FINAL EXAM Flashcards
Epinephrine responses include
CNS stimulation
increase in BP, pupil dilation, increase in HR, bronchodilation
When is epinephrine used?
Used in anaphylactic shock to increase BP, HR, and airflow through lungs
Atenolol is a cardioselective beta1 blocker that decreases sympathetic outflow to periphery and suppresses RAAS response (which will DECREASE BP).
It is used to treat
HTN (lowers BP), angina, and treatment of acute MI
Side effects of Atenolol
bradycardia, hypotension, headache, dizziness, bronchospasm
Before administering Atenolol, you should always check the pt’s HR & BP. If HR is below 50 you should
hold meds and notify provider
Side effects and adverse reactions of Bethanechol Chloride
hypotension, increased gastric acid secretion, abdominal cramps, diarrhea, bronchospasm
Bethanechol Chloride is a direct acting cholinergic agonist.
Bethanechol Chloride is the treatment for? Causes?
Urinary Retention & Neurogenic Bladder
Acts on detrusor muscle to contract bladder → Increases urination
Atropine is a cholinergic antagonist. It is used as a __________ med to reduce resp. & salivary secretions.
pre-op
Side effects and adverse reactions of atropine
Pixorize: think of the man deserted on the tropical island
xerostomia (dry mouth), nasal dryness, blurred vision, tachycardia, constipation, urinary retention
Do not give to pts w/ glaucoma
Antiseizure drugs act in three ways:
Increase action of GABA (GABA will calm the brain down), suppress sodium influx, or suppress calcium influx
Phenytoin is an antiseizure med that inhibits sodium influx.
Side effects & adverse effects of Phenytoin
Pixorize- think of the phone tower & kids
S/E: chest pain, diaphoresis, N/V, constipation, drowsiness, depression, & suicidal ideation
A/E: gingival hyperplasia, Stevens-Johnson syndrome, cardiac dysrhythmias
What is the therapeutic serum level for Phenytoin?
10-20 mcg/mL
Signs of phenytoin toxicity: ataxia, slurred speech, & nystagmus
Valproate is an antiseizure medication that decreases calcium influx.
Side effects of Valproate
Pixorize: think of valet at masquerade party
hepatotoxicity, N/V, diarrhea, tremors, headache, weight gain, &stomatitis
Do not give to children under the age of 2. This med is also teratogenic.
Rivastigmine is used to treat
Pixorize: think of alchemist selling donuts & cola on the river
mild to moderate Alzheimer’s Disease
Goal: slow disease process, decrease S/Sx, & improve cognitive function/ADL’s
Action of Rivastigmine
Rivastigmine is an acetylcholinesterase inhibitors. Acetylcholinesterase is an enzyme that digests ACh. This drug will block the enzyme from digesting ACh which leads to an
increase of ACh at synapses to improve memory
Additional info not on blueprint:
S/E: GI Sx, dizziness, orthostatic hypotension, HA, nystagmus
(repetitive eye movements), dehydration
A/R: hepatotoxicity, bradycardia, dysrhythmias, heart failure,
seizures, suicidal ideation
Carbidopa-levodopa is used to treat Parkinson’s disease.
Levodopa is converted to dopamine in the brain. Carbidopa helps Levodopa cross the blood brain barrier.
Side effects of Carbidopa-levodopa
Pixorize: think of park ranger cleaning up leaves at night; sees ghost.
orthostatic hypotension, dystonia, dyskinesia, psychosis, depression, sleep disturbances
Carbidopa-levodopa patient teaching
- Take as prescribed & don’t crush extended-release tablets
- Do not take w/ high protein foods, Vit B6, or alcohol
- Don’t stop abruptly
- May cause urine & sweat to turn brown
- Assess Sx status & “on-off” phenomenon (drug holiday)
Benztropine is an anticholinergic that blocks the release of ACh.
It is used to treat Parkinson’s disease.
Side effects of Benztropine
dry mouth, constipation, urinary retention, N/V, restlessness/anxiety, tachycardia, blurred vision, confusion
Contraindicated in pts w/ glaucoma.
Rare, potentially fatal condition re: to Conventional (typical) antipsychotics
Symptoms:
Altered mental status, seizures
Muscle rigidity, sudden high fever, profuse sweating
BP fluctuations, tachycardia, dysrhythmias
Rhabdomyolysis, acute renal failure
Respiratory failure, coma
NEUROLEPTIC MALIGNANT SYNDROME (NMS)
CONVENTIONAL (TYPICAL) ANTIPSYCHOTIC AGENTS
1st generation; Phenothiazine-like
This medication alters effects of dopamine on CNS (downer)
Treat acute psychoses, ADHD, schizophrenia, Tourette syndrome
haloperidol (Haldol)
Side effects and adverse effects of conventional antipsychotics like haloperidol
Side effects: anticholinergic effects (can’t see, pee, shit, spit), sexual dysfunction
Adverse effects: hyper/hypotension, EPS, NMS, agranulocytosis, thrombocytopenia
How is NMS treated?
Medical emergency
Immediate withdrawal of antipsychotics,
hydration, hypothermic blankets, antipyretics, icepacks
benzodiazepines, muscle relaxants
ATYPICAL ANTIPSYCHOTICS (AKA SECOND-GENERATION ANTIPSYCHOTICS (SGAS))
Aripiprazole (Abilify) interferes with binding of dopamine to dopamine and serotonin receptors.
Used to manage schizophrenia, bipolar disorder, autism, depression, Tourette syndrome. Effective in treating both positive and negative symptoms of schizophrenia.
Side effects and adverse effects of aripiprazole
Side effects: fewer than those of phenothiazines and nonphenothiazines, but similar anticholinergic side effects; weight loss/ gain
Adverse effects: Although less likely, can cause EPS, DM, sexual dysfunction, tachy/bradycardia, dysrhythmias, dyslipidemia, suicidal ideation, NMS, agranulocytosis, neutropenia
Lorazepam (Ativan) is an anxiolytic that potentiates GABA effects by binding to specific benzodiazepine receptors and inhibiting GABA neurotransmission
Used to control anxiety, treat status epilepticus, sedation induction, insomnia
Side effects & adverse effects of lorazepam
Side effects: Drowsiness, dizziness, headache, confusion, euphoria, blurred vision, constipation, restlessness, sexual dysfunction
Adverse effects: hyper/hypotension, brady/tachycardia, tolerance, dependence, seizure, suicidal ideation, NMS, agranulocytosis, thrombocytopenia, pancytopenia, respiratory depression
Lorazepam interactions/pt teaching
Increases CNS depression with alcohol, other CNS depressants, cimetidine increases lorazepam serum levels
Smoking and caffeine decreases antianxiety effects
Oral contraceptives decrease effects
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Ex: amitriptyline and imipramine
Block reuptake of neurotransmitters norepinephrine and serotonin in brain; Block histamine receptors. Treats major depression, elevates mood, increases interest in ADL’s, decreased insomnia.
