated, swallow ER tablets whole, avoid driving, and rise slowly.

What opioid agonists should you know?

Morphine, fentanyl, meperidine, hydromorphone, methadone, codeine, oxycodone, hydrocodone, and tapentadol.

What major effects do opioids cause?

Pain relief, sedation, euphoria, and respiratory depression (slow breathing).

What should be monitored with opioids?

Vital signs, respiratory rate, oxygen level, sedation, and pain relief.

What common opioid side effects need nursing care?

Constipation, orthostatic hypotension (dizziness when standing), urinary retention, and decreased coughing.

What increases opioid CNS depression?

Alcohol, benzodiazepines, barbiturates, and other CNS depressants (medications that slow brain activity).

What does naloxone do?

It blocks opioid effects and reverses opioid overdose or respiratory depression.

Why must patients be monitored after naloxone?

Naloxone may wear off before the opioid, so slow breathing can return. Withdrawal can also occur.

What is hyperuricemia and why does gout hurt?

Hyperuricemia means high uric acid in the blood. Urate crystals collect in joints and cause pain and inflammation.

How do gout medications lower uric acid?

Allopurinol and febuxostat lower uric acid production. Probenecid helps the kidneys remove uric acid.

What should you know about glucocorticoids?

They mimic cortisol, reduce inflammation, suppress the immune system, and must be tapered after long-term use.

What are the 6 Rights of Medication Administration?

Right patient, medication, dose, route, time, and documentation.

What should be checked before giving medication?

The order, allergies, patient, vital signs, labs, condition, and at least 2 patient identifiers.

What should the nurse do with an unsafe or unclear medication order?

Hold the medication and clarify the order before giving it.

How does the nursing process apply to medication therapy?

Assess, plan expected outcomes, administer safely, and evaluate effects and side effects.

What are a medication category and prototype?

A category is a group of similar drugs. A prototype is the main drug used to learn the category.

What is pharmaceutics?

How a medication's form affects dissolution (breakdown), absorption, and onset of action.

What is pharmacokinetics and what does ADME mean?

What the body does to a medication. ADME = Absorption, Distribution, Metabolism, Excretion.

Why can liver or kidney problems cause medication toxicity?

The medication may be broken down or removed too slowly and build up in the body.

What are onset, peak, duration, and half-life?

Onset = starts working. Peak = strongest effect. Duration = how long it works. Half-life = time for the drug amount to decrease by half.

What is pharmacodynamics?

What a medication does to the body. Agonists activate receptors; antagonists block receptors.

What should be checked before antimicrobial therapy?

Allergies, cultures, labs, and the patient's condition. Collect cultures before antibiotics when possible.

What general teaching applies to antibiotics?

Finish the full course. Antibiotics do not treat viruses. Report severe or persistent diarrhea.

What should you know about penicillins?

Amoxicillin is a prototype. Penicillins kill bacteria by damaging bacterial cell walls. Check for penicillin allergy.

What should you know about cephalosporins?

Cephalexin is a prototype. Check for cephalosporin allergy and serious penicillin allergy.

What should you know about carbapenems?

Meropenem and imipenem treat serious infections. Watch for allergic reactions, diarrhea, seizures, and kidney problems.

What does vancomycin treat?

Serious gram-positive infections including MRSA. Oral vancomycin can treat C. difficile.

What toxicities can vancomycin cause?

Nephrotoxicity (kidney damage) and ototoxicity (hearing or balance problems).

What happens if vancomycin is infused too fast?

Flushing, itching, and low blood pressure can occur. Slow or stop the infusion according to protocol.

What should you know about tetracyclines?

They treat acne and certain infections and can cause photosensitivity. Calcium, dairy, iron, and antacids reduce absorption.

What should you know about macrolides?

Azithromycin, erythromycin, and clarithromycin can cause QT prolongation and abnormal heart rhythms.

What should you know about aminoglycosides?

Gentamicin, tobramycin, and amikacin can damage the kidneys and hearing. Monitor kidneys, hearing, balance, and drug levels.

What serious tendon problem can fluoroquinolones cause?

Tendinitis or tendon rupture. Stop the medication and report tendon pain.

What can reduce fluoroquinolone absorption?

Antacids, iron, calcium, dairy products, and sucralfate.

What should you know about sulfonamides?

TMP-SMX commonly treats UTIs. Check for sulfa allergy, report rash, use sun protection, and drink fluids if allowed.

What should you know about nitrofurantoin?

It treats lower UTIs. Check kidney function. Antacids reduce absorption and probenecid increases toxicity.

What should you know about isoniazid (INH)?

It treats tuberculosis (TB). It can damage the liver and cause peripheral neuropathy. Vitamin B6 helps prevent nerve damage.

What should you know about rifampin?

It can damage the liver, turns body fluids red-orange, and can make hormonal birth control less effective.

What should you know about metronidazole?

It treats anaerobic bacterial and protozoal infections. Avoid alcohol and report seizures or peripheral neuropathy.

What should you know about antifungal medications?

Amphotericin B can damage the kidneys. Azole antifungals can damage the liver.

What should you know about acyclovir?

It treats herpes viruses. IV acyclovir can damage the kidneys, so hydration and slow IV administration are important.

What is ondansetron used for?

It prevents and treats nausea and vomiting from chemotherapy, radiation, or surgery.

What serious risk occurs with ondansetron?

QT prolongation and torsades de pointes (dangerous heart rhythm).

What is metoclopramide used for?

Nausea, GERD, and gastroparesis. It speeds stomach emptying and tightens the lower esophageal sphincter.

