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NUR 3180 PHARM > Exam 2 Study Guide > Flashcards

Exam 2 Study Guide Flashcards

1
Q

Insulins

A
  • Rapid-acting: Lispro & Aspart
  • Short: Regular
  • Long-acting: Glargine
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2
Q

Glucose Elevating Agents

A
  • Intravenous D50W
  • Glucagon
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3
Q

Non-Insulin (Oral)

A
  • Metformin
  • Glipizide
  • Empagliflozin
  • Sitagliptin
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4
Q

Non-Insulin (SQ)

A

Liraglutide

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5
Q

Non-Insulin Agents MOA

A
  • Incr insulin release
  • Dcr glucagon release
  • Slow GI absorption of glucose
  • Blocks glucose reabsorption in kidneys; excretes more glucose in urine
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6
Q

Insulin Compatibilities

A
  • Lispro/Aspart + Regular or NPH
    > Lispro + Regular
    > Lispro + NPH
    > Aspart + Regular
    > Aspart + NPH
  • Insulin Detemir alone
  • Insulin Glargine alone
  • Do not mix a premixed insulin w/ any other insulin
    > Novocain 70/30
    > Humulin 50/50
  • Why? Med orders are @ same time
    > use diff sites if cannot mix
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7
Q

Mixing Insulin

A
  • Gently roll cloudy insulin vial btwn hands
  • Give mixed insulins w/in 5 mins
  • Inject air into vials equaling units to be administered
  • Withdraw CLEAR insulin 1st (regular or rapid) followed by CLOUDY (intermediate-NPH)
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8
Q

Metformin (Biguanides)

MOA
Indication
Route
AE
Nursing

A
  • MOA:
    > incrs insulin SENSITIVITY
    > dcrs hepatic glucose production
    > dcrs GI glucose absorption
  • Indications: T2DM
  • Route: oral
  • AE: GI effects (N/V/D); dcrs w/ time; lactic acidosis (rare but serious)
  • Nursing: low risk for hypoglycemia, HOLD 2 days prior & 2 days after IV contrast (risk for AKI)
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9
Q

Glipizide (Sulfonylureas, 2nd Gen)

MOA
Route
Caution
AE
Nursing

A
  • MOA:
    > incrs insulin SECRETION
    > incrs insulin receptor sensitivity
    > dcrs hepatic production glucose
  • Route: oral
  • Caution: sulfa allergy
  • AE: Hypoglycemia, skin rash; hypoglycemia more likely if: low calories, prolonged exercise, alcohol, other DM meds, older adults
  • Nursing: take w/ meal
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10
Q

Empagliflozin (Jardiance) (Sodium Glucose Cotransporter Inhibitors - SGLT2 Inhibitors)

MOA
Route
AE

A
  • MOA: Blocks glucose REABSORPTION in kidney, thus excreting more glucose (blocks Na/K pump in kidney; responsible for 90% of glucose reabsorption)
  • Route: oral
  • AE: UTI, genital fungal infection, dehydration & associated symptoms
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11
Q

Liraglutide (Victoza) (Incretin Mimetics/GLP-1 Agonists)

MOA
Route
AE
Nursing

A
  • MOA: acts on beta cells to incr insulin RELEASE; dcrs glucagon release; slow gastric emptying; incr satiety
  • Route: SQ (daily)
  • AE: hypoglycemia, N/V/D, weight loss
  • Nursing: teach self-injection
  • sometimes prescribed for weight loss
  • good to study w/ sitagliptin
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12
Q

Sitagliptin (Januvia) (Dipeptidyl Peptidase {DDP-IV} Inhibitors)

MOA
Route
AE
Nursing

A
  • MOA: slows breakdown of GLP-1 leading to incrd insulin RELEASE & dcrd glucagon release
  • Route: oral
  • AE: hypoglycemia w/ sulfonylurea
  • Nursing: general hypoglycemic protocol
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13
Q

GLP-1 Agonist

A
  • Glucagon-like peptide 1
  • GLP-1 is released from gut during digestion
  • GLP-1 inhibits glucagon secretion & incrs insulin secretion
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14
Q