Increased CNS depression w/
alcohol , sedatives, hypnotics, and barbituates
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Ex: fluoxetine (Prozac)
Block reuptake of serotonin, enhancing its presence & transmission at the synapse
Treats major depressive disorder & anxiety disorders (OCD, panic disorder, PTSD, & phobias)
Side effects/Adverse effects of fluoxetine & other SSRIs
- Headache, nervousness, restlessness
- Insomnia, tremors, seizures
- GI distress
- Sexual dysfunction
- Suicidal ideation (watch in early stages)
- Serotonin Syndrome
Side effects/Adverse effects of SNRIs
(SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS)
Side effects: drowsiness, dizziness, insomnia, headache, euphoria, amnesia, blurred vision, photosensitivity, and ejaculation dysfunction
Adverse effects: orthostatic hypotension, hypertension, angioedema, blood dyscrasias, suicidal ideation, and Stevens Johnson syndrome
Serotonin syndrome sx
Within hrs of starting a new drug or increasing dose
STOP THE DRUGS
hypertensive, hyperreflexia, clonus, fever, mydriasis, tachycardia, diaphoresis, agitation, tremors
MONOAMINE OXIDASE INHIBITORS (MAO-Is) decrease effectiveness of monoamine oxidase (an enzyme that inactivates norepinephrine, dopamine, epinephrine, and serotonin); levels of those neurotransmitters will increase.
Not 1st line of treatment for depression
Risk of hypertensive crisis when taking MAO-Is due to interactions with
-foods w/ tyramine
-vasoconstrictors and cold medications
General patient teaching for antidepressants
- Take exactly as prescribed; do not double-dose
- Medical follow-up
- Report suicidal thinking
- May take up to 8 weeks for symptoms to improve
- Take even when symptom-free
- Do not use SSRIs, TCAs, and other antidepressants for at least 14 days after discontinuing MAOI drugs
because of the risk of serotonin syndrome. - Avoid alcohol
- Patients taking TCAs should not smoke because it may decrease the effectiveness of these drugs
- May cause dizziness
- Do not discontinue suddenly
Lithium is a mood stabilizer. Alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin
Used to treat bipolar disorder, manic episodes
Lithium has a very narrow therapeutic index. It is considered a high-risk drug. What are the therapeutic and toxic ranges of lithium
- Therapeutic serum range: 0.5 to 1.2 mEq/L (may see 1.5 in acute mania)
- Serum lithium levels greater than 1.5 to 2 mEq/L are toxic.
Patient teaching for lithium
-avoid activities that can cause sodium loss (e.g. heavy exertion, exercise in hot weather, saunas)
-warn against driving motor vehicles or operating dangerous equipment until drug effect is known.
-drug effect may take 1 to 2 weeks.
-encourage patient to avoid caffeine, crash diets, NSAIDs, diuretics.
-advise patient against getting pregnant because of teratogenic effects.
-wear medical alert identification.
-take drug as prescribed and keep medical appointments.
Digoxin (cardiac glycoside) inhibits the sodium-potassium pump, resulting in an increase in intracellular sodium; leads to an influx of calcium, causing the cardiac muscle fibers to contract more efficiently
Intended responses – increased contractility and cardiac output, decreased heart rate
Signs of digoxin toxicity (BADVAN)
- brady/tachycardia
- anorexia
- diarrhea
- visual disturbances
- abdominal cramps
- nausea/vomiting
Digoxin has a very narrow therapeutic range
What is it for dysrhythmias? HF?
○ 0.8-2 for dysrhythmias
○ 0.5-1 for HF
Patients taking digoxin w/ diuretics & cortisone should
take potassium supplement or foods rich in potassium to avoid hypokalemia and digitalis toxicity
Ascertain apical pulse rate before administering digoxin.
Digoxin should be held for HR less than
60 bpm
Promote sodium and water loss → decrease blood volume → lower BP
diuretics
Types:
* Thiazide and thiazide-like
* Loop diuretics
* Potassium-sparing diuretics
* Osmotic diuretics
Diuretic that acts on the distal convoluted renal tubule to promote Na, chloride, & water excretion
Treats HTN, peripheral edema, and HF (w/ACEi)
Thiazide & Thiazide-like diuretics
Ex: Hydrochlorothiazide (HCTZ, Microzide)
Side affects & adverse effects of thiazide diuretics
SE:
-fluid & electrolyte imbalances
-dizziness, HA, N/V, constipation
AE:
-significant hypokalemia (potassium wasting)
-dehydration
-renal failure
Diuretics that act on ascending Loop of Henle to inhibit chloride transport of sodium into circulation; Inhibit reabsorption of sodium; there is more sodium and water in the nephron
Used for heart failure, liver impairment (ascites), pulmonary edema, HTN, hypercalcemia
Loop diuretics
The most powerful diuretics
Ex: furosemide (Lasix)
Side effects & adverse effects of loop diuretics
SE:
-fluid & electrolyte imbalances
-high cholesterol
-orthostatic hypotension
-dehydration
AE:
-ototoxicity
-dysrhythmias
Diuresis without affecting blood potassium levels
Promotes sodium & water excretion, promotes potassium retention
Interfere with Na/K pump controlled by aldosterone
Used to treat edema, HTN, HF, and hypokalemia
Potassium-sparing diuretics
Ex: spironolactone (Aldactone)
Side effects & adverse effects of Potassium sparing diuretics
SE: N/V, diarrhea, dizziness, impotence, muscle cramps
AE: orthostatic hypotension, fainting, hyponatremia, hyperkalemia, hyperglycemia, hypocalcemia
Nursing interventions for Potassium sparing diuretics
Administer spironolactone in the morning to avoid nocturia
Teach pts to avoid foods high in Potassium and salt substitutes
Diuretic that increases osmotic pressure in plasma, extracts fluid from cells in brain
Used to decrease ICP and intraocular pressure (glaucoma)
Osmotic diuretic
Ex: mannitol (Osmitrol)
Side effects & adverse effects of Osmotic diuretics
fluid and electrolyte imbalances, pulmonary edema, nausea, vomiting, tachycardia, and acidosis
Beta blocker w/ intended responses are to reduce cardiac output by diminishing SNS response; reduce HR, decrease strength of contractions, decrease BP
Used to treat hypertension, stable angina, dysrhythmias (e.g., SVT), migraines, glaucoma, anxiety
metoprolol (Lopressor)
Side effects of beta blockers
- Decreased HR (bradycardia)
- Decreased BP (hypotension); orthostatic hypotension
- Bronchospasm (asthma and COPD patients can’t have nonselective beta blockers)
- Other: dizziness, depression, fatigue, erectile dysfunction
Do NOT stop taking beta blockers because it can cause rebound hypertension
Clonidine (Catapres) is a centrally-acting Alpha2 agonist that decreases sympathetic response; stimulate alpha2 receptors, which decreases sympathetic activity, decreases cardiac output, decreases epi, norepi, and renin release
Side effects of clonidine
drowsiness, dry mouth, dizziness, bradycardia, edema (can cause sodium and water retention)
Enalopril (Vasotec) is an ACE inhibitors that causes vasodilation of blood vessels, diuresis, lowered blood pressure, decreased workload of heart.
Used to treat HTN, HF, and post MI to limit damage to myocardium
Side effects of enalopril
persistent dry cough, dizziness, postural hypotension, N/V, tachycardia, hyperkalemia, angioedema (life-threatening swelling of face, tongue, lips, larynx), renal failure, fatigue
Contraindications for ACEi
Ex: enalopril
- Pregnancy (risk of fetal renal damage; tetratogenic)
- Potassium-sparing diuretics
- Salt substitutes that contain potassium
African American adults & older adults may not respond to ACEi monotherapy
Valsartan (Diovan) is an angiotensin II Receptor Blockers (ARBs) w/ the intended responses are the same as ACEi; better tolerated
Used to treat HTN, diabetic nephropathy, HF
Side effects include
Dizziness, hypotension, hyperkalemia
Calcium Channel Blockers (CCBs) block calcium from entering muscle cells of heart and arteries; decrease strength in heart contractions; relax vascular smooth muscle (vasodilation of coronary arteries).
