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NUR 325 PHARM > NUR 325 Final > Flashcards

NUR 325 Final Flashcards

Drugs

1
Q

what is the MOA of Heparin?

A

Prevents clotting by activating antithrombin
(Indirectly inactivates thrombin and factor Xa)

**Intrinsic Pathway

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2
Q

Indications for Heparin

A

Conditions necessitating PROMPT anticoagulation activity (evolving stroke, PE, massive DVT)

Adjunct for pts having open heart surgery

Low dose therapy for prophylaxis against post-op DVT

Treat disseminated intravascular coagulation (DIC)

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3
Q

Adverse Reactions of Heparin

A

Bleeding
Hematoma
Anemia
Thrombocytopenia

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4
Q

What should you monitor after giving Heparin?

A

BLEEDING!!
Vital signs, bruising, petechiae, hematomas, black tarry stools

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5
Q

What is Heparin-Induced Thrombocytopenia?

A

Low platelet count and increased development of thrombi

*Caused by antibody development

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6
Q

Nursing Considerations for Heparin

A

Only given parenteral (IV or SQ)

Use may be issue if pt follows kosher or Halal diets (derived from lung and intestines of pigs)

Use cautiously in pts with spinal or epidural anesthesia

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7
Q

Is Heparin a HIGH RISK med?

A

YES!!
Must double check with other RN prior to rate changes and boluses

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8
Q

What is the Antidote for Heparin?

A

Protamine SULFATE

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9
Q

What is the MOA of Enoxaparin (Lovenox)?

A

ONLY inactivates factor Xa!!
(NOT THROMBIN)

Slower onset, but LASTS LONGER than Heparin

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10
Q

What are the indications for enoxaparin?

A

Given prophylaxis and treatment

*CAN be given at HOME

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11
Q

What are the major adverse reactions of enoxaparin?

A

BLEEDING
Thrombocytopenia

HIT (heparin-induced thrombocytopenia)

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12
Q

Nursing Consideration for enoxaparin

A

Labs NOT necessary

Use cautiously in pts with spinal or epidural anesthesia

DO NOT GIVE WITH HEPARIN

DON’T give with any other anticoags EXCEPT oral Warfarin when treating PE or DVT

SQ INJECTION ONLY (pre-filled syringes - LEAVE AIR BUBBLE in plunger)

ROTATE SITES - DO NOT RUB SITE AFTER INJECTION

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13
Q

BLACK BOX WARNING:
enoxaparin

A

Potential spinal hematoma if pt has epidural catheter

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14
Q

Antidote for enoxaparin?

A

Protamine

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15
Q

What is the MOA of Warfarin?

A

VITAMIN K inhibitor

Prevents the synthesis of 4 coag factors (7, 9, 10, and prothrombin (2))

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16
Q

Indications for Warfarin?

A

Prevention of VTE/DVT/PE

Thrombotic events for pts with atrial fibrillation, or heart valves

Reduce recurrence of TIA or MI

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17
Q

Adverse reactions of Warfarin?

A

BLEEDING
Lethargy
Muscle pain
Purple toes

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18
Q

Nursing considerations for Warfarin

A

TERATOGENIC!! (Even breastfeeding)

ONLY GIVEN PO (once a day - 5pm)
– onset not until 24 hours!

MONITOR and TEACH for S/S of bleeding

HOLD before surgeries

Many drug/food interactions

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19
Q

What should we teach pts on Warfarin?

A

Wear medic alert bracelet

Use soft bristle toothbrush

Use electric toothbrush/razor

Avoid alcohol

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20
Q

What labs do you need to monitor when giving Warfarin?

A

PT - Prothrombin Time
INR - International Normalized Ratio

Therapeutic range = 2-3.5

**MONITOR MONTHLY

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21
Q

Antidote for Warfarin?

A

Vitamin K (IV)

(if that doesn’t work, give fresh frozen plasma or whole blood)

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22
Q

What is the MOA of apixaban and rivaroxaban?

A

Direct inhibitor of Factor Xa

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23
Q

Indications for apixaban and rivaroxaban?

A

Prevents strokes in pts with afib, post-op thromboprophylaxis

Treat DVT/PE

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24
Q

Adverse reactions for apixaban and rivaroxaban?

A

Bleeding
Hematoma
Dizziness and rash
GI distress
Peripheral edema

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25
Q

Nursing consideration for apixaban AND Rivaroxaban?

A

Monitor for adverse reactions

Drug interactions decrease effects: phenytoin, carbamazepine, rifampin, St. John’s wort

INCREASED EFFECTS: CYP3A4 (grapefruit juice!)

