Week 6/Week7 Meds Flashcards
1
Q
What are the indications of aspirin
A
prevent/treat MI,
prevent ischemic stroke
2
Q
Black box warnings for Apixaban (Eliquis) & Rivaroxaban (Xarelto
A
Spinal hematomas if patient has epidural catheter
Risk of thrombosis if drugs ABRUPTLY stopped
3
Q
Warfarin nursing considerations
A
Monitor and teach signs of bleeding
hold before surgeries
monitor labs
MANY drug interactions
Food interactions
Avoid alcohol
Weat medic alert bracelet, use soft toothbrush,
4
Q
antidote for Apixaban (Eliquis) & Rivaroxaban (Xarelto
A
andexxa
(recombinant factor Xa, inactivated-zhzo)
5
Q
Therapeutic use of optic-topical beta blockers
A
Open-angle glaucoma maintenance treatment
If acute-angle closure– need drops asap and other interventions
6
Q
Indications of oxybutynin
A
overactive bladder, incontinence
7
Q
Adverse effects of Tamsulosin
A
Well tolerated
Abnormal ejaculation
8
Q
Route of Clopidogrel & Ticagrelor
A
PO
9
Q
what are the adverse effects on enoxaparin
A
bleeding
thromboxytopenia
Can also cause HIT
10
Q
What is aspirin
A
NSAID -
Blocks prostaglandin synthesis through the COX enzyme pathways
11
Q
Ticagelor Black Box Warning
A
Increased bleeding risk risk with aspirin doses over 100mg
12
Q
how is protamine given
A
IV
slowly
pushing can drop BP
13
Q
What is the antidote for Enoxaparin
A
protamine
14
Q
Conjunctivitis “pink eye” VIRAL TREATMENT
A
Topical steroids provide temporary relief
Antivirals are ineffective
15
Q
How frequently do we monitor patients on warfarin for therapeutic effect
A
MONTHLY
16
Q
can you give Apixaban & rivaroxaban in conjunction with other anticoagulants
A
NO
17
Q
safety issues with sildenafil
A
Do not take if you are taking any nitrates
If you have chest pain or other signs of a heart attack during sex, stop and call 911
Sudden loss of vision in one or both eyes, sudden loss of hearing
No more than once per day
Priapism - erection is painful or lasts more than 4 hours - medical emergency
18
Q
Indication of Dutasteride (Avodart)
A
Mechanical obstruction of urethra
19
Q
Argatroban should be cautioned in patients with what
A
hepatic dysfunction
20
Q
Cautions of sildenafil
A
preexisting CV disease if on nitrate Rx
hypotension
21
Q
T/F oxybutynin can be in extended release forms
A
TRUE
22
Q
What can you do in an acute event with aspirin
A
Chew a baby aspirin but cannot be enteric coated
23
Q
Adverse effects of emollients
A
skin rashes, decreased absorption of vitamins
24
Q
MOA of Dutasteride
A
Blocks conversion of testosterone to DHT (alpha 1 &2 receptors)
Decreases epithelial tissue in prostate
25
uses of mineral oil
fecal impactions
26
Uses of stimulant laxatives
OTC for constipation or whole bowel evacuation
27
How laxative treatment is prioritized
Individualized by:
Age
Severity
Contributing factors
28
Adverse effect of dorzolamide
Stinging
Bitter taste
Allergic reactions (conjunctiva or lid reactions)
29
What are laxatives used for
treatment of constipation
30
route of docusate sodium
PO
31
uses of docusate sodium
prevent opioid-induced constipation
32
routes of hydrocortisone
PO
IV
33
Reason for low molecular weight heparin
takes large unfractionated heparin moleculaes and cleaves them into smaller fragments and this makes them have greater affinity to factor X-a making them bioavailable and have a longer half life
34
MOA of Tamsulosin
Relaxes smooth muscle cells
Selective for alpha receptors in the prostate
35
Class for dorzolamide (Trusopt)
Carbonic Anhydrase Inhibitor
36
What do we do for acute angle crisis
must treat with surgical intervention
37
Different groups of diarrheals
Adsorbants
Antimotility (anticholinergics and opiates)
Probiotics
38
