Exam 4 Flashcards
ferrous sulfate
iron deficiency anemia
cyanocobalmin
pernicious anemia
Adverse: hypokalemia (muscle weakness, nausea, palpitations and paresthesias)
cyanocobalamin or folic acid
megaloblastic anemia
Folic Acid
folate deficiency in alcoholism
prevent neural tube defects in fetus
Iron Dextran
IV or IM. Test dose 1 hr before full dose.
Monitor s/s anaphylaxis-rash, wheezing, hypotension
For IV-no faster than 50mg/min
For IM- 2-3in needle, Z-Track
Iron needed for RBC production-monitor Hgb, Hct and reticulocyte counts
Oral-staining teeth-mix with water or juice use straw rinse mouth after
Factor VIII (Hemophilia A)
Adverse: allergic reaction
mild-rash/itching-diphenhydramine
anaphylaxis-diff breathing, swelling airway, hypotension-epinephrine
Can take COX 2 inhibitor (Celecoxib)
No COX 1&2 inhibitors (aspirin, naproxen, ibuprofen) can cause GI bleed and ulceration
Desmopressin
Adverse: fluid retention with hyponatremia
Alteplase
give less than 2 hr for MI and 3-4.5 hr for CVA/Stroke
MI-chest pain, L arm pain, diaphoresis, abnormal ECG
Adverse: bleeding, symptoms of stroke. If pt taking alteplase develops stroke symptoms its hemorrhagic or bleeding in brain. stop and administer aminocaproic acid
Heparin
Adverse: bleeding/hemorrhage-hypotension, tachycardia, bruising, petechiae, hematoma & black tarry stools. Decreased RBC, Hgb & Hct
aTTP monitored-1.5-2x baseline
Protamine given to reverse heparin
Adverse: autoimmune reaction resulting in thrombocytopenia, if platelet below 100,000 stop and use non-heparin anticoagulant
Warfarin
Monitor INR-therapeutic range 2-3
Signs bleeding: light-headedness, dizziness, hypotension, tachycardia, decreased RBC, Hgb & Hct
Clopidogrel
Adverse: thrombotic thrombocytopenic purpura-early indication decreased platelets, ecchymosis and pinpoint purplish petechial rash
Increased risk bleeding with NSAIDs, alcohol and some herbal supplements (gingko biloba)
PPIs (omeprazole) decrease antiplatelet effect and increase risk blood clots
Epoetin
Adverse: hypertension, seizures, stroke symptoms
monitor Hgb for effectiveness
dont give to cancer pt with Hgb above 10
Report Hgb above 12 or 1 g/dL or more increase within 2 weeks
Filgrastim
Adverse: bone pain and fever
Monitor WBC for effectiveness
If WBC above 10,000 lower or discontinue dose unless Nadir hasnt passed
Dont give w/in 24 hrs cytotoxic chemo like topotecan
Oprelvekin
Adverse: cardiac dysrhythmias (tachycardia), fluid retention (edema), conjunctival injection (red conjunctiva) and blurred vision
monitor platelets for effectiveness
continue until platelets over 50,000 but no more than 21 days
SubQ 4-6 hr after chemo, next chemo not for at least 2 days after injection
Alprazolam
Adverse: drowsiness and inability to recall events (high doses and alcohol)
Stopping abruptly may cause withdrawal symptoms-insomnia, anxiety, tremors, diaphoresis, dizziness, panic, hypertension, seizures, paranoia and hallucinations
Taper over 1-2 weeks to decrease withdrawal
Toxicity with IV benzodiazepine (diazepam)
May cause life-threatening sedation, hypotension, tachycardia, resp depression and cardiac arrest
Flumazenil reverses benzodiazepines
Diazepam IV causes burning and venous irritation-avoid small hand veins
Buspirone
Start 2-4 weeks before tapering benzodiazepines (alprazolam) due to delayed effects of buspirone can have paradoxical effect-anxiety, restlessness, insomnia MAOI antidepressant (phenelzine) can cause HYN dont take within 2 weeks of busiprone
Amitriptyline
Adverse: increase risk suicide esp children and adolescents
increased risk OD-life threatening dysrhythmias, confusion, seizures, anxiety, delirium and coma
For OD: gastric lavage and sodium bicarbonate for dysrhythmias
No more than 1 week supply to decrease risk OD
Fluoxetine
adverse: serotonin syndrome-mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucination, incoordination, hyperreflexia, excessive sweating and tremors
Other adverse: wt gain and hyponatremia-monitor wt weekly and Na periodically
Venlafaxine
Adverse: HTN and wt loss due to anorexia Taper over 2-4 weeks to avoid w/drawal No MAOI (phenelzine) within 14 days bc increases the risk for serotonin syndrome
Phenelzine
Adverse: hypertensive crisis in presence of tyramine-containing foods (chocolate, aged cheese and red wine). If occurs, IV phentolamine or sublingual nifedipine are administered
Bupropion
Adverse: N/V, wt loss, insomnia, agitation, tremors, psychosis, hallucinations and delusions
Give w/ food to decrease N/V and wt loss
Used for prevention seasonal affective disorder and smoking cessation adjunct
Contraindicated: hx eating disorder, seizure disorder and head trauma
Lithium
Adverse: goiter, hypothyroidism, polyuria
Lithium toxicity: nausea, muscle weakness, fine to coarse hand tremors, ataxia, confusion, seizures, coma and death
Low sodium can cause lithium toxicity
NSAIDs (except aspirin) increase risk for toxicity
Chlorpromazine
Adverse: acute dystonia, parkinson-like syndrome, neuroleptic malignant syndrome and tardive dyskinesia
Neuroleptic Malignant Syndrome
Muscle rigidity, high fever, VS instability, and loss of consciousness
Tardive Dyskinesia
involuntary movements of tongue, face, limbs and trunk
Parkinson-like Syndrome
muscle rigidity, tremors, sluggish movements, drooling and shuffled gait
Acute Dystonia
Severe spasms of neck and body
Risperidone
Cause extrapyramidal effects similar to chlorpromazine but less often
Adverse: wt gain, onset or worsening DM, increased cholesterol levels
Report: polyuria, polydipsia, severe spasms, parkinson-like symptoms, inner restlessness or ability to sit still
Betaxolol
Beta blocker-can cause bradycardia, hypotension, bronchospasms or constriction of bronchioles (expiratory wheezing)
Report: slow pulse, fainting spells and wheezing
Pilocarpine
Cholinergic agonist can cause: bradycardia, constriction of bronchioles and urinary urgency
Adverse: retinal detachment
Report: dark floaters, flashes of light and “curtain” pulled over part of vision in one eye
Echothiophate
Cholinesterase inhibitor can cause: bradycardia, constriction of bronchioles and urinary urgency
Adverse: cataract development, opacity behind pupil when penlight shining in eye
Report decreased daytime and nighttime vision
Administer in evening 5 mins apart from other eye drops
Pilocarpine and Echothiophate
Pupil constriction
Adverse: decreased visual acuity esp at night
Report: urinary urgency, slow HR or wheezing
