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MSII Medication Review > Lewis 67 - Musculoskeletal Trauma and Orthopedic Surgery > Flashcards

Lewis 67 - Musculoskeletal Trauma and Orthopedic Surgery Flashcards

1
Q

MOA/Class

cyclobenzaprine, tizanidine

A

Acts on the brainstem to decrease muscle spasms

Centrally-acting muscle relaxant

Tucker 25

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2
Q

Side Effects

cyclobenzaprine, tizanidine

A

CNS depression; may have some anticholinergic effects

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3
Q

Nursing Considerations

cyclobenzaprine, tizanidine

A

Do not combine with alcohol or other CNS depressants.

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4
Q

Indications

cyclobenzaprine, tizanidine

A

Short-term/intermittent treatment of acute muscle spasms/injuries.

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5
Q

MOA/Class

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

A

Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety (morphine).

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6
Q

Side Effects

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

A

respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)

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7
Q

Nursing Considerations

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

A

Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.
May be combined with acetaminophen for synergistic effect.

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8
Q

Indications

morphine, oxycodone, hydrocodone, hydromorphone, fentanyl

A

pain
(adjunct management of anxiety, angina/HF, and air hunger)

Tucker 26

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9
Q

MOA/Class

tetanus toxoid

A

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

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10
Q

Side Effects

tetanus toxoid

A

Localized pain/soreness from injection.

Tucker 18

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11
Q

Nursing Considerations

tetanus toxoid

A

May be combined with diptheria and pertussis vaccinations (DTaP for children; TDaP for adults).

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12
Q

Indications

tetanus toxoid

A

Prevention of tetanus (commonly contracted through dirty wounds).

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13
Q

MOA/Class

tetanus immunoglobulin

A

Provides passive immunity (temporary protection) in the setting of current/suspected infection

Passive Immunization

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14
Q

Side Effects

tetanus immunoglobulin

A

Localized pain/soreness from injection.

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15
Q

Nursing Considerations

tetanus immunoglobulin

A

Consider need for administration for patients with dirty wound who are not current on tetanus vaccination

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16
Q

Indications

tetanus immunoglobulin

A

Tetanus exposure

Tucker 18

17
Q

MOA/Class

cefazolin, cefepime

A

Weakens bacterial cell wall causing death.

Beta-lactam antibiotic

Tucker 09

18
Q

Side Effects

cefazolin, cefepime

A

C. diff, rash/SJS, anaphylaxis

Tucker 09

19
Q

Nursing Considerations

cefazolin, cefepime

A

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

20
Q

Indications

cefazolin, cefepime

A

Coverage for bacterial infections for open fractures.

Tucker 09

21
Q

MOA/Class

warfarin

A

Inhibits hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, & X)

Anticoagulant

Tucker 48

22
Q

Side Effects

warfarin

A

Bleeding

Tucker 48

23
Q

Nursing Considerations

warfarin

A

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

24
Q

indications

warfarin

A

Long-term DVT prevention; Prevention of clot formation for patients with A-fib to decrease stroke risk.

Tucker 48

25
Q

MOA/Class

heparin, enoxaparin

A

Block the formation of thrombin to prothrombin

Anticoagulant - heparin

Tucker 48

26
Q

Side Effects

heparin, enoxaparin

A

Bleeding

Tucker 48

27
Q

Nursing Considerations

heparin, enoxaparin

A

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

28
Q

Indications

heparin, enoxaparin

A

DVT prevention

Tucker 48

29
Q

MOA/Class

Aspirin (ASA)

A

Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.

Salicylate

Tucker 16

30
Q

Side Effects

Aspirin (ASA)

A

GI upset, bleeding, salicylism

Tucker 16

31
Q

Nursing Considerations

Aspirin (ASA)

A

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

32
Q

Indications

Aspirin (ASA)

A

Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention

Tucker 16

33
Q

MOA/Class

rivaroxaban, apixaban

A

Interrupts the clotting cascade by inhibiting factor Xa thus preventing thrombin generation and clot development

Factor Xa inhibitor Anticoagulant

Tucker 48

34
Q

Side Effects

rivaroxaban, apixaban

A

Bleeding

Tucker 48

35
Q

Nursing Considerations

rivaroxaban, apixaban

A

Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)

Tucker 48

36
Q

Indications

rivaroxaban, apixaban

A

Clot prevention

Tucker 48

MSII Medication Review (13 decks)

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