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Pharmacology > Final Exam > Flashcards

Final Exam Flashcards

1
Q

common use of metoprolol

A

atrial fibrillation/flutter, supraventricular and ventricular dysrh. hypertension

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2
Q

common use of amiodarone

A

a fib/flutter
ventricular tachycardia or fibrillation

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3
Q

Amiodarone class

A

potassium channel blockers

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4
Q

Amiodarone MoA

A

blocks potassium channels, delays repolarization; slows HR

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5
Q

Amiodarone indications

A

v-tach v fib; afib or flutter

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6
Q

Amiodarone dose

A

maintenance: oral; acute IV push/infusion on tele floors/ICU/ACLS

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7
Q

Amiodarone Drug-drug

A

many! increase digoxin levels (up yo 50-70% loading dose); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decreases dose of either drug by 50%

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8
Q

Amiodarone AE

A

GI effects (n/v/d), corneal micro-deposits (cause visual issues- photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity

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9
Q

Amiodarone black box

A

hepatotoxicity, pulmonary toxicity, pro-arrhythmias

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10
Q

Amiodarone nursing considerations

A

no grapefruit juice, use barrier sun block; cardiac monitoring (IV), monitor electrolytes

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11
Q

Metoprolol (Toprol) class

A

beta adrenergic blocker

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12
Q

Metoprolol (Toprol) MoA

A

block beta 1 and beta 2 receptors of the SNS; slows HR and lowers BP
HR and BP

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13
Q

Metoprolol (Toprol) indications

A

HTN, HF, MI, A fib, A flutter

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14
Q

Metoprolol (Toprol) route

A

maintenance: oral
acute HTN or dysrhythmias: IV push

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15
Q

Metoprolol (Toprol) drug-drug

A

beta agonist inhaler (albuterol)

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16
Q

Metoprolol (Toprol) contraindications/cautions

A

bradycardia, hypotension, masks signs of hypoglycemia

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17
Q

Metoprolol (Toprol) AE

A

bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreases exercise intolerance, alterations in blood glucose

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18
Q

Metoprolol (Toprol) nursing considerations

A

monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed

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19
Q

Class action for Albuterol and Salmeterol

A

Beta 2 Adrenergic Agonist

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20
Q

Albuterol… LABA or SABA?

A

SABA

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21
Q

Albuterol Route

A

inhaler/nebulizer (5-15 min onset)

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22
Q

Rescue inhalor

A

Albuterol

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23
Q

Maintenance Inhalers

A

Salmeterol, Ipratropium, Fluticasone

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24
Q

Albuterol trade name

A

Pro Air

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25
Q

Albuterol indications

A

acute bronchospasm: Asthma Attack, COPD Exacerbation, pneumonia
prevention of exercise induced asthma

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26
Q

Albuterol and Salmeterol MoA

A

Beta 2 selective adrenergic agonists- BRONCHODILATION

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27
Q

Contraindications of Albuterol and Salmeterol

A

conditions exacerbated by sympomimetic effects
drug drug interactions with beta adrenergic antagonists

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28
Q

AE/SE of Albuterol and Salmeterol

A

sympomimetic stimulation: cardiac arrhythmias, tachycardia, HTN, sweating, tremors, worsened bronchospasm

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29
Q

Nursing implications with Albuterol

A

use to treat symptoms or as scheduled… overuse can cause AE/SE. administer 30-60 min before exercise

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30
Q

Class action for Fluticasone

A

inhaled corticosteroid

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31
Q

Route for fluticasone

A

inhaler

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32
Q

Trade name for fluticasone

A

Flovent

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33
Q

Indications for fluticasone

A

prevention and treatment of asthma

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34
Q

MoA for fluticasone

A

decrease inflammatory response in airways

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35
Q

AE/SE for fluticasone

A

sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal infections (oral thrush), rare systemic reaction

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36
Q

Nursing implications for fluticasone

A

assess mucous membranes- fungal infections not a rescue inhaler

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37
Q

Patient Education for Fluticasone

A

rinse mouth after each inhalation

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38
Q

polyethylene glycol (Miralax) class

A

bulk stimulants; hyperosmotic laxative

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39
Q

polyethylene glycol (Miralax) MoA

A

increase water absorption into the colon and GI tract (water follows polyethylene glycol; which stays in the colon and GI tract)

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40
Q

polyethylene glycol (Miralax) indications

A

constipation, evaluate bowel for diagnostic procedure (high dose)

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41
Q

polyethylene glycol (Miralax) AE

A

see nursing role

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42
Q

polyethylene glycol (Miralax) nursing considerations

A

mix with 4-8 oz of water; acute care fall risk

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43
Q

Potassium chloride class

A

electrolyte replacement

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44
Q

Potassium chloride MoA

A

transmission of nerve impulses, cardiac contraction, renal function, intracellular ion maintenance

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45
Q

Potassium chloride indication

A

prevention and treatment of hypokalemia

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46
Q

Potassium chloride route

A

PO, IV

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47
Q

Potassium chloride AE

A

hyperkalemia, n/v/d, GI cramping, bradycardia, cardiac arrest

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48
Q

Potassium chloride nursing considerations

A

utilize electrolyte replacement protocol: oral admin preferred; follow dosing and lab draw times
throughout admin monitor for: cardiac abnormalities and vein phlebitis
teach patient: increase intake of high K= foods, do not break, crush, or chew ER caps or enteric capsules; report burning sensation at IV site

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49
Q

Potassium Administration Oral

A

do not break, crush, or chew ER caps or enteric capsules. With or after meals with full glass of water. Dissolve effervescent tabs in 8 oz cold water

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50
Q

Potassium Administration IV infusion

A

central line preferred- caustic to veins
admin rate- 10mEq/hour
Monitor IV site- phlebitis
Do not admin SQ or IM

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51
Q

Furosemide (Lasix) class

A

loop diuretics

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52
Q

Furosemide (Lasix) MoA

A

inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na)

