ATI Pharmacology Pharmacological and Parenteral Therapies PDF

Preview

Summary

ATI focused review...

Description

ATI Pharmacology Notes: Pharmacological and Parenteral Therapies

CHAPTER 40: ENDOCRINE DISORDERS  

Endocrine System: Glands that secrete hormones, which act on specific receptor sites in order to regulate stress, growth, metabolism, and homeostasis. Disorders are usually associated with over secretion or under secretion of hormones, or an altered response by the target area or receptor.

Thyroid Hormone:   







Prototype Medication: Levothyroxine o Others: Liothyronine, Liotrix, Thyroid USP Thyroid hormones increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth processes Therapeutic Uses: o Treat hypothyroidism o Emergency treatment of myxedema coma (a severe deficiency of thyroid hormone) Complications: o Overmedication: cause indications of hyperthyroidism  Anxiety  Tachycardia  Palpitations  Altered appetite  Abd. Cramping  Heat intolerance  Fever  Diaphoresis  Weight loss  Menstrual irregularities o Chronic Overtreatment: causes atrial fibrillation and an increased risk of fractures from bone loss  Monitor TSH levels Contraindications/Precautions: o Pregnancy Risk Cat. A o Patients who have thyrotoxicosis and adrenal insufficiency- contraindicated o Contraindicated following an MI o Use caution in patients with cardio problems o Use cautiously in older patients, patients with diabetes o NOT a treatment for obesity Interactions: o Binding agents, antiulcer meds, calcium and iron supplements, and food will reduce the absorption of levothyroxine  Allow 4hrs between admin. o Antiseizure and antidepressant medications increase levothyroxine metabolism

 May need to increase dosage Levothyroxine can increase the anticoagulant effects of warfarin by breaking down vitamin K  Monitor PT/INR  Educate patients on signs of bleeding and to report  Decrease dosage of warfarin if needed Nursing Administration: o Obtain baseline vitals, weight, height, and continue to reassess during treatment o Monitor and report angina, chest paints, palpitations, and dysrhythmias o Begin with low does and gradually work up to full dose over 6-8 weeks o Take on empty stomach 30-60min before eating o Do not discontinue without checking with a provider Evaluation of Effectiveness o Decreased TSH o T4 levels within normal range o Absence of hypothyroidism symptoms Thionamides o Prototype: Propylthiouracil  Other: Methimazole  Purpose:  Block the synthesis of thyroid hormones  Prevent the oxidation of iodide  Block the conversion of T4 into T3  Uses:  Treatment of Graves’ disease  Produces of euthyroid state prior to thyroid removal surgery  Adjunct to irradiation of the thyroid gland  Emergency treatment of thyrotoxicosis  PO  Complications:  Hypothyroidism (drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia) o Reduce dosage or temporary admin. of thyroid supplement  Agranulocytosis o Monitor for sore throat, fever, fatigue o Monitor blood counts at baseline and continuous  Liver Injury, hepatitis (propylthiouracil) o Monitor for jaundice, dark urine, light-colored stool, and elevated liver function tests  Contraindications:  Pregnancy Cat. D and during lactation  Use cautiously in patients with bone marrow depression and/or immunosuppression and those at risk for liver failure  Interactions: o







