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Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Antidysrhythmics, beta blockers, calcium channel blockers, itraconazole

A

negative inotropes and may worsen HF

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2
Q

cyclophosphamide (Cytoxin), daunorubicin (cerubidine), doxorubicin (adriamycin)

A

cardiotoxic and may worsen HF

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3
Q

androgens, estrogens, glucocorticoids, NSAIDS, rosiglitazone (Avandia), pioglitazone (Actos)

A

drugs that cause increased blood volume and may worsen HF

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4
Q

6 mechanisms of action against HF

A 
adrenergic blockers
cardiac glycosides
phophodiesterase inhibitors
vasodilators
ACEI and ARBs
Diuretics
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5
Q

adrenergic blockers

A

treat HF by decreasing cardiac workload by slowing HR (B1) and decreasing BP (A1)
Carvedilol

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6
Q

Cardiac Glycosides

A

treat HF by increasing cardiac output by increasing the force of myocardial contraction
Digoxin

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7
Q

Phophodiesterase inhibitors

A

treat HF by increasing CO by increasing force of myocardial contraction
Milrinone

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8
Q

Carvedilol

A

adrenergic blocker-treats HF

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9
Q

Digoxin

A

cardiac glycoside treats HF

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10
Q

milrinone

A

phophodiesterase inhibitor treats HF

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11
Q

vasodilators

A

treat HF by decreasing cardiac workload by dilating vessels and reducing preload
isosorbide dinitrate with hydralazine

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12
Q

ACEI and ARBs

A

treat HF by increasing CO by lowering BP and decreasing blood volume
lisinopril

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13
Q

Diurectics

A

treat HF by increasing CO by reducing fluid volume and decreasing blood pressure
furosemide

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14
Q

isosorbide dinitrate with hydralazine

A

vasodilator to treat HF by decreasing cardiac workload by dilating vessels and reducing preload

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15
Q

lisinopril

A

ACEI or ARB that treats HF by increasing CO by lowering BP and decreasing blood volume

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16
Q

furosemide

A

diuretic that treats HF by decreasing fluid volume and BP to increase CO

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17
Q 
nitrates
aspirin
clot-preventing drugs
beta blockers
statins
Calcium channel blockers
A

drugs to manage angina pectoris

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18
Q

Nitroglycerin

A

dilates veins and arteries
decrease myocardial workload
decrease preload (pooling of blood in periphery)
decrease myocardial ischemia to prevent vasospasm and dilates coronary arteries to increase perfusion
can be used for prevention of treatment

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19
Q

action of nitroglycerin

A

inactivate myosin and permissive vasodilation or relaxation of vessel tone occurs

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20
Q

Nitrates side effects/teaching

A

orthostatic hypotension
headaches, dizziness, vertigo, flushing, sweating

with the onset of angina, sit down and place on NTG tab under the tonge and wait 3-5 mins. If the angina has not subsided, take another tablet sublingually and wait 3-5 mins. If the angina has not subsided, take a third tablet and call 911 for help. Notify physician immediately.

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21
Q

Metoprolol, labetalol, propanolol

A

beta blockers for treatment of stable angina prevention
IV or PO
decrease HR, BP, contractility
cardioprotective
afterload of heart is reduced due to vasodilation
perfusion is improved through the coronaries bc of vasodilation and prolonged diastole
the heart can experience a greater Ejection Fraction due to prolonged diastolic filling time

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22
Q

Calcium Channel Blockers

A

diltiazem (Cardizem)
verapamil (Calan, Isoptin)
nifedipine (procardia, Adalat)
PO

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23
Q

Action of CCBs

A

decrease SA node automaticity and AV conduction to decrease HR and myocardial contractility

Decrease HR, BP, cause vasodilation, decrease preload and afterload, decrease myocardial oxygen needs

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24
Q

side effects of CCbs

A

Cardiovascular-hypotension, palpitations, and tachycardia
GI-constipation and nausea
Other-rash, flushing, and peripheral edema

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25
Q

Ranolazine (Ranexa)

A

can be used alone or with other angina meds, such as CCBs, beta blockers, or nitroglycerin

Unlike some other angine meds, Ranexa can be used with oral erectile dysfunction meds

Ranexa changes the metabolism of myocardium from fatty acid use for fuel to glucose, thereby decreasing metabolic needs

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26
Q

Treatment of Stable Angina

A

NTG, Beta Blockers, CCBs, ACEIs

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27
Q

treatment of unstable angina

A

NTG, heparin, clopidogrel, morphine, ASA

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28
Q

treatment of Prinzmetals angina

A

NTG and CCbs

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29
Q

Goals for treatment of MI (5)

A

reperfusion of blood supply to damage myocardium
reduce myocardial oxygen demand
control and prevent future myocardium dysrythmias
reduce post MI mortality
manage pain

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30
Q

10 drug classes to manage MI

A 
thrombolytic agents
aspirin
ADP receptor blockers
Glycoprotein IIb/IIIa Inhibitors
anticoagulants
nitrates
beta blockers
ACEIs and ARBs
Pain management (morphine or demerol)
statins-post MI
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31
Q

OANM

A 
oxygen
aspirin
nitroglycerin
morphine
treatment of MI
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32
Q

Thrombolytics

A 
directly break up clots; give within 30 mins-12 hours following MI
enhance activation of plasminogen
streptokinase (Streptase)
alteplase (tPA, Activase)
anistrplase (Eminase)
reteplase (Retevase)
tenecteplase (TNKase)
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33
Q

thrombolytics contraindications

A 
active bleeding or known bleeding d/o
Hx of hemorrhagic stroke or intracranial vessel malformation
recent major surgery or trauma
uncontrolled HTN
Pregnancy
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34
Q

enoxaparin (Lovenox)

A

LMWH

fibrinolysis should be started within 12 hrs to treat MI

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35
Q

Post MI care

A

ACEI/ARB
ASA or Antiplatelet agent
beta blocker or CCB
Statin

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36
Q

Captopril (Capoten)
Enalapril (Vasotec)
Benazepril (Lotensin)
Fosinpril (Monopril)

A

ACEI

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37
Q

Aspirin
Clopidogrel (Plavix)
Ticlopidine (Ticlid)-rarely used, neutropenia

A

antiplatelet agents

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38
Q

Prevent cardiac remodeling

A 
beta blockers 
Metoprolol (Lopressor)
Atenolol (Tenormin)
Propranolol
Esmolol
Labetalol
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39
Q

Amlodipine (Norvasc)

Diltiazem (Cardizem, Adalat)

A

CCBs

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40
Q

Statins action

A 
lower cholesterol
lovastatin (Mevacor)
pravastatin (Pravachol)
simvastatin (Zocor)
atorvastatin (Lipitor)
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41
Q

Dihydropyridine

A

treats MI?
nifdeipine (Adalat, Procardia XL)
blocks Calcium channels in the vascular smooth muscle decreasing the amount of intracellular calcium available for muscle contraction this results in the fall of BP
decrease myocardial oxygen demand due to the reduced afterload

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42
Q

Nondihydropyridines

A

verapamil (Calan, Isoptin)
Block l type calcium channels in vascular smooth muscle causing vasodilation
verapamil and diltiazem block calcium channels in the myocardium decreasing the rate of conduction reducing the HR reducing the contractility of the myocardium

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43
Q

benefit of Ranolazine (Ranexa)

A

effect on HR is minimal as the drug acts on myocardial metabolism

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44
Q

Nitrates adverse effects

A

secondary to vasodilation: headache, flushing, orthostatic hypotension
potential cardiovascular collapse if mixed with alcohol

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45
Q

nitrates disadvantage

A

tolerance builds quickly

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46
Q

What happens if you D/C a long acting nitroglycerin (Isosorbide dinitrate) abruptly?

