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Pharmacology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

aspirin indications

A

Pain, fever, inflammation , prophylactic for MI, platelet aggregation

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2
Q

Drug interactions for aspirin

A

Warfarin (increases absorption and increases risk for bleeding)
Other anticoagulants and anti platelet drugs
Alcohol, increases risk of gastric bleeding

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3
Q

Contraindications/ nursing interventions for aspirin

A

Contraindicated in those bleeding or risk of
Monitor for bleeding, give with food, stop one week before invasive procedures, dont give to children/adolescents with viral illness

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4
Q

Side/adverse effects for aspirin

A

GI effects (N/V, ulcers)
Bleeding
Renal impairment
Salicylism
Reye’s syndrome
Nephrotoxic in high doses

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5
Q

What drugs are in the NSAIDs class?

A

Ibuprofen,naproxen, ketorolac,meloxicam,indomethacin

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6
Q

Contraindications for NSAIDs

A

Renal impairment, GI issues, heart issues

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7
Q

Indications for NSAIDs

A

Pain, fever

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8
Q

What is Naproxen used for?

A

Migraines; rapid absorption and analgesia

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9
Q

What adverse effect does Ketorolac cause?

A

Kidney damage if used for about five days

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10
Q

Nursing interventions for NSAIDs

A

Increase fluids, monitor for s/s bleeding, give with food, teach to avoid alcohol, s/s stroke or MI, avoid G herbs

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11
Q

Side/adverse effects of NSAIDs

A

Bleeding (GI ulcers- but not as much as aspirin), GI upset(N/V), can be nephrotoxic and hepatotoxic

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12
Q

Black box warning for NSAIDs

A

Risk for cardiovascular event and GI bleeding

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13
Q

What do you do for older adults and NSAIDs

A

Monitor renal function beforehand, encourage adequate fluids, use lower dose to decrease risk of complications

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14
Q

Anti-gout meds

A

Allopurinol,probenecid, colchicine

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15
Q

Indications for anti-gout meds

A

Acute attack (colchicine) prophylactically (probenecid and allopurinol-urate lowering agent)

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16
Q

Contraindications of anti-gout medications

A

Severe renal, cardiac, hepatic, or GI dysfunction

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17
Q

Pt teaching for anti-gout medications

A

Avoid salicylates (with probenecid), alcohol, grapefruit juice, foods high in purine (red meat, scallops,alcohol), increase fluid intake, monitor for bleeding and infection, allopurinol has s/e of metallic taste

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18
Q

S/e of allopurinol

A

Metallic taste

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19
Q

What drugs are DMARDs?

A

Entanercept,methotrexate, infliximab, adalimumbab

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20
Q

Indications for DMARDs

A

rheumatoid arthritis pain(when NSAIDs do not control pain), slows degeneration of joints

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21
Q

A/e of DMARDs

A

Injection site pain, risk for infection, blood dyscrasias, s/s HF, skin rxns (stevens-Johnson)

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22
Q

Nursing interventions for DMARDs

A

Monitor injection site, and skin for rxns, risk for infection(avoid crowds and sick ppl-bone marrow suppression),s/s of HF, monitor CBS and s/s of blood dyscrasias; phototoxic-sunscreen

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23
Q

Drug interactions for DMARDs

A

Live virus vaccines

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24
Q

Methotrexate teaching

A

Pregnancy category X
Monitor for ulcerative stomatitis, take with folic acid, birth control=important, take with food

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25
Q

Opioid analgesics

A

Morphine sulfate, fentanyl, hydrocodone, codeine, heroin, methadone, oxycodone,etc
Schedule 2 drugs

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26
Q

Indications for opioids

A

Tx for acute/chronic pain

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27
Q

Side/adverse effects opioids

A

“MORPHINE” and “DESIGNER”
Myosis (pinpoint pupils), out of it (sedation), respiratory depression, physical dependence, hypotension(orthostatic), infrequency(constipation and urinary retention), nausea, emesis, dry mouth,euphoria, itch

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28
Q

Drug interactions for opioid

A

CNS depressants ie alcohol, other opioids, muscle relaxants

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29
Q

Nursing interventions for Opioids

A

Monitor and assess tolerance, resp status and LOC, pulm function , VS, output, monitor pain level, use cautiously in pregnancy, labor and delivery, lactation

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30
Q

Opioid overdose triad

A

Coma, pinpoint pupils, respiratory depression—-> naloxone!!!

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31
Q

Pt teaching for opioids

A

S/s hypotnsion- change positions slowly, constipation (increase fiber, fluids, exercise), tolerance and cross-tolerance with other opioids- euphoric effects

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32
Q

PCA pump-opioids

A

Fentanyl given by patient controlled analgesia, dont let anyone touch but the pt!!! Have naloxone nearby and assess for overdose and pain levels frequently!

