ATI Pharmacology Study Guide

Pharmacology for Nursing Video 1(Introduction, General tips): • SKIP Chapter 5 and Chapter 3 (drug math) 1.You NEED to know the generic names of all drugs…brand names will not always be on test 2. “common side effects” go with Headaches or GI upset not anything serious like bleeding. 3. Know side effects of prednisone (steroid): weight gain, fluid retention, hypoglycemia, bone less etc. 4. Herbs that start with the letter “G” (garlic, ginger) all can increase risk of BLEEDING. 5. Medications that end in MAB or NIB are typically immune suppressants that are used to treat cancers or autoimmune disorders…big thing to watch out for is INFECTION. 6. Patients should never discontinue their medications suddenly Never double up on doses if you miss a dose 7. Antibiotics: entire course of therapy should be taken and culture should be done before starting 8. Alcohol is not okay with most meds. 9. You cannot chew or crush extensive release drugs. Video 2 and 3: Pharmacokinetics: 1. Absorption, Distribution, Metabolism, and Excretion (absorption is dependent on route; is there food in their stomach?; etc.) 1. Inhalation and sublingual are very fast. IV is immediate. 1. Digestion: albumin is needed for binding. 2. Metabolism: higher risk of toxicity in infants because their livers are not mature. Metabolism will be slower in older adults which will also lead to toxicity. 2. First pass effect of liver-Higher dose is needed on first dose to get a therapeutic effect. 3. Certain medications have a high therapeutic index meaning toxic level and therapeutic index are far off. Low TI level means its very close to toxic range. 4. Half life: time it takes for the strength of the medication to be cut in half. Longer half life=increase risk of toxicity. 5. Agonist: is used to enable an action. 6. Antagonist: like naloxone, is used to reverse that action. 7. Mix meds with applesauce so they can finish the whole thing and get all their meds. 8. Advice patients to sit upright. 9. PATCHES (transdermal): wash skin with soap and water, dry thoroughly, remove old patch before putting new patch, rotate patches, and choose a hairless area to apply patch. 10. For meds in EYES, pull down conjunctiva and put one drop in aseptically. 11. For meds in EARS, have them lie on unaffected side, put drop, and move auricle. 12. Meds through GI TUBE..flush with 15ml with sterile water both before and after. 13. Meds through SUPPOSITORY. Lay on their side. Push meds past external sphincter for 20-30 minutes and 60 minutes for systemic absorption. 14. INHALER (MDI/DPI inhaler) Shake inhaler 5-6 times, Press inhaler and take a deep breath, hold breath for 10 seconds before exhaling. 15. IM injections…for under 2years old, you're going to use vastus lateralis. After 2, use ventral gluteal site or deltoid site. Vastus and gluteal can accommodate 2ml of fluid. Deltoid can take only 1ml. Need a needle length 1-1.5 inches long—>inject at a 90 degree angle. 16. SubQ: 45 degrees to 90 degrees. 17. IV: 20 gauge are standard. Surgery: 18 gauge. Child or Older adult: 22-24 gauge. Video 4 (Chapter 2 in book): 1. PRN prescriptions are for “as needed” (like Zofran for nausea and vomiting) 2. Patient name, date and time of prescription, route, frequency/time, and name of prescription. 3. Always do a READ BACK for accuracy. Phone prescriptions need to be signed within 24 hours. 4. 6 Rights of Medications: 1. Right patient 2. Two patient identifiers (name and date of birth) (NOT their room). 3. Right medications 4. Right dose 5. Right route 6. Right documentation. (Patients also have a right to refuse medications) 5. Prescription abbreviations that should not be used IU(international units) QD (every other day); SC or SQ for SUBQ. 6. Always need a leading zero. (instead of .5 it should be 0.5) 7. Need to document everything. Video 5 (Chapter 3): 1. Always make sure to ROUND if they ask for it or your answer will be wrong. Video 6 (Chapter 4) IVs: • IV medications are absorbed right away • Risks associated with IVs…(heart failure: run the risk of circulatory overload) (adminstering the wrong meds) (vancomycin: irritates the veins) • Failure to use aseptic technique..leads to sepsis. • Patients are given IV fluid/bolus(large volume over short period of time) • DONT: • Never put into tubing that are tubing blood • use the back of their hand • fluids should not hang for long periods of time (replace tubing and fluid bag every 24 hours) • DO: • verify compatibility of the meds you are infusing • hold their hand below the level of the heart • change IV sites every 72 hours • wipe all ports with alcohol before infusing anything. Gauge size: • 16 gauge should be used for trauma • 18 for surgeries • 20 is default (can use 22 or 24 for older patients or children) • Document catheter size, site, and date and time of insertion. Veins: • Start with distal • flush IV every 8-12 hours • monitor site and infusion rate every hour. Infiltration: • S/S: pallor, local swelling and decreased skin temperature around site. • stop the infusion, remove the catheter, elevate extremity, and cold/hot compress. Hematoma: S/S: bruising at site. Warm compress and elevate extremity. Catheter embolus: DANGEROUS! • Missing catheter tip, can travel to lungs • Place a trinket high up on the extremity, prepare patient for X-ray and surgery. Phlebitis: • S/S increased skin temperature, will feel hard. • Stop the IV, remove the catheter, apply a warm compress, elevate the extremity. Cellulitis: S/S: systemic fever, malaise antibiotics, analgesics, pyretics, cold compresses. Fluid overload: • Crackles in the lungs, edema, distended neck veins, shortness of breath • slow IV rate, put up the bed, and give diuretics. Video 7 MEDICATION DOSING: • Size: The bigger someone is the more meds they will need • Age is another factor (children’s metabolism is impaired) Same thing with older clients because their liver and kidney functions might be impaired, impairing their metabolism. • Sex: Females have a higher proportion of body fat, so we respond differently. • Tolerance: IV drug users….wont touch them if you try to give them little meds. • Accumulation: A patient with decreased renal function, not excreting properly, can lead to toxicity. • Psychological factors: Placebo effect, positivity and negatively can impact their response to the medications. • Inadequate gastric acid, can effect their absorption. • Vascular insufficiency: medications wont circulate. • Liver disease and kidney disease: impairs metabolism and excretion • Pediatric dosing: body weight or body surface area • Older adults have increased gastric PH, less effective in absorption. Insufficient albumin, Impaired memory. Poly-pharmacy=can lead to toxicity. Use clear and concise instructions VERBALLY AND IN WRITING. Set up a