Exam 5 Flashcards
1
Q
what drugs are in the first generation antihistamine class?
A
diphenhydramine, hydroxyzine, meclizine, and promethazine
2
Q
indications for first gen antihistamines
A
allergic rhinitis, motion sickness, induce sleep, runny nose
3
Q
side effects for first gen antihistamines
A
sedation and anticholinergic effects (can’t see, can’t pee, can’t spit, can’t poop)
4
Q
adverse effects of 1st gen antihistamines
A
sedation
5
Q
contraindications for first gen antihistamines
A
narrow-angle glaucoma, BPH, older adults; precautions for urinary retention
6
Q
what drugs are in the second generation antihistamines class
A
loratadine, fexofenadine, cetirizine, azelastine
7
Q
indications for second gen antihistamines
A
allergic rhinitis, does not cross the blood-brain barrier
8
Q
nursing interventions for second gen antihistamines
A
do not give with orange, apple, and grapefruit juice, check for allergies, give with food, avoid operating machinery/driving, avoid alcohol/other CNS depressants, increase fluids, avoid sun/heat
9
Q
pt teaching for second gen antihistamines
A
increase fluids, avoid apple, orange,and grapefruit juice, avoid alcohol, sun/heat, use ice chips for dry mouth, eye drops for dry eyes, fiber and exercise
10
Q
what drugs are in the decongestant class
A
pseudophedrine and phenylephrine
naphazoline, oxymetazoline, tetrahydrozoline, and zylometazoline
11
Q
indications for decongestants
A
relief of temporary nasal congestion
12
Q
mechanism of action for decongestants
A
causes nasovascular vasoconstriction
13
Q
side effects of decongestants
A
sympathomimetic effects on CNS and Cardio systems
Tachycardia, nervousness, restlessness, anxiety, dry mucous membranes, tremor, weakness
14
Q
contraindications/precautions for decongestants
A
glaucoma and those with preexisting HTN, cardiac disease, and Hyperthyroidism; diabetes should talk to provider first
15
Q
what drugs are in the topical decongestant class
A
naphazoline, oxymetazoline, tetrahydrozoline, and zylometazoline
16
Q
indications for topical decongestants
A
Faster, sprays in at the site of congestion, systemic= lasts longer
17
Q
pt teaching for topical decongestants
A
Do not use for more than 3 days consecutively= dependence
18
Q
side/adverse effects for topical decongestants
A
Palpitation, HTN, arrhythmias, hallucinations, delusions, ,convulsions
19
Q
what drugs are in the expectorant drug class
A
Guaifenesin (Mucinex)
20
Q
indications for expectorant
A
Mucus not dislodging from lungs
21
Q
pt teaching for expectorant
A
Coughing, deep breathing exercises, take with full glass of water- does not help with cough, reduces adhesiveness and surface tension of mucus use cautiously with asthma, will not work without increased fluids
22
Q
what drugs are in the antitussive class
A
Dextromethorphan, codeine, benzonanate (tessalon perles)
23
Q
indications for antitussives
A
Suppress cough reflex, but only for dry, non productive cough
24
Q
side effects of antitussives
A
Drowsiness, dizziness, irritability, constipation, restlessness (a/e of respiratory depression and dependence - codeine)
25
pt teaching for antitussives
Increases fiber fluids exercise, avoid alcohol, report to provider if cough greater than week or if rash/fever,change positions slowly, hard candies for dry mouth, avoid activities that require alertness
26
what drugs are in the inhaled corticosteroid class
Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone, ciclesonide
27
indications for inhaled corticosteroids
Bronchial tree inflammation, prophylactic tx for asthma and management of COPD- maintenance drugs- NOT useful for acute attacks
28
Contraindications for corticosteroids
Active fungal infection,live virus vaccines
Precautions in those with current infection, herpes, and altered immune system
29
adverse effects of inhaled corticosteroids
Sore throat, hoarseness, coughing , dry mouth, fungal infections (pharyngeal and laryngeal)
Long-term use in children causes delayed growth and decreased adrenal function-decreased bone mass
30
pt teaching for corticosteroids
Use every day at same time regardless of s/s. Peak= 1-2 weeks can take 4 weeks for therapeutic effect
31
what drugs are in the systemic corticosteroid class
Methylprednisolone and prednisone
32
indications for systemic corticosteroids
Exacerbations may require IV doses, stress
33
contraindications for systemic corticosteroids
Infection , fungal infection, live virus vaccines
34
what drugs are in the leukotriene modifiers class
Zafirlukast and montelukast(Singulair)
35
indications for leukotriene modifiers
Oral prophylaxis and chronic tx for asthma- NOT acute attacks
36
adverse effects of leukotriene modifiers
Depression, SI , bleeding, seizures, can affect liver
S/e=HA, pharyngitis, and rhinitis
37
what drugs are in the anticholinergic class for respiratory drugs?
