Final Exam Flashcards
1
Q
common use of metoprolol
A
atrial fibrillation/flutter, supraventricular and ventricular dysrh. hypertension
2
Q
common use of amiodarone
A
a fib/flutter
ventricular tachycardia or fibrillation
3
Q
Amiodarone class
A
potassium channel blockers
4
Q
Amiodarone MoA
A
blocks potassium channels, delays repolarization; slows HR
5
Q
Amiodarone indications
A
v-tach v fib; afib or flutter
6
Q
Amiodarone dose
A
maintenance: oral; acute IV push/infusion on tele floors/ICU/ACLS
7
Q
Amiodarone Drug-drug
A
many! increase digoxin levels (up yo 50-70% loading dose); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decreases dose of either drug by 50%
8
Q
Amiodarone AE
A
GI effects (n/v/d), corneal micro-deposits (cause visual issues- photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity
9
Q
Amiodarone black box
A
hepatotoxicity, pulmonary toxicity, pro-arrhythmias
10
Q
Amiodarone nursing considerations
A
no grapefruit juice, use barrier sun block; cardiac monitoring (IV), monitor electrolytes
11
Q
Metoprolol (Toprol) class
A
beta adrenergic blocker
12
Q
Metoprolol (Toprol) MoA
A
block beta 1 and beta 2 receptors of the SNS; slows HR and lowers BP
HR and BP
13
Q
Metoprolol (Toprol) indications
A
HTN, HF, MI, A fib, A flutter
14
Q
Metoprolol (Toprol) route
A
maintenance: oral
acute HTN or dysrhythmias: IV push
15
Q
Metoprolol (Toprol) drug-drug
A
beta agonist inhaler (albuterol)
16
Q
Metoprolol (Toprol) contraindications/cautions
A
bradycardia, hypotension, masks signs of hypoglycemia
17
Q
Metoprolol (Toprol) AE
A
bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreases exercise intolerance, alterations in blood glucose
18
Q
Metoprolol (Toprol) nursing considerations
A
monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed
19
Q
Class action for Albuterol and Salmeterol
A
Beta 2 Adrenergic Agonist
20
Q
Albuterol… LABA or SABA?
A
SABA
21
Q
Albuterol Route
A
inhaler/nebulizer (5-15 min onset)
22
Q
Rescue inhalor
A
Albuterol
23
Q
Maintenance Inhalers
A
Salmeterol, Ipratropium, Fluticasone
24
Q
Albuterol trade name
A
Pro Air
25
Albuterol indications
acute bronchospasm: Asthma Attack, COPD Exacerbation, pneumonia
prevention of exercise induced asthma
26
Albuterol and Salmeterol MoA
Beta 2 selective adrenergic agonists- BRONCHODILATION
27
Contraindications of Albuterol and Salmeterol
conditions exacerbated by sympomimetic effects
drug drug interactions with beta adrenergic antagonists
28
AE/SE of Albuterol and Salmeterol
sympomimetic stimulation: cardiac arrhythmias, tachycardia, HTN, sweating, tremors, worsened bronchospasm
29
Nursing implications with Albuterol
use to treat symptoms or as scheduled... overuse can cause AE/SE. administer 30-60 min before exercise
30
Class action for Fluticasone
inhaled corticosteroid
31
Route for fluticasone
inhaler
32
Trade name for fluticasone
Flovent
33
Indications for fluticasone
prevention and treatment of asthma
34
MoA for fluticasone
decrease inflammatory response in airways
35
AE/SE for fluticasone
sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal infections (oral thrush), rare systemic reaction
36
Nursing implications for fluticasone
assess mucous membranes- fungal infections not a rescue inhaler
37
Patient Education for Fluticasone
rinse mouth after each inhalation
38
polyethylene glycol (Miralax) class
bulk stimulants; hyperosmotic laxative
39
polyethylene glycol (Miralax) MoA
increase water absorption into the colon and GI tract (water follows polyethylene glycol; which stays in the colon and GI tract)
40
polyethylene glycol (Miralax) indications
constipation, evaluate bowel for diagnostic procedure (high dose)
41
polyethylene glycol (Miralax) AE
see nursing role
42
polyethylene glycol (Miralax) nursing considerations
mix with 4-8 oz of water; acute care fall risk
43
Potassium chloride class
electrolyte replacement
44
Potassium chloride MoA
transmission of nerve impulses, cardiac contraction, renal function, intracellular ion maintenance
45
Potassium chloride indication
prevention and treatment of hypokalemia
46
Potassium chloride route
PO, IV
47
Potassium chloride AE
hyperkalemia, n/v/d, GI cramping, bradycardia, cardiac arrest
48
Potassium chloride nursing considerations
utilize electrolyte replacement protocol: oral admin preferred; follow dosing and lab draw times
throughout admin monitor for: cardiac abnormalities and vein phlebitis
teach patient: increase intake of high K= foods, do not break, crush, or chew ER caps or enteric capsules; report burning sensation at IV site
49
Potassium Administration Oral
do not break, crush, or chew ER caps or enteric capsules. With or after meals with full glass of water. Dissolve effervescent tabs in 8 oz cold water
50
Potassium Administration IV infusion
central line preferred- caustic to veins
admin rate- 10mEq/hour
Monitor IV site- phlebitis
Do not admin SQ or IM
51
Furosemide (Lasix) class
loop diuretics
52
Furosemide (Lasix) MoA
inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na)
53
Furosemide (Lasix) indications
conditions of fluid overload; hyperkalemia
54
Furosemide (Lasix) route/dose
oral, IVP (slow 20mg/min); may be given IM or as IV gtts
55
Furosemide (Lasix) contraindications
see general; ototoxic drugs; sulfa allergy
56
Furosemide (Lasix) AE
see general; hypokalemia; CNS effects: paresthesia, ototoxicity (IVP slowly)
57
Furosemide (Lasix) Nursing considerations
see general; potassium supplements; IV fall risk
58
Aspirin (ASA) class
Anti-platelet Agent/ Salicylate
59
Aspirin (ASA) MoA
inhibit platelet aggregation (COX inhibitor)
60
anti-platelets prevent what...
