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Pharm Exam 1
Miami U. Nsg 349
173 cards·by bpkstumpf@yahoo.com
pharmacologynursing
Disulfiram-like effect
The result of intake of alcohol while also talking certain anti-infectives.
S & S of disulfiram-like effect:
Throbbing of the facke and neck, headache, increased perspiration, N/V & thirst, dyspnea,
Muscle cramping, dizziness, lowered BP.
Disulfiram-like effect can also occur w/ what other class of drugs?
Anti-Diabetic agents
How soon doe sa disulfriam-like effect occur?
30 minutes
How long does a disulfiram-like effect last?
up to 72 hours
What is the treatment for a disulfiram-like effect?
There isn't a treatment.
The effect is intended for patients who are trying to recover from _______ by taking the drug
_____.
alcohol abuse & Antabuse.
Acetylsalicylic acid (asprin) is an:
anti-platelet, antipyretic, anit-inflammatory & analgesic.
What two drug can cause gastric irritation and peptic ulcers?
Asprin & Glucocorticoid steroid
What can interfere with the antiplatelet effect of apsrin?
Ibuprofen
The _____ (test) determines the drug level is not toxic.
peak
The _____ (test) determines the drug level remains theraputic from dose to dose.
trough
These specimens are to be collected during what time frame fro IV administration?
Peak: 30 minutes after IV infusion/ Trough: immediately prior to the next IV infusion.
The drug dosing qd has a longer ____ that the drug that is dosed qid.
duration
There is a cross-sensitivity of PCN and _____ and _____.
cephalosporin's & sulfa
Inhibit growth of bacteria: becterial death dependson the body's immune system: most
antiobiotics are bacteriostatic.
Bacteriostatic
Bacteria killed after exposure; prefered in immuno-compromised or site of infection in are
with limited host defernses as meningitis.
Bacterocidal
What is pseudomembranous colitis or antibiotic associated colitis?
Stool infected with Clostriduim difficile (C. diff)
How is it different from expected diarrhea from intestinal flora disruption?
Antibiotics disrupt the normal flora and cause overgrowth of C. diff. Normal diarrhea
doesn't have the same symptoms like C. diff.
How is C. diff treated?
D/C antibiotics, give vancomycin PO or Flagyl IV/PO.
What is the most frequest cause of secondary infections with antibiotic therapy?
Antibiotics mess up normaly flora making you at risk fro other infections.
What are guidelines for Tetracycline to give?
Take PO w/out food or milk, on an empty stomach, don't give to pregnant women or children under
8, it wil discolor teeth.
What is vancomycin?
A natural bactericidal antibiotic.
What is vancomycin given for?
Primary treatment for MRSA. Give on time, IV over 60 minutes.
What testing is involved with vancomycin administration?
Peak & trough testing. Peak: >mcg/ml is toxic. Trough: < 5mcg/ml (subtheraputic)
What is Romburgs test?
The test for equilibrium or balance.
Explain how to prefrom a Romburg's test.
Stand w/ feet/knees together arms at sides; should not fall & stand still for 30 seconds
Ototoxicity can be a side effect of:
Aminoglycosides, Amikacin, Gentamicin, Tobramicin, loop diuretics & asprin
Ototoxicity can be a side effect of:
Aminoglycosides, Amikacin, Gentamicin, Tobramicin, loop diuretics & asprin
Ototoxicity can be preceded with a side effect of:
Tinnitus (ringing in the ears)
What are the theraputic effects of Morphine, especially for cardic pain?
Decreased pain, vasodilator, increased perfusion to myocardium, and to reduce ischemic
pain.
What are the side effects or morphine?
Drowsiness and nausea, constipation, dry mouth, hypotension, CNS effects - miosis (pupil
constriction)
How do you respond to a patient's complatins of two common side effects discussed in class?
N/V: that will resolve in a day or two. Constipation: implement a bowel program.
What is the problem with long-term pain managment w/ Meperdine (Demerol).
Normeperdine binds to receptor site faster-blocking receptor to meperidine=no pain
relief. Avoid using Demerol more than 48 hours.
What are the signs/symptoms of meperidine toxicity?
Ceberal irritant, agitation, irritability, tremors, jerky movements
Meperidine is usually not effective as an analgesic after __ hours.
48
What class of analgesics are recommended for mild pain?
nonopioids
What class of analgesics are recommended for moderate to severe pain?
Opioids
NSAIDS are good fro what type of pain?
Mild to Moderate
A patien is taking low dose asprin (81mg) daily. What is the concern if the patient also take
ibuprofen for analgesia?
Ibuprofen will interfere with the antiplatelet activity of asprin.
What three NSAIDS contain inbuprofen?
Motrin, Advil, Nuprin
A concern with acetaminophen (Tylenol) is its possible toxic effect on the ____ and _____?
live & kidneys
What does addiction mean?
