NR293 Final Exam Review.
- Indications:
• Treatment of mania in BPD and prevention of episodes
• Potentiates serotonergic neurotransmission
•
... [Show More] Lithium ions alter sodium ions shift in catecholamine metabolism
- Do NOT adjust sodium levels while taking; ensure adequate sodium intake
- Avoid overhydration and dehydration
- Narrow therapeutic range
- Mania is caused by low serotonin
- Adverse Effects:
• Most SERIOUS = cardiac dysrhythmias
• Drowsiness
• Slurred speech
• Epilepsy seizures
• Choreoathetotic movements
• Ataxia
• Hypotension
• LONG TERM TREATMENT = HYPOTHYROIDISM
• GI discomfort
• Possible death
- Contraindications:
• Dehydration
• Sodium imbalance
• Major renal/CVD
• Renal dysfxn of any level can increase lithium levels
- Interactions:
• Thiazide diuretics
• Angiotensin-converting enzymes
4. Diazepam
- Long acting
- Indications:
• Anti-anxiety
• Muscle depressant
• Antiepileptic
• Anticonvulsant therapy
• Procedural sedation
5. Methotrexate *know everything*
- Class: Folate antagonist
- Indications:
• Solid tumors: breast, head and neck, lung cancers
• Acute lymphocytic leukemia
• Non-Hodgkins lymphoma
• RA
• Psoriasis
NR293 Final Exam Review.
- Inhibits lymphocyte multiplication
- Adverse Effects:
• Bone marrow suppression use “rescue drug” leucovorin to provide the
body w/ folic acid to prevent the death of normal cells
- IV/PO
- Interactions: displacement of MTX from protein-binding sites, enhancing its
toxicity
• Salicylates (aspirin, peptobismol)
• Sulfonamides
• Sulfonylureas
• Phenytoin
• Penicillins
• NSAIDs
- Pregnancy category D
- Contraindications:
• Hypersensitivity
• Alcoholism/hepatic impairment
• Immunosuppression
• Pregnancy/lactation
• Neonates
6. Vancomycin
- MRSA and other gram +
- Must monitor blood levels to ensure therapeutic levels and prevent toxicity; narrow
therapeutic index
- Adverse Effects:
• Red man syndrome (adverse effects): ***
a. Flushing or itching of head neck, face, upper trunk
b. Antihistamine may be ordered to reduce these effects
c. Infused too rapidly hypotension
• Nephrotoxicity
• Ototoxicity
- Should be infused over 60 mins
- Additive neuromuscular blocking
- Glycopeptide calss
- Not active against gram neg, fungi, yeast
- PO- C. diff and staph enterocolitis
- IV- bone and joint infections, bacterial bloodstream infections caused by staph
- Contraindications:
• Hypersensitivity
• Renal dysfxn
• Hearing loss
• Older adults
• Neonates
NR293 Final Exam Review.
- Carefully measure peak and trough
- IV
7. Viruses
8. Aminoglycosides
- Natural and semisynthetic
- Made from streptomyces
- Poor oral absorption: IV/IM only
- Very potent w/ serious toxicities
- Bactericidal; prevent protein syn
- Gram – bacteria; some gram +
- Gentamicin
• Adverse effects- nephrotoxicity
• Contraindications- allergy, preg category C-D. pregnant/breastfeeding, acute
renal failure
• Interactions- other nephrotoxic drugs, cyclosporin, amphotericin B,
Warfarin, Vancomycin
• IV/IM
• Gram + and gram –
• IV- peak @ 30 min; ½ life = 2-3 hr; duration = 24 hr
• IM- peak @ 30-90 min; ½ life = 2-3 hr; duration = 24 hr
- Neomycin (Neo-fradin):
• PO for gut infections or via enema; sterilizing the colon
• used to treat hepatic encephalopathy
• topical application for skin infections, bladder irrigation, treatment of e. coli
diarrhea, hepatic encephalopathy and eye infections
• tablet, solutions, powders
• peak @ 1-4 hr
• ½ life = 3 hours
• Duration = up to 24 hr
- Tobramycin (TOBI)
- Amikacin
- Flagyl- do not take w/ alcohol disulfiram effect (extreme vomiting)
- Peak is too high = don’t give; hold med; ask prescriber
- Trough is too low = give
- Indications:
• Pseudomonas, E. Coli, proteus, klebsiella, serratia
• Combo w/ other antibiotics for synergistic effect (beta lactams/vancomycin)
• Certain gram – infections that are resistant
- Adverse effects:
• Nephrotoxicity (renal damage) check BUN and creatinine
• Ototoxicity (auditory impairment) 8th cranial nerve
• Headache
NR293 Final Exam Review.
• Paresthesia
• Fever
• Superinfections
• Vertigo fall risk
• Skin rash
• Dizziness
- Therapeutic drug monitoring:
• Serum levels measured- peak and trough
• Serum levels need to be @ least 8x higher than MIC
• Time dependent killing
• Concentration dependent killing
• Peak- highest drug levels for once daily regimens
• Trough- lowest to ensure adequate renal clearance and avoid toxicity
• Post antibiotic effects
• Resistance
• Drug interxns
- Minimum inhibitory concentration- lowest concen of a drug needed to kill a certain
standardized amount of a bacteria
9. Urine and urine culture process
- Wait until cultures are back before prescribing antibiotics
10. Medical negligence/nonmaleficence
11. Opioids
Codeine Sulfate
- Mild agonist
- Schedule II high abuse potential
- Natural opiate
- Ceiling effect
- Pregnancy category D
- Indications:
• Antitussive
• Mild to moderate pain codeine + acetaminophen (schedule III)
- Adverse Effects:
• GI upset
- Contraindications:
• Pediatric patients
- PO
Fentanyl
- Synthetic agonist; very potent
- Schedule II high abuse potential
- Pregnancy category D
- Indications:
• Moderate to severe pain
• Sedation in ICU areas and mechanical ventilation
NR293 Final Exam Review.
