The right drug, The right patient, The right dose, The right route, The right time, The right assessment, The right documentation, The right evaluation, The patient's right to education, The patient's right of refusal
What are the 5 Rights of Drug Administration (plus a couple of others added recently
Hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity are adverse effects of what med?
What are adverse effects of furosemide?
Drugs that increase output of urine to treat hypertension, mobilize edematous fluid, and prevent renal failure.
What are diuretics?
Dihydropyridines, phenylalkylamines, benzothiazepines
(Nifedipine, amlodipine, verapamil, diltiazem)
What are calcium channel blockers?
Chronic inflammatory disorder of the airway.
What is asthma?
Combination of inflammation and bronchoconstriction
Sense of breathlessness
Tightening of the chest
Wheezing
Dyspnea
Cough
Cause: immune-mediated airway inflammation
Class I: act rapidly within 2-6 hours
Class II: intermediate latency (6 - 12 hours)
Class III: Most frequently used by the general public; act slowly 1 - 3 days.
What are laxatives?
Assessment, analysis, planning, implementation and evaluation
What is the nursing process
Blocks aldosterone in the distal nephron, retention of potassium, increased secretion of sodium. Frequently combined with thiazide and loop diuretics.
What is spironolactone (Aldactone)?
Used for: hypertension, edamatous states, heart failure (decreases mortality in severe failure), primary hyperaldosteronism, premenstrual syndrome, polycystic ovary syndrome, acne in young women.
Hypovolemia, acid-base imbalance, electrolyte imbalance
What are adverse effects of diuretics?
Normal, prehypertension, hypertension, stage 2 hypertension
What are the classifications of BP? (Defined by JNC 7)
Normal -> Systolic below 120mmHg and diastolic BP below 80mmHg
Prehypertension -> Systolic 120-130mmHg or diastolic BP 80-90mmHg
Hypertension -> systolic BP above 140mmHg or diastolic BP above 90mmHg
Stage 2 hypertension -> systolic BP and diastolic BP in different categories (ex: 160/92mmHg)
Chronic progressive, largely irreversible disorder characterized by airflow restrictions and inflammation
What is Chronic Obstructive Pulmonary Disorder (COPD)
Chronic cough
Excessive sputum production
Wheezing
Dyspnea
Poor exercise intolerance
Cause: smoking cigarettes, secondary smoke
Omeprazole class
What is a PPI?
Proton pump inhibitor
Used for NSAID induced ulcers
Preferred treatment along with histamine blockers
A drug can have many of these but only one of these!
What is a generic name?
Diuresis by creating osmotic force.
What is an osmotic diuretic?
Mannitol. Promotes diuresis by creating osmotic force within lumen of the nephron, Must be given parenterally, Used for prophylaxis of renal failure, Reduction of intracranial pressure, Reduction of intraocular pressure
Adverse effects: edema, headache, nausea, vomiting, fluid and electrolyte imbalance
Loop, thiazide, osmotic, potassium sparing.
What are the four major categories of diuretics?
Heart disease (myocardial infarction, heart failure, angina pectoris), kidney disease, stroke
What are consequences of hypertension?
Main pharmacologic classes for the treatment of Asthma and COPD
What are anti-inflammatory agents (glucocorticoids (prednisone) and bronchodilators (Beta2 agonists (albuterol)?
Amoxicillin, clarithromycin, bismuth products, tetracycline, metronidazole, tinidazole
What are antibiotics used in the treatment of H. pylori?
None of these drugs are used alone, the risk of resistance developing increases
This consists of absorption, distribution, metabolism, and excretion.
What is pharmacokinetics?
Undergoes continuous recycling.
What is iron?
Spironolactone and triamterene.
What are subcategories of potassium sparing diuretics.
Aldosterone antagonist - Spironolactone
Nonaldosterone antagonist - Triamterene
Sodium restriction, DASH diet, alcohol restriction, aerobic exercise, smoking cessation, maintenance of potassium and calcium intake.
What are lifestyle modificaations?
Metered dose inhalers (MDIs), Respimats, Dry-powder inhalers (DPIs), Nebulizers
What is inhalation drug therapy for asthma and COPD?
Histamine2 receptor antagonists used in the treatment of gastric and duodenal ulcers?
What are: cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)?
The time required for the amount of drug in the body to decrease by 50
What is half-life?
Disrupts sodium-potassium exchange in the distal nephron. Decreases sodium reuptake.
What is triamterene?
Uses: hypertension, edema
Used to decrease pressure in the eyes as well as lowers increased intracranial pressure.
What is mannitol?
Diuretics, sympatholytics (antiadrenergic drugs), direct acting vasodilators, calcium channel blockers, drugs that suppress RAAS
What are pharmacologic therapies for hypertension?
Glucocorticoids (budesonide (Pulmicort), fluticasone (Flonase)).
What is the foundation of asthma therapy?
Taken daily for long-term control, principal anti-inflammatory drugs
Considered the most effective anti-asthma drugs
Prophylaxis of chronic asthma
Dosing is on a fixed schedule, NOT as PRN!