daily calendar. Organized pill containers. • Pregnant: most medications should be considered harmful to fetus. Always talk to doctor. Avoid live vaccines. Should get annual flu vaccine. Video 8 (CHAPTER 7) ANXIETY DRUGS: • • • • • • • • BENZO, ends in PAM. Chlordiazepoxide KNOW: the only one that doesn't end in “pam” Uses: seizures, muscle spasms, alcohol withdrawal, maintain anesthesia. Works by increasing GABA in the body—>decreases the activity of neurons. Side effects: Sedation, respiratory depression, amnesia, dependency, withdrawal. for SHORT TERM USE only. NEVER stop abruptly antidote is FLUMAZENIL** ATYPICAL: BUSPIRON • Can be used LONG TERM. Dependency is not likely. • does not cause sedation • Takes a few weeks for medication to start work. • can take with meals to avoid GI upset • Side effects: dizziness, nausea, headache. “Women named Pam who has a lot of anxiety, takes a benzo, realizes benzo is not for long term so she takes a BUS to a Pier and decides she's going to wean benzo and take buspiron.” SSRI: end in “ENE” Fluoxetine: • Anxiety, depression, OCD, and PTSD • Inhibits serotonin re-uptake. • “Teens can sometimes be difficult and sometimes cause anxiety and depression in parents” • Side effects: Insomnia (peroxitine), nausea, fatigue, weight gain, sexual side effects • Watch out for symptoms of serotonin syndrome: Agitation, hallucinations, fever, diaphoresis. • Full effects are not felt for up to a month. Not immediate. Video 9 (MEDICATIONS TO TREAT DEPRESSION): SSRI: end in “ENE” Fluoxetine: • Anxiety, depression, OCD, and PTSD • Inhibits serotonin re-uptake. • • • • • “Teens can sometimes be difficult and sometimes cause anxiety and depression in parents” Side effects: Insomnia (peroxitine), nausea, fatigue, weight gain, sexual side effects Watch out for symptoms of serotonin syndrome: Agitation, hallucinations, fever, diaphoresis. Full effects are not felt for up to a month. Not immediate. DONT ABRUPTLY stop. BUPROPRION (WELLBUTRIN): • Used to stop smoking and depression. • “burproprion helps you be appropriate and not smoke” • Side effects: insomnia, weight loss, GI distress, agitation, seizures, and headache. Triazodone: • Major side effect: sedations TRICYCLICS ANTI-DEPRESSION: AMITRYPTYLINE: • Used to treat depression, neuropathy, fibromyalgia, anxiety, and insomnia • “Amy trips over a tricycle in the desert” “Everything is going to dry up: urinary retention, constipation, blurred vision, dry mouth, photophobia, tachycardia" (anti-cholinergic side effects). • Other side effects (3 S’s): sedation, sweating, seizures. • Key points to counteract side effects: high fiber diet, wear sunglasses, chew gum, drink lots of fluids. • Most serious side effect: urinary retention. MAOI’s: • Interact with almost anything • (Fenylzine?) • Used for depression • Side effects: agitation, anxiety, orthostatic hypotension, Hypertensive crisis*****(triggered by foods high in tyramine: chocolate, red wine, salami, avocado, rich cheeses). Video 10 DRUGS FOR BI-POLAR DISORDERS: LITHIUM • Gi upset, Fine hand tremors, coarse tremors** (sign of toxicity), electrolyte imbalances, polyuria, weight gain, electrolyte imbalances. • Monitor their plasma levels frequently. • Toxicity occurs over 1.5. (S/S: coarse tremors, tinnitus, confusion, hypotension, seizures, coma, death). • Do not take diuretics with it. • Needs lots of FLUID AND SALT. • NO NSAIDS or ANTI-CHOLINERGIC meds. ANTI-EPILEPTIC: CARBAMEZAPINE AND VALPROIC ACID • They are not only used for bi-polar, they are used for convulsions, and anti-epileptic. • Carbamezapine: blood dyscrasia —> monitor CBC. Also vision issues (double vision: nystigmus) and hyperosmolarity. • Valproic Acid: Side effect: hepatotoxicity**) GI upset, pancreatitis, thrombocytopenia. VIDEO 11: MEDICATIONS FOR PSYCHOTIC DISORDERS (SCHIZO): • Agitation, hallucinations, delusions=Positive symptoms (new symptoms) • Social withdrawal, lack of emotion, lack of energy, flattened effect=Negative effect First GEN: control the positive actions of schizophrenia Second GEN: control the positive and the negative symptoms. CHLORPROMAZINE/ HALOPERIDOL • **EPS symptoms: (spasms of tongue, neck, and back) rigidity, tartive dyskinesia • **Neuroleptic Malignant Syndrome: fever, dysrhythmias, muscle rigidity. • IM injections are available for patients that wont take their meds. ATYPICAL MEDICATIONS (ANTI-PSYCHOTICS): CLOZAPINE AND BUSPIRONE • Not as many side effects and not as many • side effects: diabetes, weight gain, increased cholesterol, orthostatic hypotension, anticholinergic effects. • control positive and negative symptoms. • BUSpriodone can be administered by IM • AVOID alcohol on these meds. VIDEO 12 ATTENTION MEDS: METHYLPHENIDATE (RITALIN), METHAMPHETEMINE (ADDERAL) • • • • Decrease a child’s appetite, can cause insomnia Do not administer at night Immediately before or immediately after a meal monitor the child’s weight throughout therapy** ALCOHOL WITHDRAWAL • withdrawal starts 4-12 hours after last drink of alcohol • can take 5-7 days. • Symptoms (peak in 24 hours) include: nausea, vomiting, tremors, increase all vital signs. • Medications for withdrawal: BENZO’S (helps calm everything down, prevent seizures), BP meds, Anti-epileptic: carbimezapine • Medication for promotion of abstinence: disulfiram: if they take this and drink… They will get really uncomfortable side effects: nausea, vomiting, etc. • Prevents cravings: Maltrexone(?)…its also available in monthly IM injections. • Abstinence: Acamprosate (?):decrease abstinence symptoms: anxiety and restlessness. OPIOD/NICOTINE WITHDRAWAL • Methadone for opioid addiction. Used for long term maintenance. Nicotine withdrawal: Buproprion. (Wellbutrin). VIDEO 13: CHRONIC NEUROLOGIC DISORDERS: Mystenia Gravis: • you do not have enough acetylcholine • meds: cholinesterase inhibitors to increase acetylcholine at receptor site MEDS: NEOSTYGMINE AND PYRODOSTYGMINE , Endrophonium “STG” “Stg is a race-car driver..so he gets out of his car and stopping cholinesterase to increase acetylcholine to relieve symptoms of MG.” • Side effects: increased salivation, bradycardia, vomiting, diarrhea, sweating (opposite of anticholinergic) • Edrophonium is what’s used to diagnose MG. If given and it makes it worse, then they don’t have MG and atropine is given. If it improves their condition then we know they had MG. PARKINSON’S DISEASE: • Patients dont have enough dopamine and have too much acetylcholine. LEVODOPA AND CARBODOPA (SINEMET): • Used to bring up dopamine • helps to decrease tremors and muscle rigidity. • Levodopa is converted to dopamine in the CNS • and Carbodopa prevents the breakdown of levodopa. • Side effects: nausea, vomiting, drowsiness, dyskinesia, orthostatic hypotension, darkening of the urine and sweat, and psychosis. • Protein meals