Module 2 Exam Flashcards
Bone marrow suppression and chemotherapy
Chemotherapy can cause bone marrow suppression, which can lead to leukopenia, thrombocytopenia, anemia, and pancytopenia.
Nausea and chemotherapy- Interventions and Teaching
Chemotherapy will cause nausea. Nurses should give antiemetics and educate; also educate to eat small frequent meals; also, dietitian consult
When handling chemo, what should you do?
wear gloves (double) and PPE
Doxorubicin Drug Class
antineoplastic antibiotic
Doxorubicin administration
Given IV; known as the “red death” which is reddening, swelling, numbness on palms and hands and soles of feet
Alkylating agent drug class
antineoplastic agent (cancer drug)
Alkylating agent precautions
do not take if pregnant or lactating, bone marrow suppression (pancytopenia) and suppressed renal function
Alkylating agent nursing assessments
assess for allergies, orientation and reflexes for CNS effects, respiratory rate and adventitious sounds, GI effects, monitor lab results and CBC which will indicate bone marrow suppression
Alkylating agent pt teaching
follow regimen, cover head at extreme temperatures, avoid exposure to infection, consult HCP related to impaired fertility; use barrier contraceptives bc can cause birth defects
Considerations for opioid analgesics
opioids cause respiratory depression
PCA pumps and benefits
PCA pumps are when the pt can control the amount of pain med they want to take
Benefits for PCA pumps: pt can control amt of pain med, speeds up recovery, do not have to wait on med
Inflammatory response sequence
Red
Swollen
Heat
Pain
Interferons action
substance that helps the immune system fight infection or other diseases like cancer
Interferons Pt Teaching
Let them know that they will feel like they have the flu
Acetaminophen
Used to treat pain and fever and musculoskeletal pain associated with arthritis
Very hard on liver, caution when taking if drinking alcohol
Acts directly on thermoregulatory cells of hypothalamus, mechanism of action is unknown
Metabolized in liver and excreted in urine; absorbed in GI tract
NSAIDs
nonsteroidal anti-inflammatory drugs; provide strong anti-inflammatory and analgesic effects (pain relieving)
If you have renal failure, what should you not take?
NSAIDs
If beta blockers are given with NSAIDs, what can occur?
a decreased antihypertensive effect, so monitor the pt closely and possibly adjust the dose to maintain the desired blood pressure
Gold Salts contraindications
Antimalarials, cytotoxic drugs, and penicillins, diabetes, CHF, renal or hepatic impairment, blood dyscrasias and lactation
Gold Salts are used to treat and example
arthritis; auranofin
Salicylates therapeutic effect
antiinflammatory, antipyretic, analgesic
ASPIRIN
Salicylates adverse effects
ototoxicity (impaired hearing)
effects on stomach and clotting systems
NSAIDs and GI bleeding
Will cause GI bleeding if you take it on an empty stomach; high possibility of GI bleeding
COX-2 inhibitors drug class
antiinflammatory (NSAID)
COX-2 inhibitors assessments
GI effects, urinary retention, and changes in bleeding time
NSAIDs and Diuretics
NSAIDs decrease the effectiveness of loop diuretics
Immune modulators action
selectively affect the function of the immune system to fight infection, cancer, etc
Immune modulators and females of childbearing age
use barrier contraceptives when taking because it can cause serious fetal harm
Colony Stimulating factors drug class
immune modulator
Colony stimulating factors pt teaching
adequate fluid intake
sargramostim (example)
avoid adverse effects (GI effects, headache)
typically given IV or subQ
Interferons and cancer
Interferons are chemicals that are secreted by cells that have been invaded by viruses and possibly by other stimuli. The interferons prevent viral replication and also suppress malignant (cancer) cell replication and tumor growth.
