Final Exam Study Guide

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Final exam study guide
Pharmacological Basis For Nursing Interventions I (Nova Southeastern University)
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NUR 3191 FALL 2011 STUDY GUIDE- FINAL EXAM
The examination will contain 75 multiple questionst Time allotted for this
exam will be 113 minutes (1 hrt 53minutes)t
The following study guide is intended to assist you in preparing for the
examination and may not contain all information included on the exam.
1 questions related to introduction and primary concepts. 14 questions
related to hematologic, antineoplastic, and immunosuppressant drugs. 7
questions related to Immunizing agents and HIV. 11 questions related to
GI drugs. 10 questions related to antianxiety and narcotic drugs. 8
questions related to antidiabetic drugs. 1 questions related to endocrine
drugs. 12 questions related to antifungal and antibiotic drugs.
Remember this is a guide.
o Intro/ concepts: CH.1 & 2

Assessment of learning needs /teaching. Steps of nursing
process and pharmacokinetics (e.g. first-pass effect,
elimination). Drug schedule and drug classification, toxicity…
 Role of RN in medication administration

o Assessment of the client
o Medication orders
o Researching the medication(s) ordered
o Analysis of data: Developing a nursing diagnosis
o Planning goals: Identifying goals and outcome criteria
o Implementation
o Patients’ rights
o Evaluation of drug therapy
 Steps of nursing process  use of the nursing process will be able to
develop effective solutions to meet patient’s needst
o Assessment
 Subjective/objective
o Diagnosis
o Planning
o Implementation
o Evaluation
 Pharmcoakinetics

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o Absorption- the movement of a drug from its site of

administration into the bloodstream
 Factors affecting rate and amount of absorption:
 Route of administration
 Gastric pH
 Contents of GI tract
 Short Bowel Syndrome
 Bariatric surgery
 Routes of administration  Topical, oral, rectal (enteral)
 Sublingual/ buccal  bypass liver  absorbed rapidly
 Transdermal bypasses first-pass affect as well
 Parenteral route (fastest)  IV, IM, SQ, ID  directly
into circulation
 IV is the fastest
 IM and SQ are slower
 Bioavailability: the term uses to express the extent of
drug absorption
 First pass effect: the initial metabolism in the liver of a
drug absorbed from the gastrointestinal tract before the
drug reaches systemic circulation through the
bloodstream
 First pass effect reduces the bioavailability of the
drug to less than 100%
 A drug that is given IV skips first pass effect 
making it 100% bioavailable
 Ext If most of the drug is chemically changed into
inactive metabolites in the liver, then a smaller
amount will pass into circulation  making it a
high pass effect and lower bioavailabilityt
 Variables affecting absorption:
 Ability of the medication to dissolve
o Fastest=liquids, elixirs, syrups
o Slowest=Enteric coated tablets
 Body surface area
 Food in stomach/other medications
o Antacids*/Dairy products*
 Decreased blood flow
 Synergistic effect

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 The effects of 2 or more medications in which one

enhances the effect of another
o Distribution- process by which drug is carried from its site of

absorption to its site of action (bloodstream or circulation 
site of action)
 Plasma protein binding
 bound drugs do not cross membranes
 Malnutrition=decrease albuminincrease free
drug
o Burns
o Malnutrition can raise the risk for drug
toxicity
 Unbound  “free drug”
o Only unbound molecules can leave the
vascular system
 Bound  inactive
o Bound molecules are too large to fit through
pores in the capillary wall
 When an individual is taking two medications that
are highly protein bound, the medications may
compete for binding sites
o Competition leads to  more free bound
drugs  drug-drug interaction (when one
drug increase or decreases the actions of
another drug when given at the same time
 Blood-brain barrier
 Areas of rapid distribution:
 Heart
 Liver
 Midneys
 Brain
 Areas of slow distribution
 Muscle
 Skin
 Fat
o Metabolism- process by which the body changes a drug from
its original form to a form that is pharmacologically inactive
and can be readily eliminated or excreted

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 Metabolism is also called BIOTRANSFORMATION

 Biotransformation of a drug into:
o Inactive metabolite
o More soluble compount
o More potent metabolite
 Organ most responsible for metabolism of drugs 
LIVER
 Other metabolic tissues include: skeletal muscle,
kidneys, lungs, plasma, and intestinal mucosa
 Factors that affect metabolism
 Decrease metabolism:
o Cardiovascular dysfunction
o Renal insufficiency
o Starvation
o Obstructive jaundice
o Slow acetylator
 Increase metabolism
o Fast acetylator
o Barbiturates
o Rifampin therapy
 Induces p-450 enzymes
 Effects of metabolism
 Delayed drug metabolism results in:
o Accumulation of drugs
o Prolonged action
 Stimulating drug metabolism results in:
o Diminished pharmacologic effects
o Excretion- Process where all drugs and/or their metabolites are
eliminated from the body
 Primary organ responsible for elimination  MIDNEY
 Liver and bowel as well
 When drugs are passed by liver they are easier to
excrete (polar or water based)
 Biliary secretion (small intestine)  drugs
eliminated by this route are taken up by the liver,
released into the bile, and eliminated in the feces
o Enterohepatic recirculation

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o Half-life- the time required for one-half (50%) of a given drug

to be removed from the body
 Drug schedule for Controlled Substances

o Schedule I
 high abuse potential
 Not legally approved
o Schedule II
 Highly abusive but with accepted use
 Prescription only
 Container must have warning label
 Ext Codeine, cocaine, morphine
o Schedule III
 lower abuse potential
 expires in 6 months, no more than 5 refills in 6 months
 ext Codeine w/ other meds such as acetaminophen
o Schedule IV
 still lower abuse
 prescriptions expire in 6 months no more than 5 refills in
6 months and container must have warning label
 ext Phenobarbital diazepam, tramadol
o Schedule V
 contain only small amount of narcotic
 Minimal risk for abuse
 Ext Meds generally for relief of coughs or diarrhea
 Drug classifications
o Actions
o Affected body system
o Symptom relieved
o Chemical characteristics
o What is a prototype?
 Prototype is the first form of the drug medication that is
use to create alternative forms
 Drug toxicity
o Related to prolonged use of a medication or accumulation of a
medication in the bodyt
o Patients with low albumin levels in their body are at risk for
drug toxicity because they will have a lot of free unbound
molecules floating in the body

