PHARM final

desmopressin (antidiuretic hormone)

ADRs - hyponatremia, fluid retention, seizures, drowsiness, headache
interventions - monitor fluid intake+output, sodium serum levels, and for diabetes insipidus
client education - increases in weight or edema, report dyspnea, uncontrolled bleeding and ab discomfort

heparin (factor Xa and thrombin inhibitor)

ADRs - hemorrhage, thrombocytopenia, hypersensitivity reactions
Interventions - monitor for signs of hemorrhage (tachycardia and hypotension), platelet count
client education - report petechiae, bruising, hematomas, or black tarry stools, calf pain, or swelling

warfarin (vitamin K antagonist)

ADRs - hemorrhage, and toxicity (overdose)
Interventions - monitor vitals + hematocrit, blood count, administer vitamin K for overdose
client education - stop taking at first sign of hemorrhage, report petechiae, black tarry stools, or hematomas, wear med bracelet

clopidogrel (antiplatelet ADP inhibitor)

ADRs - GI upset/pain, thrombotic thrombocytopenia pupura (TTP)
Intervention - monitor for signs of GI bleeding, or hemorrhagic CVA
client education - increase fluid intake, report gastric irritation, unusual bleeding, weakness, numbness, or easy bruising

alteplase (thrombolytic)

ADRs - hemorrhage (intracranial, GI, sustained)
Interventions - monitor for bleeding, neuro status, GI pain, limit needle sticks, and monitor vitals
client education - report unusual or prolonged bleeding, headache, or unilateral weakness

epoetin alfa (erythropoietic growth factor)

ADRs - HTN, seizures, cardio or cerebro accidents
Interventions - monitor HgB, BP, tumor progression, start with low doses
client education - frequent BP checks, report sudden chest pain, weakness, numbness, or worsening malignancy

filgrastim (leukopoietic growth factor)

ADRs - leukocytosis, bone pain, fever
Interventions - monitor CBC, give lower dose if WBC above 10,000, monitor temp, and for spleen enlargement
client education - report bone pain, fever, ab pain/fullness

oprelvekin (thrombopoietic growth factor)

ADRs - cardiac dysrhythmias, fluid retention, allergic reaction
Interventions - monitor vitals, EKG, fluid intake+outtake, peripheral edema
client education - report heart palpitations, rapid pulse, swelling in lower extremities

captopril (ace inhibitor)

ADRs - severe HTN, dry cough, angioedema, hyperkalemia
Interventions - begin w/ low dose, monitor BP, K levels, and cough
client education - report cough, rash, sore throat, muscle twitching

losartan (ARB)

ADRs - angioedema, dizziness, hypotension, insomnia
Interventions - treat angioedema w/ epi, monitor BP and CNS side effects
client education - report minor swelling of mouth, headaches, or dizziness

eplerenone (aldosterone antagonist)

ADRs - hyperkalemia
Intervention - monitor K levels, BUN, creatinine, and signs of hyperkalemia
client education - No K+ supplements, report palpitations, and muscle twitching

aliskiren (direct renin inhibitor)

ADRs - hyperkalemia, angioedema diarrhea, abdominal pain
Interventions - monitor K levels, BUN, and creatinine + signs for hyperkalemia
client education - No K+ supplements, report palpitations, and muscle twitching

nifedipine (calcium channel blocker)

ADRs - reflex tachycardia, headache, facial flushing, arrhythmias
Interventions - monitor HR, BP, and assist with ambulation
client education - report rapid heart beat, swelling, dizziness, or HR less than 50

doxazosin (alpha-1 blocker)

ADRs - ortho hypo, reflex tachycardia, headache
Intervention - monitor for ortho HTN and report sig block of 20 or more mmHg and pulse 2-6 hrs after 1st dose
client education - report dizziness, rapid HR, no hazardous activities for at least 12 hrs after

atenolol and metroprolol (beta-blockers)

