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219 Cards in this Set
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DRUGS FOR SENSORY ORGANS |
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What is glaucoma? |
Leading cause of blindess where visual field loss is secondary to optic nerve damage |
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What is primary open angle glaucoma? |
Most common, asymptomatic, progressive optic nerve damage with eventual impairment of vision. Aqueous fluid does not drain well out of the eye. (sink is clogged) |
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Risk factors for primary open-angle glaucoma |
Elevation of intraocular pressure African american Family history old age |
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what is it Angle closure glaucoma? |
Acute onset, irreversible, preciptation by displacement of iris that prevents the exit of aqueous humor (Sink has bobble) |
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Corrective surgery for angle-closure glaucoma******* |
Laser iridotomy Iridectomy |
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Drug therapy for angle closure glaucoma***** |
Doesnt do much, corrective surgery is the only solution |
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************Preferred route for glaucoma drug therapy****** |
Topical combined therapy |
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Surgical intervention to promote outflow of aqueous humor |
Laser trabeculoplasty Trabeculectomy |
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Example of a beta-adrenergic blocking agent for glaucoma******** |
Betaxolol, levobetaxolol, carteolol, levobunolol, metipranolol timolol @ (usually end in -ol) |
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How do beta-adrenergic blocking agents work?****** |
Topicalbeta-blockers reduce the intraocularpressure (IOP) by blockade of sympathetic nerve endings in the ciliary epitheliumcausing a fall in aqueous humour production. used primarily for open-angle glaucoma |
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Beta-Adrenergic blocking agent patient education********** |
Not optional drugs because they'll go blind if they dont use it. Stress importance of same time, same dose, every single day |
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Beta-Adrenergic blocking agent usual administration******** |
1-2 drops twice daily in conjuction with topical miotic which constricts the pupil |
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Adverse affects of beta-adrenergic blocking agents****** |
Local - Itching and burning (cotton in eye) Systemic - Bradycardia, bronchospasm |
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Example of ▫Alpha2-adrenergicagonists and which is short term, long term******* |
Brimonidine (Alphagan, long term), Apraclonidine (short term) |
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Adverse effects of alpha2-Adrenergic agonists******** |
Dry mouth, local burning and stinging, headache, blurred vision, foreign body sensation, itching |
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Example of ▫Prostaglandinanalogs ******* |
Latanoprost (Xalatan), lumigan, travatan Z |
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Prostaglandin analog adverse effects********* |
permanent harmless brown pigmentation of the iris in ppl w/ hazel, blue, or light colored eyes |
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What are second line glaucoma drugs? |
▫Cholinergic agonists▫Carbonic anhydraseinhibitors▫Nonselective adrenergicagonists |
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Glaucoma patient with asthma, which medication to give them?********** |
Betaxolol or levobetaxolol instead of timolol b/c its beta-1 selective |
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What is pilocarpine?************************************* |
It is a direct-acting cholinergic agonist that causes contraction of ciliary muscle and constriction of pupil to less than 2mm |
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Why is pilocarpine considered a 2nd line drug?******************** |
Side effects of itching and redness, DONT USE ANYMORE |
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How does pilocarpine work?***************** |
Contraction of muscarinic receptor and ciliary muscle which constricts the pupil. This increased tension opens the trabecular meshwork through tension on scleral spur, increasing IOP outflow |
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How does echothiophate work?********* |
It is a long duration cholinersterase inhibitor that inhibits breakdown of acetylcholine by promoting accumulation at muscarinic receptors |
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Echothiophate adverse effects and nursing considerations********* |
No longer a first line drug. Causes myopia (near sightedness) and parasympathomimetric responses |
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Examples of carbonic anhydrase inhibitors and what they do******* |
Dorzolamide, acetazolamide, methazolamide, that decreases production of aqueous humor that is generally well tolerated |
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Dorzolamide specific adverse effects***** |
Ocular stinging, bitter taste, allergic reaction in 10-15% |
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General carbonic anhydrase inhibitor adverse effects******** |
Nervous system, teratogenic, acid-base disturbance, electrolyte imbalance |
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What do cycloplegics do? |
Paralyze ciliary muscles resulting in loss of accommodation (unable to focus) |
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What do mydriatics do and example?*********** |
dilatethe pupil,usually due to topical application of muscarinic antagonists such as atropine, cyclopentolate, homatropine, scopolamine and tropicamide, phenylephrine |
