Uploaded by Jerry Davis

Pharmacology Final Exam Guide

Pharmacology I Final Exam Study Guide
Chapter 1
 Understand what is involved in each step of the nursing process (Assessment, Diagnosis, Planning,
Implementation, Evaluation)
o Assessment
o Human Needs Statements (Diagnosis)
o Planning: Outcome Identification
o Implementation
o Evaluation
Understand the 9 rights of medication administration and what is involved in each step.
o Right drug
o Right dose
o Right time
o Right route & form
o Right client
o Right documentation
Last 3:
o Right reason (appropriate)
 Confirm, by reviewing client’s history & asking client
o Right response
 Document assessment findings, interventions, monitoring
o Right to refuse
 First, determine the reason the client is refusing
 Make sure the client understands the medication
 Inform the prescriber
 Document refusal and continue to monitor
Chapter 2
 Know which routes undergo the first pass effect and which routes do not.
o Enteral
o Absorbed through mucosa of the stomach and/or small/large intestine
o Oral – FIRST PASS!
o Sublingual – NO FIRST PASS!
o Buccal – NO FIRST PASS!
o Rectal – NO (or mixed) FIRST PASS!
Understand the concept of protein binding and the effects it has on medication.
o A drug’s efficiency is affected by the degree to which it binds to proteins within the blood
o UNBOUND = Pharmacologically ACTIVE
o BOUND = Pharmacologically INACTIVE
o When 2 highly bound protein drugs are administered at the same time, there is more free, unbound
(ACTIVE FORM) of drug available
 Occurs when the presence of one drug decreases or increases the actions of another drug that is
administered concurrently
Know the different types of adverse drug reactions.
o Any reaction to a drug that is unexpected and undesirable and occurs at therapeutic drug dosages:
o Pharmacologic
 Extension of the drug’s normal effects
o Allergic (hypersensitivity)
 Involves immune response
o Idiosyncratic
 Unexpected genetically determined abnormal response
o Drug Interactions
2 drugs interact and produce unwanted effect
BUT can be intentional and beneficial
Review the 4 phases of pharmacokinetics (absorption, distribution, metabolism,
o Absorption
• Movement of a drug from site of administration into bloodstream for distribution to tissues
• Affected by route of administration
• Bioavailability = the extent of drug absorption (0%-100%)
• First-Pass Effect = initial metabolism in the liver of a drug absorbed from the GI tract before the drug
reaches the blood stream
o Distribution
Transport of a drug by the bloodstream to its site of action
o Metabolism
• One or more chemical reactions involving a parent drug and produces a metabolite that is either
inactive or active
• Occurs mainly in the liver
• Elimination of drugs from the body
• Occurs mainly in the kidneys
• Half-Life: time it takes for one half of the original amount of a drug to be removed from the body
• Measure of the rate at which drugs are removed from the body
Chapter 3, 4, 5, 6
 Review lifespan considerations in regards to pregnancy, fetal gestational age, and the older adult.
o Drugs primarily transfer across the placenta by diffusion
o First trimester Greatest danger for drug-induced developmental defects
 Maternal self-treatment for minor illness is strongly discouraged
o Last trimester Drug transfer is more likely
 The greatest % of maternally absorbed drug gets to fetus
o Older Adult
• Drug therapy is more likely to result in adverse effects and toxicity due to:
• Polypharmacy
• Greater Medication Errors
• Physiologic Changes
• Absorption is slowed
• Distribution is decreased
• Metabolism is decreased
• Excretion is decreased
Understand what a Black Box Warning is and why it is used.
o The strictest warning from FDA
o Indicates serious adverse effects have been reported
Review cultural considerations in regards to pharmacology.
o Drug polymorphism
o The effect of a patient’s age, gender, size, body composition, and other characteristics on the
pharmacokinetics of specific drugs
o Adherence with therapy
o Environmental and economic considerations
Pharmacokinetics and Pharmacodynamics
Health beliefs and practices
Barriers (language, poverty, access, pride, beliefs)
Understand the use of zeros and decimal points when writing medication orders. (trailing zeros, leading zeros)
0.3 is correct. 3.0 is not.
