Med-surg pharmacology – Flashcards
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1. List common CNS side effects of Famotidine (Pepcid):
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Hallucinations, confusion, agitation, depression, anxiety, insomnia, convulsion in client with impaired renal functions.
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2. Describe adverse effects associated with aminoglycoside antibiotics:
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Neurotoxicity, ototoxicity, nephrotoxicity, ataxia, vertigo.
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3. Discuss purpose of using Naloxone (Narcan) with opioids; know therapeutic actions:
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• Competitively blocks the effects of opioids, including CNS and respiratory depression, without producing any agonist (opioid like) effects. • Reversal of signs of opioid excess.
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4. Describe what comprises Balanced or Neuroleptic Anesthesia:
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The combing of several drugs, each with a specific effect, to achieve analgesia, muscle relaxation, unconsciousness and amnesia. Balanced anesthesia involves the following agents: • Preoperative meds: the use of anticholinergics that decrease secretions to facilitate intubation and prevent bradycardia associated with neural depression. • Sedative-hypnosis: to relax the patient, facilitate amnesia and decrease sympathetic stimulations. • Antiemetic: to decrease nausea and vomiting associated with the slowing of the GI activity. • Antihistamines: to decrease the chance of allergic reactions and help to dry up secretions. • Narcotics: to aid analgesia and sedation.
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5. Identify the antidote or reversal agent for Pancuronium bromide (Pavulon) used in General Anesthesia:
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(Regonol) Pyridostigmine bromide injection, neostigmine, or edrophonium, in conjunction with atropine or glycopyrrolate, will ususally antagonize the skeletal muscle relaxant action of Pancuronium bromide (pavulon) by adequacy of respiration a peripheral nerve stimulator may also be used to monitor restoration of twitch response.
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6. Identify uses for Aminophylline and list common/serious side effects:
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Uses: Treats and prevent wheezing and trouble breathing caused by ongoing lung disease like asthma, emphysema, and chronic bronchitis. Common side effects: Upset stomach, stomach pain, diarrhea, headache, restlessness, insomnia, irritability. Serious side effects: Vomiting, increasing or rapid heart rate, irregular heartbeat, seizures, skin rash.
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7. Describe lifelong medication therapy & diagnostic test(s) appropriate for Pernicious Anemia:
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Lifelong medication therapy: • A shot of B12 once a month (if a client has severe low B12 may get more shots at the beginning). • B12 supplements by mouth (for some patients a high dose of B12 tablets work well and don't need shots) • A certain type of B12 may be given though the nose. Diagnostic tests: • Physical exam, bone narrow examination (only if diagnostic is unclear), CBC, reticulocyte count, schilling test, LDH, methyl/malonic acid (MMA) level, B12 level.
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8. List states in which folic acid deficiency may exist:
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• Occurs secondary to increased demand (as in pregnancy or growth spurts). • As a result of absorption problems in the small intestines. • Because of drugs that cause folate deficiencies. • Secondary to malnutrition of alcoholism.
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9. Identify agents used to treat hyperthyroidism and nursing interventions/teaching:
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Anti-thyroid agents: • Thioamides: Methimazole (tapazole), propylthiouracil. • Iodine solutions: sodium iodide 1131 (generic radioactive iodine); strong iodine solution, potassium iodine (thyro-block) Nursing interventions: • Assess hyperthyroidism (palpitations, nervousness, loss of hair, insomnia, heat intolerance, weight loss, diarrhea). • Assess hypothyroidism (constipation, dry skin, weakness, fatigue, headache, weight gain). • Pulse, BP, T, • I;O ratio, check for edema, puffy hands, feet • Weight daily. Teaching: To report redness, swelling, sore throat, mouth lessons, fever. To keep graph of weight, pulse, mood. To avoid OTC, seafood that contains iodine and other iodine products. To not discontinue meds abruptly. To report signs of peri-orbital edema, cold intolerance and mental depression. To report tachycardia, diarrhea, fever, irritability. To not skip or double dose meds.
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10. Differentiate purpose and vaccination schedule of pneumovax and flu vaccine:
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FLU: A flu vaccine is needed every season for two reasons. First, the body's immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. For the best protection, everyone 6 months and older should get vaccinated annually. PNEUMOVAX:
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11. Identify Drug Class of oxybutynin:
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Antispasmodics (urinary tract)
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12. Describe vaccine schedule for Hepatitis A Vaccine:
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The hepatitis A vaccine is given as two shots, six months apart. The hepatitis A vaccine also comes in a combination form, containing both hepatitis A and B vaccine, that can be given to persons 18 years of age and older. This form is given as three shots, over a period of six months or as three shots over one month and a booster shot at 12 months.
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13. List nursing implications associated with clients taking trimethoprin sulfamethoxazole for treatment of urinary tract infection:
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• Assess for infection (VS; appearance of wound, sputum, urine, and stool, WBC) at beginning of and during therapy. • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be giving before receiving results. • Inspect IV site frequently. Phlebitis is common. • Assess patient for allergy to sulfonamides. • Monitor I&O ratios. • Monitor bowel functions. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to HCP promptly as a sing of pseudomembranous colitis. May begin up to several weeks following cessation therapy. • Assess for rush periodically during therapy. • Lab test considerations: monitor CBC and urinalysis periodically during therapy. • May produce elevated serum bilirubin, elevated potassium, creatinine, and alkaline phosphatase.
