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127 Cards in this Set
- Front
- Back
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Morphine Sulfate IV
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Onset: Rapid
Peak: 20 min Duration: 4-5 hr Half Life: 2-4 hr Met: Liver EXC: Renal |
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Meperdine IM
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Onset: 10 - 15 min
Peak: 30 - 50 min Duration: 2-4 hr Half Life: 2.5-4 hr Met: Liver EXC: Renal |
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Oxycodone PO
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Onset: 10 - 15 min
Peak: 60-90 min Duration: 3-6 hr Half Life: 2-3 hr Met: Liver |
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Fentanyl Patch
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Onset: 6 hr
Peak: 12 - 24 hr Duration: 72 hr while worn Half Life: 17 hr Met: Liver EXC: Renal |
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Naloxone IV
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Onset: 1-2 hr
Peak: unknown Duration: 45 min Half Life: 60-90 min Met: Liver |
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Percocet PO
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Onset: 10 - 15 min
Peak: 60-90 min Duration: 3-6 hr Half Life: 2-3 hr Met: Liver |
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Vicodin ES PO
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Onset: 10 - 30 min
Peak: 30 - 60 min Duration: 4-6 hr Half Life: 2.2 hr Met: Liver EXC: Renal |
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Acetaminophen PO
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Onset: 0.5 - 1 hr
Peak: 1-3 hr Duration: 3-8 hr Half Life:1-3 hr Met: Liver EXC: Renal |
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Corticotropin
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Indications:Stimulation of the release of cortisol from the adrenal cortex. Treatment of multiple sclerosis and corticotropin insufficiency caused by long term corticosteroid use.
Side Effects:CNS - convulsions, dizziness, euphoria, insomnia, headache, depression, psychosis. GI- N/V, peptic ulcer perforation, pancreatitis. GU- Water and Na retention, hypokalemia. Other: sweating, acne, hyperpigmentation, weakness, muscle atrophy, myalgia, arthralgia N Implications: VS, F&E values, BG levels, Chest x ray, CBC, I&O, wt., Cortisol level, allergy to pork b/c of cross-sensitivities Other: Used to dx. adrenocortical insufficiency |
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Somatotropin
somatrem |
Indications: Growth failure; AIDS- related wasting syndrome
Side Effects: Nervous-headache, Endocrine- hyperglycemia, ketosis, hypothyroidism, GU- hypercalciuria, Other - rash, uticaria, antibodies to GH, inflammation at injection site. N Implications: Thyroid Function studies, HG antibodies Other: Should increase growth in children |
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Octretide
sandostatin |
Indications: Acromegally, metastatic carcinoid tumors, VIPomas
Side Effects: s/s of carcinoid tumors stemming from the secretion of VIP N Implications: wt, I&O, monitor flushing and F&E loss, decrease plasma concentrations of VIP |
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Desmopressin
Vasopressin |
Indications: Primary nocturnal enuresis, central cranial DI, hemophilia A & type 1 von Willebrand's disease
Side Effects:CV- increase P, Nervous - drowsiness, headache, lethargy, flushing, GI - N, heartburn, cramps, GU - uterine cramping Other - Nasal irritation & congestion, tremor, sweating, vertigo N Implications: ortho BP, CBC, Cardiac enzymes, wt, ECG, Pulse, VS, I&O, wt, edema Other: similar to ADH |
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Peak
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Highest blood level
Differs per class, generally 1 hour after giving the rx |
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Trough
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Lowest blood level
Generally drawn 30 min prior to administering the medication |
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Assessment
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Data collection (subj, obj)
Medication Hx New meds are more important to teach about. Document everything even pt teaching. |
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Nursing Diagnosis
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3 steps - actual or risk of response to illness; related to; as evidenced by.
Usually refers back to admitting dx, included as an intervention. |
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Planning, Goals, Outcomes
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Must be specific and measurable, pt centered, give a time frame (specified), realistic.
Priortize |
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Implementation
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Follow 6 rights of medication administration.
