Kaplan notes pharma y mas.pdf - ex 5:00am 12= 1700 PM Pharmacology Drugs and their antidotes 1 acetaminophen(Tylenol acetylcycteine 2 benzodiazepine

Kaplan notes pharma y mas.pdf - ex 5:00am 12= 1700 PM...

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Unformatted text preview: ex: 5:00am+ 12= 1700 PM Pharmacology Drugs and their antidotes 1. acetaminophen (Tylenol)- acetylcycteine 2. benzodiazepine - flumazenil 3. coumadin - vitamin k 4. Heparin- Protamin Sulfate 5. cyanide poisoning - methylene blue 6. digitalis - digibind 7. ethylene poisoning - antizol 8. Curare - tensilon 9. iron - desferal 10. lead - edetate disodium (edta), dimercaprol (bal), succimer (chemet) 11. lovenox - protamin sulfate 12. magnesium sulfate - calcium gluconate 13. morphine sulfate (opiod) – IV Naloxone hydrochloride • • • • • • • • Opiod toxicity s/sy: Respiratory depression Small (constricted) pupils Slowed breathing Absent breathing Extreme fatigue Changes in heart rate ↓ BP, ↓pulse, ↓ RR 14. methotrexate - leucovorine 15. mestinon - atropine sulfate 16. neostigmine - pralidoxime chloride (pam) 17. penicillin - epinephrine Alcohol Antagonist Antabuse (Disulfiram) Use: Used as part of a treatment plan for problem drinking. Creates an unpleasant reaction when drinking alcohol, which reduces the desire to drink. Take at night. Contraindication: Potential contact with alcohol by both inhalation of paint or wood stain fumes as well as by skin contact with these substances; any contact with any amount or any form of alcohol will cause an alcohol- Disulfiram reaction, which is extremely uncomfortable and may even lead to shock and cardiac arrhythmias. S/SY If you drink alcohol while on this drug, you will experience uncomfortable symptoms such as: • Severe nausea & vomiting • Severe Head-aches • Body-face flushing • Blurred vision • Sweating ** Chronic alcohol abuse is the most common cause of hypomagnesia (<1.5); which may result in cardiac arrest. o Manifestation includes: increased neuromuscular irritability, tremors, tetany, and seizures. ➢ Alcohol withdrawal symptoms: Restlessness, irritable, agitated, Tremors, elevated temperature, nocturnal leg cramps, complaints of pain symptoms, fever, ↑HR ↑pulse, delusions and hallucinations. Early symptoms: tremors, elevated ↑pulse, hyper-alert, startled easily, anxiety, anorexia; signs begin a few hrs after reduction of alcohol intake and peak 24-48 hrs. ✓ Chlordiazepoxide (Librium)USE: Treats anxiety, symptoms of alcohol withdrawal, and tremor ➢ Cocaine withdrawal = sever cravings, depression o S/Sy of use: insomnia, rhinorrhea, facial pain , hypersomnia, fatigue ➢ Heroin (NARCOTIC) withdrawal = Runny nose, yawning diarrhea, tremors (remember flu like symptoms) , fever, muscle & joint pain, o Heroin overdose: No breathing, Shallow breathing, slow or difficulty breathing, small pupils, dry mouth, tongue discoloration, low BP, weak pulse, bluish- colored lips and nails. o Narcan (naloxone)- given as the antidote; client will experience: Nausea, vomiting, restlessness, abdominal cramping (Opioid w/d symptoms). ➢ Barbiturate withdrawal- N/V, tachycardia, coarse tremors, seizures ➢ Opioid withdrawal- Nausea, vomiting, restlessness, abdominal cramping. ➢ Cannabis derivatives withdrawal: insomnia, hyperactivity, decreased appetite ➢ Amphetamine withdrawal- – depression, disturbed sleep, restlessness, disorientation Narcotics Depressants Stimulants Hallucinogens Heroine Morphine Codeine Dihydrocodeine Tramadol Buprenonorphine Hydrocodone Hydromorphone Oxycodone Oxymorphone Methadone Alcohol Alprazolam Diazepam Clonazepam Nitrazepam Flunitrazepam Temazepam Barbiturates (Seconal, Butalbital) GHB Alcohol Methaqualone Carisoprodol Cyclobenzaprine Cocaine Amphetamine Crystal Meth Crank Methamphetamine Methylphenidate Ephedrine Caffeine Nicotine Cathinone 4_methylaminorex Marijuana LSD LSA Psilocybin Mescaline DMT AMT Ketamine PCP 2C-B 2C-T-7 2C-(anything) MDMA DOM TMA-2 