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ATI Pharmacology Study Guide(Etsy)
Pharmacology (Keiser University)
Studocu is not sponsored or endorsed by any college or university
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Pharmacology Proctored ATI Study Guide
Chapter 1: Pharmacokinetics and Routes of Administration
• Absorption (depends on route)
§ Route of admin affects the rate and amount of absorption
o Oral:
§ GI pH and emptying time
§ Presence of food in the stomach or intestines
§ Form of meds (liquid/XR)
§ Sit upright or put your chin to your chest to aid in swallowing
o Sublingual/buccal
§ Quick absorption systemically through highly vascular mucous
membranes
§ Must make sure it is fully absorbed before you eat or drink
o Inhalation via mouth/nose
§ Rapid absorption through alveolar capillary networks
§ Metered-dose inhaler: shake and press, inhale for 3-5 seconds and
then hold for 10 seconds before exhaling
§ Dry powder: DO NOT SHAKE
o Intradermal, topical
§ Slow, gradual absorption
o SQ/IM
§ Highly soluble meds have rapid absorption (10-30min), poorly
soluble have slower absorption
§ Blood perfusion at site of injection affect absorption
o IV
§ Immediate and complete
§ 20 gauge – standard
• Distribution
o Transportation of meds to sites of action by body fluids
o Plasma binding protein: meds compete for protein binding sites within
bloodstream, primarily albumin. The ability of med to bind to protein can
affect how much med will leave and travel to target tissues.
• Metabolism
o Primarily occurs in the liver but can take place in the kidney
o Factors that influence metabolism:
§ Age (infants/older adults require smaller doses)
§ First pass effect: liver inactivates some meds on first pass through and
thus require sublingual or IV route (may need higher dose)
• Excretion
o Eliminated through the kidneys
o Kidney dysfunction can result in elevated levels of medications.
• Med Response
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o Maintain plasma levels between minimum effective concentration and the
toxic concentration:
Therapeutic index (TI)
o High TI has a wide safety margin.
o Low TI requires monitoring of serum levels; higher risk of toxicity
o Tough levels: obtain immediately before next dose.
Half-life
o Time it takes a medication level to drop in the body by 50%.
o Short vs long half-life: long half-life has greater risk for med accumulation in
body.
Agonist: enhance/produces an action
Antagonist: blocks the action
Routes of admin:
o Oral/Enteral:
§ 90 degrees upright
§ do not mix with large amounts of food
§ lean chin in to help facilitate swallowing
o Sublingual/buccal
§ Keep med in place until completely dissolved
o Transdermal
§ Wash skin with soap and water then dry it thoroughly before placing
patch. Place patch on hairless area and rotate sites to prevent
irritation.
o Drops:
§ Place drop in center of sac.
§ Avoid placing directly on cornea.
§ If blink repeat process.
§ Apply gentle pressure with finger and a clean facial tissue on the
nasolacrimal duct for 30-60 seconds to prevent systemic absorption.
o Ears:
§ Have client lay on unaffected side.
§ Up and out for adults
§ Down and back for children
o Inhalation:
§ MDI
• Shake vigorously 5-6 times
• Take a deep breath and then exhale
• Slow deep breath for 3-5 seconds from MDI
• Hold breath for 10 seconds after
§ DPI
• DO NOT SHAKE DEVICE
• Place mouthpiece between lips and take a deep breath
• Hold breath for 5-10 seconds
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o NG/Gastrostomy tubes
§ To prevent clogging flush tube before and after each med with 1530ml of warm sterile water.
o Suppositories:
§ Left lateral sims position.
§ Remain flat or left lateral for 5 min after insertion.
o Intradermal:
§ Used for allergy testing
§ Used for tb testing
§ Small amount of solution (no more than 0.1ml)
§ 10-15-degree angle bevel up.
o Z-track: for iron
Chapter 2: Safe Med Admin and Error Reduction
• Types of Prescriptions:
o Routine/standard: regularly scheduled meds
o Single/one time: asap or a specific time
o Stat: once and immediately
o PRN: as needed
o Standing: specific circumstances or specific units: ex: heparin protocol
• Taking a phone prescription:
o Have 2nd nurse on line if possible
o Read-back prescription
o Verify and sign within 24 hours
• Med rec:
o Take place at admission, transfer of clients, and discharge.
• RIGHTS OF SAFE MED ADMIN:
o Right client
o Right med
o Right dose
o Right time
o Right route
o Right documentation
o Right client education
o Right to refuse
o Right assessment
o Right evaluation
• Evaluation
o Report all errors and implement corrective measures immediately
§ Complete incident report within time frame the facility specifies
(usually 24 hours) and it should include
• Client id, name and dose of med, time and place of incident,
accurate and objective account of event, who you notified,
what actions you took, your signature.
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Chapter 3: Dosage Calculation
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1kg=1000mg
1oz=30mL
1L=1000mL
Chapter 4: IV Therapy
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Rapid and precise
Circulatory overload is possible if too large or too rapid of an infusion
Admin can irritate vein
Can lead to sepsis if aseptic technique is broken
Distal veins on nondominant hand first
Write date/time, document size/site/appearance
Flush every 8-12 hours when not in use
Avoid tourniquets in older adults
Hold hand below heart
Change every 72 hours
Change tubing every 24 hours
Changes fluids every 24 hours
Wipe all ports with alcohol before using or inserting a syringe
Complications
o Infiltration
§ Findings: pallor, local swelling at site, decreased skin temp around
site, damp dressing
§ Treatment: stop infusion and remove catheter, elevate extremity,
encourage active range of motion, apply a cold or warm compress
depending on type of solution that infiltrated, check with provider to
determine whether the IV is still needed.
o Extravasation
§ Findings: pain, burning, redness, and swelling.
§ Treatment: stop infusion, place antidote before removing catheter if
there is one, notify provider.
o Hematoma
§ Elevate extremity, use warm compress
o Catheter embolus
§ Missing catheter tip after discontinuation. Place tourniquet high on
extremity, surgical removal.
o Phlebitis/thrombophlebitis
§ Red line up the arm with palpable band at vein site
§ Symptoms - edema, throbbing, paining, burning, increased skin temp
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DC infusion and remove catheter, elevate extremity, cold compress
to minimize flow of blood and then warm compress to increase
circulation
o Cellulitis
o Fluid overload
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STOP - Practice Question!
A nurse is caring for a client who is taking tamoxifen (Nolvadex) for treatment of
breast cancer. The nurse should inform the client that which of the side effects can
develop:(Select all that apply)
1) Bradycardia
2) Menstrual irregularities
3) Petechia
4) Hot flashes
5) Vaginal discharge
Ans: 2, 4, & 5
Chapter 6: Individual Considerations of Medication Administration
• Pediatric doses based on weight or body surface area
• Most medications are potentially harmful to the fetus
• Pregnancy is a contraindication for live-virus vaccine
• Pregnant women should get the inactivated flu vaccination
Chapter 7: Anxiety and trauma- and stressor-related disorders
• Benzodiazepines
o Chlordiazepoxide, alprazolam
§ Decrease activity of neurons by enhancing inhibitory effects of GABA
§ Therapeutic use è seizures, muscle spasm, alcohol withdrawal,
induction of anesthesia
§ Complications: CNS depression (sedation, severe resp depression),
amnesia, withdrawal effects (addictive)
§ ADMINISTER FLUMAZEMIL for benzo overdose (reversal)
§ Contraindications: short term use for risk of dependency
§ Nursing admin: keep in a secure place due to dependency risk
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Atypical anxiolytic/ nonbarbiturate anxiolytic
o Buspirone
§ Can take long term
§ Takes 1 week to take effect and 2-6 weeks for full effect
§ Taken on a scheduled basis
§ Therapeutic use è panic disorder, OCD, PTSD
§ Complications: dizziness, nausea, headache
§ Can take with food
SSRIs
o Sertraline, Paroxetine
§ Increases serotonin in system
§ Can take 4 weeks to produce therapeutic medication levels
§ Therapeutic use: insomnia (paroxetine only), OCD, Trauma,
Depressive disorders
§ Complications: sexual dysfunction, weight gain, serotonin syndrome
* agitation, hallucinations, tremors, fever, diaphoresis
§ Nursing admin: can take up to 4 weeks to have therapeutic effects
STOP - Practice Question!
A nurse is caring for an older adult client who is hospitalized. Which of the following
medication is likely to put the client at risk for orthostatic hypotension. (Select all that
apply):
1) Furosemide (Lasix)
2) Telmisartan (Micardis)
3) Phenelzine sulfate (Nardil)
4) Clopidogrel (Plavix)
5) Atorvastatin (Lipitor)
Correct answer: 1, 2, & 3
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Chapter 8: Depressive Disorders (repeat basically)
• SSRIs
o Fluoxetine
§ Increases serotonin in system
§ Can take 4 weeks to produce therapeutic medication levels
§ Therapeutic use è insomnia (paroxetine only), OCD, Trauma,
Depressive disorders
§ Complications: sexual dysfunction, weight gain, serotonin syndrome
(agitation, hallucinations, tremors, fever, diaphoresis), inability to
sleep
§ Nursing admin: can take up to 4 weeks to have therapeutic effects,
taper dose due to possible dependence
• Atypical Antidepressants
o Bupropion
§ Ther use: Depression, aid for smoking cessation
§ Complications: GI distress, insomnia, nausea, vomiting, wt. loss,
seizures
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Other atypical antidepressants
o Trazodone – sedation is a potential problem*
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Tricyclic Antidepressants
o Amitriptyline
§ Therapeutic use: Depression, neuropathic pain, fibromyalgia, anxiety
disorders, insomnia
§ Complications: anticholinergic effects (can’t pee, can’t see, can’t spit,
can’t shit), tachycardia, sedation, decreased seizure threshold,
excessive sweating, orthostatic hypotension, cardiac toxicity
(dysrhythmias, mental confusion, agitation, seizures, coma, death)
§ Nursing admin: chew sugarless gum, wear sunglasses, eat high fiber
foods, increase fluid intake
MAOIs
o Phenelzine
§ Therapeutic use: Depression
§ Complications: CNS stimulations (agitation, anxiety), hypotension,
hypertensive crisis
§ Interactions: most meds, tyramine-rich foods can lead to hypertensive
crisis (aged cheese, salami, avocado, pepperoni, figs, bananas,
smoked fish, protein dietary supplements, soups, soy sauce, red wine,
some beers)
§ Client Education: avoid taking any other medications (script or OTC)
unless approved by the provider, avoid tyramine rich foods, dietary
and med restrictions should be continued for 2 weeks after MAOI has
been discontinued, avoid caffeinated beverages/chocolate/fava
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beans/ginseng, do not use within 10-14 days before or after surgery,
can take 1-3 weeks to begin experiencing effects and full effects can
take 2-3 months, sudden discontinuation can result in relapse,
therapy is usually continued for 6 months to a year after symptoms
have resolved, assess for suicide
STOP – Practice Question!
