Partial preview of the text
Download Pharmacology advanced 2 and more Study notes Pharmacology in PDF only on Docsity!
Exam 1 Review © What is the primary function of Mitchondria? The production of energy in the form of ATP 0 Digoxin toxicity/Hold next dose/give potassium replacement /monitor heart rhythm (anypossible arrhythmias)/LISTEN TO APICAL HEART RATE 0 Where is angitensin 3 produced?? ADRENAL GLANDS (study RAAS SYSTEM) 0 TNK or Tenecteplase/Contraindications/ 1. Uncontrolled hypertension 2. CVA aka stroke within last 3 months 3. Active internal bleeding 0 Warfarin aka coumadin/INR should be between 2-3 O STATINS/adverse effects/ cataracts/hepatoxicity(drug induced liver damage) /myopathy (muscle weakness) / Rhabdomyolysis/Diarrhea 0 How do bile acid sequestrants interact w/ fat soluble vitamins??Bile acids Decrease absorption of the fat soluble vitamins 0 BILE ACID SEQUESTRANTS/DRUG INTERACTIONS/TAKE OTHER MEDS 1HR BEFORE & 4-6 HRS AFTER O Ranolazine (Ranexa)/ no grapefruit juice O Beta Blockers/can mask symptoms of hypoglycemia 0 Unstable Angina/CHEST PAIN THAT OCCURS UNPREDICTABLY AND AT REST O Stable Angina/ Relieved by Nitroglycerin or rest / No appending MI O Protect Nitrglycerin from sunlight?? Sunlight can degrade or reduce nitroglycerin effectiveness (brown bottle to protect from light) ©) Variant Angina aka Prinzmetal// characterized by chest pain due to coronary artery spasm/occuring at rest or low activity/same time each day CO Diltiazem or Cadizem/ priority for a patient w/atrial fibrillation/rate control/ Monitor hr & BP closely O Amiodarone aka cordarone / monitor frequent thyroid function, pulmonary function tests, annual eye exams 0 Acute termination of svt/ meds are ADENOSINE OR ADENOCARD OC Metoprolol/manages long term svt///verapamil & digoxin manages rate control in afib/ O Switching from an ACE inhibitor to ARB/// 36 hr washout period between stopping the ace & starting Entresto(ARB) O Digoxin induced arrhythmia//caused by electrolyte imblanaces// low potassium level aka hypokalemia © During chest pain/sublingual use of nitroglycerin//place 1 tab under tonguellet dissolve/rest for 5 minutes CO Risks associated w/ prolonged iv admin of nitroprusside// cyanide toxicity OC BETA BLOCKERS & CALCIUM CHANNEL BLOCKERS SAFE FOR PREGNANT WOMEN (NIFIDEPINE) O Symptom of ace inhibitors & noncompliance is a chronic COUGH OC ARBS/avoid during pregnancy/risk of fetal injury and death C Lisinopril/adverse effect/angioedma/effects the lips, tongue, and glottis OC RIGHT SIDED HF/MANIFESTATIONS OF abdominal distention/dependent edema/jugular vein distention////hypervolemiathrough full body O Left sided HF//hypervolemia in the lungs/crackles/pink frothy sputum O Digoxin toxcitiy// take DIGOXIN IMMUNE FAB OR DIGIBAND © FLUMAZENIL ANTIDOTE FOR BENZODIAZEPINES//ACETYLCYSTEINE IS ANTIDOTE FOR ACETAMINOPHEN/NALOXONE ANTIDOTE FOR OPIODS/PROTAMINE SULFATE IS FOR HEPARINI/VITAMIN K IS FOR WARFARIN/DEFARSIROX IS FOR IRON TOXCITIY O Side effect of NITROGLYCERIN is a HEADACHE 0 warfarin/stop taking if bleeding (nosebleed)//use electric razors O) Propranolol//report BRONCHIAL ASTHMA O verapamil /Idecreases bp/monitor for HYPOTENSION 0 Heparin does not dissolve clots///prevents new ones/heparin effect begins within minutes O Conduction of the heart////BUNDLE OF HIS TO PURKINJE///SA NODES TO AV NODES O Anticoagulant therapy primary function///prevent clot formation that can lead to stroke /////relating to ATRIAL FIBRILATION O CALCIUM CHANNEL BLOCKERS///CONTROL IRREGULAR HEART RHYTHM OR ARRYTHMIAS O CARVEDILOLI//IONSET OF SOB///STOP MED & SWITCH MED EXAM 2 OC MASTER GLAND///HYPOTHALMUS CO NEGATIVE FEEDBACK SYSTEM IN ENDOCRINE SYSTEMI////MAINTAINS HOMEOSTASIS/Irising levels of a hormone inhibit further hormone release, maintaining homeostasis (CO CORRECT UNDERSTANDING //////ENDOCRINE SYSTEM//MAINTAINS HOMEOSTASIS THROUGH HORMONE