MEDICATIONS Flashcards
Warfarin therapy and the intake of vitamin K:
Sudden increases or decreases in the consumption of Vitamin-K rich foods could inversely alter effectiveness of warfarin.
-Rather than avoid vitamin-K rich foods, the client needs to keep intake consistent.
ADDITIONAL TIPS:
- Take warfarin same time everyday
- Double dosing is contraindicated
- Antibiotics can affect INR level
Therapeutic INR?
2-3
What is albuterol? What is beclomethasone?
Albuterol: (Proventil) short-acting beta agonist administered as quick relief, rescue drug to relieve symptoms associated with persistent or intermittent asthma.
-SABA is a rescue drug, and taken on an as-needed basis and not always taken with the ICS.
Beclomethasone: inhaled corticosteroid; normally used a long-term, first-line drug to control chronic airway inflammation.
-Taken on a regular schedule
What two medications can cause bronchospasms in some clients with asthma?
Ibuprofen and aspirin
Client receiving ACE inhibitors should be monitored for what?
Hyperkalemia: ACE inhibitors decrease the excretion of aldosterone, which promotes sodium retention and causes potassium excretion.
Basal insulin glargine (Latus):
used for glucose control in diabetic clients; has no peak and should be administered even if the current BG level is w/in normal limits.
Serious adverse effect of statins:
Myopathy; muscle aches–> would then want to obtain a creatine kinase level.
Sildenafil =
Viagra
Normal aPTT:
25-35
Therapeutic aPTT:
typically 1.5-2 times the normal value; 46-70
Ipratropium:
anticholinergic agent used to treat acute asthma attacks
Antiplatelet therapy:
Aspirin, clopidogrel, prasugrel, ticagrelor
-Watch for bruising, tarry stools, and other signs of bruising (epistaxis, hematuria)
Serum theophylline level:
Narrow TI: >20 levels are associated with toxicity:
Look for: headaches, insomnia, seizures, N/V, arrhythmias
Alteration in color perception and visual changes:
Dig toxicity
Gum hypertrophy:
Phenytoin toxicity
Hyperthermia and tinnitus
Aspirin overdose
Clients should avoid what when on warfarin therapy?
Aspirin, NSAIDS, alcohol
-Usually administered for 3-6 months following PE
Initial management of PEs:
low-molecular weight heparin (enoxaparin, dalteparin)
-Once PE is resolved, maintenance drug therapy is Xa inhibitors (apixaban, rivaroxban)
*These are anticoags
aka no NSAIDS while on this drug therapy
Loop diuretics:
furosemide, torsemide, bumentanide
ACE inhibitors:
Ex: lisinopril, ACE inhibitor –> does NOT lower HR and can be given to patients w/ bradycardia
Diltiazem:
Lowers HR
Headache is a common SE of HTN. T/F
TRUE
Monitor for presence of what when giving propranolol:
Wheezing
Digoxin TI =
0.5-2
Metoclopramide:
Commonly used antiemetic medication that treats N/V and gastroparesis by increasing gastrointestinal motility and promoting stomach emptying.
What is associated with extended use/high doses of metoclopramide?
Tardive dyskinesia: a movement disorder that is characterized by uncontrolled movements (sucking/smacking lips)
-It is often irreversible
Sucralfate:
- Oral medication that forms a protective layer in the gastrointestinal mucosa, which provides a physical barrier against stomach acids and enzymes.
- Prescribed to treat and prevent stomach and duodenal ulcers
- Prescribed 1 hour before meals and at bedtime and is taken on an empty stomach with a glass of water.
- Proton pump inhibitors should be AVOIDED w/in 30 minutes of taking this med to prevent altered absorption.
Phenytoin: (Dilantin)
Antiseizure medication with a TI of 10-20:
- Tube feedings decrease phenytoin absorption, which reduces serum drug concentration and may precipitate seizures
- The nurse should pause tube feedings 1-2 hours before and after phenytoin administration to ensure adequate absorption.
