Pharm ATI Exam Cheat Sheet

PHARM ATI EXAM CHEAT SHEET System Drug Name Important Information Heart - Failure Digoxin ● (cardiac glycoside●, used to treat ● dysrhythmias and heart failure) ● Therapeutic Levels 0.5-0.8 (Pg. 177) IV digoxin: infuse over AT LEAST 5min. WITHHOLD if HR LESS THAN 60/min MUST auscultate apical pulse for one full minute Toxicity: Yellowing vision, blurry vision, anorexia, fatigue, weakness, N/V, GI effects, tinnitus, Narrow therapeutic range Positive inotrope (Increase force and efficiency of myocardial contraction), negative chronotrope (Decrease Heart rate) Hypokalemia leads to toxicity, hyper K leads to decreased effect Treatment is cholestyramine (BAR) or Digibind (FAB) To prevent “Digoxin-induced dysrhythmias, avoid hypokalemia and increased serum digoxin levels Watch for n/v and general weakness. (hypokalemic) and caution with potassium supplements. Avoid any drug that affect potassium (loop diuretics, ACE Inh and ARBs) ● ● ● ● ● ● Brain - seizure Phenytoin ● (hydantoin class, ● used to treat ● seizures) ● ● ● ● ● ● ● ● ● ● Therapeutic levels 10-20 Narrow therapeutic range Gingival hyperplasia (notify dentist, use soft brush); use of folic acid supplements decreases occurrence Hirsutism, acne Enzyme inducer- decreases effects of many drugs Serum level increased when used with valproic acid or methylphenidate Toxic levels include nystagmus, ataxia, sedation, double vision, cognitive impairment Do not take with milk, decreases absorption of Vit D and Calcium May cause thrombocytopenia Check LFT’s Stop med if skin rash occurs Infuse no faster than 50mg/min to decrease dysrhythmias and hypotension Encourage clients to consume adequate amounts of calcium and vit D Brain - seizure Carbamazepine ● ● ● ● ● ● ● ● Therapeutic levels: 4-12 Hepatic Autoinducer- oral contraceptives and warfarin Blood dyscrasias (leukopenia, anemia, thrombocytopenia, bone marrow suppression) /pancytopenia Stimulates posterior pituitary and promotes secretion of ADH so hypo-osmolarity - essentially a medication induced SIADH Can cause SJS (treat minor reactions with antihistamine, wear sunscreen, and notify provider) GI distress, drowsiness, rash, nystagmus, double vision, vertigo, staggering gait, and headache Start with low dose and titrate up ● ● ● ● ● Administer at bedtime Obtain baseline CBC and platelets, and perform ongoing monitoring Observe for indications of bruising and bleeding of gums Monitor for sore throat, fatigue, or other indications of infection Hepatotoxicity- Evidenced by anorexia, nausea, vomiting, fatigue abdominal pain, and jaundice Brain - seizure Valproic Acid ● ● ● ● ● ● ● ● ● Monitor liver and pancreatic enzymes due to damage Can be used in any type of seizure Hepatotoxicity- anorexia, nausea, vomiting, jaundice, abdominal pain, fatigue Pancreatitis- nausea, vomiting, abdominal pain Thrombocytopenia- bruising; monitor platelet count Teratogenic Enzyme inhibitor N/V, indigestion- take with food Weight gain Chemo Methotrexate ● ● ● ● ● ● ● ● Used in chemotherapy, psoriasis, rheumatoid arthritis Interrupts cell production, so monitor for bleeds in GI/mucosa/gums. Use soft brushes. Protect skin. Pregnancy Cat X (stops cell production) and is used to dissolve pregnancy. Moms need to be on strict birth control. Don’t give with folic acid Give with leucovorin (prevents side effects) Due to immunosuppression, report fever to provider stat Dosed weekly Sores in mouth (stomatitis) indicates toxicity. Diuretic Mannitol ● (Osmotic diuretic●) ● Adverse effects: Peripheral edema, Pulmonary edema (can potentiate HF) ↓ intracranial and intraocular pressure - used in glaucoma Lung crackles should be recognized as an indicator of potential complications GI Sucralfate (Mucosal Protectant) ● ● Protects mucosa (ulcers) Causes constipation, so teach patients to increase fiber and fluid Pain Morphine Sulfate● ● Primary use is analgesia Teach patients about side effects: Respiratory Depression Constipation Orthostatic Hypotension Urinary Retention Can cause biliary colic Diuretic Acetazolamide (Carbonic Anhydrase Inhibitor) ● ● ● Diuretic - carbonic anhydrase Used to decrease IOP in glaucoma patients Adverse effects include paresthesias (tingling of the extremities), hyperglycemia Airway Prednisone (Glucocorticoid) ● ● ■ ■ Prevent inflammatory response by suppression of airway mucus suppression, immune responses, adrenal function Adverse Effects Hyperglycemia Water retention Peptic ulcer disease Myopathy Delayed wound healing Gradual reduction required, taper off when done Causes demineralization of bones Can lead to osteoporosis and stress fractures Prednisone is a glucocorticoid. All glucocorticoids can lead to osteoporosis.