Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
Meds for tx of shock:
(+) inotropic agents - Dobutamine (Dobutrex) |
Class: Beta adrenergic agonist
Action & uses: Acts on beta1-ceptors in the heart to increase inotropic activity (increase contractility) & increase conduction through AV node (increase HR). AE: Angina, increased myocardial workload, tachycardia Nursing Implications: -Monitor ECG & BP closely while pt receives this drug. -Admin via infusion pump. -Marked HTN & tachycardia, & appearance of dysrhythmias are usually reversed by promptly decreasing the dose. |
|
|
Agents used to tx traumatic brain injury:
Mannitol (osmitrol): -Class -Action&Uses -Major AE -Nursing Implications |
-Class: Osmotic diuretic
-Action/Uses: (0.5 – 1.5 Gm/kg) Given to reduce cerebral edema; Reduces ICP by inducing diuresis; it creates an osmotic gradient across the BBB & increases serum osmolality. It pulls fluid out of brain cells shifting it into the blood. -AE: Hypotension, F&E imbalance, esp. hypnatremia; hypokalemia; pulmonary edema; REBOUND increase in ICP -NI: Monitor closely serum & urine electrolytes & kidney fx. |
|
|
Meds for tx of shock:
(+) inotropic agents - Milrinone (Primacor) |
Class: Phosphodiesterase inhibitor
Action & Uses: Inhibits cyclic AMP phosphodiesterase in cardiac & smooth muscle, thereby increasing myocardial contractility (increased CO) & causing vasodilation (decreased PAWP, decreased SVR). Little chronotropic activity, therefore does not significantly increase myocardial oxygen demand or increase HR. AE: Ventricular dysrhythmias, hypotension NI: -Monitor ECG & BP closely while pt receives this drug. -Admin via infusion pump. -In presence of significant hypotension, stop infusion, notify HCP. |
|
|
Agents used to tx traumatic brain injury:
Propofol (Diprivan) Midazolam (Versed) Lorazepam (Ativan) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Sedative/Hypnotic & Sedative
Action/Uses: Rapid onset sedative-hynotic used in maintenance of sedation. Sedatives reduce restlessness & agitation; all decrease metabolic rate & oxygen consumption AE: Dizziness, H/A, hypotension, respiratory depression, CNS depression NI: Monitor hemodynamic status & asses for dose-related hypotension. Observe seizure precautions Pain may occur at insertion site Monitor for hypoglycemia w/ Propofol Monitor for excessive sedation & respiratory depression. Use lowest, most effective dosing. Obtain baseline respiratory & pupillary assessment data prior to initiation |
|
|
Meds for tx of shock:
Vasoconstricting agents - Phenylephrine (Neo-synephrine) |
Class: Selective alpha adrenergic agents
Action & Uses: Sympathomimetic agent that acts directly on alpha adrenergic receptor to cause peripheral vasoconstriction (increase BP). Has some beta1 activity @ high doses AE: Ventricular dysrhythmias NI: -Monitor BP closely while pt receives this drug -Titrate dose to target BP as ordered by HCP. Give @ lowest dose possible to maintain BP. -Admin via infusion pump. -If admininstering drug via periphaerl IV site, monitor site closely for infiltration. If infiltration dose occur, stop infusion & call HCP immediately (infltration can cause ischemia & necrosis of tissue). -Avoid abrupt w/d: when drug is d/c'ed infusion rate is slowed gradually. |
|
|
Agents used to tx traumatic brain injury:
Morphine or Fentanyl -Class -Action&Uses -Major AE -Nursing Implications |
Class: Pain medication
Action/Uses: Narcotic analgesic AE: Hypotension & respiratory failure, N/V, constipation NI: Monitor for respiratory depression & hypotension, Monitor for excessive sedation; use lowest, most effective dosing, Obtain baseline RR, depth, & rhythm, & size of pupils before administering the drug. Record relief of pain Cautious use of opioids--may obscure neurological changes |
