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NUR 326 > Final Exam Meds > Flashcards

Final Exam Meds Flashcards

1
Q

levothyroxine (Synthroid) therapeutic use

A
  • thyroid replacements
  • hypothyroidism
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2
Q

propylthiouracil (PTU) therapeutic use

A
  • antithyroid drugs/propylthiouracil
  • Hyperthyroidism (Graves’ disease)
  • Thyrotoxic crisis
  • Suppression of thyroid hormone production in preparation for thyroid- ectomy
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3
Q

hydrocortisone (Cortef, Solu-Cortef) therapeutic use

A
  • glucocorticoids
  • Replacement therapy for acute and chronic adrenocortical insufficiency
    (Addison’s disease)
  • NOTE: For detailed information about glucocorticoids that treat asthma,
    refer to the Respiratory System module. For detailed information about
    glucocorticoids that treat pain and inflammation refer to the Pain and
    Inflammation module.
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4
Q

propylthiouracil (PTU) adverse reactions

A
  • Hypothyroidism
  • Agranulocytosis
  • Hepatotoxicity
  • Aplastic Anemia
  • Rash
  • Arthralgia, headache
  • Vertigo, drowsiness, headache
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5
Q

propylthiouracil (PTU) nursing interventions

A
  • Monitor thyroid function.
  • Monitor for indications of hypothyroidism (fatigue and weakness, weight
    gain, cold intolerance, dry skin, and listlessness).
  • Recommend a reduced dosage for clients who develop these effects.
  • Monitor CBC at baseline and periodically thereafter (leukocytes, neutrophils).
  • Monitor for indications of agranulocytosis; for these symptoms, stop
    therapy.
  • Monitor integumentary status.
  • Monitor for joint and muscle pain and headache.
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6
Q

propylthiouracil (PTU) medication administration

A
  • Give orally at regular intervals, such as every 8 hr.
  • Measure baseline vital signs and weight and monitor periodically thereafter.
  • Monitor T3 and T4 levels.
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7
Q

propylthiouracil (PTU) client education

A
  • Watch for and report signs of hyperthyroidism and hypothyroidism
  • Report fever or sore throat.
  • Report rash.
  • Report joint or muscle pain or headache.
  • Report any OTC meds, herbal remedies, and supplements to the provider.
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8
Q

propylthiouracil (PTU) contraindications

A
  • hypersensitivity
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9
Q

propylthiouracil (PTU) precautions

A
  • immunosuppression
  • bone marrow depression
  • infection
  • liver dysfunction
  • pregnancy
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10
Q

propylthiouracil (PTU) interactions

A
  • Concurrent use with antineoplastics or radiation therapy can lead to
    additional bone marrow depression.
  • Increased antithyroid effects noted when taken with lithium or potassium iodide.
  • Risk of agranulocytosis increases with concurrent use of phenothiazines.
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11
Q

levothyroxine (Synthroid) adverse reactions

A
  • Thyrotoxicosis, Hyperthyroidism (from excessive doses)
  • Headache, irritability, insomnia
  • Abdominal cramping, diarrhea
  • Tachycardia, arrhythmia
  • Heat intolerance, diaphoresis
  • Menstrual irregularities
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12
Q

levothyroxine (Synthroid) nursing interventions

A
  • Monitor thyroid function.
  • Monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis,
    weight loss)
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13
Q

levothyroxine (Synthroid) medication administration

A
  • Give orally to treat hypothyroidism and IV to treat myxedema coma.
  • Give daily on an empty stomach (at least 30–60 min before breakfast
    with full glass of water).
  • Measure baseline vital signs, weight, and height, and monitor periodically thereafter.
  • Monitor for cardiac excitability (angina, chest pain, palpitations, dysrhythmias).
  • Monitor T4 and TSH levels.
  • Be aware that the various formulations of thyroxine are not interchangeable; instruct clients to notify the provider if a pharmacy dispenses a different levothyroxine product.
  • Expect lifelong replacement therapy.
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14
Q

levothyroxine (Synthroid) client education

A
  • Watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and
    chest pain.
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15
Q

levothyroxine (Synthroid) contraindications

A
  • Thyrotoxicosis
  • Recent myocardial infarction
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16
Q

levothyroxine (Synthroid) precautions

A
  • Cardiovascular disorders (hypertension, angina pectoris, ischemic heart
    disease)
  • Renal impairment
  • Diabetes mellitus
  • Older adults
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17
Q