the platelet part of clotting (platelet coags forms platelet plug with anti-platelet)
61
Aspirin (ASA) Indication
Prevention of MI, TIA, ischemic CVA in high risk populations (primary or secondary prevention)
62
Aspirin (ASA) Dose
81-325 mg PO daily (81mg is a baby aspirin)
level of dose determines if its prevention or treatment
63
Aspirin (ASA) AE
GI irritation (N/V, epigastric pain)
bleeding- GI bleeding
hematuria
easy bruising
tinnitus (with toxicity)
64
Aspirin (ASA) Nursing considerations
take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)
65
Heparin Class
indirect thrombin inhibitor- anticoagulant
66
Heparin MoA
disrupts clotting cascade; prolongs bleeding time
67
Heparin route/dose
5000 units SQ q8h (prevention) or IV drip (protocol)
68
Heparin indications
prevent or treat DVT (SQ); treat PE (IV)
69
Heparin contraindications
Porker allergy; Pork abstention religion (Judaism, Muslim)
70
Heparin AE
Bleeding, heparin-induced thrombocytopenia, bruising at injection site
71
Heparin Nursing considerations
rotate/monitor injections site for SQ (do not administer IM), monitor platelet count; monitor aPTT
72
Heparin reversal agent
protamine sulfate (heparin short half life, stop infusion)
73
Warfarin (Coumadin) class
Vitamin K antagonist (anticoagulant)
74
Warfarin (Coumadin) MoA
interfere with hepatic synthesis of vitamin K dependent clotting factors; prolongs bleeding time
75
Warfarin (Coumadin) route/dose
2-10 mg/day PO based on INR
Daily in evening or HS
Hold and call PCP if INR is greater than 3.0
Expect Vitamin K order if INR is greater than 4
76
Warfarin (Coumadin) indications
chronic Afib, artificial heart valves, prevent/treat DVT, PE
77
Warfarin (Coumadin) AE
GI effects (n/v), bleeding
78
Warfarin (Coumadin) drug-drug
antibiotics (monitor INR), Amiodarone, herbals
79
Warfarin (Coumadin) nursing considerations
Monitor PT/INR; first oral anticoagulant on market
80
Warfarin (Coumadin) reversal agent
Vitamin K
81
Warfarin (Coumadin) Lab Draws
dose change= next lab in 3 days
long term monitoring= weekly or monthly
82
Warfarin (Coumadin) Diet
teach patient to maintain consistent intake (avoid) vitamin K containing foods (increased intake may decrease warfarin effect)
83
Foods High in Vitamin K
kale
collard greens
spinach
brussel sprouts
broccoli
asparagus
sauerkraut
soybeans
edamame
84
herbals to avoid with Warfarin
St. Johns Wart
Garlic
Gingko
Ginger Root
Chamomile
85
Epoetin Alfa (Procrit) class
erythopoiesis stimulating agent
86
Epoetin Alfa (Procrit) MoA
erythropoietin factor controlling rate of RBC production
87
Epoetin Alfa (Procrit) Indications
disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
88
Epoetin Alfa (Procrit) contraindications
angina, caution in CHF, anticoagulant therapy
89
Epoetin Alfa (Procrit) AE
fatigue, bone pain, edema, HTN, headache, fever, DVT, CVA, MI has occured
90
Epoetin Alfa (Procrit) nursing considerations
Monitor CBC weekly (dose depends on Hgb and indication), check VS (risk of HTN), analgesia for bone pain, goal Hgb above 10; hold if Hgb is greater than 12
91
tamoxifen class
hormone modulator
92
tamoxifen MoA
competes with estrogen binging sites in target tissue; anti-estrogen
93
tamoxifen indications
breast cancer; prophylactic breast cancer
94
tamoxifen route
oral (may take for years)
95
tamoxifen AE
anti-estrogen effects (hot flashes, menstrual irregularities), masculinizing effects in women; risk for DVT
96
tamoxifen contraindications
pregnancy/breastfeeding, anticoagulants, hx of blood clots
97
tamoxifen nursing considerations
comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures, temperature control, and stress reduction
98
antineoplastic agent general information
harmful to all rapidly growing cells- even the healthy ones. narrow therapeutic index
99
antineoplastic agents goals of treatments
limit/decrease cancer cells so immune system can eliminate rest; limit toxicity to host
100
antineoplastic agents caution
pregnancy/lactation
bone marrow suppression
hepatic or renal impairment
CNS disorders
101
antineoplastic agents routes
most common are oral or IV
nurse must have certification to administer chemotherapy
102
cell cycle specific antineoplastic agents
antagonize actions of key cellular metabolites needed for DNA synthesis (folic acid, purines, pyrimidines)
103
cell cycle nonspecific or miscellaneous antineoplastic agents
prevent cell reproduction by altering the chemical structure of cell DNA
104
cyclophosphamide (cytoxan) class
alkylating agents
105
cyclophosphamide (cytoxan) AE
toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis
106
cyclophosphamide (cytoxan) nursing considerations
encourage hydration to prevent cystitis
107
methotrexate (rheumatrex) class
folate antagonist
108
