Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacotherapy > Exam 3 Drugs > Flashcards

Exam 3 Drugs Flashcards

1
Q

Diuretic Side Effects

A

Prevent renal reabsorption of fluid –> diuresis & natriuresis –> decreased IV volume

“diuretic contraction”: increased concentration of blood content that are not excreted in urine
-Blood cells, glucose, uric acids, lipids

Electrolyte imbalance

  • Low K, Mg, Na, Bicarb
  • High Ca, BG, uric acid, LDL

Decreased BP –> orthostatic hypotension, dizziness, syncope, fall

  • Poor renal perfusion –> AKI
  • Tachycardia (reflex tachycardia)
  • Hypovolemia: Assess daily weight & Assess edema (0-4+)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Diuretics Nursing

A

Assess ability to use the urinal/BSC in 30 minutes after taking

Adherence
-Build rapport to understand the root cause of non-adherence

Avoid taking potassium supplement while skipping the diuretic dose
-Hyperkalemia & fluid overload

Take diuretics earlier in the day rather than close to bedtime

Keep a long of BP & daily weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Thiazide and Thiazide-Like

A

Thiazide

  • Chlorothiazide (PO, IV)
  • Hydrochlorothiazide= HCTZ (PO)

Thiazide-Like
-Metolazone: Give it an hour before Loop

-Oldest and cheapest; many brands

Category Class: Diuretic

Indication: Hypertension

Contraindication:

  • Hypovolemia
  • Pregnancy
  • Lactation
  • Anuria (oliguria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Loop Diuretics

A

Furosemide, bumetanide

Strongest diuretics (high ceiling)

Renal Vasodilator

  • All diuretics cause AKI due to loss of blood volume/lower BP (lower renal perfusion)
  • All diuretics should be avoided in AKI, but if we must use diuretics, Loop diuretics are the safest
  • The only diuretic that may be used in CKD

Category Class: Diuretic

Indication: Hypertension

Contraindication:

  • Hypovolemia
  • Pregnancy
  • Lactation
  • Anuria (oliguria)

Medication Administration: IV, PO, IM

Nursing Interventions:
-Dilute & very slowly IVP to avoid tinnitus (ototoxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

K-Sparing Diuretics

A

Spironolactone (PO)

Weakest diuretics

Category Class: Diuretic, Aldosterone Receptor Blocker

MOA:
-blocks the action of aldosterone –> K retention, water, Na, bicarb excretion

Indication:
-Hypertension

Secondary Indication:

  • With other diuretics to balance potassium
  • Treatment of post-adolescent acne (MOA: anti-adrogenic effect)

Contraindication:

  • Hypovolemia
  • Pregnancy
  • Lactation
  • Anuria (oliguria)

Adverse effects: Anti-androgenic effect

  • Male: impotence, gynecomastia
  • Female: deepened voice, irregular menstrual cycles

Monitor increased K

  • Place on heart monitor (dysrhythmia)
  • Bradycardia/cardiac arrest, peaked T (cardiac monitor)

Monitor for paresthesia, abd/muscle cramps, weakness, fatigue

Diet: Avoid high potassium foods
-Oranges, grapefruit, potatoes, bananas, dried fruits

Interactions:
-Avoid with ACEi and ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

-lol

A

Medication: Propranolol, Metoprolol, Atenolol, Carvedilol, Labetalol

Category Class: Beta-blocker (sleepy chicken)

MOA:

  • Decreased HR (negative chronotrope)
  • Decreased excitability (negative dromotrope)
  • Decrease BP

Indication:

  • Angina/MI, dysrhythmia, HTN, HF
  • Off label: Glaucoma, migraine

Contraindication:

  • Bradycardia, hypotension
  • Call provider & hold for HR <60 or SBP <90
  • Asthma, COPD

Side effects, Adverse reactions:

Even selective beta-blockers may become nonselective at high dose (blocking beta 2 & bronchospasm)
-Monitor breath sounds (for worsening or new wheezing)

Bradycardia, hypotension, dysrhythmia (FALL)

  • Monitor trend of HR, BP, cardiac rhythm
  • Postural hypotension and FALL (lie down if feeling dizzy, avoid sudden changes of position)

Impotence, decreased libido (build rapport and discuss factors that may affect adherence)

Medication Administration: IV, PO

Nursing Interventions (monitoring):
-Masks hypoglycemia symptoms (palpitation)- monitor DM patients BG for asymptomatic hypoglycemia

Patient Education:

  • Avoid stopping abruptly, wean off over 1-2 weeks
  • At home keep a log HR/BP and associated s/s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Methyldopa & Clonidine

A

Category Class: Alpha-2 Agonist (sleepy chicken)

MOA: Decrease sympathetic stimulation:
-Decrease HR & CO, vasodilated (decrease peripheral resistance)

Indication:
-Hypertension

Off label Indication:

  • Clonidine: CA pain, ADHD, opioid withdrawal, migraine, menopause flushing
  • Eye drops for glaucoma: brimonidine, apraclonidine

Contraindication:

  • Pregnancy
  • Lactation

Side effects, Adverse reactions:

  • Na/water retention (use with diuretics & monitor daily weight & edema)
  • Bradycardia
  • Orthostatic hypotension, dizziness, FALL
  • Impotence, decreased libido
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hydralazine

A

Medication Administration: IV, PO

MOA: Direct-acting vasodilator

Indication:

  • Quick management of acute HTN
  • Preeclampsia

Contraindication:

  • RF
  • Concurrently with sildenafil

Side effects, Adverse reactions:

  • Less blood pressure in kidney –> fluid/Na retention (combine with diuretics)
  • Increased permeability with arteriodilation (edema, nasal congestion, HA) combine with diuretics
  • Orthostatic hypotension (fall)
  • Tachycardia (reflex), patient reports palpitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Alpha 1 Blockers

A

Medication:

  • For HTN & BPH: Prazosin, terazosin, doxazosin
  • For BPH only: Tamsulosin, silodosin

MOA: vasodilation (decrease peripheral resistance), relaxing prostate

Indication: Hypertension

Side effects, Adverse reactions:

  • Orthostatic hypotension (Fall risk)
  • Na/water retention (use with diuretics & monitor daily weight & edema)
  • Tachycardia (reflex)
  • Erectile dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ACE Inhibitors (-pril)

A

​​Medication: benzepril, captopril, lisinopril, enalapril, enalaprilat

MOA: angiotensin-converting enzyme inhibitor

  • Prevent angiotensin II formation –> decrease peripheral resistance & afterload
  • AKI & hyperkalemia

Indication:

  • Hypertension
  • HF

Contraindication:
-PAAK: pregnancy, allergy, AKI (helpful for CKD), K increase

Side effects, Adverse reactions:

  • Increases bradykinin (inflammatory mediator) –> dry hacking cough, angioedema
  • AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
  • Orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Angiotensin Receptor Blocker (ARBs)

A

Medication: losartan, valsartan, telmisartan

MOA: Block the receptor site of angiotensin II

  • Very similar to ACEi but not as effective
  • Prevents vasoconstriction –> low BP
  • AKI & hyperkalemia
  • Tachycardia (reflex)

Indication:

  • Hypertension
  • HF

Contraindication:
-PAAK: pregnancy, allergy, AKI (helpful for CKD), K increase

Side effects, Adverse reactions:

  • AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
  • Orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Amlodipine & Nifedipine

A

IV, PO

MOA: CCB

  • Specific vasculature
  • Systemic vasodilation –> decreased BP (Call the provider & hold for SBP < 90)

Indication:

  • Hypertension
  • Angina

Side effects, Adverse reactions:

  • Peripheral edema (daily weight, I/O)
  • Low BP –> tachycardia (reflex)
  • Low BP –> fall
  • Low BP –> monitor renal panel for AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Midodrine

A

​​MOA: alpha-1 agonist –> vasoconstriction

Contraindication: AKI

For people at risk of hypervolemia or on hemodialysis

Side effects, Adverse reactions:

  • Urinary retention (BPH)
  • Supine HTN (HTN associated with lying supine, check BP & administer while patient in supine position)

Medication Administration: PO, IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Symptomatic Hypotension

A

Usually treated with:

  • Crystalloid (NS)
  • Colloid volume expander (albumin) if edematous

During hypovolemic shock (medical emergency)

  • vasopressin (Pitressin)=ADH
  • dobutamine (Dobutrex) (beta-1 agonist)
  • emergency drugs, used for shock and cardiopulmonary resuscitation (discussed in Endocrine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Digoxin

A

IV/PO

MOA:

  • Positive inotrope (increased force & CO) better perfusion
  • Negative chronotrope (decreased HR) lower workload
  • Negative dromotrope (decreased conduction) less excitability

Indication:

  • HF
  • Dysrhythmia

Toxicity

  • Monitor for bradycardia & hold for HR <60
  • Yellow halos around objects, blurred, diplopia, dysrhythmias
  • Narrow therapeutic window

Nursing Interventions:

  • Monitor K level, hypokalemia –> dig toxicity
  • K-wasting diuretics –> decrease K –> dig toxicity
  • K-sparing diuretics, ACE, ARB –> increased K –> decreased effect of digoxin

Patient Education:
-checking HR, toxicity s/s, avoid sildenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Milrinone

A

IV gtt

MOA:

  • Positive inotrope (inc force –> inc CO)
  • Arteriodilator –> dec BP –> dec cardiac workload

Indication:

  • For 48-72 hr. to manage acute exacerbation of HF
  • End-stage HF unresponsive to other medications

Side effects:

  • Dysrhythmias
  • Low BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dopamine

A

MOA:
-Nonspecific adrenergic: inc HR, vasoconstriction

Indication:
-HF, hypotension, shock

IV gtt. Via pump in designated central IV line (extravasation)

Many SE:

  • tachydysrhythmia
  • MI
  • N/V
  • AKI

Nursing Interventions:

  • Needs titration
  • Hemodynamic monitoring (MAP, PP) & cardiac rhythm monitoring
  • Tapering dose before stopping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dobutamine

A

MOA:
-Beta1 agonist –> pos inotrope (inc force), pos chronotrope (inc HR)

Indication:
-HF, hypotension, shock

Adverse reactions:

  • MI
  • Tachydysrhythmias
  • Tremors

IV gtt. Vis pump in designated peripheral IV

Nursing Interventions:

  • Tapering dose before stopping
  • Needs titrations
  • Hemodynamic monitoring (MAP, PP) & cardiac rhythm monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Epinephrine

A

Category Class: Nonselective adrenergic agonist- A1, B1, B2

MOA: increases BP & HR, opens airway

Indication:

  • IM/SubQ: allergic reaction (anaphylaxis)
  • IV: cardiac arrest, severe hypotension (shock)
  • Aerosol: airway obstruction (bronchospasm)

Adverse reactions

  • High risk for extravasation
  • Antidote: phentolamine mesylate

Side effects

  • Hypertension: pulmonary edema, dyspnea
  • Tachycardia: dysrhythmias/palpitations
  • Worsening prostate disease (BPH): urinary retention
  • If it crosses BBB (large dose): tremors, restlessness, dizziness, fall
  • Mydriasis: worsening glaucoma, photophobia
  • Hypercoagulability: DVT, PE, CVA, MI
  • Lower GI motility/secretions: poor absorption, N/V, constipation, xerostomia (dry mouth), hypoactive bowel sounds
  • Blood shunting: acute kidney injury, ischemic bowel, cold skin
  • Glycogenolysis: hyperglycemia particularly in DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Atropine

A

Category Class: anticholinergic

Indication:

  • IV: symptomatic bradycardia
  • PO drop: to reduce saliva (pre-op, palliative)
  • Ophthalmic drop: to produce mydriasis & cycloplegia (pre-op)
  • IM: reversal for cholinergic OD (OD with MG drugs)

Contraindication:

  • Glaucoma
  • BPH
  • MG

Side effects, Adverse reactions:

  • Tachycardia
  • Palpitations
  • Nasal congestion
  • Photophobia
  • Blurred vision
  • Dry mouth and skin
  • Constipation
  • Urinary retention
  • Impotence
  • Memory impairment
  • Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nitrates

A

MOA:

  • coronary artery dilation: inc O2
  • systemic vasodilation: dec BP —> dec workload of heart —> dec O2 demand

Contraindication:

  • Glaucoma
  • Traumatic brain injury

Side effects, Adverse reactions:
-Monitor for low BP, dizziness, faintness, HA, tachycardia, FALL

Nursing Interventions):
-Cardiac monitoring & VS (obtaining ECG and labs should not delay NTG administration)

Patient Education: When having angina

  • Stop activity, lie down, rest
  • Take NTG SL or translingual spray, chew an aspirin (at home patients don’t have morphine & O2)
  • Call 911 if pain is not resolved with the first NTG and 5 min of rest and take the second SL
  • Avoid taking > 3 SL NTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nitroglycerin

A

SL tab/translingual spray – 0.4 mg q5min

Monitor BP/HR before & q5min with SL dose

SL tablets must be kept in their own dark glass container
-Up to 6 months after opening or until expiration date if not opened

Spray lasts up to 2 years

Take SL dose prophylactically before strenuous activity (climbing a flight of stairs)

Causes severe throbbing HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Isosorbide Mononitrate, Isosorbide Dinitrate

A
  • PO
  • Do not abruptly stop taking
  • Keep a log of angina (frequency, intensity, duration, location, quality)
  • Do not crush or chew
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nitropaste

A
  • can cause tolerance => 8-12 hrs nitrate free periods per day, do not cut the patch
  • Apply to hairless area of chest, back, abd
  • Rotate side to avoid skin irritation; wipe off the old ointment when replacing
  • Avoid touching the ointment
  • FALL risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IV Nitroglycerin

A
  • Indication: acute severe angina, HF
  • Continuous infusion (gtt.), special tubing from a glass vial
  • FALL risk
26
Q

Procainamide, Flecainide

A

Na channel blockers

Category Class: Class 1

Side effects:
-Dysrhythmia, bradycardia, hypotension, dizziness, syncope, fatigue, edema, impotence (Need to put patient on heart monitor)

  • anticholinergic symptoms
  • May cause Lupus symptoms (if joint pain contact provider)
  • low blood cells (monitoring CBC)
  • Dysrhythmia: (monitor cardiac rhythm, VS)
  • paresthesia, seizure (precautions)

FALL risk

Medication Administration:

  • Cardiac rhythm must always be monitored
  • Anticoagulation is always part of plan of care
  • Continuous IV infusion eventually switched to PO
  • IV push always slow (2-3 minutes): Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS

Patient Education:

  • Keep a log of VS, side effects at home and report to cardiologist
  • Encourage adherence

Interactions:

  • Grapefruit juice
  • Caffeine
  • ETOH
  • Tobacco
27
Q

Amiodarone, Sotalol

A

K Channel Blockers

Category Class: Class III

Side effects, Adverse reactions:
-Dysrhythmia, bradycardia, hypotension, dizziness, syncope, fatigue, edema, impotence (need to put patient on a heart monitor)

FALL risk

Nursing Interventions (monitoring):