A

vasospasm

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47
Q

nitrates contraindications

A

preexisting hypotension, head trauma (vasodilation would make these worse)
pericardial tamponade and constrictive pericarditis (vasodilation would make heart unable to maintain CO to maintain BP)
no sustained release tabs on pts with glaucoma (nitroglycerin may increase introcular pressure)
caution severe kidney/liver disease (toxic levels)
dehydration and hypovolemia should be corrected before nitroglycerin is administered (severe hypotension may occur)

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48
Q

Nitrate drug interactions

A

viagra none within 24 hrs before or after-cardiovascular collapse–>hypotension

ethanol, CCBs, antidepressants, phenothiazines, and anti HTN may cause additive Hypotension

sympathomimetics (EPI) antagonize vasodilation

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49
Q

Do you take beta blockers for Prinzmetals angina

A

no, they make it worse

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50
Q

Beta Blockers action in treating Angina

A

prevention
decrease HR, BP, contractility, workload
cardioprotective

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51
Q

Why beta blockers over nitrates for prevention of angina?

A

tolerance not an issue
possess antidysrythmic properties
ideal for common disorder combo of HTN and CAD
cardioprotective

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52
Q

when to DC beta blockers

A

gradually unless fatigue, lethargy, and depression occur
With long term care, the heart becomes more sensitive to catecholamines, which are blocked by beta blockers. when w/d abruptly, adrenergic receptors are activated and rebound excitation occurs. In pts with CAD, this can exacerbate angina, precipitate tachycardia, or cause an MI

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53
Q

beta blockers adverse effects at high doses?

A

SOB and respiratory distress secondary to bronchoconstriction therefore use caution with asthma and COPD pts

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54
Q

Beta blockers and diabetes?

A

beta blockers may mask the symptoms of hypoglycemia so diabetics should monitor blood glucose more closely

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55
Q

beta blockers contraindications

A

bradycardia (may lead to primary heart block)
cardiogenic shock
overt cardiac failure

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56
Q

Atenolol (Tenormin)

A

beta blocker (beta one selective)
anti anginal agent
treats HF, HTN, stable angina, and acute MI
PO 1/day
excreted 50% renal, 50% feces not metabolized!
anticholinergic may decrease GI absorption

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57
Q

beta blockers drug interactions

A

digoxin (and other antidysrythmics that depress myocardial conduction may lead to AV block)

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58
Q

adverse effects of beta blockers

A

bradycardia and hypotension

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59
Q

dyspnea on exertion, fatigue, pulmonary cogestion, peripheral edema

A

classic symptoms of HF

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60
Q

Why are ACEIs (or ARBs) a preferred drug in the treatment of HF?

A

ACEIs block the detrimental effects of angiontensin II and aldosterone on cardiac remodeling

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61
Q

Nesiritide (Natrecor)

A

has a limited role in HF treatment; ANP and BNP (Natrecor is BNP) cause diuresis, vasodilation, and decrease aldosterone secretion. Basically, Natriuretic peptides counteract the RAAS and SNS

give to patients with acutely decompensated heart failure

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62
Q

Patients at high risk for HF

A

make lifestyle changes
treat and control HTN, dyslipidemia, and diabetes
if htn, start ACEI

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63
Q

Patients with structural evidence of heart diseaes (MI or valvular disease) but no symptoms of HF

A

lifestyle, control of modifiable factors (HTN, lipids, diabetes)
ACEIs (ARBs)
Beta blockers if prior HF symptoms
Diurectics and salt restriction if fluid retention

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64
Q

Patients with structural evidence of heart disease with symptoms of HF such as fatigue, fluid retention, dyspnea

A

ACEI (ARB) and Beta Blocker
Add Digoxin and Spironolactone if needed to control sympotoms
If symptoms do not improve, add a loop or thiazide diuretic and a combo nitrate with hydralazine

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65
Q

3 goals of Pharmacotherapy of HF

A 
reduce preload
reduce afterload (reduce vascular resistance-BP)
Inhibit RAAS and SNS (which are vasoconstrictors)
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66
Q

adrenergic blockers for HF

A

Carvedilol

decrease cardiac worload by slowing the HR (B1) and decreasing BP (alpha 1)

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67
Q

Vasodilators for HF

A

isosorbide dinitrate with hydralazine

decrease cardiac workload by dilating blood vessels and reducing preload

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68
Q

ACEI and ARBs for HF

A

lisinopril, captopril

increase cardiac output by lowering BP and decreasing blood volume

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69
Q

Phosphodiesterase Inhibitors for HF

A

Milrinone

increase cardiac output by increasing the force of myocardial contraction

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70
Q

Cardiac glycosides for HF

A

Digoxin

increase CO by increasing the force of myocardial contraction

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71
Q

Main ACEI adverse effects

A

hypotension (worse at beginning of treatment and when dose is changed) caution with Beta blockers and diuretics

renal insufficiency resultant of decreased blood flow or hyponatremia from diurectics

angioedema, cough, hyperkalemia

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72
Q

What is a risk associated with ACEI + spironlcatone?

A

hyperkalemia

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73
Q

Losartan (Cozaar)

A

ARB used for HF when ACEI is not tolerated

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74
Q

Diurectics Action

A 
reduce peripheral edema
reduce pulmonary congestion
reduce blood volume
reduce BP
reduce cardiac workload
INCREASE CO
**only use diuretics in HF pts if fluid retention is present
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75
Q

Can you give loop diuretics to pts with renal insufficiency?

A

yes

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76
Q

examples of loop diurectics

A

furosemide (Lasix)
bumetanide (Bumex)
torsemide (demadex)

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77
Q

What diuretic is prescribed for mild-moderate HF and can be combined with loop diuretics?

A

Thiazide diuretics: chlorotiazide (Diuril), hydrochlorothiazide (HCTZ, HydroDIURIL)

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78
Q

Spironolactone (Aldactone)

A

potassium sparing and aldosterone antagonist diuretic
limited efficacy in HF pts bc low performing diuretic
blocks cardiac remodeling of aldosterone

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79
Q

when is it best to give ACEI for HF

A

within 36 hrs of onset

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80
Q

Diuretic cautions

A

dehydration and electrolyte imbalances
weigh self frequently
electrolyte tests (hypokalemia loop or thiazide especially when combined with digoxin)

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81
Q

If beta blockers, being negative inotropes, make HF worse, then why do we prescribe them to HF patients?

A

Beta Blockers stop the SNS compensatory response that makes HF worse and is a vicious cycle by blocking NE and other catecholamines that cause cardiac remodeling and disease progression. The result of beta blocker therapy is reduced HR and BP which leads to decreased cardiac workload.
After several mos of therapy, heart shape, size, and function can actually return to normal-> reverse remodeling

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82
Q

Which medication can cause reverse remodeling in HF patients?

A

beta blockers, carvedilol (Coreg) and metoprolol (Toprol), propranolol (nonselective)

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83
Q

How must beta blockers be administered to HF patients?

A

To prevent making HF worse, beta blockers must be given very specifically:
Initial doses must be 1/0-1/20 target dose and then doubled every two weeks until target dose is reached.

