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206 Cards in this Set
- Front
- Back
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What are some Irritation of GI adverse effects?
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Irritation of GI tract
Stimulation of the vomiting center Increased Peristalsis GI ulceration GI bleeding Constipation Diarrhea |
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What are some Hematologic adverse effects?
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Potentially life threatening
Bone marrow depresson/suppression Hemorrhage Teach client about Signs and symptoms of bleeding (bruises, discolored urine, stool, petechiae, bleeding from gums) and to notify HCP. |
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What is an adverse reaction for a CNS depression?
What is advised when taking a CNS depressant? |
respiratory depression
2- Limit activity, avoid driving. |
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What are extrapyramidal symptoms?
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Involuntary fine motor tremors, ridgidity, uncontrollable restlessness, acute dystonia (uncontrollable head movements, eyes role back). These are common with psychotropics.
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What are the affects of anticholingergics?
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Muscarinic Receptor blockade effects smooth muscle, eyes, and exocrine glands and heart rate.
Mnemonic : “Can’t see, can’t pee, no stool, no drool” Advise client how to relieve dry mouth Sunglasses for photophobia Void before medicine to avoid urine retention |
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What is hepatoxicity?
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Liver damage from drugs – impairs drug metabolism and may cause drug
toxicity due to drug accumulation |
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What is nephrotoxicity?
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Damage to kidneys interferes with medication excretion and causes drug
toxicity |
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What is toxicity?
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Severe or life threatening
Adverse effects may be due to excessive dosing OR therapeutic dose |
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What are Allergic reactions?
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Immune response to medication can range from mild (skin rash) to life
threatening anaphylaxis Screen for drug allergies prior to drug administration |
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What is Immunosuppression?
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Decreased or absent immune response
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What is the category of this adverse drug effect:
Patient is experiencing twitching of the lips. |
Extrapyramidal symptoms (EPS)
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What is the category of this adverse drug effect:
Postural hypotension |
Cardiovascular (CV) effect
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What is the category of this adverse drug effect:
Most serious concern with Penicillin or Sulfa drugs |
Allergic reaction (anaphylaxis)
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What is the category of this adverse drug effect:
Aspirin adverse effect |
Gastrointestinal ulcers of bleeding (GIB)
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What is the category of this adverse drug effect:
Aminoglycoside ( the “mycin’ drugs- such as Gentamcyin) |
Nephrotoxicity
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What is the category of this adverse drug effect:
Digoxin adverse effect |
Cardiovascular effect (bradycardia, dsyrrhythmia)
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What is the major adverse effect that occurs with Narcotics
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Central nervous system depression (CNS depression)
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What is the category of this adverse drug effect:
Anticoagulant adverse effect |
Hematologic
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What is the category of this adverse drug effect:
Isoniazid adverse effects |
Hepatotoxicity
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What is the category of adverse drug effect:
Excessive digoxin adverse effect |
toxicity
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Information about Antimycobacterial (Antituberculosis)
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Drug examples: Isoniazid (INH)
Action and Use: Inhibits growth of mycobacteria by preventing synthesis of mycolic acid in cell wall Side effects:Peripheral neuropathy and Hepatotoxicity Nursing Measures:Monitor liver function. Interactions include: Phenytoin Alcohol Rifampin pyrazinamide Client education:Take on an empty stomach, Avoid alcohol and Notify physician of numbness and tingling in hands |
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Information about antiviral medication.
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Drug examples: Acyclovir (Zovirax)
Action and Use:Prevents the reproduction of viral DNA Uses: herpes simplex varicella cytomegalovirus Side effects:Nephrotoxicity Thrombocytopenia Reproductive toxicity Nursing Measures: Use cautiously with renal and hepatic impairment and dehydration Obtain CBC Client education: Advise women to avoid getting pregnant. |
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Information about Antiprotozoal medications.
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Drug examples: Metronidazole (Flagyl)
Action and Use:Inhibits bacteria synthesis resulting in cell death. Active against Anaerobic bacteria. Uses C-diff Helicobacter pylori Surgical prophylaxis: bone infections, brain abscesses CNS infections, bacterial endocarditis Genitourinary tract septicemia. Side effects:Dizziness Headache GI distress Metallic taste in mouth anorexia, N/V/D peripheral neuropathy, CNS toxicity leucopenia vaginal candidasis dark urine Nursing Measures:Monitor for peripheral neuropathy. Monitor renal and hepatic function. Get a CBC. Interactions: Coumadin Client education: Do not ingest alcohol. |
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Information about antifungal medications.
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Drug examples: Amphotericin B deoxycholate (Fungizone)
Action and Use: Increases cell permeability causing leakage of intracellular cations leading to death of fungus. Uses Candidasis Tinea pedis and cruris Side effects:Nephrotoxicity Thrombophlebitis Hypokalemia Bone marrow suppression Hepatotoxicity Irregular menstrual flow gynecomastia Nursing Measures:Use cautiously with renal and hepatic impairment and dehydration. Interactions: Aminoglycosides Client education: report side-effect symptoms. |
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Information about bacteriostatic inhibators/ Macrolide medication.
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Drugs:
Macrolides- Erythromycin (Emycin), (Erythrocin), (Ilosone) Extended Macrolides-Clarithromycin (Biaxin), Azithromycin (Zithromax), Clindamycin (Cleocin). Actions: Slows the growth of microorganisms by inhibiting protein synthesis (bacteriostatic). At high doses can be bactericidal. Use:Clients allergic to Penicillin, Step and chlamydia Side effects:GI discomfort Nausea Vomiting Epigastric pain trombophlebitis Nursing Measures:Administer on an empty stomach with a full glass of water. Contraindicated in liver disease, Monitor WBC and fever. Drug Interactions: Antihistamines Theophylline Carbamezepine Coumadin Client education:Complete entire dose of medications. Notify physician of GI upset or allergic reactions |
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Information about Aminoglycosides.