Two subtypes of CCBs
dihydropyridines—prototype nifedipine (-pines)
non-dihydropyridines—prototype diltiazem
What is the difference between the two?
dihydropyridines are non-specific
more effect of vasodilation
less effect on heart function
non-dihydropyridine are cardiac specific
less effect on vasodilation
more effect on heart function
CCBs side effects & adverse effects
SE: constipation, nausea, headache, flushing, rash, edema (legs), hypotension, drowsiness, dizziness, bradycardia
AE: dysrhythmia, worsening heart failure (with verapamil and diltiazem), Stevens Johnson syndrome
Important pt teaching for CCBs
-Monitor vitals for bradycardia & hypotension
-Monitor for s/sx of HF: dyspnea, weight gain, and edema
-Teach pt to avoid grapefruit juice
-Teach pt to eat high fiber diet and have good oral hygiene
Anticoagulant used to for preventing or treating blood clots
(VTEs or PEs, stroke, a fib, clot prevention with certain surgeries)
Prolongs clotting time; requires aPTT (titrated drip based on this)
High risk med w/ strict protocol
Heparin
Heparin side effects & antidote
excessive bleeding, heparin-induced thrombocytopenia
(HIT), osteoporosis
Antidote for hemorrhage: protamine sulfate
Low molecular weight heparin (LMWH) anticoagulant that does not require aPTT
enoxaparin (Lovenox)
Warfarin (Coumadin) is an oral anticoagulant that prolongs clotting time (monitored by prothrombin time) by inhibiting synthesis of Vitamin K; Dosage is based on INR lab test.
Used mainly to prevent thromboembolic conditions (thrombophlebitis, PE, and embolism formation caused by a fib, which can lead to stroke)
Side effects and adverse effects of warfarin
SE: bleeding (monitor for signs of bleeding- petechiae, ecchymosis, GI bleeding, ocular hemorrhage, hematuria)
AE: hemorrhage (rare, possibly life-threatening), warfarin induced skin necrosis
What is the antidote for warfarin?
Vitamin K
Warfarin pt teaching points
Medical follow-up to check INR and adjust dosage
Consume consistent amounts of vitamin K-rich foods (no alterations)
Do not take aspirin-containing products without consulting prescriber
Do not drink alcohol
Manage home safety
Used to prevent thrombosis in the arteries by suppressing platelet aggregation
Prophylactic use in:
Prevention of myocardial infarction or stroke for patients with familial history
Prevention of a repeat myocardial infarction or stroke
Prevention of a stroke for patients having transient ischemic attacks
Antiplatelet drugs
Ex: aspirin and clopidrogel
Inhibit COX enzyme to reduce platelet aggregation
- prevent/treat MI & thromboembolism
- stroke
-TIA
-Maintain vascular grafts
Side effects: prolonged bleedings time, GI effects
aspirin
Antiplatelet drug used frequently after MI or stroke to prevent a second event
Side effects: epistaxis, headaches, hematoma, GI distress, purpura, rash, pruritis
Adverse effects: bleeding, peptic ulcers, intracranial bleeding
clopidogrel (Plavix)
It is important for patients to read labels of OTC medications when taking antiplatelet drugs. Why?
They need to avoid products with aspirin and NSAIDs.
For thrombotic stroke, thrombolytic drugs [Ex: alteplase t-PA (Activase)] should be administered within 3 hours.
Can these types of drugs be used for hemorrhagic stroke?
No! Must get CT beforehand to determine type of stroke.
Anti-hyperlipidemia that inhibits the enzyme HMG CoA reductase in cholesterol biosynthesis; slows the production of cholesterol
Increases the ability of the liver to remove LDL from blood; No effect on HDL
HMG CoA reductase inhibitors (statins)
Ex: atorvastatin calcium (Lipitor)
Side effects & adverse effects of statins
Side effects: constipation, peptic ulcers, muscle ache
Adverse effects: hepatic/renal failure, vision changes (cataract development), Rhabdo
Nursing interventions for statins
-Monitor pt’s blood lipid levels
-Monitor lab values for liver function
-May take several weeks for blood lipid levels to decline
-Pts must have annual eye exams & report any vision changes
-Instruct pt to take at bedtime
-Teach pt to report any unexplained muscle tenderness weakness, fever, and malaise
Fibrates [Ex: gemfibrozil (Lopoid)] activate cell lipid receptors, break down lipids for elimination. Does not impact LDL’s, but can increase HDL cholesterol.
Side effects are usually mild and include
stomach upset, diarrhea, and gallstones
First gen NSAIDs
salicylates (aspirin) and propionic acid derivatives (ibuprofen)
Second gen NSAIDs
COX-2 inhibitors (celecoxib)
COX-2 triggers inflammation and pain
Intended response of NSAIDs
reduced redness, pain, swelling, and warmth at site of
inflammation; increased function; reduced fever
Prostaglandin inhibitor that decreases the inflammatory process- both COX-1 & COX-2
Reduces pain, inflammation sx, and fever
Also considered an antiplatelet drug for pts w/cardiac or cerebrovascular disorders
High doses usually needed to relieve inflammation
aspirin
Side effects of aspirin
Gastric distress is common (anorexia, dyspepsia, NV, diarrhea, constipation, abdominal pain)
Adverse reactions of aspirin
tinnitus, hearing loss, GI bleeding, ulceration, perforation/anaphylaxis, Reye syndrome, Stevens-Johnson syndrome, thrombocytopenia, leukopenia, agranulocytosis, hepatotoxicity
True or False
Aspirin can be taken with other NSAIDs
False
Aspirin should NOT be taken with other NSAIDs (decreases blood level and effectiveness of NSAIDs)
Aspirin Contraindications
Hypersensitivity to salicylates or NSAIDs, GI bleeding
How does aspirin effect labs
- Increase PT, bleeding time, INR, uric acid (gout)
- Decreased cholesterol, T3 and T4 levels
Inhibition of prostaglandin synthesis, relieving pain and inflammation
Reduces inflammatory process; relieves pain; reduce fever
Side effects: Same as aspirin, blurred vision, pruritis
Adverse reactions: Same as aspirin
Take with food/full glass of water to relieve gastric distress
ibuprofen
Drugs of choice for patients with severe arthritic conditions who need high doses of an anti-inflammatory drug
Selective COX-2 inhibitors
Ex: celecoxib
Celecoxib side effects
same as aspirin and ibuprofen, add TENDON RUPTURE
NSAID administration
Before:
* Previous problems with NSAIDs, including OTCs
* Give after meals with full glass of water or milk
* Blood pressure
After:
* Bleeding, even with one dose (aspirin particularly)
* Sensitivity reaction
Patient teaching:
* Do not take on an empty stomach
* Monitor for bleeding
* Do not take with warfarin (Coumadin)
Prevent or limit inflammation by slowing or stopping all known pathways of inflammatory mediator production
End in *lone or *sone
corticosteroids
Side effects of corticosteroids
- Short term therapy – hypertension, acne, insomnia,
nervousness, increased blood glucose - Long term therapy – adrenal gland suppression,
reduced immune function, delayed wound healing,
“Cushingnoid appearance” - (may also have changes in mental status such as
euphoria, depression, psychosis)
Cushingnoid appearance
moon face, buffalo hump, hirsutism, weight gain, skin ulcers, HTN & cardiac hypertrophy, muscle wasting, osteoporosis, erectile dysfunction, amenorrhea, emotional disturbances
Adverse effects of corticosteroids
adrenal gland atrophy, masking of infection, delayed wound healing
Patient teaching for corticosteroids
do not suddenly stop taking drug, take w/food, avoid crowds
What happens if we don’t taper corticosteroids?
acute adrenal insufficiency crisis (medical emergency caused by a lack of cortisol)
Gout is an inflammatory disease of joints, tendons, and other tissues. Usually occurs in the great toe. Defect in purine metabolism leads to uric acid accumulation.