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6 Rights of Medication Administration
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* Right Drug
* Right Dose * Right Time * Right Route * Right Patient * Right Documentation |
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Evaluation
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Monitoring the patient's response to drug therapy (expected and unexpected)
Number 0 - 10, body lang, facial expression, vital sign, explain feelings. |
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Hepatotoxicity
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Toxicity in Liver
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Nephrotoxicity
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Toxicity in Kidneys
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Age considerations
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Older patients are at a greater risk for toxicity due to slower metabolism and excretion. Children are also susceptible due to differences in body weight.
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First Pass Effect
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The metabolism of a drug & its passage from the liver into the circulation
Only enteral routes have first pass effect. Not IM, IV, Topical, SL or SQ |
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Metabolism
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Most drugs are metabolized in the liver, some by the skeletal muscle, kidneys, lungs, plasma or intestinal mucosa
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Factors that decrease Metabolism
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Cardiovascular dysfunction
Renal insufficiency Starvation Obstructive jaundice Slow acetylator Erythromycin or ketoconazole drug therapy |
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Results of delaying Metabolism
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Accumulation of drugs
Prolonged action of the drugs drug toxicity Stimulating drug metabolism causes: Diminished pharmacologic effects |
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Excretion
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Mainly from the Kidneys but also the Liver and Bowel
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Half life
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The time it takes for one half (50%) of the original amount of a drug to be removed from the body
BUN and Creatnine, usually calculated by pharmacist. Nurse makes sure the dosage is correct. |
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Drug Movement
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Onset: The time it takes for the drug to elicit a therapeutic response
Peak: The time it takes for a drug to reach its maximum therapeutic response Duration: The time concentration is sufficient to elicit a therapeutic response Very Important with insulin to time feeding and testing. |
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The Elderly
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General Considerations
Elderly: older than age 65 Use of over-the-counter medications Increased incidence of chronic illnesses Sensory and motor deficits Polypharmacy |
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The Elderly
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Physiologic Changes
Cardiovascular Gastrointestinal Hepatic Renal |
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Cutlural Considerations
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Expression of pain differs. Beliefs towards health care. Respect prayer times and religious practices. Document, Document, Document
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Outcomes
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When something happens that is not suppose to. Side effects are known expected outcomes, Adverse reactions are unexpected and unwanted such as shortness of breath. Allergic reactions can be swelling, itching, hives. Anaphlactic response can be life threatening, a systemic allergic response such as the throat closes. Idiosyncratic reaction is the opposite effect than what is expected.
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Teaching Assessment
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What does the patient know? Build on that.
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Learning Session
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Make sure you see a return demonstration before they are discharged. Do not use a family member to translate.
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Analgesics
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Medications that relieves pain without causing loss of consciousness
“Painkillers” Opioids NSAIDs |
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Tolerance
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The amount of pain a person can endure without it interfering with normal function
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Acute Pain
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Sudden onset
Usually subsides once treated |
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Chronic Pain
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Persistent or recurring
Lasts 3 to 6 months Often difficult to treat |
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Somatic Pain
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Pain that originates from skeletal muscles, ligaments, or joints
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Vascular Pain
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Pain that originates from a pathology of the vascular or perivascular tissues
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Visceral Pain
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Pain that originates from organs or smooth muscles.
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using a PCA
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Monitor respiratory status, educate won’t become addicted if in pain from surgery, takes a long time to develop an opioid tolerance. Can not use placebos, this is illegal and unethical.
