NURS 2731 PHARM Study Guide for Midterm
Content covered: WEEKS 3 and 4
PowerPoint Week 3 Part I:
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What is a prototype drug and why do we need it
o First drug developed
o Standard or typical medication representing a class of drug
o Provides basis for understanding other drugs in the class
Prototype drugs
o Ibuprofen (NSAIDs) (Advil, Motrin)
 Indications
 Pain relief (mild pain)
 Inflammation
 Fever reducetion
 Nursing considerations
 assess pain before and after
 Don’t administer if they have aspirin or NSAID allergy
 Avoid alcohol
 Caution with heart failure and if anticoagulants or
antiplatelets.
 Black box warnings
 Do NOT use after heart bypass surgery.
 cardiovascular event (Increases risk of heart attack and
stroke.)
 Can cause thrombus, MI, stroke
 GI bleeding, ulcers, or perforation—can be fatal
o Acetaminophen (analgesic and antipyretic) (tylenol)
 Indications
 Pain relief (mild to moderate)
 Fever reduction
 Nursing considerations
 orally, rectally, or IV
 a full glass of water
 Assess pain before and after
 avoid for PT with
o chronic alcohol use
o liver or kidney impairment
o sensitivity
 careful w/ long-term usage
 Maximum daily dose
 3,000-4,000 grams.
 2,000 if chronic alcoholism
 Know antidote – Acetylcysteine
 Alternative to NSAID for patients with heart failure
o Morphine (opioid agonist)
 Indications
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Pain relief (moderate to severe)
Sedation
Decreased GI motility
Cough suppression (codeine)
 Nursing considerations
 Monitor vital signs
 Stop if respiration < 12
 Avoid for patients w/ CNS depressants such as
barbiturates, benzodiazepines, alcohol)
 Obesity reduces metabolism
 Stop patient controlled anesthesia (PCA) if respiratory
distress
 Assess pain regularly using a pain scale.
 Ensure fluid intake to prevent constipation.
 Know antidote – naloxone (Narcan)
 Respiratory and CNS effects
 Respiratory depression
 Hypotension
 Light-headedness
 Dizziness
 sedation
 Use a pain scale
Local anesthetic (Lidocaine)
 Indications
 Minor procedures and dental work
 Labor and delivery
 Regional pain relief
 nursing considerations for the following
 Monitor for
o Seizure or CNS excitation
o Hypotension or low heart rate
o Allergic reaction
 Use of epinephrine in conjunction
o Contains local anesthetic to area by vasoconstriction
o Check cardiac history
o Topical and injection routes.
General anesthetics (propofol) (Diprivan)
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Indications
 Almost immediate action
 Rapid emergence from in recovery
 Unconsciousness
Nursing considerations
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Watch for nausea, vomiting, cardiac and respiratory depression.
Succinylcholine (anectine, quelicin)
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Indications
o Reduces amount of general anesthesia needed
o Skeletal muscle paralytic
Nursing considerations
o Cause paralysis of diaphragm, use with mechanical
ventilation
Anti-Parkinson’s drugs (levodopa, carbidopa, entacapone)
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Indications:
Offers relief from symptoms
Restless leg syndrome
Parkinson’s disease
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Nursing Considerations:
Nausea & vomiting
Dyskinesis (head bobbing)
Older than 18
Contraindicated with usage of MAOIs
Orthostatic hypotension
Tachycardia or palpitations
Psychosis
Avoid high protein diet
Monitor for somnolence and increased depression
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Antiepileptics (AEDs)
Indications:
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used to control various forms of seizures, not a cure for them
Nursing considerations:
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Side effects vary based on specific drug used.
In general monitor CNS effects and toxicity, abnormal event
movements, cognitive impairments, allergic reactions, steven
johnson rash
Monitor labs including electrolytes, liver function and blood levels,
anorexia or weight gain may occur, psychosis
Avoid drinking grapefruit juice, patient to keep seizure diary
Penicillin G
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There is a risk of cross reactions with PCNs, imipenem, and
cephalosporins
Timing of rash or reaction
 Immediate reaction: 2-30 minutes
 Accelerated reaction: 1 to 72 hours
 Delayed reaction: days to weeks
Response to a rash or reaction
 Penicillin should be discontinued and appropriate therapy
used
 If severe: emergency treatment w/ epinephrine and airway
management
Monitoring of IV site closely for phlebitis or infiltration
Normal gut flora can be eliminated allowing for C-diff, yeast
Tetracycline risks
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Risk for hepatotoxicity with high doses
Photosensitive protections in sun/outdoors
Hyperkalemia and dysrhythmia with high does of penicillin G
Pseudomembranous colitis (diarrhea)
Yeast infections of mouth, pharynx, vagina, or bowels.
