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what is the difference between OTC and prescription drugs?
a physician’s order is not needed for OTC drugs
what are the 5 rights of medication?
right patient
right drug
right dose
right time
right route
what are the stages of pharmacokinetics (4 stages)
absorption
distribution
metabolism
excretion
what is the definition of pharmacokinetics
how drugs move through the body (metabolizes)
what instructions to give for XL or extended release tablets?
do not crush or chew medication
(affects the therapeutic response)
what are side effects?
expected effect of the drug
what are adverse effects?
side effects that you must alert a physician if happening during treatment (EMERGENT)
what is the first pass effect?
concentration of drug is reduced before reaching systemic circulation
when you administer a medication orally what should you do with the doses
up the dosage due to the first pass effect
when you administer a medication IV/IM what should you do with the doses
lower the dosage due to the first pass effect
what is a black box warning on medication for?
a. show that the medication is limited to a certain age group
b. call attention to serious or life-threatening risks
c. to show that the medication has a certain ingredient in it
d. to show that the medication is an OTC drug
b. call attention to serious or life-threatening risks
what is a black box warning?
an adverse effect that has nothing to do with the medication use
worst thing that can happen when taking the drug
which group of people are most sensitive to medication effects?
a. infants
b. adults
c. women
d. older adults
e. infants and older adults
e. infants and older adults
what are the code of ethics for a nurse? (Select all that apply)
a. respect for human dignity
b. nurse advocates the rights, health, and safety of patients
c. a nurse focuses on virtues
d. focus on the dr’s opinion and not the patients
a. respect for human dignity
b. nurse advocates the rights, health, and safety of patients
c. a nurse focuses on virtues
what are 4 antibiotic medications?
fluoroquinolones
sulfonamides
TB meds
tetracyclines
what is patient teaching for antibiotic medications?
ALWAYS tell patients to finish the entire of course of antibiotics even if the patient feels better
what are nursing considerations for antimicrobials?
half-life
liver and renal function
dose dependency (weight)
time dependency (therapeutic level)
route
drug interactions
what is the priority assessment data for a client prescribed antibiotic therapy?
a. allergies
b. immunizations
c. surgical history
d. cardiac dysrhythmias
a. allergies
what medication is a sulfonamide?
sulfamethoxazole/trimethoprim (Bactrim DS)
what are sulfonamides used for?
used to treat UTIs, chronic bronchitis, travelers’ diarrhea, and skin infections
what are administration considerations of sulfamethoxazole/trimethoprim (Bactrim DS)? (2)
skin reaction (Stevens-Johnson syndrome)
contraindicated in pregnancy and breastfeeding mothers
what medications are fluoroquinolones? (4)
ends in -floxacin
levofloxacin (levaquin)
ciprofloxacin (cipro)
moxifloxacin (avelox)
ofloxacin
what are fluoroquinolones used for?
used to treat pneumonia, complicated skin/urinary tract infections (often reserved for use in severe infections)
what is a black box warning for fluoroquinolones?
tendinitis/tendon rupture during treatment or months after discharge in all ages
what medications are tetracyclines? (3)
ends in -cycline
doxycycline
minocycline
demeclocycline
what are tetracyclines used for?
acne treatment and to treat infections (pneumonia, gi infections, and lyme disease)
what is an administration consideration for tetracycline?
do not give to children less than 8 years old/pregnant women due to high risk of yellowing of the teeth
what are some patient teachings for tetracycline?
avoid direct sunlight exposure
wear sunscreen due to photosensitivity
avoid dairy products
impaired absorption of tetracycline with the use of dairy products
what are the antimycobacterial (TB) medications? (4)
rifampin (rifadin)
isoniazid (INH)
pyrazinamide (PZA)
ethambutol (myambutol)
what is a complication for all 4 antimycobacterial (TB) medications?
hepatotoxicity (toxic to the liver)
what is a complication of isoniazid?
peripheral neuropathy (numbness/tingling to fingers/toes)
what is a complication for rifampicin?
red discoloration of urine
what are antimycobacterial (TB) medications used for?
they are antituberculosis medications used for active TB
what is a nursing consideration of antimycobacterial (TB) meds?
monitor liver function
what is a way to remember TB meds?
R: Rifampicin
red discoloration of urine
I: Isoniazid
drug induced lupus, b6 deficiency, neuropathy
P: Pyrazinamide
GI symptoms (puke)
E: Ethambutol
optic loss (eyes)
the nurse working in the ER has multiple patients to care for. The first patient presents with sore throat and fever for 3 days. The nurse is instructed to administer amoxicillin 500mg. what should the nurse do?
a. instruct the patient to take the pill, drink a glass of water, then obtain a culture swab
b. instruct the patient to take the pill without water and then obtain the culture swab
c. obtain the culture swab and administer the amoxicillin with a glass of water
d. obtain the culture swab and instruct the patient to wait 2 days for the culture results before starting the medication
c. obtain the culture swab and administer the amoxicillin with a glass of water
what 2 systems are in the autonomic nervous system?
sympathetic nervous system
parasympathetic nervous system
what does the SNS do?
triggers fight or flight response
what does the PNS do?
triggers the rest and digest response
what does adrenergic mean?
adrenaline
what does alpha do?
constrict
what does an agonist do?
mimic
what does antagonist do?
blocks/inhibits
what does beta do?
dilate
what is muscarinic antagonist?
allows the SNS to dominate, creating similar effects as adrenergic, relaxing smooth muscle
T/F: muscarinic antagonists are anticholinergics?
