Pharmacology - Exam 1

gentamicin nursing interventions

- monitor renal function - evaluate serum labs (peak and trough)

Benzodiazepines - endings

-lam, -pam

Tricyclic antidepressants - endings

-triptyline, -pramine

Therapeutic range for Lithium?

0.6-1.2 mEq/L

Nursing Interventions for Lithium

Regular blood drawn, increase fluid, Watch sodium, avoid NSAIDS, use acetaminophen instead

What is the therapeutic range for Phenytoin?

10-20 mcg/dl Below 10 - seizure risk Above 10 - Toxic risk Both, notify HCP

What is Naloxone?

A narcotic antagonist used as an antidote/reverses the effects of opiods

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)? A. Temperature of 39.7oC (103.5oF) B. Urinary retention C. Heart rate 56/min D. Muscle flaccidity

A. Temperature of 39.7oC (103.5oF)

A man is taking chlorpromazine (Thorazine). He develops a high fever, respiratory depression, and diminished level of consciousness. What condition has the patient developed? A.Neuroleptic malignant syndrome B. Dystonia C. Anhedonia D. Akathisia

A.Neuroleptic malignant syndrome

What are the names of the tests used to test for Hepatotoxcity?

ALT, AST

What to monitor for Acetaminophen

ALT, AST,

Antidote for Overdose of Acetaminophen

Acetylcysteine

Greatest risk for death for Morphine

Advanced age, underlying pulmonary disease, post-surgery, RR under 12,

Assessing patient for Phenytoin

Allergies, pregnancy and lactation, Hepatic Function

Patient contraindications - MAOIs

Allergy, Pregnant, Lactation

Assessing patient for Benzodiazepines

Allergy, Pregnant, lactation, Hepatic function, CBC, Nephro function

Tricyclic antidepressants - Contraindications

Allergy, pregnancy, lactation

Gentamicin is a

Aminoglycoside

Isoniazid nursing interventions

Assess for allergies Avoid alcohol Take 1 hour before or 2 hours after a meal Take full course of therapy Give Vitamin B6 to decrease neuropathy Monitor liver function and Blood Sugar Avoid tyramine foods -sauerkraut, aged cheese, smoked fish -causes pounding heart, dizzy, clammy, heart attack

NSAIDS nursing interventions

Assess for bleeding. Give with food. Risk of bleeding lower than aspirin. Renal impairment- give acetaminophen.

Isoniazid is a

Anti-TB

What are Benzodiazepines given for?

Anxiety, Seizures, Alcohol withdraw, hyperexcitability, agitation.

Which are preferred more, Atypical or Typical Anti-psychotic meds?

Atypical / Clozapine

What are MAOIs used for?

Atypical depression, anti-depressants, not a first line treatment

A man has been taking imipramine (Tofranil) for 1 week for depression. He tells the nurse that he is going to stop taking this medication because it is not working. The best response is which of the following? A. "Contact your prescriber about taking a different antidepressant medication." B. "It may take up to 4 weeks before this medication makes to feel better." C. "You should slowly taper rather than suddenly discontinue this medication." D. "You should take an extra dose today to build up your blood level and get faster results."

B. "It may take up to 4 weeks before this medication makes to feel better." Takes at least a few weeks to see therapeutic effects

A nurse is teaching the importance of proper diet to a patient taking the MAO inhibitor tranylcypromine (Parnate) for depression. Which of the following food selections by the patient indicates that further teaching is needed? A. A tossed salad and a bowl of vegetable soup. B. A salami and Swiss cheese sandwich and a banana. C. A hamburger and French fries. D. A cold plate with cottage cheese, chicken salad, and grapes.

B. A salami and Swiss cheese sandwich and a banana.

A client presents at the clinic with symptoms of hyperexcitability and agitation. Which medication would the nurse expect the physician to prescribe? A. Hypnotic B. Benzodiazepine C. Barbiturate D. Other Anxiolytic and Hypnotic Drugs

B. Benzodiazepine

What are the names of the tests used to test for Nephrotoxicity?

BUN, Creatinine, Glomerular Filtration, Urine tests Creatinine - over 1.3 = bad kidney, Urine 30 mL per Hour or Less = kidney distress, Tinnitus

No need to report _ to HCP for Morphine

Burning during IV push itching - treat with antihistamine, olerance will develop over time when first taking morphine, so nausea and vomiting when first starting Don't take on empty stomach Constiipation - PRN stool softeners

Penicillin Nursing Interventions

Check culture and sensitivity before drugs are given. Monitor for bleeding. Monitor closely during first dose. Increase fluids. Take 1 hour before or 2 hours after meals. Check for superinfection. Consider safety issues.

