NUR2474 NUR 2474 Pharmacology Final Exam Review
Estrogen therapy in postmenopausal women
Women take due to vaginal dryness, hot flashes, painful sex,
... [Show More] prevent bone loss when older
Risks associated with hormonal replacement therapy
Breast and cancer development, risk of blood clots, bone loss, risk of fractures, cardiovascular disease
Penicillin and aminoglycosides interaction
Pencillin may react with aminoglycosides and cause it to be less effective in treating infection. Do NOT combine these antibiotics in same IV solution
Side effects of steroids
SHORT TERM
o Insomnia
o Mood alterations or Psychosis
o GI upset
o Increased appetite/weight gain
o Fluid retention
o Hyperglycemia
o Hypokalemia
LONG TERM
o Hyperglycemia
o Osteoporosis
o Thin skin, easy bruising, poor wound healing
o Rare: HTN, PUD, AVN, Allergic reaction
o Adrenal suppression if > 4 courses/year
TMP-SMZ
Trimethoprim/sulfamethoxazole
combination drug
-treat a variety of bacterial infections
-UTIs, ear infections, pneumonia
How to protect kidneys
Drink lots of water
When to take diuretics
In the morning
Diuretics Side Effects
Increased urination, dehydration, increased thirst, weakness, and impotence.
Antacids
Neutralize the acids in the stomach
affect acid level, have a lot of interaction so need to take a few hours apart from other meds
Cimetidine
Type of antihistamine that blocks the release of stomach acid.
Used to treat stomach or intestinal ulcers
can relieve ulcer pain and discomfort and heartburn from acid reflux
Naloxone (Narcan)
Opiate antagonist (antidote), reverses opioid induced resiratory depression
Signs of overdose
Slow breathing, blue lips and finger tips, cold damp skin, shaking, vomiting and gurgling noises
Education with anti-effectives (antibiotic, antifungal)
Make sure patient goes through whole course of treatment, go beyond "feeling better", still continue taking at least a week to get it all out
Antibiotics and C. diff
C-diff often happens after another infection. New onset diarrhea.
What antibiotics can be given with CDIFF
Vancomycin and metronidazole (flagyl)
Warfarin
Anticoagulant works later and takes longer to work, better for long-term use, PT/INR levels, hematocrit, hemoglobin
Warfarin antidote
Vitamin K
INR (therapeutic)
2-3 seconds
PT (therapeutic)
16-31 seconds
Heparin
Indication for DVT, short,rapid response and this med is first choice treatmentenhances antithrombin, rapid-acting anticoagulant, aPTT level
APTT therapeutic range
60-80 seconds
Heparin antidote
Protamine sulfate
Long term steroid use
Delayed wound healing, impaired immune system, osteroporosis
Nitroglycerin and pde5 inhibitors (erectyle dysfunction drugs)
DO NOT TAKE TOGETHER
Glipizide
Oral diabetic medicine for type 2 diabetes
Alcohol and glipizide
AVOID, do not drink alcohol with this medication
Glipizide adverse effects
HYPOGLYCEMIA, weight gain - hepatotoxicity, rash; avoid in pregnancy (esp near term) and lactation
Antiviral therapy for herpes viruses
Acyclovir is the antiviral most commonly used to treat HSV infections. "vir", many ppl who take antiviral drugs daily have no outbreaks
Pregnancy and herpes
Give ACYCLOVIR, can be given safely during pregnancy, prevents herpes outbreak and spreading to baby, drink lots of water
What to do if phlebitis/irritation to site occurs
STOP infusion and get a new site/start a new IV
Oxycodone and acetaminophen pt education
Do not overdose on Tylenol, damage liver or cause death, never take in large amounts
Tolerance to medication
The body becomes used to a medication so that it no longer works as well, just because you have a med tolerance doesnt mean you are addicted
Dependence on Medication
When a person stops using a drug, their body goes through symptoms of withdrawal.
Abuse addiction on medication
Addiction is a disease, taking drugs repeatedly and cant stop despite negative consequences
S/S of anaphylactic shock
-Low BP
-Rapid pulse
-Problems c ventilation
-Coughing
-Itching
-Dyspnea
-Decreased consciousness
-Nausea and vomiting
S/s of mild allergic reaction
Hives, rash, itching, scratchy throat, watery itchy eyes
Anaplylactic reaction
Administer epinephrine
Penicillin allergy intervention
Epinephrine, give O2, if give cephalosporins and they are mildly allergic, cautiously observe pt.
Rapid Insulin
Lispro, aspart, glulisine, humalog
Onset: 5-15 minutes•
Peak: 60 minutes•
Duration: 2-4 hours•
Indications: Rapid acting insulins are used prior to meals to correct hyperglycemia•
Route: Given only SQ
Short acting insulin
• Onset: ½ to 1 hour
• Peak: 2 - 4 hours
• Duration: 4 - 6hours
• Used also for coverage in slidingscale as well for emergencycoverage
• Route: Given SQ, IV
• Meds: Regular insulin, Humulin R, Novalin R, Velosulin BR
Intermediate acting insulin
• Onset: 2 - 4 hours
• Peak: 4 - 12 hours
• Duration: 16 - 20 hours
• Route: Administered SQ only; has protein derivative in the product that prolongs the insulin. It is thereforecloudy & must be gently rotated to mix.
