ATI Review

Pharmacology

Antipsychotics
Antipsychotic medications reduce the psychotic symptoms of schizophrenia and other mental illnesses, usually allowing a person to function more effectively and appropriately. Antipsychotic drugs are the best treatment for schizophrenia right now, but they do not cure schizophrenia or ensure that there will be no further psychotic episodes Recognizing Side Effects to Report

Antipsychotics-Atypical
Recognizing side effects Evaluating therapeutic effects Types
Risperdal clozaril

Chemotherapy Agents
Formulating a Nursing diagnosis

Migraine Medications
Reporting findings to primary care provider

Mood stabilizers
Analyzing data

Nonsteroidal Anti-inflammatory Drugs

Recognizing Data

Error Reduction
Use of Resources

Medication Administration and error Reduction

Use of resources

Opioid Agonists
Morphine administration Client need for pain medication Risk for respiratory depression Adverse effects of codeine Recognizing side effects

Antiycobacterial (antituberculosis)
Monitoring long term usage of medication

Selective serotonin reuptake inhibitors

Identifying interactions

Oral hypoglycemics
Medication interactions

Adrenergic agonists
Titrating dose Treating anaphylaxis

Alpha-Beta adrenergic agonist

Indications and Usage Correction of hemodynamic imbalances present in shock syndrome after MI, trauma, endotoxic septicemia, open heart surgery, and renal failure or chronic cardiac decompensation (eg, CHF). Dopamine
Dopamine HCl, a naturally occurring catecholamine, is an inotropic vasopressor agent.

Inotropic
Affecting the force of muscle contraction. An inotropic heart drug is one that affects the force with which the heart muscle contracts.

Dopamine
pharmacology
Stimulates beta-1 receptors in the heart, causing more complete and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic effects.

Pharmacokinetics Distribution
Widely distributed; does not cross the bloodbrain barrier to a significant extent.

Metabolism
Metabolized in the liver, kidney, and plasma by MAO and catechol-O-methyltransferase to inactive compounds. Approximately 25% of dose is taken up in the adrenergic nerve terminals where it is hydrolyzed to norepinephrine.

Dopamine
Elimination
Half-life approximately 2 min. Approximately 80% excreted in the urine within 24 h as metabolites; a very small amount excreted unchanged.

Onset
Within 5 min.

Duration
Less than 10 min.

Agonists-antagonist opiods
Evaluating medication orders

Anticoagulants
Monitoring Lab values Parenteral medication administration Contraindication for use

Medications to research
Cytoxan-side effects Egostat-side effects Baclofen-therapeutic effects

Coumadin Labs
PT: prothrombin time...tells you if pt's coumadin is at a therapeutic level.
If it's low or normal and the patient is on coumadin, then the dose is not therapeutic and needs to be increased.

INR: international normalized ratio...still has to do with coumadin therapeutic level. When lab runs a PT you get INR results also. 2-3 is therapeutic. If it's a lot higher, the patient probably needs some vitamin K to counteract it so he won't start bleeding all over the place.

PTT (aPTT):
(activated) partial thromboplastin time...tells you if patient on heparin is at a therapeutic level.
If it's low or normal and the patient is on heparin, then the dose is not therapeutic and needs to be increased. We use a sliding scale for heparin, increasing or decreasing the dosage based on APTT results.

Coumadin:
anticoagulant that take several days to start working, so heparin is given at the same time till the coumadin level is therapeutic.

Protamine: antidote for heparin (use is patient's APPT is sky high); works quickly. Vitamin K: antidote for coumadin; works slowly.

Cholinesterase Inhibitors
cholinergic crisis, a pronounced muscular weakness and respiratory paralysis caused by excessive acetylcholine, often apparent in patients suffering from myasthenia gravis as a result of overmedication with anticholinesterase drugs. Cholinergic crises
Overdosage of neostigmine can induce a cholinergic crisis. Symptoms can include nausea, vomiting, diarrhea, excessive salivation and drooling, sweating (in animals with sweat glands), miosis, lacrimation, increased bronchial secretions, bradycardia or tachycardia, cardiospasm, bronchospasm, hypotension, muscle cramps and weakness, agitation, restlessness or paralysis.

anticholinesterases
Neostigmine belongs to the group of medicines called anticholinesterases. It works by prolonging the action acetylcholine, which is found naturally in the body. It does this by inhibiting the action of the enzyme acetylcholinesterase. Acetylcholine stimulates a type of receptor called muscarinic receptors. When stimulated, these receptors have a range of effects.

