miscellaneous Flashcards
Saw Palmetto: class
- BPH agent
Saw Palmetto: MOA
- Exerts antiandrogenic, anti-inflammatory, and antiproliferative properties in prostate tissue resulting in improvement in BPH symptoms
Saw Palmetto: Indications
- taken to relieve urinary symptoms assoc with BPH
- takes 1-2 mos to develop effects
Saw Palmetto: SEs
- n/v
- constipation
- headache
Saw Palmetto: nursing implications
- contraindications: pregnancy, breast feeding
- take on a full stomach
- does not alter size of prostate, but can relieve symptoms of BPH
St. John’s Wort:class
- anti-depressant
St. John’s Wort: MOA
- can dec uptake of serotonin, NE, and dopamine
St. John’s Wort: Indications
- mild to moderate depression
- topically to manage local infection
- orally to relieve pain and inflammation
St. John’s Wort: SEs
- allergic skin rxns
- CNS effects: insomnia, vivid dreams, restlessness, anxiety, agitation, irritability
- GI discomfort
- dry mouth
- phototoxicity
St. John’s Wort: nursing implications
- do not consume grapefruit juice
- to reduce risk of phototoxicity, light skinned ppl should avoid exposure to sun, wear protective clothing, apply sunscreen
- do not use alcohol
- May potentiate effect of sedatives and side effects of other antidepressants.
- take for 4-6 wks and if no improvement, try other therapy
glucosamine: class
- anti-rheumatic
glucosamine: MOA
- stimulating cartilage and synovial tissue metabolism
- stimulates activity of chondrocytes to make cartilage and synovial fluid
- suppress production of cytokines that mediate joint inflammation
glucosamine: indications
- osteoarthritis of knee, hip, and wrist
- TMJ arthritis
- glaucoma
glucosamine: SEs
- GI: nausea, heartburn
- headache
- drowsiness
- skin rxns
- hyperglycemia
glucosamine: nursing implications
- contraindicated with a shellfish allergy and in pregnancy
- produced from shellfish exoskeleton so should be used in caution with pts with a shellfish allergy
- take prior to meals
- monitor glucose
Coenzyme Q-10: class
- antioxidant
Coenzyme Q-10: MOA
- important for mitochondrial ATP generation
- highest concentrations are found in the heart, liver, kidney, and pancreas
- potent anti-oxidant
Coenzyme Q-10: indications
- HF and muscle injuury
- caused by HMG CoA reductase inhibitors (statins)
- mitochondrial encephalomyopathy
- muscular dystrophy
- immune stimulant in HIV infection
- Parkinson’s dz
Coenzyme Q-10: SEs
- GI disturbances: gastritis, reduced appetite, nausea, diarrhea
Coenzyme Q-10: nursing implications
- may antagonize effects of warfarin
- drugs that inhibit synthesis of cholesterol can also inhibit synthesis of CoQ-10 and cause endogenous levels of CoQ-10 to drop
- Administer with a meal containing fat for optimal absorption.
ACTH: class
- polypeptide hormone produced by the anterior pituitary
ACTH: MOA
- acts on adrenal cortex to stimulate production and release of adrenocortical hormones (ie. cortisol, aldosterone)
ACTH: indications
- diagnosis of adrenocortical dysfunction
ACTH: SEs
- HTN
- weight gain
- irritability
ACTH: ADRs
- diabetes
- skin rxns
- suppression of the immune system
ACTH: nursing implications
- Routine monitoring of blood, urine, and blood pressure
- monitor blood glucose
enoxaparin: class
- antithrombotic
- low molecular weight heparin
- anti-coagulant
enoxaparin: MOA
- Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin.
enoxaparin: indications
- prevention of DVT following hip/knee replacement surgery or in abdominal surgery in pts at high risk of thromboembolic complications
- preventing ischemic complications in pts with angina, MI, STEMI
enoxaparin: SEs
- erythema at injection site
- bleeding
- anemia
- hematoma
- osteoporosis
- pruritus
- rash
enoxaparin: ADRs
- hemorrhage
- thrombocytopenia
- severe neurologic injury: paralysis
enoxaparin: nursing implications
- antidote: protamine sulfate
- report symptoms of abnormal bleeding
- do not take aspirin or ibuprofen
- can be used at home and do not require PTT monitoring
epinephrine: class
- adrenergic agonist of alpha 1/2, beta 1/2
- anti-asthma
- bronchodilator
- catecholamine
epinephrine: MOA
- sympathomimetic
- on alpha Rs–vasoconstriction
epinephrine: indications on alpha 1 receptors
- vasoconstriction
- delay absorption of local anethetics
- control superficial bleeding
- elevate BP
epinephrine: indications on beta 1 receptors
- overcome AV heart block
- restore cardiac fcn in pts in cardiac arrest with v fib, pulseless v tach, pulseless electrical activity, asystole
epinephrine: indications on beta 2 receptors
- bronchodilation of pts with asthma
epinephrine: indication due to activation of both alpha and beta receptors
- anaphylactic shock
epinephrine: SEs
- angina
- hyperglycemia
epinephrine: ADRs
- HTN crisis
- dysrhythmias
- necrosis following extravasation
epinephrine: nursing implications
- exercise caution when administering IV b/c can cause extravasation
- monitor blood glucose
- monitor EKG
- administer 2 for anaphylaxis
- effects of epi can be modified by MAO inhibitors, TCAs, anesthetics, adrenergic blocking agents
norepinephrine: class
- adrenergic agonist
- works on alpha 1/2, beta 1
- catecholamine
- vasopressor
norepinephrine: MOA
- Stimulates alpha-adrenergic receptors located mainly in blood vessels, causing constriction of both capacitance and resistance vessels.
