Kaplan: Pharm integrative exam – Flashcards

Side Effects: Myelosuppression Dizziness, drowsiness Ataxia Diploplia, tash Nursing Considerations: -moitor I/O -supervise ambulation -monitor CBC -take WITH meals -wear protective clothing d/t photosensitivity -multiple drug interactions

Class: cardiac glycosides S/E: Confusion Visual disturbances Bradycardia Nausea Abdominal pain Anorexia Nursing Considerations: -admin w/caution in elderly + renal pt -monitor renal function + electrolytes -eat high K+ foods -take apical pulse for 1 full min before admin. (Notify if risk of digitalis toxicity

Class: Benzodiazepine (anti-anxiety) S/E: Drowsiness, light-headed ness, hyoTN, hepatic dysfunction Increased salivation Orthostatic hypoTN memory impairment + confusion Nursing Considerations: -CNS depressant -safer for elderly -don't combine w/alcohol or other depressants -check renal + hepatic function -Don't d/c abruptly -teach addictive potential

Class: antivirals S/E: HA Parasthesias, dizziness Anemia Anorexia, diarrhea, nausea, GI pain Insomnia Agranulocytosis Nursing Considerations: -used for HIV infection -teach pt to strictly comply w/ dosage schedule

Class: antidepressant; heterocyclics S/E: Dry mouth Nausea Nursing Considerations: -may require gradual reduction before stopping -avoid use w/ETOH, other CNS depressants for up to 1 week after end of therapy

Class: antacid S/E: Constipation that may lead to impact ion Phosphate depletion Nursing Considerations: -monitor bowel pattern -compounds contain sodium; check if pt is on Na+-restricted diet -Aluminum + Magnesium antacid compounds interfere with tetracycline absorption -encourage fluids -monitor for signs of phosphate deficiency: malaise, weakness, tremors, bone pain -Shake well -careful use advised for kidney dysfunction

Class: anti-convulsant S/E: flushing sweating extreme thirst hypoTN sedation, confusion Nursing Considerations: -monitor I/O -before each dose, knee jerks should be tested -VS should be monitored often during parenteral admin -used for pregnancy-induced HTN

class: nitrates/antianginals S/E: flushing hypoTN HA tachycardia dizziness blurred vision Nursing Considerations: -renew supply q3 months -avoid alcoholic beverages -sublingual dose may be repeated every 5 mins for 3 doses -protect drug from light -should wet tablet w/saliva + place under tongue

class: glucocorticoids S/E: > susceptibility to infection may mask symptoms of infection edema, changes in appetite euphoria, insomnia delayed wound healing hypokalemia, hypocalcemia hyperglycemia osteoporosis, fractures peptic ulcer, gastric hemorrhage psychosis Nursing Considerations: -prevents/suppresses cell-mediated immune reactors -used for adrenal insufficiency -overdosage produces Cushing's syndrome -abrupt d/c of drug may = HA, N/V, papilledema (addisonian crisis) -give single dose before 9 am -give multiple doses at evenly spaced intervals -infection may produce few symptoms d/t anti-inflammatory action -stress (surgery, illness, psychic) may lead to > need for steroids -nightmares are often the 1st indicator of onset of steroid psychosis -check weight, BP, electolytes, I/O -used cautiously w/hx of TB -may < effects of oral hypoglycemics, insulin, diuretics, K+ supplements -assess children for growth retardation -protect from pathological fractures -admin w/antacids -don't stop abruptly Action: stimulates formation of glucose and formation + storage of fat in muscle tissue; alters normal immune response Indications: Addison's disease, Crohn's disease, COPD, lupus, leukemia, myelomas, head trauma, tumors to prevent/tx cerebral edema

Class: anti-diabetic (insulin) Action: reduces BG levels by increasing glucose transport across cell membranes; enhances conversion of glucose to glycogen Indications: type 1 diabetes; type 2 DM not responding to oral hypoglycemic agents; gestational D not responding to diet S/E: hypoglycemia Nursing Considerations: -teach client to rotate sites to prevent lipohypertrophy -only regular insulin can be given IV; all can be givven SQ -can be given after meals Onset of Action: 1-2 hours Peak Action: 6-14 hours Duration: 16 hours Time of Adverse reaction: early evening (weakness, fatigue)

