pharm chapter 11,12,13,34

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pharm chapter 11,12,13,34
2012-10-05 02:17:09
pharm chapter 11

Pharm chapter 11
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  1. Patient teaching for Anthihistamines (9 things)
    • Take meds as ordered, not take more than recomended dosage
    • avoid tasks like driving that require alertness (Driveing)
    • these drugs cause dizziness,thickening of sucretions,and upset stomach.--may need to alert healthcare provider if they persist
    • if these meds cause an upset stomach, taking them with milk, can decrease this problem.
    • the patient may develop a tolerance to an antihistamine, if this happens it can be swiched for another.
    • The Pt. should stop taking antihistamines for atlease 48 hrs. before having any skin allergy testing
    • Make sure the patient has a perscription if nessisary
    • health care provider should be aware of all drugs being taken by patient -- especially dont take alcahol or other sedatives w/antihistimine
    • keep out of reach of children, and anyone for whom it isnt perscribed.
  2. Patient teaching for Antitussives 8 things
    • Take as ordered!
    • Narcs cause drowsiness - use caution when doing tasks that require alertness.
    • over use of codine containing antitussives may cause constipation and lead to addiction.
    • these drugs increase the effect of alchol, and slow the nervous system, don't take any other medications with antitussives
    • Pt. may become nausiated during the first few minutes of taking these meds.. lie down it will pass.
    • these drugs may cause light headedness,dizziness and/or fainting when changing positions, move slowly/coutously.
    • Take with food/milk
    • keep out of reach of children, and anyone for whom it isnt perscribed.
  3. Patient teaching for  Sympathomimetic’s
    • The patient should take the medication as directed by the physician or other health care provider;  the dosage should not be changed 
    • Overuse of these drugs may result in severe side effects.                         
    • The physician should be contacted if the drug is not helping the patient.    
    • Contact the health care provider if bronchial irritation, dizziness, chest pain, insomnia, or any change in symptoms occurs.   
    • Drinking lots of fluid, especially water, makes the mucus thinner and helps the medication work better. 
    • The patient must not take any other medications without checking first with the physician or other health care provider.                             
    • The patient should take the last dose a few hours before bedtime so that the drug does not produce insomnia    
    • The drug should be protected from light; colored solutions should be thrown away.
  4. Patient teaching for Xanthines
    •     The patient should take the medications as ordered; this often means every 6 hours if taking a sustained release medication.  
    • Any unusual symptoms should be reported to the physician-especially seizures, rapid heartbeat, irregular heartbeat, vomiting, dizziness, and irritability.                         
    • The patient should avoid drinking large amounts of caffeine-containing drinks such as tea, coffee, cocoa, and cola drinks.                                                       
    • The patient should avoid taking any other drugs without first checking with the physician.  This includes drugs that may be bought over the counter; they may also have an effect on the respiratory system.                       
    •     If a dose is missed and noticed within an hour, the patient should take the prescribed dose as soon as possible.  I more than an hour has passed, the dose should be skipped and the patient should stay on the original dosing schedule.                          
    • Some suppositories must be refrigerated, whereas others may not. Check with the pharmacist about this.                           
    •    The physician should be called if use of suppositories causes burning or irritation of the rectal area. 
  5. What are intranasal steroids
    • a.       The main action of topical intranasal steroids in an anti-inflammatory effect, which decreases local congestion.  They are used to treat allergic, mechanical, or chemically induced local nasal inflammation or nasal polyps only when the more usual treatment has been tried and found to not work. Adverse reactions to intranasal steroids include asthma, nasal irritation and dryness, nausea, nosebleeds, perforation of the nasal septum, bad taste and smell, rebound congestion and skin rash.  The patient should not use these drugs if an infection is present.
    • prednisolone (Pediapred, Delta-Cortef)
    • prednisone ( Meticorten)
    •  methylprednisolone (Medrol)
  6. specialconsideration with the geriatric patient with intranasal steroids
    a.       Elderly patients are highly sensitive to these drugs and should be carefully watched for CNS stimulation. The physician may need to be contacted and doses may need to be altered.
