Final Blueprint 2 Flashcards
What should you be doing during the implementation phase of the nursing process?
- Adm med as prescribed
- Monitoring patient for therapeutic effect
- evaluate serum drug levels and results of relevant lab test
- monitor patient for adverse effects
- teach patient about the med and importance of compliance
- physiologic measurements, such as serum or urine drug levels
- -judgment of attending ph
- -patient self report
- -pill count
- -direct observation
durning the evaluation phase what is the evaluation based off?
The outcomes that were created in the planning phase, because out are related to the patient’s goals and must be measurable
Schedule I drug
Are illegal
Schedule II drugs require what kind of prescription?
Written and there are no telephone renewals
How do albumin levels effect drug absorption?
If albumin is low drug become low drugs get toxic easy, they will require a lower dose
First pass effect
Some drugs partially metabolized in the liver or portal veins before passing into the circulatory system
This explains why oral doses are greater then the IV dose
What will Half life determine?
How frequently a drug must be give to maintain a therapeutic blood level
Excretion is the process by which a drug metabolites are eliminated from the body. Which passes through the kidneys, but if the patient has kidney disease what will happen?
There will be a build up of the drug
Must monitor BUN and creatinine
What are the effects of aging on drug metabolism and excretion?
Metabolism- the liver’s efficiency in metabolizing drugs decline with age; one factor is a decline in hepatic circulation
Excretion- the related decline in renal function is not always heralded by increased serum creatinine levels causing more of a risk for nephrotoxicity (ex. Amino glycosides)
When should a peak be measured?
30 mins- 2hrs after administration
When should a trough be measured?
30 mins before the next dose
Bethanechol (urecholine)
Tx urinary retention
Edrophonium (tensilon)
Used to diagnose myasthenia gravis, has a short duration
Neostigmine (prostigmin)
Diagnose and tx myasthenia gravis and is the antidote for neuromuscular blockers
What is the antidote for cholinergic drugs?
Atropin
Patient with myasthenia gravis needs their meds when?
On time
When would you not use atropine?
If the patient has glaucoma
What is the side effects of anticholinergic drugs?
3D effects
Drying, decreased gi and gu motility, dilated pupils
Atropine
Tx bradycardia, minimizes vagal reflexes, blocks vagal effects on the heart.
It’s used pre anesthesia to decrease secretions
It does increase heart rate
What do you use to tx malignant hyperthermia?
Danteolene (dantrium)
What are the early signs of levodopa overdosage?
Eye winking and muscle twitching
What will decrease the effects of levodopa?
Vitamins and foods high in vitamin B6 will cause Parkinson’s symptoms to reoccur
Liver Green veggies Fortified cereals Whole grain cereal Lima and navy beans
What is the therapeutic range of Phenytoin( Dilantin)?
10-20
What are side effects of the anticonvulsant agents such as phenytoin (Dilantin)?
Gingival hyperplasia, hirsutism and blood dyscrasias ( thrombocytopenia and granulocytosis)
And
Steven Johnson syndrome( onset of fever, Bullae on the skin, ulcers on the lips eyes mouth nose and genitals and pneumonia)
What can you not mix phenytoin(Dilantin) with?
Do not mix drugs in the same syringe and do not mix in DW5 with IV administration
When a patient is on phenytoin (Dilantin) what should you advise the patient?
To have good oral hygiene and have routine visits with the dentist it can cause gingival hyperplasia
Why can’t you use salicylates aspirin for children with varicella or influenza?
May lead to Reye’s syndrome
What does pepto have in it?
Aspirin
Naloxone (narcan)
Drug of choice for the reversal of respiratory depression caused by narcotic overdose
Give small doses q2-3 min as needed. If pt doesn’t respond after 10 10 mg, reevaluate the diagnosis of narcotic overdose
Which general anesthesia would you not want to stimulate to awaken because of excitation and hallucinations?
Ketamine
What is the antidote for benzodiazepines a sedative and hypnotic?
Flumazeanil (romazicon)
What is the antidote for the barbiturate phenobarbital(luminal)?
