Pharm Exam 5 (Final)

Class/Subclass for Famotidine:

Anti-Ulcer/H2 Receptor Antagonists

Medication for Famotidine:

Pepcid and Zantac

Mechanism of Action for Famotidine:

Blocks histamine's action at the H2 receptor of the parietal cell reducing the production of hydrochloric acid

Therapeutic Use for Famotidine:

• Treats GERD, peptic ulcer disease, erosive esophagitis, and hyper secretory conditions or as adjunct treatment for the control of upper GI bleeding

• Treat heartburn or sour stomach

Key Adverse/Side Effects for Famotidine:

• Headache

• Dizziness

• Constipation

• Diarrhea

• Increased pain or other signs of bleeding ulcers such as coughing/vomiting of blood

Contraindications/Precautions for Famotidine:

Use caution in liver and kidney disease

Nursing/Patient Teaching for Famotidine:

• Take 15 to 60 minutes before eating foods or drinking drinks that may cause heartburn 

• Shake vigorously for 5 to 10 seconds prior to each use

• May cause constipation so fluids and high fiber diet should be encouraged

• Smoking interferes with histamine antagonists and should be discouraged

Class/Subclass for Bismuth Subsalicylate:

Antidiarrheal/Adsorbents

Medication for Bismuth Subsalicylate:

Pepto Bismol

Mechanism of Action for Bismuth Subsalicylate:

• Coats the walls of the GI tract and binds the causative bacteria or toxin for elimination from the GI tract through the stool

• Decreases the flow of fluids and electrolytes into the bowel

Therapeutic Use for Bismuth Subsalicylate:

Treat conditions that involve excess gas or toxins in the digestive system

Key Adverse/Side Effects for Bismuth Subsalicylate:

• Black or darkened tongue (black hairy tongue)

• Fever

• Ringing in the ears

Contraindications/Precautions for Bismuth Subsalicylate:

• Contraindicated in children or teenagers recovering from chicken pox or flu-like symptoms

• Contraindicated in clients with ulcers, bleeding problems, or blood or black stool

Nursing/Patient Teaching for Bismuth Subsalicylate:

• Clients should be aware of potential color changes to stool (black/darkened) that may occur

• Medication contains aspirin

• Discontinue if tinnitus occurs

• Avoid if the client has an allergy to salicylates (including aspirin) or if the client is taking other salicylate products 

• Reye's syndrome can occur in children and teenagers who have or are recovering from chicken pox

Class/Subclass for Scopolamine:

Antiemetics/Anticholinergics

Mechanism of Action for Scopolamine:

• Block ACh receptors in the vestibular center and within the brain

• Dry GI secretions and reduce smooth muscle spasms

Therapeutic Use for Scopolamine:

Prevent motion sickness and treat nausea and vomiting

Key Adverse/Side Effects for Scopolamine:

• Dry mouth

• Constipation

• Blurred vision

• Confusion

• Memory impairment

• Decreased GI motility

• Urinary Retention

Contraindications/Precautions for Scopolamine:

Contraindicated in clients with glaucoma

Nursing/Patient Teaching for Scopolamine:

• Only wear one transdermal system at any time

• Do not cut the patch

• Apply the patch in the postauricular area and wash hands after applying

• Will deliver about 1 mg over three days

• Can exacerbate psychosis, induce seizures, and cause drowsiness, confusion, and sedation

• Remove before an MRI

• Discontinue if client develops difficulty urinating

• May impair mental and/or physical abilities

• Do not drive, operate machinery, or participate in underwater sports

• Can cause temporary dilation of the pupils 

• Do not use alcohol, sedatives, hypnotics, opiates, or anxiolytics

Class/Subclass for Metoclopramide:

Antiemetics/prokinetics

Medication for Metoclopramide:

Reglan

Mechanism of Action for Metoclopramide:

• Blocks dopamine and sensitizes tissue to acetylcholine

• Used to promote peristalsis to empty the GI tract and reduce nausea

Therapeutic Use for Metoclopramide:

Treats GI disorders by improving motility 

Key Adverse/Side Effects for Metoclopramide:

• Restlessness, drowsiness, fatigue, depression, and suicide ideation

• Tardive dyskinesia

• Neuromalignant syndrome

Contraindications/Precautions for Metoclopramide:

• Contraindicated in pheochromocytoma

• Contraindicated in epileptics or clients receiving other drugs that are likely to cause extrapyramidal reactions

Nursing/Patient Teaching for Metoclopramide:

• Onset of action is 1 to 3 minutes following and IV dose, 10 to 15 minutes following IM administration, and 30 to 60 minutes following an oral dose

• Pharmacological effects persist for 1 to 2 hours

• Do not use when stimulation of GI motility might be dangerous like in the presence of GI hemorrhage

• Report new feelings of depression or tardive dyskinesia

Class/Subclass for Ondansetron:

Antiemetics/Serotonin Antagonists

Medication for Ondansetron:

Zofran

Mechanism of Action for Ondansetron:

Block serotonin receptors in the GI tract, the chemoreceptor trigger zone and the vomiting center

Therapeutic Use for Ondansetron:

Treat severe nausea and vomiting associated with chemotherapy, postoperative nausea and vomiting, and hyperemesis during pregnancy

Key Adverse/Side Effects for Ondansetron:

• Dizziness, headache

• Constipation

• Nausea

• Serotonin syndrome

• QT prolongation

Contraindications/Precautions for Ondansetron:

Use caution with SSRIs or serotonin antagonists as serotonin syndrome can occur

Nursing/Patient Teaching for Ondansetron:

Report changes in heart rate, lightheadedness, or feeling faint or signs and symptoms of hypersensitivity reactions

Class/Subclass for Loperamide:

Antidiarrheal/Opiate-like 

Medication for Loperamide:

Imodium

Mechanism of Action for Loperamide:

• Decreases the flow of fluids and electrolytes into the bowel and slow down the movement of the bowel to decrease the number of bowel movements

• Inhibits intestinal peristalsis through direct effects on longitudinal and circular muscles of the intestinal wall

Therapeutic Use for Loperamide:

Helps to resolve diarrhea

Key Adverse/Side Effects for Loperamide:

• Constipation, abdominal discomfort, nausea, and vomiting

• Dizziness and drowsiness

• Allergic skin reactions

• Abnormal heart rhythm

Contraindications/Precautions for Loperamide:

Contraindicated in children younger than two and with several other medications

Nursing/Patient Teaching for Loperamide:

• Avoid alcohol and other DNS depressants

• Do not give to a child younger than 2 y/o

Class/Subclass for Sucralfate:

Antiulcer/Mucosal Protectants

Mechanism of Action for Sucralfate:

Covers ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts

Therapeutic Use for Sucralfate:

Treats ulcers

Key Adverse/Side Effects for Sucralfate:

Constipation

Contraindications/Precautions for Sucralfate:

Precautioned in clients with chronic renal failure or those receiving dialysis 

Nursing/Patient Teaching for Sucralfate:

Administer on an empty stomach, so the medicine can coat the stomach, 2 hours after or 1 hour before meals

What is a peak drug level?

Highest concentration of a drug in the bloodstream; drawn when medication is expected to be at its maximum level.

What is a trough drug level?

Lowest concentration of a drug in the bloodstream; drawn immediately before the next dose.

What is pharmacokinetics?

Study of how the body affects a drug through absorption distribution metabolism and excretion.

What is absorption in pharmacokinetics?

Movement of a medication from administration site into circulation.

What is distribution in pharmacokinetics?

Process by which medication is transported throughout the body.

What is metabolism in pharmacokinetics?

Breakdown of drug molecules primarily by the liver.

What is excretion in pharmacokinetics?

Removal of drug waste products from the body primarily by the kidneys.

What is pharmacodynamics?

Study of what a drug does to the body and its mechanism of action.

What is an agonist?

A drug that activates receptors to produce an effect.

What is a pharmacologic antagonist?

A drug that blocks receptor action or reduces another drug’s effect.

What is the therapeutic window?

Range where a medication produces the safest and most effective treatment; considered the perfect dose.

What is the therapeutic index?

A quantitative comparison of the dose producing a therapeutic effect versus the dose causing toxicity; indicates relative drug safety.

What is medication transportation?

Process by which medication is dispensed throughout the body via bloodstream

What role does albumin play in medication transportation?

