Comprehensive Guide: Medications' Uses, Side Effects, Contraindications, Interactions, Study Guides, Projects, Research of Nursing

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NURS350: PHARMACOLOGY FINAL EXAM STUDY GUIDE CONCEPTS: Rights of Medication Administration Medication Errors Drug Classification Drug Tolerance - Body develops a physiological tolerance to the drug over time and higher doses of the drug are needed to produce a therapeutic effect Resistance and Dependence - Resistance: commonly occurs with abx, usually due to overuse or misuse - Dependence: body develops a physiological need for the drug to avoid withdrawal Nursing Process - Assessment - Diagnosis - Planning - Implementation - Evaluation Adrenergic and Cholinergic Drugs - Adrenergic drugs → sympathetic NS receptors - Sympathetic NS: increase HR, increase BP, tachycardia, decreased urine production, dry eyes - Cholinergic drugs → parasympathetic NS receptors - Parasympathetic NS: decrease HR, decrease BP, bradycardia, increased urine production Eye Drops - Cycloplegic eye drops → produce mydriasis (pupil dilation) for eye exams and to allow for greater outflow of AH to lower IOP - Cholinergic eye drops → produce miosis (pupil constriction) to stretch the trabecular meshwork to allow for greater outflow of AH to lower IOP - Adverse effects: headache, induced myopia, and decreased vision in low light - Example: pilocarpine (Isopto-Carpine) - Mydriatic eye drops → cause pupil dilation - Miotic eye drops → cause pupil constriction - Beta-blocker eye drops → decrease production AH to lower IOP - Contraindicated for patients with asthma or HF - Example: timolol (Betimol) Use of Probiotics - Used to maintain normal flora in the body during abx use to avoid secondary infections (ex. yeast infection, candidiasis) Antacids → provide temporary relief from heartburn or indigestion - Aluminum compounds → constipation - Calcium compounds → constipation - Magnesium compounds → diarrhea Vitamin B12 - Vitamin supplement for pernicious anemia or absence of intrinsic factor Use of Neuromuscular Agents Risk for Hormone Replacement Therapy and Contraceptives IV Fluid Therapy for: restoration of fluids and electrolytes, shock, sepsis, maintain BP Acetaminophen (Tylenol) - Pharmacologic Class: centrally-acting COX inhibitor - Therapeutic Class: antipyretic, nonopioid analgesic - Uses: mild to moderate pain, fever, opioid combination - Mechanism of Action: directly acts upon the hypothalamus to cause dilation of peripheral blood vessels, which enables sweating and dissipation or heat - Adverse Effects: uncommon at therapeutic doses, risk of acetaminophen poisoning increases with long-term use: anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, abd pain, diarrhea, hepatotoxicity, neutropenia, CKD - Contraindications: alcoholics, patient with liver disease - Interactions: other anticoagulants - Nursing Considerations: - Use caution when dosing for children - Monitor liver function studies - Pregnancy Category: B Albuterol (Proventil ) - Pharmacologic Class: beta-2 adrenergic agonist (short-acting) - Therapeutic Class: bronchodilator - Uses: termination of acute bronchospasms (prn treatment, not prophylactic treatment) - Mechanism of Action: SABA that facilitates mucus drainage to inhibit the release of inflammatory chemicals from mast cells to cause relaxation bronchial smooth muscle, resulting in bronchodilation - Adverse Effects: anticholinergic effects, palpitations, headaches, throat irritation, tremor, nervousness, restlessness, tachycardia, hypokalemia, hyperglycemia, insomnia, dry mouth, chest pain, anaphylaxis - Contraindications: patient with CVD, CAD, HTN - Interactions: use with beta-blockers, MAOIs - Nursing Considerations: - Instruct the client on proper use of the inhaler - Monitor intake and output - Relieve dry mouth symptoms - Monitor respiratory and cardiac function - Pregnancy Category: C Acyclovir (Zovirax) - Pharmacologic Class: nucleoside analog - Therapeutic Class: antiviral for herpes virus - Uses: herpes virus (HSV-1, HSV-2, CMV, varicella zoster) - Mechanism of Action: prevents viral DNA synthesis to decrease the frequency, duration and severity of acute herpes episodes - Adverse Effects: nephrotoxicity and neurotoxicity (IV forms), drug resistance - Contraindications: - Interactions: other nephrotoxic drugs - Nursing Considerations: - When given IV, painful inflammation of vessels at the infusion site may occur - Administer around the clock, as ordered, even if sleep is interrupted - Administer with food - Monitor for neurotoxicity (drowsiness, dizziness, tremors, headache, confusion, changes