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Other Topics EXAM 3
Other Topics EXAM 3 - Weddington Day 2
36
Pharmacology
04/26/2012

Additional Pharmacology Flashcards

 


 

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Term
tylenol dosing change
Definition
found in more than 600 products

pain relievers, fever reducers, sleep aids, cough, cold, and allergy medications

may appear on package as: acetaminophen, acetam, APAP

liquid tylenol concentration:
now 160mg/5mL or 32mg/mL
old concentration was 80mg/0.8mL (100mg/mL)

recommended maximum dose:
now 3,000 mg/day
old max dose was 4,000 mg/day

dose:
10-15 mg/kg every 4-6 hours
packaged label gives dosing based on either weight or years (weight is preferred)
Term
symptoms of tylenol overdose
Definition
abdominal pain

upset stomach

nausea/vomiting

diarrhea

convulsions

coma

jaundice
Term
tylenol patient counseling points
Definition
dose and administration

dosing changes and new maximum daily dose

signs and symptoms of overdose
Term
EpiPen auto-injector
Definition
life threatening allergic reactions - anaphylaxis
severe swelling, breathing difficulties, or loss of blood pressure

EpiPen auto-injector - yellow cap
contains 0.3 mg of epinephrine
intended for those > or equal to 30 kg (66lbs)

EpiPen Jr auto-injector - green cap
contains 0.15 mg of epinephrine
intended for those 15-30 kg (33-66 lbs)
Term
Steps to using an EpiPen
Definition
1. flip off the yellow or green cap of the auto injector

2. remove the EpiPen from the carrier tube

3. grasp the auto-injector with the orange tip pointing down and form a fist around it

4. pull off blue safety cap

5. hold orange tip near outer thigh

6. swing and firmly push against outer thigh at a 90 degree angle until it clicks

7. hold firmly against thigh for 10 seconds

8. remove auto-injector from thigh and massage for 10 seconds

9. call 911

10. take auto-injector with you to ER
Term
side effects of EpiPen
Definition
fast, irregular heartbeat

sweating

nausea/vomiting

breathing problems

paleness

dizziness

weakness

headache

feeling of nervousness or anxiety
Term
what you should avoid with EpiPen
Definition
never put thumb or fingers over the orange tip

never press orange tip with thumb or fingers - may result in loss of blood flow to fingers or hands

do not inject into buttocks

do not inject into a vein

do not drop the auto-injector carrier

do not use if solution in clear window is discolored or contains solid particles
Term
other counseling points for EpiPen
Definition
storage - do not expose to extreme heat or cold

keep nearby and ready for use at all times

periodically check the expiration date and refill before expires

examine the contents in the clear window of the auto-injector periodically and before administration
solution should be clear and free from particles

once used, about 85% of the liquid stays in the auto-injector and cannot be reused
inform patient that they are receiving the correct dose if: orange needle tip is extended and window is obscured
Term
Diastat AcuDial
Definition
gel formulation of diazepam for use in patients 2 years of age and older with refractory epilepsy or status epilepticus

dose based on age and weight

[image]
Term
how to correctly set the Diastat AcuDial dial
Definition
[image]

1. HOLD
remove a Diastat AcuDial from case; hold barrel as shown; DO NOT REMOVE CAP!

2. ADJUST
grasp cap firmly with other hand and turn to adjust dose

3. LOCK
CONFIRM prescribed dose shwon in window; now grasp locking ring and push upward to lock both sides of ring

4. REPEAT
repeat steps 1-3 for second Diastat AcuDial; return both to case

available in 2.5 mg, 10 mg, and 20 mg
Term
administration of Diastat AcuDial
Definition
after patient seizes for 5 minutes:

roll person to their side facing you

push up with thumb and pull to remove cap; be sure seal pin is removed too

lubricate rectal tip with lubricating jelly

bend upper leg forward to expose rectum

separate buttocks to expose rectum

gently insert syringe tip into rectum

slowly count to 3 while gently pushing plunger

slowly count to 3 before removing syringe

hold buttocks together for 3 seconds
Term
Diastat AcuDial proper disposal
Definition
2.5 mg syringe:
discard all used materials in the garbage in a safe place away from children and pets
do not reuse

10 mg syringe:
pull on plunger until it is completely removed from the syringe
point tip of syringe over the sink or toilet
replace plunger into syringe and push plunger down until it stops
rinse sink or flush toilet until gel is no longer visible
discard all used materials
do not reuse
Term
cough and cold medications - 4 different medication classes
Definition
antitussives:
dextromethorphan or DM

cough expectorants:
guanifenesin

nasal decongestants:
pseudoephedrine
phenylephrine

antihistamines:
brompheniramine
chlorpheniramine maleate
diphenhydramine
Term
cough and cold supportive measures
Definition
use acetaminophen or ibuprofen for fevers
ibuprofen only for those > 6 months of age