A nurse is caring for several patients who have bipolar disorder. The nurse should
recognize that which of the following medications are appropriate for treating this
condition (Select all that apply):
1) paraoxetine (Paxil)
2) lithium (Lethane)
3) tranylcypromine (Parnate)
4) valproic acid (Depakote)
5) phenytoin (Dilantin)
6) carbamazepine (tegretol)
Correct answers: 1, 2, 4, & 6
Chapter 9: Bipolar Disorders
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Mood Stabilizer
o Lithium Carbonate
§ Complications: GI distress, fine hand tremors (expected), polyuria,
wt. gain, renal toxicity, electrolyte imbalances, Lithium toxicity
(confusion, COURSE TREMORS, tinnitus, hypotension, coma and
possibly death).
§ Toxic levels >1.5
§ Interactions: Diuretics DO NOT TAKE (decreases amount of sodium
and thus likelihood of toxicity), NSAIDs (will increase renal
absorption and lead to toxicity), anticholinergics
Mood stabilizing antiepileptic drugs
o Carbamazepine, Valproic Acid
§ Complications: blood dyscrasias!* (leukopenia, anemia,
thrombocytopenia- monitor CBC), double vision, nystagmus, hypoosmolality (monitor serum sodium)
§ Complications (valproic acid): GI effects, hepatotoxicity, pancreatitis,
thrombocytopenia
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STOP – Tips!
à
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Herbal supplements that start with a ‘G’ = increase the risk for bleeding
-mab or -nib = immunosuppressants
Patients should never stop a medication abruptly; if they miss a dose, they should
not double up (UNLESS IT IS BIRTH CONTROL)
Complete the entire course of antibiotics; a blood culture must be done PRIOR to
beginning antibiotic therapy
-sone = steroids; weight gain, fluid retention, hyperglycemia, hypokalemia, peptic
ulcer disease
Chapter 10: Psychotic Disorders
• Meds are used to treat positive symptoms
• Know positive vs negative symptoms
• Antipsychotics First generation (conventional)
o Haloperidol/Chlorpromazine (low potency)
§ Complications: Extrapyramidal symptoms (acute dystonia – severe
spasms of tongue, neck, face, or back, parkinsonism, akathisiainability to stand or sit still, Tardive dyskinesia (TD) – involuntary
movements of tongue and face such as lip-smacking). Neuroleptic
Malignant Syndrome – high grade fever, muscle rigidity,
dysrhythmias.
§ Nursing administration: administer anticholinergics, beta-blockers,
and benzos to control EPSs. Advise clients can take 2-4 weeks for
significant improvement.
§ Consider Depot preps which are administer IM once every 3-4 weeks
for people who have trouble maintaining a regimen.
• Antipsychotics: 2nd and 3rd generation (atypical)
o Risperidone/Clozapine
§ Controls positive and negative symptoms.
§ Complications: DM, Wt. gain, Hypercholesterolemia, Orthostatic
hypotension, anticholinergic effects.
§ Nursing admin: administered IM once every 2 weeks (Risperidone)
Chapter 11: Meds for children and adolescents who have mental health issues
• CNS Stimulants
o Methylphenidate/Amphetamine Mixture
§ ADHD/conduct disorder
§ Complications: Insomnia, administer last dose before 4pm, decreased
appetite, wt. loss
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§
Nursing admin: admin during or immediately after meals, monitor
clients weight.
STOP –
A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets
for pain. Which of the following information should the nurse include in the teaching?
A. The medication should be taken 1 hr prior to eating
B. It takes 48 hr for therapeutic effects to occur.
C. Tablets should not be crushed or chewed.
D. Decreased respirations might occur.
Correct answer: D
A nurse in an emergency department is caring for a client who has heroin toxicity. The
client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the
following medications should the nurse plan to administer?
A. Methadone
B. Naloxone
C. Diazepam
D. Bupropion
Correct answer: B
A nurse is reviewing the medication list of a client who wants to begin taking oral
contraceptives. The nurse should identify that which of the following client medications
will interfere with the effectiveness of oral contraceptives?
A. Carbamazepine
B. Sumatriptan
C. Atenolol
D. Glipizide
Correct answer: A
Chapter 12: Substance Use Disorders
• Meds to support withdrawal/abstinence from alcohol.
o Effects of withdrawal usually start within 4-12 hours of last intake of alcohol
and can last 5-7 days: nausea, vomiting, tremors, increased HR/BP/RR,
seizures
o Withdrawal meds:
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Benzos (also used for cocaine toxicity in some cases)
• Chlordiazepoxide/diazepam/lorazepam
o Decrease risk of seizures, maintenance of vital signs
WNL
§ Adjunct meds with benzos
• Clonidine/propranolol/carbamazepine
o Decrease seizures (carbamazepine)
o Decrease HR and BP (propranolol/clonidine)
o Nursing admin: seizure precautions
o Abstinence maintenance
§ Disulfiram
• If the patient does consume alcohol, nasty side effects
including nausea, vomiting, weakness, sweating, palpitations
and hypotension
§ Naltrexone
• Suppresses craving and pleasurable effects of alcohol.
• Suggest monthly IM injections for clients who have trouble
adhering to oral form.
Meds to support withdrawal/abstinence from opioids
o Methadone substitution
§ Dependence will be transferred from illegal to methadone
§ Methadone must be slowly tapered
Meds to support withdrawal/abstinence from nicotine
o Bupropion
§ decreases cravings and withdrawal symptoms.
o Nicotine Replacement therapy
§ Nicotine gum/patch/nasal spray
o Varenicline
§ Reduces cravings for nicotine as well as the severity of withdrawal
symptoms. Notify provider if suicidal thoughts or new onset
depression occur
§
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STOP - Practice Question!
A nurse administers naloxone (Narcan) as prescribed for a client who is 8 hr.
postoperative adverse effects after administration of opioid analgesia. Which of the
following interventions should the nurse plan to take following naloxone administration?
(Select all that apply)
1) Observes the client for bleeding
2) Assess the client for nausea and vomiting
3) Check the client's pain level frequency
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4) Monitor the client for bradycardia
5) Repeat the dose every 15 min until the client responds
Correct answers: 1 & 2
Chapter 13: Chronic Neurologic Disorders
• Cholinesterase Inhibitors
o Neostigmine/Edrophonium
§ Ther use è reversal of nondepolarizing neuromuscular blocking
agents, myasthenia gravis
§ Complications: Cholinergic Crisis (excessive muscarinic stimulation
and resp depression), increased GI motility/secretions, diaphoresis,
increased salivation, bradycardia, and urinary urgency
§ Antidote: Atropine
• Anti-Parkinson’s agents
o Levodopa/carbidopa
§ Ther Use: Parkinson’s
§ Adverse effects: nausea/vomiting/drowsiness, dyskinesias (tics),
orthostatic hypotension, psychosis, discoloration of sweat and urine
(harmless)
§ Education: eat less protein, increase carbs
• Anti-epileptics
o Phenytoin/Carbamazepine/Valproic acid/lamotrigine
§ Phenytoin:
• Adverse effects: nystagmus, sedation, ataxia, double vision,
gingival hyperplasia, skin rash, dysrhythmias, hypotension,
coarsening of facial features, hirsutism, interference with Vit D
metabolism, interference with Vitamin K dependent clotting
factors causing bleeding in newborns
• Education: Can cause decreased effects of oral contraceptive
and monitor therapeutic levels.
§ Carbamazepine
• Complications: Nystagmus, double vision, vertigo, staggering
gait, h/a, cognitive function minimally impaired, leukopenia,
anemia, thrombocytopenia, FVO for pt. with Heart failure
(promotes excretion of ADH), dermatitis, rash, Steven-Johnson
syndrome
Chapter 14: Eye and Ear Disorders
• Types of Glaucoma
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o Primary Open-angle glaucoma (POAG) – most common, peripheral vision
lost gradually
o Angle-closure (narrow-angle) glaucoma – acute disorder resulting in
irreversible blindness – treated with mannitol
Beta-adrenergic blocker
o Timolol
§ Complications: stinging discomfort, systemic effects of beta blockers
on heart and lungs – overdose can increase chances of these effects
§ Nursing admin: instill one drop in the affected eye once or twice
daily, avoid touching applicator and keep lid in place when not in
use, hold gentle pressure to the nasolacrimal duct for 30-60 sec after
application to prevent or minimize systemic effects
Carbonic anhydrase inhibitor (systemic)
o Acetazolamide
§ Complications: GI side effects (give with food), electrolyte depletion
(sodium and potassium), generalized flu-like symptoms
Otitis Externa: treated by topical antimicrobial/anti-inflammatory combination
Fluoroquinolone antibiotic plus steroid medication
o Ciprofloxacin plus hydrocortisone otic drops
§ Nursing admin: warm by gently rolling the container between hands,
gently shake medication, keep client in side-lying position for 5
minutes after instillations, place a piece of cotton in ear and remove
after 5 min, dry ear canal after bathing or swimming using a towel
and tilting head to promote drainage
Chapter 15: Miscellaneous CNS meds
• Neuromuscular blocking agents
o Succinylcholine(depolarizing)/Pancuronium(nondepolarizing)
§ Pharm action: block acetylcholine at the neuromuscular junction
§ Complications: Resp arrest, Malignant hyperthermia – muscle
rigidity accompanied by increased temp as high as 109.4
§ Nursing admin: for malignant hyperthermia – O2 at 100%, cooling
measures including iced 0.9%NaCl, admin dantrolene to decrease
metabolic activity of skeletal muscle
• Muscle relaxant and antispasmodics
o Dantrolene/Baclofen
§ Purpose:
• Baclofen: produce sedative effects, and depress hyperactive
spasticity of muscles
o Ther use: Cerebral Palsy, spinal cord injury, and MS
• Dantrolene: inhibits muscle contraction by preventing release
of calcium in skeletal muscles
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o Ther use: Cerebral palsy, spinal cord injury, MS, tx of
malignant hyperthermia
§ Complications:
• Baclofen: nausea, constipation – increase high fiber foods
• Dantrolene: hepatotoxicity, muscle weakness
Muscarinic agonists
o Bethanechol
§ Pharm action: stimulation of the muscarine receptors of the GU tract
§ Ther use: nonobstructive urinary retention, usually postop or
postpartum
§ Complications: sweating, urinary urgency, bradycardia, hypotension
§ Nursing admin: admin PO 1hr before or 2hr after meal to minimize
nausea/vomiting
Muscarinic antagonist
o Oxybutynin
§ Pharm action: inhibit muscarinic receptors of the detrusor muscle of
the bladder
§ Ther use: Overactive bladder
§ Complications: Anticholinergic effects – instruct clients to drink 2-3
L/day
STOP –
A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The
client's BP is 144/86 mm Hg, heart rate 55/min, and respiratory rate is 20/min. The nurse
should withhold the medication and contact the provider for which of the following
findings?
