exam 2 Flashcards
(71 cards)
1
Q
two types of iron deficiency anemia preparations
A
- Ferrous sulfate (Feosol) is PO (tablets or liquid)-out of reach of children.
- Educate to drink liquid ferrous with a straw because it can stain their teeth.
- Iron dextran (INFeD) is IM or IV form
- Do NOT give to patients who have anemia that is not due to iron deficiency
2
Q
AE for anti-anemic drugs for iron deficiency anemia
A
•GI are most common, N/V, abd pain from po form, take with food, can cause stools to be dark black tarry.
3
Q
Interactions for anti-anemic drugs for iron deficiency anemia
A
- Vitamin c can increase the absorption of iron
- antacids + Dairy can decrease the absorption of iron
have them take with apple or orange juice to decrease GI upset.
4
Q
how to administer tablet forms of Anti-anemics for Iron deficiency anemia
A
- Spread doses evenly across waking hours (maximizes production of RBC’s)
- Give drug on empty stomach for best absorption but can be given with food to avoid GI upset (but not milk!)
- Do not crush or chew sustained-release tablets
5
Q
how to administer liquid forms of Anti-anemics for IDA
A
- Dilute in another compatible liquid
- Give through a straw (avoid staining teeth)
- Have patient rinse mouth with water
- Provide hard candy or gum to help with after taste or dilute it in another compatible liquid.
6
Q
how to administer IM/IV forms of Anti-anemics for IDA
A
- Give test dose first to test for hypersensitivity reaction. - Give prescribed dose 1 hr later if patient tolerates
- Use 2-3-inch-long needle with Z-track technique
- Give bolus NO faster than 12.4 mg/min
- Dilute intermittent infusion to 250-500 mL and run no faster than 50 mg/min
- Monitor BP closely
7
Q
iron toxicity/overdose symptoms
A
> 300 mcg/dL = serious risk
•Nausea, abdominal pain, vomiting, dizziness, hypotension, headache
•Coma, shock, seizures
8
Q
iron toxicity/overdose treatment
A
- Symptomatic + supportive measures
* Suction, maintenance of airway, correction of acidosis, control shock and dehydration, oxygen, vasopressors
9
Q
Vitamin B12 indications
A
•Pernicious anemia, lack of intrinsic factor, vitamin b12 deficiency
10
Q
Vitamin B12 AE
A
•Diarrhea, hypokalemia
11
Q
Vitamin B12 interactions
A
•Folic acid can mask s/s of vitamin b12 deficiency; alcohol, cimetidine, colchicine, aminisalicylic acid reduce absorption of oral forms of cyanocobalamin; vitamin c alters stability of oral forms
12
Q
intranasal and parenteral B12 administration
A
- best for patients with malabsorption syndrome
- Give intranasally 1 hour before or after hot foods
- Give PO forms with food to enhance absorption
13
Q
patient education with B12
A
- Expect lifelong treatment for patients who have irreversible B12 deficiencies (pernicious anemia)
- Encourage dietary intake of foods high in vitamin B12 (dairy, cereal, egg yolks)
- Monitor potassium levels
- Recommend potassium supplementation
14
Q
folic acid indications
A
Folate deficiency (alcoholism, malabsorption syndrome); macrocytic anemia; prevent neural tube defects in developing fetus
15
Q
folic acid contraindications
A
•Vitamin B12 deficiency, other types of anemia, neonates
16
Q
folic acid AE:
A
•Flushing and warmth following IV administration; yellow discoloration of urine
17
Q
folic acid nursing considerations
A
- Give IV form SLOW!