methotrexate (rheumatrex) AE
gastrointestinal ulceration, bone marrow suppression
109
methotrexate (rheumatrex) nursing considerations
see general
110
Doxorubicin (adriamycin) class
antitumor antibiotics
111
Doxorubicin (adriamycin) AE
injection site extravasation, cardiotoxic, see general
112
Doxorubicin (adriamycin) nursing considerations
see general
113
general antineoplastic adverse effects
alopecia, rashes, blisters, photosensitivity, neuropathy, cognitive dysfunction, headache, dizziness, toxicity, leukopenia, anemia, thrombocytopenia, n/v, anorexia, diarrhea, constipation, mucous membrane deterioration (stomatitis), toxicity, cystitis; dysfunction
114
antineoplastic assessment
history and physical: contraindications, AE
Labs: CBC, LFTs, kidney functions (complete metabolic panel)
115
antineoplastic nursing diagnosis
fatigue related to drug effects (anemia) and disease effects
disturbed body image related to alopecia, skin effects, etc
risk for infection related to neutropenia
116
antineoplastic expected outcomes
the client will have decreased cancer growth or spread
the client will develop limited adverse effects
the client will understand drug therapy, adverse effects, and comfort measures to relieve adverse effects
117
antineoplastic interventions for MedSurg Nurse
schedule blood tests to monitor bone marrow, liver, and renal function as prescribed
monitor AE
administer anti-nausea and anti-diarrheal as prescribed
ensure hydration to decrease risk of renal toxicity and dehydration
provide small frequent meals, mouth care, and consult the dietician to maintain nutrition.
avoid exposure to infection
observe for signs of bleeding due to thrombocytopenia
advise barrier contraception during sexual activity to avoid contaminating the partner through body fluids
118
antineoplastic discharge education
take antiemetics as prescribed, follow dietary advice for GI effects, maintain fluid intake, go to next scheduled CBC, notify provider of oncologic emergency, prevention contamination of body fluids by wearing gloves, flush 2-3 times with stool closed, place soiled linens separate, drug waste should have its own receptacle.
119
indications of oncologic emergency
fever/chills
temp higher than 100.5F
swollen tongue/crack/bleeding
bleeding gums
dry, burning, scratchy or swollen throat
blood in urine
changes in bladder function or patterns
changes in GI or bowel patterns longer than 2-3 days
bloody stools
120
med surg nurse antineoplastic responsibilities
monitor the patient before, during and after treatment and how to handle drugs after treatment.
wear PPE and call oncology nurse with questions
121
signs and symptoms of extravasation
pt reports burning, stinging, pain at site or chest wall, neck, shoulder
leakage, swelling, induration at site
122
actions for extravasation
stop infusion immediately and contact provider, aspirate residual drugs from catheter, follow protocols
123
stomatitis
ulceration of oral mucous membranes
124
mucositis
ulceration of any part of the GI system from mouth to anus
125
Filgrastim (neupogen) class
colony stimulating factors
126
Filgrastim (neupogen) MoA
stimulates production, maturation, and activation of neutrophils to reduce incidence of infection
127
Filgrastim (neupogen) indications
myelosupression conditions (antineoplastic drugs, bone marrow transplant, HIV)
128
Filgrastim (neupogen) route
SQ
129
Filgrastim (neupogen) AE
fatigue, bone pain, fever, n/v, peripheral edema
130
Filgrastim (neupogen) nursing considerations
frequent lab monitoring (CBC before treatment and twice weekly), teach self administration
131
thrombocytopenia
platelet count less than 50,000/mm3
132
platelet level indicative for transfusion
10,000/mm3
133
antineoplastic drugs in children
vulnerable to malnutrition and dehydration, need support and comfort to be like other children, management of developmental needs and infection prevention
134
antineoplsatic drugs in adults
body image may be altered after hair loss, cachexia, offer support, fear of diagnosis and treatment, may incur job stress and financial strains, need support, teaching and comfort.
135
antineoplastic drugs in older adults
more susceptible to the CNS, GI, renal and liver effects. May need reduced doses of antineoplastic drugs.
136
immune modulator
modify the actions of the immune system
137
immune stimulants
energize immune system when it needs help fighting a specific pathogen
138
immune suppressants
block normal effects of the immune system in organ transplantation and autoimmune disorders.
139
Cyclosporine class
t and b cell suppressors
140
Cyclosporine MoA
inhibits helper t cells; block antibody production of B cells
141
Cyclosporine indications
anti-rejection organ transplant; psoriasis, rheumatoid arthritis.
