Exam 1 Flashcards
1
Q
6 Rights of Medication Administration
A
Patient, medication, dose, route, time, documentation
2
Q
Additional ‘rights’
A
Assessment, client’s right to education,e valuation, client’s right to refuse medication, right reason for giving the medication
3
Q
Nurses ____ and ____ what % of all errors?
A
Nurses prevent and intercept 86% of all potential errors
4
Q
2 categories of medication errors
A
Omission and Commission
5
Q
Errors of Omission (4)
A
Not prescribed, not dispensed, not administered, not taken
6
Q
Errors of commission (11)
A
Wrong dose, wrong drug, wrong drug substitute, wrong patient, wrong route, allergic reaction, drug-food interaction, drug overuse without therapeutic effect, communication failure, failure to follow policy, failure to follow drug specific instruction
7
Q
Schedule category I
A
High abuse potential - no medical use (ex: Heroin, LSD)
8
Q
Schedule category II
A
High abuse potential - accepted medical use (ex: morphine)
9
Q
Schedule category III
A
Medically accepted - possible dependence, less potential for abuse (ex: codeine)
10
Q
Schedule category IV
A
Medically accepted - possible dependence (ex: phenobarbital)
11
Q
Schedule category V
A
Medically accepted - limited potential for dependence (ex: opioids for diarrhea and cough)
12
Q
FDA Pregnancy Category A
A
Studies show NO fetal risk
13
Q
FDA Pregnancy Category B
A
No fetal risk in animal studies (assumed no risk in humans)
14
Q
FDA Pregnancy Category C
A
Fetal risk in animal studies - need to weigh risk vs benefit
15
Q
FDA Pregnancy Category D
A
Established/proven fetal risk - weigh risk vs benefit if life threatening situation
16
Q
FDA Pregnancy Category X
A
Established/proven fetal risk - risk is greater than benefit so AVOID in pregnancy
17
Q
Receptor sites are called
A
Ligand binding domain
18
Q
Kinase Linked Receptor
A
Ligand binding domain on cell surface; drug activates enzyme within cell, initiating effect.
19
Q
Ligand-gated ion channels
A
Drug spans cell membrane, ion channels (Ca and Na) open, initiating effect
20
Q
G protein-coupled receptor systems
A
Drug activates receptor, activates G-protein, and activates effect
21
Q
Nuclear receptors
A
Effect is achieved through functions of cell nucleus by means of transcription, thus prolonged activation.
22
Q
Aliphatic example and effects
A
Chlorpromazine (Thorazine): strong sedative, lowers BP, moderate EPS
23
Q
Piperazine example and effects
A
Fluphenazine (Prolixin): strong anti-emetic, low sedative and BP effects, greater EPS
24
Q
Piperadine example and effects
A
Thioridazine (Mellani): few EPS, life threatening dysrhythmias
25
Haloperidol (Hadol)
Similar to phenothiazines but POTENT (thus smaller dosages)
| -Prolongs QTc, leading to arrhythmias
26
Acute Dystonia - symptoms and treatment
Symptoms: facial grimacing, involuntary upward eye movement, muscle spasms (tongue, neck, face, back) (trunk arches forward), laryngeal spasms
Treatment: benzodiazepine like Lorazepam (Atvian) or anticholinergic/antiparkinsonism like Bentropine (Cogentin)
27
Akathisa - symptoms and treatment
Symptoms: restless, trouble standing still, paces the floor feet in constant motion, rocking back and forth
Treatment: benzodiazepine like Lorazepam (Atvian) or beta-blocker like Propranolol
28
Tardive Dyskinesia - symptoms and treatment
Symptoms: Protrusion and rolling of the tongue, sucking and smacking of lips, chewing motion, facial dyskinesia, involuntary movements of body and extremities
Treatment: STOP med, Ca channel blockers, beta blockers
29
NMS symptoms
Sudden high fiver, BP fluctuations, altered mental status, tachycardia, acute renal failure, respiratory failure, seizure, coma, rhabdomyolysis
30
TCA action
Blocks uptake/reuptake of norepinephrine and serotonin, elevating mood, interest in ADLs and decreasing insomnia
31
TCA interactions (3)
Blocks histamine and anticholinergic receptors, increases CNS effects with alcohol and CNS depressants, increases sedation and anticholinergic effects with phenothiazines, haloperidol
32
TCA side effects (9)
Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, GI distress, weight gain, constipation, sexual dysfunction
33
Adverse reactions (4)
Orthostatic hypotension, dysrthyhmia, EPS, blood dyscrasias
34
SSRI action
Blocks reuptake of serotonin and enhances transmission
35
Which has more side effects TCA or SSRI?
