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Pharmacology Test 1 > Drug List > Flashcards

Drug List Flashcards

1
Q

name the first generation NSAIDs

A
  • aspirin
  • ibuprofen
  • naproxen
  • diclofenac/misoprostol
  • ketorolac
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2
Q

name commonalities among all first generation NSAIDs

A
  • MOA: inhibit COX 1 & 2–>inhibit PG synthesis
  • indication:
    • inflammatory disorders (RA, OA, bursitis)
    • mild-moderate pain
    • suppress fever
    • dysmenorrhea
  • ADRxns:
    • inc risk of GI bleed
    • renal impairment
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3
Q

Aspirin: Class

A

salicylates

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4
Q

Aspirin: MOA

A
  • irreversible inhibitor of COX1 and COX2–>inhibits PG synthesis
    • COX2: for inflammation, pain, fever
    • COX1: for MI and stroke (b/c it inhibits platelet aggregation)
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5
Q

Aspirin: Indications

A
  • inflammation: RA, JRA, OA, rheumatic fever, tendinitis, bursitis
  • mild-moderate pain (no tolerance or dependence like opioids)
  • reduction of fever in adults
  • dysmenorrhea
  • suppression of platelet aggregation (by inhibiting COX1)
    • so for prophylaxis of MI and stroke
  • colorectal cancer prevention
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6
Q

Aspirin: SE

A
  • gastric distress
  • nausea
  • heartburn
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7
Q

Aspirin: ADRxns

A
  • GI bleeding, gastric ulceration, perforation
    • bleeding inc b/c platelet aggregation is inhibited
  • salicylism: tinnitus, sweating, headache
  • renal impairment
    • due to COX1 inhibition
  • Reye’s Syndrome in children
    • encephalopathy and fatty liver degeneration
  • anaphylaxis and laryngeal edema
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8
Q

Ibuprofen: Class

A

NSAID

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9
Q

Ibuprofen: MOA

A
  • reversible inhibitor of COX 1 and COX 2–>inhibit PG synthesis
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10
Q

Ibuprofen: Indications

A
  • fever
  • mild to moderate pain
  • inflammation: RA, OA
  • dysmenorrhea: best NSAID for this
  • closure of DA in infants
  • **suppression of platelet aggregation is MUCH less than aspirin
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11
Q

Ibuprofen: SE

A
  • headache
  • constipation
  • dyspepsia
  • nausea
  • vomiting
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12
Q

Ibuprofen: ADRxns

A
  • gastric ulcers and GI bleeding (less than aspirin)
  • renal impairment
    • due to COX 1 inhibition
  • Stevens Johnson Syndrome
    • can cause scarring, blindness, death
  • MI and Stroke
    • b/c it causes little to no suppression of platelet aggregation, so inc risk of MI and stroke
  • exfoliative dermatitis
  • toxic epidermal necrolysis
  • anaphylaxis
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13
Q

Naproxen: Class

A

NSAID

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14
Q

Naproxen: MOA

A
  • reversible inhibitor of COX 1 (highly selective for COX 1–>inhibit PG synthesis
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15
Q

Naproxen: Indications

A
  • inflammation:
    • RA, bursitis, tendinitis
  • dysmenorrhea
  • fever
  • mild-moderate pain
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16
Q

Naproxen: SE

A
  • dizziness
  • drowsiness
  • headache
  • constipation
  • dyspepsia
  • nausea
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17
Q

Naproxen: ADRxns

A
  • GI distress, bleed
  • renal fcn impairment
  • MI
  • Stroke
    • b/c it is a selective inhibitor of COX1, the risk for MI and stroke appears less with Naproxen than other traditional NSAIDs like ibuprofen and diclofenac
  • drug induced hepatitis
  • anaphylaxis
  • Stevens Johnson Syndrome
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18
Q

Diclofenac/Misoprostol: Class

A

NSAID/cytoprotective PG

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19
Q

Diclofenac/Misoprostol: MOA

A
  • reversible inhibitor of COX 1 and COX 2–>inhibit PG synthesis
  • Misoprostol: PG analog that can protect against NSAID induced ulcers
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20
Q

