Exam 4 Flashcards
1
Q
What kind of drug is aspirin
A
Cox 1 and 2 inhibitor
2
Q
what does Cox 1 enzyme do?
A
platelet aggregation, kidney function, stomach acid and mucous production
3
Q
what does cox 2 enzyme do?
A
pain, inflammation, heat
4
Q
What are the indications for aspirin?
A
headache, reduce fever, pain relief, decrease platelet aggregation, low dose protection
5
Q
What aspirin is given to prevent MI’s and ischemic stroke?
A
81 MG enteric coated baby aspirin
6
Q
If our client is taking aspirin for headache/ fever, what dose would they receive?
A
325 mg
7
Q
what are other names for aspirin?
A
acetylsalicylic acid, ASA
8
Q
Drug interactions for aspirin?
A
warfarin absorption increases (increases risk of bleeding), alcohol increases risk of gastric irritation/bleeding, GHerbs: garlic, ginger,gink,ginsing, feverfew
9
Q
Contraindications of aspirin?
A
s/s of bleeding, s/s of hemorrhagic stroke, signs of hearing loss, surgery within 7 days
10
Q
What are signs and symptoms of bleeding?
A
petechiae, purpura, coffee ground emesis, dark tarry stools, hematuria, increased bruising
11
Q
Adverse effects of aspirin?
A
nephrotoxicity, bleeding, renal impairment, salicylism, Reye’s syndrome, teratogenic
12
Q
Symptoms of salicylism?
A
tinnitus, dizziness, headache, fever, altered mental status, sweating
13
Q
what is Reye’s syndrome?
A
when a child/adolescent has a viral infection and takes aspirin
14
Q
Symptoms of Reye’s syndrome
A
liver damage, hypoglycemia, CNS damage
15
Q
What to do if our patient has salicylism?
A
cool with tepid water, correct electrolyte imbalances, give bicarb to correct acidosis, hemodialysis, give activated charcoal to decrease absorption, gastric lavage
16
Q
Nursing interventions for aspirin?
A
monitor bleeding, take with food due to GI upset, increase fluid to reduce renal impairment, stop one week before procedures, do not crush enteric coated, inform parents about Reye’s syndrome, do not administer if platelets less than 150 thousand, inform about G herbs
17
Q
What drug should we inform children and adolescents take instead of aspirin?
A
acetaminophen
18
Q
What drugs are NSAIDs?
A
ibuprofen, naproxen, indomethacin, ketorolac, diclofenac, meloxicam
19
Q
How do NSAIDs and aspirin differ?
A
same effects except NSAIDs do not offer MI protective properties
20
Q
What properties do all NSAIDs have in common?
A
analgesic, anti-inflammatory, antipyretic properties
21
Q
contraindications of NSAIDs?
A
bleeding, renal and liver dysfunction, drinking alcohol
22
Q
If we have a patient report to the ED with acute CP, what dose can we give them?
A
4 chewable aspirin 81 mg
23
Q
Indications of NSAIDS
A
moderate pain, fever, tendonitis, sunburn, rheumatoid arthritis, osteoarthritis, naproxen primarily treats migraines
24
Q
Side effects of NSAIDs
A
nausea/vomiting
25
adverse effects of NSAIDs
GI ulcers/bleeding, nephrotoxicity, hepatotoxicity, prolonged bleeding (can be intended effect as well)
26
What are the black box warnings for NSAIDs?
risk for cardiovascular event, GI bleeding
27
NSAIDs can cause worsening ____ _____
heart failure (because NSAIDs impair renal function which causes sodium and water retention)
28
Ketorolac cannot be used longer than? Why is this
5 days due to high risk of kidney damage
29
Nursing interventions for NSAIDs
take with food and water/milk, increase fluids to flush kidneys, avoid alcohol to limit GI irritation, avoid G herbs, monitor s/s of bleeding, monitor s/s of stroke/MI, do not crush enteric coated tablets, limit use of ketorolac, expect H2 blocker or PPI
30
Why are NSAIDs sometimes given with H2 blockers or PPI?
