Henry Ford NICU Pharmacy Test

flash cards to study for the HF Main Detroit NICU Nursing Orientation Exam

Acetaminophen (Tylenol) - indication

fever, mild-mod pain (circumcisions), *PDA treatment

Steps to determine PDA treatment with Acetaminophen

1. ECHO = mod-severe PDA

2. x3 days of Tylenol treatment

3. Repeat ECHO, liver labs, & drug labs

4. *IF still mod-severe PDA, x2 more days Tylenol treatment

Acyclovir (indications)

Herpes (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV)

***HERPES VIRUSES***

Albumin 5% (indication)

(volume expander) treats hypovolemia

Albumin 25% (indications)

1. treats hypoalbuminemia (moves fluid in interstitial space back into circulation)

   1. treats hyperbilirubemia (increases bilirubin binding & removal)

Amphotericin B (indications)

treat systemic/superficial fungal infectionssuch as cryptococcal meningitis, candidiasis, and aspergillosis.

medication incompatible with NS solutions

Amphotericin B only made and flushed in Dextrose solutions and only dextrose flushes to avoid precipitation and ensure proper administration.

(incompatible with everything except dextrose, hydrocortisone, and heparin ONLY)

what type of flush to use with AMBISOME

(Amphotericin B Lysosomal) only with D5 flushes

Ampicillin (indications)

(an antibacterial) treats bacterial infections (**GBS, E coli, gonorrhea, etc.)

what must be done before starting any antibiotics ?

blood culture must be drawn and sent first

what is given immediately after ampicillin initial administration?

gentamicin is given immediately after this drug (then 2hrs after future ampicillin administration)

what common NICU antibiotic is incompatible with Na Bicarbonate?

ampicillin is incompatible with this IV med

what must be done before initial dose of aquafor is applied to infants skin?

bathe baby with sterile water FIRST before this medication is applied (for the first time)

Aquafor (contraindication)

DO NOT apply this med to wounds or superficial infections

(can lead to)

*mastercation: too much moisture causing skin breakdown

caffeine citrate

produces bronchodilation

stimulates breathing & myocardial contractility

=treats apnea & increases HR

*notify HP HR >180bpm BEFORE med due

cefepime (indications)

(bactericidal)

treats…

-meningitis

-sepsis from (E coli, H influenza…)

cefepime treatment (monitor for)

(bactericidal)

monitor for s/s super infection

(fever, thrush, diarrhea, foul smelling stools)

chlorothiazide (diurel)

diuretic that does NOT increase urinary excretion of Ca (hypercalcemia & hyperglycemia)

tx mild-mod edema

hyponatremia, hypokalemia, dehydration

Clindamycin (indications)

(antibiotic)

treats…

-bacteremia

*deep tissue infections (staph infections)

**hard on liver (monitor levels)

clindamycin (treatment contraindication)

do NOT use this antibiotic to treat meningitis

serious side effect of clindamycin (antibiotic) use

pseudomembranous colitis

s/s: bloody diarrhea, ABD pain, fever, elevated hepatic enzymes, thrombocytopenia, rash, thrombophlebitis, granulocytopenia

dexamethasone (decadron) (indications)

(steroid & immunosuppressive)

=decreases airway edema & improves lung function

used to help extubation process & shorten vent dependency in chronic lung disease

(**DART protocol**)

DART protocol

(dexamethasone treatment)

a low dose of dexamethasone is given over 10 days

(other protocols start doses high and slowly wean the patient off the steroid over 14 days)

=prevent adrenal crisis from sudden stopping of med

why are H2 antagonists added to TPN during dexamethasone tx?

H2 antagonists (ranitidine/famotidine) added to TPN to decrease risk of GI COMPLICATIONS

what medication can cause adrenal crisis?

dexamethasone can cause this serious side effect if stopped abruptly.

s/s:

hyponatremia

LOW BP

Incr HR

oliguria

clinical deterioration

(side effects of) dexamethasone

(side effects)

HTN, hyperglycemia, Na & water retention (edema), low K & Ca, *OSTEOPENIA, growth/adrenal suppression

Dobutamine (side effects)

(vasopressor side effects)

