Herbals Flashcards
learn to recognize drugs and their details by their class suffix.
-nacin
antimuscarinic (anticholinergic)
- darifenacin, solifenacin
- EXCEPTIONS: ATROPINE, BENZTROPINE, OXYBUTYNINE (muscarinic antagonist)
- MOA: Slows GI motility, Mydriasis, Increase HR, Bronchodilation, Urinary Rtn,
- CI: Narrow angle glaucoma,
- T. Use:
- SE/AR: N, Atropine-effects [Dry mouth, blurred vision, mydriasis (IOP), constipation], Antihistamine effects (sedation, drowsiness)
- Intervention: Take w/ food,
-zosin
alpha blocker
- terazosin, prazosin, doxazosin
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention
-terol
beta agonist; bronchodilator
- albuterol, formoterol, salmeterol
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention
-olol
beta blocker (Beta-adrenergic blocker)
- propranolol, metoprolol, atenolol, carvediolol
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess: Blood sugar
- Intervention:
- Monitor blood sugars (masks hypoglycemia)
- Do not stop abruptly
-caine
local anesthetic
- bupivacaine, lidocaine, prilocaine, proparacaine
- MOA: lidocaine used for ventricular (VT and V-fib)
- T. Use:
- SE/AR: Confusion, drowsiness, muscle twitching, seizures, parasthesias (see slide 33 for SAMS toxicity)
- CI:
- Assess: Cardiac monitoring, lidocaine toxicity
- Intervention:
-dipine
calcium channel blocker (CCBs)
- amlodipine, nimodipine, nisoldipine (work only on vessels)
- EXCEPTIONS: diltiazem HCL, Verapamil (work on heart and vessels)
- Calcium channels found in SA node, AV node, cardiac cells, and vascular smooth muscles – causes contraction/constriction & produces cardiac impulse
- MOA: dec. Ca IN heart
- prevents muscle contraction → causes vasodilation → dec. BP → dec. afterload, peripheral resistance, and workload
- T. use: HTN, angina, Cardiac arrhythmias
- Interventions:
- SE/AR: Hypotension, Bradycardia, HA/flushing, dizziness, Reflex tachycardia
- CI: Digoxin, ß-blockers, Antihypertensives (ACEs, ARBs, a-blockers, diuretics), IV calcium, grapfruit juice
- Nimodipine - crosses BBB, can be used to dec. vasospasm in brain
-fenac
NSAID
- bromfenac, diclofenac, nepafenac
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention
-lamide
carbonic anhydrase inhibitor
- acetazolamide, brinzolamide, dorzolamide, methazolamide
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention
parin; -parin
antithrombotic; anticoagulant (blood thinner)
- warfarin, heparin, tinzaparin,
- EXCEPTION: fondaparinux
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-phylline
xanthine derivative (bronchodilator)
- aminophylline, dyphylline, theophylline
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-pril
ACE inhibitor
- lisinopril, benazepril, captopril, enalapril, moexipril, ramipril
- MOA: dilates venuoles/arterioles → improves renal blood flow and dec. fluid vol.
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-profen
NSAID
- fenoprofen, flurbiprofen, ibuprofen, ketoprofen
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-sartan
angiotensin II receptor antagonist; ARB
- candesartan, irbesartan, losartan, olmesartan, valsartan
-semide
loop diuretic (water pill)
- furosemide, torsemide
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-statin
HMB-CoA reductase inhibitor; statins
- atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin
- MOA:
- T. Use:
- SE/AR:
- CI:
- Assess:
- Intervention:
-thiazide
thiazide diuretic (water pill)
- chlorothiazide, hydrochlorothiazide, methyclothiazide
- MOA:
No suffix
Cardiac Glycosides
- Digoxin, Digitoxin, Oubain
- MOA:
- Inc. [Na and Ca] in cardiac cells – inc. force of contraction
- Negative chronotropic fx – dec. HR
- T. use
- HF, afib & aflutter
- SE/AE: Digitalis toxicity! → N.V.D, loss of appetite (anorexia), HA, anxiety, blurred vision/ yellow vision, confusion, halluciations
- Cardiotoxicity → bradycardia
- CI:
- hypokalemia (inc. dig toxicity), hyperkalemia (dec. efficacy), Impaired renal, AV block, Wolff-Parkinson-White syndrome
- Drug I -
- Diuretics (K loss can inc. fx),
- Glucocorticoids (Inc. fx),
- Antacids (dec. absorp),
- St. John’s Wart (dec. fx),
- Sympathomimetics (dopamine inc. HR),
- ACE Inhibitors and ARB (inc. risk of hyperkalemia)
- Quinidine (inc. digtox)
- Verapamil (inc. levels of digoxin)
- Antidote: digoxin immune Fab (Digiband)
- Assessment:
- Toxicity; AHR (full60) hold if
- Monitor serum K and digoxin levels, report abnormals
- Teaching:
- Take pulse before med, Take at same time daily, Report SE of hypokalemia and digtox, Consult HCP before OTC (inlcuding antacids), Eat foods high in K, Admin IV over >5min.