|
|
Meds for tx of shock:
Vasoconstricting agents - Norepinephrine (Levaterenol, Levophed, Noradrenaline) |
Class: Non-selective alpha adrenergic agents
Action & uses: sympathomimetic agent that acts directly on alpha adrenergic receptors to cause peripheral vasoconstriction (increase BP). Has moderate beta1 inotropic activity (increase contractility). AE: Ventricular dysrhythmias, increased myocardial workload, hepatic or renal necrosis NI: -Monitor BP closely while pt receives this drug. --Titrate dose to target BP as ordered by HCP. Give @ lowest dose possible to maintain BP. -Admin via infusion pump -If admininstering drug via periphaerl IV site, monitor site closely for infiltration. If infiltration dose occur, stop infusion & call HCP immediately (infltration can cause ischemia & necrosis of tissue). -Avoid abrupt w/d: when drug is d/c'ed infusion rate is slowed gradually. |
|
|
Agents used to tx traumatic brain injury:
Hypertonic saline -Class -Action&Uses -Major AE -Nursing Implications |
Action/Uses: Diuresis through action of atrial natriuretic peptide; restores resting membrane potential & cell volume; inhibits inflammation
AE: Electrolyte abnormalities NI: Monitor serum sodium & osmolality, and renal fx |
|
|
Meds for tx of shock:
Vasoconstricting agents - Dopamine |
Class: Non-selective alpha adrenergic agents
Action & uses: Has dose-dependent pharmacologic effects. At doses < 5 mcg/kg/min, dopaminergic receptors are activated leading to vasodilation in renal & mesenteric vascular beds. At doses of 5-10 mcg/kg/min., the beta1 adrenergic effects predominate resulting in increased myocardial contractility & increased HR. At doses > 10 mcg/kg/min, alpha-adrenergic effects predominate leading to arterial vascoconstriction (increased BP). AE: Tachycardia (particular at higher doses), dysrhythmias, hypotension NI: -Notify HCP of decrased urine output in absence of hypotension, increasing tachycardia, dysrhythmias, or signs of peripheral ischemia (pallor, cyanosis, mottling, coldness). -Monitor lung sounds in pts. w/ pulmonary congestion or edema b/c of its vasoconstrictive properties, it can increase venous return to rt. side of the heart & can worsen pulmonary edema -Admin via infusion pump -If admininstering drug via periphaerl IV site, monitor site closely for infiltration. If infiltration dose occur, stop infusion & call HCP immediately (infltration can cause ischemia & necrosis of tissue). -Avoid abrupt w/d: when drug is d/c'ed infusion rate is slowed gradually. |
|
|
Agents used to tx traumatic brain injury:
Thiopental; Pentobarbital; Phenobarbital -Class -Action&Uses -Major AE -Nursing Implications |
Class: Barbituates
(**no longer 1st line therapy for elevated ICP!) Action/Uses: Induces coma to control ICP/prevent seizures; lowers cerebral metabolism & CBF; stabilizes cell membranes; head injury or intracranial hypertension management that hasn’t responded to first line therapies Pentobarbital - tx for uncontrolled increase in ICP > 20 mmHg. Phenobarbital - CNS depression & reduce seizures AE: Hypotension w/ rapid infusion; respiratory depression NI: **BP & CPP may fall w/ loading dose!! Requires complex monitoring, nursing & medical care. Requires the pt to be mechancially ventilated |
|
|
Agents used to tx traumatic brain injury:
Pancuronium (Pavulon); Atracurium (Tracrium); Vecuronium (Norcuron) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Neuromuscular blocking agents