in LOC, and seizures) - Monitor kidney function tests - Monitor intake and output - Monitor for infection as patient is immunocompromised - Pregnancy Category: C Doxycycline (Vibramycin) - Pharmacologic Class: tetracycline antibiotic - Therapeutic Class: broad-spectrum antibiotic - Uses: topical preparation for acne therapy (topically or PO at low doses) - Mechanism of Action: inhibit bacterial protein synthesis by binding to the bacterial ribosome - Adverse Effects: rash, stinging or burning with topical preparations, photosensitivity, yellow teeth discoloration, GI upset, fetal bone growth reduction, superinfections - Contraindications: - Interactions: PO preparations should not be taken with milk or iron supplements - Nursing Considerations: - Monitor for signs of superinfection - PO preparations should not be taken with milk or iron supplements - Pregnancy Category: D Beta-blockers (“-olol”) - Atenolol (Tenormin) - Pharmacologic Class: beta-1 adrenergic blocker (cardioselective) - Therapeutic Class: drug for angina, MI and HTN - Uses: hypertension (HTN), angina, acute MI - Mechanism of Action: inhibits beta-1 receptors in the heart to cause decrease in HR, contractility and BP - Adverse Effects: orthostatic hypotension, fatigue, weakness, bradycardia, hypotension - Contraindications: patients with severe bradycardia or hypotension - Interactions: CCBs, digoxin, antihypertensives - Nursing Considerations: - Assess BP before, during and after administration - Hold medication if pulse is below 60bpm or if the patient is hypotensive - Instruct patient to move positions slowly - Pregnancy Category: - Overdose treatment: Atropine can be used to reverse bradycardia and hypotension - Propranolol (Inderal) - Pharmacologic Class: beta-1and beta-2 adrenergic blocker (antagonist) - Therapeutic Class: class II antidysrhythmic - Uses: hypertension (HTN), dysrhythmias (tachycardia), heart failure (HF) - Mechanism of Action: inhibits beta-1 receptors in the heart and beta-2 receptors in pulmonary and vascular smooth muscle to cause decrease in HR, contractility, and BP - Adverse Effects: orthostatic hypotension, fatigue, bradycardia, diminished libido, hypoglycemia, dysrhythmias with kidney disease - Contraindications: patients with cardiogenic shock, sinus bradycardia, or heart block - Interactions: other beta-blockers, CCBs, MAOIs, antacids, albuterol - Nursing Considerations: - Assess BP before, during and after administration - Hold medication if pulse is below 60bpm or if the patient is hypotensive - Instruct patient to move positions slowly - Monitor glucose levels due to ability to mask hypoglycemia - Monitor kidney function studies - Pregnancy Category: C - Overdose treatment: Atropine can be used to reverse bradycardia and hypotension Corticosteroids (including inhalants) → NPA pg. 479 - Beclomethasone (Qvar) → inhaled - Pharmacologic Class: inhaled corticosteroid - Therapeutic Class: anti-inflammatory drug for asthma and allergic rhinitis - Uses: asthma management (inhalant), allergic rhinitis (nasal spray) - Mechanism of Action: reduce respiratory inflammation - Adverse Effects: hoarseness, dry mouth, changes in taste, oral candidiasis, cataract development, growth inhibition - Contraindications: acute asthma attacks, monitor pediatric patients carefully - Interactions: unknown - Nursing Considerations: - Monitor for corticosteroid toxicity - Monitor for infection as steroid can mask signs on infections - Administer after albuterol treatment - Pregnancy Category: C Digoxin (Lanoxin) - Pharmacologic Class: cardiac glycoside - Therapeutic Class: drug for heart failure - Uses: HF, dysrhythmias - Mechanism of Action: inhibits Na+-K+ ATPase to cause an increase in Na+ and release of Ca+ to ultimately increase the force of contractility and increase cardiac output to alleviate symptoms of HF and improve exercise tolerance; improved cardiac output results in increased urine production and a desirable reduction in blood volume, relieving distressing symptoms of pulmonary congestion and peripheral edema - Adverse Effects: dysrhythmias, nausea, vomiting, fatigue, anorexia, visual disturbances - Contraindications: patients with AV block or ventricular dysrhythmias unrelated to HF - Interactions: use with diuretics can cause hypokalemia, use with ACE inhibitors, spironolactone, or potassium supplements can lead to hyperkalemia, use with antacids or cholesterol-lowering drugs decrease absorption of digoxin - Nursing Considerations: - Assess apical pulse for 1 full minute prior to administration - Check recent serum digoxin levels prior to