Pharm ATI Exam

System Drug Name Important Information

Heart - Failure Digoxin

(cardiac glycoside,

used to treat

dysrhythmias and

heart failure)

● Therapeutic Levels 0.5-0.8 (Pg. 177)

● IV digoxin: infuse over AT LEAST 5min.

● WITHHOLD if HR LESS THAN 60/min

○ MUST auscultate apical pulse for one full minute

● Toxicity: Yellowing vision, blurry vision, anorexia, fatigue, weakness, N/V,

GI effects, tinnitus,

● Narrow therapeutic range

● Positive inotrope (Increase force and efficiency of myocardial contraction),

negative chronotrope (Decrease Heart rate)

● Hypokalemia leads to toxicity, hyper K leads to decreased effect

● Treatment is cholestyramine (BAR) or Digibind (FAB)

● To prevent “Digoxin-induced dysrhythmias, avoid hypokalemia and

increased serum digoxin levels

○ Watch for n/v and general weakness. (hypokalemic) and caution

with potassium supplements.

● Avoid any drug that affect potassium (loop diuretics, ACE Inh and ARBs)

Brain - seizure Phenytoin

(hydantoin class,

used to treat

seizures)

● Therapeutic levels 10-20

● Narrow therapeutic range

● Gingival hyperplasia (notify dentist, use soft brush); use of folic acid

supplements decreases occurrence

● Hirsutism, acne

● Enzyme inducer- decreases effects of many drugs

● Serum level increased when used with valproic acid or methylphenidate

● Toxic levels include nystagmus, ataxia, sedation, double vision, cognitive

impairment

● Do not take with milk, decreases absorption of Vit D and Calcium

● May cause thrombocytopenia

● Check LFT’s

● Stop med if skin rash occurs

● Infuse no faster than 50mg/min to decrease dysrhythmias and hypotension

● Encourage clients to consume adequate amounts of calcium and vit D

Brain - seizure Carbamazepine ● Therapeutic levels: 4-12

● Hepatic Autoinducer- oral contraceptives and warfarin

● Blood dyscrasias (leukopenia, anemia, thrombocytopenia, bone marrow

suppression) /pancytopenia

● Stimulates posterior pituitary and promotes secretion of ADH so hypoosmolarity - essentially a medication induced SIADH

● Can cause SJS (treat minor reactions with antihistamine, wear sunscreen,

and notify provider)

● GI distress, drowsiness, rash, nystagmus, double vision, vertigo, staggering

● gait, and headache

● Start with low dose and titrate up

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Pharm ATI Exam

● Administer at bedtime

● Obtain baseline CBC and platelets, and perform ongoing monitoring

● Observe for indications of bruising and bleeding of gums

● Monitor for sore throat, fatigue, or other indications of infection

● Hepatotoxicity- Evidenced by anorexia, nausea, vomiting, fatigue

abdominal pain, and jaundice

Brain - seizure Valproic Acid ● Monitor liver and pancreatic enzymes due to damage

● Can be used in any type of seizure

● Hepatotoxicity- anorexia, nausea, vomiting, jaundice, abdominal pain,

fatigue

● Pancreatitis- nausea, vomiting, abdominal pain

● Thrombocytopenia- bruising; monitor platelet count

● Teratogenic

● Enzyme inhibitor

● N/V, indigestion- take with food

● Weight gain

Chemo Methotrexate ● Used in chemotherapy, psoriasis, rheumatoid arthritis

● Interrupts cell production, so monitor for bleeds in GI/mucosa/gums. Use

soft brushes. Protect skin.

● Pregnancy Cat X (stops cell production) and is used to dissolve pregnancy.

Moms need to be on strict birth control.

● Don’t give with folic acid

● Give with leucovorin (prevents side effects)

● Due to immunosuppression, report fever to provider stat

● Dosed weekly

● Sores in mouth (stomatitis) indicates toxicity.

Diuretic Mannitol

(Osmotic diuretic)

● Adverse effects: Peripheral edema, Pulmonary edema (can potentiate HF)

● ↓ intracranial and intraocular pressure - used in glaucoma

● Lung crackles should be recognized as an indicator of potential

complications

GI Sucralfate

(Mucosal

Protectant)

● Protects mucosa (ulcers)

● Causes constipation, so teach patients to increase fiber and fluid

Pain Morphine Sulfate ● Primary use is analgesia

● Teach patients about side effects:

○ Respiratory Depression

○ Constipation

○ Orthostatic Hypotension

○ Urinary Retention

○ Can cause biliary colic

Diuretic Acetazolamide

(Carbonic

● Diuretic - carbonic anhydrase

● Used to decrease IOP in glaucoma patients

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Pharm ATI Exam

Anhydrase

Inhibitor)

● Adverse effects include paresthesias (tingling of the extremities),

hyperglycemia

Airway Prednisone

(Glucocorticoid)

● Prevent inflammatory response by suppression of airway mucus

suppression, immune responses, adrenal function

● Adverse Effects

○ Hyperglycemia

○ Water retention

○ Peptic ulcer disease

○ Myopathy

○ Delayed wound healing

○ Gradual reduction required, taper off when done

○ Causes demineralization of bones

■ Can lead to osteoporosis and stress fractures

■ Prednisone is a glucocorticoid. All glucocorticoids can lead

to osteoporosis.

Metabolism -

electrolyte

Sodium

Polystyrene

Sulfate

● Fixes hyperkalemia (may have heard this as kayexalate in the hospital)

● Beware giving concurrently with Digoxin

Heart - HTN Atenolol ● Cardioselective, water soluble beta blocker

● Blocks beta 1 receptors on heart (You have ONE heart) and kidney

Diuretic Furosemide (Loop

Diuretic)

OTOTOXICITY!! (Watch for tinnitus, vertigo, or hearing loss)

● Take in the AM, with milk if needed for stomach upset

● Diuretic + antihypertensive = additive hypotensive

● Causes hypokalemia & OH

○ Eat bananas to increase K

● At risk for hyperglycemia

Pain Ketorolac ● Very powerful NSAID

● GI, kidney, CV issues.

● Contraindicated in ESRD

● Can not take more than 5 days

Pain Acetaminophen ● Maximum daily dose 4g/day

● Instruct client not to exceed single dose of 325 mg (adult 4,000 mg/24 hr.)

● Percocet (Acetaminophen/Oxycodone) contains Acetaminophen, so taking

both concurrently increases the chances of Acetaminophen toxicity.

Antibiotic Doxycycline ● Tetracycline class ABX

● Consume at least 3L/day of fluid

● Bacteriostatic, do not give during pregnancy or it’ll turn the baby’s teeth

weird colors

GI Docusate Sodium ● Stool softener

● Works by lowering surface tension of stool to allow water in

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