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Pharm 1 > Exam 2 Drugs > Flashcards

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
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2
Q

When do migraine meds work the best?

A

In the aura phase

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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)

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4
Q

Prototype for migraines

A

Sumatriptan (Imitrex)

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5
Q

Sumatriptan MOA

A

Agonist at serotonin receptors

Serotonin causes vasoconstriction, which can cause migraines

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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
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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

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8
Q

What is serotonin syndrome?

A

A drug reaction due to high levels of serotonin in the body, caused by medication

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9
Q

S/S of serotonin syndrome

A

Neuromuscular excitation - tremors, hyperreflexia
ANS dysfunction - tachy, fever, sweating, flushing, headache
Altered mental status - confused

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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)
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11
Q

Patient education for Alzheimer’s medication

A

Drugs will NOT cure; can only delay progression and ease symptoms

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12
Q

Cholinesterase Inhibitor prototype

A

Donepezil (Aricept)

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13
Q

Donepezil indication

A

Alzheimer’s disease

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14
Q

Donepezil contraindications

A

NSAIDs - increases risk of GI bleeding

Bradycardia - notify prescriber if pulse is less than 60 and hold drug

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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)

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16
Q

NMDA receptor antagonist prototype

A

Memantine (Namenda)

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17
Q

Memantine indication

A

Moderate to severe Alzheimer’s disease

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18
Q

Memantine contraindications

A

Seizures
CV disease
Severe hepatic or renal impairment

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19
Q

Memantine adverse effects

A

Heart failure

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20
Q

Memantine patient education

A

No foods that alkalinize urine (citrus, veggies)

Signs of hepatic or renal impairment or heart failure

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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
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22
Q

How to monitor for renal impairment

A

BUN
Creatinine
I&Os

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23
Q

Signs of GI bleeding

A 
Blood in stool (black and tar-like)
"Coffee ground" emesis
Hematocrit low
Dizziness
Hypotensive/Tachy
Anemia
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24
Q

Signs of heart failure

A

Crackles
JVD in neck
SOB at rest or exertion
Peripheral edema

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25
Q

Hydantoin prototype

A

Phenytoin (Dilantin)

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26
Q

Phenytoin indications

A

Seizure control

Status epilepticus

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27
Q

Phenytoin therapeutic range

A

Narrow

10-20 mcg/mL

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28
Q

Phenytoin nursing considerations

A

Monitor for CNS effects
Monitor labs - CBC and hepatic function
Sleepiness/drowsiness can be caused by toxic level
call provider before stopping ed

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29
Q

Phenytoin black box warning

A

Cardiovascular toxicity - occurs by IV, usually because of pushing med too fast
- use tele pack to watch for dysrhythmia

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30
Q

Phenytoin patient education

A

Do not stop abruptly
Plan ahead for trips
Can disrupt hepatic function (no Tylenol or alcohol)

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31
Q

Traditional antiepileptic drugs prototypes

A 
Carbamazepine (Tegretol)
Valproic acid (Depakote)
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32
Q

Carbamazepine and Valproic acid indications

A

Seizures
Bipolar disorder
Mania

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33
Q

Carbamazepine contraindications

A

Pregnancy

Those with hepatic/renal dysfunction

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34
Q

Carbamazepine therapeutic range

A

4-12 mcg/mL

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35
Q

Carbamazepine AE/SE

A

Hepatic/renal dysfunction

Anorexia (LOA related to high levels/tocixicity)

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36
Q

Carbamazepine patient education

A

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)

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37
Q

Valproic acid therapeutic range

A

50-100 mcg/mL

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38
Q

Valproic acid nursing considerations

A

Monitor

  • kidney and liver labs
  • blood dyscrasia
  • S/S of depression or SI
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39
Q

Valproic acid patient education

A

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)
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40
Q

Seizure adjunct therapy prototype

A

Gabapentin (Neurontin)

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41
Q

Gabapentin indications

A

Not developed for seizure disorder, but when paired with another epileptic drug, it can be beneficial

