Medications Flashcards
Meds
1
Q
What are different types of benzos?
A
midazolam, diazepam, chlordiazepoxide, clorazepate
2
Q
What is the MOA of benzodiazepines?
A
enhances inhibitory effects of Gamma aminobutyric acid in the CNS
3
Q
What are some CNS complications of benzodiazepines?
A
sedation, lightheadedness, ataxia, and decreased cognitive function
4
Q
What are some general complications of benzodiazepines?
A
CNS depression, anterograde amnesia, acute toxicity, paradoxical response
5
Q
What happens with acute toxicity of benzodiazepines?
A
oral toxicity-drowsiness lethargy and confusion
IV toxicity- respiratory depression, severe hypotension, and cardiac arrest
6
Q
Nursing actions for benzodiazepine toxicity?
A
gastric lavage, and flumazenil
7
Q
withdrawal effects of benzodiazepines?
A
anxiety, insomnia, diaphoresis, termors, and lightheadedness
8
Q
benzodiazepine precuations
A
pregnancy risk cat D and Schedule IV
9
Q
benzodiazepines contraindicated with what conditions?
A
sleep apnea, glaucoma, and respiratory depression
10
Q
Client ed for benzodiazepines
A
avoid driving and alcohol, take with meals, for short term use mostly, and taper off or do not change dosage on own
11
Q
What are some SNRIs, and what are they used for?
A
venlafaxine and duloxetine alsong with mirtazapine and trazodone are used for depression and diabetic peripheral neuropathy
12
Q
Patient ed for SNRI in general and for duloxetine, mirtazapine, and trazadone?
A
priapism is a serious adverse effect trazadone and take at bedtime
mirtazapine is generally well-tolerated
duloxetine should be used cautiously in hepatic disease or alcoholism
in general, carefully use with hypertensive patients; don’t stop abruptly and talk about sexual dysfunction
13
Q
SE and ADR for SNRI?
A
Sexual dysfunction
hypertension
insomnia
nausea
extra weight gain
sweatiness
14
Q
What is the drug administered for an ischemic stroke and the class?
A
alteplase is a thrombolytic agent, or clot buster converting plasminogen to plasmin, a protease that breaks down blood clots
15
Q
What are some uses for glucocorticoids?
A
immunosupressant and decrease frequency and severity of exacerbations and acute asthma attacks, and Addison’s
16
Q
blood electrolyte complications of glucocorticoids?
A
increases: blood sugar, sodium, and
decreases potassium and calcium, protein
17
Q
What are some things to instruct a patient on glucocorticoids?
A
don’t stop suddenly
take vit D and exercise because of possible bone loss
PUD: administer with food or meals and avoid NSAIDS
increased infection- avoid large crowds, proper hand hygiene, notify provider, and caution with live vaccine
increased appetite and weight gain
hypokalemia can affect digoxin levels and cause dysrhthmias
increase during times of stress
18
Q
SEVEN side effects or considerations of corticosteroid therapy
A
swollen body
sepsis and increased fever
sugar and sodium increase
skinny muscles and bones
sight is poor
slowly taper
stress and surgery
19
Q
Carbamazepine toxicity
A
bruising, bone marrow depression, leukopenia, anemia, thrombocytopenia, and sore throat
20
Q
when should you use an oral dosing syringe?
A
less than 1 tspn
21
Q
For what amount of gastric residual might you not return the aspirate back to the stomach depending on facility policy?
A
greater than 250 mL
22
Q
What are the steps to administer MDI?
A
shake MDI
prime once or twice
hold 1-2 inches away from mouth
take a deep breath and then inhale slowly, hold breath for 10 sec
slowly exhale through pursed lips
**if giving more doses, then wait 20-30 sec
**if giving different MDI med, then wait 2-3 minutes
23
Q
What are the steps to administer nasal drop medication?
A
blow the patient’s nose
position head
instill midline
breathe through mouth
stay in place for at least 5 minutes
24
Q
What are the steps to administer nasal spray medication?
A
same as drops, but administer while inhaling.
25
What are the steps for administering ophthalmic medications?
If necessary, gently clean eyelids and/or eyelashes prior to administration
tilt head backward and slightly turned toward affected side.
look up while gently applying downward pressure on the lower eyelid.
hold bottle or tube 1-2 cm from eye
Squeeze prescribed number of drops or amount of ointment into the conjunctival sac and release lower lid.
If using drops, gently press inner canthus to prevent flow in to tear duct.
close eyes and no rubbing eyes
26
How to administer otic meds
warm the medication to body temp
place the client's head correctly
pull back down or up pinnae depending on age.
massage tragus
have patient not move for 2-5 minutes
27
How far in should a suppository be pushed in?
about 3-4 inches and ensure that the client stays in position for 5 minutes
28
What are some SE of lithium at therapeutic levels?
Polydipsia (mild thirst)
Ab pain
Nausea
Tremors (fine)
theses usually resolve within a few weeks of starting the medication
29
What two organs can lithium affect and what are some effects of long-term lithium use? What labs do you monitor for lithium and why?
Thyroid and kidneys
Hypothyroidism so weight gain and low energy (TSH)
Renal function and kidney impairment (BUN/creatinine)
30
What are the therapeutic and non-therapeutic ranges and when do hand tremors start for lithium ? AA, BB, CCC, D, SS
0.8 to 1.4
1.4 to 1.5 toxic (hand tremors start), n/v, diarrhea, confusion, ataxia, slurred speech, lethargy, thirst, polyuria and muscle weakness (STOP lithium)
1.6 to 2.0 toxic: coarse hand tremors, GI upset, ALOC, muscle hyperirritability, incoordination, sedation ataxia,
ISAMHAG
2.1 to 3.0 toxic: Ataxia, arrhythmias, ALOC, Blurriness, breathing problems, CNS depression, Coma, confusion, death, seizure,
Stuporous, Oliguria,
Hypotension, renal failure
31
How often should you check labs for lithium levels?
Periodically especially at the beginning, so weekly or fortnightly and three to six months after stabilization , every 2-3 days and every three months thereafter and closely monitor after every dose change
32
How should you educate the patient regarding lithium maintenance?
Maintain sodium and regular water intake because sudden changes can make lithium levels fluctuate. And don’t take diuretics and NSAIDS because it can lead to renal disease
Maintain daily fluid intake of 2,500 mL
Lower salt intake will increase lithium levels and vice versa.
Excessive exercise can cause sweating salt, dehydration, and lithium level increase, therefore increase the amount of water and electrolytes during exercise.
take with food to lower GI distress
33
At what time would you give lithium usually and why?
What about a blood draw? Why?
