1WEEK 8
3/19/21
PHARMACOLOGY REVIEW → KHAN
➔Treatment of Hypermagnesemia →
◆Have CALCIUM GLUCONATE available → ANTIDOTE
◆When magnesium goes UP → everything goes DOWN →TOXICITY →
●Decreased HR
●Decreased RR
●Decreased urine output → BELOW < 30 ml/hr
●Absent reflexes
●Altered level of consciousness
○HAVE CALCIUM GLUCONATE available
◆When magnesium goes DOWN → everything goes UP
●Polymorphic Ventricular Tachycardia
●Hypertension
●Hyperreflexia
◆Magnesium can be very dangerous for the KIDNEYS →Renal Failure → especially if
Magnesium is increased
➔Fluid Volume EXCESS
◆Ex→ If someone has a condition like SIADH → Retaining water
◆Ex→ When you're implementing plenty of fluids →It can cause neck vein distention →
central venous pressure (CVP) isINCREASED
◆Manifestations → Cough, dyspnea ,crackles , increased BP , tachycardia, tachypnea,
bounding pulse , weight gain, JUGULAR vein distention , pitting edema
●Heart rate of 190/min during sleep
●Periorbital edema
●Crackles upon auscultation
➔Fluid Volume DEFICIT
◆CVP isDECREASED → Patient can be DEHYDRATED
◆Manifestations → Weight loss, dry mucous membranes, INCREASED HR and RR, thre ady
pulse, capillary refill less than 3 seconds, weakness, fatigue, poor skin turgor, orthostatic
hypotension, flattened neck veins
◆Children → Sunken Fontanelles, sunken eyes, dry/pale skin, weight loss
➔LITHIUM → Bipolar Disorder
◆Monitor electrolytes → especially SODIUM →Na+
Downloaded by Darine Mee ()lOMoARcPSD|9085132 2◆If someone is taking Spironolactone →retaining Potassium → K+ → but removing
sodium and can go into LITHIUM TOXICITY
◆Monitor drug interactions →NSAIDS
◆Lithium therapeutic level →0.4-1.4
◆Lithium Toxicity → Increased thirst, vomiting, diarrhea, tremors
◆Careful with Lithium →Tremors, Diarrhea, Hypothyroidism
◆THYROID testing is essential for long term use of Lithium
➔Hypothyroidism →
◆Levothyroxine →Toxicity →Tremors and Anxiety
●Clinical manifestations
○Bradycardia
○Cold intolerance
○Impaired short term memory
➔Adverse Reactions →
◆Gentamicin → Should worry about KIDNEYS → Monitor Creatinine ,G F R → can cause
Nephrotoxicity →Watch out for Proteinuria
●Serum Creatinine →Females: 0.5-1.1 / Males: 0.6-1.2
●Gentamicin
○ringing of the ears (tinnitus)
○complaints of dizziness
◆Nephrotoxic →Ibuprofen, Cisplatin, Cyclosporine, Gentamicin, Cont rast dye
◆Hepatotoxicity →TB medications, Acetaminophen, Aspirin, Statins →CHECK LIVER
●Aspirin in children can cause Reye's Syndrome
◆Statins → watch out for LIVER enzymes
◆Heparin → Heparin-induced Thrombocytopenia → Platelet levels can go very low
●Antidote for Heparin →Protamine Sulfate
●When administering Heparin → monitor aPTT
○aPTT → 30-40 sec → check every 4 hours
○CAN be given to pregnant women
●Administering via deep subq intrafat
○Small needle: 25 gauge for subq injection
○Short needle ½ to ⅝ inch
○Inject into the abdomen above iliac crest → 5cm (2in) from umbilicus
○Apply firm pressure for 1 to 2 mins
◆When administering Coumadin → monitor PT & INR
●PT→ 11-12.5 sec
●INR→ 0.7-1.8 → Therapeutic level → 2.0-3.0
●Cannot be given to pregnant women
●Cannot be given with multivitamins →VITAMIN K is the ANTIDOTE for
warfarin
◆When administering Steroids → monitor for GLUCOSE levels
Downloaded by Darine Mee ()lOMoARcPSD|9085132 3◆When on glucocorticoid medications →Take CALCIUM supplements to prevent
osteoporosis and risk fractures
