Pharmacology Exam 2 Study Guide

Pharmacology Exam 2 Study Guide Liver failure oTea colored urine Opioids oDecrease RR, decrease GI tract

oAntidote: Narcan/ narlaxone

oAdminister when decrease RR Chapter 15 Miscellaneous Central nervous system medications Dantrolene (Dantrium) oAntidote for malignant hyperthermia oMuscle relaxants and antispasmodics

oMOA: stops muscle contraction

oPeripherally acting muscle relaxant that acts directly on spastic muscles and inhibits muscle contraction by preventing release of calcium in skeletal muscles oRelief of spasticity related to cerebral palsy, spinal cord injury and multiple sclerosis oTreatment of malignant hyperthermia

oCan cause CNS depression: sleepiness, lightheadedness, fatigue

oHepatic toxicity:

oAnorexia, nausea, vomiting, abdominal pain, jaundice oNurse: obtain baseline liver function test, observe for indications of toxicity, and notify provider if they occur, and start at a low dose

oMuscle weakness:

oNurse: Monitor for effectiveness of medication

oContradictions: Baclofen and dantrolene

oPregnancy risk category C oUse both meds cautiously in patients who have impaired liver and renal function oInteractions: CNS depressants (alcohol, opioids, antihistamines) have additive CNS depressant effects. Advise patient to avoid concurrent use oNursing administration: Provide assistance as needed in self-administration of medication and performance of ADLs. Advise to not stop med abruptly to avoid withdraw reaction oNursing evaluation: increased ability to preform ADLs, absence of pain, muscle rigidity, spasms and good range of motion

oRelation to calcium:

Cyclobenzaprine, tizanidine oGoes back to muscle; muscle spasticity; working in central nervous system (CNS) oActs in the CNS to enhance GABA and produce sedative effects and depress spasticity of muscles. They have no direct muscle relaxant action and do not decrease muscle strength.

Therapeutic uses: Relief of muscle spasm related to muscle injury.

Diazepam oActs in the CNS to enhance GABA and produce sedative effects and depress spasticity of muscules oValium o5- 30mg max

oTherapeutic uses:

Pharmacology Exam 2 Study Guide Muscle spasms related to muscle injury and spasticity Anxiety and panic disorders Insomnia Status epilepticus Alcohol withdrawal Anesthesia induction Baclofen oLorazepam (Ativan) first choice for seizures oActs in the CNS to enhance GABA, produce sedative effects, and depress hyperactive spasticity of muscle. There are no direct effects on skeletal muscles oTherapeutic uses: Relief of spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis Chapter 33 Connective tissue disorders Systemic lupus erythematous oAn autoimmune condition that can cause damage to joints, skin, blood vessels, and organs Fibromyalgia oA syndrome characterized by muscle pain and fatigue Gout oA painful type of arthritis caused by eleveated levels of uric acid, they accumulate and cause localized inflammation in synovial areas Antigout oMedications work by either reducing inflammation or decreasing serum uric acid levels.oAllopurinol -Agents for hyperuricemia; select prototype medication; oral, IV -Chronic gout or frequent gout attacks

Nursing considerations:

Hypersensitivity reaction, fever, rash, and kidney liver damage: If administering IV, stop infusion, severe reaction can require hemodialysis or glucocorticoids Kidney injuries: Alkalinize the urine and encourage intake of 2 to 3 L of fluids/daily. Monitor I&O, BUN, and Creatinine

Hepatitis: Monitor liver enzymes

GI distress (n/v): Administer with food

Increase in gout attacks: During first months of treatment; instruct client to report increased gout attacks to provider. Colchicine or an NSAID can be prescribed along with allopurinol to prevent this

Contraindications:

-Pregnancy risk category C -Contraindicated in patients who have medication hypersensitivity or idiopathic hemochromatosis -Rhabdomyolysis is most likely with long-term use. Risk is higher in clients taking statins for high cholesterol and those who have impaired kidneys or liver

