NUR 325 Final Flashcards
Drugs (166 cards)
1
Q
what is the MOA of Heparin?
A
Prevents clotting by activating antithrombin
(Indirectly inactivates thrombin and factor Xa)
**Intrinsic Pathway
2
Q
Indications for Heparin
A
Conditions necessitating PROMPT anticoagulation activity (evolving stroke, PE, massive DVT)
Adjunct for pts having open heart surgery
Low dose therapy for prophylaxis against post-op DVT
Treat disseminated intravascular coagulation (DIC)
3
Q
Adverse Reactions of Heparin
A
Bleeding
Hematoma
Anemia
Thrombocytopenia
4
Q
What should you monitor after giving Heparin?
A
BLEEDING!!
Vital signs, bruising, petechiae, hematomas, black tarry stools
5
Q
What is Heparin-Induced Thrombocytopenia?
A
Low platelet count and increased development of thrombi
*Caused by antibody development
6
Q
Nursing Considerations for Heparin
A
Only given parenteral (IV or SQ)
Use may be issue if pt follows kosher or Halal diets (derived from lung and intestines of pigs)
Use cautiously in pts with spinal or epidural anesthesia
7
Q
Is Heparin a HIGH RISK med?
A
YES!!
Must double check with other RN prior to rate changes and boluses
8
Q
What is the Antidote for Heparin?
A
Protamine SULFATE
9
Q
What is the MOA of Enoxaparin (Lovenox)?
A
ONLY inactivates factor Xa!!
(NOT THROMBIN)
Slower onset, but LASTS LONGER than Heparin
10
Q
What are the indications for enoxaparin?
A
Given prophylaxis and treatment
*CAN be given at HOME
11
Q
What are the major adverse reactions of enoxaparin?
A
BLEEDING
Thrombocytopenia
HIT (heparin-induced thrombocytopenia)
12
Q
Nursing Consideration for enoxaparin
A
Labs NOT necessary
Use cautiously in pts with spinal or epidural anesthesia
DO NOT GIVE WITH HEPARIN
DON’T give with any other anticoags EXCEPT oral Warfarin when treating PE or DVT
SQ INJECTION ONLY (pre-filled syringes - LEAVE AIR BUBBLE in plunger)
ROTATE SITES - DO NOT RUB SITE AFTER INJECTION
13
Q
BLACK BOX WARNING:
enoxaparin
A
Potential spinal hematoma if pt has epidural catheter
14
Q
Antidote for enoxaparin?
A
Protamine
15
Q
What is the MOA of Warfarin?
A
VITAMIN K inhibitor
Prevents the synthesis of 4 coag factors (7, 9, 10, and prothrombin (2))
16
Q
Indications for Warfarin?
A
Prevention of VTE/DVT/PE
Thrombotic events for pts with atrial fibrillation, or heart valves
Reduce recurrence of TIA or MI
17
Q
Adverse reactions of Warfarin?
A
BLEEDING
Lethargy
Muscle pain
Purple toes
18
Q
Nursing considerations for Warfarin
A
TERATOGENIC!! (Even breastfeeding)
ONLY GIVEN PO (once a day - 5pm)
– onset not until 24 hours!
MONITOR and TEACH for S/S of bleeding
HOLD before surgeries
Many drug/food interactions
19
Q
What should we teach pts on Warfarin?
A
Wear medic alert bracelet
Use soft bristle toothbrush
Use electric toothbrush/razor
Avoid alcohol
20
Q
What labs do you need to monitor when giving Warfarin?
A
PT - Prothrombin Time
INR - International Normalized Ratio
Therapeutic range = 2-3.5
**MONITOR MONTHLY
21
Q
Antidote for Warfarin?
A
Vitamin K (IV)
(if that doesn’t work, give fresh frozen plasma or whole blood)
22
Q
What is the MOA of apixaban and rivaroxaban?
A
Direct inhibitor of Factor Xa
23
Q
Indications for apixaban and rivaroxaban?
