NLN Medication Exam Study Guide Quizlet
NLN Medication Exam Study Guide Quizlet
NLN Medication Exam Study Guide Quizlet
1. Routes - Slowest to Fastest Transdermal --> sub-q --> IM --> buccal --> inhalation --> IV
2. 6 Rights of Medication Administration 1. Right Person
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Right medication
3. 3 Medication Checks 1. When removing medication from drawer/cart/pixis
2. Before dispensing medication
3. After dispensing medication but before giving it
4. Allergic/Hypersensitivity Reactions Immune response - not a side effect
Determined by degree of sensitization of the immune system
Sensitivity can change over time
mild itching to severe rash to anaphylaxsis
5. Absorption Process of incorporating drug into blood
6. Distribution Movement of drugs through the body
Transport via blood to site of action
7. Metabolism Ability to change a drug biologically from its original form into a water-soluble
form so it can be excreted by the kidneys
8. Excretion Removal of drugs from the body
9. Agranulocytosis/Neutropenia/Agranulocytopenia Acute decrease int eh number of granulocytes/leukopenia (WBCs) in peripheral
blood
Causes: treatment with broad spectrum penicillin, sulfonamides, or
cephalosporin; bone marrow transplant; chemotherapy; radiation
Generally impaired resulting from bone marrow depression by drugs and
chemicals or replacement by a neoplasm
Lymphadenopathy or lypmphadenitis may be prevalent
Could --> respiratory infection, ulceration of mouth, colon, high fever, or UTI
May be asymptomatic
10. Chelating Agents A substance whose molecules can form several bonds to a single metal ion
Involves oral administration or injection of Ethylene Diamine tetra Acetic Avide
may be used to treat hardening of the arteries, heart attack, stroke, arthritis, and
gangrene - removes excess calcium from body
Used for lead poisoning and hypercalcemia
11. Ethylenediaminetetraacetic Acid (EDTA) Use in children with a lead level between 45-70 micron/dL
Binds to lead in blood and excreted by bowel and kidney
May be toxic to the kidney - monitor urine output
Give IV - dose depends on weight of child, severity of poison
- Give q4h 5 days
- Second course may be needed if there is a rebound in blood level
Give oral and IV fluid to enhance excretion
Do not use with hypocalcemia or hypokalemia
Used to treat lead poisoning and hyperkalmeia
12. British AntiLeistie (BAL) Do not give with iron supplement
Avoid in patients with plant allergy
Give IM
Treats poisoning with heavy metals (arsenic, gold, mercury)
13. Succimer (Chemer/Chemet) Chemet = oral
Used to treat lead poisoning
Do not give in patient with encephalopathy
14. Epistaxis Nose bleed
Posterior is more serious
D/t rupture of blood vessels within richly perfused nasal mucosa
Blood can come up through eye, or flow down into stomach --> n/v
Treatment: cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon
gauze, absorbent dressing or saline sprayed into the nose
Ice pack to forehead or back of neck
pinch septum for 5 minutes
Do not pack nose with tissue or gauze
15. Half-life Time it takes for a medication to lose 1/2 its pharmacological or physiologic effect
16. Paradoxical Response to drug that is the opposite of the usual response
Reaction
17. -teron Androgens
18. -pril ACE inhibitors
19. -pressin Antidiuretic hormoens
20. -statin Antilipidemic
21. -vir Antiviral
22. -pam Benzodiazepines (mostly)
23. -lol eta Blockers
24. -pine Calcium Channel Blockers
25. Diltiazem Calcium Channel Blocker - exception
(Caridzem)
26. Verapamil Calcium Channel Blocker - exception
(Isoptin)
27. -mide Carbonic anhydrase inhibitors
28. "est" Estrogens
