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136 Cards in this Set
- Front
- Back
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cholinergic agents mimic what system?
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PSNS
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what is the neurotransmitter related to cholinergic drugs?
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acetylcholine
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bronchi/lungs response to muscarinic stimulation
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increased secretion
constriction |
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cardiovascular response to muscarinic stimulation
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blood vessels dilate
decreased HR decreased BP |
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eye response to muscarinic stimulation
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pupil constriction
decreased accomodation |
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GI response to muscarinic agents
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increased tone, increased motility
relaxed sphincters |
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GU response to muscarinic agents
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increased tone, increased motility
relaxed sphincters |
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glandular secretions response to muscarinic agents
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increased intestinal, lacrimal, sweat, & salivary gland secretion
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cholinergic drugs mechanism of action
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"rest & digest"
stimulate the PSNS pupils constrict bronchi constrict GI muscles contract decreased HR increased glandular secretion vasodilation, decreased BP decreased IOP |
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uses of direct-acting cholinergic agents
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urinary retention & atony
neurogenic bladder atrial dysrhythmias--helps regulate polarization & depolarization in conduction system GI reflux disease-effect on motility decreased IOP |
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contraindications for direct-acting cholinergic agents
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GI/GU obstruction
bradycardia, heart block, CAD hyperthyroidism epilepsy COPD, asthma Parkinson's disease |
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adverse effects of direct acting cholinergic agents
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cardiovascular: bradycardia, hypotension, conduction abnormalities (AV block, cardiac arrest)
CNS: headache, dizziness, confusion respiratory: increased bronchial secretions, bronchospasms GI: abdominal cramps, increased secretions, N/V other: lacrimation, sweating, salivation, loss of ocular accomodation, miosis (constriction) |
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what is the antidote for direct acting cholinergic agents?
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atropine sulfate is used to counteract the adverse effects of the drugs
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what is bethanechol chloride (Urecholine) used for?
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urinary retention & atony
paralytic ileus |
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nursing care/education for patients on bethanechol chloride (Urecholine)
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assess urinary frequency/retention
monitor HR & rhythm monitor RR & breath sounds monitor I&O assess bowel sounds take before or after meals |
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mechanism of action for indirect-acting cholinergic agents
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stimulate release of ACh at the receptor site resulting in more ACh availability at the receptor site. inhibits the action of acetylcholinesterase. Improves memory & learning
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uses for indirect-acting cholinergic agents
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MG
alzheimer's post-op bladder distention post-op paralytic ileus glaucoma |
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contraindications for indirect-acting cholinergic agents
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same as those for direct acting:
GI/GU obstruction bradycardia, heart block, CAD hyperthyroidism epilepsy COPD, asthma Parkinson's disease |
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indirect-acting cholinergic agents used for alzheimer's disease include:
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tacrine (Cognex): increases thinking ability. monitor liver enzymes (may increase), given QID.
donepezil (Atricept): mild-moderate alzheimers, dementia. R/T parkinson's, abnormal labs. given Q day. |
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nursing care/education for indirect-acting cholinergic agents used for alzheimer's disease
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no cure
safety--meds may cause vertigo |
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indirect acting cholinergic agents used for MG
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edrophonium chloride (Tensilon): IV-30-60 seconds, lasts 4-5 minutes. increased strength & muscle tone, used to diagnose MG.
