Pharmacology Study Guide Units 4-6 1. Digoxin Toxicity, adverse effect and things to monitor.

Some adverse effects of Dig are any types of dysrhythmias, including bradycardia, tachycardia or hypotension. Headache, fatigue, malaise, colored vision(green, yellow, or purple), halo vision, or flickering lights, anorexia, nausea, vomiting and diarrhea. You need to monitor fluid and electrolyte levels, levels of drugtherapeutic range is 0.8-2.0ng/ml. 2. Positive and Negative chronotropic and inotropic. Ionotropic drugs affect the force of myocardial contraction; positive inotropics (digoxin) increases the force of contractions and negative inotropics (beta-blockers, calcium channel blockers) decrease myocardial contractility. Chronotropics affect heart rate per minute, with positive chronotropic increases heart rate and negative chronotropics decrease the heart rate. 3. Normal and therapeutic ranges for digoxin: normal therapeutic levels of Digoxin are between 0.5 and 2 ng/ml. Higher than 2 are used to treat Afib. Theraputic on slide is 0.8-2.0ng/ml and toxic is 2.2ng/ml. To reverse toxic effect use digoxin immune fab (Digibind) Listen for 1 full minute for apical pulse, do not administer if less than 60. 4. Fungal infection medication, assessment findings, concerns: Amphotericin B, nystatin, Fluconazole. Assessment findings-odor, puritis, discharge, fever, redness, inflammation, allergies, interactions with other drugs. 5. Adverse effects of Amphotercin B: this is used to treat severe systemic mycoses (fungal infection). Adverse effects are fevers, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. 6. Pt teaching regarding Nitroglycerin: do not crush, chew or alter in any way. Sublingual doses should be taken at the first sign of chest pain if symptoms have not decreased in 5 minutes call 911 and take another dose while waiting. Pt can take us to 3 doses. Med is potent for 3 to 6 months, med should be stored in proper container and away from moisture, light, heat, and cotton filler. Avoid alcohol, hot temperatures, saunas, hot tubs, and excessive exertion. Transdermal nitrates need to be applied at the same time every day and only have one patch on at a time, do not apply to irritated skin, rotate sites, remove patch at betimes to allow 8 hr patch free period. 7. Assessment findings with Nitrates: arterial vasodilator, used to treat angina, increases supply of O2 and nutrients to the heart muscle, decrease blood return to the heart, decrease afterload. 8. Nitroglycerin tolerance: to avoid a tolerance to drug you must have an 8 hr nitrate free period. 9. Adverse effects of Beta-blockers: bradycardia, hypotension, 2 or 3 degree heart block; heart failure, altered glucose and lipid metabolism, dizziness, fatigue, mental depression, unusual dreams, impotence, wheezing and Dyspnea. 10. Pt teaching for initial antihypertensive: (pg. 401) meds should be taken as ordered with no doubling, maintain diet, avoid smoking, alcohol, saunas, hot tubs, keep up with follow-up appointments, wear medical alert bracelet, report if an ^ in weight by 2 lbs in 24 hrs or 5 lbs in 1 wk, sexual dysfunction can occur, do not discontinue medication abruptly, antihypertensives can lead to depression. 11. Adverse affects of thrombolytic therapy: bleeding, nausea, vomiting, hypotension, anaphylactic reaction, and serious dysrhythmias. (Ch 26)

Pharmacology Study Guide Units 4-6 12. Antidotes for Anticoagulants: Vitamin K is for Warfarin and Protamine Sulfate is for Heparin and LWMHs. 13. Why does a patient take aspirin: A pt. at risk for heart problems and clots would be on a daily aspirin to prevent platelet adhesion (clot). Can reduce the risk of fatal and nonfatal strokes. 14. Thrombolytic drugs and what are they used for: (ase-endings) Eminase, Activase, Retavase, TNKase, Xigris. They break down, or lyse preformed clots. tPA Tissue plasminogen activatorclot buster! 15. Goal of Anti-coagulant therapy: (pg. 449) increase comfort and relieve from pain, improve blood flow, remain free from injury resulting from disease or meds, compliance of pt. regarding lifestyle changes and medication regimen, pt demonstrates knowledge of med therapy and potential adverse effects. 