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o Ch. 54,45,41 Iron with side effects, and dextran injections. Epotein alfa.
5-Flurouracil related to administration with side effects. Chemotherapy
and infusion and intrathecal route: nursing considerations. Filgrastim:
what to look for effectiveness of therapy. Action of Tamoxifen. Effects of
estrogen to control tumor growth.
 Iron
o Essential mineral in the body
o Oxygen carrier in hemoglobin and myoglobin
o Stored in the liver, spleen, and bone marrow
o Iron deficiency results in anemia
o Dietary sources: meats, certain vegetables and grains
o Dietary iron must be converted by gastric juices before it can be
absorbed
o Some foods enhance iron absorption
 Orange juice
 Veal
 Fish
 Ascorbic acid
o Some foods impair iron absorption
 Eggs*
 Corn
 Beans*
 Cereal products containing phytates
 * Also common dietary sources of iron
o Supplemental iron may be given as a single drug or as part of a
multivitamin preparation
o Oral iron preparations are available as ferrous salts
 ferrous fumarate (Femiron), ferrous gluconate, ferrous
sulfate(FeSO4)
 Ferrous salts are contraindicated in patients with
ulcerative colitis, PUD, liver disease, and other GI
disorders
o Parenteral
 iron dextran (INFeD, Dexferrum)
 Iron: Adverse effects
o Causes nausea, vomiting, diarrhea, constipation, and stomach
cramps and pain

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o Causes black, tarry stools

o Liquid oral preparations may stain teeth
o Injectable forms cause pain upon injection
 Iron: Contraindications
o Mnown drug allergy
o Iron overload
o Hemolytic anemia
o Any other anemia not associated with an iron deficiency
 Iron: Toxicity
o Symptomatic and supportive measures
o Suction and maintenance of the airway, correction of acidosis,
control of shock and dehydration with intravenous fluids or
blood, oxygen, and vasopressors
o Chelation therapy with Desferal (deferoxamine): is used for
severe symptoms of iron intoxication, such as coma, shock, or
seizures
o Ferriprox (Deferiprone) is used in iron overload
 Parental Iron: Iron dextran
o IV or IM
o May cause anaphylactic reactions, including major orthostatic
hypotension and fatal anaphylaxis
o Test dose of 25 mg of iron dextran is administered before
injection of the full dose, and then remainder of dose is
given after 1 hour (to prevent orthostatic hypotension &
fatal anaphylaxis)
o Administer deeply into a large muscle mass using the Z-
track method
o Used less frequently now; replaced by newer products ferric
gluconate and iron sucrose (due to the fact that it can potentially
case anaphylaxis)
o Iron dextran is contraindicated in all anemia except for iron
deficiency anemia (just use for iron deficiency)
 Chemotherapy and infusion and intrathecal route: nursing
considerations.
o Drugs have a narrow therapeutic index
o Combination of agents is usually more effective than single-
agent therapy
o Nearly all agents cause side effects and adverse effects

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o Dose-limiting adverse effects

o Harmful to all rapidly growing cells
 Harmful cancer cells
 Harmful to healthy, normal human cells
 Hair follicles
 GI cells
 Bone marrow cells
o Routes of administration:
 Oral
 Subcutaneous
 Intravenous
 Intraarterial
 Intrathecal (subarachnoid space)
 This route is used to deliver certain chemo
medications to kill cancer cells in the CNS.
 may be reconstituted with NS or patients spinal
fluid
 Intraperitoneal
 Intravesicular
 Chemotherapy Implications:
o Chemotherapeutic agents – Are among some of the most toxic
drugs
o Potency of agents place clients’ at high risk for toxicity, serious
complications
o Requires very skilled and cautious administration
 PPE  change after each use or 30 minutes after wear
 Extravasation
o Leaking of an antineoplastic drug into surrounding tissues
during IV administration
o Can result in permanent damage to nerves, tendons, muscles,
loss of limbs
o Skin grafting or amputations may be necessary
o Prevention is essential
o Continuous monitoring of the IV site is essential
o If suspected, stop the IV infusion immediately but do not
remove the IV tube
o If possible, aspirate remaining drug or blood from the tube
o Follow extravasation instructions per facility protocol –

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o Do Not remove IV line - may need to give antidote through

the existing IV tube, then remove the catheter
o Some antidotes are not given through the IV catheter
o Cover area with sterile, occlusive dressing
o Apply warm or cold compresses, depending on the extravasated
agent
o Elevate the limb
o Remember, follow institution extravasation protocol - steps
listed above are just guidelines
 Nursing implications for chemotherapy (BASICALLY JUST WATCH
YOUR PATIENT CHEMO IS INTENSE)
o Follow specific administration guidelines for each
antineoplastic agent
o Assess baseline blood counts before giving any antineoplastic
agents
o Assess for complications: Bone marrow suppression
(MYELOSUPRESSION)
 Leukopenia
 Thrombocytopenia
 Anemia
 Nadir- the lowest WBC after chemo
o Remember that all rapidly dividing cells (both normal and
cancer cells) are affected
 Mucous membranes
 Hair follicles
 Skin
 Monitor for effects on these tissues or complications
 GI mucous membranes: stomatitis, altered bowel
function with high risk for poor appetite, nausea,
vomiting, diarrhea, and inflammation and possible
ulcerations of GI mucosa
o Monitor for side effects specific to the type of antineoplastic
agent given
o Monitor for fluid and electrolyte imbalance secondary to N/V/D
o Maintain accurate I & O
o Force fluids (2500 mL/day) unless contraindicated
o Monitor weight
o Monitor for signs of renal and hepatic toxicity

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 Neupogen (filgrastim) – drug used in the treatment of leukopenia

o Promotes the proliferation, differentiation, and activations of
cells that make granulocytes (WBCs)
 Epotein alfat (epogen)– works by stimulating bone marrow to make
RBCs
o Biosynthetic form of the natural hormone erythropoietin, which
is normally secreted by the kidneys in response of low RBCs
o Used for treating anemia that is associated with end stage renal
disease, chemotherapy- induced anemia, and Hb less than
11g/dl
o The medicated is ineffective without adequate body iron stores
and bone marrow function  these may need oral or IV iron
o Used in patients with head or neck cancer or patients at risk for
thrombosis is controversial as these medications increase tumor
growth and risk for thrombosis
o Most frequent adverse include HTN, headache, pruritus, rash,
N/V, arthralgia, and injection site reaction
o It was found that when hemoglobin levels are above 11 and the
drug is continued, patients experienced serious adverse effects,
including heart attack, stroke, and death
o
 5-Flurouracil related to administration with side effectst
o Pyrimidine antagonist
o Antimetabolite
o Used in a variety of treatment regimens including palliative
treatment of cancers of the colon, rectum, stomach, breast, and
pancreas
o Also used in the adjuvant setting in the treatment of breast and
colorectal cancer
o Adverse effects
 N/V
 Hair loss
 Diarrhea
 Myelosuppression
o Give antiemetic 30 minutes prior to administration due to N/V
side effect
o Do not add to any other medication IV because of the high
incidence of reactions

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o Do not give with warfarin because of the enhanced

anticoagulant effects
 Action of Tamoxifen – estrogen modulator
o It blocks the effects that the hormone estrogen has on cancer
cells and lowers the chance that breast cancer will
growt Tamoxifen: Has been used for decades to treat patients
with advanced breast cancer
o Basically it blocks the activity of estrogen in the breast  this
may stop the growth of some breast tumors that need estrogen
to grow
 Effects of estrogen to control tumor growth
o Highiamountsiofiestrsgeniinitheibloodimayiincreaseiaiwoman'si
breasticanceririsk.i
o Muromonab-CD3 administration ss. Bioterrorism agents.