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Purpose of cycloplegics and mydriatics |
Intraocular exam and surgery, treatment of anterior uveitis |
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Averse effects of cycloplegics and mydriatics********** |
Blurred vision and photophobia Precipitation of angle closure glaucoma Anticholinergic effects |
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What is allergic conjunctivitis |
Itching, burning, watery discharge of conjunctiva as a result of biphasic immune response |
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What is the timeline of allergic conjunctivitis disease process?*********** |
Symptoms peak 20 minutes from exposure, lasts 20 minutes, then reappears 6 hours later |
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Treatment for allergic conjunctivitis |
Mast cell stabalizer H1 receptor antagonist NSAIDs Gluococoricoids Advil |
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What is age-related macular degeneration?******* |
Painless disease that blurs central vision and skews fine detail, leading cause of blindess believed to be from screens
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Treatment for dry age-related macular degeneration |
Antioxidants and zinc, vitamins, lutein |
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Treatment for wet age -related macular degeneration |
Laser therapy Photodynamic therapy Angiogenesis inhibitors |
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THE SKIN |
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Adverse effects of topical glucocorticoids********* |
Stretch marks, purpura, telangiectasia (spider web), hypertrichosis (excess hair), systemic toxicity (growth retardation, adrenal suppression) |
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What do topical glucocorticoids do? |
Reduce inflammation and itching, drying agent |
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How to apply topical glucocorticoids************* |
Thin film gently rubbed into skin. No occlusive bandages or clothes |
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What do keratolytic agents do? |
Promote shedding of horny layer of skin |
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What does salicyclic acid treat?
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Warts, corn |
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What does sulfur treat? |
Acne, dandruff, psoriasis, seborrheic dermatitis |
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Drugs used to treat acne********* |
Benzoyl peroxide Clindamycin (Topical) Tetracycline, isotretinoin (oral) Retinoids such as tretinoin and adapalene and tazarotene |
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Oral antibiotics for acne***** |
1st line - doxycycline, minocycline 2nd line - tetracycline, erythromycin |
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Nursing considerations for isotretinioin (accutane)******* |
Teratogenic, triglycerides must be monitored |
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Difference between organic and inorganic sunscreen |
Organic dissipates uv light and are chemical Inorganic are physical and scatter uv light |
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Side effects of sunscreen |
Acneburning, itching, or stinging of the skin early appearance of redness or swelling of the skin late appearance of rash with or without weeping blisters that become crusted, especially in sun-exposed areas, and may extend to unexposed areas of the skin pain in hairy areas pus in the hair follicles |
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What is psoriasis?*********** |
Erratic, chronic skin of Red patches with silver scales caused by accelerated maturation of epidermal cells and inflammation |
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********What is someone taking alefacept prone for? |
Infection |
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*******Drugs for Psoriasis |
Methotrexate - decreases skin cell production and supress inflammation Acitretin Corticosteroids Cyclosporine - supresses immune system Immunomodulator drugs |
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*****Nursing considerations for methotrexate and cyclosporin |
Methotraxate can cause liver damage and decreased Whole blood Cyclosporine increases risk of infection and cancer |
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What is actinic keratoses?*********** |
Rough scaly red or brown papules caused by chronic exposure to sunlight (half of skin cancers) |
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Drugs for actinic keratoses |
Fluorouracil Diclofenac sodium Imiquimod Aminolevulinic acid |
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Difference between psoriasis and eczema******** |
Psoriasis - white patch or red scaly, most commonly on knees and elbows, genetic, adults Eczema - Self limiting and local, kids, raw and red, allergy, better to have |
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Topical immunosuppressants for eczema |
Tacrolimus Pimecrolimus |
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Drug used to remove venereal warts******** |
Podophyllin |
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Podophyllin consideration****** |
Must be applied by prescribing healthcare provider |
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Drugs for hairloss and mechanism of action |
Topical minoxidil - takes up to 12 weeks to work Finasteride - prevents testosterone conversion |
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Drugs for impetigo |
Mupirocin Retapamulin Cephalexin Dicloxacillin Clindamycin Amoxicillin |
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THE EARS |
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What is otitis media? |
Inflammation of and fluid in the middle ear characterized by ear pain |
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How is otitis media diagnosed? |