A compulsive oroverpowering drive to take a drug in order to experience psychological
effects even in the face of known potential self harm.
What does phisical dependency mean?
A pharmacological phenomenon associated w/ repeated doses of the same drug class &
characterized by abstinence (or withdrwal) syndrome.
What is tolerance?
Reduced effect from the repeated doese of the same drug class but not addicted.
Is there a top out does for patients with pain, such as chronic cancer patients?
There is no top-out dose for patients in pain.
Opioids, such as morphine < need to be _____ ___ ______ when they are to be D/C.
weaned off gradually
Narcotic prescriptions are to be filled within _ ____ and cannot be called in to the pharmacy.
1 month
Allergic reations to antibiotics ofter occur after the 2nd treatment is administered
because ______ to the drug have been developed.
antibodies
Topical lidocaine (Lidoderm) shoud be applied ____ _____ performing wenipuncture or
accessing a port.
right before
Antidepressant class of drugs have similar side effects as what other class of drugs?
Anticholinergics
What are the primary side effects of antidepressants?
Drymouth, urinary retention, constipation, drowsiness, postural hypotension
The 4 Cant's:
Pee, spit, see, poop
When a patient is starte don an opiois as morphine, what protocol is expected to be implemented
by the nurse?
A bowel program
Some drugs, such as metronidazole (Flagyl) can leave a _____ _____ and sucking on ____ ____ is
sometimes helpful.
metallic taste, sour balls
Most likely drug to treat methicillin-resistant staphaureus (MRSA)?
Vancomycin
Toradol is a:
nonopioid
Tylenol with codeine combinations contain how much codine?
Tylenol 2: 15 mg; Tylenol 3: 30mg; Tylenol 4: 60mg
What drugs can cause hearing loss?
Aminoglycosides, vancomycin, amphptericin B, tetracycline, sulfa
What are s/s to assess for hearing loss?
Ringing in the ears, loss of balance, and hearing loss
What other toxicity can increase rick for ototoxicity?
Nephrotoxicity
Agents for bone pain?
glucocorticoids
Agents for burning, seraing, or nerve pain?
antidepressants, anticonvulsants and local anesthetics
What analgesics also have anti-inflammatory properties?
NSAIDS w/ asprin, NSAIDS w/ ibuprofen, Toradol
A nursing responsibility when a patient is started on morhpine for long-term pain relief is to
initiate what?
A bowel regiment protocol
Common side effects of morphine that usually subside after 1-2 days include:
Drowsiness, nausea & constipation
Patients on long term acetaminophen need lab monitoring for what organ's functions?
Liver & kidney
First night of surgery the patient requests a sleeping pill. WHat assessment needs to be made
before administering a sedative for sleep?
Their vital signs and their pain on a sale of 1-10.
What is the ceiling does for morphine?
Maximum does is whatever works for that particular patient.
When does a drug reaction occur?
Normally after the second round of treatment, after antibodies have developed.
Can you test does for allergy to antibiotics?
Yes. You can put a small amount intradermal & if there is a reaction they are allergic.
What is stevens Johnson Syndrome?
Exfoliative dermatitis. Looks like 2nd degree burns.
What is serum sickness reaction?
A Reaction that occure after repeated injections of euuine (horse) derived immunizing
drugs.
What kind of allergic reactions can occur with serum sickness?
edema of the face, tongue, & throat; rash; urticaria;arthritis; adenopathy; fever;
flushing; itching, cough; dyspnea; cyanosis; vomiting
How are the S/S of serum sickness managed?
Best treated w/ analgesics, antihistamines, epinephrine, and or corticosteroids.
Hospitalization may be required.
What are secondary infections?
When the normal flora is destroyed by antibiotics making you susceptable to superinfection.
What are the common side effects to many antibiotics?
Allergic reaction rash angioedema Stevens-Johnson syndrome anaphaylaxis renal
toxicityototoxicity photosensitivity disulfiram-like effect
How do you monitor for theraputic effectiveness in patients receiving antibiotics?
Relief of signs & symptoms of infection and blood level monitoring. Also to give the agent on
time.
Serum creatinine test reflects what specific organ funtion?
Kidney
What is the normal range for serum creatinine?
0.5-1.2ml/dL (the higher the level, the lower the function)
What is the GI site for absorption of most nutrients and drugs?
Small intestine
What is an agonist?
A drug mimicking bodily chemical: a hormone, neurotransmitter, or drug that triggers
aresponse by binding to specific cell receptors.
What is an antagonist?
A neutralizing agent: a drug that neutralizes the effect of a substance on the body.
Another name for an antagonist is called:
partial agonist
What is a receptor?
A specific cell binding site or molecule: a molecule, group, or site that is in a cell or on a cell
surface and binds with a specific drug.
