NURS 351 - Pharm Quiz 1

Penicillin (Bilicillin)

• class: antibiotic; beta lactam

• dosing: IV, PO, IM

• action: inhibits cell wall synthesis/weakening cell wall and rupture (gram + and -)

• SE: safest, super infections

• Contradictions: allergy, cross reaction to sporins, kidney disease

• nsg considerations: take entire course, skin test for allergy, probenecid prolongs action, monitor kidney function

gentamycin

• class: antibiotic; aminoglycoside

• dosing: IM or IV

• action: disrupt bacterial protein synthesis (bactericidal)

• SE: toxicity to ears and kidneys

• Contraindications: renal impairment

• nsg considerations: doesn’t absorb well in GI, VERY STRONG, monitor peaks and troughs, discontinue immediately if toxicity presents

morphine

• class: opiate analgesic

• dosing: epidural, SQ, IV

• action: binds and activates opioid receptors (vasodilator)

• SE: respiratory depression, neurotoxic, euphoria, LOC

• Contraindications: cross reaction with benzos (pams)

• nsg considerations: assess pain level, notify provider of LOC or RR below 10, monitor for OD, avoid alcohol, increase fibers, fluids, and activity

insulin lispro (humalog)

• class: insulin; rapid acting

• dosing: SQ

• action: decrease blood glucose, carb/protein/fat metabolism, and promotes conservation of energy - stimulates cellular reuptake of insulin

• SE: HYPO: seizure, irritable, sweating, confusion

• Contraindications: ONSET: 15 - 3 mins, PEAK: 0.5 - 2.5 hours, DURATION: 3 - 6 hours

• nsg considerations: assess blood glucose, monitor for hypoglycemia, eat within 30 mins, can mix with NPH; BB can mask hypoglycemia - give all with orange juice and carbs

insulin aspart (novolog)

• class: insulin; rapid acting

• dosing: SQ

• action: stimulated cellular reuptake of insulin

• SE:

• Contraindications: ONSET: 10 - 20 mins, PEAK: 1 -3 hours, DURATION: 3 - 5 hours

• nsg considerations: assess blood glucose, monitor for hypoglycemia, eat within 30 mins, can mix with NPH

regular insulin (humulin r or novolin r)

• class: insulin; short acting

• dosing: SQ

• action: decrease blood glucose

• SE:

• Contraindications: ONSET: 30 - 60 mins, PEAK: 1 - 5 hours, DURATION: 6 - 10 hours

• nsg considerations: assess blood glucose, monitor for hypoglycemia, eat within 30 mins, can mix with NPH

NPH insulin (humulin h or novolin h)

• class: insulin; intermediate acting

• dosing: SQ

• action: decrease blood glucose

• SE:

• Contraindications: ONSET: 60 - 120 mins, PEAK: 6 - 14 hours, DURATION: 16 - 24 hours

• nsg considerations: cloudy, monitor for hypoglycemia, assess blood glucose, prepare with protamine and insulin

insulin glargine (lantus)

• class: insulin; long acting

• dosing: SQ

• action: inhibit hepatic glucose system, decrease blood glucose

• SE:

• Contraindications: ONSET: 70 mins, PEAK: none, DURATION: 18 - 24 hours

• nsg considerations: don’t mix with other insulins, assess blood glucose, monitor for hypoglycemia, give @ same time daily (night)

odansetron (zofran)

• class: antiemetic

• dosing: IV or PO (scheduled of PRN)

• action: blocks serotonin receptors to prevent N/V and morning sickness

• SE: QT prolongation, HA, diarrhea, dizziness, TORSADES

• Contraindications: cardiac issues

• nsg considerations: dethomexosone makes stronger, EKG prior to use

cyclophosphamide (cytoxan)

• class: anticancer; alkalayting agent

• dosing: IV or PO

• action: damages DNA to prevent cancer cell replication, and triggers programmed cell death (apoptosis)

