ALL THE PHARM

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

Lithium toxicity fluid intake consideration

Maintain *consistent* fluid intake

Premarin MOA

Maintain female genital system (oral estrogen)

Nitrous oxide benefit

Maintains motor and sensory function

What is the priority education topic when administering intermediate insulin at 20:00?

Make sure to consume a bedtime snack

Pregnancy & Lactation Labeling Rule

Mandates a detailed description of drug risks for: pregnancy, lactation, females and males of reproductive potential

Magnesium sulfate side effects

Many: - Flushing - Nausea/vomiting - Diplopia - Blurring vision - Headache - Lethargy

Cromolyn is a ____________________ drug.

Mast Cell Stabilizer

follicular phase of menstrual cycle

Maturation of an ovum

Effect of epinephrine on the kidneys

May cause renal vasoconstriction, thereby decreased renal perfusion and renal output

Methylphenidate MOA

May improve impulse transmission by *releasing* stored NE and D, and prohibiting reuptake (not a paradoxical reaction)

Thiazide/loop diuretics and lithium interaction

May increase lithium levels

Tocolytic agents

Medications used to *stop* uterine contractions and delay preterm birth

Uterotonics/oxytocics

Medications used to enhance or stimulate uterine contractions

Gemfibrozil cannot be given with which type 2 diabetes drug?

Meglitinides

Meperipidine and smooth muscle

Meperidine causes *less* smooth muscle spasm while other opioids cause more spasm

Terbutaline maternal adverse effects

Metabolic: - Hyperglycemia - Hypokalemia CV: - Tachycardia - Palpitations - Hypotension - Chest pain/myocardial ischemia - SOB/Pulmonary edema Other: - Nervousness - Nausea - Vomiting

Metformin inpatient consideration

Metformin not administered in the hospital as it can cause lactic acidosis

_______________ masks the signs of hypoglycemia.

Metoprolol (Beta-blockers)

What antibiotic is good for treating Trichomoniasis?

Metronidazole

What antibiotic is good for treating amebiasis?

Metronidazole

Red man symptoms

Mild: flushing/rash, pruritis, urticaria, tachycardia, hypotension Severe: hypovolemia, heart failure, hypothermia

MAOIs client education

Minimize adverse effects: -- Hypertensive crisis -- Orthostatic hypotension -- Food education Measures to minimize interactions: -- NO concurrent antidepressants -- Other Rx and OTC meds

Alpha-adrenergic blockers are also known as ______.

Minipress

Acamprosate MOA

Modulation of glutamate neurotransmission at metabotropic-5 glutamate receptors

Category C Drug Interactions

Monitor therapy

Drug interaction category C

Monitor therapy

Drug interaction: Category C

Monitor therapy

_______ is a leukotriene receptor antagonist.

Montelukast

How are adverse reactions different from side effects?

More severe than side effects and *always* undesirable

Why AM dose esomeprazole?

Most active during waking/eating hours.

Why is the HIB vaccine not given after age 5?

Most instances of serious disease occur before age 5

Issues with the former gender dysphoria model

Multitudes, incl: -- Does not address: gender non-binary, gender non-conforming, intersex -- Requires real-life experience prior to HT -- Requires a healthcare provider to determine "eligibility"

Atropine greatly affects ________ but have little effect on _________.

Muscarinic receptors; nicotinic receptors

Vasoconstrictors biggest considerations

Must first be volume resuscitated

Buproprion (Wellbutrin) is a...

NDRI (NE-D uptake inhibitor)

If a pt is being tube fed and is prescribed extended release PO opioids, you should....

NEVER crush an extended release medication.

Can SABAs be used as a scheduled medication outside of the hospital?

NO

Indomethacin drug type

NSAID

Lidocaine is a...

Na+ channel blocker (Class IB antiarrhythmic)

Class I antiarrhythmics

Na+ channel blockers

Loop diuretics inhibit the transport of _____ into the blood.

NaCl

_____ precipitates withdrawal in those dependent on opioid agonists.

Nalbuphine

Morphine reversal agent

Narcan

Category B Drug Interaction

No action needed

Drug interaction category B

No action needed

Drug interaction: Category B

No action needed

irregularly irregular rhythm

No consistent pattern to the heart rhythm

Category A Drug Interaction

No interaction

Drug interaction category A

No interaction

Drug interaction: Category A

No interaction

OPV (oral polio vaccine)

No longer used

Is exenatide used as a monotherapy for type 2 diabetes?

No, it is used in conjuction with metformin or a sulfonylurea (glipizide).

Should you monitor PTT when a patient is on enoxaparin?

No, not necessary.

_______________ calcium channel blockers are used for and primarily affect heart rate and rhythm.

Non-dihydropyridine

Labs to monitor for rivaroxaban

None

Lab for enoxaparin

None (but monitor kidney function)

Mitrazepine (Remeron) is a....

Noradrenergic and specific serotonergic antidepressants (NaSSA)

First line therapy for hemodynamic support in sepsis

Norepinephrine

Phenylephrine can be used in conjuction with _________.

Norepinephrine

Which adrenergic agonist causes extreme vasocontriction

Norepinephrine (can cause extreme tissue necrosis)

Concern with herbal supplements

Not FDA approved

Ovulatory phase

Occurs mid-cycle with the surge in LH

Enoxaparin (Lovenox) administration method

Only and always SQ

Midazolam onset + half-life

Onset (IV): 1-5 minutes 1/2-life: 2-6 hours

Albuterol onset and peak time

Onset: 3-5 minutes Peak: 25 minutes

Fentanyl (IV) onset & duration

Onset: immediate Duration: 30-60 minutes

Naltrexone is a...

Opiod antagonist/antidote

Naloxone use

Opioid overdose antidote

Tamsulosin administration

Oral (*DO NOT CRUSH* = profound hypotension)

Main adverse effect of fluticasone.

Oral candidiasis (thrush)

Augmentin administration

PO

If an opioid can be taken both PO and IV, which dose would be larger?

PO

Route of administration for minipress

PO

Bethanechol administration method

PO on an empty stomach (it is poorly absorbed from the GI tract)

Warfarin administration methods

PO only

Penicillin VK administration

PO, IM, IV

Ondansetron (Zofran) administration methods

PO, IV, IM, or SL

If possible, doxycycline should be administered...

PO.

Naloxone should *not* be administered via...

PO.

Labs used to monitor warfarin

PT and INR

Monitoring lab for warfarin

PT/INR

Lab for heparin

PTT

Lab used to monitor heparin

PTT

Non-hormonal LARC

Paraguard IUD

Which penicillin prototype drug is narrow spectrum and which is broad spectrum?

Penicillin VK is narrow spectrum while Augmentin is a broad spectrum antibiotic.

_________________ can occur after 3-7 days of decongestant use.

"Rebound" nasal congestion

Best way to elicit responses about drug use

"When was the last time you used/took _____?"

The epstein-barr viral infection is commonly referred to as...

"mono."

Adverse effects of Valsartan

(very similar to ACE inhibitors) - Cough - Angioedema - Fetal harm - Renal failure patients - Hyperkalemia

Atropine indications

*- Bradycardia* - Dilate pupils for eye examination - Palliative care to reduce secretions

Labs to monitor with Hydrochlorothiazide

*1. Creatinine*: reflects function of the kidney 2. Glucose 3. Calcium 4. Potassium/magnesium

What do you do if a medication error happens while at VUSN?

*1. NOTIFY YOUR INSTRUCTOR/NURSE* 2. Assess Patient 3. Learn from mistake

_______ ADHD medications require BP and HR monitoring

*ALL*

What patients should be on Guaifenesin?

*All* COPD patients (highly emphasized in lecture)

Diltiazem indications

*Atrial* dysrhythmias: - A-fib - A-flutter - SVT

Effect of hyperkalemia on digoxin

*Decreased* digoxin distribution to myocardium

Estrogen-related side effects of COCs

*Excess estrogen*: -- N/V -- Dizziness -- Fluid retention -- Edema -- Breast enlargement -- Breast tenderness -- Chloasma -- Leg cramps -- HAs -- HTN *Estrogen deficiency*: -- Breakthrough bleeding -- Oligomenorrhea -- Dyspareunia

Progestin-related side effects of COCs

*Excess*: -- Increased appetite -- Weight gain -- Oily skin -- Acne -- Depression -- Vaginitis -- Excess hair growth -- Decreased breast size -- Amenorrhea *Deficiency*: -- Dysmenorrhea -- Bleeding late in the cycle -- Heavy menstrual flow -- Amenorrhea

T or F: Cyclosporine should be given with food.

*False*: it must be taken on an empty stomach

Naltrexone administration

*IM* injection into gluteal area with 1.5in 20-gauge needle

Effect of hypokalemia on digoxin

*Increased* digoxin distribution to myocardium

Nucleoside RTI MOA

*Inhibits viral DNA synthesis* -- Active form of drug incorporated into growing DNA chain -- Causes premature chain termination

therapeutic uses of opioids

*Relief of moderate to severe pain* Pre-procedure use: - prevention of pain - sedation - reduction of anxiety

Tocolytic agents purpose

*Stop* uterine contractions and delay preterm birth

Fluconazole indications

*Yeast infections*: - Oropharyngeal candidiasis - Esophageal candidiasis - Vaginal candidiasis - Candida UTI

If a patient on furosemide begins to have a rising creatinine level, this suggests a risk for ______________ and ______________.

*hyper*kalemia and acute kidney failure

Lantus peak action

*none/unknown*

Interactions that *increase* cyclosporine levels (memorize!)

- "-azole" antifungals - Macrolide antibiotics - Amphotericin B - Grapefruit juice

Meds used in epidurals

- "Caines" - Narcotics

HIB immunization schedule

- # of doses depends on age at first dose - Normally 4 doses - Given at 2, 4, 6, and 12-15mo - Do not give after age 5

IgG indications

- *Acute* phase tissue rejection - Exacerbation of autoimmune processes: MS, Crohn's, ITP, vasculitis, Guillian-Barre

Tamsulosin nursing considerations

- *DO NOT CRUSH* - Orthostatic hypotension - Assess improvement in urination

Interferon Alfa side effects

- *Flu-like symptoms (up to 50%)* - Neuropsychiatric effects - Depression - Suicidal ideation - Fatigue - Thyroid dysfunction - Bone marrow suppression - GI effects - Injection site irritation

Methylphenidate adverse effects

- *Growth suppression* (d/t appetite suppression) - *Delayed sleep* - Headaches, stomach aches, *irritability* - Exacerbate tic disorders - Seizures - Arrhythmias, chest pain, *HTN*, sudden death - Psychosis (dopamine excess)

Type 1 hypersensitivity reaction

- *Immediate* - Production of antibodies in response to an allergen - Activated mast cells release histamine - Results in: vasodilation, smooth muscle spasm, increased membrane permeability - Systemic or localized to specific target tissue or organ - Eg., anaphylaxis, allergic rhinitis

Risks of TPN administration

- *Infection* (wet, warm, dark, sugar) - DVT - Cirrhosis - Pancreatitis - Cholecystitis - GI atrophy - Translocation of bacteria (intestines --> lungs, blood)

Alcohol withdrawal interventions

- *Long acting benzodiazepine* - *Thiamine*: prevent encephalopathy - *Folic Acid/Multivitamins*: correct deficiencies - Magnesium sulfate: reduce seizurese - Anticonvulsants: control seizures - PRNs to control nausea/BP/sleep - Nonpharm: supportive environment, low stress, monitor vitals

Lithium toxicity early indicators

- *N/v/d* - Thirst & polyuria - Lethargy, slurred speech - Muscle twitching, fine tremor

Cyclosporine adverse effects

- *Nephrotoxicity* - (75%) - Infection - (75%) - Hirsutism - HTN - Gingival hyperplasia - Tumor - Anemias

Adenosine MOA

- *Slows* conduction through the AV node (will briefly stop heart)

Hormonal LARCs MOA

- *Thickens cervical mucus* - *Inhibits sperm movements* - *Thins the uterine lining* - (Ovulation suppression)

Alendronate SEs

- *Ulcers of the esophagus* - *Upper GI irritation* - Irregular HR - Fractures of the femur - Hypocalcemia - Skin rash - Joint, bone, and muscle pain - Jaw bone decay (osteonecrosis) - Increased parathyroid hormone (PTH)

Cyclosporine indications

- *Whole organ transplant* (kidney, liver, heart) - Autoimmune conditions (RA, severe psoriasis)

Vaccine administration considerations

- 0 to 12mo: anterolateral aspect of the thigh is recommended - Toddlers and older children: deltoid may be used if the muscle mass is adequate

Low dose dopamine rate/effect/indications

- 1-5 mcg/kg/min - Dopaminergic - Improve perfusion of mesenteric circulation and functioning kidneys

Diphenhydramine

- 1st gen H1 antagonist - Significant CNS depression + anticholinergic effects - On Beers list

Short acting (IR) methylphenidate: - onset/duration - dosing frequency

- 30 minutes/3-6 hours - BID or TID

IPV immunization schedule

- 4 doses - 3 doses in first ~18mo - Once at 4-6 y

DTap immunization schedule

- 5 doses given before kindergarten - 1 dose before middle school - Between 27-36wk gestation for pregnant patients - Booster recommended every 10 years

Intermediate dose dopamine rate/effect/indications

- 5-10 mcg/kg/min - Dopaminergic & beta1 adrenergic agonist - Positive chronotrope and vasoconstriction

Influenza vaccine recommendations

- 6 months to 121 years old - Highly rec for those with chronic illnesses - Intranasal (live) or IM

High dose dopamine rate/effect/indications

- >10 mcg/kg/min - Alpha adrenergic agonist - Vasoconstriction

Guanfacine ER is a...

- ADHD (or BP) drug - Selective alpha-2A agonists

Methylphenidate is a...

- ADHD medication - CNS Stimulant - NDRI (norepinephrine-dopamine reuptake inhibitor) - Schedule II

Dabigatran indications

- AMI - h/p or actively needing anti-coagulation in setting of HIT

Mifepristone SEs

- Abdominal cramping - Uterine cramping - Nausea - HA - HTN - Angioedema

FTM HT changes that start at 1-6 months

- Acne - Skin oiliness - Fat redistribution; continues up to 5 years - Cessation of menses - Clitoral enlargement - Vaginal atrophy (max effect of these changes typically seen at 1-2 years)

Spironolactone off-label uses

- Acne vulgaris - PCOS - MTF hormone therapy

Succinylcholine MOA

- Acts similar to acetylcholine - Produces a state of constant depolarization of the motor endplate

Extrapyramidal side effects

- Acute dystonia - Parkinsonism - Akathisia - Tardive dyskinesia

IgG adverse effects

- Acute hypersensitivity rxns: flushing, myalgia, wheezing, tachycardia, hypotension - Renal failure - Hemolytic anemias

Etomidate adverse effects

- Adrenal suppression - Mortality with continuous infusion - Nausea/vomiting (aspiration risk)

Atropine psychosis s/s

- Agitation - Confusion - Tachycardia - Dry flushed skin

Moderate (full-blown) serotonin syndrome s/s

- Agitation & ↓ LOC - HTN, shivering, hyperthermia - Rigidity

Diltiazem titration considerations

- Aim of HR under 120 - As long as SBP >100

Parkinsonism s/s

- Akinesia - Muscle rigidity and posture changes - Tremor - Hypersalivation and drooling - Mask-like facies

Pneumococcal vaccine is recommended for...

- All under age 2 (1st dose at 2mo) - Children at high risk - All over age 60 - Adults with chronic illnesses

Cyclosporine nursing implications

- Allergies and contraindications - *Baseline* organ function (kidney, liver, electrolytes) - Assess for active/recent infection - Monitor CBC (bone marrow suppression) - Correct administration time (*EXACT same time every day*) - Draw drug levels just prior to administration of medication - Pt teaching: foods, administration, warning signs

Dermatophyte (ring worm) appearance

- Alopecia - Circular red ring - Raised borders - Central clearing

Tamsulosin MOA

- Alpha-1 Adrenergic Blocker - Antagonizes receptors in the smooth muscle of the prostate - Relaxes smooth muscles in the neck of the bladder & prostate

Phentolamine

- Alpha1 adrenergic blocker - Localized vasodilation of arterioles and capillaries - Used for localized peripheral vasodilation if infiltration occurs

Indications for TPN/PPN

- Altered digestion - Interruption - Malabsorption - Adjunct to enteral feeding

Lithium MOA

- Alters distribution of neuron important ions - Modulation of synaptic transmissions - Influences second messenger systems that are excitatory

Things that can decrease absorption of PO Levofloxacin (Levaquin)?

- Aluminum or magnesium - Milk

Resources need for intubation

- Ambubag - Suction - Sedative - Paralytic - IV access - Code status

Overall goal of transgender treatment plan

- Ameliorate gender dysphoria - Improve social/sexual functioning - Achieve serum hormone levels with physiologic "normal" biological range

Fluconazole

- An "azole" antifungal - Broad spectrum - Better GI absorption - Inhibits fungal CYP450, decreasing ergosterol synthesis - Inhibits fungal cell membrane formation

Ketamine effects

- Analgesia - Sedation - Immobility - Amnesia

Buprenorphine classification

- Analgesic - Opioid partial agonist

IPV cautions

- Anaphylactic reaction to neomycin, streptomycin, or polymyxin B - Not recommended in pregnancy

Epinephrine indications

- Anaphylaxis - Bronchospasm

Adverse effects of Lisinopril

- Angioedema - Dry hacking cough - Hyperkalemia - Fetal harm (oligohydramnios) - Renal failure patients (hyperkalemia)

Epinephrine side/adverse effects

- Anorexia - Tremors - Agitation - Dizziness - Palpitations - Tachycardia - Hypertension - Arrhythmias - MI

Hormone regimes for trans-femme clients

- Antiandrogens - Progestins - GnRH - Estrogen

Atropine indications

- Anticholinergic - AV node blocks - *Symptomatic* bradycardia

Scopolamine is a...

- Anticholinergic (antimuscarinic) - Antemetic

Medications to avoid with TCAs

- Anticholinergic drugs - CNS depressants

Medications often used to treat Parkinson's

- Anticholinergic drugs - Dopamine replacement - Dopamine agonists - MAO-B inhibitors - COMT inhibitors

TCAs interactions

- Anticholinergic drugs (benadryl) - CNS depressants

Carbidopa-Levodopa common side effects

- Anticholinergic effects - N/V (give with food) - Hypotension - Dizziness/weakness - Dark urine

Levetiracetam

- Anticonvulsant - Inhibits calcium channels and potassium currents - Rapid/complete PO absorption - AEs: SJS, suicidality, depressium, leukopenia

Combined hormone contraception medication interactions

- Anticonvulsants - Anticoagulants - Antituberculin - Antibiotics

Combined contraception medication interactions

- Anticonvulsants - Anticoagulants - Antituberculin - Antibiotics (debated)

SSRIs medication interactions

- Antidepressants - Protein binding meds

Fluoxetine is a...

- Antidepressants - Selective serotonin reuptake inhibitors (SSRIs)

Medications to avoid with SSRIs d/t interactions

- Antidepressants (that work on 5HT) - NSAIDS and anticoagulants

Dronabinal (Marinol) classificationsa

- Antiemetic - Appetite stimulant

Guanfacine ER interactions

- Antihypertensives - Valproic Acid (↑ levels) - CNS depressants

Preecampsia/HTN medications

- Antiseizure (Magnesium sulfate) - Antihypertensives: -- Hydralazine -- Methyldopa -- Labetalol

Compounding issues to screen for before/during trans HT

- Anxiety - Depression - Compulsivity - Substance abuse

Benzodiazepines uses

- Anxiety - Sleep problems - Seizures - Status epilepticus

Propofol adverse effects

- Apnea & hypotension - Loss of protective reflexes - Rapid progression between light sedation and general anesthesia

Fentanyl adverse effects

- Apnea/ ↓ respiratory drive - Histamine release (flushing) - Chest wall/glottal rigidity - Caution with opiate naive

Vasopressin alternate names

- Arginine vasopressin - Antidiuretic hormone - DDAVP

In patients with cardiovascular disease, salmeterol may increase the risk of...

- Arrhythmia - Hypertension - Heart failure

Atropine adverse effects

- Arrhythmia (vtach, afib, asystole) - Tachycardia - Dilated pupils - Anticholinergic effects - Could worsen a heart attack by increasing O2 demand

Cardiovascular collapse

- Arteries and veins become loose and floppy (no tone) - No systemic resistance - No ventricular response (no CO) = no pulse (may have normal sinus rhythm)

Tamsulosin nursing implications

- Assess BP - Do not crush - Monitoring effectiveness, bladder distention - Catheterization if needed

Doxycycline nursing implications

- Assess for pregnancy risk (cross placenta) - Avoid in children if possible

Aripiprazole

- Atypical antipsychotic - Dopamine (mostly antagonist) and serotonin (mostly agonist) stabilizer

Prednisone indications

- Autoimmune disorder: ITP - Organ transplant: renal, liver, bone marrow, heart - Acute inflammation: arthritis, allergic rxns, asthma

Herpes genitalis patient education on sexual activity

- Avoid all sexual contact when lesions are present - Use barrier method when lesions are absent

Tamsulosin indications

- BPH - Kidney stones (relaxes kidney vasculature and bladder neck; not very effective)

MOAIs interactions

- Barbiturates - TCAs - Antihistamines - CNS depressants - Antihypertensives - OTC cold meds - Cheese, wine, pickled foods

TCAs monitoring

- Baseline ECG - Plasma levels

Nursing implications for ACE Inhibitors and ARBs

- Baseline data - Therapeutic effects - Educate on adverse effects (slow standing) - Caution: > Potassium-sparing diuretics > Potassium supplements

Sedation: client monitoring

- Baseline vital signs - Oxygen administered - Respiration: assess at least every 15 minutes - EKG monitoring

Mifepristone patient education

- Be at an appropriate location within the window of pregnancy termination - Misoprostol given 24-48h after

Gardisil schedule

- Begin between 10-11y - Dosed at 0, 1, 6*mo - Need the third shot if started after age 15y or if immunosuppressed

Depression adjunct medications

- Benzodiazepines (for anxiety/agitation/irritability) - Mood stabilizers (erratic mood) - Antipsychotics

Bacterial enzymes involved in resistance to penicillins

- Beta-lactamase - Penicillinase

IgG MOA

- Bind to IL-2 receptors - Impairs adhesion and transmigration of leukocytes - Blocking T-cell proliferation

Alendronate

- Biphosphonate - First-line choice for osteoporosis treatment

Anti-depressant MOA

- Block action of MAO - Block re-uptake of monoamines - Desensitization and down-regulation

Mechanism of angiotensin II receptor blockers

- Block angiotensin II binding - Decrease vascular resistance - No inotropic or chronotropic effects - Less adverse effects

Paralytic agents MOA

- Block transmission of acetylcholine to the post synaptic receptor sites of skeletal muscle - Render a patient potionless - No sedation effects

Nicardipine MOA

- Blocks calcium ion entry through slow channels - Relaxes smooth muscles in arteries - Smooth muscle dilation

Interferon Alfa MOA

- Blocks viral entry into cells - Blocks synthesis of viral mRNA and viral proteins - Blocks viral assembly and release

S/s of magnesium sulfate toxicity

- Blurred vision - Double visions - Slowed RR - Pulmonary edema - Absent DTRs - Decreased UOP

Acyclovir IV adverse effects

- Bone marrow suppression - Granulocytopenia - Thrombocytopenia - Neutropenia - Nephrotoxic - Neurotoxic - Teratogenic/embryotoxic - Phlebitis

Mycophenolate adverse effects

- Bone marrow suppression: neutropenia, thrombocytopenia, anemia - Nausea/diarrhea - Alopecia - Infections/sepsis - Neoplasms: skin, lymphomas

Adverse effects of Metoprolol

- Bradycardia - Decreased cardiac output - Dysrhythmias - Bronchoconstriction

Atropine indications

- Bradycardia - Eye examination - Palliative care

Succinylcholine adverse effects

- Bradycardia - Hypotension - Arrhythmias - Hyperkalemia - Fasciculation (muscle twitching) - Malignant hyperthermia

Amphotericin B characteristics

- Broad spectrum antifungal - Highly toxic - Used for progressive and potentially fatal infections - Poor CSF penetration - Poor GI absorption

Mifepristone administration

- Buccal administration (effect in 2-24h)

Mycophenolate nursing implications

- CBC - Electrolytes (GI disturbance) - S/s infection

Opioid interactions

- CNS depressants - Anticholinergics - Hypotensive agents - Agonist-antagonist opioids - MAOIs

TCA interactions

- CNS depressants (extreme fatigue) - Anticholinergics - Sympathomimetics - MAOIs

Magnesium sulfate adverse effects

- CNS depression - Resp depression - Pulmonary edema

Caution using labetalol with what conditions?

