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Pharm > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

Epinephrine responses include

A

CNS stimulation

increase in BP, pupil dilation, increase in HR, bronchodilation

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2
Q

When is epinephrine used?

A

Used in anaphylactic shock to increase BP, HR, and airflow through lungs

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3
Q

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

A

HTN (lowers BP), angina, and treatment of acute MI

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4
Q

Side effects of Atenolol

A

bradycardia, hypotension, headache, dizziness, bronchospasm

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5
Q

Before administering Atenolol, you should always check the pt’s HR & BP. If HR is below 50 you should

A

hold meds and notify provider

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6
Q

Side effects and adverse reactions of Bethanechol Chloride

A

hypotension, increased gastric acid secretion, abdominal cramps, diarrhea, bronchospasm

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7
Q

Bethanechol Chloride is a direct acting cholinergic agonist.

Bethanechol Chloride is the treatment for? Causes?

A

Urinary Retention & Neurogenic Bladder

Acts on detrusor muscle to contract bladder → Increases urination

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8
Q

Atropine is a cholinergic antagonist. It is used as a __________ med to reduce resp. & salivary secretions.

A

pre-op

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9
Q

Side effects and adverse reactions of atropine

Pixorize: think of the man deserted on the tropical island

A

xerostomia (dry mouth), nasal dryness, blurred vision, tachycardia, constipation, urinary retention

Do not give to pts w/ glaucoma

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10
Q

Antiseizure drugs act in three ways:

A

Increase action of GABA (GABA will calm the brain down), suppress sodium influx, or suppress calcium influx

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11
Q

Phenytoin is an antiseizure med that inhibits sodium influx.

Side effects & adverse effects of Phenytoin

Pixorize- think of the phone tower & kids

A

S/E: chest pain, diaphoresis, N/V, constipation, drowsiness, depression, & suicidal ideation

A/E: gingival hyperplasia, Stevens-Johnson syndrome, cardiac dysrhythmias

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12
Q

What is the therapeutic serum level for Phenytoin?

A

10-20 mcg/mL

Signs of phenytoin toxicity: ataxia, slurred speech, & nystagmus

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13
Q

Valproate is an antiseizure medication that decreases calcium influx.

Side effects of Valproate

Pixorize: think of valet at masquerade party

A

hepatotoxicity, N/V, diarrhea, tremors, headache, weight gain, &stomatitis

Do not give to children under the age of 2. This med is also teratogenic.

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14
Q

Rivastigmine is used to treat

Pixorize: think of alchemist selling donuts & cola on the river

A

mild to moderate Alzheimer’s Disease

Goal: slow disease process, decrease S/Sx, & improve cognitive function/ADL’s

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15
Q

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

A

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

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16
Q

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.

A

orthostatic hypotension, dystonia, dyskinesia, psychosis, depression, sleep disturbances

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17
Q

Carbidopa-levodopa patient teaching

A
  • 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)
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18
Q

Benztropine is an anticholinergic that blocks the release of ACh.

It is used to treat Parkinson’s disease.

Side effects of Benztropine

A

dry mouth, constipation, urinary retention, N/V, restlessness/anxiety, tachycardia, blurred vision, confusion

Contraindicated in pts w/ glaucoma.

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19
Q

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

A

NEUROLEPTIC MALIGNANT SYNDROME (NMS)

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20
Q

CONVENTIONAL (TYPICAL) ANTIPSYCHOTIC AGENTS
1st generation; Phenothiazine-like

This medication alters effects of dopamine on CNS (downer)

Treat acute psychoses, ADHD, schizophrenia, Tourette syndrome

A

haloperidol (Haldol)

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21
Q

Side effects and adverse effects of conventional antipsychotics like haloperidol

A

Side effects: anticholinergic effects (can’t see, pee, shit, spit), sexual dysfunction

Adverse effects: hyper/hypotension, EPS, NMS, agranulocytosis, thrombocytopenia

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22
Q

How is NMS treated?

