ATI PN PHARMACOLOGY PROCTORED EXAM TESTBANK (26 LATEST VERSIONS 2500+ QUESTION AND ANSWERS 100% CORRECT)

 Contraindications: pregnancy, peptic ulcer disease, bleeding disorders, allergies to these meds  Interactions: alcohol increases risk of bleeding o Aspirin  Complications: Reye syndrome (children or adolescents), aspirin toxicity  Contraindications: children with flu or chicken pox o Ketorolac  Contraindications: clients with advance kidney disease, do not use longer than 5 days o Celecoxib  Contraindications: last choice for chronic pain due to increased risk of MI and stroke, allergy to sulfonamides • Acetaminophen o (Tylenol)  Ther use: pain and fever relief  Complications: acute toxicity (liver) – nausea, vomiting, diarrhea  Nursing admin: do not exceed 4g/day, limit OTC dose of acetaminophen when taking script for combination analgesics that contain acetaminophen, antidote is acetylcysteine Chapter 36: Opioid Agonists and Antagonists • Opioid agonists o Morphine/Fentanyl/Oxycodone  Complications: resp depression (stop opioids if the clients resp rate is less than 12/min), constipation, hypotension, urinary retention, sedation, nausea, vomiting  Nursing admin: assess pain regularly, take baseline VS, administer IV opioids slowly over 4-5 min, have naloxone and resuscitation equipment available, for cancer pt. administer around the clock regularly. • Agonist-antagonist opioids o Butorphanol  Nursing admin: warn clients not to increase dosage without consulting the provider • Opioid antagonists o Naloxone  Ther use: reversal of opioids and its effects  Complications: tachycardia, tachypnea, abstinence syndrome (HTN)  Nursing admin: monitor respirations for up to 2 hours after use Chapter 37: Adjuvant Meds for Pain • Tricyclic antidepressants: Amitriptyline • Anticonvulsants: Carbamazepine, Gabapentin Chapter 38: Miscellaneous Pain Medication • Migraine Medications o Sumatriptan  Complications: coronary artery vasospasm/angina, dizziness or vertigo o Ergotamine  Complications: GI discomfort (nausea/vomiting), ergotism (muscle pain, paresthesias in fingers and toes, peripheral ischemia), physical dependence, fetal harm or abortion  Interactions: Aspirin-like meds (NSAIDs/acetaminophen combination), steroids/alcohol/tobacco (GI effects increase), NSAIDs (increase bleeding)  Nursing admin: advise clients who have migraines to avoid triggers (stress, alcohol, tyramine-containing food), lie down in dark quiet place • Local Anesthetics o Lidocaine  Pharm action: blocking conduction of pain impulses  Ther use: minor surgical procedures, regional anesthesia  Complications: CNS excitation (seizures, resp depression, leading to unconsciousness), hypotension/cardio-suppression (bradycardia, heart block, cardiac arrest: common in spinal anesthesia due to sympathetic block), spinal headache, urinary retention (spinal anesthesia), labor can be prolonged o Topical EMLA cream: apply to intact skin 1 hour before routine procedures or superficial puncture and 2 hour before more extensive procedures or deep puncture, prior to the procedure, remove the dressing and clean the skin with aseptic solution Chapter 39: Diabetes Mellitus • Insulin o Nursing admin: tell clients to admin SQ in the same general area for consistent rates of absorption: thigh (lowest), upper arm, abdomen (highest), ensure proper storage: unopened stored in fridge, vials of premixed insulins can be stored for up to 3 months under refrigeration, premixed syringes can be kept in fridge for 1-2 weeks in vertical position with needles pointing up (gently move syringes back and forth before admin), store vial that is in use at room temp, avoid sunlight and intense heat and discard after 1 month. • Oral antidiabetics: o Ther use: Type 2 DM o Sulfonylureas  Glipizide/Glyburide • Pharm action: insulin release from the pancreas • Complications: hypoglycemia, photosensitivity • Nursing admin: best taken with breakfast, wear sunscreen o Meglitinides  Repaglinide • Pharm action: insulin release from the pancreas • Complications: hypoglycemia, angina • Nursing admin: eat within 30 min of taking a dose TID o Biguanides  Metformin • Pharm action: reduces production of glucose in the liver, increases muscles’ glucose uptake and use • Complications: GI effects, Vitamin b12 and folic acid deficiency, lactic acidosis • Discontinue if have surgery o Thiazolidinediones  Pioglitazone • Pharm action: Decreases insulin resistance, increases glucose uptake and decreases glucose production • Complications: fluid retention, elevations in LDL cholesterol, hepatotoxicity • Contraindications: severe heart failure • Nursing admin: take once daily with or without food o Alpha-glucosidase inhibitors  Acarbose • Slows carb absorption and digestion • Complications: GI effects, anemia due to decrease of iron absorption, hepatoxicity with long term use • Nursing admin: take with first bite of food TID • Hyperglycemic agent o Glucagon  Pharm action: increasing the breakdown of glycogen into glucose  