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Drugs:Gentamicin(Garamycin), Tobramycin (Nebcin), Streptomycin (Neomycin)
Actions:Destroy bacteria by destroying protein synthesis (bacteriocidal) Uses: gram negative bacilli (e-coli, pseudomonas, pneumonia) Side effects:nephrotoxicity neurotoxicity ototoxicity hypersensitivity elderly at greater risk, N/V/D rash tinnitus pruritis cramps Nursing Measures:Monitor UA, WBC & Peak and trough. Drug interactions include coumadin. Monitor for s/s of superinfection, WBC, temp, increase fluids Contraindicated with myasthenia gravis, renal disease, and hearing loss Drug Interactions: Penicillin Client education:Take on an empty stomach. Notify physician of hearing loss, tinnitus or vertigo |
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Information about tetracyclines.
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Drugs: Tetracycline(Achromycin ), Doxycycline (Doxychel, Vibramycin)
Actions:Broad spectrum antibiotics inhibit bacteria growth by preventing protein synthesis. Use:Helico bacter pylori mycoplasma pneumonia Tetra is used to treat acne, anthrax, UTI, bronchitis. Side effects:n/v/d, photosensitivity stomatitis nephrotoxicity hepatotoxicity superinfection Yellow brown tooth discoloration. Nursing Measures:Except for doxycycline and minocycline, it should be taken on an empty stomach. hypersensitivity, renal and hepatic. Drug interactions include antacids, milk and calcium (tetracycline), oral contraceptives. Client education: Discard outdated pills as can cause major toxicity. Administered with a full glass of water. |
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Information about penicillins.
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Drugs:1. Basic Penicillins
Penicillin G procaine (Crysticillin) Penicillin G benzathine, (Bicillin) Penicillin V potasium(V-cillin K) Penicillin G Potassium 2. Broad-Spectrum Penicillins Amoxil (amoxicillin) Omnipen (ampicillin) Augmentin (amoxicillin - clavulanate) Unasyn (Ampicillinsulbactam) 3. Penicillinase-resistant Tegopen (cloxacillin) Staphcillin (methicillin) Prostaphlin (oxacillin) 4. Extended-Spectrum Penicillins Ticar (ticarcillin) Pipracil (piperacillin) Geopen Geocillin, (carbenicillin) Zosyn (piperacillintazobactam) Actions: Destroy bacteria by weakening Bacteria cell wall. Use:Used for gram positive infections such as strep, meningitis, and bacterial endocarditis. Side effects:Hypersensitivity Nausea, Vomiting rash, Diarrhea GI disturbances Renal impairment Hyperkalemia with Penicillin G Nursing Measures:Penicillins should be taken with a full glass of water 1 hour before or 2 hours after meal time except for amoxicillins and bacampicillin, Penicillin V and Augmentin which may be taken with food. Monitor WBC and temperature. Monitor for s/s of a superinfection (mouth ulcers, vaginitis), Monitor for bleeding with high doses because of decreased platelet aggregation. Contraindicated in clients with allergies to cephalasporins Drug interactions: Oral contraceptives Aminoglycosides potassium supplements. Client education:Instruct client to take medicine on time and full course of medicine. Instruct client to increase fluids. Report signs of allergic reaction such as hives, skin rash, itching wheezing. |
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What is Peak and trough
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Peak and trough are methods used to establish the effectiveness of a drug. Peak is drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range.
Trough is drawing the serum blood levels right before the next dose. Trough is the lowest drug level that is needed to reach therapeutic range. If trough is > than normal, the patient is at risk for adverse effects. Therefore, the doctor should expand the time interval before ordering the next dose or decrease drug dose. |
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Information on Sulfonamides.
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Drugs:trimethoprimsulfmethox-zole: cotrimoxazole (Bactrim), sulfamethoxazole (Gantanol), sulfasalazine (Azulfidine, Salazoprine)
Action:Bacteriostatic, act by inhibiting bacterial synthesis of folic acid which is essential for bacterial growth. Uses:UTI Bronchitis E-coli infections Side effects:Hypersensitivity(allergic responses) photosensitivity blood disorders (anemia) from high doses, anorexia, N/V/D dizziness, headaches Crystalluria (crystals in urine) Water helps to prevent this occurrence. Cross-sensitivity might occur with the different sulfonamides. Nursing Measures:Assess for allergies, clients with renal or hepatic dysfunction, and blood dyscrasias. Monitor CBC. Force fluids to prevent crysalluria Interactions: Antacids Dilantin coumadin oral hypoglycemics. Client education:Watch for allergies such as skin rashes and itching, Administer sulfonamide with a full glass of water. Increase fluids to 8 – 10 glasses/day. Avoid prolonged exposure to the sun and wear sunscreen |
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Information on Fluoroquinolones.
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Drugs:Ciprofloxacin (cipro), Enoxacin (penetrex),Lomefloxacin (maxaquin), Norfloxacin (noroxin), Ofloxacin (floxin)
Action:Broad spectrum inhibits enzyme necessary for DNA replication. Uses:bone and joint infection bronchitis Gastroenteritis gonorrhea pneumonia UTI anthrax Side effects: N/V/D phtosensitivity dizziness, drowsiness, restlessness, supra infection (thrush, yeast infections) adverse effects include psychosis, confusion, hallucinations, hypersensitivity Nursing Measures:Monitor WBC, fever, signs of suprainfections Interactions: Dairy products Milk Iron salts aluminum-magnesium antacids Theodur Coumadin Client education:Instruct signs of suprainfection and to report to physican. |
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Information on Urinary Tract Antiseptics.
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Drugs:Nitrofurantoin (Macrodantin, Furadantin) Methenamine mandelate (Mandelamine), Trimethoprim (Proloprim, Timpex), Methenamine hippurate (Hiprex, Urex, Hip-Rex)
Action:Exert antibacterial activity but have little or no systemic antibacterial effects. Bacteriostatic in low doses and bacteriocidal in high doses. Uses: UTI Side effects:n/v GI discomfort Hypersensitivity Blood dyscrasias Peripheral neuropathy headache rash Nursing Measures: Monitor for renal function Drug interactions: antacids, sodium bicarbonate, methenamine, sulfonamides can increase the risk of crystalluria, nalidixic acid enhances coumadin false positive urine glucose tests. Client education: May be given with food. Encourage drinks that increase acidity, cranberry juice, prune juice. Teach client urine will have a brownish color. |
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Information about Monobactams.