General considerations for herbal use
- Do not take if pregnant or nursing
- Do not give to infants and young children
- Use safest for middle-aged, healthy adults
- Do not take in large quantities
- Buy only products w/plant and quantity labled
- Contact HCP before stopping Rx
- Store in a cool dry place
- Use only current products
- Don’t delay seeking care
- Advise against “miracle cures”
- Herbs are NOT placebos
- Risk for interactions are greater
Aloe vera
- External
- pain relief
- healing burns
- Internal
- constipation, arrhythmias, neuropathies, edema
Chamomile
- Relief of digestive complaints
- May have sedative effects
- Rare allergic rxn of urticaria and bronchoconstriction if allergic to daisy or ragweed.
Dong quai
- All-purpose woman’s tonic
- Frequently mixed with fillers
- Contains B12
- SE:
- fever
- excessive menstrual bleeding
Echinacea
- Stimulates immune system; however, immunosuppression may occur with extended use
- For colds, flu, recurrent respiratory and UT infections, limit to 2 weeks
- People w/ autoimmune diseases should not use.
Evening primrose
- Natural estrogen promoter; aids in lowering cholesterol and relieving pain and inflammation
- may lower seizure threshold if taken with an anticonvulsant
Feverfew
- Interferes with platelet aggregation; acts as a serotonin antagonist for migraine headaches, RA, PMS
Garlic
- Detoxifies and increases immune function; decreases platelet aggregation; for hypercholesterolemia, mild HTN
Ginger
- Stimulates digestion; antispasmodic; decreases platelet aggregation
Ginkgo biloba
- Antioxidant; peripheral vasodilator and increased blood flow to CNS; decreased platelet aggregation
- Used for dementia, early stroke, and Raynaud’s phenomenon
Kava Kava
- CNS sedation without loss of mental acuity or memory; may be hepatotoxic
Licorice
- Antiinflammatory; antibacterial; antiviral; topical: psoriasis and eczema
Milk Thistle
- Increases liver cell regeneration; liver tonic; cirrhotic disease slows and increased quality of life
Ginseng
- Used for stress relief
- Boosts energy, helps digestion
- Supports immune system, preventing infections
Peppermint
- Internal: stimulates appetite and aids in digestion
- External: relief of tension headaches when rubbed on forehead (according to research in Germany, comparable to acetaminophen)
Sage
- Herb of longevity
- Used for sore throat and cough
- Limit use to 2 weeks
Saw palmetto
- Decreases size of prostate; discontinue herb 1 to 2 weeks before PSA test because can cause false-negative test results
- “Plant catheter”
Velerian
- Mild sedative
- Sleep-inducing agent
- “Herbal valium”
- “Dirty socks” odor
St. John’s Wort
- Antidepressant and antiviral; for depression, anxiety, sleep disorders;
- effects in 4 to 8 weeks;
- drug interactions: transplant medications and antidepressants;
- not of benefit to HIV clients
- Can cause serotonin syndrome when taken with prescription anti-depressants
- NOTE: the table on p. 172 states SJW decreases level/effects of all the meds listed—this is WRONG!!
- It will increase effects of SSRIs, MAOIs, & benzodiazapines
- It will decrease effectiveness of Coumadin, Oral Contraceptives, Theophylline, and Digoxin
Potential Hazards of Herbs
- No preparations are safe in all situations
- Contamination
- Interaction with Rx and OTC drugs
Assessment for Herbs
- Baseline of client’s use of herbs
- Identify complete product information
- Identify all prescription and OTC drugs
Interventions for Herbs
- Monitor client’s response to Rx, OTC, and herbal products
- Consult w/ dietitian and others as appropriate
- Continue w/ same brand; discuss w/ HCP before changing or starting product
Pt teaching for Herbs
- General – look these up in the book!
- Diet
- SE
- Self-admin
- cultural considerations
- Evaluation
ANTIDOTE FOR DIGOXIN
DIGIBIND
S/S DIGITALIS TOXICITY
N, V, VISUAL DISTURBANCES, BRADYCARDIA
0.5-2.0 ng/mL
ANTIDOTE: DIGOXIN IMMUNE FAB
WHEN DO YOU HOLD BETA BLOCKERS
HR LESS THAN 50
S/S NITROGLYCERIN OVERLOAD
LIGHTHEADEDNESS, DIZZYNESS, HYPOTENTION, REFLEX TACHYCARDIA
ADENOSIN
FOR DYSRRHTHMIAS
FOR SUPERVENTRICULAR TACHYCARDIA
GIVE VERY QUICKLY
CAUSES THE PT TO FLATLINE BRIEFLY
USED TO DETERMINE WHAT RYTHM THEY ARE IN
KNOW WHICH BP MEDS WHICH CAN CAUSE EDEMA
WHAT CAN YOU DO FOR THIS?
