ACE INHIBITORS

S- suppresses renin angiotensin aldosterone system
W- warn clinet with renal or thyroid diseases
E- ends with pril- captopril (capoten) enalapril (vasotec)
R- rise slowly to reduce orthostatic hypotension
T- treatment of htn
E- evaluate BP

Beta- adrenergic blockers

end in lol- atenolol (Tenormin)
B- bradycardia
B- blood pressure too low
B- bronchial constriction
B- blood sugar is masked when low

Calcium channel blocker

amlodipine (norvasc), diltiazem (cardizem), nifedipine (procardia)
B- blocks calcium access to cells
I- indicated for htn
L- let client take drug with milk or meal
L- light and moisture- protect

Diuretics

D- diet; increase K+ for all except aldactone
I- intake, output, daily weight monitoring
U- undesirable effects- F&E imbalance
R- review HR, BP, and electrolytes
E- elderly careful, evening dose not recommended
T- take with or after meals and in AM
I- incrase risk of orthostatic hypotension, move slowly
C- cancel alcohol and cigs

warfarin (coumadin)
monitor?
antidote?
what food should be avoided?

prothrombin time is monitored 1.5-2.5 X control is the therapeutic range
Vit K is the antidote
Green leafy veg should be avoided

warfarin

C- check vital signs, platelte count, and PT
O- observe bleeding
R- review bleeding protocol
A- avoid ASA, may use acetaminophen

heparin sodium

PTT must be monitored 1.5-2.5 X control
Antidote is protamine sulfate
hospitalization is required for IV heparin

Clopidogrel (PLAVIX)

B- bleeding, brochospasms- undesired effects
L- lowers risk of atherosclerotic events
E- evaluate bruising
E- evaluate liver function
D- do take with food or after meals

HMG CoA inhibitors

competitive inhibitors of HMG-COA reductase, an enzyme necessary for cholesterol biosynthesis
indicated for hypercholesterolemia
atorvastatin (lipitor), simvastatin (zocor)

HMG COA inhib pneumonic

S- statin is the ending
T- take with food and at bedtime
A- always consume 2-3 L of fluid daily
T- teach client to do exercise and weight reduction as well
T- treat hypercholesterolemia
I- increase fiber in diet
N- never give if with liver disease

Antibiotics pneumonic

M- monitor superinfections
E- evaluate renal/liver function
D- diarrhea- take yogurt
I- inform provider prior to taking other meds
C- cultures prior to initial dose
A- alcohol is out, ask about allergy
T- take full course
E- evaluate cultures, WBC, temp, blood

Aminoglycosides

end in mycin
*serious infections caused by gram- negative infections

Allopurinol

G- gulp 10-12 glasses of fluid daily, GI distress (undesirable effect)
O- output and input monitor closely
U- uric acid production decreased, use no alcohol
T- take after meals

Phenytoin (dilantin)

G- gingival hyperplasia
U- use alternate birth control
M- mouth care; preventative dental check up
S- soft toothbrush don't stop abruptly

Lithium pnuemonic

L- level therapeutic 0.6-1.2 meq/l
I-increased urination
T- thirst increased
H- headache and tremor
I- increase fluids

LIDOCAINE pneumonic

(antiarrhythmic drug- subclass 1B)

L- local anasthetic
I- ICU popular antiarrythmic
D- digitalis toxicity used
O- orally inactive
C- cinetidine+ propanolol
A- decrease Automacity
I- inactivated Na Channel blocker
N- nystagmus
E- eye blurred vision, ECG change

You have 1 heart and 2 lungs":

Beta-1 are therefore primarily in the heart.
Beta-2 primarily in the lungs.

