Pharmacology Review I Chapters 1 - 28 All Materials in this presentation come from: Karch, A. (2008). Focus on: nursing pharmacology. New York, NY: Lippincott Williams & Wilkins.

Case Study # 1 Antibiotics Mrs. Smith, a lively 78 yr old woman, successfully receiving Lasix (a diuretic) for hypertension comes in to the office…complaining of UTI symptoms. She wants to know why the doctor did not prescribe Gentamicin. “I used to always take Gentamicin”…..what do you explain to her?

Mrs. Smith, a lively 78 yr old woman, successfully receiving Lasix (a diuretic) for hypertension comes in to the office…complaining of UTI symptoms. She wants to know why the doctor did not prescribe Gentamicin. “I used to always take Gentamicin”…..what do you explain to her?

Gentamicin is an aminoglycoside antibiotic…aminoglycosides and Lasix can cause severe ototoxicity Mrs. Smith, are you listening to me?

Gentamicin is an aminoglycoside antibiotic…aminoglycosides and Lasix can cause severe ototoxicity

Case Study # 2 Antibiotics Senator X receives a letter with a suspicious powder substance. What cephalosporin will he take for anthrax expsoure?

Senator X receives a letter with a suspicious powder substance. What cephalosporin will he take for anthrax expsoure?

CeClor (cefaclor) 250 mg PO q8h The Nurse warns Senator X not to go to Happy Hour, why?

CeClor (cefaclor) 250 mg PO q8h

The Nurse warns Senator X not to go to Happy Hour, why?

Cephalosporins Senator X should not consume alcohol while taking cephalosporins because of a possible disulfiram-like reaction-- Flushing, nuasea, vomiting, chest pain, palpitations, dyspnea, blurred vision, even consulsions!

Senator X should not consume alcohol while taking cephalosporins because of a possible disulfiram-like reaction--

Flushing, nuasea, vomiting, chest pain, palpitations, dyspnea, blurred vision, even consulsions!

Case Study # 3 Antibiotics Susan is ready to head to Florida for her Spring Break, too bad she has a UTI and is taking Cipro….. Why?

Susan is ready to head to Florida for her Spring Break, too bad she has a UTI and is taking Cipro…..

Why?

Photosensitvity! Cipro can cause a severe skin reaction when pt is exposed to sunlight or tanning beds. Susan’s grandmother in the nursing home doesn’t see much sunlight, she just needs to avoid using NSAIDs when taking Cipro !

Cipro can cause a severe

skin reaction when pt

is exposed to sunlight

or tanning beds.

Susan’s grandmother in the nursing home doesn’t see much sunlight, she just needs to avoid using NSAIDs when taking Cipro !

Case Study # 4 Antibiotics Uncle Larry seems confused lately…It’s a good thing the doctor prescribed Zithromax for his upper respiratory infection….. Why?

Uncle Larry seems confused lately…It’s a good thing the doctor prescribed Zithromax for his upper respiratory infection…..

Why?

Zithromax (Azithromycin) Half-life is 68 hours so patients only need to take it once a day….usefull for patients who have trouble remembering to take their pills.

Half-life is 68 hours so patients only need to take it once a day….usefull for patients who have trouble remembering to take their pills.

Case Study # 5 Antibiotics LaTasha calls the nurse: “my baby is allergic to the amoxicillin” The nurse will ask, “what are her symptoms?” LaTasha says bad diarrhea…how will you council her?

LaTasha calls the nurse: “my baby is allergic to the amoxicillin”

The nurse will ask, “what are her symptoms?”

LaTasha says bad diarrhea…how will you council her?

LaTasha and her baby Sometimes patients may confuse side effects with allergic reactions. Typical allergic reactions include: Hives, rash Difficulty breathing, respiratory arrest Increased BP, dilated pupils, Increased heart rate, diaphoresis

Sometimes patients may confuse side effects with allergic reactions.

Typical allergic reactions include:

Hives, rash

Difficulty breathing, respiratory arrest

Increased BP, dilated pupils,

Increased heart rate, diaphoresis

Amoxicillin and other penicillins Common adverse effects include nausea, diarrhea and a furry tongue. “ A furry tongue! What are you talkin’ about?” says LaTasha… Superinfections like yeast are very common…

Common adverse effects include nausea, diarrhea and a furry tongue.

“ A furry tongue! What are you talkin’ about?” says LaTasha…

Superinfections like yeast are very common…

Case Study # 6 Antibiotics Carrie’s husband has an abscessed tooth. The dentist prescribed Clindamycin (lincosamide)… Great wife that she is, she is bummed because she just cleaned her toilets…what side effect is she thinking of?