Ther use: Emergency management of hypoglycemic reactions (such as insulin overdose) in clients who are unable to take oral glucose  Complications: GI distress – nausea, vomiting  Nursing admin: glucagon SQ, IM, or IV immediately following reconstitution parameters, provide food as soon as client regains full consciousness and is able to swallow Chapter 40: Endocrine Disorders • Thyroid hormone o Levothyroxine  Pharm action: synthetic form of thyroxine (T4)  Complications: overmedication – heat intolerance, diaphoresis, wt. loss  Nursing admin: TSH levels monitored at least once a year, daily therapy begins at a low dose and increase gradually over several weeks (full effect can take 6-8 weeks), take on empty stomach 30-60 min before eating, check with provider before switching brands because dosage adjustments may be necessary • Thionamides o Propylthiouracil  Pharm action: blocks the synthesis of thyroid hormones  Ther use: Grave’s Disease, thyroid removal surgery  Complications: hypothyroidism (depression, wt. gain, bradycardia, cold intolerance), agranulocytosis, liver injury/hepatitis  Nursing admin: monitor CBC for leukopenia/thrombocytopenia • Radiopharmaceuticals o Radioactive Iodine  Ther use: hyperthyroidism, Thyroid cancer  Complications: radiation sickness, bone marrow depression, hypothyroidism  Nursing admin: maintain distance of 6 ft from others, do not prepare food for others or share utensils, encourage clients to increase fluid intake (2-3L/day) • Iodine products o Strong iodine solution  Ther use: thyroid removal surgery, thyrotoxicosis  Complications: Iodism – metallic taste/stomatitis/sore teeth and gums  Nursing admin: dilute with juice to improve taste, increase fluids, avoid salt and seafood • Anterior pituitary hormones/growth hormones o Somatropin  Nursing admin: IM or SQ, monitor growth plates monthly (stop before plates close), rotate injection site • Antidiuretic hormone o Vasopressin/Desmopressin  Ther use: used to treat diabetes insipidus (DI)  Complications: reabsorption of too much water, myocardial ischemia (notify of chest pain, tightness, or diaphoresis)  Nursing admin: monitor VS/I&O, monitor BP and HR, monitor for h/a, confusion, and other indications of water intoxication  Nursing effectiveness: reduction in large volumes of urine output associated with Diabetes insipidus to normal levels (1.5-2L/day), cardiac arrest survival • Adrenal hormone replacement o Hydrocortisone  Pharm action: mimic natural steroid hormones  Ther use: Addison’s disease/adrenal crisis  Complications: osteoporosis, adrenal suppression, peptic ulcer/GI discomfort, infection, Cushing’s syndrome  Interaction: NSAIDs and alcohol can increase gastric distress or bleed  Nursing admin: observe for peptic ulcer 9coffee ground emesis/ blood or tarry stools, do not stop abruptly, increase doses during times of stress Chapter 41: Immunizations • Artificial active immunity – killed or attenuated vaccine • Natural active immunity • Natural passive immunity – mother to fetus, then to newborn through colostrum • Artificial passive immunity – immune globulins protect against disease after exposure has occurred • Complications: allergic reaction, mod/severe illness with or without fever (precaution), common cold and minor illnesses are not contraindicated or a precaution for vaccines • IPV – do not give if allergic to neomycin/streptomycin/polymyxin B • Varicella – do not give if allergic to neomycin or gelatin • Hep B – do not give if allergic to yeast • Inactivated flu vaccine - do not give if has had GBS within 6 weeks • Live flu vaccine - do not give if pt. has had GBS within 6 weeks • HPV4/9 - do not give if allergic to yeast • HPV2 - do not give if allergic to latex • Nursing admin: avoid aspirin in children, document correctly, know where vaccine should be placed Chapter 42: Chemotherapy agents • Antimetabolites o Methotrexate • Antitumor antibiotics o Doxorubicin  Pharm action: binds to DNA, altering its structure, therefore, inhibits synthesis of DNA and RNA (intercalation)  Ther use: solid tumors  Complications: bone marrow suppression, GI effects, alopecia, acute cardiac toxicity, cardiomyopathy, heart failure, red coloration of urine and sweat  Nursing admin: Monitor CBC and liver enzymes, admin antiemetic for nausea and vomiting, monitor ECG and cardiac function • Antimitotics: o Vincristine  Pharm action: stop cell division during mitosis, M-phase specific  Complications: peripheral neuropathy (paresthesia), severe tissue damage (use central line), alopecia  DOES NOT CAUSE BONE MARROW SUPPRESSION • Alkylating agents o Cyclophosphamide  Pharm action: kills rapid growing cells by alkylation of DNA and RNA synthesis  Ther use: acute lymphomas, solid tumors  Complications: bone marrow suppression, GI discomfort (nausea/vomiting), acute hemorrhagic cystitis, alopecia  Nursing admin: encourage adequate fluid intake, monitor for blood in urine, monitor for bleeding, give antiemetic • Hormonal agents: prostate