will decrease the effectiveness of these drugs. “Carbs are preferred (carbodopa), Less protein” BENZTROPINE • Used to treat tremors and rigidity by decreasing the acetylcholine levels. • Side effects: “everything is dry” Anti-cholinergic: dry mouth, blurry vision, constipation, urinary retention. • Tell patients to chew gum, drink more waters, wear glasses. etc. PHENYTOIN AND (VALPROIC ACID) (CARBAMEZAPINE) • Phenytoin causes gingival hyperplasia**, ataxia, diplopia, nystagmus, rash, and hypertension. • Used for seizures. • monitor plasma levels to avoid toxicity: need frequent blood draws. • Decreases the effectiveness of oral contraceptives. VIDEO 14 EYE AND EAR DISORDERS: (OPEN ANGLE GLAUCOMA): TIMOLOL • Drops are put into eye. It is a beta blocker. Don’t touch tip of bottle in eye. Push lacrimal duct after applications ACETALZOLAMIDE • Can be used for heart failure and altitude sickness • Causes diuresis and lowers interocular pressure • Side effects: “flu-like” symptoms, GI upset, electrolyte imbalances (esp with sodium or K) • administer with food to decrease GI upset and closely monitor electrolyte imbalance. EAR DROPS (FOR OTITIS EXTERNA-SWIMMERS EAR) CIPROFLOXACIN WITH HYDROCORTISONE • roll the container gently and shake gently • position patient on their unaffected side • Stay on that side for 5 minutes • Tell patients to dry their ear canal after swimming to prevent getting swimmers ear in the future. VIDEO 15 CENTRAL NERVOUS SYSTEM MEDICATIONS: NEUROMUSCULAR BLOCKING AGENTS: SUCCINYLCHOLINE AND PANCURONIUM • Used for anesthesia or for intubation to cause paralysis • they work by blocking acetylcholine which causes muscle paralysis • Side effect: respiratory arrest, apnea, malignant hyperthermia (muscle rigidity, fever)***, muscle pain do to this class.** • Treatment of malignant hyperthermia: administering 100% oxygen, and implementing cooling measures (iced IV fluid, cooling blanket) and give dantrolene which is a muscle relaxer. MUSCLE RELAXANTS: DIRECT ACTING DANTROLENE: • Used for: muscle spasticity related to spinal cord injury, cerebral palsy, MS, can treat and prevent malignant hyperthermia. • MOA: prevents release of calcium which inhibits muscle contraction reducing muscle spasticity • SE: drowsiness, muscle weakness, GI upset, hepatic toxicity • Keep an eye for signs or symptoms of liver toxicity CENTRALLY ACTING MUSCLE RELAXANTS BACLOFEN: “IF YOU PULL OUT YOUR BACK, YOU NEED BACLOFEN” • Used for muscle spasticity related to spinal cord injury, cerebral palsy, MS, can also be used to treat malignant hyperthermia. • MOA: enhances the effect of GABA in the CNS which reduces muscle spasticity. • SE: drowsiness, GI upset, nausea, constipation URINARY TRACT STIMULANT BETHANECHOL “Beth has a shy bladder” • • • • Used for non-obstructive urinary retention. MOA: to stimulate the cholinergic receptors in the GU tract which allows for GI emptying. SE: flushing, sweating, urinary urgency, bradycardia, and hypotension Key: administer 1 hour before or 2 hour after meals to prevent GI upset (nausea/vomiting). URINARY TRACT ANTI-SPASMOTICS OXYBUTININ • Used for overactive bladder symptoms: frequency, urgency, nocturia. • MOA: inhibits acetylcholine in the bladder reducing frequency and urgency. • SE: anti-cholinergic side effects (dry mouth, etc). • KEY: increase fiber and fluid intake. VIDEO 16 (CHAPTER 16) MEDICATIONS THAT PROVIDE SEDATION: HYPNOSIS: FIRST CLASS: BENZODIAZEPINES (COVERED BEFORE) SECOND CLASS: NON-BENZO (ZOLIPIDAM-AMBIEN) • Used for insomnia, can cause daytime sleepiness, dizziness • MOA: increases the effect of GABA in the CNS • Instruct patients to make sure they have 8 hours for sleep IV ANESTHETICS: PENTOBARBITAL, MEDAZOLAM, PROPOFOL . • • • • Used for anesthesia, conscious sedations, intubation procedures MOA: depresses the CNS and promote loss of consciousness SE: respiratory and cardiovascular depression, pain at IV site (propofol-use within 6 hours) have resuscitation equipment available and monitor vitals and EKG. VIDEO 17 RESPIRATORY MEDICATIONS: BETA 2 ADRENERGIC AGONISTS-ALBUTEROL (short acting) AND SALMETEROL (LT) • Beta 1 is dealing with the heart. Beta 2 is dealing with the lungs “2 lungs”. • Activates receptors which in turn cause bronchodilations- asthma and COPD • Salmeterol should not be used for acute • SE: tachycardia, angina, tremors • If using alongside a glucocorticoid, first use beta2 agonist to cause brochodilations then have glucocorticoid for inflammation. (Wait 5 minutes in between). XANTHINES -THEOPHYLLINE Theo=god like” will be meeting your creator soon. • Bad side effects: to a point where its not really used anymore • can be used for long term control of asthma or COPD • acts by on cAMP by increasing it which results in bronchodilations • SE: GI upset, fatal dysrhythmias, seizures, very narrow therapeutic range. • Would need frequent blood draws to check their serum levels for toxicity. INHALED ANTICHOLINERGIC-IPRATROPIUM • Blocking acetylcholine receptors • Anti-cholinergic side effects (dry mouth, hoarseness) • Teaching: increase fluid intake, suck on sugar free candy**. INHALED GLUCOCORTICOID -BECLOMETHASONE • “Becky has asthma” • Used for asthma “sone”= steroid • can be used with albuterol or salmeterol, glucocorticoid last • SE: candidiasis** (rinse your mouth), hoarseness. • Key: Rinse your mouth with water after using this medication. ORAL GLUCOCORTICOIDS-PREDNISONE*** • Most important drug in this book • Can be used to decrease inflammation and to suppress the immune system • SE: bone loss, weight gain, fluid retention, hyperglycemia, hypocalemia, infection, muscle weakness, peptic ulcer disease, adrenal gland suppression. (KNOW ALL) • Periods of stress may require addition doses • Never stop taking it suddenly—need to taper off. • Always monitor for signs of infections • AVOID NSAIDS with these. LEUKOTRIENE MODIFIERS-MONTUKLAST, ZAFIRLUKLAST “Luklast decreases leuko” • Reduces airway inflammation • Used for asthma, exercise induced brochoconstriction. • Zafirluklast: liver enzymes can be increased with this medication • Montuklast: can take in evening or 2 hours before exercise. VIDEO 18 UPPER RESPIRATORY DISORDERS: ANTI-TUSSIVE-OPIOD (CODEINE) • Medications used for cough, decrease the patients cough reflex. • SE: sedation, respiratory depression, constipation, GI upset, and dependency. • Tell your patients to change position slowly, avoid alcohol, and increase their fluid intake. • • • • • EXPECTORANTS (GUAIFENESIN) For cough, to promote breakdown with mucus. MOA: reduces the viscosity of the secretions (thins) to make coughs more production SE: GI upset, rash. Key: Have patient drink more fluids to liquefy their secretions. • • • • • • • MUCOLYTICS (ACETYLCYSTEINE) Used for pulmonary diseases where secretions are thick=cystic fibrosis. ANTIDOTE