- COPD - Chronic lung disease - Diabetes

Torsades de pointes

- CPR - Defibrillation - *Magnesium sulfate IV* - Epinephrine

Ventricular fibrillation treatment

- CPR - Defibrillation - Epinephrine

Asystole interventions

- CPR - Epinephrine - Atropine

Asystole

- CPR - Epinephrine - CPR - Epinephrine - Rinse repeat

Decongestants should be used with caution in those with...

- CVD disease - Renal disease - High intraoccular pressure

Osteoporosis prevention

- Calcium (1200mg/day) - Vit D (800 IU/day) - Exercise - Diet - Cessation of smoking

Nifedipine MOA

- Calcium channel blocker - Relaxes smooth muscle by blocking calcium entry into the cell - Stabilizes arteries (esp. in brain)

Herpes genitalis and delivery

- Can be transmitted during delivery - Oral therapy near delivery - May eliminate need for cesarean

Most important somatropin nursing implication

- Can cause hyperglycemia - Need daily checks

Depo and mini-pills indicated clients

- Can't take combined methods b/c co-morbidities or chronic disease - Undiagnosed vaginal bleeding - Active viral hepatitis or cirrhosis - Breastfeeding clients - HTNsive clients - Clients over 35 that smoke

Prednisone nursing implications

- Cannot abruptly stop - Must be adjusted in times of stress - Monitor: bone density, glucose, WBCs, BP, electrolytes, UOP, edema, etc.

Epinephrine indications

- Cardiovascular collapse - Anaphylaxis

V-tach interventions

- Cardioversion - Defibrillation

Fentanyl age considerations

- Caution in peds patients (contraindicated <6months) - Extreme caution in elderly

Pt education for diltiazem

- Caution of orthostatic hypotension - Monitor pulse rate - Signs of intolerance

Nursing implications of Metaprolol

- Caution with diabetes > Inhibits adrenaline > Blunts signs/symptoms of hypoglycemia - Patient safety - Signs of intolerance - Cardiac monitoring

Antibiotics that when taken PO should be on an empty stomach

- Ceftriaxone - Metronidazole

TPN prerequisites

- Central access - Dedicated port - Radiographic confirmation of placement

Nicardipine caution

- Central line preferred - Alternate peripheral sites q12h

Relative contraindications to tocolytic therapy

- Cervical dilation >4 cm - Ruptured membranes

Misoprostol uses

- Cervical ripening - PP hemorrhage

Mini-pills and depo-provera MOA

- Change the endometrial and cervical mucus environments

Lithium monitoring

- Check lithium levels after 5 days of initiation or dose change - Check level every 6 months thereafter - Also q6 months: CBC, electrolytes, renal & thyroid function

Asystole first step

- Check pulse/leads - Is pt responsive?

Atropine signs of concern

- Chest pain - Decreased urinary output - HR - Narrow-angle glaucoma

ADHD psychotropic medication in children (vs. adults)

- Children often differ in response to medication - Children metabolize medications more rapidly - Final maintenance dosages may be higher in children than those used for adults - Controlled studies for children are increasing but remain lacking - Adults often lack hyperactivity symptoms, making med selection different

Buprenorphine indication

- Chronic pain - Maintenance therapy for opioid dependence - Prevents opioid associated euphoria

Severe serotonin syndrome s/s

- Coma - Shock - Tonic-clonic seizures

Low failure rates contraceptive methods

- Combination pills - Depo provera - IUD - Patch - Mini-pill - Sterilization

NuvaRing transvaginal contraception

- Combined contraceptive method - 2-inch diameter flexible indwelling ring inserted into the vagina - Non-biodegradable, transparent, and colorless

Combined contraceptive methods

- Combined oral contraceptives (COCs) - Ortho evra patch - Nuva ring

Flumenazil

- Competative benzodiazepine antagonist - Very quick action - Post-anesthesia sedation reversal - Rarely for benzo overdose (seizure risk)

Dextromethorphan side/adverse effects

- Confusion - Excitement - Irritability - Nervousness - Serotonin syndrome

Buprenorphine adverse effects

- Constipation - Sedation - CNS depression - Nausea

Parasympathetic responses

- Constricted pupils - Constricted bronchioles and increased secretions - Decreased HR - Dilated blood vessels - Increased peristalsis - Constricted bladder - Increased salivation

Priority patient education for epstain-barr virus (mono)

- Contagious - *No contact sports* (splenic rupture)

Propofol monitoring

- Continuous cardiac monitor - SpO2

MMR nursing implications

- Contraindicated during pregnancy (live) - Anaphylactic rxn to neomycin or gelatin - Known immunodeficiency - Possibly contagious for 1-2wk after admin

Nitroprusside cautions

- Coronary steal - Protect from sunlight

TPN risksvs. benefits considerations

- Cost - Infection risk - GI integrity - Organ complications - Nutritional enhancement - Prevent cellular catabolism

Albuterol indications

- Cough - Chest tightness - Wheeze - SOB - Activity intolerance - Preventative therapy for exercise induced bronchospasm (EIB) 30 mins before exercise

Olseltamivir SEs

- Cough - Chills - Sore throat - HA - N/V - Myalgia (Same as flu)

Dinoprostone side effects

- Cramping - Painful contractions - N/V/D - Fever/chills

Toxic biproduct of nitroprusside

- Cyanide - Reaches toxic levels after treatment for a few days - Also if medication exposed to sunlight

Rare but serious adverse effects of stimulants

- Death - Adverse cardiac events - Hallucinations - Seizures - Mania/hypomania

S/s kidney transplant rejection

- Decreased UOP - Increased creatinine - Flank pain

Cyclosporine warning signs

- Decreased UOP, increased creatinine - Fever, chills, diaphoresis - Fatigue

Benefits of depot antipsychotics

- Decreased nonadherence - Maximize pharmacokinetic coverage and minimize antipsychotic withdrawal - No influenced by first pass metabolism - Decreased potential for drug-drug interactions - No peaks and troughs of medication, reduced side effects

Effect of minipress on cholesterol

- Decreases "bad cholesterol" (VLDL and LDL) - Increases good cholesterol (HDL)

Herpes genitalis and acyclovir education points

- Decreases formation of additional lesions - Does not accelerate tissue healing - Decreases duration and severity - High dose oral therapy - Effective if started within 24 hours of onset - IV treatment if immunocompromised

Progestin-only contraceptive methdos

- Depo-provera - "Mini-pills" - Long acting reversible contraception (LARCs)

Mycophenolate MOA

- Destroys B and T lymphocytes - Non-specific: toxic to all proliferating cells

TPN may contain...

- Dextrose - Lipids - Amino acids - Electrolytes - Vitamins/minerals - Trace elements - Medications (eg., insulin)

Conditions that will decrease insulin requirements

- Diarrhea - Nausea/vomiting - Renal/hepatic impairment

Sympathetic responses

- Dilated pupils - Dilated bronchioles - Increased HR - Vasoconstriction - Decreased GI motility - Relaxed bladder muscle - Relaxed uterine muscle

Nitroprusside MOA

- Direct acting vasodilator - Metabolized to nitric oxide - Mediates smooth muscle relaxation

Vasopressin MOA

- Direct vasoconstrictor without inotropic or chronotropic effects

COC: if *3* or more missed pills

- Discontinue present pack and allow for withdrawal bleeding - Start new pack 7 days after last pill taken - Use back until new set of pills have been taken for at least 7 consecutive days

Bismuth subsalicylate effects

- Disrupts wall of H. pylori and its ability to adhere - Contains salicylate - Produces harmless discoloration of tongue

Alcohol and rocephine

- Disulfiram-like reaction - Extreme emesis until all alcohol is expelled

Guaifenesin adverse/side effects

- Dizziness - Drowsiness - Headache - Nausea - Kidney stone formation (if consumed in large quantities)

Sinus tachycardia sx

- Dizzy - Fluttering in chest - Heart pounding

Sinus bradycardia sx

- Dizzy - Nausea - Diaphoretic

Zolpidem teaching points

- Do not mix with alcohol - Take right before bed

Sildenafil nursing implications

- Do not mix with nitrates (=extreme hypotension) - BP monitoring with syncope/pre-syncope - Seek medical attention for priapism - Encourage discussions/questions

Doxycycline patient education

- Don't take with antacids or milk products - Take with food to lessen GI distress - Apply sunscreen + limit sun exposure

Hepatitis A immunization schedule

- Dose #1 at age 1 - Dose #2 6-12mo after dose 1 - All children 1y+ - Rec if traveling to areas with high rates of hep A

Lithium dosing

- Dosing is individualized to plasma levels - 300mg TID/QID, max = 1200 - ER form = BID

Antibiotics that cause photosensitivity

- Doxycycline - Levofloxacin - Trimethoprim/sulfamethoxazole

Antibiotics that shouldn't be taken with milk

- Doxycyline - Levofloxacin

Antipsychotics adverse effects

- EPSEs: acute dystonia, parkinsonism, akathisia, tardive dyskinesia - NMS - Agranulocytosis - Hypotension, sedation, seizures, arrhythmias - Anticholinergic SEs - Dermatological problems (rashes, jaundice) - Decreased libido, impaired orgasm, galactorrhea, menstrual irregularity, gynecomastia, ED - Weight gain, lipid + glucose dysregulation, metabolic syndrome

Mini-pill patient educations

- Each pill only offers 24 hours of protection (=*no missed pills and no withdrawal week*) - Must be taken at the *exact same time daily* (w/in 30m) - Need backup if more than 3 hours late

TCA anticholinergic symptoms

- Early toxicity: agitation and confusion - Late toxicity: seizures and coma

Exogenous testosterone nursing implications

- Education on AEs - Review admin instructions - Monitor anticipated outcomes - Maintenance of scheduled dose - Maintain physical activities - Monitor labs: cholesterol, triclycerides electrolytes

Spironolactone adverse effects

- Electrolyte abnormalities - Dehydration - Gynecomastia - Impotence - Orthostatic hypotension

DTaP nursing considerations

- Encephalopathy within 7 days of administration of previous dose of DTaP - Red flags: -- fever >102 within 48h of dose -- hx of Guillain-Barre Syndrome -- collapse or shock-like state -- seizures within 3 days -- persistent, inconsolable crying

Sildenafil mechanism of action

- Enhances the effect of nitric oxide - Produces smooth muscle relaxation and inflow of blood to the corpus cavernosum

Monoamine oxidase (MAO)

- Enzyme present in monoamine-containing neurons - Converts monoamine transmitters into active products - MAO-A and MOA-B

Tiotropium adverse effects

- Epistaxis - Nasal irritation

Common herpes viruses

- Epstein-Barr (mono) - HSV-I/HSV-II - Varicella zoster virus (VZV) - Cytomegalovirus (CMV)

Sildenafil (Viagra) indications

- Erectile dysfunction - Originally pulmonary hypertension - *Not* for arousal/stimulation/libido

Luteal phase main hormones

- Estrogen - Progesterone

Buprenorphine nursing implication

- Explain side effects and importance of not mixing with other sedatives - Reduce stigma and reassure patient

Testosterone indications

- Expression of male sex characteristics - Libido maintenance - Skeletal muscle growth - Male hypogonadism - Delayed puberty - HRT

Testosterone uses

- Expression of male sex characteristics (hypogonadism, HRT, delayed puberty) - Libido maintenance - Skeletal muscle growth

Myxedema coma

- Extreme hypothyroidism - Decreased mental status - Hypothermia - Bradycardia - Hyponatremia - Hypoglycemia - Hypotension - Coma --> Death

Follicular phase main hormones

- FSH - Estrogen - LH

FTM HT changes seen at 6-12 months

- Facial hair/body hair growth - Scalp hair loss - Increased muscle mass and strength - Deepening of the voice (max effect of these changes typically seen at 2-5 years)

Absolute contraindications to tocolytic therapy

- Fetal death - Fetal anomalies incompatible with life - Fetal compromise warranting immediate delivery - Chorioamnionitis - Severe hemorrhage - Severe chronic HTN and/or preeclampsia

Conditions that will increase insulin requirements

- Fever - Hyperthyroidism - Infection

Influenza s/s

- Fever - Cough - Chills - Sore throat - HA - N/V - Myalgia

Chronic hepatitis s/s

- Few/slow symptoms - Cirrhosis - Hepatocellular carcinoma - Liver failure - Death

Varicella immunization schedule

- First at 12-18mo - Second at 4-6y - "Catch-up" at 11y

Ways of initiating COCs

- First day start method - Sunday start - Quick start

Meningococcal vaccine schedule

- First dose at 11-12y - Booster now recommended at 16y - Strongly recommended for all college freshmen

MMR immunization schedule

- First dose given at age 12-15 months - 2nd dose at 4-6y - *Live virus*

PAC or PVC sx

- Flopping in chest - "Skipping a beat" - Palpitations

Vasodilatory nursing implications

- Fluid volume status - Frequent vital signs - CNS reassessments - Monitor chest pain - Infusion site assessment (esp peripheral IV)

A-fib/A-flutter sx

- Fluttering in chest - Heart racing - Chest pain

Methimazole

- For hyperthyroidism - Blocks synthesis of T4 + T3 by preventing oxidation of iodide

Mag sulfate nursing care

- Frequent VS (RR) - Breath sounds Q2 hours - SaO2 monitor - DTRs q 1-2h - Continuous EFM - Labs (mag, potassium, creatinine) - Bed rest (safety) - I+O every hour

Onychomycosis

- Fungal infection of the nail - Difficult to eradicate - Prolonged therapy: 3-6 months - Low success rates of treatment

Dermatophyte infections

- Fungal, mold-like organisms - Grow in warm, moist areas - Transmission: direct or secondary

Rocephine is often used for...

- GI infections - UTIs - Dermal infections (has *some* gram+ coverage)

Assessment *prior* to lithium treatment

- General health status - Renal function - Thyroid function - CBC - Electrolytes - Baseline ECG

General criteria for tocolytic use

- Gestational age - Documented preterm labor - Maternal consent

Depo-provera

- Given every 12 weeks (-2 to +1 week cushion) - IM injection

Menopausal HRT

- Goal: relieve menopausal symptoms - Estrogen-progestin therapy (EPT) for clients who have an intact uterus - Estrogen therapy (ET) for use with clients who have had a hysterectomy

Potential FTM hormone therapies

- Gonadotropin-releasing hormone agonist - Testosterone - Progestin

Initiation and discontinuation of TPN

- Gradual initiation by TPN team to avoid hyperglycemia - Gradual discontinuation or switch to dextrose to prevent hypoglycemia

Premarin liver consideration

- Greater effect on the liver due to the first-pass effect - Increases hepatic production of triglycerides, HDL, and clotting factors

Hypertonic crystalloid solutions

- Greater osmotic pressure than extracellular fluid - Pulls water from the interstitial space into the extracellular fluid via osmosis

Nicardipine adverse effects

- HA - Ischemia - Bradycardia - Infiltration: tissue ischemia and phlebitis

Diltiazem monitoring parameters

- HR - BP

Rapid response call criteria (not all inclusive)

- HR >140 or <40 - RR >28 or <8 - SBP >180 or <90 - O2 sat <90 despite supplementation - Acute change in mental status - UOP <30ml over 4h - Significant concern

Acyclovir indications

- HSV (good) - VZV (ok) - IV if severe infection or immunocommpromized (Not effective/indicated for CMV)

Vasopressin adverse effects

- HTN - ↓ cardiac output - ↓ urinary output

Typical initial TPN infusion schedule

- Half-rate for 12h - Full-rate for next 12h - Waste the rest

Ketamine adverse effects

- Hallucinations - Delirium - Excessive salivation (consider anticholinergic)

Adenosine nursing implications

- Have resuscitation equipment ready - Oxygen - Support to patient - Knowledge of drug/procedure

Type 1 hypersensitivity reaction

- Hay fever - Food allergies - Anaphylaxis

Venlafaxine (Effexor) side effects

- Headache - Anorexia - Insomnia - Discontinuation syndrome

Early/transient lithium side effects

- Headache - GI issues - Muscle weakness - Fatigue - Confusion

Sildenafil adverse effects

- Headache - Hypotension/syncope - Priapism

Indications for digoxin

- Heart failure - Atrial arrhythmias > fibrillation > flutter

Dobutamine

- Heart failure - Cardiogenic shock

Milrinone indications

- Heart failure - Increased afterload

Monitoring parameters of methylphenidate

- Height + weight - BP - HR

"True blood thinners" (prototypes)

- Heparin - Enoxaparin - Warfarin - Rivaroxaban - Dabigatran

Caution using barbiturates in what patients

- Hepatic/renal disease - CHF - Hypovolemia - Tissue necrosis with extravasation

Dead virus immunizations

- Hepatitis A + V - Influenza (shot) - IPV (Polio) - Rabies - HIB - Whooping cough - Pneumococcal - Meningococcal

Required childhood vaccines

- Hepatitis B - Polio - HIB - MMR - Varicella - DTaP

Erectile dysfunction therapy

- Herbal - Hormonal (Testosterone) - Injection/intraurethral pellet - Penile implants

Plan-B

- High dose progestin - Used to prevent pregnancy for up to 3 days after unprotected intercourse - 2 pill method: 1st as soon as possible, then 2nd 12h later - 1 pill method: 1 pill within 72h

Spironolactone indications

- Hormone associated conditions - BPH - Prostate cancer - Endometriosis - Male-pattern baldness - Acne - Hirsutism

FTM HT adverse effects

- Hormone-dependent cancers - Polycythemia/erythrocytosis d/t supratherapeutic dose - Bone demineralization d/t subtherapeutic dose - ↓ HDL & ↑ triglycerides - Transient transaminitis (contraindicated in liver dysfunction/failure)

Sedation risk factors

- Hx of airway obstruction/obesity - Chronic lung disease - Poor control of airway secretions - Craniofacial abnormalities - Myocardial dysfunction - Altered neurological status - Acute illness

Indications for ACE inhibitors

- Hypertension - Adjunct therapy for AMI treatment - Left ventricular failure - No inotropic or chronotropic effects

Indications for α-adrenergic blockers (Minipress)

- Hypertension - Benign Prostatic Hypertrophy - Raynaud's - Safe with diabetes mellitus - High VLDL and LDL cholesterol

Indications for calcium channel blockers

- Hypertension - Myocardium infarction - SA/AV Node suppression

Phenylephrine adverse effects

- Hypertension - Reflex bradycardia

Epinephrine adverse effects

- Hypertension - Tremors - Tissue ischemia - Acidosis (kidney dysfunction) - Tachycardia/dysrhythmias

Norepinephrine adverse effects

- Hypoperfusion to microvasculature

TCAs adverse effects

- Hypotension - Anticholinergic - Sedation - Diaphoresis - Cardiotoxicity (arrythmias) - Seizures - Hypomania - Yawngasm

Milrinone adverse effects

- Hypotension - Arrhythmias (brady at high doses)

Labetalol adverse effects

- Hypotension - Bradycardia

Antipsychotic overdose symptoms

- Hypotension - CNS depression - EPSEs

Tamsulosin adverse effects

- Hypotension - Orthostasis - Dizziness

Vasopressin indications

- Hypotension - Sepsis: endogenous vasopressin deficiency - Diabetes insipidus

Phenylephrine indications

- Hypotension - Shock - Nasal congestion

Nitroglycerine adverse effects

- Hypotension - Tachycardia - HA - Tachyphylaxis

Dopamine adverse effects

- Hypovolemia - Tachycardia - Increased O2 demand - Arrhythmogenic - N/V

Nursing implications of Minipress

- I&Os - Fall risk - Sexual education - Education > Diet > BP at home (same time every day before medication)

TPN frequent monitorings

- I+Os - Electrolytes (K+, Na+, Mg+, phos) - LFTs - Albumin/pre-albumin - S/s of systemic infection (fever, chills, hypoTN, lactic acid) - Central IV access - Daily tubing + bag change

Hormonal LARCs

- IUD: Mirena, Skyla, Liletta, Kyleena - Implant: Nexplanon

Amphotericin B administration

- IV - 6-8 weeks to 3-4 months

Fluconazole administration

- IV - Oral (suspension/pill)

Ketolorac (Toradol)

- IV NSAID - Very effective for kidney stone pain

Vasopressin administration

- IV for sepsis: 0.01-0.04 units/min - Nasal

Oxytocin/Pitocin administration

- IV infusion pump - Piggy-backed into proximal IV port - Titrate to uterine contractions and fetal response

Pharmacological methods of pain control in labor & delivery

- IV narcotics - Nitrous oxide - Epidural anesthesia

Epinephrine administration

- IV/IO (1:10,000): 1 mg - IM/SC (1:1000): 0.2-0.5mg - ET (1:10,000): 2-2.5mg diluted in 10mL

Treatment for ventricular tachycardia *if no pulse*

- Immediate defibrillation - Epinephrine (ongoing chest compressions)

Montelukast preferred administration times

- In the evening *or* - 2 hours prior to exposure to allergen

Common problems with antidepressant treatments

- Inadequate dosing - Discontinuation of drug prior to full recovery - Lack of tapering when discontinued - Treatment resistance requiring antidepressent combination therapies and/or augmentation with adjunctive drugs

Indications for nonstimulants to treat ADHD.