Diclofenac/Misoprostol: Indications

A
  • RA, OA pts at high risk for NSAID induced gastric/duodenal ulcers
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21
Q

Diclofenac/Misoprostol: SE

A
  • diarrhea (misoprostol)
  • abdominal pain
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22
Q

Diclofenac/Misoprostol: ADRxns

A
  • uterine contractions (misoprostol)–>miscarriage
    • contraindicated during pregnancy, pts should be on contraception to prevent pregnancy
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23
Q

Ketorolac: Class

A

NSAID

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24
Q

Ketorolac: MOA

A
  • reversible COX-1 and COX-2 inhibitor–>inhibits PG synthesis
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25
Q

Ketorolac: Indication

A
  • pain (as good as morphine, opioids)
  • use for acute, severe pain
    • post op pain
  • **minimal anti-inflammatory effects
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26
Q

Ketorolac: SE

A
  • drowsiness
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27
Q

Ketorolac: ADRxns

A
  • ulcers, GI bleed, perforation
  • renal impairment
  • premature closure of DA
  • suppress uterine contractions
  • MI/Stroke
    • b/c it causes little to no suppression of platelet aggregation, so inc risk of MI and stroke
  • exfoliative dermatitis
  • Stevens Johnson Syndrome
  • Toxic Epidermal necrolysis
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28
Q

Ketorolac: what is important to remember?

A
  • duration of therapy by all routes should be no more than 5 days
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29
Q

what is considered a second generation NSAID?

A
  • Celecoxib
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30
Q

Celecoxib: Class

A

NSAID

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31
Q

Celecoxib: MOA

A
  • COX 2 selective inhibitor–>inhibit PG synthesis
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32
Q

Celecoxib: Indications

A
  • inflammation
    • OA, RA, ankylosing spondylitis, juvenile idiopathic arthritis
  • acute pain
  • dysmenorrhea
  • familial adenomatous polyposis which predisposes to colorectal cancer
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33
Q

Celecoxib: SE

A
  • dyspepsia
  • abdominal pain
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34
Q

Celecoxib: ADRxns

A
  • possible gastric ulcers, but less likely
  • MI, stroke
    • contraindicated in pts who have heart dz
  • renal impairment
  • sulfonamide allergy
  • premature closure of DA
    • contraindicated in pregnancy
  • exfoliative dermatitis
  • Stevens Johnson Syndrome
  • Toxic Epidermal Necrolysis
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35
Q

why are gastric ulcers less likely with Celecoxib?

A
  • b/c it is only a selective inhibitor of COX2, COX1 is not inhibited, so there is no inhibition of platelet aggregation
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36
Q

why are MI, stroke ADRxns for Celecoxib?

A
  • b/c the drug does not inhibit COX1, so there is no platelet aggregation
  • b/c it does inhibit COX2, which causes increased vasoconstriction, so there is inc likelihood of vessel blockage once the process of thrombosis has begun
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37
Q

NSAIDs: general nursing implications

A
  • take with food, milk, water to prevent GI upset
  • do not crush or chew enteric coated or sustained release capsules
  • DO NOT consume alcohol (problem is 3+/day)
  • notify prescriber if GI irritation is severe or persistent
  • avoid use to prevent vaccination associated fever/pain
  • contraindicated if: hx of severe NSAID allergy, children w/ chickenpox or influenza
    • Celecoxib: for those with sulfa allergy
    • in pregnant women b/c may cause maternal anemia, premature closure of DA
  • do not take with ACE inhibitors/ARBs: inc renal impairment risk
  • do not take with glucocorticoids: b/c inc risk of GI bleed
  • give PPI or H2RA if pt at high risk for bleeding
  • discontinue before major surgery
  • be careful if taking anticoagulants
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38
Q

Aspirin: specific nursing implications

A
  • discard any that smells like vinegar
  • can cause salicylism
    • educate about S/S: tinnitus, sweating, headache, dizziness
  • avoid aspirin in children due to risk of Reye’s Syndrome
    • use acetaminophen instead
  • take about 2 hours before another NSAID b/c otherwise, NSAID antagonizes anti-platelet effect of aspirin and decreases protection for MI/stroke
  • aspirin toxicity is an emergency:
    • tx: external cooling, fluids to correct dehydration/electrolyte loss, infusion of bicarb to reverse acidosis, ventilation
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39
Q

