final Flashcards
1
Q
indications for Methadone
A
Heroin withdrawal
2
Q
Disulfiram indications
A
Meant to promote adherence to tx for alcohol use disorder; maintenance of sobriety
3
Q
magnesium sulfate use
A
Parenteral, regulates muscle contraction and blood clotting, tx for hypomagnesemia
4
Q
magnesium sulfate normal levels
A
1.3-2.1mEq/L
5
Q
nursing interventions for magnesium sulfate
A
Monitor cardiac and neuromuscular status, monitor labs (calcium, magnesium, phosphorous), monitor VS (hypotension)
Have calcium gluconate at bedside (antidote), assess DTR
Teach pt foods high in magnesium (whole grain cereals, bananas, nuts, green easy veggies)
6
Q
ferrous sulfate indications
A
Iron preparations:
Times of increased growth (pregnancy and child growing), RBC development and oxygen transport
7
Q
pt teaching for ferrous sulfate
A
Take on empty stomach, take with straw in water or juice and rinse mouth afterwards, stool color will be dark green/black, increase fiber, fluids and exercise, eat foods high in iron (tofu, green leafy veggies, dried fruits, grains), avoid caffeine, tea, coffee, dairy (lowers absorption), take with vitamin C (citrus fruits ad OJ) do not take antacids
8
Q
how do you recognize beta blockers?
A
-olol
9
Q
mechanism of action for beta blockers
A
block beta 1 and/ or beta 2 receptors- lower HR And BP and inhibit bronchospasms, also inhibit Glycogenolysis (hypoglycemia)
10
Q
indications for beta blockers
A
HTN, tachycardia, A-fib, MI, adverse tachycardia, HF
11
Q
nursing considerations for beta blockers
A
Monitor HR and BP, resp assessment
12
Q
how do you recognize benzodiazepines
A
-lam -pam
13
Q
indications for benzodiazepines
A
GAD, alcohol use disorder, panic disorder
14
Q
nursing considerations for benzodiazepines
A
Med reconciliation, VS and LOC, monitor for toxicity, flumazenil (antidote) crash cart for toxicity and airway, fall precautions, monitor renal function
15
Q
pt teaching for benzodiazepines
A
Avoid CNS depressants like opioids and alcohol, notify HCP of CNS and resp depression, report amnesia , take as ordered, report paradoxical response, s/s withdrawal, taper when d/c, limit continuous use, sleep hygiene, avoid grapefruit juice
16
Q
side/adverse effects of benzodiazepines
A
Hangover, REM rebound(vivid dreams and nightmares), CNS and resp depression, anterograde amnesia, toxicity, paradoxical response, physical dependence, tolerance, withdrawal effects, hypersensitivity rxn
17
Q
what drugs are listed under non-benzodiazepines?
A
Zolpidem,zaleplon,eszopiclone
18
Q
indications for non-benzodiazepines
A
Insomnia (short-term mngmt)
19
Q
what drug is in the Hydantoin class
A
phenytoin
20
Q
indications for hydantoins
A
Anticonvulsant, raises seizure threshold
21
Q
adverse effects of hydantoins
A
CNS symptoms(nystagmus, slurred speech, mental confusion, insomnia, HA, dizziness, nervousness, tremor), nausea,gingival hyperplasia, blood dyscrasias, osteomalacia, stevens-johnson syndrome, liver damage, cardiac collapse (IV), endocrine effects (hirstuism)
22
Q
pt teaching for hydantoins
A
Take calcium and vitamin D, avoid herbs and OTC meds, take at same time each day, do not abruptly stop meds, pregnancy category D, avoid CNS depressants and grapefruit juice, monitor for skin rash and report seizure activity
23
Q
carbamazepine
A
Anticonvulsant used as mono therapy/adjunctive therapy for tonic clonic mix and complex partial seizures in adults with epilepsy
24
Q
therapeutic drug levels for carbamazepine
A
4-12mcg/mL
25
adverse effects of carbamazepine
Dizziness, drowsiness, unsteadiness,N/V/D, stevens-Johnson syndrome, suicidal ideation, suicidality,hepatotoxicty
Black box warning for blood dyscrasias(aplastic anemia, agranulocytosis, thrombocytopenia), HF, and fluid overload
26
nursing considerations for carbamazepine
CBC, serum drug level, monitor for SI, CNS changes, ECG, electrolytes, lung sounds and edema, seizure precautions, LFT
27
donepezil indications
used to treat mild-moderate dementia associated what Alzheimer’s disease