First indication is diabetes

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42
Q

Gabapentin patient education

A

Increased risk of depression and SI
Can cause sleepiness (take at bedtime)
No alcohol - will increase CNS depression

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43
Q

Centrally acting muscle relaxants MOA

A

Work in the CNS, binds to GABA (which is why they often cause drowsiness)

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44
Q

Centrally acting muscle relaxants indications

A

Muscle spasms

Spasticity

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45
Q

Centrally acting muscle relaxants contraindications

A

Renal disease

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46
Q

Centrally acting muscle relaxants AE/SE’s

A

Drowsiness
Dizziness
Weakness
Fatigue

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47
Q

Centrally acting muscle relaxants interactions

A

Other CNS depressants -
Opioids
Benzos
Alcohol (ETOH)

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48
Q

Centrally acting muscle relaxants prototype

A

Baclofen (Lioresal)

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49
Q

Baclofen dosing

A

Low and slow

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50
Q

Baclofen onset and half-life

A

Onset - fast (30-60 minutes)
Half-life - low 2-4 hours

good for PRN dosing

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51
Q

Baclofen black box warning

A

Do not stop abruptly, taper off

- avoids rebound spasticity (high fever, muscle rigidity, etc.)

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52
Q

Baclofen patient education

A 
If GI upset, take with food or milk
Can cause dizziness, change position slowly
Taper off
Don't drive/use machinery
Fall risk precautions
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53
Q

Baclofen oral vs. injectable

A

Injectable - chronic/long term

Oral - acute

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54
Q

Peripherally acting muscle relaxants MOA

A

Works through the PNS/skeletal muscles by blocking calcium

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55
Q

Peripherally acting muscle relaxants indications

A

Muscle spasms and spasticity

Malignant hyperthermia

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56
Q

Peripherally acting muscle relaxants contraindications

A

Liver disease

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57
Q

Peripherally acting muscle relaxants AE/SE’s

A

Dizziness
Drowsiness
Fatigue
Liver toxicity

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58
Q

Peripherally acting muscle relaxants interactions

A

Other CNS depressants -
Alcohol
Benzos
Opioids

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59
Q

Peripherally acting muscle relaxants prototype

A

Dantrolene (Dantrium)

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60
Q

Dantrolene oral vs injectable

A

Oral - treats spasms

Injectable - IV form during emergent malignant hyperthermia

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61
Q

Dantrolene priority nursing interventions

A

Safety and neuro status

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62
Q

Dantrolene patient education

A

Don’t drive/use machinery
Fall risk/position changing
Diarrhea common early on - drink water

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63
Q

Sedative-hypnotics prototype

A

Zolpidem (Ambien)

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64
Q

Zolpidem MOA

A

Works with GABA and binds to same receptors as benzos

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65
Q

Zolpidem indications

A

Insomnia

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66
Q

Zolpidem contraindications

A

Sleep walking

Not being in a position to sleep for 7-8 hours after taking

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67
Q

Zolpidem black box warning (plus AE/SE’s)

A

Weird sleep activities

CNS depression

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68
Q

Zolpidem interactions

A

CNS depressants

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69
Q

Zolpidem toxicity

A

Antidote is Flumazenil

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70
Q

Zolpidem patient education

A

Allow 7-8 hours of sleep after taking

If you experience any weird behaviors, stop taking and contact prescriber

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71
Q

Types of anesthesia

A

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

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72
Q

What are adjunct anesthetics?

A

Meds used in combination to allow for whatever level of consciousness is necessary

**It is rare to use just one anesthetic

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73
Q

What is balanced anesthesia?

