NLN Pharmacology Study Guide

8/11/2019 NLN Pharmacology Study Guide

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WSUCONHSTUDY GUIDE FOR NLNPHARMACOLOGY EXAM (REVISED 6/3/2013) 1

NLN Pharmacology Study Guide

There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the informationyou will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to

prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line.

The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All aremultiple choice questions, including calculations.

Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. Theyare pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX test-taking tips to prepare for this exam also.

References:

Pearson nursess drug guide. (2013). Upper Saddle River, NJ: Pearson.

Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Mosby.

Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice(2nded.). Upper Saddle River, NJ: Pearson.

Calculations

Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or reviewa nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one ormore type of calculation.Tips:

1.

READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you selectthe correct formula and eliminate unnecessary information.

2. Double (and triple) check actual math. Did you clear the calculator correctly?3.

Does the answer make sense?4. There are both adult and pediatric calculations.5. Watch per dose, per day.

6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.


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2Common calculations include (but are not limited to):

1.

Kg to mg to mcg conversion (any which way)

LK H D M D C M - - mcg

Gliter

(kilo hecto deca meter deci centi milli skip skip micro)gram

2.

Dosage calculations

a. Tablets

b.

mg. to tablets

c. mg. to ml

d.

units to ml

e.

kg to ml

f. Half-life calculation

g. IV rate calculation (hourly infusion rate) AND adjustment

h. IV rate dosage calculation (based on units per ml, etc.)

i. Macro- vs. micro-drop tubing

j. Calculating drops/minute (gtts/min)

Examples: (abbreviated to type of question; exam will add extra information)

1.

Have 5 mg tablets; ordered dose 2.5 mg. How many tablets will the nurse administer?2. Have 2 mg/2 ml; order is 1 mg. How many milliliters will the nurse administer?

3.

Prepare a 20 mEq dose of a medication. Available solution is 40 mEq/10 ml. How many ml will be administered?

Note: calculation method is not different in examples 1 - 3, just the unit of measure (mg, units, mEq, etc.). BE SURE AVAILABLE

AND HAVE ARE THE SAME UNIT OF MEASURE.

4.

Half-life conversion: Half-life is known to be 2 hours. What percentage will be left in the body after six hours?

5. A person weighs 165 lbs. How many kg does the person weigh?


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6. The available medication has been reconstituted to 250 mg/5 ml. The order is 5 mg/kg/daily in two evenly divided doses.

Child weight 44 pounds. How many milliliters will be administered per dose? NOTE: More than one calculation method

must be used to answer this question.

7.

IV was ordered at 1000 ml over 8 hour period. After two hours, only 900 ml has infused. Calculate the new infusion rate

for the medication to be administered within the original 8 hour period.

8.

Order is for 3000 cc over a 24-hour period. What is the hourly flow rate? OR: What will the pump be set at per hour?

9.

Order is for antibiotic to be mixed in 50 ml NS and administered over 45 minutes. What is the hourly flow rate? OR:

What will the pump be set at per hour?

10.

Volume is 1000 ml. Ordered infusion time is 8 hours. Have tubing of 15 drops/ml. How many drops need to be counted to

deliver the identified milliliters per minute?

11.

Available solution = 25,000 units in 250 ml NS. Order is to administer at 22 ml/hour. How many units will be given per

hour?

12.

Available solution = 25,000 units in 250 ml NS. Administer at 2000 units/hour. How many ml will be given be hour? OR:

What will the pump be set at per hour?

Principles of Pharmacology

These include the basics! Review:

1. Routes of administration benefits and problems

2. Sizes of needles and syringes for injections

3. Six Rights of Medication Administration; Three Checks

4.

Side effects; adverse effects; paradoxical reactions; toxicity; antagonists5.

Half-life calculation

6. Allergic or hypersensitivity reactions

7.

Absorption, metabolism, distribution and excretion

8.

There may be questions on lab values as relevant.

9. There are pediatric and adult questions.

10.

Immunosuppression precautions (due to meds for cancer, HIV/AIDS, etc.)


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Administration routes: some key points

Sublingualadministration

absorbed in mucosa of oral cavities

rapid onset of action

Place tablet on floor of mouth, close mouth. Do not swallow, hold under tongue until dissolve.

Use sprayon floor of mouth under tongue and close mouth.

Buccal

place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve

slower to dissolve and absorb than sublingual

Intramuscular injections

Given in the vastus lateralis in children up to 3

Spread skin taught to bring muscle near surface of skin, with dart-like motion insert needle at 90 degrees

Aspirate to determine if needle enter a blood vessel. If there is blood return discard the needle and meds and startprocedure over.

NGtube / Gtube

NG usually temporary; G-tube for longer term

Follow instructions re crushing, dissolving medication no sustained release meds

Eye drop administration

Clean exudates from eye; (2) tilt head toward side of affected eye; (3) pull lower eyelid down; (4) have pt. look up; (5)instill drops in conjunctival sac formed by lower lid (not onto the eye); (6) Apply gentle pressure for 30 sec to 1 min overinner cantus next to nose (this prevents absorption through the tear duct and drainage of the medication). Close eyesgently massage the eyes to distribute the meds.

Slow absorption except in infants where they readily absorb

EYE OINTMENT

Same as eye drop except it is expressed directly into the conjunctival sac from the inner canthus to the outer canthus. Close

eyes and gently massage to distribute the medication


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Definitions:

Agranulocytosis / Neutropenia / agranulocytopenia

Definition: Acute decrease in the number of granulocytes/leukopenia (WBC) in peripheral blood

Causes include: treatmentwith broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime,ticarcillin, gentamycin), bone marrow transplant, chemotherapy, radiation.

Generally is impaired resulting from bone marrow depression by drugs and chemicals or replacement by a neoplasm(orallesion, ulcer necrotic, gingivitis, buccal mucosa

Lymphadenopathy, lymphadenitis may be prevalent.

Could lead to respiratory infection, ulceration of mouth colon, high fever, UTI . But may be asymptomatic

Chelating agents

A form of detoxification

Chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide (a synthetic amino acidwhich attaches to toxic substance such as lead, cadmium, aluminum and other metal in the blood to facilitate their removal

from the body.)

May be used to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to removeexcess calcium from the body.

EDTA: Ethylenediaminetetraacetic acid

Use in children with lead level between 45&70 micron/dl.

EDTA binds to lead in blood and excreted by the bowel and kidney. EDTA may be toxic to kidney. Monitor urine output.

Give this by IV. Dose depends on weight of child, severity of the poison. Agent is given every 4 hours for 5 days. A secondcourse may be needed if there is a rebound in the blood level. Give oral and IV fluid to enhance excretion

Do not use EDTA with hypocalcemia or hypokalemia.

OTHER AGENTS British antiLewisite (BAL) does not give with iron supplement and avoid in pt. with plant allergy. Give this by IM

Succimer (Chemer)

Chemet oral medication - Do not give in pt. with encephalopathy

Epistaxis

Nose bleed. Can be anterior or posterior. Posterior is more serious.

due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma

blood can come up through the eye, can also flow down the stomach causing nausea, vomiting


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Treat epistaxis

cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbentdressing or saline sprayed into the nose

Ice pack to forehead or back of the neck

pinch septum of nose for 5 minutes Do not pack nose with tissue or gauze

Half-life

The time it takes for a medication to lose half of its pharmacologic or physiologic effect

To calculate half-life: There is a formula but the easiest way to decrease count.

Example: half- life is 1 hour.Start 100%1 hr. 50%2 hrs. 25%

3 hrs. 12.5%4 hrs. 6.25%Question Half-life of xyz medication is 1 hour. After 3 hours, what percentage of the medication will be left? A = 12.5%

Osmotic agent - see entry under Mannitol

Paradoxical reaction

A response to a drug (or medical treatment) that is the opposite to the usual response, such as agitation produced in anindividual patient by a drug which is ordered to sedate or calm a person.

Sustained release / time released / extended release / controlled release

Pills or capsule formulated to dissolve slowly and release drug over time.

They can often be taken less frequently, keep steadier levels of the drug in the bloodstream

Contain in a matrix of insoluble substance (e.g. Acrylics) the drug swells up to form a gel so that the drug has first to dissolvein matrix then exit through the outer surface.

Cannot be crushed, dissolved or opened


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Medication Effects

There is a bit of an overlap here with Principles of Pharmacology. These questions tend to be medication (or classification)

specific. There are many medications on the test and many could be. As applicable, both brand and generic names are used.

We recognize the attached grid is very lengthy, but have included some of the key components as identified below. Mostmedications addressed are either high usage or high risk. Please note that auto-corrections will change generic names to

starting with caps. In the grid, we have tried to list generic first, then brand names.

Areas to know:

1. Use, dose, side effects, contraindications

2.

Since there are a limited number of questions, not all medications are addressed. You may be asked to select which

medication would be given for a particular diagnosis. When studying, focus on the classifications this may enable you

to answer without knowing the actual medication.3. Focus on what are the major side effects of a medication or class? What makes it high risk? Why might one particular

med be used other than another?

4. Patient teaching is a major focus. What would you tell the patient about the medication? What would indicate

understanding? What would indicate need for further teaching?

