PHARM ATI Final

Mnemonic: Potassium Increasing Agents

Potassium Increasing Agents K-BANK -K-sparing diuretic -Betal blocker -ACE inhibitor -NSAID -K supplement

Atropine

-is used for symptomatic bradycardia by increasing heart rate and conduction velocity. Bradycardia is defined as a heart rate of less than 60 beats per minute. Hypotension, dizziness, and blurred vision are all symptoms of bradycardia. -is an anticholinergic medication that may cause urinary retention, dry mouth, dry eyes, tachycardia, dilated pupils, blurred vision, and constipation. -decreases intestinal motility and peristalsis; the nurse should monitor the client for abdominal distention.

Acyclovir

-is used to treat herpes zoster -high doses of acyclovir can cause hallucination. -common side effects of acyclovir include malaise, rash, nausea, vomiting,headache, and diarrhea.

Rifampin

-may cause body fluids to become red or orange. Urine, tears, sweat, sputum, and feces can all be affected. This is a benign side effect.

Metformin

-puts a patient at increased risk of renal failure when combined with a contrast medium. -Metformin should be withheld 48 hours before and after all procedures. -Lactic acidosis is also a potential effect of metformin overdose because lactate uptake by the liver is diminished. -it often causes GI upset, but these side effects usually resolve within 2 weeks. -Metformin rarely causes hypoglycemia because it does not stimulate insulin release, but decreases glucose production in the liver and glucose absorption in the GI tract. It also improves insulin sensitivity.

Signs of extravasation...

-seepage or introduction of fluid, such as intravenous fluid, into the tissues surrounding a blood vessel; similar to infiltration pain around infusion sight. These signs should be taken seriously because of the risk of tissue necrosis.

what is mupirocin topical ointment used for?

-treatment of impetigo. -Overapplication of the antibiotic ointment can increase side effects and irritate the skin. Apply sparingly only to affected areas.

signs of fluid volume excess

-distended neck veins -increased blood pressure -full, bounding, radial pulses

signs of fluid volume deficit

-dry mucous membranes -decreased blood pressure

Cannabinoids

-Cannabis- medical marijuna, in the U.S., it is a Schedule I drug -Dronabinol (Marinol)- a Scheudle II drug in the U.S Rememeber most antiemetics can cause sedation so watch out for additive effect if given with narcotic analgesics and protect your client from injury.

Antihistamines (H1 histamine receptor antagonists)

-Diphenhydramine (Benadryl) -Dimenhydrinate (Gravol, Dramamine) -Meclozine (bonine, Antivert)

HT3 receptor antagonists (serotonin antagonists)

-Dolasetron (Anzemet) -Granisetron (Kytril, Sancuso) -Ondansetron (Zofran) -Tropisetron (Navoban) -It's "TRON" to the rescue

Antiarrhythmics

-Examples: amiodarone (cordarone) mexiletine (mexitil) phenytoin (dilantin) procainamide (pronestyl) propafenone (Rythmol) propranol (Inderal) quiNIDine (Quinidine Sulfate) sotalol (Betapace) verapamil (Calan, Covera, Isoptin, Cerelan) diltiazem (Cardizem, Dilacor, Tiazac, and others) acebutolol (Sectral) disopyramide (Norpace) dofetilide (Tikosyn) dronedarone (Multaq) digozin (lanozin) flecainide (Tambocor) ibutilide (Corvert) lidocaine (Xylocaine) -These medications are classified by their effects on cardiac conduction tissue. -Slow down the heart (the calcium channel blockers, dioxin, and beta-blockers) -Suppress potentially lethal cardiac arrhythmias. -Amiodarone sometimes causes the skin to take on a blue-gray color, especially in areas exposed to the sun. The coloring will go away once the medication is stopped

Dopamine antagonists

-Promethazine (Phenergan) -Prochlorperazine (Compazine) Metoclopramide (Reglan): Now this one is different in generic name because it can have some different side effects - watch for extrapyramidal side effects with metoclopramide

Propofol

-a beta blocker -can lead to zinc loss through the urine, so prolonged use of propofol should be supplemented with zinc. -it can cause hyperlipidemia

Lisinopril

-an ace inhibitor that treats congestive heart failure

Aluminum hydroxide

-can cause constipation

Magnesium hydroxide

-commonly causes diarrhea

Rights of medication administration:

1.) Right client 2.) Right medication 3.) Right route 4.) Right time 5.) Right does 6.) Right documentation

What is a vesicant?

A vesicant is an agent that causes tissue irritation and possible tissue necrosis. -can cause extravasation of the tissues -If a vesicant agent infiltrates at an I/V/ site, discontinue the I.V. immediately and remove the catheter. Get an order to place an ice pack on the site for 15 minutes, repeating this each hour for four hours.

Mnemonic: ACE inhibitor Side Effects

ACE Inhibitor Side Effects: CAPTOPRIL: -Cough -Angioedema/Agranulocytosis -Potassium excess -Taste changes -Orthostatic hypotension -Pregnancy contraindication -Renal artery stenosis contraindication -inflammation-related pain -lower GFR

Antiemetics

An antiemetic is a medication used in the treatment and/or prevention of nausea and vomiting. Remember generic names are our friend because meds in the same classification often have similar generic names but brand names can come and go.

