WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 1 NLN Pharmacology Study Guide There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the information you will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line. The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All are multiple choice questions, including calculations. Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. They are pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX test- taking tips to prepare for this exam also. References: Pearson nurses’s drug guide. (2013). Upper Saddle River, NJ: Pearson. Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN® examination. St. Louis, MO: Mosby. Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice (2 nd ed.). Upper Saddle River, NJ: Pearson. Calculations Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or review a nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one or more type of calculation. Tips: 1. READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you select the correct formula and eliminate unnecessary information. 2. Double (and triple) check actual math. Did you clear the calculator correctly? 3. Does the answer make sense? 4. There are both adult and pediatric calculations. 5. Watch ‘per dose’, ‘per day’. 6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.
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WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 1
NLN Pharmacology Study Guide
There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the information you will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line. The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All are multiple choice questions, including calculations. Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. They are pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX test-taking tips to prepare for this exam also.
References:
Pearson nurses’s drug guide. (2013). Upper Saddle River, NJ: Pearson.
Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN® examination. St. Louis, MO: Mosby.
Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice (2nd ed.). Upper Saddle River, NJ: Pearson.
Calculations
Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or review a nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one or more type of calculation. Tips:
1. READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you select the correct formula and eliminate unnecessary information.
2. Double (and triple) check actual math. Did you clear the calculator correctly? 3. Does the answer make sense? 4. There are both adult and pediatric calculations. 5. Watch ‘per dose’, ‘per day’.
6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 2
2Common calculations include (but are not limited to):
1. Kg to mg to mcg conversion (any which way)
L K H D M D C M - - mcg G liter (kilo – hecto – deca – meter – deci – centi – milli – skip – skip – micro) gram
2. Dosage calculations
a. Tablets
b. mg. to tablets
c. mg. to ml
d. units to ml
e. kg to ml
f. Half-life calculation
g. IV rate calculation (hourly infusion rate) AND adjustment
h. IV rate dosage calculation (based on units per ml, etc.)
i. Macro- vs. micro-drop tubing
j. Calculating drops/minute (gtts/min)
Examples: (abbreviated to type of question; exam will add extra information)
1. Have 5 mg tablets; ordered dose 2.5 mg. How many tablets will the nurse administer?
2. Have 2 mg/2 ml; order is 1 mg. How many milliliters will the nurse administer?
3. Prepare a 20 mEq dose of a medication. Available solution is 40 mEq/10 ml. How many ml will be administered?
Note: calculation method is not different in examples 1 - 3, just the unit of measure (mg, units, mEq, etc.). BE SURE AVAILABLE
AND HAVE ARE THE SAME UNIT OF MEASURE.
4. Half-life conversion: Half-life is known to be 2 hours. What percentage will be left in the body after six hours?
5. A person weighs 165 lbs. How many kg does the person weigh?
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6. The available medication has been reconstituted to 250 mg/5 ml. The order is 5 mg/kg/daily in two evenly divided doses.
Child weight 44 pounds. How many milliliters will be administered per dose? NOTE: More than one calculation method
must be used to answer this question.
7. IV was ordered at 1000 ml over 8 hour period. After two hours, only 900 ml has infused. Calculate the new infusion rate
for the medication to be administered within the original 8 hour period.
8. Order is for 3000 cc over a 24-hour period. What is the hourly flow rate? OR: What will the pump be set at per hour?
9. Order is for antibiotic to be mixed in 50 ml NS and administered over 45 minutes. What is the hourly flow rate? OR:
What will the pump be set at per hour?
10. Volume is 1000 ml. Ordered infusion time is 8 hours. Have tubing of 15 drops/ml. How many drops need to be counted to
deliver the identified milliliters per minute?
11. Available solution = 25,000 units in 250 ml NS. Order is to administer at 22 ml/hour. How many units will be given per
hour?
12. Available solution = 25,000 units in 250 ml NS. Administer at 2000 units/hour. How many ml will be given be hour? OR:
What will the pump be set at per hour?
Principles of Pharmacology
These include the basics! Review:
1. Routes of administration – benefits and problems
2. Sizes of needles and syringes for injections
3. Six Rights of Medication Administration; Three Checks
4. Side effects; adverse effects; paradoxical reactions; toxicity; antagonists
5. Half-life calculation
6. Allergic or hypersensitivity reactions
7. Absorption, metabolism, distribution and excretion
8. There may be questions on lab values as relevant.
9. There are pediatric and adult questions.
10. Immunosuppression precautions (due to meds for cancer, HIV/AIDS, etc.)
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Administration routes: some key points
Sublingual administration
□ absorbed in mucosa of oral cavities
□ rapid onset of action
□ Place tablet on floor of mouth, close mouth. Do not swallow, hold under tongue until dissolve.
□ Use spray on floor of mouth under tongue and close mouth.
Buccal
□ place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve
□ slower to dissolve and absorb than sublingual
Intramuscular injections
□ Given in the vastus lateralis in children up to 3
□ Spread skin taught to bring muscle near surface of skin, with dart-like motion insert needle at 90 degrees
□ Aspirate to determine if needle enter a blood vessel. If there is blood return discard the needle and meds and start procedure over.
NGtube / Gtube
□ NG usually temporary; G-tube for longer term
□ Follow instructions re crushing, dissolving medication – no sustained release meds
Eye drop administration
□ Clean exudates from eye; (2) tilt head toward side of affected eye; (3) pull lower eyelid down; (4) have pt. look up; (5) instill drops in conjunctival sac formed by lower lid (not onto the eye); (6) Apply gentle pressure for 30 sec to 1 min over inner cantus next to nose (this prevents absorption through the tear duct and drainage of the medication). Close eyes gently massage the eyes to distribute the meds.
□ Slow absorption except in infants where they readily absorb
EYE OINTMENT
□ Same as eye drop except it is expressed directly into the conjunctival sac from the inner canthus to the outer canthus. Close eyes and gently massage to distribute the medication
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 5
Definitions:
Agranulocytosis / Neutropenia / agranulocytopenia
□ Definition: Acute decrease in the number of granulocytes/leukopenia (WBC) in peripheral blood
□ Causes include: treatment with broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime, ticarcillin, gentamycin), bone marrow transplant, chemotherapy, radiation.
□ Generally is impaired resulting from bone marrow depression by drugs and chemicals or replacement by a neoplasm(oral lesion, ulcer necrotic, gingivitis, buccal mucosa
□ Lymphadenopathy, lymphadenitis may be prevalent.
□ Could lead to respiratory infection, ulceration of mouth colon, high fever, UTI. But may be asymptomatic
Chelating agents
□ A form of detoxification
□ Chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide (a synthetic amino acid which attaches to toxic substance such as lead, cadmium, aluminum and other metal in the blood to facilitate their removal from the body.)
□ May be used to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove excess calcium from the body.
EDTA: Ethylenediaminetetraacetic acid
□ Use in children with lead level between 45&70 micron/dl.
□ EDTA binds to lead in blood and excreted by the bowel and kidney. EDTA may be toxic to kidney. Monitor urine output.
□ Give this by IV. Dose depends on weight of child, severity of the poison. Agent is given every 4 hours for 5 days. A second course may be needed if there is a rebound in the blood level. Give oral and IV fluid to enhance excretion
□ Do not use EDTA with hypocalcemia or hypokalemia. OTHER AGENTS
□ British antiLewisite (BAL) does not give with iron supplement and avoid in pt. with plant allergy. Give this by IM
□ Succimer (Chemer)
□ Chemet – oral medication - Do not give in pt. with encephalopathy
Epistaxis
□ Nose bleed. Can be anterior or posterior. Posterior is more serious.
□ due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma
□ blood can come up through the eye, can also flow down the stomach causing nausea, vomiting
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Treat epistaxis
□ cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent dressing or saline sprayed into the nose
□ Ice pack to forehead or back of the neck
□ pinch septum of nose for 5 minutes
□ Do not pack nose with tissue or gauze
Half-life
□ The time it takes for a medication to lose half of its pharmacologic or physiologic effect
□ To calculate half-life: There is a formula but the easiest way to decrease count.
□ Example: half- life is 1 hour. Start 100% 1 hr. 50% 2 hrs. 25% 3 hrs. 12.5% 4 hrs. 6.25% Question – Half-life of ‘xyz’ medication is 1 hour. After 3 hours, what percentage of the medication will be left? A = 12.5%
Osmotic agent - see entry under Mannitol
Paradoxical reaction
□ A response to a drug (or medical treatment) that is the opposite to the usual response, such as agitation produced in an individual patient by a drug which is ordered to sedate or calm a person.
Sustained release / time released / extended release / controlled release
□ Pills or capsule formulated to dissolve slowly and release drug over time.
□ They can often be taken less frequently, keep steadier levels of the drug in the bloodstream
□ Contain in a matrix of insoluble substance (e.g. Acrylics) the drug swells up to form a gel so that the drug has first to dissolve in matrix then exit through the outer surface.
□ Cannot be crushed, dissolved or opened
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Medication Effects
There is a bit of an overlap here with Principles of Pharmacology. These questions tend to be medication (or classification)
specific. There are many medications on the test and many could be. As applicable, both brand and generic names are used.
