Final Study guide for final exam Questions with Answers, Exams of Pharmacy

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Final Study guide for final exam Questions with Answers

1. Aspirin (NSAID) patient education Side effects: gastric distress, heartburn, nausea are most common. Take with full glass of water and food to avoid this. Don’t take NSAIDs for extended periods of time. Major Side Effects : gastric bleeding, perforation and ulceration with extended use. Increase blood loss, renal impairment, tinnitus 2. Atenolol (Beta Blocker) nursing considerations Common side effects: bradycardia, hypotension, dizziness, weakness. Monitor pt for these signs. 3. Warfarin nursing implications/patient education/levels/labs Use: anticoagulant, long term prevention of thrombosis. Pt Education: be mindful of vitamin K intake, don’t do hazardous activities, pt is at risk for increased bleeding. Labs and Levels: aPT/INR Normal ratio: 2-3 Antidote: Vitamin K 4. Morphine (Pure opioid agonist) nursing implications Use: analgesia, sedation, euphoria, cough suppression. Adverse Effects: Respiratory depression, constipation, orthostatic hypotension, sedation. Implications: reassess pain after administration, monitor for respiratory depression/hypotension, pupil changes…..ALWAYS have Naloxone (NARCAN) on hand. 5. Medication administration to older adults Reasons for unintentional nonadherence include complex regimens, awkward drug packaging, forgetfulness, side effects, low income, and failure to comprehend instructions. Individualization of therapy for older adults is essential. Each patient must be monitored for desired and adverse responses, and the regimen must be adjusted accordingly. Because the degree of renal impairment among older adults varies, creatinine clearance (a measure of renal function) should be determined for all patients taking drugs that are eliminated primarily by the kidney.

Promote Adherence: simple regimen, trusting relationship, understand needs and goals, large labels, support system, financial support.

6. Methylphenidate (amphetamine like) patient education May cause insomnia, reduced appetite, emotional lability. May cause dizziness, and changes in vision. Do not take if history of heart conditions. 7. Metformin patient education T2DM- lowers blood glucose. Side Effects: GI upset, loss of appetite, weight loss, B12 deficiency, Don’t drink alcohol, don’t take cimetidine- both reduce absorption. 8. Estrogen/progestin patient education/side effects Combinations are used for birth control, estrogen replacement, treat menopause, osteoporosis, and acne. Prevent ovulation and increase estrogen levels. Side Effects: breast tenderness, headache, abdominal discomfort, depression, irregular period, increased risk of breast cancer, at increased risk for blood clots. Education: BC does not prevent STI, if missed one pill take 2 at your next dose, don’t smoke, report any chest pain, abdominal discomfort, leg pain. 9. Medication administration to infants Initial pediatric doses are at best an approximation. To ensure optimal dosing, subsequent doses must be adjusted on the basis of clinical outcome and plasma drug levels. Absorption of IM drugs in neonates is slower than in adults. In contrast, absorption of IM drugs in infants is more rapid than in adults. The blood-brain barrier is not fully developed at birth. Therefore, neonates/ infants are especially sensitive to drugs that affect the CNS. The drug-metabolizing capacity of neonates is low, so neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. Renal excretion of drugs is low in neonates. Thus, drugs that are eliminated primarily by the kidney must be given in reduced dosage and/or at longer dosing intervals. 10. Medication error causes

Not following the 5 Rights of medication administration, lack of patient education??

11. Ciprofloxacin (fluoroquinolone) patient education ****broad spectrum antibiotic, commonly used for UTI**** Education: avoid magnesium, zinc, antacids, aluminum, milk and iron, take on empty stomach, avoid sunlight (wear spf/ sun gear), assess for Achilles pain, FINISH OUT YOUR ANTIBIOTICS MA’AM!! 12. Captopril (ACE inhibitor) side effects Side Effects: first dose HYPOtension, persistent dry cough, HYPERkalemia, renal failure, angioedema (swelling of lips, throat, tongue, etc.), Neutropenia (risk of infection). 13. Dexamethasone (Corticosteroid) side effects Side Effects/ Adverse: adrenal insufficiency, osteoporosis, infection, hyperglycemia, myopathy (muscle injury), Na+ and H 2 O retention/ K+ Loss, growth delay, insomnia, anxiety/agitation, cataracts, PUD, drug induced Cushing Syndrome. 14. Warfarin nursing considerations and interactions Drugs to avoid: Heparin , Cimetidine, Aspirin, Phenytoin, Rivaroxaban, Glucocorticoids, VitaminK Nursing Considerations: pt at risk for bleeding, monitor aPT/ INR levels, Vitamin K is antidote, discontinue several days before surgery, be mindful of Vitamin K intake. 15. Sulfamethoxazole/trimethoprim (Bactrim) patient education/side effects Side Effects: hypersensitivity (photosensitivity/ Stevens Johnson syndrome, hemolytic anemia, kernicterus (brain damage in infants), renal damage, hyperkalemia. Education: primarily used for UTI, finish out entire antibiotics course, take with probiotic, report signs of rash, SOB, abnormal bruising, avoid taking warfarin, phenytoin (can increase effects) 16. Furosemide (Diuretic) nursing considerations Diuretic with greatest Diuresis which places pt at risk for HYPOnatremia , HYPOchloremia , HYPOkalemia , dehydration , hypotension. Pt may need to take supplements to restore K+/Cl- levels, restore hydration (ie. Oral fluids, IV), Avoid digoxin, replace with potassium sparing diuretic like spironolactone) 17. Toxic side effects of a medication Wut?? So Broad, for why?