IV extravasation

*HYPOTENSION if pt is hypovolemic

tachycardic

increases systolic BP

charting rules for vasopressor use

initiating pressor: Q15-30 min BP

titrating pressor: chart BP at exact time titration/bolus occurs

*double RN check for all calculations

route: large vein or central UVC

***NEVER UAC***

phentolamine mesylate injection (indication)

injectable med used to treat extravasation

(side effect of dopamine/dobutamine)

Dopamine

(vasopressor)

tx: hypotension & *renal perfusion

metabolized fast by liver/kidneys

what vasopressor causes azotemia?

azotemia: too much waste product in blood d/t kidneys not filtering blood properly

a side effect of Dopamine

Dopamine (side effects)

(vasopressor side effects)

bradycardia

*azotemia (poor kidney filtration causing increased waste in blood)

increased pulmonary artery pressure

necrosis/tissue sloughing

extravasation

Dopamine (nursing considerations)

(vasopressor nursing considerations)

*monitor for cold extremities

monitor for white streak along vein path

do not flush line during infusion

epinephrine (dosage)

concentration: 0.1mg/ml (**vial reads “1:10,000” dilution**)

ET EPI: 0.05-0.1mg/kg/dose

IV EPI: 0.01-0.03mg/kg/dose

IV Drip: 0.05-0.1mcg/kg/min

nebulization (for bronchospasm): 0.5ml/dose in 3ml NS

incompatible: Na Bicarb

when is epinephrine not indicated?

epinephrine not indicated with blood pH of <7.20

Fentanyl (Sublimaze) (nursing considerations

(nursing considerations)

-monitor GI motility & feeding intolerance

-NEVER push med; administer over 3-5minutes (chest wall rigidity/seizures)

Fentanyl antidote

naloxone (narcan)

Ferrous Sulfate (Fe) (nursing considerations)

(dietary supplement)

monitor H/H & relic (can cause black stools, hemolysis)

Folic Acid (Vitamin B9) (indications)

treats anemia d/t folate deficiency in preemies <1800gm

(administer with feeds; pt never D/C on this med)

monitor H/H & retic

Furosemide (lasix) (indications)

(fast acting potent diuretic)

treats: fluid overload, pulmonary edema, TTNB, BPD, hypercalcemia

what diuretic can affect bilirubin?

furosemide (lasix) can potentially displace bilirubin from albumin binding sites = bilirubin is not being removed from body (increased bilirubin)

ph imbalance side effects of furosemide (lasix) use

(diuretic side effect)

metabolic/respiratory alkalosis (d/t bicarbonate reabsorption)

gentamicin (side effects)

(anti-infective side effects)

nephrotoxicity

ototoxicity

neurotoxicity

superinfections

gentamicin lab (nursing considerations)

(anti-infective)

draw trough: prior to med administration

draw peak: 30min after med AND flush are administration

*peak serum levels: 6-10mcg/ml

*trough serum levels: <1mcg/ml

anti-infective med incompatible with high dose heparin (>1unit/ml)

gentamicin incompatible with high doses of this common med

hyaluronidase injection (nursing indication)

(extravasation antidote)

*NOT for extravasation caused by vasopressors or epi*

1. cleanse site

   1. inject 0.2ml aliquots at 5 separate sites around affected area (Sub-Q or Intradermal)

H-BIG vaccine (Hep B Immune Globin)

indication: HbsAG-Positive MOB

which vaccine can be administered without consent?

H-BIG vaccine to infants within 12hrs of life regardless of weight

VZIG vaccine (Varicella Zoster Immune Globin) (indications)

(vaccine indication)

for baby with MOB + for chickenpox within 5 days before or 48hrs after delivery

Pneumococcal Conjugate vaccine (nursing consideration)

(vaccine nursing consideration)

must shake vial before administering

rotarix vaccine (procedure)

MUST administer vaccine OFF NICU

(live viral vaccine)

1. pharmacist meets RN outside unit in hallway (bring patient, ID band, & WOW)

2. scan & char med

3. RN dilutes vaccine in diluent

4. Administer med orally

5. dispose of vaccine in biohazard bag & bin

rotarix vaccine (indication)

(normally vaccine given at 2 & 4months life)

first dose (if indicated) not given to infant 15weeks, 0 days greater than or equal to 105 days

vaccine indicated for prevention of RSV

Indomethacin (indication)

(anti-inflammatory)

helps close PDA

MAX x2 courses given

DO NOT give if GI bleeding/NEC & Pt must be NPO or on MEN protocol

MEN protocol (indication)

(minimal enteral nutrition)

for patient still being fed during indomethacin treatment

protocol: MAX 10ml/kg/day

when can feeding be resumed after last dose of indomethacin treatment?

