PHARMACOLOGY NCLEX

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PHARMACOLOGY

Anti Hypertensive:

Tricyclic antidepressants - possible cardiac toxicity in patients w/hear disease Thiazide diuretics - may induce hyperglycemia ACE Inhibitors - be cautious of a persistent cough (contact MD if present) Diltiazem - CCB Lisinopril: ACE inhibitor. 20-40mg/day. Can cause HA/dizziness/fatigue/tachycardia Nimodipine - CCB; decreases spasm in cerebral blood vessels Procardia - antianginal med (CCB) decreases myocardial O2 demand. Dopamine - increases afterload

Triametrene: a potassium sparing diuretic

Decreased Na+ levels could be a development of

dig

toxicity.

Anticlotting:

Amicar - antifibrinolytic; prevents recurrence of subarachnoid hemorrhage. Any anti-clotting - Avoid herbal supplements like ginseng, ginger, gingko, garlic (all the G's) Vit C may decrease warfarin effects Vit E may increase warfarin effects Tamoxifen - increases the effects of Warfarin sodium Ticlopidine (Ticlid) is used as a antiplatelet drug for Salicylate (Aspirin) sensitivity.

Respiratory:

Warn asthma patient about using aspirin. It can induce an asthma attack Neostigmine (Prostgmin) - is a cholinergic and can cause bronchoconstriction in asthmatic Patients

AntiCancer:

Adriamycin - Cancer drug, blood; lymph system; bladder; breast; stomach; lung; ovaries; thyroid; nerves; kidneys; bones; and soft tissues, including muscles and tendons. Vincristine - SE: N/V/A, urinary retention, neurotoxic, alopecia Bleumycin Sulfate - is an antineoplastic drug that can cause interstitial pneumonitis. Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood cells count Cytarabine (Cytosar): Crosses the blood-brain barrier Daunorucibin (cerubidine): for a client with leukemia is cardiotoxicity Cyclophosphamide (Cytoxan): SE: metallic taste. Tx: lymphoma, multiple myeloma, leukemia, mycosis fungoides, neuroblastoma, ovarian cancer, eye cancer and breast cancer.

Pain Medications:

Morphine - Contraindicated in pancreatitis or cholecystitis Percodan - oxycodone and aspirin Percocet - oxycodone and acetaminophen Butorphanol Tartrate (Stadol) - analgesic for moderate/ severe pain; SE: change in BP, bradycardia, respiratory depression.

Mental Health Medications:

Clozapine (Clozaril) - antipsychotic, treats schizophrenia, potential to suppress bone marrow and cause agranulocytosis (look for sore throat and fever) Dilantin - Urine may turn pink, red or brown Cogentin - used to tx parkinsonian side effects of Thorazine (antipsychotic med) Dilantin - Antiseizure. Causes bradycardia & Hypotension. Ergometrine - Preventing or treating acute migraine headache with or without aura (flashing lights, wavy lines, dark spots). MAOIs –

N

on

P

opular

M

eds – avoid stimulants/decongestants, opioids. Nardil, Parnate, Marplan Imipramine (Tofranil) - tricyclic antidepressant used to treat panic attacks Succinylcholine (Anectine) is given before ECT (Electroconvulsive therapy) ... common tricylics USUALLY have 3 syllables (pamelor, elavil). (remember: tri = 3) ... common MAOI's USUALLY have two (nardil marplan)

DRUGS-

Thorazine Haldol Inapsine Risperdal Mellaril Olanzapine Seroquel, Serentyl, Stelazine Prolixin Trilafon Clozapine S/E: Photosensitivity (easily get burned) Orthostatic Hypotension (dizzy, check BP, change position) Sedation (makes u sleepy, take it @ night) Anticholinergic (dry mouth, urinary retention,blurred vision, constipation) Galactorrhea (milk from breast) EPS (pseudoparkinsonism, akatisia, dystonia, tardive dyskinesia)

Antibiotics:

Indomethacin - can cause Oligohydramnios. Monitor Amniotic fluid index.

Zosyn

and

Gentamycin IV

mixing is contraindicated - wait at least an hour to decrease the risk of gentamycin inactivation. Amphoteracin B (Fungizone) - should be mixed with D5W ONLY!!! If allergic to sulfonamides dont take acetazolamide (Diamox)

Endocrine:

Aldactone - can cause persistent gynecomastia. Black Cohosh - used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Desmopressin Acetate (DDAVP): - synthetic form of ADH that causes reabsorbtion of H2O.

increase in urine osmolality, decrease in serium osmolality; fluid restored. Levothyrosine (Synthroid) - synthetic thyroid hormone. Given in the morning as single dose. Same time each day. Boniva - prevention of post menapausal osteoporosis. SE: chest pain, muscle pain, numbness. Prednisone - costicosteroid. Can cause adrenal atrophy. Before surgery, dose may be increased. Propylthiouracil (Puts Thyroid Under)- used to treat hyperthyroidism. May convert patient to hypothyroid state. Salicylates - may interact with insulin causing hypoglycemia Corticosteroids - may produce an altered effect of a vaccine. Corticosteroids - should be taken in the morning with food. Calcitonin - in increases Calcium in the BONE PTH - Puts The Calcium in the Heme (blood) Indocin - Treating moderate to severe rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs).