A. Diastolic BP
B. Systolic BP
C. Heart Rate
D. Respiratory Rate
Correct answer: C
A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for
depression. Which of the following findings should the nurse identify as an adverse effect
of the medication?
A. Tingling toes
B. Sexual dysfunction
C. Absence of dreams
D. Pica
Correct answer: B
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A nurse is teaching a client about warfarin. The client asks if they can take aspirin while
taking the warfarin. Which of the following responses should the nurse make?
A. "It is safe to take an enteric coated aspirin."
B. "Aspirin will increase the risk of bleeding."
C. "Acetaminophen may be substituted for aspirin."
D "The INR lab work must be monitored more frequently if aspirin is taken."
Correct answer: B
Chapter 16: Sedative-Hypnotics
• Nonbenzos
o Zolpidem
§ Pharm action: prolonged sleep durations and decreased awakenings
§ Ther Use: insomnia
§ Complications: daytime sleepiness, lightheadedness
§ Educations: must have time for at least 8 hours of sleep
• Intravenous anesthetics
o Barbiturates (pentobarbital), Benzos (midazolam), other meds (Propofol)
§ Pharm action: loss of consciousness and elimination of response to
painful stimuli
§ Complications
• Propofol: use within 6 hours, monitor for signs of infection
§ Nursing admin: monitor for resp arrest or hypotension, inject
Propofol into large vein to decrease pain at injection site
Chapter 17: Airflow Disorders
• Beta-adrenergic agonists (Albuterol - Short acting, prevention of asthma
episode/Salmeterol -Long acting, long term control of asthma)
§ Complications (for both): tachycardia, angina, tremors
§ Nursing admin: If has a script for both beta-adrenergic agonist and
steroid inhale beta-adrenergic agonist FIRST. Beta-adrenergic agonist
promotes bronchodilation and enhances absorption of the steroid.
Ensure the clients know the dosage schedule if the med is to be taken
on a fixed schedule or a PRN basis.
• Methylxanthines
o Theophylline
§ Complications: GI distress, dysrhythmias, and seizures
§ Nursing admin: monitor serum levels
• Inhaled anticholinergics
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•
o Ipratropium
§ Ther use: COPD, Allergen-induced and exercise-induced
bronchospasm
§ Complications: dry mouth, hoarseness
§ Nursing admin: rinse mouth after inhalation to decrease unpleasant
taste, usually adult dose is 2 puffs, wait length prescribed amount of
time between puffs, wait 5 min between medications.
Glucocorticoids
o Beclomethasone (inhalation)
§ Purpose: prevent inflammation, long-term prophylaxis of asthma
§ Complications: hoarseness, candidiasis – advise client to rinse mouth
or gargle with water after use, monitor for redness, sores, or white
patches and report to provider if they occur. Treat candidiasis with
nystatin oral suspension.
o Prednisone (oral)
§ Complications: suppression of adrenal gland function (taper dose),
bone loss – perform wt. bearing exercises/consume efficient calcium
and vit D, hyperglycemia – DM patients monitor BG/ may need to
increase insulin dosage, myopathy – muscle weakness, peptic ulcer
disease, infection, hypokalemia
o IF CLIENT IS ON LONG-TERM ORAL THERAPY, ADDITIONAL DOSES OF
ORAL STEROIDS ARE REQUIRED IN TIEMS OF STRESS, INFECTION, OR
TRAUMA
Leukotriene Modifiers
o Montelukast/Zafirlukast
§ Ther use: long-term therapy of asthma in adults and children, and to
prevent exercise induced bronchospasm
§ Complications: depression, suicidal ideation,
§ Nursing admin: take once daily at bedtime, take 2 hr before exercise.
STOP – Practice Question!
A nurse is instructing a client who has asthma. The client is currently taking albuterol
(Proventil) every 4 hours PRM for bronchial spasms. He is to start a new prescription for
montelukast (Singulair). Which of the following instructions should the nurse include:
(Select all that apply)
1) Use montelukast to relieve an asthma attack
2) Do not take montelukast with food
3) Administer montelukast 30 min before sports activities
4) Report any increased need to use albuterol
5) Take montelukast once a day in the evening
Correct answer: 4 & 5
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A nurse is assessing a client who is postoperative following an outpatient endoscopy
procedure using midazolam. The nurse should monitor for which of the following findings
as an indication that the client is ready for discharge?
A. The client's capnography has returned to baseline
B. The client can respond to their name when called.
C. The client is passing flatus.
D. The client is requesting oral intake
Correct answer: A
Chapter 18: Upper Respiratory Disorders
• Antitussives: Opioids
o Codeine
§ Ther use: nonproductive cough to decrease frequency and intensity
§ Complications: dizziness, lightheadedness (change positions slowly),
drowsiness, resp depression, nausea, vomiting, constipation, opioid
use disorder (advise of potential for abuse)
• Expectorants
o Guaifenesin
§ Ther use: Thin mucous secretions
§ Complications: GI distress, drowsiness, allergic reaction (rash)
§ Nursing admin: increase fluid intake when taking guaifenesin, in
order to promote liquifying secretions
• Mucolytics
o Acetylcysteine
§ Ther use: chronic pulmonary disorders exacerbated by large amounts
of secretions. CYSTIC FIBROSIS
§ Acetylcysteine is the antidote for acetaminophen poisoning
§ Complications: bronchospasm (use cautiously with asthma), nausea,
vomiting, rash
§ Nursing admin: smells like rotten eggs
• Decongestants
o Phenylephrine/Pseudoephedrine
§ Ther use: rhinitis, decongestant for clients with sinusitis or common
cold
§ Complications: rebound congestion, agitation, nervousness,
palpitations
• Antihistamines
o Diphenhydramine/Loratadine
§ Ther use: mild allergic reactions, motion sickness
§ Complications: sedation, anticholinergic effects
• Nasal Glucocorticoids
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o Mometasone
§ Pharm action: decrease inflammation associated with allergic rhinitis
§ Ther use: Rhinitis
§ Complications: sore throat, h/a, burning in the nose
STOP –
A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for
acetylcysteine. Which of the following information should the nurse include in the
instructions?
a.
“Expect this medication to suppress your child’s cough.”
b.
“Expect this medication to smell like rotten eggs.”
c.
“Expect this medication to cause euphoria.”
d.
“Expect this medication to turn your child’s urine orange.”
Correct answer: B
A nurse is teaching a client who has a new prescription for diphenhydramine for allergic
rhinitis. The nurse should instruct the client to monitor for which of the following
manifestations as an adverse effect of this medication? (Select all that apply.)
a.
Dry mouth
b.
Nonproductive cough
c.
Skin rash
d.
Drowsiness
e.
Urinary hesitation
correct answer: A, D, & E
Chapter 19: Medications affecting urinary output
• High-ceiling Loop Diuretics
o Furosemide
§ Pharm action: Block reabsorption of sodium and chloride and
prevents reabsorption of water
§ Ther use: pulmonary edema, hypertension
§ Complications: dehydration, hyponatremia, hypochloremia,
hypotension, ototoxicity, hypokalemia, hyperglycemia
§ Monitor: electrolyte levels, know therapeutic levels of sodium and
potassium, BG, uric acid, calcium, magnesium, lipid levels
§ Nursing admin: monitor BP and I&Os, usually dosing is 8am and
2pm, infuse IV at 20mg/min, monitor ECG, encourage clients to
consume foods high in potassium
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•
•
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Thiazide Diuretics
o Hydrochlorothiazide
§ Pharm action: blocks reabsorption of sodium and chloride, and
prevents reabsorption of water
§ Ther use: hypertension, heart failure, liver and kidney disease
§ Complications: dehydration, hypokalemia, hyperglycemia
§ Nursing admin: monitor electrolytes, take first thing in am, consume
foods high in potassium and maintain adequate fluid intake, weigh
clients same time each day, monitor BP and I&Os, If potassium level
drops below 3.5, monitor ECG and contact provide (may require
potassium supplement)
Potassium sparing diuretics
o Spironolactone
§ Pharm action: retains potassium and excretes sodium and water
§ Ther use: hypertension, heart failure
§ Complications: Hyperkalemia, impotence, gynecomastia,
irregularities of menstrual cycle
§ Contraindications: do not admin to clients with severe kidney failure
§ Nursing admin: monitor potassium levels, avoid salt substitutes that
contain potassium
Osmotic Diuretics
o Mannitol
§ Pharm action/ther use: reduce ICP and Intraocular pressure (IOP)
§ Complications: Heart failure, pulmonary edema, rebound increased
ICP, fluid and electrolyte imbalances
§ Nursing admin: to prevent administering microscopic crystals – use a
filter needles when drawing from vial and a filter on the IV tubing,
weight daily, I&Os, serum electrolytes (especially Potassium levels)
STOP –
A nurse is monitoring a client who is receiving spironolactone. Which of the following
findings should the nurse report to the provider?
a.
Blood sodium 144 mEq/L
b.
Urine output 120 mL in 4 hr
c.
Blood potassium 5.2 mEq/L
d.