29. -sone Glucocorticoids and corticosteroids
30. -dine Histamine H2 Receptor Antagonists
31. "nitr" Nitrates
32. "Pancre" Pancreatic enzyme replacements
33. -zien Phenothizines
34. -zole Proton Pump Inhibitors
35. "sulf" Sulfonamides
36. -zide Thiazide Diuretics
37. -ase Thrombolytics
38. "thy" Thyroid hormones
39. -line Xanthine brnchodilators
40. Aminoglycoside Antibiotic
Treats serious life-threatening gram negative (and some positive) infections
All end in -mycin (but not all drugs ending in -mycin are aminoglycosides)
Generally IM or IV (PO not recommended - only for bowel prep or prior to surgery)
Ex: Bactrim
57. Side Effects of Sulfonamides Rash common - most are utricaria and maculopapular
GI symptoms
Bone marrow depression
HA
Dizziness/vertigo
Ataxia
Convulsion
Depression
58. Adverse Effects/Toxicity of Hepatotoxicity
Sulfonamides Nephrotoxicity
Stevens Johnson Syndrome
59. Cautions with Sulfonamides Do not use if:
- Known allergies to sulfa drugs
- In polyuria, advanced renal or hepatic dysfunction
- With intestinal and urinary blockage
- Asthma
Adequate fluid intake (3,00-4,000 mL/day) to promote urinary output, at least 1,500 mL/d to
prevent crystalluria/stone formation
May be taken after meals to prolong time in intestine
Collect C/S prior to beginning therapy
60. Thiazdie Diuretics Ex: Chlorothiazide (Hydrodiruil), Hydrochlorothiazide (HCTZ, Diuril)
Ends in -ZIDE
Non-potassium sparing diuretic
Acts on distal tubes, blocks reabsorption of sodium, chloride, and water. Leads to increased loss
of potassium
Use for edema and mild to moderate HTN
Will see effect within 1-4 weeks
61. Side Effects with Thiazide Dizziness, vertigo, HA, weakness, dehydration, orhtostatic hypotension
Diuretics N//V, abdominal pain, diarrhea, constipation, frequent urination
Dermatitis and rash
Electrolyte imbalance
Impaired glucose tolerance
62. Adverse Effects/Toxicity of Renal Failure
Thiazide Diuretics Aplastic anemia
Agranulocytosis
Thrombocytopenia
Anaphylactic reaction
63. Cautions with Thiazdie Diuretics Take early in the day to avoid nocturia
Take with food to avoid GI upset
Thiazide is ineffective if creatinine clearance is <30 mL/min
Eat foods high in K+
Restrict sodium - do not use salt substitute if taking K+-supplement
Weigh self daily and report sudden weight gains or losses
Avoid use with children and anuria
64. Tricyclic initial mechanism takes 1-3 weeks to develop
Antidepressants Maximum response is achieved in 6-8 weeks
Long half-life
Blocks the reuptake of NE or 5HTs or both, leaving more available in the CNS. It intensifies the effect of NE
and 5HT which can elevate mood, increase activity and alertness, decrease preoccupation with morbidity,
improve appetite and regulate sleep pattern
It is used to treat insomnia, attention deficit/hyperactivity and panic disorder
HSV - does not eradicate latent herpes. Reduces shedding and formation of new lesions and speeds healing over time
Decreases symptoms with varicella zoster
Side Effects: HA, dizziness, seizure, N/V, diarrhea, acute renal failure, thrombocytopenia purpura, hemolytic uremia
syndrome
Even after HSV is controlled, latent virus can be activated by stress, trauma,fever, exposure to sunlight, and sexual
intercourse
Refrain from sex if s/s of herpes
79. Alteplase Thrombolytic agent
Recombinant Dissovles or breaks down clots to reestablish perfusion
(Activase) Indicated for those at risk of developing thrombus w/ resultant ischemia like MI, ischemic stroke, arterial
thrombosis, DVT, and PE
Also for occlusion of catheters
Do not give with pregnancy, active bleeding, recent hx of CVA, and uncontrolled HTN
Given 2 hours apart from other drugs where interaction may occur.
