Exam 4 Drugs Flashcards
Turmeric
Anti-inflammatory herb
Uses:
-Arthritis, chronic pain due to inflammation, joint health, etc.
Concerned about:
-Bleeding: antiplatelet activity
Contraindications
-With anticoagulants
St John’s Wort
Improved mood, antibiotic, antiviral
Uses:
-Depression, anxiety, insomnia
Contraindications:
-Nearly every medication
Ginko
Improve cognitive function, vasodilator
Uses:
-Improve memory and increase circulation to the brain
Contraindications:
- Antiplatelets
- Anticoagulants
Garlic
Diuretic, anthelmintic, positive circulatory effect
Uses:
-Fighting colds, lowering BP, diabetes
Caution:
- Potentiates anticoagulation/antiplatelets
- Lowers blood sugar
- Diuretic
Contraindications:
-Any drug that also have these effects
Black Cohosh
Stimulates estrogen receptors
Uses:
-Menopause (hot flashes), hormone imbalances
Contraindications
-Pregnancy
maybe worry about a blood clot
Valerian Root
Sedative effects
-Increases GABA, nature’s Benzodiazepine
Uses:
-Insomnia, anxiety
Can cause withdrawal effects
-Needs to be tapered off
Kava
Uses:
-Anxiety, depression, seizures, insomnia
Caution
-Hepatotoxicity
Use caution with all medications
Herbal Therapies Nursing
- Be respectful to individuals and cultures (ask & learn, know & document)
- Be familiar with commonly used herbs
- Ask about all herbal remedies, frequency, reason for taking, and effects
- Educate that herbs can interfere or be toxic when combined with Western medicines
- Inform your doctor if you are using herbs
- Stop taking herbs when starting a new medication (some need tapering off)
- Avoid during pregnancy and lactation
- Avoid giving them to infants & children
NSAIDs
Acetylsalicylic acid (ASA) aspirin: 1899 -Not included in FDA black box warning
Ibuprofen: PO (1969), IV (2009)
-IV gtt., never IV push or give IM
Naproxen: PO (1999), Topical
Ketorolac: IV, IM, PO (1989), nasal (2010)
Combinations: ibuprofen/hydrocodone, ibuprofen/oxycodone, ibuprofen/acetaminophen, ASA/hydrocodone, ASA/oxycodone
Category Class:
- Anti-inflammatory
- Analgesic
- Antipyretic
MOA:
-prevents prostaglandins production by inhibiting COX
Problem with MOA:
- prostaglandin => increase circulation to brain, kidney, coronary arteries => adverse reaction CVA, RF, MI
- prostaglandin => increase gastric bicarb protective layer => side effect (GI bleed)
- prostaglandin => increase platelet aggregation => secondary use ASA (antiplatelet), side effect bleeding
Indication:
- Mild pain (analgesic): joint or bone injuries (sprains, strains), muscle pain, toothache, HA
- Fever (antipyretic)
- Inflammation (anti-inflammatory): OA, RA, gouty arthritis, Lupus, dysmenorrhea
Contraindication:
- Pregnancy (D)
- PUD
- RF
- Bleeding disorders
Caution with:
- AC
- Glucocorticoid
- ACE/ARB
- History of ischemic CVA
- MI
Side effects:
-Parenteral: much higher risk of RF
FDA Black box warning
-High risk for serious thrombotic events: sudden death, MI, UA, ischemic CVA, TIA, peripheral thromboses
Interactions:
-Alcohol
NSAIDs Nursing
Educate/monitor High risk for ACS & CVA
- Never take more than one type of NSAID, take the smallest dose, limit the length of NSAID use
- Call 911 with any new chest pain or neurological deficits
Educate/monitor RF: (see code phrases)
- Monitor for worsening fluid retention => HF symptoms, I/O imbalance
- Avoid with Hx. of RF, HTN, HF
Monitor for GI bleed/PUD
- Always take with food
- Avoid other gastric irritants (alcohol or taking multiple NSAIDs)
- Monitor for bleeding, caution with AC (see code phrases)
- High risk in elderly (PUD four times more common in older adults)
Montelukast
Leukotriene Modifiers
-Leukotriene is an inflammatory mediator
Indication:
-maintenance therapy (not for acute SOB)
Side effects, Adverse reactions:
- Depression
- Suicidal ideation
- Liver failure (Causes drug toxicity because “first-pass” doesn’t occur, Do liver function tests, Don’t take hepatotoxic drugs (acetaminophen, alcohol))