pyrostigmine bromide (Mestinon): maintenance drug. neostigmine (Prostigmine): symptom treatment. monitor VS (may decrease HR & BP) |
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nursing care/education for indirect-acting cholinergic agents used for MG
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drugs taken for life
take on time carry ID report side effects assess S&S of MG assess breath sounds & quality of respirations check HR & BP I&O check urinary frequency assess abdominal cramping |
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drug interactions w/ cholinergic agents
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anticholinergic drugs: atropine, antihistamines: decrease desired effects
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myasthenia crisis
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not enough cholinergic med is being administered
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cholinergic crisis
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too much med is being administered
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anticholinergic agents mechanism of action
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block or inhibit the actions of acetylcholine at the muscarinic receptors in the PSNS
acetylcholine is unable to bind to the receptor site & fails to produce a cholinergic effect |
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uses for anticholinergic agents
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respiratory disorders (causes bronchodilation)
cardiac disease (low dose-bradycardia, higher dose-increased HR) Parkinson's disease-decreases muscle rigidity, tremors, & spasticity preoperatively-decreases secretions bladder problems-decreases voiding, urge, & increases bladder capacity |
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contraindications for anticholinergic agents
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narrow-angle glaucoma (increases IOP)
tachycardia (increases HR) MG BPH MI |
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atropine sulfate
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anticholinergic agent
blocks the muscarinic (cholinergic) receptors used for preoperative control of secretions treatment of bradycardia (high doses) this is the antidote for cholinergic agents** |
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glycopyrrolate (Robinul)
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anticholinergic agent
blocks receptor sites controlling salivation. used in PUD |
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tolterodine (Detrol)
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anticholinergic agent
treats overactive bladder decreases urgency & urge incontinence |
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nursing care/education for anticholinergic agents
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ice chips
increase water intake increase dietary fiber sensitivity to light precautions for elderly: R/F heat stroke, hyperthermia |
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meds used to treat hypersensitivity disorders & descriptions
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albuterol: frequent use may cause dose-related adverse reaction--nausea, anxiety, palpitations, tremors, increased HR
salmeterol: long-acting maintenance treatment only epinephrine: acts on alpha & beta adrenergic receptors; causes bronchodilation, increase contractility, BP, vasoconstriction... used for ACLS. acute asthma attack & anaphylaxis. pseudoephedrine: stimulates alpha & beta adrenergic receptors causing vasoconstriction, decreased nasal congestion, decreased hyperemia, & decreased swelling dobutamine: beta 1 receptors. increases CO by increasing contractility dopamine: low doses-dilate blood vessels in brain, heart, kidney, mesentery. higher doses increase heart contractility norepinephrine: vasoconstriction, increased BP |
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stimulation of alpha receptors cause:
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vasoconstriction
relax intestinal muscle contraction smooth muscle |
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stimulation of beta receptors cause:
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relax smooth muscle (bronchi)
stimulate cardiac muscle |
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adrenergic drugs mechanism of action
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stimulate the SNS
used to combat life-threatening disorders acute asthma attacks shock cardiac arrest allergic reactions |
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indications for adrenergic drugs
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resp: treat asthma & bronchospasm
nasal: decongestants, vasoconstrictor to treat allergic rhinitis ophthalmic: decrease IOP cardiac: vasoconstriction to treat hypotension |
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common reactions for adrenergic drugs
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palpitations
tachycardia N/V pallor, sweating, dizziness, weakness, tremor HA, apprehension, nervousness, anxiety |
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therapeutic actions of adrenergic drugs
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increase HR & BP
increase heart contractility bronchdilation increased respirations vasoconstriction |
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indications for epinephrine (Adrenalin)
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anaphylaxis & acute asthma ***1st line of defense in anaphylaxis
restore cardiac rhythm in cardiac arrest open angle glaucoma control surgical bleeding post op prolong activity of local anesthetics |
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contraindications for epinephrine (Adrenalin)
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known drug allergy
shock d/t trauma narrow angle glaucoma coronary insufficiency labor do not use w/ local anesthetics to the toes or fingers |
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nursing implications for epinephrine (Adrenalin)
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cardiac & resp assessments
know effects of drug patient education: -take med as prescribed -change position slowly -check pulse for full 60 seconds -report weight gain >2 lbs/24 hours -avoid caffeine & ETOH |
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Histamine functions
