Final Exam Flashcards
Inflammation
a vascular reaction in which fluids, WBC, chemical mediators accumulate at injured tissue or infection site (increases permeability)
two phases of inflammation
vascular phase
delayed phase
vascular phase
occurs 10-15 mins post injury
Vasodilation, ↑capillary permeability, blood substance move from plasma to injury
delayed phase
leukocytes infiltrate the tissue
chemical mediators released during inflammation
prostaglandins (vasodilate, relax smooth muscle, increase permeability and pain)
Cyclooxygenase (COX-1 and 2, needed for synthesis of prostaglandins)
COX-1
protects stomach lining and regulates PLTs
COX-2
triggers inflammation and pain
BLACK BOX WARNING FOR CARDIOVASCULAR DISEASE OR HISTORY OF CVA
SE of COX-1 and 2
ulcers, gastritis, stomach irritation
1st gen salicylates
ASA and diflunisal (dolobid)
salicylate derivatives
Dipentum, sulfasalazine
Para Chlorobenzoic Acids (Indoles)
NSAIDS
Indomethacin(Indocin), Clinoril, Tolectin
Phenylacetic Acid
NSAIDS
Phenylacetic Acid
NSAIDS
Voltaren, Voltaren XR, Toradol
propionic acid
NSAIDS
propionic acid
NSAIDS
Nalfon, Ansaid, Motrin, Advil, Naprosyn, Daypro
Anthranilic acids (Fenemates)
NSAIDS
Anthranilic acids (Fenemates)
NSAIDS
Meclomen, ponstel
oxicams
NSAIDS
feldene, mobic
naphthyl alkanes
relafen
COX-2 example
celebrex
salicylates prototype (aspirin, bayer, ecotrin, astrin) contra
flu or virus symptoms in children
3rd trimester in pregnancy
salicylates prototype (aspirin, bayer, ecotrin, astrin) caution
renal failure
salicylates prototype (aspirin, bayer, ecotrin, astrin) dose important fact
per rectum: double dose
salicylates prototype (aspirin, bayer, ecotrin, astrin) use
reduce pain and inflammation, body temp, inhibit platelet aggregation
salicylates prototype (aspirin, bayer, ecotrin, astrin) SE
Anorexia (check H&H), N/V/D, dizziness, confusion, hearing loss, heartburn, rash, stomach pains, drowsiness
salicylates prototype (aspirin, bayer, ecotrin, astrin) AR and LT
Adverse reactions: Tinnitus, urticarial (rash), ulceration
Life threatening: agranulocytosis, hemolytic anemia, bronchospasm, anaphylaxis, thrombocytopenia, hepatotoxicity, leukopenia
salicylates prototype (aspirin, bayer, ecotrin, astrin) nursing considerations
don’t take with ETOH or 5-7 days before surgery esp if CNS
not for children or flu-like symptoms
take with food
report SE
advil dose
200-800 mg tid/qid, max 3200mg
advil contra
severe renal or hepatic disease
asthma
peptic ulcer
NOT PRN FOR PAIN OR INFLAMMATION
DON’T TAKE ALEVE WITH ASPIRIN ALLERGY
advil drug side effects
anorexia, N/V/D, rash, purpura, tinnitus, fatigue, dizziness, lightheadedness, anxiety, confusion, fluid retention with edema
advil AR and LT
Adverse reaction: GI bleeding
Life-threatening: blood dyscrasias, cardiac dysrhythmias, nephrotoxicity, anaphylaxis
nursing considerations of advil
Observe for signs of bleeding especially with anticoag use
Take with food to reduce GI discomfort
Avoid concomitant use with ASA and acetaminophen (an hour apart is fine)
Avoid ETOH to reduce ulcer risk
Inform dentist or surgeon of use prior or procedures
Do not take if pregnant or breastfeeding
celebrex preg warning
not for 3rd trimester
celebrex indications
to treat osteoarthritis, Rheumatoid arthritis, relieve dysmenorrhea
celebrex and COX
inhibits COX-2 (inflammation), not COX-1 (good for stomach issue pts)
dose for celebrex
100-200mg daily
contra of celebrex
hypersensitivity, advanced renal disease, severe hepatic disease, anemia, concurrent use of diuretics, and ACE inhibitors
caution of celebrex
renal or hepatic dysfunction, HTN, fluid retention, HF, infection, H/O GI bleeding or ulcer, concurrent AC/steroid or ETOH
SE and AR of celebrex
Side effects: HA, dizziness, sinusitis, Nausea, flatulence, diarrhea, rash
Adverse Reactions: peripheral edema
para-chlorobenzoid acid
anti-inflammatory
Class may increase BP, sodium and water retention