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84
Q

Beta Blockers are contraindicated for

A

COPD
bradycardia
heart block

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85
Q

beta blockers are used with caution on pts with

A

PVD, diabetes, or hepatic impairment

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86
Q

What lab tests do you monitor for pts on beta blockers?

A

liver function studies for signs of toxicity

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87
Q

How do vasodilator reduce symptoms of HF?

A

Vasodilators reduce preload or afterload

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88
Q

Hydralazine with isosorbide dinitrate

A

vasodilators: relax blood vessels and lower bp creating less workload for the heart;
use is limited due to risk of orthostatic hypotension and reflex tachycardia

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89
Q

Hydralazine

A

antiHTN acts on arterioles to decrease peripheral resistance, reduce afterload, and increase CO; not a first choice drug bc of hypotension and reflex tachycardia risks

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90
Q

Isosorbide Dinitrate

A

a long acting organic nitrate that reduces preload by directly dilating veins. not effective as monotherapy and tolerance develops quickly

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91
Q

what triggers the release of BNP in the body?

A

increased ventricular stretch releases BNP which then enhances diuresis and renal excretion of sodium (counteracts RAAS and aldosterone)

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92
Q

Patients with acutely decompensated heart failure are prescribed which vasodilator?

A

Nesiritde (BNP) and monitor this patient continuously bc hypotension may occur

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93
Q

What drug do you give to patients with supraventricular tachyarrythmias (afib)?

A

Digoxin-now a drug reserved for late stage HF

digoxin has antidysrythmic properties

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94
Q

Why are cardiac glycosides used in late stage HF only?

A

they have a narrow therapeutic window and severe side effects

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95
Q

When do you hold digoxin?

A

when HR is <60bpm

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96
Q

Two Primary classes of positive inotropic agents administered to pts with acute decompensated HF:

A

Beta AGONISTS

Phosphodiesterase Inhibitors

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97
Q

Beta Agonists

A

isoproterenol (Isuprel)
EPI, NE, Dopamine
Dobutamine (Dobutrex)** ability to rapidly increase myocardial contractility with min changes to HR and BP

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98
Q

two common adverse effects of beta agonists

A

tachycardia and dysrythmias

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99
Q

When do you give dopamine in HF?

A

when the pt has both HF and hypotension bc dopamine can increase myocardial contractility and activates alpha receptors to increase BP

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100
Q

How do phosphodiesterase III inhibitors work?

A

they block the enzyme which leads to increases in the amount of calcium available for myocardial contraction. Two benefits:
positive inotropic and vasodilation, thus CO is increaseed due to increased contractility and decreased in left ventricular afterload. There is little effect on HR

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101
Q

Prototype drug for phosphodiesterase III inhibitor

A

milrinone (Primacor)

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102
Q

ACEI action r/t HF

A

Lower peripheral resistance through inhibition of angiotensin II formation
reduce blood volume through inhibition of aldosterone
yields reduced arterial BP (afterload), increased CO, and dilated veins (preload)

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103
Q

digoxin action (4)

A

decreases SNS activity and increases PNS activity-can suppress SA node and slow conduction through AV node;

inhibits NaKATP Pump

increases intracellular calcium via sodium/calcium exchange pump

positive inotrope; by increasing mycardial contractility, digoxin increase CO and that improves exercise tolerance and urine production to restore fluid balance and decrease pulmonary congestion.

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104
Q

special considerations when administering digoxin

A

must give over a min of 5 mins, can dilute in 4-5mL

can give PO but NEVER IM or SC

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105
Q

Is digoxin highly protein bound?

A

Yes, so be aware of hypoalbumuria-toxic dig

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106
Q

Adverse effects of digoxin

A

ventricular dysrhythmias including sudden cardiac death. most common cause is hypokalemia from combined diuretic therapy; hypomagnesemia and hypo calcemia and impaired renal function are add’l risk factors. AV Block, atrial dysrhythmias, sinus bradycardia

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107
Q

Normal serum digoxin levels

A

0.5-1.5ng/dL drawn 6-12 hrs after last dose

toxicity often presents with flu like symptoms/ earliest sign is anorexia

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108
Q

H2antagonist

A

antagonist agent against histamine that decreases gastrin secretion

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109
Q

cathartic

A

agent with purgative action

Rapid, intense fluid evacuation of bowel.

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110
Q

surfactant

A

a surface active agent also known as a wetting agent, tension depressant, detergent and emulsifier

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111
Q

Methoscopalamine

A

blocks effect of Ach and relaxes smooth muscles
GI Stimulant
adjunct therapy for treating peptic ulcer disease

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112
Q

Dexpanthenol

A

minimizes risk of paralytic ileus when used post op

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113
Q

metoclopramide PO meal consideration and what does it treat?

A

take 30 mins before meals and at bedtime
dopaminergic blocker
treats v/n, and expedites gastric emptying

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114
Q

metoclopramide IV considerations

A

give 30 mins prior to chemo for antiemetic effect

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115
Q

GI stimulants

A

decrease reflux by increasing sphincter tone and enhancing acid clearance and decreasing gastric emptying.
Used for delayed gastric emptying caused by diabetic gastroparesis, GERD, or post op N/V
Stimulates gastric mobility w/o stimulating gastric, biliary, or pancreatic secretion

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116
Q

GI Stimulants contraindications

A

Hx seizure d/o, pheochromocytoma, PD (metoclopramide)
GI hemorrhage, obstruction or perforation
allergy to dextran, CHF, renal failure (dexpanthenol)
depression, HTN

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117
Q

nursing considerations for GI stimulants

A

monitor for possible hypernatremia and hypokalemia paricularly if pt has CHF or liver cirrhosis
monitor BP closely with metoclopramide IV

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118
Q

Client edu for GI stimulants

A

report signs of acute dystonia immediately
do not drive a few hours after taking metoclopramide
avoid humid environments with methoscopolamine

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119
Q

Anticholinergic and Antispasmodics

A

medications for decrease GI tone and motility
pylorospasm, ileitis, and IBS
give 30-60 mins before meals and at bedtime

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120
Q

Anticholinergic and Antispasmodics Contraindications

A

narrow angle glaucoma, obstructive GI disease, paralytic ileus, obstructive uropathy, adhesions between iris and lens, myocardial ischemia, and toxic megacolon.
Caution if renal dysfunction

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121
Q

Atropine may increase the effect of

A

phenothiazines

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122
Q

increased effects of atenolol with

A

anticholinergic drugs

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123
Q

what decreases absorption of anticholinergics

A

antacids

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124
Q

Cytotec (Misoprostol) contraindications

A

contraindicated if allergic to prostaglandins, pregnant, or lactating. May cause spontaneous abortion.
Prostaglandin Analog

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125
Q

Misc drug for PUD/GERD: Misoprostol (Cytotec)

A

protects against peptic ulcers caused by NSAIDS by reducing the secretion of gastric acid and by boosting the production of gastric mucus
Is a prostaglandin Analog

126
Q

Carafate (Sucralfate)

A

butt paste; works locally in the stomach by rapidly reacting with Hcl to form a thick, paste-like substance that adheres to the gastric mucosa to form a protective acid resistant shield in the ulcer crater. In addition, stimulates prostaglandins, mucus, and bicarb; Protects the mucosa for up to 6 hrs
indicated for short term therapy, esp to treat ulcers r/t stress
**Not effective for ulcers r/t NSAIDS

127
Q

Carafate (Sucralfate) danger

A

can result in aluminum toxicity in renally compromised patients when combined with aluminum salt antacids

128
Q

carafate (Sucralfate) administration

A

1 hour before meals or 2 hours after meals; 2 hours after other po meds and not within 2 hours of antacids

129
Q

cytotec nursing considerations

A

Pregnancy test prior to starting Cytotec and should be negative within 2 weeks of starting. Use contraception while on the med and for at least 1 month after stopping.

