ATI Pharm Proctored Exam Study Guide PDF

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Summary

Use this to study for the ATI Pharmacology proctored exam....

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Pharm ATI Information: List of Drugs to review/study Note •

LEARN HOW TO GROUP DRUGS BY THEIR SPELLING (Specifically the ending of the word) o Rationale: This will better help associate the drug to the potential adverse effect or therapeutic effect of the drug EVEN IF YOU NEVER SEEN THAT DRUG BEFORE o Examples: § “pril” • ACE Inhibitors • Ex. Captopril § “Sartans” • ARBS Drug class • Ex. Losartan § “Statin” • Cholesterol and Lipid-Lowering (HMG-CoA Reductase Inhibitors) Drug Class • Ex. Atorvastatin, Lovastatin § “olol” • Beta-Blocker Class • Ex. Metoprolol, Atenolol, Propranolol § “ine” • Typically drugs with Anticholinergic effects (ex. Dry mouth, blurred vision, dry eyes, constipation, urinary retention, etc.) § “mycin” • Aminoglycosides class of Antibiotics • Ex. Gentamicin (Garamycin), Neomycin, Streptomycin § “Tron” • Common Classes of Antiemetics – Serotonin Antagonists • Ex. Ondansetron § “Fil” • Erectile Dysfunction (ED) Agents • Ex. Sildenafil, Vardenafil, Tadalafil • “Fil” the Penis

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STUDY AND KNOW ANTIBIOTICS!!!! o Isoniazid § Take on an empty stomach to improve absorption of medication § Used to treat TB o Imipenem § Possible for seizures to occur with this medication (notify provider immediately if noticed)

o Nitrofurantoin (Macrodantin) § Used to treat and prevent Urinary Treat Infections •

STUDY AND KNOW INSULIN o Regular Insulin used to Treat DKA

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STUY AND KNOW DIURETICS!!!

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Noticed Several Hypothyroidism and administration of Levothyroxine Questions While studying

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Salicylism = Aspirin Toxicity o Tinnitus = manifestation of Aspirin Toxicity

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Note: St. John’s wort increases the client risk for Serotonin Syndrome o Drugs Not compatible with St. John’s Wort § Anticonvulsants (such as Phenytoin and Valproic Acid) § Barbiturates (such as Phenobarbital and Amobarbital) • CNS depressants commonly used for Anesthesia and Treatment of Seizures § Antidepressants (SSRI, MAOIs, etc.) § Allergy Drugs (Antihistamines) § Digoxin

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Typical/Notable Adverse Effects for Steroid Medications o Hyperglycemia o Fluid retention o Hypokalemia o GI Irritation o Bleeding Tendencies o Osteoporosis (which includes fractures as well) o Adrenal Atrophy o Muscle Wasting o Cushing’s Syndrome § Weight Gain § Stretch Marks (Striae) § Thinning, fragile skin that bruise easily § Slow wound healing § Hirsutism (in women) § Irregular Menstrual Periods (in women) § Severe fatigue § Muscle Weakness

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Long-term use of Steroid Medication o Anger/Aggression

o o o o o •

Paranoia Heart Attack Delusions Stroke Kidney Failure

Simvastatin o Adverse effects § Muscle Injury (which can progress to myositis) o Nursing Consideration § Client should report any unusual onset of muscle pain or tenderness to the provider immediately

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Short-Acting Beta2-Agonist (Bronchodilator Drug); Seen Several Times While Studying o Indication of Bronchodilator § Quick relief of symptoms during asthma attack § Prevent asthma symptoms before exercise § Reverses Bronchospasms o Action of Bronchodilator § Binds to receptors in the lungs, resulting in relaxation of bronchial smooth muscles

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Propylthiouracil (Anti-thyroid agent) o Treatment of patients with Hyperthyroidism o used for treatment of Graves’ Disease

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Heparin o understanding how and where Heparin is administered

