Exam 2 Drugs Flashcards
1
Q
What are triggers for a migraine?
A
Stress Hormones Nitrates/Nitrites Red wine Chocolate Sugar and caffeine Lack of sleep Strong smells
2
Q
When do migraine meds work the best?
A
In the aura phase
3
Q
What does a patient experience during the aura phase?
A
Smelling weird smells
Seeing flashing lights
Can sense something is wrong (migraine about to start)
4
Q
Prototype for migraines
A
Sumatriptan (Imitrex)
5
Q
Sumatriptan MOA
A
Agonist at serotonin receptors
Serotonin causes vasoconstriction, which can cause migraines
6
Q
Contraindications for sumatriptan
A
Ischemic cardiac history (MI, Angina) Stroke patients Ischemic bowel disease Anyone with a high risk for coronary artery disease, such as - Post menopausal women - Men over 40 - Those with hypertension/high cholesterol - Diabetes - Smokers
7
Q
Interactions for sumatriptan
A
SSRIs (selective serotonin reuptake inhibitors)
MAOIs (monoamine oxidase inhibitors)
Antidepressants raise serotonin levels
St. John’s wart - can lead to serotonin syndrome
8
Q
What is serotonin syndrome?
A
A drug reaction due to high levels of serotonin in the body, caused by medication
9
Q
S/S of serotonin syndrome
A
Neuromuscular excitation - tremors, hyperreflexia
ANS dysfunction - tachy, fever, sweating, flushing, headache
Altered mental status - confused
10
Q
How is serotonin syndrome caught?
What should you do if it happens?
A
It can only be diagnosed clinically; the nurse connects the symptoms and drugs (no tests)
- stop the drug and provide supportive treatment (may need ICU)
11
Q
Patient education for Alzheimer’s medication
A
Drugs will NOT cure; can only delay progression and ease symptoms
12
Q
Cholinesterase Inhibitor prototype
A
Donepezil (Aricept)
13
Q
Donepezil indication
A
Alzheimer’s disease
14
Q
Donepezil contraindications
A
NSAIDs - increases risk of GI bleeding
Bradycardia - notify prescriber if pulse is less than 60 and hold drug
15
Q
Donepezil patient education
A
Teach them how to take their pulse (under 60 is bad)
Take med on a schedule (before bedtime b/c of drowsiness)
16
Q
NMDA receptor antagonist prototype
A
Memantine (Namenda)
17
Q
Memantine indication
A
Moderate to severe Alzheimer’s disease
18
Q
Memantine contraindications
A
Seizures
CV disease
Severe hepatic or renal impairment
19
Q
Memantine adverse effects
A
Heart failure
20
Q
Memantine patient education
A
No foods that alkalinize urine (citrus, veggies)
Signs of hepatic or renal impairment or heart failure
21
Q
Signs of hepatic impairment
A
Check LFTs AST/ATL increased Jaundice ( look at eyes/palms for darker skin tones) ABD pain N/V
22
Q
How to monitor for renal impairment
A
BUN
Creatinine
I&Os
23
Q
Signs of GI bleeding
A
Blood in stool (black and tar-like) "Coffee ground" emesis Hematocrit low Dizziness Hypotensive/Tachy Anemia
24
Q
Signs of heart failure
A
Crackles
JVD in neck
SOB at rest or exertion
Peripheral edema
25
Hydantoin prototype
Phenytoin (Dilantin)
26
Phenytoin indications
Seizure control
| Status epilepticus
27
Phenytoin therapeutic range
Narrow
| 10-20 mcg/mL
28
Phenytoin nursing considerations
Monitor for CNS effects
Monitor labs - CBC and hepatic function
Sleepiness/drowsiness can be caused by toxic level
**call provider before stopping ed**
29
Phenytoin black box warning
Cardiovascular toxicity - occurs by IV, usually because of pushing med too fast
- use tele pack to watch for dysrhythmia
30
Phenytoin patient education
Do not stop abruptly
Plan ahead for trips
Can disrupt hepatic function (no Tylenol or alcohol)
31
Traditional antiepileptic drugs prototypes
```
Carbamazepine (Tegretol)
Valproic acid (Depakote)
```
32
Carbamazepine and Valproic acid indications
*Seizures*
Bipolar disorder
Mania
33
Carbamazepine contraindications
Pregnancy
| Those with hepatic/renal dysfunction
34
Carbamazepine therapeutic range
4-12 mcg/mL
35
Carbamazepine AE/SE