consider honey for coughs or sore throat for kids > 1 year of age

saline drops or saline nasal irrigation to clear thick mucus

increase liquids to increase hydration and help thin mucus

place a humidifier in the child's room to add moisture

to ease congestion, elevate the child's head when resting
Term
cough and cold medications patient counseling
Definition
DON'T RECOMMEND FOR THOSE < 4 YEARS OF AGE

never give adult cough and cold medication to children

make sure patient isn't begin administered an active ingredient in several different medications

patient should see a doctor if symptoms worsen or don't improve within a few days

proper administration
Term
life cycle of lice
Definition
egg -> nymph -> adult

eggs can either be:
live
empty eggs or nits (does not necessarily indicate active infection; if close to scalp and treatment has not been given, it is most likely an active infection)
Term
who should be treated for lice?
Definition
those with an active infection

check other household members and close contacts

only treat if they also have an active infection
Term
what if a patient has been treated previously for lice?
Definition
if no dead lice are found and lice seem as active post treatment, the medicine may not be working

speak with healthcare professional before retreating
Term
OTC options for lice

pyrethrins (RID) - shampoo
Definition
work by disrupting Na channels in the CNS

100% pediculicidal activity

70-80% ovicidal activity

indications:
approved for those > 2 YEARS OF AGE

retreatment:
second treatment on day 9 to kill any newly hatched lice

other facts:
ask about allergy to chrysanthemum flower or ragweed

administration:

1. apply to DRY hair, behind ears, and back of neck
2. allow product to remain on hair for 10 minutes
3. use warm water to form a later, shampoo, then rinse
4. comb hair with a lice-nit comb and remove any other nits by hand
5. for head lice, easiest to part hair into sections
6. recheck for lice and nits
7. repeat treatment in 7 to 10 days
Term
OTC options for lice

permethrin lotion 1% (NIX) - cream, rinse
Definition
works by disrupting Na channels in the CNS

97% pediculicial activity

70-80% ovicidal activity

indications:
approved for those > 2 MONTHS OF AGE

retreatment:
second treatment on day 9 to kill any newly hatched lice

other facts:
ask about allergy to chrysanthemum flower or ragweed

administration:

1. wash hair with a shampoo WITHOUT conditioner
2. towel dry hair so that it is damp
3. shake the bottle of Nix well
4. saturate the hair and scalp with Nix, behind the ears, and back of neck
5. leave on hair for 10 minutes
6. rinse with warm water
7. part hair into 4 sections and remove nits with included comb
8. recheck for lice and nits
9. if live lice are seen 7 days after treatment, repeat treatment
Term
prescription options for lice

malathion lotion 5% (Ovide)
Definition
good pediculicial activity

partial ovicidal activity

indications:
approved for those > 6 YEARS OF AGE

retreatment:
recommended if live lice are still present 7-9 days post treatment

directions:

1. apply to DRY hair
2. leave on for 8-12 hours
3. shampoo hair and rinse hair
4. use comb to remove nits
5. retreat if live lice are found 7-9 days after treatment
Term
prescription options for lice

benzyl alcohol lotion 5% (Ulesfia)
Definition
good pediculicidal activity

NO ovicidal activity

indications:
approved for those > 6 MONTHS OF AGE

retreatment:
second treatment necessary on day 9 to kill any newly hatched lice

directions:

1. apply to DRY hair
2. leave on for 10 minutes
3. rinse hair and then shampoo hair
4. use comb to remove dead lice
5. retreat 1 week after the 1st treatment
Term
nonpharmacologic measures for lice
Definition
machine wash and dry recently worn clothes on the hot water and hot air cycles
5 minutes at a temperature of > 128.3 degrees F kills lice

items that cannot be washed, place in a sealed plastic bag for 2 weeks

vacuum floors and furniture

soak brushes and combs in hot water for 5-10 minutes
Term
constipation etiology
Definition
lack of fiber and fluid in diet

ignoring the need to have a bowel movement
may have hard bowel movement then withhold the stool
embarrassed
don't want to stop playing
don't want to use bathroom outside of their home
anxiety about toilet training
don't feel the need to go because they have previously resisted the urge
Term
nonpharm treatment of constipation
Definition
increase fluids:
infants - 2-4 oz. of water or diluted fruit juices 1-2 times/day
children - minimum of 2-3 glasses of water or fruit juices
switch to a soy formula or soy milk

increase fiber:
children > 4 months old
fruits, vegetables, cereal, whole wheat, etc.