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nerve impulse transmission in CNS
dilation of capillaries contraction of smooth muscle stimulate gastric secretions increased HR |
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H1 receptor (Histamine 1) & response to allergic reaction
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mediates smooth muscle contraction & dilates capillaries
in response to allergic reaction: constrict smooth muscle, increases bodily secretions, vasodilates & increases cap permeability...fluid moves from vessels to soft tissues causing decreased BP, edema of soft tissues |
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antihistamines mechanism of action
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decreases the physiologic effects of histamine
compete directly w/ histamine for specific histamine sites antihistamines bind to receptor sites that cause irritation & inflammation they move the histamine molecules from the surface of the cell & form a protective shield around the cell so that histamine cannot interact w/ the cell causing an allergic reaction |
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indications for H1 blockers
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H1 causes smooth muscle contraction & cap dilation
nasal allergies, rhinitis, common cold, vertigo, motion sickness, parkinson's sleep-causes drowsiness |
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common H1 blockers
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diphenhydramine (Benadryl)
cholpheniramine (Chlor-trimeton) fexofenadine (Allegra) cetirizine (Zyrtec) desloratadine (Clarinex) loratadine (Claritin) non sedating antihistamines: Zyrtec, Clarinex, Allegra, & Claritin |
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H1 blockers contraindications
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known drug allergy
as the sole therapy for asthma attack narrow angle glaucoma cardiac disease HTN kidney disease COPD PUD seizure disorder BPH pregnancy/lactation impaired liver function renal insufficiency |
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H1 blockers adverse effects
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DROWSINESS
dry mucous membranes vision changes urination difficulties constipation |
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diphenhydramine (Benadryl): action, routes, side effects, instructions
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action: antagonizes effects of histamine at H1 receptor sites & relieves allergic symptoms caused by histamine release
routes: PO, IV, IM, topical administer w/ food may cause drowsiness if used as sleep aid, take 20 mins prior to bed time **not used for elderly: may cause R/F falls, hangover effect |
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contraindications for diphenhydramine (Benadryl)
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known drug allergy
pregnancy/lactation acute asthma attacks cardiac disease & cardiac dysrhythmias driving ETOH/CNS depressants kidney disease, HTN, COPD seizure disorder |
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immunosuppressant medication uses
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primary: organ rejection
-prophylaxis to prevent rejection -treat an ongoing rejection often used in conjuction w/ corticosteroids other uses: RA, MS |
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immunosuppressant mechanism of action
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suppress T lymphocytes
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immunosuppressant contraindications
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known drug allergy
renal/hepatic failure HTN concurrent radiation therapy (decreases T cell counts) pregnancy (urgent situations only) |
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common immunosuppresants & info
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corticosteroids (coritsone, hydrocortizone, prednisone, methylprednisone, dexamethasone): adrenal cortex. many functions. route: inhalation, PO, IV. controls inflammatory response
Imuran (azathioprine): anti-rejection agent. blocks T cell proliferation. prophylaxis or organ rejection in conjuction w/ other meds. used for severe RA. routes-PO, IV. give w/ or after meals to decrease side effect of nausea. if you miss a dose, omit that dose. Tacrolimus: prevent kidney/liver rejection Sirolimus: kidney transplant rejection |
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Nursing implications & education regarding corticosteroid use
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adverse effects are more common w/ increased dose & long-term therapy
may mask signs of infection monitor I&O & daily weights assess for adrenal insufficiency can cause hyperglycemia in diabetic Pt may increase cholesterol & lipids cushing symptoms w/ prolonged therapy (facial hair & weakness) do not skip or double dose stopping suddenly may induce adrenal insufficiency consult MD prior to vaccinations notify MD of abd pain or tarry stools monitor behavior changes discuss effects on body image avoid alcohol dietary needs: increased protein, calcium, potassium & decreased Na & carbs *****do not stop therapy abruptly |
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cyclosporine action, uses, route
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inhibits activation of T cells
very potent prevents renal, cardiac, hepatic transplant rejection treats auto immune diseases that have not responded to other meds, including arthritis, psoriasis, IBS ***has a narrow therapeutic range: serum blood draws/monitoring action: interferes w/ initiation of T-cell activity routes: PO, IV |
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clycosporine nursing implications
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monitor for S&S of reaction continuously during 1st 30 minutes of therapy & w/ each treatment for allergic reactions
(S&S of allergic reaction: facial flushing, uticaria, wheezing, dyspnea, & rash) have O2 & epinephrine IV ready oral forms kept at room temp baseline BP monitor BP q12 wks during 1st 3 months of therapy ***monitor labs: kidney, liver, increased K, increased lipids, increased uric acid levels oral care to prevent gum diseases administer liquid form in glass container--adheres to styrofoam |
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cyclosporine interactions
