Pharmacology Winter Quarter

Study Guide – Exam #1

Purpose Administratio Contraindications/Dru Labs Side effects Nursing Actions

n g interactions
Factor VIII Hemophilia A Don’t give to Avoid NSAIDs due to Need baseline for factor Can cause SERIOUS Caution with
Prevents long term hemophilia B bleeding, GI ulceration, VIII allergic reactions- SOB, breast feeding and
damage to joints patients – platelet aggregation throat, swelling in face pregnancy
(esp children) won’t work Serum factor VIII before
Avoid aspirin and after Mild allergic reactions Dosage depends
Given “on demand” Slow IV push (remedy with on clinical
to stop ongoing or continuous Second gen NSAIDs are antihistamine): stuffy response- severity
bleeding infusion probably safe nose, fever, hives, rash, of bleed
urticaria
Goal is to maintain IV infusion or Teaching: hand
factor VIII 1% above central line washing, have
normal access on assistant call EMS
regular with
schedule complications,
dosage
calculations,
reconstitute
powdered
concentrate,
infusion technique,
cleanup and waste
disposal, recording
of information

Have 2 people
when infusing
Factor IX Hemophilia B Slow IV pus or Teaching: hand
continuous washing, have
Prophylaxis of infusion assistant call EMS
prevention of joint with
injury Dosage based complications,
on severity dosage
 calculations,
Twice a week reconstitute
instead of powdered
three concentrate,
infusion technique,
cleanup and waste
disposal, recording
of information

Have 2 people
when infusing
Factor VIIa Used when patient African American
develops antibodies and Hispanic
to factor VIII patients are
usually put on this
Antifibrinolytics Tranexamic acid Oral and IV Decrease dosage in
Used to prevent patients with renal
excessive bleeding Less useful to impairment
episodes from stop ongoing
occurring bleeding, but
USEFUL to
Used to prevent PREVENT
recurrent bleeding, recurrent
particularly in bleeding
mucous membranes
and dental
extractions
Desmopressin Cheaper than factor IV or Not used for Fluid retention, Fluid retention-
VIII and promotes intranasal hemophilia B patients hyponatremia edema in
release of factor VIII Oral is since doesn’t have extremities,
from endothelium available but factor IX difficulty
not for breathing; listen to
Stops trauma hemophilia lung sounds
induced bleedin g Pleural fluid-
crackles, ranchi
Not used for
hemophilia B
Iron Ferrous sulfate- Available in Don’t take with Serum ferritin Green/black stools are Duration of
preferred drug for standard tetracycline because NORMAL therapy is 2
preventing tables (enteric reduces absorption months for anemia
deficiency coated and Don’t take with GI disturbances- Ferritin restored
sustained calcium or stool nausea, pyrosis, after 4-6 months
release) softeners bloating, constipation,
diarrhea Prophylaxis
Take on empty Ascorbic acid (vit C) anemia:
stomach if no promotes iron Patients with peptic pregnancy, infants,
GI problems absopriton but ulcers, regional children, women
If GI problems, increases adverse enteritis, ulcerative with menorrhagia
take between effects colitis should not take
meals meds by mouth
Food lowers
Take at least absorption and lowers Staining of teeth- gray;
three times a GI upset dilute with juice or
day water; rinse mouth

Children easily OD!!!!!

Sodium ferric Given to patients on Slow IV push Always used with Transient flushing, Every time you
gluconate hemodialysis (over 10 min) erythropoietin hypotension, deliver drug, have
complex lightheadedness, crash cart ready
Iron deficiency in Monitor malaise, fatigue,
patients with CKD patient- fluid weakness, severe pain
undergoing chronic bolus in
hemodialysis chest/back/flanks/groi
n

Little risk of
anaphylaxis
Folate Treatment of Oral- daily Contraindicated for Serum folate, Leukopenia, Improving
megaloblastic dose pernicious anemia erythrocyte/reticulocyte thrombocytopenia, nutrition: green
anemia, initial subQ, IM, IV Inappropriate use may count, injury to oral & GI veggies, liver,
treatment of severe mask B12 deficiency hemoglobin/hematocrit mucosa; may increase counseling on
megaloblastic Prophylaxis in , bone marrow biopsy, risk of colorectal cancer alcoholism
anemia, prevention pregnant and schilling test and atherosclerosis
of folic acid lactating
deficiency (pregnant women
women)
 Severe
deficiency- IM
injection with
daily PO
CYANACOBALBI If have B12 Injection if Watch erythrocyte Hypokalemia- serious Don’t take folic
N deficiency due to numbness in count AE due to increased acid because
pernicious anemia, hands/feet, erythrocytes masks
celiac disease, anemia, Schilling test- neurodegeneratio
Vitamin B12 overuse of acid- infections in measurement of B12 n
suppressing mouth absorption
medications, Anemia can cause
regional enteritis Orally (daily), Hemoglobin/hematocrit numbness and
intranasally Bone marrow examined tingling in feet
(once a week), for megaloblasts (diabetes?)
IM (monthly) Reticulocyte counts
For intranasal
DO NOT give After a week: medications, use 1
IV - Megaloblasts hour before eating
should spicy hot foods; do
disappear not use with runny
- Reticulocytes nose
increase
- Hematocrit Lifelong treatment
normal for some patients
Tell patient to
increase
consumption of
B12 foods

