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185 Cards in this Set
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acetaminophen (Tylenol)
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liver toxic
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acyclovir (Zovirax)
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treating the symptoms of herpes (genital, simplex, zoster); also used to treat chickenpox
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adenosine (Adenocard)
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management of rapid HR (supraventricular tachycardia)
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albumin 25% (Albuminar)
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used to treat hypoalbuminemia, third spacing, etc. by increasing the colloid oncotic pressure
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albuterol (Ventolin)
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hold for increased HR or BP
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alButeRol
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amikacin (Amikin)
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nephrotoxicity; monitor BUN and creatinine levels
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amiodarone (cordarone)
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indicated for ventricular arrhythmias (PVCs, V-tach, V-fib)
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cordarrhythmias
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amoxicillin with clavulanic acid (Augmentin)
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defeat beta-lactamase producing organisms
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amphotericin B (Fungizone)
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pre-medicate with antipyretics, corticosteroids, antihistamines, meperidine, and antiemetics
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ampicillin (Omnipen)
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cross-sensitive with cephalosporins
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penICILLIN doesn't like cephalosporins
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anastrozole (Arimidex)
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blocks estrogen receptors
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Arimidestrogen blocker
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aropiprazole (Abilify)
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extrapyramidal reactions (tardive dyskinesias)
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atropine sulfate (generic)
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treatment of symptomatic bradycardia and heart blocks (increases
heart rate); treatment of pesticide and nerve agent poisonings; contraindicated in glaucoma |
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beclomethasone (Vanceril)
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asthma prophylaxis; rinse mouth out with water (will cause fungal infections)
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benztropine (Cogentin)
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contraindicated in glaucoma
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blood products
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whole blood and packed red blood cells can transmit oxygen; fresh frozen
plasma contains clotting factors |
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bosentan (Tracleer)
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indicated for pulmonary arterial hypertension
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ceftriaxone (Rocephin)
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cross blood/brain barrier; effective against CNS infections (meningitis)
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RoCNSin infections
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cephradine (Velosef)
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broad spectrum; cross-sensitive with penicillins
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CEPHalosporins don't mix with penicillins
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ciprofloxacin (Cipro)
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broad spectrum
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corticosteroid drugs
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contraindicated in active infections; adverse effects include adrenal
suppression (Cushing’s syndrome), elevated blood sugar, and osteoporosis; do not stop abruptly |
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cortisone (Cortisone)
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corticosteroid
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dexamethasone (Decadron)
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corticosteroid; reduce cerebral edema in meningitis
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methylprednisilone (Solu-Medrol)
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corticosteroid
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prednisone (Deltasone)
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corticosteroids
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cyclosporine (Sandimmune)
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decrease immune response by inhibiting T-cell activity; adverse effects may include opportunistic infections
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demeclocycline (Demclomycin)
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tetracycline; pregnancy D
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pregnancy Demeclocycline
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desmopressin (DDAVP)
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treatment of diabetes insipidus
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dextrose 50% in water (D50W)
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indicated for hypoglycemia
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diazoxide (Hyperstat)
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indicated for emergency treatment of hypertension
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Hyper = hypertension; stat = emergency
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digoxin (Lanoxin)
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increases force of cardiac contractions (+ inotropic), slows HR (- chronotropic); contraindicated in HR < 60 bpm
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digoxin serum
concentration |
0.5 - 2 ng/ml
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digoxin
maintenance dose |
0.125 - 0.25 mg
PO qd |
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digoxin monitoring
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monitor serum levels of
potassium and heart rate frequently; give daily potassium supplement |
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signs and symptoms of
digoxin toxicity |
fatigue; nausea and vomiting;
bradycardia; halo vision; heart blocks; cardiac arrest |
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digoxin immune Fab (Digibind)
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digoxin antidote; adverse effects include increased pulmonary edema
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diltiazem (Cardizem)
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calcium channel blocker; indicated for hypertension and supraventricular tachycardia (SVT)
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calcium channel blockers
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decrease HR and BP
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dopamine (Intropin)
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treatment of shock along with adequate fluid replacement
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doxycycline (Doxy Caps)
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tetracycline; treatment of anthrax; pregnancy D
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echinacea
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counters immunosuppressant drugs; blocks drugs for TB, cancers, and HIV
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enalapril (Vasotec)
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adverse effects include hypotension, dry cough, and tachycardia
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enfuvirtide (Fuzeon)
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prevents seroconversion
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enoxaparin (Lovenox)
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same as heparin, but safer because it blocks only one clotting factor; so safe patients may give themselves injections at home
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epoetin alfa (Procrit)
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stimulates RBC production in the bone marrow
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famotidine (Pepcid)
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interferes with drug/food absorption
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filgrastim (Neupogen)