  • monitor for HF, pulmonary edema (dyspnea, crackles breath sound, edema)
  • monitor for brady-dysrhythmia (monitor cardiac rhythm, low HR, low BP)
  • photophobia may progress to loss of vision

Medication Administration:

  • Cardiac rhythm must always be monitored
  • Anticoagulation is always part of plan of care
  • Continuous IV infusion eventually switched to PO
  • IV push always slow (2-3 minutes): Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS

Patient Education:

  • Keep a log of VS, side effects at home and report to cardiologist
  • Encourage adherence

Interactions:

  • Grapefruit juice
  • Caffeine
  • ETOH
  • Tobacco
28
Q

Diltiazem, Verapamil

A

Calcium Channel Blockers (CCBs)

Category Class:

  • Nonspecific (vasculature & heart) no suffix
  • Class IV

Indication: tachy-dysrhythmia

Side effects, Adverse reactions:

  • Call the provider & hold for HR < 60 or SBP < 90
  • Peripheral edema (daily weight, I/O)
  • Dec BP –> FALL
  • Dec BP –> monitor renal panel, I/O
  • May cause ventricular dysrhythmia

Medication Administration:
-Cardiac rhythm must always be monitored
-Anticoagulation is always part of plan of care
-Continuous IV infusion eventually switched to PO
IV push always slow (2-3 minutes): Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS

Patient Education:

  • Keep a log of VS, side effects at home and report to cardiologist
  • Encourage adherence

Interactions:

  • Grapefruit juice
  • Caffeine
  • ETOH
  • Tobacco
29
Q

Heparin

A

IV/SubQ
-Measured in units

Category Class: Anticoagulant

MOA: Inhibits activation of vitamin K (factor X)

Indication:
-Prophylactic: patients at high risk for thromboembolism
-Therapeutic: prevents clot enlargement
while waiting for warfarin onset of action which is 3-5 days (therapeutic INR)

Adverse reactions:
-heparin-induced thrombocytopenia (HIT), bleeding with OD

Nursing Interventions :

  • Onset of action: 20 minutes
  • Duration of action 8 hrs
  • Labs to monitor: aPTT, platelet count for thrombocytopenia (HIT)
  • Antidote: FFP, protamine sulfate IV; or wait 6-8 hrs
30
Q

Enoxaparin

A

Medication: Enoxaparin, Dalteparin, Fondaparinux

  • Low-molecular-weight heparin (LMWHs)
  • measured in mg

Category Class: Anticoagulant

Side effects:
-stinging for a few minutes after injection

SubQ

  • avoid massaging the area
  • prefilled syringes

Nursing Interventions:

  • No lab to monitor
  • Duration of action 12 hrs
  • Antidote: FFP, protamine sulfate IV; or wait 12-24 hrs
31
Q

Warfarin

A

Category Class: Anticoagulant

MOA:
-Inhibits activation of vitamin K (factor X)

Contraindication:

  • Pregnancy (switch to heparin)
  • Thrombocytopenia
  • Chronic liver disease
  • ETOH abuse

Side effects:

  • Bleeding
  • Antidote: phytonadione (Vitamin K) (PO, subQ, IM, IV), FFP transfusion

Nursing Interventions:
Frequent monitoring
-PT (normal 11-13.5 sec) (therapeutic 18-24 sec)
-INR (normal 0.8-1.1) (therapeutic 2-3)
-Takes 3-5 days for INR to reach therapeutic (bridging with heparin)
-Long ½ life => takes 5 days for INR to return to normal after discontinuing the drug

Patient Education:

  • Consistent amount of green leafy vegetables in the diet
  • frequent PT/INR monitoring; keep a diet/dose log

Interactions):
-avoid ETOH –> increase INR

32
Q

Antiplatelet

A

PO: aspirin, clopidogrel

  • takes the whole life of platelet to clear (7 days)
  • CI: NEVER to children <19 years (risk of Reye’s syndrome) => NEVER while breastfeeding

IV: eptifibatide
-duration of action: antiplatelet effect lasts 4 hrs

MOA:
-prevents platelet aggregation

Indication:
-Prophylactic for patients at risk for thromboembolism

Contraindication:

  • Pregnancy
  • Hx. of bleeding disorder
  • retinal/cerebral hemorrhage
  • Thrombocytopenia
  • PUD
  • Aneurysm
  • uncontrolled HTN

Adverse reactions:
-Hemorrhage: particularly GI bleed

Nursing Interventions:

  • Take with food to minimize GI upset/ GIB
  • for Hx. of GIB, PUD: Enteric-coated aspirin, don’t crush & Buffered aspirin (mixed with calcium carbonate)
  • Reversal agent: platelet transfusion

Interactions):

  • Avoid NSAIDs (increased risk of GI bleed)
  • Avoid alcohol (increased risk of GI bleed)
33
Q

Alteplase (tPA)

A

IV bolus followed by drip for 60 min, tapering dose

  • Goal: resolution of symptoms (t1/2 :35 min), given in ICU, ED
  • Avoid all AC & antiplatelet until thrombolytic effect is cleared (3hrs)

Category Class: Thrombolytics

MOA:
-dissolve the clots by fibrinolysis (naturally it takes 1-2 weeks)

Indication:

  • within 4hrs of the onset of MI or ischemic CVA symptoms
  • PE, DVT, restore patency of IV catheters

Contraindication:

  • BP > 180/110
  • hemorrhagic diseases (PUD), neoplasm, recent CNS trauma, aneurism
  • recent CVA, AC use, thrombocytopenia, ASA, NSAIDs, pregnancy

Adverse reactions:

  • bleeding, hemorrhagic CVA, spinal cord infarction
  • N/V, fever, angioedema, anaphylactic shock, rhabdomyolysis, dysrhythmias, pulmonary edema

“Nadia & Vlad forgot about Anna’s rehearsal dinner present”

Nursing Interventions:

  • Antidote: aminocaproic acid PO/IV, FFP, PRBC
  • Monitor trend of VS and assessment (q 15 min)
  • monitoring for: resolution of symptoms (CP, neurological deficit) & active bleeding, allergic reaction (hives, angioedema, & dyspnea, anaphylaxis)
  • cardiac monitoring (risk of reperfusion dysrhythmia treated with beta-blockers)
  • Avoid venipuncture/arterial sticks, injections (SubQ/IM) as possible: hold pressure for 30 min
34
Q

Statins

A

Medication: Atorvastatin, Simvastatin, Rosuvastatin

PO

Indication: hyperlipidemia

MOA:
-inhibit cholesterol synthesis in the liver

Contraindication:

  • Pregnancy
  • Lactation

Adverse reactions:

  • Liver failure: elevated LFT, check base line and q8wks
  • Myopathy & cramps –> hold with muscle aches
  • Rhabdomyolysis, check baseline CK & q8wks

Nursing Interventions:

  • Abruptly stopping cause rebound effect and acute MI
  • Grapefruit juice reduce statins level
  • Take at night (cholesterol biosynthesis is higher at night)
  • May cause cataract formation (annual eye exam)
35
Q

Bile Acid Resins (sequestrants)

A

Medication: Cholestyramine, Colesevelam

Indication: hyperlipidemia
-Cholestyramine: antidiarrheal (adsorbent)

MOA:

  • Bind bile acid and increase excretion of cholesterol & LDL
  • Cholestyramine: coat the wall of GI tract, adsorb bacteria/toxins

Contraindication:
-abdominal pain = possible small bowel obstruction (SBO)

Antidiarrheal Contraindications:

  • Using antidiarrheals > 2 days
  • If fever with unknown etiology is present
  • If the etiology of diarrhea is unknown

Side effects:

  • constipation, SBO, flatulence, cramping –> Increase intake of high-fiber food, fluid, activity
  • poor absorption of fat-soluble vitamins and many drugs –> Take 4 hours apart from other drugs & vitamins

Patient Education:

  • Take 30 min before meal
  • Take with at least 8 oz of water to avoid impaction of esophagus
36
Q

Nicotinic Acid (B3)

A

Medication: Niacin

  • Vitamin dose 25 mg/day (OTC)
  • Anticholesterol dose 2500 mg/day (Rx)

PO

Indication: hyperlipidemia

MOA:
-inhibits breakdown of triglycerides to free fatty acids, synthesis of LDL and breakdown of HDL

Contraindication:

  • Pregnancy
  • Liver disease
  • Gout

Side effects:

  • flushing of face/neck, feeling warmth, paresthesia
  • Hyperglycemia (caution with DM, monitor BG closely in DM patients)

Adverse reactions:

  • Hepatotoxicity: LFT, avoid alcohol and acetaminophen
  • Hyperuricemia => gout & RF (monitor renal panel, increase fluid, may need allopurinol)
37
Q

Omega- 3 acid ethyl esterase

A

Medication:

  • omega3 (Rx)
  • fish oil (OTC)

MOA:
-Inhibits triglyceride production in the liver

Indication:

  • preventive/treat hyperlipidemia
  • Off label: HTN & rheumatoid arthritis (RA)

Side effects:
-GI distress (acidic), nausea, aftertaste, rash

Patient Education:
-Take with food

38
Q

Bismuth Subsalicylate

A

OTC, liquid or chewable tablet

Category Class:
-Antiemetic, Antidiarrheal (Adsorbent)

MOA:
-Adsorbs bacteria/toxins that are causing nausea

Indication:
-Also used for diarrhea, indigestion

Contraindication:

  • Contains salicylate: Not for <19 due to causing Reye’s syndrome & Avoid if allergic to ASA or NSAIDs
  • Pregnancy (teratogenic)

Antidiarrheal Contraindications:

  • Using antidiarrheals > 2 days
  • If fever with unknown etiology is present
  • If the etiology of diarrhea is unknown

Side effects:

  • Slurred speech, hearing loss, vision problems
  • AMS
  • Muscle spasm
  • Black discoloration of stools/tongue (harmless & temporary)

“stop having visions about my brother tom”

Interactions:
-decreased absorption of other drugs

39
Q

Diphenhydramine

A

PO, IM, IV (OTC)

MOA:
-inhibit vestibular stimulation in the inner ear
(histamine)

Indication:

  • Nausea, motion sickness
  • Secondary: insomnia

Contraindication:

  • Pregnancy
  • Lactation
  • Newborn
  • Children
  • Older adults
  • Anticholinergic effects: retention, glaucoma, HTN, BPH, tachycardia

Side effects, Adverse reactions:

  • Crossing BBB: CNS depressant- drowsiness, dizziness, fatigue, disturbed coordination, FALL
  • Anticholinergic effects (PNS)
  • Hangover effect

Nursing Interventions:

  • Toxicity: excitation, hallucination, seizure
  • Warn against combination medications (decongestant A1 agonist)

Assess

  • Breathing (CNS depression –> respiratory depression –> shallow/diminished)
  • VS (for anticholinergic effects)
  • I/Os (for anticholinergic effects)

Patient Education:
-CNS depression: avoid driving or operating dangerous machinery

Interactions:
-Avoid other CNS depressants: ETOH, codeine

40
Q

Promethazine

A

PO, IV

Category Class:
-1st Gen Antihistamine, Anticholinergic (CNS), Dopamine Antagonists

MOA:

  • inhibit vestibular stimulation in the inner ear (histamine, Ach)
  • Block dopaminergic receptors in the intestine and CTZ (dopamine)

Indication:

  • Nausea, motion sickness, Ménière’s Disease, allergies
  • Nausea associated with chemotherapy, opioids, anesthesia
  • Secondary: insomnia

Contraindication:

  • Pregnancy
  • Lactation
  • Newborn
  • Children
  • Older adults
  • Anticholinergic effects: retention, glaucoma, HTN, BPH, tachycardia

Side effects, Adverse reactions:

  • Crossing BBB: CNS depressant- drowsiness, dizziness, fatigue, disturbed coordination, FALL
  • Anticholinergic effects (PNS)
  • Hangover effect
  • Is vesicant (causes blistering, tissue injury, damage to intima layer of veins) dilute IV form in a large-bore IV and very slow IV push, deep IM if you have to give IM
  • Memory impairment: caution in older adults, chronic respiratory diseases
  • CNS: seizure, EPS (high risk peds & geriatrics)

Nursing Interventions:

  • Toxicity: excitation, hallucination, seizure
  • Warn against combination medications (decongestant A1 agonist)
  • Vesicant: ensure for IV patency

Assess

  • Breathing (CNS depression –> respiratory depression –> shallow/diminished)
  • VS (for anticholinergic effects)
  • I/Os (for anticholinergic effects)

Patient Education:
-CNS depression: avoid driving or operating dangerous machinery

Interactions (with drugs/food/UV light):

  • Avoid other CNS depressants/stimulants
  • ETOH, codeine
41
Q

Scopolamine

A

Patch, PO, IM, IV

Category Class: Anticholinergic (PNS)

MOA:
-inhibits vestibular stimulation in the inner ear (Ach)

Indication:

  • Nausea
  • Motion sickness
  • Meniere’s Disease
  • Allergies

Side effects, Adverse reactions:

  • CNS depressant: drowsiness
  • Memory impairment: caution in older adults, chronic respiratory diseases
42
Q

Ondansetron

A

IM, IV, ODT

Category Class: Serotonin Antagonists

MOA:
-Blocks CTZ center in the brain & visceral stimulation (serotonin)

Overall, well tolerated (no risk of EPS)
-Drug of choice for most types of nausea associated with chemo, opioids, & anesthesia

Side effects

  • Headache
  • Diarrhea
  • Dizziness
  • Fatigue

Adverse reaction
-Dysrhythmia

“Frick Dan Had Diarrhea Daily”

Nursing Interventions:
-Monitor cardiac rhythm & avoid in Hx of dysrhythmia

43
Q

Benzodiazepines

A

PO, IM, IV

Lorazepam (Ativan)
-Epilepsy

Midazolam (Versed)
-Pre-operative

Category Class: CNS depressant, Schedule IV

MOA:
-GABA stimulation

Indication:
Sedative (anxiolytic) –> preventing alcohol withdrawal symptoms (DTs)

Epilepsy (antiepileptic)

  • Primarily prescribed for treating acute status epilepticus
  • Must be administered IV to achieve the desired response
  • Due to tolerance other anticonvulsants need to be given or dose adjustments within 6 months
  • Spasms (centrally acting muscle relaxant)
  • Insomnia (hypnotic)
  • Anesthesia induction (sedative/hypnotic)

Midazolam & Lorazepam

  • Most effective for chemotherapy related nausea
  • Often part of anesthesia induction

Side effects:

  • Lethargy
  • Poor balance
  • Respiratory suppression
  • FALL

“lets play real football”

Overdose

  • Flumazenil
  • Protect airway and breathing (intubation/ventilation)
  • Support BP
  • If oral within the last hour gastric lavage
44
Q

Glucocorticoids

A

IV: Methylprednisolone (Solu-Medrol)

PO: Dexamethasone

MOA: anti-inflammatory (similar to body’s cortisol, negative feedback)

Indication:

IV
-Acute exacerbation of inflammatory disorders (requires loading dose)

PO

  • To wean from IV and to continue to wean
  • End-stage disease for maintenance

Methylprednisolone & Dexamethasone
-Nausea associated with chemotherapy “premedication”