Example Indomethacin (Indocin)
Indications: treat RA, Gouty arthritis, OA
Highly protein bound can result in toxicity
Irritating to stomach take with food
Other examples with less side effects
Sulindac (clinoril), tolmetin (Tolection)
Phenylacetic acid derivatives
antiinflammatory
Example : diclofenac sodium (Voltaren)
Indications: decrease inflammation RA, OA, ankylosing spondylitis
POTENTIALLY safe for cardiac pts bc maybe less systemic effects
Has codeine, not for abuse pts
Ketorolac Acid (Toradol), IM/IV/PO
Inhibits prostaglandin synthesis, greater anti-inflammatory effects
Indicated for post-surgical pain
oxicams
antiinflammatory and corticosteroid
Example Piroxicam (Feldene)
Indications: Long-term arthritic conditions such as RA, OA
Lower incidence of GI distress than other NSAIDs
Full clinical response may take 1-2 weeks
Worried abt hyperglycemia, immunosuppression, and ulcers
immunomodulator
tumor necrosis factor blocker
immunomodulator
tumor necrosis factor blocker
FOR AUTOIMMUNE DISORDERS
Prototype: infliximab (Remicade)
Infliximab (Remicade)
immunomodulator
for RA and crohn’s
SE of infliximab (Remicade)
HA, dizziness, coughing, fatigue, hot flashes, anxiety, insomnia, D/V/C, rash, alopecia, urinary frequency
AR, contra, and caution of infliximab (Remicade)
Adverse reaction: severe infections!!, chest pain, hypotension, HTN, ↑ LFT’s
Contraindications: hypersensitivity, heart failure
Caution: renal or hepatic dysfunction, immunosuppression, MS, elderly
nocioreceptors
sensory receptors activated by noxious stimuli in the peripheral tissues (mechanical, thermal, chemical)
somatic
structural pain from tissue injuries
neuropathic pain
sensory disturbance involving neural hypersensitivity
cortisone
decreases phospholipase (reduces production of prostaglandins and leukotrienes)
tylenol and alcohol and pregnancy
don’t take if you’ve had 3 drinks
avoid in pregnancy if you can
SE off tylenol
anorexia, N/V, rash
AR and LT of tylenol
Adverse reaction: severe hypoglycemia, oliguria, urticaria
Life-threatening: hemorrhage, hepatotoxicity (can occur in 1-4 days), hemolytic anemia, leukopenia, thrombocytopenia
drug interactions of tylenol
increased effect with caffeine, diflunisal
decreased effect with contraceptives, anticholinergics, cholestyramine, charcoal (absorbent)
how long to take tylenol and antidote
10 days in adults, 5 in children
antidote: acetylcysteine
roxanol
controlled substance, needs a DEA number
roxanol indications
for severe pain (opioid)
roxanol SE
anorexia, N/V/C drowsiness, dizziness, sedation, confusion, urinary retention, constipation, bradycardia, flushing, euphoria
roxanol AR and LT
Adverse reactions: hypotension, urticaria (rash), seizures
Life threatening: respiratory depression, increased intracranial pressure
caution in roxanol
respiratory renal or hepatic disease, myocardial infarction (used bc it decreased preload, but make sure they don’t have cardiovascular collapse), older adults and young children
Crosses the placenta and excreted in breast milk
meperidine (demerol)
opioid
pain relief, beneficial for GI procedures
less constipation and urinary retention
not for liver pts
monitor for hypotension
don’t use >48-72h
dilaudid
synthetic opioid
more potent than morphine
less hypnotic effects and GI distress
dilaudid
synthetic opioid
more potent than morphine
less hypnotic effects and GI distress
faster onset and duration
tolerance! Don’t take >72h
dilaudid dosage
2mg or less
nalbuphine (nubain) indications
opioid
not for late trimesters
to relieve mod-sev pain
SE of nalbuphine (nubain)
dizziness, confusion, hallucinations, blurred vision, HA, flushing, sedation, nervousness, bitter, hypotension, dyspnea
AR and LT of nalbuphine (nubain)
Adverse reactions: bradycardia, tachycardia (when pts have hypotension), respiratory depression
Life-threatening: respiratory depression
caution of nalbuphine (nubain)
