Old Pharm topics:

Endorphorium - (anticholinesterase inhib.) *for Kids - Mysathenia Gravis

Clonidine
Midodrine
Aricept
Phyostigmine
Parkinsons c/ BPH - call Dr. If prob urinating
Diuretic
Stepped Care
Excess sweat
Beta blockers - age min.
Isoproterenol
Insulin pump - watch glucose levels
Type 1 in kids (IDDM) may result in delayed growth
Hypoglycemic - diaphoresis
Diabetic retinopathy
Radioactive iodine - thyroid crisis
Boniva - 1 x/Mo.
Long term corticosteroid = incrs. K+ level
Androgen for hypogonadism
Steroid dependent - adrenocort. Insuff. - dosage of med increased
Prolactin - milk production
Sandostatin - common AR = cholecysitis
Desmopressin
DDVAP - h2o intox.
Growth Hormone - knee/hip pain
Sea sick patch - works for 72 hrs
Atropine
N Dx for Adrenergic Blocking agent
Alpha 1 blockers - inhibit ctx of bladder
Alpha or beta block - asses HR
Quickest insulin: Hum. R
OD of Levothyroxine
Adr Ag. - AR = cardiac arrhythmia
Midodrine - adr. Ag - nrsg action - BP
Care plan adr. Ag - watch BP Q2-4H
Catapres- 25 y.o. Preg - QUESTION order!
Cholinergic function
Cholinergic reaction - severe drop in BP - give endophrobium
Alz. - 70 y.o - give aricept
What system is stimulated by cholinergics?
MG - drug to Tx = anticholinesterase agents
Chilinergic OD - 72 y.o. = age related phys. Changes
Scopolamine - patch effective for 72 hrs.
Atropine poison - tx physostidmine
Anti-cholinergic - elderly - risk for heat stroke
Vasopressin - therapeutic if decreased urine output
Milk production- prolactin
AR of G.H. Antag - octreotide - acute cholecystitis
Corticosteroid therapy - dietary changes ordered - increased K+
Boniva - 150 mg/ once a month
Thyroid crisis - Ø surg. Option - Rx is radioactive iodine
Hypoglyc reaction = diaphoresis
Quickest therapeutic effect = hum. R
Diabetic retinopathy - d/t/ inability of O2 to diffuse across vessel membrane to tissue in
the eye
Humulin U ??
Delayed growth/ development
Insulin pump - blood glucose - monitor !
Stepped care management approach to HTN
Non-pharmaceutical methods for controlling HTN: exercise, diet, weight loss
ACE inhibs - pt has HTN, works in construction- watch for excess sweating on job
FEMALE pt on ARB - ask LMP
Calcium channel blocker - persistent cough
Healthy meal for pt. - grilled chicken
Goal of therapy for HTN - maintain BP that is WNL
Cardiovascular system - HTN drugs control: HR, stroke volume, total periph. resistance
Long term effects of HTN
If admin dig to child - get another nurse to check child’s apical pulse
Dig toxicity - tx: digoxin immune fab
Hold dig - based on HR - if 60 or less
Diet with High potassium, low fat ???
HF - ?? The amt of blood returning to the heart
Cardiac glycosides are for: increasing the force of contraction of the heart
Dig levels should be maintained @ 3.5-5.0
Acute dig toxicity - bradycardia
inactivates troponin - enables muscle fibers to contract: Calcium
Pt taking anti-dysrhythmic - check pts. Apical & radial pulse before administering
lidocaine toxicity - watch for vasodilation
Must take med for vent. arrhythmia - or it could result in death
IV infusion - of amiodarone - watch for possible development of cardiac arrythymia
Teach pt - monitor for SYNCOPE on ant-idysrhythmic drugs
Premature vent. Contraction is stimulation of ventricles from ectopic focus
Treatment Goal for pt.with cardiac dysrhythmia - Maintain cardiac output
?? Procedures to teach pt. With dysrhythmia - in response to treatment
Help detect life-threatening dysrhythmia in p/op patient - Monitor cardiac rhythym
continuously
Stable pt c/ atrial flutter. Admin’d tikosyn (dofetilide) IV to: convert the arrhythmia to a
sinus rhythm.
If pt. Mouth dry a/ giving nitro - give sip of H2O *throbbing headache & dizziness
common AR’s
Diabetic pt taking glucophage & metoprolol - monitor blood glucose
Pt c/ angina. Discharge teaching - take Nitro S/L & repeat in 5 min (up to 3x). If pain has
not subsided. Pt should expect relief in 1-3 min.
Asthma pt. On beta blocker - observe for bronchospasm
Pt taking nitro patch - avoid alcoholic bevs
Pt c/ angina pectoris c/ exertion - most often caused by coronary atherosclerosis.
Action of nitro in relieving angina : decreases myocardial O2 consumption
Unstable angina - ndx = ineffective tissue perfusion
Pt taking cholestyramine - ndx - noncompliance related to amt. of times med is taken
Lipitor expected outcome - decrease in serum cholesterol & LDL levels