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53
Q

Furosemide (Lasix) indications

A

conditions of fluid overload; hyperkalemia

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54
Q

Furosemide (Lasix) route/dose

A

oral, IVP (slow 20mg/min); may be given IM or as IV gtts

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55
Q

Furosemide (Lasix) contraindications

A

see general; ototoxic drugs; sulfa allergy

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56
Q

Furosemide (Lasix) AE

A

see general; hypokalemia; CNS effects: paresthesia, ototoxicity (IVP slowly)

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57
Q

Furosemide (Lasix) Nursing considerations

A

see general; potassium supplements; IV fall risk

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58
Q

Aspirin (ASA) class

A

Anti-platelet Agent/ Salicylate

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59
Q

Aspirin (ASA) MoA

A

inhibit platelet aggregation (COX inhibitor)

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60
Q

anti-platelets prevent what…

A

the platelet part of clotting (platelet coags forms platelet plug with anti-platelet)

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61
Q

Aspirin (ASA) Indication

A

Prevention of MI, TIA, ischemic CVA in high risk populations (primary or secondary prevention)

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62
Q

Aspirin (ASA) Dose

A

81-325 mg PO daily (81mg is a baby aspirin)
level of dose determines if its prevention or treatment

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63
Q

Aspirin (ASA) AE

A

GI irritation (N/V, epigastric pain)
bleeding- GI bleeding
hematuria
easy bruising
tinnitus (with toxicity)

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64
Q

Aspirin (ASA) Nursing considerations

A

take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)

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65
Q

Heparin Class

A

indirect thrombin inhibitor- anticoagulant

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66
Q

Heparin MoA

A

disrupts clotting cascade; prolongs bleeding time

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67
Q

Heparin route/dose

A

5000 units SQ q8h (prevention) or IV drip (protocol)

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68
Q

Heparin indications

A

prevent or treat DVT (SQ); treat PE (IV)

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69
Q

Heparin contraindications

A

Porker allergy; Pork abstention religion (Judaism, Muslim)

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70
Q

Heparin AE

A

Bleeding, heparin-induced thrombocytopenia, bruising at injection site

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71
Q

Heparin Nursing considerations

A

rotate/monitor injections site for SQ (do not administer IM), monitor platelet count; monitor aPTT

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72
Q

Heparin reversal agent

A

protamine sulfate (heparin short half life, stop infusion)

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73
Q

Warfarin (Coumadin) class

A

Vitamin K antagonist (anticoagulant)

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74
Q

Warfarin (Coumadin) MoA

A

interfere with hepatic synthesis of vitamin K dependent clotting factors; prolongs bleeding time

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75
Q

Warfarin (Coumadin) route/dose

A

2-10 mg/day PO based on INR
Daily in evening or HS
Hold and call PCP if INR is greater than 3.0
Expect Vitamin K order if INR is greater than 4

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76
Q

Warfarin (Coumadin) indications

A

chronic Afib, artificial heart valves, prevent/treat DVT, PE

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77
Q

Warfarin (Coumadin) AE

A

GI effects (n/v), bleeding

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78
Q

Warfarin (Coumadin) drug-drug

A

antibiotics (monitor INR), Amiodarone, herbals

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79
Q

Warfarin (Coumadin) nursing considerations

A

Monitor PT/INR; first oral anticoagulant on market

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80
Q

Warfarin (Coumadin) reversal agent

A

Vitamin K

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81
Q

Warfarin (Coumadin) Lab Draws

A

dose change= next lab in 3 days
long term monitoring= weekly or monthly

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82
Q

Warfarin (Coumadin) Diet

A

teach patient to maintain consistent intake (avoid) vitamin K containing foods (increased intake may decrease warfarin effect)

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83
Q

Foods High in Vitamin K

A

kale
collard greens
spinach
brussel sprouts
broccoli
asparagus
sauerkraut
soybeans
edamame

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84
Q

herbals to avoid with Warfarin

A

St. Johns Wart
Garlic
Gingko
Ginger Root
Chamomile

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85
Q

Epoetin Alfa (Procrit) class

A

erythopoiesis stimulating agent

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86
Q

Epoetin Alfa (Procrit) MoA

A

erythropoietin factor controlling rate of RBC production

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87
Q

Epoetin Alfa (Procrit) Indications

A

disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments

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88
Q

Epoetin Alfa (Procrit) contraindications

A

angina, caution in CHF, anticoagulant therapy

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89
Q

Epoetin Alfa (Procrit) AE

A

fatigue, bone pain, edema, HTN, headache, fever, DVT, CVA, MI has occured

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90
Q

Epoetin Alfa (Procrit) nursing considerations

A

Monitor CBC weekly (dose depends on Hgb and indication), check VS (risk of HTN), analgesia for bone pain, goal Hgb above 10; hold if Hgb is greater than 12

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91
Q

tamoxifen class

A

hormone modulator

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92
Q

tamoxifen MoA

A

competes with estrogen binging sites in target tissue; anti-estrogen

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93
Q

tamoxifen indications

A

breast cancer; prophylactic breast cancer

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94
Q

tamoxifen route

A

oral (may take for years)

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95
Q

tamoxifen AE

A

anti-estrogen effects (hot flashes, menstrual irregularities), masculinizing effects in women; risk for DVT

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96
Q

tamoxifen contraindications

A

pregnancy/breastfeeding, anticoagulants, hx of blood clots

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97
Q

tamoxifen nursing considerations

A

comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures, temperature control, and stress reduction

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98
Q

antineoplastic agent general information

A

harmful to all rapidly growing cells- even the healthy ones. narrow therapeutic index

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99
Q

antineoplastic agents goals of treatments

A

limit/decrease cancer cells so immune system can eliminate rest; limit toxicity to host

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100
Q

antineoplastic agents caution

A

pregnancy/lactation
bone marrow suppression
hepatic or renal impairment
CNS disorders