Hepatic/renal dysfunction
| Anorexia (LOA related to high levels/tocixicity)
36
Carbamazepine patient education
Use non-hormonal birth control
If N/V, take with food
ER coating doesn't get digested (you can see it in stool and its ok)
Don't store in bathroom b/c it is sensitive to moisture (can break down)
Bone marrow suppression (report any signs of infection to doctor)
37
Valproic acid therapeutic range
50-100 mcg/mL
38
Valproic acid nursing considerations
Monitor
- kidney and liver labs
- blood dyscrasia
- S/S of depression or SI
39
Valproic acid patient education
At risk for
- bone marrow suppression (report signs of infection)
- pancreatitis (report ABD pain, N/V, anorexia
```
Use non-hormonal birth control
Avoid alcohol (can increase CNS depression)
```
40
Seizure adjunct therapy prototype
Gabapentin (Neurontin)
41
Gabapentin indications
Not developed for seizure disorder, but when paired with another epileptic drug, it can be beneficial
**First indication is diabetes**
42
Gabapentin patient education
Increased risk of depression and SI
Can cause sleepiness (take at bedtime)
No alcohol - will increase CNS depression
43
Centrally acting muscle relaxants MOA
Work in the CNS, binds to GABA (which is why they often cause drowsiness)
44
Centrally acting muscle relaxants indications
Muscle spasms
| Spasticity
45
Centrally acting muscle relaxants contraindications
Renal disease
46
Centrally acting muscle relaxants AE/SE's
Drowsiness
Dizziness
Weakness
Fatigue
47
Centrally acting muscle relaxants interactions
Other CNS depressants -
Opioids
Benzos
Alcohol (ETOH)
48
Centrally acting muscle relaxants prototype
Baclofen (Lioresal)
49
Baclofen dosing
Low and slow
50
Baclofen onset and half-life
Onset - fast (30-60 minutes)
Half-life - low 2-4 hours
*good for PRN dosing*
51
Baclofen black box warning
Do not stop abruptly, taper off
| - avoids rebound spasticity (high fever, muscle rigidity, etc.)
52
Baclofen patient education
```
If GI upset, take with food or milk
Can cause dizziness, change position slowly
Taper off
Don't drive/use machinery
Fall risk precautions
```
53
Baclofen oral vs. injectable
Injectable - chronic/long term
| Oral - acute
54
Peripherally acting muscle relaxants MOA
Works through the PNS/skeletal muscles by blocking calcium
55
Peripherally acting muscle relaxants indications
Muscle spasms and spasticity
| Malignant hyperthermia
56
Peripherally acting muscle relaxants contraindications
Liver disease
57
Peripherally acting muscle relaxants AE/SE's
Dizziness
Drowsiness
Fatigue
Liver toxicity
58
Peripherally acting muscle relaxants interactions
Other CNS depressants -
Alcohol
Benzos
Opioids
59
Peripherally acting muscle relaxants prototype
Dantrolene (Dantrium)
60
Dantrolene oral vs injectable
Oral - treats spasms
| Injectable - IV form during emergent malignant hyperthermia
61
Dantrolene priority nursing interventions
Safety and neuro status
62
Dantrolene patient education
Don't drive/use machinery
Fall risk/position changing
Diarrhea common early on - drink water
63
Sedative-hypnotics prototype
Zolpidem (Ambien)
64
Zolpidem MOA
Works with GABA and binds to same receptors as benzos
65
Zolpidem indications
Insomnia
66
Zolpidem contraindications
Sleep walking
| Not being in a position to sleep for 7-8 hours after taking
67
Zolpidem black box warning (plus AE/SE's)
Weird sleep activities
CNS depression
68
Zolpidem interactions
CNS depressants
69
Zolpidem toxicity
Antidote is Flumazenil
70
Zolpidem patient education
Allow 7-8 hours of sleep after taking
| If you experience any weird behaviors, stop taking and contact prescriber
71
Types of anesthesia
General - pt cannot maintain airway; used if pt going under for extended period of time
Local - doesn't affect CNS; local to the site
Moderate - Pt can maintain airway; used for short procedures
72
What are adjunct anesthetics?