Medical emergency

A

 Immediate withdrawal of antipsychotics,
 hydration, hypothermic blankets, antipyretics, icepacks
 benzodiazepines, muscle relaxants

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23
Q

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

A

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

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24
Q

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

A

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

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25
Q

Lorazepam interactions/pt teaching

A

Increases CNS depression with alcohol, other CNS depressants, cimetidine increases lorazepam serum levels

Smoking and caffeine decreases antianxiety effects

Oral contraceptives decrease effects

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26
Q

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/

A

alcohol , sedatives, hypnotics, and barbituates

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27
Q

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

A
  • Headache, nervousness, restlessness
  • Insomnia, tremors, seizures
  • GI distress
  • Sexual dysfunction
  • Suicidal ideation (watch in early stages)
  • Serotonin Syndrome
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28
Q

Side effects/Adverse effects of SNRIs

(SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS)

A

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

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29
Q

Serotonin syndrome sx

Within hrs of starting a new drug or increasing dose

STOP THE DRUGS

A

hypertensive, hyperreflexia, clonus, fever, mydriasis, tachycardia, diaphoresis, agitation, tremors

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30
Q

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

A

-foods w/ tyramine
-vasoconstrictors and cold medications

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31
Q

General patient teaching for antidepressants

A
  • 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
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32
Q

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

A
  • 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.
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33
Q

Patient teaching for lithium

A

-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.

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34
Q

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)

A
  • brady/tachycardia
  • anorexia
  • diarrhea
  • visual disturbances
  • abdominal cramps
  • nausea/vomiting
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35
Q

Digoxin has a very narrow therapeutic range

What is it for dysrhythmias? HF?

A

○ 0.8-2 for dysrhythmias
○ 0.5-1 for HF

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36
Q

Patients taking digoxin w/ diuretics & cortisone should

A

take potassium supplement or foods rich in potassium to avoid hypokalemia and digitalis toxicity

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36
Q

Ascertain apical pulse rate before administering digoxin.

Digoxin should be held for HR less than

A

60 bpm

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37
Q

Promote sodium and water loss → decrease blood volume → lower BP

A

diuretics

Types:
* Thiazide and thiazide-like
* Loop diuretics
* Potassium-sparing diuretics
* Osmotic diuretics

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38
Q

Diuretic that acts on the distal convoluted renal tubule to promote Na, chloride, & water excretion

Treats HTN, peripheral edema, and HF (w/ACEi)

A

Thiazide & Thiazide-like diuretics

Ex: Hydrochlorothiazide (HCTZ, Microzide)

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39
Q

Side affects & adverse effects of thiazide diuretics

A

SE:
-fluid & electrolyte imbalances
-dizziness, HA, N/V, constipation

AE:
-significant hypokalemia (potassium wasting)
-dehydration
-renal failure

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40
Q

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

A

Loop diuretics

The most powerful diuretics

Ex: furosemide (Lasix)

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41
Q

Side effects & adverse effects of loop diuretics

A

SE:
-fluid & electrolyte imbalances
-high cholesterol
-orthostatic hypotension
-dehydration

AE:
-ototoxicity
-dysrhythmias

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42
Q

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

A

Potassium-sparing diuretics

Ex: spironolactone (Aldactone)

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43
Q

Side effects & adverse effects of Potassium sparing diuretics

A

SE: N/V, diarrhea, dizziness, impotence, muscle cramps

AE: orthostatic hypotension, fainting, hyponatremia, hyperkalemia, hyperglycemia, hypocalcemia

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44
Q

Nursing interventions for Potassium sparing diuretics

A

Administer spironolactone in the morning to avoid nocturia

Teach pts to avoid foods high in Potassium and salt substitutes

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45
Q

Diuretic that increases osmotic pressure in plasma, extracts fluid from cells in brain

Used to decrease ICP and intraocular pressure (glaucoma)

A

Osmotic diuretic

Ex: mannitol (Osmitrol)

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46
Q

Side effects & adverse effects of Osmotic diuretics

A

fluid and electrolyte imbalances, pulmonary edema, nausea, vomiting, tachycardia, and acidosis

