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Hesi

Instructions:The contents on this guide are intended to help you organize your
preparation for the Evolve Specialty Exam (ESE) for NR292. This is NOT intended
to serve as a direct reflection of the exact questions which will be presented in
the exam. As you review the topics listed below, be sure that you can
1. Apply Pharmacological Concepts (to the drugs/drug classes listed below)
Pharmacokinetics, Pharmacodynamics, Pharmacotherapeutics
Indications and Contraindications
Adverse effects
Patient variables: Pediatric, Gerontology, Pregnancy/Breast-feeding,
Gender, and Cultural/Ethnic variations
2. Apply Nursing Considerations (to the drugs/drug classes listed below)
Assessments to include vital signs, physical assessment, labs, &
diagnostics
Drug administration: safety, route considerations, med orders
Drug toxicity (signs/symptoms) and antidote if applicable
Patient teaching
3. Perform medication calculation:
Oral, suspension, injectable, IV (ml/hr and gtt/min)
Metric and household conversions
Pharmacokinetics A drugs time to onset of action time to peak effect and duration of
action are all characteristics defined by pharmacokinetics. It is the study of what happens to
a drug from the time it is put into the body until the parent drug and all metabolites have
left the body. Absorption into, distribution and metabolism within and excretion from the
body are combined focus of pharmacokinetics.
Pharmodynamics- what a drug does to the body, ( done after phase 11 pharmacokinetic
phase absorption, distribution, metabolism and excretion) involves drug receptor
interactions
Pharmacotherapeutics (mechanism of action) focuses on the clinical use of drugs to
prevent and treat diseases It defines the principles of drug action the cellular processes
that change in response to the presence of drug molecules. Some drug mechanisms of
action are more clearly understood than others.
Pharmacologic Concepts:
Synergistic effects 1+1= 2 combination of drugs with similar action is greater
than the sum of the individual effects of the same drugs given alone.
Agonistic works together with. A drug that binds to and stimulates the activity of
one or more receptors in the body.

Antagonistic effects Inhibit a drug that binds to and inhibits the activity of one
or more receptors in the body.
Tolerance reduced response to a drug after prolonged use

Addiction dependence physiologic or psychologic need for a drug physical


dependence is the physiologic need for a drug to avoid the withdrawal symptoms
(diaphoresis and tachycardia)
Anaphylaxis severe allergic reaction closing of the throat and cutting airway off

Adverse effects undesirable effects of one or more drugs

Side effects - is an effect, whether therapeutic or adverse, that is secondary to the


one intended; although the term is predominantly employed to describe adverse
effects, it can also apply to beneficial, but unintended, consequences of the use of a
drug.

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DRUG Categories:
CNS drugs
Opioids/Pain Management:
Oxycodone (Percocet) scheduled II drug Indication used to control
postoperative and other types of pain (strong opioid) Contraindicated for people with
drug allergy or severe asthma. Opioids release histamine which causes the itching,
vein and arteries to dilate which then leads to flushing and orthostatic hypotension.
Adverse effects respiratory depression, hypotension, flushing disorientation,
bradycardia, N/V, constipation, urinary retention and pruritus. Antidote naloxone
(narcan)
Acetaminophen (Tylenol)- nonopioid analgesic Indication mild to moderate pain
and reduce fever. Mechanism of action blocks peripheral pain impulses by inhibition
of prostaglandin syntheses. Contraindications drug allergy, severe liver/ kidney
disease and genetic disease. Adverse effects- rash, nausea and vomiting or severe
effects of the blood are anemias and nephrotoxicitys and hepatotoxicity Antidote
acetylcysteine maximum dose is 4000mg however 2000mg or less may be
necessary for patients with risk factors such as advanced age or liver dysfunction.
Liver dysfunction can occur if taking acetaminophen with alcohol in access.
Fentanyl (Duragesic)- synthetic opioid schedule II Indication (cancer induced
pain med) moderate to severe pain has a high abuse potential. Available in
parenteral injections transdermal patches buccal lozenges and buccal lozenges on a
stick lollipop or IV giving fentanyl patch to a non-opioid tolerant patient may
result in severe respiratory depression. To be considered for opioid patch the patient
should have been taking for a week or longer morphine daily oxycodone or
hydromorphone. Patients should not use heating pads because it can increase
circulation that results in increased absorption causing overdose. Patches should be
folded with sticky sides together and flushed down the toilet. New patches can be
applied after 72 hours . Know that it will take 6 to 12 hours to reach steady state pain
control again. Contraindicated for people with drug allergy or severe asthma. Opioids
release histamine which causes the itching, vein and arteries to dilate which then
leads to flushing and orthostatic hypotension. Adverse effects respiratory
depression, hypotension, flushing disorientation, bradycardia, N/V, constipation,
urinary retention and pruritus. Antidote naloxone (narcan)
Aspirin (do not give to children with flulike symptoms because it can cause
ryes syndrome). It is given as prophylactic therapy for risk factors of coronary
artery disease or stroke and given as 81mg or 325mg dose. Mechanism of action
inhibit platelet aggregation known as antiplatelet activity. There used as a
prophylactic for acute myocardial infarction and many other thromboembolic
disorders. Other NSAIDS generally lack these antiplatelet. Contraindications patient
at risk for bleeding, vitamin K deficiency and peptic ulcer disease and patient with
aspirin drug allergy. NSAIDs can be given the first 2 trimesters but is contraindicated
in the 3rd trimester and is not recommended for nursing mothers. NSAIDs should also
be discontinued one week before any surgical procedures due to risk of bleeding.
Adverse effects GI symptoms such as heartburn and gastrointestinal bleeding,
noncardiogenic pulmonary edema. Symptoms of alicylate intoxication: Increased
HR, tinnitus, hearing loss, dimness of vision, headache dizziness, mental confusion,
Nausea and vomiting sweating thirst hyperventilation hypo/hyperglycemia. Antidote
for toxicity- no antidote medication goals is to remove salicylate from the GI and or
preventing its further absorption correcting fluid electrolyte and preventing its further
absorption, and acid base disturbances and implement measure to enhance
salicylate elimination including hemodialysis. NSAIDs are contraindicated for
patients with cardiovascular disease due to the increased risk of
thrombotic events MI and stroke. (Not for aspirin because aspirin as the
antiplatelet effect as other NSAIDs do not. In patients with GI upset they can be

