Exam 1 Drug Facts Flashcards
The nursing process info, nursing considerations, etc.
Tamazepam, Lorazepam, Diazepam
Benzodiazepenes -
Anxiolytic, tranquilizer
Highly protein bound
Benzodiazepine antidote flumazenil
Name 3 Benzodiazepenes -Pam
Tamazepam, lorazepam, diazepam
Tamazepam is generic for
Restoril
Lorazepam is generic for
Atavan
Diazepam is generic for
Valium
What are benzodiazapenes used for?
Use- treat insomnia
Aspirin is an example of
Salicylates
What are the functions of salicylates?
anti-inflammatory, antiplatelet, antipyretic, analgesic
Other sedatives that aren’t benzos are:
Hypnotics and melatonin agonists
An example of a nonbenzo hypnotic is:
a melatonin agonist is:
Zolpidem (Ambien)
Ramelteon (Rozerem)
Nursing Assessment for sedatives
baseline vitals, labs (renal and liver), sleeping problems, drug history (highly protein bound- benzo)
Nursing Diagnosis for sedatives
disturbed sleep pattern
Nursing Planning for sedatives
- Client will remain asleep for 6-8 hours (benzo)
- Client will receive adequate sleep w/o hangover effect when taking hypnotic (barb)
Nursing interventions for sedatives
Avoid other CNS depressants, herbs, alcohol
- Prevent injury
- Report side effects
- Nonpharmacological methods
- Avoid driving
- Assess effectiveness
Nursing evaluation for sedatives
- Effectiveness
- Side effects (hangover, barb)
- Resp depression
Describe balanced anesthesia
Combination of drugs for general anesthesia
Hypnotic night before
Premed w/ narcotic analgesic (versed) and anticholinergic (atropine)-relaxes & decreases secretions
Short acting barbiturate (pentothal)
Inhaled gas administered (nitrous oxide)
A muscle relaxant prn
What are the stages of anesthesia?
There are four:
Analgesia- induction stage
Excitement or delirium
Surgical- surgical procedure is performed during this stage
Medullary paralysis- toxic stage, ventilatory assistance required
What are the types of anesthesia?
Inhalation anesthesia- 3rd stage of balanced
IV anesthesia- Induction of balanced or as general
Topical- decrease sensitive nerve endings of affected area
Local- block pain at the site where injected
Spinal- local anesthetic injected into subarachnoid space. Remain flat after surgery, Monitor BP
Describe the nursing process for anesthesia?
Assessment- VS, Drug hx., health hx.
Diagnosis- Pain
Plan- VS will remain stable, understand care
Interventions- monitor VS, U/O, side effects, post op recovery. Teach.
Evaluation
An example of a salicylate is
Acetylsalicylic Acid - Aspirin
What are the interactions of salicylates?
anticoagulants, hypoglycemics (increase risk of hypoglycemia)
What are the adverse reactions and cautions of salicylates?
tinnitus, vertigo, bronchospasm*,urticaria, ulceration, thrombocytopenia, bleeding * = ASA toxicity
Caution: Avoid during third trimester, do not give to children with flu/viral symptoms (Reye’s syndrome)
What are the labs to monitor with salicylates?
PT, bleeding time, platelets
What are the contraindications for Benzodiazepines?
Contraindications- pregnancy, lactation, renal, liver, mental disorders
What has interactions with benzodiazepines?
Interactions- avoid alcohol, other CNS depressants, increases liver enzymes
What are side effects of benzodiazepines?
drowsiness, lethargy, hangover, dizziness, anxiety, confusion, N/V/D
What are adverse effects of benzodiazepines?
tolerance, dependence, depression, hypotension, coma w/ od
What are 3 catagories of anti-inflammatories?
NSAIDS - inhibit COX 1&2
Corticosteroids
Disease-modifying antirheumatic drugs (DMARDs)
What are nursing interventions for acetylsalicylic acid?
There are 7
Take with food/milk
Monitor for bleeding (dark tarry stools, bleeding gums, petechiae, ecchymosis, purpura)
Do not crush or break enteric coated ASA
Avoid taking 2 days before & during menses,
Avoid before surgery
Avoid Alcohol
Avoid giving to children with flu-like symptoms (risk of Reye’s Syndrome)
Name two NSAIDS
Ibuprofen (Advil)
Ketorolac (Toradol)
Ibuprofen and Ketorolac are both examples of:
NSAIDS
What are the functions of NSAIDS?