◆Any medications that can cause electrolyte imbalances →Should be in Telemetry
●Measure Input & Output
●Weigh Patient daily
➔Controlled Substances
◆Schedule 1 → Schedule 5
◆Schedule 1 is not particularly used
◆Schedule 2-5 → you need to have another person verify or witness when you WASTE
●Count each dose of narcotics in inventory
●Match number of available doses
➔Monitoring and Assessing for PAIN →
◆Different age groups and scales
●FLACC →2 months to 7 years
●FACES →4-16 years
●Numerical
●Behavioral
◆Even if a patient is on a PCA → Still need to assess for Pain
◆Ex→ Sometimes a patient is prescribed a Fentanyl patch →Have to ask the doctor for
another medication for BREAKTHROUGH pain → because the patch is removed ONCE
every 72 hours
●Patient’s need to STOP drinking grapefruit juice wh en using the patch
◆Epidural → Epidural/Morphine
●Contraindications →
○Increased ICP, HYPOTENSION , bleeding disorders, coagulation
problems
●Administering epidural → Make sure to give bolus before
●When weaning off of epidural → Make sure they can wiggle their toes and
move well before getting the patient up and walking , if not they can FALL
●Morphine
○Adverse effect of Morphine →
◆BLADDER DISTENTION , Urinary retention
○Allergic reaction → PRURITUS
○Increase fluid intake when on Morphine to reduce adverse effects
➔Gerontological Considerations →
◆Risk for toxicity is increased for elders especially in cases of POLYPHARMACY →
●Liver and Kidneys are not able to work properly →should be very worried
about Liver and Kidney toxicity → dosage based on AGE
●Signs and Symptoms of toxicity can be falsely mistaken for elder age , rather
than adverse reactions
Downloaded by Darine Mee ()lOMoARcPSD|9085132
3/19/21
PHARMACOLOGY REVIEW → KHAN
➔Treatment of Hypermagnesemia →
◆Have CALCIUM GLUCONATE available → ANTIDOTE
◆When magnesium goes UP → everything goes DOWN →TOXICITY →
●Decreased HR
●Decreased RR
●Decreased urine output → BELOW < 30 ml/hr
●Absent reflexes
●Altered level of consciousness
○HAVE CALCIUM GLUCONATE available
◆When magnesium goes DOWN → everything goes UP
●Polymorphic Ventricular Tachycardia
●Hypertension
●Hyperreflexia
◆Magnesium can be very dangerous for the KIDNEYS →Renal Failure → especially if
Magnesium is increased
➔Fluid Volume EXCESS
◆Ex→ If someone has a condition like SIADH → Retaining water
◆Ex→ When you're implementing plenty of fluids →It can cause neck vein distention →
central venous pressure (CVP) isINCREASED
◆Manifestations → Cough, dyspnea ,crackles , increased BP , tachycardia, tachypnea,
bounding pulse , weight gain, JUGULAR vein distention , pitting edema
●Heart rate of 190/min during sleep
●Periorbital edema
●Crackles upon auscultation
➔Fluid Volume DEFICIT
◆CVP isDECREASED → Patient can be DEHYDRATED
◆Manifestations → Weight loss, dry mucous membranes, INCREASED HR and RR, thre ady
pulse, capillary refill less than 3 seconds, weakness, fatigue, poor skin turgor, orthostatic
hypotension, flattened neck veins
◆Children → Sunken Fontanelles, sunken eyes, dry/pale skin, weight loss
➔LITHIUM → Bipolar Disorder
◆Monitor electrolytes → especially SODIUM →Na+
Downloaded by Darine Mee ()lOMoARcPSD|9085132 2◆If someone is taking Spironolactone →retaining Potassium → K+ → but removing
sodium and can go into LITHIUM TOXICITY
◆Monitor drug interactions →NSAIDS
◆Lithium therapeutic level →0.4-1.4
◆Lithium Toxicity → Increased thirst, vomiting, diarrhea, tremors