Common classification of medications

Note letters in medication name and look for those letters that identify a particular classification:

Androgens: end with terone: testosterone (Testoderm)

ACE Inhibitors: end with pril: enalapril (Vasotec)

Antidiuretic hormones: end with pressin: desmopressin (DDAVP)

Antilipidemic: end with statin: atorvastatin (Lipitor)

Antiviral: contain -vir: ritonavir (Norvir)


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Benzodiazepines:include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),

estazolam (ProSom), and triazolam (Halcion). Most others end with pam: diazepam (Valium)

Beta Blockers: end with lol: atenolol (Tenormin)

CCB: end with pine: amlodipine (Norvasc); some exceptions include diltiazem (Cardizem), verapamil

(Isoptin)

Carbonic anhydrase inhibitors: end with mide: acetazolamide (Diamox)

Estrogens: contain est: conjugated estrogen (Premarin)

Glucocorticoids and corticosteroids: end with sone: prednisone (Deltasone)

Histamine H2receptor antagonists: end with dine: cimetidine (Tagamet)

Nitrates: contain nitr: nitroglycerin (Nitrostat)

Pancreatic enzyme replacements: contain pancre: pancrelipase (Pancrease)

Phenothiazines: end with zine: chlorpromazine (Thorazine)

Proton Pump Inhibitors: end with zole: lansoprazole (Prevacid)

Sulfonamides: include sulf: sulfasalazine (Azulfidine)

Thiazide diuretics: end with zide: hydrochlorothiazide (HydroDIURIL)

Thrombolytics: end with -ase: alteplase (Activase)

Thyroid hormones: contain thy: levothyroxine (Synthroid)

Xanthine bronchodialators: end with line: theophylline


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Specific Diseases or treatments:

Aminoglycoside

antibiotics - Treats serious life threatening gram negative (and some positive) infections

All aminoglycoside ends Mycinbut not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin andazithromycin)Examples:

Gentamycin

Tobramycin

Vancomycin

Neomycin

Generally IM or IV.

Oral route is not recommended. It is only use for bowel prep prior to surgery (see Neomycin)

Adverse effects/toxicity:Two most commonMAJOR adverse effects:Nephrotoxicity and ototoxicity.Also:

Photosensitivity

risk for superinfections

Pseudomembranous colitis (c-diff): stop med and treat with PO Flagyl

Peak level:

Drawn 15-30 min after the infusion is completed.

Peak concentration determines that toxic level does not occur.

If peak is too high, may reduce dose.

Trough level:

Drawn immediately (within 30 minutes) before next IV dose

Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.

Dose will be adjusted if level is not sustained


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Blood administration

Start blood transfusion slow 2 ml/min. Remain with pt. for the first 15-30 min. if there is no sign of side effect, increase rateto the desired rate

Administer using largest gauge IV access as possible.

Observe for acute reaction such as: allergic s/s rash, itching, localized edema; febrile (even low grade); septic; air embolism;circulatory overload.

Observe for delayed reaction: Graft vs. host; hepatitis; hemolysis

Crack abuse effect on newborns

Crack crosses the placenta and enters the fetus.

Common presentation: Infant may appear normal or develop neurological problem. Child may develop depression orexcitability, they may be lethargy, have poor suck; weak cry and difficulty in arousing, hypotonicity, rigidity, irritability,inability to console and intolerance to change, small head, decreased birth length

Late symptoms: Some infant showed late symptoms 2-8 wks. There may be growth retardation - head growth is one of thebest indication

Diabetes treatment in children

Hypoglycemic reaction takes place most time before meals or when insulin effect is peaking.

First teaching: (1) let child wear bracelet or tag; (2) Teach how to give injection. Inject at 90 degree angle.

Teach only the essentials on the first few visits and intense later. Keep session for children to 14-20 min and adult may go upto 45-60

Have same meal as normal child time intake of food. Eat at the same time each day.

Children can start learn to assume responsibility for self-management as soon as age 4-5. At age 9, they can start givingtheir own insulin with supervision.

Exercise: do not restrict exercise. Have extra snack before and after exercise. Exercise very regularly as it decreases theneed for insulin

Carry a source of glucose at all times (hard candy, sugar cubes glucose tablets, insta glucose). The rapid releasing sugar isfollowed by complex CHO and protein such as slice of bread or cracker spread with peanut butter

After glucagon injection, vomiting may occur. Place child on the side to prevent aspiration.

Preferred way of treating ketoacidosis is by insulin IV of low dosing. Note. Run a mixture of insulin through the tubingbefore starting the drip because the insulin can chemically bind to plastic. Replace fluid over 24-48 hrs.


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Diabetes Intravenous insulin administration

Can only be done with regular insulin in management of DKA, HHNK.

Premature discontinuation can cause prolongation of DKA.

Begin SQ insulin therapy before stopping the infusion. If not, there might be prolonged hyperglycemia.

Hepatitis see belowHIV treatment antiretinoviral therapyCommon meds:

abacavir (ziagen)

stavudine (Zerit)

zidovudine (AZT)

Antiviral protease inhibitor. End in AVIR

Use prophylactically.

Use in combination to decrease viralload and increase CD4.

Reverse transcriptase inhibitors: Ends inINE

Stop replication/growth. Reducesviral load.

One major advantage is that they donot affect adversely affectdevelopment of blood cells.

Use in combination with other medsbecause resistant strains may rapidlyevolve if used as single agenttherapy.

Inhibit cell protein synthesis thatinterfere with viral replication; blockprotease activity in HIV.

Treat AIDS and AIDS-related complexto decrease viral load

Side effects:

Assess for opportunistic infection(cancer, neurological disease); HA,fatigue, nausea, vomiting, diarrhea,abdominal discomfort, anemia, tasteperversion, asthenia, circumoralparesthesia with ritonivair,

Adverse/toxicity

Hepatoxicity, Hepatotoxicity: AST,ALT, bilirubin; observe for nausea,vomiting jaundice upper rightabdominal quad enlargement andtenderness. Reduce dose in liverdysfunction.

Nephrotoxicity; creatinine, BUN,creatinine clearance, urinalysis, keepaccurate I& O, monitor for SE ofneutropenic, observe occult signs of

infection. (lower back, flank orsuprapubic pain, normal temp or lowgrade fever related to UTI

START therapy:(1) all symptomatic HIV people(presenting with a AIDS-defining illness)or(2) with a CD4 count less than 350 mm3.(3) also start pregnant women (AZT isused to prevent maternal transmissionof HIV)

STOP if severe rash or otherhypersensitivity reaction occurs.Excluding reaction to medicationsand/or ineffectiveness of medication,treatment will be long-term.

TEACH

Use neutropenic precautions

Eat small frequent meals withcomplete or complementary proteins


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Inotropic medications:Positive inotropic meds increase cardiac contractility examples: epinephrine, norepinephrine, dopamineNegative inotropic meds decrease cardiac contractility, lower BP: examples quinidine; betablockers (most end in olol)

Sulfonamides

Anti-infective.

Bacteriostatic which action onbacteria results from interferencewith the functioning of enzymesystems necessary fornormalmetabolism, growth andmultiplication

Treat: UTI, Chlamydia causingblindness, pneumonia, brain abscess,ulcerative colitis, active Crohnsdisease, rheumatoid arthritis

Examples:

Bactrim

Side effects:

Rash common; most are urticaria andmaculopapular.

GI symptoms

Bone marrow depression

Headache, dizziness, vertigo, ataxia,convulsion, depression

Adverse effects/toxicity:

Hepatotoxicity

Nephrotoxicity

Stevens Johnson syndrome (anadverse reaction of skin thatresembles appearance of partialthickness burns)

CAUTION: do not use:

known allergies to sulfa drugs In polyuria, advanced renal or hepatic

dysfunction

with intestinal and urinary blockage,

asthma

Take adequate amount to fluid 3000-

4000ml/day to promote urinaryoutput, at least 1500ml/d to prevent

crystalluria/stone formation May be taken after meals to prolong

time in intestine.

Collect C&S prior to beginningtherapy

Thiazide diuretics:Examples:chlorothiazide (Hydrodiuril),hydrochlorothiazide (HCTZ, Diuril)Name ends in ZIDE

non-potassium sparing diuretic. Acts on distal tubes, blocks

reabsorption of sodium, chloride andwater. Leads to increased loss ofPotassium.

Use for edema and mild to moderatehypertension

will see effect of within 1-4 wks.

Side effects:

Dizziness, vertigo, HA, weakness,dehydration, orthostatic hypotension

N/V, abdominal pain, diarrhea,constipation, frequent urination

dermatitis and rash

Electrolyte imbalance

impaired glucose toleranceAdverse effects/toxicity:

Renal failure,

aplastic anemia, agranulocytosis,thrombocytopenia

anaphylactic reaction

Take early in the day to avoidnocturia

Take with food to avoid GI upset.

Thiazide is ineffective if creatinineclearance is < 30ml/min

Eat foods high in potassium, restrictsodium, do not use salt substitute iftaking potassium supplement

weigh self daily, report suddenweight gains or losses

Avoid use with:

Children

anuria


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Tricyclic Antidepressants

Initial mechanism of TCA takes 1-3

weeks to develop. Maximum response is achieved in 6-8

wks.