TMT: symtoms of w/d subside w/ decreased stimuli Narcotics Narcotic withdrawal symptoms: flulike symptoms, night sweats, elevated temperature, decreased deep tendon reflexes. Heroin Anxiolytics Benzodiazepine anxiolytics: ▪ Diazepam (Valium) USE: can be given to stop seizures ▪ Alprazolam (Xanax) ▪ Lorazepam (Ativan) ▪ chlordiazepoxide (Librium)USE: Treats anxiety, symptoms of alcohol withdrawal, and tremor. SE: blurred vision, drowsiness, constipation, slurred speech, anorexia, dermitis, pancytopenia, thrombocytopenia Interventions: Give after meals or with milk to decrease GI irritation. ▪ Buspirone (BuSpar): Used for treatment of general anxiety disorder (GAD) Action: Binds to serotonin and dopamine receptors Anti-Depressants Monoamine Oxidase inhibitors (MAOI’s) (eg. Phenelzine Sulfate (Nardil) , MARPLAN, & PARNATE & ELEVIL (Amitriptyline) USE: Best for depression associated with acute anxiety attacks, phobic attacks, or many physical complaints. SE: Hypertensive crisis resulting from intake of dietary tyramine. (H/A, nausea, increased HR & BP) MAOI Teaching • Avoid Tyramine containing foods: aged cheese, red wine, chocolate, beer, processed meat, soy sauce, coffee, Dried fruits (figs, raisins, dates), bananas, avocados, and yogurt. • • Watch BP if pt cheats on diet for HTN crisis Should be discontinued 2 weeks before surgery MOOD-Stabilizers Lithium carbonate (Eskalith): Lithium is an anti-manic used to treat bipolar disorder, mild thirst is an expected side effect, other side effects include fine hand tremor, polyuria, metallic taste, & weight gain (about 20lbs). Early signs of toxicity: Nausea/Vomiting, slurred speech, & muscle weakness/twitching Advanced signs of toxicity: Coarse hand tremors, diarrhea, persistent GI upset, slurred speech, mental confusion, incoordination, Ataxia (uncoordinated walking) (severe toxicity). NURSING IMPLICATIONS OF LITHIUM ✓ Administer with meals ✓ SERUM LITHIUM LEVELS AT LEAST TWICE WEEKLY – THEN MONTHLY ✓ THERAPEUTIC LEVELS - 0.5 – 1.5 mEq/L ✓ Lithium Toxicity: greater than >2.0 mEq/L ✓ Maintain an adequate intake of sodium –excretion of lithium depends on normal lithium levels **With hold medication and obtain blood lithium level. **MAINTAIN NORMAL SODIUM INTAKE Anti-Psychotic - Initial treatment for crisis; Eg. Olanzapine (zyprexa) Haloperidol (Haldol) Use: Typical- Treats mental illness (such as schizophrenia), behavior problems, agitation, and symptoms of Tourette's syndrome. SE: hematologic problems, primarily blood dyscrasia, and EPs symptoms, Galactorreah (spontaneous flow of milk), gynecomastia (growth of male mammory glands). o Monitor VS ever 30 mins. – This med lowers BP and causes postural hypotension Anti-consultants (eg. Phenytoin (Dilantin)) USE: Treatment of tonic-clonic seizures, status epilepticus, and treatment of seizures after neurosurgery Adverse effects: Nystagmus (involuntary eye movement), dysarthria, slurred speech, ataxia, Gingival hyperplasia, bone marrow suppression, hirsutism (hairy). o May make urine pink, red or red-brown Interventions • Do not administer with Milk • If given in suspension; DO NOT SHAKE the bottle • Monitor phenytoin toxicity level • • • THERAPEUTIC level: 10-20 g/ml Phenytoin Toxicity: greater than >30 mcg/mL Toxicity effects: Nystagmus (involuntary eye movement), ataxia, slurred speech • can cause folate and Vitamin D deficiencies. Folate deficiencies can cause anemia, symptoms reflective of these nutritional deficiencies; good sources of folate are green leafy vegetables (kale), legumes, tomatoes and various fruits such are oranges and cantaloupe; good sources of vitamin D include milk. S/SY of Anemia • Shortness of breath • Breathlessness • Fatigue/ weakness S/SY vit D deficiency • Muscle weakness • Bone pain • Tiredness Phenobarbital (Luminal) USE: long term treatment of tonic-clonic seizures, simple partial, febrile seizures; used as a emergency control status epilepticus (IV form) . Adverse