Pharmacology Study Guide PDF

Medication Administration -Pharmacodynamics: interactions between meds and target cells, body systems, and organs to produce effects -Agonists: meds that bind to/mimic receptor activity -Antagonists: meds that block the receptor activity -Partial agonists: act as both -Do not mix meds with enteral f...

Medication Administration -Pharmacodynamics: interactions between meds and target cells, body systems, and organs to produce effects -Agonists: meds that bind to/mimic receptor activity -Antagonists: meds that block the receptor activity -Partial agonists: act as both -Do not mix meds with enteral feedings -Sublingual meds can still be given to patients with an NG tube, just goes in mouth instead Pregnancy Risk Categories -Category A: Safest -Category B: Animal studies show no risk, but not enough data for pregnant women -Category C: Some animal studies have shown adverse effects on fetus -Category D: Evidence of human fatal risk -Category X: Not safe for pregnancy Acetaminophen -Pharmacological action: slows the production of prostaglandins in the central nervous system -Therapeutic uses: relief of pain, reduction of fever -Complications: -Acute Toxicity (nausea, vomiting, diarrhea, sweating, and abdominal discomfort progressing to hepatic failure, coma, and death) -Administer acetylcysteine -Contraindications: pregnancy risk B, liver/kidney impairment, alcohol use disorder, malnutrition -Interactions: alcohol, warfarin -Administration: -With full glass of water, with or without food -Do not exceed 4 g/day -Do not take for more than 10 days Aspirin -Salicylism w/aspirin (tinnitus, sweating, headache, dizziness, respiratory alkalosis) -Notify provider and stop med -Reye’s syndrome -Do not give to children/adolescents when they have chicken pox or influenza -Aspirin Toxicity (sweating, high fever, acidosis, dehydration, electrolyte imbalances, coma, respiratory depression) -MEDICAL EMERGENCY -Give activated charcoal, activate hemodialysis, and gastric lavage -Stop aspirin 1 week before elective surgery or childbirth Amoxicillin-Clavulanate -Pharmacological action: eradication of H. Pylori bacteria -Therapeutic uses: treat otitis media and various other bacterial infections throughout the body -Complications: -Possible allergic reaction -GI upset -Suprainfection (oral candidiasis) -Notify provider -Contraindications: allergy to penicillin or cephalosporins, younger than 3 months -Administration: 2-3 times/day with food Vancomycin -Pharmacological action: destroys bacteria cell wall -Therapeutic uses: treats C.diff, treats other serious infections -Complications: -Ototoxicity (hearing loss) -Notify provider -Infusion reaction -Red man syndrome (related to rapid infusions): rashes, itching, flushing, tachycardia, and hypotension -Administer slowly over 60 mins -IV/IM injection site pain/Thrombophlebitis -Renal toxicity -Contraindications: allergy, renal impairment, hearing loss -Interactions: loop diuretics, ethacrynic acid, aminoglycoside antibiotics Penicillin -Pharmacological action: destroy bacteria by weakening cell wall -Therapeutic uses: pneumonia, meningitis, prophylaxis against bacterial endocarditis -Complications: -Allergies/anaphylaxis -Observe for reaction for 30 mins after administering -Ensure epinephrine and respiratory equipment is nearby -Renal impairment -Hyperkalemia -Dysrhythmias -Hypernatremia -Contraindications: pregnancy, allergies, renal impairment -Interactions: Do not mix penicillin and aminoglycosides in the same IV solution -Probenecid delays the excretion of penicillin -Administration: with 8oz of water 1hr before or 2hr after meals Cephalexin -Pharmacological action: destroy bacterial cell walls -Therapeutic uses: have high therapeutic index that treat a wide variety of infections -Complications: -Allergy/anaphylaxis (urticaria, rash, hypotension, dyspnea) -Notify provider -Bleeding tendencies -Thrombophlebitis -Infuse slowly and dilute over 3-5 mins -Renal insufficiency -Pain