HIS 2590 Pharmacology Proctored ATI Study Guide Updated 2022-2023, Exams of Nursing

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HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 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  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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  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 HIS 2590 Pharmacology Proctored ATI Study Guide Chapter 8: Depressive Disorders (repeat basically)  SSRIs o Fluoxetine  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), 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  Other atypical antidepressants o Trazodone – sedation is a potential problem*  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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: HIS 2590 Pharmacology Proctored ATI Study Guide  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 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 HIS 2590 Pharmacology Proctored ATI Study Guide 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  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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide a. Blood glucose 150 mg/dL b. Urine output 40 mL/hr c. Dyspnea d. 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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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) HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide 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 HIS 2590 Pharmacology Proctored ATI Study Guide  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 HIS 2590 Pharmacology Proctored ATI Study Guide  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  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