142
Cyclosporine contrainidications
pregnancy/lactation, renal/liver dysfunction, infection, malignancies
143
Cyclosporine drug/food
grapefruit juice- increase levels by 50-200%
144
Cyclosporine AE
infection risk, kidney and liver damage
145
Cyclosporine nursing considerations
monitor CBC, kidney/liver function, drug level, avoid infection, no grapefruit juice, s/s of kidney and liver toxicity
146
immunizations/vaccines
process of artificially stimulating active immunity by exposing body to weakened disease causing organisms.
147
titer
lab test that evaluates the level of antibodies from prior vaccine or infection. Positive titer means high levels to promote protection. negative, no protection.
148
booster
a repeat injection of a vaccine after time has passed to strengthen immune response and maintain protection.
149
vaccines in children
standard of care, nurse should provide written record, educate to report AE, warm soaks and acetaminophen to treat AE
150
vaccines in adults
immunize if traveling to areas with high risk for specific disease
151
vaccines in older adults
older adults have greater risk for severe illness if unvaccinated, there is no age limit for vaccines.
152
attenuated LIVE vaccines
alive but weakened- could produce disease if immune compromised
ex: MMR, varicella
153
Inactivated (KILLED) vaccines
killed vaccine, required booster
ex: flu and hepatitis vaccines
154
immunizing drugs general MoA
introduces inactive cells; initiates B cell response and destruction of pathogen if exposed.
155
immunizing drugs general indications
disease prevention
156
immunizing drugs general drug/drug
immunosuppressant drugs, including corticosteriods
157
immunizing drugs general AE
common: redness, discomfort at injection site, fever, minor aches, arthralgia
rare: anaphylactic reaction.
158
contraindications for vaccines
severe acute illness with or without fever
allergic reaction to vaccines
immunosuppression
history of Guillain Barre syndrome
pregnancy
159
medications label
labels have specific information that identifies a specific medication.
includes: warnings, administration information, national drug code number, brand name, generic name, drug dose, lot number, prescription status, drug manufacturer, quantity, and expiration date.
160
pharmacokinetics
what the body does to the drug
161
pharmacokinetics- absorption
getting drug to blood
162
pharmacokinetics- distribution
getting drugs to tissues
163
pharmacokinetics- metabolism
breaking drug down
164
pharmacokinetics- excretion
getting drug out of the body
165
oral route
most are absorbed through the small intestine but some in stomach. onset 30-60 min. administer 1 hour before meals or 2 hours after with a full glass of water
166
factors effecting oral route
molecular weight, lipid solubility, blood flow through GI, surface area of GI, rate of gastric emptying, drug drug interactions, food and drink administered with meds (binding)
167
sublingual route
rapid action; absorbed through highly vascular tissue
168
topical route
delivers drug directly to affected area, minimal systemic absorption
169
transdermal route
provides constant rate of drug absorption, always apply to intact skin
170
IV route
full strength: immediate onset and fully absorbed, more likely to cause toxic effects
if administering more than 1 drug at same site, they must be compatible.
171
IM route
absorbed directly into capillaries in muscle and sent into circulation. men more vascular muscles than women, men reach peak level faster than women
172
SQ route
slowly absorbed, timing of absorption varies depending on fat content and state of local circulation. increased adipose tissue means decreased absorption
173
IV bioavailability
100% absorption/bioavailability
174
IM/SQ bioavailability
100% absorption but less than 100% bioavailable
175
Oral bioavailability
less than 100% absorption/0-70% bioavailable
176
drug metabolism (biotransformation)
liver is primary site. infants and elderly, genetic disorders and severe liver disease can decrease metabolism, liver transforms drug to an active form
177
enzyme induction
increased activity of enzyme system by presence of first drug; speeds metabolism of second drug using enzyme system and cannot reach therapeutic effect.
why some drugs cannot be taken together.
178
enzyme inhibitied
some drugs inhibit enzyme system-make less effective, drug will not be broken down for excretion. blood level of drug increases to toxic level
179
first pass effect- oral route
how much the liver metabolizes the drug then effects the amount of bioavailability the drug has.
180
drug excretion
kidneys are primary organ for excretion of drugs from body. kidney dysfunction will cause toxicity. liver and bowel are secondary sire for excretion.
181
antagonist drugs
do the opposite of what its supposed to.