A

Using general and adjunct(s) to keep patient properly sedated

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74
Q

Short acting general anesthesia MOA

A

Uses CNS

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75
Q

Short acting general anesthesia indications

A

Induction (state of going to sleep)

Used throughout the procedure (used frequently because it’s short acting)

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76
Q

Short acting general anesthesia contraindications

A

Allergy

Fatigue

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77
Q

Short acting general anesthesia AE/SE’s

A

Drowsiness
Dizziness
Fatigue
Respiratory depression

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78
Q

Short acting general anesthesia interactions

A

Other CNS depressants

In some cases it can be beneficial because you want the patient to be CNS depressed to a certain extent

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79
Q

Short acting general anesthesia prototype

A

Propofol (Diprivan)

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80
Q

Propofol indication

A

Induction
Maintenance
ICU - ventilation (keep consciousness down while intubated)

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81
Q

Propofol priority nursing interventions

A

Airway

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82
Q

Propofol patient education

A

Burning sensation when injected is normal
Decreased level of consciousness
Will feel drowsy and dizzy after
Bigger dose = higher risk of hypotension

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83
Q

Benzodiazepines (general anesthesia) MOA

A

Work in the CNS and bind to GABA

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84
Q

Benzodiazepines (general anesthesia) indications

A

Used as adjunct (not first indication)

Used as sedation before anesthesia

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85
Q

Benzodiazepines (general anesthesia) contraindications

A

Pregnancy

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86
Q

Benzodiazepines (general anesthesia) AE/SE’s

A

CNS depression

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87
Q

Benzodiazepines (general anesthesia) interactions

A

Other CNS depressants

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88
Q

Benzodiazepines (general anesthesia) toxicity

A

Antidote is Flumazenil

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89
Q

Benzodiazepines (general anesthesia) prototype

A

Midazolam (Versed)

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90
Q

Midazolam IM vs IV vs oral liquid

A

IM - moderate sedation
IV - induction (super sedated)
Liquid - peds

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91
Q

Midazolam priority nursing interventions

A

Airway

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92
Q

Midazolam nursing consideration

A

Causes amnesia type effect - can be helpful when you don’t want patient remembering

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93
Q

Midazolam patient education

A

Pt might not remember so give them written instructions and tell family member

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94
Q

Opioids (general anesthesia) MOA

A

Binds to opioid receptors

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95
Q

Opioids (general anesthesia) indications

A

Adjunct (not enough on it’s own)

Used for pain reduction during surgery

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96
Q

Opioids (general anesthesia) contraindications

A

Pregnancy

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97
Q

Opioids (general anesthesia) AE/SE’s

A

CNS depression
Nausea
Constipation
Respiratory depression

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98
Q

Opioids (general anesthesia) interactions

A

CNS depressants (Can be beneficial if used as anesthesia)

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99
Q

Opioids (general anesthesia) toxicity

A

Antidote is Naloxone

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100
Q

Neuromuscular blocking drugs MOA

A

Paralysis of smooth and skeletal muscles

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101
Q

Neuromuscular blocking drugs indications

A

Induction

Pt HAS to be mechanically ventilated, can’t breathe on their own

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102
Q

Neuromuscular blocking drugs contraindications

A

Malignant hyperthermia

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103
Q

Neuromuscular blocking drugs AE/SE

A

Muscle spasms

104
Q

Neuromuscular blocking drugs toxicity

A

Antidote is Sugammadex

105
Q

Opioid (general anesthesia) prototype

A

Fentanyl (Duragesic, Actiq)

106
Q

Fentanyl IV vs transdermal vs oral

A

IV - general anesthesia, adjunct, acute pain
Transdermal - patch, long-term
Oral - pain management

107
Q

Fentanyl onset

A

Rapid, 30-60 seconds

108
Q

Fentanyl priority nursing intervention

A

Airway

109
Q

Fentanyl patient education

A

Super high potential for abuse
Might feel drowsy or dizzy
Might have nausea

110
Q

Neuromuscular blocking drugs prototype

A

Succinylcholine (Anectine, Quelicin)

111
Q

Succinylcholine indication

A

Induction

Intubation

112
Q

Succinylcholine onset and duration

A

Onset is super quick and duration is short

113
Q

Succinylcholine priority nursing interventions

A

Airway

114
Q

Succinylcholine Patient education

A

Malignant hyperthermia (assess risk and teach patient)