Carrie’s husband has an abscessed tooth. The dentist prescribed Clindamycin (lincosamide)…

Great wife that she is,

she is bummed because

she just cleaned her toilets…what side effect is she thinking of?

Severe pseudomembranous colitis So what’s a little colitis? Pseudomembranous colitis is actually another superinfection. Clindamycin may allow Clostridium difficile (C. diff) to infect the colon.

So what’s a little colitis?

Pseudomembranous colitis is actually another superinfection.

Ancef (cefazolin)* Ancef is one of the cephalosporins. Toxic to the kidneys Monitor the patient BUN levels No alcohol while taking Ancef If pt has an allergic rxn, give parenteral epinephrine to cause vasoconstriction and bronchodilation. *(Material from ATI prep)

Ancef is one of the cephalosporins.

Toxic to the kidneys

Monitor the patient BUN levels

No alcohol while taking Ancef

If pt has an allergic rxn,

give parenteral epinephrine

to cause vasoconstriction

and bronchodilation.

*(Material from ATI prep)

Case Study # 7 Antibiotics Cheryl, a young nursing student, comes to the clinic with severe acne. The doctor has prescribed tetracycline. The nurse advises her to take the medicine on an empty stomach. Most importantly of all, her nurse asks….. Hint!

Cheryl, a young nursing student, comes to the clinic with severe acne. The doctor has prescribed tetracycline.

The nurse advises her to take the medicine on an empty stomach.

Most importantly of all,

her nurse asks…..

Antibiotics and Oral Contraceptives Are you taking oral contraceptives? Several antibiotics including tetracycline, are known to lead to failure of oral contraceptives. Cheryl needs to know to use alternative methods for birth control.

Are you taking oral contraceptives?

Several antibiotics including tetracycline, are known to lead to failure of oral contraceptives.

Cheryl needs to know to use alternative methods for birth control.

Case Study # 8 Antimycobacterial Antibiotics Michael volunteers at a health clinic for refugees from other countries…He is surprised to see so many patients with T.B. He explains the treatment lasts from 6 months to two years…why?

Michael volunteers at a health clinic for refugees from other countries…He is surprised to see so many patients with T.B.

He explains the treatment lasts from 6 months to two years…why?

Tuberculosis Treatment The slow growing bacteria form a mycolic acid outer coating. Isoniazid, rifampin and ethionamide are the first line of defense…. Michael also learns to say: “Su pis hace naranja” spanish for “ your pee will be orange” for patients taking rifampin

The slow growing bacteria form a mycolic acid outer coating. Isoniazid, rifampin and ethionamide are the first line of defense….

Isoniazid (INH) Treatment for tuberculosis Can cause lupus and jaundice from liver toxicity Signs of jaundice: Yellow skin Discolored sclerae (material from ATI prep)

Treatment for tuberculosis

Can cause lupus and jaundice from liver toxicity

Signs of jaundice:

Yellow skin

Discolored sclerae

(material from ATI prep)

Case Study # 9 Antiviral Agents Nathan says he feels “like crap!” Jennifer says, “if it’s the flu and its been less than 2 days, you should try….

Nathan says he feels “like crap!”

Jennifer says, “if it’s the flu and its been less than 2 days, you should try….

Tamiflu (oseltamivir) 75 - 150 mg PO b.I.d. for 5 days Also approved for use with children

75 - 150 mg PO b.I.d. for 5 days

Also approved for use with children

Case Study # 10 Antiviral agents Relenza For the FLu Aldara for skin cancers Abreva for cold sores Hepsera For Hep. B (liver damage ) Retrovir (AZT) For HIV Acyclovir For herpes

Review antiviral agents Flu symptoms Cold sores Hepatitis B HIV Herpes Skin cancers (also genital warts) Hepsera Aldara Abreva Relenza Acyclovir Retrovir (AZT)

Flu symptoms

Cold sores

Hepatitis B

HIV

Herpes

Skin cancers

(also genital warts)

Hepsera

Aldara

Abreva

Relenza

Acyclovir

Retrovir (AZT)

Case Study # 11 Antifungals There is a fungus, among us… What common antifungal is used topically for onychomycosis ?

Antifungals Lamisil is commonly used cream and is pretty safe … however… other antifungals are not used topically Why would anyone need to take pills for fungus?

Lamisil is commonly used cream

and is pretty safe

… however…

other antifungals are not used topically

Why would anyone need to take pills for fungus?