competitive: block normal stimulation of receptor
noncompetitive: prevent reaction of another chemical with a different receptor site on cell
182
pharmacological changes related to aging: cardiovascular
decreased cardiac output
183
pharmacological changes related to aging: GI
increased gastric pH and decreased peristalsis/absorption
184
pharmacological changes related to aging: hepatic
decreased enzyme production and decreased blood flow to liver
185
pharmacological changes related to aging: renal
decreased blood flow, GFR, and overall function
186
pharmacological changes related to aging: absorption
changes can result in decreased absorption of oral drugs
187
pharmacological changes related to aging: distribution
decreased total body water increases concentration of med, decreased protein (albumin), greater amount of free drug INCREASES risk for toxicity
188
pharmacological changes related to aging: metabolism
enzyme activity decreased due to decreased function INCREASES risk for toxicity
189
pharmacological changes related to aging: excretion
decreased number of nephrons and GFR INCREASES risk for toxicity
190
manifestations of anaphylaxis
hypotension, tachycardia, dyspnea, edema, hives, itching, respiratory or cardiac arrest
191
agonist drugs
drugs interact directly with receptor sites, cause same activity of natural chemicals would cause at that site
ex: insulin- beta agonist
192
diphenhydramine (benadryl) class
antihistamines H1 receptor antagonist
193
diphenhydramine (benadryl) MoA
block release of histamine from mast cells; compete for unoccupied histamine-1 receptor sites
194
diphenhydramine (benadryl) indications
allergic rhinitis many others
195
diphenhydramine (benadryl) contraindications
older adult, condition exacerbated by anticholinergic effects
196
diphenhydramine (benadryl) AE
drowsiness and sedation; high anticholinergic effects
197
diphenhydramine (benadryl) nursing considerations
caution about driving/operating dangerous machinery
198
pseudoephedrine class
oral decongestants
199
pseudoephedrine MoA
stimulates alpha 1 sites (sympathomimetic/vasoconstriction); shrink mucous membrane and decrease mucous production in UR
200
pseudoephedrine indications
promotion of sinus drainage and decrease mucous production
201
pseudoephedrine route
oral; immediate and extended release available.
202
pseudoephedrine contraindications
condition exacerbated by sympathetic activity
203
pseudoephedrine AE
hypertension, insomnia, dizziness, anxiety
204
pseudoephedrine nursing considerations
OTC behind pharmacy counter
205
Glucagon MoA
accelerates the breakdown of glycogen to glucose in the liver, causing an increase in blood glucose levels
206
IV D50W class
glucose elevating agents
207
Lispro and Aspart
SQ injections up to 4x per day (ACHS)
risk for hypoglycemia at meal time
208
Regular Insulin
only insulin given by IV and low BG at peak action
209
Glargine (lantus)
lower risk low BG, 1-2 times daily (12-24 hrs)
210
Insulin MoA
replacement of endogenous insulin- promote cellular uptake of glucose, amino acids, potassium, protein synthesis, glycogen formation/storage, fatty acid storage
211
Insulin Indication
T1DM, T2DM, DKA (regular insulin only), Hyperkalemia
212
Insulin AE
hypoglycemia, lipohypertrophy, lipodystrophy at injection site, diarrhea, hypokalemia
213
lispro (humalog) onset, peak, duration
5-15 min
30-60 min
3-4 hour
214
Aspart (novolog) onset, peak, duration
10-20 min
1-3 hours
3-5 hours
215
regular insulin onset, peak, and duration
30-60 min
2-3 hours
6-10 hours
216
glargine (lantus) onset, peak, duration
gradual
none
up to 24
217
glucagon route
IM or SQ
218
glucagon onset, peak, and duration
1 min
15 min
9-20 min
219
glucagon AE
hyperglycemia, rebound hypoglycemia
220
glucagon nursing considerations
administer SQ/IM if no IV access for severe hypoglycemia, give supplemental carbohydrates ti replenish depleted glycogen stores
monitor: VS, LOC, BG
221
glucagon class
glucose elevating agents
222
IV D50W MoA
increase circulating blood glucose
223
IV D50W route
IV push over 2-5 min
224
IV D50W onset
minutes
225
IV D50W AE
hyperglycemia, electrolyte disturbances, hyper-osmolarity, localized phlebitis, localized tissue necrosis
226
IV D50W nursing considerations
admin IV for severe hypoglycemia
give supplemental carbohydrates when pt. able to safely swallow to replenish depleted glycogen stores
monitor VS, LOC, BG (rebound hypoglycemia)
227
prednisone MoA
anti-inflammatory and immunosurpression effects
228
prednisone indication
inflammatory and allergic disorder
229
prednisone contraindications
acute infection, diabetes mellitus, acute peptic ulcers, CHF, older adult
230
prednisone interactions
quinolones, NSAIDs, salicylates and diuretics
231
prednisone short term AE
gastric irritation, immunosuppression, edema, HTN, weight gain, insomnia, appetite increase, masks s/s infection, steroid psychosis.
232
prednisone long term AE
Cushing's syndrome; hypernatremia, hypokalemia, growth suppression, adrenal suppression.
233
cushing's syndrome s/s
weight gain- moon face and buffalo hump
hyperglycemia
osteoporosis
hypertension
muscle atrophy
bruise easily/purpura
skin thins/poor healing
234
fentanyl class
opioid agonist
235
fentanyl uses
acute and chronic pain, adjunct to general anesthesia
236
fentanyl IV dose
onset: 1 min
peak 3-5 min
duration: 30-60
50mcg evert 1-2hr PRN
PCA pumps
same considerations as morphine for IVP
237
fentanyl transdermal dose
half life 13-22 hours
common dose: 25 mcg/hour
change patch every 72 hours
238
goal of antibiotics
cause bacterial cell death without causing damage to host cells. MoA varies on the type of antibiotic
238
goal of antibiotics
cause bacterial cell death without causing damage to host cells. MoA varies on the type of antibiotic
239
Big concept of antibiotics
all antibiotics cause death of bacteria if effective
240
common AE of antibiotics
nausea, vomiting, diarrhea, rash, hives, hypersensitivity reactions, superinfections/secondary infections
241
superinfections/secondary infections
host flora suppressed by antibiotics or they are opportunistic. CM may vary.
