Pharmacology Study Guide PDF

Pharmacology Analgesics 1. Morphine Sulfate 1. NV- can occur, but tolerance develops super fast so persistent nausea is very rare 2. NSAIDS (ibuprofen, naproxen, Ketorolac, indomethacin, aspirin, meloxicam) 1. can cause cardio side effects like MI or stroke, decrea...

Pharmacology Analgesics 1. Morphine Sulfate 1. NV- can occur, but tolerance develops super fast so persistent nausea is very rare 2. NSAIDS (ibuprofen, naproxen, Ketorolac, indomethacin, aspirin, meloxicam) 1. can cause cardio side effects like MI or stroke, decrease effectiveness of BP meds and diuretics, causes peptic ulcers and chronic kidney disease 2. contraindicated for people with HTN or heart failure 3. GI- report any signs of bleeding- tarry stools 4. eat with food to reduce risk of ulcers 5. do not give to anyone with injured kidneys! 3. Hydromorphone 1. duration of action is 3-4 hours 4. Naloxone 1. duration of action is 40 min 2. if pt overdoses and this is given, the drug usually has a longer duration, so check them again in an hour and see if they need more 3. if post surgery- use does not warrant a rapid response or anything 5. Opioids (morphine, fentanyl, hydrocodone) 1. constipation! give stimulant or stool softener 2. cause pruritus and flushing and HOTN, fall risk! 3. risk for respiratory depression: use of other sedating meds (antihistamines), hx of smoking, obesity, opioid naive, >65 yo, hx of pulmonary disease, recent surgery 4. give slowly over 2-3 min 5. reassess pt 15-30 min after giving drug bc that's when it hits 6. Capsaicin topical- OTC minor pain cream 1. great for osteoarthritis or neuralgia, apply cream and wait 30 min before washing hands, may cause some stinging Cardiovascular 1. ACE inhibitors (-pril) 1. lowers BP and treats HF, does not decrease HR!! 2. S/S: dry cough that won't go away, angioedema very common in black people, causes hyperkalemia 3. can't take while pregnant!!! 4. don't give to people with kidney issues 104 2. Alpha Agonists 1. clonidine, methyldopa 2. anti HTN med, very strong 3. cannot just abruptly stop these, will get intense rebound HTN, taper over 2-4 days 4. S/S: drowsiness, dizziness, dry mouth 3. Beta Blockers (-lol) 1. reduce BP and HR, all forms! even eye drops, treats CHF 2. contraindicated in pts with acute decompensated heart failure 3. can cause bronchospasms, don't give to anyone with hx of asthma or respiratory issues 4. CCB- (-dipine and diltiazem, verapamil) 1. reduce BP and HR and chronic stable angina, 2. diltiazem great for Afib- monitor the ventricular rate, ventricular rate control is priority 3. S/S: bad ortho hypo, dizziness, headache, edema, constipation 4. no grapefruit juice! 5. ARBS (-sartan) 1. treat HTN 2. can't take while pregnant!! 3. when cant take an ACE take an ARB 4. can cause hyperkalemia 6. Anticoagulant (heparin) 1. Fondaparinux - anticoagulant used to prevent DVT, not administered until more than 6 hours after surgery 2. no anticoagulants can be given with an epidural catheter in place! will cause a hematoma 3. does not dissolve clots! it just keeps it from growing and prevents new ones 1. t-PA is used to break down clots in emergencies, usually we just let body break it down 4. heparin- monitor apTT- 46-70 seconds therapeutic, reversal agent is protamine 1. warfarin- usually given with heparin for a few days. until therapeutic INR is reached, then usually taken 3-6 mo, take same time daily 1. avoid excessive vitamin K intake- broccoli, spinach, liver 7. Antiplatelet 1. clopidogrel, aspirin 2. prevent platelet aggregation, increases bleeding risk 3. monitor for signs of bleeding and decrease platelet counts 4. does nothing to the liver! 