Class: ACE inhibitor Action: blocks ACE in lungs from converting angiotensin 1 to angiotensin 2 (vasoconstrictor); causes < BP, < aldosterone secretion, Na+ and fluid loss Indications: HTN, CHF S/E: -gastric irritation, peptic ulcer, orthostatic hypoTN -tachycardia -MI -proteinuria -rash, pruritis -persistent dry non-productive cough -peripheral edema Nursing Considerations: -< absorption if taken w/food (give 1 h ac or 2 h pc) -small, frequent meals -frequent mouth care -change position slowly -can be used w/thiazide diuretics

Class: Miotic Eye Med S/E: -painful eye muscle spasm, blurred or poor vision in dim lights -photophobia, cataracts, or floaters Nursing Considerations: -teach to apply pressure on lacrimal sac for 1 min following instillation -used for glaucoma -caution pt to avoid sunlight + night driving

class: narcotic (opioid anaglesic) S/E: dizziness, weakness sedation or paradoxic excitement Nausea, flushing, sweating Respiratory depression, < cough reflex Constipation, miosis, hypoTN Nursing Considerations: -observe for dependence, respiratory depression -encourage fluids and high-bulk foods

Class: Ulcer Med S/E: diarrhea confusion + dizziness (esp in elderly w/large doses) HA Nursing Considerations: -bedtime dose suppresses nocturnal acid production -compliance may > w/single dose regimen -avoid antacids w/in 1 hour of dose -dysrhythmias

Class: Diuretic (K+ - sparing) S/e: hyperkalemia hyponatremia hepatic + renal damage tinnitus rash Nursing Considerations: -used w/other diuretics -give w/meals -avoid salt substitutes containing K+ -monitor I/O

Class: non-steroidal anti-inflammatory (NSAIDs) S/E: HA, dizziness, epigastric distress Nursing Considerations: -admin w/food -optimal therapeutic response is seen after 2 weeks of tx -use cautiously in client w/hx of ASA allergy

Class: Med for Bipolar Disorder Action: reuptake of NE + 5HT Indications: manic episode S/E: dizziness, vertigo, drowsiness, ataxia, CHF, aplastic anemia, thrombocytopenia Nursing Considerations: -mood stabilizer used w/BPD -traditionally used for sx. + trigeminal neuralgia -obtain baseline urinalysis, BUN, liver function tests, CBC -shake oral suspension well before measuring dose -when giving by NG tube; mix w/equal volume of water, 0.0% NaCl or D5, then flush with 100 mL after dose -take w/food -drowsiness usually disappears w/in 3-4 days

Class: antitubercular agents (1st line) S/E: hepatitis peripheral neuritis rash fever Nursing Considerations: -pyridoxine as prophylaxis for neuritis -teach s/s of hepatitis -check liver function tests -alcohol > risk of hepatic complications -therapeutic effects can be expected after 2-3 weeks of therapy -monitor for resolution of s/s (fever, night sweats, weight loss); hypoTN (orthostatic) may occur initially, then resolve; caution pt to change position slowly -give BEFORE meals -don't combine w/Dilantin, causes phenytoin toxicity

class: nitrates/antianginals S/E: HA orthostatic hypotension Nursing Considerations: -change position slowly -take BETWEEN meals -don't d/c abruptly

Class: Anti-dysrhythmics (class 2 drugs) S/E: bradycardia + hypotension bronchospasm > in HF fatigue + sleep disturbances Nursing Considerations: -monitor apical HR, cardiac rhythm + BP -assess for SOB + wheezing - " " for fatigue, sleep disturbances - " " apical HR for 1 min before admin

Class: antibiotic meds S/E: skin rashes, diarrhea allergic reactions renal, hepatic, hematological abnormalities N/V Nursing Considerations: -obtain C&C before 1st dose -take careful hx. of penicillin -observe for 20 min post IM injection -give 1-2 h ac or 2-3 pc to < gastric acid destruction of dx -monitor for loose, foul-smelling stool and change in tongue -teach to continue medication for entire time prescribed, even if symptoms resolve -check for hypersensitivity to other drugs, esp cephalosporins

Class: anticonvulsant med S/E: drowsiness, ataxia nystagmus blurred vision Hirsutism Lethargy GI upset gingival hypertrophy Nursing Considerations: -give oral med w/at least 1/2 glass of water, or w/meals to minimize GI irritation -inform pt that red-brown or pink discoloration of sweat and urine may occur -IV admin may lead to cardiac arrest (have resuscitation equipment at hand) -never mix w/any other drug or dextrose IV -instruct in oral hygiene -> Vit D intake and exposure to sunlight may be necessary w/long-term use -alcohol > serum levels - > risk toxicity older adults