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Adjuvant Drugs
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Assist primary drugs in relieving pain
NSAIDs Antidepressants Anticonvulsants Corticosteroids Work with the primary medication to enhance it’s effects. Synergistic affect is achieved using adjuvant drugs. |
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Ceiling Effect
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Once a drug reaches a maximum analgesic effect and higher doses do not work, change the medication
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Agonists
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Bind to an opioid pain receptor (brain)
Cause an analgesic response (reduction of pain sensation) Helps |
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Agonists-Antagonists
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Bind to a pain receptor
Cause a weaker neurologic response than a full agonist Also called partial agonist or mixed agonist |
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Antagonists
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Reverse the effects of these drugs on pain receptors
Bind to a pain receptor and exert no response Also known as competitive antagonists |
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Indications of Analgesics
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Main: to alleviate moderate to severe pain
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief Opioids are also used for: Cough center suppression Treatment of diarrhea Balanced anesthesia |
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Contraindications for Analgesics
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Known drug allergy
Severe asthma Use with extreme caution if: Respiratory insufficiency Elevated intracranial pressure Morbid obesity Sleep apnea Paralytic ileus |
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Adverse Effects of Analgesics
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Euphoria
CNS depression Leads to respiratory depression Most serious adverse effect Nausea and vomiting Urinary retention Diaphoresis and flushing Pupil constriction (miosis) Constipation Itching |
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Nursing Management
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When administering narcotics Always make sure Narcan is on the floor!!!! Think safety, monitor breathing.
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Non-opioid Analgesics
Acetaminophen |
Analgesic and antipyretic effects
Little to no anti-inflammatory effects Available over the counter and in combination products with opioids Mechanism of Action Similar to salicylates Blocks pain impulses peripherally by inhibiting prostaglandin synthesis Indications Mild to moderate pain Fever Alternative for those who cannot take aspirin products |
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Tylenol Interactions
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Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic
Should not be taken in the presence of Drug allergy Liver dysfunction Possible liver failure G-6-PD deficiency |
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Tylenol Overdose
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Hepatotoxic
Recommended antidote: acetylcysteine Rotten egg smell (disguise the flavor) Given in a 30 mL medicine cup Repeated dose as ordered (1 hr) Vomiting (r/t smell &/or ingestion) |
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Nursing Care: Analgesics
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Obtain a thorough history (allergies, use of alcohol) VS, I&O, and pain assessment
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Nursing Care: Opioids
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Taken with food, think safety, prevent injuries, Check dosages carefully. Withhold if decline in pt condition, abnormal VS, or RR <10-12 breaths per minute
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Posterior Pituitary
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Vasopressin
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Anterior Pituitary
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Somatotropin
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Cosyntropin (Cortrosyn)
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Stimulates release of cortisol from adrenal cortex
Antiinflammatory effect Promotes renal retention of sodium Given to Addison patients. Monitor for HTN, Edema, s/s of Cushings. Teach to drink a lot of water and to avoid all vaccines. At risk for infection. |
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SOMATROPIN & SOMATREM
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GH (Growth Hormone)
Stimulate skeletal growth in patients with deficient GH hypopituitary dwarfism doesn’t solve problem but helps with the deficiency. |
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Octreotide (SANDOSTATIN)
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Anterior pituitary medication. Throws off glucose so monitor BG more frequently.
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VASOPRESSIN & DESMOPRESSIN
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Posterior pituitary – SIADH – specific gravity should increase. 90/60 – 135/80 is good if on vasopressin.
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Vasopressin
Vasoconstrictor |
Vasopressin (vasoconstrictor)
hypotensive emergencies GI bleeding pulseless cardiac arrest |
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Desmopressin
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Used for dose-dependent treatment of blood disorders
used for nocturnal enuresis |
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Administration Education
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Always rotate the site for absorption purposes. Educate pt to rotate by teaching them the different sites and relate them to times of day, make a diagram with colors, or rotate per days of the week. Taper off all hormones.
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Thyroid Medication
levothyroxine (Synthroid, Levothyroid) |
Given for hypothyroidism or after surgery. Give early in morning so can work all day and to prevent insomnia.
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Synthroid Adverse Effects
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Cardiac Dysrhythmia Monitor TSH level every 3 weeks to ensure patient is getting the correct dosage. DO NOT skip a dosage. Monitor BG, increased healing time, Large complication is cardiac arrhythmias which will also cause respiratory issues. s/s of hyperthyroidism.
