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NSG 318 - Pharm > Exam 2 DRUG CARDS > Flashcards

Exam 2 DRUG CARDS Flashcards

1
Q

Epinephrine

A

Adrenaline

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2
Q

Epinephrine classification

A

Sympathomimetic/Adrenergic agonist

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3
Q

Epinephrine action

A

(nonselective)
Alpha 1: increase BP
Beta 1: increase HR
Beta 2: promotes bronchodilation

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4
Q

Epinephrine uses

A

Anaphylaxis, anaphylactic shock
bronchospasms, status asthmaticus
cardiogenic resuscitation, cardiac arrest

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5
Q

Epinephrine side effects

A

cardiac effects: palpitations, tachycardia, hypertension,
restlessness
hyperglycemia

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6
Q

Epinephrine adverse effects

A

palpitations, tachycardia, hypertension, dyspnea, tissue necrosis at IV site

Lethal:
ventricular fibrillation, pulmonary edema

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7
Q

Epinephrine contraindications

A

cardiac dysrhythmias, hypertension,
hyperthyroidism, diabetes mellitus,
pregnancy

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8
Q

Epinephrine drug interactions

A

beta blockers, digoxin, trycyclic antidepressants (TCA) & monoamine oxidase inhibitors (MAOI)

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9
Q

Epinephrine assessment

A

Baseline VS, drug Hx, Health Hx, glucose level

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10
Q

Epinephrine intervention

A

Monitor IV site
Monitor VS and ECG
Monitor urinary output and assess for bladder distension
Provide measures to avoid nausea and vomiting

Monitor blood glucose in CT with diabetes

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11
Q

Atenolol

A

Tenormin

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12
Q

Atenolol classification

A

Beta 1 Adrenergic Antagonist

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13
Q

Atenolol action

A

Selectively blocks beta 1 sites, decrease sympathetic outflow to periphery (reduced HR, vasodilation, reduced BP), suppresses renin-angiotensin-aldosterone system (RAAS)

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14
Q

Atenolol use

A

hypertension, angina, prophylaxis, and Tx of acute myocardial infarction (MI)

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15
Q

Atenolol side effects

A

Drowsiness, dizziness, headache, depression, fatigue, nausea, diarrhea, erectile dysfunction

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16
Q

Atenolol adverse effects

A

Bradycardia, tachycardia, hypotension, chest pain, heart failure, dyspnea

Life-threatening: Bronchospasm, renal failure, dysrhythmia, thrombocytopenia

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17
Q

Atenolol contraindications

A

pregnancy, hypersensitivity to beta-blockers,
cardiogenic shock, 2nd or 3rd degree heart block,
bradycardia, cardiac failure

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18
Q

Atenolol drug interctions

A

Increased absorption with atropine and other anticholinergics
decreased effects with NSAIDs
increased risk of hypoglycemia with insulin and sulfonylureas
increased hypotension with prazosin and terazosin
increased lidocaine and verapamil levels with toxicity

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19
Q

Atenolol assessment

A

Assess VS and ECG for future comparison, drug list (report any diuretics, NSAIDS, digoxin, MAOIs, or CNS depressants), health history. Monitor changes in BP and HR, dizziness, light headedness, note if there is a stuffy nose as nasal congestion can occur

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20
Q

Atenolol evaluation

A

Evaluate if hypertension is decreased or in MI was solved

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21
Q

classification of albuterol

A

Beta 2- Adrenergic agonist

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22
Q

repeat

A

repeat

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23
Q

action of albuterol

A

Stimulates beta 2- adrenergic receptors in the lungs, which relaxes the bronchial smooth muscle, and then causes bronchodilation

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24
Q

uses/therapeutic effects of albuterol

A

Treatment of asthma, prophylactic treatment for asthma, treatment of bronchospasms (causes bronchodialation)

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25
Q

side effects of albuterol

A

Tremor, dizziness, drowsiness, nervousness, restlessness, agitation, anxiety, sweating, HA, nasopharyngitis, insomnia, weakness, nausea, diarrhea, muscle cramps

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26
Q

adverse effects of albuterol

A

Palpitations, tachycardia, hypertension, infection, hyperglycemia, hypokalemia, cardiac dysrhythmias, angioedema, bronchospasm, Stevens-Johnson syndrome

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27
Q

contraindications of albuterol

A

Hypersensitivity, milk protein hypersensitivity

Caution: cardia dysrhythmia,
CAD, severe cardiac disease,
hypertension, hyperthyroidism,
diabetes mellitus, renal dysfunction, advances age, seizures, MAOI therapy, pregnancy

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28
Q

drug interactions with albuterol

A

increased effect with other sympathomimetics; may increase effect with MAOIs and TCAs, antagonize effect with beta blockers

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29
Q

lab interactions with albuterol

A

may increase glucose level (STIMULATES GLUCONEOGENESIS IN THE LIVER); may decrease serum potassium level

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30
Q

food interactions with albuterol

A

Use with caffeine-containing-herbs (cols nut, guarana, mate, tea, coffee) increases the stimulant effect

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31
Q

nursing implications of albuterol

A

Monitor pulmonary function, observe for paradoxical bronchospasms, Assess lung sounds, pulse, BP before administration and during peak

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32
Q

evaluation for effectiveness of albuterol

A

Prevention/relief of bronchospasm

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33
Q

bethanechol

A

Urecholine

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34
Q

classification of bethanechol

A

Cholinergic Agonist: Parasympathomimetic

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35
Q

action of bethanechol

A

Stimulates the cholinergic receptors to contract of the bladder. Increases GI secretions and peristalsis, constriction of the pupil and bronchoconstriction

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36
Q

uses/therapeutic effects of bethanechol

A

To treat urinary retention and neurogenic bladder

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37
Q

side effects of bethanechol

A

Blurred vision, GI effects, Urinary frequency and urgency, Bronchoconstriction, N/V/D, abdominal cramps, hypersalivation, sweating, HA, dizziness, flushing

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38
Q

adverse effects of bethanechol

A

tachycardia, weakness, bronchospasm

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39
Q

contraindications of bethanechol

A

Intestinal and urinary tract obstruction, IBS, peptic ulcer. Severe bradycardia, hypotension, COPD, parkinsonism, hyperthyroidism. Seizures, active asthma