Observe for s/s altered PO4 levels, anorexia, muscle weakness, malaise
Increase fluid, exercise, and fiber to prevent constipation
Contraindications: abdominal pain, N/V, diarrhea, severe renal dysfunction, fecal impaction, rectal bleeding,
colostomy, ileostomy, dehydration, hpercalcemia, and hypercalciuria
83. Ampicillin (Ampicin) IV, PO, IM antibiotic (aminopenicillin)
Treats bacterial infections
- Commonly used with shigella, salmonella, E. coli, H. influenza, N. gonorrhea, N. meningitis, and gram positive
organisms
Side Effects: GI, N/V, abdominal pain , pruritus rash like measles
Do not give with fruit juice, milk, or caronated beverages (poor absorption)
Watch for hypokalemia
Take on empty stomach
May not be necessary to stop tx if mild diarrhea develops
Give yogurt or buttermilk to restore normal flora
Contraindications:
- HS to any penicillin's (use cautiously if hx of HS to cephalosporins)
- Exfoliated dermatitis
- Loop diuretics - exacerbate hypokalemia and rash
- K-sparing Diuretics - may contribute to hyperkalemia
84. Atropine Sulfate Anticholinergic (Parkinson's) and for ophthalmic use
Systemic effect is more pronounced in infants and children w/ blue eyes/blonde hair
Increased risk of toxicity w/ Down Syndrome
Adverse Effects/Toxicity: adrenocortical insufficiency, f/e disturbances, nervous system effects and
endocrine effects if absorbed systemically
Do not abruptly stop taking drug - will have withdrawal symptoms (5-7 days)
Contraindications: hypersensitivity
90. Chlorothiazide Thiazide Diuretic (non-potassium sparing)
(Diuril) Antihypertensive
Increases urinary excretion Na+ & water by inhibiting Na+ reabsorptioin
Use for edema & HTN, HF, cirrhosis, corticosteroid & estrogen therapy, diabetes insipidus
Side Effects: dizziness, vertigo, frequent urination, electrolyte imbalance, impaired glucose tolerance,
hyperuricemia, photosensitivity
Adverse Effects/Toxicity: renal failure, aplastic anemia, and anaphylaxsis
Side Effects: sedation, orthostatic hypotension, anticholinergic effect (dry mouth, blurred vision, urinary
retention, photophobia, constipation, tachycardia), liver damage, tremor are 2 major side effects,
photosensitivity
Adverse Effects/Toxicity: neuroleptic malignant syndrome (NMS), catatonia, rigidity, stupor, unstable BP,
profuse sweating, dyspnea
Get baseline ECG, thorough baseline elevation lab tests before treatment
Withdrawal of drug is necessary
Take measures to protect eyes exposed to sunlight
Contraindications: hypersensitivity
Use cautiously w/ impaired renal or hepatic function
93. Cisplatin (Platinol) Antineoplastic mediation; Alkylating agent
Major allergic rxn can occur w/n 15 min of amdin (anaphylaxsis w/n minutes)
Half-life 20-30 minutes
Treats ovaraina nd testicula rcancer by interfering with DNA replication
Maintain fluid at least 3,000 mL/24 hours - report reduced urine output
Aovid food high in thiamine --> HTN & intracranial hemorrhage
Adverse Effects/Toxicity: anaphylactic shock, sudden death, severe optic nerve atrophy (after years of
use or w/ Leber's disease)
Side Effects: temporarily decreases hearing after, mild feeling of fullness sin ear, mild itching in ear
Adverse Effects/Toxicity: emergency help w/ allergic rxn - hives, difficulty breathing, swelling of face, lips,
tongue, throat
Tilt head w/ ear facing up - pull back on ear and drop into canal
After using stay lying down w/ head tilted for 5 minutes - may use small piece of cotton to plug ear
Bubbling sound may be heard
May come w/ bulb syringe
Contraindications: ruptured ear drum, s/s of ear infection/injury, children <12 yrs w/o HCP consent, longer
than 4 days in a row
99. Diazepam Benzodiazpeine; mild tranquilizer, anticonvulsant, anxiolytic
(Valium) Absorbed form GI
Metabolized by liver