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Nursing Care with Synthroid
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Check for allergies to iodine or shellfish. Continue Synthroid if pregnant even though there is a small chance of fetal retardation. Let pt know that it takes 2 – 3 weeks to start feeling better.
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TSH Levels
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TSH should be 0.4 – 4.5
Check every 4 weeks Alert nurse if pt has more activity tolerance, BP increases to normal, Adverse = heart racing, palpitations, insomnia, exopthalamos, s/s of hyper. |
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Adrenal glands
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Medulla = epi and norepi
Cortex = (Sugar, Salt and Sex) Glucocorticoids, Mineralcorticoids (aldosterone), Sex hormones |
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Corticoid Steroid Indications
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Adrenocortical deficiency
Exacerbations of chronic respiratory illnesses, such as asthma and COPD Organ transplant (decrease immune response) |
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Corticoid Steroid Contraindications
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Drug allergies
Serious infections patients with Gastritis, reflux disease, ulcer disease Diabetes Cardiac/renal/liver dysfunction |
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Corticoid Steroid Adverse Effects
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Monitor K and Na levels. S/s of Cushings, GI and Cardiac symptoms. “Steroid Psychosis” very common – puffy look, retaining water, mood changes, moody quickly. Taper up and down to adjust dosages.
Makes skin paper thin. Given oral, IM but never SQ. Must be taken with food. |
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Insulin
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Substitute for the endogenous hormone
Restores the diabetic patient’s ability to: Metabolize carbohydrates, fats, and proteins Store glucose in the liver Convert glycogen to fat stores |
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Rapid Acting Insulin
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Give SQ not IV. lispro (Humalog), aspart (NovoLog), glulisine (Apidra).
Quickest |
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Short Acting Insulin
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Regular insulin (Humulin R)
Onset 30 to 60 minutes The only insulin product that can be given by IV bolus, IV infusion, or even IM |
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Intermediate-acting Insulin
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Isophane insulin suspension (also called NPH)
Cloudy appearance Slower in onset and more prolonged in duration than endogenous insulin |
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Long Acting Insulin
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glargine (Lantus), detemir (Levemir)
Clear, colorless solution Referred to as basal insulin |
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Combination Insulin Products
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NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30, Novolog 70/30)
NPH 50% and regular insulin 50% (Humulin 50/50) |
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Sliding Scale
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SC short-acting or regular insulin doses adjusted according to blood glucose test results
Typically used in hospitalized diabetic patients or those on TPN or enteral tube feedings Subcutaneous insulin is ordered in an amount that increases as the blood glucose increases Disadvantage: delays insulin administration until hyperglycemia occurs; results in large swings in glucose control |
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Oral Anti-Diabetic Drugs
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Used for type 2 diabetes
Lifestyle modifications Diet, exercise, smoking cessation, weight loss Oral antidiabetic drugs may not be effective unless the patient also makes behavioral or lifestyle change Used alone or in combination with other drugs and/or diet and lifestyle changes to lower the blood glucose levels in patients with type 2 diabetes |
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Biguanides
Metformin (Glucophage) |
Decrease production of glucose by the liver
Decrease intestinal absorption of glucose Increase uptake of glucose by tissues Do not increase insulin secretion from the pancreas (does not cause hypoglycemia) |
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Side Effects of Glucophage
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abdominal bloating, nausea, cramping, diarrhea, feeling of fullness
May also cause metallic taste, reduced vitamin B12 levels Lactic acidosis is rare but lethal if it occurs Does not cause hypoglycemia |
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Sulfonylureas
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chlorpropamide (Diabinese), tolazamide (Tolinase)
glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase) Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels Beta cell function must be present Improve sensitivity to insulin in tissues Result in lower blood glucose levels Work in the pancreas. |
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Sulfonylureas: Drug Interactions