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Ranitidine (H2-Antagonist) o Adverse effects § Confusion (most frequent CNS adverse effect) § Headache, Dizziness, Drowsiness, and Hallucinations (less frequent CNS adverse effects) o Nursing Intervention § Educate patient to monitor and report yellowing of the skin or eyes • Rationale: this drug can be hepatotoxic and cause jaundice

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Captopril (ACE Inhibitor Class) – Drug used to control blood pressure o Adverse Effect § Cough (MUST KNOW), Chest pain, heart failure, § Orthostatic Hypotension § Dizziness § Hyperkalemia, Arrhythmias § Neutropenia (serious adverse effect deriving from a sore throat) o Nursing Intervention § Educate patient to notify physician if they develop a sore throat • Rationale: Sore throat can indicate neutropenia

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Atenolol o Adverse Effect § Hypotension o Nursing Intervention § Assess/obtain patient’s blood pressure

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Metoclopramide o Indication § Type of Gastrointestinal Stimulants § These drugs stimulate parasympathetic activity or make the GI tissues more sensitive to parasympathetic activity o Action § Reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying o Adverse Effects § Multiple CNS adverse effects • Dizziness • Fatigue • Sedation o Contraindication § Intestinal obstruction

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Haloperidol (Antipsychotic) o Indication § Treatment of Schizophrenia o Complication of Haloperidol § Neuroleptic Malignant Syndrome (NMS) • Acute life-threatening Emergency

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Manifestation of NMS • Fever • Respiratory Distress • Diaphoresis • Hypertension • Hypotension

o Nursing Intervention § Report fever to Physician due to it being indicative of Neuroleptic Malignant Syndrome (NMS) •

Heparin Therapy o Adverse Effects § Blood in the Urine

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Docusate Sodium o Indication § Stool softener that promotes easier evacuation of Stool

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Beclomethasone (Oral Inhalation) o Nursing Intervention § Rinse mouth after inhaling the Beclomethasone

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Hydrocodone with Acetaminophen o Adverse effects § Decrease respirations (drug causes respiratory depression) o Nursing Intervention § Hydrocodone with Acetaminophen tablets can be crushed (if needed) § Drug should be taken with food or milk to decrease gastric irritation

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Atropine o Indication § Anticholinergic Agent used to reverse cholinergic toxicity o Adverse effects § Blurred Vision (when drug is given as eye drops) o Nursing Intervention § Using Atropine to reverse the effects of cholinergic crisis caused by excess amount of cholinesterase inhibitor from a person with Myasthenia Gravis

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Filgrastim o Indication § Stimulates the bone marrow to produce neutrophils § For clients receiving Chemotherapy o Nursing Intervention of Filgrastim § Increased neutrophil count = indicates effectiveness of the drug

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Furosemide, Bumetanide o Indication § Acute CHF § Acute pulmonary edema § Edema associated with CHF § Edema associated with renal or liver disease § Hypertension • Decrease fluid = decreased volume • Decrease volume = decreased pressure o Adverse Effects of Furosemide § Hypokalemia § Alkalosis § Hypotension § Dizziness/Vertigo § Ototoxicity/hearing loss o Nursing Intervention of Furosemide § Reviewing ECG/Indication of Hypokalemia – Presence of U-Waves = manifestation of Hypokalemia

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Lithium o Drug-to-Drug Interaction § Ibuprofen (should not be taken concurrently with Lithium) • Most NSAIDs can significantly increase Lithium Levels o Adverse Effects for Lithium § Fine Hand Tremors (which can interfere with performing ADLs) § Risk for Seizure and Arrhythmias o Drug-to-drug interactions / Contraindications § Diuretics § Caffeine § Alcohol § NSAIDs

o Nursing consideration for Lithium § Avoid activities that could cause sodium/water depletion § Avoid salty foods § Avoid alcoholic beverages § Drug can be administered with Food or Milk § Slurred Speech should be reported immediately (early sign of Lithium overdose or Lithium Toxicity) •

