Pharm

 

Chapter 26 - Narcotics, Narcotic Antagonists, and Antimigraine agents 

  • Identify effectiveness of Naloxone 

    • Increased respirations 

  • Identify why a patient may need higher doses of opioids after extended use 

    • Pts can develop a tolerance to the medication 

  • Discuss the use of the different classes of opioid agonists, opioid antagonists, and antimigraine agents Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with opioids and antimigraine agents. 

    • Scheduled 2 narcotics – Meperidine, Morphine, Hydromorphone 

    • Transdermal opioid – Fentanyl 

    • Narcotic antagonists – Naloxone 

 

  • Meperidine 

    • Therapeutic actions: primarily used after GI surgeries d/t less constipation and urinary retention 

    • Indications 

    • Pharmacokinetics 

    • Adverse reactions 

    • Drug-drug interactions 

     

  •  Morphine 

    • Therapeutic actions: reduces feelings of pain by interrupting the way nerves signal pain between the brain and the body  

    • Indications 

    • Pharmacokinetics 

    • Adverse reactions 

    • Drug-drug interactions 

 

  • Hydromorphone 

    • Therapeutic actions: more potent than morphine with less sedation and GI effects 

    • Indications 

    • Pharmacokinetics: faster onset, shorter duration 

    • Adverse reactions 

    • Drug-drug interactions 

 

  • Fentanyl 

    • Therapeutic actions: used for constant chronic pain control 

    • Indications 

    • Pharmacokinetics 

    • Adverse reactions 

    • Drug-drug interactions 

 

  • Naloxone (Narcan) 

    • Therapeutic actions: reverse effects of opiates – reverses respiratory depression, hypotension 

    • Indications 

    • Pharmacokinetics 

    • Adverse reactions: dysrhythmia, sweating, tremors 

    • Drug-drug interactions 

 

  • Opioids Contradiction in pts with: 

    • Head injury 

    • Respiratory disorder 

    • Shock/low bp 

 

  • Migraine and cluster headaches are treated with - Propranolol 

  • Anticonvulsants: Valproic acid and gabapentin – slow neuron firing (makes neurons less sensitive) 

  • Sumatriptan – selective serotonin receptor agonist, works on serotonin receptor to balance serotonin levels 

 

 

 

 

Chapter 8 & 9 – Antibiotics 

Antibiotics grouped into 2 types: 

Bacteriostatic drugs---inhibit further bacteria growth 

Bactericidal drugs—kill the bacteria 

  • Identify lab tests needed prior to an antibiotic being ordered 

    • Culture and sensitivity  

    • Peak – 30 mins after med administration 

    • Trough – right before next scheduled dose  

  • Describe the mechanism of a bacteriostatic antibiotic 

    • inhibit further bacteria growth 

  • Describe components of a teaching plan for a patient taking tetracycline 

    • give on an empty stomach—1 hour before or 2 hours after meals,  good oral hygiene due to the discoloration,  teach to avoid milk, antacids d/t decreased effectiveness, stay out of sun and wear sunglasses d/t photophobia 

  • Identify medications that should not be given with a PCN ALLERGY 

    • Amoxicillin, ampicillin, penicillin 

  • Antibiotics Affecting the Bacterial Cell Wall: Assessing IV Vancomycin Site 

    •  

  • Antibiotics Affecting Protein Synthesis: Adverse Effects of Erythromycin 

    • Ototoxicity (pt. Reports difficulty hearing) 

    • Hepatotoxicity ( 

    • Superinfection 

 

Chapter 10 – antiviral agents & 11 – antifungal agents  

  • Antifungals - "azoles" 

  • Identify information to include when teaching a patient about itraconazole 

    • take with food to reduce gastric distress 

    • Take with 8 ounces of acidic liquid like cola or orange juice to increase absorption 

    • Can cause drowsiness 

 

 

IV calculation: 

 

X mL/hr 

 

Pump – round to nearest tenth 

Drop rate round to nearest whole number  

 

Important to know! 

Antidotes  

Heparin – protamine sulfate  

Warfarin – vitamin K 

Opioids – Narcan 

Benzos – flumazenil 

 

 

 

Peek – high, after meds 

Trough – low dose   

 

S/S  

Hypoglycemia - Cold and calmy give them some candy 

Hyperglycemia – high and dry