If a patient who is taking Phenelzine falls acutely ill with unstable vitals and overactivity, what should the nurse do?

Check if the patient has been taking any other serotonin altercating medicine like SSRIs or TCA. Drugs should be completely stopped for 2 weeks before taking a new Anti-depressant drug

Cephalosporins - Teachings

Cross allergy with Penicillin Avoid alcohol NSAIDS and anticoagulants can cause increased bleeding

Adverse effects for Lithium that are normal

Dry mouth, thirst, use ice chips, gums, candy, drink water, brush your teeth, drowsiness, decrease appetite, weight gain

Benzodiazepines MOA

Enhance GABA-A receptor response, act in limbic system and RAS, increases GABA which inhibits neuron activity.

Other than MNS, what is another adverse effect that should be looked into?

Extrapyramidal effects - Pseudoparkinsonism - rigid, stopped posture. Dystonia - muscle spasms relating to the face. Akathisia - restlessness Tardive Dyskinesia - rolling of the tongue, smacking of the lips, chewing motion. Tremors, dry mouth, sweating,

True or False: MAOIs are generally prescribed for people with depression who respond to safer drugs.

False

If a patient comes in with Benzodiazepines overdose, which medication do you expect the provider to prescribe?

Flumazenil

Ciprofloxacin is a

Fluoroquinolone

NSAIDs adverse effects

GI upset, bleeding, ulceration (15%-20%) ↑ Bleeding time (aspirin 7-12 days, ibuprofen 1 day) due to effects on platelets Renal effects including ↓ GFR, failure, salt + H20 retention

Early signs of toxicity

GI upset, hand tremor, confusion, hyperirritability of muscles, ECG changes, sedation, incoordination, slurred speech

When taking alloprazolam, you should avoid eating/drinking what?

Grapefruit, grapefruit juice, alcohol

Adverse effects - MAOIs

Hypertensive Crisis (headaches or neck stiffness) - PRIORITY, may indicate high BP

Drug endings for MAOIs

Ice cubes (Isocarboxazid), Fennel (Phenelzine), Training Waitress (Tranylcypromine)

Why is Phenytoin toxic? What should you do to assess?

Its a long term drug, meaning it accumulates longer in the body - do routine blood tests,

NSAIDs contraindications

Known drug allergy Conditions that place the patient at risk for bleeding: Vitamin K deficiency Peptic ulcer disease

Acetaminophen adverse effects

Liver toxicity and failure - PRIORITY Hepatotoxicity Rash, fever, chest pain, bone marrow suppression.

When should Phenytoin be given?

Long term protection with seizures, such as epilepsy

What is morphine used for?

Moderate to severe pain. Pre-op and OB. MI pain. Pain associated with pulmonary edema.

Cephalosporins - Nursing intervention

Monitor Liver function - Nephrotoxicity Avoid Aminoglycosides

Amphotericin B nursing interventions

Monitor for temperature & give with food; Admin tylenol and benadryl one hr before; complete test dose before admin TAKE VITAL SIGNS Q15MIN Renal function, avoid alcohol

Adverse Effects of Phenytoin

NEW skin rash = PRIORITY Suicidal intentions Bradycardia and hypotension IS TERATOGENIC CNS depression Severe liver toxicity and bone marrow suppresion

What are the pros and cons of Benzodiazepines?

Pro - acts fast within minutes Cons - highly addictive, hard to come off, not same for long term use

NSAIDS can relieve

RA or OA

Phenelzine

Nardil, used for patients who did not respond to newer, safer antidepressants.

Patient Teaching for Lithium

No diuretics = lithium toxicity, avoid coffee, cola and teas, no Anti-cholinergic drugs (-pium), avoid driving, proper diet and exercise, decrease appetite, mild GI upset.

Patient teachings for Phenytoin -

No oral contraceptives, no stopping abruptly, take folic acid, calcium and vitamin D and encourage eating milk, cantaloupe and kale STOP tube feeding 1-2 hours before and after admin, AVOID alcohol

If a patient shows signs of gingival hyperplasia when taking phenytoin, should they stop taking the drug?

