Pharmacology Final

#each1teach1

Opioids side effects

include drowsiness, hypotension, bradycardia, constipation, nausea, and respiratory depression

Opioids Assessment

Involves evaluating pain levels, vital signs, and potential for substance abuse. Monintor HR

Opioid patient teaching

○ Avoid alcohol

○ Avoid operating machinery

○ Tolerance and cross tolerance develops with chronic use

○ For constipation, drink fluids and increase fiber intake.

Opioid Antidote

Naloxone (Narcan)

Levodopa-Carbidopa mechanism of action

Cabidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain which means dose can decrease and prevents conversion of dopamine breakdown

■ Reduces the amount of adverse side effects

Parkinson disease

low dopamine, high acetylcholine → muscle tremors, rigidity (stiff muscle), shuffling gait, bradykinesia

Chlorpromazine adverse effects

(PAAO + NATAP) MEMORIZE THIS!!

• PHOTOSENSITIVITY

• Anticholinergic effects: dry mouth, urinary retention

• Agranulocytosis

• Orthostatic hypotension

MOVEMENT IMPAIR: (NATAP) → FALL RISK!! → PT SAFETY (MEMORIZE THIS!!)

• Neuroleptic malignant syndrome (High FEVER)- STOP MED

• Acute Dystonia (spasm in tongue, neck, face, back)

• Tardive dyskinesia (involuntary face tics)

• Akathisia

• Pseudo Parkinsonism

Antipsychotic goal

○  Reduction of psychotic symptoms and stabilization of mood.

● BLOCK DOPAMINE RECEPTORS

Antipsychotic prioritization

● #1 PRIORITY → PT SAFETY

○ Dont skip doses → DO NOT COME OFF MED

○ S/s → danger to pt safety

■ Neuroleptic malignant syndrome

■ Tardive dyskinesia

Lithium therapeutic level

○  Lithium blood levels should be maintained 0.6 to 1.2 mEq/L

○ LITHIUM → HYPOTHYROIDISM (MEMORIZE THIS!!)

lithium lab monitoring adverse effect

LOW SERUM SODIUM → INCREASED RISK FOR LITHIUM TOXICITY!!!

(MEMORIZE THIS!!)

● *****DO NOT LIMIT SODIUM OR WATER INTAKE****

● Sodium & lithium balance each other out

MAOIs food and drug interaction

○ Food and beverages that contain tyramine

■ Protein based foods that age, ferment, or spoil

■ NO ALC, CHEESE, MEATS, CHOCOLATE, banana, avocado

- Other Antidepressants (AVOID!!) → SSRI, SNRI, TCA → serotonin syndrome

• 2-WEEK WASH OUT;;; MAOI= CANT MIX!! (slowly taper off)

○ OTC DRUGS = HTN CRISIS

Benzodiazepine antidote

Flumazenil

○ D - Decreased respirations (low RR) give Flumazenil

Antiseizure medication management in pregnancy

○ Diazepam and Phenytoin are for seizures should not be taken during pregnancy

○ Give magnesium sulfate during pregnancy to prevent seizures

PREGNANCY - take lowest dose & least teratogenic (c/d → a)MEMORIZE THIS!!

Antifungal medication management

○ “Zoles” like ketoconazole

○ Monitor liver

■ ALT (normal is 4 to 36 U/L)

■ AST

■ ALP

Amphotericin B patient teaching

○ Fever, chills, tachycardia, hypotension, headache, and nausea can occur

■ Occur frequently 1 to 2 hours after IV, subside after 4 hours

○ Monitor BUN, creatinine, and blood potassium every few days

○ Notify provider about low urinary output and weight changes that may indicate the kidneys are not functioning correctly

○ Monitor CBC for signs of bone marrow suppression and anemia

Rifampin patient teaching

○ Urine, saliva, tears, and sweat may turn red/orange (harmless)

○ Take on an empty stomach (works best on empty stomach)

