Pharm Exam 1 Meds .docx

Pharm Exam 1 Meds Upper Respiratory diphenhydramine (Benadryl) (1st generation) Drug Class: H1 receptor antagonists (antihistamines) H1 Blocker Competes with histamine for receptor sites and prevents a histamine response By blocking the H1 receptor sites, nasopharyngeal secretions...

Pharm Exam 1 Meds Upper Respiratory diphenhydramine (Benadryl) (1st generation) Drug Class: H1 receptor antagonists (antihistamines) H1 Blocker Competes with histamine for receptor sites and prevents a histamine response By blocking the H1 receptor sites, nasopharyngeal secretions are decreased Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching allergic rhinitis pruritus - itching urticaria common cold sneezing cough prevent motion sickness Insomnia Drowsiness dry mouth urinary retention constipation blurred vision dizziness confusion narrow-angle glaucoma Severe liver disease Metabolized in the liver Paradoxical CNS stimulation Older adults Warn the patient to avoid driving a motor vehicle and performing dangerous activities until stabilized on the drug Advise the patient to avoid alcohol and other CNS depressants. Opioids, Hypnotics, Barbiturates, MAOIs Suggest use of sugarless candy, gum, or ice chips for relief of mouth dryness Warn patients of urinary retention, dry mouth, & constipation Give with food to decrease gastric distress. Upper Respiratory cetirizine (Zyrtec) (2nd generation) Drug Class: H1 receptor antagonists (antihistamines) H1 Blocker Competes with histamine for receptor sites and prevents a histamine response By blocking the H1 receptor sites, nasopharyngeal secretions are decreased Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching allergic rhinitis urticaria drowsiness dizziness confusion narrow-angle glaucoma Severe liver disease Warn the patient to avoid driving a motor vehicle and performing dangerous activities until stabilized on the drug Advise the patient to avoid alcohol and other CNS depressants. Opioids , Hypnotics, Barbiturates, MAOIs, & alcohol Suggest use of sugarless candy, gum, or ice chips for relief of mouth dryness Warn patients of urinary retention, dry mouth, & constipation Give with food to decrease gastric distress. Upper Respiratory fluticasone (Flornase) Drug Class: Intranasal corticosteroids Anti-inflammatory Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Seasonal or perennial allergies Allergic rhinitis non-allergic rhinitis asthma hoarseness epistaxis may cause holes or ulcers in the cartilage of the nose delay wound healing Avoid use in patients with recent nasal ulcers, nasal surgery, or nasal trauma Short term use: this is to prevent the risk for systemic complications. Must take medication as directed. Preferred route is intranasal Good for treating Rhinitis. Upper Respiratory Decongestants Stimulate alpha-adrenergic receptors Affects alpha and beta receptors Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching allergic rhinitis hay fever sinusitis increased blood pressure Increased blood glucose heart palpitations nervous restless rebound nasal congestion if prolonged use hypertension cardiac disease Caffeine/tea MAOIs Beta blockers Tell patient to maintain adequate fluid intake. Inform patient that blood pressure can increase with this medication Monitor vital signs. Blood pressure can become elevated when a decongestant is taken, and dysrhythmias can also occur. PO will cause systemic side effects sprays and drops are preferred to due to less risk of systemic side effects Caution patient not to prolong use of drug to avoid rebound congestion. Observe the color of bronchial secretions. Teach patient the proper use of nasal sprays Inform patient that common cold and flu viruses are transmitted frequently by hand-to-hand contact or by touching a contaminated surface. Tell patient that medication may be limited when picking up at pharmacy Upper Respiratory Dextromethorphan hydrobromide (Robitussin DM) Drug Class: Antitussives Stops coughing by blocking the cough reflex in the medulla (cough control center) Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Non-productive cough/dry cough Common cold drowsiness dizziness headache nausea contraindicated w/ COPD Tell patients that hypotension and hyperpyrexia may occur when dextromethorphan is taken with MAOIs. Monitor vital signs. Provide adequate hydration. Observe for side effects. Lower Respiratory albuterol (Proventil) (Ventolin) Rescue Short-acting beta agonists (SABA) Drug Class: bronchodilators Sympathomimetic Beta2-Adrenergic Agonists Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Asthma COPD exercise-induced asthma ↑ heart rate hypertension feeling of nervousness bronchospasm if used to frequently dysrhythmias dry mouth difficulty sleeping heart