Dipeptidyl Peptidase (DDP-IV) Inhibitor

A
  • An enzyme that breaks down incretins (like GLP-1)
  • Help stimulate the release of insulin when need (after meals) & reduce the production of glucagon when it is not needed
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15
Q

Glucagon (Glucose-Elevating Agents)

MOA
Route
Onset
AE
Nursing

A
  • MOA: accelerates the breakdown of glycogen to glucose in the liver, causing an incr in blood glucose lvls
  • Route: IM or SQ
  • Onset: 1 min; WORKS QUICKLY
  • AE: hyperglycemia, rebound hypoglycemia
  • Nursing:
    > admin SQ/IM if no IV access for severe hypoglycemia
    > give supplemental carbos to replenish depleted glycogen stores
    > monitor: VS, LOC, BG (rebound hypoglycemia)
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16
Q

Intravenous Dextrose 50% in Water (D50W) (Glucose-Elevating Agents)

A
  • MOA: incr circulating blood glucose
  • Route: IV push over 2-5mins
  • Onset: minutes
  • AE: hyperglycemia, electrolyte disturbances, hyperosmolarity; localized phlebitis, localized tissue necrosis - must have patent IV
  • Nursing:
    > admin IV (need patency) for severe hypoglycemia
    > give supplemental carbos when pt able to swallow safely to replenish depleted glycogen
    > monitor: VS, LOC, BG
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17
Q

Rapid Acting Insulin

A
  • Lispro (Humalog) & Aspart (Novolog)
  • Onset: 0.25hrs/15mins
  • Peak: 1-2hrs
  • Duration: 4hrs
  • Route: SQ
  • risk for low BG at peak action
  • admin 3x daily w/ meals
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18
Q

Short Acting Insulin

A
  • Regular
  • Onset: 0.5-1hr
  • Peak: 2-3hrs
  • Duration: 8hrs
  • Route: SQ or IV
  • risk for low BG at peak action
  • dose: hrly per protocol
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19
Q

Long Acting Insulin

A
  • Glargine (Lantus)
  • Onset: gradual
  • Peak: none
  • Duration: up to 24hrs
  • Route: SQ
  • lower risk for flow BG
  • admin 1-2x daily (12-24hrs)
  • aka basal insulin, given in lower volumes
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20
Q

x

Hypoglycemia (Causes & CMs)

A
  • Causes:
    > too much insulin or other antidiabetic
    > too little food
    > excess physical exercise
  • CMs:
    > cool, clammy skin, tremors, headache, hunger, irritability, change in LOC
    > progression: hypotension, tachycardia, fainting, seizures, coma, death
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21
Q

Hypoglycemia Management - Conscious & Able to Eat Pt

A
  • BG <70
  • Give pt 15g rapid-acting simple carbo (sugar)
    > 4 glucose tabs; 3tsp of sugar; 1/2c juice (most common); 1c milk; 4oz soda
  • Recheck BG in 15 mins
  • Repeat until BG >80
  • Once >80, recheck BG in 1hr, call PCP if <70 still
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22
Q

Hypoglycemia Management - Unconscious or NPO Pt

A
  • IV access: admin 25-50mL D50W IV push
  • No IV access: admin Glucagon 1mg SQ/IM; turn pt on side; START IV
  • Recheck BG in 15 mins; call PCP for further orders
  • Repeat until BG above >80
  • Once pt able to swallow give 30g carbo
  • Recheck BG in 1 hr; if BG <70 call PCP
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23
Q

Prednisone (Systemic Corticosteroids)

MOA
Indication
Contraindication
D-D
AE

A
  • MOA: anti-inflamm & immunosuppressive effects
  • Indication: inflammatory & allergic disorders
  • Contraindications: acute infection, DM, acute peptic ulcers, CHF, older adult
  • Drug-Drug: quinolone antibiotics, NSAIDS, immunosuppressants, live vaccines
  • AE:
    > short term: gastric irritation, immunosuppression, edema (HTN, weight gain), insomnia, appetite incr, masks s/s of infection, steroid psychosis
    > long term: Cushing’s syndrome, hypernatremia, hypokalemia, growth suppression (children); adrenal suppression
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24
Q