Has long half-life.

Most Tricyclics ends in INE

nortriptyline (Pamelor)

amitriptyline (Elavil)

doxepin (sinequan)

imipramine (tofranil)

Block the reuptake of norepinephrineor serotonins or both, leaving moreavailable in the CNS. It intensifiesthe effect of norepinephrine and

serotonin which can elevate mood,increase activity and alertness,decrease preoccupation withmorbidity, improve appetite and

regulate sleep pattern.

It is used to treat insomnia, attentiondeficit/hyperactivity and panicdisorder.

Side effects:

orthostatic hypotension,

sedation and anticholinergic effects.


Most serious adverse effect is cardiactoxicity; in the absence of overdoseor preexisting cardiac impairment,serious cardiotoxicity is rare.

URINARY RETENTION IS URGENT

Overdose may cause convulsions

Take at nights, it causes sedation.

Do not take with MAO it will causehypertensive crisis from excessiveadrenergic stimulation of the heart

and blood vessels, monitor orthostatic BP of pt. in

hospital

Use with caution:

Glaucoma

Elderly

constipation, prostatic hyperplasia,

as they are more sensitive toanticholinergic effect

Avoid use with:

hypersensitivity,

MI, Cardiovascular disease

Vesicant Chemotherapy See precautions under Vincristine

Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxinsStages of viral hepatitis:

(1) Pre-icteric precedes appearance of jaundice, may have flulike symptoms(2)Icteric appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools(3)

Post-icteric convalescent stage; jaundice improves; color of urine and stool returns to normal


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Hepatitis A(formerlyinfectious hepatitis)

Cause: enterovirus

At risk:

Young children

Institutionalizedpeople

Health carepersonnel

Transmission:

fecal-oral

ingestion of food orliquidscontaminated withthe virus.

person by personcontact

Incubation: 3-5 wks.Infectious: usually 2wks. before the onset

of jaundice and 1 wk.after onset of jaundice.

s/s: May have nosymptoms initially.

Complications:

Fulminant hepatitis

Hepatitis B.

At risk:

IV drug users

People onHemodialysis

Health carepersonnel

Transmission:

blood and bodyfluids

contaminated

needles, parenteral sexual activity

Incubation: 6-24 weeks

s/s:

progression ofsymptoms is moreinsidious andprolonged than

Hep A virus. Initially may be

asymptomatic.

1 week -2 months ofProdromalsymptoms: fatigue,anorexia, transientfever, abdominal

Hepatitis C

At risk:

IV drug users

People receivingfrequenttransfusions

Healthcarepersonnel

Transmission:

Same as Hep B

Blood and body

fluids

Incubation period: 5-10weeks

s/s: similar to HBV butoften less severe.

Complications:

chronic liver disease

Cirrhosis.

Hepatitis D

Cause: Occurs only withHepatitis B and only

causes problems withan acute HepBinfection.

At risk:

common in Middleeast, south Africaand Mediterranean

same as HepB

Transmission:

same as Hepatitis B.

Incubation period: 7-8weeks

HepD along with HepBcauses superinfectionand worsening of

condition and rapidprogression of cirrhosisComplications:As per Hep B

Hepatitis E

Cause: waterbornevirus

At risk:

Travel to areaswhere sewage

disposal isinadequate and/orpeople bathe incontaminated rivers

At higher risk withhigher mortality:women in thirdtrimester ofpregnancy

Transmission:

Same as HepA

Incubation: 2-9 weeks

Complications: Maternal and fetal

demise


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death discomfort N/V, HA.

Then expanding to:Hepatic S/S,photophobia,

angioedema, rash,vasculitis, jaundicein Icteric phase

Complication:

Cirrhosis

Fulminant hepatitis

A grid follows with a listing of medications that may be on the exam.


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Drug Use and dosage Side effect Teaching and labs contraindication

Acetylsalicylic acid(Aspirin)

Non-narcoticanalgesic

Antipyretic

Antiplatelets

Blocks pain impulsein peripheral andsome CNS;

antipyretic result; inhibit plateletsaggregation

Treat TIA, Post MI,Stroke, angina

Increasescoagulation times

Reyes syndrome

(encephalopathyand fatty liver),

GI bleed,

tinnitus,

liver toxicity(darkurine, clay stool,itching, yellowingsclera and skin),

visual changes

Monitor coagulationstudies

Take with full glass

of water, milk forfood to preventstomach upset

Do not crush enteric

coated

given daily (81-325mg) for cardiacprophylaxis post MI,stents, strokes, etc.

Do not use with:

children under 12and/or children or

teenagers withchicken pox or flulike symptoms(because of risk ofReyes syndrome);

pregnancy in 3rdtrimester; and

vitamin K deficiency

Activated charcoal(Actidose)

Antidote

Adsorbent

Treat poison andoverdose followingoral ingestion.

Binds to poison andprevent itsabsorption by theGI tract and theneliminates in thefeces.

Administer within

60 minutes ofingestion.

Give onceor twicedepending on thelevel of toxin.

May come pre-mixed with water12.5-25 grams

Vomiting with rapidadministration

pulmonaryaspiration

Binding isirreversible socathartic such assorbitolmay beadded as well.

It allows certaindrugs/toxins to bedrawn out of theblood and bind tocharcoal in the

intestine a kind ofgut dialysis

Stools will be black

Charcoal does notchange the stomachPH.

Do not administer withIngestion of:

caustic alkali agent,

high viscositypetroleum products

OR when:

convulsions areoccurring,

cardiacdysrhythmias are

present, or there is emesis of

bloodImplement antidotesupportive care andprevent aspiration areif gastric lavage is notto be performed.


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Acyclovir(Zovirax)

Antiviral-

Herpes simplexvirus HSV

- Herpes zoster-

varicella

Used for herpessimplex. Does noteradicate latent

herpes. It reducesviral shedding andformation of newlesions and speedshealing time.

(oral, IV and topical)

To decreasesymptoms withvaricella zoster(chicken pox/shingles).

Side effects:

Headache, dizziness

seizure

nausea, vomiting,diarrhea

acute renal failure

thrombocytopenia

purpura hemolytic

uremia syndrome


nephrotoxicity

Even after HSVinfection iscontrolled, latent

virus can beactivated by stress,trauma, feverexposure tosunlight, sexualintercourse.

Refrain from sex ifS/S of herpes.

Alteplase recombinant(Activase)

Streptokinase is similar.Urokinase is givenmostly in emergencysituation.

Thrombolytic agent

Cath-flo Activase isfor occluded catheters

Dissolves or breakdown clots toreestablishperfusion.

Indicated for clientsat risk fordevelopingthrombus with

resultant ischemiasuch as MI,ischemic stroke,arterial thrombosis,DVT, PE

occlusion of IVcatheters.

Hemorrhage,

N/V,

hypotension

cardiacdysrhythmias.

Dose related is thehighest problem

Watch for s/sbleeding; VSchanges, s/s ofimpending shock

If bleeding isoccurring stoptreatment andnotify doctor. May

start on FFP andPRBC.

Aminocaprionic acid(Amicar) may beordered foroverdose orexcessive bleeding.

Do not give with:

pregnancy,

active bleeding,

recent Hx of CVA,

Uncontrolled HTN,

IM medication route iscontraindicated when

using thrombolytics.

Do not take NSAIDs

or Aspirin becauseof enhancedbleeding.


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Aluminum hydroxide(Amphogel)

Antacid

Neutralizes gastricacid,

antflatulent to

alleviate symptomsof gas and bloating

Increases gastric pH,

Decreasesabsorption of other

drugs such as dig,antibiotic, ironsupplement.

Toxicity causes

dementia,Hypercalcemia,metabolic alkalosis,worsening of HTN,heart failure fromincreased intake.

Given 2 hrs. apart fromother drugs whereinteraction may occur.

Observe for signs andsymptoms of alteredphosphate levels;anorexia, muscleweakness and malaise.

Increase fluid, exerciseand fiber to preventconstipation.

Do not use:

abdominal pain,N/V, diarrhea,

severe renaldysfunction,

fecal impaction,rectal bleeding,

colostomy,ileostomy

dehydration

hypercalcemia andhypercalciuria

Ampicillin (Ampicin)

IV, PO, IM.

Antibiotic

Aminopenicillin

Similar side effects,

allergic reaction, etc.for all Penicillins (PCN)

Treat bacterialinfectionCommonly used with:

Shigella,

salmonella,Escherichia coli,

haemophilusinfluenza,

Neisseria

gonorrhea, Neisseria

meningitis,

gram positiveorganism

allergic reaction:Skin rash, urticaria,swelling, pruritus,angioedema.

Severe allergy:hives, wheezing,anaphylacticreaction. Medicalemergency requires

immediate tx or canlead to death.

side effects: GI, N/V,diarrhea, abdominalpain.

Pruritic rash likemeasles is not a trueallergic reaction

Do not give withfruit juice, milk orcarbonatedbeverages becauseof poor absorption.

Watch forhypokalemia

Take on empty

stomach.

May not benecessary to stoptreatment if milddiarrhea develops.