Epoetin alfa Patients with CRF, Dosages Not approved for Hemoglobin SHOULD Check hemoglobin- Use caution with
anemia secondary should be low patients with leukemia NOT exceed 11!!! high Hg leads to leukemia patients
to chemo, HIV to prevent and other myeloid cardiovascular events
infected patients serious cardio malignancies Lifelong treatment
events Cardiovascular events:
Can elevate hypertension, HF, Reduces need for
erythrocyte cardiac arrest, transfusions
production pre op thrombotic events
(stroke, MI) Need to give
patient medication
guidec to explain
 May cause risks and benefits
autoimmune pure red of drug
cell aplasia

Can accelerate tumor

progression
Filgrastim Chemo drug IV, subQ Contraindicated for Blood counts and Causes a degree of
patients who are platelet counts bone pain
Promotes hypersensitive to E.
neutrophil recovery coli derived proteins CBC with platelets twice Leukocytosis
weekly May require opioids for
Treats severe Use with caution in pain relief
neutropenia patients with cancers Stop treatment when
of bone marrow origin neutrophil count
reaches 10,000
Erythropoiesis Given to patients on Check hemoglobin Causes high bp in
stimulating hemodialysis levels kidney disease patients
agent (ESA)
Increase RBC Accelerate tumor
production progression
Increase risk of serious
Class of drugs cardiovascular events
and death
Reduces need of
transfusions

Methotrexate Prevents folic acid Has to be given with Bone marrow AVOID with
(Rheumatrex) formation leucovorin suppression, pregnancy- fetal
pulmonary infiltrates, malformation
Used for oral/GI ulceration
choriocarcinoma, Death may occur Drug should be
non-Hodgkin’s, Nausea and vomiting alkalinized and
acute lymphocytic Can injure kidneys hydration should
leukemia, RA, be maintained in
Crohn’s, psoriasis, order to protect
abortion kidneys
Vincristine Chemo Numbness and tingling
(Oncovin)
Mitotic inhibitors
 Toxic to peripheral
Good for nerves
combination
therapy for non Peripheral neuropathy
Hodgkin’s,
Hodgkin’s, acute Little bone marrow
lymphocytic suppression
leukemia, Wilms’ Alopecia may develop
tumor,
rhabdomyosarcoma Nausea and vomiting
, Kaposi’s sarcoma, are uncommon
breast cancer, Sensory and motor
bladder cancer injury common
Tamoxifen Endocrine Oral Contraindicated: DVT is dangerous side AVOID during
(Nolvadex) treatment for breast pregnant women! effect pregnancy
cancer Make sure patient
Risk of endometrial is on
cancer contraceptives
In women with bone
metases, bone pain and
hyperglycemia can
occur

Common: hot flashes,

fluid retention, vaginal
discharge, nausea,
vomiting, menstrual
irregularities
Imatinib Myelodysplastic Taken with AVOID during Complete blood counts Nausea, vomiting, Cancer cells can
(Gleevec) diseases, aggressive meal and glass pregnancy and breast taken weekly during diarrhea, rash, become resistant
systemic osf water feeding first month then headache, fatigue, over time
astocytosis, acute biweekly second, fever, musculoskeletal
lymphoblastic periodically thereafter complaints AVOID during
leukemia, Fluid retention  pregnancy
hypereosinophilic pleural effusion,
syndrome, chronic pericardial effusion,
eosinophilic pulmonary edema,
leukemia, GI ascites
stromal tumor Neutropenia and
CML thrombocytopenia- risk
 of infection and
bleeding

Reports of HF, skin

reactions,
hypothyroidism
Pentazocine Agonist- antagonist subQ, IM, IV, Pentazocine and other Can precipitate Monitor for opiate
(Talwin) opioid oral drugs that block mu withdrawals withdrawals-
Indicated for mild to receptors should never yawning and
moderate pain be administered to a Toxicity reversed with sweating
person who is naloxone
Agonist at kappa physically dependent Warn patients
receptors and on pure opioid agonist Mild withdrawal against immediate
antagonist at mu symptoms: cramps, withdrawal
receptors Don’t give to patients feer, anxiety,
with acute MI restlessness

