Pharmacology Review
PPIs Suffix
-azole
Bronchodilators suffix
-ol
Calcium Channel Nursing Considerations
Administer between meals to enhance absorption Take pulse Change positions slowly
Anticonvulsants/Antiseizure Nursing Considerations
Advise females to use contraceptives Harmless urine discoloration is common Warn that may increase blood sugar levels Avoid taking alcohol Avoiding mixing other drugs in the same syringe
Albumin Indications
Ascites
Mucosal Barriers Nursing Considerations
BEFORE meals
A client who had an organ transplant is receiving cyclosporine. The nurse should monitor for what serious adverse effect of cyclosporine?
BUN/Creatinine levels to indicate nephrotoxicity
Beta Blockers Nursing Considerations
Before meals In the morning, if insomnia occurs Check pulse Change positions slowly
Digoxin Indications
CHF Atrial tachycardia Fibrillation
ACE Inhibitors Indications
CHF HTN
Doxorubicin Indication
Chemotherapy: decreases the probability of clots forming
Leucovorin Indications
Chemotherapy: diminishes toxicity of folic acid antagonists
Hyperlipedemia Examples
Cholestyramine Gemifrozil Niacin Atorvastatin (-statin)
Corticosteroids AE
Cushing's syndrome Neutropenia Osteoporosis Hyperglycemia Decreased Ca (<8.5) Decreased K (<3.5) Candidiasis Cataracts (be aware if pt has eye issues)
Calcium Channel blockers MOA
Decreases cardiac contractility and the work load of the heart Decreases the need for oxygen Promotes vasodilation
Spironolactone MOA
Excrete Na and water Reabsorb K
Loop Diuretic Example
Furosemide (Lasix)
Antacids Nursing Considerations
Give 1 hour AFTER meals Avoid giving other meds within 1-2 hours of antacid administration Take fluids to flush after intake of antacid Monitor for changes in bowel
Thiazide Adverse Effects
Hypercalcemia >10.2
ACE Inhibitors Adverse Effects
Hyperkalemia (>5.0) Dry cough Dizziness Orthostatic hypotension
Spironolactone AEs
Hyperkalemia >5.0
What drug is needed for anemia caused by blood loss?
Iron salts
Nitrate Prototypes
Isosorbide dintrate Nitroglycerine
In addition to clients who are receiving insulin for type 1 diabetes, the nurse should assess for signs and symptoms of hypoglycemia in clients who have which diagnosis?
Liver disease
Corticosteroids Indications
Maintenance therapy for asthma
Antacids AEs
Metabolic alkalosis Stone formation Electrolyte imbalance Diarrhea (magnesium) Constipation (aluminum)
Potassium Supplements Indications
Patients on diuretic treatment
Calcium Carbonate Adverse Effects
Rebound hyperacidity
Potassium Sparing Diuretics Example
Spironolactone
NSAIDs Side Effects
Stomach ulcers, nephrotoxic, hepatotoxic
Mucosal Barriers Prototype
Sucralfate Misoprostol
Types of diuretics
Thiazides Loop Potassium sparing
Cephaloycins AEs
Thrush Yeast infections
Antidepressant types
Tricyclic: amitriptyline, imipramine, desipramine MAOIs: phenelzine & tranylcpromine Second-generation: Prozac
Warfarin Nursing Considerations
test: INR Maintain normal intake of green leafy vegetables Do not take with acetylsalicylic acid (increases bleeding tendencies)
Calcium Channel Blockers Suffix
-dipine -amil
Histamin 2 Blockers Suffix
-idine ex: ranitidine
Beta Blockers Suffix
-olol
Benzodiazepines ending
-pam
Corticosteroids suffix
-prednisone
ACE Inhibitors Ending
-pril
The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. What does the nurse explain to the client regarding the purpose of the albumin?
Albumin elevates the circulating blood volume.
Nitrate Patch Nursing Considerations
Allow 10-12 hours "patch free" each day to prevent tolerance
Antacids examples
Aluminum/magnesium (Maalox) Sodium bicarbonate Calcium carbonate Magnesium hydroxide
Nitrate Indications
Angina pectoris MI Peripheral arterial occlusive disease
Types of anti-ulcer drugs
Antacids PPIs Histamine 2 blockers Mucosal barriers
Penicillins Indications
Anti-bacterial agent Limits CNS damage in syphilis
Corticosteroids MOA
Anti-inflammatory agents that reduce edema of the airways as well as pulmonary edema
When a client exhibits severe bradycardia, which type of drug should the nurse be prepared to administer?
