PHARM 180 Final Flashcards

Crash cart, BVM "Ambubag", Oxygen "connection Christmas tree", Suction "set up w/ yanker" , Heart monitor and crash cart Spo2

Sugammadex

They all might cause a drop in BP, Pt doesn't lose consciousness and is still mentally aware, do not decrease pain sensation.

a sedative

Atracurium, Cisatracurium (Nimbex), Rocuronium (RSI Intubation), Vecuronium , Pancuronium

Succinylcholine

can cause pt to go into malignant hyperthermia.

SS: Muscle rigidity and increase in temp

Tx: Dantrolene

AE: RR Depression and can lower BP

"-Lam and -Pam"

AE: RR depression Low BP

CI if allergic to Soy or Eggs

RN: Change the IV tubing Q12hrs

Use spiked infusion vials within 12hrs

AE: RR Depression, Low BP

Physicians assistant suicide drugs

"BARB" like barbie

Hallucinations

Good for BP concerns, and RR concerns (Asthma)

Lorazepam

Midazolam

Diazepam

*Chlordiazepoxide

Acute Anxiety, Panic Attacks, Insomnia, Muscle spasms, ETOH WD, Drug withdrawal,

CI: CNS depressants: Drowsiness, lethary

Paradoxial Effects: Hyperactice, Euphoric

Physical Dependence - taper off

Flumazenil

it wears off very so pt can go back to RR depression very quick so it is important to monitor the pt for at least 2 hours

(same for naloxone for opioids)

pt wont be able to make NEW memories

pt can't remember PAST memories.

Can not drive home, Check BP and RR before and after,

Midazolam: Pt on bedside HR monitor

Buspirone

Takes 3-6 weeks to work (not good for panic attack, Not for PRN)

Ramelteon (also Zaleplon)

Sleep ONset

Used when it is difficult falling asleep

Used to maintain sleep

**sleep Maintenance

Antihistamine (Diphenhydramine) PRN insomnia (Benadryl)

can help pt sleep

Benzo

Baclofen (most common in hospital)

Cyclobenzaprine no more than 3 weeks

Tizanidine

Carisoprodol.. no more than 3 weeks

Dantrolene -

Makes pt really sleepy

is CNS depressant , should not drive

Should not use no more than 3 weeks

MOA: increase the bladder pressure and contraction of the detrusor muscle to help in the excretion of urine

AE: SLUDGE, DUMBBELLS, Cholinergic Crisis

Oxybutynin, Dicyclomine-

AE: Dry as a bone (Dry mouth, dry eyes), Hyperthermia, flushing, Blind, Photophobia, delirium, Constipation, tachycardia

CI: BPH, Glaucoma

AE: Kidney damage, GI Ulcers, Take with food!

Aspirin- Stop 1 week before surgery: Reyes' Tinnitus (Salicylism)

Ketorolac (used a lot in hospitals) : Only take for 5 days, don't use w/ other NSAID's

Naproxen, Diclofenac, Ibuprofen, Indomethacin, Meloxicam

AE: Gastric Ulcers, Bleeding, Kidney toxicity, Tinnitus

CI: Avoid given it to pt with asthmas'

OVERDOSE ON ASPIRIN (Salicylate Posining)

S/S Rapid breathing, Tinnitus, Metabolic acidosis

RX: IF within 60min give Activated Charcoal, then gastric lavage w/ warmed NS via Ewald tube (or salem sump)

Charcoal: we give 5-10x the toxin amount

AE: CVA events, Heart Problems, MI, Kidney damage

CI: Bad if Pt has hx of heart attack (MI)

CI: Sulfa/ Sulfonamide allergy

CI: Alcohol use DO, Cirrhosis

AE: Liver damage

RN: Max for most (relatively healthy) pts is 4g in 24hrs;

RN: Antidote is Acetylcysteine

Methotrexate (MTX)

can hurt the liver (Hepatic Fibrosis) , No ETOH, Drink 2L of water/day

-Need to give Folic Acid Supplements , Leucovorin to help protect healthy cells from MTX

Hydroxychloroquine

AE: Blindness

Adalimumab (SQ), Infliximab (IV)

can reactivate TB test prior to starting, CI if any Hx of Hep B

Make sure you get a neg TB test

Rituximab + (Steriod before infusion)

Should stay w .the pt for 15min and has resuscitative equipment ready, same reactivation for TB , need Neg Test CI if ever had Hep B before

AE: Nephrotoxic, Hepatoxic, Gingival Hyperplasia, Used in transplant pts, lifelong Organ Rejection

If they have an organ transplant, they need to continue these meds for the rest of their lives. NO grapefruit juice.

