ATI Capstone Pharmacology
Levothyroxine
Contraindication: Osteoporosis Acute MI
Aspirin
Contraindication: Third trimester pregnancy, Thrombocytopenia, Adolescents with chickenpox
Benzodiazepines
Contraindications: Glaucoma, benzos cause intraocular pressure due to pupil dilating effects
Thrombolytic Agents
"Clot Busters" - convert plasminogen into plasmin which destroy fibrinogen - they work quickly to restore circulation (as evident by relief o chest pain, reduction of initial ST segment injury pattern shown on ECG - increased risk for bleeding (monitor baseline platelets and bleeding factors; SQ and IM injections should be limited * Streptokinase (Streptase): must be administered 4-6 hours after onset of signs and symptoms - after clot has been eliminated, administered beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias
Herb/Botanical Therapy
* Echinacea: used to treat the common cold; can decrease positive effects of medication for Tb, HIV, Cancer with long-term use. * Ginger root: decreases morning sickness, motion sickness, and nausea r/t surgery, reduce stiffness of rheumatoid arthritis; suppresses platelet aggregation; caution in pregnancy * Gingko biloba: promotes vasodilation, increases recall ability and mental processes; used commonly with dimentia and alzheimers, used in erectile dysfunction r/t SSRI impotence; interact with meds that lower seizure threshold (antihistamines, antidepressants, antiphsycotics), interferes with coagulation. * Valerian: increases GABA to prevent insomnia, promotes sleep with increased effect over time (risk for dependence), causes drowsiness and depression, avoid use in pregnancy and lactation Black Cohosh: estrogen substitute; used during menopause; increases effects of antihypertensive meds and increase effects of estrogen meds; increases hypoglycemia in patients who are taking insulin
Proton Pump Inhibitors (PPIs)
- Decrease stomach acid by inhibiting those gastric proton pumps that make the acid - They stop the acid at the pump! - Can cause B12 deficiency (long-term) * Omeprazole (Prilosec, Zegerid, Omepral, Omez) * Lansoprazole (Prevacid, Zoton, Inhibitol) * Dexlansoprazole (Kapidex, Dexilant) * Esomeprazole (Nexium, Esotrex) * Pantoprazole (Protonix, Somac, Pantozol, Zentro)
Erectile Dysfunction Agents
- ED meds act by increasing nitiric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow. - Side effects include headache, flushing, back pain, and muscle aches, temporary vision changes. - Men who have heart problems, uncontrolled BP, history of stroke, shouldn't take. * Sildenafil (Viagra): "blue vision" * Vardenafil (Levitra) * Tadalafil (Cialis)
Antiplatelets
- Increased risk for bleeding - prevents platelet from clumping together by inhibiting enzymes and factors that normally cause arterial clotting - administered orally, IV - caution with patients with peptic ulcer disease and hepatic/renal diseases - Patient education: take with food, report signs of hemorraghic stroke (weakness, dizzy, headache); coffee ground emesis, black, tarry stools; avoid corticosteroids as they increase aspirin effects * Aspirin (Ecotrin): reduces hypertensive action of beta lockers * Clopidogrel (Plavix) * Pentoxifyline (Trental)
Lisinopril
- Interacts with potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia - avoid salt subs
Antianemics
- Iron supplements for iron deficiency anemia - Iron can cause staining of teeth; dilute liquid iron with orange juice or water and drink with straw, rinse mouth. - Iron can cause staining of skin with IM injections, use z track method - Iron interactions: antacids and tetracyclines reduce absorption of iron, take 2 hours apart; vitamin C (avoid) increases absorption and increases GI complications (nausea/vomit/constipation/heartburn) - Instruct patients to take iron on empty stomach. 1 hour before meals to max absorption - Instruct patients to space out doses at equal intervals to efficiently increase red blood cell production - Inform patients to anticipate a harmless dark green or black stool - Instruct patients to increase fluid intake and fiber and maintain exercise regimen - Encourage intake of fiber (liver, egg yolks, muscle meat, yeast)
Anticoagulants
- Prevent the formation of blood clots by interfering with the clotting cascade. - Contraindicated with active bleeding, ulcers, hemorrhagic brain injuries. * Heparin: Heparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered by IV or SQ Enoxaparin (Lovenox) is a low molecular weight heparin; has the same action as heparin but longer half-life. Administered via SQ Protamine sulfate is the antidote for heparin Administer heparin when there is a likelihood of clot formation (MI or DVT) Risk for bleeding; patient education include monitor for signs of bleeding (bleeding gums, bruises, hematuria, and petechiae) Instruct patients to avoid corticosteroid use, salicylates, NSAIDs, green leafy veggies, and vitamin K foods Normal aPTT is 20-36 seconds; therapeutic while on heparin 1.5-2 times normal value (60-80 secs) * Coumadin Coumadin (Warfarin) interferes with coagulation factors by antagonizing vitamin K Oral administration normally used (3-5 days continue heparin IV) Use is contraindicated in patients with low platelets or uncontrolled bleeding Mephytone (Vitamin K) is the antidote Advice patients to avoid foods that are high in vitamin K, Tylenol, glucocorticoids, aspirin; wear medical alert bracelet Doses typically taken once daily INR and PT are monitored; PT should be 1.5-2 times control; INR 2-3 (3-4.5 patients with mechanical heart valve) No coumadin for pregnant women (category X) Use heparin