A
Prevents strokes in pts with afib, post-op thromboprophylaxis
Treat DVT/PE
24
Q
Adverse reactions for apixaban and rivaroxaban?
A
Bleeding
Hematoma
Dizziness and rash
GI distress
Peripheral edema
25
Nursing consideration for apixaban AND Rivaroxaban?
Monitor for adverse reactions
Drug interactions decrease effects: phenytoin, carbamazepine, rifampin, St. John's wort
INCREASED EFFECTS: CYP3A4 (grapefruit juice!)
26
Antidote for Apixaban and Rivaroxaban?
Andexxa
*memory cue - xa = 10 (inhibits factor Xa)
27
BLACK BOX WARNING:
apixaban & rivaroxaban
Spinal hematoma with epidural
Risk of thrombosis if stopped ABRUPTLY
28
Labs needed for apixaban & rivaroxaban?
NO ROUTINE MONITORING REQUIRED
(Watch liver function: ALT, AST, GGT)
29
What are the Anti-platelet drugs?
(Don't affect coag cascade!)
Aspirin
Clopidogrel
Ticagrelor
30
What is the MAO of Aspirin?
Blocks the prostaglandin synthesis through the COX enzyme pathways
Blocks PLATELET aggregation
31
Indications for Aspirin
Prevent/treat MI
Prevent ischemic stroke (stroke)
32
What is the dose of Baby Aspirin?
81 mg tablet
**CHEW IT (white pill)
33
Adverse Affects of Baby Aspirin?
Bleeding
GI - N/V
Drowsiness, confusion
34
Nursing considerations for Baby Aspirin?
Monitor for bleeding
Don't crush enteric coated
OTC med considerations
Reye's Syndrome - children with a virus (NO ASPIRIN)
35
MOA for clopidogrel and ticagrelor?
ADP inhibitor - alters the platelet membrane so it doesn't receive SIGNAL to aggregate
36
Indications for clopidogrel and ticagrelor?
Reduce risk of stroke, prophylaxis of TIAs, post MIs
37
Adverse reactions for clopidogrel and ticagrelor?
chest pain
edema
flu-like symptoms
abdominal pain
D/N
epistaxis (nosebleed)
rash
pruritus (itching)
38
BLACK BOX WARNING:
clopidogrel
Pts with certain genetic abnormalities have a higher rate of CV events
39
Nursing considerations for clopidogrel?
Effectiveness effected by amiodarone, calcium channel blockers, NSAIDs, PPIs
40
BLACK BOX WARNING:
tricagrelor
Increased bleeding risk with aspirin doses over 100 mg
41
MOA for argatroban and bivalrudin?
Inhibit thrombin (factor 2a)
42
Indications for argatroban and bivalrudin?
Treat HIT
For pts undergoing procedures (PCI) who are at risk for HIT
43
Adverse reactions for argatroban and bivalrudin?
Bleeding
44
Nursing considerations for argatroban and bivalrudin?
IV ONLY
Be careful in pts with hepatic dysfunction
45
Labs needed for argatroban and bivalrudin?
Anti-Xa
H&H
Platelets
46
What class is Hydrocortisone?
Glucocorticoids
47
MOA for hydrocortisone prednisone, and dexamethasone?
Mimics glucocorticoid burst by adrenals at dawn
48
Indications for hydrocortisone prednisone, and dexamethasone?
Replacement
Anti-inflammatory properties
Immunosuppression
49
Adverse Effects of hydrocortisone, prednisone, and dexamethasone?
Increased intraocular pressure
Fluid retention
High BP
Mood swings
Weight gain
Hunger
50
If you want to be able to test for adrenal function, which glucocorticoid will you administer?
Dexamethsone
51
What are the indications for fludrocortisone?
Only mineralocorticoid replacement
--May be needed with a GCC replacement
52
Adverse reactions with fludrocortisone?
Clouded eye lens
High blood sugar
Increased risk of infections
Thinning bones
Suppressed adrenal gland hormone productions
Thin skin, bruising
Slow wound healing
53
Nursing implications for fludrocortisone?
