ATI Exam Study Guide Pharmacology

Pharmacology Overview ● Overview ○ 1 oz = 30 cc/mL ○ 1 tsp = 5 cc/mL ○ 1 tbsp = 15 cc/mL ○ 1,000 mcg in 1 mg ○ 1,000 mg in 1 g ○ Always recheck medications if you or the patient has any doubt or confusion ● Medication check ○ First ■ While in the med Room, Check the six rights including right patient, dose, medication, time, reason, route, and documentation ○ Second ■ Before leaving the med room, after drawing up and pulling all meds, recheck ○ Third ■ While in the patient's room, check with the patient themselves and their ID band ○ Never leave medication on the patient's bedside with the assumptionthattheywill take it, always watch the patient take it or assist them with administration ● Antihypertensives ○ Hold medication if systolic blood pressure is less than 100 ● Anti-arrhythmic ○ Hold medication if heart rate is less than 60 ● Medication administration ○ Never crush enteric-coated tablets, long-acting tablets ○ For patients with swallowing difficulty, provide soft food that is easier to swallow than liquid Important Drugs ● Aspirin ○ Administration ■ Take with meals or an 8-oz glass of milk to reduce stomach irritation ■ Stop taking for 5 days before surgery ■ Avoid giving to children who have a fever or other symptoms of a viral infection due to the risk of development Reye's syndrome ■ Avoid chewable aspirin for one week after a tonsillectomy, or any other dental surgery ○ Overdose ■ Hearing loss, confusion, ringing in the ears, dizziness, seizures, difficulty breathing ○ Contraindications ■ Diabetic patient- if taking aspirin, it may cause false urine glucose test, aspirin may increase the effect of antidiabetic medication causing low blood glucose levels ■ Other anticoagulants due to the increase risk of bleeding  ○ Allergy to aspirin ■ Avoid ibuprofen ● Chlorothiazide ○ The body loses water and potassium ● Prednisone ● ● ● ● ● ● ● ● ○ Acts on the body's metabolism to increase blood glucose and decrease potassium ○ Monitor the patient for any signs of infection ○ Teach the patient about tapering off the drug, avoid stopping the medication abruptly Steroids ○ Monitor patients for hyperglycemia Ibuprofen ○ Take with food or antacid to reduce stomach upset ○ Contraindications ■ Do not take if allergic to aspirin ■ Do not take if causes for stomach ulcers NSAIDs ○ Elderly patients receiving them on a routine basis should be monitored for congestive heart failure and hypertension as a result of fluid retention Iron supplements ○ Take with food or immediately after meals to reduce stomach upset ○ Side effects ■ Constipation, nausea, and black stools ○ Contraindications ■ Do not take at the same time as antacids Constipation ○ If a side effect of medication, teach the patient to increase their fluid intake, exercise regularly, And increase their fiber intake Hypokalemia ○ Dizziness, tiredness, weakness, leg cramps, nausea, GI upset Isoniazid (INH) ○ Used in combination with other drugs, usually Rifampin, to treat tuberculosis ○ Side effects ■ Vitamin B6 deficiency and GI upset ■ Serious- abdominal pain, yellowing of the skin and eyes, dark urine, all indicates inflammation of the liver ○ Pyridoxine ■ Vitamin B6, counteracts the side effects ○ Patient teaching ■ Avoid swiss cheese and tuna, as these foods can cause chills, headache, tiredness, rapid and pounding heartbeat Rifampin ○ Used in combination with isoniazid to treat tuberculosis ○ Side effects ■ Orange-colored urine, saliva, tears, sweat, and feces ■ Negate birth control pills ■ Nausea and vomiting ■ Thrombocytopenia ● Streptomycin ○ Can cause damage to cranial nerve number 8 ● Theophylline ○ Main action is to relax bronchial smooth muscles ○ Administration ■ Give with food to prevent GI upset ○ Toxicity ■ Dizziness, vomiting, agitation, apical pulse above 200 ● Aminophylline ○ Most common side effect is hypotension ● Digoxin ○ Apical pulse is essential for the accurate measurement of the heart rate before Administration ○ Toxicity ■ Visual disturbances such as green halos ● Levodopa Carbidopa (sinemet) ○ Effects may not occur until several weeks after Administration ○ Nursing care ■ Advise patients to moderately restrict protein intake ■ Watch for orthostatic hypotension ● Morphine ○ Monitor patients for bradypnea ● Levothyroxine sodium ○ Side effects include rapid heart rate and palpitations ● Coumadin ○ Therapy is be gone after anticoagulation has been established by another drug ○ Used on an outpatient basis for long-term anticoagulant therapy ○ Patient teaching ■ Advise patients to shave with an