Acute onset of s/s Middle ear effusion middle ear inflammation MUST HAVE ALL 3 |
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Treatment for otitis media******* |
80% of cases resolve by themselves but acetaminophen (best), ibuprofen, codeine can be given |
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What drug is used for antibiotic-resistant otitis media******** |
High dose amoxicillin-clavulanate |
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Prevention of otitis media |
6 months breast feeding Avoid child care centers if child has respiratory infections Treat influenza *******Vaccinate against streptococcus pneumoniae |
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Best way to prevent and treat recurrent otitis media********* |
Treating influenza |
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Treatment for otitis externa |
2% solution of acetic acid and alcohol as ear drops. Ciprofloxacin for adults and cephalexin for children |
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Necrotizing otitis externa |
Rare, in high risk groups, where bacteria in EAC invade mastoid or temporal bone, causing meningitis and lateral sinus thrombosis |
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How to treat necrotizing otitis externa |
Ear drops and IV Oral ciproflaxacin |
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Fungal otitis externa |
80-90% caused by aspergillus Intense pruritus and erythema with or without pain or hearing loss. Treated with acidifying drops |
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CARDIAC DRUGS (RAAS) |
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How is the Renin- angiotensin - aldosterone stystem activated?********************************************************************** |
Fall in blood pressure and imabalance of salt/water, decreased blood volume, and stimulation of kidney by sympathetic nervous system |
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How does the RAAS regulate blood pressure? |
Constricts blood vessels and acts on kidney to promote retention of sodium and water and extretion of potassium |
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How does RAAS work? |
Kidneys release renin which cuts off all but the first 10 amino acids called angiotensin 1. ACE then removes 2 of those amino acids, converting it to angiotensin 2, which signals adrenal gland to produce aldosterone that leads to increased salt and water retention (high blood pressure). |
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Indications for ACE inhibitors |
Hypertension HF MI Diabetic and nondiabetic nephropathy Prevention of MI, stroke, and death |
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Drugs for hypertension is always included with a diuretic bradykinin to help lower blood pressure********** |
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Main adverse effects of ACE inhibitors*********** |
First dose hypotension Teratogenic effects |
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ALL ACE INHIBITORS END IN -IL********** |
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Adverse effects of angiotensin II receptor blockers********** |
Angioedema |
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Indicators for angiotensin II receptor blockers********** |
Diabetic nephropathy***** Heart failure hypertension MI, stroke |
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Eplerenone use |
Hypertension, heart failure |
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Spironolactone use |
Hypertension and heart failure |
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Spironolactone and Eplerenone Adverse effects*********** |
HYPERKALEMIA - first sign palpitations Gynecomastia Menstrual irregularities Impotence Hirsutism |
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CALCIUM CHANNEL BLOCKERS |
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How do calcium channel blockers work? |
Prevent calcium from entering cells to regulate contractions and slow action potential of SA & AV node |
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Nifedipine & amilodipine use |
Vasodilation by blocking calcium channels to lower BP, increase HR, and increase contractile force Angina pectoris HTX Migraine/preterm labor |
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Adverse effects of Nifedipine & amilodipine |
Flushing Dizziness Headache peripheral edema Gingival hyperplasia Reflex tachycardia |
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Drug interaction with nifedipine & amilodipine********** |
Beta-Adrenergic blockers |
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Verapamil use |
Reduces myocardial oxygen demand and reverses coronary vasospasm to treat angina pectoris hypertension cardiac dysrhythmias |
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Diltiazem use |
Angina pectoris Essential hypertension Cardiac arrhythmias Migraine |
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Diltiazem adverse effects |
Constipation Dizziness Facial Flushing headache Edema of ankles and feet Gingival hyperplasia |
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VASODILATORS |
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Adverse effects related to vasodilation********** |
Postural hypotension Reflex tachycardia Expansion of blood volume |
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Hydralazine & minoxadil use |
Hypertensive crisis Heart failure |
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Hydralazine & minoxadil adverse effects |
Reflex tachycardia Increased blood volume Systemic lupus erythematosus |
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Sodium Nitroprusside |
Fastest antihypertensive agent with adverse effects of excessive hypotension, cyanide poisoning, thiocyanate toxicity |
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ANTIHYPERTENSIVES |
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Difference between primary and secondary hypertension |