Colchicine (Acute Attacks)

TX: For acute attacks,

AE: Rhabdomyolysis (we teach them to increase there fluid intake)

RN: Take with food, but do not eat high purine foods

- red meat, alcohol and fish

Do not drink grapefruit juice, ETOH: Do increase fluid intake.

Allopurinol

TX: Chronic gout

Avoid high purine foods: ETOH, Red meats,

Duloxetine, Pregabalin, Gabapentin, Pyridoxine (Vit B6)

AE: Drowsiness

All these drugs prevent bone loss, can cause Hyper Ca+ Constipation.

Ca Acetate (Phoslo)*** CKD.. Reduces Phos in ESRD patients.

Alendronate, Ibandronate, Risedronate, Zoledronic Acid

AE: Stomatitis, NV, Abd Pain, Jaw Necrosis and Dysphagia, Blur Vison, Muscle/joint pain

Sit up for 30min Post Admin, Give on Empty Stomach 1st thing in the morning with water.

AE: Blood clots, DVT's, Hot flashes

PT: Notify is planned immobilization (travel, surgery)

Full Agonist: Fentanyl, Hydromorphone

Antagonist: Naloxone

Make sure to monitor pt for RR Depression (12-20)

Pinpoint Pupils, RR Depression, Decreased LOC (Coma)

Naloxone - You worry about it wearing off before the opioids do.. stay w patient for 2 hrs.

It takes 12-24 hrs to achieve the desired therapeutic affect.

Triptans: Sumatriptan, Rizatriptan (Maxalt)

- can take first dose 2hrs before and if it does not work after 2hrs they can take another dose and that is it, In pt w/ MI history, because litter arteries vasoconstrict so it decreases heart flow.

Ergots (Ergotamine)

If patient take this med, they cannot take a Triptan.

drugs ending in - Caine are local anesthetics.

we commonly add epinephrine to the local anesthetic.

- it extends the action, will make it work longer and decrease the potential for side affects.

Hypothyroid

metabolism is low, weight goes up, everything else goes down, HR,BP,RR

levothyroxine (Synthroid)

hyperthyroidism, HTN, Increased HR, Seizures, tremors, insomnia,

PO - 30-60min in the morning before breakfast on an empty stomach

once they take it they have to take it forever; hold if HR is over 110

it is less common and harder to treat. If it is bad they will need surgery. They can take Methimazole or PTU (if preggo)

Indications: Euthyroid state before/after surgery

A/E: Agranulocytosis/Pancytopenia

S/S Monitor sore throat, fever

Hypothyroidism (drowsiness, depression, weight gain, edema, bradycardia, cold intolerance, low bp)

RN: Monitor for bradycardia

Indications: Deficiency, AIDS wasting, Cachexia

A/E: Hyperglycemia S/S Renal Calculi

RN: Adjust insulin, monitor for flank pain, drink plenty of fluids, rotate injection sites.

it is a synthetic ADH

hx of heart attack, bad angina, heart problems,

pt should be on ekg because it constricts pt coronary arteries.

can make the brain swell (water intoxication) , S/S decreased Na Low Na can cause Seizures.

interactions: Lithium

monitor serum Na; monitor I&O closely, monitor urine SG

cortisol, Cortisone (Glucocorticoids), w/o cortisol the stress can kill you.

Beclomethasone, Fluticasone, Budesonide

MOA: Synthetic version of body's natural cortisol made in adrenal gland

we need to increase dosing in times of stress, illness, and injury or surgery.

It can suppress adrenal gland function (if po), Ask the MD @ Q OD Dosing, Do not stop abruptly, taper off

H. Pylori, it can create ulcers, it can live in the acid in the stomach

test with urea breath test,

with 3 medications, clarithromycin, amoxicillin, metronidazole, tetracycline

Probiotics: Saccharomyces Boulardii

Prophylactically helps prevent diarrhea, C. Diff

calcium and aluminum

magnesium

MOA: Decreases acid production

Indications: Peptic ulcers, GERD

A/E: CNS Effects

Cimetidine= Gynocomastia, ED, PNA

stop smoking because it delays wound healing, vasoconstrictor so it decreases blood flow, no alcohol can irritate the Ulcer, avoid taking NSAID's

A/E: can decrease Vit D, Absorption, which can cause osteoporosis, also lower B12

pernicious anemia - tongue gets inflamed.