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101
Q

antineoplastic agents routes

A

most common are oral or IV
nurse must have certification to administer chemotherapy

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102
Q

cell cycle specific antineoplastic agents

A

antagonize actions of key cellular metabolites needed for DNA synthesis (folic acid, purines, pyrimidines)

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103
Q

cell cycle nonspecific or miscellaneous antineoplastic agents

A

prevent cell reproduction by altering the chemical structure of cell DNA

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104
Q

cyclophosphamide (cytoxan) class

A

alkylating agents

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105
Q

cyclophosphamide (cytoxan) AE

A

toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis

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106
Q

cyclophosphamide (cytoxan) nursing considerations

A

encourage hydration to prevent cystitis

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107
Q

methotrexate (rheumatrex) class

A

folate antagonist

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108
Q

methotrexate (rheumatrex) AE

A

gastrointestinal ulceration, bone marrow suppression

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109
Q

methotrexate (rheumatrex) nursing considerations

A

see general

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110
Q

Doxorubicin (adriamycin) class

A

antitumor antibiotics

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111
Q

Doxorubicin (adriamycin) AE

A

injection site extravasation, cardiotoxic, see general

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112
Q

Doxorubicin (adriamycin) nursing considerations

A

see general

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113
Q

general antineoplastic adverse effects

A

alopecia, rashes, blisters, photosensitivity, neuropathy, cognitive dysfunction, headache, dizziness, toxicity, leukopenia, anemia, thrombocytopenia, n/v, anorexia, diarrhea, constipation, mucous membrane deterioration (stomatitis), toxicity, cystitis; dysfunction

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114
Q

antineoplastic assessment

A

history and physical: contraindications, AE
Labs: CBC, LFTs, kidney functions (complete metabolic panel)

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115
Q

antineoplastic nursing diagnosis

A

fatigue related to drug effects (anemia) and disease effects
disturbed body image related to alopecia, skin effects, etc
risk for infection related to neutropenia

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116
Q

antineoplastic expected outcomes

A

the client will have decreased cancer growth or spread
the client will develop limited adverse effects
the client will understand drug therapy, adverse effects, and comfort measures to relieve adverse effects

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117
Q

antineoplastic interventions for MedSurg Nurse

A

schedule blood tests to monitor bone marrow, liver, and renal function as prescribed
monitor AE
administer anti-nausea and anti-diarrheal as prescribed
ensure hydration to decrease risk of renal toxicity and dehydration
provide small frequent meals, mouth care, and consult the dietician to maintain nutrition.
avoid exposure to infection
observe for signs of bleeding due to thrombocytopenia
advise barrier contraception during sexual activity to avoid contaminating the partner through body fluids

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118
Q

antineoplastic discharge education

A

take antiemetics as prescribed, follow dietary advice for GI effects, maintain fluid intake, go to next scheduled CBC, notify provider of oncologic emergency, prevention contamination of body fluids by wearing gloves, flush 2-3 times with stool closed, place soiled linens separate, drug waste should have its own receptacle.

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119
Q

indications of oncologic emergency

A

fever/chills
temp higher than 100.5F
swollen tongue/crack/bleeding
bleeding gums
dry, burning, scratchy or swollen throat
blood in urine
changes in bladder function or patterns
changes in GI or bowel patterns longer than 2-3 days
bloody stools

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120
Q

med surg nurse antineoplastic responsibilities

A

monitor the patient before, during and after treatment and how to handle drugs after treatment.
wear PPE and call oncology nurse with questions

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121
Q

signs and symptoms of extravasation

A

pt reports burning, stinging, pain at site or chest wall, neck, shoulder
leakage, swelling, induration at site

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122
Q

actions for extravasation

A

stop infusion immediately and contact provider, aspirate residual drugs from catheter, follow protocols

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123
Q

stomatitis

A

ulceration of oral mucous membranes

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124
Q

mucositis

A

ulceration of any part of the GI system from mouth to anus

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125
Q

Filgrastim (neupogen) class

A

colony stimulating factors

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126
Q

Filgrastim (neupogen) MoA

A

stimulates production, maturation, and activation of neutrophils to reduce incidence of infection

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127
Q

Filgrastim (neupogen) indications

A

myelosupression conditions (antineoplastic drugs, bone marrow transplant, HIV)

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128
Q

Filgrastim (neupogen) route

A

SQ

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129
Q

Filgrastim (neupogen) AE

A

fatigue, bone pain, fever, n/v, peripheral edema

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130
Q

Filgrastim (neupogen) nursing considerations

A

frequent lab monitoring (CBC before treatment and twice weekly), teach self administration

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131
Q

thrombocytopenia

A

platelet count less than 50,000/mm3

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132
Q

platelet level indicative for transfusion

A

10,000/mm3

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133
Q

antineoplastic drugs in children

A

vulnerable to malnutrition and dehydration, need support and comfort to be like other children, management of developmental needs and infection prevention

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134
Q

antineoplsatic drugs in adults

A

body image may be altered after hair loss, cachexia, offer support, fear of diagnosis and treatment, may incur job stress and financial strains, need support, teaching and comfort.

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135
Q

antineoplastic drugs in older adults

A

more susceptible to the CNS, GI, renal and liver effects. May need reduced doses of antineoplastic drugs.

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136
Q

immune modulator

A

modify the actions of the immune system

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137
Q

immune stimulants

A

energize immune system when it needs help fighting a specific pathogen

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138
Q

immune suppressants

A

block normal effects of the immune system in organ transplantation and autoimmune disorders.

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139
Q

Cyclosporine class

A

t and b cell suppressors

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140
Q

Cyclosporine MoA

A

inhibits helper t cells; block antibody production of B cells

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141
Q

Cyclosporine indications

A

anti-rejection organ transplant; psoriasis, rheumatoid arthritis.