failure cardiac disease hypo/hyperthyroidism diabetes mellitus seizures Monitor the number of times a day patient is using short acting RESCUE inhalers If using albuterol frequently it might indicate asthma is not well controlled Use bronchodilator before using anti-inflammatory just wait 5 minutes between use Monitor vital signs. Provide adequate hydration. Observe for side effects. Administer medication at regular intervals around the clock to have a sustained therapeutic level. Advise patient having asthmatic attacks to wear an identification bracelet or MedicAlert tag. Teach patients to carry rescue inhaler Lower Respiratory salmeterol (Serevent) Long-acting beta agonists (LABA) Drug Class: Bronchodilators Sympathomimetic Beta2-Adrenergic Agonists Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching asthma COPD exercise-induced bronchospasm prophylaxis rapid heart rate increased BP feeling of nervousness dysrhythmia heart failure cardiac disease DO NOT USE LONG-ACTING AS RESCUE INHALERS Monitor vital signs. Provide adequate hydration. Observe for side effects. Administer medication at regular intervals around the clock to have a sustained therapeutic level. Advise patient having asthmatic attacks to wear an identification bracelet or MedicAlert tag. Teach patients to carry rescue inhaler Lower Respiratory tiotropium (Spiriva) Cholinergic antagonists (anticholinergic) Drug Class: Bronchodilators Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Maintenance treatment of bronchospasms associated with COPD Occasionally used as alternative to beta-agonists in asthma therapy dry mouth headache hyperglycemia constipation peripheral edema oral ulceration insomnia cardiac dysrhythmias depression narrow-angle glaucoma cardiac dysrhythmias Capsule is used in inhaler Keep capsule in package until ready to use Long acting: This drug is NOT to be used as a rescue inhaler Teach patients to carry rescue inhaler Monitor vital signs. Provide adequate hydration. Observe for side effects. Administer medication at regular intervals around the clock to have a sustained therapeutic level. Advise patient having asthmatic attacks to wear an identification bracelet or MedicAlert tag. Lower Respiratory theophylline (Theodur) Methylxanthines Drug Class: Bronchodilators Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Primarily used for long-term prophylaxis of asthma that is unresponsive to beta agonists or corticosteroids nausea vomiting CNS stimulation tachycardia palpitations restlessness insomnia nervousness anxiety Narrow margin of safety Therapeutic range 5-15 mcg/mL Toxicity greater than 20 Interact with numerous drugs Monitor vital signs and blood levels. Observe for side effects. Caffeine derivative = Do not ingest other sources of caffeine w/this IV or PO: used inpatient due to risk of toxicity Lower Respiratory montelukast sodium (Singulair) Drug Class: Leukotriene Inhibitors Also called leukotriene antagonists Prevents airway edema and inflammation by blocking leukotriene receptors in airways, decrease bronchoconstriction Reduce inflammatory component of asthma Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Asthma Exercise induced asthma as a form of prevention- not a rescue medication. Good for kids. Depending on level of activity. Angioedema Steven Johnsons syndrome NSAIDs (e.g. aspirin, ibuprofen) block drug action Monitor respirations for rate, depth, rhythm, and type. Monitor lung sounds for rhonchi, wheezing, or rales. Observe lips and fingernails for cyanosis. Encourage patient to stop smoking. Monitor depression Advise patients who have frequent or severe asthmatic attacks to wear an identification bracelet or MedicAlert tag Educate patient to Take 2 hours before exercise Do not use as a rescue inhaler Lower Respiratory beclomethasone (Beconase) Inhaled corticosteroids Drug Class: Anti-inflammatory agents-corticosteroids (glucocorticoids) Decreases inflammation in respiratory system Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching allergic rhinitis asthma candidiasis dysphonia hoarseness dry mouth throat irritation headache hyperglycemia ocular hypertension Cataracts or. Glaucoma—Use with caution. May make these conditions worse. This medicine may cause fungus infection of the mouth or throat (thrush). Glucocorticoids can irritate the gastric mucosa and should be taken with food to avoid ulceration. This drug does not replace fast-acting inhalers for sudden symptoms. Do not rely on drugs alone Monitor for infection Monitor for blood glucose levels Take even with absence of symptoms Rinse mouth to decrease bad taste, dryness, and fungal infection if inhaled Inhaled is more specific so can be done for longer less systemic effect than oral or IV IV/PO = For short term