5. contra: peptic ulcer, 5 Gs 105 8. Nitrates 1. Nitrate isosorbide mononitrate- long acting, helps pt live daily life and do activities without angina attack 2. Nitroglycerin 1. increases cardiac blood flow and relieve pain, massive vasodilator 2. infusion titrated every 3-5 min, if SBP is less than 90 then too low and slow infusion rate 3. oral- heat and light sensitive, up to 3 pills in 15 min, headache will occur, can't take with (ED drugs -fil or alpha blockers -osin) 4. EMS should be called if pain is unimproved or worsening 5 min after the first tablet 5. must be kept in room temp area light resistant bottle, og packaging 9. Statins 1. lower LDL, cholesterol, triglycerides, increase HDL 2. massively increases chances of rhabdomyolysis!! (causes massive kidney damage)- report any signs like muscle aches or weakness or dark urine 3. can cause myopathy, check creatine kinase levels 4. no grapefruit juice! take with evening meal 10. Kawasaki Disease 1. acute systemic vasculitis, can cause MI or aneurysms 2. IV immunoglobulin given to aspirin to prevent coronary aneurysms 3. pretty much one of the only times you'll give a kid aspirin bc causes Reye's syndrome 11.Adenosine 1. drug of choice for SVT (rhythm >150 bpm) 2. administered over 1-2 seconds with 20 mL flush as close to the heart as possible, watch EKG, may cause brief asystole 12. Digoxin 1. treats HF and Afib, positive inotropic effect (increased CO) and decreased HR 2. toxicity is issue, good range is 0.5-2 3. S/S of toxicity: cardiac arrhythmias, bradycardia, heart block, dizzy and light headed, visual symptoms, NV, abdominal pain, confusion, lethargy-- GI symptoms usually first 4. check pulse before taking this med! very important 5. check K levels bc hypokalemia can cause dig toxicity 6. for children, hold if HR less than 90-110, if vomits dont give a second dose 7. don't give to pt with renal issues 106 13. Amiodarone 1. antiarrhythmic med used for arrhythmias that can't be controlled with any other meds 2. really awful toxic side effects: pulmonary toxicity, thyroid issues, peripheral neuropathy, eye problems, make your skin gray, bradycardia and heart block, hepatitis 14. fall risk drugs: 1. most antiHTN, antipsychotics, antidepressants, vasodilators, narcotics, diuretics 15. thrombolytic agents and tPA (-plase, alteplase, reteplase) 1. dissolves thrombus, bleeding is a huge risk! 2. don't give to pts with active bleeding, recent trauma, aneurysms, hx of hemorrhage stroke, uncontrolled HTN 3. tpa absolute contraindications: prior intracranial hemorrhage, cerebral structural issues, stroke within 3 months, aortic dissection, active bleeding, head trauma in last 3 months 16. Thrombin Inhibitors (dabigatran) 1. reduce risk of clot formation in stroke clients with Afib 2. Bleeding precautions! 3. must be kept in original container!! 4. do not stop taking no matter what unless you've spoken to doc 17. Factor Xa Inhibitors 1. apixaban, rivaroxaban, dabigatran 2. oral anticoagulant 18. Potassium Sparing Diuretic- spironolactone 1. very weak diuretic but work to save K when used with thiazide diuretics, used mostly as a dual therapy 19. Loop Diuretics (furosemide, torsemide, bumetanide) 1. great for HF, 2. watch for hypokalemia 3. IV furosemide in high doses >120 mg can cause ototoxicity, rate of administration should not go faster than 4 mcg/min 20. thiazide diuretics (hydrochlorothiazide, chlorthalidone) 1. can cause hypokalemia and hyponatremia, hyperuricemia, hyperglycemia 2. can't eat licorice root!! can cause cardiac issues 3. take in morning, 21. Milrinone 1. increase contractility and promote vasodilation, often given when HF is not responding to anything else 2. palliative drug for end stage HF 3. requires CVA or PICC 22. prednisone can cause hyperglycemia! check BG with them 107  23. client