Lvn pharm final

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Lvn pharm final

  1. 1. Pharmacology Final<br />Blueprint<br />Part 1…Includes:<br />Antihistamines, antitussives, asthma meds, decongestants, expectorants, antihypertensives, antimigraines, antiepileptics, antiparkinsonians, psychotherapeutics, & sedative hypnotics<br />
  2. 2. Thiazide Diuretics<br />Drug of choice for hypertension b/c:<br />Cheap, available, well-tolerated<br />Can cause hypokalemia b/c they induce urinary loss w/o protecting potassium<br />Used to decrease fluid overload<br />Cause the kidneys to excrete sodium and water into the urine resulting in less fluid in the blood causing a reduction in blood pressure<br />Prevent the reabsorption of sodium and chloride through direct action on the end of the ascending loop and beginning of the distal tubule of the Loop of Henle<br />Promotes the reabsorption of calcium<br />Directly dilates the smooth muscles in the arterioles<br />
  3. 3. DiureticsDrug of choice for hypertension<br />
  4. 4. ACE Inhibitors<br />
  5. 5. Beta Blockers<br />
  6. 6. Beta Blocker Teaching<br />
  7. 7. Statins<br />Taken w/ dinner because the body naturally produces more cholesterol between midnight and 5 am<br />May affect liver function & not for use with pregnant women<br />Drugs used to lower cholesterol act by blocking the substances the body needs to make cholesterol<br />May also help your body reabsorb cholesterol that has built up in plaques in artery walls preventing further blockage<br />
  8. 8. Zocor Side Effects<br />Statin medication<br />Gastrointestinal disorders, myalgia, arthralgia, upper respiratory infections, headache, abdominal pain, constipation, N/V, pruritus, alopecia, pancreatitis, paresthesia, peripheral neuropathy, anemia, depression<br />
  9. 9. Flomax<br />Tamsulosin<br />Used to treat BPH<br />Alpha-adrenergic blocker; relaxes the muscles in the prostate and bladder to allow urine to flow easily<br />
  10. 10. What is stepped care?<br />Stepped care is a medication management plan starting with the least invasive drugs and progressing as needed to more invasive drugs.<br />
  11. 11. Vital signs needed with nitro<br />Blood pressure and pulse before administration<br />
  12. 12. Side effects of nitrates<br />
  13. 13. What are common medications for angina?<br />
  14. 14. What is long-acting nitrate for?<br />Long acting nitrates and topical, transdermal, transmucosal, and oral sustained-release nitroglycerin products are used:<br />to prevent or treat anginal attacks WHEN they are likely to occur<br />Like during exercise<br />To reduce the severity and frequency of anginal attacts<br />To reduce the work in the heart in cases of MI & chronic heart failure<br />For relief of gallbladder GI, urethral, and bronchial smooth muscle pain<br />
  15. 15. How to decrease nitroglycerin?<br />
  16. 16. What is important about the storage of nitroglycerin?<br />
  17. 17. Nitroglycerin instructions…<br /><ul><li>Take on an empty stomach, no alcoholic beverages, & minimize foods/drinks w/ caffeine
  18. 18. Pt. can develop a tolerance
  19. 19. In hospital blood pressure should be taken before dosing and between doses
  20. 20. Pt. should keep a record of all anginal attacks
  21. 21. Pt. should use nitro when an attack is expected
  22. 22. Meds are only part of the therapy…weight loss, avoiding triggers, and exercise are important
  23. 23. Keep out of reach of children </li></li></ul><li>Why take andrenergic blockers?<br />Part of the andrenergic antagonist class that assists in lowering cardiac output and/or peripheral resistance.<br />Sympathetic nervous system relies on 2 andrenergic neurohormones or neurotransmitters, epinephrine and norepinephrine. <br />Andrenergic inhibitors (blockers) occupy the adrenergic receptors to prevent stimulation <br />Lowers blood pressure by stopping epi/norepi which relaxes the walls of the blood vessels and lets the heart pump more slowly and easily <br />Used in the treatment of HTN<br />
  24. 24. Andrenergic blockers other uses<br />Can be used to treat benign prostatic hyperplasia<br />
  25. 25. Andrenergic blocker side effects<br />
  26. 26. Narrow Margin for Digoxin<br />Therapeutic levels are 0.5 to 2 ng/mL (nanograms per milliliter)<br />Toxic levels 2.5 ng/mL or more<br />“Narrow Margin” refers to the concept that the Therapeutic and Toxic levels are very close<br />
  27. 27. What are signs of digoxin toxicity?<br />One of the earliest symptoms is often extreme fatigue!<br />Atropine counteracts digoxin toxicity!<br />
  28. 28. Lanoxin/Digoxin Oral<br />Used to treat heart failure and abnormal heart rhythms (arrhythmias)/atrial afibrillation<br />
  29. 29. Furosemide<br />Loop diuretic<br />Used to treat high blood pressure & the fluid retention caused by heart and liver disease<br />Lasik<br />
