11/2/2018
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PHARMACOLOGY:
THE “NEED TO KNOW”
NCLEX Test Plan - Importance
of Activity Performance
Highest
Prepare and give meds, using rights of
medication administration. (4.90)
Ensure proper ID of client when
providing care. (4.89)
Apply principles of infection control
(hand hygiene, surgical asepsis,
isolation, sterile technique,
universal/standard precautions.(4.89)
The 8 Rights of
Medication Administration Medication
Dose
Patient
Documentation
Route
Time
Right to Know
Right to Refuse
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CALCULATIONS
Practice drug calculations
Fill-in-the-blank.
Given the unit of measurement
Rule of Rounding; Instructions; Wait to
Round!
Drop down calculator
No cell phones allowed.
Be sure you can calculate:
Lidocaine drip – mg/min; Nipride and
Dopamine– mcg/kg/min
Routes of Administration
Oral
Rectal
Topical
Vaginal
Parenteral
(IV, IM, SubQ)
Intranasal
Inhalation
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Routes of
administrationSublingual
Advantages—
rapid onset;
delayed
degradation by
avoiding first pass
metabolism
Disadvantages—
need saliva
Routes of administration
• Transdermalabsorbed
through skin to capillary
bed
– Duragesic (fentanyl)
patches for pain
– Estrogen patches
– Nicotine patches
– Catapres patches
– New patch for
Traveler’s diarrhea
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One eye drop…. or two?
•The volume of single drop varies due to the
–viscosity of the solution
•When two different types of drops are used - instill at least 5 minutes apart.
Pharmacology Study
Strategies Google the top 100 prescribed drugs.
Learn drugs in classes – using the
“ending.”
prils, sartans, statins, etc.
Review antidotes.
Learn drugs along with core content.
Generic name always given, trade
name may or may not be included.
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National Patient Safety Standards
Use two client identifiers when
providing care or giving medications.
Communicate effectively with
members of the healthcare team.
Give medications safely.
Recognize and respond to changes in
a client’s status.
Client is encouraged to be actively
involved in safety strategies.
Review
Most often used
herbal
products
Most common
OTC drugs
acetaminophen,
aspirin, and
NSAIDS
Herbal products –
www.consumerlabs.comTop herbal products sold in the US:
Gingko biloba—inhibits platelet aggregation
St. John’s Wort—decreases effectiveness of drugs
Ginseng—sodium and water retention; bleeding/clotting
Kava – adverse hepatic effects - liver failure
Saw Palmetto—questionable efficacy?
Garlic—inhibits platelet aggregation
Echinacea—immune enhancer
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St. John’s Wort…
“St. John’s wort is the most common
herb involved in drug interactions.”
www.factsandcomparisons.com
Acetaminophen
TylenolThe #1 cause of acute
LIVER failure Acetaminophen is found in over
300 OTC products
Drugs ending in “cet”
Maximum daily dose is 3 grams per day for healthy
adults
In older adults and those with liver impairment, the maximum
daily dose is 2 grams/day.
When you hear “Bayer” …
what do you think?
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High Alert Medications
adrenergic agonists, IV epinephrine phenylephrine norepinephrine
adrenergic antagonists, IVpropranololmetoprolollabetalol
antiarrhythmics, IV lidocaineamiodarone
antithrombotic agents anticoagulants
inotropic medications, IV (e.g., digoxin)
sedation drugs for adults and children
narcotics/opiates
TPN solutions
dialysis solutions
radiocontrast agents, IV
Institute for Safe Medication
Practices **High Alert Drugs
• Insulin
• Heparin
• Opiods
• Injectable potassium chloride or
potassium phosphate concentrate
• Neuromuscular blocking agents
• Chemotherapy drugs
Nursing Implications for
High Alert Medications Communication
Storage
Abbreviations
Check system for high alert meds
Infusion pump rates and concentrations
need independent check system.