Cyclosporine/ rejection. Immunity types and examples, foscarnet,
antiretroviral agents. Ch. 40, 48, 49
 Muromonab-CD3 administration ss.

o Treatment of ACTIVE rejection in kidney, liver, and heart
transplantation (reversal of organ rejection once rejection of a
transplanted organ has started)
o It specifically targets the binding sites on T cells that recognize
foreign invaders, such as transplanted organ
o Can cause cytokine release syndrome
o Patients are often pretreated with a corticosteroid
o This drug is only available in injectable form
 Bioterrorism agents
o Anthrax
o Smallpox
o Botulism
o Tularemia
o Viral hemorrhagic fever
o Plague
 Cyclosporine/ rejection
o PREVENTION of rejection of kidney, liver, heart
o May be used for the treatment of other immunologic disorders
 Arthritis, psoriasis, IBD

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o Grapefruit juice should be avoided  it may increase

bioavailability of cyclosporine by 20%-200%
o Can also cause nephrotoxicity
 Immunity types and examples
o Active immunity- occurs when one makes his/her own
antibodies
 This type of immunity is long term
 Antitoxins
 Antisera
 Toxoids
 Stimulates one’s immune system to produce a
specific antibody
 Examples: Diphtheria & Tetanus
 Vaccines
 Inactive microorganisms that stimulate production
of antibodies against a particular organism
 Prevents the person from contracting the disease
 Vaccines with live bacteria/virus provide
LIFELONG immunity
 Vaccines with killed bacteria/virus provide
PARTIAL immunity and booster shots are needed
 Examples: BCG vaccine (tuberculosis), Hepatitis
A and B virus vaccines, Measles, mumps, and
rubella virus vaccine, live—several forms
o Poliovirus vaccine, several forms
o Influenza virus vaccine
o Meningococcal vaccine
o Pneumococcal vaccine
o Rabies virus vaccine
o Human papillomavirus vaccine
o Herpes zoster vaccine
o Varicella virus vaccine
o Indications for active immunization:
 Prevents infection caused by bacterial toxins or viruses
 Provides long-lasting or permanent immunity
 “Herd immunity”
o Passive immunity (passive/artificial)- antibody produced in

another host

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 This immunity is TEMPORARY

 Short lived compared with active immunity but works
faster
 Naturally
 From mother to fetus through the placenta
 From mother to infant through breast milk
 Artificially
 Acquired from an external source, such as
injection of antibodies or immunoglobulins
 Examples:
 Antivenins: Pit viper, coral snake, Black widow spider
 Hepatitis B immunoglobulin
 Immunoglobulin, various forms
 Rabies immunoglobulin (human)
 Rh0(D) immune globulin (RhoGAM)
 Tetanus immunoglobulin
 Varicella zoster immunoglobulin (chickenpox)
o Indications for passive immunization:
 Antitoxins, antivenins, immune globulins
 Minimizes effects of poisoning by the venoms of spiders
and certain snakes
 Provides quick immunity before a person’s own immune
system has a chance to make antibodies (such as in cases
of exposure to hepatitis B or rabies viruses)
o Foscarnet—it can treat cytomegalovirus (CMV) eye infection in
AIDS patientst It can also treat herpes simplex virus infections
in the nose, mouth, vagina, and rectumt
o Antiretroviral agents
 Highly active antiretroviral therapy (HAART)
 Combinations of anti-retroviral drugs (cocktails)
 Standard of care
 HAART begins immediately upon confirmation of HIV
infection
 Goal: viral load < 50 copiest Ml
 Suppresses viral replication
 Opportunistic infections treated with infection-specific
antimicrobial drugs
 Prophylactic treatment for opportunistic infection is
common
 CD4 counts < 200 cells/mm

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 Opportunistic malignancies treated with antineoplastic

medications
 Long term HAART can cause bone demineralization and
possible osteoporosis
o 5-Classes of Antiretroviral Drugs
 Reverse Transcriptase Inhibitors
 NRTIs
 NNRTIs
 Protease Inhibiters
 Fusion Inhibitors
 Entry Inhibitor-CCR5 Coreceptor Antagonists
 HIV Integrase Strand Transfer Inhibitors
o Nursing process antiretroviral
 Monitor labs
 Monitor for s/s of opportunistic infection
 Remain upright for 30 minutes to avoid esophageal
ulceration
 Continuous monitor of labs
 Assess IV preparations for sediment/precipitate
 Ensure steady-state: administer at evenly spaced intervals
 Provide patient centered teachings
 Monitor for adverse effects
 Monitor for therapeutic effects
 Monitor for toxicity
 Reevaluate and modify the plan of care as needed
o Ch. 50,51,52 GI meds e.g. Calcium carbonate, sodium bicarbonate,

bismuth salicylate, omeprazole, Protonix including interactions with
other medicines. Citrate of magnesia, simethicone, laxatives.
 Calcium carbonate
o Used as an antacid to relieve symptoms of indigestion and
heartburn
o S/s: produces gas and belching
 Often combined with simethicone (antiflatulent) due to
gas and belching
o Can be used as an extra source of calcium
o Should be avoided in patients with renal disease
 They can accumulate to toxic levels

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 Sodium bicarbonate
o Reduces stomach acid
o Used as an antacid to treat heartburn, indigestion, and upset
stomach
o Quick acting
o Used only for TEMPORARY relief
o Recommended for patients with renal compromise because they
are easily excreted
 Bismuth subsalicylate (Pepto-Bismol)
o Oral use
o CAUTION with children and teenagers who have or recovering
from chicken pox or influenza because of the risk for Reye’s
syndrome
o Same adverse effects associated with aspirin-based products
o Darkening of tongue and stool are normal
 Omeprazole (Prilosec)
o PPI
o Works best taken 30 to 60 minutes before meals
 Pantoprazole (PROTNIX)
o PPI
o Short term treatment
o Indications: GERD, erosive esophagitis, ulcer, stress ulcer
prophylaxis
o Contraindication: drug allergy
o Only PPI available for parenteral administration, and can be
used for clients who are unable to take oral medications
o Interactions w/ other medications May increase serum
levels of diazepam, phenytoin, and cause increased chance for
bleeding with warfarin
 PPI nurse implications
o Take before meals
o The capsule should be swallowed whole, not crushed, opened,
or chewed
o It may be taken with antacids concurrently
o Emphasize that the treatment is SHORT TERM
 Citrate magnesia (citroma)
o Saline laxative