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given cytotec to prevent gastric ulcers and gastrointestinal bleeding that can occur in
patients receiving NSAIDs. Ketorolac (Toradol) powerful analgesic effect and has
an anti-inflammatory effect. Ketorolac lacks the addictive properties like opioids. Its
indicated for orthopedic injuries or surgery. Can be given orally or injection. It is a
short tem treatment not for minor or chronic pain. Adverse effects renal
impairment, edema GI pain dyspepsia and nausea- this drug can only be used for 5
days because of its potential adverse effects.
Muscle Relaxants: Baclofen Indications trauma inflammation anxiety and pain
associate with acute muscle spasms. Mechanism of action depresses nerve
transmission in the spinal cord. Contraindicated in patients with renal failure. Adverse
effects euphoria, lightheadedness, dizziness, drowsiness, and fatigue and muscle
weakness experienced early in treatment, generally short lived after growing
tolerant to them over time. Toxicity and antidote - No specific antidote or reversal
drug. Gastric lavage and close observation of the patient is recommended. Adequate
airway should be maintained and electrocardiographic monitor should be instituted
and large quantities of IV fluids to avoid crystalluria.
Neuromuscular blockers/Anesthetics: Nalbuphine (Nubain) synthetic
narcotic analgesic Indications relief of moderate to severe pain also preoperative
sedation analgesia as a supplement to surgical anesthesia. Contraindicated drug
allergy or pregnancy. Caution use in patient with emotional instability or drug abuse
head injury increased ICP cardiac disease impaired respirations, COPD GI disorders
impaired kidney or liver function MI and lactation. Nursing implications Withhold
this drug if respiratory rate is below 12 watch for respiratory depression of newborn
if given during labor and delivery avoid abrupt termination of drug following
prolonged use may result in withdrawal symptoms.
Cholinergics: Tensilon evaluation of treatment requirements of
myasthenia gravis. Diagnose cholinergic crisis - Negative Tensilon test - makes
client worse - Positive Tensilon test - client improves. Tensilon is injected
intravenously, atropine sulfate is antidote for overdose, in order to diagnose MG most clients will see improvement in 30-60sec/lasts 4-5 min
Antiepileptics: Depakote valproic acid unspecified antiepileptic Indications
treatment for generalized seizures (absence, myoclonic and tonic clonic)also
effective in partial seizures. Contraindicated in patients with liver impairment and
urea cycle disorders. Adverse reactions drowsiness, nausea and vomiting along with
other GI disturbances, tremor weight gain and hair loss. This drug has interactions to
the following drugs: aspirin, cholestyramine, diazepain and warfarin, rifampin,
tricyclic antidepressants and antimalarial medications. Advice patients to avoid
alcohol, herbal products and to notify health care provider if any thoughts or suicide
or dying /anxiety irritability or panic attacks.

CNS/Psychotherapeutic Drugs:
Stimulants: Amphetamine (Adderall) releases norepinephrine from nerve
endings to increase motor activity mental alertness and decreased fatigue
in narcoleptic patients and ADHD patients Indications ADHD and narcolepsy
Contraindicated in patients with hyperthyroidism, psychotic personalities suicidal or
homicidal tendencies chemical dependence glaucoma or pregnant. Adverse
effects/side effects hyperactivity insomnia restlessness tremor palpitations
tachycardia anorexia erectile dysfunction growth inhibition and psychological
dependence Interactions : MAOI will cause hypertensive crisis, beta blockers, digoxin
or antidepressants Nursing implementations advise patients to take at least 6 hours
before bed to prevent insomnia, monitor childrens height and weight frequently,
teach the parents how to take summer vacations from the meds.
Antidepressants: SSRIs: Fluoxetine (Prozac) newer generation
antidepressant Mechanism of action inhibits serotonin reuptake and have weak

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effects on norepinephrine and dopamine reuptake. Indications depression, bipolar,