ADRs - bradycardia, reduced cardiac output + heart failure, rebound excitation
interventions - monitor HR, vitals, and signs for heart failure
client education - check pulse daily before meds, report SOB, night cough, or extremity edema

reserpine (adrenergic neuron blocker)

ADRs - severe depression, bradycardia, ortho hypo, GI symptoms
Interventions - monitor for signs of depression and give lowest dose possible (possible discontinuation)
client education - report depression, no driving, move slowly to prevent worth hypo

clonidine (centrally acting alpha-2 agonist)

ADRs- drowsiness, dry mouth, rebound HTN crisis
Interventions - monitor for CNS effects
client education -hard candies and gum minimize dry mouth effects

carvedilol (alpha-beta blocker)

ADRs- dizziness, hypotension, bradycardia, and postural hypotension
interventions - monitor BP and HR (report if less than 60)
client education - report dizziness, check HR daily, report if HR is less than 60 bpm

hydralazine (direct acting vasodilator)

ADRs - headache, reflex tachycardia, SLE like symptoms, fluid retention, heart failure
Interventions - monitor HR and report tach, monitor joint pain, edema, and crackles in the lungs
client education - report rapid HR, facial rash, joint pain, fatigue, edema

hydrochlorothiazide (thiazide diuretic)

ADRs - electrolyte imbalance, hyperglycemia, and increased uric acid levels
interventions - monitor serum electrolyte levels, blood glucose and uric acid
client education - eat foods high in vitamin K+, report electrolyte imbalances, monitor blood glucose if diabetic

furosemide (loop diuretic)

ADRs - electrolyte imbalance, hypotension, hyperglycemia
interventions - monitor electrolyte, BP, blood glucose, and uric acid levels
client education - eat foods high in K+, report weakness, dizziness, and monitor BP

spironolactone (potassium sparing diuretic)

ADRs - hyperkalemia, menstrual irregularities, and impotence
Intervention - monitor serum K levels and endocrine effects
client education - report palpitations, irregular pulse, and avoid K+ supplements

digoxin (cardiac glycoside)

ADRs- cardiac dysrhythmias, GI upset, CNS (fatigue, blurred vision)
Interventions - monitor and report CNS effects and Gi symptoms, digoxin and serum K levels
client education - report nausea, loss of appetite, heart palpitations, hyperkalemia

dobutamine (sympathomimetics)

ADRs - tachycardia, dysrhythmias, and angina
Intervention - monitor EKG and vitals
client education - continuous monitoring and report chest pain asap

milrinone (phosphodiesterase inhibitor)

ADRs - hypokalemia, cardiac dysrhythmias, hypotension, angina chest pain
Interventions - monitor K levels, vitals, EKG, and chest pain
client education - continued ECG rhythm monitoring and VS

atorvastatin (HMG-CoA reductase inhibitor)

ADRs - myopathy, and hepatotoxicity
Intervention - monitor for myopathy and liver tests
client education - report muscle pain, ab pain, and jaundice

gemfibrozil (fibrate)

ADRs - GI upset, gallstones, myopathy, liver toxicity
intervention - monitor Gi symptoms, myopathy, gallstones, and liver function
client education - report GI upset, inability to tolerate fried foods, muscle/joint pain

nitroglycerin (nitrate)

ADRs - headache, ortho HTN, tachycardia, and decreased effectiveness over time
Interventions - monitor BP and HR and for drug tolerance
client education - report dizziness, move slowly, check pulse regularly

albuterol (beta-2 agonist)

ADRs - chest pain, palpation, nervousness, restlessness
Interventions - monitor and report dizziness, palpations, chest pain, and SOB
client education - takes as prescribed, avoid caffeine, report tremors

ipratropium (anticholinergic)

ADRs - dry mouth, increased intraocular pressure, and urinary retention
Intervention - provide water, hard candy, and routine tests for glaucoma
client education - suck on hard candy, sip water, report changes in urinary elimination

theophylline (methylxanthine)

