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Pharmacology exam notes
Nursing Pharmacology
Keiser University
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NSAIDs
Indications: Strong anti-inflammatory, analgesic, and anti-pyretic effects. Blocks COX-1 & COX-
Anti-fever, anti-inflammation for gout and arthritis
Never take 2 NSAIDs at the same time, use the lowest dose for the shortest amount of time possible
Never on an empty stomach, take with food, no vit E, gingko, garlic, or omega 3 oils these increase bleed risk
Pharmacokinetics: o Rapidly absorbed from GI tract o Peak in 1-3 hours o Metabolized in the liver. o Excreted in the urine.
Contraindications: Any NSAID or salicylate, celecoxib is also contraindicated with sulfonamide allergy. CV dysfunction or hypertension, peptic ulcer, GI bleeding, pregnancy, lactation, renal and hepatic dysfunction
Adverse effects: Nausea, dyspepsia, GI pain, constipation, diarrhea or flatulence caused by direct GI effects of the drug. GI bleed, dizziness, somnolence, platelet inhibition, hypertension, and bone marrow depression
Interactions: Decreased diuretic effect when these drugs are taken with loop diuretics; there is a potential for decreased anti-hypertensive effect on beta-blockers if these are combined; lithium toxicity, especially with ibuprofen.
Cultural considerations: Sold OTC, which may lead to abuse.
N- Naproxen: number one NSAID given S- Salicylate acid (aspirin) A- Acetylsalicylic acid (aspirin) I- Ibuprofen and Indomethacin K- Ketorolac (Toradol): only one we can give through an IV
N- not good for the entire body: GI bleeds, bronchospasms, leads to HTN and worsening heart failure, increases creatinine and BUN bad for kidneys, blood clots! S- sticky blood: increased risk for thrombosis (clots), bad for patients with clot history like MI, stroke, CVA, DVT- aspirin has no clot risk A- asthma: not safe for asthma and nasal polyps, leads to bronchospasms I- increased bleed risk: monitor and notify HCP for all types of bleeding, easy bruising, tarry and coffee ground emesis, avoid peptic ulcer patients D- dysfunctional kidneys: renal injury with long term use, nephrotoxicity, avoid renal patients S- swelling heart: CHF and HTN worsening, exacerbates fluid overload
Propionic Acids: ibuprofen, fenoprofen
Acetic Acids: declofenac, etodolac
Fenamates: mefenamic acid
Osicam derivitaves: meloxicam
COX-2 Inhibitors: celecoxib
Salicylates (aspirin, balsalazide, diflunisal, mesalamine, olsalazine, salsalate)
Indications: Inhibit synthesis of prostaglandins, used to treat mild to moderate pain and fever
Pharmacokinetics: o Absorbed from stomach. o Peak in 5-30 min. o Metabolized in the liver. o Excreted in the urine.
Contraindications: Known allergy, bleeding abnormalities, impaired renal function
Adverse effects: Effects on stomach and clotting systems
Interactions: Interacts with other drugs by interfering with absorption
Cultural considerations:
Interferons
Indications: Preventing viral particles from replicating inside other cells. Stimulating interferon receptor sites on non-invade cells to produce anti-viral proteins, Inhibiting tumor growth and replication.
Pharmacokinetics: o Absorbed well after SQ or IM injection. o Broken down in the tissues. o Excreted in the kidneys. o May be teratogenic.
Contraindications: Known allergy, pregnancy, lactation, use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
Adverse effects: Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, bone marrow depression
Interactions: None reported
Cultural considerations: N/A
Immune suppressants
o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic.
- ▪ Contraindications: ▪ Adverse effects:
▪ Interactions: ▪ Cultural considerations:
immune Modulators
Indications: Inhibit the secretion of proinflammatory cytokines and increase the secretion of anti- inflammatory cytokines from monocytes and have varying effects on cell proliferation *(Fingolimod inhibits the release of lymphocytes from the lymph nodes)
Pharmacokinetics: o Absorbed in GI tract at varied rates. o Metabolized in the Liver. o Excreted in the urine.