Give yogurt orbuttermilk torestorenormal flora(or probiotics)

Avoid with:

Hypersensitivity toany penicillins; usecautiously if historyof hypersensitivityto cephalosporins;

Exfoliateddermatitis

Loop diuretic mayexacerbatehypokalemia andrash.

Potassium-sparingdiuretic maycontribute tohyperkalemia


19/65



Atropine Sulfate.

Two different uses:

Anticholinergic

(such as forParkinsons disease)

For ophthalmicuse

Systemic effect is morepronounced in infantand children with blueeyes and blond hair.Also increased risk oftoxicity with Downsyndrome

Use to increaseheart rate (notnecessarily first

drug of choice). Decreases

involuntarymovement andrigidity inParkinsons disease

Pre-op to decreasesecretions andprevent aspirationof secretions whileunder anesthesia

Use forinflammation of theiris and uveal tract.

Dry mouth,constipation, urinaryretention or

hesitancy headache,dizziness


Paralytic ileus.

Treat overdose(resp. depressionand circulatorycollapse)symptomatically.

Adverse effect whenused for the eye

Transient stinging,

increase IOP,photophobia,

Monitor dosage ofmeds carefully, evenslight overdose can

lead to toxicity. Assess for

constipation andurinary retention;increase fluids, bulkand exercise, assessbowel sound to ruleout paralytic ileus,

Avoid driving orother hazardousactivities,drowsiness mayoccur.

For the Eye

Acute glaucoma canbe precipitated bypapillary dilation; ifnot recognized andtreat, acute

glaucoma can resultin blindness.

Wear dark sunglassand avoid brightlight forphotophobia,

Monitor intraocularpressure and vision

Increasedanticholinergiceffect with

phenothiazine,antidepressant,MAOs amantadine.

Contraindicated inpt. with narrowangle glaucoma,myasthenia gravis,or GI obstruction.


20/65



Beclomethasonediproprionate(Beclovent)

inhaledcorticosteroidmedication

note: also nasalinhalant as Beconase

Used in bronchialasthma, allergicrhinitis

Side Effects:

Pharyngeal irritationand sore throat,

coughing, dry mouth,oral fungal infections,and sinusitis.

Increasedsusceptibility toinfection,dermatologic effectsand osteoporosis,diarrhea, N/V, HA,fever, dizzinessangioedema rashurticaria andparadoxicalbronchospasm

Adverse effects/toxicity

Adrenocortical

insufficiency

fluid and electrolytedisturbances,

nervous systemeffects andendocrine effects ifabsorbedsystemically.

Decrease dose if pt.is on systematiccorticosteroid.

Assess for impairedbone growth inchildren receivinginhaledcorticosteroid

Considerations:

Monitor forhyperglycemia

Rinse mouth after

use for medication;oropharyngealcandidiasis and/orhoarseness canoccur.

Use bronchodilatorinhalant beforecorticosteroid whenboth are ordered.

Do not abruptly

stop meds taperover 2 weeks.

Be aware of steroidssymptoms - Moonface, acne, edema,increased fat pads

- notify doctor.

Report weight gain

Do not use with:

children under

Clients with known

allergy

May requireadjustment ofantidiabetic agentas there is apotential forelevated bloodglucose levels withcorticosteroids areadministered orally.

Not use inbronchospasm orstatus asthmaticus.


21/65



Benztropine mesylate(Cogentin)

Anticholinergic(cholinergicreceptorantagonist)

Anti-Parkinson

Treat Parkinsonsymptoms:Suppresses

tremors andrigidity, not tardivedyskinesia

Decreaseshypersalivation andirregularmovement relatedto Parkinsondisease.

Reduces extra-pyramidal sideeffects

Side effects:

dry mouth,

urinary

retention/hesitancy, HA,

dizziness.


paralytic ileus

Monitor dosecarefully; even slightoverdose can lead

to toxicity.

Nursing considerations:

Monitor I&Os,

Education:

Avoid driving, orother hazardousactivities;drowsiness mayoccur.

Avoid coughOTC medicationunlessprescribed.

Avoid use with:

narrow-angleglaucoma,

myasthenia gravis, GI obstruction

Buspirone (Buspar)

anxiolytic

Anxiety

Desired response 7-

10 days; Make take

3-4 weeks for fulleffect

Side effects:

Dizziness

headache

drowsiness

When switching toBuspar, taper offbenzodiazepines

Less likely to have

cognitiveimpairment thanother CNS meds

Does not causewithdrawal s/s andthus does not needto be tapered offwhen stopping

Avoid use with:

MAO Inhibitors

Lactation

Caution with:moderate to severerenal impairment


22/65



Chlordiazepoxidehydrochloride(Librium)

Anxiolytic

Sedative-hypnoticbenzodiazepine

IM & tablet form

Peak:

1-4 hours PO,

15-30 min IM.Half-life 5-30hr

To relieve tensionand/or anxiety

To manage alcohol

withdrawal

do not to stoptaking drugabruptlywill havewithdrawalsymptoms (usuallyin 5-7 days)

Adverse effect:

respiratory distress,drowsy, dizziness,

lethargy, orthostatichypotension

photosensitivity

Suicidal tendencies maybe present andprotective measuresmay be necessary.

Monitor closely forparadoxicalreactions excitement,stimulation, acuterage usually earlyin tx withholddrug and notify dr.

Give with milk orfood to prevent GIupset.

Check BP and pulseearly in tx. If BP fallsdelay medicationand notify dr.

Labs: Monitor CBC,renal and hepaticenzyme levels

watch fordependency

Education:

Avoid alcohol

no OTC meds unlessprescribed

Avoid driving andother hazardousactivities untileffects known.

Avoid use with:

Narrow angleglaucoma,

under 12 year old lactation

Use cautiously with:

impendingdepression,

impaired hepatic or

renal function,

COPD


23/65



Chloramphenicol(Chloromycetin)

Oral, injection,ophthalmicdrops andointment

Anti-bacterial

severe infection forsusceptibleorganisms when

other anti-infectiveare ineffective.

Sty, conjunctivitis,uveitis

Side effects:dermatitis, itching,stinging, swelling

Adverse effects/toxicity(oral and injection)

edema

super infection,

aplastic anemia.

Stevens-Johnsonsyndrome

obtain culturespecimen from eyebefore initiation of

treatment remove exudates.

Monitor for pain,drainage, redness,swelling.

Monitor forbleeding or bruising

Avoid use with:

hypersensitivity

Chlorothiazide (Diuril)

Thiazide diuretic,non-Potassiumsparing

Anti-hypertensive

Increases urinaryexcretion sodiumand water byinhibiting sodiumreabsorption.

Use for edema andHTN, HF, cirrhosis,corticosteroid andestrogen therapy,diabetes insipidus,

Side effects:

Dizziness, vertigo,frequent urination,electrolyteimbalance, impairedglucose tolerance,hyperuricemia,photosensitivity


Renal failure,

aplastic anemia, andanaphylaxis

Take early in themorning to avoidnocturia.

Give with food,

allow for 3-4 weeksfor maximum effect,

Will not be effectiveif creatinineclearance Is lessthan 30ml/min

Avoid use:

Client with anuria.

Use cautiously withimpaired renal orhepatic function.

If pregnant.

Will increase serumlithium level


24/65



Chlorpromazinehydrochloride(Thorazine)

phenothiazine

Antipsychoticmedication

Anti-emetic

Give bromocripitine

(Parlodel) anddantrolene(Dantrium) forNMS.

Block dopaminereceptor in CNS to

Use: treat

psychotic disorder(schizophrenia,bipolar, and othermental illnesses);prevent acuteexacerbation andmaintain highestpossible level offunction

Use to controlmanic phase(bipolar)

intractable hiccups

nausea/vomiting

Low potency anti-psychotic whichcan reduce the risk

of EPSE (extra-pyramidal sideeffects)

Side effects:

Sedation,orthostatic

hypotension, anticholinergic

effect (dry mouth,blurred vision,urinary retention,photophobia,constipation,tachycardia)

liver damage,tremorare twomajor sideeffects.

photosensitivityAdverse effects/toxicity:

Neurolepticmalignantsyndrome(NMS),catatonia, rigidity,stupor, unstableblood pressure

profuse sweating,dyspnea. Can betoxic effect andMAY last for 5-10days afterdiscontinuation ofthe med.

get baselineECG,thorough baselineevaluation lab tests

before treatment. Give bromocripitine

(Parlodel) anddantrolene(Dantrium) forNMS.

Withdrawal of drugis necessary

Take measures to

protect eyesexposed to sunlight

Monitor diabeticsclosely for glucoseintolerance


25/65



Cimetidine (Tagamet)

GI meds,

H2 receptorantagonist

Works againsthistaminereceptors,

decreases gastricsecretion.

Use short termforduodenalulcer,benign gastriculcer, acute upperGI bleed

Side effects:

Cardiac dysrhythmia,diarrhea, dry mouth,

constipationAdverse effects/toxicity:

Rare but mayincludeagranulocytosisneutropenia ,thrombocytopeniaaplastic anemia,anaphylaxis

May be given withmeals and atbedtime

Avoid smokingwhich cause gastricstimulation

Avoid antacid use

within one hour ofdose

Avoid use:

hypersensitivityUse caution:

impaired renal orhepatic function

Cisplatin (Platinol)

Half-life 20-30 minutes

Antineoplasticmedication

Alkylating agent

** Major allergicreaction can occur

within first 15 mins. ofadministration.Anaphylaxis may occurwithin minutes of druginitiation.

