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Pharm Flashcards

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1
Q

anticholinergic effects

A

dry mouth, urinary retention, blurry vision

Symptoms – dry mouth, dysphagia, urinary retention, impotence, nasal congestion

Nursing:
o Sugarless lozenges
o Good mouth care
o Void before taking medication

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2
Q

Adrenergics

A

Levophed (Norepinephrine), Intropin (Dopamine), Adrenalin (epinephrine)

Uses: cardiac arrest, COPD
Action: stimulate beta-2 receptors in lungs (so increase peripheral resistance and cause bronchodilation)

S/E: dysrhythmias, tremors, anticholinergic effects

Nursing: Monitor bp, peripheral pulses, and output
pt possibly drowsy

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3
Q

Anti-anxiety

A

(Benzodiazepines, Nonbenzodiazepines, Herbals)

Librium (chlordiazepoxide), xanax (alprazolam), ativan (lorazepam), vistaril (hydroxyzine), Equanil

Uses: anxiety disorders, panic attacks, manic episodes
Action: affect neuro transmitters

S/E: sedation, confusion, hepatic dysfunction (remember CNS depressant)

Nursing: potential for addiction/overdose

  • avoid alcohol (CNS depressant)
  • monitor liver functions ( AST, LST) (LDH)
  • DC med very slowly
  • smoking or drinking caffeine will decrease effectiveness of meds (complete in depth assessment)
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4
Q

Antacids

A

Amphojel (aluminum hydroxide), Milk of Magnesia (magnesium hydroxide), Maalox (both)

Uses – peptic ulcer, indigestion (prevent or treat), reflex esophagitis
Action – neutralize gastric acids

S/E: constipation, diarrhea, acid rebound

Nursing:
• Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives
• Monitor bowel function – can cause bowel addiction
• Timing – given 1-2 hours after eating and other medications
• Fluid and electrolyte balance important bc affecting GI tract – so monitor labs!

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5
Q

Antidysrhythmics

A

Atropine sulfate, Lidocaine, Pronestyl (procainamide), Quinidine, Isuprel (Isoproterenol)
Uses – atrial fibrillation/flutter, tachycardia, PVCs (Decrease myocardial irritability)
Action – interfere with electrical excitability of the heart

S/E: light headedness, bradycardia, hypotension, urinary retention

Nursing
• monitor vitals signs (especially pulses and bp)
• monitor cardiac rhythm
• move positions slowly

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6
Q

with beta blockers worry about

A

broncospasms so affects airway

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7
Q

General S/E with antibiotics

A

Allergies – mild to anaphylaxis
Super-infection - Kill abnormal as well as normal flora in the body
Organ toxicity – liver and kidneys

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8
Q

General teaching with antibiotics

A

o take until gone
o do not culture and sensitivity first
o encourage fluids – hard on kidneys so need more fluids
o check expiration date

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9
Q

Aminoglycosides

A

(mycin) - Antibiotics
Gentamycin, Neomycin, Streptomycin, Tobramycin

Uses – Pseudomonas, E. coli
Action – inhibits protein synthesis in gram-negative bacteria

S/E: ototoxicity, anorexia, nausea, vomiting, diarrhea, nephrotoxic (kidneys)

Nursing:
•	Check 8th cranial nerve (hearing)
•	Check renal function (BUN, urinary output 1200 ml per day)
•	Take 7-10 days – until med complete
•	Encourage fluids – 3000 ml/day
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10
Q

Cephalosporins

A

antibiotics
Ceclor (Cefaclor), Ancef (cefazolin), Keflex (chephalexin), Rocephin (Ceftriaxone), Mefoxin (cefoxitin)

Uses – tonsillitis, otitis media, peri-operative prophylaxis, meningitis
Action – inhibits synthesis of bacterial cell wall

S/E: bone marrow depression, super-infections, rash

Nursing:
• Take with food – cause GI upset
• Cross allergy with PCN!!!
• Avoid alcohol – can cause flushing, dizziness, and muscle aches
• Obtain C&S before first dose
• May give false positive for protienuria or glucose in urine

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11
Q

Macrolide antibiotics

A

Erthromycin, Cleocin (clindamycin)

Uses – acute infections, acne, Upper respiratory infections, prophylaxis before dental procedures if allergic to PCN
Action – binds to cell membrane and changes protein function

S/E: diarrhea, confusion, hepatotoxicity, super-infections

Nursing:
• Take 1 H ac or 2-3 h pc – not with food, take with full glass of water not fruit juice
• Monitor liver function
• Increases effectiveness of Coumadin and theopaline (respiratory drug)