■ Take 1 hour before meal or 2 hours after meal

Gentamycin usage caution in certain population

○ Renal failure

○ Type 2 diabetic

○ Older Adults

Aminoglycoside medication management

Monitor kidneys

●  BUN, GFR (gold standard test), creatinine

●  Need to know the age of the patient to know if GFR is in range

● Different GFR ranges for different ages
○ As you get older the number can get lower and it can still be considered normal

Tylenol antidote

Acetylcysteine
■ Smells like rotten eggs

Tylenol toxicity

○ Toxicity can occur in cold medication that contains acetaminophen

Ibuprofen lab monitoring and assessment

■ Monitor BUN and creatinine

●  BUN normal range: 10 to 20

●  Creatinine normal range: 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women.

Reye’s syndrome causing medication

○ Salicylates (such as Aspirin)

Acetylsalicylic acid low dose therapeutic effects

○ Blood thinner

■ Inhibits platelet aggregation (blood clotting)

• ○  81 mg is low dose

Warfarin food and drug interaction

Avoid green leafy vegetables: chickpeas, liver, egg yolks, mature cheese and blue cheese, avocado, olive oil

AVOID ANTICOAGULANTS

● DO NOT GIVE TO PT W/ PEPTIC ULCER (DUODENAL ULCER)

Warfarin lab monitoring

● MONITOR INR (2-3 sec) - clotting time

○  Monitor for bleeding and bruising

○  Use an electric laser

● DONT GIVE TO PREG PT; category X

Warfarin drug-drug interaction

● Drugs increase bleed effects: salicylates, metronidazole, thyroid drugs, glucagon, erythromycin, androgens, famotidine, nizatidine

● Drugs decrease effect: (brekP)Rifampin, barbiturates, phenytoin, vitamin K, vitamin E

● Warfarin → increase effect of phenytoin

Warfarin antidote

○  Vitamin K (phytonadione)

Diabetic type I patient teaching

○  Always requires insulin replacement therapy because the beta cells are no longer functioning

■ Exogenous insulin (coming from outside the body)

● Chronic requirement, life-long administration

○  Exercise

Levothyroxine dosage

25 mcg minimum and 50 maximum

Levothyroxine lab monitoring

● MONITOR LAB LVLS: T3,T4, TSH (FIND LEVELS!!)

○ TSH GOAL LVL: 0.4-4.0 mU/L

● EMPTY STOMACH, 30 mins b4 meal in morning (1x day), at same time

Levothyroxine medication therapeutic goal

○ Levothyroxine is for hypothyroidism; it is synthetic T4

Therapuetic goal: increase thyroid lvl → tx hypothyroidism

Hyperthyroid medication management

○ Methimazole and PTU for hyperthyroidism

○ Take orally; usually every 8 hours due to short half life

○ Monitor for bone marrow suppression

■ Fever, sore throat

○ Do baseline CBC to monitor for agranulocytosis

■ Decrease in leukocytes and neutrophils

Insulin patient teaching for self-administration

○ Check blood glucose levels before giving insulin

○ Rotate INJECTION SITES

Insulin antidote

Glucagon

Anticoagulation and contraindicated conditions

○ Do not give to patient with peptic ulcer (duodenal ulcer)

Heparin infusion safety

○  Antidote for heparin (Protamine)

○  Subtherapeutic levels can lead to embolism or recurrent deep vein thrombosis, while supra-therapeutic levels can lead to major bleeding complications

○ Monitor rate of infusion every 30 to 60 minutes

Anti CoA (HMG CoA) patient teaching

○ “Statin” drugs

■ TAke at bedtime/evening

○  Use contraceptives because statin drugs are teratogenic (avoid pregnancy)

○  Avoid grapefruit juice and alcohol

Anti CoA (HMG CoA) lab monitoring

Monitor ALT and AST (liver)

● HIGHER: HDL (>60mg/dL) - good cholesterol

● LOWER: LDL (<100mg/dL) TRGILYCERIDES, CHOLESTEROL

Anti CoA (HMG CoA) adverse effects

• RHABDOMYOOLYSIS: muscle pain (mylgia)