ex: c-diff and candida albicans
242
Antibiotics Potential toxicities
Acute kidney injury (R)
Neurotoxicity (N)
Liver toxicity (L)
"RN Later"
243
antibiotics- children
monitor closely for allergic reaction and superinfections
ensure adequate hydration and nutritional status
244
antibiotics- adults
instructions to take all medication as directed/do not save or share
females on birth control use additional protection against pregnancy
245
antibiotics- pregnancy
most antibiotics are contraindicated (risk v. benefit)
246
antibiotics- older adult
higher risk for toxicity
247
antibiotics nursing responsibilities
complete assessment and health history, obtain cultures as needed, note s/s of infection, may increase anticoagulant effect of warfarin, monitor therapeutic effect, lab values, AE, peak and trough if appropriate, ensure hydration, patient education.
248
anxiety
feelings of tension, nervousness, apprehension, and fear.
CM: sweating, tachycardia, rapid breathing, elevated BP
Mild: helpful in certain situations
Severe: interfere with functioning
249
general benzodiazepines MoA
depress activity of CNS through GABA receptors
250
general benzodiazepines contraindications
pregnancy (X), lactations, COPD, older adults
251
general benzodiazepines black box warning
schedule IV, CNS depressants, alcohol, opioid, others
252
general benzodiazepines AE
CNS depression; overdose; respiratory depression, coma
253
general benzodiazepines nursing considerations
caution with IV route; long term use must taper discontinuation; addictive
254
Lorazepam (Ativan) class
benzodiazepines
255
Lorazepam (Ativan) use
anxiety disorders, acute agitation, acute alcohol withdrawal, pre-operative sedation
256
Lorazepam (Ativan) AE
drowsiness, dizziness, lethargy, fatigue, hypotension; overdose: respiratory depression
257
Lorazepam (Ativan) nursing considerations
fall precautions
258
Nursing Care Plan Benzodiazepines
focused neuro and respiratory; VS
taper dose with long term use
fall precautions
don't use heavy machinery
evaluate therapeutic response
259
goal of antidepressants
more neurotransmitter in synaptic cleft
260
general antidepressants indication
depression (4-6 week onset)
261
general antidepressants black box warning
increased risk for suicidal ideation
261
general antidepressants black box warning
increased risk for suicidal ideation
262
general antidepressants contraindications
pregnancy/lactation, seizure disorders
263
general antidepressants caution
older adult more susceptible to AE
264
general antidepressants drug drug
more than 1 antidepressant increase risk for AE and serotonin syndrome; serotonergic drugs (fentanyl, St. John's Wart)
265
serotonin syndrome
initiation, increased dose or overdose; usually self limiting after discontinuing drug.
266
main serotonin syndrom CM
agitations, HTN, sweating, clonus, hyper-reflexia, tremors
267
first generation antidepressants
more significant AE, toxicity lethal, pregnancy category D/X
tricyclic and MAOIs
268
second generation antidepressants
SSRI, SNRI
more tolerable AE but still bothersome
pregnancy category C
269
antidepressant AE
orthostatic hypotension
GI effects n/v/d
drowsiness or insomnia
anticholinergic effects
weight loss or gain
sexual dysfunction
prolonged QTC
270
amitriptyline class
tricyclic antidepressant
271
amitriptyline MoA
reduce uptake of serotonin and NE into nerves- cholinergic, histaminergic, adrenergic, dopaminergic receptors. Blocks so many receptors causing multiple adverse effects
272
amitriptyline use
refractory to other treatment
273
amitriptyline caution
CV disease or seizures
274
amitriptyline drug drug
MAOIs
275
amitriptyline AE
sedation, anticholinerigc effects, overdose: cardiac arrhythmias and seizures
276
amitriptyline nursing considerations
administer at HS
277
Phenelzine class
MAOI
278
phenelzine MoA
irreversibly inhibits MAO allowing neurotransmitters to accumulate in synaptic cleft (including dopamine)
279
phenelzine use
depression refractory to other treatment: parkinsons disease
280
phenelzine caution
CV disease
281
phenelzine drug drug
sympathomimetic, serotonergic drugs; many others
282
phenelzine drug food
tyramine increased BP and risk for HTN crisis
283
phenelzine AE
hypertensive crisis
284
phenelzine nursing considerations
teach avoid tyramine containing foods, wait 2-6 weeks MAOI to SSRI
285
high tyramine containing foods
aged cheese, smoked/pickled/cured meats, yeast extracts, red wines
286
moderate/low tyramine containing foods
avocado, pasteurized light and pale beer, distilled spirits, non aged cheese, chocolate and caffeinated beverages, fruit
287
citalopram (celexa) class
selective serotonin reuptake inhibitor
288
citalopram (celexa) MoA
blocks reuptake of serotonin increasing levels in the synaptic cleft
289
citalopram (celexa) use
first line treatment of depression; OCD, panic attacks, PTSD; off label: chronic pain neuropathies
290
citalopram (celexa) drug-drug
highly protein bound (warfarin, phenytoin) risk of toxicity
291
citalopram (celexa) AE
less CV, anticholinergic, drowsiness than others; sexual dysfunction, prolonged QTC
292
citalopram (celexa) nursing considerations
slowly taper due to withdrawal syndrome
293
duloxetine (cymbalta) class
selective norepinephrine reuptake inhibitor
294
duloxetine (cymbalta) MoA
blocks reuptake of NE and serotonin
295
duloxetine (cymbalta) use
depression, anxiety; off label; neuropathic pain, fibromyalgia
296
duloxetine (cymbalta) drug drug
highly protein bound (warfarin, phenytoin) risk of toxicity
297
duloxetine (cymbalta) AE
GI effects
298
duloxetine (cymbalta) nursing considerations
see general
299
antidepressants in children
longer term effects not clearly understood. some studies-efficacy poor, increased risk for SI
300
antidepressants in pregnancy
caution, benefit vs. risk
neurological, cardiac, and respiratory effects on fetus/baby
301
antidepressants in older adults
more susceptible to adverse effects- reduce dose
302
MoA of Typical antipsychotic
dopamine receptor blockers, due to blocking of dopamine we see anticholinergic, antihistamine, and alpha adrenergic blocking effects
303
MoA of Atypical antipsychotic
block both dopamine and serotonin receptors, alleviate some of unpleasant neurological effects and depression associated with typical antipsychotics.