Physical dependence
Imipramine Treats neuropathy
(Tofranil) side effects of
chemo
Oxycodone moderate to high Not PRN Constipation Do NOT crush or
pain level Every 12 hours chew controlled
Respiratory depression- release tablets
AVOID with pregnancy notify immediately
Monitor pulse rate,
CNS depressants- risk Sedation blood pressure,
of profound sedation Orthostatic respiratory rate
and resp depression hypotension
Anticholingeric drugs- Constipation
opioid induced Urinary retention
constipation and Biliary colic
urinary retention Emesis
Hypotensive drugs- Cough suppression
antihypertensives can Miosis
lower blood pressure Neutrotoxicity
Opioid antagonists- Birth defects
abstinence syndrome; Opioid dependence in
titrate neonate
Dysrhythmias
 Agonist-antagonist
opioids- abstinence
syndrome
MAOIs- delirium,
hyperthermia, rigidity,
convulsions, coma,
death
CYP3A4 inhibitors-
fatal resp depression
Imitrex Migraine headaches Affects coronary
arteries

Know the most common side effects of chemotherapy, and know the
difference between the expected side effects and adverse effects
Know normal range of neutrophils and WBC
Understand when and how chemotherapy is administered
Nursing education for patients undergoing chemotherapy
Treatment for side effects of chemotherapy
Medications contraindicated for treating chemotherapy patients
Understand why some chemotherapeutic agents are used together
Nursing action when adverse effects occur
Know classes of chemotherapeutic agents for breast cancer and what
differentiates them
Know when it is appropriate to use PO, IV, IM, and patch for opiates
How to treat overdose of an opiate
Nursing instructions for opiates
Nursing assessments of patients taking opiates
Therapeutic benefits of opiates
Review the meaning and implications of ‘tolerance’
Know medications to treat headaches

 If oral opiates are not effective, use patch

 If pupils are dilated, patient is lethargic, heart rate is 84, bp is 85/45, resp is 8, use Narcan because high
 When patient is receiving chemo and complain of nausea and vomiting, antiemetics before chemo
 Side effects of chemo: N, V, hair loss, immunosuppression,
 Fever, high WBC, high neutrophil= CONCERNING for chemo patients
 Know WBC and neutrophil count
 Chemo- IV, intermittent (break),
 Nursing education for chemo patients: precaution with infections
 Side effects of cancer: prone to fractures, bruising, weight loss, irritation of skin, inflammation, mouth (!!)
 Opiate tolerance- ineffective, need to take higher amounts
 Physical symptoms from opiates:
o Low bp, toxicaiton, nausea, suppresses bowels (constipation)
 Pain is subjective matter
 Migraine
 If IV site is inflamed, take it out!
 Chemo drugs aren’t given alone
 Combination therapy- reduce side effects, minimal toxicity, reduce dose, different mechanisms
 Nursing education for chemo patient: avoid sick people, hair loss is expected, home remedies for nausea, bone fractures, weight loss, mouth sores
o Mouth sores- medicated mouth washes
 Tongue is sore and beefy red- iron deficiency
 Chemo patient enters with high WBC count- concerned for sepsis
o Concerning fever = >100
 Chemo patient and pain level is 3/10
o Tylenol
 Chemo patient and pain level is 9/10
o Morphine
 Pt who has iidney failure and anemia- sodium ferri gluconate and epoetin
o Redue the need for transfusion with CRF
 Lab values for epoetin- hemoglobin
o Drug raises hemoglobin
 If patient is anemic, what hemoglobin level is anemic
o <10
o Need transfusion at 7
 Hematocrit of 32 = anemic
 Have a patient who had an allergic reaction that resulted in some hives; what drug would the doc order?
o Antihistamine
 Migraine headache symptoms
 Know side effects for opiates/opioids
 opioids and NSAIDs- good together
o Can use together
o Better coverage
 Pain medication given based on number and what they tell you about pain
  Patient in a lot of pain- what to monitor?
o Get them moving
o Infections
o Pain level
o Touch the spot where it’s painful to see
 Medication to avoid with NSAIDs- factor VIII

Power of vulnerability TED talk

Notes:

 Critical thinking questions:

o Asking what you should do as a nurse
o Try to identify the life threatening condition
o Heart and resp affected by clots, loss of O2, DVT, embolism
o DVT **** omg
o Is there a life threatening event that I’’m supposed to prevent here?
o Is there enough information?
o Anaphylaxis- priority when it comes to respiratory
o Hypoglycemia- can go into seizures and die from this
o Heart problem? Lung problem? Blood sugar problem?
o Look out for upper + upper drugs = BAD
o Look out for down + downer drugs = BAD
o Always look for potassium!!! Know levels bruh
o Heart, lungs, brain, potassium, DVT, allergies, asthma, clots, oxygen, blood sugar
 Look for safety alerts in the book!
 Read summary of nursing implications :O
o Everything highlighted in blue
o Key points could be irrelevant so primarily focus on nursing implication
 Evolve – all the test questions from there!!!!
o USE IT
o Get more practice with priority questions here
 Look at purple boxes at end of chapters and put in med chart where appropriate
 Know the meds on chart and know general side effects and how to educate
 Remember: negative side effects of hemo/blood drugs
 Be sensitive to when and where you give each factor and antifibrinolytics
 Nothing about psych
 Oxycodone- put information about nursing actions and administration