with IM injection -Give in ventrogluteal site -Antibiotic-associated pseudomembranous colitis -Observe for diarrhea -Stop med -Interactions: alcohol, probenecid, calcium and ceftriaxone should not be administered together -Administration: take with food Tetracycline -Pharmacological action: prevent protein synthesis -Therapeutic uses: STIs, Lyme disease, rocky mountain spotted fever -Complications: -GI discomfort -Avoid taking at bedtime -Do not take before lying down -Tooth discoloration -Avoid giving to pregnant women and children under 8 -Hepatotoxicity (lethargy, jaundice) -Photosensitivity -Wear sunscreen  -Suprainfection -Contraindications: pregnancy, oral contraceptives, kidney disease, less than 8 years old -Interactions: milk, calcium, iron, magnesium, antacids, digoxin -Administration: on an empty stomach w/water, 1 hr before or 2 hrs after meals Erythromycin -Pharmacological action: slows growth of organisms by inhibiting protein synthesis, but can be bactericidal in high doses -Therapeutic uses: Bordetella pertussis (whooping cough) -Complications: -GI discomfort -Prolonged QT intervals -Ototoxicity with high doses -Contraindications: pregnancy, liver disease, QT prolongation -Interactions: antihistamines, theophylline, warfarin, digoxin -Administration: on empty stomach w/ water, 1 hr before or 2 hr after meals Gentamicin -Pharmacological action: disrupting protein synthesis -Therapeutic uses: amebiasis, tapeworms, tuberculosis, brucellosis -Complications: -Ototoxicity -Nephrotoxicity (proteinuria, casts in the urine, dilute urine, elevated BUN, elevated creatinine) -Monitor BUN and creatinine levels -Report hematuria and cloudy urine -Neuromuscular blockade (resp. despression/muscle weakness)  -Hypersensitivity (Rash, pruritus, paresthesia of hands and feet, urticaria) -Contraindications: kidney impairment, hearing loss, ethacrynic acid -Interactions: skeletal relaxants -Administration: -Once a day dosing: obtain blood sample to measure trough levels -Divided doses: -Peak: 30 min after administration of aminoglycoside IM or 30 min after completion of an IV infusion -TAKE TROUGH BEFORE EACH DOSE Ganciclovir -Pharmacological action: prevents the reproduction of viral DNA and interrupts cell replication -Therapeutic uses: herpes, varicella-zoster (chicken pox), aids/HIV, CMV -Complications: -Suppressed bone marrow -Leukocytes and thrombocytes -Obtain baseline CBC and platelet count -Fever, headache, nausea, diarrhea (report) -Contraindications: pregnancy, dehydration, infants younger than 6 months, renal insufficiency, malignant disorders -Interactions: cytotoxic meds -Administration: IV slowly over 1 hr, oral meds with food Insulin Lispro -Rapid acting -Onset: 15-30 mins -Peak: 0.5-3 hrs -Duration: 3-5 hrs -Can be given by IV Insulin Glargine -Long acting (U-100) -Onset: 1-4 hr -Peak: None -Duration: 24 hr -DO NOT mix with other insulins -DO NOT give by IV Glipizide -Pharmacological action: Insulin release from the pancreas; can increase tissue sensitivity to insulin over time -Complications: -Hypoglycemia -Weight gain -Contraindications: pregnancy, renal failure, heart failure -Interactions: alcohol, NSAIDs, sulfonamide antibiotics, cimetidine, beta blockers -Administration: 30 mins before breakfast, withhold med if patient cannot eat Glucagon -Pharmacological action: increases blood glucose levels by increasing the breakdown of glycogen into glucose -Therapeutic uses: Emergency management of hypoglycemic reactions -Complications:  -GI upset (nausea, vomiting) -Turn clients on their left side following administration to reduce risk of aspiration if emesis occurs -Contraindications: may not be effective if patient is suffering from starvation, caution with cardiovascular disease -Administration: give IM or IV if patient is unconscious, oral glucose once they are conscious and are able to swallow Other Insulin Information -Complications of insulin: -Hypoglycemia (glucose under 70 mg/dL) -Administer glucose - For conscious