- Toxicity produces nystagmus, dysarthria, ataxia, and encephalopathy
What is the therapeutic INR for a client with a mechanical heart valve?
2.5-3.5
What is the TI for lithium?
- 6-1.2
- Lithium toxicity produces nausea, vomiting, ataxia and tremors
Sulfasalazine: (Azulfidine)
Contains sulfapyridine and aspirin and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease.
-Yellow-orange pee is an expected finding when using this drug
-Dehydration is BIG risk when using this med
Anticholinergic side effects:
pupillary dilation, dry mouth, urinary retention, and constipation.
-Contraindications are closed-angle glaucoma, bowel ileus and urinary retention.
NOT CATARACTS
Tricyclic antidepressants:
amitriptyline, nortriptyline, desipramine, imipramine –> commonly used for neuropathic pain.
Most common side effects include: dizziness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision.
List thrombolytic agents:
- Alteplase, tenecteplase, reteplase: used to resolve acute thrombotic events (ischemic stroke, MI, PE)
- They are contraindicated in clients with active bleeding, recent trauma, aneurysm, AVM, hx of hemorrhagic stroke, and uncontrolled HTN
Most penicillin derivates (ampicillin amoxicillin) and cephalosporins (cephalexin, ceftriaxone) are generally considered safe for pregnant women or lactating. T/F
TRUE
Midazolam (Versed):
benzodiazepine commonly used to induce conscious sedation in clients undergoing endoscopic procedures
-Usually no more than 3.5mg is necessary to induce sedation
ANTIDOTE: Flumazenil (Romazicon)
Orlistat:
Lipase inhibitor that prevents the breakdown and absorption of fats from the intestine.
- This med is prescribed to clients who are obese/having trouble losing weight
- Because orlistat blocks the absoprtion of fats, also interferes with fat-soluble vitamin uptake. –> Clients will need to take a multivitamin that contains vitamin A, D, E and K.
- Most effective, multivitamins should be taken >2hours after taking orlistat
What is the initial treatment for an aspirin overdose?
Activated charcoal: binds with salicylate and inhibits absorption by the small intestine. IV sodium bicarbonate is also used AFTER the activated charcoal
Misoprostol (Cytotec)
synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promotion mucus production and cell regeneration.
- Prescribed to prevent gastric ulcers in clients receiving long-term NSAID us.
- Antacids can increase the adverse effects of misoprostol
Metoclopramide (Reglan)
Prescribed for the tx of delayed gastric emptying, GERD, and as an antiemetic. Use of this drug is associated with extrapyramidal adverse effects, including TD.
-Common SE include: sedation, fatigue, restlessness, headache, dry mouth, constipation, and diarrhea and DONT need to be reported to HCP.
What is used for diagnostic purposes and often reduces the intussusceptions in infants?
contrast enema (air enema)
ZOLES =
Proton pump inhibitors
- Long Term use associated with CDIFF
- Also decreases the absorption of calcium and promote osteoporosis
What is Riluzole (Rilutek)?
The only medication approved for ALS treatment. A glutamate antagonist, slows neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and SC.
-May slow disease progression and prolong survival for 3-6 months
Valproic acid: Depakote
Anticonvulsant that is also prescribed for bipolar disorder
Celecoxib:
a COX-2 inhibitor: has a black box warning for increased risk of cardiovascular complications
Postmortem care:
- Wash and straighten the body
- change the linens
- Place a pad under the perineum to absorb stool and urine from relaxed sphincters
- Place a pillow under the head to prevent blood from pooling and discoloring the face.
- Place dentures in the mouth, close the mouth and eyes
- Remove tubes, lines, and dressings per policy if no organ donation or autopsy is ordered
- After the family leaves, take the client to the morgue or notify the funeral home to make arrangements
* This work can be delegated to an experienced UAP
Isotonic IV solutions:
0.9% sodium chloride, lactated ringers- these solutions replace fluid losses commonly associated with vomiting and diarrhea, burns, and traumatic injury.
Extreme hyperglycemia in a client with DKA results in osmotic diuresis and dehydration. What is in the initial treatment?