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Drugs: Vancomycin
Action:Inhibits bacterial cell walls by biding to a cell wall precursor.Leads to cell lysis. Bacteriocidal Resistant strains have been reported. Uses: Used for the treatment of Antibiotic induced pseudomembranous colitis and staph enterocolitis. Parenteral vanco is indicated for bacterial endocarditis caused by staph including MRSA. Side effects:n/v, taste alterations rare side effects include: ototoxicity nephrotoxicity Red neck syndrome (flushed, chills itching) sometimes reported on too rapid injection. Nursing Measures:Peak & trough levels are usually drawn to measure serum drug levels (toxicity). Monitor renal function Ototoxicity Client education: Report side effect symptoms |
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Information on Sulfonamides.
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Drugs:trimethoprimsulfmethox-zole: cotrimoxazole (Bactrim), sulfamethoxazole (Gantanol), sulfasalazine (Azulfidine, Salazoprine)
Action:Bacteriostatic, act by inhibiting bacterial synthesis of folic acid which is essential for bacterial growth. Uses:UTI Bronchitis E-coli infections Side effects:Hypersensitivity(allergic responses) photosensitivity blood disorders (anemia) from high doses, anorexia, N/V/D dizziness, headaches Crystalluria (crystals in urine) Water helps to prevent this occurrence. Cross-sensitivity might occur with the different sulfonamides. Nursing Measures:Assess for allergies, clients with renal or hepatic dysfunction, and blood dyscrasias. Monitor CBC. Force fluids to prevent crysalluria Interactions: Antacids Dilantin coumadin oral hypoglycemics. Client education:Watch for allergies such as skin rashes and itching, Administer sulfonamide with a full glass of water. Increase fluids to 8 – 10 glasses/day. Avoid prolonged exposure to the sun and wear sunscreen |
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Information on Fluoroquinolones.
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Drugs:Ciprofloxacin (cipro), Enoxacin (penetrex),Lomefloxacin (maxaquin), Norfloxacin (noroxin), Ofloxacin (floxin)
Action:Broad spectrum inhibits enzyme necessary for DNA replication. Uses:bone and joint infection bronchitis Gastroenteritis gonorrhea pneumonia UTI anthrax Side effects: N/V/D phtosensitivity dizziness, drowsiness, restlessness, supra infection (thrush, yeast infections) adverse effects include psychosis, confusion, hallucinations, hypersensitivity Nursing Measures:Monitor WBC, fever, signs of suprainfections Interactions: Dairy products Milk Iron salts aluminum-magnesium antacids Theodur Coumadin Client education:Instruct signs of suprainfection and to report to physican. |
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Information on Urinary Tract Antiseptics.
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Drugs:Nitrofurantoin (Macrodantin, Furadantin) Methenamine mandelate (Mandelamine), Trimethoprim (Proloprim, Timpex), Methenamine hippurate (Hiprex, Urex, Hip-Rex)
Action:Exert antibacterial activity but have little or no systemic antibacterial effects. Bacteriostatic in low doses and bacteriocidal in high doses. Uses: UTI Side effects:n/v GI discomfort Hypersensitivity Blood dyscrasias Peripheral neuropathy headache rash Nursing Measures: Monitor for renal function Drug interactions: antacids, sodium bicarbonate, methenamine, sulfonamides can increase the risk of crystalluria, nalidixic acid enhances coumadin false positive urine glucose tests. Client education: May be given with food. Encourage drinks that increase acidity, cranberry juice, prune juice. Teach client urine will have a brownish color. |
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Information about Monobactams.
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Drugs: Vancomycin
Action:Inhibits bacterial cell walls by biding to a cell wall precursor.Leads to cell lysis. Bacteriocidal Resistant strains have been reported. Uses: Used for the treatment of Antibiotic induced pseudomembranous colitis and staph enterocolitis. Parenteral vanco is indicated for bacterial endocarditis caused by staph including MRSA. Side effects:n/v, taste alterations rare side effects include: ototoxicity nephrotoxicity Red neck syndrome (flushed, chills itching) sometimes reported on too rapid injection. Nursing Measures:Peak & trough levels are usually drawn to measure serum drug levels (toxicity). Monitor renal function Ototoxicity Client education: Report side effect symptoms |
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Information about ACE-inhibators
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inhibits the angiotensin converting enzyme that converts angiotensin I to angiotensin II; decreases afterload and blood pressure. Acts as a vasodilator. Indications: Mild to severe hypertension; treatment of heart failure.
Given within 48 hours of an MI to prevent ventricular remodeling and the development of heart failure. Increase survival rate after an MI. Monitor for hypotension, cough, hypokalemia; increased creatinine & BUN. Examples: enalapril (Vasotec); lisinopril (Zestril); captropril (Capoten) |
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Information about antithrombotic agents.
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Antithrombotic agents Prevent the formation of new blood clots (thrombus) and keep existing blood clots from growing larger by decreasing the coagulability (fibrin system) of the blood. Does not dissolve existing clots. Contraindicated in persons with active bleeding.
Example: Heparin, Coumadin |
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Information about Heparin.
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An antithrobotic agent.
Heparin: Inhibits thrombin and other coagulation enzymes; affects PTT value. · Antidote the nurse should have on hand: protamine sulfate · Oral anticoagulant started 3 5 days before I.V. infusion discontinued. · Watch for bleeding. |
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Information about Coumadin.
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Coumadin is an antithrombotic agent.
Coumadin: Interferes with vitamin K-dependent coagulation factors; affects PT/ INR values. · Action is cumulative and more prolonged than heparin · Should be taken at the same time each day. · Dose is adjusted to maintain a PT/ INR 2-3 X the control · Antidote: Vitamin K · Watch for bleeding |
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Antiplatelet Agents
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Make the platelets less sticky so they won’t a won t adhere to the fibrin mesh. Contraindicated in persons with active bleeding. Does not dissolve existing clots. Monitor for bleeding.
Examples: Aspirin; Plavix Clopidogrel); Ticlid; ReoPro, Integrilin, Aggrastat |
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Thrombolytics
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Degrade fibrin threads already present in the formed blood clot by activating plasminogen to plasmin. Used to dissolve thrombi in the coronary arteries and restore myocardial blood flow during the first 6 hours of an MI (“Time = muscle”).