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increases WBCs
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furosemide (Lasix)
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diuretic; inhibits reabsoprtion of lytes and water in the loop of Henle; cross-sensitive with sulfonamide antibiotics
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ginko biloba
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increases coagulation times when taken with warfarin
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glipizide (Glucotrol)
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stimulates pancreatic cells to produce insulin
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glucogon (GlucaGen)
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contraindication in starvation (no hepatic stores of glucose)
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haloperidol (Haldol)
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used acutely as “chemical handcuffs;” extrapyramidal reactions (tardive dyskinesia)
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heparin (porcine heparin)
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prevents new clots from forming
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heparin nursing
considerations |
monitor for bleeding; monitor
APTT (1.5x normal); avoid aspirin and NSAIDs; teach client: soft toothbrush, electric razor, etc.; if sign of overdose discontinue heparin, notify MD, have IV protamine sulfate ready |
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hydromorphone (Dilaudid)
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adverse effects may include respiratory depression or arrest
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ibuprofen (Advil)
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inhibits prostaglandin synthesis; contraindicated in GI bleeding
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inamrinone (Inocor)
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short-term management of CHF not responding to digoxin or after digibind
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insulins
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contraindicated in hypoglycemia
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sliding scale insulin
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if BS < 50, call MD
BS 51 - 150 = 0 units BS 151 - 200 = 2 units BS 201 - 250 = 4 units BS 251 - 300 = 6 units BS 301 - 350 = 8 units BS 351 - 400 = 10 units if BS > 400, call MD |
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DNA insulin analog (Lispro R)
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give with first bite of food
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rDNA insulin glargin (Lantus)
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24-hour insulin; give one dose daily at bedtime; SQ only, never IV
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interferon alfa-2b (Intron-A)
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adjunct with other drugs to treat leukemias, MS, chronic hepatitis (A, B, C), and AIDS
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isoniazid (INH)
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prophylaxis for TB exposure
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isosorbide (Isordil)
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long-acting nitrate; concurrent use with Viagra can result in profound hypotension
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Lactated Ringer’s solution
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replaces water and electrolytes; balanced salt solution
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leucovorin (Wellcovorin)
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protects healthy cells from antimetabolites
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levonorgestrel (Norplant)
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used to treat men with prostate cancer
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lidocaine (Xylocaine)
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ventricular arrhythmias (PVCs, V-tach, V-fib); do not use with epinephrine for a digital block
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lithium carbonate (Carbolith)
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contraindicated in CV diseases
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CARbolith = no CARdiovascular diseases
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loperamide (Imodium)
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used for diarrhea, esp. r/t tube feeding and antibiotic use; contraindicated in diarrhea caused by toxins (salmonella, shigella, etc.) because it will prevent the organisms from being moved out of the bowel and can cause toxic megacolon
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mannitol (Osmitrol)
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osmotic diuretic; inhibits reabsorption of lytes and water (potent kaluretic); adverse effects include transient volume expansion, hypokalemia, and phlebitis at the IV site (hypertonic)
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methotrexate (Folex)
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causes bone marrow depression, but it can be reduced with leucovorin rescue
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Metho-marrow
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metoclopramide (Reglan)
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accelerates gastric emptying
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metronidazole (Flagyl)
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indicated in amebic dysentery and PCP
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morphine sulfate
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can cause respiratory depression or arrest
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nevirapine (Viramune)
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prevents seroconversion; adverse effects include severe fatigue, anemia, and bone marrow suppression
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oseltamivir (Tamiflu)
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indicated for avian flu (H5N1 virus)
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propranolol (Inderal)
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lowers BP and HR; contraindicated in asthma and COPD
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protamine sulfate (generic)
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heparin antidote
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reteplase (Retavase)
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lyses thrombi; specific only to newly formed clots
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retepLYSE
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rofecoxib (Vioxx)
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increases prothrombin which causes increased clotting
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somatropin (Humatrope)
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long bone X-rays are essential prior to administering to children to be sure that their epiphyses (growth plates) have not closed
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spironolactone (Aldactone)
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must teach patient not to eat foods rich in potassium
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Alda(no K+)e
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sublingual nitroglycerine tablets (Nitro Bid)
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contraindicated in hypotension and concurrent
use with Viagra (profound hypotension) |
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tadalafil (Cialis)
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contraindicated in men using nitrates for angina (profound hypotension)
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technetium (99mTc, a radioactive isotope)
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must do serum pregnancy test
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trimethoprim/sulfamethoxazole (Septra)
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cross-sensitive with furosemide (Lasix)
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vancomycin (Vancocin)
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used for MRSA; monitor IV sites frequently; do frequent peak and trough levels of BUN and creatinine to monitor for renal function
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warfarin sodium (Coumadin)
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interferes with vitamin K clotting factors
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warfarin nursing
considerations |
PO only; monitor bleeding;
monitor PT (1.5x normal); client teaching: avoid foods containing vitamin K; avoid aspirin and NSAIDs; take as ordered, don't miss a dose, never "double up;" antidote is vitamin K SQ |
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zidovudine (AZT)
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prevents seroconversion
