Pharm II - Exam #3

diphenhydramine class & use

antihistamine
allergic reactions, common cold, sneezing, coughing, motion sickness

diphenhydramine moa

prevents histamine response

diphenhydramine se

anticholinergic effects
sedation (esp in elderly), worsening asthma and bronchoconstriction

diphenhydramine nsg con

assess sedation before and after
no alcohol, no cns dep
read otc labels - found in cold and sleep meds
review and avoid allergy triggers
take PO w food to lower GI upset
slow IV push
mon overdose s/s like euphoria and altered mental status
no driving

dextromethorphan class & use

antitussives (nonopioid)
dry nonproductive cough

dextromethorphan moa

act on cough-control center in medulla to suppress the cough reflex

dextromethorphan se

drousy, nausea
CNS depression, high doses = psychosis and halluciation

dextromethorphan nsg con

assess lung sounds (wheezing)
assess freq and type of cough, amt of sputum
expectorants to get phlegm out at daytime, cold med nighttime
careful pt w asthma and bronchitis
combo w MAOIs = serotonin syndrome
shouldn’t last more than 2 wks
maintain proper fluid intake

albuterol class & use

bronchodilators
asthma, bronchospasm

albuterol moa

selective beta 2 adrenergic agonist for bronchodilation
rapid onset, longer duration of action

albuterol se

pulmonary edema, rebound bronchospasm, palpitations, hypokalemia

albuterol nsg con

assess lung sounds
mon potassium levels
RESCUE PRN
medicalert tag or bracelet
pt ed on use of MDI and spacer
admin med at reg intervals to sustain therapeutic level
hold if pt is tachy
mon s/s fluid volume overload and pulmonary edema
mon asthma attack freq

tiotropum class & use

bronchodilators (anticholinergic)
maintenance tx of bronchospasms d/t COPD

tiotropum moa

block m3 muscarinic receptors, long acting

tiotropum se

anticholinergic effects
sore throat, infection, peripheral edema

tiotropum nsg con

mon lung sounds and vitals
admin by inhalation
contra: glaucoma, UTIs, sensitivity to milk products
record freq of asthma attacks
wear medicalert tag or bracelet
MAINTENANCE
adequate hydration
anticholinergic s/s = dry mouth, sugarless gum or ice chips
don’t get med into eyes = pupil dilation and blurred vision

digoxin class & use

cardiac glycoside

HF

digoxin moa

inc contractility, lower hr, lower conduction

digoxin se

dysrhythmias, blurred vision, bradycardia, confusion

digitalis toxicity

digoxin nsg con

mon digitalis toxicity

check apical pulse (1 min, >60 = do not give)

mon s/s of edema, daily weight

mon serum digoxin and potassium

antidote: digoxin immune fab

digitalis toxicity

overdose or from long term use of digoxin

s/s anorexia, malaise, halo vision, delirium

nitroglycerin class & use

antianginal nitrate

angina

nitroglycerin moa

vasodilation, lower pre/afterload

nitroglycerin se

headache, flushing, dizziness

orthostatic hypotension, syncope (fainting)

nitroglycerin nsg con

do not abruptly discontinue

mon effects of IV nitro

admin SL nitro tablet if chest pain occurs

mon vitals (hold if SBP <90)

w sexual-enhancing drugs = orthostatic hypo

first admin: take lying down

no alcohol

first pass in antianginals (nitroglycerin)

can admin every 5-20 min up to 3x

take w 5 min of onset

call 911 if 2nd dose doesn’t help

acebutolol class & use

antianginal beta blocker

lower workload of heart and O2 demands

acebutolol moa

block B1&2 receptor sites

block action of catecholamine (epi & norepi)

acebutolol se

bradycardia, hypotension

peripheral edema, bronchospasms

acebutolol nsg con

do not abruptly discontinue

take BP before & after

mon apical pulse & HR

orthostatic hypotension = fall risk

can mask s/s of hypoglycemia

amiodarone class & use

potassium channel blocker

atrial fibrillation/flutter

amiodarone moa

bloacks potassium channels, noncompetitive beta-blocking effects

amiodarone se

bradycardia, hypotension, photosensitivity

hepatotoxicity, thyroid dysfunction

amiodarone nsg con

mon BP & HR

mon LFTs & electrolytes

mon lung function (coughs, SOB, crackles)

sunscreen & protective clothing

hydrochlorothiazide (HCTZ) class & use

thiazide & thiazide-like diuretic

hypertension, peripheral edema

hydrochlorothiazide (HCTZ) moa

act on distal convoluted renal tubule (promote sodium, chloride, & wsater excretion)

hydrochlorothiazide (HCTZ) se

dizziness, hypotension, constipation

hyperglycemia, electrolyte imbalances

hydrochlorothiazide (HCTZ) nsg con

check vitals (low BP) and labs (lower Mg, Na, K, inc Ca)