There is no antidote
What are the side effects of M.A.O. Inhibitors?
Orthostatic hypotension, and hypertensive crisis
S/S increased BP and SEVERE headache, neck stiffness, fever and palpations
When someone is on a MAO inhibitor what food do they need to avoid?
Tyramine rich foods because they cause hypertensive crisis.
Aged cheese Aged or smoked meats ( herring or corn beef) Sour cream Yogurt Beer Red wine Chocolate Licorice Soy sauce Yeast Italian green beans Chicken liver Ripe bananas
If a patient experiences a hypertensive crisis what should you give them?
Regtine
What is lithium used to tx?
Acute episodes of mania and to prevent bipolar disorder
What drug is salt based?
Lithium
What is the therapeutic range of lithium?
0.5-1.5 mg
What should you monitor with patient taking lithium?
Monitor for polyuria or diabetes insipidus for signs of dehydration ( wt loss that exceeds 2lbs/ day dry mucus membranes and poor skin turgor)
What are signs of lithium toxicity?
Confusion, Lethargy, slurred speech, hyperflexia, N/V, tremors, seizures and diarrhea.
Stop taking and call the doctor
Observe for signs of water intoxication on lithium what are the S/S?
Decreased LOC ( first sign)
JVD
Edema
What should you advise a patient taking lithium?
To keep salt intake at a consistent level
And to stay hydrated because dehydration can lead to toxicity
What should you give to control drug induced EPS and acute dystopia?
Benztropine (cogentin)
What are symptoms of NMS?
Altered mental status, tachycardia, fever, dehydration, tachypnea, diaphoresis, muscle rigidity, hyperpyrexia, hypotension, and cardiovascular collapse.
Discontinue meds notify hcp
What is tardive dyskinesia?
It is an irreversible adverse effect of neuroleptic drugs.
Signs are lip smacking, worm like tongue movements and involuntary movements of the arms and legs
Clozapine (clozaril)
Used when patient have not responded to therapy with other antipsychotic agents or those with tardive dyskinesia
Serious adverse effects are life threatening neutropenia or agranulocytosis
Monitor for flue like symptoms: sore throat,fever, cough
What would you want a client to have checked when taking clozapine(clozaril)?
WBCs weekly
What is the therapeutic serum concentration of digoxin( lanoxin)?
0.5-2.0ng/ml
What does digoxin (lanoxin) tx?
CHF, atrial fibrillation/ flutter and paroxysmal arterial tachycardia
What predisposes a patient for digoxin toxicity?
Hypokalemia
What is the antidote for life threatening dig toxicity?
Digoxin- immune fab (digibind)
When should you hold digoxin?
If the apical pulse is less then 60
What labs need to be monitored if on digoxin?
Bun creatinine and potassium
What foods should be encouraged while on digoxin?
High in potassium foods
Bananas Fruit juice Potatoes Dried fruit Fresh fruit Oranges Some veggies
When would beta blockers be held?
If the apical pulse is below 50
How should nitrates be kept?
In the brown glass bottle that has a vent
When are beta blockers prescribed?
For long term prevention not for acute angina
What food interacts with calcium channel blockers?
Grapefruit juice
What is an adverse effect of ace inhibitors?
Tickling in the throat and a dry nonproductive persistent cough
How is cholestyramine(questran) available?
As a powder or chewable form. Mix powder with 120-189 ml of liquid
What is rhabdomyolysis?
It is a serious skeletal muscle adverse effect of lovastain
When should statins be taken?
At night with evening meal
If you take grapefruit juice with the statins you increase the risk of what?
Myopathy or rhabdomyolysis
What is the antidote for heparin?
Protamine sulfate ( give IV slowly over 1-3 min)
What is the antidote for warfarin?
Vitamin k
What do thrombolytics do?
The dissolve thrombi
What is the antidote for a thrombolytic if the patient begins to bleed out?
Aminoacaproic acids (amicar)
What are the side effects of bronchodilators?
Insomnia, tachycardia, tremors
What is the disadvantage to systemic. Decongestion?