Concurrent use with anticoagulant meds can increase anticoagulation o Monitor PT/INR/PTT  Concurrent use with digoxin can increase glycoside levels o Reduce digoxin if needed  Nursing Administration:  Therapeutic effects can take 1-2 weeks to become evident and full effect till 3-12 weeks  Propylthiouracil prevents continued synthesis of TH  Monitor vitals, weigh, I/O  Take medication at same time each day with a meal  Do NOT discontinue abruptly  Monitor for hyperthyroidism o Patients who have hyperthyroidism can be given a betaadrenergic antagonist (Propranolol) to decrease tremors and tachycardia  Monitor CBC for leukopenia or thrombocytopenia  Instruct patients to not take any OTC meds without provider consent  Nursing Evaluation of Effectiveness:  Weight gain  Vital signs within range  Decreased T4 levels  Absence of signs of hyperthyroidism Radiopharmacuticals: Prototype: Radioactive Idoine o Purpose: absorbed by the thyroid and destroys some of the thyroid producing cells. At high doses iodine destroys thyroid cells. o Uses:  At high doses:  Hyperthyroidism  Thyroid cancer  Patients who have not responded to other antithyroid treatments  At low doses:  Thyroid function studies o See how much iodine uptake by the thyroid gland  PO o Complications:  Radiation Sickness:  Monitor for hematemesis, epistaxis, intense N/V  Stop treatment  Bone Marrow Depression:  Monitor for anemia, leukopenia, and thrombocytopenia  Hypothyroidism: intolerance to cold, edema, bradycardia, weight gain, and depression 



Contraindications:  Pregnancy Cat. X, patients of the childbearing age/intent, and during lactation o Interactions:  Concurrent use with other antithyroid reduces the uptake of radioactive iodine o Nursing Administration:  Maintain a distance of 6ft from others  Limit contact with patients to 30 min/day/person  Increase fluid intake to 2-3L/day Iodine Products o Prototype: Strong iodine solution; nonradioactive iodine  Others: sodium iodide, potassium iodide o Purpose: creates high levels of iodide that will reduce iodine uptake and inhibit thyroid hormone production and block the release of thyroid hormones into the bloodstream. o Uses:  Development of euthyroid state and reduction of the thyroid gland size prior to thyroid removal  Emergency treatment of thyrotoxicosis o PO o Complications:  Iodism: due to corrosive property  Can progress to overdose  Tell patients to notify provider  Prepare to admin. sodium thiosulfate o Contraindications: Pregnancy Cat. D o Interactions:  Concurrent intake of food high in iodine increases the risk for iodism  Concurrent use of potassium-sparing diuretics potassium supplements, and ACE inhibitors increases the risk of hyperkalemia o Nursing Administration:  Used in conjunction with other therapy agents  Obtain baseline vitals, weight, I/O  Dilute iodine solution with juice for better taste  Take at the same time everyday  Increase fluid intake  Do not take OTC drugs  Do not discontinue abruptly o Nursing Evaluation of Effectiveness:  Weight gain  Vital signs within range  Decreased T4 levels  Reduction in size of thyroid gland o





Patient will get adequate sleep, achieve appropriate weight, maintain HR/BP in range, free of complications

ANTERIOR PITUITARY HORMONES/GROWTH HORMONES 

Prototype Drug: Somatropin o Purpose: stimulate overall growth and the production of protein and decrease the use of glucose o Uses:  Treat growth hormone deficiencies  Turner’s syndrome, Prader-Willi syndrome  AIDS wasting syndrome o IM or SubQ o Complications:  Hyperglycemia  Monitor for polyphagia, polydipsia, polyuria  Monitor glucose levels in patients who are diabetic and adjust insulin levels if needed  Hypercalciuria and renal calculi  Teach patients to monitor for flank pain, fever and dysuria and report o Contraindication:  Pregnancy Cat. B/C  Contraindicated for patients who are severely obese or have severe respiratory impairment  Use cautiously in patients who are diabetic, who have hypothyroidism (can suppress even more) o Interactions:  Concurrent use with glucocorticoids can counteract the growth-promoting effects o Nursing Administration:  Obtain baseline height and weight  Monitor growth patterns monthly  Reconstitute medication per directions  Do not shake, do not administer if discolored  Rotate injection sites  Abd. and thighs o Nursing Evaluation of Medication Effectiveness:  Patient increasing in height and/or weight

ANTIDIURETIC HORMONE: 

