Pharm 4 Study Guide

8/17/2019 Pharm 4 Study Guide

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Pharm Exam 4 Study Guide

Chapters 47 & 48

Review non-pharmacological measures for diarrhea andconstipation

Diarrhea

• Clear liquids

• Oral solutions (Gatorade, pedialyte

• !" ele#trolyte solutions

• $%' diet (ananas, ri#e, applesau#e, toastConstipation

• Diet ()!G) *!$E%

• +ater

• Exer#ise

• %outine oel haits

Know about promethazine (Phenergan) MOA common usesreactions side e!ects

• Phenothiazine antiemeti#

• Side e-e#ts moderate sedation, hypotension, EPS, C.Se-e#ts, mild anti#holiner/i# symptoms (dry mouth, urinaryretention, #onstipation

• !t is relati0ely 1ree 1rom EPS at the loer antiemeti# doses

• Common uses #hemotherapy, pre op, post op

• 2O inhiits #hemore#eptor tri//er 3one

"raveler#s $iarrhea• #ute diarrhea

o sually #aused y E5 #oli

o *luoroquinolone antiioti#s

o !modium

o Can e redu#ed y drin6in/ ottled ater, ashin/

1ruit, and eatin/ #oo6ed 0e/etale5 2eats should e#oo6ed until they are ell done5

%ul& 'aatives

• Psyllium (2etamu#il

•

2O

asors ater into intestines, in#reases ul6 andperistalsis ith results in 89 hours

• 2ix in /lass o1 ater or :ui#e, stir and drin6 immediately,

1olloed y /lass o1 ater

• Side e-e#ts adominal #ramps, ex#ess laxati0e; ."D,

/as

Peptic lcer $isease (P$)


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• .on pharma#olo/i#al treatment measures

o 0oid toa##o, al#ohol, and hot, spi#y, and /reasy

1oodso 'a6e any .S!Ds ith 1ood or de#rease dosa/e

o Sit upri/ht hile eatin/ and at least ttin/ #lothin/

o !1 o0erei/h, lose ei/ht

• Common Causes

o )5 pylori is the ? #ause o1 pepti# ul#ers

o 2e#hani#al, /eneti#, en0ironmental

o .S!Ds and steroids

o Stress ul#er, 1olloin/ a #riti#al situation

• 2edi#al treatment

o )istamine 9 lo#6ers

@anta#, Pep#id, xid, 'a/ameto PP!s (proton pump inhiitors

Prilose#, pre0a#id, protonix

Chapters 4= & 4

Know commonl* used drugs+ %enadr*l Pseudoephedrine$etromethorphan

• Diphenhydramine ($enadryl

o 2O Competes ith histamine 1or re#eptor sites

pre0entin/ a histamine response5 %edu#es nasopharyn/ealse#retions, it#hin/, snee3in/

o ses 'reats a#ute and aller/i# rhinitis, antitussi0e

o Patient sa1ety points #ontraindi#ated in a#ute asthma

atta#6, se0ere li0er disease, narro an/le /lau#oma,urinary retention

!n#reases C.S depression ith al#ohol and other C.S

depressants, a0oid use o1 2O!s Side e-e#ts Drosiness, dry mouth, di33iness,

lurred 0isions, hee3in/, photosensiti0ity, urinaryretention, #onstipation, G! distress, lood dys#rasias

• Pseudoephedrine (Suda1ed

o 2O stimulates alpha adrener/i# re#eptors, produ#es

nasal 0aso#onstri#tion, shrin6s nasal mu#ous memranes,redu#es nasal se#retion, reound nasal #on/estion

o ses sed primarily 1or aller/i# rhinitis hay 1e0er and

a#ute #ory3a


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o Patient sa1ety points Caution patients to use 1or


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• Mucom*st 2u#olyti#

o ique>es and loosens thi#6 mu#ous se#retions

o dminister A minutes a1ter a ron#hodilator

o S)OD .O' $E 2!HED +!') O')E% D%GS

o lso an antidote 1or a#etaminophen (/i0e orally or dilute in

so1t drin6 or :ui#e• .nhaled gluticocorticoids

o antiinammatory e-e#t

o .ot help1ul in treatin/ a se0ere asthma atta#6

o 2ay ta6e 4 ee6s 1or an inhaled steroid to rea#h its 1ull

e-e#t

,hapters /0 12 3 14

,ommonl* used antibiotics

Amoicillin %road spectrum penicillino /ainst /rampositi0e and /ramne/ati0e

o Che#6otain #ulture and sensiti0ity e1ore dru/s are /i0en

o ssess renal 1xn, esp in older adults

o 2onitor 1or leedin/

o 2O.!'O% COSEI D%!.G ')E *!%S' DOSE

o !n#rease uids

o 'a6e hour e1ore or 9 hours a1ter meals

o $road spe#trum PC.s may de#rease e-e#ti0eness o1 oral

#ontra#epti0es5o Consider sa1ety issues hypersensiti0ity and

superin1e#tion

Azithrom*cin Macrolideso @ithromax (rand name

o .O' G!"E. !2, only Oral or !"