Beta-Adrenergic Blockers – Metoprolol / Propranolol o Indication § Treatment of stable angina, Hypertension, Heart Failure, and Preventing repeat Myocardial infarction o Contraindication / Caution § Patients with Asthma § Patients with COPD o Nursing Consideration § Assess patient’s blood pressure and heart rate before giving medication § Hold medication for low blood pressure and low heart rate

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Sodium Polystyrene Sulfonate o Adverse Effect § Constipation o Nursing Consideration § Monitor the client for constipation (report this to the provider considering this could lead to fecal impaction)

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Osmotic Diuretics – Mannitol (Osmitrol) o Indication § Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma o Adverse Effects § Bibasilar Crackles (bubbling or crackling sound at the base of the lungs

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Isotretinoin o Indication § Used for treatment of severe nodulocystic acne vulgaris (severe form of acne affecting the face) • Meaning this drug is used to treat Acne o Contraindication § Vitamin A (Potential to increase toxicity)

o Nursing Consideration § Assess/Check Triglyceride levels • Rationale: measured before and periodically afterwards until the effect on Triglycerides has been evaluated o Nutshell: it’s been reported that this drug elevates Triglyceride levels (leading to clients developing Hypertriglyceridemia) •

Neostigmine o Indication § Used to treat Myasthenia Gravis o Adverse effects § Miosis = pupillary constriction (common adverse effect of Neostigmine)

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Sucralfate o Indication § Treatment of Peptic Ulcer Disease o Action § Forms a Protective Barrier over Ulcers § Forms a gel-like substance that protects ulcers

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Flumazenil (Seen Often while studying) o Indication § Antidote used to reverse Benzodiazepines (such as Diazepam) • Used for Diazepam Toxicity management

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Cyclobenzaprine (what is this)? o Nursing Intervention § Educate patient to taper off the medication before discontinuing it

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Chlordiazepoxide o Indication § For patients experiencing acute alcohol withdrawal o Action § Prevent delirium tremens during alcohol withdrawal

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Fentanyl o Indication § Used to treat breakthrough pain • Breakthrough pain = A sudden increase in pain that may occur in patients who already have chronic pain from cancer, arthritis, fibromyalgia, or other conditions. Breakthrough pain usually lasts for a short time.

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Fentanyl Transdermal Patch o Nursing Consideration § Instruct the client to avoid drinking grapefruit juice while using the fentanyl transdermal patch • Rationale: Grapefruit juice can increase the absorption of the medication (thus increasing the amount of fentanyl in the client’s blood

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Chlorpromazine (Antipsychotic Drug): Chapter 10 Pharm ATI Book o Indications § Used to help treat Schizophrenia o Adverse effects of Chlorpromazine § Neuroleptic Malignant Syndrome § Seizures § Anticholinergic Effects § Orthostatic Hypotension § Sedation § Agranulocytosis § Severe Dysrhythmias § Liver Impairment § Sexual Dysfunction § Extrapyramidal side effects • Acute Dystonia • Akathisia • Tardive Dyskinesia • Parkinsonism adverse effects o Bradykinesia o Rigidity o Shuffling gait o Drooling o Tremors o Palpitations o Tachycardia o Urinary Retention o Mask-like facial expression o Involuntary movements o Nursing Consideration of Chlorpromazine § Atypical Antipsychotic Second & Third Generation (such as Risperidone and Clozapine) have similar Adverse effects as Antipsychotic First-Generation (such as Chlorpromazine) • Note: Atypical Antipsychotic drugs have fewer adverse effects compared to Antipsychotic First-Generation drugs.

