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238 Cards in this Set

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What are the 5 rights?
patient, drug, dose, route, time
What is needed for an order to be valid?
patient's name
time and date
name of drug
dosage
route
frequency
dr. signature
What is the nurse legally responsible for knowing?
the purpose of the drug
therapeutic effects
possible adverse reactions
How does the nursing process relate to medication administration?
Assess the need for the drug
plan when to give the drug
administer the drug (implement)
evaluate the effects of the drug
What are some variables that affect pharmaceutical phase?
type of drug preparation (ex sustained release)
pH of gastric fluids
incomplete swallowing
Variables that affect medication absorption.
Bioavailability- % of drug that reaches systemic circulation. Its affected by route of administration, and 1 and 2nd pass effect
Number of mucosal microvilli in small intestine (less surface area for absorption)
gastric motility (quicker motility =less absorption, fast excretion)
Presence/absence of food (either aids in absorption or slows it down)
Food-Drug and drug-drug interactions (some foods and drugs helps, other hinder absorption)
Variables that affect medication distribution?
Circulation of blood (poor circulation delays distribution)
Degree of plasma protein binding (less binding sites = more free circulating drugs)
Plasma protein levels (malnutrition can cause low plasma proteins,reducing #of binding sites)
Presence of tumors or abscesses (block distribution)
Variables that affect medication metabolism.
Liver disease (decreases livers ability to metabolize drugs.
Length of half-life (longer half-life = longer time to metabolize drugs)
Variables that affect medication excretion
Renal disease (kidneys are unable to excrete metabolized drugs.
What does therapeutic range mean?
the ratio between the minimum effective concentration and the minimum toxic concentration.
What is an agonist drugs and antagonist drugs?
agonist drugs are those that work to mimic the effect of a neurotransmitter in the brain. Antagonist drugs work by blocking neurotransmitters in the brain.
Can cause peptic ulcers due to inhibition of COX-1.It is recommended for patients to take histamine2 blockers or proton pump inhibitors while taking these agents
NSAIDs and Salicylates, corticosteroids, antiinflammatories
Can cause bleeding disorders due to anti-platelet aggregation.
NSAIDs and Salicylates, antiinflammatories
Can cause vasoconstriction of the kidneys leading to renal damage.
NSAIDs and Salicylates, antiinflammatories
Can cause edema leading to hypertension
NSAIDS, antiinflammatory
Can take days or weeks to reduce inflammation
NSAIDS, antiinflammatory
Can predispose the body to infection, decrease the ability to fight infection and mask the signs/symptoms of infection
Corticosteroids, antiinflammatory
Inhibits the release of histamines, leukotrienes and prostaglandins.
corticosteroids, antiinflammatory
Long term use or high doses of corticosteroids can cause :
impaired immune system response
hypernatremia
edema
hypertension
hyperglycemia
hypokalemia
hypocalcemia
osteoporosis
mood swings
weight gain
change in fat distribution
Must be discontinued in tapering doses over 5-10 days to prevent adrenal insufficiency
corticosteroids
Can be used to reduce pain, suppress cough,slow respiratory rate and decrease peristalsis.
Narcotic Analgesics (Opioids)
When should opioids not be given?
Head trauma (can mask symptoms)
Shock (can decrease BP)
severe respiratory depression
When should opiods be used cautiously?
clients with a history of addiction
urinary retention
asthma
What is very likely to occur with opioids use?
constipation
What should be monitored while taking anti-convulsants?
seizure activity
blood levels in those with narrow therapeutic levels
liver enzymes for those who are hepatotoxic
What should a nurse watch for when administering anticonvulsants?
drowsiness when giving sedating agents
What condition may occur with taking Hydantoins?
Gingival hyperplasia, special dental care may be indicated
What needs to be assessed when administering magnesium sulfate, an anticonvulsants?
deep tendon reflexes
drowsiness
muscle weakness
depressed respirations
frequent blood test for magnesium levels
What pregnancy category is most anticonvulsants?
C and D
What needs to be given to pregnant women on anticonvulsants?
Folic Acid because anticonvulsants increase folic acid loss
What are nursing considerations for Barbituates?
Used to treat generalized and partial seizures
Sedating
May be used in conjunction with other anti-convulsants
How is chronic pain managed?
By scheduled doses around the clock
What are nursing considerations for agents used to treat Parkinson's disease?