Contents of the GI tract above the pyloric sphincter are generally _____, and in the bowel are
_____.
acidic & basic
What is first pass effect?
A drug givent he oral route may be metabolized by the liver before reaching the systemic
circulation.
What administration routes by-pass the first-pass effect?
Sublingual, buccal, rectal, vaginal, topical, IM, SC, IV, intraarterial, intraarticular,
intraosseous
In converting a drug from parenteral to oral route, the oral dose usually needs to be:
increased
What is biologic half life?
The time it takes for a substance to lose half of its pharmacologic activity.
What is the most recommended drug, and daily does, for preventing MIs?
Asprin @ 81 mg/dose
What is synergistic effect?
When 2 drugs are given at the same time and the effect of the 2 ddrugs are greater that giving one.
What is the most common reaction that can occur w. administration of blood & drugs, especially
those given IV?
Anaphylactic
Who is anaphylactic reaction characterized?
Constriction of airway, urticaria, anxiety, hypotension, tachycardia, and quickly, shock
and death.
How many extra-strength acetaminophen tablets taken at one time can cause liver
failure/death?
11-13 tablets
What are the endogenously produced chemicals that are similar to opioids?
Enkephallins & endorphines
What is the strongest opioid?
Carfentanil
It may take how long for the tricyclic antidepressants and other antidepressants to reach a
theraputic level?
2-3 weeks
Metanx is a newer formula for preventing or delaying development of what condition?
Diabetic neuropathy
Of what is Metanx composed?
L-methylfolate calcium, Pyridoxal 5'-phosphate and Methylcobalamin.
What are the clinical manifestations of C. diff infection?
4-6 watery stools, foul smelling w/ mucous/blood.
When diarrhes occurs, what electrolyte imbalance may occur?
Hypokalemia (decrease in K+)
When diarrhes occurs, what vitamin loss occurs and can result in what side effect?
Pernicious anemia, or impaired bowel function due to the inability to absorb vitamin B12.
Antibiotics are effective for what type of infections?
Bacterial
What type of infections are antibiotics not effective in treating?
Viral
What teaching is needed for the patient with drug photosensitivity?
Avoid direct UV light, sun & tanning beds, wear hat, long sleeves/pants, sunglasses,
sunscreen SPF 50
What are anticonvulsants not used as readily for neuropathis pain as some other drugs?
Abticonvulsants are more dangerous becasue of the risk of toxicity.
What is Narcan?
An opioid antagonist.
What is Narcan used for?
To reverse narcotic induced CNS/respiratory depression, but the analgesic effect.
What preparations are made prior to administering Narcan?
answer
What monitoring is done during administration of Narcan and following?
answer
Patients having taken what class of drugs responds to Narcan?
Opioids
Can an overdose of barbiturates be with Narcan?
No, when administering Narcan, if no reversal occurs you know the overdose was a
barbiturates.
Naturally occuring alkaloid derived from the opium poppy.Schedule II
controlledsubstance.Indicated for severe pain,has a high abuse potenti
Morphine (1)
Extended release forms include MS contin, Kadian, & Avinza. Has potentially toxic
metabolite known as morphine 6-glucuronide.
Morphine (2)
How do you administer Fentanyl?
Can be given parenteral injections, transdermal patched, buccal lozenges, and lozenges on a
stick.
What is Fentanyl?
A aynthetic opioid (schedule II) used to treat moderate to severe pain.
When is Fentanyl at a theraputic level once applied?
8-12 hours after applying patch.
How long is a Fentanyl patch left on the body?
72 hours/3 days. If it falls off, place a new patch in another area.
Can a patien bathe, shower, swim with a Fentanyl patch?
Yes, but avoid scrubbing area where patch is placed.
What are the restrictions with a Fentanyl patch?
Avoid electric blankets, heating pads, sun lamps, heated water beds of other sources of
direct heat on patch. Could increased the absorption
Can other analgesics can be administered with a Fentanyl patch in place?
Other quick acting analgesics can be used as needed to treat breakthrough pain.
How do you dispose of a used Fentanyl patch?
Fold sticky sides together and flush down the toilet.
Can a Fentanyl patch be cut?
No, it cannot be cut.
Can a Fentanyl patch be applied to the opioid naive, why or why not?
Yes, but a low dose of 25/mcg/h should be used.
What is Hydromorphone (Dilaudid)?
It is a semi-synthetic opioid, a morphine derivative, a narcotic. It is also an antitussive
(cough suppressant).
How is Hydromorphone usually administered?
It is usually given IV and is an alternative to morphine.
How much stronger is Hydromorphone than Morphine?
It is 6-8x stronger than morphine but less chance of drug dependency. It is a good choice for
severe breakthrough pain.
What is Oxycodone?
