Pharm exam

• Adverse effects of Prednisolone (Medrol)

  • Impaired wound healing
  • Masking of infections
  • Hypokalemia
  • Peptic ulcers
  • Edema
  • Sodium/fluid retention
  • Nausea
  • Anxiety
  • Weight gain
  • Heart failure
  • Increased intraocular pressure
  • Fragile skin
  • Candidiasis (inhaler use use)
• Adverse effects of Warfarin (Anticoagulant)

  • Thrombocytopenia (HIT) (Decreased platelet count)
  • Bleeding
  • Hematuria
  • Nausea
  • Local irritation (preferably injected SC into abdomen)
• Goal of anticoagulant therapy/ purpose

  • Help prevent blood clots
  • Clients lab value exhibit a decrease in blood coagulation
  • Client demonstrates an understanding of drugs effects and precautions
• What medications are used for cough?

  • Pseudoephedrine (Decongestant)
  • Dextromethorphan (Antitussive)
  • Guaifenesin (Expectorant)
  • Antihistamine
• Nursing Considerations before starting metformin

  • 1st line therapy for type 2 DM
  • Must be taken with meals
  • Must stop medication 48 hours prior to iodine radiological studies
  • Does not cause weight gain
  • Adverse effects usually go away within 7-14 days after start of therapy
  • Reduced folate and B12 absorption (reduced intrinsic factor proteins)
• Adverse Effects of Metformin

  • Diarrhea
  • Nausea
  • Metallic taste in mouth
  • Anorexia
• Purpose (indications) and mechanism of Aspirin

  • Indications: Venous Thrombosis
  • Angina
  • CVA Thrombosis
  • MI
  • Mechanism of Action: Interfere with platelet aggregation via blocking the formation of thromboxane A2
• Angles of injection


  • Subcutaneous: 45 to 90 degrees
  • Intramuscular: 90 degrees
  • Intravenous: 25 degrees
  • Intradermal: 15 degrees
• Who regulates medications in Canada
• Contraindications of taking warfarin(Anticoagulants)

  • Allergy
  • Active interval bleeding
  • Severe hypertension
  • Bleeding disorders
  • ASA?/NSAIDS(Increased anticoagulant effect)
  • Trauma
  • Intracranial hemorrhage
  • Pregnancy
• Contraindications for beta blockers

  • Allergy
  • Antacids (decrease B-blocker activity)
  • Asthma (seen with non-cardio selective medications; labetalol, propranolol)
• When a patient demonstrates understanding of beta blockers

  • May cause heart rate to decrease
  • Cardio selective
  • Understanding of adverse effects: Bradycardia
  • Hypotension
  • Dizziness (decreased BP)
  • N/V/D
  • Hypoglycemia
  • Decreased libido
• Nursing Considerations for beta blockers

  • Thorough cardiovascular assessment is required prior to administration
  • (Kids) preferred drug for treatment of hypertension
  • (Kids) do not administer if HR is < 60bpm
• Nursing Considerations for Lipitor (HMG-CoA Reductase inhibitor)

  • Obtain a baseline serum lipid profile
  • Continuous monitoring of blood pressure for hypotension
  • Effects not often seen for 6-8 weeks
  • Obtain baseline serum liver profile
  • Encourage low fat/heart healthy diet
• Nursing Considerations for Spironolactone (Potassium-Sparing Diuretics)

  • Thorough cardiovascular assessment is required prior to administration
  • Monitor potassium levels (hyperkalemia)
  • Instruct client to decrease diet of sodium-rich foods
  • Client should report a weight loss of more than 2ln/week
  • (Kids) Accumulates in children with renal failure
  • (Geriatric) High risk of hyperkalemia r/t renal impairment (frequent serum electrolytes, BUN and creatinine are needed)
• Nursing Considerations for Digoxin (Cardiac Glycoside)

  • Thorough cardiovascular assessment is required prior to administration
  • Hold if apical pulse is <60 bpm
  • Antacids decrease absorption
  • Serum drug levels should be obtained regularly (toxicity occurs in about 20% of patients; ref range 1.0 to 2.6 nmol/l)
• Adverse Effects of Digoxin

  • Dysrhythmias
  • Nausea/Vomiting (toxicity)
  • Visual disturbances (green blurry halos around lights; often suggests that concentration is above therapeutic limits)
  • (Kids) neonate toxicity starts with unexpected slowing of heart rate
• Mechanism of action for antihypertensives