Mnemonic: ARB Side Effects

Angiotensin II Receptor Blocker (ARB) Side Effects Halt Dangerous Hypertension: -Headache -Dizziness -Hyperkalemia

Anticoagulants

Anticoagulants prevent the formation of blood clots by interfering with the clotting cascade, thereby preventing coagulation. The use of this class of medications is contraindicated with active bleeding, such as with bleeding disorders, ulcers, or hemorrhagic brain injuries. HEPARIN and COUMADIN are the two main anticoagulant medications. See the acrostics below for helpful hints and important facts about these drugs. HEPARIN H eparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or SQ. E noxaparin (Lovenox) is a low-molecular weight heparin. It has the same action as heparin, but has a longer half-life. It is administered via subcutaneous injection. P rotamine sulfate is the antidote for heparin. A dminister heparin when there is the likelihood of clot formation, such as with myocardial infarction or deep-vein thrombosis. R isk for bleeding is the major side effect that clients should be educated about. Clients should be educated to monitor for bleeding, including bleeding gums, bruises, hematuria, and petechiae. I nstruct clients to avoid corticosteroid use, salicylates, NSAIDs, green leafy vegetables, and foods high in Vitamin K. N ormal activated partial thromboplastin time (aPTT) is 20 to 36 seconds, but to maintain a therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5 to 2 times the normal value (60 to 80 seconds). COUMADIN C oumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing vitamin K. O ral administration is typically used. Clients may need continued heparin infusion via IV until therapeutic effect of Coumadin is experienced (may take3-5 days). U se is contraindicated in clients with low platelet counts or uncontrolled bleeding. M ephyton (trade name vitamin K) is the antidote for Coumadin. A dvise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use. D oses are typically taken once daily. I NR and PT are monitored for clients who are taking Coumadin. Depending on intent of therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for clients with a mechanical heart valve. N o Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X. Heparin maybe safely used in pregnancy.

Mnemonic: Aspirin Side Effects

Aspirin Side Effects ASPIRIN -Asthma -Salicyalism -Peptic ulcer disease -Intestinal blood loss -Reye's syndrome -Idiosyncracy -Noise (tinnitus)

Mnemonic: Emergency Drugs

Drugs to LEAN on -Lidocaine -Epinephrine -Atropine Sulfate -Narcan The above drugs work in a variety of emergency settings. Lidocaine can me used in emergency situations for ventricular arrhythmias. Epinephrine is a vital drug in the ACLS protocol. Atropine can be given with symptomatic bradycardia. Narcan is the reversal agent for opiate overdose.

Mnemonic: Calcium Channel Blocker Side Effects

Calcium Channel Blocker Side Effects: SHED the GAPS: -Stevens Johnson syndrome -Headache -Edema -Dizziness -Gingival hyperplasia -Angina -Palpations -Sleepiness

Mnemonic: Cyclosporine Side Effects

Cyclosporine Side Effects, 5 H: -Hirsutism -Hyperplasia of gums -harm to kidneys -Hypertension -Hyperglycemia

ACE inhibitors -prils

Dry cough and hypotension are the most common side effects associated with ACE inhibitors such as lisinopril. Report them. Many patients cannot tolerate the dry cough and must be switched to an angiotensin II receptive blocker (ARB) for the management of congestive heart failure. -weight gain (especially rapid) can be associated with worsening CHF and should be reported to the patients medical provider. -A client taking an enalapril can develop hyperkalemia due to potassium retention by the kidneys -A build up of bradykinin from this medication can cause a dry cough and lead to life-threatening consequences. The client should stop taking the medication and report this to the provider.

Erectile Dysfunction Agents

Erectile dysfunction (ED) meds act by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection). Here is where the generic name is our friend again - meds in the same class often have similar generic names but brand names will come and go: Here are some common ED meds: -Sildenafil (Viagra) -Vardenafil (Levitra) -Tadalafil (Cialis) Notice these end in 'fil'. 'Fil' helps the nitric oxide to 'fil' the penis. While 'Fil' is a great guy (well-tolerated by most clients) he does have a few side effects - headache, flushing, back pain and muscle aches (with Levitra), temporary vision changes, including "blue vision" (with Viagra) and not all men can spend time with 'Fil'. Men who have heart problems, uncontrolled blood pressure problems, history of stroke, or a health problem at can cause priapism can't hang out with 'Fil.'

Laxatives

Examples -bisocodyl (Dulcolax) -docutase sodium (Colace) -glycerin suppositories (generic) -lactulose (Chronulac) -magnesium chloride -phosphate -psyllium (metamucil) -polyethlene glycol (Miralax) -These medications are typically classified as either bulk-forming agents, osmotic, salines, stimulate laxatives or stool softeners. -treat or prevent constipation -laxatives should not be used when constipation is accompanied by abdominal pain, fever, nausea, or vomiting.

