Exam 1 Review Packet (new) Flashcards
what 6 drugs are used for inflammation (NSAIDs)
o ibuprofen
o ketorolac
o meloxicam
o naproxen
o indomethacin
o aspirin
what enzyme results in inflammation?
cyclooxygenase
o COX 1
o COX 2
what was the highest priority for the nurse to monitor for/anticipate in one taking opioids?
respiratory assessment
o resp. rate
o resp. depth
o SpO2
o lung sounds
what causes something to be placed on the list of controlled substances
risk for abuse and dependency
ASA?
acetylsalicylic Acid
o another word for Aspirin
what are four roles of ASA (aspirin)?
o anti-inflammatory
o antipyretic
o analgesia
o anti-platelet/anti-coagulant
what is the primary organ of metabolism?
liver
what is the most common complication of using NSAIDs?
GI Bleed
i.e S/S:
o indigestion
o low blood count
o bloody stool
o anything w/Gi
what drugs can be used as first line treatment for acute migraines?
serotonin 5-HT agonist (drug class)
o sumatriptan (drug)
(other drug class for this disease are ERGOT ALKALOIDS)
a nurse is teaching a patient about their new medication that has a narrow therapeutic index.
what should the nurse teach the patient to expect?
o start slowly and increase slowly
o routine lab work
o must take meds as prescribed (exact dose and time)
o notify provider of adverse effects
stimulates or activates
agonists
inhibits or blocks
antagonist
what is the primary organ of excretion and why is it important
kidney
o filters waste products, excess water and other substance from bloodstream to produce urine.
o help maintain body’s fluid balance, regulate electrolyte
routes from fastest onset to slowest onset?
IV, IM, SubQ, Transdermal, Oral
what would be signs of hepatotoxicity?
o hepatomegaly (enlarged liver)
o elevated AST and ALT
o jaundice, fatigue, N/V, abdominal pain, edema, loss appetite
which patients should not receive a nephrotoxic drug?
o patients with pre-existing kidney disease
o elevated BUN & creatinine (means kidney issues)
o elderly patients
o individuals w/concurrent medical conditions (diarrhea, HBP)
o pregnant women
what medication blocks the opioid receptors?
naloxone
a patient that is taking ibuprofen must be educated about what signs or symptoms related to its primary adverse effect?
o jaundice
o abdominal pain
o N/V
o stomach pain
o black/tarry stools
treats physical signs of opioid OD
methadone
what OTC pain medication would be preferred in a patient that is in the hospital for rhabdomyolysis (disease of the muscles)?
acetaminophen
allows a nurse to administer medication to a patient provided that the parameters for administration have been met
standing orders
what must a nurse monitor for in all patients receiving an IV medication
patency of medication
name four adverse effects of long term steroid use
o hyperglycemia
o decrease in bone mass
o hypertension
o immunocompromise
what is the term for the difference between the minimum effective concentration and the toxic concentration
therapeutic range
what are signs of opioid toxicity?
o euphoria
o sedation
o constricted pupils
o SOB
o decrease LOC
o impaired motor coordination and speech
a patient tells their nurse that they are on a medication that is teratogenic and just found out they are pregnant. what is the correct nursing action?
o notify provider immediately
what condition in a patient’s hx might exclude them from taking sumatriptan?
o cardiac disease
o uncontrolled hypertension
o and if they are pregnant
what does cyclooxygenase do in the body?
it is an enzyme that plays a crucial role in our body’s inflammatory response
COX 1 prostaglandins are involved in the regulation o blood flow to organs, protects gastric mucosa and maintain platelet aggregation
COX 2 produces prostaglandins that mediate pain, fever, and inflammation
how would nurse assess their patient for any adverse effects relating to a medication that is nephrotoxic?
o oliguria (low urine output)
o blood in urine
o lower back pain
o elevated BUN & increased serum creatinine level
why can we not administer aspirin to children?
reye’s syndrome
why can’t enteric coated pills be crushed?