panic attacks, obsessive compulsive disorder, post tramatic stress disorder.
Contraindicated in patients who use MAOI in the past 14 days and certain
antipsychotic drugs, cardiac disease or seizures. Bupropion (wellbutrin or zyban antidepressant) is also contraindicated in cases of eating disorder and seizure
disorder because it can lower the seizure threshold. Adverse effects insomnia
weight gain sexual dysfunction and serotonin syndrome (due to concurrent use of
MAOI and SSRI) potential to cause hypertensive crisis when taken with tyramine
(aged cheese, red wine, cured meats like pepperoni and jerky sauerkraut spam
Vienna sausages corn beef bologna or beer on tap).Teach patient not to take with
OTC medication unless consulting with physician like St. Johns Wart.
Antipsychotics: Clozapine (Clozaril) newer generation of atypical antipsychotic
drugs- Indication psychotic disorders and Parkinsons disease. Mechanism of action Have
a very weak dopamine blocking ability and which it becomes associated with minor to no
symptoms of extrapyramidal symptoms, which makes this drug the # 1 choice for treatment
of psychotic disorders and Parkinsons. Adverse reactions agranulocytosis, leukocytopenia
(monitor blood levels frequently and if it falls below 3000 then withhold medication until it
rises about this value. Contraindicated in patients with drug allergy, myeloproliferative
disorders, severe granulocytopenia, CNS depression or angle closure glaucoma and in
comatose patients. Interacting drugs include alcohol and other CNS depressants
/antihypertensive (risk of hypotension) Haloperidol (Haldol)
Musculoskeletal Drugs
Osteoporosis tx: Miacalcin (calcitonin nasal spray) there are three types of
drugs that treat osteoporosis Bisphosphonates, selective estrogen
receptor modulators and calcitonin. Indication treatment of osteoporosis
mechanism of action directly inhibits osteoclastic bone reabsorption.
Contraindicated in patients with drug allergy to salmon because the drug is salmon
derived. Adverse effects flushing of the face nausea diarrhea and reduced appetite.
Interactions may cause hypercalcemia monitor electrolytes carefully and avoid
giving aspirin or NASIDs if they are taking bisphosphonates cause it can irritate the
stomach.
Respiratory drugs
Leukotrienes (Singular) (Montelukast and zafirlukast) Leukotriene
receptor antagonists mechanism of action modify or inhibit the activity of
leukotrienes which decreases arachidonic acid induced inflammation and allergen
induced bronchoconstriction. Indication prophylaxis and long term treatment of
asthma in adults and children 12 years of age and older. Not meant for the
management of acute asthmatic attacks, takes around 1 week to work.
Contraindications drug allergy or allergy to povidone, lactose, titanium dioxide or
cellulose derivatives because these ingredients are in this medication. Adverse
effects headaches nausea and diarrhea.
Anticongestants Decongestants Indication nasal decongestants to reduce the
nasal congestion. Decongestants can be taken orally to produce a systemic effect can
be inhaled or administered topically to the nose (pseudoephedrine and phenylephrine
both OTC) Contraindicated in patients narrow angle glaucoma, cardiovascular disease
hypertension diabetes hyperthyroidism and prostatitis. Adverse effects nervousness
insomnia palpitations and tremors however they are usually very well tolerated. The
most common adverse effect for intranasal steroids is irritation and dryness.
Interactions sympathomimetic drugs and sympathomimetic nasal decongestants
are more likely to cause drug toxicity when given together. MAOI may result in raising
of the BP also medications with pH buffers. Nursing implication- encourage plenty of
fluids if not contraindicated to loosen the secretions.
Antitussives Although all opioid drugs have antitussive effects only codeine and
its semisynthetic derivative hydrocodone are used as antitussive. Non opioid

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antitussive drugs are less effective than the other and are available either alone or in
combination with other drugs of OTC cold and cough medications. Mechanism of
action suppress the cough reflex through direct action on the cough center in the
medulla. Indications stop cough reflex when the cough is nonproductive and or
harmful for the patient. Contraindicated in patients with opioid dependency and high
risk for respiratory depression, hyperthyroidism advanced cardiac and vessel disease
hypertension glaucoma and the use of MAOI in the last 14 days. Nursing
interventions - Antitussive medications may cause drowsiness or dizziness so inform
patient not to drive or operate machinery while taking. It may also cause respiratory
depression if giving with other antitussive medications, so the medication needs to
be given in spaced intervals.
Expectorant aid in the expectoration of excess mucus that has accumulated in the
respiratory tract by breaking down and thinning out secretions. (guaifenesin
mucinex) Mechanism of action loosen and thin secretions in response to an irritation
of the GI tract produced by the drug and the direct stimulation of the secretory
glands in the respiratory tract. Indication bronchitis laryngitis pharyngitis pertussis
influenza and measles. Contraindicated for patients who are allergic to guaifenesin.
Adverse effects minimal nausea vomiting and gastric irritation. Interactions NONE
Bronchodilators- COPD patients! Help to relax bronchial smooth muscle bands to
dilate the bronchi and bronchioles that are narrowed. Three types : beta2 agonists
(albuterol, ephedrine and epinephrine fast acting), anticholinergic (ipratropium and
tiotropium their actions are slow and prolonged and used for prevention of
bronchospasms associated with chronic bronchitis and emphysema and not for acute
symptoms.) and xanthine derivatives (plant alkaloids caffeine theobromine and
theophylline)
Inhaled corticosteroids reduce inflammation and enhance the activity of beta
agonists to prevent the inflammatory process. Ex: inhaled - pulmicort, decadron
phosphate respihaler, aerobid, Flonase, azmacort and the oral corticosteroids used
for respiratory illness is prednisone and methylprednisolone (IV or oral).
Nursing implementations for respiratory drugs
Provide other measures such as humidified o2 etc.
Caution about use of alcohol, narcotics and sedative hypnotics due to CNS depression
(antitussive)
Encourage cessation of smoking
Monitor therapeutic response and adverse responses
Show patient how to use the inhalers or nasal sprays with return demonstration
Have patient rinse mouth with inhaled corticosteroids / do not use for acute
respiratory attacks/ taper off the corticosteroids because it can affect your adrenals.