Cushing’s Syndrome

A
  • Weight gain/redistribution of fat
    > Moon face
    > Buffalo hump
    > Pendulous abdomen and stretch marks
  • Hyperglycemia
  • Osteoporosis
  • Hypertension
  • Muscle atrophy (arms/legs)
  • Bruise easily/purpura
  • Skin thins/poor healing
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25
Q

Review slides 12, 14, 15 of endocrine drugs on wk 5

A
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26
Q

Nursing Assessment - Corticosteroids

A
  • Physical exam focused on cardiac, respiratory, neuron, s/s infection
    > monitor VS closely for HTN, fever
  • Labs: CBC, creatinine/BUN, electrolytes (Na/K), BG
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27
Q

Nursing Diagnosis - Corticosteroids

A
  • Excess fluid volume r/t water/sodium retention
  • Risk for infection r/t immunosuppression
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28
Q

Expected Outcomes - Corticosteroids

A
  • Therapeutic effect w/ limited AEs
  • Understanding of drug therapy, AEs, safety
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29
Q

Nursing Interventions - Corticosteroids

A
  • Admin in morning (normal peak diurnal concentration) & multiple dose in equal intervals (homeostasis)
  • Take w/ food
  • Taper dose when d/c long term use or from high doses
  • Do not give live vaccines when immunosuppressed (risk infection)
  • Avoid unnecessary exposure to infection
  • Educate: avoid infections, taking dose as appropriate, s/s adrenal crisis, managing AEs
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30
Q

Nursing Evaluation - Corticosteroids

A
  • Therapeutic response
  • AEs
  • Teaching; was it effective?
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31
Q

Levothyroxine (Synthroid) (Thyroid Agents)

MOA
Indication
AEs (CMs)
BB
Nursing

A
  • MOA: replaces hormones
  • Indication: hypothyroidism
  • AE: r/t too much med (hyperthyroidism); need PCP to adjust dose
    >CMs: nervousness, insomnia, tremors, tachycardia, palpitations, angina, arrhythmias, diaphoresis, heat intolerance
  • BB: contraindicated for weight loss
  • Nursing: teach; take med at same time every day on EMPTY STOMACH
    > report: CMs, assess & monitor BP + pulse, monitor TSH lvls
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32
Q

Vasopressin (Synthetic ADH)

MOA
Indications
AEs
Nursing

A
  • MOA: incrs water permeability in renal tubular cells resulting in dcrd urine vol & incrd urine osmolality (incrs reabsorption of water)
  • Indications: neurogenic diabetes insipidus; severe hypotension
  • AE: r/t too much med (Syndrome of inappropriate antidiuretic hormone secretion); need PCP to adjust med
    > SIADH: water intox/cerebral edema (hyponatremia, HTN, seizures, coma)
    > high doses: direct vasoconstriction; HTN
  • Nursing: monitor BP, HR, urine specific gravity, plasma/urine osmolality, serum electrolytes, s/s of hyponatremia
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33
Q

Estrogen (Hormone Replacement Therapy)

MOA
Indication
Route
Contraindictions
AEs

A
  • MOA: replace endogenous estrogen
  • Indication: vasomotor symptoms of menopause, uterine bleeding, osteoporosis, atrophic vaginitis, cancers & more
  • Route: oral, transdermal, topical
  • Contraindications: pregnancy, hx of VTE
  • AE: VTE, photosensitivity (BEGEL(S))
  • BB: endometrial & breast cx, cardiovascular events
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34
Q

Nursing Assessment - HRT/Estrogens

A
  • Menstrual hx
  • Last PAP/breast exam
  • Hx of VTE
  • Tobacco use
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35
Q

Nursing Interventions - HRT/Estrogens

A
  • Instruct pt to take oral drug at same time every day w/ meals or a snack to minimize GI upset
  • Instruct pt to change patch 1 or 2x weekly & apply to lower abdomen
  • Educate pt to immediately report high BP, severe headache, edema, abdominal pain, chest pain
36
Q

BEGEL(S) w/ Cream Cheese

A

B = Breakthrough bleeding
E = Edema
G = GI effects (N/V/bloating)
E = Embolism
L = Lost libido
(S) = Stop smoking
C = Contraceptives less effective w/ antibiotics
C = Cardiovascular events; incrd risk

37
Q

Norethinedrone/Ethyl Estradiol (Loestrin) (Oral Contraceptives)