designed to be resistant to stomach acid so that it can be dissolved in intestine.
prevents it from being destroyed by stomach acid
(shield stomach from pill)
why can’t sustained release and extended release pills not be released
designed to be released slowly and consistently over extended period of time.
crushing and breaking pill can disrupt their specific formulation and alter their intended release mechanism
when assessing for an overdose of what drug this module would you monitor for tinnitus?
aspirin
what are five CAMs and their uses?
o echinacea = cold/flu
o chamomile = anxiety, insomnia
o gingko biloba = memory/cognition
o ginger = GI upset/nausea
o St. John’s Wort = mental health/depression
o cranberry juice = prevent UTI (not treat)
what are some mild side effects that most patients can address on their own?
o headache
o N/V
o muscle aches
o drowsiness
o pyrexia (fever)
o upset stomach/GI upset
what are some potentially serious side effects that patients should report?
o allergic reactions
o severe persistent pain
o unusual bleeding or bruising
o rash
o difficulty breathing/SOB
what are some S/S you would assess for in a person who took a drug that causes “CNS effects”?
o LOC
o bradypnea
o SOB
o N/V
o autonomic dysfunction
o changes in mental status
o mood and behavior changes
o motor abnormalities
o headache
o sleep disturbance
o dizziness
o usual disturbance
what are some adverse effects to assess for in a patient that regularly receives subcutaneous injections?
o lipodystrophy (rare condition that causes a disproportionate distribution of fat in the body) - change sites
o injection site reactions
o bruising/hematoma
o infection
o allergic reaction
o pain/discomfort
o systemic side effects
NEED TO KNOW THIS
what do we need to consider when giving medications to someone in kidney failure
o decrease patient’s dosage - if we dont, can lead to OD because kidney is filtering only half the pill and medication stays in and keeps adding on each pill causing OD
what is the risk of combining a medications within a class?
i.e. taking 2 NSAIDs or 2 opioids
risk of OD
how should a RN encourage a child to take a medication
o have mom or dad help to encourage child to take meds
NEVER FORCE
assessments a nurse can perform to monitor for the primary adverse effect of fentanyl?
o SpO2
o chest rise & fall
o respiratory rate/depth
o LOC
o breathing pattern
o listen to lung sounds
what is the difference between an expected outcome and desired effect?
(same thing - synonymous terms)
o predicted/anticipated results or intentions one aims to get from a medication
what would you teach a patient about a PCA pump?
PCA pump is a programmable electronic device that connects to an IV line or other route of medication delivery that allows patients to self administer through a hand help device.
PCA has a lockout feature that determines the minimum time between doses to prevent OD and maximum dose limit over a specific timeframe
what is the most common side effect of opioids?
constipation
o patient education would be to increase fiber, fluid, and activity (move around more).
what IM has the smallest volume limit?
deltoid muscles (only 1-2 mL)
what would the nurse expect to find in a patient that received an opioid antagonist?
o reversal of opioid effects
o aggression
o improved breathing
o symptoms of opioid withdrawal such as sweating, N/V, tremors, anxiety, increased heart rate, increased BP, dizziness, abdominal cramping, headache
provide two examples of a BBW and the drug that it goes with from this module?
o GI bleed -> ketorolac (NSAIDs)
o hepatoxicity -> acetaminophen (central acting antagonist)
what is polypharmacy and who is most at risk?
o taking multiple medications simultaneously
o geriatric or patients with chronic genetic diseases
how must morphine be given?
via IV push (2-5 minutes)
types of pain
o neuropathic - nerves
o visceral - organs
o simple - i.e. paper cut, punch, kicked
what type of pain is easiest to treat?
simple pain
what type of pain is not treated with analgesics?
neuropathic pain is not treated with analgesics
what meds are used for neuropathic pain?
adjuvant medications (adjuvant therapy)
o gabapentin
o pregabalin (lyrica)
adjuvant have nothing to do with analgesics (organ pain) but do work for neuropathic pain