o $inds to A=S riosomal suunits and inhibits protein

synthesiso $road spe#tum

o Uses moderatetose0ere in1e#tions

%espiratory G! tra#t

S6in

so1t tissue

S'!s

o Treats

my#oplasmal pneumonia

e/ionnaireJs disease


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o Side efects

'innitus, ototoxi#ity

G! distress

Superin1e#tion

)epatoxi#ity

o Dru/ intera#tions

e0els o1 ar1arin, theophylline, and #arama3epine

in#rease Erythromy#in le0els in#rease ith u#ona3ole and

6eto#ona3ole KKKK%!SL O* SDDE. C%D!C DE')!.C%ESESKKKK

3ithromy#in le0els may e redu#ed y anta#ids

o .ursin/ inter0entions

C&S e1ore therapy

2onitor li0er en3ymes and 1or SS o1 :aundi#e

d0ise pt to ta6e 1ull re/imen 'a6e hour e1ore or 9 hours a1ter meals 1ull /lass

o1 ater 'a6e anta#ids 9 hours e1ore or 9 hours a1ter

medi#ation Pt #ould de0elop #on:un#iti0is hile usin/

a3ithromy#in, donJt ear #onta#t lenses hile ta6in/ %eport ss o1 super in1e#tion

'a6e on#e daily

%eprt onset o1 loose stools or diarrhea,

pseudomemranous #olitis should e ruled out

• %o#ephin Cephalosporins, road spe#trum (e-e#ti0e a/ainst/ram positi0e and /ram ne/ati0e

o Side e-e#ts pruritus, G! distress

+ith hi/h doses in#reased leedin/, sei3ures

KKKKK.EP)%O'OH!C!'IKKKKK assess renal 1xn

o Dru/ intera#tions l#ohol KK!2PO%'.' 'EC)!.G

PO!.'KK 2ay #ause ushin/, di33iness, heada#he, nausea,

0omitin/, mus#ular #rampso !nter0entions assess 1or aller/y

Per1orm C&S e1ore therapy (#ulture and sensiti0ity ssess li0er and renal 1xn

dminister !" o0er


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• 'etra#y#line

o 2O inhiits protein synthesis

o $road spe#trum

o *i/hts )5 pylori

o 'reats a#ne (oral, topi#al

o $a#terial resistan#eo %oute oral, !2, !"

o Side e-e#ts

Photosensiti0ity

Dis#oloration o1 permanent teeth KKdo not /i0e to

#hildren youn/er than 8 or to omen in the lasttrimesterKK

Stomatitis, G! distress

Pseudomemranous #olitis

$lood dys#rasia

Super in1e#tion C.S toxi#ity, hepatoxi#ity

.ephrotoxi#ity in hi/h doses

o d0erse e-e#ts

G! disturan#e

i0er 1ailure

"erti/o

Deposition o1 dru/ in ones and teeth

"O!D !. P%EG..CI

Phototoxi#ity

o !ntera#tions

2il6 produ#ts and anta#ids

Oral #ontra#epti0es

Di/oxin asorption is in#reased, leadin/ to toxi#ity

o !nter0entions

C&S

hour e1ore or 9 hours a1ter meals

2onitor 6idney and li0er 1xn

Edu#ate omen o1 #hild earin/ a/e aout side

e-e#ts terato/eni# e-e#t Store out o1 li/htheat

se suns#reen se e-e#ti0e oral hy/iene to pre0ent stomatitis

(mouth ul#ers se a a#6 up method 1or irth #ontrol i1 ta6in/ oral

#ontra#epti0es


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• Gentami#in

o mino/ly#oside 2a:or toxi# e-e#ts o1 amino/ly#osides

are ototoxi#ity and nephrotoxi#ityo .ursin/ inter0entions

Che#6 C&S

2onitor renal 1xn, hearin/ loss, alan#e se suns#reen photosensiti0ity

2onitor 1or super in1e#tion

2onitor pea6 and trou/h le0els

• Pea6 A8m#/ml

• 'rou/h =5A9m#/ml

2onitor !&Os

!1 uid inta6e is not restri#ted, en#oura/e pt to

in#rease uids

• $a#trim

o 'rimethoprimsul1amethoxa3oleo Syner/isti# e-e#t oth dru/s to/ether in one #ompound