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40
Q

drug interactions of bethanechol

A

Antidysrhythmics decreases bethanechol effect;
Ganglionic blocking agents cause significant hypotension following severe abdominal symptoms;
False test results (amylase & lipase) may result, bethanechol skews reults.
Atropine, flavoxate, and opiates counteract bethanechol action

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41
Q

lab interactions of bethanechol

A

increases AST, bilirubin, amylase, lipase

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42
Q

nursing implications of bethanechol

A

baseline vital signs (IF BP IS LOW, CAN’T ADMINISTER DRUGS), monitor BP and HR, teach a patient to rise slowly from a lying position, auscultate breath sounds, record fluid I&Os, monitor the patient for possible cholinergic crisis (overdose). GIVE 1 hour before or 2 hours after meals to minimize N/V, check serum amylase, lipase, AST, bilirubin levels. Monitor GI side effects

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43
Q

evaluation for effectiveness of bethanechol

A

evaluate urinary output

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44
Q

classification of atropine sulfate

A

Cholinergic antagonist: Anticholinergic

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45
Q

action of atropine sulfate

A

Inhibits acetylcholine by occupying the receptors; increases HR by blocking vagus stimulation; promotes pupil dilation and blocking iris sphincter muscle

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46
Q

uses/therapeutic effects of atropine sulfate

A

Pre-operative medication to reduce salivation SO THAT YOU DON’T ASPIRATE, increase heart rate for bradycardia, and dilate pupils for diagnostic exams

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47
Q

side effects of atropine sulfate

A

dry mouth, constipation, dry skin, blurred vision, photophobia, urinary retention

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48
Q

adverse effects of atropine sulfate

A

tachycardia, paradoxic bradycardia, hypertension, hypotension, angina, pulmonary edema, seizures. Dysrhythmias, laryngospasm, Stevens-Johnson syndrome, coma

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49
Q

contraindications of atropine sulfate

A

Glaucoma, obstructive GI disorders, UC, tachycardia, BPH, myasthenia gravis, myocardial ischemia.
Use with caution: renal or hepatic disorders, COPD, heart failure

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50
Q

drug interactions of atropine sulfate

A

increases effect with phenothiazines, antihistamines, TCAs, amantadine, quinidine;
high dose anticholinergics may decrease effects of carbidopa/levodopa by delaying GI absorption;
may enhance therapeutic effects of other drugs at therapeutic doses

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51
Q

nursing implications of atropine sulfate

A

monitor VS (report if tachycardia occurs), monitor urinary I&Os (urinary retention may occur), assess bowl sounds, provide mouth care and eye drops, avoid hot environments, wear sunglasses in bright light after eye dilation

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52
Q

evaluation for effectiveness of atropine sulfate

A

Evaluate patient response to the drug, determine whether constipation, urinary retention, or increased pulse rate is a problem

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53
Q

alprazolam

A

Xanax

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54
Q

classification of alprazolam

A

Benzodiazepine: Sedative-hypnotics, Anxiolytics

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55
Q

action of alprazolam

A

CNS depression, binds receptors in limbic system and reticular formation, increases GABA and GABA receptors; shift of chloride ions leads to less excitability and stabilizes neuronal membranes

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56
Q

uses/therapeutic effects of alprazolam

A

To treat anxiety and panic disorders

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57
Q

side effects of alprazolam

A

Drowsiness, dizziness, amnesia, memory impairment, GI effects (nausea, vomiting)

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58
Q

adverse effects of alprazolam

A

Depression, tolerance, dependence, withdrawal, hepatic failure, Stevens-Johnson syndrome

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59
Q

contraindications of alprazolam

A

Respiratory depression, acute alcohol intoxication, psychotic reactions, recent respiratory depressants.
Use with caution: suicidal ideation, drug abuse

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60
Q

drug interactions of alprazolam

A

decreases respiration with alcohol, CNS depressants. Don’t combine w Benadryl

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61
Q

food interactions of alprazolam

A

Do not combine the CAMs kava kava, valerian, chamomile. Grapefruit increases alprazolam levels, green tea decreases its effects

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62
Q

nursing implications of alprazolam

A

Observe the patient for adverse reactions, especially an older or debilitated patient. Teach patient to use nonpharmacologic methods, to induce sleep before giving them the prescription. Advise patients to report adverse reactions. Teach patient that benzodiazepines should be gradually withdrawn. Antidote- Flumazenil (given if respiratory depression is present) FASTER ONSET THAN LORAZEPAM BUT FADES QUICKER

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63
Q

what is the antidote for benzodiazepines?

A

Flumazenil

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64
Q

evaluation for effectiveness for alprazolam

A

Evaluate the effectiveness of sedative-hypnotic in promoting sleep, evaluate anxiety

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65
Q

lorazepam

A

Ativan

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66
Q

classification of lorazepam

A

Benzodiazepine: Sedative-hypnotics, Anxiolytics

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67
Q

action of lorazepam

A

Potentiates GABA effects by binding to specific benzodiazepine receptors and inhibiting GABA neurotransmission

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68
Q

uses/therapeutic effects of lorazepam

A

To control anxiety and to treat status epilepticus, for sedation induction, for insomnia

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69
Q

side effects of lorazepam

A

CNS effects, ataxia, amnesia, GI distress, hallucinations

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70
Q

adverse effects of lorazepam

A

Bradycardia, hypo/hypertension, seizures, suicidal ideation, NMS, respiratory depression

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71
Q

contraindications of lorazepam

A

Hypotension, sleep apnea, pregnancy, hypothermia, seizures, respiratory problems
Caution: severe hepatic/renal impairment, depression, children under 12, geriatric patients

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72
Q

drug interactions of lorazepam

A

alcohol, antihistamines, antidepressants, opioid analgesics, clozapine, other sedative-hypnotics, oral contraceptives

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73
Q

CAM interactions for lorazepam

A

when taken with kava kava, valerian, and chamomile can increase CNS depression

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74
Q

nursing implications of lorazepam

A

observe for side effects, monitor VS, encourage family to be supportive, advise patient not to drive or operate dangerous equipment, warn patient not to consume alcohol or CNS depressant. Peds/Geri: assess for prolonged CNS depression, assess degree and manifestation of anxiety and mental status. Toxicity: Antidote- Flumazenil. SLOWER ONSET BUT LASTS LONGER Discontinuation: gradually decrease does over several days, withdrawal develops slowly (2-10 days) and lasts several weeks. Withdrawal symptoms: tremor, agitation, nervousness, sweating, insomnia, anorexia, muscle cramps

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75
Q

what is the difference between alprazolam and lorazepam?

