Pharm exam 4

PUD medication

PPI -prazoles
H2RA - tidines
antacid
sucralfate

PUD treatment includes four approaches

- treat w/antibiotic (H.Pylori)
- slow/lower acid production
- coats and protects
- neutralizes environment

What should be avoided when taking PUD medications

steroids

What should be taken with H2RA

2x/day food or no food
once healed - 1/day

S/Sx of H2RA

C/D/N

Labs for H2RA

ast/alt/bun/creatinine

when should ppi administered

before breakfast

PPI medication should not be

crushed, chew, sprinkled, or dissolved

PPI can cause

osteoporosis and fractures (females)

What should be monitored when taking a ppi?

GI bleeding

What should be avoided when taking a ppi?

alcohol, steroids, and nsaids

Labs for ppi

ast/alt/bun/creatinine

MOA of sucralfate

coats the ulcer

When to give sucralfate

1 hr before meals po (last 6 hrs, give 4x/day

Who should not take sucralfate

renal failure or hemodialysis

Magnesium containing causes

diarrhea and hypermagnesemia

Who should avoid magnesium containing

impaired renal function

hypermagnesemia s/sx

diminished dtrs, muscle paralysis, shallow respiration, cardiac arrest, lethargy

antacid labs

constipation and hypercalcemia

hypercalcemia s/sx

bone pain, weakness, dysrhythmias, confusion

Aluminum containing causes

constipation and hyperphophatasemia

hyperphosphatasemia s/sx

muscle cramp, numbness around mouth, tetany, bone and joint pain, rash

Sodium containing causes

fluid retention and electrolyte imbalances in pts. w/renal impairment >> alkalosis

Labs for sodium containing

BUN and creatinine

What should be reported if someone is taking an antacid?

bleeding

antacid treats

stress induce ulcer

antacid complications

constipation, fluid retention, electrolyte imbalance, alkalosis toxicity

Ferrous sulfate treats

iron deficiency

S/Sx of ferrous sulfate

C/N/heart burn
teeth staining >> dilute liquid iron w/water or juice, drink w/straw, and rinse mouth after swallowing

Ferrous sulfate administration

without food if tolerated
one hr after antacids
1-2 hrs after tetracyclines

physical assessment of ferrous sulfate

brittle nails, cold feet and hands

Labs for ferrous sulfate

Hgb and HCT

Ferrous sulfate fatal iron toxicity in children

2-10 g is ingested

Normal stool for ferrous

black or dark green

Population most likely to take ferrous

infants, children, and pregnancy

What increases absorption of ferrous

vitamin c
- food decrease absorption

Evaluation of ferrous

reticulocyte count increased 4-7 days after therapy
increase in hgb 2g/dL/month
increase energy

Folic acid moa

DNA and erythropoiesis production (RBC, WBC, platelets)

folic acid treats

prevent neural tube defects during pregnancy

What medication decrease folic acid levels

methotrexate and sulfonamides

Folic acid decreases

phenytoin blood levels due to increased metabolism

Labs for folic acid

folic acid, hgb, hct, reticulocyte count

What foods should be taken with folic acid

liver, green leafy vegetables, citrus fruits, beans

Antidiarrheal medication

Diphenoxylate Plus Atropine

Antidiarrheal effects

anticholinergic effects

Who should cautiously use antidiarrheals/diphenoxyllate plus atropine

pregnant population

What should be avoided when taking diphenoxyllate plus atropine

alcohol and cns depressants

What should be managed if diarrhea is severe

dehydration - drink electrolyte fluids, avoid water

Max dose of diphenoxylate

5 mg and max dose: 8 tabs/day

Antiemetic drugs

promethazine, ondansetron, dronabinol, metoclopramide

Antiemetic labs

bun/creatinine, ast, alt

Dopamine antagonist

promethazine, metoclopramide

Promethazine/metoclopramide side effects

anticholinergic effects >> can't see, pee, poop >> constipation
EPS, sedation, respiratory depression

EPS s/sx

restlessness, anxiety, and spasms of face and neck >> stop medication

EPS is treated w/

diphenhydramine or benztropine

Who should not take promethazine and metoclopramide?

children under 2

Serotonin receptor antagonist medication

ondasetron

When should the nurse administer ondasetron

30 to 60 minutes before initiating chemotherapy

Ondansetron can cause

sedation and risk for life-threatening dysrhythmias (torsades de pointes)

Cannabinoid medication

dronabinol

How does dronabinol work

increases appetite

What should be avoided when taking dronabinol

alcohol

What drug should be avoided when taking dronabinol

antihypertensives >> can increase hypotension
- X cardiovascular disorders

What can increase anticholingeric effect of dronabinol?

antihistamines

Laxative medications

psyllium, docusate sodium, bisacodyl, magnesium hydroxide

Bulk-forming laxative

psyllium
- similar to fiber

psyllium is used for

IBS and diverticulosis

pt. education for psyllium

- drink a full 8 oz glass of water
- no immediate results

Surfactant MOA

lower surface tension of stool to allow penetration of water >> softens stool

surfactant laxative medication

docusate sodium

docusate sodium contraindicated

pts. w/ulcerative colitis or diverticulitis

complications w/docusate sodium

can cause fluid retention due to sodium phosphates

pt. education for docusate sodium

drink 2 to 3 L of water daily

bisacodyl MOA

stimulates peristalsis and increases the volume of water and electrolytes in the intestines

bisacodyl uses

constipation caused by opioid

Pt. education for laxative bisacodyl

- do not crush or chew tabs
- do not use regularly

When does bisacodyl start working

po at hs results in 6-12 hrs
suppositories 1 hr

Osmotic laxative

magnesium hydroxide

Labs for magnesium hydroxide

bun and creatinine

Who should not take magnesium hydroxide

pt. w/impaired kidney function

complications w/magnesium hydroxide

hypermagnesemia

magnesium uses

- prevent painful elimination
- rapid evacuation of bowel after ingestion of poisons

Laxative complications

gi irritation
rectal burning, toxic magnesium levels
sodium absorption and fluid retention
dehydration
obstruction

Which laxatives are category C

bisacodyl and docusate sodium

Rapid acting insulin: onset, peak, duration

onset: 15 - 30 min
peak: 30 min to 3 hrs
duration: 3 to 5 hrs

Short-acting insulin: onset, peak, duration

onset: 30 min to 1 hr
peak: 1 to 5 hr
duration: 6 to 10 hr

Intermediate acting insulin: onset, peak, duration

onset: 1 to 2 hrs
peak: 4 to 14 hrs
duration: 14 to 24 hrs

Long acting insulin: onset, peak, duration

onset: 1 to 4 hrs
peak: none
duration: 24 hrs

What does long acting insulin not have?

a peak >> continuous amount - no highs or lows >> not at risk for hypoglycemia

CANNOT NOT BE MIXED W/OTHER INSULIN

Rapid-acting insulin name

Lispro insulin

Short-acting insulin name

regular insulin

What is short acting insulin used for?

To cover meals / before meals
- give when the meal tray is there

Intermediate acting insulin name

NPH

How long does NPH last?

throughout the day

What does NPH solution look like?

cloudy

Long acting insulin name

Insulin glargine

What is DM?

inadequate amount of insulin being used or produced

Type 1 DM

chronic condition where the beta cells produce little to no insulin >> lifelong insulin >> autoimmune

How is type 2 DM managed

Diet and w/insulin admin or diabetic agent

Type 2 DM

insulin resistance and decrease insulin secretion of beta cells