Name purine containing foods
organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)
- Inhibit migration of leukocytes to inflamed site (anti-inflammatory)
- Uses: Decreases pain and inflammation in acute gout attacks, prevents future gout attacks
- Side effects: GI distress
- Nursing Implications: Taken with food to avoid GI distress and avoid grapefruit juice
- Contraindications: Severe renal, cardiac, or GI problem
Antigout Drugs: Colchicine
- Not an anti inflammatory drug
- Inhibits final steps of uric acid biosynthesis and lowers serum uric acid levels (prevents uric acid from forming)
- This will prevent an attack
- Frequently used as a prophylactic to prevent gout, long term-use
Antigout Drug: Allopurinol
- Nonopioid that is not an NSAID (not drug of choice for inflammation)
- Safe, effective drug when given at therapeutic doses
- Causes little to no gastric distress, does not interfere with platelet aggregation
- Toxic when taken at high doses, too often, or with alcohol
- Risk for permanent liver or kidney damage
acetaminophen
What are the early symptoms of hepatic damage from excessive acetaminophen?
N/V, diarrhea, abdominal pain
Acetaminophen overdose antidote
N-acetylcysteine
Ex: Mucomyst, Acetadote
Opioid agonist
Prescribed to moderate to severe pain
Acts on CNS- activated u receptors, suppresses pain impulses, possess antidiarrheal and antitussive effects
Side effects – constipation, nausea/vomiting, drowsiness (mild sedation), orthostatic hypotensive
Adverse effects – anaphylaxis, respiratory depression, addiction, dependence, tolerance, withdrawal, seizures, urinary retention in older
adults
Naloxone as antidote
Opioid analgesics
Ex: morphine
Opioid patient teaching
- Take with food
- Do not drive or operate heavy machinery (while titrating)
- Change positions slowly
- Increase fluids, fiber, and activity
- Avoid stopping suddenly if taking for longer than 2-3 weeks due to withdrawals
Medications used for Patient Controlled Analgesia (PCA)
- Loading dose given initially to achieve pain relief
- Predetermined safety limits, patient controls administration
- Patient pushes a button, specific dose of analgesic into IV
line - Lockout mechanism prevents patient from continuously
pushing the button - Near-constant analgesic level, avoiding episodes of severe
pain or oversedation
- Morphine most often used for PCA
- Also fentanyl, hydromorphone
Block opioid activity
* Compete for opioid receptor, displaces opioid
* Reverse symptoms of addiction, toxicity, and overdose
Opioid antagonist
Ex: Naxalone (Narcan)
Side effects of opioid antagonist
- Sweating, flushing, agitation, dyspnea
- Hypo/hypertension, tachycardia
- Nausea, vomiting
- Reversal of analgesia (rapid)
Opioid Withdrawal (3 or more symptoms)
- Dysphoric (negative) mood
- N/V
- Muscle aches
- Runny nose or watery eyes
- Dilated pupils
- Goosebumps or sweating
- Diarrhea
- Fever
- Insomnia
Blocks reverse transcriptase to prevents viral DNA synthesis. Virus then can’t replicate.
Treat symptoms of HIV combined with other drugs
Prevents maternal HIV transmission; Post-exposure prophylaxis for HIV-exposed healthcare workers
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)
Ex: Zidovudine
ART is a life-long treatment that helps people with HIV live longer, healthier lives. But effective ART depends on adherence.
Teach patients the importance of taking their drugs exactly as prescribed to maintain the effectiveness of cART drugs. Even a few missed doses per month can promote drug resistance (remember the 90% rule)
1st gen antihistamine that competes and occupies H1 receptor sites to block the effects of histamine. Results in decreased nasal secretions, nasal itching/tickling that causes sneezing
SE: drowsiness, dizziness, dry mouth, decreased secretions, urine retention, blurred vision, and wheezing
Name the drug.
Diphenhydramine (Benadryl)
2nd gen antihistamines that work peripherally to block actions of histamine. Fewer anticholinergic effects and lower incidence of drowsiness than 1st gen.
Name the drugs.
Azelastine, Cetirizine, & Loratadine
Properties of antihistamines
antihistaminic, anticholinergic, and sedative
Stimulating alpha-adrenergic receptors on vascular smooth muscle.
Vascular constriction occurs, shrinking of the nasal mucosa = reduction in nasal secretions.
Act promptly. Fewer side effects than systemic decongestants.
Name the class and drugs.
Nasal decongestants
Ex: Oxymetazoline (Afrin)
Repeated or freq. use of nasal spray/drops can result in
tolerance/rebound nasal congestion.
May need to take permanently.
Relieve nasal congestion for a longer period of time. Found in many cough/cold preparations.
Can increase blood pressure & glucose levels.
Use extreme caution in patients w/ hypertension, cardiac disease, hyperthyroidism, and diabetes.
Systemic decongestants
Ex: Pseudoephedrine (Sudafed) and Phenylephrine hydrochloride
Used for nonproductive coughs, suppresses cough
Act on the cough control center in the medulla
Cross the placenta and breastmilk
Name class and drugs.
Antitussive
Ex: Benzonatate (Tessalon), Codeine, Dextromethorphan (Benylin), and Hydrocodone (hHcodan)
Loosens bronchial secretions by reducing the viscosity of mucoid secretions.
Found in many OTC cold remedies.
Caution in use with elderly patients, asthmatic patients, and patients w/ respiratory insufficiency
Expectorants
Ex: Guaifenesin (Mucinex)
Short acting beta2 adrenergic agonist
Rapid onset of action (5-15 min) for acute bronchospasm
Rescue inhaler
Albuterol
Side effects and adverse effects of beta2 adrenergic agonists
Side effects: Tremor, nervousness, restlessness, agitation, dry mouth, urinary retention
Adverse reactions: Palpitations, tachycardia, HTN, dysrhythmia, bronchospasm, increased blood glucose
- Excessive use of aerosol drug can lead to tolerance and loss of drug effectiveness *
INSTRUCTIONS: INHALATION (AEROSOL) THERAPY
Remove mouthpiece cap
If appropriate, shake container
Stand up or sit upright, exhale deeply
Place mouthpiece between teeth, close lips tightly around inhaler
While breathing in, press down on inhaler to activate and release
medication; continue breathing in slowly for several more seconds
Hold breath for 5-10 seconds
Breathe in/ out normally
Important to perform mouth care afterwards
Relaxes smooth muscles of the bronchi, bronchioles, and pulmonary vessels (bronchodilates). Also stimulates CNS & respirations.