Anticholinergic R: block parasympathetic effects
Antiplatelet Medications
Aspirin Dipyridamole Clopidogrel
To begin the administration of total parenteral nutrition (TPN), a client has a right subclavian central venous access device inserted. Immediately after insertion of the catheter, what is the priority nursing action?
Auscultate the lungs to evaluate breath sounds. R: most significant and life-threatening complication of insertion of a subclavian catheter is a pneumothorax because of the proximity of the subclavian vein and the apex of the upper lobe of the lung; a client's respiratory status always is the priority
Cimetidine Nursing Considerations
Avoid giving other drugs Gynecomastia may develop with chronic use
MAO Nursing Considerations
Avoid tyramine-riche foods: cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce, and yeast
Thiazides MOA
Blocks Na & K reabsorption Reabsorbs Ca
Loop diuretics MOA
Blocks Na, K, Ca reabsorption
Neuroleptics MOA
Blocks dopamine receptors in the limbic system, hypothalamus, and other regions of the brain
Histamin 2 Blockers MOA
Blocks histamin receptors in the stomach Reduces gastric acid secretions
Tetracyclines AEs
Bone problems
Calcium Channel Blockers Adverse Effects
Bradycardia Hypotension Headache Reflex tachycardia Constipation
Bronchodilators Indications
Bronchospasm Asthma Bronchitis COPD
Adrenergic Agents Indications
Cardiopulmonary arrest Hypotension COPD Asthma Nasal congestions Allergic reactions
Doxorubicin AEs
Cause the urine to turn red for a few days Stomatitis Hyperuricemia Cardiotoxicity = CHF & dsyrythmia
Mucosal Barriers MOA
Coats the mucosa to prevent ulcerations
Narcotic analgesics
Codeine Meperidine Morphine
Beta Blockers MOA
Competes with epinephrine at beta receptors in heart, pulmonary airways, peripheral circulation & CNS
Sucralfate Nursing Considerations
Constipation
Opioids Side Effects
Constipation Drowsiness N/V
Bronchodilators Nursing Considerations
Contraindicated in hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure disorder
NSAID (Aspirin, Ibuprofen, Naproxen) Indications
Decrease pain, fever, and inflammation
What changes does the nurse expect to find if digoxin is therapeutically effective? Select all that apply.
Decreased edema Diuresis Decreased pulse rate
Ceftriaxone SEs
Diarrhea
Aspirin Side Effects
Diarrhea N/V
Benzos Adverse Effects
Dizziness CNS depression Hangover-effect Respiratory depression
ACE Inhibitors Nursing Considerations
Don't given with K+ sparing drugs Rise slowly Do not discontinue medications because it can cause rebound HTN
Antidepressants Adverse Effects
Dry mouth Blurred vision Urine retention Constipation Orthostatic hypotension Insomnia
Neuroleptics Adverse Effects
EPS: lip smacking, fine worm-like tongue movement, involuntary movements of arms & legs NMS: fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse, muscle rigidity, seizures, orthostatic hypotension
Short acting beta agonist indications? examples?
Emergency symptom relief: wheezing, chest tightness, shortness of breath Albuterol, Levabuterol,
Niacin Nursing Considerations
Expect flushing
PPIs Nursing Considerations
Give BEFORE meals, preferably in the morning
Histamin 2 Blockers Nursing Considerations
Give BEFORE or with meals
Anti-Parkinsonian Nursing Considerations
Give after meals to reduce GI symptoms May cause harmless darkening of urine & sweat Avoid taking B6 vitamins (reversal effect) Change positions slowly (prevent orthostatic hypotension)
Calcium Channel Blockers Indications
HTN Angina Arrhythmia
Nitrate Adverse Effects
Headache Orthostatic hypotension
Erythromycin AEs
Hepatitis
MAO Adverse Effects
Hypertensive crisis
Loop diuretics Adverse Effects
Hypocalcemia <8.5 Hypokalemia <3.5
Loop Diuretics Nursing Considerations
If administered too fast, can cause tinnitus
To minimize the side effects of the vincristine that a client is receiving, what does the nurse expect the dietary prescription to include?