Give at night before bed and blood draw is in the morning 12 hours after admin with the trough level
34
What are some contraindications for lithium? (CAPSID)
cardiovascular problem
Anticholinergics/ aspirin
Pregnancy
schizophrenia/seizures
Insulin
Diuretics/diabetes
35
What are the six main and 2 other things that a prescription should have?
client's name
date
name of med
dose
route
frequency of administration
special instructions
signature of prescriber
36
What is the difference between standing/routine prescriptions vs PRN medications?
standing- meds given on a regular basis (daily lisinopril)
PRN- prescriptions administered only when needed or requested (tylenol for fever above 100.5)
37
Which is more urgent, stat or now?
STAT and now should be given within a 90-minute time frame
38
What is the difference between AC and PC?
before meal (ante comer)
after meal (post comer)
39
What are the six rights?
Ten rights?
patient
medication
dose
route
time
indication (assessment, vitals, labs)
*documentation
*education right
*response to medication
*right to refuse
*expiration
40
What is the difference between synergistic and potentiating effects?
synergistic- combo of meds results in a greater effect than that of separate administration like opioid analgesics and antihistamines/alcohol
potentiating effects- intentional combo of meds that increases the positive or negative effects like RIPE to treat TB
41
What should a med error report include and be filed when?
the client's info, location and time of incident, description of what happened and what was done about it, condition of the client, nurses' signature. within 24 hrs
42
What is the most common type of interruption that contributes to med errors?
85% are human interactions
43
What is the needle diameter, needle length, and angle for intradermal?
25-27, 1/2 to 5/8, 5-15 degrees
44
What is the needle diameter, needle length, and angle for subcutaneous?
25-27, 3/8 to 5/8, 45-90 degrees
45
What is the needle diameter, needle length, and angle for subcutaneous insulin?
25-31, 5/16 to1/2, 45-90 degrees
46
What is the needle diameter, needle length, and angle for IM?
18-25, 5/8 to 1 1/2, 90 degrees
47
Where should you give a deltoid injection?
two to three finger width down from the acromial process and midaxillary line
48
How many inches should you pull back for z-track, and with what part of your hand?
side of hand and finger, pull sideways 1 inch, and depress plunger for 1 mL/10 sec, 1-1 1/2 for vastus lateralis
49
What to doc after IM injection
injection, medication, date, time, site of injection, agent administered, outcome
50
landmarks for vastus lateralis
one handwidth below greater trochanter, one handwidth above knee.
51
landmark for IM ventrogluteal
place heel of hand on greater trochanter and thumb pointing toward abdomen, index toward anterior superior illiac spine and other fingers along illiac spine. Find flesshy part between index and middle finger "v"
52
Where are the best locations for IM injections?
deltoid, Vast. Lat, Ventrogluteal, not dorsogluteal
53
What happens if the volume exceeds the syringe for an injection?
use two syringes in two places
54
What is a good place to give viscous injections?
vetrogluteal
55
How many inches under the skin do you put a syringe for an intradermal injection?
1/8 inch
56
How much to pinch for subcutaneous injection for 90 and 45 degrees?
2 inches 90 degrees
1 inches 45 degrees
57
What are some medications that should go through a Central IV?
vasoconstrictors and Dobutamine and Acyclovir, chemotherapies, antibiotics long-term
58
What is an IV bolus?
medication directly into the bloodstream with a small amount of fluid, but dangerous because of the large concentration
59
What is an IV bolus or IV push? Where to give and for how long?
IV push is usually given over 3-5 minutes through an injection port closest to the patient
60
When are PICCs better options than CVC?
good for acute care and has fewer and less severe complications
61
What can CLABSI lead to?
increased cost in health care
longer hospital stays,
worsening of pre-existing conditions
death
62
What are some reasons for midline catheters? and some reasons for not
limited peripheral veins
altered peripheral skin integrity
longer term IV antibiotics
heparin infusions for DVT
repeated steroid infusions
NOT: parenteral nutrition, solutions with osmolarity more than 600, routine blood draws, and incompatible med administration
63
Where are midline catheters inserted and land and for how long?
inserted in the upper arm, preferably the basilica vein because it is straight, but doesn't go further than ancillary vein. 1-4 wks.
64
How often are peripheral IV's replaced?
usually every 72 to 96 hours or per AgPo
65
How is phlebitis usually manged?
discontinue, apply moist warm compress, and send for culture, using the most severe symptom for phlebitis grading
66
How is infiltration different from phlebitis?
infilitration has edema, pallor, and decreased skin temperature that is usually not warm like in phlebitis
67
What is extravasation and how is it different than infiltration?
IV catheter is dislodged this time and medication infuses into the tissue, characterized by pain, stinging, burning, swelling or redness at the site
68
What drug class had drugs that end in "pril" and what is the MOA?
Angiotensin-converting enzyme inhibitors, which block conversion of ANG I to Ang II, and lead to vasodilation, excretion of NA and H2O and retention of K+ by the kidneys
69
What are complications and nursing interventions from taking ACE inhibitors?
*cough- discontinue
hyperkalemia- monitor for paresthesia & tingling in hands and feet
rash and dysgeusia
angioedema- discontinue and subcut epi
neutropenia- rare but serious, so monitor q2wks and then for 3 mos
70
ACE contraindications and precautions
precaution: pregnancy and lactation
contraindication- hx of sensitivity, renal problems, or single kidney
71
ACE inhibitors can increase levels of what?
BP, lithium and potassium
72
what ACE inhibitors should be taken one hr before meals and when should others be taken?
captopril and moexipril- one hr before meals and other ACE inhibitors with or w/o food
73
What is the difference between an agonist and antagonist?
An agonist is a chemical that activates a receptor, while an antagonist is a chemical that blocks a receptor.
74
What is a common ending for aminoglycosides and how do they work?
"mycin" that destroy micro-organisms by disrupting protein synthesis.
75
What are complications of aminoglycosides? (5)
ototoxicity- stop drug b/c possible damage
nephrotoxicity from cumulative doses increasing- monitor B&C and cloudy urine
hypersensitivity- Rash, pruritus, paresthesia of hands and feet, urticaria
intense neuromuscular blockade- monitor for those with MyGrav, taking muscle relaxants and general anesthetics
streptomycin only- neurologic disorder with peripheral neuritis; report sasap
76
Contraindications and precautions for Aminoglycosides.
tobramycin and streptomycin: congenital hearing loss
kidney impariment, hearing loss, myasthenia gravis
ethacrynic acid, amphotericin B, cephalosporin, vancomycin (increases the risk for nephrotoxicity), and neuromuscular blocking agents (tubocurarine).
administer probiotic products at least 2 hrs after dosing
77
What type of drug do aminoglycosides interact with? How, and what do you do?
penicillins will inactivate aminoglycosides, so don't mix them
78
What are the complications of statins?
hepatotoxicity- basline liver function tests and monitor for anorexia, nausea, jaundice
myopathy- rhabdo and muscle aches; obtain CK levels
79
Which statin should be taken with a meal, and when should the others be given?
lovastatin with evening meal and others without food in the evening
80
What drug class is colesevelam and what complications does it have?
bile-acid sequestrant to lower cholesterol, which can cause constipation so increase intake of high-fiber food and oral fluids, if not restricted.