Prototype: Vasopressin o Other: Desmopressin o Purpose: Vasopressin stimulates the potent action of ADH, which is vasoconstriction and promoting reabsorption of water within the kidneys. o Uses:

  o

o

o

o

o

o

Treat diabetes- desmopressin Vasopressin is sometimes used during CPR to temporarily decrease blood flow to the periphery and increase blood to the heart and brain

Admin:  Desmopressin: PO, intranasal, SubQ, IV  Vasopressin: SubQ, IM, IV Complications:  Reabsorption of too much water  Patients should reduce fluid intake  Myocardial Ischemia: due to excessive vasoconstriction  Monitor ECG and BP Contraindications:  Patients who have coronary artery disease, decreased peripheral circulation, or chronic nephritis  Vasopressin is pregnancy cat. C, desmopressin is cat. B  Use caution is patients who have renal impairment Interactions:  Carbamazepine and tricyclic antidepressants can increase the antidiuretic action  Concurrent use of alcohol, heparin lithium, and phenytoin can decrease effects Nursing Administration:  Monitor vital signs, central venous pressure, I/O, specific gravity, and lab studies  K+, Na-, BUN, creatinine, specific gravity, osmolarity  Monitor for HA, confusion  Monitor IV site Nursing Evaluation of Medication Effectiveness:  Reduction of urine output in diabetes patients  Cardiac arrest survival

ADRENAL HORMONE REPLACMENT: 

Prototype: Hydrocortisone o Others:  Glucocorticoids:  Prednisone  Dexamethasone  Mineralocorticoid: Fludrocortisone o Purpose: mimic the effect of natural steroid hormones o Uses:  Acute and chronic replacement therapy for adrenocortical insufficiency  Addison’s disease and adrenal crisis  Nonendocrine disorders  Cancer, inflammation, and allergic reactions o PO, IV o Complications: Hydrocortisone

Osteoporosis: tell patient to take calcium supplements, vitamin D, and bisphosphate  Adrenal Suppression:  Tell patient to monitor for fatigue, muscle weakness, weight loss, hypotension  Increase dose with stress, do not stop suddenly  Peptic Ulcer  Tell patient to monitor for coffee-ground emesis, bloody or tarry stools and abd. pain  Administer prophylactic H2 receptor antagonists  Infection:  Avoid people with communicable diseases  Monitor for indications like fever  Cushing’s Syndrome:  Monitor for muscle weakness, moon face, buffalo hump, cutaneous striations Complications: Fludrocortisone  Retention of sodium and water  Lead to hypertension, edema, HF, hypokalemia  Monitor weight, BP, serum potassium, breath sounds urine output  Educate patient on s/s of sodium and water retention Contraindications:  Pregnancy Cat. C  Patients who have a viral, bacterial, or fungal infection not controlled by antibiotics  Use caution in clients who have had a recent MI gastric ulcer, hypertension, kidney disorder, osteoporosis, diabetes, hypothyroidism, myasthenia gravis, glaucoma, seizure disorder Interactions: Hydrocortisone  NSAIDs, acetaminophen, or alcohol can increase gastric distress or bleed  Concurrent use with oral anticoagulants can increase or decrease anticoagulation  Concurrent use with potassium depleting agents can cause increased potassium loss  Concurrent use with vaccines and toxoids can reduce the antibody response Interactions: Fludrocortisone  Barbiturates and phenytoin can reduce the effects  Antidiabetic effects of insulin and sulfonylureas decrease with concurrent use  Closely monitor blood glucose levels Nursing Administration:  Monitor weight, BP, and electrolytes  Give with food  Monitor for peptic ulcers and notify if they occur  Do not stop suddenly 

o

o

o

o

o

o

 Notify if symptoms of acute adrenal insufficiency occur  Increase dosage during times of stress  Therapy for Addison’s disease is for life  Carry extra for emergencies Nursing Evaluation of Medication Effectiveness:  Relief of adrenocortical deficiency

HYPERPITUITARYISM MEDICATIONS: 