Timing of sildenafil
up to 4 hours before ssexual activity (onset 30-60 minutes)
39
Adverse effects of psyllium
Impaction above strictures
Fluid/electrolyte imbalance
Gas formation
Esophageal blockage
40
mirabegron(Myrbetriq) class
Antispasmotic (urinary)
41
What 5 things do we monitor for when giving heparin
vital signs,
bruising,
petechiae,
hematomas,
black tarry stools
42
indications of Warfarin (3)
prevention VTE/DVT/PE,
thrombotic events for patients with afib or heart valves,
reduce recurrence of TIA or MI
43
MOA of bismuth subsalicylate
coats the walls of the GI tract
Bind the causative agent for elimination
44
Conjunctivitis “pink eye” ALLERGIC TREATMENT
Artificial tears, topical antihistamines, or steroids
45
What is the antidote for Aspirin
DDAVP (Desmopressin)
46
what is the 1 mineral corticoid
Fludrocortisone (Florinef)
47
MOA of optic-topical beta blockers
Block sympathetic nervous system stimulation of beta receptors
48
prednisone can be used for
COPD
Chronic disease states
49
How do we dose IV heparin
based on clotting time labs
50
Contraindications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke
51
What are anticoagulants
Inhibit the action or formation of the clotting factors
PREVENT clots
52
T/F meds can be injected into the eye for macular degeneration
TRUE
53
Hyperosomtic drugs
glycerin
lactulose
polyethylene glycol
54
T/F Heparin is a HIGH-RISK MED
True - must double check with other RN prior to rate changes and boluses
55
What patients do we use caution when giving Heparin
patients with spinal or epidural anesthesia
56
Drugs used to treat Diarrhea
Anti-diarrheals
57
Hydrocortisone
synthetic, identical to cortisol
some Mineral corticoid (MCC) action
58
action of epinephrine
Inhibits release of mediators from mast cells
59
Major Side/Adverse Effects of Epinephrine
CV: Angina, arrhythmias, hypertension, tachycardia
CNS: Nervousness, restlessness, tremor
60
What is the class for Heparin and LMWH (Enoxaparin)
Heparins
61
MOA for phenazopyridine (Pyridium)
dye used in paint, local analgesic action
62
goal of steroid replacement
Mimic physiologic levels
MUST increase dose in times of stress
63
Adverse effects of saline laxatives
Magnesium toxicity
Electrolyte imbalance
Cramping, diarrhea
64
Dutasteride (Avodart) Class
5-α reductase inhibitors
65
2 Thrombin Inhibitors
argatroban
bivalrudin
66
What does aspirin block
Platelet aggregation
67
Indication of Finasteride (Proscar)
Mechanical obstruction of urethra
68
Steroids can be given for 3 reasons
Replacement
Anti-inflammatory
Immunosuppression
69
What is the onset of warfarin
24 hrs
70
Are labs necessary for Enoxaparin
No
71
Finasteride adverse effects
Impotence
Decreased libido (5-10%)
Gynecomastia
72
nursing considerations for aspirin
Don’t crush enteric coated
OTC medication considerations
Reye’s syndrome: children with a virus NO ASPIRIN
73
class of Oxybutynin (Oxytrol)
anti-cholinergic
74
Nursing implications for epi dosing
Correct dose is crucial
Overdose can be FATAL
Have coworker recheck dose
For subcu use – use TB syringe
75
MOA of antimotility drugs
Slow peristalsis
Drying effect\*
76
Therapeutic use for phenazopyridine
relief of pain due to UTI
77
Route of Heparin
Only given parental (IV or SQ)
78
what does aspirin prevent
platelets from clumping together
79
what patients do we use caution when giving enoxaparin
patients with spinal or epidural anesthesia
80
what is the anti-dote for Heparin
Protamine Sulfate
81
Normal INR value without warfarin
about 1
82
Dosage of Epinephrine
Adults: 0.2 to 1 mg
Peds: 0.01/mg/kg
83
Side/Adverse Effects of phenazopyridine
Well tolerated
REDDISH-ORANGE URINE
84
Therapeutic value with warfarin
