Pharmacology Blue Print

TB Treatment

- treatment for up to 2 years. Multi-drug reduces resistance

Why is vitamin B6 (pyridoxine) taken with isoniazid (INH)?

To decrease the risk of peripheral neuropathy

What is a common side effect of using a SABA?

tachycardia

Why should you rinse your mouth after ICS mouth administration?

To prevent oral yeast infection

What goes first, a SABA or ICS?

Adminster SABA before ICS

For an acute asthma attack, what should you give fist?

SABA

If a patient uses a nasal congestant for more than 3-5 days, what can occur?

Rebound congestion

caution for elderly taking OTC cold remedies

Elevaed BP

What should not give to a patient who has a common cold?

Do not give antibacterial

What is the most common side effect of an antihistamine?

Drowsiness

DDAVP can cause what to occur?

decreases U/O

Levothyroxine treatment is:

lifelong patient needs to be compliant

Levothryoxine interfers with what?

wrafarin (increase risk of bleeding)

PTU work by:

slowing down the production of thyroid hormone

When to administer insulin aspart (Novolog)?

administer when the breakfast tray is ready to eat

Fast acting insulin will be given when?

15 minutes of eating

What do you each a DM taking insulin?

to rotate the injection site

hypogylcemia

abnormally low level of sugar in the blood manifested as confsuin and sweating

if the pt is unconscious IV regular insulin

diabetic ketoacidosis

give regular insulin IV

Sufonylureas (i.e glipizide)

require some functioning beta cells, take 30 minutes before meal

What lab value must you monitor for a patient taking metformin?

creatinine levels

SIADH

fluid retention and hyponatremia; can be caused by lung cancer, treat with fluid restriction and anti-ADH drugs.

DI

give vasopressin

Antibiotic resistance can:

occur when antibiotic is given for viral infection

What do you take to prevent superinfections?

probiotics

Caution for tetracyclines

Can cause permanent discoloration of teeth

Vancomycin is indicated for

MRSA

Silvadine

don't give if sulfa allergy; indicated for burns

PCN allergy is associated with what?

cephalosporin allergy

If patient is allergic to sulfa what do you administer?

Nitrofurantoin for UTI

Antivirals

indicated for HSV, shingles and varicella, NOT for bacterial infections.
Antivirals for flu should be given with in 2 days

When should antifungals be given?

at least 2 weeks

Bactroban is used for

impetigo

Cipro black box warning

achilles tendinitis
tendon rupture

When taking a sulfa drug, what should you advise the patient?

to increase fluids (2-3 L)

What should you ask before administering antibiotics?

ask if the patient has any allergies

Patients taking doxycycline should:

wear sunscreen outdoors

Superinfection

occurs due to the disruption in the normal flora

Isotretinoin (Accutane)

assess for depression/SI, avoid sun exposure[ 2 forms of contraception, LFT, screen for depression

Adverse reactions of gentamicin

ototoxicity, nephrotoxicity, neurotoxicity

What is amphotericin is used for what?

used for very serious fungal infections

- If vancomycin is infused too quickly, it can cause __________.

red man syndrome

Levothryoxine (Synthroid)

Hypothyroidism
- Increase the levels of T4
- Take on an empty stomach

Levothyroxine: Action

Increase metabolism, body growth

Levothyroxine: Side Effects

o Nervousness, headache, insomnia, weight loss
o Tremors, GI distress, tachycardia, hypertension
o Dysrhythmias, palpitations, angina, thyroid crisis

Caution with levothyroxine

cardiac problems

Tetracycline: Action

- inhibits protein synthesis
- broad-spectrum
- bacterial resistance

Tetracycline: Use

o Effective against gram-positive and gram-negative bacteria, such as Helicobacter pylori, MRSA
o Treats acne, anthrax, plague, gingivitis, cholera, STIs, skin, and urinary and respiratory infections, Lyme disease