Increase in water R: prevents constipation
Inotropes MOA
Increases CO in HF patinets
Digoxin MOA
Increases intracellular calcium - causes the heart muscle fibers to contract more efficiently Increases CO Slows heart rate
Inotropes AEs
Increases urine output Hypotension Irregular heartbeat Dizziness Headache Fatigue
PPIs MOA
Inhibit the proton (H+) to combine with Cl- to form hydrochloric acid
Quinolones AEs
Insomnia
PTU MOA
Interferes with the synthesis of thyroid hormone
When administering albumin intravenously, what fluid shifts does the nurse anticipate?
Interstitial compartment to the intravascular compartment
Aminoglycosides AEs
Kidney problems Hearing loss
Inotropes Examples
Lanoxin, Primacor, Inocor
A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action?
Lowers the surface tension of feces
Long acting beta agonist indications? examples?
Maintenance therapy, used in conjunction with steroids Salmeterol, Formoterol
A healthcare provider prescribes transdermal fentanyl 25 mcg/hr every 72 hours. During the first 24 hours after starting the fentanyl, what is the most important nursing intervention?
Manage pain with oral pain medication. R: takes 24 hours for peak
Osmotic Diuretic Example
Mannitol
The nurse is caring for a client who is experiencing side effects from high doses of methotrexate. Leucovorin calcium is prescribed and is to be administered immediately after the infusion of methotrexate. What is the best indicator that leucovorin calcium is effective?
Methotrexate level less than 0.05 micromole
A healthcare provider prescribes doxorubicin for a client with acute myelogenous leukemia. Which specific interventions should the nurse implement? Select all that apply.
Monitor for jaundice (hepatotoxic drug) Increase fluids by mouth Provide frequent oral care Assess vital signs routinely
Digoxin Nursing Considerations
Monitor for toxicity: N/V, anorexia, halo vision, confusion, bradycardia, heart blocks - if blurred vision/yellow vision, HOLD medication & REPORT to HCP Do NOT administer if pulse is less than 60 bp Should Monitor for ARRHYTHMIAS Therapeutic Index: 0.5-2 ng/mL -Thiazide & loop diuretics, piperacillinn, ticarcillin, corticosteroids and excessive laxatives may cause *hypokalemia* which increases risk of toxicities. Licorice & stimulant natural products (aloe) may increase risk of K depletion St. Johns Wort may decrease levels and effect Use cautiously in patients with hypothyroidism & hypokalemia
Opioid Analgesics Nursing Considerations
Monitor respiratory depression and hypotension Do not give to inflammatory bowel disease patients because they are at risk for toxic megacolon d/t slowed peristalsis
When are diuretics given? MOA?
Morning Decrease blood volume
Non-narcotic analgesics
NSAIDs: aspirin, ibuprofen, paracetamol, & acetaminophen
A healthcare provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of digoxin toxicity?
Nausea
Antacids MOA
Neutralizes the stomach acidity
Misoprostol Nursing Considerations
Not for pregnant
A healthcare provider prescribes ampicillin for a client with an infection. What information should the nurse include in the teaching plan about this medication?
Notify HCP if diarrhea develops R: best absorbed with water, not food
The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?
Observe for signs of infection R: may lower WBCs
Doxorubicin Nursing Considerations
Only given intravenously Provide frequent oral hygiene & increase oral fluids
A nurse recalls that the shift of body fluids associated with the intravenous administration of albumin occurs by which process?
Osmosis
Heparin Lab & Antidote
PTT Protamine Sulfate
Hyperthyroidism medication
PTU
Bronchodilators Adverse Effects
Palpitations/Tachycardia Restlessness Tremors Anorexia N/V Headache Dizziness
Antipsychotics/Neuroleptics Drugs
Phenothiazines: chlorpromazine; thioridazine Others: olanzapine; haloperidol
Anticonvulsants/Antiseizure Medications
Phenytoin (Dilantin) Phenobarbital (Luminal)
Aspirin indications
Promotes comfort Prophylatic for MI Anitinflammatory (for RA)
Anti-platelet Indications
Prophylaxis of LT complications following MI, coronary revascularization & thrombotic CVA
The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client?
Protection should be worn during intercourse with a pregnant female. R: Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink an enlarged prostate.