IV fluid resuscitation with isotonic 0.9% sodium chloride
Albumin is smaller than most proteins and is typically the first protein that is seen in the urine when kidney dysfunction begins to develop. T/F and how would you see the trace of albumin?
TRUE - you would see this on an urine dipstick test.
-150mg/day of protein in the urine is normal
When a medication prescription is outside the safety range, the nurse must clarify/question the prescription with the provider and not administer the drug automatically. T/F
TRUE
Tamoxifen:
Selective estrogen receptor modulator.
- In the breast, they block estrogen and help inhibit the growth of breast cancer cells.
- Irregular or excessive menstrual bleeding in premenopausal woman or any bleeding can be a sign of endometrial cancer.
TWO MOST SERIOUS SE:
- Thromboembolic events (DVT, PE, stroke)
- Endometrial cancer
Cephalexin:
Cephalosporin –> chemically similar to penicillin.
NSAIDs (ibuprofen) should be avoided in which clients?
- Clients with nasal polyps
- NSAIDs can also exacerbate asthma symptoms
- Acetaminophen is a better choice for these clients
ACE inhibitors (ending in “pril”) are the drugs of choice in which clients?
Hypertension and proteinuria
________ is a common, early symptom of HTN crisis that should be evaluated immediately in clients taking MAOIs?
Headache
Pyridostigmine (Mestinon):
first-line drug that inhibits acetylcholine breakdown and is prescribed to temporarily increase muscle strength in clients with MG; priority medication as difficulty swallowing indicates weakness of the muscles involved in swallowing and increases aspiration risk
First-line medication for treatment of hypothyroidism during pregnancy?
Levothyroxine; should be taken in the morning on an empty stomach
-Dose may need to be increased as the pregnancy continues
Anemia associated with CKD is treated how?
Recombinant human erythropoietin
- Therapy is initiated when hemoglobin <10 to alleviate symptoms of anemia. Therapy should be discontinued or the dose reduced for hemoglobin >11.
- HTN is a major adverse SE of erythropoietin administration –> uncontrolled HTN is contraindicated to recombinant erythropoietin therapy.
What is used to treat hyperkalemia?
Sodium polystyrene sulfonate (Kayexalate)
When administering IV vanco:
- Draw the prescribed trough level prior to administration. Therapeutic vanco levels = 10-20
- Infuse medication over at least 60 minutes
- Monitor blood pressure; hypotension is a possible adverse effect
- Assess for hypersensitivity
- Monitor for anaphylaxis
- Observe IV site every 30 minutes
Glycoprotein IIB/IIa receptor inhibitors: abciximab, eptifibatide, tirofiban
Inhibit platelet aggregation and increase bleeding risk
-Serious thrombocytopenia can occur within a few hours, further increasing bleeding risk. After administration the nurse should monitor the client’s blood counts, blood pressure, and heart rate and rhythm, as well as watch for signs of bleeding
Sulfasalazine (Azulfidine): Use and SEs
Used for mild to moderate chronic inflammatory RA and inflammatory bowel disease
SE include:
- Crystalluria: client should drink 8 glasses of water daily
- Photosensitivity
- Folic acid dependency (megaloblastic anemia and stomatitis)- client should take folic acid supplement
- Agranulocytosis: client should be monitored for complete blood count
- Steven-Johnson syndrome: client should stop the medicine if rash develops
What is thrombocytopenia?
Low blood platelet count; if platelet count is LOW LOW then don’t administer heparin
Should pregnant women be taking lisinopril?
NO its a teratogenic; can cause embryonic/fetal development abnormalities
Gingival hyperplasia is a common SE of what drug? and should the med be stopped if it occurs?
Phenytoin (Dilantin); and is no reason to stop drug
Radioactive iodine (RAI):
Treats hyperthyroidism by partially damaging or destroying the thyroid gland
- Requires up to 3 months for maximal effect
- After administration, the client emits radiation, and excreted bodily fluids are radioactive.
What home precautions should be taught to protect those who have undergone radioactive iodine?
