Exam 3 Pharmacology Flashcards
Fentanyl, Warfarin, Enoxaparin, Prednisone, Promethazine, Pantoprazole, Mannitol, Metronidazole
Fentanyl MOA
synthetic opioid agonist
100x more potent than morphine
- changing the brain and CNS response to pain
Fentanyl expected effects
relaxation
euphoria
pain relief
sedation
confusion
drowsy
dizzy
N/V
urinary retention
pupillary constriction
respiratory depression
Fentanyl adverse effects
dysrhythmias, increase HR
agitation, hallucinations, fever, sweating, confusion
n/v, loss of appetite, weak or dizzy
inability to keep erection or a period
seizure
chest pain
extreme drowsiness
Fentanyl nursing interventions
Monitor respirations and O2 for depression
- neuro
Fentanyl is used for
Pain
Sedative for mechanical ventilation
Fentanyl Routes
Transdermally (long-lasting)
- 72 hours max then remove and apply the next one
Lollipops
SL
Buccal
Sprays
injections
Fentanyl is a type of
Narcotic analgesic (opiate)
How to use lozenges with Fentanyl?
place within cheek and gum
actively suck and move around in the mouth using the handle (twirl often)
- do not chew, crush, or bite
- do not eat or drink while it is in your mouth
- Finish within 15 minutes
If the patient has a fentanyl lozenges, and starts to feel dizzy, sleepy, or nauseous, then
remove and dispose of properly
- out of reach of children
- hot running water to dissolve
Fentanyl OD antidote?
Naloxone
Fentanyl OD s/s
excessive drowsiness or sleepiness
slow or shallow breathing
difficulty breathing
cold, clammy skin
narrowing or widening of the pupils (black circles in the middle of the eyes)
unable to respond or wake up
slowed heartbeat
unusual snoring
Fentanyl Contraindications medical
severe asthma or other breathing problems
stomach or bowel obstructions (paralytic ileus)
Warfarin MOA
inhibits essential enzyme for activating the vitamin K available in the body
- reduces clotting factors
Warfarin expected outcomes
decrease clotting
- No DVT, stroke or PE
BRUISE EASILY
Warfarin adverse effects
uncontrollable bleeding
hemoptysis
bleeding gums
hematuria
bloody stool
dizzy,weak
fever
nosebleed
Warfarin nursing interventions
- limit vitamin K consumption (green and leafy)
- careful about bleeding, OTC, alcohol
don’t stop unless directed - ID bracelet
Warfarin used for
prevention of DVT and stroke
a fib (irregular HR)
prosthetic heart valves
patients of an MI
Warfarin drug type
Anticoagulant
Warfarin contraindications
erythromycin
phenytoin decrease
NSAIDs, steroids,tylenol
Warfarin INR LEVEL
2-3 x therapeutic levels
Warfarin antidote
Vitamin K AND FFP
Warfarin onset
slow acting
5 days
Warfarin lab levels to monitor
PT/INR
Enoxaparin MOA
binds and potentiates antithrombin (circulating anticoagulant) to stop the clotting factors
Enoxaparin expected outcomes
no DVT, PE, ors ischemic cardiac complications
- bleeding
- bruising
- pain/irritation at the injection site
Enoxaparin adverse effects
bleeding (gums, nosebleeds, bruising)
injection site reaction
anaphylaxis
thrombocytopenia
osteoporosis
N/V/D
HA
Enoxaparin nursing interventions
Digoxin toxicity (N/V)
Enoxaparin labs to monitor
Platelets <150000 and CBC
Half-life 3-6 hours
Do not rub/massage after injection site
Monitor for constipation
soft bristle toothbrush,tarry stools, hematuria
Enoxaparin used for
preventing blood clots
prophylactic on surgically, bedrest patients
unstable angina, MI
Enoxaparin precautions
bleeding disorders
kidney/liver pts
NSAIDs/ASA
elderly
Enoxaparin contraindications
HIT (Heparin)
active bleeding (GI and hemorrhagic stroke)
endocarditis
spinal anesthesia
- thrombolytics, SSRI/SNRI, NSAIDs, antiplatelet, digoxin
- garlic, ginger, ginkgo biloba, vitamin E, fish oil, danshen, dong quai, saw palmetto
Enoxaparin drug type
antithrombotic
Prednisone MOA
lowers inflammation by reducing the activity and volume of the immune system
Prednisone expected outcomes
low immune system
high blood sugar
low inflammation
weight gain
nausea
HA
mood swings
Prednisone adverse effects
blurry vision
dizzy
fainting
fast and irregular HR
