Module 4 Flashcards
1
Q
What are prostaglandins?
A
group of lipids with hormone-like actions that your body makes primarily at the site of tissue damage or infection
2
Q
What do the COX-1 and COX-2 produce?
A
Prostaglandins
3
Q
COX-1 is __________, meaning it runs no matter what the cellular needs are.
A
Constitutive
4
Q
COX-2 is ________, which means it needs a _______.
A
Inducible, inflammatory stimuli
5
Q
COX-1 is responsible for:
A
Platelet regulation, kidney function, and regulating stomach acid/mucous production
6
Q
COX-2 is responsible for:
A
Inflammation responses: swelling, pain, heat
7
Q
COX-1 has a constant _____ level of prostaglandin production
A
Low
8
Q
COX-2 has a constant _____ level of prostaglandin production
A
High
9
Q
Aspirin inhibits COX _______
A
1 and 2
10
Q
What is another name for aspirin?
A
Acetylsalicylic acid
11
Q
ASA is another name for?
A
Aspirin
12
Q
Function of aspirin?
A
Suppresses inflammation, pain, and fever; causes irreversible inactivation of COX 1 and 2
13
Q
What condition can aspirin cause in children with viral illnesses?
A
Reye’s syndrome
14
Q
What kind of medication is aspirin?
A
Antiplatelet (prevents clots, platelet aggregation)
15
Q
Side and adverse effects of aspirin?
A
GI distress, bleeding, renal impairment, salicylism , Reye’s syndrome , and can be nephrotoxic in high doses
16
Q
What kind of pt is aspirin contraindicated for?
A
Risk for or actively bleeding, children with viral illnesses, renal impairment/failure
17
Q
Drug interactions for aspirin?
A
Warfarin(and other anticoagulants) and alcohol (increased risk for bleeding as well)
18
Q
What forms does aspirin come in?
A
Chewable, plain, enteric coated, time released, and rectal
19
Q
Dosage for aspirin is ______ and ____ dependent
A
Age and condition
20
Q
Nursing interventions for aspirin:
A
Decrease risks for bleeding (precautions), monitor for s/s bleeding, give with food, dont crush or allow pt to chew enteric coated, be aware of children and if have viral illness
21
Q
What is salicylism?
A
Aspirin toxicity
22
Q
What is the antidote for Salicylism?
A
Activated charcoal to inhibit absorption, hemodialysis if needed, gastric lavage( if needed)
23
Q
S/S for salicylism
A
Tinnitus, vertigo, HA, fever, ALOC, sweating
24
Q
Ibuprofen inhibits_______
A
COX-1 and COX-2
25
How do aspirin and ibuprofen differ?
Ibuprofen does not have anti-inflammatory properties like aspirin does and it is not cardio protection. Ibuprofen has a black box warning for risk of a cardiovascular event and GI bleeding
26
Side/adverse effects of ibuprofen?
N/V, GI injury (ulcers, bleeding), can be nephrotocxic and/or hepatotoxic, prolonged bleeding (but not as much as aspirin); BLACK BOX warning: cardiovascular event, GI bleeding
27
Ibuprofen nursing interventions
Teach to take with food and to increase fluids, avoid alcohol and “G” herbs(ginger, ginseng, ginkgo, garlic), report s/s bleeding, teach and report s/s of MI and stroke, do not crush, cut, chew ER/enteric coated tabs, teach that Ketorolac can cause kidney damage if used for about 5 days
28
What interventions should be used for older adults and NSAIDs?
Monitor renal function beforehand, encourage adequate fluid intake, and use lower dose to decrease the risks of complications
29
Corticosteroids
“-one”; anti-inflammatory and used for pain; used to suppress immune system (i.e. transplant pts)
Long half-life, taper off over several days
May cause: edema, hyperglycemia, increased appetite, weight gain, neutropenia
30
Etanercept, infliximab, adalimumab are all examples of a __________
DMARDs (disease-modifying anti-rheumatic drugs )
31
Prednisone, prednisolone, and dexamethasone are all _______
Corticosteroids
32
When are disease modifying anti-rheumatic drugs used?
When NSAIDs are unsuccessful in treating rheumatoid arthritis pain, prevents progression by suppressing prostaglandin activity and slowing degeneration of joints; delayed effect (3-6 weeks)
33
How long do DMARDs take to become therapeutic?
