Module 3 Bluprint Flashcards
How does the nurse recognize ASA/ salicylate toxicity?
tinnitus (ringing in ears)
How does ASA work?
produces analgesia by inhibiting prostaglandin synthesis
How does Tylenol work?
produces analgesic & antipyretic effects by inhibits prostaglandin synthesis.
It does not act on inflammation or platelet function
How do NSAID’s work?
They inhibit the Cox enzyme (the 1st enzyme in the prostaglandin pathway).
What system is Tylenol toxic to?
Liver, LAB TEST: CHECK BILIRUBEN
What can ASA cause in children under the age of 12?
Reye’s syndrome
What will pyridium need to be prescribed with?
an antibiotic, because it will just relieve dysuria and urgency of UTI. ( remember: It colors the urine orange. This is harmless side effect)
If a patient is prescribed Fentanyl (sublimaze) or (Duragesic patch) how long will the patch be worn?
Patch is left for 72 hrs. NOT 24
what will the patient be given if they are experiencing respiratory depression caused by narcotic overdose?
Naloxone (narcan)
Why are narcotic agonist contraindicated in head injury?
mask changes in LOC
What is an adverse effect of anesthesia?
hypothermia (shivering, increased BMR so demand for O2 is increased [monitor O2 sats]).
Bupivacaine (Marcaine)
highly bound to plasma proteins, making placental transfer the lowest of local anesthetics, so it is used in OB.
Lidocaine (Xylocaine)
used on mucous membranes as a gel or viscous liquid to ease discomfort by instruments used during urethral catheterization or gastroscopy, or in cancer pts to relieve stomatitis (mouth ulcers)
How do local and topical anesthetics work?
- They are used to interrupt the transmission of pain impulses from peripheral nerves by causing a temporary loss of sensation in limited area of the body.
What are the “caine” drugs known for?
The “Caine” drugs are common allergens (be sure to assess for allergies due to allergic to ‘caine” drugs)
What do you want to make sure to monitor for after a patient has had a “caine” drug?
monitor gag reflex is back before giving anything PO. Test by: can they swallow saliva, ice chips
what would the nurse give a patient who has had to much Alprazolam-(Xanax) -a sedative?
Benzodiazepines- Romazicon is antidote
Why are benzodiazepine preferred over barbiturate?
effectiveness and safety (rare instances of physical & psychological dependence)
What are the adverse reactions of benzodiazepine?
respiratory depression, & physical & psychological dependence with long term use.
What are the adverse effects of barbiturate?
- daytime sedation,
- hangover effect,
- dizzy
- impairment of judgment and motor skills during hangover
- physical dependence with prolonged use
What are the adverse effects of Nonbenzodiazepines-nonbarbiturates ?
- respiratory depression
- psychological & physical dependence with prolonged use
if giving Phenobarbital, secobarbital, or pentobarbital how do you know you shouldn’t use it?
it is cloudy
can you mix Phenobarbital, secobarbital, or pentobarbital in the same syringe?
No
how should you not give a barbiturates?
• Avoid using intramuscular (IM) route for barbiturates; select a large muscle mass if IM is necessary
If other CNS are prescribed at same time during benzodiazepine therapy what should you do?
Consult with MD; combo can be lethal
what should you teach a patient about taking CNS depressants?
not to drink alcohol
Imipramine (Tofranil)
used to treat depression, enuresis in child >6.
Also used at ½ dose for migraines PHYSCOLOGICAL SYMTOMS TAKES 2-4 WEEKS
Amitriptyline (Elavil)
treat depression, greater sedative & anticholinergic effects that other tricyclics;
PO or IM
Unipolar depression
(major depression or endogenous) 90%.
- Symptoms are vague so it is hard to diagnose.
- Symptoms are: poor appetite, wt loss, loss of interest in activity, sleep disturbances, feelings of worthlessness, hopelessness, slowed mental processes, thoughts of death.
In depression diminished levels of one or both neurotransmitters exists-
(norepinephrine & serotonin).
Bipolar disorder
periods of mania alternating w/ depression; much less common than depression.
- Symptoms of mania are: euphoria, rapid speech, flight of ideas, over activity, overly sexually active, decreased need for sleep.
In mania an excessive concentration of neurotransmitters exists
(norepinephrine & serotonin).
It takes 14-21 days for antidepressant & antimanic drugs to be effective.
MAO inhibitors: (Monoamine Oxidase
- Non-selectively inhibit the enzyme monamine oxidase,
which metabolizes neurotransmitters at receptor sites.
There are two types of MAO enzymes:
MAO-A to treat depression
MAO-B to treat Parkinson’s (Eldepryl)
-They are rapidly absorbed from GI tract, the onset of action ranges from 1-2 weeks, start on low dose, can increase dose gradually, & effects may continue for 1-2 weeks after discontinuation
what foods interact with MAOIs?
- Foods rich in tyramine should be avoided while on MAOI
Avoid:Aged cheesesHerring - CORNED BEEF, BAKED POTATOE W/SOUR CREAM, W/ ITALIAN BEENS, Yeast, Broad beans
What are adverse effects of MAOI’s?
restlessness, drowsiness, dizziness, headache, nausea, dry mouth, blurred vision, orthostatic hypotension, hypertensive crisis
hypertensive crises
what are S/S of hypertensive crises?
extremely high BP, headache, palpitations, N&V, neck stiffness, fever, clammy skin, mydriasis, photophobia, tachy/bradycardia
what are early signs of Lithium toxicity?
diarrhea, anorexia, muscle weakness, N&V, tremors, slurred speech ( DON’T GIVE MEDS, CALL DOCTOR TELL ABOUT OBSERVATIONS) , & drowsiness
when is Lithium used?
It is used to treat acute episodes of mania & to prevent relapses of bipolar disorders
what is the therapeutic range of Lithium?
1-1.5 mEq/L
when does lithium toxicity becoming more likely?
In situations where sodium levels are depleted (sweating, decreased salt intake, diarrhea, diuretics), the kidney actively reabsorbs more lithium
how should you administer Lithium?
with food to decrease GI effects
Long term use of Barbiturates can lead to?
tolerance, and physical or psychological dependence
what should you keep in mind when antianxiety drugs are DC?
Don’t not discontinue abruptly
what is Tardive dyskinesia?
is an irreversible adverse effect of neuroleptic drugs
What are early signs of Tardive dyskinesia?
lip smacking, fine wormlike tongue movements, & involuntary movements in the arms & legs.
what should the nurse use the AIMS (abnormal involuntary Movement Scale)?
perfomed q 90 days by RN to evaluate for early s/s of tardive dyskinesia.
what are the rare but serious adverse effects of neuroleptics?
blood dyscrasias, jaundice, & NMS (Neuroleptic Malignant Syndrome)
Neuroleptic Malignant Syndrome causes AMS (altered mental status) what are the S/S?
tachycardia, fever, tachypnea, disphoresis, muscle rigidity, hyperpyrexia, decreased BP, cardiovascular collapse.
what should you do if you see S/S of Neuroleptic Malignant Syndrome?
Discontinue medications & notify MD immediately if signs of NMS occur
what drug mask tardive dyskinesia?
phenothiazines