increased urination/thirst
irritable
Prednisone nursing interventions
no crowds/live vaccines
insulin not for diabetes
Prednisone used for
inflammation flare ups
arthritis
asthma
adrenal crisis
Prednisone contraindications
blood thinners (Warfarin and NSAIDs)
desmopressin
other immunosuppressants
Prednisone drug type
corticosteroids
Prednisone labs to monitor
blood sugars
CBC
wt gain
urea and electrolytes
sweeling in lower extremity
Promethazine MOA
histamine antagonist
alpha adrenergic
- prevent nausea/vomiting
short term for insomnia
relieve allergies s/s
Promethazine EXPECTED OUTCOMES
induction of sleep which can be easily aroused again if needed
- drowsy
- dizzy
- constipation
- blurred vision
- dry mouth
(anticholinergic)
sedation
- nightmares
- confused
- respiratory depression
- extrapyramidal (dystonia, akathisia, and parkinsonism)
Promethazine adverse effects
trouble urinating
extravasation
Promethazine nursing interventions
large bore IVs patency
monitor for tissue necrosis
Promethazine used for
tx allergic reactions
anxiety and tension
N/V
Promethazine contraindications
pregnancy and lactating
coma
tx of asthma
Promethazine drug type
Antihistamine
- sedating
Promethazine labs to monitor
VS - BP and HR
Blood sugar
Pantoprazole MOA
reduces the amount of stomach acid made
Pantoprazole expected outcomes
no ulcers or hematuria
HA, dizzy
stomach pain, gas, N/V/D
joint pain
fever, rash, cold s/s
Pantoprazole adverse effects
stomach cramps
bloated
diarrhea
fever
N/V
unusual tiredness
Pantoprazole nursing interventions
diarrhea = infection
oliguria
hemturia
More likely to break a bone if long term
-increase risk of fx in the hips, wrist and spine
Pantoprazole used for
esophagitis
GERD
Ulcers tx and prevention
allows the digestive system to rest
Pantoprazole contraindications
long term = harder to digest B12
osteoporosis
Digoxin, diuretic, methotrexate
Pantoprazole drug type
Proton pump inhibitor
Pantoprazole monitor labs
BUN and Creatinine
I&Os
bowel sounds
Mannitol MOA
elevates blood plasma osmolality
- enhanced flow of water from tissues to
brain and CSF into interstitial fluid and plasma
Mannitol expected outcomes
neuro status improved
- 1st transient hyponatremia then hypernatremia as water is
lowers ICP and cerebral edema
raises HTN during dialysis
Mannitol onset and duration
within 5-10 minutes
last up to 6 hours
Mannitol adverse effects
worsening cerebral edema
- confusion
- lethargy
- HA
heart failure
diuresis
- low Na, K, Ca
dyspnea
hypotension
anaphylaxis
- Mannitol nursing interventions
extravasation
I&Os strict (30-50mL/hr or 0.5mL/kg/hr)
ICP
NEURO STATUS
dysrhythmias (K imbalance)
fluid shifts = hemodynamic instability
Mannitol used for
decreasing ICP, IOP, and cerebral edema
excrete toxins
improve BP during dialysis
Acute renal failure in oliguric phase
Mannitol contraindications
pulmonary edema
active cranial bleeding
significant hypovolemia
heart and kidney failure
kidney insufficiency
electrolyte imbalances
CAUTION with Digoxin
Mannitol drug type
osmotic diuretics
- crosses the blood brain barrier
Mannitol monitor labs
electrolytes (Na and K)
SERUM osmolality
Metronidazole MOA
inhibits protein synthesis by interacting with DNA
and breaks down bacteria to prevent or stop infections
cytotoxic
Metronidazole expected outcomes
no fever, normal WBCs
dizzy
lightheaded
N/V/D
slight metallic taste in the mouth
Metronidazole adverse effects
encephalopathy
meningitis aseptic
neutropenia
peripheral neuropathy
Metronidazole nursing interventions
Call HCP if s/s of liver damage or renal damage
NEURO STATUS
ER - without food 1 hour before or 2 hours after a meal
- do not break or crush
Metronidazole used for
- not for colds, flu, or other viruses
skin infections, rosacea, mouth infections - infected gums and dental abscesses
bacterial vaginosis and pelvic inflammatory disease
*stds)
Metronidazole contraindications
pregnant/breastfeeding
liver problems
dialysis
drinking alcohol
Metronidazole drug type
Antibiotic
Metronidazole monitor labs
WBC
liver enzymes
triglycerides
