PHARM ESSENTIALS FINAL

side effects of fluphenazine for treating schizophrenia

• dizziness

• headache

• blurred vision

• weight gain

• dry mouth

• hyperhidrosis

• urinary retention

• seizures

• Cerebral and peripheral edema

• tachycardia

• EPS (drug induced movement disorder ei involuntary facial movements, stiff muscles, tremors, blood dyscrasias

how to administer Haldol for treating schizophrenia

should be administered by deep intramuscular injection into the gluteal region

loading doses

• used to quickly induce a therapeutic response

• do not shorten the half-life of a drug

• do not reduce the occurrence of side effects

• not all meds are initiated w a loading dose

first pass effect

refers to the ability that the liver must remove a portion of the drug when the drug is absorbed by GI tract

the concentration of the drug is greatly reduced before it enters the

systemic circulation

side effects of morphine

• constipation

• nausea

• vomiting

  • can decrease respiratory rate

what is the biggest priority with opiods?

ABC’s and safety, followed by pain

Acetylcysteine (Mucomyst)

• antidote for acetaminophen overdose

• for kidney protection against dyes

• acts as a mucolytic agent

narcan (Naloxone)

antidote for opioid overdose; should be administered ASAP if overdose is suspected like in the case of a decrease in the respiratory rate in a patient receiving opioids

what is the first nursing intervention if a patient complains of incisional pain?

assess the site

• remember AAPIE (nursing process)

because some opioids will cause nausea what will need to be administered prior?

an antiemetic

in what patients are the use of opioids contraindicated and why?

patients with brain hemorrhage bc they will not be able to be assessed appropriately due to the sedation caused by the opioids

what must a patient do if they wish to receive a refill of their opioid prescription?

meet with the physician in person, no refills are done over the phone.

how does Aspirin function?

by blocking irreversibly the protective action of cox 1 and cox 2 (inflammatory response)

what should patients be taught when taking Aspirin?

that they should take it with food

when should a nurse question orders to give a patient Aspirin?

if a patient is scheduled for surgery that day as Aspirin will take about a week to lose its effectiveness

NSAIDs should always be taken with

food

NSAIDs should be avoided if a patient has

peptic ulcer disease

what meds can be used to treat gout?

• allopurinol

• colchicine

Allopurinol

is a xanthene oxidase inhibitor that reduces uric acid synthesis

• used prophylactically

Colchicine

another medication that can be used in the treatment of acute gout symptoms if NSAIDs or Corticosteroids are not working.

how do diuretics work?

they increase urinary output

what is the best measurement of diuretic effectiveness?

• weight (#1)

• intake and output

  • output has to be higher than intake

the more water the patient loses while taking diuretics

the more the patient will drop in weight

what does a urinalysis look at?

• Urine Ph

• Protein

• Glucose

• Specific gravity

• Ketones

• Leukocytes

patients who are on diuretics should take them

daily as prescribed and not only if their BP is high

antihypertensive therapy should be part of a

daily regimen

hydrochlorothiazide

• patient will lose potassium so they should eat foods high in potassium

• take med first thing in the morning to avoid nocturia

• #1 diuretic to treat hypertension

• should be taken daily not only if BP is high

loop diuretics

if a patient is taking a loop diuretic they should check the potassium level; if level is abnormal notify the provider

what should one expect to be administered if a patient who has CKD is experiencing hyperkalemia?

• Kayexalate

• Regular insulin IV

• lasix diuretic

what would not be administered in the case of a patient who has CKD and is experiencing hyperkalemia?

Lantus SQ (long acting insulin)

side effects of Lasix

• postural hypotension

• ototoxicity and tinnitus if pushed too fast

• hypokalemia

• hyperglycemia

digoxin/ Lanoxin has a therapeutic index that requires

it to be monitored for toxicity

what is the maximum dose of Digoxin until it is considered toxic?

1.8; must be reported and held

if Digoxin levels are too high the MD might prescribe

Digibind, digoxin antidote

s/s of Digoxin toxicity

• anorexia

• nausea

• vomiting

• visual disturbances (halos)

• fatigue

• cardiac dysrhythmias

• weakness

If your patient is taking a combination drug (Diuretic and Beta blocker) which intervention should the nurse implement?

instruct the patient to sit on the side of the bed before getting out of the bed

because Digoxin is a cardiac glycoside, what effects does it have on the heart?

• it increases contractility and decreases HR

• positive inotropic

• negative chronotropic

• makes the heart a more effective pump

how will you know that Digoxin therapy is working?

because the patient will be able to tolerate walking and preform ADLs without getting tired

how do ACE inhibitors work?

by blocking the conversion of Angiotensin 1 to Angiotensin 2

Angiotensin 2

is an extreme potent vasoconstrictor, thus by blocking Angiotensin 2 conversion, ACE inhibitors block vasoconstrictions from taking place leading to vasodilation and decreasing BP

ACE inhibitors are

• used for controlling hypertension

• used to decrease mortality from M.I.

