NUR 325 exam 2 Flashcards
cholinesterase inhibitor
donepezil
donepezil moa
-inhibits acetylcholinesterase in brain
-increases acetylcholine
donepezil indication
mild-moderate alzhiemers
NMDA receptor agonist
memantine
memantine agonist moa
blocks stimulation of NMDA receptors
memantine indication
moderate-severe alzhiemers
memantine se
constipation (give with stool softener)
centrally acting analgesic
tramadol
tramadol moa
-binds to mu opioid receptors
-inhibits reuptake of serotonin and norepinephrine
tramadol indication
moderate-severe pain
gabapentin, pregabin class
anticonvulsants
gabapentin moa
-unknown
-suppresses neural firing
gabapentin indication
neuropathic pain
gabapentin side effects
drowsy, dizzy, visual problems
gabapentin ceiling effect
1800mg
acetaminophen moa
-unknown
-decrease prostaglandin synthesis in cns
acetaminophen indication
mild-moderate pain, fever
acetaminophen overdose
hepatic necrosis, liver failure, nephropathy
acetaminophen ceiling effect
1000mg
acetaminophen dosing
4g/24hr max in adults
2mg/24hr max in alcoholics
non-selective cox inhibitors
ibuprofen, naproxen, ketorolac, aspirin
nonselective cox inhibitor moa
block cox1 and cox2
cox1
protect gastric mucosa and thromboxane synthesis
cox2
inflammation and fever
nonselective cox inhibitor indication
mild-moderate pain, fever
nonselective cox inhibitor bbw
cardiovascular and gi risk
naproxen nursing consideration
-hard on kidneys
-lasts longer
ketorolac nursing considerations
-most potent nsaid
-used for <5days
-hard on kidneys
aspirin toxicities
salicylate poisoning, Reye’s syndrome
salicylate poisoning
-nausea, vomiting, seizures, cerebral edema
-tinnitus, hearing loss
reye’s syndrome
-severe brain and kidney damage
-high mortality rate
-do NOT give children <15yo aspirin
aspirin moa
-blocks cox1
-stops thromboxane synthesis
-stops platelet aggregation
cox2 selective nsaid
celecoxib
celecoxib indication
mild-moderate pain, inflammation
celecoxib side effects
cardiovascular thrombotic events (clotting)
all opioids are…
high alert drugs
assess before administering opioids
LOC, BP, pulse, RR before and periodically after admin (initial drowsiness expected, but watch for hypoventilation)
opioid nursing consideration
-impaired ability to drive
-proactively treat constipation (paralytic ileus)
-make sure patient is ok with opioids
morphine moa
-mimics endogenous opioids
-binds to mu receptors
morphine indication
moderate-severe pain
morphine side effects
-interacts with alcohol and cns depressants
-resp depression
-cns depression
-constipation
hydromorphone moa
-mimics endogenous opioids
-binds to mu receptors
hydromorphone indication
SEVERE pain
fentanyl considerations
-completely synthetic
-often transdermal patch
fentanyl indications
moderate-severe pain (surgical inductions, chronic pain)
merperidine indication
-moderate-severe pain
-weaker than morphine
-less resp depression
meperidine side effects
-lots of drug interactions
-do NOT give multiple doses
codeine indication
-mild-moderate pain
-antitussive
codeine nursing considerations
-NOT for children <18yo
-life threatening breathing problems
oxycodone considerations
HIGH potential for abuse
percocet
oxycodone and acetaminophen
oxycontin
time release oxycodone
oxycodone indication
moderate-severe pain (10x more potent than codeine)
hydrocodeine indications
-mild-moderate pain (6x more potent than codeine)
-cough suppressant
methadone indication
detox treatment for opioid addiction
naloxone class
opioid antagonist
naloxone moa
clogs, but does not activate, opioid receptors
naloxone indications
reverse effects of opioids
aed moa
- increases threshold of activity in motor cortex
- limit spread from origin
- decrease speed of impulse in neuron
aed bbw
increases suicidal ideation and mood changes
aed side effects
teratogen, dizzy, drowsy, gi upset
aed nursing considerations
-do NOT stop abruptly (will cause seizures)
-continued therapeutic monitoring
-started after MULTIPLE seizures
hydantoins
phenytoin
phenytoin indications
tonic-clonic and focal seizures
phenytoin side effects
-gingival hyperplasia
-hirsutism, osteoporosis
-dilantin facies
phenytoin nursing considerations
-highly protein bound, interacts with other drugs
-watch albumin and pre albumin levels
valpronic acid indications
generalized and partial seizures
valpronic acid contraindications
liver disease, urea cycle disorders
valpronic acid side effects
hepatoxicity, pancreatitis
valpronic acid nursing considerations
-highly protein bound, interacts with other drugs
-watch albumin and pre albumin levels
topiramate indications
partial and secondary generalized seizures
topiramate side effects
-cns depression
-gi upset
-glaucoma
topiramate nursing considerations
interacts with oral contraceptives
levetiracetam indications
-inpatient setting
-partial seizures with or without generalization
sulfonylureas
glipizide, glyburide
sulfonylureas moa
-close KATP channels in pancreatic beta cells
-increase insulin production
-decrease glucose release
sulfonylureas side effects
hypoglycemia
sulfonylurea nursing considerations
NOT during pregnancy
biguanides
metformin
metformin moa
-decrease production of glucose in liver
-increase glucose uptake by muscle
metformin side effects
acidosis, not for elevated ALT
metformin nursing considerations
hold for 48 hr after IV contrast
DPP4 inhibitors
linagliptin, sazagliptin, sitagliptin
DDP 4 inhibitor moa
-inhibits DPP4
-increases insulin release
-decreases glucose absorption
-slows digestion
DPP4 side effects
increased risk of pancreatitis
GLP1 receptor agonist
dulaglutide, exenatide, semaglutide
GLP1 moa
-increase glucose dependent insulin response
-slows gastric emptying
GLP1 bbw
thyroid and renal issues
SLGT2 inhibitors
dapaglifloxin
dapaglifloxin moa
prevents kidneys from reabsorbing glucose into blood
dapaglifloxin side effects
uti
glucagon moa
-activates glucagon receptors
-releases glucose from liver
glucagon indications
hypoglycemia
orlistat moa
-blocks pancreatic and gastric enzymes
-stops fat absorption
orlistat bbw
liver injury
orlistat side effects
gi problems and vitamin insufficiency
insulin lispro
rapid
onset: 15 min
peak: 1 hr
duration: 2-4 hr
insulin regular
short acting
onset: 30 min
peak: 2-4 hr
duration: 3-8 hr
NHP insulin
intermediate
onset: 2-4 hrs
peak: 4-10 hr
duration: 10-20 hr
glargine
long acting
onset: 70 min
peak: none
duration: all day
lipodystrophy and lipoatrophy
depression of skin at insulin injection site
somogyi effect
-overdose of insulin
-counterregulates hypoglycemia with hyperglycemia and ketosis
-usually from poor diabetes management
dawn phenomenon
-hyperglycemia in the morning
-due to natural hormonal release