Onset: 30 min IM, 0 min PO, 15 min IV
Peak: 1-2 hour PO
Duration: 15 min-1 hour IV, up to 3 hrs. PO
Half-life = 20-50 minutes
Relieves pain from discomfort w/ musculoskeletal disorders, manages anxiety, manages acute alcohol withdrawal
Max effect w/n 1-2 weeks (2-4 wks for addictive effect)
Side Effects: Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness, cardiovascular collapse,
laryngospasm, dizzy, weakness, nausea
Adverse Effects/Toxicity: erythema multiforme, angioedema, anaphylaxis, dysrhythmia, seizure
Contraindications: compromised pulmonary function, hepatic disease, impaired myocardial function, acute EtOH
intoxication, infant <6 months, narrow angle/open angle glaucoma
100. Digoxin Cardiac glycoside, antiarrhythmic drug
(Lanoxin) Therapeutic Range = 0.5-2.0 ng/mL
Toxic Level > 2ng/mL
Antidote = digibind
Positive inotropic effect
In HF it increases contraction of heart muscle
In a-fib it slows HR
Contraindications: HS
Caution w/ kidney failure
IV calcium increases risk of cardiac dysrhythmia
Erythromyocin increases dig level
Quinidine, verapamil, and amiodarone increases dig levels (decrease dig dose by 50%)
Cyclophosphamide combineed with dig causes toxicity
101. Disulfiram Only EtOH antagonist in use
(Antabuse) Enzyme inhibitor and anti-EtOH agent
Half-life = 24-36 hours
Onset up to 12 hours
Duration up to 2 weeks
Absorbed from GI tract
Excreted via feces or in breath as carbon disulfide
Adjacent treatemnt of pt. w/ chronic alcoholism who sincerely wants to maintain sobriety
At least 12 hours should elapse from last EtOH intakke and initial dose
Use only in those w/ high physical health
Use 1-2 weeks
Intended Rxn w/ EtOH: flushing face, arms, chest; pulsating HA, nausea, violent vomiting, thirst, sweating, marked
uneasiness
Adverse Effects/Toxicity: acetaldehyde syndrome (hypotension to shock levels, arrhythmias, acute congestive
failure, marked resp. depression, unconsciousness, convulsions, sudden death)
Contraindications: people who don't want to stop drinking, severe cardiac disease, psychoses, pregnancy, multiple
drug dependence
102. Epinephrine Alpha & beta Adrenergic Agonist; Vasopressor; Bronchodilator
(Adrenaline) IM/sub-q results in 5 minutes and lasts up to 4 hours
Also available in eye drops and intranasal
Side Effects: nervousness, tremors, increased HR/BP, insomnia, anorexia, cardiac stimulation, vascular HA
Adverse Effects/Toxicity: tachyarrhythmias, chest pain, restlessness, agitation, nervousness, insomnia, nasal burning
& stinging, eye burning
Hypersensitivity of eyes: lid itching, discharge, crusting eyelid (notify HCP and d/c)
May be taken w/ food. Pain relief may not be experienced for several days.
TCA and MAOI combination can --> hypertensive crisis from excessive adrenergic stimulation of the heart and
blood vessels
105. Fluphenazine (Proloxin) Phenothaizine; antipsychotic
Half-life = >24 hours
Onset = 1 hour
Peak 0.5 hour
Effect seen in 1-2 days, but full effect takes weeks
Side Effects: EPS (reversible), Anticholienrgic (dry mouth), blurred vision, constipation, drowsiness;
photosensitivity, increased risk of agrnaulocytosis, gynecomastia, amenorrhea, wight gain
Adverse Effects/Toxicity: neurolpetic malignant syndrome (NMS
Monitor LFT's
Avoid alcohol use and other CNS depressants
Do not abruptly stop
Avoid sun exposure
With oral concentrate avoid spills - rinse skin w/ warm water immediately w/ contact
Dilute liquid drug w/ fruit juice, water, carbonated beverage, milk, or soup - avoid mixing with
caffeine, tea, apple juice
Caution with narrow angle glaucoma, hepatic/renal dysfunction, and seizure disorders
DO NOT BREASTFEED!
Reduced doses in elderly
106. What to treat Cogentin, Artane, Benadryl, Symmeteral
Extrapryamidal Side Effects
(EPS) with?