Treat ovarian andtesticular cancer byinterfering withDNA replication

Side effects:

anorexia,uncontrolled N/V,fluid retention,weight gain


Major toxicitiesoccur in the blood,GI, and reproductivesystem.

Watch urine outputand specific gravity-nephrotoxicity mayoccur within 2 wks.

ototoxicity (tinnitusor difficulty hearingin the highfrequency range)

maintain fluid atleast 3000 ml in 24hr. ; report reducedurine output

Avoid food high inthiamine (beer,wine cheese,brewers yeast,chicken liver &banana) - may lead

to hypertension &intracranialhemorrhage

Avoid use:

Hx of sensitivity toplatinum-containingcompounds,

impaired renalfunction andhearing,

Hx of gout, renalstones.

Incompatible with

dextrose andReglan, Vanco

Lasix may increase

otoxicity

other nephrotoxicdrugs may increasenephrotoxicity andrenal failure.


26/65



Codeine sulfate

Opioid analgesic(agonist)

Antitussive (coughsuppressant)

Rapid onset if IM or IV.Peak 1-2 hrs.,Duration up to 7 hours.

To treat mild tosevere pain

most oral

preparationscombined with ASAor acetaminophen

hyperactive cough

Side effects:

Constipation, urinaryretention, dizziness,

lightheadedness.Adverse effects/toxicity:

Respiratorydepression,respiratory arrest,circulatorydepression, ICP.

Long term use maycause withdrawalsymptoms whenstopped

Assess for:

respiration andusually hold


27/65



Cyclosporine(Sandimmune)

Immuno-suppressantmedication

Metabolized in theliver.Peak4-5hr,Duration20-54 hrs.Half-life 19-27 hrs.

Inhibit T helper andT suppressor cells.

Prevent rejection of

kidney, liver andheart transplants.

Treat chronicrejection in peoplewho have receivedimmuno-suppressive agent,rheumatoidarthritis,recalcitrant plaquepsoriasis

Side effects:

Hypertension,

increased risk of

infection Tremor is an

expected side effect


Renal toxicity,

hepatotoxicity

Monitor labs: AST,ALT, BUN, creat,platelet count, K,

TEACH: Take with food to

reduce GI upset

mix with milk,

chocolate milk ororange juice but notwith Grapefruit juice

Mix in glass, notplastic

Avoid use of livevaccine

Prevention ofinfection and reportsigns of infections

Immunosuppressedprecautions

Do not use:Pregnant/lactatingmom,

Use cautiously inrenal and hepaticimpairment

Antiepilepticmedicationsdecreasecyclosporine levels

oral contraceptiveincrease levels


28/65



Debrox drops

Ear drops to dewax

used to soften andloosen ear wax,making it easier to

remove.

Side effects:

temporary decreasein hearing after

using the ear drops mild feeling of

fullness in the ear

mild itching inside

the ear.Adverse effects/toxicity:

Get emergencymedical help if youhave any of thesesigns of an allergicreaction: hives;difficulty breathing;swelling of yourface, lips, tongue, orthroat

Use:

Tilt head with earfacing upward. Pull

back on ear to openup the ear canal.Drop the correctnumber of ear dropsinto the ear.

After using the eardrops, stay lyingdown or with yourhead tilted for atleast 5 minutes. You

may use a smallpiece of cotton ballto plug the ear andkeep the medicinefrom draining out.

A bubbling soundinside may be heardafter putting in thedrops. This is caused

by the foamingaction of carbamideperoxide, whichhelps break up thewax

May come with bulbsyringe.

Do not use:

With a ruptured eardrum.

any signs of earinfection or injury

Do not use thismedication in achild younger than12 years old withoutthe advice of adoctor.

Do not use for

longer than 4 daysin a row.


29/65



Diazepam (Valium)

Benzodiazepine

(have zep and zapin them)

minor tranquilizers,

anticonvulsant,

anxiolytic

Absorbed from GI,

metabolize in liver

Onset30 min IM, 60PO, 15 IV. Worksquickly.Peak 1-2hr PO,Duration15 min to 1hrIV; up to 3 hrs. PO.Half-life20-50 min

Relieve pain anddiscomfort frommusculoskeletal

disorders, manage anxiety,

Manage acutealcohol withdrawal

Maximum effectwillbe seen in 1-2 weeks.Can take 2-4 wks. It hasaddictive effect.

Side effects: ABCD.

Anticholinergic (drymouth),

Blurred vision, Constipation, &

Drowsiness,

cardiovascularcollapse,laryngospasm,dizzy, weakness,nausea


Erythemamultiforme,

angioedema,

anaphylaxis,

dysrhythmia

seizure

Watch for CNSeffect.

Monitor CBC WBC

with diff. notify dr. if drop in

BP of 20 mm Hg

Assess for allergicreaction includingidiosyncraticreaction,anaphylaxis, rashfever resp distress

Teach

Do not stopabruptly withdrawalsymptoms willoccur(insomnia,nausea HA,spasticity,tachycardia).

No alcohol (will

increase CNSdepression)

Suicide preventionprecautions

Do not use:

compromisedpulmonary

function, hepatic disease,

impairedmyocardialfunction,

acute alcoholintoxication

infant < 6 months

narrow angleglaucoma, openangle glaucoma


30/65



Digoxin (Lanoxin)

Cardiac glycoside,

antiarrhythmicdrug.

Therapeutic range:0.5-2.0ng/ml

Toxic level > 2

Antidote: digibind(digoxin immune fab)

Positive inotropiceffect

In heart failure it

Increasecontraction of theheart muscle.

In atrial fib, it slows

the heart rate

Side effects:

Nausea, HA, loss ofusual appetite.

Adverse effects/toxicity: Toxicity may go

unrecognized sinceit presents withsame symptoms asflu (N/V, anorexia,diarrhea, vomitingvisual disturbance).

Blurred green oryellow vision or halo

effect** In HF, early sign of

toxicity includesdysrhythmias.

Children rarely showsigns of N/V,diarrhea, visualproblem, anorexia

(could become dig toxic

without showing usuals/s)

may give withoutregard for food

IVP over 5 min, do

not give IM, it willcause tissueirritation.

Monitor apical

pulse, if


31/65



Disulfiram (Antabuse)

The only alcohol

antagonist in use.

Enzyme inhibitor

Anti-alcohol agent.

Half-life 24-36 hourOnset up to 12 hrs.Duration up to 2 wks.Absorbed from the GI

excreted in feces or inthe breath as carbondisulfide

Adjunct treatmentof patient withchronic alcoholism

who sincerelywants to maintainsobriety.

At least 12 hoursshould elapse fromthe time of lastalcohol intake andthe initial dose

Use only in peoplewith high physical

health. Use for 1-2 wks.

INTENDEDReactionwith alcohol ingestion:

flushing face, chest,arms

pulsating HA

Nausea

violent vomiting thirst

sweating

marked uneasiness

Side effects:

Rare in the absenceof alcohol

Adverseeffects/toxicity:** Acetaldehydesyndrome

hypotension toshock levelarrhythmias,

acute congestive

failure, marked respiratory

depression,

unconsciousness,

convulsions

sudden death

The effects ofdisulfiram maypersist for 2 weeks

after last dose istaken; alcohol mustnot be consumeduntil this interval isover.

Give in the morningwhen the resolvenot to drink is thestrongest. Give atbedtime to

minimize the effectof drug

avoidalcohol of allforms include thosefound in sauces,cough mixture andafter shave lotions,colognes andliniments

Do not use:

In people who donot want to stop

drinking. Severe cardiac

disease,

psychoses,

pregnancy,

multiple drugdependence.


32/65



Epinephrine(Adrenalin)

alpha and beta

adrenergic agonist

vasopressor

bronchodilator

If given IM, SQ -result seen in 5 min& lasts up to 4 hrs.,

Also available eyedrops andintranasal

Reversesanaphylacticreaction

Restores cardiacrhythm in cardiacarrest

Acute asthmatic

attack

Also use inophthalmicdecongestant,manage open angle

glaucoma

Side effects:

nervousness,

tremors,

increased HR, BP, insomnia,

anorexia

cardiac stimulation

vascular HA.


Tachyarrhythmias,

chest pain,

restlessness, agitation,

nervousness and

insomnia.

Nasal burningstinging,

eye burning

D/C if hypersensitivity

develops (develops oflids, itching, discharge,crusting eyelid). Notifydoctor

Teach

Report nervousnessand sleeplessness -

dose should bereduced.

Administer eyedrops at bedtime.May experienceheadache andstinging but subsidewith continued use.Report if continues.

Monitor VSespecially HR andBP because ofcardio effect.

If use with MOAinhibitors may lead to

hypertensive crisis. Narrow angle

glaucoma,

hemorrhagictraumatic orcardiogenic shock,

arrhythmias,

organic heart orbrain disease.