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14. Discuss teaching points for a client taking levothyroxine:
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• Instruct patient to take meds as directed at the same time each day. Take missed doses as soon as remembered unless almost time for the next dose. If more than 2-3 doses are missed, notify the doctor. Do not discontinue without consulting the doctor. • Explain the patient that meds do not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong. • Advise patient to notify the doctor if headache, nervousness, diarrhea, excessive swelling, heat intolerance, chest pain, increase pulse rate, palpitations, weight loss or any unusual symptoms occur. • Caution patient to avoid taking other meds concurrently with thyroid preparations unless instructed by doctor. • Instruct patient to inform doctor of thyroid therapy. • Emphasize importance of follow up exams to monitor effectiveness of therapy. Thyroid test is performed at least yearly.
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15. Provide the rationale for use (therapeutic action) for each of the following ?medications used to treat GERD (gastrointestinal reflux disease):
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-Bethanechol: ?Bladder emptying. ?-Metoclopramide: ?Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Easier passage of nasogastric tube into the small bowel. ?-Omeprazole: ?Diminished accumulation of acid in the lumen with lessened gastro-esophageal reflux. Healing of duodenal ulcers, ?-Misoprostol: ?Prevention of gastric ulceration from NSAIDs. With mifepristone pregnancy of less than 49 days.
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16. Describe common adverse side effects associated with finasteride:
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Breast cancer, prostate cancer.
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17. Explain the onset of insulin action of NPH and Regular insulin
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NPH: 2-4 hours REGULAR INSULIN: 1/2 to 1 hr
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GI-GERD-GI MOTILITY-PUD
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Omeprazole Famotidine Bethanecol Sulcralfate Metoclopramide Misoprostol
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Omeprazole
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Antiulcer agents. Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux (GERD). Healing of duodenal ulcers.
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Famotidine
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Antiulcer agents Healing and prevention of ulcers. Decreased symptoms of gastroesophageal reflux. Decreased secretion of gastric acid.
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Bethanechol
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Urinary tract stimulant Bladder emptying
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Sulcralfate
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Antiulcer agents Protection of ulcers, with subsequent healing.
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Metoclopramide
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Antiemetics Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Easier passage of nasogastric tube into small bowel.
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Misoprostol
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Antiulcer agents, cytoprotective agents Prevention of gastric ulceration from NSAIDs. With mifepristone terminates pregnancy of less than 49 days.
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Agents to control blood glucose:
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Insulin types, action and onset Control of hyperglycemia in diabetic patient NPH 2 to 4 hours REGULAR 1/2 to 1 hour
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Antibiotics/Anti-infectives:
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-Aminoglycoside (gentamycin) -1st Generation cephalosporin (cefazolin) -3rd generation cephalosporin (cetriaxone) -Flouroquinolones (ciprofloxacin) -Sulfonamide (trimethoprin sulfamethoxazole)
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Aminoglycoside (gentamycin)
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Anti-infective Bactericidal action
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-1st Generation cephalosporin (cefazolin)
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Anti-infectives Bactericidal action against susceptible bacteria
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-3rd generation cephalosporin (cetriaxone)
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Anti-infectives Bactericidal action against susceptible bacteria
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Flouroquinolones (ciprofloxacin)
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Anti-infective Death of susceptible bacteria
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-Sulfonamide (trimethoprin sulfamethoxazole)
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Anti-infective antiprotozoals Bactericidal action against susceptible bacteria
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Anti-inflammatory/Immune:
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Olsalazine salicylate Mesalamine Hep A Vaccine schedule Influenza Vaccine schedule
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Olsalazine salicylate
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Gastrointestinal anti-inflammatories Reduction in the symptoms of inflammatory bowel disease
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Mesalamine
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Gastrointestinal anti-inflammatories Reduction in the symptoms of ulcerative colitis, proctosigmoiditis, and proctitis
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CNS/Peripheral nervous system
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Naloxone
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Cardiovascular
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Metoprolol Amlodipine Enoxaparin Folic acid Cyanocobalamin Ferrous sulfate
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Metroprolol
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Antianginals, antihypertensive Decreased BP and heart rate.
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Amlodipine
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Antihypertensive Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreasing frequency and severity of attachs of angina
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Enoxaparin
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Anticoagulant Prevention of thrombus formation (DVT)
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Folic acid
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Antianemics, vitamins Restoration and maintenance of normal hematopoiesis
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Cyanocobalamin
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Antianemics, vitamins Corrects manifestation of pernicious anemia. Corrects vitamin B12 deficiency
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Ferrous sulfate
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Antianemics Resolution or prevention of iron deficiency anemia
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Renal/Urinary tract:
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Furosemide Spironolactone Finasteride Oxybutynin
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Spirolactone
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Diuretic, potassium-sparing diuretic Increase survival in patients with severe heart failure. Weak diuretic
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Finasteride
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Hair regrowth stimulants Reduced prostate size with associated decrease in urinary symptoms. Decreases hair loss; promote hair regrowth.
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Oxibutynin
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Urinary tract antispasmodics Increased bladder capacity. Delayed desired to void. Decreased urge incontinence, urinary urgency, frequency and decreased number of urinary numbers associated with overactive bladder
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Respiratory:
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Albuterol Aminophylline
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Albuterol
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Bronchodilator Bronchodilation (to control and prevent reversible airway obstruction caused by asthma or COPD)
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Aminophylline
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Bronchodilator Bronchodilation Long-term control of reversible airway obstruction caused by asthma or COPD
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Endocrine
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Levothyroxine Propylthiouracil
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Levothyroxine
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Hormones Replacement in hypothyroidisn to restore normal hormonal balance. Suppression of thyroid cancer
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General anesthesia:
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Balanced anesthesia Pancurtonium
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Percurtonium
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Neuromuscular blocker (nondepolarizing). PAVULON® (pancuronium bromide) injection is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