Contraindications: active internal bleeding; recent stroke, surgery, or trauma; severe hypertension; pregnancy Examples: Retavase, TNKase(tenecteplase), t-PA (tissue plasminogen activator), streptokinase |
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A patient with a low hemoglobin and the need to replace oxygen carrying capacity requires what?
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Only packed red blood cells instead of whole blood
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What are the 9 steps to transfusing blood?
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1- Obtain a HCP order
2- Check IV patency 3- purge blood tubing with normal saline. 4- Obtain VS 5- Obtain blood component from blood bank 6- double check order with another licensed personnel 7-double check donor and recipient ABO blood type. 8-Double check patient identity 9- obtain VS |
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What gauge IV is needed to transfuse blood?
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19 gauge or larger. central lines may require a blood warmer to prevent cardiac dysrhythmias. Warm blood removed from the blood bank can not be returned.
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When preparing for a blood transfusion what type of filter should be used and how?
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A micro aggregate filter. Which should be changed every 4-6 hours, and only used for up to 4 units of blood. Need to attach 1 part isotonic saline solution and other part blood product. Should always purge tubing with saline prior to requesting blood.
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Information about ACE inhibitors
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Drugs include: Enalapril (Vasotec), Lisinopril (Zestril), Captropril (Capoten).
Angiotensin-converting enzyme works to decrease afterload and bp. Acts as a vasodilator. Used for mild to severe hypotension, and HF. Given within 48 hours of MI increases survival rate. Monitor for hypotension, cough, hypokalemia, and increased creatinine & BUN. |
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Information about antithrombotic agents.
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Drugs include: Heparin & Coumadin
Prevent the formation of new blood clots. Contraindicated in people with active bleeding. Heparin: Affects PTT value. Antidote should be on hand (protamine sulfate), an oral anticoagulant shoudl be started 3-5 days before IV is discontinued. Coumadin: Interferes with Vitamin K dependent factors, affects PT/ INR values, Action in cumulative and more prolonged than heparin, should be taken at the same time each day, antidote is Vitamin K. |
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Information on Antiplatelet agents.
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Drugs include: Aspirin, Plavix (Clopidogrel), Ticlid, ReoPro, Integrilin, Aggrastat.
Makes platelets less sticky so they won't adhere to fibrin mesh Contraindicated for pts with active bleeding. Does not dissolve the clot, Monitor for bleeding. |
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Thrombolytics
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Drugs include: Retavase, TNKase, t-PA, Streptokinase.
Degrade fibrin threads already present in the formed blood clot by activating plasminogen to plasmin. Used to dissolve thrombi in the coronary arteries during the first 6 hours of a MI. Used to dissolve thrombi in an ishemic stroke within the first 3 hours. |
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Antidysrthmics
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Drugs include: Amiodarone, Lidocaine, quinidine, procainamide.
Used for abnormal electrical activity such as A fib or Ventricular dysryhythmias. Monitor HR, rhythm, and hypotension. |
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Antilipid Medications
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Drugs include: Lovastatin, simvastatin (Zocor), Atorvastatin (Lipitor), Niacin, Questran, gemfibrozil (Lopid).
Help to lower circulating LDL. Initiated only after diet and other non-pharm therapies have proven ineffective. Monitor for muscle weakness (Rare side effect: rhabdomyolysis[upper arm and muscle weakness]), GI disturbances. |
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Beta Blockers
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Drugs include: Metoprolol (Lopressor), atenolol (Tenormin), carvedilol (Coreg).
Slow the HR and decrease bp by blocking catecholamine-induced increases in HR. Also prolongs diastole and icreases myocardial perfusion while reducing the force of mycardial contraction. Adverse effects: fatigue, lethargy, impotence, wheezing, dyspnea, HF, contraindicated in bronchial asthma. |
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Calcium channel blockers
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Drugs include: Diltiazem (Cardizem), Verapamil (Calan).
Inhibit calcium through the cardiac and smooth muscle cells. Enhances vasodilation and myocardial perfusion, decreases afterload. Indications: Angina, mild to moderate hypertension, dysrhythmias, NOT INDICATED FOR AN MI. Monitor: HR, rhythm, bp |
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Diuretics
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Drugs include: Lasix (administer 10mg/min), demade, edecrin, and hydrocholorothiazide.
Promote excretion of water, used to reduce preload. Monitor: I&O, electrolytes (especially K+), BUN/Creatinine levels. Adverse effects: K+(low K+ will put the pt at high risk for digoxin toxicity), Mg++, depletion and dehydration. *potassium sparing diuretics-inhibit aldosterone, causing Na+ to be excreted in exchange for K+. Exp spironolactone (Aldactone). |
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Sympathomimetics
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Dobutamine: Stimulates beta 1 receptors increasing cardiac contractiliyt, CO, and SV, with minor effects on HR.
Dopamine: direct stimulation of beta1 receptors. At low doses, increases blood flow to the kidneys. Epinephrine:Stimulates beta & beta2 receptors causing cardiact stimulation, bronchodilation, and decongestion. |
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Digibind
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Used for life-threatening digoxin toxicity.
Adverse events: Exacerbation of HF or a-fib due to withdrawal of digoxin. |
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What is the mechanism of action of propranolol in HTN?
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Decreases BP by decreasing CO
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What is the mechanism of action of propranolol in angina pectoris?
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Decreases HR, decreases contractility, so decreases O2 demand of the myocardium.
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What is the mechanism of action of propranolol in CHF?
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Blocking beta receptors allow the mycardium to remodel and limits stress by preventing myotoxicity caused by chronic high doses of catecholamines.
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What is the mechanism of action of propranolol in in supraventricular cardiac arrhythmias?
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slows AV nodal conduction velocity.
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What is MOA of propranolol on migraines?
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BLocks catecholamine induced vasodialation in cerebral vasculature.
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What is the adverse effects of hydrochlorothiazide in use of HTN?
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1- hypokalemia
2-hyperglycemia 3-hyperlipidemia 4-hyperuricemia 5- hypercalcemia |
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What are the adverse effects of loop diuretics?