- Limit close contact and time spent with preggo women and children
- Use a separate toilet, and flush 2 or 3 times after each time
- Use disposable cups, plates, and utensils, and do not share foods that could transfer saliva
- Isolate personal laundry and wash it separately
- Sleep in sep. bedrooms
- Dont sit near others for a prolonged period of time
- Breastfeeding should be stopped 6 weeks before treatment; cannot be resumed with same child but can be resumed in future pregnancies
ACE inhibitors increase serum potassium by decreasing urinary potassium excretion: SO what should the nurse check prior to administration of these meds?
Check K+ levels
SSRIs:
fluoxetine, paroxetine, citalopram, escitalopram, sertraline –> sexual dysfunction is a possible SE
The nurse should avoid what while administering ferrous sulfate?
Calcium supplements or antacids within 1 hour of taking ferrous sulfate
-Encourage to take with orange juice tho!
Antiplatelet agents: Clopidogrel, ticagrelor, aspirin
Prevent platelet aggregation. They prolong bleeding time and should NOT be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage
A serious complication associated with statin is what?
RHABDO; Client should immediately report any signs of muscle aches or weakness to HCP
The UAP can perform sterile dressing changes and perform drain care. T/F
FALSE- the RN must do this
Important educational info to tell clients who are switching from a tricyclic antidepressant to a monoamine oxidase inhibitor:
A drug-free period of at least 2 weeks should elapse between the tapered discontinuation of the TCA and the initiation of the MAOI.
-The client should taper off of the imipramine, then discontinue for two weeks before starting phenelzine
A tyramine-restricted diet is indicated for clients on an what medications?
MAOIs to decrease the risk of hypertensive crisis
What is the Beers criteria?
A list that classifies potentially harmful drugs to avoid or administer with caution in the elderly:
Ex: Amitriptyline, chlorpheniramine, and lorazepam
Teratogenic medications:
- Phenytoin: neural tube defects, orofacial clefts, microcephaly, nail or digit hypoplasia
- Lithium
- Valproate
- Isotretinoin
- Methotrexate
- ACE inhibitors
- Warfarin
- Doxycycline
MAOI interactions:
MAOIs- Selegiline
SSRIs- escitalopram/, sertraline/Zoloft
MAOIs interact with many medications.
-Concurrent use of MAOIs with SSRIs may have life-threatening adverse reactions
Benzos =
Alprazolam (Xanax), lorazepam (Ativan), hypnotics (zolpidem ((Ambien))
What does heparin do?
Slows the time it takes blood to clot, keeping the current clot from growing bigger and preventing new clots from forming.
-DOES NOT DISSOLVE CLOTS
Clients taking long-term corticosteroid replacement should be taught the following: Used to treat addison’s disease
- Do not discontinue therapy abruptly.
- Report any S/S of infection to the HCP
- Stay aware to signs of stress and increase dose of steroid during times of stress
- A side effect of corticosteroid is hyperglycemia.
- A diet high in calcium and protein but low in fat is recommended 2T the chances of osteoporosis and muscle weakness.
- Cataracts are SE, make an eye appointment yearly
- Should be taken on an empty stomach.
Pharmacological treatment modalities to treat asthma attack:
- Oxygen to maintain >90%
- High-dose inhaled short-acting beta SABA - Albuterol and anticholinergic agent (Ipratropium) neb treatment every 20 mins
- Systemic corticosteroids (Solu-Medrol)
When taking potassium supps, instruct the client to do what?
Take the tablets with plenty of water and remain sitting upright for at least 30 minutes
ACHES with contraceptive use:
- More at risk for blood clots
- DONT SMOKE
A= abdominal pain C= Chest pain H= headaches E= eye problems S= severe leg pain
Sodium polystyrene sulfonate (Kayexalate):
Is used to treat mild to moderate hyperkalemia–> exchanged for sodium in the intestines and excreted in the stool, thereby lowering the serum potassium –> in clients without normal bowel function, there is a risk for intestinal necrosis –> so as nurse you need to assess the clients abdomen and review frequency of stools!!