clients, administer a snack of 15 g carbohydrates, wait 15 mins and administer more if still under 70 mg/ dL. Repeat until glucose is normal. -If the client is not fully conscious administer glucose parenterally (IV glucose) or subcutaneous/IM glucagon. -Hypokalemia -Lipohypertrophy -Rotate injection sites -Contraindications: use w/caution for pregnancy and lactation -Interactions: beta blockers, thiazide diuretics, alcohol -Other info: -Draw up short acting insulin (regular insulin), before long acting insulin (NPH) (clear before cloudy), but you inject air into NPH first -Unopened vials can be stored in the refrigerator until their expiration date -Vials of premixed insulins can be stored up to 3 months in refrigeration -Insulins premixed in syringes can be kept for 1 to 2 weeks under refrigeration  -Vials in use should be stored at room temperature for up to 1 month Isoniazid -Pharmacological action: prevents synthesis of mycolic acid -Therapeutic uses: active and latent TB -Complications: -Peripheral neuropathy (tingling, numbness, pain, burning) -Due to deficiency of pyridoxine (vitamin B6) -Administer 50 to 200 mg vitamin B6 daily -Observe for manifestations and notify provider -Hepatotoxicity (anorexia, malaise, yellowish discoloration of skin/eyes) -Contraindications: pregnancy risk C, liver disease, alcohol use disorder -Interactions: phenytoin, rifampin, alcohol, tyramine foods (ages cheese/cured meats) -Administration: 1 hr before or 2 hr after meals w/water Rifampin -Pharmacological action: inhibits protein synthesis (bactericidal) -Therapeutic uses: tuberculosis -Complications: -Orange colored bodily fluids (this is normal/not harmful) -Jaundice -GI discomfort -Pseudomembranous colitis -Monitor/report fever, diarrhea, abdominal pain, bloody stool -Discontinue med -Contraindications: caution w/pregnancy and liver dysfunction -Interactions: warfarin, oral contraceptives, don’t use often with pyrazinamide as it can cause hepatotoxicity -Administration: 1 hr before or 2 hr after meals w/water Metronidazole Therapeutic uses: C.diff, trichomoniasis, prophylaxis, H. Pylori -Complications: -GI discomfort (notify provider) -Darkening of urine (harmless affect) -Dizziness, headache, seizures, etc. -Notify provider and stop med -Contraindications: pregnancy, renal impairment, seizures, neurological issues -Interactions: alcohol, warfarin, phenytoin, lithium -Administration: oral/IV Morphine/Codeine -Pharmacological action: act on the mu and kappa receptors -Therapeutic uses: relief of moderate pain, sedation, relief of diarrhea, cough suppression (codeine) -Complications: -Respiratory depression -Stop meds if respiratory rate is less than 12/min and notify provider -Constipation -Orthostatic hypotension -Urinary retention -Palpate bladder every 4-6 hrs to assess bladder for distention -Cough suppression -Auscultate lungs for crackles -Sedation  -Biliary Colic -Nausea/vomiting -Opioid toxicity (coma, respiratory depression, and pinpoint pupils) -Provide mechanical ventilation and give naloxone -Contraindications: biliary tract surgery, caution w/pregnancy, premature infants, caution w/asthma -Interactions: alcohol, CNS depressants, antihistamines, antihypertensives -Administration: -IV slowly over 4-5 mins -Double check with another nurse before administering -Taper meds slowly over 3 days -Patient education: -Cough frequently to prevent blocked airways -Increase liquids -Void every 4 hrs Diphenhydramine -Pharmacological action: suppresses cough through its action on the CNS -Therapeutic uses: cough suppression, motion sickness -Complications: mild nausea, sedation, dizziness, euphoria in high doses -Contraindications: pregnancy -Interactions: can cause high fever when used within 2 weeks of MAOI antidepressants -Administration: capsules, liquids, and syrups Albuterol -Pharmacological action: activating the beta2 receptors in the bronchial smooth muscle, resulting in bronchodilation -Therapeutic uses: prevention of asthma