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12
Q

Penicillins

A

Amoxil (amoxicillin), Ampicillin , Augmentin (Amoxicillin/clavulanate)

Uses – moderate to severe infections, syphilis, gonococcus infections, Lyme disease
Action – inhibits synthesis of cell wall

S/E: stomatitis (breakdown in the mouth and along GI tract), diarrhea, allergic reactions, renal and hepatic changes

Nursing:
•	Check for hypersensitivity  - multiple exposures cause reaction
•	Give 1-2 h ac or  2-3 h pc 
•	Cross allergy with cephalosporins
•	Watch renal and hepatic labs
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13
Q

Sulfonamides

A

Gantrisin (acetyl sulfisonxazole), Bactrim (co-trimoxazole), Azulfidine (sulfasalazine)

Uses – ulcerative colitis, Crohn’s disease, otitis media, UTIs
Action – antagonize essential component of folic acid synthesis

S/E: peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis

Nursing:
• Take with meals or food
• Encourage fluids – bc of crystal formation 3000 ml/day
• Good mouth care

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14
Q

Tetracyclines

A

Vibramycin (doxycycline), Panmycin (tetracycline)

Uses – infections, acne, prophylaxis for ophthalmia neonatorum (given to every baby when born to prevent infection)
Action – inhibits protein syntheis

S/E: discoloration of primary teeth if taken my mom during pregnancy, glossitis, rash, phototoxic reactions

Nursing:
• Take 1 h ac or 2-3 h pc
• Do not take with antacid, milk, iron – decrease absorption
• Note expiration date – if taken beyond expiration is toxic
• Monitor renal function
• Avoid sunlight - Sunblock!

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15
Q

All antibiotics before and after meals except

A

cephalosporins and sulfonamides

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16
Q

Antimpotence

A

Viagra (sildenafil), levitra (vardenafil), Cialis (Tadalafil)

S/E: headache, hypotension, priapism
Contraindications: nitrates, alpha blockers - will cause hypotension

Nursing:
• Can not take with grapefruit juice
• Call PCP if erection lasting longer than 4 hrs

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17
Q

Meds that can’t be taken with grapefruit juice

A

lipitor, antimpotence drugs, anticonvulsants

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18
Q

Anticholinergics

A

– inhibit the action of acetcholine, block parasympathic nerve

Pro-Banthine (propanthekine), Atropine, Scopace (scopolamine)

Uses – ophthalmic exam, motion sickness, pre-operative (to reduce GI and bladder motility)
Action – dilates pupils, causes bronchodilation and decreased secretions, decreases mobility and GI secretions

S/E: blurred vision, dry mouth, urinary retention, change in heart rate

- Nursing
•	monitor output (1500 ml normal)
•	contraindicated with glaucoma
•	give 30 min ac, hs, or 2 h pc 
•	not used with paralytic illeus – don’t want to slow down more, BPH – enlarged prostate and don’t want to slow down bladder
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19
Q

Anticonvulsants

A

Dilatin (phenytoin), Luminal (Phenobarbital), depakote (divalproex sodium), Tegretol (carbamazepine), Klonopin (clonazepam)

Uses – seizures
Action – decreases flow of calcium and sodium across neuronal membranes

S/E: respiratory depression, aplastic anemia, gingival hypertrophy, ataxia

Nursing
•	don’t discontinue abruptly
•	monitor I&O
•	caution with use medications that lower seizure threshold (MARI, antiphsychotics)
•	avoid alcohol – CNS depressant
•	pts become drowsy 
•	may turn urine pink
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20
Q

Monamine oxidase inhibitors (MAOI)

A

Antidepressant

Marplan (isocarboxazid), parnate (tranylcypromine), nardil (phenelzine)

Uses – depression, chronic pain
Action – causes increased concentration of neurotransmitters

S/E: hypertensive crisis when taken with tyramine-containing foods, photosensitivity
• Hypertensive crisis – severe headache, palpitations, diaphoretic, stiff neck – can progress to intracranial hemorrhage

Nursing:
• Avoid foods containing tyramine (aged cheese, bologna, pepperoni, salami, bananas, raisins, beer) – can cause hypertensive crisis
• Monitor output
• Takes 4 weeks to work
• Can’t take with CNS stimulates and cold medications