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47
Q

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

A

metoprolol (Lopressor)

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48
Q

Side effects of beta blockers

A
  • 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

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49
Q

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

A

drowsiness, dry mouth, dizziness, bradycardia, edema (can cause sodium and water retention)

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50
Q

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

A

persistent dry cough, dizziness, postural hypotension, N/V, tachycardia, hyperkalemia, angioedema (life-threatening swelling of face, tongue, lips, larynx), renal failure, fatigue

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51
Q

Contraindications for ACEi

Ex: enalopril

A
  • 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

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52
Q

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

A

Dizziness, hypotension, hyperkalemia

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53
Q

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?

A

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

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54
Q

CCBs side effects & adverse effects

A

SE: constipation, nausea, headache, flushing, rash, edema (legs), hypotension, drowsiness, dizziness, bradycardia

AE: dysrhythmia, worsening heart failure (with verapamil and diltiazem), Stevens Johnson syndrome

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55
Q

Important pt teaching for CCBs

A

-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

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56
Q

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

A

Heparin

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57
Q

Heparin side effects & antidote

A

excessive bleeding, heparin-induced thrombocytopenia
(HIT), osteoporosis

Antidote for hemorrhage: protamine sulfate

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58
Q

Low molecular weight heparin (LMWH) anticoagulant that does not require aPTT

A

enoxaparin (Lovenox)

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59
Q

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

A

SE: bleeding (monitor for signs of bleeding- petechiae, ecchymosis, GI bleeding, ocular hemorrhage, hematuria)

AE: hemorrhage (rare, possibly life-threatening), warfarin induced skin necrosis

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60
Q

What is the antidote for warfarin?

A

Vitamin K

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61
Q

Warfarin pt teaching points

A

 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

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62
Q

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

A

Antiplatelet drugs

Ex: aspirin and clopidrogel

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63
Q

Inhibit COX enzyme to reduce platelet aggregation

  • prevent/treat MI & thromboembolism
  • stroke
    -TIA
    -Maintain vascular grafts

Side effects: prolonged bleedings time, GI effects

A

aspirin

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64
Q

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

A

clopidogrel (Plavix)

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65
Q

It is important for patients to read labels of OTC medications when taking antiplatelet drugs. Why?

A

They need to avoid products with aspirin and NSAIDs.

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66
Q

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?

A

No! Must get CT beforehand to determine type of stroke.

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67
Q

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

A

HMG CoA reductase inhibitors (statins)

Ex: atorvastatin calcium (Lipitor)

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68
Q

Side effects & adverse effects of statins

A

Side effects: constipation, peptic ulcers, muscle ache

Adverse effects: hepatic/renal failure, vision changes (cataract development), Rhabdo

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69
Q

Nursing interventions for statins

A

-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

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70
Q

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

A

stomach upset, diarrhea, and gallstones

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71
Q

First gen NSAIDs

A

salicylates (aspirin) and propionic acid derivatives (ibuprofen)

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72
Q

Second gen NSAIDs

A

COX-2 inhibitors (celecoxib)

COX-2 triggers inflammation and pain

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73
Q

Intended response of NSAIDs

A

reduced redness, pain, swelling, and warmth at site of
inflammation; increased function; reduced fever

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74
Q

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

A

aspirin

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75
Q

Side effects of aspirin

A

Gastric distress is common (anorexia, dyspepsia, NV, diarrhea, constipation, abdominal pain)

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76
Q

Adverse reactions of aspirin

A

tinnitus, hearing loss, GI bleeding, ulceration, perforation/anaphylaxis, Reye syndrome, Stevens-Johnson syndrome, thrombocytopenia, leukopenia, agranulocytosis, hepatotoxicity

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77
Q

True or False

Aspirin can be taken with other NSAIDs

A

False

Aspirin should NOT be taken with other NSAIDs (decreases blood level and effectiveness of NSAIDs)