electric razor, use soft toothbrushes, and Report any coffee grounds or bloody vomit or stool ● Heparin ○ Protamine sulfate is an antidote for overdose ○ Never massage the area after injection ● Lovenox ( enoxaparin) ○ Duringtheadministration,theairbubbleshouldnotberemovedfromthepre-filled syringe ● Zidovudine ○ Can cause bone marrow problems ○ Patient teaching ■ Notify provider with the development of chills, fever, and sore throat ● Chemotherapeutic agents ○ Patient teaching ■ Avoid those with infections and large crowds do to immunosuppression ● Dilantin ○ Patient teaching ■ Teach patient to maintain a comprehensive oral hygiene programduetothe risk of gingival hyperplasia ■ Advise the patient that this drug can also causeconstipationanddrowsiness and irritation to GI tissues ● Lithium ○ Expected range is 0.6 to 1.2 ○ Not metabolized, excreted unchanged by the kidneys ○ Toxicity ■ Can begin at 1.4, increase to 2 ■ Symptoms include diarrhea, nausea, vomiting,drowsiness,muscleweakness, coma, convulsions, and death ■ Treatment includes gastric lavage, fluid balance correction, and Mannitol to increase urine excretion ○ Contraindications ■ Avoid diuretics, non-narcotic pain medications, and anti-inflammatory drugs, as these cannot increase the level of lithium ○ Patient teaching ■ Take with meals to avoid GI upset ■ Teach the client to maintain adequate fluid and sodium levels in order to prevent toxicity ■ Patient will have blood draws every month to watch stability of levels ● Amitriptyline (elavil) ○ Teach the patient that the full facts may not occur until 2 to 4 weeks after beginning therapy ● MAOI inhibitors ○ Isocarboxazid ■ Avoid foods high in tyramine ● Narcotics ○ Before Administration, assess the patient for any respiratory depression ● Burns ○ Silver nitrate solution 0.5% for treatment, including a wet dressing 1-2x daily ○ Silver sulfadiazine 1% cream can be placed with a light dressing ○  Mafenide acetate (sulfamylon) Placed on the wound using an open exposure method, applied up to four times a day ■ This medication is known to be painful on application, premedicate the patient before application Frequent Monitoring Drugs & Toxicity ● Acetaminophen ● ● ● ● ● ● ● ● ● ○ Contraindicated in liver disease ○ Toxicity can be shown in hepatic necrosis Aminoglycosides ○ Monitor for ototoxicity ( vestibular and cochlear), nephrotoxicity, neurotoxicity, and hypersensitivity ○ Monitor for tinnitus, hearing loss, vertigo, rash, dizziness, or difficulty urinating Amitriptyline (elavil) ○ Contraindicated in narrow angle glaucoma and with MAOI inhibitors ○ Side effects include drowsiness, sedation, lethargy, dry mouth and eyes, blurred vision, hypotension, and tachycardia ○ Advise patients to use sunscreen Carbamazepine ( Tegretol) ○ Contraindicated in bone marrow suppression ○ Toxicity can be shown in drowsiness, dizziness, and ataxia ○ Advise patient to use sunscreen and where medical alert bracelet Chlordiazepoxide ( Librium) ○ Contraindicated with comatose patients with CNS depression or narrow angle glaucoma ○ Toxicity can be shown in drowsiness, dizziness, delirium tremens may occur in alcohol withdrawal patients Disopyramide (norpace) ○ Contraindicated in cardiogenicshock,secondorthirddegreeheartblocks,andsick sinus syndrome ○ Toxicity can be shown in symptoms of congestive heart failure Diazepam (Valium) ○ Contraindicated in comatose patients with CNS depression, and narrow angle glaucoma ○ Toxicity can be shown in sedation with Ataxia, dizziness, and slurred speech Digoxin ○ Contraindicated in uncontrolled ventricular arrhythmias or AV blocks ○ Side effects include anorexia, nausea, vomiting, visual  disturbances, and bradycardia Doxepin ○ Contraindicated narrow angle glaucoma ○ Toxicity can be showninsedation,fatigue,blurredvision,hypertension,drymouth, and constipation ○ Advise patients are always wear sunscreen Glucocorticoids ○ Contraindicated in serious infections ○ Monitor patient for adrenal insufficiency, with symptoms such as hypotension, weight loss, weakness, nausea and vomiting, lethargy, confusion, and restlessness ● ● ● ● ● ● ○ Other serious side effects include depression or Euphoria, personality changes, hypertension, decrease wound healing, patiki eye, ecchymosis, hyperglycemia, hypoglycemia, hypernatremia, fluid retention, osteoporosis, cushions appearance via moon face and buffalo hump ○ Patient teaching ■ Monitor patient's blood sugar, b u n, and creatinine levels ■ Medication should not be abruptly discontinued, taperoffoverthecourseof two to four weeks Lithium ○ Contraindicated in severe cardiovascular renal disease, as well as dehydrated or debilitated patients ○ Toxicity can be shown in vomiting, diarrhea, slurred speech, Kris coordination, drowsiness, muscle weakness and twitching ○ Patient teaching ■ Effects will be seen within 1 to 3 weeks after the start of initial therapy ■ Maintain adequate sodium and fluid intake to avoid toxicity Lidocaine (Xylocaine) ○ Contraindicated in advanced AV block ○ Toxicity can be shown in confusion, blurred or double vision, nausea, vomiting, ringing of the ears,Tremors,convulsions,difficultybreathing,severedizziness,and bradycardia Magnesium sulfate ○ Contraindicated in patients with hypermagnesemia, hypocalcemia, anuria, and heart block ○ Toxicity can be seen in decreased respiratory rate, bradycardia, arrhythmia, hypotension, flushing, sweating, and hypothermia ○ Patient teaching ■ Monitor neuro status before and throughout therapy and initiate seizure precautions Phenobarbital ○ Contraindicated in comatose patients with CNS depression ○ Toxicity can be seen in confusion, drowsiness, dyspnea, slurred speech, and staggering Phenytoin (Dilantin) ○ Contraindicated in science bradycardia and heart block ○ Toxicity can be seen in nystagmus, Ataxia, nausea, confusion, slurred speech, and dizziness Propranolol (Inderal) ○ Contraindicated in decompensated congestive heart failure, pulmonary edema, cardiogenic shock, bradycardia, and heart blocks ○ Toxicity can be seen in bradycardia, dizziness, drowsiness, dyspnea, bluish fingernails or palms, and seizures ○ Caution diabetic patients to closely monitor blood sugar levels ● Quinidine ○ Contraindicated in conduction defects and digitalis glycosides toxicity ○ Toxicity can be seen in tinnitus, hearing loss,visualdisturbance,headache,nausea, and vomiting ○ Cardiotoxicity includes QRS widening and asystole, as well as ventricular ectopic beats, paradoxical tachycardia, and arterial embolism ● Salicylate ○ Contraindicated in hypersensitivity to aspirin or other salicylates, bleeding disorders, or thrombocytopenia ○ Toxicity can be seen in tinnitus, headache, hyperventilation, mental confusion, lethargy, diarrhea, and sweating ● Theophylline ○ Contraindicated in uncontrolled arrhythmias and hyperthyroidism ○ Toxicity can be seen in anorexia, nausea and vomiting, stomach cramps, diarrhea, confusion, headache, flushing of the skin, increased urination, insomnia, and tacky arrhythmias ○ First signs of toxicity include tachycardia, ventricular arrhythmias, and seizures ● Valproic acid (depakene) ○ Contraindicated in hepatic impairment ○ Toxicity can be seen in anorexia, nausea and vomiting, yellowing of the skin and eyes, fever, sore throat, weakness, facial edema, lethargy, unusual bleeding or bruising, and seizures ● Insulin ○ 100 units of insulin in each mL of U100 syringe ○ Regular insulin is the only one that can be given IV, is clear in color ○ NPH and lente insulin are cloudy due to zinc precipitate ○ 100 units of 70/30 insulin contains 70 units of intermediate insulin and 30unitsof regular insulin ○ Regular insulin ■ Onset of 30 minutes to 1 hour ■ Peaks within two to five hours ○ NPH insulin ■ Onset of 1 to 1 1/2 hours ■ Peaks Within 4 to 12 hours ○ Lente SC ■ Insulin zinc suspension that peaks with an 8 to 12 hours ○ Both lente and NPH should be mixed by Rolling between the Palms prior to withdrawing the dose ○ Insulin can be left at room temperature for up to 4 weeks ○ Mixing insulin ■ Regularinsulinshouldbewithdrawnfirstfollowedbytheintermediateacting insulin ■ Inject air into NPH insulin ■ Inject air into regular, short-acting insulin ■ Keep the needle and the regular insulin and draw up regular ■ Finally, draw up NPH ○ Current vials of insulin being used should not be refrigerated duetothepossibility of local irritation insight ○ Always rotate sites to prevent lipodystrophy, never massage the site after injection ○ Oral anti-diabetic drugs ■ Stimulate beta cells of the pancreas to secrete more insulin and to decrease insulin resistance at receptor sites ○ Sliding scale ■ Administered based on glucose levels for short-term management ○ Interactions ■ Salicylates with insulin can cause hypoglycemia ● Complementary drug therapy ○ All has potential adverse drug interactions with normal FDA-approved drugs ○ Black cohosh ■ Contraindicated with antihypertensive medication due to increasing the effect of these medications ○ Garlic,gingerroot,andGinkgo cansuppressplateletsaggregationandincreasethe risk of bleeding for patients taking aspirin an anticoagulant such as Heparin and Warfarin