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142
Q

Cyclosporine contrainidications

A

pregnancy/lactation, renal/liver dysfunction, infection, malignancies

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143
Q

Cyclosporine drug/food

A

grapefruit juice- increase levels by 50-200%

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144
Q

Cyclosporine AE

A

infection risk, kidney and liver damage

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145
Q

Cyclosporine nursing considerations

A

monitor CBC, kidney/liver function, drug level, avoid infection, no grapefruit juice, s/s of kidney and liver toxicity

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146
Q

immunizations/vaccines

A

process of artificially stimulating active immunity by exposing body to weakened disease causing organisms.

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147
Q

titer

A

lab test that evaluates the level of antibodies from prior vaccine or infection. Positive titer means high levels to promote protection. negative, no protection.

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148
Q

booster

A

a repeat injection of a vaccine after time has passed to strengthen immune response and maintain protection.

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149
Q

vaccines in children

A

standard of care, nurse should provide written record, educate to report AE, warm soaks and acetaminophen to treat AE

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150
Q

vaccines in adults

A

immunize if traveling to areas with high risk for specific disease

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151
Q

vaccines in older adults

A

older adults have greater risk for severe illness if unvaccinated, there is no age limit for vaccines.

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152
Q

attenuated LIVE vaccines

A

alive but weakened- could produce disease if immune compromised
ex: MMR, varicella

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153
Q

Inactivated (KILLED) vaccines

A

killed vaccine, required booster
ex: flu and hepatitis vaccines

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154
Q

immunizing drugs general MoA

A

introduces inactive cells; initiates B cell response and destruction of pathogen if exposed.

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155
Q

immunizing drugs general indications

A

disease prevention

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156
Q

immunizing drugs general drug/drug

A

immunosuppressant drugs, including corticosteriods

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157
Q

immunizing drugs general AE

A

common: redness, discomfort at injection site, fever, minor aches, arthralgia
rare: anaphylactic reaction.

158
Q

contraindications for vaccines

A

severe acute illness with or without fever
allergic reaction to vaccines
immunosuppression
history of Guillain Barre syndrome
pregnancy

159
Q

medications label

A

labels have specific information that identifies a specific medication.
includes: warnings, administration information, national drug code number, brand name, generic name, drug dose, lot number, prescription status, drug manufacturer, quantity, and expiration date.

160
Q

pharmacokinetics

A

what the body does to the drug

161
Q

pharmacokinetics- absorption

A

getting drug to blood

162
Q

pharmacokinetics- distribution

A

getting drugs to tissues

163
Q

pharmacokinetics- metabolism

A

breaking drug down

164
Q

pharmacokinetics- excretion

A

getting drug out of the body

165
Q

oral route

A

most are absorbed through the small intestine but some in stomach. onset 30-60 min. administer 1 hour before meals or 2 hours after with a full glass of water

166
Q

factors effecting oral route

A

molecular weight, lipid solubility, blood flow through GI, surface area of GI, rate of gastric emptying, drug drug interactions, food and drink administered with meds (binding)

167
Q

sublingual route

A

rapid action; absorbed through highly vascular tissue

168
Q

topical route

A

delivers drug directly to affected area, minimal systemic absorption

169
Q

transdermal route

A

provides constant rate of drug absorption, always apply to intact skin

170
Q

IV route

A

full strength: immediate onset and fully absorbed, more likely to cause toxic effects
if administering more than 1 drug at same site, they must be compatible.

171
Q

IM route

A

absorbed directly into capillaries in muscle and sent into circulation. men more vascular muscles than women, men reach peak level faster than women

172
Q

SQ route

A

slowly absorbed, timing of absorption varies depending on fat content and state of local circulation. increased adipose tissue means decreased absorption

173
Q

IV bioavailability

A

100% absorption/bioavailability

174
Q

IM/SQ bioavailability

A

100% absorption but less than 100% bioavailable

175
Q

Oral bioavailability

A

less than 100% absorption/0-70% bioavailable

176
Q

drug metabolism (biotransformation)

A

liver is primary site. infants and elderly, genetic disorders and severe liver disease can decrease metabolism, liver transforms drug to an active form

177
Q

enzyme induction

A

increased activity of enzyme system by presence of first drug; speeds metabolism of second drug using enzyme system and cannot reach therapeutic effect.
why some drugs cannot be taken together.

178
Q

enzyme inhibitied

A

some drugs inhibit enzyme system-make less effective, drug will not be broken down for excretion. blood level of drug increases to toxic level

179
Q

first pass effect- oral route

A

how much the liver metabolizes the drug then effects the amount of bioavailability the drug has.

180
Q

drug excretion

A

kidneys are primary organ for excretion of drugs from body. kidney dysfunction will cause toxicity. liver and bowel are secondary sire for excretion.

181
Q

antagonist drugs

A

do the opposite of what its supposed to.
competitive: block normal stimulation of receptor
noncompetitive: prevent reaction of another chemical with a different receptor site on cell

182
Q

pharmacological changes related to aging: cardiovascular

A

decreased cardiac output

183
Q

pharmacological changes related to aging: GI

A

increased gastric pH and decreased peristalsis/absorption

184
Q

pharmacological changes related to aging: hepatic

A

decreased enzyme production and decreased blood flow to liver

185
Q

pharmacological changes related to aging: renal

A

decreased blood flow, GFR, and overall function

186
Q

pharmacological changes related to aging: absorption

A

changes can result in decreased absorption of oral drugs

187
Q

pharmacological changes related to aging: distribution

A

decreased total body water increases concentration of med, decreased protein (albumin), greater amount of free drug INCREASES risk for toxicity

188
Q

pharmacological changes related to aging: metabolism

A

enzyme activity decreased due to decreased function INCREASES risk for toxicity

189
Q

pharmacological changes related to aging: excretion

A

decreased number of nephrons and GFR INCREASES risk for toxicity

190
Q

manifestations of anaphylaxis

A

hypotension, tachycardia, dyspnea, edema, hives, itching, respiratory or cardiac arrest