MOA
Indication
Contraindications
AE
BB

A
  • MOA: prevent ovulation; incr uterine mucous viscosity which dcrs sperm movement & prevents implantation of fertilized egg
  • Indication: pregnancy prevention, hypermenorrhea
  • Contraindications: pregnancy category X, hx of VTE
  • AE: photosensitivity, breakthrough bleeding/menstraul irregularities, changes in libido, fluid retention (edema, headaches, dizziness), GI effects (N/V, abd cramps, bloating), VTE
  • BB: endometrial & breast cx, cardiovascular events
38
Q

Nursing Assessment - Contraceptives

A
  • Lifestyle, menstrual cycle, pregnancy hx, wellness exams, cx screenings
  • Risk for cardiovascular events
39
Q

Nursing Interventions - Contraceptives

A
  • Counsel tobacco smokers on cessation
  • Educate route, timing, AEs
    > oral: pill must be taken at same time each day; missed dose follow package directions & use alternate form of contraception for 7 days
    > contraceptives less effective when taking antibiotics; use alternate form of birth control
  • May take w/ food if GI upset occurs
  • Use condoms to prevent STIs
40
Q

Alendronate (Fosamax) (Bisphosphonates)

MOA
Indications
Contraindications
AE
Nursing

A
  • MOA: slows bone resorption
  • Indications: osteoporosis
  • Route/Dose: oral daily or weekly
  • Contraindications: esophageal or gastric ulcer, esophagitis
  • AE: esophageal erosion, GERD
  • Nursing: teach; take in AM w/ full glass of water 30 min prior to food or drink, sit upright for at least 30 mins after admin; limit use to 5yrs (long half-life)
41
Q

Finasteride (Prosper) (5-Alpha Reductase Inhibitor)

MOA
Indication
AE

A
  • MOA: blocks testosterone; shrinks prostate
  • Indication: benign prostatic hypertrophy
  • AE: hypotension, sexual dysfunction
42
Q

Tamsulosin (Flomax) (Alpha-1 Adrenergic Blockers)

MOA
Indications
D-D
AE
Nursing

A
  • MOA: blocks alpha-1 adrenergic receptor in smooth muscle of prostate, relaxes bladder neck and urethra; allows urine flow
  • Indications: benign prostatic hypertrophy
  • Drug-Drug: antihypertensive drugs
  • AE: hypotension, sexual dysfunction
  • Nursing: monitor closely for hypotension; monitor for symptom improvement
43
Q

Sildenafil (Viagra) (drugs for penile erectile dysfunction)

MOA
Indications
Route
Contraindications
D-D
AE

A
  • MOA: causes prolonged smooth muscle relaxation; allowing flow of blood into corpus cavernous & facilitating erection
  • Indications: penile erectile dysfunction
  • Route: oral prior to sexual stimulation
  • Contraindications: numerous; check drug resource prior to admin
  • Drug-Drug: no nitrates w/in previous 24hrs; no alpha-adrenergic blockers
  • AE: hypotension, headache
44
Q

Nursing Implications for Finasteride

A
  • Women of childbearing age should wear gloves when handling med
  • Pregnant women should NOT handle the med; Pregnancy category X
  • Pts should NOT donate blood or father a child while taking this med
  • Symptom improvement should occur in 3-6mnths
45
Q

Pt Education for Sildenafil

A
  • Take 1hr prior to sexual stimulation
    > onset: 1hr, duration: 4-6hrs
    > high-fat meal will delay absorption
  • Prolonged erection (>4hrs) should be reported to prescriber immediately (medical emergency)
  • AEs include hypotension & headache
    > report: dizziness, lightheadedness, syncope
  • Don’t take w/ nitrate; unsafe drop in BP
  • Avoid grapefruit juice (dcrs metabolism, incrs drug)
46
Q

Testosterone (male hormone replacement)

MOA
Indication
Routes
AE
BB
Nursing

A
  • MOA: replace testosterone
  • Indication: androgen deficiency
  • Routes: oral, buccal, injectable, topical
  • AE: changes in libido, acne, male pattern baldness, abn liver func tests, elevated cholesterol
  • BB: VTE, MI
  • Nursing: anabolic steroids limited use (DEA schedule III drug), abuse risk of sterility, cardiovascular disease, liver cx
47
Q