ADRs - rare but nausea, vomiting, diarrhea, seizures
intervention - monitor plasma levels, HR, rhythm, and give activated charcoal for overdose
client education - reduce or eliminate caffeine intake, periodic testing of drug levels

beclomethasone dipropionate (glucocorticoid)

ADRs - hyperglycemia, PUD, infection, headache
Intervention - monitor plasma drug levels, blood glucose, and give with food
client education - use a spacer, take drug on alternate days, avoid NSAIDs, increase fluid intake

prednisone (glucocorticoid)

ADRs - hyperglycemia, PUD, infection, headache
Intervention - monitor plasma drug levels, blood glucose, and give with food
client education - report weakness, weight gain, polyphagia, signs of infection

fluticasone

class - glucocorticoids (flonase+flovent)
mechanism - suppresses inflammation -> decreases edema in airways
ADRs - hyperglycemia, PUD, infection, headache
Intervention - monitor plasma drug levels, blood glucose, and give with food

cromolyn (mast cell stabilizer)

ADRs - allergic reaction
Intervention - administer epinephrine for allergic reactions
client education - seek medical care for sudden rash, swelling of mouth

montelukast (leukotriene modifier)

ADRs - zyflo can cause liver damage and suicidal ideation
Interventions - monitor liver function and observe behavioral changes
client education - report ab tenderness, nausea, and behavioral changes

diphenhydramine (first gen antihistamine)

ADRs - drowsiness, dizziness, dry mouth, and constipation
Interventions - monitor client while ambulating, give w/ food, high intake of fluids
client education - take at bedtime, take w/ food, increase fluids and fiber, take laxative as needed

cetirizine (second gen antihistamine)

ADRs - drowsiness, fatigue, dry mouth, nose, and throat
Interventions - monitor client when ambulating and provide water
client education - once daily, take frequent sips of water

Phenylephrine (sympathomimetics)

ADRs - CNS effects, increased BP, tachycardia, palpations, rebound congestion
Interventions - monitor for anxiety, BP, HR, administer only when needed
client education - report prolonged tachycardia and have BP checked regularly

codeine (opioid antitussives)

ADRs - drowsiness, sedation, GI distress, respiratory depression
Interventions - drug w/ food or drink, diet w/ high fiber and fluids
client education - avoid alcohol, take drug w/ food or milk, increase fiber and fluids

dextromethorphan (nonopioid antitussive)

ADRs- drowsiness, sedation, GI distress, respiratory depression
Interventions - drug w/ food or drink, diet w/ high fiber and fluids
client education - take drug PRN for a short time, increase fluids and fiber intake

guaifenesin (expectorant)

ADRs - dizziness, drowsiness, GI distress, and allergic reaction
Intervention - give drug w/ food or 8oz water
client education - change positions gradually, take w/food

acetylcyseine (mucolytic)

ADRs - GI distress and bronchospasms
interventions - monitor respiratory status and keep suction available
client education - report difficulty breathing, worsening cough, drink 2,000+ mL water daily

amoxicillin (penicillin)

ADRs - GI upset, allergic reaction, superinfection (candida)
interventions - monitor GI, bloody/watery stools, monitor for allergic reactions or candida infections
client education - report bloody, watery stool, mouth pain, vaginal burning, take w/ meals

cephalexin (cephalosporin)

ADRs - Gi upset, cross allergy with PCN, thrombophlebitis, hemorrhage
interventions - monitor for bloody/watery stools, diarrhea, assess for allergy, prothrombin, thrombophlebitis, BUN/ creatinine
client education - take w/ food, report watery/bloody stools, unusual bleeding, burning, pain, or swelling at IV site

Aztreonam (monobactam)

ADRs - thrombophlebitis, abdominal distress, rash and chest pain
interventions - monitor site for redness, swelling, pain, assess bowel function, and anaphylaxis
client education - report pain, swelling, and redness at the IV

imipenem (carbapenem)

