PHARM final

desmopressin (antidiuretic hormone)

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