Testosterone Functions

A
  • Development of bone & muscle tissue
  • Inhibition of protein catabolism
  • Retention of nitrogen, phosphorus, potassium & sodium
  • Stimulates production of RBCs
48
Q

Androgen Deficiency

A
  • CMs:
    > low energy
    > difficulty sleeping
    > reduced exercise
    > endurance
    > depression
    > short term memory loss
    (labs to test: liver function, serum testosterone, RBCs count)
49
Q

Contraindications & Warnings - Contraceptive Drugs

A
  • Pregnancy/lactation (Cat. X)
  • Hx of cardiovascular disease (DVT, MI, CVA)
  • Smoking incrs risk of VTE
  • Contraceptives less effective when taken w/ antibiotics
  • BB Warning:
    > incrd risk of cardiovascular events
    > incrd risk of endometrial & breast cx
50
Q

Common Adverse Effects - Antibiotics

A
  • GI effects
    > N/V/D
  • Skin effects
    > rash, hives
  • Hypersensitivity Reactions
    > may be immediate, w/ next exposure, or delayed allergic; in severe cases anaphylaxis can occur (PCN & Sulfa)
    > cross-sensitivity (penicillin & cephalosporins) possible
    > allergy vs adverse effect
  • Superinfections/secondary infections
51
Q

Superinfections / Secondary Infections

A
  • Cause:
    > host flora suppressed by antibiotics; pathogenic microorganisms multiply
  • CMs Vary:
    > diarrhea/cramping, painful urination, abn vaginal discharge, rash
  • EX:
    > Clostridium difficile (C-diff) overgrowth
    > Candida albican (oral or vaginal yeast)
  • Prevention:
    > probiotics; limited evidence
52
Q

Key Drug-Drug Interactions w/ Antibiotics

A
  • Warfarin
    > antibiotics incr anticoagulant effect
    > monitor PT/INR
  • Oral Contraceptives
    > antibiotics dcr effectiveness
    > use alternative birth control method
53
Q

Potential Toxicities Associated w/ Antibiotics (order of probability)

A
  1. Acute Kidney Injury
    > CM: dcr urine output, protein in urine, elevated creatinine & BUN; dcrd GFR
    > Prevention: adequate hydration
  2. Neurotoxicity
    > CM: headache, dizziness, confusion, loss of hearing (ototoxicity), vision damage
  3. Liver Toxicity
    > CM: hepatitis (jaundice, elevated liver func test)
54
Q

General Nursing Responsibilities Associated w/ Antibiotic Therapy - Prior to Administration

A
  • Complete assessment & hlth hx
    > diseases, pregnancy, allergies, drugs, OTCs, alcohol
  • Obtain cultures as indicated
    > should not delay care, nurse may obtain culture - hold for order
  • Note S/S of current infection
    > severe, fatigue, elevated WBC count, redness, swelling, discomfort
55
Q

General Nursing Responsibilities Associated w/ Antibiotic Therapy - Oral Administration

A
  • Take on empty stomach w/ full glass of water 1hr before meals or 2-3hrs after
  • Do not take w/ fruit juice, soft drinks, or milk
  • Ciprofloxacin: may give w/ food, admin 4hrs before antacids & ferrous sulfate’ no dairy (dcrs absorption)
  • Erythromycin: do not give w/ fruit juices
  • Sulfamethoxazole: may give w/ food to alleviate GI effects
  • Doxycycline: no dairy (dcrs absorption), admin w/ full glass of water (dcrs esophageal irritation), antacids 1hr after
56
Q

General Nursing Responsibilities Associated w/ Antibiotic Therapy - Intravenous Administration

A
  • Observe site for phlebitis
  • Check rate of infusion or intravenous push (IVP)
  • Check compatibility w/ meds/IV fluids
  • Some antibiotics central line preferred (Vancomycin)
57
Q

General Nursing Responsibilities Associated w/ Antibiotic Therapy - Throughout Administration

A
  • Monitor & report
    > therapeutic effects
    > lab values: CBC, kidney func, LFTs
    > AEs
  • Peak or trough if appropriate
  • Ensure adequate hydration or prevent accumulation of drug & reduce risk of AKI
58
Q