levothyroxine (Synthroid) interactions

A
  • Cholestyramine (Questran), antacids, iron and calcium supplements,
    and sucralfate (Carafate) reduce absorption, so clients should not take
    levothyroxine within 4 hr of these drugs.
  • Food reduces absorption.
  • Many antiseizure and antidepressant drugs, including carbamazepine
    (Tegretol), phenytoin (Dilantin), phenobarbital, and sertraline (Zoloft),
    decrease levels.
  • Anticoagulant effects of warfarin (Coumadin) increase.
  • Cardiac response to catecholamines (such as epinephrine) increases.
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18
Q

hydrocortisone (Cortef, Solu-Cortef) adverse reactions

A

Few at low, therapeutic levels
* Multiple at high levels needed to suppress inflammation and the immune system
* Adrenal insufficiency
* Cushing’s Syndrome

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19
Q

hydrocortisone (Cortef, Solu-Cortef) nursing interventions

A
  • Monitor for side effects related to adrenal insufficiency
  • Weight loss, hypotension, weakness, anorexia, nausea, vomiting, confusion, lethargy or restlessness
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20
Q

hydrocortisone (Cortef, Solu-Cortef) medication administration

A
  • Give orally (with meals) for chronic adrenal insufficiency, as a total daily
    dose in the morning right after waking up or in divided doses (two thirds
    in the morning and one third in the early afternoon).
  • Give IV for acute and emergency situations.
  • Obtain CBC, electrolytes, glucose, and glucocorticoid levels at baseline
    and periodically thereafter.
  • Make sure clients wear a medical alert band and carry an emergency
    supply of glucocorticoids.
  • Taper the dose slowly to establish the lowest possible oral dose.
  • Give supplemental doses as needed in times of stress
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21
Q

hydrocortisone (Cortef, Solu-Cortef) client education

A
  • Report increased stress, as higher dosages are essential at such times
    (generally three times the usual dose for three days).
  • Avoid live vaccines
  • Monitor and report weight gain, swelling, or vision changes
  • Include a diet high in protein, potassium, calcium and low in sodium and
    carbohydrates
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22
Q

hydrocortisone (Cortef, Solu-Cortef) contraindications

A
  • When given in small doses – none
  • Large doses: severe infection and live vaccines
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23
Q

hydrocortisone (Cortef, Solu-Cortef) precautions

A
  • When given in small doses – none
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24
Q

hydrocortisone (Cortef, Solu-Cortef) interactions

A
  • When given in small doses – none
  • Large doses: oral contraceptives, phenytoin, phenobarbital, and rifampin
25
Q

First Generation (Conventional) Antipsychotics

A
  • chlorpromaizne (Thorazine), haloperidol (Haldol)
  • Use: suppress positive symptoms of schizophrenia
  • Pharmacologic Action: suppresses the release of dopamine by blocking the receptors for norepinephrine, acetylcholine, dopamine, and histamine
  • Adverse reactions: extrapyramidal effects (acute dystonia: hours to days, requires immediate intervention; tardive dyskinesia: months to years, requires immediate intervention, may get on benztropine to reverse effects, elevated temp, BP, HR, etc.; akathisia: days to weeks, treat side effect; pseudoparkinsonism: weeks to months, usually resolves, treat side effect; may need to hold med and call provider to discontinue), notice uncontrollable mouth movement
  • Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, tachycardia
  • Neuroleptic malignant syndrome (NMS): MEDICAL EMERGENCY
  • Sexual dysfunction
  • Administration: Give with food or water for GI upset; lay recumbent for 30 minutes are IM or IV; give IV bolus slow
  • Contraindications and Precautions: ETOH withdrawl, bone marrow suppression, CNS depression, pregnancy or lactation, COPD, glaucoma, diabetes, HTN, cardiac, liver, or thyroid disorders
  • Interactions: CNS depressants, antacids, antidiarrheals, increase levels of anticonvulsants (MEASURE SERUM LEVELS ESPECIALLY WITH MEDS FOR BPD [i.e. valproic acid (Depakote)])
26
Q

Anticholinergic Side Effects

A

SAME EFFECTS OF ANTIHISTAMINES
- Blind as a bat
- Dry as a bone
- Red as a beet
- Mad as a hatter
- Full as a flask
- Hot as a hare
OR
- can’t pee
- can’t see
- can’t spit
- can’t shit

27
Q

Extrapyramidal Effects (EPS)