cancer meds o Leuprolide  Pharm action: testes stop producing testosterone by stopping the release of LH and FSH  Complications: hot flashes, decreased libido, gynecomastia, decreased bone density (increase calcium and vitamin D)  Nursing admin: monitor PSA and testosterone levels (both should decrease) • Hormonal agents: breast cancer meds o Tamoxifen  Pharm action: stops growth of breast cancer cells which are estrogen-dependent cancers  Complications: endometrial cancer, hypercalcemia, PE, hot flashes • Biologic Response Modifiers o Interferon alfa-2b  Pharm action: increases immune response and decreases production of cancer cells  Complications: flu-like symptoms, bone marrow suppression, alopecia, cardiotoxicity, neurotoxicity, depression, anxiety insomnia, altered mental status Chapter 43: Principles of antimicrobial therapy • Selection of antimicrobials o ID of causative agent  Lab testing of body fluids such as blood/urine/sputum/wound drainage  Gram stain: exam under microscope  Culture: preferred when gram stain does not give a positive ID, collect specimen PRIOR to antibiotic therapy Chapter 44: Antibiotics Affecting the bacterial cell wall • Penicillins  Pharm action: kill bacteria by weakening cell wall  Complications: allergies/anaphylaxis, renal impairment  Nursing admin: Give IM injections cautiously to avoid injecting into nerve or artery o Penicillin-G  Interactions: do not mix penicillin and aminoglycosides in the same IV solution o Amoxicillin o Piperacillin tazobactam • Cephalosporins o Cephalexin/Cefazolin/Ceftriaxone  Complications: allergic reaction, suprainfection, thrombophlebitis (rotate injection sites, admin dilute intermittent infusion or slowly over 3-5 minutes), pain with IM injection (deep ventrogluteal site preferred) • Carbapenems o Imipenem-cilastatin  Complications: GI upset, cross-sensitivity to penicillin or cephalosporins, suprainfection • Other inhibitors of cell wall synthesis o Vancomycin  Ther use: C. diff  Complications: ototoxicity, infusion reactions (admin slowly over 60 minutes), thrombophlebitis (rotate injection sites), renal toxicity  Nursing admin: monitor vancomycin trough levels, need to do creatinine levels to indicate IV dosing Chapter 45: Antibiotics Affecting Protein Synthesis • Tetracyclines o Tetracycline/Doxycycline  Pharm action: bacteriostatic  There use: acne vulgaris, Rocky mounted spotted fever, Lyme disease  Complications: GI discomfort, yellow or brown tooth discoloration/hypoplasia of tooth enamel (avoid admin in children <8yo and women who are pregnant), hepatoxicity, photosensitivity, superinfection  Contraindications: taking after 4th month of pregnancy can stain deciduous teeth but does not affect deciduous teeth. Does stain permanent teeth of children 4mos to 8yo  Interactions: avoid milk products and antacids or separate by 2 hours, milk products/calcium/iron/laxatives with magnesium/antacids  Nursing admin: take on empty stomach with 8oz of water, do not take right before laying down (esophageal ulceration), use additional contraception • Macrolides o Erythromycin/Azithromycin  Pharm action: bacteriostatic  Ther use: used in clients allergic to penicillin, treats legionnaire’s disease/pertussis/diphtheria, and treats chlamydia  Complications: GI upset, dysrhythmias (do not use in clients with prolonged QT intervals), ototoxicity (report hearing loss, vertigo and tinnitus)  Nursing admin: admin on an empty stomach with 8 oz of water (1 hr before/2 hr after meals), erythromycin IV only for severe infections, monitor PT/INR for those who take warfarin concurrently, monitor LFTs for therapy lasting longer than 2 weeks • Aminoglycosides o Gentamicin  Complications: Ototoxicity, nephrotoxicity  Nursing admin: peak – 30 min after admin IM or IV, trough – right before next dose Chapter 46: Urinary Tract Infections • Sulfonamides and trimethoprim o Trimethoprim-sulfamethoxazole  Pharm action: preventing the synthesis of a folic acid derivative  Complications: blood dyscrasias, crystalluria (encourage adequate oral fluid intake) • Urinary tract antiseptics o Nitrofurantoin  Pharm action: injures bacteria by damaging DNA  Complications: GI upset, hypersensitivity reactions, blood dyscrasias, peripheral neuropathy  Nursing admin: turns urine rust yellow to brown and can stain teeth • Fluoroquinolones o Ciprofloxacin  Pharm action: inhibition of an enzyme necessary for DNA replication  Complications: GI upset, Achilles tendon rupture, suprainfection (thrush) • Urinary tract analgesic o Phenazopyridine  Pharm action: local anesthetic on the mucosa of the urinary tract  Ther use: relieves manifestations of burning with urination, pain, frequency, and urgency  Nursing admin: changes urine to an orange-red color Chapter 47: Mycobacterial, fungal, and parasitic infections • Antimycobacterial (selective antituberculotic) o Isoniazid  Ther use: indicated for active OR latent TB  Complications: peripheral neuropathy, hepatotoxicity  Interactions: tyramine foods and