Blood pressure 140/90 mmHg
Correct answer: C
A nurse is caring for a client who has increased intracranial pressure and is receiving
mannitol. Which of the following findings should the nurse report to the provider?
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a.
b.
c.
d.
Blood glucose 150 mg/dL
Urine output 40 mL/hr
Dyspnea
Bilateral equal pupil size
correct answer: C
A nurse is planning care for a client who has a new prescription for torsemide. The nurse
should plan to monitor for which of the following conditions as potential adverse
reactions of this medication? (Select all that apply.)
a.
Respiratory acidosis
b.
Hypokalemia
c.
Hypotension
d.
Ototoxicity
e.
Ventricular dysrhythmias
correct answer: B, C, D, & E
Chapter 20: Medications Affecting Blood Pressure
• ACE-inhibitors
o Captopril/Lisinopril
§ Pharm action: blocking the conversion of angiotensin I to angiotensin
II
§ Ther use: HTN, heart failure, MI, diabetic/nondiabetic nephropathy
§ Complications: hypotension, cough, hyperkalemia, rash, angioedema
(ACE- Angioedema, Cough, Elevated potassium)
•
•
•
Angiotensin II Receptor Blockers (ARBs)
o Losartan/Valsartan
§ Pharm action: vasodilation
§ Ther use: HTN, heart failure, diabetic nephropathy, protect against
MI
§ Complications: angioedema, hypotension, GI upset
Aldosterone antagonists
o Spironolactone
§ Pharm action: Blocks aldosterone receptors
Calcium Channel Blockers
o Nifedipine/Verapamil/Diltiazem
§ Nifedipine pharm action: vasodilation of smooth muscle and
arteries/arterioles of the heart
§ Ther use: angina pectoris, HTN
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Nifedipine Complications: hypotension, peripheral edema,
constipation (also verapamil), dysrhythmias
§ Verapamil/Diltiazem Interactions: grapefruit juice (avoid)
§ Nursing admin: monitor BP and HR
Centrally Acting Alpha2 Agonists
o Clonidine
§ Pharm action: results in decreased cardiac output which leads to
decreased BP
§ Ther use: HTN
§ Complications: drowsiness, dry mouth
Beta adrenergic blockers
o Metoprolol/atenolol/Carvedilol/Labetalol/Propranolol
§ Ther use: HTN, Angina, heart failure, MI
§ Complications: Bradycardia (monitor pulse), decreased cardiac
output, hypotension, fatigue, erectile dysfunction, for propranolol –
bronchoconstriction
Medications for Hypertensive Crisis
o Nitroprusside
§ Pharm action: rapid reduction of BP through direct vasodilation of
arteries and veins
§ Ther use: Hypertensive crisis
§ Complications: hypotension, cyanide poisoning/thiocyanate toxicity
– risk of cyanide poisoning is reduced by administering med for no
longer than 3 days and at a rate of 5mg/kg/min or less (avoid
prolonged use)
§ Nursing admin: prepare med by adding diluent for IV infusion, note
color of solution – if any other color than light brown discard, protect
IV container and tubing from light, discard med after 24 hours, start
at a low dose and go up every few minutes
§
•
•
•
Chapter 21: Cardiac Glycosides and Heart Failure
• Cardiac glycosides
o Digoxin
§ Pharm action: increased force of myocardial contraction, decreased
HR
§ Ther use: heart failure, dysrhythmias (A Fib)
§ Complications: Dysrhythmias, bradycardia, GI Effects – anorexia,
nausea, vomiting, abdominal pain, fatigue, weakness, vision changes,
diplopia, blurred vision, yellow-green or white halos around objects
§ Nursing admin: check pulse and rhythm before admin of digoxin and
record (notify if less than 60 bpm), monitor digoxin levels during
treatment (keep levels between 0.5ng/mL and 0.8ng/mL to prevent
toxicity), instruct clients to observe for signs of hypokalemia (muscle
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weakness), monitor for signs of digoxin toxicity (fatigue, weakness,
vision changes, GI effects)
§ Mgmt. of Digoxin Toxicity: stop digoxin and potassium sparing meds
immediately, monitor potassium levels (supplement if lower than
3.5), treat dysrhythmias with phenytoin or lidocaine, treat
bradycardia with atropine, activated charcoal/cholestyramine/digoxin
immune Fab (any can be used for excessive over dose) they bind with
digoxin and prevent absorption
Adrenergic Agonists
o Epinephrine/Dopamine/Dobutamine
§ Epinephrine
• pharm action: increased HR/Cardiac output
• Ther use: cardiac arrest
• Complications: Hypertensive crisis, dysrhythmias
§ Dopamine
• Ther use: shock, heart failure
• Pharm action (high dose): renal blood vessel dilation,
increased HR, increased myocardial contractility
• Complications: chest pain, dysrhythmias
§ Dobutamine
• Pharm action: increased myocardial contractility and cardiac
output
• Ther use: heart failure
STOP –
A nurse is reviewing laboratory results for a client who is receiving heparin via continuous
IV infusion for DVT. The nurse should discontinue the medication infusion for which of
the following client findings?
A. Potassium 5.0
B. aPTT 2x the control
C. Hemoglobin 15
D. Platelets 96,000
Correct answer: D
A nurse is reviewing the medication administration record of a client who has
hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify
that which of the following medications can interact with calcium gluconate?
A. Felodipine
B. Guaifenesin
C. Digoxin
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D. Regular insulin
Correct answer: C
A Nurse administers a dose of metformin to a client instead of the prescribed dose of
metoclopramide. Which of the following actions should the nurse take first?
A. Report the incident to the charge nurse
B. Notify the provider
C. Check the client's blood glucose
D. Fill out an incident report
Correct answer: C
Chapter 22: Angina
• Organic Nitrates
o Nitroglycerin (NTG)
§ Ther use: acute angina attack
§ Complications: h/a, orthostatic hypotension, reflex tachycardia
§ Nursing admin:
• Sublingual tablet/translingual spray
o Treat acute angina attack
o Prophylaxis of acute attack
o Use the rapid acting nitrate at first sign of chest pain
DO NOT WAIT UNTIL PAIN IS SEVERE
o Take no more than 3 times but each time is 5 minutes
apart if pain is persistent
o Use prior to an activity that is known to cause chest
pain
o Place tablet under tongue and allow it to dissolve,
store tablets in original bottles and in a cool/dark
place.
o Spray translingual spray against oral mucosa and do
not inhale
Chapter 23: Medications Affecting Cardiac Rhythm
• Antidysrhythmic Medications
o Class I Meds: sodium channel blockers slow cardiac conduction velocity
§ Class IA: Procainamide
• Pharm action: slow impulse conductions in the atria,
ventricles, and His-Purkinje system
• Ther use: Supraventricular tachycardia (SVT), atrial flutter, A
fib
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Class IB: Lidocaine (V Fib)
• Ther use: short term use only for ventricular dysrhythmias
• Complications: drowsiness, altered mental status, paresthesias,
seizures (administer phenytoin to control seizure activity),
respiratory arrest (had resuscitation equipment at bedside)
• Nursing admin: IV admin starts with a loading dose which is
wt. based followed by maintenance dose of 1-4mg/min, adjust
rate according to cardiac response, usually used for no more
than 24 hours, never administer lidocaine prep that contains
epinephrine – severe HTN or dysrhythmias can occur
o Class II Meds: Beta blockers prevent sympathetic nervous system stimulation
of the heart
§ Propranolol
• Ther use: A Fib, A flutter, paroxysmal SVT, HTN, angina
• Complications: hypotension, bradycardia, fatigue,
bronchospasm in pt. with asthma
o Class III Meds: Potassium channel blockers prolong the action potential and
refractory period of the cardiac cycle
§ Amiodarone
• Ther use: A Fib, recurrent ventricular fibrillation, recurrent
ventricular tachycardia
• Complications: pulmonary toxicity, sinus bradycardia, liver
and thyroid dysfunction, GI disturbances
o Class IV Meds: Calcium Channel blockers prolongs cardiac conduction,
depresses depolarization and decreases oxygen demand of the heart
§ Verapamil/Diltiazem
• Complications: bradycardia, hypotension, heart failure
§
Chapter 24: Antilipemic Agents
• HMG-CoA reductase inhibitors (statins)
o Atorvastatin/Simvastatin
§ Ther use: primary hypercholesterolemia, protection against MI,
increasing levels of HDL
§ Complications: Hepatotoxicity, muscle aches/pains (myopathy),
rhabdomyolysis
§ Nursing admin: admin lovastatin with evening meal, most cholesterol
is synthesized during the night, monitor liver and kidney function
• Cholesterol absorption inhibitors
o Ezetimibe
§ Pharm action: inhibits absorption of cholesterol secreted in the bile
and from food
§ Complications: hepatitis, myopathy (obtain baseline and monitor CK
levels)
§ Nursing admin: liver and kidney function tests
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•
•
Nicotinic acid
o Niacin
§ Pharm action: decrease LDL cholesterol and triglyceride levels
§ Complications: GI distress, facial flushing, hyperglycemia,
hepatotoxicity
Fibrates
o Gemfibrozil
§ Pharm action: decrease triglyceride levels, increase HDL
§ Complications: GI distress, gallstones, muscle tenderness/pain
(myopathy), hepatotoxicity
Chapter 25: Medications Affecting Coagulation
• Parenteral Anticoagulants
o Heparin/Enoxaparin
§ Heparin
• Therapeutic Use: evolving stroke, PE, Massive DVT
• Complications: Hemorrhage (monitor aPTT and keep value at
1.5-2 times the baseline), heparin induced thrombocytopenia
(low platelets and increased thrombi), allergic reactions,
• Nursing admin: monitor aPTT q4-6hr until appropriate dose
has been determined, then monitor daily, monitor for
bleeding, use an electric razor for shaving and a soft bristled
toothbrush
• Nursing effectiveness: aPTT levels of 60-80 seconds
§ Enoxaparin
• Monitor platelets, discontinue meds for platelet count less
than 100,000/mm3
• Oral Anticoagulant
o Warfarin
§ Pharm action: antagonize Vitamin K
§ Ther use: Treatment of Venous thrombosis, Tx of A Fib, Prevention of
PE/DVT
§ Complications: Hemorrhage, hepatitis
§ Nursing admin: monitor PT levels (18-24 seconds therapeutic) and
INR levels (2-3 therapeutic)
§ Full effects not achieved for 3-5 days – use a continued heparin
infusion when starting oral warfarin, Vitamin K for warfarin overdose,
soft bristled toothbrush
§ Nursing Effectiveness: PT- 1.5 to 2 times control, INR 2-3 for
treatment of DVT/PE/MI/A Fib/tissue heart valves, INR 3-4.5 for
mechanical heart valve or recurrent systemic embolism
• Direct Thrombin Inhibitors
o Argatroban
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Ther use: To prevent or treat thrombosis in clients who cannot take
heparin due to heparin-induced thrombocytopenia
Direct Inhibitor of Factor Xa
o Rivaroxaban
§ Pharm action: selectively and directly by inhibiting factor Xa
§ Ther use: A fib, prevention of DVT and PE
§ Complications: Bleeding (monitor H&H), elevated liver enzymes and
bilirubin (monitor liver function)
Antiplatelets
o Antiplatelet/salicylic
§ Aspirin
• Pharm action: inhibit platelet aggregation
• Ther use: primary prevention of MI, prevent ischemic stroke
• Complications: hemorrhagic stroke, tinnitus, hearing loss
• Contraindications: Do not give to children or adolescents who
have fever or recent chickenpox
o Antiplatelet/ADP inhibitors
§ Clopidogrel
• Pharm action: inhibit platelet aggregation
• Ther use: primary prevention of MI, prevent ischemic stroke
• Complications: Bleeding, diarrhea, dyspepsia, pain
Thrombolytic Medications
o Alteplase (tPA)/Retaplase
§ Ther use: Tx acute MI/massive PE/ischemic stroke, restore potency to
central IV catheters (tPA only)
§ Complications: bleeding
§ Contraindications: hemorrhagic stroke, active internal bleeding,
severe HTN
§ Nursing admin: best if used within 3 hours of onset, monitor
H&H/CBC/aPTT/INR/PT /fibrinogen levels, limit venipunctures and
hold pressure for up to 30 minutes on injection sites until oozing
stops.
