Pharm 3

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jessiharri
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74018
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Pharm 3
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2011-03-22 23:10:32
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pharmacology
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Pharm 3
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  1. Aloe uses and side effects
    Burn/wound healing, constipation, cold sores/increases menstrual flow and acute renal failure
  2. Cranberry uses and side effects
    prevent kidney stones, UTI prevention because it fights E Coli, vit C supp, antioxidants, digestive aid, decreased elimination of many drugs renally excreted/severe allergic reactions, diarrhea, stomach upset in large quantities
  3. Scopalamine
    Anticholinergic/motion sickness, also postop nausea and vomiting, contraindicated in glaucoma, 72 hr transdermal patch behind ear
  4. Antihistamines
    H1 receptors block acetylcholine in brain to relieve nausea and vomiting/Vistaril, Dramamine, Antivert, motion sickness, not all are effective as antiemetics, contraindicated with glaucoma, caution with peds
  5. Antidopaminergics
    CNS depressants/Block dopamine from receptor sites and CTZ/prevents nausea and vomiting from drugs, radiation and surgery/innefective in motion sickness, cause sedation/Compazine and Phenergan most used
  6. Prokinetics
    Reglan/increases GI motility and gastric emptying by releasing acetylcholine in GI tract/can cause extrapyramidal side effects, contraindicated in pts with breast cancer, seizure disorders or GI obstruction, for diabetic, chemo and postop
  7. Serotonin blockers
    OndanSETRON and graniSETRON/used for chemo, radiation and postop
  8. THC
    psychoactive substance in marijuana/Dronabinol/decreases perception of nausea, improves appetite, AIDS and cancer pts, glaucoma
  9. Antiemetic and Antinausea patient teaching
    • Take drugs before causative event
    • Tea, broth, gelatins are good to try after acute vomiting
    • Meds may cause drowsiness
    • Take meds 30 before and every 4-6 hrs
  10. Nursing Actions for Antiemetics and AntiNausea
    • Omit antiemetic if pt is hypotensive or excessivly drowsy
    • Side effects: sedation, anticholinergic effects, extrapyramidal effects, when used with other CNS can be addictive, so not drive or operate heavy machinery, decrease stimuli, help rest, oral care is important, replace fluids
  11. Peptic Ulcer Disease
    ulcer on esophagus, stomach, or duodenum/from H pylori, NSAIDS, acid and pepsin/also smoking, ethanol, bile, aspirin, steroids, stress
  12. PUD symptoms
    epigastric pain=gnawing or burning 1-3 hrs after meals, relieved by food or antacids, nausea, vomiting, dyspepsia, heartburn
  13. GERD
    when amount of gastric juice that refluxes into esophagus exceeds normal limit=hyperacidity
  14. Antacids
    • neutralize acids
    • raise pH
    • aluminum has low neutralizing capacity and slow onset and may cause constipation=Amphogel
    • magnesium has high neutralizing capacity and rapid onset, may cause diarrhea=milk of magnesia
  15. Antacids
    • calcium may cause acid rebound, kidney stones but has rapid onset
    • Combinations may be used=maalox, mylanta both mg and al
    • may also contain simethicone=antiflatulence
    • may cause problems with absorbtion when taken with other meds
  16. H2 receptors
    • histamine causes strong stimulation of gastric acid secretion
    • inhibits basal secretion of gastric acid and secretion stimulated by histamine, acetylcholine and gastrin
    • end in INE
  17. PPI
    • proton pump inhibitors
    • inhibits gastric acid secretion
    • Prilosec, Nexium, Prevacid, Protonix
  18. Prostaglandin E
    • inhibits gastric acid secretion
    • increases mucus and bicarbonate secretion
    • Cytotec
    • indicated for clients at high risk for GI ulceration and bleeding and taking high doses of NSAIDS
    • contraindicated in preg, induces abortion
  19. Sucralfate
    • prevent and treat peptic ulcer disease
    • coats gastric and duodenal mucosa
    • low incidence of adverse effects
    • give 2 hrs before or after drugs
    • dissolve in water in slurry
  20. H Pylori Agents
    • multiple drugs needed to eradicate
    • 2 antimicrobials= amoxicillin, metronidazole, tetracycline
    • Pepto Bismol
    • PPI or H2
  21. Principles of Therapy
    • PPI's first choice in most pts
    • H2 receptor drugs 2nd in defense
    • antacids used prn for heartburn and ab discomfort
    • simethicone for flatulence
    • sucralfate must be taken b4 meals
  22. PT Teaching
    • 2 common causes PUD=infection and NSAID use
    • To minimize reflux:elevate HOB, small meals, avoid supine for 1-2 hrs after meals
    • minimize fats, choc, citrus, coffee
    • avoid smoking and obesity
    • take meds with 8 oz water
    • do not take OTC meds for > 2 weeks
    • Cimetidine can increase toxicity of many drugs (rarely used now)