Cardiovascular Drugs
Antianginals: Nitrates/Nitroglycerin dilate all blood vessels used as
prophylaxis and treatment for angina and other cardiac problems.
Indications treat stable unstable and vasospastic angina rapid acting dosages are
used to treat acute episodes. Contraindication- severe anemia closed angle glaucoma
hypotension and head injury. Along with erectile dysfunction drugs such as Viagra.
Adverse effects- headache, hypotension which can cause risk for falls, skin
inflammation for topical nitrate forms. MAKE SURE TO PROTECT FROM HEAT AND
LIGHT. Intravenous dosing is for emergency and the nurse needs to closely monitor
BP and pulse and constant ECG monitoring, and the medication is only potent for 3-6
months. Patient should avoid alcohol hot environmental temperatures saunas hot
tubs and excessive exertion. Sublingual: 1 tab under tongue at first sign of chest pain
if pain not relieved after 1 dose call 911 may repeat up to 3 times
Antidysrhythmics: Digoxin - Cardiac glycoside , Mechanism of action Increases force of myocardial contraction. Prolongs refractory period of AV node.

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Decreases conduction through SA and AV nodes, Indication - CHF, super ventricular
tachydysrhythmias such as Aflutter, A fib Contraindications - V-Fib, V-Tach; Use with
caution with acute MI
Adverse effects Dysrhythmias, hypotension, AV block Nursing interventions- all
electrolyte and drug levels should be checked to be sure they are within normal
limits. The nurse should always measure the patients apical pulse rate for 1 full
minute. If the pulse rate is below 60 or above 100 hold the medication and contact
the doctor. Should a toxicity occur and digoxin rise to a life threatening level the
antidote is digoxin immune Fab (digibind). Normal digoxin levels are 0.5-2 ng Low
potassium levels can cause the potential for digoxin toxicity. Cordarone - one of the
most effective antidysrhythmic drugs for controlling supraventricular and ventricular
dysrhythmias and is considered a last resort drug. Mechanism of action - Blocks
sodium channels at rapid pacing frequencies, exerts noncompetitive antisympathetic
action, lengthens cardiac action potential, blocks potassium channels, slows
conduction and prolongs refractoriness.
Amiodorone is also vasodilator and decreases cardia workload and oxygen
consumption Indications Ventricular fibrillation and V-tach. Precautions and
contraindications sinus brady cardia, AV block and hypotension. Side effects visual
halos and photophobia, hypotension, may precipitate with sodium bicarbonate and
the half-life is very long and last up to 40 days

Lidocaine is used for ventricular dysrhythmias


Antihypertensives: Calcium Channel Blockers pines Calcuim plays an
important role in the excitation contraction coupling process that occurs in
the heart and vascular smooth muscle cells as well as in skeletal muscles.
Preventing calcium from entering into this process therefore prevents
muscle contraction and promotes muscle relaxation, which causes then to
dilate. Increasing the blood flow to the ischemic heart which in turn
increases the oxygen supply and helps shift the supply.
Classification : benzothiazepines (diltiazem) dihydropyridines pines amiodipine,
felodipine, isradipine, nicardipine ect.) and Phenylalkylamines (verapamil)
Indication: Treatment of Prinzmentals angina, effort associated angina, chronic stable
angina, also used to treat essential hypertension, paroxysmal supraventricular
tachycardia
Action: prevents the movement of calcium into the cardiac and smooth muscle cells
when the cells are stimulated, interfering with their ability to contract. Leads to loss
of smooth muscle tone, vasodilation, and decreased peripheral resistance; Decrease
cardiac workload and oxygen consumption.
Adverse effects: dizziness, light headedness, headache, asthenia, peripheral edema,
bradycardia, atrioventricular block, flushing, rash, nausea
Nursing Implications:
Monitor blood pressure, cardiac rhythm, cardiac output
Coagulation Modifiers: Antiplatelets Aspirin, clopidogrel (Plavix)
eptifibatide (integrilin)
Indications Aspirin MI prophylaxis, TIA prophylaxis
Plavix Reduction of atherosclerotic events, acute coronary syndrome without ST
segment elevation.
Eptifibatide (integrilin) Unstable angina, MI percutaneous coronary procedures
Contraindications thrombocytopenia, active bleeding, leukemia, traumatic injury, GI
ulcer, Vitamin K deficiency and recent stroke. Adverse effects serious bleeding
episodes
Nursing implementation patients should avoid taking aspirin or NSAIDs 5-7 days
before a surgical procedure. Also avoid the concurrent use of other anticoagulants,
antiplatelets and fibrinolytics should not be given together.

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Antilipemics: Statins hydroxymethylglutaryl-coenzyme a Reductase