- Inadequate or undesirable response to stimulants - Tic/Tourette's disorder - Pt of family hx of SUDs - Don't want to take or give a stimulant - Adjunct to a stimulant

Anabolic-androgenic steroids indications

- Increase cellular protein synthesis - Buildup of muscle tissue - Virilizing properties

Effects of CNS stimulants in ADHD patients

- Increases: vigilance and attention, short term memory - Decreases: motor activity, impulsiveness, emotional lability

Pharmacologic goals of FTM HT

- Induce masculine secondary sex characteristics of the identified gender - Induce virilization - Diminish secondary natal sex characteristics

Amphotericin B adverse effects

- Infusion rxns - Nephrotoxicity - Hematologic effects - Leukocytosis - Agranulocytosis - Coagulation deficits - Leukopenia - Thrombocytopenia

Phenytoin

- Inhibit Na influx in motor cortex - *Target range: 10-20 mcg/mL* - Discolors urine - AEs: teratogenic, gingival hyperplasia, pancytopenia

Acetaminophen

- Inhibits prostaglandin - Used for pain + fever - Hepatotoxicity

Magnesium sulfate MOA

- Inhibits release of acetylcholine in neuromuscular junctions - Also thought to provide neuroprotective effect decreasing the incidence and severity of cerebral palsy in preterm infants

TCAs MOA

- Inhibits reuptake of NE and 5HT

Oxytocin (Pitocin) uses

- Initiate/increase uterine contractions frequency/strength - Initiate/augment labor - PP hemorrhage

First day start method

- Initiated on first day of menstruation - No backup needed

Sunday start

- Initiated on the Sunday after the first day of menstruation - *Need a backup method* unless menstruation starts on Sunday

Quick start

- Initiated the day the client receives the contraception - *Need a backup method* for at least 7 days

Drug resistance

- Insensitivty/decreased sensitivity to a medication - Can be inherent or acquired

"Metabolic syndrome" associated with atypical antipsychotics

- Insulin resistance - HTN - High serum lipids - Obesity - Coagulation abnormalities

Bethanechol should *not* be prescribed to patients with:

- Intestinal/urinary tract obstruction - severe bradycardia - active asthma

Medical screening questions for immunizations

- Is your child well today? - Is your child taking any medications? - Does your child have allergies? - Has your child ever had a reaction to vaccines in the past?

Sedation airway nursing interventions

- Jaw thrust - Insertion of nasal airway - Insertion of oral airway

"Good Samaritan Law"

- Law that protects providers when they prescribe naloxone to anyone who is in a position to administer this medication - Requires instructions/quiz module for...

Systemic mycoses (fungal infection)

- Less common - Extremely dangerous

Hypotonic crystalloid solutions

- Less osmotic pressure than extracellular fluid which allows water to move into cells - Will cause a shift from vascular system into tissues and cells

Varicella nursing implications

- Live virus - Not given to pts who have had the disease - Contraindicated in pregnancy - Contraindicated if immunodeficient

Acute phase hepatitis s/s

- Liver inflammation - Jaundice - Elevated ALT - Typically resolves spontaneously

Continuous COCs

- Long period of active pills - Only one or a few withdrawal bleeds each year

Hypogonadism s/s

- Loss of body hair - Muscle loss - Abnormal breast growth - Reduced growth of penis and testicles - Erectile dysfunction - Osteoporosis - ↓ sex drive - Infertility - Fatigue - Hot flashes - Difficulty concentrating - ↓ libido

Concern with epidural -caines

- Loss of sensation and ability to control affected areas - Diaphragm paralyzation (resp) - Difficulty pushing + progressing

Monoamine oxidase inhibitors (MAOIs) MOA

- MAOIs prevent MAO from inactivating NE and 5HT after reuptake - Allows increased amounts of transmitters to be released - Result in irreversible inhibition (10-14 days) meaning recovery from inhibition requires new synthesis of the enzyme

Live virus immunizations

- MMR - Rotavirus - Smallpox - Varicella - Yellow fever - Shingles - Intranasal influenza

Gentamicin indications

- MRSA - Significant gram- infections

Widely used tocolytic agents

- Magnesium sulfate - B-adrenergic agent (Terbutaline) - Prostaglandin synthetase inhibitor (Indomethacin) - Calcium channel blocker (Nifedipine)

Vasoconstrictor nursing implications

- Maintain lowest effective dose - Adequate IV site - Assess for complications - Assess for signs of hypoperfusion or worsening shock

Vasopressin nursing considerations

- Maintain ordered dose - NOT TITRATED

Naltrexone for opioid treatment - nursing implications

- Make sure they have a "clean stream" (7-10 days clean) - Will precipitate withdrawal from opioids - Once on naltrexone, pts can use opioids without precipitation of withdrawal (blunts high) - Hepatoxicity

Lithium intoxication s/s

- Marked tremor - Nausea/diarrhea - Blurred vision

Serotonin Syndrome (Central Serotonin Syndrome)

- May begin within minutes to hours after initiation of *ANY* medication that increases serotonin levels

Monitoring for trans patients on feminizing hormone therapy

- Measure lipids before initiating - Monitor feminizing and adverse effects every 3mo for 1st years, every 6-12mo thereafter - Monitor serum testosterone and estradiol - Montior prolactin and triglycerides - Monitor potassium if taking spironolactone - Bone density if risk for osteoporosis - Screen for breast and prostate cancer appropriately

Pharmacological management of schizophrenia

- Medication selection and dosing - Initial and maintenance treatment - Monitoring for ERSEs and other effects

Recommended vaccines

- Meningococcal - Rotavirus - Pneumococcal - Influenza - Hepatitis A - Gardasil

Nexplanon common side effects

- Menstrual irregularities - Weight gain - Headaches - Vaginitis

Antihypertensive drugs with decreased effectiveness in """""""""African Americans"""""""""

- Metoprolol (B-blockers) - Lisinopril (ACE-inhibitors)

Antibiotics that inhibit protein synthesis

- Metronidazole - Azithromycin - Doxycycline

Antibiotics processed in the liver

- Metronidazole - Trimethoprim/Sulfamethoxazole

Misoprostol side effects

- Minimal - Uterine tachysystole

Cytomegalovirus

- Minimal symptoms - Virus remains dormant - Causes no detectable injury or clinical illness - Immunocompromised hosts *and fetuses* at high risk of death from initial infection or reactivation

Benefits of informed consent model

- Minimize number of clinic visits - Client has better control of their outcomes - Therapy is optional and not a requirement

Mifepristone nursing implications

- Monitor for s/s abnormal bleeding - Monitor vital signs: BP and HR - S/s HTN - S/s hemorrhagic shock - Symptom management (N/V, pain)

IgG nursing implications

- Monitor: creatinine, electrolytes, UOP - CBC

Enzymes that breakdown neurotransmitters in the SNS and PsNS

- Monoamine oxidase - Catechol-O-methyltransferase - Acetylcholine

Major categories of COC

- Monophasic - Biphasic - Triphasic

benefits of atypical antipsychotics

- More effective for negative symptoms - Few EPSEs (but more anticholinergic SEs) - Less risk of TD

MONA

- Morphine - Oxygen (if <92% sat) - Nitrates - Aspirin

HSV I/II

- Mouth, face, genitalia

Candida superficial mycoses

- Mucous membranes - Moist skin - Scalp, nails, other non-moist areas

Late manifestation of hypothydroidism

- Myxedema coma

Premarin SEs

- N/V - Breast tenderness - Fluid retention - Leg cramps

Adderall XR

- NDRA - Take every morning - Contains immediate and delayed release - Common CNS stimulant SEs - Sudden death if cardiac defect

Naltrexone adverse effects

- Nausea - Dizziness - Loss of appetite - Depression

Common symptoms of *drug-drug* interactions

- Nausea - GI upset - Headache - Dizziness

Common symptoms of drug interactions

- Nausea - Vomiting - Diarrhea - Dizziness

Common drug interaction side effects

- Nausea - Vomiting - Dizziness - Rash

Alcohol withdrawl effects

- Nausea/vomiting/diarrhea - Diaphoresis - Elevated BP - Anxiety - Tremors - Insomnia - Delirium - Seizure

Doxycycline adverse effects

- Nausea/vomiting/diarrhea - Rash - Photosensivity ***should not be taken right before bed as it can cause gastritis

Nitrous oxide limitations

- Need to have regularly spaced contractions to coach inhalation to achieve pain relief at the correct time - Does not take all of the pain way - Not offered at many hospitals

Fluconazole adverse effects

- Negative inotropic effects - QTc prolongation - Hepatotoxic

Lithium life threatening toxicity symptoms/complications

- Neurotoxicity - Delirium - Encephalopathy

Propofol reversal agent

- None - Short half-life

Stevens-Johnson Syndrome

- Not an allergic reaction - Rash on all epithelial tissue

Hepatitis B treatment options

- Nucleoside RTI - Interferon

Viruses

- Obligate intracellular parastie - Use biochemical machinery of host cells to reproduce

Immunization safety considerations

- Observe patients for 15m after vaccine administration - Assess for possible s/s of an allergic rxns - Pts should remain sitting or lying after administration to avoid injury r/t syncope

How to assess for orthostatic hypotension

- Obtain HR and BP after lying down for 5 minutes - Have pt sit up and take HR and BP again after 5 minutes

SSRI discontinuation syndrome

- Occurs abruptly - Persists 1-2 weeks - Severity depends on duration, dosage, half-life - S/s: GI upset, headaches, somatic complaints, anxiety

SSRI withdrawal symptoms

- Occurs abruptly, persists 1-2 weeks ...

Lithium toxicity later indicators

- Oliguria, anuria - Confusion, impaired consciousness - Poor coordination, frank twitching, seizures - Blurred vision, tinnitus - Coma, death

Nucleoside RTI nursing implications

- Only recommended for high risk patients (↑ AST/ALT, hx of hepatic inflammation, advanced fibrosis) - Different doses for HIV and HBV - Repeated interval use can promote resistant HIV strains

Succinylcholine onset + half-life

- Onset: 30-60 seconds - Half-life: 6 minutes

Methadone indications

- Opioid dependence - Chronic pain

Suboxone indication

- Opioid dependency - Induction of detox - Opioid dependence maintenance therapy

Indications for vasoactive therapy

- Optimize perfusion (heart, brain, kidneys, lungs) - Optimize oxygen delivery - Minimize complications

TCAs adverse effects

- Orthostatic hypotension - Anticholinergic effect - Hazards of sedation

TCAs patient education

- Orthostatic hypotension - Anticholinergic effects - Hazards of sedation

Isotonic crystalloid solutions

- Osmolality equal to plasma - Usually functions as a volume expander and does not cross into red blood cells

Corticosteroid administeration methods

- PO - IV - IM

Rocephine (Ceftriaxone) administration considerations

- PO/IV/IM - Preferably on empty stomach - Caution with renal failure

Heparin monitoring parameters

- PTT - S/s hemorrhage (hypoTN, tachycardia) - GI bleeding, nasal bleeding, incision/IV bleeding - low platelets (HIT)

Varenicline (Chantix) classification

- Partial nicotine agonist - Smoking cessation aid

Norepinephrine cautions

- Patient must be normovolemic - Cardiogenic shock

Antibiotics used for UTIs

- Penicillins - Ceftriaxone - Levofloxacin (no longer) - Trimethoprim/Sulfamethoxazole - Nitrofurantoin

Antibiotics that target the cell wall

- Penicillins - Ceftriaxone - Vancomycin

Which classes of antibiotics are cell wall inhibitors?

- Penicillins - Cephalosporins - Glycopeptides

Antibiotics used for respiratory infections

- Penicillins - Levafloxacin - Trimethoprim/Sulfamethoxazole

Antibiotics used for otitis media infections

- Penicillins - Trimethoprim/Sulfamethoxazole

Interactions that *decrease* cyclosporine levels (memorize!)

- Phenytoin (anti-seizure) - Phenobarbital (anti-seizure, sedative) - Carbamazepine (anti-seizure) - Rifampin (anti-TB) - Terbinafine (anti-fungal) - Trimethoprim/Sulfamethoxazole (antibiotic)

Persistent lithium side/adverse effects

- Polyuria/polydipsia - Leukocytosis

Nexplanon contraindications

- Pregnancy - Active liver disease - Active VTE

HRT contraindications

- Pregnancy - Hx of endometrial cancer - Hx of breast cancer - Hx of thromboembolic disorders - Acute liver disease or chronic impaired liver function - Active gallbladder or pancreatic disease - Coronary artery disease (CAD) - Undiagnosed vaginal bleeding - Endometriosis

Contraindications to FTM HT

- Pregnancy - Unstable coronary artery disease - Untreated polycythemia

Reasons for taking contraception

- Pregnancy prevention - Cycle regulation - Decrease ovarian cysts - PMS and PMDD - Endometriosis - Ovarian and endometrial cancer

Testosterone treatment side/adverse effects

- Premature epiphyseal closure - Gynecomastia - Priapism - Acne - Elevated triglycerides - Decreased HDL

Exogenous testosterone adverse effects

- Priapism - Premature epiphyseal closure - Gynecomastia - Profound secondary sex characteristics - Acne - ↓ HDL & ↑ triglycerides - Bone demineralization

Can hepatitis C be sexually transmitted?

- Primarily transmitted by blood - Sexual transmission is controversial

Amphotericin B patient education

- Prolonged therapy - Not an antibiotic - Frequent labs

Aspirin indications

- Prophylaxis for CAD, CVA, TIA - Treatment for AMI, CVA

Monophasic COCs

- Provides the same amount of hormones every day for 21 days, placebos 22-28

Neurotransmitter sites of activation in the SNS and PsNS

- Pupils - Lungs - Heart - Blood vessels - GI - Urinary Bladder - Uterus - Salivary glands

When administering opioids it is especially important to continually assess which vital signs?

- RR - Pain - HR - BP

Nitroglycerine cautions

- RV infaction - Volume depletion

Lithium exretion

- Rapid renal excretion - Sodium depletion causes accumulation - Dehyrdration causes retention

Stevens-Johnson Syndrome

- Rare and *serious* reaction to medications or infections - Disorder of skin and mucous membranes - Symptoms: facial swelling, tongue swelling, hives, skin pain, rapid-spreading red/purple rash, blisters on skin/mucous membranes of mouth/eyes/genitals, shedding skin, fever, sore throat, fatigue, cough, burning eyes

Rotavirus vaccine schedule

- Rec for infants at 8wks - 3-series vaccine - 2nd dose 4-10wks after first - 3rd dose 4-10 wks after second

Vasoconstrictor infiltration nursing implications

- Refer to facility protocol - Proper IV line to prevent - Monitor IV site per protocol - Promote vasodilation if occurs

Mood stabilizers use

- Relieve symptoms during manic and depressive episodes of BPAD - Prevent recurrence of manic and depressive episodes of BPAD - Relieve and prevent recurrence of labile mood in non-BPAD disoders

Treatment for tardive dyskinesia

- Removal (taper) of offending drug - Vesicular monoamine transport 2 inhibitors - Switch to another agent with less potential for TD - Clonazepam - Vitamin E *- Congentin may make it worse*

Systemic mycoses challenges

- Resistant to treatment - Prolonged therapy - High toxicity of treatment drugs

Characteristics of depth of sedation

- Responsiveness - Airway - Spontaneous ventilation - Cardiovascular function

Mild serotonin syndrome s/s

- Restlessness - Diaphoresis and ↑ HR - Myoclonus (spasm)

Nicotine withdrawal symptoms

- Restlessness - Difficulty sleeping - Irritability - Craving - "Nic Fit"

Parkinson's Disease symptoms

- Rigidity - Bradykinesia - Tremors - Faskes facies - Pill-rolling tremors

Primary risks associated with immunosuppressants

- Risk for infection - Risk for neoplasms

Mifepristone black box warning

- Risk for serious bleeding and fatal infections - Atypical presentation of infections - Sepsis - Prolonged heavy bleeding (sign of incomplete abortion)

Cytomegalovirus transmission

- Saliva - Urine - Blood - Tears - Breast milk - Semen - Other fluids

Indications for antipsychotics

- Schizophrenia - Mania - Depression - Drug/medication intoxication - Drug/medication withdrawal - General medical conditions - Delirium - Traumatic brain injury - Dementia

Propofol effects

- Sedation - No analgesia

Milrinone MOA

- Selective phosphodiesterase inhibitor (PDE3): found in cardiac and vascular tissue - No beta effects = positive inotrope with no effect on HR

Venlafaxine (Effexor) serious adverse effects

- Serotonin syndrome - NMS - HTN - Bleeding - ↑ serum lipids - Mania

Mycophenolate indications

- Severe refractory RA - Lupus - MS - Psoriasis - Whole organ transplantation (heart, kidney, liver)

Neuroleptic malignant syndrome

- Severe rigidity and tremors - Sudden high fever - Severe sweating and drooling - Autonomy instability - LOC changes: seizures, death

Agranulocytosis

- Severely decreased WBC

SSRIs Client Education

- Sexual dysfunction - Caloric intake - Hazards of dizziness and fatigue - Signs of bruxism - Symptoms like suicidality

Why aren't tricyclic antidepressants (TCAs) widely used for depression anymore?

- Significant potential for overdose

SBAR

- Situation - Background - Assessment - Recommendation

Dermatophytes superficial mycoses

- Skin, hair, & nails - More common than candida

Fluoxetine consideration

- Slow taper to stop

Combined contraceptives contraindications

- Smokers if over 35 - HTN - Strong family hx of heart disease - Clotting disorders - Breastfeeding - Known or suspected endometrial cancer - Diagnosis of breast cancer current or past

Basic guidelines for antidepressant use

- Start low and go slow - May have a "lag period" - Most SE's occur in first 1-2 weeks - Suicide risk increases with energy level

Norepinephrine MOA

- Stimulates alpha and beta adrenergic receptors - Increases vascular tone

Epinephrine MOA

- Stimulates alpha, beta1, and beta2 adrenergic receptors - Positive inotrope and chronotrope - Antagonizes histamine effects

Mifepristone MOA

- Stimulates uterine contractions - Blocks the effects of progesterone

Plan-B MOA

- Stops ovulation - Won't disturb an established pregnancy

Risks associated with menopausal clients

- Stroke - Heart disease - Fractures, especially hip - Colorectal cancer - Endometrial cancer

Gender Dysphoria

- Strong, persistent feelings of identification with the opposite (sic) gender - Discomfort with one's own assigned sex that results in significant distress or impairment

Sedation orders have been placed. What else should you have in place?

- Suction - Ambubag - Oxygen - Cardiac monitoring - SpO2 - BP monitoring - Stethoscope

Warnings on CNS stimulants

- Sudden death associated with cardiac structural abnormalities - Abuse and dependence - Reports of murmur, syncope, chest pain, HTN, arrythmias - Family hx of heart disease - Psychotic or bipolar disorders - Tics or Tourette's

SSRIs side/adverse effects

- Suicidality - Nervousness, insomnia, anxiety - Headache - Nausea - Weight loss/gain - Sexual dysfunction - Activation of mania/hypomania - Bruxism - *Platelet dysfunction* - *Hyponatremia* - *Skin rashes* (possible SJS)

MOA of combined contraceptives

- Suppresses FSH & LH via continuous levels of estrogen and progesterone - Progesterone suppresses LH to prevent the mid-cycle surge (stops ovulation) - Progesterone also thickens cervical mucus to impair sperm travel - Estrogen suppresses FSH to prevent the selection and emergence of a dominant follicle

Prednisone MOA

- Suppresses migration of leukocytes - Inhibits mitosis of lymphocytes - Reduces lymphatic system activity - Inhibit production of inflammatory mediators: leukotrienes, prostaglandins, histamines, bradykinins

Paralytic agents

- Surgical procedures - ECT - Intubation/mechanical ventilation - Critically ill - V-tach (impair shiver reflex)

Phenylephrine MOA

- Synthetic agent - Direct actin alpha adrenergic agonist - No beta adrenergic effect - Does not effect cranial blood vessels

Dobutamine MOA

- Synthetic catecholamine - Stimulates B-1 adrenergic receptors - Little effect on B2 and alpha receptors - Positive inotropic effect

Dobutamine adverse effects

- Tachycardia - Hypertension - Ventricualr arrhythmias

COC: if *2* missed pills

- Take 2 a day until caught up - Use *backup*

COC: if *1* missed pill

- Take pill as soon as realized - Take next tablet as scheduled - Backup *not* required

Antidepressant medication selection considerations

- Target symptoms - Side effect profiles - Medical illnesses - Relative's response - Suicide risk

Doxycycline is contraindicated in which patient populations?

- Teratogenic during 1st trimester of pregnancy - Children under 8 yrs: discoloration of teeth and slow long bone growth in premies

Perimenopause

- The transition phase between regular menstrual periods and no periods at all - 2-8y (avg=4y)

Prednisone side effects

- Thinning skin - Infection - Bone dissolution - Impaired growth - Adrenal insufficiency - Increased water retention - Polydipsia - Increased glucose

Warning signs of a hypertensive crisis

- Throbbing, occipital headache - Retroobrital pain - Stiff neck - Apprehension - Nausea, chills, fever, pallor, sweating, flushing of skin, palpitations, chest pain

Nystatin indications

- Thrush - Candida of skin

Muscle most often involved in acute dystonia

- Tongue - Neck - Face - Laryngeal

Nystatin administration

- Topical (powder) - Oral (swallow or swish/spit)

Nitroprusside adverse effects

- Toxicities: cyanide - CNS dysfunction: seizures and altered mental status

Adenosine adverse effects

- Transient arrhythmias - Chest pain - Diaphoresis - Nausea - *Feel horrible*

Cromolyn side effects

- Transient cough - Pruritis of nose - Burning sensation of nose

General adverse effects of lithium

- Tremor - Goiter/hypothyroidism - Weight gain - ECG changes (K+ or sinus dysrhythmias) - Renal toxicity - Fetal effects (Ebstein's Anomaly)

Trimethoprim/Sulfamethoxazole indications

- UTI, OM, bronchitis, pneumocystis - *MRSA*

Most common diagnoses treated with antibiotics

- UTIs - Upper respiratory tract infection (URI) - Bronchitis - Pharyngitis - Sinusitis - Otitis media

Nitroglycerine indications

- Unstable angina - Adjunct therapy for AMI - HTN crisis/urgency

General guidelines for antibiotics and combined contraceptives

- Use backup method for duration of treatment *PLUS* 7 days - New contraception needed if long-term

True preterm labor must include:

- Uterine contractions *AND* - Cervical change

Nonpharmacological treatments to control postpartum bleeding

- Uterine massage - Breast feeding

Atropine (chronotrope) MOA

- Vagolytic/parasympatholytic - Blocks acetylcholine at parasympathetic sites: smooth muscle, secretory glands, CNS - Speeds conduction from SA to AV node

Antibiotics with a risk of ototoxicity

- Vancomycin - Gentamicin

Antibiotics with an ototoxicity risk

- Vancomycin - Gentamicin

Antibiotics that are good for treating MRSA

- Vancomycin - Gentamicin - Trimethoprim/Sulfamethoxazole

Antibiotics that are good for treating C diff

- Vancomycin (PO) - Metronidazole

Herpes Simplex - Varicella Zoster

- Varicella (chickenpox) - Herpes zoster (shingles)

The hypersensitivity/inflammatory response includes...