h/o drug abuse, emotional instability, impaired respirations, ↑ ICP, biliary tract surgery, renal or hepatic dysfunction
CNS depression w ETOH
what to keep nearby with fentanyl
saline bc hypotension
also itching is normal
transdermal fentanyl
change patch every 24h
migraine
unilateral throbbing head pain with N/V and photophobia, lasting 2-24 hours
Caused by inflammation of blood vessels in cranium
Thought to be a serotonin imbalance
2/3 women 20-30, decrease during pregnancy and menopause (hormonally related)
Triggers: red wine, cheese and chocolate
cluster headache
Severe unilateral non-throbbing pain usually around eye
Occur in clusters of severe attack one or more attacks for several days over several weeks
Occurs in men more commonly than women
Related to stress
preventative meds for migraines
Beta-adrenergic blockers (inderal, tenormin)
Anticonvulsants (valproic acid), neurontin
TCA (elavil, tofranil)
treatment or cessation of migraines
Analgesics, opioid analgesics, ergot alkaloids, SSRA (triptans)
5-HT 1 receptor agonist: sumatripan (imitrex) indication
to TREAT (not prevent) cluster headaches and migraines
take med when they feel the aura
sumatriptan (imitrex) SE
dizziness, fainting, tingling, numbness, drowsiness, muscle cramps, N/V/D, abdominal cramps
sumatriptan (imitrex) AR and LT
Adverse effects: hypotension, HTN (more common than hypotension), heart block, angina, dysrhythmias, thromboembolism (from vasoconstriction), seizures
Life threatening: coronary artery vasospasm, MI, cardiac arrest
sumatriptan (imitrex) contra and caution
Contraindicated: hypersensitivity, CAD, HTN, obesity, DM, smoking, CVA
Caution: liver or renal dysfunction
symptoms of psychosis
Difficulty processing information/conclusion
Delusions
Hallucinations
Incoherence
Catatonia (no facial expression)
Aggressive behavior
positive symptoms of schizo
(exaggeration of normal function)
Incoherent speech
Hallucinations
Delusions
Paranoia
negative symptoms of schizo
(decrease/loss of function or motivation)
Loss of speech
Poor self-care
Social withdrawal
phenothiazines/nonphenothiazine
Blocks norepinephrine causing sedative hypotensive effects when started
Ex: chlorpromazine HCL (thorazine)
Fluphenazine HCL (prolixin)
Trilafon, mellaril
atypical antipsychotics
Ex. Clozapine
1st line treatment for schizophrenia due to decreased SE
Good for use in other psychotic disorders that don’t respond to typical antipsychotics
Ex: clozaril, zyprexa, risperdal, abilify, seroquel
dopaminergic antagonists
D1-5
extrapyramidal syndrome
pseudoparkinsonism
MARCHING MOVEMENT
adverse effects of antipsychotics
Acute dystonia: muscle spasms of face, tongue, back and neck, facial grimacing, abnormal upward eye movement, laryngeal spasms that can impair respiration
Akathisia: difficulty standing still, restless, paces floor
Tardive dyskinesia: protrusion and rolling of tongue, sucking and smacking movements of lips, chewing motion, involuntary movement
Neuroleptic malignant syndrome: rare, potentially fatal condition associated with antipsychotic drugs
typical antipsychotic ending
-azine
fluphenazine (prolixin)
typical antipsychotic
fluphenazine (prolixin)
typical antipsychotic
to manage psychosis/schizo
contra of fluphenazine (prolixin)
subcortical brain damage, blood dyscrasia, renal/liver damage, coma
SE of fluphenazine (prolixin)
sedation, dizziness, HA, dry mouth, nasal congestion, blurred vision, photosensitivity, N/C, urinary retention
AR and LT of fluphenazine (prolixin)
Adverse reactions: HTN, hypotension, tachycardia, extrapyramidal symptoms (tardive dyskinesia), impaired thermoregulation, convulsions
Life threatening: agranulocytosis
kava kava with fluphenazine (prolixin)
may increase dystonia
haldol
typical antipsychotic
to treat acute and chronic psychoses, children with severe behavior problems who are combative, suppress narcotic withdrawal symptoms, schizophrenia resistant to other drugs, tourette syndrome, symptoms of dementia in older adults