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α-tocopherol (vitamin E)
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best antioxidant; donates electron and becomes a free radical; vitamin C donates an electron to it to turn it back into vitamin E
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Drug
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influences living systems, a
group of molecules that affects patient molecules |
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Pharmacology
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study of drugs
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Pharmacotherapeutics
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use of drugs to prevent,
diagnose, or treat diseases (empirical-tradition vs. rational-research) |
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Pharmacokinetics
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what your body does to the drug
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Pharmacodynamics
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what a drug does to your body
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Pharmacogenetics
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study of how an individual will respond to a drug,
use DNA screening |
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Pharmacognosy
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study of drugs derived from plants or animals
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Teratogenesis
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harm a drug does to a fetus
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Toxicology
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study of poisons and toxins
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FDA phase 1 of new drug approval
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pre-clinical trials - animal studies
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FDA phase 2 of new drug approval
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healthy humans
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FDA phase 3 of new drug approval
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small population of persons with the disease/condition
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FDA phase 4 of new drug approval
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large sample of persons with the disease/condition
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FDA phase 5 of new drug approval
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continual evaluation (ongoing monitoring)
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DEA controlled drug schedule
I |
high abuse potential, no accepted medical use, illegal (heroin, LSD)
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DEA controlled drug schedule
II |
high abuse potential, severe dependency liability (pain meds, narcotics, amphetamines)
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DEA controlled drug schedule
III |
less abuse potential, moderate dependency liability (sedatives, stimulants, some narcotics)
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DEA controlled drug schedule
IV |
less abuse potential and less dependency liability than schedule III (anti-anxiety agents, non-narcotic analgesics)
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DEA controlled drug schedule
V |
limited abuse potential, primarily small amounts of narcotics (codeine used in cough meds, etc), some can be purchased without a prescription
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Pregnancy category A
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little maternal or fetal risk (Tylenol)
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Pregnancy category B
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little maternal risk, some fetal risk in 1st trimester, little risk in 2nd and 3rd trimesters (antibiotics)
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Pregnancy category C
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some maternal and fetal risks, but drug may be acceptable in some cases despite the risks
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Pregnancy category D
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fetal risks have been demonstrated, but drug may be used in life-threatening maternal conditions
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Pregnancy category X
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absolute maternal/fetal risk – do not administer, will abort or severely damage fetus (chemotherapy)
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Pharmacogenetics
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study of genetic differences associated with individual variability in drug responses
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Chromosomes
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one double-stranded (helix) of DNA
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Gene
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single segment of DNA
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Nucleotides
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sub-unit of DNA strand
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Genome
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all of the genetic information contained in an organism
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Human Genome Project
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has determined exact sequence of > 3 billion nucleotides within the human genome
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Genotype
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a person’s specific DNA composition
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Polymorphism
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mutations in an individual’s DNA that makes him/her different from others (all humans are 99.9% alike)
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Single-nucleotide polymorphism (SNP)
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a snip profile is a way to scrutinize the genetic bases for diseases and a way to predict a patient’s response to a drug
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Single-gene disorders
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cystic fibrosis, sickle cell anemia
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Multiple-gene or more complex disorders
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diabetes, hypertension, asthma
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Cytochrome P-450 Enzyme
System (CYP) |
hepatic enzyme that metabolizes all drugs
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CYP2DC
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subset of the CYP system that metabolizes ~25% of all drugs
many people have genetic variations in the CYP2DC subset |
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If enhanced CYP2DC
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ultra rapid metabolism (drugs are ineffective due to rapid excretion)
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If deficient CYP2DC
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poor metabolism (drug may become toxic even at normal doses)
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4 processes of pharmacokinetics
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absorption
distribution metabolism/biotransformation excretion |
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Absorption
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administered and absorbed into systemic circulation (blood)
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Distribution
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to various body compartments
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Metabolism/biotransformation
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chemically broken down by enzymes in the liver
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Excretion
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eliminated from body, mostly via the renal system
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Absorption: enteral route
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PO and per rectum (PR) must undergo the first-pass effect in the liver, all substances absorbed via the gut enter the portal circulation, pass through the liver where hepatic enzymes metabolize or biotransform them
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Absorption: parenteral route
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injectable drugs (SQ, ID, IM, IV, and sublingual) have no first pass effect, IV & SL routes have the fastest onset of action, then IM, then SQ
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Absorption varies with
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skin thickness, temperature, perfusion
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Only drugs that can directly penetrate cell membranes
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lipid-soluble