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1-potassium wasting
2-metabolic alkalosis 3- hypotension 4- ototoxicity. |
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What are the side effects of beta blockers?
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impotence, asthma, bradycardia, CHF, AV block, sedation, sleep alterations.
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What are the side effects of captopril?
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Hyperkalemia, cough, angioedema, proteinuria, taste changes, hypotension, pregnancy problems, rash, increased renin, lower angiotensin II
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What is the action of nifedipine, verapamil, and diltizaem?
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Blocks voltage dependent calcium channels of cardiac and smooth muscle, so it reduces muscle contractility.
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What are the clinical uses of calcium channel blockers?
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Hypertension, angina, arrythmias
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What are the side effects of calcium channel blockers?
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dizziness, flushing, constipation, and nausea
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What effects does nitrates have on the heart?
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1- dilate veins
2-decreases BP (dilates arteries) 3- increases contractility 4- increases HR 5- decrease ejection time 6- decreases O2 consumption |
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What effect does beta-blockers have on myocardial O2 consumption?
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1- dilate veins
2-decreases BP (dilates arteries) 3- increases contractility 4- increases HR 5- decrease ejection time 6- decreases O2 consumption |
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Beta blockers vs nitrate?
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beta blockers decreases afterload, while nitrates decrease preload.
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Oral hypoglycemic's are what drugs?
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Sulfonylureas (1st generation): tobutamide, chlorpromaide
Sulfonylureas (2nd generation): Glipizide( glucotrol, glucotol XL) used 30 min before 1st meal of the day; glyburide (diabeta, micronase) used daily with 1st meal; glimerpide (amaryl) used daily with 1st main meal. Meglitinides: repaglinide(Prandin) Biguanides: metformin (glucophage) Thiazolidinediones: Rosiglitazone (Avandia) Alpha-Glucosidase inhibitors: Acarbose (precise) |
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Antithyroid medications include?
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Propylthiouracil (PTU) & Methimazole (Tapazole)
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Pituitary hormones/growth hormones include?
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anterior pituitary: Somatropin, Somatrem (Protropin)
Posterior Pituitary: Vasopressin (Pitressin synthetic), Desmopressin (DDAVP, stimate) |
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Oral hypoglycemic agents are used for those clients with what?
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Type two diabetes Mellitus.
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What oral hypoglycemic is began slowly and increased gradually?
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Sulfonylureas
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What oral hypoglycemic is taken 30 min before each meal?
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Repaglinide (Pradin)
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What oral hypoglycemic does not promote insulin release from the pancreas, and therefore does not cause hypoglycemia?
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Biguanides (Glucophage)
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What oral hypoglycemic should be taken with the first bite of food at three daily meals?
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Alpha glucosidase inhibitors (precrose)
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What oral hypoglycemic is not effective with clients with type 1 DM since the pancreatic islets are not capable of producing insulin?
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Repaglinide (prandin)
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What medication is used if insulin overdose occurs?
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Glucagon.
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What is a synthetic form of T4 that increase metabolic rate, protein synthesis, cardiac output, renal perfuson, oxygen use, body temperature, blood volume, growth processes.
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Thyroid hormones
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What hormone medication can be used for the emergency treatment of a myxedema coma?
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Synthroid, Thyroid USP
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Thyroid hormone replacement is Not used in the treatment of what?
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Obesity
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When doing thyroid hormone replacement you should monitor what levels?
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T3 & T4 Levels
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What blocks conversion of T3 & T4, preventing oxidation of iodine, and blocking synthesis of thyroid hormones?
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PTU and Tapazole
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Propylthiouracil (PTU) is used to treat what disease?
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Graves disease
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High doses of what hormone destroys thyroid cells?
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High doses of (PTU) propylthiouracil
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Bone marrow depression with PTU use has what symptoms?
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Anemia, leukopenia, thrombocytopenia
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Lugol's solution is a medication that does what?
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Lugol's solution creates high levels of iodine that inhibits reuptatke, thyroid hormone production, and release of thyroid into the bloodstream.
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What type of hormones stimulate the overall growth, the production of protein, and decrease use of glucose?
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Anterior pituitary or growth hormones.
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Growth hormones are effective when the client experiences what?
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Increase in height
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What medication works on the posterior pituitary and causes vasoconstriction due to the contraction of vascular smooth muscle?
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Vasopressin
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List the three rapid acting insulin's, there peak, and the duration.
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Drugs: Apidra, Humalog, Novolog.
They peak 1-2 hours Duration is 3-4 hours. |
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List the two regular insulin's, when they start, peak, and the duration of there affects.
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Drugs:Humulin R & Novolin R.
Start 1/2- 1 hour Peak 2-3 hours Duration 3-6 hours |
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List the two intermediate acting insulin's, when they start, peak, and the duration of there affects.
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Drugs: Humulin N & Novolin N
Start 2-4 hours Peak 4-10 hours Duration 10-16 hours |
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List the two Long acting insulin's, when they start, peak, and the duration of there affects.
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Drugs: Levemir & Lantus
Levemir: Start 3/4- 2 hours, minimal peak action and lasts up to 24 hours. Lantus: starts 2-4 hours, has no peak, and lasts 20-24 hours. |
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If your client is on Novolin N. When should you offer their AM snack if they took their AM dose of insulin at 6:48?
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between 8:48-10:48
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A client on Lantus is experiencing an increase in their BS 12 hours after administration of 20 units. The nurse should do what?
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Notify the physician as this is not an expected event.
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Which type of insulin is anticipated when a client is experiencing a sudden increase in BS?
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Rapid or regular
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Which type of insulin is safe to use in an insulin drip?
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Regular only
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Which insulin is typically given HS?
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Long acting (Levemir or Lantus)
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What is a bulk forming laxative?
|
Drugs:
Calcium Polycarbophil Fructan Malt Soup Extract Methylcellulose Psyllium Psyllium Hydrophillic Muciloid Bulk-forming (fiber) laxatives pass through the body undigested. The fibers attract water to the intestine, absorb the water and swell to form a soft, bulky stool. |
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what are the 7 types of enemas?
