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226 Cards in this Set

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What do most OTC analgesics act on?
Cox Enzymes which are necessary for prostaglandin formation
Does Cox 1 act peripherally or centrally?
when Cox 1 is inhibited, what effects are caused?
gastric ulceration
acute renal failure
bleeding tendencies
relaxes uterine muscles
What are the good effects of Cox 1?
gastric protection
maintains renal bl. flow
causes clotting
promotes uterine contractions
Does Cox 2 act peripherally or centrally?
peripheral act: causes inflammation
central: causes pain & fever
Inhibition of Cox 2 causes?
reduced inflammation, fever and pain
What are non-narcotic analgestics?
Para Aminophenol Derivatives:
NSAIDs- AIMs- motrin,ibuprophen, aleve
Urinary tract analgesic:
Sayicylates/ASA acts by?
Most common adverse effect?
inhibiting Cox 1 & 2
GI upset, PUD. renal failure
Renal failure w/ ASA high doses may occur in pts with?
Rheumatoid arthritis, chronic headaches
What are the signs of ASA toxicity?
dizziness, tinnitus, N&V
Why are ASAs contraindicated for children under 18?
Reye's syndrome
How does para aminophenals-Tylenol/acetaminophens work?
inhibit Cox enzymes centrally not peripherally
What is the max dose of Tylenol?
4 gm/day
Large doses of Tylenol may cause?
What is the overdose antidote for Tylenol?
What are the catagories of NSAIDS?

What are the non-selective NSAID?
AIMS - Aleve, ibuprophen, Motrin
What are the selective NSAID?
What are the adverse effects of NSAIDs?
Which Cox does Celebrex block and which properties does it have?
blocks 2

pain & anti-inflammatory
What are NSAIDs useful in treating?
Rheumatoid arthritis
Menstrual cramps
Post op-pain
Drug of choice for pt with renal failure?
alcoholic pt?
less effective w/inflammation?
(if no liver problems)
Most effective in treating pain in a chronic inflammatory condition?
NSAIDs - less GI impact
Urinary tract analgesics like Pyridium are often combined with?
Bactrim- antiseptic
so sulfa drug and pain drug together-turns urine orange-red
What are common Opioids?
How do Opioids work?
bind to opiate receptors in brain and spinal cord
alters pain perceptions
Bad side effect of Opioids?
decreased GI motility-constipation, respiratory depression (<12=hold drug)
Overdose of Opioids treated with?
Narcan is contraindicated with?
chemically dependent pts, will cause withdrawal
What nursing assessments/interventions should be noted for Opioids?
pain scale
Which is a mixed agonist-antagonist Opioid?
How does Stadal work?
decreases pain w/o respiratory depression and GI problems, but not as effective to treat pain about the same as tylenol/NSAIDs
How does Valium work?
increases neurotransmitter levels, reduces anxiety-anti-anxiety drug, pain drug, muscle relaxant
What is another anti-anxiety drug?
contraindicated with

elderly-long half life
Most common side effect w/ anti-anxiety is?
and d/c slowly to prevent withdrawal
Most common Barbituate?
How is Luminal used?
treats anxiety, seizures, reduces pain and is a sedative
The drug effects of Luminal are?
suppresses REM sleep
raises the seizure threshold
What are nervous system stimulants?
How does Dexadrine work?
increases norepinerphrine, dopamine and serotonin
Dexadrine causes?
amp.-euphoria, good side effects
it is what makes them be abused
causes: hyperactivity
What is Dexadrine/dextroamphetamine used to treat?
How do you know there is an overdose?
narcolepsy, ADHD & obesity

causes convulsions/seizures, increases HR
Do not give amphetamines with?
What happens when you give amps with MAOIs?
MAO inhibitors-

hypertensive crisis
Since amps increase nonepinphine which pts should not get this drug?
Heart disease, HTN, glaucoma pts
do not give with MAOI's "blocks the blocker"-doubles the epinephrine
What are some antidepressants?
St.Johns Wort
What is a typical anti-depressant?
What is a non-typical/atypical anti-depressant?
Tricyclic agents-Elavil-treats chronic pain & depression

Wellbutron- MAOI's-treat unusual problems such as bulimia
Elavil is used to treat what?
depression & chronic pain
What are the side effects of Elavil?
sedation, orthostatic hypotension, wgt gain
anticholinergic effects
Most serious side effect of Elavil?
cardiac toxicity/arrythmias
Elavil is contraindicated in pts that?
are suicidal-lethal with 5-10 day supply
Elavil is contraindicated with what drugs?