Administer meds on time to prevent worsening symptoms
Abrupt discontinuation can lead to a Parkinsonian crisis
Foods high in pyridoxine (B6) can decrease the effects of these drugs
change positions slowly to prevent faintness or dizziness
Monitor for anticholinergic effects: blurred vision, dry mouth, urinary retention, constipation and tachycardia
When should anti-parkinsons drugs be administered?
on time to prevent worsening symptoms
How should anti-parkinson's drugs be discontinued?
tapering doses to prevent parkinsonian crisis
What type of foods decrease effects of drugs used to treat Parkinson's?
Food high in pyridoxine (B6)
What effects can anti-cholinergic drugs cause?
dry mouth, blurred vision, constipation,urinary retention,tachycardia
What must a nurse know about drugs used to treat Alzheimers?
Supervision needed to take these drugs due to memory impairment
These drugs work best in early to middle stage Alzheimers
Can cause GI distubances
What are some problems associated with TCAs,an anti-depressants?
sedation
lowered seizure threshold
heart block w/large doses
orthostatic hypotension
anti-cholinergic effects
increased appetite w/ weight gain
inorgasmia
When should the patient expect to begin to see therapeutic effects when taking anti-depressants?
4-6 weeks
How long should anti-depressant therapy last?
6 months - 1 year
A nurse should watch for signs of what in patients taking anti-depressants?
suicidal ideation.
Why may suicidal ideation becomes a problem in patients taking anti-depressants?
Patients may not have had the energy to commit suicide,however once anti-depressant begin to have effect they may have the energy to carry out their plans.
What should patients taking TCAs, antidepressants limit in their diets?
grapefruit to prevent toxicity
What should be assessed when administering Adrenergic Agonist (Sympathomimetics)?
tachycardia and hypertension with agents that stimulate alpha1 and beta1

coolness and/or bluish discoloration of the extremities due to peripheral vasoconstriction
Adrenergic Agonist should be used cautiously in patients with what type of disease?
Coronary Artery Disease
Hypertensive
What adrenergic agonist drugs must be administered through a central venous line?
IV Dopamine, norepinephrine, and phenylephrine.Could cause gangrene if administered through a peripheral line due to severe vasoconstriction.
If severe vasoconstriction occurs when administering IV dopamine, norepinephrine, or phenylephrine what are some things that could be done?
Stop infusion and try to aspirate the solution through a syringe.
Normal saline and phentolamine can be inject into the area to vasodilate blood vessels.
A quicker and easier method to vasodilate is to apply nitroglycerine paste.
What can overuse of nasal sprays cause?
rebound vasodilation of the nasal mucosa.
What should be monitored when administering Adrenergic Antagonist Drugs?
BP, hypotension can result
Reflex tachycardia w/alpha1 adrenergic blockers
What should be assessed when administering alpha1 and beta1 adrenergic blockers, adrenergic antagonist?
Signs of decreased cardiac out such as SOB and activity intolerance. These agents can decrease force of cardiac contractions
What should be assesed when administering beta adrenergic blockers, adrenergic antagonist?
bradycardia
bronchoconstriction
What may occur when taking Cholinergic Agonist?
abdominal cramping
diarrhea
What should be assessed when administering cholinergic agonist drugs,especially in patients with COPD?
Bronchoconstriction
increased bronchial secretions
What needs to be watched for while administering cholinergic agonist drugs?
cholinergic crisis,which is characterized by muscle weakness and respiratory distress.
Mestinon, an acetylcholinesterase inhibitor,is used to treat Myasthenia Gravis, what is important about administering this drug?
Any drug used to maintain muscle strength in myasthenia gravis should be given exactly on time
What side effects are likely to occur when using Cholinergic Antagonist?
dry mouth
dehydration
constipation
urinary retention
intra-ocular pressure may increase
blurred vision
Why must cholinergic antagonist be used cautiously in patients with enlarged prostates?
It causes urinary retention
Why must cholinergic antagonist be used cautiously in patients with glaucoma?
it causes increased intra-ocular pressure
What is the goal of positive inotropic agents?
To increase the force of cardiac contraction
What needs to be assessed when administering digoxin, a positive inotropic agent?