We recognize the attached grid is very lengthy, but have included some of the key components as identified below. Most
medications addressed are either high usage or high risk. Please note that auto-corrections will change generic names to
starting with caps. In the grid, we have tried to list generic first, then brand names.
Areas to know:
1. Use, dose, side effects, contraindications
2. Since there are a limited number of questions, not all medications are addressed. You may be asked to select which
medication would be given for a particular diagnosis. When studying, focus on the classifications – this may enable you
to answer without knowing the actual medication.
3. Focus on what are the major side effects of a medication or class? What makes it high risk? Why might one particular
med be used other than another?
4. Patient teaching is a major focus. What would you tell the patient about the medication? What would indicate
understanding? What would indicate need for further teaching?
Common classification of medications
Note letters in medication name and look for those letters that identify a particular classification:
◊ Androgens: end with –terone: testosterone (Testoderm)
◊ ACE Inhibitors: end with –pril: enalapril (Vasotec)
◊ Antidiuretic hormones: end with –pressin: desmopressin (DDAVP)
◊ Antilipidemic: end with –statin: atorvastatin (Lipitor)
◊ Antiviral: contain -vir: ritonavir (Norvir)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 8
◊ Benzodiazepines: include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),
estazolam (ProSom), and triazolam (Halcion). Most others end with –pam: diazepam (Valium)
◊ Beta Blockers: end with –lol: atenolol (Tenormin)
◊ CCB: end with –pine: amlodipine (Norvasc); some exceptions include diltiazem (Cardizem), verapamil
(Isoptin)
◊ Carbonic anhydrase inhibitors: end with –mide: acetazolamide (Diamox)
◊ Estrogens: contain est: conjugated estrogen (Premarin)
◊ Glucocorticoids and corticosteroids: end with –sone: prednisone (Deltasone)
◊ Histamine H2 receptor antagonists: end with –dine: cimetidine (Tagamet)
◊ Xanthine bronchodialators: end with –line: theophylline
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 9
Specific Diseases or treatments:
Aminoglycoside
□ antibiotics - Treats serious life threatening gram negative (and some positive) infections All aminoglycoside ends Mycin but not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin and azithromycin) Examples:
□ Gentamycin
□ Tobramycin
□ Vancomycin
□ Neomycin
□ Generally IM or IV.
□ Oral route is not recommended. It is only use for bowel prep prior to surgery (see Neomycin) Adverse effects/toxicity: Two most common MAJOR adverse effects: Nephrotoxicity and ototoxicity. Also:
□ Photosensitivity
□ risk for superinfections
□ Pseudomembranous colitis (c-diff): stop med and treat with PO Flagyl Peak level:
□ Drawn 15-30 min after the infusion is completed.
□ Peak concentration determines that toxic level does not occur.
□ If peak is too high, may reduce dose. Trough level:
□ Drawn immediately (within 30 minutes) before next IV dose
□ Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.
□ Dose will be adjusted if level is not sustained
□
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Blood administration
□ Start blood transfusion slow 2 ml/min. Remain with pt. for the first 15-30 min. if there is no sign of side effect, increase rate to the desired rate
□ Administer using largest gauge IV access as possible.
□ Observe for acute reaction such as: allergic s/s – rash, itching, localized edema; febrile (even low grade); septic; air embolism; circulatory overload.
□ Observe for delayed reaction: Graft vs. host; hepatitis; hemolysis
Crack abuse effect on newborns
□ Crack crosses the placenta and enters the fetus.
□ Common presentation: Infant may appear normal or develop neurological problem. Child may develop depression or excitability, they may be lethargy, have poor suck; weak cry and difficulty in arousing, hypotonicity, rigidity, irritability, inability to console and intolerance to change, small head, decreased birth length
□ Late symptoms: Some infant showed late symptoms 2-8 wks. There may be growth retardation - head growth is one of the best indication
Diabetes treatment in children
□ Hypoglycemic reaction takes place most time before meals or when insulin effect is peaking.
□ First teaching: (1) let child wear bracelet or tag; (2) Teach how to give injection. Inject at 90 degree angle.
□ Teach only the essentials on the first few visits and intense later. Keep session for children to 14-20 min and adult may go up to 45-60
□ Have same meal as normal child time intake of food. Eat at the same time each day.
□ Children can start learn to assume responsibility for self-management as soon as age 4-5. At age 9, they can start giving their own insulin with supervision.
□ Exercise: do not restrict exercise. Have extra snack before and after exercise. Exercise very regularly as it decreases the need for insulin
□ Carry a source of glucose at all times (hard candy, sugar cubes glucose tablets, insta glucose). The rapid releasing sugar is followed by complex CHO and protein such as slice of bread or cracker spread with peanut butter
□ After glucagon injection, vomiting may occur. Place child on the side to prevent aspiration.
□ Preferred way of treating ketoacidosis is by insulin IV of low dosing. Note. Run a mixture of insulin through the tubing before starting the drip because the insulin can chemically bind to plastic. Replace fluid over 24-48 hrs.
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Diabetes – Intravenous insulin administration
□ Can only be done with regular insulin in management of DKA, HHNK.
□ Premature discontinuation can cause prolongation of DKA.
□ Begin SQ insulin therapy before stopping the infusion. If not, there might be prolonged hyperglycemia.
Hepatitis – see below
HIV treatment – antiretinoviral therapy Common meds:
□ abacavir (ziagen)
□ stavudine (Zerit)
□ zidovudine (AZT) Antiviral protease inhibitor. End in AVIR
□ Use prophylactically.
□ Use in combination to decrease viral load and increase CD4.
Reverse transcriptase inhibitors: Ends in INE
□ Stop replication/growth. Reduces viral load.
□ One major advantage is that they do not affect adversely affect development of blood cells.
□ Use in combination with other meds because resistant strains may rapidly evolve if used as single agent therapy.
□ Inhibit cell protein synthesis that interfere with viral replication; block protease activity in HIV.
□ Treat AIDS and AIDS-related complex to decrease viral load
Side effects:
□ Assess for opportunistic infection (cancer, neurological disease); HA, fatigue, nausea, vomiting, diarrhea, abdominal discomfort, anemia, taste perversion, asthenia, circumoral paresthesia with ritonivair,
Adverse/toxicity
□ Hepatoxicity, Hepatotoxicity: AST, ALT, bilirubin; observe for nausea, vomiting jaundice upper right abdominal quad enlargement and tenderness. Reduce dose in liver dysfunction.
□ Nephrotoxicity; creatinine, BUN, creatinine clearance, urinalysis, keep accurate I& O, monitor for SE of neutropenic, observe occult signs of infection. (lower back, flank or suprapubic pain, normal temp or low grade fever related to UTI
START therapy: (1) all symptomatic HIV people (presenting with a AIDS-defining illness) or (2) with a CD4 count less than 350 mm3. (3) also start pregnant women (AZT is used to prevent maternal transmission of HIV) STOP if severe rash or other hypersensitivity reaction occurs. Excluding reaction to medications and/or ineffectiveness of medication, treatment will be long-term. TEACH
□ Use neutropenic precautions
□ Eat small frequent meals with complete or complementary proteins
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 12
□ Bacteriostatic which action on bacteria results from interference with the functioning of enzyme systems necessary for normal metabolism, growth and multiplication
□ Thiazide is ineffective if creatinine clearance is < 30ml/min
□ Eat foods high in potassium, restrict sodium, do not use salt substitute if taking potassium supplement
□ weigh self daily, report sudden weight gains or losses
Avoid use with:
□ Children
□ anuria
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 13
Tricyclic Antidepressants
□ Initial mechanism of TCA takes 1-3 weeks to develop.
□ Maximum response is achieved in 6-8 wks.
□ Has long half-life. Most Tricyclics ends in INE
□ nortriptyline (Pamelor)
□ amitriptyline (Elavil)
□ doxepin (sinequan)
□ imipramine (tofranil)
□ Block the reuptake of norepinephrine or serotonins or both, leaving more available in the CNS. It intensifies the effect of norepinephrine and serotonin which can elevate mood, increase activity and alertness, decrease preoccupation with morbidity, improve appetite and regulate sleep pattern.
□ It is used to treat insomnia, attention deficit/hyperactivity and panic disorder.
Side effects:
□ orthostatic hypotension,
□ sedation and anticholinergic effects. Adverse effects/toxicity:
□ Most serious adverse effect is cardiac toxicity; in the absence of overdose or preexisting cardiac impairment, serious cardiotoxicity is rare.
□ URINARY RETENTION IS URGENT
□ Overdose may cause convulsions
□ Take at nights, it causes sedation.
□ Do not take with MAO it will cause hypertensive crisis from excessive adrenergic stimulation of the heart and blood vessels,
□ monitor orthostatic BP of pt. in hospital
Use with caution:
□ Glaucoma
□ Elderly
□ constipation, prostatic hyperplasia, as they are more sensitive to anticholinergic effect
Avoid use with:
□ hypersensitivity,
□ MI, Cardiovascular disease
Vesicant – Chemotherapy
□ See precautions under “Vincristine”
Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins Stages of viral hepatitis:
(1) Pre-icteric – precedes appearance of jaundice, may have flulike symptoms (2) Icteric – appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools (3) Post-icteric – convalescent stage; jaundice improves; color of urine and stool returns to normal
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 14
Hepatitis A (formerly “infectious hepatitis”) Cause: enterovirus At risk:
□ Young children
□ Institutionalized people
□ Health care personnel
Transmission:
□ fecal-oral
□ ingestion of food or liquids contaminated with the virus.