MAOIs, sympathomimetics, anticholinergics
s.e. of Elavil/Tricyclic is anticholinergic as is MAOI and sympathomimetics so would be senergenic
SSRI's such as Prozac have what side effects?
sexual dysfunction, wgt gain, & Serotonin syndrome
Which drugs are associated with Serotonin syndrome?
Prozac (SSRI) & MAOI- cannot use together-all anti-depressants can cause-all Opioids-all CNS stimulates (amps)-lithium-illegal drugs
MAO inhibitors like Wellbutrin are used to treat?
bulimia, panic attacks, OC disorders
Main side effects of MAOI's?
CNS stimulation, hypotension
hypertensive crisis if eat foods with tyramine
many drug interactions especially with any serotonions- will cause Serotonin syndrome
What is released if you eat foods with tyramine?
What is main side effect of St. John's Wort?
What is the major mood stabilizer?
Lithium is what type of mineral?
salt- can cause fluctuations in renal Na regulation
Because of renal Na fluctuations in the taking of Lithium, what labs should be done?
blood serum levels
Why is written permission required for the taking of Lithium?
there is a high risk for toxicity
Major side effects of Lithium that affect 70% of pts?
tremors, wgt gain, fatigue, edema (w/all its problems)
many drug-drug interactions
What do anti-psychotics treat?
What are the antipsychotics?
typical- Thorazine

Atypical- Resperdal
What are the positive effects of schizophrenia?
What drug treats these?
agitation, delusions, hallucinations, paranoia
What are the negative effects of schizophrenia?
What drug treats these?
blunted affect, poor hygiene, poverty of speech, social withdrawal
How do antipsychotics work?
decrease amts of neurotransmitters, dopamine & serotonin in CNS
could take w/antidepressants with caution by assessing for serotonin symdrome, CNS stimulators
Extrapyramidal symptoms are caused by what group of drugs, which drug in particular?

What are the symptoms of Extrapyramidal symptoms (EPS)
early symptoms:
Late symptoms:
Tardive dyskinesia
What is dystonia? and which group of drugs cause this?

spasms, prolonged contractions of muscle groups
When give antipsychotics will cause pts to pull to one side
can be treated w/Sinemet or Artane (both anti-parkinson)
What is akathisia? what group of drugs cause this?
continuous restlessness, inability to sit still
antipsychotics- Thorazine, Haldol
What is tardive dyskinesia?
a late symptom of EPS- a side effect of anti-psychotic drugs like Haldol or Thorazine-lip smacking -usually irreversible "fly catching"
The most serious of all side effects of antipsychotics are?
Neuroleptic Malignant Syndrome- lead pipe, sudden high fever & changes in cognition
Dantrium used for treating
Atypical Antipsychotic Agents are?
What does Risperdal treat?

What are the side effects of Risperdal?
it treats the negative symptoms of schizophrenia

orthostatic hypotension, fewer EPS symptoms
What group does Respirdal treat well and what does it treat?
treats the elderly and treats agitation (the negative effects-although agitation is a postive effect?)
Nursing implications of anti-psychotics are:
READ the literature
take as prescribed
refer to mental health agency
monitor pt during 1st few wks
report any anticholinergic effects -urinary retention etc
Neuromusclar System drugs/skeletal muscle relaxants are which drugs?
How does Flexeril and Lioresal work?
What are the side effects?
relieves acute muscle spasms, (does not treat spasticity)
& Lioresal treats spasticity
drowsiness, dizziness
do not use w/other CNS depressants
What are the antiparkinson agents?
Anticholinergics- Artane/trihexyphenidyl

