*CH 50 adverse effects interactions and contradictions Flashcards
central nervous system effects
Stimulation (excitement)
CNS depression
Nurses action for CNS effects
implement seizure precautions for CNS stimulation
Client education for CNS effects
CNS depression do not drive operate heavy machinery or participate in dangerous activities
extrapyramidal symptoms
abnormal body movements
ex: tremors rigidity, restlessness, acute dystonia (spastic movement of the back neck tongue face)
Nurse action for extrapyramidal symptoms
most common on mental health meds that target CNS
keep client safe when movement and balanced are uncontrollable
Anticholinergic effects
result from muscarinic receptor blockade and effect the eyes, smooth muscle tone, exocrine glands and heart.
nurse action for Anticholinergic effects
sip fluids for dry mouth
wear sunglasses outdoors to prevent photophobia
urinate before taking meds to reduce urinary retention
increase exercise fiber and fluids to prevent constipation
reduce overheating bc you might not sweat
Cardiovascular effect
involve blood vessels and heart
ant-hypertensives can cause orthostatic hypotension
nursing action for cardiovascular effect
instruct pt to sit or lie down and get up slowly when needed to reduce light headedness
GI effects
local irritation of the GI tract
stimulation of vomiting center
stimulation or slowing bowel motility
Nursing action of GI effects
Many NSAIDS cause GI distress
take meds with food notify provider about consistent GI effects
Hematologic effects
common AND life threatening
nursing action for hematologic effects
bone marrow depression can result from anticancer meds
hemorrhagic disorders from anticoagulants and thrombolytics
pt should report bruising discolored urine stool petechiae and bleeding gums
Hepatotoxicity
damage to the liver
nursing action for hepatoxicity
increase liver damage when 2 meds are hepatotoxic
Nephrotoxicity
result of antimicrobial agents and NSAIDS
impaired kidney function interferes with meds excretion –> accumulation and adverse effects
nursing action for nephrotoxicity
aminoglycosides can cause kidney damage
monitor Blood creatinine and BUN levels
Toxicity
sever and potential life threatening effects from excessive dosing but can also occur in therapeutic levels
fun fact
acetylcysteine minimizes liver damage due to acetaminophen toxicity
rapid hypersensitivity
rapid or immediate
occurs when inhaling, ingestion, injection direct contact with allergen
allergies to substances
rapid hypersensitivity results
acute inflammation
histamine release
vasoactive amines release
rapid hypersensitivity reactions
include superficial response (hay fever, rhinosinusitis) allergic asthma anaphylaxis angioedema
angioedema
swelling of deep tissue ( lips, face, neck) can occur in first 24 hours or long exposure. NSAIDS and ACE inhibitors are the most common meds that can cause angioedema
Anaphylaxis
rapid systemic reaction following allergic response to an allergen. (dyes food, bites, stings, foods)
anaphylaxis symptoms
GI cramping
itching hives
progression of angioedema and intensely large itchy hives
anaphylaxis respiratory manifestation
lung crackles wheezing decreased breath sounds lump in throat hoarseness stridor
anaphylaxis cardiovascular manifestation
include weak thready pulse
tachycardia
hypotension
nurse actions for anaphylaxis
epinephrine for severe allergic reaction bronchodilators antihistamines respiratory support monitor ABGs albuterol monitor hemodynamics status (may experience extensive vasodilation, capillary leak) tachycardia weak pulse monitor client frequently
client education
wear medical alert bracelet
keep epinephrine available all the time
Immunosuppression
a decrease or absent immune response
nurse actions for immunosuppression
glucocorticoids depress the immune response and increase risk of infection
monitor for indication of infection
Increase therapeutic effects nursing actions
taking some meds together can increase therapeutic effect
fun med fact
inhale albuterol (beta2 adrenergic agonist) 5 minutes before inhaling fluticasone (a glucocorticoid) to increase absorption of fluticasone
Increase adverse effect nurse actions
taking two meds that do the same thing increase the risk or worsen adverse effects
fun med fact
Diazepam and hydrocodone with acetaminophen both have CNS depressant effects.
Decrease therapeutic effect nurse actions
one med increase metabolism of another med = decrease level and effectiveness of meds
fun med fact
Phenytoin increase hepatic med-metabolizing enzymes that affect warfarin = decrease blood level and therapeutic effect of warfarin
decreased adverse effects nurse action
one med can counteract the adverse effect of another med.
fun med fact
ondansetron (an antiemetic helps with nausea and vomiting) counteracts the adverse effect of nausea and vomiting’s from chemo
increase blood levels, leading to toxicity
one med can decrease the metabolism of a second med = increase serum level of the second med and lead to toxicity
fun med fact
fluconazole (antifungal) inhibits hepatic med-metabolizing enzymes that affect aripiprazole (antipsychotic) = increase blood levels of aripiprazole
medication-food interactions
food can alter medication absorption and can contain substances that react with some meds
tyramine
consuming food with tyramine while taking monoamine oxides inhibitors (MAOIs) can lead to hypertensive crisis.
(avocados, figs, aged cheese, yeast extract, beer, smoked meats)
vitamin K
decrease the therapeutic effects of WARFIN and put clients at risk for blood clots
dairy
tetracycline can interact with chelating agent (milk) to form an insoluble, unobservable compound
take tetracycline 1 hr before or 2 hr after taking dairy
Grapefruit
inhibits presystolic medication metabolism in the small bowel = increasing absorption of some oral medication (nifedipine) a calcium channel blocker = increase effects reaction
caffeine
theophylline, a methylaniline for asthma control and caffeine can result in excessive CNS excitation
Antacids Vitamin C
taking aluminum-containing antacids with citrus beverage can result in excessive absorptions of aluminum
fun med fact
morphine depresses respiratory function. asthma patients or respiratory dysfunction require precaution with the use or morphine
