Pharmacology nursing lecture notes PDF

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nursing care process, medications, antibiotics, NEED TO KNOW...

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Pharmacology lecture notes 2/3/2021   

Nursing pharmacology 60-70% of nurses’ work is medication administration Nursing care process (problem solving approcach) Nursing process (example: abdominal distention) Step 1: assessment (data collection – name, vital signs, weight, height, food intake, etc.) (example: weight, abdominal girth, bowel movement, bowel sounds, 24-hr food recall) Step 2: diagnosis/ analysis (no longer used) Step 3: planning (short and long term plan) (example: exercise/lose weight) Step 4: implementation/nursing interventions/nursing actions Types of implementation: Independent: no doctors (use the word provider instead of doctor) order Dependent: need doctors (providers) order Collaborative/Interdependent: work with members of a team (PT, RT, dietitian, social worker) Step 5: evaluation (reassessment (is medication affective/therapeutic or not?)) Pharmacokinetics Absorption/route/fastest action: via injection (parenternal) – subcutaneous (fats) , intramuscular (musles), intravenous (bloodstream) Distribution: protein level or albumin Metabolism: liver Excretion: kidneys (waste) Half life (t1/2): If the half – life is short: give the medication more frequently If the half-life is long: give it once a day (example: morphine (powerful pain medication) , half life of morphine = 4 hours ) 9am – wednesday : 10 mg 1 pm: 5 mg 5 pm: 2.5 mg – 3 mg 9pm: 1.5 mg or 2 1am- Thursday : 1 mg 5 am

Pharmocokinetics (example) Morphine 8 mg IV every 4 hours Half-life morphine = 4 hours Achieving the therapeutic level Pro re nata = only as needed Rtc = round the clock Wed – 9 am: 8mg 1 pm: 4 mg + 8 mg = 12 mg 5 pm: 6 mg + 8mg = 14 mg 9 pm: 7 mg + 8mg = 15 mg Thursday - 1 am: 7.5 round to 8 = 8 mg + 8 mg = 16 mg achieved the therapeutic level, stable amount of morphine in their bloodstream 5 am 9 am 1 pm

Pharmacodynamics – serum or plasma (say instead of blood) Pharmacology most imp. Organs (kidneys & liver) (metabolism) *****Nclex RULE = LUNGS, HEART, BRAIN**** in order of most important Determine death: stop breathing (lungs) , heart stops beating Organ toxicity Hepatotoxic: LIVER (blood/lab test = AST & ALT (hepatic enzymes or liver enzymes) Further damage = Tylenol or alcohol How do you know if your liver is damaged ?  liver is located on the upper right quadrant so look for pain here  jaundice (yellowish)  scleral icterus  pruritus  dark urine  clay colored or pale colored stool  bleeding Nephrotoxic: KIDNEY memorize the numbers  blood/lab tests (BUN (10-20 = the normal range) and creatinine (0.6 – 1.2) creatinine is most sensitive)  urine output (30-50 mL/hr)  oliguria = less than 400 mL/24 hours  anuria = less than 100 mL/24 hours

Teratogenic - monster baby = contraceptive or condom (don’t get pregnant), give folic acid Cardiotoxic: HEART  12 lead EKG, cardiac dysrhythmias (irregular heart rhythm) Neurotoxic: BRAIN  Decrease level of consciousness (first thing to check is the level of consciousness)  Altered mental status (personality or behavioral changes)  Seizure attack Hypersensitivity/ allergic reactions: anaphylaxis (severe form of allergy) bronchial constriction  Signs = rash, pruritus (itching), hives (urticaria), palpitations, low blood pressure, flushed skin or generalized erythema (red skin)  DOB (difficulty breathing) / SOB (shortness of breath) : dyspnea, expiratory wheezing. Oculotoxic: EYES (nclex says “visual disturbances”)  Blurred vision, floaters and curtains, halo Ototoxic: INNER EAR BALANCE (Fall precautions)  Headache  Dizziness  Lightheadedness  Vertigo  Nausea/vomiting  TINNITUS (buzzing in the ear, hearing impairment (hearing or audiogram test)) Pulmotoxic: DOB/SOB, cyanosis, abnormal breath sounds Carcinogenic: medications that can cause cancer = CHEMOTHERAPY (is treatment but can also cause cancer again in 10-20 years) *although medication helps it can also kill a patient* *if the antibiotic is nephrotoxic than it is also ototoxic* Nclex question examples: 1. a nurse is caring for a client who is recieveing a hepatotoxic drug. Which of the following assessment findings is expected? A. decreased urine output B. buzzing in the ear C. urine discoloration (discoloration could mean any color) D. abnormal heart rhythm 2. A nurse is preparing to give a medication to one of his clients. Which of the following actions should the nurse do first? A. Check the price of the drug B. Ask if the client has allergies C. Check the client’s temperature D. Ask the client’s height *Antibiotic infections- read chapters *