- Over 30-60 seconds or add to an IV fluid infusion
- Obtain baseline serum folate, Hgb, Hct, RBC and reticulocyte count
•Encourage daily intake of foods high in folate:
green veggies, liver, some breakfast cereals, lentils
18
Q
Epoetin Alfa MOA:
A
•Stimulates the production of RBCs in the bone marrow
19
Q
Epoetin Alfa indications
A
•Chronic renal failure, preoperative anemia, chemotherapy, Zidovudine (Retrovir) therapy for HIVsevere depletion of RBC,end stage renal disease
20
Q
Epoetin Alfa contraindications
A
•Uncontrolled HTN, some malignancies, cancer without chemotherapy or radiation, iron deficiency anemia
21
Q
Epoetin Alfa AE
A
•Hypertension, cardiovascular and cerebrovascular events; may also cause progression of some malignancies
22
Q
Epoetin Alfa Nursing considerations
A
- Obtain baseline values for BP, Hgb, Hct, erythropoietin level
- Ensure BP is controlled during therapy-within normal limits
- Recommend antihypertensive drugs for the patient with hypertension
- Only give to cancer patients whose Hgb level is less than 10 gm/dL
23
Q
Methotrexate indications
A
Anti-rheumatic for cancer and RA
24
Q
Etanercept indications
A
anti-rheumatic used for adult and juvenile RA
25
Methotrexate considerations
•Depresses immune system so do NOT give to patients with active infection
AE: Causes bone marrow suppression-more common when treating for cancer
* Lower doses used for RA than for treatment of cancer
* Going to take about 6 weeks to see maximum therapeutic effects.
26
Etanercept considerations
* Do NOT give to patients with an active infection
* Avoid giving live vaccines to patients taking etanercept
* Administered SubQ every 2 weeks or monthy: monitor for injection site reactions, treat with antihistamine if needed
* 3-6 weeks to see max therapeutic effects to treat symptoms
* Avoid places with a lot of people, immunocompromised, if the have any symptoms of infection report to Dr. asap.
27
Enteral Nutrition AE
* GI intolerance (diarrhea), dumping syndrome, risk for aspiration pneumonia
* Dumping syndrome = nausea, weakness, sweating, palpitations, syncope, sensations of warmth, diarrhea
28
Enteral Nutrition interactions
* antibiotics, corticosteroids, phenytoin
| * If on a continuous feed, Hold tube feeding 2 hours before or 2 hours after administering the above drugs
29
peripheral parenteral nutrition (PPN)
* IV
* Temporary use (less than 2 weeks)
* Main complication: Phlebitis! Inflammation of the vein, thready rope-like feeling, painful.
* Requires more fluid to meet nutritional needs.
Risk of fluid overload in patients with renal and heart failure
30
total parenteral nutrition (TPN)
Central or PICC line
•Prolonged use (longer than 7-10 days)
AE: Central or PICC line associated with infection
•Hyperglycemia!
normal to have sliding scale insulin and accu checks
31
nutritional supplement assessment nursing int:
* Daily weights
* Dietician consult
* Daily labs – CBC, CMP, lipid profile-will be given a protocol to follow
* Allergies
* Baseline Cardiac and renal status
* Baseline Gag reflex, and ability to swallow d/t aspiration, bowel sounds (enteral) before and during therapy
* Knowledge of patient and caregiver-understanding how to work piccline, flushes, s/s on infection, dressing changes by a nurse (sterile), home health
32
nutritional interventions for enteral nutrition
* Check NG tube placement prior to each use
* # 1 way to check is through x-ray. Other air bolus and pH testing.
* Aspirate residual volumes before each feeding and/or administration of medications when first starting enteral feedings to see what the pt is able to tolerate.
* Keep HOB elevated at least 30 degrees while feeding is being administered - Pause feeding when patient is laying flat
* Change tubing every 24 hours-to avoid bacteria on tubing
33
nursing interventions parenteral nutrition
* Monitor s/s of hyperglycemia (polydipsia, polyuria, polyphagia, HA, N/V, dehydration, weakness)
* Accu-checks and sliding scale insulin commonly ordered
* If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur - Provide 5%-10% glucose or D5W/D10W
* Monitor for s/s of fluid overload (edema, hypertension, SOA, weight gain, ascites, crackles lung sounds)
* Measure I&O-daily weights.