#ause a#terial resistan#e to de0elop mu#h more sloly5o sed 1or urinary, intestinal, and loer respiratory tra#t

in1e#tions5 Otitis media, prostatitis and /onorrhea5 lsoused to pre0ent Pneumo#ysitis #arinii in patients ith !DS

o Side e-e#tsd0erse rea#tions

2oderate rashes

norexia

."D

Stomatitis

Crystalluria

Photosensiti0ity

KKK/ranulo#ytosis, aplasti# anemia

KKKller/i# myo#arditis

• !*E ')%E'E.!.G CO.D!'!O.S

o .ursin/ inter0entions

dminister ith 1ull /lass o1 ater hour e1ore or 9

hours a1ter meals !n#rease uid inta6e

2onitor 1or sore throat, ruisin/, leedin/

C$C Superin1e#tion

Do not ta6e ith anta#ids

0oid dire#t sunli/ht

Can in#rease hypo/ly#emi# e-e#t ith oral

antidiaeti# dru/s !n#reases anti#oa/ulant e-e#t ith ar1arin


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Chapters A & A9

Review ,onditions

• 5*poth*roidismDe#rease in thyroid hormone se#retion

o Chara#teri3ed y $rady#ardia, ei/ht /ain, extreme

1ati/ue, hair loss, #old intoleran#e, thi#6 ton/ue, slospee#h

o 2yxedema dult

o Cretinism #hild

• 5*perth*roidism !n#rease in #ir#ulatin/ '4 and '< le0els

o Gra0es disease and hyperthyroidism #aused y hyper

1un#tion o1 the thyroid /land5o Chara#teri3ed y ta#hy#ardia, palpitations, ex#essi0e

perspiration, heat intoleran#e, ner0ousness, irritaility,ul/in/ eyes, ei/ht loss

• $iabetes insipidus )i/h urinary output

o lo le0els o1 D)

o )ypernatremia

o Dehydrated

o ose too mu#h uid

o Presents ith ex#essi0e thirst

• 5*poparoth*roidism P') de>#ien#y, 0itamin D de>#ien#y,renal impairment, diureti# therapy, hypo#al#emia KKK

• 5*perparoth*roidism 2ali/nan#ies o1 the parathyroid /landso E#topi# P') hormone se#retion 1rom lun/ #an#er

o Prolon/ed immoility, durin/ hi#h #al#ium is lost 1rom

one

Review6• Pituitar* gland nterior and posterior

o nterior

Groth hormone tar/ets tissues and one (no

/land 'S) 'hryotropin thyroid stimulatin/ hormone

tar/et /land is the thyroid C') stimulates the release o1 #ortisol,

aldosterone, and andro/en 1rom the adrenal #ortexo Posterior

Oxyto#in

D)

• "h*roid gland re/ulates protein synthesis, en3yme a#ti0ity,stimulates mito#hondrial oxidation


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o 'hyroxine ('4

o 'riiodothyronine ('


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o 'ea#h pt ho to #he#6 lood /lu#ose

o 'ea#h pt ho to administer insulin

o 2ust #he#6 insulin dose ith another nurse i1 in an

inpatient settin/o 'ea#h 1amily memers to administer /lu#a/on y in:e#tion

i1 pt has a hypo/ly#emi# episode"*pes of insulin

• Rapid acting (clear) onset o1 a#tion AA minutes

o Pea6


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o #tions are to enhan#e insulin se#retion, in#rease eta#ell

responsi0eness, suppress /lu#a/on se#retion, slo /astri#emptyin/, and redu#e 1ood inta6e

o Gi0en 0ia pen in:e#tion

• Glimeperide and Glu#otrol

o Se#ond /eneration sul1onylureaso sed to treat type 9 diaetes

o Stimulate pan#reati# eta #ells to se#rete more insulin

• Glu#a/on

o )yper/ly#emi# dru/

o )yper/ly#emi# hormone se#reted y the alpha #ells o1 the

islets o1 an/erhanso !n#reases lood su/ar y stimulatin/ /ly#o/enolysis

o sed to treat insulinindu#ed hypo/ly#emia hen other

methods o1 pro0idin/ /lu#ose are not a0ailaleo

Parenteral use (su, !2, !"

8ursing interventions for oral antidiabetics dminister ith 1ood to de#rease G! upset

2onitor $G le0els

d0ise pt that hypo/ly#emi# episodes may o##ur, esp ith

sul1onyreas 'ea#h pt ss o1 hypo and hyper/ly#emia

'ea#h pt aout #omplian#e to li1estyle #han/es

'ea#h pt to report side e-e#ts ."D and rash

Caution pt not to drin6 al#ohol

Explain use o1 oran/e :ui#e, hard #andy, su/ar #ontainin/ drin6shen hypo/ly#emi# rea#tions e/in

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Pharm 4 Study Guide