Meds used in combination to allow for whatever level of consciousness is necessary
**It is rare to use just one anesthetic
73
What is balanced anesthesia?
Using general and adjunct(s) to keep patient properly sedated
74
Short acting general anesthesia MOA
Uses CNS
75
Short acting general anesthesia indications
Induction (state of going to sleep)
| Used throughout the procedure (used frequently because it's short acting)
76
Short acting general anesthesia contraindications
Allergy
| Fatigue
77
Short acting general anesthesia AE/SE's
Drowsiness
Dizziness
Fatigue
Respiratory depression
78
Short acting general anesthesia interactions
Other CNS depressants
**In some cases it can be beneficial because you want the patient to be CNS depressed to a certain extent**
79
Short acting general anesthesia prototype
Propofol (Diprivan)
80
Propofol indication
Induction
Maintenance
ICU - ventilation (keep consciousness down while intubated)
81
Propofol priority nursing interventions
Airway
82
Propofol patient education
Burning sensation when injected is normal
Decreased level of consciousness
Will feel drowsy and dizzy after
Bigger dose = higher risk of hypotension
83
Benzodiazepines (general anesthesia) MOA
Work in the CNS and bind to GABA
84
Benzodiazepines (general anesthesia) indications
Used as adjunct (not first indication)
Used as sedation before anesthesia
85
Benzodiazepines (general anesthesia) contraindications
Pregnancy
86
Benzodiazepines (general anesthesia) AE/SE's
CNS depression
87
Benzodiazepines (general anesthesia) interactions
Other CNS depressants
88
Benzodiazepines (general anesthesia) toxicity
Antidote is Flumazenil
89
Benzodiazepines (general anesthesia) prototype
Midazolam (Versed)
90
Midazolam IM vs IV vs oral liquid
IM - moderate sedation
IV - induction (super sedated)
Liquid - peds
91
Midazolam priority nursing interventions
Airway
92
Midazolam nursing consideration
Causes amnesia type effect - can be helpful when you don't want patient remembering
93
Midazolam patient education
Pt might not remember so give them written instructions and tell family member
94
Opioids (general anesthesia) MOA
Binds to opioid receptors
95
Opioids (general anesthesia) indications
Adjunct (not enough on it's own)
| Used for pain reduction during surgery
96
Opioids (general anesthesia) contraindications
Pregnancy
97
Opioids (general anesthesia) AE/SE's
CNS depression
Nausea
Constipation
Respiratory depression
98
Opioids (general anesthesia) interactions
CNS depressants (Can be beneficial if used as anesthesia)
99
Opioids (general anesthesia) toxicity
Antidote is Naloxone
100
Neuromuscular blocking drugs MOA
Paralysis of smooth and skeletal muscles
101
Neuromuscular blocking drugs indications
Induction
**Pt HAS to be mechanically ventilated, can't breathe on their own**
102
Neuromuscular blocking drugs contraindications
Malignant hyperthermia
103
Neuromuscular blocking drugs AE/SE
Muscle spasms
104
Neuromuscular blocking drugs toxicity
Antidote is Sugammadex
105
Opioid (general anesthesia) prototype
Fentanyl (Duragesic, Actiq)
106
Fentanyl IV vs transdermal vs oral
IV - general anesthesia, adjunct, acute pain
Transdermal - patch, long-term
Oral - pain management
107
Fentanyl onset
Rapid, 30-60 seconds
108
Fentanyl priority nursing intervention
Airway
109
Fentanyl patient education
Super high potential for abuse
Might feel drowsy or dizzy
Might have nausea
110
Neuromuscular blocking drugs prototype
Succinylcholine (Anectine, Quelicin)
111
Succinylcholine indication
Induction
| Intubation
112
Succinylcholine onset and duration
Onset is super quick and duration is short
113
Succinylcholine priority nursing interventions
Airway
114
Succinylcholine Patient education
Malignant hyperthermia (assess risk and teach patient)
115
Succinylcholine AE/SE
Can cause hyperkalemia which can lead to cardiac dysrhythmia
116
Local anesthetic MOA
Affects a specific spot (peripheral)
117
Local anesthetic indications
```
Surgical
Dental
Diagnostic
Pain
Spinal anesthesia
```
118
Local anesthetic contraindications
None, it's well tolerated
119
Local anesthetic AE/SE's