Anti-Epileptic Side Effect

ABCDEFGH

A taxia
B lood dyscrasia
C left lip
D upuytrens / Vit D deficiency
E xfoliation of skin & Stevens Johnson's
F its
G I upset/gum hypertrophy
H epatitis/hairy

Barbiturate Side Effects

ABCD

A taxia
B ehavioral disturbance
C oncentration decreased/coma
D epression/drowsy/diplopia

ACE Inhibitor Side Effects
CAPTOPRIL

C ough
A naphylaxis
P alpitations
T aste
O rthostatic hypotension
P otassium elevated
R enal impairment
I mpotence
L eukocytosis

SIDE EFFECTS OF CORTICOSTERIODS;

(CORTICOSTEROIDS)

C-cushings syndrome
O-osteoporosis
R-retardation of growth
T-thin skin n easy brusibility
I-infections n immunosupression
C-cataract n glaucoma
O-odema
S-supression of HPA axis
T-thining n ulceration of gastric mucosa
E-Emotional disturbance
R-rise in BP
I-Increase in hair growth(hirsuitism)
O-otherz like fetal abnormalties n hypokalemia
D-diabetes mellitus precipitation
S-stria

Drugs for heart failure-
< 3 D's for heart
failure >

Digoxin,
Diuretics,
Dilators

Respiratory Depression Inducing drugs

STOP breathing":
Sedatives and hypnotics
Trimethoprim
Opiates
Polymyxins

TB treatment

If you forget your TB drugs, you'll die and might need a PRIEST":
Pyrazinamide
Rifampin
Isoniazid (INH)
Ethambutol
STreptomycin

Drugs to treat viral respiratory infections

"You'd get a respiratory infection if you shoot an ARO (arrow) laced with viruses into the lungs":
ARO:
Amantadine
Rimantadine
Oseltamivir

Atropine

emergency drugs to LEAN on

Drugs for Bradycardia and decreased BP
(IDEA)

Cholinergic crisis- SLUD

Beta Blocker Actions

Anticancer drugs

These drugs can interact (TDCI)

aminoglycoside toxicity

Quinalones and Tetracyclines ok in pregnancy???

SE of adrenergic antagonists

Lidocaine Toxicity
SAMS

B6 relationship to INH and levadopa?

Mixing insulin

antiinflammatory

salicylate poisoning

SASH technique

serious complications of oral birth control pills
(ACHES)

saw palmetto

stomach problems
alters PSA
watch for bloody urine

ginko

before couldn't think well.. now can think better!

Potassium

estrogen

Bipolar clown image

Buspar

Dueteronomy

miotics

insulins and onset

metformin

a major complication with this medicine is lactic acidosis

cushing

synthroid

PTU

tuberculin syringe has the capacity of?

0.5 ml

Drug label should be read?

3 times

patch testing

identify sensitivity to contact materials such as soap, pollen, and dyes.. allergen on patch is placed in contact with back, arms, or thighs. Patch is left in place for 48 hours. Site is aired for 15 min, then read. Wheal is the definitive reaction measured from 1+ to 4+. Emergency equipment must be available in case of anaphylaxis.

after applying eye drops how long do you hold pressure to the inner corner of eyelid?

1-2 min

how to put in ear drops for child younger than 3

down and back
*older than 3 up and back
They should remain in position for a few min after application

MDI meds should be shaken?

vigorously 5-6 times prior to use. The client may position her mouth around the device or 2-4 cm in front of mouth

DPI (dry powder inhalers)

not to be shaken, and the client should place the mouthpiece between lips.

*For DPI and MDI client should exhale and then inhale the med deeply through the mouth for 3-5 sec and then hold breath for 5-10 sec.

why might a spacer be attached to an MDI

the spacer keeps the med in the device longer and thereby facilitates delivery of the med to the lungs and decreases the amount of med deposited in the oropharynx. This is beneficial for the delivery of glucocorticoids

after applying ear drops apply pressure to the?

tragus of the ear with finger

how are suppositories stored?

refrigerated! Remove foil wrapper and lubricate supposiory if needed. Instruct client to retain med and not expel it. Rectal suppositories are insterted beyond the internal sphincter and vaginal suppositories are inserted with an applicator.

Intramuscular route

used for irritating meds, solutions in oils, and aqueous suspensions.
common sites are the ventrogluteal, dorsogluteal, deltoid, and vastus lateralis (peds).
needle gauge 22-25, 18-27 needle size
1 1/2 inch long and inject 90 degree angle.

volume injected IM route

1-3 ml. If a greater amount is required it should be divided into 2 syringes and two different sites should be used.

z-track

prevents medication from leaking back into subcutaneous tissue
used for meds that cause visible or permanent skin stains such as certain iron preps

Intradermal

tuberculin testing or checking med/allergy sensitivities
may be used for cancer immunotherapy
small amount of solution 0.01-0.1 ml in a tuberculin syringe with a fine gauge needle 26-27 in lightly pigmented, think skin, hairless site. 10-15 degree angle

Time release capsules crushed?

