ALL THE PHARM
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
