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Pharmacology NUR 111
Pharm
| Question | Answer |
|---|---|
| Loop Diuretics (Action) | Inhibit reabsorption of NA and chloride in loop of Henle and distal tubule. Increases the excretion of Na, Chloride and H2O by kidneys. |
| Loop Diuretics (Use) | Hypertension, Edema in HF, Cirrhosis, Renal Impairment |
| Loop Diuretics (Drug Names) | Suffix- "mide" Furosemide Torsemide |
| Loop Diuretics ( Side Effects) | Orthostatic Hypotension, Hypokalemia ( normal 3.5-5.3) Hyperglycemia Constipation Polyuria(excessive) Nocturia Dehydration Impotence Hearing loss from ototoxicity (tendinitis) |
| Loop Diuretics (Misc) | Most potent diuretics. Never push IV Lasix fasted than 10 mg/min Increase the risk of digoxin toxicity Increase risk of lithium toxicity |
| Loop Diuretics (Interventions) | Check b/p before and 15(IV) 60 (PO) mins after admin Check Potassium level prior to admin Check renal function (BUN, creatinine) Monitor Blood glucose levels Give early in the day ( to prevent nocturia) Give with food, milk if GI upset |
| Loop Diuretics (Interventions Cont.) | Ensure access to bathroom/urinal Monitor I &O, Daily weight( to monitor fluid loss) Monitor for signs of dehydration (^HR, v b/p, dry mouth) Instruct pt to change positions slowly Encourage foods high in K+(banana, raisons, OJ, avocado, spinach) |
| Thiazide Diuretics (Action) | Inhibit reabsorption of Na and Chloride in distal renal tubule, increasing the excretion of Na, Chloride, and water by the kidneys. |
| Thiazide Diuretics (Use) | Hypertension, Edema in HF, Cirrhosis, Renal Impairment |
| Thiazide Diuretics (Drug Names) | Suffix- "thiazide" hydrochlorothiazide(HCTZ) chlorothiazide |
| Thiazide Diuretics ( Side Effects) | Orthostatic Hypotension Hypokalemia (3.5-5.3) Hyperglycemia Constipation Polyuria Nocturia Dehydration Impotence |
| Thiazide Diuretics (Interventions) | Check b/p IV (15 mins) PO (60 mins) after admin Check potassium level prior to admin Check renal function (BUN, creatinine) Give early in the day (to prevent nocturia) Give with food, milk if GI upset Ensure access to bathroom or urinal |
| Thiazide Diuretics (Interventions Cont.) | Monitor I & O, Daily Weight for fluid loss Monitor signs of dehydration (^HR v BP dry mouth) Instruct patients to change positions slowly Encourage foods high in K+(banana, raisins, OJ, avocado, spinach, baked potato) |
| Thiazide Diuretics (MISC) | Increase risk for digoxin toxicity Increase risk for lithium toxicity NSAIDs may decrease effectiveness of Thiazide Diuretics |
| K+ Sparing Diuretics (Action) | Block the effect of aldosterone on the renal tubule leading to a loss of Na and water, while retaining K+ |
| K+ Sparing Diuretics (Use) | Hypertension Edema in HF Cirrhosis Renal Impairment |
| K+ Sparing Diuretics(Drugs) | Spirnolactone - think SPare SPirnolactone |
| K+ Sparing Diuretics (Side Effects) | Hyperkalemia Orthostatic Hypotension Constipation Polyuria Nocturia Menstural Irregularities ^ hair growth in women Impotence Gynecomastia ( growth of breast tissue) Lethargy &/or Mental Confusion |
| K+ Sparing Diuretics (Interventions) | Check B/P before and 15 mins (IV) and 60 mins (PO) after admin Check Potassium levels prior to admin Check Renal Function (BUN, Creatnine) Give early in the day (to prevent nocturia) Give with food, milk if GI upset Ensure access to bathroom/urinal |
| K+ Sparing Diuretics (Interventions Cont.) | Monitor I&O, Daily Weight(to monitor fluid loss) Monitor for signs of Dehydration (^HR vBP dry mouth) Instruct patient to change positions slowly Avoid foods high in K+ Avoid salt substitutes (they are high in K+) |