Prescribed mostly for maintenance therapy in patients with chronic stable asthma and COPD when other drugs have failed to show improvement
What med class and drug prototype?
METHYLXANTHINES
Ex: Theophylline
Theophylline has a low therapeutic index & narrow desired therapeutic range. What is it?
5-15mcg/mL
Lower resp. drug that inhibits histamine and other inflammatory mediators release from mast cells to prevent asthmatic attacks.
No longer recommended as first-line, but has shown good results in children, preventing house-dust induced bronchospasms and exercise-induced asthma.
SE: cough, postnasal drip
AE: rebound bronchospasm if abruptly stopped
Cromolyn
Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function
Glucocorticoid medications
Side effects and adverse effects of glucocorticoid meds
Euphoria, insomnia, psychotic behavior
Hyperglycemia
Peptic ulcer
Fluid retention
Withdrawal symptoms
Increased appetite
Never stop medication abruptly!
Hypothyroidism
Drugs that cause synthetic T4 is converted to T3 (a more potent form of the thyroid hormone and more capable of penetrating cell nucleus and producing thyroid mediating hormone effects
Usually lifelong
TH replacement drugs
Ex: levothyroxine sodium (Synthroid)- synthetic form of thyroxine (T4)
Side effects & adverse effects of levothyroxine sodium (Synthroid)
Side effects – thyrotoxicosis (tachycardia, tremors, angina, insomnia, heat intolerance) hypertension, increased bowel movements, weight loss, N/V
Adverse effects –MI, HF, seizures, palpitations
Pt teaching when administering TH replacement drugs
-Teach symptoms of hyperthyroidism
-Take exactly as prescribed (preferably on an empty stomach, before breakfast)
-Not to be taken for weight loss
-Dietary fiber supplements (and increased fiber in the diet) decrease absorption
-Monitor TSH levels after 6-8 weeks (should decrease)
-Take pulse at scheduled times: before taking drug & before bedtime
Hyperthyroidism
Drugs that block the action of thyroid peroxidase (inhibiting hormone synthesis
PTU blocks conversion of T4 to the more active form of T3
Thyroid-Suppressing Drugs
Ex: methimazole (Tapazole), propylthiouracil (PTU)
Side effects & adverse effects of propylthiouracil (PTU)
Side effects include agranulocytosis and rash
PTU may cause hepatotoxicity
Pt teaching when administering Thyroid-Suppressing
Medical follow-up
Administer meds with meals
Do NOT stop suddenly
Regular monitoring of blood counts
Monitor for jaundice; report if present
Monitor vital signs, weight
What needs to be checked before and after administering thyroid-suppressing drugs?
Check before: liver function tests
Check after: blood counts; assess for jaundice
Adverse effects of insulin
Adverse effects – hypoglycemia (insulin shock)
Can result from:
Insulin overdose
Improper timing of insulin dose
Skipping a meal
Drugs that directly stimulate beta cells in the pancreas to secrete more insulin
Indirectly alters sensitivity of peripheral insulin receptors, allowing increased insulin binding
Uses: control hyperglycemia in type 2 DM
Take once or twice a day
2nd gen Sulfonylureas
Ex: glipizide (Glucotrol)
Side effects & adverse effects of glipizide (Glucotrol)
-Hypoglycemia (especially in individuals who drink alcohol while taking)
-GI distress, weight gain
-Drowsiness, dizziness, confusion
-Blood dyscrasias (agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia, pancytopenia) hepatic failure
Drugs that stimulate pancreatic beta cells to release insulin (action similar to sulfonylureas)
Short-acting
Take 15-30 minutes before each meal
Meglitinides
Ex: nateglinide (Starlix) and repaglinide (Prandin)
Meglitinides are contraindicated in pts w/
Liver dysfunction (decrease liver metabolism, more drug in the body, could cause hypoglycemia)
Act on liver to reduce release of glucose from stored glycogen
Increase cell sensitivity to insulin (does not cause hypoglycemia)
Reduce absorption of glucose from intestinal tract
Biguanides
Ex: Metformin (Glucophage)
Iodinated contrast media can increase risk of renal failure and lactic acidosis when taking metformin (Glucophage). How long does the drug need to be held before and after testing w/ contrast?
48 hrs
What is the goal of immunosuppression?
The goal of immunosuppression therapy is to decrease
the patient’s risk of rejecting the newly transplanted organ,
while minimizing the side effects, risk of infections, & malignancy
Cyclosporine is a immunosuppressant- maintenance drug that suppresses activation of T lymphocytes.
Adverse effects?
Hypertension, blood sugar, cholesterol
Nephrotoxicity, Acute Renal Failure
Electrolyte disturbance
Neurotoxicity with increased trough levels
Gingival hyperplasia, hirsutism
What monitoring is required for cyclosporine?
Trough levels, electrolytes, renal function, BP, blood sugar
AVOID grapefruit juice
Varicella vaccine is for prevention of chickenpox; stimulates active immunity against natural disease
First dose is 12-15 months and second dose is 4-6 years
Contraindications?
- Contraindicated in individuals with previous anaphylaxis to this vaccine or gelatin and neomycin (antibiotic)
- Contraindicated during pregnancy
Antiemetics that blocks dopamine receptors in the brain
Inhibits signals to vomiting center in medulla
Uses: post-op nausea, vomiting, chemotherapy, radiation sickness
Dopamine Antagonists
Ex: Chlorpromazine (Thorazine), prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol)
Side effects & adverse effects of promethazine (Phenergan)
Applies to other dopamine antagonists
Side effects: Dry mouth, sedation, constipation, orthostatic hypotension, tachycardia
Adverse effects: Extrapyramidal symptoms with prolonged therapy
Antiemetics that blocks serotonin receptors in CTZ, blocks vagal nerve terminals in upper GI tract
More effective when used with dexamethasone
Uses: post-op, chemotherapy
Serotonin Antagonists
Ex: Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)
Side effects & adverse effects of ondansetron (Zofran)
Side effects: Headache, dizziness, hypotension, palpitations, constipation, edema, fatigue
Misc. antiemetic blocks dopamine receptors in CTZ
Uses: post-op emesis, chemotherapy, radiation therapy
High doses can cause sedation and fatigue
Metoclopramide (Reglan)
Side effects of Metoclopramide (Reglan)
- Drowsiness, fatigue, headache, anticholinergic side effects (constipation, urinary retention, blurred vision, tachycardia)
- EPS (involuntary movements)
Nursing interventions for antiemetics
- Provide oral care after vomiting
- Avoid alcohol when taking antiemetics
- Avoid driving motor vehicles or engaging in risky behaviors
- Monitor bowel sounds
- Check vital signs
Type of drug used to ease or stimulate defecation
* Soften the stool
* Increase stool volume
* Hasten fecal passage through the intestine
* Facilitate evacuation from the rectum
* Relieve or prevent constipation
Most not intended for long term use
Laxatives
When should laxatives be avoided?
-S/sx of acute abdomen (severe abd pain, tenderness, fever, rigid abd, guarding)
-Abdominal obstruction
-Appendicitis, ulcerative colitis, diverticulitis
Do not assume its constipation. Get an Xray.