2-3.5
85
what protocol is heparin given
weight-based in kg
86
Adverse reactions of mirabegron(Myrbetriq)
HTN\*
Urinary retention
UTI
Headache
87
Characteristics for Fludrocortisone (Florinef)
Only mineralocorticoid replacement
May be needed with GCC replacement
Salt wasting (inability to maintain Na+ levels, K+ levels high despite adequate renal function)
88
Class of Sildenafil (Viagra)
PDE-5 Inhibitors
89
5 Nursing considerations for Enoxaparin
Don’t give with really any other anticoagulants except oral warfarin when treating PE or DVT
Given in pre-filled syringes easy to administer and teach to give at home
Do not expel the air bubble: will remain in plunger to ensure whole dose is given
Slower onset of action
compared to heparin but LONGER half-life
Rotate injection sites
90
Side effects of Clopidogrel & Ticagrelor
chest pain,
edema,
flu-like symptoms,
abdominal pain,
diarrhea,
nausea,
epistaxis,
rash,pruritus
91
What do we monitor for in Epinephrine
Vital signs closely!
Status for reversal of symptoms
92
What are the 2 types of coagulation drugs
Anticoagulants
Anti platelet
93
S/E of Aspirin
GI (n/v),
drowsiness/confusion,
bleeding
94
Indications of Apixaban (Eliquis) & Rivaroxaban (Xarelto
prevent strokes in patients with afib,
post-op thrombo-prophylaxis, treat DVT & PE
95
MOA of warfarin
Vitamin-K inhibitor
-prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)
96
What is Jalyn
Prototype: dutasteride and tansulosin
FDA approved for BPH
97
What foods should be monitored when taking warfarin
Avoid foods High in Vitamin K
green, leafy vegetables
98
Indication of brimonidine
Used for open-angle glaucoma and increased intraocular pressure
99
Indications for Heparin
conditions necessitating PROMPT anticoagulant activity
100
Epinephrine routes
All except PO
SQ preferred
101
Nursing implications for corticosteroid use
DO NOT ABRUPTLY STOP TAKING
Steroid taper
Tell patients to take at the same time throughout the day
Especially with long-term use
Wear a medical-alert bracelet with long-term use
Monitor weight & blood sugar
102
What is the MOA of Enoxaparin or Low molecular weight heparin
Prevents clotting by activating ANTITHROMBIN
ONLY inactivates factor Xa (not thrombin)
103
What are antiplatelets
Prevent platelet plugs from forming by inhibiting platelet aggregation
Best for preventing heart attacks and stroke
104
Treatment options of hypersensitivity include
Immunosuppressants
Antihistamines
Epinephrine
105
Route of aspirin
PO
106
MOA of latanoprost
increases outflow drainage of aqueous humor
107
What is Enoxaparin (Lovenox)
Low-molecular weight heparin
108
Antidote of warfarin
Vitamin K (IV)
If that doesn't work
Fresh frozen plasma or whole blood
109
What are the nursing consideratoins for Heparin induced thrombocytopenia (HIT)
Monitor platelet counts
Stop heparin immediately if platelet count \<100,000/mm3
Non-heparin anticoagulants can be used as substitute if anticoagulation still needed
110
What is the antimotility drugs
loperamide (Imodium)
diphenoxylate [atropine] (Lomotil)
111
route of antidiarrheals
oral
112
indications of argatroban and bivalrudin
treat HIT, and for patients undergoing procedures (PCI) who are at high risk for HIT
113
Conjunctivitis “pink eye” BACTERIAL TREATMENT
Usually self-limiting
Antibiotic drops can shorten the course
114
Signs of internal bleeding
tachycardia
skin pallor
low BP
respiration Increasing
115
What are the 3 glucocorticoids
Hydrocortisone
Prednisone
Dexamethasone
116
Can you give Enoxaparin and heparin together
No
117
type of sodium salt
fleet enema
118
treatment of BPH
Mild symptoms = watchful waiting
Moderate symptoms = drug therapy