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78
Q

Aspirin Contraindications

A

Hypersensitivity to salicylates or NSAIDs, GI bleeding

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79
Q

How does aspirin effect labs

A
  • Increase PT, bleeding time, INR, uric acid (gout)
  • Decreased cholesterol, T3 and T4 levels
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80
Q

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

A

ibuprofen

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81
Q

Drugs of choice for patients with severe arthritic conditions who need high doses of an anti-inflammatory drug

A

Selective COX-2 inhibitors

Ex: celecoxib

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82
Q

Celecoxib side effects

A

same as aspirin and ibuprofen, add TENDON RUPTURE

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83
Q

NSAID administration

A

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)

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84
Q

Prevent or limit inflammation by slowing or stopping all known pathways of inflammatory mediator production

End in *lone or *sone

A

corticosteroids

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85
Q

Side effects of corticosteroids

A
  • 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)
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86
Q

Cushingnoid appearance

A

moon face, buffalo hump, hirsutism, weight gain, skin ulcers, HTN & cardiac hypertrophy, muscle wasting, osteoporosis, erectile dysfunction, amenorrhea, emotional disturbances

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87
Q

Adverse effects of corticosteroids

A

adrenal gland atrophy, masking of infection, delayed wound healing

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88
Q

Patient teaching for corticosteroids

A

do not suddenly stop taking drug, take w/food, avoid crowds

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89
Q

What happens if we don’t taper corticosteroids?

A

acute adrenal insufficiency crisis (medical emergency caused by a lack of cortisol)

90
Q

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

A

organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer)

91
Q
  • 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
A

Antigout Drugs: Colchicine

92
Q
  • 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
A

Antigout Drug: Allopurinol

93
Q
  • 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
A

acetaminophen

94
Q

What are the early symptoms of hepatic damage from excessive acetaminophen?

A

N/V, diarrhea, abdominal pain

95
Q

Acetaminophen overdose antidote

A

N-acetylcysteine

Ex: Mucomyst, Acetadote

96
Q

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

A

Opioid analgesics

Ex: morphine

97
Q

Opioid patient teaching

A
  • 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
98
Q

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
A
  • Morphine most often used for PCA
  • Also fentanyl, hydromorphone
99
Q

Block opioid activity
* Compete for opioid receptor, displaces opioid
* Reverse symptoms of addiction, toxicity, and overdose

A

Opioid antagonist

Ex: Naxalone (Narcan)

100
Q

Side effects of opioid antagonist

A
  • Sweating, flushing, agitation, dyspnea
  • Hypo/hypertension, tachycardia
  • Nausea, vomiting
  • Reversal of analgesia (rapid)
101
Q

Opioid Withdrawal (3 or more symptoms)

A
  • Dysphoric (negative) mood
  • N/V
  • Muscle aches
  • Runny nose or watery eyes
  • Dilated pupils
  • Goosebumps or sweating
  • Diarrhea
  • Fever
  • Insomnia
101
Q

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

A

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)

Ex: Zidovudine

102
Q

ART is a life-long treatment that helps people with HIV live longer, healthier lives. But effective ART depends on adherence.

A

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)

103
Q

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.

A

Diphenhydramine (Benadryl)

104
Q

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.

A

Azelastine, Cetirizine, & Loratadine

105
Q

Properties of antihistamines

A

antihistaminic, anticholinergic, and sedative

106
Q

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.

A

Nasal decongestants

Ex: Oxymetazoline (Afrin)

107
Q

Repeated or freq. use of nasal spray/drops can result in

A

tolerance/rebound nasal congestion.

May need to take permanently.

108
Q

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.

A

Systemic decongestants

Ex: Pseudoephedrine (Sudafed) and Phenylephrine hydrochloride

109
Q

Used for nonproductive coughs, suppresses cough

Act on the cough control center in the medulla

Cross the placenta and breastmilk

Name class and drugs.