Action/Uses: Reduces skeletal muscle activity, metabolic rate, & oxygen consumption; (such as in the case of a sedated pt that becomes cold and therefore shivers...will reduce metabolism and therefore ICP*) AE: Causes total skeletal muscle paralysis. Always used w/ sedatives & mech vent. NI: Assess CV and Resp. status continuously. Observe pt closely for residual muscle weakness & signs of respiratory distress during recovery period. Monitor BP & VS Peripheral nerve stimulator may be uses to assess the effects of pancuronium & to monitor restoration of neuromuscular fx. |
|
|
Agents used to tx traumatic brain injury:
Phenytoin (Dilantin); Fosphenytoin (Cerebyx); Lorazepam (Ativan); Levetiracetam (Keppra) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Anticonvulsants
Action/Uses: In general, these agents stabilize cell membranes; prevent & control seizure activity in patients who are at high risk for seizures. Therapeutic lvls: 10-20 microgm/ml AE: May cause hypotension. Serial measurements of serum drug levels are required to assess therapeutic dosing NI: Continuously monitor VS during IV infusion, & for an hr afterward Monitor for respiratory depression & hypotension. Continuous cardiac monitoring is recommended. Monitor serum drug levels Monitor & trend CBC, hct, hgb, glucose, Ca, LFT **Dilantin can ONLY be mixed w/ NS...any other diluent will form precipitation***!! |
|
|
Agents used to tx acute traumatic spinal cord injury:
Gabapentin (Neurontin) & pregabaline (Lyrica); Amitriptyline (Amitril)** -Class -Action&Uses -Major AE -Nursing Implications |
Class: Neuropathic pain analgesics*
Act/Uses: Gabapentin: Exact mechanism of action is unknown. It may increase release of gamma-aminobutyric acid (GABA) thereby inhibiting neuronal firing. Primary use is as an anticonvulsant; however, it is also effective in controlling neuropathic pain (e.g., postherpetic pain, spinal injury pain, some forms of migraine headache). Amitriptyline: Serotonin and norepinephrine reuptake inhibitor-restores neurotransmitter levels that results in antidepressant effect; also reduces neuropathic pain. AE: Most common: Drowsiness, fatigue; Other: dizziness, sedation, orthostatic hypotension, constipation. Rare: bone marrow depression. NI: Do not stop abruptly-withdraw over one-week period. Space dose at least two hours when taking antacids. May require several weeks to achieve full effects. Monitor for therapeutic and nontherapeutic effects. Baseline and periodic monitoring of blood cell levels. Monitor blood pressure. Monitor for constipation. *Opioid analgesia (e.g., morphine or fentanyl) is ordered for noneuropathic pain. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Baclofen (Lioresal); Diazepam (Valium); Dantrolene (Dantrium*) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Skeletal muscle relaxants
Act/Uses: Act in the spinal cord to inhibit hyperactive reflexes. Useful in treatment of muscle spasticity in neuromuscular disorders such as cerebral palsy, spinal cord injury, and multiple sclerosis. Benzodiazepines are also used for treating anxiety and sleep problems in spinal cord injured patients. AE: Most common: Drowsiness. *Dantrolene not used as much b/c of side effects NI: Cautious use in presence of hepatic or renal dysfunction. Interacts with other drugs that depress CNS, including alcohol. Can increase serum glucose, AST, and alkaline phosphatase levels. Should not be stopped suddenly-results in withdrawal symptoms that can be severe. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Others: Serotonin noradrenalin reuptake inhibitors (e.g. venlafaxine (Effexor) as well as steroids Anticonvulsants used? |
May also be used to treat pts w/ SCI neuropathic pain.