Prednisone: Class

A

glucocorticoids

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40
Q

Prednisone: MOA

A
  • anti-inflammatory:
    • inhibit synthesis of chemical mediators (PG, histamine, LT)
    • reduce swelling, warmth, redness, pain
    • suppress infiltration of phagocytes, so damage from lysosomal enzymes averted
  • immunosuppressive
    • proliferation of lymphocytes
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41
Q

Prednisone: Indication

A
  • RA: reduce inflammation and pain
  • SLE
  • IBD: ulcerative colitis, Crohn’s
  • bursitis, tendinitis, OA
  • allergic rxns: rhinitis, bee stings
  • asthma
  • skin dz
  • neoplasms
  • suppression of allografts
  • prevention of respiratory distress syndrome in preterm infants
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42
Q

Prednisone: SE

A
  • osteoporosis
  • infection: especially Pneumocystic pneumonia
  • glucose intolerance
  • myopathy, muscle weakness
  • fluid and electrolyte disturbance–>HTN, edema
  • growth delay (in children)
  • psychological disturbances: insomnia, anxiety
  • cataracts, glaucomas
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43
Q

Prednisone: ADRxns

A
  • adrenal insuffiency
  • psychological disturbances: hallucinations, suicide
  • peptic ulcer dz
    • b/c inhibits PG synthesis
  • Cushing’s
    • moon face, buffalo hump, potbelly, hyperglycemia, osteoporosis, muscle wasting
  • thromboembolism
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44
Q

Prednisone: Nursing Implications

A
  • contraindicated for those with systemic fungal infections and receiving live virus vaccines
  • DO NOT drink with grapefruit juice
  • avoid taking aspirin and acetaminophen with it
  • should be taken with food to prevent gastritis
  • do not stop abruptly
  • inform pts about early signs of infection: fever, sore throat
  • educate pt about S/S of fluid retention (weight gain, swelling of extremities) and hypokalemia (muscle weakness, irregular pulse, cramping)
  • notify doc if vision becomes cloudy, blurred
  • notify doc if black, tarry stool
  • notify pt about possible psychologic rxns
  • watch for signs of compression fractures and fractures of other bones
  • take w/ Ca and vitamin D to prevent osteoporosis
    • also should have bone scans
  • evaluate growth of children
  • pt should receive eye exams
  • watch for signs of hyperglycemia
  • watch for thinning of the skin, especially in older pts
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45
Q

Diphenhydramine: Class

A

Antihistamines

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46
Q

Diphenhydramine: MOA

A
  • H1 Receptor Antagonist
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47
Q

Diphenhydramine: Indications

A
  • sneezing
  • rhinorrhea
  • nasal itching
  • allergic rhinitis
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48
Q

Diphenhydramine: SE

A
  • sedation
  • anticholinergic effects: dry mouth, constipation, urinary hesitancy, blurred vision (b/c of pupil paralysis), HTN, tachycardia
  • anorexia
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49
Q

Diphenhydramine: Nursing Implications

A
  • does not work against common cold
  • more effective if taken prophylactically, before symptoms begin
  • should be administered on regular basis throughout allergy season
  • have to be careful when giving to older adults, b/c it may inc risk of falls
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50
Q

name the H2 Receptor Antagonists

A
  • cimetidine
  • ranitidine
  • famotidine
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51
Q

name commonalities among H2 Receptor Antagonists

A
  • MOA: suppression of gastric acid from parietal cells
  • indication: gastric and duodenal ulcers
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52
Q

Cimetidine: Class

A
  • H2 Receptor Antagonist
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53
Q

Cimetidine: MOA

A
  • when H2 receptors are activated, then gastric acid secretion is promoted
    • so cimetidine acts by reducing volume of gastric juice and its hydrogen ion concentration, suppresses acid secretion
54
Q

