Download Pharmacology Exam Study Guide: Key Principles and Medications and more Exams Pharmacology in PDF only on Docsity!
lOMoARcPSD|47246286 lOMoARcPSD|
NUR 210 Exam 4 Study Guide
Principles of Pharmacology -
Galen
100% Guarantee passing score
Macrolides: Azithromycin Action : inhibits protein synthesis Use : used when patients are allergic to PNC/Cephalosporins, for stronger bacterial infections Side effects/adverse reactions : blurred vision, headache, drowsy, fatigue, GI distress, photosensitivity, allergic reaction/anaphylaxis, tinnitus (ototoxicity), superinfection, hepatotoxicity, SJS Contraindications/cautions: allergy, heart issues (dysrhythmias), hepatic/renal dysfunction Interactions: levels of warfarin increase, levels of digoxin increase, oral birth control Assessment: vital signs, I&O; urinary output, check labs for liver/kidney function, drug history, medical history Nursing interventions: ● Obtain culture and sensitivity (C&S) before therapy ● Monitor vital signs & urine output ● Monitor liver enzymes and for S/S of live issues
● Monitor for superinfection ● Administer antacids 2 hours before or 2 hours after macrolides ● Give azithromycin 1 hour before or 2 hours after meals with full glass of water- no fruit juice ● Use sunscreen ● Ok to give with food stomach upset Glycopeptides: Vancomycin action/uses: started in the 1950s, serious infections, MRSA, bacteria have developed a resistance to this drug (VRE) Given : Oral, IV-slowly Side effects/adverse reactions : Chills, dizzy, GI distress, thrombophlebitis (given in a central line IV), nephrotoxic, ototoxic (can lead to permanent hearing loss because of cranial nerve damage) (can lead to permanent loss of balance), SJS
Red man syndrome - giving it too fast can cause a rash to face, neck,
back, and chest (toxic effect). Other symptoms can include
hypotension, tachycardia, wheezing, and sometimes itching
Nursing interventions: ● Obtain C&S before therapy ● Monitor vancomycin levels (peak and trough) ● Administer over 1 to 2 IV ● Monitor BP ● Monitor IV site ● Monitor renal function test including creatinine clearance as ordered on renal patients ● Hearing ● Monitor patient for superinfection
● Tale all of the med ● Teach to side effects and how to manage and the adverse reactions to report ● To use another form of birth control Aminoglycosides: Gentamicin Use : more serious infections, Usually given IV Side effects/adverse reactions: confusion/tremors/headache/GI distress, allergy, superinfection, ototoxicity, blood dyscrasias (platelet, RBC’s WBC’s), nephrotoxicity, SJS Interaction: warfarin Contraindications: renal disease, Older Adults - last resort Assessment : VS, urine output, any labs that are available - renal/liver, medical history including medications, peak and trough (if patient is on med) Nursing interventions: ● Obtain C&S ● Monitor VS & I&O ● Monitor renal function, urine output - increase fluids ● Monitor for ototoxicity ● Give IV slowly and diluted - usually central line ● Monitor peak and trough and other labs ● Monitor for superinfection
Downloaded by Cripto Fluoroquinolones: Ciproflaxacin Uses : severe infection Side effects/adverse reaction: GI upset, CNS issues- HA, dizziness, tremors, nightmares, photosensitivity, bradycardia, blood dyscrasia - RBC’s, WBC’s, platelets, super infection, hepatotoxicity, nephrotoxicity, tendon rupture Drug interactions: increases effect of oral hypoglycemics caffeine Contraindications: renal/hepatic disease, neuromuscular disease, children under 14 Assessment : VS and urine output, any kidney/liver labs, drug and health history Nursing interventions: ● Obtain C&S ● Infuse slow IV over 60 to 90 minutes ● Monitor I&O ● Increase fluid intake to more than 2000 mL/d ● Check for superinfection ● Monitor blood sugar for diabetics for hypoglycemia Teaching: ● Increase fluids ● Avoid caffeine ● Can cause dizziness - use care ● Use sunblock - photosensitivity ● To side effects to expect and how to minimize them and what adverse reactions to report
● Monitor for signs and symptoms of allergic reaction ● Monitor vital signs ● Increase fluids- monitor I&O ● Take on empty stomach best but with food is okay ● Consider safety issues ● Administer IV over 30 minus, For IM mix with sufficient solution to give IM Teaching: ● Take the entire prescribed dose ● Teach to the side effects to expect and adverse reactions to report (yeast infection) ● Teach to use buttermilk, yogurt, acidophilus milk, or probiotics to maintain GI flora ● Teach signs and symptoms of allergy ● For children’s doses chew tablets, shake suspension, refrigerated, use a measure device ● Decreases effect of oral birth control Sulfonamides - Trimethoprim - sulfamethoxazole: Use : synergistic effect, both drugs together in one compound cause bacterial resistance to develop much more slowly, seeing it used for MRSA, urinary infections, alternative therapy for patients allergic to penicillin Route : oral , topical, ophthalmic
