pharm exam 2

what are the nursing considerations of Calcium citrate and Calcium carbonate?

-take 1 hr before or 2 hrs after glucocorticoids, levothyroxine, tetracycline and quinolone antibiotics

-instruct pt to chew oral forms and follow with a full glass of water to prevent renal stones

-calcium citrate absorbs easier

-chewing absorbs faster

-do not exceed the recommended dosage

-rhubarb, spinach, cereals decrease absorption of calcium

what are the adverse effects of Calcium citrate and Calcium carbonate?

-hypercalcemia esp if admin in IV (cardiac dysrhythmias - admin slowly)

-development of renal stones

what is the classification of Calcium citrate and Calcium carbonate?

calcium supplements

what kind of drugs are these of Calcium citrate and Calcium carbonate?

prototype drug

what is the classification of Verapamil, Nifedipine, and Diltiazam?

calcium channel blocker

what is the category of Verapamil, Nifedipine, and Diltiazam?

antianginal

what is the mechanism of action of Verapamil, Nifedipine, and Diltiazam?

inhibits the movement of calcium ions across the membranes of myocardial and arterial muscle cells, blocking muscle cell contraction

what is the indication of Verapamil, Nifedipine, and Diltiazam?

prinzmetal angina

what are the adverse effects of Verapamil, Nifedipine, and Diltiazam?

-reflex tachycardia

-headache

-dizziness

-flushing

-peripheral edema

-arrhythmias

-abrupt drop in pressure: compensatory reflex

what are the significant interactions of Verapamil, Nifedipine, and Diltiazam?

-grapefruit

-rifampin

-phenobarbital

-phenytoin

-carbamazepine

-st john’s wort

what is the mechanism of action of Methotrexate?

acts primarily to suppress the immune system, resulting in decreased joint inflammation

what are the nursing considerations of Methotrexate?

-monitor for s/s of infection, do not admin in pts with active infection or liver/renal disease

-monitor for GI bleed

-monitor cbc

-no alcohol

-both men and women should use contraceptives

-may impact fertility

-oral, IM, SQ once a week

what are the adverse effects of Methotrexate?

-bone marrow suppression

-hepatotoxic

-GI ulceration

-pulmonary fibrosis

-tertogenic

what is the classification of Methotrexate?

disease-modifying antirheumatic drugs

what are the nursing considerations of Raloxifene?

-monitor bone density

-periodically monitor clotting factors (P, PTT, fibrinogen levels)

-instruct pts to consume foods high in calcium and vitamin D, perform daily weight-bearing exercises to promote bone density, use contraceptives to avoid pregnancy if possible

-given orally

what are the adverse effects of Raloxifene?

-all are related to estrogen

-increased risk of blood clot formation

-hot flashes

-stroke

-PE

-DVT

-teratogenic

what is the mechanism of action of Raloxifene?

acts to reduce bone resorption and overall bone loss, maintaining bone mineral density by balancing estrogen uptake in some tissue and reducing estrogen uptake in others (breast)

what is the classification of Raloxifene?

selective estrogen receptor modulator

what are the nursing considerations of Calcitonin-salmon?

-monitor integrity of mucus membranes if using the intranasal form

-alternate nostrils each day, one spray per, prime new containers

-can also be given SQ or IM

-allergy testing prior to starting this med

what are the adverse effects of Calcitonin-salmon?

-hypersensitivity to salmon/seafood may precipitate anaphylaxis

-hypocalcemia

what is the mechanism of action of Calcitonin-salmon?

-acts to treat current post-menopausal osteoporosis, does not prevent the condition

-used to treat hypercalcemia by inhibiting osteoclasts and increasing calcium excretion

what is the classification of Calcitonin-salmon?

calcitonin

what is the mechanism of action of Etanercept?

acts primarily to suppress the immune system, resulting in decreased joint inflammation

what are the nursing considerations of Etanercept?

-monitor for s/s of infarction

-do not admin in pts with MS

-test for TB prior to treatment and periodically throughout treatment

-monitor lung sounds, report changes, frothy pink sputum, dyspnea, etc

-SQ weekly

-may acquire or transmit infection if receives live vaccine while taking med

what are the adverse effects of Etanercept?