Sucralfate, forms a barrier over the ulcer S/S Bleeding

RN: Increase dietary fiber and fluid intake

relieves symptoms of ulcers, CI: Pregnancy

Makes sure you do pregnancy test before giving it

bulk forming - Psyllium Husks (Metamucil) Need to drink H2O

Surfactant Laxatives - Docusate Sodium makes poop soft "stool softener"
Stimulant - Bisacodyl, Senna, Stimulant Laxative.. no milk within 1 hr of Bisacodyl supp can cause burning sensation

Osmotic - Really makes you go, magnesium hydroxide (MOM) Mag citrate, sodium phosphate

PEG, Lactulose, Sorbitol, Sodium Polystyrene Sulfonate (Kayexalate)

Indications: Constipation, Emesis

CI: GI Obstruction, w/ seizure history, pheochromocytoma, parkinsons

A/E: EPS (Tardive Dyskinesia), NMS, Sedation

RN Teaching: monitor for involuntary movements, do not drink ETOH

A/E: Atropine, added so pts do not take high doses of this drugs

Interactions: ETOH and other CNS Depressants

monitor dehydration, Avoid drinking 3 things: ETOH, Caffeine, water

not a controlled substance

CI: UC, Bloody stools, Diarrhea w/ high fever, or caused by ABX

Indications: Often used to reduce amount of stool in people w/ ileostomy

Monitor dehydration

Avoid drinking: ETOH, Caffeine, water, tonic water, grapefruit juice

Anticholinergic: scopolamine; A/E: Anti-ach, not for BPH/Glaucoma pts

H1 antihistamines: Dimenhydrinate (Motion sickness)

Give 30-60min prior to activity; not for BPH/glaucoma pts

Serotonin antagonists: Ondansetron (Zofran)

Has aspartame (CI in PKU); AE prolonged QT interval, headache, Dizziness

Dopamine Antagonists: Prochlorperazine, Metoclopramide

TX: For ETOH use DO

Certain malnutrition pts

contains: multivitamins, B Vit. Folic acid/Thiamine, magnesium

Used when won't be able to eat more than 7 days. A.E: Infection

RN: Give through a filter, start infusion slowly, do not stop abruptly as can cause fatal hypoglycemia, if bag empty or no replacement available then hang D10%W

Change tubing every Q24hrs for TPN

Q12 hrs for lipids.

increase glucose and potassium

A/E: Hypoglycemia, Hypokalemia, lipodystophy

How do you store the vials?

unopened: in fridge until expiration date

opened: room temp for 1 month.

onset: 15-30min

Peak: 30min - 2.5 hrs

Duration: 3-6hr

onset: 30min - 1hr

Peak: 1-5hr

duration 6-10hr

Onset: 1-2hr

Peak: 6-14hr

Duration: 16-24hr

onset: 70min

Peak: none- levels are steady

Duration: 18-24hr

A/E: Lactic Acidosis

CI: ETOH, Renal impairment

CT scan with contrast, usually stop before test, and hold for 48hrs afterwards and until normal BUN/CR

RN: NO ETOH

RN: Is a PO med that does not need insulin/pancreas to function

Generic name:

Midazolam

Acetaminophen

U.S. Pharmacopeia

Non prescription drugs

Placed into one of five schedules

Marijuana (Cannabis)

Cocaine

what is the med given for?

Like prochlorperazine and metoclopramide

have weird tics and twiches, might never go away

reason to NOT give/prescribe the drug to pt

to prevent constipation in pt receiving opioids

Prescribed for a different use than what it was made for

calcium

it is called a drug interaction

cinnamon, garlic, gingko, ginger, ginseng

GI Tract

gets broken down

10 to 4mg - first pass effect, it happens in the liver when taken PO

What effects metabolism?

Grapefruit juice, other drugs, pt body size/weight, age, activity level

Gets delivered through the blood

exit the body

drugs/chemicals that cause birth defects

long stays in body for long times, short half-life stops working quickily.