inhibitor (Lipitor, questran, Zetia) Mechanism of action decreases the rate of
cholesterol production in the liver. Indications hypercholesterolemia especially
elevated levels of LDL. Contraindicated in patients with liver disease or elevation of
liver enzymes and pregnancy. Adverse effects headache dizziness blurred vision
fatigue nightmares and insomnia, constipation diarrhea nausea changes in bowel
function myalgias and skin rashes. Should ALT and AST levels increase it should be
discontinued cultural differences should be assessed with a focus on the individuals
beliefs about how to control diet and cholesterol levels.
Diuretics:
Loop: Furosemide (Lasix)- Prototype: Furosemide (Lasix)
Indication: Treatment of edema associated with CHF, acute pulmonary edema,
hypertension
Action: Inhibits the reabsorption of sodium and chloride form the proximal and distal
renal tubules and the loop of henle; leading to a sodium rich dieresis
Adverse effects: Dizziness, vertigo, paresthesias, blurred vision, orthostatic hypotension,
thrombophelebitis, photosensitivity, rash, uticaria, nausea, anorexia, vomiting,
constipation, glycosuria, urinary bladder spasm, leucopenia, anemia, thrombocytopenia,
muscle cramps, and spasms, ototoxicity
Nursing Implications:
This can be taken with food, maintain your usual fluid intake and try to avoid
excessive intake of salt
Eat foods that are high in potassium (orange juice, raisins, and bananas)
Weigh yourself each day, at the same time of day and in the same clothing
Change positions slowly
Suck on sugarless lozenges and frequent mouth care.
Report muscle cramps or pain
Osmotics: Mannitol Indications treatment of patients in the early oliguric phase of
acute renal failure, however renal blood flow and glomerular filtration must still remain to
enable the drug to reach the renal tubules. It can also promote the excretion of toxic
substances, reduce intracranial pressures and treat cerebral edema. Contraindicated in
patients with known drug allergy sever renal disease pulmonary edema ( use loop diuretic
instead) and active intracranial bleeding. Adverse effects convulsions thrombophlebitis
pulmonary congestion, headaches chest pain tachycardia and blurred vision. Nursing
interventions: Blood pressure, pulse rate, intake and output daily weights should be
monitored and record during diuretic therapy. Changes from the initial assessment would
alert the nurse to problems with the drug therapy.
Anti-infectives
Antibiotics:
o Tetracycline- The tetracyclines were developed as semisynthetic antibiotics
based on the structure of a common soil mold. They work by inhibiting protein
synthesis in susceptible bacteria. They are composed of four rings, which is how
they got their name. Researchers have developed new tetraclyclines to increase
absorption and tissue penetration. Widespread resistance to the tetracyclines has
limited their use in recent years.
Vancomycin (vancoin, vancoled) is an antibiotic that interferes with cell
wall synthesis is suspectible bacteria. It was developed as a result of a need for a
drug that could be used both in patients how are intolerant to or allergic to
penicillin and or cepalosporins and in the treatment of patients with
staphylococcal infections that no longer respond to penicillin or cephalosporins. It
can cause renal failure, ototoxicity, superinfections, and a condition known as
red man syndrome
o Cephalosporins- The cephalosporins were the first introduced in the 1960s.
These drugs are similar to the penicillin in structure and in activity. Over time,

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four generations of cephalosporins have been introduced, each group with its own
spectrum of activity, described in the following text:
First generation cephalosporins are largerly effective against the same
gram-positive bacteria that are affected by penicillin G, as well as the
gram-negative bacteria Proteus mirabillis, E.coli, and Klebsiella
pneumonia ( PEcK; use these letters as a mnemonic device to
remember which bacteria are susceptible to the first-generation
cephalasporins).
Second generation cephalosporins are effective against those strains,
as well as Haemophilus influenza, Enterobacter aerogenes, and
Neisseria species. (Remember HENPeCK). The second generation drugs
are less effective against gram-positive bacteria.
Third- generation cephalosporins are relatively weak against grampositive bacteria but are more potent against the gram-negative bacilli
as well, as Serratia marcescens (Remember HENeCKS)
Fourth-generation cepahalosporins are in development. The first drug
of this group, cefepime (Maxipime), is active against gram-negative
and gram-positive organisms, including cephalosporin-resistant
staphylococci and P. aeruginosa.
o Metronidazole (Flagyl)
Metronidazole (Flagyl)
Also used to treat malaria, but for people who cannot take the -quines
#1 drug of choice for Trichomoniasis
Helps with many other bacteria that lives in the gut
Not just an antibiotic but also an antiprotozoal no other antibiotics classify as an
antiprotozoal
Bactericidal, amebicidal, trichomonacidal
Used for treatment of trichomoniasis, amebiasis, giardiasis, and antibioticassociated pseudomembranous colitis
Also decreases anthelmintic (worms) activity
#1 DO NOT drink alcohol projectile vomiting, headaches, and chest pain

o Piperacillin + tazobactam (Zosyn)


Penicillins cilin
Bactericidal kills things
Kills gram positives
Natural penicillin regular penicillin G-#1 treatment for syphilis/strep/staph
Aminopenicillins amoxicillin - #1 treatment for ear infections not that
successful now we use Cephalosporins=2 nd drug of choice now is #1

Penicillinbeta-lactamase inhibitor combination drugs used to fight the


beta-lactam ring.

Ampicillin + sulbactam = Unasyn

Amoxicillin + clavulanic acid = Augmentin

Piperacillin + tazobactam = Zosyn


Allergic reactions to penicillins hives or rash (Normal) its ok to try them with
Cephalosporins
Anaphylactic shock/reaction do NOT try Cephalosporins
#1 thing people complain about=diarrhea/GI upset
#1 have a problem with oral contraceptives use a different method while on it
and a week after

o Drotrecogin alfa (Xigris)


Is a recombinant form of human activated protein C that has anti-thrombotic, antiinflammatory, and profibrinolytic properties. Drotrecogin alpha (activated) belongs to

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the class of serine proteases. Drotrecogin alfa has not been found to improve
outcomes in people with severe sepsis.
Drotrecogin alfa does not improve mortality in severe sepsis or septic shock but does
increase bleeding risks therefore a 2011 Cochrane review recommended that
clinicians and policy makers not recommend its use.[
NOT ON MARKET ANYMORE!!!!