18. Itraconazole (antifungal) nursing considerations Assess for GI upset, give with food, assess for acute heart failure, assess for hepatic damage (monitor liver enzymes/function), don’t administer with antacid medications (1 hour before or 2 hours after). 19. Cimetidine (H 2 Receptor Antagonist) interactions Antihistamine and antacid Avoid: warfarin, phenytoin, theophylline, and lidocaine (can all be raised to toxic levels if taken with Cimetidine. 20. PCA pump opioid side effects Patient Controlled Analgesia (PCA)- drug delivery device that lets pt administer opioids PRN. Timing control prevents chance of overdose, dont administer while pt sleeping. Side Effects: nausea, low BP, sleepiness, constipation, respiratory depression. 21. Cephalosporin (Antibiotic) nursing considerations/side effects ** cefazolin, cefotetan, ceftriaxone, cefepime, and ceftaroline treat gram + and – bacteria Considerations:** NOT for those allergic to penicillin’s (potential cross reaction), assess renal function before administration, common hypersensitivity reactions (have epinephrine ready), avoid antiplatelet medications, AVOID ALCOHOL. 22. Glucocorticoids side effects Side Effects: infection, fever, hyperglycemia , hypertension, mood changes, osteoporosis , cataracts, weight gain, GI upset , PUD, DONT GIVE W/ NSAIDs. 23. Sildenafil (Viagra) side effects/interactions Side Effects: hypotension, priapism (painful erection 4+ hours), blurring/loss of vision, hearing loss, headache, flushing, diarrhea. Interactions: AVOID Nitrates & alpha blockers (promote hypotension), AVOID CYP3A4 inhibitors (erythromycin, cimetidine) increase levels to toxic, NO grapefruit juice. 24. Glipizide patient education Education: used in conjunction with calorie restriction and exercise to maintain glycemic control, only for T2DM, DO NOT take with alcohol, admin with food. **25. Acyclovir (antiviral) indications ** Used to treat herpes simplex and varicella- zoster viruses, drug of choice****

suppress viral reproduction by inhibiting viral DNA and cause termination of viral DNA strand.

**26. Patient education for analgesics

27. Colchicine, Allopurinol, Probenecid indications and differences** Colchicine (Anti-gout agent): anti-inflammatory specific for gout. Treats gout flare and prevents recurrence. Used to be first line drug, but causes too many GI disturbances. Allopurinol (Xanthine Oxidase Inhibitor): used for those with hyperuricemia, reduces uric acid. Probenecid (Uricosuric Agent): treats gout by increasing excretion of uric acid. Prevent formation of tophi and promotes regression of present tophi. 28. Acetaminophen patient education Education: risk for hepatoxicity with prolonged use, no more than 3000mg/daily, may cause liver damage, GI upset **29. Aspirin patient education already answered this #1
28. Fexofenadine (2nd^ Generation H 1 Antagonist) patient education Antihistamine; Cause much less sedation than first gen, avoid CNS depressants (alcohol), do not take with grapefruit juice. 31. Heparin side effects/antidote Side Effects: hemorrhage, spinal/epidural hematoma, thrombocytopenia (reduced platelet count), hypersensitivity reactions. Antidote: Protamine Sulfate 32. Vancomycin (antibiotic) nursing considerations ** most common antibiotic used: principle use C. diff and MRSA Considerations: do not take with NSAIDs, may cause renal failure, rapid infusion may result in flushing, rash, tachycardia, and hypotension, infuse slowly over 60 min or more, take with probiotic. 33. Opioids tolerance, addiction, and dependency