• Meds: Humulin N, Iletin NPH. Look forN or NPH on the label
Long lasting insulin
Onset: 1 hour
• No Peak as this agent is sustained over24 hours
• Duration: 24 hours
• this agent is clear. Cannot be mixedwith any other insulin. Usually given HS
• Route: only administered SQ
• Meds: Lantus (glargine), Detremir(Levemir), Ultralente
Pre-mixed/ combination insulin
Onset: 15-30 min
Peak: 2-12 hrs
Duration: 14-24 hrs
these are two types of insulin that are pre-mixed in the same container. They always contain regular (short-acting) and intermediate actinginsulin
.• They include: 50/50; 70/30; 75/25• All are cloudy and need rotatingprior to SQ injection (only).
Meds: Humulin 70/30, Novolin 70/30, Novolog 70/30
Beta Blockers SE
LOW HR, bronchospasms, affect asthma
Beta blockers and insulin
be careful, can mask symptoms of HYPOglycemia
Hypoglycemia SE
Confusion
tachycardia
sweating
nausea
hunger
pale skin
what to do if patient develops hypoglycemia
retest sugar level, give simple carbohydrates
Doxazosin
treatment for males with enlarged prostate (BPH)
PO once a day, taken around same time
Doxazosin SE
dizziness, fatigue, orthostatic hypotension, SOB
what medication to have ready for pregnant woman who recieved opioids during delivery?
Naloxone in worst cases, baby will have withdrawals for whatever opioids or drugs mom takes
Lithium therapeutic range
0.6-1.2 mEq/L
Lithium
used for long term maintenance and stabilizes mood fluctuations such as mania and bipolar disorder, can be used with antidepressants
Lithium toxicity level
2 mEq/L
Lithium SE
slurred speech, unsteadiness, Polyuria, fine hand tremors, thirst, dry mouth, increase in motility of GI system
lab values to check for renal function
Albumin/creatinine and GFR
Creatinine- 88/137 mL/min
BUN levels- 7-20 mg/dL
Theophylline
a bronchodilator used to treat asthma and bronchitis and emphysema
Theophylline AE
Cardiac arrhythmias, tachycardia and seizures, vomiting
Theophylline SE
upset stomach, stomach pain, diarrhea, headache, restlessness, difficulty falling asleep or
staying asleep, irritability
Ginkgo biloba
if you have bleeding disorder or preggo, DO NOT take. this should not be given with blood thinners, cause risk of bleeding
bleeding with anticoagulant therapy
blood in pee and poop, severe bruising, prolonged nosebleeds, bleeding gums, vomiting blood, difficulty breathing/chest pain
warfarin and green leafy vegetables
DO NOT TAKE. green leafy veggies are high in vitamin K which is warfarin antidote.
testosterone hormone replacement therapy in males
through skin for tx of low testoterone levels, rub gel into upper arms and shoulders, DO NOT give to women and children the gel
Ibuprofen SE
gastric distress, tinnitus, dizziness, confusion, edema, blood dyscrasias, dysrhythmias, nephrotoxicity
Ibuprofen indications
Mild pain or fever, headache, muscle aches
Ibuprofen common dosing range
300-800mg three times to four times daily, max 3200mg/day
Androgen side effects
Men: decreased spermatogenesis, may exacerbate prostate cancer.
Women: Masculinization, pseudohermaphroditism of fetus of pregnant woman.
Both: Acne, oily skin, decreased HDL, psychological changes, fluid retention/edema, baldness
why you cant quit steroid use cold turkey
for children, can cause growth suppression, cant quit cold turkey bc serious potential for harmful SE and withdrawal- severe fatigue, weakness, body aches
Sucralfate
does NOT affect acid level, just coats stomach lining
when to take sucralfate
BEFORE MEAL
Inhaled Steroids Use
rinse mouth afterwards, spit it out
metformin therapy
- Most common blood sugar med
-An oral medication given to non insulin dependent diabetics to lower blood sugar, also available in combination with other drugs
Metformin MOA
reduces hepatic glucose production
Metformin SE
weight loss, GI upset, rarely lactic acidosis
antihistamine use in pregnancy
be super careful, teratogens to growing baby, contraindicated in 3rd trimester so avoid if you can
Asthma tx in pregnancy
always better to treat than not to, increase chance of stillbirth if not treated
Infant Maturation
-kidney function is the same at 1 year of age, they clear meds as fast as adults.
-children are given the same med as an adult just lower doses based on weight
-liver does not work like adult after birth
newborns and liver maturity
reduce dose to newborns compared to adults since liver is not matured yet until 12yo
Digoxin therapeutic level
0.5-0.8 ng/mL
Digoxin toxicity
low pulse, Confusion, yellow hallos around light. dysrhythmia, anorexia, nausea
Digoxin
used to treat heart failure, helps heart work better and control heart rate.
do NOT administer is apical pulse is less than 60 bpm.
NO GRAPEFRUIT juice with digoxin and verapamil
children and CNS side effects
are more predisposed to CNS SE than adults are in general, due to body system immaturity. [Show Less]