Apical pulse- do NOT administer if HR is not between 60-110 BPM
Serum potassium levels frequently- hypokalcemia often results in digoxin toxicity
monitor serum digoxin levels periodically
What are signs of digoxin toxicity?
yellow spots aka "yellow vision"
loss of appetite, nausea, vomiting
What should be monitored when administering catecholamines?
hypertension cause they cause peripheral vasoconstriction.
In what conditions are diuretics desirable?
hypertension
edema
increased intraocular pressure
ascites
renal insufficiency
When should diuretics be administered?
in am to avoid urination during night
What should be monitored when administering diuretics?
urine output
drop in BP
What should be monitored when administering thiazide & thiazide like diuretics?
urine output
drop in BP
weight, be alert to gain of 2+lbs in a day
blood for sodium, chloride,potassium and magnesium losses- loss of chloride can = metabolic alkalosis
blood for increase of calcium, uric acid, glucose and lipid
A patients taking thiazide & thiazide like diuretics may be predisposed to what?
UTIs due to alkalitic urine
What should be taught to patients taking thiazide & thiazide like diuretics?
Potassium and magnesium rich foods and supplements
What are loop diuretics used to treat?
When a large fluid loss is desired (they are very potent)
hypercalcemia
stimulate urine output in renal insufficiency
desirable in CHF and pulmonary edema
What should patients be questioned about before administering loop diuretics?
Allergies to sulfa
What should be monitored when administering loop diuretics?
urine output
drop in BP
weight-be alert to gain of 2+lb/day
dehydration
blood for sodium, chloride, potassium, magnesium, and calcium losses-loss of chloride can = metabolic alkalosis
blood for increased glucose and uric acid
abdominal girth daily for patients with ascites
ototoxicity
breath sounds, crackles should dimnish
What should be taught about when administering loop diuretics?
importance of consuming potassium and magnesium rich foods and supplements
What should be known when administering furosemide via IV, a loop diuretic?
Should be administered no faster then 40 mg over 1-2 mins
What should be monitored when administering Aldosterone Inhibitors, a diuretic?
urine output
drop in BP
weight
What should be avoided when administering Aldosterone Inhibitors, a diuretic?
potassium supplements
ACE inhibitors (raises potassium levels)
When should Aldosterone Inhibitors, a diuretic not be administered?
patients with renal insufficiency or failure
What conditions are osmotic diuretics used in?
increased intracranial pressure
increased intraocular pressure
acute renal failure
What should be monitored when administering osmotic diuretics?
urine output
drop in BP
sodium, chloride and potassium loss
dehydration
neurological status- alertness should increase.
Your patient is taking an osmotic diuretic. You notice and increase in BP and decrease in HR.What could this indicate?
It indicates increased intracranial pressure. This is an emergency!
What should a nurse know when administering Mannitol?
Cool temps causes Mannitol to crystalize. The container must be ran under warm water to disssolve crystals before infusions. Some agencies require filters in IV tube to trap any crystals.
What conditionis Carbonic Anhydrase, a diuretic, useful in treating?
glaucoma because it decreases the production of aqueous humor
What should be monitored when administering carbonic anhydrase, a diuretic?
urine output
sodium, potassium and bicarbonate loss
increase in calcium, glucose,and uric acid
A patient taking carbonic anhydrase, a diuretic, becomes lethargic, has a headache, dropping BP, nausea and vomiting. What could be causing this?
These are all signs of metabolic acidosis. The loss of bicarbonate will cause metabolic acidosis.
Carbonic anhydrase, a diuretic may cause this GU problem?
crystalluria can occur causing renal stones
What effect does nitrates have?
they relax vascular smooth muscle
What must you instruct a patient taking nitrates to do pertaining to ambulation?
To move from a laying position to a standing position slowly to avoid decreased BP
What must you teach a patient taking nitroglycerines, a nitrate?
Tablets are administered sublingually
Tablets must be kept in a dry, dark container to prevent deterioration.
Remove old paste and transdermal patches before applying new ones.
When should thrombolytic agents be administered to prevent irreparable tissue necrosis?
Within 6 hours of MI (myocardial infarction)
Within 3 hours of a thrombotic stroke
What should be monitored when administering thrombolytic agents?
bleeding
platelet count
What does anticoagulants prevent?
prevent intravascular clots
prevent the extension of preexisting clots
They DO NOT dissolve existing clots
What does anticoagulants treat?