191
Q

agonist drugs

A

drugs interact directly with receptor sites, cause same activity of natural chemicals would cause at that site
ex: insulin- beta agonist

192
Q

diphenhydramine (benadryl) class

A

antihistamines H1 receptor antagonist

193
Q

diphenhydramine (benadryl) MoA

A

block release of histamine from mast cells; compete for unoccupied histamine-1 receptor sites

194
Q

diphenhydramine (benadryl) indications

A

allergic rhinitis many others

195
Q

diphenhydramine (benadryl) contraindications

A

older adult, condition exacerbated by anticholinergic effects

196
Q

diphenhydramine (benadryl) AE

A

drowsiness and sedation; high anticholinergic effects

197
Q

diphenhydramine (benadryl) nursing considerations

A

caution about driving/operating dangerous machinery

198
Q

pseudoephedrine class

A

oral decongestants

199
Q

pseudoephedrine MoA

A

stimulates alpha 1 sites (sympathomimetic/vasoconstriction); shrink mucous membrane and decrease mucous production in UR

200
Q

pseudoephedrine indications

A

promotion of sinus drainage and decrease mucous production

201
Q

pseudoephedrine route

A

oral; immediate and extended release available.

202
Q

pseudoephedrine contraindications

A

condition exacerbated by sympathetic activity

203
Q

pseudoephedrine AE

A

hypertension, insomnia, dizziness, anxiety

204
Q

pseudoephedrine nursing considerations

A

OTC behind pharmacy counter

205
Q

Glucagon MoA

A

accelerates the breakdown of glycogen to glucose in the liver, causing an increase in blood glucose levels

206
Q

IV D50W class

A

glucose elevating agents

207
Q

Lispro and Aspart

A

SQ injections up to 4x per day (ACHS)
risk for hypoglycemia at meal time

208
Q

Regular Insulin

A

only insulin given by IV and low BG at peak action

209
Q

Glargine (lantus)

A

lower risk low BG, 1-2 times daily (12-24 hrs)

210
Q

Insulin MoA

A

replacement of endogenous insulin- promote cellular uptake of glucose, amino acids, potassium, protein synthesis, glycogen formation/storage, fatty acid storage

211
Q

Insulin Indication

A

T1DM, T2DM, DKA (regular insulin only), Hyperkalemia

212
Q

Insulin AE

A

hypoglycemia, lipohypertrophy, lipodystrophy at injection site, diarrhea, hypokalemia

213
Q

lispro (humalog) onset, peak, duration

A

5-15 min
30-60 min
3-4 hour

214
Q

Aspart (novolog) onset, peak, duration

A

10-20 min
1-3 hours
3-5 hours

215
Q

regular insulin onset, peak, and duration

A

30-60 min
2-3 hours
6-10 hours

216
Q

glargine (lantus) onset, peak, duration

A

gradual
none
up to 24

217
Q

glucagon route

218
Q

glucagon onset, peak, and duration

A

1 min
15 min
9-20 min

219
Q

glucagon AE

A

hyperglycemia, rebound hypoglycemia

220
Q

glucagon nursing considerations

A

administer SQ/IM if no IV access for severe hypoglycemia, give supplemental carbohydrates ti replenish depleted glycogen stores
monitor: VS, LOC, BG

221
Q

glucagon class

A

glucose elevating agents

222
Q

IV D50W MoA

A

increase circulating blood glucose

223
Q

IV D50W route

A

IV push over 2-5 min

224
Q

IV D50W onset

225
Q

IV D50W AE

A

hyperglycemia, electrolyte disturbances, hyper-osmolarity, localized phlebitis, localized tissue necrosis

226
Q

IV D50W nursing considerations

A

admin IV for severe hypoglycemia
give supplemental carbohydrates when pt. able to safely swallow to replenish depleted glycogen stores
monitor VS, LOC, BG (rebound hypoglycemia)

227
Q

prednisone MoA

A

anti-inflammatory and immunosurpression effects

228
Q

prednisone indication

A

inflammatory and allergic disorder

229
Q

prednisone contraindications

A

acute infection, diabetes mellitus, acute peptic ulcers, CHF, older adult

230
Q

prednisone interactions

A

quinolones, NSAIDs, salicylates and diuretics

231
Q

prednisone short term AE

A

gastric irritation, immunosuppression, edema, HTN, weight gain, insomnia, appetite increase, masks s/s infection, steroid psychosis.

232
Q

prednisone long term AE

A

Cushing’s syndrome; hypernatremia, hypokalemia, growth suppression, adrenal suppression.

233
Q

cushing’s syndrome s/s

A

weight gain- moon face and buffalo hump
hyperglycemia
osteoporosis
hypertension
muscle atrophy
bruise easily/purpura
skin thins/poor healing

234
Q

fentanyl class

A

opioid agonist

235
Q

fentanyl uses

A

acute and chronic pain, adjunct to general anesthesia

236
Q

fentanyl IV dose

A

onset: 1 min
peak 3-5 min
duration: 30-60
50mcg evert 1-2hr PRN
PCA pumps
same considerations as morphine for IVP

237
Q

fentanyl transdermal dose

A

half life 13-22 hours
common dose: 25 mcg/hour
change patch every 72 hours

238
Q

goal of antibiotics

A

cause bacterial cell death without causing damage to host cells. MoA varies on the type of antibiotic

238
Q

goal of antibiotics

A

cause bacterial cell death without causing damage to host cells. MoA varies on the type of antibiotic

239
Q

Big concept of antibiotics

A

all antibiotics cause death of bacteria if effective

240
Q

common AE of antibiotics

A

nausea, vomiting, diarrhea, rash, hives, hypersensitivity reactions, superinfections/secondary infections

241
Q

superinfections/secondary infections

A

host flora suppressed by antibiotics or they are opportunistic. CM may vary.
ex: c-diff and candida albicans