General Nursing Responsibilites - Antibiotics

A
  • Pt Education:
    > take as directed (entire prescription)
    > females taking BC pills (use alternative protection)
    > drink 3L water/day
    > report AE to PCP
59
Q

Gentamicin (Aminoglycosides)

AE
BB
Nursing

A
  • AE: 8th CN (tinnitus, hearing loss) & general
  • BB: nephrotoxicity, neurotoxicity
  • Nursing: draw peak; general
60
Q

Ertapenem (Carbapenems)

AE
Nursing

A
  • AE: N/V/D, rash, hives, hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
  • Nursing: all general
    “Hit them with the big guns”
61
Q

Ciprofloxacin (Fluoroquinolone)

AE
Nursing

A
  • AE: photosensitivity; tendon rupture possible if taken w/ corticosteroids; dysrhythmias w/ IV route - need telemetry
  • Nursing: telemetry if indicated, wear sunscreen, general notes
62
Q

Erythromycin (Macrolides)

AE
Nursing

A
  • AE: N/V/D, rash, hives, hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
  • Nursing: general notes
63
Q

Amoxicillin (Penicillin)

Contraindications
D-D
AE
Nursing

A
  • Contraindications: sensitivity to cephalosporin, pregnancy Cat. B
  • Drug-Drug: dcrs effectiveness of oral contraceptives, incrs anticoagulation effect of warfarin
  • AE: N/V/D, rash, hives. hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
  • Nursing; general notes
64
Q

Cefazolin (Caphalosproins 1st Gen)

Contraindication
D-F
AE
Nursing

A
  • Contraindications: allergy to penicillin, pregnancy B
  • Drug-Food: alcohol
  • AE: systemic routes higher risk toxicities, N/V/D, rash, hives. hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
  • Nursing: avoid alcohol (7 days), general notes
65
Q

Sulfamethoxazole/Trimethoprim (SMZ-TMP) (Sulfonamides)

Containdications
AE
Nursing

A
  • Contraindication: Sulfa allergy, pregnancy C/D
  • AE: GI effects, photosensitivity
  • Nursing: wear sunscreen, highly resistant, general notes
66
Q

Doxycycline (Tetracycline)

AE
Contraindication
D-D
Nursing

A
  • AE: teeth discoloration, photosensitivity
  • Contraindication: pregnancy (slow fetal skeletal growth, children under 8-tooth enamel hypoplasia)
  • Drug-Drug: dcrs effectiveness of oral contraceptives
  • Nursing: use sunscreen, general notes
67
Q

Vancomycin (Misc. Antibiotic)

Indications
AE
Nursing

A
  • Indications: severe infections by MRSA
  • AE: superinfection, nephrotoxicity, ototoxicity, Red Man Syndrome - histamine release/anaphylactic response; severe hypotension, fever, chills, paresthesia, & erythema (neck & back)
  • Nursing: admin over at least 1hr; central line preferred, draw trough lvls - dose adjusted by PCP, renal function, general notes
68
Q

Metronidazole (Misc. Antibiotic/Antiprotozal)

AE
Nursing

A
  • AE: metallic taste, severe N/V w/ alcohol intake
  • Nursing: avoid alcohol, general notes
69
Q

Tuberculosis (TB) Treatment Medications (Misc. Antibiotics/Antimycobacterial Agents)

A
  • Prescribed in combination (2+ agents) to incr effective & dcr emergence of resistant strains
  • Common 1st-line drugs included Isoniazid, Rifampin, Pyrazinamide
  • Major AE: N/V/D, orange tint to body fluids, neuropathy, bone marrow suppression, liver toxicity
  • Drug-Drug: Antihypertensives, corticosteroids, oral contraceptives, oral anticoagulants, oral anti antidiabetic agents
70
Q

Oseltamivir (Tamiflu) (Neurominidase Inhibitors)

A
  • MOA: prevents entry of virus into cell stops replication
  • Indications: treatment or prophylaxis to dcr influenza symptoms
  • Route: PO
  • Contraindications: pregnancy/breastfeeding
  • AE: N/V/D
  • Nursing:
    > Tx should be initiated w/in 48hrs of symps
    > Do not admin 48hr before flu vaccine or 2 weeks after
    > may take w/ food to dcr GI intolerance
71
Q

