Meds from the blueprint Flashcards
What category class are ibuprofen and aspirin?
NSAIDs COX 1 and Cox 2 Inhibitor
What is the expected pharmacological action of ibuprofen and aspirin?
Inhibit action of cyclooxygenase (COX) –> inhibit release of prostaglandins
What are some complications of ibuprofen and aspirin?
gastric upset, heartburn, nausea, gastric ulceration, renal dysfunction, increased risk of thromboembolic events with non-aspirin NSAIDs, increased bleeding with aspirin, salicylism, reye’s syndrome (in kids when given aspirin)
What is salicylism?
poison of salicylates, usually seen with OD of aspirin; common side effects are: tinnitus, confusion, headache, diaphoresis (excessive sweating), tachypnea (can result in respiratory alkalosis), nausea, and vomiting
What is Reye’s Syndrome?
poison of aspirin in children; causes confusion, swelling in the brain, and liver damage
What are the therapeutic uses of ibuprofen and aspirin?
inflammation suppression, analgesia for mild-moderate pain, reduce fever, dysmenorrhea, inhibit platelet aggregation (aspirin)
What are the medical administrations of ibuprofen and aspirin?
orally through enteric coated or sustained release forms
What are contraindications to ibuprofen and aspirin?
teratogenic drug, hypersensitivity to aspirin or other NSAIDs, peptic ulcer disease, bleeding disorder (aspirin), perioperative discontinue aspirin 1 week before surgery, hypertension
What are some precautions for ibuprofen and aspirin?
older, smoke, alcohol use disorder, helicobacter pylori infection, heart failure, advanced kidney dysfunction
What are some interactions for ibuprofen and aspirin?
anticoagulants, glucocorticoids, and alcohol increase the risk of bleeding; ibuprofen decreases anti platelet effects of low dose aspirin, ACE inhibitors/angiotensin receptor blockers with aspirin increase the risk of renal failure
What are some nursing interventions for ibuprofen and aspirin?
Test for helicobacter pylori; monitor for signs of bleeding (easy bruising, black/tar colored stool, petechiae, excessive bleeding), abdominal pain, nausea, hematemesis (vomit with blood); recommend proton pump inhibitor for clients at risk for gastric bleeding; monitor for I&O, BUN and creatinine (increased levels of the last two); watch out for signs/symptoms of salicylism and Reye’s Syndrome
What should you recommend for kids with viral diseases instead of aspirin?
acetaminophen or non-aspirin NSAIDs in small doses for short periods of time
If a provider prescribes a NSAID COX1-COX2 Inhibitor for long term therapy, make sure they prescribe what drug with it and why?
low dose aspirin, prevent embolic events
What should be included in client education for ibuprofen and aspirin?
take drug with food, milk, or 8 oz of water; avoid alcohol and why; inform them of complications and to report any; report rapid weight gain (sign of water retention), decreased urine output, edema/swelling/bloating; immediately report chest pain/heaviness, shortness of breath, sudden/severe headache, one sided numbness, weakness, visual disturbances, or confusion; stop taking aspirin if symptoms of salicylism start
What drug class is celecoxib?
NSAID COX-2 Inhibitor
What is the expected pharmacological action of celecoxib?
decrease prostaglandin release only from COX 2
What are the therapeutic uses of celecoxib?
suppress mild to moderate pain and inflammation, decrease fever, dysmenorrhea
What are some complications of taking celecoxib?
gastric upset, heartburn, nausea, diarrhea, gastric ulceration (possibly less than with COX-1 inhibitors), kidney dysfunction, cardiovascular and cerebrovascular events (worse than with COX-1 inhibitors because it causes vasoconstriction without decreasing platelet aggregation)
What is the medical administration of celecoxib?
Give 2 hours before or after magnesium - or aluminum - based antacids; monitor for initial and therapeutic side effects
What are contraindications of celecoxib?
teratogenic, severe hepatic/kidney impairment, minors, gastrointestinal bleeding, anemia, pain from coronary artery bypass grafting, allergy to celecoxib/sulfa/sulfonamides
What are some precautions of celecoxib?
alcohol use disorder, heart failure, cardiovascular disease, hypertension, diabetes mellitus, asthma, liver/renal impairment
What are some nursing interventions for celecoxib?