81
What meds do bile-acid sequestrants interact with?
Bile-acid sequestrants interfere with the absorption of many medications, including levothyroxine, second-generation sulfonylureas (glipizide), phenytoin, fat-soluble vitamins (A, D, E, K), and oral contraceptives. They also form insoluble complexes with thiazide diuretics, digoxin, and warfarin.
82
What does a Selective estrogen receptor modulator do, and what is an example?
endogenous estrogen in bone, lipid metabolism, and blood coagulation to decrease bone resorption, preserve bone density, decrease plasma cholesterol and protect agains breast cancer
raloxifene
83
What are complications of Selective estrogen receptor modulators?
hot flashes
DVT and PE* leg tenderness should raise a red flag
84
What are some contraindications to Selective estrogen receptor modulator and raloxifene
raloxifene is a pregnancy risk cat X, hx of venous thrombosis
85
Amylin mimetics MOA and prototype
Pramlintide mimics the actions of the peptide hormone amylin to decrease gastric emptying time and inhibit the secretion of glucagon, which reduces postprandial glucose levels. It also satiates, which helps decrease caloric intake.
86
Complications of amylin mimetics
nausea- decrease dose
reaction at injection sites
87
How do Alpha1 adrenergic antagonists work? examples
decrease mechanical obstruction of the urethra by relaxing smooth muscle of the bladder neck and prostate and nonselective agents can cause vasoodilation and lower BP for BPH and hpertension uses too
Selective alpha1 receptor antagonist: Tamsulosin, Silodosin
Nonselective alpha1 receptor antagonists
Alfuzosin, Terazosin Doxazosin
88
What are some complications with alpha1 receptor antagonists?
more likely with nonselective antagonists
hypotension and dizziness
problems with ejaculation
floppy iris syndromee with cataract surgery, so hold before cataract surgery
89
What drug class is finasteride?
5- alpha reductase inhibitors that decrease useable testosterone by inhibiting the converting enzyme, causing a reduction of the prostate size and increased hair growth
90
Complications of 5- alpha reductase inhibitors
Decreased libido, ejaculate volume
gynecomastia
91
What is the moa of sucralfate and drug class?
mucosal protectant- acidic stomach acid changes sucralfate into a protective barrier
92
What are some complications of sucralfate? Interactions?
constipation and interacts with absorption of phenytoin, digoxin, warfarin, and ciprofloxacin, so keep two hr interval.
Take sucralfate 30 min before or after antacids.
93
What is an indications of Heparin-induced thrombocytopenia, and nursing actions?
low platelet count and increased development of thrombi: mediated by antibody development, and monitor platelet count periodically throughout treatment, especially in the first month.
Stop heparin if platelet count is less than 100,000/mm3.
94
manifestations of malignant hyperthermia
Hypermetabolic condition- alteration in calcium activity in muscle cells (muscle rigidity, hyperthermia, and damage to the CNS)
Triggering agents, such as inhalation anesthetic agents and succinylcholine
Increased carbon dioxide level, decreased oxygen saturation level, and tachycardia occur first, followed by dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, and muscle-cell protein in the urine (myoglobinuria)
Extremely temperature a late manifestation: as high as 41.7° C (107° F)
95
nursing actions for malignant hyperthermia
Stop surgery
Administer IV dantrolene, a muscle relaxant.
100% oxygen.
Obtain ABGs to monitor for metabolic acidosis and blood tests to check for hyperkalemia.
Infuse iced IV 0.9% sodium chloride.
cooling blanket; ice to axillae, groin, neck, and head; and iced lavage.
Insert an indwelling urinary catheter to monitor output and for myoglobinuria (due to muscle breakdown)
Monitor cardiac rhythm and treat dysrhythmias.
Transfer to ICU
96
What are complications of digoxin therapy and patient ed or nursing interventions?
dysrhythmias- maintain high and stable K+ levels and avoid hypokalemia like furosemid treatment
GI effects- anorexia and n/v and pain
CNS- fatigue, weakness, yellow-green halos
97
What are some adverse effects of theophylline? toxicity? Think: Theo sinned for toxicity
Adverse effects include tachycardia, nausea*, and diarrhea, insomnia*, seizures*
98
What is the therapeutic range of theophylline? What does it do?
5-20, long term control of asthma and bronchospasm
99
What are some foods and drugs to avoid with theophylline?
caffeine, sudafed, energy drinks,
cimetidine (h2 blocker for heartburn)
ciprofloxacin (abx)
furosemide
acetaminophen
100
What are some anticholinergics for asthma?
ipratropium blocks the parasympathetic nervous system
101
What are some precautions/ interactions for inhaled anticholinergics?
conta fro peanut allergy
careful with narrow-angle glaucoma and BPH
102
Medications are for prophylaxis and are used to decrease airway inflammation (4)
Corticosteroids, such as fluticasone and prednisone
Leukotriene antagonists, such as montelukast
Mast cell stabilizers, such as cromolyn
Monoclonal antibodies, such as omalizumab
103
At what HR should the nurse watch propanolol administration?
dont let propanolol patient hr drop below 50
104
Famotidine drug class and MOA
histamine H2-receptor antagonists or H2-blocker to decrease amount of acid secretion
105
What is the difference between PPI and H2 antagonist?
PPIs directly inhibit the "pumps" that release acid into the stomach, while H2 blockers only partially block the signals that stimulate acid production, making PPIs more effective for frequent heartburn but potentially taking longer to take effect compared to H2 blockers which provide faster relief for occasional acid reflux
106
What are some ADR of magnesium hydroxide and too much magnesium?
decreased AV conduction
respiratory depression
flaccid paralysis like decreased DTR
painful muscle contractions
107
What are some conditions to consider when giving magnesium hydroxide?
renal and heart disorders
108
What are some similar considerations of amphotericin B and fluconazole?
watch for renal and hepatic function and do not take alcohol, but amphotericin b is very toxic and must be given IV, not PO
109
What do aminoglycosides do and MOA?
disrupt protein synthesis in gram-negative bacteria, treats tapeworm infections, neomycin suppresses normal flora of GI preop for colorectal surgery
110
What are some complications of aminoglycosides?
ototoxic- tinnitis, nausea, dizziness, vertigo
nephrotoxic- monitor BUN, creat, hematuria, and cloudy urine
neuromuscular blockade- respiratory depression and muscle weakness
hypersensitivity- rash, urticaria, paresthesia of hands and feet
streptomycin- neurologic disorder and Peripheral neuritis, optic nerve dysfunction, tingling/numbness of the hands and feet, Peripheral neuritis, optic nerve dysfunction, tingling/numbness of the hands and feet
111
What are some drug interactions with aminoglycosides?
