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Flashcards in Pharm HESI study Deck (183):
1

Aim at drug therapy for Parkinsons disease

To increase amount of dopamine or to lower amount of acetylcholine.

2

-cyclines

Anbx

3

Tetracyclines not for who?

children <8 (teeth d/c) and pregnant (passes to breastmilk)

4

What don't you give tetracyclines with

dairy, iron, sodium bicarb, antacids, kaolin and pectin

5

-tidines

Histamine (H2) receptor blockers

6

Do not take what with CCBs

grapefruit juice

7

Do not give what with MAOIs?

Anything with thiamin

8

What contains thiamin

aged cheese, chocolate, red wine, organ meats, beer, yogurt

9

What will thiamin and MAOI cause?

hypertensive crisis that can lead to stroke

10

When do you draw peaks?

30 to 60 min after giving

11

When do you draw troughs?

Right before next dose

12

Edema can affect what?

Absorption

13

What can potentiate digoxin toxicity

hypokalemia

14

Herbs can lead to what

bleeding toxitcities

15

Salt palmedo can cause what?

False positive in PSA tests

16

St johns wart can affect what

Oral contraceptives and decreases anticoagulation of coumadin

17

Black cohosh can cause what

Hypotension if on antihypertensives and hypoglycemia if on insulin

18

How to apply ear drops in children

Pull down and back

19

How to apply ear drops in adults

Pull up and back

20

How to apply eye drops

lower eye, midline. Not in inner canthus b/c can cause systemic absorption. Do not drop directly on cornea.

21

When do you remove nitro patches & why

At nighttime to prevent hypotension

22

-lol

Beta blockers

23

-cycline

antibiotics

24

-prazole

Proton pump inhibitors

25

-mycin

Antibiotics

26

-semide

loop diuretics

27

What metabolizes drugs

liver

28

What excretes drugs

Kidneys, breast milk, lungs and bile

29

Antidote for lovenox

protamine sulfate

30

slowest route for absorption

Transdermal

31

Fastest route for absorption

IV

32

Antidote for iodine toxicity

sodium theosulfate

33

What do anticholinergics do?

reduce cholinergic activity

34

Adverse reactions for anticholinergics

increased HR, postural hypotension, dry mouth, urinary retention, constipation

35

Teaching for anticholinergics

Not to change positions abruptly, gum or hard candy for dry mouth, avoid extreme heat

36

Dopamine replacement drugs do what?

stimulate dopamine production or increase sensitivity of dopamine receptors

37

Adverse effects for dopamine replacements?

involuntary movements

38

Teaching for dopamine replacements

may take months to work, avoid foods high in vitamin B, take last dose early in day, avoid driving

39

What foods to avoid with dopamine replacements (levodopa)

foods high in vitamin B

40

MAOI (selegine) are used with?

Dopamine agonists when their symptoms do not respond

41

Adverse effects of selegine

confusion, dizziness, nausea, dry mouth and insomnia

42

Tetracycline teaching

Do not give to children, pregnant or lactating women, causes teeth staining, decreases effect of oral contraceptives, do not give with dairy or antacids or iron, potentiates effect of anticoagulatns, give 1-2 hrs before eating, can cause photosensitivity

43

If OD on opiates give what

NARCAN, IV. Onset <2 min. Duration is 0.5-2 hrs

44

Adverse effect of narcan

opiate withdrawal

45

Spironolactone (aldactone) desired effects

Excretion of Na + H2o and retention of K+. (Competitive antagonist of aldosterone). It binds to aldosterone receptors and blocks reabsorption of NA and H20 in the collecting ducts. It elevates chloride levels.

46

contraindications for aldactone

Severe renal failure, hyperkalemia and anuria

47

What not to take with aldactone because can cause hyperkalemia

Ace inhibitors

48

Food teaching with aldactone

Avoid foods high in potassium (bananas, oranges, apricots, dates, tomatoes, potatoes)...

49

When do you give H2 receptor blockers

Morning and bedtime

50

When do you admin PPIS

before meals (30 min). can be mixed

51

When do you give antacids

after meals, not within 1-2 hours of other meds

52

When do you give carafate (sucraflate)

1 hr before meals and at bedtime.