28
nursing considerations for donepezil
Assess for improvement in cognitive function, crash cart in case of Cholinergic crisis (ventilation needed atropine=antidote for cholinergic crisis)
29
Cholinergic crisis
Increased GI motility, bradycardia, muscle twitches and contractions , pupillary constriction (miosis), increased salivation and sweating
30
indications for carbidopa-levodopa
Parkinson's disease
31
pt teaching for carbidopa-levodopa
Do not stop abruptly, eat food after taking and avoid protein , change positions slowly, avoid activities that require alertness, good oral hygiene for dry mouth, avoid multivitamins that contain B6(pyroxidine) and iron , darkening of urine is expected, notify HCP of a/e(palpitations, urinary retention, involuntary movements, behaviors changes, new skin lesions, severe N/V/D), risk for injury and falls, on/off syndrome
32
neostigmine
Reversible cholinesterase inhibitor, indirect acting Cholinergic agonist
33
indications for neostigmine
Treat and diagnose myasthenia gravis, reverse neuromuscular blockade
34
side/adverse effects of neostigmine
Excessive muscarinic stimulation, Cholinergic crisis, myasthenic crisis
35
nursing considerations for neostigmine
Contraindicated in those with GI obstruction, ileus, urinary tract obstruction,peritonitis, use cautiously in those with peptic ulcer disease, hypothyroidism, seizure disorder, hypotension, bradycardia
Antidote is atropine
Edrophonium IV can determine between Cholinergic and myasthenic crisis
36
what drugs are in the central-acting muscle relaxants class
Baclofen, dantrolene, cyclobenzaprine
37
indications for central-acting muscle relaxants class
muscle spasms
38
evaluation for central-acting muscle relaxants
Dereases pain and increase ROM
39
what are the neuromuscular blocking drugs?
Succinylcholine (depolarizing)
Vancuronium and pancuronium (non-depolarizing neuromuscular blocking drugs)
40
adverse effects and treatment for neuromuscular blocking drugs
Respiratory arrest(paralyzed resp muscles) and muscle pain (12-24 hrs after d/c) antidote is neostigmine
41
what are the typical antipsychotic drugs in the class
Haloperidol, chlorpromazine
42
indications for typical antipsychotic drugs
Schizophrenia and drug-induced psychosis
43
adverse effects of typical antipsychotics
Acute dystonia, Parkinsonism, akathisia, tardive dyskinesia, neuroleptic malignant syndrome, anticholinergics effects, neuroendocrine, seizures, skin effects, orthostatic hypotension, sedation, agranulocytosis, liver impairment, severe dysrhythmias, sexual dysfunction
44
S/s of neuroleptic malignant syndrome
Sudden high-grade fever, BP fluctuations, dysrhythmias, muscle rigidity, diaphoresis, tachycardia, changes in LOC leading to coma
45
what drugs are in the atypical antipsychotics class
Clozapine, olanzapine, risperidone
46
side/adverse effects of atypical antipsychotics
DM, weight gain, hypercholesterolemia, orthostatic hypotension agranulocytosis, anticholinergic effects, agitation, dizziness, sedation, sleep disturbance, mild EPS, elevated prolactin levels, sexual dysfunction
47
pt teaching for atypical antipsychotics
Report abnormal movements
May cause drowsiness
Avoid CNS depressants
Report s/s of DM
Diet and exercise
Change positions slowly
Teach ways to manage anticholinergic effects
48
what are the SSRI drugs
Sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine,paroxetine
49
indications for SSRIs
Tx for major depression (and PTSD and anxiety)
50
adverse effects of SSRIs
Sexual dysfunction, weight loss, serotonin syndrome, rash , gi bleeding, bruxism, hyponatremia, withdrawal syndrome,
51
nursing considerations for SSRIs
Interacts with grapefruit juice (risk for toxicity) and warfarin , pregnancy category C(Paroxetine is category D), contraindicated Erin those taking MAOIs or TCAs
Assess for SI and nonadherence
52
MAOIs
Inhibits MAO
Never mix with other antidepressants
MAOOI
Massive HTN crisis risk
Avoid tyramine