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33
Q

Acetaminophen

A

Non-opioid analgesic
Analgesic and antipyretic actions, but no anti-inflammatory /anti thrombotic action- no GI upset

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34
Q

Indications for acetaminophen

A

Pain, fever; drug of choice for older adults and children

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35
Q

Pharmacokinetics of acetaminophen

A

Metabolized by liver, excreted by kidneys

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36
Q

Tx for acetaminophen overdose

A

Acetylcysteine Within 8 hours of ingestion, gastric Lavage within 4 hours

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37
Q

Fasting and alcohol increase the risk for _______ with acetaminophen

A

Acute toxicity
S/s= N/V/D, sweating, abd pain, coma, death, liver damage (within 48 hrs)

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38
Q

Max daily dose for acetaminophen

A

4 grams for healthy liver, 2 for 3 drinks or more in a day

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39
Q

Triptans indications

A

1st line med for migraines; both for acute migraines or abortive therapy

40
Q

Mechanism of action for triptans

A

Relieves pain by constricting blood vessels and suppressing inflammation

41
Q

Pt teaching for triptans

A

Change positions slowly, dangle feet (dizziness=s/e)
Take when migraine first sensed, second dose 2 hours later if s/s persist, do not exceed 100 mg in single dose; subcutaneous-administer, no more than 2/24 hrs
Nasal spray- single dose, may repeat in 2 hrs
Lie down in a dark and quiet room

42
Q

Naloxone

A

Antidote for opioid overdose
S/s of overdose: coma, pinpoint pupils, respiratory depression , works in minutes

43
Q

Metoclopramide mechanism of action

A

Blocks dopamine receptors(antiemetic), promotes gastric emptying (constipation)

44
Q

Indications for metoclopramide

A

Prevention of chemo induced N/V, constipation, diabetic gastroparesis(delayed gastric emptying), GERD (for those who can’t tolerate standard tx)- may cause extrapyramidal symptoms

45
Q

Psyllium husk pt teaching

A

Bulk forming; increase fluid intake(2-3 L Q day) and fiber diet, mix powder in 8 oz of water and follow with another 8 oz,ask if have trouble swallowing (risk of esophageal obstruction)

46
Q

Indications for psyllium husk

A

Decrease diarrhea in diverticulitis, IBS, control stool in ileostomy/colostomy bags, promote defecation in older adults

47
Q

Safest laxative

A

Psyllium husk

48
Q

Cardiac safe laxative

A

Psyllium husk

49
Q

Antihistamines/anticholinergic drugs

A

Hydroxyzine(sedation and anxiety), scopolamine(motion sickness), and doxylamine and pyridoxine(B6) combo( pregnant women and morning sickness)

50
Q

Pt teaching for antihistamines/anticholinergics

A

Hard candy for dry mouth, avoid heat (can’t sweat), increase fluids, fibers exercise, bland diet to reduce nausea , eye drops , retention risk, I/O

51
Q

Side/adverse effects antihistamines and anticholinergics

A

Can’t see, can’t pee, can’t spit, can’t poop
Fatigue, dizziness, drowsiness, urinary retention, constipation, dry mouth, blurred vision

52
Q

Contraindications for antihistamines or anticholinergics

A

Those with glaucoma or BPH(risk of urinary retention)

53
Q

Stimulant laxatives

A

Bisacodyl, senna, castor oil

54
Q

Pt teaching for stimulant laxatives

A

Avoid chronic use (dependence), dont crush or chew enteric coated, milk and antacids destroy enteric coating- take 1 hr apart, take and bedtime (BM in am), reddish brown urine is s/e of senna, increase fiber and fluids with exercise

55
Q

Contraindications to laxatives

A

Dependence, s/s of appendicitis, regional enteritis, diverticulitis, ulcerative colitis, acute surgical abd, fecal impaction or bowel obstruction , bowel perforation, caution in pregnancy

56
Q

Surfactant laxatives

A

Docusate Sodium

57
Q

Indications for surfactant laxatives

A

Hard stool(constiation, prevents painful elimination and straining) decreases risk for fecal impaction and promotes defecation in older adults

58
Q

Mechanism of action for surfactant laxatives

A

Increases water and electrolytes in intestines , promotes defecation by softening stool-NOT making them go

59
Q

pt teaching to prevent constipation

A

Increase fiber(bran, flakes, fruits, vegetables), fluids(2-3L Q day, exercise

60
Q

Saline laxatives

A

Magnesium hydroxide and magnesium sulfate

61
Q

Pt teaching for saline laxatives

A

Milder and slower acting laxatives ; increase fluids

62
Q

Complications for saline laxatives

A

Absorbed systemactially; Dehydration, hypermagnesemia, sodium retention, exacerbate HF, HTN , edema