Tetracycline: Side effects

o Anaphylaxis, superinfection
o Photosensitivity, diplopia
o Discoloration of permanent teeth
o Do not give to children younger than 8 years.
o Stomatitis, glossitis, GI distress
o Clostridium difficile-associated diarrhea
o Ototoxicity, hepatotoxicity, nephrotoxicity
Pancytopenia, Stevens-Johnson syndrome

Tetracycline: Drug-food interactions

o Milk products
o Antacids
o Oral contraceptives
o Penicillin's
oAminoglycoside

Gentamicin classification

Aminoglycosides

gentamicin use

o For treating endocarditis, meningitis, bacteremia, sepsis, and respiratory, intraabdominal, bone/joint, skin, and urinary tract infections. Aminoglycosides are effective against Pseudomonas aeruginosa, Escherichia coli, and species of Proteus, Enterococcus, Haemophilus, Klebsiella, Salmonella, Serratia, Staphylococcus, and Streptococcus

gentamicin: action

inhibits bacterial protein synthesis; bactericidal effect

Gentamicin: Side effects

o Stomatitis, nausea, vomiting, alopecia, rash, pruritus, skin/ocular irritation, photosensitivity, headache, dizziness, confusion, depression, tinnitus, weakness, arthralgia, conjunctivitis, phlebitis, injection site reaction, paresthesias, vitamin B6 and B12 deficiency

Gentamicin: Adverse Side Effects

o Peripheral neuropathy, laryngeal edema, hearing loss, ototoxicity, hypokalemia, hypomagnesemia, hyponatremia, neurotoxicity, hyperbilirubinemia
o Life-threatening: Anaphylaxis, nephrotoxicity, thrombocytopenia, anemia, agranulocytosis, eosinophilia, leukopenia, hepatic dysfunction, increased intracranial pressure

Novolog (insulin aspart)
Humalog

rapid acting insulin
Onset 15 minutes
peak 1 hour
duration 3 hours

Regular insulin

HumuLIN R, NovoLIN R (Short acting)
can be given IV
Onset 30 minutes
peak 2 hours
duration 8 hours

Glipizide class

second-generation sulfonylurea, antidiabetic

Glipizide use

treat type 2 diabetes

Glipizide action

stimulates the pancreas to release more insulin, can also increase cellular sensitivity to insulin

Glipizide side effects

o Hypoglycemia
o GI distress, weight gain
o Nervousness, tremors, confusion
o Blood dyscrasias, seizures, coma

Metformin class

biguanide, hypoglycemic

metformin action

§ Decrease hepatic production of glucose from stored glycogen
§ Diminish increase in serum glucose after meals
§ Blunt postprandial hyperglycemia
§ Decrease glucose absorption from small intestine
§ Increase insulin receptor sensitivity
§ Increase peripheral glucose uptake at the cellular level

Vancomycin classification

Glycopeptide

vancomycin: actions

o Inhibits cell wall synthesis
o Effective against gram-positive MRSA
o Bactericidal
o Narrow therapeutic range: monitor peak/trough

Vancomycin use

o Respiratory, skin, and bone/joint infections
o Bacteremia, septicemia, and endocarditis
MRSA, Clostridium difficile

Vancomycin side effects

o Anaphylaxis, superinfection
o Red neck or red man syndrome
o Occurs when IV too rapid
o Severe hypotension
o Red blotching of face, neck, chest, and extremities
o Disulfiram-like reaction to alcohol
o GI distress and peripheral edema
o Ototoxicity and nephrotoxicity
o Clostridium difficile-associated diarrhea
o Stevens-Johnson syndrome

Glargine (Lantus)

Long-acting insulin
Onset 1 hour
Peak (none)
Duration 10-24 hours

Isoniazid (INH) class

anti-infective
antituberculars

Isoniazid (INH) action

- Inhibits bacterial cell wall synthesis

Isoniazid (INH) route

oral, IM

Isoniazid (INH) Side effects

o Dry mouth, GI distress, constipation
o Blurred vision, photosensitivity, tinnitus
o Drowsiness, dizziness, peripheral neuropathy
o Psychotic behavior, tremors, seizures
o Hyperglycemia, hepatotoxicity
o Thrombocytopenia, agranulocytosis

