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Pharmacology-RN > Test 1 > Flashcards

Test 1 Flashcards

1
Q

When are opiates needed instead of Tylenol?

A

When pain is severe enough to cause anxiety

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2
Q

Can tramadol and apap be taken together?

A

Yes, they are compatible

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3
Q

What is the difference between tramadol and Tylenol?

A

Tramadol is central acting, acetaminophen is peripheral acting

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4
Q

What precautions are needed with opiates?

A

Check respiration’s,
BP,
pulse oximetry before giving it. Expect constipation
and offer PRNs

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5
Q

At what point should narcan be given and why?

A

When respiration’s or BP are low enough to compromise 02/CO2 excursion

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6
Q

What is the difference in the half life of narcan vs Morphine

A

Narcan half life is shorter.

Resp depression can recur when it wears off

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7
Q

What is the difference between Roxanol and MS Contin

A

Both are Morphine but Roxanol acts quick under the tongue

And MS Contin is slow release Morphine

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8
Q

What effects of opiates need to be considered when timing these medications?

A

BP drops lead to falls, but if activity will cause pain , MS should be give before activity

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9
Q

When is aspirin (ASA) needed instead of Tylenol (APAP)

A

Aspirin trouble shoots inflammation along with blood thinning and Tylenol does not

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10
Q

Risk of too much Tylenol

A

Liver damage

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11
Q

Antidote for Tylenol overdose?

A

Mucomyst /acetylycysteine

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12
Q

Risks of too much aspirin ?

A

Renal failure, GI erosion , and bleeding

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13
Q

What precautions are needed with aspirin or Advil

A

Give with food , watch renal labs

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14
Q

How should the nurse handle pain control for people with addictions

A

Tolerance implies the need for larger doses when anxiety related to pain escalates

The nurse should never assume complaints of pain are a drug seeking behavior

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15
Q

Should opiates or sedatives be given to people who are inebriated? (Intoxicated)

A

No!

Potentiation occurs and effects are quadrupled

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16
Q

Where benzodiazepines given in delirium tremens and when you do do DTs occur

A

DTs usually occur 2 days after the end of binge drinking.

Metabolites cause fever, tachycardia, hypertension, and delusions. Calming is needed to reduce O2 demand. The alcohol itself is sufficiently eliminated to reduce risk of potentiation.

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17
Q

What should be documented before and after giving pain meds?

A

Before and after- Pain rating

O2 sats and vital signs especially if Rx is not routine

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18
Q

What rules apply to controlled substances?

A

Order must be hand delivered to pharmacy

No refills

Double count every shift

All wastes witnessed

Pharmacist must collect and dispose of unused supplies

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19
Q

What meds are in each controlled substance category?

C2:

C3:

C4:

C5:

A

C2: morohine, dilaudid, oxycodone, fetanyl, Demerol, hydrocodone, methadone, cocaine, amphetamines, adderall, Ritalin, sleep barbiturates (Seconal), and parenteral narcotics. Vitals of codeine or benzodiazepine

C3: lesser doses codeine (Tylenol#3) and anabolic steroids

C4: Ativan, klonopin, Xanax, halcion, dalmane, lunesta, Valium, Librium, chloride hydrate, ambien, midtown, luminal, Talwin, Nubian, stadol, tramadol (some treat this as C2)

C5: Robitussin with Codeine, some institutions and states treat this as a C3

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20
Q

What are the different pregnancy risk categories A, B vs C and D

A

A is known safe in human babies while B is known safe in animals

C is know. Risk to animal babies while D is known risk to humans ?

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21
Q

What is the primary precaution regarding herbal remedies

A

Know interactions with other drugs and reputable processors

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22
Q

What should patients be advised regarding internet medications

A

You could be getting anything

There is no monitoring of processing

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23
Q

How do the FDA and DEA differ?

A

FDA authorize release of medications DEA enforces enforces law pertaining to controlled substances

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24
Q

Why does toxicity occur in non overdose situations

A

Liver failure or renal failure

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25
Q

What are the signs and risks of toxicity

A

Signs:

Confusion, ataxia, somnolence

Risks:

Arrhythmias and seizures

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26
Q

What are the rules about giving ipacac for overdose

A

Take it with water. Don’t give to babies, somnolent people or following corrosives

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27
Q

What kinds of oral medications can be given rectally?