episode, treats acute episode -Complications: -Tachycardia, angina -Observe for chest, jaw, arm pain or palpitations, and notify the provider if they occur -Check pulse and report increase of greater than 20-30/min -Avoid caffeine -Tremors -Contraindications: pregnancy, tachydysrhythmia, caution with diabetes and heart disease and hypertension/angina -Interactions: beta blockers, MAOIs, -Administration: inhale beta 2 med (albuterol) before glucocorticoids Theophylline -Pharmacological action: relaxation of bronchial smooth muscle, resulting in bronchodilation -Therapeutic uses: long term control of asthma or COPD, now for emergency use as it has toxic effects -Complications: -Mild Toxicity (GI distress and restlessness) -Can cause dysrhythmias and seizures -Keep levels within range (5-15 mcg/mL) -Adverse effects are unlikely to occur under 20 mcg/mL -Stop med, give activated charcoal -Contraindications: pregnancy, diabetes, heart disease, kidney/liver issues -Interactions: caffeine, phenobarbital, phenytoin, rifampin, ciprofloxacin -Administration: do not crush or chew, do not double dose if you missed one Montelukast -Pharmacological action: suppress the effects of leukotrienes, thereby reducing inflammation, bronchoconstriction, airway edema, and mucus production -Therapeutic uses: long-term therapy of asthma and to prevent exercise induced bronchospasm. Used in children as young as 12 months of age -Complications: -Depression, suicidal ideation -Contraindications: pregnancy, liver dysfunction -Interactions: phenytoin -Administration: once daily at bedtime, and 2 hr before exercise. Do not take additional dose for exercise if taking this medication already daily Atorvastatin -Pharmacological action: lowers LDL, increases HDL -Therapeutic uses: protects against MI or stroke, hypercholesterolemia -Complications: -Hepatotoxicity -Due to an increase in aspartate transaminase (AST) -Notify provider -Myopathy -Muscle aches, pain, and tenderness -Obtain baseline creatine kinase level -Report and discontinue med if creatinine is high -Contraindications: pregnancy, liver disorder, if asian decent then dose should be lowered -Interactions: fibrates, erythromycin, grapefruit juice -Administration: with food but evening dose is best because cholesterol is synthesized at night Furosemide -Pharmacological action: work in the loop of henle, blocks reabsorption of sodium and chloride -Therapeutic uses: pulmonary edema, hypertension -Complications: -Dehydration -Report urine output less than 30 mL/hr and notify provider -Hypotension -Ototoxicity -Hypokalemia (less than 3.5 mEq/L) -Consume high potassium foods -Hyponatremia, hypomagnesemia, hypocalcemia -Decrease in HDL -Increase in LDL -Contraindications: pregnancy, anuria, taking lithium, diabetes, kidney impairment, electrolyte depletion, hypoproteinemia -Interactions: digoxin, lithium, antihypertensives, NSAIDs -Administration: avoid giving late in day to avoid nocturia, usual dosing around 0800 and 1400 -IV give slowly 20 mg/min Hydrochlorothiazide -Pharmacological action: work in the early distal convoluted tubule, blocks the absorption of sodium and chloride -Therapeutic uses: first choice for essential hypertension -Complications: -Dehydration and hyponatremia -Hypokalemia and hypochloremia -Hyperglycemia -Hyperuricemia, hypomagnesemia, increased lipids -Contraindications: pregnancy, renal impairment, gout, diabetes -Administration: first thing in the morning, if second does is needed take before 1400 Spironolactone -Pharmacological action: potassium retention, excretion of water and sodium -Therapeutic uses: hypertension, edema, heart failure, effects can take 48-72 hrs -Complications: -Hyperkalemia -Initiate cardiac monitoring if potassium is above 5 mEq/L -Hirsutism, deepened voice, gynecomastia, irregularities of menstrual cycle, impotence -Notify provider -Avoid salt substitutes -Drowsiness, metabolic acidosis -Contraindications: pregnancy, hyperkalemia, severe kidney issues, anuria, metabolic