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o Used to clean stool from intestines before surgery or certain

bowel procedures (etgt colonoscopy, radiography)
o Helps remove unabsorbed poisons from GI tract
o Used for relief of occasional constipation
o Usually creates bowel movement with 30 minutes to 3 hours
o Drink water to prevent dehydration
o Watery stool
o Unpleasant tasting
o CAUTION with patients with renal insufficiency because they
can be absorbed enough to cause hypermagnesia
 Simethicone (mylicon)
o OTC antiflatulent
o Only available for oral use
o Used to reduce the discomforts of gas or intestinal gas
(flatulence) and aids in its release via mouth or rectum
o Alters elasticity of mucus-coated bubbles, causing them to
break
 Laxatives
o Bulk forming
 Mechanism of action
 High fiber
 Absorbs water to increase bulk
 Distends bowel to initiate reflex bowel activity
 Indications
 Acute and chronic constipation
 Irritable bowel syndrome
 Diverticulosis
 Side effects
 Impaction
 Fluid overload
o Emollient
 Stool softeners and lubricants
 Promote more water and fat in the stools
 Lubricate the fecal material and intestinal walls
 Indications
 Acute and chronic constipation

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 Softening of fecal impaction; facilitation of BMs

in anorectal conditions
 Side effects
 Skin rashes
 Decreased absorption of vitamins
 Examples:
 Stool softeners: (docusate salts) Colace, calcium and
sodium
 Lubricants: mineral oil
o Hyperosmotic
 Increase fecal water content
 Result: bowel distention, increased peristalsis, and
evacuation
 Indications
 Chronic constipation
 Diagnostic and surgical preps
 Side effects
 Abdominal bloating
 Rectal irritation
o Saline
 Increase osmotic pressure within the intestinal
tract, causing more water to enter the intestines
 Result: bowel distention, increased peristalsis, and
evacuation
 Indications
 Constipation
 Diagnostic and surgical preps
 Removal of helminths and parasites
 Side effects
 Magnesium toxicity (pts with renal insufficiency)
 Cramping
 Diarrhea
 Increased thirst
o Stimulant
 Increases peristalsis via intestinal nerve
stimulation
 Indications

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 Acute constipation
 Diagnostic and surgical bowel preps
 Side effects
 Nutrient malabsorption
 Skin rashes
 Gastric irritation
 Rectal irritation
o Ch. 10 Analgesic: acetaminophen, fentanyl patch, and Morphine

Sulfate side effects. Therapeutic effect of opioid analgesic. Monitoring
patients with PCA pump. Anxiety and pain combination meds. Alcohol
and meds. Lorazepam, barbiturates mechanism of action
 Acetaminophen
o Mechanism of action  blocks peripheral pain impulses by
inhibition of prostaglandin synthesis
o Analgesic and antipyretic (fever reducer) effects
o No anti-inflammatory effects
o No link to Reye’s syndrome
o No increase in bleeding potential
o Available OTC and in combination products with opioids
o Overdose—Toxic to hepatic cell = liver toxicity
o Alternative to aspirin
o Contraindications
 Drug allergy
 Severe liver disease
o Adverse side effects
 Skin disorders
 Nausea
 Vomiting
 Anemia
 Nephrotoxicity
 Hepatotoxicity (MOST SERIOUS)
 Associated with excessive doses
 Acetaminophen is combined with hydrocodone
and oxycodone and patients may exceed limit
without knowing
 FDA limits 4000mg however Tylenol says
3000mg/day

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 Patients with liver disease or chronic alcohol

consumption 2000 mg/day
o Toxicity and Management of Overdose
 Ingestion of large amounts of acetaminophen as in acute
overdose or chronic unintentional misuse can cause
hepatic necrosis
 Long term ingestion of large doses can result in severe
hepatotoxicity
 Acetylcysteine is the recommended antidote
 It works by preventing the hepatotoxic metabolites
of acetaminophen from forming
 Most effective when given within 10 hours of
overdose
 It is given oral and IV
o Oral smells like rotten eggs people vomit
 Given 140 mg/kg then you give 70
mg/kg q4h for 17 doses
o IV is tolerated better
 Fentanyl patch
o Transdermal delivery (patch) has been shown to be highly
effective in the treatment of chronic pain syndromes such as
cancer-induced pain, especially in patients who cannot take oral
medicationst
o Fentanyl patches are difficult to titrate and are best used for
non-escalating pain
o Fentanyl patches take 6 to 12 hours to reach steady state pain
control after appliedt Most pts experience pain control for about
72 hourst A new patch is to be applied every 72 hours
o Do not expose the patch to heat because it diffuses faster into
the ptst Body
o Unused patches should be flushed down the toilet
 Morphine sulfate
o Naturally occurring opioid → derived from poppy seed
o Available oral, injectable, rectal
o MS contin/ Madian → extended release

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o Potentially toxic metabolite → morphine 6 glucuronide (mostly in

renal ptt)
o Itching is not allergic reaction, it is a pharmacologic effect due to

histamine release
 Therapeutic effect of opioid analgesic

o Decreased severity of pain
o Decreased complaints of pain
o Increased periods of comfort
o Improved activities of daily living, appetite, and sense of well-
being, self-care,
o Decreased fever (acetaminophen)
 Random opioids stuff
o Opioids are used for:
 Cough center suppression
 Treatment of diarrhea
 Balanced anesthesia
o Considerations: peds and elderly
o Opioid tolerance is result of chronic opioid treatment  which
then results in larger dose of opioid to main same level of
analgesia
 Monitoring patients with PCA pump
o Amount and time of dosing needs to be noted
o Monitor for CNS depression
o Have PRN antidote like narcan (naxalone) because of the risk
of overdose
 Anxiety and pain combination meds
 Alcohol and meds
o Alcohol is the most the most dangerous interaction with
acetaminophen
o Chronic heavy alcohol abusers may be at increased liver
toxicity from excessive acetaminophen use
o A maximum 2000mg is generally recommended for alcohol
abusers
o Should not exceed three drinks daily
 Lorazepam (Ativan)
o Should only be used in short term
o Side effects of drug

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 drowsiness, dizziness, tiredness;

 blurred vision;
 sleep problems (insomnia);
 muscle weakness, lack of balance or coordination;
 amnesia or forgetfulness, trouble concentrating;
 nausea, vomiting, constipation;
 Appetite changes; ort
 Skin rasht
o Dependence and tolerance develop quickly
o S/S of with-drawl
 Anxiety, tremors, insomnia
 Grand mal seizures, delirium
 Respiratory depression and death
 Barbiturates
o Mechanism of action  CNS depressants that act primarily on
the brainstem in an area called the reticular formation
o Don’t give barbiturates with anti-anxiety because it could cause
CNS depression
o Ch. 32 Metformin, glipizide, sulfonylurea, regular insulin. Lispro.