  30. 30. Lopressor<br />Peripheral vasodilator<br />Metoprolol<br />Used alone or in combination with other medications to treat high blood pressure, prevent angina, and to improve survival after a heart attack<br />
  31. 31. Verapamil<br />Calcium Channel blocker<br />Used to treat high blood pressure and control angina<br />Relaxes the blood vessels so that the heart doesn’t have to work as hard<br />They selectively limit the passage of extracellular calcium ions through specific ion channels of the cell membrane in cardiac, vascular, and smooth muscle cells which causes a lowered peripheral vascular resistance & a fall in systolic and diastolic bp<br />
  32. 32. Pyridium<br />
  33. 33. Restoril<br />Benzodiazepine Sedative-hypnotic indicated for the short term treatment (7-10 days) of insomnia<br />Induces sleep in 20-40 minutes<br />Generally in 30 mg doses for adults; in elderly or debilitated patients 15 mg doses<br />SE = drowsiness, headache, fatigue, nervousness, lethargy, hangover, N/V/D, anorexia, ataxia, tremor, dyspnea, palpitations, amnesia, & hallucinations<br />
  34. 34. Lithium & BW<br />Primary drug used to treat patients in a manic state<br />Therapeutic levels are close to toxic levels, so serum lithium level must be monitored on a regular basis. <br />Blood should be drawn 12 hours after the dose of lithium is given.<br />Monitoring should be carried out every few days during the initial therapy and at least every 2 months thereafter<br />Therapeutic level is 1 to 1.5 mEq/L<br />
  35. 35. What is the special teaching about Dilantin?What is the initial dose?<br />Patients taking hydantoins (like Dilantin) should see a dentist every 6 months & maintain good oral hygiene brushing teeth and gums twice a day with a soft toothbrushing and rinsing well<br />Initial dose:<br />Children 5 mg/kg/day PO in 2 or 3 equally divided doses initially<br />Adults 100 mg PO 3 times daily initially<br />
  36. 36. What is Elavil/Welbutrin used for?<br />Elavil<br />Amitriptyline/elavil is a tricyclic antidepressant used to treat the symptoms of endogenous depression<br />Welbutrin<br />Buproprion/welbutrin is an antidepressant that worked in the brain to treat major depression, seasonal affective disorder, and for smoking cessation<br />
  37. 37. MAO inhibitor teachings…<br />
  38. 38. MAO inhibitors<br />Block the inactivation of the biogenic amines resulting in an increased concentration of dopamine, epinephrine, norepinephrine, and serotonin at neuronal synapses<br />Used to relieve the symptoms of severe reactive or endogenous depression that have NOT responded to tricyclic antidepressant therapy, electro-convulsive therapy, or other modes of psychotherapy<br />
  39. 39. Ritalin<br />CNS stimulant intended to treat ADD, ADHD, & narcolepsy<br />
  40. 40. Paxil<br />SSRI indicated for the treatment of major depression, panic disorder, OCD, generalized anxiety disorder, social anxiety disorder, PTSD<br />NOT to be used concurrently with MAO inhibitors<br />
  41. 41. Aricept<br />Reversible acetyl cholinesterase inhibitor<br />Indicated for the treatment of dementia of the Alzheimer’s type<br />Should be taken in the evening w/ or w/o food<br />
  42. 42. Antiparkinson Meds<br />
  43. 43. Goal of Parkinson Treatment<br />There is no known cure for Parkinson’s<br />Treatment goals are designed to relieve symptoms and maintain movement and activity of the patient<br />Symptoms are controlled by changing the neurotransmitters produced in the brain<br />Two main actions:<br />Block uptake of acetylcholine at postsynaptic muscarinic cholinergic receptor sites<br />Elevate the functional levels of dopamine in motor regulatory centers<br />
  44. 44. Antimigraine Teachings<br />
  45. 45. Imitrex<br />Serotonin (5-HT) Receptor Agonist<br />Indicated for use as an antimigraine in adults that have migraines with no aura<br />Serious cardiac & hypertensive crises have occurred with the use of imitrex<br />Not for use with MAOIs<br />Not for use in patients with history of ischemic or cerebrovascular syndromes<br />
  46. 46. Valium<br />Diazepam<br />Indicated for the treatment or management of:<br />Anxiety<br />Alcohol withdrawal tremors<br />Relief of skeletal muscle spasm<br />Spasticity from cerebral palsy or paraplegia<br />Athetosis<br />Epilepsy<br />Tetanus<br />Can be habit forming<br />Diazepines accumulate in the adipose tissue, which substantially increases their half-life, making them dangerous, particularly for elderly patients<br />Abrupt termination of these agents may cause delayed withdrawal up to a week later<br />
  47. 47. Expectorant Teachings – agents that decrease the thickness of respiratory secretions<br />