34. Lispro (short-duration rapid acting insulin) nursing considerations Considerations: for patients with T1DM, 15-30 min onset, lasts 3-6 hours, admin 15 min before meals or immediately after meals, administer into fatty tissue, rotate sites. 35. Penicillin (antibiotic) side effects/nursing considerations Side Effects: allergic reaction (rash to anaphylaxis), can cause sodium overload, renal impairment. Considerations: take with full glass of water 1 hour before meals or 2 hours after, finsh entire course, monitor for potential allergic reaction, advise pt with penicillin allergy to wear medical bracelet, avoid in pt with hypertension/cardiac problems, do not mix with Aminoglycosides (gentamicin) 36. Doxazosin and Finasteride indications Used to treat Benign Prostatic Hyperplasia (BPH) enlarged prostate Doxazosin: Alpha 1 Adrenergic Antagonists: relax smooth muscle in bladder, prostate and urethra, which decrease obstruction of urethra. Finasteride: 5 Alpha Reductase Inhibitors: decrease mechanical obstruction (overgrowth of epithelial cells), mainly for men with HIGHLY enlarged prostate. Combined therapy is more effective than just one of the two 37. Lithium patient education, lab levels Education: take with food to avoid GI upset, DONT excessive work out, DONT take diuretics, NSAIDs, ACE inhibitors (raise lithium to TOXIC levels), short half life of drug means divided daily doses Lab Levels: ideal is 0.6-0.8 mEq/L, anything over 1.5 mEq is TOXIC levels. 38. Theophylline (Methylxanthines) considerations and side effects Bronchodilator for COPD and asthma Considerations: avoid drinking caffeinated beverages, drink plenty fluids to improve secretion, VERY narrow therapeutic range so dosage must be carefully controlled, dosage should start low and slow and increase over time, if dose missed DO NOT take double next dose, monitor blood levels of drug regularly to ensure toxic levels are avoided, administer activated charcoal if serum levels reaches above 25mcg/ L. Side Effects: CNS stimulant effects (restlessness, tachycardia, dizziness), nausea, diarrhea, chest discomfort, increased urine output. 39. Prioritization of care

Airways, Breathing, Circulation?? Pain levels?

40. Digoxin nursing considerations/ levels Considerations: ALWAYS assess apical pulse!!! If pulse falls below 60 BPM HOLD DOSE! Monitor digoxin serum levels, monitor potassium levels, cause hypokalemia. Therapeutic Range: 0.8-2.0 ng/mL Toxic Range: > 2.0 ng/mL ** pt will report seeing HALOS around dark objects or lights, fatigue, GI upset, dysrhythmias w/ hyperkalemia** 41. Anticoagulant side effects Side Effects: hemorrhaging, low blood pressure, increase heart rate, discolored urine, Thrombocytopenia (reduced platelets), hypersensitivity. 42. Evaluating allergies to medications Skin Tests: admin small amount of drug to skin, if it turns itch and red this is a positive result and you are allergic to the drug. This is commonly done with Penicillin’s. Other signs: rash, itchy skin, angioedema, bronchospasm, hypotension, fever, hives. 43. Define side effects, toxicity, adverse reaction, allergy reaction. Side Effects: secondary, unavoidable and undesirable effect to a drug. Not necessarily life- threatening. (ie. Drowsiness, headache,) Toxicity: degree of detrimental physiologic effects caused by excessive drug dosing. Adverse Reaction: unintended/ undesired effect. Can range from mildly annoying to life- threatening (ie. Neutropenia, cardiac dysrhythmias) Allergy Reaction: immune response to prior sensitization of a drug, that when reintroduced to that drug causes the immune system to trigger allergic response. 44. Define medication interaction, drug-drug interaction, drug-food interaction. Medication Interaction: reaction between two or more drugs/ food that causes an adverse reaction to take place, or that raises or lowers the drug serum levels to dangerous limits. Drug-to-drug Interaction: taking two or more drugs that may diminish therapeutic effects or intensify adverse effects. Some drugs cause serum levels to either decrease or increase to levels that are no longer therapeutic. Drug-food Interactions: Some foods cause certain drugs to either raise to unsafe and non- therapeutic levels or cause the drug to not be absorbed properly.

45. Define low therapeutic index. Indicates the drug is relatively unsafe. There is a small range where the drug is “therapeutic” if it exceeds that range the drug is toxic. Drugs with low therapeutic index need to be carefully monitored. 46. Define antagonist, agonist, selective, and potent. Agonist: molecules that activate certain receptors. Antagonist: prevent/ shield certain receptors from being activated. 47. Define half-life. The amount of time required for the amount of drug in the body to be decrease by 50%. Example: The half-life of morphine is approximately 3 hours. If there are 50 mg of morphine in the body, 25 mg (50% of 50 mg) will be lost in 3 hours; if there are only 2 mg of morphine in the body, only 1 mg (50% of 2 mg) will be lost in 3 hours. 48. Define first-pass effect and blood-brain barrier. First Pass Effect: rapid hepatic inactivation of certain oral drugs. Certain drugs are not therapeutic once they pass the live (Ie. Nitroglycerin oral is an example) Blood Brain Barrier: collection of capillaries in the CNS that serve as a barrier to accept certain drugs and not others. ONLY lipid soluble or drugs with a transport system can cross. **49. Metabolization of medications