A

Symptom control medications like morphine or medications for nausea

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28
Q

What are the risks of giving medications this way (rectal)

A

GI irritation, flashbacks in victims

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29
Q

What types of meds require loading doses?

A

Lanoxin, heparin, aminophylline

meds with long half life’s ramp up slowly

Loading helps meet urgent need for effects

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30
Q

What needs to occur before and after IV push meds are given?

A

Careful assessment of vital signs anticipated and actual effects

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31
Q

What should the nurse do about giving an Rx if the patient is NPO for testing?

A

Ask the MD to provide for an alternate route

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32
Q

What do hives signify?

A

Allergy with potential to escalate into anaphylaxis

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33
Q

What happens in anaphylaxis and how should the nurse respond

A

Obtain an order for (and then administer) epinephrine and steroids

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34
Q

What is the difference between hypersensitivity and a true allergy?

A

Hypersensitivity means the body is highly responsive to the med

35
Q

What precautions are needed when when administering stimulants

A

Check vitals signs

Keep Rx out of child’s hand

Monitor intake

Give in AM

36
Q

What should parents of children taking ADHD medications be taught

A

Don’t get them filled in Mexico or over the internet

Be aware of their street value

37
Q

When should stimulants be given

A

After breakfast

38
Q

What is a washout period and why is it needed between antidepressants ?

A

Time in between stoping and starting a new medication such as an SSRI

To avoid serotonin syndrome

39
Q

What are the dangers of tricyclic overdose and how are they managed

A

Anticholinergic effects:

Watch for voiding and BMs, give ice chips for thirst, fall precautions

40
Q

What precautions should be taken with MAOIs and why?

A

No alcohol, no fermented or comfort food (they cause hypertension)

41
Q

What is the primary tx for OCD ?

A

High dose SSRI , anafranil

42
Q

What are the anticholinergic side effects

A

GI shut down, urine retention, tachycardia, dry , displayed pupils

43
Q

What medications cause anticholinergic side effects

A

Tricycic antidepressants, some antipsychotics and Benadryl

44
Q

Who should not take meds with anticholinergic effects

A

People with BPH (enlarged prostate) or glaucoma

45
Q

What are the effects and side effects of adrenergics

A

Hypertension, rapid pulse , tension

46
Q

What are the effects and side effects of

Beta adrenergic blockers:

Alpha adrenergic blockers:

A

Hypotension, bradycardia, wheezing , hypoglycemia

Hypotension

47
Q

What precautions are needed when giving beta blockers

A

Check pulse , BP, glucose, lung sounds

48
Q

What are the effects and side effects of cholinergics

A

GI and bladder contractions , diarrhea, drool

49
Q

Name 3 situations where a cholinergic medication might be used

A

Myasthenia Gravis glaucoma , post op urine retention/ ileus, Alzheimer’s and paralysis reversal

50
Q

What is romazicon and how is it different from rozerem?

A

Rozerem is a sleeper. Romazicon is the antidote for sleeping pills (benzodiazepines)

51
Q

What do barbiturates and benzodiazepines have in common?

A

Both sustain GABA (inner calm)

52
Q

How are barbiturate vs benzodiazepine overdoses are managed

A

Romazicon for Benzodiazipines vs supportive care for barbiturates

53
Q

What is the risk of prolonged use of benzodiazepines

A

Addiction and tolerance

54
Q

What is the risk of abrupt withdrawal from benzodiazepines?

A

SeiZures

55
Q

What is status epilepticus and what can be done about it ?

A

Prolonged seizures must be stopped with IV benzodiazepines like Valium or Ativan

56
Q

How is Dilantin different from depakote

A

Dilantin blocks sodium influx, depakote sustains GABA

57
Q

What are the side effects of Dilantin and related precautions

A

Gingivitis is one that Nursing can control

58
Q

What are the risks of Dilantin toxicity

A

Arrhythmias

59
Q

What do Dilantin, depakote and tegretol have in common ?

A

All are antiepileptics used to treat bipolar illness

60
Q

Who should/ should not receive triptans ?

A

People with pounding migraines need vasoconstriction, people with cerebral circulatory insufficiency don’t need cerebral vasoconstriction

61
Q

How are triptans like immitrex different from Zoltan?