□ person by person contact
Incubation: 3-5 wks. Infectious: usually 2 wks. before the onset of jaundice and 1 wk. after onset of jaundice. s/s: May have no symptoms initially. Complications:
□ Fulminant hepatitis
Hepatitis B. At risk:
□ IV drug users
□ People on Hemodialysis
□ Health care personnel
Transmission:
□ blood and body fluids
□ contaminated needles, parenteral
□ sexual activity
Incubation: 6-24 weeks s/s:
□ progression of symptoms is more insidious and prolonged than Hep A virus.
Incubation period: 5-10 weeks s/s: similar to HBV but often less severe. Complications:
□ chronic liver disease
□ Cirrhosis.
Hepatitis D Cause: Occurs only with Hepatitis B and only causes problems with an acute HepB infection. At risk:
□ common in Middle east, south Africa and Mediterranean
□ same as HepB
Transmission:
□ same as Hepatitis B. Incubation period: 7-8 weeks HepD along with HepB causes superinfection and worsening of condition and rapid progression of cirrhosis Complications: As per Hep B
Hepatitis E Cause: waterborne virus At risk:
□ Travel to areas where sewage disposal is inadequate and/or people bathe in contaminated rivers
□ At higher risk with higher mortality: women in third trimester of pregnancy
Transmission:
□ Same as HepA Incubation: 2-9 weeks Complications:
□ Maternal and fetal demise
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□ death
discomfort N/V, HA.
□ Then expanding to: Hepatic S/S, photophobia, angioedema, rash, vasculitis, jaundice in Icteric phase
Complication:
□ Cirrhosis
□ Fulminant hepatitis
A grid follows with a listing of medications that may be on the exam.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 16
Drug Use and dosage Side effect Teaching and labs contraindication
Acetylsalicylic acid (Aspirin)
□ Non-narcotic analgesic
□ Antipyretic
□ Antiplatelets
□ Blocks pain impulse in peripheral and some CNS;
□ antipyretic result;
□ inhibit platelets aggregation
□ Treat TIA, Post MI, Stroke, angina
□ Increases coagulation times
□ Reye’s syndrome (encephalopathy and fatty liver),
□ Severe allergy: hives, wheezing, anaphylactic reaction. Medical emergency requires immediate tx or can lead to death.
□ side effects: GI, N/V, diarrhea, abdominal pain.
□ Pruritic rash like measles is not a true allergic reaction
□ Do not give with fruit juice, milk or carbonated beverages because of poor absorption.
□ Watch for hypokalemia
□ Take on empty stomach.
□ May not be necessary to stop treatment if mild diarrhea develops.
□ Give yogurt or buttermilk to restore normal flora (or probiotics)
Avoid with:
□ Hypersensitivity to any penicillins; use cautiously if history of hypersensitivity to cephalosporins;
□ Exfoliated dermatitis
□ Loop diuretic may exacerbate hypokalemia and rash.
□ Potassium-sparing diuretic may contribute to hyperkalemia
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Drug Use and dosage Side effect Teaching and labs contraindication
Atropine Sulfate. Two different uses:
□ Anticholinergic (such as for Parkinson’s disease)
□ For ophthalmic use Systemic effect is more pronounced in infant and children with blue eyes and blond hair. Also increased risk of toxicity with Down syndrome
□ Use to increase heart rate (not necessarily first drug of choice).
□ Decreases involuntary movement and rigidity in Parkinson’s disease
□ Pre-op to decrease secretions and prevent aspiration of secretions while under anesthesia
□ Use for inflammation of the iris and uveal tract.
□ Dry mouth, constipation, urinary retention or hesitancy headache, dizziness
Adverse effects/toxicity:
□ Paralytic ileus.
□ Treat overdose (resp. depression and circulatory collapse) symptomatically.
Adverse effect when used for the eye
□ Transient stinging,
□ increase IOP, photophobia,
□ Monitor dosage of meds carefully, even slight overdose can lead to toxicity.
□ Assess for constipation and urinary retention; increase fluids, bulk and exercise, assess bowel sound to rule out paralytic ileus,
□ Avoid driving or other hazardous activities, drowsiness may occur.
For the Eye
□ Acute glaucoma can be precipitated by papillary dilation; if not recognized and treat, acute glaucoma can result in blindness.
□ Wear dark sunglass and avoid bright light for photophobia,
□ Monitor intraocular pressure and vision
□ Increased anticholinergic effect with phenothiazine, antidepressant, MAO’s amantadine.
□ Contraindicated in pt. with narrow angle glaucoma, myasthenia gravis, or GI obstruction.
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Drug Use and dosage Side effect Teaching and labs contraindication
Beclomethasone diproprionate (Beclovent)
□ inhaled corticosteroid medication
note: also nasal inhalant as Beconase
□ Used in bronchial asthma, allergic rhinitis
Side Effects:
□ Pharyngeal irritation and sore throat,
coughing, dry mouth, oral fungal infections, and sinusitis.
□ Increased susceptibility to infection, dermatologic effects and osteoporosis, diarrhea, N/V, HA, fever, dizziness angioedema rash urticaria and paradoxical bronchospasm
Adverse effects/toxicity
□ Adrenocortical insufficiency
□ fluid and electrolyte disturbances,
□ nervous system effects and endocrine effects if absorbed systemically.
□ Decrease dose if pt. is on systematic corticosteroid.
□ Assess for impaired bone growth in children receiving inhaled corticosteroid
Considerations:
□ Monitor for hyperglycemia
□ Rinse mouth after use for medication; oropharyngeal candidiasis and/or hoarseness can occur.
□ Use bronchodilator inhalant before corticosteroid when both are ordered.
□ Do not abruptly stop meds taper over 2 weeks.
□ Be aware of steroids symptoms - Moon face, acne, edema, increased fat pads
- notify doctor.
□ Report weight gain
Do not use with:
□ children under
□ Clients with known allergy
□ May require adjustment of antidiabetic agent as there is a potential for elevated blood glucose levels with corticosteroids are administered orally.
□ Not use in bronchospasm or status asthmaticus.
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Drug Use and dosage Side effect Teaching and labs contraindication
□ Will not be effective if creatinine clearance Is less than 30ml/min
Avoid use:
□ Client with anuria.
□ Use cautiously with impaired renal or hepatic function.
□ If pregnant.
□ Will increase serum lithium level
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 24
Drug Use and dosage Side effect Teaching and labs contraindication
Chlorpromazine hydrochloride (Thorazine)
□ phenothiazine
□ Antipsychotic medication
□ Anti-emetic
□ Give bromocripitine (Parlodel) and dantrolene (Dantrium) for NMS.
□ Block dopamine receptor in CNS to
□ Use: treat psychotic disorder (schizophrenia, bipolar, and other mental illnesses); prevent acute exacerbation and maintain highest possible level of function
□ Use to control manic phase (bipolar)
□ intractable hiccups
□ nausea/vomiting
□ Low potency anti-psychotic which can reduce the risk of EPSE (extra-pyramidal side effects)
□ liver damage, tremor are two major side effects.
□ photosensitivity Adverse effects/toxicity:
□ Neuroleptic malignant syndrome (NMS), catatonia, rigidity, stupor, unstable blood pressure profuse sweating, dyspnea. Can be toxic effect and MAY last for 5-10 days after discontinuation of the med.
□ get baseline ECG, thorough baseline evaluation lab tests before treatment.
□ Give bromocripitine (Parlodel) and dantrolene (Dantrium) for NMS.
□ Withdrawal of drug is necessary
□ Take measures to protect eyes exposed to sunlight
□ Monitor diabetics closely for glucose intolerance
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 25
Drug Use and dosage Side effect Teaching and labs contraindication
Cimetidine (Tagamet)
□ GI meds,
□ H2 receptor antagonist
□ Works against histamine receptors, decreases gastric secretion.
□ Use short term for duodenal ulcer, benign gastric ulcer, acute upper GI bleed
□ Rare but may include agranulocytosis neutropenia , thrombocytopenia aplastic anemia, anaphylaxis
□ May be given with meals and at bedtime
□ Avoid smoking which cause gastric stimulation
□ Avoid antacid use within one hour of dose
Avoid use:
□ hypersensitivity Use caution:
□ impaired renal or hepatic function
Cisplatin (Platinol) Half-life 20-30 minutes
□ Antineoplastic medication
□ Alkylating agent ** Major allergic reaction can occur within first 15 mins. of administration. Anaphylaxis may occur within minutes of drug initiation.
□ Treat ovarian and testicular cancer by interfering with DNA replication
Side effects:
□ anorexia, uncontrolled N/V, fluid retention, weight gain
Adverse effects/toxicity:
□ Major toxicities occur in the blood, GI, and reproductive system.
□ Watch urine output and specific gravity-nephrotoxicity may occur within 2 wks.