OTC meds-CAAN=calcium,antacids, acetaminophen,NSAIDs=HTN crisis
Other antidepressants
Inc SI risk
53
what drugs are in the MAOI class
Phenelzine, isocarboxacid, selegiline transdermal, tranylcypromine
54
indications for MAOIs
Tx for neurotic or atypical depression , panic disorder, social phobia
2-4 weeks for therapeutic effects
55
interactions with MAOIs
Drug: any CNS stimulant, sympathomimetic, vasopressin’s, TCAs, SSRIs, general anesthetics
Food: Tyramine- aged cheese and meats, pickled pods, coffee, yogurt, chocolate, beer and red wine , yeast, bananas,liver smoked meats
56
indications for lithium
Mood stabilizer that reduces fluctuations in moods- bipolar disorder and schizophrenia
Low therapeutic index
57
toxicity levels for lithium
0.6-1.2= therapeutic range
Early= below 1.5
Advanced= 1.5-2.0
Severe=2-2.5 (possible death)
Lithium greater than 2.5mEq/L=coma and death
58
s/s of lithium toxicity (severe)
Extreme Polyuria, tinnitus, ataxia, involuntary movements, severe hypotension, seizures , irritability, tachycardia, anxiety, diaphoresis, tremors
59
pt teaching for lithium
Dehydration increases risk for toxicity, pregnancy category D, calming effect, takes days to reach desired effect, must be tapered, monitor sodium
60
what drugs are in the TCA class
Amitriptyline,nortriptyline, imipramine
61
side/adverse effects for TCAs
Anticholinergic effects, orthostatic hypotension, sedation , toxicity, decreased seizures threshold, excessive sweating, sexual dysfunction, arrhythmias
62
what drugs are in the NSAIDs class
Aspirin,ibuprofen,Ketorolac, naproxen, indomethacin, diclofenac, meloxicam
63
adverse effects of NSAIDs
Bleeding,N/V, renal impairment, nephrotoxicity, hepatotoxicity(ibuprofen), Reye’s syndrome( viral illness in children on aspirin) salicylism (aspirin)
64
nursing interventions for NSAIDs
Take with food, increases fluids to protect kidneys, avoid alcohol and G herbs (ginger, ginseng, ginkgo and garlic), report s/s bleeding, s/s MI or stroke, do not cut crush or chew EC tabs, ketorolac can ace kidney damage if use more than 5 days, stop taking aspirin 1 wk before surgery
65
indications for aspirin
Inflammation, fever, pain, MI prevention, acute chest pain
66
drug interactions for aspirin
Warfarin and alcohol
67
adverse effects of aspirin
Bleeding, renal impairment, salicylism, Reye’s syndrome, nephrotoxicity (high doses)
68
what drugs are in the antigout class
Colchicine(acute attack), allopurinol (prophylacticinhibiting uric acid production), probenecid (prophylactically inhibits uric reabsorption)
69
nursing interventions for antigout meds
Increase fluids, take with food, avoid grapefruit juice and alcohol, foods high in purine, monitor for bleeding and infection, metallic taste with allopurinol- not concerning , monitor uric acid and CBC as well as LFT/RFT
70
pt teaching for antigout meds
Avoid grapefruit juice, alcohol and foods high in purine. S/S bleeding and infections- report
Take with food
Increase fluids
Allopurinol causes a metallic taste
71
methotrexate
DMARD (disease-modifying anti-rheumatic drug), used when NSAIDs do not control pain, prevent progression, immunomodulator- slow/delay worsening of RA
72
indications for methotrexate
Rheumatoid arthritic pain not manageable by NSAIDs, slow or delay the worsening of RA
73
contraindications for methotrexate
Pregnancy category X, liver failure, alcohol use disorders, blood dyscrasias
74
opioid agonist drugs
Morphine, fentanyl, codeine, heroin, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphone
75
adverse effects of opioid agonists
Sedation, respiratory depression, dysphoria, hallucinations,N/V, constipation, cardiac arrest, nephrotoxicity, myosis, physical dependence, hypotension, urinary infrequency, dry mouth, itch
76
what drug is in the opioid antagonist class
Naloxone, Narcan, naltrexone
77
how would you know you need to give the opioid antagonist
Respiratory depression
78
how do you recognize cephalosporins
cef- or ceph-
79
how do you recognize penicillins?