Pharmacology Exam 2 Study Guide Interactions: slows the metabolism of warfarin within the liver, which places patient at risk for bleeding. Instruct patient to observe for signs of bleeding (bruising, petechiae, hematuria). Monitor PT and INR levels, and adjust warfarin dosages accordingly

oColchicine -Anti-inflammatory agent; select prototype medication; oral -Best for gout attacks -Used when patients can’t respond or tolerate safer agents

-Pharmacology action: effective only for inflammation caused by gout; decrease

inflammation -Therapeutic uses: abort acute attack in response to precursor symptoms, treatment of acute attacks, decrease incidence of acute attacks for people who have chronic gout.-(RBCs, WBCS, Platelets) -Increases bone marrow -Affects GI tract -Narrow therapeutic index

Nursing considerations:

-Mild GI distress/ toxicity: Abdominal pain, diarrhea, nausea, and vomiting. Take oral med with food, provide antidiarrheal agent as prescribed, if GI distress occurs, stop med and notify provider -Thrombocytopenia suppressed bone marrow: Advice patient to notify the provider of bleeding, bruising, or sore throat -Sudden onset of muscle pain, tenderness: Rhabdomyolysis; notify provider if onset

-Contradictions:

-Pregnancy risk category C -Contraindicated for clients who have severe renal, cardiac, hepatic, or GI dysfunction -Use cautiously in older adults and patients who are debilitated or have blood disorders or mild to moderate hepatic dysfunction.-Interactions: Grapefruit or grapefruit juice can increase adverse effects; avoid oCyclosporine -Decrease immune system; remission and exacerbation -Flu like symptoms, painful urination -

Which enzyme forms uric acid:

oXathine oxidase

NSAIDS

oEat before oTake with water to be absorbed better oCan cause peptic ulcers oBloody stool

oInteractions:

Chapter 34 Bisphosphonates oTreatment for osteoporosis oInhibits bone resorption

Pharmacology Exam 2 Study Guide

oMeds: Protype- Alendronate

-Ibandronate -Risendronate

-IV: Zoledronic

oExpected pharmacological action:

oDecrease the number and action of osteoclasts oInhibits bone break down  suppress osteoblast

oTherapeutic uses:

-Prophylaxis and treatment of postmenopausal osteoporosis -For males who have osteoporosis -Prophylaxis and treatment of osteoporosis produced by long-term glucocorticoid use -For clients who have Paget’s disease of the bone

oComplications: Esophagitis, esophageal ulceration

oInstruct the client to sit upright or ambulate for 30 min after taking this medication orally* oClients taking ibendronate must remain upright and not ingest food or other medications for 1 hour after taking the medication orally oInstruct the client to take tablets with at least 240 mL (8oz) water and liquid formulation with at least 60 mL (2oz) oDiscontinue the medication and contact the provider for difficulty swallowing or new heartburn

oContraindications:

oMost bisphosphates are pregnancy category; zoledronic acid is pregnancy category oThese meds are contraindicated for clients who have dysphagia, esophageal stricture, esophageal disorders, serious kidney impairment, and hypocalcema. This med should not be administered to clients who cannot sit upright or stand for 30 min after med administration oUse cautiously for women who are lactating, and in patients who have upper GI disorders, infection, and liver impairment oOlder adults are at slight risk for femoral fractures, which can occur without trauma wile taking bisphosphonates.

oInteractions: Alendronate absorption decrease when taken with calcium, iron,

magnesium supplements, antacids, orange juice, and caffeine

oNursing administration:

oTablets are prescribed once daily or once a week. The liquid form is prescribed once a week oMonitor bone density. Patient should have a bone density scan every 12 to 18 months oMonitor serum calcium

oClient education:

oAdvise patient to take the med on an empty stomach first thing in the morning with at least 240 mL (8oz) water oWait 30 min after administration to take antacids or supplements oSit or ambulate for 30 min after taking the medication oAvoid calcium containing foods for 30 min prior to med; avoid gum oPerform weight bearing exercises daily 30 to 40 min each day oFor maximum benefits of the medication, consume adequate amounts of calcium and vitamin D