Pharmacology Exam 2

Glucovance

(glyburide and metformin HC1) is a combination of two oral diabetes medicines that help control blood sugar levels for people with type 2 diabetes who do not use daily insulin injections.

Cetirizine (Zyrtec)

-2nd generation antihistamine -non-sedating -Anticholinergic effects: GI(nausea and vomiting) and paradoxical effect(excitation in children)

Salmeterol

-LABA (Long-acting beta-agonist) -Dosing on fixed schedule not PRN -Used in asthma and COPD. -If taken for asthma combined with a glucocorticoid -Slow onset of action and will not abort an acute bronchospasm

Albuterol

-SABA (Short-acting beta agonist) -Treats wheezing and shortness of breath caused by asthma and COPD -Quick relief -taken PRN

Diphenhydramine(Benadryl)

-first generation antihistamine -Side effects include sedation and anticholinergic effects: GI(nausea and vomiting) and paradoxical effect(excitation in children)

max dose of acetaminophen daily

4000mg/day

Short insulin such as Humulin R and Novolin R have a peak time of

2-3 hours

Osmotic laxatives such as magnesium hydroxide (milk of magnesia) side effects

Acute renal failure- Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication.

Propylthiouracil (PTU) adverse effects

Agranulocytosis (most serious)- neutrophil account less than 100, high risk for infection Hypothyroidism Can cause severe liver damage

Memantine

Alzheimers In patients with mild renal impairmenta dosage reduction may be needed Patients with severe renal damage contraindicated Monitor BUN and creatinine

Donepezil

Alzheimers Will not STOP disease progression but may slow it

Flumazenil is the antidote for

Benzodiazepines

Stimulant laxative examples

Bisacodyl [Dulcolax] Senokot (Senna)

Anti-anxiety drug Grapefruit juice may increase amount of this in the body

Buspar

Insulin:Intermediate Duration NPH insulin (Humulin N, Novolin N) facts

Cloudy - only cloudy insulin; roll to mix without bubbles Only insulin suitable for mixing with short duration insulins* clear before cloudy

What insulin do you never mix with other insulins

Detemir (Levemir), Insulin Glargine

Most commonly used antidiarrheal agents

Diphenoxylate [Lomotil] and loperamide [Imodium]

Propylthiouracil (PTU) therapeutic uses

Graves disease

Ondansetron [Zofran] is an antiemetic. Its main side effects include

Headache, diarrhea, dizziness, *prolonged QT interval*, risk of torsades de pointes

Protamine sulfate is the antidote for

Heparin

When using a product such as laxatives that are sodium phosphate products watch out for

Hyperphosphatemia, which can cause acute, reversible renal damage and possibly chronic, irreversible renal damage

MAOIs adverse effcts

Hypertensive crisis from dietary tyramine warning: foods with tyramine include aged cheese, cured meats, pickled vegetables, alcohol

Intermediate acting insulins have peak times of

Isophane(NPH) (6-12 hours), Detemir(3-14 hours)

Used for all forms of hypothyroidism

Levothyroxine(Synthroid)

Rapid insulins such as Lispro and Aspart have a peak time of

Lispro(1 hr), Aspart(40-50 mins)

Metoclopramide [Reglan] is an antiemetic. Its side effects include

Long-term high-dose therapy: Can cause irreversible *tardive dyskinesia (TD)*, also sedation and diarrhea common

Mitoxantrone

MS, every 3 months

Biguanides: Metformin(Glucophage) monitor

Monitor renal and liver function at start and annually

Oral anti-diabetic agent facts

NOT THE SAME AS INSULIN AS MUST HAVE SOME BETA CELL FUNCTION IN PANCREASE TO USE Actions- Stimulate release of insulin from pancreas

A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?

Never abruptly withdraw therapy.

Management strategies for NSAIDs side effects

Proton pump inhibitors

Glatiramer acetate (Copaxone)

Therapeutic uses: long term therapy of relapsing/remitting MS

A patient takes levothyroxine (Synthroid) 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed?

Thyroid-stimulating hormone (TSH)

Lamotrigine

Treats epilepsy seizures and bipolaer disorder Important warning: may cause rashes, Stevens-Johnson syndrome

What does a stimulant laxative do?

Two effects on bowel: Stimulate intestinal motility and Increase amounts of water and electrolytes in intestinal lumen

DKA presentation

Type 1, Fruity breath (caused by the production of acetone, a type of ketone) Kussmaul respirations Ketones in urine

HHS presentation

Type 2, profound dehydration

vitamin K is antidote for

Warfarin(Coumadin)

What do surfactant laxatives do?

absorbs extra water and fat into stool to soften stool

acetylcysteine is the antidote for

acetaminophen/tylenol overdose

Antibacterial activity is highest at a neutral pH and thus can be enhanced by reducing gastric acidity with an _________________ agent (for example, omeprazole)

antisecretory: Proton pump inhibitor (PPI)

In simple terms Metformin does what?

lowers the amount of sugar your body makes and absorbs from food

Salicylates and NSAIDS notify provider if

black or tarry stools

transdermal fentanyl patch

management and treatment of chronic pain and cancer pain Avoid direct external heat source bc it can cause fentanyl to be absorbed faster

Very long acting insulin such as glargine have a peak time of

continuous, no peak time

Surfactant laxative example

docusate sodium (Colace)

Treatment for Addison's disease

glucocorticoids

guidelines recommend using at least two antibiotics for which bacterial infection?

h. pylori

Regular insulins such as humulin R and Novolin R are short acting and are the only type of insulins approved for

infusion therapy, also can be given subq

Biguanides: Metformin(Glucophage) interactions

iodinated products (hold before and after all procedures involving dye until renal function confirmed as okay; often held 48 hours before procedure until 48-72 hours after procedure

Drug Interactions w/ Cholinesterase inhibitors

meds that block cholinergic receptors such as -1st generation antihistamines -tricyclic antidepressants(TCAs) -conventional antipsychotics thesec an all reduce an individuals response to cholinesterase inhibitors

Should you stop using a long acting inhaler if you have an acute bronchospasm response?

no

Narcan is the antidote for

opioids

Salicylates (aspirin) suppress

platelet aggregation

Glipizide tells your pancreas to

release insulin

Benzodiazepine lorazepam (Ativan) is recommended for first-line management of

seizures

Laxatives for opioid use over 2-3 days

stimulant

Insulin lispro (Humalog) Insulin aspart(Novolog) are rapid acting insulins and are given by what route

subcutaneous

Lamotrigine (Lamictal)

treats epilepsy and bipolar disorder. ADVERSE RXN: Steven Johnson Syndrome

Which patients should NOT get Biguanides(Metformin)

§Pts with renal insufficiency (GFR <30) §Liver disease §Severe infection §History of lactic acidosis §Excessive ETOH consumption §Shock

Beta Blockers (Propranolol) for hyperthyroidism

•Can suppress tachycardia, tremor, anxiety and other symptoms of Graves' disease •Benefits derive from beta-adrenergic blockade, not from reducing levels of T3 or T4 •Beneficial in thyrotoxic crisis •Does not treat hyperthyroidism, only the symptoms**