NPH. Mechanism of action, uses. Nursing considerations.
 Metformin (Glucophage)
o Decreases glucose production from the liver
o Increase uptake of glucose by tissues
o Does not stimulate insulin secretion from the pancreas 
therefore not associated with weight gain or hypoglycemia
o Decreases triglycerides and cholesterol
o Metformin is taken with meals to reduce GI effects
o Indications
 Type 2
 Prediabetes
 CAN be used in combination with insulin and
sulfonylurea drugs
o Contraindications
 Renal patients

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1t Metformin is primarily secreted by the kidneys and

can accumulate in these patients causing an
increased risk of lactic acidosis
2t Alcoholism
3t Metabolic acidosis
4t Hepatic disease
5t Heart failure
o Adverse effects
 GI (take it with meals to prevent)
 Bloating
 Cramping
 Diarrhea
 Reduced b12 levels
 Metallic taste in mouth
 Lactic acidosis  hyperventilation, cold clammy skin,
muscle pain, irregular heart beat
o Interventions
 Stop metformin 24 hours before CONTRAST test and 48
hours’ after
 Sulfonylureas
o Bind to specific receptors on beta cells in the pancreas to
stimulate the release of insulin
o Second step drugs for patients whose A1C levels remain
elevated after metformin
o Should NOT be used in patients with advanced diabetes and
dependent on insulin
o Not used in type 1 diabetes
o Side effects
 Hypoglycemia, hematologic effects, nausea, epigastric
fullness, heartburn
 Glipizide (Glucotrol)
o Rapid stimulation of insulin of pancreas
o Contraindications  in cases of known drug allergy, type 1 or
late type 2 diabetes (you need functioning beta cells on
pancreas for drug to work)
o Can be used with metformin
o Can NOT be used with insulin
 Once insulin is started administered sulfonylureas are
stopped

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o It is not contraindicated with patients with severe renal failure

o Works best if given 30 minutes before meals, usually before
breakfast
 Regular Insulin
o Short acting
o Humulin R, Novolin R
o The only insulin product that can be given by IV bolus, IV
infusion, or even IM
o IV is often used in cases of DKA or coma associated with
uncontrolled type 1 diabetes
o Best given 30 minutes before a meal
o Function as a substitute for the endogenous hormone
o Effects are the same as normal endogenous insulin
o Restores the diabetic client’s ability to:
 Metabolize carbohydrates, fats, and proteins
 Store glucose in the liver
 Convert glycogen to fat stores
 Lispro (Humalog)
o RAPID ACTING
o Most rapid onset of action (15 minutes)
o Shorter duration
o It essential patient eats meal after injection
 Injection should be within 15 minutes of mealtime
o Hypoglycemia will be result if there is no meal after injection
o The effect of lispro is most like that of the endogenous insulin
produced by the pancreas in response to a meal
 NPH (isophane)
o Humulin N, Novolin N
o Intermediate acting
o The only available intermediate-acting insulin product
o NPH is acronym for neutral protamine Hagedorn insulin
o Appears cloudy and opaque
o Slower onset and longer duration than regular insulin but not as
long as long-acting insulins
o NPH is often combined with regular insulin to reduce the
number of insulin injections per day
 Nursing considerations

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o Before giving any drugs that alter glucose levels, obtain:

 A thorough history
 Vital signs
 Blood glucose level
 Potential complications and drug interactions
 Assess the client’s ability to consume food
 Assess for nausea or vomiting
 Hypoglycemia may be a problem if antidiabetic agents are
given and the client does not eat
 If a client is NPO for a test or procedure, consult physician
to clarify orders for antidiabetic drug therapy
 Keep in mind that overall concerns for any diabetic
client increase when the client:
at Is under stress
bt Has an infection
ct Has an illness or trauma
dt Is pregnant
 Thorough client education is essential regarding:
 Disease process
 Diet and exercise recommendations
 Self-administration of insulin or oral agents
 Potential complications
 When insulin is ordered, ensure:
 Correct route, Correct type of insulin, Timing of the dose
and Correct dosage
 Insulin order and prepared dosages are second-checked with
another nurse
o Insulin
 Check blood glucose level before giving insulin
 Administration: Depends on if using insulin pens or vials
 Ensure correct storage of insulin if using vials
 ONLY insulin syringes, calibrated in units, are to be used to
measure and give insulin
 Ensure correct timing of insulin dose with meals
o Oral antidiabetic agents
 Always check blood glucose levels before giving
 Usually given 30 minutes before meals
 Alpha-glucosidase inhibitors are given with the first bite of
each main meal
 metformin is taken with meals to reduce GI effects

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 Assess for signs of hypoglycemia

 If hypoglycemia occurs:
 Have the client eat glucose tablets or gel, corn syrup, honey,
fruit juice or soft drink
 Or have the client eat a small snack such as crackers or half
a sandwich
 Give glucagon as prescribed
 Monitor blood glucose levels
 Monitor for therapeutic response
at Decrease in blood glucose to normal levels or to the
level prescribed by health care provider
bt Watch for hypoglycemia and hyperglycemia
ct Hemoglobin A1C to monitor long-term compliance to
diet and drug therapy
o Ch. 30,31 & 33 Effects of corticosteroids, glucocorticoids,
Vasopressin, Corticotrophin therapy (side effects). Levothyroxine,
management, ss. Education.
 Effects of corticosteroids
o Moon face occurs after long term use
o Corticosteroids can inhibit the immune response when given in
combination with immunizing biologics
o Can reduce hypoglycemic effects of antidiabetic drugs and
result in elevated blood glucose levels
o Short term or long term use can lead to steroid psychosis
o Long term use of steroids should NOT be stopped abruptly
 The administration of these drugs cause the body’s own
production of the hormones to stop
 Adrenal suppression (HPA) can cause impaired stress
response and place the patient at risk for developing hypo
adrenal crisis
 Adrenal suppression can occur as early as one week after
a corticosteroid is started
 HPA usually doesn’t occur in patients taking prednisone
5mg or less
 Tapering of the drug allows the time to recover and
stimulation of normal production of hormone
o Patients on long-term steroid therapy who are taking at least
10mg/day of prednisone and who undergo trauma or require

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surgery will need replacement doses of steroids known as stress

doses
 Glucocorticoids
o Topical, systemic, inhaled, nasal
o Glucocorticoids inhibit or help control inflammatory and
immune responses
o Administration:
 By inhalation for control of steroid-responsive
bronchospastic states
 Nasally for rhinitis and to prevent the recurrence of
polyps after surgical removal
 Topically for inflammations of the eye, ear, and skin
o Contraindications
 Drug allergy
 Cataracts
 Glaucoma
 PUD
 Mental health problems
 Diabetes metillus (may increase blood glucose)
o Glucocorticoids are usually avoided when it comes to
infection due to their immunosuppressant properties except
for tuberculosis meningitis
 For TB meningitis it is used to prevent inflammatory
CNS damage
o Don’t give to patients with GI issues  it can lead to gastric
perforation
o Serious adverse effect  adrenal suppression
o Examples: (sones  steroids)
 (betamethasone) several formulations
 (hydrocortisone) (several formulations)
 (dexamethasone) Decadron
 (cortisone)
 (Methylprednisolone) Solu-Medrol
 (prednisone)
 (prednidolone)
 Many others
 Vasopressin
o Post pituitary agent