administration to ensure therapeutic levels - Monitor digoxin use in geriatric and pediatric patients - Pregnancy Category: A Opioid antitussives - Codeine & hydrocodone and homatropine - Pharmacologic Class: opioid antitussive - Therapeutic Class: antitussive - Uses: cough suppression - Mechanism of Action: raise the cough threshold in the CNS to suppress cough reflex - Adverse Effects: nausea, vomiting, constipation, confusion, dizziness, sedation, hypotension, seizures, bradycardia, respiratory depression - Contraindications: use with caution in patients with asthma due to risk for bronchoconstriction - Nursing Considerations: - Do not use in patients younger than 18 years old - Monitor respiratory function and heart rate - Increase intake of fiber and fluids to decrease constipation - Assess for fall risk Metoclopramide (Reglan) - Pharmacologic Class: phenothiazine - Therapeutic Class: antiemetic - Uses: prevention of nausea and vomiting, peptic ulcer disease symptoms - Mechanism of Action: inhibit dopamine or serotonin receptors in the brain - Adverse Effects: anticholinergic effects: dry eyes, blurred vision, dry mouth, constipation, drowsiness; photosensitivity, agranulocytosis - Nursing Considerations: - Monitor intake and output - Relieve anticholinergic side effects (ice chips, hard candies, increased fluid intake) Diphenoxylate with atropine (Lomotil) - Pharmacologic Class: opioid - Therapeutic Class: antidiarrheal - Uses: severe diarrhea in patients 13 and older - Mechanism of Action: diphenoxylate slows peristalsis to allow for additional water reabsorption from the colon and more solid stools; atropine has no therapeutic effect but it discourages patients from taking too much of the drug - Adverse Effects: dizziness, drowsiness - Contraindications: patients with jaundice and diarrhea associated with PMC - Interactions: use with CNS depressants, alcohol, MAOIs - Nursing Considerations: - Severe dehydration or electrolyte imbalances should be corrected prior to administration - Instruct patient not to operate heavy machinery until adverse effects are known - Pregnancy Category: C - Overdose treatment: naloxone (Narcan) Levodopa, carbidopa and entacapone (Stalevo) - Pharmacologic Class: dopamine precursor, dopamine-enhancing drug combination - Therapeutic Class: drug for Parkinson’s - Uses: Parkinson’s symptoms of tremor, bradykinesia, gait, muscle rigidity - Mechanism of Action: restores dopamine balance in the brain - Adverse Effects: uncontrolled movements, loss of appetite, nausea, vomiting, orthostatic hypotension, psychosis - Contraindications: patients with narrow-angle glaucoma, suspicious lesions, melanoma - Interactions: MAOIs, antihypertensives, anticonvulsants, antacids - Nursing Considerations: - Assist patient with administration if needed - Abrupt withdrawal can result in Parkinson’s symptoms - Pregnancy Category: C Medroxyprogesterone (Depo- Provera) - Pharmacologic Class: progestin - Therapeutic Class: hormone; drug for dysfunctional uterine bleeding - Uses: uterine bleeding, endometriosis, amenorrhea, contraception - Mechanism of Action: inhibits effect of estrogen in the uterus to restore normal hormonal balance in the endometrial tissues - Adverse Effects: breast tenderness, breakthrough bleeding, weight gain, depression, HTN, nausea, vomiting, vaginal candidiasis, thromboembolic events, loss of bone density - Contraindications: pregnant or lactating women, patients with thromboembolic risk, hepatic impairment or depression - Interactions: carbamazepine, barbiturates, primidone, rifampin, azole antifungals - Nursing Considerations: - Can be administered PO, IM or SQ - Give PO with meals to avoid gastric distress - Injections provide 3 months of contraceptive protection - Observe IM sites for abscess - Record and monitor weight - Pregnancy Category: X Benzodiazepines - Diazepam (Valium) - Pharmacologic Class: benzodiazepine, GABA-A receptor agonist - Therapeutic Class: antiseizure drug - Uses: epilepsy, seizures (except absent) - Mechanism of Action: binds to GABA receptor chloride channels in the CNS to suppress abnormal neuronal activity - Adverse Effects: with IV: hypotension, muscle weakness, tachycardia, respiratory depression - Contraindications: patients with glaucoma, shock, coma, depressed vital signs, obstetrical patients, and infants less than 30 days of age - Interactions: MAOIs, alcohol, other CNS depressants, oral contraceptives, valproic acid, levodopa, barbiturates, phenytoin - Nursing Considerations: - During IV administration, assess respirations every 5-15 minutes Potassium chloride (KCl) - Pharmacologic Class: electrolyte, potassium supplement - Therapeutic Class: drug for hypokalemia - Uses: prevention or treatment of hypokalemia - Mechanism of Action: replenishes potassium in the body - Adverse Effects: nausea, vomiting (PO), phlebitis and venous irritation (IV), hyperkalemia, CKD - Contraindications: use extreme caution with potassium-sparing diuretics, patient with hyperkalemia, CKD, systemic acidosis, severe dehydration, extensive tissue breakdown as in severe burns, adrenal insufficiency - Interactions: potassium-sparing diuretics, ACE inhibitors - Nursing Considerations: - Dilute with water due to risk of causing peptic ulcer - Administer IV slowly to decrease heart overload and cardiac arrest (do not exceed 10 mEq/hr) - Be cautious of IV infiltration and extravasation - Give PO med when patient is sitting upright to prevent esophagitis - Can be given with antacid to avoid GI upset - Do not crush or chew tablets - Monitor kidney function studies - Monitor intake and output - Usually used with patients taking loop or thiazide diuretics due to K+ depletion - Pregnancy Category: A Somatotropin (Accretropin) - Pharmacologic Class: growth hormone - Therapeutic Class: hormone replacement - Uses: hypersecretion of growth hormone from the pituitary, short stature in children - Mechanism of Action: stimulates the growth and metabolism of nearly every tissue in the body through DNA recombination - Adverse Effects: hyperglycemia, thyroid dysfunction - Contraindications: patients with closed epiphyses - Nursing Considerations: - Monitor glucose levels - Monitor thyroid function studies - Usually given by SQ route Desmopressin (DDAVP) - Pharmacologic Class: ADH analog - Therapeutic Class: drug for diabetes insipidus and nocturia - Uses: treatment of diabetes insipidus; management of bleeding patient with hemophilia A - Mechanism of Action: acts on the kidneys to increase reabsorption of water to control acute symptoms in DI who have insufficient ADH secretion - Causes contraction of smooth muscle in the vascular system, uterus and GI system and also increases clotting factor for management of bleeding - Adverse Effects: water intoxication symptoms (headache, drowsiness, convulsions, coma), headache, nausea, mild abd pain, hypertension - Contraindications: patient with DI due to kidney disease, use cautiously in patients with CAD and HTN - Interactions: chlorpropamide, NSAIDs, lithium, heparin, epinephrine, alcohol - Nursing Considerations: - PO route is preferred - Check serum sodium concentration is normal before administration - Give at night due to ability to lower urine production and prevent nocturia - During IV administration, monitor for swelling at IV site - After IV injection, fluids must be restricted and carefully monitored - Monitor weight, intake and output - Monitor blood pressure and pulse - Monitor electrolytes, kidney function studies, specific gravity - Assess neurological status for headache or changes in mental status - Instruct patients to avoid alcohol - Pregnancy Category: B - Overdose treatment: water restriction, osmotic diuretics Antidiuretic hormone (ADH) - aka Vasopressin - Secreted from the posterior pituitary when hypothalamus detects a decrease in plasma volume or when osmolality of the blood has increased too much - ADH secretion stops when serum osmolality levels return to normal - Maintains fluid homeostasis by acting on the collecting ducts in the kidneys to increase water reabsorption - Also called vasopressin due to its ability to constrict blood vessels and raise BP - Deficiency in ADH results in diabetes insipidus - Diabetes insipidus (DI): a rare condition characterized by the production of large volumes of very dilute urine, accompanied by increased thirst and polyuria - Desmopressin (DDAVP) is the most common drug for treating DI - Vasopressin (Vasostrict) is a synthetic drug with a structure identical to that of human ADH that may be used off-label for DI Levothyroxine (Synthroid) - Pharmacologic Class: thyroid hormone replacement (synthetic form of T4) - Therapeutic Class: thyroid hormone - Uses: hypothyroidism - Mechanism of Action: same as those of thyroid hormone (loss of weight, improved tolerance to environmental temperature, increased activity, and increased pulse rate) - Adverse Effects: hyperthyroid symptoms (palpitations, dysrhythmias, anxiety, insomnia, weight loss, and heat intolerance), menstrual irregularities, osteoporosis - Contraindications: patient with thyrotoxicosis, CVD, MI, adrenal insufficiency, HTN, CKD - Interactions: cholestyramine, colestipol, epinephrine, norepinephrine, warfarin (Coumadin), soy