PHARM ATI Review

7/31/2019 PHARM ATI Review

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ATI Review

Pharmacology


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Antipsychotics

Antipsychotic medications reduce the

psychotic symptoms ofschizophrenia and

other mental illnesses, usually allowing a

person to function more effectively and

appropriately. Antipsychotic drugs are thebest treatment for schizophrenia right now,

but they do not cure schizophrenia or

ensure that there will be no further

psychotic episodes Recognizing Side Effects to Report
http://mentalhealth.about.com/od/schizophrenia/http://mentalhealth.about.com/od/schizophrenia/


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Antipsychotics-Atypical

Recognizing side effects

Evaluating therapeutic effects

Types

Risperdal clozaril


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Chemotherapy Agents

Formulating a Nursing diagnosis


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Migraine Medications

Reporting findings to primary care provider


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Mood stabilizers

Analyzing data


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Nonsteroidal Anti-inflammatory

Drugs

Recognizing Data


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Error Reduction

Use of Resources


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Medication Administration and

error Reduction

Use of resources


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Opioid Agonists

Morphine administration

Client need for pain medication

Risk for respiratory depression

Adverse effects of codeine Recognizing side effects


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Antiycobacterial (antituberculosis)

Monitoring long term usage of medication


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Selective serotonin reuptake

inhibitors

Identifying interactions


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Oral hypoglycemics

Medication interactions


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Adrenergic agonists

Titrating dose

Treating anaphylaxis


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Alpha-Beta adrenergic agonist

Indications and Usage

Correction of hemodynamic imbalances

present in shock syndrome after MI,

trauma, endotoxic septicemia, open heart

surgery, and renal failure or chronic

cardiac decompensation (eg, CHF).

Dopamine

Dopamine HCl, a naturally occurring

catecholamine, is an inotropic vasopressoragent.

Inotropic

Affecting the force of muscle contraction. An

inotropic heart drug is one that affects the force

with which the heart muscle contracts.
http://www.rxlist.com/script/main/art.asp?articlekey=20210http://www.rxlist.com/script/main/art.asp?articlekey=38653http://www.rxlist.com/script/main/art.asp?articlekey=38653http://www.rxlist.com/script/main/art.asp?articlekey=20210


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Dopamine pharmacology

Stimulates beta-1 receptors in the heart,causing more complete and forceful

contractions (inotropy). Also acts on alpha

receptors (dose dependent) and has

dopaminergic effects.

Pharmacokinetics Distribution Widely distributed; does not cross the blood-

brain barrier to a significant extent.

Metabolism

Metabolized in the liver, kidney, and plasma byMAO and catechol-O-methyltransferase to

inactive compounds. Approximately 25% of

dose is taken up in the adrenergic nerve

terminals where it is hydrolyzed to

norepinephrine.


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Dopamine

Elimination

Half-life approximately 2 min.

Approximately 80% excreted in the urine within

24 h as metabolites; a very small amount

excreted unchanged.

Onset

Within 5 min.

Duration

Less than 10 min.


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Medications to research

Cytoxan-side effects

Egostat-side effects

Baclofen-therapeutic effects


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Coumadin Labs

PT: prothrombin time...tells you if pt's

coumadin is at a therapeutic level.

If it's low or normal and the patient is on

coumadin, then the dose is not therapeutic and

needs to be increased. INR: international normalized ratio...still

has to do with coumadin therapeutic level.

When lab runs a PT you get INR results

also. 2-3 is therapeutic. If it's a lot higher,the patient probably needs some vitamin K

to counteract it so he won't start bleeding

all over the place.


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PTT (aPTT):

(activated) partial thromboplastin

time...tells you if patient on heparin is at a

therapeutic level.

If it's low or normal and the patient is on

heparin, then the dose is not therapeutic andneeds to be increased. We use a sliding scale

for heparin, increasing or decreasing the

dosage based on APTT results.