What serious effects can metoclopramide cause?

EPS (extrapyramidal symptoms), tardive dyskinesia, and NMS (neuroleptic malignant syndrome).

What is loperamide used for?

It treats diarrhea by slowing intestinal movement. Avoid with bloody or infectious diarrhea or bowel obstruction.

What should you know about sulfasalazine?

It treats ulcerative colitis. Check for sulfa allergy and monitor CBC. Report fever, rash, sore throat, or infection.

What should you know about psyllium and docusate?

Psyllium needs at least 8 oz of water. Docusate softens stool. Avoid with bowel obstruction.

What should you know about stimulant and osmotic laxatives?

Stimulants increase bowel movement. Osmotic laxatives pull water into the bowel and can cause electrolyte imbalance.

What is lactulose used for?

It treats constipation and lowers ammonia in hepatic encephalopathy (brain problems caused by liver disease). Monitor stools, hydration, and electrolytes.

What should you know about antacids?

Aluminum can cause constipation. Magnesium can cause diarrhea. Antacids may interfere with medication absorption.

What are H2 blockers and PPIs used for?

They lower stomach acid for GERD and ulcers. Famotidine is an H2 blocker; omeprazole and esomeprazole are PPIs.

What should you know about sucralfate and misoprostol?

Sucralfate coats ulcers. Misoprostol prevents NSAID ulcers but can cause uterine contractions and pregnancy loss.

What should be assessed before and after respiratory medications?

Breathing, lung sounds, respiratory rate, oxygen level, vital signs, improvement, and adverse effects.

What is albuterol?

A SABA rescue inhaler used for quick bronchospasm relief. It can cause tremors and a fast heart rate.

What is salmeterol?

A LABA for long-term control. It works for about 12 hours and is not a rescue medication.

What should you know about inhaled corticosteroids?

Budesonide and fluticasone reduce airway inflammation. Rinse the mouth after use to prevent thrush.

What is prednisone used for in respiratory disease?

It decreases inflammation during asthma or COPD exacerbations. Long-term use can cause adrenal suppression and bone loss.

What is ipratropium?

A SAMA bronchodilator. It can cause dry mouth and blurred vision. Use caution with glaucoma and BPH (enlarged prostate).

What should you know about theophylline?

Therapeutic level = 10–20 mcg/mL. Above 20 can be toxic and may cause seizures or abnormal heart rhythms.

What is guaifenesin?

An expectorant that loosens mucus. Drink fluids if allowed and swallow ER tablets whole.

What is acetylcysteine?

A mucolytic that thins mucus. It can cause bronchospasm and also treats acetaminophen overdose.

What should you know about codeine and benzonatate?

Both suppress coughing. Codeine can slow breathing. Benzonatate must be swallowed whole.

What should you know about phenylephrine?

An alpha1 decongestant that can raise blood pressure. Limit topical nasal use to about 3–5 days.

What should you know about antihistamines?

Diphenhydramine causes more sedation. Loratadine usually causes less sedation. Use caution with glaucoma or BPH.

Which vitamins are water-soluble and fat-soluble?

Water-soluble: B-complex and C. Fat-soluble: A, D, E, and K.

What can cause iron-deficiency anemia and what are its symptoms?

Pregnancy, poor absorption, pica, and other causes. Symptoms include fatigue, pallor, shortness of breath, and fast heart rate.

What teaching applies to iron supplements?

Vitamin C increases absorption. Dark stools are expected. Take iron as directed, away from interfering foods or medications.

What forms of iron should you know?

Ferrous sulfate = oral iron.
Iron dextran = iron given IM or IV.

What are vitamin B12 and folic acid used for?

Vitamin B12 treats pernicious anemia. Folic acid (vitamin B9) helps treat anemia and prevent neural tube defects.

What is hawthorn used for?

Hawthorn is used for heart problems, including heart failure and high blood pressure (hypertension).

What should you know about potassium replacement?

Furosemide and hydrochlorothiazide (HCTZ) can lower potassium. IV potassium is given by pump and NEVER IV push.

What are signs of magnesium sulfate toxicity?

Respiratory depression, weakness, paralysis, and decreased DTRs (deep tendon reflexes). Antidote: calcium gluconate.

Which supplements can increase bleeding risk?

Vitamin E, ginger, garlic, ginkgo biloba, ginseng, and omega-3.

What should you know about St. John's wort?

It increases serotonin. Avoid combining it with SSRIs, MAOIs, and TCAs because of serotonin syndrome risk.

What should you know about kava, valerian, and licorice root?

Kava can damage the liver. Valerian has a calming effect. Licorice root can cause high blood pressure and low potassium.

What should you know about echinacea and other herbs?

Echinacea may increase bleeding. Saw palmetto is used for BPH, and black cohosh is used for menopausal hot flashes.

What oral medication forms should not be crushed?

Enteric-coated (EC) and extended-release (ER, XL, SR, XR, SA) medications.

What injection angles should you know?

IM = 90°. SubQ = 45° or 90°. Intradermal = 5–15° with bevel up.

What teaching applies to enteral and transdermal medications?

Enteral: keep HOB (head of bed) at least 30° and flush before/between medications. Transdermal: remove the old patch first.

What key administration rules apply to inhalers, eyes, and ears?

Use bronchodilator before inhaled steroid; rinse after steroid. Eye drops go in conjunctival sac. Adult ear: up and back.

What is the oral medication calculation formula?

Desired ÷ Have × Quantity.

What is the IV pump formula?

Total volume ÷ Hours = mL/hr.