Sulfa drugs: Bactrim (SMZ-TMP)


Sulfonamides sulf
Bacteriostatic- inhibits the growth or slows down the growth
Sufamethoxazole (Bactrim only a pill) common drug - #1 drug for UTIs and
staph infection (they kill e-coli and staph/especially MRSA) ----- UTIs are caused by
e-coli -----Cellulitis and abscess are caused by staph --- in children it is (Septra a
liquid)----also helps with pneumocystis pneumonia (HIV patients)
Adverse effects hemolytic and aplastic anemia but you have to be on it for a
long period of time people usually only stay on it for 3-7 days greater risk for HIV
patients #1 thing people complain about=diarrhea/GI upset
Sulfadiazine KNOW!(main drug in silvadene cream) used for burns if
someone if allergic to sulfa drugs can they apply silvadene cream to their burns? No

Drugs for treating UTI:


o Nitrofurantoin (Macrodantin)
nitrofurantoin (Macrodantin) dont get confused with seizure drugs. Treated for UTIs
in pregnant women.
o Pyridium
Pyridium (used for UTI) teach pt ahead of time that it will change the color or they
will come in complaining

Antivirals: HSV and hepatitis tx


acyclovir (Zovirax)
#1 drug of choice for herpatic conditions. #1 and #2 (all herpes)
Cold sores, shingles, and genital
There is a whole bunch of other virs but your body breaks it all down into acyclovir.
The reason why our body breaks it all down. The reason we have all of it is because
you have to take acyclovir 4-5 times a day. We found other drugs that last longer so
you dont have to take it as often but they all break down into acyclovir.
HIV Drugs: Protease inhibitors
zidovudine (Retrovir)
First anti-HIV medication in the word..retrovir..not going to ask you about this particular
drug but it came out in 1981
Protease inhibitors (PIs)
Work in the same situation but stop the replication part.

Protease inhibitors (PIs)

Inhibit the protease retroviral enzyme, preventing viral replication

amprenavir (Agenerase)

indinavir (Crixivan)

nelfinavir (Viracept)

ritonavir (Norvir)
# side affects of antiretroviral is nausea and vomiting.

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Antitufungals: Terbinafine (Lamisil)


Terbinafine is used to treat fungal infections of the toenail and fingernail. Terbinafine
is in a class of medications called antifungals. It works by stopping the growth of
fungi.

Antituberculars: Rifampin- (Rifadin, Rimactane), which alters DNA and RNA


activity in the bacterium.
No alcohol while taking this.
Urine, Stool, Saliva, Sputum, Sweat, or Tears may become reddish-orange.
Do NOT become pregnant while taking.

Antihelminthics: Vermox
Drug of choice for worms.
mebendazole (Vermox)
Inhibits uptake of glucose and other nutrients, so the parasite cant eat anything, leading to
autolysis and death of the parasitic worm
We like it because it kills a lot of worms - roundworms, hookworms, and some tapeworms
Adverse Effects
GI most common
Nausea / vomiting
Diarrhea
Headaches
Nursing Interventions
Some drugs may cause the urine to have an asparagus-like odor, or cause an unusual
skin odor or a metallic taste; be sure to warn the patient ahead of time Vermox
GI drugs
GERD/PUD Tx:
o Sucralfate (Carafate)
Sucralfate is used to treat ulcers. It adheres to damaged ulcer tissue and protects
against acid and enzymes so healing can occur.
Shake well before you use.

o Aluminum hydroxide (Amphojel)


Aluminum hydroxide is used for the relief of heartburn, sour stomach, and peptic
ulcer pain and to promote the healing of peptic ulcers.
be aware that aluminum hydroxide may interfere with other medicines, making them
less effective. Take your other medications 1 hour before or 2 hours after aluminum
hydroxide.

Antiemetics- Anti-nausea/vomiting drugs- Phenergan from phenothiazines. In low


dose they are effective and at higher dosage they are used as antipsychotic. S/E
drowsiness, muscle, dystonia (extra pyramidal). Zofran used for chemo- take 30
minutes before. Reglan is another drug.

Laxatives:
o Bulk-formingFiber!
Causes gas
Psyllium (Metamucil)
Increases the consitancy in the stool and then helps absorb the water so the stool is
looser and not as hard or compacted.

ESE Study Guide

Absorbs water to increase bulk

Enulose (Lactulose) - Lactulose (Chronulac) is the alternative choice for


patients with cardiovascular problems. This saltless osmotic laxatives pulls fluid
out of the venous system and into the lumen of the small intestine.
Vitamins & Mineral Supplements:
o Iron
1st thing we try to do is? Diet
What do they need to eat? Spinach, liver, organ meat, green leafy veggies, red meats
Use with it? Encourage drink citrus (orange juice) to help break down the iron so our body
can absorb it better. One thing grape-fruit juice is ok with.
Avoid? KNOW! Tea it kilates (does not allow for it to be absorbed) iron do not drink tea
within 30min to 1hr of taking iron
When taking iron drink lots of fluid, increase fiber, take a stool softener, take before meals
or eat with it.
Kids higher potential of having iron deficiency make sure to tell parents to keep
Flintstone/gummies vitamins in a secure area because kids think they taste like candy can
become iron toxic and can die. Only give one.
Oral liquid iron what do we tell our patients it will stain their teeth use a straw dilute it
can dilute with orange juice
o

KNOW! When someone is taking iron pills do we tell them to lay down and go to sleep? NO
because of reflux it is very erosive to the esophagus
o
o

Vitamin C
Important in wound healing and prevention of bleeding.