Cimetidine: Indications

A
  • gastric and duodenal ulcers
  • GERD
  • Zollinger Ellison Syndrome (hypersecretory syndromes)
  • aspiration pneuomonitis: aspiration of gastric acid
    • occurs in surgery b/c anesthesia suppresses glottal reflex so the gastric acid goes to lungs
  • OTC: heartburn, acid indigestion, sour stomach
55
Q

Cimetidine: SE

A
  • antiandrogenic effects: gynecomastia, reduced libido, impotence
  • CNS effects: confusion, hallucinations, CNS depression (lethargy), CNS stimulation (restlessness, seizures)
  • pneumonia: when acidity is dec, bacterial colonization inc
56
Q

Ranitidine: differences from cimetidine

A
  • more potent
  • fewer ADRxns
  • fewer drug rxns
57
Q

Ranitidine: Class

A

H2 Receptor Antagonists

58
Q

Ranitidine: MOA

A
  • H2 receptor blocker that suppresses secretion of gastric acid from parietal cells
59
Q

Ranitidine: Indications

A
  • short term tx of gastric/duodenal ulcers
  • prophylaxis of recurrent duodenal ulcers
  • tx of ZE Syndrome: better than cimetidine
  • tx of GERD
60
Q

Ranitidine: SE

A
  • rare CNS effects: b/c penetrates BBB poorly
  • **no antiandrogenic effects b/c does not bind to androgen Rs
61
Q

Famotidine: Class

A

H2 Receptor Antagonists

62
Q

Famotidine: MOA

A
  • binds to H2 R and blocks it, so suppresses secretion of gastric acid
63
Q

Famotidine: Indications

A
  • tx and prevention of duodenal ulcers
  • tx of gastric ulcers
  • GERD
  • ZE Syndrome (hypersecretory states)
  • OTC: heartburn, acid indigestion, sour stomach
64
Q

Famotidine: SE

A
  • elevation of gastric pH may inc risk of pneumonia
  • **no antiandrogenic effects b/c does not bind to androgen Rs
65
Q

H2 Receptor Antagonists: Nursing Implications

A
  • may be taken w/o regard to meals
  • make sure pt knows the dosing schedule
  • avoid cigarettes and aspirin/NSAIDs
  • advise pt to stop drinking b/c drinking exacerbates ulcer symptoms
  • tell pts 5-6 small meals may be preferable to 3 larger meals
  • educate pt about signs of GI bleed: black/tarry stools, coffee ground vomitus
  • inform pt about S/S of respiratory infection, notify provider if these occur
  • for PUD, need dx with visualization of ulcer and test for H. pylori
  • inform pt that cimetidine can cause anti-androgenic effects (gynecomastia, dec libido, ED) but reverses after drug withdrawal
    • also can cause CNS effects–notify provider of this
66
Q

Cyclosporine: Class

A
  • immunosuppressants–calcineurin inhibitors
67
Q

Cyclosporine–MOA

A
  • binds to a protein, cyclophilin, to inhibit calcineurin which is needed to synthesize IL-2
    • w/o IL-2, proliferation of B cells and cytolytic T cells is suppressed
68
Q

Cyclosporine–Indications

A
  • to prevent rejection of allogenic kidney, liver, and heart
    • dispense with prednisone
  • psoriasis
  • RA
69
Q

Cyclosporine: SE

A
  • HTN
  • tremor
  • hirsutism
  • leukopenia
  • gynecomastia
  • sinusitus
70
Q

Cyclosporine–ADRxns

A
  • nephrotoxicity
  • infection
  • hepatotoxicity
  • lymphomas
  • anaphylaxis
  • seizures
  • posterior reversible encephalopathy syndrome
  • progressive multifocal leukoencephalopathy
  • **interaction w/ grapefruit juice–inhibits cyclosporine metabolism–>inc risk for toxicity
71
Q

Cyclosporine–Nursing Implications

A
  • avoid if pregnant, inoculated with live virus vaccine, chickenpox, herpes zoster
  • dispense oral liquid using specially calibrated pipette
    • mix well with diluent and drink immediately
    • refill container with diluent and drink to ensure ingestion of entire dose
  • can mix with apple juice or OJ to improve taste
    • DO NOT drink grapefruit juice
  • inform pt about needing periodic tests for kidney fcn (BUN, creatinine) and liver fcn (bilirubin, LFTs)
    • if creatinine level inc too high in the blood, then this is sign that the kidneys are failing
  • inform pt about early signs of infection: fever, sore throat
  • inform pt about possible increase growth in hair, but that this is reversible
  • do not breast feed
  • women of child-bearing age should be using mechanical contraception
72
Q

