Nursing exam pharm - Exam #2 Flashcards
what are the 6 NSAIDs
Salicylates, Para-chlorobenzoic acid, propionic acid derivatives, Fenamates
Aspirin
toxic serum salicylate level is >300 mcg/mL
NSAID salicylate class
dosing max is 3900 mg/d
diagnosis for arthritic conditions, lower temperature
Reasons not to give:
do not give to children as it increases the risk of reye syndrome, can be toxic to kidneys do not give to patients in renal failure
Side effects: dizziness, headache, dyspepsia, n/v, abdominal pain
Adverse reactions: tinnutus, hearing loss, hyperkalemia, Hypernatremia, elevated hepatic enzymes
Education to patient: warn parents to not administer to children when they are experiencing flu-like symptoms, take with food, if patient has been observed taking a large amount call the poison control center immediately, stop taking 7 days before surgery
antidote: lavage, monitor electrolytes, VS
Evaluation: decreased inflammatory symptoms and decreased pain level
Para- chlorobenzoic acid (indomethacin)
highly protein bound, must take with food, may cause dizziness N/V/D, used for treatment of Rheumatoid arthritic/ gout/ osteoarthritis, may cause sodium retention and increased blood pressure
Ibuprofen
class: NSAIDs propionic acid derivative
dosing max 3200 mg/d
reasons not to give: is patient is on lithium, bleeding disorders, peptic ulcer, gi bleeding
Education:
for female patients do not 1-2 days before mestrual period to avoid heavy flow, advise pregnant patients to avoud NSAIDs, do not take Ibuprofen and acetaminophen with other NSAIDS, avoid alcohol can result in gastric ulcer
Evaluation: decrease in pain, decrease in swollen joints, and increase in mobility
Antidote: lavage and induce diuresis
Propionic acid derivatives NSAIDS what to know
do not take with other nsaids take with food, increased bleeding, increased side effects of lithium, steven johnsons syndrome
Fenamates what to know
Potent medication, avoid alcohol, higher rates of GI irritation, do not take if you have peptic ulcer disease, prescribed medication for moderate pain, dysmenorrhea, osteoarthritis
Ketorolac
do not take with other NSAIDs, first injectable NSAID, use for less than 5 days, typically used post-surgical `
Oxicams
(the term is in the medication)
What to know
they have a long half-life, oral, once daily, highly protein bound, may take up to 2 weeks to work, long term use for RA/OA, do NOT take with other NSAIDs, may cause GI distress/ulcerations
Celecoxib
class: NSAIDs selective cox-2 inhibitors
dosage max in adult is 800 mg/d
max in older adults
400 mg/d
used to treat OA/RA, dysmenorrhea, and moderate to severe pain for ankylosing spondylitis, migraines
Reasons to not give to patients: patients with renal or hepatic dysfunction, peptic ulcer disease, GI bleeding, alcohol abuse
Side effects: headache, dizziness, drowsiness, sinusitis, pharyngitis, cough, anorexia, abdominal pain
Adverse reactions: Gi bleeding/obstruction/ulcer/perforation, hypertension, hearing loss, dyspnea, tendon rupture
Education to patient:
stop taking before procedure and surgery, if you experience hearing loss, Gi bleeding, hypertension call us immediately or visit your nearest emergency center, this drug can affect certain lab values such as INR, can increase toxicity to lithium, nasal sprays such as fluconazole and ketoconazole can increase the drug levels in your system
evalate: relieve inflammatory symptoms and pain and migraine.
Corticosteroids
end in -sone
used to treat acute pain, decreased mobility, activity intolerance
do not take with caffeine as adverse reactions can occur such as facial swelling/ hypersensitivity reactions/ serizures/ increased joint pain, shoould be taken in the morning due to long half-life and must be taken with food, continuously monitor blood glucose levels
Evaluation:
able to take as prescribed with minimal complications, decreased pain/ swelling/ inflammation
what are some examples of immunosuppressive agents
Azathioprine, Cyclophosphamide, Methotrexate
what are the classes of Disease-Modifying Anti-Rheumatic Drugs
Immunisuprressive agents, Immunomodulators, Antimalarials
what are some examples of Immunomodulators
Infliximab (IV), Adalimumab (SubQ), Leflunomide (oral)
what are antimalarials
these are taken when other methods have failed can take 4 - 12 week for noticeable effects
what do disease-modifying anti-rheumatic drugs treat and do
alleviate RA/OA/ severe psoriasis/ Crohns/ ulcerative colitis
Infliximab
immunomodulator
used to treat arthritic conditions, ulcerative colitis and Crohn’s disease
Drug lab - interactions:
can put person at an increased risk of infection
Side effects: headache, dizziness, cough, fatigue, chills, flushing, fever,nausea
adverse reactions: hypo/hypertension, chest pain, dyspnea, seizures, bone fractures, anemia, pulmonary edema
education: do not drive until you are adjusted to the drug, report to physician if infection occurs
what are the different anti-gout drugs
colchicine, xanthine oxidase inhibitors, Probenecid
the different types of pain
acute, chronic, cancer, somatic, superficial, vascular, visceral
Febuxostat
antigout: xanthine oxidase inhibitors
Contraindications: patients with hypersensitivity to xanthine oxidase inhibitors, hepatic/renal disorders, cardiac disease, stroke, chemotherapy
Side effects: Dizziness, headache, blurred vision, dry mouth, abdominal pain
Adverse reactions: bradycardia, gout exacerbations, Guillan-Barre syndrome, dyspnea, chest pain
Education: avoid alcohol, do not double dose, flares can occur during the 6 weeks of treatment talk to your provider
Evaluation: decreased pain in joints, decreased formation of stones in kidneys
Colchicine
first anti inflammatory gout medications, used for acute attacks, GI irritation, nto to be used with patient with severe renal, cardiac, GI dysfunctions
Probenecid
uricosuric increases uric acid excretion,
used for chronic gout,
not for acute attacks, can be used with other anti-gout medications, Highly protein bound, Gi irritation make sure to take with food and increase fluid intake
Allopurinol
antigout: xanthine oxidase inhibitor
used for treatment of gout
not to be given to pregnant patients or patients that have renal/hepatic disorders
side effects: N/V/D, rash, anorexia,
adverse reaction: renal failure and HF
Education: encourage patinets to have regular blood tests to monitor for blood dyscrasias (CBC), increase fluid intake can increase excretion and uric acid excretion
evaluation decreased pain in joints, decreased stone formation in kidneys, decreased uric acid levels,
possible hemodialysis
Nonopioid analgesics
NSAIDs, Acetaminophen
What are the different Opiod anlagesics
codeine, hydrocodone, oxycodone, morphine, methadone, Fentanyl, Hydromorphone, Meperidine, Nalbuphine
Acetaminophen
analgesic not an anti inflammatory
Therapeutic uses: to decrease pain and fever
reasons not to give: renal/ hepatic disorder, hypertension, diabetes Mellitus, alcohol use disorder, Older adults
Side effects: headache, insomnia, anxiety, fatigue, anorexia, nausea, vomiting, constipation, peripheral edema
adverse reactions: oliguria, hearing loss, hypomagnesemia, elevated hepatic enzymes
education: teach patients to read the label of the OTC drug make sure to not exceed the limit of 4g/d to avoid hepatic damage, avoid alcohol when taking the prescription, teach parents of patient to not self-medicate acetaminophen for no more than 5 days for adults no more than 10 days without a heath care providers approval
Do call posion control center if ingested large amount or unknown amount of acetaminophen
Evaluation: lower pain scale rating, decreased temperature reading
Antidote: acetylcysteine
NSAIDs
These are anti-inflammatory drugs,
it can affect clotting, GI irritation, reyes syndrime in children,
DO not give with other nsaids due to being highly protein bound, the antidote is sodium bicarbonate
what are some adjuvant therapies for analgesics?
anticonvulsants, antidepressants, corticosteroids, antidysrhythmic, Anesthetics
Meperidine
Class of medication: Opiod Analgesic
CSS II
Uses: moderate to severe pain preoperatively, post operatively, general anesthesia maintenance, sedation induction,
Reasons not to give: if the patient has chronic pain, severe liver dysfuntion, sickle cell disease, history of seizures, Severe Coronary artery disease, or cardiac dysrhythmias
Side effects: decrease in blood pressure, drowsiness, dizziness, sedation, confusion, headache,
Adverse reactions: respiratory depression (rr is 8 a minute), anaphylaxis ( rash/ swelling), Increased intracranial pressure
Drug/lab test: increased amylase and lipase
teachings to patient: do not stop this medication abruptly as it cna cause withdrawal symptoms, do not drive or operate vehicle under this medication, do not use long term this is very addictive, when moving positions do it very slowly to prevent becoming unconscious when standing up,
Evaluation: decrease in pain
Antidote: Naloxone, vasopressors, O2, Iv fluids
Nalbuphine
Opioid agonist-antagonist
analgesic
used to relieve moderate to severe pain and for anesthesia induction and maintenance.
Reasons not to give to patient: Patients with addictive disorder, respiratory insufficiency, head injury can increase intracranial pressure, renal or hepatic disorder cation in older adults
Side effects: sizziness, drowsiness, headache, dry mouth, nausea, vomiting, diaphoresis, erestile dysfunction
Adverse reactions: Bradycardia, hypo/hypertension, dyspnea
Teachings to patient: do not use alcohol while taking nalbuphine can cause passing out due to SOB in patient, suggest nonpharmacological methods to lessen pain such as ambulation changing positions, Can be very addictive
Evaluation: lower pain scale rating after 1 hour after medication administration
Antidote: Naloxone, iv fluids, O2, vasopressors,
what are the different types of headaches
migraine and cluster
what anticonvulsant is used as adjuvant therapy for analgesics
Gabapentin
used for neuropathic pain, inhibits neural excitability.
what is used as adjuvant therapy for analgesics antidepressants?
Amitriptyline
prevents the reuptake of serotonin, effective in treating neuropathy
what is a antidysrhythmic used as adjuvant therapy for analgesics?
Mexiletine
suggested in the management of neuropathic cancer pain
what is an anesthetic used as adjuvant therapy for analgesics?
Lidocaine
interrupts the transmission of pain signals to the brain
what is the antidote for opiods?
Naloxone
what is the antidote for Acetaminophen?
Acetylcysteine
what is the antidote for NSAIDs?
Sodium Bicarbonate
what are the differences between migraine/ cluster headaches
a migraine is unilateral throbbing head pain unlike cluster headaches that are non throbbing around the eye
migraine include nausea, vomiting and light sensitivity unlike cluster headaches that do not induce nausea and vomiting
time suration of migraine is hours to days and cluster is it can last several weeks
