Med Pass Exam Flashcards
What is the purpose of aspirin administration?
Treat: Mild to moderate pain like rheumatoid arthritis, osteoarthritis, thromboembolic disorders, transient ischemic attacks, post-MI, prophylaxis of MI, ischemic stroke, angina; acute MI, Kawasaki disease and treat mild to moderate fever like rheumatic fever.
What are the precautions of aspirin med?
Abrupt discontinuation
acetaminophen/NSAIDs hypersensitivity
acid/base imbalance
alcoholism
ascites
asthma
bone marrow suppression, geriatric patients, dehydration, G6PD deficiency, gout, heart failure, anemia, renal/hepatic disease, pre/postoperatively,
gastritis
pregnancy C 1st trimester
Administration of aspirin med?
Demonstration
PO route:
• Do not break, crush, or chew enteric product
• Administer to patient crushed or whole (regular PO product); chewable tab should be chewed
• Give with food or milk to decrease gastric symptoms; separate by 2 hr of enteric product; absorption may be slowed
• Give antacids 1-2 hr after enteric products
• Give with 8 oz of water and have patient sit upright for 30 min after dose; discard tabs if vinegar-like smell is present; avoid if allergic to tartrazine
Side effects of aspirin?
Constipation
abdominal cramping/upset
headache, heartburn, indigestion, light-colored stool
Adverse effects of aspirin?
GI bleeding
hepatoxicity
hemolytic anemia
Reye’s syndrome (children), anaphylaxis, laryngeal edema, angioedema
Mode of action of aspirin?
Blocks pain impulses by blocking COX-1 in CNS = reduces inflammation by inhibition of prostaglandin synthesis
Antipyretic action results from vasodilatation of peripheral vessels
decreases platelet aggregation
Nursing assessment of aspirin?
Assess for hepatotoxicity: dark urine, clay-colored stools, yellowing of the skin and sclera, itching, abdominal pain, fever, diarrhea if patient is on long-term therapy
Assess for allergic reactions: rash, urticaria; if these occur, product may have to be discontinued; in patients with asthma, nasal polyps, allergies, severe allergic reactions may occur
Assess for ototoxicity: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
Monitor salicylate level: therapeutic level 150-300 mcg/ml for chronic inflammation
Beers: Avoid chronic use in older adults, GI bleeding may occur
Assess for pain: character, location, intensity, ROM before and 1 hr after administration
Therapeutic outcome: Decreased pain, inflammation, fever; absence of MI, transient ischemic attacks, thrombosis
Functional class and chemical class of aspirin?
Functional class: Nonopioid analgesics
Chemical class: salicylate
Purpose of atorvastatin med?
As an adjunct in primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyceride levels
Prevention of cardiovascular disease by reduction of heart risk in those with mildly elevated cholesterol
Precaution of atorvastatin
Past liver disease, alcoholism
severe acute infections, trauma, severe metabolic disorders
electrolyte imbalance
Side effects of atorvastatin?
• Headache
• hoarseness
• lower back or side pain
• pain or tenderness around the eyes and cheekbones
• painful or difficult urination
• stuffy or runny nose
Adverse effects of atorvastatin?
liver dysfunction, pancreatitis, rhabdomyolysis
Mode of actions of atorvastatin
Inhibits HMG-CoA reductase enzyme = which reduces cholesterol synthesis
[high doses lead to plaque regression]
Nursing assessment of atorvastatin?
Hypercholesterolemia: assess nutrition: fat, protein, carbohydrates; nutritional analysis should be completed by dietitian before treatment. Monitor triglycerides, cholesterol at baseline and throughout treatment.
Rhabdomyolysis: Assess for muscle pain, tenderness, obtain CPK baseline, if markedly increased, product may need to be discontinued, many drug interactions make the possibility of rhabdomyolysis greater
Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected, do not breastfeed or use in pregnancy
Monitor ALT, AST for liver function
Monitor amylase and lipase for pancreas function
Therapeutic outcome: Decreased cholesterol levels and LDLs, increased HDLs
Functional class and chemical class of atorvastatin?
Functional class: antilipidemic
Chemical class: HMG-CoA reductase inhibitor
Functional and chemical class of lisinopril?
Functional class: Antihypertensive, angiotensin converting enzyme (ACE) I inhibitor
Chem. class.: Enalaprilat lysine analog
Purpose of lisinopril?
Mild to moderate hypertension, adjunctive therapy of systolic HF, acute MI
Precautions of lisinopril?
Pregnancy (1st trimester), breastfeeding, renal disease, hyperkalemia, renal artery stenosis, HF, aortic stenosis
Side effects of lisinopril?
