Dr. Grim Pharmacology Review Rights of Medication Administration: 1. Right Patient 2. Right Medication 3. Right Dose 4. Right Route 5. Right Time 6. Right Documentation 7. Right To Refuse 8. Right Reason How to verify a patient for medication administration if they are nonverbal? Check their photo ID? What should you do prior to administering medication? Assess & Monitor Lab Values (so you can identify possible toxicity) What do you do when a patient refuses a medication? Evaluate why the patient is refusing Document the refusal Notify the provider of the refusal What to do when given a verbal order? Always read it back to the provider to confirm that you heard it correctly What should you do when you make a medication error? Assess the patient Notify the patient Notify the provider Report it as an incident & document it but NOT in patient medical record Lithium Important to monitor sodium levels because sodium too low can cause toxicity Note that a contraindication would be a diuretic med because it can lower sodium levels Neostigmine Used for patients with mysasthania gravis to increase acetycholine levels Adverse Effects: Can’t see, Can’t pee, Can’t shit, Can’t spit Oxybutynin Used for neurogenic bladder incontinence (helps to hold onto urine) Donapezil Used to treat altheimerz (it increases the amount of acetylcholine available) It is a cholinergic agonist (rest & digest) which can cause side effects such as hypotension, pupils constricted (can cause issues driving at night), little pupil response during assessment *Know how to put sympathetic vs parasympathetic drugs into their specific class because it will help you with figuring out the side effects* Morphine Adverse effects: respiratory depression, sedation Nursing care: Monitor patient’s respiratory status, educate patient to use call bell when getting out of bed because fall precautions, assess PCA pump settings every hour?, to treat constipation use fluids/fiber/mobilization Fluoxetine SSRI Used to treat depression Cannot be taken with St. Johns Wart because it can cause serotonin syndrome Treats anxiety & trauma Adverse effects: suicidal ideations, gain weight, impairs sexual functioning For all antidepressants can you start a new one right away? No you have to taper off of it And wait a period before trying a new one What antidepressant has a dietary contraindication? MAOIs Contrainidcation: Tyramine containing foods (Ex: cheddar cheese, wine, beer, aged things) Cyclobenzipine Used to treat muscle spasms Educate patient on safety risks with driving or operating equipment Adverse effect: sedation Hydrocodone Antidote: Naloxone (because it is an opiod) When coming off this drug, withdrawal symptoms can be experienced by the patient Educate patient on safety risks with driving Educate patient to not drink alcohol while taking this medication Benzodiazepine Antidote: Flumazenil Acetaminophen Antidote: Acetylcystine Acetylcystine Mucolytic Used to treat cystic fibrosis Midazolam Is a benzodiazepine Important to monitor LOC Cannot drive on this drug Medication Reconciliation Needs to be done for every single transition of care Haloperidol Can cause Neuroleptic Malignant Syndrome (Extrapyramidal Effects) Looking at uncontrolled movement of tongue & jaw Buproprion Used to treat smoking cessation Can also be used to treat depression Clozapine Class: Atypical Antipsychotic Used to treat schizophrenia Adverse effects: Agranulocytosis Carbidopa/Levodopa Used to treat Parkinson’s Disease Adverse Effects: Orthostatic hypotension, depression, psychosis, discolors urine Fentanyl Used for patients that have chronic pain for pain relief Can be used in patch form (patch can be worn for 3 days, but cannot be disposed of in trash, must be disposed of properly) Can also come in lollipop form for children with cancer (must be stored back inside proper container if not finished with lollipop for later use) Baclofen Muscle Relaxer Can be given via pump for patients with spastic muscles such as those with cerebral palsy Lithium Carbonate Therapeutic range: 0.6-1.2 if greater than 1.5 do NOT give it Meperidine *(Look this one up because could be wrong info written)* If used for a prolonged period of time it can build up in the system and have bad affects Contraindicated for patients with renal disorders What medication can be used for breakthrough pain? Cardiac Drugs: Alpha 1: BIB (Bladder, Iris, Blood Vessels) Doxazosin Used to treat BPH & treat hypertension Adverse effects: Hypotension Educate patient to rise slowly Beta Blockers Contraindications: patients with asthma Adverse effects: bradycardia, decreased energy levels Nitroglycerin Patch Should be taken off for 10 to 12 hours a day Verepamil (Think Very Nice Drugs) Class: Calcium Channel Blocker Adverse effects: edema, decreased heart rate, decreased BP Digoxin Used to increase strength of heart contraction Increased toxicity signs: anorexia, halo vision, ____? Monitor potassium levels if patient is on digoxin & a diuretic that is potassium wasting such as furosemide Enalapril Class: Ace Inhibitor Adverse effects: hypotension What is a potassium sparing diuretic? Spironolactone What is another type of diuretic? Thiazides (have less adverse effects tha other diuretics, not as strong?) What type pf diuretic is used to treat ICP and pressure build up? Mannitol (Osmotic diuretic) Nitroprusside Used to treat hypertensive crisis Adverse effects: cyanide toxicity? Nitroglycerin Stored in a dark container to protect from tongue Tablets are taken sublingually every 5 minutes up to 3 times & call 911 as well Do not store it in a bathroom or in a warm place, must be placed in a cool & dry place Sublingual tablets must fizz when placed under tongue Prior to taking sublingual tablet patient may need a sip of water first Monitor vital signs before during and after dose Patch form is applied every 6 hours, need to make sure old patches are removed before applying new patch Contrainidcated: Viagra & calcium channel blockers? Adverse effects: reflex tachycardia, hypotension Educate patient to rise out of bed slowly Statins Adverse