ALPHA-ADRENERGIC BLOCKERS
ALPHA2 AGONISTS
Ca CHANNEL BLOCKERS
Tx with DIURETIC (HTCZ)
ANTIDOTE FOR HEPARIN
PROTAMINE SULFATE
WHEN DO YOU GIVE DIURETICS?
HOW OFTEN
GIVE ONCE OR TWICE
IN THE MORNING AND EARLY AFTERNOON
ASSESSMENTS FOR DIURETICS
DAILY WEIGHT
I AND O
ELECTROLYTES
RESPIRATORY (CRACKLES)
ACE INHIBITORS
KNOW THE CLASSIFICATIONS OF THE MEDS – WHAT ARE DIFFERENT
WHAT IS THE DIFFERENT SYMPTOM FOR ACE
ALWAYS COUGHING EXCESSIVELY
KNOW MEDS USED TO TREAT CHEST PAIN
MORPHINE SULFATE
NITROGLYCERIN
OXYGEN
ROUTE OF ADMIN FOR HEPARIN, TESTS TO LOOK AT, WHERE TO ADMINISTER
FOR HEPARIN, LOVANOX, ETC.
K, NA, PT/INR, APTT, PTT
IV, SQ
aPTT, PTT
KNOW HOW ST. JOHN’S WART AFFECTS DIGOXIN LEVELS
KNOW WHAT DIAMOX WORKS AS A DIURETIC
ANTIDOTE FOR ENOXAPARIN SODIUM (LOVENOX)
PROTAMINE SULFATE
ANTIDOTE FOR WARFARIN
VITAMIN K
ANTIDOTE FOR MYASTHENIA GRAVIS
ATROPINE
ANTIDOTE FOR MORPHINE SULFATE
NARCAN
ANTIDOTE FOR BETA AND CALCIUM CHANNEL BLOCKER OVERDOSE
GLUCAGON
Anticoagulants include
heparins and oral anticoagulants (Warfarin)
- Anticoagulants - Prevent clot formation, they do NOT dissolve the clot
Heparin
- Anticoagulant - inhibits clot formation (they do not dissolve clots!)
- T. Use: prevention and/or management of pulmonary embolism, DVT
- Admin: IV or SQ
- Labs: PTT (=>90), aPTT(35-40)
- Antidote: protamine sulfate
- SE: bleeding, thromboctopenia
- Teaching: soft toothbrush, no straight edge razors, etc.
Low-Molecular-Weight Heparin (LMWH)
- Enoxaparin sodium (Lovenox) and dalteparin sodium (Fragmin)
- Don’t require freq. aPTT monitoring
- SE: similar to Heparin - bleeding, thrombocytopenia
- Admin: ONLY SQ in anterolateral area (Love Handles)
- H1/2: 2-4x longer than heparin
- Antidote: protamine sulfate
- Always keep the air bubble in for enoxaparin sodium (Lovenox)
- OK for pregnant women
Oral Anticoagulants
warfarin (Coumadin)
- Use: prevention of clots
- SE: Bleeding (check stools, monitor PT/INR, electric shaver, soft toothbrush)
- Monitor:
- PT (13.75 - 37.5)
- INR (2.6 - 6)
- Interactions
- garlic, ginger, gingko all inc. bleeding itme
- Avoid Vitamin K rich foods: green leafy veggies, potatoes, prunes
- Antidote: Vitamin K
Antiplatelets work by
- Prophylactic use to prevent thrombis by decreasing the stickiness of platelets (aggregation)
- Antiplatelet drugs
- ASA (aspirin)
- Clopidogrel (Plavix)
- Ticlopidine (Ticlid)
- Dipyridamole (Persantine)
- Taken with ASA, garlic, gingko, and feverfew can increase bleeding
How do Thrombolytics work?
- They dissolve clots (should be given within 3 hrs of thrombolyti stroke
- Fx: Promotes converstion of plasminogen to plasmin
- CI: Stroke (hemorrhagic), contusion
- Drugs: Alteplase (t-PA), streptokinase, reteplase
- SE: Hemorrhage, vascular collapse
- A CT Scan MUST be done to determine what type of stroke it is.
Good cholesterol is
HDL
- removes cholesteral from blood and transports to liver for elimination
Bad Cholesterol is
LDL
- Containes higher percent of cholesterol
Very low-