-cillin
80
indications for cephalosporins and penicillins
Bacterial infection
81
general adverse rxns and tx for penicillins and cephalosporins
Hypersensitivity, superinfection, neuropathy , CNS toxicity, hepatic injury, bleeding, C. DIFF
Evaluate LFT and RFT, report s/s diarrhea, increase fluids, report s/s bleeding. Vancomycin tx for C. DIFF ad MRSA
82
nursing interventions for penicillins and cephalosporins
ask for allergies
Culture and sensitivity needed
RFT and LFT
Monitor for candidiasis
Monitor for bleeding
Report abnormals
Ceftriaxone=ventrogluteal , take probiotic, avoid alcohol, s/s infection
83
vancomycin side and adverse effects
Red man syndrome, ototoxicity, nephrotoxicity, Steven-Johnson syndrome, thrombophlebitis
84
nursing interventions for vancomycin
Culture and sensitivity first, monitor peak and trough, administer IV 60 min or more, hearing changes ?, monitor infusion site, RFT, superinfection?
85
how do you recognize fluoroquinolones?
-oxacin
86
indications for fluoroquinolones
Broad spectrum abx that inhibits DNA replication to complicated infections
87
adverse effects for fluoroquinolones
Achilles tendon rupture, arthropathy, superinfection, crystalluria, hypersensitivity rxns,photosensitivity, GI upset
88
what drug did we talk about in the aminoglycosides class
Gentamicin
89
peak and trough levels for aminoglycosides
Peak= 30 min after administration complete
Trough= 15-30 min before next dose
90
Indications for INH
TB
91
side/adverse effects for INH
Peripheral Neuropathy(vit B6 helps), hepatotoxicity(most reversible)
92
nursing interventions for INH
Give B6 (pirodoxine)
S/S monitor hepatitis, RFT regularly
93
pt teaching for INH
Take B6 for neuropathy
Avoid alcohol and foods with tyramine(beer, one, protein dietary supplement), use barrier method for birth control, S/S hepatitis (jaundice, abd pain, fatigue, nausea, LFTs will be drawn regularly
94
acyclovir indications
Antiviral medication- HSV (herpes simplex virus) and Varicella oyster virus (shingles-> dermatomes)
95
fluconazole indications
Vagina yeast infection, antifungal (systemic) used to treat mycoses
Two organisms- candida and dermatophite
96
tamoxifen indications
Breast cancer - stops growth of breast center cells by blocking estrogen
97
Adverse effects of tamoxifen
Endometrial cancer/ vagina bleeding, hypercalcemia, blood clots (pregnancy category D)
98
Epoetin alfa
Stimulates production of RBCs, produced by kidneys
99
Indications for epoetin Alfa
kidney disease pt, chemo, surgery, HIV/AIDS, anemia
100
Adverse effects of epoetin Alfa
HTN, risk for thrombotic events, DVT, HA, body aches
101
Oprelvekin
growth factors for platelets
102
Indications for oprelvekin
Severe thrombocytopenia
103
Evaluating effectiveness for oprelvekin
Monitor CBC (clotting time)
104
Decongestants drugs
Pseudoephedrine, phenylephrine, naphazoline, oxymetazoline, tetrahydrozoline, zylometazoline
105
Indications for decongestants
Temporary relieve nasal congestion by vasoconstriction
106
Side effects for decongestants
Tachycardia, nervousness, restlessness, anxiety, dry mucous membranes, tremor, weakness
107
Adverse effects of decongestants
Palpitations, HTN, arrhythmias, hallucinations, delusions, convulsions
108
Contraindications for decongestants
Glaucoma and those with preexisting HTN, cardiac disease, and hyperthyroidism… caution in those with DM
109
Methylxanthines- avoid
Smoking (decrease serum levels of med), caffeine (coffee, tea, soda, chocolate), report N/V/D and restlessness (toxicity)
110
Drugs in methylxanthines class
Theophylline and aminophylline
111
Indications for methylxanthines
Used for asthma and bronchospasms, reversal for chronic airway limitation
112
Drug interactions for methylxanthines