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Coumadin:

anticoagulant that take several days to

start working, so heparin is given at the

same time till the coumadin level is

therapeutic.

Protamine: antidote for heparin (use is

patient's APPT is sky high); works quickly.

Vitamin K: antidote for coumadin; works

slowly.


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Cholinesterase Inhibitors

cholinergic crisis, a pronounced muscularweakness and respiratory paralysis caused by

excessive acetylcholine, often apparent in

patients suffering from myasthenia gravis as a

result of overmedication with anticholinesterasedrugs.

Cholinergic crises

Overdosage of neostigmine can induce a cholinergic

crisis. Symptoms can include nausea, vomiting,

diarrhea, excessive salivation and drooling, sweating

(in animals with sweat glands), miosis, lacrimation,

increased bronchial secretions, bradycardia or

tachycardia, cardiospasm, bronchospasm,

hypotension, muscle cramps and weakness, agi-

tation, restlessness or paralysis.


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anticholinesterases

Neostigmine belongs to the group of

medicines called anticholinesterases.

It works by prolonging the action

acetylcholine, which is found naturally in

the body.

It does this by inhibiting the action of the

enzyme acetylcholinesterase.

Acetylcholine stimulates a type of receptor

called muscarinic receptors. When

stimulated, these receptors have a range

of effects.


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What is Neostigmine used for?

Abnormal muscle weakness (myasthenia

gravis)

Difficulty in passing urine (urinary

retention)

Failure of function of part of the gut

causing an obstruction (paralytic ileus
http://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htm


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Cephalosporins

Cephalosporins also interferes directly

with vitamin K metabolism, and as a result

can lead to abnormal bleeding

Use

Bronchitis, otitis media, pneumonia, cellulitis

Recognizing allergic reactions


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drug class: Cephalosporins

drugs and trade names:

Cefuroxime: Ceftin

Cephalexin: Cefanex, Keflet, Keflex,

Keftab

Cefixime: Suprax Cefpodoxime: Vantin

Cefprozil: Cefzil

Ceftriaxone: Rocephin

Cephadroxil: Duricef, Ultracef Cephaclor: Ceclor

Loracarbef: Lorabid


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Keflex

Keflex is an antibiotic used to treat

infections of the respiratory tract, the

middle ear, the bones, the skin, and

urinary systems.

Most common side effect for keflex

diarrhea


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Selective Estrogen receptor

modulators/SERMS

Selective estrogen receptor modulators,

called SERMs for short, block the effects

of estrogen in the breast tissue. SERMs

work by sitting in the estrogen receptors in

breast cells. If a SERM is in the estrogenreceptor, there is no room for estrogen and

it can't attach to the cell. If estrogen isn't

attached to a breast cell, the cell doesn't

receive estrogen's signals to grow andmultiply.


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modulators/SERMS

Cells in other tissues in the body, such as

bones and the uterus, also have estrogen

receptors. But each estrogen receptor has a

slightly different structure, depending on the

kind of cell it is in. So breast cell estrogenreceptors are different from bone cell estrogen

receptors and both of those estrogen receptors

are different from uterine estrogen receptors.

As their name says, SERMs are "selective"this means that a SERM that blocks estrogen's

action in breast cells can activate estrogen's

action in other cells, such as bone, liver, and

uterine cells.


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modulators/SERMS

There are three SERMs:

tamoxifen (also called tamoxifen citrate; brand

name: Nolvadex)

Evista (chemical name: raloxifene)

Fareston (chemical name: toremifene)


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Thrombolytic medications

Minimizing adverse effects


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Biphosphonates

Medication Administration

You take most bisphosphonates by mouth-

every day, once or twice a week, or even

once a month. Zoledronic acid is given

intravenously, usually only once eachyear. One form of ibandronate is also

given intravenously, usually every 3

months.

Etidronate (Didronel) is not approved bythe U.S. Food and Drug Administration

(FDA) for osteoporosis. But it is used in

Canada and Europe for this purpose.