  7. whatmay affect theophylline (Elixophyllin)
      Drinking or eating foods high in caffeine, like coffee, tea, cocoa, and chocolate, may increase the side effects caused by theophylline. Avoid large amounts of these substances while you are taking theophylline. Also the half life is shorter in people who smoke as appose to people who don’t smoke. 
  8. how do Antihistamines work?
    - block the action ofhistamine by competing with it for the H_1 receptor site on the effectorstructures… The blocking action limits the vasodilatation (opening) andincreased capillary permeability and reduces the edema (swelling) caused byhistamine.  Antihistamines also have asedative effect on the central nervous system.   Cetirizine (Zyrtec) , fexofenadine (Allegra ), loratadine (Claritin) , hydroxyzine (Vistaril) , promethazine (Phenergan), diphenhydramine (Benadryl)
  9. How do Antitussives
    narcotic Antitussives suppress the cough reflex by acting directly on the cough center in the medulla of the brain.  Non-narcotic Antitussives reduce the cough reflex at its sources by anesthetizing stretch receptors in respiratory passages, lungs and pleura, and by decreasing their activity. codeine phosphate hydrocodone (Hycodan)
  10. How does Cromolyn sodium work? Asthma.
    a.       Cromolyn sodium helps treats asthma by slowing down the destruction of sensitized mast cells.  As mast cells are destroyed, they release histamine and the slow-reacting substance of anaphylaxis created by breathing in specific antigens.
  11. How do Bronchodilators work?
    • Bronchodilators the main action of sympathomimetic’sbronchodilators (adrenergic stimulants) in asthma and other respiratorydiseases is to relax the smooth muscle cells of the bronchi by stimulatingbeta_2- adrenergic receptors.  They alsostimulate alpha adrenergic receptors, which produce a vasoconstriction responseall through the body (systemically), especially a narrowing or constriction inthe blood vessels of the bronchialmucosa. This results in less mucosal and submucosal edema. 
    • levalbuterol (Xopenex) , , ipratropium (Atrovent)
  12. how do Sympathomimetic’sbronchodilators work?
    • Sympathomimetic’s bronchodilators stimulate beta_1 receptors, which results in an increased rate and force of theheart’s contractions.
    • albuterol (Proventil), ephinephrine (Adrenalin Chloride)
  13. how do Xanthines work?
    act directly to relax the smooth muscle cells of the bronchi thereby dilating or opening up the bronchi, and blood vessels in the lungs.  These drugs also act directly on the kidneys to produce diuresis (increased production and excretion of urine).  These drugs cause CNS effects.  theophylline (Elixophyllin)
  14. how do Leukotriene receptorinhibitors work?
    a.       belong to the newest category of drugs used in treating asthma.  These are not bronchodilators but act to block receptors for the cysteinyl leukotrienes C_4, D_4 and E_4 cysteinyl leukotrienes.  These drugs are rapidly absorbed orally.  Food interferes with their absorption, so they should be taken on an empty stomach. montelukast sodium (Singular)
  15. how do Corticosteroids work?
    • arethe most potent (powerful) and consistently effective medications for thelong-term control of asthma.  Theiraction on the inflammatory process may account for their effectiveness.  They block the reaction to allergens andreduce airway hyper responsiveness. --
    • inhailed
    • : triamcinolone acetonide (Azmacort) ,
    • Budesonide (Pulmicort Turbuhaler) ,
    • fluticasone (Flovent or Flonase)
    • Systemic/oral:
    • prednisolone (Pediapred, Delta-Cortef)
    • prednisone ( Meticorten)
    •  methylprednisolone (Medrol)
  16. How do Decongestants work
    • Decongestants directly affect the alphareceptors of blood vessels in the nasal mucosa, causing vasoconstriction.  This action reduces blood flow, fluidmovement, and mucosal edema.  Many agentsalso act on beta receptors, which may cause rebound vasodilatation, or anincrease in blood flow leading to further congestion.  This problem is commonly seen with prolongeduse of the medication
    • oxymetazoline (Afrin)
    • pseydoephedrine sulfate (Sudafed)
  17. How do Expectorants work?
    • They decrease the thickness of respiratory secretions and aid in their removal.  It is believed they work by increasing the amount of fluid in the respiratory tract.