SE of haldol
sedation, extrapyramidal symptoms, orthostatic hypotension, HA, photosensitivity, dry mouth and eyes, blurred vision (anticholinergic side effects)
AR and LT of haldol
Adverse reactions: tachycardia, seizures, urinary retention
Life threatening: laryngospasm, resp depression (especially in the elderly), cardiac dysrhythmias, neuromalignant syndrome, agranulocytosis
risperidone (risperdal)
atypical antipsychotic
to manage psychosis/schizo
for elderly pts with dementia
risperidone (risperdal) SE
sedation (a lot, goes away in about a week or so), weight gain, HA, fatigue, photosensitivity, blurred vision, sexual dysfunction, alopecia, amenorrea, agitation
AR and LT of risperidone (risperdal)
Adverse reactions: orthostatic hypotension, HTN, bradycardia, tachycardia, EPS, convulsions
Life threatening: suicidal ideation, neuroleptic malignant syndrome
contraindications and drug effects of risperidone (risperdal)
Contraindicated: hypersensitivity, dehydration, ETOH, intoxication, suicidal ideation
Drug interactions: increased effects of hypertensives
abilify
for psychosis
abilify drug interactions
antidiabetic agents; can cause hypoglycemia
Hypotension with antihypertensives, other antipsychotics increases risk of NMS and EPS syndrome
Anticholinergic effects, CNS depressants
Grapefruit juice may increase blood levels
St. john’s wort may decrease blood levels
nursing considerations of abilify
Monitor for orthostatic hypotension
Make sure pt has swallowed pill
Observe for EPS
May take 6 weeks or longer for full clinical effect
Do not d/c abruptly
Avoid CNS depressants, ETOH
May be excreted in breast milk
Wear med-alert bracelet
Tolerance to sedative effect develops over a few weeks
benzos
for anxiety
Ex: alprazolam (xanax), clorazepate HCL (librium), diazepam (valium)
Ativan
Azapirones
Ex: buspar
lorazepam (ativan)
STRONG
to control anxiety, status epilepticus, preop sedation
contra and caution of ativan
Contraindications: hypersensitivity, CNS depression, shock, coma, narrow-angle glaucoma, pregnancy, lactation
Caution: hepatic or renal dysfunction, suicidal (used to off themselves)
drug interactions of ativan
Cimetidine increases lorazepam plasma levels, increases dilantin levels, smoking decrease anti anxiety effects
Kava: may potentiate sedation
reversal agent for ativan
flumazenil (mazicon)
ending for benzos
-am
buspirone HCL (buspar)
less sedating
1-2 weeks to be effective
grapefruit juice only 8oz
nursing considerations of ativan
2-4 months max to avoid dependence
lower doses in children and elderly
orthostatic hypotension
no driving or ETOH
do not abruptly d/c
reactive depression
Sudden onset after an event (death of a loved one)
Client knows why depressed
Lasts for months
Treatment: benzodiazepine
major depression
Primary
Not r/t health problem
Secondary
R/t health problem (drugs/psychiatric)
Loss of interest in work
Inability to complete tasks
Deep depression (dysphoria)
bipolar affective depression
Manic depressive
Swings between moods
Euphoria/dysphoria
Treatment of choice: depakote
herbal supplement for depression
st. john’s wort and gingko biloba
d/c 1-2 weeks before surgery bc increased bleeding
tricyclic antidepressants examples
Amitriptyline (elavil), clomipramine (anafranil), imipramine (tofranil)
-INE
d/c gradually
SSRIs for depression examples
Citalopram (celexa), fluoxetine (prozac), fluvoxamine (luvox), paxil, zoloft
atypical antidepressants examples
Amoxapine (asendin), bupropion (wellbutrin), venlafaxine (effexor), MAOIs
amitriptyline HCL
for depression, BPD, alcoholism, migraines, anxiety, and urinary incontinence
amitriptyline HCL SE
sedation, drowsiness, nervousness, blurred vision, metallic taste, dry mouth and eyes, urinary retention, constipation, weight gain, N/A increased intraocular pressure
amitriptyline HCL AR and LT
Adverse reactions: orthostatic hypotension, cardiac dysrhythmias, extrapyramidal symptoms