Common AR’s for Zetia - midl abd. Pain & diarrhea
Bar owner taking Lipitor - nurse makes sure to question pt. On alcohol consumption
HMG-CoA inhibitor - take at nite - thats when the body makes cholesterol
Goal when pt taking Niacin - less than 200
*target cholesterol total = 200. 240 = HIGH
P/ taking pravastatin - not feeling well, bc drinking grapefruit juice - TOXICITY
Helps increase HDL - Exercise
CAD risks - modifiable - obeisity, inactivity, diet, smoking
Pt c/ high cholesterol & triglycerides - pt goal - hi hdl’s, low ldl’s & triglycerides
Hyper-cholesterolemia in kids - familial
Pt c/ DVT, taking heparin SQ. Avoid IM injections. Protamine sulfate has to be on hand
if pt begins to bleed.
Pt on coumadin - should not take aspirin for arthritis - blood-thinning properties, lab
tests - PT/INR, give vitamin K if they bleed
Lovenox (heparin) - leave small air bubble in the syringe to lock in the dose
2 pathways activated by coag. Begins when factor XII is activated - extrinsic & intrinsic
Anticoag’s prevent thromboembolic disorders by altering vit. K - reduces ability to
participate in the coag.
Hemophaelia - prevent trauma to body
Female - 32 y.o. Taking oral contraceptive. May need aminocaproic acid - increased
risk for hypercoagulation
Vit. B12 -causes hemocytoblast to RBC
Iron preparation - watch H&H
Pernicious anemia -b12 injections bc oral forms of B12 will not be absorbed
Oral iron preps - may cause constipation
Chronic renal failure - anemia bc lack of erythropoietin
Genetic counseling - sickle cell anemia - african american parents
Elderly lady - pernicious anemia - intrinsic factor secreted by gastric mucosa
Fatigue, pica, low serum iron, low ferritin level - iron deficient anemia
Hydroxyurea - tx for anemia - but is cytotoxic
Lidocaine toxicity - watch for PVC - premature ventricular contrax.
Clonidine - adrenergic agonist - tx HTN bc it blocks release of norepinephrine from
nerve axons *if changing to another anti-HTN - taper drug over 2-4 days
Isoproterenol (beta specific adr. Agonist) - EMERGENCY only b/c of adverse reactions.
make sure beta blocker is on hand for adverse reaction *
Alpha agonist - *monitor ortho. Hypo.
Teaching priority for diabetic pt. - understand s/s of hypo/hyper glycemic reaction
Pt taking adrenergic blocker - dx - for comfort - acute pain - CV/Systemic effects
Tenormin - beta 1 blocker for HTN - teach pt to avoid NSAIDs
Pt c/ BPH taking Minipress - alpha blocker - to inhibit contraction of urinary bladder
80 yr old brought in ERreceiving dopaminemonitor for cardiac arrhythmias
Pt taking MidodrineMonitor BP
Care plan for pt taking an adrenergic agonisttake pt heart rate and BP Q2-4H
ClonidineQuestion order because drug not used in pregnancy
Shock, bronchospasms, and some types of asthmaSympathiomimetic drugs
What age is considered an adult12
Clonidineblocks release of NE from nerve axons
Isoproterenol (isuprel) a beta specific adrenergic agonist parenterally; what have in hand in case a severe
reaction occurs?Beta-adrenergic blocker
ClonadineTaper drug over 2-4 days
Alpha-specific adrenergic agonistorthostatic hypotension
Isoprotenol is reserved for emergency situations, whyit’s adverse effects.
A priority nursing assessment for a pt receiving a alpha or beta adrenergic blocking agentAssess HR
Teaching priority for diebetic being treated with a non-specific beta-blockerrecognize S/S of hypo and
hyper glycemia
Adrenergic blocking agentDx Acute pain related to CV and systemic effects
Tenormin a beta-1 specific adrenergic blocking agentavoid NSAIDs
Benign prostatic hypertrophy (BPH) has been prescribed prazozin. How do Alpha 1 assist in treating
symptoms of BPHthey inhibit contraction of urinary bladder
Before administering a beta-adrenergic blockercheck pulse and BP
Naldodol for hypertensionnever stop taking the drug abruptly
African American MD ordered phentolamine/indication?Extravasation of intravenous NE or
Epinephrine.
What to monitor when giving phenolamine (Regitine)Tachycardia
Beta blockercount and record radial pulse daily
Nursing plan when taking bethanechol improved bladder function
Pt in ER with severe drop of BP (cholinergic reaction) administer Atropine (generic)
What drug to Dx myasthenia gravis in childrenEdroponium (Tensilon)
Cholinergic drug used to treat AlzheimersDonepezil (Aricept)
Cholinergic agonist increase the activity of acetylcholine receptors throughout the body

