[Type text]
GENERAL
Final Review Fall 2020
What is a Loading dose? And why do we use loading doses?
In pharmacokinetics, a loading dose is an initial higher dose of a drug that may be given at the beginning of a
course of treatment before dropping down to a lower maintenance dose. A loading dose is most useful for
drugs that are eliminated from the body relatively slowly, i.e. have a long systemic half-life
Review First Past effect.
The first pass effect (also known as first-pass metabolism) is a phenomenon of drug metabolism whereby
the concentration of a drug, specifically when administered orally, is greatly reduced before it
reaches the systemic circulation.
Clinical investigation includes performing tests on healthy volunteers, and later, on selected
clients with a particular disease.
Opioids medications/pain:
Review side effects of opioids like morphine:
- Constipation, nausea, vomiting (If too much, it can decrease respiratory
rate) Pain is a very big priority- after the ABC’s and safety, pain is next priority.
Acetylcysteine can be used as an antidote for what drug? Acetaminophen toxicity
Narcan (naloxone) is the antidote for what medication overdose? Opioids
Remember nursing Process: Assessment before Interventions. ADPIE
Some opioids will cause nausea and an antiemetic will need to be administered prior to pain
medication
Opioids are contraindicated for patients with Brain Hemorrhage/ patient LOC will not be
able to be assessed appropriately due to the sedation caused by the opioids.
Review schedule II drugs like opioid restrictions as far as reordering these medications. Can
we call in for a refill?
Schedule II drugs cannot be refilled by phone order. The client must see the physician for a
refill.
NSAIDS-
Review how aspirin works. Review what education should be done for patients taking
NSAIDs.
Aspirin works by blocking the production of prostaglandins, the on-off switch in cells that regulate
pain and inflammation, among other things. That's why aspirin stops mild inflammation and pain
NSAIDs Can cause GI side effects due to non selective blockage of COX 1 and 2, if pt has history of
GI peptic ulcer or liver disease or large use of alcohol NSAIDs must be used with caution, it can
lead
, [Type text]
GENERAL
to renal impairment, increased bleeding (esp older adults) and decreased GI mucous production,
decreases prostaglandin production, decrease dysmenorrhea pain by decreasing uttering
contraction, it is nephrotoxic and pt should drink lost of fluids and make sure to eat before taking
NSAIDs,
Aspirin will take about a week to lose its effectiveness; thus, a nurse should question orders to
give aspirin to a patient that is scheduled for a surgery today
Review therapy for GOUT.
Allopurinol used as a prophylactic in order to prevent a gout attack by reducing uric acid
formation. Colchicine is used for an acute gout attack by reducing the uric acid crystals in the
joints and prevents the inflammatory response, only to be used short term. PT should avoid
beef, sardines, liver, organ meat, salmon, high purine foods and alcohol ingestion (beer) bc
of their productive nature of uric acid in the body
Diuretics/renal:
How do they work?
- Increase urinary output
- More water patient loses, will cause patient to have a drop on the weight. Thus, why
weight is the best measurement of diuretic effectiveness.
- Intake and output can also be used to gauge effectiveness. Output has to be higher
than the intake.
Hydrochlorothiazide – patient will lose potassium, so they should eat foods high in
Potassium/ they should take the medication first thing in the morning to avoid nocturia. It is
# 1 diuretic therapy used to treat hypertension. This medication should be taken daily when
used for hypertension; not just if blood pressure is high)
Whenever patient is on a loop diuretic, nurse should check potassium level. If Potassium is
abnormal notify provider, supplementation should be warranted. Normal Potassium Levels
range from 3.5-5 mEq/L
Patients with CKD if experiencing Hyperkalemia, one expects to see administration of the
following treatments: Kayexalate, Regular Insulin IV, Lasix diuretics. You would not
expect to see administration of Lantus SQ.
Review side effects for Lasix.
Ototoxic so it can lead to hearing loss. If pt complains of tinnitus, it is sign of the adverse effect.
Also can cause hypokalemia, hypotension, hyperuricemia, hyperglycemia, if the med is IV
pushed too quickly
Cardiac:
Digoxin/Lanoxin has a therapeutic index that requires it to be monitored for toxicity…
What is the maximum dose of this medication till it is considered toxic?