  48. 48. Decongestants & Hypertension<br />When the drugs are absorbed from the GI tract, systemic effects such as nervousness, nausea, dizziness, tachycardia, dysrhythmia & a transient INCREASE in blood pressure may occur<br />Should be used with caution in stable hypertensive patients on guanethidine, bethanidine, or debrisoquine sulfate<br />
  49. 49. Antitussives & Addiction<br />Antitussives are used to relieve overactive or nonproductive coughs<br />Narcotic antitussives may cause drug dependence<br />Some narcotic antitussives are Schedule II controlled substances<br />
  50. 50. Antihistamine Dosing<br />Over dosage is potentially fatal, especially in children<br />Infants/young children often have anticholinergic side effects<br />Pediatric patients w/ spastic paralysis or brain damage often need lower dosing<br />In hot weather children have an increased risk of developing rapid body temp increase<br />Dosage adjustments are needed for infants, Down Syndrome, & blonds<br />Elderly patients need lower doses because they are susceptible to developing extrapyramidal reactions and paradoxical reactions<br />“Go Slow and Stay Low” is important<br />
  51. 51. How antihistamines affect vitals<br />As adverse reactions…antihistamines can actually cause both hypertension and hypotension<br />They block the action of histamine by competing with it for the H1 receptor sites on the “effector structures” which limits the vasodilation and increases capillary permeability and reduces the edema caused by histamine<br />Nurses should monitor pulse and blood pressure before and during therapy<br />Nurse should assess lung sounds and character of bronchial secretions<br />
  52. 52. Extrapyramidal Effects<br />A group of adverse reactions occurring on the extrapyramidal portion of the nervous system<br />Parkinson like symptoms<br />Akathisia<br />Dystonia<br />Tardive Dyskinesia (TD)<br />Syndrome of potentially irreversible involuntary rhythmic movements of the tongue, face, mouth, jaw, or extremities.<br />May occur in patients who are on antipsychotic drugs or after discontinuing such drugs<br />There is NO known treatment<br />When it occurs the drug must be discontinued<br />
  53. 53. Treatment for Asthma<br />
  54. 54. How are antibiotics chosen?<br />Each infection in a patient must be carefully evaluated to identify the specific organism causing the infection and the drug that will be most effective against it<br />Whenever possible cultures should be drawn before starting antibiotic therapy…you may need to culture sputum, urine, blood, wound, or nonhealing sites on the skin<br />The type of infection will dictate the antibiotic used and whether treatment guidelines apply<br />Diagnosis of previous food/drug allergies, dementia, and dehydration may all influence the drug ordered, the dosage, & the rate of administration<br />
  55. 55. Broad Spectrum Antibiotics<br />Antibiotics effective against a wide variety of organisms<br />Act in different ways to affect pathogenic bacteria…may attack a bacterium’s internal cell processes or they may destroy the external cell wall<br />Many cross the placental barrier and are secreted in breast milk<br />
  56. 56. Penicillin<br />Interferes with creation of mucopeptide cell wall<br />Main antibiotics for many years<br />Allergy to penicillin has increased over the years as has the development of penicillin resistant diseases…these are the result of overuse of penicillin to treat infections for which they were not effective<br />Broad spectrum drug of choice for susceptible gram-positive and gram-negative organisms<br />Also used for prophylactic treatment against bacterial endocarditis in patients with rheumatic or congenital heart disease before surgery/dental<br />Some penicillins may be useful against organisms used by terrorists as bioweapons<br />
  57. 57. Adverse reactions to penicillin<br />
  58. 58.
  59. 59. Antibiotics & Birth Control Pills<br />Some antibiotics and oral contraceptives together have produced menstrual irregularities and unplanned pregnancies<br />
  60. 60. How do you know if aminoglycosides are working?<br />They have a narrow therapeutic range…closely monitor blood levels to avoid toxicity<br />Dosage is calculated by weight and increased to achieve blood level<br />This is all I could find…ask Cheryl Ball :lol:<br />
  61. 61. Antibiotic Teaching<br />Patient should:<br />Take medication as prescribed and not stop because symptoms stop. Every dose should be taken<br />Use care when bathing/brushing teeth to watch for signs of itching, irritation, & infection<br />Notify HCP if rash, hives, decreased urination, diarrheas or other symptoms develop<br />If treatment is for an STD, then sexual activity should cease until treatment is over and all partners should be tested/treated<br />Drink water<br />Avoid excessive sunlight exposure<br />

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