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21
Q

Selective serotonin reuptake inhibitors

A

antidepressants
Prozac (Fluoxetiner), Paxil (paroxetine hydrochloride), Zoloft (sertraline)

Uses – depression, OCD, bulimia
Action – inhibits CNS uptake of serotonin

S/E: anxiety, GI upset, change in appetite and bowel function, urinary retention

Nursing:
•	Suicide precautions (Do you have a plan! – only yes/no question)
•	Takes 4 weeks for full effect
•	Take in AM
•	Monitor nutrition 
•	Turn urine pink
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22
Q

Tricycilics

A

Antidepressants
Elavil (amitriptyline), Toranil (imipramine), Norpramin (desipramine)

Uses – depression, sleep apnea
Action – inhibits reuptake of neurotransmitters

S/E: sedation, anticholinergic effects, confusion, postural hypotension, urinary retention

Nursing:
•	Monitor for suicide
•	Takes 2-6 weeks to work
•	Take at night – bc sedative effect 
•	Monitor vital signs
•	Tell pt to slowly get up and down
•	Wean off over time – headache, vertigo, weight gain if come off too quickly
•	No alcohol
•	Avoid exposure to the sun
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23
Q

Heterocyclics

A

Antidepressant

Wellbutrin (bupropion), Desyrel (trazadone)

Uses – depression and smoking cessation
Action – alter affects serotonin in the CNS

S/E:
• Wellbutrin – agitation
• Desyrel - sedation

Nursing:
• Avoid alcohol and CNS depressants
• Wean off slowly

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24
Q

Non insulin antidiabetic

A

Diabinease, Orinase, Dymelor, Micronase

Uses – Type II diabetes
Action – stimulates insulin release from beta cells in pancreas - Push pancreas to produce more insulin – only used in type II

S/E: hypoglycemia, allergic skin reactions, GI upset

Nursing:
• Taken before breakfast – take to tell pancreas to produce insulin before eating, take awhile to work
• Instruct pt that they need to eat if taken the medication
• Monitor glucose levels (70-110 normal)
• Avoid alcohol, aspirin, sulfamides, oral birth contro, MAOIs – increase chance of hypoglycemia