A dry, tickly cough that does not get better
Feeling dizzy or lightheaded, especially when you stand up or sit up quickly
Headaches
Being sick (vomiting)
Diarrhea
Itching or a mild skin rash
Blurred vision
Adverse effects of lisinopril?
Stroke, hepatic failure, hepatic necrosis, pancreatitis, Proteinuria, renal insufficiency, neutropenia, agranulocytosis
Mode of action of lisinopril?
Selectively suppresses renin-angiotensin-aldosterone system = inhibits ACE = prevents conversion of angiotensin I to angiotensin II
Nursing assessment of lisinopril?
Hypertension: monitor B/P, check for orthostatic hypotension, syncope; if changes occur, dosage change may be required
Acute MI: can be used in combination with salicylates, beta blockers, thrombolytics
HF: check for edema in feet, legs daily, weight daily, dyspnea, wet crackles
Assess blood studies: platelets, WBC with differential: baseline, q3mo; if neutrophils are < 1000/mm3 , discontinue treatment
Assess for anaphylaxis, toxic epidermal necrolysis, angioedema, allergic reactions: rash, fever, pruritus, urticaria; facial swelling, dyspnea, tongue swelling (rare), have emergency equipment nearby, may be more common in Black patients; product should be discontinued if antihistamines fail to help
Monitor renal/liver function tests baseline and periodically: protein, BUN, creatinine; watch for increased levels that may indicate nephrotic syndrome and renal failure; monitor renal symptoms: polyuria, oliguria, frequency, dysuria
Positive therapeutic outcome
• Stable and improved serum glucose, A1C, weight loss
Functional and chemical class of diphenhydramine?
Functional class: Antihistamine (1st generation, nonselective), antitussive
Chem. class.: Ethanolamine derivative, H1 -receptor antagonist
Purpose of diphenhydramine?
Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime sedation, infant colic, nonproductive cough, insomnia in children, dystonic reactions
Precautions of diphenhydramine?
Pregnancy, breastfeeding, children < 6 yr, increased intraocular pressure, renal/cardiac disease, hypertension, bronchial asthma, seizure disorder, stenosed peptic ulcers, hyperthyroidism, prostatic hypertrophy, bladder neck obstruction
• Avoid use in children under 6 yr, death has occurred; overdose has occurred in topical gel taken orally (adult/child)
• Give 20 min before bedtime if using for sleep aid
Administration of diphenhydramine?
Demonstration
PO
• Give with meals if GI symptoms occur; absorption rate may be slightly decreased; cap may be opened and product mixed with food/fluids for patients with swallowing difficulties
Side effects of diphenhydramine?
dry mouth, nose, and throat
drowsiness
dizziness
nausea
vomiting
loss of appetite
constipation
increased chest congestion
headache
muscle weakness
excitement (especially in children)
nervousness
Adverse effect of diphenhydramine?
Seizure, headache, Thrombocytopenia, agranulocytosis, hemolytic anemia, anaphylaxis
Mode of action of diphenhydramine?
Acts on blood vessels, GI, respiratory system by competing with histamine for H1 -receptor site; decreases allergic response by blocking histamine
Nursing assessment for diphenhydramine?
Assess respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness; provide fluids to 2 L/day to decrease secretion thickness
Monitor I&O ratio: be alert for urinary retention, frequency, dysuria, especially geriatric; product should be discontinued if these occur
Monitor CBC during long-term therapy; blood dyscrasias may occur but are rare
EPS: If giving for dystonic reactions, assess type of involuntary movements and evaluate response to this medication
Cough: Assess characteristics including type, frequency, thickness of secretions; evaluate response to this medication, increase fluids to 2 L/day unless contraindicated
Anaphylaxis: Assess for rash, throat tightness, have emergency equipment nearby
Therapeutic outcome: Absence of allergy symptoms and rhinitis, decreased dystonic symptoms, absence of motion sickness, absence of cough, ability to sleep
Functional class of ibuprofen?
NSAID: Non-steroidal anti-inflammation drug
Max of ibuprofen given per day? And how many hours apart?
Adult/adolescent: PO (OTC product) 200 mg q4-6hr, may increase to 400 mg q4-6hr; max 1200 mg/day for self-treatment of minor aches/pains
Though it can go up to 3200 mg/day max
Purpose of ibuprofen?
Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, dental pain, musculoskeletal disorders, fever, migraine, patent ductus arteriosus
Precautions of ibuprofen?
Pregnancy (1st and 2nd trimester), breastfeeding, children, geriatric, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, HF, CCr <25 mL/min
Side effects of ibuprofen?
Headaches
Feeling dizzy
Feeling sick (nausea)
Being sick (vomiting)
Wind
Indigestion
Adverse effects of ibuprofen?