Spinal - common to have spinal headache after (sever, worst headache, sensitive to light)
Super common
120
Local anesthetic prototype
Lidocaine (Xylocaine)
121
Lidocaine IV
Can cause cardiac problems
122
Lidocaine priority nursing interventions
Monitor for spinal headache
| Monitor injection site
123
Lidocaine patient education
Risk of spinal headache - tell provider if symptoms occur
| Intradermal can burn
124
Amphetamines MOA
It's a CNS stimulant so works with norepinephrine and epinephrine in CNS
125
Amphetamines indications
ADHD
| Narcolepsy
126
Amphetamines contraindications
Severe hypertension (not controlled or stabilized)
127
Amphetamines AE/SE's
Speeds up everything in the body
- Tachy
- Hypertension
- Anxiety
- Insomnia
- Tremors
Dry mouth
LOA
Weight loss
128
Amphetamines interactions
Caffeine
| Other CNS stimulants
129
Amphetamines prototype
Amphetamine/dextroamphetamine (Adderall)
130
Amphetamine/dextroamphetamine black box warning
High potential for abuse if not taken responsibly
| Withdrawal if not taken
131
Amphetamine/dextroamphetamine nursing considerations
Taper off - stopping abruptly could cause bad withdrawal symptoms (most commonly depression)
132
Amphetamine/dextroamphetamine patient education
Do not stop abruptly - bad withdrawal symptoms (most commonly depression)
Take in the morning, never past 4 pm
Drug holidays
Monitor weight, make sure you're getting enough nutrition
133
What is a drug holiday?
Taking a break from the medication
- limits adverse effects
Example: kids should take M-F and not on weekends
134
CNS stimulant (not amphetamine) prototype
Methylphenidate (Ritalin, Concerta)
135
Methylphenidate application
Apply patch every morning and remove after 9 hours (will cause insomnia otherwise)
136
Methylphenidate priority nursing interventions
Taper off - stopping abruptly could cause bad withdrawal symptoms (most commonly depression)
*same as amphetamines
137
Methylphenidate patient education
Do not stop abruptly - bad withdrawal symptoms (most commonly depression)
Apply in the morning, remove after 9 hours
Drug holidays
Monitor weight, make sure you're getting enough nutrition
138
Methylphenidate black box warning
High abuse potential if misused
139
Non-amphetamines prototype
Modafinil (Provigil)
140
Modafinil indications
Excessive daytime sleepiness
| Shift work sleep disorders
141
Modafinil SE/AE's
N/D
142
Modafinil interactions
Decreases effects of oral contraceptive
Increases effects of Warfarin
Increases phenytoin (might need to be adjusted if taken together)
143
Modafinil priority nursing interventions
Encourage fluid intake - dehydration
Monitor S/S of bleeding
Fall precautions
144
Modafinil patient education
Warn about oral contraceptive and warfarin and phenytoin effects
145
Non-amphetamines vs Amphetamines
Less abuse potential
| Not as much CNS stimulation
146
Dopamine replacement drugs prototype
Carbidopa/levodopa (Sinemet)
147
Carbidopa/levodopa indications
Parkinson's
148
Carbidopa/levodopa contraindications
Glaucoma
| Undiagnosed skin conditions - can activate malignant melanoma
149
Carbidopa/levodopa AE/SE's
Orthostatic hypotension
Dyskinesia (unwanted movements)
Constipation
Dark sweat and urine
150
Carbidopa/levodopa interactions
Vitamin B6 (reduces effectiveness)
151
Carbidopa/levodopa MOA
Dopamine cannot cross the blood brain barrier, needs levodopa to cross
Levodopa needs carbidopa so that it doesn't break down before it gets to the brain
152
Carbidopa/levodopa related phenomenons
On-Off phenomenon - there are periods where there is greater systematic control and periods where there is less systematic control
Wearing off phenomenon - meds lose effectiveness and Parkinson's symptoms get worse
153
Carbidopa/levodopa priority nursing interventions
Safety - fall precautions
| Monitor BP
154
Carbidopa/levodopa patient education
Position changes
Be aware of dyskinesia and let provider know
Take it on an empty stomach
Avoid a high protein diet (can slow down absorption; 10 minutes before or 1 hr after)
Constipation prevention
Results may take up to 6 months, keep taking!