Review ways to prevent medication errors.
o Checks and balances
o Prescribers must write legible
o Consult drug references/pharmacist
o Check the med order 3 times before giving drug
o 9 rights of medication administration
o 2 patient identifiers (name & DOB)
o Do not administer if you did NOT draw up or prepare yourself
o Minimize verbal or telephone orders
o Avoid abbreviations, acronyms
o Never assume anything!
o Do not try to decipher illegibly written orders
o No trailing zeros (Do not use 5.0 mg; use 5 mg instead)
o ALWAYS use leading zeros (Do not use .25 mg; use 0.25 mg instead)
o Use generic names
o Check patient allergies
o Always listen to and honor any concerns expressed by patients regarding medications
o Safeguard meds the patient may have already taken (on admission or transfer) so double-dose is not
o Mandatory recalculation of every drug dose for high-risk drugs or high risk-patients
o Educate patients to know their medications
Review best practices for patient education, especially in the older adult.
o Discharge planning and teaching begins upon admission!
o Assess verbal and non-verbal communication
o Use open-ended questions
o Identify patient’s level of understanding and develop teaching to meet their needs
Knowledge deficit with older adults/those with cognitive ability is a big problem:
 Lack of understanding about a medication, its action, side effects
 Don’t understand how to administer the medication
 Lacks motor skills needed to safely administer the medication
 Non adherence is a big problem due to cost and A/E
Chapter 7
 Review advantages and disadvantages of OTC medications.
o Advantages:
 Patient’s can conveniently and effectively self-treat many minor aliments
 Healthcare costs tend to decrease when drugs are re-classified as OTC
o Disadvantages:
 Delays patients from seeking medical care until they are very ill (bc they are self-treating and
only relieving symptoms)
 Insurance usually doesn’t pay for OTC medications
 Many are inexperienced in the interpretation of medication labels, which results in misuse and
drug-to-drug interactions
 Can be hazardous for patients with various chronic illnesses
 Abuse or overuse can be potential hazard (think of overuse of Tylenol and liver toxicity)
Review the criteria that determines whether a drug is considered OTC.
o Do NOT require a HC provider's prescription
o Bought off-the-shelf in stores
o Regulated by FDA through OTC Drug monographs
Chapter 8
 Understand how genetics play a role in the administration of medications and how the nurse might assess for
these genetic factors.
o Genetic testing and counseling-most common BRCA…also prenatal testing for cystic fibrosis and Down
o Use of rDNA vectors in the laboratory to make recombinant forms of drugs
 Hormones, vaccines, antitoxins, and monoclonal antibodies
 Escherichia coli bacterial genome: used to manufacture a recombinant form of human insulin
o Pharmacogenetics/genomics help differentiate between “poor” and ”rapid” metabolizers with medications
such as warfarin, phenytoin, codeine, and quinidine. Rapid metabolizers may need higher doses of
warfarin for the desired effect.
o Nursing Implications:
 Take thorough client, family, and drug histories
 Recognize situations that may warrant further investigation through genetic testing
 Identify resources for clients
 Teaching
 Maintain confidentiality and privacy
 Ensure that informed consent is obtained
Chapter 10
 Review acetaminophen (Tylenol)
• Block pain impulses by inhibition of prostaglandin synthesis
• Mild to moderate pain and fever
• Drug allergy, severe liver disease, G6PD deficiency
• N/V, hepatotoxicity, nephrotoxicity
• Alcohol (most dangerous); phenytoin, warfarin, rifampin, beta blockers
Maximum daily dose for healthy adults:
• 3000 mg/day
• 2000 mg/day for older adults & those with liver disease
• Inadvertent excessive doses may occur when different combination drug products are taken together
Review tramadol (Ultram)
Non Opioid
• Centrally acting analgesic- acts similar to opiods
• Treatment of moderate to moderately severe pain
• Drug allergy
• Similar to opioids: dizziness, drowsiness, HA, constipation, respiratory,depression, very hard on the
stomach, take with food.
• TCA's, SSRI's, MAOI's
• Concurrent use with TCAs comes a risk of seizures and serotonin syndrome with SSRIs
Review morphine
o • Treats severe pain
• High abuse potential
• Oral, IV, and rectal dosage forms -used a lot in hospice
• Extended release forms are also available
• Watch use in patients with renal impairment!