Rapid decrease in pt response to drug

Unexpected increase in effects when 2 drugs are given together

Salivation/Sweating, Lacrimation, Urination, Diarrhea, GI Upset, Emesis, Bradycardia, Bronchoconstriction, Bronchorrhea

Diarrhea, urination, Miosis, bradycardia, bronchoconstriction, bronchorrhea, emesis, lacrimation, salivation, sweating

A/E: Dehydration, Drop BP, Hyponatremia, Hypokalemia, Hypocalcemia, Hypomagnesemia, Hyperglycemia, Hyperuricemia, Ototoxicity/ Tinnitus

RN: Check BP before give, Daily weights, weigh at same time everyday, same amt of clothing/bedding

Do not take in evening (Nocturia)

Get up slowly, be aware of ortho hypotension risk

Request Potassium Supplement

Causes of Loop Diuretics

Lay down 5min, Standing 1min, Standning 3min

A.E: Dehydration, Hypotension, Hyponatremia, Hypokalemia, Hyperglycemia, Hyperuricemia, Hypercalcemia

*good for pt w. tinnitus

A/E: Hyperkalemia , Hyponatremia

A/E: Endocrine effects, deep voice, hirsute, irreg menstrual cycle; gynecomastia, impotence

Triamterene causes Blue Urine

Ka levels go up, it is dangerous when taking concurrently that also cause ka to rise.

CI if Kidney failure, pregnant

Ca Chloride

IV: Sodium Bicarbonate

Iv Insulin: D50

IV Loop Diuretics

Neb Beta-agonist (Albuterol)

PO or Supp Sodium Polystyrene Sulfonate (Kayexylate)

TX: Reduce intracranial and intraocular pressure

A/E: HF (Fluid overload)

Can form crystals, draw up in syringe using filter needle, or use a filter IV tubing set, see if visible crystals in the vial then warm and agitate

A/E: GI distress

Take 1hr before meals, on an empty stomach.

but food greatly decreases absorption.

Teeth Staining

Dilute liquid with water or juice and use a straw w/ liquid form (teeth) rinse mouth afterwards. Do not keep on teeth because it can stain them.

Stools can become black or dark green.

anaphylaxis and you tx it with Epinephrine 1 to 1,000 concentration IM but can be given subcu as well.

know antidote is deferoxamine

it tx pernicious anemia

monitor for S/S of B12 deficiency (Red beefy tongue)

pallor, neuropathy, encourage to eat foods high in B12

Tx: Supplement for alcohol use DO (due to poor dietary intake and injury to the liver)

TX: ETOH DO

TX: Certain malnutrition pts, homeless, pysch

TX: Hypokalemia, concurrent w/ Diuretics or steroids; replacement after prolonged diarrhea, laxatives, vomiting etc.

CI: Renal Disease

Assess ability to swallow - PILL IS HUGE, don't dissolve tablet in mouth, take w. meals, never give IV push, IV Infusion give peripheral no faster than 10mEq/hr. central...20mEq/hr.

Torsade de pointes: IV Magnesium is first line tx

If administering IV magnesium, then put on monitor (any electrolyte)

S/S Pallor/Swelling, site feels cool

stop the infusion, remove the bad IV

vesicant medication

EG: Epi, Potassium chloride, Dopamine

Stop the infusion, leave bad IV to infuse antidote, Notify the M.D.

(Packed red blood cells)

we get the blood from blood bank

Blood tubing, has 2 filters, with NS only.

start admin of blood within 30min of pickup at the blood blank, never administer any medications in a line that is infusing blood product.

finish within 4hrs

Temp increase to >1.8 deg, other concerning S/S: SOB, Drop SBP, Hives

if it occurs:

stop the infusion, notify MD, save blood and old tubing for blood bank (they will test)

Tx: pt who gave AIDS, Cachexia and other muscle wasting conditions.

instruct clients use gel formulas to wash their hands after every application due to the Possibility of skin-to-skin transfer to others.

A/E: Decreased libido, Gynecomastia, decreases PSA levels.

RN/Teaching is usually lifelong therapy,

female clients shouldn't handle medication (wear gloves!) avoid semen.

therapeutic effects can take 6 months or longer: SLOW.

A/E: Hypotension, Dizziness, retrograde ejaculation

CI: Client start using sildenafil or NTG; Hx of syncope

RN/Teaching: Monitor BP, especially at the start of therapy and with changes of dose.

usually lifelong meds, take tamsulosin 30min after meals, works fast 48hrs!