Levothyroxine (Synthroid)
- Treats hypothyroidism - Patient education: taken once in the morning to prevent insomnia
Antiemetics
- Used to treat/prevent nausea/vomiting - monitor for sedation - 5HT3 Receptor Antagonist (serotonin antagonists) * Dolasetron (Anzemet) * Granisetron (Kytril, Sancuso) * Ondansetron (Zofran) * Tropisetron (Navoban) - Dopamine antagonists * Promethazine (Phenergan) * Prochlorperazine (Compazine) * Metoclopramide (Reglan): monitor extra-pyramidal - Antihistamines * Diphenhydramine (Benadryl) * Dimenhydrinate (Gravol. Dramamine) * Meclizine (Bonine, Antivert) - Cannabinoids * Cannabis: medicinal marijuana * Dronabinol (Marinol)
Insulins
- assessment should occur during the peak of insulin action - signs and symptoms of abrupt onset of hypoglycemia: tachycardia, palpitations, diaphoresis, shakiness. - signs and symptoms of gradual onset of hypoglycemia: tremors, headache, weakness * Rapid acting - Lispro (humalog) - ONSET: less than 15 minutes - PEAK: 30-60 minutes - DURATION: 3-4 hours * Short-acting - Regular (Humulin R) - ONSET: 30 -60 mins - PEAK: 2-3 hours - DURATION: 5-7 hours * Intermediate-acting: NPH (Humulin N) - ONSET: 1-2 hours - PEAK: 4-12 hours - DURATION: 18-24 hours - Long-acting - Glargine (Lantus) - ONSET: 1 hour - PEAK: none -DURATION: 10-24 hours
A neutropenic client is receiving filgrastim. What are three (3) nursing considerations for this medication?
Administer filgrastim via intermittent IV bolus, continuous IV, subcutaneous infusion, or subcutaneous injection. Do not agitate the vial of medication. Use each vial for one dose, and do not combine with other medications.Do not put the needle back into the vial when withdrawing the medication. Monitor CBC two times per week.
Disulfiram
Adverse effect: hepatotoxicity
The nurse is caring for a client taking spironolactone. Identify the adverse effects of spironolactone and what findings should be reported to the provider.
Adverse effects to be reported to provider: Hyperkalemia, Endocrine effects (impotence in males, irregular menstrual cycles in females), drowsiness, metabolic acidosis. Client teaching to avoid these adverse effects: The use of ACE inhibitors increases the risk of hyperkalemia. Teach clients to avoid potassium containing salt substitutes
Before administering blood products, what action should be taken first?
Assess the client's vital signs, obtain consent for the procedure and ensure compatibility, prime the iv tubing with 0.9% normal saline
A nurse is assessing a client prior to administering the scheduled dose of propranolol for hypertension. Name a minimum of two (2) assessment findings the nurse would recognize as adverse effects of the medication.
Bradycardia (HR <50 bpm)Hypoglycemia Decreased cardiac output AV block Orthostatic Hypotension Rebound myocardium excitation Bronchoconstriction
What actions should be taken by the nurse when caring for a client that has refused prescribed medications?
The nurse should explain the consequences of not taking the prescribed medications, inform the provider and document the refusal in the MAR.
Methylprednisolone (Medrol)
Corticosteroid Suppresses airway mucus production
Digoxin (Lanoxin)
Digitalis toxicity: Anorexia and weakness. Bradycardia is commonly noted in digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects).
A nurse is caring for a client who has a new prescription for alosetron. What are the expected therapeutic effects of this medication?
Effectiveness of alosetron can be evidenced by relief of diarrhea, and decrease in urgency and frequency of defecation.
The nurse has identified that a medication error has occurred. What are the guidelines for reporting and completing an incident report?
Evaluate client's response to medications, document and report them. Report all errors and implement corrective measures immediately. Complete an incident report within the time frame specified by the facility, (Usually 24 hours). This report should include: Client's identification Name and dose of the medication Time and place of the incident Accurate and objective account of the event Who was notified What actions were taken Your signature (or that of the person who completed the report.) Do NOT reference or include this report in the client's medical record.
A client's blood glucose level is 23 mg/dL. The client is unresponsive and unable to swallow. What priority action should be taken to increase the blood glucose rapidly.
Glucagon is administered as emergency management for hypoglycemic reactions to increase blood glucose levels by increasing the breakdown of glycogen into glucose.
