PHARM FINAL

NURSING CARE- ANTICHOLINERGICS (prt 2)

•Provide mouth care- ice or hard candy to relieve dry mouth •Encourage patient to avoid hot environments and excess physical activity •Darkened room, sunglasses for eye comfort •Instruct not to drive or operate machinery if vision is blurred

Quick-Relief Medications

•Short-acting beta2 adrenergic agonists (inhaled) •Anticholinergics (inhaled) •Corticosteroids- (inhaled & IV)

Diuretics classes

•Thiazide diuretics •Loop diuretics •Osmotic diuretics •Potassium Sparing diuretics

Fluoroquinolones ("-acin" suffix)

•Tings to Note with this "-acin" drug Cipro can increase serum levels of caffeine***; •***Avoid antacids, iron supplements, and dairy products for at least 6 hours after taking medicine; they can decrease absorption of Cipro •Administer IV over 60 minutes*** •Patients should wear sunscreen & protective clothing when in sunlight***

Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin)

•azelastine (Astelin)- nasal spray •olopatadine (Patanol)- ophthalmic drops

Three major lipoproteins

▪High density lipoprotein (HDL)- contains less fat ▪Low density lipoprotein (LDL)- contains more fat ▪Very low density lipoprotein (VLDL)- carries mostly triglycerides and less cholesterol

Statins: pravastatin (Pravachol); simvastatin (Zocor)

▪Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis, so decrease cholesterol, decrease LDL, and slightly increase HDL ▪Have been found to decrease coronary artery disease and mortality rates

Coronary Artery Disease

▪Lumens of the blood vessels become narrowed due to plaque (cholesterol or fatty deposits) ▪Decreases oxygenated blood supplying myocardium ▪Angina pectoris "suffocation of heart muscle"; chest pain

pravastatin (Pravachol); simvastatin (Zocor) = aka Statins

▪May be combined with other drugs for better results ▪Positive effects may be seen in 2 wks, but it takes 2 to 4 wks for therapeutic effect to be achieved

Be aware- Statins: pravastatin (Pravachol); simvastatin (Zocor)

▪May cause an *increase in liver enzyme levels*- should be checked for the first few months; avoid use with alcohol*

Coronary Artery Disease (prt 2)

▪Myocardial infarction: when area of the myocardium becomes ischemic and then necrotic ▪Severe pain, often described as "crushing" or "suffocating"; usually nausea, diaphoresis, feeling of "pending doom", anxiety; epigastric pain ▪Women may experience atypical symptoms, including no complaint of actual chest pain

3 types of drugs that address Chest Pain

▪Nitrates ▪Beta blockers ▪Calcium channel blockers

Cholesterol Absorption Inhibitors

▪Prototype: ezetimibe (Zetia)- (PO)

Fibric Acid Agents: Gemfibrozil (Lopid)

▪Reduces triglyceride and VLDL levels ▪Drug of choice for extremely high triglyceride levels

Nitrates: nitroglycerin (Nitrostat)

▪Relax & dilate veins, arteries, & capillaries; dilation of coronary arteries, bringing more blood and oxygen to myocardium ▪Reducing amount of blood returning to the heart (reduces workload of heart)

Pulmonary Circulation

▪Right side of heart sends blood to the lungs ▪Carbon dioxide & some waste products are removed from blood ▪Oxygen is picked up by RBCs

Non-pharmacologic Methods of treating cholesterol

▪Saturated fats and cholesterol in the diet should be reduced ▪Total fat intake should be 30 percent or less of caloric intake, cholesterol intake 300 mg/day or less ▪Choose lean meats, especially chicken and fish ▪Exercise is important in reducing cholesterol and increasing HDL ▪Smoking should be eliminated- increases LDL and decreases HDL

Side effects of Statins: pravastatin (Pravachol); simvastatin (Zocor)

▪Side effects: HA, flatulence, abdominal pain, cramps, constipation, rhabdomyolysis with acute renal failure, rash ▪Observe for muscle tenderness or weakness** (rhabdomyolysis) ▪Avoid use in pregnancy

Side effects of Fibric Acid Agents: Gemfibrozil (Lopid)

▪Side effects: dyspepsia, diarrhea, abdominal pain, nausea, and vomiting (GI distress); muscle pain ▪Taking with meals reduces GI symptoms ▪*Contraindicated in patients with hepatitis or gallbladder disease*

Drugs Used to Treat Chest Pain accomplish their primary goal by.....

▪Slow heart rate ▪Dilate veins so heart receives less blood-reduced preload ▪Dilate coronary arteries ▪Decrease force of contraction-reduced contractility ▪Lower blood pressure so less resistance-reduced afterload

Drugs for Hyperlipidemia

▪Statins (HMG-CoA reductase inhibitors) ▪Bile acid sequestrants ▪Fibric acid agents ▪Nicotinic acid Cholesterol absorption inhibitors

diuretics are used for....,.

◦Hypertension ◦Heart failure ◦Kidney failure ◦Liver failure or cirrhosis ◦Pulmonary edema

Sympathetic

"Fight or Flight" •Activated under conditions of stress •Readies the body for an immediate response to a potential threat •Heart rate and BP increase, more blood is shunted to skeletal muscles, liver produces glucose for energy, bronchi dilate for more oxygen, pupils dilate for better vision •Neurotransmitter is norepinephrine

syncope

"Passing out", loss of consciousness or fainting NOTE: this is a side effect for Barbiturates (- "tal" suffix)

Parasympathetic

"Rest and Digest" •Activated under non-stressful conditions •Digestive processes promoted, heart rate and BP decline, bronchi constrict since no extra oxygen needed, bladder contracts, pupils constrict •Neurotransmitter is acetylcholine

Side effects of Beta Blockers: carvidolol olol (Coreg) metoprolol (Lopressor)

"olol" Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression Can *mask symptoms of hypoglycemia

Beta Blockers

"olol" suffix

Tetracyclines

("-CLINES" SUFFIX) Prototype- tetracycline (Sumycin) (po, TOP) OTHERS: DOXYCYCLINE MINOCYCLINE •Inhibits bacterial protein synthesis •Broad spectrum; BUT Much drug resistance IN RECENT YEARS •Used for Rocky Mountain spotted fever, typhus, cholera, Lyme disease, H. pylori, chlamydia, acne (a substitute for penicillin allergies)

Tetracyclines

("-CLINES" SUFFIX) •SIDE EFFECTS: Gastric distress is common-N/V/D, BONE MARROW SUPPRESSION, RASH, & SUPERINFECTION, PHOTOSENSITIVITY •May cause permanent brown discoloration of permanent teeth in young children- Don't give to children under 8 yrs old***** •Affects fetal bone growth and teeth development**** (Preg Cat. D)

Fluoroquinolones

("-acin" suffix) Prototype- ciprofloxacin (Cipro) (PO, IV) Others: levofloxacin (Levaquin), finafloxacin (xtoro) •Interfere with bacterial DNA enzyme synthesis; Broad spectrum •Four generations •Well absorbed orally and may be administered once or twice daily, well tolerated •Used for many types of infections including UTI, Resp, skin, as well as anthrax (germ warfare)

Fluoroquinolones

("-acin" suffix) THIS DRUG: •Interfere with bacterial DNA enzyme synthesis; Broad spectrum •Side effects: GI upset, n/v/d; dizziness, headaches, and restlessness; photosensitivity* •Black box warning: tendon rupture; Report any tendon pain or inflammation*

Penicillins

("-cillins" suffix) Prototype: amoxicillin (Amoxil) (PO,...other IM or IV) Others: penicillin G, ampicillin, or oxacillin •Disrupt bacterial cell walls •Amoxicillin is broad spectrum, some other penicillins are narrow spectrum

Penicillins

("-cillins" suffix) •Indicated for many types of infections, often strep & staph •broad-spectrum (ex. Amoxil) and extended-spectrum (ex. Zosyn) •Safe antibiotics- allergy is most common adverse effect- may have rash, itching, fever- possibly severe reaction- observe 30 minutes after injectable administration

Aminoglycosides ("-cin" suffix)

("-cin" suffix) •Prototype- gentamicin ( opth, top, IV, & IM) •Others: neomycin, streptomycin •Inhibit bacterial protein synthesis; bactericidal •Used for serious systemic infections caused by aerobic gram-negative microorganisms •Sometimes given concurrently with another antibiotic

Aminoglycosides

("-cin" suffix) •May cause serious adverse effects-***** •Ototoxicity •Nephrotoxicity •Neuromuscular blockade leading to flaccid paralysis & fatal respiratory depression

Aminoglycosides

("-cin" suffix) •Serum therapeutic range is 5-10 mcg/ml •Inhibit bacterial protein synthesis; bactericidal

Macrolides

("-mycin" suffix) •Prototype: azithromycin (Zithromax) (PO, IV) •Others erythromycin; clarithromycin (Biaxin), fidaxomicin (dificid) Bactericidal/bacteriostatic; protein synthesis; broad spectrum

Macrolides

("-mycin" suffix) •Treats a lot of respiratory infections, derm, uti, & GI •few adverse effects, when they do occur, mostly gi related •Adverse effects: n/v/d, anorexia, pseudomembranous colitis, confusion, cns changes, rash, superinfection

LINCOSAMIDES

("-mycin" suffix) •Use cautiously with liver or renal impairment •Adverse effects: severe gi reactions, n/v/d, fatal pseudomembranous colitis, bone marrow suppression

LINCOSAMIDES

("-mycin" suffix) •Prototype: clindamycin (Cleocin) (PO, IM, IV, Top) •Others lincomycin •Bactericidal; protein synthesis •Treat serious infections such as septicemia, bone/joint infections

Carbapenems

("-nem" suffix) •Prototype: imipenem-cilastin (Primaxin) (IM or IV) •Others: ertapenem, doripenem •inhibiting construction of cell wall; Bactericidal; very broad spectrum •Treats intra-abdominal, UTI, skin, bone, joint and gyne infections Can only be given parenterally

Carbapenems

("-nem" suffix) •inhibiting construction of cell wall; Bactericidal; very broad spectrum •Can only be given parenterally •Adverse effects- N/V/D, pseudomembranous colitis, rash, thrombophlebitis at injection site, superinfections, HA, dizziness

Oxazolidinones

("-olid" suffix) •Effective against many resistant strains (vre & mrsa) •Avoid maoi drugs and foods containing tyramine; may cause life-threatening hypertension •Adverse effects: cns effects (HA, dizziness), n/v/d, thrombocytopenia, risk for pseudomembranous colitis

Oxazolidinones

("-olid" suffix) •Prototype: linezolid (zyvox) (PO, IV) •Others: tedizolid (Sivextro) •Bactericidal; protein synthesis

Cephalosporins

("cef-" prefix) •Prototype: cefaclor (Ceclor) (PO.....but others given IM & IV) •Similar mechanism of action as penicillin •Inhibit bacterial cell wall synthesis •Used to treat a variety of infections (gram +/-)

Cephalosporins

("cef-" prefix) •Several generations of cephalosporins- the later the generation, the more effective and/or broader the spectrum- fourth and fifth-generation are effective against microorganisms that have developed drug resistance to earlier drugs (such as MRSA) •5-10% of people allergic to penicillin will also be allergic to cephalosporins (cross hypersensitivity)

Sulfonamides

("sulfa-" prefix) Prototype- trimethoprim-sulfamethoxazole/cotrimoxazole (Bactrim, Septra) (PO) Others- sulfadiazine, sulfasalazine •Suppress bacterial growth by inhibiting synthesis of folic acid •Broad spectrum; but lots of drug resistance to sulfa drugs •Cheap drugs; Used for otitis media, uTI's; some std's

Sulfonamides

("sulfa-" prefix) •***teratogenic (avoid in pregnancy & BREASTFEEDING) •Adverse effects- N/V/D, LIVER TOXICITY, allergic reactions, BONE MARROW SUPPRESSION, STEVENS-JOHNSON SYNDROME, RASH, HIVES, PHOTOPHOBIA** •POSSIBLE TOXIC NEPHROSIS (KIDNEYS) FROM CRYSTALS IN THE URINE, TEACH PATIENTS TO INCREASE FLUID INTAKE •TEACH PATIENTS TO AVOID SUN EXPOSURE

Barbiturates

(- "tal" suffix)

Angiotension II Receptor Blockers (ARBs)

(-"sartan" suffix)

Typical Antipsychotics Phenothiazines

(1st Gen) Prototype- chlorpromazine (Thorazine) (IM , PO, or IV)

atypical antipsychotics

(2nd Gen) Side/adverse effects- drowsiness, sedation, seizures, weight gain*, headache, dry mouth, photosensitivity, orthostatic hypotension, hyperglycemia*, fever, neuroleptic malignant syndrome

Celebrex

(Cox-2 Inhibitor) prototype: celecoxib (Celebrex) is the only drug in the class Function: To decrease bone/joint pain and inflammation USED FOR: Most NSAIDS are nonselective inhibitors for both COX-1 and COX-2.

Adverse effects: somatrem (Genotropin)

(Growth Hormone Deficiency) Adverse effects: development of antibodies to growth hormone, insulin resistance, swelling, joint pain, HA, injection-site pain Pt teaching: monitor blood glucose; child's nutritional needs must be monitored

prototype: somatrem (Genotropin)

(Growth Hormone Deficiency) Replaces the GH; stimulates skeletal growth & growth of internal organs

Pt teaching: monitor blood glucose; child's nutritional needs must be monitored

(Growth Hormone Deficiency) somatrem (Genotropin)

pt teaching

(Growth Hormone Deficiency) somatrem (Genotropin) = monitor blood glucose; child's nutritional needs must be monitored

Parenteral routes of administration

(Injection of medication into the body tissues) 1. Intradermal (ID) 2. Subcutaneous (SubQ) 3. Intramuscular (IM) 4. Intravenous (IV)

Prednisone

(PO, IM, IV) Have various uses; a) treat Addison's disease, and b)suppress severe inflammation & they do so by acting on many of the chemical mediators; do a great job with severe inflammation*

TRAP

(Tremor, Rigidity, Akinesia, Postural instability); an acronym for symptoms of Parkinson's disease

Acetaminophen

(Tylenol) Has no anti-inflammatory effect but does treat pain & is often combined with narcotics/opioids; does NOT affect platelet aggregation; does NOT cause GI bleeding or ulcers* •Pregnancy Category B •Do NOT administer to people to drink alcohol regularly because of liver damage**

partial agonist

(agonist-antagonist): produces a weaker or less efficacious response

Benzodiazepine

(anxiolytic w/ sedative properties) --- "pam/lam" suffix

COPD

(chronic obstructive respiratory disease)-chronic condition that occurs over time; of result of chronic bronchitis, emphysema; obstruction is not fully reversible

avoid what foods and stimulants when taking Methylxanthines: aminophylline (Theophylline)

**Avoid caffeine, nicotine, chocolate, and other stimulants

be aware that Direct Vasodilators such as hydralazine (Apresoline)

*May cause reflex tachycardia*- can be prevented by administering a beta blocker with the direct vasodilator

OSMOTIC DIURETICS: MANNITOL (OSMITROL) is NOT the best drug for....

*NOT BEST DRUG FOR HEART FAILURE*-DUE TO MASSIVE PULL OF FLUID INTO VASCULAR SPACE

Aspirin Implications

*Never give children/teens aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye's syndrome* •*Avoid activities that may cause or promote bleeding*; stop at least a week before surgery •Preg Category D in last trimester (or 'non-classified')

local anesthetic: lidocaine (Xylocaine)

*Note*: sometimes epinephrine is added to or used in conjunction with lido to decrease bleeding; lidocaine with epinephrine should NEVER be injected into fingers, toes, ears, noes, or penis*

for a patient exhibiting hypoglycemia symptoms

*Prepare to administer 50% Dextrose IV for acute hypoglycemia of the client with decreased LOC*

Parenteral drugs

- Given by a route other than the GI tract - Drugs administered by injectable routes - Means "excluding the intestines" - Administered by needle and syringe

Pure opioid agonists

-Activate mu receptors and kappa receptors -Can produce analgesia, euphoria, sedation, respiratory depression, physical dependence, constipation, and other effects Morphine: Strong opioid agonists and moderate to strong opioid agonists Codeine: Moderate to strong agonists

Dextromethorphan

-Antitussive (antagonizes NMDA glutamate receptors). -Synthetic codeine analog. Has mild opioid effect when used in excess. -Naloxone can be given for overdose. Mild abuse potential. -May cause serotonin syndrome if combined with other serotonergic agents

OmniPod

-Fill with insulin -Deliver insulin via cannula -Uses wireless PDM

parasympathetic responses

-Rest-and-digest response. -Conserve and restore body energy. -↑ digestive and urinary function. -↓ body functions that support physical activity.

Paul Ehrlich

-developed concept of selective toxicity -identified dyes that effectively treated African sleeping sickness (African trypanosomiasis)

acute imflammation

-immediate onset; 8-10 days to resolve typically

chronic inflammation

-slower onset for prolonged periods; usually worsens over time (rheumatoid arthritis, systemic lupus, etc.)

Common Conversions

1 meter = 1000 mm 1 meter = 1 mcg .001 mg = 1 mcg 1 gram = 1000mg 1000 g = 1 kg 1tbs (T) = 15mL 1 tsp = 5 mL 20 drops = 1mL 2.2lb = 1 kg 1 lb = 453.6 gm 1 oz = 30 gm 1 mL = 1 cc 1 dL = 100 mL

Package inserts

1) FDA regulates content and format (FDA approves of package insert) 2) must contain a summary of scientific info that is needed for SAFE and EFFECTIVE use 3) info must be infomrative, accurate and not promotional in tone and canNOT be FALSE or MISLEADING 4)MUST have SPECIFIC info under the listed headings in a SPECIFIC order

right sided heart failure

1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement)

Left sided heart failure

1. Pnea, SOB 2. Crackles 3. Oliguria 4. Frothy Sputum 5. Displaced Apical Pulse (Hypertrophy)

alklating agents

1. busulfan 2. nitrosureas (carmustine) 3. cyclophosphamide

Insulin Concentrations

100 units/ml or 500 units/ml

High risk blood sugar

100-125 mg/dL

Diabetes

126 mg/dL or HIGHER

Typical Antipsychotics Nonphenothiazines

1st Gen Prototype- haloperidol (Haldol)

Drugs for Pituitary Disorders

2 Lobes- Anterior Drug- growth hormone Posterior Drugs- desmopressin and oxytocin

Patient-controlled analgesia (PCA)

2 nurses must assess and document amount used and wasted when discontinued*** Usually a max dose, a lockout interval, & 4-hour limit programmed into the machine

sympathetic

4 GROUPS OF DRUGS IN AUTONOMIC NERVOUS SYSTEM: •Adrenergic agonists (sympathomimetics) •Adrenergic antagonists or blockers (sympatholytics)

parasympathetic

4 GROUPS OF DRUGS IN AUTONOMIC NERVOUS SYSTEM: •Cholinergic agonists (parasympathomimetics) •Cholinergic antagonists or anticholinergics (parasympatholytics)

Hemaglobin A1C

4-6% NORMAL: <5.7%

High risk Hemaglobin A1C

5.7%-6.4%

Diabetes Hemaglobin A1C

6.5% or HIGHER

Normal range for blood glucose

60-100mg/dL (70-110; 80-120) HbA1c should be less than 7%

Normal blood glucose

70-110 LESS THAN (<100 mg/dL)

competition for resources

A cause of conflict that occurs when the demand for resources is greater than the resources available. Think of foreign bacteria against your bodies normal flora (protective bacteria)

fever

A client has recently been started on an SSRI drug. Which of the following if reported by the client might lead the nurse to suspect that the client is suffering from serotonin syndrome? 1.Severe nausea & diarrhea 2.Somnolence 3.Bradycardia 4.Fever

status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes. POWERPOINT: V administration of diazepam or lorazepam is preferred treatment THINK: Benzodiazepines

anemia

A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.

Dysrhythmia

A disruption in the cardiac rate or rhythm Sinoatrial Node is the "pacemaker" of the heart

Neuroleptic Malignant Syndrome

A life-threatening idiosyncratic reaction (a reaction that occurs rarely & is unpredictable) to many antipsychotic & neuroleptic (& some other drugs affecting the nervous system)

HMO (Health Maintenance Organization)

A managed care organization that provides comprehensive medical services for a predetermined annual fee per enrollee. Health insurance that requires a PCP and wants you to use only in-network doctors

Pseudoparkinsonism

A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles.

Psychosis / Schizophrenia

A mental condition characterized by abnormal behaviors. Thought processes are disturbed, as evidenced by: positive and negative symptoms

bipolar disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

nucleus

A part of the cell containing DNA and RNA and responsible for growth and reproduction

First pass effect

A phenomenon in which drugs given orally or carry directly to the liver after absorption, or they may be largely in activated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses then drugs given by other routes because of this early break down

Phase 1 study

A pilot study of a potential drug using a small number of selected, usually healthy human volunteers

medication reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. UP TO DATE

Neuroleptic Malignant Syndrome (NMS)

A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus.

Negative Feedback System

A reaction that causes a decrease in function in response to some kind of stimulus.

anaphylactic reaction

A serious allergic reaction that requires immediate treatment

vesicant

A severe ____ - can cause tissue necrosis if it infiltrates (see picture)

narcolepsy

A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.

isotonic solution

A solution in which the concentration of solutes is essentially equal to that of the cell which resides in the solution RBC in this solution will RETAIN its shape

hypertonic solution

A solution in which the concentration of solutes is greater than that of the cell that resides in the solution RBC places in this solution will SHRINK and SHRIVEL up as water moves OUT of the cell

Avoirdupois system

A system of measure used in pharmacy. In the avoirdupois system units such are the fluid ounce and the pound are used.

continuous bladder irrigation

A three-way (lumen) irrigation is used to decrease bleeding and to keep the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation (inflow); one lumen is for outflow.

Phagocytosis

A type of endocytosis in which a cell engulfs large particles or whole cells

Pinocytosis

A type of endocytosis in which the cell ingests extracellular fluid and its dissolved solutes.

Extrapyramidal Syndrome (EPS)

A variety of signs and symptoms, including muscular rigidity, tremors, drooling, shuffling gait, restlessness, peculiar involuntary postures, and many other neurological disturbances. Often a side-effect of antipsychotic medications.

Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

ACE Inhibitors (-"pril" suffix)

aptopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

ACE Inhibitors (-"pril" suffix)

POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)

ACT IN THE COLLECTING DUCT AND LATE DISTAL TUBULE TO ENHANCE SECRETION OF SODIUM AND RETENTION OF POTASSIUM (OPPOSITE OF ALDOSTERONE)

LOOP DIURETICS: FUROSEMIDE (LASIX)

ACT ON THE LOOP OF HENLE TO BLOCK REABSORPTION OF SODIUM AND CHLORIDE- SODIUM AND WATER ARE LOST

Antidiuretic Hormone Deficiency

ADH- secreted by posterior pituitary ADH-Promotes water reabsorption from the renal tubules to maintain water balance (helps to hold on to water), is hemostatic & has vasopressor properties

administration of ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

ADMINISTERED SQ OR IV; DON'T SHAKE SOLUTION

Adverse effects of beta blockers

ADRENERGIC ANTAGONISTS (BLOCKERS) Prototype: propranolol; metoprolol (Lopressor, Toprol)- drug names end in "olol" ______ _______: Prototype: propranolol; metoprolol (Lopressor, Toprol)- drug names end in "olol"

Alpha blockers

ADRENERGIC ANTAGONISTS (BLOCKERS) act on vascular smooth muscle to decrease BP.

Beta blockers

ADRENERGIC ANTAGONISTS (BLOCKERS) decrease rate and force of contraction of the heart and slow electrical conduction through the AV node; primary use is to treat hypertension.

Adverse effects of alpha blockers

ADRENERGIC ANTAGONISTS (BLOCKERS): Alpha blockers Prototype- prazosin (Minipress)- drug names end in "zosin" ____ ______: HA, dizziness, tachycardia, hypotension, nausea, dyspepsia, diarrhea

prazosin

ADRENERGIC ANTAGONISTS (BLOCKERS): Alpha blockers prototype: _____ (Minipress)- drug names end in "zosin"

propranolol & metoprolol

ADRENERGIC ANTAGONISTS (BLOCKERS): Beta Blockers Prototype: _____ & _____ (Lopressor, Toprol)- drug names end in "olol"

ADVERSE EFFECTS of THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)

ADVERSE EFFECTS: DIZZINESS, VERTIGO, ORTHOSTATIC HYPOTENSION, N/V/D, MUSCLE CRAMPS, MUSCLE SPASMS

cytophosphamide

ALKYLATING AGENTS Prototype- ______ (Cytoxan)**** •Others: chlorambucil •Interfere with DNA to prevent cancer cells from dividing Effective against many types of cancer •Adverse effects: bone marrow suppression; N/V/D; anorexia, alopecia, hepatic & renal toxicity; hemorrhagic cystitis

Cytoprotectant

ALKYLATING AGENTS mesna (Mesnex) helps reduce chance of hemorrhagic cystitis

true

ALL drugs are potentially dangerous

SHAMPOO FOR LICE

ALLOW MEDICATION TO REMAIN ON HAIR & SCALP FOR AT LEAST 10 MINUTES BEFORE REMOVAL; USE A FINE COMB TO REMOVE LICE EGGS

secondary action

ALMOST ALL DRUGS HAVE THIS effects in addition to the desired effect Benadryl causes drowsiness

phenylephrine (Neo-Synephrine); oxymetazoline (Afrin)•(PO, IV, and Topically)

ALPHA-ADRENERGIC AGONIST DRUGS

Topical/Intra-nasally (Afrin)

ALPHA-ADRENERGIC AGONIST DRUGS causing vasoconstriction in nose to decrease congestion THINK: oxymetazoline or Afrin

Topically/Eye drop

ALPHA-ADRENERGIC AGONIST DRUGS pupil dilation for eye exam

Injection/IV

ALPHA-ADRENERGIC AGONIST DRUGS to treat shock and shock-like symptoms (highly vesicant)

PO

ALPHA-ADRENERGIC AGONIST DRUGS used in many cold/allergy products

acarbose (Precose)

ALPHA-GLUCOSIDASE INHIBITORS

COMPLICATIONS OF RENAL FAILURE (prt 1)

ANEMIA-IMPAIRED ERYTHROPOIETIN PRODUCTION HYPERKALEMIA-UNABLE TO ADEQUATELY EXCRETE POTASSIUM HYPERPHOSPHATEMIA-UNABLE TO ADEQUATELY EXCRETE PHOSPHAT

mebendazole

ANTHELMINTIC AGENTS Prototype: ______ (Emverm) (PO) Others: ivermectin (Stromectol) Interfere with metabolic processes causing death •Treats nematode infections (whipworm, pinworm, roundworm, & hookworm) •Mebendazole is not systemically absorbed (fewer side effects) •Adverse effects: transient abdominal pain, diarrhea, fever

clotrimazole

ANTIFUNGAL ("-AZOLE" SUFFIX) Prototype: _______ (Lotrimin/Mycelex) (topical creams, lozenges, vaginal) •Treatment of tinea pedis, tinea cruris, and tinea corporis; treatment of oral & vaginal candidiasis •Damages fungal cell wall causing cell death •Not absorbed systemically; not very dangerous; available OTC Adverse effects: •Topical- stinging, redness, rash, swelling •Vaginal-burning/irritation, urinary frequency, lower abdominal pain •Oral- N/V, abnormal liver function tests

amphotericin B

ANTIFUNGAL: AMPHOTERICIN B _____ ____ (AmBisome) (IV only) •A very potent IV antifungal reserved for the most severe systemic mycoses; reserved for progressive, potentially fatal infections due to high prevalence of dangerous side effects •Would only be used during pregnancy in life-threatening situations •Side effects: severe renal impairment, bone marrow suppression, GI irritation with N/V/D (severe), anorexia, weight loss, pain at IV site

fluconazole

ANTIFUNGALS ("-AZOLES" SUFFIX) Prototype: ______ (Diflucan) (PO, IV) Others: itraconazole (Sporonox), ketoconazole •Binds to sterols in cell membrane; fungicidal/fungistatic •Treats oropharyngeal, esophageal & vaginal candidiasis •Use w/ caution in liver or renal impairment; pregnancy •Adverse effects: HA, N/V/D, abdominal pain, rash

leucovorin calcium

ANTIMETABOLITES (Fusilev)- sometimes used as "rescue drug" to prevent serious toxicity; rescues "normal cells" by infusing folic acid

methotrexate

ANTIMETABOLITES Prototype- ______** (MTX, Rheumatrex)- also used for inflammatory disorders •Resemble natural metabolites; enter into normal cellular processes- antimetabolites disrupt nutrient or nucleic acid metabolism of rapidly growing tumor cells •Drugs are classified according to nutrients with which they interfere, such as folic acid, purine, and pyrimidine •Adverse effects: Bone marrow suppression**, N/V/D, anorexia, mucositis, renal toxicity, fatigue, malaise

doxorubicin

ANTINEOPLASTIC ANTIBIOTICS Prototype is _____ (Adriamycin)**** •Isolated from microorganisms and have antitumor properties; Interfere with DNA in a similar mechanism to alkylating agents; also have similar actions and adverse effects •More cytotoxic than traditional antibiotics •Must be administered IV or via a catheter into a body cavity •May cause vesication- blistering of the tissue •Adverse effect: * cardiac toxicity* {dexrazoxane (Zinecard) is a cytoprotectant}; alopecia, N/V/D, *red urine*, fever, chills, rash, bone marrow suppression

chloroquine

ANTIPROTOZOAL: ANTIMALARIAL("-QUIN" SUFFIX) Prototype: _______ (Aralen) (PO) •Others: quinine (Qualaquin); hydroxychloroquine •Blocks parasitic DNA reproduction •Avoid in pts with liver disease, alcoholism, pregnancy, or retinal disease •Side effects: HA, dizziness, fever, chills, malaise, N/V/D, anorexia, hepatic dysfunction, rash, pruritus, hypotension, retinal changes

metronidazole

ANTIPROTOZOAL: MULTIPLE USE Prototype: ______ (Flagyl) (PO, IV) Treats intestinal amebiasis, amebic liver abscess, trichomoniasis, some anaerobic bacteria •Bacterial cell death; prevents reproduction in protozoa •Side effects: HA, dizziness, ataxia, common GI upset, N/V/D, *metallic taste*, *darkening of urine*, *alcohol intolerance* •Alcohol causes disulfram-type reaction: facial flushing, sweating, N/V, severe headache, slurred speech, palpitations, psychosis

acyclovir

ANTIVIRAL: HERPESVIRUS Prototype: ______ (Zovirax) (PO, IV, Top) Others: famciclovir, valacyclovir •Family of DNA viruses; causes repeated blister-like lesions on the skin, genitals, and other mucosal surfaces. Ex.: shingles, fever blister, genital herpes

rimantadine

ANTIVIRAL: INFLUENZA Prototype: ______ (Flumadine) Others: amantadine (Symmetrel), oseltamivir (Tamiflu) •Unknown mechanism; prevents viral replication •Teratogenic; caution with renal impairment •Affects dopamine levels in brain •Side effects: light headedness, dizziness, insomnia, nausea, orthostatic hypotension, depression, Stevens-Johnsons

herpesvirus

ANTIVIRAL: _____ Prototype: Acyclovir (Zovirax) (PO, IV, Top) Antiviral drugs lower frequency of acute herpes virus episodes and diminish intensity of acute disease •Relieve acute symptoms, prevent recurrences• DO NOT provide cure •Recommended: Zoster vaccine (Zostavax), especially for those over 50 years old

adefovir

ANTIVIRALS: HEPATITIS B Prototype: ______ (Hepsera) (PO) Others: entecavir, telbivudine •Blocks DNA replication in the treatment of chronic Hep B •Caution in pt with liver or renal disease •Adverse effects: HA, asthenia, nausea, fatal hepatomegaly, nephrotoxicity, lactic acidosis

Nevirapine

ANTIVIRALS: HIV & AIDS HIV virus attacks helper T cells within the immune system •Prevent viral DNA replication •Adverse effects: HA, N/V/D, rash, liver dysfunction, chills, fever •Flu-like syndrome occurs often with anti-HIV drugs

nevirapine

ANTIVIRALS: HIV & AIDS Several different classes Prototype: _____ (Viramune) (PO) •Others: zidovudine (Retrovir); there are many

CREAM/LOTION FOR SKIN (SCABIES)

APPLIED TO ENTIRE SKIN AND ALLOWED TO REMAIN FOR 8-14 HOURS BEFORE BATHING; A SINGLE APPLICATION CURES 95% OF PATIENTS, ALTHOUGH ITCHING MAY CONTINUE FOR SEVERAL WEEKS

myalgia

AS NURSES WE MUST MONITOR FOR THIS ADVERSE EFFECT: Muscular pain, "muscle aches" THINK: Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)

rhabdomyolysis

AS NURSES WE MUST MONITOR FOR.... dissolution of striated muscle (muscle tenderness or weakness**) side affect of Statins: pravastatin (Pravachol); simvastatin (Zocor)

Hyperreflexia

Abnormally increased reflexes resulting from nervous system damage NOTE: this is an adverse affect for monoamine oxidase inhibitors (MAOIs)

consumer awareness

Access to information has become so broad in the past decade that consumers are often overwhelmed with details, facts, and choices that affect their health care.