Penicillin inactivates aminoglycosides when in the same IV solution.
112
What is the difference in EPS, sedation, anticholinergic effects, and potency in first vs second-generation antipsychotics?
ist gen: usually high potency, high EPS, low sedation, anticholinergic SE and hypotension, except for chlorpromazine which is high treats positive manifestations
2nd gen: low potency, low EPS, high sedation, anticholinergic SE and hypotension (negative and positive manifestations of schizophrenia)
113
Types of Second- and third-generation (atypical) medications
Olanzapine
Quetiapine
Ziprasidone
Clozapine
Lurasidone
Paliperidone
Iloperidone
Aripiprazole, brexpiprazole, cariprazine (third-generation)
114
Types of First-generation (conventional) antipsychotics
Chlorpromazine: low potency
Haloperidol: high potency
Fluphenazine: high potency
Thiothixene: medium potency
Perphenazine: medium potency
Loxapine: medium potency
Trifluoperazine: high potency
115
Which antipsychotic causes agranulocytosis and what do you do for it?
clozapine, so monitor WBC and neutrophil count weekly usually
116
Which antipsychotic causes mad weight gain? and DMII?
Olanzapine
117
Which antipsychotic might you want to watch for sedation and anticholinergic effects and do an eye exam q6mos?
quetiapine- for sedation usually, so remove clutter and titrate slowly and increased risk for seizures
118
Which antipsychotic might you need to take with food?
lurasidone and ziprasidone- about 350-500 cal more to increase absorption
119
Which antipsychotic might you need to monitor ECG changes?
ziprasidone because there are QT prolongation and can lead to torsades de pointes
120
What are some general complications for second generation antipsychotic?
DM
weight gain
hypercholesterolemia
orthostatic hypotension
anticholinergic effects
agitation, dizziness, sedation, sleep disruption
Mild EPS- tremors and akathisia
elevate prolactin- gynecomastia and amenorrhea
sexual dysfunction- impotence and low libido, osteoporosis/fractures
121
What is a third gen antipsychotic that can be given monthly and what does it improve?
aripiprazole improves positive and negative symptoms and cognitive function, but common SE are insomnia and akathisia
122
What are ways to stop NMS or ADR to fluphenazine?
stop antipsychotic
monitor VS
apply cooling blankets and meds
increase fluids
administer diazepam (anxiety), dantrolene and bromocriptine (muscle relaxation), antidysrhythmics
ICU because can turn into coma
123
What would you avoid giving with digoxin to prevent severe bradicardia?
parenteral calcium
124
What is salicylism? s/s
a toxic condition caused by an excessive intake of salicylates
Tinnitus, sweating, headache, dizziness, and respiratory alkalosis from hyperventilation
125
What to do for aspirin toxicity?
activate charcol
hemodialysis
cool with tepid water
correct dehydration with IV fluids
reverse acidosis with bicarb
gastric lavage
126
When is ketorolac contraindicated? and how to use and why? What is it good for?
contraindicated in clients who have advanced kidney disease. Use should be no longer than 5 days because of the risk for gastrointestinal, cardiovascular, and renal complications
Concurrent use with opioids allows for lower dosages of opioids and minimizing ADR (constipation and respiratory depression).
127
What is the last choice medication for chronic pain, and why? contraindications for this medication
Celecoxib, an NSAID COX-2 inhibitor, is a last-choice medication for chronic pain due to the increased risk of myocardial infarction (MI) and stroke due to secondary suppression of vasodilation.
Celecoxib is contraindicated in clients who have an allergy to sulfonamides.
128
What are some complementary supplements that can interfere with NSAIDS?
feverfew, garlic, and ginger can increase the risk for bleeding in clients who are taking NSAIDs.
Ginkgo biloba can suppress coagulation and is used with caution in clients who are taking NSAIDs.
129
Oral contraceptives' effectiveness decreases with the use of what medications?
decreases with use of carbamazepine, phenobarbital, ritonavir, rifampin, St. John Wort.
130
Hormonal contraceptives are contraindicated with what?
smokers and 35+ years of age.
hx of thrombophlebitis and cardiovascular events
Suspected or known breast cancer
Liver conditions
Abnormal vaginal bleeding.
131
When would you use dopamine and what does it do?
shock, HF, and AKI,
renal vessel dilation
positive inotrope and chronotrope
increased rate of conduction through AV node
mydriasis
132
What are some types of SSRI?
Sertraline
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
133
What are some late ADR of SSRI?
Insomnia, headache, and sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest)
Weight changes
GI bleeding
Hyponatremia- usually with diuretics
Serotonin syndrome- AMS, disorientation, difficulty concentrating, anxiety, hallucinations, myoclonus (spastic, jerky muscle contractions), hyperreflexia, incoordination, tremors, fever, diaphoresis, hostility, delirium, seizures, tachycardia, labile blood pressure, nausea, vomiting, diarrhea, abdominal pain, coma leading to apnea, and death in severe cases (at least three)
133
What are some early ADR of SSRI?
First few days/weeks: Nausea, diaphoresis, tremor, fatigue, drowsiness
134
What causes serotonin syndrome and what are some nursing actions?
taking 2+ medication that increase the levels of serotonin-like St. John's/MAOI, TCA and SSRI
stop medications and treat the symptoms like dantrolene and cooling measures
Shaking/hyperreflexia/myoclonus
Agitation/Agnixiety
Labile BP
Ataxia
Diaphoresis
135
What happens if you stop SSRI suddenly?
withdrawal syndrome of discontinuation symptoms
dizziness, nausea, malaise
anxiety
pins and needles
zappers
loss of efficacy
136
How should opioids be discontinued?
withdrawn slowly and tapered over a period of three days
137
What are some foods that contain pyrodoxine and what medication will it interfere with?
Avoid vitamin preparations and foods containing pyridoxine (wheat germ, green vegetables, bananas, whole-grain cereals, liver, legumes), which reduce the therapeutic effects of levodopa/carbidopa.
138
Complications of carbidopa/levadopa
Nausea and vomiting, drowsiness- don't take with pyridoxine
syskinesia- decrease dosage and give amantadine
orthostatic hypotension- increase salt and water
tachycardia, palpiations and irregular Heart beat- ECG
psychosis- 2nd gen antipsychotic, but no conventional like haloperidol b/c it blocks dopamine receptors and avoid MAOI (2 wk buffer)
urine and sweat discoleration
malignant melanoma- assess skin
139
What is the window of max therapeutic effects for carbidopa/levadopa?
4-6 wks after starting dose to 5 yrs max, so ask provider about medication holiday
140
How should furosemide be taken?
with milk to avoid gastric irritation and in the morning
141
How should dantrolene be administered for malignant hyperthermia?
very fast push after reconstituting with 60 mL of bacteriostatic agent
142
Why might a patient using fentanyl patches at home be prescribed a stool softender?
Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.
143
What type of OTC should a patient on fluoxetine take for headaches?
acetaminophen over ibuprofen
Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.
144
How long does it take for zolpidem to kick in and how long does it take? What does it resolve?
resolves headaches within a couple days, but don't take long term
145
patient teaching for corticosteroids
blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels.
avoid contact with persons who have known infections
grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression.
take the medication with food or milk to avoid gastrointestinal manifestations.
146
What is the normal carbamazepine level?
5-12 mcg/mL
147
normal dig levels
reference range of 0.8 to 2 ng/mL
148
how to use ethinyl estradiol/norelgestromin
apply the patch once a week for 3 weeks and then go without the patch for 1 week to promote menstruation.
emove and dispose the old patch before applying a new patch to prevent toxicity
apply the patch within 7 days of menses to prevent ovulation and the need for another contraceptive method.
149
What are complications of mannitol?
heart failure, pulmonary edema,- stop meds immediately
rebound increased intracranial pressure- monitor for LOC, pupils, nausea/vomiting change,
fluid and electrolyte imbalance- metabolic acidosis
150
What drugs interact with mannitol? so what should you watch for?
lithium- increases extretion through kidneys
hypokalemia with cardia glycosides- monitor potassium and ECG
151
What are some contraindications with mannitol?
intracranial bleed
anuria
pulmonary edema
severe dehydration
renal failure
preg/breastfeeding
152
What types of patients should opioids be used cautiously?
asthma, emphysema, or head injuries; infants; and older adult clients (risk of respiratory depression)
obese- med accumulation and slow metabolism
IBD- megacolon or paralytic ileus
enlarged prostate- urinary retention
hepatic/renal disease
153
What can be administered to patients on opioids to prevent constipation?
stimulant laxative (bisacodyl) to counteract decreased bowel motility, or a stool softener (docusate sodium) to prevent constipation.
end-stage disorders (cancer or AIDS), administer an opioid antagonist (methylnaltrexone) designed to treat severe constipation
154
What is the opioid toxicity triad? What to do?
Coma, respiratory depression, and pinpoint pupils
monitor vitals
provide mechanical vent
naloxone
155
What are some abortive therapies for severe headaches?
Triptan (zolmitriptan sumatriptan, eletriptan) to produce a vasoconstriction
Ergotamine with caffeine (dihydroergotamine) to narrow blood vessels and reduce inflammation
Isometheptene in combo formulations when other meds don't work
156
What are some preventative medication for frequent headaches?
NSAIDs with beta-blocker (propranolol), calcium channel blocker, beta-adrenergic blocker or antiepileptic medications (divalproex, topiramate).
OnabotulinumtoxinA for adults with chronic migraines. Injected into specific areas of the head and neck up to 5 treatment cycles.
*check pulse whit BA blockers and CCB
157
What medication alleviates pain by decreasing bladder spasms from renal calculi?
oxybutynin, a spasmodic
158
What are some things to remember about trandermal methylphenidate?
leave on the hips for 9 hrs and then remove, but use the open tray within 2 months
159
What is the difference between scabies and head lice infestation?
Scabies: Pencil-like marks on skin.
Head lice: Adult lice are hard to see: small, grayish-tan, and no wings. Nits look like dandruff on the hair shaft and are firmly attached.
160
client ed for head lice
Avoid home remedies, as it can worsen infection.
Understand correct laundering of potentially infected clothing, bedding.
Bag items that cannot be laundered into tightly sealed bag for 14 days.
Boil combs, brushes and hair accessories for 10 min or soak in lice-killing products for 1 hr.
Avoid sharing of personal items.
161
How is permethrin used for contagious critters?
scabies: Apply a scabicide (5% permethrin cream) over the entire body to remain on the skin for 8 to 14 hr; repeat in 1 to 2 weeks. Difficult cases: May use oral ivermectin.
head lice: 1% permethrin shampoo; Difficult cases: use malathion 0.5%
162
What medication might be good for alcohol craving stopping?
Naltrexone, which blocks the need to ingest alcohol. Vivitrol-IM is monthly.
Ondansetron is good for early onset
Acamprosate
SSRI in late onset
Topiramate: action glutamatergic system
163
Why are hallucinations and delusions a priority for nurses?
Cognitive changes and fever are impending or already manifested DT s/s
164
What are some common signs of stimulant abuse? “if it elevates, they dilate”
Dilation of the pupils, dry oronasal cavity, sweaty, excessive motor activity, elevated VS, insomnia, and psychosis
Think of a constantly zig-zagging dragonfly with iridescent wings
165
What are some withdrawal symptoms of cocaine?
(VLAD PINS)
vomiting
lethargy
anxiety
depression
paranoia
insomnia
nausea
sweating
166
What are some physical and psych effects of amphetamines?
Anorexia, restlessness, tremors, dizziness, dry mouth, dilated pupils, hyperactive reflexes, tachycardia.
arrhythmia**
generalized tonic-clonic seizures**
Labile affect, anxiety, delirium, euphoria, violence, hallucinations, and irritability
like manic person, but with extra serious things
167
What are some withdrawal effects of amphetamines?
Depression (suicidal ideation)
Psychomotor Changes (panoia, agitation, later retardation)
Appetite Increase.
Nightmares (unpleasant dreams)
Tiredness (fatigue)
Sleep (insomnia, later changes to hypersomnia)
168
What are some things to use for smoking cessation?
Varenicline, bupropion, and transdermal patch in the form of nicotine gum, and lozenges.
169
How would a patient use a nicotine gum?
Chew and park. When it starts tingling, the meds have been activated, so you put it between the the gum and teeth and then you chew it again and move it somewhere else
Don’t eat or drink 15-30 minutes before or after gum no swallowing
Max 16 hrs per day
Lozenge is no more than 20 hrs daily
170
What are some meds to use if someone is withdrawing from opiates?
Methadone- highly addictive but given to wean people off heroin and needs to be prescribed
Suboxone- buprenophine combined with naloxone
Naltrexone- antagonist that blocks the euphric effects of opioids
Bupenorphrine- blocks s/s of opioid withdrawal
Clonidine- effective somatic treatment in combo w/ naltrexone
LAAM- alternative to methadone
171
What is the CIWA equivalent of opiates?
The COWS scale for opiate withdrawal
172
What are some physical and psych effects of barbiturates, sedatives, and hypnotics?
Drowsiness, fatigue, orthostatic hypotension, anorexia, slurred speech, ataxia, seizure, and dizziness
Euphoria, irritability, anxiety, poor memory and understanding, delirium, depressed mood, and violence
173
withdrawal effects of barbiturates, sedatives, and hypnotics? serious s/s?
n/v generalized malaise, tachycardia, excessive sweating, anxiety, irritability, ortho hypotension, insomnia and
**seizures, coarse tremors and delirium which are very serious, so call doc
like a cat waking up from a nap
174
Where is THC stored in the body?