Anticonvulsants used include: carbamazepine (Tegretal), valproic acid (Depakote) |
|
|
Agents used to tx acute traumatic spinal cord injury:
Amitriptyline (Elavil - as previously described. Tricyclic); Others -Class -Action&Uses -Major AE -Nursing Implications |
Class: Antidepressants
Act/Uses: Depression is commonly noted in SCI patients. Antidepressants are commonly used for short-term therapy and may be required for long-term therapy. The dual role of amitriptyline as an effective analgesic as well as an antidepressant may be advantageous in this patient population as well. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Bisacodyl (Dulcolax) suppository; Docusate sodium (Colace) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Stool softeners/laxatives
Act/uses: Bisacodyl: Increases fluid volume in intestines and stimulates peristalsis. Docusate sodium: Allows fats and water into stool through lowering the surface tension of stool this softens stool, making it easier to pass. AE: Most common: Cramping, nausea, diarrhea. Fluid and electrolyte imbalances are possible. NI: Important to establish a daily bowel program. Laxative therapy is used when needed if poor results on bowel program. Observe for development of ileus. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Enoxaparin (Lovenox) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Anticoagulants
Act/Uses: A LMW heparin contains antithrombotic properties-antifactor Xa and antithrombin. Used to prevent deep vein thrombosis. AE: Potentially life-threatening-angioedema, hemorrhage. NI: Should be initiated within 72 hours of spinal cord injury. Should have baseline studies of coagulation. Monitor platelet count. Monitor for bleeding. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Methylprednisolone (Solu-Medrol) -Class -Action&Uses -Major AE -Nursing Implications |
Class: Anti-inflammatory
Act/Uses: A synthetic corticosteroid with strong anti-inflammatory action. Used for reducing inflammation and edema in spinal cord injury. Commonly administered by paramedics at the site of the accident (SCI). AE: No major common SE for short-term use. NI: For acute non-penetrating SCI within eight hours of trauma but not recommended for SCI over eight hours after injury nor for penetrating SCI. |
|
|
Agents used to tx acute traumatic spinal cord injury:
Blood Pressure Agents Antihypotensives: Ephedrine (Efedron); Midodrine (ProAmatine). Antihypertensives: Nifedipine (Procardia); Nitroglycerine -Class -Action&Uses -Major AE -Nursing Implications |
Class: BP agents antihypotensives
Act/Uses: Antihypotensives: Stimulates the sympathetic nervous system, thereby increasing contractility and cardiac output. Used when nonpharmacologic therapies are not successful in controlling orthostatic hypotension in patients with spinal cord injury. Antihypertensives: Through various mechanisms cause vasodilation that results in decreased blood pressure. Use in SCI as a treatment for autonomic dysreflexia to rapidly reduce blood pressure. AE: Antihypotensives: Tachycardia, hypertension, tremors, nervousness, and restlessness. Antihypertensives: Dizziness, hypotension, flushing, diarrhea, headache. NI: Antihypotensives: Give 45 minutes to one hour before raising head of the bed or assuming a sitting position. Midodrine: Dose may need to be adjusted for renal dysfunction. Antihypertensives: Nifedipine-Capsules must be opened so that liquid contents come into direct contact with oral mucosa for rapid onset of action (one to five minutes). Sublingual-onset is l mucosa for rapid onset is one to three minutes liquid contents come into direct contact with oral mucosa for rapid onset of action (one to five minutes). Monitor blood pressure and heart rate. Find and relieve cause of dysreflexia episode |
|
|
Topical Antimicrobials (For Burn injury):
Silver Sulfadiazine (Silvadene) -Class -Action&Uses -Major Side Effects -Nursing Implications |
Class: Sulfonamide
Act/Uses: Silver salt is slowly released and exerts its bactericidal effect only on the bacterial cell membrane and wall; has broad antimicrobial activity including many gram-negative and gram-positive bacterial and yeast SE: Potential for toxicity if applied to extensive areas of the body surface. NI: Apply w/ sterile, gloved hands to cleansed, debrided burned areas. Reapply cream to areas where it has been removed by patient activity; cover burn wounds w/ med at all times. Reapply after bathing. Dressing not required but may be used if necessary. Store at room temp, away from heat. Pain may be experienced upon application; intensity and duration depend on depth of burn. |
|
|
Topical Antimicrobials (For Burn injury):
Mafenide Acetate (Sulfamylon) -Class -Action&Uses -Major SE -Nursing Implications |
Class: Sulfonamide Derivative
Act/Uses: Produces marked reduction of bacterial growth in vascular tissue’ active presence of purulent matter; bacteriostatic against (inhibit growth and reproduction without killing them) many gram-positive and gram-negative organisms. SE: Intense pain, burning, or stinging at application sites. NI: Apply to burn areas to a thickness of approximately 15 mm (1/16 inch) one or two times a day. Pain may be experienced upon application; intensity and duration depend on depth of burn. Store in light-resistant container, avoid extremes of heat. Pain may be experience upon application; intensity & duration depend on depth of burn |
