Mod 8 Flashcards
Explain some common nursing interventions and safety measures for patients taking opioids.
Monitor RR less than 12
Low BP - slow position changes
Dizzy/lightheaded
Low CNS sedation
Easily falls asleep when talking
Unarousable
Assist to a seated position
Fiber, fluids, stool softeners
Use cautiously in pts with breathing issues such as asthma
Encourage coughing
No alcohol
Define the side effects of opioids?
Respiratory depression
Constipation
Orthostatic hypotension
Urinary retention
Cough suppression
Sedation
Biliary colic
N & V
Opioid toxicity triad
Coma, respiratory depression, pinpoint pupils
Describe adverse effects of levodopa-carbidopa
Nausea and vomiting, drowsiness
Dyskinesias
Orthostatic hypotension
Cardiovascular effects from beta1 stimulation (tachycardia, palpitations, irregular heartbeat)
Psychosis
Discoloration of sweat and urine
Activation of malignant melanoma
Describe the teaching principles for adolescents taking SSRI’s (antidepressants)
SSRI’s Drugs:
Fluoxetine
Sertraline
-Effects may take 1-3 weeks
-⇧ in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages
-⇧ risk of GI bleeding when taken with NSAIDs
Describe the most effective pain control method for immediate post op use.
Opioids (IV)
Morphine 2-3 minutes IV push
Reassess 15-30 min
Fentanyl
Explain how do benzodiazepines compare to barbiturates
-Benzo = CNS Psychoactive
-Barb = CNS Depressant
-Barbiturates bind directly to and open GABA receptors = slows down activity of brain
-Benzo do NOT stimulate GABA receptors directly = increase effects of GABA receptors
-Benzos are safer, rarely cause death vs -High dose of Barbiturates = death
-Mostly only used pre-op
-Barbiturates have a high risk for overdose and addiction
Explain how pre-existing cardiac disease affects those taking tricyclic antidepressants.
-TCAs have known potentially cardio-toxic effects
-⇧ risk for dysrhythmias by prolonging QT intervals
-Affect cardiac contractility
Discuss the nursing implications of administering buspirone.
-Take with food for nausea
-Increase fiber and fluid
-Report manifestations of depression & thoughts of suicide
-Interacts with MAOIs
-Interacts with erythromycin, ketoconazole, st. john’s wort, and grapefruit juice
-Can take 2-4 weeks for full effect
Identify the purpose and rationale for Disulfiram administration.
-Treats chronic alcoholism / alcohol dependence
-Blocks the oxidation of alcohol at the acetaldehyde stage during alcohol metabolism causing an accumulation of acetaldehyde in the blood producing highly unpleasant symptoms
Describe the therapeutic considerations for antiepileptic drugs
Drug: Phenytoin
-Reduce seizures so that the patient can live a near normal life
Therapeutic Considerations:
-Diagnosis & drug selection
-Drug Evaluation
-Trial period
-Monitor plasma drug levels
-Promote patient adherence
-Withdraw slowly up to a few months
-Suicide risk
Compare and contrast methadone and buprenorphine.
Both prescribed for opioid addiction treatment, LONG term
Methadone= Full opioid agonist, facility only
Buprenorphine= Partial opioid agonist Ceiling effect: helps reduce the risk of misuse
Discuss alternatives to taking smoking cessation medication if it fails.
Drug: Varenicline, Bupropion
Ask: screen all patients for tobacco use
Advise: tobacco users to quit.
Assess: willingness to make a quit attempt.
Assist: with quitting (offer medication and provide or refer to counseling).
Arrange: follow-up contacts, beginning within the first week after the quit date.
Drug and counseling COMBO
Describe acetaldehyde syndrome (Alcohol).
An alcohol-medication interaction
Side effects:
Facial flushing
Nausea / vomiting
Tachycardia
hypotension
Explain how certain drugs can alter brain structure.
Certain drugs affects neurotransmitters that can alter therapeutic responses and side effects
Identify the side effects of histamine 1 antagonists (Diphenhydramine).
Histamine = affects immune system
Constipation
Increase mucus secretions
Urinary retention
Sedation
Anticholinergic effects (dry mouth, drowsiness)
GI distress
Itchy eyes
Respiratory depression
Discuss the patient teaching principles of prescribed hypnotics (sleep aids).