Smoking and caffeine= decreases drug serum levels
Serum levels must be monitored= 5-15mcg/mL
113
Mucolytic drug
Acetylcysteine-used to liquify secretions
Smells bad-rotten eggs
114
Pt teaching for mucolytic
Increase fluids, deep breathing and coughing, IS, does not stop cough, nebulizer administeration
115
Beta 2 agonist drugs in this class
Albuterol, levalbuterol, formoterol, salmeterol, epinephrine
116
Indications for beta 2 agonist
Prevent asthma attack, acute asthma attack tx, tx for acute bronchospasm and prevent exercise induced asthma, tx for COPD
117
Short acting vs long acting beta 2 agonist
short acting= rescue , 2-3 X q wk (Albuterol, levalbuterol)
Long-acting = formoterol, salmetorol (maintenance and prevention)
118
Pt teaching for beta 2 agonists
Use bronchodilator before corticosteroid, use as ordered (rescue 2-3 times per week= routine needs change)
Use a spacer and how
Limit/avoid caffeine
119
Adverse effects for beta 2 agonists
Tachycardia, HTN, palpitations dizziness, angina, hyperglycemia,
120
Most common s/e of Albuterol?
Tremors, anxiety, nervousness
121
How do you recognize inhaled corticosteroids?
-asone, -onide, -olide
122
Indications for inhaled corticosteroids
Asthma and COPD
Inflammation, maintenance drugs
123
Pt teaching for inhaled corticosteroids
Use bronchodilator first then steroid, spacer, rinse spacer and MDI, rinse mouth and throat,use everyday, can take up to 4 weeks for effects, avoid sick crowds and lots of ppl- hand hygiene, taper off, contraindicated if live virus vaccine taken or active fungal infection
124
Cardiac glycosides
3 actions
Positive inotropic (inc myocardial contraction)
Negative chronotropic (dec HR)
Negative dromotropic (dec conduction)
Increases pumping ability
125
What drugs are in the cardiac glycosides class
Digoxin, digitoxin, digitalis
126
Indications for cardiac glycosides
HF, A.Fib, A flutter
Decrease workload and increase contractility=increase output
127
Side /adverse effects of cardiac glycosides
Cardio toxicity (bradycardia), GI effects (anorexia, N/V/D), CNS effects (green yellow halos, diplopia, dysrhythmias, fatigue, drowsiness, HA)
128
Nursing interventions for cardiac glycosides
Take apical pulse prior to administration- hold if <60
S/S HF(SOB, edema, crackles, ect)
Digoxin level 0.5-2ng/mL
Potassium level 3.5-5
129
What drugs are in the nitrate class
Nitroglycerin, amyl nitrate, isosorbide dinitrate, isosorbide mononitrate
130
Indications for nitrates
Angina
Decrease Cardiac oxygen demand and vasodilators to lower preload
131
Pt teaching for transdermal nitrate patch
Patches is for chronic pain, rotate sites, make sure skin is hairless and dry, take it off at bedtime to prevent tolerance
132
Side effects for nitrates
HA, hypotension, dizziness, weakness, syncope, flushing, peripheral edema, tolerance
133
Adverse effects For nitrates
Orthostatic hypotension, reflect tachycardia, palpitations, dyspnea
134
Contraindications for nitrates
Concurrent use of PDE5 inhibitors,alcohol use, hypotension,BP meds, vasodilators, cardiac hx
135
What drugs are in potassium sparing diuretics
Spironolactone, amiloride, triamterene, eplerenone
136
Indications for potassium-sparing diuretics
Tx for hypokalemia, fluid retention/edema
137
Side and adverse effects for potassium-sparing diuretics
Hyperkalemia, dizziness, androgen effects, gynecomastia, diarrhea, increased risk of gastric bleeding, tumor-prone, HA, abd cramping
138
Nursing interventions for potassium-sparing diuretics
Monitor for s/s hyperkalemia(N/V, diarrhea, paresthesia, tachycardia, oliguria, abd cramps), monitor potassium levels, educate on potassium-rich foods, long half-life
139
What drug is in the thiazides class?