MI (myocardial infarction)
PE (pulmonary embolism)
DVT (deep vein thrombosis)
Vascular occlusion
disseminated intravascular clotting
What is the onset and duration of warfarin (Coumadin)?
onset takes 3 days,
duration lasts 4-5days after discontinuation
What is the antidote for warfarin (Coumadin)?
Vitamin K
What should monitored when administering warfarin (coumadin)?
bruising
bloody urine or sputum
epistaxis
tarry stools
bleeding gums
hypoglycemia
What should be avoided when taking warfarin (coumadin)?
Aspirin or NSAIDS
Foods high in vitamin K
What is a normal INR lab reading for patient taking warfarin (coumadin)?
2-3
What pregnancy category is warfarin (coumadin)?
Pregnancy Category X
Do not use during pregnancy,can cross placental barrier.
What can warfarin (coumadin) increase?
increase hypoglycemic action of sulfonylureas, monitor for hypoglycemia
increase serum levels of phenytoin (Dilantin) monitor for toxicity.
What is Heparin used for?
to prevent the formationof arterial and venous clots
prevent the extension of existing clots
Anticoagulant choice for vascular events during pregnancy because of quick onset and short duration and does not cross placental barrier
What should be monitored when administering Heparin?
bleeding
lab values
Heparin is mostly used to prevent clots in patients that
are immobile
had hip, knee, abdominal surgeries
Heparin should not be given with...
aspirin and NSAIDS
What should a nurse know when administering heparin SQ
do not aspirate or massage after injection
What actions does calcium channel blockers exert?
decreased peripheral resistance
promotes vasodilation
decrease myocardial contractility
What side effects may occur with calcium channel blockers?
hypotension causing headache, dizziness and syncope
bradycardia
What should be avoided when administering calcium channel blockers?
Grapefruit can raise calcium channel blockers to toxic levels.
What can calcium channel blockers predispose a patient to?
Heart failure because it decreases the myocardial contractility.
What should be monitored when administering Statins, an anti-lipidemic?
liver enzymes should be monitored every 3monthsfor 1st year. can be hepatotoxic
Any muscle pain or weakness- can cause break down of muscle causing renal failure.
What pregnancy category are statins,anti-lipidemics?
Pregnancy category X
What side effects does niacin cause?
Severe flushing of the skin with frequent burning sensation
What may niacin predispose the patient to?
the development of gout
High doses of niacin needed to reduce lipid levels can be....
hepatotoxic
What should be monitored when administering Fibrates, antilipidemics?
liver enzymes should be monitored every 3 months for 1st year, could be hepatotoxic.
When should Fibrates, antilipidemics, be cautiously used?
Patients with history of pancreatitis.
How should bile acid sequestrants, antilipidemics be prepared?
mix powder in water or juice
When should other meds be administer while patient is taking bile acid sequestrants, antilipidemics?
1 hour before or 4-6hours after other medication administration.
What is the pharmcotherapy goals for heart failure?
increase contractility of the myocardium
decrease edema
decrease pre load
decrease after load
decrease sympathetic nervous system response
What should a nurse know about hypokalemia and hyperkalemia?
hypokalcemia often results in digoxin toxicity
ACE inhibitors cause reduced levels of aldosterone being released causing potassium to be retained resulting in hyperkalemia
Reduced aldosterone = hyperkalemia
Potassium is excreted when using diuretics except for aldosterone inhibting diuretics
What are some side effects from taking ACE inhibitors?
dizziness
orthostatic hypotension
GI distress
nonproductive cough
headache
What are the therapeutic effects of ACE inhibitors?
decrease peripheral vascular resistance without increasing CO, HR, or cardiac contractility
What should be checked when a patient taking ACE inhibitors potassium levels not WNL?
Check HR and rhythm
What is the therapeutic effect of expectorants?
loosen bronchial secretions so they can be eliminated with coughing.
What is the therapeutic effect of antitussives?
suppress cough
What should be monitored when administering antitussives?
Respiratory status in children and elderly
What should a nurse know about Diphenhydramine, an antihistamine?
Causes a high incidence of drowsiness.