155
Direct-acting dopamine receptor agonists prototype
Pramipexole (Mirapex)
156
Pramipexole MOA
Binds to same receptors as dopamine and acts like dopamine
157
Pramipexole indications
Restless leg syndrome
| Parkinson's
158
Pramipexole contraindications
Allergy
159
Pramipexole AE/SE's
```
Orthostatic hypotension
Drowsiness
GI upset (usually subsides over time)
```
160
Pramipexole interactions
CNS depressants
161
Pramipexole priority nursing interventions
Safety and fall risk
162
Pramipexole patient education
Take with food/milk
| Slow and low administration
163
Monoamine oxidase inhibitors (MAOI) prototype
Selegiline (Eldepryl)
164
Selegiline MOA
Inhibits monoamine oxidase (which breaks down dopamine)
165
Selegiline indications
LAST RESORT for Parkinson's and depression
166
Selegiline contraindications
EVERYTHING
167
Selegiline AE/SE's
Orthostatic hypotension
168
Selegiline interactions
EVERYTHING
169
Selegiline diet
Avoid tyramine - causes toxicity
- charcuterie boards
- red wine and beer
- Asian food
170
Selegiline priority nursing interventions
Monitor BP
| Assess med list and menu
171
Selegiline patient education
```
Position changes
Diet
Contraindications
Timing of medicine
- Very strict schedule
- Takes awhile to become therapeutic, don't stop taking!!
```
172
Tolerance versus dependence
Tolerance - need more med to get the same effect after repeated exposure
Dependence - withdrawal symptoms if you stop taking or take a smaller dose that you're used to
173
What is patient-controlled analgesia?
PCA pump
Patient can push the button to receive IV pain meds as needed (has lockout to prevent overdosing)
Watch out for PCA by proxy!
174
Breakthrough pain is
Pain that occurs between doses of pain medication
175
Adjuvant drugs are
Medications from other drug classes added to pain meds (opioids) that assist in relieving pain
176
A synergistic effect is
A drug interaction where two drugs work greater together than separately (1+1=3)
177
Opioid agonist MOA
Binds to opioid pain receptors
178
Opioid agonist indications
Alleviate moderate to severe pain
| Can help with sedation/reduce anxiety pre-op
179
Opioid agonist contraindications*
```
Pregnancy
Renal failure (meds are hard to excrete)
Respiratory insufficiency (can cause respiratory depression)
```
180
Opioid agonist AE/SE's*
```
Respiratory depression
Sedation
Dizziness
Constipation*
N/V
Orthostatic hypotension*
Urinary retention*
Pruritus (itching)*
```
181
Opioid agonist interactions*
CNS depressants (Benzos, alcohol, other opioids)*
Anticholinergics (urinary retention)
Anti-hypertensives (hypotension)
182
Opioid agonist toxicity
Antidote is naloxone (Narcan)
183
Opioid agonist prototype
Morphine sulfate (MS IR, Roxanol, MS Contin)
184
Morphine sulfate IV onset
5-10 minutes
185
Morphine sulfate AE/SE's
N/V
Pruritus (itching)
Constipation
186
Morphine sulfate contraindications
Renal impairment - difficulty excreting metabolites
Geriatric
Gallbladder surgery or issues (causes retraction of Sphincter of Oddi)
187
Morphine sulfate black box warning
Addiction, abuse, and misuse
Life-threatening respiratory depression
Neonatal opioid withdrawal syndrome
Risks from concomitant use with benzodiazepines or other CNS depressants
188
Morphine sulfate priority nursing interventions
Monitor
- Respiratory
- Constipation
- Neuro status (level of consciousness)
- BP
- Position changes
- I&O's
189
Morphine sulfate patient education
Only take when needed and on short-term basis
Do not take if mental alertness is necessary
Position changes