Antianxiety Agents

Examples: -AlPRAZolam (Xanax) * -buspirone (buspar) -diazepam (Valium) * -doxepin (sinequan) -Lorazepam (Ativan)* -meprobomate (equanil) -midozolam (versed) * -Paroxetine (paxil) -velafaxine (effexor) These medications act at many levels in the central nervous system (CNS), producing an anxiolytic effect. They may produce CNS depression. The effects may be mediated by GABA. -Treat of Generalized Anxiety Disorder (GAD) and panic disorder. -Manage anxiety associated with depression -Benzodiazepines are better of intermittent or short term use -Valerian is frequently used as a sedative to improve sleep. Valerian should deb stopped at least 1 week prior to surgery as it might interact with anesthesia.

Antirheumatics

Examples: -abatacept (Orecia) -adalimumab (Humira)* -anakinra (Kineret) -azathipprine (Imuran, Azasan) -certolizumab pegol (Cimzia) -cycloSPORINE (neural, SandIMMUNE) -etanercept (Enbrel)* -gold sodium thiomalate (Mychrysine) -golimab (simponi) -hydroxychloroquine (plaquenil) -inFLIXimab (Remicade) -leflunomide (Arava) -methotrexate (Rheumatrex, Trexal) ** -These medications treat RA. They receive pain (analgesics), reduce inflammation (NSAIDs and steroids) and control the underlying disease (disease modifying RA drugs or DMARDS and biologic drugs) -Long-term solutions to control symptoms of RA by slowing down join destruction and preserving joint functions (DMARDs) -Target specific components of the immune system -For most clients, treatment of RA usually begins with methotrexate (or leflunomide). Methotrexate is taken once a week and since it is a folic acid antagonist, clients must ad 1 mg folic acid supplement daily. -Like other DMARDs, methotrexate increases the fisk of liver damage. -sulfasalazine can cause body secretions to have an orange tinge, which can stain clothing -The most significant side effect of biologic agents i an increased risk of all types of infections, including TB. Clients must have a TB skin test prior to starting therapy.

Antidepressants- Cyclic

Examples: -amitriptyline (Elavil) -amoxapine (Asendin) -desipramine (Norpramin) -doxepin (SINEqaun) -imipramine (Tofranil) -maprotiline (ludiomil) -nortriptyline (pamelor) -protriptyline (vivactil) -trimipramine (Surmontil) -These medications inhibit the nerve cells ability to repute serotonin and norepinephrine, resulting in increased levels of these neurotransmitters in the brain. They also block the action acetylcholine and histamine. -Relieve depression and help treat OCD and bedwetting. -Off label use include panic disorder, bulimia, and chronic pain. -Can cause sedation. Even if taken at bedtime, the client may feel tired the next day -At the onset of treatment, may cause feelings of restlessness or anxiousness, increased perspiration or night sweats, and clouded thinking or difficulty concentrating. Although usually short-lived, these effects may cause your client to stop taking this medication. -leading cause f death by drug OD

Corticosteroids

Examples: -beclomethasone (Qvar) -betamethasone (Celestone) -budesonide (Entocort Ec) -cortisone (cortone Acetate) -dexamethasone (Decadron) -flunisolide (AeroBid) -fluticasone (Flonase)* -methylPREDNISolone (Medrol, Depo-Medrol)* -prednisoLONE (Orapred, Prelone) -predniSNE (Sterapred)* -mometasone furoate (Nasonex)* -These medications mimic the effect of hormones produced naturally by the adrenal glands. When the dose exceeds the boys usual hormone levels, they will suppress inflammation, as well as the immune system. -Oral forms treat inflammation and pain associated with arthritis and autoimmune disease (such as lupus, Crohn's) -Inhaled medication treat asthma and allergies. -Topical application helps heal skin conditions. -Injected forms treat the pain and inflammation of arthritis, gout, and other inflammatory diseases. -should not be suddenly discontinued due to the risk of adrenal insufficiency. -they should be tapered gradually when being discontinued. -Skin atrophy, poor wound healing, or thinning is a common side effect and does no warrant the discontinuation of the medication -They are maintenance therapy for asthma and will not resolve acute episodes of wheezing. -Hypertension and hyperglycemia are common side effects. A diet low in carbohydrates may counteract this. -can cause fluid retention and edema, so a diet low in sodium may counteract this. -can cause hypokalemia, so a diet high in potassium can counteract it. -the client should take the med in the morning (with food) to coincide with the body's normal secretion of cortisol. -Clients taking corticosteroids should not receive a "live" vaccine. They should call their primary care practitioner if they are exposed to chicken pox or measles. -can cause osteoporosis so a diet high in calcium is recommended -increase protein -cataracts and cushing syndrome.

