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83 Cards in this Set
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dextromethorphan (Robitussin DM) Antitussive |
Use: Manage non-productive coughs Route: PO MOA: Suppress as a narcotic M/E: Kidney, Liver CI: Emphysema or asthma Com ADR: N/V, irritability Ser ADR: Drowsiness/Dizziness Max: Administer in evenly spaced intervals Min: Safety precautions Pt. Edu: Seek medical attention is cough does not resolve |
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psuedophedrine (Sudafed) Decongestant |
Use: relieve nasal congestion Routes: PO MOA: Mimics SNS to cause vasoconstriction M/E: Liver/Kidney CI: HTN, Cardiac disorders Com ADR: Tachycardia, palpations, nervousness Ser ADR: Dysrhythmias, HTN Max: Increase fluid intake, use humidifier Min: Safety precautions Pt. Edu: Use as directed |
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fexofenadrine (Allegra) Antihistamine |
Use: Allergic disorders Route: PO MOA: blocks action of antihistamine M/E: Liver/Kidney CI: Children <12 Com ADR: Flulike symptoms, N/V, drowsiness Ser ADR: QT interval prolongation Max: increase fluid intake, use humidifier Min: Safete precautions Pt. Edu: use for allergies not flu like symptoms |
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guaifenesin (Robitussin) Expectorant |
Use: Manage dry cough Route: PO MOA: decreases adhesiveness of secretion = thin out secretion M/E: Liver/Kidney CI: Hypersensitivity Com ADR: H/V, anorexia Ser ADR: - Max: Good pulmonary hygiene Min: Give with meals Pt. Edu: Seek medical attention if cough does not resolve |
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acetylcystine (Mucomyst) Mucolytic |
Use: liquify thick secretions in pts with CF Route: Nebulizer, IV MOA: Splits disulfide bond that holds mucous together; others: acetaminophen OD, contrast induced renal complications receiving IV contrast dye M/E: Liver/Kidney CI: Hypersensitivity Com ADR: N/V Ser ADR: Bronchospasm or bronchoconstriction Max: refridge solution and use within 96 hrs Min: keep suction equipment Pt. Edu: correct use of suction equipment |
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albuterol (Priventil) Bronchodilator |
Use: Bronchodilator in managing CAL and asthma *RESCUE* Route: PO, Inhalation MOA: Dilate bronchi, increases respiration depth, moderatley selective beta-2 agonist M/E: Liver/Kidney CI: hypersensitivity Com ADR: Throat irritation, tachycardia, anxiety, tremors, increase BP Ser ADR: Rebound bronchoconstriction, angioedema Max: Correct use of device Min: Don't use more than prescribed Pt. Edu: used 1st in acute settings |
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ipratropium bromide (Atrovent) Anthicholinergic |
Use: 1st line for CAL, maintenance Route: PO or IV MOA: bronchodilator M/E: Liver/Urine CI: allergies to soy or legumes Com ADR: Cough, hoarseness, throat irritation Ser ADR: bronchospasm, anaphylaxis Max: Administer daily Min: use as prescribed Pt. Edu: don't use in an acute setting |
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theophylline Xanthine derivative |
Use: Relieve bronchospasm and bronchoconstriction Route: PO or IV MOA: direct effect on smooth muscle; inhibitors phosphodieterse; increased force of diaphragm contractions M/E: Liver/Urine CI: Status of asthmatic or arrhythmia Com ADR: Headaches, N/V, insomnia Ser ADR: seizure or arrhythmia Max: Stabilize serum levels of theophylline Min: Monitor theophylline levels Pt. Edu: If doses missed take ASAP, but NEVER 2 doses at the same time |
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flunisolide (Aerobid) Anti-inflammatory |
Use: Maintenance drugs for CAL Route: PO, inhalation MOA: inhibits production of leukotrienes and prostaglandins, reduced inflammation, increase beta cell receptors, decrease mucous M/E: Liver/Kidney CI: Active respiratory infections Com ADR: Dry mouth Ser ADR: systemic absorption Max: teach how to use Min: use as directed Pt. Edu: daily use, NOT rescue |
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comolyn sodium (Intal) Mast Cell Stabilizer |
Use: Mild asthma, exercise induced asthma Route: PO, Inhalation MOA: inhibit mast cell rupture M/E: Liver/ Feces CI: Acute asthma symptoms, hypersensitivity Com ADR: dry throat, cough, wheezing Ser ADR: anaphylaxis, bronchospasm Max: teach how to use Min: use as directed Pt. Edu: daily use, not rescue |
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zafurlukast Leukotriene receptor antagonist |
Use: Treatment of CAL and asthma Route: PO MOA: blocks receptors for luekotriene bound to amino acid cysteine, anti-inflammatory M/E: Liver/Feces CI: allergy to providone of lactose Com ADR: Headache, sore throat Ser ADR: hepatic failture Max: Administer 1 hour before meals or 2 hours afters Min: take daily Pt. Edu: Will NOT treat acute track |