Salt wasting
54
MOA for bismuth subsalicylate?
Coats the walls of the GI tract
Bind the causative agent for elimination
55
Indication for bismuth subsalicylate?
Anti-diarrheal
56
Adverse reactions for bismuth subsalicylate?
Increased bleeding time
Constipation
Dark stools
Darkening of the tongue
57
Nursing considerations for bismuth subsalicylate?
It is a form of Aspirin
58
What class is bismuth subsalicylate?
It is an adsorbent
59
What is the class for loperamide and diphenoxylate?
Antimotility
*anti-diarrheal
60
What is the MOA for loperamide and diphenoxylate?
slows peristalsis
Drying effect (anti-cholinergic)
61
Adverse reactions for loperamide and diphenoxylate?
Urinary retention
Headache/dizziness/drowsiness
Anxiety
Bradycardia/hypotension
Dry skin
Flushing
62
Nursing considerations for loperamide and diphenoxylate?
Used alone or in combination with adsorbents and opiates
63
What is the class for bacid, culturelle, and florastor?
probiotics
64
what is the MOA for bacid, culturelle, and florastor?
replenish bacteria and restore normal gut flora
suppresses growth of diarrhea causing bacteria
65
What is the indication for florastor? What bacteria does it specifically replenish compared to bacid and culturelle?
C.Diff
66
What kind of laxative is psyllium?
bulk-forming
67
what is the MOA for psyllium?
act similar to dietary fiber
absorbs water into the intestine
68
what is the indication for psyllium?
constipation
69
Adverse reaction of psyllium?
Impaction above strictures
Fluid/electrolyte imbalance
Gas formation
Esophageal blockage
70
Nursing considerations for psyllium
OKAY for long-term use
71
What kind of laxative are docusate sodium and mineral oil?
emollient
72
What is the MOA for docusate sodium?
lubricates fecal material and walls
Promotes fat absorption into fecal mass
73
Indication for docusate sodium?
prevent opioid induced constipation
74
Adverse reactions for docusate sodium?
Skin rashes
Decreased absorption of vitamins
75
Nursing considerations for docusate sodium?
PO ONLY
76
MOA for mineral oil?
lubricates intestines
77
Indications for mineral oil?
fecal impactions
78
Adverse reactions for mineral oil?
Skin rashes
Decreased absorption of vitamins
79
Nursing considerations for mineral oil?
PO and PR (rectal)
80
Class for glycerin, lactulose, polyethylene glycol?
Hyperosmotic
81
MOA for glycerin, lactulose, polyethylene glycol?
Increasing water content in feces
Promotes distention, peristalsis, and evacuation
82
Indication for glycerin, lactulose, polyethylene glycol?
But which is most common?
Evacuate bowels before Dx testing and surgical procedures
Polyethylene glycol is most commonly used
83
Adverse reactions for glycerin, lactulose, polyethylene glycol?
Abnormal bloating
Rectal irritation
Electrolyte imbalance
84
What are the different types of magnesium salts?
Magnesium citrate
Magnesium hydroxide
Magnesium sulfate
85
What class of laxative are magnesium salts?
Saline
86
What is the MOA for magnesium salts?
Increase osmotic pressure and draw water into the colon
87
Indication for magnesium salts?
constipation
88
Adverse reactions for magnesium salts?
Magnesium toxicity
Electrolyte imbalance
Cramping
Diarrhea
89
What is the difference between magnesium salts and sodium salts?
NOTHING!!
Sodium salts = fleet enema
90
What class of laxatives are bisacodyl and senna?
Stimulants
91
Indication for bisacodyl and senna?
Constipation
Whole bowel evacuation
92
Adverse reactions for bisacodyl and senna?
Nutrient malabsorption
Gastric irritation
Electrolyte imbalance
93
Route for bisacodyl?
PO and PR
*OTC
94
Route for senna?
PO ONLY
*OTC
95
Class for Epinephrine?