TCA !
| TCA is less expensive too
36
SSRI side effects (10)
Insomnia, nervousness, sexual dysfunction, dry mouth, blurred vision, H/A, nausea, anorexia, diarrhea, suicidal ideation
37
MAOI interactions and what can they cause?
CNS stimulant and sympathomimetics, tyramine foods with MAOI can result in hypertensive crisis
38
Lorazepam (Ativan) action
Enhances GABA effects inhibiting rapid neurotransmissions and decreasing signs and symptoms of anxiety
39
Lorazepam absorption, PB, half life, excretion
Rapid GI absorption, High PB (91%), 12-4 hours T 1/2, excreted in urine
40
Lorazepam side effects (11)
Drowsiness, dizziness, weakness, confusion, blurred vision, N/V, anorexia, sleep disturbances, restlessness, hallucination
41
Lorazepam adverse reactions (2)
Hypertenison, hypotension
42
Signs of lorazepam withdrawal
Agitation, muscle tremors, cramps, nausea, sweating
43
Antihistamine action
Competes with histamine for receptor sites preventing histamine response - decreases nasopharyngeal secretions, itching, and sneezing
44
Antihistamine uses (3)
Acute and allergic rhinitis, antitussive, and pre-med for blood transfusion
45
Antihistamine contraindications (3)
Severe liver disease, narrow-angle glaucoma, urinary retention
46
Antihistamine interactions
Increased CNS depression with alcohol and CNS depressants, avoid with MAOIs
47
Antihistamine side effects (10)
Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dycrasias
48
Albuterol class
Selective Beta-2 receptor agonist
49
Systemic effects of albuterol
Increased BP, increased HR, decreased GI and renal blood flow
50
Alpha 1 adrenergic agonist
Vasoconstriction, mydriasis, increased heart contractility
51
Alpha 2 adrenergic agonist
Decreased BP (decreased norepinephrine)
52
Beta 1 adrenergic agonist
Increased heart rate (tachycardia)
53
Beta 2 adrenergic agonist
Bronchodilation
54
Bronchodilator Assessment (4)
RR, use of accessory muscles, JVD, edema
55
NTG action
Increases cyclic guanosine monophastphate which promotes smooth muscle relaxation and vascular and coronary vasodilation to increase blood flow
56
NTG most common side effects (7)
HEADACHE, decreased BP, dizziness, lightheadedness, rebound MI if topical tapered over several weeks, reflex tachycardia if given too rapidly, circulatory collapse
57
NTG drug interactions (3)
Enhanced hypotensive effect if given with beta blockers, ca channel blockers, antihypertensives, alcohol; IV NTG can decrease heparin effects; contraindicated with sildenafil/tedalafil/vardenafil due to risk for severe hypotension or cardiovascular collapse
58
Beta blocker action
Blocks action of catecholamines to decrease HR and BP
59
Beta blocker contraindications (4)
2nd or 3rd degree AV block sinus bradycardia, HF, patients with COPD/Asthma/CHF/DM
60
Propranolol (Inderal) class
Non-selective beta blocker
61
Adverse reactions of Propranolol
Bronchoconstriction, Impotence
62
Metoprolol (Lopressor) class
Selective beta blocker
63
Metoprolol contraindication
DM (because it masks the symptoms of hypoglycemia)
64
Metoprolol side effects (14)
Dizziness, fatigue, weakness, nasal stuffiness, N/V, diarrhea, bradycardia, heart block, impotence, decreased libido, depression, mental changes, thrombocytopenia, agranulocytosis
65
Atenolol (Tenormin) class
Selective beta blocker
66
ACE inhibitor side effects (11)
Dizziness, hypotension, tachycardia, hyperkalemia, rash, taste disturbance, intestinal angioedema, agranulocytosis, anaphylactoid rection, nausea, impotence
67
Furosemide (Lasix) Action
Inhibits exchange of Cl-Na-K in thick segment of ascending loop of henle, promoting sodium and water depletion leading to decreased extracellular fluid volume
68
Furosemide side effects (3)
Nausea, diarrhea, hypokalemia
69
Which Ca Channel blocker is the most potent?