• Metabolites can accumulate in kidneys
Chapter 11
 Review the following prototypes: Succinylcholine
What is a benefit of succinylcholine?
o Quick onset of action and short duration = used most commonly to facilitate ET intubation
neuromuscular blocking drug: succinylcholine (Anectine, Quelicin)
o Depolarizing: acetylcholine competitive agonist
Route: IV
Uses:•Facilitate controlled ventilation during surgery
•Induction of ET
Duration:•Short-acting: 4-6 minutes
•Used as an adjunct to general anesthesia
-seldom used over long periods of time because causes muscle fasciculations (twitching)
Understand general anesthesia, local anesthesia, and moderate sedation.
moderate sedation
o -conscious sedation, anesthesia that does not cause complete loss of consciousness and no respiratory
-used for planned procedure, allows patient to be discharged soon after procedure
-physician can monitor patient and perform procedure at the same time
general anesthesia
o -complete loss of consciousness and loss of body reflexes, includes loss of respiratory function and
requires mechanical or manual ventilation support
-controlled conditions (anesthesiologist or CRNA)
-one or more drugs may be used, synergistic affects can mean smaller doses and better control of patient's
local anesthesia
o eliminates pain in tissues innervated by peripheral or spinal nerve impulses, does not involve paralysis of
respiratory function
Review malignant hyperthermia.
uncommon, but potentially fatal, genetically linked adverse metabolic reaction
•Rapid rise in body temperature
•Muscular rigidity
Chapter 12
Review the nursing implications in regard to the use of benzodiazepines.
•Emphasize: should only be taken as prescribed. Do not double up on the dose unless directed.
•Teach: Do not drive or perform activities that require mental alertness.
•Do not abruptly discontinue these drugs (avoid rebound insomnia)
•Sedative-hypnotics for sleep promotion are not intended for long-term use
•Patients taking benzodiazepines should not eat grapefruit or drink grapefruit juice
Review the following prototypes: Cyclobenzaprine
•Uses: reduce spasms following musculoskeletal injuries
•AE’s: marked sedation
•Routes: Oral
•Structurally and pharmacologically related to tricyclic antidepressants
Chapter 13
 Review priority nursing considerations for new Ritalin prescription
◦Pot. contraindications and interactions
◦use of herbal therapies
◦Conditions such as abn. cardiac rhythms, seizures, palpitations, liver problems
◦For children, assess baseline ht/wt
◦Last daily dose should be given 4-6 hours before bedtime to ↓ insomnia.
◦Take on an empty stomach 30-45 minutes before meals.
◦Drug “holidays” may be ordered.
◦Instruct parents to keep a journal to monitor child’s response to therapy.
◦Monitor for continued phys. growth, including ht/wt.
Review anti-migraine patient teaching
◦Provide specific teaching about correct medication administration. (ex: blow nose before nasal spray)
◦Instruct patients to keep a journal to monitor response to therapy.
Chapter 14
 Review nursing implications in regards to antiepileptic medications
Routine monitoring of drug levels with phenytoin
•Administer at the same time each day to maintain therapeutic levels
•Do not skip doses or abruptly discontinue the drug
•Contact prescriber immediately if one or more doses is missed
•Report any suicidal thoughts immediately
•Avoid intake of alcohol, smoking & caffeine
•May be driving limitations
•Therapeutic response = decreased or absent seizure activity
-diazepam used to treat status epilepticus
•Prevent or reduce the severity of epilepsy and different types of epileptic seizures, not just convulsive seizures
•Goal = control or prevent seizures while maintaining a reasonable quality of life
•Have many AE’s – often difficult to achieve seizure control while avoiding AE’s
•Usually LIFELONG treatment
•Do NOT abruptly stop taking = withdrawal seizures
•Not recommended after a single isolated seizure event
•Always start single-drug therapy first, then may add multidrug therapy
•Serum drug concentrations must be measured
•If seizure-free for 1-2 years, MAY be able to stop meds.
Review the following prototypes: phenytoin, valproic acid
•Uses: management of tonic-clonic and partial seizures
•Contraindications: heart conditions that involve bradycardia
•AE’s: A LOT!
•Abnormal movement
•Mental confusion/cognitive changes
•Dilantin facies
•Gingival hyperplasia
•Routes: Oral, IV
•Therapeutic drug levels 10 to 20 mcg/mL
•Toxic levels = nystagmus, ataxia, dysarthria, encephalopathy
•Highly bound to albumin
•Induces cytochrome P-450 enzymes
• Long half life = twice or once daily dosage
•Monitor CBC monthly for 1 year (thrombocytopenia, agranulocytosis)
•Monitor liver enzymes to check for hepatitis (hepatotoxicity)
•Very irritating!