§
•
•
•
Chapter 26: Growth Factors
• Erythropoietic Growth Factors
o Epoetin Alfa
§ Pharm action: increased production of RBCs
§ Ther use: Anemia related to CKD/chem/HIV/AIDS
§ Complications: HTN, risk of thrombotic event, DVT
§ Nursing admin: monitor BP, do not agitate vial of medication,
monitor iron levels and implement measures to ensure they are in the
expected reference range, monitor H&H twice a week until target
range reached
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Nursing effectiveness: effectiveness can be evidenced by Hgb level of
10-11g/dL and max Hct of 33%
Leukopoietic Growth Factor
o Filgrastim
§ Pharm action: stimulates bone marrow to increase production of
neutrophils
§ Ther use: decreases risk of infection for pt. with neutropenia, cancer,
and other conditions
§ Complications: bone pain, leukocytosis, splenomegaly/risk of splenic
rupture
§ Nursing admin: do not agitate vial of medication, monitor CBC two
times a week
§ Nursing effectiveness: absence of infection, WBC and differential in
the expected reference range.
§
•
•
•
Granulocyte-macrophage colony-stimulating factor
o Sargramostim
§ Nursing effectiveness: absence of infection, WBC and differential in
the expected reference range.
Thrombopoietic Growth Factors
o Oprelvekin
§ Platelet count greater than 50,000
Chapter 27: Blood and Blood Products
• Whole Blood
o Pharm action: increases circulating blood volume
o Ther use: acute blood loss, volume expansion in dehydration/shock
• Packed RBCs (PRBCs)
o Ther use: anemia (Hgb 6-10g/dL)
• Platelet concentrate
o Ther use: Platelets indicated in thrombocytopenia
• Fresh Frozen Plasma (FFP)
o Ther use: replacement therapy for coagulation factors II, V, VII, IX, X, XI
• Complications with blood products:
o Acute hemolytic reaction
§ Chills, fever, low back pain, tachycardia, tachypnea, hypotension
§ Ensure client identity (using two nurses) and that Rh and ABO types
are compatible
§ Stop infusion immediately, keeping IV line open with 0.9% sodium
chloride and new IV tubing
o Febrile nonhemolytic reaction, fever, headache
§ Febrile – most common (sudden chills), increase in temperature
greater than 1 degree from baseline
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§ Administer acetaminophen for fever
o Anaphylactic reactions
o Mild allergic reactions (flushing, itching, urticaria)
§ If occur – stop infusion immediately keeping IV line open with
0.9%NaCl
§ If occur – if mild and no resp. compromise, antihistamines can be
prescribed, and transfusion slowly restarted
o Circulatory Overload
§ Cough, SOB, crackles, HTN, tachycardia, distended neck vein
§ If possible, wait two hours between units of blood when multiple
units prescribed
§ If occurs – stop transfusion place client in a sitting position with legs
down
Nursing admin for blood products
o Obtain baseline lab values: H&H, platelet, TP, albumin levels, PT, PTT,
fibrinogen, K, pH, serum Ca
o Ensure client has signed consent for transfusion. Assess for risk of fluid
overload. A diuretic may be prescribed between units
o Obtain baseline VS – monitor VS for 15-30 minutes then hourly
o Use a 20g or larger bore IV catheter
o USE ONLY 0.9% NaCl to admin with blood products
o Need 2 RNs
o Document: blood product, blood type, total volume infused, time of start
and completion of transfusion, VS, and any adverse effects as well as actions
taken
o COMPLETE TRANSFUSION TIMES:
§ Whole Blood/PRBCs: infuse within 2-4 hours
§ PLT concentrate: Infuse within 15-30 minutes/unit
§ FFP: infuse over 30-60 min/unit
o IF REACTION IS NOTED:
§ Stop transfusion
§ Administer 0.9% NaCl through new tubing
§ Notify blood bank, recheck ID tag, check numbers on ID tag, send
blood bag and IV tubing for analysis
§ Obtain a urine specimen and send to lab to determine RBC
hemolysis
Chapter 28: Peptic Ulcer Disease
• Antibiotics
o Amoxicillin/Clarithromycin/Metronidazole
§ Pharm action: eradication of H. pylori bacteria
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Ther use: therapy should include a combination of two or three
antibiotics for 14 days to increase effectiveness and to minimize, the
development of medication resistance.
§ Nursing admin: advise client to take amoxicillin, clarithromycin, and
metro with food to decrease gastric disturbances. Remind clients to
take the full course of prescribed meds.
Histamine2- receptor antagonists
o Ranitidine/Famotidine/Cimetidine
§ Pharm action: reduces the volume of gastric acid and lowers the
concentration of hydrogen ions in the stomach
§ Ther use: gastric and duodenal ulcers, GERD, hypersecretory
conditions (Zollinger-Ellison syndrome)
§ Contraindications: H2 receptor antagonists decrease gastric acidity,
which promotes bacterial colonization of the stomach and respiratory
tract. Use cautiously in clients who are at a high risk for pneumonia,
including clients who have COPD
§ Nursing admin: advise clients to eat meals on a regular schedule in a
relaxed setting and do not overeat, avoid foods that promote gastric
acid secretion, such as caffeine beverages and decaffeinated and
caffeinated coffee, reduction of stress can promote healing, avoid
smoking (which can delay healing), avoid aspirin and other NSAIDs,
adhere to medication regimen and provide support, Ranitidine can
be taken with or without food, Tx starts with PO dose BID and after
healed switch to SID (daily) at qhs (bedtime)
Proton pump inhibitors
o Omeprazole/Pantoprazole
§ Pharm action: inhibiting the enzyme that produces gastric acid
§ Ther use: gastric and duodenal ulcers, erosive esophagitis, GERD,
and hypersecretory disorders
§ Complications: diarrhea, nausea, vomiting; long-term: osteoporosis
and fractures
§ Nursing admin: do not open capsule and sprinkle contents over food
to facilitate swallowing, clients should take omeprazole once per day
prior to eating in the morning, treated for 4-6 wks.
Mucosal Protectants
o Sucralfate
§ Pharm action: adheres to ulcer and protects is from acid and pepsin
§ Complications: constipation
§ Nursing admin: 4 times daily, 1 hr before meals and at bedtime
Antacids
o Aluminum hydroxide/Magnesium Hydroxide/Calcium Carbonate
§ Pharm action: antacids neutralize gastric acid by producing neutral
salts and inactivating pepsin
§ Ther Use: Peptic ulcer disease, GERD
§
•
•
•
•
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Complications: Magnesium hydroxide (diarrhea), the other two cause
constipation
§ Nursing admin: chew tablets thoroughly and then drink 8 oz of
water/milk, shake liquid formulation, med can be administered seven
times a day 1 hr before and 3 hr after meals and again at bedtime,
encourage compliance by reinforcing the intended effects of antacids
(relief of pain/healing of ulcer)
Prostaglandin E analog
o Misoprostol
§ Pharm action: decreases acid secretion, increases secretion of
bicarbonate and protective mucous
§ Ther use: long term NSAIDs to prevent gastric ulcers, induce labor by
causing cervical ripening
§ Complications: diarrhea, dysmenorrhea, miscarriage
§ Nursing admin: take with meals and at bedtime
§
•
Chapter 29: Gastrointestinal Disorders
• Antiemetics
o Serotonin antagonists: Ondansetron
§ Pharm action: blocking the serotonin receptors in the chemoreceptor
trigger zone (CTZ)
§ Ther use: prevents emesis related to chemo, radiation, and postop
recovery
§ Complications: H/a, diarrhea, dizziness
§ Nursing admin: admin med before chemo to treat nausea BEFORE It
occurs.