| K+ Sparing Diuretics (MISC) | Overall effect is weaker with K+ sparing diuretics Can be given in combination with loop or thiazide diuretics to counteract the hyperkalemia affects of these meds. |
| Opioids (Action) | Opioids Agonist bind with mu receptors at the opioid receptor sites (they essentially act like endorphins) Opioid Agonist- Antagonist are mu receptor antagonist and kappa receptor agonists- main drug is butorphanol mainly given in OR as anaesthesia |
| Opioids (Uses) | Moderate/Severe Pain Pre-operative to sedate and ease anxiety inter-op analgesia |
| Opioids (Drugs) | Codeine Fentanyl Hydrocodone Hydrocodone/Acetaminophen Hydromorphone Morphine Oxycodone Oxycodone/ Acetaminophen |
| Opioids (Side Effects) | Respiratory Depression Hypotension(dizzy/lightheadedness) Euphoria/Confusion/Sedation/Coma Visual Disturbance Bradycardia Nausea and Vomiting Anorexia (can lead to weight loss in long term users) Constipation |
| Opioids (Side Effects Cont) | Urinary Retention (due to decreased sensation of full bladder) Cough Suppression |
| Opioids (Interventions) | Check B/P, HR, RR & O2 sat prior to administration Pain assess prior to admin and 30 mins(IV) 60 mins (PO) after Safety Precautions (bedrails up, assist to ambulate) Avoid alcohol, antihistamines, and other sedating drugs Monitor I & O |
| Anticoagulants (Action) | Disrupt the clotting process, resulting in a slowdown in the clotting process Heparin- Inhibits thrombin Warfarin- Blocks the formation of Vitamin K Rivaroxaban- Xa Inhibitors |
| Anticoagulants (Use) | A-fib Pulmonary Embolism (will not disolve clots) Prevent DVT post surgery Use after and to prevent Myocardial Infraction TIAs ???? |
| Anticoagulants (Drugs) | Heparin (IV, SQ) Warfarin (PO) Enoxaparin (IV, SQ) Rivaroxaban (PO) |
| Anticoagulants (Side Effects) | Hemorrhage Skin- Bruising GI Tract- bleeding gums, nose bleeds, hematemesis (blood in vomit) Melena (blood in stool) GU Tract- Hematuria, heavy menstruation Brain- altered mental status (agitation, decreased level of consciousness) |
| Anticoagulants (Side Effects Cont.) | Lungs- hemoptysis (blood in sputum) Heparin induced Thrombocytopenia(HIT) sudden unexplained drop in platelet count. If patient develops this heparin should be stopped immediately. |
| HMG-CoA Inhibitors (Action) | Inhibits HMG-CoA essential for hepatic production of cholesterol. Results in decrease in serum cholesterol and LDL (low density lipoproteins bad cholesterol) and triglycerides, VLDL (very-low-density) and increase in HDL (high-density good cholesterol) |
| HMG-CoA Inhibitors (Use) | Hyperlipidemia (elevated lipids) Hypercholesterolemia ( elevated cholesterol) |
| HMG-CoA Inhibitors (Drugs) | Suffix- "statin" Atorvastatin Lovastatin Rosuvastatin Simvastatin |
| HMG-CoA Inhibitors (Side Effects) | Myopathy (muscle cramps, tenderness or weakness) Blurred Vision Rhabdomyolysis (muscle tissue breakdown that releases protien in the blood) can result in possible renal failure Hepatotoxicity (toxic liver disease)-Increase in serum liver function test |
| HMG-CoA Inhibitors (Interventions) | Administer at bedtime- maximizes effects Monitor serum liver function test(LFTs) Educate pt on low cholesterol diet (avoid organ meat and dairy products) Educate pt to minimize alcohol |
| HMG-CoA Inhibitors (MISC) | Avoid Grapefruit juice- increase risk of adverse effects Increase risk of bleeding when taking Warfarin |
| NSAIDs (Action) | block COX enzymes and reduce prostaglandins, resulting in anti inflammatory, analgesic (pain reliever), and anti-pyretic(fever reducer) effect. |
| NSAIDs (Use) | Mild to Mod Pain Rheumatoid Arthritis Osteoarthritis Fever |