16. Pt. teaching Re: cholesterol med (power)(pg. 446): Powder should be dissolved for at least 1 minute, needs to be taken 1 hr before or 4-6 hrs after meals. Never take as dry powder, take with fruit or 4 to 6oz of fluids. 17. Good and Bad Cholesterol: HDL is your good (happy) cholesterol 40-60mg/dl, LDL (lousy) <100. 18. Tetracycline adverse effects and pt. teaching: adverse effects are superinfection, diarrhea, pseudomembranous colitis (CDiff), yeast infection, gastric upset, and rash. Pt teaching would be to avoid milk products, iron preps, antacids, and other dairy products, meds should be taken with 6 to 8oz of fluid preferably water, and due to photosensitivity avoid sunlight and tanning beds. Should not be taken by pregnant or lactating women can cause tooth discoloration, can also retard fetal skeletal development. 19. Adverse effects and symptom after 2nd dose of IV antibiotic therapy: Serious toxicity such as nephrotoxicity and ototoxicity. Monitor for superinfection, puritis, rash. Monitor IV site for phlebitis and infiltration. 20. UTI symptoms and what you would collect and what you would get: frequent urination, dysuria, purities. Culture and Sensitivity Test. Once the results of c/s test are available antibiotic therapy is then tailored to treat the identified organism. 21. What would indicate a therapeutic response to antibiotic therapy: improvement of signs and symptoms, return to normal vital signs, negative culture and sensitivity test, disappearance of fever, lethargy, drainage, and redness. 22. What causes a superinfection: when you take an antibiotic and it reduces or completely eliminates the normal bacterial flora cause another diagnosis. 23. When on antibiotic therapy what should you assess and monitor for: Assess liver functions, renal functions, cardiac functions, culture and sensitivity, WBCs, and RBCs. Monitor for improvement of s/s of infection, return to normal vital signs, negative culture and sensitivy tests, disappearance of fever, lethargy, draingage, and redness. Monitor for adverse reactions. 24. I&H medication and why it is received: Isoniazide and is used as a first line drug for Antitubercular (TB). 25. What is a therapeutic response to a TB injection: resolution of pulmonary and extrapulmonary Myocobatrium TB infections. 26. What is Rifampin therapy: Antituberculer and antibiotic drugs. Treatment to TB

Pharmacology Study Guide Units 4-6 27. What is antituberc therapy: used for the initial treatment of TB, and are effective in the management of treatment failures and relapses. 28. Pt teaching re: anti-malarials: Instruct pt to notify MD asap if ringing in the ears occur, hearing decrease, visual difficulties, n/v, diarreah, abdominal pain. Take medication with food, may have asparagus like odor, or metallic taste. 29. Pt teaching re: organ rejection and meds: Immunosupressants for the prevention of organ rejection. Muromonab-CD3 treatment once rejection has begun. (Cellcept, Zenapax, Simulect, Rapamune, Imuran, cyclosporine, prograf.) 30. Lukocyte counts: 4300-10,800 31. Equine drugs: horse derived immunity drug 32. What are side effects of immunizations and parent teaching: Side effects can consist of minor reaction that can be treated with acetaminophen and rest, more severe would be higher fever. Serum sickeness occurs after repeated injections, signs and symptoms would be edema of the face, tongue, and throat, rash, uticaria, fever, flushing. Parents should keep immunization records and any allergic response to them. 33. Hep B prevention: Passive Hep B prophylaxis 34. Childhood immunizations (intervals) what parents need to be aware of: 35. What do antivenins treat: they prevent and minimize the effect of poisoning by the venoms. 