A

Antitussive

Ex: Benzonatate (Tessalon), Codeine, Dextromethorphan (Benylin), and Hydrocodone (hHcodan)

110
Q

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

A

Expectorants

Ex: Guaifenesin (Mucinex)

111
Q

Short acting beta2 adrenergic agonist

Rapid onset of action (5-15 min) for acute bronchospasm

Rescue inhaler

A

Albuterol

112
Q

Side effects and adverse effects of beta2 adrenergic agonists

A

 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 *
113
Q

INSTRUCTIONS: INHALATION (AEROSOL) THERAPY

A

 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

114
Q

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?

A

METHYLXANTHINES

Ex: Theophylline

115
Q

Theophylline has a low therapeutic index & narrow desired therapeutic range. What is it?

A

5-15mcg/mL

116
Q

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

A

Cromolyn

117
Q

Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function

A

Glucocorticoid medications

118
Q

Side effects and adverse effects of glucocorticoid meds

A

 Euphoria, insomnia, psychotic behavior
 Hyperglycemia
 Peptic ulcer
 Fluid retention
 Withdrawal symptoms
 Increased appetite

Never stop medication abruptly!

119
Q

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

A

TH replacement drugs

Ex: levothyroxine sodium (Synthroid)- synthetic form of thyroxine (T4)

120
Q

Side effects & adverse effects of levothyroxine sodium (Synthroid)

A

Side effects – thyrotoxicosis (tachycardia, tremors, angina, insomnia, heat intolerance) hypertension, increased bowel movements, weight loss, N/V

Adverse effects –MI, HF, seizures, palpitations

121
Q

Pt teaching when administering TH replacement drugs

A

-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

122
Q

Hyperthyroidism

Drugs that block the action of thyroid peroxidase (inhibiting hormone synthesis

PTU blocks conversion of T4 to the more active form of T3

A

Thyroid-Suppressing Drugs

Ex: methimazole (Tapazole), propylthiouracil (PTU)

123
Q

Side effects & adverse effects of propylthiouracil (PTU)

A

Side effects include agranulocytosis and rash

PTU may cause hepatotoxicity

124
Q

Pt teaching when administering Thyroid-Suppressing

A

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

125
Q

What needs to be checked before and after administering thyroid-suppressing drugs?

A

Check before: liver function tests

Check after: blood counts; assess for jaundice

126
Q

Adverse effects of insulin

A

Adverse effects – hypoglycemia (insulin shock)

Can result from:
Insulin overdose
Improper timing of insulin dose
Skipping a meal

127
Q

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

A

2nd gen Sulfonylureas

Ex: glipizide (Glucotrol)

128
Q

Side effects & adverse effects of glipizide (Glucotrol)

A

-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

129
Q

Drugs that stimulate pancreatic beta cells to release insulin (action similar to sulfonylureas)

Short-acting

Take 15-30 minutes before each meal

A

Meglitinides

Ex: nateglinide (Starlix) and repaglinide (Prandin)

130
Q

Meglitinides are contraindicated in pts w/

A

Liver dysfunction (decrease liver metabolism, more drug in the body, could cause hypoglycemia)

131
Q

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

A

Biguanides

Ex: Metformin (Glucophage)

132
Q

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?

A

48 hrs

133
Q

What is the goal of immunosuppression?

A

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

134
Q

Cyclosporine is a immunosuppressant- maintenance drug that suppresses activation of T lymphocytes.

Adverse effects?

A

Hypertension, blood sugar, cholesterol
Nephrotoxicity, Acute Renal Failure
Electrolyte disturbance
Neurotoxicity with increased trough levels
Gingival hyperplasia, hirsutism

135
Q

What monitoring is required for cyclosporine?

A

Trough levels, electrolytes, renal function, BP, blood sugar

AVOID grapefruit juice

136
Q

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?