Toxic effects (overdose)

Acetaminophen: Effects & Implications: Hepatotoxicity**; risk of liver damage is a concern •Thrombocytopenia •Antidote- acetylcysteine (Mucomyst)** given IV, protects the liver from toxic metabolites

Methylxanthines: aminophylline (Theophylline)

Act as bronchodilators- also stimulate the CNS and respiration, chemically related to caffeine Infrequently used in the treatment of asthma and other chronic lung diseases- narrow margin of safety

CHOLINERGIC AGONISTS (prt 1)

Act in one of two ways: By activating a tissue response at the receptors (direct acting)

CHOLINERGIC AGONISTS (prt 2)

Act in one of two ways: By inhibiting the action of the enzyme cholinesterase (indirect acting)

Potassium-Sparing Diuretics: spironolactone (Aldactone)

Act in the collecting duct and late distal tubule to enhance secretion of sodium and retention of potassium (opposite of aldosterone)

Adrenergic agonists (sympathomimetics)

Act on adrenergic receptor sites to produce epinephrine-like symptoms Used to treat •Nasal congestion •Hypotension •Cardiac arrest, heart failure, shock •Asthma •Premature labor contractions

Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)

Act on distal convoluted renal tubule- block sodium reabsorption and increase potassium and water excretion

Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)

Act on distal convoluted renal tubule- block sodium reabsorption and increase potassium and water excretion Not effective for immediate diuresis; used often for hypertension, mild/mod heart failure

Antitussives: dextromethorphan (Robitussin DM; Delsym)

Act on the cough control center in the medulla to suppress the cough reflex

Loop Diuretics: furosemide (Lasix)

Act on the loop of Henle to block reabsorption of sodium and chloride- sodium and water are lost Used in heart failure pts & when emergent need to move fluid (ex: pulmonary edema); given PO, IV, and IM

ADRENERGIC ANTAGONISTS (BLOCKERS)

Act to block alpha and/or beta receptor sites; Most block either alpha or beta receptors

Anticholinergics (inhaled): ipratropium (Atrovent)

Act to dilate bronchioles in patient with chronic obstructive lung disease who have daily symptoms; maintenance treatment of bronchospasm associated with COPD

Decreases preload & afterload, which decreases cardiac workload & oxygen demand

Action of Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)

Thiazolidinediones: rosiglitazone (Avandia)

Action- decrease tissue resistance to insulin and improve blood glucose control

Cardiac Glycosides = digoxin (Lanoxin)

Action- exerts a cardiotonic or positive inotropic effect- improves pumping ability; also has negative chronotropic and dromotropic effects- slows the heart rate and rate of electrical conduction**

Incretin Enhancers

Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption THINK: GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)

ALPHA-GLUCOSIDASE INHIBITORS: acarbose (Precose)

Action- inhibits a digestive enzyme in the small intestine responsible for release of glucose from carbohydrates in the diet, so digestion of glucose is delayed

BIGUANIDES: metformin (Glucophage)

Action- reduces fasting and postprandial glucose levels by decreasing hepatic production of glucose, reducing insulin resistance*, & alter intestinal absorption of glucose

Meglitinides: repaglinide (Prandin)

Action- stimulate beta cells to release insulin* Similar action to sulfonylureas Can be used alone or with other oral hypoglycemic classes

ACETAMINOPHEN

Action: Inhibits prostaglandin synthesis Uses: Relieves pain, discomfort, fever Maximum dose: 4 g/day Side effects: Lower incidence of GI distress Toxic effects/overdose; Hepatotoxicity; Thrombocytopenia Antidote- acetylcysteine (Mucomyst) Sometimes mixed with narcotics

Acetaminophen (Tylenol)

Action: Inhibits prostaglandin synthesis; reduces fever by acting on hypothalamus Uses: Relieves pain, discomfort, fever Maximum dose: 4 g/day*

RAAS

Activated when blood flow to kidneys is decreased (hypotension) Kidneys release renin which is transported to the liver Angiotensinogen (produced in liver) is converted to Angiotensin I

Direct acting cholinergic agonists

Activates a tissue response at the receptors

warfarin (Coumadin)

Acts by inhibiting hepatic synthesis of vitamin K, inhibiting clotting factors

digoxin (Lanoxin) = Cardiac Glycosides

Acts to inhibit sodium-potassium pump, resulting in an influx of calcium into cardiac cells- end result is more efficient muscle fiber contraction

administration of Methylxanthines: aminophylline (Theophylline) by........

Administer IV infusions slowly to avoid adverse effects of stimulatio

Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums) administration

Administer at least 2 hrs before or after other meds- antacids interfere with absorption

right time

Administer on time; acceptable to administer 30 minutes before scheduled time up until 30 minutes after (policy)

administration of epoetin alfa; erythropoietin (Epogen; Procrit)

Administered SQ or IV; don't shake solution

administration of Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)

Administered by nasal spray, drops, tablet, capsule, or liquid form

Nursing responsibility

Administering drugs Assessing drug affects Intervening to make the drug regimen more tolerable Providing patient teaching about drugs and drug regiment Monitoring the overall patient care to prevent medication errors

Corticosteroids

Adrenal Disorder Drugs: glucocorticoids and mineralocorticoids) for adrenal dysfunction (adrenal insufficiency- Addison disease

Opioid agonist-antagonist (partial agonists) (prt 2)

Advantages are decreased risk of opioid abuse; butorphanol more often used for pain control during labor; less risk of respiratory depression for mom & baby

Penicillins ("-cillins" suffix)

Adverse Affects & other things to monitor for with this "-cillin" drug Monitor for bleeding- may lower RBC, WBC, and platelet counts (bone marrow suppression) •Monitor renal function in compromised patients. •Monitor closely during first couple doses for allergy •Rapidly absorbed in gi tract; Take on empty stomach (Take 1 hour before or 2 hours after meals) •Check for superinfection (yeast infections, hairy tongue)

meropenem

Adverse Affects GI toxicity: ______ almost always causes very uncomfortable GI effects the use of this drug has been associated with potential fatal pseudomembranous colitis furthermore, this drug results in headaches, dizziness, rash, and superinfections due to these adverse reaction this drug is only used in those infections with PROVEN sensitivity to the drug

red man syndrome

Adverse affect of vancomycin rash on the upper body caused by certain anti-infectives

adverse effects of Methylxanthines: aminophylline (Theophylline)

Adverse effects include nausea, vomiting, stomach pain, headache, nervousness, hypotension, dysrhythmias, convulsions

Ibuprofen

Adverse effects of a nonspecific inhibitor: Nausea, vomiting, heartburn, epigastric pain & dizziness; rash •GI ulcers & GI bleeding •Can lead to renal (kidney) impairment

monoamine oxidase inhibitors (MAOIs)

Adverse effects- constipation, dry mouth, orthostatic hypotension, delirium, CNS stimulation, mania, dizziness, vertigo, hyper-reflexia, potential for hypertensive crisis

Adverse effects of Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)

Adverse effects- headache, N/V/D**, rash, abdominal pain, vertigo, insomnia

adverse effects of Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)

Adverse effects: HA, N/V/D, dizziness; confusion (elderly); somnolence, cardiac arrhythmias, gynecomastia (Tagamet)

Adverse effects: Alpha Adrenergic Blockers - prazosin (Minipress); doxazosin (Cardura)

Adverse effects: HA, dizziness, tachycardia, hypotension, nausea, dyspepsia, diarrhea, edema, flushing, nasal congestion, priapism

Adverse effects of OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)

Adverse effects: bleeding**, bruising, HA, dizziness, rash, stomach upset, abdominal pain, diarrhea, thrombocytopenia

Opioid agonist-antagonist (partial agonists) (prt 3)

Adverse effects: dizziness, sedation, euphoria, N/V, constipation, palpitations, sweating, ureteral spasm, dependence

Anticonvulsants for Partial Seizures: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO)

Adverse effects: drowsiness, ataxia, dizziness, N/V, hepatitis, hematological disorders( anemia, agranulocytosis), Stevens-Johnson syndrome

benzodiazepines

Adverse effects: drowsiness, sedation, depression, abnormal heart rhythm; CNS depression (esp. respiratory)

Paralytic Agent: succinylcholine (Anectine)

Adverse effects: respiratory depression/arrest; apnea; bronchospasm, arrhythmias MUST have respiratory support (either by hand or mechanical ventilation); continuous oxygenation & cardiovascular monitoring; only administered in areas where ventilation is provided (ACLS)

Methylphenidate (Ritalin)

Adverse reactions include insomnia*, nervousness, anorexia*, weight loss, irritability, nausea, abdominal pain, tachycardia

Adverse reactions of heparin

Adverse reactions: hemorrhage (occult blood, hematuria, bleeding gums, bruising); thrombocytopenia; use cautiously with patients who have spinal anesthesia (bleeding at spinal site)

alteplase (Activase, tPA); streptokinase (Streptase) can cause allergic reaction....

Allergic reactions are possible with the drugs- more with streptokinase than the others THINK: THROMBOLYTIC DRUGS

Uses for steroids

Allergies Asthma Cancer Edema (hepatic, neurologic, renal disorders)Inflammatory bowel disease (& other inflammatory disorders)

prazosin (Minipress); doxazosin (Cardura)

Alpha Adrenergic Blockers

carvidolol olol (Coreg) metoprolol (Lopressor) = Beta Blockers

Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II Used in heart failure to decrease cardiac workload- slow the heart rate and decrease blood pressure; Use with caution in patients with asthma or heart failure (due to negative inotropic effect)

benzodiazepines

Also intensify effect of GABA (inhibit neurotransmitters) Used to treat various types of seizures, as well as acute status epilepticus (rapid sequence of seizures, no recovery period in between) May be administered IV to stop an acute seizure- beware of respiratory depression

Health Maintenance Organization (HMO)

Alternative means of health care in which people or their employers are charged a set amount and the HMO provides health care and covers hospital costs.

Preload

Amount of blood brought back to the heart to be pumped; degree to which myocardial fibers are stretched just prior to contraction

Muscle

An injection administered into _____ (IM) will usually be absorbed faster than a subcutaneous injection due to more capillaries in the muscle tissue

chemotherapeutic adverse reactions

Anemia- low RBC count*** Neutropenia- low WBC count*** Thrombocytopenia- low platelet count*** Anorexia, nausea, vomiting, diarrhea Mucositis (stomatitis)- changes in oral mucosa Alopecia- hair loss Fatigue Infertility

CAD symptoms

Angina, SOB, palpitations, tachycardia, nausea, sweating, tachycardia

RAAS (prt 2)

Angiotensin I travels to lungs where it is converted to Angiotensin II by angiotensin-converting enzyme (ACE) Angiotensin II causes widespread vasoconstriction (raising BP) Aldosterone is also released by adrenal cortex which causes retention of Na & water Also, antidiuretic hormone (ADH) from posterior pituitary is

losartan (Cozaar); valsartan (Diovan)

Angiotension II Receptor Blockers

losartan (Cozaar); valsartan (Diovan)

Angiotension II Receptor Blockers (ARBs)

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)

Antacids

systemic

Anti-infective agents ae used to treat ___ infections and sometimes as a mean of prophylaxis (to prevent infections BEFORE they occur)

natural resistance

Antibiotics act on specific enzyme systems or processes, so bacteria that don't use that particular system or process are said to be naturally resistant

atropine (Atropair)

Anticholinergic Drug: blocks acetylcholine at the muscarinic receptor

Most common side effects

Anticholinergic Drug: atropine (Atropair) = dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urinary retention, mydriasis (dilation)

Antiemetic Drugs: Prescription antiemetics

Anticholinergics and antihistamines Benzodiazepines- lorazepam (Ativan) Phenothiazines Serotonin (5-HT3) antagonists Corticosteroids- dexamethasone (Decadron) and methyprednisolone (SoluMedrol)- chemotherapy Cannabinoids- marijuanaAntimetics

benztropine (Cogentin) & diphenhydramine (Benadryl)

Anticholinergics to Treat Parkinsons: Adverse effects: Disorientation, confusion, memory loss, dizziness, depression, blurred vision, dry mouth, constipation, urinary retention & hesitation, flushing, decreased sweating Use with caution in clients taking drugs with other anticholinergic properties such as TCAs and phenothiazines

benztropine (Cogentin) & diphenhydramine (Benadryl)

Anticholinergics to Treat Parkinsons: Not as effective in treating Parkinson's as dopaminergic drugs but can be used as adjunct therapy to suppress the effects of acetylcholine dominance Can also be used to treat side effects from cholinergic drugs (again opposite acting)

desmopressin (DDAVP, Stimate) OR vasopressin (Pitressin)

Antidiuretic Hormone Deficiency

vasopressin (Pitressin)

Antidiuretic Hormone Deficiency administered IV has shorter half life & causes vasoconstriction

Adverse effects: desmopressin (DDAVP, Stimate) OR vasopressin (Pitressin)

Antidiuretic Hormone Deficiency: Adverse effects: HA, facial flushing, nausea, fluid retention, increase in BP, local reaction at injection site, possible water intoxication at high doses Monitor vital signs (esp. BP), monitor I&O, monitor electrolytes (esp. sodium)

antidote for Warfarin (Coumadin)

Antidote for Coumadin toxicity is Vitamin K; for acute bleeding, fresh frozen plasma

Acetylcysteine (Mucomyst)

Antidote for toxic effects of acetaminophen is ______ ** given IV, protects the liver from toxic metabolites

Antimetics: Diphenhydramine (Benadryl); scopolamine

Antihistamines and Anticholinergics Side effects: drowsiness, dizziness, dry mouth

A- Alpha1 blockers

Antihypertensives categories: Alpha2 agonists; Angiotensin converting enzyme (ACE) inhibitors; Angiotensin receptor blockers (ARBs)

Direct Vasodilators (diuretics)

Antihypertensives categories: Decrease the BP by relaxing vascular smooth muscle and reducing SVR.

Calcium Channel Blockers

Antihypertensives categories: agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension

B-Beta Blockers

Antihypertensives categories: decrease heart rate and dilate arteries by blocking beta receptors

Atypical

Antipsychotic Drugs (two major categories) block both dopamine & serotonin receptors; used to treat both positive and negative symptoms Less side effects than typical (balanced suppression) Seen frequently now as first line drugs

Conventional (Typical)

Antipsychotic Drugs (two major categories) block dopamine receptors & limit stimuli in the brain; more helpful for positive symptoms Phenothiazines & Nonphenothiazines

anticonvulsants

Antiseizure medications are sometimes called ______

dextromethorphan (Robitussin DM; Delsym)

Antitussives

influenza

Antiviral: _____ Best approach—vaccination for prevention***• ______ used to prevent illness, decreases severity of acute symptoms when infected •Flu type A, B, H1N1, RSV (respiratory viruses)

Herpesvirus

Antiviral: ______ Use drugs with extreme caution with pre-existing renal or hepatic disease; use caution in clients who are dehydrated •Side effects: HA, vertigo, tremors, N/V, rash •Judicious use is warranted during pregnancy •Emphasize compliance with antiviral therapy •Some drugs cause digestive distress and should be taken with food

Nursing Care for

Anxiolytics/Sedatives/Hypnotics: Fall safety precautions Watch for side/adverse effects: drowsiness, dizziness, respiratory distress

mechanical ventilation indications

Apnea Acute ventilatory failure/ acute respiratory failure: Insufficient spontaneous ventilation VC <1000 MIP <20 PCO2 >45

Supraventricular arrhythmias

Arrhythmia a.k.a. Dysrhythmia that originate in the atrium (above the ventricle)

Ventricular Arrhythmias

Arrhythmia a.k.a. Dysrhythmia that originate in ventricles; typically more dangerous because more likely to affect cardiac output

TYPES OF DRUGS AFFECTING COAGULATION

Aspirin & clopidogrel (Antiplatelets) Heparin, enoxaparin, warfarin, Pradaxa & others (Anticoagulants) Alteplase, reteplase, streptokinase (Thrombolytic agents) Protamine sulfate (reversal agent for heparin) Vitamin K (reversal agent for warfarin)

GENERAL NURSING CARE- ALL OPIOIDS

Assess for allergy Use a pain scale to evaluate effectiveness of drug Monitor for adverse effects (especially respiratory for agonists); also monitor for constipation Monitor vital signs

Nursing Care- Laxatives

Assess medical history to determine cause of bowel problems Encourage increased water intake and high fiber foods Remind that drug is not for long-term use Teach how to mix and take drugs correctly

Nursing Care/Implications- Anticonvulsants

Assess patient's knowledge about medication regimen and promote compliance Monitor lab tests that are indicated- such as serum levels, liver enzymes Teach patients about possible side/adverse effects of drugs, such as gingival hyperplasia, slurred speech, dizziness

Nursing Care for Thyroid Hormone Drugs (prt 2)

Assess thyroid and glucose levels Regulate environmental temp for comfort Dietary teaching- some foods inhibit thyroid secretion- hypo function can cause constipation; drink fluids

Drug to drug interactions

At the side of action One drug may be in antagonist of the other drug or may cause effects that oppose those of the other drug, leading to non-therapeutic effect

Drug to drug interactions

At the site of absorption One drug prevents work ceasing absorption of the other drug

Nursing Care- Drugs for Gastric Acid Disorders

Avoid giving antacids with other oral drugs- wait 1-2 hrs before administering Explain that treatment with PPIs and H2 blockers may take a few wks for therapeutic results Monitor fluid and electrolyte balance

Nonpharmacologic measures to treat gastric acid disorders should be used before drugs:

Avoid tobacco and alcohol Lose weight Avoid hot, spicy, greasy foods; also caffeine, chocolate, citric acids Elevate head of bed, don't eat before bedtime Wear loose-fitting clothes NOTE: Continue these measures after drugs have been used to prevent recurrence

prednisone should be avoid in pt with _______

Avoid use in pts with active infections (viral, bacterial, fungal or protozoal) because it suppresses the body's own immune system; can mask infection***

b/c POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) work like aldosterone....

BECAUSE WORK LIKE ALDOSTERONE CAUSE ANDROGEN EFFECTS: HIRSUTISM, GYNECOMASTIA, DEEPENING OF VOICE, IRREGULAR MENSES; OTHER MASCULINE SYMPTOMS

metformin (Glucophage)

BIGUANIDES

Anticholinergic effects

BLOCK the effects of acetylcholine in the PNS dry mouth constipation photophobia blurred vision Tachycardia

URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)

BLOCKS SPASMS OF URINARY TRACT CAUSED BY VARIOUS CONDITIONS SUCH AS CYSTITIS, PROSTATITIS, URETHRITIS

Direct Vasodilators = hydralazine (Apresoline)

BP decreases and sodium and water are retained- cause peripheral edema- may give diuretics to decrease edema

Intermediate-acting

Barbiturates (- "tal" suffix) Classified as: & used for sustained sedation

Long-acting

Barbiturates (- "tal" suffix) Classified as: such as phenobarbital USED FOR- sedation and may be used to treat seizures

Short-acting

Barbiturates (- "tal" suffix) Classified as: used to induce sedation or as adjunct to general anesthetic- THINK: thiopental (Pentothal)

addiction

Barbiturates (- "tal" suffix) have a higher potential for _____, dependence, & respiratory depression

Phenobarbital (Luminal)

Barbiturates: Adverse effects: drowsiness, somnolence, Vit D & B deficiencies; laryngospasms; can cause severe CNS depression, hypnosis, coma & death; hallucinations, nightmares, do NOT take with alcohol or other CNS depressants; hypoventilation, respiratory depression

phenobarbital (Luminol)

Barbiturates: Intensify the action of gamma-aminobutyric acid (GABA), a neurotransmitter that has inhibitory function; end result is CNS depression (decreased neuron firing) Used to treat various types of seizures

heparin

Before discontinuing ______, oral therapy with warfarin (Coumadin) or Plavix usually is begun

anxiety

Benzodiazepine (pam/lam) are used for ____ can also be used to enhance pre-anesthesia medication

flumazenil (Romazicon)

Benzodiazepine antagonist- this is a reversal agent for benzodiazepines*****

midazolam (Versed)

Benzodiazepine/Pre-Operative Sedative Prototype: _____ (versed) (PO, IM, or IV)

BEST USE for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)

Best when used within 4-6 hours of event (stroke)

atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)

Beta Blockers (- "olol" suffix)

carvidolol (Coreg) metoprolol (Lopressor)

Beta Blockers (- "olol" suffix)

carvidolol olol (Coreg) metoprolol (Lopressor)

Beta Blockers (- "olol" suffix)

albuterol (Proventil)

Beta2 Adrenergic Agonists- Bronchodilators

cholestyramine (Questran)

Bile Acid Sequestrant

Lithium (Eskalith; Lithobid)

Bipolar Disorder: Manic Mood Stabilizers Adverse effects- headache, lethargy, fatigue, memory loss, muscle weakness, hand tremors, tinnitus, blurred vision; N/V/D; if dehydrated can lead to cardiovascular collapse, coma

Lithium (Eskalith; Lithobid)

Bipolar Disorder: Manic Mood Stabilizers: Has a narrow therapeutic serum range- 0.6 to 1.5 mEq/L- greater than 1.5 to 2- toxicity Should be monitored biweekly until therapeutic level has been obtained, then monthly on the maintenance dose

lithium (Eskalith; Lithobid)

Bipolar Disorder: Manic Mood Stabilizers: Used to treat the manic symptoms of bipolar affective disorder Increases receptor sensitivity to serotonin Newer seizure drugs also used, such as valproic acid (Depakene)

Adequate

Bipolar Disorder: Manic Mood Stabilizers: Lithium (Eskalith; Lithobid) Caution in patients on diuretics; _____ fluid and sodium intake should be maintained

monitor sodium

Bipolar Disorder: Manic Mood Stabilizers: Lithium (Eskalith; Lithobid) Conditions where sodium is lost (sweating/dehydration) lithium toxicity can occur ____ ____

Adrenergic Antagonists/Blockers

Block by occupying the receptors or indirectly by inhibiting the release of the neurotransmitters norepinephrine and epinephrine

Phenothiazines (1st Gen)

Block dopamine receptors; limit brain stimuli; also have anticholinergic, antihistamine & alpha-adrenergic blocking effects

Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)

Block histamine receptors of parietal cells in stomach- reduce acid secretion Available over-the-counter

Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)

Block the calcium channel in vascular smooth muscle, promoting vasodilation (can also decrease heart rate) (smooth muscle relaxer-uterus) Many are used to treat chronic hypertension, angina, and dysrhythmias

Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)

Block the calcium channel in vascular smooth muscle, promoting vasodilation (can also decrease heart rate) (smooth muscle relaxer-uterus) Many are used to treat chronic hypertension, angina, and dysrhythmias

SSRIs

Block the reuptake of serotonin into the nerve terminal- enhancing its transmission at the synapse More costly than TCAs but have less side effects

Sliding Scale Insulin

Blood glucose checks are done and Insulin is ordered according to a scale

inflammation

Body's defense mechanism in response to toxic chemicals, extreme heat, invading microorganisms, or cell death

Types of laxatives

Bulk-forming Saline (Osmotic) Stimulants Stool softeners Herbal

mixed opioid agonist

Buprenorphine

TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) administration

CAN BE GIVEN PO OR IV; HOWEVER, NEVER, NEVER, NEVER GIVE POTASSIUM IV PUSH AS IT WILL CAUSE SUDDEN CARDIAC ARREST; NOT TO BE CONFUSED WITH IV DRIP SUCH AS D5W W/ 20 MEQ KCL

ACETAZOLAMIDE (DIAMOX)

CARBONIC ANHYDRASE INHIBITORS

CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX)

CARBONIC ANHYDRASE IS A COMPONENT IN THE FORMATION OF SODIUM BICARBONATE & THE EXCRETION OF HYDROGEN (WHICH IS WHY URINE IS USUALLY SLIGHTLY ACIDIC)

OSMOTIC DIURETICS: MANNITOL (OSMITROL) can cause cardiac.....

CARDIAC DECOMPENSATION IN PT WITH HEART FAILURE

THIAZIDE SIDE EFFECTS & NURSING CONSIDERATIONS

CAUSE CALCIUM REABSORPTION- HYPERCALCEMIA CAN OCCUR WATCH FOR DEHYDRATION, HYPOKALEMIA*, & HYPERGLYCEMIA (MAY ELEVATE BLOOD GLUCOSE)

Cytotoxic reactions (Type II)

CBC shows damage to blood cells treatment: D/C the drug

M phase (mitosis)

CELL DIVISION prophase, metaphase, anaphase, telophase

viruses

CHARACTERISTICS OF _____: nonliving intracellular parasite virions

Leukotrienes

CHEMICAL MEDIATORS Increased permeability of blood vessels, phagocytic attachment ***similar to histamines

complement

CHEMICAL MEDIATORS proteins; destroys the antigen; stimulates histamine

Cyclooxygenase (COX)

CHEMICAL MEDIATORS the enzyme responsible for converting arachidonic acid into prostaglandins and their products ***related to prostaglandins

Prostaglandins

CHEMICAL MEDIATORS Modified fatty acids that are produced by a wide range of cells. ***attract WBCs; cause pain & induce fever

histamine

CHEMICAL MEDIATORS a compound that is released by cells in response to injury and in allergic and inflammatory reactions, causing contraction of smooth muscle and dilation of capillaries ***cause vasodilation, smooth muscle constriction, tissue swelling & itching

bradykinin

CHEMICAL MEDIATORS a powerful vasodilator that increases capillary permeability and constricts smooth muscle ***vasodilator, also causes pain

Inflammation

CLINICAL PRESENTATION OF _______: Signs •Redness •Swelling (edema) •Heat •Pain •Loss of function •Fever (sometimes)

Prototype- methylphenidate (Ritalin)

CNS Stimulants: Drugs for ADHD

atomoxetine (Strattera)

CNS Stimulants: Drugs for ADHD Non-CNS stimulants are also used, but are more effective as adjuncts

Methylphenidate (Ritalin)

CNS Stimulants: Drugs for ADHD Schedule II controlled substances

paradoxical hyperactivity

CNS Stimulants: Drugs for ADHD: Prototype- methylphenidate (Ritalin) These drugs may create ___ ____

Nursing Care- Steroids s/e

CNS effects- euphoria, nervousness, insomnia, personality changes Acne Facial hair Menstrual changes Impaired ability to respond to stress Increased blood glucose levels

Norco/Vicodin

COMMON COMBINATION ANALGESICS: hydrocodone & acetaminophen

Percocet

COMMON COMBINATION ANALGESICS: oxycodone & acetaminophen

Percodan

COMMON COMBINATION ANALGESICS: oxycodone & aspirin

oral candidiasis

COMMON TYPE OF mycoses: a white deposit on the tongue which is EASILY scraped away, usually seen in immunocompromised patients

tinea pedis

COMMON TYPE OF mycoses: athlete's foot

Tinea curis

COMMON TYPE OF mycoses: jock itch. dermatophyte infection in groin (used topical agents or oral antifungals)

tinea corporis

COMMON TYPE OF mycoses: ringworm of the body

THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)

CONSIDERED MILD DIURETICS ACT ON DISTAL CONVOLUTED RENAL TUBULE- BLOCK SODIUM & CHLORIDE REABSORPTION (LOST); WHILE INCREASING POTASSIUM AND WATER EXCRETION

Purpose of heart is

CONTRACTION: its pumping action (think of heart as a pump)

OSMOTIC SIDE EFFECTS & NURSING CONSIDERATIONS

CRYSTALLIZATION IN THE VIAL WHEN EXPOSED TO LOW TEMPERATURE; *USE FILTER NEEDLE* WATCH KIDNEY FUNCTION, MONITOR POTASSIUM, CALCIUM, URIC ACID, AND GLUCOSE LEVELS

Prototype- nifedipine (Procardia); diltiazem (Cardizem)

Calcium Channel Blockers

nifedipine (Procardia); diltiazem (Cardizem)

Calcium Channel Blockers

Avoid grapefruit juice

Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem) inhibits metabolism of drug & may cause toxic levels

Peripheral edema may occur with what type of drug?

Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem) NOTE: since these drug lead to peripheral edema they may be taken with a diuretic

beta blockers = atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)

Can *mask symptoms of hypoglycemia*

diuretics can affect.....

Can affect one or more segments of the renal tubules

Benefit of Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)

Can be given at home because aPTT monitoring is not necessary

acetaminophen

Can interfere with Warfarin (Coumadin) and cause toxic levels of the anticoagulant to occur ****May increase liver enzymes*

antidote for Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)

Can still use Protamine Sulfate as antidote, if necessary

HEPARIN (ANTICOAGULANT) cannot be absorbed....

Can't be absorbed orally through the GI tract; given SQ for prophylaxis or IV for treatment of acute thrombosis; apply firm pressure after SQ administration and don't rub site

INSULIN ADMINISTRATION

Cannot be given orally Give subcutaneously at 90 degree angle with insulin syringe- do not rub after injection

digoxin (Lanoxin)

Cardiac Glycosides

What medication works best when patient achieves a steady state tissue concentration

Cardiac Glycosides = digoxin (Lanoxin) BE SURE TO - check therapeutic level

Opioid agonist-antagonist (partial agonists)

Cause analgesia but withdrawal symptoms or adverse effects are not as intense due to partial activity of receptor subtypes; work on either the mu or kappa receptors but not both

Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) = Cause calcium reabsorption

Cause calcium reabsorption- hypercalcemia can occur

hydrochlorothiazide (Microzide, HydroDIURIL, HCT) = Thiazide Diuretics

Cause calcium reabsorption- hypercalcemia can occur Watch for dehydration, hypokalemia*, & hyperglycemia (may elevate blood glucose) Uric acid levels may elevate and precipitate gout

Laxatives: stool softeners = docusate (Colace)

Cause more water and fat to be absorbed into stools; May be used to prevent constipation- example- hospitalized patients

Angiotension II Receptor Blockers (ARBs): losartan (Cozaar); valsartan (Diovan)

Cause vasodilation and decrease peripheral resistance- however, decrease in cough from bradykinin; less likely to cause angioedema

losartan (Cozaar); valsartan (Diovan) (ARBs)

Cause vasodilation and decrease peripheral resistance- however, decrease in cough from bradykinin; less likely to cause angioedema Side effects: dizziness, HA, diarrhea, abdominal pain, hypotension

celecoxib (Celebrex)

Celebrex (Cox-2 Inhibitor) Drug of choice for patients with severe arthritic conditions who need high doses of an antiinflammatory drug, because of the risk for GI ulcer and bleeding •Watch for dyspepsia, GI irritation, diarrhea

Easily

Cells that reproduce or are replaced rapidly such as bone marrow cells, Gastrointestinal cells, hair follicles are more_____ affected by these chemotherapeutic agents

baclofen (Lioresal)

Centrally Acting Muscle Relaxants Others: carisoprodol (Soma)•Work in the CNS to interfere with reflexes that are causing the muscle spasm; often referred to as spasmolytics Often used in addition to rest, physical therapy, & other treatments Adverse effects: drowsiness, dizziness, weakness, fatigue, constipation, HA, insomnia, hypotension, nausea, dry mouth, urinary frequency Avoid alcohol & other CNS depressants

Speed

Certain foods that increase stomach acid ID, such as milk products, alcohol, and protein, also _____ the breakdown of mini drugs This is why oral drugs are given typically one hour before or two hours after a meal

platyhelminths

Cestodes = tapeworms bilaterally symmetric, flat bodies, unsegmented, mouth but no anus

Meropenem (Merrem)

Ch. 8 Anti-infective Agents Drug List: carbapenem antibiotic

Vancomycin

Ch. 8 Anti-infective Agents Drug List: Blocks cell wall synthesis by sequestration Blocks peptidoglycan synthesis by binding to a portion of the bacterial cell wall, inhibiting bacterial cell wall synthesis

Bacitracin MOA

Ch. 8 Anti-infective Agents Drug List: Is an antibiotic ointment MOA: Inhibition of 2nd stage wall synthesis

Gentamicin

Ch. 8 Anti-infective Agents Drug List: MOA: Inhibit protein synthesis go inside cell, unlike all drugs we have talked about so far aminoglycoside antibiotic Aminoglycoside. Binds to 30s subunit. Gram +/- effective, better gram -. First line bacterial ocular tx. SE: SPK and delayed re-epithelialization.

Polymyxin B

Ch. 8 Anti-infective Agents Drug List: MOA: disrupts membrane structure and function injury to plasma membrane cationic detergent that disrupts bacterial membranes causes neurotoxicity and acute tubular necrosis

Parkinson's disease

Characteristics are tremors, muscle rigidity, bradykinesia (extreme slowness), difficulty with 'purposeful' movements, postural instability, & affective flattening, shuffling gait, mask-like facial appearance, difficulty swallowing

NMS

Characterized by fever, altered mental status/confusion, muscle rigidity, and autonomic dysfunction (variable blood pressure, heart rate and temperature)

hormones

Chemical messengers, mostly those manufactured by the endocrine glands, that are produced in one tissue and affect another

Drugs

Chemicals that are introduced into the body to bring about change

Fried rule

Child's dose (1-2 years) = child's age (months) / (150 x average adult dose)

Surface area rule

Child's dose = surface area of child (sq m) / (1.73 x average adult dose)

Clark Rule

Child's dose = weight of child (lb) / (150 x average adult dose)

small intestine

Cholesterol Absorption Inhibitors: Ezetimibe (Zetia) work in which intestine small or large???

cholinergic agonists

Cholinergic drugs are also used to treat anticholinergic toxicity (overdose of anticholinergic drug)

diuretic classes

Classes: ◦Thiazide diuretics ◦Loop diuretics ◦Osmotic diuretics ◦Potassium Sparing diuretics ◦Carbonic anhydrase inhibitors

Controlled substance act of 1970

Classifies 5 levels of drugs that have potential for abuse and are restricted in their distribution. The DEA was created by the CAS to enforce its regulations CII records must be kept for 7 years and stored separately

Pharmacotherapeutics

Clinical pharmacology this is the branch of pharmacology that deals with drugs; chemicals that are used in medicines for the treatment; prevention and diagnosis of disease in humans

Insulin isophane NPH 50/50

Combination insulin: NPH 50%, regular 50%

Humalog 75/25

Combination insulin: lispro protamine 75%, lispro 25%

Humulin 70/30

Combination insulin: (NPH/regular) NPH 70%, regular 30%

Helicobacter pylori Treatment

Combinations of drugs classes, usually 2 antibacterials and an acid blocking drug for 7-14 days

Pepsin inhibitor: sucralfate (Carafate

Combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin Side effect: sleepiness, dizziness, vertigo, insomnia, rash, N/VD, indigestion, dry mouth

Common side effects of ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

Common side effect is a persistent, dry cough****(increase in bradykinin causing inflammation); Watch for hyperkalemia*** (potassium sparing diuretics increase this risk)***; May cause angioedema (swelling of tongue & oral pharynx)

THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase) are commonly used in early minutes of......

Commonly used in early minutes of onset of symptoms of MI or thrombotic CVA to preserve tissue and prevents negative outcomes (may also be used to restore patency to central lines)

calculating dose

Concentration X duration of exposure X rate = dose

low molecular weight heparin: enoxaparin (Lovenox) is contraindicated in.....

Contraindicated in CVA, peptic ulcers, and blood anomalies- do not give if having eye, brain, or spinal surgery

Thiazolidinediones: rosiglitazone (Avandia) is contraindicated in patients with______

Contraindicated in patients with symptomatic heart disease and later stages of CHF May be used in combination with other oral hypoglycemic drugs

THROMBOLYTICS are contraindicated in.....

Contraindicated in recent major surgery patients and trauma patients****; intracranial hemorrhage is also concern; caution if hx of GI bleed THINK: this is part of your nursing care for this drug class!!

Stoke volume

Control of Blood Pressure: amount of blood that is pumped out of the ventricle with each heartbeat (volume of blood)

Peripheral resistance

Control of Blood Pressure: resistance of the muscular arteries to the blood being pumped

Baroreceptors (pressure receptors)

Control of Blood Pressure: sends info to the brain about blood pressure (feedback mechanism)

Coronary Circulation

Coronary blood vessels delivers oxygenated blood back to myocardium

OPIOID AGONISTS (prt 2)

Cough suppression (codeine) Most are Schedule II drugs Most are derived from opium poppy plant; some are synthetic Undergo first-pass metabolism- oral doses must be larger

WARFARIN/COUMADIN

Coumadin has a long half-life and very long duration = Drug accumulation can occur and cause bleeding

Nursing Implications & Care- Digoxin

Count apical pulse rate for 1 full minute before administering; hold if below 60 beats per minute Teach patient and family to take pulse and to seek health care provider's advice for rates less than 60 bpm or more than 100 bpm (adults). Monitor for hypokalemia- may cause dysrhythmias & toxicity Patients should maintain adequate dietary intake of potassium as directed by health care provider.

transdermal

Crossing through the skin. Example: The physician prescribed a transdermal nicotine patch for a patient participating in the smoking cessation program. BE SURE TO WEAR GLOVES

monoamine oxidase inhibitors

Currently not used often- MANY drug-drug & drug-food interactions CNS stimulants (vasoconstrictors, cold medicines) can cause adverse reaction when taken with MAOIs

URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM)

DIRECT TOPICAL ANALGESIC EFFECT ON THE URINARY TRACT MUCOSA TO REDUCE SYMPTOMS OF URINARY TRACT IRRITATION (FROM INFECTION, TRAUMA OR SURGERY)

Incretin enhancers

DRUGS FOR DIABETES: Mimics Glucagon Like Peptides-1 agonists (promotes release of insulin) Dipeptidyl Peptidase (P-4) inhibitors (therefore promoting release of insulin)

nursing considerations for pain medication (prt 2)

Decrease doses slowly in those who may have physical dependence

Beta Blockers: carvidolol olol (Coreg) metoprolol (Lopressor)

Decrease heart rate and myocardial contractility, reducing cardiac output & oxygen demand *Monitor HR & BP*

Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor)

Decrease heart rate and myocardial contractility, reducing cardiac output and therefore lowering BP *Monitor HR & BP* Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II

Beta Blockers: atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)

Decrease heart rate and myocardial contractility, reducing cardiac output and therefore lowering BP *Monitor HR & BP* Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II

Major responses of anticholinergics

Decrease in GI motility Decrease in salivation Dilation of pupils (mydriasis)

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions NOTE: this is a adverse effect of the Tricyclic Antidepressants (TCAs) Imipramine (Tofranil)

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions THINK: adverse reaction of Opiate Agonists

Local Anesthetics: lidocaine (Xylocaine)

Decreases pain by blocking conduction of pain impulses in a specific area; does NOT cause loss of consciousness Early symptom of toxicity is CNS excitement; irritability, confusion

Parkinson's Disease

Degenerative disorder of the CNS caused by death of neurons that produce the neurotransmitter dopamine

Teach about side effects of steroids

Delayed wound healing Masked infection Bone changes "Moon face" and weight gain Increased appetite

Circulation

Delivers blood containing oxygen & nutrients throughout the body

Subcutaneous injections

Deposit the drug just under the skin, where it is slowly absorbed into circulation With this method of injection the time of absorption varies depending on the fat content of the injection site in the state of local circulation

Nursing Care- Antimetics

Determine cause of illness and treat Use nonpharmacologic methods to relieve nausea Encourage rest Replace lost fluids

prednisone contradicted in

Diabetic patients will likely require more insulin (& non-diabetic patients may temporarily require it) When used with Amphoteracin B can cause increased potassium loss

dantrolene (Dantrium)

Direct Acting Skeletal Muscle Relaxants: Acts directly within the muscle fibers, interfering with the release of calcium; this prevents muscle contraction Can be liver toxic, especially if combined with estrogen Increase fluid intake because drug may cause crystalline urine and painful urination Adverse effects: drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, BP changes, rash, and urinary frequency

Mucolytic: acetylcysteine (Mucomyst)

Directly loosens thick bronchial secretions by inhalation; decreases viscosity in respiratory secretions; also protects liver from acetaminophen effects in overdose-PO administration

barbiturates

Discontinuance should be gradual to avoid recurrence of seizures Soft tissue irritant/inflammation when given IM; can cause tissue necrosis (vesicant) when given IV

what Promote water and electrolyte loss, which decreases extracellular fluid volume

Diuretics

DO NOTE GIVE IRON SUPPLEMENTS: ferrous sulfate (iron) with.....

Do NOT give with antacids or Tetracycline; DO take with Vitamin C to increase absorption*; liquid forms may stain teeth*; *iron overdose may be fatal in young children*** (causing CNS toxicity progressing to coma/death)

Potassium-Sparing Diuretics: spironolactone (Aldactone) do not cause.......

Do not cause a loss of potassium- patient does not require a potassium supplement, as with other diuretics that cause a loss

Potassium-Sparing Diuretic = spironolactone (Aldactone)

Do not cause a loss of potassium- patient does not require a potassium supplement, as with other diuretics that cause a loss Must be monitored for hyperkalemia- serum potassium should be 3.5 to 5mEq/L Used as mild diuretics or in combination with another diuretic

Intranasal Corticosteroids: fluticasone (Flonase) Do not cause...

Do not cause the systemic effects of steroids taken by other routes

DO NOT give w/i ..... for Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)

Do not give within an hour of antacids (decreases absorption)

Placebo effect

Documented effect of the mind on drug therapy; it's a person perceives that a drug will be effective, the drug is much more likely to actually be effective

Alpha-glucosidase inhibitors: acarbose (Precose)

Does not cause a hypoglycemic reaction This medication is for patients who do not achieve results with diet alone NOTE: Monitor liver function***; may also decrease absorption of iron

metformin (Glucophage) (PO)

Doesn't produce hypoglycemia**** Can cause GI disturbances*** (nausea, vomiting, diarrhea) Must have liver function tests performed regularly Lactic acidosis is a rare but potentially fatal adverse effect** THINK: BIGUANIDES

Dopaminergic drugs

Don't use in pt with possible melanoma or psychosis; don't use if has narrow-angle glaucoma; Lots of Vit B6 may interfere with drug Abrupt withdrawal may cause neuroleptic malignant syndrome

increase

Dosing schedules, or protocols _____ the effectiveness of chemotherapy

Generic drug

Drag sold by their generic name; not brand-name or tradename product

In other words-

Drug Treatment for Heart Failure: Increase cardiac output (unload heart) Reduce vasoconstriction (lower BP) Promote loss of excess fluid (diuresis)

A combination of drugs are used to

Drug Treatment for Heart Failure: Reduce preload Reduce afterload Inhibit renin-angiotensin-aldosterone system and vasoconstriction of sympathetic nervous system

Administration

Drug absorption is influenced by the route of _____

Adverse effects

Drug affects sometimes called side effects, that are not the desired therapeutic effect; maybe unpleasant or even dangerous

Alpha Adrenergic Blockers: prazosin (Minipress); doxazosin (Cardura)

Drug names end in "osin" Block alpha-1 adrenergic receptors; causes vasodilation resulting in fall of BP

Propylthiouracil (PTU) and methimazole (Tapazole)

Drug therapy to *decrease thyroid hormone* production

These drugs treat chest pain

Drugs Used to Treat Angina: ▪Nitrates ▪Beta blockers ▪Calcium channel blockers

Primary goal

Drugs Used to Treat Chest Pain: _______ is to reduce myocardial demand for oxygen

Men

Drugs administered to ______ via the IM route reach a peak level faster than they do in women

Hyperlipidemia (HLD)

Drugs for Lipid Disorders: an excess of one or more lipids in the blood

Posterior Drugs

Drugs for Pituitary Disorders: (2 Lobes) this one is desmopressin and oxytocin

Anterior Drug

Drugs for Pituitary Disorders: (2 Lobes) this one is growth hormone

CNS Stimulants

Drugs for Psychiatric Disorders ADHD& Narcolepsy

Mood Stabilizers

Drugs for Psychiatric Disorders Bipolar affective disorder (Mania)

Antipsychotics

Drugs for Psychiatric Disorders Psychosis & Schizophrenia

GI Drugs

Drugs for gastric acid disorders Laxative Antidiarrheal Antiemetics

oral route

Drugs given by ___ ___ are absorbed more SLOWLY than those given parenterally

Beta2 adrenergic agonists: epinephrine (Adrenalin)

Drugs may be given by aerosol or orally; ***Use with a spacer to help ensure better distribution of medication***

antihypertensives

Drugs may be used alone or in combination with others

Anticonvulsants

Drugs prescribed for prevention and control of seizures

CHOLINERGIC AGONISTS

Drugs stimulate the parasympathetic nervous system "Rest or Digest"; Mimic acetylcholine

Directly

Drugs that are injected IM are absorbed _____ into the capillaries in the muscle and sent into circulation

Toxic affects

Drugs that are injected IV reach their full strength at the time of injection They bypass initial breakdown and have an immediate onset as they are fully absorbed administration because they directly into the bloodstream These drugs or more likely to cause ____ _____ because the marginal for error in dose is much smaller

Mixed opioid agonist-antagonist

Drugs that bind to a receptor (and causes response) binds to another receptor and prevents response Pentazocine & Butorphanol

Orphan drugs

Drugs that have been discovered but would not be profitable for a drug company to develop; usually drugs that would treat only a small number of people; these orphans can be adopted by drug companies to develop

Nicotine, alcoho, glucocorticoids (cortisone)

Drugs that induce or increase activity in the side of chrome P450 hepatic enzyme system

Ketoconazole (Nizoral), Amiodarone (generic, Quinidine (generic)

Drugs that inhibit or decrease activity in the cytochrome P450 hepatic enzyme system

ANTICHOLINERGIC DRUGS

Drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors Anticholinergics and adrenergic agonists produce many of the same responses

Mitotic Inhibitors

Drugs that kill cells as the process of mitosis begins

ANALGESICS

Drugs that relieve pain

Drug to drug interactions

During bio transformation One drug stimulates or blocks the metabolism of the other drug

Drug to drug interactions

During distribution One drug competes for the protein binding site of another drug, so the second drug cannot be transported to the reactive tissue

Drug to drug interactions

During excretion One drug compete for excretion with the other drug, leading to accumulation and toxic effects of one of the drugs

Heart is distended

During heart failure: ______ becomes hypertrophied, sodium and water are retained, causing decreased renal blood flow

Loop Diuretics: furosemide cause K+ loss which leads to.....

Dysrhythmias may occur from potassium loss

loop diuretics = furosemide (Lasix)

Dysrhythmias may occur from potassium loss Ototoxicity is possible; watch for dehydration, hyponatremia, hypochloremia, hypotension*, hypokalemia*, hyperglycemia & increased uric acid

OSMOTIC DIURETICS: MANNITOL (OSMITROL) effects throughout the....

EFFECTS THROUGHOUT THE BODY, USED TO PREVENT KIDNEY FAILURE AND DECREASE INTRACRANIAL PRESSURE **- ALSO TO DECREASE INTRAOCULAR PRESSURE*

Ibuprofen

EFFECTS and IMPLICATION of what nonselective COX-1 and COX-2 inhibitor: Black Box: may cause an increased risk of serious thrombotic event, MI & stroke •Don't take if have ulcers; may increase the clotting time •Can significantly increase risk of bleeding if taken with aspirin

for either shampoo or cream/lotion treatment note....

EITHER MAY REPEATED IN 7-10 DAYS TO TREAT ANY NEWLY HATCHED LICE (FROM EGGS NOT REMOVED)

Teach patient safety precautions related to drug effects

ENERAL NURSING CARE- ALL OPIOIDS: •Do not get up out of bed without assistance •Use call light •Change positions slowly •Do not drive or use heavy machinery •Do not mix with alcohol or other CNS depressants (especially agonists)

Rough ER

ER that is dotted with ribosomes

EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC

OSMOTIC DIURETICS: MANNITOL (OSMITROL)

ESSENTIALLY IS A SUGAR THAT IS NOT REABSORBED BY TUBULES; PULLS LG AMOUNT OF FLUID INTO URINE

LOOP SIDE EFFECTS & NURSING CONSIDERATIONS

EXTREMELY POTENT DIURETICS- CAN CAUSE SEVERE FLUID AND ELECTROLYTE LOSSES** MAY CAUSE RAPID LOSSES OF FLUID AND ORTHOSTATIC HYPOTENSION DYSRHYTHMIAS MAY OCCUR FROM POTASSIUM LOSS

Insulin Pen Advantages

Ease of use Less pain Better compliance

Drug-food interaction for warfarin (coumadin)

Eating foods high in Vit. K (green leafy vegetables) can decrease effect of drug, therefore eat those foods consistently & in moderation

Signs Thyroid Hormone Deficiency (prt 2)

Edema Thick dry skin Cold intolerance Slow pulse Constipation Weight gain Abnormal menses

Narrow spectrum antibiotics

Effective against specific bacteria

imipramine (Tofranil)

Effective and less expensive than some other classes of antidepressants Block the reuptake of norepinephrine and serotonin

diuretics are Effective as....

Effective as first-line drugs for mild to moderate hypertension

Guidelines for Hypertension Management

Eighth Joint National Committee (JNC-8) report of the National High Blood Pressure Education Program Coordinating Committee recommendations: First line drugs: ▪ACE inhibitors ▪ARBs ▪Thiazide diuretics Second line drugs: ▪Beta blockers ▪Centrally acting alpha and beta blockers ▪Direct acting vasodilators ▪Direct renin inhibitors ▪Peripherally acting adrenergic neuron blockers

Cardiovascular System

Electrocardiogram (ECG/EKG): measure of electrical activity (But...no information about 'mechanical' activity of the heart)

Hormones

Endocrine system: chemical messengers, released into bloodstream to communicate a message

Glands

Endocrine system: organized groups of specialized cells that secrete hormones

active transport

Energy-requiring process that moves material across a cell membrane against a concentration difference

Expectorants: guaifenesin (Mucinex)

Enhances the output of respiratory tract fluids; facilitates the removal of viscous mucous (helps thin & loosen mucous so it can be coughed up); for productive coughs

Enteric coated aspirin

Enteric coated (helps reduce ulcers)

Laxatives: stimulants

Example- bisacodyl (Dulcolax)- OTC (PO or rectal)

Laxatives: stool softeners

Example- docusate (Colace) (PO)

examples of Helicobacter pylori Treatment

Examples: omeprazole (Prilosec), clarithromycin (Biaxin), and amoxicillin (Amoxil) omeprazole (Prilosec), clarithromycin (Biaxin), and metronidazole (Flagyl) omeprazole (Prilosec), bismuth subsalicylate (Pepto-Bismol), metronidazole (Flagyl), and tetracycline

Hypnosis

Extreme sedation; used to help people sleep

Loop Diuretics: furosemide (Lasix) is EXTREMELY POTENT DIURETIC

Extremely potent diuretics- can cause severe fluid and electrolyte losses**

furosemide (Lasix) = loop diuretics

Extremely potent diuretics- can cause severe fluid and electrolyte losses** May cause rapid losses of fluid and orthostatic hypotension

cardiovascular collapse

Failure of the heart and blood vessels; shock THINK: adverse effect of Lithium (Eskalith; Lithobid)

Food and Drug Administration (FDA)

Federal agency responsible for the regulation and enforcement of drug evaluation and distribution policies

Anxiety

Feeling of tension, nervousness, apprehension, or fear Involves unpleasant reactions to a stimulus whether known or unknown

Gemfibrozil (Lopid)

Fibric Acid Agents

diphenhydramine (Benadryl)

First Generation-Antihistamines

First Generation-Antihistamines: diphenhydramine (Benadryl)

First generation- sedating; many cause drowsiness and dry mouth

PAIN MANAGEMENT

First step in pain management is accurate pain assessment (i.e. umerical 0-10; Wong Baker "Faces" pain scale) & determine location (head, abdomen, etc) & quality (sharp, stabbing, aching, throbbing, etc.) Consider nonpharmacologic treatments first•Warmth (heat packs), massage, positioning, acupuncture, meditation, relaxation techniques

barbiturates

First used as a sedative in the 1900s CNS depressant causing sedation, hypnosis, anesthesia; can lead to coma

INSULIN USES:

For any patient who is at risk of developing elevated blood sugars (ex: pts taking high doses of corticosteroids) Safe for gestational diabetes (pregnant patients who have diabetes induced by pregnancy)

Drug Indications-Endocrine Disorders (prt 2)

For hormonal disorders of: Pituitary Thyroid Adrenals Pancreas

HEPARIN (ANTICOAGULANT) is used for.....

For prevention & treatment of venous thrombosis & pulmonary embolus; also used for surgical and critically ill patients to prevent blood clots

ADLs (activities of daily living)

For pt suffering from Parkinson's Disease: The goals of pharmacotherapy is to increase ability of the pt to perform normal _____; medication does not cure the disease***

acetylcholine

For pt suffering from Parkinson's Disease: Therapy attempts to restore balance b/w declining levels of dopamine (which are inhibitory in nature) and _______ (which become dominant)

IV

For the Benzodiazepines drugs when they are given by _____ and/or in HIGHER doses we may see amnesia, weakness, disorientation, ATAXIA, BP & HR changes, blurred vision, N & V; depression, CONSTIPATION, urinary retention

Frequent use of Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)

Frequent use of spray or drops can result in rebound nasal congestion; Do not use more than 3-5 days ***

Antitussives: dextromethorphan (Robitussin DM; Delsym) Frequently combined with.....

Frequently combined with other cold medications, such as Robitussin DM

Aspirin dosing

Full dose is 325 mg; baby aspirin dose 81 mg is enough to provide antiplatelet effects

phenothiazines (1st Gen)

Full therapeutic effects may not be evident for 3-6 wks, but observable therapeutic response may be seen in 7-10 days*** THINK: patient teaching

Precautions for Steroids

Fungal / bacterial infections Caution in patients who are at risk for infections- may mask symptoms* Caution in diabetes-often causes hyperglycemia* Caution in peptic ulcer disease

Incretin Enhancers include......

GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)

Insulin

GLUCOSE REGULATION: Pancreatic beta cells-Islets of Langerhans •Released in response blood glucose increasing •*Has the effect of DECREASING blood sugar

Glucagon

GLUCOSE REGULATION: •Released from alpha cells in the islets of Langerhans •Released in response to low blood glucose levels •Has the effect of INCREASING blood sugar

goal for ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

GOAL IS RETURN HGB LEVELS TO 10-11 G/DL AND HCT OF AROUND 33%

metoclopramide (Reglan)

Gastrointestinal Stimulants (Stomach Emptying)

propofol (Diprovan)

General Anesthetic: Often used in ICU for patients who are on the ventilator to keep them sedated Onset 40-60 seconds; duration 10-15 minutes; often used continuous IV drip

Oral route

Generally, drugs given by the ____ ____ are absorbed more slowly than those given parenterally

Nicotinic Acid: Niacin (vitamin B2)

Given in larger doses (2-3 grams/day) than what is recommended for daily dietary needs (25 mg)- maximum dose is 6 grams/day

Long acting insulin

Glargine (Lantus) Onset- Gradual 1-2 hrs; Peak- none; Duration- 24 hrs

INCRETIN ENHANCERS

Groups: GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza)- injectables**injected*** DPP-4 inhibitors- sitagliptin (Januvia)- oral drug

somatrem (Genotropin)

Growth Hormone Deficiency

octreotide (Sandostatin)

Growth Hormone Excess

Acromegaly

Growth Hormone Excess disorder excessive growth after puberty- bones become deformed

Gigantism

Growth Hormone Excess disorder excessive growth during childhood

GH antagonist

Growth Hormone Excess disorder suppresses growth hormone release

Adverse effects: octreotide (Sandostatin)

Growth Hormone Excess: HA, back pain, fatigue, abdominal pain; gallbladder disease; hyperglycemia Monitor patient response to drug Monitor for adverse effects

First Generation-Antihistamines: diphenhydramine (Benadryl) MOA

H1 antagonists compete with histamine for receptor sites

tamoxifen

HORMONES Prototype- ______ (Soltamox)- breast cancer*** •Used to treat hormone-sensitive tumors of the breast •Others- corticosteroids, gonadal hormones, estrogen antagonists, and androgen antagonists Side effects: Hot flashes, rash, N/V, vaginal bleeding, menstrual irregularities, edema, pain, CVA, pulmonary emboli

Corticosteroids

HORMONES ______ suppress inflammation, reduce cerebral edema, may slow tumor growth Side effects: Hot flashes, rash, N/V, vaginal bleeding, menstrual irregularities, edema, pain, CVA, pulmonary emboli

NOT

HORMONES Prototype- tamoxifen (Soltamox)- breast cancer*** ______ true chemotherapeutic agents, but are used as an adjunct to treatment (block estrogen @ the receptor; estrogen antagonist)

COMPLICATIONS OF RENAL FAILURE (prt 2)

HYPERVOLEMIA-UNABLE TO EXCRETE SODIUM & WATER (RETENTION) HYPOCALCEMIA-HYPERPHOSPHATEMIA LEADS TO LOSS OF CALCIUM METABOLIC ACIDOSIS-UNABLE TO ADEQUATELY EXCRETE METABOLIC ACIDS

CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX) can cause....