Tacrolimus vs. Cyclosporine

A
  • tacrolimus is somewhat more effective than cyclosporine but more chance of toxicity
73
Q

Tacrolimus–Class

A

immunosuppressants–calcineurin inhibitor

74
Q

Tacrolimus–MOA

A
  • binds to protein (FKBP-12) which then inhibits calcineurin, so IL-2 and IFN gamma are suppressed–>inhibits proliferation of B cells and cytotoxic T cells
75
Q

Tacrolimus–indications

A
  • to prevent allogenic organ rejection of liver, kidney, and heart transplants
    • administer with glucocorticoids
76
Q

Tacrolimus–SE

A
  • GI effects: diarrhea, nausea, vomiting
  • HTN
  • hyperkalemia
  • hyperglycemia
  • hirsutism
  • paresthesia
77
Q

Tacrolimus–ADRxns

A
  • nephrotoxicity
  • neurotoxicity: headache, tremor, insomnia
  • anaphylaxis (if did IV administration)
  • infection
  • lymphomas
  • posterior reversible encephalopathy syndrome (PRES)
  • seizures
  • **metabolized by CYP3A4, and grapefruit juice inhibits this enzyme, so if drink grapefruit juice, then there will be inc circulating levels of tacrolimus
78
Q

name the immunosuppressant–cytotoxic medications

A
  • azathioprine
  • mycophenolate
79
Q

name the commonalities among the immunosuppresant cytotoxic drugs

A
  • MOA: suppress immune response by killing B and T cells undergoing proliferation
  • SE:
    • bone marrow suppression
    • GI distress
    • reduced fertility
    • alopecia
80
Q

Azathioprine–Class

A

immunosuppressants: cytotoxic drugs

81
Q

Azathioprine–MOA

A
  • suppresses immune response by inhibiting proliferation of B and T cells
    • nonspecific: toxic to all proliferating cells
82
Q

Azathioprine–Indications

A
  • used with cyclosporine and glucocorticoids to suppress transplant rejection
  • severe refractory RA in non pregnant adults
  • autoimmune dz
83
Q

Azathioprine–SE

A
  • GI distress: nausea, vomiting
  • alopecia
  • reduced fertility
  • anemia
84
Q

Azathioprine–ADRxns

A
  • bone marrow suppression–>neutropenia and thrombocytopenia
  • pancreatitis
  • blood dyscrasias
  • neoplasms
  • progressive multifocal leukoencephalopathy
  • malignancy
  • serum sickness
85
Q

Azathioprine–Nursing Implications

A
  • take CBC of pt for baseline before use
  • avoid during pregnancy
86
Q

Mycophenolate–Class

A

Immunosuppressants–cytotoxic drugs

87
Q

Mycophenolate–MOA

A
  • selective inhibitor of B and T cell proliferation
    • mycophenolate is converted to mycophenolic acid (MPA)–>inhibits inosine monophosphase dehydrogenase (which is required to synthesize purines)–>inhibits B and T cell proliferation
88
Q

Mycophenolate–indications

A
  • to prevent rejection of allogenic heart, liver, kidney
    • administered with cyclosporine and glucocorticoids
89
Q

Mycophenolate–SE

A
  • GI distress: diarrhea, vomiting
  • alopecia
  • reduced fertility
  • paresthesia
  • anxiety
  • dizziness
90
Q

Mycophenolate–ADRxns

A
  • bone marrow suppression–>severe neutropenia, thrombocytopenia
  • sepsis: cytomegalovirus viremia
  • pure red cell aplasia
  • neoplasms
  • infection
  • progressive multifocal leukoencephalopathy (PML)
  • GI bleed
91
Q

Mycophenolate–Nursing Implications

A
  • avoid during pregnancy
    • do pregnancy test before medication administration
    • women should use 2 reliable forms of contraception
  • CBC should be done before administration
92
Q