A

alprazolam: FASTER ONSET THAN LORAZEPAM BUT FADES QUICKER
lorazepam: SLOWER ONSET BUT LASTS LONGER

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76
Q

evaluation for effectiveness of lorazepam

A

Increase sense of well-being, decrease in anxiety, improvement of sleep patters

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77
Q

flumazenil

A

Romazicon

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78
Q

classification of flumazenil

A

Benzodiazepine Antagonist

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79
Q

action of flumazenil

A

Antagonizes the CNS depressant effects of benzodiazepine compounds

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80
Q

uses/therapeutic effect of flumazenil

A

Reversal of benzodiazepine effects, ANTIDOTE (similar to Narcan for opioids)

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81
Q

side effects of flumazenil

A

Dizziness, agitation, confusion, drowsiness, HA, blurred vision, flushing, sweating, N/V

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82
Q

adverse effects of flumazenil

A

Seizures, arrythmias, hypertension, phlebitis

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83
Q

contraindications of flumazenil

A

Patients who are receiving benzodiazepines for life-threatening medical problems
Caution: History of seizures, sever hepatic impairment, pregnancy

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84
Q

nursing implications of flumazenil

A

DO NOT CONFUSE WITH FLU VACCINE, institute seizure precautions

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85
Q

evaluation for effectiveness of flumazenil

A

Improves LOC, decrease in respiratory depression caused by benzodiazepines

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86
Q

zolpidem tartrate

A

Ambien

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87
Q

classification of zolpidem tartrate

A

Sedative-hypnotic: Non-benzodiazepine

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88
Q

action of zolpidem tartrate

A

CNS depression, neurotransmitter inhibition

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89
Q

uses/therapeutic effects of zolpidem tartrate

A

To treat insomnia

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90
Q

side effects of zolpidem tartrate

A

Hangover (residual sedation), drowsiness, lethargy, N/V, dizziness, memory impairment, anterograde amnesia, nightmares, binge eating

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91
Q

adverse effects of zolpidem tartrate

A

Tolerance, psychological or physical dependence, withdrawal, sleep-related behaviors, hypotension, angioedema, depression, suicidal ideation, pulmonary edema, renal failure

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92
Q

contraindications of zolpidem tartrate

A

Hypersensitivity to benzodiazepine, respiratory depression, lactation
Caution: renal or liver dysfunction, mental depression, suicidal ideation, pregnancy, children, older adults, debilitated individuals

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93
Q

drug interactions of zolpidem tartrate

A

decreases CNS function with alcohol, CNS depressants, anticonvulsants, phenothiazines; increases levels with azole antifungals, decreased levels with rifampin

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94
Q

food interactions of zolpidem tartrate

A

decreases absorption

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95
Q

nursing implications of zolpidem tartrate

A

monitor VS (respiratory depression), bed alarm for elderly, teach patient to take it right before bedtime. Teach patient to use of nonpharmacological methods to induce sleep, avoid alcohol, antidepressants, antipsychotics and narcotics, medication takes effect with in 15 to 30 minutes (tell patient to take medication 15-30 minutes before bedtime), warn patient to use caution when driving as drowsiness may occur

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96
Q

evaluation for effectiveness of zolpidem tartrate

A

Evaluate if it was effective in promoting sleep

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97
Q

phenytoin

A

Dilantin

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98
Q

classification of phenytoin

A

Anticonvulsant, Anti-seizure: Hydantoin

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99
Q

action of phenytoin

A

reduces motor cortex activity by altering ion transport

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100
Q

uses/therapeutic effects of phenytoin

A

to prevent tonic-clonic and partial seizures and status epilepticus

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101
Q

side effects of phenytoin

A

gingival hyperplasia, N/V, fatigue, headache, drowsiness, dizziness

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102
Q

adverse effects of phenytoin

A

leukopenia, hepatic impairment, depression. Hyperglycemia, bradycardia, peripheral neuropathy. Purple glove syndrome. Aplastic anemia, thrombocytopenia, Stevens-Johnsons syndrome, hypotension, ventricular fibrillation, suicidal ideation

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103
Q

contraindications of phenytoin

A

Pregnancy (teratogenic), hypersensitivity, heart block, bradycardia
Caution: hyponatremia, hypotension, hypoglycemia, suicidal ideation. Thyroid disease, alcoholism, DM. Renal and hepatic impairment, Asian culture

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104
Q

nursing implications of phenytoin

A

monitor serum drug levels of antiseizure drug to determine therapeutic range. Therapeutic range is 10-20mcg/mL. Warn female patients taking oral contraceptives and antiseizure drugs to use additional contraceptive method, advise against pregnancy. Use seizure precautions for patient at risk for seizure. Determine if client is receiving adequate nutrition as anorexia, nausea and vomiting are side effects. Advise patients not to drive or perform other hazardous activities when initiating drug therapy, must be taken for life at same time every day!