- Vascular permeability - Vasodilation - Hypotension - Urticaria - Bronchoconstriction

DDAVP (desmopressin)

- Vasopressin (ADH) - Used for diabetes insipidus and nocturnal enuresis

TPN downsides

- Very expensive - 2 nurse check (critical that mixture is correct) - New IV tubing for each bag of TPN - Must have dedicated port (central access)

Modified monophasic COCs

- Very low dose estrogen on days 24-28

Common candidiasis infections

- Vulvovaginal - Oral

Metoprolol

- a β Adrenergic Blocker - selective inhibition of β1-receptors - little or no effect on β2-receptors at low doses

Adverse effects of Lomotil (Diphenoxylate with Atropine)

- abdominal cramping - constipation

Intramuscular vs intravenous medication

- absorbed a bit less rapidly

Nociceptive pain

- active tissue damage or potentential tissue damage

Pharmacokinetics

- activity or fate of a drug in the body - how the body *moves* the drug around

life-threatening adverse reactions of bethanechol

- acute asthma attack - heart block - circulatory collapse - cardiac arrest

Nitroglycerine

- an organic nitrate

Effects of stimulating Kappa receptors

- analgesia - sedation - decreased GI motility

Effects of stimulating Mu receptors

- analgesia - sedation - decreased GI motility - respiratory depression - euphoria - physical dependence

Major indications for epinephrine

- anaphylaxis - bronchospasm

Nitroglycerine indications

- angina - hypertension - induce vascular dilation

Digoxin toxicity

- anorexia - nausea/vomiting - bradycardia - heart blocks - visual disturbances

side effects/adverse reactions of epinephrine

- anorexia - tremors - agitation - dizziness - palpitations - tachycardia - hypertension - arrythmias - myocardial infarctions

Interventions for opioid caused emesis

- anti-nausea medication

Nursing implications for digoxin

- apical pulse - monitor effects/adverse effects - monitor serum levels - potassium level > hyperkalemia: decreased digoxin distribution to myocardium > hypokalemia: increased digoxin distribution to myocardium

Common Schedule IV drugs

- ativan - valium - librium

Things that affect drug distribution

- blood flow (pulse, BP) - protein binding - lipid solubility - ability to enter cells

Neuropathic pain

- chronic initiated by nervous system lesions or dysfunction

Common Schedule III drugs

- codeine preparation - talwin

Therapeutic range/level/window

- concentrations between the MEC and toxic concentration - where the drug is effective but still safe

Major responses to anticholinergics are:

- decrease in GI motility - decrease in salivation - dilation of pupils (mydriasis) - an increase in pulse rate - decreased bladder contraction - decreased rigidity and tremors related to neuromuscular excitement

Nitrate tolerance

- decrease in the effect of a drug when administered continually - impaired conversion to nitric oxide

Therapeutic effects of digoxin for heart failure

- decreased pulmonary congestion - decreased edema - increased activity tolerance

Signs of concern after epinephrine administration

- decreased urinary output - afibrillation with RVR

Effects of Nifedipine

- decreased vascular resistance - negative chronotrope - negative inotripe - minimal reflex tachycardia

Common Schedule II drugs

- demerol - morphine - oxycodone - codeine - amphetamines

Factors that impact bioavailability.

- destruction in gastric acid - liver metabolism - non-absorbable molecule

Sympathetic physiological responses

- dilated pupils - dilated bronchioles - increased HR - vasoconstruction - decreased GI motility - relaxed bladder muscle - relaxed uterine muscle

Random level

- drug level not related to administration time - reflects steady state concentration

Biotransformation

- enzymatic alteration of drug structure - may activate or inactive the drug

Metabolism of digoxin

- extensive first-pass effect

Nonpharmacologic antiemetic measures

- genger/peppermint - tea - flat soda - gatorade/pedialyte - crackers/toast

Gardasil is recommended for...

- girls up to 26y - boys up to 21y

Therapeutic effects of digoxin for atrial dysrhythmias

- gradual slowing of heart rate - improved regularity of rhythm

Foods that often impact drug absorption

- grapefruit juice - fiber - tyramine - meal timing

Nitroglycerine adverse effects

- headache - orthostatic hypotension - reflex tachycardia - interaction with other drugs (VIAGRA) - tolerance

Common Schedule I drugs

- heroine - LSD - peyote - merijuana

Characteristics of Anti-Anginals: Organic Nitrates

- highly effective - inexpensive - long history of usage - rapid onset

Side effects of bethanechol

- hypotension - bradycardia - blurred vision - excessive salivation - increased gastric acid secretion - abdominal cramps - diarrhea - bronchoconstriction - cardiac dysthymias (rare)

Guanfacine most serious side effects

- hypotension, bradycardia, & syncope - sedation & somnolence

Major effects of epinephrine

- increased pulse - decreased mucous secretion - bronchodilation - decreased GI motility - urinary retention - dilate pupils

Opportunistic infection

- infection by a microorganism that normally does not cause disease - becomes pathogenic when the body's immune system is impaired and unable to fight off infection

Levofloxacin (Levaquin) mechanism of action

- inhibits DNA gyrase - inhibits relaxation of double helix and promotes breakage of DNA - inhibits DNA replication and thus cell division

Digoxin mechanism of action

- inhibits Na+/K+ ATPase - Decreases movement of Na+ out of cardiac cells after contraction - cells utilize Na+/Ca2+ channels - increased calcium availability for actin and myosin

Antagonist

- inhibits the body's normal internal response

Middle opioid withdrawal symptoms

- irritability - tremor - anorexia - "goose flesh"

Toxic concentration

- level at which a substance can damage an organism

First-pass effect

- liver removes a large portion of activated drug during it's first pass through the cardiovascular system

Bethanechol can be *cautiously* prescribed to patients with:

- low blood pressure - low heart rate

Interventions for opioid caused sedation

- more frequent smaller doses

Absorption

- movement of a drug from its site of administration into the blood

Adverse reactions of minipress

- orthostatic hypotension - palpitations - bradycardia - pancreatitis

Most common antibiotic errors in practice

- overzealous use - inappropriate duration - lack of indication - poorly selected agent - incorrect dose

Nitroglycerine nursing implications

- patient safety - wear gloves - effectiveness - maintenance dosage vs. rescue dosage

Minimum effective concentration (MEC)

- plasma drug level below which therapeutic effect will not occur

CYP450

- primary method of drug metabolism

Partial agonist

- produces a weaker or less effective response than the internal response

Agonist

- produces the same response as the body's normal internal response

Factors that affect drug absorption

- rate of dissolution - surface area exposure (pill shape) - drug solubility - pH of environment and substance - molecular size - interactions with food/other drugs - blood flow/health status/age

Dose-response

- relationship between the size of a dose and the intensity of the response produced

Adverse effects of opioids

- respiratory depression - constipation - sedation - emesis - orthostatic hypotension

How can morphine be intravenously delivered?

- scheduled - PRN - PCA

ACHES

- severe *A*bdominal pain - *C*hest pain - *H*eadache - *E*ye problems - *S*evere leg pain

Interventions for opioid caused orthostatic hypotension

- slow movem

Late opioid withdrawal symptoms

- sneezing - weakness - N/V - diarrhea - abdominal and muscle cramping - pain

major responses of cholinergic agonists

- stimulate bladder and GI tone - construct pupils - increase neuromuscular transmission

Receptor-drug affinity

- strength of binding between a drug and its receptor

Digoxin administration methods

- sublingual - extended release - topic/transdermal - IV

Digibind

- the antidote for digoxin toxicity - binds to digoxin molecule, complex is excreted in urine

Bioavailability

- the fraction of administered dose that reaches systemic circulation

Means of drug excretion

- urine - bile - sweat - saliva - breast milk - expired air

Prevention of nitrate tolerance

- use lowest effective dose - "drug holiday"

Effects of calcium channel blockers

- vasodilation - increases myocardial oxygen delivery - decreased myocardial oxygen demands

Pharmacodynamics

- what the drug does to the body/cells - biochemical and physiological effects - mechanism of action

Initial opioid withdrawal symptoms

- yawning - sweating - rhinorrhea

Anabolic-androgenic steroids adverse effects

- ↑ LDL - ↓ HDL - Acne - HTN - Liver damage - Left ventricular structural changes

Atomoxetine considerations

- ↑ risk for suicide in child/adolescents - Better for inattentive - Poor for hyperactivity

Nystatin (Oral) SEs

-- GI upset -- HAs -- Insomnia

Nystatin (Topical) SEs

-- stinging -- erythema -- edema -- pruritis -- urticaria

Types of medications used in epidurals

-caines and opioids

ACE inhibitors end in the suffix...

-pril

Angiotensin II receptor blockers end in what suffix?

-sartan

Bioavailability of a non-IV administered drug.

0 to 100%

Normal duration of the QRS complex

0.06 - *0.1* seconds (upper limit more important)

Insulin bolus dosage for treatment of DKA

0.1 unit/kg of body weight

Normal PR interval

0.12 - 0.2 seconds

Typical dilaudid (IV/IM/SQ) dose range

0.2-1 mg

The width of the large boxes on an EKG represents...

0.20 s

The height of the large boxes on an EKS represents...

0.5 mV

Peak effect of rapid-acting insulin (Lispro)

0.5-1 hour

Lithium therapeutic range

0.6 to 1.2 mEq/L (up to 1.5 if super manic)

Blood levels of Meglitinides peak _______ after dosing.

1 hour

To be considered menopausal, the patient must have had no menstruation for ______.

1 year

Inflammatory effects of prostaglandins (4)

1) vasodilation 2) relaxation of smooth muscle 3) increased capillary permeability 4) sensitization of nerve cells to pain

The influenza vaccine is effective ________ after administration.

1-2 weeks

Insulin pump infusion sets should be changed every...

1-3 days.

Midazolam typical dosing

1-5 mg (IV/IM/PO)

Epidural rare risks

1. "wet tap" resulting in severe spinal HA 2. "high level" resulting in paralyzing musculature 3. Accidental IV injection can result in cardiovascular collapse

Hydrochlorothiazide side/adverse effects

1. *Hyper*calcemia 2. *Hyper*glycemia 3. *Hypo*kalemia 4. *Hyper*uricemia

The three S's of the pathophysiology of asthma

1. *Squeeze*: smooth muscles around bronchioles tightens 2. *Snot*: increased mucus production 3. *Swell*: occurs inside bronchioles

Treatment of hypoglycemia

1. *Test gag reflex* 2. Administer 10-20g of carbohydrates 3. In severe case, IV dextrose or IM glucagon is administered

Ways to minimize medication errors

1. 2 patient identifiers *every time* 2. CPOE 3. SBAR 4. 6 rights of medication administration 5. Barcode scanning/electronic MAR 6. Avoid banned ebbreviations

Esomeprazole (Nexium)

1. A proton pump inhibitor 2. Irreversibly binds to ATPase enzyme 3. Inhibits the parietal cell H+/K+ ATP pump 4. Suppresses basal and gastric acid secretion

Epidural administration

1. A thin catheter is passed into the epidural space at L3-L4 2. Meds may infuse continuously or have intermittent doses

Biguanide side/adverse effects

1. Abdominal cramping 2. Diarrhea 3. Decreased Appetite 4. Decreased absorption of vitamin B12 and folate

Drug interactions that affect pharmacokinetics

1. Absorption 2. Distribution 3. Metabolism 4. Excretion

Drug interactions that affect pharmcodynamic interactions

1. Additive drug effect 2. Synergistic drug effect or potentiation 3. Antagonistic drug effect

Trimethoprim/Sulfamethoxazole patient teaching

1. Adequate hydration 2. Sunscreen due to sun sensitivity 3. Do not breastfeed 4. *D/c immediately* if signs of hypersensitivity 5. *Immediately* report adverse effects

Furosemide nursing implications

1. Administer slowly if IV (20mg/minute) 2. Monitor effectiveness of therapy 3. Caution with digoxin

Nitrofurantoin nursing implications

1. Administer with meals and plenty of water 2. Monitor effectiveness/ineffectiveness

Major risk factors for hyperlipidemia

1. Age 2. Family history 3. Current cigarette smoking 4. Hypertension 5. Low HDL 6. Diabetes mellitus

Risk factors for type 2 diabetes

1. Age > 45 2. Gestational diabetes 3. Overweight/obesity 4. Family history 5. Elevated cholesterol and/or triglycerides 6. Hypertension

Typical asthma exacerbation daily medications

1. Albuterol 2. Oral steroids

Pharmacological management of COPD Exacerbations:

1. Albuterol (SABAs) 2. Short-acting anticholinergic agents (lipatropium) 3. Systemic glucocorticoids (prednisone) 4. O2 supports (88-92% Osat)

Promethazine (Phenergan) safety concerns

1. Alcohol consumption 2. Driving 3. Other meds

Metronidazole indications

1. Amebias 2. Trichomoniasis (parasites) 3. Inflammatory bowel 4. Bacterial vaginosis 5. H pyloria

Peptic Ulcer Disease pharmacological agents

1. Antibiotics (H pylori) 2. Antisecretory agents 3. Mucosal protectants 4. Antacids

Premature atrial contraction (PAC) parameters

1. Any HR 2. *Typically* irregularly irregular 3. P waves inconsistent appearance 4. PR interval 0.12 - 0.2 5. QRS 0.06 - 0.1

Premature ventricular contraction (PVC) parameters

1. Any HR 2. *Typically* irregularly irregular 3. P-waves absent from the irregular beat 4. PR interval: unable to determine 5. QRS greater than 0.12

Indications for rivaroxaban

1. Arrhythmias 2. AMI 3. Known DVTs/PEs 4. Prophylaxis for DVT in joint replacement

Antihypertensive medications may affect:

1. Arteries/arterioles 2. Veins 3. Arterioles & veins

Additional Rights of Medication Administration

1. Assessment 2. Documentation 3. Education 4. Evaluation 5. Refusal

Azithromycin nursing implications

1. Assessment for organ dysfunction 2. Take with meals 3. Report inability to tolerate medicine 4. Aluminum taste 5. IV/PO/Opthalmic administration

Montelukast indications

1. Asthma 2. Allergic rhinitis 3. Exercise induced bronchospasim 4. Chronic urticaria (hives)

Prostaglandins E2 - Caution in patients with:

1. Asthma 2. HTN 3. 4. 5. 6. 7.

Metoprolol indications

1. Atrial dysrhythmias - A-fib - A-flutter - Atrial tachycardia 2. Ventricular dysrhythmias - PVCs - V-Tach

Lidocaine indications

1. Atrial dysrhythmias - A-fib - A-flutter - SVT 2. Ventricular dysrhythmias - PVCs - V-Tach - V-Fib

Amiodarone indications

1. Atrial dysrhythmias - A-fib - A-flutter - SVT 2. Ventricular dysrhythmias - V-tach - V-fib

Rocephine patient teaching

1. Avoid alcohol 2. Caution with antiplatelet medications

Metronidazole patient teaching

1. Avoid alcohol while taking and for two days afterwards 2. Dry mouth 3. May turn urine dark

Measures taken for those at risk for anaphylaxis must...

1. Avoid allergens 2. Medical alert bracelet 3. Skin testing 4. Awareness of precipitating environment 5. Epi pen

Management of allergic rhinitis

1. Avoid allergens 2. Pharmacotherapy

Nitrofurantoins kinetics

1. Becomes concentrated in the urine 2. Only used for UTIs since it does not achieve high concentration in tissues

Cholestyramine mechanism of action

1. Binds with bile salts in intestines 2. Bound bile acids and cholesterol are eliminated in the feces

H Pylori "quadruple therapy"

1. Bismuth 2. Metronidazole 3. Tetracycline 4. PPI

Heparin side/adverse effects

1. Bleeding 2. Hemorrhage 3. Epistaxis 4. GI Bleed 5. Hematuria 6. Hematemesis

Warfarin side/adverse effects

1. Bleeding 2. Hemorrhage 3. Epistaxis 4. GI bleed 5. Hematuria 6. Hematemesis

Diltiazem actions

1. Blocks slow calcium influx 2. Decreases contractility/HR 3. Decreases conduction velocity 4. Decreases automaticity 5. Prolongs repolarization, esp at AV node

Metoprolol side/adverse effects

1. Bradycardia 2. Bronchospasms 3. Hypotension

Pharmacological management of COPD includes:

1. Bronchodilators (β₂ agonist and/or anticholinergics) 2. ICSs

Contrindicated conditions for polyethylene glycol use

1. CHF 2. Renal failure

ADHD pharmacological treatments (from most to least effective)

1. CNS Stimulants (methylphenidate) 2. Strattera (atomoxetine) 3. Alpha Agonists (guanfacine) 4. Antidepressants (TCA's, bupropion)

Long term PPI use increases the risk of:

1. Cancer 2. Increased incidence of dementia 3. Electrolyte imbalances 4. Rebound reflux

Nursing implications for Lomotil (Diphenoxylate with Atropine)

1. Cause of diarrhea 2. Inform of adverse effects 3. Timeframe of administration

Choice of antidysrhythmic drugs is based on (3):

1. Cause of dysrythmia 2. Side effect profile 3. Other medical conditions

How to prevent IV-caused thrombophlebitis

1. Change IV sites 2. Dilute solution 3. Administer slowly

H pylori "triple therapy"

1. Clarithromycin 2. Amoxicillin or Metronidazole 3. PPI

Ranitidine (Zantac) actions

1. Competitive inhibition of H₂ receptors of the gastric parietal cells 2. Reduced gastric acid secretion, gastric volume, and hydrogen ion concentration is reduced 3. No effect on H₁ receptors

General antiobiotic use principles for pt teaching

1. Complete prescribed course 2. Notify of possible reactions 3. Minimize alcohol, sun exposure if indicated 4. Take with food/milk if indicated 5. Time of day (dosing) 6. Drug/food interactions 7. Prevent transmission of infection

Furosemide is predominately used for fluid removal secondary to...(3).

1. Congestive heart failure 2. Pulmonary edema 3. Ascites

Cholestyramine side/adverse effects

1. Constipation 2. Bloating/belching 3. Nausea 4. Esophageal obstruction (rare) 5. Esophageal irritation (rare)

Indications for docusate sodium (Colace)

1. Constipation 2. Prophylaxis against Valsalva 3. Ease of stool passage with hemorrhoids

Metronidazole mechanism of action

1. Converted into active form within the anaerobic cell 2. Inhibits protein synthesis

Furosemide labs to monitor

1. Creatinine 2. Potassium 3. Magnesium

Nitrofurantoin mechanism of action

1. Damages DNA and ribosomal proteins *Bacteriostatic in low concentrations **Bacteriocidal in high concentrations

Goals of diarrhea pharm agents

1. Decrease intestinal motility 2. Slow transit 3. Increased absorption time 4. Dependency and systemic effects do not occur

Metoprolol antidysrhythmic actions

1. Decreases conduction velocity 2. Decreases automaticity 3. Prolongs refractory period

Action of biguanide (Metformin)

1. Decreases production of glucose in the liver 2. Reduce glucose absorption in the gut 3. Sensitizes insulin receptors in target tissues

Atropine is primarily used for (2):

1. Decreasing salivary secretions preoperatively 2. Increasing heat rate when bradycardia is present

Torsades or V-fib interventions

1. Defibrillation 2. Epinephrine 3. Magnesium (Torsades)

Polyethylene glycol adverse effects

1. Dehydration 2. Magnesium and phosphorus accumulation 3. Sodium absorption/ fluid overload 4. Nausea/abdominal pain 5. Diarrhea

Steps of EKG interpretation

1. Determine HR 2. Determine heart rhythm 3. Look at the P-wave 4. Measure PR Interval 5. Measure QRS duration 6. Interpret rhythm

Possible effects of hepatic activity on drugs

1. Detoxification 2. First-pass effect 3. Activation/deactivation of drugs 4. Cytochrome P540

Hypotonic crystalloid solution indications

1. Diabetic ketoacidosis 2. Hyperosmolar Hyperglycemic Nonketotic Syndrome 3. To provide free water to promote excretion of body waste

Adverse effects of docusate sodium

1. Diarrhea 2. Abdominal cramping

Amiodarone action

1. Diminishes potassium movement during repolarization 2. Prolong refractory period 3. Decreases automaticity 4. Increases PR interval 5. Widens QRS complex (overall slowing of conduction)

Bismuth subsalicylate (Pepto-Bismol)

1. Disrupts cell wall of H. pylori & adherence 2. Contains salicylate 3. Produces harmless discoloration of tongue and feces

Spironolactone indications

1. Diuresis 2. Hypertension 3. Minimization of potassium loss 4. Hyperaldosteronism 5. PCOS 6. Acne 7. Hirsutism

Pharmacologic treatments of hypertension

1. Diuretics 2. RAAS inhibition 3. Beta Adrenergic Antagonists 4. Alpha drugs 5. Direct vasodilators 6. Calcium Channel Blockers 7. Nitrates

Gentamicin patient teaching

1. Do not skip or double dose 2. Avoid NSAIDS (increased nephrotoxicity)

Epidural common risks

1. Does not work or have "spotty" block 2. Hypotension (mild to severe)

Indications for ranitidine

1. Duodenal ulceration 2. Gastric ulceration 3. GERD 4. Aspiration pneumonitis 5. Multi-therapy for H. pylori

Mannitol adverse effects

1. Edema 2. Relative hypervolemia 3. Electrolyte imbalances

Penicillin anaphylaxis prevention

1. Education/avoidance 2. Skin testing 3. Desensitization

Warfarin food considerations

1. Efficacy impacted by vitamin K intake 2. Interacts with protein bound foods which effects INR

Side/adverse effects of furosemide

1. Electrolyte imbalances 2. Ototoxicity 3. Hyperuricemia 4. Hypotension 5. Volume depletion

Spironolactone nursing implications

1. Electrolyte management (hyperkalemia) 2. Monitor: vital signs + daily weight 3. Morning administration 4. Hypoaldosteronism

Gliptins actions

1. Enhances the actions of incretin hormones 2. Increases insulin production in response to meals 3. Decreases the amount of glucose produced by the liver 4. Administer with or without food

Causes of hypoglycemia

1. Excessive insulin 2. Decreased intake of food 3. Vomiting 4. Diarrhea 5. Decreased insulin absorption 6. Exercise 7. Labor

Promethazine (Phenergan) adverse effects

1. Extrapyramidal effects 2. Anticholinergic effects 3. Hypotension 4. Sedation/ respiratory depression

Hypertonic crystalloid solutions risks

1. Fluid volume overload 2. Pulmonary edema

Magnesium sulfate nursing implications

1. Frequent, vigorous vital sign assessment 2. Breath sounds Q 2 hours 3. SaO2 monitor 4. DTRs q 1-2 hours 5. EFM - continuous 6. Labs 7. Bed rest 8. I & Os every hour (assess for decreased UOP)

Rosuvastatin side/adverse effects

1. GI distress 2. Rhabdomyolysis

Side/adverse effects of gemfibrozil

1. GI related symptoms 2. Cholelithiasis 3. Elevated INR with warfarin

Nitrofurantoin adverse effects

1. GI upset (take with meals) 2. Hemolytic reactions 3. Peripheral neuropathy 4. Urine color turns orange/brown

Indications for Esomeprazole

1. Gastric/duodenal ulcers 2. Erosive esophagitis 3. GERD 4. Stress ulcer prophylaxis

Ophthalmic prophylaxis protects against:

1. Gonorrhea 2. Chlamydia

Fasting lipid panel measures...