May take several months
34
A/E for disease modifying anti-rheumatic drugs
Injection site pain, risk for infection, blood dyscrasias, skin reactions(stevens-Johnson), HF
35
Nursing interventions for DMARDs
Monitor injection site, watch for s/s infection and skin reactions as well as HF, obtain CBC and look for blood dyscrasias
36
Drug interactions for DMARDs
Live virus vaccines (avoid)
37
Methotrexate
DMARD, immunomodulator used to slow or delay the worsening of rheumatoid arthritis , can take 3-6 weeks to see full effects
38
A/e of methotrexate
Infection, hepatotoxicity, bone marrow suppression, ulcerative stomatitis, fetal death
39
Nursing interventions for methotrexate
Monitor for s/s infection, labs and hepatotoxicity, give folic acid, monitor stomatitis, give with food, and educate about a need for contraceptives (fetal harm); educate to avoid crowds, trauma, sick ppl.
40
Pregnancy category for methotrexate
Category X: contraindicated
41
Contraindications for methotrexate
Liver failure, alcohol use, pregnancy, blood dyscrasias
42
What should a nurse do before administering DMARDs?
Check for infection
43
Pt teaching for DMARDs
Phototoxic- sunscreen s/s stevens-Johnson, s/s HF, s/s infection
44
gout
Extremely painful inflammatory condition that affects joints, tendons, and other tissues; increased Uric acid levels, tophi
45
Tophi
chunks of uric acid developed around and within joints- advanced gout
46
Gout pt should avoid foods high in ________
Purine (red meats, alcohol, fish, scallops
47
Gout pts should increase fluid intake to prevent
Kidney stones (nephrolithiasis)
48
How is acute gout treated?
Colchicine, NSAIDs, intra-Articular glucocorticoids
49
What kind of gout attack is colchicine given for?
Acute
50
What is allopurinol?
Urate-lowering agent; works by inhibiting the production of uric acid, used prophylactically; tx for hyperuricemia for chronic gout- avoid alcohol and increase fluids; causes a metallic taste (normal s/e)
51
A/e for allopurinol
Hypersensitivity, kidney injury,hepatitis, GI distress, increase in gout attacks for first months of treatment, CNS effect
52
Anti-gout medications
Pregnancy category C
Colchicine decreases inflammation, used for acute attack
Decreases inflammation
A/e= GI distress, bone marrow suppression , rhabdomyolysis
Contraindications in those with severe renal, cardiac, hepatic , or GI dysfunction
53
What is probenecid?
An anti-gout medication that inhibits uric acid reabsorption, used prophylactically (prevent gout)
A/e= kidney calculi, GI effects, hypersensitivity
54
Anti-gout medication drug/food interactions
Grapefruit juice (increases med effect), avoid salicylates with probenecid
55
Nursing interventions for anti-gout medications
Teach them to take it with food, avoid grapefruit juice and alcohol; monitor uric acid, CBC LFT and RFT, monitor for bleeding and infection, teach them to avoid foods high in purine, increase fluids, and allopurinol causes a metallic taste ( not concerning)
56
What type of drug is acetaminophen?
Non-opioid analgesic
57
How does acetaminophen work?
Analgesic and antipyretic actions, but no anti-inflammatory or anti thrombotic actions, does not cause GI upset,but liver damage can be fatal; used to treat fever and minor pain, drug of choice for older adults (initial mild-operate musculoskeletal pains) and children
58
What’s is the antidote for acetaminophen?
Acetylcysteine (oral, IV)
59
Pharmacokinetics of acetaminophen
Metabolized by liver and excreted by kidneys
60
Drug interactions for acetaminophen
Alcohol (damages liver as well) and warfarin (increases INR) monitor the pt
61
What is the max daily dose for acetaminophen in someone with a healthy liver?
4 g per day
62
In someone who drinks ______ or more drinks in a day, the max dose of acetaminophen is _______ per day
3; 2g
63
What two factors increases the risk for acute toxicity of acetaminophen?
Fasting and alcohol
64
S/s of acetaminophen toxicity
N/V/D, swearing, abd pain, coma, death, liver damage (within 48 hours)
65
What is the treatment for an acetaminophen overdose?
