Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
SUPPLEMENTALS ON PHARMACOLOGY
BULLETS
TOXIC LEVEL
LITHIUM 2.0 MeQ/l DIGOXIN 2.0 NG/ML THEOPHYLLINE 20 MCG/ML
THEOPHYLLINE,DILANTIN,COUMADIN,ILO SONE
PEAK 1 HOURS AFTER ADMINISTRATION TROUGH 30 MINUTES PRIOR TO THE NEXT DOSE ORAL BIRTH CONTROL PILLS-COMP.
ABDOMINAL PAIN CHEST PAIN-SOB HEADACHES AND HYPERTENSION EYE PROBLEMS SEVERE LEG PAIN
EXAMPLES
PROPANOLOL,TENORMIN,LOPRESSOR
DOXAZOSIN
CALCIUM ANTAGONISTS VERY NICE DRUGS BLOCKS CALCIUM ACCESS TO CELLS CAUSING DECREASED COTRACTILITY,CONDUCTIVITY OF THE HEART AND DEC. FOR OXYGEN DEMAND SIDE EFFECTS:HYPOTENSION,BRADYCARDIA(AV BLOCKPRECIPITATES)HA,ABDL.DISC,PERIPHERAL EDEMA EXAMPLES:
ANTIHYPERTENSIVE DRUGS ACE INHIBITORSCAPOTEN/CAPTOPRIL,VASOTEC/ENAL APRIL,LOTENSIN/BENZAPRIL) BETA BLOCKERSINDERAL/PROPANOLOL, TENORMIN/ATENOLOL CALCIUM ANTAGONIST- CALAN ISOPTIN/VERAPAMIL, CARDIZEM/DIALTIZEM, PROCARDIA/ NIFEDIPINE
ACE INHIBITORS
ACTIONS- DECREASED PERIPHERAL VASCULARRESISTANCE WITHOUT INCREASED CARDIAC OUTPUT,CARDIAC RATE AND CARDIAC CONTRACTILITY
B-BLOCKERS
ACTION BLOCKS BETA RECEPTORS IN THE HEART CAUSING DECREASED HEART RATE, FORCE OF CONDUCTION AND RATE OF AV CONDUCTION SIDE EFFECTSBRADYCARDIA,LETHARGY,GI DIST. CHF ,HYPOTENSION,DEPRESSION
STEROIDS- (ENDS IN ONE) ANTIINFLAMMATORY INH INCREASE B6 LEVODOPA DECREASE B6 MAO-NO PICKLES,WINE,CHEES,BARBITURATES ,TRICYCLIC ANTIDEPRESSANTS,ANTIHISTAMINES, ANTIHYPERTENSIVES,OTC COLD MEDS
SWEATING,TREMORS,HYPERTHERMIA,HPN,
BOUNDING HEART
SAMPLE DISCUSSION
ANTI BIOTICS
ERYTHROMYCIN- clindamycin , erythromycin TETRACYCLINE- doxycycline(Vibramycin) AMINOGLYCOCIDES-streptomycin, kanamycin,gentamycin(Garamycin), tobramycin , neomycin POLYMYXIN CHLORAMPHENICOL- chloromycetin
ANTI BIOTICS
SIDE EFFECTS
PHOTOTOXICITY HYPERURECEMIA ENAMEL HYPOPLASIA,DENTAL CARRIES AND BONE DEFECTS ( DRUG BINDS TO CALCIUM IN TISSUE)
ANTI BIOTICS
AMINOGLYCOSIDES
OTOTOXICITY
LEUKOPENIA THROMBOCYTOPENIA HEADACHE
ANTI BIOTICS
CHLORAMPHENICOL
BLOOD
ANTI BIOTICS
NURSING CARE
ASSESS
DRUG HISTORY MONITOR FOR ADVERSE REACTIONS AND SUPERINFECTIONS; SUGGEST YOGURT OR FOOD SUPPLEMNETS CONTAINING LACTOBACILLUS EMPHASIZE STRICT COMPLIANCE AND TIMING EVALUATE RESPONSE
CEPHALOSPORINS FALSE POSITIVE URINE GLUCOSE TETRACYCLINES-AVOID DURING LAST HALF OF PREGNANCY OR BY CHILDREN YOUNGER THAN 8 YEARS. POTENTIATES ANTI COAGULANTS, AVOID SUNLIGHTDAIRY PRODUCTS , ANTACIDS OR IRON PREPARATION( REDUCE EFFECTIVENESS) AMINOGLYCOSIDES- ASSESS FOR POTENTIATION OF NEUROMUSCULAR BLOCKING AGENT / GENERAL ANESTHETIC OR MAGNESIUM CHLORAMPHENICOL B;LOOD WORK ASSESSMENT BEFORE AND DURING POTENTIATION OF PHENYTOIN, OHAS, ANTICOAGULANTS
ANTIVIRALS
PROVIDE PROPHYLAXIS WHEN EXPOSURE TO VIRAL INFECTION HAS OCCURRED Acyclovir sodium (Zovirax) Amantadine Hcl (Symmetrel) Interferon(Roferon A) AZT Idoxuridine ( Stoxil)
ANTIVIRALS
cns stimulation and orthostatic hypotension, nephrotoxicity, dizziness and constipation Nsg. Consideration: support natural defense encourage high fiber foods evaluate response
Sulfonamides
treat UTI sulfamethazole(Gantanol) Sulfixazole(Gantrisin) sulfazaline( Azulfidine) sulfamethazole and trimethoprim(Bactrim and Septra)
Sulfonamides
S/E; nausea and vomiting (gastric irritation) decreased absorption of folacin rash malaise blood dyscrasias crystaluria(drug precipitation in acidic urine) stomatitis , hypersensitivity and photosensitivity