107. Neuroleptic Malignant Presents with cataonia, rigidity, stupor, unstable BP, hyperthermia, profuse sweating, dyspnea,
Syndrome (NMS) incontinence
Stop the drug and treat with Dantrium and Parlodel
Lasts 5-10 days after stopping the med
Fatal side effect of meds
108. Furosemide Loop Diuretic; antihypertensive
(Lasix) Peak = 60-70 minutes PO, 20-60 minutes IV
Onset = 30-60 minutes PO, 5 minutes IV
Duration = 2 hours
Half-life = 30 minutes
Rapid-acting loop diuretic; inhibits reabsorption of sodium and water (in Loop of Henle); lowers BP by
decreasing edema and intravascular fluid
Treats: acute pulmonary edema, edema, heart failure, chronic renal impairment, HTN, hypercalcemia
Contraindications: anuria, electrolyte depletion, increasing oliguria, hepatic coma, pregnancy, lactation
Interactions with digitalis - can increase arrhythmias
Interaction w/ aminoglycoside - risk of ototoxicity
109. Gentamicin Aminoglycoside antibiotic
(Garamycin) Peak drawn 15-30 minutes after infusion completed
Trough drawn 30 minutes before next dose (1-2 g/mL)
Peak = 30-90 min
Half-life = 2-4 hours
Broad-spectrum antibiotic; parenteral use limited to severe infections unreponsive to other ab's
Ophthalmic use: treats superficial infection of the eye; have patient keep eyes closed 1-2 minutes after
instillaiton; vision blurred immediately
Maintain hydration to protect kidney damage (2,500-3,000 mL/day); Give high protein foods
Monitor WBC, kideny function tests (BUN, Cr.) closely
Report sore throat, watery stools >4-6/day, severe n/v - indicates possible superinfection
Should awaken w/n 5-20 minutes of giving; givee 50% glucose if no repsonse
Teach: test blood sugar; teach family how to administer
Incompatible w/ NaCl
113. Glyburide (Micronase, Oral antidiabetic; Sulfonylurea
DiaBeta) More potent drug
Onset = 15-60 minutes
Peak = 1-2 hours
Duration up to 24 hours
Half Life = 10 hours
Metabolized in the liver, excreted in urine and feces
Lowers blood sugar concentration in diabetics and nondiabetics by sensitizing pancreatic beta cells to
release insulin in the presence of serum glucose
Use: T2D
Adjunct to diet and exercise to lower blood sugar
Side Effects: anticholinergic (dry mouth), blurred vision, constipation, drowsiness, EPS (Parkinson's S/S);
photosensitivity
Adverse Effects/Toxicity: elderly may develop neuroleptic malignant syndrome (NMS)
EPS: usually first few days of treatment; dose-related and controlled by dose or anti-Parkinson's drugs
Oral: give w/ milk or food
Taper dose slowly when stopping
Injection: deep IM - risk for orhtostatic hypotension
No EtOH or driving until repsonse is known
Does not dissolve clots - prevents enlargement and development of new clots
Use bleeding precautions
Monitor labs - aPTT (normal = 25-40; coagulated = 1.5-2x normal = 60-80)
Adjust IV dose based on labs
Give w/ food or milk to reduce GI upset; give doses early in the day to avoid nocturia
Limit Na+ intake and eat foods high in K+ - replacement med is not usually needed
Photosensitivity rxn can occur in 10-14 days after initial sun exposure
Side Effects: CNS depression; drowsiness, dizziness, dry mouth, anticholinergic effect, constipation,
visual changes, photosensitivity
Administer deep IM - z-track - gluetus maximus or vastus lateralis in adults; vastus lateralis in kids
Monitor mouth daily; no EtOH, hard candy, ice chips, or rinse mouth w/ warm water frequently to
relieve dry mouth
Side Effects: CNS, renal system, eyes, nephrotoxicity, dysuria, hematuria, oliguria, azotemia, blurred
vision, ototoxicity
Child toxicity = Rash, Stevens Johnson Syndrome
Side Effects: hypoglycemia (anxiety, confusion, nervousness, hunger, diaphoressis, cool, clammy skin);
lipodysrophy, local allergic rxn
Adverse Effects/Toxicity: Somogyi phenomenon; coma, hyperosmolar hypeglycemic state (HHS), diabetic
ketoacidosis (DKA)
Obtain med alert bracelet; open vial can be stored at room temp for up to 1 month; rotate sites; alcohol
will increase sugar
Requires long-term monitoring of blood sugar control and potential complications
Adverse Effects/Toxicity: cardiotoxicity is most serious if vomiting does not occur and the substance is retained
use of this med is not automatic - verify appropriateness w/ poison control center
Contraindications = sinus bradycardia, severe degrees of SA, AV, intraventricular heart block
Caution w/: hepatic or renal disease, CHF, hypovolemia, shock, hyperthermia, elderly
Side Effects: drowsiness, sedation, mild medication w/ limited toxic potential; resp. depression is rare
Paradoxical rxns: nightmares, mania, etc may occur in children, psych pts., and the elderly
Contraindications: acute narrow-angle glaucoma, primary depression, acute EtOH intoxication, pregnancy and
lactation
Caution w/: renal/hepatic impairment; myasthenia gravis, suicidal tendencies
129. Magnesium Iron (Epsom Salt - oral form)