Primary- Idiopathic, treated but not cured Secondary- primary cause, possible to treat, cure |
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****ALL ANTIHYPERTENSIVE THERAPIES START WITH DIURETICS****** |
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Medication consideration for someone with both hypertension and asthma******** |
Cardiac specific beta blocker |
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Examples of diuretics used with hypertensive drugs |
HCTZ Lasix, Bumex Aldactone |
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Examples of sympatholytics |
Toprol Alpha 1 blockers Carvedilol and labetalol Alpha 2 agonists Adrenergic neuron blockers |
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Sodium nitroprusside Considerations****** |
Lowers blood pressure really really quickly |
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Fenoldopam considerations****** |
Causes arterial vasodilation leading to a decrease in blood pressure. Promotes sodium excretion. very short acting |
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Labetalol considerations******** |
IV push, very rapid drop in BP |
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Diazoxide consideration**** |
Potent potassium channel activator causing relaxation of smooth muscles |
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HEART FAILURE DRUG THERAPY |
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4 major goals of heart failure treatment********************* |
–Reliefof pulmonary and peripheral congestive symptoms –Improvefunctional capacity and quality of life –Slowcardiac remodeling and progression of LV dysfunction –Prolonglife |
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Vicious cycle of congestive heart failure********** |
Cardiac dilation --> Activates sympathetic nervous system --> activates RAAS --> Increase in blood and water
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Diagnosis for heart failure********* |
Ejection fraction below 55%, stroke volume is amount being pushed out of the heart |
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Adverse effects of ACE inhibitors |
Hypotension Hyperkalemia Intractable cough Angioedema |
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Beta blocker action |
Protects from excessive sympathetic stimulation and dysrhythmias |
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Beta blocker adverse effects****** |
FATIGUE LIKE YOUVE NEVER FELT BEFORE Fluid retention hypotension bradycardia |
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Digoxin and cardiac glycosides******* |
Increases strength of muscular contraction, increases myocardial contractile force without increasing energy expenditure, alters electrical activity of the heart by slowing depolarization of pacemaker cells in av node |
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Normal BNP level******* |
Less than 200 |
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Beta Blocker is 1st line while Digoxin is 2nd line******* |
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Digoxin adverse effect******** |
Causes severe dysrhythmias Anorexia, nausea, vomiting, fatigue |
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Hemodynamic effects of digoxin****** |
Decreased renin and sympathetic tone Increased urine and sensitivity of baroreceptors |
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Patient teaching for digoxin****** |
Check pulses |
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Examples of sympathomimetics |
Dopamine Dobutamine |
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Examples of phosphodiesterase inhibitors |
Inamrinone Milrinone |
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Considerations and adverse effects for nitroglycerin**************** |
Causes coronary dilation, give sublingual Hypotension Resultant reflex tachycardia |
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Adverse effect of sodium nitroprusside******** |
Pass out from vasodilation and profound hypotension |
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Adverse effect of nesiritide******* |
Symptomatic hypotension |
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ANTIARRHYTHMIC DRUGS |
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Where do fast potentials occur and what are the phases? |
Fibers of his-purkinje system and atrial ventricular muscle Depolarization Repolarization Plateua Repolarization Stable potential |
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Where do slow potentials occur and what are phases? |
Cells of SA node and AV node Slow depolarization Absent Depolarization |
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Quinidin effects on heart******* |
DELAYS REPOLARIZATION Blocks sodium channels Slows impulse conduction Blocks vagal input |
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Effects of quinidine on ECG********* |
Prolongs the QT interval and ventricular polarization |
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Adverse effects of quinidine****** |
Cinchonism (can happen after 1 dose) Diarrhea Cardiotoxicity Arterial embolism Alpha adrenergic blockade |
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Lidocaine effects on the heart |
Blocks cardiac sodium channels to slow conduction. Reduces automaticity in ventricles and his-purkinje system Accelerates repolarization |
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Adverse effects of lidocaine |
CNS Drowsiness Confusion Paresthesias |
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Flecainide and propafenone use & considerations |
Blocks cardiac sodium channels and delays ventricular repolarization However, exacerbates and creates dysrhythmias |
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Propanolol effects on heart and ECG |
Decreased automaticity of SA node, velocity of conduction through AV node, and myocardial contractility |
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Propanolol use and adverse effect******* |
