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Module 7 (Critical Care) > Exam 3 Pharmacology > Flashcards

Exam 3 Pharmacology Flashcards

Fentanyl, Warfarin, Enoxaparin, Prednisone, Promethazine, Pantoprazole, Mannitol, Metronidazole

1
Q

Fentanyl MOA

A

synthetic opioid agonist
100x more potent than morphine
- changing the brain and CNS response to pain

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2
Q

Fentanyl expected effects

A

relaxation
euphoria
pain relief
sedation
confusion
drowsy
dizzy
N/V
urinary retention
pupillary constriction
respiratory depression

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3
Q

Fentanyl adverse effects

A

dysrhythmias, increase HR
agitation, hallucinations, fever, sweating, confusion
n/v, loss of appetite, weak or dizzy
inability to keep erection or a period
seizure
chest pain
extreme drowsiness

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4
Q

Fentanyl nursing interventions

A

Monitor respirations and O2 for depression
- neuro

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5
Q

Fentanyl is used for

A

Pain
Sedative for mechanical ventilation

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6
Q

Fentanyl Routes

A

Transdermally (long-lasting)
- 72 hours max then remove and apply the next one

Lollipops
SL
Buccal
Sprays
injections

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7
Q

Fentanyl is a type of

A

Narcotic analgesic (opiate)

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8
Q

How to use lozenges with Fentanyl?

A

place within cheek and gum
actively suck and move around in the mouth using the handle (twirl often)
- do not chew, crush, or bite
- do not eat or drink while it is in your mouth
- Finish within 15 minutes

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9
Q

If the patient has a fentanyl lozenges, and starts to feel dizzy, sleepy, or nauseous, then

A

remove and dispose of properly
- out of reach of children
- hot running water to dissolve

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10
Q

Fentanyl OD antidote?

A

Naloxone

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11
Q

Fentanyl OD s/s

A

excessive drowsiness or sleepiness
slow or shallow breathing
difficulty breathing
cold, clammy skin
narrowing or widening of the pupils (black circles in the middle of the eyes)
unable to respond or wake up
slowed heartbeat
unusual snoring

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12
Q

Fentanyl Contraindications medical

A

severe asthma or other breathing problems
stomach or bowel obstructions (paralytic ileus)

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13
Q

Warfarin MOA

A

inhibits essential enzyme for activating the vitamin K available in the body
- reduces clotting factors

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14
Q

Warfarin expected outcomes

A

decrease clotting
- No DVT, stroke or PE
BRUISE EASILY

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15
Q

Warfarin adverse effects

A

uncontrollable bleeding
hemoptysis
bleeding gums
hematuria
bloody stool
dizzy,weak
fever
nosebleed

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16
Q

Warfarin nursing interventions

A
  • limit vitamin K consumption (green and leafy)
  • careful about bleeding, OTC, alcohol
    don’t stop unless directed
  • ID bracelet
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17
Q

Warfarin used for

A

prevention of DVT and stroke
a fib (irregular HR)
prosthetic heart valves
patients of an MI

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18
Q

Warfarin drug type

A

Anticoagulant

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19
Q

Warfarin contraindications

A

erythromycin
phenytoin decrease
NSAIDs, steroids,tylenol

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20
Q

Warfarin INR LEVEL

A

2-3 x therapeutic levels

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21
Q

Warfarin antidote

A

Vitamin K AND FFP

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22
Q

Warfarin onset

A

slow acting
5 days

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23
Q

Warfarin lab levels to monitor

A

PT/INR

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24
Q

Enoxaparin MOA

A

binds and potentiates antithrombin (circulating anticoagulant) to stop the clotting factors

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25
Q

Enoxaparin expected outcomes

A

no DVT, PE, ors ischemic cardiac complications
- bleeding
- bruising
- pain/irritation at the injection site

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26
Q

Enoxaparin adverse effects

A

bleeding (gums, nosebleeds, bruising)
injection site reaction
anaphylaxis
thrombocytopenia
osteoporosis
N/V/D
HA

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27
Q

Enoxaparin nursing interventions

A

Digoxin toxicity (N/V)

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28
Q

Enoxaparin labs to monitor

A

Platelets <150000 and CBC
Half-life 3-6 hours
Do not rub/massage after injection site
Monitor for constipation
soft bristle toothbrush,tarry stools, hematuria

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29
Q

Enoxaparin used for

A

preventing blood clots
prophylactic on surgically, bedrest patients
unstable angina, MI

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30
Q

Enoxaparin precautions

A

bleeding disorders
kidney/liver pts
NSAIDs/ASA
elderly

31
Q

Enoxaparin contraindications

A

HIT (Heparin)
active bleeding (GI and hemorrhagic stroke)
endocarditis
spinal anesthesia
- thrombolytics, SSRI/SNRI, NSAIDs, antiplatelet, digoxin
- garlic, ginger, ginkgo biloba, vitamin E, fish oil, danshen, dong quai, saw palmetto

32
Q

Enoxaparin drug type

A

antithrombotic

33
Q

Prednisone MOA

A

lowers inflammation by reducing the activity and volume of the immune system

34
Q

Prednisone expected outcomes

A

low immune system
high blood sugar
low inflammation
weight gain
nausea
HA
mood swings

35
Q

Prednisone adverse effects

A

blurry vision
dizzy
fainting
fast and irregular HR
increased urination/thirst
irritable

36
Q

Prednisone nursing interventions

A

no crowds/live vaccines
insulin not for diabetes

37
Q

Prednisone used for

A

inflammation flare ups
arthritis
asthma
adrenal crisis

38
Q

Prednisone contraindications

A

blood thinners (Warfarin and NSAIDs)
desmopressin
other immunosuppressants

39
Q

Prednisone drug type

A

corticosteroids

40
Q

Prednisone labs to monitor

A

blood sugars
CBC
wt gain
urea and electrolytes
sweeling in lower extremity

41
Q

Promethazine MOA

A

histamine antagonist
alpha adrenergic
- prevent nausea/vomiting
short term for insomnia
relieve allergies s/s

42
Q

Promethazine EXPECTED OUTCOMES

A

induction of sleep which can be easily aroused again if needed
- drowsy
- dizzy
- constipation
- blurred vision
- dry mouth
(anticholinergic)
sedation
- nightmares
- confused
- respiratory depression
- extrapyramidal (dystonia, akathisia, and parkinsonism)

43
Q

Promethazine adverse effects

A

trouble urinating
extravasation

44
Q

Promethazine nursing interventions

A

large bore IVs patency
monitor for tissue necrosis

45
Q

Promethazine used for

A

tx allergic reactions
anxiety and tension
N/V

46
Q

Promethazine contraindications

A

pregnancy and lactating
coma
tx of asthma

47
Q

Promethazine drug type

A

Antihistamine
- sedating

48
Q

Promethazine labs to monitor

A

VS - BP and HR
Blood sugar

49
Q

Pantoprazole MOA

A

reduces the amount of stomach acid made

50
Q

Pantoprazole expected outcomes

A

no ulcers or hematuria
HA, dizzy
stomach pain, gas, N/V/D
joint pain
fever, rash, cold s/s

51
Q

Pantoprazole adverse effects

A

stomach cramps
bloated
diarrhea
fever
N/V
unusual tiredness

52
Q

Pantoprazole nursing interventions

A

diarrhea = infection
oliguria
hemturia
More likely to break a bone if long term
-increase risk of fx in the hips, wrist and spine

53
Q

Pantoprazole used for

A

esophagitis
GERD
Ulcers tx and prevention
allows the digestive system to rest

54
Q

Pantoprazole contraindications

A

long term = harder to digest B12
osteoporosis
Digoxin, diuretic, methotrexate

55
Q

Pantoprazole drug type

A

Proton pump inhibitor

56
Q

Pantoprazole monitor labs

A

BUN and Creatinine
I&Os
bowel sounds

57
Q

Mannitol MOA

A

elevates blood plasma osmolality
- enhanced flow of water from tissues to
brain and CSF into interstitial fluid and plasma

58
Q

Mannitol expected outcomes

A

neuro status improved
- 1st transient hyponatremia then hypernatremia as water is
lowers ICP and cerebral edema
raises HTN during dialysis

59
Q

Mannitol onset and duration

A

within 5-10 minutes
last up to 6 hours

60
Q

Mannitol adverse effects

A

worsening cerebral edema
- confusion
- lethargy
- HA
heart failure
diuresis
- low Na, K, Ca
dyspnea
hypotension
anaphylaxis

61
Q
  • Mannitol nursing interventions
A

extravasation
I&Os strict (30-50mL/hr or 0.5mL/kg/hr)
ICP
NEURO STATUS
dysrhythmias (K imbalance)
fluid shifts = hemodynamic instability

62
Q

Mannitol used for

A

decreasing ICP, IOP, and cerebral edema
excrete toxins
improve BP during dialysis
Acute renal failure in oliguric phase

63
Q

Mannitol contraindications

A

pulmonary edema
active cranial bleeding
significant hypovolemia
heart and kidney failure
kidney insufficiency
electrolyte imbalances
CAUTION with Digoxin

64
Q

Mannitol drug type

A

osmotic diuretics
- crosses the blood brain barrier

65
Q

Mannitol monitor labs

A

electrolytes (Na and K)
SERUM osmolality

66
Q

Metronidazole MOA

A

inhibits protein synthesis by interacting with DNA
and breaks down bacteria to prevent or stop infections
cytotoxic

67
Q

Metronidazole expected outcomes

A

no fever, normal WBCs
dizzy
lightheaded
N/V/D
slight metallic taste in the mouth

68
Q

Metronidazole adverse effects

A

encephalopathy
meningitis aseptic
neutropenia
peripheral neuropathy

69
Q

Metronidazole nursing interventions

A

Call HCP if s/s of liver damage or renal damage
NEURO STATUS
ER - without food 1 hour before or 2 hours after a meal
- do not break or crush

70
Q

Metronidazole used for

A
  • not for colds, flu, or other viruses
    skin infections, rosacea, mouth infections
  • infected gums and dental abscesses
    bacterial vaginosis and pelvic inflammatory disease
    *stds)
71
Q

Metronidazole contraindications

A

pregnant/breastfeeding
liver problems
dialysis
drinking alcohol

72
Q

Metronidazole drug type

A

Antibiotic

73
Q

Metronidazole monitor labs

A

WBC
liver enzymes
triglycerides

Module 7 (Critical Care) (22 decks)

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