Sulfate Onset = 1-2 hours PO, 1 hour IM
Duration = 30 minutes IV, 3-4 hours PO
Eliminated by kidneys
Normal Mg = 1.8-3 mEq/L
Oral: laxative (by osmotic retention of fluid whyponatremai, hich distends the colon, increases the content of
feces, and causes bowel stimulation)
Parenteral: CNS depressant; used in seizures of toxemia; for hypomagnesmia
Use in oliguria and ARF (helps to prevent RF and reduce increased intracranial or intraoccular pressure); increases
osmolality of plasma, glomerular filtrate, and tubular fluid. Decreases the reabsorption off f/e which increases the
excretion of H2O, CL, and Na and slightly increases the excretion of K
Side Effects: HA, confusion, syncope, f/e imbalance (esp. hyponatremia), pulmonary congestion, rhinitis, water
intoxication
Adverse Effects/Toxicity: seizure, thrombophelbitis, CHF, CV collapse, hponatremia
May be a rebound increase in ICP 12 hours after administration of med - complains of HA and confusion
Use filter needle and/or filter in infusion tubing because crystals may form in he sol'n
Held if serum osmolality exceeds 310-320
Daily weights
Non-narcotics like tylenol if HA
Therapy based on urine flow rate
Reassure pt that excessive thirst, blurred vision, rhinitis should subside when Mannitol is d/c'd
Contraindications: severely impaired renal fx; marked dehydration, breast feeding, hepatic failure, active ICP, anuria,
intracranial bleed/shock
Side Effects: N/V, anorexia, sedation, dizziness, elevated BP, rash, urticaria, tremors, hyperventilation
Adverse Effects/Toxicity: respiratory depression, respiratory arrest, circulatory depression, increased ICP
Contraindications: acute bronchial asthma, upper airway obstruction, increased ICP, convulsive disorder, pancreatitis,
acute UC, severe liver/kidney insufficiency
Caution w/: children and elderly
133. Metoprolol Tartate Beta Blocker; Antihypertensive, Antiangial
(Lopressor, Toprol) Decreases HR and CO - lowers BP
Mild-to-severe HTN, angina pectoris, post-acute MI
Max effect takes 1 week
Side Effects: usually well tolerated; n/v; weight gain; worsening CHF; insomnia
Adverse Effects/Toxicity: profound bradycardia, heart block, acute CHF, bronchospasm, laryngospasm
Contraindications: HS to opiates; acute bronchial asthma or upper airway obstruction; ICP, convulsive
disorders, pancreatitis, acute UC, severe liver/kidney disease
Do not give to children
135. S/S of Morphine Craving
Withdrawal Chills
Sweating
Piloerection
Abdominal pain/cramps
Diarrhea
Runny nose
Irritability
136. Naloxone HCl (Narcan) Opioid Antagonist
Onset = 1-2 min IV, 2-5 min SQ/IM
Duration = 1 hr. IV, up to 4 hrs. IM but starts to diminish after 20 minutes
Competes w/ opioids at the opiate receptor sites, blocking effects of the opioids
Reverses effects of opiates (resp. depression, sedation, hypotension)
May need every few hours
Side Effects: increased BP, HR, hyperapena, tremors, hyperventilation, drowsiness, nervousness, N/V
Adverse Effects/Toxicity: hypotension, V-tach/v-fib; convulsion, hepatitis, pulmonary edema
Contraindications: known allergy, resp. depression d/t non-opioids, substance abuse (--> withdrawal
s/s)
137. Nedocroil (Tilade) Inhaled NSAID - anti-inflammatory/antiasthmatic
Also in opitic form
Asthma prophylaxsis - not acute attacks
Up to one week for full effectiveness
Must be taken regularly to be effective
Rinse mouth after taking med to avoid dry mouth; do not use for an attack
Non-compliance is concern d/t bitter taste
Side Effects: usually well tolerated; HA, fatigue, dizziness, postural hypotension, peripheral edema
Adverse Effects/Toxicity: gingival hyperplasia
For fetal anoxia: stop infusion, turn mom on left side and O2 PRN
Stop infusion for: contraction occurring >q2 minutes or lasting >90 seconds
Antidote to atropine
Side Effects: visual blurring, myopia, irritation, brow pain, and HA (w/ ophthalmic);
increased pigmentation of iris and eyelids, long eye lashes
Adverse Effects/Toxicity: Retinal detachment, ataxia, confusion, and seizure
Apply gentle pressure for 1-2 minutes to nasolacrimal drainage area after administering
eye drops
Eye therapy will continue long-term
Side Effects: dizziness, drowsiness, fatigue, weakness, priapism, impotence, orthostatic hypotension
Adverse Effects/Toxicity: first dose phenomenon - syncope w/n 30 minutes to 1 hour - effect is transient
and may diminish by giving at bedtime
Contraindications: HS, blood dyscrasias, dementia related psychosis in elderly, young children, seizures,
lactation
146. Promethazine Antiemetic, antihistamine, anti-vertigo
(Phenergan) Long-acting med; motion sickness; nausea
IM route: give deep; not SQ (can cause necrosis)
Avoid intra-arterial injection - can cause necrosis
Side Effects: resp. depression, drowsiness, confusion, agranulocytosis, blurred vision, dry mouth, EPSE
Decrease GI distress by giving PO dose w/ milk or food. May crush and mix w/ food.