  23. PT Teaching cont.
    • Do not use Cytotec if pregnant or planning pregnancy
    • Magnesium can cause diarrhea
    • Aluminum or calcium can cause constipation
    • For acute PUD, treatment for 4-8 wks
    • antacids taken 1-2 hrs before meals or after meds
  24. Nursing Actions
    • Follow manufacturers recommendations for with/without foods
    • Shake liquids before dosing
    • Chew antacids and drink with water
    • be aware of drug-drug reactions
  25. Diabetes Mellitus
    • changes in metabolism of cholesterol, fat and pretein resulting in hyperglycemia (high blood sugar)
    • cells need insulin to move glucose into cell
  26. Type 1
    client does not produce insulin
  27. Type 2
    client is resistant to insulin
  28. Normal blood sugar levels
    Hyperglycemia=
    • 70-120
    • >126
  29. Type 1 characteristics
    • may occur in childhood or young adult but can at any age
    • autoimmune disorder that destroys beta cells in pancreas
    • NO insulin is produced so client requires insulin replacement
    • Spmptoms: polyuria, polydipsia, polyphagia and weight loss
    • Associated with more ketoacidosis, remal failure and end organ damage
  30. Type 2 characteristics
    • High blood sugars due to insulin resistance
    • They produce insulin but cannot get into cells and cells starve
    • Usually adults, gradual onset, often obese
    • Controlled with diet and exercise, oral antidiabetics
    • Associated with more heart attacks and strokes
    • Risk factors: genetic, obesity, sedentary life, race (AA, hispanics, native americans)
  31. Insulin Therapy
    • Only therapy for Type 1 pts
    • May be used for type 2 if not controlled without other meds or lifestyle change
    • Increased need for insulin:stress, . .
    • Blood sugars determin amt insulin needed
  32. Injection Sites
    • Abdomen: absorbs quickly (not w/i 2 in of naval)
    • Arms: Absorb slower than ab
    • Thighs and butt: Absorb slowest
  33. Insulin Lispro
    • Humalog
    • Onset 15 min, Peak: 1-2 hrs Duration 3-5 hrs
    • Synthetic
    • Used with longer acting insulin
    • Doses taken immediately prior to eating
  34. Regular insulin
    • Short acting
    • Humalin R, Novolin R
    • Onset: 30-60 min, Peak 2-3 hrs, Duration: 6-10 hrs
    • Drug of choice in emergency, severe infections, surgery and preg
    • Only insulin given IV
  35. NPH
    • intermediate
    • Humalin N
    • Onset: 1-2 hrs, Peak: 4-8 hrs, Duration: 10-18 hrs
    • Long term use
    • Cloudy fluid must be mixed before aspirating into syringe
    • Hypoglycemia may be experienced mid to late afternoon
  36. Insulin Mixtures
    • NPH 70/30 Humalin or Novalin 70/30
    • Cloudy and must be mixed
    • O, P, D same as if taken separate
  37. Long Acting Insulin
    • Glargine (lantus) or insulin Detemir (levemir)
    • Onset: 1-2 hrs, no peak, duration 24 hrs
    • Provides small amounts all day long
  38. Insulin Administration
    • SQ with insulin syringe
    • Room temp
    • Discard after 30 days
    • Keep in fridge
  39. Mixing insulin
    • Clear-Cloudy-Cloudy-Clear
    • Inject air equal to insulin units
    • Expel air bubbles and verify correct dose