They should not be crushed or diluted as med will be absorbed at a faster rate than recommended.

When should a breastfeeding mother take medication to ensure the least amount is recieved by the infant?

immediately after breastfeeding so this will minimize med concentration in the next feeding

Instilling vag meds

pt in lithotomy position, elevate hips with pillow
remain in position for 5-10 min after application
wash applicator with warm soapy water after each use.

antimicrobials

treat bacterial, viral, and fungal infections

narrow spectrum antibiotics

are effective against a few species of microorganisms such as gram positive cocci, gram positive bacilli, and gram neg aerobes

broad spectrum antibiotics

effective against a wide variety of microorganisms

what should be collected prior to antimicrobial therapy

specimens for a culture and sensitivity test

prescribed antimicrobial meds should be taken with what freq?

around the clock to maintain therapeutic blood levels

adverse reactions to antimicrobials

rash
anaphylaxis
suprainfection
organ toxicity (nephrotoxicity and ototoxicity)
decrease oral contraceptives effectiveness

how do penicillins destroy bacteria

weaken the bacterial cell wall

penicillins are the choice for?

gram + cocci such as streptococcus pneumonia (pnuemonia and meningitis)infectious endocarditis, streptococcus pyogenes (pharyngitis)

penicillins are also med of 1st choice for

meningitis - gram neg cocci and for treatment of syphillus

should penicillin and aminoglycosides be mixed in same intravenous solution

no, b/c penicillin inactivates aminoglycosides when mixed in same IV solution

nurse gives penicillin, what should nurse watch for?

observe client 30 min following admin of parenteral penicillin
monitor clients kidney function and cardiac and electrolyte status

________ are beta lactam antibiotics sim to penicillins that destroy bacterial cell walls causing destruction of the micro-organism

cephalosporins, grouped into 4 generations. they are broad spectrum with a high therapeutic index that treat UTI, post op infections, pelvic infections, and meningitis

clients should take oral cephalosporins with?

food, oral cephalosporin suspensions should be stored in the refrigerator.

bacteriostatic

prevent bacteria from reproduction

carbapenems

meropenem, beta lactam antibiotics that destroy bacterial cell wall
effective for serious infections like pneumonia, peritonitis, and uti cause by gram positive cocci, gram neg cocci and bacilli, and mixed aerobic and anaerobic bacteria.

monobactams- vancomycin

beta lactam antibiotics destroy bacterial cell wall
*drug of choice for serious infections caused by methicillin resistant staph and c-diff

vancomycin peak blood levels should be collected?

1-2 hrs after completion of IV infusion. Appropriate peak levels are between 30-40 mg/ml

how do we evaluate vancomycins effectiveness?

clear breath sounds, wound healing, improvement of sx of antibiotic associated pseudo colitis symptoms such as resolution of diarrhea and negative stool cultures for c-diff.

Tetracyclines (sumycin)

other meds- doxycycline. Broad spectrum antibiotics that inhibit microorganism growth by preventing protein synthesis (bacteriostatic). Tx acne. 1st line med for rickettsia (rocky mountain spotted fever, typhus fever, infections of urethra or cervix caused by chlamydia, lyme disease, anthrax, GI infections caused by h.pylori and periodontal disease.

avoid giving tetracycline to?

children under 8, yellow/brown tooth discoloration
avoid taking it at bedtime to reduce the risk of esophageal ulceration

taking tetracycline with milk/calcium/mag/antacids

should take tetracyclines at least 1 hr before and 2 hr after taking food and supplements containing calcium and mag

Tetracyclines should not be given with food except for?

doxycycline and minocycline

Bacteriostatic inhibitors

erythromycin, clindamycin, axithromycin, etc
slows the growth of microorganisms by inhibiting protein synthesis. At high doses it can be bactericidal.

bacteriostatic inhibitors are used to?

treat infection in clients with a penicillin allergy. ex) diptheria, whoop cough, chlamydia.

medication interactions with erythromycin?

antihistamines, theophyline (asthma med), carbamazepine (anticonvulsant), and warfarin (anticoagulant). result in toxicity

aminoglycosides- gentamicin

bactericidal antibiotics disrupt protein synthesis. med of choice against aerobic gram neg bacilli

aminoglycosides adverse effects

ototoxicity and nephrotoxicity

peak levels of aminoglycosides should be obtained?