effects: drowsiness, deep coma, hypotension, respiratory depression, and nightmares. Carbamazepine (Tegretol) USE: Treats partial seizures, Tonic-clonic seizure; treatment of trigeminal neuralgia, bipolar disorder Contraindications: interferes with the action of hormonal contraceptives; client should use another form of birth control. Wear sunscreen can cause (photosensitivity) Valproic acid (Depakote) Therapeutic levels 50-100 mcg .Toxicity s/s include chills, fevers, abdominal pains, s/s of liver disease Biguanide Oral Hypoglycemic Metformin (glucophage) Treats type 2 diabetes. SE: metallic taste, abdominal cramps, Interventions: take with food Cardiac Glycoside LANOXIN (digoxin) Digitalis Use: Treats certain heart rhythm problems (atrial fibrillation). Also used to treat heart failure, usually in combination with a diuretic (water pill) and an angiotensin-converting enzyme (ACE) inhibitor. -↑ myocardial contraction and left ventricular output→ increased CO ➢ 0.25 mg is the digitalizing dose and should be administered in divided doses over 24hrs. ➢ Caution: check for apical pulses for 1 min before administration; watch out for toxicity that can cause dangerous dysrhymias ➢ Apical pulse: between the 4th and 5th intercostal space at the mid-claviclular line ➢ When the pts rhythm is AFIB and the heart rate is less than <60 bpm or greater than >100/min, or the rhythm becomes regular, the nurse may with hold the med and notify physician bc this may indicate the development of AV conduction block ➢ Direct IV administration; requires infusing over 5mins; use diluted solution immediately; observe IV site; extravasation can lead to tissue irritation and sloughing. ➢ Normal Heart Rate for an infant is 120-160 bpm (resting); bradycardia is rate below 80-100; withhold medication if rate is below <90-110; ➢ Infant TOXICITY: excessive slowing of beats may indicate digitalis toxicity. ➢ Take digoxin at the same time everyday, AM ➢ Do not take anti-acids at the same time . Separate meds by at least 2 hrs ➢ Digoxin THERAPEUTIC LEVEL 0.5- 2.0 ng/ml ➢ Digoxin Toxicity greater than >2.4 ng/ml SE: anorexia, Nausea, vomiting, fatigue (early effects of digitalis toxicity), bradycarida, yellow or green halo around objects especially lights Antidote: Digifab (Digibind) Drug-drug interactions- verapamil, amiodarone, quinine, erythromycin, tetracycline, or cyclosporine. Herbals: don’t admin with St. John’s wort as it decreases effectiveness of digoxin; digoxin toxicity when admin with ginseng and licorice *** A low potassium level (hypokalemia) could increase the serum digoxin sensitivity level. It can rapidly deteriorate to ventricular tachycardia or sudden death. Analgesics NSAID’s (non- steroidal anti-inflammatory) Side effects: Headache, dizziness, gastrointestinal distress, pruritus, and rash Naproxen Sodium Ibuprofen (Motrin) Aspirin (acetylsalicylic acid) Use: Treats pain, fever, arthritis, and inflammation. It may also be used to reduce the risk of heart attack. SE: ringing in the ears, GI & duodenal ulcers, bleeding, GI symptoms, nausea, dyspepsia Toxicity: ringing in the ears, headache, hyperventilation, agitation, confusion, sweating, GI distress and diarrhea Contraindications: cross-sensitivity between tartrazine & aspirin; an allergic response to one may indicate an allergic response to another. - Do not give to children; can cause Reye syndrome: Sudden (acute) brain damage and liver function problems. Not an NSAID Acetaminophen (Paracetamol) - Tylenol Use: Treats minor aches and pain and reduces fever Complications- Overdose: hepatic toxicity is a serious complication resulting from acute acetaminophen overdose that manifests 1-3 days after initial ingestion; there is an increase in the serum transaminase liver enzymes, (ALT) and (AST); PT should also be monitored as acetaminophen prolongs it. Pyridium (Phenazopyridine) USE: Relieves pain, burning, and discomfort caused by urinary tract infections and