CAUTION in: older adults,

HTN

TB, long standingbronchial asthmaand emphysema

children < 6

No breastfeeding


33/65



Famotidine (Pepcid)

Histamine

H2 antagonist.Onset 1 hr. Peak1-3hr

Duration10-12 hrs.Half-life2.5-4hr

Decreases outputof gastric acid

Short term

treatment induodenalulcer orbenign gastriculcer.

Metabolized inliver, excreted inurine

Side effects:

diarrhea,constipation, dry

mouthAdverse effects/toxicity:

thrombocytopenia

May be taken withfood.

pain relief may not

be experienced forseveral days

Use cautiously withimpaired renal orhepatic function.

Do not breastfeed

avoid antacid usewithin 1 hour ofdose

Fluoxetinehydrochloride (Prozac)

psych med.

Tricyclicantidepressant.

Selective SerotoninReuptake inhibitors(SSRI)

Half-life1-6 days.Onset 2-3 weeks to be

effective.Peak 4-8hrs.Metabolized in liver,absorbed from GI tract,excreted in urine andface.

Major depressivedisorder

Obsessivecompulsivedisorder,

bulimia,

panic disorder

obesity

alcoholism

chronic pain.

Such as rash. Wait 4-6

weeks before switch toMAO Inhibitor

Common side effects:

Orthostatichypotension

sedation

Anticholinergic

Hypomania

Sexual dysfunctionAdverse effects/toxicity:

Cardiac toxicitySelective Serotoninsyndrome (early s/s:diaphoresis, agitation,

low grade temp.) Thenincrease in BP, musclerigidity, temp, resp,pulse. Mental statuschanges, tremors,hyperthermia, sweatinghypersalivation.Notify dr ASAP.

DO NOT stopabruptly.

Give meds once aday at about noonbecause it causesinsomnia. Ifprescribed 2 timesdaily give dose inthe morning earlyand 12 noon toprevent insomnia

Teach side effects

of drugs Therapeutic

response takessome weeks to beestablished.

MI, cerebrovasculardisease.

If suicide risk,should not haveaccess to a largequantity.

Do not take whilepregnant

** The combinationof TCA and MAOIcan lead to

hypertensive crisisfrom excessiveadrenergicstimulation of theheart and bloodvessels.


34/65



Fluphenazine (Prolixin)

phenothiazine; Ends

with azine antipsychotic

Half-life > 24 hoursOnset: 1 hr.,peak 0. 5 hr. meds

effect can be seen 1-2days but full effectseveral weeks

Potent medicationfor treatment ofantipsychotic

symptoms,includingschizophrenia.

Treatment is notcurative.

Adjust dose tosymptoms.

Use injectable form

for long term

maintenance- the rate of relapse isusually reduced and ismore favorable

Produces EPS whichare reversible.

** Treat EPS with

Cogentin, Artane,Benadryl, SymmetrelSide effects: ABCDE

Anticholingergic(dry mouth), Blurredvision, Constipation,Drowsiness, EPS

Photosensitivity

may increase risk of

agranulocytosis

gynecomastia,

amenorrhea

weight gainAdverse effects/toxicity:Neuroleptic malignantsyndrome (NMS)a fatalside effect. Presentswith catatonia, rigidity,stupor, unstable blood

pressure, hyperthermiaprofuse sweating,dyspnea, incontinence.Stop drug. Tx withDantrium and Parlodel.Condition lasts for 5-10days after stoppingmed.

Monitor LFTs

TEACH

Avoid alcohol useand other CNSdepressants

Do not alter dose orstop abruptly

Avoid sun exposure

With oralconcentrate, avoidspills. Rinse skin

with warm waterimmediately if thereis contact

Dilute liquid drugwith fruit juicewater, carbonatedbeverage, milk,soup avoid mixing

with caffeine, tea,apple juice.

Avoid with:

Caution withnarrow angle

glaucoma, hepaticor renal dysfunctionand seizuredisorder.

Do not breastfeed

Dose should bereduced in theelderly.


35/65



Furosemide (Lasix)

Loop diuretics,

Anti-hypertensive

Peak 60-70 min PO, 20-60 min IV.Onset 30-60 min PO, 5min IV,Duration2 hrs.,

Half-life30 min

Rapid acting loopdiuretic

Inhibits

reabsorption ofsodium and water(in Loop of Henle)

Lowers BP by

decreasing edemaand intravascularfluid

Treat

acute pulmonary

edema, edema, heart failure,

chronic renalimpairment,

hypertension,

hypercalcemia

Side effects:

Ototoxicity

headache

Dizziness Orthostatic

hypotension

weakness


s/s hypokalemia

Hyponatremia,

hypochloremia,

hypomagnesaemia

hypocalcemia

IV form:

Administer slowly;hearing loss canoccur if injectedrapidly (ototoxicity).

Give over 1-2minutes to preventhypotension.

TEACH

change positionslowly to avoid

dizziness andorthostatichypotension

report ringing in theear immediately

Take with food ormilk

Give early in day toavoid nocturia

Replace potassium

(dietary or meds)

Monitor labs,especiallyelectrolytes. Alsohgb, hct, platelet asthese increase d/themoconcentration

Monitor bodyweight and I&O.

Avoid with:

anuria, electrolytedepletion,

increasing oliguria,anuria

hepatic coma,

pregnancy,

lactation

Interaction withdigitalis canincreasearrhythmias.

Interaction withaminoglycosidesincreases risk ofototoxicity.


36/65



Gentamicin(Garamycin)

Aminoglycosides.

Antibiotic

Peak level:

Drawn 15-30 min

after the infusion iscompleted.

Peak concentrationdetermines thattoxic leveldoes notoccur.

If peak is too high,may reduce dose.

Trough level:

Drawn immediately(within 30 minutes)before next IV dose

Assures thattherapeutic levelofdrug is maintained.

Trough level is 1-2g/mlbetweendoses.

Dose will beadjusted if level isnot sustained

Peak 30-90 minHalf-life 2-4 hr.

Broad-spectrumantibiotic

Parenteral use

limited to severeinfections,unresponsive toother antibiotics.

Ophthalmic:

treat superficialinfection of theeye.

Have pt. keep eyesclosed for 1-2 minafter instillation.

Vision will beblurred initially

Side effects:

HA, parenthesia,skin rash fever


Nephrotoxicity

Ototoxicity.

This may causeirreversible auditoryimpairment andvestibular damageSigns of ototoxicityincludeHA, NV unsteady

gait, tinnitus, vertigo,high frequency, hearingloss and dizziness

Hypersensitivityreactions

Superinfection: asecondary infectioncaused byeradication of

normal flora:Candidiasis, skin andmucous membrane

Maintain hydrationto protect kidney

damage. Fluidintake should be2,500-3000 ml/day

give high proteinfoods

LABS

WBC to monitor theeffectiveness oftherapy

Watch kidney

function tests (BUN,Creat) closely due totoxicity risk

Report sore throat,watery stoolsgreater than 4-6 perday, severe nauseaor vomiting,

indicating possiblesuper infection

Avoid with:

Pre-existing renaldisease

Use caution withpre-existing hearingloss

Pregnancy,

lactation

Increased risk withnephrotoxic drugs,prolongedtreatment withaminoglycosides,

impaired renalfunction and otherototoxic drug suchas Lasix, Vanco.


37/65



Glipizide (Glucotrol)

oral antidiabetic

Sulfonylurea

duration: 12-24 hoursOnset: 15-30 minPeak: 1-2hr

Metabolized by theliver

Stimulatespancreatic betacells to secrete

insulin. Type 2 diabetes

mellitus

Give dose 1-3 timedaily

may use alone or incombination withinsulin

Side effects:

GI distress

dizziness

drowsiness

headache


Severe skin rash,pruritus

Hypoglycemia

Monitor labsincluding glucose,Hgb A1C

TEACH

Take with first dailymeal.

Take any misseddose as soon asremembered.

Report s/s ofhypoglycemia ifthey occur

Avoid alcohol

Avoid with:

Pregnancy,lactation

Allergy to sulfa orurea

Diabeticketoacidosis

Caution with:

impaired renal andhepatic function

Adrenal or pituitaryinsufficiency.

Glucagon

Anti-hypoglycemic

Onset 5-20 min,Peak30 minDuration1-1.5 hr.,Half-Life;3-10 minutes

Metabolizes in liver,plasma and kidneys

Emergencytreatment ofseverehypoglycemia inunconscious clientor those unable toswallow

Comes in powder

form. Reconstitutewith provideddiluent.

Give IV, IM or SQimmediately

Give IV throughD5W only, not NS

Side effects:

Nausea/ vomiting


Hypersensitivityreaction,

hyperglycemia

Hypokalemia

Should awakenwithin 5-20 minafter giving.

Give 50% glucose ifno response toglucagon

Teach

test blood sugar,

teach family how toadminister SQ or IM

Incompatible withsodium chloridesolution.


38/65



Glyburide(Micronase, DiaBeta)

Oral antidiabetic, more potent drug

Sulfonylurea

Onset 15-60 minPeak 1-2 hrs.Duration up to 24 hrs.Half-life 10 hours

Metabolized in the

liver, excreted in urineand feces.

Lowers blood sugarconcentration indiabetics and

nondiabetics bysensitizingpancreatic betacells to releaseinsulin in thepresence of serumglucose.