  • B-Blockers: Block SNS stimulation of B-adrenergic receptors located in the heart, kidneys, and blood vessels to inhibit vasoconstriction and reduce heart rate
  • Cardio selective: they have a 20x binding affinity for B-1 receptors in the heart versus B-2 which are found in the bronchioles
  • ACE Inhibitors: Inhibits angiotensin-converting enzyme = angiotensin 1 = angiotensin 2 = vasoconstriction = aldosterone secretion = sodium and water re-absorption
  • ARBs: Blocks the effects of angiotensin 2
  • Renin Inhibitors: Blocks the conversion of angiotensinogen to angiotensin 1
  • Calcium Channel Blockers: Dilates and relaxes arterial muscle, decreases blood pressure and heart rate, thus decreasing cardiac workload
• Adverse Effects of Ace Inhibitors

  • Headache (vasodilation)
  • Dizziness (r/t decreased BP)
  • Orthostatic hypotension
  • Dry cough (increased bradykin)
  • Rash (increased bradykinin levels)
  • Hypotension
  • Hyperkalemia (r/t decrease renal filtration (eGFR))
• Contraindications for laxatives


  • Bulk forming Laxative: Allergy
  • Acute abdomen
  • Intestinal obstruction
  • Undiagnosed abdo pain
  • Appendicitis
  • Electrolyte imbalance
  • Renal failure
  • Children <6 years (not established)
  • Emollient laxative: Allergy
  • Acute abdomen
  • Intestinal obstruction
  • Undiagnosed abdo pain
  • Appendicitis
  • Electrolyte imbalance
  • Renal failure
  • Caution in pregnancy
  • Hyperosmotic Laxative: Allergy
  • Acute abdomen
  • Intestinal obstruction
  • Undiagnosed abdo pain
  • Appendicitis
  • Electrolyte imbalance
  • Renal failure
  • Diabetes (lactulose contains lactose)
  • Saline Laxative: Allergy
  • Acute abdomen
  • Intestinal obstruction
  • Undiagnosed abdo pain
  • Appendicitis
  • Electrolyte imbalance
  • Renal failure
  • Children <2 years
  • Magnesium binds with quinolone and tetracycline to form a non-absorbable complex; reducing effectiveness of the antibiotic
  • Stimulant Laxative: Allergy
  • Acute abdomen
  • Intestinal obstruction
  • Undiagnosed abdo pain
  • Appendicitis
  • Electrolyte imbalance
  • Renal failure
  • Children < 6 years
• Adverse Effects of Laxatives

  • Bulk forming Laxative: Constipation
  • Abdo cramping
  • Flatulence
  • Emollient Laxative: Cramping
  • Diarrhea
  • Hyperosmotic Laxative: Decreased BP
  • Diarrhea
  • Abdo cramping
  • Electrolyte imbalances
  • Belching & flatulence
  • Saline Laxative: Decreased BP
  • Diarrhea
  • Abdo cramping
  • Electrolyte imbalances
  • Muscle cramping
  • Dizziness
• Nursing Considerations for inhaled corticosteroids

  • Long-term use may cause osteoporosis (decrease absorption & increase excretion of calcium)
  • Long-term use may cause Cushing's disease/syndrome
  • Oral glucocorticoids (long-term use) should be given In the morning to decrease amount of adrenal suppression (resulting in fatigue, hypoglycemia, weakness, etc)
  • Oral glucocorticoids should be given with milk or food to decrease GI upset
  • (Kids) Growth retardation is possible. Thus, smaller doses should be considered, and accurate weekly height must be documented
  • (Geriatric) Corticosteroids often aggravate other conditions (i.e., hypertension, CHF, diabetes, infection)
  • Rinse mouth after inhaled use to prevent candidiasis
• Nursing Considerations for Antihistamines

  • (Kids) May experience paradoxical excitement
  • (Geriatric) May cause confusion, dizziness, and hypotension
  • (Geriatric) Diphenhydramine is sometimes used as a sleeping aid for occasional use
  • Avoid drinking and use of heavy machinery
  • Second generation antihistamines are ineffective treatment options for a cough
• What to do if a cough medication isn't working
• What to do during an asthma attack