• Laxatives
o Contraindications: fecal impaction, bowel obstruction, acute surgical
abdomen to prevent perforation
o Nursing admin: increases amount of fluids, maintain regular exercise
o Psyllium
§ Bulk-forming laxative
§ Pharm action: soften fecal mass and increase bulk
o Docusate sodium
§ Surfactant laxative
§ Pharm action: lower surface tension of the stool to allow penetration
of water
o Bisacodyl
§ Stimulant laxative
§ Pharm action: Stimulation of the intestinal peristalsis
o Magnesium hydroxide
§ Osmotic laxative
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Pharm action: Draw water into intestine to increase the mass of stool,
stretching musculature, which results in peristalsis
§ Complications: toxic magnesium levels, dehydration
o Lactulose
§ Complications: Hepatic encephalopathy, GI upset, hyperglycemia,
used to decrease ammonia levels to increase LOC
Antidiarrheals
o Diphenoxylate plus atropine/Loperamide
§ Pharm action: activate opioid receptors to decrease intestinal motility
and to increase the absorption of fluid and sodium in the intestine
§ Complications: constipation, typical opioid effects
Prokinetic agents
o Metoclopramide
§ Blocking dopamine and serotonin receptors in the CTZ
§ Ther use: nausea, vomiting, GERD
§ Complications: EPSs (restlessness)
Meds for IBS with diarrhea (IBS-D)
o Alosetron
§ Pharm action: blockade of 5-HT3 receptors
§ Complications: constipation
Meds for IBS with constipation (IBS-C)
o Lubiprostone
§ Pharm action: increases fluid secretion in the intestine to promote
intestinal motility
§ Complications: diarrhea, nausea
5-Aminosalicytes
o Sulfasalazine
§ Pharm action: decreases inflammation by inhibiting prostaglandin
synthesis
§ Ther use: IBS, Crohn’s, Ulcerative colitis
§ Complications: blood disorders (agranulocytosis, anemia), nausea,
cramps, rash, arthralgia
§
•
•
•
•
•
Chapter 30: Vitamins, Minerals and Supplements
• Iron Preparation
o Ferrous Sulfate/Iron dextran
§ Ther use: iron-deficiency anemia
§ Complications: GI distress, Teeth staining (liquid form – drink with a
straw), staining of skin and other tissues (IM), hypotension
§ Nursing admin: take on an empty stomach 1 hr before meals
(stomach acid increases absorption), if GI effects occur than take with
food, space doses equally apart, dilute liquid iron with water or juice
and drink with straw, rinse mouth after swallowing, increase
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•
•
•
•
•
•
•
•
•
•
•
•
•
water/fiber/Vitamin C intake, maintain exercise regimen, therapy can
last 1-2 months, increase foods high in iron, keep out of reach of
children.
Vitamin B12/Cyanocobalamin
o Vitamin B12
§ Pharm action: all cells rely on folic acid for DNA production, loss of
intrinsic factor within the cells of the stomach causes an inability to
absorb Vitamin B12
§ Nursing admin: Monitor for B12 deficiency (beefy rad tongue, pallor,
neuropathy), clients may need lifelong treatment usually parenterally
Folic Acid
o Folic Acid
§ Ther use: megaloblastic anemia, prevention of neural tube defects,
supplement of alcohol use disorder
Potassium Supplements
o Potassium Chloride
§ Ther use: hypokalemia, for clients using diuretics (ex: furosemide)
§ Complications: Hyperkalemia
§ Nursing admin: Never admin IV bolus (can be fatal), infuse slowly
Magnesium sulfate
o Mag sulfate/Mag hydroxide/Mag Oxide/Mag Citrate
§ Ther use: IV mag sulfate is used to stop preterm labor and an
anticonvulsant during labor and delivery
§ Complications: muscle weakness, flaccid paralysis, resp depression,
§ Nursing admin: have IV calcium available for reversal
Black cohosh
o Acts as an estrogen substitute, treats manifestations of menopause
Echinacea
o Stimulates the immune system
Garlic
o Can increase risk of bleeding
Ginger Root
o Suppresses platelet aggregation
Ginkgo biloba
o Decreases platelet aggregation, can decrease risk of thrombosis
Glucosamine
o Stimulates cells to make cartilage and synovial fluid, treats osteoarthritis
St. John’s Wort
o Affects serotonin, used for mild depression
Saw Palmetto
o Can decrease prostate symptoms of hyperplasia
Valerian
o Reduces anxiety related to restlessness
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Chapter 31: Medications Affecting the Reproductive Tract
• Estrogens
o Conjugated equine estrogens/Estradiol
§ Ther use: Contraception, prevention of postmenopausal osteoporosis,
treatment of prostate cancer
§ Complications: potential risk for estrogen-dependent cancer,
embolic events (MI/PE/DVT/Stroke)
§ Contraindications: breast or estrogen-dependent cancer, hx or risk of
thromboembolic disease
§ Interactions: smoking increases risk of thromboembolic event
§ Nursing admin: report menstrual changes and dysmenorrhea
• Progesterones
o Medroxyprogesterone
§ Ther use: use progestins alone or with estrogens for contraception,
prevent preterm birth
§ Complications: Thromboembolic events, breakthrough bleeding,
amenorrhea, breast tenderness, edema
§ Nursing admin: delay pregnancy for 3 months
• Hormonal contraceptives
o Estrogen-progestin combinations
§ Pharm action: oral contraceptives stop conception by preventing
ovulation, they also thicken the cervical mucous and alter the
endometrial lining to reduce the chance of fertilization
§ Complications: thromboembolic events, HTN (estrogen)
•
•
5-alpha reductase inhibitors
o Finasteride
§ Pharm action: decreases usable testosterone
§ Ther use: BPH, male pattern baldness
§ Complications: decreased libido/ejaculation volume, gynecomastia
§ Contraindications: Pregnancy (don’t touch)
Alpha1-adrenergic antagonists
o Tamsulosin
§ Pharm action: relaxes smooth muscles of bladder neck and prostate,
vasodilation and can lower BP
§ Ther use: BPH, thus increasing urine flow
§ Complications: hypotension, dizziness, problems with ejaculation
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Nursing admin: monitor BP, give 30 min after meal at the same time
each day
Phosphodiesterase
o Sildenafil
§ Pharm action: enhanced blood flow to the corpus cavernosum and
penile erection
§ Ther use: erectile dysfunction
§ Complications: MI, sudden death, priapism (notify if erection lasts
more than 4 hours)
§ Contraindications: clients taking any meds in the nitrate family, use
cautiously in clients who have cardiovascular disease
§ Interactions: do not use with nitrates or alpha blockers
§
•
Chapter 32: Meds Affecting Labor and Delivery
• Uterine Stimulants: Oxytocics
o Oxytocin
§ Ther use: induction of labor, delivery of placenta, management of
postpartum hemorrhage
§ Complications: uterine rupture, uterine tachysystole (monitor
length/strength/duration of contractions, assess fetal status, monitor
VS/I&O, <60sec q2-3min apart)
§ Nursing admin: continuously monitor FHR and rhythm report fetal
distress, monitor BP/RR/Pulse every 30-60 min, monitor uterine
contractions every 15 minutes with every dosage change during first
stage and every 5 min during second stage
o Dinoprostone
§ Complications: uterine tachysystole
• Tocolytic medications
o Terbutaline
§ Ther use: can be used for up to 24 hours to delay but not to prevent
preterm labor
§ Mag sulfate relaxes smooth muscle
§ Complications: tachycardia (maternal/fetal)
§ Contraindications: >6cm or >34 weeks
• Opioid analgesics
o Meperidine
§ Pharm action: decrease perception of pain without LOC
§ Complications: dry mouth, neonatal depression, hypotension,
decreased FHR variability, sedation
§ Nursing admin: verify labor is well established by vaginal exam
showing cervical dilation of at least 4cm with fetus engaged,
naloxone admin only in severe resp depression of the newborn
Chapter 33: Connective Tissue Disorders
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Disease-modifying antirheumatic drugs
o Hydroxychloroquine (antimalarial agent)
§ Complications: retinal damage (blindness) – have eye exams q6mos
o Pharm action:
§ Glucocorticoids: symptomatic relief of inflammation and pain
§ NSAIDs: provide rapid relief of pain and inflammation
o Complications:
§ Methotrexate: increased risk of infections, hepatic toxicity, bone
marrow suppression
§ Cyclosporine: risk of infection (graft vs host disease), hepatotoxicity,
nephrotoxicity, hirsutism
§ Glucocorticoids: risk of infection
o Contraindications:
§ azathioprine (same concept as cyclosporine): pregnancy, chicken
pox, herpes zoster virus
Antigout medications
o Colchicine (once considered a drug of choice but is now reserved for clients
who do not respond/can’t tolerate the safer agents (NSAIDs/Glucocorticoids)
§ Pharm action: only effective for inflammation caused by gout
§ Ther use: Prednisone is used for clients who have acute gout who are
unable to take or are unresponsive to NSAIDs. This med is not for
patients who have hyperglycemia.
§ Interactions: grapefruit juice/grapefruit
o Agents for hyperuricemia (allopurinol)
§ Ther use: hyperuricemia due to chronic gout or secondary to chemo
§ Interactions: warfarin (increase bleeding risk)
o Probenecid
§ Interactions: salicylates – lessen effectiveness of medication
o Nursing admin: avoid alcohol and foods high in purine
o Nursing effectiveness: improvement of pain caused by gout attack (decrease
in joint swelling, tiredness, uric acid levels), decrease in number of gout
attacks, decrease in uric acid levels
Chapter 34: Bone disorders
• Calcium supplements
o Calcium Citrate
§ Ther use: hypocalcemia or deficiencies of parathyroid hormone,
vitamin D, or dietary calcium
§ Complications: hypercalcemia (>10.5mg/dL, muscle weakness,
constipation, abdominal pain).