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hypoglycemic effect increases when taken with alcohol, anabolic steroids, allergic cross-sensitivity may occur with loop diuretics and sulfonamide antibiotics
Adrenergics, corticosteroids, thiazides, others may reduce hypoglycemic effects May interact with alcohol, causing a disulfiram-type reaction Need to eat their breakfast when they take this. |
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Side Effects of Sulfonylureas
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Hypoglycemia
Hematologic effects Nausea, epigastric fullness Heartburn |
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Glinides
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repaglinide (Prandin), nateglinide (Starlix)
Action similar to sulfonylureas Increase insulin secretion from the pancreas Prandin is taken only once a day in the mornings. Must take while eating not prior to. Glucose is fighting with insulin. |
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Thiazolidinediones (glitazones)
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pioglitazone (Actos), rosiglitazone (Avandia)
Decrease insulin resistance “Insulin sensitizing drugs” Increase glucose uptake and use in skeletal muscle Inhibit glucose and triglyceride production in the liver |
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Glinides Side Effects
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Headache, hypoglycemic effects, dizziness, weight gain, joint pain, upper respiratory infection or flulike symptoms
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Thiazolidinediones Side Effects
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Moderate weight gain, edema, mild anemia
Hepatic toxicity—monitor ALT levels |
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Alpha-Glucosidase Inhibitors
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aacarbose (Precose), miglitol (Glyset)
Delays absorption of glucose. Does not cause hypoglycemia. Take with first bite of meal. |
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Accarbose
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Route: PO
Onset: 1-1.5 hr Peak:2 hr Half Life:2-3 hr Duration: unknown |
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Glipizide
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Route: PO
Onset: 1hr Peak:1-3 hr Half Life:2-5 hr Duration:6-8 hr |
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Metformin
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Route: PO
Onset: < 1 hr Peak:1-3 hr Half Life:1.5-5 hr Duration:24 hr |
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Actos
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Route: PO
Onset: Delayed Peak: 2 hr Half Life:3-7 hr Duration:Unknown |
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Prandin
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Route: PO
Onset: 15-60 min Peak:1 hr Half Life:2-3 hr Duration:4-6 hr |
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Nursing Care with Diabetes
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Diet is most important with Type 2. H A1c should be less than 6%. If NPO and BG is 350 in am give insulin. Recheck BG pt should always have IV fluids going. If pt is 120 you could probably hold the insulin until after the surgery.
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Education with Diabetes
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Educate even if they have been diabetic for years. Don’t adjust based on how you feel. How to take the insulin properly. Diabetic educators are available at the hospital. Use lancets and needles only once.
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Nursing Care with Insulin
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Check blood glucose level before giving insulin
Roll vials between hands instead of shaking them to mix suspensions Ensure correct storage of insulin vials ONLY use insulin syringes, calibrated in units, to measure and give insulin Ensure correct timing of insulin dose with meals |
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Hypoglycemia
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If the patient is conscious, give oral form of glucose
Give the patient glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink or have the patient eat a small snack such as crackers or a half sandwich If the patient is unconscious, give D50W or glucagon, intravenously |
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Parietal Cells
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Produce & secrete HCl (Histamine)
Primary site of action for many acid-controller drugs |
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Helicobacter pylori
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Tx: Biaxin (Clarithromycin)H Pylori can lead to stomach cancer after eating away at the lining the cells change increasing the risk.
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(TUMs)
Antacids |
Neutralizes stomach acid and promotes gastric mucosal defense. Buffers the acidic properties of Hcl. DO NOT prevent overproduction of acid. DO NOT neutralize the acid once it is in the stomach.
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Anti-acids (antacids) Effects
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Palliative Only!! Reduction of pain, neutralizes pH. Renal patients should not take antacids due to renal calculi, and increased calcium.