True
what are the 4 muscarinic antagonist medications?
atropine
oxybutynin
benztropine
scopolamine
what does atropine do?
specific anticholinergic responses are dose related
what does oxybutynin do?
relaxes overactive bladder
what does benztropine do?
reduces tremors and muscle rigidity in parkinson’s disease/antipsychotic
what does scopolamine do?
used for motion sickness, and post-op n/v
what medication is a first generation antihistamine?
diphenhydramine (benadryl)
what medication is a second generation antihistamine?
cetirizine (zyrtec)
what does diphenhydramine (benadryl) do?
sedate
what does cetirizine (zyrtec) do?
non-sedating
what are decongestant medications? (3)
ends in -rine
pseudoephedrine (sudafed)
ephedrine
phenylephrine (neo-synephrine)
what do decongestants do?
reduce nasal congestion in allergic rhinitis, sinusitis, and common cold
what is an adverse reaction for decongestants?
may not be suitable for those with diagnosis of hypertension
what is a beta-2 agonist (bronchodilators)
mimics lungs
what does a beta-2 agonist do?
stimulates our fight-or-flight response
what is SABA?
short acting beta agonist
what is a medication for SABA?
albuterol
rescue inhalers
what is LABA?
long acting beta agonist
what is a medication for LABA?
salmeterol
maintenance
what is patient teaching for beta-2 agonist?
always take beta-2 agonist before corticosteroid
why do you take beta-2 agonist before corticosteroids?
the lungs need to dilate first so the steroid has somewhere to go
what is nitroglycerin used for?
treatment of acute chest pain (angina)
how do you take nitroglycerin?
patients may take up to 3 sublingual tabs within 15 minutes (1 every 5 minutes) to relieve chest pain
what is a side effect of nitroglycerin?
headache
what is the therapeutic level of digoxin?
0.8-2 ng/mL
what level does toxicity occur when on digoxin?
greater than 2 ng/mL
what should be monitored with digoxin?
serum digoxin level
potassium
what is normal potassium levels?
3.5-5 mEq/L
what is an administration consideration for digoxin?
assess apical heart rate
what is patient teaching for digoxin?
monitor pulse rate and report <60 bpm
what are ACE inhibitor medications? (7)
ends in -pril
lisinopril
captopril
enalapril
benazepril
fosinopril
ramipril
moexipril
what do ACE inhibitors do?
vasodilation and sodium/water excretion by blocking aldosterone
what is the black box warning for ACE inhibitors?
do not use while pregnant
what are the side effects of ACE inhibitors? (7)
cough
persistent/dry
angioedema
anaphylactoid reactions
neutropenia
hyperkalemia
hypotension
proteinuria
What are Beta-1 Antagonists used for? (3 things)
to treat hypertension
chest pain due to poor blood flow to heart
abnormal fast heart rate.
What happens when higher doses of Beta-1 Antagonists are given?
Higher doses can block Beta-2 receptors in the lungs causing bronchoconstriction.
What is an administration consideration for Beta-1 Antagonists?
Monitor blood sugar in diabetic patients because drug can mask symptoms of hypoglycemia
What adverse effect can happen with Beta-1 Antagonists?
Respiratory: Dyspnea and wheezing
What is Warfarin used for?
It is used to prevent additional clot formation. (does not break up the blood clot)
What labs should you monitor before administering warfarin?
PT & INR
What is the antidote for Warfarin?
Vitamin K
What medications should you take for ulcers? (5)
Antacid
H2 Blocker
PPI
Mucosal protectants
Antiflatulent
What medications should you avoid for ulcers? (2)
Aspirin
NSAID’s
What are PPI’s used for?
lower stomachs acidity
What can happen if you take PPI’s long-term?
hypomagnesium
What teaching and education should you give your patient in regards to PPI’s?
call provider if bleeding occurs
What are mucosal protectants used for?
Treatment of ulcers
What is an administration consideration given to your patient about mucosal protectants?
take on an empty stomach
2 hrs after or 1 hr before meals
bedtime
What does type 1 diabetes do to your body?
causes an autoimmune reaction (body attacks itself by mistake)
What does type 2 do to your body?
cells don’t respond normally to insulin
aka, insulin resistance
Which diabetes type is treated with insulin for life?
Type 1
Can you take oral medications to treat type 1 diabetes?
NO
What treatments can be used for type 2 diabetes?
oral medications
insulin
What is gestational diabetes?
Diabetes that is developed during pregnancy
What is Diabetic Ketoacidosis (DKA)?
life-threatening complications of diabetes that causes increased blood glucose
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