other urinary problems. SE: yellow discoloration of the skin or sclera indicates medication accumulation due to renal impairment. Nitrates Nitrostat (Nitroglycerin) Use: This medication relaxes blood vessels allowing more blood to flow through. This improves blood flow to the heart. Oral dose forms are used to prevent angina (chest pain). This medication is NOT for treating an attack of chest pain that is already happening. Nitroglycerin (SL, no chewing, check the effectiveness of med, MR q 5 min. for 15 min.) CLIENT EDUCATION regarding response to chest pain ➢ Vasodilators can cause orthostatic hypotension ➢ Stop activity and rest ➢ Place Nitroglycerin tablet under tongue to dissolve ➢ If pain is unrelieved in 5 min, the client should call 911 ➢ The client can take up to 2 more doses or Nitroglycerin at 5-min intervals ➢ Remind client headache is a common side effect ➢ Encourage the client to sit and lie down slowly ➢ keep med in a dark container ** When a client first takes a nitrate, the nurse expects which symptom that often occurs? Headaches Anti-Hypertensive Betablockers "olol"- Blocks the beta1-adrenergic receptors in the cardiac tissues. They are as effective as anti-anginals b/c Decrease heart rate and decrease myocardial contractility. Propranolol (Inderal) Use: Treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, tremors, and lowers the risk of repeated heart attacks. Warning: May mask symptoms of hypoglycemia, removing your body’s early warning system. CAUTION diabetic patients about this. Contraindicated in clients w/ asthma bc it can cause bronchospasms. ACE-Inhibitors (Angiotensin-Converting Enzyme inhibitors) "pril” These drugs treat hypertension and congestive heart failure. All generics end in "pril” BENZAPRIL (Lotensin), LISINOPRIL (Zetril), CATOPRIL (Capoten), ENALAPRIL (Vasotec) SE: hypotension, dry cough, N & V, headache, angioedema (swelling of the face, lips, tongue, throat), salty or metallic taste, Irregular heartbeats (this could be caused by too much potassium in your blood). Considerations: o Monitor ↑ k (potassium) levels, ace inhibitors cause the body to retain potassium. o Avoid foods high in potassium. o Do not use salt substitutes (they contain potassium) o Signs of too much potassium in the body include confusion, irregular heartbeat, nervousness, numbness or tingling in hands, feet or lips, shortness of breath or difficulty breathing, and weakness or heaviness in legs. Calcium channel blockers (End in “Pine”) • Diltiazem (Cardizem) TMT: essential (age related) HTN Also treats angina. Drug-drug interactions with beta-blockers, digoxin, carbamazepine, Prazosin (Minipress-alpha blocker), quinidine; don’t mix with beta-adrenergic meds within 48 hours of each other Nursing implications: Avoid grapefruit juice because can lead to toxic level of drug, encourage fiber and fluid because of constipation side effects Antibiotics Name Action Side Effects AninoGlycosides -Gentamycin (geramycin) -kanamycin (Kantrex)
 -Tobramycin (Nebcin) -Aerobic-Gram-Negative bacteria -TB -Meningitis, -Osteomyelitis, -Endocarditis, -Toxic shock syndrome (TSS), -Ghonorrhea, -Salmonella, -E. coli, -Pneumonia, -Shigellosis, -Pseudomonas, -Septicemia, (*can be uses in combination with Vancomycin) Photosensitivity
 Superinfection Tertracylines Doxycycline (Vibramycin) Vancomycin Vancomycin Hydrochloride, Bleomycin Cephalosporin Cephalexin (keflex) -Ceftriaxone sodium (Rocephin) -Pneumonia -Respiratory tract infections -Acne -Infections of skin, -Genital -Stomach ulcers (Helicobacter pylori) For bacterial infections -Rheumatic fever -C.diff -Respiratory infections

 -Otitis media (ear infection)

 -Bone/joint infections

 -UTI -Photosensitivity -Red neck or red man syndrome
Occurs when IV -Nephrotoxicity -Pseudomembraneous colitis 
 
Ototoxicity
 Nephrotoxicity Considerati Check C&S.
Monitor ons renal function, hearing loss.
Warn client to use sunblock.
Monitor for superinfection.