Tonic-clonic seizures
involuntary muscle contractions followed by relaxation appearing as an aggressive spasm; loss of consciousness
Absence seizures
abrupt 3-5 seconds that does not involve muscle contractions
Myoclonic seizures
characterized by short, sporadic periods of muscle contractions that last for several minutes, rare
Status Epilepticus
state in which seizures rapidly recur; most severe form of generalized seizures; treated by benzodiazepine (antidote is flumazenil)
Phenytoin lab values, within range, high, low and nurse actions
Range: 10-20 mg/mL
High: do not give med and contact HCP
Low: give med, institute seizure precautions, contact HCP
IBS common medication
dicyclomine (anticholinergic)
Benzodiazepine drug class
antiepileptic agent
Benzodiazepine reversal agent
flumazenil
Opioid reversal agent
naloxone
Edrophonium diagnostic
used to diagnose myasthenia gravis
Anticholinergics contraindications
Myasthenia Gravis
hyperthyroidism
glaucoma
enlarged prostate (benign prostatic hypertrophy)
hypertension
urinary tract blockage
increased heart rate (tachycardia)
Anticholinergics Pt Teaching
may have hypotension, risk for falls, blurred vision
Anticholinergics adverse effects
tachycardia
slowed GI activity
urinary retention
pupil dilation
cycloplegia (relaxation of accommodation)
hot/dry
dry mouth
Levodopa drug class
dopaminergic agent; used to treat parkinson’s
Levodopa Pt Teaching
often combined with carbidopa
common effects are fatigue, weakness, drowsiness, dizziness fainting, increased sweating, darkened urine, headaches, difficulty sleeping
Benztropine Drug Class
anticholinergic
Benztropine Uses
treatment of parkinson’s
Benztropine Adverse Effects
confusion, fall risk, dry out body (CNS effects and peripheral anticholinergic effects)
DO NOT GIVE IF PT HAS URINARY RETENTION
Cyclobenzaprine Drug Class
centrally acting skeletal muscle relaxant
Cyclobenzaprine Pt Teaching
do not drink alcohol while taking, do not take CNS depressants while taking, and do not operate heavy machinery
Donepezil Drug Class
cholinergic agonist
Donepezil Nurse Assessments
LOC every shift
Benefits of Triptans over Ergot meds
triptans are not associated with as many adverse systemic effects compared to ergot meds
Sympathomimetic Drugs - changes in VS
increase in VS, hypertension, tachycardia, tachypnea
Midodrine Drug Class
adrenergic agonist
Midodrine Nursing Assessments
LOC, affect, reflexes, and vision (CNS effects)
bp, pulse, peripheral perfusion, ECG
urine output, nausea, constipation, renal and liver function
OTC cold and allergy preparations - Pt Teaching for parents
many OTC cold and allergy preparations contain phenylephrine (alpha1 agonist/vasoconstrictor)
do not give to pt’s with hypertension
Alpha-specific adrenergic agonists - Pt Teaching and Examples
avoid driving and operating heavy machinery, CNS effects, vasoconstrictor
clonidine, midodrine, phenylephrine
Adrenergic blocking agents - mechanism of action
sympatholytic; block effects of SNS
Adrenergic blocking agents - examples
-osin, -olol, yohimbine/antidepressants, labetalol
Adrenergic blocking agents - pt teaching
block the effects of SNS
Non-specific beta blockers and diabetics
blood sugar; masks the symptoms of hypo/hyperglycemia
Tamsulosin - uses
alpha-1 antagonist; dilates and lowers BP
Labetalol drug class
non-selective beta blocker
Labetalol causes
bronchoconstriction; used to treat cardiac-related conditions (decrease BP, HR, renal perfusion)
Pyridostigmine drug class
cholinergic agonist
Pyridostigmine uses
control myasthenia gravis
Bethanechol drug class
cholinergic agonist
Bethanechol uses
treats urinary retention (post op and postpartum) and neurogenic bladder atony
Scopolamine drug class
anticholinergic
Scopolamine pt teaching
PNS blocked, pupils dilate, HR increases, GI activity and urinary bladder tone and function decrease
Too much acetylcholine causes
cholinergic crisis
Question admin of cogentin (benztropine) for what pts?
