Pharmacology - RNSG 2363 Lecture Notes

30 vocabulary-style flashcards covering key drugs and concepts from the lecture notes.

Amiodarone

Potassium channel blocker antiarrhythmic; delays repolarization to treat atrial and ventricular dysrhythmias; IV or oral; loading dose often given IV; Loading dose over 10 minutes when given IV, followed by continuous infusion for up to 96 hours or until stable rhythm. It can cause bradycardia, hypotension, and photosensitivity.

• When initiating IV, patient must be on EKG monitor –risk of AV block

• Monitor for changes in patient's rhythm

• Educate patient on sxs of toxicity

• No grapefruit juice

 

Atropine

Muscarinic antagonist used for symptomatic bradycardia; increases heart rate; routes include IM, IV, SQ, or topical (eye); half-life about 3 hours; monitor on ECG; interacts with antihistamines and other anticholinergics. ACLS

Side Effects:

Tachycardia, dry mouth, blurred vision, urinary retention, asthma

 

Diltiazem

Calcium channel blocker for angina, hypertension, and dysrhythmias; side effects include bradycardia and AV block, heart failure (decreases CO), constipation; routes: PO or IV; IV administration for cardiac dysrhythmias, give slowly (2–3 minutes).

Nursing Considerations

o   Contraindicated in severe hypotension, SSS, 2nd or 3rd degree blocks

o   For IV administration, the patient should be on a cardiac monitor

o   Educate pt on keeping track of angina and to monitor BP

o   Diltiazem can increase plasms levels of digoxin

o   Grapefruit juice can increase levels of diltiazem

o   Beta blockers increase risk of AV block and bradycardia

Epinephrine

Potent adrenergic agonist; vasoconstrictor; used to delay local anesthetic absorption, control bleeding, elevate BP, and treat cardiac arrest; routes: topical or IV; cardiac arrest dosing: 1 mg IV every 3–5 minutes; monitor for increased cardiac workload; extravasation can cause necrosis.

Side Effects:

o   Hypertensive crisis, dysrhythmias, angina

IV is immediate action; can be given as a continuous infusion in shock

Cardiac Arrest- 1mg every 3-5 minutes

    Nursing Considerations

o   Increases the cardiac workload and O2 demand

o   Necrosis with extravasation—must be in CVC or PICC

o   Patient should be on EKG monitor

  Drug Interactions

o   Anesthetics-can cause tachydysrhythmias

o   Beta-adrenergic blockers, alpha-adrenergic receptors

Dopamine

Alpha and beta adrenergic agonist; used in shock and heart failure to increase cardiac output and perfusion; route: continuous IV; extravasation risk; monitor BP and HR; interacts with MAO inhibitors.

Dobutamine

Beta-1 selective adrenergic agonist; for short-term inotropic support in heart failure; increases myocardial squeeze; route: IV with continuous titration; monitor EKG and BP every 15 minutes; weight-based dosing; interacts with MAO inhibitors.

Nitroglycerin

Potent vasodilator for angina and HF; rapid onset (IV within 1 minute); forms include IV, tablets, spray, SL, ointment; reduces myocardial oxygen demand; adverse effects include orthostatic hypotension and headaches; monitor BP and titrate; topical forms require gloves and clean skin.

Nitroprusside

Vasodilator used in hypertensive crisis and acute heart failure; IV continuous infusion with careful titration; can cause cyanide/thiocyanate toxicity; light-sensitive; monitor BP closely and check thiocyanate levels.

Procainamide

Class IA antiarrhythmic; widens QRS and prolongs QT; adverse: lupus-like syndrome, cardiotoxicity, bradycardia, hypotension; routes: PO or IV; monitor baseline and ongoing EKG changes; interactions with digoxin.

Losartan

Angiotensin II receptor blocker (ARB); uses include HTN, diabetic nephropathy, stroke prevention; generally well tolerated; fetal harm risk; PO; monitor BP; cautious with other antihypertensives; interactions with other BP meds.

Methylprednisolone

Corticosteroid with anti-inflammatory effects; used for allergic disorders, autoimmune diseases, septic shock, spinal cord injury, etc.; monitor glucose; infection risk; contraindications include live vaccines and certain infections; route IV; long-term use requires monitoring; interactions with other drugs.

Insulin lispro (Humalog)

Rapid-acting insulin; for Type 1 diabetes; given before meals; onset ~15 minutes; peak 1–5 hours; duration up to ~10 hours; route: subcutaneous or IV.

Regular insulin

Short-acting insulin for Type 1 diabetes; onset 30–60 minutes; peak 1–5 hours; duration up to 10 hours; discard vials that are colored/cloudy or contain precipitate; routes: SQ or IV (rare).