Monitor peak and trough level -Discoloration of permanent teeth
 years
 -Stomatitis, -GI distress Pseudomembranous colitis
 -Blood dyscrasia Superinfection
 -CNS toxicity, hepatotoxicity
 -Nephrotoxicity in high doses Do not take anti-acids w/I 1-3 hrs after taking this Do not give to children younger than 8 -use sunblock Drug-drug interaction s -Penicillins decrease aminoglycoside effectiveness.
 -Penicillins increase warfarin's effec too rapid:
Severe hypotension
Red flushing of face, neck, chest, extremities
 -Ototoxicity
-hearing loss -Pseudomembraneous colitis 
 Nephrotoxicity
 -Blood dyscrasias
 -Stevens-Johnson syndrome -Steven-Johnson Syndrome, -hepatic and renal dysfunction. 
-Check C&S before therapy.
 -Give over 1 to 2 hours IV.
 -Rotate sites. -
Monitor BP.
 -Monitor IV site.
 -Monitor renal function tests and hearing. -
Monitor client for superinfection - never give IV push Eat yogurt & acidophilus milk to maintain normal intestinal flora -patient with a history of PCN would also be allergic to cephalosporin -Do Not take w/ milk products. 
-Do not take w/ antacids. -Decrease effects of oral contraceptives.
 -Digoxin absorption is increased leading to toxicity. ***Nephrotoxicity (renal toxicity)- When kidney damage occurs, you are unable to rid your body of excess urine, and wastes. Your blood electrolytes (such as potassium, and magnesium) will all become elevated. Nephrotoxicity can be temporary with a temporary elevation of lab values (BUN and/or creatinine) **Super infection: infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics. Antibiotics Quinalone Cipro (Ciprofloxacin) Drink w/ plenty of fluids; may cause crystalluria and stone formation Do not take w/ milk or yogurt – decreases the absorption of cipro Do not at the same time as vitamins Immunosuppressant Cyclosporine Use: This medication is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant. It’s also used to treat severe rheumatoid arthritis and a certain skin condition (severe psoriasis). SE: • reduction in urine output • 
Hypertension and tremor
 • Other common: headache, gingival hyperplasia, elevated hepatic enzymes
 • Periodic blood counts are necessary to ensure WBC's don't fall below 4,000 or platelets below 75,000
 • Long-term therapy increases risk of malignancy - especially lymphomas and skin cancers Interactions: DO NOT take with grapefruit juice b/c the bioavailability of cyclosporine will increase from 20 to %200. Hormone replacement therapy Synthroid (levothyroxine) Treats hypothyroidism. Also treats an enlarged thyroid gland and thyroid cancer. SE: nervousness, insomnia, irritable, headache, fever, hot flashes, sweating Tapazole (methimazole) Treats hyperthyroidism (too much thyroid hormone produced by the thyroid gland). SE: flue like, sore throat, easy bruising Herbal Alternatives -Ginkgo is an antiplatelet agent and CNS stimulant given for dementia syndrome; increase risk of bleeding when given with NSAID’s. - Herbal Licorice- used for digestive system complaints including stomach ulcers, heartburn, colic, and ongoing inflammation of the lining of the stomach (chronic gastritis).

Some people use licorice for sore throat, bronchitis, cough, and infections caused by bacteria or viruses. ➢ Contraindication: Do not take if you have HF or taking digoxin; ; can increase potassium loss and ma cause digoxin toxicity Drugs affecting blood coagulation Heparin IV or SQ Prevents clots in the blood vessels before or after surgery or during certain medical procedures. Warfarin (Coumadin) oral Prevent new blood clots from forming, and helps to keep existing blood clots from getting worse. This medicine is a blood thinner (anticoagulant). -Labs - APTT -Protamine sulfate (antidote) for an abnormal lab value - if pt is on heparin they must also be on Coumadin -Labs= PT, INR 2-3 if pt is Afib or has had sx its 2-4 -Pt. can go home w/ this -Always give at 5pm in a health care setting - Give Vitamin K (antidote) for an abnormal lab value (eg PT/INR 4.5-5) SE: Bleeding, decreased LOC = intracranial bleeding Drug-to-Drug Interactions Heparin and oral anticoagulants, salicylates, penicillins, or cephalosporins, nitroglycerine SE: bleeding, bruising Nausea, loss of appetite, or stomach/abdominal pain Considerations: DO NOT increase foods w/ high vit K; m...
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