A/E: MI, sudden death, OH, Priapism, sudden hearing loss and visual char

CI: **Any client taking Nitroglycerin NTG, or nitrate drug such as isosorbide dinitrate** do not drink grapefruit juice

report erection lasting >4hrs

teach pt to avoid hot showers, because giving NTG ask if pt has used male enhancement in last 48hrs

TX: contraception

CI if >35+ and smoker

A/E: Endometrial, breast, and ovarian CA

PO: Do not place patch near breast, waistline

A/E: Hypercoagulability (DVT, Stroke, MI)

Avoid Cig smoking/ nicotine products.

A depot injection Releases slowly overtime

RN: Use gloves if you are or could be pregnant

Implants (Nexplanon) must be replaced in 3yrs

IUDs lasts 3-10yrs

A/E: Last syndrome Local anesthetic systemic toxicity

RN: know that Epinephrine is added to the local to extend the action of the drug and prevent it spreading away from the site of incision .. helps prevent LAST

Medical emergency

"status asthmaticus"

Early signs - anxiety, confusion and restlessness

Late signs - cyanosis, hypotension (sys. failure)

no, they will take drugs daily to improve breathing, but it is nonreversible.

chronic meds are maintaince meds

B - Beta Adrenergic Agonists

A - Anticholingerics

M - Methylxanthines

S- Steroids

L - Leukotriene

M- Mast cells

BAMs are primarily Bronchodilators and SLaMs are primarily anti inflammatory.

tx: prn for acute asthma attacks, acute breathing problems, bronchospasms

**Use B2 agonist first, wait 5min before using steroid inhaler**

Status Asthmatics meds

IV terbutaline - Peds

IV Epinephrine (B1 & B2) , IV Isoproterenol (B1 & B2) affect the heart increase HR

We also give IV steroid during status - Methylprednisolone

Not used for PRN acute breathing problems

A/E: Tachy, Angina, MI

A/E: Hyperglycemia, hypokalemia

A/E: insomnia, tremors

Avoid use of caffeine

report HR >20-30/min

Shake MDI, Exhale, Put MDI in mouth, Press button and inhale slowly and deeply at same time, try and hold breath for 10 secs, exhale

- wait 1-2 min between puffs same med

- wait 5min between different meds

A/E: Dry mouth

CI: Soy peanut allergies, caution BPH Glaucoma

Do not swallow capsules.

Epinephrine

IM 0.5mg of 1:1,000

A/E: Dysrhythmias, tachycardia

CI: not with caffeine

Therapeutic range 5 to 15 mcg

Smoking increases theophylline metabolism

tx: inhaled Q daily for long term prophylaxis in COPD, chronic severe asthma

Status Asthmaticus (IV Methylprednisolone)

A/E: Candidiasis/ Hoarseness,

Prevent by rinse in mouth with water

treat with Nystatin preparation (swish and spit/swallow) avoid eating for 15min

TX: long term asthma maintenance therapy in adults and children 1yr+ seasonal allergies maintenance is a PO chewable pill

A/E: SuicudaLLL ideation, LLiverr injury

CI: Cirrhosis

Obtain : LLLL (Lfts ALT/AST)

PO once daily at bedtime

TX: Exercise Induced Bronchospasm adults

A/E: Metallic taste, burns throat.

15-30min before exercise

Used to thin mucus., give zofran (Ondansetron) before giving.

A/E: Bronchospasm

RN/Teaching: Suction setup for emesis/aspiration

Smells like rotten eggs,

Tx: Chronic non-productive ("dry") cough

CI: Etoh and CNS depressants, No codeine in children <12 yo , breastfeeding

Mimic an opioid but is not one.

Potential abuse as can instill euphoria in high doses but no prescription us required.

MOA: Numbing certain nerves in the lungs and airways, lessening the urge to cough.

Might cause mucus to build up in these areas.

MOA: Sympathomimetic

A/E: Rebound congestion, CNS stimulation, agitation, can keep you awake.

RN: Short term therapy no more than 3-5 days!

for "Wet" cough

take with full glass of water drink lots of fluids

moa: Decrease inflammation

Clear blocked nasal passages with a topical decongestant prior to glucocorticoid admin

TX: Itching, sneezing, seasonal allergic reactions, rhinorrhea, motion sickness,

CNS: Drowsy, confusion

Anticholinergic like effects - Dry mouth, dry eyes

GI: GI upset (can take with food to minimize)

AVOID CNS depressants avoid driving, increase fluid intake.

A/E: RR depression

ci: <2yr YO or breafastfeeding

<6yr

COPD, OSA

tx: allergies, itching, sneezing, rhinorrhea, urticaria, lacrimation, redeyes

RN: Take with water, do not take with fruit juices