Contraindications: Pregnancy, lactation, and severe liver impairment
Adverse effects: Unknown
Interactions: Unknown
Cultural considerations: N/A
Anti-infectives (aminoglycosides, fluoroquinolones, penicillin, antitubercular)
Aminoglycosides (Gentamycin) – group of powerful antibiotics used to treat serious infections; Inhibits protein
synthesis in susceptible strains of gram-negative bacilli bacteria causing cell death
- Indications: Treatment of serious infections caused by susceptible bacteria
- Pharmacokinetics: o Poorly absorbed from the GI tract, but rapidly absorbed after IM injection, reaching peak levels within 1 hour. o Widely distributed throughout the body, crossing the placenta and entering breast milk o Excreted unchanged in the urine and having an average half-life of 2-3 hours
o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations: o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations:
anti-virals
o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations:
antifungals
o Indications:
▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations:
anti-malarials
o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations: anti-helminthics
o Indications: ▪ Pharmacokinetics:
- Absorbed well after SQ or IM injection.
- Broken down in the tissues.
- Excreted in the kidneys.
- May be teratogenic. ▪ ▪ Contraindications: ▪ Adverse effects: ▪ Interactions: ▪ Cultural considerations:
anti-neoplastics
o Indications: ▪ Pharmacokinetics:
reverse transcriptase to copy the RNA and produce a double-stranded viral DNA. The virus uses various nucleotides found in the cell to synthesize this DNA strand. The DNA strand enters the host cell nucleus and slices into the chromosomal DNA to change the cells process to one that produces ne viruses, changing the cell into a virus-producing cell. The cell can no longer perform normal immune function. o Malaria: r/t the destruction of RBC and toxicity in the liver. Tx aims at attacking the parasite at the various stages of its development inside and outside the human body. It is characterized by cyclic fever and chills as the parasite is released from RBC. Causes serious liver, CNS system, heart, and lung damage. It is spread through a female mosquito. o pinworm infection: nematode that causes a common helminthic infection in humans, lives in the intestine and causes anal and possible vaginal irritation and itching. Pinworms are usually transmitted when the worm eggs are ingested or inhaled and swallowed. These are the most common helminthic infections among school aged children. ▪ Managing infection: keep nails short, hands clean w/ frequent hand washing, shower in the am, change and launder undergarments, sheets, pajamas daily, disinfect toilet seat daily ▪ Tx: based on causative agent ▪ Identified by collecting stool specimen and sending culture for ova and parasites o hookworm infection: eggs are found in the soil where they hatch into larva that molts and becomes infective to humans through the skin. They penetrate the skin and then enter the blood and reach the intestines within a week. They attach to the small intestine and suck blood from the walls, damaging it and leading to severe anemia w/ lethargy and fatigue. ▪ Tx: focuses on anemia and fluid and electrolyte disturbances o cancer (development): starts with a single cell that is genetically different from the other cells in the surrounding tissue. This cell divides, passing along abnormalities to daughter cells, eventually producing a tumor, or neoplasm, that has characteristics quite different from those of the original tissue. The more original cells they lose the more they can exhibit anaplasia, autonomy, and metastasis. ▪ Causes: genetic predispositions, viral infections, constant irritation and cell turnover, stress, lifestyle factors, environmental factors ▪ Types: solid tumors- carcinomas and sarcomas, and hematological malignancies ▪ Tx: surgery to remove tumors, stimulation of immune system, radiation therapy, drug therapy, antineoplastic agents o athlete’s foot: fungal infection caused by tinea (ringworm). Usually begins between the toes. Symptoms include a scaly rash that usually causes itching, stinging, and burning