decreases risk of a GI ulcer
31
What are special considerations we should make for our older adults on NSAIDs?
start low and go slow, monitor renal function, increase fluids
32
What does DMARDS stand for?
disease modifying anti-rheumatic drugs
33
What drugs are DMARDs?
etanercept, infliximab, adalimumab, methotrexate
34
What are the indications for DMARDs?
slow degeneration of joints, slow progression of RA
35
DMARDs can cause _____ which increases the risk of?
immunosuppression ; infection
36
How long does it take for DMARDs to become therapeutic?
several months
37
Adverse effects of DMARDs (etanercept, infliximab, adalimumab)?
injection site pain, risk for infection, blood dycrasias, skin reactions such as Stevens Johnsons, heart failure
38
Symptoms of infections?
green sputum, high WBC, fever, chills, coughing, sore throat, etc
39
Nursing interventions for DMARDs (etanercept, infliximab, adalimumab)?
stop if reaction occurs at injection site, monitor for skin reactions such as blisters (from Stevens Johnson with flu-like symptoms), monitor s/s of heart failure (edema, SOB), monitor CBC and blood dyscrasias (bleeding, bruising, fever, anemia), monitor s/s of infections
40
Adverse effects of DMARD methotrexate?
infection, hepatotoxicity, bone marrow suppression, ulcerative stomatitis, fetal death (pregnancy category x)
41
Nursing interventions for DMARd methotrexate?
s/s of an infection, RFTs, LFTs, s/s of hepatotoxicity (abdominal pain, jaundice, N/V), advise patient to take folic acid, monitor for stomatitis, take with food, advise patient to be on birth control
42
With bone marrow suppression, we should monitor our clients for?
bleeding, infections, anemia
43
Why should those on methotrexate take folic acid?
reduces hepatotoxicity
44
What is stomatitis?
inflamed and sore mouth
45
Patients on DMARDs should avoid what type of vaccines?
live virus
46
How should nurses check for infection before starting our client on DMARDs?
do full review of systems and tuberculosis test
47
What are the anti-gout medications?
colchicine, allopurinol, probenecid
48
What are the indications for colchicine?
acute attack
49
How can colchicine be administered?
0.6 mg, wait one hour, another 0.6 mg(this is the max dose)
50
What causes gout?
increased uric acid
51
Indications for allopurinol?
non acute attack, used to lower uric acid (urate)
52
Indications for probenecid?
inhibits uric acid reabsorption
53
Clients with gout should avoid foods high in?
purine
54
examples of purine rich foods?
red meat, alcohol, seafood
55
Why should patients with gout increase fluid intake?
prevent kidney stones and encourage uric acid excretion
56
What is rhabdomyolysis, a side effect of anti-gout meds? What lab should we monitor in our patients?
muscle breakdown; creatinine kinase and urinalysis
57
Contraindications of anti-gout meds?
severe renal, cardiac, hepatic, or GI dysfunction
58
Patient teaching for anti-gout meds?
take with food, avoid grapefruit juice, avoid foods high in purine, avoid alcohol, avoid salicylates with probenecid, increase fluids, report s/s of infection, report muscle pain, metallic taste with allopurinol is normal
59
Allopurinol can cause what disease characterized by flu-like symptoms and blisters/rash?
stevens-johnson
60
Clients taking allopurinol should report what symptom?
rash
61
is the metallic taste experienced with allopurinol normal?
yes
62
What type of drug is acetaminophen?
non opioid analgesic
63
How does acetaminophen differ from NSAIDs and ASA?
has analgesic and antipyretic actions but no anti-inflammatory or antithrombotic action
64
Does acetaminophen cause GI upset?
no
65
Indications for acetaminophen?
fever and minor pain (such as musculoskeletal)
66
acetaminophen is the drug of choice for?
children and older adults
67
Symptoms of acetaminophen overdose?