for Acetaminophen. MOA: helps improve the flow of secretions SE: bronchospasm**, nausea, vomiting, rash. Use cautiously in patients with asthma. Smells like rotten eggs. • • • • DECONGESTANTS-PHENYLEPHRINE, PSEUDOEPHEDRINE “EPHRINE” Used for rhinitis (nasal congestion), causes vasoconstriction of the respiratory tract mucosa. SE: causes agitation, nervousness, palpitations, rebound congestion if used for too long. ANTI-HISTAMINES- DIPHENYHYDRAMINE, LORATIDINE • First Gen: Diphenyhyramine. Second generation: loratadine. • Used for nasal congestion • mild allergic reactions, and for motion sickness • MOA: blocks histamine • SE: (benadryl) some anticholinergic type effects, sedation**. • • • • • • NASAL GLUCOCORTICOIDS-MOMETASONE (nasonex) “Mom has a stuffy nose” Other nasal glucocorticoids also end in that “sone” Used for rhinitis MOA: decreases inflammation in the nasal passages SE: headache, nasal burning, and pharyngitis VIDEO 19 CARDIOVASCULAR MEDICATIONS: LOOP DIURETICS -FUROSEMIDE • Lasix is the brand name: blocks the reabsorption of sodium chloride in the ascending loop of henle: causing diuresis. • Used for pulmonary edema, heart failure edema, kidney disease edema, hypertension, liver disease edema. • SE: hypotension, hyponatremia, hypokalemia, auto-toxicity**, dehydration, hyperglycemia. • KEY: Infuse IV at 20mg/minute, weight clients daily, input and output, monitor electrolytes, eat foods high in K. • administer during the day so they're not peeing all night. THIAZIDE DIURETICS- HYDROCHLOROTHIAZIDE • Blocks the the absorption of sodium, chloride, and water at the distal tube. • used for hypertension, edema related to heart failure related to kidney disease • risk for hypokalemia and hyperglycemia • Do not have to worry about auto-toxicity • KEY: administer during the day, monitor weight (I and Os), encourage potassium rich foods. POTASSIUM SPARING DIURETICS (SPIRINOLACTONE) • Potassium sparing diuretic • MOA: blocks aldosterone promoting excretion of sodium and water but retention of potassium. • Used for heart failure, hypertension • contraindicated in patients with severe kidney disease. • SE: runs the risk of hyperkalemia, can cause issues with menstruation in women, diarrhea, gynecomastia (in men). • KEY: monitor potassium levels closely, avoid salt substitutes that contain K.** OSMOTIC DIURETICS -MANNITOL • Used to treat edema increase ICP and increased interocular pressure • “I had so much intracranial pressure but man-it-all went away when i took mannitol” • MOA: reduces ICP and IOP by increasing serum osmolality by drawing fluids back into interstitial fluid. • SE: heart failure, pul Edema, renal failure, dehydration, electrolyte imbalances. • KEY: use a filter needle for IV tubing, monitor weight (Is and Os) and electrolytes. VIDEO 20: MEDICATIONS THAT AFFECT BLOOD PRESSURE: RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM • When your body senses the blood pressure is going down, your kidneys will release renin, renin activates angiotensin into angiotensin I. ACE=angiotensin converting enzyme, converts angiotensin I into angiotensin II. Angiotensin II causes wide spread vasoconstriction, increasing your blood pressure. It causes the adrenal cortex to release aldosterone, then aldosterone causes the kidneys to re-absorb more sodium and water in an effort to bring on more volume to the blood volume. ACE INHIBITORS -CAPTOPRIL • “end in Pril” • blocks the Ace enzyme, blocks the conversion of angiotensin I to angiotensin II. Causes vasodilation. • Used for hypertension, heart failure, MI, diabetics nephropathy, • SE: rash, risk of hypotension, cough**, hyperkalemia**, angioedema** KNOW** • KEY: want the patient to closely monitor blood pressure, change positions slowly due to risk of hypotension. ANGIOTENSIN II RECEPTOR BLOCKERS-LOSARTAN • Blocking the action of Angiotensin II (End in SARTAN) • Uses: hypertension, heart failure, MI, diabetic nephopathy. • SE: Angioedema*, GI upset*, Hypotension SPIRINOLACTONE: BLOCKS ALDOSTERONE VIDEO 21 MEDICATIONS THAT AFFECT THE HEART: CALCIUM CHANNEL BLOCKERS- DILTIAZEM, VERAPAMIL, NIFEDIPINE • Used for hypertension, angina • work by blocking calcium channels in the blood vessels and in the heart causing vasodilation, decrease in heart rate. • SE: hypotension, decreased heart rate, dysrhythmias, constipation, peripheral edema. • KEY: the patient should not take any GRAPE FRUIT juice, monitor blood pressure and heart rate carefully. ALPHA 2 AGONISTS-CLONIDINE • If you activate those it decreases SNS—>increase in vasodilation-> decrease in heart rate and BP. • Used for hypertension • SE: drowsiness, and dry mouth. • KEY: should increase their fluid intake and suck on hard candy for dry mouth. BETA 1 BLOCKERS -METOPROLOL, ATENOLOL • Primary in the heart, will increase in heart rate and contractions • Uses: hypertension, angina, HF, and MIs • Block beta 1 receptors: decrease in HR and BP • SE: bradycardia, hypotension, fatigue, and erectile dysfunction • KEY: change positions slowly, check BP and pulse at home daily. NON-SELECTIVE BETA BLOCKERS-PROPRANOLOL, CARVEDILOL, LABETALOL • Block both beta 1 and beta 2-non selective • Uses: hypertension, arrhythmia, HF, and MIs • SE: can cause bronchoconstriction** (only with non selective)—do not use with patients who have asthma**, fatigue, hypotension, bradycardia and decreased CO. VASODILATOR FOR HYPERTENSIVE CRISIS -NITROPRUSSIDE • dilates arteries and veins which rapidly lowers the BP • SE: hypotension, cyanide poisoning**, thiocyanate toxicity* (know). VIDEO 22 HEART MEDICATIONS: CARDIAC GLYCOSIDES-DIGOXIN • KNOW • Uses of HF and AFIB • “Mom “diga" get a prescription for your HF? yes, I did, I got digoxin” • Positive inotropic effect: increase in force and efficiency in heart contractions. • Negative chronotropic effect: decrease the heart rate. • SE: dysrhythmia, bradycardia • S/S of toxicity: nausea, vomiting, fatigue, weakness, and vision changes • KEY: always need to check pulse rate for 1 min before administration. DO not administer under 60. • Monitor serum levels should be between .5-2. • Hypokalemia can increase risk for digoxin toxicity. Should increase intake of K rich foods. • Treat bradycardia with atropine • Overdose treated with Digibind. ADRENERGIC AGONISTS -EPINEPHRINE, DOPAMINE, DOBUTAMINE • Epinephrine: this stimulates the alpha 1, beta 1 and beta 2 receptors • Used for cardiac arrest or asthma: causes brochodilation and vasoconstriction (increase BP), increased HR and CO. • Dopamine is used for shock and HF. Helps to increase renal blood flow. Increases HR and CO. • Dobutamine: Used mostly just for HF. Increases CO. • SE for all: hypertensive crisis, dysrhythmias, angina. ANTI-ANGINAL MEDICATIONS -NITROGLYCERIN • Used for angina or chest pain • causes vasodilation, decreases pre-load and myocardial oxygen demand • SE: headache, orthostatic hypotension, reflex tachycardia • ADMINISTRATION: • stop activity: put 1 tablet under tongue and rest for 5 minutes, if they have pain, call 911, take a second, wait 5 minutes, then take another 1. 