30 min after admin IM or IV.

sulfa

TMP- bactrim. inhibit bacterial growth by inhibiting synthesis of folic acid. folic acid is essential for production of DNA, RNA, and proteins.

Bactrim drug of choice

for uti caused by e.coli and other infections (otitis media, bronchitis, shigellosis, pneumonia)

Bactrim is contraindicated in?

clients with a folate deficiency, b/c it increases the risk of megaloblastic anemia. Avoid use in pregnancy and lactation risk of kernicterus increases. Do not use if creatinine clearance is less than 15 ml/min

how should bactrim be taken?

on an empty stomach with a full glass of water

antimycobaterial (antituberculosis)

isoniazid INH, streptomycin, ethambutol, pyranzinamide

INH

highly specific for mycobacteria. Inhibits growth of mycobacteria by preventing sysnthesis of mycolic acid in cell wall. Indicated for active and latent use.
latent- INH only daily for 6 months
active- multiple med therapy including INH, rifampin, pyrazinamide, and/or pyridoxine daily for 6 months.

Stop INH if?

Liver function tests are elevated

pt on INH develops peripheral neuropathy

admin 50-20 mg of vit b6 daily

How should patient take INH?

on an empty stomach 1 hr before meals or 2 hrs after. Can taken INH with meals if GI upset occurs.

Antiviral (acyclovir)

prevents reproduction of viral DNA
med of choice for HSV, chicken pox, and cytomegalovirus.

ganciclovir

tx of choice for CMV retinitis in immunocompromised clients with HIV, transplant clients at risk for CMV infection. Med of choice for CMV (cytomegalovirus).

pt on ganciclovir, if neutrophil count is below 500?

stop treatment. Cell counts improve within 3-5 days.

gancyclovir and pregnancy?

it is tetratogenic, women should avoid pregnancy during course of therapy and for 90 days after the end of therapy. males should be informed about sterility.

never admin acyclovir by?

IV bolus, it should be administered by IV infusion slowly over 1 hr or longer. Clients should understand than acyclovir diminishes symptoms but does not cure the virus. For topical admin advise client to put on rubber gloves to avoid transfer of virus to other areas of body.

Fluoroquinolones

ciproflaxacin (cipro), levaquin, floxin
inhibits the activity of DNA gyrase, an enzyme needed for the replication of bacteria
broad spectrum antimicrobials used for gram - and gram +, klebsiella, ecoli

ciproflaxacin should not be administered to children less than 18 years of age due to?

risk of achilles tendon rupture

common s/e of quinolones

N, V, diarrhea, discomfort, dizzy, light headed

used to treat soft tissue infections

quinolones.. contraindicated in children, pregnancy
potential for permanent cartiladge dammage

for inhalation anthrax infection ciproflaxacin is administered every?

12 hours for 60 days

treat UTI and otitis media, used prophylactically in pts susceptible to streptococcal infection or rheumatic fever when penicillin is contraindicated

sulfanomides

antiprotozoals

metronidazole (flagyl)
only effective against anaerobic bacteria

s/e of flagyl

GI discomfort, dry mouth, metallic taste, dark urine (harmless effect of med), CNS symptoms (stop med)

flagyl is effective when

no more bloody muscoid diarrhea,
has formed stool, neg stool for ameba and giardia. Negative blood cultures for anaerobic organisms in the CNS

Streptogramins

synercid
inhibit protein synthesis or bacterial cells
Treat VRE and MRSA

Antitubercular agent
Ethambutol (Myambutol)