monitor for and report gastric upset, heartburn, nausea, diarrhea, and GI bleeding; test for/treat helicobacter pylori infection; proton pump inhibitor for clients at high risk for GI bleeding; monitor input/output, BUN, and creatinine levels; short periods of time, low doses; monitor for thromboembolic events through MI and cerebrovascular accident; for long term therapy recommend low dose aspirin
What are some interactions of celecoxib?
furosemide (Lasix) decreases diuretic effects; fluconazole (Diflucan) increases celecoxib levels; increase anticoagulant effects of warfarin (Coumadim); hypertensive effects of ACE inhibitors decrease; increased risk of lithium carbonate toxicity
What should be included in client education of celecoxib?
low dose aspirin daily for long term therapy; take drug with food, milk, or 8 oz of water; report persistent gastric irritation, gastric bleeding, changes in urine output, weight gain, edema, bloating, chest pain/heaviness, shortness of breath, sudden/severe headache, numbness, weakness, visual disturbances, confusion
What drug category class is tramadol in?
Centrally Acting Nonopioid
What is the expected pharmacological action of tramadol?
treats pain by acting on the CNS: binds to selected opioid receptors and blocks reuptake of norepinephrine and seratonin in the CNS
What is the therapeutic use of tramadol?
Moderate to moderately severe pain relief
What are some complications of tramadol?
Sedation, dizziness, headache, nausea, vomiting, constipation, respiratory depression (rare), seizures (rare), urinary retention
What are the medical administrations of tramadol?
swallow extended release form whole; clients wont feel effects for 1 hr, plan repeat dosing so clients wont feel pain
What are some contraindications to tramadol?
acutely intoxicated with alcohol, opioids and psychotropic drugs, seizure disorders, respiratory depression
What are some precautions of tramadol?
substance abuse history, liver/kidney disease, children under 12, older adults, increased intracranial pressure
What are some nursing interventions for tramadol?
Monitor clients during ambulation, recommend lowest possible dose for shortest time, give with food, keep and eye on vital signs, monitor for signs of seizure, monitor for signs of complications
What are some interactions of tramadol?
MAOIs increase risk of hypertensive crisis; increases effects of CNS depressants and decreases carbamozepine levels; St. John’s wort increase sedative effects; increased risk of serotonin syndrome with some serotonin-norepinephrine reuptake inhibitors, tricylic antidepressants, MAOIs, and triptans
What should be included in client education of tramadol?
Don’t crush the pill; don’t take before activities that require mental alertness; take drug only when needed; if urinary retention occurs –> notify provider; sit/lie down if feel lightheaded; if constipated –> increase fiber and fluid intake and exersize
What drug class is morphine in?
Opioid agonist
What is the expected pharmacological action of morphine?
primarily bind to mu-tupe opioid receptors to produce analgesic effects
What is the therapeutic use of morphine?
moderate-severe pain; preoperative sedation and anxiety decrease
What are some complications morphine may cause?
Respiratory depression, sedation, dizziness, lightheadedness, drowsiness, constipation, nausea/vomiting, orthostatic hypotension, urinary retention, cough suppression, potential for abuse and tolerance
What is involved with medication administration of morphine?
measure baseline vitals before administration and throughout therapy; routes: orally, IV, IM, SC, rectally, epidurally; monitor PCA use and pump setting carefully; administer cancer clients with a fixed 24/7 dosing schedule that keeps therapeutic effects ongoing
What are some contraindications of morphine?
teratogenic, kidney failure, increase intracranial pressure, biliary colic, preterm labor
What are some precautions with morphine?
schedule II controlled substance, older adults/infants, decreased respiratory reserve, head injury, inflammatory bowel disease, prostatic enlargement, hypotension, hepatic/kidney disease
What are some nursing interventions for morphine?
monitor vital signs, pulse oximetry, lung sounds; monitor clients when ambulating; if respiratory problems occur then give client opioid agonist (naloxone); monitor bowel movement, BP, nausea; prepare urinary catheter
What are some interactions of morphine?
CNS depressants increase CNS depression; anticholinergic agents increase anticholinergic effects (causes constipation and urinary retention); MAOIs (medicines that treat depression, ex meperidine) can cause hyperpyrexic syndrome (s/s excitation, seizures, hyperpyrexia); antihypertensives increase hypotensive effects; St. John’s wort can increase sedation
What should be included in client education of morphine?
advise clients with physical dependence not to stop abruptly - taper off over 3 days; encourage clients to cough frequently to prevent buildup of respiratory secretions; encourage clients to urinate ever 4 hours
What drug class is butorphanol a part of?