Laxatives that contain electrolyte salts
Hyperosmolar salts pull water into colon and increase water in feces to increase bulk –> stimulates peristalsis and defecation
Produces semi-formed to watery stool
Uses: Bowel prep for diagnostics or surgery
Osmotic (Saline) Laxatives
Ex:
* Sodium salts (sodium phosphate or Phospho-Soda)
* Magnesium salts (magnesium hydroxide [Milk of Magnesia],
magnesium citrate)
Side effects of magnesium hydroxide [Milk of Magnesia]
Fluid & electrolyte imbalances, cramps, NVD, flatulence
Laxatives that irritate sensory nerve endings in intestines, stimulate peristalsis
Irritates mucosa
Uses: opioid induced constipation, slow intestinal transit
Can make constipation worse if used long-term
Stimulant laxatives
Ex: Bisacodyl (Dulcolax)
Side effects & adverse effects of bisacodyl (Dulcolax)
Side effects: Dizziness, cramps, nausea, diarrhea, potassium and calcium imbalances, reddish/brown urine
Adverse effects: Overuse can decrease tone and sensation in the large intestine (usually reversible)
Laxatives that absorb water into the intestine, increase bulk, and peristalsis
Typically works in 1-3 days
Uses: short term tx, IBS, ileostomy/colostomy
Bulk forming laxatives
Ex: Psyllium (Metamucil), polycarbophil (FiberCon)
Side effects & adverse effects of psyllium (Metamucil)
Side effects: cramps, n/v/d, flatulence
Adverse effects: insufficient fluid intake causes intestinal obstruction
Bulk-Forming Laxatives: Patient Teaching
- Mix in glass of water or juice
- Stir and drink immediately
- Follow with another full glass of water
Laxatives that promotes water accumulation in the intestine and stool
Uses: Stool softener, prevent constipation, decrease straining, post-op pts
Typically starts working in 1-3 days
Emollients (Lubricants and Stool Softeners)
Ex: Docusate sodium (Colace)
Side effects of Docusate sodium (Colace)
NVD, cramping
Antidiarrheals are used to decrease GI motility, decrease reabsorption/secretion of fluid in bowel, decrease activity of bacteria
- Side effects: Constipation, abdominal discomfort, dizziness, dry mouth
- Adverse effects (rare): Intestinal obstruction, toxic megacolon
Nursing Interventions
- Monitor frequency of bowel movements
- Assess bowel sounds
- Check for evidence of dehydration
- Administer cautiously to pregnant patients, patients with glaucoma, liver disorders, or ulcerative colitis
Pt teaching for antidiarrheals
- Encourage patients to drink clear liquids
- Avoid fried foods or milk products
- If no relief in 2 days; if fever, abdominal pain, or distention occurs; blood or mucus appears in stool, notify prescriber
- Avoid alcohol, other CNS depressants
Drugs that decrease secretion of gastric acid, heal and prevent ulcers
Blocks H2 receptors in stomach –> decreases acid production
End in “tidine”
Most OTC
Histamine H2 blockers
Ex: Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid)
No more ranitidine (Zantac)
Side effects of famotidine (Pepcid)
headaches, agitation, dizziness, n/v, constipation/diarrhea, erectile dysfunction, skin rash, pruritis, can decrease B12 absorption
Nursing Interventions for Histamine H2 blockers
Ex: famotidine (Pepcid)
- Administer 30 minutes before meals or at bedtime to decrease food-induced acid secretion
(“-tidine” = 30 minutes before you go to dine) - Avoid smoking
- Avoid NSAIDs
- Tell patient that drug-induced impotence is reversible
- Avoid foods and liquids that cause gastric irritation
- Avoid overeating
- Decrease stress
- Avoid OTC use for more than 2 weeks, consult doctor
- Watch for confusion in older adults!
What to eat when you have an ulcer
fruits veggies, legumes, lean meats, fish & seafood, eggs, whole soy foods, fermented dairy, healthy fats, grains, green tea, herbs & spices
What to avoid when you have an ulcer
alcohol, coffee, caffeine, milk or cream, fatty meats, fried foods, heavily spiced foods, salty foods, citrus foods & juices, tomatoes, chocolate
Drugs that suppress secretion of gastric acid by inhibiting hydrogen/potassium ATPase in gastric parietal cells
Most powerful drugs for treating GERD and PUD
End in “azole”
Proton Pump Inhibitors (PPIs)
Ex: Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
Side effects and adverse effects of PPIs
Side effects: diarrhea, constipation, gas, headache
Adverse effects: allergic reactions, bone fractures from porous bones, GI bleeding
Used as stress ulcer prophylaxis on Med-Surg units
PPIs
Nursing Interventions for PPIs
- Give approximately 30 minutes before meals, preferably in morning
- Assess for black, tarry stools
- Educate pts to report black/tarry stools, diarrhea, abd pain, persistent HA
Neutralize acidity of stomach contents, relieve heartburn and indigestion, decrease GERD symptoms, heal ulcers
* Short-acting
Antacids
Ex: Sodium bicarbonate (Alka-Seltzer), Calcium carbonate (Tums), Magnesium hydroxide/aluminum hydroxide (Maalox), Aluminum hydroxide (Amphogel) –> SCAM
Side effects and adverse effects of antacids
Side effects (very rare): constipation (Al and Ca), diarrhea (Mg) = mellows GI tract), stomach cramps
Adverse effects: usually none
Reminders for antacids
Impairs absorption of other drugs
* Anti-acids = anti-mixing
* 1 hour before or after other meds
Encourage patient to drink at least 2 oz of water to ensure drug reaches stomach
Why should we do a C&S before starting antibiotics?
Aculture is atestto find microorganism responsible for causing an infection.
Asensitivity testchecks to see what kind of medicine, such as an antibiotic, will work best to treat the illness or infection.
How long does it take for bacteria be seen in culture?
Most bacteria can be seen in culture in 2-3 days (could take 10 days or longer)
Broad-spectrum antibiotics may be started before lab culture completed
Antibacterial that is bactericidal, most widely effective, & least toxic
Major side effect: allergy
Penicillin
Side effects & adverse effects of penicillin
Side effects: NVD, pain at injection site
Adverse effects: bacterial resistance, allergic reaction, anaphylaxis, Clostridium difficile-associated diarrhea
Nursing interventions for penicillin
-Obtain C & S specimen
-Monitor for evidence of superinfection, especially in patients taking high doses of an antibiotic for a prolonged time.
-Examine the patient for an allergic reaction, especially after the 1st and 2nd doses.
-Instruct patient to take complete course of treatment.
Side effects & adverse effects of ceftiaxone (Rocephin)
Side effects: GI distress (nausea, vomiting, diarrhea), Alteration in blood clotting (increased bleeding)
Adverse effects: Nephrotoxicity, Stevens-Johnson syndrome, Anaphylaxis, Thrombocytopenia
Ceftiaxone (Rocephin) drug interactions
Alcohol
May cause disulfiram-like reaction
Flushing, dizziness, headache, nausea, vomiting, and muscular cramps
Disulfiram (also called Antabuse) is given to people who chronically drink alcohol- it causes an acute reaction when the person drinks alcohol after taking this drug
Nursing interventions for Ceftiaxone (Rocephin)
-C & S prior to starting antibiotic
-Tell patient to report signs of superinfection.
-Instruct patient to take complete course of treatment.
-Observe for hypersensitivity reactions.
-Advise patient to take medication with food if gastric irritation occurs.