N/V/D, sweating, abdominal pain, coma, liver damage up to 48 hrs after ingestion
68
Treatment for acetaminophen overdose?
administer acetylcysteine within 8 hrs of ingestion, gastric lavage within 4 hrs of ingestion
69
acetylcysteine can be given by?
nebulizer, oral, iv
70
What is the max daily dose of acetaminophen for healthy liver
4 g/day
71
What is the max daily dose of acetaminophen for unhealthy liver
2g/day
72
How to determine if a liver is healthy
normal AST and ALT tests
73
What are triptans?
drugs for headache
74
How to identify triptans?
end in -triptan
75
Indications of triptans?
headaches, migraines
76
Mechanism of action for triptans
relieves pain by constricting blood vessels and suppressing inflammation
77
How should we teach patients to take oral triptans?
take when migraines are first sensed, second dose 2 hrs later (do not exceed 100 mg in single dose and 200 mg total a day)
78
How should we teach patients to administer subcutaneous triptans
how to administer, do not give more than 2 injections in 24 hours
79
How should we teach patients to administer nasal spray triptans
administer as a single dose, can repeat in two hours
80
Should triptans be avoided in pregnancy?
yes
81
Indications for naloxone?
overdose symptoms: respiratory depression and respirations less than 10, cardiac arrest, neurotoxicity
82
what drugs are opioid analgesics?
morphine sulfate, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphone, tramadol
83
Indications for opioid analgesics?
acute or chronic pain
84
Side effects of opioids?
sedation, dysphoria, hallucinations, nausea, constipation, decrease urine output, dizziness, orthostatic hypotension, pupillary construction, itching sensations
85
Opioids can cause dysphoria. What does this mean?
depression, anxiety, restlessness
86
Adverse effects of opioids?
respiratory depression, cardiac arrest, neurotoxicity (indicators of overdose) (bradycardia, hypotension, respiratory depression)
87
those in opioid overdose can experience neurotoxicity, what are symptoms?
delirium, agitation, mild clonus
88
Nursing interventions for opioids?
monitor vital signs before and during, monitor respiratory status and LOC, monitor urine output, monitor constipation, use cautiously during pregnancy/delivery/lactation, stop IV opioids before discharge, closely monitor patients taking drug, get pain level before and during,
89
What is diversion? How can we determine if this is happening to our patient?
Someone not prescribed the opioids is taking them. Count pills and ask patient "tell me how you take your medication"
90
What is the opioid overdose triad?
pin point pupils, respiratory depression, coma
91
Drug interactions with opioids?
anti-seizure medications, other CNS depressants like alcohol and antidepressants,
92
Patient teaching for opioids?
report symptoms of hypotension/ change positions slowly and dangle legs, increase fluid/fiber/exercise for constipation, teach how to use PCA pump, notify them tolerance can develop
93
what is a PCA pump?
patient controlled analgesia
94
a PCA pump must be ordered with?
naloxone
95
What is basal/bolus CPA pump
basal is set dose, bolus is patient controlled
96
Is anyone else allowed to press basal /bolus besides patient?
no
97
if our patient is oversedated on a PCA pump we should?
discontinue the pump and notify provider
98
If bolus is very frequently pushed we may need to?
increase basal dose
99
What kind of drug is metoclopramide?
dopamine antagonist
100
What is the mechanism of action for metoclopramide?
blocks dopamine receptors
101
What are the indications for metoclopramide?
fix N/V caused by diabetic gastroparesis (slow emptying) or GERD
102
What drug is psyllium husk?
bulk forming laxative
103
What are the indications for psyllium husk?
decrease diarrhea in those with diverticulosis or IBS, control stool in colostomy and ileostomy promote defecation in older adults
104
Patient teaching with psyllium husk?
increase fiber, fluids, exercise (2-3L)
105
Can we give psyllium husk if our patient has difficulty swallowing? Why?