HYPOKALEMIA MAY OCCUR

Intranasal Corticosteroids: fluticasone (Flonase)

Have an anti-inflammatory action- decrease allergic rhinitis symptoms and congestion; direct local effect

Drug labels

Have specific information that identifies a specific drug These labels identify the brand and generic names for the drug, the drug dosage, expiration date, and specific drug warnings

Hypotonic

Having a lower concentration of solute than another solution RBC placed in this solution will SWELL and BURST as water moves into the cell

teratogenic

Having adverse effects on the fetus

adverse effects of Nitrates: nitroglycerin (Nitrostat)

Headache**;Hypotension***; Nausea, vomiting; Dizziness; Reflex tachycardia; Flushing

Drugs Used for Heart Failure

Heart Failure = ACE inhibitors and ARBs Beta blockers Diuretics Cardiac glycosides vasodilators Phosphodiesterase inhibitors

What is heart failure?

Heart fails as a "pump"; fails to pump blood effectively

Signs of Thyroid Hormone Hypersecretion (prt 2)

Heat intolerance Nervousness Exophthalmos Weight loss Confusion Behavioral changes

Schedule II (C-II)

High abuse potential with severe dependence liability (narcotics, amphetamines, and barbiturates) (i.e. narcotic opioids, amphetamines, barbiturates, cocaine, methamphetamine, opium, morphine, codeine)

limits

High doses, to the ____ of tolerance of normal tissues are usually most effective

Nicotinic Acid have a High incidence of adverse effects such as

High incidence of adverse effects*- flushing, nausea, pruritus, headache, bloating, diarrhea, palpitations- take aspirin 30 minutes before to reduce symptoms

famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)

Histamine Blockers (H2 antagonists)

Toxicity

Human Immune Response: It is difficult to treat an immunocompromised individual because.... 1. anti-infective drugs cannot totally eliminate the pathogen without causing severe _____ in the host

inflammatory

Human Immune Response: It is difficult to treat an immunocompromised individual because.... 2. these patient lack the ____ or immune response in place to deal with even a few invading organisms

Antiinfective Therapy

Human Immune Response: the goal of ___ ___ is reduction of the population of the invading organism to a point at which the human immune response can take care of the infection

Laxatives: saline (osmotic) = polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)

Hyperosmolar salts pull water into the colon to increase bulk to stimulate peristalsis

Diuretics are Used for:

Hypertension Heart failure Kidney failure Liver failure or cirrhosis Pulmonary edema

Ibuprofen

IMPLECATIONS of ____ (a nonspecific COX -1 & COX-2 Inhibitor) May give on empty stomach if tolerated; with food if not •Pt's with asthma or allergies to aspirin may experience a hypersensitivity reaction

first pass effect

IMPORTANT NOTE: FROM THIS PROCESS it explains why many doses taken ORALLY must be a lot HIGHER than doses administered IV

LOOP DIURETICS: FUROSEMIDE (LASIX): think increased hydrogen ion loss can lead to.....

INCREASED HYDROGEN ION LOSS MAY LEAD TO METABOLIC ALKALOSIS

OSMOTIC DIURETICS: MANNITOL (OSMITROL) increases.....

INCREASES OSMOLALITY (CONCENTRATION) AND SODIUM REABSORPTION IN THE PROXIMAL TUBULE AND LOOP OF HENLE

GLP-1 agonists

INCRETIN ENHANCERS: exenatide (Byetta) and liraglutide (Victoza)- injectables**injected*** Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption

DPP-4 inhibitors

INCRETIN ENHANCERS: sitagliptin (Januvia)- oral drug Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption

tinnitus

INDICATES ear damage ringing in the ears

ferrous sulfate (iron)

IRON SUPPLEMENTS

General Anesthetic: propofol (Diprovan)

IV general anesthesia Used to induce general anesthesia for surgery (in conjunction with other meds)

Nursing Care- Antidiarrheals (prt 1)

Identify and treat underlying cause Monitor for and treat dehydration and electrolyte loss Monitor vital signs

Antidiarrheals: Nonpharmacologic treatment-

Identify cause and treat Clear liquids and electrolyte solutions

Pharmacokinetic

In clinical practice, ______ considerations include the onset of drug action (i.e. how long it will take to see the beginning of the therapeutic effect), drug half-life, timing of the peak affect (i.e. how long it will take to see the maximum effect of the drug), duration of the drug affects (i.e. how long the patient will experience the drug effects), metabolism or biotransformation of the drug, and the side of excretion

Cultural Considerations

In the United States, African Americans are at highest risk for hypertension Men are at greater risk than women

Laxatives: stimulants = bisacodyl (Dulcolax)- OTC

Increase peristalsis by irritating nerve endings in the intestinal mucosa

Major responses of anticholinergics (prt 2)

Increased heart rate Decreased bladder contraction (may cause urinary retention) Decreased rigidity and tremors

Anticholinergic Drug: atropine (Atropair)

Increases heart rate by blocking vagus stimulation Dilates pupils by paralyzing the iris sphincter Most common side effects are dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urinary retention, mydriasis (dilation)

TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia) increases the amount of......

Increases the amt of fetal hemoglobin produced in the bone marrow & dilutes the formation of abnormal hemoglobin S; results in less clogging of small vessels

GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)

Incretin Enhancers

donepezil (Aricept)

Indirect-Acting Cholinergic Agonists: cholinesterase inhibitor •Alzheimer's disease-helps improve memory •Adverse effects: insomnia, N/V/D, dyspepsia, abdominal pain, muscle cramps

pyridostigmine (Mestinon)

Indirect-Acting Cholinergic Agonists: cholinesterase inhibitor •Myasthenia gravis -increases muscle strength •Adverse effects: bradycardia, tearing, salivation, N/V, urinary frequency/incontinence

anti-inflammatory agents

Inhibit biosynthesis of prostaglandin & COX (inflammation suppression) •Relieve mild to moderate pain (analgesic)

MAOIs

Inhibit monoamine oxidase- causes levels of norepinephrine, dopamine, epinephrine, and serotonin to rise Effective as antidepressants, but adverse reaction (hypertensive crisis) may occur from eating certain foods when taking the drugs Many foods that contain tyramine interact

Hydantoins: Phenytoin

Inhibit sodium influx, preventing disruptive neuron firing Stabilize cell membranes, reducing repetitive neuronal firing, so limiting seizures Also acts as an antidysrhythmic Small sedation effect, is non-addictive

Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)

Inhibits absorption of cholesterol, also reduces LDL and triglycerides- need to combine with a statin for maximum effectiveness

ASPIRIN (ANTIPLATELET): aspirin

Inhibits platelet aggregation; reduces risk of stroke; reduces risk of fatal MI; MI prophylaxis (also an anti-inflammatory, analgesic & antipyretic)

Intramuscularly (IM)

Injection into large muscles

Nursing Implications & Care- Digoxin (prt 2)

Instruct patient to take digoxin at same time each day to ensure steady-state dosing and to contact health care provider for instructions if dose is missed. Emphasize importance of regular follow-up exams to determine effectiveness and to monitor for toxicity. Caution patient to avoid taking OTC medications without consulting health care provider. Antacids and antidiarrheals slow absorption of digoxin.

NURSING CARE- ALPHA ADRENERGIC AGONISTS (prt 2)

Instruct patient to watch OTC drug labels for cold and diet medications- many have sympathetic drugs •Explain caution in using nasal sprays that adrenergic agonists- rebound effect •Instruct use of medications (nasal spray) •Instruct about side/adverse effects

Type 1- (IDDM aka juvenile)

Insulin is treatment

fluticasone (Flonase)

Intranasal Corticosteroids

PAIN

Is a subjective experience; described as an unpleasant sensation & emotional experience

Opiate Agonists (Narcotic Analgesics) (prt 2)

Itching •Nausea & vomiting* (common) •Constipation***, urinary retention •Respiratory depression******; apnea •Tolerance and dependence (cross-tolerance), withdrawal symptoms •Possible anaphylaxis

Research studies have shown that African Americans are (prt 3)

LESS responsive to ACE inhibitors, ARBs, renin inhibitors & beta-blockers

Topical

LOCAL ANESTHETICS ROUTES: creams, sprays, suppositories, lozenges; applied to mucous membranes (ex: throat spray)

Infiltration

LOCAL ANESTHETICS ROUTES: direct injection into tissue or surgical site; blocks specific group on nerves in small area (ex: mole removal)

Spinal anesthesia

LOCAL ANESTHETICS ROUTES: injected into cerebral spinal fluid in the spine (ex: to work on legs)

Epidural

LOCAL ANESTHETICS ROUTES: injected into the epidural space of the spinal cord (ex: for childbirth)

Nerve Block

LOCAL ANESTHETICS ROUTES: injected into tissue proximal to surgical site; effects bundles of nerves; larger area (ex: to work on hand/foot

FUROSEMIDE (LASIX)

LOOP DIURETICS

Prototype: enoxaparin (Lovenox) (SQ)

LOW MOLECULAR WEIGHT HEPARIN (LOVENOX)

Lab test for warfarin (Coumadin)

Lab tests to monitor Coumadin are prothrombin time (PT) and international normalized ratio (INR) NOTE: PT is measured in seconds and adjusted (standardized) to derive the INR

labs for heparin

Labs: Monitor the PTT/aPTT

psyllium (Metamucil)

Laxatives: Bulk-forming

polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)

Laxatives: saline (osmotic)

bisacodyl (Dulcolax)- OTC

Laxatives: stimulants

docusate (Colace)

Laxatives: stool softeners

Systemic Circulation

Left side of heart send oxygenated blood out to the cells of the body

Schedule III (C-III

Less abuse potential than schedule II drugs and moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics) (i.e nonbarbiturate sedatives, nonstimulant amphetamines, and limited amounts of certain narcotics, some codeine mixtures, anabolic steroids)

Schedule IV (C-IV)

Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics) (i.e. some sedatives, antianxiety agents, nonnarcotic analgesics)

Nonphenothiazines (1st Gen)

Less sedation and anti-cholinergic effects than phenothiazines but similar action- EPS may still occur May be given in a decanoate form- injectable slow release form (called depot injections)

Signs Thyroid Hormone Deficiency

Lethargy Apathy Memory impairment Emotional changes Slow speech Deep course voice

Leukotriene Modifiers: montelukast (Singulair)

Leukotriene is a chemical mediator that can cause inflammatory changes in the lung

Preventing Resistance

Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used Make sure doses are high enough, and the duration of drug therapy long enough Be cautious about the indiscriminate use of anti-infectives

Schedule V (C-V)

Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. The purchaser must be at least 18 years of age and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist. (i.e small amount of codeine, such as in cough medicines)

intravenous solutions

Liquids infused into the blood of a vein; most are isotonic so that blood cells do not rupture or shrink.

Rapid acting insulin

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Onset- <15 min; Peak- 30-90 min; Duration- 3-5 hrs

lidocaine (Xylocaine)

Local Anesthetics: Adverse effects: HA, convulsions, urinary retention, respiratory depression, hypotension, bradycardia & cardiac arrest NOTE: **these are NOT common when used topical, field block or nerve block; more common when used as epidural/spinal

furosemide (Lasix)

Loop Diuretics

Act on the loop of Henle to block reabsorption of sodium and chloride- sodium and water are lost

Loop Diuretics: furosemide (Lasix)

Sedation

Loss of awareness; may be desirable in clients who are restless, nervous, irritable or overreacting; or those undergoing surgery

Opioids and the Law

Lost, wasted, or contaminated doses must be accounted for (or disposed of) on the record and signed by 2 nurse •Shift change count by 2 nurses Nurse should check for a valid prescription that has not expired (time stop policy)

Barbiturates

Low margin for safety, high potential for dependence (Schedule IV)

Barbiturates

Low margin for safety, high potential for dependence (Schedule IV), cause severe CNS depression, but inexpensive, long acting, high incidence of adverse effects

cellular defenses

Lymphocytic and Myelocytic

THROMBOLYTIC DRUGS

Lyse (break down) existing clots Clot Busters

RENAL SYSTEM 4 major functions

MAINTAIN VOLUME/COMPOSITION OF BODY FLUIDS W/IN NORMAL RANGE REGULATION OF VITAMIN D AND CALCIUM LEVELS REGULATION OF BLOOD PRESSURE THROUGH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM REGULATION OF RED BLOOD CELL PRODUCTION (ERYTHROPOIETIN)

SKIN DISORDERS: SCABIES OR PEDICULOSIS = PERMETHRIN (NIX)

MAY BE ADMINISTERED AS A CREAM, LOTION OR SHAMPOO TO KILL HEAD LICE, CRAB LICE AND MITES

KAYEXALATE

MAY BE GIVEN FOR HYPERKALEMIA. USUALLY A LIQUID GIVEN PO ALONG WITH A LAXATIVE; SODIUM IS EXCHANGED FOR POTASSIUM IN THE GI TRACT; CAUSES LARGE BOWEL MOVEMENT AND BASICALLY POTASSIUM IS EXCRETED THROUGH THE EVACUATION OF FECES

CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX) may be used to treat....

MAY BE USED AS ADJUNCTS TO OTHER DIURETICS; ALSO OFTEN USED TO TREAT GLAUCOMA BECAUSE INHIBITION OF CARBONIC ANHYDRASE DECREASES SECTION OF AQUEOUS HUMOR

CARBONIC ANHYDRASE INHIBITOR SIDE EFFECTS & NURSING CONSIDERATIONS

MAY CAUSE ACID-BASE DISTURBANCES METABOLIC ACIDOSIS IS RELATIVELY COMMON & POTENTIALLY DANGEROUS

repaglinide (Prandin)

MEGLITINIDES

vincristine

MITOTIC INHIBITOR/ PLANT ALKALOIDS Prototype is _____ (Oncovin)** •Leukemia, Hodgkin, lymphoma, etc •Derived from natural products and block cell division •Three subdivisions- vinca alkaloids (periwinkle plant), taxanes (yew plant), topoisomerase inhibitors (May apples) •Side effects: may cause peripheral nerve damage and neurotoxicity*** (nerve toxicity)*, ataxia, alopecia, muscle wasting, leukopenia

NOTE when taking TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) monitor....

MONITOR FOR HYPERKALEMIA

GENERAL NURSING CARE DIURETICS

MONITOR INTAKE AND OUTPUT* MONITOR LAB VALUES- ESPECIALLY ELECTROLYTES AND BLOOD GLUCOSE MONITOR FOR SYMPTOMS OF ELECTROLYTE IMBALANCE- LEG CRAMPS, WEAKNESS, DIARRHEA, TACHYCARDIA MONITOR FOR DEHYDRATION** AND COMPLIANCE WITH DRUG

THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) first line for hypertension.....

MOSTLY FIRST LINE FOR HYPERTENSION, MILD/MOD HEART FAILURE ; INEFFECTIVE IN PATIENTS WITH SEVERE RENAL FAILURE

POTASSIUM SPARING SIDE EFFECTS & NURSING CONSIDERATIONS

MUST BE MONITORED FOR HYPERKALEMIA- SERUM POTASSIUM SHOULD BE 3.5 TO 5.0 MEQ/L

prednisone (prt 2)

MUST TAPER off doses, do not stop suddenly** Pregnancy Category C

hypertension

Main objective of ______ treatment is to attain & maintain goal BP

Major adverse effect for Heparin

Major adverse effect is bleeding- antidote is protamine sulfate

major complication for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)

Major complication is hemorrhage

Insulin quick facts

Manufactured by DNA technology Human insulin has a low incidence of allergic effects and insulin resistance Analogs are modifications of human insulin with alterations in onset and duration of action

Anticonvulsants classes

Many classes of drugs are used- •Hydantoins / hydantoin-like drugs •Barbiturates •Benzodiazepines •Valproate

Proteins

Many drugs are bound to ______ and are not liquid soluble These drugs cannot be distributed to the central nervous system CNS because of the effective blood brain barrier which is highly selective and allowing lipid soluble substances to pass into the CNS

Placenta

Many drugs readily passed through the _____ affecting the developing fetus in pregnant woman It is best not to administer any drugs to pregnant woman because of the possible rest of the fetus

warning for warfarin (coumadin)

Many other drugs may interact with Coumadin

Imipramine (Tofranil) class

Many side/adverse effects- sedation, orthostatic hypotension*, cardiac toxicity, seizures, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia), sexual dysfunction, bone marrow suppression

virions

Mature virus particles.

acetaminophen (Tylenol)

Maximum dose: 4 g/day*

Vasodilators: hydralazine (Apresoline) isosorbide dinitrate- (Isordil)

May be combined to act synergistically- hydralazine with isosorbide dinitrate (BiDil)- especially effective in treating HF in African American patients

Drug Indications-Endocrine Disorders

May be for: Replacement therapy To shrink hormone-sensitive tumors To produce an exaggerated response To block the action of endogenous hormones

Antitussives: dextromethorphan (Robitussin DM; Delsym) can be mixed with....

May be mixed with a narcotic for cough suppression

Note: heart failure might be......

May be right or left-sided heart failure- many times is a combination

Expectorants: guaifenesin (Mucinex) may be used with or without....

May be used with or without other medications; Found in many OTC cold medications

serotonin syndrome

May begin 2-72 hours after starting treatment with SSRI (or any drug affecting serotonin) Withhold medication if any of the following develop: Mental confusion, difficulty concentrating Fever Agitation or anxiety Hallucinations Incoordination or hyper-reflexia Diaphoresis Tremors

phenytoin (Dilantin)

May cause local site irritation and sloughing; (vesicant) give in large vein or central line Flush line with saline before & after giving**

Loop Diuretics: furosemide (Lasix) can cause.....

May cause rapid losses of fluid and orthostatic hypotension

Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil) may cause........

May cause reflex tachycardia*- can be prevented by administering a beta blocker with the direct vasodilator

ACE Inhibitors (-"pril" suffix): Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

May produce first-dose phenomenon (start w/ low dose & monitor closely) Drugs inhibit ACE- inhibits formation of angiotensin II (blocks vasoconstriction) and blocks the release of aldosterone (sodium and water are excreted and potassium is retained)

ACE Inhibitors: captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

May produce first-dose phenomenon (start w/ low dose & monitor closely) Drugs inhibit ACE- inhibits formation of angiotensin II (blocks vasoconstriction) and blocks the release of aldosterone (sodium and water are excreted and potassium is retained) End result is decreased peripheral resistance and diuresis; used for HTN and heart failure

Mechanism of action of HEPARIN (ANTICOAGULANT)

Mechanism of action- prolongs clotting time; Indicated for rapid anticoagulant effect

Psychotic symptoms

Mechanisms of Action of Drugs: result from an imbalance of dopamine in the brain

NURSING CARE FOR NON-INSULIN DIABETIC DRUGS (prt 2)

Medic Alert card, tag, or bracelet No alcohol Report vomiting, diarrhea, fever, inability to eat **Consider holding meds if patient is not able to eat or take anything by mouth**

partial agonist

Medication that produces a weaker, or less efficacious, response than an agonist.

ORAL DIABETIC DRUGS (TYPE II DIABETES) (prt 2)

Meglitinides Incretin enhancers such as- GLP- 1 agonists & DPP-4 inhibitors

aminophylline (Theophylline)

Methylxanthines

acquiring resistance

Microorganisms develop resistance in a number of way: 1.) Mutations that allow an enzyme to inactivate the antibiotic (lactem Ring) 2.) Mutations to make protein that binds to antibiotic 3.) Mutation to decrease up take of drug or to eject it from cells more 4.) Transformation from other bacteria 5.) Gene transfer from conjugation and transfer of R plasmids a.) MRSA became Vancomycin resistant from plasmid (with transposons) transfer b.) From Vancomycin resistant Entrococcus (VRE)

mix Bulk-forming laxatives = psyllium (Metamucil) in????

Mix in a glass of water or juice, followed by another glass of liquid

NURSING CONSIDERATIONS/IMPLICATIONS FOR PAIN MEDS

Monitor & document pain frequently; document response Take VS; If resp rate < 12/minute, notify physician & hold medication Have naloxone & resuscitation equipment available When giving IV push, give over 4-5 minutes Always ensure removal of old patch when using transdermal route

NURSING CARE- THROMBOLYTICS (prt 1)

Monitor bleeding studies before administration Watch for complications, such as hemorrhage, reperfusion dysrhythmias, allergic reaction- bleeding may occur up to 24 hrs after therapy

Nursing Care for Pituitary Hormone Disorders

Monitor for desired effect of the drug based on reason for administering: I and O and urine specific gravity (specific gravity may be low in diabetes insipidus indicating dilute urine) Monitor physical growthMonitor vital signs (signs of dehydration) Assess for thirst, other signs of dehydration with ADH Monitor blood sugar and electrolytes Monitor correct use of medications and adverse effects

Nursing Care- Typical Antipsychotics

Monitor for fluctuations in BP and tachycardia avoid skin contact w/ liquid meds Admin oral drugs WITH food or milk Amin IM DEEP into muscle Observe for EPS Assess for NMS Record urine output Teach pt to use sunscreen or to wear long sleeves and hat high fiber foods, plenty of liquids hand candy or lozenges for dry mouth teach pt about time it take to reach therapeutic affect DON'T stop abruptly

Nursing Care- Laxatives (prt 2)

Monitor for fluid and electrolyte loss Monitor bowel sounds and vital signs Teach to report any blood in stools Teach possible side/adverse effects- N&V, diarrhea, abdominal cramping, weakness, dizzines

Nursing Care- Diuretics

Monitor intake and output* Monitor lab values- especially electrolytes and blood glucose Monitor for symptoms of electrolyte imbalance- leg cramps, weakness, diarrhea, tachycardia Monitor for dehydration** and compliance with drug

NURSING CARE- ADRENERGIC BLOCKERS (prt 2)

Monitor urine output •Monitor for nasal stuffiness due to vasodilation •Teach how to take medication and to take own pulse and BP •Instruct to report mood changes and depression •*Do NOT stop taking abruptly.

Nursing Care- Antimetics monitor

Monitor vital signs Monitor for dehydration and electrolyte imbalance

NURSING CARE- ALPHA ADRENERGIC AGONISTS

Monitor vital signs and EKG •Monitor urine output and assess for bladder distention •Evaluate blood glucose levels (hyperglycemia)

Nursing Care- Drugs for Heart Failure

Monitor vital signs and teach patient to take own BP and pulse Observe for peripheral and pulmonary edema Monitor serum digoxin level and electrolytes Teach low sodium diet and fluid limitations

Nursing Care for Thyroid Hormone Drugs

Monitor vital signs, EKG, weight Monitor other medications for interactions

Nursing Care- Antihypertensives

Monitor vital signs- teach patients to take own BP and keep a log Teach side/adverse effects of drugs, such as cough, angioedema, peripheral edema Monitor fluid and electrolyte balance, especially if combined with a diuretic

Research studies have shown that African Americans are (prt 2)

More responsive to diuretics, calcium-channel blockers & alpha-adrenergic blockers

Expectorants

Most common is guaifenesin (Mucinex) (PO)

Methylxanthines: aminophylline (Theophylline) most commonly used....

Most commonly used- theophylline, aminophylline; therapeutic levels are 5-15 mcg/mL***

Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) most effective....

Most effective drugs at blocking acid; available OTC

Research studies have shown that African Americans are

Most responsive to single-drug therapy (instead of combinations)

anticonvulsants for partial seizures

Most work by blocking sodium channels; decrease seizure activity, particularly in partial or focal seizures. Teratogenic*-(spina bifida & cleft palate); Preg Cat. D

Distribution

Movement of a drug to body tissues; the places were drug may be distributed depend on the drugs solubility, perfusion of the area, cardiac output, and the binding of the drug to plasma proteins

diffusion

Movement of solutes from an area of higher concentration to an area of lower concentration to reach equilibrium

osmosis

Movement of water from an area of high concentration to an area of low concentration in an attempt to equalize the concentration

Not

Moving forward drugs will ______ have a pregnancy category listed but will have a risk level for affects on fertility, pregnancy, and when used in breast-feeding

Guaifenesin

Mucinex (generic name is ???)

acetylcysteine (Mucomyst)

Mucolytic

Neuromuscular Abnormalities

Muscle Spasms & Muscle Spasticity

intracellular parasites

Must be in host cell to replicate and cause infection •Many viruses infect specific host cells

Cardiovascular System

Myocardium: heart muscle Diastole: cardiac muscle at rest Systole: cardiac muscle contracts

succinylcholine (Anectine)

NEUROMUSCULAR JUNCTION BLOCKER(AKA "PARALYTIC AGENT")

COX-2 inhibitors

NONOPIOID ANALGESICS: Celecoxib (Celebrex)

Acetaminophen

NONOPIOID ANALGESICS: Tylenol

Salicylates

NONOPIOID ANALGESICS: acetylsalicylic acid, ASA (Aspirin)

NSAIDS and Related Drugs

NONOPIOID ANALGESICS: •ibuprofen (Advil) •ketorolac (Toradol) •meloxicam (Mobic) •naproxen (Aleve)

THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) is NOT an effective......

NOT EFFECTIVE FOR IMMEDIATE DIURESIS;

SIDE EFFECTS of URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)

NOTE MOST SIDE EFFECTS ARE R/T ANTICHOLINERGIC ACTIVITY SIDE EFFECTS: DROWSINESS, DIZZINESS, BLURRED VISION, TACHYCARDIA, DRY MOUTH, NAUSEA, URINARY HESITANCY, DECREASED SWEATING

excretion

NOTE: most significant means of excretion occurs through the KIDNEYS Other methods of excretion: skin saliva lungs bile and feces

Intermediate acting insulin

NPH (Humulin N, Novolin N) Onset- 1-1.5 hrs; Peak- 4-12 hrs; Duration- 18-24 hrs

NONOPIOID ANALGESICS

NSAIDs, Salicylates, COX-2 inhibitors and acetaminophen

Brand-name

Name given to a drug by the pharmaceutical company that developed it; also called a trade name or proprietary name

Chemical name

Name that reflects the chemical structure of a drug

OPIOIDS AND THE LAW

Narcotic drugs must be secured with 2 locks or secured computerized system- only licensed people have access Dose recorded on a special record, as well as patient record

oxymetazoline (Afrin) (intranasal spray)

Nasal and Systemic Decongestants

Laxatives: Bulk-forming = psyllium (Metamucil)

Natural fibrous substances- promote large soft stools by absorbing water into intestine- increases bulk and peristalsis; preferred drug for chronic constipation

Laxatives: herbal

Natural products available OTC Most commonly used is senna (PO)- a potent herb that irritates the bowel and increases peristalsis Newer drugs to treat constipation of IBS (lubiprostone- Amitiza) and Opioid-induced constipation (methylnaltrexone- Relistor; noloxegol- Movantik)

IRON SUPPLEMENTS: ferrous sulfate (iron)

Necessary for the production of hemoglobin and RBCs Often prescribed for or to prevent anemia

intestine invading worms

Nematodes: pinworms whipworm threadworm ascaris hookworms OR Platyhelminths: Cestodes (tapeworm)

Phenylephrine

Neo-Synephrine

Polymyxin B

Nerve damage caused by antiinfective agent: this drug can be toxic to human hosts leading to nephrotoxicity, neurotoxicity (facial flushing, dizziness, ataxia, paresthesia and drowsiness) and drug fever and rashes Therefore, this drug is reserved for use in acute situations when the invading bacterium has been PROVEN to be sensitive to the drug and less sensitive to other less toxic antibiotics

NMS

Neuroleptic Malignant Syndrome Onset-days/weeks after taking dopamine agonist or after sudden withdrawal of dopaminergic Rigid "lead pipe-like" muscles; hyporeflexia High fever Usually no GI symptoms Recovery days to weeks; higher mortality rate Tx: benzodiazepines; levodopa; bromocriptine

Muscle Spasms

Neuromuscular Abnormalities: Often result from injury to the musculoskeletal system Caused by flood of sensory impulses Impulses stimulate painful and intense muscle contraction

muscle spasticity

Neuromuscular Abnormalities: Result of damage to neurons within the CNS; which is permanent May lead to excessive stimulation of muscles called hypertonia May result in contractures or permanent structural changes

Nicotinic Acid

Niacin (vitamin B2)- reduces VLDL and LDL & inhibits release of free fatty acids from adipose tissue

diabetics

Nicotinic Acid: Niacin (vitamin B2) is not prescribed to pt that are diagnosed with _______ b/c it can ELEVATE blood glucose

nitroglycerin (Nitrostat)

Nitrates

SCHEDULE II PRESCRIBING LIMITATIONS IN MISSOURI (prt 2)

No refills allowed Prescription valid for 6 months only Quantity limited for 30 days in most cases In Missouri nurse practitioners can prescribe 5 days of hydrocodone only

Ibuprofen (Advil/Motrin)

Non-selective COX -1 & COX-2 Inhibitor: Aspirin-like but have stronger effects and less gastric irritation (may still have gastric upset) •Blood dyscrasias (& bleeding) not as common' OTC in lower doses than prescription form (200 mg) •If taken with aspirin, ibuprofen's effect may be decreased & increase risk of bleeding •May have many other drug interactions

haloperidol (Haldol)

Nonphenothiazines (1st Gen): Elderly should have decreased dose Drugs may lower seizure threshold- may need increased dose if on seizure drugs

Normal INR

Normal INR is 1.3 to 2- if on Coumadin, patient is maintained at an INR of 2 to 3 or higher for anticoagulation THINK: important lab for warfarin (Coumadin)

blood pressure categories

Normal: <120/80 mmHg Prehypertension: 120-139/80-89 mmHg High blood pressure: >140/90 mmHg

Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)= Not effective for immediate diuresis

Not effective for immediate diuresis; used often for hypertension, mild/mod heart failure

Leukotriene Modifiers: montelukast (Singulair) are NOT recommended for treatment of.....