Alter cellular RNA synthesis and phosphate metabolism
tx- tb
S/E- N, V, A, abdominal cramps
serious- red greeen vision change, confusion, hallucination, blurred vision

why is vit B6 admin with INH?

decrease neurologic side effects

Antitubercular Agent
Rifampin

prevent RNA synthesis by inhibiting DNA dependent RNA polymerase
use- eliminate meningococci and H. influenza type b, hib from asymptomatic carriers
s/e- reddish orange discoloration of secretions

antifungals
amphotericin B deoxycholate

acts on fungal cell membranes to increase cell permeability which results in leakage of intracellular cations leading to cell death. These agents can be fungistatic (slow growth) or fungicidal (destroys fungus).

topical antifungal agents

clotrimazole, miconazole, ketoconazole, nystatin,

amphotericin B

tx systemic life threatening fungal infections. Administration of amphotericin B should be infused slowly over 2-4 hr by IV route. Renal dammage can be lessened with administration of 1L saline solution on the day of amphotericin B infusion.

Ketoconazole

antifungal used to tx superficial fungal infections; dermatophytic infections, tinea pedis, tinea cruiris.

amphotericin B- infusion reactions

fever, chills, rigors, h/a 1-3 hr after innitiation. Pretreat with diphenhydramine (Benadryl) and aspirin. Meperidine or dantrolene may be given for rigors
use lipid based prep of amphotericin B to minimize reactions

Griseofulvin

stop cell division and new growth
tx ringworm
s/e N,V, abdominal cramps

B lymphocytes or B cells

produce antibodies IgA, IgD, IgG, IgE, or IgM

Helper T lymphocytes or CD 4 cells

activate B cells and are responsible for teh delayed hypersensitivity reaction

CD 8 cells

destroy target cells directly causing death of the microorganism

hep B immunization

dosese at birth, 1-2 months and 6-18 months

Diptheria and tetanus toxoids and pertussis vaccine DTAP

doses at 2, 4, 6, 15 to 18 months, and at 4-6 yrs

TDAP

11-12 years

TD booster

every 10 years following DTAP

HIB

dose at 2, 4, 6, and at 12-15 months

innactivated polio virus vaccine

dose at 2, 4, 6 to 18 months, and at 4-6 yrs

MMR measles, mumps, and rubella

12- 15 months and at 4-6 years

caricella vaccine

single dose at 12-18 months or 2 doses administered 4 weeks apart if administered after age 13

Pneumococcal conjugate vaccine (PCV)

dose at 2,4,6, and 12-15 months

hep A

2 doses 6 months apart after age 12

influenza vacinne

begin at age 6 months (october through november)

meningococcal vaccine MCV4

a dose at age 11-12 years

MMR is contraindicated in?

pregnant women and children who are allergic to eggs, gelatin, and neomycin
client with hx of thrombocytopenia, or thrombocytopenic purpura
immunocompromised children
clients with advanced HIV
for clients who recently recieved blood products or immunoglobulins

DTAP is contraindicated in?

severe febrile illness
occurence of encephalopathy 7 days after administering DTAP immunization
an occurence of seizure within 3 days of vaccination

Hep B is contraindicated in?

prior hx of anaphylactic reaction
an allergy to bakers yeast

if you have a hypersensitivity to eggs can you get the influenza vaccine?

no, vaccine is grown in eggs and may contain small amount of egg proteins. conduct a skin test prior to administration

adult influenza vaccine

annually after age 50, earlier if specific risk factors

PPV adult

one dose at age 65 and revaccinate every 6-8 years after initial vaccination

Immune globulins provide what immunity

passive immunity and provide gamma globulin antibodies
effective when- prevention of infection and increase platelets

Immune globulins given-

within 6 days of measles exposure, 7 days of hep B exposure, and within 14 days of hep A exposure

Interferon Alfa- Interleukin 2

immunostimulant enhance host immune response and reduce proliferation of cancer cells

Interleuken-2 is used to tx

hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma, AIDS

S/E interleuken 2

flu like sx, bone marrow suppression, alopecia, cardiotoxicty, neurotoxicity, hypotension

meds to avoid while on interleuken 2

antihypertensives, retrovir ( increase risk of neutropenia), theophylline

storage and admin of interleuken 2

store med in refrigerator and do not freeze. Administer at room temp. Do not shake vial. Admin subcutaneously or IM as prescribed.