Dopaminergic agents-L-Dopa
What do anticholinergic/antiparkinson agents do?
decrease acetylcholine
Side effects of anticholinergic/Artane are?

anticholinergic reactions
CNS depression, thick pulmonary secretions
antiparkinson drug
What are the side effects of Dopaminergic drugs-L-Dopa?
NV, orthostatic hypotension
At what time of the day would you take L-Dopa?
unusual s.e.-gradual loss of effectiveness during day
may lose effectiveness for no reason
then lose their effectiveness after 2 yrs
What is Sinemet 25/100?
combination drug for antiparkinson- L-dopa and carbidopa
What are the anticonvulsant drugs?
Hydantoins & Barbituates & Tegretol
What does Dilantin treat?
anticonvulsant-prevents seizures
What are the side effects of Dilantin?
nystagmus, gingival hyperplasia
many drug-drug interactions
decreases effect of contraceptives
treats epilepsy
What does Luminal/phenobarbital treat?
How does it work?
anticonvulsive-treats seizures
raises the seizure threshold
What are the side effects of Luminal?
drowsiness, dizziness
What does Tegretol treat?
seizures-treats better than other drugs but has to have labs done
What labs are needed when taking Tegretol?
CBC's need to be drawn
What is the problem with Tegretol?
causes hematologic problems
Anesthesia -what are some of the drugs?
Penothal/thiopental (barbituate-short acting)
General- Forane/isoflurane
Nitrous Oxide-
Conscious sedation- Versed/midazolam
How does Penothal work?
neuromusclar blocking agent, opioid, relieves pain
How does Forane work?
admin by inhalation
decreases laryngeal reflexes
offer precise and rapid control of depth of anesthsia
What organ excretes Forane?
the lungs
What are the s.e. of Forane?
hypotension, respiratory suppression, Malignant Hyperthermia (sudden & severe increase in body temp)
What side effects do any Opioid have?
respiratory distress, sedation,
What is the antidote for Forane?
Also antidote for Thorazine induced NMS
How does Nitrous Oxide work?
relieves pain and numbs conciousness-begins in seconds and last 10 min
What is the most common injectible anesthesia?
ketamine/Ketalar "special K"
How is ketamine/Ketalar used?
for short term surgery
causes pain relief, sedation, immobility & AMNESIA
What is Versed used for?
anesthesia drug, conscious sedation, minor surgeries and endoscopy, not analgesic so often combined with one
What are the side effects of Versed?
respiratory depression & cardiac arrest
What drug interaction does Versed have?
when given with opioids must decrease the dosage of the opioids in half-synergises the opioid
What are some adjuncts of Anesthesia?
often pain reliever, anticholinergic, and anti-anxiety agents given pre-op
often cholinergic agents are given post-op-Duvoid
What are some Emetic drugs?
Syrup of Ipecac
Why must you monitor pts on Amorphine?
has narcotic effect, do not want pt to throw up while passed out
How is amorphine given?

injection or infusion
What are some nursing implications of emetic drugs?
do not give to pts w/decreased gag reflex-must be alert
do not give if ingested petro or caustic materials
give charcoal after emetic
What is the main Antiflatulent drug?
How does it work?
disperses gas pockets
What are some of the digestive agents?
Pancreatic agents-Pancreatin
Hepatic agents-bile salts
How does HCI work?
How do you admin HCI?
Contraindicated in?
changes pepsinogen to pepsin
by straw
What is Pancreatin used for and how is it taken?
used for replacement therapy (for ex. in Cystic fibrosis) and taken with meals
What are the uses of bile salts and the contraindications of them?
stimulates prod. of bile & bile flow from liver
prevents gallstones
cont>biliary obstruction
What are the two types of antidiarrheals?
systemic- Paragoric/Lomotil
What type of drug is Paragoric and what is its action?
When is it used?
it is an opium derivative (creates constipation) and it decreases peristalsis
with acute non-specific diarrhea and in tube feedings
What is Kaopectates action?