1. HDL and total cholesterol 2. Triglycerides 3. LDL

Parameters of a normal sinus rhythm

1. HR 60-100 2. Regular 3. P-waves present & consistent 4. PR interval 0.12 - 0.2 s 5. QRS 0.06 - 0.1 s

Atrial fibrillations parameters

1. HR < 100 (or with RVR) 2. Irregularly irregular 3. P waves absent, fibrillation waves 4. PR interval: unable to measure 5. QRS: 0.06-0.1

Atrial flutter parameters

1. HR < 100 (or with RVR) 2. Irregularly irregular 3. P waves absent, flutter waves 4. PR interval: unable to measure 5. QRS: 0.06 - 0.1

Parameters of sinus bradycardia

1. HR < 60 2. Regular 3. P-waves present & consistent 4. PR interval 0.12 - 0.2 s 5. QRS 0.06 - 0.1 s

Parameters of sinus tachycardia

1. HR > 100 2. Regular 3. P-waves present & consistent 4. PR interval 0.12 - 0.2 s 5. QRS 0.06 - 0.1 s

Ventricular tachycardia parameters

1. HR > 150 2. Regular 3. No P-waves 4. No PR interval 5. QRS > 0.12

Atrial paced EKG characteristics

1. HR may be variable 2. Regular 3. Presence of pacer spike *before* P-wave 4. PR: 0.12- 0.2 5. QRS: 0.06 - 0.1

Atrioventricular paced EKG characteristics

1. HR typically fixed 2. Regular 3. P-wave following pacer spike 4. PR typically > 0.2 5. QRS greater than 0.12

Ventricular paced EKG characteristics

1. HR typically fixed (may be variable) 2. Regular 3. P-wave may or may not be absent 4. PR absent or greater than 0.2 5. QRS greater than 0.12 with abnormal T-wave

Do not administer Trimethoprim/Sulfamethoxazole to patients who...(5)

1. Have allergies to sulfa 2. Hypersensitivity 3. Liver cirrhosis 4. Are pregnant/breastfeeding 5. Are infants <2 months

Intermediate symptoms of hypoglycemia

1. Headache 2. Confusion 3. Drowsiness 4. Fatigue

Salmeterol side/adverse effects

1. Headache 2. Thoat irritation 3. Pain 4. Hypertension 5. Edema 6. Anxiety 7. Change in BP 8. Angina, arrhythmias 9. Hypokalemia 10. Hyperglycemia

Pioglitazone side/adverse effects

1. Headache 2. Weight gain 3. Fluid retention 4. May be hepatotoxic 5. May worsen heart failure

Digoxin indications

1. Heart failure 2. Atrial arrhythmias (A-fib; A-flutter)

Biguanide is contraindicated in patients with...(3)

1. Heart failure 2. Renal disease *or* 3. Are acutely ill

Trimethoprim/Sulfamethoxazole kinetics

1. Hepatic metabolism 2. Excreted in urine as combo of metabolites and unchanged drug

Levofloxacin kinetics

1. High tissue concentrations 2. Kidneys, gallbladder, liver, lungs, gynecological tissue, and prostatic tissue 3. Excreted in urine and feces

Metronidazole kinetics

1. Highly absorbed 2. Widely distributed 3. Metabolized in liver 4. Excreted in urine and feces

SSRIs pharmacokinetics

1. Highly protein bound 2. Extensive hepatic metabolism with resulting active metabolites 3. Prolonged half-life = steady-state plasma levels in about 4 weeks

Colloid solution examples

1. Hydroxethyl Starch 6% 2. Albumin 5% or 25%

Spironolactone side/adverse effects

1. Hyperkalemia (monitor K+, Mg+, and creatinine) 2. Gynecomastia 3. Menstrual irregularities

Trimethoprim/Sulfamethoxazole adverse effects

1. Hypersensitivity 2. Hematologic effects 3. Nausea/vomiting 4. Rash

Adverse effects of Rocephine

1. Hypersensitivity 2. Thrombophlebitis

Indications of antihypertensive medication

1. Hypertension 2. Angina pectoris 3. Hear failure 4. Myocardial infarction

Indications for diuretic therapy

1. Hypertension 2. Decrease total body fluid volume 3. Electrolyte management 4. Decrease intercranial pressure (ICP)

Hydrochlorothiazide indications

1. Hypertension 2. Peripheral edema secondary to HTN management

Insulin contraindications

1. Hypoglycemia 2. Documented hypersensitivity

Adverse/side effects of insulins

1. Hypoglycemia 2. Hypokalemia 3. Hunger

Glipizide adverse reactions

1. Hypoglycemia 2. Tachycardia 3. Seizures 4. Coma 5. Respiratory depression

Gliptins side/adverse effects

1. Hypoglycemia if used in conjunction with a Sulfonylurea 2. Rarely: pancreatitis and hypersensitivity reactions

Exenatide side/adverse effects

1. Hypoglycemia when combined with a sulfonylurea 2. Diarrhea, nausea, committing 3. Risk for pancreatitis 4. Renal impairment

Lidocaine side/adverse effects

1. Hypotension 2. Bradycardia 3. Arrhythmias 4. Cardiac arrest

Magnesium sulfate serious fetal/neonatal side effects

1. Hypotonia 2. Lethargy 3. Hypocalcemia

Colloid solution indications

1. Hypovolemia 2. Hypovolemic shock

Types of allergic reactions to penicillins/cephalosporins

1. Immediate (2-30m) 2. Accelerated (1-72 hours) 3. Late (days or weeks)

Actions of Mannitol

1. Increases osmolality of blood 2. Increases kidney perfusion

With each increased generation of cephalosporins...(4)

1. Increasing activity again gram- and anaerobes 2. Decreased gram+ 3. Increased resistance to beta-lactamases 4. Increased cost

Asthma exacerbations result from exposure to triggers and result in (3):

1. Inflammation of the airways 2. Hyperresponsiveness of bronchi 3. Bronchospasm

Antibiotics can work by... (5)

1. Inhibiting cell wall synthesis 2. Increasing membrane permeability 3. Inhibiting protein synthesis 4. Inhibiting folic acid metabolism 5. Inhibiting RNA/DNA synthesis

Action of -statins.

1. Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase 2. Reduces cholesterol synthesis and LDL

Niacin mechanism of action:

1. Inhibits release of free fatty acids 2. Increased lipoprotein lipase activity

Complications if vitamin K not received

1. Intracranial hemorrhage 2. Intrabdominal hemorrhage 3. Overt bleeding 4. Bruising/pallor 5. Lethargy 6. Poor feeding and vomiting

Steps to assessing the P-wave

1. Is it present? 2. Does it occur regularly? 3. Is there a P-wave with each QRS

Epidural side effects

1. Itching & nausea 2. Urinary retention 3. Longer labor 4. Increased risk of oxytocin use 5. Longer second stage of labor (pushing) 6. Increased forceps or vacuum assisted delivery 7. Does not correlate with increased rate of Cesarean delivery

Significant interactions/contraindications for heparin

1. Known bleeding disorder, recent hemorrhagic stroke 2. Use cautiously in renal impairment, elderly patients 3. Contraindicated in: pregnancy, HITT, hemophilia, thrombocytopenia, purpura, severe HTN, intracranial hemorrhage

Salmeterol black box warnings

1. LABAs should never be used as monotherapy 2. LABAs should never be used for the treatment of acute symptoms 3. Increased risk of asthma-related deaths and paradoxical bronchospasms

Anaphylaxis symptoms

1. Laryngeal edema 2. Bronchoconstriction 3. Severe hypotension

Organs likely to experience amiodarone toxicity

1. Liver 2. Thyroid 3. Lungs 4. Skin 5. Eyes 6. Heart (Bradycardia)

*Do not* administer hypotonic solutions in cases of...(3)

1. Liver disease 2. Shock 3. Burns (Risk of depleted intravascular volume)

First-line lifestyle modifications for treating hyperlipidemia

1. Low-cholesterol/low fat diet 2. Exercise 3. Reduce smoking

Vancomycin indications

1. MRSA 2. Antibiotic-associated pseudomembranous colitis 3. Broad gram+ coverage

Forms of inhaled medications

1. Metered-dose inhaler 2. Dry Powder Inhaler (DPI) 3. Nebulizer

There are essentially two ADHD CNS stimulants:

1. Methylphenidate 2. Amphetamine

Heparin nursing implications

1. Monitor for bleeding, adverse reactions, safety, fall-risk 2. Frequent lab draws 3. Reversed with protamine and discontinuation of heparin

Advantages of second generation sulfonylureas (eg., Glipizide) over first generation.

1. More potent 2. Convenient dosing

Sucralfate (Carafate)

1. Mucosal protectant 2. Coats stomach lining

Magnesium sulfate serious *maternal* adverse effects

1. Muscle weakness 2. Loss of DTRs 3. Pulmonary edema 4. Respiratory arrest 5. Ileus 6. Hypocalcemia 7. Cardiac arrest

Indomethacin maternal adverse effects

1. N/v 2. Dizziness 3. Skin rash 4. Decreased renal blood flow 5. Postpartum hemorrhage

Nitrous oxide maternal adverse effects

1. N/v in 5-36% of women 2. Vertigo 3. Dysphoria, anxiety, restlessness 4. Does not help pain

Tiotropium should be used with caution in patients with...

1. Narrow-angle glaucoma 2. Bladder neck obstruction and BPH

Effects of β Adrenergic Blockers

1. Negative inotrope & chronotrope 2. Decrease vascular resistance 3. No reflexive tachycardia

Mannitol nursing implications

1. Neuro assessment monitoring 2. Signs of hypervolemia 3. Monitor total body fluid volume status 4. Urinary output 5. Medication crystallizing in bottle

Ventricular fibrillation parameters

1. No discernable HR 2. Irregular 3. No P-waves 4. No PR interval 5. No QRS complexes

Blood component transfusion tubing

1. No ports 2. Y-set 3. 170 micron filter

Treatment of ketoacidosis

1. Normalization of potassium and glucose 2. Replacement of fluid and sodium 3. Insulin bolus

Common newborn pharmacological treatments

1. Ophthalmic prophylaxis 2. Initiation of clotting cascade 3. Hepatitis infection prevention

Postpartum pharmacological pain control options

1. Opiods 2. NSAIDs 3. Epidural

Fluticasone side/adverse effects

1. Oral candidiasis (thrush) 2. (rarer) Rhinitis, upper respiratory infection, pharyngitis

Gentamicin adverse effects

1. Ototoxicity 2. Nephrotoxicity 3. Vertigo 4. Ataxia 5. Rash

Vancomycin adverse effects

1. Ototoxicity (*STOP IMMEDIATELY*) 2. Red Man Syndrome/Exfoliative Dermatitis 3. Thrombophlebitis 4. Thrombocytopenia 5. Superinfections

Treatment for C diff

1. PO Vancomycin 2. And/or Metronidazole 3. Fluid replacement 4. Fecal transplantation

SABA side/adverse effects

1. Palpitations 2. Headahce 3. Insomnia 4. Tachycardia 5. Tremors 6. Anxiety 7. Paradoxical brochospasm 8. Hyperactivity (in children)

Rights of Medication Administration

1. Patient 2. Medication 3. Time 4. Dose 5. Indication (if ordered PRN)

Medication Orders must include

1. Patient's name 2. Date/time of order 3. Medication name 4. Dosage of medication 5. Route of administration 6. Time/frequency 7. Parameters/indications 8. Signature of person ordering medication

Adverse effects of Ranitidine

1. Pneumonia 2. Antiandrogenic effects (breast swelling) 3. CNS depression (very rare) 4. Suppression of leukocytes and T-lymphocytes

Adverse effects of antihypertensive medications

1. Postural (orthostatic) hypotension 2. Reflex tachycardia 3. Peripheral edema 4. Sexual dysfunction

Typical adverse effects of antihypertensive medications

1. Postural (orthostatic) hypotension 2. Reflex tachycardia 3. Peripheral edema 4. Sexual dysfunction

Spironolactone cautions

1. Potassium supplements 2. ACE inhibitors (can increase K+) 3. High potassium foods

Warfarin contraindications

1. Pregnanyc 2. Hemophilia 3. Thrombocytopenia

Sulfonylureas (Glipizide) actions

1. Promote insulin release 2. Increase sensitivity of insulin receptors on target cells

Purposes of the 'Comprehensive Drug Abuse Prevention and Control Act of 1970'

1. Promotion of drug education and research into the prevention and treatment of drug dependency 2. Strengthening of enforcement authority 3. Establishment of treatment and rehabilitation facilities 4. Designation of schedules for controlled substances

Vitamin K for newborns rational

1. Protects from bleeding caused by vitamin K deficiency 2. Essential component in clotting cascade 3. Made by bacteria in the intestine but newborn gut is sterile

Torsades or V-fib presentation

1. Pulseless 2. Lifelesss 3. Pale 4. Cyanotic

Azithromycin adverse effects

1. QT prolongation/sudden cardiac death 2. Thrombophlebitis 3. GI upset (more so with erythromycin)

Factors that affect drug absorption

1. Rate of dissolution 2. Surface area exposure 3. Drug solubility 4. pH of environment and substance 5. Molecular size 6. Interactions with food/other drugs 7. Blood flow/health status/age

Clopidogrel indications

1. Recent AMI, drug-eluting stents s/p AMI 2. CVA

The decision process for antibiotic selection

1. Recognize signs of infection 2. Investigate the possible source of infection 3. Determine the causative pathogen(s) 4. Select the most appropriate class of antibiotic ($$) 5. Select the most appropriate route of administration

Red Man Syndrome (Exfoliative Dermatitis)

1. Redness of face/whole body 2. NOT AN ALLERGIC RESPONSE 3. Nonspecific mast cell degranulation 4. Entirely rate dependent: infuse medication slowly 5. Antihistamines

Niacin actions:

1. Reduces VLDL and LDL 2. Reduces triglycerides

Gemfibrozil actions

1. Reduces VLDL and triglycerides 2. Inhibits: - breakdown of stored fats - Uptake of free fatty acids - Hepatic production of triglycerides

Fluticasone mechanism of action

1. Reduces the number of circulating T lymphocytes and inhibits T-lymphocyte activation 2. Inhibits the production of IL-2 & IL-4 3. Reduces circulating numbers of eosinophils 4. Reduce seasonally induced increases in nasal mast cells and histamine level

Stimulation of ß₂-receptors causes...(4)

1. Relaxation of smooth muscles of the lungs 2. A decrease in gastrointestinal tone and motility 3. Activation of glycogenolysis in the liver and increased blood glucose 4. Relation of the uterine muscle, resulting in a decrease in uterine contraction

Gentamicin nursing implications

1. Renal impairment (monitor renal functions and serum labs) 2. Pre-existing hearing impairment 3. Concurrent ototoxic and/or nephrotoxic 4. Close attention to peak and trough levels

Indications for use of penicillins

1. Respiratory infections 2. UTIs 3. Otitis media 4. Sinusitis 5. Dental infections

Rosuvastatin should be discontinued if the patient experiences:

1. Rhabdomyolysis 2. Unexplained muscle pain/weakness 3. Fatigue 4. Fever

Outcomes of severe hypoglycemia

1. Seizure 2. Coma 3. Death

Pharmacologic antiemetic options

1. Serotonin antagonist (eg, Zofran) 2. Dopamine antagonist (eg, Phenergan) 3. Anticholinergics 4. Cannabinoids 5. Benzodiazepines

Hypertonic crystalloid solution indications

1. Severe hyponatremia 2. To decrease ICP with cerebral edema

Niacin side/adverse effects

1. Skin flushing and itching 2. Gastrointestinal intolerance 3. Myalgias

Exenatide actions

1. Slows gastric emptying 2. Stimulates glucose-dependent release of insulin 3. Prohibits prostprandial release of glucagon 4. Suppresses appetite

Non-pharmacologic nursing interventions for COPD include education about:

1. Smoking cessation 2. Reduction of other risk factors 3. Vaccinations

Thiazide (and Thiazide-like diuretics) *promote* the excretion of...(3)

1. Sodium 2. Chloride 3. Water ***remember this

Cervical ripening definition

1. Softening and effacement of the cervix 2. Rearrangement of collagen, elastin, and smooth muscle cells

COCs are differentiated based on...

1. Strength of the estrogen component 2. Type of progestin used 3. Whether E or P activity predominate

Non-pharmacologic treatments of hypertension

1. Stress reduction 2. Exercise 3. Salt restriction 4. Nicotine reduction

Lidocaine action

1. Suppresses automaticity 2. Decreases likelihood of ectopy 3. Prolongs QT interval

Valproic acid (Depakote) MOA

1. Supresses sodium channels 2. Supresses calcium influx 3. Increases GABA effects 4. May inhibit glutamate/NMDA receptor-mediated neuronal excitation

Prophylactic antibiotic uses

1. Surgery 2. Bacterial endocarditis 3. Neutropenia

Conditions that often necessitate use of insulin in type 2 diabetics

1. Surgery 2. Pregnancy (oral drugs cannot be used) 3. Renal disease

Ventricular tachycardia presentation

1. Syncopal 2. Chest pain 3. Palpitations 4. Dizzy 5. Pulseless

Initial symptoms of hypoglycemia

1. Tachycardia 2. Palpitations 3. Sweating 4. Nervousness

Amiodarone patient education

1. Take with food 2. Photosensitivity 3. Photophobia 4. Regular eye exams 5. Notify provider of dyspnea/cough

Signs of a transfusion reaction

1. Temperature change 2. HR change 3. BP change 4. New onset pain 5. Chills 6. Sweats

Adverse effects of Levofloxacin

1. Tendon rupture (d/c) 2. Nausea/vomiting/diarrhea 3. Photosensitivity 4. Candida infection

Asthma non-pharmacologic interventions

1. Trigger avoidance 2. Lifestyle (obesity + smoking)

Trimethoprim/Sulfamethoxazole mechanism of action

1. Trimethoprim suppresses synthesis of tetrahydrofolic acid 2. Sulfamethoxazole disrupts synthesis of tetrahydrofolic acid ***bacteriostatic

Biguanide uses

1. Type 2 diabetes 2. Obesity 3. PCOS

Routes of drug excretion

1. Urine 2. Bile 3. Sweat 4. Saliva 5. Breast milk 6. Expired air

SABA use that indicates poor asthma control.

1. Use of SABAs >2 days/week 2. Increasing Use *or* 3. Use of more than one canister per month

Indomethacin neonatal adverse effects

1. Ventricular hypertrophy 2. Premature closure of ductus arteriosus 3. Oligohydramnios

Glipizide side effects

1. Weight gain 2. Hypersensitivity reactions 3. Diarrhea 4. Flushing, palpitations, nausea

If an adverse reaction occurs, what factors needs to be evaluated?

1. Who witnessed 2. To what 3. When was reaction 4. Localized or systemic 5. Presentation 6. Severity 7. Associated symptoms

Opioid caution/contraindications

1. liver diseases 2. L & D, pregnancy 3. Prostatic hypertrophy 4. Hypotension 5. Head trauma

PCA Teaching

1. push button as soon as pain is perceived 2. push button before activity or painful procedure 3. It is better to push at onset than waiting for worsening severity 4. Do *NOT* allow others to push button for the patient 5. Do not push button if not in pain

OTC medication concerns

1. unclear ingredients 2. self-diagnosis & treatment 3. overdose risk 4. risk of drug-drug interactions

Bethanachol chloride signs of concern

1. wheezing 2. hypotension 3. peptic ulcer 4. severe bradycardia

Lithium intoxication level

1.5-1.9 mEq/L

Rivaroxaban half-life

10 hours

Nifedipine dose

10-20 mg PO every 4-6h

U-100 insulin contains...

100 units/mL.

Bioavailability of an IV administered drug.

100%

ADA average bedtime glucose goal

100-140

Second dose of adenosine if first dose not work

12 mg

Average filtration rate of the kidneys

125 mL/minute

Luteal phase days

14-28

Meglitinides must be taken ______ before meals.

15-30 minutes.

(BG-100)/10 = # units insulin A patient's blood sugar is 250. How many units of insulin do you administer?

15.

EKG: There are ______ small boxes in a 1 minute span.

1500

The age of legal medical competence in the US

16

Humulin N duration of action

18-24 hours

Fentanyl dosing compared to morphine

1mg fentanyl = 100 mg morphine

Diphenydramine is a...

1st generation H1-antagonist.

Minimum fasting period for clear liquids

2 hours

Naloxone onset

2-18 min depending on route (possibly faster)

Lantus onset of action

2-4 hours

Humulin R peak action

2.5-5 hours

Typical morphine (IV/IM/SQ) dose range

2.5-5 mg

Gestation age that would indicate tocolytic use

20-34 weeks

Tocolytics are most often used at EGA ________

20-34 weeks

Normal adult fluid intake

2300-2900 mL/day

Lantus duration of action

24 hours

Extended COCs

24-26 days of active pills instead of just 21

Olseltamivir (Neuraminidase Inhibitor) must be started within ______ of flu symptom onset to be effective.

24-48h

Typical fentanyl (IV/IM/transdermal/PO) dose range

25-50 mcg

Cetirizine is a...

2nd generation H1-antagonist.

Half-life of minipress

3 hours (quick)

Skyla duration

3 years

Lispro duration of action

3-4 hours

It may take ___________ to achieve desired effect of Pioglitazone.

3-4 months

Unused blood products must be returned to blood bank within ____________ of arriving on the floor.

30 minutes

Lispro peak action

30 minutes - 1 hour

When do you measure peak levels of an IV drug?

30 minutes after administration

Stimulants are not tolerated in up to ___% of patients.

30%

Allergic rhinitis affects ____% of adults and ____% of children in the US.

30%; 40%

Digoxin half-life

30-40 h

Alteplase (tPA) half life

30-45 minutes

Humulin R onset of action

30-60 minutes

EKG: There are _____ large boxes in a 1 minute span.

300

Indomethacin is only given prior to _____ weeks EGA.

32

Warfarin (Coumadine) half-life

36 hours (protein bound)

Minimum fasting period for breast milk

4 hours

Packed red blood cells must be infused within...

4 hours.

Humulin N peak action

4-12 hours

Goal range of magnesium sulfate as tocolytic agent

4-7.5 mg/dL

Humulin R duration of action

4-8 hours

The peak effect of Tiotropium may take _______________.

4-8 weeks

___% of those with type 2 diabetes are treated with insulin.

40%

Amiodarone half-life

40-60 days

Kyleena duration

5 years

Liletta duration

5 years

Mirena duration

5 years

Lispro onset of action

5-15 minutes

Hypoglycemia occurs when blood glucose is < ________.