Ipratropium (short acting) and tiotropium ( long acting)
Tx for asthma, bronchitis, pulmonary emphysema
38
contraindications/precautions for anticholinergics respiratory drugs
Allergy to peanuts, cautiously in those with narrow-angle glaucoma and BPH
39
what drugs are in the methylxanthines class
Theophylline and aminophylline
40
indications for methylxanthines
Reversal for bronchospasm s, tx for asthma and chronic airway limitation; second-line drug bc requires serum level monitoring(a/e at therapeutic doses)
41
side effects/adverse effects for methylxanthines
20-25mcg= GI sympoms-N/V/D
>30mcg=CNS effects- HA, insomnia, irritability,hypotension, hyperglycemia, arrhythmias, seizures, Brian damage, death
42
drug interactions for methylxanthines
Smoking decreases serum levels of med and caffeine is a stimulant= worse s/e
Report s/s toxicity=N/V/D and restlessness
43
Serum levels for Methylxanthines
5-15mcg/mL
44
what drugs are in the bronchodilators/Beta 2 agonists class
Albuterol, levalbuterol, pirbuterol(short acting/rescue)
Arformoterol, formoterol, indacaterol, olodaterol, salmeterol(long acting)
45
indications for bronchodilators/Beta 2 agonists
Prevent asthma attack, acute asthma attack (short acting) or tx for pneumonia and COPD
46
side effects/ adverse effects for bronchodilators/Beta 2
Inhaled= throat irritation, sinus tachycardia, HTN, anxiety, nervousness, tremor, dizziness, palpitations, angina, hyperglycemia. Bronchospasm, urticaria, angioedema=rare
47
pt teaching for bronchodilators/Beta 2 agonists
Use bronchodilator before steroid, use as ordered (rescue= 2-3 times per week, not effective maintenance), use a spacer, tolerance, Side effects diminish, avoid/limit caffeine intake (soda, chocolate, tea, coffee)
48
spacer for bronchodilators/Beta 2 agonists
All MDI; press, inhale and hold for 5-10 sec or as long as able, exhale softly
49
what drug is used for thyroid hormone replacement therapy
Levothyroxine
50
drug interactions for levothyroxine
Warfarin (increases effect of levothyroxine) and digoxin (decreases effect of levothyroxine)
Some vitamins/supplements decrease absorption of levothyroxine
51
pt teaching for levothyroxine
Take in AM before breakfast on empty stomach, four hours before vitamins/supplements
List of meds
Medic alert
Report s/s hyperthyroidism
Read labels
Lifeline replacement therapy
Do not abruptly stop
52
adverse effects for levothyroxine
Hyperthyroidism s/s, thyroid storm
Overmedication and chronic overtreatment
Contraindicated in those with thyrotoxicosis, adrenal insufficiency, and post MI
Hold if HR>100
53
Those on methimazole should avoid
Seafood (iodine)
54
what are the drugs in the antithyroid class
Methimazole, Propylthiouracil
55
assessment/interventions for antithyroid medications
Monitor VS, daily weight, thyroid hormones, CBC, s/s infection, s/s hypothyroidism
Assess s/s thyroid crisis/storm= tachycardia, fever, flushed skin, restlessness, confusion, behavior changes
56
what drugs are used in the antidiuretic hormones class
Vasopressin an desmopressin
57
indications for antidiuretic hormone meds
Diabetes insipidus
Contraindicated in those with CAD, creatinine clearance <50, decreased peripheral circulation, chronic nephritis
58
nursing interventions for antidiuretic hormone drugs
Monitor for overhydration, reduce fluid intake, smallest effective dose, s/s MI
Monitor labs(K, Na, creatinine, BUN, specific gravity,osmolality) I&O, water intoxication (HA, ALOC, EKG)
59
adverse effects for antidiuretic hormone drugs
Reabsorption of too much water, MI, hyponatremia, black box warning:severe hyponatremia
60
evaluation for antidiuretic hormone drugs
Increased specific gravity, decreased output, decrease thirst
61
what is the drug we talked about in the calcitonin-Salmon class
Calcitonin
62
side effects/ adverse effects of calcitonin-salmon drugs
Gi disturbances, skin rash, flushing, nasal irritation.