•Give slow IV push in large vein
•Do not exceed 50 mg/min
•Large gauge IV (20 or larger)
•Monitor for bradycardia
•Dilute only in NS
•Use in-line filter
Valproic Acid:
•Uses: treatment of generalized seizures, bipolar disorder
•Contraindications: liver impairment, urea cycle disorders
•Hepatotoxicity, pancreatitis, drowsiness, n/v, tremor, weight gain, transient hair loss
•Interactions: A LOT! (see table 14.5)
•Routes: oral, IV
•Do not take with carbonated beverages, take with 4-6 oz of water, take with food to minimize GI upset
Chapter 15
 Review nursing implications in regard to antiparkinson medications:
•Take exactly as prescribed.
•Delaying dose by even 30 min. may lead to "off" period & may last hours
•Drugs are usually titrated to the patient's response and may take 3-4 weeks for therapeutic response
Review the following prototypes: selegiline, carbidopa-levodopa
•MOA: increases levels of dopaminergic stimulation in CNS by inhibiting monoamine oxidase
•Routes: Oral (usually given BID), oral disintegrating (buccal)
•Contraindications: meperidine (Demerol)
•AE’s: mild (see table 15.3, page 234), postural hypotension
•Interactions: tyramine-containing foods (aged cheese, sausages, beer), antidepressants (serotonin syndrome)
•Uses: directly restores dopaminergic activity in PD
•Contraindications: angle-closure glaucoma, any undiagnosed skin condition (can activate malignant melanoma)
•AE’s: cardiac dysrhythmias, hypotension, chorea, muscle cramps, GI distress (constipation)
•Interactions: pyridoxine (vitamin B6) (reduces effectiveness)
•Routes: Oral
•Best taken on empty stomach, avoid high-protein diet, drink water
Chapter 16
 Review dosing considerations related to tricyclic antidepressants
-Requires at least 6 weeks of therapy with adequate doses to be able to fully evaluate results
-May require upward titration of dosages over several weeks
-Should be used in conjunction with psychotherapy
-Higher risk of suicide among both adult and pediatric population
-OD can be lethal, prescribe 3-4 days initially and then only up to 30
-Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia
-Increased appetite is an effect of TCAs; therefore, TCAs are sometimes used to treat anorexia nervosa.
-Sedation, Impotence, Orthostatic hypotension
-Older patients (Dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors)
Review the following prototype: buspirone (Buspar)
-Unknown mechanism of action
-May have drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)
- Administered on a scheduled basis
- Lacks sedative properties and dependency potential as other benzodiazepines
- Adverse effects - Paradoxical anxiety, Blurred vision, Headache, Nausea
- Do not administer with MAOIs
Review fluoxetine (Prozac)
-Prototypical SSRI
-Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder
-Contraindications: known drug allergy and concurrent MAOI therapy
-Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others
-highly protein bound, can lead to toxicity
Chapter 18
 Review the differences between inotropy, chronotropy, and dromotropy
Inotropicincrease the force of contraction
chronotropic increase heart rate
dromotropic- increase conduction through the AV node
Review epinephrine: Indications, adverse effects, contraindications
•Administered in emergencies, lethal dysrhythmias, ACLS, anaphylactic shock
-hypertension, hypothermia, pulmonary edema, myocardial ischemia, hypovolemic shock
-nervousness, restlessness, HA, tremor, pulmonary edema, dysrhythmias, chest pain, hypertension, tachycardia,
Review adrenergic agonists: indications and adverse effects
•Topical Nasal Decongestant
•Overactive Bladder
•Cardiac failure or shock
Adverse effects:
•Unwanted CNS effects
•Other significant effects:
•Sweating, nausea, vomiting, muscle cramps
•Extension of common adverse effects
•Hypotension or hypertension
•Dysrhythmias, palpitations
•Dizziness, nervousness
Chapter 19
 Review carvedilol (Coreg) for indications, contraindications, adverse effect
Carvedilol (Coreg)
•Nonselective beta blocker
•Indications: heart failure, HTN, angina
•Contraindications: uncompensated HF, asthma, cardiogenic shock, advanced heart blocks
•AE’s: dizziness, HA, hypotension, bradycardia, edema, UTI, urinary retention
Review metoprolol (Lopressor) for indications, expected therapeutic effects
Metoprolol (Lopressor)
•Indications: post-MI, HTN, stable heart failure
•Has shown to increase survival in pts post-MI
Review tamsulosin (Flomax) for indications, contraindications, adverse effects
treat BPH (men) or kidney stones (women)
•Contraindications: known drug allergy; concurrent use of erectile dysfunction drugs
•AE: headache, abnormal ejaculation, rhinitis
Chapter 20
 Review cholinergic agonists adverse effects
Exaggeration of these effects:
•Stimulate intestines and bladder
•Increased gastric secretions, GI motility, and urinary frequency
•Stimulate constriction of pupils
•Decreases intraocular pressure
•Increase salivation and sweating
•CV effects
•Reduced HR and vasodilation
•Pulmonary effects
•Bronchi constriction and airway narrowing
Review the manifestations and early signs of cholinergic crisis:
•Circulatory collapse, hypotension, bloody diarrhea, shock, & cardiac arrest.