alcohol • Broad spectrum antimycobacterial (antituberculotic) o Rifampin  Ther use: given in combination with at least one other med to prevent antibiotic resistance  Complications: discoloration of body fluids (orange color of urine, saliva, sweat, and tears), hepatotoxicity (anorexia, malaise, fatigue, and avoid alcohol), Gi discomfort (nausea, anorexia, abdominal discomfort), pseudomembranous colitis (fever, diarrhea, abdominal pain, bloody stool)  Contraindications: avoid alcohol  Nursing admin: use non-hormonal contraceptives  Nursing effectiveness: improvement of TB such as clear breath sounds, no night sweats, increased appetite, and no afternoon rises of temperature. Three negative sputum cultures for TB (3-6 months) • Antiprotozoal o Metronidazole  Ther use: treatment of protozoal infections and obligate anaerobic bacteria, H. pylori in combo with tetracycline and bismuth subsalicylate in clients who have peptic ulcer disease  Complications: GI discomfort, metallic taste, darkening of urine  Interactions: alcohol  Nursing effectiveness: resolution of bloody mucoid diarrhea, formed stools, negative for giardia, decrease or absence of discharge, negative blood cultures • Antifungals o Ketoconazole/Amphotericin B  Therapeutic use  systemic fungal infections  Complications: test dose of amphotericin B to assess for reaction, thrombophlebitis, nephrotoxicity, bone marrow suppression, hepatotoxicity (jaundice/clay colored stools/dark urine)  Nursing effectiveness: improvement of systemic fungal infection Chapter 48: Viral Infections, HIV, AIDS • Antivirals o Acyclovir  Ther use: Herpes/Varicella -zoster virus,  Complications: Phlebitis/nephrotoxicity,  Nursing admin: inform clients to expect relief of manifestations, but not a cure o Ganciclovir  Therapeutic use  cytomegalovirus  Complications: suppressed bone marrow VERSION 5 PHARMACOLOGY REVIEW CHAPTERS 1-5 ATI BOOK TEST #1 1. The client was switched from a brand-named drug to a generic version of the same drug. The nurse knows to assess the client’s response because: it is possible for the client to respond in a different manner to the generic version. 2. The client is an elderly woman with mild liver damage due to hepatitis. The nurse is aware that the client may need reduced dosages of medications because: the drugs may accumulate in the client’s body and produce toxicity. 3. The client asks the nurse if she should take the herb ginkgo to help with her forgetfulness. The nurse’s best response: herbal medicines are not regulated by the FDA, therefore, their safety and effectiveness cannot be established. 4. The study of how drugs are best used to treat illness is called: pharmacotherapeutics 5. Sterile sealed glass containers that hold a single liquid dose are called: ampules 6. During the earliest stages of development, the first name applied to a new drug is its: chemical name 7. Under the controlled substances act of 1970, schedule 1 drugs are those that have: high potential for abuse and no accepted medical use in the united states. 8. Drugs that are administered via the sublingual route: are absorbed directly into the bloodstream 9. After receiving numerous does of a narcotic for pain, the client seems to require the medication more often and states that it does not seem to be working now. The nurse understands that this probably represents the client having developed to the medication or dose. Tolerance 10. The nurse understands that when administering a medication, the route of administration primarily affects the drugs: absorption 11. A client taking a medication to increase the time it takes to clot her blood (anticoagulant) has a long history of using herbal agents. Which of the following statements made by the client would indicate the need for further teaching? I can continue to use the garlic for dietary supplement to decrease my cholesterol 12. A client has renal insufficiency and is taking multiple medications. The nurse understands that: the client may need to have lower dosages, because of the risk of accumulation of the medications 13. A client has renal insufficiency and is taking multiple medications. The nurse understands that: the client may need to have lower dosages, because of the risk of accumulation of the medication. 14. What action should the nurse take before administering a drug in suspension form? Shake the suspension thoroughly 15. Green tea contains small amounts of vitamin k. thus, oral use can decrease the properties of which of the following medications? Warfarin 16. A second-year nursing student is preparing to administer medications to clients in a small rural hospital. The questions that follow review some of the information she will need to know to administer medication safely and effectively. Which of the following abbreviations means right away? STAT 17. A second-year nursing student is preparing to administer medications to clients in a small rural hospital. The questions that follow review some of the information she will need to know to administer medications safely and effectively. The type of syringe most frequently used for allergy injections is a: tuberculin syringe 18. A second-year nursing student is preparing to administer medications to clients in a small rural hospital. The questions that follow review some of the information she will need to know to administer medications safely and effectively. Medications administered under the tongue are said to be given: sublingually 19. Which of the following routes frequently requires use of a 22 gauge, 1 ½ inch needle? Intramuscular 20. When pouring liquid medications, the nurse knows to raise the measuring device to eye level and to read the measurement at: the lowest point of the meniscus 21. When administering ear drops to children less than 3 years old, the pinna is: pulled back and down 22. The nurse receives a medication prescription with no route specified. What is the best action by the nurse? Call the health care provider to clarify the prescription 23. When a nurse discovers that a client is not taking medications as prescribed, it is the nurse’s responsibility to do which of the following? Ask the client why he or she is not taking the medications as prescribed 24. Which of the following measures is equivalent to 30ml? 2 tablespoons 25. Which of the following measures is equivalent to 1 grain? 60 milligrams 26. The client with a nasogastric tube is prescribed four medications via the tube. The nurse is aware that optimal administration of these medications is by which of the following methods? Crush tablets and pace each into a separate medication administration cup diluted in warm water. 27. Which of the following interventions is essential for the nurse to perform when caring for a client receiving an intravenous drug infusion? Monitor the client during the infusion 28. When preparing to administer an intravenous push medication via a primary infusion, the nurse must first: check compatibility of the medication with the infusion fluid 29. The nurse is initiating an intravenous access. After the vein has been pierced by the IV needle, which of the following would be indicative that the needle is in the vein? Backflow of blood into the tubing 30. In the preparation of an intravenous infusion, the nursing action necessary to prevent air embolism is to: prime the tubing of the intravenous administration set. 31. The nurse assesses the client’s IV site and determines that it has infiltrated. The nurse’s best response is to: immediately stop the IV infusion 32. A client’s peripheral IV infusion setup was initiated 3 days ago. The nurse realizes that there is a need to: change (rotate) the IV site 33. The nurse understands that which of the following are necessary pieces of information needed when measuring the plasma concentration of a drug? Select all that apply. Clients renal, hepatic, and cardiovascular functioning status, clients use of other medications, clients age and weight 34. How are subcutaneous injections administered? Choose all that apply. 45-degree angle, 90-degree angle, in the subcutaneous tissue 35. When attempting venipuncture, if applying a tourniquet fails to raise an appropriate vein, the nurse may try which of the following? Select all that apply. Instruct client to open and close a fist, apply warm compresses for 10 to 15 minutes to the site of the appropriate vein, request the client lower the body part to below 36. The nurse understands that besides extravasation, pain at the site of an IV infusion can result from which of the following? Select all that apply. Administering irritating medications too rapidly, the IV catheter touching the wall of the vein, administering medication that is not properly diluted 37. The gauge of the IV needle is determined by which of the following factors? Select all that apply. Viscosity of the medication, condition of the vein selected, nature of the therapy, size of the vein selected. 38. Which of the following dosage forms should NOT be disrupted? Choose all that apply. Enteric- coated medications, vaginal suppositories, gel tablets, sustained action medications, products containing a wax matrix. 39. Which of the following Is true of intravenous therapy? Select all that apply. It is used to maintain water balance, it is used as nutritional therapy, it can prove fatal if incorrect fluid is infused, blood and blood products are IV solutions, IV fluids are prescribed according to osmolality of the fluid, it is used as a replacement therapy 40. If the half-life of an antibiotic is 6 hours, the percentage of the original dose that will remain in the clients body 24 hours after a single dose has been administered is: 6.25% 41. The study of the biochemical and physiological effects of drugs as well as their mechanisms of action is called: pharmacodynamics 42. Soft gelatin capsules are most commonly employed in: liquid drugs 43. Because aspirin can be purchased without a prescription order form, it is called an: over