A/e=hypocalcemia(tetany and seizures)
63
how do you recognize the drugs in the Biphosphonate drug class
-dronate
64
indications for biphosphonates
Prophylaxis tx of post menopausal osteoporosis, male clients with osteoporosis, prophylaxis and treatment of osteoporosis caused by glucocorticoids, pts with Paget’s disease
65
Biphosphonate mechanism of action
Inhibit osteoclast activity and decrease bone turnover/resorption
66
pt teaching for biphosphonates
Take on empty stomach, remain upright for 30 min, take with 8 oz water, report visual changes, avoid dental work,notify HCP-GI issues prevent intake,weight-bearing exercises, diet high in calcium and vitamin D
67
Contraindications for biphosphonates
Preexisting swallowing or esophageal issues, severe kidney impairment, hypocalcemia, cannot sit or stand upright for 30 min
68
what drugs are in the corticosteroid class
Glucocorticoids and mineralocorticoids
69
What drugs are in the glucocorticoids class
Dexamethsone, prednisone, fluticasone, betamethasone, methylprednisolone, prednisolone, triamcinolone
70
What drugs are in the mineralocorticoids class
Fludrocortisone
71
what corticosteroids have the same potency as glucocorticoids?
Cortisol and hydrocortisone
72
indications for corticosteroids
Glucocorticoids:inhibit inflammatory and immunological response
Mineralocorticoids:salt and water balance
73
adverse effects of glucocorticoids
Glucocorticoids:suppression of adrenal gland function, Cushing’s syndrome, osteoporosis, hyperglycemia and glycosuria, myopathy, PUD, infection, fluid and electrolyte imbalances, growth suppression in children
74
Adverse effects for mineralocorticoids
Retention of Na and water= HTN, edema, HF, hypokalemia
75
pt teaching for corticosteroids
Taper when d/cing,illness or high stress may need higher doses,take with food in am, wear medical ID, anti inflammatory=every other day,report s/s acute adrenal insufficiency, avoid NSAIDS report s/s bleeding, weight bearing exercises and diet high in calcium and vitamin D report s/s infection , muscle weakness, s/s Cushing’s
76
S/s Cushing’s disease
Moon face, buffalo hump, muscle weakness, cutaneous Striations
77
S/s of acute adrenal insufficiency
Anorexia, hypoglycemia, N, lethargy, malaise, restlessness
78
what are the different type of insulins
Rapid-acting, sort-acting, immediate-acting, long-acting, combinations
79
Rapid-acting insulins
Lispro, as part, insulin glulisine
80
Short-acting insulin
Regular
81
Intermediate-acting insulin
NPH
82
Prolonged duration insulin
Insulin detemir and insulin glargine
83
Rapid onset, peak, duration rapid-acting insulin
Onset=15-30 min
Peak-30min-2.5hrs
Duration=3-6 hrs
84
Short-acting insulin onset, peak, duration
Onset=30-60 min
Peak=1-5 hrs
Duration=6-10 hrs
85
Intermediate-acting insulin onset, peak ,duration
Onset=1-2hrs
Peak=6-14 hrs
Duration=16-24 hrs
86
Long-acting insulin onset, peak, duration
Onset=70 min
Peak=none
Duration=18-24 hrs
87
action of insulin
Promote use of glucose by body cells, store glucose as glycogen in muscles, reduces blood glucose
88
pt teaching for insulin
Keep snacks, glucagon administration, s/s hypoglycemia, how to administer, keep refrigerated, wear medic alert bracelet, diet/exercise, use meds as prescribed , how to check blood sugar