• S: Salivation
• L: Lacrimation
• U: Urinary incontinence
• D: Diarrhea
• G: GI cramps
• E: Emesis
•Early signs: Abdominal cramps, salivation, flushing of the skin, nausea, and vomiting, transient
syncope, transient complete heart block, dyspnea, orthostatic hypotension
 Review donepezil (Aricept) indications, nursing implications
Indications: Mild to moderate Alzheimer’s disease
These drugs will stimulate the PNS & mimic the action of acetylcholine.
•Allergy, presence of GI or GU obstruction, asthma, peptic ulcer disease, & coronary artery disease
•Baseline assessment of VS, systems overview
•Take meds as ordered. Never stop abruptly.
•Spread doses evenly apart to optimize the effects.
•Overdosing can cause life-threatening problems.
•Do not adjust dosages unless directed by prescriber.
•When prescribed for
-Alzheimer’s - drugs are for management of symptoms (not a cure).
-Monitor for therapeutic effects.
In clients with Alzheimer’s disease look for improvement in symptoms, mood and decrease in confusion
-may not occur for up to 6 weeks.
Chapter 21
 Review atropine: indications, adverse effects
•Indications: primarily for CV disorders ( cholinergic crisis)
•Symptomatic second-degree atrioventricular block
•ACLS – for sinus bradycardia and ventricular systole
•Angle-closure glaucoma
A/E: -blurred vision, dry mouth, constipation, urinary retention
Chapter 38
 Review Healthcare Acquired Infections (Nosocomial Infections)
o Health care-associated (nosocomial) infections
 Contracted in hospital, institutional setting
 Infection was not present or incubating in the client on admission to the facility
 Occurs more than 48 hrs. after admission
 Difficult to treat. Often drug-resistant & virulent
Review super infections
o Occurs when antibiotics reduce or eliminate normal bacterial flora
 C. difficile infection
 Yeast infections
Review amoxicillin (Amoxil)
o MOA:
 inhibit bacterial cell wall synthesis
 bactericidal (many G+ & some G-)
 streptococcus, and staphylococcus
 drug allergy
allergic reactions occur in 0.7-4%. Most common: urticaria, pruritus, angioedema, N/V/D
 aminoglycosides, NSAID’s, oral contraceptives, warfarin
Review erythromycin
o MOA:
 bacteriostatic but can be bactericidal with high concentrations
 inhibit protein synthesis
o Indications:
 wide variety of infections
 Decreased GI motility (gastroparesis)
o Contraindications:
 known drug allergy
o AE/SE:
 GI related: N/V
o Interactions:
 many drugs due to highly protein bound & metabolized in liver (P-450 complex)
 oral contraceptives
o Nursing Considerations:
 Baseline CV function
 Baseline hearing status
 Liver function & hx of liver disease
 Drug interactions: warfarin, digoxin, theophylline
 Use add’l form of contraception.
 Do not take w/fruit juices.
 Inform about drug interactions.
 Teach to report: CP, palpitations, dizziness, jaundice, rash, hearing loss.
 Take with meals or snacks.