ADRs - GI upset, thrombophlebitis, superinfx, possible cross allergy
interventions - monitor for nausea, redness/swelling at IV, assess for allergy, test BUN, AST, creatinine
client education - report nausea, pain, swelling at IV, report all drugs to provider, mouth pain, vaginal irritation

vancomycin

ADRs - nephrotoxicity, red man syndrome, ototoxicity, thrombophlebitis, hypotension
interventions - monitor vital signs, trough levels, BUN/creatinine
client education - report flushing, feelings of faintness, tinnitus, increase/decrease in urine output

tetracyclines

ADRs - GI upset, hepatotoxicity, photosensitivity, superinfections
interventions - monitor and report GI, pregnancy before, liver function tests, skin reaction
client education - take w/ non-diary, report pregnancy, jaundice, abdominal pain, watery/bloody stools

erythromycin (macrolide)

ADRs - GI upset, serious ventricular dysrhythmias, ototoxicity, superinfx
interventions - monitor and report GI, question prolonged QT interval, monitor liver function, and ototoxicity
client education - take w/ food, report palpitations, fainting spells, hearing loss, bloody/watery stool, mouth pain

gentamicin (aminoglycoside)

ADRs - increased trough levels can cause ototoxicity and nephrotoxicity
interventions - monitor for tinnitus, peak and trough, BUN/ creatinine, urine for protein casts, and I&O
client education - report onset of tinnitus, headache, hearing loss, an increase of output of dilute urine

ciprofloxacin (fluoroquinolone)

ADRs - mild CNS symptoms, GI upset, photosensitivity, Achilles tendon rupture, seizure, suicide, hepatotoxicity
interventions - monitor and report GI upset, do not let pt. go out in the sun w/o covering their skin
client education - decrease caffeine intake, report CNS and GI s/s, avoid sunlight exposure, increase fluid intake

Trimethoprim/Sulfamethoxazole (sulfonamide)

ADRs - GI upset, allergic skin reaction, superinfx, SJS, blood cell deficiencies
interventions - monitor and report rash, diarrhea, encourage fluids, monitor I&O, CBC, and urinalysis
client education - take w/ food, report rash, hives, pallor, watery/bloody stool, diarrhea, pain in the mouth, increase fluids

nitrofurantoin (urinary tract antiseptic)

ADRs - GI upset, chills/fever, SOB, permanent neuropathy, blood cell deficiency, brown urine, photosensitivity
interventions - monitor and report GI, respiratory, nephropathy symptoms, I&O, and bowel function
client education - take w/ milk or food, report dyspnea, fever, cough, numbness, fatigue, rinse mouth after suspension

metronidazole (antiprotozoal)

ADRs - GI upset, darkening of urine, CNS, dry mouth
interventions - monitor and report GI and CNS symptoms
client education - take b4 or w/ a meal, report GI and CNS symptoms, avoid alcohol, metallic taste

chloroquine (anitmalarial)

ADRs - visual symptoms, GI upset, headaches
interventions - monitor and report visual and GI symptoms
client education - wear sunglasses, report vision changes, take b4 or w/ meal

amphotericin B (polyene antibiotic)

ADRs - infusion reaction, renal toxicity, hypokalemia, RBC suppression
interventions - admin tylenol or benadryl before the drug, monitor vitals, BUN, creatinine, blood potassium, I&O, and weight
client education - be aware of infusion rates, comply with lab testing, report increase in fatigue

ketoconazole (azole)

ADRs - liver toxicity, GI upset, topical use (burning, itching, redness, hypersensitivity)
Interventions - monitor liver tests, report severe GI symptoms, and CNS
client education - report abdominal pain, jaundice, take w/ food, do not take antacids

acyclovir (purine analog)

ADRs - topical (burning, itching) oral (GI, headache, vertigo), IV (renal toxicity/ CNS toxicity)
interventions - monitor for severe skin reactions, CNS, BUN, creatinine, infuse IV slowly
client education - avoid scratching, at application site, take w/ food, report restlessness, tremors, burning, pain

