Meds

Question 1

Uppers and Downers

Answer 1

• Uppers
  
  • overdose on upper, everything goes up
  • withdrawal on upper, everything goes down
• Downers
  
  • overdose on downers, everything goes down
  • withdrawal on downers, everything goes up

Question 2

Aminoglycosides

Answer 2

• Powerful abx
• Trough and Peaks
• Administered Q8H (IM or IV)
  
  • Administered PO w/ hepatic encephalopathy (kill e-coli and reduce ammonia)
  • Administered PO pre-op with bowel surgery (clear out bowels)
  • PO administered to sterilize bowels (Neomycin & kanamycin)
• “a mean old mycin for a mean old infection”
• all end in - mycin except the -thro mycins (not aminoglycosides)
  
  • Azithromycin
  • Clarithromycin
  • Erythromycin
• Examples
  
  • Streptomycin
  • Cleomycin
  • Tobramycin
  • Gentamycin
  • Vancomycin
  • Clindamycin
• Toxic effects
  
  • “mice = ears”
    
    • ototoxicity
      
      • monitor hearing, balance, tinitus
  • human ear is shaped like a kidney
    
    • nephrotoxicity
      
      • monitor creatinine
  • Toxic to cranial nerve #8

Question 3

Trough and Peak

Answer 3

• Draw trough 30 minutes before the next dose
• Draw peak of sublingual meds 5-10 minutes after drug dissolves
• Draw peak of IV meds 15-30 minutes after medication is finished
• Draw peak of IM meds 30-60 minutes after injecting it

Question 4

Calcium Channel Blockers

Answer 4

• “Like valium for your heart”
  
  • relaxes the heart
  • → Given for tachy arrhythmias
  • not given when heart needs stimulating
• Negative inotrope
• Indications
  
  • Antihypertensive
  • Anti-Angina (imbalance between O2 supply and demand
  • Anti Atrial Arrhythmic (Aflutter & Afib, SVT)
• Side effects
  
  • Headache, hypotension
• Meds
  
  • ending in -dipine
  • verapamil
  • Cardizem (gtt) - measure BP and hold if systolic <100, titrate

Question 5

Negative inotrope vs. Positive inotrope

Answer 5

• Positive inotrope (stimulants)
  
  • Atropine, epinephrine and norepinephrine
• Negative inotrope (depressant)
  
  • Calcium channel blockers, beta blockers

Question 6

Insulin overview

Answer 6

• Check expiration date
• Refrigerate only when unopened
  
  • teach patients to refrigerate at home
• Drawing up mixed insulin
  
  1. Draw up total dose in air
  2. Put air in N vial
  3. Put air in R vial
  4. Draw up R dose
  5. Draw up N dose

Question 7

Insulin Type: R

Answer 7

• Humulin R, Novolin R
• Times
  
  • Onset: 1 hours
  • Peak: 2 hours
  • Duration: 4 hours
• R = Regular, Rapid acting, Run (IV drip)

Question 8

Insulin Type: NPH

Answer 8

• N = NPH, Not in the bag (No IV), Not so fast, not clear (cloudy)
• Times
  
  • Onset: 6 hours
  • Peak: 8-10 hours
  • Duration: 12 hours

Question 9

Insulin Type: Humalog

Answer 9

• Lispro
• With meals
• Fastest
• Times
  
  • Onset: 15 minutes
  • Peak: 30 minutes
  • Duration: 3 hours

Question 10

Insulin Type: Lantus

Answer 10

• Long-acting
• Glargine
• Slow absorption
• Times
  
  • No Peak
  • Duration: 12-24 hours

Question 11

Toxicities

Answer 11

• Lithium
  
  • Therapeutic: 0.6-1.2
  • Toxic: 2+
• Lanoxin (Digoxin)
  
  • Therapeutic: 1-2
  • Toxic: 2+
• Aminophylline
  
  • Therapeutic: 10-20
  • Toxic: 20+
• Bilirubin (babies)
  
  • Therapeutic: 10-20 (elevated in babies compared to adults)
  • Toxic: 20+
  • Kernicterus
    
    • bilirubin in the CSF
  • Opisthotonos
    
    • position of slight extension in the neck seen in patients with kernicterus

Question 12

Injections

Answer 12

• IM
  
  • length and gauge
    
    • 1 in both gauge and length (ex. 21 gauge, 1” length)
• SQ
  
  • length and gauge
    
    • 5 in both gauge and length (ex. 25 gauge, 5/8” length)

Question 13

Heparin vs. Coumadin

Answer 13

• Heparin
  
  • Given IV or SQ
  • Works immediately
  • Can only take for 21 days (except for lovenox)
  • Antidote - Protamin sulfate (heParin)
  • Labs - PTT and all clotting and bleeding times (“HTTP”)
  • Can use in pregnancy (class C)
• Coumadin
  
  • Given PO
  • Takes days to work
  • Can take for entire life
  • Antidote - Vitamin K
  • Labs - PT, INR
  • Can not use in pregnancy (class x)

Question 14

Baclofen (Lioresal) & Flexeril

Answer 14

• Muscle relaxants
• S/E
  
  • fatigue
  • paresis (muscle weaknesS)
• Teachings
  
  • Do not drink alcohol
  • Do not drive/operate heavy machinery
  • do not watch kids under age 12

Question 15

K sparing and wasting diuretics

Answer 15

• Wasting
  
  • Diuretics ending in x will “x out k” plus diuril
    
    • ex/ Lasix
• Sparing
  
  • all others

Question 16

Guessing strategies - pharm

Answer 16

• Side effects most commonly tested
  
  • Pick s/e of system medication is working on
    
    • ex. tachycardia for heart meds
• For PO meds, pick a GI s/e
• Never tell a child medicine is candy

Question 17

Oncology Meds

Answer 17

• Cyclophosphamide (Cytoxan)
  
  • s/e - hemorrhagic cystitis
• Bleomycin
  
  • s/e - pulmonary fibrosis
• Cisplatin
  
  • s/e - peripheral neuropathy, constipation, ototoxicity
• Doxorubicin (Adriamycin)
  
  • s/e - cardiotoxicity
• Vincristine
  
  • s/e - peripheral neuropathy, constipation
• DTIC-dome
  
  • s/e - Flu-like symptoms
• Methotrexate
  
  • s/e - toxic to every organ except heart
    
    • toxicity made worse with ASA

Question 18

Chemo Man

Answer 18

Question 19

Digitalis

Answer 19

• Toxic effects
  
  • Anorexia
  • N/V
  • HA
  • Yellow/green vision
  • Arrhythmia

Question 20

Theophylline

Answer 20

• Bronchodilator
• Used to treat asthma
• Toxicity
  
  • N/V
  • Coffee ground emesis
  • Tachycardia
  • Tremors
• Therapeutic level 10-20