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