acidosis -Interactions: ACE inhibitors, potassium supplements, salt substitutes -Triamterene can turn urine a bluish color. Potassium Chloride Verapamil -Pharmacological action: blocking of calcium channels in blood vessels leads to vasodilation of peripheral arterioles and arteries/ arterioles of the heart -Therapeutic uses: angina, hypertension, dysrhythmias -Complications: -Orthostatic hypotension and peripheral edema -Constipation -Bradycardia, heart failure -Dysrhythmias -Acute toxicity -Administer medications (norepinephrine, calcium, isoproterenol, lidocaine, and IV fluids) -Have equipment for cardioversion and cardiac pacer available -Contraindications: pregnancy, hypotension, heart block, digoxin toxicity, heart failure, GERD -Interactions: digoxin, grapefruit juice, beta blockers, verapamil, diltiazem -Administration: injections slowly over 2-3 mins, withhold med if pulse is under 50/min Metoprolol/Atenolol -Pharmacological action: decreases heart rate -Therapeutic uses: hypertension, angina, heart failure, MI -Complications: -Bradycardia -Hold med if pulse is under 50/min, notify provider -Decreased cardiac output -AV block -Orthostatic hypotension  -Rebound myocardium excitation -Discontinue over 1-2 weeks -Contraindications: pregnancy, AV block, asthma, heart failure, cautiously in clients who have myasthenia gravis -Interactions: calcium channel blockers, antihypertensives -Administration: orally once or twice a day with food Nitroglycerin -Pharmacological action: increases oxygen supply -Therapeutic uses: acute angina attack -Complications: -Headache -Use aspirin or acetaminophen to relieve pain -Notify provider if headache does not go away for weeks -Orthostatic Hypotension -Reflex tachycardia -Administer metoprolol if needed, or a calcium channel blocker (verapamil) -Tolerance -Leave 8 drug free hours every day -Contraindications: pregnancy, hypersensitivity to nitrates, severe anemia, closed-angle glaucoma, and traumatic head injury -Interactions: alcohol, beta blockers, diuretics -Administration for angina attack: -Sit or lie down -Take sublingual tablet, wait 5 minutes -If pain does not subside, call 911, then take another tablet -Do not exceed 3 tablets Heparin -Pharmacological action: inactivates thrombin and factor Xa -Therapeutic uses: pulmonary embolism, DVT -Complications: -Toxicity -Administer protamine -Give protamine no faster than 20 mg/min -Do not exceed over 100mg in a 2hr period -Hemorrhage -Hematoma -Thrombocytopenia -Do not give med if platelet count is under 100,000 -Argatroban can be used instead if needed -Hypersensitivity, chills, fever, urticaria -Contraindications: use w/caution for pregnancy, low platelet counts, hypertension, peptic ulcer disease -Interactions: aspirin, NSAIDs, resveratrol and saw palmetto, garlic, ginger, glucosamine or ginkgo biloba, salicylates -Administration: administer in the abdomen, 2 inches away from umbilicus. Rub the site for 1-2 mins after. -The nurse should ensure that they monitor the aPTT every 4-6hrs -The range for aPTT is 60-80 seconds Warfarin -Pharmacological action: antagonizes vitamin K -Therapeutic uses: prevents venous thrombosis and pulmonary embolism, reduction of MI -Complications: -Hemorrhage -Hepatitis -Toxicity  -Give vitamin K 1 -If that does not help, administer fresh frozen plasma or whole blood -Contraindications: pregnancy, low platelet counts, uncontrolled bleeding, surgeries of the eyes/brain/spinal cord, vitamin K deficiencies, threatened abortion -Interactions: heparin, aspirin, phenobarbital, vitamin K, resveratrol and saw palmetto, Coenzyme Q-10, feverfew, garlic, ginger, glucosamine, or ginkgo biloba -Administration: orally, once daily at the same time -Full therapeutic effect takes 3-5 days -Monitor INR (2-3) and PT (18-24 seconds) Cimetidine -Pharmacological action: block H2 receptors, which suppress secretion of gastric acid and lowers the concentration of hydrogen ions in the stomach -Therapeutic uses: treat gastric and duodenal