□ ototoxicity (tinnitus or difficulty hearing in the high frequency range)
□ maintain fluid at least 3000 ml in 24 hr. ; report reduced urine output
□ Avoid food high in thiamine (beer, wine cheese, brewer’s yeast, chicken liver & banana) - may lead to hypertension & intracranial hemorrhage
Avoid use:
□ Hx of sensitivity to platinum-containing compounds,
□ impaired renal function and hearing,
□ Hx of gout, renal stones.
Incompatible with
□ dextrose and Reglan, Vanco
□ Lasix may increase otoxicity
□ other nephrotoxic drugs may increase nephrotoxicity and renal failure.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 26
Drug Use and dosage Side effect Teaching and labs contraindication
Codeine sulfate
□ Opioid analgesic (agonist)
□ Antitussive (cough suppressant)
Rapid onset if IM or IV. Peak 1-2 hrs., Duration up to 7 hours.
□ To treat mild to severe pain
□ most oral preparations combined with ASA or acetaminophen
□ Long term use may cause withdrawal symptoms when stopped
Assess for:
□ respiration and usually hold <12 breaths per minute,
□ CNS changes (LOC),
□ allergic reaction TEACH:
□ no alcohol
□ no OTC pain meds unless ordered
□ Avoid driving until drug response is known.
Do not use:
□ Hypersensitivity
□ Increased ICP, head injury
□ Acute alcoholism
□ labor
Cyanocobalamin (Vitamin B12) Half- life: 6 days
□ Vitamin B12 helps in the formation of red blood cells essential for the proper production of blood platelets and red and white blood cells and the nervous system
□ Malabsorption syndrome
□ Pernicious anemia
□ water-soluble vitamin that is stored in the liver.
Adverse effects/toxicity:
□ Anaphylactic shock, sudden death,
□ severe optic nerve atrophy (may develop after years of use or with Leber’s disease)
Teach:
□ Injection is once per month for life with pernicious anemia .
□ Oral preps may be mixed with fruit juice but give immediately since ascorbic acid (Vit. C) affects stability of B12.
□ Dietary B12: best are organ meats, egg yolk, clams, oysters, crabs, sardines, salmon
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 28
Drug Use and dosage Side effect Teaching and labs contraindication
Debrox drops
□ Ear drops to dewax
□ used to soften and loosen ear wax, making it easier to remove.
Side effects:
□ temporary decrease in hearing after using the ear drops
□ mild feeling of fullness in the ear
□ mild itching inside the ear.
Adverse effects/toxicity:
□ Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
Use:
□ Tilt head with ear facing upward. Pull back on ear to open up the ear canal. Drop the correct number of ear drops into the ear.
□ After using the ear drops, stay lying down or with your head tilted for at least 5 minutes. You may use a small piece of cotton ball to plug the ear and keep the medicine from draining out.
□ A bubbling sound inside may be heard after putting in the drops. This is caused by the foaming action of carbamide peroxide, which helps break up the wax
□ May come with bulb syringe.
Do not use:
□ With a ruptured ear drum.
□ any signs of ear infection or injury
□ Do not use this medication in a child younger than 12 years old without the advice of a doctor.
□ Do not use for longer than 4 days in a row.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 29
Drug Use and dosage Side effect Teaching and labs contraindication
Diazepam (Valium)
□ Benzodiazepine (have zep and zap in them)
□ minor tranquilizers,
□ anticonvulsant,
□ anxiolytic
□ Absorbed from GI, metabolize in liver
Onset 30 min IM, 60 PO, 15 IV. Works quickly. Peak 1-2hr PO, Duration 15 min to 1hr IV; up to 3 hrs. PO. Half-life 20-50 min
□ Relieve pain and discomfort from musculoskeletal disorders,
□ manage anxiety,
□ Manage acute alcohol withdrawal
Maximum effect will be seen in 1-2 weeks. Can take 2-4 wks. It has addictive effect.
□ weigh daily and report weight greater than 2 lbs. per day
Avoid use with:
□ hypersensitivity to dig
□ Caution with kidney failure
Interaction:
□ IV calcium with dig may increase risk of cardiac dysrhythmias,
□ erythromycin will increase dig level,
□ quinidine, verapamil and amiodarone will increase dig levels and dig dose should be decreased by 50%
□ Cyclophosphamide combined with dig cause dig toxicity
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 31
Drug Use and dosage Side effect Teaching and labs contraindication
Disulfiram (Antabuse) The only alcohol antagonist in use.
□ Enzyme inhibitor
□ Anti-alcohol agent. Half-life 24-36 hour Onset up to 12 hrs. Duration up to 2 wks. Absorbed from the GI excreted in feces or in the breath as carbon disulfide
□ Adjunct treatment of patient with chronic alcoholism who sincerely wants to maintain sobriety.
□ At least 12 hours should elapse from the time of last alcohol intake and the initial dose
□ Use only in people with high physical health.
□ Use for 1-2 wks. INTENDED Reaction with alcohol ingestion:
□ Short term treatment in duodenal ulcer or benign gastric ulcer.
□ Metabolized in liver, excreted in urine
Side effects:
□ diarrhea, constipation, dry mouth
Adverse effects/toxicity:
□ thrombocytopenia
□ May be taken with food.
□ pain relief may not be experienced for several days
□ Use cautiously with impaired renal or hepatic function.
□ Do not breastfeed
□ avoid antacid use within 1 hour of dose
Fluoxetine hydrochloride (Prozac)
□ psych med.
□ Tricyclic antidepressant.
□ Selective Serotonin Reuptake inhibitors (SSRI)
□ Half-life 1-6 days. Onset 2-3 weeks to be effective. Peak 4-8hrs. Metabolized in liver, absorbed from GI tract, excreted in urine and face.
□ Major depressive disorder
□ Obsessive compulsive disorder,
□ bulimia,
□ panic disorder
□ obesity
□ alcoholism
□ chronic pain. Such as rash. Wait 4-6 weeks before switch to MAO Inhibitor
Common side effects:
□ Orthostatic hypotension
□ sedation
□ Anticholinergic
□ Hypomania
□ Sexual dysfunction Adverse effects/toxicity:
□ Cardiac toxicity Selective Serotonin syndrome (early s/s: diaphoresis, agitation, low grade temp.) Then increase in BP, muscle rigidity, temp, resp, pulse. Mental status changes, tremors, hyperthermia, sweating hypersalivation. Notify dr ASAP.
□ DO NOT stop abruptly.
□ Give meds once a day at about noon because it causes insomnia. If prescribed 2 times daily give dose in the morning early and 12 noon to prevent insomnia
□ Teach side effects of drugs
□ Therapeutic response takes some weeks to be established.
□ MI, cerebrovascular disease.
□ If suicide risk, should not have access to a large quantity.
□ Do not take while pregnant
□ ** The combination of TCA and MAOI can lead to hypertensive crisis from excessive adrenergic stimulation of the heart and blood vessels.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 34
Drug Use and dosage Side effect Teaching and labs contraindication
Fluphenazine (Prolixin)
□ phenothiazine; Ends with azine
□ antipsychotic Half-life > 24 hours Onset: 1 hr., peak 0. 5 hr. meds effect can be seen 1-2 days but full effect several weeks
□ Potent medication for treatment of antipsychotic symptoms, including schizophrenia.
□ Treatment is not curative.
□ Adjust dose to symptoms.
□ Use injectable form for long term maintenance
- the rate of relapse is usually reduced and is more favorable
□ Produces EPS which are reversible.
** Treat EPS with Cogentin, Artane, Benadryl, Symmetrel Side effects: ABCDE
□ weight gain Adverse effects/toxicity: Neuroleptic malignant syndrome (NMS) a fatal side effect. Presents with catatonia, rigidity, stupor, unstable blood pressure, hyperthermia profuse sweating, dyspnea, incontinence. Stop drug. Tx with Dantrium and Parlodel. Condition lasts for 5-10 days after stopping med.
Monitor LFTs TEACH
□ Avoid alcohol use and other CNS depressants
□ Do not alter dose or stop abruptly
□ Avoid sun exposure
□ With oral concentrate, avoid spills. Rinse skin with warm water immediately if there is contact
□ Dilute liquid drug with fruit juice water, carbonated beverage, milk, soup – avoid mixing with caffeine, tea, apple juice.
Avoid with:
□ Caution with narrow angle glaucoma, hepatic or renal dysfunction and seizure disorder.
□ Do not breastfeed
□ Dose should be reduced in the elderly.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 35
Drug Use and dosage Side effect Teaching and labs contraindication
Furosemide (Lasix)
□ Loop diuretics,
□ Anti-hypertensive Peak 60-70 min PO, 20-60 min IV. Onset 30-60 min PO, 5 min IV, Duration 2 hrs., Half-life 30 min
□ Rapid acting loop diuretic
□ Inhibits reabsorption of sodium and water (in Loop of Henle)
□ Lowers BP by decreasing edema and intravascular fluid
Treat
□ acute pulmonary edema, edema,
□ heart failure,
□ chronic renal impairment,
□ hypertension,
□ hypercalcemia
Side effects:
□ Ototoxicity
□ headache
□ Dizziness
□ Orthostatic hypotension
□ weakness Adverse effects/toxicity:
□ s/s hypokalemia –
□ Hyponatremia,
□ hypochloremia,
□ hypomagnesaemia
□ hypocalcemia IV form:
□ Administer slowly; hearing loss can occur if injected rapidly (ototoxicity).