-reactivation of TB

-reactivation of heart failure

-injection site reactions are common

what is the classification of Etanercept?

disease-modifying antirheumatic drugs

what are the nursing considerations of Alendronate?

-admin with a full glass of water on an empty stomach, pt must sit upright or stand for 30 minutes after swallowing the med, wait 30 min after taking the drug before eating or consuming other foods or liquids other than water

-admin tylenol if pt experiences joint or muscle pain

-do not admin calcium supplements or dairy products within 30 min of admin

what are the adverse effects of Alendronate?

-high risk of GI distress (all kinds)

-milk joint and muscle pain

what is the mechanism of action of Alendronate?

acts by inhibiting the action of osetoclasts

what is the classification of Alendronate?

bisphosphonate

what is the category of Prednisone, Hydrocortisone, and Methyl-Prednisone?

glucocorticoids

what are the adverse effects of Prednisone, Hydrocortisone, and Methyl-Prednisone?

-glaucoma

-limb muscle atrophy

-peptic ulcer

-cataract

-osteoporosis

-cushing syndrome

-osteonecrosis

-retardination of growth

-thinning of skin

-infections

-changes in mood/psyche

-edema

-impaired wound healing

-DM

-suppression of HPA axis (not able to regulate stress and energy levels)

what are the interactions of Prednisone, Hydrocortisone, and Methyl-Prednisone?

-vaccines

-live vaccines

-furosemide (lasix)

-digoxin

-increases needed dose for insulin

-increases risk for GI bleed and ulcerations when admin with NSAIDs

what are the nursing considerations of Prednisone, Hydrocortisone, and Methyl-Prednisone?

-monitor closely for s/s of adrenal insufficiency and adrenal excess

-can admin in any way

-monitor glucose, sodium, potassium, and calcium for pts taking long-term

-fever may be blunted, assess for s/s of infection

-pt may need PPI to reduce gastric irritation/risk of GI bleed

-monitor lung sounds

-instruct pt need for regular ophthalmic exams (cataracts)

-taper off slowly (adrenal insufficiency may result)

what is the category of Allopurinol and Probenecid?

uricosuric medication

what are the adverse effects of Allopurinol and Probenecid?

(rare but may occur)

-hypersensitivity (fever, rash, eosinophilia)

-hepatic and renal failure

-GI disturbances

-drowsiness

-headache

-vertigo

-metallic taste in mouth

-cataract development if pt takes >3 years

-SJS

-bone marrow suppression

-sensitivity to light

what are the interactions of Allopurinol and Probenecid?

-increases effect of warfarin

-increased risk for rash if taken with ampicillin and ACE inhibitors and thiazide diuretics

-increase effects of hypoglycemic agents

what are the nursing considerations of Allopurinol and Probenecid?

-give with food or after meals if n/v

-may be given IVPB - slow infusion

-expect metallic taste

-stay hydrated (3L)

-visit eye doctor frequently

-report s/s of hypersensitivity and stop drug

-wear sunscreen outside

-monitor CBC with differential for s/s of bone marrow depression

-monitor liver and renal function tests

-uric acid levels takes 2-3 days to come down

what is the classification of Tramadol?

centrally acting non-opioid

what are the interactions of Tramadol?

-MAOI: hypertensive crisis

-serotonin syndrome possible if taken with some antidepressants

-increased CNS depression if taken with CNS depressant meds

-st john’s wort

what are the nursing considerations of Tramadol - instructions?

-admin with food

-do not take with food

-pt safety

-take only when needed (PRN)

-typically a short term med

what are the nursing considerations of Tramadol - monitoring?

-seizure activity

-VS, esp RR

-urinary retention

-a little constipation

-slight risk for abuse

what is the classification of Morphine, Fentanyl, Codeine, and Methadone Oxycodone?

opioid analgesic (opioid agonists)

what are the adverse effects of Morphine, Fentanyl, Codeine, and Methadone Oxycodone?

-respiratory depression

-decreased GI motility (constipation)

-confusion

-sedation

-dizziness

-orthostatic hypotension

-urinary retention (pt does not know bladder is full)

what are the interactions of Morphine, Fentanyl, Codeine, and Methadone Oxycodone?

