ATI Pharmacology Review-Good One!!
Cephalosporin -broad spectrum -ceph/cefs -Similar to PCN/ don't give if PCN allergy -can cause bleeding w/ other bleeding meds monitor bleeding time (tonsil story) - Disulfiram reaction (puke & puke & puke) just like Flagyl, the protozoal drug - Store in fridge & take with food ALL antibiotics have these side effects - allergy, hypersensitivity - suprainfection - organ (kidney & ear) toxicity - lowers OC effectiveness Vancomyocin - serious infections like MRSA - colitis by c-diff - ototoxicity: get hearing test, tell dr. if hearing getting worse -given over 60 minutes Tetracyclines - Sumycin, Doxycycline (Vibramycin) - broad, rocky mtn fever, lyme disease, acne, GI infections by H. Pylori - bad GI discomfort - Don't give to kids ≤8; teeth permanently yellow - Bad photosensitivity- wear sunscreen! - Can't take with milk, iron, or antacids - Take on empty stomach with a full glass of water When is Arythromycin given? What class of drugs is it? worse adverse effect? When pt allergic to PCN and needs abx. Bacteriostatic inhibitor bad GI issues Aminoglycosides ototoxicity, Renal toxicity, Can't take with PCN at all! - gentamicin, neomycin, streptomycin TMP-SMZ -Contains Sulfa - use for UTI - Blood problems; get CBC baseline -photosensitivity wear sunscreen and glasses! - empty stomach with a full glass of water Isoniazid (INH) -antiTB - take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp. - Liver toxicity (hepato) check liver fxn - Don't take with alcohol (liver fxn remember?) - Take on empty stomach Antiviral: Acyclovir, Ganciclovir Teratogenic preg. X; put on rubber gloves if topical! remember my purple glove experience -thrombocytopenia, lowers WBC What class of drugs if Flagyl? What is the weird effect it has? protozoal. works on C. diff & H. Pylori PUD. Antibuse effect if taken with alcohol Amphotericin B anti-fungal. HIGHLY TOXIC - infusin rxns (fever and chills) - nephrotoxicity - hypokalemia - hepatoxicity - gynecomasita - C/I with aminoglycosides (just like PCN) -azole Fungal ______ causes malignant hyperthermia. Use ____ to stop it succinylcholine, Dantrium/Dantrolene. Morphine adverse effects -Constipation -Resp depression -urinary retention -Sedation - Orthostatic HOTN - Cough suppression Morphine drug-drug interactions (think of what morphine does to the body) - MAOIs -anticholinergics -CNS depressants -hypotensive drugs -opiod antagonists (narcan) - antihistamines Morphine patient education re how to take Take with food for N/V, lie still will help Opiod withdrawl (stop abruptly is taking ≥6weeks). Is it life-threatening? Will it subside? sweating, restless, agitated, dilated pupils, tremors, tachycardia, increased BP, N/V, cramps, muscle spasms with kicking movements. NO, subside in 7-10 days. Migraine medicine & can you take them right after each other? vasoconstriction, ergot's and triptans. NO, space out ergot and triptan by at least 24 hours. What pain meds reduces fever? ibuprofen, tylenol What pain med reduces platelet aggregation? NSAIDS (aspirin), reduce thrombus but will bleed easier, too What pain med reduces fever but has NO anti-inflammatory effect and NO platelet effect? tylenol What can give child Reye's syndrome if they have viral illness? Aspirin NSAIDS education w/ how to take med. NSAIDS= with food, milk, or full glass of water to reduce gastric discomfort. Ibuprofen, Celebrex, Naproxen, Aspirin acetaminophen max dose/day? 4 grams When to withhold morphine/opiates RR 12/min & notify Dr Triptans & pregnancy Triptan= Teratogenic. Pregnancy X Rheumatoid Arthritis Drugs name potent toxic drug DMARDs, 1st choice: methotrexate. Bone Marrow Suppression and Fetal Death Methotrexate: most concerned about... bone marrow suppression; Baseline CBC and platelet counts, What are the s/s of circulatory