Case Study # 12 Antifungals Answer: Superinfections Azoles are used to treat Candidiasis, systemic fungal infecitons and to prevent candidiasis in bone marrow transplants Remember the “furry tongue” see case # 5

Answer: Superinfections

Azoles are used to treat Candidiasis, systemic fungal infecitons and to prevent candidiasis in bone marrow transplants

Remember the “furry tongue” see case # 5

Antifungal Drug to Drug interactions Systemic antifungals like azoles may become toxic with: digoxin oral hypoglycemics warfarin phenytoin cyclosporine Sounds like the average nursing home cocktail to me…

Systemic antifungals like azoles may become toxic with:

digoxin

oral hypoglycemics

warfarin

phenytoin

cyclosporine

Case Study # 13 Antiprotozoal agents Michael decides to take his clinic to Africa… What drug will he need to take to prevent malaria? Should Michael and his wife plan to have kids while they are over there?

Michael decides to take his clinic to Africa…

What drug will he need to

take to prevent malaria?

Should Michael and his wife plan to have kids while they are over there?

Antimalarial medication Chloroquine (Aralen) blocks the reproduction of the plasmodium organisms. Chloroquine has potential risk to pregancy Also can cause serious eye damage and blindness

Chloroquine (Aralen) blocks the reproduction of the plasmodium organisms.

Chloroquine has potential risk to pregancy

Also can cause serious eye damage and blindness

Case Study # 14 Antiprotozoals Cindy and Tara went backpacking in the Smoky Mtns. Cindy warned Tara not to drink the water, but she did…. Now Tara has pale, mucous filled stools and rotten egg smelling diarrhea…sounds like she needs---

Cindy and Tara went backpacking in the Smoky Mtns. Cindy warned Tara not to drink the water, but she did….

Now Tara has pale, mucous filled stools and rotten egg smelling diarrhea…sounds like she needs---

Metroniadazole (Flagyl, MetroGel, Noritate) 750 mg PO tid for 5-10 days for amebiasis and giardiasis 2 g PO as one dose for Trichimoniasis The Travelers’ Real Friend…

(Flagyl, MetroGel, Noritate)

750 mg PO tid for 5-10 days for amebiasis and giardiasis

2 g PO as one dose for Trichimoniasis

The Travelers’ Real Friend…

Case Study # 15 Anti-inflamatory agents Grandpa believes “if one is good, two is better” when it comes to aspirin for his arthritis. Lately, he complains about ringing in his ear…is there a connection?

Grandpa believes “if one is good, two is better” when it comes to aspirin for his arthritis.

Lately, he complains about ringing in his ear…is there a connection?

Tinnitus Yes! Ringing in the ears is a classic sign of aspirin toxicity, called salicyclism. Also sweating, headache and dizziness, Granpa’s liver may not be meatbolizing the aspirin as fast as it use to ….

Yes!

Ringing in the ears is a classic sign of aspirin toxicity, called salicyclism.

Also sweating, headache and dizziness, Granpa’s liver may not be meatbolizing the aspirin as fast as it use to ….

Case Study # 19 Anti-inflammatory agents Brenda, an alcoholic, has had a migraine for three days. She’s been taking Tylenol extra strength whenever it starts to ache. Yesterday, she started to have flu symptoms so she’s been taking DayQuil (325 mg acetaminophen), a couple of swigs every few hours. She comes to ER with nausea, vomiting, and GI upset-- The doctor recognizes Acetaminophen Toxicity and prescribes:

Brenda, an alcoholic, has had a migraine for three days.

She’s been taking Tylenol extra strength whenever it starts to ache.

Yesterday, she started to have flu

symptoms so she’s been taking DayQuil

(325 mg acetaminophen),

a couple of swigs every few hours.

She comes to ER with nausea, vomiting, and GI upset--

The doctor recognizes Acetaminophen Toxicity and prescribes:

Acetylcysteine (Mucomyst) is 100% effective in preventing liver overdose The Liver Can’t “live” Without it!

(Mucomyst) is 100% effective in preventing liver overdose

Gold Salts Gold Salts are available for treatment of rheumatoid arthritis Monitor the patient for mouth sores , GI inflamation and allergic rxns. And anaphylatic shock

Gold Salts are available for treatment of rheumatoid arthritis

Monitor the patient for mouth sores ,

GI inflamation and allergic rxns. And anaphylatic shock

Anaphylactic shock Allergic rxn where body produces histmaines Immediate swelling and constricting of bronchi Symptoms include: urticaria (hives) Shortness of breath Give epinephrine Urticaria

Allergic rxn where body produces histmaines

Immediate swelling and constricting of bronchi

Symptoms include:

urticaria (hives)