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Cleansing enema, Comercially prepared disposable enema (Fleet), Carminative enema, Anthelminthic enema, Emollient enema, oil retention enema, and a medicated enema.
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What is a cleansing enema?
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Instillation of enough fluid into the colon to help stimulate peristalsis and soften feces.
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What is a Fleet enema
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Uses a hypertonic solution to pull water from the colon to soften feces.
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What is a Carminative enema?
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Stimulates peristalsis to evacuate gas from the intestines.
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What is anthelminthic enema?
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If a client can't handle medication orally, to kill parasites. The medication can be given as an enema.
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What is metamucil? When is it's peak affect?
|
Metamucil is a psyllium or a bulk forming laxative. It peaks between 24-72 hours.
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Teach clients taking senna that he/she may experience a change in
urine. A ________ discoloration is normal |
Yellowish brown
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What are contraindications for metamucil?
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1- Intestinal obstruction
2- Abdominal pain 3- appendicitis symptoms 4- Fecal impaction |
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What is Bisacodyl?
|
Bisacodyl (INN) is a stimulant laxative drug. It is typically prescribed for relief of constipation and for the management of neurogenic bowel dysfunction. Bisacodyl is a diphenylmethane derivative
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What is a contraindication for promethazine (phenergan)?
|
Glaucoma
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What is a life threatening side effect for prochloroperzine?
|
tardive dyskinesia
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What antiemetic drug causes depression of XTZ in the medulla?
|
Phenergan (Promethazine)
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What lab value should be monitored closely for clients taking cimetidine and warafin?
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PT
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What vitamin absorption is impaired when taking cimetidine?
|
B12
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What antiemetic has an H2 receptor antagonist?
|
Ranitidine (Zantac)
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A client taking misoprostol should avoid taking antacids that contain What Substance, bc diarrhea could result?
|
magnesium
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Intravenous cimetidine (antiemetic) is incompatible with what medication?
|
Cefazolin (mainly used to treat bacterial infections in the skin)
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What antiemetic is a proton pump inhibitor?
|
Omeprazole (prilosec)
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If concurrent administration of prilosec and phenytoin occurs, what is the impact on the phenytoin therapeutic level?
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It is increased.
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What is a medication commonly used to manage nausea in clients receiving treatment for cancer?
|
Ondansetron (Zofran)
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What is an immune globulin? side effects? How is it administered? Client teaching? Evidence of effectiveness?
|
IgG (gamma globulin)
It provides passive immunity and antibodies. It is used for immunodeficiency, Bone marrow transplantation, Hep A & B exposure, MMR and chicken pox exposure. s/e Local erythema swelling, pain. Rare risk of allergic reaction, risk for pregnant women. Administered Deep IM or IV Teach the clients that passive immunity is temporary, and it should be given with in 6 days of exposure of measles or 14 days of hep. Evidence of effectiveness: Monitor for prevention of infection and increased platelets. |
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What are immunostimulants? What are they used for? S/E? Contraindications?
|
Drugs: Interferon Alfa, Aldeslukin (Interleukin 2)
They enhance host immune responses and reduce proliferation of cancer cells. Used for:Hairy cell leukemia, malignant melanoma, Aids related Kaposi’s Sarcoma S/e: flu like symptoms, bone marrow suppression, alopecia contraindications: cardiotoxicity, neurotoxicity, hypotension, hypersensitivity to meds, risck for category C (pregnancy) |
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How is immunostimulants administered? Client teaching? Evidence of effectiveness?
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Sub-q or IM
Teach: Do not shake vial, store in the refrigerator. Effectiveness: Monitor for decreased cell proliferation. |
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What are immunosuppressants? What are they used for?
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Drugs: Calcineurin inhibators- cyclosporine; glucocorticoids-prednisone; cytotoxics- azathioprine (Imuran); Tacrolimus (Prograf) methotrexate (Rheumatrex, trexall)
They act on helper T lymphocytes to suppress production of immune response resulting in suppression of the proliferation of B cells and cytotoxic T cells. Used: Autoimmune disorders (RA, SLE, MG) and to prevent organ rejection (lifelong therapy required) |
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What are s/e of immunosuppressants?
What are contraindications? |
S/e: Increased risk for infection, fever sore throat
Contraindications: Cyclosporine-Hepatotoxicity, nephrotoxicity; Glucocorticoid- osteroporosis, adrenal insuff, fluid retention; Cytotoxic- bone marrow depression All- hypersensitivity, recent vacc or contact with active infection, systemic fungal infections, risk category C (pregnancy-tetrogenesis) |
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How is immunosuppressant given? Client teaching? Evidence of effectiveness?
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Given: initial cyclosporine over 2-6 hours.
Teaching: mix cyclosporine with milk/OJ (do not drink grapefruit juice while on therapy), lifelong therapy, report s/s rejection or infection. Effectiveness: monitor for improvement of symptoms. |
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What is the action of antihistamines? What are the types/drugs of antihistamines? What are the two types of antihistamines used for?
|
Action: Block histamine release in the small blood vessels, capillaries, and nerves during allergic reactions.
1st generation H1 antagonists: Benadryl, phenergan, dramimine. 2nd generation H1 antagonists: Claritin, Zyrtec, Allegra, Clarinex. 1st generation uses: mild allergic reacitons, anaphylaxis, motion sickness, insomnia 2nd generation uses: Long term seasonal allergies. |
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When are antihistamines contraindicated?
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third trimester of pregnancy or while breast feeding.
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What are Chemotherapy agents?
|
Anticancer agents that destroy cancer cells, as well as healthy cells by preventing the replication of DNA.
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What chemotherapy drug is used with breast cancer?
|
Tamoxifen (Nolvadex)
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What chemotherapy drug is used with prostate cancer?
|
Leuprolide (Lupron)
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What are s/e of chemotherapy agents?
|
Bone marrow suppression, n/v, Alopecia, Mucositis (GI tract), Reproductive toxicity (congenital abnormalities, amenorrhea, menopausal symptoms, atrophy of epithelium, sterility in males), Hyperuricema.
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Risk of IV complications increase if peripheral IV catheter remains in vein
over _____ hours |
72
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What intravenous of solution has an osmolarity similar to plasma?