36. Difference between active and passive immunizations and when contraindicated: active immunization is when the body is exposed to antigen (active immunization drugs: BCG:Tb, TDap, Hep A and B, and haemophilus B), Passsive immunization is either natural which is given by the mother or artificially by injection of antibodies or immunoglobins. (Passive Immunizing drugs RhoGAM, Tetanus, Chickenpox, 37. What is the HIB vaccine: Haemophilus influenza, given to those at high risk for acquiring H. influenza. Before vaccine was established infections caused by HIB was the leading cause of bacterial meningitis in children age 3 months to 5 yrs. 38. Interluken drug therapy and nurse action: 39. Vancomyocin infusion and nursing implications: Should be infused over 60 minutes, rapid infusion can cause hypotension. Monitor site closely, ensure adequate hydration. Before beginning therapy assess for drug allergies, hepatic, renal and cardiac functions, and other lab studies, assess for other drug interactions. IT IS ESSENTIAL TO OBTAIN CULTURES FROM APPROPRIATE SITES BEFORE BEGINNING ANTIBIOTIC THERAPY! 40. Why would you prescribe and antibiotic with aminoglycoside therapy: (pg. 608) They are combined for a more synergistic effect. 41. What are the therapeutic levels with aminoglycosides: Monitor peak and trough blood levels to prevent nephrotoxicity and ototoxicity. Make sure trough level is lower than 2. 42. What is Zyvox therapy: used to treat vancomycin resistant entercococcus (VRE), hospital acquired skin infections, including those with MRSA. 43. What antivirals do you take with HIV? Retrovir, given to HIV positive safe for pregnancy, Rescriptor, viadex,. 44. What do you give for the flu and what is the time frame: Tamiflu, within 2 days of first symptoms

Pharmacology Study Guide Units 4-6 45. Pt teaching about anti-virals: Instruct patient possible drug interactions, immunosuppressants patients should avoid crowds, practice safe sex, frequent oral hygiene, report any new symptoms, medication should be taken as prescribe, maintain steady blood levels. 46. Antigout therapy and pt teaching: Zyloprim, colchine, benemid. Pt teaching- should be taken 1 hour prior to meals or 2 hour after meals, avoid alcohol, increase fluid intake to 3 Liters per day, adhere to complete medical regimen, report in side effects or allergic reactions to MD or any unknown bleeding. 47. Aspirin therapy in children: children under the age of 18 should not receive aspirin due to Reyes syndrome which is a serious condition that causes swelling in the brain and liver. 48. Treatment of osteoarthritis, combo drugs: Antinflammatory with Opiods or antihistamine or antimetics for nausea. (Enbrel) (Glucosamine and Chondroitin) 49. Daily aspirin therapy (profalactic): used to prevent heart attack or stroke by reducing clots. 50. Theraputic effects of NSAIDs: Decrease swelling, pain, and stiffness, and tenderness of a joint or muscle area. Improvement of ADLs. Reduction of fever, return of normal lab values of CBC, RBC, Hematocrit, Hemoglobin. 51. Theraputic response with iron therapy injections, administration: Improved nutritional status, Increased weight, activity tolerance, well being. Absence of fatigue. 52. Increasing iron dietary measures: meats, vegetables, dried beans and fruits, green leafy vegetables. 53. Vitamin to prevent neurotube defects: Folic Acid 54. Pt teaching about acne meds: signs of depression and suicidal ideations. Stay away from sun and tanning beds. 55. Pt having surgery who is allergic to betadine: Caution the use of IVP Dye and Shellfish. 56. Recurrent yeast infections: Oral contraceptives, preganacy, diabettis, bacteria, not wiping front to back. 57. Fungal infections of the skin: Yeast, ring worm, fungus 58. Acne treatment meds and pt teaching: Accutane- teach patient to use 2 forms contraceptives and do not get pregnant. Trentinoin- Retin A- may result in severe irritation and skin peeling and increase redness of the skin. 59. Contraindications for topical antibiotic creams: drug allergies, kidney and liver failure. 60. Adverse effects of acne treatment: Birth defects, stay out of sunlight, increase severity of symptoms, redness, swelling, pain, drainage, and fever.