Glyburide

- 30 mins before breakfast

Repaglinide

- rapid acting oral hypoglycemic agent.

Neostigmine (prostigmin)

: Parasympathomimetic used to treat myasthenia gravis and is an antidote for nondepolarizing neuromuscular blocking agents. DE: bronchioconstriction, HoTN, increases action of morphine. Prednisone, Prograf, and Cellcept - helps to prevent kidney rejection

Oral Contraceptives:

decrease the effectiveness of insulin.

Hyperthyroidism Medications:

Antithyroids -Methimazole (Tapazole) Iodine Lugol’s solution Radiation -Radioactive Iodine 131 Topical Corticosteroids - can be absorbed into systemic circulation. Absorbtion higher in regions where skin is expecially permeable, and lower where permeability is poor (back, palms, soles)

Gasterointestine Medications

: Amphojel - SE is constipation Librium - antianxiety used to tx symptoms of acute alcohol withdrawal. Phenazopyridine (pyridium) Used to treat UTI Allopurinol - for chronic gout Colchicine - for acute gout attack Sodium Phosphate (Neurta-Phos): Avoid spinach, rhubarb, bran and whole grains (they can interfere with absorbtion).

Motion Sicknness medications:

Imenhydrinate (Dramamine)

Scopolamine (Transderm-Scop) Promethazine (Phenergan) Prochlorperazine (Compazine)

Pregnancy

: Pregnancy Hemabate (prostaglandin): can be given intra-uterinlly. Methergine - contrainticaded when BP > 140/90 Terbutaline - tx preterm labor. SE = tachycardia. Best route = SQ Sulfasalazine: Sulfa- antibiotic. decreases the absorbtion of folic acid. Increase supplementation. Folate Dosage: Planning Pregnancy: 400 mcg Post/intrapartum: 300 mcg. RhoGam - post partum 300 mcg. Ergonovine (Ergotrate) - causes uterine contractions. Only give to normotensive pts. Methotrexate - dont take supplemental folic acid and (teratogenic) please don’t take while pregnant..can cause premature labor and bleeding. Immunosuppressant. Newborn Vit K Dose - 0.5 – 1.0 mg PCN - RX for Group B Beta Strep. Maximum Pitocin Rx - 20 mili Units Premarin - Treating certain symptoms of menopause. Cervidil - Cervical ripening agent No birth control pills with antiseizure meds....lowers the birth control pill effects

Skin Medications:

Coal Tar - used to treat psoriasas. Unplesant odor, stains, can cause phototoxicity. Clotrimazole - antifungal; treats rashes. Cyprofloxacin - use with caution on patients with renal disease,CNS,and seizure disoders Sodium hypochlorite - solution used to irrigate wounds. Cant be used to pack. Solution loses its potentcy during storage. Lindane - Tx for scabies. Applied and removed 12 hrs later. One application necessary

HEENT Medications:

Timoptic - Timolol ophthalmic (for the eyes) is a beta-blocker that also reduces pressure inside the eye. Timolol ophthalmic is used to treat open-angle glaucoma and other causes of high pressure inside the eye. Topiramate (Topamax) - an anticonvulsant. Should drink 2000-3000ml of fluid daily to prevent kidney stones Side effects: orthostatic hypotension, ocular symptoms, Blindness and decrease effects of hormonal contraceptives. Protamine sulfate - comes from the sperm of salmon and other fish so don't use if allergic to fish Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured cerebral aneurysm. Mydratics - (big word, big pupil) treats cataracts Miotics - (small word, small pupil) treats glaucoma Filgrastim (Neupogen) - increase NEUtrophil count Epoietin alfa (Epogen) - increase RBC/erythrocytes

Theohylline - OD = irriatibility. RX is minetabolized by the liver into caffeine. Phenobarbital (Luminal): - is commonly used to treat and prevent recurrent seizures in infants and young children Ezetimibe (Zetia): - Lowers LDL, triglycerides and apolipoprotein B. Blocks absorbtion in GI tract. Minimimal adverse effects. Calcium Supplements: 1-1.5 hrs after meals. Antihymocyte globulin is used to prevent transplant rejection. The nurse should skin test a dose before IV administration to identify hypersensitivity to the medication. Premedication with acetaminophen (Tylenol) and or dephenhydramine (Benadryl) may be prescribed to prevent reaction to the dose. Muromonab-CD3 (Orthoclone OKT3) is can cause fatal anaphylactic reactions. S/Sx = include pulmonary edema, cardiovascular collapse and cardiac or respiratory arrest. Assessing lung sounds is a priority. -mycins - if fever, notify MD Sucrofate (carafate): coats stomach – attaches to ulcer. Give 1 st . Tetracycline can cause staining of the teeth Adverse Affects of Psychotics = SHANCE S – Sunlight Sensitivity H – Helatotoxitity A – Agranulocytosis N – Neuroleptic Maligant Syndrome C – Circulatory Problems E – Extra Pyramidal Symptoms Sources of Potassium P - potatoes,pork,beef,veel O-oranges T-tomatoes A-avacado,banana,carrots,cantaloupe S- spinach S-strawberries,raisins I- fIsh U M-mushrooms