What are some side effects of antihistamines?
drowsiness
anticholinergic effects (except fexofenadine)
dehydration, especially in the elderly
urinary retention or hesitancy,especially with enlarged prostatic conditions
thicken secretions
cause bronchospasms, use cautiously with asthma
worsen glaucoma
What is a side effect that should be closely monitored for in the elderly who are taking antihistamines?
dehydration
What is a side effect that should be closely monitored for a patient with enlarged prostatic glands?
urinary retention and hesitancy
Why should antihistamines be cautiously used with asthma patients?
they cause bronchospasms
What should be monitored when administering sympathomimetics (alpha and beta adrenergic agonist), anticholinergic agents, methylxanthines?
increase in HR
nervousness
irritability
insomnia
headache
seizures
What should be monitored when administering sympathomimetics (alpha and beta adrenergic agonist)?
increaseHR
increase BP
What should you know when administering sympathomimetics, anticholinergic agonist and methylxanthines PO?
Oral preparations may be taken with food to decrease gastric distress.
What should you know about administering theophyline, a methylxanthines?
periodic therapeutic blood levels must be drawn
What side effects can occur when administering anticholinergic drugs?
can cause dry mouth and blurred vision
What can prolonged use of intestinal irritants, a laxative, cause?
damage to sensory nerve endings in the intestine
How should bulk forming laxatives be administered?
Mixed with water or and be taken with at least8 oz of water to prevent the fibers solidifying
and causing an obstruction
What must a nurse know about Metoclopromide?
Has many neurological adverse effects
What therapeutic effect does anti-diarrheal agents have?
Slow GI motility and propulsion
decrease intestinal fluid
What may occur if patient is taking MAO inhibitors is administered Lomotil, an opiate related/anticholinergic drug?
Hypertensive crisis can be induced
What should be the nurse's first action when caring for a patient with diarrhea?
The cause of the diarrhea should be determined and treated. Diarrhea should not be stopped if toxins need to be eliminated in the stool.
What should be administered if the diarrhea is caused by an infectious process?
anti-infectives
What is a side effect of opiates, an antidiarrheal?
CNS depression (brain, heart, lungs) decreased rate of breathing,decreased HR, decreased level of consciousness
What is a side effect of antidiarrheals?
constipation
What should a nurse know when administering an antihistamine to a patient with glaucoma?
Antihistamines worsen glaucoma
What side effects may occur when administering antitussives and expectorants?
drowsiness
nausea and vomiting, esp. with codeine
What should a nurse teach a patient who is taking a liquid form of antitusssives or exoectorants?
Patient should wait 5 minutes after taking meds before eating or drinking anything
What therapeutic effect does sympathomimetics: alpha and beta agonist have?
Bronchodilation
Why should systemic antacids be used cautiously?
They may cause hypernatremia, water retention, metabolic alkalosis, and acid-rebound
What is the therapeutic effect of antacids?
raise the pH of hydrochloric acid
What is the therapeutic effect of proton pump inhibitors, an anti-ulcer agent?
inhibit gastric acid secretion. they are more effective then H2 receptor blockers
How often should proton pump inhibitors, an anti-ulcer agent, be administered?
Once a day
What is the pharmacotherapy goal of chemotherapeutic drugs?
Halt division and growth of abnormal cells
boost immune system
multiple drug classifications may be used
What should be known about administering anti-cancer drug?
RNs with special training must administer the drugs
Protective gear must be worn when handling these agents
What should be assessed for when administering anti-cancer drugs?
dehydration
anorexia
changes in mucosal lining of mouth
Lab results: RBCs,WBCs, platelets
What should a nurse be alert to when administering chemotherapy to patients?
hair loss may change body image
mastecomy may cause feelings of loss femininity
testicular and prostate cancer may cause feelings of loss masculinity
How does anticholinergic agents exert therapeutic effects in patients with urinary incontinence?
Improves the tone of the urinary sphincter.
What must a nurse know about Pyridium?
Will turn urine, underclothes, sclera, contact lens orange.
Should not be used more then 2 days, could cause cumulation
Should not be used in real insufficiency
What is the goal of drugs used to treat BPH?
improve urine flow by:
decreasing size of prostate
relaxing smooth muscles of prostate and bladder neck
When should be determined before administering drugs used to treat BPH?
Prostate cancer and UTI should be ruled out?
What should be obtained when administering drugs used to treat BPH?
baseline prostate-specific antigen
What should a nurse know when administering Dutasteride?
It is pregnancy category X.Should not be touched by women, can cause androgenic effects
What should a nurse know when administering Finasteride?
It is pregnancy category X.Should not be touched by women, can cause androgenic effects
What is a side effect of alpha adrenergic blockers, a drug used to treat BPH?