-addictive CNS depression esp with barbituates

-ETOH

-benzodiazepines

-increases anticholinergic effects

-increased hypotension if taken with antihypertensive meds

what are the nursing considerations of Morphine, Fentanyl, Codeine, and Methadone Oxycodone?

-short term use is best

-monitor BP, RR, LOC, effectiveness of med

-schedule 2 drug

-take stool softener daily/cathartic med as needed

-instruct pt to report severe constipation or inability to urinate

-if IV, give over 4-5 min, have naloxone and resuscitative equipment readily available

-terminal cancer pain, give on fixed schedule with extra for breakthrough pain

-may take with food or milk if GI irritation occurs

-longer on opioids, the higher the tolerance will build and then you will need more

what is the classification of Butorphanol?

opioid agonist-antagonist

what are the adverse effects of Butorphanol?

increases cardiac workload

what are the interactions of Butorphanol?

-CNS depressants (increased risk of respiratory depression)

-decreases the effectiveness of opioids (do not mix)

what are the nursing considerations of Butorphanol?

-should be given on a short-term basis

-given IM, IV, or intranasally (every 60-90 min PRN to manage pain)

-safety (falls)

-do not take for anginal pain

-do not mix with an opioid

-monitor baseline VS and throughout therapy

-do not give if RR is <12

-monitor pain levels before and after therapy

aspirin Nursing Considerations

-instruct pt to take with food or with a glass full of water/other liquid

-monitor for salicylism (hearing loss, tinnitus early signs)

-instruct pt not to admin to children esp with viral illness

-hold ASA for 1 week prior to surgery and other invasive procedures

-instruct pt to report s/s of GI irritation or prolonged bleeding

-do not crush or chew ER, SR, or EC forms of the medication

Ibuprofen, naproxen, indomethacin Nursing Considerations

-same as aspirin except

‣ no salicyism risk

‣ may need to take PPI (proton pump inhibitor) to prevent gastric ulceration

‣ monitor i/o, BUN, creatinine

‣ instruct pt to report chest pain, heaviness, dyspnea, sudden and severe HA, s/s CVA

‣ avoid ETOH

‣ do not consume alcohol or heavily monitor amount

‣ monitor kidney function

celecoxib Nursing Considerations

‣ take med with food, milk, or 8 oz or more of water

‣ avoid ETOH

‣ report gastric irritation, s/s of GI bleeding, chest pain/heaviness, dyspnea, sudden and severe HA, s/s CVA

• stroke-like symptoms

‣ might take with aspirin

◦ monitor i/o / fluid retention, BUN and creatinine, s/s of CVD/CVA

◦ long term therapy

‣ pt should take low dose aspirin to prevent excessive clotting

what generation are the NSAIDs?

-first gen is aspirin, ibuprofen, naproxe, and indomethacin

-second gen is celecoxib

what is the classification of Verapamil?

calcium channel blocker

what is the category of Verapamil?

class 4 antidysrhythmics

what is the indication of Verapamil?

atrial flutter, atrial fibrillation, and supraventricular tachycardia (SVT)

what is the mechanism of action of Verapamil?

slows conduction, decreases contractility, similar to beta blockers

what are the nursing considerations of Verapamil?

-admin PO or IV

-keep supine 1 hr after admin

-hold if systolic B <90 mmHg or HR <60 bpm

-may need diuretic if edema occurs

-monitor cardiac rhythm and VS close with IV therapy

-older adults may be slower rate and reduced dosage

what is the classification of Amiodarone?

potassium channel blocker

what is the category of Amiodarone?

class 3 antidysrhythmics

what is the indication of Amiodarone?

ventricular fibrillation and supraventricular tachycardia (SVT)

what is the mechanism of action of Amiodarone?

blocks K, Na, and Ca channels, slows conduction and dilates the coronary arteries

what are the nursing considerations of Amiodarone?