Withdrawl

: Amphetamine = depression, disturbed sleep, restlessness, disorientation Barbituates = N/V, seizures, course tremors, tachycardia. Cocaine

= severe cravings, depression, hypersomnia, fatigue. Heroin = runny nose, yawning, fever, muscle/joint pain, diarrhea (flu-like)

Insulin :

Rapid : (Lispro) Onset: <15min Peak: 1hr Duration : 3hr Short : (Regular) Onset: 1/2hr-1hr Peak: 2-3 hr Duration: 4-6 hr Intermediate : (NPH or Lente) Onset: 2hr Peak: 6-12 Duration: 16-24 Long Acting : (Ultralente) Onset: 4-6 hr Peak: 12-16hr Duration: >24 hrs Very Long: (Lantus) Onset: 1 hr Peak: NONE Duration: 24 hr continuous Peak hours: • Regular insulin- 2-4 hours • Insulin Aspart (Novolog)- 1-3 hours • Inslulin lispro (Humalog)- 1 hour • NPH/Humulin N- 6-12 hours • Insulin Zinc (Lente)- 8-12 hours • Ultralente- 18-24 hours • Insulin glargine- 5 hours • Humulin 70/30 4-8 hours For TB Drugs think SPRITE S - Streptomycin (Monitor for ototoxic, nephrotoxic and neurotoxic rxn) P -Pyrazinamide ( P hotosensitivity-- so avoid sunlight or UV rays) R - Rifampin ( R ed orange urine is normal.. think about R for rifampin and R for red urine) I - INH ( SE is Vit B6 deficiency so pt needs inj. and avoid tyramine containing foods) T - Tubasal aka Aminosalicylate sodium ( avoid aspirin with this med) E - E thambutol ( E for eye problems- assess visual acuity and color discrimination esp to green) Cycloserine is an antituburculan and needs weekly drug levels

Drugs that can cause Nephrotoxicity Acetaminophen ( high doses, acute) Acyclovir, parenteral ( Zovirax) Aminoglycocides Amphotericin B, parenteral ( Fungizone) Analgesic combinations containing (acetaminophen, asprin, or other salicylates in high doses) Ciprofloxacin Cisplatin (Platinol) Foscarnet (Foscavir) Methotrexate (high doses) Nonsteriodal anti-inflammatory drugs ( NSAIDs) Rifampin Sulfonamides Tetracyclines ( exceptions are doxycline and minocycline) Vancomycin, parenteral (Vancocin) Drugs that can cause Hepatotoxicity ACE inhibitors Acetaminophen Alcohol Iron overdose Erythromycins Estrogens Fluconazole ( Diflucan) Isoniazid ( INH) Itraconazole ( Sporanox) Ketoconazole ( Nizoral) Nonsterodial anti-inflammatory drugs ( NSAIDs) Phenothiazines Phenytoin ( Dilantin) Rifampin ( Rifadin) Sulfamethooxazole and trimethoprin ( Bactrin, Septra) Sulfonamides Zarfirlukast (Accolate) Ototoxic drugs: Loop diuretics (Lasix) NSAIDs Cisplatin (Platinol-AQ) Aminoglycosides Antimyobacterials Thiazides Antineoplastics PHARMACOLOGY MISC: Celebrex is contraindicted in pts with a history of cirrhosis Chromium : is helpful in maintaining glucose homeostasis by enhancing the activity of insulin. Take statins

with at night with meals. Give ampicillin on empt stomach (penicillin can be given without regards to meals) Give captopril one hour before meals. Dont take cytoxan while pregnant or dont handle the drug while pregnant. Isotretinoin (Accutane): Can elevate triglyceride levels. Methotrexate therapy =in 2 weeks expect to see signs of bone marrow depression Mafenide acetate : can suppress renal excretion of acid-cause acidosis. Monitor for hyperventilation. Cipro treats anthrax Pyrazinamide (PZA) = DC if big toe pain; means Hyperuricemia ;Gout Humera : tx Rheumatoid arthritis, Chrohn’s if other meds no help, psoriasis. To prevent further damage to bones/joints. Get a TB test done before starting humera.

MineralCorticoids

: increase reabsorbtion of Na + by increasing H + and K + excretion in the distal tubule.

GlucoCorticoids:

decrease inflammation by suppressing leukocyte migration and modifying the body’s immune response.

Pancreatic enzyme should be administered in cold medium such as applesauce to maintain medication integrity

The usual gauge (size of the needle) for an IM injection is 19-23 Less viscous IM = 1” 25g More viscous IM = 1” 20g

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