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25
Antidiarrheal
Kaopectate (bismuth subsalicylate), Lomotil (diphenoxylate/atropine), Imodium (loperamide), Paregoric (tincure of opium) Uses – diarrhea Action – slows peristalsis, increase tone of sphincters S/E: constipation, anticholinergic effects (dry mouth, urinary retention, blurry vision) dizziness, drowsiness Nursing • do not use with abdominal pain • monitor for urinary retention – pay attention to output • give 2 h before or 3 h after other meds • encourage fluids
26
Antiemetics
Tigan (Trimethobenzamide), Compazine (Prochlorperazine), Reglan (metoclopramdie), Antivert (Meclizine), Dramamine Uses – vomiting Action – increases GI motility, blocks effect of dopamine in chemoreceptor trigger zone S/E: sedation, anticholinergic effects Nursing • used before chemotherapy • when used with viral infections may cause Rye’s syndrome (toxic encephalopy)
27
Antifungals
Amphotericin B (fungizone), Nystatin (mycostatin) Uses – candidiasis, oral thrush, histoplasmosis Action – impairs cell membrane of the fungus S/E: hepatotoxicity (hard on the liver to metabolize), thrombocytopenia (decrease platelets, so monitor for bleeding and hemorrage), leucopenia (decreased WBC, increase risk for infection), pruritius (itching) Nursing • give with food • monitor liver function (AST, ALT) • good oral hygiene
28
Antigout
Colchincine (colsalide) (acute phase of gout), Probenecid (benemid) (chronic phase of gout), Allopurinol (Zyloprim) Uses – gout Action – decreases production and resorption of uric acid S/E: agranulocytosis, GI upset, renal calculi Nursing • monitor for renal calculi (give fluids 3000 ml/day) • give with milk, food, antacids
29
Antihistamines
Chlor-Trimeton, Benadryl (diphenhydramine), Phenergan (promethazine), Laratadine Uses – allergic rhinitis, allergic reactions to blood, reactions to other meds Action – block effects of histamine S/E: drowsiness, dry mouth, photosensitivity, bronchospasm ``` Nursing • give with food • use sunscreen • avoid alcohol • assess respirations, mouth care ```
30
Antihyperlipidemic Agents
Questran (Cholestyramine) – block absorption, Lipitor (atorvastin) – inhibit synthesis of absorption of cholesterol and triglycerides Uses – elevated cholesterol, reduce incidence of cardiovascular disease Action – inhibits cholesterol and triglyceride synthesis S/E: constipation, fat-soluble vitamin deficiency Nursing • take at hs or 30 min before ac • administer 1 h before 4-6 h after other meds • assess diet
31
ACE inhibitors
(A = arteries, decrease bp by affecting the arteries in the body) – the prils Capoten (captoril), vasotec (enalpril) Uses – HTN, CHF Action – blocks ACE in lungs (so block angiotension I to angiotension II – causes vasoconstriction – so will have vasodilation if blocked) S/E: GI upset, orthostatic hypotension, dizziness Nursing: • Give 1 h ac or 3 h pc – bc food decreases absorption • Change positions slowly • Monitor vitals
32
Beta adrenergic blockers
(B is for beats, affects heart beats itself – slows them down) Tenormin (atenolol), Corgard (nadolol), Inderal (propranolol) Uses – HTN, angina, SVT Action – blocks beta-adrenergic receptors – decreases excitability of the heart S/E: changes in heart rate, hypotension, bronchospasms Nursing: • Masks signs of shock and hypoglycemia • Take with meals • Do not discontinue abruptly – taper over 2 weeks
33
Calcium channel blockers
(C in the heart) Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem) Uses – angina, HTN, interstitial cystitis Action – inhibits movement of calcium across cell membrane S/E: orthostatic hypotension, renal failure, angioedema Nursing: • Caution about position changes • Monitor for edema, (facial swelling and shortness of breath) • Vital signs are important (pulse and bp)
34
Angiotensin II receptor blockers
(sartans) Candesartan (Atacand), Losartan (Cozaar) Uses – HTN, heart failure, MI, diabetic neuropathy, stroke prevention Action – blocks vasoconstriction and aldosterone effects of angiotensin II S/E: hypotensin, dizziness, GI distress Nursing: • Monitor vitals • Do not chew or divide sustained release tablets
35
Alpha 1 adrenergic blockers
Doxazosin (Cardura), Prazosin (Minipress) Uses – hypertension, benign prostatic hypertrophy, reflex tachycardia Action – selective blockade of alpha 1 reception in peripheral blood vessels (affects peripheral system not heart itself) S/E: reflex tachycardia, orthostatic hypotension, nasal congestion Nursing: • Administer 1st dose at bedtime to avoid fainting • Monitor BUN, weight, and edema • Change position slowly
36
Centrally acting alpha-andrenergics
Aldomet, Catapres Uses – HTN Action – stimulates alpha receptors in medulla (affecting CNS to tell the heart to do something different) S/E: sedation, orthostatic hypotension ``` Nursing: • Don’t discontinue abruptly • Monitor for fluid retention • Change position slowly • Check blood pressure and pulses ```