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Normal Saline
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What solution is used commonly in postoperative client because its osmolality is similar to body fluids?
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Lactated ringers
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What are the 12 cranial nerves?
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Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory (vestibulocochlear), Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal
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What is the normal range of ICP?
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4-15
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What are s/s of increased ICP?
|
Change in LOC, HA, pupillary changes, N/V, papilledema, seizures,
Late s/s= slow bounding pulse, irregular respirations, increased systolic blood pressure with widening pulse pressure. |
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What occured if the blood or brain size increase?
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Cerebral edema, hematoma, tumor
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What is it called when CSF increases?
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Hydrocephalus.
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What is CPP?
|
Cerebral Perfusion Pressure: Mean arterial pressure (MAP)-ICP
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What is the average CPP?
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85 mm Hg
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What levels does cerebral anoxia occur?
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Must be > 65 mm Hg to prevent cerebral anoxia.
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What diuretics are used for increased ICP?
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Osmotic diuretics- Mannitol (withdrawls fluid from normal tissue, works within 20 min, but may cause rebound cerebral edema)
Loop diuretics (Furosemide)- reduce rate of CSF production. |
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When is corticosteroids used with ICP?
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Only documented to work with brain tumors. Dexamethasone (Decadron)- stabilize cell membranes.
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How should BP be controlled when a pt has ICP?
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Avoid hypotention and hypertension. Keep systolic bp < 160 mmHg.
Except in management of vasospasms associated with subarachnoid hemorrahage (then higher bp may be required.) |
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How much fluid should be given when a pt has ICP?
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Fluid should be restricted to 75-100 mL/hr.
Except in management of vasospasms associated with subarachnoid hemorrahage (then higher rates may be required to prevent vasospasms.) |
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What are the three main neurotransmitters for the ANS? (autonomic nervous system/ viseral)
|
Acetyhcholine (ACH), Epi, and Norepi
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CNS medications are used to treat what dzs?
|
Parkinson's, seizure disorders, mental health disorders, and to provide analgesia and anesthesia.
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What is the somatic nervous system?
|
The somatic nervous system (SNS) is the part of the peripheral nervous system[1] associated with the voluntary control of body movements through the action of skeletal muscles, and with reception of external stimuli, which helps keep the body in touch with its surroundings
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Sympathetic vs parasympathetic regulation?
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Sympathetic= increased HR, blood vessels, Flight or fight!
Parasympathetic= decreased HR, increased GI tract movement, pupil constriction, and bronchial smooth muscle contraction. |
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What do nicotinic receptors do?
|
Nicotinic n/ nicotinic m= release epi from the adrenal medulla, and cause skeletal muscle contraction.
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What do muscarinic receptors do?
|
increase secretions, decrease HR, contract smooth mscles in the brochi/GI, constrict pupils, relax bladder/bowl.
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What do dopamine receptors do?
|
Dilate blood vessels in the kidneys.
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What do Alpha 1 receptors do?
|
pupil dilation, constrict veins and arterioles, male sex organs are activated.
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What do Beta 1 receptors do?
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Increase HR & contractility (conduction through AV), release of renin
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What do beta 2 receptors do?
|
dilates bronchi, relaxes uterine smooth muscle, vasodilates arteriols in the heart, lungs, and skeletal muscles. causes skeletal muscle contraction.
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When instilling eye drops why do you apply pressure to the inner canthus after administration?
|
To prevent rapid absorption of medication
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Explain the reason for administering ear drop(s) at room temperature.
|
extreme temperatures of otic medication can result in dizziness, nausea and/ or pain
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How do you straighten the ear canal for an adult? Child under 3?
|
Adult- pull the pinna up and back
child- pull the pinna down and back |
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What is one of the biggest problems with TPN?
|
Hyperglycemia
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When giving pts insulin who are on TPN, when should blood glucose checks be done?
|
Blood glucose measurement every six hours – routine serial blood glucose
checks are most appropriate |
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What is the mechanism of an antihistamine?
|
Acts by blocking the H1 receptors on the surface of basophils and mast cells. Competes with histamine.
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|
|
What are the side effects of antihistamines?
|
Drowsiness, dry mouth, change in vision, difficulty urinating, constipation
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What action does Beta 2 adrenergic agonsist have?
|
Stimulates beta receptors in the lung, relaxes bronchial smooth muscle, increases vital capacity, decreases airway resistance.
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What is theophylline used for?
What are the symptoms of theophylline (dimethylxanthine) toxicity? |
Used: respiratory dz like COPD and Asthma.
nausea, arrhythmia, tachycardia, nervousness, tremors. |
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What respiratory medication are used for chronic conditions and could cause thrush?
|
Corticosteroids and inhalers
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What are the interactions for using leukotriene receptor antagonist?
|
Prophylaxis and chronic treatment of asthma in adults and children > 6 years old. Blocks the receptor that inhibits leukotriene formation, preventing he signs of asthma.
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Why are fluids important to a client with asthma?
|
Fluids assist in decreasing the viscosity of the respiratory secretions facilitating removal.
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If a _______________inhalant is to be used with a ___________, wait 5-15 minutes before using the inhaler containing the _______ for the ______________ effect.
|
1- glucocorticoid
2- bronchodilator 3-steroid 4-bronchodilator |
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|
What category of respiratory meds must not be stopped abruptly but tapered?
|
Corticosteroid inhalers
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|
List nonnarcotic analgesics.
|
Acetaminophen (tylenol), Non steroidal anti-inflammatory drugs (NSAIDS)
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|
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What are the types of NSAIDS?
|
Salicylates= Aspirin, Dolobid, Bufferin, Ecotrin, Anacin (Only type of NSAID that decreases platelet aggregation); Phenylacetic acid= Toradol (only injectable NSAID); propionic acid= Ibuprofen (motrin, advil, nuprin, medipren); Cox-2 inhibators= Celebrex ( newer class that do not block prostaglandins that help protect the stomach)
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What are 6 things you should teach a patient taking NSAIDS?
|
- for GI upset take with a glass of water
- Notify doctor of s/s of bruising or bleeding, tinnitus or GI irritation -Do not chew enteric coated medications (Ecotrin= salicylate). -Avoid alcohol bc of increased GI risk -Never adminster aspirin to children under 15 with chicken pox or flue like symptoms -Alternating acetaminophen and NSAIDS can reduce fever more quickly. |
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What are 7 nursing measures for a pt taking NSAIDS?
|
-Assess for contraindications
-Assess for signs of toxicity (tinnitus, decreased hearing, n/v, confusion, lethargy) -Discontinue 24-48 hrs before surgery, consult doc if pt takes daily to see if it should be stopped 1-2 wks before surgery. -Monitor CBC for signs of blood dyscrasias or bone marrow depression -for overdose prevent further systemic absorption through gastric lavage or diuretic therapy -Drug interactions include wafarin, glucosteroids, alcohol, ibuprofen (increased bleeding) |
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A patient has the diagnosis of arthritis. Which class of medications would be the drug of choice. Why?
|
Nsaids for their anti-inflammatory effects.