  • Administer Beta-adrenergic Agonist (B2-Agonist)
  • Administer Corticosteroids
  • Antileukotriene
  • Xanthine (Methylxanthines)
• Adverse Effects of inhaled corticosteroids

  • Impaired wound healing
  • Masking of infections (normal inflammatory response is altered; reduced fever or pain in a client)
  • Hypokalemia
  • Hyperglycemia (r/t increased insulin resistance)
  • Peptic ulcers
  • Edema
  • Sodium/fluid retention
  • Nausea
  • Anxiety
  • Weight gain
  • Heart failure
  • Increased intraocular pressure
  • Fragile skin
  • Candidiasis (inhaler use)
• Know drug legislations


  • The Canadian Food and Drugs act is the primary piece of legislation governing foods, drugs, cosmetics, and medical devices in Canada
  • The food and drugs act regulates the information manufacturers may put on a drug label, including directions for use
  • According to the act, and to protect the consumer, drugs must comply with official prescribed standards stated in recognized pharmacopoeias and formularies (i.e., Canadian Formulary, National Formulary, United states pharmacopeia, etc)
  • Controlled Drugs an substances Act (CDSA) prohibited activites such as possession, possession for the purpose of trafficking, trafficking, importing and exporting, and cultivation of narcotics or controlled and restricted drugs
• What to know about giving meds to kids

  • Age and weight are important factors
  • Immaturity of organs
  • Gastric emptying is slower
  • Skin is thinner
  • IM absorption is faster
  • Less body fat content
  • Immaturity of blood brain barrier
  • CYP450 enzymes will not reach full levels until approx.. 1-3 months (decreased metabolism)
• Synergistic


  • A drug's action enhances the action of another
  • Combined effects are larger than the sum of effects for each drug in isolation
  • 1+1=>2
• What to do if there's an adverse reaction with levofloxacin (Fluoroquinolone)

  • Clients must complete full course of treatment
  • Encourage fluids to produce a urine output of 1,200-1,500 mL/day to avoid crystalluria (drug crystals in the urine)
  • Avoid exposure to
• Controlled Drugs an substances Act (CDSA) prohibited activites such as possession, possession for the purpose of trafficking, trafficking, importing and exporting, and cultivation of narcotics or controlled and restricted drugs
• Factors to consider when giving meds to kids

  • Age and weight are important
  • Immaturity of organs
  • Gastric emptying is slower
  • Skin is thinner
  • IM absorption is faster
  • Less body fat content
  • Immaturity of blood brain barrier
  • CYP450 enzymes will not reach full levels until approx.. 1-3 months (decreased metabolism)
• Synergistic


  • A drug's action enhances the action of another
  • Combined effects are larger than the sum of effects for each drug in isolation
• What to do if there's an adverse reaction with levofloxacin (Fluoroquinolone)

  1. Clients must complete full course of treatment

  2. Encourage fluids to produce a urine output of 1,200-1,500 mL/day to avoid crystalluria (drug crystals in the urine)

  3. Avoid exposure to sunlight
• Prophylaxis


  An attempt to prevent diseases
• Empiric therapy


  Treatment given based on experience, without precise knowledge of the cause or nature of the disorder
• Contraindications for antidiarrheal medications


  • Adsorbents
  • Atypical
  • Antimotility Agents/ Opiates
  • Children
  • Acute GI condition (Ulcerative colitis)
  • Cirrhosis
  • Diarrhea from poisoning
  • ASA (A,AT)
  • Hematochezia
• Mechanism of action for pepto-bismo (Antidiarrheal)

  1. Decreased GI motility

  2. Absorbents: coat GI to protect it

  3. Modifiers of electrolyte and fluid transport

  4. Atypical: anti-inflammatory, antacid, absorbent, and antibiotic properties (MOA not well understood)
• Nursing Considerations for inmodium (Antidiarrheal)

  • Patients should follow a bland diet
  • Onset 1-3 hours; d/c if no improvement within 48 hours
  • Patients should drink adequate fluids and take other medications 2-3 hours after taking antidiarrheal
  • Patients should not exceed recommended dose
  • Black stools (bismuth preparations)
• Contraindications for pepto-bismo


  • Children
  • Acute GI condition (Ulcerative colitis)
  • Cirrhosis
  • Diarrhea from poisoning
  • ASA (A,AT)
  • Hematochezia