NURSE EXTERN PHARMACOLOGY EXAM PREP WITH VERIFIED SOLUTIONS

sublingual -place tab on floor of mouth, close mouth -do not swallow, hold under tongue until dissolved -use spray on floor of mouth under tongue and close mouth buccal -tab between tongue and cheek near back of mouth -slower to dissolve and absorb than sublingual Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:01 / 0:15 Full screen IM injections -given in vastus lateralis in children up to 3 -aspirate to determine if needle entered a blood vessel. do not want blood return NG tube / G tube -NG usually temporary -G tube for longer term -no sustained release meds eye drops 1. tilt head toward side of affected eye 2. pull LOWER eyelid down 3. have pt look UP 4. instill drops in conjunctival sac (NOT ONTO EYE) 5. apply gentile pressure for 30 to 60 sec to inner canthus (prevent absorption through tear duct) 6. close eyes and massage gently to distribute meds -slow absorption EXCEPT IN INFANTS WHERE THEY READILY ABSORB eye ointment -applied to conjunctival sac from inner to outer canthus -close eyes and gently massage to distribute med agranulocytosis/neutropenia/agranulocytopenia -acute decrease in # of granulocytes (WBC) in peripheral blood -CAUSES: broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime, ticarcillin, gentamycin), bone marrow transplant, chemo, radiation. -lymphadenopathy, lymphadenitis may be prevalent -could lead to respiratory infection, ulceration of mouth or colon, high fever, uti -MAY BE ASYMPTOMATIC chelating agents -form of detoxification -injection or oral ethylene diamine tetra acetic avide (a synthetic amino acid that attaches to toxic substances like lead, cadmium, aluminum, and other metal in blood to facilitate their removal) -may be used to treat hardening of arteries, heart attack, stroke, arthritis, and gangrene because of ability to remove excess CALCIUM from body EDTA: ethylenediaminetetraacetic acid -use in children with lead level between 45 & 79 micron/dl -EDTA binds to lead in blood and excreted by bowel and kidney -EDTA may be TOXIC TO KIDNEY. monitor urine output -GIVE BY IV -given q4h for 5 days -give oral and iv fluid to increase excretion -DO NOT USE EDTA WITH HYPOCALCEMIA OR HYPOKALEMIA british antilewisite (BAL) -chelating agent -do not give with iron supplement and avoid in pt with plant allergy -IM injection Chemet -oral medication -do not give in pt with ENCEPHALOPATHY Epistaxis -nose bleed. anterior or posterior. POSTERIOR more serious -due to rupture of blood vessels -blood can come up through eye, can also flow down the stomach causing N/V -TREAT: cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent dressing, or saline -ice pack to forehead or back of neck -pinch nose for 5 mins -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 -EX half-life is 1 hour start: 100% 1 hr: 50% 2 hrs: 25% 3 hrs: 12.5% 4 hrs: 6.25% paradoxical agent -a response to a drug 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/timed release/extended release/controlled release -pills or capsule formulated to dissolve slowly and release drug over time -taken less frequently, keep steadier levels in blood -CANNOT BE CRUSHED, DISSOLVED, OR OPENED -contained in a matrix of insoluble substance (eg acrylics) the drug swells up to form a gel so first has to dissolve in matrix then exit through outer surface 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 -end with VIR -ritonavir (Norvir) benzodiazepines -alprazolam (Xanax) -chlordiazepoxide (Librium) -clorazepate (Tranxene) -extazolam (Pro Som) -triazolam (Halcion) -MOST others end with PAM beta blockers -end with LOL -atenolol (Tenormin) calcium channel blockers -end with PINE -amlodipine (Norvasc) -EXCEPTIONS: diltiazem (Cardizem), cerapamil (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 0cimetidine (Tegamet) nitrates -contain NITR -nitroglycerin (Nitrostat) pancreatic enzyme replacements -contain PANCRE -pancrelipase (Pancrease) phenothiazines -end with ZINE -chlorpromazine (Thorazine) proton pump inhibitors -end with ZOLE -lansoprazole (Prevacid) sulfonamides -include SULF -sulfasalazine (Azulfidine) thiazide diuretics -end with ZIDE -hydrochlorothiazide (HydroDIURIL) thrombolytics -end with ASE -alteplase (Activase) thyroid hormones -contain THY -levothyroxine (Synthroid) xanthine bronchodialators -end with LINE -theophylline aminoglycoside -antibiotics for severe life threatening gram negative (some +) infections -gentamycin, tobramycin, vancomycin, neomycin (NOT ERYTHROMYCIN OR AZITHROMYCIN) -generally IM or IV -ADVERSE EFFECTS: NEPHROTOXICITY AND OTOTOXICITY, photosensitivity, risk for superinfections, c-diff (stop med and treat with PO Flagyl) -PEAK LEVEL: DRAWN 15-30 MINS AFTER INFUSION COMPLETE. DETERMINES THAT TOXIC LEVEL DOES NOT OCCUR. REDUCE DOSE IF PEAK TOO HIGH. -TROUGH LEVEL: DRAWN IMMEDIATELY (WITHIN 30 MINS) BEFORE NEXT IV DOSE. ASSURES THERAPEUTIC LEVEL OF DRUG IS MAINTAINED. 1-2 G/ML BETWEEN DOSES. blood administration -start slow at 2ml/min. remain with pt for first 15 to 30 min. if no side effect increase rate to desired rate -use largest gauge IV possible -OBSERVE FOR: 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 and newborns -crack crosses the placenta -PRESENTATION: infant may present normal or develop neuro prob. child may develop depression or excitability, may be lethargic, have poor suck, weak cry, difficult arousing, hypotonicity, rigidity, irritability, inability to console, intolerance to change, small head, decreased birth length -LATE SYMPTOMS: 2-8 wks, growth retardation - HEAD GROWTH IS ONE OF THE BEST INDICATIONS diabetes in children -hypoglycemic reaction takes place most time before meals or when insulin effect is peaking -first teaching: let child wear bracelet or tag, teach how to give injection, inject at 90 degree angle -teach only essentials first few visits. keep session 14-20 min long for child and 45 to 60 for adult. -eat at same time each day -child to assume responsibility for self-management AS SOON AS AGE 4-5 -start giving own insulin with supervision AT AGE 9 -do not restrict exercise, have snack before exercise -carry source of glucose at all times -after glucagon injection, vomiting may occur -treat DKA with insulin IV of low dosing. NOTE: run a mix of insulin through tubing before starting drip because insulin can chemically bind to plastic. -replace fluid over 24-48 hours