Acyclovir (Purine Nucleoside Analog)

MOA
Imdications
Routes
AE
Nursing

A
  • MOA: interrupts viral DNA synthesis & replication
  • Indications: herpes, varicella zoster
  • Routes: topical, oral, IV
  • AE:
    > oral: malaise, headache, N/V/D
    > IV; nephrotoxicity/neurotoxicity possible
  • Nursing:
    > oral: admin ATC w/ food
    > topical: follow guidelines
    > IV: infuse over 1hr to dcr renal damage; ensure pt hydrated
72
Q

Nystatin (Topical Antifungal Agents)

MOA
Indications
Routes
AE
Nursing

A
  • MOA: incrs cell wall permeability; cell death
  • Route: PO, topical
  • Indications: candida infections of vagina, skin, mouth
  • AE:
    > topical: contact dermatitis
    > oral: N/V/D
  • Nursing:
    > Oral candida: direct pts to swish 2 min & swallow; children - swab
    > topical: apply to affected area
73
Q

Fluconazole (Diflucan) (systemic antifungal agent: azoles)

MOA
Indications
Routes
AE
Contraindications
D-D
Nursing

A
  • MOA: incrs cell wall permeability; cell death
  • Indications: systemic or superficial fungal infections
  • Route: oral, IV
  • AE: N/V/D, long duration: liver toxicity
  • Contraindications: pregnancy; liver disease
  • Drug-Drug: Warfarin (bleeding), antidiabetics (hypoglycemia), H2 blockers
  • Nursing: monitor labs (LTFs); long duration common (3-6mnths)
74
Q

Acetaminophen (Tylenol) (non-opioid analgesic)

MOA
Indications
Contraindications
AE
Toxicity
Nursing

A
  • MOA: inhibits prostaglandin synthesis in the CNS; unclear how/which COX pathways
  • Indications: reduce pain & fever (no effect on peripheral inflamm, NOT an NSAID)
  • Contraindications: chronic alcoholism, reduced liver func
  • AE:
    > common: headache, skin rash (generally well-tolerated)
    > rare: liver toxicity (overdose or liver disease)
  • Toxicity: acute liver failure; antidote: acetylcysteine
  • Nursing: max dose 4g/day (4000mg/day); consider combo meds (highlighted in yellow)
75
Q

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) General Notes

A
  • Indications:
    > analgesia (pain): musculoskeletal disorders/inflamm (OA, RA, ankle sprain)
    > fever
    > CVD prevention (aspirin only)
  • Common AE: N/V, gastritis/epigastric pain, peptic ulcers, upper GI bleedings
  • Contraindications: kidney disease, PUD, alcohol use
  • Drug-Drug: anticoagulants, corticosteroids, other NSAIDS
76
Q

Aspirin (ASA) (Anti-Inflamm: Salicylates) (NSAIDS)

MOA
Indications
Contraindications
AE
Nursing

A
  • MOA: dcr inflamm & platelet aggregation (non-selective cox inhibitor - blocks both COX 1&2); irreversibly inhibits Cox 1
  • Indications: mild pain, inflamm (high dose: 325-650mg po prn); Anticoagulation (platelet inhibitor) for CVD (low dose: 81mg or 325 po daily)
  • Contraindications: viral illness children (Reye syndrome)
  • AE: easy bruising, general notes
  • Nursing: hold 1wk prior to procedures/surgery
    >teach: take as prescribed, take w/ food & full glass of water; report GI pain &/or dark/bloody stools, monitor H/H if UGI bleed
77
Q

Ibuprofen (Advil) (NSAIDS)

MOA
Max Dose
BB
AE
Nursing

A
  • MOA: suppresses inflammation (non-selective Cox inhibitor)
  • Max Dose: 3200mg/day in divided doses (prescripition); 1200mg/day in divided doses (OTC)
  • BB: GI bleeding; risk: MI, CVA
  • AE: chronic use; NA/water retention (edema), HTN, rare: AKI, general notes
  • Nursing: follow dosing, avoid chronic use, take w/ full glass water or food
78
Q

Gabapentin (Neurontin) (adjuvant)