Usually administered by inhalation but IV and oral routes are also options
Must be discontinued slowly when on oral therapy
Rids the body of ammonia
What is lactulose?
Laxative action
An initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.
What is a loading dose?
Medication of choice for iron deficiency.
What is ferrous sulfate
Adverse effects: GI disturbances, staining of teeth
Toxicity: nausea, vomiting, diarrhea, shock, followed by acidosis, gastric necrosis, hepatic failure, pulmonary edema, vasomotor collapse
Most frequently prescribe loop diuretic?
Furosemide (Lasix)
Acts on the loop of Henle to block reabsorption, this is why it is called a loop directic
Rapid onset (PO 60 minutes; IV 5 minutes)
Uses: pulmonary edema, edematous states, hypertension
Beta-adrenergic blockers, alpha1 blockers, alpha/beta blockers; (carvedilol and labetalol), centrally acting alpha1 agonists, adrenergic neuron blockers
What are sympatholytic (antiadrenergic drugs)?
Bronchodilators, glucocorticoids, phosphodiesterase-4 inhibitors (Daliresp (Pro), Generic name: roflumilast)
What is the management of stable COPD?
Medication used in the treatment of H. pylori that can cause a disulfiram-like reaction
What is Tinidazole? Similar to metronidazole
Do not combine with alcohol
A nearly unavoidable secondary drug effect produced at therapeutic doses.
What is a side effect?
Colbalamin
What is vitamin B12
Needs intrinsic factor in the stomach to absorb, Essential for synthesis of DNA, Elimination occurs slowly, Daily requirement, Dietary sources: Limited to microorganisms, animal products (liver, dairy products), fortified foods
Digoxin, ototoxic drugs, potassium-sparing diuretics, lithium, hypertensive agents, NSAIDS.
What are drug interactions when taking furosemide?
Note: don't use in gout, diabetes, pregnant
Prevention of myocardial infarction and death; prevention of myocardial ischemia an anginal pain
What are the two goals of angina drug therapy?
A common leukotriene modifiers
Montelukast (Singular), Zileuton (Zyflo), Zafirlukast (Accolate)
Second line agent (asthma)
Most effective drugs for suppressing secretion of gastric acid. Used short term. Well tolerated. Can increase the risk of serious adverse events -> fracture, pneumonia, acid rebound and possibly intestinal infection with C. dif
What are proton pump inhibitors?
Omeprazole (Prilosec), Esomeprazole (Nexium, Nexium IV), Lansoprazole (Prevacid, Prevacid IV, Prevacid 24 Hr), Dexlansoprazozle (Dexilant), Rabeprazole, Pantoprazole (Protonix)
The study of the biochemical and physiologic effects of drugs (especially pharmaceutical drugs).What drugs do to the body and how they do it.
What is pharmacodynamics?
Must never be combined with potassium supplements
What is Spironolactone?
Similar to loop diuretics. Increases renal excretion of sodium, chloride, potassium, and water. Elevates levels or uric acid and glucose. Not effective when urine flow is scant.
What are thiazide diuretics?
Hydrochlorothiazide (HCTZ)
Acts on the early segment distal convoluted tubule
Used for essential hypertension, edema, diabetes insipidus
Organic nitrates, beta blockers, calcium channel blockers
What are three families of antianginal agents?
Cromolyn
What is anti-inflammatory drug?
Used for prophylaxis, not for quick relief
Suppresses inflammation, it is not a bronchodilator
Prevents the release of histamine and other mediators
Inhibits eosinophils, macrophages, and other inflammatory cells
Route -> inhalation - nebulizer
Used in chronic asthma, exercise-induces bronchospasm, allergic rhinitis
Creates a protective barrier for up to 6 hours.
What is sucralfate? Used for acute ulcers and maintenance therapy
Adverse effects: constipation
This complementary/alternative therapy may interfere with oral contraceptives, warfarin, digoxing, antidepressants, Ca channel blockers, and cyclosporine
What is St. Johns Wort?
Aspirin, clopidogrel, abciximab, eptifibatide, subcutaneous LMW heparin (Lovenox), or IV unfractionated heparin
What are antiplatelet/anticoagulant therapy?
This class of medication may result in ototoxicity, hypokalemia, digoxin toxicity, and lithium toxicity
What is Loop diuretic? (Thiazide all but ototoxicity)
This class of antihypertensive may be contraindicate in African-Americans due to concerns about efficacy and potential adverse effects.
What are ACE Inhibitors? (Angiotensin-Converting Enzyme Inhibitors)
These medications relax the bronchial smooth muscle, resulting in bronchodilation. They are contraindicated in active peptic ulcer disease and caffeine, furosemide, and acetaminophen may increase therapeutic levels.
What are Methylxanthines (aminophylline, theophylline)?
These medication effect the vomiting center in the brain and may be used post-op, chemotherapy, or for disease process
What are Anti-Emetics?
Promethazine (EPS/anticholenergic), Metoclopermide (EPS), Ondansatron (avoid with prolonged QT), Scopolamine (avoid with glaucoma)