What does it treat?
adsorbent, sooths intestine, mild action
bacterial or toxic diarrhea
What is a side effect of Kaopectate (topical antidiarrheal)?
decreases the absorption of some meds.
What should a nurse look for when given antidiarrheals?
assess bowel function

Should not use for more than 48 hours
What are the types of laxatives?
1.Hyperosmolar-MOM, fleets, glycerin suppository
2.fiber/bulk -Metamucil
3.Emollient/stool softener-Surfak & colase
5.Lubricant- Mineral Oil
How do most laxatives work?

In what time period do they work?
by causing water to be drawn into the bowel and/or by increasing peritalsis
most take 6 hrs and over po or if supp. then 30 min,
bulk and stool softerners take a couple of days
What must a pt do when taken any type of laxatives?
drink plenty of water-may cause hypovolemia (low bl. volume) if they do not
Who should use a stool softener?
pt that should avoid straining at stool
or with disease of the rectum or anus
How does Dulcolax work?
increase peristalisis
discolors urine
can cause rectal fissures
What is the problem with Mineral Oil?
decrease absorption of KADE vitamins
don't use in pts with rectal surgary
How do antihistamines cause constipation?
How do decongestants cause constipation?
it has anticholinergic effects

sympathetic response-slows peristalsis
What are the antiemetics?
What do antiemetics treat?
nausea and motion sickness
Most antiemetics have the side effects of?
sedation(except for Emetecon),. anticholinergic effects photosensitivety
How does Phenergan work?
Emetecon is usually used when?
Scopolamine is used for?
Reglan works by?
central acting-blocks CNS receptors
-with anesthesia-inhibits the nausea
motion sickness by patch
-increasing GI motility & suppresses vomiting center
What are some problems with Reglan?
monitor for respirations, moves quickly through GI tract & constricts cardiac spincture
What are some of the gastric secretions?
what PH should the gastric tract have?
What PH should the Mucous layer have
HCI, pepsin, intrinsic factor, gastrin


What are some intestional secretions?
what is the ideal PH for intestines?
pancreatic enzymes, bile-creates alkaline

above 7.0
What causes PUD?
increased HCI production
maybe damage to mucosal layer due to
increased nocturnal acid production
How long does it take for the treatment of PUD to take effect?
4-6 wks
What are the types of drugs that treat PUD?
Histamine H2 receptor antagonists
Cytotec/misoprostol(NSAID induced pud)
Prilosec/omeprazole(proton pump)
What are the actions of antacids?
mixes with stomach contents to raise PH 3-3.5, alkalizes the stomach
stops esophageal ulceratins
How should you take antacids?
on an empty stomach will take 1 hr, on full -3 hrs
but should take round the clock
What are some of the side effects of antacids?
Diarrhea with magnesium
constipation with aluminum
electrolyte imbalance
What are some of the nursing implications of antacid dosage?
don't give w/ oral meds
chew tablets and then drink water
don't give w/enteric coated tablets
may speckle stools
What are the H2 drugs?
Histamine receptor antagonists
Tagamet(not a good drug)
How does Sucralfate/Carafate work?
What is wrong with scheduling this drug?
adheres to ulcer site-forms a protective barrier
give 30 min ac (b4 meals) and hs (b4 bedtime)
What is the bad side effect of Cytotec/misoprostol?
induces abortions=PUD drug
What is Prilosec used for?
How does it work?
reflux exophagitis
inhibits a step in the acid production process
Why would antibiotics be given for treating PUD?
may be caused by H. pylori-
treated w/Tetracyclines
What are corticosteroids?
all secretions of the adrenal glands, produced cyclically-lrg amt in morning, smlest at night
-works on negative feedback
What are the good and bad effects of corticocorticoids?
may cause atrophy
adrenal crisis (gradually withdraw)
inhibits inflammation-increases chances of infection
causes edema (w/all effects)
including HTN & lower K+
-causes Cushing symptoms
GI disturbances
Hyperglycemia-breaks down protein which release glucose
-has a catabolic effect
-CNS effects
What are the nursing implications of steroids?
do not use w/pts w/PUD, HTN, infections, diabetes
do not give w/ASA or NSAIDs
monitor wgt gain, lab values
and many many more
When would you use a steriod?
with allergies, dermatitis, rheumatic diseases
colitis, emphysema, lupus
What is a mineralcorticoid?
glucocorticoid, Aldosterone
What is the use of Aldosterone?
what is its action?
replacement therapy in adrenal insufficiency
on the kidney to retain Na and water, and excrete K+
What would be s,e. of Aldosterone?
Contradictions of Aldosterone?
edema, hypertension, hypernatremia, hypokalemia
HTN & heart disease
all steroids will have edema problems-w/edema get high sodium, low K+, hypertension, heart disease
What should be the nursing implications of