Side effects, Adverse reactions:

  • Hyperglycemia (in diabetic patients)
  • Leukocytosis (yet immunosuppressant)
  • Immunosuppressant (anti-inflammatory mechanism- higher risk of infection)
  • Water/Na retention (worsening of HF, edema, HTN) –> hypokalemia (dysrhythmia)
  • Water/Na retention –> increased IOP (worsening of glaucoma)
  • SubQ tissue loss with chronic use –> “paper skin” or “steroid skin”
  • Adrenal suppression (never stop abruptly to avoid adrenal crisis) requires weaning
  • Osteoporosis (take Vitamin D, Ca++, and exercise)

Nursing Interventions:
-Must always wean off

45
Q

Dronabinol

A

PO

One of the active ingredients is marijuana

Category Class: Cannabinoids, Schedule III

MOA:
-unknown, affecting cerebral cortex

Indication:

  • N/V secondary to chemotherapy (since 1985)
  • Appetite stimulant for AIDS, failure to thrive

Contraindication: psychiatric disorders

Side effects: THC related
-Mood changes, euphoria, drowsiness, dizziness, HA, depersonalization, nightmares, confusion, incoordination, memory lapse, dry mouth, orthostatic hypotension, tachycardia, FALL

46
Q

Ipecac Syrup

A

OTC

Category Class: Emetic

MOA:
-Stimulates CTZ and acts directly on gastric mucosa

Indication: may inducing vomiting only if

  • If <60min after ingestion (before the substance leaves the stomach)
  • If no antidote as available (contact Poison Control)
  • If no risk of aspiration
  • if ingested substance is not caustic/erosive to the mucous membrane

Nursing Interventions:
-Risk of abuse (anorexia nervosa patients)

47
Q

Activated Charcoal

A

With or without sorbitol which is a sweet osmotic laxative

PO, via NG tube

MOA: adsorbent

Side effects, Adverse reactions:

  • Constipation
  • Bowel obstruction

Nursing Interventions:
-May be used with gastric lavage (if toxic ingestion <60min and if indicated)

48
Q

Opiate Related Agents

A

Medication:

  • Diphenoxylate with Atropine (OTC, Rx)
  • Loperamide (OTC)

MOA:
-dec peristalsis by activating opioid receptors in the GI

Indication: Antidiarrheal

Contraindication:

  • Atropine contraindicated in glaucoma/BPH (Added to discourage abuse since diphenoxylate is a synthetic opioid & Also for its anticholinergic effects on GI)
  • Using antidiarrheals > 2 days
  • If fever with unknown etiology is present
  • If the etiology of diarrhea is unknown

Side effects, Adverse reactions:

  • CNS & respiratory depression (Especially children, older adults, & polypharmacy)
  • Physical dependence (short-term use only)

Interactions (with drugs/food/UV light):

  • ETOH
  • Other CNS depressants
49
Q

Lactobacillus Acidophilus

A

PO

MOA:

  • probiotic to replace GI normal flora
  • Reduces colonization by pathogenic bacteria

Indication:

  • prophylactic superinfection from antibiotic use (Administer at least 2hrs apart from antibiotics)
  • IBS, UC, C.Diff infection

Contraindication:
-lactose intolerance

Antidiarrheal CI:

  • Using antidiarrheals > 2 days
  • If fever with unknown etiology is present
  • If the etiology of diarrhea is unknown
50
Q

Antidiarrheals Nursing Interventions

A

Assessment: BM consistency, frequency, & quantity; bowel sounds

Prior to administering antidiarrheal:
-Collect a stool sample to rule out C.diff, OB, C&S, O&P

Monitor VS trend for hypovolemia and shock (low BP, tachycardia)

Educate:

  • only short term drugs (only for 48 hrs.)
  • increase fluid intake (PO/IV)
51
Q

Laxatives

A

Indications: therapeutic/prophylactic treatments for constipation associated with

  • Opioid use
  • Pregnancy
  • Prevent painful BM with hemorrhoid or post episiotomy
  • Prevent straining (with aneurysm, myocardial infarction)
  • Evacuation of bowel (prep for colonoscopy, post-ingestion of poisons)

Contraindications:
with other enteral medication (separate at least for 2 hours)

abdominal pain/cramping, nausea, vomiting

  • fecal impaction, bowel obstruction, ischemic bowel
  • biliary obstruction, appendicitis, diverticulitis, GI bleed
52
Q

Hyperosmolar Saline

A

Medication

  • Polyethylene glycol (PEG): PO drink
  • Polyethylene glycol (PEG) with electrolytes: PO drink
  • Magnesium hydroxide, PO drink, also antacid
  • Saline Enema

Category Class: Osmotic Laxatives

MOA:
-Pull more water into the intestine (osmotic effect)

Indication:

  • Quick treatment, results within 2 hours
  • Colonoscopy prep

Contraindication:

  • Polyethylene glycol (PEG): using > 1 week
  • RF: Requires renal function to excrete excess electrolytes
  • Children < 2

Side effects, Adverse reactions:

  • Hypermagnesemia: cardiac arrest (monitor serum Mg)
  • Hypovolemia: monitor VS trends of low BP with tachycardia