Shortness of breath

Give epinephrine

Immunization schedule Hep B Hib Dtap 5 - dose series (Diptheria, Tetanus,Pertussis) IPV MMR PVC Varicella

Hep B

Hib

Dtap 5 - dose series

(Diptheria, Tetanus,Pertussis)

IPV

MMR

PVC

Varicella

Anxiolytics and Hypnotic Agents Xanax - anxiety, panic Librium - anxiety, alcohol withdrawal Klonopin - restless leg syndrome, panic Valium - muscle relaxant, antiepiletptic ProSom - hypnotic, insomnia Ativan - anxiety, preanesthesia Serax - preferred for elderly

Xanax - anxiety, panic

Librium - anxiety, alcohol withdrawal

Klonopin - restless leg syndrome, panic

Valium - muscle relaxant, antiepiletptic

ProSom - hypnotic, insomnia

Ativan - anxiety, preanesthesia

Serax - preferred for elderly

Case Study # 20 Benzodiazepines Mr. Mason came into ER. He is a known drug abuser. He was admitted for possible stroke. Kim, his nurse asks when was the last time he had a beer? Mr. Mason says 3 days. Kim calls the doctor to request Ativan (STAT), why? (based on a true story)

Mr. Mason came into ER. He is a known drug abuser. He was admitted for possible stroke.

Kim, his nurse asks when was the last time he had a beer? Mr. Mason says 3 days.

Kim calls the doctor to request Ativan (STAT), why?

(based on a true story)

Ativan (lorazepam) Kim has seen this before…. Mr. Mason is probably an alcoholic and will begin to have withdrawal symptoms if he stays any longer at the hospital. Ativan will prevent wild behavior and lasts 12 - 24 hours ------------> (that will cover her shift)

Kim has seen this before….

Mr. Mason is probably an alcoholic and will begin to have withdrawal symptoms if he stays any longer at the hospital.

Ativan will prevent wild behavior and lasts 12 - 24 hours

------------> (that will cover her shift)

Ativan (lorazepam) Kim requests only 1 mg/day PO for Mr. Mason The normal dosage is 2 -6 mg/day Why?

Kim requests only 1 mg/day PO

for Mr. Mason

The normal dosage is 2 -6 mg/day

Why?

Benzodiazepines Mr. Mason is an African American. Kim knows special care needs to be taken because he may have a genetic predisposition to delayed metabolism of benzodiazepines. She will closely monitor him for adverse effects like cardiovascular issues, urinary retention, sedation, confusion and blurred vision. Use lowest possible dose

Mr. Mason is an African American.

Kim knows special care needs to be taken because he may have a genetic predisposition to delayed metabolism of benzodiazepines.

She will closely monitor him for adverse effects like cardiovascular issues, urinary retention, sedation, confusion and blurred vision.

Benzodiazepines Mr. Mason threatens to leave the hospital. “You can’t make me stay!” Kim explains to him Ativan plus alcohol can cause serious CNS depression. She flips on the movie channel and Mr. Mason calms down. Just another day for Super Nurse!

Mr. Mason threatens to leave the hospital. “You can’t make me stay!”

Kim explains to him Ativan plus alcohol can cause serious CNS depression.

She flips on the movie channel and Mr. Mason calms down.

Barbituates Amytal sodium - convulsions, sedative Luminal - preanesthetic, seizures Seconal - preanesthetic, seizures

Amytal sodium - convulsions, sedative

Luminal - preanesthetic, seizures

Seconal - preanesthetic, seizures

Selective Serotonin Reuptake Inhibitors (SSRIs) Luvox Paxil Zoloft Celexa Cymbalta Prozac Inform patients: May take 4 weeks To see improvement May cause cystitis, Urgency sexual dysfunction Need alternative birth control (If using oral contraceptives) Do not combine with St. John’s Wort 70 % experience Sexual dysfunction That’s depressing!

Luvox

Paxil

Zoloft

Celexa

Cymbalta

Prozac

Inform patients:

May take 4 weeks

To see improvement

May cause cystitis,

Urgency

sexual dysfunction

Need alternative

birth control

(If using oral contraceptives)

Do not combine

with St. John’s Wort

Case Study # 20 Tricyclic Antidepressants TCAs treat depression Clamipramine is for OCDs TCAs are anticholinergic so caution with: Cardiovascular disorders Urinary disorders Imipramine also treats…..?

TCAs treat depression

Clamipramine is for OCDs

TCAs are anticholinergic so caution with:

Cardiovascular disorders

Urinary disorders

Imipramine also treats…..?

Imipramine (Tofranil) 25 mg/day 1 hr before bed For bed wetting Monitor for anticholinergic effects like dry mouth, constipation, rash, anxiety and bone marrow depressi

25 mg/day 1 hr before bed

For bed wetting

Monitor for anticholinergic effects like dry mouth, constipation, rash, anxiety and bone marrow depressi

Case Study # 21 Tricyclic antidepressants Your patient is on Elavil (amitrptyline) (to elevate her mood obviously) What side effects will you monitor for? I’m gonna push the ‘upper’ button

Your patient is on Elavil (amitrptyline)

(to elevate her mood obviously)

What side effects

will you monitor for?

Elavil (amitriptyline) TCAs have anticholinergic effects Monitor for dry mouth and urinary retention!

TCAs have anticholinergic effects

Monitor for dry mouth and urinary retention!

Anxiolytic and Hypnotic Drugs Sonata Ambien (zolpidem) Lunesta Phenergan Benadryl Cause sedation and are used for Short-term treatment insomnia of Used preoperatively May cause thick secretions I need Lunesta

Sonata

Ambien (zolpidem)

Lunesta

Phenergan

Benadryl

Case Study # 22 Antidepressant agents Tonya has been depressed for awhile, so the doctor prescribed Nardil (phenelzine). She was doing much better until her birthday: her nursing friends had a gala wine tasting event. (Caviar, aged cheeses, wines, sausage) She went to ER thinking she had a stroke…….. What happened?

Tonya has been depressed for awhile, so the doctor prescribed Nardil (phenelzine). She was doing much better until her birthday: her nursing friends had a gala wine tasting event.

(Caviar, aged cheeses, wines, sausage)

She went to ER thinking she had a stroke……..

MAOIs Occipital headache, palpitations, nausea, vomiting,sweating, tachycardia, chest pain, …even stroke can result when MAOIs are combined with tyramine-containing foods (like wines and cheeses) MAOIs can also cause hypoglycemia No worries, Tonya sued her nursing friends for a fortune……..

Occipital headache, palpitations, nausea, vomiting,sweating, tachycardia, chest pain, …even stroke can result when MAOIs are combined with tyramine-containing foods (like wines and cheeses)

MAOIs can also cause hypoglycemia

No worries, Tonya sued her nursing friends for a fortune……..

Case Study # 23 Antidepressant agents Nicole’s husband wants to quit smoking. The doctor prescribed Zyban (bupropion). The doctor forgot to mention a major side effect and Nicole is about ready to scream. What is the side effect?

Nicole’s husband wants to quit smoking. The doctor prescribed Zyban (bupropion). The doctor forgot to mention a major side effect and Nicole is about ready to scream.

What is the side effect?

Bupropion (Wellbutrin, Zyban) Major side effect: insomnia “ Oh, well,” says the doctor, “at least he won’t be depressed”

Major side effect: insomnia

“ Oh, well,” says the doctor, “at least he won’t be depressed”

Antipsychotics Treatment of: Schizophrenia Psychotic disorders Combative behavior Agitation in elderly Hyperactivity Any adverse effects ?

Treatment of:

Schizophrenia

Psychotic disorders

Combative behavior

Agitation in elderly

Hyperactivity

Adverse effects of Psychotherapeutic Agents CNS depression, tremor, drowsiness Cardiovascular effects Anticholinergic effects Dry mouth Constipation, urinary retention Extrapyramidal effects Pseudoparkinsonism Dystonia,akathisia

CNS depression, tremor, drowsiness

Cardiovascular effects

Anticholinergic effects

Dry mouth

Constipation, urinary retention

Extrapyramidal effects

Pseudoparkinsonism

Dystonia,akathisia

Case Study # 24 Psychotherapeutic agents Granpa’s Alzheimers’ is getting worse. Yesterday, he slugged the nurse when she tried to give him a shower… Now,he is taking Seroquel (quetiapine) 50 mg PO bid Grandma wants to know why he is drooling…he never did that before?

Granpa’s Alzheimers’ is getting worse. Yesterday, he slugged the nurse when she tried to give him a shower…

Now,he is taking Seroquel (quetiapine) 50 mg PO bid

Grandma wants to know why he is drooling…he never did that before?

Atypical psychotherapeutics Tell grandma that since grandpa still needs to take his beta-blocker for his heart, he is having an increased response to the Seroquel The nurse will also monitor for dyspnea and heart arrhythmias.

Tell grandma that since grandpa still needs to take his beta-blocker for his heart, he is having an increased response to the Seroquel

The nurse will also monitor for dyspnea and heart arrhythmias.