3=15min. • Patch: place it on a hairless area of the body • rotate the sites to prevent skin irritation • wash site with soap and water and dry before you put another patch • watch out for being exposed to it on your own skin. VIDEO 23 MEDICATIONS THAT AFFECT CARDIAC RHYTHM. ANTI-DYSRHYTHMIC MEDICATIONS CLASS 1-PROCAINAMIDE, LIDOCAINE • Used for SVT, ventricular tachycardia, aFIB, aFlutter • “Procain (McCain)McCain lost and ended up taking Procainamide” • MOA: sodium channel blocker • SE: hypotension (all 4 classes), lupus*, leukopenia*, thrombocytopenia. CLASS 2-PROPRANOLOL • Used for Afib and Aflutter, SVT, angina • Impact beta 1 and beta 2 (lungs) • SE: it can cause brochospasms (never use for patients who have asthma), hypotension, bradycardia, fatigue, and weakness. CLASS 3-AMIODARONE • aFIB, ventricular tachycardia • acts as a potassium channel blocker • SE: hypotension, bradycardia, pulmonary toxicity, visual disturbances, GI upset, liver toxicity, and thyroid dysfunction. CLASS 4-VERAPAMIL, DILTIAZEM • Used for arrhythmia, to lower BP, aFib, aFlutter, angina, SVT. • SE: hypotension, bradycardia and GI upset ANTIPLATELETS: ASPIRIN, ABCIXIMAB, CLOPIDOGREL • Inhibit platelet aggregation, prevent MI's, strokes • Side effects – GI upset is common, bleeding is an important side effect. With aspirin watch for tinnitus • Contraindicated in children for fevers (risk for Reye's Syndrome) and pt's with bleeding disorders. THROMBOLYTIC: ALTEPLASE, RETAPLASE, “END IN -ASE OR -PLASE” • Break up existing clots, does not prevent. These are "busters." • "If you are trying to break up a clot you've come to the right place." • For pt's with MI's, PE or strokes. Can be used for an occluded PICC line • Mode of action – breaks up fibrogen • Side effects – bleeding • Contraindicated – In pt's who have had hemorrhagic bleeding, recent trauma, surgery or severe hypertension. • Needs to be given within 3 hours of onset of symptoms • Monitor – Labs & vitals, limit venous punctures and IM injections ANEMIA: EPOETIN ALFA • Increases production of RBC's and anemia related issues such as kidney disease, HIV or chemotherapy. • Mode of action – Stimulates the bone marrow to produce more RBC's • Side effects – hypertension, increased risk of stroke, DVT or MI • Monitor – BP during therapy, hemoglobin and hematocrit 2x's a week, ensure sufficient iron levels COLONY STIMUALTING: FILGRASTIM • For pt's with neutropenia (low WBC count) • Increases production of neutrophils, decreases risk of infection. Mostly used for pt's receiving chemotherapy • Mode of action: causes the bone marrow to produce increased levels of neutrophils • Side effects- Bone pain, leukocytosis, enlarged spleen • Monitor- CBC levels 2x's a week GASTROINTESTINAL ANTIBIOTICS: AMOXYCILLIN, ERYTHROMYCIN, METRONIZDAZOLE H2 RECEPTOR ANTAGONIST: RANITIDINE, FAMOTIDINE, “DINE” • H pylori infection is the most common cause for peptic ulcer. • Pt will be treated with 2-3 different antibiotics for 14 days, combo is for effectiveness and prevent drug resistance • Will also prescribe a H2 receptor antagonist -famotidine (Pepcid AC) or a proton pump inhibitor (omeprazole (Prilosec), a mucosal protectant and an antacid. • Used for - Duodenal and gastric ulcers, GERD, gastroesophageal reflux, zollinger-ellison syndrome (a condition that causes increase in gastro secretion of gastric juices) • Mode of action – Blocks H2 receptor in stomach, reducing stomach acid secretion • Side effect- Increases risk of infection of bacterial colonization in the stomach an d possibly respiratory tract • Pt teaching – Should not overeat, avoid smoking, aspirin, NSAID's PROTON PUMP INHIBITORS: OMREPRAZOLE, PANTOPRAZOLE • Used for - Duodenal and gastric ulcers, GERD, gastroesophageal reflux, zollinger-ellison syndrome (a condition that causes increase in gastro secretion of gastric juices) • Mode of action – Inhibits an enzyme needed for gastric acid secretion • Side effects – GI upset, increased risk of osteoporosis with long term use MUCOSAL PROTECTANT: SUCRALFATE • Used for duodenal ulcers • Reacts with the stomach acid to create a thick paste that adheres to the ulcers • Side Effects- Know that is causes constipation. Increase fiber and fluid • Administration guidelines – Know to be given 1 hour before meals and at bedtime = 4x's a day ANTACIDS: ALUMINUM HYDROXIDE, SODIUM BICARBONATE, CALCIUM BICARBONATE, MAGNESIUM HYDROXIDE • Used for – peptic ulcer disease, GERD • Mode of action – Neutralizes the stomach acid • Side effects – Will vary depending on type of antacid. For aluminum or calcium based: can cause constipation. Magnesium based: can cause diarrhea • Administration guidelines - take 1 hour and 3 hours after meals and at bedtime. Give at least 1 hour in between other medications. Never take antacids with other medications or with meals PROSTAGLANDINS: MISOPROSTOL • Used to prevent gastric ulcers in pt's taking NSAID's on a long term basis. Can also be used to induce labor by ripening the cervix • Mode of action – Decrease stomach acid production and increase production of protective mucous and bicarbonate • Side effects – Dysmenorrhea, miscarriage and GI upset. • Monitor – Labs for pregnancy test fist (cause for miscarriage) ANTIEMETICS: ONDANSETRON • Used for – nausea and vomiting from chemo, radiation, post-op anesthesia • Mode of action – Block serotonin receptors in the CTZ (chemo receptor trigger zone) • Side effects- GI upset, dizziness, headache • Administration guidelines- For chemo pt, administer prior to the chemotherapy LAXATIVES: MAGNESIUM HYDROXIDE, LACTULOSE, BISACODYL, DOUSATE SODIUM, PSYLLIUM • psyllium is bulk forming laxative, helps soften stool and increase bulk • Docusate sodium, a surfactant laxative softens the stool by increasing the water content of the stool • bisacodyl, a stimulant laxative is used to empty bowels before surgery • magnesium hydroxide, an osmotic laxative, draws water into the intestine and promotes peristalsis. Monitor for magnesium toxicity and dehydration • Key Points – Laxatives are contraindicated in pt's with bowel obstruction, encourage pt to increase fiber and fluid intake and exercise to prevent constipation • lactulose is used for hepatic encephalopathy. Used to decrease the ammonia levels and improve mental status of pt (high levels of ammonia causes confusion) • Mode of action for lactulose – lower the pH in the colon which promotes ammonia excretion • Side effects – GI upset, electrolyte imbalance, hyperglycemia ANTI-DIARRHEAL: LOPERAMIDE, DIPHENOXYLATE-ATROPINE • Mode of action loperamide – stimulate opioid receptors in the stomach, decreases motility and increases absorption of sodium and water • Side effects loperamide – constipation, drowsiness. For diphenoxylate-atropine, in high doses can cause opioid and anticholinergic effects PROKINETIC AGENTS: METOCLOPROMIDE • Used for – nausea and vomiting, gastroparesis, GERD • Mode of action – accelerates gastric emptying to prevent vomiting. Blocks dopamine and serotonin receptors in the CTZ • Side effects- drowsiness, extrapyramidal symptoms IBS IBS WITH DIARRHEA: ALOSETRON • Blocks five H3 receptors which increase the firmness of stool and decreases the urgency • Side effect – constipation • IBS WITH CONSTIPATION: LUBIPROSTONE • Increases fluid secretion in the intestine and increase intestinal motility • Side effect – diarrhea or nausea 5-AMINOSALICYLATE: SULFASALAZINE • Used for – IBS, Crohn's disease and ulcerative colitis • Inhibits prostaglandin synthesis which decreases colon inflammation • Side effects – blood dyscrasia (anemia agranulocytosis), GI upset, rash & headache VITAMINS AND IRON SUPPLEMENTS: IRON SUPPLEMENTS: FERROUS SULFATE (PO), IRON DEXTRAN (IV, IM) • used for – iron deficiency anemia • Side Effects - *Know PO form – GI upset is common, constipation, teeth staining (use a straw), stools can turn dark green or black (harmless and an expected finding). IV & IM form, staining at IV site, hypotension and flushing • Key points – Vitamin C increases absorption of iron. • Take iron on empty stomach 1 hour before meals. Increase fluid and fiber intake to prevent constipation. • Use the Z track method for IM • Keep out of reach with children • Encourage pt to intake iron rich foods B12-CYANOCOBALAMIN • For megaloblastic anemia; lack of folic acid or B12, lacking intrinsic factor for B12 • Taken nasal or IV form for rest of life • For folic acid, to prevent neural tube defects alcohol use disorder from poor dietary intake and for megaloblastic anemia when the issue is insufficient folic acid POTASSIUM: • For hypokalemia, pt's using diuretics, prolonged vomiting or diahrrea • Side effects – hyperkalemia. Never give a rapid infusion, can cause fatal hyperkalemia, give no more than 10 ml/EQ per hour MAGNESIUM: • When magnesium is too low, magnesium sulfate is also used to stop preterm labor and a anticonvulsant during labor and delivery • Side Effects – too much magnesium can cause paralysis, respiratory depression. Calcium gluconate can be given in case of toxicity HERBAL SUPPLEMENTS: • Black Cohosh – Acts like an estrogen substitute to help treat symptoms of menopause • Echinacea – To help stimulate the immune system • Garlic, ginder & ginko biloba – Risk with these are increased bleeding. The 3 G's. They have antiplatelet qualities. • Glucosamine – Stimulates cells to male cartilage and synovial fluid for osteoarthritis • St, John's Wart – Affects serotonin, can be used for mild depression • Saw Palmetto- Helps with prostate symptoms • Valerian – Reduce anxiety related restlessness (increases GABA) ANTILIPIDEMIC: CHOLESTEROL LOWERING MEDS: ATORVASTATIN, SIMVASTATIN, “STATINS” • Raises HDL (“H” is for happy) Lowers LDL (“L” is for lousy) • Side effects – muscle pain, hepatotoxicity, rhabdomyolysis • hepatotoxicity is common across all statins • administer in evening with a meal • Monitor liver function, creatine kinase levels • avoid alcohol CHOLESTEROL ABSORPTION INHIBITORS: EZETIMIBE • Inhibits the absorption of cholesterol in the small intestine • The “z” causes cholesterol to “ZIP” through and not be absorbed • Side effects - muscle pain, hepatotoxicit , rhabdomyolysis BILE ACID SEQUESTRANTS: COLESEVELAM (WELCHOL): • Binds bile acids in the intestine and excretes cholesterol and lowers LDL’s • Liver makes bile, in order to make bile cholesterol is needed • Side effects – constipation • Pt needs to increase fiber and fluids, take with food and full glass of water • Interferes with fat solube vitamins (A,D,E,K) and oral contraceptives NIACIN NICOTINIC ACID • Decreases lipoprotein and triglyceride synthesis which lowers LDL and triglycerides • Causes flushing of the face, GI distress, hepatotoxicity, hyperglycemia • Monitor liver function and blood glucose FIBRATES: GEMFIBBROZIL • Decrease triglyceride production and transport and increases HDL • Side Effects – GI upset, gall stones, hepatotoxicity, muscle pain • Monitor – Liver function and creatine kinase. Give 30 minutes before breakfast and dinner ANTICOAGULANTS: HEPARIN, ENOXAPARIN (LOVENOX) • Used for stroke, PE, DVT. Prevents new clots from forming will not break up existing clots • Side Effects – Bleeding with heparin induced thrombocytopenia, hypersensitivity • Monitor – PTT levels 1.5-2x’s baseline • Antidote for heparin is protamine • Watch for coffee ground emesis and black tarry stool • Pt teaching - Soft toothbrush, electric razor ORAL ANTICOAGULANTS: WARFARIN (COUMADIN): • Venous thrombosis, AFib with a thrombus, prevention of MI’s and DVT’s • Side Effects – Bleeding, GI upset, hepatitis • Monitor PT & INR levels (2-3 level) • 3-5 days for therapeutic level • Antidote is vitamin K DIRECT INHIBITOR FACTO XA: RIVAROXABAN (XARELTO) • prevention of DVT, PE, stroke in AFib pt’s • Selectively inhibits factor Xa and blocks coagulation • Side effects – Bleeding, possible elevated liver enzymes • Monitor liver function, hemoglobin and hematocrit REPRODUCTIVE: ESTROGEN, CONJUGATED EQUINE ESTROGEN, ESTRADIOL • Used for contraception in combination with progesterone, also for PMS, post-menopausal osteoporosis dysmenorrhea and prostate cancer • **Know side effects and contraindications • Side Effects – Increased risk for DVT, MI, stroke, hypotension, weight gain, edema, and increase risk in some cancers like estrogen dependent cancer • Key Points – Contraindicated in pt’s who smoke, hypertension, pt’s at risk for emboli, estrogen dependent cancers PROGESTERONE: • Used for contraception in combination with estrogen. Can also be used to maintain a pregnancy. Helps counter some adverse side effects of estgrogen • Side Effects – DVT, PE, MI, stroke, amenorrhea or breakthrough bleeding, edema, increase risk for breast cancer • Key Points – Pt’s should delay contraception for 3 months after discontinuing. Contraindicated in pt’s at risk for embolic events ANDROGENS-TESTOSTERONE • Used in boys with delayed puberty. Hypogonadism. Post menopausal breast cancer • **Be familiar with side effects of testosterone • Side Effects – Acne, increased cholesterol edema, liver dysfunction, polycythemia (increased hematocrit and hemoglobin), premature epiphyseal closure. In women can cause deepening of voice and abnormal hair growth • Contraindicated in pt’s with prostate cancer and high abuse potential BENIGN PROSTATIC HYPERPLASIA (BPH)-ANDROGEN INHIBITOR: FINASTERIDE (PROSCAR) • Used for