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What advantage does aspirin have over the other NSAIDS and tylenol?
|
Anti-platelet effects
|
|
|
What type of medical diagnoses would warrant daily aspirin usage?
|
Prevention of cardiovascular disorders: MI, CVA (from thrombus), DVT
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What s/s would you want to teach pts to call the doctor when taking NSAIDS?
|
Bruising, bleeding, GI pain
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|
List Opioid agonists?
|
Morphine sulfate (duramorph, MS contin, Roxanol, Epimorph) & Meperidine (Demerol) & Codeine
|
|
|
What action does opioid agonists have?
|
Analgesia, respiratory depression, euphoria, decrease GI motility, and sedation.
& Codeine is a cough suppresant. |
|
|
What are the s/e of opioid agonists?
|
REspiratory depression, constipation, orthostatic hypotension, bradycardia, urinary retention, cough suppression, sedation, biliary colic, emesis
|
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What are nursing measures that should be taken when a pt takes opioid agonists (morphine, demerol, codeine)?
|
-notify physician if pt rr is less than 12
-keep narcan available -administer IV slowly over 4-5 min -Monitor for seizures and neurotoxicity with repeated use of demerol. -Assess for bladder distension, hypoactive bowel sounds, I&O, auscultate lung sounds and encourage TCDB. -don't give with biliary colic or biliary surgery -Use cautiously with asthma, emphysema, and Head injuries -Morphine for cancer pain, demerol for short-term use. |
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|
What drugs should be avoided when taking a opioid agonist?
|
CNS depressants, barbiturates, phenobarbital, benzoidiazepines, alcohol, MAOI, anticholinergics (Benadryl), tricylic depressants (Elavil), and antihypertensives
|
|
|
List some narcotic agonists?
|
Codeine, dilaudid, oxyCotin, Percodan, Darvocet, Fentayl (used in surgery to induce anesthesia)
|
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|
You are caring for a client with a history of chronic back pain taking Morphine 10 mg PO TID. When walking into the client’s room, you notice he is lethargic and not communicating. Prioritize the following nursing interventions.
a. Document your findings b. Assess apical pulse c. Assess respirations d. Notify the physician |
CBDA
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|
What med would you anticipate if a pt is taking Morphine an order for it the respirations were 10?
|
Narcan
|
|
|
What is an advantage of morphine over demerol?
|
It can be used for chronic and long term pain, like cancer pain or MI.
|
|
|
List the 4 narcotic agonist-antagonists?
|
Buprenophine HCL (Buprenex), Stadol, Nubain, Talwin
|
|
|
What actions does narcotic agonist-antagonists have?
|
Antagonistic- Block mu receptors decreasing effects of euphoria, analgesia, rep depression, sedation, physical dependence, and decreased GI motility.
Agonistic- Act on Kappa receptors producing analgesia, sedation, and decrease GI motility. They have less potential for abuse, little euphoria and less resp depression, In high doses anxiety, restlessness, and mental confusion can occur. Used to relieve mild to moderate pain. |
|
|
What is abstinence syndrome?
|
Cramping, hypertension, vomiting. It can be seen when giving pts an agonist-antagonist agent when they are physically addicted to opiates.
|
|
|
What are narcotic antagonists? actions? uses? s/e?
|
Drugs: Narcan, Revex, Trexan, ReVia
Actions: interferes with the action of opiates by binding to opiate receptors, NO effect in the absence of opiates. Used- for treatment of opiate overdose and reversal of resp depression S/e= tachycardia, tachypnea, abstinence syndrome. |
|
|
What are nursing measures to consider when giving an narcotic antagonist?
|
-monitor vitals
-keep resuscitative equipment at bedside -do not administer orally -observe client for withdrawl |
|
|
What 2 drugs are used to enhance opiodes without altering effects, for relief of neuropathic pain?
|
Tricyclic antidepressants (Elavil) & anticonvulsants (tegretol, neurontin, dilantin)
|
|
|
What drug is used to enhance opiodes without altering effects, for decreasing ICP and relive spinal cord compression?
|
Glutcocorticoids (decadron and deltasone)
|
|
|
What drug is used to enhance opiodes without altering effects, for relieving cancer induced bone pain?
|
Biphosphates (didronel & Aredia)
|
|
|
What are antigout medications? Uses?
s/e? medication interactions? |
Drugs: Colchicine, Indocin, Zyloprim
Action: decreases inflammation in clients with gout and prevents infiltration of leukocytes. use- to relieve pain from gout s/e- GI toxicity, renal injury interactions- Coumadin (places client at risk for bleeding) & Salicylates (decreases effectiveness of probenecid) |
|
|
What are side effects of loop diuretics?
|
loss of K+, dizziness, lightheadedness, or fainting when getting up from a lying or sitting position
|
|
|
What are the 5 H side effects of thiazide diuretics?
|
Hypokalemia, hyponatremia, hyperuricemia, hypercalcemia, hyperglycemia
|
|
|
With osmotic diuretics what should you prepare for and how?
|
• The cardiovascular status of the patient should be carefully evaluated before rapidly administering Mannitol since sudden expansion of the extracellular fluid may lead to fulminating congestive heart failure
• Shift of sodium-free intracellular fluid into the extracellular compartment following Mannitol infusion may lower serum sodium concentration and aggravate pre-existing hyponatremia |
