Drugs Flashcards
Paracetamol
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Analgesic
Generic names: Panadol, PanadolOsteo, Panamax, Dymadon
Indication:
- mild to moderate pain
- fever reduction
Key mechanism of action:
- inhibits prostaglandin synthesis in the CNS
Prostaglandins control inflammation, blood flow and blood clot formation
- antipyretic in the same way it reduces inflammation
- Prostaglandins inhibit endogenous pain control mechanisms by blocking transmission at spinal noradrenergic synapses.
2x adverse effects:
- dyspepsia (intergestion)
- renal disfunction
- liver failure
- nausea and vomiting
Major nursing considerations:
- as it is metabolised by the liver caution use in patient with chronic liver disease= can result in hepatotoxicity
- caution use in patient with alcohol dependance as as their livers are already compromised.
Ibuprofen
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Analgesic
Generic names: Neurophen, Brufen
Indication:
- fever
- mild to moderate pain
Key mechanism of action:
- inhibit COX-1 (enzyme that produces prostaglandins) non-selectively and selectively binds to COX-2 decreasing signs and symptoms of inflammation and pain.
- it inhibits the speed of prostaglandin pain messengers
2x adverse effects: - rash - epigastric pain - diarrhoea - abdominal pain - heart burn - prolonged bleeding time GI bleeding/ulceration
Major nursing considerations:
- contraindicated with asprin or NSAIDS as it increases risk of GI side effects such as ulceration and pain
- caution with concurrent warfarin use → increases risk of bleeding
- caution use when patient is at any risk of bleeding
- use of antacids will decrease the absorption of ibuprofen
Opioids
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Opioid analgesics are commonly used during the surgical journey
Intraoperatively → as an adjunct to inhalation anaesthesia, will also reduce the amount of anaesthetic agents required to produce anaesthesia
postoperatively → administered to counteract perioperative pain i.e. directly from the surgical procedure
Side effects are similar for all;
- resp depression
- constipation
- rash
- nausea
Schedule 8 drugs (2x nurse check)
Morphine Sulfate
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Opoid Analgesic
Generic names: Morphine, Anamorph, Kapanol
Indication:
- moderate to sever pain
- supplementary analgesia during GA
Key mechanism of action:
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- this prevents CNS smooth muscle pains from being noticed
- decreases respiratory centre, suppresses cough, stimulates vomiting centre, increases smooth muscle tone in the GIT, reduces peristalsis, reduces anxiety, can produce euphoria or dysphoria and drowsiness
2x adverse effects - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations:
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
Fentanyl
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Opoid Analgesic
Generic names: Durogesic, Fenpatch, Denpax
Indication:
- moderate to sever pain
Key mechanism of action:
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- acts on mu receptors of the brain and spinal cord
- more potent than morphine
2x adverse effects - muscle rigity - bleeding gums - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
Oxycodone
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Opoid Analgesic
Generic names: Endone, Oxycontin, Oxynorm
Indication: Moderate to sever pain
Key mechanism of action
- semi-synthetic opooid
- similar to morphine but shorter acting
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- acts on mu receptors of the brain and spinal cord
- more potent than morphine
2x adverse effects - muscle rigity - bleeding gums - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations
- may increase effects of warfarin → need to check INR regularly
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
Antiemetics
- act by blocking the neurotransmitters in the vomiting centre, the cerebral cortex and the CTZ
Nausea and vomiting is a complex process involving multiple nerve pathways and neurotransmitters
- results from impulses sent via efferent nerves from the emetic centre to the upper GIT, diaphragm and abdominal muscles
- strong contractions of the abdominal muscles forces the stomach contents past the oesophageal sphincter and into the mouth
- coordinated responses between sensory nerve cells (chemoreceptor trigger zone - CTZ) located in the brain and the vomit centre located in the medulla
- considered a protective mechanism to rid the body of a toxic substance
in severe cases however, it can result in fluid and electrolyte disturbances
Ondansetron
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: 5HT3 Receptor Antagonist
Indication: control nausea and vomiting
Generic names: Zofran, Ondaz, Onsetron
Key mechanism of action
- preventing nausea and vomiting in children and adults related to chemotherapy use, radiation therapy, and the effects of postoperative anesthesia
2x adverse effects
- headache
- dizziness
- fatigue
- diarrhoea
- constipation
- extrapyramidal reactions → confusion, dyskinesia, tremors, muscle contractions = oculogyric crisis
Major nursing considerations
