Medications Pt 2 Flashcards
what is erythropoietin alfa and used for
treat anemias associated with renal failure and chemotherapy
used to reduce the need for blood transfusion in clients with planned surgeries
ex: erythropoietin alfa
naturally occurring substance in body that is excreted by kidneys in response to hypoxia
erythropoietin alfa contraindications
reaction
those who have uncontrolled hypertension
erythropoietin alfa common side effects
arthralgia
muscle weakness
flu-like symptoms
injection site reactions
dizziness
tachycardia
nausea
vomiting
these meds: linked to
- seizures
- strokes
- thromboembolic events
- heart failure
erythropoietin alfa considerations
evaluate iron level, BP and hemoglobin level
monitor side effects
have hemoglobin levels assessed regularly
- if at home, inject these meds at home
- should be taught the method for injection
what is filgrastim and used for
prevent or treat low leukocyte levels associated with cancer treatment, congenital or idiopathic neutropenia
ex: filgrastim
stimulates the formation of neutrophil progenitor cells
filgrastim contraindications
hypersensitivity reaction
filgrastim common side effects
arthralgia myalgia headache rash complain of injection site pain
thrombocytopenia
splenomegaly
splenic rupture
filgrastim considerations
obtains baseline data:
- CBC
- Hct
- platelet levels
monitor response to medication
- nurse should assess for ecchymosis and spleen enlargement
what are immunosuppressants and used for
used to suppress the immune system
common indications including preventing transplant rejection
used in autoimmune diseases
ex:
- cyclosproine
- tacrolimus
immunosuppressants contraindications
reaction
dont use pregnancy or when breastfeeding
caution should be used with clients that have severe renal impairment or that have neoplasms
immunosuppressants common side effects
headache gum hyperplasia tremors hypertension kidney dysfunction
secondary infections
bone marrow suspensions
immunosuppressants nursing considerations
baseline data
- BP
- pregnancy status
- hx of neoplasms
nurse should verify renal function
teach about infection preention
laxatives used for
treat or prevent constipation
softener laxative
docusate
chemical stimulant laxative
cascara
senna
bisacodyl
bulk stimulant laxative
lactulose
magnesium citrate
polyethylene glycol
psyllium
lubricant laxative
mineral oil
laxative contraindications
use with caution if client is a diabetic
do not use in client with acute bowel illness or diarrhea
laxatives should be used with caution in client with a hix of cardiovascular disease
and for those who are pregnancy
laxative common side effects
nausea, vomiting
abdominal cramping
fecal incontinence
laxatives nursing considerations
baseline data
- bowel movement patterns and abdominal assessment
laxative should not be used as a weight loss plan
what is HMG- CoA reductase inhibitors and used for
reduce blood lipids in an effect to reduce the morbidity and mortality of cardiovascular disease
lipid lowering agent
should be used in conjunction with diet and exercise
ex:
- atorvastatin
- rosuvastatin
- simvastatin
HMG- CoA reductase inhibitors contraindications
reaction
pregnancy and breastfeeding
active liver disease
caution should be used when administering these meds to diabetics
HMG- CoA reductase inhibitors common side effects
constipation
decreased absorption of fat soluble vitamins
abdominal pain
arthralgia
rhabdomylosis
upper resp tract infections
simvastatin has been linked to cataracts
HMG- CoA reductase inhibitors nursing considerations
baseline data
- liver function tests
- renal functions tests
monitor for liver dysfunction, muscle pain and renal function
use this conjunction with diet and exercise
notify HCP for muscle pain, decrease urination or sings of resp infection
bile acid sequestrates and used for
used in conjunction with diet and exercise resume serum
lipid lowering agents
choelsterol levels
ex
- cholestyramine
used to treat pruritus associated with partial biliary obstruction
increases the livers cholesterol to make more bile acids, resulting in a decreased serum cholesterol level
bile acid sequestrates contraindications
reaction
total biliary obstruction or impaired renal function
used if med is warranted during pregnancy
bile acid sequestrates common side effects
headache
fatigue
drowsiness
gastrointestinal irritation
bile acid sequestrates nursing considerations
baseline data
- bowel patterns
- biliary patency
- pregnancy status
- abdominal assessment
monitor sxs of biliary obstruction
teach client on how to prevent constipation
report any right upper quadrant pain
-use with dietary changes and exercise
migraine-specific drugs and used for
used to treat acute migraine attacks
ex:
- sumatriptan
not used for prevention of migraine headaches
metabolized in the liver and excrete in urine
cross the placenta and have shown toxic effects to fetus
also enter breast milk
migraine-specific drugs contraindications
reaction
acute myocardial infarction
diagnosed with coronary artery disease
caution when giving to clients of advanced age and those that have renal or liver impairment
migraine-specific drugs common side effects
paresthesia
burning sensation
weakness
muscle pain
vertigo
BP changes
angina
migraine-specific drugs nursing considerations
baseline data
- BP
- cardiac history
- renal and liver function
monitor for angina
BP changes and renal or liver impairment
teach to take meds at first sign of migraine
- report any chest tightness or tingling of extremities to their HCP
do not take if pregnancy or lactating
atropine and used for
treat bradysystolic cardiac arrest and to correct bradycardia
used when treating life-threatening exposure to nerve agents
used in small doses, atropine decreases salivary and bronchial secretions by acting on exocrine glands
atropine contraindications
glaucoma
asthma
gastrointestinal or urinary obstruction
high doses of atropine should be used with caution as they can cause hallucinations, coma and death
atropine common side effects
agitation
diplopia
dry mouth
dizziness
altered taste
urinary retention
tachycardia
muscle twitching
photophobia
mydriasis
increase in intraoocular pressure
shallow breathing
decrease in sweating ability
atropine nursing considerations
baseline data
- BP
- reaction to atropine
- HR
- hx of urinary retention, prostate enlargement or cardiac dysfunction
notify HCP if abdominal pain, urinary retention, blurred vision or heart palpitation
avoid strenuous activity and overheating
urinary antispasmodic and used for
treat bladder hyperactivity including symptoms of urgency
frequency
nocturia
incontinence
ex:
- oxybutynin
- tolteradine
urinary antispasmodic contraindications
reactions
with other meds that have an anticholinergic action
- antihistamines
urinary antispasmodic common side effects
dry mouth
drowsiness
constipation
urinary retention
blurred vision
nausea
vomiting
decrease in sweating abilities
urinary antispasmodic considerations
baseline data
- urinary frequency
monitor intake and output
- urinary retention
- bowel activity
avoid alcohol
avoid activities that require alertness
take surgarless candy to treat dry mouth
avoid strenuous activity and overheating
non-opioid analgesics and used for
used to control inflammation, mild to moderate pain and fever
aspirin
- used to inhibit platelet aggregation
first gen:
- aspirin
- ibuprofen
- ketorolac
second gen
- celecoxib
acetaminophen
non-opioid analgesics contraindications
peptic ulcer disease
used with caution in Helicobacter pylori infection
ketorolac is contraindicated in clients with hx of severe kidney disease
second gen NSAIDs
- used with caution in clients that have cardiovascular disease
- for client that have an allergy to drugs containing sulfa
non-opioid analgesics common side effects
abdominal pain and nausea
may lead to bleeding ulcers
NSAIDs associated with eight cranial nerve stimulation
non-opioid analgesics nursing considerations
baseline data
continually monitor amount of medication
acetylcysteine is used as an antidotes to an acetaminophen overdose
teach:
appropriate use of med
meds that mask sxs
aspirin toxicity may progress from ringing in ear and fever to coma and resp depression
- limit amount of acetaminophen to less than 4,000mg/day in adults
opioid analgesics and used for
manage moderate to severe pain
ex: codeine hydrocodone hydromorphone meperidine morphine oxycodone
opioid analgesics contraindications
reaction
resp depression
paralytic ileus
upper airway obstruction
used cautiously in client who also take CNS depressants like alcohol
caution with advanced age and those that suffer from chronic resp conditions
opioid analgesics common side effects
nausea, vomiting
resp distress
orthostatic hypotension
bradycardia
impaired cognitive capabilities
opioid analgesics nursing considerations
meds should not be administered if respiratory tracts are lower than 12 breaths per minute
monitor resp status and breathing patterns
withdrawal symptoms may occur
keep this med in a safe space
- never combine other CNS depressants with these meds
antidote for opioids is an opioid antagonist called naloxone
- repeated doses may be needed to rapidly reverse opioid meds
sedative hypnotic and used for
short term treatment of insomnia
ex:
zolpidem
zaleplon
eszopiclone
sedatives contraindications
reaction
before bedtime prevent client from getting 6-8 hours of sleep
should be used with caution if other CNS depressants are being taken
caution in clients with advanced age or those suffering from depression
sedative hypnotics common side effects
drowsiness
amnesia
behavioral changes
blurred vision
constipation
after beginning these meds, a worsening of depression, hallucinations or suicidal ideation can occur
sedative hypnotics nursing considerations
baseline data monitor sxs - dizziness - liver and kidney function - bowel patterns
teach client to avoid using alcohol or other CNS depressant during usage
take meds when 6-8 hours of sleep is possible
skeletal muscle relaxants and used for
treat spasticity associated with spinal cord disease like:
- cerebral palsy
- multiple sclerosis
- lesions
used in conjunction with other modalities to reduce muscle spams and pain
- rest
- heat
- physical therapy
ex:
cyclobenzaprine
baclofen
skeletal muscle relaxants contraindications
caution in clients with advnaced age
those with renal disease
cardiac dysfunction or heart failure
skeletal muscle relaxants common side effects
headache dizziness drowsiness confusion insomnia
cyclobenzapine: drowsiness dizziness fatigue dry mouth constipation headache
baclofen:
increased urinary frequency
seizures
skeletal muscle relaxants considerations
baseline data
avoid other CNS depressants like alcohol
avoid activities that require mental alertness until reaction to these medications
skeletal muscle relaxants drug specific considerations
those taking cyclobenzaprine may experience anticholinergic effects like dry mouth and urinary retention
those taking baclofen, should be instructed to take it with food
- discontinuing used of baclofen, abruptly can cause severe adverse reactions
thyroid hormone replacement and used for
used to treat low levels or absent levels of thyroid hormones, myxedema coma
ex:
levothyroxine
desiceated thyroid
thyroid hormone replacement contraindications
hypersensitivity
caution when administering these meds to breastfeeding mothers and clients that suffer from addison disease
medications should not be stopped during pregnancy
- dosages are often increased during pregnancy
NOT approved for weight loss
thyroid hormone replacement common side effects
palpitations dysrhythmias tremors anxiety insomnia
thyroid hormone replacement nursing considerations
baseline data
monitor for sxs
teach client to take meds 30 min before breakfast
- not abruptly stop the med without discussing with HCP
urate lowering drugs (antigout agents) and used for
treat primary gout and hyperuricemia
also used to treat secondary hyperuricemia related to cancer and recurrent calcium oxalate calculi
Ex:
allopurinol
urate lowering drugs (antigout agents) contraindications
presence of a reaction
caution when administering to client with history of renal or liver impairment
urate lowering drugs (antigout agents) common side effects
drowsiness chills peripheral neuoropathy nausea vomiting
urate lowering drugs (antigout agents) nursing considerations
prior to giving:
obtain CBC and uric acid
- review renal and liver function tests prior to administration
monitor sxs
teach:
- take med after meals
- drink enough water to produce 2 liters of urine a day
- adhere to a low purine diet to prevent uric acid
- report any abnormal bleeding and bruising
- during first months of use, an increase in gout “flare ups” may occur
client should contact HCP for this but should not discontinue use
biphosphonates and used for
treat osteoporosis and increase bone mass
alendronate
thought these meds reduce bone remodeling and thus bone reposition
- leads to gradual increase in bone mass
- meds do not undergo metabolism and are excreted in the urine
biphosphonates contraindications
hypersensitivity reaction
hypocalcemia
inability to sit upright for 30 minutes after taking med
esophageal emptying difficulties such as strictures
meds can cause esophageal irritation and preliminary studies
caution should be used in clients with renal impairment
biphosphonates common side effects
headache
vertigo
new or worsening bone pain
diarrhea
esophageal irritation and erosion
biphosphonates nursing considerations
baseline assessment
- serum calcium level
- ability to sit upright
- hypersensitivity reaction
should not be given with food, antacids, calcium or iron a
- will cause decrease in absorption
monitor for sxs of side effects, renal impairment and hypocalcemia
teach:
- take med in morning with water
- sit upright or stand for 30 minutes after taking
- take calcium and vitamin D supplement
bronchodilators and used for
dilate airways for relief of narrowed airways and difficulty breathing associated with asthma and COPD
albuterol
ipratropium
theophylline
beta 2 adrenergic agnonist work by targeting beta 2 receptors in the bronchial smooth muscles
bronchodilators contraindications
not be used in client that have:
- heart disease
- hypertension
- hypothyroidism
- seizure disorder
hypersensitivity reaction
conditions that would be exacerbated by anticholinergic effect of this drug
allergy to soy or peanuts due to methods used to prepare the drug
bronchodilators common side effects
albuterol: nervousness restlessness tremor headache
insomnia
hyperactivity
nausea
vomiting
hypergylcemia
hypokalemia
ipratropium: dry mouth dizziness headache fatigue palpitations urinary retention
theophylline: restlessness palpitation sinus tachycardia dizziness anorexia vomiting headache insomnia
adverse effects are more likely to occur at theophylline serum levels greater than 20 meq/mL
bronchodilators nursing considerations
when clients use both inhaled steroids and inhaled bronchodilators
- should use bronchodilator first to open up airways
then wait few minutes and use the steroid so it can be more effective
rinse and spit after using inhalers
albuterol drug specific considerations
assess lung sounds, pulse and BP before administration and during peak of medication
pulmonary function tests before initiating therapy and periodically during therapy
observe for paradoxical bronchospasm - wheezing
- if this condition occurs, withhold the medication and notify the HCP immediately
teach how to monitor HR
avoid caffeine
teach proper inhaler use
theophylline drug specific considerations
alcohol caffeine and smoking are prohibited contact provide if: - nausea - vomiting - anxiety - insomnia - convulsions
draw peak serum theophylline levels 15-30 min after an administering IV loading dose
ensure that dizepam is readily available
anti-inflammatory bronchodilators and used for
dilate airways
treat or prevent inflammatory process that leads to narrowing of airways
budesonide - inhaled steroids
zafirlukalst
montekulast
- these are leukotriene receptor antagonists
inhaled steroid:
decrease inflammatory process in airways by decreasing effects of inflammatory cells
leuotriene receptor antaonigsts:
block receptors that increase the production of leukotrienes
action that block the inflammatory process associated with asthma
anti-inflammatory bronchodilators contraindications
avoided in clients that have history of reaction
none are used to treat acute asthma attack or status asthmaticus
inahled steroids should be used cautiously when clients have an active infection of respiratory tract
leukotriene receptor antagonists used cautiously with hepatic or renal impairment
montekulast side effects
dizziness headache upper resp infection fever pharyngitis
cough
Gi upset
otitis media
runny nose
sinusisits
leukotriene receptor antagonists side effects
dizziness
headache
nausea
diarrhea
fever
injection
myalsiga
anti-inflammatory bronchodilators considerations
assess baseline monitor for: - infection - headache - dizziness - generalized pain
meds are not used for acute attacks
therapeutic effects may take weeks to achieve
anti-inflammatory bronchodilators drug specific considerations
montekulast may increase:
- hallucination
- aggression
- anxiousness
- suicidal behavior
- tremors
calcium channel blockers and used for
treat hypertension decreased cardiac workload angina abnormal heart rhythms - afib - paroxysmal supra ventricular tachycardia
used to treat post myocardial infarction client who cannot tolerate beta-blockers
amlodipine
diltiazem
felodipine
verapamil
slows the rate at which calcium passes into vessel walls
- relaxes the vessel and allows blood to flow more easily through them
verapamil and diltiazem = work by blocking the calcium channels in the myocardium
calcium channel blockers contraindications
reaction
can have toxic effect on liver
- clients with liver impairment should not take meds
hypotension
having an acute MI
symptomatic heart failure and heart bloc
calcium channel blockers common side effects
headache dizziness fatigue nausea vomiting
flushing
rash
constipation
abdominal pain
calcium channel blockers considerations
baseline data
- BP
- HR
- vitals
- liver function
teach:
- do not consume grapefruit when taking meds
- change positions slowly to decrease dizziness and possible syncope
- discuss any OTC meds with HCP
- importance of monitoring their HR
central nervous system stimulants
to improve concentration and focus for those with ADD
can be used to decrease appetite and promote weight loss
lisdexamfetamine
methylphenidate
increase physical activity, mental alertness and attention span
central nervous system stimulants contraindications
anxiety
tension headaches
glaucoma
hx of seizures
central nervous system stimulants common side effects
headache
resp infection
hyperhidrosis
decreased appetite
visual disturbances
abdominal pain cough nausea insomnia restlessness
central nervous system stimulants nursing considerations
obtain important baseline data
monitor side effects
teach to monitor their weight
- take meds in the morning
dose must be tapered off to avoid withdrawal syndrome
corticosteroids and used for/examples
treat inflammation and pain associated with arthritis and autoimmune disease
glucocorticoids
methylprednisolone
prednisolonne
dexamethasone
betamethason
mineralcorticoids
cortisone
fludrocortisone
hydrocortisone
corticosteroids contraindications
infection
at high risk for infection
used with caution in clients that have diabetes
corticosteroids common side effects
headache
vertigo
impaired wound healing
increased appetite
weight gain and increased appetite
long term use of corticosteroids cushings syndrome is common
- truncal weight gain
corticosteroids nursing consideration
baseline data to see no active infections are present
sodium and potassium levels
should not receive live vaccines
- call HCP if exposed to chicken pox or measles
take prescribed dose in morning
- maintain a low sodium, higher potassium diet
avoid grapefruit
loop diuretics (potassium-wasting) and used for
treat edema and hypertension
bumetanide
furosemide
loop diuretics (potassium-wasting) contraindications
suffering from electrolyte depletion and anuria
should not use loop diuretics during pregnancy or if they have severe liver or kidney disease
hx of diabetes should expect an increase in blood sugar
loop diuretics (potassium-wasting) common side effects
hypotension
hypovolemia
photophobia
hypokalemia
ototoxicity and even deafness
- especially when giving large doses IV too quickly
loop diuretics (potassium-wasting) considerations
baseline data
- live and renal function
- reaction
- BP
monitor for;
- dizziness
- hypotension
- hypovolemia
- weight
- intake and output
eat potassium rich diet and take any potassium supplements
- weigh in morning
- use sun protection
osmotic diuretics and used for
treat intracranial pressure or increased introocular pressure
mannitol
osmotic diuretics common side effects
fluid and electrolyte imbalance
hypernatremia
hypovolemia
nausea
vomiting
hypotension
shock may occur
leakage of mannitol can cause edema and skin necrosis
osmotic diuretics considerations
baseline data
monitor BP, intake and output and electrolyte
may crystallize
- use filter needle to withdraw mannitol from vial
- in line filter needle with continuous infusion
report any chest pain, breathing, difficulty or pain at IV site
- should also change position slowly to decrease dizziness
potassium sparing diuretics and used for
treat client with heart failure
spironolactone
works by blocking aldosterone in distal tube
potassium sparing diuretics contraindications
acute renal insufficiency
addisons disease
hyperkalemia
pregnancy
potassium sparing diuretics common side effects
dizziness
headache
tinnitus
abdominal pain
impotence gynecomastia irregular menses amenorrhea hirsutism deepening of the voice
potassium sparing diuretics considerations
baseline data
monitor potassium levels, cardiac dysrhythmias, BP, edema status
take med with food or milk
change position slowly
potassium and used for
transmission of nerve impulses in cardiac and skeletal muscle
potassium common side effect
abdominal discomfort
dysrhythmias
paresthesia
hyperkalemia
for oral supplements, various forms exist including tablets, effervescent tablets and liquid form
- can be mixed with water and/or juice to aid in swallowing
injectable supplements often cause irritation to the veins
- should be administered slowly after proper dilution
if injected without dilution, potassium can be fatal
potassium considerations
baseline data
adequate renal function
monitor potassium
- frequent check of IV site and vein should be performed
report;
- heart rate changes
- palpitations
- GI bleeds
magnesium and used for
cause by malnutrition, alcoholism of magnesium depleting meds
magnesium oxide
magnesium sulfate
require for ATP functions
magnesium common side effects
decreased reflexes
flatulence
dysrhythmias
dizziness
magnesium considerations
baseline data
- magnesium level
- cardiac hx
- HR, BP
recognize toxification:
- bradycardia
- decreased reflexes
- double vision
- trouble breathing
- excessive diarrhea
calcium gluconate is used to treat mag toxification
calcium and used for
treat hypocalcemica and as part of cardiac resuscitation
calcium chloride
calcium citrate
calcium gulconate
calcium contraindications
hypersensitivity to calcium salts or calcium containing meds
calcium common side effects
dizziness
hypotension
weakness
lethargy
depressed reflexes
anorexia
nephrolithiasis
increased BP
calcium nursing considerations
monitor chvostek and trousseaus
report any paresthesia or abnormal reflexes
erectile dysfunction drugs and used for
treat erectile dysfunction and pulmonary artery hypertension
sildenafil
works by increasing effects of nitric oxide, which increases blow flow to penis
erectile dysfunction drugs contraindications
use of nitrates, like nitroglycerin
- risk of hypotension
used with caution in clients that have hx of diabetes, myocardial infarction or stroke
hepatic or renal impairment
erectile dysfunction drugs common side effects
dizziness
hypotension
diplopia
erectile dysfunction drugs considerations
baseline data
sxs for hypotension or a reaction
client suffering from acute myocardial infarction
- medication protocols change if client reports use of this med
- should not receive nitroglycerin
teach:
- if nitrates are used with these meds, severe hypotension can occur
- notify HCP if erection lasts longer than 4 hours or off and on
diabetic clients should monitor their blood sugar closely while taking this med