with HTN should not take OTC cold and flu meds bc they are vasoconstrictors and make HTN worse and can cause HTN crisis 24. sodium replacements are high in potassium, don't use if taking Ace or ARB Endocrine 1. Desmopressin- synthetic form of ADH, treats DI by decreasing urine output which increases specific gravity 1. complications: water intoxication, hyponatremia - headaches, mental status changes, seizures 2. sulfonylurea meds(glyburide, glipizide, glimepiride) 1. for DM 2. cause hypoglycemia and weight gain 3. glyburide makes you sunburn super easily 3. Radioactive Iodine therapy 1. treats hyperthyroid disorders, destroys thyroid tissue so they have to take levothyroxine forever, you will emit radiation for 1 week after 2. no pregnant people!! 3. limit close contact with children and pregnant women, use separate toilet and fluid 2/3 times, use disposable cups and plates, don't share anything, sleep in separate bed, don't sit near people for too long (flying), no breastfeeding 4. insulin pumps 1. better control of a consistent BG, no more ups and downs, you have to stick your finger still, just no shots 5. Glucocorticoid replacement (prednisone, hydrocortisone) 1. treats Addison's disease- adrenal issue 2. report any signs of infection bc these cause immunosuppression 3. report increase in thirst, hunger and urination bc hyperglycemia 4. increase dose during times of stress 5. take with food 6. when giving insulin- check potassium!! don't wanna give and make hypokalemia even worse 7. Regular insulin is the only insulin that can be administered IV push! the rest are subQ 8. Glargine should never be mixed with another insulin in a syringe- only R and NPH 9. Levothyroxine 1. for hypothyroidism 2. can't take with antacids, calcium or iron 3. take on empty stomach in the morning 108  4. requires TSH testing, lifelong treatment- if TSH level too high it means that drug isn't working and you need to increase dose, you want TSH to be low bc then you know it's getting picked up 5. fine to take while pregnant, may need to be increased, 6. may take 8 weeks to see full effect, maybe a little better in 3-4 weeks 10. Beers Criteria list 1. old people cannot take: sulfonylureas (glyburide), tricyclic antidepressants, antipsychotics, barbiturates, benzodiazepines, sliding scale insulin, NSAIDS, muscle relaxants, anti HTN, drowsy antihistamines 11.Thiazolidenediones (rosiglitazone, pioglitazone, -glitazone) 1. treat type 2, make HR worse by causing fluid retention 12. metformin 1. oral antidiabetic, increases sensitivity of insulin receptors and reduces glucose production by liver 2. prevent huge glucose rise after eating 3. metformin does not pose risk for hypoglycemia if taken without food, only works if taken with food GI 1. PPI (-prazoles) 1. suppress gastric acid secretions, great for peptic ulcer disease and GERD 2. increase risk for C. Diff for reasons unknown, also fractures from decreased bone density, pneumonia, and hypomagnesemia 2. Sulfasalazine 1. contains sulfapyridine and aspirin 2. treats IBD 3. risk for dehydration and can cause kidney injury, watch urine specific gravity for dehydration (it will be elevated0 4. normal gravity (1.002-1.030) 3. Dicyclomine hydrochloride- anticholinergic 1. treats IBS 2. don't give if urinary retention, glaucoma or bowel obstruction 4. Sucralfate 1. oral med that forms protective layer over GI, take 1 hour before meals with glass of water 5. Metoclopramide 1. antiemetic- treats N and gastroparesis 2. can cause tardive dyskinesia (sucking smacking of life is common, uncontrollable motions in face, puffing of cheeks) 109  6. Activated charcoal - treatment of choice for aspirin overdose 7. orlistat- lipase inhibitor 1. prevents the breakdown and absorption of