Not recommended for treatment of an acute asthma attack- used for prevention of symptoms

Antineoplastic Antibiotics

Not selective only for bacterial cells; toxic to human cells

BP

Nursing Care for Anxiolytics/Sedatives/Hypnotics: Monitor vital signs- especially respirations and ____

drug abuse

Nursing Care for Anxiolytics/Sedatives/Hypnotics: Watch for ____ ____

DO NOT

Nursing Care for Anxiolytics/Sedatives/Hypnotics: ___ ____ drive/operate machinery or mix alcohol NOTE: the nurse needs to withdraw drugs slowly

Teach about Thyroid Hormone medications

Nursing Care for Thyroid Hormone Drugs: Do not stop abruptly or switch name brands Take on empty stomach at the same time each day

Morphine

OPIOID AGONISTS-Contraindications: ____ can cause biliary tract spasms so not preferred for gallbladder disease/gallstones* (increases tone at the sphincter of Oddi); meperidine (Demerol) is preferred for gallbladder pain

Fentanyl

OPIOID AGONISTS: 50-100 times more potent than morphine

Contraindications

OPIOID AGONISTS: Head injuries, increased intracranial pressure Respiratory disorders (however, may see used for pulmonary edema and congestive heart failure) Shock or hypotension

Codeine

OPIOID AGONISTS: often mixed with other medications

MANNITOL (OSMITROL)

OSMOTIC DIURETICS

Antiemetic Drugs: Nonprescription antiemetics

OTC for motion sickness, such as dimenhydrinate (Dramamine); diphenhydramine (Benadryl); bismuth subsalicylate (Pepto-Bismol)

Prototype- clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid) (PO)

OTHER ANTIPLATELET DRUGS

LOOP DIURETICS: others

OTHER LOOPS: BUMETANIDE (BUMEX); TORSEMIDE (DEMADEX)

URINARY TRACT ANTISPASMODICS: others

OTHER MEDS: TROSPIUM (SANCTURA); TOLTERODINE (DETROL)

POTASSIUM SPARING DIURETICS: others

OTHER POTASSIUM SPARING DRUGS: TRIAMTERENE (DYRENIUM); AMILORIDE (MIDAMOR)

CARBONIC ANHYDRASE INHIBITORS: others

OTHER SIMILAR DRUGS: DICHLORPHENAMIDE (KEVEYIS)

THIAZIDE DIURETICS: other

OTHER THIAZIDE & THIAZIDE-LIKE MEDS: METHYCLOTHIAZIDE; INDAPAMIDE

LOOP DIURETICS: FUROSEMIDE (LASIX) can cause....

OTOTOXICITY IS POSSIBLE; WATCH FOR DEHYDRATION, HYPONATREMIA, HYPOCHLOREMIA, HYPOTENSION*, HYPOKALEMIA*, HYPERGLYCEMIA & INCREASED URIC ACID

NURSING CARE- CHOLINERGIC AGONIST DRUGS (prt 2)

Observe for general cholinergic side/adverse effects, such as gastric pain, diarrhea, increased salivary or bronchial secretions, bradycardia, and orthostatic hypotension

Nursing Care- Antidiarrheals (prt 2)

Observe for side/adverse effects of drugs Limit fried foods or milk products until diarrhea stops Avoid alcohol Teach proper hand washing and handling of foods

NURSING CARE- ANTICOAGULANTS (prt 1)

Obtain a history for any abnormal clotting or associated health problems Monitor lab values (RBCs, H&H, Platelets) Observe for bleeding and teach patient signs/symptoms of bleeding and to report Monitor vital signs Instruct to use a soft toothbrush and electric razor

Nursing Care- Antidepressants

Obtain a medication history to prevent interactions Assess for suicidal tendency (increased energy levels) Instruct patient that it may take 2-4 weeks to see improvement in symptoms

Passive diffusion

Occurs across a concentration gradient When there is a greater concentration of the drug on one side of a cell membrane the drug will move through the membrane to the area of lower concentration This process does not require any cellular energy

Respiratory depression

Of the following which is of the greatest concern to the nurse in a client who is taking a benzodiazepine? 1.Tachycardia 2.Sedation 3.Depression 4.Respiratory depression

Niacin (vitamin B2) = aka Nicotinic Acid

Often used in lower doses with a statin or bile acid-binding drug

caution with Drugs for Gastric Acid Disorders

Older patients may need reduced doses of acid blockers- watch for confusion, headache in H2 blockers Caution in renal failure patients who take antacids containing aluminum and sodium

1 month

Once opened, insulin may be kept at room temperature for _______

Heparin onset

Onset is immediate when IV with a peak within minutes Does not cross placenta; but DOES enter breast milk

neuroleptic malignant syndrome

Onset usually occurs within a few weeks of someone who has started taking antipsychotics/neuroleptics but can happen at anytime Immediately stop causative med; symptomatic treatment (cooling, management of BP & HR)

naloxone (Narcan)

Opioid Antagonists: Antidote for opiate overdose Reverse effects of opiates, including respiratory depression, sedation, hypotension; Respiratory distress, respiratory depression

analgesics two classes

Opioids-work in the CNS Nonopioids-work on nociceptors/chemical (COX)

delayed

Optimum dosing schedule may be _____ at times until the patient recovers from drug toxicities (usually due to bone marrow suppression)

Type 2- (NIDDM aka adult onset)

Oral diabetic drugs, sometimes insulin

right route

Oral, IV, topical, subcutaneous, IM

Adrenergic Antagonists Blockers

Other uses- migraines, angina pectoris, dysrhythmias, heart failure, myocardial infarction, glaucoma

Other Intranasal Corticosteroids

Others- mometasone (Nasonex), budesonide (Rhinocort)

phase 1 biotransformation

Oxidation, reduction, hydrolysis

alpha cells of pancreas

PANCREATIC CELLS: Secrete/produce glucagon which raises blood sugar

beta cells of pancreas

PANCREATIC CELLS: secrete insulin in response to high levels of glucose. Insulin decreases blood glucose by promoting its uptake into body cells

pt taking POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) do NOT require....

PATIENT DOES NOT REQUIRE A POTASSIUM SUPPLEMENT, AS WITH OTHER DIURETICS THAT CAUSE A LOSS

NOTE GENERAL NURSING CARE DIURETICS

PATIENT MAY BE ON FLUID RESTRICTION MONITOR PULSE AND BP- SIT AND STAND SLOWLY UNTIL

SPIRONOLACTONE (ALDACTONE)

POTASSIUM SPARING DIURETICS

patient safety

PRIMARY GOAL for a nurse

THIAZIDE DIURETICS

PROTOTYPE- HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) (PO)

POTASSIUM SPARING DIURETICS

PROTOTYPE- SPIRONOLACTONE (ALDACTONE) (PO)

CARBONIC ANHYDRASE INHIBITORS

PROTOTYPE: ACETAZOLAMIDE (DIAMOX) (PO, IV)

ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC

PROTOTYPE: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

LOOP DIURETICS

PROTOTYPE: FUROSEMIDE (LASIX) (PO, IM, IV)

antitubercular drugs

PROTOTYPE: Isoniazid (INH Can cause: dose-related peripheral neuropathy (PARESTHESIA; NUMBNESS/TINGLING), clumsiness, unsteadiness, muscle ache; GI distress, jaundice, BONE MARROW SUPPRESSION, *drug-induced hepatitis* •Take on empty stomach either 1 hr before or 2 hr after meals •RIFAMPIN WHEN USED CAN CAUSE DISCOLORATION OF SWEAT & TEARS; CAN INTERFERE WITH ORAL BIRTH CONTROL

ANTITUBERCULIN DRUGS

PROTOTYPE: Isoniazid (INH) (po) •Used to treat tuberculosis (TYPICALLY in combinations w/ other drugs) •STRIPE (streptomycin; rifampin; isoniazid; pyrazinamide; ethambutol) •Bacteriostatic/bactericidal •TREATMENT PROTOCOL LASTS FROM 6 MO UP TO 2 YRS •Use w/ caution in people with alcohol or liver problems Depletes vitamin B6

URINARY TRACT ANTISPASMODICS

PROTOTYPE: OXYBUTYNIN (DITROPAN) (PO; PATCH)

SKIN DISORDERS: SCABIES OR PEDICULOSIS

PROTOTYPE: PERMETHRIN (NIX) (SHAMPOO, LOTION)

URINARY TRACT ANALGESIC

PROTOTYPE: PHENAZOPYRIDINE (PYRIDIUM) (PO)

TREATMENT FOR HYPOKALEMIA

PROTOTYPE: POTASSIUM CHLORIDE (KCL) (PO, AND MIXED IN IV FLUIDS)

patient

Pain is whatever the _____ says it is.

Hypoglycemia S/S

Pallor Cool, clammy skin Diaphoresis Nausea /vomiting Tachycardia Low blood glucose reading (less than 50 mg/dl)•Irritability, nervousness•Headache Change in level of consciousness (LOC) Seizures Death

HEPARIN DOSING

Partial thromboplastin time (PTT) and activated partial thromboplastin (aPTT) are lab tests used to monitor heparin therapy

Important note for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)

Patient may be placed on anticoagulant/antiplatelet drug once thrombotic event has been corrected to prevent recurrence

Hemorrhagic cystitis

Patient should be well hydrated to prevent ____ ____

Patients taking Nitrates: nitroglycerin (Nitrostat) must be taught.....

Patients are taught to take 1 SL every 5 minutes up to 3 tablets- if pain not relieved within 10-15 minutes of first dose, seek medical care

Warning for low molecular weight heparin: enoxaparin (Lovenox)

Patients should not take other anticoagulant drugs with LMWH or heparin (unless transitioning to oral drug)

Heavier

People who are much ____ may require larger doses to get a therapeutic effect from a drug because they have increased tissue to perfuse and increased receptor sites in some reactive tissue

Pepsin Inhibitor & Prostaglandin Analogue

Pepsin inhibitor: sucralfate (Carafate) PO - Combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin & Prostaglandin analogue: misoprostol (Cytotec) - Suppresses gastric acid secretion and increases cytoprotective mucus in GI tract

PO

Per Os (by mouth)

nifedipine (Procardia); diltiazem (Cardizem) = calcium channel blockers

Peripheral edema may occur*- may be taken with a diuretic Do not give with beta blockers- both decrease myocardial contractility (unless treating reflex tachycardia)

myelocytic

Pertaining to blood cells formed in the bone marrow Neutrophils •Eosinophils •Monocytes/macrophages

Antimetics: Prototype- prochlorperazine (Compazine); promethazine (Phenergan)

Phenothiazine antiemetics- may cause EPS Side effects: drowsiness, dystonia, photophobia, blurred vision

milrinone (Primacor)

Phosphodiesterase Inhibitors

sublingual

Placed under the tongue, where it dissolves and is absorbed into the bloodstream. DO NOT CHEW OR SWALLOW

spironolactone (Aldactone)

Potassium-Sparing Diuretics

Weaker diuretics than thiazides and loop diuretics; given PO

Potassium-Sparing Diuretics: spironolactone (Aldactone)

Must be monitored for hyperkalemia

Potassium-Sparing Diuretics: spironolactone (Aldactone) MONITOR ______ (NOTE: serum potassium should be 3.5 to 5mEq/L)

hydralazine (Apresoline) = Direct Vasodilators

Potent antihypertensive drugs Act by relaxing the smooth muscles of arteries, causing vasodilation; often used to address severe hypertension that hasn't responded to other drugs

cephalosporins

Potential Adverse Affects: •Watch for hypersensitivity reactions: rash, itching (pruritic), fever •May cause anorexia, N/V/D; superinfection •Notify HCP if diarrhea occurs-may lead to Clostridium difficile infection •Refrigerate oral solutions

Insulin pen injectors

Prefilled and reusable Examples: Humulin 70/30 and Humalog 75/25, Lantus

methylphenidate (Ritalin)

Primary drug treatment is with CNS stimulants The drugs reverse many of the symptoms, helping patients focus on tasks; can also be used to treat narcolepsy

selective serotonin reuptake inhibitors

Primary use is for major depression, but may also be used to treat anxiety disorders Takes several wks for therapeutic effect

Excretion

Process by which metabolic wastes are eliminated from the body

Genetic engineering

Process of altering DNA, usually of bacteria: to produce a chemical to be used as a drug

DIURETICS

Produce increased urine flow Used to reverse abnormal fluid retention in the body

Diuretics

Produce increased urine flow; Can affect one or more segments of the renal tubules; Used to reverse abnormal fluid retention in the body; Fluid loss == lower BP

Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox) produces more....

Produce more stable responses at recommended doses so frequent lab tests (aPPT) are not required

Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)

Promote ulcer healing by neutralizing hydrochloric acid

pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)

Proton Pump Inhibitors

Meds for Gastric Acid Disorders

Proton pump inhibitors Histamine2 receptor blockers Antacids Helicobacter pylori (H. pylori) treatment Other drugs: Carafate & Cytotec

Treating Thyroid Hormone Hypersecretion

Prototype- Propylthiouracil (PTU) and methimazole (Tapazole)

Beta2 Adrenergic Agonists- Bronchodilators

Prototype- albuterol (Proventil)

Antacids

Prototype- aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums); (PO)-come in chewable or liquid

Atypical Antipsychotics (2nd Gen)

Prototype- aripiprazole (Abilify); clozapine (Clozaril); risperidone (Risperdal) (PO, IM)

direct acting cholinergic agonists

Prototype- bethanechol (Urecholine)- stimulates receptor directly & Prototype: pilocarpine (Pilocar)•PO=treats dry mouth from salivary gland issues

ACE Inhibitors (-"pril" suffix)

Prototype- captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil) (PO)

Bile Acid Sequestrant

Prototype- cholestyramine (Questran)- (PO)

OTHER ANTIPLATELET DRUGS

Prototype- clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid) (PO)

Antidiuretic Hormone Deficiency

Prototype- desmopressin (DDAVP, Stimate) (PO, Nasal) Also, vasopressin (Pitressin); administered IV has shorter half life & causes vasoconstriction

Antidiarrheals: Prescription drugs

Prototype- diphenoxylate with atropine (Lomotil) less potential for dependence than other opiates slows GI motility- Schedule V drug

Histamine Blockers (H2 antagonists)

Prototype- famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid ); [ranitidine (Zantac)*-off market] (PO, IV)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Prototype- fluoxetine (Prozac);sertraline (Zoloft); paroxetine (Paxil) (PO)

Intranasal Corticosteroids

Prototype- fluticasone (Flonase)

Fibric Acid Agents

Prototype- gemfibrozil (Lopid)- (PO)

Direct Vasodilators

Prototype- hydralazine (Apresoline)

Thiazide Diuretics

Prototype- hydrochlorothiazide (Microzide, HydroDIURIL, HCT)

Tricyclic Antidepressants (TCAs)

Prototype- imipramine (Tofranil) (PO)

Anticholinergics (inhaled)

Prototype- ipratropium (Atrovent)- (Inhaled)

Treating Thyroid Hormone Deficiency

Prototype- levothyroxine (Synthroid)

Bipolar Disorder: Manic Mood Stabilizers

Prototype- lithium (Eskalith; Lithobid)

BIGUANIDES

Prototype- metformin (Glucophage) (PO)

CNS Stimulants: Drugs for ADHD

Prototype- methylphenidate (Ritalin)

Phosphodiesterase Inhibitors

Prototype- milrinone (Primacor)- (IV drip)

Opioid Agonists

Prototype- morphine (Duramorph); codeine, fentanyl, hydromorphone (Dilaudid) (most available PO, IM, IV, or via patch)

Opioid Antagonists

Prototype- naloxone (Narcan)***** (IV) Antidote for opiate overdoses****

Calcium Channel Blockers

Prototype- nifedipine (Procardia); diltiazem (Cardizem) (PO)

Nitrates

Prototype- nitroglycerin (Nitrostat) (SL, PO, IV, Spray, Topical)

Proton Pump Inhibitors

Prototype- pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) (PO)

Monoamine Oxidase Inhibitors (MAOIs)

Prototype- phenelzine (Nardil); tranylcypromine (Parnate); isocarboxazid (Marplan) (PO)

Barbiturates

Prototype- phenobarbital (Luminol) (PO, IM, IV)

ALPHA-ADRENERGIC AGONIST DRUGS

Prototype- phenylephrine (Neo-Synephrine); oxymetazoline (Afrin)•(PO, IV, and Topically)

Hydantoins

Prototype- phenytoin (Dilantin); fosphenytoin (Cerebyx) (PO/IV)

Hydantoin (Dilantin)

Prototype- phenytoin (_____): Usually given PO, if given IV should NEVER mix with dextrose (causes precipitate)****; only give with IV saline

Statins

Prototype- pravastatin (Pravachol); simvastatin (Zocor) (PO)

Alpha Adrenergic Blockers (-"osin" suffix)

Prototype- prazosin (Minipress); doxazosin (Cardura)- (PO)

Laxatives: Bulk-forming

Prototype- psyllium (Metamucil) (PO)

Potassium-Sparing Diuretics

Prototype- spironolactone (Aldactone)

Vaproate

Prototype- valproic acid (Depakene/Depakote) (PO)

ALPHA-GLUCOSIDASE INHIBITORS

Prototype: acarbose (Precose)

Mucolytic

Prototype: acetylcysteine (Mucomyst) (Inhalation & PO)

THROMBOLYTIC DRUGS (CLOT-BUSTERS)

Prototype: alteplase (Activase, tPA); streptokinase (Streptase) (IV)

Methylxanthines

Prototype: aminophylline (Theophylline)

ASPIRIN (ANTIPLATELET)

Prototype: aspirin (PO)

anticholinergic drugs

Prototype: atropine (Atropair) blocks acetylcholine at the muscarinic receptor

Centrally Acting Muscle Relaxants

Prototype: baclofen (Lioresal) (PO)

Anticholinergics to Treat Parkinsons

Prototype: benztropine (Cogentin); diphenhydramine (Benadryl) (PO)

Anticonvulsants for Partial Seizures

Prototype: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO)

Beta Blockers (- "olol" suffix)

Prototype: carvidolol (Coreg) metoprolol (Lopressor) (PO)

Beta Blockers (- "olol" suffix)

Prototype: carvidolol olol (Coreg) metoprolol (Lopressor) (PO)

Second Generation-Antihistamines

Prototype: cetirizine (Zyrtec), loratadine (Claritin) (PO)

Direct Acting Skeletal Muscle Relaxants

Prototype: dantrolene (Dantrium) (PO or IV)

Antitussives

Prototype: dextromethorphan (Robitussin DM; Delsym) (PO)

Cardiac Glycosides

Prototype: digoxin (Lanoxin) (PO, IV)

First Generation-Antihistamines

Prototype: diphenhydramine (Benadryl) (PO, IM, IV)

Serotonin Norepinephrine Inhibitors

Prototype: duloxetine (Cymbalta); venlafaxine (Effexor) (PO)

LOW MOLECULAR WEIGHT HEPARIN (LOVENOX)

Prototype: enoxaparin (Lovenox) (SQ)

ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC

Prototype: epoetin alfa; erythropoietin (Epogen; Procrit) (SQ)

IRON SUPPLEMENTS

Prototype: ferrous sulfate (iron) (PO)

Loop Diuretics

Prototype: furosemide (Lasix)

Loop Diuretics

Prototype: furosemide (Lasix) (PO, IV, & IM)

Sulfonylureas

Prototype: glipizide (Glucotrol); glyburide (Micronase) (PO)

TREATMENT FOR SICKLE CELL ANEMIA

Prototype: hydroxyurea (Droxia) (PO)

Dopaminergic

Prototype: levodopa-carbidopa (Sinemet); bromocriptine (Parlodel) (PO)

LOCAL ANESTHETICS

Prototype: lidocaine (Xylocaine) (various location of injections; patch)

Angiotension II Receptor Blockers (ARBs)(-"sartan" suffix)

Prototype: losartan (Cozaar); valsartan (Diovan) (PO)

Gastrointestinal Stimulants (Stomach Emptying)

Prototype: metoclopramide (Reglan) (PO, IM, IV)

Leukotriene Modifiers

Prototype: montelukast (Singulair)

Growth Hormone Excess

Prototype: octreotide (Sandostatin) (SQ)

Nasal and Systemic Decongestants

Prototype: oxymetazoline (Afrin) (intranasal spray)

barbiturates (- "tal" suffix)

Prototype: phenobarbital (Luminal); pentobarbital (Nembutal) (PO, IM, IV) THINK: (- "tal" suffix)

GENERAL ANESTHETIC

Prototype: propofol (Diprovan)

MEGLITINIDES

Prototype: repaglinide (Prandin)

THIAZOLIDINEDIONES

Prototype: rosiglitazone (Avandia)

Growth Hormone Deficiency

Prototype: somatrem (Genotropin) (IM, SQ)

NEUROMUSCULAR JUNCTION BLOCKER(AKA "PARALYTIC AGENT")

Prototype: succinylcholine (Anectine) (IV)

ANTIMIGRAINE: "TRIPTANS"

Prototype: sumatriptan (Imitrex); zolmitriptan (Zomig) (PO/SQ/Nasal spray)

WARFARIN (COUMADIN) (ANTICOAGULANT)

Prototype: warfarin (Coumadin) (PO) oral* anticoagulant

Sedative/Hypnotic

Prototype: zolpidem (Ambien)* (PO)

OPIOID AGONIST-ANTAGONISTS (PARTIAL AGONISTS)

Prototypes: nalbuphine HCl (Nubain); butorphanol (Stadol); pentazocine (Talwin)

Benzodiazepines

Prototypes:- clonazepam (Klonopin); lorazepam (Ativan); diazepam(Valium)

Orphan drug act of 1983

Provided incentives for the development of orphan drugs for treatment of rare diseases

Negative symptoms

Psychosis / Schizophrenia apathy, poor personal hygiene, withdrawn, poverty of speech

Positive symptoms

Psychosis / Schizophrenia delusions, hallucinations, bizarre behavior

pt teaching for OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)

Pt teaching: report any abnormal bleeding/bruising; stop 7-10 days before surgical procedures

contain

Purpose of inflammation is to _____ the injury or destroy the microorganism

OSMOTIC DIURETICS: MANNITOL (OSMITROL) leads to rapid......

RAPID FLUID AND ELECTROLYTE LOSS*; PROMOTES LOSS OF WATER WHILE RETAINING SODIUM

OSMOTIC DIURETICS

ROTOTYPE: MANNITOL (OSMITROL) (IV)

alpha-adrenergic antagonists

Rapid onset, peak, and duration of action; works on alpha receptors (vasoconstriction) Injection/IV-to treat shock and shock-like symptoms (highly vesicant) Topically/Eye drop- pupil dilation for eye exam

Neuroleptic Malignant Syndrome

Rare but potentially fatal condition associated with antipsychotic drugs Muscle rigidity, sudden high fever, altered mental status, BP fluctuations, tachycardia, dysrhythmias, incontinence, seizures, organ failure

NOTE about Proton Pump Inhibitors

Recent studies have suggested an increase in fractures because the drug interferes with calcium absorption Don't crush, chew or break sustained release Take once a day prior to eating in the morning

anti-inflammatory agents

Reduce body temperature (antipyretic) •Inhibit platelet aggregation-aspirin (anticoagulant) •dysmenorrhea

TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia)

Reduces the frequency of painful sickle cell crisis; decreases need for blood transfusions in sickle cell clients

Liver

Referred to in the text as a sewage treatment plant where everything that is absorbed from the G.I. tract first enters into this organ to be treated

Short acting insulin

Regular (Humulin R, Novolin R) Onset- 30-60 min; Peak- 2-4 hrs; Duration- 6-12 hrs

NURSING CARE FOR NON-INSULIN DIABETIC DRUGS

Regulate diet, exercise, medications Follow-up for lab tests Teach signs/symptoms of hypoglycemia and action to take Teach self-blood glucose monitoring

INSULIN

Released from beta cells of islets of Langerhans in response to an increase in blood glucose

OPIOID AGONISTS

Relieve moderate to severe pain Reduce pain perception in the brain Produce sedation, euphoria Reduce anxiety often caused with pain Produce miosis (pupillary constriction

pain medication mechanism of action

Relieve pain by binding to opioid receptors in the brain and spinal cord; some receptors have been found in the periphery Bind in different ways to different receptors to varying degrees- different actions are classified on this basis

Excretion

Removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, or feces

Drugs usually work 1 in 4 ways

Replace or act as substitutes for missing chemicals (i.e. insulins) Increase or stimulate certain cellular activities Depress or slow cellular activities (seizure patients) Interfere with functioning of foreign cells, such as invading microorganisms or neoplasm (antibiotics)

zolpidem (Ambien)

Requires: Schedule IV Also works on GABA/CNS depression Used for insomnia / sleeping pill Give immediately before bedtime; onset 7-27 minutes

Antiemetics Nonpharmacologic measures

Rest Weak tea Flattened carbonated beverage Gatorade, Pedialyte Crackers, dry toast

Heart failure results in

Results in increased cardiac workload, myocardial dysfunction, and worsening heart failure

reversal agent for heparin

Reversal agent: Protamine Sulfate

Uses for steroids (prt 2)

Rheumatic disorders Shock Skin disorders Transplant rejection prophylaxis

Neuroleptic Malignant Syndrome (NMS)

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (e.g., bromocriptine). THINK: abrupt withdrawal of Dopaminergic drugs may cause this

parentally

Route of administration in which a drug is injected

Adverse effects: Propylthiouracil (PTU) and methimazole (Tapazole)

S/Sx of hypothyroidism; bradycardia, anemia, slowed body movements, emotional dullness, weight gain, constipation

Aspirin

SALCYLATES Adverse Reactions: •Tinnitus (ringing in the ears)* •Gastric ulceration and bleeding* •Anaphylaxis Blood dyscrasias & thrombocytopenia* •Hyperventilation •Sweating & fever* •Dehydration & ULCERS

Low dose aspirin

SALICYLATES (baby aspirin 81mg) used for antiplatelet effect (for lifespan of platelets 8-11 days)*

aspirin

SALICYLATES is a prostaglandin inhibitor- anti-inflammatory, antipyretic, & antiplatelet properties (decreases platelet aggregation) •Gastric distress* is a common problem due to large doses needed for anti-inflammatory effect

Aspirin (ASA)

SALYCYLATES Common Side Effects: Anorexia •N/V/D •Dizziness •Confusion •Hearing loss •GI burning; epigastric pain; heartburn •Increase in bleeding time*** & ULCERS

Type I hypersensitivity reaction

SEVERE reaction and can be Life-threatening TREATMENT: Immediately D/C the drug a& administer epinephrine

URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM) discontinuation.....

