11/2/2018

1

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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2

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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3

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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4

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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5

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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7

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)

54

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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!