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omeprazole (-ZOLE) (Priolsec) Proton Pump Inhibitor |
Use: Heartburn, GERD Route: PO (only) MOA: suppresses last phase of gastric acid production; anti-microbial on H.Pylori M/E: Liver/Kidney CI: hypersensitivity Com ADR: Headache, diarrhea Ser ADR: pneumonia Max: take daily, swallow capsule whole Min: if taking large dose, divide into 2 Pt. Edu: take before meal NOT after, slow acting (2-8 weeks), may w/ take antacid |
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ranitidine (Zantac) Histamine-2 Receptor Antagonist |
Use: Active ulcers, maintenance, GERD (short term) Route: PO, IM, IV MOA: Blocks histamine-2 receptors, inhibiters gastric secretion M/E: Liver/Kidney CI: Caution with heptic/renal pts Com ADR: Wells tolerated, reacts with many drugs Ser ADR: none Max: Ranitidine + Antacid (spread over 2 hours) Min: monitor serum levels, admin IV slowly Pt. Edu: do not sub w/ OTC, do not double dose |
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aluminum hydroxide w/magnesium hydroxide (mylanta) Antacid |
Use: upset stomach, esophagitis, peptic ulcers Route: PO (liquid or pill) MOA: raise gastic pH, acid neutralizer (empty stom: 20-60 mins, after meal : 3 hours) M/E: liver/kidney CI: chronic renal failure, hypophosohatemia Com ADR: diarrhea Ser ADR: Hypermagnesimia, hypophosohatemia Max: suspension: shake, tablet: chew Min: admin 2 hours after other drugs, 1 hour before meal Pt. Edu: contact provider if GI bleed, don't take >2 weeks |
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metclopramide (Regen) prokinetic agents |
Use: GERD, anti-nausea, diabetic gastroparesis Route: PO, IV, IM, SQ, rectally MOA: unclear, cholinergic like effects, increase peristalsis, block N/V receptors M/E: lLier/Urine CI: When stimulation of GI motility may be dangerous Com ADR: CNS complaints Ser ADR: Depression, extrapyramidal symptoms Max: PO for nausea, IV over 15 mins, don't admin with anti-cholinergeic drugs Min: Monitor extrapyramidal and tardive dykinesia symtoms Pt. Edu: Take 30 mins before meals, teach pt to recognize extrapyramidal symptoms BBW: Tardive dyskinesia (tongue and mouth) |
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pancrelipase digestive (pancreatic) enzyme |
Use: enzyme replacement therapy, used for CP and chronic pancreatitis Route: PO MOA: contain lipase, amylase, and protease which break down food M/E: Liver/Kidney CI: Pork allegies Com ADR: N/V, GI upset Ser ADR: none Max: don't interchange brands Min: take as directed Pt. Edu: do not crush or chew tablets, take before or with meals, ID weight loss and steatorrhea |
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ondansetrone (Zofran) selective serotonin receptors |
Use: N/V (chemotherapy) Route: IV, IM, PO, ODT (oral disintegrating tablets) MOA: blocks serotonin receptors to prevent N/V M/E: Liver Kidneys CI: other drugs that prolong QT interval Com ADR: sleepiness, headache, constipation Ser ADR: arrhythmia, hypotension, prolongation of QT intervals, extrapyramidal effects Max: take 30 mins before chemo Min: undiluted for IV push Pt. Edu: take prior to chemo, report extrapyramidal effects |
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simethicone (Mylicon) antiflatulents |
Use: relieve pain or discomfort from gas Route: PO or rectal MOA: alters surface tension M/E: acts in GI tracts/ FECES Max: give after meals and bedtime Pt. Edu: chew tablets, increase fiber and reduce fat |
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diphenoxylate HCL with atropine sulfates (Lonox) antidiarrheal |
Use: diarrhea that is not responsive to OTC drugs Route: PO MOA: acts on smooth muscles, slows motility, prolongs transit times and allows for reabsorption of water M/E: liver/kidney CI: hypersensitivity, stool positive for bacterias, children <2 Com ADR: CNS depression, drowsiness/dizziness Ser ADR: toxic megacolon, atropine OD Max: admin 4x/day Min: decrease dose when diarrhea decreased; use <10 days, MAOIs cause HTN crisis Pt. Edu: don't exceed dose, avoid alcohol, notify is diarrhea last longer than a few days |
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magnesium hydroxide saline laxative |
Use: acute or chronic constipation, radiological testing Route: PO MOA: local GI effect, attracts and retains sald to retain water and increase pressure and soften stool, promotes peristalsis M/E: Liver/Kidney CI: abdominal pain or N/V/D, renal patients, caution in pregnancy Com ADR: GI upset Max: take will full glass of water Min: 2 hours before admin of other drugs, s-t use only Pt. Edu: not long-term use, increase fruits and veggies, don't ignore urge to defecate |