Hydrochlorothiazide (HCTZ)
140
Indications for thiazides
Edema, HF, central HTN, hyperkalemia, urinary retention
141
Evaluation for thiazides
BP, edema, dyspnea, crackles decreases (if fluid retention or HTN)
142
What drug is in the loop diuretic class
Furosemide
143
Indications for loop diuretics
HTN, edema/fluid overload (edema, dyspnea, crackles, BP)
144
Pt teaching for loop diuretics
Change positions slowly
Take in AM (urinate frequently)
Check BG for DM pts
Teach K+ rich foods (bananas, potato, tomato apricot, spinach, citrus fruits, dried fruit , nuts
S/S hypokalemia, hypomagnesemia, hypocalcemia
Take with food
Wear sunscreen (phototoxicity)
Avoid foods high in sodium
Daily weight
Keep BP log
145
Evaluating effectiveness for loop diuretics
S/s FVO and BP improve
146
How do you recognize calcium channel blockers
-dipine, -mil, -dial except diltiazem
147
Indications for calcium channel blockers
HTN
148
Adverse effects of calcium channel blockers
Edema(hands, feet, ankles), hypotension, bradycardia(reflex tachycardia), CHF, flushing, palpitations
149
Nursing considerations for calcium channel blockers
Monitor VS, ECG, I&O, DW, labs, edema, and flushing
150
Pt teaching for CCBs
Taper the dose, report CP or SOB, drug interactions (statins, grapefruit juice)
151
Clonidine
Central-acting alpha 2 agonist; transdermal patch
152
Clonidine indications
Stimulate alpha 2 receptors-vasodilation decrease CO, antihypertensive
153
Clonidine pt teaching
Change every 7 days, watch for skin rxns, make sure skin is clean and dry and hairless, and reapply rotating sites ; monitor BP at home
Anticholinergic effects
154
ACE inhibitors- how will you recognize them
-pril
155
Indications for ACE inhibitors
Tx for HTN and HF by blocking aldosterone release in the RAAS, preservers renal function
156
Side effects for ACE inhibitors
Dry, irritated cough- hyperkalemia
157
Adverse effects of ACE inhibitors
Angioedema, elevated potassium
158
Pt teaching for ACE inhibitors
Taper the dose, avoid K+ foods, BP range and normal, how to take BP, pregnancy
159
Cultural considerations for ACE inhibitors
Not as effective monotherapy for black pts; diuretics (thiazide) used first
160
Warfarin
Tx for DVT, prevent thrombus formation in those with A-fib or prosthetic heart valves, prevent MI, PE, TIA
161
Labs and therapeutic values for warfarin
PT and INR
PT:18-24 sec
INR:2-3=therapeutic
162
Interactions for warfarin
Aspirin and others antiplatelet/ anticoagulant drugs , alcohol, preg cat X, highly protein bound
163
Pt teaching for warfarin
Vitamin K=antidote
Foods high in vitamin K
Avoid smoking (inc metabolism of warfarin)
Avoid prolonged sitting and crossing legs, notify dentist
Bleeding precautions
S/s hepatitis and report
Pregnancy category X
164
Nursing considerations for warfarin
Bleeding percautions- soft bristle toothbrush, electric razor
Antidote is vitamin K- keep it at bedside
Monitor for s/s bleeding
Labs-PT and INR monitor LFT
165
Antidote for warfarin
Vitamin K
166
What is heparin used to treat
Stroke, PE, DVT
Prevents clotting
167
Labs and therapeutic levels for heparin
aPTT before every infusion and any rate change q4-6hrs
aPTT:60-80 sec
Platelets: > or = 100,000 (100-400k)
168
Interactions for heparin
NSAIDs, blood thinners
169
Antidote for heparin
Protamine sulfate
170
HMG-CoA Reductase inhibitors
reduce cholesterol levels
171
How do you recognize HMG-CoA Reductase inhibitors?