□ Give over 1-2 minutes to prevent hypotension.
TEACH
□ change position slowly to avoid dizziness and orthostatic hypotension
□ report ringing in the ear immediately
□ Take with food or milk
□ Give early in day to avoid nocturia
□ Replace potassium (dietary or meds)
□ Monitor labs, especially electrolytes. Also hgb, hct, platelet as these increase d/t hemoconcentration
□ Interaction with digitalis can increase arrhythmias.
□ Interaction with aminoglycosides increases risk of ototoxicity.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 36
Drug Use and dosage Side effect Teaching and labs contraindication
Gentamicin (Garamycin)
□ Aminoglycosides.
□ Antibiotic Peak level:
□ Drawn 15-30 min after the infusion is completed.
□ Peak concentration determines that toxic level does not occur.
□ If peak is too high, may reduce dose.
Trough level:
□ Drawn immediately (within 30 minutes) before next IV dose
□ Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.
□ Dose will be adjusted if level is not sustained
Peak 30-90 min Half-life 2-4 hr.
□ Broad-spectrum antibiotic
□ Parenteral use limited to severe infections, unresponsive to other antibiotics.
Ophthalmic:
□ treat superficial infection of the eye.
□ Have pt. keep eyes closed for 1-2 min after instillation.
□ Vision will be blurred initially
Side effects:
□ HA, parenthesia, skin rash fever
Adverse effects/toxicity:
□ Nephrotoxicity
□ Ototoxicity. This may cause irreversible auditory impairment and vestibular damage Signs of ototoxicity include HA, NV unsteady gait, tinnitus, vertigo, high frequency, hearing loss and dizziness
□ Hypersensitivity reactions
□ Superinfection: a secondary infection caused by eradication of normal flora: Candidiasis, skin and mucous membrane
□ Maintain hydration to protect kidney damage. Fluid intake should be 2,500-3000 ml/day
□ give high protein foods
LABS
□ WBC to monitor the effectiveness of therapy
□ Watch kidney function tests (BUN, Creat) closely due to toxicity risk
□ Report sore throat, watery stools greater than 4-6 per day, severe nausea or vomiting, indicating possible super infection
Avoid with:
□ Pre-existing renal disease
□ Use caution with pre-existing hearing loss
□ Pregnancy, lactation
□ Increased risk with nephrotoxic drugs, prolonged treatment with aminoglycosides, impaired renal function and other ototoxic drug such as Lasix, Vanco.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 37
Drug Use and dosage Side effect Teaching and labs contraindication
Glipizide (Glucotrol)
□ oral antidiabetic
□ Sulfonylurea duration: 12-24 hours Onset: 15-30 min Peak: 1-2hr Metabolized by the liver
□ Stimulates pancreatic beta cells to secrete insulin.
□ Type 2 diabetes mellitus
□ Give dose 1-3 time daily
□ may use alone or in combination with insulin
Side effects:
□ GI distress
□ dizziness
□ drowsiness
□ headache Adverse effects/toxicity:
□ Severe skin rash, pruritus
□ Hypoglycemia
□ Monitor labs including glucose, Hgb A1C
TEACH
□ Take with first daily meal.
□ Take any missed dose as soon as remembered.
□ Report s/s of hypoglycemia if they occur
□ Avoid alcohol
Avoid with:
□ Pregnancy, lactation
□ Allergy to sulfa or urea
□ Diabetic ketoacidosis
Caution with:
□ impaired renal and hepatic function
□ Adrenal or pituitary insufficiency.
Glucagon
□ Anti-hypoglycemic Onset 5-20 min, Peak 30 min Duration 1-1.5 hr., Half-Life; 3-10 minutes Metabolizes in liver, plasma and kidneys
□ Emergency treatment of severe hypoglycemia in unconscious client or those unable to swallow
□ Comes in powder form. Reconstitute with provided diluent.
□ Give IV, IM or SQ immediately
□ Give IV through D5W only, not NS
Side effects:
□ Nausea/ vomiting Adverse effects/toxicity:
□ Hypersensitivity reaction,
□ hyperglycemia
□ Hypokalemia
□ Should awaken within 5-20 min after giving.
□ Give 50% glucose if no response to glucagon
Teach
□ test blood sugar,
□ teach family how to administer SQ or IM
□ Incompatible with sodium chloride solution.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 38
Drug Use and dosage Side effect Teaching and labs contraindication
Glyburide (Micronase, DiaBeta)
□ Oral antidiabetic,
□ more potent drug
□ Sulfonylurea Onset 15-60 min Peak 1-2 hrs. Duration up to 24 hrs. Half-life 10 hours Metabolized in the liver, excreted in urine and feces.
□ Lowers blood sugar concentration in diabetics and nondiabetics by sensitizing pancreatic beta cells to release insulin in the presence of serum glucose.
□ Type 2 diabetes
□ Use as adjunct to diet and exercise to lower blood sugar
Side effects:
□ Hypoglycemia,
□ epigastric fullness
□ heartburn
□ pruritus Adverse effects/toxicity:
□ hypoglycemia
□ Give once in the morning with breakfast or with first main meal
□ Monitor labs including glucose, HgbA1c
Teach
□ Report reaction
□ Loss of control of blood glucose level may be due to fever, surgery, trauma, stress, infection.
Avoid use with:
□ diabetic ketoacidosis
□ Type I diabetes Caution with:
□ renal or hepatic insufficiency
□ older adult
□ malnourished pt.
□ adrenal or pituitary insufficiency
Haloperidol (Haldol) High potency drug
□ Antipsychotic
□ Butyrophenone
□ Antiemetic Onset: 30-45 min IM Effects can be seen in 1-2 days. Substantial improvement 2-4 wks. Full effect several months.
□ Psychotic disorders
□ Long acting drug for maintenance – to control symptoms
□ Tourette’s syndrome
Side effects: ABCDE:
□ Anticholinergic (dry mouth)
□ Blurred vision
□ Constipation
□ Drowsiness
□ Extrapyramidal syndrome (such as Parkinson’s s/s)
□ Photosensitivity Adverse effects/toxicity:
□ Elderly patient may develop Neuroleptic Malignant Syndrome (NLMS)
□ EPSE: usually first few days of tx, dose related, controlled by dose or anti-Parkinson’s drugs
□ Oral: Give with milk or food.
□ Taper dose slowly when stopping.
□ Injection: deep IM – risk for orthostatic hypotension
□ no alcohol or driving until response known
Avoid with:
□ Parkinson’s disease
□ seizure disorder
□ severe mental depression
Use caution:
□ older adults,
□ lithium therapy
□ HTN
□ Lactation
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 39
Drug Use and dosage Side effect Teaching and labs contraindication
Heparin
□ Anticoagulant Antidote = Protamine sulfate (see separate listing)
□ As anticoagulant – given IV or SQ
□ Use as continuous IV infusion for DVT, Pulmonary embolus, angina, acute MI
□ SQ for prevention
□ Hep-lock (flush) is to maintain patency of IV catheters; not for anticoagulant therapy
Side effects:
□ Bleeding
□ Heparin-induced Thrombocytopenia (HIT) – may appear up to several weeks later.
□ Does not dissolve clots – prevents enlargement and development of new clots.
□ Use bleeding precautions
□ Monitor labs: aPTT Normal = 25-40 Coagulated = 1.5-2 times normal = 60-80
□ Effects noted 3-4 days; max effect takes 3-4 weeks
□ Most widely prescribed diuretic for HTN
□ Act on distal tubules of nephron and increases urinary excretion of sodium, chloride, potassium, water, bicarbonate
□ Decreases edema and lowers blood pressure
Side effects:
□ Glucose intolerance, hyperglycemia
□ Hypokalemia (low K+)
□ Give with food or mild to reduce GI upset.
□ Give dose(s) early in the day to avoid nocturia
□ Limit Sodium intake
□ Eat foods high in K+. – replacement med usually not needed
□ photosensitivity reaction occur 10-14 days after initial sun exposure
Avoid with:
□ Anuria
□ Hypersensitivity to thiazide
Use caution:
□ Bronchial asthma
□ hepatic cirrhosis
□ renal dysfunction
□ history of gout
□ diabetes
□ SLE
□ Lactation
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 40
Drug Use and dosage Side effect Teaching and labs contraindication
Hydroxyzine HCl (Atarax, Vistaril)
□ Anti-emetics
□ Anti-histamine (H1 receptor antagonist)
□ antipruritic Onset 15-30 min PO Peak 4-6 hrs. Duration Absorbed form GI. Metabolized in the liver
□ Treat N/V (use anticipatorily)
□ Relieve anxiety
□ Reduce narcotic requirement before and after surgery.
□ Treat acute or chronic alcoholism with withdrawal symptom or DTs
□ Pruritus Usually PO for maintenance
Side effects:
□ CNS depression,
□ Drowsiness
□ Dizziness
□ dry mouth, anticholinergic effect
□ constipation
□ visual changes
□ photosensitivity
IM:
□ Administer deep IM, Z-track – gluteus maximum or vastus lateralis in adults; vastus lateralis in children
□ monitor mouth daily
□ no alcohol
□ hard candy, ice chips or rinse mouth with warm water frequently to relieve dry mouth
Avoid with:
□ CNS depression and coma.