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Bisphosphonates for osteoporosis

Generic Name Brand Name

alendronate Fosamax

etidronate (not approved by

FDA for osteoporosis)Didronel

ibandronate Boniva

risedronate Actonel

risedronate with calcium

carbonateActonel with Calcium

zoledronic acid Reclast


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Glucocorticoids

Client teaching for MDIs


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Cerebral palsy

Monitoring for medication therapeutic

effects


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Hematopoietic growth factors

Evaluating client response


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Cardiac Glycosides

Recognizing side effects

Contraindications to Administration

Sick sinus syndrome, Wolff-Parkininson-White

syndrome, ventricular fibrillation, ventricular

tachycardia lation

Digoxin-hydrocholorothiazide (HCTA)

interaction

Because HCTZ can lower potassium level thiscan cause digoxin tocicity

cardiac


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Digoxin

Digoxin belongs to a class of medications

called cardiac glycosides. It works by

affecting certain minerals (sodium and

potassium) inside heart cells. This reduces

strain on the heart and helps it maintain a

normal, steady, and strong heartbeat. Side effects

Gastrointestinal Nausea, vomiting Neurological

Blurred vision, visual hallucinations Cardiac

Atrial tachycardia,

Other Side Effects? Patients withhypokalemia, second-degree AV block, third-

degree AV block, and patients with atrial

fibrillation , who also have Wolfe-Parkinson-

White syndrome should not be given digoxin.


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What is the mechanism of

Digoxin?

Digoxin inhibits the sodium/potassium

ATPase pump resulting in increased

intracellular sodium leading to impaired

sodium/calcium exchange in increased

intracellular calcium. This increased intracellular calcium is

stored in the sarcoplasmic reticulum of the

cardiac muscle , resulting in increased

calcium reserve stronger musclecontraction.

Digoxin also potentiates the vagally

mediated slowing of AV conduction and

increased atrial ventricular block.


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Immunosuppressant Besides corticosteroids, the immunosuppressant medications

most often used in patients with autoimmune diseases include: Azathioprine (Imuran), which is primarily used in

autoimmune hepatitis and rheumatoid arthritis.

Cyclophosphamide (Cytoxan), which is primarily used in

systemic lupus erythematosus, autoimmune hemolytic

anemia, Wegeners granulomatosis, and other forms of

vasculitis. Cyclosporine (Sandimmune, Neoral) is primarily used in

psoriasis soriasis.suite101.com/article.cfm/psoriasis,

rheumatoid arthritis, multiple sclerosis, diabetes,

myasthenia gravis, and scleroderma.

Glatiramer acetate (Copaxone) is primarily used in

treatment of relapsing-remitting multiple sclerosis.

Methotrexate is primarily used in rheumatoid arthritis and

otherconnective tissue disorders

Mycophenolate mofetil (CellCept) is used in scleroderma

and systemic lupus erythematosus.

Sirolimus (Rapamune) is used for the treatment of

psoriasis.
http://www.suite101.com/content/AutoimmuneHepatitisI-a845http://www.suite101.com/content/connective-tissue-disorders-a14546http://www.suite101.com/content/connective-tissue-disorders-a14546http://www.suite101.com/content/AutoimmuneHepatitisI-a845


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Immunosuppressant Drug Interactions

The drug allopurinol used for gout may

enhance the effects of azathioprine,

Estrogens, androgens, cimetidine,

erythromycin, and ketoconazole may

increase the effects of cyclosporine. The risk of cancer increases in people on

immunosuppressants who are on other

medications that suppress the immune

system including corticosteroids,chlorambucil, cyclophosphamide, and

mercaptopurine.


