ATI Pharm Final Exam Study Guide

Antihistamine adverse reactions drowsiness; sedation; dryness of mouth, nose, throat; thickening of bronchial secretions Antitussive adverse reactions lightheadedness, dizziness, drowsiness or sedation codeine uses mild to moderate pain relief; severe, persistent, nonproductive cough relief dextromethorphan action centrally acting (medulla) cough suppressant expectorant use relieve cough associated with respiratory tract infection (sinusitis, asthma, bronchitis, pharyngitis), especially when cough is dry and nonproductive xerostomia dry mouth Xerostomia management -frequent mouth care -water on hand to hydrate throughout day -enhance water with lemon, lime, or cucumber -ice chips -chew gum -hard candy -avoid alcohol-based mouthwash Nasal decongestant overuse complication rebound congestion Oxymetazoline use nasal decongestant (Afrin), nose bleed cessation albuterol teaching and use -take for acute bronchospasm and prevent exercise-induced bronchospasm -excessive use may cause paradoxical bronchospasm -reactions include tachycardia, palpitations, or cardiac arrhythmias, hypertension, nervousness, anxiety, insomnia -prime inhaler away, shake, tilt head back slightly, exhale and open mouth, position inhaler, inhale slowly and press to release medication, breathe in 3-5 seconds, hold breath for 10 seconds to allow drug to reach deep into lungs bronchodilator use treat bronchospasms What is a bronchospasm? tightening of airway muscle (bronchi) Short acting Beta 2 agonist adverse reactions -tachycardia -palpitations -cardiac arrhythmias -hypertension -nervousness -anxiety -insomnia theophylline toxicity anorexia, nausea, vomiting, diarrhea, headache, insomnia abdominal cramping, confusion, restlessness, tachycardia, arrhythmias, seizures antihyperlipidemic used to lower abnormally high blood levels of fatty substances (lipids). (Lipitor, Lopid, Mevacor, Nicobid, Zocor) antihyperlipidemic teaching -alert HCP of paradoxical elevated blood lipid levels for different antihyperlipidemic prescription -beware of constipation, rash, flushing, nausea, malabsorption of vitamins (A, D, K), risk for bleeding, dizziness -statins at bedtime/evening -no grapefruit juice (enzyme reaction) -antacids 2 hours after statin -may cause photosensitivity -red yeast may cause liver or muscle damage with antihyperlipidemics Less than 200 Total Cholesterol, less than 100 LDL desirable 240 Total is high, 160 and higher LDL is high, HDL is happy cholesterol cholestyramine adverse reactions constipation, impaction, vitamin malabsorption, bleed risk propranolol use Hypertension, dysrhythmia, angina, heart failure atenolol use hypertension, angina, prophylaxis and treatment of acute MI atenolol teaching Do not stop abruptly Take same time everyday Do not give to asthmatic Metoprolol use hypertension Metoprolol nursing considerations Assess HR and BP before admin. If HR <60 or BP <90/60 hold med and notify HCP Nitroglycerin use relieve acute anginal attack pain sublingual dose every 5 minutes; three doses in 15-minute period, no more than three metered doses in 15-minute period nitro ointment wear gloves, do not massage or rub area, apply to area without hair, check vitals, rotate sites of application to prevent skin inflammation verapamil use Slow heart rate, dilate blood vessels, lessen peripheral resistance and myocardial oxygen demand. Treat supraventricular dysrhythmia, angina, hypertension. verapamil parameters Decreased BP, improvement in HR and rhythm, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of nitroglycerin for chest pain. Nitrates nitrogen compounds used to relax cardiac muscle, dilate arteries and increase blood flow; adverse reactions: headache, dizziness, weakness, restlessness, hypotension, flushing, rash Heparin labs Prothrombin time (PT) and international normalized ratio (INR); activated partial thromboplastin time (aPTT); therapeutic range of PT is 1.2-1.5; INR 2-3 (above 5 is dangerous) heparin antidote protamine sulfate warfarin diet restrictions avoid excess vitamin K (greens, St. John's wart) warfarin labs PT/INR Digitalis toxicity weakness, lethargy, anorexia, N/V/D, headache; sensitivity increased with hypokalemia digoxin use heart failure, atrial fibrillation digoxin side effects Cardiovascular: bradycardia, AV blocks, dysrhythmias Neurological: confusion Digoxin Nursing Considerations Take pulse for 1 min; <60 notify HPC eat high K+ diet; signs of hypokalemia increse risk for toxicity monitor of renal insufficiency licorice - potentiates - K+ loss Schedule V controlled substances limited abuse potential What is an antagonist drug? a drug that blocks the receptor so they can't be activated What is idiosyncrasy? Abnormal drug response that is usually genetic Stevens-Johnson syndrome a rare, serious disorder of the skin and mucous membranes. It's usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days. Sulfonamides fluid intake 2000mL Anaphylactic reactions itch, redness, increased HR and RR cefazolin adverse reactions N/V/D, malaise, nephrotoxicity, SJS Ceftriaxone allergy alert Penicillin allergic patient may also be allergic to cephalosporins Amnioglycosides adverse effects N/V, anorexia, rash, urticaria, nephrotoxicity, ototoxicity, neurotoxicity Nephrotoxicity monitor UA (protein in urine), BUN, decreased urine output, increased creatinine ferrous teaching glass of water in the morning fluoroquinolone adverse reaction