• Selective estrogen receptor modulator (agonist/antagonist)
o Raloxifene
§ Pharm action: decreases bone resorption
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Ther use: postmenopausal osteoporosis, protects against breast
cancer
§ Complications: hot flashes, leg cramps
§ Nursing admin: consume adequate amounts of calcium rich foods
and vitamin D (egg yolks), monitor bone density, monitor serum
calcium
Bisphosphonates
o Alendronate
§ Pharm action: inhibit bone resorption
§ Ther use: postmenopausal osteoporosis, Paget’s disease of the bone
§ Complications: esophagitis, GI disturbances, musculoskeletal pain,
visual disturbances
§ Nursing admin: monitor bone density, monitor serum calcium
§ Client education: take first thing in am after out of bed, take on empty
stomach (drink 8oz water with tables and 2oz water with liquid), sit
or ambulate for 30 minutes after taking medication
Calcitonin
o Calcitonin-salmon
§ Ther use: postmenopausal osteoporosis, severe Paget’s disease,
hypercalcemia caused by hyperparathyroidism, cancer
§ Complications: nausea, nasal dryness/irritation (intranasal route)
§ Nursing admin: check for Chvostek’s and Trousseau’s signs of
hypocalcemia, monitor bone density, consume calcium and vitamin
D
§
•
•
Chapter 35: Nonopioid Analgesics
• NSAIDs
o Aspirin/Ibuprofen/Naproxen/Indomethacin
§ Ther use: inflammation suppression, mild to moderate pain, reduce
fever
§ Complications: GI discomfort, GI bleeding, Impaired kidney function
§ Contraindications: pregnancy, peptic ulcer disease, bleeding
disorders, allergies to these meds
§ Interactions: alcohol increases risk of bleeding
o Aspirin
§ Complications: Reye syndrome (children or adolescents), aspirin
toxicity
§ Contraindications: children with flu or chicken pox
o Ketorolac
§ Contraindications: clients with advance kidney disease, do not use
longer than 5 days
o Celecoxib
§ Contraindications: last choice for chronic pain due to increased risk
of MI and stroke, allergy to sulfonamides
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Acetaminophen
o (Tylenol)
§ Ther use: pain and fever relief
§ Complications: acute toxicity (liver) – nausea, vomiting, diarrhea
§ Nursing admin: do not exceed 4g/day, limit OTC dose of
acetaminophen when taking script for combination analgesics that
contain acetaminophen, antidote is acetylcysteine
Chapter 36: Opioid Agonists and Antagonists
• Opioid agonists
o Morphine/Fentanyl/Oxycodone
§ Complications: resp depression (stop opioids if the clients resp rate is
less than 12/min), constipation, hypotension, urinary retention,
sedation, nausea, vomiting
§ Nursing admin: assess pain regularly, take baseline VS, administer IV
opioids slowly over 4-5 min, have naloxone and resuscitation
equipment available, for cancer pt. administer around the clock
regularly.
• Agonist-antagonist opioids
o Butorphanol
§ Nursing admin: warn clients not to increase dosage without
consulting the provider
• Opioid antagonists
o Naloxone
§ Ther use: reversal of opioids and its effects
§ Complications: tachycardia, tachypnea, abstinence syndrome (HTN)
§ Nursing admin: monitor respirations for up to 2 hours after use
Chapter 37: Adjuvant Meds for Pain
• Tricyclic antidepressants: Amitriptyline
• Anticonvulsants: Carbamazepine, Gabapentin
Chapter 38: Miscellaneous Pain Medication
• Migraine Medications
o Sumatriptan
§ Complications: coronary artery vasospasm/angina, dizziness or
vertigo
o Ergotamine
§ Complications: GI discomfort (nausea/vomiting), ergotism (muscle
pain, paresthesias in fingers and toes, peripheral ischemia), physical
dependence, fetal harm or abortion
§ Interactions: Aspirin-like meds (NSAIDs/acetaminophen
combination), steroids/alcohol/tobacco (GI effects increase), NSAIDs
(increase bleeding)
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Nursing admin: advise clients who have migraines to avoid triggers
(stress, alcohol, tyramine-containing food), lie down in dark quiet
place
Local Anesthetics
o Lidocaine
§ Pharm action: blocking conduction of pain impulses
§ Ther use: minor surgical procedures, regional anesthesia
§ Complications: CNS excitation (seizures, resp depression, leading to
unconsciousness), hypotension/cardio-suppression (bradycardia,
heart block, cardiac arrest: common in spinal anesthesia due to
sympathetic block), spinal headache, urinary retention (spinal
anesthesia), labor can be prolonged
o Topical EMLA cream: apply to intact skin 1 hour before routine procedures
or superficial puncture and 2 hours before more extensive procedures or
deep puncture, prior to the procedure, remove the dressing and clean the
skin with aseptic solution
§
•
STOP –
A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new
prescription for sucralfate. Which of the following actions of sucralfate should the nurse
include in the teaching?
A. Decreases stomach acid secretion
B. Neutralizes acids in the stomach
C. Forms a protective barrier over ulcers
D. Treats ulcers by eradicating H. pylori
Correct answer: C
A nurse is providing teaching for a client who has multiple sclerosis and a new
prescription for methylprednisolone. Which of the following instructions should the nurse
include? (SATA)
A. Blood glucose levels will be monitored during therapy.
B. Avoid contact with people who have known infections.
C. Take the medication 1 hr before breakfast.
D. Decrease dietary intake of foods containing potassium.
E. Grapefruit juice can increase the effects of this medication
Correct answers: A, B, & E
Chapter 39: Diabetes Mellitus
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•
•
Insulin
o Nursing admin: tell clients to admin SQ in the same general area for
consistent rates of absorption: thigh (lowest), upper arm, abdomen (highest),
ensure proper storage: unopened stored in fridge, vials of premixed insulins
can be stored for up to 3 months under refrigeration, premixed syringes can
be kept in fridge for 1-2 weeks in vertical position with needles pointing up
(gently move syringes back and forth before admin), store vial that is in use
at room temp, avoid sunlight and intense heat and discard after 1 month.
Oral antidiabetics:
o Ther use: Type 2 DM
o Sulfonylureas
§ Glipizide/Glyburide
• Pharm action: insulin release from the pancreas
• Complications: hypoglycemia, photosensitivity
• Nursing admin: best taken with breakfast, wear sunscreen
o Meglitinides
§ Repaglinide
• Pharm action: insulin release from the pancreas
• Complications: hypoglycemia, angina
• Nursing admin: eat within 30 min of taking a dose TID
o Biguanides
§ Metformin
• Pharm action: reduces production of glucose in the liver,
increases muscles’ glucose uptake and use
• Complications: GI effects, Vitamin b12 and folic acid
deficiency, lactic acidosis
• Discontinue if have surgery
o Thiazolidinediones
§ Pioglitazone
• Pharm action: Decreases insulin resistance, increases glucose
uptake and decreases glucose production
• Complications: fluid retention, elevations in LDL cholesterol,
hepatotoxicity
• Contraindications: severe heart failure
• Nursing admin: take once daily with or without food
o Alpha-glucosidase inhibitors
§ Acarbose
• Slows carb absorption and digestion
• Complications: GI effects, anemia due to decrease of iron
absorption, hepatoxicity with long term use
• Nursing admin: take with first bite of food TID
Hyperglycemic agent
o Glucagon
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§
§
§
§
Pharm action: increasing the breakdown of glycogen into glucose
Ther use: Emergency management of hypoglycemic reactions (such
as insulin overdose) in clients who are unable to take oral glucose
Complications: GI distress – nausea, vomiting
Nursing admin: glucagon SQ, IM, or IV immediately following
reconstitution parameters, provide food as soon as client regains full
consciousness and is able to swallow
STOP –
A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure.
The nurse should identify which of the following as an indication of hypokalemia?
A. Tall, tented T-waves
B. Presence of U-waves
C. Widened QRS complex
D. ST elevation
Correct answer: B
The nurse is caring for a client who has cancer and is taking oral morphine and docusate
sodium. The nurse should instruct the client that takin the docusate sodium daily can
minimize which of the following adverse effects of morphine?
A. Constipation
B. Drowsiness
C. Facial flushing
D. Itching
Correct answer: A
A nurse is planning care for a client who is receiving mannitol via IV continuous infusion.
The nurse should monitor the client for which of the following adverse effects?
A. Weight loss
B. Increase intraocular pressure
C. Auditory hallucinations
D. Bibasilar crackles
Correct answer: D
Chapter 40: Endocrine Disorders
• Thyroid hormone
o Levothyroxine
§ Pharm action: synthetic form of thyroxine (T4)
§ Complications: overmedication – heat intolerance, diaphoresis, wt.
loss
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§
Nursing admin: TSH levels monitored at least once a year, daily
therapy begins at a low dose and increase gradually over several
weeks (full effect can take 6-8 weeks), take on empty stomach 30-60
min before eating, check with provider before switching brands
because dosage adjustments may be necessary
•
Thionamides
o Propylthiouracil
§ Pharm action: blocks the synthesis of thyroid hormones
§ Ther use: Grave’s Disease, thyroid removal surgery
§ Complications: hypothyroidism (depression, wt. gain, bradycardia,
cold intolerance), agranulocytosis, liver injury/hepatitis
§ Nursing admin: monitor CBC for leukopenia/thrombocytopenia
•
Radiopharmaceuticals
o Radioactive Iodine
§ Ther use: hyperthyroidism, Thyroid cancer
§ Complications: radiation sickness, bone marrow depression,
hypothyroidism
§ Nursing admin: maintain distance of 6 ft from others, do not prepare
food for others or share utensils, encourage clients to increase fluid
intake (2-3L/day)
Iodine products
o Strong iodine solution
§ Ther use: thyroid removal surgery, thyrotoxicosis
§ Complications: Iodism – metallic taste/stomatitis/sore teeth and gums
§ Nursing admin: dilute with juice to improve taste, increase fluids,
avoid salt and seafood
Anterior pituitary hormones/growth hormones
o Somatropin
§ Nursing admin: IM or SQ, monitor growth plates monthly (stop
before plates close), rotate injection site
Antidiuretic hormone
o Vasopressin/Desmopressin
§ Ther use: used to treat diabetes insipidus (DI)
§ Complications: reabsorption of too much water, myocardial ischemia
(notify of chest pain, tightness, or diaphoresis)
§ Nursing admin: monitor VS/I&O, monitor BP and HR, monitor for
h/a, confusion, and other indications of water intoxication
§ Nursing effectiveness: reduction in large volumes of urine output
associated with Diabetes insipidus to normal levels (1.5-2L/day),
cardiac arrest survival
Adrenal hormone replacement
•
•
•
•
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o Hydrocortisone
§ Pharm action: mimic natural steroid hormones
§ Ther use: Addison’s disease/adrenal crisis
§ Complications: osteoporosis, adrenal suppression, peptic ulcer/GI
discomfort, infection, Cushing’s syndrome
§ Interaction: NSAIDs and alcohol can increase gastric distress or bleed
§ Nursing admin: observe for peptic ulcer 9coffee ground emesis/
blood or tarry stools, do not stop abruptly, increase doses during
times of stress
Chapter 41: Immunizations
• Artificial active immunity – killed or attenuated vaccine
• Natural active immunity
• Natural passive immunity – mother to fetus, then to newborn through colostrum
• Artificial passive immunity – immune globulins protect against disease after
exposure has occurred
• Complications: allergic reaction, mod/severe illness with or without fever
(precaution), common cold and minor illnesses are not contraindicated or a
precaution for vaccines
• IPV – do not give if allergic to neomycin/streptomycin/polymyxin B
• Varicella – do not give if allergic to neomycin or gelatin
• Hep B – do not give if allergic to yeast
• Inactivated flu vaccine - do not give if has had GBS within 6 weeks
• Live flu vaccine - do not give if pt. has had GBS within 6 weeks
• HPV4/9 - do not give if allergic to yeast
• HPV2 - do not give if allergic to latex
• Nursing admin: avoid aspirin in children, document correctly, know where
vaccine should be placed
STOP –
A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse
notes the client has anxiety, hypotension, and dyspnea. Which of the following
medications should the nurse administer first?