Sulfonamides
I;
increase OFI maintain alkaline urine moniotr blood work megaloblastic anemia(dec. folacin) potentiates anticoagulant and oral hypoglycemic effects
Anti Tuberculars
administered in combination over a prolonged time period to decrease the possibility of mycobacterial drug resistance first line :
ethambutol-mycobacterial RNA Isoniazid mycobacterial cell wall Paraaminosalicylic acid preparation(PAS)mycobacterial folic acid synthesis Rifampin-interferes with mycobacterial RNA Streptomycin sulfate inhibits mycobacterial protein synthesis pyrazinamide ethionamide capriomycin
second line:
Anti Tuberculars
S/E:
GI irritation suppressed absorption of fat and B complex , spec. folacin and B12, depletion of B6 by isoniazid dizziness,CNS and liver disturbances blod dyscrasias streptomycin : ototoxicity( direct auditory{eight cranial nerve}toxicity) ethambutol: visual disturbances ( direct optic nerve toxicity)
Anti Tuberculars
nursing care:
support defense mechanisms obtain sputum specimens for acid fast bacillus monitor blood work enforce compliance , avoid alcohol instruct regarding nutriitonal deficits Rifampin urine dark orange Streptomycin: auditory exams Ethambutol visual exams PZA liver functions
Anti fungals
used to treat sytemic and localized fungal infections Amphotericin ( Fungizone) Fluconazole (Diflucan ) Griseofulvin ( Grisactin ) Nystatin ( Mycostatin, Nilstat )
Anti - fungals
nausea and vomiting( gastric irritation) headache( neurotoxicity) fever and chills ( blood dyscrasias ) paresthesia( neurotoxicity) review proper method of application assess vital signs, throughout course of therapy evaluate clients response
Anti fungals
Amphotericin B
use infusion control device and protect from light monitor blood works-hypokalemia and hypomagnesemia
Griseofulvin assess for antagonism if patients are taking anti coagulants. avoid sunlight topical prep- wash drug stained clothing with soap and water., report signs of local irritation
Anti parasitics
interfere with parasite metabolism and reproduction, helminthic as well as protozoal infestations respond to this class of drugs
Antihelmithic Mebendazole ( Vermox) Piperazine ( Vermazine ) Pyrivinium Pamoate ( Povan) Amebicides Chloroquine HCl ( Aralen) Emetine Hcl Metronidazole ( Flagyl) Antimalarials Chloroquine HCl ( Aralen) Hydroxychloroquine SO4 ( Plaquenil) Pyrimethamine ( Darapime) Primaquine PO4
Anti parasitics
antihelminthics-GI irritation, CNS disturbance, skin rash amebicides GI iiritation, blood dyscrasias, skin rash, headache, dizziness Antimalarials-nausea and vomiting, blood dyscrasias, visual disturbances
Anti parasitics
administer drug with meals and assess VS monitor blood works and instruct client about proper hygiene use safety prec if CNS effects are manifested antimalarials frequent visual examinations evaluate response to treatment and understanding of therapy
general anesthetics
used in balanced combination o produce loss of consciousness , pain control and skeletal muscle relaxation acts by depressing CNS throught the following progressive sequence stage 1 euphoria, gradual LOC stage 2- hyperexcitement,hyperactive reflexes, pupil dilation stage 3 depression of corneal reflex and pupillary response to light, absence of voluntary control, decreased muscle tone, stage of surgical anesthesia stage 4 medullary paralysis( respiratory / cardiac failure) death