the counter drug 44. The process by which a drug passes into the fluids of the body is called: absorption 45. Drug molecules that are bound to plasma proteins are: pharmacologically inactive 46. The minimal level of drug required to elicit a pharmacological response is called: minimum effect concentration 47. When the pharmacological effects of one drug are potentiated or diminished by another drug, it is called: interaction 48. A physician has prescribed enteric coated tablets for the client. The nurse knows that which of the following is true about enteric- coated tablets? Tablets are designed to carry drugs that can irritate the stomach VERSION 6 Pharmacology ATI Exam Chapter 1: Pharmacokinetics and Routes of Administration • Absorption – how quickly or how well it is absorbed; DEPENDS ON THE ROUTE o Oral – takes a while, must pass through the GI tract  Food can SLOW this down  pH juices play a role  Liquids vs extended release tablets o Sublingual – quick, under the tongue o Intradermal/topical – slow, gradual o Intravenous (IV) – the FASTEST route; immediate absorption • Distribution – requires binding proteins of medication o Albumin is a common binding protein • Metabolism – medication is inactivated o Occurs primarily in the LIVER o Factors that Influence Metabolism:  Age – dysfunction of liver  Children – metabolism is not mature yet o First-pass effect – medications are inactivated through their first pass of the liver; THEREFORE, you may need a HIGHER DOSE of the medication to reach therapeutic effects • Excretion – primarily done by the KIDNEYS • Therapeutic Index o HIGH TI = wide safety margin, no need for routine monitoring o LOW TI = small safety margin; NEEDS MONITORING; HIGH risk of toxicity  Ex: vancomycin; need to draw peak/trough blood levels • Half-life – the amount of time it takes for the medication in the body to drop by 50% o Short half-life – leaves the body quickly o Long half-life – lingers in the body for long periods; HIGH risk of toxicity • Agonist – medication designed to produce an action • Antagonist – opposes the action • Nursing Considerations for Routes of Administration o Oral:  May need to mix with apple sauce  Want patient to sit up/Fowler’s position  “Chin to chest” to help with swallowing  REMEMBER! NEVER chew enteric-coated capsules  REMEMBER! Never break/chew extended-release capsules o Sublingual/buccal:  Keep medication in place until it is completely dissolved  DO NOT eat/drink until it is completely dissolved o Transdermal:  Wash and dry thoroughly  Place patch on a hairless area  Rotate patch sites o Eyes:  Put into conjunctival sac  Apply pressure to the nasolacrimal duct  Wait 5 minutes between different drops  Never touch the eye with the dropper (1-2 cm away) o Ears:  Lay on unaffected side  Pull up and out if they are an ADULT  Pull down and back if they are a CHILD o NG/Nose:  Flush before and after with 15 ml  One last flush of 15 ml-30 ml o Suppository:  Place just beyond the external sphincter  Left lateral sims’ position o Inhalation:  MDI (meter dose inhaler) • SHAKE 5-6 TIMES • TAKE DEEP BREATH 3-5 secs • HOLD BREATH 10 secs  DPI (dry powder inhaler) • AVOID SHAKING INHALER • HOLD BREATH 10 secs o Intramuscular:  REMEMBER! VASTUS LATERALIS for children under 2 years-old  REMEMBER! DELTOID site MAX 1 mL of fluid  REMEMBER! Z-TRACK prevents medication from walking back into subcutaneous tissue Chapter 2: Safe Medication Administration and Error Reduction • Routine/standard – regular schedule medication • One-time – only one dose • STAT – immediately • PRN – as needed • Medication reconciliation – comparing at home medications with hospital medications o Done UPON ADMISSION o Done UPON TRANSFER o Done AT DISCHARGE • REMEMBER! NEVER use trailing 0 • REMEMBER! ALWAYS use leading 0 • REMEMBER! NEVER administer a medication prepared by someone else • REMEMBER! NEED to fill out INCIDENT REPORT if given the WRONG MEDICATION o INCIDENT REPORTS DO NOT GO IN THE PATIENT’S CHART Chapter 4: Intravenous (IV) Therapy • Risks Associated with IV Therapy o Circulatory overload if the dose is too large or too rapid o Little time to correct errors o Failure to maintain surgical asepsis • DOs and DON’Ts o REMEMBER! NEVER put IV meds through tubing that is infusing blood or blood products o REMEMBER! NEVER infuse meds through tubing that is administering TPN o Verify compatibility of medications o Use a BP cuff instead of tourniquet; especially for OLDER ADULTS o Hold arm below the level of the heart o Try to stay away from back of hand o Want to change sites (usually every 72 hours) o REMEMBER! Fluids should NOT hand for more than 24 hours UNLESS it is a CLOSED BAG SYSTEM o Start distally 1st o Flush IV every 8-12 hours to keep patency o Monitor every hour at the least • Complications a. Infiltration – solution outside of the veins i. PALLOR, SWELLING, COLDNESS b. Extraversion – medication leaking outside of the veins i. PAIN, BURNING, REDNESS, SWELLING c. Hematoma – bruising at