Chapter 39
 Review fluoroquinolones
o MOA:
 destroy by altering bacteria DNA
 Excellent oral absorption (comparable to IV)
o Indications:
 Complicated UTI’s, resp, skin, GI, & bone & joint infections
o Contraindications: drug allergy
o Caution in: Prepubescent children
o Black box warning: increased risk of tendon rupture
o Interactions:
 antacids, calcium, magnesium, iron, zinc, sucralfate, enteral feedings
 amiodarone: prolonged QT interval (dangerous dysrhythmias)
Review the prototypes: gentamicin, metronidazole (Flagyl), vancomycin (Vancocin)
o MOA:
 Prevent protein synthesis
 Often combined w/other antibiotics (i.e. penicillins)
Serious G+ and G- infections
 not for pregnant women except in case of life-threatening infections when safer drugs are
ineffective- can cause congenital deafness
 not for lactating women
AE/SE: (serious toxicities):
 nephrotoxicity
 ototoxicity
 other nephrotoxic drugs (i.e. vancomycin, cyclosporine, amphotericin B)
Nursing Considerations:
 Baseline hearing, vestibular, & neuromuscular function
 Encourage ↑ fluid intake
 3 L/day unless contraindicated.
 Inform hc provider if change in:
 hearing, tinnitus, ataxia, nystagmus, dizziness
 IV admin: solution may be slightly yellow but should be clear.
 Admin. diluted at corrected rate.
 metronidazole (Flagyl
o MOA:
 Interferes w/microbial DNA synthesis (like quinolones)
 Antimicrobial activity against anaerobic organisms
o Indications:
 Intraabd. & GYN infections
 Protozoal infections (amebiasis, trichomoniasis)
 Pseudomembranous colitis
o AE/SE:
 dizziness, ha, GI discomfort, nasal congestion, reversible neutropenia & thrombocytopenia
o Interactions:
 Alcohol intolerance!
 Lithium  increased toxicity of lithium
o Nursing considerations:
 Baseline neuro, GI & GU exams
 Avoid alcohol
 vancomycin (Vancocin)
o MOA:
 Bactericidal antibiotic
o Indications:
 IV: MRSA, bone/joint infections, sepsis
 PO: Clostridium difficile
o Cautious use:
 pre-existing renal impairment
 hearing loss
 older adults & neonates
o AE/SE:
 red man syndrome
 ototoxicity
 nephrotoxicity
o Interactions:
 other nephrotoxic meds
o Nursing considerations:
 Obtain trough: 15-20 mcg/mL
 Admin. over 1 hour or longer.
Chapter 40
Review the prototype: acyclovir
o MOA:
 Impairs viral replication by blocking enzymes
o Indications:
 DOC for HSV-1 & HSV-2; herpes zoster (shingles)
o Dosages:
 High dose: acute episodes
 Lower: viral suppression
o Formulations:
 PO, topical, injectable
o AE/SE:
 N/D, headache, burning (topical)
o Interactions:
 CNS stimulants
 Antibiotics
 Probenecid
Review post exposure prophylaxis (PeP)
o Indications: after potentially exposed to HIV; to prevent infection
o Dosing: Start within 72 hours after possible exposure. The sooner the better. Take it once or twice daily
for 28 days.
Chapter 41 & 42
 Review nursing implications in regards to antitubercular medications
o Drug therapy often last long time – up to 24 months
o Important to adhere to drug regimen
o Multiple drugs are often used
o Important to take same time each day
o Must complete all that is prescribed, even if feeling better
o May need to be taken w/ food to minimize GI upset
Review the following prototypes: isoniazid, rifampin, amphotericin B
o isoniazid (INH)
 MOA: bactericidal = kills mycobacteria by disrupting cell wall synthesis and cellular functions
 Uses: prophylaxis & treat active TB
 Routes: Oral, injectable
 Contraindicated: acute liver disease
 Black Box Warning: possible hepatitis
 AE’s: pyridoxine (Vit B6) deficiency – often give B6 supplement, liver toxicity
 Interactions: See table 41.4, page 650 – antacids (reduces absorption)
 Slow acetylators – genetic deficiency of liver enzymes needed to metabolize drug
o rifampin (Rifadin)
 MOA: bactericidal = kills bacteria by inhibiting protein synthesis
 Uses: prophylaxis & treat active TB
 Routes: Oral, IV
 AE’s: hepatitis, hematologic disorders
 SE’s: urine, saliva, tears, and sweat to be red-orange-brown colored
 Potent enzyme inducer = many drug interactions (see table 41.4), oral contraceptives, beta
blockers, benzodiazepines, oral antidiabetics, anticoagulants
o amphotericin B (Fungizone)
 Uses: treatment of severe systemic fungal infections
 Contraindications: bone marrow suppression, renal impairment