Type 2 diabetes

Use as adjunct todiet and exercise to

lower blood sugar

Side effects:

Hypoglycemia,

epigastric fullness

heartburn

pruritus


hypoglycemia

Give once in themorning withbreakfast or with

firstmain meal Monitor labs

including glucose,HgbA1c

Teach

Report reaction

Loss of control ofblood glucose levelmay be due tofever, surgery,

trauma, stress,infection.

Avoid use with:

diabeticketoacidosis

Type I diabetes

Caution with:

renal or hepatic

insufficiency

older adult

malnourished pt.

adrenal or pituitaryinsufficiency

Haloperidol (Haldol)

High potency drug

Antipsychotic

Butyrophenone

Antiemetic

Onset: 30-45 min IMEffects can be seen in 1-2 days. Substantialimprovement 2-4 wks.Full effect severalmonths.

Psychotic disorders

Long acting drugfor maintenance to controlsymptoms

Tourettessyndrome

Side effects: ABCDE:

Anticholinergic (drymouth)

Blurred vision

Constipation

Drowsiness

Extrapyramidal

syndrome (such asParkinsons s/s)

PhotosensitivityAdverse effects/toxicity:

Elderly patient maydevelop NeurolepticMalignantSyndrome (NLMS)

EPSE: usually firstfew days of tx, doserelated, controlledby dose or anti-Parkinsons drugs

Oral: Give with milk

or food.

Taper dose slowlywhen stopping.

Injection: deep IM risk for orthostatichypotension

no alcohol or drivinguntil responseknown

Avoid with:

Parkinsons disease

seizure disorder

severe mentaldepression

Use caution:

older adults, lithium therapy

HTN

Lactation


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Heparin

Anticoagulant

Antidote = Protaminesulfate(see separatelisting)

As anticoagulant given IV or SQ

Use as continuous

IV infusion for DVT,Pulmonaryembolus, angina,acute MI

SQ for prevention

Hep-lock (flush) isto maintainpatency of IVcatheters; not for

anticoagulanttherapy

Side effects:

Bleeding

Heparin-induced

Thrombocytopenia(HIT) may appearup to several weekslater.

Does not dissolveclots preventsenlargement and

development ofnew clots.

Use bleedingprecautions

Monitor labs: aPTTNormal = 25-40Coagulated = 1.5-2times normal = 60-80

Adjust IV dose

based on labs.

Avoid use with:

Hemorrhage, activebleeding

Do not give IM.

Hydrochlorothiazidehydrochloride(Hydrodiuril, HCTZ)

Electrolyte andwater balance

Thiazide diuretic

Effects noted 3-4days; max effecttakes 3-4 weeks

Most widelyprescribed diureticfor HTN

Act on distaltubules of nephronand increasesurinary excretion ofsodium, chloride,potassium, water,bicarbonate

Decreases edemaand lowers bloodpressure

Side effects:

Glucose intolerance,hyperglycemia

Hypokalemia (lowK+)

Give with food ormild to reduce GIupset.

Give dose(s) early inthe day to avoidnocturia

Limit Sodium intake

Eat foods high in K+

.replacement medusually not needed

photosensitivityreaction occur 10-14days after initial sunexposure

Avoid with:

Anuria

Hypersensitivity tothiazide

Use caution:

Bronchial asthma

hepatic cirrhosis

renal dysfunction

history of gout

diabetes

SLE

Lactation


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Hydroxyzine HCl(Atarax, Vistaril)

Anti-emetics Anti-histamine (H1

receptorantagonist)

antipruritic

Onset 15-30 min POPeak 4-6 hrs.Duration

Absorbed form GI.Metabolized in the liver

Treat N/V (useanticipatorily)

Relieve anxiety

Reduce narcoticrequirement beforeand after surgery.

Treat acute orchronic alcoholismwith withdrawalsymptom or DTs

Pruritus

Usually PO for

maintenance

Side effects:

CNS depression,

Drowsiness

Dizziness

dry mouth,anticholinergiceffect

constipation

visual changes

photosensitivity

IM:

Administer deep IM,Z-track gluteus

maximum or vastuslateralis in adults;vastus lateralis inchildren

monitor mouth daily

no alcohol

hard candy, icechips or rinse mouthwith warm water

frequently to relievedry mouth

Avoid with:

CNS depression andcoma.

Other CNS medsUse caution with:

glaucoma

seizure

intestinalobstruction

prostatichyperplasia

asthma

cardiac, pulmonaryor hepatic disease

Ibuprofen(Advil, Motrin)

Analgesic

Non-steroidal anti-inflammatory(NSAID)

For high dosetherapy:therapeutic effectmay take up to onemonth

Treat mild tomoderate pain

absorbed in GI;metabolized in liver

Side effects:

CNS, renal system,eyes

Nephrotoxicity

dysuria, hematuria,

oliguria, azotemia,

Blurred vision.

OtotoxicityChildren toxicity:

Rash, Stevens-Johnson syndrome

Increases toxicity ofanticoagulant,lithium

Avoid alcohol, ASA,other NSAIDs

Avoid with:

GI bleed

Reaction to otherNSAIDs

Children under 6

months


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INSULINS

- quick acting:

-

short acting-

intermediate acting-

long acting

Insulin is also availablein a premixed form ofRegular and NPH(example: 70/30 = 30%regular, 70% NPH).

Diabetes mellitus,type 1 or type 2

Could be made of:pork/beef, pork orhuman insulin type.

Short acting andintermediate actinginsulin may begiven more thanonce per day.

Side effects:

Hypoglycemia(anxiety, confusion,

nervousness,hunger, diaphoresis,cool, clammy skin)

Lipodystrophy(abnormal depositsof subcutaneous fatat injection sites),

local allergicreaction


Somogyiphenomenon:arebound responsewith high bloodsugar in response tolow level at night.

Coma

Hyperosmolarhyperglycemic state

(HHS)

Diabeticketoacidosis (DKA)

obtain med alertbracelets

Open vial can be

stored at roomtemp for up to onemonth.

Rotate sites

Alcohol will increaseblood sugar

Requires long-termmonitoring of blood

sugar control andpotentialcomplications.

Do not usebeef/pork insulin ifsensitivity


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Insulin Regular(Humulin R)

**THIS IS THE ONLYTYPEOF INSULIN WHICH CAN BE

GIVEN IV.**

Short acting insulin

Given IV or SQ

type 1 and type 2

diabetes mellitusand ketoacidosis.

given before mealsaccording to bloodlevels

hypoglycemia Regular insulin isclear and colorless.

Isophane (NPH) insulin(Humulin N)

Intermediateacting insulin

Give 30 min beforefirst meal of theday. If necessary, a

second smallerdose may beprescribed 30 minbefore bedtime.

If given beforebreakfast,hypoglycemicepisode is mostlikely to occur

between mid-afternoon anddinner, when itpeaks. Eat snack inmidafternoon andcarry sugar candy.

NPH Insulin is acloudy suspension.

Roll the bottle tomix; do not shake.

NOTE: NPH may bemixed with Regularinsulin injectionwithout alteringeither solution.

Insulin Glargine(Lantus)

**LANTUS CANNOTBEMIXED IN SAME SYRINGE

WITH ANY OTHER

INSULIN.**

Long acting insulin

Type 1 children &

adults; Type 2adults

SQ injection

Usually given oneper day at bedtime.May be given twotimes per day.

With Type 2diabetes, may or

may not be givenconcurrently withoral agents.


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Iron Mineralreplacement

Side effects:

Nausea/vomiting

Staining of teeth

Constipation

Black stools(normal)

Taking on emptystomach preferredwith full glass of

water or citrus juice Calcium inhibits ironabsorption do nottake with milk.

Vitamin C increasesiron absorption

Liquid form canstain teeth

Ipecac Syrup

Emetic

Antidote

Alternate: ActivatedCharcoal (see separatelisting)

For overdose oncertain drug orpoison

stimulates vomitingwithin 20-30 min

Adverse effects/toxicity: Cardiotoxicity is

most serious ifvomiting does notoccur and thesubstance isretained.

Use of thismedication is notautomatic verifyappropriatenesswith Poison controlcenter

Do not use: With reduced level

of consciousness orconvulsions

poison byPetroleumdistillates, strongalkaline, acid orstrychnine


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Lidocaine HCl(Xylocaine)

Antiarrhythmic Topical Anesthetic

Bolus dose mayrepeat then startcontinuous infusion stop when stable.Therapeutic level: 1.5-6mcg/ml

Treat VENTRICULARarrhythmias, PVCs,V-Tach.

Use for rapidcontrol ofventriculardysrhythmiasduring acute MI orCardiac cath

Use microdriptubing and infusionpump.

Side effects:

Drowsiness,headache, dizziness,

mild hypotension.Adverse effects/toxicity:

convulsions,respiratorydepression

CV: hypotension,bradycardia, heartblock CV collapse,and arrest

Stop infusion withEKG changes such asprolonged PR,widened QRS, heartblock.

LAB

Monitor Lidocainelevels assess,

therapeutic level is1.5 -6mcg/ml

Assess electrolyte,check baseline liverand renal bloodstudies.