Minerals/Electrolytes/pH Modifiers

Examples: -calcium acetate (Eliphos) -caclium carbonate (Caltrate) -calcium chloride (generic) -calcium citrate (Citracal) -calcium gluconate (generic) -calcium lactate (Ridactate) -magnesium sulfate (generic) -potassium bicarbonate (Effervescent Potassium) -potassium bicarbonate and potassium citrate -potassium chloride -potassium citrate -potassium phosphate -sodium bicarbonate -sodium phosphate -These medications correct imbalances minerals and electrolytes or make the urine more alkaline (pH modifiers) -Prevent and treat deficiencies or excesses of electrolytes -Prevent crystals from forming in theurine and inhibit the formation of kidney stones (acidifiers and alkalinizes) -Treat pre-eclampsia and eclampsia (magnesium sulfate) -calcium carbonate is ac cost-effective calcium supplement that is absorbed best when taken with food- at breakfast and dinner. -

Anti-Infectives- Fluroquinolones

Examples: -ciprofloxacin (Cipro) * -levofloxacin (levaquin) * -moxifloxacin (avelox) -norfloxacin (Noroxin) -gemifloxacin (factive) -ofloxacin (Floxin) -These medications are bactericidal; they are the only class of antimicrobial agents in clinical use that directly inhibit DNA synthesis in bacteria. -They treat a wide range of infections of the sinuses, skin, lungs, ears, airways, urinary tract, bones, and joints cause by gram negative and gram positive organisms.

Antidiabetics-Oral Agents

Examples: -sitaGlIPtin (Januvia) -acarbose (Precose) -glimepiride (Amaryl) -glipiZIDE (Glucotrol) -glyBURIDE (DiaBeta, Micronase) -MetFORMIN( Glucophage) -miglitol (Glyset) -nateglinide (Starlix) -pioglitazone (Actos) -repaglinide (prandin) -rosiglitazone (Avandia) -These medications stimulate insulin release from the beta cells of the pancreas. -Impove insulin's ability to move glucose into cells, especially muscle cells -Enhance insulin effectiveness in both muscle and adipose tissue. -Block enzymes that help digest starches, slowing the risen blood sugar. -Treats type 2 DM -Oral antidiabetic agents can be used alone or in combination as effective therapy for type 2 diabetes. however, these oral meds sometimes stop working after a few months or years (the cause is often unknown) -Sulfonylureas are potent and cost-effective glucose-lowering agents but all of them cause weight gain and may not be the best choice for obese clients. -Glyburide can cause people to sunburn more easily. Clients should be warned to wear protective clothing and use (SPF 30 or higher)

Vitamins

Examples: -vitamin A (Lumitene, Aquasol A, Retinol) -cholecalciferol/D3 (Drisdol, Calciferol) -vitamin E (Aquasol E) -vitamin K (Mephyton) -ascorbic acid/ C -thiamine/B1 -niacin/B3 (niacor, niaspan) -pyridoxine/B6 -folic acid -cyanocobalamin/B12 -These organic compounds, present in minute amounts in foods, are essential for normal growth and development. Fat-soluble vitamins are stored in the liver and excreted via the feces; water soluble vitamins are not stored in the body and are excreted in the urine. -Used for dietary supplements, treating vitamin deficiency, skin conditions. -Sun exposure is an easy and reliable way for most people the get vitamin D -Infants born in hospitals are given a prophylactic intramuscular dose of vitamin K to prevent vitamin k-deficiency bleeding -Vitamin B12, which is found almost exclusively in animal products, is necessary to produce red blood cells and prevent anemia. Vegans should take vitamin B12 supplements.

Statins

HMG CoA Reductase Inhibitors also known as 'statins' are some of the most prescribed medications in this country. Statins are used to treat primary hypercholesterolemia, for prevention of coronary events (primary and secondary), for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia. Remember LDL is the 'bad' cholesterol and HDL is the 'good' cholesterol (HDL helps keep the 'bad' cholesterol from building up in artery walls). You want your LOW (LDL)LOW and your HIGH (HDL) HIGH. Statins are another example that generic names are our friends - check out these common 'statins': -Atorvastatin (Lipitor) -Simvastatin (Zocor) -Lovastatin (Mevacor) -Pravastatin (Pravachol) -Rosuvastatin (Crestor) -Fluvastatin (Lescol) While statins are a wonderful addition to our pharmaceutical arsenal, they are not without risk. When you think 'statins' think that we need to protect the liver and muscles stat: There is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor liver function tests after12 weeks and then every 6 months and to avoid alcohol. There is also a risk of myopathy and peripheral neuropathy. Clients should be told to report muscle weakness and/or aches, pain, tingling and tenderness. CK levels will be monitored periodically during treatment as well. -are pregnancy category X and should never be taken while pregnant or if planning on becoming pregnant. -Common side effects: GI upset is a common side effect of statins and is usually mild and not serious, headache, mild muscle pain, joint pain, constipation, abdominal pain, and insomnia -Mild injury, causing muscle weakness or aches, develops in some clients taking statins, and this occasionally progresses to myositis. Creatinine kinase (CK) levels rise in response to enzymes released with muscle injury.