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o Used in treatment of DI (diabetes insipidus)

o Used in the treatment of various types of bleeding, especially
GI bleeding
o Agents should NOT be discontinued abruptly
o Vasopressin should reduce severe thirst and decrease urinary
output
o Elevates BP
o Contraindicated in patients with a known hypersensitivity to it
o Should be used in caution in patients with seizure disorders,
asthma, cardiovascular disease, and renal disease
o WATCH IV SITE CLOSELY for any signs of infiltration
 IV infiltration may lead to severe vasoconstriction and
localized tissue necrosis
o Nasal vasopressin not to be inhaled
 Cortiotropin therapy
o Corticosteroids decrease bone formation→ osteoporosis
o Cortisol reduces calcium absorption in intestine
o Cortisol decreases synthesis of collagen which is important

component of connective tissue

 Levothyroxine (Synthroid)
o Synthetic thyroid hormone T4
o Mechanism of action:
 Thyroid preparations are given to replace what the
thyroid gland cannot produce to achieve normal thyroid
levels (euthyroid)
 Thyroid drugs work the same way as thyroid hormones
o Levothyroxine is the preferred agent because its hormonal
content is standardized; therefore, its effect is predictable
o Its half-life is long enough that it only needs to be administered
once a day
o Used for thyroid replacement in clients whose thyroid glands
have been surgically removed or destroyed by radioactive
iodine in the treatment of thyroid cancer or hyperthyroidism
o Side effects:
 Cardio dysrhythmia is the most significant adverse effect

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 May also cause:

 Tachycardia, palpitations, angina, hypertension,
insomnia, tremors, headache, anxiety, nausea, diarrhea,
menstrual irregularities, weight loss, sweating, heat
intolerance, others
o Nursing implications:
 Assess for drug allergies, contraindications, potential
drug interactions
 Obtain baseline vital signs, weight
 Cautious use advised for those with cardiac disease,
hypertension, and pregnant women
 Teach client to take thyroid agents once daily in the
morning to decrease the likelihood of insomnia if taken
later in the day
 Teach client to take the medications at the same time
every day and not to switch brands without physician
approval
 Teach clients to report any unusual symptoms, chest pain,
or heart palpitations
 Teach clients not to take OTC medications without
physician approval
 Teach clients that therapeutic effects may take several
months to occur
o Ch. 38, 39 & 42 Tetracycline, penicillin (V and G), Erythromycin,

trimethoprim/sulfamethoxazole (Bactrim). Management of effects,
education, IVF. Schedule, interactions. Gentamycin and vancomycin
therapy. Nursing considerations, monitoring with labs. Neomycin
uses. In general safety while administering medications.
 Tetracycline
o Inhibit bacterial protein synthesis by binding to the 30S
bacterial ribosome
o Co-administration with milk, iron salts, or antacids because of the
reduction in oral absorption
Mechanism of action
o Inhibit the growth of and kill a wide range of rickettsia,
chlamydia, and mycoplasma organisms as well as a variety of
gram negative/positive bacteria

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o Treatment of spirochetal infections, such as syphilis and Lyme

disease and pelvic inflammatory disease
o Demeclocycline is also used to treat SIADH, and pleural and
pericardial effusions
Indications
o Inhibit growth of gram negative and positive bacteria
o Traditionally used to treat acne in adolescents and adults
Contraindications
o Avoided in pregnant women and nursing women and children
younger than 8 years old
Adverse effects
o Discoloration of permanent teeth and tooth
enamel in fetuses and children
o Should be avoided - may retard fetal skeletal development if
taken during pregnancy
o Should be avoided in children less than 8yrs
o Photosensitivity  demeclocycline
o Alteration in intestinal flora may result in:
o Super infection (overgrowth of non-susceptible organisms
such as Candida)
o Diarrhea
o Pseudomembranous colitis
o Thrombocytopenia
o Exacerbation of SLE
o Hemolytic anemia
o May also cause:
o Vaginal moniliasis  itchiness
o Gastric upset
o Enterocolitis
o Maculopapular rash
Interactions
o Dairy products, antacids, and iron preparations, calcium, enteral
feedings, antidiarrheal drugs, the oral absorption of tetracyclines is
reduced
o Can potentiate the effects of oral anticoagulants which necessities
more frequent monitoring of anticoagulant effect and possible
dosage adjustment

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o Can increase BUN levels

Nursing Implications
o Avoid milk products, iron preparations, antacids, and other
dairy products should be avoided because of the chelation and
drug-binding that occurs
o All medications should be taken with 6 to 8 ounces of fluid,
preferably water
o Due to photosensitivity, avoid sunlight and tanning beds
 Penicillin’s
 Bactericidal antibiotics, meaning they kill a variety of gram-
positive and some gram-negative bacteria
o Mechanism of Action
 Involves the inhibition of bacterial cell wall synthesis by passing
through cell wall and binding to penicillin-binding proteinst By
binding to these proteins, the penicillin molecules interfere with
normal cell wall synthesis causing the formation of defective cell
walls that are unstable and easily broken down
 Bacterial death usually results from lysis (rupture) of the bacterial
cells due to this drug-induced disruption of cell wall structure
o Indications
 Indicated for the prevention and treatment of infections caused by
susceptible bacteria
 Commonly destroy penicillin’s that are gram-positive including
Strep, entero, and stapht
 Most natural penicillin has little if any ability to kill gram-negative
bacteriat However, the extended- spectrum penicillin’s (Zosyn)
have excellent gram positive/negative, and anaerobic coveraget
Because of this, the extended-spectrum penicillin’s are used to treat
infections such as pneumonia, intrabdominal infections and sepsis
o Contraindications
 Mnow drug allergy
o Adverse effects
 Less than1% of allergic reactions are life threatening
 Allergic reactions occur in 0t7% to 4% of cases
 Most common reactions are Uticaria, pruritus, and angioedema
 If patient has renal dysfunction, monitor closely because penicillin
IV has large amounts of potassium and sodium
 Small incidence of cross-reactivity between cephalosporin’s and
penicillin’s (1% - 4%)