Corticosteroids (which refers to both Glucocorticoids and Mineralocorticoids) • Glucocorticoids • Fludrocortisone •

Glucocorticoids o Adverse effect § Small stature for age o Nursing Consideration § Long-term use of Inhaled Glucocorticoids can cause slowing in the rate of growth in children

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Fludrocortisone o Adverse effect § Hypokalemia (due to excess sodium and water retention which results in the loss of excessive amounts of potassium)

Estrogen-Related Drugs (Tamoxifen, Raloxifene) • Tamoxifen (Estrogen receptor blocking drug); Antineoplastic Medication o Indication § Treatment of Breast Cancer (in both females and males) o Action § Compete with Estradiol for binding to estrogen in tissues containing high concentrations of receptors o Adverse effect § Hot flashes o Adverse Effects § Thromboembolism (considered the greatest risk to clients on Tamoxifen) o Nursing Considerations for Tamoxifen § Monitor patient for manifestations of Thromboembolism (such as leg tenderness, redness, swelling, and shortness of breath) § Monitor Calcium Levels • Rationale: Drug may increase calcium, cholesterol, and triglyceride levels •

Raloxifene (Seen a Few times throughout studying) o Indication § Osteoporosis (ex. Preserves bone mineral density; prevent and treat postmenopausal § Myocardial Infarction (Lowers LDL Cholesterol which lowers risk of Myocardial infarction in women who have MI risk factors

o Adverse Effects of Raloxifene § Sudden onset of dyspnea § Increase risk for DVT § Increase risk for Pulmonary Embolism § Increase risk for Stroke o Contraindication § Deep-vein Thrombosis/History of DVT § Pulmonary Embolism Stroke •

NSAID o Nursing Intervention (related to Chronic Gout) § NSAIDs used to reduce the intensity of chronic gout manifestation § Reduces Gout Flare-ups § Used for Acute Gout Attacks

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Diltiazem (Antiarrhythmic agent) o Indication § Reduces the ventricular rate in atrial fibrillation

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Etanercept (TNF Inhibitor) o Indication § Commonly used to treat Rheumatoid Arthritis o Nursing Consideration § Risk for infections (such as Tuberculosis)

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**Alendronate - Anti-hypercalcemic (against high levels of calcium) agents Bisphosphonates Drug § Including Risedronate as well § **Seen several times while studying** o Indication § Used in treatment in patients with osteoporosis § Used in treatment of Paget’s disease o Action § Slow or Block bone resorption o Nursing Consideration § Alendronate sodium should be taken with at least 230 mL (8 oz) of water 30 minutes before ingesting foods (full cup of water) § Drug should be taken in an Upright position to decrease risk of esophagitis • Sitting upright for 30 minutes after taking this medication

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MAOI Drug Class – Phenelzine: Antidepressant drug o Adverse effects § Orthostatic Hypotension (all MAOIs cause orthostatic hypotension) o Nursing Consideration of Phenelzine § Know about foods that interact with MAOI drug class • Cured meats (Smoked Salmon, Pepperoni, Salami, etc.) • Most Cheese (except cottage cheese and cream cheese) • Avoid Avocados (contains tyramine) § Beef Steak and other meats that are fresh do not interact with Phenelzine and are safe to consume

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Antacids Class of Drugs o Nursing Consideration § Take antacids 1 hour apart from other medications

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What is Saw Palmetto? o A supplement used primarily for manifestations related to prostatic conditions such as benign prostatic hypertrophy (BPH) o A supplement used to promote Urinary Health

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Clopidogrel – Plavix (Brand Name): Antithrombotic/Antiplatelet Medication o Adverse effect § Bleeding (caused by the thinner blood effect of the drug)

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Ginkgo Biloba (seen several times while studying) o Action § Decrease platelet aggregation § May delay the mental deterioration of Alzheimer’s disease if taken in the early stages o Nursing Consideration § Increases the client’s risk of bleeding when taken with warfarin • Had a drug-to-drug interaction with Warfarin

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Linezolid (Antibiotic Drug) o Nursing Consideration § Rare reaction where some clients develop irreversible peripheral neuropathy and reversible optic neuropathy • This is a reportable finding and client should be switched to another antibiotic