effects: Muscle pain (because this can lead to rhabdomylysis) Gemfibrozil Used to prevent absorption of cholesterol Taken with meals? Niacin Adverse effects: flushing of the face To treat flushing of face or prevent it, ensure patient takes aspirin before taking their niacin Losartan Used to treat hypertension & heart failure Heparin Aptt normal range: 50 to 80 If apt range is too high you administer protamine sulfate If apt too high you up the dosage Antidote: protamine sulfate Note: can also be on warfarin because of therapeutic bridge of effectiveness (takes 3 days to become effective?) Warfarin Antidote: vitamin k INR normal range: 2 to 3 (3.5 for patient with heart valve) PT normal range: Metformin Given orally Need to stop taking it before & after contrast dye studies Adverse effects: lactic acidosis Best to take it in the evening Works on the liver NPH Insulin Only insulin that is cloudy Vial must be rolled Long Acting Insulins Ex; Lantus Do not have any peak or trough Levothyroxine Used to treat low thyroid levels Adverse effects (if taking too high of dose): Tachycardia, restlessness, weight loss L> if taking too high a dose basically causes hyperthyroidism symptoms Steroids Adverse effects: osteoporosis, moon face (cushing’s), buffalo hump back, etc. What do you teach women about birth control pills? Loses effectiveness when taking antibiotics at same time Do not skip a dose If you miss two pills then you restart a new pack Do not smoke Risk for DVTs What are the protective effects of estrogen? Heart, Bones, ? Androgens Adverse effects: facial hair Can help to increase RBCs Can help with muscle building Oxytocin & Pitocin Used to stimulate contractions Contraindication: Cephalopelvic disproportion Monitoring mom & baby HR important Terbutaline Class: Tocolytic Given PO or SubQ Used to promote fetal lung maturity Magnesium Sulfate Used for preterm labor & preeclampsia Adverse effects: decreases muscle tone & movement Antacid Use Long Term can cause what? Pernicious anemia Could also mask underlying disorder such as stomach cancer Misoprostol Used to expel uterine contents (Ex: for abortion) Can also be used for NSAID ulcerations? Can be used for postpartum hemorrhage? Aluminum Hydroxide (Tums) Adverse effects: constipation Magnesium Products (for GI) Adverse effects: diarrhea Metamucil Educate patient to drink a lot of water by taking it because it can expand in esophagus if not flushed down enough Laxatives Educate patient that chronic use is bad Go Lightly Can cause dehydration & electrolyte abnormalities What to teach patient for enteral tube feedings? Check blood glucose around the clock to make sure it’s in range Placement is checked with length of tube, xray, & stomach acid pH How to do peg tube feed? Flush with 15 to 30 mL of water (does not have to be sterile) before and after giving crushed med For TPN how often does tubing have to be changed? Every 24 Hours How should you stop TPN feeding? Taper off of it slowly because if not can cause adverse effects for blood glucose What to do if TPN feeding is not ready yet? Give dextrose 10%? What medication do you use for high residual with peg tube feeding patient? Metoclopramide (increases motility of GI tract) Bronchodilators Adverse effects: jitteriness, tachycardia, Rescue inhaler= Albuterol Steroidal inhaler= Given AFTER rescue inhaler What should you do after using inhaler? Rinse out mouth Fluticasone? Adverse effects: rebound edema?, nasal polyps? What type of medication to use for allergies? Antihistamines Two types of Antihistamines: First Gen & Second Gen First Gen causes drowsiness Second Gen does not cause drowsiness Ambien Causes severe drowsiness & to fall asleep Do NOT drive on this drug Antitussives Only should be used for non-productive cough Allopurinol Used to treat Gout Alendronate Must be taken early in the morning Sit upright after taking it for 30 minutes Adverse effects: Jaw necrosis, brittle bones Has an extremely long half life What hormone affects calcium levels? Parathyroid Hormone (increases calcium levels in blood) Calcitonin (Take tone to the bone so decreases serum calcium?) Vitamin D for absorption Rifampin Adverse effects: turns urine orange Cephelosporin, & Carbapenems & Penicillin antibiotics that do what? Affect the cell wall What specific drug has a contraindication for antibiotics? Warfarin Antiviral Meds= All contain -vir in them Gentamycin Adverse effects: ototoxcity & nephrotoxicity Vancomycin Very powerful drug Nephrotoxic & ototoxic Isotretinoin Used to treat severe acne Requires Ipledge Monthly pregnancy tests because it is a teratogen What to watch for with antibiotics? Superinfection such as oral candidas in mouth or yeast infection How to treat superinfections? With Antifungal medications such as nystatin or another drug that can come in troche form (instruct patient that with troches to not eat or drink anything directly before or after, & allow to fully dissolve in mouth) Fluroquinolones Ex: Ciprofloxacin Adverse effects: Tendon rupture Sulfonamides Allergies with these: Thiazides, Diabetics, Sun sensitivity??? Education for antibiotics should always include? Finishing full course even if you feel better What is a contraindication for a child getting a flu shot? If they have a fever Patient on chemotherapy you should be careful about coming into contact with what? Urine, Saliva, any kind of excretent What is the therapeutic level for phenytoin? 10 to 20 Phenytoin Used to treat seizures Adverse effects: gingival hyperplasia, nystagmus Naloxone Used to treat opiod overdose People that are longterm users of opiods or take them multiple times per day may need a second dose of naloxone? HDL=Good cholesterol LDL=Lousy Cholesterol We want HDL High & LDL Low EKG changes that you may see because of hypokalemia? Prominent U wave Sodium Polystyrone Sulfonate (KayExelate) Causes potassium to exit the body Ergotamine & Sumatriptan Both used for migraines Ergotamine is more prophylactic Sumatriptan is given IM through injection (can be repeated twice) What medication to give patient that is anemic? Erythropoetin