Interferon Beta 1A–Class

A

Immunomodulators–Multiple Sclerosis

93
Q

Interferon Beta 1A–MOA

A
  • inhibits migration of pro-inflammatory leukocytes across BBB, so prevents them from reaching CNS
  • suppresses helper T cell activity
94
Q

Interferon Beta 1A–Indications

A
  • relapsing MS
    • decreases freq of attacks, reduces size and number of MRI lesions, delays progression of disability
  • secondary progressive MS
95
Q

Interferon Beta 1A–SE

A
  • flu like rxns–headache, fever, chills, malaise, muscle aches, stiffness
    • will diminish
    • minimized by: starting low dose and titrating up, giving analgesic/antipyretic med (NSAID)
  • injection site rxns–pain, erythema, rash, itching
    • can minimize by: rotating injection site, apply ice, apply warm compress
    • help with itching with oral diphenhydramine or topical hydrocortisone
  • depression
  • neutralizing Abs
96
Q

Interferon Beta 1A–ADRxns

A
  • hepatoxicity
  • myelosuppression–suppress bone marrow fcn–>dec production of all blood cell types
  • drug interactions–w/ any drug that suppresses bone marrow or causes liver injury
97
Q

Interferon Beta 1A–Nursing Implications

A
  • obtain baseline liver fcn and CBC
    • also check throughout therapy
  • don’t use in those who abuse alcohol or have liver dz
  • instruct pt to store drug in fridge, teach to self inject, advise them to rotate injection site
  • if flu like rxn, pt can take analgesic-antipyretic med
  • if injection rxn:
    • can minimize by: rotating injection site, apply ice, apply warm compress
    • help with itching with oral diphenhydramine or topical hydrocortisone
      • don’t use hydrocortisone continuously b/c skin damage may occur
98
Q

Cimetidine: ADRxns

A
  • arrhythmias
  • agranulocytosis
  • aplastic anemia
99
Q

Ranitidine: ADRxns

A
  • arrhythmias
  • agranulocytosis
  • aplastic anemia
100
Q

Famotidine: ADRxns

A
  • arrhythmias
  • agranulocytosis
  • aplastic anemia
101
Q

Misoprostol–Class

A

PG E1 analog, anti-ulcer drug

102
Q

Misoprostol–MOA

A
  • prevents NSAID induced ulcers by acting as a replacement for endogenous PG
    • PGs protect stomach by suppressing secretion of gastric acids and promotes secretion of bicarbonate and protective mucous
103
Q

Misoprostol–Indications

A
  • prevention of gastric ulcers caused by long term therapy with NSAIDs
  • w/ mifepristone, can induce medical termination of pregnancy
104
Q

Misoprostol–SE

A
  • dose related diarrhea
  • abdominal pain
  • spotting
  • dysmenorrhea
105
Q

Misoprostol–ADRxns

A
  • miscarriage
106
Q

Misoprostol–Nursing Implications

A
  • women of child bearing age must:
    • be able to comply with birth control
    • be given oral/written warnings about the dangers
    • have a negative serum pregnancy test result w/in 2 weeks before beginning therapy
    • begin therapy only on 2nd or 3rd day of next normal menstrual cycle
107
Q

Metoprolol–Class

A

2nd generation beta blockers

108
Q

Metoprolol–MOA

A
  • selective blockade of beta 1 receptors in the heart
    • usually does not block beta 2
109
Q

Metoprolol–Indications

A
  • HTN
  • angina pectoris
  • heart failure
  • MI
110
Q

Metoprolol–SE

A
  • fatigue
  • weakness
  • erectile dysfunction
111
Q

Metoprolol–ADRxns

A
  • bradycardia
  • heart failure (if use incautiously)
  • pulmonary edema
  • reduced cardiac output
  • AV heart block
  • rebound cardiac excitement (w/ abrupt withdrawal)
112
Q