No, this is completely normal

Rifampicin adverse effects

Orange/Red stain on body fluids Hepatotoxicity Pruritus, rash Nausea Vomiting Flu-like syndrome 3-6 months after treatment

Acetaminophen usually for

Pain and fever in children, moderate to mild pain,

Aspirins are

Salicylates - block the inflammatory response, anti-pyretic, analgesic

Biggest priority side effect for Benzodiazepines?

Sedation - BIGGEST PRIORITY sleepiness, low BP, low RR, Urinary retention, constipation, confusion

What are the adverse effects of Morphine?

Sedation - PRIORITY Respiratory Depression, CNS/Neurological effects - easily fall asleep, unarounsable Orthostatic hypotension - seated position CA, GI effects

Adverse effects of Tricyclic Antidepressants

Sedation / Orthostatic Hypotension - PRIORITY Can cause fatal overdose arrythmia. Constipation, hypotension, dry mouth,

Amphotericin B adverse effects

Severe Renal impairment, bone marrow suppression

Some drugs have a narrow therapeutic index meaning?

Small difference between dose to reach therapeutic effect and dose to reach adverse effects, so we should give it at the same time every day

Patient Assessment for Lithium

Sodium depletion (Hyponatremia), Hepatic and Renal function, Pregnant, Thyroid function test, Serum Lithium levels,

What patient has a high risk for Lithium Toxicity? / Report to HCP

Stomach Flu (diarrhea & vomiting) Excessive Urination and extreme thirst Neuro Muscular Excitability

Pregnancy Category X

Studies in animals or humans show abnormalities; use in pregnancy is contraindicated

Patient teachings for Benzodiazepines

Take at bedtime, don't skip doses, taper off slowly, don't drink alcohol including wine, avoid operating dangerous equipment

Rifampin nursing interventions

Take on an empty stomach Do not use contact lenses Monitor CBC and liver function Do not take with antacid Use additional birth control Many drug/drug interactions

A person taking Chlorpromazine/Thorazine suddenly starts showing signs of muscle rigidity, uncontrollable actions, fever and an unstable mental status. What should the nurse do?

Take the person off all anti-psych medications immediately. This is Neuroleptic Malignant Syndrome.

Ciprofloxacin adverse effects

Tendon rupture - BLACK BOX WARNING in young patients Insomnia, Depression GI effects CNS effects, phototoxicity, Candida infections, CDI

What are some contraindications of Anti-psych drugs and who should avoid them?

Tetragonic effects - pregnant/lactating avoid, Prolonged QT internal, avoid beta blockers, alcohol and thioridazine.

Lithium toxicity

Toxicity over 1.5, <1.5 = nausea and vomiting

Tube feeding vs IV for Phenytoin

Tube feeding - Flush with 30-50mL of tap water IV - Flush with normal saline

What is the difference between a typical and Atypical Antipsychotic Drug? Name examples of each

Typical - block ONLY dopamine receptors, Chorpromazine Atypical - block dopamine AND serotonin receptors Clozapine

Anti-manic drugs

Used to treat bipolar disorder

Foods to avoid when taking MAOIs

Wine, aged cheeses, meats - any foods with tyramines

antibiotic therapy

a therapeutic treatment involving the use of a substance with known toxicity to bacteria

Psychosis

abnormal condition of the mind

Cephalosporins contraindication

allergy, gallbladder disease, pseudomembranous colitis, Phlebitis with IV

Acyclovir nursing interventions

antiviral (herpes) Nephrotoxicity - dosage is right, drink plenty of water

Lithium treats

bipolar disorder and schizoaffective disorder

Tricyclic antidepressants

block reuptake of serotonin and norepinephrine, relieves symptoms of depression, Treatment of enuresis (bedwetting) - Imipramine.

Don't give aspirin to

children, Reye's syndrome

Principles of Antibiotic Resistance

happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them

Cephalosporins

inhibit cell wall synthesis

MRSA infection

invasion of body tissue by methicillin-resistant staphylococcus aureus

rifampin labs

liver labs: ALT AST

MAOIs

monoamine oxidase inhibitors

Gentamicin Adverse Effects

nephrotoxicity and ototoxicity

Isoniazid adverse effects

peripheral neuropathy, hepatotoxicity

Salicylism

syndrome associated with high levels of salicylates—dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude

Penicillin adverse effects

the safest class of antibiotics; bacteria can become resistant; allergy is possible; lowered red/white blood cell and platelet levels

Pharmacokinetics

what the body does to the drug

Pharmacodynamics

what the drug does to the body