□ Other CNS meds Use caution with:
□ glaucoma
□ seizure
□ intestinal obstruction
□ prostatic hyperplasia
□ asthma
□ cardiac, pulmonary or hepatic disease
Ibuprofen (Advil, Motrin)
□ Analgesic
□ Non-steroidal anti-inflammatory (NSAID)
□ For high dose therapy: therapeutic effect may take up to one month
□ Treat mild to moderate pain
□ absorbed in GI; metabolized in liver
Side effects:
□ CNS, renal system, eyes
□ Nephrotoxicity
□ dysuria, hematuria, oliguria, azotemia,
□ Blurred vision.
□ Ototoxicity Children toxicity:
□ Rash, Stevens- Johnson syndrome
□ Increases toxicity of anticoagulant, lithium
□ Avoid alcohol, ASA, other NSAIDs
Avoid with:
□ GI bleed
□ Reaction to other NSAIDs
□ Children under 6 months
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 41
Drug Use and dosage Side effect Teaching and labs contraindication
INSULINS - quick acting: - short acting - intermediate acting - long acting Insulin is also available in a premixed form of Regular and NPH (example: 70/30 = 30% regular, 70% NPH).
□ Diabetes mellitus, type 1 or type 2
□ Could be made of: pork/beef, pork or human insulin type.
□ Short acting and intermediate acting insulin may be given more than once per day.
□ Lipodystrophy (abnormal deposits of subcutaneous fat at injection sites),
□ local allergic reaction
Adverse effects/toxicity:
□ Somogyi phenomenon: a rebound response with high blood sugar in response to low level at night.
□ Coma
□ Hyperosmolar hyperglycemic state (HHS)
□ Diabetic ketoacidosis (DKA)
□ obtain med alert bracelets
□ Open vial can be stored at room temp for up to one month.
□ Rotate sites
□ Alcohol will increase blood sugar
□ Requires long-term monitoring of blood sugar control and potential complications.
□ Do not use beef/pork insulin if sensitivity
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 42
Drug Use and dosage Side effect Teaching and labs contraindication
Insulin – Regular (Humulin R) **THIS IS THE ONLY TYPE
OF INSULIN WHICH CAN BE
GIVEN IV. **
□ Short acting insulin
□ Given IV or SQ
□ type 1 and type 2 diabetes mellitus and ketoacidosis.
□ given before meals according to blood levels
□ hypoglycemia □ Regular insulin is clear and colorless.
Isophane (NPH) insulin (Humulin N)
□ Intermediate acting insulin
□ Give 30 min before first meal of the day. If necessary, a second smaller dose may be prescribed 30 min before bedtime.
□ If given before breakfast, hypoglycemic episode is most likely to occur between mid-afternoon and dinner, when it peaks. Eat snack in midafternoon and carry sugar candy.
□ NPH Insulin is a cloudy suspension.
□ Roll the bottle to mix; do not shake.
□ NOTE: NPH may be mixed with Regular insulin injection without altering either solution.
Insulin – Glargine (Lantus) ** LANTUS CANNOT BE
MIXED IN SAME SYRINGE
WITH ANY OTHER
INSULIN.**
□ Long acting insulin
□ Type 1 children & adults; Type 2 adults
□ SQ injection
□ Usually given one per day at bedtime. May be given two times per day.
□ With Type 2 diabetes, may or may not be given concurrently with oral agents.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 43
Drug Use and dosage Side effect Teaching and labs contraindication
Iron □ Mineral replacement
Side effects:
□ Nausea/vomiting
□ Staining of teeth
□ Constipation
□ Black stools (normal)
□ Taking on empty stomach preferred with full glass of water or citrus juice
□ Calcium inhibits iron absorption – do not take with milk.
□ Vitamin C increases iron absorption
□ Liquid form can stain teeth
Ipecac Syrup
□ Emetic
□ Antidote Alternate: Activated Charcoal (see separate listing)
□ For overdose on certain drug or poison
□ stimulates vomiting within 20-30 min
Adverse effects/toxicity:
□ Cardiotoxicity is most serious if vomiting does not occur and the substance is retained.
□ Use of this medication is not automatic – verify appropriateness with Poison control center
Do not use:
□ With reduced level of consciousness or convulsions
□ poison by Petroleum distillates, strong alkaline, acid or strychnine
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 44
Drug Use and dosage Side effect Teaching and labs contraindication
Lidocaine HCl (Xylocaine)
□ Antiarrhythmic
□ Topical Anesthetic Bolus dose – may repeat – then start continuous infusion – stop when stable. Therapeutic level: 1.5-6mcg/ml
□ Treat VENTRICULAR
arrhythmias, PVC’s, V-Tach.
□ Use for rapid control of ventricular dysrhythmias during acute MI or Cardiac cath
□ CV: hypotension, bradycardia, heart block CV collapse, and arrest
□ Stop infusion with EKG changes such as prolonged PR, widened QRS, heart block.
LAB
□ Monitor Lidocaine levels assess, therapeutic level is 1.5 -6mcg/ml
□ Assess electrolyte, check baseline liver and renal blood studies.
Report:
□ lightheadedness,
□ dizziness, confusion,
□ numbness or tingling of lips, tongue or fingers
□ visual changes or
□ ringing in ears
□ Correct hypokalemia before giving Lidocaine
Avoid with:
□ Sinus bradycardia
□ Severe degrees of SA, AV and intraventricular heart block.
Use caution:
□ hepatic or renal disease
□ CHF
□ Hypovolemia
□ shock
□ hyperthermia
□ elderly
□ BETA BLOCKERS increase the effect of lidocaine
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 45
Drug Use and dosage Side effect Teaching and labs contraindication
Lithium carbonate (Eskalith)
□ Mood stabilizer
□ Antipsychotic
□ Therapeutic level 0.8-1.5meq/L.
□ Toxic level >2.
□ Lithium has short half-life (about 1 day) and high toxicity.
□ Drug of choice to control manic episodes in bipolar disorder
□ Anti manic effects are usually seen in 5-7 days after initial doses, but full effect does not occur for 2-3 wks.
□ Lithium is a salt; exact action uncertain
□ This med does not cause sedation.
Mild Side effects:
□ fine tremor, nausea, thirst, polyuria,
Adverse effects/toxicity:
□ Vomiting, diarrhea, slurred speech, lack of coordination, drowsiness, muscle weakness, or twitching) – withhold dose and notify provider but DO NOT stop abruptly.
□ Give with meals
□ Hydration is essential – dehydration will increase levels
□ Watch for weight gain (fluid retention)
□ Avoid NSAIDs and diuretics.
□ Essential to monitor mood and behaviors
□ Labs: Lithium level every 3 months initially, then every 6 months.
Do not use with:
□ Dehydration, severe debilitating, severe cardiovascular.
Use caution:
□ elderly,
□ pt. with cardiac, renal, thyroid or diabetes
□ pregnancy
Lorazepam (Ativan)
□ Anxiolytic
□ Sedative-hypnotic
□ Benzodiazepines. Onset 1-5 min IV, 15-30 IM, Peak 60-90 min IM, 2 hrs. PO Duration 12-24 hrs.
□ anxiety disorder
□ short term for relief of symptoms of anxiety
□ Pre-anesthetic medication to produce sedation and reduce anxiety.
□ Status epilepticus
Side effects:
□ Drowsiness
□ sedation
□ Mild medication with limited toxic potential
□ respiratory depression is rate
Paradoxical reactions (nightmares, mania, etc.) may occur in children, psych patients and the elderly.
□ Avoid alcohol
□ Taper dose when stopping to avoid withdrawal symptoms
□ Watch for suicidal risk
Do not use with:
□ Acute narrow-angle glaucoma,
□ Primary depression
□ acute alcohol intoxication.
□ Pregnancy and Lactation
Use caution:
□ renal or hepatic impairment
□ myasthenia gravis
□ suicidal tendencies
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 46
Drug Use and dosage Side effect Teaching and labs contraindication
Magnesium Sulfate iron(Epsom salt – oral form) Onset 1-2 hrs. PO; 1 hr. IM. Duration 30 min IV, 3-4 hr. PO Eliminated by kidneys Normal Magnesium level: 1.8-3 mEq/L
□ Oral: laxative (by osmotic retention of fluid which distend the colon, increase content of feces and cause bowel stimulation)
□ Parenteral: CNS depressant; used in seizures of toxemia; for hypomagnesemia
□ 4 gm. loading dose is give over 20-20 min via pump.
Side effects:
□ Flushed warm feeling
□ fluid and electrolyte imbalance
□ hyponatremia
□ N/V Adverse effects/toxicity: Early indication of magnesium toxicity
□ Respiratory depression
□ Cathartic effect
□ profound thirst
□ feeling of warmth
□ sedation
□ confusion
□ depressed deep tendon reflexes
□ muscle weakness
□ can lead to cardiac arrest
s/s hypomagnesemia:
□ irritability
□ tremors, tetany
□ tachycardia
□ hypertension
□ psychotic behavior
□ Monitor urinary output and hydrate adequately with parenteral administration.
Avoid with:
□ MI, heart block, cardiac arrest except for certain arrhythmias.