A health care provider prescribes ranitidine for a client with heartburn. During a teaching session, which information will the nurse share with the client about how this drug works?
Ranitidine reduces gastric acidity in the stomach.
Acetaminophen Side Effects
Rash and itching, N/V, stomach pain Hepatotoxicity
Beta Blockers Indications
Raynaud's disease HTN Pheochromocytoma Angina Arrhythmias Mitral valve prolapse Glaucoma
Mannitol MOA
Reduces cerebral edema (decreases ICP); Decreases fluid in the brain
Plicamycin Nursing Considerations
Remove a patch after 12-14 hrs to avoid the development of tolerance Discontinue vitamin D
Potassium Supplements Nursing Considerations
Report any abdominal distress, side effects are usually GI ulcers and bleeding
What should the nurse include in a teaching plan for a client taking calcium channel blockers such as nifedipine? Select all that apply.
Report peripheral edema (signifies HF) Avoid drinking grapefruit juice Change to a standing position slowly
Aspirin Education
Report ringing in the ear (signifies aspirin toxicity) Take with food Do not chew Report persistent abdominal pain Take with a full glass of water if aspirin with food still causes GI upset
Adrenergic Agents AEs
Restlessness Insomnia Tremors Nausea Palpitations Angina Tachycardia HTN
Pulmonary TB Drugs
Rifampin & Isoniazid
Antidepressants Nursing Considerations
Rise slowly Take with food
Sulfonamides AEs
SJS Photosensitivity
Anticonvulsants/Antiseizure Adverse Effects
Sedation Drowsiness Gingival hyperplasia Diplopia Nystagmus Vertigo Dizziness Thrombocytopenia Aplastic anemia
Rifampin& Isoniazid Education
Should take 1 hour before meals or 2 hours after meals (for better absorption) Avoid foods containing tyramine (red wine, tuna fish, hard cheese) Interacts with oral contraceptives (can lead to unplanned pregnancy) Urine or tears running red-orange (expected, call HCP) Take Vitamin B6
Albumin Nursing Considerations
Slow IV rate (5-10 mL/min) Restricted fluid intake
A nurse on the Code Blue/Arrest team responds to a code that is called for a client with hyperkalemia who is experiencing cardiac standstill. What would an appropriate immediate treatment plan include?
Sodium bicarbonate R: Sodium bicarbonate decreases the potassium level. It works by increasing the movement of potassium from the blood into the cells
Nitrate Sublingual Nursing Considerations
Take BP before giving Offer sips of water (dryness may inhibit absorption) Do NOT swallow pill Protect the pill from the light Onset is 1-3 mins; give another pain every 5 minutes for a total of 3 doses
Levothyroxine Nursing Considerations
Take in the morning Monitor for signs of hyperthyroidism
Corticosteroids Nursing Considerations
Take with food Eat foods high in potassium, low in sodium Avoid taking NSAIDs Take inhaled bronchodilators first Rinse mouth after use
Non-narcotic analgesics Nursing Considerations
Take with food Monitor for bleeding complications Contraindicated for patients under 18 with flu-like symptoms Tinnitus -> toxicity!
Antiplatelet Nursing Considerations
Take with food to decrease the side effects of gastric discomfort, diarrhea, and GI bleeding Monitor bleeding time
Neuroleptics Nursing Considerations
Teach signs of EPS & NMS Photosensitivity with phenothiazine Symptom relief may not occur for several weeks
A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply.
Tremors Heat intolerance Tachycardia Insomnia HTN R: Excessive levothyroxine produces adaptations similar to hyperthyroidism
Nitrate MOA
Vasodilator, including of the coronary arteries Decreases preload and afterload
Benzos Nursing Considerations
Warn clients of injuries & falls Brief period of confusion & excitement upon waking up is common Do NOT d/c meds abruptly Avoid alcohol Rotate (don't shake) Don't mix with other drugs Associated with cleft lip -> female pt pregnant?
Beta Blockers Adverse Effects
Wheezing Hypotension AV block Bradycardia Others: depression, insomnia, vertigo, dyspnea, nasal stuffiness, cold extremities
Pancrelipase Nursing Considerations
With meals
Adrenergic agents prototype
epinephrine phenylephrine terbutaline albuterol
A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply.
hypotension pallor weakness tachycardia tachypnea