A
  • Pseudoparkinsonism: stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill-rolling motion of the hand, sluggish movements
  • Acute Dystonia: facial grimacing, involuntary upward eye movement, muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward), laryngeal spasms, severe and painful spasms
  • Akathisia: restless, trouble standing still, paces the floor, feet in constant motion (rocking back and forth), uncontrollable need for movement
  • Tardive dyskinesia: protrusion and rolling of the tongue, sucking and smacking movements of the lips, chewing motion, facial dyskinesia, involuntary movements of the body and extremities
28
Q

Treatment of Extrapyramidal Effects (EPS)

A
  • Acute dystonia: emergency IM or IV injection of anticholinergic
  • Tardive dyskinesia: hold the med, then contact provider
29
Q

Neuroleptic Malignant Syndrome

A

Signs and Symptoms: very high fever (102 - 104 degrees F), irregular pulse, tachycardia,tachypnea, muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low BP
- Nursing interventions: cooling blanket, aspirin or APAP for fever, hydration, IV admin of bromocriptine or dantrolene (dopamine agonist and muscle relaxer)

30
Q

Second Generation (Atypical) Antipsychotics

A
  • risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel)
  • Use: treats schizophrenia, bipolar disorders, irritability due to autism
  • Pharmacologic Action: blocks dopamine and serotonin receptors
  • Adverse Reactions: EPS at high doses, metabolic side effects (weight gain, dyslipidemia, diabetes), drowsiness, insomnia, dizziness, elected prolactin –> gynecomastia (male breast development)
  • Administration: PO mix with juice, milk or H2O, sublingual, IM Q2Weeks
  • Contraindications/Precautions: CNS disorders, cardiac concerns, cerebrovascular accidents, hypotension, seizure disorders, kids and older adults
  • Interactions: increase effects of antihypertensives, interacts with anticonvulsants
31
Q

benztropine (Cogentin)

A
  • Anticholinergic
  • Use: treat side effects associated with antipsychotics (i.e. pseudoparkinsonism, acute dystonia, etc.)
  • Pharmacologic Action: blocks histamine receptors and antagonizes (blocks) acetylcholine
  • Adverse Reactions: anticholinergic effects (can’t see, can’t pee, can’t spit, can’t shit)
  • Administration: PO, IV, or IM
  • Contraindications/Precautions: glaucoma, tardive dyskinesia, GI obstruction or ileus, caution in kids and older adults
  • Interactions: increased effects if taken with other antihistamines or anticholinergics, CNS depressants, decreased effects if taken with cholinergic medications
32
Q

digoxin (Lanoxin) therapeutic use

A
  • Cardiac Glycosides/inotropic
  • Second-line drug for HF
  • Treats some cardiac dysrhythmias
  • Atrial fibrillation
  • Atrial flutter
  • Paroxysmal atrial tachycardia
33
Q

digoxin adverse reactions

A
  • Cardiac dysrhythmias, especially likely with digoxin toxicity
  • Any dysrhythmia may occur, with AV block being most common
  • GI symptoms – early signs of toxicity
  • Nausea, vomiting, anorexia
  • CNS symptoms
  • Fatigue, visual disturbances, such as yellow vision and blurred vision
  • Increased mortality in women
34
Q

digoxin contraindications and precautions

A

Contraindications:
* Uncontrolled Ventricular dysrhythmias
* AV block or severe heart disease
* Digoxin toxicity

Precautions:
* Hypokalemia, hypercalcemia
* Concurrent use of diuretics
* Impaired kidney function
* Infants, children and older adults

35
Q

digoxin interactions

A
  • Erythromycin and some other antibiotics increase digoxin levels
  • Other antidysrhythmics (verapamil, quinidine, amiodarone, flecainide)
    increase digoxin levels; decrease digoxin dosage for concurrent
    administration
  • Diuretics increase risk for digoxin toxicity by decreasing potassium
    levels
  • Herbal ginseng increases risk of digoxin toxicity; St. John’s wort
    decreases digoxin levels
  • Note that the above interactions do not comprise a complete list. It’s
    important to check for interactions when other drugs are given along
    with digoxin
36
Q

digoxin administration

A
  • Available as oral tablets, capsules, and elixir, as well as for IV use
  • Give oral form with or without food
  • Tablets may be crushed and mixed with food if necessary
  • IV form may be administered directly over at least 5 min; monitor site
    carefully for infiltration, which can cause tissue damage
37
Q