• Patch cancer pain and chronic pain syndromes; best for non-escalating
pain; opioid tolerant patients; NOT FOR ACUTE OR POST-OP PAIN
- PO/IV/Transdermal
- Buccally absorbed through mucosa
- 0.1 mg Fentanyl = 10 mg morphine
- Patch- 6-12 hours to reach steady-state pain control after 1st patch applied;
adequate pain control for 72 hours; 17 hours for 50% of fentanyl to be eliminated
- Unused patches flushed down toilet
- Keep patch away from high heat diffuse in skin faster
Hydromorphone (Dilaudid)
- Opioid agonist
- Schedule II
- 7x more potent than morphine
- Exalgo osmotic extended release oral delivery system of hydromorphone;
difficult to crus or extract for injection to help reduce abuse potential
- IV
- Rapid onset
- Pregnancy category D
Meperidine Hydrochloride (Demerol)
- Not recommended for long term use b/c of accumulation of a neurotoxic
metabolite normeperidine which causes ***seizures***
- Strong agonist
- Synthetic
- Schedule II
- Pregnancy category D
- Contraindications:
• Older adults
• Patients who require long term analgesia
• Kidney dysfxn
- Not recommender for long term treatment
- Indications:
• ER acute migraine headaches; immediate post-op period to reduce
shivering
- IM
Methadone Hydrochloride (Dolophine)
- Synthetic
- Schedule II
- Indications:
• Detox for heroine addicts in methadone maintenance programs
• Chronic and cancer pain
- Strong agonist
- Readily absorbed through the GI tract
- ½ life longer than duration b/c bound to tissues of liver, kidneys, and brain
NR293 Final Exam Review.
- Eliminated through the liver safer for patients who have renal impairment
- Adverse effects:
• Cardiac dysrhythmias
- PO/IV
- Pregnancy category D
Morphine Sulfate
- Natural alkaloid
- Prototype for all opioid drugs
- Schedule II
- Indications:
• Severe pain
- Adverse effects:
• Respiratory depression
• Itching
- PO/IV/Rectal
- Extended release forms MS Contin and Kadian
- Potentially toxic metabolite morphine-6-glucuronide (likely to accumulate in
patients w/ renal impairment)
- IV
- Pregnancy category D Naloxone
Hydrochloride (Narcan)
- Pure opioid antagonist
- Blocking drug for opioid drugs
- Does not produce analgesia or respiratory depression
- Indications:
• Drug of choice reversal of opioid induced respiratory depression
• Acute opioid OD
• Post-op anesthesia reversal
- Adverse effects:
• Opioid withdrawal syndrome over-reversal in opioid tolerant pt
- Contraindications:
• Hypersensitivity
- IV
12. Pharmacokinetics- excretion/metabolism
- What happens to a drug from the time it is put into the body until the parent
drug and all metabolites have left the body
NR293 Final Exam Review.
13. Leucovorin
- Rescue drug for methotrexate
- Indications provide the body w/ folic acid to prevent the death of normal cells
14. Side effects of anti-neoplastic drugs
- Bone marrow suppression
- Alopecia
- Nausea
- Vomiting
- Infertility
15. Fosamax- osteoporosis
• Sit up for 30 mins after taking
16. Latanoprost
• Prostaglandin agonist
• Reduces ICP by reducing outflow of aqueous fluid
• Single daily dosing
• Can change eye color to permanently brown even if med is stopped
17. Eyedrops are antibiotics/anticholinergics- know uses
18. Mydriatics dilate pupils
19. Mitotics constrict pupil
20. Cycloplegics dilate, dry up, paralysis
21. Depo-provera breakthrough bleeding
22. Doxazosin
Part 1
1. Review primary, secondary hypothyroidism and the causes.
- Primary- stems from an abnormality in the thyroid gland; thyroid gland is not
able to release thyroid hormones; most common
- Secondary- reduced secretion of TSH
2. Review the hyperthyroid med PTU propylthiouracil indications, mech of action
PTU
NR293 Final Exam Review.
- Indications too much thyroid (hyperthyroidism)
- Preg cat D
- Therapy needed for 2 weeks before symptoms improve
- Adverse effects:
• Agranulocytosis
• Decreased urine output; smoky urine
• Rash; pruritus
• Increased BUN and creatinine levels
• Enlarged thyroid
• Drowsiness
• Headache
• Nausea/vomiting
- MoA:
• Inhibit incorporation of iodine molecules into tyrosine
• These drugs impede the formation of thyroid hormone
• Inhibit the conversion of T4 to T3 in the peripheral circulation
• Neither drug can inactivate already existing thyroid hormone
3. Review in depth about warfarin and heparin including lab tests and antidote associated
with each
Heparin
- Inhibit clotting factors
- Antidote protamine sulfate
- Lab tests:
• Unfractionated PPT must be done; give bolus to jump start
• LMWH no labs needed
Warfarin
- Inhibit vitamin K synthesis
- Antidote vitamin K
4. Review indications for aminophylline
- Prodrug of theophylline
- Indications pt w/ status asthmaticus who have not responded to epi
- Metabolized in the liver; use w/ caution in pt w/ liver impairment
5. Review adverse effects of xanthine drugs used for respiratory diseases
- Nausea/vomiting
- Anorexia
- Sinus tachycardia
- Extrasystole
- Palpitations
- Ventricular dysrhythmias
- Transient increased urination
- Hyperglycemia
- OD activated charco [Show Less]