lOMoARcPSD|3333773
Nursing implications
o Any patient taking a penicillin should be carefully monitored for an
allergic reaction for at least 30 minutes after its administration
o The effectiveness of oral penicillin’s is decreased when taken with
caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice
 Penicillin G
o 3 salt forms
 Benzathine, procaine, and potassium
o IV or IM use
o Potassium is the only IV
o Benzathine and procaine slats are used as longer acting IM
injectionst They are formulated into a thick, white, paste like
material that is designed for prolonged dissolution and
absorption from the IM site of injectiont
o Never give Benzathine and procaine preparations IV because
their consistency is too thick for IV administration and such use
can be fatal
o The IM formulations can be helpful in treating syphilis because
only one injection is needed
 Penicillin V
o PO (tablet or liquid)
o Nursing Interventions
o If procaine penicillin is to be given, assess for procaine
hypersensitivitiest Note results for culture and sensitivity testing as
soon as they are available to confirm the appropriateness of
therapy
o Check if patient is allergic cephalosporin’s because of the adverse
reactions
o Monitor patients with electrolyte imbalances, cardiac disease and
renal disease is assessment of sodium and potassium levels,
primarily high sodium and potassium concentrations in some
penicillin preparations
o With penicillin’s, the natural flora in the GI tract may be killed off
by the antibiotict Unaffected GI bacteria such as Ct diff may
overfrowt This process may be prevented by the consumption of
probioticst

lOMoARcPSD|3333773
o Advise patients to take oral penicillin’s with at least 6 ounces of

water (not juices); juices are acidic fluids and may nullify the
drugs antibacterial action
o Penicillin V are given with water and 1 hour before or 2 hours after
meals to maximize absorption; however because of GI upset, these
medications may need to be taken with a snack or meals
o Procaine and benzathine salt penicillin’s are thick solutions; give
them as ordered as IM, 21 gauge needle into a large muscle mass
(butt), rotating sites as needed
Nursing implications
o These agents are highly protein-bound and will cause severe
interactions with other protein-bound drugs
o The absorption of oral erythromycin is enhanced when taken on an
empty stomach, but because of the high incidence of GI upset, many
agents are taken after a meal or snack
 trimethoprim/sulfamethoxazole (Bactrim)
o a fixed combination drug product containing 5:1 ratio of
sulfamethoxazole to trimethoprimt It is available in both oral and
injectable forms
o Mechanism of Action
 Sulfonamides do not actually destroy bacteria but rather inhibit
their growth
 They are considered bacteriostatic antibiotics
 They inhibit the growth of susceptible bacteria by preventing
bacterial synthesis of folic acid
o Indications
 Broad spectrum of antibacterial activity, including activity against
both gran-positive and gram-negative organisms
 These antibiotics have very high concentrations in the kidneys,
through which they are eliminated
 Used in the treatment of UTIs, otitis media
 Also used for respiratory tract infectionst However, now it is less
effective against streptococci
 The combination of these two drugs allows for a synergistic
antibacterial effect

lOMoARcPSD|3333773
 Used for prophylaxis and treatment of opportunistic infections in

patients with HIV, especially infection by Pneumocystis jirovecii, a
common cause of HIV associated pneumonia (PCP)
 Also the most common treatment for outpatient Staphylococcus
infections, due to the high rate of community associated St aureus
(MRSA) infections
o Contraindications
 Mnown drug allergy to sulfonamides
 Celebrex
 Pregnant women at term and in infants younger than 2 months of
age
o Adverse Effects
 Cause delayed cutaneous reactionst These reactions frequently
begin with fever followed by a rash
 Common cause of allergic reaction “sulfa” or “sulfur allergy”
 Photosensitivity reactions are another type of skin reaction that is
induced by exposure to sunlight during sulfonamide drug therapyt
In some cases, such reactions can result in severe sunburn
 It is believed sulfonamide reactions are immune mediated and
involve the production of reactive drug metabolites in the body
o Interactions
 May potentiate the hypoglycemic effects of sulfonylureas in
diabetes treatment, the toxic effects of phenytoin, and the
anticoagulant effects of warfarin, which can lead to hemorrhage
 May increase the likelihood of cyclosporine-induced
nephrotoxicity
 Pts receiving these drug combinations require more frequent
monitoring
 May also reduce the efficacy of oral contraceptives

lOMoARcPSD|3333773
oAdministration
PO and IV
oNursing Interventions/Education
Encourage an increase in fluids (2000 to 3000 mL/24 hrt),
preferably water, to prevent drug related crystalluria
 Oral dosage forms are to be taken with food to minimize GI upset
 Perform thorough skin assessment before and after therapy for
occurrence of Stevens-Johnson Syndrome
 Check CBC before therapy because of drug induced anemia
 With frequent or long term therapy, assess renal studies such as
BUN/Creatinine and urinalysis due to crystalluria
MACROLIDES
Mechanism of action
o Considered bacteriostatic; however in high enough concentrations
they may be bactericidal to some susceptible bacteria
o Mechanism of action
 Inhibit protein synthesis by binding reversibly to the 50S
ribosomal subunits of susceptible microorganisms
Indications
o Inhibits strep, as are mild to moderate upper and lower respiratory
tract infections caused by Haemophilus influenzae
o A therapeutic effect of erythromycin outside its antibiotic actions is its
ability to irritate the GI tract, which stimulates smooth muscle and GI

lOMoARcPSD|3333773
motilityt This may be of benefit to patients who have decreased GI

motility, such as delayed gastric emptying in diabetic patientst It has
also been shown to be helpful in facilitating the passage of feeding
tubes from the stomach into the small bowel
Contraindications
Adverse Effects
o GI related adverse effects, especially N/V
Interactions
o Two properties that can lead to drug interactions: they are high protein
bound, and they metabolized by the livert For drugs metabolized by
the liver, drug interactions arise from competition between the
different drugs for metabolic enzymes, specifically cytochrome P-450
complex
o Such enzymatic effects generally lead to more drug interactions than
competition for protein bindingt The result is a delay in the metabolic
clearance of one or more interacting drugs and thus a prolonged and
possible toxic drug effect
o Do not give erythromycin with drugs that prolong the QT interval
because it could cause a malignant dysrhythmias
o Reduces the effect of oral contraceptives
Assessment
o Baseline cardiac function with VS because these drugs may lead to
palpitations, chest pain, and ECM changes
o Hearing status because of drug related hearing loss and tinnitus
o Assess liver function because of hepatotoxicity
o Special considerations with warfarin, digoxin, or theophylline
resulting in possible toxicity of the latter drugs
o The effectiveness of oral penicillin’s is decreased when taken with
caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice
 Erythromycin
o Macrolide antibiotic
o Take oral with meal or snack to reduce stomach irritation
o Associated with many drug interactions because it is a strong
inhibitor of cytochrome P450 enzymes
 IVF
 Schedule, interactions