53

PPIs end in what

-prazole

54

H2 receptor blockers end in what

-tidine

55

tiotropium (spiriva) is for what

COPD (maintanence medication)

56

what does spiriva do

relaxing airways and keeping them open. (blocks ach receptors to prevent bronchoconstriction)

57

common side effect for spiriva

dry mouth, constipation and trouble passing urine

58

Report s/sx of what with spiriva

acute narrow angle glaucoma

59

Orlistat (Xenical) is for what

Weight management (anorexiant)

60

Patient teaching for xenical

Give with or 1 hrs after meals with fats, give multivitamin 2 hrs before, supplementation of vitamin ADE and beta carotene, skip dose if missed meal or meal doesnt have fats, glycemic control may change with weight loss, report sx of hepatic failure,may cause flatulence and fecal incontinence.

61

Vancomycin trough optimal level

10-20 mcg/mL

62

Vancomycin peak optimal level

18-50 mcg/mL

63

Vancomycin too low if level....

<5 mcg/mL

64

Vancomycin too high if level...

>50 mcg/mL

65

Vancomycin too high can cause

nephrotoxicity and ototoxicity

66

Non harmful effect of vanc if given too rapid

red man syndrome

67

What are effects if giving vancomycin too rapidly

Red man syndrome and hypotension.

68

donepezil (aricept) is used for what

Dementia

69

What does aricept do?

Increases level or acetylcholine

70

Aricept increase risk for what?

Increases gastric secretions which can cause ulcers

71

When do you take aricept

In evening

72

How to check efficiency of aricept

improvement in s/sx of alzheimers

73

Triglycerides may be high if....

eating a lot of candy

74

Signs of digoxin toxicity

visual and GI disturbances (yello, green halios, hypotension, blurred vision, NVD, dyrthmias, fatigue, muscle weakness, drowsiness)

75

What is an early sign of dig toxicity

vomiting (spit up in babies)

76

Teaching for digoxin

Take apical pulse, <60bpm hold. For children, take 1 full minute. No skipping or making up missed doses. Do not mix with food or formula. Give 1 hrs before or 2 hrs after meals

77

Therapeutic level for digoxin

0.5-2

78

What can occur if overdiuresing with LAsix

Leg cramping (hypokalemia)

79

Signs of hypokalemia

K+ level <3.5, muscle weakness, cramping, decreased GI, anorexia, fatigue, dysrthmias, paresthesia, flat T waves on ECG

80

brand name for diclofenac potassium

Zipsor

81

Zipsor is what

NSAID used to treat mild to moderate pain (>18 yrs age) for rheumatoid arthritis, osteoarthritis

82

NSAIDS reduce effect of what

ACE inhibitors

83

Whn is pain releived by with Zipsor

1 hrs

84

Byetta is used for what

Type 2 diabetes

85

What does byetta do

enhances body's ability to release own insulin. When body senses blood sugar low, the release slows.

86

Do not take byetta with what

rapid acting or short acting insulins

87

Report signs of what with byetta

Pancreatitis

88

What is a COMMON side effect of byetta

Nausea occurs when first starting byetta and will becomes less over time

89

How to administer Byetta

Prefilled syringe given SC (thigh, abdomen and upper arm) taken twice a day, at any time within 1 hr before morning and evening meals, NOT after your meals, give birth control and anbx 1 hrs before, do not skip dose or double up.

90

Rapid acting insulins names

lispro (humalog) and insulin aspart (novalog)

91

short acting insulin name

Regular insulin

92

Intermediate acting insulin name

NPH and humulin L

93

Long acting insulin

Lantus

94

Rapid acting Onset, peak and duration

Onset 5-30 min, peak 1-1.5 hrs, duration 3-4 hrs

95

short acting onset, peak and duration

onset 30-60 min, peak 2-3 hrs, duration 3-6 hrs

96

Intermediate acting onset peak and duration

Onset 2-4 hrs, peak 4-10 hrs, duration 10-16 hrs

97

Long acting insulin

Onset 1-3 hrs, peak none, duration 24 hrs

98

What insulin can you give IV

Regular

99

When is lantus usually administered

Same time each day, usually at night time.

100

s/sx of hyperthyroidism

T3 > 220, T4 >12. Exopthalmus, weight loss, tachycardia, sensitivity to heat, diarrhea, palpitations, HTN, diaphoresis. Thyroid storm and graves disease.