Cytotec take on empty stomach and not within 30 minutes (before or after) food intake

130
Q

opioid related drugs, kaolin and pectin (in bananas) to treat diarrhea

A 
Decrease peristalsis in the intestines.
Include:
Difenoxin
Diphenoxylate with Atropine (Lomotil)*
Loperamide (Imodium)- is an analog of Demerol
131
Q

which opioid related drug treats long term diarrhea?

A

Loperamide is also used to treat chronic diarrhea

132
Q

opioid related drugs adverse effects

A

GI distress
Lomotil- dizziness, lethargy, drowsiness; at high doses the anticholinergic effects may be observed (drowsiness, flushing, dry mouth & tachycardia); additive effects with other CNS depressants

133
Q

antidiarrheal agents

A 
paregoric/opium tincture
diphenoxylate (Lomotil®)
defenoxin (Motofen®)
loperamide (Imodium, Kaopectate®)
bismuth subsalicylate (Pepto-Bismol)
Octreotide acetate (Sandostatin)- profuse watery diarrhea, severe diarrhea associated with metastatic tumors
134
Q

nursing indications of antidiarrheals

A

Do not give to clients with C. difficile
Typically do not use to treat diarrhea in children.
Avoid bismuth subsalicylate if allergic to aspirin. This medication may temporarily darken stools and tongue.

135
Q

kaolin and pectin

A

Pharmacodynamics:
Bind with bacteria, toxins, and other irritants on the intestinal mucosa.
Pectin decreases the pH in the intestinal lumen which provides a soothing effect on the irritated mucosa.
Pharmacotherapeutics:
Used to relieve mild to moderate diarrhea.

136
Q

osmotic laxatives

A 
Work by drawing water into the intestine promoting bowel distention and peristalsis.
Include the following drugs:
Glycerin (Glycerol)
Lactulose (kristalose)
Polyethylene glycol (Miralax)
Saline compounds
137
Q

PUD lifestyle treatments

A 
Lifestyle changes
Stop tobacco use
Stop ETOH
Stop Caffeine
Weight control
Decrease use of NSAIDS, ASA*
138
Q

PUD drug therapy

A

Aimed at either eradicating H. pylori or restoring balance between acid and pepsin secretions and the GI mucosal defense.
These drugs include: systemic antibiotics, antacids, Histamine-2 (H2)-receptor antagonists, proton pump inhibitors, and other peptic drugs such as misoprostol and sucralfate.

139
Q

H2 Blockers

A 
BLOCK the release of hydrochloric acid in the stomach in response to gastrin
"Tidines"
cimetidine (Tagamet®)
ranitidine (Zantac®)*
famotidine (Pepcid®)
nizatidine (Axid®)
140
Q

Antacids

A

Interact with gastric acids at the chemical level to neutralize them
are inorganic compounds that contain aluminum, magnesium, sodium, or calcium to neutralized gastric acid and inactivate pepsin. They stimulate prostaglandin production and increase LES tone (reduces GERD)
therapeutic levels must increase stomach acid to at least 3.5

141
Q

PPIs

A

Suppress secretion of hydrochloric acid into the stomach lumen
*Drugs of choice for PUD/GERD
Omeprazole (prilosec)
“prazoles”
bind irreversibly to enzymes that produce Hcl-long acting
take 2–30 mins before breakfast
no renal clearance (ok to give to pts with renal insufficiency)-metabolized in liver, excreted in urine/feces
long term therapy increases risk for osteoporosis (decrease calcium absorption)
other PPIs
Esmomeprazole (Nexium)
lansoprazole (prevacid)
pantoprozole (Protonix)
rabeprazole (AcipHex)

142
Q

anticholinergics: Pirenzepine (Gastrozepine)

Misc drug for PUD/GERD

A

Reduce gastric motility

Adverse effects of dry mouth, constipation make this rarely prescribed now.

143
Q

Mucosal barrier protectants

A

Coat any injured area in stomach to prevent further injury from acid

144
Q

Lactulose (kristalose)

A

osmotic laxative
given in renal disease too
pulls amonia into gut and you poop it out

145
Q

H2 Blockers Indications

A 
PUD
GERD
Reflux esophagitis
Prevention of aspiration pneumonia
Prevention of stress ulcers in critically ill clients, and as combination therapy to treat H pylori infection
146
Q

H2 Blockers Nursing considerations

A

Avoid antacid use within 1 hour of po administration.*
IV preparations should not be mixed with other medications.
Once a day dosing should be at bedtime; more often five before meals.
Use cautiously in clients with renal or hepatic function impairment.

147
Q

PUD

A

the incidence of PUD is associated with the following risk factors:
H. pylori infection
Family hx of PUD
corticosteriods, NSAIDS, ASA, platelet inhibitors
Blood group O (H. pylori may bind to this antigen)
Smoking tobacco
excessive caffeine
stress

148
Q

NSAID related ulcers are usually where? (PUD)

A

gastic ulcers
less common
anorexia, weight loss, vomiting

149
Q

H. pylori related ulcers are usually where? (PUD)

A

duodenal ulcers
gnawing or burning upper abdominal pain that occurs 1-3 hrs after a meal. Pain is worse in empty stomach and often disappears with ingestion of food. (presence of food closes the sphincter and keeps acid in stomach) red vomit, black tarry stools.

150
Q

what contributes to stress ulcers? (PUD)

A

vasoconstriction secondary to SNS involvement causes decreased blood flow to small intestine

151
Q

ZES (Zollinger-Ellison Syndrome)

A

less common cause of PUD
caused by a tumor that secretes gastrin (gastrin increases Hcl secretion)
results in too much acid

152
Q

GERD

A

persistent Heartburn, dysphagia, dyspepsia, chest pain, nausea, belching
symptoms worsen following large meals, exercise, and when reclining

153
Q

What makes GERD worse?

A

caffeine, alcohol, citrus fruits, tomato based products, onions, carbonated beverages, spicy food, chocolate, smoking, pregnancy, and obesity

154
Q

Which meds make GERD worse?