89
sliding scale for insulin
Dependent on blood glucose, AC/HS, rapid or short-acting insulin
90
complications for insulin
Hypoglycemia, hyperglycemia,lipohypertrophy, hypokalemia, somogyi effect, dawn phenomenon
91
mixing insulin process
Inject air into NPH (cloudy first), then regular and draw up regular followed by NPH
92
what drugs are in the sulfonylureas class
Glimepiride, glipizide, glyburide
93
indications for sulfonylureas
Type 2 DM, releases insulin from the pancreas
94
pt teaching for sulfonylureas
Monitor s/s hypoglycemia, keep snacks (15 g carbs), keep BG log, take with breakfast, avoid alcohol refer to dietician or diabetic educator
95
contraindications for sulfonylureas
Tx of DKA, sulfa allergy
96
indications for metformin
Control blood glucose levels in those with type 2 DM
Three actions: reduce liver glucose production, decrease intestinal absorption of glucose, and increase insulin sensitivity
97
pt teaching for metformin
Take with food, eat prescribed diet, s/s hypoglycemia, encourage drug compliance, warn to avoid alcohol, teach about IV dye
98
indications for glucagon
Emergency management of insulin induced hypoglycemia
99
estrogens, progesterones, and combined oral contraceptives
estrogens=Estradiol, estriol
Progestines= progesterone, hydroxyprogesterone, medroxyprogesterone, megestrol, norgestrel
Combined=ethinyl estradiol and norelgestromin
100
adverse effects of estrogens
N/V, breast tenderness, endometrial hyperplasia, hyperpigmentation, edema, weight gain
Endometrial and ovarian cancers, potential risk for estrogen-dependent breast cancer, emboli events
101
Adverse effects of progestins
Weight gain, edema, depression , thromboembolism, breast cancer, jaundice, migraine headaches, birth defects and spontaneous abortions
102
adverse effects of estrogen-progestin combinations
Breast fullness, N/V, depression and edema, increased risk of abnormal clotting, thrombolytic events, HTN, uterine/vaginal bleeding, breast cancer, hyperglycemia, hyperkalemia
103
contraindications for estrogens
pregnancy category X, heart disease/family hx, vaginal bleeding, certain cancers, hx of thrombotic disease, fibroid tumors, tobacco use
Black box warning: start at lowest dose and use for shortest duration
104
contraindications for oral contraceptives
Smoking and over 35 y/o, hx of thromboembolus or CV events, family hx or risk factor for breast cancer, experience abnormal vaginal bleeding
105
indications for tamsulosin
Treat BPH by relaxant smooth muscles, highly protein bound
106
adverse effects for tamsulosin
Hypotension , dizziness, nasal congestion , sleepiness, faintness, problems with ejaculation, floppy iris syndrome
107
mechanism of action for tamsulosin
Relaxing smooth muscles
108
indications for PDE5 inhibitors
Erectile dysfunction
Onset of action is 20-60 min and duration is 4 hours
109
PDE5 inhibitor contraindications
Alcohol, preexisting HTN, and on alpha-adrenergic blockers
Interacts with grapefruit juice,nitrates, alcohol, antihypertensives, and alpha-adrenergic blockers
110
indications for finasteride
Tx for BPH
111
pt teaching for finasteride
Therapeutic effects are not immediate, pregnant women should avoid, do not donate blood, antihypertensive teaching