304
antipsychotics general AE
CNS: sedation, tremor
anticholinergic effects
CV effects: hypotension, arrhythmias, HF
Gynecomastia
laryngospasm/bronchospasm
EPS
neuroleptic malignant syndrome: fever, altered mental status, muscle rigidity, autonomic dysfunction
305
EPS examples
dystonia: spasm of tongue, neck, back, and legs
akathisia: continuous restlessness, constant movement, foot tapping
pseudo-Parkinsonism: muscle tremors, drooling, shuffling gait
tardive dyskinesia: abnormal muscle movements; lip smacking, tongue darting, chewing movements
306
antipsychotics caution and contraindications
CNS depression, Parkinson's disease, cardiac disease, arrhythmias, bine marrow suppression, immunosuppressed, dementia, seizures, conditions exacerbated by anticholinergic effects
307
antipsychotics drug drug
CNS depression and alcohol
anticholinergic
SSRI and SNRI
anti-dysrhythmic
308
haloperidol (haldol) class
typical antipsychotics
309
haloperidol (haldol) MoA
block dopamine receptors, preventing stimulation of post synaptic neurons
310
haloperidol (haldol) uses
acute psychotic disorders
311
haloperidol (haldol) AE
see general
312
haloperidol (haldol) nursing considerations
see general; many other typical antipsychotics used for acute episodes and or maintenance
313
clozapine (clozaril) class
atypical antipsychotics
314
clozapine (clozaril) MoA
block dopamine and serotonin receptors, depresses the reticular activating system of brain
315
clozapine (clozaril) AE
increase blood glucose, weight gain, decreased WBC
316
clozapine (clozaril) nursing considerations
periodically monitor blood glucose; check WBC before starting therapy
317
Lithium class
bipolar disorder agents
318
lithium MoA
alters Na transport in nerve and muscle cells; inhibits release of NE and dopamine from neurons
319
lithium contraindications/cautions
renal disease, cardiac disease, sodium depletion/altered sodium levels, pregnancy (X), lactation
320
lithium drug drug
many; diuretics, haloperidol
321
lithium AE
Gi effects n/v/d
lethargy, slurred speech, weakness, tremor, ataxia, clonic movements, hyper-reflexia, seizures
mild polyuria, nephrogenic diabetes insipidus
life-threatening arrhythmias
322
acetylcholine
enables muscle action, learning and memory
323
dopamine
influences movement, learning, attention and emotion
324
serotonin
affects mood, hunger, sleep, arousal
325
norepinephrine
helps control alertness and arousal
326
gamma- aminobutyric acid (GABA)
major inhibitory NT
327
glucamate
major excitatory NT; involved in memory
328
generalized seizure
simultaneous disruption of electrical activity/onset in bilateral hemispheres. tonic clonic seizure is most common major motor seizure.
329
focal seizure
begin with a specific area of the cerebral hemisphere. with impaired consciousness, or without impairment of consciousness
330
epilepsy
chronic disorder of recurrent seizures
331
status epilepticus
multiple seizures occur with no recovery between them- hypotension, hypoxia, brain damage, and dead; Emergency- diazepam
332
general anti seizure medication MoA
alter movement of sodium, potassium, calcium, and magnesium ions; changes in movement of ions result in more stabilized and less excitable cell membranes
333
general anti seizure medication AE
Gi upset, CNS depression, confusion, ataxia
334
general anti seizure medication toxicity
hepatotoxicity
335
general anti seizure medication drug drug
CNS depressant, alcohol, many other (highly protein bound)
336
general anti seizure medication cautions
risk of birth defects; pregnancy category C/D/X
do not abruptly withdrawal
monitor for levels of toxicity
black box of SI
337
Diazepam (valium) MoA
potentiates effects of GABA
338
Diazepam (valium) use
staus epilepticus
339
Diazepam (valium) route
IVP 2mg/min; onset 1-5 min; peak 30 min; duration 60 min
340
Diazepam (valium) AE
resp. depression, bradycardia, hypotension
341
Diazepam (valium) nursing considerations
monitor cessation of seizure, VS
342
Diazepam (valium) class
benzodiazepines
343
phenytoin (Dialantin) class
hydantoins
344
phenytoin (Dialantin) MoA
stabilize nerve membranes throughout CNS-less excitability
345
phenytoin (Dialantin) AE
see general & gingival hyperplasia
346
phenytoin (Dialantin) drug drug
many-highly protein bound, hepatic enzyme inducer, warfarin bleeding
347
phenytoin (Dialantin) nursing considerations
therapeutic blood level 10-20 mcg/mL; teach good oral hygiene
348
phenytoin (Dialantin) IV administration
IV push in a large vein and large catheter do not exceed 50 ml/min
infuse with dilution of NS
follow with a NS flush to decreases vein irritation
monitor site for inflammation and extravasation
monitor cardiac rhythm and blood pressure
349
phenobarbital (luminal) class
barbituates
350
phenobarbital (luminal) MoA
enhances action of GABA NT
351
phenobarbital (luminal) AE
see general; they resolve over time
352
phenobarbital (luminal) toxicity
respiratory depression, coma, IV route (be cautious)
353
phenobarbital (luminal) nursing considerations
therapeutic blood level: 10-40 mcg/L; admin once daily dosing at HS due to sedating effects
354
valproic acid MoA
increase levels of GABA in brain
355
valproic acid AE
see general; weight gain; increase bleeding time.