    • guaifenesin (Robitussin, Mucinex, & Mytussin)
  18. Patient teaching for Cromolyn Antitussives
    • 1.       The airway should be cleared of as much mucus as possible before taking drug
    • 2.       Pt should avoid using these drugs when unable to take a deep breath and hold it or if having an asthma attack
    • 3.       These drugs must be taken every day at regular intervals
    • 4.       If the pt is using a bronchodilator at the same time, it should be used first;
    • 5.       Throat irriation,
    • dryness of the mouth, and hoarseness may be prevented by rinsing and gargling after each dose
    • 6.       To receive the appropriate dosage of Cromolyn, the pt must use the aerosol solution correctly and keep the mouthpiece clean
    • 7.       Stopping the medication quickly can make the pt have an acute attack of asthma
    • 8.       The nurse, physician or other HCP should be called if symptoms do not improve or if they get worse
  19. Patient teaching for Nedocromil Antitussives
    • 1.       The inhalation canister must be primed by pressing three times before the first use. Repeat this if canister remains unused for 7 days
    • 2.       The pt should take the med at regular intervals and at the same time every day
    • 3.       In a pt whose asthma symptoms are under control, other asthma medication may be decreased as the pt is stabilized
  20. patient teaching for Bronchodilators
    •   The pt should take the medication as directed by the nurse practitioner, physician or other HCP; the dosage should not be changed                        
    • Overuse of these drugs may result in severe side effects                                                
    • The nurse practitioner, physician or other HCP should be contacted if the drug is not helping the pt                                            
    • Contact HCP if bronchial irriation, dizziness, chest pain, insomnia, or any change in symptoms occur                                           
    • Drinking lots of fluid, especially water, makes the mucus thinner and helps the med work better                                           
    • Pt must not take any other meds without checking first with the HCP                                                         
    • Pt should take the last dose  a few hours before bedtime so that the drug does not produce insomnia                                        
    • Drug should be protected from light; colored solutions should be thrown away
  21. patient teaching for  Xanthine
    •  Pt should take the med as ordered                   
    • Any unusual symptoms should be reported                   
    • Pt should avoid drinking large amounts of caffeine                                 
    • Pt should avoid taking any other drugs without first checking with the HCP                             
    • Pt should take the medicine with a glass of water or with meals to avoid an upset stomach If a dose is missed and noticed within an hour, the pt should take the prescribed dose as soon as possible. If more than an hour has passed, the dose should be skipped, and the pt should stay on the original dosing schedule
  22. Patient teaching for Leukotriene receptor inhibitors
    • Taking food with these meds reduces the drug’s absorption                                            
    • Women should not take these drugs if they are pregnant or breastfeeding                                                           
    • Meds should be kept out of the reach of children or thers for whom they are not ordered                             \
    • These meds are used together with other types of ashma meds.
  23. patient teaching for Corticosteroids
    Teach pt how to take the med and how to contact HCP
  24. Patient teaching for   Decongestants
    • These meds are OTC meds. They should be carefully used and the HCP should be told whether they are on these or not       
    •   Also not for little children
  25. Patient teaching for Expectorants
    • Pt should be aware that these drugs will help make the sputum more liquid. This will make it easier to bring sputum up when the pt coughs.
    • The pt should use a humidifier and drink at least 2 quarts of water daily while taking an expectorant. These actions will help get the mucus out   
    • HCP should be notified if the cough is present wit ha high fever, rash or persistent headaches, or if the cough returns once the pt thinks it has been under control                    
    • The pt should use the med only in the dosage recommended to decrease chances of side effects
  26. Patient teaching for Topical Intranasal Steroids
    • The pt should not use these drugs if an infection is present. Pts should notify the HCP if an infection develops while taking this drug                                                             
    • The pt should not exceed the prescribed dosage and frequency.                                                           
    • There may be temporary dryness and irritation of the nose       
    • When stopping this drug, the dosage must be tapered slowly and not stopped suddenly           