Opioid agonist-antagonist
What is the expected pharmacological action of butorphanol?
bind to mu and kappa opioid receptors: simultaneously stimulating and blocking analgesic effects; not as effective as opioid agonists but are an alternative for clients addicted to opioids or women in labor
What is the therapeutic use of butorphanol?
produce milder analgesic effects than opioid agonists with fewer mu-related adverse effects (respiratory depression, euphoria, dependence)
What are some complications of butorphanol?
limited respiratory depression, sedation, dizziness/lightheadedness, drowsiness, headache, nausea, increased cardiac workload, abstinence syndrome (withdrawals, but less severe that clients who are opioid dependent)
What is the medication administration of butorphanol?
routes: IM, IV, IN; IN: spray in 1 nostril q60-90 min; preoperative IM: give 60-90 min as prescribed before surgery; avoid discontinuing drug abruptly
What are some contraindications of butorphanol?
clients who have had a MI or are depended on opioids
What are some precautions with butorphanol?
clients with: history of substance abuse, head injury, increase intracranial pressure, decreased respiratory reserve, hepatic/renal disease, hypertension, cardiac insufficiency
What are some nursing interventions of butorphanol?
Ask client about opioid use before administering; measure baseline vital signs (especially respirations, if under 12 breaths/min stop administering and stimulate breathing); monitor clients when ambulating
What should be included in client education of butorphanol?
take only when needed and short term; don’t take prior to activities that require mental alertness; if dizzy/lightheaded -> sit/lie down; change positions gradually; don’t use for anginal pain; don’t take opioids
What are some interactions of butorphanol?
Other CNS depressants (barbiturates, phenobarbital, benzodiazepines) increase CNS depression and risk of respiratory depression; decreases effects of opioids
What drug category is naloxone in?
Opioid antagonist
What is the expected pharmacological action of naloxone?
block opioid receptors, reversing or antagonizing the effects of opioids
What is the therapeutic use of naloxone?
reversal of opioid effects/overdose; reversal of neonatal respiratory depression (from maternal analgesia)
What are some complications of naloxone?
ventricular arrythmias; increased respiratory rate/bp/heart rate; abstinence syndrome (vomiting, hypertension, cramping) in opioid dependent clients; might increase patient’s pain
What is the medication administration of naloxone?
IM, IV, SC; IV: titrate dose carefully; monitor vitals q5-15 min while administer and up to several hours after administration; therapeutic effects last 60-90 min; administer every 2-3 min until effects of opioid = reversed
What are some contraindications of naloxone?
opioid dependent clients, respiratory depression because of non-opioid drugs
What are some precautions of naloxone?
cardiac irritability, head injury will increase intracranial pressure, brain tumor, seizure disorder
What are some nursing interventions of naloxone?
monitor for dangerous increased BP and other vital signs, monitor heart rhythms
What are some interactions of naloxone?
decrease effects of opioids
What should be included in client education of naloxone?
inform client of the need for the drug if they’re awake; warn clients of adverse drug effects and possible return of pain
What drug category is acetaminophen in?
Nonopioid analgesic
What are the expected pharmacological actions of acetaminophen?
Cox inhibitor, but the effects are limited to the CNS: antipyretic, analgesic
What is the therapeutic use of acetaminophen?
pain reliever (mild to moderate) and reduce fever
What are some complications of acetaminophen?
liver damage when drug is given in toxic doses over long periods of time; hypertension (mostly in women) when used daily
What is the medication administration of acetaminophen?
orally, rectally, IV; max 4g a day for adults and kids over 12
What are some contraindications of acetaminophen?
clients with alcoholism, liver damage
What are some precautions of acetaminophen?
clients with: anemia, immune suppression, hepatic disease, renal disease
What are some nursing interventions of acetaminophen?
monitor for early symptoms of overdose/poisoning (abdominal discomfort, nausea, vomiting, diarrhea, sweating); if overdose occurs then give acetylcycsteine (Mucomyst or Acetedote); monitor BP regularly
What are some interactions of acetaminophen?
alcohol increases risk of liver injury; warfarin (Coumadin) increases risk of bleeding; cholestyramine (Questran) reduces absorption of acetaminophen
What should be included in client education of acetaminophen?
proper dosing; immediately report: abdominal discomfort, nausea, vomiting, sweating, or diarrhea; check BP daily