Penicillin substitute
Used if pt has a hypersensitivity to penicillin
Macrolides
Ex: Azithromycin
Side effects of Macrolides
GI distress including nausea, vomiting, diarrhea, cramping
Photosensitivity
Headache, fatigue, dizziness
Oral candidiasis
Adverse effects of Macrolides
Anaphylaxis
Superinfection
Hepatotoxicity (use with caution in patients with hepatic dysfunction)
Stevens-Johnson syndrome
Blood dyscrasias
Nursing interventions for Macrolides
Obtain a sample for C&S testing before starting antibiotic.
Monitor the patient for liver damage.**
Administer antacids either 2 hours before or 2 hours after taking**
Encourage patient to report side effects/adverse effects.
Tell patient to report onset of loose stools/diarrhea (c-diff)**
Drugs used to treat MRSA, pseudomembranous colitis caused by clostridium difficile
Dosing may be based on peak & trough levels
Glycopeptides
Ex: Vancomycin
Side effects of Glycopeptides
GI symptoms (nausea, vomiting)
Dizziness
Superinfection
Disulfiram-like reaction to alcohol
Adverse reactions of Glycopeptides
Ex: Vancomycin
Ototoxicity**
Nephrotoxicity**
Anaphylaxis
Blood dyscrasias
Stevens-Johnson syndrome
Clostridium difficile-associated diarrhea
S/sx of adverse reaction of Glycopeptides
Ex: Vancomycin
Occurs when IV too rapid
Severe hypotension
Red blotching of face, neck, chest, extremities
Toxic reaction not allergic reaction
Nursing interventions for Vanco
Check C&S before therapy
Monitor vancomycin levels**
Administer over 1 to 2 hours IV**
Monitor BP**
Monitor renal function tests (BUN and creatinine) and hearing**
Monitor patient for superinfection
Side effects of Tetracyclines
Ex: Doxycycline
Nausea and vomiting
Diarrhea
Photosensitivity (severe burns)
Discoloration or hypopolasia of teeth and temporary stunting of growth
Do not give to children younger than 8 years.
Stomatitis, glossitis
Adverse effects of Tetracyclines
Anaphylaxis
Clostridium difficile-associated diarrhea
Ototoxicity, hepatotoxicity, nephrotoxicity
CNS toxicity
Pancytopenia, Stevens-Johnson syndrome
Drug/food interactions for Tetracyclines
Milk products (decreased absorption)
Antacids
Oral contraceptives
Penicillins
Aminoglycosides
Nursing interventions for Tetracyclines
Check C&S before drug
Monitor kidney and liver function.**
Take on an empty stomach and full glass of water **
Advise patient to use sunscreen (photosensitivity)**
Teach patient to report superinfection.
Warn patient to avoid milk, iron, antacids (interfere with absorption).**
Recommend that the patient use a non-hormonal birth control method in addition to OCP’s (to reduce risk of pregnancy and is also Class D medication)**
Side effects & adverse effects of Aminoglycosides
Ex: Gentamycin
SE: photosensitivity, superinfection, stomatitis, NV, fever, lethargy
AE: anaphylaxis, seizures, ototoxicity, nephrotoxicity, C. Diff, Stevens-Johnson syndrome
Nursing interventions for Aminoglycosides
-Check C&S.
-Check for hearing loss and renal function.**
-Check that therapeutic drug monitoring has been ordered for Peak & Trough drug levels.**
-Monitor for s/sx of superinfection
Side effects/adverse effects of Trimethoprim-Sulfamethoxazole
Ex: Trimethoprim-Sulfamethoxazole (Bactrim, Septral)
GI distress, stomatitis, photosensitivity
Crystalluria, renal failure
Blood dyscrasias, Stevens-Johnson syndrome
Nursing interventions for Trimethoprim-Sulfamethoxazole
Increase fluid intake to at least 2000 mL/day.**
Monitor CBC and renal function.**
Monitor for rash, superinfection.
Avoid during third trimester.**
Avoid antacids**
Monitor for sore throat, bruising, bleeding**
Teach patient to avoid direct sunlight**
Side effects & adverse effects of Fluroquinolones
Ex: Ciprofloxacin (Cipro)
SE: Rash, nausea, headache, abdominal pain, vomiting, dizziness, changes in taste, sleep disturbances, photosensitivity
AE: Serious heart dysrhythmias (esp. when taken with other drugs), neurotoxicity, Stevens-Johnson syndrome, changes in blood glucose level, tendon rupture, peripheral neuropathy
Nursing interventions for Fluroquinolones
Check C&S.
Monitor heart rate and rhythm**
Infuse IV over 60 to 90 minutes.**
Increase fluid intake to more than 2000 mL/d. **
Tell patient to avoid caffeine.**
Check for superinfection
Teach patient to stop drug and notify prescriber of any tendon or joint pain/swelling**
Monitor blood glucose**
General take-home points for antibacterials
Finish medication to prevent superinfection
Decreases oral contraception effectiveness in amoxycillin, doxycycline
No alcohol- antibiotics can harm the liver
Take on an empty stomach and full glass of water with azithromycin (macrolides), doxycycline (tetracycline), levofloxacin (fluoroquinolones)
No sun with levofloxacin (fluoroquinolones), doxycycline (tetracyclines), sulfa drugs (Bactrim)
Vancomycin, gentamycin, neomycin- very toxic to kidneys and ears
Take amoxicillin with food to decrease GI symptoms and increase absorption
Vanco is incompatible with a lot of IV drugs, so be careful when infusion
Antitubercular drugs are either bactericidal or bacteriostatic.
First line TB drugs
Isoniazid (INH), Ethambutol, Pyrazinamide, and Rifampin
Antitubercular drug used to treat active TB and as a prophylactic measure against TB (inhibits bacterial cell-wall synthesis).
Bactericidal or bacteriostatic depending on drug concentration.
Isoniazid (INH)
Side effects & adverse effects of INH
Side effects:
Drowsiness, tremors, photosensitivity, tinnitus, N/V, dry mouth, constipation
Adverse effects:
Peripheral neuropathy, hepatotoxicity, psychotic behavior, seizures, optic neuropathy (usually reversible but may cause permanent vision loss), blood dyscrasias, thrombocytopenia, agranulocytosis
Hepatitis is the most serious adverse effect associated with INH
NOTE: risk of neuropathy decreased with Vitamin B-6
Pt teaching for INH
Take INH 1 hour before meals or 2 hours after meals.
Avoid caffeine, avoid alcohol.
Collect sputum specimen in early morning.
Take pyridoxine (vitamin B6) to prevent peripheral neuropathy.
Check liver enzymes, CBC.
Need frequent eye examinations
Report numbness, tingling, burning.
Teach sun precautions, to avoid antacids
Antitubercular drug that inhibits enzyme needed for protein synthesis
Rifampin
Side effects & adverse effects of Rifampin
Side effects: Abdominal pain, urinary retention, reddish-orange secretions
Adverse effects: Liver toxicity (so use caution in older patients, alcoholics, and chronic liver disease)
Generally well tolerated, most common adverse reactions include N/V, rash
Ethambutol is an antitubercular drug that is bacteriostatic; inhibits cell wall synthesis
Side effects & adverse effects
Side effects: increase uric acid (use with caution in patients with gout)
Adverse effects: hepatotoxicity, optic neuropathy (in high doses)
Most important adverse effect of Ethambutol
optic neuritis- results in visual acuity and loss of ability to discriminate between red and green
Pyrazinamide (PZA) is an antitubercular drug with unknown mechanism of action
Side effects: increase uric acid, aches, pains, photosensitivity, acne
Adverse effects: Liver toxicity
Although the drugs do focus on the tumor, they also attack other
fast-growing healthy cells.