Amanda’s review:

Cardio
3 main risk factors in cardio: HTN, Heart attack/ CVA, Ischemia -(irritable heart)
HTN - lasix 20-40 mg - loop diurectic (loop of henley) - not @night
Worried about hypokalemia - K+ - heart probs: watch for dysrhythmia
Beta Blockers (LOL) block beta receptors. Beta 1 heart, Beta 2 lungs - watch for HR/
Resp rate., worried about BP - orthostatic hypotension.
Lopressor, metoprolol: sit up slowly, dangle feet, support while she gets up, dizzy?
Ace Inhibitior - watch for cough. (PRIL) - works in lungs. Contra - Asthma, Resp Probs.
COPDers - Ø give!! Metabolizes in lungs. Biggest concern - unproductive, unrelenting
cough
Calcium channel blockers - (PINE). Slows heart ctx. Good for ischemia. Worry about:
possible dysrhythmia or Arrhythmia - ASYSTOLE. Blocking Ca+ = biggest AR:
hypocalcemia - not absorbing - has to go somewhere - pee it out
Heart Attack - chest pain - give nitro. B/C Increases contractility. Decreases O2
demand. S/L, paste, patch. 3x, 5 min apart. Monitor pulse: must be at least 60, BP, resp
CVA: give: heparin (lovenox- $$$$) - clotting risk, coumadin Lab: PTT - hep give sub q,
abdomen. Also check before ANY surgery. Watch for bruising - ecchymosis, bleeding.
Ø contact sports. Coumadin PT/INR. Blood drawn monthly, continuous pressure on site
for 20 min. Coum dissimenates into adipose tissue
Aspirin - hard on stomach, nsaid, risk for ulcers - bc incr. Risk for bleeding, 81 mg, PO
enteric coating to protect stomach. Ø crush/chew. Ø to alcoholics - bc thins blood - bad
liver
Ischemia - high risk for heart attack. A-Fib > atrium is going crazy - (not as bad as V-
tach - marching tombstones) give Amlodopine - ca+ channel blocker - IV stat on crash
cart. Monitor vitals q5 min. HR/resp ABC
Thiazide diuretics - HCTZ - worried about hypokalemia. NOT K+ sparing. May be on
KChl. Watch for: dyskinesia
4 anti-arrhythmitic classes: NBKCa, in order! 1)sodium, 2)beta 3) potassium, 4) Calcium
Nitro drip - Adverse: BP> may bring BP too low. Check Q5M
Solalol - must take on empty stomach!
Amlodipine (Norcasc) - tx of ischemia - Ø grapefruit!
Nitro - watch for cyanide toxicity
Procardia - tx of ischemia
Hyperstat - crashing - DO NOT give to diabetic
Cardiac Glycoside (use in pts c/ renal failure ~ BP of kidneys) Increases Ca+ & renal
perfusion. Tx of A.Fib