Used for dysrhythmias caused by excessive sympathetic stimulation Supreventricular tachydysrhythmias BRONCHOSPASM WORSENS ASTHMA AND COPD |
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Bretylium use and adverse effect |
Ventricular fibrillation and tachycardia Profound persistent hypertension and severe emesis |
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Amiodarone use and effect on ECG********** |
For life threatening ventricular dysrhythmias QRS widening and prolong of PR and QT intervals |
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Amiodarone adverse effects******* |
Thyroiditis Cardio and pulmonary toxicity |
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Varapamil and diltiazem use******* |
Slow ventricular rate and terminates SVT caused by av nodeal reentrant circuit |
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Varapamil and diltiazem adverse effects |
AV block Heart failure edema |
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Adenosine use**************************************************************** |
Termination of paroxysmal SVT |
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Adenosine medication administration********** |
Very short half life, given IV push 6,6,12mg |
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Adverse effects of adenosine****** |
Sinus bradycardia Dypsnea |
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AGENTS FOR CHOLESTEROL AND ELEVATED LIPIDS |
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Ideal cholesterol levels |
LDL under 100 HDL above 40 |
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Atorvastatin, simvastatin, crestor uses |
Hypercholesterolemia Primary and secondary prevention of CV events Diabetes |
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Atorvastatin, simvastatin, crestor adverse effect********* |
headache myopathy/rhabdomyolysis muscle fatigue |
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Nicotinic acid Adverse effects******** |
Skin flushing/itching hepatotoxicity |
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Cholestyramine & Colestipol adverse effects |
Constipation Decreased uptake of fat soluble vitamins |
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Gemfibrozil adverse effects |
Hepatotoxic Rashes Gallstones myopathy |
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Ezetimibe adverse effects |
Rhabdomyolysis hepatitis Pancreatitis Thrombocytopenia |
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ANTI ANGINAL AGENTS |
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Chronic stable angina aggravating factors********** |
Large meals Cold exposure |
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Treatment focus for chronic stable angina******** |
Increase cardiac oxygen supply |
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What is variant angina? |
Coronary artery spasm |
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What is unstable angina? |
Angina at rest, new onset or intensification of existing angina |
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Adverse effects of nitroglycerin******** |
Headache Orthostatic hypotension |
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Drug for percutaneous transluminal coronary angioplasty********** |
integrillin and riopro |
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MANAGEMENT OF ST-ELEVATION MYOCARDIAL INFARCTION |
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What does tombstone t-wave show? |
Death of cardiac muscle |
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What does MONA stand for in STEMI drugs?**************************** |
Morphine, oxygen, nitro, aspirine will decrease oxygen demand |
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DRUG THERAPY FOR THE DIGESTIVE TRACT |
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First pass effect |
Liver removes big % of drug before reaching inferior vena cava. Dont give these drugs orally. |
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What is enterophepatic recirculation? |
When drugs can recycled in the body because 95% of bile salts are reabsorbed back into the hepatic portal circulation |
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Two kinds of drugs that can lead to ulcers******** |
Corticosteroids and NSAIDS b/c they are prostaglandin antagonists |
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What is the purpose of somatostatin |
Supresses gastrin, decreasing acid secretion |
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Duodenal ulcer pain************ |
Worse when stomach is empty, goes away with meals because the presence of food closes the pyloric sphincter and keeps acid in the stomach |
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Seriously ill or mechanically ventilated clients are treated prophylactically to prevent stress ulcers******* |
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Zolligner Ellison syndrome |
Tumor secreting gastrin creastes over production of HCL, leading to ulcers |
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What does GERD do to the esophagus?*********** |
Injures esophageal tissue leading to barret's esophagus and possible cancer |
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DRUGS FOR PEPTIC ULCER DISEASE AND GERD |
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How do PPIs work?********* |
Binds to hydrogen ions, inhibiting ATPase enzyme which stops stomach acid production |
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When to take PPI |
20-30 min before first meal |
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PPIs end in -ZOLE******** |
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Nursing concern for patient taking PPIs********* |
If they have diarrhea, report it, do not treat |
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DO NOT TAKE PLAVIX WHEN TAKING PRILOSEC, REDUCES EFFECTIVENESS OF PLAVIX LEADING TO STROKE*********** |