encourage foods high in K+, low in Na
monitor those lab values
monitor wgt
is a steroid so edema
What is the major immunosuppressant used?
anti-rejection agent
How is cyclosporine used?
How does it work?
stops organ rejection sometimes with another immunosuppressant for synergistic effect-
-inhibits or modifies the immune system
Problems with cyclosporine?
highly protein bound
many drug interactions
---no immunizations with any immunsuppressants
What are some side effects of immunesuppressants like cyclosporine?
Nephrotoxity, infection
What is the nursing implications for immunesuppressants like cyclosporine?
Nephrotoxicity- monitor creatine & BUN levels, watch for decreased urinary output
What are the meds for Antigout?
How do all three Antigouts work?
Benemid-increases pee
allpurinol-inhibits enzyme in uric acid synthesis
Colchicine (treatment only) stops the inflammation,decreases leucocyte movement into the tissues
What are the side effects of Antigout meds?
GI upset
renal calculi
How should Benemid be taken?
with meals, with plenty of fluids, with vegs but not with ASA
What is the last choice drug for rheumatoid arthritis?
gold salts- given w/NSaids
se-diarrhea, stomatitis, alopecia, monitor CBC
What are side effects of antiinfectives?
Toxic effects: nephrotoxicity
opic nerve damage
What drug is given with Penicillin to increase the time it stays in the body?
Benemid, antigout med
What should you watch for when giving cillins?
they are mixed with K+ or Na so can cause renal problems when either electrolyte is higher or lower
What should nurses look out for when giving cillins and cefs?
diarrhea called pseudomembranous colitis, caused by opportunistic growth of C.difficile in in the bowel
What should the pt not use as a fluid to take cillins?
acidic fluids, destroys cillins
Are cillins gram negative or gram positive?
Are cefs gram - or gram +?
gram negative
gram +
What antiinfective must you watch out for if you are allergic to cillins?
What are nursing implication for cefs?

assess for renal function, Pseud. colitis
thrombophlebitis at IV infusion site
What are complications of Aminoglycoside/mycin dosage?
kidney (nephrotoxic) ears(ototoxic)
keep well hydrated
follow peak & troughs**
do not give more than 10 days
effects last even after dose is stopped
What is one of the most common mycins/Aminoglycoside?
gentomyacin-gram negative
What is the most common Fluoroquinolones/oxacins?
-broad spectrum
What age group is not to be given Cepro?
under 18-cause joint problems
What are side effects of Cepro?
liver dysfunction
What does Tetracyclines treat?
PUD caused by H.pylori
various fevers
broad spectrum
What is contraindicated when taking Tetracyclines?
do not give with milk or multi vitamins
discolors teeth under 8yrs old
decreases eff. of contraceptives
can cause suprainfections
What is a very toxic anti-infective?
What are the toxic effects of Chloramphenicol?
aplastic anemia
gray syndrome
bone marrow depression
What anti-infective is used for serious infections?
What is a side effect of Clindamycin?
pseudomembranous colitis
What is one of the most common anti-infectives?
erythromycin E-mycin
What does sulfonamides treat?
most often urinary infections
What anti-infective causes Stevens-Johnson syndrome?
almost All anti-infectives cause?
diarrhea (some P.colitis)
must hydrate
can be nephrotoxic & ototoxic
What drug is used to treat MRSA?
What is the drug resistant strain caused by misuse of Vanomycin?
What are the side effects of Vancomycin?
very ototoxic & nephrotoxic
RED man syndrome
What is a urinary antiseptics?
What are side effects of Macrodantin?