They have a systemic stimulation and are not heart friendly
What is the disadvantage to topical decongestion?
They can have rebound nasal congestion with frequent or long term use
Misoprostal (cytotec)
They prevent NSAIDs induced gastric ulcers. They are a synthetic prostaglandin E1 analogue with antisecertory and muscosal protective properties. NSAIDs inhibit prostaglandin synthesis which diminishes mucosal secretions
This drunk is also used to ripen the ceviche during labor
Sulcrafate ( carafate)
Short term tx ( up to 8 weeks) of duodenal ulcers. In a acid environment it becomes paste like highly viscous, and adhesive. It forms a barrier at the ulcer site, allows the ulcer to heal
Give on an empty stomach because it is more effective in a low ph level
Promethaxine ( phenergan)
Must be diluted
When should bioposphonates anti- osteoporotic drugs be taken?
In the morning upon rising
Do not take with food or water for atleast 30 min
Do not lie down for 30 min after taking the drug to facilitate delivery to the stomach and to decrease esophageal irritation
Diphenhydramine( Benadryl)
Has anticholinergic effects. It will dry you out and drowsiness is a major side effect.
It is sometimes used as a sleep aid
What can probenecid be taken with?
It can be taken with colchicine. A small dose should be given before starting probenecid
When probenecid is used concurrently with penicillin what happens??
It increases the serum concentration of penicillin by blocking tubular secretions of the drug
Combined therapy may be used to tx bacterial endocarditis or acute gonorrhea
If a patient is allergic to penicillin what could they also be allergic to?
Cephalosporins
Before administration of Clindamycin(cleocin) a lincosamides what kind of assessment would you want to be sure to do?
Take the clients history because clients with gi disease particularly colitis and regional enteritis are at a higher risk for AAPMC and this is an adverse reactions to this drug
Abdominal cramps, diarrhea, weight loss or weakness are s/s of what?
Antibiotic associated pseudomembranous colitis
AAPMC
What is the side effect of vancomycin (vancocin) a glycopeptides?
Ototoxic, nephrotoxic, and red man syndrome
What is red man syndrome?
It results after a bolus of a drug or to rapid of infusion, caused by a histamine release it is characterized by a sudden severe hypotension, fever, chills, paresthesia’s erythema, or redness of the neck and back
This is a toxic effect not a allergic reaction
How do you tx red man syndrome?
By slowing the infusion
What can tetracyclines be used to tx?
H. Pylori if combined with metronidazole and bismuth subsalicylate
Also used for acne and other dermatological problems
Sinusitis
What are the side effects of tetracycline?
- Photosensitivity
- Teratogenic effects during first trimester of pregnancy( and through out)
- irreversible discoloration of tooth enamel ( should not be given to children under 8 years old)
- outdated drugs breakdown to a toxic by- product
What interacts with a tetracycline?
Antacids, milk and high ca because it prevents absorption except with minocycline and doxycycline
What are the side effects of gentamycin(garamycin) a aminoglycosides?
Ototoxicity (vestibular and auditory- messes with balance)
Nephrotoxicity(watch urine output)
Neurotoxicity s/s tremors, tinnitus, numbness, twitching of extremities
How should you DC corticosteroids?
Taper off over a period of 5-10 day because if you stop to rapidly it will cause a adrenal crisis.
What do glucorticoids decrease?
The ability to fight infection
When a client is taking merhylprenisolone ( solu-medrol) what labs should you monitor?
Electrolytes(NA and K) and blood sugars
Why do steroids make patient s more susceptible to infection?
Because they impact the inflammatory response and mask the s/s of infection
How should steroids be administered?
In the morning with food because they are ulcerogenic and can lead to insomnia
Why should people on merhylprenisolone ( solu-me drop) avoid people with respiratory infections?
Because they are immune suppressed
A patient on fludrocorisone( Florine’s) a mineralcorticoids should be monitored for what?
Hypokalemia- N/V, muscular weakness, abd distention, paralytic ileus, irregular hR