SHOULD DISCONTINUE DRUG IF SCLERA OR SKIN BECAUSE YELLOW TINGED

SIDE EFFECTS of OSMOTIC DIURETICS: MANNITOL (OSMITROL)

SIDE EFFECTS: DEHYDRATION-DIZZINESS, HEADACHE, HYPOTENSION, NAUSEA, DRY MOUTH, THIRST; SUDDEN DROP IN FLUID LEVELS

SIDE EFFECTS of LOOP DIURETICS: FUROSEMIDE (LASIX)

SIDE EFFECTS: DIZZINESS, VERTIGO, ORTHOSTATIC HYPOTENSION, N/V, PARESTHESIA

side effects of URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM)

SIDE EFFECTS: GI UPSET, HEADACHE, RASH, *REDDISH-ORANGE COLORING OF URINE, SKIN, & SCLERA (EYES) STAINING OF CONTACT LENSES*, RENAL OR HEPATIC TOXICITY

side effects of POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)

SIDE EFFECTS: HYPERKALEMIA (LETHARGY, CONFUSION, ATAXIA, MUSCLE CRAMPS, CARDIAC ARRHYTHMIAS), DIZZINESS, HA, DIARRHEA, HIRSUTISM, GYNECOMASTIA

side effects of ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

SIDE EFFECTS: HYPERTENSION RELATED TO INCREASING HEMATOCRIT LEVEL; RISK FOR THROMBOTIC EVENT (MI, STROKE, DVT); HEADACHE & BODY ACHES; SEIZURES

side effects of CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX)

SIDE EFFECTS: WEAKNESS, FATIGUE, PARESTHESIA OF EXTREMITIES, CONFUSION, DROWSINESS, RAPID SHALLOW BREATHING, ANOREXIA, BONE MARROW SUPPRESSION

PERMETHRIN (NIX)

SKIN DISORDERS: SCABIES OR PEDICULOSIS

NOTE for URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)

SPASMS CAN LEAD TO DYSURIA, URGENCY, INCONTINENCE, NOCTURIA

SKIN DISORDERS: SCABIES OR PEDICULOSIS

SYMPTOMS OFTEN OCCUR DUE TO THE BURROWING OF THE MITE & LAYING OF EGGS; CAUSES SEVERE ITCHING & MAY LEAD TO SECONDARY INFECTIONs

Aspirin

Salicylates *Not recommended for children/adolescents; especially w/ viral infections (Reye's syndrome)

Benzodiazepine (pam/lam)

Schedule IV (schedule 4) due to risk of dependence/addiction Potentiates the effects of GABA which is an inhibiting neurotransmitter

cetirizine (Zyrtec), loratadine (Claritin)

Second Generation-Antihistamines

Zolpidem (Ambien)

Sedative/Hypnotic

70%

Seizures are controlled in about _____ of patients with the drugs Usually taken throughout the person's lifetime May trial a discontinuance if no seizure in several years

SELECTION OF PAIN MEDICATION

Selection of an analgesic is based on: •Effectiveness of the agent •Duration of action •Desired duration of therapy •Ability to cause drug interactions •Hypersensitivity of the patient •Available routes of drug administration

celecoxib (Celebrex)

Selective COX-2 inhibitors

ATIENT-CONTROLLED ANALGESIA (PCA)

Self-administration of IV doses of opioid analgesics using a special infusion pump Used for acute pain after surgery Also for chronic pain in an outpatient setting (IV or possibly through an epidural catheter)

Stevens-Johnson Syndrome (SJS)

Serious disorder characterized by ocular and/or genital lesions in addition to skin involvement usually triggered by a drug; young adults and 10% of body surface involved THINK: adverse effect of Anticonvulsants for Partial Seizures: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO

SS

Serotonin Syndrome Onset-within minutes to hours of taking any serotonin drug Hyperreflexia; agitation Elevated temp Hyperactive bowels (N/V/D)•Usually resolved w/in 24 hours Tx: benzodiazepines; SSRI, SNRIs

Antimetics: Prototype: ondansetron (Zofran) (PO/IV)

Serotonin receptor antagonists- most effective for chemotherapy- related N & V- no EPS effects, less drowsiness Side effects: HA, dizziness, drowsiness, myalgia, urinary retention, constipation

What measurements are usually part of screening performed for lipid disorders

Serum cholesterol and triglyceride measurements

MEGLITINIDES: repaglinide (Prandin)

Short acting drugs Watch for hypoglycemic episodes Monitor liver function

antidepressants

Should not be taken with MAOIs and should not be used within 14 days after discontinuing MAOI

side effects of Loop Diuretics: furosemide (Lasix)

Side effect: ototoxicity is possible; watch for dehydration, hyponatremia, hypochloremia, hypotension*, hypokalemia*, hyperglycemia & increased uric acid

Opioid Antagonists: naloxone (Narcan)

Side effects •Tremors, sweating •Erratic BP Hypo- then Hypertension, tachycardia, hyperventilation •Nausea, vomiting •Reversal of analgesia Usually administered for respirations < 10; keep resuscitation equipment close by; may require several doses for full reversal

side effects of Nasal and Systemic Decongestants

Side effects (PO): anxiety, restlessness, HA, dizziness, nervousness, hypertension

Antimigraine: Triptans

Side effects/adverse effects: chest pressure (heavy arms or chest tightness); coronary artery vasospasm/angina; dizziness, vertigo, hypertension Use caution in people with liver disease; cardiac disease* & hypertension*

Opiate Agonists (Narcotic Analgesics)

Side effects/adverse reactions •Hypotension; orthostatic hypotension** •Sedation, confusion, blurred vision, euphoria •Lightheadedness, dizzines

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Side effects/adverse reactions: N/V, constipation, tachycardia, sweating, erectile dysfunction, *serotonin syndrome*; hypertension, urinary retention Black box warning: increased risk of suicide thoughts & behaviors, especially with children, adolescents, and young adults

ACETAMINOPHEN

Side effects: Generally safe in appropriate doses •Rash •Low incidence of GI distress

Side effects of Bile Acid Sequestrant: cholestyramine (Questran)

Side effects: Bloating and constipation may occur; flatulence, exacerbation of hemorrhoids May interfere with absorption of vitamins and minerals

Side effects of Leukotriene Modifiers: montelukast (Singulair)

Side effects: HA, dizziness, N/V, respiratory infection, pharyngitis, cough

side effects of Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)

Side effects: May cause constipation (aluminum preparations); systemic alkalosis; gastric acid rebound when stopped NOTE: Do not block acid- they are acid neutralizers!

side effects of Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)

Side effects: Mild abdominal pain; *myalgia,*hepatitis, URI, arthralgia, and diarrhea are the most common adverse effects.

general anesthetic: propofol (Diprovan)

Side effects: apnea; respiratory depression/arrest; hypotension Must use other means of ventilation*** and respiratory support

side effects of milrinone (Primacor) = Phosphodiesterase Inhibitors

Side effects: arrhythmias, hypotension, N/V, thrombocytopenia

side effects of THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)

Side effects: bleeding***, HA, hypotension, rash, bronchospasm, pain, fever, *Reperfusion dysrhythmias can occur*

Side effects of Warfarin (Coumadin)

Side effects: bleeding***, petechiae, ecchymosis, tarry stools, hematemesis, hematuria

Side effects of Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor)

Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression Can *mask symptoms of hypoglycemia*

sedative zolpidem (Ambien)*

Side effects: daytime sedation, confusion, amnesia, dizziness, depression w/ suicidal thoughts Adverse effects: severe neuropsychiatric reactions; hallucinations, sensory distortion, sleepwalking, nocturnal eating

side effects of Bulk-forming laxatives = psyllium (Metamucil)

Side effects: diarrhea, abdominal cramps, bloating

side effects of Laxatives: stool softeners = docusate (Colace)

Side effects: diarrhea, abdominal cramps, bloating

side effects of saline (osmotic) laxative = polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)

Side effects: diarrhea, abdominal cramps, bloating

Side effects of Angiotension II Receptor Blockers (ARBs): losartan (Cozaar); valsartan (Diovan)

Side effects: dizziness, HA, diarrhea, abdominal pain, hypotension

Side effects of Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)

Side effects: dizziness, HA, peripheral edema*, bradycardia, flushing

calcium channel blockers = nifedipine (Procardia); diltiazem (Cardizem)

Side effects: dizziness, HA, peripheral edema*, bradycardia, flushing **Avoid grapefruit juice*** (may cause toxic level of medication)

side effects of TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia)

Side effects: dizziness, HA, rash, erythema, anorexia, N/V, stomatitis, bone marrow depression

Side effects of First Generation-Antihistamines: diphenhydramine (Benadryl)

Side effects: drowsiness, sedation, dizziness, epigastric distress, thickening of bronchial secretions, urinary retention, rash, bradycardia

Side effects of Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin)

Side effects: drowsiness, tiredness, dry mouth; stomach pain (but less drowsiness/tiredness than 1stgeneration)

side effects for epoetin alfa; erythropoietin (Epogen; Procrit)

Side effects: hypertension related to increasing hematocrit level; risk for thrombotic event (MI, stroke, DVT); headache & body aches; seizures, dizziness, edema, N/V/D

Side effects of Intranasal Corticosteroids: fluticasone (Flonase)

Side effects: local burning & irritation, stinging & drying of the nasal mucosa, HA, increase in risk of infection

side effects of Antitussives: dextromethorphan (Robitussin DM; Delsym)

Side effects: nausea, dizziness, drowsiness, respiratory depression

side effects Mucolytic: acetylcysteine (Mucomyst)

Side effects: nausea, stomatitis, urticaria, bronchospasm, rhinorrhea

Side effects of IRON SUPPLEMENTS: ferrous sulfate (iron)

Side effects: nausea, vomiting, constipation*, may cause *dark/tarry stools* often mistaken for GI bleed

Dopaminergic: levodopa-carbidopa (Sinemet); bromocriptine (Parlodel) (PO)

Side effects: nausea, vomiting, drowsiness; dyskinesias (head bobbing, tics, grimacing, tremors-may be signs of toxicity); orthostatic hypotension; cardiovascular effects (tachycardia, irregular heartbeat, palpitations); psychosis; harmless discoloration of sweat & urine (dark brown or red)

Side effects of Expectorants: guaifenesin (Mucinex)

Side effects: nausea, vomiting, headache, dizziness

Side effects of Anticholinergics (inhaled): ipratropium (Atrovent)

Side effects: nervousness, dizziness, HA, nausea, GI distress, palpitations

side effects of Beta2 adrenergic agonists: epinephrine (Adrenalin)

Side effects: nervousness, tremor, tachycardia , palpitations, dysrhythmias, angina, elevated BP, and hyperglycemia*

side effects of Gastrointestinal Stimulants (Stomach Emptying): metoclopramide (Reglan)

Side effects: restlessness, drowsiness, fatigue, extra-pyramidal effects, Parkinson-like reactions, nausea, diarrhea

Vaproate: valproic acid (Depakene/Depakote)

Side effects: sedation; drowsiness; GI upset** (nausea, vomiting, indigestion); prolonged bleeding time; hepatotoxicity*; pancreatitis; HA, tinnitus

Phenytoin (Dilantin)

Side effects: slurred speech, ataxia, tremor, confusion, thrombocytopenia, leukopenia, agranulocytosis; and gingival hyperplasia**; dysrhythmias; hypotension; hyperglycemia; Stevens Johnsons syndrome; if toxicity occurs may see nystagmus Drug inhibits release of insulin if taken for long periods of time; interferes with folic acid absorption

Side effects of ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

Side effects: tachycardia, arrhythmias, rash, gastric irritation, peptic ulcers, bone marrow suppression, hypotension

Side effect of low molecular weight heparin: enoxaparin (Lovenox)

Side effects: watch for hemorrhage/bleeding (occult blood, hematuria, bruising, bleeding gums); thrombocytopenia; use cautiously in patients with spinal anesthesia

side effects of ASPIRIN (ANTIPLATELET): aspirin

Side effects: watch for s/sx of aspirin toxicity; nausea, dyspepsia, heartburn, GI bleed, dizziness, tinnitus, urticaria, anaphylaxis, sweating, fever, hyperventilation, acidosis, increased risk of bleeding/bruising, blood dyscrasias

SCHEDULE II PRESCRIBING LIMITATIONS IN MISSOURI

Signed in original ink if written Verbal orders in an emergency by doctor only May fax if injectable, to long term care facility or hospice

ARBs: losartan (Cozaar); valsartan (Diovan)

Similar to ACE inhibitors- prevent angiotensin II from reaching receptors (bind with the receptors), causing same effect as ACE inhibitors

Angiotension II Receptor Blockers (ARBs)(-"sartan" suffix): losartan (Cozaar); valsartan (Diovan)

Similar to ACE inhibitors- prevent angiotensin II from reaching receptors (bind with the receptors), causing same effect as ACE inhibitors

Serotonin Syndrome

Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity NOTE: this is something to look for with Selective Serotonin Reuptake Inhibitors (SSRIs)

Since heparin is naturally occurring....

Since naturally occurring, there are few drug interactions (but of course, use cautiously with other anticoagulants)

barrier defenses

Skin-1st line of defense •Mucous membranes-cilia and/or mucous •Gastric acid-destroys many pathogens •Antigens-identifies "self"

NOTE smoking and its effects on Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)

Smoking reduces the effectiveness

apsirin implications

Some come enteric-coated so they are designed to dissolve in the intestines instead of the stomach •Increased risk of bleeding: older than 60, use of other anticoagulants or corticosteroids, smoking, & alcohol use

diuretics are Sometimes administered.....

Sometimes are administered with other antihypertensive drugs examples- ▪Potassium sparing- spironolactone (Aldactone) ▪Thiazide- hydrochlorothiazide (Microzide)- research has shown a decrease in mortality and morbidity with use of this class for hypertension ▪Loop- furosemide (Lasix)

Antidepressants

Sometimes called mood elevators These drugs are used for depression accompanied by sadness, hopelessness and helplessness

Receptor sites

Specific areas on cell membranes that react with certain chemicals to cause and effect within the cell

INSULIN USES: prt 2

Standard treatment for Type 1 diabetics Sometimes temporarily used for Type II diabetics who may be under stress due to illness or medications & may need insulin coverage temporarily

anticonvulsants

Start on low dose and gradually increase until control is achieved Stabilize nerve cell membranes by manipulating ion influx into neurons and suppress the abnormal electric impulses in the cerebral cortex Prevent seizures but do not eliminate the cause or provide a cure Many are used for other pathologies, such as bipolar disorders, migraines, and neuropathic pain

pravastatin (Pravachol); simvastatin (Zocor)

Statins

Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)

Stimulate adrenergic receptors to cause vascular constriction of the capillaries in the nasal mucosa- results is shrinking of the nasal mucous membranes and a reduction in fluid secretion

Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray) MOA

Stimulate adrenergic receptors to cause vascular constriction of the capillaries in the nasal mucosa- results is shrinking of the nasal mucous membranes and a reduction in fluid secretion

Adrenergic Agonists

Stimulate the sympathetic nervous system- "Fight or Flight" •Mimic norepinephrine and epinephrine

Gastrointestinal Stimulants (Stomach Emptying): metoclopramide (Reglan)

Stimulates movement of the upper GI tract without stimulating secretions; increases sensitivity to acetylcholine prevention of operative nausea & vomiting; stimulates gastric emptying

Sympathetic Nervous System Influence

Stimulates the heart Increase heart rate Speeds conduction Increase in force of contraction

Anxiety

Stimulation of SYMPATHETIC nervous system: sweating, tachycardia, tachypnea, hypertension Mild ____ can be useful BUT severe can be debilitating

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Category B

Studies indicate no risk to the animal fetus; information for humans is not available

Category A

Studies indicate no risk to the human fetus

ORAL DIABETIC DRUGS (TYPE II DIABETES)

Sulfonylureas Biguanides Alpha-glucosidase inhibitors Thiazolidinediones

Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)

Suppress gastric acid secretion by inhibiting the hydrogen/potassium ATPase enzyme system in gastric parietal cells- final step of acid production

Prostaglandin analogue: misoprostol (Cytotec)

Suppresses gastric acid secretion and increases cytoprotective mucus in GI tract May be used for patients on NSAIDS who experience gastric distress Side effect: N/V/D*, flatulence, hypermenorrhea, bleeding/spotting, *miscarriage* (Pregnancy Category X**)

effects of thrombocytopenia

Symptoms Easy or excessive bruising (purpura) Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs. Prolonged bleeding from cuts. Bleeding from your gums or nose. Blood in urine or stools. Unusually heavy menstrual flows. Fatigue. Enlarged spleen.

extrapyramidal syndrome (EPS)

Symptoms of abnormal posture and movement secondary to use of antipsychotic drugs

food interactions with MAOIS

Symptoms: Sweating, tremors Bounding heart rate Increased BP Increased temperature

Chemotherapeutic agents

Synthetic chemicals used to interfere with the functioning foreign foreign cell populations, causing cell death This term is frequently used to refer to the drug therapy of neoplasms, but it also refers to drug therapy affecting any foreign cell

preventing resistance

TAKE ALL OF THE PRESCRIPTION

URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM) pt teaching

TEACH PATIENT ABOUT URINE DISCOLORATION & STAINING OF CLOTHING

GENERAL NURSING CARE DIURETICS TEACHING

TEACH PATIENT TO READ LABELS AND WATCH SODIUM AND POTASSIUM INTAKE- IF ON POTASSIUM WASTING DRUG- EAT POTASSIUM-RICH FOODS TEACH TO TAKE DRUG IN THE AM

Drug allergy

THEORETICALLY it should NOT happen the very 1st time exposed Be sure to assess for "true" allergies; many listed allergies by patients are other side effects and not tur allergies

challenges

THERAPY _______ FOR VIRAL INFECTIONS: Difficult for drug to find virus without injuring normal cells •Each antiviral drug specific to one particular virus

HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)

THIAZIDE DIURETICS

rosiglitazone (Avandia)

THIAZOLIDINEDIONES

Barbiturates

THINK: -tal Side effects: somnolence, agitation, confusion, ataxia, CNS depression, hallucinations, bradycardia, hypotension, syncope, N/VD, or constipation, hypoventilation, apnea

Selective Serotonin Reuptake Inhibitors

THINK: SSRIs May cause cholinergic effects, insomnia, headache, dizziness, nervousness, tremor, seizures, anorexia, nausea, diarrhea, sexual dysfunction, suicidal ideation, & weight changes Watch for Serotonin Syndrome

adverse effects of glipizide (Glucotrol); glyburide (Micronase)

THINK: SULFONYLUREAS *hypoglycemia, weight gain, hypersensitivity reactions, GI distress, N/V/D, heartburn and hepatotoxicity Alcohol ingestion may cause disulfiram-like reaction- flushing, palpitations, nausea

Grapefruit juice inhibits drug metabolism

THINK: Statins: pravastatin (Pravachol); simvastatin (Zocor) what is a food that SHOULD NOT be taken with this drug???

Fluoroquinolones ("-acin" suffix)

THIS DRUG SHOULD BE MONITORED FOR: •Dysrhythmias and hepatotoxicity are the most serious adverse effects; tendon rupture •Monitor for prolonged QT interval in cardiac patients •**Not approved for children under 18 because of potential for affecting cartilage development* •Avoid use in pregnancy or if breast feeding

alteplase (Activase, tPA); streptokinase (Streptase)

THROMBOLYTIC DRUGS (CLOT-BUSTERS)

POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) treats....

TREAT EDEMA ASSOCIATED WITH HEART FAILURE, LIVER DISEASE, OR RENAL DISEASE; TREATS HYPERALDOSTERONISM

POTASSIUM CHLORIDE (KCL)

TREATMENT FOR HYPOKALEMIA

hydroxyurea (Droxia)

TREATMENT FOR SICKLE CELL ANEMIA

Antimigraine Agents

TRIPTANS: Used to stop a migraine headache; vasoconstriction of cranial vessels; usually works within 10-20 minutes

Adrenergic

TYPES OF RECEPTORS: •Alpha1- constricts blood vessels, dilates pupils •Alpha2- inhibits release of norepinephrine •Beta1- increases heart rate and force of contraction, releases renin •Beta2- inhibits smooth muscle

Cholinergic

TYPES OF RECEPTORS: •Nicotinic- stimulates smooth muscle and gland secretions •Muscarinic- decreases heart rate and force of contraction, stimulates smooth muscle and gland secretions

Alpha 1

TYPES OF RECEPTORS: Adrenergic constricts blood vessels, dilates pupils

Beta 1

TYPES OF RECEPTORS: Adrenergic increases heart rate and force of contraction, releases renin

Alpha 2

TYPES OF RECEPTORS: Adrenergic inhibits release of norepinephrine

Beta 2

TYPES OF RECEPTORS: Adrenergic inhibits smooth muscle

Muscarinic

TYPES OF RECEPTORS: Cholinergic decreases heart rate and force of contraction, stimulates smooth muscle and gland secretions

Nicotinic

TYPES OF RECEPTORS: Cholinergic stimulates smooth muscle and gland secretions

Problems related to OTC drug use

Taking these drugs could mess the signs and symptoms of underlining disease, making diagnoses difficult Taking these drugs with prescription medication could result in drug interactions and interfere with drug therapy Not taking these drugs as directed could result in serious overdoses

Nursing Care- Steroids

Teach appropriate use of drugs- on time and as directed Alert other care givers about use Don't stop drug abruptly Avoid infection

Nursing Care- Drugs for Gastric Acid Disorders pt teaching

Teach nonpharmacologic methods for reducing pain from gastric acid secretion Teach how to take drugs and explain side/adverse effects Teach to report any GI bleeding

NURSING CARE- ANTICOAGULANTS (prt 2)

Teach not to smoke during therapy- increases metabolism and need for more Coumadin No aspirin; avoid NSAIDS Avoid large amounts of green leafy vegetables if taking Coumadin (be consistent & consume in moderation) Encourage patient to wear a Medic-Alert bracelet Use cautiously in trauma patients; need to stop most anticoagulants/antiplatelets 7-10 days prior to scheduled surgery

Nursing Care- Antihypertensives (prt 2)

Teach other nonpharmacologic methods to lower BP- stress reduction, weight control, no smoking or caffeine, etc. Teach to sit or stand slowly until used to drug Teach adherence to drug regimen- don't stop or miss doses Lab tests may be necessary- such as BUN, creatinine, blood glucose levels

Nursing Care/Implications- Anticonvulsants (prt 2)

Teach patient and family about environmental protection from injury in case seizures occur Teach to avoid alcohol and other CNS depressants Patient should have medic-alert bracelet/necklace Do not abruptly stop drug therapy Teach to keep dental appointments at regular intervals (phenytoin)

teach pt using Mucolytic: acetylcysteine (Mucomyst) to.....

Teach patient appropriate use of drug nebulizer

NURSING CARE- THROMBOLYTICS (prt 2)

Teach patient bleeding precautions Monitor vital signs Avoid using aspirin, NSAIDS

Nursing Care- Drugs for Heart Failure (prt 2)

Teach patient to monitor daily weights- report if 2 lb/day or 5 lbs/week No smoking, alcohol, limit caffeine Teach to report dyspnea, frothy sputum, excessive fatigue, edema

nursing care for antidepressants

Teach patient to not stop abruptly; ***taper off of medications***

Nursing Care- Diuretics (prt 2)

Teach patient to read labels and watch sodium and potassium intake- if on potassium wasting drug- eat potassium-rich foods Patient may be on fluid restriction Teach to take drug in the AM Monitor pulse and BP- sit and stand slowly until becoming used to the drugNursing Care- Diuretics

Nursing Care- Antimetics pt teaching

Teach to avoid alcohol Safety precautions if driving, operating machinery, etc.

Hydantoins: Prototype- phenytoin (Dilantin) & fosphenytoin (Cerebyx)

Teratogenic to fetus during pregnancy***;cleft palate & heart defects; (cat. D); & can interfere with birth control Serum drug level should be in therapeutic range- 10-20 mcg/ml*****

vaproate: valproic acid (Depakene/Depakote)

Teratogenic** (cleft palate & heart defects) (Cat. D & X) Interferes with many drugs

Smooth ER

That portion of the endoplasmic reticulum that is free of ribosomes.

Liver

The _____ is the most important site of drug metabolism, or bile transformation, the process by which drugs are changed them to new, less active chemicals Think of this organ as a sewage treatment plant: everything that is absorbed from the G.I. tract first enters this organ to be treated then this organ detoxifies many chemicals and uses others to produce needed enzymes and structures

Half life

The absorption rate, the distribution to the tissues, the speed of bio transformation, and how fast the drug is excreted are all taken into consideration when determining the ______ of the drug

Urine

The acidity of ______ can play an important role and drug excretion

Dynamic equilibrium

The actual concentration that a drug reaches in the body results from a _______ _______ involving the rate of several processes: Absorption from the side of entry Distribution to the active site Biotransformation or metabolism in the liver Excretion from the body

combination therapy

The administration of two or more antimicrobial medications simultaneously to prevent the growth of mutants that might be resistant to one of the antimicrobials

aminocaproic acid (Amicar)

The anti-thrombolytic drug _____ _____ may be used to stop the hemorrhage

immune response

The body's defensive reaction to invasion by bacteria, viral agents, or other foreign substances.

3.It is possible that this medication may cause discoloration of your urine and sweat.

The client is taking levodopa-carbidopa (Sinemet). Which of the following should the nurse include in his patient teaching? 1.This drug has been shown to be a very effective cure for Parkinson's disease. 2.On occasion, clients normally develop a fever while taking this medication. 3.It is possible that this medication may cause discoloration of your urine and sweat. 4.You should try to add additional Vitamin B6 to your diet.

Hyponatremia

The client is taking lithium (Eskalith). In order to decrease the risk of toxicity, it is important for the client to avoid what condition? 1.Hyperkalemia 2.Hypoglycemia 3.Hypernatremia 4.Hyponatremia

Gluconeogenesis

The combination of small carbon containing compounds to yield glucose.

Critical concentration

The concentration of a drug must reach in the tissues that respond to the particular drug to cause the desired therapeutic affect

patient teaching

The drug class Barbiturates (- "tal" suffix) must include important ____ ____ to AVOID alcohol or other CNS depressant drugs when taking this medication if not there is risk for respiratory depression, comma , & death

Conical pharmacology address is two key concerns

The drugs affect on the body in the body's response to the drug

G1 phase

The first gap, or growth phase, of the cell cycle, consisting of the portion of interphase before DNA synthesis begins.

renal injury

The glomerulus in the kidney has a very small capillary network that filters the blood into the renal tubule. Some drug molecules are just the right size to get plugged into the capillary network, causing acute inflammation and severe renal problems. Some drugs are excreted from the kidney unchanged; they have the potential to directly irritate the renal tubule and alter normal absorption and secretion processes.

first pass effect

The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.

Receptor site

The interactions between the chemical and the ____ ____ affects enzyme systems within the cell The activated enzyme system then produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations and cellular metabolism

trough level

The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.

peak level

The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring.

Protein

The more bound to the _____, the more difficult it can be for the medication to be released and able to cross membranes to get to the tissue cells The drug must be freed from the proteins binding site to act on the tissues

Active transport

The movement of substances across a cell membrane against the concentration gradient; this process requires the use of energy

Cheese

The nurse would tell the client who is taking an MAOI to avoid which of the following foods? 1.Peanut butter 2.Carrots 3.Cheese 4.Romaine lettuce

Generic name

The original designation that I drug is given when the drug company that developed it applies for the approval process

Fast pass effect

The portion of the drug that gets through the ______ ______ ____ is delivered to the circulatory system for transport throughout the body

glucose metabolism

The process by which cells commonly obtain energy by breaking the chemical bonds of glucose molecules and use this energy to form ATP

150

The recommended dose of a drug is based on drug evaluation studies and is targeted at a ______ pound person

Exocytosis

The removal of large amounts of material from a cell by pushing them through the cell membrane

G2 phase

The second growth phase of the cell cycle, consisting of the portion of interphase after DNA synthesis occurs.

Pharmacodynamics

The study of the interactions between the chemical components of living systems and the foreign chemicals, including drugs, that inter-living organisms; the way a drug affects the body

S phase

The synthesis phase of the cell cycle; the portion of interphase during which DNA is replicated.

Half life

The time it takes for the amount of drug in the body to decrease to 1/2 of the peak level it previously achieved

Pharmacokinetics

The way the body deals with the drug, including absorption, distribution, bio transformation, and excretion

Antiinfectives

Therapeutic Actions: Some _____ interfere with BIOSYNTHESIS of the pathogen cell wall bacterial cells have a slightly different composition than human cells this is an effective way to destroy the bacteria without affecting the host Ex. penicillin

antiinfectives

Therapeutic actions: many ______ interfere with the steps involved in PROTEIN SYNTHESIS which is a process necessary to maintain the cell and allow for cell division ex. aminoglycosides and macrolides

antiinfectives

Therapeutic actions: some _____ interfere with DNA synthesis in the cell which leads to the inability to divide and eventually cell death ex. fluoroquinolones

Antiinfectives

Therapeutic actions: some ______ PREVENT the cells of the invading organism from using substances essential to their growth and development This inhibits cell division which leads to the invading organisms death ex. sulfonamides and antimycobacterial drugs

Category D

There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.

P450 system (cytochrome P450)

These enzymes are found in most cells but are especially abundant in the liver

Orphan drugs

These may be useful in treating a rare disease, or they may have potentially dangerous adverse effects

prednisone

They are a natural hormone (adrenal cortex); and when given can actually suppress the body's own production of corticosteroids (may cause adrenal insufficiency)

hydrochlorothiazide (Microzide, HydroDIURIL, HCT)

Thiazide Diuretics

Watch for dehydration, hypokalemia*

Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) WATCH FOR ______ and hyperglycemia (may elevate blood glucose) b/c this drug affects these things

Tetracyclines ("-CLINES" SUFFIX)

Things to monitor and other adverse affects of this "-clines" drug: •Alteration of vaginal & intestinal flora cause diarrhea, GI upset, risk of yeast infection; Monitor for diarrhea (might develop into C. diff) •***Often causes photosensitivity! Instruct to wear sunscreen & protective clothing*** •**Take on an empty stomach; Only take antacids, milk products, and iron supplements at least 2 hours after dose was taken (ALL AFFECT ABSORPTION)

cytotoxic reaction

This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days.

serum sickness reaction

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug

Kidney dysfunction

This can lead to toxic levels of a drug in the body because the drug cannot be excreted

Curare

This drug is said to be a competitive antagonist of acetylcholine

Oral route

This is the most frequently used drug in ministration route and clinical practice It is not invasive and as a rule it is less expensive than drug in ministration by other routes It is also considered the safest way to deliver drugs

delayed allergic reaction

This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.

GI upset

This was the stared side effect for Vaproate: valproic acid (Depakene/Depakote)

Very low density lipoprotein (VLDL)

Three major lipoproteins: carries mostly triglycerides and less cholesterol

High density lipoprotein (HDL)

Three major lipoproteins: contains less fat

Low density lipoprotein (LDL)

Three major lipoproteins: contains more fat

Signs of Thyroid Hormone Hypersecretion

Thyroid Hormone Excess-: known as Graves disease Tachycardia Palpitations Dysrhythmias Diaphoresis

drug half life

Time required for one-half of an administered drug to be lost through metabolism and elimination. the time required for the amount of drug in the body to decrease by 50%

Drug

To become a ________, a chemical must have a demonstrated therapeutic value or efficacy without severe toxicity or damaging properties

How drugs work

To depress or slow cellular activities

How drugs work

To increase our stimulate certain cellular activities

How drugs work

To interfere with the functioning of foreign cells, such as invading micro organisms or neoplasms leading to cell death Drugs at acting this way or called chemotherapeutic agents

How drugs work

To replace or act as substitutes for missing chemicals

levothyroxine

To treat thyroid deficiency-(replaces hormones) T4 and T3 are the primary hormones

Synthetically

Today, many drugs are developed _________ after chemicals and plants, animals, or the environment have been tested and found to have therapeutic activity

Ototoxicity

Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is likely to be permanent.

levothyroxine (Synthroid)

Treating Thyroid Hormone Deficiency

Prototype- Propylthiouracil (PTU) and methimazole (Tapazole)

Treating Thyroid Hormone Hypersecretion

inflammation

Treatment Strategies for ____: ____ is a nonspecific process •Identify cause and remove it if possible •Most of the time it is mild and self-limiting •Use topical agents (creams, ointments, patches, intranasal sprays) when possible•Goal of treatment is to reduce intensity of inflammatory response •Common diseases that benefit from anti-inflammatory meds: allergic rhinitis, anaphylaxis, contact dermatitis, Crohn's disease

systemic infections

Treatment of ____ ____: Factors of treatment must include the identification of the CORRECT pathogen and then selecting the drug that is MOST likely to cause the LEAST complications for the patient and be the the MOST effective against the pathogen involved

Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin) used for.....