    • Rotate injection sites
  40. Drugs that sensitize body to insulin and/or control hepatic glucose production
    • Thiazolidinediones
    • Biguanides
  41. Drugs that stimulate pancreas to make more insulin
    • Sulfonylureas
    • Glinides
  42. Drugs that slow absorption of starches
    Alpha-glucosidase inhibitors
  43. Sulfonylureas
    • Increase endogenous insulin secretion0makes body make more insulin
    • Side effects: hypoglycemia, weight gain, no specific effect on plasma lipids or BP, least expensive
    • Glyburide, Glipizide
    • Problem if allergic to sulfa
  44. Alpha Glucosidase Inhibitors
    • Block enzymes that digest starches in small intestine
    • Must be taken at beginning of meal
    • S/E: Flatulence, ab discomfort, no effect on lipids or BP, no weight gain, contraindicated in pts with inflammatory bowel or cirrhosis
    • Acarbose (precose)
  45. Biguanides
    • Decrease hepatic glucose production and increase insulin mediated peripheral glucose uptake
    • S/E: diarrhea, ab discomfort, lactic acidosis, decrease in LDL and triglycerides, no weight gain, possible weight loss, contraindicated in pts with impaired renal function (monitor BUN and creatinine)
    • Affects dyes in radiology so stop day b4 and 2 days after
    • Metformin
  46. Thiazolidinediones
    • Decrease insulin resistance be making muscle and adipose cells more sensitive to insulin and suppress hepatic glucose production
    • S/E: weight gain, edema, hypoglycemia with insulin, contraindicated in pts with abnormal liver function or heart failure
    • improves HDL and triglycerides
    • Avandia-risk for heart probs
  47. Glinides
    • Stimulate insulin secretion (rapidly and for short duration) in presence of glucose
    • Tak 30 minutes before meals
    • Not taken if meal is skipped
    • S/E: hypoglycemia, weight gain, no effect on plasma levels
    • repaglinide
  48. Incretin Mimetics
    • Slows inactivation on incretin hormones DDP4
    • Stimulates insulin secretion
    • Slows gastric emptying
    • Increases satiety
    • S/E:potential for hypoglycemia, weight loss, nausea, vomiting, diarrhea
    • Januvia
  49. Guidelines for AD drugs
    • Pregnancy: insulin injections only, no oral
    • Pts with DM 2 may need more agents in conjuntion with diet and exercise
    • Teach clients to monitor fingerstick BS
    • Teach pts symptoms of hypoglycemia and hypoglycemia
    • Have 2nd nurse double check doses
    • Pts should wear medic alert bracelet
  50. Type 1 signs and symptoms
    • Polyuria=increased urination
    • Polydipsia=increased thirst
    • polyphagia=increased hunger
    • weight loss fatigue, infections, rapid onset, insulin dependant, genetic, 10-15 yrs
  51. Hypoglycemia symptoms
    Tachycardia, irritability, restless, hungry, diaphoresis, depressioon
  52. Herbal supplements to increase BS
    bee pollen, ginko biloba, glucosamine
  53. Herbal supplements to decrease BS
    basil, bay leaf, chromium, echinacea, garlic, ginseng,
  54. Opoids relieve. . .
    • severe pain, decrease perception of pain, produce sedations, decrease effect of prostaglandin
    • Schedule II (high abuse poten)