50. Gentamicin (Aminoglycosides) toxicity** Can cause serious toxicity in inner ears (ototoxicity), and kidneys. Do not take with Penicillins. 51. Narrow therapeutic index Small difference in dose or blood concentration may lead to serious therapeutic failures/ adverse effects. Drug levels must stay within narrow range. 52. Define absorption, distribution, metabolism, excretion. Absorption: movement of drug from site of administration to the blood. Distribution: movement from blood to interstitial space of tissues and into cells. Metabolism: chemical alteration of drug structure. Excretion: removal of drugs from the body

53. Selective Serotonin Reuptake Inhibitor (SSRI) ****Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil)**** Action/ Use: block reuptake of serotonin, increase serotonin to treat depression, OCD, panic disorder and PTSD. Side Effects: sexual dysfunction, nausea, headache, nervousness, insomnia, paradoxical effects. Contraindications: DONT take with MAOI!! NO grapefruit juice Pt Education: may take up to 2 weeks to feel the medication working, don’t take with grapefruit juice, report any suicidal thoughts. 54. Monoamine Oxidase Inhibitor (MAOI) ****Phenelzine (Nardil), Isocarboxazid (Marplan)**** Uses/Action: increase serotonin, norepinephrine and dopamine. Used to treat depression, bulimia, agoraphobia, and ADHD. Used when SSRI/SNRI and TCA are not effective. Side Effects: hypertensive crisis if food with tyramine are eaten, orthostatic hypotension Contraindications: amphetamines, SSRI/ SNRI, tyramine rich foods. Pt Education: no foods with tyramine 55. Antiepileptic considerations/pregnancy Taking antiepileptic medications while pregnant can negatively affect the fetus. It is r recommended to take benzodiazepines or the lowest dose of phenytoin possible. 56. Carbidopa/Levodopa (Dopaminergic) Use: Parkinson’s, reduce symptoms by increasing dopamine, restore balance of Ach. Levodopa crosses the BBB and carbidopa blocks the destruction of levodopa. Side Effects: Orthostatic hypotension, GI upset, hallucinations, anxiety, dark urine and sweat. Contraindications: antipsychotic drugs (decrease levodopa), MAOI (increase levodopa levels), avoid high protein foods (reduce absorption). Pt education: do not take with food (reduces absorption), given at same time each day to reduce symptoms. 57. Dantrolene indications

Drug that reduces muscle spasticity, act on skeletal muscle, unlike baclofen. Used for MS,cerebral palsy, and spinal cord injury. MALIGNANT HYPERTHERMIA.

58. Phenytoin (antiseizure) levels/patient education Levels: Narrow therapeutic index (10- mcg/mL) Pt Education: good oral hygiene to decrease gingival hyperplasia, report double vision or staggering gait **59. Valproate lab results **Epilepsy and Bipolar**** Monitor blood labs for leukopenia, thrombocytopenia. Plasma concentration: 50-120 mg/ mL 60. Clozapine lab results Clozapine is an SGA, Because clozapine can cause agranulocytosis , however, it should be reserved for patients who have not responded to safer alternatives. mandatory monitoring of the WBC count and absolute neutrophil count (ANC). Before starting clozapine, both the total WBC count and ANC must be in the normal range (i.e., WBC count of 3500/mm3 or greater and ANC of 2000/mm3 or greater). During treatment, the WBC count and ANC must be monitored weekly for the first 6 months, then every 2 weeks for the next 6 months. After 1 year of treatment, WBC and ANC monitoring is decreased to monthly. If the total WBC count falls below 3000/mm3 or if the ANC falls below 1500/mm3, treatment should be interrupted. When subsequent daily monitoring indicates that counts have risen above these values, clozapine can be resumed. If the total WBC count falls below 2000/mm3 or if the ANC falls below 1000/mm3, clozapine should be permanently discontinued. Blood counts should be monitored for 4 weeks after drug withdrawal. 61. First-generation antipsychotic (FGA) Chlorpromazine (low-potency): Block receptors for dopamine, Ach, histamine and norepinephrine. ****Suppress POSITIVE symptoms schizophrenia****

• Side Effects/Adverse: May cause EPS !! Anticholinergic effects, Orthostatic Hypotension, Agranulocytosis , severe dysrhythmias, metabolic effects.