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105
Q

evaluation for effectiveness of phenytoin

A

evaluate if prevention of seizures was achieved

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106
Q

fluoxetine

A

Prozac

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107
Q

classification of fluoxetine

A

Selective Serotonin Reuptake Inhibitor (SSRI)

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108
Q

action of fluoxetine

A

serotonin is increase in nerve cells because of blockage from nerve fibers

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109
Q

uses/therapeutic effects of fluoxetine

A

treatment for depression, bipolar disorder, bulimia disorder. OCD, panic disorder, premenstrual dysphoric disorder

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110
Q

side effects of fluoxetine

A

CNS effects, memory impairment. Tremors, dry mouth, blurred vision, GI effects, erectile dysfunction (impotence)

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111
Q

adverse effects of fluoxetine

A

Seizures, angioedema, hyponatremia, hypokalemia, hyperkalemia, hypoglycemia, dehydration, bleeding osteoporosis. Stevens-Johnson syndrome, hepatic dysfunction, suicidal ideation

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112
Q

contraindications of fluoxetine

A

Hypersensitivity
Caution: MI, if taken with MAOIs, dehydration. Lactation, suicidal ideation. Liver disease, osteoporosis, glaucoma, seizure disorder, DM, malnourished, anticoagulant therapy, diarrhea

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113
Q

drug interactions of fluoxetine

A

alcohol and CNS depressants (increase effect of CNS and respiratory depression), aspirin NSAIDs and Anticoagulants (increase bleeding potential, MAOIs and SSRIs (increased risk of serotonin syndrome),

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114
Q

food interactions of fluoxetine

A

Grapefruit juice (can lead to toxicity)

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115
Q

CAMs interactions of fluoxetine

A

St. Johns wort (increase risk of serotonin syndrome, increase effects of hypoglycemia)

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116
Q

nursing implications of fluoxetine

A

observe patient for signs of depression, mood changes, insomnia, apathy, or lack on interest in activities. Monitor VS, food and drug interactions. Provide list of foods patient should avoid. Counsel female clients regarding the teratogenic effects of the drug. Caution patient not to consume alcohol or other CNS depressants concurrently

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117
Q

evaluation for effectiveness of fluoxetine

A

Evaluate mental state, depression, bipolar, bulimia disorder, ect

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118
Q

vanlafaxine

A

Effexor

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119
Q

classification of vanlafaxine

A

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

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120
Q

action of venlafaxine

A

serotonin and norepinephrine are increased in nerve cells due to blockage from nerve fibers

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121
Q

uses/therapeutic effects of venlafaxine

A

to treat depression, generalized anxiety disorder, social anxiety disorder panic disorder

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122
Q

side effects of venlafaxine

A

CNS effects, euphoria, amnesia, anticholinergic effects, weakness, diarrhea, anorexia

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123
Q

adverse effects of venlafaxine

A

tachycardia, seizure, HTN, serotonin syndrome. Suicidal ideation, NMS, renal failure, Stevens-Johnson syndrome

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124
Q

contraindication of venlafaxine

A

Hypersensitivity
Caution: while taking MAOIs and CNS depressants, anticoagulation therapy, renal and hepatic impairment. Pregnancy and lactation, narrow angle glaucoma, seizures. Hypokalemia, Hyponatremia, hyperthyroidism. MI, heart failure

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125
Q

drug interactions of venlafaxine

A

Alcohol and CNS depressants (may increase effects of CNS, respiratory depression, hypotension) Anticoagulants and aspirin (may increase bleeding) Taking with other SNRIs and SSRIs (may increase risk for NMS) MAOIs (hypertensive crisis and death) St Johns wort (serotonin syndrome)

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126
Q

nursing implications of venlafaxine

A

observe patient for signs of depression, mood changes, insomnia, apathy, or lack on interest in activities. Monitor VS, food and drug interactions. Provide list of foods patient should avoid. Counsel female clients regarding the teratogenic effects of the drug. Caution patient not to consume alcohol or other CNS depressants concurrently

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127
Q

evaluation for effectiveness of venlafaxine

A

Evaluate mental start, depression and anxiety disorders

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128
Q

action of tricyclic antidepressants (TCAs)

A

blocks uptake of neurotransmitters norepinephrine and serotonin in brain, elevated mood, increases interest in ADLs, decreases insomnia. Blocks histamine receptors which leads to sedation. Blocks cholinergic receptors which leads to anticholinergic effects

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129
Q

uses/ therapeutic effects of TCAs

A

major depression

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130
Q

side effects of TCAs

A

drowsiness, dizziness, blurred vision, dry mouth and eyes, GI distress, urinary retention , sexual dysfunction, weight gain, seizures, sleep-related behaviors, suicidal ideation, orthostatic hypotension, dysrhythmias

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131
Q

drug interactions of TCAs

A

alcohol and other CNS depressants potentiate CNS depression. MAOIs may lead to toxic psychosis, cardiotoxicity. Anti-thyroid drugs may increase dysrhythmias

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132
Q

nursing implications of TCAs

A

observe patient for signs of depression, mood changes, insomnia, apathy, or lack on interest in activities. Monitor VS, food and drug interactions. Provide list of foods patient should avoid. Counsel female clients regarding the teratogenic effects of the drug. Caution patient not to consume alcohol or other CNS depressants concurrently

133
Q

evaluation for effectiveness for TCAs

A

Evaluate for relief of depression

134
Q

action monoamine oxidase inhibitors (MAOIs)

A

Monoamine oxidase enzyme (MOA) inactivates norepinephrine, dopamine, epinephrine and serotonin

135
Q

uses/therapeutic effect of MAOIs

A

Depression not controlled by TCAs and second-generation antidepressants

136
Q

side effects of MAOIs

A

agitation, restlessness, insomnia, anticholinergic effects, orthostatic hypotension, Hypertensive crisis from tyramine interaction (foods w tyramine like ages cheese coffee yogurt, chocolate, bananas, beer, red wine, yeast, ect)

137
Q

drug interactions of MAOIs

A

CNS stimulants such as vasoconstrictors and cold medications containing phenylephrine and pseudoephedrine can cause hypertensive crisis when taken with an MAOI

138
Q

CAMs interactions of MAOIs

A

FATAL with St. John’s wort, hypertensive crisis with caffeine containing herbs

139
Q

food interactions of MAOIs

A

Hypertensive crisis from tyramine interaction (foods w tyramine like ages cheese coffee yogurt, chocolate, bananas, beer, red wine, yeast, ect)

140
Q

evaluation for effectiveness of MAOIs

A

Evaluate for relief of depression

141
Q

cyclobenzaprine

142
Q

classification of cyclobenzaprine

A

muscle relaxant

143
Q

action of cyclobenzaprine

A

Relieves muscle spasms through a central action, possibly at the brain stem level

