Exam 2 Study Guide Flashcards
1
Q
Insulins
A
- Rapid-acting: Lispro & Aspart
- Short: Regular
- Long-acting: Glargine
2
Q
Glucose Elevating Agents
A
- Intravenous D50W
- Glucagon
3
Q
Non-Insulin (Oral)
A
- Metformin
- Glipizide
- Empagliflozin
- Sitagliptin
4
Q
Non-Insulin (SQ)
A
Liraglutide
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
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
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)
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)
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
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
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
25
Review slides 12, 14, 15 of endocrine drugs on wk 5
26
Nursing Assessment - Corticosteroids
- Physical exam focused on cardiac, respiratory, neuron, s/s infection
> monitor VS closely for HTN, fever
- Labs: CBC, creatinine/BUN, electrolytes (Na/K), BG
27
Nursing Diagnosis - Corticosteroids
- Excess fluid volume r/t water/sodium retention
- Risk for infection r/t immunosuppression
28
Expected Outcomes - Corticosteroids
- Therapeutic effect w/ limited AEs
- Understanding of drug therapy, AEs, safety
29
Nursing Interventions - Corticosteroids
- 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
30
Nursing Evaluation - Corticosteroids
- Therapeutic response
- AEs
- Teaching; was it effective?
31
Levothyroxine (Synthroid) (Thyroid Agents)
| MOA
Indication
AEs (CMs)
BB
Nursing
- 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
32
Vasopressin (Synthetic ADH)
| MOA
Indications
AEs
Nursing
- 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
33
Estrogen (Hormone Replacement Therapy)
| MOA
Indication
Route
Contraindictions
AEs
- 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
34
Nursing Assessment - HRT/Estrogens
- Menstrual hx
- Last PAP/breast exam
- Hx of VTE
- Tobacco use
35
Nursing Interventions - HRT/Estrogens
- 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
BEGEL(S) w/ Cream Cheese
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
Norethinedrone/Ethyl Estradiol (Loestrin) (Oral Contraceptives)
| MOA
Indication
Contraindications
AE
BB
- 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
Nursing Assessment - Contraceptives
- Lifestyle, menstrual cycle, pregnancy hx, wellness exams, cx screenings
- Risk for cardiovascular events
39
Nursing Interventions - Contraceptives
- 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
Alendronate (Fosamax) (Bisphosphonates)
| MOA
Indications
Contraindications
AE
Nursing
- 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
Finasteride (Prosper) (5-Alpha Reductase Inhibitor)
| MOA
Indication
AE
- MOA: blocks testosterone; shrinks prostate
- Indication: benign prostatic hypertrophy
- AE: hypotension, sexual dysfunction
42
Tamsulosin (Flomax) (Alpha-1 Adrenergic Blockers)
| MOA
Indications
D-D
AE
Nursing
- 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
Sildenafil (Viagra) (drugs for penile erectile dysfunction)
| MOA
Indications
Route
Contraindications
D-D
AE
- 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
Nursing Implications for Finasteride
- 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
Pt Education for Sildenafil
- 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
Testosterone (male hormone replacement)
MOA
Indication
Routes
AE
BB
Nursing
- 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
Testosterone Functions
- Development of bone & muscle tissue
- Inhibition of protein catabolism
- Retention of nitrogen, phosphorus, potassium & sodium
- Stimulates production of RBCs
48
Androgen Deficiency
- CMs:
> low energy
> difficulty sleeping
> reduced exercise
> endurance
> depression
> short term memory loss
(labs to test: liver function, serum testosterone, RBCs count)
49
Contraindications & Warnings - Contraceptive Drugs
- 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
Common Adverse Effects - Antibiotics
- 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
Superinfections / Secondary Infections
- 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
Key Drug-Drug Interactions w/ Antibiotics
- Warfarin
> antibiotics incr anticoagulant effect
> monitor PT/INR
- Oral Contraceptives
> antibiotics dcr effectiveness
> use alternative birth control method
53
Potential Toxicities Associated w/ Antibiotics (order of probability)
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
General Nursing Responsibilities Associated w/ Antibiotic Therapy - Prior to Administration