Mnemonic: Statins Side effects

HMG-CoA reductase inhibitor (Statin) side effects: HMG-CoA -Hepatotoxicity/headache -myalgia/myopathy -GI symptoms (constipation, pain, flatulence) -CPK increased -Atrial Fibrillation

Herb/Botanical Therapy

Herbal supplements are widely used and have much less precise dosages than more regulated medications. Clients may not mention herbal supplements as a part of their medication history, so it is important to ask clients specifically if they are taking any supplements in addition to prescription or over the counter medications. Here are a few common herbal therapies: Echinacea: · Used to treat the common cold. · With chronic use, echinacea can decrease positive effects of medications for TB, HIV, or cancer. Ginger root: · Used to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery. · May also decrease the pain and stiffness of rheumatoid arthritis. · These medications suppress platelet aggregation. · Should be used cautiously in pregnancy. Ginkgo biloba: · Promotes vasodilation and may be used to increase recall ability and mental processes. · Used commonly with dementia and Alzheimer's Disease. · May also be used for erectile dysfunction in clients who take SSRIs and experience impotence as a side effect. · May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics. · May interfere with coagulation. Valerian: · Increases GABA to prevent insomnia. · Promotes sleep with increased effect over time. There is a risk of dependence. · May cause drowsiness and depression. · Should be used cautiously in clients with mental health disorders. · Avoid use in pregnancy or while breastfeeding. Black cohosh: · Acts on the female reproductive system as an estrogen substitute. · May be used instead of estrogen therapy during menopause. · Increases the effects of antihypertensive medications and may increase effect of estrogen medications. · Increases hypoglycemia in clients who are taking insulin or other medications for diabetes. THE BOTTOM LINE: Clients who are taking herbal supplements should be advised to speak to their provider about possible interactions or adverse reactions that may occur.

Mnemonic: Drugs for Bradycardia & Low Blood Pressure

IDEA -Isoproterenol -Dopamine -Epinephrine -Atropine Sulfate *Symptomatic brady and low blood pressure

Thrombolytic Agents

In order to truly appreciate this drug tip, you need to familiarize yourself with the Ghostbusters. If you haven't heard the theme song, cue it up before reading further. We promise it will be worth it. PRIORITY POINT: If the Ghostbusters had a medication class of choice, this would be it! Thrombolytic Agents are CLOT BUSTERS. They work QUICKLY to restore circulation. As such, they increase a client's risk for bleeding. Who you gonna call? Streptokinase (Streptase). Call right away! These medications must be administered within 4 to 6 hours of onset of symptoms. If there's something strange in your neighborhood: Thrombolytic agents dissolve clots that have already been formed. These medications convert plasminogen to plasmin, which destroy fibrinogen and other clotting factors. What's the goal? Restoration of circulation, as evidenced by relief of chest pain, and reduction of initial ST segment injury pattern as shown on ECG. What's the risk? Increased bleeding. These medications should only be given while the client is closely monitored. Baseline platelet and blood counts (including aPTT, PT, and INR) shouldbe carefully assessed. Venipunctures and SQ and IM injections should be limited. After the clot has left the building: Administer beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias.

Insulins

Insulins are used to manage diabetes mellitus, a chronic illness that results from an absolute or relative deficiency of insulin. There are various insulins that are available to manage diabetes. For each type of insulin, you will need to know the onset, peak, and duration. NCLEX questions may focus on when clients need to be assessed after insulin administration. Assessment should occur frequently, but especially during the PEAK of insulin action, as this is when hypoglycemia is most likely to occur. Signs and symptoms ofabrupt-onset hypoglycemia include tachycardia, palpations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with headache, tremors, or weakness. We'll CLIMB TO THE PEAK...starting FAST and ending SLOW. FASTEST: Rapid acting insulins:Lispro (Humalog). ONSET: Less than 15 minutes. PEAK: 30 minutes to 1 hour. DURATION: 3 to 4 hours. FAST: Short acting insulins: Regular (Humulin R). ONSET: 30 minutes to 1 hour. PEAK: 2 to 3 hours. DURATION: 5 to 7 hours. SLOW: Intermediate-acting insulins: NPH insulin (Humulin N). ONSET: 1 to 2 hours. PEAK: 4 to 12 hours. DURATION: 18 to 24 hours. SLOWEST: Long-acting insulins: Insulin glargine (Lantus). ONSET: 1 hour PEAK: None DURATION: 10 to 24 hours. Many students look for ways to more easily remember all of the ranges associated with insulin. It is helpful to think generally rather than trying to recall all exact numbers when memorizing this information, and, if you can only remember one thing about each insulin, CLIMB TO THE PEAK. Pick one number from each time frame (onset, peak, duration) to help reduce the values that you're trying to memorize. Remember that onset, peak, and duration build sequentially as you move from one type of insulin to another, so it may be helpful to remember, for example, that onset times go from 15 minutes, to 30 minutes, to 1 hour (trend: all onsets are less than an hour). Peak times go from 30 minutes, to 2 hours, to 4 hours (trend: even numbers). Finally, duration goes from 3 hours, to 5 hours, to 24 hours. If you always organize your thoughts by O.P.D.(onset, peak, and duration), starting FAST (rapid acting) and ending SLOW (long acting) when studying the different types of insulin, these tips will be helpful. The key is consistency...looking at values in the same order every time.