115
Q

Succinylcholine AE/SE

A

Can cause hyperkalemia which can lead to cardiac dysrhythmia

116
Q

Local anesthetic MOA

A

Affects a specific spot (peripheral)

117
Q

Local anesthetic indications

A 
Surgical
Dental
Diagnostic
Pain
Spinal anesthesia
118
Q

Local anesthetic contraindications

A

None, it’s well tolerated

119
Q

Local anesthetic AE/SE’s

A

Spinal - common to have spinal headache after (sever, worst headache, sensitive to light)

Super common

120
Q

Local anesthetic prototype

A

Lidocaine (Xylocaine)

121
Q

Lidocaine IV

A

Can cause cardiac problems

122
Q

Lidocaine priority nursing interventions

A

Monitor for spinal headache

Monitor injection site

123
Q

Lidocaine patient education

A

Risk of spinal headache - tell provider if symptoms occur

Intradermal can burn

124
Q

Amphetamines MOA

A

It’s a CNS stimulant so works with norepinephrine and epinephrine in CNS

125
Q

Amphetamines indications

A

ADHD

Narcolepsy

126
Q

Amphetamines contraindications

A

Severe hypertension (not controlled or stabilized)

127
Q

Amphetamines AE/SE’s

A

Speeds up everything in the body

  • Tachy
  • Hypertension
  • Anxiety
  • Insomnia
  • Tremors

Dry mouth
LOA
Weight loss

128
Q

Amphetamines interactions

A

Caffeine

Other CNS stimulants

129
Q

Amphetamines prototype

A

Amphetamine/dextroamphetamine (Adderall)

130
Q

Amphetamine/dextroamphetamine black box warning

A

High potential for abuse if not taken responsibly

Withdrawal if not taken

131
Q

Amphetamine/dextroamphetamine nursing considerations

A

Taper off - stopping abruptly could cause bad withdrawal symptoms (most commonly depression)

132
Q

Amphetamine/dextroamphetamine patient education

A

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
Q

What is a drug holiday?

A

Taking a break from the medication

  • limits adverse effects
    Example: kids should take M-F and not on weekends
134
Q

CNS stimulant (not amphetamine) prototype

A

Methylphenidate (Ritalin, Concerta)

135
Q

Methylphenidate application

A

Apply patch every morning and remove after 9 hours (will cause insomnia otherwise)

136
Q

Methylphenidate priority nursing interventions

A

Taper off - stopping abruptly could cause bad withdrawal symptoms (most commonly depression)

*same as amphetamines

137
Q

Methylphenidate patient education

A

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
Q

Methylphenidate black box warning

A

High abuse potential if misused

139
Q

Non-amphetamines prototype

A

Modafinil (Provigil)

140
Q

Modafinil indications

A

Excessive daytime sleepiness

Shift work sleep disorders

141
Q

Modafinil SE/AE’s

A

N/D

142
Q

Modafinil interactions

A

Decreases effects of oral contraceptive
Increases effects of Warfarin
Increases phenytoin (might need to be adjusted if taken together)

143
Q

Modafinil priority nursing interventions

A

Encourage fluid intake - dehydration
Monitor S/S of bleeding
Fall precautions

144
Q

Modafinil patient education

A

Warn about oral contraceptive and warfarin and phenytoin effects

145
Q

Non-amphetamines vs Amphetamines

A

Less abuse potential

Not as much CNS stimulation

146
Q

Dopamine replacement drugs prototype

A

Carbidopa/levodopa (Sinemet)

147
Q

Carbidopa/levodopa indications

A

Parkinson’s

148
Q

Carbidopa/levodopa contraindications

A

Glaucoma

Undiagnosed skin conditions - can activate malignant melanoma

149
Q

Carbidopa/levodopa AE/SE’s

A

Orthostatic hypotension
Dyskinesia (unwanted movements)
Constipation
Dark sweat and urine