lOMoARcPSD|3333773
AMINOGLYCOSIDES
o Bactericidal
o Potent antibiotics which makes aminoglycosides the drug of choice
for treatment of virulent infections
o Poor oral absorption  no PO form
o Measure serum levels because of toxicity especially with kidneys;
nephrotoxic and ototoxic
o Measure serum levels because it has to be 8 times higher than the
minimum inhibitory concentration (MIC)
o Trough (lowest) levels are routinely measured to ensure adequate
renal clearance of the drug and avoid toxicity
o With once daily dosing, the blood sample for trough measurement is
drawn at least 8 to 12 hours after completion of dose administration
o You do not take peak levels if you take the medication once a day but
you need to measure peak and trough if you are giving 3 times a day
o Measure peak 30 minutes after a 30 minute infusion and trough before
you give the next dose
o Meep trough levels below 2 mcg/mL
Mechanism of action
o Often used in combination with other antibiotics for synergistic effect
Indications
o Used to kill gram-negative bacteria such as Pseudomonas spp., E.
coli, Proteus spp., Klebsiella spp., Serratia sppt
o Often used in combination with other antibiotics for synergistic effect
o All aminoglycosides are poorly absorbed through the GI tract, and
given parentally
o Neomycin can be given orally to decontaminate the GI tract before
surgical procedurest Also used as an enema for this purpose (this is the
only one that can be given PO)
Contraindications
o Aminoglycosides have been shown to cross the placenta and cause
fetal harm when administered to pregnant women  could cause
irreversible bilateral congenial deafness in babies
o Only given to pregnant women in the event of life-threatening
infections when safer drugs are ineffective

lOMoARcPSD|3333773
o These drugs are also distributed in breast milk and should not be used
by lactating women to avoid the risk for drug toxicity in nursing
infants
o Neonates because of the immaturity of the nervous and renal systems
Adverse effects
o Ototoxicity and nephrotoxicity are the most significant
o Nephrotoxicity typically occurs in 5% to 25% of patients is usually
manifested by urinary casts, proteinuria, increased BUN and serum
creatinine
o Headache
o Vertigo
o Paresthesia’s
o Skin rash
o Neuromuscular blockade
o Fever
o Dizziness
o Super infections
Interactions
o Risk for nephrotoxicity can be increased with concurrent use of other
nephrotoxic drugs such as vancomycin
o Concurrent use with loop diuretics increases the risk for ototoxicity
o Mills intestinal bacterial flora, they also reduce the amount of vitamin
M produced by these gut bacteria
o Concurrent use with neuromuscular blocking drugs may prolong the
duration of action of the neuromuscular blockade
 Gentamycin
o IV or IM
o Indicated for the treatment of infection with several susceptible
gram positive and gram negative bacteria
o Also available topical and ophthalmic
 Neomycin uses
o Given ORALLY to decontaminate the GI tract before surgical
procedures
o Mostly used for bacterial decontamination of the GI tract before
surgical procedures and it is given orally and rectally (enema)

lOMoARcPSD|3333773
o Other uses include topical application for skin infections,

bladder irrigation, and treatment for Etcoli, hepatic
encephalopathy and eye infections
o In hepatic encephalopathy, the drug helps reduce the number of
ammonia-producing bacteria in the GI tractt The subsequent
reduced blood ammonia levels sometimes result in
improvement of neurologic symptoms of the hepatic illness
o This drug is only PO in tablet form, solutions and powders for
oral, topical, or irrigation administration
 Vancomycin (miscellaneous antibiotic)
o Natural, bacterial antibiotic
o Destroys cell wall
o Treatment choice for MRSA, and other gram-positive
infections
o Must monitor blood levels to ensure therapeutic levels and
prevent toxicity
o May cause ototoxicity and nephrotoxicity
o Vancomycin must be infused over at least 60 minutes and
longer for higher doses
o Monitor IV site closely
o Redman’s syndrome may occur
 Decreased BP, flushing of neck and face
 Antihistamine may be ordered to reduce these effects
o Ensure adequate hydration (2L fluids/24 hours) if not
contraindicated to prevent nephrotoxicity
 Nursing implication for Antibiotics

o Before beginning therapy assess:
 Drug allergies
 Hepatic
 Liver
 Cardiac function
 Lab studies
o Be sure to obtain thorough health history, including immune
status
o Assess for conditions that may be contraindications to antibiotic
use or that may indicate cautious use
o Assess for potential drug interactions

lOMoARcPSD|3333773
o It is ESSENTIAL to obtain cultures from appropriate sites

BEFORE beginning antibiotic therapy
o Patients should be instructed to take antibiotics exactly as
prescribed and for the length of time prescribed; they should
not stop taking the medication early when they feel better
o Assess for signs and symptoms of superinfection: fever,
perineal itching, cough, lethargy, or any unusual discharge
o For safety reasons, check the name of the medication carefully
because there are many agents that sound alike or have similar
spellings
o Each class of antibiotics has specific side effects and drug
interactions that must be carefully assessed and monitored
o The most common side effects of antibiotics are nausea,
vomiting, and diarrhea
o All oral antibiotics are absorbed better if taken with at least 6 to
8 ounces of water
o
 Please read the question and choose the best answer based on the
scenario
Good luck!

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Final exam study guide

Pharmacological Basis For Nursing Interventions I (Nova Southeastern University)

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NUR 3191 FALL 2011 STUDY GUIDE- FINAL EXAM

o Intro/ concepts: CH.1 & 2

 Role of RN in medication administration

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o Absorption- the movement of a drug from its site of

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 The effects of 2 or more medications in which one

o Distribution- process by which drug is carried from its site of

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 Metabolism is also called BIOTRANSFORMATION

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o Half-life- the time required for one-half (50%) of a given drug

 Drug schedule for Controlled Substances

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o Causes black, tarry stools

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o Dose-limiting adverse effects

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o Do Not remove IV line - may need to give antidote through

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 Neupogen (filgrastim) – drug used in the treatment of leukopenia

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o Do not give with warfarin because of the enhanced

o Muromonab-CD3 administration ss. Bioterrorism agents.

 Muromonab-CD3 administration ss.

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o Grapefruit juice should be avoided  it may increase

o Passive immunity (passive/artificial)- antibody produced in

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 This immunity is TEMPORARY

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 Opportunistic malignancies treated with antineoplastic

o Ch. 50,51,52 GI meds e.g. Calcium carbonate, sodium bicarbonate,

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o Used to clean stool from intestines before surgery or certain

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 Softening of fecal impaction; facilitation of BMs

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o Ch. 10 Analgesic: acetaminophen, fentanyl patch, and Morphine

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 Patients with liver disease or chronic alcohol

o Available oral, injectable, rectal

o MS contin/ Madian → extended release

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o Potentially toxic metabolite → morphine 6 glucuronide (mostly in

o Itching is not allergic reaction, it is a pharmacologic effect due to

 Therapeutic effect of opioid analgesic

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 drowsiness, dizziness, tiredness;

o Ch. 32 Metformin, glipizide, sulfonylurea, regular insulin. Lispro.

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