fats, helps you lose weight 2. interferes with fat soluble vitamin uptake, 3. take a multivitamin with ADEK at least 2 hours after the orlistat\ Musculoskeletal 1. methadone 1. potent narcotic, very high risk for overdose bc long half life 2. signs of toxicity: NV and lethargy 2. methotrexate 1. drug for rheumatoid arthritis 2. S/S: bone marrow suppression, hepatotoxicity, GI issues, thrombocytopenia- so watch for bleeding 3. calcium supplementation 1. essential for bone strength 2. take in divided doses with meals because body only absorbs 500 mg at time 3. side effect is constipation 4. Allopurinol 1. med for gout, prevents uric acid deposits and prevents kidney stones 2. this med can cause Stevens Johnson syndrome so if you see any kind of rash of any kind then call doc asap 3. takes several months to become effective, take with a full glass of water and increase fluid intake bc the uric acid comes out in your urine Integumentary 1. cyclines (tetracycline, doxycycline, minocycline) 1. taken for acne 2. take on empty stomach an hour before meals 3. avoid antacids and dairy 4. causes photosensitivity, decreases effectiveness of oral contraceptives 5. can cause gingival hyperplasia 2. Phenytoin - anticonvulsant 1. can cause SJS so if any rash develops then stop it! 3. Metronidazole (flagyl) 1. consuming alcohol while on this while cause a disulfiram like effect 2. treats trichomoniasis and amebiasis 110  4. Isotretinoin (Accutane) 1. make sure they aren't pregnant!!, two forms of BC, two negative pregnancy tests, swallow pill whole 2. made up of vitamin A so don't take even more vitamin A supplements Neuro 1. Triptan drugs 1. sumatriptan 2. treat migraines by contracting cranial vessels 3. don't give to anyone with CAD or HTN 4. if taking SSRI or SNRI then monitor for serotonin syndrome 2. Benztropine 1. anticholinergic medication 2. great for parkinson's disease 3. watch for glaucoma, urinary retention 3. Carbidopa- levodopa 1. increases dopamine levels, helps the bradykinesia in parkinsons, reduces tremor and rigidity, never ever stop suddenly 2. takes several weeks to kick in, changes color of secretions, avoid high protein meals, 3. overdose signs: dyskinesia 4. Transdermal Fentanyl patch 1. treats moderate to severe chronic pain, takes up to 17 hours to kick in 5. Lidocaine patch- helps with local pain and neuralgia 6. tPA- must be given 3-4.5 hours in onset of symptoms 7. Anticonvulsants- depresses CNS causing drowsiness and fatigue (goes away in 4-6 weeks), can cause SJS 1. Levetiracetam 1. watch for suicidal ideation! big issue! 2. Phenytoin (anticonvulsant) 1. causes gingival hyperplasia, folic acid depletion and osteoporosis 2. narrow therapeutic range (10-20)- toxicity signs: nystagmus, balance troubles, ataxia, slurred speech 3. if getting it through tube feeding, you gotta pause the feeding for 1-2 hours while giving this 4. metabolized in liver 3. Carbamazepine (anticonvulsant) 1. great for neuropathic pain like trigeminal neuralgia 2. causes leukocytosis and infection risk 111  4. just bc you are on an anticonvulsant doesn't mean you can just start driving again- you gotta jump through a lot of hoops 8. Riluzole 1. slows down ALS- progressive terminal disease where everything slowly shuts down - 3-5 yrs expectancy 9. Malignant Hyperthermia- inherited muscle abnormality triggered by inhaled anesthetics 1. they are very rigid, increase O2 demand and later on super high fever 2. it is inherited! 