Final drug flashcards

Question 1

Desmopressin (DDAVP) – POSTERIOR PITUITARY

Answer 1

prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous ADH. Because of their vasoconstrictive properties, they are useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage.

• Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand’s disease because of its effects on various blood-clotting factors.
• Given via nasal pump after nasal passages have been cleared.
• With desmopressin, assess vital signs as well as a history of seizures, asthma, or cardiovascular disease. These conditions require cautious use with careful monitoring of vital signs, heart sounds, and breath sounds.

Question 2

Adverse effects of Desmopressin (DDVAP)

Answer 2

increased BP, fever, headache, abdominal cramps and nausea

Question 3

Desmopressin and Vasopressin: common adverse effects

Answer 3

• Cardiovascular: increased BP
• Central Nervous: Fever, vertigo, HA
• Gastrointestinal: Nausea, heartburn, cramps
• Genitourinary: Uterine cramping
• Other: Nasal irritation and congestion, tremor, sweating

Question 4

Vasopressin is also used to control various types of?

Answer 4

bleeding (in particular gastrointestinal hemorrhage) and in pulseless arrest and vasodilatory shock

Question 5

Vasopressin

Answer 5

available as a nasal spray or as an IM or IV injection.

• Always check clarity of parenteral solutions BEFORE administering the medication.
• Discard solution if there are visible particles or any fluid discoloration.
• Be alert to the adverse effects of elevated blood pressure, fever, nausea, or abdominal cramping. If these worsen or persist, notify the prescriber immediately.

Question 6

Octreotide (Sandostatin)

Answer 6

• alleviating certain symptoms of carcinoid tumors stemming from the secretion of VIP, including severe diarrhea and flushing and potentially life-threatening hypotension associated with a carcinoid crisis
• also used for Tx of esophageal varices and acromegaly
• may impair gallbladder function and needs to be used with caution in patients with renal impairment
• may affect glucose regulation, and severe hypoglycemia may occur in patients with type 1 diabetes
• may cause hyperglycemia in patients with type 2 diabetes or in patients without diabetes. -may enhance toxic effects of drugs that prolong QT interval. -Ciprofloxacin may enhance QT-prolonging effects of octreotide
• intravenously (IV), intramuscularly (IM), or subcutaneously
• classified as pregnancy category B drug

Question 7

Levothyroxine (Synthroid)

Answer 7

thyroid replacement – for HYPOthyroidism. Given ONCE per day. IV dose is 50% of oral dose. Switching between brands during treatment can destabilize the treatment. Peak action is 3-5 days.

Question 8

Nursing consideration for thyroid medication

Answer 8

TAKE thyroid medications in the morning 30 mins BEFORE breakfast on an EMPTY stomach. ANTACIDS are to be avoided

Question 9

Thyroid hormone replacement requirements are approximately 25% lower in patients 60 years of age and older than in younger patients. Dosage in older adult patients may therefore need to be?

Answer 9

adjusted or titrated downward.

Question 10

Thyroid drugs: common adverse effects

Answer 10

• cardiovascular: Tachycardia, palpitations, angina, dysrhythmias, HTN
• Central nervous: Insomnia, tremors, HA, anxiety
• GI: Nausea, diarrhea, cramps
• Other: Menstrual irregularities, weight loss, sweating, heat intolerance, fever

Question 11

What foods to avoid for thyroid drugs

Answer 11

Iodized salt and iodine-rich foods, such as soybeans, tofu, turnips, high-iodine seafood, and some breads must also be avoided.

Question 12

Thyroid drugs: Patients must avoid interchanging brands because of?

Answer 12

possible differences in the bioequivalence of drugs from various manufacturers.

Question 13

Thyroid replacement drugs nursing considerations

Answer 13

If needed, patients may crush tablets. If the patient is scheduled to undergo radioactive iodine isotope studies, the thyroid replacement drug is usually discontinued about 4 weeks before the test, but only as prescribed.

Question 14

Propylthiouracil (PTU)

Answer 14

anti-thyroid med- for HYPERthyroidism.

• used during first trimester only, and then methimazole is used for remainder of the pregnancy
• Most serious adverse effects are liver and bone marrow toxicity
• Approximately 2 weeks of therapy with propylthiouracil may be necessary before symptoms improve
• available only in oral form as a 50-mg tablet.

Question 15

Radioactive iodine works by?

Answer 15

destroying the thyroid gland, in a process known as ablation. It is a commonly used treatment for both hyperthyroidism and thyroid cancer.

Question 16

Antithyroid drugs: common adverse effects

Answer 16

• Central nervous: Drowsiness, HA, vertigo, paresthisea
• GI: Nausea, vomiting, diarrhea, hapatitis, loss of taste
• Genitourniary: Smokey urine, decreased urine output
• Hematologic: Agranulocytes, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy, bleeding
• Integumentary: rash, pruritus
• Musculoskeletal: Myalgia, arthralgia
• Renal: Increased blood urea nitrogen ands serum creatinine levels
• Other: Enlarged thyroid gland, nephritis

Question 17

Anti-thyroid drugs interactions

Answer 17

interactions with oral anticoagulants (which can cause an increase in anticoagulation and thus risk for bleeding) and any medications that may lead to bone marrow suppression or cause leukopenia (antithyroid drugs may cause additive effects or worsening of bone marrow suppression).