◆Careful with Lithium →Tremors, Diarrhea, Hypothyroidism
◆THYROID testing is essential for long term use of Lithium
➔Hypothyroidism →
◆Levothyroxine →Toxicity →Tremors and Anxiety
●Clinical manifestations
○Bradycardia
○Cold intolerance
○Impaired short term memory
➔Adverse Reactions →
◆Gentamicin → Should worry about KIDNEYS → Monitor Creatinine ,G F R → can cause
Nephrotoxicity →Watch out for Proteinuria
●Serum Creatinine →Females: 0.5-1.1 / Males: 0.6-1.2
●Gentamicin
○ringing of the ears (tinnitus)
○complaints of dizziness
◆Nephrotoxic →Ibuprofen, Cisplatin, Cyclosporine, Gentamicin, Cont rast dye
◆Hepatotoxicity →TB medications, Acetaminophen, Aspirin, Statins →CHECK LIVER
●Aspirin in children can cause Reye's Syndrome
◆Statins → watch out for LIVER enzymes
◆Heparin → Heparin-induced Thrombocytopenia → Platelet levels can go very low
●Antidote for Heparin →Protamine Sulfate
●When administering Heparin → monitor aPTT
○aPTT → 30-40 sec → check every 4 hours
○CAN be given to pregnant women
●Administering via deep subq intrafat
○Small needle: 25 gauge for subq injection
○Short needle ½ to ⅝ inch
○Inject into the abdomen above iliac crest → 5cm (2in) from umbilicus
○Apply firm pressure for 1 to 2 mins
◆When administering Coumadin → monitor PT & INR
●PT→ 11-12.5 sec
●INR→ 0.7-1.8 → Therapeutic level → 2.0-3.0
●Cannot be given to pregnant women
●Cannot be given with multivitamins →VITAMIN K is the ANTIDOTE for
warfarin
◆When administering Steroids → monitor for GLUCOSE levels
Downloaded by Darine Mee ()lOMoARcPSD|9085132 3◆When on glucocorticoid medications →Take CALCIUM supplements to prevent
osteoporosis and risk fractures
◆Any medications that can cause electrolyte imbalances →Should be in Telemetry
●Measure Input & Output
●Weigh Patient daily
➔Controlled Substances
◆Schedule 1 → Schedule 5
◆Schedule 1 is not particularly used
◆Schedule 2-5 → you need to have another person verify or witness when you WASTE
●Count each dose of narcotics in inventory
●Match number of available doses
➔Monitoring and Assessing for PAIN →
◆Different age groups and scales
●FLACC →2 months to 7 years
●FACES →4-16 years
●Numerical
●Behavioral
◆Even if a patient is on a PCA → Still need to assess for Pain
◆Ex→ Sometimes a patient is prescribed a Fentanyl patch →Have to ask the doctor for
another medication for BREAKTHROUGH pain → because the patch is removed ONCE
every 72 hours
●Patient’s need to STOP drinking grapefruit juice wh en using the patch
◆Epidural → Epidural/Morphine
●Contraindications →
○Increased ICP, HYPOTENSION , bleeding disorders, coagulation
problems
●Administering epidural → Make sure to give bolus before
●When weaning off of epidural → Make sure they can wiggle their toes and
move well before getting the patient up and walking , if not they can FALL
●Morphine
○Adverse effect of Morphine →
◆BLADDER DISTENTION , Urinary retention
○Allergic reaction → PRURITUS
○Increase fluid intake when on Morphine to reduce adverse effects
➔Gerontological Considerations →
◆Risk for toxicity is increased for elders especially in cases of POLYPHARMACY →
●Liver and Kidneys are not able to work properly →should be very worried
about Liver and Kidney toxicity → dosage based on AGE
●Signs and Symptoms of toxicity can be falsely mistaken for elder age , rather
than adverse reactions
Downloaded by Darine Mee ()lOMoARcPSD|9085132