34
calcium citrate
Indications: hypocalcemia, have/or at risk for calcium deficiency
Contraindications: hypercalcemia, low phosphate levels, history of kidney stones, cardiac dysrhythmias
Adverse effects: Hypercalcemia (N/V, constipation, polyuria, depression, confusion)
Interactions: glucocorticoids, thyroid supplements, tetracycline, quinolones
35
Hypocalcemic: calcitonin-salmon (Miacalcin, Calcimar)
MOA: inhibits osteoclasts, increasing excretion of calcium
Indications: treating osteoporosis, hypercalcemia, Paget’s disease
Contraindications: allergy to salmon or fish
*Adverse Effects: hypocalcemia (muscle spasms and cramps, tingling in fingers and toes, lethargy, confusion, irritability), nasal dryness/irritation
Interactions: Lithium
Nasal spray should be primed, alternate nostrils with each dose given, and store bottle in up-right position
*If treating osteoporosis – monitor Ca levels and provide diet high in Ca and vit D
36
Thyroid Replacement Drugs: levothyroxine (Levoxyl)
Contraindicated with recent MI & thyrotoxicosis
Interactions with many drugs and foods (mostly effects absorption of levothyroxine)
Take in AM on empty stomach, take 30 min-1 H before breakfast
Brand name vs generic matters!
Therapeutic effects may take several weeks (up to 6 weeks) to occur
Must monitor serum TSH and free thyroid levels for appropriate dosing
Dosed in mcg - This is important to remember to avoid making a med error!
37
Thyroid Replacement Drugs: levothyroxine (Levoxyl) AE
AE’s: usually result from excessive doses > causes s/s of HYPERthyroidism
➢ rapid HR ➢ wt. loss
➢ ↑↑appetite ➢ anxiety
38
Antithyroid Drugs cont. and AE
Contraindicated in pregnancy
Adverse Effects of liver and bone marrow toxicity, agranulocytosis – Monitor CBC at baseline and throughout therapy
39
Antithyroid Drugs
| propylthiouracil (PTU)
propylthiouracil (PTU) –
2 weeks of therapy needed before symptoms improve
take with meals to prevent GI upset
40
Antithyroid drug
| Iodine-131 (Iodotope)
Contraindicated in pregnancy, lactation, and if trying to conceive (must wait 6 months after treatment)
Can contaminate others
➢ 1-3 days: 🚫public places, travel
➢ 1-5 days: 🚫@ work, close to kids/pregnant ppl
➢ 2-3 days: 🚫car rides, prepare food, share utensils, stand to urinate
➢ 1-11 days: separate bed
41
what do adrenal drugs do?
| hydrocortisone (cortef, Solu-cortef) fludrocortisone
* Anti-inflammatory
* Immunosuppressant
* Respiratory illnesses
* Replacement therapy for Addison’s Disease
42
Adrenal drugs AE
* Elevated pressure in the eyes (glaucoma)
* Clouding of the lens in one or both eyes (cataracts)
* A round face (moon face)
* High blood sugar, which can trigger or worsen diabetes
* Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
* Thinning bones (osteoporosis) and fractures
* Suppressed adrenal gland hormone production s/s, severe fatigue, loss of appetite, nausea and muscle weakness
* Thin skin, bruising and slower wound healing
43
•Adrenal Drugs (Corticosteroids) hydrocortisone interactions
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interactions:
● non-K+ sparing diuretics ➢ hypocalcemia + hypokalemia
● aspirin➢ GI effects and PUD
● antidiabetic drugs = ↑ blood sugar
•Long-term use should never be abruptly stopped!!!
•Adrenal suppression-adrenal crisis
pt .edu:
● NEVER stop abruptly
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44
Beta 2 Adrenergic Agonist: albuterol (Proventil, Ventolin)
Bronchodilator - OPEN AIRWAY
Used for management of bronchospasms associated with asthma
Contraindications: uncontrolled hypertension, cardiac dysrhythmias, high risk for stroke
AE: If used too frequently = anxiety, palpitations, tremors, tachycardia
**Use before inhaling glucocorticoids
Interacts with beta-blockers and caffeine
RESCUE emergency inhaler for asthma - DURING ASTMATIC EPISODE
45
Inhaled Anticholinergics: ipratropium (Atrovent)
Used for bronchoconstriction associated with COPD
May cause dry mouth and hoarseness (nebulizer or inhaler)
Contraindications: Glaucoma, BPH, bladder neck obstruction
Interacts with other anticholinergics
Wait 1-2 minutes between doses
Wait 5 minutes before using another type of inhalant
NOT rescue emergency drug!