What is Neostigmine used for?

Abnormal muscle weakness (myasthenia gravis) Difficulty in passing urine (urinary retention) Failure of function of part of the gut causing an obstruction (paralytic ileus

Cephalosporins
Cephalosporins also interferes directly with vitamin K metabolism, and as a result can lead to abnormal bleeding Use
Bronchitis, otitis media, pneumonia, cellulitis

Recognizing allergic reactions

drug class: Cephalosporins

drugs and trade names: Cefuroxime: Ceftin Cephalexin: Cefanex, Keflet, Keflex, Keftab Cefixime: Suprax Cefpodoxime: Vantin Cefprozil: Cefzil Ceftriaxone: Rocephin Cephadroxil: Duricef, Ultracef Cephaclor: Ceclor Loracarbef: Lorabid

Keflex
Keflex is an antibiotic used to treat infections of the respiratory tract, the middle ear, the bones, the skin, and urinary systems. Most common side effect for keflex
diarrhea

Antiepileptics AEDs
Antiepileptic drugs (AEDs) are prescribed to reduce the severity and number of seizures that occur in someone with epilepsy. They are also referred to as "anticonvulsants" or "seizure medications". Antiepileptic drugs work by suppressing the rapid and excessive firing of neurons in the brain that start a seizure

Antiepileptics AEDs
Interventions for adverse reactions

Selective Estrogen receptor modulators/SERMS

Selective estrogen receptor modulators, called SERMs for short, block the effects of estrogen in the breast tissue. SERMs work by sitting in the estrogen receptors in breast cells. If a SERM is in the estrogen receptor, there is no room for estrogen and it can't attach to the cell. If estrogen isn't attached to a breast cell, the cell doesn't receive estrogen's signals to grow and multiply.

Selective Estrogen receptor modulators/SERMS

Cells in other tissues in the body, such as bones and the uterus, also have estrogen receptors. But each estrogen receptor has a slightly different structure, depending on the kind of cell it is in. So breast cell estrogen receptors are different from bone cell estrogen receptors and both of those estrogen receptors are different from uterine estrogen receptors. As their name says, SERMs are "selective" this means that a SERM that blocks estrogen's action in breast cells can activate estrogen's action in other cells, such as bone, liver, and uterine cells.

Selective Estrogen receptor modulators/SERMS

There are three SERMs:
tamoxifen (also called tamoxifen citrate; brand name: Nolvadex) Evista (chemical name: raloxifene) Fareston (chemical name: toremifene)

Thrombolytic medications
Minimizing adverse effects

Biphosphonates
How It Works
Bisphosphonates are antiresorptive medicines, which means they slow or stop the natural process that dissolves bone tissue, resulting in maintained or increased bone density and strength. This may prevent the development of osteoporosis. If osteoporosis already has developed, slowing the rate of bone thinning reduces the risk of broken bones. Bisphosphonates may be taken by men or women.

Biphosphonates
Medication Administration You take most bisphosphonates by mouthevery day, once or twice a week, or even once a month. Zoledronic acid is given intravenously, usually only once each year. One form of ibandronate is also given intravenously, usually every 3 months. Etidronate (Didronel) is not approved by the U.S. Food and Drug Administration (FDA) for osteoporosis. But it is used in Canada and Europe for this purpose.