A

nitrates, benzodiazepines, anticholinergics, beta blocker, alpha blockers, estrogen, progesterone, iron, CCBs, NSAIDS, tricyclic antidepressants, opioids, levodopa, biposphonates, and some chemo agents

155
Q

Warning s/sx of GERD

A

unexplained weight loss, early satiety, anemia, vomiting, initial onset of symptoms after age 50, prolonged anorexia or dysphagia

156
Q

Goals of PUD pharmcotherapy

A

provide immediate relief, promote healing of ulcer, prevent complications, prevent future recurrence

157
Q

for PUD patients with H. pyloria

A

antibiotics are key to pharmacotherapy

158
Q

Drugs to provide relief for PUD/GERD

A 
neutralizing gastric acid
PPIs
H2 blockers
Antacids
*long term acid suppression leads to deficiency in folic acid, iron, and vit B12**
159
Q

H2 blockers

A 
"Tidines"
cimetidine (Tagamet)
famotidine (Pepcid)
nizatidine (Axid)
ranitidine (Zantac)
160
Q

Sodium antacids disadvantages

A

avoid if sodium restricted diet or have HTN, HF, and renal impairment bc they cause fluid retention

161
Q

Magnesium antacid disadvantages

A

hypermagnesemia (fatigue, hypotension, dysrhythmias)

laxative effect in large intestine

162
Q

Calcium antacid disadvantages

A

constipation risk and may cause/aggravate kidney stones
hypercalcemia, renal failure at high doses
calcium carbonate antacids with milk or vit D can cause milk-alkali syndrome

163
Q

s/sx of hypercalcemia and milk-alkali syndrome

A

HA, urinary frequency, anorexia, nausea, fatigue

164
Q

Aluminum antacids disadvantages

A

constipation

aluminum carbonate and aluminum hydroxide may interfere with dietary phosphate absorption to cause hypophosphatemia

165
Q

bicarb antacid disadvantages

A

may provoke metabolic alkalosis (fatigue, mental status changes, muscle twitching, depressed RR)
bicarb combines with gastric acids to form CO2-causes bloating and belching

166
Q

drug interactions with antacids

A

increase stomach pH-affect solubility and absorption of many PO meds

acidic drugs will have a lesser therapeutic effect and basic drugs will have a more intense effect

enteric coated or delayed release drugs are designed to dissolve in the alkaline environment of the small intestine-antacid use may cause these drugs to dissolve early in the stomach and the drug may then irritate stomach lining
antacids bind to tetracyclines and digoxin

by changing urine pH, antacids delay the elimination of basic drugs (amphetamines) and speed the elimination of acidic drugs (aspirin)

167
Q

Acidic drugs

A

NSAIDs, sulfonylureas, salicylates, warfarin, barbiturates, isonizaid, digoxin (decreased action with antacid)

168
Q

basic drugs

A

morphine sulfate, antihistamines, tricyclic antidepressants, amphetamines, quinidine (increase action with antacid)

169
Q

To decrease potential for antacid-drug interactions, what should the nurse advise her patients to do?

A

other meds should be taken at least 1 hour before or 2 hours after an antacid

170
Q

Pharmacotherapy of H. Pylori

A

Omeprazole (PPI), clarithromycin (Biaxin), amoxicillin

or
add metronidazole (Flagyl), bismuth subsalicylate (peptobismol) and tetracycline
171
Q

how does bismuth compound work to treat H pylori?

A

inhibit bacterial growth by disrupting cell walls and prevent h pylori from adhering to gastric mucosa

172
Q

how do PPIs treat h pylori?

A

suppress h pylori, and the increased pH creates a hostile environment for H pylori, thus enhancing effectiveness of antibiotics

173
Q

Misc drug for PUD/GERD: bismuth compounds (Kaopectate or PeptoBismol)

A

contains both bismuth and salicylate which stim mucosal bicarb and prostaglandin production and inhibits H pylori from adhering to ulcerated tissue. causes cell wall death to h pylori.

turns stool black-normal side effect

174
Q

childrens pepto

A

contains calcium carbonate but no salicylates due to increased risk of developing Reye’s syndrome with salycylate use under age 19

175
Q

Misc drug for PUD/GERD: Metoclopramide (Reglan)

A

more commonly prescribed to treat n/v associated with chemo, but used for PUD/GERD when pts dont respond to first line drug therapy

Causes muscles in the upper intestine to contract, resulting in aster emptying of the stomach

Decreases esophageal relaxation and blocks food from entering the esophagus (GERD benefit)

176
Q

adverse effects of metoclopramide (Reglan)

A

drowsiness, fatigue, confusion, insomnia

uncommon: parkinsonism (bradykinesia, akathisia, and tardive dyskinesia)

177
Q

which two antacid compounds may cause constipation?

A

aluminum and calcium antacid compounds may cause constipation
Sodium compounds may cause flatulence
Magnesium compounds may cause diarrhea

178
Q

What adverse effects should a nurse monitor for in pts taking ranitidine (Zantac)?

A

blood dyscrasisas have been reported, especially neutropenia, and thrombocytopenia so the nurse should performed periodic blood counts

179
Q

Bulk forming laxatives
calcium polycarbophil (FiberCon, Equalactin)
methylcellulose (Citrucel)
psyllium mucilloid (Metamucil, Naturacil)

A

absorb water, thus adding to the size of fecal mass (the larger the fecal mass, the greater the neural stimulus for defecation)
take with plenty of water or you could obstruct your esophagus!!
Bulk forming laxatives are the treatment of choice for chronic constipation and may be taken on a regular basis without ill effects.

180
Q

Stimulant laxatives
bisacodyl (Correctol, Dulcolax)
castor oil (Emulsoil, Neoloid)

A

promote peristalsis by irritating the bowel; rapid acting and more likely to cause diarrhea and cramping than bulk forming laxatives.

do not use frequently: laxative dependence, abdominal cramping, and fluid/electrolyte imbalances may occur

used as a bowel prep prior to bowel exams/surgeries

181
Q

Surfactant laxatives / stool softeners

docusate (Colace)

A

cause more water and fat to be absorbed in stool

ineffective in treating constipation but are most often used to prevent the condition.

182
Q 
Saline/Osmotic Cathartics 
magnesium hydroxide (Milk of Magnesia)
polyethylene glycol (MiraLAX)
sodium biphosphate (Fleet Phospho-Soda)
Glycerin (Glycerol)
Lactulose (kristalose)
Saline compounds
A

pull water into the fecal mass to create a more watery stool

can produce a BM very quickly

do not use long term due to risk of dehydration and electrolyte depletion

Saline laxatives are important for colonoscopy prep or for purging toxins from body

183
Q

mineral oil as a laxative

A

should not be used bc it interferes with absorption of fat-soluble vitamins

184
Q

opioids are the most effective drugs for controlling

A

severe diarrhea (codeine, Difenoxin
or diphenoxylate with atropine (Lomotil)*
caution use with MAOIs (hypertensive crisis may ensue)

185
Q

loperamide (Imodium)

A

analog of meperidine (Demerol)
antidiarrheal agent
no analgesic actions, no issues with dependence

186
Q

what do you administer to counteract an od of Lomotil (opioid)?

A

Naloxone

187
Q

Ocreotide (Sandostatin) as an antidiarrheal

A

treats severe diarrhea associated with cancer
prevents release of serotonin and other active peptides that promote diarrhea; directly inhibits intestinal secretions and enhances absorption
long term therapy usually causes gallstones or cholestatic hepatitis

188
Q

Treat IBS with

A

immunosuppressants and anti-inflammatory drugs

  1. 5-ASA (sulfasalazine, olsalazine, balsalazide, mesalamine)
  2. oral coritcosteriods (prednisone)
  3. (Immunosuppressants) azathioprine (Imuran), mercaptopurine (Purinethol), methotrexate- onset 3 mos effective at expanding time between relapses
  4. TNF inhibitor (Remicade), adalimumab (Humira)
189
Q

Budesonide (Entocort-EC)

A

corticosteriod that is first line for treatment of IBS bc it is encapsulated so it is not absorbed in stomach or duodenum (not GI irritation)

Drug is slowly released and reaches a high concentration in the terminal ileum and proximal colon (2 most affected sites for IBD)

almost entirely removed by liver in first pass metabolism-nill on side effects

190
Q

treat n/v with

A

antiemetics

  1. cannabinoids
  2. serotonin blockers (antipsychotics)

antihistamines and anticholinergics
antacids
herbal supplements peppermint, ginger