use Inhaler = Prevention of Exacerbation Give bronchodilator first and wait at least 5 min Diabetes: chronic disease results from deficient glucose metabolism   Type 1: Insulin dependent  Type 2: Insulin resistant   Major symptoms: 3 P’s (polyuria, polydipsia, polyphagia)     Insulin lispro (Humalog) (clear)  Drug Class: Rapid-Acting Insulin   Onset of action (10-30 minutes) Peak (30 minutes to 90 minutes) Duration (3 to 5 hours) Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 1 diabetes     Hypoglycemia   Confusion Irritable or nervous Excessive sweating Tiredness, lightheadedness Feeling dizzy and weak pale, cold, clammy skin ↑ HR Lipohypertrophy Weight gain Hypersensitivity to insulin   Stress   Older adults  Altered nutrition   Monitor the patient’s HbA1c to provide feedback of diabetic control.  Determine blood glucose levels and report changes  Teach patient to recognize and report hypoglycemia and hyperglycemia  Teach patient how to administer insulin  Advise patient that hypoglycemic reactions are more likely to occur during peak action time  Always carry a carbohydrate snack  Don’t inject cold insulin    Check BS before and sometimes after administration Review drugs that can cause increase or decrease in BS when giving meds Double-check type of insulin and dose with another nurse    Regular Human Insulin (Human R) (clear)  Drug Class: Short-Acting Insulin   Onset of action (30 to 60 minutes)  Peak (1.5 to 3.5 hours)  Duration (5 to 7 hours)  Primary use: short-acting insulin, with an onset of 30–60 minutes, a peak effect at 2–3 hours, and a duration of 5–7 hours to quickly decrease blood glucose Also for emergency management of ketoacidosis Mechanism of action: promotes entry of glucose into cells Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 1 Diabetes Hypoglycemia   Confusion Irritable or nervous Excessive sweating Tiredness, lightheadedness Feeling dizzy and weak pale, cold, clammy skin ↑ HR Lipohypertrophy Weight gain Hypersensitivity to insulin   Stress   Older adults  Altered nutrition     Monitor the patient’s HbA1c to provide feedback of diabetic control.  Determine blood glucose levels and report changes  Teach patient to recognize and report hypoglycemia and hyperglycemia  Teach patient how to administer insulin  Advise patient that hypoglycemic reactions are more likely to occur during peak action time  Always carry a carbohydrate snack  Don’t inject cold insulin    Check BS before and sometimes after administration Review drugs that can cause increase or decrease in BS when giving meds Double-check type of insulin and dose with another nurse Humulin N (cloudy)  Drug Class: Intermediate- Acting Insulin   Onset of action (1.5 hours)  Peak (4 to 12 hours)  Duration (24 hours)  Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 1 Diabetes Hypoglycemia   Confusion Irritable or nervous Excessive sweating Tiredness, lightheadedness Feeling dizzy and weak pale, cold, clammy skin ↑ HR Lipohypertrophy Weight gain Hypersensitivity to insulin   Stress   Older adults  Altered nutrition   Monitor the patient’s HbA1c to provide feedback of diabetic control.  Determine blood glucose levels and report changes  Teach patient to recognize and report hypoglycemia and hyperglycemia  Teach patient how to administer insulin  Advise patient that hypoglycemic reactions are more likely to occur during peak action time  Always carry a carbohydrate snack  Don’t inject cold insulin    Check BS before and sometimes after administration Review drugs that can cause increase or decrease in BS when giving meds Double-check type of insulin and dose with another nurse   Insulin Glargine Injection (Lantus)  Drug Class: Long- Acting Insulin  • Onset of action (1.5 hours)  • Duration (24 hours)  • Administered at bedtime  Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 1 Diabetes Hypoglycemia   Confusion Irritable or nervous Excessive sweating Tiredness, lightheadedness Feeling dizzy and weak pale, cold, clammy skin ↑ HR Lipohypertrophy Weight gain Hypersensitivity to insulin   Stress   Older adults  Altered nutrition       Monitor the patient’s HbA1c to provide feedback of diabetic control.  