Pharm Exam 3

UNM NMNC 3230: Nursing Pharmacology

Aspirin

Class: NSAID

Use: pain relief + inhibits platelet aggregation

ADR: GI irritation, bleeding, Tinnitus with toxicity

Safety: Narrow therapeutic index, DO NOT GO OVER 4g/24hrs

Do not give to Peds → Reye’s syndrome

Give with full glass of water

Ibuprofen (Motrin, Advil)

Class: NSAID

Use: pain relief, reduces inflammation, and lowers fever.

ADR: GI irritation - ulcers <1%, CV disorders - with IV

Black Box warning – risk for CV (stroke + MI)+ GI events

Give w/ food or milk

Dosage 1200-2300 mg

Acetaminophen (Tylenol)

analgesic and antipyretic

little to no anti-inflammatory effects

ADR: Overdose → Liver Failure

MAXIMUM DAILY DOSE: 4g/24 hours

Overdose treatment → Acetylcysteine

Morphine

Class: opioid analgesic

Use: moderate/severe pain

ADR: respiratory depression, constipation, n/v, prutisis

Fentanyl

class: opioid analgesic (C-II)

• 100X more potent that morphine

Use: induction of anesthesia, analgesia

ADR: respiratory depression, constipation, n/v, prutisis

• higher incidence than morphine, esp. muscle rigidity

Elders: high risk of confusion

Oxycodone

class: opioid analgesic (C-II)

PO only

Use: moderate/severe pain

Popular drug of abuse

ADR: respiratory depression, constipation, n/v, prutisis

Hydromorphone (Dilaudid)

class: opioid analgesic (C-II)

• 7X more potent than morphine

Use: analgesia

ADR: miosis, orthostatic hypotension, respiratory depression, itching/pruritis, constipation, N/V

Methadone

Class: synthetic opioid analgesic (C-II)

Use: detoxification treatment of opioid addicts in methadone maintenance programs

ADR: prolonged QT interval, constipation, respiratory depression

Buprenorphine

Class: opioid agonist-antagonist

Use: acute pain, chronic pain, opioid use disorder (OUD)

• used to treat opioid addiction

ADR: similar to morphine with less respiratory depression, lower risk of abuse and addiction

can cause withdrawal in opioid dependent patients

Naloxone (Narcan)

Class: opioid antagonist

Use: partial or complete reversal of opioid induced respiratory depression, opioid overdose

ADR: Headache, Hypertension, Immediate reversal of opioid induced effects (pain, seizures, death)

reverse respiratory depression induced by an opioid

respiratory assessment

Allopurinol

Class: Anti-hyperuricemic agent

Use: prevents gout and lowers uric acid levels.

ADR: Pruritus, rash → discontinue, Bone marrow suppression

Asians at higher risk for severe skin reactions

Prednisone

Class: glucocorticoid (steroid)

Use: inflammatory diseases or conditions, allergies

MoA: inhibits inflammatory and immune responses

ADR: hypertension, psychosis, hyperglycemia, abdominal obesity

Take in the morning + DO NOT stop abruptly
*weakens immune system

*Adrenocortical insufficiency if stopped abruptly

Calcium Carbonate (Tums)

Class: Antacids

MoA: neutralizes gastric acid secretion and promotes gastric mucosal defense mechanisms

ADR: rebound hyperacidity, constipation, kidney stones

Safety: Interacts with absorption with other drugs; give 2-3 hours apart

• when using as a Ca2+ supplement, take with Vitamin D for better absorption & efficacy

Magnesium Hydroxide

Class: Antacids

MoA: neutralizes gastric acid secretion and promotes gastric mucosal defense mechanisms

ADR: diarrhea

Safety: Interacts with absorption of other drugs: give 2-3 hours apart

• not safe for patients with renal failure

Aluminum Hydroxide (Amphogel)

Class: antacid

MoA: neutralizes gastric acid secretion and promotes gastric mucosal defense mechanisms

ADR: Constipation

Safety: interacts with absorption of other drugs: give 2-3 hours apart

• chronic use may elevate systemic aluminum levels

Antacids

Assessment: GI symptoms, renal function

Safety: Caution when given with other drugs. MANY drug interactions

Avoid long-term use

Histamine 2 Receptor Antagonists

MoA:

• blocks H2 receptors of the acid-producing parietal cells

• Less acid secretion occurs and gastric pH is raised

Common suffix: “-tidine”

Assessment: GI symptoms

Can be administered with ANTACIDS

Best taken at bedtime

Ranitidine (Zantac)

class: H2 blocker

Indications: GERD, Peptic Ulcer Disease (PUD), erosive esophagitis, stress ulcer prophylaxis

ADR: confusion, lethargy, and increased prolactin secretion

Proton Pump Inhibitors (PPI’s)

MoA: Block proton pump from secreting gastric acid

Common suffix: “-prazole”

Indications: GERD, stress ulcer prophylaxis, long-term treatment of hypersecretory conditions, with antibiotics for H. Pylori infections

Assessment: GI symptoms

Administration: dilute IV with sterile saline

• PO or NG: do not crush or chew capsule or granules

Omeprazole (Prilosec)

class: PPI

ADR: myopathy and bone fracture (long-term use), associated with C. difficile infection

Administered PO or NG tube

• Watch out for tube clogging!