37
Direct-acting vasodilators
Apresoline (hydralazine), Minoxidil Uses – HTN Action – relaxes smooth muscle S/E: tachycardia, increase in body hair Nursing: • Teach pt to check pulse (if
38
Bipolar meds
Lithium, Tegretol (carbamazepine), Depakote (divalproex) Uses – manic episodes Action – reduces catecholamine release S/E: GI upset, tremors, polydipsia, polyuria - Nursing • monitor serum levels (with lithium) • give with meals • increase fluids
39
Antineoplastc Agents
–chemo drugs rapidly producing cells within the body (good or bad) Cannot tell the good from the bad General side effects: hepatotoxicity, bone marrow suppression (decreases WBC
40
Alkylating Agents
Cisplatin, Myleran (busulfan), Cytoxan (cyclophosphamide) Uses – leukemia, multiple myeloma Action – interferes with rapidly reproducing DNA (hair mucous membranes, blood cells (white and red) – cannot tell the good from the bad S/E: hepatotoxicity, bone marrow suppression, Nursing: • Check hematopoietic function • Force fluids • Good mouth and skin care
41
Antimetabolites
5-FU (flurorouracil), Methotrexate Uses – acute lymphatic leukemia, cancer of the colon, breast, pancreas Action – inhibits DNA polymerase (stop DNA replication) S/E: nausea, vomiting, oral ulceration, bone marrow suppression, alopecia, Nursing: • Monitor hematopoietic function • Good mouth care • Discuss body image changes
42
Antitumor antibiotics
Adriamycin, Bleomycin, Actinomycin D Uses – cancer Action – interferes with DNA and RNA synthesis S/E: bone marrow suppression (WBC, RBC, platelets), alopecia, stomatitis Nursing: • Monitor vital signs • Give antiememetic before administration • Infection, bleeding, oxygen, rest
43
Hormonal agents
Nolvadex (tamoxifen), Testosterone Uses – cancer Action – changes hormone input into sensitive cells (turns off cancer by changing hormones) S/E: leucopenia, bone pain, hypercalcemia • Testosterone - Fluid retention, increasing appetitive, mood swings, hair growth Nursing: • Check CBC • Monitor serum calcium
44
Vinca alkaloids
Velban (vinblastine), Oncovin (vincristine) Uses – cancer Action – interfere with cell division – every rapidly producing cell in the body S/E: stomatitis, alopecia, loss of reflexes, bone marrow suppression ``` Nursing: • Give antiemetic before administration • Check reflexes • Given with Zyloprim to decrease uric acid • Make sure IV patent before given ```
45
Antiparkinson Agents
Artane, Cogentin, L-Dopa (levodopa), Parlodel, Sinemet (carbidopa-levodopa) – work in different ways, may see multiple drugs used Uses – Parkinson’s disease Action – converted to dopamine, stimulates postsynaptic dopamine receptors S/E: dizziness, ataxia, atropine like effects - Nursing • monitor for urinary retention • large doses of vitamin B6 reveres effects • avoid use of CNS depressants (alcohol, narcotics, sedatives)
46
Antiplatelet
Aspirin, Persantine (dipyridamole), Plavix (copidrogel) Uses – venous thrombosis, pulmonary embolism Action – interferes with platelet aggregations S/E: hemorrhage, thrmbocytopenia - Nursing • check for signs of bleeding (urine, teeth, feces) • give with food or milk – bc can cause GI upset
47
Antipsychotic Medications
Thorazine (chlorpromazine) – low traditional , Trilafon (perphenzine) – medium traditional, Haldol (haloperidol) –high traditional o Low = high sedation, high = low sedation Uses – acute and chronic psychoses Action – blocks dopamine receptors in basal ganglia S/E: akathisia, dyskinesia, dystonias, Parkinson’s syndrome, tardive dyskinesisas, leucopenia Nursing: o Check CBC o Monitor vital signs o Avoid alcohol and caffeine
48
Atypical Antipsychotic
Clozaril, Risperdal Uses – acute and chronic psychoses Actions – interferes with binding of dopamine in the brain S/E: extrapyramidal, anticholinergic, sedative, orthostatic hypotension, dystonia – early sign tongue swelling, occluded airway – late sign ``` Nursing: • Monitor blood • Change positions slowly • Use sunscreen • Monitor airway status ```
49
Antipyretic Agents
Tylenol (acetaminophen) Uses – fever Action – antiprostaglandin activity in hypothalamus S/E: GI irritation, liver dysfunction - Nursing • monitor liver function • aspirin contraindicated for younger than 21 years old bc of risk for Rye’s syndrome
50
Antithyroid Agents
Tapazole (methimazole), SSKI (saturated solution potassium iodine) Uses – hyperthyroidism, myxedema Action – reduce vascularity of thyroid, inhibits release of thyroid into circulation S/E: leucopenia, rash, thrombocytopenia ``` - Nursing • stop taking 2 weeks prior to any surgery • bitter taste • may cause burning in mouth • give with meals • check CBC ```
51
Thyroid Replacement Agents
Synthroid (Levothyroxine), Cytomel (liothyronine) Uses – hypothyroidism, grave’s disease Action – increases metabolic rate S/E: nervousness, tachycardia, weight loss - Nursing • monitor weight • take in AM – bc won’t be able to sleep • monitor pulse and BP • enhances effect of Coumadin and anitdepressants • decrease effectiveness of insulin, digoxin