 AE’s: MANY! -- fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia,
n/v, headache
 Usually take antipyretics, antihistamines, antiemetics, and corticosteroids in addition to decrease
severity of AE’s
 Interactions: see table 42.3, page 659
Routes: IV
Review which types of clients antifungals are contraindicated
o Those with liver/hepatic disease/disorders
Chapter 44
 Review ketorolac (Toradol)
o Acetic acid derivative
o Powerful analgesic effects
o Some anti-inflammatory activity
o Indications: short-term use (up to 5 days) to manage moderate to severe acute pain (good alternative to
opioids) ( use short term due to kidney risk)
o AE/SE:
 Renal impairment
 Edema
 GI pain, dyspepsia, nausea
Review allopurinol (Zyloprim)
o MOA:
 Inhibits xanthine oxidase to prevent production of uric acid
o Indications:
 Gout caused by excessive production of uric acid (hyperuricemia)
o Contraindications:
 Allergy
o AE’s:
 Agranulocytosis, aplastic anemia, potentially fatal skin conditions
o Interactions:
 Azathioprine and mercaptopurine
Chapter 56
 Review topical dermatologic drug formulations
o Ointments have an oil base that makes them sticker than creams. These are better for smaller areas. Not
removable with water.
o Creams have a water base that makes them better for larger surfaces.
o Gels tend to enhance penetration of the active ingredient.
o Lotions are similar to creams but are lighter.
Review age considerations with the use of dermatologic drugs
o Systemic absorption is higher in very young and very old patients because their skin may be more
Chapter 57
 Review the different ophthalmic medications and their indications
o Cholinergic (miotic): pilocarpine (Isopto Carpine)
 Indications: open-angle, angle-closure, convergent strabismus, & in ocular surgery
o Sympathomimetic (mydriatic): dipivefrin (Propine)
 chronic open-angle glaucoma (initial or long-term therapy) & ocular hypertension
o Beta-Adrenergic Blocker: timolol (Timoptic)
 reduce IOP in chronic open-angle glaucoma and ocular hypertension
o Cholinesterase Inhibitor: echothiophate (Phospholine Iodide)
 Indications: open-angle and angle-closure; preoperatively to control IOP
Review the prototype drug: latanoprost (Xalatan)
o Newest class of drugs.
o MOA: these drugs reduce intraocular pressure by increasing the outflow of aqueous humor between the
uvea and sclera as well as via the usual exit through the trabecular meshwork.
o Indications: these drugs are used in the treatment of glaucoma
Contraindications: the only usual contraindication is drug allergy
AE/SE: generally well tolerated. Adverse effects include foreign body sensation, dotted appearance of the
cornea, stinging, bloodshot eyes, blurred vision, itching, and burning.
Only available in eye drop form. About 3-10% of patients have increased iris pigmentation after 3-4.5
months of treatment
In some people with hazel, green, or bluish-brown eye color, eye color will turn permanently brown, even
after the medication is discontinued.
Interactions: concurrent administration of these drugs with other eye drops that contain the preservative
thimerosal may cause precipitation
Nursing considerations: Same as the rest.
Chapter 58
 Review otic drugs nursing considerations:
o Assess baseline hearing or auditory status.
o Evaluate the patient’s symptoms.
o Assess drug and food allergies.
o Assess for contraindications.
o Keep in mind that perforated eardrum(s) may be a contraindication to these drugs.
o If necessary or if ordered, remove cerumen by irrigation before instilling eardrops.
o Cleanse the outer ear thoroughly.
o Warm eardrops to approximately body temperature before instillation.
o Allow refrigerated solutions to warm to room temperature.
o Keep in mind that cold eardrops may cause vomiting and dizziness.
o Technique for administering:
o Adults: Hold the pinna up and back.
o Children younger than 3 years: Hold the pinna down and back.
o Allow time for eardrops to flow down into the ear canal.
o Have patients lie on the side opposite to the side of the affected ear for about 5 minutes after instilling
o A small cotton ball may be gently inserted into the ear canal to keep the drug in but do not force the
cotton into the ear canal.
o Gently massage the tragus of the ear to encourage flow of medication.