Vasopressor
Bronchodilator
Anti-asthmatic
Vasoconstrictor
96
MOA for epinephrine?
Inhibits release of mediators form mast cells
97
Indication for epinephrine?
Severe allergic reactions
Cardiac arrest
Severe asthmatic attack
98
Adverse effects of epinephrine in the CV system?
Angina
Arrhythmias
Hypertension
Tachycardia
99
Adverse effects of epinephrine in the CNS system?
Nervousness
Restlessness
Tremor
100
Nursing considerations for epinephrine
SQ preferred
MONITOR: VS, reversal of symptoms
TEACH:
Contact clinician immediately after use
Take EXACTLY as directed
101
Dosing for epinephrine?
Adult: 0.2-1mg
Peds: 0.01/mg/kg
102
Class for phenazopyridine?
Urinary tract Analgesic
103
MOA for phenazopyridine?
UNKNOWN
BUT it exerts a topical analgesic effect on mucosa of urinary tract
104
Indication for phenazopyridine?
RELIEF of PAIN due to a UTI
105
Adverse effect of phenazopyridine?
Reddish-Orange urine
106
Class for mirabegron?
Antispasmodic (urinary)
107
MOA for mirabegron?
Selectively stimulates beta-3 adrenergic receptors
RELAXES BLADDER SMOOTH MUSCLE
108
Adverse effects of mirabegron?
HTN
Urinary retention
UTI
Headache
109
Lower UTI medications?
Trimethoprim-sulfamethoxazole
Ciprofloxacin
Nitrofurantoin
110
We cannot give Trimethoprim-sulfamethoxazole for what allergy?
Which lower UTI med do we give instead?
Sulfa allergy
Give instead: Ciprofloxacin
111
Nitrofurantoin is given for what recurring urinary infection?
Recurring lower UTIs
112
Class of oxybutynin?
Anti-cholinergic meds
113
MOA of oxybutynin?
Block the action of acetylcholine
(acetylcholine activates smooth muscle contraction)
114
Indication for oxybutynin?
overactive bladder incontinence
115
Adverse effects of oxybutynin?
Dry mouth
Constipation
116
What additional form can oxybutynin come in?
Extended release form
117
Fluoxetine is what class of medication?
Antidepressant
(Selective Serotonin Reuptake Inhibitor)
*SSRI
118
MOA of fluoxetine?
Inhibitors of serotonin at nerve endings
More serotonin is available at the nerve endings
119
Indication for fluoxetine?
Depression and anxiety
120
Adverse effects of fluoxetine?
Weight gain
GI: N/V/D, constipation, dry mouth
CNS: headache, nervousness, insomnia
Sexual dysfunction
Serotonin syndrome
Withdrawal syndrome
Suicidal risk
Neonatal effect
121
Nursing considerations for fluoxetine?
AVOID USE WITH MAOIs
Therapeutic benefit 3-4 weeks
122
Class of med for vanlafazine?
Antidepressant
Serotonin and Norepinephrine Reuptake Inhibitor
**SNRI
123
MOA of venlafazine?
Blocks neuronal activity of serotonin and norepinephrine
124
Indication for venlafazine?
Depression and anxiety
125
Adverse effects of venlafazine?
Nausea
Insomnia
Headache
Anorexia
Somnolence
Sexual dysfunction
Withdrawal syndrome
Sweating
Blurred vision
126
Nursing considerations for venlafazine?
CONTRAINDICATED -- MAOIs
DO NOT GIVE IF PT IS TAKING MAOIs
127
Class of med for amitryptaline?
Tricyclic Antidepressants (TCA)
128
MOA of amitryptaline?
Block reuptake of 2 monoamine transmitters: norepinephrine and serotonin (intensify effect)
*makes more available in the synapse
129
Indication for amitryptaline?
Depression and anxiety
Also used to treat neuropathic pain and nocturnal enuresis
130
Adverse effects of amitryptaline?