decrease constipating foods:
cow's milk, yogurt, cheese, cooked carrots, bananas, etc.
Term
pharmacologic treatment of constipation
Definition
STOOL SOFTENERS:

docusate
oral - all ages
rectal - older children

OSMOTICS

magnesium citrate/hydroxide
oral - all ages

glycerin
rectal - all ages

polyethylene glycol
oral - children > 6 months

LUBRICANTS

mineral oil
oral - children > 5 years
rectal - children > 2 years

MISCELLANEOUS

lactulose
oral - all ages
rectal - all ages

ENEMAS

phosphate soda

saline

mineral oil

magnesium - AVOID b/c of cardiac toxicity, vasodilation, hypotension

STIMULANTS

bisacodyl
oral - children > 3 years of age
rectal - all ages

senna
oral - children > 1 month of age

caution with using stimulants in children!
chronic use may lead to dependency
can result in electrolyte and fluid imbalance
do not use longer than 1 week
Term
diarrhea etiology
Definition
virus - rotavirus, enterovirus

bacteria - E. coli, salmonella, campylobacter, shigella

parasite - giardia, cryptosporidium
Term
when to call a doctor about diarrhea
Definition
< 6 months of age

severe or prolonged episode of diarrhea

fever > or equal to 102 degrees F

repeated vomiting or refusal to drink fluids

severe abdominal pain

diarrhea that contains blood, pus, or mucus

co-morbid disease

severe dehydration

if haven't urinated in 8 hours
Term
diarrhea and dehydration signs and symptoms
Definition
sunken eyes

decreased frequency of urination; decreased number of wet diapers

sunken fontanel

no tears when child is crying

dry or sticky mucous membranes

lethargic

irritable and inconsolable
Term
diarrhea and dehydration treatment

oral rehydration solutions
Definition
recommend products that end in "lyte"
pedialyte solution, Rehydralyte solution, Infalyte solution

rehydration phase:

50-100 mL/kg over 3-4 hours

replace for stool and vomiting loss - 10 mL/kg for each

use an ORS with 75-90 mEq Na

maintenance phase:

use Holiday-Segar method:
0-10kg = 100mL/kg/day
11-20kg = 1000mL/day + 50mL/kg/day for each kg > 10
> 20kg = 1500mL/day + 20mL/kg/day for each kg > 20

recommend ORS with 40-60 mEq Na
Term
probiotics
Definition
live microorganisms which increase the amount of beneficial bacteria n the intestinal tract and:
aid in digestion
boost body's natural defenses
fight off harmful bacteria

may help to shorten duration of diarrhea by about one day in those with acute viral gastroenteritis

no evidence showing treatment in antibiotic associated diarrhea

may not help, but they have not been shown to harm children
Term
community acquired pneumonia
Definition
guidelines updated August 2011

states that the following conditions are beyond the scope of these guidelines:

neonates and young infants < or equal to 3 months of age

immunocompromised children

children on home mechanical ventilation

children with chronic conditions or underlying lung disease
Term
CAP - most common pathogens
Definition
Streptococcus pneumoniae

Group A streptococcus

Staphyloccus aueus

Haemophilus influenzae

Mycoplasma pneumoniae

Chlamydophila pneumoniae
Term
CAP recommendations
Definition
fully immunized infants or school aged children should be administered AMPICILLIN OR PENICILLIN G if substantial high level penicillin resistance for invasive S. pneumoniae is not an issue

empiric therapy with a 3rd generation cephalosporin, ceftriaxone, or cefotaxime, should be administered to:
infants and children who are not fully immunized
in regions where there is a documented high level penicillin resistance to invasive pneumococcal strains
infants and children with life threatening infections (empyema)

children with a concerm for M. pneumoniae and C. pneumoniae just empiric therapy with a macrolide and beta lactam antibiotic

children with a concern for S. aureus use empiric therapy with a vancomycin or clindamycin + beta lactam antibiotic
Term
inpatient treatment of CAP
Definition
fully immunized with conjugate vaccines for Haemophilus influenzae type b and Streptococcus pneumoniae; local penicillin resistance in invasive strains of pneumococcus is minimal:

AMPICILLIN OR PENICILLIN G

alternatives - ceftriaxone or cefotaxime; addition of vancomycin or clindamycin for suspected CA-MRSA

not fully immunized for H. influenzae type b and S. pneumoniae; local penicillin resistance in invasive strains of pneumococcus is significant

CEFTRIAXONE OR CEFOTAXIME; addition of vancomycin or clindamycin for suspected CA-MRSA

alternative - levofloxacin; addition of vancomycin or clindamycin for suspected CA-MRSA
Term
outpatient treatment of CAP
Definition
< 5 years old (preschool):

AMOXICILLIN, oral (90 mg/kg/day in 2 doses)

alternative - oral amoxicillin clavulanate (amoxicillin component 90 mg/kg/day in 2 doses)

> or equal to 5 years old:

oral AMOXICILLIN (90 mg/kg/day in 2 doses to a maximum of 4 g/day)

for children with presumed bacterial CAP who do not have clinical, laboratory, or radiographic evidence that distinguishes bacterial CAP from atypical CAP, a macrolide can be added to a beta-lactam antibiotic for empiric therapy

alternative - oral amoxicillin clavulantae (amoxicillin component 90 mg/kg/day in 2 doses to a maximum dose of 4 g/day)

amoxicillin counseling - rash, diarrhea, N/V, tastes better if cold, better if taken with food (easier on stomach), shake well