Bisphosphonates for osteoporosis

Generic Name alendronate etidronate (not approved by FDA for osteoporosis) ibandronate risedronate risedronate with calcium carbonate zoledronic acid Brand Name Fosamax Didronel Boniva Actonel Actonel with Calcium Reclast

Glucocorticoids
Client teaching for MDIs

Cerebral palsy
Monitoring for medication therapeutic effects

Hematopoietic growth factors

Evaluating client response

Cardiac Glycosides
Recognizing side effects Contraindications to Administration
Sick sinus syndrome, Wolff-Parkininson-White syndrome, ventricular fibrillation, ventricular tachycardia lation

Digoxin-hydrocholorothiazide (HCTA) interaction

Because HCTZ can lower potassium level this can cause digoxin tocicity

cardiac

Digoxin
Digoxin belongs to a class of medications called cardiac glycosides. It works by affecting certain minerals (sodium and potassium) inside heart cells. This reduces strain on the heart and helps it maintain a normal, steady, and strong heartbeat. Side effects
Gastrointestinal Nausea, vomiting Neurological Blurred vision, visual hallucinations Cardiac Atrial tachycardia, Other Side Effects? Patients with hypokalemia, second-degree AV block, thirddegree AV block, and patients with atrial fibrillation , who also have Wolfe-ParkinsonWhite syndrome should not be given digoxin.

How is Digoxin excreted?

Digoxin is excreted renally, therefore , patients with renal insufficiency need to be monitored closely.

What is the mechanism of Digoxin?

Digoxin inhibits the sodium/potassium ATPase pump resulting in increased intracellular sodium leading to impaired sodium/calcium exchange in increased intracellular calcium. This increased intracellular calcium is stored in the sarcoplasmic reticulum of the cardiac muscle , resulting in increased calcium reserve stronger muscle contraction. Digoxin also potentiates the vagally mediated slowing of AV conduction and increased atrial ventricular block.

Immunosuppressant:
medications therapy to prevent organ rejection
Example of this medication is cyclosporine

Contraindications
Pregnancy Liver and kidney disease shingles

Immunosuppressant
Besides corticosteroids, the immunosuppressant medications most often used in patients with autoimmune diseases include: Azathioprine (Imuran), which is primarily used in autoimmune hepatitis and rheumatoid arthritis. Cyclophosphamide (Cytoxan), which is primarily used in systemic lupus erythematosus, autoimmune hemolytic anemia, Wegeners granulomatosis, and other forms of vasculitis. Cyclosporine (Sandimmune, Neoral) is primarily used in psoriasis soriasis.suite101.com/article.cfm/psoriasis, rheumatoid arthritis, multiple sclerosis, diabetes, myasthenia gravis, and scleroderma. Glatiramer acetate (Copaxone) is primarily used in treatment of relapsing-remitting multiple sclerosis. Methotrexate is primarily used in rheumatoid arthritis and other connective tissue disorders Mycophenolate mofetil (CellCept) is used in scleroderma and systemic lupus erythematosus. Sirolimus (Rapamune) is used for the treatment of psoriasis.

Immunosuppressant Drug Interactions

The drug allopurinol used for gout may enhance the effects of azathioprine, Estrogens, androgens, cimetidine, erythromycin, and ketoconazole may increase the effects of cyclosporine. The risk of cancer increases in people on immunosuppressants who are on other medications that suppress the immune system including corticosteroids, chlorambucil, cyclophosphamide, and mercaptopurine.

Insulin
Adjusted dosage Client teaching to prevent hypoglycemia

Organic Nitrates
Self administration Medication interaction

Anti-parkinson medications
Mechanism of action

Leukotriene Modifiers
Purpose of administration

Tocolytic medications
Monitoring adverse reactions

antilipemics
Monitoring side effects Client teaching

tetracycline's
Medication interactions http://www.drugs.com/druginteractions/tetracycline-index.html
THIS WEBSITE WILL SHOW YOU 294 MEDICATIONS THAT INTERACT WITH TETRACYLINE Administration of a tetracycline with aluminum, calcium, or magnesium salts significantly decreases tetracycline serum concentrations. The proposed mechanism is chelation of tetracycline by the cation, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. The interaction has also been reported with parenteral doxycycline and oral antacids. CITRACAL

Age-consideration of medication administration

Pain managemnt for older adult clients

Basic pharmacologic principles

Controlled substances

Tegretol-carbamazepine
is an anticonvulsant and mood stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia. It is also used offlabel for a variety of indications, including attention-deficit hyperactivity disorder (ADHD), schizophrenia, phantom limb syndrome, complex regional pain syndrome, paroxysmal extreme pain disorder, neuromyotonia, intermittent explosive disorder, and post-traumatic stress disorder.