144
Q

uses/therapeutic effects of cyclobenzaprine

A

for short term treatment of muscle spasms

145
Q

side effects of cyclobenzaprine

A

Anticholinergic effects (such as dry mouth), arrythmias, CNS effects, unpleasant taste

146
Q

adverse effects of cyclobenzaprine

A

Allergic reactions, angioedema, MI, seizures, ileus

147
Q

contraindications of cyclobenzaprine

A

CV: acute MI, bradycardia, heart block, cardia arrhythmias, HTN, heart failure. Endocrine: DM, hyperthyroidism. Other: Cerebral palsy, hypokalemia, paralytic ileus, concurrent use with MAOIs
Caution: Seizures, alcohol, CNS depressants, glaucoma, BPH, urinary retention, hepatic disease, lactation

148
Q

drug interactions of cyclobenzaprine

A

additive CNS depression with other CNS depressants, additive anticholinergic effects with other anticholinergics, avoid using within 14 days of MAOIs

149
Q

CAM interactions with cyclobenzaprine

A

kava kava, valerian, chamomile increase effect

150
Q

nursing implications of cyclobenzaprine

A

Assess geri patients for anticholinergic effects (sedation and weakness), assess for serotonin syndrome, autonomic instability, neuromuscular aberrations, GI symptoms, educate patient that it causes drowsiness so don’t drive, don’t drink

151
Q

evaluation for effectiveness of cyclobenzaprine

A

Decrease in pain and in swollen joints and increase in mobility

152
Q

salicylate

153
Q

salicylate classification

A

Analgesic: Antiinflammatory; NSAID

154
Q

salicylate action

A

Inhibition of prostaglandin synthesis, inhibition oh hypothalamic heat-regulator center, inhibits COX-1 and COX-2

155
Q

salicylate uses/therapeutic effects

A

To reduce pain and inflammatory symptoms, decrease fever, and inhibit platelet aggregation, for osteoarthritis and rheumatoid arthritis (ANTI-INFLAMMATORY, ANTIPYRETIC, ANTICOAGULANT)

156
Q

therapeutic serum salicylate level

A

15-30 mg/dL

157
Q

salicylate side effects

A

dizziness, drowsiness, headache, anorexia, N/V, diarrhea, heartburn, abdominal pain, rash

158
Q

salicylate adverse effects

A

TINNITUS, hearing loss, GI ulceration and bleeding(usually prolonged use) Life threatening- agranulocytosis, hemolytic anemia, Reyes syndrome, anaphylaxis, hepatoxicity

159
Q

Salicylate contraindications

A

Hypersensitivity, flu or virus in children, GI bleeding Caution: in renal or hepatic disorders, gout, alcoholism, anticoagulant therapy, GI bleeding, head trauma, pregnancy
Caution: Do not take with other NSAIDs, avoid during the last trimester of pregnancy, do not give to children (below age of 19) with flu or virus symptoms as it may lead to Reye syndrome

160
Q

salicyclate drug interaction

A

INCREASED RISK OF BLEEDING WITH ANTICOAGULANTS AND OTHER NSAIDs, risk for hypoglycemia with oral antidiabetics, increased gastric ulcer risk with glucocorticoids, decreased effects of ACE inhibitors, loop diuretics, probenecid, Salicylate effects are decreased by corticosteroids

161
Q

salicylic lab interactions

A

increase PT, bleeding time, INR, uric acid, decrease cholesterol, T3 and T4 levels

162
Q

salicylic containing food

A

prunes, raisins, licorice, certain spices such as curry paprika

163
Q

salicylic nursing implications

A

Take with water, food or milk d/t GI distress; observe patient for signs of bleeding; advise pt. to not take with alcohol, ENTERIC COATED ASPIRIN WILL DECREASE GI DISTRESS, discontinue aspirin approximately 7 days before surgery to reduce risk of bleeding

164
Q

salicylic evaluation for effectiveness

A

Reduction in pain and/or fever. Coagulation studies within normal limits

165
Q

Ibuprofen

166
Q

ibuprofen classification

A

NSAID; Propionic Acid Derivative

167
Q

ibuprofen action

A

Inhibits prostaglandin synthesis (COX-1 AND COX-2); thus relieving pain and inflammation

168
Q

ibuprofen uses/therapeutic effects

A

Reduce pain and inflammatory process, reduce fever, osteoarthritis, rheumatoid arthritis (arthritic conditions)

169
Q

ibuprofen side effects

A

HA, dizziness, anorexia, N/V, diarrhea, edema, rash, fluid retention

170
Q

ibuprofen adverse effects

A

Hearing loss, tinnitus, bleeding, anemia, neutropenia, thrombocytopenia, anaphylaxis

171
Q

Ibuprofen contraindications

A

Hypersensitivity, CABG
Caution: bleeding disorders, pregnancy, lactation, lupus, asthma, peptic ulcer, anticoagulant therapy, renal or hepatic disease

172
Q

ibuprofen drug interactions

A

Drug: increased bleeding with warfarin, increased effects with phenytoin, sulfonamides, warfarin, cephalosporins, decreased effects with aspirin

173
Q

ibuprofen CAMs

A

CAMS: dong quai, feverfew, garlic, ginger, and ginkgo may cause bleeding when taken with NSAIDS

174
Q

ibuprofen nursing implications

A

observe the patient for bleeding gums, petechiae, ecchymoses, black tarry stools, report if patient had GI discomfort, advise patient to avoid alcohol

175
Q

ibuprofen evaluation

A

Decrease in pain and in swollen joints and increase in mobility

176
Q

celecoxib

177
Q

celecoxib classification

A

Selective COX-2 Inhibitor; NSAID (Corticosteroid)

178
Q

celecoxib action

A

Selectively inhibits COX-2 enzyme without inhibition of COX-1 (so it doesn’t cause GI distress and allows platelets to aggregate)

179
Q

celecoxib use

A

Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pain, dysmenorrhea

180
Q

celecoxib side effect

A

HA, dizziness, sinusitis, abdominal pain, nauseam flatulence, diarrhea, rash

181
Q

Celecoxib adverse effects

A

Peripheral edema, bleeding, hypertension, stroke

182
Q

celecoxib contraindications

A

Hypersensitivity, CABG
Caution: renal/hepatic dysfunction, angina, hypertension, dysrhythmias, heart failure, anemia, dehydration, peptic ulcer disease, GI bleeding, steroids, alcoholism, immunosuppression