Fatty tissues in the brain and the reproductive system
175
How long can THC be detected in the body?
Six weeks
176
What are some long-terms effects of marijuana?
Lethargy, anhedonia, difficulty concentrating, loss of memory
177
What is the difference between codependency and enabling?
Codependency is over responsible and doing for others what they could do for themselves because there is a need for control, and enabling is thinking that someone else will always fix or solve and make the consequences go away like lying to cover for the alcoholic.
178
What are some characteristics of codependency?
Overly responsible behavior
Making excuses for other’s behavior (not lying, just covering up)
Maladaptive behaviors and people pleasing
Defining self-worth by caring for others
Needing to control
179
What are medications for Alzheimer's?
Cholinesterase inhibitors: Donepezil (mild to severe), Galantamine, Rivastigmine (Exelon) patch
NMDA Antagonist: memantine (moderate-severe stages)
SSRI: citalopram, paroxetine
Anti-anxiety: lorazepam, oxazepam
180
How do cholinesterase inhibitors work in Alzheimer's patients?
Increase acetylcholine at cholinergic synapses to inhibit its breakdown by acetylcholinesterase, which increases the availability of acetylcholine
181
What are some SE and ADR of cholinesterase inhibitors for Alzheimers?
GI- n/v/d so promote good fluid intake
bradycardia and syncope, so take pulse for patient and HD screening
182
What are some contraindications and precautions with cholinesterase inhibitors?
careful with NSAIDS- GI bleeding
antihistamines, TCA, conventional antipsychotics that block cholinergic receptors
183
Nursing considerations for cholinesterase inhibitor meds for AD?
start low and increase gradually
admin at bedtime with or without food
Donepezil- once daily b/c long half-life, but others twice daily
rivastigmine- either with food once or daily patch
184
MOA of memantine and nursing actions
blocks entry of calcium into nerve cells to slow brain-cell death
can be used with cholinesterase inhibitor
admin with or without food
ADR- dizziness, confusion, constipation
185
Nursing actions for mebendazole, abendazole, and pyrantel pamoate for helminthic infections?
administer a single doses and repeat in 2 weeks to get the hatchlings
give mebendazole for kids older than 2 y.o.
186
Types of TCA
Imipramine
Doxepin
Nortriptyline
Amitriptyline
Trimipramine
Desipramine
Clomipramine
187
What are some complications of TCA?
Orthostatic hypotension
Anticholinergic effects
Sedation- diminishes over time
Toxicity- dysrhythmias, mental confusion, and agitation, followed by seizures, coma, and possible death
decreased siezure threshold
excessive sweating
188
What are some atypical antipsychotics for treating depression?
ARIPIPRAZOLE: augmenting antidepressant agent in conjunction with SSRIs.
QUETIAPINE: treatment of depression and bipolar depression.
BREXPIPRAZOLE: adjunct agent for treatment of resistant depression such as major depressive disorder.
CARIPRAZINE: acute bipolar mania, mixed episodes
LURASIDONE: acute depressive bipolar disorder by blocking receptors for dopamine and serotonin. Take with food for best absorption.
VORTIOXETINE: MDD. Is a serotonin antagonist and reuptake inhibitor. Weight gain, sedation, headache, and dizziness are adverse effects of the medication.
189
Therapeutic uses of MAOIs
Bulimia nervosa
OCD
Depression
Anxiety- Panic, Social, Generalized, PTSD
You cannot drink wine for BODA disorders at weddings when taking MAOIs
190
What are some antipsychotics to treat ADHD and some other uses?
risperidone, olanzapine, quetiapine, Aripiprazole
Autism spectrum disorder
Conduct/ Intermittent explosive disorder
PTSD
Relief of psychotic manifestations
OCD
Tic disorders (including Tourette syndrome)
191
Mild and severe effects of cocaine
dizzy, irritable tremors blurred my vision
Hot Hallucinations give me cardiac problems like angina, hypertension, and tachycardia, causing seizures and death
192
What meds should be avoided with donepezil and rivastigmine and why?
NSAID- GI bleeding
Antihistamines, tricyclic antidepressants, and conventional antipsychotics (medications that block cholinergic receptors) can reduce the therapeutic effects of donepezil.
193
cholinergic crisis manifestation: SLUDGE and the Killer Bs
Salivation
Lacrimation
Urination
Diaphoresis/Diarrhea
Gastrointestinal cramping
Emesis
Bradycardia
Bronchospasm
Bronchorrhea
194
What is a medication for anorexia treatment?
fluoxetine
195
Labetolol should not be given in the same IV as what?
furosemide/
196
verapamil causes what adverse effects?
constipation, orthostatic hypotension, dysrhythmias, and acute toxicity
197
How slowly should CCB IV be given?
push 2-3 min
198
what happens if verapamil is taken with digoxin?
digoxin toxicity
199
What conditions are ntg contradindicated in?
severe anemia, closed-engle glaucoma, and traumatic head injury
200
What should be taken with methotrexate to protect the patient? and how does it help?
leucovorin is a folic acid that should be given within 24 hours to protect healthy cells from cytotoxic effects of methotrexate, but it can cause thrombocytosis and wheezing
201
What is a side effect of EPO besides htn and how can it be resolved?
headache, that can lead to seizures or encophalopathy, and can be relieved with dialysis
202
If a woman misses an Oral contraceptive dose n the morning, what should they do?
take ASAP, but if mor than 24 hours, then take as instructed on package instructions and use barrier method
203
What are some ADR of carbemazepine?
Carbamazepine can cause agranulocytosis, aplastic anemia, thrombocytopenia, and leukopenia. Carbamazepine can cause Stevens-Johnson syndrome, which can be fatal.
don't take during pregnancy and if first time to drive
204
How long does it take for buspirone to work?
at least 2-4 weeks to reach full effects, so not for PRN
205
What are some therapeutic uses of buspirone?
Panic disorder
Social anxiety disorder
Obsessive-compulsive and related disorders
Trauma- and stressor-related disorders, PTSD
Generalized anxiety disorder (GAD)
Bruxism
206
complications of buspirone?
Dizziness, nausea, headache, lightheadedness, agitation
Constipation
SI
207
What are some interactions of buspirone?
Erythromycin, ketoconazole, St. John't wort, and grapefruit juice can increase the effects of buspirone.
208
client ed for buspirone?
with meals to prevent gastric irritation.
take regularly
Tolerance, dependence, or withdrawal effects are not an issue with this medication.
209
What is the manmade version of Vitamin K called?
phytonadione
210
How many days before a surgery should clopidogrel be stopped?