GI /GU- risk factors

GERD - H2 - anti histamine zantac - & phenergan - (phen: the only reason you arent
nauseous is bc ur knocked out). Limits GI secretions- ph 2-3, which will upset the body’s
7.35-.45 ph)
Test for ulcers: pH strips
UTI: confusion - common in females(short urethra), caths (direct path to urethra),
geriatric.
Tx: Cipro, keflax, Pyridium - orange urine, bladder relaxant, antispasmotic (not for pt
on blood thinner - b/c discolors urine)
Neurogenic bladder - M/S
Metabolic alkalosis - pts at risk: dehydration. Vomiting (monitor for anti-acids). Diarrhea
causes metabolic acidosis.
Reglan - incr. GI motility (don’t give w/ dig)
****KNOW DIG**** know coumadin*****
Fiber - bulk forming lax. - give c/ lots of h2o
Bleeding alot - give Vitamin K
Laxatives: be careful about abuse c/ teen girls. Need to be separated by 30 min.
Because u don’t want it to rush it thru.
Travelers Diarrhea - tx with Xiafaxan
Parasites*

If child ingested something - call poison control

Chem responsible for vomiting - ipecac - pt presents to ER> place NG c/ suctions. bc
ABC - gotta keep airway patent. If Ø patent, then you have to intubate, hard to intubate
if they are puking
Test Q’s::: ALWAYS think safety, assessment, ABC
Most important - airway patency
How do you know if airway is patent: chest rise & fall, noiseless, feel breath.
Normal resp: 12-20, newborn = higher, abd. Breathers.
Adults are diaphragmatic breathers
Pneumonia: risk for aspiration (bacterial) - HOB elevate 90° Open airway. If MRSA: give
vancomycin (penicillin deriv.) give IVPB, QID. Watch for: N/V. Can be given with
phenergan PRN or zofran (zofran is given to chemo. Pts. For nausea)

Respiratory - asthma - wheezing - giving albuterol (bronch. Dilator) solumedrol IV

push> then Ø wheezes = impaired gas exchange/ no air thru (doesn’t mean “it worked”)
b/c it may constrict right back up
COPDers: big list of meds. Hard time breathing -

**********

Day 2 Review from Amanda:

Rifampin
Dilantin
Catapress: (Tx of HTN & antidysrythmia) if ordered for child - QUESTION order!!
CHF - if pain > do pain asses - could be MI
Potassium levels - know the range
Hypokalemia: risk = weakness, disrhythmia
Hyperkalemia - can cause ischemia, dysrhythmia