Vaccines (Birth to 6 years)

hepatitis A + B, rotavirus, DTaP, Hib, MMR, polio, varicella

Vaccines (7-18 yrs)

booster TDaP, HPV, meningococcal, flu

Vaccines (Adults/Older adults)

flu, TD, pneumococcal, herpes zoster, varicella, hepatitis A/B, MMR

methotrexate (folic acid analog)

bone marrow suppression which leads to low neutrophils, neutropenic precautions

cytarabine (pyrimidine analog)

Nadir (following chemo when WBC+ platelets are lowest) when to look for s/s

mercaptopurine (purine analog)

admin of antiemetics to prevent severe emesis and nausea

cyclophosphamide (nitrogen mustard)

alopecia -> review mental status and self-esteem of patient

carmustine (nitrosourea)

teratogenic which can cause cancer, malformations, or death to the fetus

cisplatin (platinum compound)

increase hydration to 1/2 L before therapy and monitor I&O

Doxorubicin (anthracycline)

overgrowth of candida/yeast, monitor for s/s of thrush

vincristine (vinca alkaloid)

constipation in children which can lead to paralytic ileus (impaction)

paclitaxel (taxane)

monitor neutrophil count prior to administration

topotecan (topoisomerase inhibitor)

monitor platelet count, avoid needles and excessive pressure when taking BP, monitor LOC which can indicate a cranial bleed

flutamide (androgen receptor antagonist)

give drug with GRH to stop testosterone production

tamoxifen (estrogen receptor antagonist)

increased risk for endometrial cancer

anastrozole (aromatase inhibitor)

check familial history for osteoporosis

trastuzumab (monoclonal antibody)

HF effects on the ventricles of the heart and increased urination at night (nocturia)

alfa 2a + beta - 1b (interferon)

ensure pharmacy sends the RIGHT drug

imantinib (targeted antineoplastic drug)

fluid retention monitoring (pulmonary edema and ascities)

aspirin+ibuprofen(COX-1+COX-2 Inhibitor)

ADRs - Reyes syndrome+salicylism (aspirin), GI upset, renal dysfunction
interventions - monitor BUN+creatnine and I&O
client education - report persistent gastric irritation, prolonged bleeding, weight gain, buzzing in ears, SOB

celecoxib (selective Cox-2 inhibitor)

ADRs- GI upset, MI, CVA, and thromboembolic events
interventions- monitor for gastric upset, I&O, rapid rise in BUN+creatnine, signs of MI
client education- avoid alcohol, persistent gastric upset, changes in I&O, chest pain

acetaminophen (nonopioid analgesic)

ADRs- liver toxicity/damage and hypertension
interventions- monitor for symptoms of an overdose and prepare to administer acetylcysteine if overdose occurs.
client education- limit intake to 4g a day, report any nausea or other GI discomfort, do not take many other OTC drugs while taking ace.

tramadol (centrally acting nonopioid)

ADRs- sedation, GI upset, respiratory depression, urinary retention
interventions - give w/food, monitor respirations and urinary retention
client education - increase fiber intake, change positions slowly

morphine (opioid agonist)

ADRs- respiratory depression, ortho hypotension, urinary retention
interventions- monitor VS, respiratory status, I&O
client interaction - PRN, increase fiber+fluid intake, report inability to urinate

butorphanol / pentazocine (opioid agonist-antagonist)

ADRs- sedation, resp. depression, increases cardiac workload
interventions- VS + resp. status, DO NOT give to pt. w/ MI
client education - PRN, lie down when nausea, do not use for angina or use opioids

naloxone (opioid antagonist)

ADRs- ventricular arrhythmias and abstinence syndrome
interventions - monitor VS and EKG, have oxygen and emerg. equipment ready

allopurinol (antihyperuricemic)

ADRs- cataracts, metallic taste, hypersensitivity syndrome, GI upset
interventions - monitor CBC, uric acid, ophthalmic exams, give after meals
client education - report rash, swelling, take w/ food, blurred vision, 3L/day hydration

prednisone (glucocorticoid)