o
o

Vitamin D
Sunlight

Endocrine Drugs
Antidiabetics:
o Insulin
Type 1 insulin dependent do not produce insulin at all - no point of taking oral
Type 2 oral / not insulin dependent producing insulin but your body is not utilizing
it

Rapid onset (15min) and duration (3-4) Lispro take when eating & NovoLog
Short onset (30min) and duration (3-6) Regular (Humulin R) four times a day
every meal and right before bedtime
Intermediate onset (2-4) and duration (10-16) NPH (cloudy) & Humulin give twice
a day morning and at dinner
Long onset (1-2) and duration (24) Lantus (clear) once a day give at night
does not peak
70NPH/30Regular Lantus & Levemir
Draw up clear first then draw up the cloudy
IV regular

Oral Type 2 diabetes


Biguanides- metformin(Glucophage) #1 drug of choice/ 1st line of treatment for
diabetes - helps lose weight / wont be big anymore does not cause hypoglycemia
does not stimulate - makes the insulin you have more effective

ESE Study Guide

How they work - They decreased production of glucose by the liver, decrease
intestinal absorption of glucose, increase uptake of glucose into the cells, and DO
NOT increase insulin secretion from the pancreas DOES NOT cause hypoglycemia
because it does not increase insulin secretion it just makes the insulin you have
more effective

KNOW! Metformin - #1 choice for all type 2 diabetes primarily effects the GI tract
most people will lose weight with this can cause gas and diarrhea but doesnt last
long - can cause lactic acidosis, dehydration makes it worse, KNOW! if someone is on
Metformin they have to stop it 24-48 hrs. before they get IV contrast and then after
they cant take it again for another 24-48 hrs.

If they dont feel right, clammy, and hands shaking what are we going to do? Give
them juice, crackers, simple carb with a simple protein, cheese and crackers, cheese
and peanut butter juice is quick put all 3 together juice, carb, and protein
If they are laying there unconscious what are you going to do?
D50 IV push what size IV? At least a 20g Why? It is a hypertonic solution and the
tissue can become necrotic if IV site is not available give glucagon because it is an
IM shot
How long does glucagon work? less than 5 min

o Glimepiride (Amaryl)
Sulfonylureas
First generation: chlorpropamide (Diabinese), tolazamide (Tolinase)
Second generation: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta,
Micronase)

Sulfonylureas stimulates insulin secretion, better beta cell function, improve


sensitivity of the insulin, result in lower glucose levels DO cause
hypoglycemia because it stimulates insulin secretion
KNOW! Pts have tendencies of hypoglycemia
Adrenal drugs: ACTH
Oversecretion leads to cushings syndrome
Cushings Syndrome - They have too much steroid. They will have trunkal obesity,
fluffy and doughy, moon face. They have too much adipose tissue and too much third
spacing

-tropin
Anterior pituitary drugs
o Cosyntropin
o Somatotropin
o Somatrem
o Octreotide
Posterior pituitary drugs
o Vasopressin use in a code blue or someone has extreme hypotension very
strong vasoconstrictor
o Desmopressin
Mimics sympathetic increase heart rate, bp, respirations
Mechanism of action mimics the sympathetic nervous system if someone has a pituitary
tumors, what are they going to have? You end up getting oversectretion of the productions
of the hormones hypertensive crisis because you have the vasopressin is being released.

ESE Study Guide


Indication anti-inflammatory and promotes renal retention of sodium and results in edema
and hypertension

Thyroid drugs:
o PTU- Propythiouracil (PTU) is the most frequently used thioamide; it is
associated with severe GI effects. The other available thioamide is
methimazole (Tapazole). Hematological adverse effects are more common in
with methimazole, so the patient needs to have a complete blood count and
differential monitored regularly. GI effects are somewhat led pronounced with
methiamzole, so it may be the drug of choice for patients who are unable to
tolerate PTU.
o Radioactive Iodine
If someone has thyroid cancer or graves disease will they have to be on thyroid
placement forever? YES
The thyroid could be destroyed by radioactive iodine, removed surgically, or can just
have half of thyroid removed anytime someone has had any of these things done
they will have to be on a thyroid replacement forever
How do we treat it? Kill your thyroid we kill the thyroid then give you thyroid
hormones that we can have control over we kill it with radioactive iodine, surgery,
remove only half of thyroid, then after that need lifelong thyroid hormone
replacement
Give these drugs until they can get into surgery or get radioactive iodine: In the
meantime
methimazole (Tapazole)
propylthiouracil (PTU)
All they do is decrease the amount of thyroid hormone your body uptakes blocks
they try to decrease your bp and heart rate All she cares about
Some people who got the radioactive iodine and it didnt completely kill the thyroid
put them on this
Worry about Radioactive iodine treatment problem is that it causes liver and bone
marrow toxicity

Corticosteroids
Glucocorticosteroids:
There are multiple ways to use this. They care used for the respiratory system for asthma
and COPD. Administration is inhaled. If you have sinus issues they are intranasal.
The side effects:
Inhaled: dry mouth and thrush
Nasal spray: irritation, nosebleeds, headaches, and dry mucous membranes
Oral: weight gain, high blood sugar, cushings (moon face)
All cortocosteroids all end in -sone
Mineralocorticoid
fludrocortisone acetate
Adrenal steroid inhibitor
aminoglutethimide
These are the adrenal corticosteroids but they are not used often because we dont like to
mess around with peoples adrenal glands.