Statins
HMG-CoA reductase inhibitors - Used to treat primary hypercholesterolemia, for prevention of coronary events, protection vs MI and stroke for patients with diabetes, and to help increase HDL (helps prevent LDL from building up in arteries) - Risk of hepatotoxicity; obtain AST and ALT before and 12 weeks after and every 6 months - Avoid alcohol! - Risk for myopathy and peripheral neuropathy; report muscle weakness, aches, pain, tingling, and tenderness; monitor CK levels - Think "we need to protect the liver and muscles stat" * Atorvastatin (Lipitor) * Simvastatin (Zocor) * Lovastatin (Mevacor) * Pravastatin (Pravachol) * Rosuvastatin (Crestor) * Fluvastatin ( Lescol)
A nurse is administering vancomycin to a client who develops an infusion reaction sometimes referred to as red man syndrome. What action by the nurse could have prevented this reaction?
Infusion reactions (rashes, flushing, tachycardia, and hypotension, sometimes called "red man syndrome") is an adverse effect of vancomycin administration that could be prevented by administering vancomycin slowly over 60 min.
A client is prescribed a protease inhibitor—ritonavir. Identify three (3) nursing considerations when administering a protease inhibitor.
Instruct client to report all other the counter medications; except for indinavir, take protease inhibitors with food to increase absorption; administer with another antiretroviral; advise barrier form of contraception; advise diet high in calcium and vitamin D
A nurse is providing teaching to a client who is prescribed methotrexate for chemotherapy treatment. What should the nurse include in the teaching for this medication?
Instruct clients to take the medication on an empty stomach. Advise clients to protect the skin from sunlight.Advise female clients to use birth control during and for 6 months after completing treatment (Pregnancy Risk Category X).
A nurse is administering albumin to a client. What are three (3) clinical manifestations of circulatory overload?
Manifestations related to circulatory overload include cough, shortness of breath, crackles, hypertension, tachycardia, and distended neck veins.
A home health nurse is evaluating the client's knowledge of the medication terazosin. Which statement by the client alerts the nurse the client needs further education on this medication?
Medication is to be taken at bedtime due to the possibility of dizziness.
Lithium Carbonate
Mood stabilizer - produces neurochemical changes in the brain including serotonin receptor blockade - decreases atrophy and/or increases neuronal growth; - used in the treatment of bipolar disorders to control episodes of acute mania, help prevent the return of mania or depression, and decrease the incidence of suicide - Complications: *GI (administer with meals or milk) *Fine Hand Tremors (exacerbation coffee and stress) (administer propranolol) (adjust to lowest possible dose, divide doses) (report increased tremors) * Polyuria/mild thirst (use spironolactone) (hydration 1.5-3 mL) *Weight gain *Renal Toxicity (monitor I&Os, keep low dose, assess baseline kidney function) *Goiter & Hypothyroidism with longterm use (obtain T3T4 and TSH levels, admin levothyroxine) (monitor for s&s of hypothyroidism - cold dry skin, decreased heart rate, weight gain *Bradydysrhytmia, hypotension and electrolyte imbalances (maintain adequate fluid and sodium intake - Lithium toxicity * levels below 1.5 mEq/L ^diarrhea, N/V, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy *levels 1.5 - 2.0 mEq/L ^ongoing GI distress, mental confusion, poor coordination, coarse tremors, sedation (withhold medication and report to MD) * levels 2.0 - 2.5 mEq/L ^extreme polyuria of dilute urine, tinnitus, involuntary extremities movement, blurred vision, ataxia, seizures, severe hypotension leading to coma, death respiratory complications (whole bowel irrigation) * levels greater than 2.5 ^Oliguria, seizures, rapid progression of manifestations leading to coma and death (hemodialysis)
Medication error
Nurse should acknowledge the error and report it to the provider
Montelukast (Singulair)
Patient edu: take once at bedtime
Isosorbide
Patient education: This medication is prescribed for long-term prophylaxis against anginal attacks.
Metoclopramide (Reglan)
Patient education: Notify your provider if you experience restlessness or spasms of the face or neck.
Doxazosin (Cardura)
Patient education: dhange positions slowly and lie down if dizziness occurs. First-dose orthostatic hypotension can occur with Cardura. The nurse should instruct clients to change positions slowly and to lie down if feeling dizzy, lightheaded or faint.
Propranolol
Patients with asthma should avoid beta 2 blockers bronchoconstriction can occur
A client has been prescribed misoprostol for the treatment of peptic ulcer disease. What is a true contraindication for this medication?
Pregnancy, misoprostol is pregnancy risk category X.
A nurse is caring for a client who has a new prescription for raloxifene. What are contraindications for this medication that the nurse should discuss with the client?
Raloxifene is Pregnancy Risk Category X. This medication is contraindicated in clients who have a history of venous thrombosis. The medication should be stopped 3 days before periods in which risk of DVT is high (such as before surgical procedures).
Vasopressin (ADH)
Stimulates water reabsorption in the kidneys
A nurse is instructing a client who has a new prescription for nitroglycerin transdermal patch about administration. What instructions should the nurse include?
To ensure appropriate dose, patches should not be cut. Place the patch on a hairless area of skin (chest, back, or abdomen) and rotate sites to prevent skin irritation. Remove old patch, wash skin with soap and water, and dry thoroughly before applying new patch.Remove the patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication‑free between 10 and 12 hr/day.