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41 Cards in this Set
- Front
- Back
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What are thecontraindications for aspirin? What lifespan considerations are important toknow? |
considerations: age, do not give to kidsor teenagers b/c of Reye’s Syndrome AND do not give if they have a viral infection – reye’s syndrome Contraindications: risk for reye’s syndrome, may lead to bleeding ulcers give acetaminophen to those who cannot tolerate aspirin, impaired renal fxn,hypersensitivity to aspirin, chronic alcohol abuse |
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Whatare the adverse effects associated with the use of NSAIDs? How will the nursemonitor for these effects? |
adverse: nausea, dyspepsia,heartburn, epigastric discomfort, bruising, petechiae, GI blood loss,hemorrhage, salicylism Monitor: toxicity, GI symptoms, dizziness, bowel and bladder, unusualbleeding |
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What are the differencesbetween NSAIDs and acetaminophen? |
acetaminophenlacks anti-inflammatory |
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What are the consequencesof acetaminophen overdose? How is it managed/what is the antidote? |
hepatotoxicity -Managed with gastric lavage and charcoal. Acute ingestion may be reversed withacetylcysteine. Long-term toxicity is permanent |
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What are the diseaseprocess contraindications/precautions to the use of acetaminophen? What labsshould be monitored? |
-contraindications: drug allergy, severe liver disease,G6PD,renal failure, pregnancy -Closely monitor for chronic poisoning, look for symptoms such as rapid, weakpulse, dyspnea, cold clammy extremities.; monitor liver function studies; assess kidney/liver fxn ; alt & ast, CBC blood platelet |
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What are the components ofcommonly prescribed combination medications containing acetaminophen? |
Oxycodone/acetaminophen (Percocet)hydrocodone/acetaminophen (vicodin) |
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What is tolerance? What isdependence? Is there a difference? |
tolerance is a decreasing responseto repeated drug dosesdependence is a physiologic or psychological need for a drug-psychological dependence = addiction; there is a difference. |
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What is the relationshipbetween liver dysfunction and opioid dosing and toxicity? |
liver dysfunction may cause metabolite accumulation andproduce prolonged sedation (decrease dose needed and monitoring by nurse)-the risk for toxicity increases with diminished fxn of liver and kidneys soreduced dosage may be needed |
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What are the common adverseeffects associated with opioids? How would the nurse manage these effects? Howis overdose managed? |
-constipation,N/V, sedation, respiratory depression -hypotension, flushing,bradycardia, sedation, disorientation, euphoria, lightheadedness, dysphoria,nausea, vomiting, constipation, biliary tract spasm, urinary retention-monitor vitals, LOC, respiratory -overdose is managed Narcan & ReVia ; restore and maintain respiratory fxn |
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What should the nurseinclude in a patient education plan for a client on a PCA pump |
ptis able to self-administer meds when needed. Prevents overdose. Will dispense acertain amount of med/hr. Do not let family push button. Do not press to go tosleep |
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What drug-drug interactionsbetween opioids and other drugs should the nurse be aware of? What are theconsequences of these reactions? |
-alcohol,antihistamines, barbituates, phenothiazine, benzodiazepines, [sedatives,antidepressants]-depressed respiratory |
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What is anagonist-antagonist? |
Drugbinds to receptor; response is diminished compared with that elicited by anagonist. These drugs have either no action or limited action. They can produceopioid withdrawal in opioid dependent clients |
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What drugs in this chapterare agonist-antagonists? |
Opioidanalgesics: butorphanol & nalbuphine |
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Why is it important to avoid administration of agonist-antagonist drugs to an opioiddependent client?
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it can cause withdrawal |
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What disease processescontraindicate the use of anticholinergic medications and other medicationswith “anti-cholinergic”-like side effects? |
Contraindications:known drug allergy, angle-closure glaucoma, acute asthma/ other resp. distress,acute CV instability and GI/GU tract obstruction, myasthenia gravis |
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What should be included ina patient education plan for a client who will be taking an anticholinergicdrug? Are there any safety considerations? Any lifespan considerations?
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-Do not take anti-histamines, take as prescribed, dry mouth management,exercise with caution, avoid tasks requiring alertness, dark tintedglasses/sunglasses - blurred vision may occur- do notoperate heave machinery -Elderly: higher risk for heat stroke, increase in cardiac, CNS and eye-relatedadverse effects
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What is the purpose forusing an anti-cholinergic drug in the pre-operative setting? |
Reduce salivary secretions which aids in intubation,and reduces post-op N/V |
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What are the uses for scopolamine?How would you teach a patient to use this drug? |
-preventmotion sickness, pre-op control of secretions and preventative for post-opvomiting, corrects imbalance b/w acetyl and norepinephrine in Vomiting center. -one patch behind one ear 4-5hr before traveling; wash hand immediately; do notconsume alcohol; put patch on clean, dry intact skin; do not change positionsquickly, don’t discontinue drug abruptly, causes insomnia. |
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What are the uses foratropine? If the nurse is administering the drug IV for symptomatic bradycardiawhat adverse effects should the nurse monitor for?