Nursing Interventions:
-Monitor for abnormally high level of electrolytes

53
Q

Bisacodyl, Senna, Castor Oil

A

Medication:

  • bisacodyl: OTC PO, suppository
  • senna: OTC PO
  • castor oil: OTC PO

Category Class: Stimulant (irritants)

MOA:
-Increase peristalsis by irritating sensory nerve endings in intestinal mucosa

Quick treatment

  • PO: 6-12 hours
  • PR: 15-60 minutes

Side effects, Adverse reactions:

  • Anorexia, N/V, cramps, weakness, reddish brown urine
  • Dependence
  • Suppository: Proctitis: inflammation of the rectum and anus, burning sensation

“Nadia & Vlad Can Always Wear Red Dresses”

Interactions:
-Avoid milk or antacid with PO form (at least 1 hour apart)

54
Q

Soapsuds Enema

A

Castile is a mild soap

Category Class: Stimulant (irritants)

MOA:

  • The suds irritate the bowels increasing the peristalsis
  • The soap also works as an emollient
  • The large volume water increases the water in stool

Indication:
-used when other medications are not effective

55
Q

Emollients (Stool Softeners)

A

Medication:

  • Docusate sodium
  • Docusate sodium/senna
  • Mineral oil enema

MOA:

  • Lowers surface tension (works like surfactant) –> Promotes water penetration in the stool
  • Emulsifies and lubricates feces for easier passage
  • Maintenance: slow action

Indication: Constipation

56
Q

Psyllium

A

Category Class: Bulk-forming

MOA:
Natural fibers (nonabsorbable) made from psyllium plant seed
-Identical to the action of dietary fiber
-Increase fecal bulk & soften fecal mass

Maintenance: results in 8-24 hours

Indication: Constipation

Patient Education:

  • No dependence
  • Drink plenty of water to prevent bowel obstruction
57
Q

Antacids

A

Medication:

  • Calcium-carbonate: chewable tab, suspension, gum
  • Magnesium-hydroxide: suspension/tablet (osmotic laxative)
  • Magnesium-hydroxide/aluminum-hydroxide: suspension, tab

MOA: Neutralize HCL acid –> dec pepsin activity

  • Promote healing of ulcers, dec inflammation
  • Antagonistic interaction with ETOH

Indication: PUD

Contraindication: Constipation or diarrhea

  • Mg –> diarrhea
  • Al –> constipation

Side effects, Adverse reactions: OD of electrolytes (Mg, CA, Al)
-Specially with history of RF

Patient Education:

  • Take up to 7 doses/day (1 & 3 hrs after meals & at HS)
  • Take other drugs at least 1 hr before or 4 hrs after antacids
  • Monitor for diarrhea as a sign of infection (low acidity –> opportunistic infections)
  • Chewable (must chew), suspension (must shake well)
  • Take with 8 oz water, just enough to ensure the drug reaches stomach
58
Q

H2 Receptor Blockers

A

Medication:

  • Famotidine: IV, PO
  • Cimetidine: IV, PO
  • Nizatidine: PO

MOA:

  • Reduce gastric acid by blocking H2 receptors on the stomach wall
  • Promote healing of ulcer by reducing hydrochloric acid production

Indication: PUD

Contraindication: RF

Side effects, Adverse reactions:

B12 deficiency (take supplement)

Blocking androgen receptors
-Impotence, decreased libido, gynecomastia

CNS effects

  • Lethargy, depression, confusion (take at bedtime)
  • Caution: geriatric population

Low gastric acidity: may cause bacterial colonization (precautions)

RF

Nursing Interventions:

  • Take right before meals: To decrease food-induced acid secretion
  • Monitor I&Os: Monitor lab: renal panel, CMP
  • Don’t take with antacids (lower absorption)- take separately 1-2 hours
  • May cause toxicity with warfarin, phenytoin, theophylline, lidocaine
  • Older adults need smaller dose due to less gastric acid
59
Q

Proton Pump Inhibitors (PPI)

A

Medication:

  • Pantoprazole: IV, PO
  • Omeprazole: PO

MOA:

  • Reduces gastric acid
  • Oral peak effect: after several days

Indication: PUD

Side effects, Adverse reactions:

  • Diarrhea, insomnia, dizziness, dry mouth, flatulence, liver failure, C-diff
  • Long term use –> osteoporosis

Nursing Interventions:

  • Take at least an hour before meal/drugs (to avoid poor digestion/absorption)
  • Taper off to avoid rebound acid hypersecretion
60
Q

Sucralfate

A

PO (tablet, oral suspension)

Category Class: Pepsin Inhibitors

MOA:

  • Reacts with gastric acid and forms a thick paste
  • Selectively adheres to the ulcer protecting it from acid and pepsin for up to 6 hours

Indication: PUD

Side effects:
-Constipation, hyperglycemia (sugar content of the drug)

Nursing Interventions:

  • Given 30 minutes AC & HS (qid)
  • Avoid taking with other drugs (At least 2 hours apart from other drugs to prevent poor absorption)
  • Finish the course even if feeling better
  • Increase activity, water, fiber to avoid constipation

Pharmacotherapy (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions