*CH 50 adverse effects interactions and contradictions

Question 1

central nervous system effects

Answer 1

Stimulation (excitement)

CNS depression

Question 2

Nurses action for CNS effects

Answer 2

implement seizure precautions for CNS stimulation

Question 3

Client education for CNS effects

Answer 3

CNS depression do not drive operate heavy machinery or participate in dangerous activities

Question 4

extrapyramidal symptoms

Answer 4

abnormal body movements

ex: tremors rigidity, restlessness, acute dystonia (spastic movement of the back neck tongue face)

Question 5

Nurse action for extrapyramidal symptoms

Answer 5

most common on mental health meds that target CNS

keep client safe when movement and balanced are uncontrollable

Question 6

Anticholinergic effects

Answer 6

result from muscarinic receptor blockade and effect the eyes, smooth muscle tone, exocrine glands and heart.

Question 7

nurse action for Anticholinergic effects

Answer 7

sip fluids for dry mouth
wear sunglasses outdoors to prevent photophobia
urinate before taking meds to reduce urinary retention
increase exercise fiber and fluids to prevent constipation
reduce overheating bc you might not sweat

Question 8

Cardiovascular effect

Answer 8

involve blood vessels and heart

ant-hypertensives can cause orthostatic hypotension

Question 9

nursing action for cardiovascular effect

Answer 9

instruct pt to sit or lie down and get up slowly when needed to reduce light headedness

Question 10

GI effects

Answer 10

local irritation of the GI tract
stimulation of vomiting center
stimulation or slowing bowel motility

Question 11

Nursing action of GI effects

Answer 11

Many NSAIDS cause GI distress

take meds with food notify provider about consistent GI effects

Question 12

Hematologic effects

Answer 12

common AND life threatening

Question 13

nursing action for hematologic effects

Answer 13

bone marrow depression can result from anticancer meds
hemorrhagic disorders from anticoagulants and thrombolytics
pt should report bruising discolored urine stool petechiae and bleeding gums

Question 14

Hepatotoxicity

Answer 14

damage to the liver

Question 15

nursing action for hepatoxicity

Answer 15

increase liver damage when 2 meds are hepatotoxic

Question 16

Nephrotoxicity

Answer 16

result of antimicrobial agents and NSAIDS

impaired kidney function interferes with meds excretion –> accumulation and adverse effects

Question 17

nursing action for nephrotoxicity

Answer 17

aminoglycosides can cause kidney damage

monitor Blood creatinine and BUN levels

Question 18

Toxicity

Answer 18

sever and potential life threatening effects from excessive dosing but can also occur in therapeutic levels

Question 19

fun fact

Answer 19

acetylcysteine minimizes liver damage due to acetaminophen toxicity

Question 20

rapid hypersensitivity

Answer 20

rapid or immediate
occurs when inhaling, ingestion, injection direct contact with allergen
allergies to substances

Question 21

rapid hypersensitivity results

Answer 21

acute inflammation
histamine release
vasoactive amines release

Question 22

rapid hypersensitivity reactions

Answer 22

include superficial response (hay fever, rhinosinusitis) allergic asthma anaphylaxis angioedema

Question 23

angioedema

Answer 23

swelling of deep tissue ( lips, face, neck) can occur in first 24 hours or long exposure. NSAIDS and ACE inhibitors are the most common meds that can cause angioedema

Question 24

Anaphylaxis

Answer 24

rapid systemic reaction following allergic response to an allergen. (dyes food, bites, stings, foods)

Question 25

anaphylaxis symptoms

Answer 25

GI cramping itching hives progression of angioedema and intensely large itchy hives

Question 26

anaphylaxis respiratory manifestation

Answer 26

``` lung crackles wheezing decreased breath sounds lump in throat hoarseness stridor ```

Question 27

anaphylaxis cardiovascular manifestation

Answer 27

include weak thready pulse tachycardia hypotension

Question 28

nurse actions for anaphylaxis

Answer 28

``` epinephrine for severe allergic reaction bronchodilators antihistamines respiratory support monitor ABGs albuterol monitor hemodynamics status (may experience extensive vasodilation, capillary leak) tachycardia weak pulse monitor client frequently ```

Question 29

client education

Answer 29

wear medical alert bracelet | keep epinephrine available all the time

Question 30

Immunosuppression

Answer 30

a decrease or absent immune response

Question 31

nurse actions for immunosuppression

Answer 31

glucocorticoids depress the immune response and increase risk of infection monitor for indication of infection

Question 32

Increase therapeutic effects nursing actions

Answer 32

taking some meds together can increase therapeutic effect

Question 33

fun med fact

Answer 33

inhale albuterol (beta2 adrenergic agonist) 5 minutes before inhaling fluticasone (a glucocorticoid) to increase absorption of fluticasone

Question 34

Increase adverse effect nurse actions

Answer 34

taking two meds that do the same thing increase the risk or worsen adverse effects

Question 35

fun med fact

Answer 35

Diazepam and hydrocodone with acetaminophen both have CNS depressant effects.

Question 36

Decrease therapeutic effect nurse actions

Answer 36

one med increase metabolism of another med = decrease level and effectiveness of meds

Question 37

fun med fact

Answer 37

Phenytoin increase hepatic med-metabolizing enzymes that affect warfarin = decrease blood level and therapeutic effect of warfarin

Question 38

decreased adverse effects nurse action

Answer 38

one med can counteract the adverse effect of another med.

Question 39

fun med fact

Answer 39

ondansetron (an antiemetic helps with nausea and vomiting) counteracts the adverse effect of nausea and vomiting's from chemo

Question 40

increase blood levels, leading to toxicity

Answer 40

one med can decrease the metabolism of a second med = increase serum level of the second med and lead to toxicity

Question 41

fun med fact

Answer 41

fluconazole (antifungal) inhibits hepatic med-metabolizing enzymes that affect aripiprazole (antipsychotic) = increase blood levels of aripiprazole

Question 42

medication-food interactions

Answer 42

food can alter medication absorption and can contain substances that react with some meds

Question 43

tyramine

Answer 43

consuming food with tyramine while taking monoamine oxides inhibitors (MAOIs) can lead to hypertensive crisis. (avocados, figs, aged cheese, yeast extract, beer, smoked meats)

Question 44

vitamin K

Answer 44

decrease the therapeutic effects of WARFIN and put clients at risk for blood clots

Question 45

dairy

Answer 45

tetracycline can interact with chelating agent (milk) to form an insoluble, unobservable compound take tetracycline 1 hr before or 2 hr after taking dairy

Question 46

Grapefruit

Answer 46

inhibits presystolic medication metabolism in the small bowel = increasing absorption of some oral medication (nifedipine) a calcium channel blocker = increase effects reaction

Question 47

caffeine

Answer 47

theophylline, a methylaniline for asthma control and caffeine can result in excessive CNS excitation

Question 48

Antacids Vitamin C

Answer 48

taking aluminum-containing antacids with citrus beverage can result in excessive absorptions of aluminum

Question 49

fun med fact

Answer 49

morphine depresses respiratory function. asthma patients or respiratory dysfunction require precaution with the use or morphine