191
Q

Phenothiazines: prochlorperazine (Compazine), metoclopramide (Reglan), perpehenazien (Phenazine, Trilafon)

A

treat psychoses and antiemetic

EPS are a concern with long term therapy

192
Q

Benzodiazepines lorazepam (Ativan)

A

anxiety and antiemetic

193
Q

Cannabinoids dronabinol (Marinol)

A

like marijuana

194
Q

Corticosteriods dexamethasone (Decadron) and methylprednisolone (Solu-Medrol)

A

prevent chemotherapy induced and post surgical n/v

195
Q

serotonin (5-HT3) receptor antagonists: dolestron (Anzemet), granisetron (Kytril), ondansetron (Zofran)

A

most widely prescribed for treating n/v induced by chemo

196
Q

Pancrelipase (Creon, PAncreaz, Zenpep)

A

used as replacement therapy for patients with pancreatitis or cystic fibrosis

197
Q

The client who is taking sulfasalazine (Azulfidine) develops a sore throat, bruising, and severe fatigue. The nurse determines that the client is most likely experiencing drug induced

A

blood dyscrasias

198
Q

The nurse teaches the client taking procholperazine (Compazine) to dc the medication immediately if what occurs?

A

facial twitching, tremors, muscle spasms, pacing

199
Q

A nurse should question the order for pancrelipase for a client

A

with a pork allergy

200
Q

A healthcare provider orders magnesium hydroxide (Mil of Magnesia) for a client with constipation. Before administering the drug, what should the nurse assess?

A

bowel sounds to make sure no obstruction

201
Q

drugs used for weight management affect

A

appetite or the absorption of fats

202
Q

lipase inhibitors (Orlistat/Alli/Xenical) cause weight loss

A

by interfering with the absorption of fats
indicated for those with BMI>30
only effective if taken with meals containing lipids; omit med if the meal has no lipid content

203
Q

Anorexians

A

drugs used to induce weight loss by suppressing appetite and hunger

204
Q

Lactulose

A

Lactulose is used to treat constipation and decrease ammonia* production and absorption from the intestines in liver disease.

205
Q

Mineral Oil (lubricant laxative)

A

May impair the absorption of many oral medications such as fat-soluble vitamins (A,D,E,K ), oral contraceptives, and anticoagulants.

206
Q

condansetron (Zofran®) antiemetic of choice in US

A

Doesn’t affect dopamine receptors, so no extrapyramidal effects*

207
Q

absorbant drugs for OD treatment

A

Most commonly used adsorbent drug is activated charcoal.*

208
Q

simple partial seizure

A

one hemisphere, manifestations include alterations in motor function, sensory signs, or sensory or autonomic symptoms

209
Q

complex partial seizures

A

temporal lobe, may be preceded by an aura
impaired loc, repetitive, non-purposeful movements such as lip smacking, picking or aimless walking
amnesia is common

210
Q

generalized partial seizure

A

both hemispheres

211
Q

absence seizure

A

generalized, last 5-30 seconds, sudden cessation of motor activity and blank stare, can occur occasionally or up to 100x/day, eyelid fluttering and lip smacking, more common in children than adults

212
Q

Tonic-clonic seizure

A

AKA grand mal
most common seizure
may be proceded by aura or have no warning
typically begins with loss of consciousness and sharp muscle contractions
pt falls to floor and may have urinary and/or bowel incontinence
breathing ceases and cyanosis develops during tonic phase
clonic phase follows with alternating muscle contraction and relaxation in al extremities, hyperventilation, eyes rolled back in head
postictal period: pt is relaxed with quiet breathing, unconscious, unresponsive, gradually regaining consciousness and may have transient confusion and disorientation

213
Q

Diazepam (Valium)

A

Benzodiazepine
for seizures
most serious side effect is cardiovascular collapse; assess for hypotension, tachycardia, and edema
treat od with Flumazenil (Romazicon) reverses CNS depression
listed on Beers List of potentially inappropriate drugs for the older adult
hold drug if BP drops 20mmHG (orthostatic hypotension)
Assess respiratory status for depression (rate, rhythm, depth)

214
Q

Phenytoin (Dilantin)

A

Hydantoin
prevents seizures (except absence seizures)
loading doses common; can be very toxic (nystagmus, confusion, ataxia, coma, seizures), monitor closely
gingival hyperplasia (use soft bristle toothbrush)
do not DC abruptly-risk for seizure
assess for blood dyscrasias (sore throat, bruising, nosebleeds)
Monitor serum glucose closely as Dilantin may inhibit insulin release-risk for hyperglycemia

215
Q

therapeutic range of Phenytoin (Dilantin)

A

10-20 mcg/mL

216
Q

Carbamezepine (Tegretol)

A

antiepileptic
risk for Stevens Johnson syndrome (fever, sore throat, fatigue)
treat OD with activated charcoal and gastric lavage

217
Q

Valproic Acid (Depakote)

A

GABA Agonist
adverse effects of photosensitivity and pulmonary edema
treat OD with Naloxone (Narcan); hemodialysis can lower drug serum levels. Caution must be used when administering Narcan bc it can reverse the anitseizure action of Depakote

218
Q

Therapeutic level of Valproic Acid (Depakote)

A

50-100mcg/mL

219
Q

Muscle Spasm Medications

A 
Carisoprodol (Soma)
Cyclobenzaprine (Amrix, Flexeril)
Diazepam (Valium)
Metaxalone (Skelaxin)
Methocarbamol (Robaxin)
220
Q

Diazepam (Valium) uses besides seizures

A

anxiety, acute alcohol w/d, treat tetanus

221
Q

Nursing considerations for muscle spasm meds

A 
blood studies (CBC, WBC with differentials)
assess for CNS depression, dizziness, drowsiness, and psychiatric symptoms
222
Q

myasthenia gravis

A

occurs when antibodies attack nicotinic synapses on skeletal muscles resulting in symptoms of extreme fatigue, double vision, and difficulty chewing or swallowing. The most obvious symptom is ptosis. Diagnosis is accomplished by clinical symptoms and presence of antibodies to Ach.

223
Q

Pyridostigmine (Reganol)

A

treats myasthenia gravis

224
Q

Edrophonium (Tensilon)

A

diagnose Myasthenia Gravis; administer IV rapidly while observing pt repsonse. works 1x; toxic to liver and loses efficacy the more you use it

225
Q

pyridostigmine (Reganol) side effects

A

severe cholingeric response (excessive salivation, sphincter relaxation, diarrhea, vomiting)

226
Q

pyridostigmine (REganol) nursing considerations

A

assess repiratory

give w/ meals on time to keep in therapeutic range (short half live)

227
Q

Levodopa and Carbidopa (Sinemet); Pramipexole (Mirapex); Benztropine (Cogentin)

A

treat parkinsons disease

228
Q

levodopa and carbidopa (SInemet)

A

dopamine replacement agent
carbidopa makes levodopa more effective at smaller doses by inhibiting its breakdown in the intestine and peripheral tissues (more reaches brain); levodopa treats tremor, bradykinesia, gait and muscle rigidity

imbalance, sensory problems, sexual dysfunction and constipation do not respond well to levodopa

229
Q

pramipexole (Mirapex)

A

dopamine receptor agonist

230
Q

benztropine (Cogentin)

A

cholinergic antagonist

231
Q

Dietary restrictions assoc with levodopa and carbidopa (SInemet)

A

avoid food high is pyridoxine (vit B6) (Beef, liver, ham, pork, egg yolks, whole-grain or fortified cereals, or multivitamins)-they will decrease medicinal effects

do not take with foods high in protein-neg effect on absorption

the full therapeutic effect of meds may take several months to appear

232
Q

What’s another drug that is used synergistcally with levodopa to treat PD?