Use caution:
□ impaired kidney function
□ other cardiac glycosides
□ Lactating moms and children
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 47
Drug Use and dosage Side effect Teaching and labs contraindication
Mannitol (Osmitrol)
□ Electrolyte and water balance agent
□ osmotic diuretic Onset 1-3 hr. diuresis; 30 to 60 min IOP, 15 min. for ICP Duration 4-6 hr. IOP, 3-8 hr. ICP Serum osmolality is 275-300 mmol/kg. Give IV. Usually give test dose which should result in Output of 30 to 50 ml/hr. and is produced 2-3 hrs. after administration.
□ Use in oliguria and acute renal failure. Help to prevent renal failure and reduce increased intracranial or intraocular pressure
□ It acts by increasing the osmolality of plasma, glomerular filtrate, and tubular fluid. This decreases the reabsorption of fluid and electrolytes, which increases excretion of water, chloride and sodium and slightly increase the excretion of Potassium.
□ In intraocular (IOP) and CSF (ICP), it pulls the fluid and sends it to the plasma and extravascular systems
Side effects:
□ HA, confusion, syncope
□ fluid and electrolyte imbalance, esp. hyponatremia
□ pulmonary congestion, rhinitis
□ Water intoxication Adverse effects/toxicity:
□ Seizure,
□ thrombophlebitis,
□ CHF, Cardiovascular collapse
□ Hyponatremia Warning: There may be a rebound increase in ICP about 12 hours after administration of med. Pt may complain of HA, or confusion.
□ Use filter needle and/or filter in infusion tubing because crystals may form in the solution.
□ Mannitol is held if serum osmolality exceeds 310 -320.
□ Daily weights Teach
□ Non-narcotics such as Tylenol if there is headache
□ Therapy is based on urine flow rate.
□ Reassure pt. that excessive thirst, blurred vision, rhinitis should subside when Mannitol is discontinued
Do not use:
□ severely impaired renal function
□ marked dehydration
□ breast feeding
□ hepatic failure,
□ active ICP
□ anuria
□ Intracranial bleed shock
□ Question the administration of mannitol if the patient has cor pulmonae (right sided heart failure) because Mannitol pulls fluid and it may lead to circulatory overload which the heart could not handle. This client would need loop diuretic to prevent serious complications
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 48
Drug Use and dosage Side effect Teaching and labs contraindication
Meperidine HCl (Demerol)
□ Narcotic analgesic (opioid agonist) Give Narcan for toxicity - It is use to reverse respiratory depression induced by overdose Onset: 15 mins. PO, 10 mins. IM, 5 mins IV duration 2-4 hours
□ Given for moderate to severe pain.
□ Potent, long acting
Side effects:
□ N/V, Anorexia
□ Sedation, dizziness
□ elevated BP
□ rash, urticaria
□ tremors
□ hyperventilation Adverse effects/toxicity:
□ Resp depression,
□ respiratory arrest,
□ circulatory depression,
□ increased intracranial pressure
Assess:
□ LOC
□ rash, urticaria
□ respiratory rate. If respirations < 12 per minute – withhold meds.
□ Given IV; maximum dose of 50 mg in 10 min time period; should be titrated according to the time and length of time the heparin was administered
Side effect:
□ Abrupt drop in BP if administered too rapidly.
□ Monitor vital signs and labs closely (aPTT)
See listing for HEPARIN
Avoid use with:
□ Hemorrhage not induced by heparin overdose.
Ranitidine hydrochloride (Zantac)
□ H2-receptor antagonist.
□ Higher potency than cimetidine (Tagamet)
□ Reduce gastric secretion.
□ Active duodenal ulcer, maintenance after healing
□ GERD
□ benign gastric ulcer (short-term)
Side effects:
□ headache
□ taste disorder, diarrhea, constipation
□ dry mouth Adverse effects/toxicity:
□ hepatotoxicity
□ thrombocytopenia
□ Give without regard to meals
□ Usually give 1 x day
□ reduce dose in renal patient
□ avoid smoking to
□ avoid antacid within 1 hour of dose
Avoid use with:
□ Hypersensitivity Use caution with:
□ Impaired renal of hepatic function.
□ May increase effects of alcohol, aspirin, Coumadin and sulfonylureas
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 56
Drug Use and dosage Side effect Teaching and labs contraindication
Rh0(D) immune globulin (RhoGAM)
□ Biological response modifier
□ Immunoglobulin (IgG)
Peak 2 hour Half-life 25 days
□ Given to Rh-negative moms with RH positive babies.
□ Provides passive immunity by suppressing active antibody response and formation of anti-RHo when (1) positive fetal RBC enters maternal circulation during the third stage of labor; (2) there is
fetal maternal hemorrhage or other trauma during pregnancy; (3) termination of pregnancy or miscarriage; or (4) following a Rh+ transfusion.
Side effects:
□ Injection site irritation
□ slight fever
□ myalgia
□ lethargy
□ Send sample of newborn cord blood to lab for cross match and typing immediately after delivery before administer RHo (D)
□ Give to mom IM via deltoid. (Only a few forms can be given IV).
□ Give immediately after reconstitution
□ Recommended at 28 weeks gestation and then within 72 hours after delivery or 3 hrs. of termination of pregnancy or miscarriage.
□ Keep epinephrine available; systemic allergic reactions sometimes occur.
□ TEACH it will prevent hemolytic disease in a subsequent pregnancy
Avoid use with:
□ Known sensitivity to human immunoglobulins.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 57
Drug Use and dosage Side effect Teaching and labs contraindication
Setraline hydrochloride (Zoloft)
□ Antidepressant
□ SSRI (selective serotonin reuptake inhibitor)
□ panic disorders
□ Anxiety disorders
□ OCD
□ PTSD
□ 2-3 wks. to be effective
Side effects:
□ Cause fewer disorders than other
antidepressants
□ fewer side effects on HR and HTN
□ Sexual dysfunction
□ Weight gain Major complication
□ (Selective Serotonin Syndrome): Pt. can die from it. Elevated temp up to 105. Every speed up. BP, HR, Temp. May progress to coma.
□ Give with food in the morning to prevent insomnia
□ Watch for suicide risk
□ Increases effect of Coumadin
□ Avoid grapefruit juice
Avoid use:
□ Within 14 days of using MAO inhibitor
□ Seizure disorder
Spironolactone (Aldactone)
□ Fluid & electrolyte balance
□ antihypertensive
□ Potassium sparing diuretic
□ Increases sodium excretion; does not decrease potassium
□ treatment of primary aldosteronism
□ Use for edema and HTN associated with heart failure.
Side effects:
□ Headache
□ dizziness, weakness
□ orthostatic hypotension
Adverse effects/toxicity:
□ Hyperkalemia (nausea, vomiting, diarrhea, cramps, tachycardia then bradycardia)
□ aplastic anemia
□ thrombocytopenia
□ Take with food
□ avoid salt substitute high in K+
□ Avoid excessive ingestion of foods high in potassium.
□ no potassium supplement needed
□ Monitor VS and urine output
□ Avoid direct sunlight
Avoid use with:
□ Serum K+ level > 5.5
□ anuria, acute and chronic renal insufficiency
□ diabetic nephropathy
□ hypersensitivity
□ impaired hepatic function
□ Decreases effect of Dig;
□ increases chance of lithium toxicity
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 58
Drug Use and dosage Side effect Teaching and labs contraindication
Sucralfate (Carafate)
□ Antiulcer
□ Gastro-protective agent
□ Protects the ulcer from gastric acid by forming an adherent coating; it absorbs pepsin decreasing its activity.
□ Duodenal ulcer
□ Short term with gastric ulcer
□ esophageal ulcer related to radiation or chemotherapy
Side effects:
□ constipation
□ nausea
□ No antacid use within ½ hour of this medication
□ Avoid gastric irritants such as caffeine, alcohol, smoking and spicy foods.
Avoid use with:
□ Chronic kidney failure
□ Decreases absorption of Cipro, Dig, Dilantin,
Tetracycline (so take these med 2 hours apart from Sucralfate)
Theophylline (Theo-dur)
□ Bronchodilator (resp. smooth muscle relaxant)
□ xanthines
□ Normal level 10-20. toxic level (> 20) may develop quickly
□ bronchospasms
□ asthma
□ bronchitis
□ emphysema
Side effects:
□ Tachycardia
□ Seizures
□ N/V, anorexia, Adverse effects/toxicity:
□ restlessness, agitation, HA, and insomnia
□ note: restlessness could be due to toxicity or hypoxia so close assessment is required
□ PO: take with water and after meals.
□ Wait 4-6 hours after IV to start PO.
□ Take same time each day
□ Limit caffeine
□ Smoking decreases effect of med
□ Increases lithium excretion
Avoid use with:
□ CAD, angina
□ Renal or liver disease
□ Pregnancy, lactation
□ children
□ CHF and acute viral
□ can cause seizure (with high doses/levels) so avoid with seizure disorder unless bronchospasm is unresponsive to other treatments
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 59
Drug Use and dosage Side effect Teaching and labs contraindication
□ short term management of insomnia (4 weeks) characterized by difficulty falling asleep, frequent wakeful periods
□ Drowsiness, lethargy, confusion
□ sleepwalking Adverse effects/toxicity:
□ Physical dependence
□ Seizures (with rapid withdrawal)
□ With overdose: coma, respiratory depression, paradoxical anxiety
□ Do not use in addictive prone pt.