Gentamicin risks: can cause ototoxicity if administered with loop diuretic such as
furosemide. First sign of ototoxicity is ringing of the ears. Can also damage kidneys
causing nephrotoxicity
Always check for allergies especially PCN and cephalosporins
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Furosemide (Lasix)
 Indications: to rapidly mobilize fluids due to fluid buildup in the
heart due to heart failure/edema
 Loop diuretic therefore can deplete potassium, monitor kidney
function and K lab levels
 Nursing considerations
 Monitor for urine output and for dehydration
 Daily weights (report changes)
 Monitor electrolyte changes (hypokalemia)
 Changes in kidney functions
 Monitor blood pressure (hypotension)
 Give in morning to avoid nocturia
 Avoid drugs that can cause ototoxicity (GENTAMICIN and
AMINOGLYCOSIDE ANTIBIOTICS)
o Give IV slowly
Hydrochlorothiazide (HCT)
 Indications
 Treatment for hypertension
 Treat mild to moderate heart failure
 Often used in combination drugs (losartan)
 Nursing considerations
 Give in AM if possible to avoid nocturia
 Review food rich in potassium
 Monitor:
o Urine output, if <30 cc/hour
o For dehydration
o Daily weights (report large changes)
o Electrolyte changes (Hypokalemia)
o Changes in kidney function
o Blood pressure (hypotension)
Spironolactone
 Potassium sparing diuretic
 Monitor electrolytes and kidney function
 Monitor weights
 Monitor for hyperkalemia
 Use glucose and IV insulin to treat hyperkalemia
 Use caution with RAAS drugs.
Captopril (ace inhibitor)
 Indications
 Hypertension
 Heart failure
 Post MI to decrease mortality
 Neuropathy
 Nursing considerations
 Additive hypotensive effects with anti-hypertensives
 Monitor for
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Blood pressure effects
Persistent cough (bradykinin)
Hyperkalemia, renal insufficiency
Neutropenia with captopril
Angioedema
 Severe treated with epinephrine
Losartan (ARB)
 Indications
 Hypertension
 Heart failure
 Stroke prevention
 Diabetic neuropathy/retinopathy
 Nursing consideration
 Monitor for:
o Blood pressure effects
o Orthostatic hypotension
o Angioedema (use caution if had angioedema with an
ACE)
o Causes dizziness, and lightheadedness
o Monitor weight changes
o Edema effects
 Grapefruit because it increases bioavailability
 Lithium interaction: may increase lithium levels leading to lithium
toxicity (a life threatening conditions (excreted by kidneys)
Metoprolol /Propranolol
 Cardio selective, Beta 1 (metoprolol), affects only the heart
versus non-selective drugs (propranolol) affects heart and lungs
 Nursing considerations
 Increased risk of hypoglycemia
 With the history of Asthma, use beta 1 (metoprolol) to
avoid bronchoconstriction.
 Monitor for
o Heart rate, if < 50 hold drug
o ECG
o Orthostatic hypotension
 General slide on beta blockers:
 Monitor Blood Pressure and Heart Rate
o Monitor for side effect of slow pulse less than 50
o Monitor for side effect of low systolic blood pressure
less than 90
o Assess symptoms if has low pulse or heart rate
o Hold medication as needed and Notify Provider
 Bronchoconstriction
o Non-selective Beta blockers (Propranolol) Use
caution in asthma or COPD
 Taper off medication
Taper off if discontinued
Do not stop abruptly
Administering Nitroglycerin slide ie timing for chest pain emergency
 Dosage
 Place one tablet or spray one dose under tongue onset of
chest pain.
 Do not swallow or chew tablet
 Let dissolve under tongue
 Timing
 Wait 5 minutes after the first dose
 May take up to to 3 doses, 5 minutes apart
 Seek emergency care if chest pain continues after the third
dose.
 Storage
 Keep NTG in its original bottle
 Tightly closed
 Light-resistant container
 Degrades with light, heat, and moisture. Don’t store in the
bathroom or in direct sunlight.