Administer oral or IV acetylcysteine (within 8 hours of ingestion) or gastric lavage (within 4 hours of ingestion, if needed)
66
What are the chronic non-cancer pain steps to pain management?
Step 1: non-opioid analgesic
-adjuvant analgesic
Step 2: weak- opioid analgesic
Non opioid analgesic
Adjuvant analgesic
Step 3: minimal invasive intervention
Non- opioid analgesics
Adjuvant analgesic
Step 4: strong opioid analgesic
Non-opioid alagesic
Adjuvant analgesic
67
Opioid analgesics
Act on specific receptors in the CNS to reduce perception of pain (mu, kappa, delta receptors , mostly mu) but do NOT eliminate pain
68
Contraindications for opioid analgesics
Head injuries
69
Routes for opioid analgesics
oral, IM, IV, rectal, epidural, transdermal
70
What are the agonists for opioid analgesics?
Morphine, fentanyl, codeine, heroin, hydrocodone, hydro morphine, meperidine(less potent than morphine no resp dep), methadone, oxycodone, oxymorphone
71
Weak agonists/ reuptake inhibitors for opioid analgesics
Tramadol
72
Mixed-agonists-antagonists opioid analgesics
Buprenorphine, butorphanol
73
Opioid side effects
“MORPHINE”
Myosis (pin-point pupils)
Out of it (sedation)
Respiratory depression
Physical dependence
Hypotension(orthostatic)
Infrequency(constipation/urinary retention)
Nausea
Emesis (vomiting)
74
What do opioids increase the effects of?
Alcohol, sedatives, muscle relaxers, and any other CNS depressants
75
What are opioids used for?
Pain relief, diarrhea, cough suppression, replacement therapy for OUD, reversing opioid overdose…
76
Opioid Side effects besides “MORPHINE”…..
DESIGNER
Dry mouth
Euphoria
Sedation
Itch
Gastro(constipation)
Nausea/vomiting
Eyes (pupillary constriction)
Respiratory depression
77
Opioids are a schedule ____ drug, which means….
2; high risk for abuse, but are safe and accepted for use
78
Opioids should be used cautiously in……
Children, older adults, renal and liver impairment
79
S/E of opioids?
Dysphoria(restlessness), sedation, hallucinations, nausea, constipation, dizziness, orthostatic hypotension, pupillary constriction, depression, anxiety, and itching sensation, bowel perf, hemorrhoids, rectal tearing
80
What is the opioid prototype?
Morphine sulfate
81
Codeine is used for…..
Cough suppressant and pain, less potent than morphine
82
Opioid patients are high risks for….
Falls!(orthostatic hypotension, confusion, dizziness, etc.) bed alarm
83
Overdose of opioids
Respiratory depression , cardiac arrest, neurotoxicity, impaired pulmonary function
84
Nursing interventions for opioids
Respiratory status and LOC monitor and pulmonary function, take VS, urine output and constipation(retention), cautiously in pregnancy, labor and delivery, and lactation , monitor for tolerance or dependence, frequent assessments, breakthrough pain (tx w/ non opioid), fixed schedule, opioid overdose triad (coma, pinpoint pupils, respiratory depression)
85
What is the opioid overdose triad
Coma, pinpoint pupils, respiratory depression
86
Pt teaching for opioids
S/s hypotension- change positions slowly, constipation- increase fiber, fluids, and exercise
Monitor tolerance (cross-tolerance can occur between morphine and other opioids)
87
Fentanyl
100 times the potency of morphine, three routes: parenteral, transdermal, and transmucosal
88
what is parenteral fentanyl used for?
Surgical anesthesia
89
How is transdermal fentanyl used?
Patch
90
How is transmucosal fentanyl used?
Lozenge on a stick, buccal film, buccal tablets, sublingual tablets,sublingual spray; can be used for surgical analgesia, chronic pain control,and control of breakthrough pain (all routes- schedule 2)
91
What opioid can be given via PCA (patient controlled analgesia)?
Fentanyl- dont let anyone else but pt push it!
92
What should the nurse monitor for in a pt with PCA fentanyl?