CV thrombotic events, MI, stroke, GI bleeding, ulceration, necrotizing enterocolitis, GI perforation, hepatitis, Blood dyscrasias, nephrotoxicity, necrotizing fasciitis, toxic
Mode of action of ibuprofen?
Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic
Nursing assessment of ibuprofen?
GI bleeding/perforation: chronic use can cause gastritis with or without bleeding; in those with a prior history of peptic ulcer disease or GI bleeding, initiate treatment at lower dose; geriatrics are at greater risk, as are those who consume >3 alcohol drinks/day
Assess for infection; may mask symptoms
Assess pain: location, duration, type, intensity before dose, 1 hr after
Assess musculoskeletal status: ROM before dose, 1 hr after
Monitor liver function tests: AST, ALT, bilirubin, creatinine if patient is on long-term therapy, monitor electrolytes as needed, make sure patient is well hydrated
Perioperative pain in CABG: MI and stroke can result for 10-14 days, can be fatal, those taking NSAIDs are at greater risk of MI and stroke, even in first few weeks of therapy
Serious skin disorders: For skin rash, swelling of lips, face, tongue, discontinue immediately, provide supportive care
Nephrotoxicity: Monitor renal function tests: BUN, urine creatinine if patient is on long-term therapy
Identify fever: length of time in evidence and related symptoms
Beers: Avoid chronic use in older adults unless other alternatives are not effective, increased risk of GI bleeding
Pregnancy: Identify if pregnancy is planned or suspected, if breastfeeding
Therapeutic outcome: Decreased pain, inflammation, fever
Functional class and chemical class of azithromycin?
Functional class: Anti-infective ;Chemical class: Macrolide
Purpose of azithromycin?
• Mild to moderate infections of the upper respiratory tract
• In children: acute otitis media, lower respiratory tract; uncomplicated skin and skin structure infections, nongonococcal urethritis, or cervicitis
• Prophylaxis of disseminated Mycobacterium avium complex (MAC); Bacillus anthracis, Bacteroides bivius, Bordetella pertussis, … , viridans streptococci;
• opthalmic: bacterial conjunctivitis
Precautions of azithromycin?
Pregnancy, breastfeeding, child < 6 mo for otitis media, child <2 yr for pharyngitis, geriatric, renal/hepatic/cardiac disease, tonsillitis, QT prolongation, ulcerative colitis, torsades de pointes, sunlight exposure, sodium restriction, myasthenia gravis, CDAD, contact lenses, hypokalemia, hypomagnesemia
Administration of azithromycin?
Demonstration
PO route
• Provide adequate intake of fluids (2 L) during diarrhea episodes
• Give with a full glass of water; give susp 1 hr before or 2 hr after meals; tabs may be taken without regard to food; do not give with fruit juices
• Store at room temperature
• Reconstitute 1 g packet for susp with 60 ml water, mix, rinse glass with more water and have patient drink to consume all medication; packets not for pediatric use
• Do not take aluminum/magnesium-containing antacids or food simultaneously with this product
Intermittent IV infusion route
• Reconstitute 500 mg product/4.8 ml sterile water for inj (100 mg/ml), shake, dilute with ≥ 250 ml 0.9% NaCl, 0.45% NaCl, or LR to 1-2 mg/ml; diluted solution is stable for 24 hr or 7 days if refrigerated • Give 1 mg/ml sol over 3 hr or 2 mg/ml sol over 1 hr, never give IM or as a bolus
Side effects of azithromycin?
Feeling sick (nausea)
Diarrhoea
Being sick (vomiting)
Losing your appetite
Headaches
Feeling dizzy or tired
Changes to your sense of taste
Adverse effects of azithromycin?
Seizures, QT prolongation, torsades de pointes (rare), hepatoxicity, cholestatic jaundice, CDAD, leukopenia, thrombocytopenia, Angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Mode of action of azithromycin?
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin
[more effective against gram-negative organisms]
Nursing assessment of azithromycin?
QT prolongation, torsades de pointes: assess for patients with serious bradycardia, ongoing pro-arrhythmic conditions, or elderly; more common in these patients
Assess for serious skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, discontinue if rash occurs
Assess for CDAD: blood or pus in diarrhea stool, abdominal pain, fever, fatigue, anorexia; obtain CBC, serum albumin Assess for superinfection: sore throat, mouth, tongue; fever, fatigue, diarrhea, anogenital pruritus
Assess for signs and symptoms of infection: drainage, fever, increased WBC >10,000/mm3 , urine culture positive, sore throat, sputum culture positive
Therapeutic outcome: Bacteriostatic against the following susceptible organisms: PO, acute pharyngitis/tonsillitis (group A streptococcal); acute skin/soft tissue infections; community-acquired pneumonia