Side effects/adverse reactions: GI distress, stomatitis, photosensitivity, hypoglycemia, blood dyscrasias (RBC’s, WBC’s, platelets), crystalluria can lead to renal failure, SJS Contraindications : renal or liver disease, anemia Caution : older adults, diabetes Interactions : increase bleeding with warfarin, increases effect of hypoglycemic, increase digoxin level Assessment : vital signs, renal function - urine output/labs as available, medical history, allergies, CBC (baseline) Nursing interventions: ● Obtain C&S ● Administer with a full glass of water ● Increase fluid intake to at least 2000 mL/day ● Monitor I&O ● Monitor VS ● Monitor for bleeding, CBC and renal function ● Monitor for rash, superinfection ● Avoid during third trimester ● Best given on empty stomach Teaching: ● Increase fluids to several quarts a day ● Do not take antacids with med ● Warn patient if allergic to this one (oral hypoglycemics- sulfonylureas) ● Teach side effects and how to minimize them
Side effects: headache, dizziness, fatigue and weakness, no EPS Antiemetic: Metoclopramide Action : blocking dopamine receptors in the CTZ, increasing GI emptying Uses : treatment of postoperative emesis, cancer chemotherapy and radiation therapy Side effects : high doses can cause sedation and diarrhea, occurrence of EPS is more prevalent in children than in adults, contraindicated with GI obstruction, hemorrhage, or perforation, no alcohol or other CNS depressants Assessment : medication/medical hx (glaucoma), assess emesis, number, quantity, appearance, and for possible causes, baseline VS I nterventions: ● Monitor VS - patient may become dehydrated ● Fluid status ● Bowel sounds ● Provide mouth care ● Monitor for EPS with promethazine and metoclopramide ● Give metoclopramide before meals if used to help with GI emptying Teaching: ● Teach when to take - 30-60 minutes prior to chemo or motion ● Do not drive ● Instruct to non-pharmacological methods of controlling nausea ● Avoid OTC antiemetic drugs ● No alcohol and other CNS depressants ● Instruct to side effects and report EPS
Antidiarrheals: Diphenoxylate with atropine Action : inhibits gastric motility by slowing peristalsis, combination weak opioid and anticholinergic Uses : treat diarrhea Side effects/adverse reactions : long term use (paralytic ileus) Contraindications/interactions : similar to opioids and anticholinergic, no CNS depressants, no glaucoma, C.Diff or other infectious diarrhea Assessment: medication/medical/travel/food hx, vital signs, bowel sounds, diarrhea, narcotic use history interventions/teaching: ● Monitor VS ● Monitor fluid/electrolyte status ● Notify HCP if diarrhea continues longer than 48 hours or acute abdominal pain occurs ● Do not take with CNS depressants ● Take medication as prescribed ● Drink a lot of fluids ● No fried foods or milk product ● Constipation can result from overuse Laxative: Bisacodyl Action : increases peristalsis by direct effect on smooth muscle of intestine Use : bowel prep, short term tx for constipation
Assessment : pain, renal function, electrolyte imbalances, medication/medical hx Interventions: ● Do not take within 1 hour before and wait 2 hours after any other medication ● Take a small amount of fluid to ensure drug reaches stomach ● Do not take with meals - can slow GI emptying ● Notify HCP if constipation (aluminum) or diarrhea (magnesium) occurs ● Talk to HCP is using for more than 2 weeks ● Help patient with stress control measures ● Instruct diet to reduce increase acid Antiulcer Drugs (histamine 2 blockers) : Famotidine Action : reduce gastric acid by blocking histamine at H2 receptors of parietal cells in stomach, promote healing of ulcer by eliminating cause Use : prevent and treat peptic ulcers, GERD, and stress ulcers Side effects : confusion, headache, dizziness, diarrhea, constipation, nausea, rash, blurred vision, malaise, decreased libido Adverse reactions : hepatotoxicity, cardiac dysrhythmias, blood dyscrasias Interactions : take 30 minutes before other drugs, can cause confusion in older adults Contraindication : pregnancy, breastfeeding, severe renal or liver disease Antiulcer Drugs (proton pump inhibitors) : Pantoprazole Action : reduce gastric acid by inhibiting hydrogen/potassium ATPase enzyme in