A. Diphenhydramine
B. Albuterol inhaler
C. Epinephrine
D. Prednisone
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Correct answer: C
A nurse is planning care for a client who has hypertension and is to start taking
metoprolol. Which of the following interventions should the nurse include in the plan of
care?
A. Weigh the client weekly
B. Determine apical pulse prior to administering
C. Administer the medication 30 min prior to breakfast.
D. Monitor the client for jaundice
Correct answer: B
A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who
weighs 44 lb. How many mg should the nurse administer per dose?
Correct answer: 300 mg
A nurse in an emergency department is caring for a client whose family reports the client
has taken large amounts of diazepam. Which of the following medications should the
nurse anticipate administering?
A. Ondansetron
B. Magnesium sulfate
C. Flumazenil
D. Protamine sulfate
Correct answer: C
Chapter 42: Chemotherapy agents
• Antimetabolites
o Methotrexate
• Antitumor antibiotics
o Doxorubicin
§ Pharm action: binds to DNA, altering its structure, therefore, inhibits
synthesis of DNA and RNA (intercalation)
§ Ther use: solid tumors
§ Complications: bone marrow suppression, GI effects, alopecia, acute
cardiac toxicity, cardiomyopathy, heart failure, red coloration of
urine and sweat
§ Nursing admin: Monitor CBC and liver enzymes, admin antiemetic
for nausea and vomiting, monitor ECG and cardiac function
• Antimitotics:
o Vincristine
§ Pharm action: stop cell division during mitosis, M-phase specific
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Complications: peripheral neuropathy (paresthesia), severe tissue
damage (use central line), alopecia
§ DOES NOT CAUSE BONE MARROW SUPPRESSION
Alkylating agents
o Cyclophosphamide
§ Pharm action: kills rapid growing cells by alkylation of DNA and
RNA synthesis
§ Ther use: acute lymphomas, solid tumors
§ Complications: bone marrow suppression, GI discomfort
(nausea/vomiting), acute hemorrhagic cystitis, alopecia
§ Nursing admin: encourage adequate fluid intake, monitor for blood
in urine, monitor for bleeding, give antiemetic
§
•
Hormonal agents: prostate cancer meds
o Leuprolide
§ Pharm action: testes stop producing testosterone by stopping the
release of LH and FSH
§ Complications: hot flashes, decreased libido, gynecomastia,
decreased bone density (increase calcium and vitamin D)
§ Nursing admin: monitor PSA and testosterone levels (both should
decrease)
• Hormonal agents: breast cancer meds
o Tamoxifen
§ Pharm action: stops growth of breast cancer cells which are estrogendependent cancers
§ Complications: endometrial cancer, hypercalcemia, PE, hot flashes
• Biologic Response Modifiers
o Interferon alfa-2b
§ Pharm action: increases immune response and decreases production
of cancer cells
§ Complications: flu-like symptoms, bone marrow suppression,
alopecia, cardiotoxicity, neurotoxicity, depression, anxiety insomnia,
altered mental status
Chapter 43: Principles of antimicrobial therapy
• Selection of antimicrobials
o ID of causative agent
§ Lab testing of body fluids such as blood/urine/sputum/wound
drainage
§ Gram stain: exam under microscope
§ Culture: preferred when gram stain does not give a positive ID,
collect specimen PRIOR to antibiotic therapy
•
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Chapter 44: Antibiotics Affecting the bacterial cell wall
• Penicillins
§ Pharm action: kill bacteria by weakening cell wall
§ Complications: allergies/anaphylaxis, renal impairment
§ Nursing admin: Give IM injections cautiously to avoid injecting into
nerve or artery
o Amoxicillin
o Piperacillin tazobactam
• Cephalosporins
o Cephalexin/Cefazolin/Ceftriaxone
§ Complications: allergic reaction, suprainfection, thrombophlebitis
(rotate injection sites, admin dilute intermittent infusion or slowly
over 3-5 minutes), pain with IM injection (deep ventrogluteal site
preferred)
• Carbapenems
o Imipenem-cilastatin
§ Complications: GI upset, cross-sensitivity to penicillin or
cephalosporins, suprainfection
• Other inhibitors of cell wall synthesis
o Vancomycin
§ Ther use: C. diff
§ Complications: ototoxicity, infusion reactions (admin slowly over 60
minutes), thrombophlebitis (rotate injection sites), renal toxicity
§ Nursing admin: monitor vancomycin trough levels, need to do
creatinine levels to indicate IV dosing
Chapter 45: Antibiotics Affecting Protein Synthesis
• Tetracyclines
o Tetracycline/Doxycycline
§ Pharm action: bacteriostatic
§ There use: acne vulgaris, Rocky mounted spotted fever, Lyme disease
§ Complications: GI discomfort, yellow or brown tooth
discoloration/hypoplasia of tooth enamel (avoid admin in children
<8yo and women who are pregnant), hepatoxicity, photosensitivity,
superinfection
§ Contraindications: taking after 4th month of pregnancy can stain
deciduous teeth but does not affect deciduous teeth. Does stain
permanent teeth of children 4mos to 8yo
§ Interactions: avoid milk products and antacids or separate by 2 hours,
milk products/calcium/iron/laxatives with magnesium/antacids
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§
Nursing admin: take on empty stomach with 8oz of water, do not
take right before laying down (esophageal ulceration), use additional
contraception
•
Macrolides
o Erythromycin/Azithromycin
§ Pharm action: bacteriostatic
§ Ther use: used in clients allergic to penicillin, treats legionnaire’s
disease/pertussis/diphtheria, and treats chlamydia
§ Complications: GI upset, dysrhythmias (do not use in clients with
prolonged QT intervals), ototoxicity (report hearing loss, vertigo and
tinnitus)
§ Nursing admin: admin on an empty stomach with 8 oz of water (1 hr
before/2 hr after meals), erythromycin IV only for severe infections,
monitor PT/INR for those who take warfarin concurrently, monitor
LFTs for therapy lasting longer than 2 weeks
•
Aminoglycosides
o Gentamicin
§ Complications: Ototoxicity, nephrotoxicity
§ Nursing admin: peak – 30 min after admin IM or IV, trough – right
before next dose
Chapter 46: Urinary Tract Infections
• Sulfonamides and trimethoprim
o Trimethoprim-sulfamethoxazole
§ Pharm action: preventing the synthesis of a folic acid derivative
§ Complications: blood dyscrasias, crystalluria (encourage adequate
oral fluid intake)
• Urinary tract antiseptics
o Nitrofurantoin
§ Pharm action: injures bacteria by damaging DNA
§ Complications: GI upset, hypersensitivity reactions, blood dyscrasias,
peripheral neuropathy
§ Nursing admin: turns urine rust yellow to brown and can stain teeth
• Fluoroquinolones
o Ciprofloxacin
§ Pharm action: inhibition of an enzyme necessary for DNA replication
§ Complications: GI upset, Achilles tendon rupture, suprainfection
(thrush)
• Urinary tract analgesic
o Phenazopyridine
§ Pharm action: local anesthetic on the mucosa of the urinary tract
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§
§
Ther use: relieves manifestations of burning with urination, pain,
frequency, and urgency
Nursing admin: changes urine to an orange-red color
Chapter 47: Mycobacterial, fungal, and parasitic infections
• Antimycobacterial (selective antituberculotic)
o Isoniazid
§ Ther use: indicated for active OR latent TB
§ Complications: peripheral neuropathy, hepatotoxicity
§ Interactions: tyramine foods and alcohol
• Broad spectrum antimycobacterial (antituberculotic)
o Rifampin
§ Ther use: given in combination with at least one other med to
prevent antibiotic resistance
§ Complications: discoloration of body fluids (orange color of urine,
saliva, sweat, and tears), hepatotoxicity (anorexia, malaise, fatigue,
and avoid alcohol), Gi discomfort (nausea, anorexia, abdominal
discomfort), pseudomembranous colitis (fever, diarrhea, abdominal
pain, bloody stool)
§ Contraindications: avoid alcohol
§ Nursing admin: use non-hormonal contraceptives
§ Nursing effectiveness: improvement of TB such as clear breath
sounds, no night sweats, increased appetite, and no afternoon rises of
temperature. Three negative sputum cultures for TB (3-6 months)
• Antiprotozoal
o Metronidazole
§ Ther use: treatment of protozoal infections and obligate anaerobic
bacteria, H. pylori in combo with tetracycline and bismuth
subsalicylate in clients who have peptic ulcer disease
§ Complications: GI discomfort, metallic taste, darkening of urine
§ Interactions: alcohol
§ Nursing effectiveness: resolution of bloody mucoid diarrhea, formed
stools, negative for giardia, decrease or absence of discharge,
negative blood cultures
• Antifungals
o Ketoconazole/Amphotericin B
§ Therapeutic use è systemic fungal infections
§ Complications: test dose of amphotericin B to assess for reaction,
thrombophlebitis, nephrotoxicity, bone marrow suppression,
hepatotoxicity (jaundice/clay colored stools/dark urine)
§ Nursing effectiveness: improvement of systemic fungal infection
Chapter 48: Viral Infections, HIV, AIDS
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•
Antivirals
o Acyclovir
§ Ther use: Herpes/Varicella -zoster virus,
§ Complications: Phlebitis/nephrotoxicity,
§ Nursing admin: inform clients to expect relief of manifestations, but
not a cure
o Ganciclovir
§ Therapeutic use è cytomegalovirus
§ Complications: suppressed bone marrow
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