-statin
172
Baseline labs for HMG-CoA Reductase inhibitors
Cholesterol: 150-200
HDL:>60
LDL:<100
Triglyceride:40-150
LFT:ALT and AST
RFT
Creatinine kinase
Homocysteine
CRP
Eye exam yearly
173
Nursing interventions for HMG-CoA Reductase inhibitors
Monitor s/s hepatotoxicity
LFT
CK monitor
Avoid alcohol and grapefruit juice
Report myalgia
Report pregnancy (X)
Take before bed (when body makes cholesterol)
Take with food
174
Side effects for HMG-CoA Reductase inhibitors
HMGCRI
Hepatotoxicity
Myopathies
GI effects
Cataract risk increase
Rhabdomyolysis
Increased risk of DM
Diplopia
175
Adverse effects of HMG-CoA Reductase inhibitors
Rhabdomyolysis , hepatotoxicity,myalgia, brown/tea colored urine (bad)
176
What drug is in the surfactant laxative class
Docusate sodium
177
Indications for surfactant laxatives
Constipation in MI and aneurysm pts
Risk for fecal impaction
Older adults
Immobile pts
Pregnant pts
Pts on opioids
178
Mechanism of action for surfactant laxatives
Promotes defecation-stool softener
Prevents staining and hemorrhoids and decreases risk for fecal impaction
Inc water and electrolytes in intestines
179
Lactulose
Osmotic laxative
180
Indications for Lactulose
Constipaqtion and prevents and tx for portal-systemic encephalopathy
Dec ammonia levels
181
Sucralfate
Mucosal protectant
182
Indications for Sucralfate
Stomach ulcer
183
Mechanism of action for sucralfate
Coats stomach mucosa and protects ulcer
1 hr before meals and at bedtime
Major s/e=constipation
184
Evaluation of sucralfate
Less stomach pain
185
Misoprostol
Mucosal protectant
186
Indications for misoprostol
NSAID-induced stomach ulcer
187
Mechanism of action for misoprostol
Increases mucin and bicarbonate release, inhibits acid secretion, protects stomach lining, repairs ulcer
PREGNANCY CAT X
188
Evaluation for misoprostol
Reduced pain
189
Antacids
Increase gastric pH- two types
190
What are the different types of antacids?
H2 receptor antagonists(inhibit gastric secretions) and PPI (proton pump inhibitors-suppress gastric acid)
191
Pt teaching for antacids
Chew thoroughly, mix suspension and take with water or milk (8 oz)
2 hours after other drugs
HTN/HF pts avoid Na
192
H2 Receptor blockers
-tidine
193
What drugs are in the H2 receptor blocker class
Cimetidine and famotidine
194
Indications for H2 receptor blockers
Prevent histamine induced acid release, first choice-drugs for tx of ulcers
195
Interactions for H2 Receptor blockers
Smoking(decreases effectiveness), warfarin and lidocaine (inc effectiveness), NSAIDs and aspirin
196
Pt teaching for H2 receptor blockers
Avoid decaf coffee, alcohol, caffeine
Avoid smoking ‘avoid NSAIDs and aspirin
Schedule appt with PCP if s/s persist
Report s/s GI bleeding’
S/S resp infection
Take 30min-1 hr before eating
1-2 hrs apart from antacids
197
Proton pump inhibitors
Reduce acid secretion
198
How do you recognize proton pump inhibitors
-prazole
199
Indications for proton pump inhibitors
Tx for ulcers, erosive esophagitis
200
Adverse effects for proton pump inhibitors
HA, N/V/D(short-term use)
Pneumonia, osteoporosis/Dx, rebound acid hypersecretion, hepatotoxicity, hypomagnesemia (long-term use)
201
Anti thyroid drugs
Methimazole(1st line tx) and Propylthiouracil(BBW:severe hepatoxicity)
Tx for grave’s disease, emergency management of thyrotoxicosis
202
Evaluation for anti thyroid drugs
S/s hyperthyroidism decrease
3-12 weeks for benefits
203
Indications for glucocorticoids
Malfunctioning adrenal glands , inhibit inflammatory and immunological responses
Promote catabolism of proteins and gluconeogenisis
204
Adverse effects of glucocorticoids
Cushing’s syndrome (long-term use)
Osteoporosis/bone loss
Hyperglycemia and glucoscuria
Myopathy
PUD
Infection
Fluid/electrolyte imbalances
Growth suppression in children
205
Pt teaching for glucocorticoids
Take it food in AM
S/s acute adrenal insufficiency
Avoid NSAIDs and report tarry black stools
Weight baring exercises and high calcium dit and vit D
S/s infection, muscle weakness, cushing’s
Do not stop abruptly
206
Indications for Levothyroxine
Inc T3 and T4
Tx for goiter
Tx for hypothyroidism
207
Pt teaching for Levothyroxine
Avoid some vitamins and supplements (dec absorption of Levo)
Take on empty stomach - 30-60 min before breakfast
List of meds
Read labels
Lifelong therapy
Do not abruptly stop
S/s hyperthyroidism
Monitor weight
208
How will you recognize biphosphonate drugs?