(PDA med)

feeding can resume 12hrs after last dose given

indomethacin (nursing considerations)

(PDA med nursing considerations)

-labs drawn & WNL before med started (kidney labs, Plts, bill labs, electrolytes)

-monitor murmur, PP, low UO

increase gentamicin doses to Q36hrs

-contraindicated with D7.5/D10 & Ca gluconate

Insulin (Regular, Humulin) (continuous infusion med administration)

1. IV tubing primed with 10ml/more

2. allow tubing to sit for 20min after priming

3. prime tubing again

   1. administer per order

insulin bolus infusion (nursing consideration)

(hypoglycemic agent nursing consideration)

administer via SLOW IV push & flush with NS per standard protocol

does NOT require insulin priming before administration

insulin (nursing considerations)

(hypoglycemic agent nursing considerations)

-monitor BS Q1-2hrs until stable

-change infusion set-up Q24hrs

-careful of meds that can increase/decrease med effect

Intralipids (20% Fat Emulsion) (nursing considerations)

(nutritional med)

-monitor triglycerides, liver labs, BS, platelets, albumin, bilirubin

-septic shock=hold lipids for 24hrs

increase lipid rate if lipids fall behind d/t med administration

(no more than MAX of 0.15gm/kg/hr rate increase w/out HP order)

-cannot exceed 50-60% of nonprotein calories

what nutritional med can cause overloading syndrome?

(nutritional med)

lipids can cause overloading s/s: seizures, fever, shock, increased WBC

(heparin can be added to lower triglyceride levels if needed)

when are triglyceride labs ordered?

(lipids)

this lab is ordered once lipids reach 3gm/kg/day

lorazepam (Ativan)

(anticonvulsant sedative)

management of seizures

side effects: respiratory depression

slowly push over 5-10min

MCT Oil (nursing considerations)

(caloric supplement)

-mix with feeds

-assess for diarrhea

-increase dose slowly

(mazola oil used after D/C)

midazolem (Versed) (nursing considerations)

(sedative nursing considerations)

-monitor respiratory status, low BP, hepatic function, s/s withdrawal

morphine sulfate (nursing considerations)

-monitor s/s slowed GI motility

-keep naloxone (narcan) on hand

FIN score >12

increase original morphine dose by 5%

FIN score 8-11

leave the morphine dose the same

(for these FIN scores)

FIN score <8 for 48hrs

decrease original morphine dose by 10%ll

(if FIN score still <8 after another 48hrs, reduce dose by 0.2mg/kg then discontinue)

multivitamins (poly-vi-sol) (indication)

(nutritional supplment)

for premature infant that has reached tolerated FULL FEEDS

-mix with feedings and not with other supplements at the same time (to avoid feeding intolerance)

nafcillin (unipen) (indication)

(antibiotic)

treats MSPS (methicillin sensitive penicillinase-producing staphylococci)

-very costic to veins

-monitor liver labs

naloxone (narcan) (inidcations)

(narcotic antagonist)

reverses respiratory depression

CAUTION: can cause withdrawal symptoms in NAS babies

naloxone (narcan) (nursing considerations)

(narcotic antagonist)

-do not give to NAS babies

-emergency equipment at bedside

-monitor for bleeding

palivizumab (Synagis) (nursing considerations)

(RSV monoclonal antibody)

for: kids <2yrs w/ chronic lung disease between Nov-Mar months

-med given every month throughout RSV season

-x2 kids can use from same vial within 1hr of med delivery

what disorder is contraindicated for palivizumab (Synagis) administration?

infants with cyanotic heart disease should not take this antibody med

Pen G Potassium (indication)

(antibiotic)

treats congenital syphilis & untreated GBS

-monitor electrolytes & I/O’s

phenobarbital (luminal) (indication)

(sedative anticonvulsant)

limits seizure activity & reduces bili levels (tx hyperbilirubemia)

phenobarbital (luminal) (nursing considerations)

(sedative anticonvulsant)

assess for barbiturate toxicity (labored breathing, cyanosis, clammy skin, hypotension)

-monitor liver function

Prostaglandin E (Prostin VR, PGE) (indications)

(hormone)