| NSAIDs (Drugs) | Aspirin Ibuprofen Naproxen Ibupropen Celecoxib |
| NSAIDs (Side effects) | GI bleeds GI upset Dyspepsia (Indigestion) Tinnitus (ringing in the ear) Ototoxicity Renal Impairment Liver Impairment Thrombocytopenia (low platelet count Normal- 150,000-450,000) Neutropenia (low neutrophils type of WBC Normal- 1500-8000) |
| NSAIDs (Interventions) | Admin with food Advise pt to avoid taking OTC drugs they may contain other NSAIDs Educate pt to avoid Alcohol (ETOH) Educate pt to report bruising, black, tarry stools Monitor BUN, creatinine & LFTs (liver function test) |
| NSAIDs (MISC) | Use with caution in liver, renal, and HF patients Decreased diuretic effect with loop diuretics Never give Aspirin to child can cause Reyes Syndrome (causes confusion, swelling in the brain, and liver damage) Acetaminophen is NOT an NSAID |
| Anticoagulants (Interventions) | Fall precautions Monitor for signs of bleeding Monitor CBC Monitor PT & Anti Xa for patients on Heparin, LMWH and Anti Xa Inhibitors Monitor PTT & INR for patients on Warfarin Educate pt that high Vitamin K (kale,spinach,brussel sprouts) V effect |
| Anticoagulants (MISC) | Herbal Medicines can interact so consult MD before taking Teach pt to use soft toothbrush, electric razor Never give to patient with epidural or spinal Wear life alert bracelet- with name of anticoagulant taking |
| Anticoagulants (MISC Cont.) | Educate pt to tell their MD and dentist their on anticoagulant, meds need to be stopped before invasive procedure Educate pt on warfarin of the importance of monthly blood draws to check Prothrombin time (average time blood to clot 10 -13 sec) & INR |
| Proton Pump Inhibitors (Action) | Inhibit hydrogen-potassium ATPase enzyme in parietal cells of the stomach. This suppresses gastric acid production |
| Proton Pump Inhibitors (Use) | GERD Gastric Ulcers Esophagitis Dyspepsia (indigestion) Zollinger-Ellison Syndrome (condition where tumors in pancreas and upper small intestines secrete too much gastric acid) |
| Proton Pump Inhibitors (Drugs) | Suffix "zoles" Omeprazole Esomerprazole Pantoprazole Lansoprazole |
| Proton Pump Inhibitors (Side Effects) | MS- Bone loss (long-term use) Neuro- Headache, dizziness GI- nausea, vomiting and diarrhea, abd pain, flatulence Electrolytes- hypomagnesemia(low Mg+), hypocalcemia decreases calcium |
| Proton Pump Inhibitors (Interventions) | Admin 30 mins before meals Swallow whole capsules, do not crush Encourage intake of calcium (dairy, products, leafy green veggies, fish) Encourage Magnesium intake (spinach, tuna, avocados, pumpkin seeds) |
| Proton Pump Inhibitors (MISC) | Use caution when using sucralfate, it decreases absorption of the PPI, so give at least 30 mins apart Serum levels can increase when taking valium, phenytoin,warfarin Increased risk of C-diff Increased risk of bone density loss (2nd to decreased cal) |
| Opioids (Intervention Cont.) | Encourage fluids to prevent constipation Discourage driving/ operating mechanical equipment |
| Opioids (MISC) | Long term leads to tolerance require increasing doses Addiction can occur but not with short term use Naloxone is opioid antagonist that is used to reverse the effects when severe respritary depression occurs |
| Opioids (MISC Cont.) | Naloxone Side Effects: tachycardia, ventricular dissarythmias, hypertension, vomiting and tremors. Can be given IV,IM,SQ Administer every 3-5 mins until respiratory depression resolves. Drug effects last 60-90 mins respiratory depression can reoccur |
| Beta Blocker (Action) | Block beta- adrenergic receptors (B1-heart B2-lungs) decrease HR and force of contraction, reduces renin which decreases angiotensin resulting in vasodilation. |