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What's so special about the PPI Aciphex?************ |
Only one reversible with shorter duration of action |
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Examples of PPI |
Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole |
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H2 RECEPTOR ANTAGONISTS |
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H2 RECEPTOR ANTAGONISTS END IN -DINE********** |
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Examples of H2 receptor antagonists |
Cimetidine Famotidine Nixatidine Ranitidine |
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Cimetidine administration************* |
IV slow push over a minimum of 5 minutes
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When and with what to take H2 Blockers with*************** |
With or right after meals, Antacids must be taken 2 hours before or after with full glass of water |
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H2 Blocker with dissolving tab for pediatric GERD********** |
Ranitidine |
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Ranitidine adverse effects |
Confusion, gynecomastia, impotence, loss of libido |
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Most potent H2 blocker |
Famotidine |
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Which H2 blocker is not used for high incidence of adverse effects |
Cimetidine |
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What is sucralfate? |
Adheres to ulcer sites to repair them |
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How do bismuth compounds protect mucus? |
Stimulates bicarb and prostaglandin so H.Pylori can't adhere to ulcerated tissue |
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Adverse effects of Misoprostol************** |
Pregnancy category X MUST NOT USE IN PREGNANCY This is the abortion pill Cytotec is combined with mifepristone to terminate pregnancies |
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PHARMACOTHERAPY OF BOWEL DISORDERS |
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LAXATIVES |
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Constipation is a medical emergency if........ |
Acute pain & abdominal distension |
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What are bulk-producing agents and administration of them************** |
Gentlest of laxatives, causes stool be be bulky and retain water as well as emollient gel to help move along. SHOULD BE TAKEN WITH PLENTY OF WATER |
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Surfactant laxatives |
Lowers surface tension of water, well-received |
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Stimulant laxatives |
Act on intestinal mucosa or nerve plexus to alter water and electrolyte secretion |
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Examples of osmotic laxatives*********** |
Saline Agents Milk of magnesia Magnesium citrate |
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What does lactulose do in the body?******* |
Retains colon water, lowering pH and increasing colonic peristalsis. Reduces ammonia levels in liver disease. Also indicated for use in portal-systemic encephalopathy |
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When is whole bowel irrigation used? and what solutions?************* |
Prepare bowel for surgery or colonoscopy Sodium bicarb, sodium chloride, potassium choloride |
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DIARRHEA |
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When are antidiarrheals contraindicated in diarrhea?******** and why? |
Diarrhea caused by poisoning, infection with toxin producing organisms, C.diff infection Fatal toxic megacolon can result! |
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Loperamide nursing considerations********** |
No narcotic effect, not controlled substance Low doses OTC, high dose Rx Tablet, capsule, liquid |
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Long term adverse effects of Oral corticosteroids*********** |
Infection, hyperglycemia |
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Azathioprine (Imuran) nursing consideration********* |
Monitor CBC w/ differential b/c rare type of t-cell lymphoma has been reported |
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Action of Sulfasalazine************** |
Inhibits mediators of inflammation in colon and reduces inflammation associated with ulcerative colitis |
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IRRITABLE BOWEL SYNDROME |
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Alosetron nursing consideration |
Black box warning, no refills without follow up from provider |
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Dicyclomine adverse effect |
Dry mouth, blurred vision, drowsiness, urinary hesitancy, tachycardia |
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Nursing consideration for lubiprostone*********** |
DO NOT GIVE TO CLIENTS WITH DIARRHEA OR GI OBSTRUCTION, PREGANANCY CATEGORY c |
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DRUGS FOR OBESITY |
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Sibutramine Adverse effects |
Headache, constipation, insomnia |
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Orlistat adverse effects |
GI effects Reduced absorption of fat soluble vitamins |
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Phentermine adverse effects*********** |
Dry mouth Tachycardia Flushing Insomnia Dizziness Tolerance |
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What is scopolamine and adverse effects?********** |
Anticholingergic transdermal patch Drowsiness and blurred vision |
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Phenothiazines adverse effect********* |
Sedation and extrapyramidal symptoms |
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Prochoperazine contraindication********* |
Black box warning, death in elderly with dementia DO not use in comatose or CNS depression |