□ Monitor symptoms of overdose (slurred speech, confusion, somnolence, impaired coordination and coma).
□ following long term use, tolerance may develop so do not stop taking abruptly
Avoid use with:
□ Known sensitivity
□ Alcohol intoxication
□ Suicidal ideas
□ Pregnancy, lactation
Trihexyphenidyl HCl (Artane)
□ Anticholinergic
□ Antispasmodic
□ Treat Parkinson’s disease.
□ Diminishes hyper-salivation; rigidity and irregular movements in Parkinson’s.
□ Use to control drug-induced extra-pyramidal side effects
Side effects:
□ Drowsiness
□ Decrease urine output, retention or hesitancy
□ Dry mouth
□ Constipation Adverse effects/toxicity:
□ Paralytic ileus
□ Monitor I& O
□ increase fluids, bulk and exercise
□ void before taking to reduce urinary retention
□ Avoid driving or other hazardous activities as drowsiness may occur.
□ Avoid OTC such as cough medicine with alcohol.
□ Very dose sensitive
Avoid use with:
□ narrow angle glaucoma,
□ myasthenia gravis
□ GI obstruction
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 61
Drug Use and dosage Side effect Teaching and labs contraindication
Vincristine sulfate (Oncovin)
□ Antineoplastic
□ Vinca alkaloids (from plant)
□ mitotic inhibitor
□ IS a vesicant; administer into the side arm portal of a freely flowing IV.
□ Hyaluronidase is given if this vesicant should infiltrate. May apply heat to site to disperse drug and minimize sloughing.
□ Acute lymphoblastic and other leukemias
□ lymphosarcoma,
□ Hodgkin’s disease
□ breast and lung cancers
□ Major toxicities occur in the hematopoietic, integumentary, neurologic and reproductive, system.
□ Peripheral neuropathy
□ Paralytic ileus (more common in young children)
□ Alopecia Adverse effects/toxicity:
□ Neurotoxicity - loss of sensation of the soles of feet and fingertips
□ Depression of the Achilles reflex is the earliest sign of neuropathy
□ Children are especially likely to develop neuro changes
□ Neutropenic precautions prn
□ Assess hand grasp and deep tendon reflexes
□ Maintain a regimen against constipation and paralytic ileus; report a change in bowel habits.
Vesicant safety precautions:
□ Good vein, prefer central line access or fresh butterfly stick
□ chemo-trained nurse
□ remain during infusion
□ have antidote handy
Avoid use with:
□ Obstructive jaundice
□ Pre-existing neuromuscular disease
□ Active infection
□ Pregnancy, lactation
□ Bronchospasm may occur in pt previously treated with mitomycin
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 62
Drug Use and dosage Side effect Teaching and labs contraindication
Vitamin B6 (Pyridoxine HCl)
□ Water-soluble vitamin
Absorbed by GI tract s/s of deficiency:
□ Lack of energy
□ Decreased brain functioning
□ skin lesions,
□ conjunctivitis
□ Prevention and treatment of pyridoxine deficiency (see causes)
□ Co-enzyme in amino acid metabolism and red blood cell production
□ Treats acute toxicity of INH, hydralazine.
Side effects:
□ Pain at injection site Adverse effects/toxicity:
□ Neuropathy
□ Ataxia
□ seizures
Causes of deficiency:
□ Alcoholism
□ Malabsorption disorders
□ Oral contraceptives Dietary sources:
□ green leafy veg.
□ organ meats, fish, poultry
□ legumes, chickpeas
□ bananas
□ whole grains,
□ potatoes
Use with caution:
□ Renal disease
□ Cardiac disease Common drug interactions:
□ INH, hydralazine, oral contraceptives
□ Reverses or antagonizes effects of levodopa.
Vitamin B12
(see entry under Cyanocobalamin)
Vitamin C (Ascorbic acid)
□ Water soluble vitamin
s/s of Deficiency which is called Scurvy
□ Malaise, lethargy
□ pinpoint hemorrhages
□ bleeding gums, rough skin and blotchy spots especially legs
□ Protects connective tissue, strengthens blood vessel walls, forms scar tissue, provides matrix for bone growth
□ Supports immune system
□ helps in absorption of iron and to metabolize amino acid
□ acidifies urine
Side effects: Rare at normal doses Adverse effects/toxicity:
□ crystalluria
□ Increases absorption of Iron
□ Mix oral solutions with food
Causes of deficiency:
□ Normal aging
□ Alcohol
□ Other meds Dietary Sources:
□ citrus fruits, cantaloupe, strawberries,
□ broccoli, cabbage, cauliflower
□ tomatoes
Avoid use with:
□ Prone to kidney stones
□ Megadoses of Vit. C can interfere with absorption of Vitamin B12.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 63
Drug Use and dosage Side effect Teaching and labs contraindication
Vitamin D2 (Ergocalciferol)
□ Fat-soluble vitamin s/s deficiency which is called rickets
□ bones fail to calcify
□ bowed legs
□ osteomalacia
□ muscle spasm
□ Calcium and phosphate metabolism
Remember calcium and phosphorus are inverse (high one, lower other)
□ Necessary to develop and maintain strong bones
□ osteomalacia and osteoporosis
□ hypo-parathyroidism
□ Treat and prevent rickets
Side effects:
□ Uncommon at normal doses
□ Metallic taste Adverse effects/toxicity:
□ n/v,
□ fatigue, headache,
□ hallucinations
□ dysrhythmias
□ Hypercalcemia
□ Stones
Causes of deficiency:
□ Inadequate sunlight
□ Dietary intake
□ hypoparathyroid Dietary Sources:
□ Egg yolks
□ fortified cereals and milk
□ Cod liver oil
□ some fish
□ Also obtained from sunlight
Avoid use with:
□ Hypersensitivity to Vit. D
□ Hypercalcemia
□ Hyper-phosphatemia
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 64
Drug Use and dosage Side effect Teaching and labs contraindication
Vitamin E (alpha-tocopherol)
□ Fat-soluble vitamin s/s deficiency:
□ Hemolytic anemia
□ Dietary supplement
□ Hemolytic anemia in neonates
□ Topical to chapped skin
□ Prevents cell membrane damage protects against blood clot development
Side effects:
□ Uncommon at normal doses
Adverse effects/toxicity:
□ N/V
□ fatigue,
□ headache
□ blurred vision Toxic:
□ jaundice
□ brain damage
Causes of deficiency:
□ normal aging
□ Prematurity
□ Malabsorption diseases
Dietary Sources:
□ Wheat germ
□ Vegetable oils
□ Green leafy vegetables
□ Nuts
□ Dairy, eggs
Use with caution:
□ Bleeding disorders
□ Pregnancy
□ Avoid mineral oil
Vitamin K1 (Aquamephyton) (Phytonadione)
□ Fat soluble vitamin s/s deficiency:
□ Deficiency causes hemorrhage.
Given as antidote for Coumadin (warfarin) overdose. Onset IV = 6 hours See entry under Warfarin (Coumadin)
□ Promotes liver synthesis of clotting factors
□ Given to newborns to prevent bleeding
□ Given as antidote for coumadin toxicity.
□ Also reverses hypo-prothrombinemia from various causes
Side effects:
□ Swelling and pain at injection site
Adverse effects/toxicity:
□ Hypersensitivity or anaphylaxis – like reaction
□ Bronchospasm, Cardiac arrest
□ SQ administration preferred over IM.
□ Labs: Monitor PT/INR (see note under ‘warfarin’)
Causes of deficiency:
□ fat malabsorption
□ medication Dietary Sources:
□ Asparagus, broccoli, cabbage, Green leafy vegetables
□ Green tea
□ Tomatoes
Avoid use with:
□ Known hypersensitivity to med
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 65
Drug Use and dosage Side effect Teaching and labs contraindication
Warfarin sodium (Coumadin)
□ ORAL anticoagulant To reserve hyperanticoagulation – (1) Hold and/or skip
doses of Coumadin (2) Antidote which is
Vitamin K1 (Aquamephyton)
□ Coumadin interferes with synthesis of clotting factor(s) that require Vit. K.
□ Given PO.
□ Has narrow therapeutic range. Can take 1 week for Therapeutic effect
□ PT level will be maintained at 1.5 – 2.5 the times the control value (which is 12-15 sec.)
□ INR range from 2.0- 3.0 (control 1.0)
□ Labs need monitored often (sometimes 2-3 x week) initially, then are decreased over time
Side effects:
□ Ecchymotic skin
□ GI & skin problem
□ Hypotension
□ thrombocytopenia Adverse effects/toxicity:
□ Bleeding is the major adverse effect.
□ Coumadin may be started while pt is still on continuous IV heparin therapy). Heparin is tapered off slowly over 2-3 days. Pt. remains on oral Coumadin.
□ Often given in the evening with lab draws in the morning – it must be taken same time each day
□ Avoid or use consistently foods high in Vit. K
□ May be long-term medication depending on reason for medication
□ Teach bleeding precautions
□ Observe closely and report s/s bleeding
Avoid use with:
□ hemorrhaging or bleeding tendencies
□ malignant hypertension
□ past history of allergic reaction to Coumadin
□ Many, many meds have drug interactions with Coumadin