Metoprolol–Nursing Implications

A
  • contraindicated in those with sinus bradycardia, AV block greater than 1st degree
  • use carefully in heart failure pts
  • safer than propranolol in pts with asthma and severe allergic rxns b/c only minimally binds to beta 2
  • safer in diabetics than propranolol
    • but will mask common signs of hypoglycemia so need to watch for other signs like hunger, fatigue, and poor concentration
  • do not stop abruptly
  • pts should know about early signs of heart failure: shortness of breath, night coughs, swelling of extremities
113
Q

Metoclopramide–Class

A

Prokinetic drugs: inc tone and motility of GI tract

114
Q

Metoclopramide–Indications

A
  • used for chemotherapy induced vomiting and chronic constipation
  • NOT A LAXATIVE
  • PO:
    • diabetic gastroparesis
    • suppression of GERD
  • IV:
    • suppression of post op nausea and vomiting
    • suppression of CINV
    • facilitation of small bowel intubation
    • facilitation of radiologic exam of GI tract
115
Q

Metoclopramide–SE

A
  • diarrhea
  • sedation
116
Q

Metoclopramide–ADRxns

A
  • tardive dyskinesia: repetitive involuntary movements of the arms, legs, facial muscles
    • especially in older adults
    • so tx should be as short as possible
117
Q

Metoclopramide–Nursing Implications

A
  • tx should be as short as possible to prevent tardive dyskinesia
  • contraindicated in pts with GI obstruction, perforation, or hemorrhage
118
Q

Magnesium Sulfate–Class

A

Tocolytic drug

119
Q

Magnesium Sulfate–MOA

A
  • inhibits release of acetylcholine at neuromuscular junction both in uterus and skeletal M
  • smooth muscle relaxer
120
Q

Magnesium Sulfate–Indication

A
  • suppression of preterm labor by suppressing contractions
  • prevention and tx of seizures associated with eclampsia and pre-eclampsia
121
Q

Magnesium Sulfate–SE

A
  • transient hypoTN
  • flushing
  • headache
  • dizziness
  • lethargy
  • dry mouth
  • feeling of warmth
122
Q

Magnesium Sulfate–ADRxns

A
  • hypothermia
  • paralytic ileus
  • pulmonary edema
  • in infants:
    • infant mortality: if used in high doses b/c drug readily crosses placenta
    • hypotonia (muscle weakness)
      • may last 3-4 days and may need mechanical ventilation during this time
    • sleepiness
123
Q

Magnesium Sulfate–Nursing Implications

A
  • low dose may offer benefit of neuroprotection (from cerebral palsy)
  • high dose can cause inc risk of infant mortality
  • if get pulmonary edema, need to discontinue immediately and give diuretic to accelerate magnesium excretion
  • contraindicated in pts with myasthenia gravis, renal failure, hypocalcemia
124
Q

Acetaminophen–Class

A

analgesic, antipyretic

125
Q

How is acetaminophen different from aspirin?

A
  • acetaminophen is not an anti-inflammatory or anti-rheumatic
    • could be b/c it only inhibits COX in CNS while aspirin does it in CNS and PNS
  • does not suppress platelet aggregation, cause GI ulcers, or lead to renal impairment
126
Q

Acetaminophen–indication

A
  • fever
  • mild to moderate pain
  • in children with chickenpox/flu
127
Q

Acetaminophen–MOA

A
  • inhibit COX (but only in CNS)–>inhibit PG synthesis
128
Q

Acetaminophen–SE

A
  • HTN (if more than 500 mg/day)
  • asthma
129
Q

Acetaminophen–ADRs

A
  • liver injury (if overdose)
  • anaphylaxis
  • Stevens Johnson Syndrome
  • acute generalized exanthematous pustulosis (AGEP)
  • toxic epidermal necrolysis
130
Q

Acetaminophen–nursing implications

A
  • if drink alcohol regularly, consume no more than 2000 mg/day (same for those with liver damage)
    • should not drink 3+/day
  • may inhibit warfarin metabolism–>inc risk of bleeding
    • monitor if taking warfarin and more than 1 g of acetaminophen/day
  • monitor BP
  • inform pts about S/S of anaphylaxis: trouble breathing and swelling of face, mouth, throat
  • consume no more than 4000 mg/day (total)
    • if undernourished, consume no more than 3000 mg/day total
  • antidote is acetylcysteine

Pharmacology Test 1 (3 decks)

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