products, calcium and iron supplements - Nursing Considerations: - Doses are highly individualized for each patient - Periodic monitoring of thyroid function is necessary (serum TSH, T3, T4) - Administer the medication at the same time every day, preferably in the morning - Assess weight and vital signs - Assess for tachycardia, irregular heart rate, HTN - Assess anxiety or nervousness - Monitor renal function - Monitor for excess fatigue, slow speech, hoarseness or slow pulse (may indicate underdosage) - Pregnancy Category: A Radioactive iodine (RI) - (I-131) - Pharmacologic Class: radioactive antithyroid drug - Therapeutic Class: antithyroid drug - Uses: hyperthyroidism, Grave’s disease - Mechanism of Action: kills overactive thyroid cells - Adverse Effects: Nausea, rash, pruritus, weight gain, headache, fever, numbness in fingers, leukopenia, diarrhea, hypothyroidism, granulocytosis, bradycardia - Nursing Considerations: - Patients may become hypothyroid and require levothyroxine therapy - Patients must be quarantined for a few days following therapy - Patient should be on a low-iodine diet 2-3 weeks prior to RI therapy ZOOM FINAL REVIEW NOTES - What predisposes medication errors? - Ibuprofen vs. Aspirin vs. Acetaminophen - Ibuprofen → NSAID for mild to moderate pain, fever, inflammation - Aspirin → no longer used as NSAID, used primarily for anticoagulant effects - Acetaminophen → non-NSAID for mild-moderate pain, fever - Drug tolerance vs. drug dependence - Drug tolerance: body builds up tolerance so a higher dose is needed to achieve therapeutic effect - Drug dependence: body has physiological need for the drug and abrupt discontinuation can cause symptoms of withdrawal - Proventil (Albuterol) → bronchodilator for acute bronchospasm - Steroid inhalers → bronchodilator for prophylactic bronchospasm treatment - Antibiotic resistance → occurs due to overuse or improper use of antibiotics - Acyclovir (Zorivax) → hepatotoxic adverse effect - Cyclopledgic eye drops → dilate pupils for eye examinations - Eye drop administration → drop into lower conjunctival sac; occlude lacrimal duct to avoid systemic absorption - Adrenergic drugs → sympathetic NS receptors - Cholinergic drugs → parasympathetic NS receptors - Beta-blockers → used for HTN and dysrhythmias (lowers HR and BP) - Folic acid → important during pregnancy to avoid neural tube defects - Vitamin B12 → used for patient with pernicious anemia and those with GI bypass surgery due to absence of intrinsic factors - Steroids → mask hyperglycemia, increases risk for infection, decreases bone density - Topical corticosteroids → for itching and inflammation on the skin - Statins → rhabdomyolysis adverse effect - Hydrochlorothiazide → thiazide diuretic → may cause hypokalemia and electrolyte imbalances - Coumadin → used in patient with afib or coagulant disorders → increase vitamin K intake - Diphenhydramine → antihistamine → causes drowsiness and anticholinergic effects - Opioids → constipation adverse effect (increase fluid and fiber intake), anticholinergic effects, respiratory depression - Naloxone (Narcan) as antidote - Inhaler use: administer albuterol first, corticosteroid second (risk for oral candidiasis) - Metoclopramide (Reglan) → antacid for nausea, short-term use only - Probiotics → use with antibiotics to maintain normal flora in the body - MAOIs → avoid foods with tyramine (may cause HTN crisis) - Contraceptives → smoking increases clotting risk, antibiotics may lower efficacy of contraceptives - Metabolic acidosis treatment → use sodium bicarbonate (IV administration in clinical setting) - Kayexalate → treatment for hyperkalemia; binds with potassium and stool to promote excretion - IV fluid replacement therapy used for: - Restoration of fluids and electrolytes - Patients with shock - Patients with sepsis - Maintain BP - Isotonic, hypertonic and hypotonic solutions - Antidiuretic hormone (ADH) → diabetic med (Desmopressin) - Hypothyroidism → levothyroxine (Synthroid) treatment - Hyperthyroidism → propylthiouracil (PTU), methimazole (Tapazole), RI for treatment - Propylthiouracil (PTU) and methimazole (Tapazole) act by inhibiting the incorporation of iodine atoms into T3 and T4 - Methimazole (Tapazole) is the preferred drug because it offers the advantage of less frequent dosing and has fewer adverse effects - Propylthiouracil (PTU) is preferred during the first trimester of pregnancy for the treatment of thyroid storm and when a patient is unable to tolerate methimazole - Insulin - IV: humulin R (regular insulin) only - Sulfonaureas → hepatotoxic, avoid use with alcohol - 5 Math Questions