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potentiates effects of diltiazem, verapamil, fluconazole, allopurinol, metaclopramide, amphoterin, & cimetidine
decreases effects of phenobarbital, riampin, & phenytoin grapefruit juice: increases bioavailability of drug by 20-200% (potential for toxicity) |
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Muromonab-CD-3
AKA: orthoclone OKT3 |
only med indicated for reversal of graft rejection
disables t cells similar to antibodies produced by the body contraindicated in patients w/ fluid overload & hypersensitivity IV only-bolus injection QD x 14 days |
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Muromonab-CD-3
AKA: orthoclone OKT3 nursing implications |
assess renal function (BUN & Cr)
assess liver function obtain baseline CV function & note history of dysrhythmias, CP, or HTN CNS baseline resp assessment for dyspnea or wheezing monitor for risk for infection, injury, pain increased risk for noncompliance d/t side effects |
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Immunomodulation agents definition & 3 major types
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various subclasses of biologic modifying response drugs (BMRs) that specifically or non specifically enhance or reduce an immune response
3 major types: 1.) adjuvants 2.) immunostimulants 3.) immunosuppressants |
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Biologic response modifying drugs (BMR's)
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alters the body's response to diseases such as cancer, autoimmune, anti-inflammatory, & infectious diseases
enhances/restores host's immune system defense against tumors use of agents toxic to tumor cells, causing them to lyse or rupture, cytotoxic against cancer cells modify the tumor's biology: prevent the cell from dividing & metastasizing |
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2 broad classes of BMR's
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hematopoietic drugs
immunomodulating drugs |
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4 types of immunomodulating drugs
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1.) interferons
2.) monoclonal antibodies 3.) interleukins 4.) miscellaneous IMDs |
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interferons: effects, indications, contraindications
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antiviral & immunoregulatory properties
3 effects on immune system: 1.) restores function if it is impaired 2.) augment the immune system's ability to function as the body's self defense 3.) inhibits the immune system from working indications: treatment of viral infections, various cancers, & some autoimmune disorders adverse effects: flu like symptoms contraindications:known allergies, hepatitis, liver failure, concurrent immunosuppressants, Karposi's sarcoma |
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nursing implications for interferons
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monitor for S&S of depression
monitor Hgb, WB, Plts, LFT's administer at the same time rotate injection sites store in fridge SQ flu-like symptoms may occur risk of photosensitive reactions may cause spontaenous abortion-women use BC |
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interleukins
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called lymphokines
soluble proteins released from activated lymphocytes anakinra-a pharmaceutical interleukin symptom control of RA w/o response to other meds contraindicated in allergy to med injection only |
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nursing process for clients receiving immunomodulating agents
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assess: research meds, complete hx & head to toe assessment. baseline VS & CBC
diagnosis: infection, lifestyle changes, fatigue, decrease ability to do ADL's plan: goal to decrease inflammation implement: give directly as prescribed, VS throughout therapy, may need pre-medication. may need to stay w/ Pt for 1st 30 mins evaluation: decrease in growth of mass of tumor or lesion, reduction of symptoms R/T tumor or disease process |
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antiviral meds definition
antiretroviral meds definition |
general term used for any drug that destroys viruses-either directly or indirectly-by suppressing their replication
antiretroviral agents is a more specific term for an antiviral drug that works against retroviruses such as HIV |
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when are antiretroviral (HIV) drugs effective?
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only during viral replication... not during "dormant" stage
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antiretroviral mechanism of action
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alter viral reproduction... reverse transcriptase enzyme. promotes RNA converting to DNA in HIV
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what are the 5 classes of antiretroviral agents?
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1. non-nucleoside reverse transcriptase inhibitors (NNRTI's)
2. nucleoside reverse transcriptase inhibitors (NRTI's) 3. protease inhibitors (PI's) 4. fusion inhibitors (FI's) 5. integrase inhibitors (II's) |
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antiretroviral agents mechanism of action
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suppresses viral replication
interrupt viral replication; decreases viral load, decreases opportunistic infections, increases T cell count |
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what is HAART?
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highly active antiretroviral therapy
multiple antiretroviral drugs combined usually a combination of at least 3 meds |
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antiretroviral drugs indications
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active HIV infection (increased viral load, decreased CD4 counts)
prophylactic therapy for known potential exposure to HIV healthcare workers high-risk infants |
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antiretroviral contraindications
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known severe drug allergy or other intolerable toxicity
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antiretroviral drugs adverse effects
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need to modify drug dosage r/t adverse effects...