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Bethanechol o Indication § Treatment of Urinary Retention o Nursing Consideration § Therapeutic effect of drug noted when client states they are able to urinate more freely

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Nitroglycerin (cardiac related drug) o Indication § Patients with Unstable Angina

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Prednisone (Steroid related drug) o Indication § Generalized Rheumatoid Arthritis o Adverse Effect § Gastric Ulceration (reportable finding) § Osteoporosis § Adrenal suppression § Sore throat (reportable finding)

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Propylthiouracil o Indication § Treat Hyperthyroidism o Nursing Consideration § Laboratory test need to be done to check liver function • Rationale: This drug is Hepatotoxic and can cause severe liver injury

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Metoprolol (Beta-blocker drug) o Nursing Consideration § This drug can mask hypoglycemia for patients with hypertension and type 1 diabetes

Antidepressant Class of Medication (Selegiline, Fluoxetine, Amitriptyline) •

Selegiline o Indication § Used to treat Parkinson’s Disease and Major Depressive Disorder

o Adverse Effects of Selegiline § Drowsiness § Dry Mouth § Dizziness •

Fluoxetine (SSRI Drug) o Indication § Treatment of Depression, OCD, and Bulimia § Treatment of Premenstrual Disorder (by decreasing psychological symptoms of tension, irritability, and dysphoria in women o Adverse effect § Sexual Dysfunction o Nursing Considerations § Using this drug to treat Premenstrual Disorder will improve manifestations quickly § When on this drug, take acetaminophen for headaches instead of NSAIDs to prevent further suppression of platelet aggregation • Rationale: Meaning there’s an increased risk for bleeding when Fluoxetine is given concurrently with NSAIDs and anticoagulants

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Amitriptyline – Tricyclic Antidepressants (SEEN A LOT WHILE STUDYING) o Indication § Treatment of Depression o Adverse effects § Urinary Retention (Anticholinergic effect caused by Amitriptyline) § Constipation § Decrease in Libido § Dry Mouth (due to the blocking of acetylcholine receptors that cause anticholinergic responses) § Orthostatic Hypotension o Nursing Consideration § ECG (Electrocardiogram) should be performed prior to starting this drug to obtain a baseline for the patient’s cardiovascular status § Move slowly when standing up because this drug can cause a decrease in blood pressure

DMARD Medications (Methotrexate, Sulfasalazine) •

Methotrexate (DMARD medication) o Indication § Chemotherapy and Immunosuppressive drug used to treat cancer of the blood, bone, lung, breast, head, and neck § Treatment of Rheumatoid Arthritis and Psoriasis o Nursing Consideration § Methotrexate used alongside with NSAIDs helps to delay the progression of Rheumatoid Arthritis and to delay join damage § Start within 3 months of a Diagnosis of Rheumatoid Arthritis to prevent or delay joint degeneration

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Sulfasalazine (DMARD Sulfasalazine) o Adverse Effects § Jaundice (Yellow discoloration of the skin) § Yellow/Orange discoloration of the urine § Bone marrow suppression (which can lead to agranulocytosis, Hemolytic anemia, and macrocytic anemia o Nursing Consideration § Monitor Complete Blood Count periodically and prior to administering this medication

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Rifampin (Seen several times while studying) o Indication § Treatment of TB o Adverse Effects § Red-Orange colored urine, saliva, sweat, and tears (as medication is excreted from the body) § Decreased Visual Acuity o Nursing Consideration § Educate client that permanent staining of contact lenses can occur § Educate client that dark color urine is indicative of hepatotoxicity § The nurse should instruct the client to monitor for changes in visual acuity or color identification as indications of optic neuritis to report to the provider (can lead to irreversible blindness)

Antipsychotics Medications (Clozapine, Haloperidol) •

Clozapine (prototype) - Atypical Antipsychotics o Indicatio...