46
Methylxanthines: theophylline (Theolair, Theochron, Theo-24)
Used for bronchodilator for long term management of asthma - pill
Contraindications: uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, peptic ulcers
MANY interactions! (caffeine (additive effects), charcoal-broiled foods (decreased therapeutic blood levels), high protein, and low carbohydrates, smoking) -
*Therapeutic blood level = 5-15 mcg/ml
>15 mcg/ml = unwanted adverse effects (nervousness, insomnia, tremors, seizures, tachyarrhythmias, increased contractility of skeletal muscles)
46
Methylxanthines: theophylline (Theolair, Theochron, Theo-24)
Used for bronchodilator for long term management of asthma - pill
Contraindications: uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, peptic ulcers
MANY interactions! (caffeine (additive effects), charcoal-broiled foods (decreased therapeutic blood levels), high protein, and low carbohydrates, smoking), chocolate
*Therapeutic blood level = 5-15 mcg/ml
>15 mcg/ml = unwanted adverse effects (nervousness, insomnia, tremors, seizures, tachyarrhythmias, increased contractility of skeletal muscles)
47
Glucocorticoids: beclomethasone dipropionate (QVAR)
Used for long term management of chronic asthma by suppressing inflammation - inhaled
Watch for oral candidiasis – rinse mouth after use and use spacer
Use on a regular schedule rather than PRN
*Take after beta 2 adrenergic agonist (after albuterol)
DO NOT use for acute attack! – Not a rescue inhaler
48
Leukotriene Modifiers: montelukast (Singulair)
Used for chronic asthma, prophylaxis for exercise-induced asthma, allergic rhinitis
Taken once daily in evening; or 2 hours before exercising
Not meant for acute relief of asthma – NOT used PRN
Interactions: phenytoin, phenobarbital, rifampin
49
Sedating Antihistamines: diphenhydramine (Benadryl)
Antagonize H1 by binding to receptors
Used for mild allergic reactions, severe anaphylactic reactions, motion sickness, insomnia
Causes drowsiness and dizziness - Take at bedtime
Anticholinergic effects = can’t see, can’t pee, can’t spit, can’t sh*t (dry mouth, urinary retention, changes in vision, constipation )
Interacts with CNS depressants
FALL RISK!
50
Nonsedating Antihistamines: cetirizine (Zyrtec)
Antagonize H1 without binding
Used for allergic rhinitis, chronic idiopathic urticaria (hives)
Longer duration of action – once a day dosing
Minimal anticholinergic effects
Monitor for drowsiness and dizziness with first dose
Interactions: theophylline and other antihistamines
51
Sympathomimetic: phenylephrine (Neo-Synephrine)
Alpha 1 adrenergic agonist - nasal spray
Decreases nasal congestion r/t allergic rhinitis, sinusitis, common cold
Contraindications: chronic rhinitis, glaucoma, heart disease, HTN, dysrhythmia
*Watch for rebound nasal congestion and abuse – only use nasal route for 3-5 days
52
Antitussives (suppress cough): opioids: codeine
Used for suppression of non-productive cough r/t allergies or URI
Contraindications: chronic asthma, emphysema, liver or renal disease, acute alcoholism
Adverse effects: CNS depression, dizziness, N/V, constipation, respiratory depression
Interactions: Other CNS depressants
53
Antitussives: Nonopioid: dextromethorphan (Delsym)
Used to suppress non-productive cough r/t allergies or URI
May cause CNS depression in large doses
Contraindications: opioids
54
Expectorants (productive cough): guaifenesin (Mucinex)
Used for productive cough r/t colds, URI, bronchitis, pneumonia
Increase fluid intake!!!!
Do not give with combination products for colds that also include guaifenesin
55
Mucolytics: acetylcysteine (Acetadote)
*Decreases viscosity of mucus to facilitate expectoration - thin mucus out
Used for bronchopulmonary disease and CF, acetaminophen overdose
*Contraindications: risk of/or actual GI bleed, severe respiratory insufficiency
* Adverse reaction: an increased volume of liquefied bronchial secretions
* Respiratory assessment and monitoring is essential!