Avoid sunlight exposure
Avoid EtOH and other CNS depressants
Contraindications: HS
Caution w/: impaired renal/hepatic function
May in crease effects of EtOH, aspirin, Coumadin, and sulfonylureas
149. Rho(D) Biological response modifier; Immunoglobulin
Immune Peak = 2 hours
Globulin Half-life = 25 days
(RhoGAM) Given to Rh-negative moms with Rh positive babies
Provides passive immunity by suppressing active antibody response and formation of anti-RHo when positive fetal
RBCs enter maternal circulation in 3rd stage of labor, there is fetal maternal hemorrhage or trauma during
pregnancy, termination of pregnancy or miscarriage, or following an Rh+ infusion
Send sample of newborn cord blood to lab for cross match and typing immediately after delivery before
administering RHo (D)
Give to mom IM via deltoid - only a few forms IV
Give immediately after reconstitution
Recommended at 28 weeks gestation and then w/n 72 hours after delivery or 3 hours of termination/miscarriage
Keep epinephrine available - systemic allergic rxns sometimes occur
Teach it will prevent hemolytic disease in a subsequent pregnancy
Side Effect: causes fewer disorders than other antidepresants; fewer SE on HR and HTN, sexual
dysfunction; weight gain
Major Complication: selective serotonin syndrome - pt. can die; elevated temp up to 105 (increased
BP/HR/Temp); may progress to coma
Contraindications: serum K >5.5; anuria; acute/chronic renal insufficiency; diabetic nephropathy; HS;
impaired hepatic function
Decreases effect of digoxin
Increases chance of lithium toxicity
152. Tobramycin Sulfate Aminoglycoside antibiotic
IV/IM; inhalation (TOBI), and ophthalmic (Tobrex)
Broad-spectrum antibiotic that kills bacteria cell by affecting protein synthesis; kills gram-negative
infection
Inhalation: preventative w/ CF (28 days on and 28 off)
Eye - external eye infections
Doses are based on weight. Do not give other meds in the same IV!
Labs: peak/trough, serum cr., BUN
Side Effects: drowsiness, decreased U.O (retention and hesitancy), dry mouth, constipation
Adverse Effects/Toxicity: paralytic ileus
Uses: acute lymphoblastic and other leukemias, lymphosacroma, Hodgkin's disease, breast/lung disease
Side Effects: major toxicities occur in hematopoietic, integumentary, neurologic, and reproductive system;
peripheral neuropathy; paralytic ileus (more common in young children); alopecia
Adverse Effect/Toxicity: neurotoxicity - loss of sensation of the soles of feet and fingertips; depression of the
Achilles reflex is the earliest sign of neuropathy; children are especially likely to develop neuro changes
Contraindications: obstructive jaundice, preexisting neuromuscular disease, active infection, pregnancy, lactaiton
Bronchospasm may occur in pt. previously treated wwith mitomycin
157. Hyaluronidase Given if vesicant infiltrates (Vincristine Sulfate - Oncovin)
158. Vesicant Good vein - prefer central access or fresh butterfly stick
Safety Chemo-trained nurse
Precautions Remain during infusion
Have antidote handy
159. Vitamin B6 Water-soluble vitamin absorbed by GI tract
(Pyridoxine Prevention and treatment of pyridoxine deficiency
HCl) Co-enzyme in AA metabolism and RBC production
Treats acute toxicity of INH, hydralazine