Medications Pt 1 Flashcards
what are anticoagulants and what is it used for
heparin
enoxaparin
Warfarin
use to inhibit platelet clotting factor
used for:
- stroke
- heart failure
- heart valve disease
- coronary artery disease
- dysrhythmias, afib
- DVT
contraindications in anticoagulatns
coagulation disorder
peptic ulcer disease
malignancy
bleeding or recent trauma/surgery
pregnancy or lactating
used cautiously in those getting epidural analgesia
anticoagulants common side effects
bleeding fever heparin induced thrombocytosis anemia pain and bruising at the injection site
anticoagulants nursing consideration
treatment is effective when there is no emboli, stroke, MI
monitor for bleeding
- bleeding in urine
- dark tarry stools –> bleeding in stools
- decreased serum platelets and hct
wear a med bracelet
have bleeding precautions:
electric razor
soft toothbrush
let HCP know if: bleeding gums excessive bruising black, tarry stools bloody nose
ginger, gingko, garlic, ginseng, alfalfa, chamomile can interact with anticoagulants
vitamin C may prolong PT and vitamin E can increase Warfarin’s anticoagulation effect
you should consume foods high in Vitamin K:
green leafy vegetables
meats, fish, eggs, liver
if scheduled for a spinal or epidural procedure, you must check with HCP
Heparin antidote: protamine sulfate
Warfarin antidotes: Vit K, fresh frozen plasma
what are alpha 1 adrenergic blockers
Doxazosin
Tamsulosin
Prazosin
Terazosin
used alone or in combination
used to control blood pressure or treat symptoms associate with BPH
causes decreased blood pressure and the prostate and bladder neck to relax in BPH
alpha 1 adrenergic blockers contraindications
hypersensitivity to drugs within this class
if you are taking aninazolines
this could cross into breast milk and cause adverse effects in newborn
Doxazosin: should be used with caution in client’s with
- constipation
- Gi obstruction
- ileus
- liver impairement
Terazosin, Prazosin and Tamsulosin are contraindicated in clients:
- who have undergone cataract or galucoma surgery
- clients who has a history of angina, or orthostatis hypotension
alpha 1 adrenergic blockers common side effects
hypotension
dizziness
loss of muscle strength and energy
headache and edema
alpha 1 adrenergic blockers nursing considerations
before first dose, obtain:
- vitals
- HR
- fluid status
- weight
- BUN
- creatinine
administer first dose at bedtime because considered risk for falls
monitor: BP, pulse GI function liver function muscle strength fluid volume status
change positions slowly and consult with HCP before discontinuing
make lifestyle changes:
- management of weight
- increasing activity levels
- low sodium diet
what are ACE inhibitors and what is it used for
Captopril
Lisinopril
Enalapril
Ramipril
Captopril:
take on an empty stomach 1 hour before meals or 2 hours after meals
may be crushed
might experience loss of taste for 2-3 months so monitor nutritional intake
Lisionpril:
can take without regard to food
may be crushed
Enalapril:
cardio adverse reaction, especially when given parenterally
so monitor BP before and after
administered over 5 min
Ramipril:
can take without regard to food
can be mixed with juice, water, applesauce
used to control blood pressure
treat heart failure
prevent CVA, stroke
used as a kidney protect for those with diabetic nephropathy
ACE inhibitors contraindications
use with caution in clients with impaired renal function or renal artery stenosis
cross the placenta and causes severe fetal abnormalities and death
hypersensitivity reaction or those that use aliskiren
ACE inhibitors common side effects
persistent dry hacking cough hypotension rash hyperkalemia los of taste
rare: angioedema hepatotoxicity pancreatitis pancytopenia - lower than normal number of RBCs, WBCs, plts renal damage
ACE inhibitors nursing considerations
before first dose, assess if they have ever gotten ace inhibitor-induced angioedema (swelling of the face and tongue)
- if they have report to HCP immediately
baseline date:
- BP, pulse, rhythm, fluid, negative pregnancy test
- BUN, Cr, sodium and potassium
do not breastfeed and use barrier contraceptives if childbearing age
change positions slowly
avoid potassium supplements
if pregnany, disconitnus ACE inhibitors
persistent cough doesn’t mean that they should stop taking ACe inhibitors
OTC meds, cough, cold and allergy meds may exacerbate hypertension
lifestyle changes:
- manage weight, increasing activity, changing unhealthy dietary habits
what are ARBs and what is it used for
“sartans”
losartan
valsartan hydrochlorothiazide
Valsartan
used to control blood pressure and treat heart failure
used with clisent who cannot tolerate ACE inhibitors
ARBs contraindications
hypersensitivity reaction
cross the placenta and cause severe fetal abnormalities