Nifedipine (Procardia)
70
Which Ca Channel blocker is mainly used for chronic HTN?
Amlodipine (Norvasc)
71
Nifedipine (Procardia) uses
Long term antianginal treatment, HTN, some dysrhythmias
72
Amlodipine T 1/2
30-60 hours, dosed daily
73
Amlodipine side effects (7)
Headache, dizziness, flush, fatigue, nausea, peripheral and ankle edema, bradycardia
74
Amlodipine adverse reactions (4)
Hypotension, heart block, angioedema, angina
75
Amlodipine drug-food interaction
Do NOT take with grapefruit juice (it decreases clearance, increasing bioavailability and thus hypotension)
76
Nifedipine side effects (6)
Headache, hypotension, dizziness, flushing, reflex tachcyardia as result of decreased BP, peripheral and pulmonary edema
77
Bile Acid Sequestrants action
Bind with bile acids in intestine to reduce LDL
78
Bile Acid Sequestrants side effects (3)
constipation, flatulence, cramping
79
Fibrates action
Breaks down lipoprotein from tissues and removes them from plasma, decreases synthesis of triglycerides
80
Fibrates drug-drug interaction
Do not take with anticoagulants because they compete for protein sites
81
Nicotinic acid action
Inhibits release of free fatty acids from adipose tissues to promote triglyceride removal from plasma; also increases HDL
82
Nicotinic acid side effects include (3)
Cutaneous flushing, nausea, gout
83
Cholesterol Absorption Inhibitor action
Acts on cells in small intestine to inhibit cholesterol absorption
84
What do you need for optimum Cholesterol Absorption Inhibitor effect?
Combine with a statin
85
Statin action
Inhibits HMG CoA reductase --> lowers LDL and slightly elevates HDL
86
Statin contraindication
Active liver disease, pregnancy
87
Statin side effects (8)
H/A, sinusitis, pharyngitis, rash, pruritis, diarrhea, constipation, leg cramps
88
Statin adverse reactions (4)
Myalgia, photosensitivity, cataracts, rhabdomyolysis
89
1st line treatment of mild HTN
diuretics
90
Calcium channel blocker action
Inhibit calcium from moving into the heart and vessels thus the smooth muscle contraction is reduced causing vasodilation. They decrease preload and oxygen demand.
91
Major side effect of Furosemide
Hypokalemia
92
Calcium channel effect on spasms
Decreases coronary artery spasms
93
Besides the heart, what do calcium channel blockers relax?
Relaxes peripheral arterioles, decreasing cardiac oxygen demand
94
Why are beta blockers contraindicated in asthmatic patients?
Beta blockers can increase airway resistance and bronchial constriction
95
Anticoagulant purpose
Prevents new clots from forming, does NOT dissolves clots that have already formed
96
Heparin mechanism
Prevents clot formation by inactivating Thrombin, inhibiting conversion of fibrinogen to fibrin
97
What route of heparin is used for DVT prophylaxis?
SQ
98
What route of heparin is used for acute treatment?
IV
99
Heparin - adverse effect
Heparin-induced thrombocytopenia (HIT)
100
Heparin-Induced Thrombocytopenia (HIT)
Allergic reaction where the platelet factor 4 binds to Heparin, combined with IgG to create an immune complex. This immune complex binds to circulating platelets, reducing levels and causing thrombosis.