52
Antitubercular
1st line - INH (Isoniazid), Rifampin, Ethambutol, Stretomycin, 2nd line - PAS (para-amino-salicyclic acid), PZA (pyrazinamide) Uses – tuberculosis, to prevent disease in person expose to organism Action – inhibits cell and protein synthesis S/E: hepatisis, peripheral neuritis - Nursing • check liver function tests • Vitamin B6 given for peripheral neuritis • Used in combination • Avoid alcohol • Watch for decreasing s/s fever, night sweats, rapid wt loss
53
Antitussive Agents/Expectorants
Benylin DM, Robitussin Uses – coughs due to URI, COPD Action – suppress cough reflex by inhibiting cough reflex in medulla, decrease viscosity of secretions S/E: bradycardia, respiratory depression, drowsiness, dizziness, anticholinergic effects (dry mouth, urinary retention, blurry vision) - Nursing • monitor pulse and respiratory status • monitor cough • avoid alcohol
54
Antiviral
Zovirax, AZT, Videx, Famvir, Cytovene Uses – recurrent HSV (herpes), HIV infections Action – inhibits DNA and RNA replication S/E: headache, dizziness, GI symptoms - Nursing • encourage fluids • not a cure, but relieves symptoms
55
Attention Disorder Agents
Ritalin (methlyphenidate), Dexedrine (dextroamphetamine) Uses – ADD, narcolepsy Action – increases level of catecholamines - so stimulant S/E: restlessness, insomnia, tachycardia, palpitations - Nursing • monitor growth rate • monitor liver enzymes • give in AM
56
Biophosphonates
Bone-Reabsorption Inhibitors Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva) Uses – Osteoporosis, Paget’s Disease Action – inhibits resorption of bone S/E: esophagitis, Arthralgia Nursing: • Sit upright for 30 mins after taking • Take med in the morning
57
Bronchodilators
Aminophylline, Brethine, Atrovent, Proventil, Primatene mist Uses – COPD, preterm labor (Terbutaline) Action – decreases activity of phosphodiesterase S/E: tachycardia, dysrhythmias, palpitations, anticholinergic effects - Nursing • monitor BP and heart rate • When used with steroid inhaler, use bronchodilator first • May aggravate diabetes Used for preventative treatment for travel to environment where could have reaction – singular, albuteral, terbutaline Used for acute bronchospams – aminophyline, epinerphrine
58
Carbonic Anhydrase Inhibitors
Diamox Uses – open angle glacoma Action – decreases production of aqueous humor in ciliary body S/E: blurred vision, lethargy, depression - Nursing • monitor for systemic effects – lethargy, depression, anorexia • elevate mental status of pt before given for glaucoma
59
Cardiac Glycosides
Lanoxin (digoxin) Uses – left sided HF Action – increases force of myocardial contraction, slows rate S/E: bradycardia, nausea, vomiting, visual disturbances ``` - Nursing • Take apical pulse before administering for full minute • Notify MD if adult 70 • Monitor potassium levels (3.4-5) • Antidote - digabind • 0.5-2 normal levels of dig ```
60
Cytoprotective Agents
Carafate (sucralfate) Uses – duodenenal ulcer Action – forms a barrier on ulcer surface S/E: constipation, vertigo - Nursing • take 1 hr before meals (ac) • give 2 hr before or after other medications
61
Diuretics
HydroDIURIL (hydochlorothiazide), Aldactone (sprionlactone), Lasix (furosemide), Mannitol Uses – CHF, renal disease Action – inhibits reabsorption of sodium and water, blockes effects of aldosterone S/E: dizziness, orthostatic hypotension, leukopenia - Nursing • taken with food or milk • Take in the morning • Monitor fluid and electrolytes * Thiazide diuretics – hydrocholorothiazide - monitor electrolytes (especially potassium) * Potassium sparing – Aldactone – avoid large amounts of potassium * Loop diuretics – Lasix – can be given IV and see diuresing in 1-2 mins, if PO then see in 30 mins * Osmotic – mannitol – increase fluid in central nervous system
62
Electrolytes
Os-Cal (Calcium), Slow Mag (Magnesium), K-dur (potassium), sodium chloride (sodium) Uses – fluid and electrolyte imbalances, osteoporosis Action – replaces needed electrolytes S/E: electrolyte imbalances - Nursing • monitor fluid and electrolytes * Calcium – see bone issues * Magnesium – see nerve, muscle, and enzyme reactions effective * Potassium – cell growth, muscle – heart and skeletal
63
Iron Preparations
Feosol (ferrous sulfate), Imferon (iron dextran) Uses – iron deficiency anemia Action – increase availability of iron for hemoglobin S/E: constipation, dark stools, tachycardia ``` - Nursing • take on empty stomach • Vitamin C increases absorption, Vitamin E delays absorption • Monitor Hct and Hgb • Can be mixed with juice, but not milk! • Drink with straw to not stain teeth ```
64
Eye Medications