Prototype: Octreotide o Others: Lanreotide, Pegvisomant o Purpose: suppress growth hormone release o Uses:  Giantism in children  Acromegaly in adults o Admi.:  Octreotide: IM. SubQ  Lanreotide/Pregvisomant: SubQ o Complications: Octreotide  GI Disturbances  Nausea, cramps, diarrhea, flatulence  Advise will subside in 1-2 weeks  Admin without food or at bedtime to reduce symptoms  Hypo/Hyperglycemia o Complications: Lanreotide  GI Disturbances  Abd. pain, diarrhea, nausea, vomiting, flatulence, cholelithiasis  Hypo/hyperglycemia o Complications: Pegvisomant  Nausea, diarrhea  Hypoglycemia  Liver injury  Discontinue is jaundice appears and notify  Monitor liver studies  Chest pain  Flu-like symptoms o Contraindications  Octreotide  Pregnancy cat. B  Use cautiously in patients who have diabetes, hypothyroidism, and renal disease and older patients  Lanreotide  Pregnancy cat. C  Use cautiously in patients who have gallbladder, liver, or renal disease; diabetes; hypothyroidism; and cardiac disease

Pegvisomant  Pregnancy cat. B  Use cautiously in patients who have liver or renal disease, diabetes, pituitary tumors, or neoplastic disease Interactions:  Octreotide: conduction delays can occur if used with antidysrhythmias  Lanreotide: Bradycardia can occur with concurrent use of medications that affect HR  Pregvisomant: Concurrent use with opioids can reduce the effect of drug Nursing Administration:  Teach patient how to give injection self  Rotate site to reduce pain  Abd., hip, thigh  IM injection in large muscle slowly Nursing Evaluation of Medication Effectiveness:  Suppression of the excess growth hormone for the management of acromegaly when surgery or radiation has failed 

o

o

o

CHAPTER 17: AIRFLOW DISORDERS 

Asthma: Chronic inflammatory disorder of the airways, obstructing the bronchioles. o Intermittent and reversible o Due to either inflammation or hyper-responsiveness leading to bronchoconstriction  Medications usually address both  they can also be used to treat COPD  medications include: o bronchodilators: beta2-adrenergic agonists, methylxanthines, inhaled anticholinergics o anti-inflammatory agents: glucocorticoids, mast cell stabilizers, and leukotriene modifiers o Beta2- Adrenergic Agonists:  Prototype: Albuterol  Others: Formoterol, Levalbuterol, Salmeterol, Terbutaline  Purpose: selectively activating beta2-receptors in the bronchial smooth muscle, resulting in bronchodilation o Bronchospasm is relieved o Histamine release is inhibited o Ciliary motility is increased  Uses: Albuterol, Levalbuterol o Inhaled, short-acting o Oral, long-acting (albuterol) o Prevention of asthma episode o Inhaled, short-acting, used for prevention of asthma o Treatment of bronchospasm o Long-term control of asthma  Uses: Formoterol, Salmeterol o Inhaled, long acting o Long-term control of asthma  Uses: Terbutaline o Oral, long acting o Long-term control of asthma  Complications: o Tachycardia and Angina: Due to activating alpha1 receptors in the heart  Monitor for chest, jaw, or arm pain and report  Tell patient to check pulse and report if increase of greater than 20-30 beats/min  Avoid caffeine  Dosage may need to be reduced o Tremors: Due to activation of beta2 receptors in skeletal muscles  Reduce dosage if they do not resolve