Drugs: Alprazolam, Clonazepam
-Administer at bedtime
-Avoid alcohol and other CNS depressants
Identify the side effects of alpha 1 receptor blockers and the patient teaching implications.
Orthostatic hypotension
-Slow position changes
-Monitor BP
Sexual dysfunction
-Not harmful
Reflex tachycardia
-Taper dose
CNS depression
-Take prescribed dose
Blurred vision
Describe how a PCA pump for pain control works and explain the patient education needed.
Method to self administer opioids
Used after surgery for long term recovery
Only the client can push the button
Before giving another dose, 1st action: Pain Assessment
Identify the onset of action and duration of Fentanyl drug therapy via the transdermal route. Explain the nursing implications of these to pharmacological actions.
Slow Onset: 12-24 hours
Peak: 24-72 hours
Duration: 1-4 days
Nursing Implications:
Change hairless application spot
Remove patch after 72 hours, fold it in half when discarding
Patch are for Persistant pain
Not for Post-0p or intermittent pain
Fentanyl patch = use stool softeners
Explain the nursing interventions for patients who have overdosed on a narcotic.
Treatment: Naloxone
Nursing Interventions:
Monitor respiration depression
Coma & pinpoint pupils
Short half life 1-2 hrs so have to administer multiple
Still have to administer it when trying to get normal levels
List the signs of alcohol withdrawal syndrome.
Seizure
Headache
Tremors
Anxiety/insomnia
Hallucinations
Increased BP or HR
Discuss the patient teaching required for those taking methylphenidate.
Patient Teaching
Take on a regular schedule
Avoid alcohol & caffeine
Take med BEFORE 6pm
Report palpitations or insomnia
Monitor weight 2-3 x weekly
List the side effects of medications used to treat attention-deficit/hyperactivity disorder (ADHD).
Amphetamine
Dextroamphetamine
Methylphenidate
Side Effects:
Weight loss
Hypertension
Palpitations, angina
Restlessness & insomnia
Paranoid psychosis
Identify the medications used to treat acute and intense anxiety.
Benzodiazepines
Alprazolam
GAD and panic disorder
Buspirone
SSRIs/ SNRIs
Describe the nursing interventions for an overdose of alprazolam (xanax).
Treatment: Flumazenil (benzodiazepine antagonist)
Reverses sedative effects but not respiratory depression
Monitor respirations, keep airway patent, support BP with IV
No charcoal
List the labs affected by Lithium.
Electrolytes
Creatinine
GFR
BUN
Thyroid function tests
CBC
EKG
Identify the foods which negatively interact with MAOIs.
Drug: Phenylzen
Foods that are high in tyramine
Cheese
Beer
Fermented soy products
Cured meats
Identify key teaching concepts for patients taking anti-depressants.
Resolves symptoms slow: 1-3 weeks initial response
Cannot be taken PRN
Increased risk of suicide
SSRI
-Serotonin symptoms
-Confusion, poor concentration, tachycardia, seizures, N & V, hallucinations
-Taper dose gradually
-Use a mouth guard if experiencing bruxism (teeth grinding) at night and report to provider
SNRIs:
-Avoid driving until effects are known
-Monitor for serotonin syndrome
-Report sexual dysfunction to provider
Atypical antidepressants
-Sip on fluids for dry mouth
-Headache, GI distress, constipation, tachycardia, restlessness, and insomnia and notify provider
-Avoid grapefruit with vilazodone and trazodone
Tricyclic antidepressants
-Orthostatic hypertension- sit up slowly
-Anticholinergic effects - sip on water
-Sedation - avoid driving until effects are known
-Excessive sweating
MAOIs
-CNS stimulation effects (anxiety, etc) and notify provider
-Sit up slowly
-Monitor for severe headaches bc MAOIs can cause hypertensive crisis
-Don’t eat tyramine rich foods
List the medications for Schizophrenia, which negatively affect glucose levels.
Second and third gen psychotics
Risperidone
Causes weight gain and dyslipidemia
Clozapine
Patients with diabetes can cause new onset of diabetes mellitus or loss of glucose control
Explain the patient teaching needed for patients taking propranolol.