Sedation
Orthostatic hypotension
Anticholinergic effects
Sexual dysfunction
Cardiac toxicity
131
Nursing considerations for amitryptaline?
FATAL OVERDOSES
Older drug, inexpensive
SIGNIFICANT drug/drug interactions with MAOIs
With MAOIs = HTN crisis
132
Drug class of phenelzine?
Monoamine Oxidase Inhibitors
(MAOIs)
133
MOA for phenelzine?
Inhibits MAO (enzyme found in the liver, intestinal walls, and terminals of neurons)
MAO converts norepi, 5-HT, and dopamine to inactive product
*Decreased MAO increases availability of neurotransmitters at the nerve endings
134
Indication for phenelzine?
Refractory depression (other meds don't work)
Works better for atypical depression
135
Adverse effects of phenelzine?
Food/drug interactions (aged cheese, smoked meats, yeast, red wine)
CNS stimulation
Orthostatic hypotension
SIG drug/drug interactions (antihypertensives, SSRI, TCA, meperidine)
Can lead to rapid increase in BP, stroke, coma
136
Nursing considerations for phenelzine?
HTN CRISIS when taken with Tyramine
137
Drug class for buproprion?
Atypical Antidepressant
138
Indication for buproprion?
Depression and anxiety
139
Adverse effects of buproprion?
Seizure
Agitation
Headache
Dry mouth
Constipation
Weight loss
GI upset
Dizziness/tremors
140
How long does buproprion take to see effect?
1-3 weeks
141
Ketamine drug class?
Atypical Antidepressants
142
Indication for ketamine?
Rapidly helps with suicidality and other serious symptoms of depression
Treat extreme pain
143
Adverse effects of ketamine?
Perceptual disturbances
Dissociation
144
Nursing consideration for ketamine?
LOW DOSE
Intranasal admin
145
Drug class of trazadone?
Atypical Antidepressant
146
MOA of trazadone?
Blockade of 5-HT reuptake
147
Indications for trazadone?
Insomnia
Anxiety
148
Nursing considerations for trazadone?
Second line agent
Minimal effectiveness for depression
149
Drug class of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
Benzodiazepines
150
MOA of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
Enhance inhibitory effects of GABA in the CNS
151
Antidote for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
Flumazenil
152
Indication for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
Generalized anxiety disorder
Panic disorder
153
Adverse effects of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
CNS depression
Withdrawal effects
Memory loss
Respiratory depression (more common with IV use)
154
Nursing consideration for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?
TERATOGENIC
Schedule 4 med
DO NOT MIX with other meds that can cause decreased LOC (Benadryl, alcohol, opioids, barbiturates)
Avoid eating with grapefruit juice or fatty foods (inhibits absorption)
155
MOA of methadone?
Synthetic opioid analgesic
Mu agonist
156
Indication for methadone?
Medication-assisted treatment (MAT) for heroin and Rx painkillers
157
Adverse reactions for methadone?
Lightheaded
Hives
Chest pain
Tachycardia
Hallucinations
Confusion
158
Nursing considerations for methadone?
Reduces symptoms of withdrawal r/t opioid use
Helps ppl avoid use of opioids
Addictive, but potential is lower
Methadone clinics = once daily dose
159
MOA of buprenorphine and naloxone (Suboxone)?
Combination of agonist/antagonist
Helps pts recover more quickly from addiction
160
Indications of Suboxone?
Opioid addiction
161
Adverse effects of Suboxone?
Headache, nausea
Opioid withdrawal syndrome
Anxiety, insomnia
Sweating
Depression
Constipation
162
Nurisng considerations for Suboxone?
Potential for abuse (less than methadone and buprenorphine)
Sublingual and buccal
163
MOA of Naloxone?
Opioid ANTAGONIST (blocks opioid receptors)
164
Adverse effects of Naloxone?
Opioid withdrawal symptoms
165
MOA for buprenorphine (Subutex)?
Partial opioid AGONIST (helps block receptors to prevent craving)
166
Adverse effects of buprenorphine?
Opioid withdrawal symptoms