BPH, baldness. Inhibits 5-alpha reductase which reduces reduction in prostate and increases hair growth • Side Effects – Erectile dysfuntion and gynecomastia • Pregnant women should NEVER handle this med. All others should wear gloves when handling PERIPHERALLY ACTING ADRENERGIC: TAMSULOSIN (FLOMAX): • Used for BPH. Antagonizes alpha-1 adrenergic receptors in the prostate and in the veins • Relaxes the muscle of the prostate to improve urine flow • Side Effects – Hypotension, dizziness, headache, issues with ejaculation • Key Points – Take med at same time everyday, usually 30 minutes after a meal. Monitor BP. ERECTILE DYSFUNCTION: SILDENAFIL “ENDS IN FIL” • Mode of action – Enhances the effects of nitric oxide released during sexual stimulation, increasing blood flow to the corpus cavernosum • Side Effects – Prolonged excretion. **Increased risk of MI ** IMPORTANT TO REMEMBER • Key Points – Should not take this med with other nitrates such as nitroglycerin **IMPORTANT TO REMEMBER** • Contraindicated in men who have cardiovascular disease LABOR AND DELIVERY: OXYTOCIN (PITOCIN): • A uterine stimulant used to induce or enhance labor. Also helps to deliver the placenta, stops postpartum hemorrhaging • Side Effects – Painful contractions, uterine rupture (serious side effect) • Key Points – Closely monitor contractions. Should be less than 60 seconds and every 2-3 minutes apart • *If there is and ATI or NCLEX question contractions lasting over 60 seconds or more that is too long. Need to discontinue oxytocin and notify the provider • During administration, need to monitor maternal and fetal BP and pulse. If over stimulation occurs, can use magnesium which can help relax the uterus PRETERM LABOR: TERBUTALINE SULFATE • Used for preterm labor. Helps delay but does not prevent. Also used for COPD and asthma because it activates Beta 2 adrenergic receptors in both the uterus and lungs. Will cause uterine relaxation as well as bronchodilation. • Side Effects – tachycardia, angina, restlessness and tremor • Contraindicated in gestation of 34 weeks or greater. The risks outweigh the benefits. Also with cervical dilation greater then 6cm MEPEREDINE: • Used for severe pain during labor • Binds to opioid receptors in CNS, decreases pain without causing significant respiratory depression with the mom and baby • Side Effects – GI upset, sedation, dry mouth, hypotension, decreased fetal heart rate • Key Points – Labor should be well established. Cervix should be at least 4cm dilated. In case of respiratory depression, can administer naloxone HYDROCHLOROQUINE: • Is actually anti-malaria med • Side Effects – Can cause retinal damage. Eye exams every 6 months • Meds in this class/section that end in “mab” or “nib” – these are typically immunosuppressant’s used for cancer or autoimmune disorders. Main thing to remember is a big risk for infection • Be familiar w NSAID’s and prednisone can be used to treat rheumatoid arthritis for inflammation and pain METHOTREXATE: • Used for rheumatoid arthritis, psoriasis and cancers • Inhibits folic acid metabolism which prevents cell reproduction • Side Effects – Risk for infection. Prevent crowds. Hepatotoxicity, bone marrow suppression, GI upset • Key Points – Notify provider asap if any s/s of infection. Monitor liver function carefully as well as CBC levels CYCLOSPORINE • Used for ulcerative colitis, RA, psoriasis. Also used in graft-versus host disease and transplant pt’s • Mode of action – Inhibits normal immune response by blocking interlukin 2 • Side Effects – Increased infection, hepatotoxicity, nephrotoxicity, GI upset, unusual hair growth • Key Points – Notify the provider asap with any s/s of infection. Monitor liver function and renal function NON-OPIOD ANALGESICS (NSAIDS): ASPIRIN, IBUPROFEN, NAPROXEN, INDOMETHACIN • Used for mild-moderate pain, fever and inflammation • Mode of action – Inhibits prostaglandin synthesis (across the board). Aspirin also inhibits platelet aggregation • Side Effects – GI upset and bleeding, renal toxicity, and rash. Aspirin can cause tinnitus. • Contraindications- Never administer aspirin to a child with a fever because it can cause Reye's Syndrome, pt's with peptic ulcer disease, or bleeding disorders. Pt's should avoid alcohol. • Monitor for signs of salicylism, which include sweating, dizziness, headache, tinnitus, and respiratory alkalosis ACETAMINOPHEN (TYLENOL): • Used for mild-moderate pain or fever • Mode of action – Inhibits prostaglandin synthesis in the CNS • Side Effects - **Important to know** hepatotoxicity can happen in high doses. Limit intake to a max of 4 grams per day • Patient teaching – with other medications with combination of acetaminophen. Acetylcysteine is the antidote for acetaminophen overdose OPIOD AGONISTS: MORPHINE, FENTANYL, OXYCODONE: • Used for moderate-severe pain and for promotion of sedation • Mode of action – They bind to opioid receptors in the CNS • Side Effects - **Important to know** - Respiratory depression, sedation, constipation, GI upset, hypotension, and urinary retention • Key Points – Naloxone is the antidote for opioid analgesics. Monitor the pain level, VS, and respiratory status. Administer slowly, and should be around the clock for cancer pt's. Increase fiber and fluid intake. OPIOD ANTAGONIST: NALOXONE • Competitively blocks opioid receptors in the CNS • Side Effects – Hypertension, angina, agitation, GI upset • Key Points – Monitor respiration status, monitor pain ADJUNCT MEDICATIONS: TRICYCLIC ANTI-DEPRESSANTS: AMITRIPTYLINE (ELAVIL) • Used for depression and also neuropathic pain ANTI-CONVULSANT: CARBAMEZAPINE • Used for seizures, neuropathic pain as well as bipolar disorder MEDICATIONS FOR GOUT: COLCHICINE, PROBENECID, ALLOPURINOL: • With gout there is increased levels of uric acid that accumulate and form crystals that leads to localized inflammation in synovial areas. Often the big toes are affected • Colchicine is used to decrease inflammation in acute gout attack. Side effects include GI upset, thrombocytopenia • Probenecid inhibits uric acid reabsorption. Used to treat hyper uricemia related to chronic gout. Side effects GI upset and kidney stones • Allopurinol inhibits uric acid production. Treats hyperuricemia related to chronic gout. Side effects include GI upset, rash, hepatotoxicity, and nephrotoxicity MIGRAINE MEDICATIONS ERGOT ALKALOIDS: ERGOTAMINE: • Used for vascular headaches like migraine and cluster headaches • Mode of action- Vasoconstriction of intracranial blood vessels **Important to know** • Side Effects – GI upset, muscle pain, numbness, tingling, and hypertension • Key Points- Advise pt's to lay down in a dark quiet place. Should avoid tyramine rich foods and alcohol TRIPTANS: SUMATRIPTAN -Used for acute attacks of vascular headaches including migraine and cluster headaches -Mode