If diabetic: monitor blood glucose (glucose masking)
Monitor HR and BP
Monitor orthostatic hypotension
Teach to stand slowly
Common side effects:
Tiredness & fatigue
Can exacerbate symptoms of asthma
Promote depression
Describe how to assess the effectiveness of Sumatriptan. (used to treat migraines)
Suppression of migraines/headache
Suppression of associated symptoms include nausea, neck pain, photophobia, phonophobia
Discuss how to counteract the negative effects of opioid medications.
Adverse Effects:
Respiratory depression (Low RR below 12)
Low BP
Low CNS sedation (easily falls asleep while talking, unarousable)
Nausea / Vomiting
Dizziness
Constipation
Antidote: Naloxone
Explain the side effects of spinal anesthesia and associated nursing interventions.
Drugs: Lidocaine, Tetracaine, Bupivacaine
Adverse Effects:
Hypotension
Bradycardia
Dizziness
Paresthesia
Respiratory depression
Nursing Interventions:
Monitor vital signs
Monitor for CNS effects: respiratory depression
Have IV access and fluid therapy ready for hypotension
Describe the mechanism of action for Baclofen (muscle relaxant) and its effects on patients.
CNS drug that enhances GABA (reduces nerve excitability) to produce sedative effects & acts in the spinal cord to depress hyperactive spasticity of muscles
Reduces discomfort of spasticity
Adverse Effects:
Nausea, constipation, urinary retention, seizures
Identify the priority nursing implications for patients taking anti-seizure medication.
Medications:
Phenytoin
Nursing Interventions:
Taper slowly over 6 weeks
Provide safety measures to prevent injury
Monitor for hypersensitivity reactions
Explain the mechanism of action for Donepezil (AD) and its effects on patients.
It is a cholinesterase inhibitor which stops cholinesterase from inactivating acetylcholine
Increases the amount of acetylcholine available at receptor sites ⇨ increased transmission of nervous impulse at all sites
Adverse Effects:
INCREASE muscarinic stimulation
Increase GI motility, GI secretions, diaphoresis, salivation, bradycardia, urinary urgency
Cholinergic crisis
Excessive muscarinic stimulation and respiratory depression from neuromuscular blockade
Paralysis of respiratory muscles
Describe the effects of dopamine agonists on a patient.
1st line drug for PD
Carbidopa / Levodopa
Activate dopamine receptors to balance dopamine and acetylcholine extrapyramidal nervous system
Treats motor symptoms
Identify patient teaching principles for those on CNS drugs (relax, slow body down).
Tolerance & Physical Dependence
CNS depression:
Avoid activities that require alertness
Avoid alcohol
Taper dose
Antidotes for toxicity:
Opioids ⇨ Naloxone
Benzodiazepines ⇨ Flumazenil
Alcohol withdrawal ⇨ Chlordiazepoxide
Tricyclic Antidepressants ⇨ sodium bicarbonate
Administer medication with food for GI distress
Discuss the nursing implications (including patient teaching for levodopa/carbidopa.
Describe adverse effects of levodopa-carbidopa
Nursing Implications:
Observe for development of suicidal tendencies
Monitor BP
Patient Education:
Slow onset 2-6 weeks
Slow position changes
Red, brown urine normal
Take w/ food, but avoid high protein meals
Warn patients about abrupt loss of therapeutic effects
Adverse Effects:
Nausea / Vomiting
Drowsiness
Dyskinesia
Orthostatic hypotension
Cardiovascular effects
Psychosis
Activation of malignant melanoma
Explain why a patient’s health history is important when administering medication. Give an example using Propofol.
A patient’s health hx is important to consider prior to drug administration because of allergic reactions and anaphylactic shock. Avoid drug-drug interactions and look at allergies.
Propofol has a narrow therapeutic range.
Contraindications:
Hypersensitivity rxn to allergies of eggs and soybeans
Asthma
Bleeding disorders
Cardiac diseases
Hepatic impairment
Define cross-tolerance, physical dependence, tolerance, and addiction.
Cross-tolerance:
Becoming tolerant to all drugs in a drug class by becoming tolerant to just one of the drugs in the class
Physical dependence:
Experiencing physical symptoms when drug use is abruptly stopped
Tolerance:
Body gets used to drug dose ⇨ larger dose is required to achieve therapeutic response
Addiction:
The inability to control the use of drugs due to behavioral and brain disorders