gastric parietal cells, used in H. Pylori treatment with antibiotics Side effects/adverse reactions: headache, insomnia, dizziness, dry mouth, GI distress Contraindications : allergic, pregnancy/breastfeeding Interactions: take on empty stomach as food can decrease effectiveness, take 30 minutes before other medications Assessment ( H2 and PPI) : pain assessment, GI assessment, Fluid and electrolyte imbalance, medication/medical hx Interventions : ● Take as directed ● Avoid smoking ● Avoid driving until effect is known ● Eat food rich in Vitamin B ● Avoid food that cause irritation Antiulcer Drugs (pepsin inhibitor) : Sucralfate Actions : combines with gastric acid to form thick paste covering ulcer, protects from acid and pepsin Side effects : drowsiness, constipation, GI distress, hyperglycemia Contraindications : renal failure Interactions : other drugs may not be absorbed give 1-2 hours around other drugs Assessment : evaluate patient’s pain, GI status, renal function
Action : increases production, maturation, and activation of neutrophils and enhances their phagocytosis Uses : to decrease the incidence of infection in patients who are taking chemotherapy agents or having bone marrow transplants that are myelosuppressive. Also used in patients with chronic neutropenia Side effects : GI upset, skeletal pain, joint pain flu like symptoms, headache, cough, chest pain Adverse reactions : allergy, splenomegaly Contraindications : allergy to E. coli, 24 hours before or after cytotoxic chemo Interactions : no major interactions noted Assessment : obtain a medical and medication hx, obtain baseline labs including CBC, family’s ability to self administer, head to toe assessment, allergies Nursing interventions : ● Monitor patient for side effects focusing on vital signs, fluid balance, DVT, cardiac, respiratory ● Increase fluids to 2L day ● Monitor for signs and symptoms of anemia (epoetin alfa) and plan care accordingly. Monitor for SE/AR ● Monitor for signs and symptoms of infection (filgrastim) and plan care accordingly. Monitor for SE/AR Evaluation : ● Epoetin alfa - increase in RBCs ● Filgrastim - no s/s of infection
Hormone therapy : Conjugated Estrogen Use : to minimize symptoms of menopause Action : replaces the hormone estrogen Side effects : adverse reactions: fluid detention, breakthrough bleeding, breast tenderness, jaundice, DVT, depression, gallbladder disease, CVA, PE, MI, endometrial cancer Contraindications : pregnancy, undiagnosed vaginal bleeding, acute liver disease or chronic impaired liver function, personal history of breast cancer/endometrial cancer (black box warning), history of thromboembolic disorders (DVT) black box warning), active gallbladder or pancreatic disease, CAD, endometriosis Interactions: corticosteroids - increases effect of estrogen, anticoagulants - decreases effects of anticoagulants, hypoglycemics - decreases effects of hypoglycemics Oral bisphosphonate : Alendronate Action : reduce the breakdown of bone microstructure, the bone cells grow around the medication. Once covered by bone the drug is no longer active. it can take time to grow around the bone Uses : prevention and treatment of osteoporosis
- Can be ordered daily or weekly - weekly most commonly ordered
- These have a very long half life - for example alendronate can have up to a 10 - year half life, so if the patient takes it for 5 years, it can last another 5 or more years
Assessment : Pt’s knowledge of therapy/reason for therapy, medication/medical history, liver/kidney function, overall behavior, VS, labs Nursing interventions/teaching : ● Monitor behavior ● Monitor VS, weight, labs ● Teach to proper administration and to take exactly as ordered ● Take with food to minimize GI upset ● Teach to maintain good skin care to minimize acne ● Report issues with urination ● Drink plenty of fluids Sexual dysfunction : Sildenafil Action : increases blood flow to the penis Uses : erectile dysfunction, benign prostatic hypertrophy Side effects/adverse reactions : headache, nasal congestion, GI upset, GU issues, Photosensitivity Contraindications : significant cardiovascular disease, history of priapism Caution : other antihypertensives & heart medication Interactions: nitroglycerin ( cannot be taken together. If taking or on PRN NGT, it cannot be used within 24 hours (or more depending on liver/kidney function), grapefruit juice- increases action of sildenafil and S/E and A/R
Alpha adrenergic blocker (agonist) : Tamsulosin Action : relaxes muscles in prostate, increases urine flow in patients with BPH Uses : improves symptoms associated with BPH such as dribbling, frequency, hesitation, nocturia. Additionally causes vasodilation Side effects : dizziness, headache, fatigue, miosis, nasal congestion, polyuria, GI upset Adverse reactions : orthostatic hypotension ( vasodilation), edema, dyspnea, palpitations Assessment : vital signs, urinary status, other meds/medical conditions Interventions/teaching: ● Monitor blood pressure ● Teach to get up slowly to prevent orthostatic hypotension ● Take at bedtime ● Be careful performing dangerous activities/driving until effect of medication is known ● Notify MD if having eye surgery ● Take with food ●