digoxin nursing interventions

A
  • Recognize that vomiting can cause hypokalemia, which increases risk
    for digoxin toxicity
  • Monitor for and report GI symptoms
  • Monitor for and report CNS effects
  • Take apical pulse for 1 full minute before administering digoxin;
    withhold drug if pulse falls below prescribed parameters (such as 60/
    min in adults)
  • Monitor digoxin levels frequently
  • Monitor serum potassium levels; administer potassium for low or
    borderline low values
  • Monitor cardiac rhythm and treat dysrhythmias per protocol
  • For severe digoxin toxicity, digoxin immune FAB (Digibind) is
    administered IV as an antidote to neutralize digoxin
38
Q

digoxin client educations

A
  • Report nausea, loss of appetite, or vomiting to provider
  • Report headache, visual disturbances to provider
  • Report heart palpitations to provider
  • Learn to monitor pulse rate and report decrease or increase beyond
    prescribed parameters
  • To decrease risk of toxicity or low serum levels, take digoxin at the
    same time each day; do not skip or double a dose
  • Report signs of hypokalemia, such as muscle weakness
  • High risk of toxicity
39
Q

furosemide (Lasix) therapeutic use

A
  • Loop diuretic
  • Treats pulmonary edema in heart failure
  • Treats edema caused by renal, hepatic or cardiac failure not affected by
    other diuretics
  • Treats hypertension not controlled by other diuretics
40
Q

furosemide (Lasix) adverse reactions

A
  • Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss
    (dehydration), and hypokalemia
  • Hypotension
  • Ototoxicity (all loop diuretics can be temporary or permanent
    depending on the specific drug)
  • Hyperglycemia (especially in clients who have diabetes mellitus)
  • Increased uric acid levels (hyperuricemia) with possible gouty arthritis
    in susceptible clients
41
Q

furosemide (Lasix) nursing interventions

A
  • Monitor serum electrolyte levels periodically; notify provider for
    abnormal levels
  • Monitor carefully for signs of electrolyte imbalance
  • If hypokalemia occurs, monitor for cardiac dysrhythmias
  • If hypokalemia is a risk (e.g., client also taking digoxin) furosemide can
    be combined with a potassium-sparing diuretic
  • Monitor blood pressure frequently during treatment
  • Ensure that the client does not take other ototoxic drugs (additive
    effect)
  • Monitor for hearing loss, tinnitus, and vertigo
  • Monitor blood glucose periodically in all clients
  • Monitor blood glucose more frequently in clients who have diabetes
    mellitus; insulin or oral antidiabetic drug dosage can need to be
    increased
  • Monitor uric acid levels periodically
42
Q

furosemide (Lasix) medication administration

A
  • Available for oral, IM, or IV use
  • Give oral form with food to prevent GI symptoms
  • If prescribed more than once daily, give second dose by early afternoon
    to prevent nocturia and sleep loss
  • Give IV form undiluted; administer slowly to prevent ototoxicity
  • Protect all forms from light; store oral solution in refrigerator and other
    forms at controlled room temperature
43
Q

furosemide (Lasix) client education

A
  • Eat foods rich in potassium (if indicated), such as citrus fruits, potatoes,
    and bananas
  • Report signs of electrolyte imbalance, such as confusion, muscle
    twitching or weakness, irregular pulse, and nausea
  • Teach client to have blood pressure monitored frequently
  • Report dizziness, syncope to provider
  • Avoid hazardous activities (e.g., driving) until effects are known
  • Report new onset of hearing loss, ringing in ears, or vertigo to provider
  • Clients who have diabetes mellitus need to carefully monitor blood
    glucose levels and notify provider for persistent hyperglycemia
  • Know that this effect can occur, usually without symptoms
  • Clients who have a history of gout need to report symptom onset to
    provider
44
Q

furosemide (Lasix) contraindications and precautions

A

Contraindications:
* Allergy to furosemide
* Hepatic coma
* Electrolyte imbalance or dehydration
* Anuria

Precautions:
* Renal or hepatic disorders
* Diabetes mellitus
* Older adults
* Pregnancy/lactation

45
Q

furosemide (Lasix) interactions

A
  • Digoxin toxicity is a high risk with hypokalemia
  • Other diuretics increase the diuretic effect
  • NSAIDs can decrease diuretic effect
  • Neuromuscular blocking agents can have prolonged effect
  • Lithium toxicity can occur
  • Amphotericin B and corticosteroids increase risk for hypokalemia
  • Other ototoxic drugs (e.g., aminoglycoside antibiotics) increase risk for
    ototoxicity
46
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) therapeutic use