- Also has minor beta-adrenergic activity (myocardial stimulation).
norepinephrine: indications
- hypotensive state
- cardiac arrest
norepinephrine: SEs
- angina
norepinephrine: ADRs
- HTN crisis
- dysrhythmias
- necrosis following extravasation
norepinephrine: nursing implications
- effects of NE can be modified by MAO inhibitors, TCAs, anesthetics, adrenergic blocking agents
- exercise caution when administering IV b/c can cause extravasation
fludrocortisone: class
- mineralocorticoid
fludrocortisone: MOA
- suppresses glucocorticoid activity
- acts like aldosterone
- holds onto Na to hold onto water
fludrocortisone: indications
- primary adrenal insufficiency
- primary hypoaldosteronism
- CAH
- **most times you should use it with a glucocorticoid
fludrocortisone: SEs
- dizziness
- headache
- adrenal suppression
- weight gain
- muscle weakness
fludrocortisone: ADRs
- excess salt and water retained and K+ lost
- inc blood volume
- HTN
- edema
- cardiac enlargement
- hypokalemia
- HF
fludrocortisone: nursing implications
- monitor weight, BP, K+ levels
- carry medic alert information
glucagon: class
- polypeptide hormone produced by alpha of the pancreas
glucagon: MOA
- has effects on carb metabolism that are opposite those of insulin
- acts on liver and muscles
- promotes breakdown of glycogen to glucose, reduces conversion of glucose to glycogen, and stimulates synthesis of glucose
- causes plasma glucose to rise
- promotes relaxation of GI smooth muscle
glucagon: indications
- severe hypoglycemia
- antidote to beta blockers, CCBs
glucagon: SEs
- nausea
- vomiting
- hypotension
glucagon: ADRs
- anaphylaxis
glucagon: nursing implications
- monitor blood glucose
- if available, use IV glucose instead of glucagon to raise blood sugar b/c it works faster than glucagon
- glucagon takes 20 min or so
- cannot correct hypoglycemia caused by starvation b/c it acts by breakdown of glycogen
bupropion: class
- antidepressant
- smoking deterrent
buproprion: MOA
- stimulant
- blockade of dopamine/NE reuptake
bupropion: indications
- major depressive disorder
- prevention of seasonal affective disorder
- smoking cessation
- unlabeled use: relief of neuropathic pain, tx of depressive disorders in bipolar, mgmt of ADHD
bupropion: SEs
- agitation
- headache
- dry mouth
- constipation
- weight loss
- photosensitivity
- tremor
- insomnia
- blurred vision
- inc sexual desire
- psychotic symptoms: hallucinations, delusions
bupropion: ADRs
- suicide risk in children, adolescents, young adults
- seizures
bupropion: nursing implications
- contraindicated: seizure disorders, breast feeding
- exercise extreme caution in children b/c of inc risk of suicide
- to reduce risk of seizures:
- avoid doses above 450 mg/day
- avoid in pts with other seizure risk factors
- avoid bedtime doses b/c can cause insomnia
- for SAD: Begin administration in autumn prior to the onset of depressive symptoms. Continue therapy through winter and begin to taper and discontinue in early spring.
- may need to take for at least 4 weeks to see effects
- Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth.
- use sunscreen and protective clothing to prevent photosensitivity reactions.
buspirone: class
- anxiolytic drug
- anti-anxiety
buspirone: MOA
- NOT a CNS depressant
- binds with high affinity to receptors for serotonin and with lower affinity to receptors for dopamine
buspirone: indication
- generalized anxiety disorder
buspirone: SEs
- dizziness
- nausea
- headache
- nervousness
- sedation
- lightheadedness
- excitement
- fatigue
- blurred vision
- tachycardia
- angina
- rashes
- myalgia
- numbness
- paresthesia
- clamminess
buspirone: nursing implications
- contraindicated: hepatic/renal impairment
- no withdrawal symptoms noticed
- do not consume grapefruit juice
- no abuse potential and does not intensify the effectsof CNS depressants (benzos, alcohol, barbiturates)
- effects take weeks to appear
- so NOT suitable for PRN use
- can take with food
buspirone and benzodiazepines
- buspirone is an attractie alternative to benzos in pts who require long term therapy but cannot tolerate benzo induced sedation
- buspirone doesn’t display cross dependence with benzos
- so, when pts are switched from a benzo to buspirone, the benzo must be tapered slowly
- since the effects of buspirone are delayed, buspirone should be initiated 2-4 weeks before beginning benzo withdrawal