A
  • Contraindicated in individuals with previous anaphylaxis to this vaccine or gelatin and neomycin (antibiotic)
  • Contraindicated during pregnancy
137
Q

Antiemetics that blocks dopamine receptors in the brain

Inhibits signals to vomiting center in medulla

Uses: post-op nausea, vomiting, chemotherapy, radiation sickness

A

Dopamine Antagonists

Ex: Chlorpromazine (Thorazine), prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol)

138
Q

Side effects & adverse effects of promethazine (Phenergan)

Applies to other dopamine antagonists

A

Side effects: Dry mouth, sedation, constipation, orthostatic hypotension, tachycardia

Adverse effects: Extrapyramidal symptoms with prolonged therapy

139
Q

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

A

Serotonin Antagonists

Ex: Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)

140
Q

Side effects & adverse effects of ondansetron (Zofran)

A

Side effects: Headache, dizziness, hypotension, palpitations, constipation, edema, fatigue

141
Q

Misc. antiemetic blocks dopamine receptors in CTZ

Uses: post-op emesis, chemotherapy, radiation therapy

High doses can cause sedation and fatigue

A

Metoclopramide (Reglan)

142
Q

Side effects of Metoclopramide (Reglan)

A
  • Drowsiness, fatigue, headache, anticholinergic side effects (constipation, urinary retention, blurred vision, tachycardia)
  • EPS (involuntary movements)
143
Q

Nursing interventions for antiemetics

A
  • 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
144
Q

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

A

Laxatives

145
Q

When should laxatives be avoided?

A

-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.

146
Q

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

A

Osmotic (Saline) Laxatives

Ex:
* Sodium salts (sodium phosphate or Phospho-Soda)
* Magnesium salts (magnesium hydroxide [Milk of Magnesia],
magnesium citrate)

147
Q

Side effects of magnesium hydroxide [Milk of Magnesia]

A

Fluid & electrolyte imbalances, cramps, NVD, flatulence

148
Q

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

A

Stimulant laxatives

Ex: Bisacodyl (Dulcolax)

149
Q

Side effects & adverse effects of bisacodyl (Dulcolax)

A

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)

150
Q

Laxatives that absorb water into the intestine, increase bulk, and peristalsis

Typically works in 1-3 days

Uses: short term tx, IBS, ileostomy/colostomy

A

Bulk forming laxatives

Ex: Psyllium (Metamucil), polycarbophil (FiberCon)

151
Q

Side effects & adverse effects of psyllium (Metamucil)

A

Side effects: cramps, n/v/d, flatulence

Adverse effects: insufficient fluid intake causes intestinal obstruction

152
Q

Bulk-Forming Laxatives: Patient Teaching

A
  • Mix in glass of water or juice
  • Stir and drink immediately
  • Follow with another full glass of water
153
Q

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

A

Emollients (Lubricants and Stool Softeners)

Ex: Docusate sodium (Colace)

154
Q

Side effects of Docusate sodium (Colace)

A

NVD, cramping

155
Q

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

A
  • 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
156
Q

Pt teaching for antidiarrheals

A
  • 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
157
Q

Drugs that decrease secretion of gastric acid, heal and prevent ulcers

Blocks H2 receptors in stomach –> decreases acid production

End in “tidine”

Most OTC

A

Histamine H2 blockers

Ex: Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid)

No more ranitidine (Zantac)

158
Q

Side effects of famotidine (Pepcid)

A

headaches, agitation, dizziness, n/v, constipation/diarrhea, erectile dysfunction, skin rash, pruritis, can decrease B12 absorption

159
Q

Nursing Interventions for Histamine H2 blockers

Ex: famotidine (Pepcid)

A
  • 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!
160
Q

What to eat when you have an ulcer

A

fruits veggies, legumes, lean meats, fish & seafood, eggs, whole soy foods, fermented dairy, healthy fats, grains, green tea, herbs & spices

161
Q

What to avoid when you have an ulcer

A

alcohol, coffee, caffeine, milk or cream, fatty meats, fried foods, heavily spiced foods, salty foods, citrus foods & juices, tomatoes, chocolate

162
Q

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”

A

Proton Pump Inhibitors (PPIs)

Ex: Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)

163
Q

Side effects and adverse effects of PPIs

A

Side effects: diarrhea, constipation, gas, headache

Adverse effects: allergic reactions, bone fractures from porous bones, GI bleeding