Determine blood glucose levels and report changes  Teach patient to recognize and report hypoglycemia and hyperglycemia  Teach patient how to administer insulin  Advise patient that hypoglycemic reactions are more likely to occur during peak action time  Always carry a carbohydrate snack  Don’t inject cold insulin    Check BS before and sometimes after administration Review drugs that can cause increase or decrease in BS when giving meds Double-check type of insulin and dose with another nurse   Glipizide  Drug Class: Second- generation sulfonylureas  Stimulate pancreatic beta cells to secrete more insulin Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 2 Diabetes Hypoglycemia   Hyponatremia   Blurred vision   N/V/D Weight gain   Nervousness   Tremors   Confusion   Older adults  May have problems monitoring glucose levels  Harder to recognize hypoglycemia   Higher risk of hypoglycemia   Pregnancy/Breastfeeding   Insulin preferred (oral meds may enter breast milk and impact infant)  Administer oral antidiabetics with food to minimize gastric upset  Monitor blood glucose levels and report changes  Teach patient to recognize symptoms of hypoglycemia and hyperglycemia  Teach patient necessity of adherence to diet and drug regimen  Blood cell changes can occur (Decrease in WBC, RBC & Platelets): MONITOR   metformin (Glucophage)  Drug Class: Biguanides   Acts by Sensitizing: increased receptor sensitivity & uptake at cellular level. Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 2 Diabetes   Most side effects are minor and GI  N/V/D Upset stomach   Weakness  Metallic taste in the mouth lactic acidosis (usually patients with HF or RF)       Can not get CT with contrast w/ metformin Instruct patient to take metformin tablets with meals  Direct patient to take drug exactly as prescribed and not to change the dosage or frequency unless instructed.  Stress the importance of following prescribed diet, exercising regularly, controlling weight, and checking blood glucose level  Teach patient how to measure blood glucose level and recognize hyperglycemia and hypoglycemia  Urge him to notify prescriber of abnormal blood glucose level.  Caution patient to avoid alcohol, which can increase the risk of hypoglycemia  Instruct patient to watch for early signs of lactic acidosis, including drowsiness, hyper-ventilation, malaise, and muscle pain, and notify prescriber if such signs develop  Advise patient to expect laboratory monitoring of glycosylated hemoglobin level every 3 months until blood glucose is controlled  Monitor labs/glucose     pioglitazone (Actos) Drug Class: Thiazolidinediones (TZD’s) (insulin-enhancing agents)  Decreases insulin resistance   Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 2 Diabetes Headache  Fluid retention  Weight gain  Hepatoxicity   Pulmonary and peripheral edema  Dizziness  Blurred vision  Contraindicate in class III and IV heart failure     Administer oral antidiabetics with food to minimize gastric upset  Monitor blood glucose levels and report changes  Teach patient to recognize symptoms of hypoglycemia and hyperglycemia  Teach patient necessity of adherence to diet and drug regimen  Does not cause hypoglycemia  Can increase HDL, LDL   Dapagliflozin  Drug Class: Selective Sodium-Glucose transporter  Preventing the kidney from reabsorbing glucose that was filtered from the blood into the urine. Glucose then remains in the urine and is excreted Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 2 Diabetes Side effects  Urinary frequency  Thirst   Weight loss   Adverse effects  Vaginal/urinary tract infections  renal failure/hyperkalemia, increased risk of bladder cancer  Hypotension, hypoglycemia, dehydration     Pediatric    Pregnancy and Breastfeeding   Administer oral antidiabetics with food to minimize gastric upset  Monitor blood glucose levels and report changes  Teach patient to recognize symptoms of hypoglycemia and hyperglycemia  Teach patient necessity of adherence to diet and drug regimen    Semaglutide (Ozempic)  Drug Class: Glucagon-Like Peptide 1 Agonists  Act like the natural gut hormones secreted in response to food in the stomach   Works with insulin to prevent BG levels from becoming too high after meals   Increase the insulin secretion  Decrease in glucagon secretion  Slower rate of gastric emptying   Indication  Side Effects/Adverse Effects  Caution or Contraindications  Nursing Intervention/Teaching  Type 2 Diabetes Headache   Dizziness   Jitteriness   GI distress     Pediatric    Pregnancy and Breastfeeding   Administer oral antidiabetics with food to minimize gastric upset  Monitor blood glucose levels and report changes  Teach patient to recognize symptoms of hypoglycemia and hyperglycemia  Teach patient necessity of adherence to diet and drug regimen        Glucagon   Drug Class: Hyperglycemic Drugs  Glucagon- Hyperglycemic hormone secreted by the alpha cells of the islets of Langerhans in the pancreas  Increase BG by stimulating glycogenolysis   Used to treat insulin-induced hypoglycemia   Indication Side Effects/Adverse Effects Caution or Contraindications Nursing Intervention/Teaching Type 2 Diabetes Nausea   Headache   Blurred vision  Tachycardia   Dizziness     Patients prone to hypoglycemic reactions should keep glucagon in their home   Family members should be educated on how to administer Sub-Q or IM injections