Mnemonic: Morphine Side Effect

Morphine Side Effects MORPHINES -Myosis -Orthostatic hypotension -Respiratory depression -Pneumonia (aspiration) -Hypotension -Infrequent waste release (constipation, urinary retention) -Nausea -Emesis -Sedation

What medications are typically used to treat Alzheimer's

N-Methyl-D-aspartate receptors

Mnemonic: Osmotic Diuretics

Osmotic Diuretics MIG -Mannitol -Isosorbide -Glycerol

Proton Pump Inhibitors (PPIs)

PPIs decrease stomach acid by inhibiting those gastric proton pumps that make the acid - they stop the acid at the pump! Here are some common PPIs: -Omeprazole (brand names: Prilosec, Zegerid, Omepral, Omez) -Lansoprazole (brand names: Prevacid, Zoton, Inhibitol) -Dexlansoprazole (brand name: Kapidex, Dexilant) -Esomeprazole (brand names: Nexium, Esotrex) -Pantoprazole (brand names: Protonix, Somac, Pantozol, Zentro) Think of a pump in your stomach just churning out the acid - 'Zole' is the nice guy who shuts off the pump. 'Zole' is very friendly (well-tolerated by most clients) but can cause vitamin B-12 deficiency if he stays around too long (with long-term use).

Antiplatelets

PRIORITY POINT: Recall that this class of medications increases a client's risk for bleeding because of their prevention of platelet aggregation. Nursing interventions and client education focus on the client's increased risk for bleeding. Names to Know: · Aspirin (Ecotrin) · Clopidogrel (Plavix) · Pentoxifylline (Trental) How they work: Antiplatelets prevent platelets from clumping together by inhibiting enzymes and factors that normally cause arterial clotting. What they are used for: These medications are used to prevent myocardial infarction and stroke. Low dose therapy (81 mg) is effective for prevention of strokes and MI. How are they given: These medications are most commonly taken orally. They may also be administered IV. Nursing Interventions: WATCH FOR BLEEDING. · These medications should be taken with food. · These medications should be used cautiously in clients with peptic ulcer disease and in clients with severe renal/hepatic disorders. What do clients who are taking these medications need to know? · Observe for signs of weakness, dizziness, and headache and report them if they occur. These may be signs of hemorrhagic stroke. · Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should be reported. Watch for bruising, petechiae, and bleeding gums. What interactions may occur? · Avoid concurrent use of mediations that enhance bleeding, including NSAIDs, heparin,and warfarin. · Corticosteroids should be avoided as they may increase aspirin effects. · Concurrent use of aspirin may reduce hypertensive action of beta blockers.

Mnemonic: Side Effects of Corticosteroids

Side Effects of Corticosteroids CUSHINGOID -Cataracts -Ulcers -Skin thinning, bruising and striae -Hyperglycemia/Hypertension/Hirsutism -Infections -Necrosis. Avascular necrosis of the femoral head -Glycosuria -Osteoporosis, Obesity -Immunisuppression -Diabetes

Mnemonic: Stevens-Johnson Syndrome Causes

Stevens-Johnson Syndrome Causes BAPSHM -Barbiturates -Antibiotics (Penicillins) -Phenytoin, other anticonvulsants -Sulfonamides -Herpes simplex -Mycoplasms

Mnemonic: Drug Interactions

TDCI (These Drugs Can Interact) -Theophylline -Dilantin -Coumadin -Iosone (Erythromycin) Coumadin and ilosone: ilosone can increase the effects of coumadin, increase risk for bleeding. Coumadin and Dilantin: potential for increase effects of both Coumadin and Dilantin Theophylline and dilantin: if taken orally they can interfere with absorption of each other and decrease medication effect

Mnemonic: Antimuscarinic/Anticholinergic Side Effects

The ABCD'S of anticholinergic side effects: -Anorexia -Blurry vision -Constipation/Confusion -Dry Mouth -Stasis of urine

Antianemics

There are many causes of anemia and the antianemic prescribed will be based upon the cause. -With iron deficiency anemia, iron supplements are commonly prescribed. Beware though - Iron is 'heavy' stuff and shouldn't be taken 'lightly'! · Iron can cause teeth staining (liquid form). Teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing. -Iron can cause staining of skin and other tissues with IM injections. If IM route must be used, give IM doses deep IM using Z track technique. - Iron also has several drug administration interactions- of antacids or tetracycline's reduces absorption of iron. Separate use by at least 2 hr. - Vitamin C increases absorption, but also increases incidence of GI complications. Avoid vitamin C intake when taking medication. ·-Instruct clients to take iron on an empty stomach such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. However, iron can cause GI distress(nausea, constipation, heartburn) If intolerable, iron can be administered with food to increase compliance with therapy but this does reduce absorption. -Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. -Inform clients to anticipate a harmless dark green or black color of stool. - Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an exercise program to counter the constipation effects. -Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast).