Function: Antiinflam., Analgesic, Antipyretic; Given for Rheumatoid and Osteoarthritis
What are the interactions of NSAIDS?
Interactions: Increase effects of Warfarin (Coumadin), sulfonamides, certain cephalosporins, phenytoin, insulin, oral hypoglycemics, some herbs
What are the adverse effects of NSAIDS?
Adverse Effects: gastric upset, GI bleed, N, V, edema, (bleeding gums, petechiae, ecchymosis, black, tarry stools)
What are nursing interventions for NSAIDS?
Educate:
Side effects
Avoid taking ASA with NSAIDS
Avoid use 2 days before and and first 2 days of menses
Avoid during 3rd trimester
Avoid before surgery
Avoid alcohol
Administer with food
Interactions with following herbs:
Dong quai, garlic, feverfew, ginko
What do COX 1 and COX 2 inhibitors affect?
COX-1Inhibition leads to decreased stomach lining protection and decreased clotting time.
COX-2 Inhibition leads to decreased inflammation & pain
Introduction of selective COX-2 inhibitiors have decreased GI problems (and bleeding) associated with NSAIDS
What are two examples of selective COX-2 inhibitors?
Celecoxib (Celebrex) & Meloxicam (Mobic)
What are the adverse effects of selective COX-2 inhibitors? What labs are important?
Less incidence of GI problems & bleeding but higher risk of problems associated with clots
AE: edema
Labs: renal
Name three Corticosteroids ~one
Prednisone, prednisolone, dexamethasone
What is the T1/2 of corticosteroids?
T1/2 > 24h
What are corticosteroids used for?
Frequently used as anti-inflammatory
May be used for arthritic flare-ups
What are steroid considerations?
Do not stop abruptly; important to be tapered; gradually weaned off
May elevate blood sugars (hyperglycemia)
Causes immunosuppression
Lab Interactions: Elevated blood glucose, elevated WBC’s
Name 3 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS)
Imuran, Cytoxan, methotrexate
What are DMARDS used for?
As anti-inflammatory for Rheumatoid Arthritis (RA)
primarily used to suppress cancer growth and proliferation, but might also be used to suppress the inflammatory process of RA
What are 3 types of DMARDS (not drug names -types)
Immunosuppressive, Immunomodulators, Antimalarials
Discuss Immunosupressive DMARDS
Disrupt the inflammatory process and delay disease progression
Predispose patient to severe infection
TNF (Tumor necrosis factor )Blockers
Bind to TNF and block it from attaching to TNF receptors on synovial cell surfaces
Etanercept (Enbrel), influximab (Remicade), (Humira)
Interleukin (IL-1) receptor antagonists
IL-1 is a proinflammatory cytokine that contributes to synovial inflammation and joint destruction
Anakinra (Kineret)
Name 4 Immunosuppresive DMARDs
Etanercept (Enbrel), influximab (Remicade), Adalimumab (Humira)
Anakinra (Kineret)
Things to know about antimalarial DMARDS
Action: anti-inflammatory, analgesic for RA (Rheumatoid Arthritis)
Response: May take up to 4-12 weeks
May be used in combination with NSAIDS
What is gout?
uric acid metabolism disorder and defect in purine metabolism that leads to hyperuricemia
Name an anti-inflamatory gout drug:
Colchicine
Considerations for Colchicine
Action: Inhibits migration of leukocytes
Side effects: N, V, D (75% taking high doses)
Contraindications: Severe renal, GI problems
Nursing Implications:
Avoid foods rich in purines (wine, alcohol, organ meats, sardines, salmon, gravy)
Increase fluid intake
Take acetaminophen for pain; Not ASA
How do you prevent REM rebound when using Benzodiazepines?
Do no tuse for longer than 3-4 weeks.
Benzodiazepines are Schedules IV Narcotics- True or False
True
3 chemical mediators of inflammation:
Prostaglandins
COX: enzyme that promotes synthesis of prostaglandins
COX 2 – triggers inflammation & pain
Three complications of hyperuricemia
pain, urinary calculi, gouty nephropathy
What are the five stages of the inflammatory response?