A

Zofran (an antiemetic) blocks 5HT3 receptors while triptans trigger 5HT1 receptors

62
Q

When is haldol used?

A

To calm agitated, dangerous people

63
Q

What are the following side effects of long term Haldol use?

A

TD (permanent mouth movements)

Dystopia (serious back or neck arching)

Akathesia (restless motor movements unaccompanied by anxiety )

64
Q

Why do these extrapyramidal symptoms EPS occur?

A

Dopamine blockade causes an imbalance between dopamine And acetylcholine

65
Q

How to prevent EPS symptoms?

A

Block acetyl choline by giving a med like cogentin or Benadryl

66
Q

What is cogentin (benztropine) and what kinds of effects does it have ?

A

??
used to treat movement disorders due to antipsychotics such as Parkinson’s and dystonia but does not treat TD.

See anticholinergic effects

67
Q

How are EPS symptoms monitored?

A

AIMS or

DISCUS tools

68
Q

What is the advantage of using haldol over a 3 generation med like risperdal?

A

It works right away. Risperdal and zyprexa take 2 weeks to ramp up

69
Q

Why are risperdal, zyprexa, and geoden better than haldol for long term use?

A

EPS (dyskinesias) aren’t caused by these meds as much

70
Q

Why are these medications contraindicated for people with Parkinson’s

A

They block dopamine and people with Parkinson’s are dopamine depleted

71
Q

What is the tx for Parkinson’s ?

A

Dopamine replacement and sustainment

72
Q

What are the signs of bipolar illness vs lithium toxicity ?

A

Lithium Toxicity: mimics intoxication

Bipolar- extreme mood swings -These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

73
Q

Why do these meds lead to water intoxication and what can be done to prevent it ?

A

Lithium is a salt

Tricyclics cause anticholinergic symptoms

Cogentin is an anticholinergic

Offer ice chips

74
Q

What are the therapeutic levels of :

Depakote :

Lithium:

Dilantin :

A

50-110

0.5-1.5

10-20

75
Q

What is the difference between ASA and Celebrex

A

Celebrex is easier on the stomach and does not block fever like aspirin

76
Q

What is the difference between prednisone and ASA

A

Both stop inflammation

Prednisone is more immune suppressive

It also stops the liberation and histamines and leukotrienes

77
Q

What are the risks of prednisone therapy

A

Infection

GI bleeding

Weight gain

Edema

Hypertension

Hyperglycemia

Osteoporosis

Cushing’s syndrome

78
Q

What precautions are needed when giving prednisone ?

A

Give with food

Watch more infection and report early signs

Practice infection control precautions

Small frequent low calorie meals

Watch blood sugar and Bp

Elevate legs to trouble shoot edema

79
Q

Fight or flight

A

Adrenergics

Sympathethetics

Med for asthma/ wheezing (bronchodilator)

Albuterol inhaler

Used to elevate BP in shock, dobutamine a vasopressor (opens arteries)

80
Q

Rest and digest meds

A

Parasympathomimetics

Cholinergics

Med used urine retention

Neostigmine- reverses paralysis

For Glaucoma

Can cause: Bradycardia , GI spasms

Can reverse anticholinergic side effects and restore bowel and bladder

81
Q

Adrenergic blockers

A

(Tricyclic)

Sympatholytics

Treat hypertension (lowers BP)

End in OLOL

Glaucoma

Vasodilator

Cause falls due to low BP

Cause Bradycardia

82
Q

Anticholinergics

A

Parasympatholytics

Can cause urine retentions or UTI

Causes:

pupil dilation, dry mouth, urine retention, constipation, pre op to stall bowel and bladder , open airways , dry secretions

Used to :

Treat wheezes , increase pulse , neurogenic/spastic bladder, calm GI in IBS

Trycylic antideoressants have these side effects

Detrol, ditropan, sanctura, vesicare

83
Q

Seriquel/ closeril- why we don’t like to give?

A

Reduces bone marrow

84
Q

What happens in anaphylaxis

A

Immune system realeases a flood of chemicals that can cause shock to the body. Bp decreases and pulse decreases , nausea, vomiting , rash airways narrow

Pharmacology-RN (3 decks)

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