    • The HCP should be notified if symptoms do not improve or if they get worse
  27. What is the best way to assure thet the antibiotic will be effective?
    a.       The best way to assure that the antibiotic will be effective is to have the organism responsible for the infection to be identified by a culture.  The patient needs to take the medication exactly as prescribed for as long as prescribed, and not stop because of feeling better.  Every dose should be taken.  Avoid Bacteriostatic antibiotics such as tetracycline and erythromycin because these drugs can decrease the bactericidal effect of other antibiotics especially Penicillin.  Avoid antacids especially with Penicillin because it may decrease the absorption of the antibiotic. Also many antibiotics interfere with the action of birth control pills, leaving women at risk of pregnancy.  Tell women on birth control on antibiotics to use a backup method for protection. 
  28. Aminoglycosides
    • a.       Aminoglycosides is an antibiotic b.      And may cause significant damage to the kidney (nephrotoxicity) or ears (ototoxicity).
    • c.       Bacitracin may cause renal failure as a result of tubular and glomerular necrosis; therefore, the patient’s renal status must be closely monitored. It is effective in treatment of gram-negative infections when penicillin contraindicated.
    • d.      An adverse reaction with aminoglycosides would be significant renal toxicity, which is usually reversible; risk of toxicity increases in patients with renal impairment. Significant auditory and vestibular ototoxicity may occur in patients on prolonged therapy or those taking higher than recommended dosages
    • .e.       Aminoglycosides have a narrow therapeutic rage, so closely monitor blood levels of these drugs to avoid toxic levels. Dosage is calculated on the basis of the patient’s weight and is increased or decreased based on blood levels so an effective level is maintained. The narrow therapeutic range (when the lowest and highest acceptable drug levels are not far apart) requires that the sample for the antibiotic blood level be drawn just before the next scheduled dose is given. This sample will show the lowest blood level of the antibiotic (found at the “trough”), rather than a blood level at a higher range (at or near the “peak”). The lowest blood level will determine whether the dosage needs to be adjusted to stay within the therapeutic range and not go above the toxic level or below the effective level. Because of the nephrotoxicity of these agents, blood urea nitrogen and creatinine levels must also be monitored during the course of therapy.
  29. Adverse vs.side effect
    • a.       Side Effect: Any effect of a drug, chemical, or other medicine that is in addition to its intended effect, especially an effect that is harmful or unpleasant.
    • Adverse Effect: In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery
  30. What is primaquine
    a.       Primaqine is a synthetic compound derived from quinoloine and used in the treatment of malaria. It belongs to a group of drugs called antimalarials. It interferes with the metabolism of parasites.
  31. Which drugs are used for urinary tract infections?
  32. sulfonamides
    • a.       ACTION: Bacteriostatic effect against a wide range of gram-positive and gram-negative microorganisms by inhibiting folic acid synthesis. b.     
    • USES: Treatment of acute & chronic UTIsc.      
    • ADVERSE REACTIONS: Headache, drowsiness, fatigue, dizziness, vertigo, tinnitus, hearing loss, insomnia, peripheral neuropathy, hypothyroidism, hypoglycemia, anorexia, nausea, vomiting, stomatitis, abdominal pain, drug fever, blood dyscrasias, generalized maculopapular or urticarial rash, fever, weakness, pruritus, dermatitis, local irritation, periorbital edema, anaphylactic shock, crystalluria, hematuria, proteinuria, and toxemia. d.     
    • INTERACTIONS: Increase effect of oral anticoagulants, methotrexate, sulfonylureas, thiazide diuretics, phenytoin, and uricosuric agents. They may be displaced from plasma albumin by probenecid, salicylates, phenylbutazone, promethazine, sulfinpyrazone, and indomethacin; increase sulfonamide effect. Penicillins less effective. Effect may be antagonized by local anesthetics. Antacids decrease absorption. Change results of various lab tests.