Report:

lightheadedness,

dizziness, confusion,

numbness or

tingling of lips,tongue or fingers

visual changes or

ringing in ears

Correcthypokalemia beforegiving Lidocaine

Avoid with:

Sinus bradycardia

Severe degrees of

SA, AV andintraventricularheart block.

Use caution:

hepatic or renaldisease

CHF

Hypovolemia

shock

hyperthermia elderly

BETA BLOCKERSincrease the effectof lidocaine


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Lithium carbonate(Eskalith)

Mood stabilizer

Antipsychotic

Therapeutic level

0.8-1.5meq/L.

Toxic level >2.

Lithium has short

half-life (about 1day) and hightoxicity.

Drug of choice tocontrol manicepisodes in bipolardisorder

Anti manic effectsare usually seen in5-7 daysafter initialdoses, but fulleffect does notoccur for 2-3 wks.

Lithium is a salt;exact actionuncertain

This med does notcause sedation.

Mild Side effects:

fine tremor, nausea,thirst, polyuria,Adverse effects/toxicity:

Vomiting, diarrhea,

slurred speech, lackof coordination,drowsiness, muscleweakness, ortwitching) withhold dose and

notify provider butDO NOT stopabruptly.

Give with meals

Hydration isessential

dehydration willincrease levels

Watch for weightgain (fluidretention)

Avoid NSAIDs anddiuretics.

Essential to monitormood and behaviors

Labs: Lithium level

every 3 monthsinitially, then every6 months.

Do not use with:

Dehydration,severe debilitating,severecardiovascular.

Use caution:

elderly,

pt. with cardiac,renal, thyroid ordiabetes

pregnancy

Lorazepam (Ativan)

Anxiolytic

Sedative-hypnotic

Benzodiazepines.

Onset1-5 min IV, 15-30 IM,Peak60-90 min IM, 2 hrs. PODuration12-24 hrs.

anxiety disorder

short term for reliefof symptoms ofanxiety

Pre-anestheticmedication to

produce sedationand reduce anxiety.

Status epilepticus

Side effects:

Drowsiness

sedation

Mild medicationwith limited toxicpotential

respiratorydepression is rate

Paradoxical reactions(nightmares, mania,etc.) may occur inchildren, psych patientsand the elderly.

Avoid alcohol

Taper dose whenstopping to avoidwithdrawalsymptoms

Watch for suicidal

risk

Do not use with:

Acute narrow-angleglaucoma,

Primary depression

acute alcoholintoxication.

Pregnancy andLactation

Use caution:

renal or hepaticimpairment

myasthenia gravis

suicidal tendencies


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Magnesium Sulfate

iron(Epsom salt oralform)

Onset 1-2 hrs. PO; 1 hr.IM.Duration30 min IV, 3-4hr. POEliminated by kidneys

Normal Magnesium

level: 1.8-3 mEq/L

Oral: laxative (byosmotic retentionof fluid whichdistend the colon,increase content offeces and causebowel stimulation)

Parenteral: CNSdepressant; used inseizures oftoxemia; forhypomagnesemia

4 gm. loading doseis give over 20-20min via pump.

Side effects:

Flushed warmfeeling

fluid and electrolyteimbalance

hyponatremia

N/V

Adverse effects/toxicity:Early indication ofmagnesium toxicity

Respiratorydepression

Cathartic effect

profound thirst

feeling of warmth

sedation

confusion

depressed deeptendon reflexes

muscle weakness

can lead to cardiac

arrest

s/s hypomagnesemia:

irritability

tremors, tetany

tachycardia hypertension

psychotic behavior

Monitor urinaryoutput and hydrateadequately withparenteraladministration.

Avoid with:

MI, heart block,cardiac arrestexcept for certainarrhythmias.

Use caution:

impaired kidneyfunction

other cardiacglycosides

Lactating momsand children


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Mannitol (Osmitrol)

Electrolyte andwater balanceagent

osmotic diuretic

Onset1-3 hr. diuresis; 30 to 60min IOP, 15 min. for ICPDuration4-6 hr. IOP,3-8 hr. ICP

Serum osmolality is 275-300 mmol/kg.

Give IV.Usually give test dosewhich should result in

Output of 30 to 50ml/hr. and is produced2-3 hrs. afteradministration.

Use in oliguria andacute renal failure.Help to preventrenal failure andreduce increasedintracranial orintraocularpressure

It acts by increasingthe osmolality ofplasma, glomerularfiltrate, and tubularfluid. This

decreases thereabsorption offluid andelectrolytes, whichincreases excretionof water, chlorideand sodium andslightly increase theexcretion of

Potassium. In intraocular (IOP)and CSF (ICP), itpulls the fluid andsends it to theplasma andextravascularsystems

Side effects:

HA, confusion,syncope

fluid and electrolyteimbalance, esp.hyponatremia

pulmonary

congestion, rhinitis

Water intoxication


Seizure,

thrombophlebitis,

CHF,Cardiovascularcollapse

Hyponatremia

Warning: There may bea rebound increase inICP about 12 hours afteradministration of med.Pt may complain of HA,

or confusion.

Use filter needleand/or filter ininfusion tubingbecause crystalsmay form in thesolution.

Mannitol is held ifserum osmolalityexceeds 310 -320.

Daily weightsTeach

Non-narcotics such

as Tylenol if there is

headache Therapy is based on

urine flow rate.

Reassure pt. thatexcessive thirst,blurred vision,rhinitis shouldsubside whenMannitol is

discontinued

Do not use:

severely impairedrenal function

markeddehydration

breast feeding

hepatic failure,

active ICP

anuria

Intracranial bleedshock

Question theadministration ofmannitol if thepatient has corpulmonae (rightsided heart failure)because Mannitolpulls fluid and itmay lead to

circulatory overloadwhich the heartcould not handle.This client wouldneed loop diureticto prevent seriouscomplications


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Meperidine HCl(Demerol)

Narcotic analgesic(opioid agonist)

Give Narcan fortoxicity - It is use toreverse respiratorydepression induced byoverdose

Onset: 15 mins. PO, 10

mins. IM, 5 mins IVduration 2-4 hours

Given for moderateto severe pain.

Potent, long acting

Side effects:

N/V, Anorexia

Sedation, dizziness

elevated BP rash, urticaria

tremors

hyperventilationAdverse effects/toxicity:

Resp depression,

respiratory arrest,

circulatorydepression,

increasedintracranial pressure

Assess:

LOC

rash, urticaria

respiratory rate.If respirations < 12 perminute withholdmeds.

Avoid use with:

acute bronchialasthma, upperairway obstruction

increasedintracranialpressure

convulsive disorder

pancreatitis, acuteulcerative colitis

severe liver orkidney insufficiency

Caution with:

children and elderly

Metoprolol tartrate(Lopressor, Toprol)

Beta adrenergicantagonist

(beta blocker)

Antihypertensive

Antianginal = sameaction as withpropanolol

Decreases heartrate and cardiacoutput

Lowers BP

Mild to severe HTN

angina pectoris

**Post - acute MI**

Max effect may

take 1 week

Side effects:

Usually welltolerated

Nausea, vomiting

Weight gain

worsening CHF

insomnia

Adverse effects/toxicity: profound

bradycardia

heart block

acute CHF,

bronchospasm

laryngospasm

Give with or w/ofood, but consistent

Do not stopabruptly; may causerebound effect.Gradually decreaseover 1-2 wks.

Hold meds if BP < 90or pulse < 60

Watch for s/s heartfailure

Can lead to elevatedBUN, creat.

May maskhypoglycemia

Avoid use with:

Heart block greaterthan 1stdegree

Sinus brady,

cardiogenic shockUse caution:

hyperactive airway

syndrome ( asthmaor bronchospasm)

Increases chance of

both Dig andLithium toxicity


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Morphine Sulfate

(MS Contin = sustainedrelease form)

Narcotic analgesic(Opioid agonist)

Give Narcan fortoxicity.

Onset, Peak, Durationdepend on route ofmedication.Onset: Immediate IV,rapid if given IM or oral,except MS Contin

Produces effect bybinding to opioidreceptorsthroughout theCNS.

Schedule II drug,major drug abuse.

For severe, chronicor acute pain.

Most commonly

use in post-

operative setting. mild bronchodilator

to improvebreathing

MS Contin issustained release;it will not controlbreak-through pain

because it is timerelease.

Side effects:

Nausea vomitinganorexia, GI,

pruritus,

light headedness

constipationAdverse effects/toxicity:

Classic triad ofsymptoms:respiratorydepression, coma,pinpoint pupils.

Withdrawal begins

6-8 hrs. After thelast dose, reachpeak intensity within48-72 hrs. S/Sinclude craving,chills, sweatingpiloerection (gooseflesh), abdominalpain and cramps,

diarrhea, runnynose, irritability.

Morphine inducedCNS stimulation paradoxical reactioncommon in womenand older adults.

Avoid alcohol use

Hold medication ifrespirations < 12/min

Hydrate adequately

to preventconstipation

Avoid use with:

Hypersensitivity toopiates)

acute bronchialasthma or upperairway obstruction,

ICP

convulsivedisorders

pancreatitis, acute

ulcerative colitis

severe liver orkidney disease

Do not givemorphine tochildren


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NLN Pharmacology Study Guide