=vasodilates all arteries, inhibits platelet aggregation

keeps PDA open

for congenital cardiac abnormalities

Prostaglandin E (Prostin VR, PGE) (nursing considerations)

(hormone) (nursing considerations)

Q15min V/S during first hour; then hourly

monitor BP Q15min

-assess ductal patency (pulses, murmur, PPUO, gases

route: large vein OR UAC positioned near ductus

H2 Antagonists (ranitidine ZANTAC or IV famotidine PEPCID) (inidcations)

(histamine antagonist)

=reduces volume of gastric juices

helps with GE Reflux & upper GI mucosal lesions

(risk of late onset bacterial/fungal sepsis)

can be added to TPN

Na Bicarbonate (serious contraindication)

never give this med with calcium gluconate (any calcium; med will precipitate immediately)

sodium bicarbonate (NaHCO3) (indication)

(alkalinizing agent)

treats metabolic acidosis by increasing the bicarbonate in the blood

-improves myocardial function

MUST have stable respiratory status to use med (will increase PCO2 levels)

Na Bicarbonate tetany (antidote)

(alkalinizing agent antidote)

=Ca Gluconate

1. discontinue med & administer NS infusion

2. treat tetany with 10% Ca Gluconate IV

Na Bicarbonate (side effects)

(alkalinizing agent side effects)

*metabolic alkalosis

*IVH

tetany (give antidote Ca Gluconate after NS)

-edema/CHF

Spironolactone (Aldactone) (indications)

(K+ sparing diuretic) (indications)

-generalized edema

-fluid overload, pulmonary edema, CHF, BPD< HTN

Survanta (surfactant) (inidcations)

(natural bovine lung extract)

Prophylaxis: birth weight <1250gm and/or <28wks

also for: mec aspiration, pneumonia, PPHN

up to x4 doses in first 28hrs of life (MAX Q6hrs)

Survanta (surfactant) (nursing considerations)

(natural bovine lung extract nursing considerations)

-warm room temp 20min OR in hands 8min

-do NOT use artificial warming techniques

-do NOT SHAKE (swirl gently)

-can be returned to fridge & reused x1 more time

use MAC catheter

-suction before administration

-set vent to 100% FiO2 & IMV 60/min

-each half dose administered in side-lying position (30sec each side before turning)

-o.5ml air in MAC catheter to push remaining med into lungs

-return pt midline & vent settings back to normal

how long to wait after survanta given to suction?

wait at least 1hr before suctioning after this med given

TPN (nursing considerations)

requires double RN check

-change Q24hrs @2100

-aseptic technique

-BUN >50 = protein should be decreased

-monitor BS Q8hrs until BS stable

-UAC can be used if all other routes not available

-MAX dextrose of 12.5% through PIV or PICC

-avoid med off more than 30min

Tromethamine (THAM) (indications)

(alkalinizing agent indications)

=increases pH to correct acidosis

treats: metabolic acidosis when with hypercarbia/hypernatremia

causes hypoglycemia

when is tromethamine indicated instead of Na Bicarbonate?

this med is used when respiratory status limited and respiratory/metabolic acidosis requires treatment

tromethamine (THAM) (nursing considerations)

(alkalinizing agent nursing considerations)

-do NOT use in ANURIC patients

-NOT compatible with ANY MEDS

vancomycin (vancocin)

(antibiotic)

treats MRSA & C Diff or serious infections where other antibiotics failing

nephrotoxicity, ototoxicity, neurotoxicity, red-man syndrome, hypotension w/ rapid infusion

NEVER give IM

-peaks and troughs (trough 1hr after med & flush finishes)

Vecuronium (norcuron) (indication)

(neuromuscular blocking agent)

=produces skeletal muscle paralysis

used to help intubation/procedures to prevent “fighting”

administered via IV PUSH

there will be NO respiratory effort after this med given

what must be done before first dose of vecuronium (norcuron) given?

(neuromuscular blocking agent)

patient must be intubated BEFORE first dose of this med given

vecuronium (norcuron) (nursing considerations)

(neuromuscular blocking agent nursing considerations)

-patient intubated first

-HP/NP must be present to give first dose

gas Q15-30min after each dose

-suction frequently

-protect dry eyes with eye drops

-crede bladder Q2-4hrs (bladder massage)

-provide passive ROM & reposition Q1-2hrs