Haloperidol (high-potency): Block receptors for dopamine, Ach, histamine and norepinephrine. ****Suppress POSITIVE symptoms schizophrenia****

- Side Effects/Adverse: May cause EPS !! Likelihood of NMS Anticholinergic effects, Orthostatic Hypotension, severe dysrhythmias, metabolic effects. Contraindications of FGA: Anti-cholinergic drugs (atropine, benztropine , diphenhydramine), CNS depressants (ie. Alcohol), Levodopa !! Nursing Considerations: Monitor BP (hypotension), administer FGA w/ food, observe for EPS (movement disturbances, ridged, tremors, tardive dyskinesia,) monitor NMS symptoms (high fever, irregular heartbeat, altered mental status, irregular breathing) 62. Clonazepam (Benzodiazepine) patient education Anxiety, insomnia, and seizure disorder Safer than barbiturates, lower abuse potential. Take w/ food to avoid GI upset, do not increase or discontinue w/o consulting doctor, sleep patterns will normalize once precipitating factors eliminated, avoid driving while taking, may add to effects of CNS depressants (avoid alcohol) *May cause paradoxical effects, should be discontinued. May cause respiratory depression 63. Lorazepam (Benzodiazepine) nursing considerations Anxiety, insomnia, and seizure disorder Safer than barbiturates, lower abuse potential Monitor pt for paradoxical effects (insomnia, anxiety, etc.), instruct pt not to drink alcohol while taking, 64. Cholinesterase inhibitors side effects Prototype: Donepezil: used to treat mild-moderate Alzheimer’s. Side Effects: nausea, diarrhea, dizziness, bronchoconstriction in asthma patients, bradycardia, fainting (LOWERS BP!!) 65. Interferon beta (Immunomodulators) side effects Treat multiple sclerosis, decrease severity of attacks Side effects: Flu-like reactions, Hepatotoxicity (liver failure), Myelosuppression (bone marrow suppression), injection site reactions. 66. Baclofen (Centrally acting muscle relaxer) side effects

Relieve muscle spasticity related to MS Side Effects: CNS depressant (drowsy, dizzy, weak), visual hallucinations and seizure if abruptly discontinued, vomit, constipation, urinary retention.

67. Define acute dystonia, akathisia, tardive dyskinesia. Acute Dystonia: involuntary contractions of muscles in extremities, lead to abnormal movements and posture (ie. Facial grimacing, upward eye movement, muscle spasms of tongue/face) Akathisia: inability to remain still, intense need to move especially lower body (ie. Restlessness) Tardive Dyskinesia: movement disorder that causes repetitive muscle movements in face, neck, arms (ie. Rolling tongue, chewing motion, sucking/smacking lips, involuntary moment of limbs) 68. Bulk-forming agents Prototype: Methylcellulose & psyllium: same effect on bowel function as fiber. Action: swell in water to form gel, soften fecal mass and increase bulk. Stretch intestinal wall and stimulate peristalsis. Uses: temporary constipation relief, diverticulitis, and IBS. Adverse Effects: rare but esophageal obstruction (MUST take with full glass of water) 69. Sucralfate (Anti-ulcer medication) patient education Used for therapy of duodenal ulcers, no serious side effects **Administer antacids at least 30 min apart due to absorption effects, ALSO Sucralfate affects absorption of: phenytoin, theophylline, digoxin, warfarin **administers sucralfate at least 2 hrs. apart from these drugs

70. Proton-pump inhibitor (PPI) indication Action: (Omeprazole):** suppress gastric acid and secretions, gastric ulcers and GERD. Blocks the ATPase which is the enzyme that generates gastric acid. May take days to weeks for full recovery. 71. H2 receptor antagonist use Action (Cimetidine): Histamine (H2) receptor antagonist, treat gastric ulcers. Promote healing by suppressing secretions of gastric acid 72. Short and long acting beta2 agonists

Short Acting (SABA): Albuterol, metaproterenol: taken to abort ongoing asthma attack Long-Acting (LABA): budesonide/formoterol, and fluticasone/vilanterol: anti- inflammatory and bronchodilation benefits, more long-term effects.

73. Bronchodilators Beta 2 Adrenergic Agonist: (Albuterol) relieve bronchospasm by activating beta 2 receptors in lungs. Used primarily for Asthma. Methylxanthines: (Theophylline) relax smooth muscle on bronchi, CNS excitation. Not recommended for asthma management Anticholinergic drugs: (Ipratropium): block muscarinic receptors in bronchi to relieve bronchoconstriction. Used primarily for COPD 74. Fluticasone (Glucocorticoid) patient education Used for prophylaxis of asthma and COPD. Most common side effects are thrush (oral candidiasis), and hoarseness / difficulty speaking. Make sure patient is rinsing mouth out after every use to avoid this. Additionally may contribute to bone loss so ensure pt is taking calcium and vitamin D and weight bearing exercise. 75. Sulfasalazine (Antirheumatic drugs) nursing considerations Uses : treat rheumatoid arthritis and IBS. Nursing Considerations: monitor and report signs of agranulocytosis (fever, sore throat) and thrombocytopenia (bruising and nose bleeds), weakness 76. Lactulose (Osmotic laxative) indications Semisynthetic disaccharide, poorly absorbed and cannot be digested by intestinal enzymes. Can relieve constipation, but causes more side effects (flatulence, and cramping). Used for those who DONT respond to bulk forming agents. 77. Scopolamine (Muscarinic/ Anticholinergic drug) side effects Principle use is for motion sickness (ie. Nausea and vomiting) Side Effects: agitation, dilated pupils, blurred vision, increased sensitivity to light. 78. Cimetidine (H 2 Antagonist) side effects Used to treat peptic ulcers Side Effects: reduced libido, CNS effects in those with renal impairment, risk of pneumonia.