parkinson’s (bc will make urinary retention worse)
benign prostate hypertrophy
ileus
Triptan uses
treats migraines
Phenytoin (Dilantin) can cause
(antiseizure agent) severe liver toxicity and bone marrow suppression and birth defects
Antiseizure meds Pt Teaching
birth defects
barrier contraception
bone marrow suppression
compliance (can worsen condition)
ABCs of anticholinergic agents
Artane (trihexyphenidyl)
Benadryl (diphanhydramine)
Cogentin (benztropine)
Anticholinergic drugs do what
dry out body and slow things down
S/S confusion, fall risk
Carbidopa-levodopa
most commonly prescribed and most effective medicine for controlling symptoms of PD, particularly bradykinesia and rigidity
Anaphylaxis
severe allergic reaction (can’t breathe)
Dantrolene drug class
direct-acting skeletal muscle relaxant
Adrenal Medulla - sympathetic and parasympathetic effects
release of epi
no parasympathetic effect
Arteries - sympathetic and parasympathetic effects
vasoconstriction (except coronary arteries and arteries to skeletal muscles which are dilated)
most arteries are not supplied by parasympathetic nerves
Heart - sympathetic and parasympathetic effects
increase HR, AV conduction, and contractility
decrease HR, AV conduction, and slightly decreases contractility
Intestines, GI motility, and secretions - sympathetic and parasympathetic effects
DECREASES
INCREASES
Postganglionic Neurotransmitter - sympathetic and parasympathetic effects
norepinephrine released
acetylcholine released
Pupil of Eye - sympathetic and parasympathetic effects
dilation (mydriasis)
constriction (miosis)
Respiratory Passages, lower - sympathetic and parasympathetic effects
bronchodilation
bronchoconstriction
Urinary Bladder - sympathetic and parasympathetic effects
relaxation
contraction
Urinary Sphincter - sympathetic and parasympathetic effects
contraction
relaxation
Does sympathetic or parasympathetic last longer?
sympathetic bc it activates adrenal medulla
Alpha 1 agonist example
phenylephrine (triggers SNS - constricts)
Alpha-1 antagonist example
Tamsulosin, Doxasosin (dilate - stops SNS)
What is phenylephrine generally prescribed for?
nasal congestion and hypotension
Alpha-2 agonist example
Clonidine (BP med)
Alpha 1, beta 1 action
STIMULATE
HR, BP increases; periphery bl vessels constrict
Alpha 2, beta 2 action
INHIBIT
airways dilate, relax - allow more air
Catecholamines
epinephrine, norepinephrine, dopamine, dobutamine
Noncatecholamines
phenylephrine, terbutaline, ephedrine, didodrine
Cholinergic effects
rest, digest, movement
increased swelling
loss of bladder control
muscle weakness
N/V/D or stomach cramps and pain
SOB, tightness in chest, wheezing
slow or irregular heartbeat
unusual tiredness or weakness
watering of mouth
Anticholinergic effects
increased heart rate - possibly tachycardia
decrease GI activity - slows
decrease in urinary bladder tone and function
pupil dilation
cycloplegia (relaxation of accommodation)
relax smooth muscle in GI tract, bladder, and lung and can be used for GI, urological, or respiratory conditions associated with spasm and dysmotility
Myasthenia Gravis meds
neostigmine (Bioxiverz)
pyridostigmine (Mestinon)
Alzheimer’s Disease med
donepezil (Aricept)
Anticholinergic Agents examples
atropine, scopolamine
Anticholinergic effects
decrease secretions (dry)
restore cardiac rate and blood pressure
pylorospasm and hyperactive bowel
relax uterine hypertonicity
CNS: altered, agitated
Pupils dilated
Sympathomimetic Effects
cocaine, meth
wet skin, hyperactive bowels, no urinary retention
CNS: altered, agitated
Pupils: dilated
Cholinergic S/S (dumbbel)
diarrhea/drooling
urinary output
miosis - pupil constriction
bronchoconstriction
bradycardia
emesis
lacrimation - tearing
Are anticholinergics quick-relief meds?
no, but they’re effective in controlling difficult asthma symptoms