the site d. Catheter embolus (VERY SERIOUS SITUATION) – missing catheter tip after discontinuation e. Phlebitis – i. EDEMA, WARMTH, BURNING, PAIN f. Cellulitis – i. PAIN, WARMTH, EDEMA ii. SYSTEMIC SYMPTOMS: MALAISE, FEVER g. Fluid overload – i. DISTENDED NECK VEINS, HYPERTENSION, TACHYCARDIA, CRACKLES, DYSPNEA Chapter 6: Individual Considerations of Medication Administration • Factors Affecting Medication Dosages and Responses o Body weight – the bigger someone is, the higher the dose will need to be to get therapeutic effects o Age – Young children will need a smaller dose because their liver/kidneys are not fully developed, blood-brain barrier poorly developed, increased ability to absorb topical medications; older client’s liver/kidney function may be impaired o Gender – females have a higher proportion of body fat o Tolerance (IV DRUG USERS) o Accumulation – if someone has impaired kidney function, they may not be able to excrete it properly which could lead to toxicity o Psychological factors – someone’s frame of mind can impact effects o Medical problems –  Diarrhea  Inadequate gastric acids  Liver disease  Kidney disease • Pregnant o REMEMBER! MOST OF THE TIME it is NOT okay to take medications while pregnant o REMEMBER! Pregnant women should NOT have live vaccines (measles, mumps, rubella, polio) o REMEMBER! They should get the INACTIVATED INFLUENZA vaccine Chapter 7: Anxiety and Trauma-and Stressor-Related Disorders • Benzodiazepines (end in –am) o Diazepam o Lorazepam o Alprazolam o Chlrodiazepoxide  Use: treatment of ANXIETY, seizures, muscle spasms, alcohol withdraw  Action: increase the effects of GABA in your body  SE: SEDATION, RESPIRATORY DEPRESSION, amnesia, dependency, withdraw  Recommended for SHORT-TERM use  NEVER just quit taking  Antidote: FLUMAZENIL • Atypical anxiolytic (anti-anxiety) o Buspirone  Use: ANXIETY, PANIC DISORDER, OCD, PTSD  KEY POINTS: • CAN BE USED LONG TERM • SEDATION IS USUALLY NOT A PROBLEM • TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR • DEPENDENCY RISK IS LOW  SE: dizziness, nausea, headache  (PAM HAS ANXIETY WENT ON A BENZO AND TAKES IT FOR A ONG TIME BUT REALIZES IT IS NOT HEALTHY SO SHE TAKES A BUS TO A PIER AND REALIZES SHE IS GOING TO BE HEALTHIER AND TAKE BUSPIRONE) • SSRI’s (end in –ine) o Paroextine o Sertaline o Fluoxetine  Use: ANXIETY, DEPRESSION, OCD, PTSD  Action: inhibit serotonin reuptake (increases the amount of serotonin in the body)  (TEENS (-ines) CAN BE DIFFICULT AND CAUSE PARENTS TO HAVE ANXIETY AND DEPRESSION)  SE: nausea, fatigue, WEIGHT GAIN, SEXUAL DYSFUNCTION  WATCH FOR SERITONIN SYNDROME (TOO MUCH SERETONIN) SE: agitation, hallucinations, fever, tremors  TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR Chapter 8: Depressive Disorders • SSRI’s (end in –ine) o Paroextine o Sertaline o Fluoxetine  Use: DEPRESSION  Action: inhibit serotonin reuptake (increases the amount of serotonin in the body)  SE: WEIGHT GAIN, SEXUAL DYSFUNCTION, nausea, fatigue  WATCH FOR SERITONIN SYNDROME (TOO MUCH SERETONIN) SE: agitation, hallucinations, fever, tremors  TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR • Atypical Antidepressants o Buproprion o Trazadone (MAJOR SE IS SEDATION)  Use: DEPRESSION, SMOKING CESSATION  SE: insomnia, weight loss, GI distress, agitation, seizures, headache  (B APPROPRIATE AND DON’T SMOKE OR YOU’LL GET DEPRESSION) • Tricyclic Antidepressants o Amitriptyline  Use: DEPRESSION, NEUROPATHY, BIPOLAR DISORDER  (AMI TRIPPED OVER A TRICYLE IN THE DESSERT)  SE: ANTICHOLINERGIC (CAN’T PEE, CAN’T SEE, CAN’T SPIT, CAN’T SHIT)  KEY POINTS: • IN ORDER TO COUNTERACT THESE SE’S  CHEW GUM, WEAR SUNGLASSES, DRINK LOTS OF FLUIDS, HIGH FIBER DIET • MOST SERIOUS? Urinary retention • MAOI’s o Phenelzine  Use: DEPRESSION  THERE ARE A LOT OF DRUG INTERACTIONS  SE: agitation, anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS  IF YOU EAT FOODS RICH IN TYRAMINE, YOU CAN TRIGGER THE HYPERTENSIVE CRISIS  (I AM A PHENE FOR AGED CHEESES, BOLOGNA, WINE, AVACODO, SOY SAUCE, SALAMI, PEPPORONI, ETC BECAUSE OF MY DEPRESSION) Chapter 9: Bipolar Disorders • Mood stabilizer o Lithium carbonate  Use: bipolar disorder  SE: GI UPSET, FINE HAND TREMORS (COURSE HAND TREMORS ARE A SIGN OF TOXICITY), weight gain, renal toxicity  NEED ADEQUATE FLUID INTAKE!  