164
Q

Used as stress ulcer prophylaxis on Med-Surg units

A

PPIs

165
Q

Nursing Interventions for PPIs

A
  • 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
166
Q

Neutralize acidity of stomach contents, relieve heartburn and indigestion, decrease GERD symptoms, heal ulcers
* Short-acting

A

Antacids

Ex: Sodium bicarbonate (Alka-Seltzer), Calcium carbonate (Tums), Magnesium hydroxide/aluminum hydroxide (Maalox), Aluminum hydroxide (Amphogel) –> SCAM

167
Q

Side effects and adverse effects of antacids

A

Side effects (very rare): constipation (Al and Ca), diarrhea (Mg) = mellows GI tract), stomach cramps

Adverse effects: usually none

168
Q

Reminders for antacids

A

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

169
Q

Why should we do a C&S before starting antibiotics?

A

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.

170
Q

How long does it take for bacteria be seen in culture?

A

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

171
Q

Antibacterial that is bactericidal, most widely effective, & least toxic

Major side effect: allergy

A

Penicillin

172
Q

Side effects & adverse effects of penicillin

A

Side effects: NVD, pain at injection site

Adverse effects: bacterial resistance, allergic reaction, anaphylaxis, Clostridium difficile-associated diarrhea

173
Q

Nursing interventions for penicillin

A

-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.

174
Q

Side effects & adverse effects of ceftiaxone (Rocephin)

A

Side effects: GI distress (nausea, vomiting, diarrhea), Alteration in blood clotting (increased bleeding)

Adverse effects: Nephrotoxicity, Stevens-Johnson syndrome, Anaphylaxis, Thrombocytopenia

175
Q

Ceftiaxone (Rocephin) drug interactions

A

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

176
Q

Nursing interventions for Ceftiaxone (Rocephin)

A

-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.

177
Q

Penicillin substitute

Used if pt has a hypersensitivity to penicillin

A

Macrolides

Ex: Azithromycin

178
Q

Side effects of Macrolides

A

GI distress including nausea, vomiting, diarrhea, cramping
Photosensitivity
Headache, fatigue, dizziness
Oral candidiasis

179
Q

Adverse effects of Macrolides

A

Anaphylaxis
Superinfection
Hepatotoxicity (use with caution in patients with hepatic dysfunction)
Stevens-Johnson syndrome
Blood dyscrasias

180
Q

Nursing interventions for Macrolides

A

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)**

181
Q

Drugs used to treat MRSA, pseudomembranous colitis caused by clostridium difficile

Dosing may be based on peak & trough levels

A

Glycopeptides

Ex: Vancomycin

182
Q

Side effects of Glycopeptides

A

GI symptoms (nausea, vomiting)
Dizziness
Superinfection
Disulfiram-like reaction to alcohol

183
Q

Adverse reactions of Glycopeptides

Ex: Vancomycin

A

Ototoxicity**
Nephrotoxicity**
Anaphylaxis
Blood dyscrasias
Stevens-Johnson syndrome
Clostridium difficile-associated diarrhea

184
Q

S/sx of adverse reaction of Glycopeptides

Ex: Vancomycin

A

Occurs when IV too rapid
Severe hypotension
Red blotching of face, neck, chest, extremities
Toxic reaction not allergic reaction

185
Q

Nursing interventions for Vanco

A

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

186
Q

Side effects of Tetracyclines

Ex: Doxycycline

A

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

187
Q

Adverse effects of Tetracyclines

A

Anaphylaxis
Clostridium difficile-associated diarrhea
Ototoxicity, hepatotoxicity, nephrotoxicity
CNS toxicity
Pancytopenia, Stevens-Johnson syndrome

188
Q

Drug/food interactions for Tetracyclines

A

Milk products (decreased absorption)
Antacids
Oral contraceptives
Penicillins
Aminoglycosides

189
Q

Nursing interventions for Tetracyclines

A

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)**

190
Q

Side effects & adverse effects of Aminoglycosides

Ex: Gentamycin

A

SE: photosensitivity, superinfection, stomatitis, NV, fever, lethargy

AE: anaphylaxis, seizures, ototoxicity, nephrotoxicity, C. Diff, Stevens-Johnson syndrome