A
  • Penicillins
  • Treats broad-spectrum infections caused by gram-positive cocci and
    bacilli, such as ear and throat infections and urinary tract infections.
  • Amoxicillin treats gonorrhea caused by non-penicillinase-producing
    bacteria.
  • Addition of clavulanic acid increases spectrum of disorders treated by
    amoxicillin and its ability to kill bacteria.
47
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) adverse reactions

A
  • GI symptoms: diarrhea, nausea, vomiting
  • Rarely may cause Clostridium difficile (C. Diff) superinfection (more
    frequent with other antibiotics than amoxicillin)
  • Superinfection with Candida albicans
  • Allergy to penicillin (rash, hives, wheezing and difficulty breathing)
48
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) nursing interventions

A
  • Monitor for GI symptoms.
  • Monitor and report bloody stools or long-term watery diarrhea.
  • Monitor for and report Candida infections of mouth or vagina.
  • Expect to treat Candida infections with an antifungal agent.
  • Ask clients if they are allergic prior to administering the first dose.
  • Monitor for allergy manifestations and notify provider.
  • For injectable penicillins (IM or IV), keep client in facility for 30 min after
    administration and monitor for allergy.
  • Prepare to treat rash/hives with antihistamines; anaphylaxis with
    epinephrine and respiratory support.
49
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) medication administration

A
  • Client should not crush or chew extended-release form.
  • Chew chewable forms before swallowing.
  • For infants or young children, place drops directly on tongue or mix
    with a small amount of juice or formula; ensure that child takes full
    dose.
  • Give at the beginning of meals to decrease GI symptoms and increase
    absorption.
  • Give amoxicillin with probenecid, if prescribed, to increase therapeutic
    activity of amoxicillin.
50
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) client education

A
  • Report watery or bloody diarrhea to provider.
  • Take drug at the start of meals.
  • Report mouth pain or inability to eat.
  • Report vaginal burning, itching, and discharge.
  • Stop drug and notify provider for possible allergic reactions.
  • Call 911 for severe symptoms, such as difficulty breathing.
51
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to penicillins, hypersensitivity to procaine and benzathine

PRECAUTIONS
* Renal impairment may need reduced dose

52
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) interactions

A
  • Probenecid increases penicillin blood levels.
  • Bacteriostatic agents may decrease therapeutic effects.
  • Reduced effectiveness of oral contraceptives.
53
Q

vancomycin (Vancocin) therapeutic use

A
  • Vancomycin
  • Severe infections
  • Methicillin-resistant Staphylococcus aureus infections (MRSA)
  • Infections in clients with an allergy to penicillin
  • Clostridium difficile-associated diarrhea (CDAD)
54
Q

vancomycin (Vancocin) adverse reactions

A
  • Renal failure secondary to nephrotoxicity
  • Hypotension, tachycardia and flushing of the face and trunk (“red man”
    syndrome) occur with rapid IV infusion
  • Rare – ototoxicity (usually reversible)
  • Thrombophlebitis at IV site and tissue damage with IV infiltration
55
Q

vancomycin (Vancocin) nursing interventions

A
  • Administer over 1 hr by IV infusion. Follow recommendations for
    dilution.
  • Monitor vital signs during infusion.
  • Monitor vancomycin trough levels.
  • Monitor BUN and creatinine levels.
  • Assess IV infusion for redness and swelling.
  • Assure that the IV is patent during infusion.
56
Q

vancomycin (Vancocin) medication administration

A
  • Give orally for C diff infections
  • Give IV for all other infections.
  • Administer slowly IV and follow recommendations for dilution.
  • Infuse separately, if possible (incompatible in solution with many other
    IV drugs).
57
Q

vancomycin (Vancocin) client education

A
  • Report flushing and feelings of faintness during IV infusion.
  • Instruct clients to report tinnitus or perceived loss of hearing.
  • Instruct clients to report an increase or decrease in urine output.
  • Report pain, swelling, and redness at IV site immediately.
  • Report vertigo
58
Q

vancomycin (Vancocin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to vancomycin
* Hypersensitivity

PRECAUTIONS
* Renal insufficiency (reduce dosage)
* Impaired hearing
* Colitis

59
Q

vancomycin (Vancocin) interactions

A
  • Drugs that are toxic to hearing or kidney increase the risk for ototoxicity
    or nephrotoxicity.
  • Vancomycin is incompatible in a solution with multiple other IV drugs.

NUR 326 (27 decks)

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