- Drug interactions
Medication Administration: PO
Nursing Interventions:
-consider age limits (for 1-year & up)
2nd Gen Antihistamines
Medication:
- Cetirizine
- Fexofenadine
- Loratadine
Medication Administration: PO (PRN)
Nursing Interventions (monitoring):
- Little to no sedative effect
- Little to no anticholinergic effect
Diphenhydramine, Meclizine
Category Class: 1st Gen Antihistamine
Mechanism of Action:
-inhibit vestibular stimulation in the inner ear
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
Medication Administration: PO, IV, IM
Toxicity: excitation, hallucination, seizure
Assess
- Breathing (CNS depression –> respiratory depression –> shallow/diminished)
- VS (for anticholinergic effects)
- I/Os (for anticholinergic effects)
Warn against combination medications (decongestant A1 agonist)
Patient Education:
-CNS depression: avoid driving or operating dangerous machinery
Avoid other CNS depressants: ETOH, codeine
Aspirin
PO: takes the whole life of platelet to clear (7 days)
Category Class:
-Antiplatelet: small scheduled dose (MI, CVA prophylaxis)
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
- NEVER to children <19 years (risk of Reye’s syndrome) => NEVER while breastfeeding
Adverse reactions:
-Hemorrhage: particularly GI bleed
Nursing Interventions (monitoring):
- Take with food to minimize GI upset/ GIB
- Reversal agent: platelet transfusion
- Stop taking for 7 days to clear from body after consulting with provider
- May be taken with clopidogrel (for further antiplatelet effect)
- Emergency medicine for acute MI, must chewReversal agent: platelet transfusion
for Hx. of GIB, PUD:
- Enteric-coated aspirin, don’t crush
- Buffered aspirin (mixed with calcium carbonate)
Interactions (with drugs/food/UV light):
- Avoid NSAIDs (increased risk of GI bleed)
- Avoid alcohol (increased risk of GI bleed)
Glucocorticoids
IV
-Methylprednisolone (Solu-Medrol)
PO
- Methylprednisolone (Medrol)
- Prednisone (Deltasone)
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" Inflammatory disorders
Contraindication:
-fungal/viral infections, live attenuated virus vaccine (intranasal influenza, small pox)
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)
Medication Administration:
-IM, IV, PO, aerosol, topical, intra-articular injection
Nursing Interventions (monitoring): -Must always wean off
Methotrexate
MOA:
-slow down the progression of autoimmune diseases, peak effect in 3-6 weeks
Immunomodulator:
-High risk of infection, hepatotoxicity
Cytotoxic agent:
- Ulcerative stomatitis (sign of toxicity): inspect and assess mouth, gums, throat daily
- Bone marrow suppression: monitor CBC trend
Contraindication:
- Never during acute infection
- pregnancy/lactation (class X teratogenic)
- pediatrics
Patient Education:
- Take on empty stomach
- Avoid sunlight
Azathioprine, Cyclosporine, Tacrolimus
Category Class: immunosuppressant
MOA:
-slow down the progression of autoimmune diseases, peak effect in 3-6 weeks
Contraindication:
-Never during acute infection
Side effects:
- Renal failure, hepatotoxicity, Blood dyscrasia & bleeding
- Hirsutism (male pattern hair growth) reversible with discontinuing the medication
- Gingival hyperplasia: good dental hygiene and routine check-ups
“Ron Harry Hermione Beat Bad Guys”
Colchicine
MOA:
-anti-inflammatory only for gout
Contraindication:
-Pregnancy: C
Side effects:
- GI distress: take with food, avoid grapefruit juice
- suppressed bone marrow: Monitor CBC
- Rhabdomyolysis: Monitor for muscle pain and RF
-PO
Allopurinol
MOA:
-lowers serum uric acid biosynthesis
Contraindication:
-Pregnancy: C
Side effects:
-Hepatotoxicity, higher risk of nephrolithiasis: Monitor labs, I/O balance
-PO, IV
Antigout Nursing
Increase fluid (2-3 L/day) & monitor I/Os -to increase uric acid excretion => to avoid risk of nephrolithiasis
Avoid foods high in purine
- red meat, organ meat, scallops, aged cheese