101
Heparin nursing precautions (2)
AVOID interruption of the infusion and use a dedicated line
102
Low Molecular Weight Heparin (LMWH)
(Anticoagulant) Made of fragments, derivatives, of unfractioned heparin
103
LMWH mechanism
Binds with antithrombin and accelerates the rate at which antithrombin inhibits factor Xa and thrombin
104
LMWH antidote
Protamine Sulfate
105
LMWH notes (5)
Less risk bleeding, more stable response, does not require frequent aPTT monitoring, longer half life, less likely to get thrombocytopenia
106
Warfarin (Coumadin) mechanism
Inhibits the hepatic synthesis of coagulation factors dependent on vitamin K
107
What is warfarin mainly used for?
To prevent thromboembolic conditions such as embolism caused by A fib (can lead to stroke)
108
What do you need to monitor with warfarin?
INR!
109
Warfarin goals of therapy (A fib, artificial valves, DVT and PE)
A fib (2-3), artificial valves (2.5-3.5), DVT and PE (2-3)
110
Warfarin antidote
Vitamin K
111
What is indicated if a patient on warfarin experiences acute bleeding?
Fresh Frozen Plasma (FFP) - contains clotting factors!
112
Aspirin classification
Antiplatelet
113
Aspirin action
Inhibits platelet aggregation by interfering with thromboxane A2
114
Aspirin uses (5)
MI, CVA, CAD prophylaxis, within 48 hours of stroke, pre and post endarterectomy.
115
Aspirin side effects (2)
Tinnitus, bleeding
116
Aspirin adverse effects (8)
Nausea, dyspepsia, heartburn, GI bleed, H/A, tinitus, toxicity, anaphylactoid reaction
117
Aspirin antidote?
No antidote, but discontinue 1 week before surgery
118
Aspirin absorption
Rapidly absorbed in the GI tract, onset of 5-30 min
119
Aspirin inhibits platelets within ____ and peaks ____
Within 60 min, peaks 25min - 2 hours
120
Procalnamide (Pronestyle, Procan-SR) class
Antidysrhythmic class I
121
Antidysrhythmic class I use
Paroxysmal atrial tachycardia, supraventricular dysrhythmia
122
Antidysrhythmic class I mechanism
Depresses the phase 0 of action potential --> SLOWS conduction and PROLONGS depolarization --> MORE RELAXATION (decreased HR and helps dilate heart vessels)
123
All antidysrhythmics can cause.... (2)
Hypotension and bradycardia
124
Torsade de pointes
Adverse effect of Procainamide = uncommon form of ventricular tachycardia with prolonged QT interval; may evolve into V fib (life-threatening)
125
More vulnerable to Torsade de points if low in ____
magnesium
126
Procainamide indications (2)
Check HR and BP, monitor serum procainamide and NAPA levels
127
Procainamide Absorption (2)
Oral ER 90-120 min, IM 15-60 min
128
Metabolism and Excretion of Procainamide
Converted by liver to NAPA, an active anti arrhythmic compound - 30-60% excreted unchanged by kidney
129
Procainamide half life
2.5 - 4.7 hours - prolonged in renal impairment
130
Procainamide Side Effects
N/V, anorexia, dizziness, drowsiness, heart blocks, hypotension, and CHF
131
Procainamide food interaction
AVOID citrus juices and fruits when taking quinidine
132
Long term therapy side effects of Procainamide
Lupus-like syndrome with rash and small joint pain, pericarditis with tamponade, notify provider immediately as may need to discontinue
133
Toxic if Procainamide levels are
> 10 mcg/ml
134
Amiodarone (Cordarone) class
Antidysrhythmic (Class III)
135
Amiodarone (Cordarone) mechanism
Blocks potassium and slows upward movement during phase 3 - prolongs depolarization and slows the HR (Heart RELAXATION and SLOWS HR)
136
Amiodarone (Cordarone) use
Treatment AND OR maintenance
137
Side effects of Amiodarone (Cordarone) are related to
Size of dose
138
Amiodarone (Cordarone) side effects (7)