Increase fluid and fiber intake
Nausea? Take with food or milk
Report difficulty/inability to urinate
Cough regularly
190
Non-opioid analgesic prototype
Acetaminophen (Tylenol)
191
Acetaminophen indications
Used to treat mild to moderate pain and fever
192
Acetaminophen contraindications
Children
| Liver disease
193
Acetaminophen toxicity
Antidote is acetylcysteine
194
Acetaminophen dosing
3500/24 hours
*monitor other drugs that have acetaminophen in them
195
Acetaminophen nursing interventions
Monitor liver (ALT/AST) - Jaundice
196
Acetaminophen patient education
Monitor dosing - keep a log
Don't take with other drugs that contain acetaminophen
Don't drink alcohol (hepatotoxicity)
S/S hepatotoxicity
197
Centrally acting non-opioid prototype
Tramadol (Ultram)
198
Tramadol onset
Slow, 1 hour
199
Tramadol AE's
```
Rare
Sedation
Dizziness
Headache
Nausea
Constipation
```
200
Tramadol contraindications
Seizures - med lowers threshold for seizures
| Adults over 75 or children under 12
201
Tramadol priority nursing interventions
Monitor
- CNS depression
- Constipation
- Nausea
202
Tramadol patient education
Takes a while to work
- Take before pain gets too bad
- Don't double dose to get it to work faster
203
Opioid antagonist prototype
Naloxone (Narcan)
204
Naloxone MOA
Kicks opioids from receptors
205
Naloxone indications
Reversal of opioid overdose or respiratory depression
206
Naloxone injection vs intranasally
Injection - healthcare setting
Intranasally - community setting
207
Naloxone duration of action
1-2 hours
| Might need a second dose if it wears off before opioids are out of the system
208
Naloxone priority nursing interventions
Monitor airway
Level of consciousness
If given after surgery b/c of respiratory depression, have other pain meds ready
209
Naloxone patient education
If you give a dose, get person to ER
Duration is only 1-2 hours, so monitor person
210
What enzyme converts arachidonic acid to prostaglandin-is what causes inflammation, needed for normal gastric
COX
211
What is the difference between COX-1 and COX-2?
COX-1
- Gastric mucosa unprotected – leads to ulcer formation
- Decreases platelet aggregation – leads to anticoagulant effects (bleeding, bruising)
- Impairs renal perfusion – decreases urine output, increases BUN and creatinine
COX-2
- Decreases inflammation
- Decreases pain
- Decreases body temperature
212
NSAIDs: first gen: non-selective are
COX-1 and COX-2 inhibitors
213
NSAIDs: first gen indications
Analgesic
Anti-inflammatory
Antipyretic
Platelet inhibition (thin blood)
214
NSAIDs: first gen contraindications
Pregnancy
Peptic ulcers/GERD/gastritis
Bleeding disorders
Severe kidney/hepatic disease
215
NSAIDs: first gen AE/SE's
```
Nausea
Heartburn
Gastric ulcers
Bleeding
Renal dysfunction
```
216
NSAIDs: first gen interactions*
Anticoagulants*
Glucocorticoids* (can contribute to additional GI issues)
Lithium
Bisphosphonates
217
NSAIDs: first gen prototype
Aspirin (ASA)
218
Aspirin dosing
325 mg - for anti-inflammatory properties
| 81 mg - “baby aspirin” given for cardiovascular reasons (NOT GIVEN TO BABIES)
219
Aspirin AE's
Bruising
Bleeding
GI upset
Tinnitus
220
Aspirin contraindications
Children - Reye's syndrome
221
Aspirin toxicity
S/S
- Tachy
- Tinnitus
- Hearing loss
- Headache
- N/V
- Hyperventilation
- Dizziness
- Drowsiness
- Hypoglycemia
- Respiratory and renal failure
**NO ANTIDOTE**
Mild = discontinuation of aspirin and supportive therapy
Severe = discontinuation of aspirin, intensive supportive therapy, dialysis
222