101

Drugs for hyperthyroidism

PTU and methimadole (tapazole)

102

What does PTU and tapazole do

block synthesis of t3 and T4. Dosage based on BW and give over several months

103

s/sx of hypothyroidism

weight gain, fatigue, drug skin and hair, bradycardia, goiter, periorbital edema, facial puffiness, intolerance to cold, low T3 (<5), presence of T4 antibodies.

104

mEdication for hypothyroidism

Levothyroxine (synthroid)

105

Action of synthroid

Increases metabolic rates of T4

106

Teaching for foods for synthroid

Avoid voids high in iodine

107

when to take synthroid

early in day

108

What is an intranasal antidiuretic hormone

DDAVP for DI

109

what does desmopressen acetate DDAVP do

causes retention of water, increase in urine osmalality and decrease in serum osmalaltiy

110

Labs to check with tylenol overdose

ALT and AST; liver enzymes

111

What to give for tylenol overdose

Mucomyst, give one empty stomach and mix it with a drink (tastes horrible)

112

When do you hold clopidogrel

Before surgery and invasive procedures like liver biospy.

113

Why is clopidogrel given

Antiplatelet agent used for short term use after cardiac interventions, reduces the risk of thrombolytic stroke and preventing thrombo disorders.

114

Antifungal medication see if working

Wont have a rash anymore

115

Antifungal application

Keep area clean and dry, avoid contact with eyes, wear gloves, common place applied in toes, groin, under breast and folds

116

Why do we give NSAIDs

decrease inflammation and pain. (analgesic, antiinflammatory and antipyretic). Used to treat headaches, myalgia, neuralgia, arthralgia, postop pain, inhibit platelet aggregation

117

All NSAIDS can cause what

GI bleeding because they are ulcerogenic

118

Pregabalin trade name

Lyrica

119

Lyrica is what

Antidepressant and anticonvulsant

120

What is lyrica used for

fibromyalgia, refractory pain, neuropathic pain, partial seizures

121

When discontining Lyrica

Do it slowly over 7 days, can cause seizures if not

122

Efficiency for lyrica

Decreae pain intensity in neuropathy, fibromyalgia and neuropathic, reduction in frequency of seizures.

123

Teahing for lyrica

Driving, do not get pregnant, teach contraceptive measures

124

Another name for acyclovir

Zovirax

125

Zovirax is used for what

antiviral for Herpes, CMV

126

What is important when taking zovirax

Increase fluids to 2000-4000 mL/day because acute glomeruloneprhitis is a complication that is possible

127

Viagra is contraindicated wit...

nitrates because it vasodilates.

128

When do you administer bronchodilators

With wheezing, acute exacerbation of asthma

129

Long steroid use can cause

hyperglycemia, decreased immunity, growth retardation in children, immunosuppression, impaired wound healing

130

Long term steroids should be administerd when

IN the morning to coincide with normal secretion of cotisol.

131

Patient taking long term steroid should increase intake of what

Calcium and dairy products.

132

Rifampin is used fr what

TB

133

RIfampin can cause what

Orange color urine and secretions and decreaes effectiveness of oral contraceptives

134

Accutane teaching

No pregnancy, hard on liver, vitamin A toxicity can occur so no additional multivitamins, stop taking for 6 months before cosmetic procedures, admin 2x daily for 15-20 weeks, if need 2nd course have to wait 2 months, take with food, do not crush, monitor triglyceride (can elevate), no tetracyclines. Discontinue -cyclines before use, sun toxicity

135

Monitor what with antisezure meds

Liver enzymes

136

Drug of choice for C diff

metronidazole or Flagyl

137

Teaching for flagyl

may have metallic taste, admin with or after meals, NO alcohol

138

trade name for esomeprazole

nexium

139

Why take nexium

To reduce the risk of ulcers in patients who are regular users of NSAIDS. Take before meals.

140

Antidepressants and addiction

Taper off antidepressants rather than stopping abruptly

141

Side effects of nitroglycerin

Headaches. They vasodilate. Decrease in blood presssure.

142

What does nitro do

It reduces myocardial consumption, which decreases ischemia and reduces chest pain. It vasodilates

143

Diet for coumadin

Diet with no vitamin K (green leafy vegetables, peas, asparagus, meat, milk, soybean oil)

144

Bulk forming laxative teachin

lots of fluids, high fiber diet, take with at least 8 ox of water, do not take if N/V or abdominal pain, swallow tablets whole, contact HCP with abdominal pain dizziness weakness and cramps b/c can be f&e problems.