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alosetron IBS drugs |
Use: IBS-D in women, for those who haven't responded to other meds Route: PO MOA: PAIN; blocks 5-HT receptors, changes visceral sensation to decrease pain; DIA: increase transit time and decrease chloride and water secretion M/E: liver/kidney CI: patients with constipation Com ADR: constipation Ser ADR: ischemic colitis (severe abdominal pain and blood diarrhea) Min: discontinue immediately is constipation occurs Pt. Edu: read med guide, report constipation BBW: serious GI effects, women only |
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mesalmine IBD drug |
Use: IBD, ulcerative colitis, decrease inflammation Route: PO or rectal MOA: unknown M/E: liver/feces CI: allergies to sulfates, active peptic ulcer disease, caution in renal/heptic patients Com ADR: GI upset Ser ADR: rare Max: enema (8 hrs), suppository (3 hrs) Min: do not chew or crush Pt. Edu: stop taking if fever or rash occur, increase liquids |
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IBS |
- altered bowel habits, abdominal discomfort or pain -varying presentations, no clear indicators -Symptoms: painful diarrhea, constipation |
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Ulcerative Colitis |
- inflammatory bowel disease (IBD) - inflammation of intestines - Symptoms: diarrhea with pus and blood |
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Crohn's disease |
- IBD - inflammation deep into the layers of the intestine - symptoms: diarrhea and abdominal pain |
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GERD causes |
gastroesophogeal reflux disease - esophagus opens up at wrong time or too often - stomach acid backs up |
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GERD symptoms |
1. heartburn 2. regurgitation 3. dysphagia (difficulty swallowing) 4. water brash (sudden sour fluid release into mouth) |
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H. Pylori Infection |
- bacteria removes stomach lining - increase risk for gastric cancer - diagnosed using urea breath test |
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H. Pylori treatment |
- eradication of bacteria antibiotic + PPI (gastric secretion)+ bismuth (heartburn) |
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Peptic Ulcer Disease (PUD) |
- esophagus, stomach, duodeum ulcers - com symptom: pain - ser symptom: hematemesis (vomitng blood), melena (dark, black stool), N/V |
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Pancreatitis |
- acute or chronic - over time pancreas becomes destroyed and cannot produce enzymes to break down food - this can increase insulin in body and pt will become diabetic |
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Pancreatitis symptoms |
- abdominal pain, gets worse with eating |
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Pancreatitis treatment |
acute: rest chronic: replace digestive enzymes (pancrealipase) |
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Dry powder inhaler |
- maintenance use - prep medication for inhaler - mouth piece to lips - hold breath for 10 seconds - don't swallow - don't put in water |
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Mast cells |
- vasoactive substances are located in mast cells - when ruptures, substances cause an inflammatory response |
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Common Cold |
- viral infection that starts in upper RT and can spread to lower, no fever, mild symptoms |
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Allergic/ Seasonal Rhinitis |
- Inflammation of nasal cavity - upper airways respond to certain allergens |
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Sinusitis |
- epithelial lining of the sinus cavities become inflamed - swelling pushes against the bony cavity - viral or bacterial |
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Pharyngitis |
- inflammation or infection of pharynx - bacterial or viral - redness and swelling of throat |
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Laryngitis |
- inflammation of larynx or voice box - viral or bacterial |
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Influenza |
- caused by several strains of virus - transmitted through respiratory tracts by inhalation or infection |
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Function of Thyroid hormone |
1. control metabolism 2. promote growth and development 3. regulate blood volume, heat, CO, oxygen consumption, metabolism of fat/protein/CHO |
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Symptoms of hypothyroidism |
weight gain hypoactive reflexes memory loss lethargy hypotension bradycardia |
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Primary hypothyroidism |