ulcers, GERD, Zollinger- Ellison syndrome, heartburn, and acid indigestion, H.pylori -Complications: -Decreased libido, gynecomastia, and impotence -Lethargy, hallucinations, confusion, restlessness -Constipation, diarrhea, nausea (report) -Contraindications: pneumonia, COPD, kidney impairment -Interactions: warfarin, phenytoin, theophylline, lidocaine, antacids, smoking -Administration: oral dose twice a day until ulcer is healed, then a maintenance dose once a day at bedtime Omeprazole -Pharmacological action: block basal and stimulated acid production, and reduce gastric acid secretion -Therapeutic uses: stress ulcers/duodenal ulcers, erosive esophagitis, and Gerd -Complications: -Pneumonia (report) -Osteoporosis and fractures -Consume more vitamins D and calcium -Rebound acid hypersecretion -Take low dose and taper off slowly -Take antacid to manage discomfort -Hypomagnesemia -C.diff -Contraindications: pregnancy, pneumonia, COPD -Interactions: digoxin, methotrexate, diazepam, tacrolimus, antifungal agents, phenytoin, ketoconazole, itraconazole, atazanavir, clopidogrel -Administration: once a day before eating in the morning Sucralfate -Pharmacological action: a protective barrier that adheres to an ulcer. This protects the ulcer from further injury from acid and pepsin. Can stick to the ulcer for up to 6 hr -Therapeutic uses: acute duodenal ulcers -Complications: constipation -Contraindications: hypersensitivity, kidney disease, diabetes -Interactions: phenytoin, digoxin, warfarin, ciprofloxacin, antacids  -Take sucralfate 30 min before or after antacids. -Maintain a 2-hr interval between this med and other interacting meds -Administration: 4 times a day, 1 hr before meals and again at bedtime -if needed you can break med and dissolve in water but do not crush or chew it Docusate Sodium -Pharmacological action: lowers surface tension of the stool to allow penetration of water. This softens the stool so it can be passed more easily -Therapeutic uses: constipation and fecal impaction -Complications: GI irritation and fluid retention -Contraindications: bowel obstruction, abdominal pain, ulcerative colitis and diverticulitis -Administration: take with 8oz of water Liothyronine -Therapeutic uses: hypothyroidism, emergency treatment of myxedema coma -Complications: -Overmedication -Anxiety, tachycardia, chest pain, nervousness, tremors, palpitations, abdominal cramping, heat intolerance, fever, diaphoresis, weight loss -Report to provider -Chronic over treatment -Increases risks for fractures due to accelerated bone loss -Monitor TSH levels at least once a year -Contraindications: older adults may need lower doses, caution with diabetes, does not treat obesity -Interactions: digoxin, epinephrine, dopamine, phenytoin, warfarin -Administration: daily on an empty stomach, 30-60 min before breakfast -Total T3 range: 80-180 -Free T3 range: 2.3-4.2 -Total T4 range: 5-12 -Free T4 range: 0.8-2.7 -TSH range: 0.4-4.0 Expectorants: Guaifenesin -Pharmacological action: promotes increased cough production by increasing and thinning mucous secretions -Therapeutic uses: decreases chest congestion -Complications: -GI Upset -Drowsiness, dizziness -Allergic reaction (rash) -Stop medication -Contraindications: pregnancy, asthma -Administration: with a full glass of water, can sprinkle on food if GI upset occurs Ciprofloxacin -Pharmacological action: bactericidal due to inhibition of an enzyme necessary for DNA replication -Therapeutic uses: treats E.coli, urinary infections, respiratory infections, and anthrax -Complications: -GI discomfort -Tendon Rupture -Report swelling or redness of achilles tendon -Stop med and avoid exercise -Phototoxicity -Avoid sun exposure -Stop taking med -Contraindications: pregnancy, younger than 18 yrs old, increases risk for C.diff, cardiovascular disorders -Interactions: aluminum/magnesium antacids, sucralfate, iron salts, dairy, theophylline, warfarin -Administration: dilute IV solution and give slowly over 60 mins