N/V, GI distress, dizziness, hypotension, arrhythmia, decrease HR can proceed to 2nd or 3rd degree heart block, blue-grey hyper pigmentation
139
Amiodarone (Cordarone) adverse reactions (7)
Hypothyroidism, hyperthyroidism, corneal microdeposits, hepatic dysfunction, pulmonary fibrosis, peripheral neuropathy, proximal muscle weakness
140
Amiodarone (Cordarone) drug interactions (3)
Week/month long half life; interacts with quinidine or dioxin (increases blood levels of class I), increased risk of QT prolongation with some drugs (increases warfarin)
141
Amiodarone (Cordarone) food interactions
Grapefruit juice inhibits enzymes in GI tract that metabolize Amiodarone (Cordarone)
142
What should you assess antidysrhythmic patient for? (4)
Neurotoxicity, monitor thyroid function, eye exams, signs of pulmonary toxicity (SOB)
143
Clopidogrel (Plavix) class
Thienophyridine - antiplatelet
144
Clopidogrel (Plavix) mechanism
Prevents platelet aggregation by blocking Adenosine Diphosphate from binding to platelet receptor
145
Clopidogrel (Plavix) has similar side effects/adverse reactions to
ASA
146
Clopidogrel (Plavix) onset
Several days and lasts for 7 days
147
Can you take Clopidogrel (Plavix) if you're allergic to aspirin ?
Yes
148
General contraindications of anticoagulants (8)
Bleeding disorders, peptic ulcer, severe hepatic or renal disease, hemophilia, CVA, eye/brain/or spinal surgery, risk for injury from fall.
149
What are baseline labs to assess for anticoagulant therapy?
CBC, coagulants, LFT, renal labs, aPTT (heparin), PT or INR (warfarin)
150
When assessing a patient on anticoagulant therapy, you should assess for signs and symptoms of what? (3)
Bleeding, thrombosis, and embolism (pulmonary)
151
Why should a patient on anticoagulant therapy watch out for OTCs including gingko, garlic, and ginseng?
They increase bleeding with Coumadin
152
How do Tylenol, NSAIDs, PCN, Prilosec affect anticoagulants?
They increase anticoagulant effects
153
What kind of injections should you NOT give to a patient on anticoagulant therapy
IM injections of any drugs
154
Sympathomimetics - caution in what kind of patients?
Cardiac patients
155
Compared to diphenhydramine, Loratadine (Claritin)... (2)
Non-sedating, fewer anticholinergic effects
156
Antianginals increase myocardial blood flow by increasing _______ or decreasing ______
Antianginals increase myocardial blood flow by increasing oxygen supply or decreasing oxygen demand
157
Antilipidemic planning: client's total cholesterol will be _____ in ____ weeks
Client's total cholesterol will be less than 200 mg/dL in 8-12 weeks
158
Antilipidemic planning: LDL will be _____
LDL will be less than 100 mg/dL
159
Antilipidemic planning: HDL will be ______
HDL will be 45-60 mg/dL
160
Antilipidemic planning: Triglycerides will be _____
Less than 150 mg/dL
161
Antidysrhythmic Class 1
Fast Sodium Channel Blockers - Procainamide
162
Procainamide therapeutic level
4-10 mcg/mL
163
NAPA therapeutic level
15-25 mcg/mL
164
Combined procainamide and NAPA therapeutic level
10-30 mcg/mL
165
IV amiodarone is notorious for...
causing phlebitis - monitor IV site frequently!
166
Heparin side effect
Itching, burning, ecchymosis (discoloration/bruising) at injection site
167
What are the vitamin K factors that Warfarin inhibit?
Factors 2, 7, 9 10
168
Direct-Acting Thrombin Inhibitors - action
Directly inhibits thrombin
169
Direct-Acting Thrombin Inhibitors - uses
HIT!!! Unstable angina, angioplasty
170
Direct-Acting Thrombin Inhibitors - contraindication
Liver failure
171
Factor Xa Inhibitors are
Oral anticoagulants