242
Q

Antibiotics Potential toxicities

A

Acute kidney injury (R)
Neurotoxicity (N)
Liver toxicity (L)
“RN Later”

243
Q

antibiotics- children

A

monitor closely for allergic reaction and superinfections
ensure adequate hydration and nutritional status

244
Q

antibiotics- adults

A

instructions to take all medication as directed/do not save or share
females on birth control use additional protection against pregnancy

245
Q

antibiotics- pregnancy

A

most antibiotics are contraindicated (risk v. benefit)

246
Q

antibiotics- older adult

A

higher risk for toxicity

247
Q

antibiotics nursing responsibilities

A

complete assessment and health history, obtain cultures as needed, note s/s of infection, may increase anticoagulant effect of warfarin, monitor therapeutic effect, lab values, AE, peak and trough if appropriate, ensure hydration, patient education.

248
Q

anxiety

A

feelings of tension, nervousness, apprehension, and fear.
CM: sweating, tachycardia, rapid breathing, elevated BP
Mild: helpful in certain situations
Severe: interfere with functioning

249
Q

general benzodiazepines MoA

A

depress activity of CNS through GABA receptors

250
Q

general benzodiazepines contraindications

A

pregnancy (X), lactations, COPD, older adults

251
Q

general benzodiazepines black box warning

A

schedule IV, CNS depressants, alcohol, opioid, others

252
Q

general benzodiazepines AE

A

CNS depression; overdose; respiratory depression, coma

253
Q

general benzodiazepines nursing considerations

A

caution with IV route; long term use must taper discontinuation; addictive

254
Q

Lorazepam (Ativan) class

A

benzodiazepines

255
Q

Lorazepam (Ativan) use

A

anxiety disorders, acute agitation, acute alcohol withdrawal, pre-operative sedation

256
Q

Lorazepam (Ativan) AE

A

drowsiness, dizziness, lethargy, fatigue, hypotension; overdose: respiratory depression

257
Q

Lorazepam (Ativan) nursing considerations

A

fall precautions

258
Q

Nursing Care Plan Benzodiazepines

A

focused neuro and respiratory; VS
taper dose with long term use
fall precautions
don’t use heavy machinery
evaluate therapeutic response

259
Q

goal of antidepressants

A

more neurotransmitter in synaptic cleft

260
Q

general antidepressants indication

A

depression (4-6 week onset)

261
Q

general antidepressants black box warning

A

increased risk for suicidal ideation

261
Q

general antidepressants black box warning

A

increased risk for suicidal ideation

262
Q

general antidepressants contraindications

A

pregnancy/lactation, seizure disorders

263
Q

general antidepressants caution

A

older adult more susceptible to AE

264
Q

general antidepressants drug drug

A

more than 1 antidepressant increase risk for AE and serotonin syndrome; serotonergic drugs (fentanyl, St. John’s Wart)

265
Q

serotonin syndrome

A

initiation, increased dose or overdose; usually self limiting after discontinuing drug.

266
Q

main serotonin syndrom CM

A

agitations, HTN, sweating, clonus, hyper-reflexia, tremors

267
Q

first generation antidepressants

A

more significant AE, toxicity lethal, pregnancy category D/X
tricyclic and MAOIs

268
Q

second generation antidepressants

A

SSRI, SNRI
more tolerable AE but still bothersome
pregnancy category C

269
Q

antidepressant AE

A

orthostatic hypotension
GI effects n/v/d
drowsiness or insomnia
anticholinergic effects
weight loss or gain
sexual dysfunction
prolonged QTC

270
Q

amitriptyline class

A

tricyclic antidepressant

271
Q

amitriptyline MoA

A

reduce uptake of serotonin and NE into nerves- cholinergic, histaminergic, adrenergic, dopaminergic receptors. Blocks so many receptors causing multiple adverse effects

272
Q

amitriptyline use

A

refractory to other treatment

273
Q

amitriptyline caution

A

CV disease or seizures

274
Q

amitriptyline drug drug

275
Q

amitriptyline AE

A

sedation, anticholinerigc effects, overdose: cardiac arrhythmias and seizures

276
Q

amitriptyline nursing considerations

A

administer at HS

277
Q

Phenelzine class

278
Q

phenelzine MoA

A

irreversibly inhibits MAO allowing neurotransmitters to accumulate in synaptic cleft (including dopamine)

279
Q

phenelzine use

A

depression refractory to other treatment: parkinsons disease

280
Q

phenelzine caution

A

CV disease

281
Q

phenelzine drug drug

A

sympathomimetic, serotonergic drugs; many others

282
Q

phenelzine drug food

A

tyramine increased BP and risk for HTN crisis

283
Q

phenelzine AE

A

hypertensive crisis

284
Q

phenelzine nursing considerations

A

teach avoid tyramine containing foods, wait 2-6 weeks MAOI to SSRI

285
Q

high tyramine containing foods

A

aged cheese, smoked/pickled/cured meats, yeast extracts, red wines

286
Q

moderate/low tyramine containing foods

A

avocado, pasteurized light and pale beer, distilled spirits, non aged cheese, chocolate and caffeinated beverages, fruit

287
Q

citalopram (celexa) class

A

selective serotonin reuptake inhibitor

288
Q

citalopram (celexa) MoA

A

blocks reuptake of serotonin increasing levels in the synaptic cleft

289
Q

citalopram (celexa) use

A

first line treatment of depression; OCD, panic attacks, PTSD; off label: chronic pain neuropathies

290
Q

citalopram (celexa) drug-drug

A

highly protein bound (warfarin, phenytoin) risk of toxicity

291
Q

citalopram (celexa) AE

A

less CV, anticholinergic, drowsiness than others; sexual dysfunction, prolonged QTC