50 mg/dL

Cytomegalovirus affects ____% of Americans 40y and older.

50-85%

U-500 insulin contains...

500 units/mL.

Minimum fasting period for infant formula

6 hours

Minimum fasting period for light meal

6 hours

Minimum fasting period for non-human milk

6 hours

First dose of adenosine

6 mg

The flu vaccine can be administered after age ___.

6 months

Heparin PTT therapeutic range

60-100

Humulin N onset of action

60-120 minutes

ND-NMB onsent

60-90 seconds

Clopidogrel half-life

8 hours

Methadone half life

8-59 hours

ADA average fasting glucose goal

80-120

Chance of drug-drug interactions is ~___% when taking 5 drugs.

90

Average reabsorption (%) of water/electrolytes/nutrients in the kidneys

99%

ADA BP goal

< 130/80

ADA triglycerides goal

< 150

ADA cholesterol goal

< 200

ADA Hgb A1c goal

< 7

Adenosine half-life

<10 seconds

Tachysystole

> 5 uterine contractions in 10 minutes (averaged over a 30 minute period)

Diphenoxylate with Atropine (Lomotil) actions

> Acts on circular and longitudinal intestinal muscles > Inhibits peristalsis and prolongs transit time > Suppresses fluid secretion into intestines

Indications for sulcralfate

> Acute and maintance therapy > Gastric and duodenal ulcers

Doxycycline mechanism of action

> Binds to 30S and 50S ribosomal subunits > Inhibits protein synthesis > bactericidal

Adverse effects of sucralfate

> Constipation > Minimal adverse effects or interactions

Indications for diphenoxylate with atropine (Lomotil)

> Diarrhea associated with inflammatory bowel disease > Relief of acute nonspecific diarrhea > Reduce volume of ileostomy discharge

Adverse effects of ondansetron (Zofran)

> Headache > QT interval prolongation > Increased risk for C-diff > Constipation

Polyethylene glycol (Miralax/GoLYTELY) indications

> Laxative > Bowel evacuation

Hypersensitivity reaction to Rocephine

> Maculopapular drug rash > Penicillins allergy - 10% cross-reactivity

Risk factors for C difficile

> Multiple antibiotic use

Polyethylene glycol

> Osmotic laxative > Poorly absorbed salts > Increases fecal mass - stretches intestinal wall - stimulates peristalsis

Administration of esomeprazole

> PO/IV > Do not crush > AM dosing

Levofloxacin indications

> Pneumonia > UTI (no longer responding well) > soft tissue infection

Ondansetron (Zofran) actions

> Selective 5-HT3-receptor antagonist > Blocks serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone

Psyllium (Metamucil)

> a bulk-forming laxative > similar to dietary fiber > nondigestible and forms a viscous solution/gel in water > good for diarrhea *and* constipation

Levofloxacin (Levaquin) antibiotic class

> a fluoroquinolone antibiotic

Bisacodyl (Dulcolax)

> a stimulant laxative > increase water and electrolyte contents of intestinal lumen > episodic, *not regular*

Doxycycline kinetics

> almost complete oral absorption > hepatic and renal excretion as active drug

Promethazine (Phenergan)

> antiemetic > blocks postynaptic mesolimbic dopaminergic receptors in the brain

Patient-controlled analgesia

> bolus dose when patient presses button

Adverse effects of nifedipine

> bradycardia > peripheral edema > constipation > dizziness/headache

Augmentin

> broad spectrum penicillin > used due to resistance to penicillin VK > contains a beta-lactamase inhibitor

Indications for psyllium

> constipation > diverticulosis > irritable bowel disease

Nursing implications of nifedipine

> evaluate effectiveness > evaluate tolerance > *is effective* in African Americans and older adults

Bisacodyl adverse effects

> gastric irritation if crushed or chewed > take on empty stomach so dissolution is not accelerated > proctitis with chronic use

Indications for opioids

> labor & delivery > post-operative > MI > cancer > hemolytic crisis

Symptoms of bowel obstruction

> lack of bowel sounds > pain > nausea > vomitting

Penicillins and allergic reactions

> must have had prior exposure > usually manifests as a rash (most common) > anaphylaxis > cross sensitivity to Cephalosporins 5-10%

Adverse effects of psyllium

> non-absorbable > reactions rare > *bowel obstruction*

Indications for bisacodyl

> opioid-induced constipation > slow intestinal transit constipation > suppositories

Indications for aluminum hydroxide

> peptic ulcer disease > minimize aspiration pneumonitis > GERD

Antibiotic associated pseudomembranous colitis

> potentially fatal superinfection caused by Clostridium difficile > profuse diarrhea, abdominal pain, fever, and leukocytosis > stools appears watery, mucoid, and bloody

Pharm agents to increase stool transit/facilitate evacuation

> stimulant laxatives > osmotic laxatives

Peni*cillin*s mechanism of action

> targets penicillin binding proteins > inhibits bacterial wall synthesis > inhibits transpeptidase > activates autolysins

Atropine

A classic anticholinergic (muscarine antagonist) drug

Ortho-evra transdermal patch

A combined contraceptive delivered through a topical patch

What is the danger of using Metaprolol in patients with diabetes?

A drop in blood sugar is normally accompanied by a sympathetic response. This response is blunted by Metaprolol.

What is usually administered before an epidural is placed?

A fluid bolus to combat an expected drop in blood pressure

Vancomycin action

A glycopeptide antibiotic that: - binds precursors for cell wall biosynthesis - inhibits bacterial cell wall synthesis

Diabetic Ketoacidosis (DKA)

A life threatening complication of severe insulin deficiency characterized by severe hyperglycemia, water loss, hypokalemia, and altered fat metabolism (production of ketones)

Beers criteria

A list of medications that are generally considered inappropriate when given to elderly people

Why is atropine used in palliative care?

A low dose is used to alleviate secretions and ease breathing.

Azithromycin actions

A microlide antibiotic that: - binds to the 50S ribosomal subunit - blocks addition of new amino acids to peptide chain - bactericidal

Docusate sodium (Colace)

A surfactant laxative/stool-softener > works by lowering surface tension >facilitates penetration of water into feces

Prinzmetal angina

A variant of angina pectoris that occurs at rest

Primary prevention of dyslipidemia includes which of the following? (Select all that apply) A. Diet changes B. Exercise C. Stop smoking D. Brushing with a soft toothbrush

A, B, and C

Which of the following medications would be of most concern in a patient receiving insulin?: A. Beta Blocker B. Ace Inhibitor C. Calcium Channel Blockers D. OTC vitamins

A. Beta Blocker (masks s/s of hypoglycemia)

Which of the following is an important education topic for insulin pump use?: A. Signs and symptoms of skin infection B. Don sterile gloves prior to insertion of the needle C. Change the infusion set every week D. You will only receive insulin when your blood glucose rises

A. S/s of skin infection

Use of inhaled corticosteroid (eg., fluticasone) has the risk of which of the following?: A. Yeast infection B. Adrenal activation C. Hypoglycemia D. Tremors

A. Yeast infection (thrush)

Antihypertensive drugs with a risk of angioedema

ACE inhibitors (-prils) ARBs (-sartans)

What procedures must be completed before administering thrombolytics?

ALL procedures (intubation, catheterization, IV start, etc)

Dextromethorphan mechanism of action

Acts centrally on the "cough center" in brain to elevate threshold for coughing

Albuterol mechanism of action

Acts on β₂-receptors inducing bronchodilation via relaxation of the smooth muscle

Betamethasone recommended use

Administered to pregnant women at 23-24 weeks EGA, at risk for preterm delivery within 7 days

ACE inhibitors are rarely used in what population?

African American

Oxytocin to treat postpartum hemorrhage is administered at what point?

After the placenta has been delivered

What drug is the first-line treatment of *acute respiratory symptoms* and prevention of EIB

Albuterol

What medication should be given first for an acute asthma exacerbation?

Albuterol (a SABA)

Acamprosate indication

Alcohol dependence: Reduces the rate of patients returning to drinking

Naltexone indication

Alcoholism; Opioid addiction

Disulfiram classification

Aldehyde dehydrogenase inhibitor

Which of the following comorbid conditions would be of concern with an order from a provider for "bowel care of choice"? A. Renal failure B. Hypertension C. CHF D. Renal insufficiency

All of the above

Patients should not be on a PPI for an extended period of time due to the risk of which of the following? A. Cancer B. Increased incidence of dementia C. Electrolyte imbalances D. Rebound Reflux

All of the above.

Hepatitis B immunization primary contraindications

Allergic to baker's yeast (used in vaccine formula)

IV narcotics for l&d pain: SAFETY consideration

Always have *Narcan* maternal and neonatal dosages on hand

Zolpidem brand name

Ambien

Main drug for systemic mycoses

Amphotericin B (terrible)

RhoGAM postpartum use

An Rh- mom with an Rh+ baby

Rh isoimmunization

An immune response that can occur when an Rh- person is pregnant with a Rh+ baby

What kind of bacteria does metronidazole target?

Anaerobic

Aspirin drug class

Anti-platelet

Heparin classification

Anticoagulant: Indirect Thrombin Inhibitor

Antidepressant black box warning

Antidepressant increase risk of suicidal thinking and suicidality in children and adolescents with major depressive disorder and other psychiatric disorders.

Treatment for ventricular tachycardia *if a pulse is present*

Antidysrhythmics

Medication Error

Any *preventable* event that may cause or lead to inappropriate medication use or *harm* to a patient

Drug

Any chemical that can affect a living process

Opioid

Any drug with actions similar to morphine

Cromolyn indication

Asmtha: long term control or EIB

FTM

Assigned female at birth, identify as male or more masculine

MTF

Assigned male at birth, identify as female or more feminine

Dextromethorphan is contraindicated in patients with what condition?

Asthma

With which disease process would a caution exist for administration of Class II antidysrhythmics? A. Seizures B. Asthma C. Hypertension D. Osteoporosis

Asthma (B-blockers can cause bronchospasms)

Go-to benzo for active seizure

Ativan

Category X Drug Interactions

Avoid combination

Drug interaction category X

Avoid combination

Drug interaction: Category X

Avoid combination

MAOI food considerations

Avoid foods high in tyramine (MAO metabolizes tyramine)

Antibiotic that can be administered opthamalically

Azithromycin

Antibiotic that can cause QT prolongation/sudden cardiac death

Azithromycin

Antibiotic that can cause QT-prolongation and sudden cardiac arrest

Azithromycin

Antibiotic that can produce an aluminum taste

Azithromycin

Three antibiotics that target the ribosome

Azithromycin, doxycycline, and nitrofurantoin

Bile acid sequestrants act like which of the following medications?: A. Colace B. Psyllium C. Morphine D. Fentanyl

B. Psyllium

Myalgia would be most concerning with which of the following medications?: A. Niacin B. Rosuvastatin C. Benadryl D. Amiodarone

B. Rosuvastatin (could be a sign of rhabdomyolysis)

Lab that shows extent of heart failure

BNP

_____ and _____ should be monitored when on guanfacine.

BP; pulse

Retrograde ejaculatory dysfunction

Backward passage of semen into the bladder -- Not harmful -- Associated infertility

High failure rates contraceptive methods

Barrier methods: -- Cervical cap -- Diaphram -- Periodic abstinence -- Condoms & spermicides

Oral diabetic medications that do not pose a risk of hypoglycemia

Biguanide, Pioglitiazone

Benzodiazepines mechanism

Binds to GABA receptors to enhance actions of GABA

Oxytocin (Pitocin) MOA

Binds to myometrial (uterine) oxytocin binding sites to increase myometrial activity (contractions)

Nicotine MOA

Binds to nicotinic-cholinergic receptors at the autonomic ganglia, in the adrenal medulla, neuromuscular junctions, and the brain

Opioids MOA

Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain

Elderly patient's often use/abuse which laxative?

Bisacodyl (Dulcolax)

Stimulant laxative

Bisacodyl (Dulcolax)

1st Generation Antipsychotics MOA

Block D2 receptors sites in mesolimbic pathway (reduces *postive* symptoms)

Meglitinides mechanism of actions

Blocks ATP-sensitive potassium channels of pancreatic beta cells thereby facilitating calcium influx that leads to insulin release

Non-depolarizing (competitive) neuromuscular blockers MOA

Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Naltrexone MOA

Blocks mu-opioid receptor

Indomethacin mechanism of actions

Blocks production of prostaglandins leading to smooth muscle relaxation

Why is is cancer a concern with hydrochlorothiazide use?

Both can increase calcium levels.

Why is diabetes a concern with Hydrochlorothiazide use?

Both increase the risk for hyperglycemia

Major atropine indication

Bradycardia

Cromolyn nursing concern

Bronchospasm

Cholelithiasis

Buildup in the gallbladder (a side effect of gemfibrozil)

With what condition should you *NOT* inhibit diarrhea?

C difficile infection

Glipizide is pregnancy category __

C.

The HH nurse is visiting a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care? A. Ask the client why he started taking illegal drugs. B. Ask the client how long he thought that he could take drugs without someone finding out. C. Ask the client about the amount of drug use and its effect D. Not ask any questions for fear that the client is in denial and would quickly terminate the visit.

C. Ask the client about the amount of drug use and its effect

Which of the following drugs would be the most beneficial to a client experiencing wheezing?: A. Glucocorticoids B. Anticholinergics C. Beta-2 adrenergic agonists D. Leukotrine modifiers

C. Beta-2 adrenergic agonists

CAGE

C: Have you ever felt the need to CUT DOWN on your drinking/drug use? A: Have you have been ANNOYED at criticism of your drinking/drug use? G: Have you ever felt GUILTY about something that you have done when you have been drinking or taking drugs? E: Have you ever had an EYE OPENER - drinking or taking drugs first thing in the morning to get going to avoid withdrawal symptoms?

__________ are found to be effective over placebo in approximately 90% of ADHD patients.

CNS Stimulants

Alcohol is a...

CNS depressant

Ritalin is a...

CNS stimulant.

Weight and growth should be monitored in children on which ADHD medications?

CNS stimulants and Strattera

Methylphenidate is a...

CNS stimulate.

Magnesium sulfate antidote

Calcium gluconate

Nicotine effect

Calming or excitation, increased concentration, agitation

Respiratory down-side of metoprolol

Can cause bronchospasm

Why are carbidopa and levodopa combined to treat parkinsons?

Carbidopa prevents breakdown of levodopa in bloodstream, so more levodopa can reach the brain

Indications for Metoprolol

Cardiac selective: - Angina pectoris - Hypertension - Cardiac dysrhythmias - Myocardial infarction - Heart failure Non-cardiac selective: - Glaucoma - Pheochromocytoma - Migraine - Hyperthyroidism

Beta blocker that is especially cardioprotective

Carvedilol

Why is atropine used for eye exams?

Causes pupils to dialate

Antibiotic that produces an extremely unpleasant reactions when combined with alcohol

Ceftriaxone

Antibiotics to be used with extreme caution in patients with renal failure

Ceftriaxone

Cefrtiaxone is a _______ antibiotic.

Cephalosporin

_____________ antibiotics are grouped into "generations".

Cephalosporin

2nd generation oral antihistamine

Cetrizine

What should -statins be dosed nocturnally?

Cholesterol production primarily occurs at night/during sleep.

Asthma

Chronic respiratory inflammatory disease with periods of acute exacerbation

Metoprolol is a....

Class II antiarhythmic/Beta-blocker.

Amiodarone is a...

Class III antiarhythmic (Potassium Channel Blocker)

Diltiazem is a....

Class IV antiarhythmic - Calcium channel blocker

CIWA

Clinical Institute Withdrawal Assessment

Bacteria causing antibiotic associated pseudomembranous colitis

Clostridium difficile

Goal of antipsychotic agents

Complete remission or significant reduction of psychotic symptoms

Opiate

Compound present in opium

Mifepristone med interaction caution

Concurrent use with *any* blood thinners could lead to increased risk of severe uterine bleeding

Drug interaction category D

Consider therapy modification

Drug interaction: Category D

Consider therapy modification

Category D Drug Interactions

Consider therapy modifications

Miosis

Constriction of pupils

Estrogen in male patients

Converted from testosterone by aromatase

Levodopa

Converts to dopamine

Mannitol mechanism of action

Creates a large gradient between tissue and vasculature, causing a large fluid shift from the third space into the vasculature

______ should be monitored when on Rosuvastatin.

Creatine kinase (indicator of muscle status)

Type 2 hypersensitivity reaction

Cytotoxic: eg., transfusion reactions

When considering a beta-2 agonist, which condition would be most concerning prior to administration?: A. Diabetes mellitus B. Peripheral vascular disease C. COPD D. Atrial fibrillation with rapid ventricular response

D. Atrial fibrillation with rapid ventricular response

The most beneficial means of objective information of drug efficacy in a client receiving Amiodarone is which of the following? A. Complaints of chest pain B. Serum potassium levels C. Lung sounds D. EKG

D. EKG

Nitrofurantoin antibiotic class

DNA inhibitor

Nitrofurantoin is a ________ antibiotic.

DNA inhibitor

Gliptins are...

DPP-4 inhibitors.

Before administering magnesium sulfate it's important to assess

DTRs

Anticoagulant that directly inhibits thrombin

Dabigatran

__________ cause "rebound" nasal congestion after 3-7 days of use.

Decongestants

Tocolytic agent benefits

Decreased neonatal morbidity and mortality

Pioglitazone (Actos) action

Decreases insulin resistance

There is no analgesic effect of stimulating ______ opioid receptors.

Delta

Depo-provera and estradiol

Depo suppresses estradiol levels, which can lead to decreased bone mass

Type I Diabetes etiology

Destruction of the beta cells of the pancreas which are responsible for insulin synthesis

Challenge of treating viral infections

Difficult to suppress viral replication without doing significant harm to the host

_______________ calcium channel blockers are used for and primarily affect blood pressure.

Dihydropyridine

Nicardipine is a ____________.

Dihyrdopyridine calcium channel blocker

Which antidysrhythmic agent is indicated only for atrial dysrhythmias?

Diltiazem

1st generation oral antihistamine

Diphenhydramine (Benadryl)

H₁-antagonist prototype drug

Diphenhydramine (Benadryl)

Dabigatran drug class

Direct thrombin inhibitor anticoagulant

Rocephine (Ceftriaxone) mechanism of action

Disrupts cell wall synthesis and activates autolysis.

Parkinson's is related to dysfunction of which neurotransmitter

Dopamine (esp in the extrapyramidal motor pathway)

Hepatitis B immunization schedule

Dose #1 at birth, dose 2+3 in a few months thereafter

Antibiotic that can cause discoloration of teeth in children under 8yo

Doxycycline

Antibiotic that can cause slowed long bone growth in premature infants

Doxycycline

Antibiotic that causes discoloration of teeth in children under 8 and slowed long bone growth in premature infants

Doxycycline

Antibiotic that is teratogenic in the 1st trimester of pregnancy

Doxycycline

Peak level

Drug level following administration of a particular number of doses; typically pertains to IV drugs

Random (drug) level

Drug level not related to administration time; reflects steady state concentration

Trough level

Drug level within *30 minutes* prior to drug administration

Madnesium sulfate fetal surveillance

EFM and BPP: - May depress fetal activity - May decrease baseline FHR variability

What is the *most* significant nursing assessment when giving a patient furosemide?

EKG monitoring (potassium alterations)

Torsades de Pointes parameters

ELECTRICAL CHAOS: 1. HR > 150 2. Irregular 3. No P-waves 4. No PR interval 5. QRS variable morphology

Asystole parameters

Electrical silence: 1. No discernable HR 2. Absent rhythm 3. No P-waves 4. No PR interval 5. No QRS complexes

Indications for promethazine (Phenergan)

Emesis: > surgery > chemotherapy > toxins

Naloxone route

Endotracheal, IM, SQ, inhalation

Betamethasone MOA (OB)

Enhances fetal lung maturity by promoting increased synthesis and release of surfactant resulting in improved neonatal lung function

Zolpidem MOA

Enhances the activity of GABA

Anticoagulant that is always and only administered SQ

Enoxaparin (Lovenox)

Anticoagulant with a significant risk of renal impairment

Enoxaparin (Lovenox)

Pulseless electrical activity would first be treated with

Epinephrine

Nexplanon MOA

Etonorgestrel: -- blocks Lh surge to prevent ovulation -- thickens the cervical mucus -- thins the endometrial lining

What time of day should Rosuvastatin be taken?

Evening time (most cholesterol is produced at night)

Akathisia

Extremely uncomfortable profound sense of restlessness

T or F: Ondansetron is indicated for nausea and vomiting

FALSE --> Off-label use

Warfarin is reversed with...

FFP (fresh frozen plasma) and vitamin K

Warfarin is reversed with...

FFP and Vitamin K.

T or F: Buspirone (Buspar) is a sedative-hypnotic

False

T or F: Dopamine crosses the blood-brain barrier

False

T or F: Insulin therapy is used for every patient who has diabetes

False

T or F: Pioglitazone poses a risk of hypoglycemia.

False

T or F: Patient have the same insulin requirements when hospitalized

False: Insulin needs may increase or decrease when hospitalized.

T or F: Nasal decongestants are an effective long-term therapy for allergic rhinitis

False: decongestants should only be used for short periods

Why are most medications dosed higher in children?

Faster metabolism

Ebstein's Anomaly

Fetal cardiac defect affecting the tricuspid valve and right ventricle of the heart

Terbutaline fetal/neonatal adverse effects

Fetal: - Tachycardia - Hyperinsulinemia - Hyperglycemia Neonatal: - Hypoglycemia - Hypocalcemia - Hypotension - Ileus

Follicular phase days

First 13-14 days

Crystalloid IV solutions

Fluids and electrolytes that are able to freely cross capillary walls

Intranasal corticosteroid prototype drug

Fluticasone

__________ is especially effective for nasal congestion associated with allergic rhinitis.

Fluticasone

__________ is more effective than oral anthistamines with fewer side effects.

Fluticasone

Why is heparin usually given before warfarin?

For the first day or two on Warfarin, you are actually *hyper*coagulable.

For how long does aspirin inhibit platelets?

For the life of the platelet (7-10 days)

Digoxin is the extract of...

Foxglove flower.

Acamprosate classification

GABA agonist/Glutamate antagonist

Meglitinides *cannot* be given with ____________.

Gemfibrozil (Lopid)

Antibiotic that can cause nephrotoxicity and is contraindicated in renal failure

Gentamicin

Antibiotics to *NEVER* be used in patients with renal failure

Gentamicin

Antibiotic with an especially narrow therapeutic range

Gentamicin (levels must be monitored)

RhoGAM antepartum use

Given to *all* Rh- moms at 26-28 weeks

Nitrous oxide effect during labour

Gives euphoric effect so "you still hurt, you just don't care"

You should not use ______, if you are allergic to Sulfonamide antibiotics.

Glipizide

Concern with prescribing Glipizide in conjunction with a Beta Blocker

Glipizide increases risk of hypoglycemia while Beta Blockers mask the s/s of hypoglycemia

Oral diabetic medications that can cause weight gain

Glipizide, Pioglitiazone

Major alprazolam interaction

Grapefruit/grapefruit juice!

