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Common Indications for Medications:

• Infection (with penicillin allergy): Alternatives such as azithromycin or clindamycin are necessary to avoid allergic reactions while effectively treating the infection.

• Urinary incontinence: Medications such as anticholinergics or beta-3 agonists can help manage symptoms by reducing urgency and frequency.

• Menopausal manifestations: Hormone replacement therapy, including estrogen and progesterone options, may be indicated to alleviate symptoms such as hot flashes and night sweats, tailored on an individual basis.

• GERD: Proton pump inhibitors (e.g., omeprazole) or H2 receptor antagonists (e.g., ranitidine) are common choices for reducing stomach acidity and managing symptoms of gastroesophageal reflux disease.

• Allergic reactions: Antihistamines (e.g., diphenhydramine) and corticosteroids (e.g., prednisone) are used to relieve symptoms, while pre-treatment with antihistamines can improve outcomes during desensitization protocols.

• Erectile dysfunction: PDE5 inhibitors (e.g., sildenafil, tadalafil) are often prescribed, requiring evaluation of cardiovascular health prior to initiation.

• Vitamin D deficiency: Supplementation with Vitamin D2 or D3 is recommended, with doses adjusted based on serum vitamin D levels and individual absorption capabilities.

• Bipolar disorder: Mood stabilizers (e.g., lithium) or atypical antipsychotics (e.g., quetiapine) may be prescribed to stabilize mood and prevent episodes of mania or depression.

• Chronic Obstructive Pulmonary Disease (COPD): Bronchodilators (e.g., albuterol) and inhaled corticosteroids are crucial in managing exacerbations and maintaining respiratory function.

• Depression: Antidepressants, including SSRIs (e.g., sertraline) and SNRIs, are prescribed based on the patient’s symptom profile, potential side effects, and individual response to previous treatments.

• Herpes Zoster: Antiviral agents such as acyclovir are used to reduce the duration and severity of symptoms, especially if started within 72 hours of rash onset.

• Seasonal allergies: Antihistamines (e.g., loratadine) and nasal steroids (e.g., fluticasone) are commonly used to relieve symptoms such as sneezing, runny nose, and itchy eyes.

Medication Math Tips:

• Fill-in-the-Blank Format:

  • Avoid entering labels in answers as they will be provided in questions, focusing solely on numerical responses.

  • Follow specific rounding instructions provided in the exam (e.g., round to the nearest tenth), noting how it may affect total calculations.

• Verification:

  • Always double-check your answers to ensure accuracy, especially in calculations involving dosages, to prevent medication errors.

• Conversions to Know:

  • 1 ext{ mg} = 1000 ext{ mcg}

  • 1 ext{ mg} = 0.001 ext{ g}

  • To convert pounds to kilograms: ext{weight in kg} = \frac{\text{weight in lbs}}{2.20462}

• Practice Resources:

  • Utilize online platforms like ATI and Google to find pharmacological math practice questions and quizzes for better understanding and system familiarity.

Vancomycin IV Therapy Considerations:

• Lab Values to Monitor for Dosage Adjustments:

  • Serum Trough Level: Low trough levels (below therapeutic range) indicate a potential need to increase dosage for effective treatment.

  • Peak Level: High peak levels may suggest a need to reduce dosage to prevent toxicity.

  • Note that white blood count values are not indicative of antibiotic dosage changes but rather general infection response.

Interventions for IV Complications:

• For Infiltration: Use a warm compress and elevate the affected site to ease discomfort and reduce swelling.

• For Catheter Embolus: Apply a tourniquet above the catheter site, maintaining circulation while seeking immediate medical help.

• For Extravasation: Aspirate the drug if possible to minimize tissue damage and consult with a healthcare provider for further actions.

• For Hematoma: Assess for high blood pressure and treat accordingly to prevent worsening of the hematoma.

• For Phlebitis: Apply a warm compress to reduce inflammation and pain at the IV site.

Central Line Care:

• Technique: Sterile technique is essential during insertion to prevent infections; complications may arise from improper insertion.

• Potential Complications:

  • Air embolism and pneumothorax: Immediate assessment and intervention are crucial following any signs of respiratory distress or hemodynamic instability.

  • Dwell complications: include occlusion, infection, and bleeding, with regular monitoring essential to catch issues early.

Total Parenteral Nutrition (TPN):

• Solution Type: TPN is a hypertonic solution designed for providing essential nutrients intravenously.

• Administration Method: Delivered via PICC line, central line, or NG tube, requiring skilled nursing management for safety.

• Preparation: Must be prepared daily with sterile technique to avoid contamination.

• Infusion Management:

  • If TPN is not available, infuse lactated Ringer's or normal saline as an interim measure to prevent hypoglycemia, ensuring that blood glucose levels are monitored.

  • Blood Glucose Monitoring: Checked every 4-6 hours upon initiation and adjusted based on results, especially in patients with diabetes.

  • New TPN bags are hung every 24 hours along with a new filter each time to maintain integrity and prevent complications.

Pharmacology of Antihypertensive Medications:

• Classes to Learn:

  • ACE Inhibitors: End in -pril (e.g., lisinopril) used to lower blood pressure by preventing the conversion of angiotensin I to angiotensin II.

  • Beta Blockers: End in -olol (e.g., metoprolol), reduce heart rate and cardiac output, popular in managing hypertension and heart failure.

  • Calcium Channel Blockers: End in -pine (e.g., amlodipine) with exceptions such as verapamil and diltiazem that affect heart rate and vascular tone.

  • Diuretics:

  • Thiazides: e.g., hydrochlorothiazide, with common side effects including hyponatremia and hyperglycemia; monitor electrolytes regularly.

  • Potassium-Sparing Diuretics: e.g., spironolactone which can cause hyperkalemia; utilize cautiously in renal impairment.

• Adverse Effects:

  • Common side effects across diuretics include dehydration and electrolyte imbalances; patients should be educated about monitoring signs of these issues.

Antidepressants and Antipsychotics:

• Types of Antidepressants:

  • Tricyclics: e.g., amitriptyline; monitor for side effects such as confusion and tremors, particularly in the elderly.

• Antipsychotic Medications:

  • Typical antipsychotics: e.g., haloperidol carry risks for sedation and extrapyramidal symptoms (EPS); educating patients on these potential side effects is crucial.

  • Atypical antipsychotics: e.g., olanzapine are associated with weight gain and metabolic syndrome; regular monitoring of weight and metabolic panels is recommended.

Parkinson's Disease Pharmacology:

• Goal of Therapy: Increase dopamine levels to alleviate tremors and improve mobility; therapy should be individualized based on symptom severity.

• Medications:

  • Levodopa/Carbidopa: Administer with food to enhance absorption and limit protein intake during meals.

• Side Effects to Monitor:

  • Include dyskinesias, orthostatic hypotension, and cardiovascular issues; regular follow-up is key to adjust treatment as necessary.

Patient Education:

• Instructions for Medications: Educate patients on timing and dietary restrictions when taking certain medications to prevent complications and ensure maximum therapeutic effect.

• Monitoring Needs: Regular follow-up for side effects is vital, especially with IV medications and long-term treatments to ensure patient safety and medication efficacy.