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Distribution of drugs
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all drugs bind to albumin in the blood to some degree
protein bound drugs are not bioavailable as drugs slowly become unbound they become bioavailable |
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Unbound drugs
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affect the body quickly
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Time-release drugs
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must be very bound
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Drug-drug interactions
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some drugs bind to each other which reduces bioavailability
some drugs cancel each other out some drugs can increase the potency of other drugs which causes adverse effects |
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Hypoalbuminemia
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condition of decreased serum albumin (liver diseases, etc.) which results in more free drug than desired, dosages must be reduced in patients with decreased albumin
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Metabolism: liver
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cytochrome P-450 enzyme system (CYP) metabolizes drugs and detoxifies various substances
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P-450 enzyme
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decreased in children because of their immature system, the elderly because of decreased function, and patients with liver diseases; must reduce their dosages
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Excretion
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most drugs are excreted in the urine
some drugs excreted in sweat, feces, and by exhalation drug excretion is decreased in children, the elderly, and patients with renal diseases |
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Pharmacokinetic curve: duration
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onset of drug until it drops below the therapeutic range
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Pharmacokinetic curve: terminal phase half-life
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5 half-lives
drug is completely excreted from the body used for dosing schedules |
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4 ways that drugs work
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replacing missing chemicals/enzymes (insulin)
increasing or stimulating cell activities depressing or slowing cell activities interfering with (killing) foreign cells – microorganisms or neoplasms |
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Agonist drugs
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stimulate cell receptors to function
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Antagonist drugs
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block sites by either competing with enzymes/hormones or by blocking action
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Non-specific drugs
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alter or disrupt cellular membrane or DNA (antibiotics and anticancer drugs)
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Body fluids
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75% of total body weight
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Extracellular fluid
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intravascular fluid
interstitial fluid |
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Intravascular fluid
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water in blood vessels
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Interstitial fluid
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water surrounding cells
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Crystalloids
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IV solutions containing small molecules in water; usually clear (NaCl, KCl)
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Colloids
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IV solutions containing large molecules in water; usually cloudy (albumin)
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Hydrostatic pressure
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pressure exerted by blood pressure (left ventricle); pushes water out of blood vessels into interstitial space and cells
water is forced through a semi-permeable membrane to an area of lower pressure (high to low) |
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Colloid oncotic pressure
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osmotic pressure exerted by colloids (proteins) in blood; pulls water from interstitial spaces and cells into blood vessels
water will go from an area of low concentration to an area of high concentration (low to high) |
coLLoid = puLLing pressure
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Dehydration
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excessive water loss; cell shrinkage (burns)
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Edema
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fluid accumulation; overload, cells swell
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Plasma
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watery, straw-colored fluid component of the blood in which blood cells are suspended, plasma contains electrolytes and proteins (albumin)
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Tonicity
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concentration of solids in a solution
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Isotonic
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IV fluid with the same concentration of solids as human plasma
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Hypertonic
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IV fluid with greater concentration of solids than human plasma
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Hypotonic
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IV fluid with less concentration of solids than human plasma
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Electrolytes
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substances in a solution that conduct an electrical current such as sodium, chloride, potassium, also called ions
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Fluid balance
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balance between hydrostatic and oncotic pressures
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Sodium
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cation
extracellular fluid (interstitial and plasma) |
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Potassium
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cation
intracellular fluid |
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Chloride
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anion
extracellular fluid (interstitial and plasma) |
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Serum osmolality
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measurement of the amount of dissolved electrolytes in the serum or plasma
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Normal range of serum osmolality
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280 – 294 mOsm/kg
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High range of serum osmolality
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> 300 mOsm/kg – concentrated, dehydrated
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Low range of serum osmolality
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< 280 mOsm/kg – diluted, too much water
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Serum osmolality equation
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mOsm/kg = 2(Na) + BUN/2.8 + Glucose/18
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Active immunization
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exposure to attenuated (neutralized) antigen forces body to produce antibodies; long term, lasting defense
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Passive immunization
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by-passing the body’s immune system by giving agents containing antibodies (immune globulins); short-acting protection
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Booster injection
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a vaccine or toxoid given in small amounts periodically to maintain immune response
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Immunoglobulins (IgG)
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prepared from human serum, antibodies vs. many diseases (hepatitis B, H-BIG)
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Toxoid
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exotoxins produced by bacteria that are detoxified (attenuated), cause production of antibodies
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Vaccine
|
live or attenuated microorganisms that promote active immunity against the particular organism
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