5-alpha reductase inhibitors
Alpha1-adrenergic antagonists
Severe symptoms = invasive options
119
indication for latanoprost
open-angle glaucoma
ocular hypertension
120
T/F psullium is OK for long term use
TRUE
121
adverse effects of latanoprost
Well-tolerated
122
route of mineral oil
PO
PR
123
2 Type of stimulant laxative
bisacodyl (Ducolax)
senna (Senokot)
124
T/F Antimotility drugs can be Used alone or in combination with adsorbants and opiates
TRUE
125
Long-term side effects of corticosteroid use
If a patient takes steroids for long-term (months to years)
Clouded eye lens (cataracts)
High blood sugar worsening
or developing diabetes
Increased risk of infections (remember WBC suppression)
Thinning bones (osteoporosis) & fractures
Suppressed adrenal gland hormone production
Fatigue, loss of appetite, nausea, muscle weakness
Think skin, bruising, slow wound healing
126
Can you give warfarin to pregnant women or breastfeeding
NO
127
route of senna
PO
128
What Labs do we monitor for Warfarin
PT- prothrombin time
INR- International normalize ratio
129
Drug interactions with Apixaban (Eliquis) & Rivaroxaban (Xarelto
Decreased effects: phenytoin, carbamazepine, rifampin, and st. johns wort
Increased effects: CYP3A4 inhibitors (amiodarone, erythromycin, ketonazole, HIV meds, diltiazem, verapamil, grapefruit juice)
130
Urinary tract analgesic med
phenazopyridine (Pyridium)
131
What 3 things do nurses want to monitor for bleeding
Hemoglobin
hematocrit
Vital Signs
132
Adverse Effects (Bismuth subsalicylate)
Increased bleeding time
Constipation
Dark stools and darkening of tongue
133
Medication used in the treatment of C-Diff
Saccharomyces boulardii (Florastor)
134
What drug characteristics do we look for when treating galucoma
Drugs that DECREASE aqueous humor production
INCREASE aqueous humor drainage
Or both
135
route of Warfarin
only given PO, Once daily
136
most common antibiotics used for lower UTIs
Trimethoprim-sulfamethoxazole (Bactrim)
First-line
Don’t give with sulfa allergies
Ciprofloxacin (For sulfa allergies)
Nitrofurantoin
(Macrodanti/Macrobid)
For recurring lower UTIs
137
3 types of magnesium salts
magnesium citrate (Citroma)
magnesium hydroxide (Phillips Milk of Magnesia)
magnesium sulfate (epsom salts)
138
MOA of brimonidine
decreases AH production, may increase drainage/outflow
139
contraindications for Topical optic beta blockers
Same as oral beta-blockers (non-selective versus beta 1)
140
What scenarios would we give steroids
Allergies
Dose and route depends upon severity
Asthma
Inhaled steroids
COPD exacerbation
IV transitioned to po
Chronic inflammatory bowel disease
Rheumatic disorders
Post-transplant
Frequently weaned off if no rejection episodes
141
SIDE NOTES for Finasteride
Decreases prostate specific antigen (PSA) levels
Used for male-pattern baldness
Caution in Handling
142
MOA of mineral oil
lubricate intestines
143
MOA of heparin
Prevents clotting by activating ANTITHROMBIN -\> indirectly inactivates thrombin & factor Xa
Inhibits FIBRIN formation
144
MOA of docusate sodium
lubricates fecal material and walls, promotes fat absorption into fecal mass
145
hydorcortisone dosing
low dose- minimal to no adverse effects
Large dose- toxic
146
What labs do we monitor with Direct thrombin inhibitors
Anti-Xa
H&H
platelets
147
what do emollients prevent
water from moving out of intestines
148
adverse effects of oxybutynin
dry mouth,
constipation
149
What route is Enoxaparin available
SQ injectable
150
what does epinephrine do
halts mediator activity
151
What amount and frequency can Heparin be given
5000u injection 2-3x a day or as an IV drip with a bolus
152
Mineralocorticoids
Once per day dosing