| Beta Blocker (Use) | Hypertension, Tachy-arrhythmias, Post Heart Attack, Heart Failure |
| Beta Blocker(Drugs) | Suffix- olol Atenolol Carvedilol Metoprolol Proprantolol |
| Beta Blockers (Side Effects) | Bradycardia Hypotension Palpitations A-V Block (Heart block- causes heart to beat slowly or skip beats) Impotence Insomnia Bronchospasm (frequent coughing or wheezing) Can mask hypoglycemia |
| Beta Blockers(Interventions) | Check HR & BP prior to admin HOLD if HR is less than 60 and notify MD Fall precautions for orthostatic hypotension Monitor blood sugar in diabetics Never stop taking beta blockers suddenly can cause rebound hypertension( BP spikes hard to lower) |
| Beta Blocker(MISC) | Contraindicated in asthmatics because of bronchospasms |
| ACE Inhibitors (Action) | Angiotensin- converting enzyme blocks ACE in lungs from converting angiotensin I to angiotensin II. Results in vasodilation & excretion of NA, H2O, and retention of K+ in kidneys. |
| ACE Inhibitors (Use) | Hypertension, Heart Failure, Myocardial Infraction (Heart Attack) |
| ACE Inhibitors(Drugs) | Suffix- pril Captopril Enalapril Lisinopril |
| ACE Inhibitors (Side Effects) | Dry mouth, Dry cough Hyperkalemia (3.5-5.3) Angioedema ( swelling around face and lips) Neutropenia ( low neutrophils WBC) Orthostatic Hypotension |
| ACE Inhibitors (Interventions) | Check B/P prior to admin Fall precautions for orthostatic hypotension Monitor BUN (5-20) Creatinine (0.5-1.5) Monitor NA & K+ levels |
| ACE Inhibitors (MISC) | NSAIDs reduce the effects of ACE Inhibitors so avoid OTC drugs, esp cough cold allergy meds that contain NSAIDs Advise pt to avoid salt subsitutes |
| Calcium Channel Blockers (Action) | Block the movement of calcium across the myocardial and arterial muscle membrane. Results in decrease in HR and force of contraction (decrease in myocardial O2), and vasodilitation |
| Calcium Channel Blockers (Use) | Hypertension Tachy-arrhythmias Heart Failure Angina (chest pain caused by vasospasm) TIA (transient ischemic attack)mini stroke resulting from cerebral vasospasm |
| Calcium Channel Blockers (Drugs) | Suffix- "pine" **Diltazem amlodipine nifedepine verapamil |
| Calcium Channel Blockers (Side Effects) | Bradycardia Hypotension Palpitations Headache Flushing Edema |
| Calcium Channel Blockers (Interventions) | Check HR & BP prior to admin, HOLD if HR lower then 60 bpm notify MD Falls precautions for orthostatic hypotension |
| Calcium Channel Blockers (MISC) | Avoid Grapefruit |
| Cardiac Glycosides (Action) | Increase Intercellular calcium results increase force of myocardial contraction, increase renal perfusion and decreases HR. |
| Cardiac Glycosides (Use) | Heart Failure A-Fib (Atrial Flutters) |
| Cardiac Glycosides (Drugs) | Digoxin |
| Cardiac Glycosides (Side Effects) | Bradycardia Orthostatic Hypotension Digoxin toxicity (higher then 2, nausea vomiting, weakness, blurred vision, green and yellow halos around lights) |
| Cardiac Glycosides (Interventions) | Monitor apical pulse for 1 min before giving, hold if lower then 60 Monitor for signs of digoxin toxicity Monitor K+ and calcium levels Monitor BUN and creatinine levels Monitor digoxin levels (therapeutic levels 0.5-0.8) |
| Cardiac Glycosides (MISC) | Teach pt to check pulse everyday Hypokalemia increases digoxin toxicity |
| What are the BUN levels? | 5-20 |
| What are the creatinine levels? | 0.5-1.5 |
| What are the normal K+ levels? | 3.5-5.3 |
| What are the normal platelet count? | 150,000-400,000 |
Created by:
cberna00
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