10. Scopolamine 1. anticholinergic 2. prevents NV from motion sickness 3. place clean dry hairless area behind ear, apply patch >4 hrs before traveling, replace every 72 hrs, throw away patch far away from kids and pets, wash hands after touching 11.Benzodiazepines (midazolam) 1. great for conscious sedation 2. can cause respiratory arrest 3. antidote: flumazenil 12. Donepezil, Rivastigmine- great for alzheimers 13. St. John's wort - good for depression but interacts with most other antidepressants and causes serotonin syndrome 1. agitation, sweating, tachy, diarrhea, clonus, hyperreflexia, mydriasis (eyes super dilated) Hematological/ oncology 1. herbal supplements 1. increased risk for bleeding: garlic, ginkgo, ginger, ginseng, feverfew 2. clopidogrel can cause thrombocytopenia 3. Tamoxifen 1. estrogen modulator- prevents breast cancer recurrence, blocks estrogen 2. can cause thromboembolic events and endometrial cancer (increase and weird vaginal bleeding) 3. menopausal symptoms are normal 4. Ferrous Sulfate - oral iron supplement 1. treats iron deficiency anemia 2. don't give with calcium or antacids! 3. taking with vitamin C increases absorption 5. Brachytherapy 112  1. lead room and lead shields, limit time of exposure, staff involved with pt must wear dosimeter badge, avoid device dislodgement by bedrest, visitors must stay at least 6 ft away from them 6. Enoxaparin 1. do not rub inj site! on side of bellies, might cause some bruising 2. watch for thrombocytopenia 7. Tumor lysis syndrome 1. causes hypocalcemia, hyperuricemia, hyperkalemia and hyperphosphatemia (2.4-4.4) 2. allopurinol is given to decrease hyperuricemia and keep it normal (4.4-7.6) 8. TNF inhibitor drugs 1. etanercept, infliximab, adalimumab) 2. reduce RA and slow progression of joint damage 3. causes major immunosuppression 4. big issue is if pt has latent TB then it will become active on these drugs! must get a TB test 9. Filgrastim - stimulated neutrophil count, often given to chemo patients 10. Cisplatin- cancer drug 1. causes major renal issues- watch kidney labs Immunity 1. Immunosuppressant 1. Azathioprine 1. causes bone marrow depression , increased risk for infection, watch for leukopenia 2. treats IBDs and prevents organ transplant rejections 3. Methotrexate- bone marrow suppression!, also good for RA- but also no drinking!!! hepatotoxic and teratogenic! 2. anaphylaxis 1. if epi doesn't work first time, then give it again in 5-15 min 2. then treat with steroids and bronchodilators 3. Isoniazid- antitubercular drug for latent or active, don't give to anything with liver issues 1. interferes with vitamin B6 and causes peripheral neuropathy- take with B6 supplements 4. Sulfa drugs (sulfasalazine, sulfa antibiotics, glyburide, diuretics) 1. given for IBD and RA 2. can cause KI, drink a lot of water, photosensitivity, folic acid deficiency, leukopenia, SJS 5. Duloxetine (SSRI) 1. also helps with fibromyalgia 113  2. pregabalin and amitriptyline also help with nerve pain 6. Hydroxychloroquine- SLE drug, watch for eye issues! Infectious Diseases 1. Metronidazole (flagyl) 1. treats C. Diff 2. no alcohol, can cause SJS 2. Vancomycin 1. must draw trough serum concentrations to monitor, want to avoid oto and nephrotoxic effects 2. therapeutic range (10-20) 3. vesicant- watch IV site, watch BP, any reactions, infuse over at least 60 min 3. clients with penicillin allergies might also be allergic to cephalosporins (cefazolin, cephalexin, ceftriaxone) 4. nystatin 1. antifungal for oral candidiasis 2. if wear denture, soak them in it, check mouth first for any ulcers, swish for a few minutes then swallow, shake med well first 5. Linezolid- oxazolidinone antibiotic 1. given for vanco,methicillin resistant infections 2. low key an MAOI so dont give with SSRIs and avoid foods with tyramine 3. Macrolide antibiotics (-thromycins) 1. cause prolonged QT intervals and hepatotoxicity- watch EKG and liver values 6. TB drugs: isoniazid, rifampin, pyrazinamide, ethambutol (must get eyes checked) 7. aminoglycosides (gentamicin, tobramycin, amikacin)are the same as mycins basically- oto and nephrotoxic Mental Health 1. SSRI 1. sertraline, escitalopram, fluoxetine, paroxetine, citalopram 2. treat major depression and anxiety disorders- cause increased serotonin in the brain, takes 4-6 weeks to kick in 3. S/S: sexual dysfunction, hyponatremia, weight gain 4. report any suicidal thoughts 2. SNRI 1. venlafaxine 3. methylphenidate 114  1. ADHD drug 2. can cause weight loss and increase BP and tachy- check on that 4. Buspirone 1. anxiety drug that lacks any CNS effects, does not cause withdrawal dependence or anything 2. kicks in about a week 5. Benzodiazepine (lorazepam, alprazolam) 1. CNS depressant, don't drive after taking 2. taken daily but only before bed, never stop abruptly 6. Neuroleptic malignant syndrome 1. reaction to antipsychotics 2. S/S: mental status change,s hyperthermia, muscle rigidity, tachy, weird BP, diaphoresis 3. hold psychotic drugs and call doc! 7. Benztropine 1. anticholinergic/antiparkinson used to treat extrapyramidal symptoms from psych drugs like acute dystonia, akathisia, tardive dyskinesia, pseudoparkinsonism 8. Trazodone 1. treats major depressive disorders 2. causes ortho hypo, sedation, priapisms 3. no drinking!! 9. MAOIs 1. isocarboxazid, phenelzine, tranylcypromine, selegiline 2. major depressive disorder 3. avoid tyramine containing foods- aged cheese, milk products, red wine, imported beer, avocados, smoked and processed meats, soy sauce, raisins 1. tyramines will cause HTN crisis 4. SE: stimulation of CNS, insomnia, agitation, manic symptoms, anxiety 5. cannot give with SSRIs!!!!! must give 14 days in between 10. Lithium- DO NOT GIVE IF DEHYDRATED 1. sodium levels must be adequate- no low or high diets, drink a lot of water 2. really really don't want to be dehydrated bc will get toxic- report any diarrhea 3. routine blood tests- monitor range and kidney and thyroid function 4. can't take NSAIDS 5. takes 1 week for mania to decrease 6. SE: dry mouth, weight gain, drowsiness 11.antipsychotics 1. clozapine 115  1. for schizophrenia 2. awful side effects, neutropenia, weight gain, cardiac disease, seizure, sedation 2. Ziprasidone 1. for acute bipolar mania and agitation 2. can cause prolonged QT interval, watch for HOTN and seizures 3. risperidone 4. haloperidol 12. Tricyclic antidepressants (amitriptyline, imipramine, nortriptyline, desipramine) 1. anticholinergic, ortho hypo. drowsy, photosensitive Maternity/newborn 1. copper IUD 1. works immediately, check strings every month, causes heavier bleeding 2. Don't take NSAIDS when pregnant especially during third trimester 3. transdermal contraceptive patch 1. higher risk for DVT than pill 4. Teratogenic :doxycycline, ARBS, ACE, warfarin, methotrexate, isotretinoin, lithium, phenytoin 5. Cervical ripening- misoprostol 1. cervix softens 2. don't give if pt already getting oxytocin, hx of uterine surgery (c section) or abnormal fetal HR Urinary/ Renal 1. Anticholinergics (tolterodine, oxybutynin, solifenacin) 1. used for overactive bladder, should decrease amount you have to pee to a normal amount 2. often causes heat intolerance and hyperthermia 2. Phenazopyridine hydrochloride 1. uricalm 3. Potassium supplements 1. erode esophagus- take with a lot of water and sit upright after 4. Alpha Adrenergic antagonists 1. Terazosin, doxazosin, tamsulosin, alfuzosin 2. treats BPH, relaxes smooth muscle 1. causes ortho hypo 5. Saw Palmetto- treats BPH but also increases bleeding risk 116  6. Sodium Polystyrene sulfonate 1. works in GI to decrease potassium bu pooping it out 2. often given to people with CKD bc they often deal with hyperkalemia 7. Erythropoietin 1. anemia is big issue with CKD, this drug often given to CKD patients, give only is hgb