Frequently do not need to replace
153
when does SQ heparin start working
20-30 minutes
154
2 Optic-Topical Beta-Blockers
timolol - nonselective
betaxolol - B1 receptor
155
Class of brimonidine (Alphagan)
alpha-adrenergic agonist
156
contraindications for aspirin
thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke
157
adverse effects of antimotility drugs
Urinary retention
Headache
dizziness
anxiety
drowsiness
Bradycardia
hypotension
Dry skin
Flushing
158
Cautions with optic topical agents
Keep them localized
use nasolacrimal pressure with instillation (prevents systemic effects)
hold pressure for 2 minutes
159
route of argatroban and bivalrudin
IV only
160
MOA of saline laxatives
increase osmotic pressure and draw water into colon
161
Finasteride MOA
Blocks conversion of testosterone to DHT (alpha 1 receptors)
Decreases epithelial tissue in prostate
162
Adverse Effects of stimulant laxatives
Nutrient malabsorption
Gastric irritation
Electrolyte imbalance
163
how does Jalyn work
Combining a 5-alpha-reductase inhibitor with an alpha blocker is superior to either agent alone
164
indication of tamsulosin
Dynamic obstruction of urethra
165
What reduces the effectiveness of Clopidogrel
amiodarone,
calcium channel blockers, NSAIDS,
PPIs
166
Examples of when to give Heparin (4)
Evolving stroke, PE, massive DVT
Adjunct for patients having open heart surgery or dialysis
Low-dose therapy for prophylaxis against post-op DVT
Treat disseminated intravascular coagulation
167
epinephrine class
Vasopressor, bronchodilator, antiasthmatic, vasoconstrictor
168
characteristics of bismuth subsalicylate (Pepto-Bismol)
form of asprin
contains activated charcoal
169
Bulk-forming medication
psyllium (Metamucil)
170
MOA of probiotics
Replenish these bacteria and restore normal flora
171
When Does IV heparin start working
Immediately
172
Acute Side effects of glucocorticoid replacement
Increased intraocular pressure problem for people with eye diseases like glaucoma
Fluid retention
High blood pressure
Mood swings
Weight gain- fat deposits in abdomen, face, and back of neck (centralized)
Hunger
173
patient teaching for Topical optic beta blockers
Must take– otherwise will progress to blindness
Apply nasolacrimal pressure with instillation
174
Drug name for adsorbent drug
bismuth subsalicylate (Pepto-Bismol)
175
uses of hyperosomtic drugs
Evacuate bowels before diagnostics and surgical procedures
176
what does ANTIHISTAMINES do
Suppress histamine mediator activity
177
Do you have to routine monitor Apixaban (Eliquis) & Rivaroxaban (Xarelto
NO
178
what is the duration of warfarin
2-5 days
179
What is Heparin induced thrombocytopenia (HIT)
Low platelet count and increased development of thrombi
caused by antibody development
180
adverse effects of sildenafil
most common HA (16%)
flushing (10%)
dyspepsia (7%)
181
Adverse effects of Warfarin
bleeding
lethargy
muscle pain
purple toes
182
class of argatroban and bivalrudin
Direct Thrombin Inhibitors
183
Adverse effects of Apixaban (Eliquis) & Rivaroxaban (Xarelto
bleeding,
hematoma,
dizziness,
rash,
gastrointestinal distress, peripheral edema
184
Clopidogrel Black Box Warning
patients with certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite
185
indication of epinephrine
Severe allergic reactions,
cardiac arrest,
severe asthmatic attack
186
Finasteride (Proscar) CLASS
5--reductase inhibitors
187
What is the biggest concern in anti-coagulant medications
most common S/E is bleeding
188
MOA of mirabegron(Myrbetriq)
selectively stimulates beta-3 adrenergic receptors, relaxing bladder smooth muscle
189
Adverse effects of brimonidine
Burning/stinging
Dry mouth
Fatigue,
H/A,