Can cause orthostatic hypotension and BP should be monitored.
What should be done before administering anti-infectives used in the urinary system?
Obtain urine C&S
What must a nurse teach a patients taking anti-infectives for UTI?
Meds should be completely finished to prevent recurrence of UTI
Encourage fluid intake to flush out bladder
What is the time period for treatment of UTIs with anti-infectives?
1-14 days
What is the time period for treatment of bacterial prostatitis with anti-infectives?
28-42 days
What are signs/symptoms of hyperglycemia?
frequent urination
increased thirst
fatigue and weakness
delayed wound healing, increased infections
frequent
high blood glucose level
high levels of sugar in urine
What are signs/symptoms of hypoglycemia?
Anxious
Sweaty
Hungry
confused
blurred vision
shaky
irritable
cool, clammy skin
What is the therapeutic effect of drugs used to treat hypothyroidism?
life-long hormone replacement therapy
What must a nurse teach patients taking drugs to treat hypothyroidism?
Best to take meds before breakfast. Absorption is better on an empty stomach and taking later in day may cause insomnia
What should be monitored when administering drugs to treat hypothyroidism?
Signs of drug-induced hyperthyroidism
drug-drug interactions
Why should a patient taking drugs to treat hypothyroidism not take iron supplements and estrogen?
Iron and estrogen will decrease absorption of thyroid hormones
Exogenous thyroid hormones may decrease the effectiveness of what other agents?
beta blockers
digoxin
insulin
oral anti-diabetic agents
What should be monitored for when administering drugs used to treat hyperthyroidism?
All agents can cause
hypothyroidism
What may occur if drugs used to treat hyperthyroidism and Lithium is used concurrently?
It can increase the occurrence of hypothyroidism
What should be monitored when administering Thiomides?
CBC because thiomides may decrease white blood cell count and can predispose a patient to infection.
Thiomides can cause an increase in the effects of...
Coumadin
digoxin
theophyllin
What should a nurse know when administering Iodine and Iodides?
should be taken through a straw because it may cause discoloration to teeth.
Should be diluted and taken after meals
Potassium iodide shouldnt be used concurrently with ACE inhibitors or potassium sparing diuretics. hyperkalemia could result
What should a nurse teach patients with exophthalmos (bulging eyes) who is taking drugs to treat hyperthyroidism?
Will need eye lubricants to prevent drying of the corneas
What are the short acting insulins?
Lispro
reular
What is the onset,peak duration of lispro?
Onset: 5min
Peak: 30 min.- 1 h
Duration: 2-4 h
What is the onset,peak duration of regular insulin?
Onset: 30 min- 1h
Peak: 2-4 h
Duration:6-8 h
What are the intermediate acting insulins?
Lente
NPH
What is the onset,peak duration of Lente?
Onset: 2-4 h
Peak: 8-12 h
Duration: 18-24 h
What is the onset,peak duration of NPH
Onset: 1-2 H
Peak: 6-12
Duration: 18-24 H
What are the long acting insulins?
Insulin Glargine
Insuline Detemir
What is the onset, peak and duration of Insulin Glargine?
Onset:
Peak: peakless
Duration: 24 h
What is the onset, peak and duration of Insulin Detemir?
Onset:
Peak: 6-8 H
Duration:24 H
What should the nurse assess before administering sulfonylureas?
Allergies to sulfonamides.
What are some problems associated with sulfonylureas?
hypoglycemia
weight gain
long term failure
may take several weeks to significantly decrease blood glucose
Where are most vitamins obtained from?
Plant and animals sources except:
Vitamin A is formed from precursor carotene
Vitamin D is formed from UV light on skin
Vitamin K is formed from bacteria in intestines
How can broad spectrum antibiotics effect vitamin K?
Antibiotics can diminish normal flora in the intestine which can result in deficiencies.
What may occur from intaking less then the RDA of Vitamin D?
It will decrease the amount of calcium and phosphorous absorption from the GI tract
What are some foods rich in potassium?
bananas
citrus fruits
potatoes
tomatoes
What is hyperkelemia a sign of?
renal insufficiency or failure
What can be used to treat hyperkalemia?
loop diuretics, binding agents or dialysis
How should potassium be administered?