Macrolide antibiotics: azithromycin, erythromycin, clarithromycin
Can cause prolonged QT intervals, which may lead to sudden cardiac death due to torsades de pointes.
-Concurrent use of these antibiotics with other drugs that prolong the QT interval (amiodarone) will further increase this risk.
Lithium toxicity prevention:
- Avoid sodium depletion; low sodium intake precipitates lithium toxicity
- Eat regular diet and drink adequate fluids
- Therapeutic level is 0.6-1.2
- Level >1.5 is considered toxic
- Takes several weeks to reach therapeutic level
Increased levels of BUN and creatinine may indicate what:
Nephrotoxicity and ototoxicity
Saline lock:
Keeps the line patent and allows greater mobility than a continuous infusion
Clients with an allergy to penicillin antibiotics could possibly experience a cross-sensitivity reaction to what class of drugs?
Cephalosporin antibiotics: cefazolin, cephalexin, ceftriaxone
*The nurse needs to first assess what type of reaction the client had
Levothyroxine sodium: levoxyl, levothroid, synthroid
Used to replace thyroid hormone in clients with hypothyroidism and for those who have had their thyroid removed.
- Clients will be on this for the rest of their lives
- Clients must notify HCP of heart palpitations/tachy, weight loss, insomnia
Terazosin:
Alpha-adrenergic blocker can relieve urinary retention in clients with BPH.
CAUTION: can also cause hypotension, should be taken at bedtime, avoid viagra
Misoprostol (Cytotec):
Cervical ripening agent; can also stimulate frequent contractions
- CONTRAINDICATIONS:
- The client is receiving another uterotonic simultaneously (oxytocin)
- Client has a history of uterine surgery
- Client has an abnormal fatal heart rate pattern or uterine tachysystole (>5 contractions in 10 min)
Client education on flagyl:
- Abstain from sex
- Avoid drinking alcohol during and 3 days after completion of therapy
- Have partners treated
- Can turn urine dark color
Rifapentine:
Clients taking this medication should be taught to prevent pregnancy with non-hormonal contraceptives, notify HCP of any signs or symptoms of hepatotoxicity and expect red-orange colored secretions
Clients taking ethambutol should have what checked?
Baseline and periodic eye examinations
Codeine:
- Opioid drug prescribes as an analgesic to treat mild-moderate pain and as an antitussive to suppress the cough reflex
- SE: constipation, orthostatic hypotension, N/V (take medicine with food)
Clients should never stop taking Phenytoin abruptly due to the possible seizure occurrence. What is the only exception?
Development of a skin rash; may indicate SJS with is a potentially life-threatening reaction. Starts with flu like symptoms and a painful red-purple rash
Gingival hyperplasia is common with cyclosporine and phenytoin. T/F
TRUE
Who should get the flu vaccine?
All clients age >/- 6 months
Special emphasis on high-risk individuals that should receive the flu vaccine:
- Clients with chronic conditions may experience exacerbation of symptoms if infected
- Immunocompromised clients have decreased ability to fight infection
- Healthcare workers
- Pregnant clients
- Healthy children 6-23 months and >/- 65yo
Infliximab, adalimumab, and etanercept:
Tumor necrosis inhibitors that suppress the inflammatory response in autoimmune diseases such as RA, Crohn’s, and psoriasis
-Clients taking these drugs are at increased risk of infection –> clients with current, recent, or chronic infection should not take a TNF inhibitor
The following should be taught to clients taking tetracyclines:
- Take on empty stomach
- Avoid antacids or dairy products
- Take with full glass of water
- Photosensitivity
Allopurinol:
INCREASE FLUID INTAKE; Prevent the formation of renal stones and promote diuresis
NG tube meds contraindications:
-Crushing an enteric-coated, slow-release, extended-release, or sustained-release drug disrupts its designed time of release and is contraindicated –> nurse should contact HCP
What food allergies also increase the risk for latex allergy?
-Avocado, banana, tomato