Class: antiplatelet agent S/E: short-term: -GI bleeding, heartburn, occasional nausea long-term: -salicylism: metabolic acidosis, respiratory alkalosis, dehydration, fluid electrolyte imbalance, tinnitus Nursing Considerations: -observe for bleeding gums, bloody/black stool, bruises -give w/milk, water, or food, or use enteric-coated tablets (Ecotrin) to minimize gastric distress Contraindications: -GI disorders, severe anemia, vit K deficiency, anti-inflammatory, anaglesics, antipyretic

Class: antilipemic agent Action: inhibits cholesterol + triclyceride synthesis; liver enzyme levels Nursing Considerations: -< LDL cholesterol levels = peripheral vasodilation -take WITH food; absorption is < by 30% on any empty stomach -avoid ETOH -contact health care provider if unexplained muscle pain, esp. w/fever or malaise -take at night -give w/caution with < liver function -meds should be used w/dietary measures, physical activity + cessation of smoking

Class: Anti-hypertensive med S/E: drowsiness, dizziness dry mouth, HA dermatitis severe rebound HTN Nursing Considerations: -don't d/c abruptly -apply patch to nonhairy area (upper outer arm, anterior chest)

administration: -begin at 0.5-1milliunits/min -increase dose 1-2 munits/min at intervals of 30-60 mins until desired contractions -can administer up to 20mL mU/min (follow unit/health care provider policy/order) -piggyback to principal IV line -admin via infusion pump -usual contraction pattern: q2-3 min, lasting for 90 seconds or less -stop infusion if fetal distress or hypertonic contractions begin (last > 90 seconds or > every 2 min)

Class: MArcotics (opioid) S/E: frequent dizziness, occasional tremors uncoordinated muscular mvmts constipation, urinary retention bradycardia Nursing Considerations: -observe for dependence -give repeated doses intramuscularly -local irritation if given SQ -avoid giving to older adults and those w/renal disease -prolonged 1/2 life of a metabolic accumulates with repeated doses and can lead to life-threatening seizures -older adults: increased risk of toxicity; tremors and seizures

Class: Anti-psychotic med S/E: low sedative effect low incidence of hypoTN high incidence of EPS s/e Nursing Considerations: -used in large doses for assaultive pt -used w/elderly (risk of falling reduced) -decanoate: long-acting form given every 2-4 week; IM into deep muscle Z-track

Class: antiparkinson med S/E: drowsiness, N/V atropine-like effects (blurred vision, mydriasis) antihistamine effects (sedation, dizziness) Nursing Considerations: -acts by lessening cholinergic effects of dopamine deficiency -suppresses tremor of Parkinsonism most s/e are reversed by changes in dosage -additional drowsiness can occur w/other CNS depresssants

Class: Antihypertensive: calcium channel blockers (CCB) Actions:inhibits mvmt of calcium ions across membrane of cardiac and arterial muscle cells = slowed impulse conduction, depression of myocardial contractility, dilation of coronary arteries; O2 of myocardial cells Indications: Angina, HTN, dysrhythmias, interstitial cystitis, migraines S/E: dizziness, HA, nervousness, peripheral edema, angina, bradycardia, AV block, flushing, rash, impotence Nursing Considerations: -monitor VS -don't chew or divide sustained-release tablets -meds also have anti-anginal actions -contraindications in heart block, contact HCP if BP < 90/60 -instruct pt to avoid grapefruit juice (verapamil) -monitor for signs of heart failure

Class: anti-tubercular agents (1st line) S/E: Hepatitis, fever Nursing Considerations: -orange urine, tears, saliva -check liver function tests -can take w/food

Class: thyroid replacement med S/E: nervousness, tremors insomnia tachycardia, palpitations dysrhythmias, angina Nursing Considerations: -tell pt to report chest pain, palpitations, sweating, nervousness, SOB to HCP

Class: antipsychotic med (atypical) S/E: moderate orthostatic Hypotension moderate sedation significant weight gain doses over 6 mg can = tarditive dyskinesia Nursing Considerations: -chosen as 1st line antipsych d/t mild EPS and very low anticholinergic s/e

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Class: cardiac glycosides S/E: Anorexia Nausea Bradycardia Visual disturbances Confusion Abdominal pain Nursing Considerations: -admin w/caution in elderly + pt w/renal problems -eat high K+ foods -take apical pulse -notify HCP if AP <60 bpm -Digoxin immune fab (Digibind) - used for toxicity -teach: pt to check pulses + know s/e - < K+ increases risk of digitalis toxicity