congenital or as a result of dysfunction or destruction of thyroid gland |
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Secondary hypothyroidism |
Impaired hypothalamic or pituitary functioning SLOWED or LOW metabolism (pregnancy) |
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Treatment of hypothyroidism |
lifelong replacement of thyroid |
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Thyroid crisis |
when hypothyroidism goes unnoticed, caused by infection, severe CNS |
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Somatropin |
Use: growth hormone in children CI: closed epiphyses, cranial lesions Route: SC or IM |
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Demopression |
Use: treatment of neurogenicdiabetes insipidus Childrenand elderly at risk for hypernatremia and water intoxication, because its an antidiuretic |
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Calcitonin |
Use: treatment of Paget, postmenopausal osteoporosis, and hypercalcemia CI: hypersensitivity to fish, safety in children not established |
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Levothyroxine |
Use: replacement therapy for hyperthyroidism Route: PO (slow onset of action) MOA: increase O2 consumption, respiration, HR, growth and maturation, and metabolism of fat, CHO and protein M/E: Liver/Kidney CI: those with CVDs, HR >100 Com ADR: HTN, tachycardia, arrhythmia, anxiety, nervousness, GI upset Max: take daily Pt Ed: take before breakfast BBW: not used for weight loss! |
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HPA Axis |
Regulates and stimulate cortisol synthesis and release by adrenal cortex |
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Negative feedback loop |
Stimulation of the hypothalamus > release of CRH > stimulate release of ACTH > acts on the adrenal cortex to produce cortisol > acts back o the hypothalamus and pituitary glads to suppress CRH and ACTH |
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Corticoid steroid property |
1. anti-inflammatory 2. anti-allergenic 3. immunosuppressive |
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Adrenal cortex |
synthesizes and secretes glucocorticoid (glucose) and miceralcorticoid (sodium and water balance) |
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Glucocorticoid steroids have indirect and direct effects |
1. Immune response 2. Inflammatory response 3. Response to stressful stimuli |
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Primary Adrenal Insufficiency |
- Addison's Disease - destruction of adrenal cortex as a result of infection, glucocorticoiddeficiency (low sugar), mineralcortoid deficiency (electrolyte imbalance) |
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Secondary Adrenal Insufficiency |
As a result of something else (e.g. stopping drugto quickly) |
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prednisone Glucocorticoid steroid |
Use: Anti-inflammatory, immunosuppressant, treat adrenal insufficiency, numerous uses Route: Many MOA: Suppress negative feedback loop to create cortisol M/E: Liver/Kidney CI: systemic fungal infections, immunosuppressed , Caution: geriatric, pediatrics, pregnancy Com ADR: CNS complaints, decreased wound healing, cushioned states Ser ADR: adrenal insufficiency Max: admin before 9 am, stress does response Min: ST Use < 2 wks, no need to taper, LT use: 2-3 weeks, taper, alternate dosing Pt. Edu: Stay away from sick people, take with food, learn signs of adrenal sufficiency |
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hydrocortisone Glucocorticoid steroid |
Use: adrenal insufficiency replacement Route: Many MOA: synthetic cortisol M/E: Liver/Kidney CI: Systemic fungal infections, serious infections Com ADR: cushioned state, dose dependent |
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prednisolone Glucocorticoid steroid |
Use: Same as prednisone, NOT for adrenal insufficiency Route: PO (syrup) |
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methlyprednisolone Glucocorticoid steroid |
Use: Potent inflammatory and immunosuppressant, NOT for AI Route: PO (comes in pack for 5-7 days) |
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fludrocortisone mieralcorticoid steroid |
Use: Replacement therapy for AI Route: Absorbed in GI tract MOA: Reabsorption of Na+ to increase K+ secretion M/E: Liver/Kidney CI: systemic fungal infections, immunosuppressed , Caution: renal or CV dysfunction, pregnancy Com ADR: Na+ retention & K+ excretion Ser ADR: hyperkalemia, heart failure Max: stress dose Min: Monitor BP, low sodium and high K+ diet Pt. Edu: daily weights, K+ supplements |
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Principles of diabetes intervention |