63
Q

Nursing interventions for saline laxatives

A

Monitor skin turgor, daily weight, I/O, monitor renal function

64
Q

Osmotic laxatives

A

Polyethylene glycol (miralax) and polyethylene glycol electrolyte solution (golytely)

65
Q

Indications for osmotic laxatives

A

Occasional constipation (miralax) and bowel prep(golytely)

66
Q

Promethazine (phenergran)

A

N/V

67
Q

Pt teaching for promethazine

A

Can cause extrapyramidal symptons(restlessness, anxiety , spasms of face and neck) , avoid alcohol and opioids, increase fiber, fluids, exercise, eye drops, avoid sunlight,report EPS, report s/s of extravasation

68
Q

Antidiarrheals

A

Diphenoxylate with atropine(opiate related diarrhea symptomatic tx), loperamide(acute and chronic diarrhea)

69
Q

Indications for antidiarrheals

A

Diphenoxylate-severe diarrhea NOT c-diff, dehydration , severe electrolyte imbalance or pt <2 yrs old
Loperamide-travelers diarrhea, IBS

70
Q

Antacids indications

A

Aluminum hydroxide with magnesium hydroxide;Neutralizes stomach acid—> GERD, indigestion, heart burn

71
Q

Side/adverse effects antacids

A

calcium=constipation
Magnesium=diarrhea
sodium=fluid retention
Aluminum hydroxide: hypophosp
hatemia, hypomagnesemia

72
Q

Contraindications for antacids

A

GI perforation,/ obstruction , abd pain

73
Q

Sucralfate(mucosal protectant) indications

A

GI ulcer

74
Q

Sulcralfate mechanism of action

A

Coats mucosa and protects the ulcer, minimally absorbed, major s/e constipation; one hour before meals and at bedtime

75
Q

Sucralfate evaluation

A

Reduced pain

76
Q

H2 blockers

A

Prevents histamine induced acid release ; Cimetidine, famotidine

77
Q

H2 blocker drug interactions

A

smoking decreases effectiveness,increases levels and effects of warfarin, lidocaine, and phenytoin

78
Q

Pt teaching for H2 blockers

A

Avoid smoking, diet to decrease heart burn, rest, avoid stress, NSAIDs avoid except for low dose aspirin, report s/s GI bleeding and resp infection, take 30 min to before to 1 hr eating

79
Q

Misoprostol indications

A

Tx for NSAID-induced ulcer

80
Q

Mechanism of action for misoprostol

A

Increases bicarbonate and mucin release, reduced acid secretion and protects the lining of the stomach and helps to repair the ulcer

81
Q

Contraindications for misoprostol

A

Pregnancy (cat X)

82
Q

Proton pump inhibitors

A

Omeprazole, esomeprazole, pantoprazole

83
Q

Proton pump inhibitor indications

A

Ulcers, erosive esophagitis,reflux

84
Q

Proton pump inhibitor drugs- recognize?

A

-prazole

85
Q

Mechanism of action for proton pump inhibitors

A

Reduces acid secretion

86
Q

Proton pump inhibitor pt teaching

A

Bone density screenings needed, quit smoking, tx=2-8 weeks, avoid alcohol and NSAIDs, report s/s GI bleeding, take once a day in morning

87
Q

Adverse effects for proton pump inhibitors

A

HA, diarrhea, N/V with short-term use
Long-term= pneumonia, osteoporosis/fractures, rebound acid hyper secretion, hepatotoxicity, hypomagnesimia

88
Q

Iron pt teaching

A

Take on empty stomach,
Prevent teeth staining with water rinsing and juice, with a straw
Stool will be dark green or black
Increase fiber, fluids, exercise
Avoid caffeine, tea, dairy
Take with vitamin C
Do not take with anti acids

89
Q

Side/adverse effects for iron

A

GI distress(heart burn, N, const), teeth staining, staining of skin (IM), anaphylaxis, hypotension, fatal Iron toxicity in children

90
Q

Folic acid indications

A

Pregnancy and breastfeeding

91
Q

Folic acid pt teaching

A

Okra, spinach, Asparagus, liver, seeds, OJ (iron high)

92
Q

Magnesium sulfate overdose

A

Tx calcium gluconate

93
Q

Potassium chloride nursing interventions

A

EKG, continuous cardiac monitoring , monitor IV site, dilute, no after than 10 mEq/hr

94
Q

S/s of hypokalemia

A

Muscle weakness, cramps, GI issues, cardiac issues, flat/inverted T wave, U wave

95
Q

S/s hyperkalemia

A

GI issues, paresthesia, cardiac issues

96
Q
A

Pharmacology (12 decks)

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