Increased urination could be....

a signal for an underlying medical condition that may need further evaluation (such as UTI, BPH in a male, or diabetes)

MSO4, MgSO4, and MS IU, QD, QOD, u, or any version of it, and trailing zeros or lack of leading zeros are ...

all on the Joint Commission's official "Do Not Use" abbreviation list. They can be easily confused with one another and are not acceptable abbreviations.

Antipsychotics

are used to treat schizophrenia and antagonize dopamine, serotonin, and other receptors in the brain, which allows fewer of these chemicals to bind the receptors and stimulate the brain.

ALL ophthalmic medications...

can cause local irritation including itching, burning, and inflammation. These symptoms are usually transient and not serious.

Opiod analgesics

commonly cause constipation, especially in the elderly and patients on bed rest.

Bile acid sequestrates commonly cause...

constipation and can be used to treat diarrhea associated with mile acid malabsorption.

PT and INR are monitored with the use of....

coumadin (warfarin)

hyperlipidemia

diet changes should be made as a holistic approach to treating hyperlipidemia. Vegetarianism promotes healthy eating and should be encouraged.

Digoxin

has a positive inotropic effect and a negative chronotropic effect, producing increased contractility and cardiac output while decreasing the heart rate. -The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of dgoxin toxicity -nausea is a sign of toxicity and the client should be further assessed to determine if there are other indications of digoxin toxicity, such as as low apical pulse. -Digoxin has a narrow therapeutic range (0.5-2) Clients with low potassium levels can develop digoxin toxicity even when digoxin levels are not elevated. Common symptoms of toxicity include dizziness without vertigo, confusion, visual changes (blurred vision, seeing yellow or green halos), irregular heartbeat, headache, and dyspnea.

Category X medications

have been shown to cause serious abnormalities of the fetus in animals, humans, or both. Therefore, the fetal risks outweigh any possible benefits to the mother.

Benzodiazepines

increase the activity of GABA, a common inhibitory neurotransmitter in the brain. Through this action they promote a calming effect, relax skeletal muscles, and induce sleep.

Somatic pain

involves structures of the body wall, such as bone or muscles.

Labetalol

is a beta and alpha blocker that inhibits the release of epinephrine and norepinephrine. The result is hypotension, which can lead to sexual dysfunction and impotence. -Common side effects: dizziness, headache, edema, dyspnea, nausea/vomiting, and fatigue.

Aspirin

is a cyclooxygenase (COX) inhibitor that interferes with platelet aggregation. This means this platelets are less "sticky" and may decrease the risk of thrombus formation. -Tinnitus may indicate ototoxicity; therefore, the client should not take any further doses and come to the provider for further care.

Ropinirole

is a dopamine agonist used to treat Parkinson's disease. It acts by stimulating dopamine receptors in the brain. -Because it increases dopamine in the brain, an action opposite of antipsychotics, the side effects include psychosis, somnolence, and hallucinations.

Montelukast

is a leukotriene modifier which provides long-term asthma control and prevention of exercise-induced bronchospasm. The client should not use montelukast to treat an acute asthma attack.

Nedocromil

is a mast cell stabilizer, which provides long-term control of asthma.

Dilitiazem

is a non-dilhydropydridine calcium channel blocker used in the treatment of arrhythmias and/or hypertension. -Calcium channel blockers, especially dilimiazem, are generally not used to treat congestive heart failure. One reason is because peripheral edema is a common side effect. -Clients taking a calcium channel blocker may develop pedal edema and should report this to the provider.

Spironolactone

is a potassium-sparing diuretic that can cause hyperkalemia, potentially resulting in cardiac arrhythmias. -Clients who are taking potassium-sparing diuretics should not use salt substitutes as these contain potassium and place the client at risk for hyperkalemia. -can cause lethargy

Omeprazole

is a proton pump inhibitor that decreases gastric acid secretion. When combined with Coumadin, omeprazole can actually prolong elimination and increase INR. -Omeprazole should be taken before breakfast, once a day (it has a 72-hour duration, 50% efficacy after 24 hours).

Aspart

is a rapid-acting insulin with an onset of 15 minutes -Clinical trials demonstrate the optimal time for administration is 15 minutes before meals

Albuterol

is a short-acting beta-2 agonist. Instruct patients to use albuterol for acute brochospasms and ipratropium bromide as a scheduled/maintenance medication

Glipizide (Glucotrol)

is a sulfa-containing medication for type 2 diabetes. Sulfa allergies are common and all sulfa-containing medications and drug combinations can potentially cause allergic reactions. However, sulfa based antibiotics are the most common source of allergic reactions for patients.

Acarbose

is an alpha-glucosidase inhibitor that is used to treat type 2 diabetes. -it inhibits the absorption of carbohydrates, lowering blood glucose after a meal.