mon daily weights & urine output

take in the morning

slowly change positions

contraindication: renal failure
drug interactions: digoxin

furosemide class & use

loop diuretic, lasix

lower excess fluid retention & edema d/t CHF

furosemide moa

act on ascending loop of henle

excrete Na, H2O, K, Ca, Mg

furosemide se

hypoglycemia, orthostatic hypotension, hearing loss

furosemide nsg con

admin IV slowly (too fast = hearing loss)

eat foods high in K+ (leafy greens, bananas, potatoes, spinach)

mon vitals (lower BP)
mon urinary output and I&Os

mon K+ esp w digoxin = digitalis toxicity

report sulfonamide allergy

spironolactone class & use

potassium sparing diuretic

edema d/t HF, liver cirrhosis

spironolactone moa

back action of aldosterone

excrete Na & H2O, keep K+

spironolactone se

hyperkalemia (palpitations, muscle cramps), sexual dysfunction, hyperuricemia, orthostatic hypotension

spironolactone nsg con

avoid foods w high potassium

mon s/s hyperkalemia (>5 = discontinue)

mon urinary output & daily weight

admin at morning

fall risk, rise slowly

report menstrual irregularities

prazosin class & use

Alpha 1 adrenergic blockers

tx hypertension d/t lipid abnormalities

prazosin moa

block A1- adrenergic receptors

vasodilation & lower BP

prazosin se

bradycardia, edema, irregular heartbeat, orthostatic hypotension

prazosin nsg con

fall risk precautions

mon weight 2x/wk & fluid retention

mon vitals (BP & HR)

mon lungs for crackles

take at night to lower dizziness & falls

DASH diet

valsartan class & use

angiotension II receptor bloack (ARBs)

HTN, HF, acute MI

valsartan moa

act on RAAS, block angiotensin II from angiotensin 1 receptors

valsartan se

hypotension, hyperkalemia, hyperglycemia, edema

valsartan nsg con

NO FOOD HIGH IN K+

mon s/s of angioedema

mon fluid & electrolye depletion

mon BP before & after

mon orthostatic hypotension = rise slowly, fall precautions

mon renal function (BUN, creatine)

amlodipine class & use

calcium channel blockers

HTN, angina, CAD

amlodipine moa

block calcium channels in vascular smooth muscle cells promoting vasodilation

amlodipine se

flushing, blurred vision

peripheral edema, bradycardia, hypotension, constipation

amlodipine nsg con

mon BP & HR

assess s/s of worsening HF (SOB, weight gain, edema, crackles)

proper dental care = gingival hyperplasia

report palpitations and new chest pain

lower dose if there’s flushing, dizziness, or edema

heparin class & use

anticoagulants

prevent venous thrombosis

heparin moa

bind with antithrombin III
inhibit conversion of fibrinogen to fibrin
inhibit clot formation

heparin se

bleeding, anemia, HIT

heparin nsg con

antidote = protamine sulfate

mon PTT and aPTT before admin

bleeding precautions

NO NSAIDS

what is HIT

heparin-induced thrombocytopenia

drastic dec in platelets d/t to long term use

check platelets & downward trend

warfarin class & use

oral anticoagulant

prevent PE, DVT, thromboembolism

warfarin moa

inhibit hepatic synthesis of vitamin K

affecting clotting factors II, VII, IX, X

warfarin se

bleeding, bruising, dermal necrosis

warfarin nsg con

vitamin K = warfarin overdose

mon PT/INR

bleeding precautions

acute bleeding = fresh frozen plasma or platelets

inform dentist when taking anticoagulants

DO NOT DOUBLE DOSE

no NSAIDs, aspirin, St John’s Worts, alcohol

alteplase class & use

thrombolytic

short term emergency management of PE, DVT, thromboembolism

alteplase moa

bind to fibrin, promoting conversion of plasminogen to plasmin

alteplase se

dysrhythmias, hypotension, anaphylaxis, bronchospasm, hemorrhage

alteplase nsg con

antidote = aminocarproic acid (amicar)

mon s/s of active bleeding

no venipuncture/arterial sticks

atrovastatin class & use

HMG CoA reductase inhibitors

high cholesterol, hyperlipidemia

atrovastatin moa

inhibit HMG CoA reductase in cholesterol biosynth

dec LDL, inc HDL

atrovastatin se

cataracts, hyperglycemia

hepatotoxicity, myalgia, rhabdomyolysis

atrovastatin nsg con

mon pt blood lipid levels (AST, ALT)

METALLIC TASTE IS NORMAL

mon liver function

no red meat, DASH diet

abrupt discontinuation = rebound effects

annual eye exams & report changes in visual acuity

report muscle cramps early on = use diff med