- 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
General Nursing Responsibilities Associated w/ Antibiotic Therapy - Oral Administration
- 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
General Nursing Responsibilities Associated w/ Antibiotic Therapy - Intravenous Administration
- 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
General Nursing Responsibilities Associated w/ Antibiotic Therapy - Throughout Administration
- 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
General Nursing Responsibilites - Antibiotics
- Pt Education:
> take as directed (entire prescription)
> females taking BC pills (use alternative protection)
> drink 3L water/day
> report AE to PCP
59
Gentamicin (Aminoglycosides)
| AE
BB
Nursing
- AE: 8th CN (tinnitus, hearing loss) & general
- BB: nephrotoxicity, neurotoxicity
- Nursing: draw peak; general
60
Ertapenem (Carbapenems)
| AE
Nursing
- AE: N/V/D, rash, hives, hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
- Nursing: all general
"Hit them with the big guns"
61
Ciprofloxacin (Fluoroquinolone)
| AE
Nursing
- AE: photosensitivity; tendon rupture possible if taken w/ corticosteroids; dysrhythmias w/ IV route - need telemetry
- Nursing: telemetry if indicated, wear sunscreen, general notes
62
Erythromycin (Macrolides)
| AE
Nursing
- AE: N/V/D, rash, hives, hypersensitivity reactions, cross-sensitivity, superinfections/secondary infections
- Nursing: general notes
63
Amoxicillin (Penicillin)
| Contraindications
D-D
AE
Nursing
- 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
Cefazolin (Caphalosproins 1st Gen)
| Contraindication
D-F
AE
Nursing
- 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
Sulfamethoxazole/Trimethoprim (SMZ-TMP) (Sulfonamides)
| Containdications
AE
Nursing
- Contraindication: Sulfa allergy, pregnancy C/D
- AE: GI effects, photosensitivity
- Nursing: wear sunscreen, highly resistant, general notes
66
Doxycycline (Tetracycline)
| AE
Contraindication
D-D
Nursing
- 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
Vancomycin (Misc. Antibiotic)
| Indications
AE
Nursing
- 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
Metronidazole (Misc. Antibiotic/Antiprotozal)
| AE
Nursing
- AE: metallic taste, severe N/V w/ alcohol intake
- Nursing: avoid alcohol, general notes
69
Tuberculosis (TB) Treatment Medications (Misc. Antibiotics/Antimycobacterial Agents)
- 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
Oseltamivir (Tamiflu) (Neurominidase Inhibitors)
- 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
Acyclovir (Purine Nucleoside Analog)
MOA
Imdications
Routes
AE
Nursing
- 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
Nystatin (Topical Antifungal Agents)
MOA
Indications
Routes
AE
Nursing
- 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
Fluconazole (Diflucan) (systemic antifungal agent: azoles)
MOA
Indications
Routes
AE
Contraindications
D-D
Nursing
- 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
Acetaminophen (Tylenol) (non-opioid analgesic)
MOA
Indications
Contraindications
AE
Toxicity
Nursing
- 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
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) General Notes
- 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
Aspirin (ASA) (Anti-Inflamm: Salicylates) (NSAIDS)
MOA
Indications
Contraindications
AE
Nursing
- 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
Ibuprofen (Advil) (NSAIDS)
MOA
Max Dose
BB
AE
Nursing
- 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
Gabapentin (Neurontin) (adjuvant)
MOA
Uses
D-D
Route/Dose
AE
Nursing
- 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
Baclofen (central skeletal muscle relaxant) (adjuvant)
MOA
Indications
D-D
AE
Nursing
- 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
Nurse Role: Managing Controlled Substances
- 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
Opioid Agonists (AE, Caution, Contraindications)
- 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
Naloxone (Narcan) (opioid antagonist)
MOA
Indication
Route & Dose
Onset, peak, duration
AE
Nursing
- 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
Codeine (opioid agonist)
- 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
Oxycodone (OxyContin) (opioid agonist)
- 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
Morphine (opioid agonist)
- 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
Fentanyl (opioid agonist)
- 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