General chemo side effects
● Myelosuppression (Bone Marrow Suppression)
○ Blood cells – RBCs (anemia) = fatigue, SOB
○ WBCs (leukopenia) = infection risk!
○ Platelets (thrombocytopenia) = bleeding risk! (bruising, bleeding of
gums/nose, injury)
● GI cells
○ Anorexia, N/V/D
○ *premedicate with antiemetic! ~ before treatment!
○ Mucositis/Stomatitis = infection in the mouth = good oral care!
Other
● Hair → Alopecia (hair loss) overall hair loss
● Fatigue
● Infertility, Peripheral Neuropathy, Cardiomyopathy, Secondary Cancers
(Leukemia)
Alkylating agent that damages the cell’s DNA by cross-linkage of DNA strands, abnormal base pairing, or DNA strand breaks.
This prevents the reproduction of cancer cells & Kills cells in all phases of the cell cycle.
cyclophosphamide (nitrogen mustard)
Nursing care for cyclophosphamide
◦ MESNA (sodium 2-mercaptoethanesulfonate) uroprotectant administered prior to
cyclophosphamide to inactivate drug metabolites to be excreted by the kidney.
◦Keep the patient well hydrated (2L/d)-hemorrhagic cystitis. Assess for
hematuria.
◦Can cause cardiotoxicity in high doses
◦Drug interactions: accurate list of medications and supplements.
◦Teach infection precautions: myleosuppression. Monitor labs
◦Teach to empty bladder every 2-3 hours
◦Can cause photosensitivity: use sunscreen daily
◦Eat low purine diet (alkaline urine), avoid citric acid.
◦Body secretions can be toxic
Doxorubicin (Adriamycin) is an antitumor antibiotic that interferes with DNA replication, RNA transcription → most are cell cycle non-specific
Side effects of the drug include:
● Bone marrow suppression
● N/V
● Stomatitis/Mucositis
● Infertility
● Alopecia
● Lipophilic → reduced clearance in people who are obese
● Avoid eating foods/products that contain turmeric (curcumin) → decreases effect of the drug
Nursing care for Doxorubicin (Adriamycin)
◦Doxorubicin: monitor for cardiotoxicity (MUGA scan, Echo) assess HR (tachycardia, irregular rhythm) and signs of heart failure.
◦Assess WBC, RBC, platelet counts.
◦Teach patient/family to report signs of abnormal bleeding
◦Monitor IV sit closely for signs of infiltration- stop IV immediately and call extravasation team or healthcare provider.
◦Teach patient/family infection control measures, handwashing to avoid infection. Call healthcare provider if temp 100 or higher.
◦Notify patient that the color of urine may change (pink-red)
◦Call healthcare provider if signs of heart failure are present, chest pain, dyspnea, palpitations.
Combined Hormonal Contraceptives contain progestin and estrogen.
Estrogen component inhibits ovulation by preventing formation of
dominant follicle. Progestin suppresses luteinizing hormone surge.
Side effects due to excess estrogen
○ CLOTS! → can lead to DVT, PE, & MI
○ Nausea, vomiting, dizziness
○ Fluid retention, edema, bloating, electrolyte disturbances
○ Breast enlargement, breast tenderness
○ Breakthrough bleeding, menstrual irregularities, dysmenorrhea,
amenorrhea
○ HA, mental changes
Nursing Care: Combined
Hormonal Contraceptives
● Patients receiving estrogen should receive an annual medical exam,
including breast exam and Paps
● Advise patients not to smoke because of increased risk of thrombotic
events!
● Not indicated during pregnancy or lactation because of potential for
adverse effects on fetus or newborn
● Monitor for swelling and changes in vision or fit of contact lenses to
monitor for fluid retention
Clomiphene citrate is used to stimulate ovarian follicle growth (stimulating release of FSH & LH).
Side effects & adverse effects include
headache, dizziness, fatigue, depression, anxiety, GI distress,
gynecomastia, hot flashes,decreased visual acuity, ovarian
hyperstimulation, ectopic pregnancy
Menopause: Conjugated Estrogens
Hormone therapy improves vasomotor symptoms and vaginal dryness and
decreases risk of osteoporosis.
Boxed warning—hormone therapy should be used only for the treatment
of menopausal symptoms, at the lowest dose possible, for the shortest
duration possible, usually < 5 years.
Side effects & adverse effects include:
Side Effects → N/V, fluid retention, breast tenderness, breakthrough bleeding
Adverse effects → thromboembolism, PE, MI
Contraindicated in pregnancy (cat X) and lactation
Hormone therapy = estrogen + progestin is used for females w/
an intact uterus
Hormone therapy = estrogen only for females w/
a hysterectomy
Testosterone binds to androgen receptors to control development and maintenance of sexual processes, accessory sexual organs, cell metabolism,
and bone/muscle growth.
Indications for testosterone:
Indications:
● Androgen deficiency, hypogonadism
● Replacement therapy for testicular failure
● Delayed puberty in adolescent
Side Effects/Adverse Effects of Testosterone
● Priapism, gynecomastia, urinary urgency, polyuria
● Stops spermatogenesis, oligospermia, virilization
● GI distress, increased salivation, mouth soreness
● Insomnia, injection site reaction, impaired bone growth
● Increased or decreased sexual desire, lethargy
● Hypercalcemia, decreased muscle tone
● Baldness or hirsutism, vocal changes
● Increases cholesterol, alters thyroid and liver function
How to Treat BPH
● Alpha-blockers
○ Tamsulosin, bethanechol chloride
○ Inhibit prostate smooth muscle contraction by blocking alpha-1 receptor,
decreasing resistance to urinary flow
● 5-Alpha-Reductase Inhibitors
○ Finasteride (Propecia)
○ Decreases production of DHT (dihydrotesterone; potent androgen that
affects prostate growth)*
● Anticholinergics
○ Oxybutynin, tolterodine
○ Relaxes bladder smooth muscle by reducing muscarinic effect of
acetylcholine on smooth muscle
○ Used in patients with BPH with overactive bladder, can relieve symptoms
of urgency, frequency,and nocturia
● Phosphodiesterase-5 (PDE5) Inhibitors
○ sildenafil citrate (Viagra), tadalafil (Cialis)
○ FDA-approved for treatment of erectile dysfunction; smooth muscle cells
of prostate and bladder contain PDE5
Anticholinergics for Overactive Bladder
● Antispasmodic actions to decrease detrusor muscle spasms and
contractions
● Used in patients with urinary incontinence and urinary urgency/ frequency
Examples: oxybutynin, tolterodine
● Causes anticholinergic symptoms, drowsiness, & dyspepsia
● Instruct patient to report constipation that lasts longer than 3 days
Tamsulosin inhibits smooth muscle contraction in the prostate, which improves the rate of urine flow for patients with BPH
Side effects include
decreased libido, HA, and dizziness (including orthostatic hypotension)
Bethanechol Chloride increases detrusor muscle tone to allow strong start to voiding for patients with postoperative urinary hesitancy
Side effects include
Excessive salivation, abdominal cramping, diarrhea