Albumin binds and transports many medications through the bloodstream like a bus.

What are the rights of medication administration?

Right patient

Right medication

Right dose

Right route

Right time

Right documentation

Right reason

Right response

What is the right patient?

Use two patient identifiers to verify correct client.

What is the right medication?

Verify correct medication and appropriateness for the patient.

What is the right dose?

Confirm safe dose based on patient age, size, and condition.

What is the right route?

Verify appropriate route for the patient's condition.

What is the right time?

Administer medication according to prescribed schedule.

What is the right documentation?

Accurately record administration and verify unclear orders before giving medications.

What is the right reason?

Ensure medication is being given for the correct indication.

What is the right response?

Evaluate expected outcomes and monitor for adverse effects.

What are black box or boxed warnings?

Strongest FDA safety warnings indicating significant risk for serious or life-threatening adverse effects.

What is polypharmacy?

Simultaneous use of multiple medications to treat one condition or multiple conditions increasing interaction risk.

How can medication errors be prevented?

• Use safe systems

• Effective communication

• Bar coding system

• Proper labeling

• Attention to near misses.

What are LASA drugs?

Look-alike sound-alike drugs that increase risk for medication errors.

What is the purpose of barcode medication administration?

Helps verify right patient and right medication reducing errors.

What is an adverse effect?

Undesired or harmful reaction resulting from a drug, treatment, or medical procedure, which can range from mild to life-threatening

What is pharmacology?

Branch of medicine concerned with the uses, effects, and modes of action of drugs

Class/Subclass for Penicillin:

Penicillin

Medication for Penicillin:

Amoxicillin

Mechanism of Action for Penicillin:

• Interfere with cell wall synthesis

• Bactericidal and kill bacteria rapidly

Therapeutic Use for Penicillin:

Treat streptococcal infections, pneumococcal infections, and staphylococcal infections

Key Adverse/Side Effects for Penicillin:

• Nausea

• Vomiting

• GI distress

• Diarrhea

• Black hairy tongue

• Monitor for C-diff, candidiasis, and hyperkalemia

Nursing/Patient Teaching for Penicillin:

• Clients are at risk for developing superinfections

• Probiotics may be encouraged

• Cross-sensitivity for clients allergic to cephalosporins

• Alternative birth control recommended

• Notify provider if fever or diarrhea develops

• Avoid citrus product

• Report rash or signs of superinfections

• Contains potassium so client receiving potassium sparing diuretics or potassium supplementation should be monitored for sings of hyperkalemia

• Obtain culture before first dose

• Take with a full glass of water

• Best absorbed on empty stomach

• Monitor INR, platelets, and PT

Class/Subclass for Tetracycline:

Tetracyclines

Mechanism of Action for Tetracycline:

Penetrate the bacterial cell wall and bind to the 30S ribosome, inhibiting the protein synthesis required to make the cellular wall

Therapeutic Use for Tetracycline:

Treat many gram positive and gram-negative infections (broad spectrum and bacteriostatic)

Key Adverse/Side Effects for Tetracycline:

• GI upset

• Photosensitivity

• Oral candidiasis

• C-diff

• May cause permanent teeth discoloration if given to patients < 8 y/o

• Increased ICP

• Headaches

• Blurred vision

• Diplopia

• Vision loss

• Decrease effectiveness of oral contraceptives

Contraindication/Precautions for Tetracycline:

• Precautioned with renal or hepatic impairment

• Precautioned in children under age 8 and pregnant women

Nursing/Patient Teaching for Tetracycline:

• Severe reversible nephrotoxicity

• Effectiveness is reduced when drug is given with milk or other dairy products, antacids, or iron products

• Give with full glass of water on an empty stomach at least 1 hour before or 2 hours after meals

• Give drug at least 1 hour before bedtime to prevent esophageal irritation or ulceration

• Avoid using in children younger than age 8

• Stop if female patient gets pregnant

Class/Subclass for Metronidazole:

Antiprotozoal

Mechanism of Action for Metronidazole:

• Inhibit protozoan folic acid synthesis

• Target infectious protozoans that cause severe diarrhea

Therapeutic Use for Metronidazole:

• Treats acne rosacea, bacterial vaginosis, or trichomonas

• Treats giardia and serious anaerobic bacterial infections