• HEPATOXIXTY

• Heachache, dizzines, blurred vision, GI upset

Beta-Blocker and its medical condition contraindication

LOWER HR/BP (eg: atenolol end with -olol)

● HEART: Bradycardia, heart block, cardiogenic shock

• ASTHMA, COPD, THROTIXICOSIS (bad for them: must know!!)- it narrows lungs

Pathophysiological of left side heart failure

Affects the Lungs- think L for Lungs

• Crackles and wheezes

• Paroxysmal nocturnal dyspnea

• Orthopnea

• Frothy pink cough

Pathophysiological of right-side heart failure

SWELLING

● Edema - pitting → lower extremeties (assess) MEMORIZE THIS!!

○ Elevate legs

BP regulation elements

○ Renal system (Renin-angiotensin system), cardiovascular system, central nervous system, occasionally adrenal glands

Nitroprusside indication

○ Acute management of hypertensive crisis

■ Headache, dizziness, chest pain, altered mental status, change in vision

○ Direct acting vasodilator

Sustain released medication management and teaching

○ Do not crush or chew

ACE inhibitor adverse effects patient teaching

○ Captopril

• “Pril” medications

○  Patient should notify you about dry or persistent cough

● Angioedema - swelling of face/tongue → airway risk

● Elevated Potassium → Hyperkalemia (>5.0)

Spironolactone prioritization assessment

● Adverse (PPHED)

○ PRIORITIZE BLOOD PRESSURE!!

○ PRIORITIZE POTASSIUM LVL B4 STARTING MEDS

○ HYPERKALEMIA

Loop diuretic usages and pt teach

○ Furosemide: blocks reabsorption of Na, Cl, and water ascending loop of Henle

- actue HF, pulmonary edema and edema (related to #1 for HF, liver/kidney disease)

○ HTN (fast iv push)

CONSUME FOODS HIGH IN POTASSIUM

Metered dose inhaler proper administration patient teaching

○ Use a spacer to deliver more medicine more easily

○ Rinse mouth and wash spacer afterwards

Ranitidine mechanism of action

● GERD,

● active duodenal/benign gastric ulcer (short-term)

● heartburn/acid ingestion

inhibits gastric acid secretion, reduces total pepsin output MEMORIZE

Ranitidine drug interaction

Antacids (salts of calcium, magnesium, and aluminum)

• Concurrent use of antacids can decrease the absorption of ranitidine. Patients should not take antacids 1 hour before or after taking ranitidine.

Ranitidine patient teaching

• patients should eat meals on a regular schedule in a relaxed setting and avoid overeating. Avoiding foods that increase stomach acid, like caffeine and spicy foods

• Notify your doctor immediately if you have any signs of bleeding, such as black or bloody stools or vomit.

Asthma medication management

○ Short-acting beta agonists are the first choice for asthma management

○ Albuterol is first line of defense for asthma attacks

• B BEFORE C → bronchodilator b4 corticosteroids: wait 1-5 mins btwn

Hypothyroid dosing adjustment and lab monitoring

○ If dose is too high it can cause hyperthyroidism

○ TSH and T4

Bowel management program in neurological deficient patients

○ Paralyzed patient may have issues feeling bowel movements

○ Patients that are paralyzed are going to have alterations in their bowel

elimination

○ Body gives ques about defecating, but they don't kick in right after paralysis

Misoprostol patient teaching

○ Use contraceptives

■ Misoprostol can result in misscarriage, premature birth

■ Used to get patient ready for birth or help with postpartum

hemorrhage

Intracranial Pressure medication management

Osmotic- - pulls h20 into renal tube w/o sodium loss

Hydrochlorothiazide medication management

○ Make sure patient is not allergic to sulfa (contraindication)

○ Risk for hypokalemia so patients should eat food rich in potassium

■ Normal range of potassium is 3.5 to 5.2

■ Citrus fruits, potatoes, bananas

○ Give well before bed time so patient does not need to constantly get up to urinate in the middle of the night

■ Do not give past 3 p.m.

