Lewis 67 - Musculoskeletal Trauma and Orthopedic Surgery Flashcards
MOA/Class
cyclobenzaprine, tizanidine
Acts on the brainstem to decrease muscle spasms
Centrally-acting muscle relaxant
Tucker 25
Side Effects
cyclobenzaprine, tizanidine
CNS depression; may have some anticholinergic effects
Tucker 25
Nursing Considerations
cyclobenzaprine, tizanidine
Do not combine with alcohol or other CNS depressants.
Tucker 25
Indications
cyclobenzaprine, tizanidine
Short-term/intermittent treatment of acute muscle spasms/injuries.
Tucker 25
MOA/Class
morphine, oxycodone, hydrocodone, hydromorphone, fentanyl
Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety (morphine).
Tucker 26
Side Effects
morphine, oxycodone, hydrocodone, hydromorphone, fentanyl
respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)
Tucker 26
Nursing Considerations
morphine, oxycodone, hydrocodone, hydromorphone, fentanyl
Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.
May be combined with acetaminophen for synergistic effect.
Tucker 26
Indications
morphine, oxycodone, hydrocodone, hydromorphone, fentanyl
pain
(adjunct management of anxiety, angina/HF, and air hunger)
Tucker 26
MOA/Class
tetanus toxoid
Introduces antigen to the body so that body can mount an immune response and create a pattern for easy replication of antibodies in the event of subsequent exposure
Active Immunization
Tucker 18
Side Effects
tetanus toxoid
Localized pain/soreness from injection.
Tucker 18
Nursing Considerations
tetanus toxoid
May be combined with diptheria and pertussis vaccinations (DTaP for children; TDaP for adults).
Tucker 18
Indications
tetanus toxoid
Prevention of tetanus (commonly contracted through dirty wounds).
Tucker 18
MOA/Class
tetanus immunoglobulin
Provides passive immunity (temporary protection) in the setting of current/suspected infection
Passive Immunization
Tucker 18
Side Effects
tetanus immunoglobulin
Localized pain/soreness from injection.
Tucker 18
Nursing Considerations
tetanus immunoglobulin
Consider need for administration for patients with dirty wound who are not current on tetanus vaccination
Tucker 18
Indications
tetanus immunoglobulin
Tetanus exposure
Tucker 18
MOA/Class
cefazolin, cefepime
Weakens bacterial cell wall causing death.
Beta-lactam antibiotic
Tucker 09
Side Effects
cefazolin, cefepime
C. diff, rash/SJS, anaphylaxis
Tucker 09
Nursing Considerations
cefazolin, cefepime
Obtain culture before starting abx if possible
Ingesting alcohol may cause acetaldehyde syndrome
Patients with PCN allergy may have cross-allergy with cephalosporins
Tucker 09
Indications
cefazolin, cefepime
Coverage for bacterial infections for open fractures.
Tucker 09
MOA/Class
warfarin
Inhibits hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, & X)
Anticoagulant
Tucker 48
Side Effects
warfarin
Bleeding
Tucker 48
Nursing Considerations
warfarin
Monitor PT/INR
Therapeutic INR typical 2-3 (2.5-3.5 for high-risk patients)
May need bridge therapy with heparin or enoxaparin until INR is therapeutic
Need consistent intake of vitamin K-rich foods
Administer vitamin K to reverse anticoagulation (effective up to 7 days)
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)
Tucker 48
indications
warfarin
Long-term DVT prevention; Prevention of clot formation for patients with A-fib to decrease stroke risk.
Tucker 48
MOA/Class
heparin, enoxaparin
Block the formation of thrombin to prothrombin
Anticoagulant - heparin
Tucker 48
Side Effects
heparin, enoxaparin
Bleeding
Tucker 48
Nursing Considerations
heparin, enoxaparin
Enoxaparin has longer half-life and more predictable effects than heparin. Since effects are more predictable, PTT monitoring is not needed. (Enoxaparin is a low-molecular weight heparin).
Protamine sulfate may be used for toxicity if necessary.
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)
Monitor for heparin-induced thrombocytopenia.
Tucker 48
Indications
heparin, enoxaparin
DVT prevention
Tucker 48
MOA/Class
Aspirin (ASA)
Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.
Salicylate
Tucker 16
Side Effects
Aspirin (ASA)
GI upset, bleeding, salicylism
Tucker 16
Nursing Considerations
Aspirin (ASA)
Risk for Reye’s syndrome when given to children or with concurrent chicken pox or influenza.
Salicylism manifestations - tinnitus, sweating, headache, dizziness, acidosis. Give activated charcoal and/or bicarbonate.
Dose of 81 mg is typically for antiplatelet activity. May give larger dose for antiplatelet effect in acute situations (i.e., active MI).
Risk for hypersensitivity in patients with asthma and/or nasal polyps.
Tucker 16
Indications
Aspirin (ASA)
Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention
Tucker 16
MOA/Class
rivaroxaban, apixaban
Interrupts the clotting cascade by inhibiting factor Xa thus preventing thrombin generation and clot development
Factor Xa inhibitor Anticoagulant
Tucker 48
Side Effects
rivaroxaban, apixaban
Bleeding
Tucker 48
Nursing Considerations
rivaroxaban, apixaban
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)
Tucker 48
Indications
rivaroxaban, apixaban
Clot prevention
Tucker 48