PO or IV
Never given IM or IV push
Should be diluted
What can potassium values lower or higher than normal cause?
life-threatening abnormal heart rhythms
cardiac arrest
What are TPNs composed of?
dextrose 10%-70%
amino acids
lipids
What may occur if TPN is abruptly discontinued?
hypoglycemia
What should be monitored for in patients receiving TPN?
hyperglycemia
What is a possible source of infection when administering TPN?
The IV catheter.
What are examples of isotonic solutions?
0.9% sodium chloride
Lactated Ringer's
D5%0.225%
D5W, (glucose rapidly metabolizes making it hypotonic)
What are examples of Hypotonic solutions?
0.45% sodium chloride
(D5W is theoretically isotonic but in clinical use, is hypotonic)
What are examples of hypertonic solutions?
Usually Combination of fluids
D5%/0.45%S
D5%/0.9%S
D5%/Lactated Ringers
3% Saline-ICU Use
What should a nurse know about Saw Palmetto?
Improves urine flow in BPH
Can take 6 months for effect
Rule out Prostate CA first
What are problems associated with antiinfectives?
resistance
side effects
adverse reactions
When administering anti-infectives, what be known about the patient?
Any allergies
What must be taught to a patient about taking anti-infective medications?
Patient should take entire prescription to completely eradicate infection and prevent resistance.
When obtaining a specimen culture, when should anti-infective meds be administered?
After obtaining a culture to prevent false reading?
How long should an organism grow in a petri dish?
24-72 hours
What are some major problems associated with penicillins?
high incidence of allergic reactions
drug resistance
narrow spectrum of many preparations
What are some side effects when administering penicillin?
GI problems such as nausea, vomiting, diarrhea, and stomatitis
supraimposed infections
What should be known by patients taking oral contraceptives and penicillin?
Penicillin will reduce effectiveness of oral contraceptives.
After administering penicillin to a patient, the patients urine is positive for glucose. What would this indicate?
Penicillin cause urine to show a false positive for glucose and indicates a side effect to penicillin.
What should be monitored when administering IV penicillin?
Monitor for phlebitis because penicillin can be irritating to veins.Penicillin should be diluted in an IVPB
What should be administered in the case of an allergic reaction to penicillin?
Diphenhydramine (Benadryl)
epinephrine
glucocorticoid.
What can high doses of penicillin cause?
Increase the time it takes for blood to clot leading to bleeding disorders
What should be checked before administering cepahlosporins?
Allergies to peniicillin due to possible cross-allergy to cepahlosporins.
What should not be ingested while on cepahlosporins?
Alcohol may cause flushing, dizziness, headache, muscular weakness. This is called disulfiram
Who should cepahlosporins be used cautiously in?
geriatric patients and patients with pre-existing renal disease because it may cause nephrotoxicity
What increases with large doses of cepahlosporins?
bleeding time increases
What are signs/symptoms of anaphylaxis?
difficulty breathing
nausea
vomiting
rash
How to assess for nephrotoxicity?
increased BUN
increased creatine
decreased urine output
What drug has a narrow therapeutic index and needs peak and trough levels drawn usually before third dose is administered?
Glycopeptides
What are side effects of Sulfonamides?
GI disturbances
Crystalluria- drug should be followed by 8 oz of water, 2000mL daily during therapy
hematuria (blood in urine)
blood dyscrasias (imbalanced blood)
rash, itching, exfoliative dermatitis
photosensitivity
headache
dizziness
What should sulfonamides not be administered with?
Do NOT administer with antacids
What should sulfonamides be used cautiously with?
oral anti-coagulants
oral anti-diabetic agents
anti-seizure agents

sulfonamides increase all these agents
Tetracyclines are often prescribed when what allergry is present?
penicillin
How should tetracyclines be administered?
Should not be taken with aluminum, calcium, or iron. These will prevent absorption.
Should be taken on an empty stomach with water. except Doxycycline is better absorbed with food
What pregnancy category is tetracyclines?
Category D.
They interfere with teeth and bone formation of fetus.
Who should not take tetracyclines?
Children younger then 8
Pregnant women
What can occur while taking tetracyclines?
photo-sensitivity
nephrotoxicity
hepatotoxicity
damage to vestibular part of ear leading to equilibrium problems
What happens to tertracyclines when exposed to light and heat?
they decompose
What is important to know about out of date tetracyclines?
They can be toxic
What must a nurse teach a patient taking both oral contraceptives and tetracyclines?
teracyclines decrease effectiveness of oral contraceptatives