Cimetidine adverse effects

○ Impotence, gynecomastia, reduced libido

○ Headache, nausea, vomiting, diarrhea, drowsiness, dizziness

○ Increased risk of pneumonia

Clopidogrel and patient health history which contraindicated

● PT NEEDS TO STOP TAKING AT LEAST 5 DAYS B4 ANY SURGERY

● DONT GIVE TO PT W/ BLEEDING DISORDER

● Pt gets into accident & on clopidogrel → have packed RBC on hand (PRBC)

● NO PREGNANT, BREASTFEEDING

Corticosteroid mechanism of action in asthma

○ Suppress inflammation in the airways

○ Prevents the release of leukotrienes, prostaglandins, and histamine which mediate inflammation

Antiemetic in post-op patient

○  Ondansetron (Zofran) is the first line of treatment

(serotonin antagonist blocks serotonin)

○ Given during postoperative recovery period

• GIVE 1 HR BEFORE ANESTHESIA, POSTOP, THEN EVERY 8 HRS AS NEEDED

Potassium sparing diuretic patient teaching

■ Can cause hyperkalemia because it is potassium sparing

■ Inform about lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias associated with hyperkalemia

■ Can cause hirsutism, gynecomastia, deepening of voice, and irregular

menses

■ Decreased effect when paired with salicylates

Proton Pump Inhibitors indication

Omeprazole

○ Prevent and treat gastric and duodenal ulcers, prolonged dyspepsia, GERD, erosive esophagitis, Zollinger-Ellison syndrome, and systemic mastocytosis

■ NSAIDs are the number one cause of ulcers

Glucocorticoid/Steroid care planning and medication management

○ Adrenal suppression

○ Gradually tapered when discontinuing

can cause Soft bones → osteoporosis

Digoxin therapeutic effects

○ Digoxin increases intracellular calcium and allows more calcium to ender myocardial cells during depolarization causing

○ Overall effect is to increase cardiac output which may relieve symptoms in heart failure

○ Indicated for the treatment of heart failure, atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia

Glipizide patient teaching

Pt teach (MEMORIZE THIS!!)

● Glucometer (how to check their blood sugar)

● Report signs of HYPOGLYCEMIA

● Take it ONCE a day w/meals

• for type 2 diabetes

Ciprofloxacin

• A rare but serious side effect is Achilles tendon rupture, especially in older adults. Clients should monitor for pain, swelling, and redness in the Achilles tendon area and avoid exercise if these symptoms occur.

• w/food

• Prolonged use can lead to suprainfection, such as thrush or vaginal yeast infections.

Penicillin

• Take on empty stomach

• People allergic to one penicillin are likely allergic to others and might also have a cross-sensitivity to cephalosporins.

Tetracycline

• Can stain developing teeth in children and should not be given to children under 8 years old.

• Protect skin from the sun due to increased photosensitivity

Morphine

• Educate clients about the signs of respiratory depression (slowed breathing, difficulty breathing, bluish lips) and the importance of seeking immediate medical attention if these occur.

• constipation

• opioid

Tramadol

• combining tramadol with other CNS depressants, like alcohol, benzodiazepines, or barbiturates, can significantly increase the risk of respiratory depression

Diazepam

DIAZEPAM (BENZO, ABUSED, GABA = GRANDMA (night time/slow/sleepy)

SEDATION INCREASE; MERCEDES BENZ; -PAM,-LAM)

● SEDATION = LOW & SLOW

● Pharm Act: enhances action of gamma-aminobutyric acid (GABA) in CNS

● Thep: anxiety disorders,

Loop sparing diuretic patient teaching

■ Do not use during pregnancy

■ Can cause ototoxicity and deafness

■ Risk of ototoxicity increases if loop diuretics are combined with

aminoglycosides or cisplatin

MORPHINE (opioid agonist) adverse effect

Respiratory depression→<12 RR → STOP MED!!