overload? Seen if giving too much fluids flush, SOB, cough, heart palpitations What type of diuretic is not effective in renal failure? Thiazide - HCTZ Bumex is ___x more potent than lasix 40 Thiazide diuretics are good for the ___ and perfect for the eldery __ with HTN bones, woman Lasix drug-drug interaction: for manic depressive ppl it'll get to toxic levels in the body Lithium will become toxic Signs of hypokalemia weakness, dysrhymias, increased cardiac sensitivity of digoxin, ileus, Flat T wave Aspirin toxicity symptoms Tinnitus, HA Glucocorticoids adverse effects potent; suppress adrenal glad fxn, hyperglycemia, osteoporosis, if taken with NSAIDS, increase risk of GI ulcer, mask infection and suppress immune system Reo Pro (-mab) what is it for & adverse effects. What other use does Reo Pro have? Immunosuppressant for RA, Lupus. toxic to bone marrow, acute pulm edema, infection risk, neoplasia risk. Antiplatelet action. Classic CNS depressant drug classes and what they're used for Benzodiazepines, Barbituates. Anxiety. -lam & -pam are the endings for ________ Benzodiazepines Benzodiazepine Lorazepam (ativan) increases the possibility of ______. seizures Benzodiazepine antidote? Romazicon 1/2 life of 1 hour Other anxiolytics: and what they're for -Valproic Acid: anti-seizure, bi-polar - Phenergan: NV, anxiety, extrapyramidal effects Amitriptiyline (Elavil) drug drug interactions and how to take med Anticholinergics b/c TCA already have anticholinergic effects - void prior to dosing & take at bedtime to sleep through fatigue side effect MAOI's ___ line of choice for depression b/c of the adverse effects with _____. If eat _____ will cause an _____ ______ 2nd or 3rd, tyramine. Tyramine, hypertensive crisis MAOI adverse effects are related to stimulation of the _____ and include: SNS, CNS stimulation, CV-hypertensive crisis, palpitations, Liver toxicity 1st drugs of choice for depression and are equally as effective as _ _ _ but don't see _____ & ____ SSRI, TCA, hypotension and sedation SSRI drug examples: prototype and 2 popular drugs Prozac, Celexa, Zoloft Atypical antidepressant _______ better use in elderly Wellbutrin SSRI uses depresssion OCD bulimia PTSD Panic attacks Social phobias PMDD What time of day to give SSRI Give in the AM for optimal effects Lithium is used for Bipolar Disorder Valproic Acid is used for Anti-seizure Lithium and Diuretics toxicity if taking diuretics Anti-depressants have ___________ effects anticholinergic: dry mouth, constipation, lack of sweat, lack of voiding Antidepressants and anti-anxiety meds may take _ to __ weeks to take effect 1-3 weeks all anti-depressants have _____ ______ effect and pt must have their __ monitored orthostatic hypotension. BP If patient taking an antihypertensive and just got ordered MAOI, Nardil, Marplan, or Parnate, then... monitor their BP and call the Dr if theres a significant drop and may need to reduce the anti-htn dosage Lithium and Triptans? Safe in pregnancy? NO both lithium and triptans are teratogenic Therapeutic Levels of Lithium 0.4-1.0 mEq/L. Take 2-3 times a day. Chemotherapy Agents, name as much as you can! neosar (cyclophosphamide), methotrexate, doxorubicin, tamoxifen Cyclosporine is an _________ immunosuppressive drug PTT lab value should stay at _________ for what medication? What is the therapeutic PTT level? 2 times the baseline, Heparin. 60-80 seconds To prevent HIT, stop heparin at platelet count of ________ 100,000 How to inject heparin, starting from drawing up draw up with 22-25 ga needle from vial, then use 25 or 26 ga to put into abdomen 2in from umbilicus. Drug to help with heparin overdose Protamine Sulfate Warfarin C/I (2) liver failure (no clotting proteins will lead to too much bleeding), alcoholism (additive risk of bleeding) Lab values to watch with Warfarin -PT (18-24 sec) -INR (2-3) patient education with aspirin (food-wise) take with food Prevention of strokes, MI, and reinfarctions can be accomplished with low-dose aspirin of ___mg 81 mg Thrombolytic drug prototype Streptokinase, dissolves clots that have already been formed When should thrombolytics, streptokinase, be given? 