Ipratropium bromide

is an anticholinergic and is not a fast acting as albuterol, which is a short acting beta-2 agonist. -this is a scheduled/maintenance medication

Heparin

is an anticoagulant that inhibits the conversion of prothrombin to thrombin. -Can cause a decreased platelet count (thrombocytopenia) -inactivates clotting factors -May be used to treat an acute MI Heparin infusions require close monitoring of the patient's partial thromboplastin time (PTT)

Warfarin

is an anticoagulant. -Blocks vitamin k synthesis, which decreases the risk for blood clots. -Commonly used to treat DVT, pulmonary embolism, and atrial ibrillation -should be taken at the same time every day, usually in the evening or at bedtime

Carbamazepine

is an anticonvulsant used to treat epilepsy and for mood stabilization in bipolar disorder and epilepsy. It may also be used for chronic neuropathic pain, migraine prophylaxis, or other uses. -It has a black box warning due to the risk of Stevens-Johnson syndrome and bone marrow suppression, which can lead to leukopenia, and a granulocytosis -common side effects: liver damage, thyroid damage, drowsiness, nausea, blurred vision, dizziness, and dry mouth. -

Metronidazole

is an antimicrobial medication used in the treatment of both fungal and bacterial infections. -In rare, but serious cases, it can cause seizures. -Common side effects are: GI symptoms, dizziness, headache, dry mouth, candidiasis, and a metallic taste

Tamoxifen

is an estrogen antagonist used in the treatment and prevention of breast cancer. -side effects: menstrual irregularities, hot flashes, bruising

Cyclosporine

is an immunosuppressant used to prevent organ rejection after a transplant, severe rheumatoid arthritis, or severe psoriasis. -The most common side effects are renal dysfunction (leading to hyperkalemia), tremor, hirsutism, acne, hypertension, immunosuppression, which increases the risk of infection, and gingival (gum) hyperplasia. -An elevated serum creatinine level may indicate nephrotoxicity, an adverse effect of cyclosporine.

Beclamethasone

is an inhaled corticosteroid, which provides long-term control of asthma.

Mannitol

is an osmotic diuretic used to decrease cerebral edema and intracranial pressure. -Diuresis (increased urinary volume) and reduced intracranial pressure (ICP) should start to occur 30-60 minutes after administration as fluid is pulled into the vascular space. -hypotension is a side effect. -The greatest risk to the client receiving mannitol IV is development of heart failure; therefore, the nurse should report peripheral edema to the provider immediately.

Cutaneous pain

is located at the skin.

Midazolam

is used for conscious sedation for medical procedures. It has short half-life compared to chlordiazepoxide, diazepam, and lorazepam.

Doxycycline

is used to treat acne vulgaris. -it commonly causes GI upset and can be taken with food to reduce this side effect. -The medication is prescribed for a once a day administration. (q24)

Propylthiouracil (PTU)

is used to treat hyperthyroidism and blocks the synthesis of thyroid hormones. -Iodine is utilized in the synthesis of thyroid hormones and will interfere with the action of propylthiouracil; therefore, it should be reduced or eliminated. -The most serious adverse reaction is agranulocytosis, or education in granulocytes (neutrophils, basophils, eosinophils). This most commonly occurs during the first three months of therapy.

Beta blockers

lower blood pressure by inhibiting neurotransmitters from binding with beta adrenergic receptors in the heart. A gradual rise in blood pressure would occur if the patient builds tolerance and the medication is no longer effective.

Activated partial thromboplastin time (aPTT)

measures the efficacy of the intrinsic coagulation pathway and common coagulation pathway. This measures the effect of heparin on clotting. -The goal is a PTT of 1.5-2.5 times the control

Nitrates

promote coronary vasodilation and may also be used to treat an acute MI or angina (chest pain)

common, non life-threatening side effects of chemotherapy

rash, nausea, dizzines, and dry mouth

Visceral pain

refers to pain of body organs such as the appendix or pancreas.

Phantom limb pain

refers to the limb sensations or pain a person feels after an amputation as if the limb was still there.

Miglitol

taken orally for DM. It inhibits carbohydrate absorption and should be taken with the first bite of every meal. -It only works with food, so if the dose is forgotten at a meal, the dose is skipped. -The timing should be emphasized in the teaching because taking the medication too soon reduces the effects while taking it after meals has no effect.

Allopurinol

works by decreasing the amount of uric acid produced by the body. It is used to prevent acute attacks of gout, but it is not helpful to treat acute attacks of gout because it takes 2-6 weeks to be fully effective. -patients with gout should reduce available urates by consuming an alkaline diet low in sodium, calcium, and oxalate-rich foods. The patient should consume the drug after meals, try to consume 3L of water a day, and avoid ETOH to reduce uric acid concentrations and the risk of renal calculi. -Red meats (and other purine-rich foods) should deb avoided or eating in small amounts because they may cause an acute attack of gout. Purines are broken down to make uric acid, which is what is built up or crystalized to cause gout attacks. -Allopurinol may interfere with therapeutic drug-metabolizing enzymes that are responsible for inactivating warfarin and thereby extend the anticoagulant effects, placing the client at risk for bleeding.