Tearisol, Liquifilm, Visine, Timoptic Uses – ocular irritaion Action – lubricant, causes vasoconstriction by local adrenergic action S/E: headache, dizziness, blurred vision, pupillary dilation - Nursing • apply light pressure on lacrimal sac for 1 min after instilling drops • monitor BP and pulse
65
Glucocorticoids
Solu-Cortef (hydrocortisone), Decadron (dexamethasone), Prednisone Uses – Addison’s disease, Crohn’s disease, COPD, leukemias Action – stimulate formation of glucose, alters immune response S/E: susceptible to infection and masks infection, insomnia, hypoglycemia, hypokalemia, psychoses, depression, stunted growth - Nursing • monitor fluid and electrolyte balance – especially glucose and potassium • don’t discontinue abruptly – will see severe headache, swelling of eyes, nausea and vomiting • monitor for signs of infection • effected by stress – might need to increase dosage
66
Mineralocorticoids
Florinef Uses – adrenal insufficieny Action – increases sodium reabsorption, potassium and hydrogen ion secretion in kidney S/E: hypertension, edema, hypokalemia - Nursing • monitor BP, I&O, weight, and electrolytes • give with food • Low sodium, high protein, high potassium diet
67
Heavy Metal Antagonist
Desferal mesylate, BAL in Oil (dimercaprol), EDTA Uses – gold and arsenic poisoning, acute lead encephalopathy Action – forms stable complexes with metals S/E: tachycardia, pain and induration at injection site - Nursing • Monitor I&O and kidney function – med toxic to kidneys • Administer with local anesthetic – very painful injection • Seizure precautions - pulling the lead out rapidly increases risk of seizures
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Immunosuppressants
Sandimmune (cyclosporine) Uses – prevent rejection for transplanted organ Action – prevents production of T cells and their response to interleukin-2 S/E: hepatotoxicity, nephrotoxicity, leucopenia, thrombocytopenia ``` - Nursing • take once daily in AM • Used with adrenal corticosteroids • Monitor renal and liver function tests • Can be combined with milk or juice • Teach pt how to limit exposure of infections ```
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Laxatives/Stool softeners
Cascara, Dulcolax (bisacodyl), Colace (docusate), Milk of magnesia Uses – constipation, preparation for surgery and procedures Action – absorb water increasing bulk, lubricate surface of stool, stimulate peristalsis S/E: diarrhea, dependence, abdominal cramps, hypermagnesemia (CNS depressant – so respiratory function) ``` - Nursing • contraindicated with symptoms of acute abdomen • Monitor fluid and electrolytes • Chronic uses may cause hypokalemia • Encourage fluids ```
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Miotic Eye Medications
Isopto-Carpine, Eserine, Carbacel Uses – ocular surgery, open-angle glaucoma Action – causes constriction of sphincter muscles of iris S/E: headache, photophobia, hypotension, bronchoconstriction - Nursing • apply pressure on lacrimal sac for 1 min – decreases likelihood for systemic circulation • avoid sunlight • may experience transient brow pain and myopia
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Mydriatics
Atropine sulfate, Cyclogyl Uses – diagnostic procedures, acute iritis, uveitis Action – anticholinergic actions leaves pupil under unopposed adrenergic influence S/E: tachycardia, blurred vision, photophobia, dry mouth - Nursing • Contraindicated with glaucoma – because of pupil dilation • Apply pressure on lacrimal sac for 1 min • Wear dark glasses
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Narcotics
Morphine sulfate, Codeine, Demerol (meperidine), Dilaudid (hydromorphine), Percodan (oxycodone) Uses – moderate to severe pain, preoperative, postoperative Action – acts on CNS receptor cells S/E: dizziness, sedation, respiratory depression, hypotension, constipation - Nursing • Safety precautions • Avoid alcohol • Monitor respiratory rate before given and vital signs • Use narcotic antagonist if necessary (Narcan)
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Antianginals
Nitroglycerine, Isordil (Isosorbide) Uses – angina, peri-operative hypertension, HF Action – relaxes smooth muscle, decreases venous return S/E: hypotension, tachycardia, headache, dizziness - Nursing • Check expiration date – should fizz, if doesn’t then out of date • Teach when to take medication – take at first onset of pain • May take q 5 min x 3 doses • Wet with saliva and place under tongue • Wear gloves, can’t put over hair, remove old patch before put new one on, take off before defib
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Nonsteroidal Anti-Inflammatory (NSAIDS)
Motrin (ibuprofen), Indocin (indomethacin), Naprosyn Uses – arthritis, mild to moderate pain, fever Action – inhibits prostaglandin synthesis S/E: FI upset, dizziness, headache, bleeding, fluid retention ``` - Nursing • Take with food or after meals – bc can cause GI upset • Monitor liver and renal function • Use cautiously with aspirin allergy • Check for bleeding ```