4-6 of onset of symptoms Do/Do not mix any medications in IV with thrombolytic agents DO NOT What medications are usually given with thrombolytics, streptokinase? (think when this drug is used) Beta-blockers to lower myocardial oxygen consumption H2 antagonists like Zantac or PPI like Prilosec to prevent GI bleeding Ferrous Sulfate use Iron Deficiency Anemia Ferrous Sulfate Patient Education (adverse effects, among other things) -GI distress however can't take with food b/c that will decrease it's absorption greatly -Teeth staining; drink w/ straw or dilute in water or juice and rinse mouth after swallowing - Don't take with tetracycline, or antacids -Poop will be a harmless dark green or black color - Drink more water and exercise more to counter constipation effects why would a patient be given vitB12-cyanocobalamin pernicious anemia, partial removal of stomach What vit/min masks the signs of Vit b12 deficiency? folic acid E-alfa, hematopoietic growth factor, is dependent on adequate levels of ___ ___ & ___ Iron, Folic acid, Vitamin B12 In giving whole blood, what do you do before and during? obtain vital signs, stay with the client and monitor VS q5 min for 15 minutes When giving whole blood, what do you need the 2nd person for? check identification of the donor blood and recipient, blood compatibility and expiration date. Only give blood products with what type of IV fluid? 0.9% NS. anything else will cause lysis of the RBC Bronchodilator albuterol: therapeutic uses Prevention of asthma attack long-term control of asthma Short acting treatment for asthma attack Bronchodilator side effects; overall stimulation of the B2-adrengeric receptors... tachycardia, angina How to use a MDI (metered dose inhaler) shake the inhaler, 1/2-2 in away from mouth and tilt head back slightly and open mouth wide. press inhaler same time you breath in deep. Hold breath for 10 seconds. Wait 1 full minute b4 another puff. When prescribed a beta2-agonist and an glucocorticoid, which do they inhale first? the beta-2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid What does the med theophylline do? short term or long-term control? relaxes bronchial smooth muscle and does bronchodilation. Long-term control of asthma attacks. Inhaled atrovent what class of medication is it anti-cholinergic used for long term control of asthma Glucocorticoids for asthma are used for _____ and oral glucocorticoids are only give for ___-___ days long-term control of asthma attacks. 3-10 days Codeine is used for ___. classification of drug? chronic, non-productive cough. it's an opiod. Codeine adverse effects -CNS effects -GI distress take with food and increase fluids! Mucomyst (Acetylcysteine) is a mucolytic and it's therapeutic effect is to: make nasal and bronchial secretions watery to enhance their passage Mucomyst's adverse effects are: (think of its effect on mucus) aspiration and bronchospasm What does Mucomyst acetylcysteine smell like? How to take it? rotten eggs. dilute with water or juice What do nasal decongestants like phenylephrine do to the body? CNS stimulation b/c they stimulate alpha-1 adrenergic receptors. Vasoconstriction-watch HTN and CAD patients! How fast do you infuse K chloride in IV pump? no faster than 10 mEq/hr You should dilute ___and give no more than 40 mEq/L to prevent vein irritation KCl. remember in clinical he said it was really burning his vein. SERMS raloxifene is used for _______ osteoporosis and prevent bone fractures Raloxifiene