02/10/2021 Rule number 1 = *Know medications *

ANTIBIOTICS 

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Penicillin (ALLERGY) (cross-sensitivity with cephalosporin) - Amoxicillin - Ampicillin - Nafcillin - Penicillin G and Penicillin V (some of these contain potassium (too much potassium = cardiac dysrhythmia = cardiac arrest)) Normal potassium (3.5-5.0) - Piperacillin / tazobactam Cephalosporin (cross-sensitivity with penicillin, allergic to one- can be allergic to the other)  *gram negative and gram positive (easier to kill) - 1st gen: cephalexin, cefazolin = gram positive - 2nd gen: cefuroxime, cefotetan = gram positive and gram negative - 3rd gen: ceftriaxone, ceftazidime, cefpodoxime = gram negative –  The 3rd, 4th, and 5th crosses your blood brain barrier. - 4th gen: cefepime = gram negative - 5th gen: ceftaroline = gram negative  Meningitis = better to give 3rd, 4th, and 5th generation  Latest medications are more expensive  Giving an IV, watch out for phlebitis Aminogylcosides : Nephrotoxic (BUN and creatinine tests) = ototoxic (hearing/audiogram test) risk for fall- fall precaution. Serum peak (highest concentration) and trough (lowest concentration) - Amikacin : strongest - Gentamicin - Tobramycin - neomycin Tetracycline – LYME DISEASE, STD, ACNE or pimples Teratogenic: damage to teeth (yellow discoloration or enamel damage, DO NOT GIVE to pregnant patient or to pediatric patient) C: CONTRACEPTIVE and CONDOMS!!! Teratogenic interacts with other drugs and food T- tetracycline A- Aluminum M- milk products IIron (ferrous sulfate) C- Calcium A- Antacids

Photosensitivity: patient teaching 1. Wear a wide ring hat 2. Wear sunglasses 3. Wear long sleeves (cover body) 4. Wear sunscreen 5. Avoid tanning salon 6. Avoid going out during high csun concentration (9am – 4 pm) - Minocycline - Doxycycline  Macrolides (respiratory antibiotics – infection of lung (pneumonia)) Qt drug (potential to give cardiac dysrhythmia – baseline 12 lead EKG) - Azithromycin (zpack) - Clarithromycin (HIV/AIDS, peptic ulcer disease, H. pylori bacteria (gastritis)) - Erythromycin  Fluoroquinolones- Qt drug (cardiac dysrhythmia), photosensitivity, tendon rupture or tendonitis (bone pain – older adults, steroids, physically active young adults) , muscle weakness  Good for UTI, abdominal infection  Ciprofloxacin- C-diff, you have to give early in the morning, UTI - Levofloxacin - Ofloxacin - monifloxacin  Carbapenems- can cause severe infection (sepsis)  Sepsis: infection goes into your blood stream , you will see low blood pressure to indicate this = hypotension  Ex: 140/100  Ex: 85/50 = look at systolic number to indicate sepsis  Systolic below 90 mm Hg = low - Meropenem - Doripenem - Ertapenem  Sulfa antibiotics: ALLERGY, drink lots of water – hydrate!!! - TMP-SMX - Trimethoprim - Sulfamethoxazole (BACTRIM)  Vancomycin- sepsis, C-diff, MRSA  when giving IV- you have to give for two hours – use IV pump (***nclex will say infuse it for more than an hour***)  powerful but cheap antibiotic  watch out for phlebitis ( especially in babies  ** ON NCLEX** RED MAN SYNDROME = 80/40 blood pressure, flushed skin or generalized erythema  Metronidazole- another name is FLAGYL (cheap and powerful, used often)