S/s overdose—- have naloxone ready
93
Opioid antagonist
Narcan (naloxone, naltrexone), antidote to opioid agonists, starts working in 1-2 min
94
A/E of Naloxone/ Narcan
Withdrawal symptoms (immediate), drowsiness, decreased respirations
95
Withdrawal s/s seen on Narcan
Tremors, sweating, HTN, tachycardia, N/V
96
Headaches are a symptom caused by
Dilation and inflammation of intracranial blood vessels
97
What drugs are used for headaches?
Triptans
98
Triptans
“-triptan”
Serotonin receptor agonists, 1st line med for migraine, abortive therapy (stops migraine) by constricting blood vessels and suppressing inflammation- dont use more than 2 times a week
99
What route is the fastest in treating a migraine in triptans
IV and nasal forms faster than oral
100
S/E and A/E for triptans
Chest s/s not dangerous and coronary vasospasm (ED!), fatigue, tingling sensations, avoid in pregnancy and Hx of CAD
101
Pt teaching for triptans
Take when migraine first is sensed, second dose hrs later if s/s persist, do not exceed 100 mg in single dose or 200 mg in a day
Subcutaneous- how to admin, no more than 2 injections in 24 hours
Nasal spray- admin as a single dose may repeat in 2 hours
Lie down in a dark, quiet room
102
Antiemetics are given
To suppress nausea and dominating; commonly used for chemotherapy induced N/V (CINV)
103
Antiemetics are better used ______ than _______
Prophylactically reactively
104
When should antiemetics be given for chemo pts?
About 30 min before therapy and around the clock
105
What foods should a nauseas and vomiting avoid?
High fat foods
106
Hydroxyzine
First-generation antihistamine- sedation (anxiety); oral / IM
side and a/e: anticholinergic effects, sedation (can’t see, can’t pee, can’t poop, can’t spit)
107
Doxylamine and pyridoxine (B6) are given
To pregnant women for morning sickness
108
What is scopolamine
Anticholinergic Used for motion sickness, transdermal patch behind the ear for 3 days, apply 4 hours before motion activity
109
What patients are contraindications for scopolamine?
Glaucoma and BPH pts
110
Side effects/Adverse effects for antihistamines and anticholinergics
Fatigue, dizziness, drowsiness(bc first gen antihistamine), dry mouth, blurred vision, urinary retention, constipation
111
Nursing considerations for antihistamines and anticholinergics
Increase fluids, fiber, and exercise (constipation), I&O, monitor for bladder distention (bladder scanner, may need straight cath), BM monitor, teach to avoid heat bc can’t sweat, and use hard candy or mints for dry mouth
112
Ondansetron
5-HT3/ serotonin receptor antagonist
Used for N/V, CINV
PO/IV
Side and A/E: headache, constipation, malaise, diarrhea, drowsiness, dizziness, prolonged QT interval that can lead to serious dysrhythmias
113
What can a pt on Ondansetron take for a HA?
Acetaminophen
114
What pts are contraindicated for Ondansetron?
Those with long QT syndrome (diagnosed with EKG and telemetry)
115
What is the normal dose of Ondansetron, and if it does not work (in a hospital setting) what can be done?
4 mg; call provider and ask for another dose
116
What is the Ondansetron dose for a chemo pt?
16 mg over 15 min via IV pump
117
Phenothiazines/ Dopamine antagonist
First-generation (typical) antipsychotics, blocks dopamine, M1 muscarinic & H1 histamine- blocking effects
Depresses the CNS used for N/V and to treat schizophrenia or psychosis
118
Promethazine is used for
N/V, contraindicated in children below 2 years (black box warning)
Side/adverse effects: anticholinergic effects, photosensitivity, drowsiness, sedation, hypotension, and confusion. Extravasation
119
What can Promethazine cause (s/s abnormalities)
Extrapyramidal symptoms
120
What are extrapyramidal symptoms?
Restlessness, anxiety, spasms (face and neck)
121
What should you do if a pt exhibits extrapyramidal symptoms
Stop the med immediately
122
What should be avoided when on Promethazine?
Other CNS depressants (i.e. alcohol and opioids)
123
Can RF and LF pt take Promethazine?
Yes, doses need to be lowered
124
How should Promethazine be given via IV?
With IV pump and fluids diluted to about 10 mL for about over 10 min
125
What is the max dose for Promethazine
25 mg
126
Why can Promethazine not be given subcutaneously?
Causes extravasation
127
What is required of an IV for promethazine?
20G above the wrist
128
Aprepitant
Substance P/ Neurokinin 1 Antagonist
Inhibits substance P/neurokinin in the brain
Has extended duration of action (peak=4 hrs)
129
Side and adverse effects of Aprepitant
Fatigue, weakness, dizziness, abnormal heart rhythm, headache, hiccups, possible liver damage, pain at IV site
130
Dronabinol
Cannabinoid, related to marijuana, potential for abuse
Antiemetic but also used as an appetite stimulate in cancer/AIDS patients
PO
131
Side effects/ adverse effects of dronabinol
Drowsiness, confusion, dizziness
132
What are contraindications for dronabinol?
Pts with mental health disorders (can make s/s worse)
133
Laxative effect
Production of soft, formed stool over a period of 1 or more days; relatively mild
134
Catharsis
Prompt, fluid evacuation of the bowel; fast and intense—- cramping and straining (stimulant)
135
Contraindications for laxatives
Symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis. Acute surgical abd, fecal impact ion/ bowel obstruction; bowel perforation, habitual use, use in caution in pregnancy and lactation
136
What is important to remember when it comes to laxatives
Always assess at least once every shift
137
Psyllium husk
Bulk-forming OTC mix with water (full 8 oz and then follow with 8 oz)
Safest laxative ; about 2 weeks, risk for electrolyte imbalances, decrease diarrhea in diverticulosis and IBS, control loose stool-ileostomy/colostomy - promote defecation in older adults
138
S/a effects of psyllium husk
Flatulence, bloating, cramping(s/e)
Esophageal or Bowery obstruction (if not enough water)
139
What kinds of patients is psyllium husk safe for?
Cardiac pt, those who are able to swallow
140
Docusate Sodium
Surfactant laxative(stool softener); relieves constipation and prevents painful elimination and straining, decreases risk for fecal impaction
Increases water and electrolytes in intestines
141
S/a effects for Docusate Sodium
No serious adverse rxns, s/e= diarrhea, abd cramps, edema
142
What laxatives are most frequently abused?
Cathartics
143
Bisacodyl, castor oil, senna
Stimulant laxatives (cathartics) that cause direct stimulators effect on intestinal mucosa
144
S/a effects of bisacodyl, castor oil, or senna
GI irritation , rectal burning sensation, proctitis
Senna s/e=reddish/brown urine
145
Saline laxatives
Magnesium hydroxide and magnesium citrate
146
Magnesium hydroxide and magnesium citrate are_________
Milder and slower acting laxatives
147
You should cautiously use saline laxatives in
Renal dysfunction pts
148
Complications of saline laxatives
Absorbed systematically = dehydration, hypermagnesemia, sodium retention
Exacerbates HF, HTN, edema
149
Osmotic laxatives
Polyethylene glycol (miralax) and polyethylene glycol electrolyte solution (golytely); cautiously use in those with a Hx of seizures
150
S/a effects of osmotic laxatives
GI effects, dehydration s/s, CNS effects (dizziness, HA), sweating, palpitations, flushing and fainting, dry mouth
151
Polyethylene glycol electrolyte solution (Golytlely) is used for
Bowel prep for procedures , must finish all of it clear liquid diet
152
Lactulose
Hyperosmotic laxative tx for constipation and prevention/tx for portal-systemic encephalopathy(increases ammonia levels)
153
use lactulose cautioulsy in those with
Diabetes
154
Lactulose ins contraindicated in those with
Appendicitis, a true surgical abd, fecal impaction, intestinal obstruction
155
Dopamine atagonist, prokinetic agent
Metoclopramide- antiemetic effect
156
How does metoclopramide work?
Increases the rate of gastric emptying, used for diabetic gastroparesis
157
Contraindications for metoclopramide
Bowel perf, obstruction/ hemorrhage
158
A/e for metoclopramide
EPS, sedation, drowsiness, depression, insomnia, diarrhea
159
What can you give for extrapyramidal symptoms from metoclopramide?
Benadryl
160
Causes for laxative abuse
Misconception that movements must occur daily
161
Consequences of laxative dependence
Diminished defamatory reflexes, reliance on laxatives
162
Tx for laxative abuse
Abruptly withdraw ALL LAXATIVES