turns urine brown or rust colored
a urinary antiseptic
What drug is Macrodantin combined with to treat urinary infection?
Bactrim (sulfa & antiseptic)
Drugs used to treat TB are?
What is the s.e of INH?
What is the s.e of Rifampin
What is the s.e of Ethambutol?
peripheral neuropathy(tingling)
-GI upset & red-orange secretions
-optic neuritis-cannot see red & green
How are most anti-TB drugs used?
in combination with other TB drugs
What drug treats infuenza A?
amatadine/symmatrel-an antiviral agent- an immunization
What are the s.e. of AZT?
bone marrow s.e.: anemia, neutropenia
What antifungal treats severe infections?
amphortericin B/Fungizone
What is a bad s.e. of Fungizone?
very nephrotoxic so should
hydrate, check output
With IV admin of Fungizone what should be done pre-op?
give tylenol, benadryl, corticosteroid or Demerol b/c IV admin causes fever & chills
Should Fungizone be admin. fast or slow through the IV
slow with large bore needle, and admin low-dose Heparin
What anti-fungal treats yeast infections?

Fungazode treats systemic infections
Why is nystatin/Mycostatin given with antibiotics?

because yeast is an opportunistic infection
What is an Anthelmintic agent?
kills worms
What are the s.e of Chemotherapy?
Neutropenia(wbc)-causes infection
Reproductive effects
What should be a normal WBC?
What is NADIR?
on chemo if less than 3,000 red flag
-lowest WBC following chemo
7-14 days following
-major dose limiting factor
What is a normal platelet count?
150,000 to 300,000 so hold chemo if less than 100,000
bleeding risk if less than 50,000
What are some of the really bad systemic s.e. of chemo?

Nephrotoxicity-assess creatine, BuN, fluid I&O
Pulmonary toxicity/fibrosis
(Bleomycin-Bleo lungs)
Cardiac toxicity (Adriamycin)
Hemorrhagic Cystitis (alkalating agents-usually order 1 L of fluid w/drug)
Neurotoxicity(Plant Alkaloids)
Extravasation of vesicants given IV which results in necrosis
Hemorrhagic cystitis- is bad infection in a woman's bladder caused by chemo drugs
What is a Alkalating agent?
Cytoxan-assess for bl. in urine
What is a Antimetabolite agent? chemo
Folic acid analogues(methotrexate)
Pyrimidine analogues 5-FU
What is an Antibiotic Antineoplastic Agent? chemo
Bleomycin, Adriamycin
What are the Hormonal agents used in chemo?
Antiestrogens, and antiandrogens
What is a Plant Alkaloid for chemo?
What is used to prevent breast cancer?
The most serious systemic effect of antibiotics is?
How do prostaglandins work?
activate pain receptors and increase the inflammatory response
Which lab should be checked when there is renal/neprotoxicity problems?
creatine levels
Which OTC drugs should you not give if a pt should not take ASA?
Kaopectate has Aspirin
What type of drug is Pyridium besides an urinary tract analgesic?
AZO standard drug-treats pain
lidocaine effect-calms the bladder
If a MAO breaks down epinephrine how does a MAOI work?
blocks the break down of epinephrine so do not give with CNS stimulants
AIM (not NSAIDs) means?
Abnormal, involuntary movements
two more side effects of thorazine are?
hyperprolactinemia-spontaneous lactation, sexual dysfunction
dyskinesias-movement disorders
How is the dosage of Artane given?
with an intial dose to prevent progression
What eletrolyte is lost with diarrhea?