Isoniazid (INH) Assessment

o Obtain a general medical history from the patient.
Assess for hearing changes if drug regimen includes streptomycin

Isoniazid (INH) Nursing diagnosis

o Knowledge, Deficient related to unfamiliarity with medications

Isoniazid (INH) Planning

o The patient's sputum test for acid-fast bacilli will be negative 2-3 months after prescribed antitubercular therapy.

Isoniazid (INH) Nursing interventions

o Administer INH 1 hour before or 2 hours after meals.
o Give pyridoxine (vitamin B6) as prescribed with INH to prevent peripheral neuropathy.
o Monitor hepatic function tests.
o Emphasize importance of complying with drug regimen.

Albuterol Class

Sympathomimetic Bronchodilator

Albuterol action

bronchodilation

Albuterol use

Asthma, acute bronchospasm, bronchospasm prophylaxis

A;buterol side effects

headache, rhinitis, excitability, tremors, palpitations, tachycardia

Albuterol assessment

o Assess for wheezing, decreased breath sounds, cough, and sputum production
o Determine hydration

Albuterol nursing diagnosis

o Breathing Pattern, Ineffective related to fatigue
o Gas Exchange, Impaired related to ineffective airway clearance

Albuterol planning

o Patient's wheezing will be eliminated/diminished

Albuterol nursing interventions

o Monitor vital signs.
o Provide adequate hydration.
o Observe for side effects.
o Administer medication at regular intervals around the clock to have a sustained therapeutic level.
o Advise patient having asthmatic attacks to wear an identification bracelet or MedicAlert tag.

Mometasone (Asmanex) class

Glucocorticoid steroid

Mometasone (Asmanex) action

antiinflammatory effect

Mometasone (Asmanex) administration

MDI inhaler, tablet, intravenous

Mometasone (Asmanex) side effects

o Dry mouth, throat irritation, hoarseness
o Risk for oral candidiasis with inhaler use
o Headache, euphoria, confusion, depression
o Hyperglycemia, GI distress, hypertension
o Electrolyte imbalance, fluid retention
o Osteoporosis, psychosis, superinfections

Guaifenesin (Mucinex) class

expectorant

Guaifenesin (Mucinex) action

- Loosen bronchial secretion by reducing surface tension of secretions and allows elimination by coughing

Guaifenesin (Mucinex) side effects

o Drowsiness
o Dizziness
o Irritability
o nausea

Diphenhydramine (Benadryl) class

antihistamine

Diphenhydramine action

Competes with histamine for receptor sites and prevents a histamine response by blocking H1 receptor sites, nasopharyngeal secretions, and itching decrease

Diphenhydramine use

Acute and allergic rhinitis, pruritis, urticaria, common cold, sneezing, cough, prevent motion sickness

Diphenhydramine Contraindications

- glaucoma, urinary retention, severe liver disease

Diphenhydramine interactions

Increases CNS depression with alcohol and other CNS depressants

Diphenhydramine Assessment

o Obtain a history of environmental exposures
o Assess for evidence of urinary dysfunction
o Assess cardiac and respiratory status

Diphenhydramine Nursing diagnosis

Airway Clearance, Ineffective related to nasal congestion

Diphenhydramine Planning

Patient will have decreased nasal congestion, mucosal secretions and cough

Diphenhydramine Nuring Intervention

o Give oral form of diphenhydramine with food to decrease gastric distress.
o Warn the patient to avoid driving a motor vehicle and performing dangerous activities until stabilized on the drug.
o Advise the patient to avoid alcohol and other CNS depressants.
o Suggest use of sugarless candy, gum, or ice chips for relief of mouth dryness