Foods rich in vitamin K

Green leafy vegetables

Most effective smoking cessation strategies

Group support

Cough expectorant prototype drug

Guaifenesin (Mucinex)

The flu vaccine should not be administered to a patient with a history of ____________.

Guillain-Barre syndrome

Ranitidine is a...

H2-receptor antagonist. (reduces gastric acid secretion)

Nucleoside RTI treats

HBV (and HIV)

90% of hepatitis is caused by...

HBV or HCV.

Why is renal failure a concern with Hydrochlorothiazide use?

HCTZ acts on the kidneys and could therefore exacerbate renal failure

Non-fasting lipid panel measures...

HDL and total cholesterol

Most effective antihyperlipidemic agent group

HMG-CoA reductase inhibitors (-statins)

-statin drugs are....

HMG-CoA reductase inhibitors.

____________ is the first line treatment for non-psychiatric hospitalized patients experiencing agitation and/or delirium.

Haloperidol

Paraguard SEs

Heavier menstrual bleeding and cramping

Interferon Alfa treats

Hepatitis C

Buprenorphine MOA

High affinity for the mu opioid receptor

Flumazenil risk

High risk of seizure when used as a benzo reversal agent

________ mediates the hypersensitivity reaction & inflammatory response.

Histamine

ND-NMBs adverse effects

Histamine release: -- bradycardia -- hypotension -- bronchospasm

___________ is not indicated for acute diuresis because of it's slow-onset effect.

Hydrochlorothiazide

Most common side effect of meglitinides

Hypoglycemia

What condition should the nurse monitor for after administering glipizide?

Hypoglycemia

Methylphenidate is Schedule __.

II

Most legal narcotics are schedule __

II

The strongest feelings of gender dysphoria typically occurs around tanner stage __

II (early emergence of secondary sex characteristics)

Barbiturates schedule

II-IV

Betamethasone administration

IM: 2 doses given 24 hours apart

Lab for warfarin

INR/PT

Is heparin given to inpatients or outpatients?

INpatients

Benzodiazepines schedule

IV

Metronidazole administration

IV PO (preferably on empty stomach)

Gentamicin must be administered....

IV (or IM).

How is adenosine administered?

IV as fast as possible

Doxycycline administration methods

IV, IM, PO

What position is the patient in when an epidural is placed?

Ideally sitting and hunched over

Goal of TPN

If possible, transition to enteral feeds as soon as safely indicated

When would you check a magnesium level in the context of hypokalemia?

If you've tried to replete potassium and the hypokalemia persists

Ischemic priapism

Impaired venous flow

Medications used to treat postpartum hemorrhage

In order of preference: 1. Pitocin 2. Cytotec 3. Hemabate 4. Methergine

Guaifenesin patient education

Increase fluid intake to ensure mobilization of secretions

Nonischemic priapism

Increased arterial flow

Primary indication for mannitol

Increased interaranial pressure

Black Box Warning for *all* antipsychotics

Increased mortality in elderly patients with dementia-related psychosis treated with antipsychotic medications (r/t cerebrovascular adverse events including stroke, heart failure)

Alcohol MOA

Increases GABA receptor function in some studies

Pioglitazone mechanism of action

Increases insulin sensitivity by stimulating muscles and the liver to increase glucose utilization and decrease glucose production

Exenatide is a(n) _____________.

Incretin mimetic (GLP receptor agonist)

Chorioamnionitis

Infection of the amniotic membranes

Olseltamivir (Neuraminidase Inhibitor) treats...

Influenza A + B

Methadone nursing education

Information surrounding half life and danger of mixing with other sedatives

How to prevent vancomycin induced red man syndrome

Infuse slowly; over 60 minutes or more

ICSs

Inhaled Corticosteroids

Preferred first-line, long-term chronic respiratory condition control therapy

Inhaled Corticosteroids (eg., fluticasone)

Fluoxetine (Prozac) MOA

Inhibits 5HT reuptake resulting increased availability and intensified transmission at post-synaptic site

Tiotropium mechanism of action

Inhibits M3 receptors at smooth muscle, leading to *bronchodialation*

Action of SGLT-2 Inhibitors

Inhibits SGLT-2 receptors, thereby excreting excess glucose via urine

Potassium-sparing diuretics mechanism of action

Inhibits aldosterone in distal collecting tubule and collecting ducts

Mechanism of calcium channel blockers

Inhibits calcium ion from entering the "slow channels"/select voltage-sensitive channels

Ketamine MOA

Inhibits catecholamine uptake

Magnesium sulfate mechanism of action

Inhibits release of acetylcholine in neuromuscular junctions

Tricyclic Antidepressants (TCAs) MOA

Inhibits reuptake of NE and 5HT (primary actions = varies by med)

Diphenhydramine mechanism of action

Inhibits the action of histamine by binding to H₁-receptor sites on mast cells in the respiratory tract

Is the influenza vaccine live?

Injection: inactivated Nasal: live, attenuated

Oligohydramnios

Insufficient production of amniotic fluid

Nexplanon implantation

Into the non-dominant arm and left in place for up to 3 years

First-line treatment for allergic rhinitis

Intranasal corticosteroids (eg., fluticasone)

Terbutaline indications

Intrauterine fetal resuscitionation: 1. FHR prolonged deceleration 2. Tetanic uterine contraction 3. Increased uterine resting tone

Common manifestations of tardive dyskiesia

Involuntary twisting movements, beginning with the face and tongue, and progressing to limbs and trunk

Why should metoprolol be pushed slowly?

It has an effect on heart rate very quickly.

Why is mannitol contraindicated in heart failure patients?

It increases intravascular fluid volume thereby putting more stress on the heart

L- I- T- H- I- U- M-

L- Leukocytes I- Increased T- Tremors H- Hypothyroid I- Increased U- Urine M- Moms-to-be

_______ drugs should never be used for the treatment of acute respiratory symptoms.

LABA

An acutely ill patient who is receiving metformin is especially at risk for what condition?

Lactic acidosis

Special administration fact about levofloxacin

Leads to same serum concentration if administered PO, IV, etc.

LITHIUM

Leukocytes Increased Tremors Hypothyroid Urine Mom's to be

Antibiotic good for soft tissue infections

Levofloxacin

Antibiotic with risk of tendon rupture

Levofloxacin

Antibiotic that must be discontinued if tendon/joint pain occurs

Levofloxacin (risk of tendon rupture)

Where are insulins metabolized?

Liver, kidney, adipose tissue, and muscle

Insulin has the greatest effect on which tissues?

Liver, muscle, and adipose tissue.

Decanoate (depot) preparations

Long-acting, injectable formulations used for long-term maintenance therapy of schizophrenia (BPAD)

________ is very common after DTaP administration

Low grade fever

Dextromethorphan use should not coincide with use of a ____________.

MAO inhibitor

_______ drugs do not play well any other drugs.

MAOI

Automatically assume an abscess is...

MRSA.

PPN

Peripheral parenteral nutrition: -- short term use -- Partial nutritional support

1st Gen Antipsychotics categories

Phenothiazines and Nonphenothiazines

Misoprostol administration

Pill given either PO or per vagina

Most commonly given drug to initiate/increase uterine contracts

Pitocin (synthetic oxytocin)

Monitor _____ when administering lisinopril or valsartan.

Potassium

Salmeterol is known to decrease what electrolyte?

Potassium

Weakest diuretic type

Potassium-sparing diuretics (Aldosterone antagonists)

Naloxone adverse effects

Precipitates unpleasant withdrawal

Suboxone adverse effects

Precipitates withdrawals unless pt uses heroin after on maintenance therapy + constipation

Mifepristone indications

Pregnancy termination: intrauterine pregnancy through 70d gestation (given with misoprostol)

Carbipoda

Prevents breakdown of levodopa in bloostream, so more reaches the brain.

Trazodone significant and common adverse reaction

Priapism

Hypersensitivity Type I

Production of antibodies in response to an allergen which leads to mast cell activation and histamine release

Triphasic COCs

Progesterone *and* estrogen levels vary *every* week during cycle

Biphasic COCs

Progesterone increases halfway through cycle

Inhibited ejaculatory dysfunction

Prolonged

Propofol MOA

Promotes release of GABA

Misoprostol is a...

Prostaglandin E1 cervical ripening agent

Dinoprostone is a __________ medication.

Prostaglandin E2

Rivaroxaban is reversed with...

Prothrombin Complex Concentrate

New oral anticoagulants are reversed with...

Prothrombin complex concentrate.

Atropine psychosis

Psychotic delirium caused by excess anticholinergic effects

Bulk-forming laxative

Psyllium

Asystole presentation

Pulseless and lifeless

Onset of minipress

Quick: 0.5hr

Ondansetron (Zofran) indications

Radiotherapy and anesthesia associated nausea

Nitrous oxide onset/clearance

Rapid: 30-60 seconds

Stevens-Johnson Syndrome

Rare and serious reaction to medications or infections that can cause damage to any epithelial tissue, especially skin and mucus membranes

____________ is associated with missed doses of Guanfacine.

Rebound HTN

Rivaroxaban significant interactions/contraindications

Recent trauma/intracranial bleed

Go-to benzo for a child having a seizure at home

Rectal diazepam

Action of cholestyramine

Reduces LDL

Acamprosate desired effects

Reduces tension, dysphoria, cravings associated with abstinence from alcohol

Down regulation

Reducing stimulation at the post-receptor (post-synaptic) site. Cell is less sensitive to the neurotransmitter

When mixing insulins, which should be drawn up first?

Regulin insulin (RN-regular before intermediate; clear to cloudy)

Nifedipine mechanism of action (OB)

Relaxes smooth muscle by blocking calcium entry into the cell

Assessment of what system is most important before administering Rocephine (Ceftriazone)?

Renal (excreted in urine)

Significant adverse effect of enoxaparin (Lovenox)

Renal impairment

Common side effect of SGLT-2 Inhibitors

Repeated urinary tract infections

Betamethasone prevents or decreases the severity of...

Respiratory Distress Syndrome (RDS)

Adverse effects of opioids

Respiratory depression, constipation, nausea, hypotension, anemia, death

ACHES

Review with every patient on combined contraceptives: -- *A*dominal pain -- *C*hest pain -- *H*eadache -- *E*ye problems -- *S*evere leg pain

RhoGAM prevents

Rh isoimmunization

Suspected diagnosis: - JVD distention - Slight RUQ pain - BLE pitting edema - 3+ DP and PT pulses

Right sided heart failure

Safety concern with Hydrochlorothiazide

Risk for postural hypotension

Most significant risk of antidysrhythmic medications

Risk of causing another dysrhythmia/arrhythmia

Why is biguanide not administered in hospitalized patients?

Risk of lactic acidosis in the acutely ill

Anticoagulant used for prophylaxis of DVT in joint replacement

Rivaroxaban (Xarelto)

Ceftriaxone brand name

Rocephine

______ asthma drugs are not intended to be used daily.

SABA

Blood pressure that would indicate antihypertensive medication in a patient younger than 60

SBP >140 DBP >90

Blood pressure that would indicate antihypertensive medication in a patient older than 60

SBP >150 DBP >90

Venlafaxin (Effexor) is an...

SNRI

Terbutaline administration method

SQ (recommended)

Trazodone (Desyrel) is a...

SSRI and 5HT@ antagonist

S.L.U.D.

Salivation Lacrimation Urination Defecation (Anticholinergic effects)

LABA prototype

Salmeterol

_______ is used in combination with ICSs for long-term control and prevention of symptoms in patients whose asthma is not well controlled with ICSs alone.

Salmeterol

Respiratory drug with a lot of interactions and contraindications with common health conditions.

Salmeterol (LABAs)

Methdone advers effects

Same as other opioids: - Respiratory depression - Bradycardia - Sedation - Constipation

Nalbuphine schedule

Schedule IV (low abuse potential)

SBIRT

Screening, Brief Intervention, and Referral to Treatment

Buproprion (Wellbutrin) significant adverse effect

Seizures

Atomoxetine classification

Selective norepinephrine reuptake inhibitor

Salmeterol mechanism of action

Selectively binds to β₂-receptors to relax bronchial smooth muscle to achieve bronchodilation

Effect of opioids

Sense of contentment, miosis, parasympathetic nervous system activation, "nodding out," dreamlike state, analgesia

SNRI

Serotonin-norepinephrine reuptake inhibitor

Dystonia

Severe muscle spasms

Concern with transdermal medication administration

Skin breakdown - need to check and rotate placement frequently

What is used in place of biguanide in the hospital setting?

Sliding scale insulin

Why should furosemide be administered in the morning?

So that the patient is not urinating frequently throughout the night

Cyanide antidote

Sodium thiosulfate

Colloid IV solutions

Solutions that contain protein or other large molecular substances that stay within the intravascular compartment (AKA - plasma expanders)

Premature ejaculatory dysfunction

Sooner than desired

Potassium-sparing diuretic

Spironolactone

Risk associated with contact sports after epstein-barr viral infection

Splenic rupture

Action of Meglitinides

Stimulate the pancreas to release insulin

Nitrous oxide MOA

Stimulates endogenous endorphin release

Common significant side effect with Strattera

Stomach upset (give with food)

Trimethoprim/Sulfamethoxazole is a ___________ antibiotic.

Sulfonamide

Sulfonylureas are derived from...

Sulfonamide antibiotics.

Antiviral MOA

Suppress biochemical processes unique to viral reproduction: -- Inhibit viral penetration -- Inhibit viral DNA replication -- Inhibit budding of newly formed viral particles

MOA of diphenhydramine in treating extrapyramidal symptoms

Suppression of central cholinergic activity and prolonging action of dopamine by inhibiting its reuptake and storae

Adenosine indications

Supraventricular tachycardia (afib, aflutter w/ RVR)

Agranulocytosis s/s

Suspect if patient on FGA develops sore throat, fever, or malaise during first two months of medication

Somatropin

Synthetic growth hormone

______ is given to patients who have had a reaction to a previous DTaP injection.

TD (tetanus and diphtheria)

Supraventricular tachycardia (SVT)

Tachyarrhythmias that originate above the ventricular electrical conduction system

How to avoid the flushing side effect associated with niacin

Take an aspirin ~30 minutes beforehand.

Administration consideration for docusate sodium (Colace)

Take with a full glass of water

Recommendations for PO administration of penicillin VK and Augmentin

Take with food since they can cause GI upset.

Extrapyramidal side effect that is sometimes irreversible

Tardive dyskinesia

Doxycycline belongs to which class of antibiotics?

Tetracycline

_____________ is the gold standard for asthma treatment.

The Asthma Action Plan

Resource for deciding antibiotic in individual cases

The Sanford Guide to Antimicrobial Therapy

Preload

The amount of ventricular stretch at the end of diastole

autologous transfusion

The collection and later reinfusion of a patients own blood or blood components.

What step of the RAAS do ACE inhibitors prevent?

The conversion of angiotensin I to angiotensin II

Why do opioids have a more dramatic effects on fetuses in utero than on the mother?

The metabolites of opioids are the active compound and fetuses/infants are hypermetabolizers

Steady state

The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose.

Receptor sensitivity hypothesis of depression

The post-synaptic neuron tries to compensate for a lack of stimulation via supersensitivity and upregulation

Afterload

The pressure against which the heart must work to eject blood during systole

C diff is usually caused by...

The use of multiple antibiotics for a long period of time *or* a suppressed immune system.

Polypharmacy

The use of multiple medications on a regular basis: -- Common in the geriatric population -- Increases risks of drug-drug interactions

What is the peak time of Glargine?

There is no peak time for long-acting insulin

Pioglitazone is a ________________ drug.

Thiazolidinedione

Guaifenesin (Mucinex) mechanism of action

Thought to act by increasing the effective hydration of the respiratory tract and reduces the viscosity of respiratory mucus, thereby further facilitating its removal by the natural clearance processes

Ateplase (tPA) drug class

Thrombolytic agent

"Clot busters" are called...

Thrombolytics.

Lag period

Time between starting medication and obtaining full symptom relief. Believed to occur as a result of down regulation.

Respiratory anti-cholinergic prototype drug

Tiotropium

TCA discontinuation consideration

Titrate dose down

Why should you obtain pain intensity (pain scale) before administering analgesics?

To establish a baseline and later evaluate medication effectiveness

Postpartum oxytocin indications

To produce uterine contraction during the third stage of labor and to control postpartum bleeding or treat hemorrhage

Why should insulin injection sites be rotated?

To reduce the risk of lipodistrophy

Onchomycosis treatment

Topical or oral antifungals (eg., fluconazole)

TPN

Total parenteral nutrition: -- Short or long term -- Significant nutritional support

Premarin therapeutic effect

Treatment of moderate to severe vasomotor symptoms

COPD non-pharmacologic interventions

Trigger avoidance: obesity and smoking

T or F: Calcium channel blockers have a negative inotrope and negative chronotrope effect

True

T or F: Guiafenesin should be given to a patient with COPD.

True

T or F: Morphine crosses the blood-brain barrier

True

T or F: Naloxone is approved for use in pediatric population

True

T or F: All patients should be on a PPI or an H₂ blocker while in the hospital

True. (including acutely ill pediatric patients)

Chronic constipation is defined as...

Two or more for at least 3 months: 1. Strain at least 1/4 of the time 2. Lumpy/hard stools at least 1/4 of the time 3. Sensation of incomplete evacuation at least 1/4 of the time 4. Two or fewer bowl movements in a week

What is the most concentrated insulin?

U-500 insulin

Nitrofurantoin indications

UTIs only

Guanfacine MOA for ADHD

Unknow, but thought to work on NE signaling in some way

Digoxin excretion

Urine: 50-70% unchanged

Antibiotic and oral contraceptives

Use a back-up method of birth control while on antibiotics and for the entire cycle afterwards

Hypertonus

Uterine resting tone between contractions of between 20 mmHg if IUPC or firm to palpation

Bad cholesterols

VLDL, IDL, LDL

Antibiotic known to cause red man syndrome

Vancomycin

Diltiazem side/adverse effects

Vasodilatory effects: 1. Flushed skin 2. Headache 3. Dizziness 4. Hypotension

Vasoconstrictor that is not titrated

Vasopressin

Gentamicin excretion

Via urine as unchanged drug

Olseltamivir MOA

Viral particles are unable to bud off from host cytoplasmic membrane

Antidote for warfarin

Vitamin K

Best way to prevent thrush when taking fluticasone

Wash spacer frequently!

Tinea pedis

What is this?

When should CNS stimulants and Strattera be administered?

With or immediately after a meal

Antipsychotic-induced acute dystonia usually develops when?

Within the first few days of use, often within hours.

Can warfarin be prescribed to outpatients?

YES

First-line treatment for relief of *acute* asthma symptoms

a SABA

In addition to its cell wall inhibiting capability, Augmentin also contains...

a beta-lactamase inhibitor.

Epinephrine (drug)

a catecholamine that acts as a sympathetic stimulant and parasympathetic depressant

Basal and PCA combined analgesia dosing

a constant level of opioid administration *plus* additional bolus doses per patient's demand

A narrow therapeutic range/window indicates...

a difficult-to-use, more dangerous drug

Nifedipine

a dihydropyridine calcium channel blocker

High tyramine can cause...

a hypertensive crisis

Glasgow coma scale

a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment

regularly irregular rhythm

a rhythm that is abnormal but follows a pattern

Meperipidine

a strong opioid agonist that is almost entirely out of practice

Trimethoprim/Sulfamethoxazole antibiotic class

a sulfonamide antibiotic

Gentamicin antibiotic class

a very strong aminoglycoside

What information should the nurse provide regarding administration of methylphenidate (Concerta)?: a. Do not crush or chew the medication b. Chew one tablet twice daily c. Crush the drug and mix it in apple sauce d. Dissolve the tablet in juice or milk

a. Do not crush or chew the medication

If a patient is taking bethanechol chloride and they develop ___________ the nurse needs to reassess.

abdominal pain

When should you *NOT* administer bethanachol chloride?

abdominal pain or a history of GI blockage

Selective toxicity

ability of a drug to injure a target cell without injuring other cells/organisms

Most common drug-lab interaction

abnormal plasma/serum electrolyte concentrations

arrythmia

absence of heart rhythm

AMI

acute myocardial infarction

IM

administered intramuscularly

IV

administered intravenously

PO

administered orally

PR

administered rectally

SQ

administered subcutaneously

SL

administered sublingually

Steady state

administration rate = rate of clearance

Epinephrine is a... (drug class)

adrenergic agonist.

First concern to address during anaphylaxis

airway

SABA prototype drug

albuterol

SABA prototype drug

albuterol (short-acting beta agonist)

Riskiest detoxification

alchohol and benzodiazepines (seizures)

CAGE screening assesses...

alcohol addiction.

Topiramate, gabapentin, and antidepressants can be used off-label to treat...

alcohol dependence.

CIWA assesses withdrawal from...

alcohol.

Naloxone onset

almost immediate

Give ________ (ADHD med) at bedtime to help with sedation.

alpha agonists

Tamsulosin is a...

alpha-1 adrenergic blocker (blocks sites on the neck of the bladder and prostate)

Minipress is a...

alpha-adrenergic blocker.

Drug interactions

altered or modified action or effect of a drug as a result of interaction with one or multiple drugs

Gentamicin is an ____________ antibiotic.

aminoglycoside

Nalbuphine

an agonist-antagonist opioid: - kappa agonist - Mu antagonist

Aldactone (spironolactone)

an aldosterone antagonist

Valsartan

an angiotensin II receptor blocker (ARB)

Aluminum hydroxide

an antacid

A wide theraputic range/window indicates...

an easier, safer drug

Combination contraceptives contain...

an estrogen and progestin.

Naloxone

an opioid antagonist used to prevent opioid agonist effects

WHO Ladder

analgesic guidelines for cancer pain (1-3)

Spironolactone is a...

androgen antagonist

Epidurals are place by...

anethesiologists or CRNAs. (sometimes OBs)

Aluminum hydroxide is a...

antacid.

Taking ________ with mycophenolate will lead to decreased absorption of the mycophenolate due to lowered pH.

antacids

Warfarin (Coumadin) mechanism of action

antagonist of vitamin K, inhibits vitK dependent clotting factors

Clopidogrel is a...

anti-platelet (like aspirin)

Aspirin is a...

anti-platelet drug.

Buspirone (Buspar) is used as an...

antianxiety agent.

Atropine is a ________ drug.

anticholinergic

Atropine is a _________ drug.

anticholinergic

Thiazide (and Thiazide-like diuretics) are often combined with...

antihypertensive drugs.

Dextromethrophan is a...

antitussive.

*DO NOT USE* _______ with asthma patients.

antitussives (cough suppressants) *highly emphasized in lecture!*

Nalbuphine precipitates withdrawal symptoms in patient who...

are dependent on opioid agonist.

Stimulation of α1-receptors causes...

arterioles and venules to constrict, increasing peripheral resistance/blood pressure and blood return to the heart

Dextromethorphan should never be used to treat...

asthma patients.