Life-threatening: agranulocytosis, thrombocytopenia, leukopenia, seizures
Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias
amitriptyline HCL AR and LT
Adverse reactions: orthostatic hypotension, cardiac dysrhythmias, extrapyramidal symptoms
Life-threatening: agranulocytosis, thrombocytopenia, leukopenia, seizures
Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias
amitriptyline HCL contra and caution
Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias
Caution: severe depression with suicidal tendency (when we make them feel better, they feel more willing to kill themselves so be careful!!), cardiovascular, liver or kidney dysfunction, narrow angle glaucoma, seizures, prostatic hypertrophy, DM, hyperthyroidism
drug interactions with amitriptyline HCL
increased CNS respiratory depression, hypotension with ETOH
Increased sedation and anticholinergic effects with phenothiazines and haldol
HTN crisis and death may occur with MAOIs, NEVER take together
TCAs
for agitated depressed ppl
Amitriptyline (elavil), doxepin (sinequan), trimipramine (surmontil) have highly sedative effects
prozac use
SSRI for depression
for calm pts, NOT agitated
prozac SE
headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, sexual dysfunction
AR of prozac
seizures, hyponatremia, palpitations, chest pain
SSRI ending
oxetine
SSRI 3 major SE
confusion
slurred speech
altered LOC
contra, caution, and drug interactions of prozac
Contraindications: AMI, taking MAOIs
Caution: severe depression with suicidal tendency, severe liver or kidney disease
Drug interactions: increased effect of CNS, respiratory depression, hypotension with ETOH
effexor and MAOIs
DON’T TAKE TG
14 days after you d/c MAOIs
SE and AR of effexor
Side effects: drowsiness, dizziness, nervousness, insomnia, HA, N/V/D, weight loss
Adverse effects: bradycardia, tachycardia, hyponatremia, seizures
MAOIs use
to relieve symptoms of depression
examples of MAOIs
isocarboxazid (marplan), phenelzine sulfate (nardil), tranylcypromine sulfate (parnate), selegiline HCL (eldepryl)
SE of MAOIs
agitation, restlessness, insomnia, and orthostatic hypotension
adverse effects of MAOIs
HTN crisis from food and drug interactions
drug interactions of MAOIs
DO NOT TAKE W TCAS
NOT MIXED WITH SYMPATHOMIMETICS OR CNS STIMULANTS
decreased effectiveness of anticonvulsants
foods to avoid with MAOIs
Cheese
Bananas, raisins
Pickled foods
Red wine, beer
Cream, yogurt
Chocolate, coffee
Italian green beans
Liver
Yeast
Soy sauce
mood stabilizers
used for BPD
for this and manic depression, it makes them tired so compliance is low
lithium use as a mood stabilizer
Calming effect without impairing intellectual activity
Controls evidence of flight of ideas and hyperactivity
Manic behavior often returns when a person stops taking lithium
lithium and fluid intake
Increase water intake to 2-3L per day in the first week then 1L per day
drug range of lithium
0.5-1.5
SE of lithium
HA, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, D/V, polyuria, hypotension, abdominal pain, muscle weakness, restlessness
adverse reactions of lithium
urinary incontinence, hyponatremia, clonic movements, stupor, azotemia, leukocytosis, nephrotoxicity
LT reactions of lithium
dysrhythmia and circulatory collapse
contra and caution of lithium
Contraindications: liver and renal disease, pregnancy, lactation, severe cardiac disease, severe dehydration, brain tumor or brain damage, sodium depletion, children <12
caution: thyroid disease
drug interactions of lithium
increased sodium levels with thiazide diuretics, methyldopa, haldol, NSAIDs, antidepressants, carbamazepine
Lithium may cause sodium depletion
nursing considerations of lithium
When drawing blood levels check immediately before next dose (8-12 hours after last dose)
Monitor and maintain weight and urine output
Maintain adequate fluid intake (2-3L/day initially, then 1-2L maintenance)
Take with meals to decrease GI distress