150
Q

Carbidopa/levodopa interactions

A

Vitamin B6 (reduces effectiveness)

151
Q

Carbidopa/levodopa MOA

A

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
Q

Carbidopa/levodopa related phenomenons

A

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
Q

Carbidopa/levodopa priority nursing interventions

A

Safety - fall precautions

Monitor BP

154
Q

Carbidopa/levodopa patient education

A

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
Q

Direct-acting dopamine receptor agonists prototype

A

Pramipexole (Mirapex)

156
Q

Pramipexole MOA

A

Binds to same receptors as dopamine and acts like dopamine

157
Q

Pramipexole indications

A

Restless leg syndrome

Parkinson’s

158
Q

Pramipexole contraindications

A

Allergy

159
Q

Pramipexole AE/SE’s

A 
Orthostatic hypotension
Drowsiness
GI upset (usually subsides over time)
160
Q

Pramipexole interactions

A

CNS depressants

161
Q

Pramipexole priority nursing interventions

A

Safety and fall risk

162
Q

Pramipexole patient education

A

Take with food/milk

Slow and low administration

163
Q

Monoamine oxidase inhibitors (MAOI) prototype

A

Selegiline (Eldepryl)

164
Q

Selegiline MOA

A

Inhibits monoamine oxidase (which breaks down dopamine)

165
Q

Selegiline indications

A

LAST RESORT for Parkinson’s and depression

166
Q

Selegiline contraindications

A

EVERYTHING

167
Q

Selegiline AE/SE’s

A

Orthostatic hypotension

168
Q

Selegiline interactions

A

EVERYTHING

169
Q

Selegiline diet

A

Avoid tyramine - causes toxicity

  • charcuterie boards
  • red wine and beer
  • Asian food
170
Q

Selegiline priority nursing interventions

A

Monitor BP

Assess med list and menu

171
Q

Selegiline patient education

A 
Position changes
Diet
Contraindications
Timing of medicine
- Very strict schedule
- Takes awhile to become therapeutic, don't stop taking!!
172
Q

Tolerance versus dependence

A

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
Q

What is patient-controlled analgesia?

A

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
Q

Breakthrough pain is

A

Pain that occurs between doses of pain medication

175
Q

Adjuvant drugs are

A

Medications from other drug classes added to pain meds (opioids) that assist in relieving pain

176
Q

A synergistic effect is

A

A drug interaction where two drugs work greater together than separately (1+1=3)

177
Q

Opioid agonist MOA

A

Binds to opioid pain receptors

178
Q

Opioid agonist indications

A

Alleviate moderate to severe pain

Can help with sedation/reduce anxiety pre-op

179
Q

Opioid agonist contraindications*

A 
Pregnancy
Renal failure (meds are hard to excrete)
Respiratory insufficiency (can cause respiratory depression)
180
Q

Opioid agonist AE/SE’s*

A 
Respiratory depression
Sedation
Dizziness
Constipation*
N/V
Orthostatic hypotension*
Urinary retention*
Pruritus (itching)*
181
Q

Opioid agonist interactions*

A

CNS depressants (Benzos, alcohol, other opioids)*
Anticholinergics (urinary retention)
Anti-hypertensives (hypotension)

182
Q

Opioid agonist toxicity

A

Antidote is naloxone (Narcan)

183
Q

Opioid agonist prototype

A

Morphine sulfate (MS IR, Roxanol, MS Contin)

184
Q

Morphine sulfate IV onset

A

5-10 minutes

185
Q

Morphine sulfate AE/SE’s

A

N/V
Pruritus (itching)
Constipation

186
Q

Morphine sulfate contraindications

A

Renal impairment - difficulty excreting metabolites
Geriatric
Gallbladder surgery or issues (causes retraction of Sphincter of Oddi)

187
Q

Morphine sulfate black box warning

A

Addiction, abuse, and misuse
Life-threatening respiratory depression
Neonatal opioid withdrawal syndrome
Risks from concomitant use with benzodiazepines or other CNS depressants