Interactions: can cause certain drugs to reach toxic levels due to inhibition of drug metabolizing enzyme. Drugs to avoid: Warfarin, phenytoin, theophylline, and lidocaine.

79. Leukotriene blocker side effects ****Asthma, bronchodilator**** Prototype: (zileuton, zafirlukast, and montelukast): suppress effects of leukotrienes which promote smooth muscle constriction, blood vessel permeability and inflammatory responses through direct action and recruitment of eosinophils. **Side Effects:

80. Magnesium hydroxide side effects** Antacids. magnesium hydroxide promote diarrhea. Can have Na loading effects. CAN CAUSE MAGNESIUM TOXICITIY, which leads to CNS depression in patients with renal impairment. 81. Bismuth Subsalicylate Act topically to disrupt the cell wall of H.Pylori thereby causing lysis and death. May also inhibit urease activity and prevent H.Pylori from adhering to the gastric surface. Can impart harmless black coloration of the tongue and stool. Long term therapy may carry a risk for neurologic injury. Can prevent and treat mild diarrhea. digo Can be used in sequence with metronidazole, tetracycline, PPI, H2RA for pt. with penicillin allergy and in patient with clarithromycin resistant H.pylori. 82. Promethazine nursing considerations First gen H1 receptor antagonists CNS depression is most prominent. Sedation can occur. Can cause anticholinergic effects. Can cause fatal respiratory depression. DO NOT GIVE TO CHILDREN UNDER 2. Parenteral promethazine can cause local tissue injury if extravasation occur. (Gangrene or necrosis) Not antidote to OD, can give charcoal, reduce hyperthermia, and control seizures with benzo. 83. Metoclopramide mechanism of action **Prokinetic agents Surpress blocade of dopamine and serotonin receptors in the CTZ. Can surpress post op N/V as well as emesis. Can increase GI motility by enhancing actions of acetylcholine. 84. Beclomethasone side effects

**Glucocorticoids **Inhaled Side effects: oropharyngeal candidiasis (thrush) and dysphonia. Adrenal suppression can happen with long term use. Monitor for adrenal insufficient (hypoglycemia, hypotension, mental status alterations). Can slow growth. Can promote bone loss. Increase risk for cataracts and glaucoma (more with high dose inhaled glucocorticoids)

85. Omeprazole patient education Take right before a meal. Inform about side effects: pneumonia, rebound hypersecretion if abrupt withdrawal, hypomagnesemia, fractures. Can increase risk of C.Diff Can reduce adverse effects of clopidegrel and also its beneficial effects. 86. Propranolol side effects **Beta blocker Can cause HF, AV block, and sinus arrest. Hypotension can occur. Can cause bronchospasm in people with asthma. Can cause bradycardia and reduced contractility. CAN MASK SIGNS OF HYPOGLYCEMIA. Can have depression, insomnia, bizarre dreams, sexual disfunction. 87. Verapamil side effects **CCB, nondihyropyridines Generally well tolerated, can cause constipation, which is usually be severe in OA. Dizziness facial flushing, HA, edema. Can cause bradycardia, AV block, decrease contractility. Has been associated with chronic eczematous eruptions. 88. Spironolactone patient education **POTASSIUM SPARRING DIURETICS. Take with or after meals to minimize GI effects. RESTRICT INTAKE OF POTASSIUM RICK FOODS. Can cause menstrual irregularities and impotence. Avoid use with ACE inhibitors, ARB, and direct renin inhibitors. 89. Metoprolol side effects/expected outcomes. Same as propanalol, but less severe. Can be used for people with asthma or sensitive hearts. Still use with caution. 90. Calcium channel blockers nursing considerations Do Not Take With Beta Blocker!! REFER TO 86