292
Q

citalopram (celexa) nursing considerations

A

slowly taper due to withdrawal syndrome

293
Q

duloxetine (cymbalta) class

A

selective norepinephrine reuptake inhibitor

294
Q

duloxetine (cymbalta) MoA

A

blocks reuptake of NE and serotonin

295
Q

duloxetine (cymbalta) use

A

depression, anxiety; off label; neuropathic pain, fibromyalgia

296
Q

duloxetine (cymbalta) drug drug

A

highly protein bound (warfarin, phenytoin) risk of toxicity

297
Q

duloxetine (cymbalta) AE

A

GI effects

298
Q

duloxetine (cymbalta) nursing considerations

A

see general

299
Q

antidepressants in children

A

longer term effects not clearly understood. some studies-efficacy poor, increased risk for SI

300
Q

antidepressants in pregnancy

A

caution, benefit vs. risk
neurological, cardiac, and respiratory effects on fetus/baby

301
Q

antidepressants in older adults

A

more susceptible to adverse effects- reduce dose

302
Q

MoA of Typical antipsychotic

A

dopamine receptor blockers, due to blocking of dopamine we see anticholinergic, antihistamine, and alpha adrenergic blocking effects

303
Q

MoA of Atypical antipsychotic

A

block both dopamine and serotonin receptors, alleviate some of unpleasant neurological effects and depression associated with typical antipsychotics.

304
Q

antipsychotics general AE

A

CNS: sedation, tremor
anticholinergic effects
CV effects: hypotension, arrhythmias, HF
Gynecomastia
laryngospasm/bronchospasm
EPS
neuroleptic malignant syndrome: fever, altered mental status, muscle rigidity, autonomic dysfunction

305
Q

EPS examples

A

dystonia: spasm of tongue, neck, back, and legs
akathisia: continuous restlessness, constant movement, foot tapping
pseudo-Parkinsonism: muscle tremors, drooling, shuffling gait
tardive dyskinesia: abnormal muscle movements; lip smacking, tongue darting, chewing movements

306
Q

antipsychotics caution and contraindications

A

CNS depression, Parkinson’s disease, cardiac disease, arrhythmias, bine marrow suppression, immunosuppressed, dementia, seizures, conditions exacerbated by anticholinergic effects

307
Q

antipsychotics drug drug

A

CNS depression and alcohol
anticholinergic
SSRI and SNRI
anti-dysrhythmic

308
Q

haloperidol (haldol) class

A

typical antipsychotics

309
Q

haloperidol (haldol) MoA

A

block dopamine receptors, preventing stimulation of post synaptic neurons

310
Q

haloperidol (haldol) uses

A

acute psychotic disorders

311
Q

haloperidol (haldol) AE

A

see general

312
Q

haloperidol (haldol) nursing considerations

A

see general; many other typical antipsychotics used for acute episodes and or maintenance

313
Q

clozapine (clozaril) class

A

atypical antipsychotics

314
Q

clozapine (clozaril) MoA

A

block dopamine and serotonin receptors, depresses the reticular activating system of brain

315
Q

clozapine (clozaril) AE

A

increase blood glucose, weight gain, decreased WBC

316
Q

clozapine (clozaril) nursing considerations

A

periodically monitor blood glucose; check WBC before starting therapy

317
Q

Lithium class

A

bipolar disorder agents

318
Q

lithium MoA

A

alters Na transport in nerve and muscle cells; inhibits release of NE and dopamine from neurons

319
Q

lithium contraindications/cautions

A

renal disease, cardiac disease, sodium depletion/altered sodium levels, pregnancy (X), lactation

320
Q

lithium drug drug

A

many; diuretics, haloperidol

321
Q

lithium AE

A

Gi effects n/v/d
lethargy, slurred speech, weakness, tremor, ataxia, clonic movements, hyper-reflexia, seizures
mild polyuria, nephrogenic diabetes insipidus
life-threatening arrhythmias

322
Q

acetylcholine

A

enables muscle action, learning and memory

323
Q

dopamine

A

influences movement, learning, attention and emotion

324
Q

serotonin

A

affects mood, hunger, sleep, arousal

325
Q

norepinephrine

A

helps control alertness and arousal

326
Q

gamma- aminobutyric acid (GABA)

A

major inhibitory NT

327
Q

glucamate

A

major excitatory NT; involved in memory

328
Q

generalized seizure

A

simultaneous disruption of electrical activity/onset in bilateral hemispheres. tonic clonic seizure is most common major motor seizure.

329
Q

focal seizure

A

begin with a specific area of the cerebral hemisphere. with impaired consciousness, or without impairment of consciousness

330
Q

epilepsy

A

chronic disorder of recurrent seizures

331
Q

status epilepticus

A

multiple seizures occur with no recovery between them- hypotension, hypoxia, brain damage, and dead; Emergency- diazepam

332
Q

general anti seizure medication MoA

A

alter movement of sodium, potassium, calcium, and magnesium ions; changes in movement of ions result in more stabilized and less excitable cell membranes

333
Q

general anti seizure medication AE

A

Gi upset, CNS depression, confusion, ataxia

334
Q

general anti seizure medication toxicity

A

hepatotoxicity

335
Q

general anti seizure medication drug drug

A

CNS depressant, alcohol, many other (highly protein bound)

336
Q

general anti seizure medication cautions

A

risk of birth defects; pregnancy category C/D/X
do not abruptly withdrawal
monitor for levels of toxicity
black box of SI