toxicity: pancreatitis
356
valproic acid drug drug
many-highly protein bound; warfarin- bleeding
357
valproic acid nursing considerations
do not crush or chew ER
358
nursing care plan: interventions for seizure medications
reduce risk for falls, seizure precaution, counsel women of childbearing age, lab monitoring for TE levels
359
anti seizure medications- child
more sensitive to sedating effects, monitor closely. children 2 months-6 years absorb and metabolize quickly; may require larger dose per kg to maintain TE
360
anti seizure medications- adult
medic alert identification
consider lifestyle changes (work, transportation, etc)
361
anti seizure medications- older adult
more susceptible to AE anf toxicity
dose adjustment for reduced liver/kidney function
362
levodopa/carbidopa (sinemet) class
dopaminergic agent
363
levodopa/carbidopa (sinemet) MoA
restores dopamine concentration in brain
364
levodopa/carbidopa (sinemet) indication
parkinson's disease
365
levodopa/carbidopa (sinemet) drug drug
antihypertensives, CNS depression
366
levodopa/carbidopa (sinemet) caution
CV disease, asthma, urinary obstruction, PUD
367
levodopa/carbidopa (sinemet) AE
orthostatic hypotension, dry mouth, constipation, urinary retention, confusion, agitation, insomnia
368
levodopa/carbidopa (sinemet) nursing considerations
abrupt cessation may cause Parkinsonism crisis; take as prescribed and do not double dose
369
donepezil (aricept) class
cholinesterase inhibitor (cholinergic agonist)
370
donepezil (aricept) MoA
enhances the effects of acetylcholine in neurons in cerebral cortex that have not been damaged
371
donepezil (aricept) indication
alzheimers disease
372
donepezil (aricept) AE
n/v/d, insomnia or drowsiness, bradycardia/AV block
373
donepezil (aricept) nursing considerations
assess BP/HR; monitor mental status; give at bed time unless insomnia occurs. Teach- not to increase or decrease dose abruptly. Risk of cholinergic crisis
374
anesthetics
drug that reduce or eliminate pain by depressing nerve function in the central and or peripheral nervous system
375
general anesthesia
involves complete loss of consciousness and loss of body reflexes, including respiratory muscles (ventilatory support to avoid brain damage)
376
moderate sedation
allows patient to relax and tolerate procedure but maintains respiratory function and response to stimuli
RN may be trained
must have ACLS training
377
nursing role- moderate sedation
ensure life support equipment is readily available, patent IV, supplied for IV push meds, monitor LOC and pain, VS, alert provider of major changes, and LOC and VS after procedure
378
midazolam (versed) class
benzodiazepines (anesthetic)
379
midazolam (versed) indications
moderate sedation for diagnostic procedures, induction of anesthesia, sedation of intubated patients, decreased anxiety prior to procedure
380
midazolam (versed) onset/peak/duration IV
1-5 min, less than 30 min, 2-6 hours
381
midazolam (versed) drug drug
CNS depressants, opioids
382
midazolam (versed) AE
respiratory depression, CNS depression, disorientation, amnesia, restlessness, bradycardia, hypotension
383
midazolam (versed) nursing
assume patient will remember things said/done during sedation/anesthesia
384
nursing role- medically induced coma
trained intensive care RN, assist with intubation, prepare for IV push drugs, keep patient comfortable/ tolerate of ET tube, taper drugs prior to extubating (removing ET tube)
benzo/sedative then paralytic
385
rocuronium class
neuromuscular blocking drugs
386
rocuronium MoA
bind to ACh receptors at NTM junction, blocking action of ACh, induced paralysis of skeletal muscle (peripheral to central)
387
rocuronium indications
endotracheal intubation; surgery
388
rocuronium onset, peak , duration IV
1-2 min, 4 min, 30 min
389
rocuronium AE
muscle damage, hyperkalemia, cardiovascular collapse (higher dose and prolonged administration
390
rocuronium nursing considerations
administer prescribed sedation prior to neuromuscular blocking agent