Immunosuppressants

cyclosporine, glucocorticoid, prednisone, cytotoxics, imuran, prograf, rehumatrex

immunosupressants act-

suppression of the proliferation of b cells and t cells.
immunosuppressants are used for the tx of autoimmune disorders, RA, SLE, myasthenia gravis, early type 1 diabetes.

antiviral

famvir, inhibit viral replication, tx recurrent infections of genital herpes and acute herpes zoster

zidovudine (AZT) retrovir

hiv inhib viral replication. Used in combin with other antiviral agents to HIV-1.

antihistamine actions is on-

H1 receptors which results in blocking histamine release in the small blood vessels, capilaries, and nerves during an allergic reaction.

antihistamines/pregnancy

contraindicated during the third trimester of pregnancy for mothers who are breastfeeding and for newborns. Newborns are sensitive to the sedation effects of this med

Chemotherapy agents

cytoxan, methotrexate, rheumatrex,
destroy cancer cells as well as healthy cells by preventing the replication of DNA.

s/e of chemo agents

bone marrow suppression
GI discomfort,
alopecia
mucositis
reproductive toxicity- males sperm bank before tx
hyperuricemia- elevated levels of uric acid may cause renal dammage
* administer allopurinol is uric acid level is elevated.

dosage for chemo agents should be

individualized

when should a pt preparing for chemo select a hairpiece?

before the occurence of hair loss

patient who has recieved immune globulins, whole blood, serum, and specific immune globulins, when should MMR vaccine be scheduled?

postponed 3-6 months.

does tylenol have an antiinflammatory effect?

no, but it has analgesic and antipyretic effects

salicylism

tinnitus, sweating, headache and dizziness, respiratory alkalosis

when should aspirin be stopped before a scheduled surgery

1 week

take aspirin with?

food, milk, water to reduce gastric discomfort

Ketorolac

provides analgesia w/o anti-inflammatory. Ketorolac should ne used no more than 5 days. Usually started as a parenteral administration and then progresses to oral doses.

not to exceed ___ g tylenol a day

4 g

antidote of tylenol-

mucomyst

pt on tylenol and coumadin-

places client at risk for bleeding, watch for bruising, petechia, hematuria,

opiod agonist- morphine sulfate
fentanyl, demerol, oxycontin

act on the mu receptors, produces analgesia, respiratory depression, euphoria, and sedation,
relieve of moderate to severe pain

stop opiods if the clients RR is less than

12 bpm

avoid use of opiods with?

CNS depressants (barbituates, benzo's, and consumption of alcohol)

pt on morphine assess the clients bladder?

for distention by palpating the lower abdomen area every 4-6 hr

morphine is contraindicated in

premature infants and after biliary tract surgery

meperidine dosing

do not administer more than 600 mg/24 hr and limit its use to less than 48 hrs

opiods/antihypertensives

don't, it can further lower BP...

administer opiods

intravenously slowly over a period of 4-5 min, have narcan and resuscitation equipment available.

administer opiods to client with cancer

on a fixed schedule around the clock, not when necessary

fentanyl is 100 times more potent than

morphine

agonist-antagonist

stadol and talwin
low potential for abuse
less respiratory depression
cause analgesia, sedation, and decrease GI motility
tx- of mild to moderate pain

abstinenece syndrome-

cramping, htn, vomitting, may be precipitated when given to clients who are physically dependent on opiod agonsits.

opiod antagonist- narcan

tx of opiod overdose
reversal of respiratory depression
S/E- tachypnea and tachycardia
abstinence syndrome may also occur

route to admin nalaxone

IV,IM, or SC. Do not administer orally.

Adjuvant meds for pain

tricyclic antidepressants- elavil
anticonvulsants- tegretol, neurontin, dilantin
CNS stimulant- ritalin, dexedrine
antihistamine- vistaril
glucocorticoids- decadron, deltasone
biphosphonates- didronel and aredia

*used in combin with opiods, cannot be used as a substitute