The P-wave corresponds to...

atrial depolarization

Major anticholinergic drug

atropine

When should the daily dose of Ritalin be administered?: a. Before breakfast b. Just after breakfast c. Immediately before lunch d. As soon as the child awakens in the morning

b. Just after breakfast (bc Ritalin depresses appetite)

Generally, what is the best insulin injection site to use in the hospital setting?

back of the arms

Are cell wall inhibiting antibiotics bactericidal or bacteriostatic?

bacteriocidal

Why are benzodiazepines only Schedule IV?

because the FDA says so.

If you have any alcohol while on disulfiram, you will...

become *violently* ill.

BPH

benign prostatic hypertrophy

Alprazolam is a...

benzodiazepine.

_______ should not be prescribed with opioids.

benzodiazepines (additive effects of respiration, heart, CNS, etc)

Labetalol is a...

beta blocker (non-cardiac selective)

Terbutaline is a...

beta-agonist

Cholestyramine is a...

bile acid sequestrant.

Minipress is excreted via...

bile and feces. (only 10% urine)

Dabigatran mechanism of action

binds to thrombin site thus preventing fibrin formation, platelet aggregation and Factor XIIa activation

Before administering lisinopril you should check...

blood pressure, potassium (and creatinine).

Before administering furosemide you should check...

blood pressure, potassium, and creatinine.

Thrombolytics mechanism of action

breaks down fibrin mesh.

Your patient has severe COPD and is prescribed a non-selective β₁ adrenergic blocker. What adverse effect should the nurse anticipate?

bronchospasm

Pharm agents to increase stool volume

bulk-forming laxatives

Suboxone is...

buprenorphine + naloxone

Which finding is often associated with ADHD?: a. Excellent testing ability b. Hostility c. Impulsivity d. Positive peer relationships

c. Impulsivity

Which of the following is a potential side effect associated with CNS stimulants?: a. Lethargy b. Increased appetite c. Insomnia d. Urticaria

c. Insomnia

Cyclosporine is a...

calcineurin inhibitor.

Nifedipine is a

calcium channel blocker

Salmeterol is used with caution in patients with seizures because it...

can induce CNS stimulation.

Unlike other sedatives, etomidate produces minimal ______ effects.

cardiovascular

Unlike other sedation medications, ketamine does not cause...

cardiovascular compromise.

Neurobiologically, ADHD is an imbalance of...

catecholamin (NE and DA) metabolism in the cerebral cortex.

Angina pectoris

chest pain due to coronary heart disease

Taking ________ with mycophenolate will lead to decreased absorption of the mycophenolate by binding it.

cholestyramine

Common Schedule V drug

codeine in cough preparations

CPOE

computerized *provider* order entry

Time dependent killing

concentration must remain above the minimum effective concentration (MEC) for a prolonged period of time

Therapeutic range/level

concentration of drug in the blood serum that produces the desired effect without causing toxicity

Basal (continuous) analgesia

continuous administration of opioid

Betamethasone is a

corticosteroid

What drugs cause thinning skin?

corticosteroids

If you are concerned about kidney function, you should especially be looking at which to serum lab values?

creatinine and K+.

You should never _____ extended release (ER) and sustained release (SR) drugs.

crush

Corticosteroid is usually always prescribed with _______ for transplants.

cyclosporine

Mycophenolate is usually prescribed as a tertiary agent alongside __________ and __________ for immunosuppression.

cyclosporine; corticosteroids

Mycophenolate is a...

cytotoxic agent.

Enoxaparin (Lovenox) dosing frequency

daily or BID

Many ___________ drugs will exacerbate high blood pressure.

decongestant

Adrenergic antagonic will ___ BP.

decrease

Adrenergic antagonists will ___ HR.

decrease

Penicillins combined with oral anticoagulents can cause...

decreased GI flora that synthesize vitamin K.

Important (negative) effect of uterine contractions

decreased utero-placental blood flow

Mannitol _________ the amount of fluid reabsorbed back into the kidney.

decreases

Negative inotrope

decreases force of contraction

Negative chronotrope

decreases heart rate

Magnesium sulfate is thought to provide a neuroprotective effect by...

decreasing the incidence and severity of cerebral palsy in preterm infants.

Cervical dilation is caused by...

degradation of collagen by proteolytic enzymes

Severity of abstinence syndrome depends on...

degree of dependence.

The only cure for preeclampsia is...

delivery.

Congestive heart failure

deterioration of systolic and/or diastolic performance due to loss of myocardial function

Transmission of hepatitis C most often leads to...

development of a chronic infection.

Antitussive prototype drug

dextromethorphan

A potential adverse effect of all laxatives except psyllium

diarrhea

Atropine/diphenoxylate is used to treat...

diarrhea.

Hydrochlorothiazide should be used only with profound caution with ______ and other potassium-______ drugs.

digoxin; wasting

Mydriasis

dilation of the pupil

Rivaroxaban drug class

direct factor Xa inhibitor anticoagulant (competitively binds Xa)

Bactericidal

directly lethal to bacteria, causing cell death

Rhabdomyolysis

dissolution of striated muscle

Thiazide (and Thiazide-like diuretics) act on the _______________ of the nephron.

distal convoluted tubule

dysrhythmia

disturbance in heart rhythm

First signs of hypotension/bradycardia

dizziness/light-headedness

Surfactant laxative

docusate sodium (Colace)

Promethazine (Phenergan) is a...

dopamine antagonist (anti-emetic)

Cabidopa-Levodopa is a ________ drug

dopamine replacement

Equianalgesic

dose that will produce the same degree of analgesia (as 10mg of parenteral morphine Q3-4H)

Peak level

drug level following administration of a particular number of doses

Trough level

drug level within 30 minutes prior to drug administration

Analgesic

drugs that relieve pain without causing loss of consciousness

Steroid medications must be increased....

during times of stress!

Concentration dependent killing

effect is solely dependent upon reaching a concentration above the MEC

The regular flu vaccine should not administered to a patient with hypersensitivty to ____.

eggs

Morphine mimics the effects of...

endogenous opioid peptides.

Cytochrome P450

enzymes that function to metabolize potentially toxic compounds, including drugs and products of endogenous metabolism such as bilirubin, principally in the liver.

Progestin (esp 1st + 2nd gen) can exhibit ________________________ side effects.

estrogenic, androgenic, and anabolic (T)

Sulfonylureas (Glipizide) carry a higher risk of hypoglycemia when combined with ______ or ______.

exenatide; gliptins

EIB

exercise-induced bronchospasm

Guaifenesin is a...

expectorant (Mucinex).

Desensitization

exposure to small, progressively larger doses of the allergen

ER

extended release

Do not prescribe _____ opioids for acute pain.

extended release/long acting

Most common side effect of montelukast

fatigue

Hepatitis A transmission

fecal-oral

Hepatitis E transmission

fecal-oral

Gemfibrozil is a...

fibric acid derivative.

Furosemide is predominately used for ______________ and typically *not* for _______________.

fluid removal; hypertension

Isotonic crystalloid solutions are indicated in cases of...

fluid volume deficit.

Isotonic crystalloid solutions should be used with caution in patients at an increased risk of...

fluid volume overload.

Antacids may affect...

fluid/electrolyte balance.

Levofloxacin is a ___________ antibiotic.

fluoroquinolone

Warfarin is reversed with...

fresh frozen plasma or vitamin K.

Receptors

functional macromolecule within a cell - on the surface - within the cytoplasm - within the nucleus of cell

Nasal/oral airways should not be placed in a patient who still has a...

gag reflex. (GCS of 8 or less)

Prenisone is a...

glucocorticoid.

Vancomycin is a ______ antibiotic.

glycopeptide

What food/beverage is especially likely to affect the absorption of drugs?

grapefruit juice

Consuming __________________________ with Rosuvastatin increases the risk of rhabdomyolysis.

grapefruits or pomegranates

Wide therapeutic index

greater distance between effective dose and toxic dose

If parents can't afford pedialyte, recommend...

half water half gatorade.

Steady state depends on ___________.

half-life

In the absence of opioids, Naloxone will...

have no effects.

beta 1 receptor location

heart and kidneys

What vital signs should you especially assess for before administering analgesics?

heart rate, blood pressure, and respiratory rate

Before administering digoxin you should check...

heart rate, potassium (and creatinine).

Alteplase (tPA) risks/adverse events

hemorrhagic event

HITT

heparin induced thrombocytopenia

Antifungals are often ____toxic.

hepato

Naltrexone black box warning

hepatotoxicity

Haloperidol is a...

high potency non-phenothiazine (1st generation antipsychotic)

Reversing benzodiazepines is very dangerous because...

high risk of seizures.

Mast cells release _______.

histamine

The release of _____ causes allergic reactions.

histamine

ACHES should be reviewed with every patient on....

hormonal contraceptives.

Strattera is not a great option for ADHD patients with...

hyperactivity.

Etomidate is a....

hypnotic.

Adenosine onset

immediate

Antidiarrheal agents should not be used...

in cases of C. diff.

Heparin mechanism of action

inactivates thrombin.

Guanfacine does not work well for _________ ADHD patients.

inattentive

Bethanechol (Urecholine) is primarily used to...

increase micturition in the treatment of urinary retention and neurogenic bladder.

In patients with diabetes, salmeterol may...

increase serum glucose.

Stimulation of ß₁-receptors causes...

increased myocardial contractility and heart rate.

Mannitol ______ osmolality of the blood.

increases

The effect of most drugs _______ as the dose increases.

increases

Proctitis

inflammation of the lining of the rectum

Fluticasone is a...

inhaled corticosteroid

Fluticasone is a...

inhaled corticosteroid (ICS)

Indirect-acting cholinergic agonists

inhibit the action of the enzyme cholinesterase (CHe) (acetylcholinesterase) by forming a chemical complex, thus permitting acetylcholine to persist and attach to the receptor

fluticasone mechanism of action

inhibits immune and inflammatory systems by suppressing the synthesis, secretion, and actions of chemical mediators of the inflammatory response

Enoxaparin (Lovenox) mechanism of action

inhibits thrombin (same as heparin)

IR

instant release

Humulin N is...

intermediate acting insulin.

The utility of nicotinic acid is limited by...

intolerance of side effects.

arrhythmia

irregular heartbeat

Middle withdrawal syndromes

irritability, tremor, anorexia, "goose-flesh"

Lactated ringers is a(n) _____________________ solution.

isotonic crystalloid

0.9% Sodium Chloride is a(n) ______________ solution.

isotonic crystalloid.

Furosemide is occasionally used to help treat hyper_______.

kalemia

Nalbuphine is a...

kappa agonist and mu antagonists

Decreased urinary output after epinephrine administration indicates...

kidneys may not be adequately perfused and may be damaged.

Tolerance

larger doses are required to achieve the same response

If a drug has high protein binding, then it will be ____ available for the body to use.

less

Montelukast is a...

leukotriene receptor antagonist (for respiratory illness)

Toxic concentration

level of drug that will result in serious adverse effects

When sodium is displaced...

lithium takes its place, and your kidneys go to waste.

Tri/Sulfa should not be given to patients with...

liver cirrhosis.

Lantus is...

long acting insulin.

Which type of insulin should *never* be mixed with any other insulin?

long acting insulins

LABAs

long acting β₂ agonists

Propofol *will* cause _______.

low blood pressure

Enoxaparin (lovenox) classification

low-molecular weight heparin

Montelukast dose consideration in pediatric patients

lower dose

Azithromycin is a _________ antibiotic.

macrolide

If on levaquin, encourage patients to...

maintain proper hydration.

Cromolyn is a...

mast cell stabilizer (used to treat asthma).

RhoGAM should be administered anytime there is a potential for...

mixing of maternal and fetal blood

agonists

molecules that stimulate receptor sites and mimic the body's regulatory molecules

Depression is caused by a deficiency of...

monoamines, particularly NE and 5HT.

Valproic acid (Depakote) is used as a...

mood stabalizer.

If a drug has low protein binding, then it will be ____ available for the body to use.

more

Drug distribution

movement of drugs throughout the body

Sucralfate is a...

mucosal protectant.

Bethanechol (Urecholine) acts on...

muscarinic cholinergic receptors.

Narrow therapeutic index

narrow distance between effective and toxic dose

Penicillin VK spectrum

narrow spectrum

n/v

nausea and vomiting

Adverse effects of naloxone

nausea/vomitting, tachycardia, hypertension, tremors, VFIB, cardiac arrest

Cromolyn is administered via...

nebulizer.

Administering Naltrexone SQ would cause...

necrosis of the skin.

Calcium channel blockers have a _______ chronotropic effect.

negative

Digoxin is a ______ chronotrope.

negative

UTIs are usually caused by gram__ bacteria.

negative

Naloxone *is* approved for use in...

neonates.

Oseltamivir (Tamiflu) is a...

neuraminidase inhibitor.

Opioids do not work for _____ pain.

neuropathic pain

Niacin is a....

nicotinic acid.

Difference between HSV I and II

no difference in presentation

Dabigatran monitoring lab

none

Rivaroxaban monitoring lab

none

FDA approved tocolytic agents

none!

What should you change in an opioid assessment for someone with a history of substance abuse?

nothing

Insulin vials may remain at room temperature once opened for...

one month.

Insulins are defined by...

onset, peak, and duration of action.

Benzodiazepines and ______ are potentially a fatal combo.

opiates

Naloxine is a...

opioid antagonist

Which administration method is *not* used for epinephrine?

oral (rapid metabolism in GI and liver cause unstable serum levels)

Pharmacologically, type 2 diabetes is primarily treated with...

oral agents.

Warfarin (Coumadin) classification

oral anticoagulant (inhibits venous thrombus)

Most drugs are administered _______.

orally (PO)

Amiodarone is used cautiously due to...

organ toxicities and prolonged half-life.

Mannitol is a...

osmotic diuretic.

Potassium-sparing diuretics are most often used in conjunction with...

other diuretics.

If IV pushed too fast, Furosemide can cause _______.

ototoxicity

PCA

patient controlled analgesia

Promethazine (Phenergan) is a poor treatment for ______ patient's because...

pediatric; it causes intense drowsiness which leads to dehydration

Augment is a _______ antibiotic.

penicillin

Penicillin VK is a ___________ antibiotic.

penicillin

Hepatitis B, C, + D transmission

percutaneuous permucosal (blood/blood-derived body fluids)

Priapism

persistent and painful erection

Osmotic laxative

polyethylene glycol

Digoxin is a ______ inotrope.

positive

Skin infections are usually caused by gram ___ bacteria

positive

Spironolactone is a...

potassium-sparing diuretic (aldosterone antagonist).

side effects

predicted physiologic effects not related to desired drug effects

Antitussives

prevent or relieve coughing

antagonists

prevent receptor stimulation; block the body's regulatory molecules

ß₁-receptors are located...

primarily in the heart, but also in the kidneys.

In male patients, luteinizing hormone stimulates...

production of testosterone.

Akathisia can be treated with ______.

propanolol

Heparin is given SQ for...

prophylaxis of DVTs.

Heparin is reversed with...

protamine.

COX-1

protects stomach lining and regulates blood platelets

Dabigatran is reversed with...

prothrombin complex concentrate.

Rivaroxaban is reversed with...

prothrombin complex concentrate.

Esomeprazole is a...

proton pump inhibitor.

The withdrawal bleeding that occurs with COCs is...

psuedomenstruation.

The majority of erectile dysfunction has a ________ etiology.

psychogenic

Etomidate is often used for...

quick procedures (eg., joint reduction, intubation, cardioversion).

Lispro is...

rapid acting insulin.

Maculopapular rash

rash with a flat red area that also has raised bumps

Acute hemolytic transfusion reaction

reaction to blood type incompatibility

Raynaud's disease

recurrent episodes of pallor and cyanosis primarily in fingers and toes

Administration of Gardisil to males...

reduces their likelihood of acquiring genital warts and passing cervical cancer to female partners.

Which insulin can be given IV?

regular insulin

U-500 insulin is only available as...

regular insulin.

Stimulation of α2-receptors causes...

release of norepinephrine to be inhibited, thereby causing a decrease in vasocontriction and a decrease in blood pressure.

Lithium levels are dependent upon...

renal function.

Rivaroxabane's half-life will be prolongued in...

renal impairment and elderly patients.

homologous transfusion

replacement of blood by transfusion of blood received from another person

Tiotropium is a...

respiratory anti-cholinergic.

Tinea cruris

ringworm of the groin

Warfarin is derived from....

rodenticides (rat poison).

rhinorrhea

runny nose

Patients on Naltrexone need to carry a...

safety card (in case of accident)

LABA prototype drug

salmeterol (long-acting beta agonist)

directed donor transfusion

same requirements as allogenic donor, but the blood is intended for a specific patient

Superinfection (suprainfection)

secondary infection usually caused by a depletion of natural flora (eg., thrush, C diff, vaginal yeast infection)

Magnesium sulfate is administered for preeclamspia to prevent...

seizure activity.

Strattera is a...

selective NE re-uptake inhibitor (nonstimulant)

Guanfacine ER is a...

selective alpha-2A agonist (nonstimulant)

Ondansetron is a...

serotonin receptor antagonist (antiemetic).

Maximum relief of symptoms of psychosis using antipsychotics agents usually occurs after...

several weeks or months (after first few doses)

During exams, if there is a woman with a child under the age of 1 yr, assume _____________________________ until proven otherwise.

she is breastfeeding

During exams, if there is a woman, assume _____________________________ until proven otherwise.

she is pregnant

Humulin R is...

short acting insulin.

SABAs

short acting β₂ agonists

S/S

signs and symptoms

Nicotinic receptors affect

skeletal muscles

beta 2 receptor location

skeletal smooth muscle, bronchial smooth muscle, and walls of GI tract/bladder

Bacteriostatic

slows bacterial growth but does not cause cell death

Biguanide is absorbed by the ____________ and secreted unchanged by the ________.

small intestine; kidneys

Late withdrawal syndromes

sneezing, weakness, n/v, diarrhea, abdominal and muscle cramping, pain

Every patient with an MDI should also have a ________.

spacer

Muscarinic receptors

stimulate smooth muscle and slow the heart rate

Desired effect of bethanachol chloride

stimulate the bladder to empty

Alpha agonists action

stimulate the vagus nerve

Salmeterol is used with caution in patients with hyperthyroidism because it...

stimulates thyroid activity.

The skin flushing/itching associated with niacin is caused by...

stimulation of prostaglandins.

Addison's disease often occurs from...

sudden cessation of steroid medications.

Clopidogrel is essentially a....(layman's terms)

super-aspirin.

Most common type of fungal infection

superficial mycoses

Pharm agents to soften stool

surfactant laxatives

SR

sustained release

Dronabinal is a...

synthetic form of marijuana.

Bruxism

teeth grinding

In male patients, follicle-stimulating hormone causes...

testicular growth & sperm maturation.

Doxycycline is a __________ antibiotic.

tetracycline

Minimum effective concentration (MEC)

the blood concentration needed for a drug to produce a response

Nicardipine is an especially good medication for maintaining adequate perfusion to....

the brain and kidneys.

Lethal dose (LD)

the concentration at which a drug becomes lethal

Polypharmacy is more common and more severe in what population?

the elderly

Biotransformation

the enzymatic alteration of drug structure

Cyclooxygenase (COX)

the enzyme responsible for converting arachidonic acid into prostaglandins and their products

Antipsychotic induced akathisia usually develops within...

the first 2 months of medication use.

β1 receptors are mainly found in...

the heart.

NSAIDs are metabolized in...

the kidneys.

Maximal efficacy

the largest effect that a drug can produce

Why is liver disease a contraindication for opioid administration?

the liver metabolizes opioids

Naloxone is metabolized by...

the liver.

Tylenol is metabolized in...

the liver.

β2 receptors are found in...

the lungs.

Patients initiating interferon alfa antiviral therapy should be warned that...

the medication will most likely cause flu-like symptoms. (depression and suicidal ideation also possible)

α2-receptors are located in...

the post ganglionic sympathetic nerve endings.

Excretion

the removal of drugs from the body

Dopaminergic adrenergic receptors are located in...

the renal, mesenteric, coronary, and cerebral arteries.

ß₂-receptors are located mostly in...

the smooth muscles of the lung and gastrointestinal tract, the liver, and uterine muscle.

Pharmacology

the study of drugs and their interactions with living systems

Half-life

the time required for the amount of drug in the body to decrease by 50%

Half-life

the time required for the amount of drug in the body to decrease by 50%.

Stimulation of dopaminergic adrenergic receptors causes...

the vessels to dilate and blood flow to increase.

Nonstimulants are usually prescribed for ADHD when...

there is an inadequate or endesirable response to stimulants.

Side/adverse effects of FGAs usually occur because...

they block *all* D2 receptors.

Grapefruits and pomegranates should not be consumed if on Rosuvastatin because...

they inhibit CYP450 thereby increasing serum drug level.

Loop diuretics act on the ______________ in the nephron.

thick ascending loop of Henle

Gliptins are considered ___-line therapy.

third

Alteplase (tPA) is a...

thrombolytic agent (clot buster).

Type of dermatophyte infection that must be treated orally

tinea capitis

Naloxone use

to treat opioid overdose

Cross-tolerance

tolerance for a substance one has not taken before as a result of using another substance similar to it (eg., tolerant to dilaudid after taking morphine)

Normeperidine

toxic metabolite of meperidine

Amiodarone is usually only used in the elderly because...

toxicity is guaranteed after a number of years.

Antibiotics are given to pregnant people to prevent...

transmission of group B streptococcus to the fetus/neonate

Heparin is given IV for...

treatment of an acute event.

COX-2

triggers inflammation and pain

Fibric acid derivatives lower _______ but have little effect on _____.

triglycerides; LDL

Penicillins excretion

unchanged in urine and feces

Bethanachol Chloride indications

urinary retention

Polypharmacy

using medications to treat the effects of other medications

Alteplase (tPA) indications

venous or arterial clots

Sildenafil is aka...

viagra.

Loop diuretics are potassium-_______.

wasting

Must monitor __________ if on depo-provera

weight and BP

Strattera is dosed according to...

weight.

With Hydrochlorothiazide, daily ______ should be monitored.

weights

Penicillins distribution

widely distributed

Abstinence syndrome

withdrawal

Dependence

withdrawal symptoms occur if the drug is stopped abruptly

Betamethasone is recommended for...

women at 23-34 weaks EGA at risk for preterm delivery within 7 days.

Initial withdrawal syndromes

yawning, sweating, rhinorrhea

Can morphine cross the blood-brain barrier?

yes.

Vitamin K takes about how long to act as an antidote to warfarin.

~1 day

Amiodarone toxic effects usually take ____ years to take place.

~10 years

Which receptors does epinephrine stimulate?

α₁, α₂, ß₁, and ß₂

β-receptors associated with the lungs

β₂-receptors

Lithium life threatening toxicity levels

≥ 2.0 mEq/L (less if renal dysfunction)

Blood pressure that would indicate antihypertensive medication in adult under 60

≥140/190

Blood pressure that would indicate antihypertensive medication in adults over 60

≥150/90


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