Contraindications: o Pregnancy Cat. C o Patients who have tachydysrhythmia o Use cautiously in patients who have diabetes, hyperthyroidism, heart disease, hypertension, and angina  Interactions: o Use of beta-adrenergic blockers can negate effects of both medications o MAOIs and tricyclic antidepressants can increase the risk of tachycardia and angina  Nursing Administration: o Teach patient how to use metered-dose inhaler (MDI), drypowder inhaler (DPI), and nebulizer o Inhale beta2 before glucocorticoid  Beta2 will enhance the absorption of the glucocorticoid o Ensure the patient knows when to take medication  Formoterol and salmeterol are long-acting. They are used every 12 hours, NOT for asthma attack or exacerbation  Short-acting beta2 is for acute episodes o Have the patient keep a log of the frequency and intensity of attacks  Notify provider if there is an increase  Nursing Evaluation of Medication Effectiveness: o Long-term control of asthma o Prevent exercise-induced asthma o Resolution of exacerbations Methylxanthines: Prototype: Theophlline  Purpose:  Relaxation of the bronchial smooth muscle, causing bronchiole dilation  Used to be the first-line  Uses: oral form is for long-term control of chronic asthma of COPD  PO or IV  Complications:  Mild toxicity can cause GI distress and restlessness  Higher doses can cause dysrhythmias and seizures  Nursing Considerations:  Monitor serum levels  Stop medications if manifestations occur o Charcoal is used to decrease absorption o Lidocaine treats dysrhythmias o Diazepam treats seizures  Report N/D or restlessness  Contraindications: 

o

Pregnancy Cat. C Use cautiously in patients with heart disease, hypertension, liver and kidney dysfunction and diabetes  Interactions:  Caffeine o Incrases CNS and cardiac AE o Will increase serum levels  Phenobarbital, phenytoin, and rifampin decrease theophylline levels  Nursing Administration:  Do not double if the patient misses a dose  Do not chew or crush the sustained-release forms  Nursing Evaluation of Medication Effectiveness:  Long-term control of chronic asthma or COPD Inhaled Anticholinergics: Ipratropium  Others: Tiotropium  Purpose: Block muscarinic receptors, resulting in bronchodilation  Uses:  Relive bronchospasms associated with COPD  Allergen-induced and exercise-induced bronchospasms  Inhalation  Complications:  Local Anticholinergic Effects o Dry mouth, hoarseness o Tell patients to sip fluids and suck on candy to control  Contraindications:  Pregnancy Cat. B  Patients who have peanut allergy due to the medication containing soy lecithin  Use cautiously in patients who have narrow angle glaucoma ad benign prostatic hyperplasia  Nursing Administration:  Rinse mouth after use  Adult dosage is two puffs, wait the needed time between o 5min  Evaluation of Medication Effectiveness:  Control of bronchospasms in patients with COPD  Prevent allergen/exercise-induced bronchospasms Glucocorticoids:  Prototype:  Inhalation: Beclomethasone  Oral: Prednisone  Purpose:  Prevent inflammation, suppress airway mucus production, and promote response to beta2 receptors  

o

o



 





 Uses: 

Reduce airway mucosa edema

Short-term: IV agents for status asthmaticus, oral to treat manifestations of an acute asthma episode  Long-term: inhaled for prophylaxis of asthma, oral to treat chronic/severe asthma  Promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth Complications: Beclomethasone  Difficulty speaking, hoarseness, and candidiasis Complications: Prednisone  Suppression of adrenal gland function: o Cannot produce glucocorticoids  Admin. oral  Monitor blood glucose levels  Taper the dose  Bone loss o Perform weight-bearing exercises o Consume enough vitamin D and calcium o Use lowest dose possible o Oral meds should be given altering days  Hyperglycemia and glycosuria o Monitor blood glucose in patients with diabetes o May need an insulin increase  Myopathy (muscle weakness) o Reduce dosage  Peptic ulcer disease o Avoid NSAIDs o Report black, tarry stools o Check for blood in stools o Admin with food  Infection: o Notify  Disturbances in fluid and electrolyte o Fluid retention  Weight gain, edema, hypokalemia o Observe and report Contraindications:  Pregnancy Cat. C  Patients who have received live vaccines and fungal infections  Cautiously in children who have diabetes, hypertension, heart failure, peptic ulcer di...