    • Orally goes through significant first pass effect
    • Metabolized in liver and excreted thru kidneys
  55. Opoids are well absorbed via. . .
    • oral, IM, SQ
    • oral doses larger than inject
    • Effects may be therapeutic or adverse depending on use
  56. Opoid Analgesics
    CNS Effects:
    • Analgesia
    • CNS depression
    • Depressed mental and physical
    • REspiratory depression
    • N/V
    • pupil constrication
  57. Opoid Analgesics
    GI effects:
    • Slowed motility
    • Constipation
    • Smooth muscle spasms in bowel and bilary tract
  58. Opoid Analgesics
    Mechanism of Action:
    Indications for use:
    Contraindications:
    • Bind to opoid receptors in brain and spinal cods
    • Activate endogenous analgesia system
    • Used to prevent pain, relieve severe cough, slow GI tract
    • Contraindicated in pts with respiratory dep, chronic lung dis, liver or kidney disease, increased intracranial press, allergy
  59. Agonist: Morphine
    • Reduce moderate to severe pain
    • Schedule II
    • Produce analgesia, CNS depression, respiratory depression, GI depression
    • Activate endogenous analgesia system
    • PO, IM SQ
    • Contraindicated in liver disease, resp dep, lung disease, prostatic hypertrophy, ICP or hypersensitivity
  60. Morphine Onset/Peak
    • IV onset 10-20 min
    • IM onset 30 m in
    • SC onset 60-90
    • PO peaks at 60 min with 5-7 hr duration
  61. Codeine
    naturally occuring opiod alkaloid analgesic and antitussive
  62. Hydrocodone
    • similar to codeine
    • often in combo
    • Loritab=combo hydrocodone and acetaminophen
  63. Hydromorphone
    • Dilaudid
    • semisynthetic derivative of morphine
    • More potent than morphine
  64. Meperidine
    • Demerol
    • Synthetic similar to morphine
  65. Methadone
    • Dolophine
    • Synthetic like morphine
    • Often used in detox and maintaince of opoid addicts
  66. Oxycodone
    • semisynthetic derivitave of codeine
    • Also mixed with ASA or acetaminaphhen
    • Percodan/Persocet
  67. Fentanyl
    • Duragesic
    • transdermal patch
    • 72 hr duration
    • chronic severe pain or cancer pain
  68. Antagonists
    Naloxone:
    • Reverse or block analgesia, CNS and respiratory dep and other effects of opiod agonists
    • Complete and replace reseptors
    • Narcan most common
    • Therapeutic effect w/i minutes and last 1-2 hrs
    • May require multiple doses
  69. Principles of Drug Selection
    • Morphine drug of choice for severe pain (good for cancer pts)
    • If 2 analgesics ordered, use least potent to relieve pain
    • Non opoid/Analgesic combos-alternate or concurrent, synergistic effects (Lortab)
  70. Routes
    • Oral preferred
    • IV for rapid relief
    • PCA
    • Continuous IV
    • Epidural
    • Rectal supp
    • Skin patches
  71. Opoid Therapy in Children
    • Pain often undertreated
    • Labor and delivery drugs may affect neonate
    • Pain expression differs by age
    • Calculate doses carefully!