Similar names
Premixed solutions
Only vial on unit is saline
Single dose vials
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Antidotes
Narcotics – Narcan
Coumadin – Vitamin K
Heparin – Protamine Sulfate
Benzodiapines – Flumazenil
(Romazicon)
Magnesium Sulfate – Calcium
Gluconate
Antidotes
Digoxin toxicity – Digibind
Methotrexate – Leucovorine
Barbiturates & Aspirin – activated
charcoal, dialysis
Isoniazid (INH) – B6
Lithium toxicity - hemodialysis
Other notes…
• Acetylcysteine– Mucomyst given to
clients with CRF to minimize reaction to
contrast dye; can be used as treatment
for acetaminophen overdose
• Albuterol can be for high K+
• Insulin drives K+ back into cells in
metabolic acidosis
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Review generic last names Prils—ACE inhibitors
Sartans—ARBS Angiotension Receptor Blockers
Triptans—Serotonin (5-HT1D) agonists –Serotonin agonists
Prazoles—Proton Pump Inhibitors for GERD
Olols, alols, ilols—Beta blockers
Dipines—Calcium Channel Blockers (CCBs)
Tidines—H2 blockers (Histamine 2)
Zepams or zolams—Benzodiazepines
Statins—lower LDL cholesterol
• Coxib – Selective Cox 2 inhibitors
Endings of common
drugs
Amine–histamine (diphenhydramine)
Ase, plase–thrombolytic agent (ase –
enzyme)
Caine–local anesthestic
Cet–acetaminophen containing pain
meds
Endings of Common Drugs
Dronates – osteoporosis drugs
Ide – diuretic – HCTZ, furosemide
Lone, sone, pred – corticosteroid
Phylline – xanthine bronchodilator-theophylline
Barb – barbiturate - phenobarbital, secobarbital
Nitro – nitrates
Sal – salicylates or ASA
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Antimicrobials
• Cillins, Pen, Pen VK – Penicillin family
• Cephalosporins – “cef” or “kef”
• Mycins – aminoglycosides
• Exceptions
– Vancomycin
– Erthromycin (Macrolide family)
• Cyclines – Tetracyclines
• Azoles – antifungals
• Floxicin – Fluoroquinolones
The
Penicillins
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Aminoglycosides
“mycins”
» .
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The ear and kidney
connection…
Otorenalaxis
Nephrotoxicity
Ototoxicity
Aminoglycosides
Streptomycin sulfate - (1944) first clinically used to treat TB
Amikacin (Amikin)
Gentamicin (Garamycin)
Paromomycin (Humatin)—parasitic infections
Tobramycin (Nebcin)—very effective against Pseudomonas; less toxic effects
Kanamycin and Neomycin (given orally as bowel prep to inhibit intestinal bacteria prior to surgery;
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Sulfonamides “sulfa”Trimethoprim
sulfamethoxazole (Bactrim)
Common treatment of UTI
make sure they are not
allergic to sulfa.
Lots of water to prevent
crystalluria
Tetratogenic
Photosensitivity
Fluoroquinolones
Ciprofloxacin (Cipro); Levofloxacin
(Levaquin)
Used in the treatment of infections in
the urinary tract, respiratory tract, GI
tract, bones, and skin. Also used in
the treatment of Anthrax.
Adverse Effects: GI symptoms,
dizziness, candida infections
Rare tendon rupture (achilles) Cipro
Women’s Health6.40
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NCLEX® HINT
Although Flagyl is treatment of
choice for some vaginal
infections, its use is
contraindicated in first trimester
of pregnancy, and it’s use during
second trimester is controversial.
The antifungals--the
“azoles”
Miconazole (Monistat)
Clotrimazole
[Canesten](Mycelex)
Fluconazole (Diflucan)
Intraconazole (Sporanox)
Ketoconazole (Nizoral)
Voriconazole (Vfend)
“You have a yeast
infection…”
The antiherpetics—the
“cy{i}clovirs” Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)
Ganciclovir
Treatment for shingles started within
48-72 hours after first signs of
vesicular eruption for greatest
benefits
+ Prednisone
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Treatment for allergic
reactions
Mild case
Epinephrine 1:1000
0.2-0.5 mL SQ
Severe case
Epinephrine 1:10,000 0.5 mL IV
Volume expanding fluids
Digitalis preparations
Vasoconstrictors (Levophed,
Dopamine)
Serotonin makes you happy
SSRIsThe #1 class
of drugs
prescribed
for
depression
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The SSRIs
• fluoxetine (Prozac)
longest ½ life.