337
Q

Diazepam (valium) MoA

A

potentiates effects of GABA

338
Q

Diazepam (valium) use

A

staus epilepticus

339
Q

Diazepam (valium) route

A

IVP 2mg/min; onset 1-5 min; peak 30 min; duration 60 min

340
Q

Diazepam (valium) AE

A

resp. depression, bradycardia, hypotension

341
Q

Diazepam (valium) nursing considerations

A

monitor cessation of seizure, VS

342
Q

Diazepam (valium) class

A

benzodiazepines

343
Q

phenytoin (Dialantin) class

A

hydantoins

344
Q

phenytoin (Dialantin) MoA

A

stabilize nerve membranes throughout CNS-less excitability

345
Q

phenytoin (Dialantin) AE

A

see general & gingival hyperplasia

346
Q

phenytoin (Dialantin) drug drug

A

many-highly protein bound, hepatic enzyme inducer, warfarin bleeding

347
Q

phenytoin (Dialantin) nursing considerations

A

therapeutic blood level 10-20 mcg/mL; teach good oral hygiene

348
Q

phenytoin (Dialantin) IV administration

A

IV push in a large vein and large catheter do not exceed 50 ml/min
infuse with dilution of NS
follow with a NS flush to decreases vein irritation
monitor site for inflammation and extravasation
monitor cardiac rhythm and blood pressure

349
Q

phenobarbital (luminal) class

A

barbituates

350
Q

phenobarbital (luminal) MoA

A

enhances action of GABA NT

351
Q

phenobarbital (luminal) AE

A

see general; they resolve over time

352
Q

phenobarbital (luminal) toxicity

A

respiratory depression, coma, IV route (be cautious)

353
Q

phenobarbital (luminal) nursing considerations

A

therapeutic blood level: 10-40 mcg/L; admin once daily dosing at HS due to sedating effects

354
Q

valproic acid MoA

A

increase levels of GABA in brain

355
Q

valproic acid AE

A

see general; weight gain; increase bleeding time.
toxicity: pancreatitis

356
Q

valproic acid drug drug

A

many-highly protein bound; warfarin- bleeding

357
Q

valproic acid nursing considerations

A

do not crush or chew ER

358
Q

nursing care plan: interventions for seizure medications

A

reduce risk for falls, seizure precaution, counsel women of childbearing age, lab monitoring for TE levels

359
Q

anti seizure medications- child

A

more sensitive to sedating effects, monitor closely. children 2 months-6 years absorb and metabolize quickly; may require larger dose per kg to maintain TE

360
Q

anti seizure medications- adult

A

medic alert identification
consider lifestyle changes (work, transportation, etc)

361
Q

anti seizure medications- older adult

A

more susceptible to AE anf toxicity
dose adjustment for reduced liver/kidney function

362
Q

levodopa/carbidopa (sinemet) class

A

dopaminergic agent

363
Q

levodopa/carbidopa (sinemet) MoA

A

restores dopamine concentration in brain

364
Q

levodopa/carbidopa (sinemet) indication

A

parkinson’s disease

365
Q

levodopa/carbidopa (sinemet) drug drug

A

antihypertensives, CNS depression

366
Q

levodopa/carbidopa (sinemet) caution

A

CV disease, asthma, urinary obstruction, PUD

367
Q

levodopa/carbidopa (sinemet) AE

A

orthostatic hypotension, dry mouth, constipation, urinary retention, confusion, agitation, insomnia

368
Q

levodopa/carbidopa (sinemet) nursing considerations

A

abrupt cessation may cause Parkinsonism crisis; take as prescribed and do not double dose

369
Q

donepezil (aricept) class

A

cholinesterase inhibitor (cholinergic agonist)

370
Q

donepezil (aricept) MoA

A

enhances the effects of acetylcholine in neurons in cerebral cortex that have not been damaged

371
Q

donepezil (aricept) indication

A

alzheimers disease

372
Q

donepezil (aricept) AE

A

n/v/d, insomnia or drowsiness, bradycardia/AV block

373
Q

donepezil (aricept) nursing considerations

A

assess BP/HR; monitor mental status; give at bed time unless insomnia occurs. Teach- not to increase or decrease dose abruptly. Risk of cholinergic crisis

374
Q

anesthetics

A

drug that reduce or eliminate pain by depressing nerve function in the central and or peripheral nervous system

375
Q

general anesthesia

A

involves complete loss of consciousness and loss of body reflexes, including respiratory muscles (ventilatory support to avoid brain damage)

376
Q

moderate sedation

A

allows patient to relax and tolerate procedure but maintains respiratory function and response to stimuli
RN may be trained
must have ACLS training

377
Q

nursing role- moderate sedation

A

ensure life support equipment is readily available, patent IV, supplied for IV push meds, monitor LOC and pain, VS, alert provider of major changes, and LOC and VS after procedure

378
Q

midazolam (versed) class

A

benzodiazepines (anesthetic)

379
Q

midazolam (versed) indications

A

moderate sedation for diagnostic procedures, induction of anesthesia, sedation of intubated patients, decreased anxiety prior to procedure

380
Q

midazolam (versed) onset/peak/duration IV

A

1-5 min, less than 30 min, 2-6 hours

381
Q

midazolam (versed) drug drug

A

CNS depressants, opioids

382
Q

midazolam (versed) AE

A

respiratory depression, CNS depression, disorientation, amnesia, restlessness, bradycardia, hypotension

383
Q

midazolam (versed) nursing

A

assume patient will remember things said/done during sedation/anesthesia

384
Q

nursing role- medically induced coma

A

trained intensive care RN, assist with intubation, prepare for IV push drugs, keep patient comfortable/ tolerate of ET tube, taper drugs prior to extubating (removing ET tube)

benzo/sedative then paralytic

385
Q

rocuronium class

A

neuromuscular blocking drugs

386
Q

rocuronium MoA

A

bind to ACh receptors at NTM junction, blocking action of ACh, induced paralysis of skeletal muscle (peripheral to central)

387
Q

rocuronium indications

A

endotracheal intubation; surgery

388
Q

rocuronium onset, peak , duration IV

A

1-2 min, 4 min, 30 min

389
Q

rocuronium AE

A

muscle damage, hyperkalemia, cardiovascular collapse (higher dose and prolonged administration

390
Q

rocuronium nursing considerations

A

administer prescribed sedation prior to neuromuscular blocking agent

Pharmacology (6 decks)

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