SECRETION ( DESMOPRESSINI//diabetes insipidus///decreases urine output///antidiuretic hormone O somatropin//growth hormone deficiency//adverse effect///joint &muscle pain © Acromegaly and gigantism is are related to excess secretion of GROWTH HORMONE ( CORTICOSTEROIDS MUST NEVER BE STOPPED ABRUPTLY ////FURTHER EDUCATION IS NEEDED WHEN TRYING TO STOP/TAPER DOSE/LEADS TO ADRENAL INSUFFICIENCY 0 ADDISONS DISEASE//assessment findings//hyponatremia/hypoglycemia/hyperpigmentation O Regular insulin peaks in 2-4 hrs OC metformin//IREPORT MUSCLE CRAMPS & MALAISE(DISCOMFORT OR ILLNESS) Final Review Antiemetic associated w/qt prolongation ?///ondasetron or zofran Take on empty stomach & ‘hr before meals///sucralfate Long-term use of PPIs increase the risk for///Cdiff & bone fractures Lactulose used for //constipation & hyperammonia Mistoprostol contraindicated in pregnancy// Induces labor Gentamicin toxicity//kidney & ears//nephrotoxic and ototoxic Orange tears & urine & sweat///Rifampin Drugs that require b6 supplements//pyradoxine//INH or isoniazid//TB medication Red man syndrome///caused by Vancomycin//stop infusion! call provider Associated w/Tendon rupture//ciprofloxacin************* Which insulin has no peak///glargine aka long acting A peak of 30-90 min///rapid insulin levothyroxine should be taken when////morning on empty stomach Methmazole caries risk for AGRANULOCYTOSIS ADDISON’S DISEASE is caused by LOW Cortisol Digoxin toxc signs include yellow green halos//digband or immune fab//hold digoxin if the pulse is below 60 Beta Blockers//use w/caution with ppl with asthma Aldosterone causes body to retain SODIUM & WATER FUROSEMIDE CAUSES hypokalemia or hyperglycemia Med that lowers ICP/// Mannitol Rinse the mouth after inhaled steroids prevents thrush Patient teaching//taking metoclopramide or reglan/monitor extrapyramidal —dystonia or muscle spasms//akathisia or restlessness//tardice dyskinesia or involuntary movements Promethazine is contraindicated in two year olds or with asthma /copd due to respiratory depression Laxative is safe for daily use///Psyllium w/ water/ do not lay down pancrelipase//take with meals Pepto bismol or bismuth salicylate//contraindicated in children Reyes syndrome//aspirin contraindicated in children Med that increase risk of gi bleed///Nsaids Amphotericin B//causes nephrotoxicity Monitor weekly when on INH?? For hepatoxicity On ciprofloxacin//please avoid milk and antacid Drug that lowers birth control effectiveness//rifampin-treats tb On vancomycin with rising creatinine and bun is experiencing nephrotoxicity Symptom with INH requires immediate report?//numbness & tingling Peak & trough ??? get trough 1hr before the next dose//peak is right after the dose is done metronidazol //dont take with alcohol Patient is diaphoretic/shaky/confused//priority is to give 15 grams of fast acting carbs Levothyroxine effectiveness//evaluated by increased hr and energy Addison disease//taking hydrocortisone must report FEVER & SORE THROAT METFORMIN//TEACH PATIENT TO AVOID ALCOHOL AND CONTRAST DYE ORAL DIABETIC MED TO CAUSE hYPOGLYCEMIA///GLYPIZIDE FUROSEMIDE GIVEN TOO QUICKLY///PRIORITY IS OTOTOXICITY MANNITOL CONTRAINDICATED WITH ACUTE KIDNEY INJURY AND NO URINE OUTPUT Amlopindine is a calcium channel blocker Antidote for heparin-protamine sulfate Antidote for acetaminophen//acetylcysteine Final Exam Key Points — Detailed Bullet Notes 1. Adverse effects of H. antagonists (e.g., ranitidine, famotidine, cimetidine) e Headache, dizziness, confusion (especially elderly) Hypotension with IV administration Gl effects: diarrhea or constipation Cimetidine-specific: o Gynecomastia, impotence Interferes with hepatic metabolism — ¢ levels of warfarin, phenytoin, theophylline a Bismuth subsalicylate a Metronidazole a Tetracycline 4. Sucralfate e Coats ulcers with protective barrier (like a “band-aid”) e Activated in acidic environment — forms paste over ulcer e Take on an empty stomach e Separate from other meds by 2 hours (decreases absorption) e Adverse effects: o Constipation (#1) o Dry mouth o Aluminum toxicity in renal patients 5. Prostaglandins (misoprostol) Uses e Prevent NSAID-induced ulcers e Cervical ripening & labor induction (OB use) Mechanism e Increase mucus/bicarbonate Increase mucosal blood flow Decrease gastric acid secretion Contraindications Pregnancy (Category X) — causes miscarriage Allergy to prostaglandins 6. Nursing interventions for digestive enzymes (pancrelipase) e Give with meals and snacks Monitor for decreased steatorrhea (fatty stools) Assess for pork allergy (porcine-derived) Check for improved nutrition, weight gain Avoid crushing enteric-coated capsules Monitor uric acid (can increase levels) 7. PPI (omeprazole, pantoprazole, etc.) Strongest inhibitors of gastric acid secretion Take 30 minutes before meals Adverse effects: o Glinfections (C. diff) e Teaching: do not use daily 4. Osmotic (lactulose, magnesium citrate, polyethylene glycol) e MOA: draws water into colon e AE: dehydration, electrolyte imbalance e Lactulose: | ammonia in liver failure 5. Lubricant (mineral oil) e MOA: coats stool e AE: aspiration pneumonia e Teaching: avoid in older adults 9. Metoclopramide e MOA: ¢ GI motility, + gastric emptying; dopamine antagonist e Uses: GERD, gastroparesis, nausea e AE: o Extrapyramidal symptoms (EPS) o Tardive dyskinesia o Sedation o Diarrhea e Contraindications: GI obstruction, Parkinson’s disease 10. Where are the CTZ receptors? e Chemoreceptor Trigger Zone e Located in the medulla oblongata e Outside the blood-brain barrier — sensitive to toxins, meds 11. Promethazine, Ondansetron, Scopolamine Promethazine e Antihistamine (H1 blocker) e AE: severe sedation, respiratory depression, EPS, anticholinergic effects e Black Box: tissue necrosis if IV infiltrates Ondansetron e 5-HT3 receptor blocker e Uses: chemoflradiation/post-op nausea e AE: QT prolongation, headache, constipation Scopolamine e Anticholinergic patch for motion sickness e AE: dry mouth, urinary retention, blurred vision e Apply patch behind ear 4 hours before travel 12. Types of immunity e Severe illness e Allergy to components (ex: neomycin in MMR) 14. Methotrexate e Antimetabolite; folic acid antagonist e Uses: RA, psoriasis, cancer e AE: o Bone marrow suppression (|WBC, |RBC, | platelets) o Hepatotoxicity o Glulcers o Fetal toxicity e Nursing: © Give folic acid to reduce adverse effects o Monitor LFTs, CBC o Avoid alcohol and pregnancy 15. Metronidazole e Antiprotozoal/antibiotic e Uses: C. diff, bacterial vaginosis, trichomoniasis, H. pylori e AE: o Metallic taste o Peripheral neuropathy o Dark urine o Disulfiram reaction with alcohol e Teaching: avoid alcohol during therapy + 72 hrs after 16. Ketoconazole e Antifungal (inhibits ergosterol synthesis) e AE: o Hepatotoxicity o Gynecomastia o Glupset e Teaching: o Avoid antacids (needs acidic environment) °o Monitor liver function 17. Salicylate toxicity vs. salicylism + treatment Salicylism (mild) e Tinnitus e Dizziness e Biologics (etanercept, adalimumab) o Risk of infection (TB, hepatitis reactivation) °o No live vaccines e Slow onset: weeks—months 19. NSAIDs e MOA: block COX-1 & COX-2 — | prostaglandins e Uses: pain, fever, inflammation e AE: o Gl bleeding & ulcers o Kidney injury o Cardiovascular risk (MI, stroke) o Bleeding risk e Contraindications: o Renal failure o Gl bleeding o Pregnancy (third trimester) 20. Patient education for immunosuppression e Avoid crowds & sick people No live vaccines Report fever >100.4°F immediately Good hand hygiene Avoid undercooked food, unwashed produce Wear mask in public Avoid gardening/soil (fungal exposure) Monitor for signs of infection (sore throat, cough, dysuria) Take medications exactly as prescribed Avoid pregnancy (many immunosuppressants are teratogenic) 