Loperamide (Imodium)

Class: opiate antidiarrheal

MoA: decreases GI motility/peristalsis (antimotility)

ADR: low incidence (OTC)

Contraindications: ulcerative colitis, e. coli

Diphenoxylate & Atropine (Lomotil)

Class: Opiate antidiarrheal (atropine added to prevent abuse)

• Rx only

MoA: decreases GI motility/peristalsis (antimotility)

Contraindicated: IBD (ulcerative colitis & crohn’s disease)

• Higher risk of toxic megacolon

Psyllium (Metamucil)

Class: bulk-forming laxative

Indications: constipation (OTC)

MoA: fiber retains fluid, stimulates peristalsis

ADR: low incidence

Safety:

• must be taken w/ LOTS of water to prevent obstruction or compaction

• OK for long-term use

Take other meds 2 hours apart

Docusate (Colace, Soften, Docu-lax)

Class: Emollient laxative

Indication: Used to prevent constipation (OTC, PO)

MoA: Decreases surface tension of stool, allowing more water to enter.

• Makes stool softer or lubricates the intestinal wall

ADR: Low incidence

Bisacodyl (Dulcolax, etc.)

Class: stimulant laxative

Indications: constipation, prep for GI procedures

• OTC; Onset – Rectal 15 – 60 min, PO 6-12 hr

MoA: stimulates nerve endings to increase peristalsis

ADR: Cramps, GI distress, Laxative abuse

Stop use after 7 days

Meclizine (Antivert)

Class: antihistamine antiemetic

Indications: motion sickness, non-productive cough, allergy symptoms, sedation

MoA: H1 receptor blocker

• inhibits ACh by binding to H1 receptors

• prevents cholinergic stimulation in the vestibular region of the brain

ADR: Anticholinergic (drowsiness, tachycardia, urinary retention)

Metoclopramide (Reglan)

class: prokinetic antiemetic drug

Indications: prevention of nausea & vomiting, delayed gastric emptying, GERD

MoA: increased GI motility

Contraindications: seizure disorders, breast cancer, GI obstruction

ADR: EPS, tardive dyskinesia

PO and IV/IM

Ondansetron (Zofran)

Class: serotonin receptor blocker antiemetic

Indications: prevention of nausea and vomiting due to chemotherapy, radiotherapy, and surgery

MoA: blocks serotonin receptors in the GI, CTZ, VC

Suffix = -setron

ADR: Headache, Diarrhea, Prolonged QT interval

Rapid Acting Insulin

Lispro

Onset: 15 min, Peak: 1-2 hr, Duration 3-5 hr

“15 minutes feels like an hour during 3 rapid responses”

Short-acting insulin

Regular

Onset: 30 min, Peak: 2.5hr, Duration: 6-10 hr

“Short staffed nurses went from 30 pts 2(to) 8 pts”

Intermediate acting insulin

NPH

Onset: 1-2 hr, Peak: 4-8 hr, Duration: 10-18 hr

“Nurses Play Hero 2 8 16 yo”

Long-acting insulin

Glargine (NEVER mixed with anything else)

Onset: 1-2 hr, No peak, Duration: 24 hr
“The 2 long nursing shifts never peaked but lasted 24 hrs”

Insulins

Indications: Type 1 and Type 2 Diabetes Mellitus

MoA: substitute for endogenous insulin

• metabolize carbohydrates, fats, and proteins

• store glucose in the liver

• convert glycogen to fat

ADR: HYPOGLYCEMIA (cBG’s), autonomic neuropathy, injection site reactions, lipodystrophy

HIGH ALERT DRUG

Only insulin allowed to give IV: Regular Insulin

Mixing: Clear (fast-acting) before Cloudy (long-acting) (not glargine)

SubQ ONLY + Rotate around site

Hypoglycemia Adverse Effects

Sweating, tremors, tachycardia, hunger, headache, impaired cognition, blurred vision, pallor, and seizures, disorientation, unconsciousness (more severe)

Treatment: give fruit juice, glucose tablet or other simple sugar

• Severe: 50% Dextrose slow IV push over 3-5 mins

Metformin (Glucophage)

class: biguanide

indications: initial oral drug for prediabetes or type 2 diabetes

MoA: decreases hepatic glucose production, increases insulin sensitivity

ADR:

• GI upset (n/v)

• black box warning: lactic acidosis in patients with kidney problems; elders at increased risk

  • discontinue if Cr rises or will be receiving IV contrast

Glipizide (Glucotrol)

class: second generation sulfonylurea; oral antidiabetic drug

indication: type 2 diabetes mellitus

MoA: stimulates release of insulin from pancreatic beta cells

ADR: hypoglycemia, weight gain, photosensitivity

Safety: hypoglycemia risks

Pioglitazone (Actos)

 Class: oral antidiabetic, thiazolidinedione (“glitazone”)

Indication: type 2 diabetes, may be combined with other oral antidiabetic drugs or insulin

MoA: decreases insulin resistance by sensitizing insulin receptors

ADR: edema, weight gain, increased risk of fracture

Safety: black box warning - may worsen heart failure

GLP-1 agonists

”Glucagon-like peptide 1” = hormone

Secreted in response to food intake → release of insulin

Cause:

1. increased insulin release

2. decreased glucagon release

3. decreased gastric emptying

4. increased satiety

ADR: GI disturbances, weight loss, pancreatitis, medullary thyroid cancer, headache

Blood sugar GOAL: 60 – 120 mg/dL

Levothyroxine (Synthroid)

class: thyroid hormone replacement

MoA: mimics the effect of natural thyroid hormones

• increases basal metabolic rate

• affects temperature regulation

• stimulation of the heart→increased cardiac output

• increased renal blood flow

ADR

• cardiac symptoms – tachycardia thru cardiac arrest

• nausea, diarrhea

• weight loss

Safety: do NOT use for weight control or weight loss

Give on an empty stomach & in AM