  72. Opoid therapy in Older Adults
    • Use non drug measures and non opoids when possible
    • Use opiods with short half life
    • Start low and increase gradually
    • May take longer to metabolize due to slower liver function
    • Monitor urine output for kidney function
  73. Opoid Patient Teaching
    • Stay in bed 30-60 after injectable opoid
    • Counsel on constipation prevention
    • Take PO doses with water or after meal
    • Do not crush long acting pills
    • Do not cut patches
    • Do not drive or operate heavy mach
    • No alcohol or other sedative
    • Adverse effects: low BP, sedation, confusion
  74. Opoid:
    Nursing Actions
    • Check vitals:rate depth and rhythm
    • If respiration less than 12/min delay/omit and call provider
    • If BP low, call provider
    • Lie down for injection and 30 min after
    • Give IV doses slow in small amount
    • Side rails up and call for assistance
    • Have wasted meds witnessed and cosigned
  75. Opoid: Observe for therapeutic effects:
    • Statement of relief
    • Decreases S&S of pain
    • Sleep
    • Increase in activity
  76. Opoid: Observe for adverse effects:
    • Respiratory depression
    • Hypotension
    • Excessive sedation
    • N/V
    • constipation
  77. What do NSAIDS do?
    Act centrally and peripherally to block transmission of pain impulses
  78. Prostaglandins
    • Chemical mediators in most tissue
    • Regulate cell function
    • normal inflammatory response-causing pain, fever, edema
    • Stimulated by infection, dehydration, act as pyrogens
  79. How to prevent prostaglandins from causing problems?
    • Cyclooxygenase is enzyme needed to produce prostaglandin
    • ASA NSAIDS and Acetaminophen inactivate cyclooxygenases
    • COX1 and 2-help you for clots
    • block COX1 and you increase adverse effects
    • block COX 2 and you increase therapeutic effects
    • Best=Celecoxib
  80. Action on Platelets
    • Aspirin and most NSAIDS inhibit platelet aggregation
    • platelets become slippery
    • at risk for bleeding
    • Acetaminophen and Cox2 do not affect platelet function
  81. ASA and Non selective NSAIDS
    • PUD
    • GI or bleeding disorders
    • Caution in pts with asthma
    • impaired renal function
    • Allergic to ASA=possible allergy to non ASA NSAIDS
    • ASA not for kids
  82. Aspirin ASA
    • well absorbed orally
    • onset of action 15-30 min, peak 1-2 hrs
    • food slows absorption, but decreases GI effects
    • Distributed to all body tissues and platelets (good for ppl with cardiovas disease because it makes platelets slippery and prevents clots
  83. Ibuprofen
    • well absorbed orally
    • onset of action 30 min, peaks 1-2 hrs, lasts 4-6 hrs
    • adults and kids take safely
  84. Indomethacin (Indocin)
    • Strong antiinflammatory effect
    • More seve adverse effects: GI ulceration, bone marros, hemo anemia
    • IV indo used to treat patent ductus arteriosus in infants
  85. Ketorolac (Toradol)
    • Pain relief, not for antiinflammatory
    • Orally or IV
    • parentarelly compares to morphine for post op pain relief
    • limited to 5 days use because bleeding/kidney damage
  86. Celecoxib (Celebrex)
    • well absorbed orally
    • peaks 3 hrs
    • Dosed 1/day
    • Low GI adverse effects
    • May increase BP in pts with hypertension
    • BLACK BOX warning: May increase rick of MI
  87. Acetaminophen
    • effective for mild pain relief
    • no nausea, vomiting, or GI bleeding
    • no interfecence in clotting
    • no antiinflammatory effects
    • peaks 1/2 to 2 hrs
    • Toxic metabolite=do not give more than 4000 mg/day
    • Do not use if kidney or liver disease
  88. Allopurinol (Zyloprim)
    Tx: Gout by preventing uric acid production
  89. Herbals:Glucosamine and Chrondroitin
    • Usually taken together to treat pain from osteoarthritis
    • Gluc may cause drowsiness, headache, GI distress
    • Chondroiton may cause GI distress
  90. ASA NSAIDS
    Patient Teaching
    • Can take COX 2 with daily low dose ASA
    • If one NSAID not effective, try another
    • For inflammation, improvement may occur 24-48 hrs with ASA, 1-2 wks with NSAID
    • Avoid ASA week before surgery and after to avoid bleeding probs
    • Avoid alcohol
  91. ASA NSAIDS
    Patient Teaching
    • Take with full glass of water and food
    • Do not take enteric coated with antacid
    • Increase fluids with NSAIDS to protect kidneys
    • Dont exceed 4000 mg acetaminophen per day
    • Avoid alcohol, Watch for salicylate toxicity
  92. Salicylate Toxicity
    • Increaced HR
    • Tinnitus, dizziness, confusion, drowsiness, N/V
  93. ASA NSAIDS
    Nursing Actions
    • Monitor for evidence of bleeding (black or tarry stools, bruises, bleeeding gums)
    • Lab work: CBC for hemoglobin hematocrit
    • BUN and Creatinine for kidney function
    • Monitor intake and output:
    • Intake 3000 mL per day
    • Output 30-60 ML per day

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