* Have suction equipment at bedside
* Expect sulfur-like (rotten-egg) odor
* If given via nebulizer – make sure it does not include metal or rubber parts
56
Lispro (Humalog)-rapid acting
| onset, peak and duration
•onset 15 mins;
peak 1-2 hrs;
duration 3-5 hrs, see food ,
need patient to be eating before you give this. May take multiple times a day.
57
Regular (Humulin R)-short acting-
| onset, peak and duration
•acting onset 30-60 mins;
peak 2-3 hrs;
duration 6-10 hrs
only one that can be given IV
58
•Isophane suspension (NPH; Humulin N)-intermediate-
onset, peak and duration
•onset 1-2 hrs; peak 4-8 hrs; duration 10-16 hrs
59
•Insulin glargine (Lantus)-long acting-onset, peak and duration
•onset 1-2 hrs;
peak: 8 hours
duration 5-6 hrs (mean); up to 24 hrs with high doses
60
insulin considerations
* Remember to protect all insulin from light and heat and do NOT freeze!
* Mark the expiration date on all opened vials:
* If stored in the refrigerator, they are good until the expiration date on the vial
* If stored at room temp, they are good for 1 month
* Before administering insulin ALWAYS check your patient’s blood glucose levels
* Check doses with another RN before administering
* Ensure correct timing of doses with meals and know if the patient is NPO
61
Pramlintide (Symlin) considerations
* is indicated for both type 1 and type 2 diabetes
* Should not be mixed with insulin in the same syringe
* Given subQ injection
* Peak action occurs within 20 minutes
62
Exenatide (Byetta) considerations
* is indicated for type 2 diabetes
* Given as subQ injection 60 minutes BEFORE morning and evening meals
* Do NOT administer after meals!
* Expect peak action 2 hours after dosing
* Doesn’t cause weight gain
63
oral antidiabetic drugs: type 2
Sulfonylurea: Glipizide (Glucotrol)
Biguanide: Metformin (Glucophage)
Thiazolidinediones: Pioglitazone (Actos)
AE:
Hypoglycemia, weight gain, and GI discomfort
64
lactic acidosis with metformin (Glucophage); this is a serious AE!
s/s: hyperventilation; cold, clammy skin; muscle weakness/pain; malaise; dizziness; palpitations
65
Black box warning with pioglitazone (Actos):
exacerbate CHF
Do NOT administer this drug to patients with heart disease/CHF!
66
Glipizide (Glucotrol):
Typically second-step drug for treatment of Type 2 DM
Onset in 1 hour, low cost, high A1c efficacy
Do not give to pregnant/lactating patients or patients with DKA
Watch for drug-drug interactions:
Sulfonamide antibiotics -reduce affect
Alcohol -glipizide is not as effective if they drink alcohol
67
Metformin (Glucophage);
Usually first-line drug for treatment of Type 2 DM
Causes significant GI AE’s
Patients may not tolerate it well due to these AE’s
Can take with food to help
Rarely causes hypoglycemia, reduces chance of CV events, low cost, high A1c efficacy
Interacts with IV contrast dye! -Stop taking 24 hours before drinking contrast then restart 24 hours after
68
Pioglitazone (Actos):
May not see the maximum therapeutic outcome for months - Combined with other oral antidiabetics for this reason
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Multiple drug interactions:
Insulin
Gemfibrozil (Lopid)
Ketoconazole
Green tea, ginseng, garlic
Remember black box warning for patients with CHF!
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69
All Antidiabetics consideration
Patients with diabetes will need to wear medical alert bracelets
Must monitor blood glucose and HgbA1c levels frequently
Encourage the patient with diabetes to stop smoking and reduce alcohol consumption
Teach the patient s/s of hyperglycemia and hypoglycemia
Educate about situations that may alter glucose levels:
Stress, fever, illness, surgery, increased activity
70
Glucose Elevating Drug
| Glucagon (GlucaGen)
can be administered IV, IM, or subQ
Glucagon may take about 20 minutes to have its effects so monitor patient closely during this time
Patient may have N/V once glucagon begins working
Glucagon is used most often for patients with hypoglycemia who are not responsive