5-7 days
211
what is the medication that is ok for pregnant women with diabetes?
glyburide, insulin
212
How do mast cell stabilizers work? example?
cromolyn works long-term to control persistent asthma and can be taken several times a day, and not to prevent attacks
213
What are some complications of levidopa/carpidopa and some education about it?
nausea, vomiting, drowsiness- limit pyridoxine (B6)-wheat germ, green veggies, bananas, liver
dyskinesia- decrease dosage, admin AMANTADINE
orthosptatic hypotension- increase salt and water
cardiovascular increase, palpitations
psychosis- admin 2nd gen antipsychotic and not first gen or MAOI
discolored sweat and urine- harmless
214
What drug class is ipratropium and what are the complications? Contraindications?
inhaled anticholinergics, so anticholinergic effects that cause dry mouth and hoarseness
not for peanut allergy
careful in glaucoma and BPH
215
What electrolytes go down for thiazide meds? what about up?
down- magnesum, chlorine, sodium, and potasium
up- hyperglycemia, lipids, uricemia
216
What are some complications of acyclovir
Phlebitis and inflammation at the site of infusion- rotate sites
nephrotoxicity- slowly over 1 hr, and caution in renal impairment
mild discomfort in PO like N/H/D
217
What ae carbonic anhydrase inhibitors used for?
Quickly lower IOP in clients for whom other medications have been ineffective.
Acetazolamide, a nonantimicrobial sulfonamide, c-emergency medication pre-op for acute angle-closure glaucoma and 2nd-line medication for the treatment of POAG.
-acute altitude sickness, seizures, and heart failure (as a diuretic).
218
What are some severe reactions to acetazolamide?
Severe allergic reactions
Rare serious blood disorders (bone marrow depression)
Gastrointestinal (GI) effects (nausea, diarrhea)
Electrolyte depletion (sodium and potassium), dehydration, altered liver function--> increase fluid, and weigh
flu-like manifestations
Central nervous system disturbances- paresthesia of extremities, fatigue, sleepiness
glucose fluctuations up/down
nephrolithiasis
219
What are some other names for potassium-sparing diuretics
Triamterene
Amiloride
220
adverse effects of progesterone vs estrogen
General OC adverse effects include headache, nausea, breast tenderness, and breakthrough bleeding.
estrogen: nausea, breast tenderness, fluid retention.
Progestin:increased appetite, fatigue, depression, breast tenderness, oily skin and scalp, and hirsutism
221
Metformin is contraindicated for what clients?
Severe infection, shock, kidney impairment, and any hypoxic condition.
The medication should not be used by clients who have alcohol use disorder.
222
Acarbose is contraindicated for what clients?
gastrointestinal disorders (inflammatory disease, ulceration, or obstruction).
223
Pioglitazone is contraindicated for what clients?
severe heart failure, history of bladder cancer, and active hepatic disease. Use cautiously in clients who have mild heart failure and in older adults.
224
Canagliflozin is contraindicated for what clients?
renal failure and are undergoing dialysis.
225
Semaglutideis contraindicated for what clients?
DMI
226
Complications of SNRI
Appetite/growth suppression, weight loss
GI effects (nausea, vomiting, upper abdominal pain)
Suicidal ideation (in children and adolescents)- report
Hepatotoxicity- report flue-like s/s
CNS effects (headache, insomnia, irritability)
227
3 TB induration meaning?
5 mm+: positive test for clients who are at high risk (have HIV, had recent contact with someone who has TB, have positive chest x-ray, or immunosuppressed).
10 mm+ positive test for clients who are at moderate risk (born in a country where TB is common, have a substance use disorder, work in a high-risk area such as a laboratory of congregate setting, have medical conditions which place them at high risk, or are younger than 5 yrs
15mm+: positive test for clients who have known risk factors for TB.
228
What are the administration considerations for captopril?
Available for oral use only
Must be taken two to three times daily for hypertension; three times daily for heart failure
Give captopril 1 hr before meals for adequate absorption
## Footnote
Captopril is an ACE inhibitor used primarily for hypertension and heart failure management.
229
What are the administration considerations for losartan?
ARBs are available for oral administration only
Losartan is also available in combination with hydrochlorothiazide (Hyzaar)
May be taken with or without food
Beginning dose is decreased for clients taking diuretics or with liver failure
## Footnote
Losartan is an angiotensin II receptor blocker (ARB) used to treat hypertension.
230
What are the administration considerations for spironolactone?
Available for oral use only
Give alone or combined with other antihypertensive drugs
Maximum effect of eplerenone may take up to 4 weeks
## Footnote
Spironolactone is a potassium-sparing diuretic that helps prevent the body from absorbing too much salt.
231
What are the administration considerations for aliskiren?
Available in oral form only
High fat-meals decrease absorption
Give at a consistent time daily before eating
Expect 2 weeks before full effect is seen
Monitor for hypotension at beginning of therapy and after dose increase
## Footnote
Aliskiren is a direct renin inhibitor used for hypertension.
232
What are the administration considerations for nifedipine?
Available for oral use in capsules and sustained-release tablets; sustained release form is approved to treat hypertension
Sustained-release form must be swallowed whole and not chewed or crushed
To prevent reflex tachycardia, nifedipine may be combined with a beta-blocker
## Footnote
Nifedipine is a calcium channel blocker used to treat hypertension and angina.
233
What are the administration considerations for doxazosin?
Available in oral form only
Give at bedtime – especially first dose; subsequent doses individualized based on orthostatic blood pressure changes
## Footnote
Doxazosin is an alpha-1 blocker used to treat hypertension and benign prostatic hyperplasia.
234
What are the administration considerations for atenolol and metoprolol?
Atenolol and metoprolol are available for oral or IV use
Give IV initially and then orally for acute myocardial infarction
Give orally for hypertension
Atenolol may be crushed or swallowed
Metoprolol must not be crushed and must be swallowed whole
Absorption of metoprolol may be enhanced with food; take at consistent time each day
Atenolol is best taken before meals or at bedtime
## Footnote
Atenolol and metoprolol are beta-blockers used for hypertension and heart disease.
235
What are the administration considerations for reserpine?
Available for oral use only
Administer with food or milk to prevent GI symptoms
## Footnote
Reserpine is an antihypertensive medication that works by decreasing the amount of norepinephrine available.
236
What are the administration considerations for clonidine?
Available orally or as transdermal patch to treat hypertension
Give oral dose at bedtime to prevent daytime sedation
Begin oral dosage low and gradually increase to prevent severe hypotension
Apply transdermal patch to a dry, relatively hairless area of skin once every 7 days
Rotate transdermal sites and monitor skin for inflammation
Be sure to remove the old patch before applying a new patch
Monitor for correct dosage/administration due to potential for abuse
## Footnote
Clonidine is an alpha-2 adrenergic agonist used for hypertension management.
237
What are the administration considerations for carvedilol?