• used to delay the progression of diabetic neuropathy

• the first line therapy for HF

Viagra is contraindicated in patients with

unstable angina bc its vasodilatory action can cause reflex tachycardia which is not beneficial if patient is having unstable angina

Nitrates and Viagra

• should not be mixed

• both lead to vasodilation

Nitrates can lead to a patient developing

reflex tachycardia

what meds lower LDL levels and how

Statins decrease production of Cholesterol in the liver

what symptom should be questioned if a patient is taking Statins such as Lipitor or Crestor

pain or muscle tenderness which could be a sign of a rare adverse effect known as rnhabdomylosis

what plasma lipoprotein level mostly correlated to CAD?

elevated LDL levels

why should Statins be administered in the evening?

because the liver synthesizes cholesterol mostly at night

what is a common side effect with the use of Nitrates and what can the nurse recommend?

headaches, nurse should instruct the patient to take Tylenol PRN

Nitrates do NOT

have effect on increase of myocardial contraction, so it does not cause bradycardia

Nitrates will

• dilate veins

• decrease venous return due to its vasodilatory effect

• reduce coronary artery spasm

• can lead to reflex tachycardia

Niacin

nurse should teach the patient about taking aspirin 30 mins prior to avoid flushing which is a common side effect

Welchol or Questran

does not affect gout but patient may report complaints of GI distress

if a patient is taking bile acid sequestrants the nurse should tell the patient to expect

complains of bowel changes and constipation

Type 1 diabetes can be managed with

insulin

type 2 diabetes can be managed with

oral hypoglycemics

type 2 diabetes is

• the most common type of diabetes

• most associated with obesity and hereditary characteristics

a patient receiving glucocorticoid therapy might require

an increase in the dose of insulin because glucocorticoids can lead to hyperglycemia even in non-diabetic patients

what is HgbA1C level used for

to check on diabetic management

what is the purpose of glucagon

it increases the BS level in the body (tx for hypoglycemia)

s/s of hypoglycemia

• shaking

• irritability

• sweating

what is diabetic ketoacidosis

when the body cannot utilize the sugar due to lack of insulin production and it switches to fat as metabolism, thus producing ketones and turning the ph. acidic

What type of insulin has an onset of action of less than 15 minutes?

• humalog Lispro

• Regular insulin

what insulin is the only type that can be infused IV?

regular

how are all other insulins (Lantus, NPH) administered?

subcutaneously (SQ)

If patient takes regular insulin at 0700, what meal will prevent patient from going Hypoglycemic?

breakfast (30 min onset)

If patient takes 25 units of NPH insulin to a client with DM Type I at 1600. Nurse should ensure that

the client eats a snack at bedtime because this insulin has a peak of 4-12 hrs; this means that starting at 8 PM through 4 AM the patient is at risk for hypoglycemia which is why they need a snack at bedtime

Metformin (biguanide) helps by

decreasing hepatic production of glucose from stored glycogen.

order for drawing insulin

cloudy clear clear cloudy

what is best practice before initiating antibiotic therapy?

ensuring that culture and sensitivity has been obtained in order to identify the causing agent and its best treatment therapy

what can be given before culture and sensitivity results are received?

the MD can start the patient on broad spectrum antibiotic therapy until the culture and sensitivity reveals the best course of therapy

what are some signs that a patient may have an infection?

temperature

what is a sign that antibiotic therapy is effective

if a patient’s temp goes to 98.6 oral

what should the nurse do with a patient who is taking an antibiotic for the first time?

stay with the patient for at least the first 30 mins to check if the patient has developed a reaction

tetracycline

• should be taken on an empty stomach bc minerals like calcium can decrease the absorption of tetracycline

• should be avoided in pregnant pts

• can lead to teeth discoloration

vancomycin requires

peak and trough

trough should be taken

just before starting administration of the next dose

peak should be taken

30 mins to 1 hour after end of administration of dose

in certain cases, for a patient taking Isoniazid (INH) the health department will assign the patient to

be in direct observation therapy, which means someone from the health department will watch the pt take the med

Diflucan/Fluconazole, an antifungal medication adverse effects is:

hepatotoxicity, so if a patient states that their skin is turning yellow the nurse should advise the patient to stop taking the med and contact the MD

important patient education for patients taking Rifampin include

• possible discoloration of body fluids that can stain their clothing

• patient should avoid using contact lenses during therapy

what should the nurse do prior to applying topical fungal medications on the affected area?

cleanse the area with warm water prior to applying the medication

IV administration of antibiotics will

put the patient prone to having reactions much more than oral routes

if a patient starts complaining of itchiness and SOB while receiving antibiotics IV

discontinue IV

multi-drug therapy is usually not recommended except if the patient has

TB or H.pylori to lower potential for bacterial resistance

why are antibiotics always taken as ordered to its entirety?

because stoping it too soon may lead to bacteria developing resistance

what does colored sputum indicate and what should be done?

it can indicate pneumonia and antibiotics will be prescribed

if a patient is allergic to penicillin the nurse should question the use of

cephalosporins bc of cross sensitivity with penicillin

if a patient comes to the hospital with symptoms of an infection what should be drawn before starting antibiotics?

ALL cultures

why should glucocorticoid drugs like prednisone need to be tapered down slowly?

Adrenal collapse / adrenal gland atrophies as we start with synthetic glucocorticoids. Thus, if patient stops medication abruptly the adrenal glands will not be able to re-start hormonal production that fast and collapse will take place

what should the nurse suggest to the patient while taking glucocorticoids

stay away from large crowds because glucocorticoids decrease one’s immune system

what labs should be monitored for patients taking glucocorticoids IVP

blood glucose levels

Disorders of the adrenal gland can be differentiated by

under production of the adrenal hormones or overproduction of the same hormones

Addison’s disease is caused by

too little amounts of adrenal hormones

Cushings disease is caused by

too much adrenal hormones

Addison’s disease is characterized by

• syncope

• darkening of the skin

• weakness

• fatigue

Cushing is characterized by

• upper body obesity

• rounded face

• increased fat around the neck

• thinning arms and legs

• fatigue

• weakness

• high blood pressure

• mood disorders

• children tend to be obese with slowed growth rates.

what is used to treat hyperthyroidism

Iodine 131 therapy

Adverse reaction from glucocorticoids

bleeding ulcers