MOA
Uses
D-D
Route/Dose
AE
Nursing

A
  • MOA: chemical analogue of GABA (inhibiting neurotransmitter)
  • Uses: anticonvulsant (seizures), post herpetic neuralgia, neuropathy, off label; neuropathies
  • Drug-Drug: CNS depressants
  • Route/Dose: oral; titrate as directed
  • AE: drowsiness, confusion, unsteady gait, impaired cognition
  • Nursing: slow titration when incring & dcring doses, do not operate heavy machinery; fall risk
79
Q

Baclofen (central skeletal muscle relaxant) (adjuvant)

MOA
Indications
D-D
AE
Nursing

A
  • MOA: inhibits spinal reflexes in CNS
  • Indications: spinal cord injury, multiple sclerosis, spinal cord disease
  • Drug-Drug: CNS depressants, alcohol
  • AE: drowsiness, dizziness, constipation, hypotension, urinary frequency
  • Nursing: monitor CNS, do not operate heavy machinery, fall risk
80
Q

Nurse Role: Managing Controlled Substances

A
  • Access to controlled substances
    > licensed personnel: nurse, physicians, advanced practice providers, pharmacists, RT
    > authorized personnel: pharmacy techs & pharmacy interns
  • Retrieve meds immediately prior to admin
  • May not leave meds at bedside (unless locked & properly labeled)
  • Unused portions waste or return immediately
  • Waste procedure:
    > should not be disposed of in modalities where retrieval is possible: pharmaceutical waste container (not wastewater or sharps)
    > requires a witness (licensed or authorized)
81
Q

Opioid Agonists (AE, Caution, Contraindications)

A
  • AEs: sedation, resp depression, drowsiness, constipation, urinary retention, N/V, hypotension, itching, euphoria (abuse), hallucinations, bradycardia
  • Caution: hypersensitivity, opioid naive, resp disease (asthma, COPD, PNA), pregnancy
  • Contraindications: resp depression, substance abuse
82
Q

Naloxone (Narcan) (opioid antagonist)

MOA
Indication
Route & Dose
Onset, peak, duration
AE
Nursing

A
  • MOA: block opioid activity at opioid receptor
  • Indication: reverse overdose
  • Route: IV, inhaled
  • Dose: repeat in 2-3mins if resp status does not improve
  • Onset: 1-2min
  • Peak: 5-15min
  • Duration: 45min (IVP)
  • AE: rapid loss of analgesia, incrd BP, tachycardia, hyperventilation, N/V/D, tremors, sweating
  • Nursing: careful monitoring of pt (resp status); have resuscitative equipment available
83
Q

Codeine (opioid agonist)

A
  • MOA: depresses pain transmission at spinal cord lvl by interacting w/ opioid receptors; dcrs cough reflex, dcrs GI motility
  • Use: mild to mod pain; off label use: diarrhea, nonproductive cough
  • Caution:
    > 10% of codeine is metabolized to morphine by liver
    > metabolism unpredictable, varies by race
84
Q

Oxycodone (OxyContin) (opioid agonist)

A
  • Use: moderate to severe pain; acute & chronic pain
  • Route/Dose: PO prn or scheduled
  • Short acting (immediate release-IR)
    > breakthrough pain (post-surgical): Oxycodone IR 5mg PO q6hr PRN
  • Long acting (extended release-ER)
    > chronic pain: Oxycodone ER 30mg PO q12hr; do not split, crush, or chew
85
Q

Morphine (opioid agonist)

A
  • Use: acute & chronic pain
  • Dose/Route Considerations:
    > morphine considered “gold standard” for doing opioids; EX: morphine 30mg equiv to 200mg, oxycodone 20mg, fentanyl 12.5mcg
    > IV push: follow facility protocol, deliver over 4-5mins, monitor closely for AEs, peaks @ 20 mins
86
Q

Fentanyl (opioid agonist)

A
  • Use: acute & chronic pain, adjunct to general anesthesia
  • Dose/Route Considerations:
    > IV: onset 1min, peak 3-5 min, duration 30-60min; common dose: 50mcg q1-2hrs PRN; commonly used PCA pumps, same considerations as morphine for IVP
    > Transdermal: half-life 13-22hrs; common dose: 25mcg/hr, change patch q72hrs

NUR 3180 PHARM (6 decks)

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