Available for oral use only
Give with food to minimize orthostatic hypotension
## Footnote
Carvedilol is a non-selective beta-blocker and alpha-1 blocker used for heart failure and hypertension.
238
What are the administration considerations for hydralazine?
Available in oral, IM, or IV forms
Give oral dose with food to enhance effectiveness
Oral dosage usually begins low and is gradually increased
Administer IV form undiluted; do not add to other solutions
## Footnote
Hydralazine is a vasodilator used to treat high blood pressure.
239
What are the administration considerations for hydrochlorothiazide?
Available orally alone and in fixed-dose combinations with multiple other drugs
Chlorothiazide is available in IV form
Give with food to minimize GI effects
Give last dose of day by 3 p.m. to prevent nocturia
## Footnote
Hydrochlorothiazide is a thiazide diuretic used for hypertension and edema.
240
What are the administration considerations for furosemide?
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
Give IV form undiluted; administer slowly to prevent ototoxicity
Protect all forms from light
## Footnote
Furosemide is a loop diuretic used to treat edema and hypertension.
241
What are the administration considerations for digoxin?
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
## Footnote
Digoxin is a cardiac glycoside used for heart failure and atrial fibrillation.
242
What are the administration considerations for dobutamine?
Available for IV infusion only
Dose based on client’s weight and titrated based on monitoring
Peak effect obtained about 10 minutes after infusion begins
Use dedicated IV line for infusion
Correct any fluid volume deficits before administering dobutamine
## Footnote
Dobutamine is a sympathomimetic drug used for heart failure.
243
What are the administration considerations for milrinone?
Available for IV infusion only
Give a loading dose over 10 minutes and then administer a dose based on weight
Use dedicated IV line if possible
## Footnote
Milrinone is a phosphodiesterase inhibitor used for heart failure.
244
What are the administration considerations for atorvastatin?
Available orally only
For greatest effectiveness, take in the evening with or without food
## Footnote
Atorvastatin is a statin used to lower cholesterol levels.
245
What are the administration considerations for gemfibrozil?
Available for oral use only
Usually taken twice daily, 30 minutes before meals
Monitor periodic LDL, HDL, triglyceride, and total cholesterol levels
## Footnote
Gemfibrozil is a fibrate used to lower triglyceride levels.
246
What are the administration considerations for nitroglycerin?
Available as sublingual tablets, sustained-release capsules, translingual spray, transdermal ointment or patch, and IV form
Sublingual tablets dissolve under tongue when chest pain starts; if not relieved in 5 minutes, call 911
Transdermal patches are for prevention only; apply to a hairless area and rotate sites
Remove patches for 10–12 hours daily to prevent tolerance
## Footnote
Nitroglycerin is used to relieve angina pectoris.
247
What are the administration considerations for quinidine and procainamide?
Available in oral, IM, and IV forms
IM administration is painful with poor absorption
Oral dosing is preferred; give oral dose 1 hr before or 2 hr after meals
Do not crush or chew extended-release tablets
## Footnote
Quinidine and procainamide are antiarrhythmic medications.
248
What are the administration considerations for lidocaine?
Available for IV infusion (IV preferred for dysrhythmias; local administration for anesthesia only)
IM administration is for emergency use only
Ensure the correct lidocaine preparation is used
Incompatible in solution or tubing with other drugs
## Footnote
Lidocaine is used primarily for ventricular dysrhythmias.
249
What are the administration considerations for flecainide and propafenone?
Available for oral use only
Begin with low dose and increase gradually no more frequently than every 4 days
## Footnote
Flecainide and propafenone are antiarrhythmic agents.
250
What are the administration considerations for propranolol?
Available for oral or IV use
Use the IV route to treat life-threatening dysrhythmias
Take either with or without food at consistent times
Monitor BP and pulse before administering; withhold if BP is below 90 mm/Hg systolic
## Footnote
Propranolol is a non-selective beta-blocker used for hypertension and anxiety.
251
What are the administration considerations for amiodarone?
Available for oral and IV use
Give oral amiodarone with or without food, but at consistent times
Infuse IV dose through central line catheter to prevent thrombophlebitis
Correct low potassium or magnesium levels before beginning therapy
## Footnote
Amiodarone is an antiarrhythmic medication used for various types of dysrhythmias.
252
What are the administration considerations for verapamil?
Available for oral or IV use
Give oral dose with food to prevent GI upset
IV form: give dose using recommended dilution over 2 to 3 minutes
## Footnote
Verapamil is a calcium channel blocker used for hypertension and angina.
253
What are some antidiarrheals and their uses?
Select Prototype Medication: Diphenoxylate plus atropine
Loperamide
Paregoric
254
When is diphenoxylate contraindicated?
Diphenoxylate is contraindicated in clients who have severe electrolyte imbalance or dehydration. It is a Schedule V agent under the Controlled Substances Act (CSA). QS
255
What are some complication of metaclopramide?
Tardive dyskinesia- with long term therapy
Extrapyramidal symptoms
sedation
diarrhea
256
What are 5 main complications of phenytoin?
CNS effects: Nystagmus, sedation, ataxia, double vision, cognitive impairment
gingival hyperplasia- maintain good oral hygiene, up folic acid
skin rash-STOP drug
Cardiovascular effects: dysrhythmias, hypotension
endocrine: coarsening of facial features, hirsutism, and interference with vitamin D metabolism
257
probiotics should be administered when with antibacterial or antifungal dosing. what?
at least 2 hrs after doses because the meds can cill the bacteria and yeasts in probiotics- sa,e wotj spu
258
What are som ADR or SE of dnepezil?
hepatotoxicity
GI stuff- infection, vomiting, and nausea
259
When is donepezil expected to start working?
around 4-6 weeks.
260
What are some ADR of Levodopa/carbidopa?
N/V/ drowsiness- eat protein in small portions w/p vitamin, banana, green veggies
dyskinesias-amantadine
orthostatic hypotension
cardio effects
psychosis- no MAOIs
discoloration of sweat and urine- harmless
activation of malignant melanoma
261
What are some ADR of Valproic Acid?
Vomiting
Abdominal discomfort/alopecia
liver- hepatotoxic
pancreatitis/platelets (thrombocytopenia)
think Mr. Potatohead- CBC. ALT/AST, LDH
262
Carbamazepine ADR
CNS effects- nystagmus, double vision, vertigo,
blood dyscrasias- leukopenia, anemia
hypo-osmolarity-
skin disorders- SJS, photosensitivity- anti-inflammatory and antihistamine
Think: ate too many carbs in a maze on a hot sunny day, you're feeling, hot (anticholingergic) burned (skin disorders/photosensitivity), and dizzy (CNS effects),
263
What are some ADR of lamotrigine
SLOW titration of two wks to avoid SE!!
CNS- somnolence, aphasia, double or blurred vision,
Aseptic meningitis- headache, fever, stiff neck
skin disorder- SJS, organ failure, sedation