-dronate
209
Indications for biphosponates
Hyperparathyroidism
Inhibit osteoclast activity and dec bone turnover/resorption
Prophylaxis ant tx: post-menopausal osteoporosis’, males with osteoporosis, glucocorticoid osteoporosis and paget disease
210
Adverse effects of biphosphonates
Esophagitis, esophageal ulceration, GI disturbances, musculoskeletal pain, visual disturbances, biphosphonate-related Osteonecrosis of the Jaw, kidney toxicity (IV infusion )
211
Contraindications for biphosphonates
Preexisting swallowing or esophageal issues, severe kidney impairment, hypocalcemia or cannot it upright for 30 min
212
Pt teaching for biphosphonates
Sit upright for 30 min after taking , on empty stomach, 8 oz water, report visual changes and GI issues, weight-bearing exercises and diet high in calcium and vit D, avoid dental work, Can take OTC analgesic
213
What drugs are in the sulfonylureas class?
glimepiride, glipizide, glyburide
214
Indications for sulfonylureas
Oral hypoglycemic
T2DM
Insulin release from pancreas
215
Adverse effects of sulfonylureas
Hypoglycemia, weight gain, hypersensitivity rxn
216
Nursing considerations for sulfonylureas
Monitor for s/s hypoglycemia, assess POC glucose , teach pt to eat 15 g carb snacks,keep BG log give with breakfast
217
Pt teaching for sulfonylureas
S/s hypoglycemia
15g carb snacks= 4oz OJ, 2 oz grape juice, 8 oz milk, glucose tabs per box instructions
218
Indications for glucagon
Emergency management of insulin induced hypoglycemia; injection for unconscious pt
219
Metformin indications
Control blood glucose levels in T2 DM
Three actions: reduce liver production of glucose, reduce absorption of glucose in intestines, increases insulin sensitivity
220
Side effects of metformin
Weight loss,GI distress
221
Adverse effects of metformin
Vitamin B12 and folic acid deficiency, lactic acidosis
222
Mixing insulins
Inject air into NPH first then regular, draw up regular first then NPH
223
Onset, peak, duration f rapid-acting insulin
Onset:15-30 min
Peak: 3pm in-2.5 hrs
Duration:3-6 hrs
224
Onset, peak, duration of regular insulin
Onset 1-2 hrs
Peak: 6-14 hrs
Duration: 16-24 hrs
225
Onset peak and duration of short-acting insulin
Onset: 30-60 min
Peak:1-5 hrs
Duration:6-10 hrs
226
Onset peak and duration of long-acting insulin
Onset: 70 min
Peak:none
Duration:18-24 hrs
227
Indications for oxybutynin
Dec urinary incontinence (OAB-overactive bladder)
Muscarinic antagonist
228
Contraindications for oxybutynin
Glaucoma, myasathenia gravis, paralytic ileus, GI/GU obstruction, BPH, urinary retention
229
Indications for bethanechol
Increases bladder tone, non obstructive urinary retention
230
Side effects and adverse effects of bethanechol
SLUDGES
Electrolyte and fluid imbalances
231
What drugs are in the PDE5 inhibitor class
sildenafil, tadalafil
Tx for ED, highly protein bound
232
Contraindications for PDE5 inhibitors
Severe liver failure
233
Toxicity (ATI ch 5)