N/V, diarrhea, anorexia headache, seizures peripheral neuropathies bone marrow suppression rash pancreatitis, increased LFT's, renal stones fatigue |
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antiretroviral drugs interactions
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there are many drug to drug interactions... oral contraceptives, etc
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main goals of HAART drugs
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1. viral suppression
2. immunologic restoration 3. improvement in quality of life |
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non-nucleoside reverse transcriptase inhibitors (NNRTI's)
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action: directly act on reverse transcriptase to stop HIV replication
therapeutic uses: primary HIV-1 infection; often used in combo w/ other antiretroviral meds to prevent med resistance route: PO side effects: rash (Steven Johnson); flu like symptoms; fatigue **assess skin,treat rash w/ benadryl |
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nucleoside reverse transcriptase inhibitors (NRTI's)
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action: reduces HIV symptoms by inhibiting DNA synthesis
therapeutic uses: treats HIV infection route: PO, IV side effects: bone marrow suppression, N/V, diarrhea, liver function rectal bleeding, dehydration, take w/ food to decrease GI distress |
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protease inhibitors (PI's)
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action: alter & inactive the HIV virus enzymes needed for HIV replication
therapeutic uses: treat HIV infection in combination w/ other antiretroviral meds to reduce med resistance route: PO side effects: hyperglycemia, hypersensitivity, N/V, increased lipids, thrombocytopenia, & leukopenia *monitor glucose, increased thirst, increased U/O (R/F diabetes) monitor for infection |
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fusion inhibitors (FI's)
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action: blocks HIV virus from attaching to & entering the CDC4 T cell
therapeutic uses: treat HIV infection that is unresponsive to other antiretroviral meds route: subq side effects: localized injection site reaction, bacterial pneumonia, fever, chills, rash, hypotension *rotate injection sites, monitor skin *resp assessment prior to & during treatment |
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integrase inhibitors (II's)
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action: inhibits the activity of the integrase enzyme, this preventing the integration of the virus into human DNA
therapeutic uses: used in treatment-experienced pts showing resistance to current therapy route; PO side effects: myopathy & rhabdomyolysis (breakdown of muscle--can lead to renal failure) |
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nursing process for Pts receiving treatment for HIV/AIDs
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assess: full physical including medical hx, inquire about energy levels, weight loss, baseline VS
diagnosis: activity intolerance, R/F injury, knowledge deficit, anxiety, acute pain implement: guidelines for med administration. med adherence, don't double dose evaluate: delayed progression of HIV/AIDS & reduction in flu-like symptoms |
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what are the fungal opportunistic infections?
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candidiasis & pneumocystic jirovecii
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pneumocystic jirovecii
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common med: Nebupent, Pentam
action: antiprotozoal therapeutic uses: pneumonia caused by pneumocystis jirovecii organism action: kills the organism that causes the infection route: IV or IM nursing considerations: assist w/ frequent movement to allow for uniform distribution of med *****do not give med w/ e-mycin IV: fatal arrhythmias monitor BP frequently EKG assess for S&S of hypoglycemia monitor BUN, Cr |
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Candidiasis
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common med: amphotericin B or ketoconazole
action: antifungal, acts on cell membrane to cause cell death therapeutic uses: treatment of choice for systemic fungal infections route: IV, central line recommended monitor closely during test dose w/ frequent VS CBC, Plts, BUN, Cr, & K ***life threatening hypokalemia may occur after each dose d/t many adverse effects, Pts pretreated w/ acetaminophen, anti histamines, & antiemetics *may cause renal damage, hydration |
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herpes simplex & cytomegalovirus
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viral
common meds: acyclovir & ganciclovir action: interrupts cell replication by preventing reproduction of viral DNA therapeutic uses: acyclovir treats herpes simplex & varicella-zoster viruses ganciclovir treats & prevents cytomegalovirus route: acyclovir-PO, topical, IV gancyclovir: PO, IV monitor IV sites infuse acyclovir slowly over 1 hr ensure adequate hydration during & after infusion--nephrotoxocity |
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mycobacterium tuberculosis
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bacterial opportunistic infection
common meds: rifampin therapeutic uses: broad spectrum antibiotic, mycobacterium TB action: inhibits protein synthesis nursing implications: organ color to urine, saliva, sweat, tears monitor LFTs assess for anorexia, fatigue, malaise no alcohol accelerates metabolism of coumadin evaluation: improved resp function, clear BS, no night sweats, increased appetite, maintenance of normal temp |
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Kaposi's sarcoma
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opportunistic neoplasia