No ; increases risk of esophageal obstruction
106
If our patient on psyllium husk does not increase fluids what could occur?
bowel obstruction
107
What drugs are antihistamines/ anticholinergics?
hydroxyzine, scopolamine, doxylamine + pyridoxine (b6)
108
Patient teaching for scopolamine?
place 4 hours before, leave on for three days, rotate ears during next dose
109
What combination of antihistamines can pregnant patients take?
pyridoxine (vitamin b6) and doxylamine
110
General side and adverse effects for antihistamines/anticholinergics?
can't see, can't pee, can't spit, can't poop. Dry eyes, sedation, drowsiness, fatigue
111
General patient teaching for anticholinergics/antihistamines?
increase fiber, fluid, exercise for constipation. Suck on candy for dry mouth. Avoid heat because you do not sweat. Report vision changes
112
Contraindications for antihistamines/anticholingerics?
glaucoma, BPH and urinary retention
113
What kind of drug is promethazine?
phenothiazine and dopamine blocker
114
Indications for promethazine?
nausea, vomiting, psychosis, schizophrenia
115
Patient teaching for promethazine?
do not take with other CNS depressant like opioids and alcohol, report extrapyramidal symptoms: neck and face spasms, restlessness, anxiety
116
What are the extrapyramidal symptoms seen in promethazine?
face and neck spasms, restlessness, anxiety
117
What medications are stimulant laxatives?
bisacodyl, castor oil, Senna
118
How do stimulant laxatives work?
stimulate intestinal mucosa to do peristalsis
119
Patient teaching for stimulant laxatives?
avoid chronic use, do not take with milk and antacids, take at bedtime, reddish/brown urine is normal, increase fiber and fluids
120
When should stimulant laxatives be taken?
at bedtime
121
What is the surfactant laxative?
docusate sodium (stool softener)
122
Mechanism of action for the surfactant laxative docusate sodium
increases water and electrolytes in bowel lumen to soften stool
123
Indications for surfactant laxatives?
relieve constipation, prevent painful elimination, prevent straining, decreases risk for fecal impaction, promote defecation
124
General contraindications for laxatives?
bowel obstruction, acute surgical abdomen, appendicitis, diverticulitis, ulcerative colitis
125
Patient teaching to prevent constipation?
increase fiber fluid exercise
126
What are the saline laxatives?
magnesium hydroxide, magnesium citrate
127
Complications of saline laxatives?
absorb systemically leading to: dehydration, hypermagnesemia, sodium retention
128
Patient teaching for saline laxatives?
129
Nursing intervention for saline laxatives?
skin turgor, daily weights, I&O, monitor for edema, monitor renal function, monitor sodium and magnesium levels
130
what drugs are osmotic laxatives?
polyethylene glycol (miralax), polyethylene glycol electrolyte solution (Golytely), lactulose
131
Indications for polyethylene glycol? osmotic laxative
occasional constipation (2-4 days)
132
Indications for polyethylene glycol electrolyte solution?
bowel prep for surgery/colonoscopy
133
Indications for lactulose? osmotic laxative
prevention and treatment of encephalopathy (bring down ammonia levels)
134
What are the antidiarrheals?
diphenoxylate with atropine, loperamide
135
Indications for diphenoxylate with atropine?
provide symptomatic treament of diarrhea with opioids
136
Is diphenoxylate with atropine a controlled substance?
yes
137
Indications for loperamide ?
acute and chronic diarrhea
138
Can our antidiarrheal medications be given if diarrhea is caused by organism? (ex. c-diff)
No
139
What are antacids used to treat?
peptic ulcer disease and hyperacidity
140
What are the different types of antacids?
aluminum, magnesium, calcium, sodium bicarbonate
141
Side and adverse effects of aluminum antacids?
constipation, hypohosphatemia, hypomagnesemia, pregnancy category C
142
Side and adverse effects of magnesium antacids?
diarrhea, hypermagnesemia and toxicity with impaired renal function
143
Side and adverse effects of calcium antacids?
constipation
144
Adverse and side effects of sodium bicarbonate antacids?
fluid retention
145
Contraindications of sodium bicarbonate antacids?
those with HTN or HF
146
Contraindications of magnesium antacids?
kidney dysfunction (avoid toxicity)
147
Contraindications of aluminum antacids?
pregnancy
148
What kind of drug is sucralfate?
mucosal protectant
149
What is the indication for sucralfate?
gastric ulcer
150
What is the mechanism of action for sucralfate?
coat the mucosa and protect the ulcer
151
What evaluation tells us sucralfate is effective?
reduced pain
152
What kind of drug is misoprostol?
mucosal protectant
153
Indication for misoprotol?