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Insulin

Adjusted dosage

Client teaching to prevent hypoglycemia


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Organic Nitrates

Self administration

Medication interaction


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Leukotriene Modifiers

Purpose of administration


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Tocolytic medications

Monitoring adverse reactions


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antilipemics

Monitoring side effects

Client teaching


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tetracycline's

Medication interactions

http://www.drugs.com/drug-interactions/tetracycline-index.html

THIS WEBSITE WILL SHOW YOU 294

MEDICATIONS THAT INTERACT WITH

TETRACYLINE

Administration of a tetracycline with aluminum,calcium, or magnesium salts significantly

decreases tetracycline serum concentrations.

The proposed mechanism is chelation of

tetracycline by the cation, forming an insoluble

complex that is poorly absorbed from thegastrointestinal tract. The interaction has also

been reported with parenteral doxycycline and

oral antacids.

CITRACAL
http://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.html


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Age-consideration of medication

administration

Pain managemnt for older adult clients


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Basic pharmacologic principles

Controlled substances


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Tegretol-carbamazepine

is an anticonvulsant and mood stabilizing

drug used primarily in the treatment of

epilepsy and bipolar disorder, as well as

trigeminal neuralgia. It is also used off-

label for a variety of indications, includingattention-deficit hyperactivity disorder

(ADHD), schizophrenia, phantom limb

syndrome, complex regional pain

syndrome, paroxysmal extreme paindisorder, neuromyotonia, intermittent

explosive disorder, and post-traumatic

stress disorder.
http://en.wikipedia.org/wiki/Anticonvulsanthttp://en.wikipedia.org/wiki/Mood_stabilizerhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Phantom_limbhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Neuromyotoniahttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Neuromyotoniahttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Phantom_limbhttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Mood_stabilizerhttp://en.wikipedia.org/wiki/Anticonvulsant


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Tegretol-carbamazepine

Common adverse effects include

drowsiness, headaches and migraines,

motor coordination impairment and/or

upset stomach. Carbamazepine

preparations typically greatly decrease aperson's alcohol tolerance
http://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Motor_coordinationhttp://en.wikipedia.org/wiki/Motor_coordinationhttp://en.wikipedia.org/wiki/Adverse_drug_reaction


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Rifadin (Rifampin)

Rifampin eliminates bacteria that cause

tuberculosis (TB). It is generally used with

other drugs to treat tuberculosis or to

eliminate Neisseria meningitidis (a

bacteria) and to prevent you from givingthese infections to others. However,

rifampin is not used to treat Neisseria

meningitidis infection.
http://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0w


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Singulair-(montelukast)

is used to prevent asthma attacks in adults

and children as young as 12 months old.

Singulair is a leukotriene (loo-koe-TRY-

een) inhibitor. Leukotrienes are chemicals

your body releases when you breathe inan allergen (such as pollen). These

chemicals cause swelling in your lungs

and tightening of the muscles around your

airways, which can result in asthmasymptoms.
http://bones.emedtv.com/bone/bone.htmlhttp://bones.emedtv.com/bone/bone.html


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Lithobid-lithium carbonate

Lithium is used to treat and prevent

episodes of mania (frenzied, abnormally

excited mood) in people with bipolar

disorder (manic-depressive disorder; a

disease that causes episodes ofdepression, episodes of mania, and other

abnormal moods). Lithium is in a class of

medications called antimanic agents. It

works by decreasing abnormal activity in

the brain.


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Lithium may cause side effects

restlessness

fine hand movements that are difficult to control

loss of appetite

stomach pain or bloating

gas

indigestion

weight gain or loss dry mouth

excessive saliva in the mouth

tongue pain

change in the ability to taste food

swollen lips

acne

hair loss

unusual discomfort in cold temperatures

constipation

depression

joint or muscle pain

thin, brittle fingernails or hair


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Lithobid-DOSING:

Doses vary widely and are adjusted basedon measurements of the levels of lithium in

the blood.

Recommended blood levels are 06-1.2

mEq/L.

Early in therapy, dose adjustments are

made as often as every 5 to 7 days to

establish the correct dose.

Most patients require 900-1200 mg daily in2-3 divided doses.

Patients with kidney diseases excrete less

lithium from the body and, therefore,

require lower doses.