145

What is bulk forming laxatives used for

acute and chronic constipation, IBS and diverticulitis

146

Side effects of dilaudid

lifht headedness, dizziness, sedation, nause, vomiting, sweating, flushing, euphoria, dry mouth, pruritis.

147

Concepts of weaning off steroids

Do not stop abruptly. The production of steroids is controlled by feedback mechanism "HPAA and continuous use of steroids inhibits this mechanism causing it to hibernate. Tapering drug gives adrenal gland time to return to their normal pattern of secretion. 4 to 6 weeks is a reasonable period.

148

Concepts of aspirin and anticlotting effect

Decreases size of clot if already have clot. Makes platelet less sticky by decreasing platelet aggregation

149

What do you evaluate when assessing effects of atorvastatin (lipitor)

Look at cholesterol. Used to treat hypercholesteremia and hypertriglyceridemia. Decreases LDL and plasma triglycerides and increases HDLs. Lowers rate of cholesterol production.

150

what to monitor with statins

Liver panel....hard on liver

151

S/sx of hypoglycemia

sweaty, shaky, confused, belligerent, pale, dizzy, tremors, faintness, cold and clammy, emotional changes, slurred speech, BS <70

152

S/sx of hyperglycemia

gradual onset. high BS, increased urination, increase in appetite followed by decrease, weakness, fatigue, blurred vision, headache, glycosuria, nausea, vomiting, abdominal crmps

153

Treatment for hypoglycemia,

if conscious give sugar, orange juice, soft drink honey or candy. If unconscious give IV or SC glucagon or give 50% dextrose IV

154

Effects of NPO and blood sugar

give them their diabetic meds even if they are NPO. Hypoglycemia may occur if med isnt taken and they havent eateb.

155

Neupogen (filgastim) is used for what

To reduce risk of infection in patients with turmors who are recieving strong chemo that may cause severe neutropenia with fever.

156

How to see if neupogen is effective

WBC 10,000 (causes raise),

157

How to give neupogen

IV or SC, dilute in D5W for IV infusion

158

Epogen affects what

RBCs (HCT) ....epogen stimulates production of RBCS.

159

What do you use epogen for

anemia

160

Monitor what lab for eopgen

HCT

161

If erythropoetin is too high, what are they at risk for

uncontrolled hypertension

162

Cyclosporin (gengraf) is used for what

to lower your bodys immune system in transplant patients (protect from treating new organ as invader).

163

Administration of cycloporin (gengraf)

AVOID grapefruit juice, admin on consistent schedule, give 4-12 hrs prior to transplantation or given postop. Monitor serum creatinine and blood pressure every 2 weeks during first 2 months. NO live vaccines.

164

Phenytoin (dilantin) teaching

can cause gingival hyperplasia. Teach good oral hygeine. Can cause hirsutism. Do not abruptly withdraw.

165

Signs of drug toxicity with dilantin

nystagmus and diplopia

166

Therapeutic level of dilantin

10-20 mcg/ml

167

Administration of dilantin

Admin IV in 0.9% NS with in line filter. Abrupt withdraw after long term can cause seizures, must be seizure free for 2-5yrs before weaning

168

What is toradol

paraenteral NSAID. (nonopioid analgesic)

169

How to evaluate effectiveness of toradol

Pain rating scale

170

NItrofuratoin (macrodantin) used for what

UTI

171

Teaching for macrodantn

take with food, milk. Do not freeze, SHake well. Can change urin color. Avoid using antacids.

172

Theophylline can cause what

nervousness and tachycardia

173

Teaching with theophylline

Avoid caffeine and stimulatns, give with food, assess pulse (causes tachycardia)

174

Theophyilline therapeutic level

10-20

175

what is mannitol for

ICP

176

How to give mannitol

within live filter, give slowly over 30 to 90 minutes. short term use only

177

what helps assess effectiveness of mannitol

urine output

178

What is lithium for

manic phase of bipolar disorder

179

Therapeutic level for lithium

0.6-1.2

180

Moderate toxicity of lithium

1.8

181

Think what with lithium toxicity for s/sx

think being intoxicated. Staggering gait, blurred vision, cotton mouth, slurred speech. If toxic, stop taking and go to er.

182

When to monitor levels for lithium

Moniro every 2 months once stable. Assess concentration 2 to 4 days after initial therapy

183

What labs to check with lithium

Liver and lithium levels