general anesthetics
inhalation
Methohexital Na ( Brevital) Thiopental Na (Penthotal ) Thiamylal Na ( Surital) Ketamine HCl ( Ketaject) Midazolam ( Versed)
inhalation
IV Barbiturates
Local Anesthetics
pain control without rendering the client unconscious block nerve impulse conduction in sensory , motor and autonomic nerve cells major side effects:
Local Anesthetics
lidocaine HCL ( Xylocaine), also used for nerve block Dibucaine ( Nupercainal) Piperocaine HCl ( Metylcaine ) Tetracaine HCl ( Pontocaine ) also used for spinal anesthesia an nerve block
Local Anesthetics
Epidural : injected into the epidural space of the of the spinal column
Nerve Block injected at perineural site distant from desired anesthesia site
Local Anesthetics nursing care assess for allergies and other medical
problems have o2 and emergency resuscitative equipment monitor vital signs protect anesthetized body parts from mechanical or thermal injuries keep client flat for a specified period ( usually 6 12 hours ) after spinal anesthesia to prevent sece3re headache, avoid pillows and monitor for hypotension maintain side lying after general anesthesia and restrict fluids until after gag returns
Sedatives ad Hypnotics
produce sedation in small doses and sleep in large doses, acts by depressing CNS barbiturates:
non-barbiturates:
Chloral hydrate ( Noctec) Flurazepam HCl ( Dalmane) Glutethimide ( Doriden ) Methyprylon ( Noludar)
Sedatives ad Hypnotics
S/E:
drwsiness\hypotension dizziness GI irritation Skin rash blood disorders dependence Barbiturates
Sedatives ad Hypnotics
avoid administration with other depressants caution patient to avoid activities that require alertness and avoid alcohol assess for signs of dependence supportive measures to promote sleep administer controlled substances according to appropriate schedule restrictions
Analgesics
peripheral mechanism, inhibiting prostaglandin and other chemical mediators exert antipyretic activity salicylates- analgesic, antipyretic, anti inflammatory, uricosuric anti platelet-aggregating efects blocks opioid receptors in the CNS, altering awareness of pain depress CNS and produce effects on multiple body system,produce euphoria and are addicting
Analgesics
Nonnarcotics ( Salicylates)
Aspirin (ASA , Ecotrin) Magnesium salicylate ( Magan) acetaminophen ( Tylenol, Datril) Diflunisal ( Dolobid) codeine sulfate meperidine HCL ( Demerol) Morphine Sulfate Oxycodone ( Percodan) Pentazocine HCl( Talwin) Propoxyphene HCl ( Darvon) Nalbuphine HCL ( Nubain)
Narcotics
Non narcotics(salicylates)
Analgesics
gastric irritation visual disturbances prolonged bleeding time tinnitus sore,throat and fever skin rash hepatotoxicity
Non-narcotics(Non-salicylates)
Narcotics
respiratory depression hypotension constipation and euphoria urinary retention and miosis
Analgesics
administer medication before pain becomes severe assess for covert signs of pain( VS and Non verbal cues) evaluate response and understanding of teaching administer narcotics as ordered:
do not adm. if RR , 12/min have Naloxone ( Narcan ) available observe for overdosage triad ( respiratory depression, pinpoint pupils and coma) avoid adm. w/ CNS depressants/ head injuries
SAMPLE DISCUSSION
FOCUSSED PHARMACOLOGY
SLECTED DRUGS
C LASSIFICATION HOW TO ASSESS FOR EFFECTIVENESS EXACT TIME CLIENT TEACHING TIPS KEYS IN SAFETY