- alcohol & caffeine can increases uric acid
For acute attacks
- NSAIDs
- Glucocorticoids
Acetaminophen
Category Class:
- Analgesic
- Antipyretic
MOA:
-Not anti-inflammatory: without the negative side effects of NSAIDs
-PO, PR, IV
Educate: max dose 4000mg/24 hrs. (to avoid hepatic failure) see code phrases
- For malnourished clients the limit is 3000mg/24 hrs
- ETOH use > 2drinks/day the limit is 2000mg/24 hrs
- Children age specific max dose
OD is managed by acetylcysteine
Acetaminophen (APAP)
Category Class:
- Analgesic
- Antipyretic
MOA:
-Not anti-inflammatory: without the negative side effects of NSAIDs
-PO, PR, IV
Educate: max dose 4000mg/24 hrs. (to avoid hepatic failure) see code phrases
- For malnourished clients the limit is 3000mg/24 hrs
- ETOH use > 2drinks/day the limit is 2000mg/24 hrs
- Children age specific max dose
OD is managed by acetylcysteine
Opioid Side Effects
respiratory suppression
- monitor respiration rate, depth, oxygenation
- caution with respiratory disorders
Loss of cough and gag reflexes
- monitor for silent aspiration
- hence used as antitussive
Suppress ANS control
- monitor VS for low HR & BP
- caution with cardiac disorders, dysrhythmias (heart block)
- monitor for orthostatic hypotension (FALL)
Suppress GI motility
- Monitor bowel sounds for hypoactive bowel sounds
- Monitor for constipation, ileus, bowel obstruction, anorexia
- always use prophylactic laxative
- increase fluid/fiber & activity
Stimulates CTZ in the brain and causes N/V
-Manage prophylactically
Suppress CNS –> sedation, hypnotic effect
- Monitor for drowsiness (risk of fall)
- Hence used for induction of anesthesia
- Assess home med list for any other drugs affecting CNS (stimulants, suppressants, alcohol, illicit drugs)
Relaxes the bladder muscles (detrusor muscles)
-Monitor for urinary retention
Relaxes the pupil
- Miosis (pinpoint pupils) even in dim light
- Poor vision in dim light, fall risk
Euphoria, dependence, tolerance, abuse disorder
- Check history for use disorder
- Cross-tolerance
- Taper-off to avoid withdrawal symptoms (anxiety, N/V, and pain, muscle pain, seizure, death)
- Assess for any chronic pain and how it is managed
Increase intracranial pressure
-CI after head trauma/injury or hemorrhagic CVA is suspected or inc ICP
Codeine Sulfate
Indication:
-PRN for cough, diarrhea, mild pain
Pro-drug: the drug metabolite is morphine
Route: PO, SubQ, IM, IV
Combination
- acetaminophen / codeine (300/30 mg) Rx.
- acetaminophen / codeine (300/60 mg) Rx.
Hydrocodone
Indication: PRN moderate pain
Route: Only PO
Combinations
- hydrocodone / acetaminophen
- hydrocodone / aspirin
- hydrocodone / ibuprofen
Oxycodone
Indication: PRN moderate pain (IV, PO)
Combinations:
- oxycodone / acetaminophen(5, 7.5, 10)
- oxycodone / ibuprofen
- oxycodone / aspirin
Tramadol
Route: PO (Sched IV)
Pro-drug: the drug metabolite is morphine
-Opioid-like (weaker but similar properties and effects)
tramadol ER for around the clock moderate pain mgmt.
Max dose: 300 mg/24 hrs
Morphine
Routes: PO/oral drop, PR, IV, IM, epidural, spinal (intrathecal/subarachnoid)
Not SQ
10x stronger than tramadol
Indication: PRN for severe pain
Controlled release
Hydromorphone
Routes: PO, IV, PR, IM, SQ
Indication: PRN for severe pain
6x stronger than morphine
Meperidine
Opioid-like
Routes:
-PO, SubQ, IM, IV
MOA:
- anticholinergic with secondary analgesic effects
- less respiratory side-effects
- patients allergic to opiates
short duration of action
-hence used in OR
Side effects:
- neurotoxicity (delirium, seizure)
- dysrhythmias
Contraindications:
-RF (higher risk of seizure and neurotoxicity)
Fentanyl
Routes: IV, IM (indication: anesthesia)
transdermal patch 12.0-100 mcg/h (indication: chronic pain
oral trans-mucosal lozenge(indication: acute pain in ED)
50-100 times more potent than morphine (is a synthetic opioid)
Short-acting for severe pain (onset immediate; duration 30-60 min)