91. Lisinopril patient education/side effects/adverse effects Pt education instruct patients to lie down if hypotension develops, warn about persistent dry and nonproductive cough (seek out provider), avoid potassium supplements, warn against teratogenic. Seek medical attention if edema in tongue, glottis, and pharynx. Avoid NSAID use because it can affect antihypertensive effects. Adverse: First dose hypotension, cough, hyperkalemia, can cause fetal harm, angioedema, renal failure 92. Furosemide therapeutic effects Furosemide is a powerful drug that is generally reserved for situations that require rapid or massive mobilization of fluid. This drug should be avoided when less efficacious diuretics (thiazides) will suffice. Conditions that justify use of furosemide include (1) pulmonary edema associated with congestive heart failure (CHF) (2) edema of hepatic, cardiac, or renal origin that has been unresponsive to less efficacious diuretics; (3) hypertension that cannot be controlled with other diuretics. Furosemide is especially useful in patients with severe renal impairment, because, unlike the thiazides (see later in the chapter), the drug can promote diuresis even when renal blood flow and glomerular filtration rate (GFR) are low. If treatment with furosemide alone is insufficient, a thiazide diuretic may be added to the regimen. There is no benefit to combining furosemide with another loop diuretic. 93. Bumetanide side effects **Loop diuretics Hyponatremia, hypochloremia, hypokalemia, dehydration, hypotension, hyperglycemia, hyperuricemia, otoxicity 94. ACE inhibitors side effects Adverse: First dose hypotension, cough, hyperkalemia, can cause fetal harm, angioedema, renal failure 95. Ventricular dysrhythmias medications Ventricular dysrhythmias can cause significant disruption of cardiac pumping. Accordingly, the usual objective is to abolish the dysrhythmia. Cardioversion is often the treatment of choice. When antidysrhythmic drugs are indicated, agents in class I or class III are usually employed. Quinidine, prodainamide, disopyramide—Na channel blocker

Amiodarone, sotalol, dofetilide, ibutilide, breylium—Potassium channel blocker.

96. Mannitol indications **Osmotic diuretics Uses: prophylaxis of renal failure, reduction of ICP, reduction of IOP. Adverse effects: EDEMA. **97. Medication for anemia Ferrous iron salts, B12, folic acid.

98. Hematopoetic growth factor side effects** Usually well tolerated, most significant is hypertension. improper use of epoetin alfa has been associated with serious cardiovascular events, tumor progression, and deaths. Among these are cardiac arrest, HTN, HF, and thrombotic events like stroke/MI. Very rare: pure red cell aplasia (PRCA) a condition characterized by severe anemia and a complete absence of erythrocyte precursor cells in bone marrow. The cause is production of neutralizing antibodies directed against epoetin itself, as well as any native erythropoietin the body is still able to produce. 99. Aminocaproic acid Two antifibrinolytic drugs are currently available: aminocaproic acid and tranexamic acid. Both agents act primarily by preventing the formation of plasmin from its precursor (plasminogen). These drugs are most useful for controlling bleeding in mucous membranes of the nose, mouth, and throat in addition to bleeding caused by dental extractions—presumably because fibrinolytic activity at all of these sites is especially high. 100. Nitrates common side effects/use Use: acute therapy of angina, sustained therapy of angina, Common side effects: generally well rolerated, but usual adverse effects is HA, hypotension, and tachycardia. 101. Exetimibe mechanism of action Acts on the cells of the brush border of the small intestine to inhibit dietary cholesterol absorption. Also inhibits reabsorption of cholesterol secreted in the vile. Reduces the total cholesterol, LDL, TG, and apolipoprotein B. (Small increase in HDL cholesterol) 102. Filgrastrim indication

It is a leukopoietic growth factor, it has three principal uses which is elevate neutrophil counts in cancer patients, mobilization of hematopoietic progenitor cells into peripheral blood for collection and treatment of severe neutropenia. Uses: patients undergoing myelosuppressive chemotherapy, patients undergoing bone marrow transplantation, for harvesting of hematopoietic stem cells, and severe chronic neutropenia.

103. Lovastatin **A statin. HMG-COA reductase inhibitor, referred to as statins. Most effective drug to lower LDL and total cholesterol. Elevate HDL and reduce triglycerides levels. Mechanism: inhibition of hepatic HMG-COA reductase the rate limiting enzyme in cholesterol biosynthesis. This cause the hepatocytes to synthesize more LDL receptors, which can remove more LDL from blood. Used for: primary hypercholesterolemia, dyslipidemia, prevent coronary events. Adverse: generally well tolerated, side effects are uncommon. Some may develop HA, rash, memory loss, or GI problems. Rare and severe adverse effects hepatoxicity and myopathy. VERY VERY RARE: new onset of diabetes **104. Clopidogrel patient education **Plavix, blood thinner**** Supposed to take it once a day. INFORM PATIENTS ABOUT RISK OF BLEEDING. (bruising easily, bleed more easily, nose bleeds, it will take longer than usual to stop). Call provider immediately about signs of bleeding. Discontinue clopidogrel 5 days before surgery. Clopidogrel is contraindicated in patients with active pathologic bleeding, including ICH and bleeding ulcers. AVOID clopidogrel in poor metabolizers. 105. Desmopressin An analog of antidiuretic hormone can stop or prevent bleeding in patients with MILD hemophilia. Works by releasing stored factor VIII from vascular endothelium. Used to stop episodes of bleeding and can be given preop to maintain hemostasis during surgery. Adverse: fluid retention and hyponatremia. 106. Glucagon Treat severe hypoglycemia.

A polypeptide hormone produced by alpha cells of the pancreas. Has effects on carbohydrate metabolism that are opposite to those of insulin. Glucagon promotes the breakdown of glycogen to glucose, reduces conversion of glucose to glycogen, and stimulate biosynthesis of glucose. CAUSES PLASMA GLUCOSE TO RISE. CAN NOT CORRECT HYPOGLYCEMIA RESULTING FROM STARVATION.

107. Finasteride Mechanism: acts in reproductive tissue to inhibit 5-alpha reductase an enzyme that conversts testosterone to dihydrotesterone (DHT). Decreases DHT which promotes regression of prostate epithelial tissue and therby decreases mechanical obstruction of the urethra. Works for men whos prostate is enlarged. Adverse: Can increases likelihood of high grade tumor. Can decrease ejaculate volume and libido, gyno, teratogenic to male fetus but should be avoided regardless. Can decrease PSA a marker for prostate 108. Metformin patient education Inform patients about early signs of lactic acidosis such as hyperventilation, myalgia, malaise, and unusual somnolence and instruct them to seek medical attention. AVOID alcohol. 109. Know which insulins can be mixed, durations, peaks, and onsets. Regular NPH Glargline Degludec Type Short acting Intermediate Short, rapid acting Ultra long acting Onset, peak, duration O: 30-60 min P: 1-5 Hours D: 6-10 Hours O: 60-120 min P: 6-14 Hours D: 16-24H O: 10-15min P: 1-1.5 hours D: 3-5 hours O: 30-90 min P: none D: >24 hours 110. Fludrocortisone education Excessive dose causes retention of Na and H20, and excessive excretion of potassium. This results in increased BV, HTN, cardiac enlargement, edema, and hypokalemia. Inform patients about signs of salt, water retention, hypokalemia. NOTIFY PROVIDER. 111. ACTH nursing considerations ACTH is a tropic hormone produced by the anterior pituitary 112. Levothyroxine patient education Take on an empty stomach or at least 30-60 min before breakfast. Inform patients of thyrotoxicosis (tachy, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating, etc)

Avoid drugs that lower levothyroxine levels or to administer 4 hours apart, (H2 receptor blockers, PPI, cholestramine, sucralafate, anatacids, iron supplement, ca supplement, Mg salt, orlistat).

113. Somatropin side effects **Human growth hormone Adverse: hyperglycemia, hypothyroidism neutralizing antibodies, fatality in PWS patients (major risk factors are severe obesity, upper airway obstruction, sleep apnea, and respiratory infection), and interaction with glucocorticoids. 114. Vasopressin side effects **Antidiuretic hormone Water intoxication. Cardiovascular effects, it’s a powerful vasopressin which can cause angina pectora, myocardial infarction and gangrene if extravasation. 115. Methimazole side effects Drug used for hyperthyroidism. Works by inhibiting thyroid hormone synthesis. Side effects: generally well tolerated, but should be avoided in women who are pregnant or breastfeeding, can cause neonatal hypothyroidism or hypothyroidism in general. Agranulocytosis is the most dangerous toxicity, hypothyroidism. 116. Naloxone mechanism of action Naloxone [Narcan] is a structural analog of morphine that acts as a competitive antagonist at opioid receptors, thereby blocking opioid actions. Naloxone can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia. 117. Dimenhydrinate indications Also known as Dramamine, is an antihistamine used in motion sickness. (Antimetic 118. Acetaminophen antidote acetylcysteine [Mucomyst , Acetadote] Acetylcysteine reduces injury by substituting for depleted glutathione in the reaction that converts the toxic metabolite of acetaminophen to its nontoxic form. 119. Acetylsalicylic acid aspirin is commonly known as acetylsalicylic acid, or simply ASA.

Aspirin is a nonselective inhibitor of COX. Most beneficial effects—reductions of inflammation, pain, and fever—result from inhibiting COX-2. One beneficial effect—protection against MI and ischemic stroke—results from inhibiting COX-1. Major adverse effects—gastric ulceration, bleeding, and renal impairment—result from inhibiting COX-1. aspirin is an irreversible inhibitor of COX. In contrast, all other NSAIDs are reversible (competitive) inhibitors. Because inhibition of COX by aspirin is irreversible, duration of action depends on how quickly specific tissues can synthesize new molecules of COX-1 and COX-2.

120. Epinephrine indications **Anaphylaxis, emergency situations.

121. Fexofenadine side effects/contraindications *Antihistamine**** Still can have sedation, anticholinergic effects, GI (N/V). With older adult, can cause delirium. Certain fruit juices (e.g., apple juice, orange juice, grapefruit juice) can reduce fexofenadine absorption, possibly reducing therapeutic effects. Metformin and CT scan: Hold dose prior and then wait until 48 hours after to give dose, risk of lactic acidosis