183
Q

celecoxib drug interaction

A

decreased effect of ACE inhibitors, increase GI bleeding with warfarin, toxicity with lithium

184
Q

celecoxib CAMs

A

Ginkgo may increase bleeding risk

185
Q

celecoxib nursing implications

A

Assess for skin rash, assess ROM, tell patient to watch for unexplained weight gain or edema

186
Q

celecoxib evaluation

A

Reduction in joint pain, tenderness, and swelling

187
Q

infliximab

188
Q

infliximab classification

A

immunomidulator: Tissue Necrosis Factor (TNF) blocker

189
Q

infliximab action

A

binds to TNF and blocks it from attaching to TNF receptor

190
Q

infliximab administration

A

IV infusion given over at least 2 hours

191
Q

infliximab uses

A

To treat psoriasis, RA, psoriatic arthritis, UC, Crohns (auto immune type diseases)

192
Q

infliximab side effects

A

HA, dizziness, cough, fatigue, chills, flushing, fever, anxiety, N/V, diarrhea, constipation, flatulence, abdominal pain, weight loss, rash, alopecia, dry skin, pharyngitis

193
Q

infliximab adverse effects

A

Severe infections, chest pain, hypo/hypertension, seizures, arthralgia, bone fractures, increased hepatic enzymes, anemia, neutropenia, pancytopenia, Steven-Johnson Syndrome

194
Q

infliximab contraindications

A

hypersensitivity, heart failure
Caution: renal/hepatic dysfunction, bone marrow suppression, DM, COPD, immunosuppression, MS, seizures, older adults

195
Q

infliximab drug interactions

A

may decrease effectiveness of vaccines; concurrent immunosuppressives may increase risk for infection or adverse effects

196
Q

infliximab nursing implications

A

Assess for S/S of systemic infection, assess for confusion relates reactions, TB SKIN TEST AND CBC TO CHECK FOR WBC COUNT

197
Q

infliximab evaluation

A

Decreased pain and swelling with decreased rate of joint destruction and improves physical function

198
Q

Allopurinol classification

A

Antigout; Uric acid inhibitors

199
Q

Allopurinol action

A

inhibits production of uric acid; decreases uric acid synthesis, but doesn’t help inflammation so this is more of a preventative drug

200
Q

Allopurinol uses

A

lowers serum uric acid levels prevents gout attacks

201
Q

Allopurinol side effects

A

flushing, drowsiness, diarrhea, N/V

202
Q

Allopurinol adverse effects

A

hyper/hypotension, brady cardia, heart failure, renal failure, rash, urticaria (FIRST SIGN OF RASH DISCONTINUE), bone marrow depression

203
Q

Allopurinol contraindications

A

Hypersensitivity
Caution: acute attacks of gout, renal insufficiency, dehydration, lactation

204
Q

Allopurinol drug interactions

A

Drug: use with oral hypoglycemia agents and warfarin increase the effect of this drug

205
Q

Allopurinol Nursing Implications

A

check uric acid levels, fluid intake, don’t eat foods with purines, monitor BIN and creatinine levels, fluid intake is extremely important because it prevents renal stones from being formed

206
Q

Allopurinol evaluation of effectiveness

A

Decreased gout-related pain, decreased serum and urinary uric acid levels

207
Q

Acetaminophen

208
Q

Acetaminophen classification

A

Non-opioid Analgesic, NOT AN NSAID

209
Q

Acetaminophen action

A

Inhibits prostaglandin synthesis

210
Q

Acetaminophen uses

A

Muscular aches and pain, fever, NOT FOR INFLAMMATION

211
Q

Acetaminophen max dose

A

4 g/day, if taken frequently 2 g/day, 4000mg/day

212
Q

Acetaminophen side effects

A

rash, HA, insomnia, low incidence of GI distress

213
Q

Acetaminophen adverse effects

A

hepatotoxicity & renal failure (you would see very little urine output), thrombocytopenia, hemolytic anemia, leukopenia, neutropenia

214
Q

Acetaminophen contraindications

A

Acetaminophen hypersensitivity, sever hepatic disease
Caution: renal disease, alcoholism, severe hypovolemia, chronic malnutrition

215
Q

Acetaminophen drug interactions

A

Increased effect with caffeine, decreased effect with oral contraceptives, antacids, anticholinergics, barbiturates, phenytoin

216
Q

Acetaminophen nursing implications

A

check liver enzyme tests (hepatic lab values) for abnormalities as toxicity can occur, teach patient to keep acetaminophen out of children’s reach, teach patient to avoid alcohol do not self-medicate for more than 10 days

217
Q

Acetaminophen evaluation

A

Evaluate pain relief using a pain scale

218
Q

Indomethacin

219
Q

Indomethacin classification

A

Nonopioid analgesic (NSAID); Para-chlorobenzoic Acid

220
Q

Indomethacin action

A

Inhibit prostaglandin synthesis

221
Q

Indomethacin uses

A

Relieve mild to severe pain, gout, tendinitis, osteoarthritis, RA

222
Q

Indomethacin side effects

A

Dizziness, HA, GI distress, and GI bleeding

223
Q

Indomethacin adverse effects

A

Drug-induced hepatitis, GI bleeding, anaphylaxis

224
Q

Indomethacin contraindications

A

Avoid if allergic to aspirin, ulcer disease, children
Caution: severe renal or hepatic disease, pregnancy epilepsy, hypertension

225
Q

Indomethacin drug interactions

A

concurrent use with aspirin may decrease effects, additive adverse GI effects when taken with aspirin, increases chance to hypoglycemia from insulins or oral hypoglycemia agents

226
Q

Indomethacin CAM interaction

A

increased bleeding risk with anise, arnica, chamomile, clove, dong quai, feverfew, ginger, ginkgo, ginseng