NSAID induced ulcer
154
Mechanism of action for misoprostol?
increase bicarbonate and mucin release. Reduces acid secretion which protects the lining of the stomach and helps ulcer repair
155
Contraindications of misoprostol?
pregnancy category x, diarrhea, bleeding
156
What are the H2 receptor blockers?
cametidine, famotidine (end in -tidine)
157
Drug interactions of H2 Blockers?
warfarin, theophylline, lidocaine, phenytoin can cause toxicity
158
Patient teaching for H2 Blockers
report s/s of respiratory infection, report gynecomastia and impotence, avoid alcohol, avoid smoking, avoid NSAIDs and aspirin, get rest, reduce stress, report s/s of bleeding, take on empty stomach
159
Why should patients on H2 blockers, -tidines, report signs of respiratory infection
increased gastric pH from H2 blockers can cause increased bacteria --> risk of developing pneumonia
160
How to recognize proton pump inhibitors?
end in -prazole
161
What are the indications for proton pump inhibitors?
ulcers, erosive esophagitis
162
Mechanism of action for proton pump inhibitors?
reduces acid secretions
163
Adverse effects of proton pump inhibitors?
short term: headache, diarrhea, NV
Long term: pneumonia, osteoporosis, rebound acid hyper secretion, hepatotoxicity, hypomagnesemia
164
Why do proton pump inhibitors put patient at risk of pneumonia?
increase ph leads to increase gastric bacteria which can spread to lungs
165
We should be cautious of PPI in what patients?
high risk for pneumonia, dysphagia, and liver dx
166
patient teaching for proton pump inhibitors
need bone density screenings, increase calcium and vitamin d, smoking cessation, stop alcohol and NSAIDs, notify s/s of bleeding, take in morning before eating
167
How long does treatment for proton pump inhibitors typically last?
1-2 weeks (but up to 8)
168
How to recognize iron?
ferrous in front
169
Side effects/adverse effects of iron?
teeth staining, skin staining, go distress, including constipation, ,anaphylaxis, hypotension, toxicity in children
170
patient teaching for iron
take on empty stomach if tolerable, rinse mouth after oral solution, black stool is normal, increase fiber fluid and exercise, avoid caffeine coffee tea dairy antacids, take with vitamin c
171
Iron dextran and Iron sucrose require?
test dose and pretreatment with acetaminophen and diphenhydramine
172
Indications for folic acid?
DNA, erythropoiesis, neural tube defects
173
Patient teaching for folic acid?
if planning to become pregnant take folic acid (b9) and prenatal vitamin, maintain taking folic acid during pregnancy
174
How many mcg of folic acid should pregnant women take a day
400 or 600
175
What is overdose treatment for magnesiums sulfate?
calcium gluconate
176
Normal ranges for potassium chloride?
3 - 7
177
Signs of hypokalemia
muscle cramps/ weakness, inverted T wave, abnormal U wave, gi distress, cardiac issues
178
Signs of hyperkalemia
paresthesia, GI issues, cardiac issues
179
What is bethanechol used to treat?
"Big Bladder" - urinary retention NOT caused by obstruction
180
Side effects/ adverse effects of buthanechol
cholinergic effects (SLUDGES)
overdose: increased gastric acid, hypotension, bradycardia, bronchoconstriction
181
Indications of oxybutynin
Overactive bladder
182
Indications of phenazopyridine?
relieve painful symptoms of UTI (does not reduce bacteria)
183
Side effects of phenazopyridine?
red/orange urine, N/V, false positive glucose test on UA
184
Adverse effects of phenazopyridine?
hepatitis, acute renal failure, hemolytic anemia
185
Can bethanechol be given to someone with respiratory disorder?
No because cholinergic affects cause bronchoconstriction
