Meds - Exam 2 Flashcards
Antihypertensive medications - protein spilling:
MoA: Blocks ACE, the enzyme responsible for converting angiotensin I to angiotensin II in the lungs; decreases vascular resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor)
Contra/Caution: ACE-inhibitors, ARB’s, K+ sparing-diuretics, NSAIDs (kidneys)
AE: Common-Persistent dry cough, orthostatic hypotension, hyperkalemia; Rare-angioedema
Nursing: monitor K+, renal function
ACE-I (lisinopril)
(usually only if not tolerate ACE-I)
MoA: Blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE-inhibitors
Contra/Cautions: ACE-inhibitors, ARB’s, K+ sparing-diuretics, NSAIDs (kidneys)
AE: GI effects (n/v/d)
ARB
Indications: Control nonproductive cough; treat mild to moderate pain; non-infectious diarrhea
Contraindications: CNS depression
AE: Constipation, N/V, sedation, respiratory depression
Opioid
MoA: Inhibits helper T-cell; block antibody production of B cells
Indications: antirejection organ transplant; psoriasis, rheumatoid arthritis
Contraindications: Hypersensitivity, pregnancy or lactation, renal/liver dysfunction, infection, malignancies
Drug/Food: grapefruit juice -increase levels by 50-200%
AE: infection risk, kidney/liver damage
Nursing: monitor lab: CBC, renal/liver function, drug level; Teach – avoid infection, no grapefruit juice, s/s kidney/liver toxicity
Immunosuppressant - SLE
Interfere with biosynthesis of pathogen cell wall (penicillin)
Prevent pathogen growth and reproduction division (sulfonamides)
Interfere with steps involved in protein synthesis (aminoglycosides)
Interfere with DNA synthesis in cell (fluoroquinolones)
Alter permeability of cell membrane - leak essentials (antifungal, antiprotozoal, and some antibiotics)
AE:
GI effects: Nausea, vomiting, diarrhea (n/v/d)
Skin effects: Rash, hives
Hypersensitivity reactions: May be immediate, with next exposure, or delayed allergic; Severe cases, anaphylaxis can occur; cross-sensitivity (e.g., penicillins & cephalosporins) possible; Determine what client experienced - true allergy or expected adverse effect
Superinfections/secondary infections
Antibiotics
flush and get kidneys moving
General contraindications: Pregnancy/lactation; Severe renal failure; Hypotension; Dehydration; Drug-Drug: Digoxin: Increased potassium (K+) loss may occur; Anticoagulants, antidiabetic drugs: reduced effectiveness; Lithium: Increased risk of toxicity
AE: GI effects (n/v/d); Hypotension; Dehydration (fluid volume deficit); Fluid and electrolyte disturbances: Sodium and potassium; Fluid rebound
Diuretics -
stimulate bone marrow to make RBC; to replace EPO
MoA: Erythropoietin factor controlling rate of RBC production
Indications: Disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
Contraindications: Angina, caution in CHF
AE: Fatigue, bone pain, edema, hypertension (HTN), headache, fever (DVT, CVA, MI has occurred)
Nursing: Monitor CBC weekly (dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal Hgb above 10; hold if Hgb > 12
Epoetin alfa/Epogen -
Statin
a type of lipid-lowering medication. It is used along with exercise, diet, and weight loss to decrease elevated lipid levels. It is also used to decrease the risk of heart problems in those at high risk. It is taken by mouth
AE: muscle weakness in your hips, shoulders, neck, and back; trouble lifting your arms, trouble climbing or standing; or liver problems–loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
ZOCOR/Simvastatin
MoA: Suppresses inflammation (non-selective COX inhibitor)
Max dose: 3200 mg/day in divided doses (prescription); 1200 mg/day in divided doses (OTC)
Black box: GI bleeding; CV: MI, stroke
AE: chronic use: Na/water retention (edema), hypertension; Rare: AKI
Nursing: OTC and prescription
NSAIDS (ibuprofen)
MoA: inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na)
Indications: Conditions of fluid overload; hyperkalemia
Route/dose: oral; IVP (slow IV push 20 mg/min); may be given IM or as IV gtt
Contraindications: See general; ototoxic drugs; sulfa allergy
AE: See general; hypokalemia; CNS effects: paresthesia, ototoxicity (IVP slowly to prevent)
Nursing: See general; potassium supplements; IV fall risk
Furosemide
Use: Acute and chronic pain
Dose/route considerations:
Morphine considered “gold standard” for dosing opioids
IV push considerations: Follow facility protocol; Deliver over 4-5 min (do not infuse rapidly); Monitor closely for adverse effects!
Morphine
is an opioid used to treat moderate to severe pain
mental clouding, changes in mood, nervousness, and restlessnessConstipation, nausea, vomiting, impaired coordination, loss of appetite, rash, slow or rapid heartbeat, and changes in blood pressure
Dilaudid
Works in about 12 hours
nonsteroidal anti-inflammatory drug commonly used as a prescription medication to reduce fever, pain, stiffness, and swelling from inflammation. It works by inhibiting the production of prostaglandins, endogenous signaling molecules known to cause these symptoms.
AE: Mild headache; Continuing ringing or buzzing or other unexplained noise in the ears; difficulty having a bowel movement (stool); discouragement; feeling sad or empty; general feeling of discomfort or illness; hearing loss; irritability; loss of interest or pleasure; sleepiness; trouble with concentrating
Indomethacin
Other NSAIDS can be used as well
Work quickly
Decreases inflammation - reduces pain
MoA: Suppresses inflammation (non-selective COX inhibitor)
Max dose: 3200 mg/day in divided doses (prescription); 1200 mg/day in divided doses (OTC)
Black box: GI bleeding; CV: MI, stroke
AE: chronic use: Na/water retention (edema), hypertension; Rare: AKI
Nursing: OTC and prescription
Ibuprofen
Great med - reduces uric acid level in body; not work quickly; be on qday; goal reduce chances further attacks in future; maintenance med
is a medication used to decrease high blood uric acid levels. It is specifically used to prevent gout, prevent specific types of kidney stones and for the high uric acid levels that can occur with chemotherapy.
AE: Ankle, knee, or great toe joint pain; joint stiffness or swelling; rash; rash with flat lesions or small raised lesions on the skin
Allopurinol