CNS general - Ø give 2 stimulants or 2 depressants (intensify each other) or 1 stim. & 1
depress - counteract each other.
Benzos & Barbs: on kids: concern is hyperactivity. Teachers try to dx ADHD
Benzo OD - flumazenil
Luminal- for seizures - status epilep. - only 5 min. To work
Diamox- kid epilepsy- should have medic alert bracelet
Isuprel (Tx: incrs. BP) - may see in OR *prevents bronchospasm, watch ABC, bc
mechanically ventilated
Adrenergic blocker - worried about incrs. In RR bc it will get high
Anti-HTN - if taking ginseng - will counteract each other
Hyperglycemia - Ø celery for evening snack - makes blood sugar low - bottoms out
around 3am, wake up, stumble in the dark to get OJ - UNSAFE
Cholinergic meds - face is flush
Anti-cholinergic - photophobia, dries you up>fluid retention >increase in pressure (fluids
everywhere)
Lopressor - tx of HTN - drs love bc 1-a-day dose
HTN in young ppl - diuretic & drink powerade zero (electrolytes)
Zebeta - beta blocker - tx of HTN - Ø eat eggs, b/c has a protein derivative in it
Tegretol - tx of diabetic neuropathy
DIG: check apical pulse, radial pulse, pulse deficit, watch for arrythmias. ANTIDOTE =
immune fab (digifab)
*Quinidine = No Dig, No Kids

Endocrine
Growth hormone - watch for excessive weight gain
Ritalin - CBC levels , watch for RBCs bc growth rate/bones > if Ø O2 flow > necrosis
Absence seizures - kids - brief loss of consciousness
Ibuprofen - risk for GI bleed - Ø give to pts c/ Crohn’s

ANS

*********
Misc.
HBA1C - 6.5
Fluoxetine - sex dysfxn
Imitrex - take when migraine sx appear
Cirrhosis - decrs. Standard dosage
Coumadin - Ø aspirin prn
PTU 4 wks: lower HR
Elavil - report urine retention
Morphine - evaluate 1 hr p/ giving 3/10 pain scale
TB -Tx c/ INH, RIF, Pyrazin, ethamb. - to eliminate resistant TB
Give other be first * Na Polystyrene
Bupropion - assess insomnia
Hypothyroid - synthroid - if breast feeding > take med p/ feeding
Ferrous sulfate - enhance absorp. Of ascorbic acid
Augmentin - change in antibiotic
Lithium - joint pain - aspirin
Dilantin - seizure frequency chart
Ancef - give Epi
Gold salts - call Dr. If sores in mouth
Dtap @ 2 months
Baclofen - decrease in flexor/extensor spasms
Tylenol - dr rx’d percodet prn - tell dr. Percocet/tylenol OD
Morph. Sulf. PCA - 10 respirations stop PCA
Tylenol toxicity - give mucomyst
Gentamycin - tell dr immediately if turning up volume
Ritalin - maintains age-appropriate weight
Ampicillin - cellulitis - allergy= rash
TB - AR’s of INH - tell dr if yellow skin
Oral contracept. Interferes c/ carbamazapine
PCN allergy - cephalexin - uticaria - admin epinephrine (bc that is sign of anaphalactic -
allergic response)
PT c/ HF - lasix - K+ = 2.6 - put on Heart Monitor
Reglan - watch for sedation
Fosamax - PO daily - remain upright for 30 min.
2nd dose ceftriaxone - uticaria/dyspnea - d/c infusion
Aspirin for arthritis -if pt gets tinnitus = toxicity
Lisinopril- side effects - cough
MG - neostigmine - AR = diarrhea
Fentanyl - bc of AR’s, give stool softener
Diamox - for glaucoma - anticipate AR’s - tingling fingers
Tagament - report immediately if green sputum
Pt taking lithium - hand tremors - restrict caffeine
Pronestyl - MI - with hold med if QRS widening greater than 50%
Digoxin dysrhythmia - with hold lasix
Patient rcv’ing Tx for Lupus - prednisone - monitor long term c/ bone density scans
Nurse teaching pt. New med - consult pharmacist
Client Dm - given glucophage - anxious @65 mg - give OJ
Discharge teaching - rx’d lasix - Ø take @ nite & tell Doc about Lasix if antibiotic is
needed
Coumadin - A-fib - check PT/INR result
Nurse - monitor client on lipitor for CK - creatinine kinase
Timolol - concern if giving & pt. Starts to have bradycardia
Pt. C/ morph. Sulf. For thoracic procedure - pt needs to be able to TCDB
HF - give vasotec - monitor for hyperkalemia