188
Q

Morphine sulfate priority nursing interventions

A

Monitor

  • Respiratory
  • Constipation
  • Neuro status (level of consciousness)
  • BP
  • Position changes
  • I&O’s
189
Q

Morphine sulfate patient education

A

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
Q

Non-opioid analgesic prototype

A

Acetaminophen (Tylenol)

191
Q

Acetaminophen indications

A

Used to treat mild to moderate pain and fever

192
Q

Acetaminophen contraindications

A

Children

Liver disease

193
Q

Acetaminophen toxicity

A

Antidote is acetylcysteine

194
Q

Acetaminophen dosing

A

3500/24 hours

*monitor other drugs that have acetaminophen in them

195
Q

Acetaminophen nursing interventions

A

Monitor liver (ALT/AST) - Jaundice

196
Q

Acetaminophen patient education

A

Monitor dosing - keep a log
Don’t take with other drugs that contain acetaminophen
Don’t drink alcohol (hepatotoxicity)
S/S hepatotoxicity

197
Q

Centrally acting non-opioid prototype

A

Tramadol (Ultram)

198
Q

Tramadol onset

A

Slow, 1 hour

199
Q

Tramadol AE’s

A 
Rare
Sedation
Dizziness
Headache
Nausea
Constipation
200
Q

Tramadol contraindications

A

Seizures - med lowers threshold for seizures

Adults over 75 or children under 12

201
Q

Tramadol priority nursing interventions

A

Monitor

  • CNS depression
  • Constipation
  • Nausea
202
Q

Tramadol patient education

A

Takes a while to work

  • Take before pain gets too bad
  • Don’t double dose to get it to work faster
203
Q

Opioid antagonist prototype

A

Naloxone (Narcan)

204
Q

Naloxone MOA

A

Kicks opioids from receptors

205
Q

Naloxone indications

A

Reversal of opioid overdose or respiratory depression

206
Q

Naloxone injection vs intranasally

A

Injection - healthcare setting

Intranasally - community setting

207
Q

Naloxone duration of action

A

1-2 hours

Might need a second dose if it wears off before opioids are out of the system

208
Q

Naloxone priority nursing interventions

A

Monitor airway
Level of consciousness

If given after surgery b/c of respiratory depression, have other pain meds ready

209
Q

Naloxone patient education

A

If you give a dose, get person to ER

Duration is only 1-2 hours, so monitor person

210
Q

What enzyme converts arachidonic acid to prostaglandin-is what causes inflammation, needed for normal gastric

A

COX

211
Q

What is the difference between COX-1 and COX-2?

A

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
Q

NSAIDs: first gen: non-selective are

A

COX-1 and COX-2 inhibitors

213
Q

NSAIDs: first gen indications

A

Analgesic
Anti-inflammatory
Antipyretic
Platelet inhibition (thin blood)

214
Q

NSAIDs: first gen contraindications

A

Pregnancy
Peptic ulcers/GERD/gastritis
Bleeding disorders
Severe kidney/hepatic disease

215
Q

NSAIDs: first gen AE/SE’s

A 
Nausea
Heartburn
Gastric ulcers
Bleeding
Renal dysfunction
216
Q

NSAIDs: first gen interactions*

A

Anticoagulants*
Glucocorticoids* (can contribute to additional GI issues)
Lithium
Bisphosphonates

217
Q

NSAIDs: first gen prototype

A

Aspirin (ASA)

218
Q

Aspirin dosing

A

325 mg - for anti-inflammatory properties

81 mg - “baby aspirin” given for cardiovascular reasons (NOT GIVEN TO BABIES)

219
Q

Aspirin AE’s

A

Bruising
Bleeding
GI upset
Tinnitus

220
Q

Aspirin contraindications

A

Children - Reye’s syndrome

221
Q

Aspirin toxicity

A

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
Q

Aspirin patient education

A 
Correct dosage
Don't take with other anti-coagulants
Bleeding precautions
Be cautious and safe
Don't take prior to procedures
223
Q