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Thrombolytics
Streptokinase, Urokinase, Tissue plasminogen Activator (TPA) Uses – acute pulmonary emboli, thrombosis, MI Action – dissolves or lyses blood clots S/E: bleeding, bradycardia, dysrhythmias - Nursing • Contraindicated in hemophilia, bleeding irregularity, recent trauma (sx included), 75 or older, on heprin or Coumadin • Monitor for bleeding • Have amino caproic acid available – antagonist for these meds • Check pulse, color, sensation of extremities • Monitor EKG • Do neuro checks every 30 mins when started on meds • Monitor urine and feces for bleeding
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H2 Receptor Blockers
Tafamet, Zantac Uses – ulcers, gastroesophageal reflux Action – inhibits action of histamine and gastric acid secretion S/E: dizziness, confusion, hypotension, impotence ``` - Nursing • Take with meals and hs • Smoking will decrease effectiveness • Monitor liver functions and CBC • Can interfere with production of RBC and WBC ```
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Oral Contraceptives
prevent pregnancy, hormone control HA, dizziness, nausea breakthrough bleeding, wt gain, horomonal mood swings ``` Nursing: • No smoking • Condom use • If missed dose take as soon as possible, use protection • Take at the same time each day • Do no protect against STDs ```
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Estrogens
treat menopausal symptoms, cancers, osteoporosis Estrace (esstradiol), Premarin (estrogen) S/E: Nausea, gynecomastia, contact lens difficulty Call MD if breast lumps, vaginal bleeding, edema, dark urine, blurred vision, chest pain
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Alpha 1 adrenergic blockers
decrease urinary urgency, hesitancy, nocturia, prostatic hyperplasia Terazosin (hytrin), Tamsulosin (Flomax) HA, dizzy, orthostatic hypotension ``` Nursing: • Watch position changes • Avoid alcohol • Avoid CNS depressants • Give at bedtime ```
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Anaphylaxis
Symptoms – hives, rash, difficulty breathing, diaphoresis Nursing: o Epinephrine 0.3 ml of 1:1000 solution SQ o Massage site o May repeat in 15-20
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Delayed allergic reaction
Symptoms – rash, hives, swollen joints ``` Nursing: o Discontinue medication o Topical antihistamines o Corticosteroids o Comfort measures ```
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Dermatologic Reactions
Symptoms – hives, exfoliative dermatitis, erythema multiform excidativum (stevens johnsons – dark red papules all over body) Nursing: o Good skin care – gentle! o Antihistamines o Topical corticosteroids
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Stomatitis
Symptoms – swollen gums and tongue, difficulty swallowing, bad breath, mouth pain ``` Nursing: o Good mouth care – frequent rinses, soft tooth brush o Small feedings, non spicy foods o Antifungals o Local anesthetic ```
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Super infections
Symptoms – fever, diarrhea, black hairy tongue, glossitis, vaginal itching and discharge Nursing: o Good mouth and skin care o Antigungals
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Bone Marrow Depression
Symptoms – fever, chills, sore throat, back pain, dark urine, anemia, thrombocytopenia, leucopenia Nursing: o Monitor CBC o Protect from infections o Avoid injury
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Liver Impairment
Symptoms – fever, malaise, jaundice, light stools, dark urine, abdominal pain, elevated AST and ALT, altered PTT Nursing: o Good skin care o Comfort measures o Rest
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Renal Impairment
Symptoms – elevated BUN and Creatinine, decreased HCT, altered electrolytes, fatigue, edema, altered outputs ``` Nursing: o Diet and fluid restrictions o Electrolyte replacement o Dialysis o Rest ```
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Ocular Impairment
Symptoms – blurred vision, color vision changes, blindness Nursing: o Monitor vision o Monitor exposure to light
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Auditory Impairment
Symptoms – dizziness, ringing in ears, loss of hearing, loss of balance Nursing: o Monitor hearing o Safety measures to prevent falls
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CNS Impairment
Symptoms – confusion, insomnia, drowsiness, hallucination Nursing: o Safety measure to prevent injury o Avoid activities that require alertness o Frequent orientation to surroundings
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Supplements that should not be taken near time of surgery
``` (may affect anesthesia or coagulation) o Echinacea o Garlic o Ginger o Ginseng o Kava o St john’s wart ```

NCLEX!!! (7 decks)

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