ARBs common side effects
headache dizziness syncope weakness back pain tooth pain abdominal discomfort sxs of upper respiratory infection
ARBs nursing considerations
obtain baseline data:
- BP, pulse, weight, resp status
- GI function, liver function
labs:
- BUN
- liver function tests
- creatinine
needs to have negative pregnancy test
do not breastfeed and discontinue if pregnant
make lifestyle changes:
- weight management
- increasing activities
- low sodium diet
Anti Alzheimer’s Dementia Agents and what is it used for
- anticholinesterase inhibitors:
- prevent the breakdown of acetylcholine
- metabolized in the liver and excreted in the urine and feces
- Donepezil
- Galantamine
- Rivastigmine - NMDA receptor antagonists:
- decreasing the effect of glutamine
- minimal metabolism, excreted in urine
- memantine hydrochloride
used to slow the progression of Alzheimer disease
anti-alzheimers dementia agents contraindications
used with caution in clients with a history of :
- asthma
- COPD
- bradycardia
- bladder obstruction
- ulcer disease
Galantamine and Rivastigmine: not used in clients with low body weight
anti-alzheimers dementia agents commons side effects
headache insomnia generalized pain dizziness anorexia diarrhea
NMDA additional effects: hypertension and cough
overdose of anticholinestera drugs can lead cholinergic crisis
- nausea
- hypotension
- diaphoresis
- bradycardia
- seizures
- cardiac arrest
- muscle weakness
- resp depression
antidote for cholinergic crisis: atropine sulfate given IV
anti-alzheimers dementia agents nursing consideration
baseline data
- cognitive function
- vitals
- medical history
- allergy or severe renal disease with anticholinesterase inhibitors
first dosage should be lowest possible, then gradually increase
Donepezil: no regard to food and should be taken at night
Galantamine and Rivastigmine: should be given with meals
teach sxs on overdose
aminoglycosides and what is it used for
“mycin’
amikacin
gentamycin
tobramycin
antibiotics
treat gram negative aerobic bacillus
poorly absorbed in the GI tract, but rapidly absorbed after injection
excreted unchagned in urine
crosses the placenta and enter breastmilk
aminioglycosides contrainidications
hypersensitivity renal or hepatic disease preexisitng hearing loss herpes myasthenia gravis
parkinsons
breastfeeding
if used in pregnancy, can cause congenital defects
aminoglycosides common side effects
BLACK BOX WARNING: nephrotoxicity and irreversible ototoxicity
others:
- anorexia
- nausea
- vomiting
- diarrhea
- pain at injection site
aminoglycosides nursing considerations
get baseline data:
- renal, auditory and hepatic function
given for short period of time
monitor for sxs:
- tinnitus, vertigo, worsening infection
report any changes in bowel patterns, discomfort, tinnitus, or perceived changes to hearing
cephalosporins and what is it used for
1st:
cephalexin
2nd gen:
cefuroxime
3rd gen:
cefidinir
4th gen:
cefepime
they are antibiotics
1st gen: narro spwcturm 4th gen: broad spectrum that is effective against: - respiratory tract infections -skin and soft tissue infections -urinary tract infections
excrete in urine
cephalosporins contraindications
anaphylactic reaction to penicillin
caution should be used when administering to clients with renal impairment or:
- history of GI ulcer disease
- history of penicillin allergy
cephalosporins common side effects
oral or vaginal candidiasis diarrhea abdominal cramping serum sickness-like reaction - fever - arthralgia colitis -inflammation of the inner lining fo the colon
cephalosporins nursing consideration
baseline data:
- renal
- resp status
- vitals
- skin assessment
monitor for candidiasis or any bowel changes
complete full regimen
report candidiasis and persisitent diarrhea
fuloroquinolones and what is it used for
“floxacin”
ciprofloxacin
levofloxacin
moxifloxacin
antibiotics used to treat gram negative and gram positive bacteria that infect the: - lower respiratory tract - soft and skin tissues - urianry tract - STDs
effective against anthrax inhalations
fluoroquinolones contraindications
history of reaction to quinolones
under 18 years of age
caution when giving to:
- daibetes
- renal impairment
- rheumatoid arthritis
- prolonged QT intervals
- myasthenia gravis
fluoroquinolones common side effects
Gi distress
confusion
crystalluria
- crystals in the urine
colitis
photosensitivity
burning of the eyes and crusty discharge
BLACK BOX WARNING: tendonitis and tendon rupture
fluoroquinolones nursing considerations
superinfections, colitis, diarrhea
baseline data:
- hypersenstivity reaction
- impaired renal function or liver function
- EKG to rule out prolonged QT interval
during and after first dose, monitor for reactions
oral cipro and floxacin should be administered with a glass of water one hour BEFORE or 2 hours AFTER meals, antacids or supplements