An analgesic drug that is structurally related to morphine and has comparable analgesic
activiy. (Schedule II)
What is nonopioid is Oxycodone usually combined with?
Commonly combined w/ acetaminophen (percocet) an asprin (Percodan).
What other forms is Oxycodone available in?
Immediate release (Oxy IR) and sustained release (OxyContin) formulations.
What is Codeine?
Natural opiate alkaloid (schedule II) obtained from opium.
Is codeine an effect analgesic?
It is less effect as an analgesic, and is the only agonist to possess a ceiling effect.
What is Codeine commonly combined with, and why?
Acetaminophen (elixir) and used as an antiussive drug in an array of cough preparations, and
for mild to severe pain.
What is Meperidine (Demerol)?
A synthetic opiod analgesic (schedule II).
Are there any cautions when using Meperidine?
Yes when using in the elderly and patients who require long term analgesia or people w/ kideny
dysfunction.
Why are there cautions when using Meperidine?
An active metabolite, normeperidine, can accumulate to toxic levels and lead to seizures.
What forms of Meperidine are available?
Oral and injectible forms.
What is Lidocaine (Lidoderm)?
A topical/local anesthetic.
What are the indication for Lidocaine?
For the treatment of posttherpetic neuralgia, a painful skin condition that remains after an
outbreak of shingles.
How many Lidocaine patches can be placed on a patient at one time?
Up to 3, and cannot be worn for more than 12 hours to aviod systemic drug toxicity.
How do tricyclic antidepressants work?
Believed to work by correcting imbalance in the neurotransmitter concentration of
serotonin & norepinephrine at the nerve endings in the CNS
How is the action of tricyclic antidepressent accomplished?
By blocking presynaptic reuptake of the neurotransmitter, which makes them available fro
transmission of nerve impulses to adjecent neurons.
Substances or procedures that prevent or reduce the severity of epleptic or other convulsive
seizures are:
Anticonvulsants
Enteric-coated tablets are intended to disintegrate in what part of the GI tract?
Small intestine
What medication would enteric-coated be appropriate and why?
Any drug that is acid-unstable, such as aspirin,which have an irritant effect on the stomach
would be appropriate for enteric coating.
What is pharmacokinetics?
What a drug does to the body.
What is pharmacodynamics?
What the body does to a drug.
What class of drugs have a cross sensitivity w/ cephalosporins?
Penicillins
Why is it necessary to maintain a theraputic blood level of an antibiotic?
Decreased level (below theraputic) will not prevent bacterial growth.
What is the trade name for gabapentin?
Neurontin
For what 2 conditions is gabapentin given?
Epilepsy and neuropathic pain (ie...shingles)
Why is it usually the second line of drug given for neuropathic pain?
Anticonvulsants increase adverse effect from toxic levels.
What sign usually precedes respiratory supression in a patient receiving morphine or an
opioid?
Increased drowsiness
What causes superinfections?
Overgrowth of normal flora becasue antibiotics kill off the normal flora.
Most drugs are eliminated through what organ?
Kidneys
What is promethazine (Phenegran)?
An antiemetic, antihistamine and sedative.
If promethazine is given IVP, how would it be administered?
Diluted in at least 10mL of fluid and given in a running IV line at the port furthest from the
patients vein, or through a large bore vein.
If promethazine is given IM, how would it be administered?
Very deep IM, extremely painful, and arterial apasms can occur.
If patient cannot take promethazine orally, what would a preferred route be?
Rectally
What is hydroxyzine (Ataraz)?
An anti‐histamine medication that has been studied in anxiety disorders.
What is hydroxyzine given for?
Relieve anxiety, nausea/vomiting, reduce narcotic requirements pr/post op, treatment of
delirium tremors.
If giving hydroxyzine IM, how would it be administered?
Z-tract
What does the patient need in the diet to facilitate effective use of medications?
answer
What are non-pharmacological means of relieving pain?
Cold & heat therapy, menthol proximal, wet terry cloth in plastic sleeve
How does pressure work?
Pressure works by blocking the pain messages from getting tot he brain.
How long should cold application be applied? Why?
20 minutes on, 20 minutes off; becasue < 20 minutes can cause vasodilation and damage to
tissues.
What is the risk with taking outdated drugs?
Reduced bioavailability of the drug, decreasing its potency.
How does the route of administration affect the rate and extent of absorption of the drug?
Status of the GI tract (acidity, motility, blood flow) parenteral routes all go directly into
circulation (avoiding the 1st pass effect).
What is enteral administration?
Anything taken by alimentary canal (PO)
What is parenteral administration?
Any route other that enterally.
How do you evaluate the effectivness of a drug?
Monitoring to determine if a drug is fulfilling its intended therapeutic action. (Pek &
trough testing)
What is prophylaxis vs. therapeutic?
Prohylaxis is to prevent infection, while therapeutic is used to treat an existing
infection.