• SE: bone marrow suppression, alopecia, bladder injury, bleeding

• Contraindications: bone marrow suppression and immunosuppression

• nsg considerations: adequate hydration and mensa to protect bladder, can develop resistance; used for solid tumors, hodkins disease, and non-hodgkins lymphoma

fentanyl (duragesic)

• class: opioid analgesic

• dosing: buccal, sublingual, transdermal, IV, IM, intranasal and mucosal

• action: mimics action of opioids at Mu and Kappa receptors

• SE: respiratory depression, sedation, constipation, N/V, and urinary retention

• Contraindications: children/people under 110 lbs, never used opioids, choking hazard

• nsg considerations: tansdermal - peak at 24 hours, lasts 48 - 72 hours; in MCG; used for - sedation, breakthrough pain; 100x more potent than morphine; no heat exposure; transmucosal = breakthrough cancer pain; antidote = narcan; fever = cute dose

oxycodone (oxycontin or roxicodone)

• class: opioid analgesic

• dosing:

• action: mimics action of opioids at Mu and Kappa receptors

• SE: cough suppression, miosis (pupil constriction), respiratory depression, sedation, constipation, N/V, and urinary retention

• Contraindications: ROXY: short, immediate, breakthrough pain; CONTIN: long, controlled release, scheduled Q12 hours

• nsg considerations: added to a lot of other meds (percocet), antidote: narcan, less respiratory effects and analgesia than morphine

tamoxifen (nolvadex)

• class: anticancer; anti-estrogen

• dosing: 1x daily

• action: blocks estrogen receptors on the cell to prevent estrogen binding and activating

• SE: DVT, PE, stroke, endometrial cancer

• Contraindications: pregnant, history of DVT/PE or stroke, endometrial cancer

• nsg considerations: USED FOR PRE AND POST-MENOPAUSE, does not change the amount of estrogen, only the activation of cells, used for - adjunctive therapy post therapy for 5 years OR metastatic disease OR high risk for breast cancer

anastrazole (arimidex)

• class: anticancer; aromatase inhibitor

• dosing:

• action: blocks the enzyme aromatase that converts androgens into estrogen in the tissue

• SE: HTN, anorexia, osteoporosis

• Contraindications: premenopausal women, osteoporosis or bone issues

• nsg considerations: decrease amount of estrogen, monitor Ca and Vit D for osteoporosis - if concerning, give bisphosphonate

prednisone (deltasone)

• class: corticosteroid

• dosing: morning

• action: inhibit the action of histamine to treat endocrine or exocrine inflammation, suppress inflammatory response

• SE: cushing’s (LT use), immunosuppression

• Contraindications:

• nsg considerations: TAPER TAPER TAPER!, monitor cholesterol as you taper, risk for blood glucose imbalance, PUD, and osteoporosis, monitor Ca and Vit D, increased dose for renal insufficiency, always give with food

ceftriaxone (rocephin)

• class: beta lactam; cephalosporin

• dosing: IV

• action: inhibits bacterial wall synthesis (bactericidal)

• SE: diarrhea, changes in mental status, anemia

• Contraindications: hypersensitivity with cephalosporins and penicillins, caution with GI disease, impaired vit K, hepatic impairment

• nsg considerations: push over 2 mins, prolong treatment may cause superinfection, monitor liver enzymes for toxicity

quinolones - ciprofloxacin (cipro)

• class: broad spectrum antibiotic; fluoroquinolone

• dosing: PO or IV

• action: inhibits bacertial DNA, topoisomerase and gyrase, which are necessary for DNA replication

• SE: N/V/D, abdominal pain, HA, and rash

• Contraindications: hypersensitivity to cipro, myasthenia gravis, tendon problems, peripheral neuropathy

• nsg considerations: monitor EKG for QT prolongation, C. Diff associated diarrhea can occur (superinfection), hypoglycemia, don’t take with dairy or calcium-fortified products, photosensitivity, complete full course