NSAID: Propionic acid derivative prototype

A

Ibuprofen (Motrin, Advil)

224
Q

Ibuprofen indications

A

Anti-inflammatory

Antipyretic

225
Q

Ibuprofen half-life

A

Short; 2 hours (take often)

226
Q

Ibuprofen contraindications

A

Well tolerated with few adverse effects

227
Q

Ibuprofen patient teaching

A

Need acid-reducing med if you’re going to be taking for an extended period
Avoid alcohol
Decreases effectiveness of ACE inhibitors

228
Q

NSAIDs: second generation: selective prototype

A

Celecoxib (Celebrex)

229
Q

Celecoxib MOA

A

Inhibits COX-2 only

Only one on the market – others were pulled for adverse CV events

230
Q

Celecoxib indications

A

Pain relief (primarily with arthritis)

231
Q

Celecoxib AE’s

A

Sodium and fluid retention

232
Q

Celecoxib contraindications

A

Sulfa allergy

Prone to sodium and fluid retention

233
Q

Celecoxib black box warning

A

Cardiovascular - increased risk for events

Gastrointestinal

234
Q

Celecoxib primary nursing interventions

A

Assess allergy
S/S of fluid overload/retention
Antacids can cause difficulty with absorption (2 hrs before or after)
CAN take with anticoagulants

235
Q

Celecoxib patient education

A

Take on an empty stomach

236
Q

Antigout: antihyperuricemics prototype

A

Allopurinol (Zyloprim)

237
Q

Allopurinol MOA

A

Inhibits enzyme xanthine oxidase, preventing uric acid production

238
Q

Allopurinol indications

A

For patients whose gout is caused by EXCESS PRODUCTION of uric acid

**not for those who can’t excrete UA*

239
Q

Allopurinol AE’s

A

Agranulocytosis (can cause lowered WBC, anemia)
Aplastic anemia
Skin conditions
Can cause metallic taste in mouth

240
Q

Allopurinol Interactions

A

Warfarin (increased effects)

241
Q

Allopurinol priority nursing interventions

A

Monitor serum uric acid levels

CBC (blood counts)

242
Q

Allopurinol patient education

A

Bleeding precautions
S/S of infection and anemia
Metallic taste is normal

243
Q

Steroidal anti-inflammatory drugs: corticosteroids: glucocorticoids MOA

A

Inhibit inflammatory response by mimicking cortisol inhibiting prostaglandin production (inflammation)

244
Q

Glucocorticoids indications

A

Reduces inflammation

245
Q

Glucocorticoids Contraindications

A 
Diabetics
Osteoporosis
Risk for infection, presence of infection, organ transplant 
PUD, gastritis, GERD
Glaucoma/cataracts
246
Q

Glucocorticoids AE/SE’s

A

Moon face
Hyperglycemia
Psychosis
Adrenal suppression

247
Q

Glucocorticoids interactions

A 
MANY! 
Non-potassium sparing diuretics
NSAIDs
Immunizing biologics (live vaccines)
Antidiabetic drugs
248
Q

Glucocorticoids prototypes

A

Prednisone (Deltasone)

Methylprednisolone (Solu-Medrol)

249
Q

Prednisone indications

A

Anti-inflammatory
Immunosuppressant
Respiratory illnesses

250
Q

Prednisone half-life

A

Long half life = longer duration of action

251
Q

Prednisone patient education

A 
Taper off - prevents adrenal crisis
High blood sugar
GI distress
Immunosuppression
Explain anxiety and emotions might be increased
252
Q

What is adrenal crisis?

A

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
Q

Methylprednisolone indications

A

Anti-inflammatory

254
Q

Methylprednisolone contraindications

A

Cannot be given to children younger than 28 days because of the preservative

255
Q

Methylprednisolone priority nursing interventions

A

Long-term use should never be abruptly stopped

Pharm 1 (6 decks)

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