Tegretol-carbamazepine
Common adverse effects include drowsiness, headaches and migraines, motor coordination impairment and/or upset stomach. Carbamazepine preparations typically greatly decrease a person's alcohol tolerance

Rifadin (Rifampin)
Rifampin eliminates bacteria that cause tuberculosis (TB). It is generally used with other drugs to treat tuberculosis or to eliminate Neisseria meningitidis (a bacteria) and to prevent you from giving these infections to others. However, rifampin is not used to treat Neisseria meningitidis infection.

Singulair-(montelukast)
is used to prevent asthma attacks in adults and children as young as 12 months old. Singulair is a leukotriene (loo-koe-TRYeen) inhibitor. Leukotrienes are chemicals your body releases when you breathe in an allergen (such as pollen). These chemicals cause swelling in your lungs and tightening of the muscles around your airways, which can result in asthma symptoms.

Lithobid-lithium carbonate
Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lithium is in a class of medications called antimanic agents. It works by decreasing abnormal activity in the brain.

Lithium may cause side effects

restlessness fine hand movements that are difficult to control loss of appetite stomach pain or bloating gas indigestion weight gain or loss dry mouth excessive saliva in the mouth tongue pain change in the ability to taste food swollen lips acne hair loss unusual discomfort in cold temperatures constipation depression joint or muscle pain thin, brittle fingernails or hair

Lithobid-DOSING:
Doses vary widely and are adjusted based on measurements of the levels of lithium in the blood. Recommended blood levels are 06-1.2 mEq/L. Early in therapy, dose adjustments are made as often as every 5 to 7 days to establish the correct dose. Most patients require 900-1200 mg daily in 2-3 divided doses. Patients with kidney diseases excrete less lithium from the body and, therefore, require lower doses.

NOLVADEX (tamoxifen citrate)

a nonsteroidal antiestrogen SIDE EFFECTS- In these studies, the most common side effects of Nolvadex included:
Hot flashes -- in up to 80 percent of people Vaginal discharge -- up to 50 percent Water retention -- up to 32 percent Nausea -- up to 26 percent Irregular menstrual periods -- up to 25 percent Weight loss -- up to 23 percent Vaginal bleeding -- up to 23 percent.

NOLVADEX (tamoxifen citrate)

Other common side effects (occurring in 2 to 19 percent of people taking the drug) included:
Bone pain Back pain Headaches Cough High cholesterol (see Tamoxifen and High Cholesterol) Fatigue Muscle pain Ovarian cysts Skin changes Infection Indigestion or heartburn Insomnia (see Tamoxifen and Insomnia) Constipation or diarrhea Anemia Weight gain (see Tamoxifen and Weight Gain) Mood changes Hair loss (see Tamoxifen and Hair Loss).

Zoloft
Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder Know side effects

Medication administration
Nursing responsibility

aminoglycosides
Assessing for adverse effects

Beta adrenergic blocker (Sympotholytics)

Monitoring clients

Bacteriostatic inhibitors
Client instructions regarding selfadministration

Pharmacological Pain management

Opioid agonist:
client needs for pain medication recognizing side effects Evaluating patient-controlled analgesia use

Age specific considerations of medications: pain management for older clients Basic pharmacologic principles: controlled substances

Pharmacological interactions
Antilipemics: client teaching Tetracycline: medication interactions

Pharmacological agents/actions
Selective serotonin reuptake inhibitors: identifying interactions Immunosuppressants: contraindications Leukotriene modifiers: purpose for administration Opioid agonist: risk for respiratory depression Anti-parkinsons medication; mechanism of action

Medication administration
Bisphosphonates: medication administration Organic nitrates: self administration Thrombolytic medication: minimizing adverse effects Cardiac glycosides: contraindications of administration Glucocorticoids: client teaching for MDIs Adrenergic agonists: titrating dose Anticoagulants: monitoring lab values

Pharmacological and parenteral therapies

Expected effects and outcomes