GENERAL
Final Review Fall 2020
What is a Loading dose? And why do we use loading doses?
In pharmacokinetics, a loading dose is an initial higher dose of a drug that may be given at the beginning of a
course of treatment before dropping down to a lower maintenance dose. A loading dose is most useful for
drugs that are eliminated from the body relatively slowly, i.e. have a long systemic half-life
Review First Past effect.
The first pass effect (also known as first-pass metabolism) is a phenomenon of drug metabolism whereby
the concentration of a drug, specifically when administered orally, is greatly reduced before it
reaches the systemic circulation.
Clinical investigation includes performing tests on healthy volunteers, and later, on selected
clients with a particular disease.
Opioids medications/pain:
Review side effects of opioids like morphine:
- Constipation, nausea, vomiting (If too much, it can decrease respiratory
rate) Pain is a very big priority- after the ABC’s and safety, pain is next priority.
Acetylcysteine can be used as an antidote for what drug? Acetaminophen toxicity
Narcan (naloxone) is the antidote for what medication overdose? Opioids
Remember nursing Process: Assessment before Interventions. ADPIE
Some opioids will cause nausea and an antiemetic will need to be administered prior to pain
medication
Opioids are contraindicated for patients with Brain Hemorrhage/ patient LOC will not be
able to be assessed appropriately due to the sedation caused by the opioids.
Review schedule II drugs like opioid restrictions as far as reordering these medications. Can
we call in for a refill?
Schedule II drugs cannot be refilled by phone order. The client must see the physician for a
refill.
NSAIDS-
Review how aspirin works. Review what education should be done for patients taking
NSAIDs.
Aspirin works by blocking the production of prostaglandins, the on-off switch in cells that regulate
pain and inflammation, among other things. That's why aspirin stops mild inflammation and pain
NSAIDs Can cause GI side effects due to non selective blockage of COX 1 and 2, if pt has history of
GI peptic ulcer or liver disease or large use of alcohol NSAIDs must be used with caution, it can
lead
, [Type text]
GENERAL
to renal impairment, increased bleeding (esp older adults) and decreased GI mucous production,
decreases prostaglandin production, decrease dysmenorrhea pain by decreasing uttering
contraction, it is nephrotoxic and pt should drink lost of fluids and make sure to eat before taking
NSAIDs,
Aspirin will take about a week to lose its effectiveness; thus, a nurse should question orders to
give aspirin to a patient that is scheduled for a surgery today
Review therapy for GOUT.
Allopurinol used as a prophylactic in order to prevent a gout attack by reducing uric acid
formation. Colchicine is used for an acute gout attack by reducing the uric acid crystals in the
joints and prevents the inflammatory response, only to be used short term. PT should avoid
beef, sardines, liver, organ meat, salmon, high purine foods and alcohol ingestion (beer) bc
of their productive nature of uric acid in the body
Diuretics/renal:
How do they work?
- Increase urinary output
- More water patient loses, will cause patient to have a drop on the weight. Thus, why
weight is the best measurement of diuretic effectiveness.
- Intake and output can also be used to gauge effectiveness. Output has to be higher
than the intake.
Hydrochlorothiazide – patient will lose potassium, so they should eat foods high in
Potassium/ they should take the medication first thing in the morning to avoid nocturia. It is
# 1 diuretic therapy used to treat hypertension. This medication should be taken daily when
used for hypertension; not just if blood pressure is high)
Whenever patient is on a loop diuretic, nurse should check potassium level. If Potassium is
abnormal notify provider, supplementation should be warranted. Normal Potassium Levels
range from 3.5-5 mEq/L
Patients with CKD if experiencing Hyperkalemia, one expects to see administration of the
following treatments: Kayexalate, Regular Insulin IV, Lasix diuretics. You would not
expect to see administration of Lantus SQ.
Review side effects for Lasix.
Ototoxic so it can lead to hearing loss. If pt complains of tinnitus, it is sign of the adverse effect.
Also can cause hypokalemia, hypotension, hyperuricemia, hyperglycemia, if the med is IV
pushed too quickly
Cardiac:
Digoxin/Lanoxin has a therapeutic index that requires it to be monitored for toxicity…
What is the maximum dose of this medication till it is considered toxic?