ADRs - adrenal suppression , hyperglycemia, myopathy, cushing's, osteoporosis
interventions - monitor BG, I&O, ophthalmic exams
client education - report increased stress, s/s of infection, weight gain, and increase weight bearing exercise

methotrexate (nonbiologic DMARD)

ADRs- bone marrow suppression, pulmonary fibrosis, hepatotoxicity, GI upset
interventions - monitor CBC, liver function+tests, s/s of infection
client education - report ab bleeding, s/s of infection, avoid alcohol, 2L/day

etanercept (biologic DMARD)

ADRs- psoriasis, pancytopenia, HF, SJS, pharyngitis
interventions - assess for infection, s/s of HF, TB test prior to admin
client education - report s/s of infection, s/s of HF, SOB

raloxifene (SERM)

ADRs - thromboembolic events, stroke, vasomotor symptoms
interventions - monitor bone density and s/s of thromboembolism
client education - report calf pain or SOB, NO estrogen replace therapy, increase calcium, vitamin D, and weight bearing activity

alendronate (bisphosphonate)

ADRs - GI upset, esophagitis, muscle+joint pain, eye pain/vision changes
interventions - take w/ 8oz water, sit upright 30 min after admin, avoid calcium supplements, monitor for visions changes
client education - avoid eating or drinking anything besides water 30 min after, report changes in swallowing or vision

calcitonin-salmon (calcitonin)

ADRs- nasal dryness, hypersensitivity, hypocalcemia
intervention - monitor Ca, intradermal allergy test prior to therapy, diet high in calcium
client education - report rash, itching, swelling, muscle spasms, monitor for loss of bone density

calcium citrate (calcium supplements)

ADRs- hypercalcemia, GI upset, kidney stones
interventions - monitor serum Ca, I&O, decreased gastric mobility
client education - teach signs of hypercalcemia, 1 hr b4 or 1-2 after other meds, 1hr after meal w/ 8oz water, do not exceed 600mg, high fiber diet

cimetidine (histamine antagonist)

ADRs - impotence, aplastic anemia, pneumonia, arrhythmias
interventions - monitor older clients for confusion
client education - take meds as prescribed, avoid smoking, report signs of GI bleeding

omeprazole (proton pump inhibitor)

ADRs- osteoporosis, headache, GI upset, hypomagnesemia, C. Diff
interventions- monitor mag level, bone density, lowest dose/shortest duration
client education - weight-bearing exercise, increase calcium, vitamin D, clear fluids

sucralfate (mucosal protectant)

ADRS - constipation
interventions - monitor bowel function, stool softener if needed - empty stomach admin 1 hr prior, avoid meds 2 hr before/after admin
client education - increase fiber, fluids, exercise, report any signs of GI bleeding

aluminum hydroxide (antacid)

ADRs - constipation (Al/Ca) diarrhea (mag), hypophosphatemia
interventions - monitor bowel function, take w/ glass of water, monitor mag and phos levels
client education - DO NOT take w/in 1-2 hrs of other meds, increase fiber, fluids, exercise, report GI bleed, pain, dirrhea

misoprostol (prostaglandin-E analog)

ADRs - dysmenorrhea, uterine cramping, miscarriage, ab pain
interventions - give w/ meals, monitor for severe bleeding, ab pain, diarrhea
client education - report worsening diarrhea, plenty of clear fluids, report menstrual changes

ondansetron (serotonin antagonist)

ADRs- serotonin syndrome, SJS, CNS symptoms
interventions - by mouth or IV, monitor for persistent headache/dizziness, severe diarrhea,
client education - report headache, dizziness, diarrhea, plenty of fluids

dimenhydrinate (antihistamine)

ADRs - sedation, dry mouth, anticholinergic symp
intervention - monitor when ambulating, bowel elimin patterns, VS, 30-60 min b4 activity
client education - increase fluid, fiber, activity, urinate every 4 hrs