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Disulfiram reaction – alcohol withdrawal Avoid alcohol products (mouthwash, aftershave, drinking alcohol) Dark urine = harmless, peripheral neuropathy (nerve pain (pins and needles)) UTI antibiotics - Fosfomycin - TMP-SMX - Nitrofurantoin - Levofloxacin Antituberculars / Antimycobacterial - Rifampin - Isoniazid - Pyrazinamide - Ethambutol

***Principles of antibiotics*** (on exam, nclex, ati) MUST KNOW 1. Infection: check white blood cell count (WBC) (white blood cell count increases) Normal WBC: 5,000-10,000 Leukocytosis is elevated WBC 2. Check Temperature: fever, purulent drainage = pus, yellow/green abscess, foul smell 3. Side-affects of antibiotics = ALLERGY (anaphylaxis = severe form of allergy) 4. Before giving the first dose of antibiotics you need to do CULTURE ( know the specific bacteria inside their body) and SENSITIVITY (tells you what antibiotic will kill that specific bacteria) - Send urine, stool, sputum (pneumonia), nasopharyngeal secretions, spinal fluid (meningitis), vaginal and penile discharges (STD, STI) . - Lab results take 28-72 hours (2-3 days) Broad spectrum antibiotic until we get back the lab results 5. One – two weeks of antibiotics. If you don’t finish the antibiotic (MDRO = multi-drug resistant microorganisms) Drug resistant antibiotics: MRSA, VRE = drug resistant bugs (to prevent this, finish the antibiotics!!) 6. GI upset: A/N/V/D = anorexia, nausea, vomiting (emesis), diarrhea To prevent upset GI take medication with food 7. Phlebitis: Inflammation of IV line (veins) To prevent this, monitor the IV site 8. Clostridium difficile: C-DIFF (cause of this is antibiotics) (treatment is also antibiotics) - Symptom of C-DIFF is constant diarrhea - Priority is IV fluids - Normal flora (good bacteria) - Colitis (bad bacteria) - Fluid/ electrolyte loss - Antibiotics that will cause C-DIFF = C: clindamycin, cephalosporin, ciprofloxacin - Treatment: metronidazole, vancomycin, last resort is a fecal transplant

9. When giving antibiotics (if it is the first time) – check the patient constantly with in the 15-30 minute time frame to make sure they don’t develop allergy. 10. One – two weeks antibiotics but sometimes the patient still needs more = 3-4 weeks or even more FUNGUS = super infection (candida, candidiasis (oral thrush (thrush is white) and vaginal candidiasis – white cheeselike substance) Medication for mouth = nystatin mouthwash (swish and spit or swish or swallow) 11. Some antibiotics are nephrotoxic (BUN 10-20 and creatinine 0.6-1.2) = ototoxic (inner ear) (balance = implement fall precautions) Dialysis – renal failure – half dose = RENAL DOSE 12. Proper handwashing 13. Do not share antibiotics (drug resistance) 14. Evaluate: how do you know if the antibiotic is effective? WBC decrease, temperature decrease, white – clear or serous drainage.

ANTIBIOTICS ABX (class) PCN cephalosporin

Adverse effects Allergy Allergy / phlebitis

aminoglycosides

Nephrotoxic/ototoxic

tetracyclines

Teratogenic, photosensitivity

macrolides fluoroquinolones

Qt drug Qt drug, photosensitivity, tendonitis

Carbapenems sulfa vancomycin metronidazole

allergy Nephrotoxic/ototoxic, red man syndrome DISULFIRAM reaction, dark urine

Nursing care Cross-sensitivity Cross-sensitiivity/ check IV site BUN, creatinine, peak and trough Contraceptives/condoms, avoid TAMICA (sunlight) 12-lead EKG 12-lead EKG, monitor for muscle weakness This is for sepsis Hydration Infuse for more than an hour/ BUN and creatinine Avoid alcohol products...