A

Pramipexole (Mirapex)
Watch for hallucinations, dizziness, drowsiness, and nausea
orthostatic hypotension
EPS (tongue rolling, confusion, jerking)
fainting, mood changes, muscle cramps/spasms, increased tremors, swelling of ankles/feet, chest pain, vision changes, dysrhythmias
BUN/cr

233
Q

How do you combat EPS in Pramipexole drug therapy

A

pair with Cogentin (Benztropine)

234
Q

adverse effects of Benztropine (Cogentin)

A

paralytic ileus, tachycardia, cardiovascular collapse, anaphylactic shock, can cause some psych conditions to worsen so monitor closely

235
Q

Nursing responsibilities r/t Cogentin

A

use caution in hot weather, avoid using mechanical/heavy machinery (dizziness/drowsiness), avoid OTCs and alcohol

236
Q

Alzheimers treatment

A

Donepezil (Aricept)
reversible cholinesterase that causes elecated Ach levels in the cortex, which slows the neuronal degradation of Alzheimers disease
adjust dosage no more frequently than q6wks

237
Q

Donepezil (Aricept) Contraindications

A 
DC if jaundiced
urinary frequency and incontinence common
A fib possible
assess BP to hypotension
monitor liver function studies
238
Q

Patient education r/t Donepezil (Aricept)

A

report side effects of twitching, n/v/d, or rash
do not increase or decrease dosage abruptly
stop smoking

239
Q

Sharp, stabbing, dull, aching-

A

nociceptive pain

240
Q

Burning, tingling=

A

neuropathic pain

241
Q

peripheral nociceptors analgesics

A

local anesthetics

Anti-inflammatory drugs

242
Q

peripheral nerve analgesics

A

local anesthetics

243
Q

Dorsal horn analgesics

A

local anesthetics, opioids, alpha2 agonists

244
Q

brain analgescis

A

opioids, alpha 2 agonists

245
Q

Endocet

A

oxycodone HCl + acetaminophen

246
Q

norco

A

hydrocodone + acetaminophan

247
Q

Percocet

A

oxycodone HCl + acetaminophen

248
Q

Percodan

A

oxycodone + aspirin

249
Q

Vicodin or Lortab

A

hydrocodone + acetaminophen

250
Q

Vicodin HP

A

hydrocodone + acetaminophen

251
Q

opium

A

morphine + codeine

252
Q

activation of mu receptor

A

responsible for the analgesic properties of the opioids as well as some of the adverse effects such as respiratory depression and physical dependence (opioid agonists)

253
Q

opioid agonist

A

activate both mu and kappa receptors

morphine, codeine

254
Q

mixed opioid agonist-antagonist

A

occupy one receptor and block (or have no effect) on the other
pentazocine (Talwin)
butorphanol (Stadol)
buprenorphine (Buprenex)

255
Q

Opioid Antagonist

A

block both mu and kappa receptors

naloxone (Narcan)

256
Q

kappa binding only

A

analgesia, sedation, decreased GI motility

257
Q

Mu binding

A

analgesia, sedation, decreased GI motility

respiratory depression, euphoria, physical dependence

258
Q

**general actions of opioids

A 
Analgesia
Respiratory depression
*Constipation (decrease GI motility)
*Urinary retention
*Cough suppression
Emesis
Increased ICP
Indirect through CO2 retention
Euphoria/Dysphoria
Sedation
Miosis
Pupil constriction
decreased Preload & afterload
Watch for hypotension!
259
Q

promethazine (phenergan)

ondansetron ( Zofran)

A

antiemetic drugs usually used to combat nausea/vomiting r/t opioid use

260
Q

clinically used opioids for analgesia

A

fantanyl, morphine

261
Q

clinically used opioids for cough suppression

A

codeine, Dextromethorphan

262
Q

clinically used opioids Antidiarrheal

A

(Diphenoxylate,Loperamide)

263
Q

clinically used opioids Acute Pulmonary edema

A

(Morphine)

264
Q

clinically used opioids anesthesia

A

(Fentanyl)

265
Q

clinically used opioids Opioid Dependence or adjunct in chronic pain

A

(Methadone)

266
Q

highly effective opioids

A 
fentanyl
hydromorphone
levorphanol
meperidine
methadone
morphine
oxymorphone
**risk for respiratory failure!!
267
Q

moderately effective opioids

A 
codeine
hydrocodone
oxycodone
percocet
**Hepatotoxicity, respiratory depression, circulatory collapse, coma
268
Q

opioids wit mixed agonist-antagonist effects

A

buprenorphine (mu agonist, kappa blocker) *resp depression
burorphanol (weak mu blocker, kappa agonist)
nalbuphine weak mu blocker, kappa agonist)
pentazocine (weak mu blocker, kappa agonist)

269
Q

morphines respiratory depressive action may be used to treat

A

SOB assoc end stage cancer
HF
pulmonary edema

270
Q

advantages of morphine therapy

A

no upper end dose limit and pts develop tolerance to all the adverse effects except constipation

271
Q

morphine drug interactions

A

alcohol, skeletal muscle relaxants, MAOIs (increased sedation)
kava, valerian, chamomile (increase CNS depression)
St John’s Wort may decreased analgesic action

272
Q

duramorph

A

a preservative free morphine sulfate commonl used for IV, epidural, and intrathecal use (PCA pumps)

273
Q

nursing responsibilities for morphine

A

Nursing implications
Baseline vital signs (BP will be lower, RR, O2 sat, pain rating) monitor output (ensure no urinary retention), watch for falls, d/c all previous orders for pain meds, administer by micro-drip and infusion pump
Predetermined dose and lockout interval

274
Q

hydromorphone (Dilaudid)

A

7-10 time effect of morphine
faster onset, but shorter duration of action
high abuse potential

275
Q

hydrocodone

A

often paired with tylenol (Vicodin) or aspirin (Lortab)

increased risk of hepatotoxicity (no vicodin for pts with hepatitis)

276
Q

Meperidine (Demerol)

A

duration of action is shorter than morphine
good for pts with GI pain (pancreatitis, biliary colic) *does not increase biliary tract pressure
Patients with pain and acute asthma
Less likely to produce histamine release

277
Q

contraindications for meperidine (demerol)

A

Cautions/Contraindications
Neurotoxicity with sickle cell, burn injuries, or cancer
Severe/fatal reaction if given to patient taking MAOI
Produces a vagolytic effectincrease HR
In COPD may result in resp. depression
In increased ICP, may mask neuro parameters
If given IM, rotate sites as tissue irritation is common

278
Q

Methadone

A

more potent that morphine
used for detox and maintenance programs
cautions: OTC drugs may potentiate action, orthostatic hypotension is common side effect and can last several weeks
**no euphoria prod by other opioids

279
Q

oxycodone

A

pproximately 10 times more potent than codeine
Examples
Percocet, Tylox- with acetaminophen
Percodan- with aspirin

280
Q

fentanyl

A

Brands
Sublimaze, Innovar, Duragesic
Uses
premed, with anesthesia, post anesthesia