Treats allergy symptoms, hay fever, hives & itching, watery itchy eyes, sneezing

tissue invading worm infections

Trichinosis (lung, heart, brain) Filariasis (lymphatic tissue) Shistosomiasis (liver, spleen, CNS, cardiac)

4 groups of antidepressants

Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) Serotonin norepinephrine inhibitors (SNRIs)

SULFONYLUREAS

Two generations of drugs --- Second generation drugs are effective at lower doses, have a longer duration of action, and cause fewer side effects Has similar side effects as insulin-( hypoglycemia)

Short-Acting

Types of corticosteroids: Cortisone & hydrocortisone

Long-Acting

Types of corticosteroids: Dexamethasone & betamethasone

Intermediate Acting

Types of corticosteroids: Prednisone & methylpredmisolone

Food interactions with MAOIs

Tyramine: Cheese Bananas, raisins, papaya Avocados, figs Pickled foods Red wine, beer Sour cream, yogurt Chocolate, coffee Fava beans Beef or chicken liver Meat extracts Pepperoni, salami, sausage Bologna, sausages, hot dogs Yeast Soy sauce Symptoms: Sweating, tremors Bounding heart rate Increased BP Increased temperature

LOOP DIURETICS: FUROSEMIDE (LASIX) increase urine.....

UNLIKE THIAZIDE DIURETICS, FUROSEMIDE CAN INCREASE URINE OUTPUT EVEN WHEN BLOOD FLOW TO THE KIDNEYS IS DIMINISHED; AKA "HIGH CEILING DIURETICS" DUE TO GREATER DEGREE OF DIURESIS

THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) elevate.....

URIC ACID LEVELS MAY ELEVATE AND PRECIPITATE GOUT

PHENAZOPYRIDINE (PYRIDIUM)

URINARY TRACT ANALGESIC

OXYBUTYNIN (DITROPAN)

URINARY TRACT ANTISPASMODICS

POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) used as.....

USED AS MILD DIURETICS OR IN COMBINATION WITH ANOTHER DIURETI

LOOP DIURETICS: FUROSEMIDE (LASIX) used in.....

USED IN ACUTE HEART FAILURE PTS & IN KIDNEY PATIENTS; ALSO WHEN EMERGENT NEED TO MOVE FLUID (EX: PULMONARY EDEMA); GIVEN PO, IV, AND IM

TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL)

USED TO TREAT OR PREVENT HYPOKALEMIA; OFTEN PRESCRIBED FOR CLIENTS TAKING POTASSIUM DEPLETING DIURETICS

ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)

USES: *ANEMIA RELATED TO CHRONIC RENAL FAILURE; (DIALYSIS PATIENTS); ANEMIA RELATED TO CHEMOTHERAP

Damage

Unfortunately, most other chemotherapeutic agents also ______ normal human cells, causing many of the adverse effects associated with anti-pathogen and anti-neoplastic chemotherapy

room temperature

Unopened insulin may be stored at _____ NOTE: avoid sunlight and excessive heat

Monitor Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) for......

Uric acid levels may elevate and precipitate gout

nursing considerations for pain medication

Use schedule as opposed to PRN for cancer patients & those in severe pain (trauma injuries)

use Nasal and Systemic Decongestants cautiously in clients with....

Use with caution in clients with HTN, cardiac disease, hyperthyroidism, and diabetes

atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic) = beta blockers

Use with caution in patients with asthma or heart failure Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression

Paralytic Agent: succinylcholine (Anectine)

Used as an adjunct to sedation in some types of surgical procedures, during intubation, or during mechanical ventilation to cause temporary flaccid paralysis (rapid onset/short duration)

spironolactone (Aldactone) = Potassium-Sparing Diuretics

Used as mild diuretics or in combination with another diuretic

First Generation-Antihistamines: diphenhydramine (Benadryl) Used for

Used for allergic & seasonal rhinitis; cold symptoms to decrease nasopharyngeal secretions; May decrease nasal itching and tickling that cause sneezing

Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) used for...

Used for gastric & duodenal ulcers, erosive esophagitis, GERD

Anticoagulants are used for......

Used for venous and arterial disorders that put patients at high risk for clot formation •Deep vein thrombosis (DVT); including post-operatively •Pulmonary embolism (PE) •Coronary thrombosis (MI) •Artificial heart valves •Cerebrovascular accident (CVA)

Anticholinergic Drug: atropine (Atropair)

Used for- •Preoperative medication to decrease salivation •Antispasmodic to treat peptic ulcers •To increase heart rate when bradycardia is present

Loop Diuretics: furosemide (Lasix)

Used in heart failure pts & when emergent need to move fluid (ex: pulmonary edema); increase cardiac output by reducing fluid volume and decreasing BP; Effective in increasing urine output and decreasing peripheral edema and pulmonary congestion; Used in combination with other classes of drugs for heart failure treatment when there is evidence of fluid retention

Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil)

Used in heart failure to decrease cardiac workload- dilate vessels and reduce preload

Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor) are used in heart failure to ........

Used in heart failure to decrease cardiac workload- slow the heart rate and decrease blood pressure; Use with caution in patients with asthma or heart failure (due to negative inotropic effect)

Cardiac Glycosides: digoxin (Lanoxin)

Used in heart failure to improve cardiac output- increase the force of contraction of the heart; increased cardiac output & renal perfusion

ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)

Used in heart failure to increase cardiac output by lowering BP and decreasing blood volume Studies have shown these drugs can slow the progression of heart failure and reduce mortality Reduces preload, afterload, and blood volume to decrease workload on the heart

Phosphodiesterase Inhibitors: milrinone (Primacor)

Used in heart failure to increase cardiac output- increase the force of myocardial contraction Block the enzyme phosphodiesterase in cardiac and smooth muscle- increases available calcium for contraction and vasodilates

ANTICOAGULANTS

Used to inhibit clot formation by prolonging bleeding time Do not dissolve clots that have already formed- act to prevent clots from forming or growing larger

Drugs for Lipid Disorders

Used to maintain or decrease blood lipid (cholesterol) concentrations

warfarin (Coumadin) is used to.....

Used to prevent thromboembolic conditions- also for atrial fibrillation (high risk for clots); onset is delayed so usually given as follow up to Heparin/Lovenox; used for more long-term treatment

OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)

Used to prevent thrombosis in the arteries by suppressing platelet aggregation

Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)

Used to prevent venous thromboembolism Lower risk of bleeding than regular heparin; do not affect thrombin, clotting, or PT as MUCH and cause fewer systemic effects

THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)

Used to promote conversion of plasminogen to plasmin, which destroys fibrin of blood clot and results in breakdown of clot- also called fibrinolytic drugs (clot busters)

ADH

Used to treat Diabetes insipidus- a deficiency of ADH- large amounts of water and electrolytes excreted- very dilute urine (low specific gravity); loses lots of urine; *has increased thirst***

atypical antipsychotics (2nd Gen)

Used to treat both positive and negative symptoms Not as likely to cause EPS; Several drugs in the class Weight gain is a common side effect*

somatrem (Genotropin) (Growth Hormone Deficiency)

Used to treat growth failure in children (dwarfism) Should be given before epiphyses have closed Start early in life for best results Must monitor glucose tolerance and thyroid function

sliding scale insulin

Used to treat temporary anticipated blood glucose elevations; ***sometimes patients must temporarily be on insulin during illness even though they have previously been managed or oral medications***

Uses for epoetin alfa; erythropoietin (Epogen; Procrit)

Uses: *Anemia related to chronic renal failure; (dialysis patients); anemia related to chemotherapy

dopaminergic

Uses: restores neurotransmitter dopamine; relieving some symptoms such as tremor bradykinesia, gait, & muscle rigidity

octreotide (Sandostatin) (Growth Hormone Excess)

Usually caused by pituitary tumor GH antagonist- suppresses growth hormone release Gigantism- excessive growth during childhood Acromegaly- excessive growth after puberty- bones become deformed Treatment- surgery, radiation, medication

Anticholinergics (inhaled): ipratropium (Atrovent) is usually given by.....

Usually given by metered dose inhaler 3-4 times a day Fewer side effects with inhaled drugs, as opposed to PO anticholinergics

Autonomic Nervous System Influence

Vagus nerve-slows heart conduction

valproic acid (Depakene/Depakote)

Vaproate: Widespread anti-seizure action; GABA & calcium channels•Used to treat a variety of seizures & migraines

Drugs for Gastric Acid Disorders

Various classes of drugs are used to treat medical conditions caused/aggravated by stomach acid

BP decreases and sodium and water are retained- cause peripheral edema- may give diuretics to decrease edema

Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil)

Plant Alkaloids

Vincristine sulfate (oncovin), vinblastine sulfate (velban); indicated for ALL, Hodgkin, Wilms tumor, sarcoma, breast cancer, testicular cancer; adverse reactions: bone marrow suppression, neurotoxicity, weakness, paresthesia, jaw pain, constipation, stomatitis, alopecia, headaches, minimal NV; administer antiemetic, monitor for neurotoxicity

URINARY TRACT ANTISPASMODICS SIDE EFFECTS & NURSING CONSIDERATIONS

WATCH FOR POTENTIAL INCREASE IN INTRAOCULAR PRESSURE (DEVELOPING OF GLAUCOMA) MONITOR I&O; OFFER SIPS OF WATER OR HARD CANDY TO HELP WITH DRY MOUTH

weaker diuretic - POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)

WEAKER DIURETICS THAN THIAZIDES AND LOOP DIURETICS; GIVEN PO

TREATMENT FOR HYPOKALEMIASIDE EFFECTS & NURSING CONSIDERATIONS

WHEN GIVEN PO CAN IRRITATE ESOPHAGUS SO GIVE DILUTED AND WHILE THE PATIENT IS UPRIGHT; CAN CAUSE VENOUS IRRITATION WHEN GIVEN IV

Gemfibrozil (Lopid) = aka Fibric Acid Agents

WITH THIS DRUG you do NOT use in combination with statins, may increase risk of rhabdomyolysis & liver damage

URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN) works by.....

WORK BY BLOCKING PARASYMPATHETIC ACTIVITY & SUPPRESSING OVERACTIVITY

ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT) works on....

WORKS ON THE BONE MARROW TO INCREASE THE PRODUCTION OF RBCS;

Warning about Thiazolidinediones: rosiglitazone (Avandia)

Warning about greater risk for cardiac events with use- may cause fluid retention May be used in combination with other oral hypoglycemic drugs

Cardiac Glycosides Digoxin/Lanoxin (cont'd)

Watch for dysrhythmias, especially bradycardia *Hypokalemia increases risk of digoxin toxicity** Monitor digoxin level; Digoxin level- 0.5 to 1.8 (2.0) ng/ml therapeutic range; Do not re-dose if part of the dose is not ingested

Cardiac Glycosides Digoxin/Lanoxin (cont'd prt 2)

Watch for toxicity: bradycardia; GI effects (anorexia, nausea, vomiting, & abdominal pain); CNS effects (vision changes-double vision, blurred vision, yellow/green halos around objects)****

Potassium-Sparing Diuretics: spironolactone (Aldactone)

Weaker diuretics than thiazides and loop diuretics; given PO Act in the collecting duct and late distal tubule to enhance secretion of sodium and retention of potassium (opposite of aldosterone)

Factors affecting the body's response to a drug

Weight Age Gender Psychological factors Pathological factors Genetic factors Physiological factors Immuno logical factors Environmental factors Drug tolerance Accumulation effects Interactions

acarbose (Precose)

What ALPHA-GLUCOSIDASE INHIBITOR medication is usually well tolerated- may cause abdominal cramping & distention, diarrhea, flatulence Monitor liver function***; may also decrease absorption of iron

Midazolam (Versed)

What Benzodiazepine/Pre-Operative Sedative Produces unconsciousness/amnesia; given as a pre-operative sedative; eases induction of anesthesia; conscious sedation

midazolam (Versed)

What Benzodiazepine/Pre-Operative Sedative has side effects including..... Side effects: **respiratory depression; hypotension; amnesia; potential cardiac arrest *Use continuous respiratory & cardiac monitoring*

metformin

What drug also lowers triglyceride and total and low-density lipoprotein (LDL)cholesterol level and promotes weight loss? THINK: BIGUANIDES

Systemic decongestants

What drug can relieve congestion longer than nasal decongestants ; Intranasal decongestants act more rapidly and cause less side effects

Avoid aspirin

What drug should we avoid using in children/teens with fever; stop at least a week prior to surgical procedures

Absorption

What happens to the drugs from the time it enters the body until it enters the circulating fluid; intravenous administration causes the drug to directly enter the circulating blood, bypassing the many complications of absorption from other routes

hydration

What is a very important natural expectorant; encourage fluids

Glucose

What is converted to glycogen for future glucose needs in the liver and muscle, thereby lowering blood glucose level

Glucocorticoids (cortisol)

What they do... Have significant anti-inflammatory effect Have significant immunosuppressive effects Some have mineralocorticoid activity and affect potassium, sodium, and water levels in the body

glucocorticoids

What they do... Stimulate increase in glucose levels for energy Increase rate of protein breakdown (preserves energy) Causes formation & storage of fat in the body

when given IV HEPARIN (ANTICOAGULANT) .......

When given IV, may be given as an IV bolus or continuous infusion (often via weight-based protocol)

warfarin (coumadin) cannot be given with______

Which anticoagulants drug do you not give aspirin with????

1.You should be sure to have regular dental check ups

Which of the following patient teaching points should the nurse reinforce with a patient taking phenytoin (Dilantin)? 1.You should be sure to have regular dental check ups 2.This medication does have a risk for addiction 3.You should take this medication with milk 4.This drug is safe during pregnancy

imipramine

With the Tricyclic Antidepressants (TCAs) prototype _____ (Tofranil) should.... Have a clinical response in 2-4 wks* & Should be discontinued slowly*

epoetin alfa; erythropoietin (Epogen; Procrit)

Works on the bone marrow to increase the production of RBCs; goal is return Hgb levels to 10-11 g/dL and Hct of around 33%

aspirin toxicity

____ ___ treated by correcting acidosis* (salicylic acid); activated charcoal can be given to decrease absorption• *Never give children/teens aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye's syndrome*

COX-2

_____ Inflammatory prostaglandins: •Inflammation •Pain •Fever •Decreased platelet aggregation

helminthic infections

_____ _____ infections in GI tract or other tissues from worm infestation •Most common types in humans are the nematodes (roundworms) & the platyhelminths (flatworms)

Insulin syringes

_____ ______ are marked in units of 100 units per 1 ml for insulin U100

Opioids

_____ are narcotics (controlled substances) •Derived from opium or opium-like compounds •Potent analgesic effects •Possible significant alteration of mood and behavior •Potential for dependence and tolerance

high

_____ dose chemotherapy results in better tumoricidal effects

chemotherapy

_____ drugs are more effective against neoplastic cells that have a high growth fraction

candida

_____ is a fungus that is normal flora in our mucous membranes; generally only cause trouble when there is an imbalance

Coughing

_____ is a natural protective mechanism to clear the airway; antitussives should only be used for nonproductive coughs

malaria

_____ is a parasitic disease; vector transmission via Anopheles mosquito

Leukotriene antagonists

______ _____ and modifiers are effective in reducing inflammation triggered by allergic* and environmental stimuli

fungi

______ are unaffected by most antibiotics

Heparin; Coumadin

______ can be used during pregnancy- does not cross placental barrier- ______does, so should not be used during pregnancy

Antihypertensives

______ drugs are used when nonpharmacologic means to decrease blood pressure have not been successful (stress-reduction, exercise, salt restriction, decreased alcohol consumption, and weight reduction)

goal

______ for treatment of systemic infections is to reduce bacterial load so that the immune system can handle it

combinations

______ of anticancer agents-more effective tumoricidal activity than single-dose therapy •Two or more drugs act in several cell cycle phases & more effective at killing cells •Frequently used in conjunction with radiation and/or surgery

Anticancer

______ rugs are not selective, so both cancer cells and normal cells are affected •Side effects are related to toxic effects on normal cells

COX-1

_______ Cytoprotective prostaglandins: Gastroprotection •Increased platelet aggregation •Renal protection •Vasodilation •Bronchodilation

Insulin promotes uptake of glucose, amino acids, and fatty acids

__________ and converts them to substances that are stored in body cells (the key that allows glucose into cells)

chemical mediators

a chemical released in the body during an inflammatory response or immune response

triptans

a class of drugs commonly used to treat migraines, they work by causing dilated (enlarged) blood vessels to constrict (become smaller)

phase II study

a clinical study of a proposed drug by selected physicians using actual patients who have the disorder the drug is designed to treat; patients must provide informed consent

cost comparison

a comparison of the relative cost of the same drug provided by different manufacturers to determine the costs to the consumer

Physician's Desk Reference (PDR)

a comprehensive book listing of drug products for medical professionals

Cushing's syndrome

a condition caused by prolonged exposure to high levels of cortisol

Thrombocytopenia

a condition in which there is an abnormally small number of platelets circulating in the blood

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it THINK: Anticonvulsants for Partial Seizures

shistosomiasis

a disease that results from eggs that penetrate the walls of veins of the small intestine or urinary bladder and cause tissue damage and bleeding liver, spleen, CNS< cardiac

sickle cell anemia

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape

Phenothiazines

a group of antihistamine drugs that became the first group of effective antipsychotic medications

renin-angiotensin-aldosterone system (RAAS)

a hormone cascade pathway that helps regulate blood pressure and blood volume

GABA (gamma-aminobutyric acid)

a major inhibitory neurotransmitter

agonist

a molecule that increases a neurotransmitter's action

HEPARIN (ANTICOAGULANT)

a natural substance in the liver that prevents clot formation; given (SQ or IV)

first pass effect

a phenomenon in which drugs given orally are carried directly to the liver after absorption, where they may be largely inactivated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses than drugs given by other routes because of this early breakdown

mechanical ventilator

a positive- or negative-pressure breathing device that supports ventilation and oxygenation OR breathing assistance provided by a ventilator, one of various types of devices that support and maintain respiratory function

Reye's syndrome (RS)

a potentially fatal condition that has been linked to giving aspirin to children suffering from viral infections

negative feedback system

a process that results in a response that reverses the original stimulus

Schizophrenia

a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

Electrocardiogram

a record of the electrical activity of the myocardium

false (correct answer is not secondary effect but actually allergic reaction)

a secondary effect occurs when a body forms antibodies to a particular drug causing an immune response

Blood Brain Barrier (BBB)

a selective mechanism that protects the brain from toxins and infections Almost all antibiotics are not lipid soluble and cannot cross the blood brain barrier

Golgi apparatus

a series of FLATTENED sacs in the cytoplasm that prepare HORMONES or other substances for secretion and may produce lysosomes and store other synthesized proteins Package Center

nasogastric

a soft flexible tube introduced through the nose into the stomach for gavage, lavage, or suction USUALLY SHORT TERM

precipitate

a solid that forms and settles out of a liquid mixture THINK: Hydantoin (Dilantin)

apothecary system

a very old system of measure that was specifically developed for use by apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid measure

cancer

a.k.a "neoplasms" •Antineoplastic agents: a branch of chemotherapy that act on, kill, or alter human cells •Anticancer drugs are those used to kill, damage, or slow the growth of cancer cells, as well as those drugs used to prevent or treat adverse drug effects •Anticancer drug therapy is commonly known as chemotherapy •Chemotherapy causes cell death by interfering with cell replication

a PTT normal range

aPTT normal range is 25 to 35 seconds- anticoagulant effect should be 1 ½ to 2 times higher than the patient control (pre-treatment value); therapeutic aPTT is usually around apparox. 40-70 THINK: important factor for heparin dosing

resistance

ability of pathogens over time to adapt to an anti-infective to produce cells that are NO longer affected by a particular drug

blood dyscrasia

abnormal blood cell production DECREASED hematocrit (anemia)

hypertension

abnormally high blood pressure

hypotension

abnormally low blood pressure

Topical

absorbed through the skin

mucous membranes

absorbed through thin mucous membranes (mouth, vagina, etc)

drug abbreviations

ac= before meals bid=twice a day cap=capsule gtt=drop h or hr= hou rIM= intramuscular IV=intravenous

acetylcysteine (Mucomyst)

acetaminophen antidote

Vasodilators: hydralazine (Apresoline)

acts primarily on arterioles

vasodilators: isosorbide dinitrate

acts primarily on veins (Isordil)

montelukast (Singulair)

acts to inhibit bronchoconstriction by reducing inflammation

acute dystonia

acute sustained contraction of muscles, usually of the head and neck Facial grimacing involuntary upward eye movement muscle spasms of the tongue, face, beck, and back laryngeal spasms

Young rule

age of child(in yrs)/ ((age of child + 12)x adult dose)

young rule

age of child(in yrs)/age of child + 12 hrs x adult dose

adrenergic agonists (sympathomimetics)

agents that activate adrenergic receptors in the sympathetic nervous system

Alkaline substances

aluminum, magnesium, sodium, or calcium THINK: antacids treatment

gentamicin (POTH, TOP, IV & IM)

aminoglycosides (-cin) inhibit bacterial protein synthesis (BACTERICIDAL) ***Serious adverse effects: ototoxicity, nephrotoxicity, neuromuscular blockage (leads to flaccid paralysis and fatal respiratory depression)

lymphocytic

an agranulocytic leukocyte formed in lymphatic tissue Natural killer cells •B cells •T cells

ratio and proportion

an equation in which a ratio containing two known equivalent amounts is on one side and a ratio containing the amount desired to convert and its unknown equivalent is on the other side

intramuscular injection

an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm

MU cell receptor

analgesia decreased GI motility respiratory depression sedation physical dependence

Kappa cell receptor

analgesia decreased GI motility sedation

Acetaminophen (Tylenol)

analgesic, antipyretic Pain control

broad spectrum antibiotics

antibiotics that affect a broad range of gram-positive or gram-negative bacteria

ADH

antidiuretic hormone secreted by posterior pituitary Promotes water reabsorption from the renal tubules to maintain water balance (helps to hold on to water), is hemostatic & has vasopressor properties

Bacterialcidal

antimicrobial agent that directly kills bacteria

arrhythmia/dysrhythmia

any of several kinds of irregularity or loss of rhythm of the heartbeat

instillations and irrigations

applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina

inhalations

applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing

dermatological preparations

applied to the skin

salicylates

aspirin is a prostaglandin inhibitor- anti-inflammatory, antipyretic, & antiplatelet properties (decreases platelet aggregation) •Gastric distress* is a common problem due to large doses needed for anti-inflammatory effect

NSAIDS

aspirin-like drugs that inhibit COX, which is needed for biosynthesis of prostaglandins; Primarily used to relieve inflammation and pain

Beta Blockers (- "olol" suffix)

atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)

P wave

atrial depolarization

ANS

autonomic nervous system (sympathetic and parasympathetic)

Non-competitive antagonist

binds to an allosteric (non-agonist) site on the receptor to prevent activation of the receptor.

metabolism

biotransformation PIRMARY SITE = LIVER breakdown of drugs occur to change them into non-toxic substances and more easily accessed to use and excrete

Coagulation

blood changing from fluid state to solid state

leukopenia

blood dyscrasia- Abnormally low white blood cell count

anemia

blood dyscrasia- decreased hematocrit

pancytopenia

blood dyscrasia- deficiency of all types of blood cells

thrombocytopenia

blood dyscrasia- low platelet count

blood dyscrasia

bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen

Lower respiratory tract

bronchi & alveoli that make up the lungs

Intravenously (IV)

by vein, in reference to administration of drugs or nutrients

Antipsychotic drugs block dopamine

called dopaminergic antagonists- block dopamine receptors

Diastole

cardiac muscle at rest

Systole

cardiac muscle contracts

Beta2 adrenergic agonists

cause dilation of the bronchioles

mitosis

cell division resulting in TWO identical daughter cells

G phase

cell grows and synthesizes structures other than DNA

CNS

central nervous system; brain and spinal cord

attention deficit disorder

characterized by a short attention span and impulsive behavior that is inappropriate for the child's developmental age

Bio transformation (metabolism)

chemical inactivation of a drug through conversion to a more water soluble compound that can be excreted from the body

Chemical mediators of inflammation

chemical mediators can act on the local level or systemic level. Some local mediators can move into the blood stream and have systemic effects as they work at longer distances.

Agonists

chemical substances that mimic or enhance the effects of a neurotransmitter on the receptor sites of the next cell, increasing or decreasing the activity of that cell

ANTIMETABOLITES

chemicals that prevent cell division by inhibiting formation of substances necessary to make DNA; used in cancer chemotherapy

Ezetimibe (Zetia)

cholesterol absorption inhibitor

Combination therapies

combine 2 or more drugs to treat an infection

Renin-Angiotensin-Aldosterone System

compensatory process that leads to increased blood pressure and blood volume to ensure perfusion of the kidneys; important in the continual regulation of blood pressure

toxic range

concentration at which drug level is too high

SL/buccal

considered either ENTERAL or TOPICAL

Phase II biotransformation

consists of a coupling or conjugation of a variety of endogenous compounds to polar chemical groups of the drug

Chronic pain

constant/intermittent pain that keeps occurring

Phase 4 study

continual evaluation of a drug after it has been released for marketing

antidysrhythmic

controls and prevents cardiac dysrhythmias(abnormal rhythm) THINK: Hydantoins or prototype- phenytoin (Dilantin)

codeine

cough suppressant

liver injury

darkening of urine

depot injection

decanoate form: a slow-release, injectable form of antipsychotic medication for maintenance therapy THINK: Nonphenothiazines (haloperidol (Haldol))

COX-1 inhibitors

decrease protection of the stomach lining and prevents blood clotting

Coronary artery disease (CAD)

decreased blood flow to heart

hypokalemia

deficient level of potassium in the blood

Afterload

degree of pressure in the aorta that must be overcome for blood to be ejected from the left ventricle; resistance/pressure against which the heart has to beat

microdrip

delivering 60 drops per milliliter of fluid

perfusion-vascular system (bloodstream)

delivers drugs to cells/tissues if poor perfusion, it impedes ability for drug to reach target ex. poor circulation

Enteric-coated tablets

designed to dissolve in the alkaline environment of the small intestine

rate of absorption

determines how soon and effects will begin Determined by the site of administration and the drug formulation.

alpha adrenergic antagonists

dilate the arterioles and veins. These drugs can lower blood pressure quickly, but their use is limited because of frequent and bothersome side effects.

bethanechol (Urecholine)

direct acting cholinergic agonists: stimulates receptor directly •Atonic bladder post operative or post partum •Adverse effects: Abdominal discomfort, salivation, N/V/D, sweating, flushing

pilocarpine (Pilocar)

direct acting cholinergic agonists: •PO=treats dry mouth from salivary gland issues •Eye drops=treats glaucoma •Adverse effects: (eye drops) stinging, burning, tearing, red eyes, HA

IV (intravenous)

direct entry to the VENOUS SYSTEM

trichinosis

disease caused by eating raw or undercooked meat, usually pork, infected with Trichinella larvae lung, heart, brain

mycoses

diseases caused by fungi

Asthma

disorder characterized by recurrent & reversible episodes of bronchospasm leading to narrowed or obstructed airways

DAW

dispense as written

organelles

distinct structures found WITHIN the cell cytoplasm

When mixing inculin

draw up fastest acting first- clear to cloudy if regular and NPH) **Remember "R" before "N" Clear to Cloudy = withdrawing meds Cloudy to Clear = injecting air into vial

first pass metabolism

drug metabolism that occurs in the intestines and liver during oral absorption of drugs into the systemic circulation

Dopaminergic

drug treatment for Parkinson's Disease is either anticholinergic or ____ referring to cells that use dopamine as their synaptic transmitter (i.e. increases dopamine)

anticholinergic

drug treatment for Parkinson's Disease is either dopaminergic or ______ blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane) DECREASE effects of acetylcholine

Hypoglycemia

drugs can affect metabolism and the use of glucose causing LOW serum blood glucose concentration (_____)

hyperglycemia

drugs can simulate the breakdown of glycogen or alter metabolism in such a way that the cause HIGH serum glucose levels (_____)

over-the-counter (OTC) drugs

drugs that are available without a prescription for self-treatment of a variety of complaints; deemed to be safe when used as directed

Anticoagulants

drugs that block or inhibit any step of the coagulation process; preventing or slowing clot formation

Parkison-like syndrome

drugs that directly and indirectly affect DOPAMINE (neurotransmitter MESSENGERS) levels in the bran that can cause a syndrome that resembles Parkinson disease

Schedule One controlled substance

drugs that have a high potential for abuse, has no currently accepted medical use, and lack of safety (i.e heroin, LSD, marijuana, ecstasy)

Antiplatelet agents

drus that interfere with the aggregation or clumping of platelets to form the platelet plug

anticholinergic effects

dry mouth constipation photophobia blurred vision Tachycardia NOTE: this is a adverse effect of the Tricyclic Antidepressants (TCAs) Imipramine (Tofranil)

programmed

each cell is ______ by the genes

Dromotropic

electrical conduction

lysosomes

encapsulated digestive enzymes found within a cell they DIGEST old damaged areas of the cell and are responsible for destroying the cell when the membrane ruptures and the cell dies

sensitivity testing

evaluation of pathogens obtained in a culture to determine the anti-infectives to which the organisms are sensitive and which agent would be appropriate for treatment of a particular infection

Laxatives: saline (osmotic)

example- polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema); (PO or enema)

Hypersensitivity

excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response

Drug conversions

finding the equivalent values between two types of measure within each system of measure and between systems of measure

Endoplasmic Reticulum (ER)

fine network of interconnected channels know as cisternae found in the cytoplasm; site of CHEMICAL reactions within the cell

tiotropium (Spiriva)

first long-acting inhaled anticholinergic drug for treatment of COPD; also supplied in combination with a bronchodilator- ipratropium with albuterol (Combivent)- more effective and longer duration of action

Rivaroxaban (Xarelto) (PO)

first oral anticoagulant indicated for DVT that directly *inhibits Factor X*- also used in patients with atrial fibrillation -Does not require aPTT or Protime; no antidote -Given orally by tablet -Side effects: bleeding; GI upset

Inotropic

force of contraction

drug allergy

formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug

P450 system

group of enzyme families in the liver which metabolize drugs and endogenous compounds

Hypertension

heart has to work harder to pump against high pressures

Myocardium

heart muscle

hyperkalemia

high levels of potassium in the blood

Insulin type is prescribed based on unique patient characteristics such as

how brittle their blood sugars are; typical diet; exercise level; all these are considered when choosing an insulin based on the insulin's onset & duration**** Note: Mix type will determine onset, peak & duration

subcutaneously

how is insulin generally administered?

Hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

Vasodilators two primary drugs-

hydralazine (Apresoline)-acts primarily on arterioles isosorbide dinitrate- (Isordil)-acts primarily on veins

cushing's syndrome

hyperglycemia, redistribution of fat to the shoulders & face, muscle weakness, bruising, ****monitor potassium

sensory distortions and hallucinations

hypnotized subjects may be led to experience auditory or visual hallucinations NOTE: this is an adverse effect for the sedative zolpidem (Ambien)*

immunocompromised

impaired immunologic defenses caused by an immunodeficiency disorder or by therapy with immunosuppressive agents

Indirect-Acting Cholinergic Agonists

inactivate the enzyme cholinesterase, permitting acetylcholine to accumulate at the receptor site (hence the name "cholinesterase inhibitors" Prototype- pyridostigmine (Mestinon)-cholinesterase inhibitor & Prototype- donepezil (Aricept)- cholinesterase inhibitor

alternative therapy

includes herbs and other "natural" products as often found in ancient records; these products are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication

Sympathetic nervous system is stimulated

increased heart rate, force of contraction, and blood pressure

Nonphenothiazines

indicated to control psychotic bejhavior, less sedative than penothiazines; adverse reactions include severe extrapyramidal reactions, leukocytosis, blurred vision, dry mouth, urinary retention; teach to avoid alcohol; orap is used only for touretts syndrome

filariasis

infection of the blood and tissues of healthy individuals by worm embryos or filariae lymphatic tissue

superinfections

infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy

superinfection

infections that occur when opportunistic pathogens that were kept in check by the "normal" bacteria have the opportunity to invade tissues and cause infections because the normal flora bacteria have been destroyed by antibiotic therapy

Sinusitis

inflammation of the epithelial lining of the sinus cavities

Pneumonia

inflammation of the lungs that can be caused by bacterial or viral invasion of the tissue; or by aspiration of foreign substances

stomatitis

inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems

Inhalation

inhaled and absorbed through lung capillaries

Pre-clinical trials

initial trial of a chemical thought to have therapeutic potential; uses laboratory animals, not human subjects

parenteral

injected via needl

intradermal administration

injection of a drug in between the epidermis and dermis.

FASTER

insulin injected into the abdominal is absorbed _____ than other SQ sites****

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors protrusion and rolling to the tongue sucking and making smacking movements of the lips chewing motion facial dyskinesis involuntary movements of the body and extremities

Penicillin (antibiotics)

is one such drug that cause bacterial cell death w/o disrupting most human cell functioning

meperidine (Demerol)

is preferred for gallbladder pain

epinephrine (Adrenalin)

is sometimes given in an acute asthma attack to dilate bronchioles and increase airway patency**

distribution

is the movement of a drug to the body's tissues

culture and sensitivity (C&S)

laboratory test that grows a colony of bacteria removed from infected area in order to identify the specific type of bacteria and then determine its sensitivity to a variety of antibiotics

Rectal drug administration

left side lying (Sim's position) water soluble lubricant to assist ask pt. to take deep breath

cytoplasm

lies within the cell membrane contains organelles fro producing proteins, energy, and so on

cell cycle

life cycle of a cell, which includes the phases G0, G1, S1, G2, and M During the M phase, the cell DIVIDES into two identical daughter cells

cell membrane

lipoprotein structure that separates the interior of a cell from the external environment; regulates what can enter and leave a cell

vaginal drug administration

lithotomy position (supine with knees bent and separated)

Hepatic microsomal system

liver enzymes tightly packed together in the hepatic intracellular structure, responsible for the biotransformation of chemicals, including drugs

Jaundice

liver failure/disease ALSO rising amounts of bilirubin in the blood Signs to look for: yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood

Antidiarrheals: OTC drugs

loperamide (Imodium)- similar to opiates- no narcotic effects bismuth subsalicylate (Pepto-Bismol) Probiotic- Lactobacillus

benzodiazepine prototypes

lorazepam (Ativan); alprazolam (Xanax); diazepam (Valium) (PO, IM, IV) THINK: "pam/lam" suffix

LMWH

low molecular weight heparin: enoxaparin (Lovenox) Given SQ once or twice a day, depending on regimen; do not rub site of injection Average treatment period- 7 to 14 days

heparin infusion

low platelet count is bad, monitor and report (normal platelet count is 150,000-400,000)

rashes, hives

many drugs are know to cause skin reactions HOWEVER, it is important to determine weather a rash or skin reaction is an allergy or a side effect/adverse effect of a drug

Protein bound drugs

many drugs bind to proteins to be carried this makes it difficult for drugs to be released which inhibits them from crossing membranes since most membranes do not let proteins pass

eye damage

many drugs such as hydroxchlorquine can damage the retina

Simethicone

may be added as an antiflatulent THINK: antacids treament

nephrorenal

means kidneys

metric system (SI)

measuring system that uses the powers of ten

medical history

medical conditions and drug use, allergies, level of unedrstandingand family support

right dose

medication dosage ***3 TIMES be sure to ask yourself: is this a typical dosage range for the drug If not question/verify order

right drug

medication name; check label ***3 TIMES leave in package until time to administer

diuretics

medications administered to increase urine secretion in order to rid the body of excess water and salt

ribosomes

membranous structures that are the sites of protein production WITHIN a cell

Synthetic opioids

meperidine (Demerol) hydromorphone (Dilaudid) Use •Relief of severe pain •Antitussive (especially codeine); cough suppressant* (except meperidine)

Nursing Care- Antidepressants (prt 2)

monitor for BP changes Monitor for anticholinergic effects- teach about foods/liquids to prevent constipation Observe for seizures if has a known seizure disorder Monitor for drug/food interactions and adverse effects of drugs Observe for herbal use- many interact

media influence on drugs

more drug advertising in mass media but is regulated in part by federal guidelines

chemotherapeutic drugs

most _____ drug DO NOT have selective toxicity

resistance

most commonly, the development of ____ depends on the degree to which the drug act to ELIMINATE the invading microorganisms that are most SENSITIVE to its effects

placenta

most drugs readily cross ___ and enter into breast milk

suppressed

most serious fungal infections occur in patients with ____ immune systems ex. patients with HIV

self-limiting

most viruses are _____; and require no pharmacotherapy ex. rhinovirus that causes common cold

akathisia

motor restlessness restless trouble standing still paces the floor feet in constant motion (rocking back and forth)

Passive diffusion

movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy

filtration

movement through pores in cell membrane either by concentration gradient or from the pull of plasma proteins hydrostatic, blood, or osmotic pressure

Cardiomyopathy/cardiomegaly

muscle alterations & ineffective pumping

pure opioid agonists

naloxone

azelastine (Astelin)

nasal spray

Side/adverse effects of adrenergic agonist drugs

nervousness, hypertension, tachycardia, palpitations, restlessness, tremors, dysrhythmias, dizziness, urinary retention, dry mouth, nausea, vomiting, dyspnea, and pulmonary edema; hyperglycemia THINK: phenylephrine (Neo-Synephrine) OR oxymetazoline (Afrin)

street drugs

nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure

Upper respiratory tract

nose, mouth, pharynx, larynx, & trachea

Role of the Nurse

nurse is the one most FREQUENTLY administering drugs Must know and watch for side effects (PATIENT SAFETY) Must teach patient and family about drugs How to INTERVENE when a side effect occurs

CoQ10

nutritional supplement; lipid enzyme that helps in moving electrons along electron transport chain; also acts as an antioxidant; increases mitochondrial function; levels decline with age THINK: Statins: pravastatin (Pravachol); simvastatin (Zocor) when using Statins these supplements may be indicated

depression

occurs because of a deficiency of norepinephrine, dopamine, or serotonin

superinfection

often exhibited as overgrowth of yeast; in mucous membranes (mouth, vagina) or sometimes in the GI tract Provide symptomatic care and antifungals when needed

household system of measurement

older system of measurement that uses teaspoons, tablespoons, and cups

MAINTAIN VOLUME/COMPOSITION OF BODY FLUIDS W/IN NORMAL RANGE

one of the 4 major renal system functions: •CLEARING OF NITROGENOUS WASTE •MAINTAIN ACID-BASE BALANCE & ELECTROLYTE LEVELS •EXCRETING VARIOUS DRUGS

milliequivalent

one-thousandth of an equivalent, which is the chemical combining power of a substance mEq

Beta2 Adrenergic Agonists- Bronchodilators: albuterol (Proventil)

onset in 30 minutes- duration of action 2-6- for acute attacks and maintenance (Inhaled)

olopatadine (Patanol)

ophthalmic drops

milrinone (Primacor) = Phosphodiesterase Inhibitors

or short term therapy of advanced heart failure- only given IV Very short half-life; therapy limited to acute patients and only 2-3 days- have risk for ventricular dysrhythmias and hypotension

Routes of Absorption

oral (GI tract), subcutaneous/intramuscular, mucous membranes

antiinfectives

other ____ alter the PERMEABILITY of the cell membrane to allow essential cellular components to leak out which leads to cell death ex. antibiotics, antifungals and antiprotozoal drugs

poisoning

overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

gingival hyperplasia

overformation of gum tissue THINK: Hydantoin --> Phenytoin (Dilantin)

PCA pump

patient controlled analgesic administered intravenously with a machine NOTE: teach the patient and family use and philosophy of the PCA system BUT only the patient should push the button

self-care

patients self-diagnosing and determining their own treatment needs

drug abbreviations

pc= after meals PO=by mouth prn=as needed qid=four times per day q2h= every 2 hour q4h=every 4 hourq6h= every 6 hour q8h=every 8 hour q12h= every 12 hour STAT=immediately tid= three times a day

OTHER ANTIPLATELETS & ANTICOAGULANTS

pentoxifylline (Trental) (PO) & Rivaroxaban (Xarelto)-(PO)

PR

per rectum

PNS

peripheral nervous system BREAKS into ANS & Somatic nervous system

chlorpromazine (Thorazine)

phenothiazines (1st Gen) adverse effects- sedation, drowsiness, vertigo, dizziness, HA, dry mouth, orthostatic hypotension, EPS, NMS, photophobia

Other Nasal and Systemic Decongestants

phenylephrine (Neo-Synephrine), pseudoephedrine (Sudafed) (PO)

Blood Brain Barrier (BBB)

physiological barrier between the circulatory system and the central nervous system that establishes a privileged blood supply, restricting the flow of substances into the CNS

buccal

placed between the cheek and gum

insulin pen

portable device that contains a prefilled cartridge of insulin

insulin pump

portable, battery-powered device that delivers insulin through the abdominal wall in measured amounts

Bacteriostatic

prevent microbes from growing

kidneys

primary excretion organ

Enzyme induction

process by which the presence of a chemical that is biotransformed by a particular enzyme system in the liver causes increased activity of that enzyme system

diaphoresis

profuse sweating NOTE: this is something to note when looking for the presentation of Serotonin Syndrome

Laxatives

promote a bowel movement

Selective toxicity

property of a chemotherapeutic agent that affects only systems found in foreign cells without affecting healthy human cells (e.g., specific antibiotics can affect certain proteins or enzyme systems used by bacteria but not by human cells)

Platelet aggregation

property of platelets to adhere to injured surface & then attract other platelets; which then clump together

histocompatibility antigens

proteins found on the surface of the cell membrane; they are determined by the genetic code and provide cellular identity as a self-cell (i.e., a cell belonging to that individual)

The Medical Letter on Drugs and Therapeutics

provides cost comparisons on drugs that are reviewed in each issue

Drug Classes for Asthma Management

quick-relief medication v. long acting medication

spectrum

range of bacteria against which an antibiotic is effective

Chronotropic

rate of contraction

Opioid receptors

receptor sites that respond to naturally occurring peptides, endorphins other chemicals

electrocardiogram

record of the electrical activity of the heart

right documentation

record the administration of the med in the patient record

COX-2 inhibitors

reduce pain and inflammation and don't have negative effects of COX-1 inhibition

Niacin (vitamin B2)

reduces VLDL and LDL & inhibits release of free fatty acids from adipose tissue THINK: drug class Nicotinic Acid

pentoxifylline (Trental) (PO)

reduces viscosity of red blood cells and increases their flexibility(antiplatelet)- to increase circulation in patients with *intermittent claudication* -Given orally, may cause GI upset

Convulsions

refer to tonic-clonic muscle contractions

enteral

refers to meds administered at ANY point through the GI tract stomach (PO or through tube)

affect

refers to people's feelings in response to their environment; state of mind

neuropsychiatric

relating to organic and functional diseases of the nervous system NOTE: this is an adverse effect for the sedative zolpidem (Ambien)*

interferons

released by host in response to viral invasion

sympathetic nervous system stimulation

releases norepinephrine and initiates a cyclic AMP second-messenger system to increase contractility

Teach about medications: Nursing Care for Thyroid Hormone Drugs

report adverse effects Synthroid: ,(possible thyrotoxocosis) such as *tachycardia*,increased BP, heat intolerance, diarrhea, cramps, angina tremors, nervousness, insomnia, headache, weight loss, nausea and vomiting (Synthroid)

Acute pain

response to recent tissue damage or injury; makes person aware

Cathartics

result in a stronger and more complete bowel emptying- used for diagnostic procedures of the GI tract

mitochondria

rod-shapes organelles that produce ENERGY within the ell in the form of ATP Powerhouse of the cell

For cloudy insulin

roll (don't shake) to mix

culture

sample of the bacteria to be grown in a laboratory to determine the species of bacteria that causes an infection

partial seizure

seizure involving only limited areas of the brain with localized symptoms POWERPOINT: involves only one hemisphere of brain

Generalized seizures

seizures that involve the entire brain POWERPOINT: involves both hemispheres of brain

Pain

sensory & emotional experience associated with actual or potential tissue damage

genes

sequences of DNA that control basic cell functions and allow for cell division

SNRI

serotonin-norepinephrine reuptake inhibitor Affect serotonin, norepinephrine, or dopamine reuptake to elevate mood

Myxedema

severe deficiency in adults THINK: Treating Thyroid Hormone Deficiency Prototype- levothyroxine (Synthroid)

Cretinism

severe deficiency in children THINK: Treating Thyroid Hormone Deficiency Prototype- levothyroxine (Synthroid)

liver

sewage treatment plant

sustained release

should NOT be crushed

Prednisone (generic) (PO, IM, IV)

should ONLY use short term due to side effects (around 4-10 days) when treating inflammation Often referred to as corticosteroids/glucocorticoids

right preparation

should it be crushed, diluted, reconstituted (added water or saline)?

side effects of Laxatives: stimulants = bisacodyl (Dulcolax)- OTC

side effects: diarrhea, abdominal cramping, fluid & electrolyte imbalance, and laxative dependence

fungus

single-celled or multicellular organisms •More complex than bacteria Include mushrooms, yeasts, molds •Decompose dead organisms •Humans exposed by handling contaminated soil or inhaling spores

dermatological reactions

skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis

barrier defenses of innate immunity

skin, mucous membranes, secretions

somnolence

sleepiness NOTE: this is a side effect for Barbiturates (- "tal" suffix)

biological weapons

so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to incapacitate or destroy a population

gastrostomy

soft flexible tube surgically placed directly into patient's stomach; long term placement

Atypical antipsychotics

some block dopamine and some block other receptors, such as serotonin- cause fewer side effects

right storage

some drugs require specific storage environments

scored pills

sometimes the desired dose of a medication will be a fraction of the tablet or capsule so this method is used on the pill to help aid in cutting correctly

enteric coated

special coating on drug that prevents absorption until drug reaches the small bowel

Intravenous (IV)

specific techniques depend on whether it is IV push, IV bolus, or IV infusion

aspirin

stop taking a week before surgery

Lipoproteins

structure composed of proteins and lipids; the bipolar arrangements of the lipids monitors substances passing in and out of the cell

vesicant

substance that can cause tissue necrosis and damage THINK: Hydantoin (Dilantin)

bactericidal

substance that causes the death of bacteria, usually by interfering with cell membrane stability or with proteins or enzymes necessary to maintain the cellular integrity of the bacteria

Bacteriostatic

substance that prevents the replication of bacteria, usually by interfering with proteins or enzyme systems necessary for reproduction of the bacteria

kidney injury

sufficient urine output is NOT occurring

sustained release

tablets or capsules designed to dissolve slowly over an extended time

Side effects of ACE Inhibitors (captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil))

tachycardia, arrhythmias, rash, gastric irritation, peptic ulcers, bone marrow suppression, hypotension Common side effect is a persistent, dry cough****(increase in bradykinin causing inflammation) Watch for hyperkalemia*** (potassium sparing diuretics increase this risk)*** May cause angioedema (swelling of tongue & oral pharynx)

Get into the habit of always asking a patient

tell me your name, DOB , and do you have any allergies Follow up question: What types of symptoms do you experience

cell

the ____ is the basic structural unit of the body

freely

the _____ moving nature of the cell membrane allows it to adjust to the changing shapes of the cell so that areas of the membrane an move together to repair the membrane

selective toxicity

the ability to affect certain proteins or enzyme systems that are used by the infecting organism but not by human cells

Glycolysis

the breakdown of glucose to pyruvate to yield energy.

critical concentration

the concentration a drug must reach in the tissues that respond to the particular drug to cause the desired therapeutic effect

tolerance

the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect

sympathetic nervous system

the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations FIGHT OR FLIGHT

parasympathetic nervous system

the division of the autonomic nervous system that calms the body, conserving its energy REST AND DISEST

somatic nervous system

the division of the peripheral nervous system that controls the body's skeletal muscles

cleft palate

the failure of the palate to close during the early development of the fetus THINK: Anticonvulsants for Partial Seizures

liver injury

the first pass effect of drugs exposes the liver cells to the full impact of the drug BEFORE it is broken down for circulation throughout the body SINCE most drugs are METABOLIZED in the liver many metabolites that are irritating or toxic will affect the liver's INTEGRITY

peak

the highest plasma concentration of the drug at a specific time INDICATES THE RATE OF ABSORPTION

ataxia

the loss of full control of bodily movements

oral drugs

the most commonly used route of admin. it is usually the most convenient and comfortable for the pt. drug action has a slower onset and a more prolonged, but less potent, effect.

passive diffusion

the movement of drugs from an area of higher concentration to lower concentration

Glomerular filtration

the passage of water and water-soluble components from the plasma into the renal tubule

Minimum effective concentration (MEC)

the plasma drug level below which therapeutic effects will not occur the blood concentration needed for a drug to produce a response

Endocytosis

the process of engulfing substances and moving them into a cell by extending the cell membranes AROUND the substance;

Glycogen synthesis and breakdown

the storage and recovery of glucose from glycogen polymer.

Pharmacology

the study of drugs and their interactions with living systems

Pharmacogenomics

the study of genetically determined variations in the response to drugs

adverse reactions

these affects can occur as a result of antiinfective therapy: kidney damage, GI toxicity, neurotoxicity, hypersensitivity reactions, and superinfections

receptor site

these sites are very important in the functioning or neurons, muscle cells, endocrine glands, and other cell types and they play a very important role in clinical pharmacology

drowsiness/sedation**

this affect may DECREASE w/ time and tolerance for the drug class Benzodiazepines

lysosomes

this cell structure becomes very important clinically when cell death (from disease of drug effect) leads to the death of neighboring cells, causing those cells to die and release their lysozymes THINK: decubitus ulcer

cholestyramine (Questran) = aka Bile Acid Sequestrant

this drug is often combined with statins

primary actions

this is an extension of the DESIRED effect but too much Ex. BP meds but leads to hypotension

nitroprusside (Nipride)

this is used for hypertensive emergency; given IV drip in ICU (watch for severe hypotension) THINK: Direct Vasodilators = hydralazine (Apresoline)

oral route

this route of administration is NOT invasive Is less expensive Easy for the patient to continue dosing at home BARRIERS: Acidic stomach environment Some food (Increase acidity or block absorption)

receptor site

this site imbedded in the cell membrane reacts with specific chemicals OUTSIDE of the cell to stimulate a reaction with the cell

Aspirin toxicity

tinnitus (ringing of ears), dizziness, headache, & excessive sweating; fever; initial respiratory alkalosis then metabolic acidosis*

discharged

to save cost, patients are being ____ from hospitals far earlier than ever before and many are not even admitted into hospitals as a result less monitoring is occurring and more of the care needs fall directly to the patient

Digoxin toxicity

treated with digoxin immune fab (DigiFab; Digibind)

prophylaxis

treatment to prevent an infection before it occurs, as in the use of antibiotics to prevent bacterial endocarditis in high-risk patients OR antiprotozoals to prevent malaria

levothyroxine (Synthroid) s/e

tremors, HA, nervousness, palpitations, tachycardia, loss of hair, N/V/D, weight loss

Subcutaneous drug administration

under the skin

Loading dose

use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner

phase 3 study

use of a proposed drug on a wide scale in the clinical setting with patients who have the disease the drug is thought to treat

Z-track method

used to minimize local skin irritation by sealing the medication in muscle tissue pull overlying sking and sub Q tissue laterally to the side 1 -1.5 inches, inject the needle into the muscle leaving in for 10 seconds after injection, then release the skin.

off-label use

uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA Off-label use may lead to new indication for the drug

Neuroleptic Malignant Syndrome

usually related to anesthesia drugs and drugs affective neurotransmitters symptoms: slow reflexes high fever hypertension (HTN) tachycardia

Valvular disease

valves do not work effectively, causes blood to leak & backflow

adverse affects

vancomycin (vancocin) ____ ___: highly toxic it can cause renal failure, ototoxicity, superinfections, and a condition called "red man syndrome"

Lipoglycopeptides

vancomycin (vancocin) was the 1st drug in a class called

QRS complex

ventricular depolarization and atrial repolarization

T wave

ventricular repolarization

right patient

verify patient ID using 2 identifiers, NAME AND DOB, ID/medical record # EVERY TIME you administer medication ---Use bracelet, verbal and/or picture ---ALLERGIES ---Bar code scanning

Common cold

viral infection of the upper respiratory tract that initiates the release of histamine & prostaglandins & causes an inflammatory response

mutate

viruses ___ rapidly,, and drugs eventually become ineffective

aspirin

warn patient to watch for excessive bruising, blood in stools, or any abnormal or excessive bleeding when taking ____

Benzodiazepine (pam/lam) IV

what drug and what form of administration must we watch respirations closely for respiratory depression***??

IMPORTATN NOTE ABOUT- Fibric Acid Agents: Gemfibrozil (Lopid)

what drug class is *Contraindicated in patients with hepatitis or gallbladder disease*

SUDDEN CARDIAC ARREST

what is the result of administrating TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) through IV push????

Prednisone Often causes

what often causes --- hyperglycemia (High blood sugar)*, mood changes, irritability, cataracts, peptic ulcers, electrolyte imbalances & osteoporosis Long term use can result in Cushing's syndrome: hyperglycemia, redistribution of fat to the shoulders & face, muscle weakness, bruising, monitor potassium

Rotate sites

what should you do to avoid lipodystrophy when injecting insulin?

Heart failure

when the heart cannot pump enough blood to meet tissue oxygen and nutrient demands

Seizures

when there is a sudden discharge of excessive electrical energy from nerve cells located within the brain

Clark Rule

which accounts for eight in the dose formila

Fried rule

which considers age for a child under the age of 2 years

Regular insulin

which insulin is is the only one that can be given IV***

intravenous (IV)

which route of absorption basically by passes the absorption process?

Endocrine system

works to maintain homeostasis Glands: organized groups of specialized cells that secrete hormones Hormones: chemical messengers, released into bloodstream to communicate a message

Bile Acid Sequestrant: cholestyramine (Questran)

}Binds with bile acids in intestine (which are then excreted) to reduce LDL) Are not absorbed systemically (which is why few side effects)

Insulin injection sites

• Arm • Abdomen -best • Thighs *Rotate around same site to decrease lipodystrophy 2-3 weeks *heat them up to increase aborption

drugs act as:

•-RNA synthesis inhibitors • -Protein synthesis inhibitors • -Antimetabolites • -DNA synthesis inhibitors • -Cell wall synthesis inhibitors

glipizide (Glucotrol); glyburide (Micronase)

•Action- directly stimulates working beta cells to secrete insulin* THINK: Sulfonylureas

Antihistamines: Indications for Use (prt 1)

•Allergic rhinitis •Anaphylaxis •Allergic conjunctivitis •Drug allergies

Drugs for Upper Respiratory Disorders

•Antihistamines •Decongestants •Corticosteroids •Antitussives •Expectorants and Mycolytics

NURSING CARE- CHOLINERGIC AGONIST DRUGS (prt 3)

•Auscultate bowel and breath sounds for abnormality •Have IV atropine available as an antidote- early signs of toxicity include flushing, salivation, sweating, nausea, and abdominal cramps

Antihistamines: Indications for Use (prt 2)

•Blood/blood product transfusion reactions •Dermatologic conditions •Miscellaneous- motion sickness, vertigo, nausea and vomiting, sedation

Nursing Care- Antihistamines

•Caution if driving a vehicle or performing tasks due to drowsiness •Avoid alcohol and CNS depressants •Watch for confusion, hypotension, dizziness, drowsiness, urinary retention, blurred vision •May cause paradoxical excitation in children

Lipoglycopeptides

•Check C&S before therapy •Administer over 1 to 2 hours IV (slowly) •Peak and trough drug levels must be monitored*** •Monitor renal function tests and hearing- may cause nephrotoxicity and ototoxicity**** •Red Man Syndrome- may occur from histamine release from drug infusion- flushing and rash of upper body- can be caused by infusing drug too rapidly************

Long-Acting Medications

•Corticosteroids (inhaled or PO) •Leukotriene modifiers •Long-acting beta2 adrenergic agonists •Methylxanthines

Nursing Care- Upper Respiratory Disorders (prt 2)

•Get adequate rest •Watch for OTC medications that contain similar ingredients- caution if diabetic, cardiac, hyperthyroid, etc. •Teach use of medications- •Nasal sprays- 1 or 2 puffs as directed- watch for rebound congestion with adrenergic agonists

Non-selective COX -1 & COX-2 Inhibitors

•Ibuprofen (Advil/Motrin) •Indomethacin (Indocin) •Meloxicam (Mobic) •naproxen (Naprosyn); naproxen sodium (Aleve) •diclofenac (Voltaren, Cataflam, Cambia, Zipsor) •ketoralac

Preventing resistance

•Limit the use of antibiotics unless it is known that they have a bacterial infection (not viral) •Make sure does is high enough, for long enough to eradicate the bacterial illness it is treating •Around the clock dosing •Culture when possible •Take exactly as prescribed (even if feeling better), for the current illness only ***take all of the prescription***

Nursing Care- Upper Respiratory Disorders (prt 1)

•Monitor temperature and use antipyretics properly •Prevention of spread of infection •Hydration Don't drive or operate machinery if drowsy

NURSING CARE- ADRENERGIC BLOCKERS

•Monitor vital signs (HR & BP) and EKG •Assess for respiratory difficulty •Monitor for dizziness, insomnia, depression, chest pain •Assist with ambulation from orthostatic hypotension

NURSING CARE- CHOLINERGIC AGONIST DRUGS

•Monitor vital signs and urine output •Monitor liver enzymes, bilirubin, and serum amylase

NURSING CARE- ANTICHOLINERGICS

•Monitor vital signs, especially heart rate •Assess urine output- retention may occur •Encourage adequate fluid intake and high fiber foods •Monitor and record bowel sounds- may cause paralytic ileus

Aminoglycosides ("-cin" suffix)

•Peak & trough levels should be drawn (blood lab sample); ototoxicity is associated with troughs that are too high, rather than peaks being too high* •Monitor kidney (renal) function by watching labs (BUN and creatinine levels) •Instruct patient to report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness, and vertigo •If toxic, administer IV calcium gluconate for treatment of neuromuscular blockade

Cephalosporins ("cef-" prefix)

•Prototype: cefaclor (ceclor) •Examples of generations of cephalosporins •First-generation •cephalexin (Keflex), cefazolin (Kefzol) •Second-generation •cefaclor (Ceclor), cefoxitin (Mefoxin)

cephalosporins ("cef-" prefix)

•Prototype: cefaclor (ceclor) •Examples of generations of cephalosporins •Third-generation •cefoperazone (Cefobid), ceftriaxone (Rocephin) •Fourth-generation •cefepime (Maxipime) •Fifth-generation •Ceftaroline (Teflaro)

Lipoglycopeptides

•Prototype: vancomycin (PO, IV) •Others: telavancin (Vibativ), oritavancin (Orbactiv) •Bactericidal; disrupt cell membrane •Usually reserved for severe infections from gram-positive organisms, often when bacteria have become drug resistant, such as MRSA •Check C&S before therapy