Acetaminophen
- A- absence of bleeding: used instead of NSAIDs to decrease bleeding risk- for patients with
peptic ulcer or hemophilia for pain or fever
A- alcohol history: liver toxic, avoid ETOH and alcoholics, TyLenol Toxic Liver
A- acetylcysteine: antidote: acetylcysteine blocks acetaminophen
- Tylenol and NSAIDs can be used interchangeably to reduce a fever- once you hit the maximum
dose of one for the day, you can take the other one
Recommended for kids with the flu
Labs to monitor with overdose: liver both ALT and AST
Use this instead of NSAIDs for asthma and nasal polyps, also in kidney disease
Aspirin
o Indication: Tx of mild to moderate pain, fever, inflammatory conditions, reductions of
risk of transient ischemia or stroke, reduction of risk of MI
o Action: inhibits the synthesis of prostaglandins, blocks the effects of pyrogens at the
hypothalamus, inhibits platelet aggregation by blocking thromboxane A
o Pharmacokinetics: Oral onset 5-30 min, peak 0-2 hours, duration 3-6 hours, rectal
onset1-2 hours, peak 4-5 hours, duration 6-8 hours
o Adverse effects: nausea, vomiting, heartburn, epigastric discomfort, occult blood loss,
dizziness, tinnitus, acidosis
Azithromycin
o Not too hard on kidneys or ears
o Prolonger QT intervals that could lead to MI
o Hepatotoxic- monitor ALT/AST in the liver
o Don’t take with Tylenol
•
Acyclovir
Used to treat herpes virus (genital, cold sores, shingles)
Taken daily, drink extra fluids, not a cure only used to slow the virus
Avoid sex while lesions are present
Effect: Less frequent eruptions of lesions
Zidovudine
NRTI – Reverse Transciptase inhibitors. Used with other medications in HIV treatment cocktails
prophylaxis – action or method taken to prevent disease
o tinnitus – experience of high-pitched ringing or other noises in one or both ears, not caused by
external noise
- broad spectrum antibiotics - group of ABXs that act against extensive range of disease-causing
bacteria; targeting both gram-positive and gram-negative bacterial groups
- narrow spectrum antibiotic – group of ABXs that are active against a selected group of bacterial types.
They can act on either gram-positive or gram-negative bacterial; but not both.
- bactericidal – kills bacteria directly by interfering with the cell membrane stability or with proteins or
enzymes necessary to maintain the cellular integrity of the bacteria
- bacteriostatic – prevents the growth/replication of bacteria, usually by interfering with proteins or
enzyme systems necessary for the reproduction of bacteria
extravasation – leakage of fluid into the surrounding tissues
superinfections – infections that occur when opportunistic pathogens that were kept in check by the
normal bacteria have the opportunity to invade tissues and cause infection because the normal flora
bacteria have been destroyed by antibiotic therapy
- stool culture – lab test to find organisms (such as worms) in feces that can be causing gastrointestinal
symptoms and disease
6 Test tips of ABX:
Finish Med – to prevent super infection a. Take until all the med is finished b. Do not stop taking when starting to feel better
Accidental pregnancy – oral contraceptives ineffective, use additional contraception like IUD, condom a. C – Child Care b. “-cillins” - penicillin, amoxicillin c. “-cycline” - doxycycline, tetracycline
No Alcohol – Antibiotics are hard on the liver
No Food – Take on empty stomach, full glass of water for these classes of ABX a. M Macrolides - Azithromycin b. T Tetracycline - doxycycline c. F Fluoroquinolones – Levafloxacin
No Sun – Avoid Fun in The Sun (F.T.) - photosensitivity, Avoid direct sun exposure, sun burns a. F Fluoroquinolones – Levofloxacin b. T Tetracycline – doxycycline c. S Sulfa drugs – Sulfamethoxazole/trimethoprim (Bactrim)
Super Toxic (Kidney + Ears) - “It’s a Sin to give –mycins, because toxic”
Pharmacology exam notes
Course: Nursing Pharmacology
University: Keiser University
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