Question 18

RAPID ACTING – Insulin lispro (Humalog)

Answer 18

Rapid onset of 15 mins. Give 15 minutes before eating. Subcutaneous injection

Question 19

SHORT ACTING – Insulin Regular (Humulin R)

Answer 19

often used in DKA or coma with type 1 diabetes. Faster onset of action

Question 20

INTERMEDIATE ACTING – Isophane susp (NPH)

Answer 20

insulin is a sterile suspension of zinc insulin crystals and protamine sulfate in buffered water for injection. The suspension appears cloudy or opaque. NPH insulin has a slower onset and longer duration of action than regular insulin, but not as long as the long-acting insulins. NPH insulin is often combined with regular insulin to reduce the number of insulin injections per day.

Question 21

LONG ACTING – Insulin Glargine (Lantus)

Answer 21

usually dosed once per day or every 12 hours. Because insulin glargine provides a more prolonged, consistent blood glucose level, it is sometimes referred to as a basal insulin

Question 22

Glipizide (Glucotrol) sulfonylureas

Answer 22

• rapid onset and short duration of action
• common adverse effect is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease.
• Another predictable adverse effect is weight gain because of the stimulation of insulin secretion.
• Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn. Contraindicated with renal failure. GIVE 30 MINUTES before meal, usually before breakfast. WEIGHT GAIN

Question 23

Metformin (Glucophage) biguanide

Answer 23

works by decreasing glucose production by the liver
-may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity. This results in increased peripheral glucose uptake and use, and decreased hepatic production of triglycerides and cholesterol. Unlike sulfonylureas, metformin does not stimulate insulin secretion and therefore is not associated with weight gain and significant hypoglycemia when used alone

Question 24

Metformin (Glucophage) biguanide adverse effects

Answer 24

abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea, especially at the start of therapy. These effects usually self-limiting can be lessened by starting low dosages, titrating up slowly, and taking the medication with food

• Less common adverse effects metallic taste, hypoglycemia, and a reduction in vitamin B12 levels after long-term use.
• Lactic acidosis is an extremely rare complication with metformin, but risk increases with very high blood glucose levels and/or clinical conditions predisposing to hypoxemia. Lactic acidosis is lethal in up to 50% of cases. Symptoms of lactic acidosis include hyperventilation, cold and clammy skin, muscle pain, abdominal pain, dizziness, and irregular heartbeat. Discontinue before and for 48 hours after MRI with contrast.

Question 25

Nursing considerations for antidiabetic oral drugs

Answer 25

Do not shake NPH (cloudy) and premixed insulin mixtures, but roll between the hands before administering the prescribed dose. The rolling helps to avoid air in the syringe and inaccurate dose administration. Administer insulins at room temperature. Insulin may be stored at room temperature if used within 1 month; otherwise, refrigeration is needed. Refrigeration is also recommended in warm or hot climates and with any major changes in environmental temperatures from cold to hot. Never use expired or discolored insulin.

Question 26

Oral antidiabetic drugs are usually given at?

Answer 26

least 30 minutes before meals, as ordered

Question 27

ADRENAL DRUGS

Indications:

Answer 27

Glucocorticoids are also administered by inhalation for the control of steroid-responsive bronchospastic states. However, glucocorticoid inhalers are not used as rescue inhalers for acute bronchospasm. Nasally administered glucocorticoids are used to manage rhinitis and to prevent the recurrence of polyps after surgical removal. Topical steroids are used in the management of inflammation of the eye, ear, and skin. Prednisone is the most commonly used oral drug, followed by dexamethasone. Methylprednisolone is the most commonly used injectable glucocorticoid, followed by hydrocortisone and dexamethasone. Betamethasone is the drug of choice for women in premature labor to accelerate fetal lung maturation.

Question 28

Adrenal glands contraindications

Answer 28

Cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The adrenal drugs may intensify these diseases.
-For example, one common adverse effect seen in hospitalized patients is an increase in blood glucose levels, often requiring insulin. This is not to say that diabetic patients who require glucocorticoids should not receive them, but the potential for increases in blood glucose levels exists. Because of their immunosuppressant properties, glucocorticoids are often avoided in the presence of any serious infection, including septicemia, systemic fungal infections, and varicella. One exception is tuberculous meningitis, for which glucocorticoids may be used to prevent inflammatory central nervous system damage. Caution is emphasized in treating any patient with gastritis, reflux disease, or ulcer disease because of the potential of these drugs to cause gastric perforation, as well as any patient with cardiac, renal, and/or liver dysfunction because of the associated alterations in elimination.

Question 29

Adrenal Agen, Mineralcorticoids: Fludrocortisone (Florinef)

Answer 29

partial replacement therapy for adrenocortical insufficiency in Addison’s disease and in the treatment of salt-losing adrenogenital syndrome.