191
Q

Nursing interventions for Aminoglycosides

A

-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

192
Q

Side effects/adverse effects of Trimethoprim-Sulfamethoxazole

Ex: Trimethoprim-Sulfamethoxazole (Bactrim, Septral)

A

GI distress, stomatitis, photosensitivity
Crystalluria, renal failure
Blood dyscrasias, Stevens-Johnson syndrome

193
Q

Nursing interventions for Trimethoprim-Sulfamethoxazole

A

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**

194
Q

Side effects & adverse effects of Fluroquinolones

Ex: Ciprofloxacin (Cipro)

A

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

195
Q

Nursing interventions for Fluroquinolones

A

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**

196
Q

General take-home points for antibacterials

A

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

197
Q

Antitubercular drugs are either bactericidal or bacteriostatic.

First line TB drugs

A

Isoniazid (INH), Ethambutol, Pyrazinamide, and Rifampin

198
Q

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.

A

Isoniazid (INH)

199
Q

Side effects & adverse effects of INH

A

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

200
Q

Pt teaching for INH

A

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

201
Q

Antitubercular drug that inhibits enzyme needed for protein synthesis

A

Rifampin

202
Q

Side effects & adverse effects of Rifampin

A

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

203
Q

Ethambutol is an antitubercular drug that is bacteriostatic; inhibits cell wall synthesis

Side effects & adverse effects

A

Side effects: increase uric acid (use with caution in patients with gout)

Adverse effects: hepatotoxicity, optic neuropathy (in high doses)

204
Q

Most important adverse effect of Ethambutol

A

optic neuritis- results in visual acuity and loss of ability to discriminate between red and green

205
Q

Pyrazinamide (PZA) is an antitubercular drug with unknown mechanism of action

A

Side effects: increase uric acid, aches, pains, photosensitivity, acne

Adverse effects: Liver toxicity

206
Q

Although the drugs do focus on the tumor, they also attack other
fast-growing healthy cells.

General chemo side effects

A

● 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)

207
Q

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.

A

cyclophosphamide (nitrogen mustard)

208
Q

Nursing care for cyclophosphamide

A

◦ 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

209
Q

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:

A

● 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

210
Q

Nursing care for Doxorubicin (Adriamycin)

A

◦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.

211
Q

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

A

○ 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

212
Q

Nursing Care: Combined
Hormonal Contraceptives

A

● 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

213
Q

Clomiphene citrate is used to stimulate ovarian follicle growth (stimulating release of FSH & LH).

Side effects & adverse effects include

A

headache, dizziness, fatigue, depression, anxiety, GI distress,
gynecomastia, hot flashes,decreased visual acuity, ovarian
hyperstimulation, ectopic pregnancy

214
Q

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:

A

Side Effects → N/V, fluid retention, breast tenderness, breakthrough bleeding

Adverse effects → thromboembolism, PE, MI

Contraindicated in pregnancy (cat X) and lactation

215
Q

Hormone therapy = estrogen + progestin is used for females w/

A

an intact uterus

216
Q

Hormone therapy = estrogen only for females w/

A

a hysterectomy

217
Q

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:

A

Indications:
● Androgen deficiency, hypogonadism
● Replacement therapy for testicular failure
● Delayed puberty in adolescent

218
Q

Side Effects/Adverse Effects of Testosterone

A

● 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

219
Q

How to Treat BPH

A

● 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

220
Q

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

A

● Causes anticholinergic symptoms, drowsiness, & dyspepsia
● Instruct patient to report constipation that lasts longer than 3 days

221
Q

Tamsulosin inhibits smooth muscle contraction in the prostate, which improves the rate of urine flow for patients with BPH

Side effects include

A

decreased libido, HA, and dizziness (including orthostatic hypotension)

222
Q

Bethanechol Chloride increases detrusor muscle tone to allow strong start to voiding for patients with postoperative urinary hesitancy

Side effects include

A

Excessive salivation, abdominal cramping, diarrhea

Pharm (19 decks)

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