Atorvastatin /Statins
 Indications:
 High cholesterol levels
 Prevention of cardiac events
 Protection for diabetics against MI
 Primary prevention for cardiac risk
 Nursing considerations:
 Monitor cholesterol levels and Liver function tests (LFTs)
 Avoid alcohol
 Check interactions with other medications
 Monitor for myopathy
o Muscle aches, pain, tenderness
o Large muscle groups or general
o Can progress to rhabdomyolysis
o Check CK level for elevation
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Power Point Week 3 Part II:
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Review resources for week 3
Albuterol
 Indications
 Inhaled for asthma and bronchospasm
 Oral long-acting for asthma
 COPD
 Nursing considerations
 Monitor for tachycardia or angina with oral route
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Monitor for tremors
Use Beta 2 agonist inhaler before glucocorticoid inhaler (opens
bronchioles for better absorption of 2nd inhaler)
Monitor response
Wait at least 2 minutes between inhalations if giving 2 inhalers
Beclomethasone / Prednisone / glucocorticoid inhalers:
 Nursing considerations:
 Rinse with water after inhaler
 Never abruptly stop therapy
 Monitor for development symptoms of adrenal suppression
 Monitor for
 Hyperglycemia
 Bone loss
 Muscle weakness
 Peptic ulcer disease
 Infection
Heparin
 Antidote – protamine sulfate
 Treatment for clots /DVT /PE
 Nursing considerations:
 Subcutaneous or IV
 Monitor for:
 bleeding/hemorrhage
 heparin -induced thrombocytopenia
 Stop if platelets < 100.000
 PTT lab test for dosing
 Hypersensitivity reaction (chills, fever, urticaria (HIVES)
Warfarin (coumadin)
 Indications:
 Anticoagulant (low molecular weight heparin)
 Prevent venous thrombosis or PE
 Reduce risk for recurrent transient ischemic attack (TIA) or MI
 Prevent thrombotic events
 Atrial fibrillation
 prosthetic/mechanical heart valve
 Nursing considerations:
 Observe for bleeding
 Avoid alcohol
 Soft bristle toothbrush
 Use electric razor to shave
 Monitor platelets: discontinue if less than 100,000
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Give fresh frozen plasma if bleeding and no response from vitamin
K
 Monitor baseline, and routine PT and INR for dosing range
 Avoid concurrent use with antiplatelets, ASA, NSAIDS, and other
anticoagulants
 Use caution with clients with liver disease
 Antidote – Vitamin K
Insulin
 Nursing consideration
 Observe for hypoglycemia (glucose < 70)
 Administer 15g carbohydrate
 Not fully conscious, give IV parenterally
 Follow dosage orders and protocols
 Deliver via subcutaneous or IV
 Monitor glucose levels intermittently or continuously.
Metformin
 Indication
 first choice for type 2 diabetics
 Nursing considerations
 Monitor for anorexia, nausea, vomiting, diarrhea
 Monitor for vitamin B12 and folic acid deficiency
 Monitor for lactic acidosis, kidney function and renal impairment
 Discontinue 24-48 hours before procedures using contrast dye
 Monitor glucose levels regularly
Antidiabetic slide – review this
 Onset /peak/duration of insulin
 Know the difference between long-acting and rapid acting insulins.
 Hypoglycemia
 Monitor for signs: sweating, shakiness, confusion
 Ensure quick access to source of glucose
Levothyroxine
 Indication
 Treat hypothyroidism with thyroid hormone replacement
 Nursing considerations
 Chronic overtreatment can cause AFIB and increased bone
fractures
 Can increase warfarin levels, monitor for bleeding
 Take on empty stomach 30 to 60 min before breakfast
 Effects may differ w/ brands
 Full glass of water
 Do not discontinue
 Monitor for
 Overmedication symptoms
 Weight changes
 Cardiac palpitations or angina
 TSH and T4 levels
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Methotrexate (slows or delay worsening of disease)
 Nursing considerations
 Monitor of infection, jaundice, anorexia, GI ulcerations
 Monitor liver and kidney function tests
 Monitor CBC for bone marrow suppression
 Contraindicated w/ liver failure alcohol use disorder, blood
dyscrasias
 Evaluate medication interactions
Concepts of effectiveness overview this
 Potency: amount of drug needed for desired effect
 Selectivity: targeted action versus non selective effects
 Onset, peak, and duration: effects in relation to time
 Therapeutic window: range of therapeutic effect
 Side effect: known unintended effects
 Adverse effects: severe, unpredictable effects.
 Bioavailability: proportion of drug available in circulation to exert
therapeutic effect.
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Oral meds go through the liver (fast pass) and decrease availability.