227
Q

indomethacin nursing implications

A

Patients who have asthma, aspirin-induces allergy and nasal polyps are at increased risk for developing hypersensitivity reactions— monitor for rhinitis, urticaria, asthma, check hepatic and renal labs PO: DO NOR BREAK CRUSH OR CHEW

228
Q

Indomethacin evaluation

A

Decrease in severity of pain, improves joint mobility

229
Q

Ketorolac

230
Q

Ketorolac classification

A

Non-opioid Analgesics; Phenylacetic Acid Derivative

231
Q

Ketorolac action

A

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia

232
Q

Ketorolac uses

A

SHORT-TERM management (5 days or less)

233
Q

Ketorolac side effects

A

CNS effects, edema, GI distress, elevated hepatic enzyme levels, drowsiness, HA

234
Q

Ketorolac adverse effects

A

Stroke, MI GI bleeding and perforation, Steven-Johnson syndrome, epidermal necrolysis, exfoliative dermatitis

235
Q

Ketorolac contraindications

A

Preop use, history of GI bleeding or peptic ulcers, alcohol intolerance, renal or hepatic impairment, OB
Caution: CVD, children and older adults

236
Q

Ketorolac drug interactions

A

probenecid increases levels and the risk of adverse reactions; concurrent use is contraindicated, Increased risk of bleeding when used with pentoxifylline; concurrent use with aspirin may decrease effects

237
Q

Ketorolac CAM interactions

A

increased bleeding risk with anise, arnica, chamomile, clove, dong quai, feverfew, ginger, ginkgo, ginseng

238
Q

ketorolac nursing implications

A

Patient who have asthma, aspirin-induces allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions monitor for rhinitis, urticaria, asthma, asses for rash periodically, hepatic lab values, given IM or IV

239
Q

Ketorolac evaluation

A

Decrease in severity of pain

240
Q

Tramadol

241
Q

Tramadol classification

A

Non-opioid Analgesics (NSAID)

242
Q

Tramadol action

A

Binds to m-opioid receptors; inhibits reuptake of serotonin and norepinephrine in the CNS

243
Q

Tramadol uses

A

For moderate to severe pain

244
Q

Tramadol side effects

A

GI effects, HA, CNS effects with anxiety, agitation, N/V, drowsiness, dizziness

245
Q

Tramadol adverse effects

A

Seizures, serotonin syndrome

246
Q

Tramadol contraindications

A

Severe alcoholism, use of opioids or CNS depressants, pregnancy
Caution: children and older adults

247
Q

Tramadol drug interactions

A

increased risk of CNS depression when used concurrently with other CNS depressants, use cautiously in patients who are taking MAOIs (increased reisk of serotonin syndrome)

248
Q

Tramadol CAM interactions

A

concomitant use of kava kava, valerian or chamomile can increase CNS depression, increased risk of serotonin syndrome when used with St. John’s wort

249
Q

Tramadol nursing implications

A

educate patient to not operate heavy machinery because of sedative effect, warn about its addictive effects, overdose may cause respiratory depression so monitor VS

250
Q

Tramadol evaluation

A

Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status

251
Q

morphine sulfate classification

A

Opioid Analgesics

252
Q

morphine sulfate action

A

Binds to opiate receptors in the CNS and alters the PERECPTION OF and RESPONSE TO painful stimuli while producing generalized CNS depression

253
Q

morphine sulfate uses

A

decrease in severity of pain

254
Q

morphine sulfate side effects

A

confusion, sedation, dizziness, depression, GI distress and constipation, orthostatic hypotension, urinary retention, euphoria

255
Q

morphine sulfate adverse effects

A

respiratory depression, urticaria, seizures, dependence

256
Q

morphine sulfate contraindications

A

acute/post-op pain, hypersensitivity, respiratory depression, acute asthma, paralytic ileus

257
Q

morphine sulfate drug interactions

A

EXTREME CAUTION in patient using MAOIs within 14 days prior, sedatives, alcohol

258
Q

morphine sulfate CAM interactions

A

concomitant use of kava-kava, valerian, or chamomile can increase CNS depression

259
Q

morphine sulfate lab interactions

A

increased AST and ALT

260
Q

morphine sulfate nursing implications

A

Antidote: Naloxone (Narcan) Assess LOC, BP, pulse, and RR before and during administration, if BP is elevated hold the medication and notify HCP, pupils can be impossible to see to indicate OD

261
Q

repeat

262
Q

morphine sulfate evaluation

A

Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status

263
Q

Naloxone

264
Q

Naloxone classification

A

Opioid Antagonist

265
Q

Naloxone action

A

completely blocks the effects of opioids without producing any agonist effect

266
Q

Naloxone uses

A

reversal signs pf opioid excess, opioid antidote

267
Q

Naloxone side effects

A

hyper/hypotension, N/V

268
Q

Naloxone adverse effects

A

ventricular arrhythmias

269
Q

Naloxone contraindications

A

Hypersensitivity
Caution: CVD, patients physically dependent on opioids, pregnancy

270
Q

Naloxone drug interactions

A

can precipitate withdrawal in patients physically dependent on opioid analgesics

271
Q

Naloxone nursing implications

A

Monitor RR, rhythm and depth (they may need another dose if respiratory depression shows again)

272
Q

Naloxone evaluation

A

Adequate. Ventilation, alertness without significant withdrawal symptoms

273
Q

Fentanyl (transdermal) classification

A

Opioid Analgesics

274
Q

Fentanyl (transdermal) action

A

binds to opiate receptors in the CNS, altering the response and perception of pain

275
Q

Fentanyl (transdermal) uses

A

decrease in severity of chronic pain, use for anesthesia induction and maintenance

276
Q

Fentanyl (transdermal) side effects

A

constipation, dry mouth, N/V, sweating

277
Q

Fentanyl (transdermal) adverse effects

A

anorexia, confusion, sedation

278
Q

Fentanyl (transdermal) contraindications

A

Hypersensitivity
Caution: patient with acute, mild or intermittent pain

279
Q

Fentanyl (transdermal) interactions

A

Grapefruit juice is a moderate inhibitor

280
Q

Fentanyl (transdermal) nursing implications

A

Antidote: assess VS before and during administration, MUST BE DISPOSED IN A SAFETY CONTAINER WITH A LOCK ON IT AT A PHARMACY, more potent than morphine by 100x!