can give the women ___ ____ and increase the risk for _ _ _s hot flashs, DVTs Bisphosphonates, like Fosamax or Boniva sit or stand for 30 minutes after taking -have enough vit d and calcium Neostigmine for myasthenia gravis; adverse reaction diarrhea Dilantin (phenytoin) and adverse effects Anti-seizure; blurred vision, bad rash, beardy chesty, teratogenesis, dysrhythmias Which vitamin promotes iron absorption but increases its side effects? Vit C Carbamazipine (Tegretol) 1) Use 2) cannot be used with _____ ______ (all of these meds can't) anti-convulsant -oral contraceptives PTU is given for ______ & clinically see its working by: hyperthyroidism lowered Hr, weight gain, lowered T4 levels -opril -april ACE inhibitor All ACE inhibitors cause: (2) dry, persistant, irritating, cough and increases body's uptake of K causing hyperkalemia 70% of patients on an SSRI experience _____ ______ sexual dysfunction Fentanyl is used for: severe cancer pain, will cause constipation ____ will increase the toxicity of Lithium NSAIDS, tylenol is NOT an NSAID Carbonic Anhydrase inhibitor use glaucoma Metoclopramide Ulcers, GERD, Bupropion (Zyban) to help stop smoking has what action on the CNS system? Stimulation Therapeutic level of Digoxin? 0.5-2.0 Gold Salts for RA toxicity. RA drugs dosing rash, sores in mouth, intense itching - once-a-week at first then down to once-a-month HBA1c goal for DM 7% Amitryptoline (Elavil) has _______ effects. What is Elavil drug class? anticholinergics. TCA Lithium adverse effects hand tremors, thirst, GI upset Digoxin toxicty can occur in the presence of ________ which can happen with what medication? Hypokalemia, Lasix Name 4 NSAIDS Aspirin, celebrex, ibuprofen, naproxen Neostigmine, for myasthenia gravis, side effects. Medication given to counteract neostigmine? cholinergic effects: high GI motility, bradycardia, urinary urgency. -Atropine Dilantin (phenytoin) is used for _____ and it's side effects are seizures, double vision, hirsuitism, skin rash, teratogenesis, dysrhythmias, Dilantin (phenytoin) cannot be used with what two other drugs? OC's and Warfarin Beta1 heart meds are used to treat Heart Failure and Cardiac arrest Alpha1 agonsts like epinepherine is used for __ raising BP Beta1 activation in the heart can cause ________ dysrhythmias Dopamine is used for ____ and _____ ____ shock Heart Failure Multiple drug interactions with Heart medications: MAOI, TCA enhance epinephrine effect (vasocontriction) - Phentolamine -A blocker - Propanolol B blocker Alpha Adrenergic Blockers (minipress) all have a first-dose ____________ ___________ effect and what OTC analgesics counteract the anti-hypertensive effect? orthostatic hypotension b/c venous dilation -NSAIDS Clonidine (catapress) does what to the pt's BP and CO? decrease BP and CO Clonidine (catapress) and ______ (alpha blocker) counteract each other Prazosin (Minipress) Which Beta blocker is non-selective and causes bronchoconstriction, too? Propanolol -pril ACE inhibitors block Ang I from becoming II resulting in: vasodilation, excretion of water & sodium, retain K, Worse Adverse Effect seen with -prils? Hyperkalemia -sartan Ang II receptor blockers -prazole PPI -tidine H2 receptor antagonists -statins Cholesterol drugs -pine, -amil (verapamil: non-selective) Ca channel blocker Cardiac Glycoside drug Digoxin The main difference between ARB's and ACE inhibitros is that ______ and _______ are not side effects of ARB -cough - hyperkalemia Ca Channel Blocker (-ipine/-amil) vasodilate and adverse effects (2) - reflex tachycardia - Peripheral edema Dysrhythmias are seen as a ________ QRS interval widened Action of Digoxin (2) increase myocardial contraction Lower Heart Rate giving ventricles more time to fill The most dangerous adverse effect of Digoxin is it's ability to create ________, particularly in patients who have _______ Dysrhythmias - hypokalemia ACE inhibitors (-prils), ARBs (-sartan), Thiazide & looop diuretics increase the likelihood of ________ and it's level should be monitored when taking _______ with these meds. hypokalemia -digoxin Cimetidine (tagamet) is for ulcers cyclosporine is an immunosuppressant Clonidine (catapress) is a alpha agonist and has what two adverse effects dry mouth drowsiness & sedation Ca Channel Blockers adverse effects are related to __________ & the immediate-acting drugs can cause _____ ________ vasodilation: headache, dizziness, edema, flushing -reflex tachycardia Metoclopramide (Reglan) controls post-op NV Ranitidine Hydrochloride (Zantac) is a __ ____ ______ and is used for _____ and _____ H2 receptor antagonist -PUD and GERD by suppressing the secretion of gastric acid -tidines and -prazole's lowers gastric pH which promotes bacteria in the stomach and _______ _______ so use cautiously in pts who are at high risk for ______ -respiratory tract -pneumonia -tidine H2 receptor antagonist used for ulcers and GERD -prazole. is the gastric acid lowering reversible? PPI. Irreversible inhibiting of gastric acid Don't take -prazoles with ____ and ____ antibiotics and digoxin Aluminum hydroxide gel (amphojel), Milk of Mag, Sodium Bicarb are all antacids Aluminum and Calcium cause ______ while milk of mag causes _______ -constipation - diarrhea How many times does the patient take antacids? 7 times a day! it'll relieve their pain and heal the ulcer Take any medications at least _ ___ b4 or after antacids 1 hour Misoprostol: who used them & intended use -ppl taking long-term NSAID therapy and pregnant women -prevent ulcers and induce labor examples of anti-emetics -Ondansetron (zofran) -Dexamethasone - Prochlorperazine (Compazine) - Dramamine prevents motion sickness -phenergan - metoclopradmie (reglan) All anti-emetics should not be used with these 3 medications b/c they intensify anti-emetic side-effects opiods- intensify CNS depression anti-HTNs Anticholinergics Anti-diarrheals diphenoxylate (lomotil) loperamide (Imodium) Caffeine makes diarrhea worse or better? worse Metoclopramide (reglan) use and side effects anti-emetic -extra pyramidal effects -diarrhea - sedation Insulin moves __ into cells along with Glucose K+ Can synthroid be given to a pregnant woman? yes- its a pregnancy level A Is PTU safe to use in pregnancy? What side effects are there for PTU NO c/i b/c neonatal hypothyroidism can occur - overmedication goes to hypothyroidism -can increase anticoagulant effects Estrogens can decrease the effectiveness of ______, an anticoagulant drug warfarin What medication class lower the effectiveness of birth control? (4) -benzodiazepines/ phenobarbital -phenytoin (dilantin) - rifampin (TB drug) -antibiotics True/False: TSH at 2 micro units indicates good treatment of hypothyroidism True True/False: Photosensitivity and blurred vision are anti-cholinergic side effects? True What are signs of an "infusion reaction" with amphotericin B? fever and chills Antifungals are safe to use with Warfarin? False; antifungals inhibit the degradation of warfarin pancrelipase for pancreative enzyme deficiency used every time they eat Stevens-Johnson Syndrome= dry,crusty rash and should be reported to the PCP INR therapeutic range: what about mechanical heart valve patients? 2-3. 3.5-4.5 PTT therapeutic range 60-80 What is the only immunization given at birth? Hepatitis B vaccine It could take __ to __ months for a person on RA drugs to start to feel better 4 to 6 months Anticholinergic effects dry mouth constipation photophobia blurred vision Tachycardia Bisphosphanates for osteoporosis should be taken with food or on an empty stomach? Empty stomach
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cephalosporin