ESE Study Guide


Mechanism of action:
Different drugs have different potencies, duration and action but they all do the same thing.
The number one reason why we give glucocorticosteroids is for inflammation. That is the
number one mechanism of action: it is an anti-inflammatory.
Indications
Adrenocortical deficiency
Cerebral edema
Collagen diseases
Dermatologic diseases
GI diseases
Exacerbations of chronic respiratory illnesses, such as asthma and COPD
We also give them to people who just had an organ transplant. THE BIGGEST THING THAT
YOU HAVE TO UNDERSTAND ABOUT HAVING SYSTEMIC CORTICOSTEROIDS IS THAT IT WILL
DECREASE YOUR IMMUNE SYSTEM. YOU TREAT PEOPLE WHO ARE ON LONG STANDING
TREATMENT OF CORTICOSTEROIDS AS IF THEY ARE HIV POSTIVE, JUST WENT THROUGH
CHEMO, ETC. BECAUSE THEIR IMMUNE SYSTEM IS JUST AS BAD. That is when it is systemic.
When someone has a chronic inflammation from things like lupus, people who have RA, any
type of autoimmune. Their immune system is going crazy so we give them something that
will decrease their immune system and decrease inflammation. This is usually the drug of
choice for autoimmune disorder. This is why people will only take steroids for a few days
(immune system). Topical, creams and stuff is not such a big deal. Systemic steroids have to
be tapered.
Nursing Implications
Know a baseline weight and height because the majority of the time they give people
steroids based upon their weight
Systemic forms may be given by oral, IM, IV, or rectal routes (not SC) never given
subq because it is very toxic to the skin.
Oral forms should be given with food or milk to minimize GI upset
Topical is used for psoriasis or eczema you need to make sure that they put on
sunblock also. The skin will become sensitive to the sun
Immunologic Drugs
Immunosuppressants: Cyclosporine
Mix oral cyclosporine solution in a glass container because they will eat through the
Styrofoam
Oral immunosuppressants should be taken with food to minimize GI upset
Grapefruit juice also interacts with some of these drugs iron is the only one we take
with citrus
o Primary drug used for the prevention of kidney, liver, heart, and bone marrow
transplant rejection
o May be used for other autoimmune disorders

Biologic Response Modifiers (BRMS): Filgrastim (Neupogen)


These substances arouse the body's response to an infection.
Filgrastim is used to decrease the chance of infection in people who have certain
types of cancer and are receiving chemotherapy medications that may decrease the
number of neutrophils (a type of blood cell needed to fight infection), in people who
are undergoing bone marrow transplants, and in people who have severe chronic
neutropenia (condition in which there are a low number of neutrophils in the blood).

ESE Study Guide


Filgrastim is also used to prepare the blood for leukapheresis (a treatment in which
certain blood cells are removed from the body and then returned to the body
following chemotherapy). Filgrastim is in a class of medications called colonystimulating factors. It works by helping the body make more neutrophils.
Reproductive Drugs
Steroids (anabolic)
#1 illegal unless you have a prescription for it for a particular reason
Schedule III does not require a triplicate (Ms. Martin can prescribe)
Problem is most of the time it is misused for a number of reasons normally athletes
because the biggest thing it does is muscle mass
The reason why they made them illegal (Arnold Swartzinegar) all that muscle mass gets
droopy because the skin got real big and the muscle underneath it is not there anymore - He
has also had 4 open heart surgeries
Heart disease is the #1 thing that anabolic steroids cause
What she wants us to know
It is illegal they only reason why they use it is for children with growth defects or
who needs some secondary male characteristics that are not being developed for
some reason
Causes heart disease
Causes testicular hypertrophy if you keep taking it (small testies and you will
become infertile)
Adverse Effects: Peliosis of the liver, other severe hepatic effects (they mess with your liver
and your heart)
Dermatologic Drugs
Anti-Acne: Isotretinoin (Accutane)
isotretinoin (Accutane)
o Oral
o Pregnancy category X!!!!!!!!!!!!!!!!!!!!!!!
o You have to make a contract with whoever your prescriber is iPLEDGE which is a
program for safety that tells them you will use two forms of birth control and you
will not get pregnant when your taking the medication you will have to do
monthly pregnancy tests
o Biggest side effects with this drug is depression and suicidal thoughts while
taking this drug you have to see your provider at least once a month do
depression screening
o Monitor liver and kidneys
o If youre a boy and gets someone pregnant while he is on this he can still have
chances of the baby having problems
o Must wear sunscreen!
Ophthalmic Drugs
Beta-blockers
Prototype: Metroprolol (Toprol)
Indication: Treatment of hypertension, angina pectoris
Action: These drugs block beta-adrenergic receptors and vasoconstriction (thereby stopping
an increase in blood pressure) and prevent the increase in heart rate and increased intensity
of myocardial contraction. These actions decrease the cardiac workload and the demand for
oxygen.
Used in combination with nitrates to increase exercise tolerance.
Not for prinzmental angina

ESE Study Guide


The dose that is used to prevent angina is lower than doses used to treat hypertension.
Adverse effects: dizziness, vetigo, CHF, arrhythmias, gastric pain, flatulence, diarrhea,
vomiting, impotence, decreased exercise tolerance
Nursing implications:
Do not stop these drugs abruptly after chronic therapy but taper gradually over 2 weeks

Miotics
o Constrict the pupil
Cholinergic Drugs slows things down and dilate
Mimic the PSNS neurotransmitter ACh
Also called miotics, cholinergics
Direct-acting and indirect-acting drugs
They lead to reduction of the interocular pressure by increasing the outflow of
aqueous humor
Adverse Effects
Hypotension
Bradycardia
Nausea
Vomiting

Yaaahhh all done..

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