281
Q

Fentanyl (transdermal) evaluation

A

Decrease in severity of pain without significant alteration in LOC, respiratory status, or BP

282
Q

Hydromorphone

283
Q

Hydromorphone classification

A

Opioid Analgesics

284
Q

Hydromorphone action

A

Binds to opiate receptors in the CNS, alters perception of and response to painful stimuli while producing generalized CNS depression, suppresses cough reflex

285
Q

Hydromorphone uses

A

decrease in moderate to severe pain, suppression of cough

286
Q

Hydromorphone side effects

A

Dizziness, floating feeling, HA, unusual dreams, constipation, dry mouth, N/V, urinary retention, flushing, sweating

287
Q

Hydromorphone adverse effects

A

Sedation, hallucinations, respiratory depression, bradycardia, hypotension, dependence, tolerance

288
Q

Hydromorphone contraindications

A

hypersensitivity, acute asthma, paralytic ileus, acute post-op pain, pregnancy
Caution: head trauma, renal or hepatic disease, seizure disorder, alcoholism, older adults

289
Q

Hydromorphone drug interactions

A

EXTREME CAUTION WITH MAOIS!!!

290
Q

Hydromorphone CAM interactions

A

concomitant use of kava kava, valerian, or chamomile can increase CNS depression

291
Q

Hydromorphone nursing implications

A

Antidote: assess VS before and suring administration, overdose Narcan, educate that this drug has a potential to be abused, 6 times more potent than morphine

292
Q

Hydromorphone evaluation

A

decrease in severity of pain without significant alteration in LOC, respiratory status or BP, suppression of cough

293
Q

Oxycodone

294
Q

Oxycodone classification

A

Opioid Analgesics

295
Q

Oxycodone action

A

Binds to opiate receptors in the CNS, alters perception of and response to painful stimuli while producing generalized CNS depression

296
Q

Oxycodone uses

A

decrease moderate to severe pain

297
Q

Oxycodone side effects

A

confusion, dizziness, floating feeling, HA, unusual dreams, orthostatic hypotension, dry mouth, N/V, flushing sweating

298
Q

Oxycodone adverse effects

A

respiratory depression, sedation, hallucinations, GI obstruction, dependence, tolerance

299
Q

Oxycodone contraindications

A

hypersensitivity, acute asthma, paralytic ileus, acute post-op pain, pregnancy
Caution: head trauma, renal or hepatic disease, seizure disorder, alcoholism, older adults

300
Q

Oxycodone drug interactions

A

EXTREME CAUTION WITH MAOIS!!

301
Q

Oxycodone nursing implications

A

Educate to take with food to avoid GI distress, DONOT ABRUPTLY DISCONTINUE (TAPER OFF!!), BROKEN, CHEWED, CRUSHED TABS GET ABSORBED TOO FAST AND CAN BE FATAL, 1.5-2 times stronger than morphine

302
Q

Oxycodone evaluation

A

decrease in severity of pain without significant alteration in LOC or respiratory status

303
Q

Oxycodone with Acetaminophen

304
Q

Oxycodone with Acetaminophen classification

A

Opioid Analgesics

305
Q

Oxycodone with Acetaminophen action

A

inhibits prostaglandin synthesis, acts on CNS to suppress pain impulses, suppress coughing

306
Q

Oxycodone with Acetaminophen uses

A

decrease moderate to severe pain

307
Q

Oxycodone with Acetaminophen side effects

A

dizziness, drowsiness, HA, euphoria, itching, dry mouth, GI distress, constipation, N/V

308
Q

Oxycodone with Acetaminophen adverse effects

A

hypotension, dependence, tolerance

309
Q

Oxycodone with Acetaminophen nursing implications

A

educate to take with food

310
Q

nalbuphine

311
Q

nalbuphine classification

A

Opioid agonist-antagonist (helps decrease opioid abuse)

312
Q

nalbuphine action

A

Inhibits pain impulse transmitted in the CNS by binding with opiate receptors and increasing pain threshold

313
Q

nalbuphine uses

A

Relief of moderate to severe pain and for anesthesia induction and maintenance, gives you a higher pain threshold

314
Q

nalbuphine side effects

A

dizziness, drowsiness, HA, dry mouth, N/V, diaphoresis

315
Q

nalbuphine adverse effects

A

Bradycardia, tachycardia, hypotension, hypertension, dyspnea, respiratory depression

316
Q

nalbuphine contraindicatins

A

hypersensitivity
Caution: history of alcohol or drug abuse, head injury, respiratory insufficiency, increased ICP, renal or hepatic dysfunction

317
Q

nalbuphine drug interactions

A

Drug: CNS depression is potentiated with alcohol or other CNS depressants

318
Q

nalbuphine nursing implications

A

DO NOT use alcohol, VS, UO, bowl movement for constipation

319
Q

nalbuphine evaluation

A

Evaluate effectiveness of pain relief

320
Q

sumatriptan

321
Q

sumatriptan classification

A

Anti-migraine; 5-HT agonist

322
Q

sumatriptan action

A

causes vasoconstriction of cranial arteries to relieve migraine attacks (agonizes serotonin for pain to cause vasoconstriction)

323
Q

sumatriptan uses

A

to treat migraine and cluster HA

324
Q

sumatriptan side effects

A

dizziness, vertigo, HA, paresthesia, fatigue, flushing, drowsiness, N/V, injection site reaction, pruritis

325
Q

sumatriptan adverse effects

A

hypo/hypertension, AV block, angina, dysrhythmias, bradycardia, elevates hepatic enzymes, thromboembolism, seizures, MI, cardiac arrest, suicidal ideation

326
Q

Sumatriptan contraindications

A

hypersensitivity, CAD, PVD, hypertension
Caution: renal or hepatic dysfunction, obesity, DM, smoking, seizures, older adults

327
Q

sumatriptan drug interactions

A

Drug: risk of vasospasm and BP elevation with dihydroergotamine, increased levels and toxicity within 2 weeks of MAOIs

328
Q

sumatriptan evaluation

A

Relief of migraine

NSG 318 - Pharm (11 decks)

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