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Aluminum Salts
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Constipating Often recommended for patients with renal disease (more easily excreted)
Basaljel, Maalox, Mylanta, Gaviscon, |
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Magnesium Salts
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Diarrhea (side effect)
Milk of Magnesia Dangerous when used with renal failure Combination products such as Maalox, Mylanta (aluminum and magnesium) |
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Calcium Salts
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Carbonate is most common (TUMs) May cause constipation, kidney stones
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Sodium Bicarbonate
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Buffers. Quick onset, short duration. May cause metabolic alkalosis
Monitor the ph, CO2,HCO3 levels Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency |
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Antiflatulents
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Simethicone (Mylicon)
used to relieve the painful symptoms associated with gas |
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Nursing Guidelines for Antacids
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Assess for allergies, Fluid imbalances
Renal disease GI obstruction Heart failure (HF) &/or Hypertension Pregnancy Patients with HF or hypertension should not use antacids with high sodium content |
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Administration of Antacids
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Most medications should be given 1-2 hours after giving an antacid
Chewable tablets are chewed thoroughly Liquid forms are shaken well before giving Administer with at least 6-8 oz of water to enhance absorption |
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H2 Blockers
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Reduce acid secretion by Block histamine at the (H2) receptors of acid-producing parietal cells. cimetidine (Tagamet)
nizatidine (Axid) famotidine (Pepcid) or Pepcid AC ranitidine (Zantac). Used to treat GERD, PUD, Erosive esophagitis |
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H2 Blockers adverse effects
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Cimetidine may induce impotence and gynecomastia
Extreme Cases: May cause headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects Smoking has been shown to decrease the effectiveness of H2 blockers (Patient Education) |
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Administration of H2 Blockers
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Pepcid can be given IV in the hospital if the pt is NPO or has dysphagia.
Take 1 hour before or after antacids |
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Proton Pump Inhibitors
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Stops the Pumps from working.Inhibits pump from allowing the secretions to be used. End in prazole
lansoprazole (Prevacid) omeprazole (Prilosec)* rabeprazole (AcipHex) pantoprazole (Protonix) (IV form available) esomeprazole (Nexium) |
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PPI Nursing Care
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May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin
The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 g or the tube may become clogged Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules Proton pump inhibitors often work best when taken 30 to 60 minutes before meals |
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Sucracalfate (Carafate)
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Used for stress ulcers, peptic ulcer disease
Does not stop the acid production! May impair absorption of other drugs—give other drugs at least 2 hours before sucralfate H2 and Carafate work together to decrease the secretions and line the stomach. |
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Antinausea and Antiemetics
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Timing is important for effectiveness.
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Anticholinergics
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Bind to and block acetylcholine (ACh) receptors in the inner ear labyrinth
Scopolamine (Trans-derm SCOP) Also used for motion sickness (transdermal patch) Place patch behind ear at least 4 hours before you incur motion. Change every 3 days or if it gets wet. |
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Antihistamine (H1 Blockers)
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Prevent cholinergic stimulation in vestibular & reticular areas, thus preventing nausea and vomiting
Used for motion sickness, nonproductive cough, allergy symptoms, sedation Examples dimenhydrinate (Dramamine) diphenhydramine (Benadryl) meclizine (Antivert) |
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Antidopaminergics
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Blocks dopamine prochlorperazine (Compazine)
-> Adverse Reactions: may cause Parkinson-like clinical manifestations; extra-pyramidal (involuntary movements, facial grimacing, hand trembling) promethazine (Phenergan) droperidol (Inapsine) Use is controversial r/t cardiac dysrhythmia |
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Prokinetics
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Cause CTZ to be desensitized to impulses it receives from the GI tract
Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents. Also used for GERD, delayed gastric emptying Examples: metoclopramide (Reglan) |
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Serotonin Blockers
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Used for nausea and vomiting in patients receiving chemotherapy & for postoperative nausea and vomiting
Examples: dolasetron (Anzemet) palonosetron (Aloxi) granisetron (Kytril) ondansetron (Zofran) |
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Tetrahydrocannabinoids
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Alter mood and body’s perception of its surroundings
Example: dronabinol (Marinol) Used for nausea and vomiting associated with chemotherapy, and anorexia associated with weight loss in AIDS patients Stimulates appetite |
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Homeopathic: Ginger
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Adverse effects
anorexia, nausea, & vomiting (smell), skin reactions Don’t give warfarin or coumadin if taking Ginger. May interact causing bleeding. |