IF LITIUM LEVELS ARE OVER 1.5  INDICATES TOXICITY  STAY AWAY FROM DIURETICS AND ANTICHOLINERGIC MEDS AND NSAIDS • Antiepileptic drugs o Valproic acid (SE: HEPATOXICITY *) o Carbmazepine (SE: anemia, leukocytopenia, etc)  Use: BIPOLAR DISORDER, anti-seizures Chapter 10: Psychotic Disorders • Antipsychotics (conventional) o Chlorpromazine o Haloperidol  Use: psychotic disorders (schizophrenia, tourettes syndrome)  SE: A BUNCH OF SIDE EFFECTS, EXTRAPYRAMIDAL SE’S, NEUROLEPTIC MALIGNANT SYDROME  If the patient isn’t good about taking the medication, can get IM injections every 2 weeks • Antipsychotic (atypical) o Risperdone o Clozapine  Use: schizophrenia  SE: diabetes, weight gain, increased cholesterol, orthostatic hypotension  If the patient isn’t good about taking the medication, can get IM injections every 2 weeks  SHOULD AVOID ALCOHOL Chapter 11: Medications for Children and Adolescents with Mental Health Issues • CNS Stimulants o Methylphenidate o Amphetamine mixture (Adderall)  Use: ADHD, conduct disorder  SE: INSOMNIA, RESTLESSNESS, WEIGHT LOSS  SHOULD NOT ADMINISTER AT NIGHT  GIVE IMMEDIATELY BEFORE OR IMMEDIATELY AFTER A MEAL  MONITOR THE CHILD’s WEIGHT Chapter 12: Substance Use Disorders • Alcohol withdraw – usually starts 4-12 hours after the last consumption of alcohol o SE: vomiting, tremors, increased BP, increased RR, increased HR WITHDRAW MEDICATIONS • Benzodiazepines (end in –am) • Adjunct medications to treat the high blood pressure (propranolol) ABSTINENCE MEDICATIONS • Disulfiram o IF THEY TAKE THIS, THEY WILL GET THE BAD SIDE EFFECTS • Naltrexone o SUPPRESSES THE CRAVING FOR ALCOHOL • Acamprosate o DECREASES THOSE ABSTINENCE SYMPTOMS OPIOD ADDICTION • Methadone substitution (THINK A METHADONE CLINIC) o Substitutes the use of opioids o GRADUALLY TAKE THEM OFF THIS MEDICATION NICOTINE ADDICTION • Buproprion o (B APPROPRIATE AND DON’T SMOKE) • Nicotine gum, nicotine patch • Varenicline (CHANTEX) o MONITOR FOR DEPRESSION Chapter 13: Chronic Neurologic Disorders • Myasthenia gravis – do not have enough acetacholine at receptor sites • Cholinesterase Inhibitors o Neostigmine o Physostigmine  Use: treats myasthenia gravis  SE: CHOLINERGIC EFFECTS o Edrophonium  USED TO DIAGNOSIS MYASTHENIA GRAVIS o ATROPINE IS THE ATIDOTE • Anti-Parkinson’s Medications o Levadopa/carbidopa  Use: Parkinson’s  SE: nausea, vomiting, diarrhea, dyskinesia (grimacing, tics, tremors), orthostatic hypotension, darkening of urine and sweat, psychosis  YOU WANT TO EAT CARBS, BUT LESS PROTEIN BC IT CAN DECREASE THE EFFECTIVENESS OF MED o Benzotropine  Use: Parkinson’s  SE: anticholinergic effects • Antiepileptics o Phenytoin  Use: seizures  SE: gingival hyperplasia (NEED TO CONSULT YOUR DENTIST)  VERY CLOSELY MONITOR PLASMA LEVELS TO AVOID TOXICITY  Decreased effectiveness of oral contraceptives Chapter 14: Eye and Ear Disorders • Beta-adrenergic blocker o Timolol (THESE ARE EYE DROPS)  Use: decrease IOP in glaucoma • Carbonic anhydrase inhibitor o Acetazolamide  Use: glaucoma  SE: flu-like symptoms, GI effects, electrolyte imbalances  Administer with food to prevent GI upset • Fluroquinolone Antibiotics plus steroid medications o Ciprofloxacin plus hydrocortisone  Use: otitis externa (swimmer’s ear) Chapter 15: Miscellaneous Central Nervous System Medications • Neuromuscular blocking agents o Succinycholine o Pancuronium  Use: anesthesia for muscle paralysis in surgery  SE: MALIGNANT HYPERTHERMIA (muscle rigidity, fever), muscle pain  Administer cooling measures if they have malignant hyperthermia  Administer DANTROLENE • Muscle relaxants and antispasmodics o Dantrolene  Use: malignant hyperthermia, muscle spasticity  SE: drowsiness, muscle weakness, hepatotoxicity o Baclofen  Use: muscle spasticity, malignant hyperthermia  SE: drowsiness, constipation  (IF YOU PULL OUT YOUR BACK, YOU MIGHT NEED BACLOFEN AS A MUSCLE RELAXER) • Muscarinic agonists o Bethanechol  Use: treats urinary retention  (BETH HAS A SHY BLADDER, SO THIS HELPS HER GO TO THE BATHROOM)  SE: cholinergic effects  Administer 1 hour before or 2 hours after meals • Muscarinic antagonists o Oxybutynin  Use: overactive bladder, frequency, urgency, nocturia  SE: anticholinergic effects  Contraindicated: glaucoma Chapter 16: Sedative-Hypnotics • Nonbenzodiazepines o Zolpidem  Use: insomnia  SE: daytime sleepiness, dizziness  Make sure patient has 8 hour dedicated sleep time • Intravenous anesthetics o Pentobarbital sodium o Propafal (CAN CAUSE PAIN AT THE IV SITE) o Medazolam  Use: conscious sedation, intubation procedures  SE: respiratory and cardiovascular depression, HIGH RISK FOR HYPOTENSION Chapter 17: Airflow Disorders • Beta2 Adrenergic Agonists o Albuterol  Use: asthma, COPD  SE: tachycardia, angina, tremors, jittery • Methylxanthines o Theophylline  (IF YOU TAKE THEOPHYLLINE, YOU MIGHT BE SEEING GOD SOONER THAN YOU INTENDED)  Use: asthma, COPD  SE: BAD!!!!! GI upset, dysrhythmias, seizures  VERY NARROW THERAPEUTIC RANGE  WILL HAVE TO HAVE FREQUENT BLOOD DRAWS • Inhaled anticholinergics o Ipratropium  Use: asthma, COPD  SE: anticholinergic effects  TELL PT TO INCREASE FLUIDS  SUCK ON SUGAR FREE CANDY OR CHEW GUM TO RELIEVE THE DRY MOUTH • Glucocorticoids o Beclomethasone  (BECKY HAS ASTHMA)  Use: asthma, can be used alone or with the albuterol (DECREASES THE INFLAMMATION)  SE: candidiasis **  NEED TO INFORM PT TO RINSE THEIR MOUTH OUT TO PREVENT THE FUNGAL INFECTION o Prednisone (VERY IMPORTANT DRUG! USED FOR A WIDE VARIETY OF THINGS; USED ALMOST ANY TIME YOU NEED TO REDUCE INFLAMMATION) o NEED TO KNOW ALL SIDE EFFECTS!!!!!!!  Use: asthma, anything with inflammation, immune disorders  (MUSCLE WEAKNESS), PEPTIC ULCER DISEASE, INFECTION !!!!! NEED TO KNOW ALL