-closely monitor pt

-available in PO or IV form

-IV form requires a central line

-report HR <60 bpm

-take at the same time each day to avoid toxicity

what is the classification of Quinidine?

sodium channel blockers

what is the category of Quinidine?

class 1a antidysrhythmics

what is the mechanism of action of Quinidine?

reduces the amount of sodium that can enter the cells, which will slow the impulse conduction and decrease the automaticity of the ventricles (the ability to generate action potentials)

what is the indication of Quinidine?

-atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia

-premature ventricular contractions, ventricular tachycardia and fibrillation

what are the nursing considerations of Quinidine?

-monitor for s/s of stroke or pulmonary embolism (if treating afib)

-serve hypotension can occur in IV form

-use cardiac monitor with IV meds (telemetry must be continual)

-reinforce teaching regarding AE and what to watch for

what is the classification of Nitroglycerin?

nitrate

what is the category of Nitroglycerin?

antianginal

what is the mechanism of action of Nitroglycerin?

acts directly on smooth muscle to cause relaxation and depress muscle tone

what is the indication of Nitroglycerin?

prevention and treatment of attacks of angina

what are the adverse effects of Nitroglycerin?

-headache, dizziness, and weakness

-nausea, vomiting

-hypotension, reflex tachycardia

what are the significant interactions of Nitroglycerin?

-HTN drugs

-alcohol

-sildenafil: hypotension

-anticholinergics: decreases absorption of sublingual nitro

what is the classification of Flecainide?

sodium channel blockers

what is the category of Flecainide?

class 1c antidysrhythmics

what is the indication of Flecainide?

-atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia

-premature ventricular contractions and ventricular tachycardia/fibrillation

what is the mechanism of action of Flecainide?

increases the length of the refractory period (the resting period after a stimulus where the cell cannot respond to another stimulus) (very potent for significant dysrhythmias)

what are the nursing considerations of Flecainide?

-correct any electrolyte abnormalities prior to therapy

-monitor vision changes

-monitor for HF s/s

-may exacerbate current dysrhythmias or create new ones (specific to flecainide)

-closely monitor pt

what is the classification of Metaprolol and Bisoprolol?

beta blocker

what is the category of Metaprolol and Bisoprolol?

antianginal

what is the mechanism of action of Metaprolol and Bisoprolol?

blocks beta-adrenergic receptors in the heart and kidneys, decreases the influence of the SNS on these tissues, and decreases cardia output and the release of renin

what is the indication of Metaprolol and Bisoprolol?

treat stable angina and hypertension

also decreases mortality following an MI

what are the adverse effecs of Metaprolol and Bisoprolol?

-fatigue

-dizziness

-low blood pressure

-slow heart rate

-reflex tachycardia

-HF

what are the significant interactions of Metaprolol and Bisoprolol?

-antihypertensive medications: increased effects

-digoxin; bradycardia and toxicity

-antacids: decrease absorption

-oral hyperglycemic meds: increase risk for hypoglycemia

-anticholinergic meds: decrease effect

what is the classification of Propranolol?

beta blocker

what is the category of Propranolol?

class 2 antidysrhythmics

what is the indication of Propranolol?

-supraventricular tachycardia (SVT), atrial fibrillation, and atrial flutter

what is the mechanism of action of Propranolol?

decreases the SNS effects (slows the HR, prolongs the PR interval on the EKG)

what are the nursing considerations of Propranolol?

-pt should check HR daily

-report if <60 bpm

-monitor for HF

-do not stop abruptly

-report CP

-protect fingers/toes from cold

what is the classification of Lidocaine?

sodium channel blocker

what is the category of Lidocaine?

class 1b antidysrhythmics

what is the indication of Lidocaine?

-atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia

-premature ventricular contractions and ventricular tachycardia

what are the nursing considerations of Lidocaine?

-given in IV form

-continuous cardiac monitoring

-frequent vital signs

what is the mechanism of action of Lidocaine?

not overly potent for dysrhythmias, can cause bradycardia

what is the classification of Gemfibrozil?

fibrates

what is the category of Gemfibrozil?

antilipemic

what is the mechanism of action of Gemfibrozil?

reduces triglycerides in the plasma and increases HDL

what is the indication for gemfibrozil?

-high triglycerides

-high cholesterol

-hypercholesterolemia