Aspirin patient education
```
Correct dosage
Don't take with other anti-coagulants
Bleeding precautions
Be cautious and safe
Don't take prior to procedures
```
223
NSAID: Propionic acid derivative prototype
Ibuprofen (Motrin, Advil)
224
Ibuprofen indications
Anti-inflammatory
| Antipyretic
225
Ibuprofen half-life
Short; 2 hours (take often)
226
Ibuprofen contraindications
Well tolerated with few adverse effects
227
Ibuprofen patient teaching
Need acid-reducing med if you're going to be taking for an extended period
Avoid alcohol
Decreases effectiveness of ACE inhibitors
228
NSAIDs: second generation: selective prototype
Celecoxib (Celebrex)
229
Celecoxib MOA
Inhibits COX-2 only
Only one on the market – others were pulled for adverse CV events
230
Celecoxib indications
Pain relief (primarily with arthritis)
231
Celecoxib AE's
Sodium and fluid retention
232
Celecoxib contraindications
Sulfa allergy
| Prone to sodium and fluid retention
233
Celecoxib black box warning
Cardiovascular - increased risk for events
| Gastrointestinal
234
Celecoxib primary nursing interventions
Assess allergy
S/S of fluid overload/retention
Antacids can cause difficulty with absorption (2 hrs before or after)
CAN take with anticoagulants
235
Celecoxib patient education
Take on an empty stomach
236
Antigout: antihyperuricemics prototype
Allopurinol (Zyloprim)
237
Allopurinol MOA
Inhibits enzyme xanthine oxidase, preventing uric acid production
238
Allopurinol indications
For patients whose gout is caused by EXCESS PRODUCTION of uric acid
**not for those who can't excrete UA*
239
Allopurinol AE's
Agranulocytosis (can cause lowered WBC, anemia)
Aplastic anemia
Skin conditions
Can cause metallic taste in mouth
240
Allopurinol Interactions
Warfarin (increased effects)
241
Allopurinol priority nursing interventions
Monitor serum uric acid levels
| CBC (blood counts)
242
Allopurinol patient education
Bleeding precautions
S/S of infection and anemia
Metallic taste is normal
243
Steroidal anti-inflammatory drugs: corticosteroids: glucocorticoids MOA
Inhibit inflammatory response by mimicking cortisol inhibiting prostaglandin production (inflammation)
244
Glucocorticoids indications
Reduces inflammation
245
Glucocorticoids Contraindications
```
Diabetics
Osteoporosis
Risk for infection, presence of infection, organ transplant
PUD, gastritis, GERD
Glaucoma/cataracts
```
246
Glucocorticoids AE/SE's
Moon face
Hyperglycemia
Psychosis
Adrenal suppression
247
Glucocorticoids interactions
```
MANY!
Non-potassium sparing diuretics
NSAIDs
Immunizing biologics (live vaccines)
Antidiabetic drugs
```
248
Glucocorticoids prototypes
Prednisone (Deltasone)
| Methylprednisolone (Solu-Medrol)
249
Prednisone indications
Anti-inflammatory
Immunosuppressant
Respiratory illnesses
250
Prednisone half-life
Long half life = longer duration of action
251
Prednisone patient education
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Taper off - prevents adrenal crisis
High blood sugar
GI distress
Immunosuppression
Explain anxiety and emotions might be increased
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252
What is adrenal crisis?
Body thinks it doesn't have to produce hormones because med is going it; have to let body know it needs to work again
253
Methylprednisolone indications
Anti-inflammatory
254
Methylprednisolone contraindications
Cannot be given to children younger than 28 days because of the preservative
255
Methylprednisolone priority nursing interventions
Long-term use should never be abruptly stopped