monitor for muscle weakness or tendon swelling, gastric upset or photosensitivity
maintain hydration
report diarrhea, bloody stools, muscle weakness or tendon swelling
macrolides and what is it used for
“mycin” these are also mycin so don’t get it mixed up with aminoglycosides
azithromycin
clarithromycin
erythromycin
azithromycin:
used as prophylaxis for endocarditis in dental work and pulmonary exacerbations in cystic fibrosis
clrithromycin:
used as prophylaxis for endocarditis before dental work and pertussis and lyme disease
antibiotics
metabolized in the liver and excreted in urine
macrolides contraindications
history of hepatic impairment realted to aithromycin use
using lovastatin, simvastatin, ergotamine
caution in clients that have renal or hepatic impairment, liver disease, myasthenia gravis, prolonged QT interval
aluminum or magensium antacids can decrease absorptions
if they take calcium channel blockers or other meds that prolong QT intervals
macrolides common side effects
nausea vomiting diarrhea topical use: dry skin IV: pain and redness at injection site
clarithromycin: headaches and altered taste
macrolides nursing considerations
baseline data:
- history of reaction
- impaired renal function or liver function
- EKG to rule prolonged QT interval
monitor for reaction
- azithro and clarithro = can take without regard to food
monitor for GI upset, bowel patterns, liver function and pruritus
report: diarrhea
avoid aluminum and mangesium antacids
complete full course
penicilline and what is it used for
“cillin”
amoxicillin
ampicillin
penicillin
used to prevent or treat strep, syphilis, lyme
penicillin contraindications
history of penicillin related or cephalosporin related hypersensitivity
caution when administering to:
- renal or hepatic impairment
- seizure disorder
- asthma
- hypersensitvity to cephalosporins
penicillin common side effects
allergic reactions
renal, hepatic or hematologic abnormalities
nausea vomiting diarrhea lethargy electrolyte imbalances
penicillin nursing considerations
baseline data:
- electrolytes
- integumentary and liver/kdiney function test
-verify that a client does not have pre-existing penicillin or cephalosporin allergy
report diarrhea, topical rash or ecchymosis
tetracyclines and what is it used for
“cycline”
doxycycline
minocycline
used to treat respiratory infections, skin infections, syphilis, chlamydia and UTI
prophlyaxis for malaria
antibiotics
tetracyclines contrainidications
sulfite-related hypersensitvity
pregnant
children less than 8 years old
- cause permanent discoloration of teeth
caution should be used in clients with:
- candidiasis
- renal or hepatic or hematologic impairment
tetracylines common side effect
photosensitivity anorexia GI upset diarrhea renal, hepatic or hematologic abnormalities increase in intracranial pressure
tetracyclines nursing consideration
baseline data:
- culture and sensitivity test
- NO tetracycline and sulfite reaction
perform central nervous assessment
verficiation of pregnancy status
evaluate renal and hepatic function
monitor renal function and bowel patterns
teach about barrier contraceptives because there is a decreased effectivness in oral contraceptives
wear protective clothing in direct sunlight
avoid taking with antacids or iron supplements
complete full course
nitrates and what is it used for
isosorbide nitrate
nitroglycerine
anti-anginal
used to prevent and treat angina pectoris
work by relaxing and dilating blood vessels which reduce cardiac workload
cross the placenta and enter breast milk
nitrates contraindications
taking sildenafil, vardenafil, tadalafil
-within 24-36 hours of taking a nitrate
severe anemia
cerebral trauma or cerebral hemorrhage
caution in clients with:
- hepatice or renal impairment
- hypotension or hypovolemia
nitrates common side effects
headache dizziness syncope nausea vomiting hypotension reflex tachycardia increased angina
nitrates nursing considerations
baseline data:
- BP
- HR
- history of taking ergot derivatives or sildenafil, vardenafil, tadalfil
monitor for sxs of worsening or unrelieve angina, hypotension or reflex tachycardia
may suffer from headache and can take common pain relievers to treat headache
change positions slowly
keep fresh supply of nitroglycerin on hand
store tablets in an airtight, dark glass bottle with a metal cap
- loses its potency approx 3 months later
if 3 sublingual tablets taken over a 15 min time period do not relieve chest pain, then go to the hospital because it might be MI
anticonvulsants / antiseizure and what is it used for
phenytoin - Dilantin phenobarbital clonazepam diazepam ethosuximide valproic acid carbamezapine gabapentin
control epileptic seizures and treat neuropathic pain
treat migraine hedaches and bipolar disorder