NOLVADEX


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NOLVADEX(tamoxifen citrate)

a nonsteroidal antiestrogen

SIDE EFFECTS- In these studies, the

most common side effects of Nolvadex

included:

Hot flashes -- in up to 80 percent of people

Vaginal discharge -- up to 50 percent

Water retention -- up to 32 percent

Nausea -- up to 26 percent

Irregular menstrual periods -- up to 25 percent Weight loss -- up to 23 percent

Vaginal bleeding -- up to 23 percent.

NOLVADEX
http://menopause.emedtv.com/hot-flashes/hot-flashes.htmlhttp://menopause.emedtv.com/hot-flashes/hot-flashes.html


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NOLVADEX(tamoxifen citrate)

Other common side effects (occurring in 2to 19 percent of people taking the drug)

included: Bone pain

Back pain

Headaches Cough

High cholesterol(seeTamoxifen and High Cholesterol)

Fatigue

Muscle pain

Ovarian cysts

Skin changes

Infection

Indigestion orheartburn

Insomnia(seeTamoxifen and Insomnia)

Constipation ordiarrhea

Anemia

Weight gain (seeTamoxifen and Weight Gain)

Mood changes

Hair loss (seeTamoxifen and Hair Loss).
http://bones.emedtv.com/bone/bone.htmlhttp://back-pain.emedtv.com/back-pain/back-pain.htmlhttp://headache.emedtv.com/headaches/headaches.htmlhttp://cholesterol.emedtv.com/high-cholesterol/high-cholesterol.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-high-cholesterol.htmlhttp://skin.emedtv.com/skin/skin.htmlhttp://digestive-system.emedtv.com/heartburn/heartburn.htmlhttp://insomnia.emedtv.com/insomnia/insomnia.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-insomnia.htmlhttp://constipation.emedtv.com/constipation/constipation.htmlhttp://diarrhea.emedtv.com/diarrhea/diarrhea.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-weight-gain.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-hair-loss.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-hair-loss.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-weight-gain.htmlhttp://diarrhea.emedtv.com/diarrhea/diarrhea.htmlhttp://constipation.emedtv.com/constipation/constipation.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-insomnia.htmlhttp://insomnia.emedtv.com/insomnia/insomnia.htmlhttp://digestive-system.emedtv.com/heartburn/heartburn.htmlhttp://skin.emedtv.com/skin/skin.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-high-cholesterol.htmlhttp://cholesterol.emedtv.com/high-cholesterol/high-cholesterol.htmlhttp://headache.emedtv.com/headaches/headaches.htmlhttp://back-pain.emedtv.com/back-pain/back-pain.htmlhttp://bones.emedtv.com/bone/bone.html


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Zoloft

Sertraline is used to treat depression,obsessive-compulsive disorder

(bothersome thoughts that won't go away

and the need to perform certain actions

over and over), panic attacks (sudden,unexpected attacks of extreme fear and

worry about these attacks), posttraumatic

stress disorder

Know side effects


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Medication administration

Nursing responsibility


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aminoglycosides

Assessing for adverse effects

Beta adrenergic blocker


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Beta adrenergic blocker

(Sympotholytics)

Monitoring clients


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Bacteriostatic inhibitors

Client instructions regarding self-administration

Pharmacological Pain


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Pharmacological Pain

management

Opioid agonist: client needs for pain medication

recognizing side effects

Evaluating patient-controlled analgesia use

Age specific considerations ofmedications: pain management for older

clients

Basic pharmacologic principles: controlled

substances


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Pharmacological interactions

Antilipemics: client teaching

Tetracycline: medication interactions


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Medication administration

Bisphosphonates: medicationadministration

Organic nitrates: self administration

Thrombolytic medication: minimizing

adverse effects

Cardiac glycosides: contraindications of

administration

Glucocorticoids: client teaching for MDIs

Adrenergic agonists: titrating dose

Anticoagulants: monitoring lab values


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