281
Q

Propoxyphene (Darvocet)

A 
less potent that morphine
Darvon (ASA)
Darvocet (acetaminophen)
not a good choice for older adults
caution history of alcohol abuse
282
Q

Butorphanol (Stadol) mixed opioid

Cautions:

A

hypertensive clients, contraindicated in MI ( cardiac workload), may increase CSF (monitor ICP)

283
Q

Pentazocine (Talwin) mixed opioid

Caution

A

cardiac function

284
Q

Nalbuphine (Nubain) mixed opioid

uses

A

preeop as adjunct to anesthesia; obstetric analgesia

285
Q

opioids to avoid for older adults

A

Meperidine (Demerol), propoxyphene (Darvon),and pentazocine (Talwin) are more toxic in older adults and should be avoided
Diminished circulation, which results in slower absorption of IM or SQ drugs

286
Q

Tramadol (Ultram)

A

centrally acting non opioid analgesic
no GI ulceration like NSAIDs
no respiratory depression of opioids
bind to pioid mu receptor (weak mu agonist) 10X<codeine
inhibits NE and serotonin reuptake in spinal neurons (inhibits pain transmission)

287
Q

Tramadol adverse effects

A

vertigo, dizziness, HA, n/v, constipation, and lethargy
nervousness, tremor, anxiety, agitation, confusion, visual impairment, and hallucinations
seizures if also taking antidepressants

288
Q

adjuvant analgesics

A

antidepressant (tricyclic antidepressants, SSRIs) for neuropathic pain

antiseizure (gabapentin [neurotonin], valproic acid [depakene], phenytoin [dilantin], carbamazepine [tegretol] for neuropathic pain

corticosteroids antiinflammatory; dexamethasone [decadron], prednisone [deltasone]

local anesthetics: Mexiletine [mexitil] antidysrhythmic for neuropathic pain; lidocaine [Xylocaine]

muscle relaxants: benzodiazepines for muscle spasms and anxiety; diazepam [Valium], lorazepam [Ativan], oxazepam [Serax]

289
Q

meds to treat migraines

A 
Ergot preparations
Ergotamine tartate (Ergostat)
Dihydroergotasmine mesylate (Migranal)
**Sumatriptan (Imitrex)
Antiseizure drugs
Beta-adrenergic blockers
Calcium channel blockers
Tricyclic antidepressants
290
Q

meds to treat tension headaches

A

Analgesics – ASA, acetaminophen, or ibufrophen
Muscle relaxants- amitriptyline (Elavil)
Anti-depressants with counseling

291
Q

When giving pre-op sedatives/hypnotics to elderly patients

A

monitor closely for confusion or excitement and initiate measures to prevent injury or fall

292
Q

First IV agents will be given, act within seconds

Then once patient is unconscious, inhaled agents will be given to maintain anesthesia

A

Inhaled agents are gases (nitrous oxide) or volitile liquids— prevent flow of sodium into neurons
Exact mechanism not known, likely that GABA receptors are activated
Not same mechanism of action as local anesthetics

293
Q

agents administered to achieve balanced anesthesia

A

neuromuscular blockers
short-acting benzodiazepines
opioids
general anesthetics

294
Q

IV meds first

A

promote relaxation, diminish pain, and promote sleep

295
Q

Inhaled agents administered once IV agent has caused loss of consciousness

A

maintain anesthetized state

296
Q

Malignant hyperthermia

A

triggered by all inhalation anesthetics except Nitrous oxide
characterized by muscle rigidity and profound elevation of temperature (109F)
risk is greatest when inhalation anesthesia is combined with succinylcholine, a neuromuscular blocker that can also trigger the reaction

297
Q

Preanesthesia Agents

Benzodiazepines

A

Diazepam Valium
Midazolam Versed
Reduce anxiety, sedation, amnesia, “conscious sedation”

298
Q

Preanesthesia Agents

Antihistamines

A

hydroxyzine [Vistaril]

sedation

299
Q

Preanesthesia Agents

Opiod Analgesics

A 
Morphine [Morphine]
Meperidine [Demerol]
Fentanyl [Sublimaze]
remifentanil [ultiva]
Sedation to reduce tension, anxiety, and to provide analgesia
300
Q

Preanesthesia Agents

Phenothiazines

A

promethazine [phenergan]

Sedation, antihistaminic, antiemetic,decreased motor activity

301
Q

Preanesthesia Agents

Anticholinergics

A

Atropine
glycopyrollate [robinul]
Inhibits secretions, bradycardia, vomiting, and laryngospasms

302
Q

Preanesthesia Agents

GI Drugs

A

Ondansetron [Zofran]
Cimetidine [Tagamet]
metoclopramide [reglan]

Antiemetic
Decrease gastric acidity
Decrease stomach contents

303
Q

Non anesthetic drugs nursing considerations

A

Physical assessment should include:
VS, reflexes, muscle tone and response, pupil size and reactivity, ECG, lung sounds, bowel sounds, affect and LOC

Monitor for:
HTN, tachycardia, prolonged apnea, bronchospasm, respiratory depression, paralysis, and hypersensitivity

If history is positive for hepatic or renal dysfunction, neuromuscular disease, fractures, myasthenia gravis, malignant hypertermia, glaucoma, or penetrating eye injury, the use of succinylcholine is contraindicated.

304
Q

Propofol (Diprivan)

A

IV sedative-hypnotic used for induction and maintenance of anesthesia
Used to sedate patients undergoing mechanical ventilation or noninvasive procedures (endoscopy, radiation therapy, MRI)
Single injection onset 60 seconds and lasts 3-5 minutes; can be given low-dose continuous infusion
Adverse effects: respiratory depression, hypotension
Contains soybean oil, glycerin and egg lecithin (check for allergy); these are a great growth medium for bacteria- open and discard within 6 hours

305
Q

Ketamine (Ketalar)

A

Causes sedation, immobility, analgesia and amnesia; responsiveness to pain is lost
Assessment-produces analgesia, amnesia and immobility, but not muscular relaxation
Increases secretions of the salivary and bronchial glands
During recovery, hallucinations, disturbing dreams and delirium may occur
Useful for young children* undergoing minor surgical and diagnostic procedures

306
Q

anesthetics are usually combined with

A

EPI to decreaed systemic absorption and prolong the duration of action of the anesthetic and to promote local hemostasis.

caution used on end tissues (may cause tissue ischemia or necrosis) assess gag reflex if used in oral cavity

Use of vasoconstrictors, usually epinephrine, decreases local blood flow and delays systemic absorption and prolongs anesthesia and reduces risk of toxicity. If anesthesia absorption is slower, a lower dose can be used.

307
Q

Local Anesthetics

A 
Sodium Channel Blockers
Classifications:
Esters
Cocaine
procaine (Novocain)
Benzocaine (Solarcaine)
Amides 
lidocaine
308
Q

If area has localized infection or abscess, tissue environment will be acidic and effectiveness of agent will be decreased—-

A

will add sodium hydroxide to neutralize environment

309
Q

Amides

A

produce fewer side effects and usually have a longer duration of action

310
Q

lidocaine (Xylocaine)

A

most commonly used amide for short surgical procedures

311
Q

Ester-type anesthetics

A

(Cocaine, Novocain, Benzocaine) are metabolized in the blood by esterase enzymes.

312
Q

Amide-type anesthetics (lidocaine)

A

are metabolized by enzymes in the liver.

Pharmacology (3 decks)

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