Glycemic control Treat HTN Treat hyperlipidemia |
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Beta Cells |
Produced by pancreas Produce and secrete insulin Triggered when you eat a meal to control blood sugar |
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Alpha Cells |
Produced by pancreas Produce and secrete glucagon Triggered when you DON'T eat a meal to increase blood sugar |
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MOA of Insulin |
Biphase Phase 1: quick release, rapid Phase 2: delayed onset, longer |
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Type 1 DM |
- Absolute insulin deficiency - Pancreas beta cell destruction - Presentation: Polyphagia (hunger), Polydispia (thirst), polyuria (urination) |
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Type 2 DM |
- Insulin resistant - Beta cell dysfunction - Presentation: asymptomatic at first, because there are still functioning beta cells - Test all adults over 45 yrs - FPG >126 mg/dL |
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Diabetic Ketoacidosis |
- DM Type 1 - Glucose level > 500 - Altered mental state, drunk like, dehydrated, sweet/alcohol breath |
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Nonketotic hyperglycemia |
- DM Tep 2 - Glucose levels > 600 - Altered mental state, seizures |
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Hyperglycemia |
- Hunger - Extreme thirst - Dry Skin - Nausea - Drowsiness - Blurred vision - Frequent urination |
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Dawn Phenomenon |
- Increased glucose levels early morning - larger doses of insulin at qhs |
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Somogyi Effect |
- Early morning rebound hyperglycemia - Lesser doses of insulin and/or dietary intake at bedtime |
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When to use insulin |
- Type 1: all patient, basal insulin - Type 2: at time of diagnosis to achieve glycemic control; OR in the acutely ill; OR when PO meds aren't working |
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SHORT acting, RAPID onset insulin |
- aspart (peak 1-3 hours) - glusine (peak 30-90 mins) - lisprso (peak 30-90 mins) Use: Type 1 and Type 2 Duration: 3-5 hours ROute: SQ |
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regular |
Short acting insulin, clear Use: Type 1 and Type 2 Route: SQ or IV (only type that can be used in an IV) MOA: QUICK onset (30-60 mins); PEAK (2-3 hours); SHORT duration (4-6 hours) CI: hypoglycemia, caution: adolescent (adherence), older adults (small needle) Com ADR: lipodystropher (lipohypertrophy or lipoatrophy) Ser ADR: hypoglycemia Max: room temp when admin, intra-site rotation Min: monitor for hyperglycemia Pt Ed: monitor glycose, diet and exercise |
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nph (Humulin N) |
Intermediate acting insulin, cloudy MOA: Onset (1-2 hours), Peak (6-14 hours), Duration (16-24 hours) Route: SQ only |
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detemir (Levemir) |
Long acting insulin, clear Use: basal insulin (DM 1) MOA: Onset (1-2 hours), Peak (6-8 hours), Duration: dose dependent (12 or 20 hours) Route: SQ only |
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glargine (Lantus) |
Long acting insulin, clear Use: provides constant glucose for over 24 hours MOA: onset (< 1 hour), NO peak, Duration (>24 hours) Route: Admin SQ daily at bedtime |
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glyburide (Diabeta) |
Non-insulin med, sulfonylureas Use: adjunct treatment to diet and exercise MOA: stimulate beta cells to release insulin (pt must have some working beta cells) M/E: Liver/Kidney CI: not approved for children, sufonamide allergy ADR: hypoglycemia, hypnaturimia, weight gain Max: give before meals Min: lower doses in elderly, lower doses in renal and liver disease pt Pt Edu: Avoid alcohol, signs of hypoglycemia, diet and exercise |
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metformin |
Biguanide, non-sulfonylurea, non-insulin med Use: DM 2 MOA: anti-hyperglycemic (reduce glucose production, lower TRG and LDL Route: PO, BID dosing (morning and evening meals CI: renal patients, heart failure, > 80 yrs old Com ADR: metallic taste, GI upset Ser ADR: hypoglycemia (only occurs when using other glucose lowering agents - NOT metformin alone) Pt Ed: Loses effectiveness after 5 years BBW: lactic acidosis (hold 48 hours before and after iodine contrast, hold prior to and after surgery) |
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glucagon |
Use: treat hypoglycemia, emergency treatment MOA: opposite effect of insulin, raises blood sugar; stimulates gylcogenolysis; ONLY works if glycogen is available Route: IM, IV, SQ RAPID onset, SHORT acting |