blurred vision,
hypotension
190
treatment of hordeolum
warm compresses 3-4 times a day
191
MOA of Apixaban (Eliquis) & Rivaroxaban (Xarelto
Direct inhibitor of factor Xa
192
adverse effects of hyperosomtic drugs (3)
Abdominal bloating
Rectal irritation
Electrolyte imbalance
193
Adverse effects of Topical optic beta blockers
Transient burning & discomfort
If allowed to go systemic- can have systemic effects
194
What are the indications for Enoxaparin
given prophylaxis & treatment
195
Antidote for Clopidogrel & Ticagrelor
DDAVP or platelet transfusion
196
what is the black box warning for Enoxaparin
potential spinal hematoma if patient has epidural catheter
197
MOA of psyllium
Act similar to dietary fiber
Absorb water into the intestine, increasing bulk
Distends bowel to initiate reflex bowel activity and bowel movement
198
Conjunctivitis “pink eye” CHLAMYDIA TREATMENT
Oral antibiotics, however, some infections resistant
199
What do Immunosuppressants (including corticosteroids)
do
Suppresses cell-mediated immunity
Antiinflammatory
200
Use of dozolamide
2nd line treatment for open-angle and increased IOP
201
what 2 considerations should nurses know about their patient on anti-coagulant medications
Know why your patient is on an anti-coagulant
know what sites they may be at risk for bleeding
202
MOA of oxybutynin
block the action of acetylcholine
Acetylcholine activates smooth muscle contractions
203
MOA of hyperosomtic drugs
Increasing water content in feces
Promotes distention, peristalsis, and evacuation
204
Class of latanoprost (Xalatan)
Prostaglandin Analogs
205
What is the advantage of Enoxaparin
can be given at home
206
Glucocorticoids (non-endocrine disorders)
Alternate-day therapy
Before 9 am
‘Mimics’ glucocorticoid burst by adrenals at dawn
Traditional dosing multiple, small doses
207
What is the first sign of fluid volume deficit ?
tachycardia
208
Adverse effects of Heparin (4)
bleeding
hematoma
anemia
thrombocytopenia
209
home use of Epi
Teach: take EXACTLY as directed
Contact clinician directly after taking!
210
2 types of antiplatelet drugs
```
Aspirin
Clopidogrel (plavix)
```
211
route of bisacodyl
PO
PR
212
MOA of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
Antiplatelet ADP inhibitor
Alters the platelet membrane so it doesn’t receive the signal to aggregate
213
T/F Bruising can be a late sign of internal bleeding?
True
214
Adverse effects of argatroban and bivalrudin
bleeding
215
Indications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
reduce risk of stroke, prophylaxis of TIAs,
post-MI
216
How is epinephrine supplied
1 mg in 1 mL vial (1:1000) concentration
217
Tamsulosin (Flomax) class
Alpha1-Adrenergic Antagonists
218
indications of sildenafil
Relief of ED
Pulmonary arterial hypertension
BPH
219
MOA of sildenafil
Inhibits PDE5
Increases and preserves cGMP levels
Only enhances the normal response to sexual stimuli
220
2 Types of Saline salts
Magnesium salts
sodium salts
221
Different groups of laxatives (5)
Bulk-forming
Emollient
Hyperosmotic
Saline
Stimulant
222
MOA of Direct Thrombin Inhibitors
Inhibit thrombin (factor IIa)
223
what should you no do with hordeolum
Do not squeeze or pop the sty, can spread the infection
224
MOA of dozolamide
decreased production of aqueous humor
225
dexamethasone can be used to test what
adrenal function
226
Adverse Effects of Dutasteride
Similar to finasteride
227
What organ function and levels do we need to monitor with Apixaban & rivaroxaban
Liver function
ALT
AST
GGT
228
What 2 labs do we monitor with Heparin
Anti-Xa OR aPTT (activated partial thromboplastin time)
229
Emollient medications
docusate sodium (Colace)
mineral oil