• sertraline (Zoloft)
shortest ½ life.
• Escitalopram (Lexapro)
may ease depression and
anxiety quicker
• Give antidepressants time to work!
• 3-5 weeks…but monitor closely
during this time
Drugs that cause
significant
Weight Gain
SSRIs
Anti-seizure drugs
(Valproic Acid-
Depakote)
Atypical antipsychotics
clozapine (Clozaril)
olanzapine (Zyprexa)
The “statins”
Lova (Mevacor), atorva (Lipitor), prava
(Pravachol),
simva (Zocor), fluva (Lescol), rosuva (Crestor)
Anti-inflammatory
Anti-lipid
Decrease plaque formation
Stabilize plaques & prevent plaque rupture
Side effects - Muscle aches and pains—
Check CK (creatine kinase) muscle damage
Monitor liver enzymes
Rhabdomyolitis
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The “prazoles”**—Proton
Pump Inhibitors
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
• **Exception: Aripiprazole/Abilify—an new
antipsychotic—a dopamine system
stabilizer
The “tidines” (H2 blockers)
• **Cimetidine--Tagamet—can cause delirium in the elderly
• increases bioavailability of many drugs—beta blockers, theophylline, morphine
• Ranitidine (Zantac)
• Nizatidine (Axid)
• Famotidine (Pepcid)
• Best to give at hs—decrease vagally-induced histamine release in stomach
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Normal functions of
acetylcholine
In the brain - helps you to think
Makes your pupils constrict
Makes saliva from salivary glands
Slows your heart rate down
Speeds up the bowels (peristalsis)
Relaxes detrusor muscle of the
bladder (urinary sphincter) - void
Anti-cholinergic drugs—side
effects
Confusion
Pupillary dilation (blurred vision,
glaucoma)
Tachycardia (angina, possible MI)
Decreased salivation (dry mouth)
Loosens LES (GERD)
Decreased peristalsis in GI tract
(constipation)
Tighten urinary sphincter (urinary
retention)
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The “osins” and the prostate
gland
Alpha 1 receptors located on prostate—
tamsulosin (Flomax) prostate-selective
alpha one blocker.
Others used—HTN and BPH
tamsulosin/Flomax
sildodosin/Rapaflo
terazosin (Hytrin)
doxazosin/Cardura)
The Older Adult
American Geriatric Society
Beer’s Criteriahttp://www.americangeriatrics.org/
Medications - inappropriate when risk of adverse
effects outweighs benefits in elderly.
List updated 2003—medications deemed
inappropriate because there are safer, equally
efficacious alternative medications.
Digoxin, Demerol, Tagament
Benadryl, Valium, Prozac
triazolam/Halcion
amitriptyline/Elavil)
Lots more…
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Considerations
for the Older
Adult
Functional
Reserve
&
The
1% rule
Changes in Body
Function with Aging
Albumin, the liver, the role
metabolism of medications
The significance of acetylcholine;
use of anticholinergic drugs
Detection of infection, cellulitis,
inflammation
Causes of delirium
Liver Metabolism/ Albumin
Production Albumin is principle protein that “binds” drugs
number of binding sites with aging…drugs “competing” for binding sites
Bound drugs vs. “free” drugs
Highly “protein bound” vs. loosely protein bound
percentage of drug is bound, percentage of drug is free
If drug is loosely bound it can be “knocked” off its binding sites very easily and become “free and functional”
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Excretion
Conditions influencing
renal blood flow may influence
renal excretion
Renal Function – Older
Adult PrioritySerum creatinineMisleading in older patient due to ↓muscle mass and ↓ GFR—may give a false normal reading.0.2 – 1.0 mg/dL
Values ↓ with age
24 Hr Creatinine Clearance Best measurement of renal functionMen – 90-135 mL/minute
Women – 80-125 mL/min
The
End!