    • TEACHING: More fully absorbed on empty stomach with full glass of water. Drink large amounts of water to prevent crystal formation. Avoid excessive sun and UV light exposure. Take all drugs. Notify physician if symptoms don’t improve within 2 to 3 days, or development of skin rash, blood in urine, bruises, nausea, or other adverse effects.
  33. antiretroviralagents when used and how they work
    • They are used to slow the advance of AIDS infection and support whatever immunity the patient still has they can be used to prevent HIV babies born to infected mothers or in health care workers who have been exposed to HIV.
    • b.      Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the DNA this prevents more viruses from being produced            
    •                Reverse transcriptase inhibitors 
    •                Nonnucleoside analoque reverse transcriptase inhibitorsc.
    • Protease inhibitors is another medication used for AIDS patientd.     
    • Antiretroviral medications are given only under the direction of a specialist but you may encounter patients getting these drugs when they are admitted with other health problems
  34. Know about cytomegalovirus retinitis
    • a.       Cytomegalovirus (CMV) retinitis is a viral inflammation of the retina of the eye.
    • b.      CMV retinitis is caused by a member of a group of herpes-type viruses. CMV is very common. Most people are exposed to CMV in their lifetime, but typically only those with weakened immune systems become ill from CMV infection. Serious CMV infections can occur in people who have weakened immune systems due to:
    •                                                                i.      AIDS            
    • Bone marrow transplant                                                              
    • Chemotherapy                                                            
    • Drugs that suppress the immune system                                                     
    • Organ transplant
  35. mouthand throat preparations
    • a.       Miscellaneous products are used to soothe minor irritation in the mouth and throat. Some release oxygen to provide cleansing, and some contain an anesthetic property to reduce pain. Products available are mouthwashes, sprays, solutions, troches, lozenges, and disks. Patients shouldn't take these products for more than 3-4 days for normal therapy.
    • Oral Preparations: (Carbamide peroxide/Oragel )
    • ozenges and troches: Mouth pain Cepacol, Cepastat, Robitussin, Sucrets, (clotrimazole/Mycelex for oral thrush)
    • Gargles,Gels, Mouthwashes, and Sprays: Cepacol, Chloraseptic for mouth pain,(nystatin/Mycostatin- Antifungal for oral thrush
    • Saliva Substitutes: Salivart-used to relieve dry mouth and throat.
  36. differenttopical skin products (example burn preps)
    Acne Products, Topical anti-infective, combination products, topical corticosteroids, Anesthetics for mucous membranes and skin, antipsoriatics.
  37. Know about emollients
    • Emollients are used topically for the integument producing a soothing effect
    • b.    They are fatty or oily substances - usually called a cream
    • c.    Render skin softer and more pliable
    • d.    Shield skin from irritants, airborne bacteria, etc.
  38. Reviewdifferent Ophthalmic preparations and what their used for
    • a.    Ophthalmic preparations are used for the eye - drops or ointmentb.    Categories:                                         
    • i.    Local anesthetics are used in the eye for procedures such as Tonometry, Gonioscopy, cataract surgery, and removal of foreign bodies from the cornea.