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-atropine is used to treat symptomatic bradycardia & antidote for anticholinesterase poisoning -increase oxygen demand on the heart causing ischemia
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What conditions contraindicatethe use of oxybutynin(Ditropan)? [hint:used for over active bladder] |
GI obstruction, urinary retention, colitis, myastheniagraves, unstable CV disease, glaucoma |
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Which part of the nervoussystem is affected by anti-cholinergic drugs? |
inhibitseffects of parasympathetic nervous system (rest & digest system) |
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How is atropine overdosemanaged? Is there a specific antidote? What are the priority assessments andinterventions? |
Antidoteis physostigmine; assessments and interventions: BP, HR and electrocardiogramneeded; monitor breathing |
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What non-pharmacologicinterventions should the nurse implement for client experiences insomnia? Whatwould you include in an education plan for this client? |
Reducingcaffeine at night- drink decaf, avoid daytime napping, avoid alcohol inevening, relax with music/yoga, decrease loud noises, avoid late nightexercise, kava and valerian root, no nicotine |
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Discuss the variouspharmacological uses for the benzodiazepines |
sedation,hypnotic, sleep induction, skeletal muscle relaxation, anxiety relief,anxiety-related depression, treatment of acute seizure disorders, alcoholwithdrawal, agitation relief, balanced anesthesia and moderate/conscioussedation |
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Compare and contrastbenzodiazepines with non-benzodiazepines |
benzoare used to treat anxiety and to sedate; high potential for abuse; lesscommonly prescribed; hypnoticnonbenzo are used to treat insomnia; lower potential for abuse; more commonlyprescribed |
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What should the nurseinclude in an education plan for a client who will be taking ramelteon as an outpatient? eszopiclone as an outpatient?
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-Ramelteon:no alcohol, take 30 minutes prior to bed time, cannot be taken after high fatmeal -Eszopiclone: drug requires 8hrs of sleep, no hypnotics, no CNS depressants;short to intermediate acting agent
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What drug-drug interactions should the nurse be aware of and educate theclient regarding.... (ramelton and eszopiclone???)? |
Effects of CNS depressants and alcohol |
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What interventions (withregards to safety) should the nurse implement for a client who has received abenzodiazepine? |
useside rails, bed alarms, ambulate with assistance, avoid drinking or activitiesthat require alertness |
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Which drugs in this chapterare considered drugs of abuse? How does this effect length of therapy? |
Benzodiapinesand nonbenzodiazapines (diazepam, carisoprodol, midozalam temazepam), therapyis shorter; barbiturates |
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How is barbiturate overdosemanaged? Is there a specific antidote? What are the priority assessments andinterventions? |
-overdose managed with maintaining adequate airway, assistedventilation/oxygen therapy, fluids, pressor support to raise BP -activated charcoal if orally ingested -ABC! |
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Reviewcontraindications for ramelteon. What conditions should the nurse assess for? |
-contraindicatedin patient’s with liver dysfunction -assess for head to toe, med history, allergies confusion/light headedness,pregnancy, liver dysfunction; assess for history use of fluxonazole orketoconazole |
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How is benzodiazepineoverdose managed? Is there a specific antidote? |
-treatmentis supportive and symptomatic -antidote is flumazenil ; if overdose is paired with an opioid, Narcanwould also need to be administered |
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Which drugs in chapter 21can be used to manage acute anxiety? |
lorazepam (Ativan), Midazolam? |
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What adverse effects shouldthe nurse monitor for in a patient receiving hydroxyzine (Vistaril) for thetreatment of n/v? How should this drug be given? Are there any safetyconsiderations? |
-dizziness,drowsiness, confusion, blurred vision, dilated pupils, dry mouth, urinaryretention -NEVER be given IV!! ; Given PO orIM..if given IM, use Z-track (placement: ventro gluteal) - significant tissue damage, gangrene and thrombosis can result |
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What is the most commonadverse effect associated with antiemetics? |
drowsiness,dizziness, blurred vision |
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What category ofanti-emetics have adverse effects often associated with anti-psychotics (i.e.EPS)? |
Antidopaminergic drugs |
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What drug iscontraindicated for use in pediatric patients due to a risk of respiratorydepression? |
Promethazine (Phenergan) – [use ondanestrone instead] |
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What route ofadministration is contraindicated for promethazine? Why? Review principles ofadministration for approved routes. |
-IV route because it is chemically irritating -IV route must be diluted -IM route must use Z-track to prevent leakage of med into other tissues or skin |
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Which drug/category ofdrugs promotes gastric emptying? Which classification of drugs has been foundto be most effective in managing nausea & vomiting in cancer patientsreceiving chemotherapy? |
-prokinetic drug for gastric emptying -serotonin blockers for cancer pt’s with chemo |
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Which anti-nausea drugcould be used to stimulate appetite in a cachectic patient? Are there anyconsiderations to the use of this drug? |
-dronabinol-only contraindication is known drug allergy; oral use only |
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Under what circumstancesshould syrup of ipecac be used? Rationale? |
it should never be used! It can cause more toxicity in drugscoming back up than when originally ingested; risk for aspiration especially inaltered mental status pt |