- wafers should be placed on the tongue, allowed to dissolve and then swallowed
- may decrease analgesic effects of tramadol
- given during most anesthetics
Metoclopramide
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: antiemetic
Generic names: Maxolon, Pramin
Indication: controls nausea and vomiting
Key mechanism of action
- stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary or pancreatic secretions
- increases tone and amplitude of gastric contraction, relaxes the pyloric shincter and increases peristalsis of the duodenum and jejunum
- exact mode of action is unknown
- it sensitises tissues to the action of acetylcholine
2x adverse effects
- restlessness, drowsiness, headache, dizziness
- constipation
- tardive dyskinesia
- extrapyramidal reactions → confusion, dyskinesia, tremors, muscle contractions = oculogyric crisis
Major nursing considerations
- not recommended to use in pregnancy
- not safe for children under 15 (increased risk of acute dystonic reactions- a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements)
- contraindicated whenever gastric motility might be dangerous → GIT haemorrhage, bowel obstruction, perforation
- extrapyramidal reactions could occur up to 36 hours after administration
Explain and describe PCAs
Advantages and disadvantages
Patient controlled analgesics
- will contain schedule 8 drugs e.g. morphine, fentanyl, tramadol
Advantages
- avoidance of analgesic peaks and troughs
- allows patient to recieve medication without delya = increased patient empowerment and control
- patients are able to anticipate activities such as coughing or movement associated with increased pain and provide themselves with an opioid bolus in advance
- enables increased patient mobility
Explain the 3 PCA pump models
- PCA mode only → demand dose, the patient will only receive a dose of analgesia when they press the PCA button, there is a lock-out period after each bolus dose self-administered by the patient as a safety measure
- Continuous infusion → a background infusion where the patient will receive a continuous dose of analgesia, cannot be altered by the patient
- Continuous infusion with additional demand analgesia → the PCA is set for a continuous background infusion as per orders but the patient can self-administer an additional bolus of analgesia as required
Explain the nursing management for a PCA pump
- Always review the medical order, including the section on reportable observations
- RN must have a thorough understanding of the medication being administered, including common adverse effects
- When caring for a patient on a PCA, the following reviews / assessments should be performed hourly, unless indicated by the medical orders or organisational clinical practice guidelines:
- vital signs= assess your patient for CNS effects of opioid overdose → respiratory depression, drowsiness, confusion
- pain assessment
- device review to ensure there are no problems such as leaking around connections / kinked tubing
- IVC assessment
- documentation
What is a contraindication for a PCA?
PCAs are only suitable for patients that have a clear understanding of the use → patient’s with a cognitive impairment will not understand the concepts of self-administering analgesia and they will not be able to comply with the instructions on how to use the device
Explain bronchodilators as a whole and the 3 groups of them
Action: increase airway diameter to reduce airway resistance and improve gaseous exchange.
There are three groups of bronchodilators:
• β2 agonists
• Methylxanthines
• Anticholinergics
B2 adrenoceptor agonists
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: B2 adrenoceptor agonists (Sympathomimetic Bronchodilators)
Generic names:
Short acting β2 agonists: Salbutamol (Ventolin) Terbutaline (Bricanyl)
Long acting β2 agonists: Salmetrol (Serevent) Eformoterol (Oxis, Foradile)
Indication:
Bronchial constriction
Key mechanism of action
- Relaxes bronchial smooth muscle causing bronchodilation by stimulating β2 receptors
(also relaxes uterine and blood vessel smooth muscles)
2x adverse effects
- fine skeletal muscle tremor
- palpitations
- tachycardia
- nervousness
Major nursing considerations
- contraindicated in pregnancy (unless benefits outweigh risks)
- check inhaler technique
- monitor vital signs as an elevated heart rate may be a side effect
- monitor and escalate any arrhythmias
- educate patients on possible side effects
Xanthine Derivatives
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
Class: Methylaxnthines
Generic names:
Aminophylline (IV) Theophylline (Nuelin)
Indication:
Key mechanism of action:
- dilate bronchioles by relaxing smooth muscles
- Stimulant effect on myocardium, CNS and respiration
- relax smooth muscle in the blood vessels so result in a decrease in peripheral resistance
- Inhibit release of inflammatory mediators & histamine
- Promote diuresis
- Uses: Severe, acute asthma
- Maintenance therapy in severe asthma and COPD
2x adverse effects:
- anxiety
- headache
- nausea and vomiting
- bradycardia
Major nursing considerations:
- warn patient not to take excessive amounts of caffeine related beverages
- xanthines, diuretics and hypoxia may increase the risk of hypokalaemia if administered with beta2 adrenoreceptor agonists