MEMORIZE THIS!!

lithium lab monitoring with diuretic medication combination therapy

Interactions (AVOID) MEMORIZE THIS!!

○ DIURETICS → lowers lvl of sodium (RISK OF LITHIUM TOXICITY)

○ MONITOR KIDNEY, LIVER

○ THIAZIDE DIURETICS & THIAZIDE LIKE DIURETICS

○ NSAIDS

ANTIBIOTICS MED MANAGE AND PT TEACH

• Finish ENTIRE Rx even if s/s improve\

• Take on empty stomach (RAAD: Rifampin, Rifabutin, Ampicillin, and Diloxacillin)

Benzodiazepines

○ DONT SKIP DOSES

○ ADDICTIVE, EFFECTIVE WITHIN MINUTES

○ TAKE AT BEDTIME!! → EXTREME SEDATION

What regulates the cardiovascular system if patient is on antihypertensive medication?

○ Heart rate, stroke volume, and total peripheral resistance

Gentamycin serum levels

CHECK SERUM LVLS: (MEMORIZE THIS!!)

• PEAK: 30 mins (IV) & 1 hr (IM) after administration

• THROUGH: right before next dose of administration

NO MORE THAN 10 DAYS OF TX

GFR (gold standard)→ <90 mL/min → BAD!!

• As u get older → gfr gets lower → normal (based on age)

Gentamycin theraputic index

NARROW THEP INDE 3-5 mg/kg/d

Spironolactone pt education

● Education: AVOID SALT SUBSTITUTES CONTAINING POTASSIUM

○ Avoid green leafy veggies, potassium supps, salt supps

IBUPROFEN /ASPIRIN LAB MONITOR

Kidney Dysfunction → monitor I&O, BUN, Creatinine

ANTI CoA (HMG coA) (“STATINS”)

LOWER: LDL (<100mg/dL) and TRIGLYCERIDES, CHOLESTEROL

HIGHER: HDL (<60mg/dL)

Beta blockers contradiction

bad for pt w COPD, asthma

HEART: Bradycardia, heart block, cardiogenic shock

CYSTIC FIBROSIS

• Chest physical therapy (CPT),

• Low calorie, high protein diet

ASTHMA extreme case

● EXTREME CASE (life threatening): status asthmaticus

ACUTE (sudden) RESPIRATORY DISTRESS SYNDROME (ARDS)

● MECHANICAL VENTILATION: opens up collapsed sac → better gas exchange

• Paralytic meds: stops respiratory efforts, provides oxygen → muscle relaxants

THEOPHYLLINE (xanthine) pt teach

Avoid: caffeine!!!!!, smoking

MEMORIZE THIS!! (CAFFEINE ESPECIALLY)

THEOPHYLLINE (xanthine) med manage

● NARROW THEP RANGE: 10-20 MCG/ML

3 T’s: Memorize this!!

• Toxic >20

• Tonic-clonic seizures- 1st priority

• Tachycardia

LACTULOSE INDICATION

short-term tx of constipation, hepatic encephalopathy

• hepatic encephalopathy- - cloudy brain from high ammonia lvl MEMORIZE THIS!

LACTULOSE CAUTION

● Watch for high ammonia lvl → hepatic encephalopathy

LACTULOSE PT TEACH

MONITOR!! MEMORIZE THIS!!

●  2-3 stools per day

●  Ammonia level decrease

• ●  Congiton improved → “improved mental status”

● INCREASE NATURAL DIET FIBER

● INCREASE FLUID!!

MANNITOL (sugar) ind. and adverse effect

● Adverse: (HEP)

○ **HEART FAILURE

○ Electrolytre/fluid imbalance (Na, K)

○ **PULMONARY EDE

Mannitol (sugar) ind.

decreases intracranial pressure (ICP), intraocular pressure before surgery (IOP), edema (BRAIN!). Take mannitol - lower headache

Contradic. lithium

Diuretics used together causes lithium toxicity

Opioid schedule

Level II

Glipizide use

increase insulin release

Coma pt.

serotonin