common meds: doxil, adrimycin therapeutic uses: AIDS r/t Kaposi's sarcoma route: IV only very expensive nursing implications: monitor VS & watch for acute cardiac toxicity observe for acute infusion related reactions--anaphylaxis w/ 1st dose administer anti-emetic 45 mins prior to dose monitor CBC, BUN, Cr wear gloves, mask, gown when handling med monitor oral mucosa urine may be red for 1-2 days wear gloves when handling excretions for up to 5 days post admin |
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antiprotozoal meds
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used for toxoplasmosis encephalitis, & cryptosporidosis
destroys or prevents development of protozoans in human hosts common: metronidazole (Flagyl) antimicrobial, bactericidal side effects- GI, darkening urine, numbness/tingling, seizure activity-stop meds contraindications: known allergy, liver/renal disease take flagyl w/ food |
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cosyntropin
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used in diagnosis of adrenal cortical insufficiency at adrenal cortex
treatment is based on what hormone is deficient once adrenal cortical insufficiency has been established |
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what are 2 growth hormones?
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somatrem (Protropin)
somatropin (Humatrope) used for hypopituitary dwarfism |
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growth hormones mechanism of action
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skeletal & muscle growth
increases liver glyconeolysis increases protein synthesis |
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indications for growth hormones
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inadequate secretion of endogenous GH
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drug-drug interactions for growth hormones
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glucocorticoids-decrease effect of GH
thyroid hormones-GH decreases effects of thyroid meds |
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nursing assessment/teaching for growth hormones
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cant have hypothyroidism
abuse potential-athletes, may cause acromegaly monitor liver & kidneys monitor drug therapy-growth rate of 2cm/yr rotate admin sites store in fridge-stable for 14 days follow up MD visits q3-6 mos to document growth must taper, not D/C abruptly therapy limited to period before epiphyseal closeure monitor for increased glucose levels |
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adverse effects of growth hormones
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HA
hyperglycemia hypothyroidism |
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name a growth hormone inhibitor & its mechanism of action
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octreotide (Sandostatin): a synthetic GH inhibiting drug
action-inhibits GH release through negative feedback system |
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growth hormone inhibitor indication
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acromegaly & metastatic cancer tumors
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growth hormone inhibitor drug-drug interactions
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cyclosporine increases risk of transplant rejection
ciproflaxin-prolongation of QT interval |
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nursing assessment/teaching for growth hormone inhibitor
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monitor liver/kidney function
IV, IM, SC daily or weekly baseline thyroid function tests may need decreased dosing if underlying liver or kidney function |
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adverse effects for growth hormone inhibitors
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fatigue, malaise, HA
glucose regulation difficulties conduction abnormalities dyspnea |
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vasopressin/desmopressin
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vasopressin-physiologic functions of ADH
desmopressin-synthetic form of vasopressin |
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metabolic effects of vasopressin/desmopressin & indications
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metabolic effects: causes vasoconstriction, causes H20 reabsorption
vasopressin indications: decreases thirst in DI, esophageal varices desmopressin indications: control & prevent polyuria/polydipsia & dehydration in DI *monitor I&O |
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drug-drug interactions for vasopressin/desmopressin
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carbamazepine-increases desmopressin effects (oliguria)
lithium & alcohol-decreases desmopressin effects-increases U/O |
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nursing assessment/teaching for vasopressin/desmopressin
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vasopressin given IV, IM, SC daily or weekly
desmopressin given intranasally use cautiously in Pts w/ CAD, HTN, & inadequate circulation small doses can precipitate an MI |
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vasopressin/desmopressin adverse effects & adverse reactions
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adverse effects: nasal irritation from spray, & hypertension
reactions-angina, MI, HA |
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name 3 thyroids meds
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levothyroxine (Levoxyl, Synthroid): preferred drug, synthroid is synthetic T4
liothyronine (Cytomel): synthetic T3 liotrix (Thyrolar):T3 T4 combo |
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thyroid meds indications
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hypothyroidism & replace missing hormones
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thyroid meds drug-drug interactions