of action- Vasoconstriction of intracranial blood vessels **Important to know** -Side Effects - Warm tingling sensation, dizziness, angina, and possible injection site discomfort -Key Points - Advise pt's to lay down in a dark quiet place. Should avoid tyramine rich foods and alcohol LIDOCAINE -Local anesthetic that can be used topically or parenterally. Using topically is used for conditions involving the skin or mucous membranes like IV insertion and minor surgical procedures like dental work or epidurals. -Mode of action – Blocks conduction of pain impulses in a specific area -Side Effects – Typically with parenteral lidocaine can include hypertension, bradycardia prolonged labor, spinal headache and allergic reaction -Key Points – If using Emla cream, apply cream I hour before the procedure and cover with an occlusive dressing, remove dressing clean off ORAL ANTI-DIABETIC MEDICATIONS: SULFONYLUREAS: GLIPIZIDE, GLYBURIDE • Used for type 2 diabetes helps bring blood sugar levels down • Mode of action – Increases insulin release from the pancreas • Side Effects – Hypoglycemia, photosensitivity and GI upset • Key Points – Take med 30 minutes before a meal, avoid alcohol and use sunscreen MEGLITINIDES: REPAGLINIDE • Used for type 2 diabetes helps bring blood sugar levels down • Mode of action – Increases insulin release from the pancreas • Side Effects – Hypoglycemia, and angina • Key Points – Take med 3 x's a day eat within 30 minutes of dose BIGUANIDES: METFORMIN • Used for type 2 diabetes helps bring blood sugar levels down • Mode of action – Decreases glucose production in the liver and increases glucose uptake • Side Effects – GI upset, B12 deficiency, lactic acidosis, and metallic taste • Key Points – Take med with a meal, avoid alcohol, with a B12 issue will have to take a B12 supplement. Will need to discontinue prior to a procedure that requires NPO or contrast dye • Monitor – For diarrhea, dizziness, hypotension, bradycardia, and weakness THIAZOLIDINEDIONES: PIOGLITAZONE • Used for type 2 diabetes helps bring blood sugar levels down • Mode of action – Decreases insulin resistance, increases glucose uptake and decreases glucose production • Side Effects - **Important to know** - Fluid retention and increased LDL, hepatotoxicity • Contraindicated – In pt's with heart failure • Key Points – take med once daily, with or without food ALPHA-GLUCOSIDATE INHIBITOR: ACARBOSE • Used for type 2 diabetes helps bring blood sugar levels down • Mode of action – Inhibits glucose absorption in the GI tract • Side Effects – GI upset, hepatotoxicity, anemia • Key Points is contraindicated – in pt's with GI disorders. Take med 3 x's a day with meals with the first bite of food HYPERGLYCEMIA AGENTS: GLUCAGON • used for severe hypoglycemia when pt is unable to take oral glucose (unconscious or swallow issues) • Stimulated the breakdown of glycogen into glucose in the liver • Side Effects – GI upset • Key Points – Administer via sub Q, IM or IV route and provide food as soon as pt is able safely swallow ENDOCRINE DISORDERS: THYROID MEDICATIONS: LEVOTHYROXINE • used for hypothyroidism. Acts as a synthetic form of T3 & T4 • Side Effects – If dose is too high, hyperthyroidism; anxiety, heat intolerance and weight loss • Monitor – Levels of TSH and T4. Take med on empty stomach with full glass of water before breakfast • lifelong treatment ANTI-THYROID MEDICATIONS: PROPYLTHIOURACIL (PTU) • Used for Graves Disease and prep for thyroidectomy • Mode of action – Blocks synthesis of thyroid hormones • Side Effects – Agranulocytosis GI upset, rash and hepatotoxicity, If dose is too high, hypothyroidism; lethargy, weight gain, cold intolerance bradycardia and depression • Key Points – May take 1-2 weeks for full effect, important to monitor CBC levels and liver function RADIOACTIVE IODINE • Used for hyperthyroidism and cancer, absorbed by the thyroid and destroys thyroid producing cells • Side Effects – Radiation sickness, bone marrow suppression and hypothyroidism • Key Points- Instruct pt to increase fluid intake and void frequently and limit contact with others STRONG IODINE SOLUTION • Used for – hyperthyroidism, prep for a thyroidectomy • Inhibits thyroid production and release due to high levels iodine • Side Effects – GI upset, iodism; metallic taste, stomatitis, sore throat and gums **Important to know** Also can cause hypersensitivity • Key Points- Instruct pt to increase fluid intake. Can mix the solution with juice, avoid foods high in iodine GROWTH HORMONE: SOMATROPIN • Used to treat growth hormone deficiency both in peds and adult population • Acts by mimicking naturally occurring growth hormones. Helps by stimulating growth and protein synthesis • Side Effects – Hyperglycemia, • Key Points – Administer via IM or sub Q, and rotate sites. **Important to know** - Stop treatment prior to epiphyseal closure. So you will need to closely monitor the growth rate and bone age frequently ANTI-DIURETIC HORMONES: VASOPRESSIN, DESMOPRESSIN • Used for diabetes insipidus • Vasopressin mimics ADH which is produced by the posterior pituitary gland, causes reabsorption of water in the kidneys which helps decrease urine output and increase urine osmolality • Side Effects – over-hydration • Key Points – Pt's need to reduce fluid intake during therapy. Monitor eyes and nose very carefully and urine specific gravity. Ensure urine output is between 1.5-2 L within a 24 hour period ADRENAL HORMONE REPLACEMENT: HYDROCORTISONE • Used for adrenal cortical insufficiency in Addison's disease • Mode of action – Mimics naturally occurring cortisol which helps to maintain BP and regulate metabolism • Side Effects – Bone loss, peptic ulcer, infection, GI upset, weight gain, adrenal suppression, skin fragility • Key Points – Monitor for s/s of peptic ulcer; coffee ground emesis, tarry stool, never abruptly stop med. May need to increase the dose during times of stress. Also monitor for s/ s of infection. Pt should take calcium and vitamin D supplement, avoid NSAID's and alcohol IMMUNITY AND VACCINATIONS • Active natural immunity - Exposed to a pathogen in the real world and causes body to develop antibodies • Active artificial immunity – receiving a vaccine with a killed virus or weak virus causes body to develop antibodies • Passive natural immunity – through breast milk or placenta • Passive artificial immunity – administration of immunoglobulin to help fight off a disease when an exposure has already occurred • Expected findings after some vaccines – Low grade fever, pain at injection site • Can receive a shot with a cold, but not with a fever, previous anaphylactic reaction, allergy to any component of the vaccine, high fever within 2 days, encephalopathy after a vaccine, pregnancy in many but should get flu vaccine, immunocompromised pt's (HIV,etc) -