NPH insulin

Intermediate-acting insulin for hyperglycemic control; cloudy vials that require agitation; can be mixed with regular insulin; usually twice daily; not for postprandial control; watch for lipohypertrophy.

Promethazine

Antiemetic and antihistamine with anti-motion-sickness effects; routes include rectal, PO, IV, IM; CNS depression and dry mouth are common; nursing: mix 25 mg with 25–50 mL NS for IVPB to avoid gangrene; monitor resp. depression; avoid in kids under 2; CNS depressants interactions.

Calcium acetate

Phosphate binder used in ESRD to control hyperphosphatemia; side effects include nausea and hypercalcemia; oral; take with meals; monitor electrolytes; do not give with other calcium supplements; monitor blood levels 2x/ week; contraindicated with renal calculi.

Octreotide

Somatostatin analog that slows intestinal motility and reduces variceal blood flow; used in upper GI bleeding with pantoprazole; IV or continuous IV infusion; monitor bleeding, glucose, I&O; watch for EKG changes; interactions with diuretics.

Lactulose

Osmotic laxative that reduces ammonia in hepatic encephalopathy; side effects include diarrhea; monitor stool and ammonia labs; caution in diabetes and pregnancy; avoid other laxatives; report belching/fullness; avoid concomitant laxatives.

Vancomycin

Broad-spectrum antibacterial; nephrotoxicity, chills, dizziness, rashes, tinnitus; routes IV or oral; monitor trough levels (12–20), monitor kidney function and UOP; extravasation risk; red man syndrome with rapid infusion; interactions with other renally cleared meds.

Bivalirudin

Direct thrombin inhibitor; IV anticoagulant given as continuous infusion; monitor for bleeding; caution in renal impairment; interactions with other bleeding diuretics/anticoagulants.

Apixaban

Direct Factor Xa inhibitor; oral anticoagulant; risk of bleeding and spinal hematoma; monitor liver and kidney function; half-life ~12 hours; fast-acting; interactions with CYP3A4 and P-glycoprotein; caution in pregnancy and hepatic/renal impairment; avoid St. John’s wort.

Heparin

Anticoagulant that prevents clot extension; IV or SQ; monitor with aPTT or anti-Xa for IV titration; antidote is protamine sulfate; two-RN verification; monitor platelets for HIT; interactions with other anticoagulants; caution in liver disease.

Alteplase (tPA)

Thrombolytic used for acute MI, acute ischemic stroke, and massive PE; dissolves clots; major bleeding risk; antidote aminocaproic acid; IV administration; time-critical therapy; baseline labs and neuro checks.

Diazepam

Benzodiazepine for anxiety, insomnia, muscle spasm, alcohol withdrawal; routes: PO/IV/IM; side effects include drowsiness and dizziness; monitor LFTs, HR, BP, mental status; avoid abrupt withdrawal; antidote flumazenil; avoid alcohol; fall risk.

Haloperidol

Antipsychotic; risk of dystonia, tardive dyskinesia, seizures, QT prolongation; routes IM/PO; monitor EKG; watch for hyperthermia and autonomic instability; dry mouth; interactions with alcohol and QT-prolonging drugs.

Ziprasidone (Geodon)

Antipsychotic for schizophrenia, acute agitation, bipolar I; side effects include confusion, somnolence, suicidality, respiratory depression; QT prolongation; routes PO/IM; baseline EKG; monitor for DRESS and metabolic syndrome; fall risk; interactions with antihypertensives; not for elderly; avoid opioids.

Spironolactone

Potassium-sparing diuretic; mild diuresis for HTN and hyperaldosteronism; side effects hyperkalemia and renal concerns; monitor K; oral; monitor I&O and weights; interactions with ACE inhibitors, anticoagulants, digoxin; licorice may increase risk of hypokalemia.

Mannitol

Osmotic diuretic used to reduce cerebral edema and lower ICP; side effects include seizures, dizziness, hypertension, thirst; IV; may crystallize; use filtered IV tubing; monitor renal and cardiac function; interactions with lithium and nephrotoxic meds.

Propofol

IV anesthetic agent for induction and maintenance of anesthesia or sedation; side effects bradycardia, hypotension, apnea, respiratory depression; continuous IV infusion; monitor vitals and RASS; prolonged use can turn urine green; interactions with alcohol and other sedatives.

Fentanyl

Potent opioid analgesic for anesthesia and analgesia; routes IV, continuous IV, and transdermal patch; side effects CNS and respiratory depression; reversal with naloxone; heat can increase patch delivery; titrate to pain/ras; interactions with amiodarone, benzodiazepines, phenytoin, erythromycin.