ANTABUSE
CAUSES AN UNPLEASANT REACTION WHEN COMBINED WITH ALCOHOL PATIENT AVOIDS ALCOHOL BEST TAKEN AFTER ABSTAINING ALCOHOL FOR 12 HOURS INSTRUCT PATIENT TO AVOID ALCOHOL BASED SUBSTANCES INSPECT PATIENTS BELONGINGS AND CONFISCATE ALCOHOLIC SUBSTANCES, MONITOR lftS
APRESOLINE -HYDRALAZINE
ANTI HYPERTENSIVE DECREASED BP BEST TAKEN WITH FOOD RISE SLOWLY MONITOR FOR ORTHOSTATIC HYPOTENSION AND HR FOR TACHYCARDIA
ATROPHINE SULFATE
ANTICHOLINERGIC, VAGOLYTIC DRYING AGENT INCREASES HEART RATE IN A CLIENT WITH HEART BLOCK, USED PRE-OPERATIVELY TO DECREASE SECRETIONS BEST TAKEN 30 MINUTES BEFORE MEAL MAY CAUSE FACIAL FLUSHING, AVOID TASKS THAT REQUIRE ACUTE VISION AVOID HOT ENVT. CHECK BP, CAUSES HYPOTENSION, CONSTIPATION AND DRYMOUTH
CELESTONE(BETHAMETHASONE)
STEROID,STIMULATES LUNG MATURITY IN INFANTS - RESP DISTRESS GIVEN WITH FOOD REPORT SIGNS OF INFECTION MONITOR WEIGHT , GIVE ONCE A DAY DOSE IN THE MORNING TO AVOID INSOMNIA GIVEN 48 HOURS BEFORE DELIVERY
CLOZARIL-CLOZAPINE
ANTIPSYCHOTIC DECREASED DELUSION,HALLUCINATIONS AND LOOSENESS OF ASSOCIATION BEST TAKEN AFTER MEALS REPORT SORETHROAT AND AVOID EXPOSURE TO SUNLIGHT CHECK BP CAUSES HYPOTENSION, ASSESS FOR AKATHISIA, TARDIVE DYSKENISIA-TONGUE TWITCHING AND LIP SMACKING
LIBRIUMCHLORDIAZEPOXIDE
ANTIANXIETY-BENZODIAZEPINES DECREASED ANXIETY AND INC. RELAXATION WITH FOOD OR MILK NO ACTIVITY REQUIRING ALERTNESS , SUGARLESS GUM HOLD DRUG IF BP DROPS MORE THAN 20 MMHG , WATCH OUT FOR ECG CHANGES AND TACHYCARDIA-REFER
GARAMYCIN(GENTAMYCIN)
AMINOGLYCOSIDE,BACTERICIDAL - INFECTION NO SPECIFIC TIME INCREASE FLUID INTAKE, TINNITUS INDICATES OTOTOXICITY MONITOR FOR SIGNS AND SYMPTOMS OF OTOTOXICITY, NEPHROTOXICITY AND NEUROTOXICITY
INDERAL -PROPANOLOL
ANTI ANGINAL, ANTIARRYTHMIC, ANTIHYPERTENSIVE,REDUCES PORTAL PRESSURE AND DECREASES THE RISK OF BLEEDING FROM ESOPHAGEAL VARICES DECREASED BP BEST TAKEN WITH MEALS AVOID DRIVING , DO NOT DISCONTINUE ABRUPTLY CHECK BP CAUSES HYPOTENSION
ISORDIL
ANTIANGINAL/RELAXES SMOOTH MUSCLES DECREASED BP BEST TAKEN ON EMPTY STOMACH CHANGE POSITION SLOWLY, CAUSES FACIAL FLUSHING CHECK BP, DO NOT CHEW SUSTAINED RELEASE FORM
LEVODOPA
ANTIPARKINSONISM MUSCLES BECOME LESS STIFF BEST TAKEN WITH MEALS AVOID FOODS CONTAINING B6 OR CHON RICH FOODS-DECREASES ABSORPTION ENSURE PATIENT VOIDS-MAY CAUSE URINARY RETENTION
LITHIUM CARBONATE
ANTIMANIC DECREASED HYPERACTIVITY BEST TAKEN AFTER MEALS INCREASE OFIS 3 L/D AND Na 3 GM./DAY AVOID ACTIVITIES THAT INCREASE PERSPIRATION TAKES 10-14 DAYS BEFORE THERAPEUTIC EFFECT BECOMES EVIDENT.ANTIPSYCHOTIC GIVEN DURING THE FIRST TWO WEEKS TO MANAGE ACUTE SYMPTOMS MONITOR SERUM LEVEL , NAVDA-INDICATES TOXICITY, MANNITOL - ANTIDOTE
AMPHOGEL MAALOX
LIDOCAINE
AMINOGLYCOSIDES CEPHALOSPORINS
PROBANTHINE
LOMOTIL / IMMODIUM
AMPHOTERICIN
BENADRYL
QUESTRAN
ANTIHYPERTENSIVES
LITHIUM ANTINEOPLASTIC AGENTS
ANTIPARKINSONIAN
AGENTS
ASA
ANTIPSYCHOTICS
TYLENOL AND PARACETAMOL ANTI-THYROIDS THYROID REPLACEMENTS ANTI TUBERCULAR MUCOLYTIC,EXPECTORANTS BRONCHODILATORS ANTIVIRAL
RITALIN
, CYCLERT
DIURETICS
ELECTROLYTE REPLACEMENT EYE MEDICATIONS STEROIDS H2-RECEPTOR BLOCKERS IMMUNOSUPRESSANTS LAXATIVES AND STOOL SOFTENERS MIOTICS AND MYDRIATICS
MORPHINE
DEMEROL
SULFATE
NITROGLYCERIN
ISORDIL
NSAIDS STREPTOKINASE
ENDURANCE
DEVELOPS EVERYTIME YOU DEFEAT THE TEMPTATION TO GIVE UPQUITTERS NEVER LOSE BUT THEY NEVER WIN. REST IF YOUMUST. BUT DONT QUIT