    • 1.    Examples: benoxinate (Fluress), proparacaine (Alcaine), tetracaine (Pontocaine)                                        
    • ii.    Antiseptics are compounds capable of preventing infection - used for the prevention of gonorrheal ophthalmic neonatrum when babies are born or anytime germicidal or astringent (tissue restriction is needed
    • 1.    Example: silver nitrate                                        
    • iii.    Anti-infective are used to treat common eye infections caused by bacteria, fungi, or viruses
    • a.    antibiotics like gentamycin (Garamycin) - if it ends in “-cin” it’s usually an antibiotic - drops and ointmentsb.    Antiviral - drops, injections, inserts            
    • i.    Artificial Tears provide tarlike lubrication to relieve dry eyes, eye
    • irritation r/t contact lenses, or deficient tear production
    • 1.    Examples: Isopto Tears, Refresh Plus, Tearisol, Systane                                        
    • ii.    Diagnostic products are used to detect foreign bodies or scratches1.    Example: topical fluorescein stains
  39. glaucoma
    a.    Glaucoma: increased intraocular pressure from either excess production or reduced outflow of aqueous humor
  40. Tree types of glacoma
    • i.    Primary glaucoma
    • 1.    Narrow-angle: shallow anterior chamber; may be genetic and requires surgery
    • 2.    Wide-angle: gradual onset and is managed with drug therapy                                       
    • ii.    Secondary glaucoma: may result from other eye issues such as a cataract surgery; treated with meds                                      
    • iii.    Congenital glaucoma: birth defect requiring surgery
    • 1.    Medications for treating glaucoma use a variety of mechanisms to increase outflow of aqueous humor
  41. a.    Antiglaucoma agents:
    • i.    Mydriatic-cycloplegics: used in tests for glaucoma (cause dilation and short-term paralyzation of eye muscles)                                      
    • ii.    Long acting-cholinesterase inhibitors, Parasympathomimetic or Miotics, Cholinesterase inhibitors: increased aqueous humor outflow
    • a.       Sympathomimetic agents (epinephrine) produce vasoconstriction and decrease intraocular pressure 
  42. acne products 
    • a.       Differin – adapalene. Wash face then apply a thin film of gel once daily to affected areas. An exacerbation of acne may initially be seen; therapeutic results usually seen in 8-12 wks
    • b.      Azelex – axelaic. Wash face and dry thoroughly. Then apply thin film twice daily to affected areas and gently massage into skin. Results usually seen in 4 wks
    • c.       Clearasil/Desquam-X/Oxy Oil-Free Acne Wash – benzoyl peroxide cream and soaps – apply daily to affected areas after cleansing skin. After 3 – 4 days, if redness, dryness and peeling do not occur increase application to twice daily. Use instead of soap. These products promote drying of skin and provide a gentle abrasive action when applied. If undue skin irritation develops, stop use and contact nurse, physician, or other health care. Available OTC.
    • d.      Accutane – isotretinoin. This product must not be taken by women who are pregnant, because sever fetal abnormalities may be produced. Women in childbearing years should be protected by adequate contraception methods during course of therapy.                                                                i.      Cystic acne: 1-2 mg/kg/day divided into 2 doses for 2wk. Dosage may then be adjusted for individual weight and severity of disease
    • e.      Liquimat – sulfur preparations. Thin film of medication should be applied daily or twice daily to clean skin. Used to treat oily skin and mild acne.
    • f.        Tazorac – tazarotene. Wash face and then apply a thin film to affected areas once daily
    • g.       Retin-A/Vesanoid – tretinoin. Wash face and apply to affected area daily at bedtime. Start with low doses; may irritate skin initially. Make individuals more sensitive to sun, necessitating sun screen. Evidence suggests that this product restores skin collagen and turgor, reversing fine wrinkles. Not for use by pregnant women
  43. medication for seasonal allergies
    • a.        Antihistamines are used to treat seasonal allergic rhinitis and perennial allergic rhinitis. Antihistamines block the action of histamine by competing with it for the H1 receptor sites on effector structures.
    • Cetirizine (Zyrtec) ,
    • fexofenadine (Allegra ),
    • loratadine (Claritin) ,
    • hydroxyzine (Vistaril) ,
    • promethazine (Phenergan),
    • diphenhydramine (Benadryl)
  44. Ophthalmiclocal anesthetics
    • benoxinate/Fluress
    • Often   used when suturing of eye is required. Use 1-2 drops before procedure
    • proparacaine   /Alcaine
    • Use   1-2 drops immediately before Tonometry, 2-3 min before suture removal or   removal or foreign body.
    • tetracaine   /Pontocaine
    • Use   1-2 drops or ½-1 inch of ointment to lower conjuctival area
  45. Burrow solution
    a.       Burrow’s solution is a pharmacological preparation made of aluminium acetate dissolved in water. he preparation has astringent and antibacterial properties and is used to treat a number of skin conditions such as insect bites, rashes caused by poison ivy and poison sumac, swelling, allergies and bruises. Burrow’s solution is traditionally applied in cold compresses over the affected area. In otology, it is applied as ear drops of a 0.13% solution.[1] Burrow’s solution is available over as a generic preparation.