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increases effect of coumadin--increased R/F bleeding
decreases absorption of digitalis |
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nursing assessment/teaching for thyroid meds
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take on empty stomach 1x day in AM--may cause insomnia
do not switch brand of drug educate for S/S of hyperthyroidism |
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contraindications for thyroid meds
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MI, hyperthyroidism, adrenal insufficiency
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adverse effects for thyroid meds
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cardiac dysrhythmias, HTN, tachycardia
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name 2 antithyroid meds
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methimazole (Tapazole): do not use in pregnancy, only alternative drug to PTU, rarely used
prophylthiouracil (PTU): may take 2+ weeks to see effects only available as 50 mg PO tablet |
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implications for antithyroid meds
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treat hyperthyroidism
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nursing management/assessment for antithyroid meds
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baseline vitals/I&O
frequent blood counts--watch for leukopenia & thrombocytopenia liver function studies-bleeding assess for adrenal insufficiency-thyroid preparations are contraindicated |
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nursing education for antithyroid meds
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life-long replacement
do not used iodized salt, shellfish, or tofu educate S&S of hypothyroidism |
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adverse effects for antithyroid meds
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liver toxicity, hepatitis
drowsiness N/V, diarrhea nocturnal muscle cramps analgesia |
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circadian rhythms
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affect release of cortisol. cortisol levels are elevated in AM & low in PM
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actions of glucocorticoids
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anti-inflammatory
inhibit/control inflammation BP maintenance: Na/ H20 retention carb & protein metabolism stress protection |
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name some glucocorticoids & indications
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prednisone, methylprednisone
autoimmune disorders, neurologic disorders, ophthalmic inflammation, COPD, organ transplant to decrease immune response |
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glucocorticoids drug-drug interacions
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increase potency of glucocorticoids: nsaids or ASA increase GI symptoms
K wasting diuretics resulting in severe hypocalcemia & hypokalemia decrease potency: -warfarin, anticholinesterase, cortisone, barbituates, phenytoin |
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nursing assessment/teaching for glucocorticoids
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PO forms take w/ milk/food to decrease Gi upset
IV, IM, rectally, NOT SC topic-follow instructions nasal-clear passage before giving & rinse mouth after avoid contact w/ infectious people. report fever, increased weakness, lethargy, sore throat to HCP take same time q day ***do not d/c abruptly--Adrenal crisis etoh, nsaids, asa increase GI symptoms |
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glucocorticoids side effects
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hyperglycemia, mood swings, abnormal fat distribution, muscle wasting, delayed wound healing/bruising, weight gain, GI upset
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glucocorticoids contraindications
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cataracts, glaucoma, PUD, diabetes
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name a mineralocorticoid
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fludrocortisone (Florinef)
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mineralocorticoids indications for use
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addisons, distal tubule to reabsorb Na & affect the excretion of K, increase H20 reabsorption, increase BP for orthostatic hypotension
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mineralocorticoids drug-drug interactions
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thiazides or loop diuretics--hypo K
phenobarbital-increases florinef clearance |
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nursing assessment/teaching for mineralocorticoids
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take w. milk or food
daily weights... >2 lb weight gain in 24 hrs call MD |
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mineralocorticoids adverse effects
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heart failure, HTN, increased ICP--seizures
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name an anti-adrenal med & mechanism of action
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aminoglutethimide (Cytadren)-PO form only
action-obstructs the normal action/function of the adrenal cortex by inhibiting the conversion of cholesterol to adrenal corticosteroids |
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nursing assessment/teaching for anti-adrenal meds
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monitor for HTN, HA, confusion, dizziness
***avoid high doses-fatal ventricular arrhythmias or CNS convulsions |
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anti-adrenal meds indications for use
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cushing's syndrome
metastatic breast cancer adrenal cancer |