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26
Q

Antidote for Apixaban and Rivaroxaban?

A

Andexxa

*memory cue - xa = 10 (inhibits factor Xa)

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27
Q

BLACK BOX WARNING:
apixaban & rivaroxaban

A

Spinal hematoma with epidural

Risk of thrombosis if stopped ABRUPTLY

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28
Q

Labs needed for apixaban & rivaroxaban?

A

NO ROUTINE MONITORING REQUIRED

(Watch liver function: ALT, AST, GGT)

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29
Q

What are the Anti-platelet drugs?

(Don’t affect coag cascade!)

A

Aspirin
Clopidogrel
Ticagrelor

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30
Q

What is the MAO of Aspirin?

A

Blocks the prostaglandin synthesis through the COX enzyme pathways

Blocks PLATELET aggregation

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31
Q

Indications for Aspirin

A

Prevent/treat MI
Prevent ischemic stroke (stroke)

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32
Q

What is the dose of Baby Aspirin?

A

81 mg tablet

**CHEW IT (white pill)

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33
Q

Adverse Affects of Baby Aspirin?

A

Bleeding
GI - N/V
Drowsiness, confusion

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34
Q

Nursing considerations for Baby Aspirin?

A

Monitor for bleeding
Don’t crush enteric coated
OTC med considerations
Reye’s Syndrome - children with a virus (NO ASPIRIN)

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35
Q

MOA for clopidogrel and ticagrelor?

A

ADP inhibitor - alters the platelet membrane so it doesn’t receive SIGNAL to aggregate

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36
Q

Indications for clopidogrel and ticagrelor?

A

Reduce risk of stroke, prophylaxis of TIAs, post MIs

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37
Q

Adverse reactions for clopidogrel and ticagrelor?

A

chest pain
edema
flu-like symptoms
abdominal pain
D/N
epistaxis (nosebleed)
rash
pruritus (itching)

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38
Q

BLACK BOX WARNING:
clopidogrel

A

Pts with certain genetic abnormalities have a higher rate of CV events

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39
Q

Nursing considerations for clopidogrel?

A

Effectiveness effected by amiodarone, calcium channel blockers, NSAIDs, PPIs

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40
Q

BLACK BOX WARNING:
tricagrelor

A

Increased bleeding risk with aspirin doses over 100 mg

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41
Q

MOA for argatroban and bivalrudin?

A

Inhibit thrombin (factor 2a)

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42
Q

Indications for argatroban and bivalrudin?

A

Treat HIT
For pts undergoing procedures (PCI) who are at risk for HIT

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43
Q

Adverse reactions for argatroban and bivalrudin?

A

Bleeding

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44
Q

Nursing considerations for argatroban and bivalrudin?

A

IV ONLY
Be careful in pts with hepatic dysfunction

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45
Q

Labs needed for argatroban and bivalrudin?

A

Anti-Xa
H&H
Platelets

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46
Q

What class is Hydrocortisone?

A

Glucocorticoids

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47
Q

MOA for hydrocortisone prednisone, and dexamethasone?

A

Mimics glucocorticoid burst by adrenals at dawn

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48
Q

Indications for hydrocortisone prednisone, and dexamethasone?

A

Replacement
Anti-inflammatory properties
Immunosuppression

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49
Q

Adverse Effects of hydrocortisone, prednisone, and dexamethasone?

A

Increased intraocular pressure
Fluid retention
High BP
Mood swings
Weight gain
Hunger

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50
Q

If you want to be able to test for adrenal function, which glucocorticoid will you administer?

A

Dexamethsone

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51
Q

What are the indications for fludrocortisone?

A

Only mineralocorticoid replacement
–May be needed with a GCC replacement

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52
Q

Adverse reactions with fludrocortisone?

A

Clouded eye lens
High blood sugar
Increased risk of infections
Thinning bones
Suppressed adrenal gland hormone productions
Thin skin, bruising
Slow wound healing

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53
Q

Nursing implications for fludrocortisone?

A

Salt wasting

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54
Q

MOA for bismuth subsalicylate?

A

Coats the walls of the GI tract
Bind the causative agent for elimination

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55
Q

Indication for bismuth subsalicylate?

A

Anti-diarrheal

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56
Q

Adverse reactions for bismuth subsalicylate?

A

Increased bleeding time
Constipation
Dark stools
Darkening of the tongue

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57
Q

Nursing considerations for bismuth subsalicylate?

A

It is a form of Aspirin

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58
Q

What class is bismuth subsalicylate?

A

It is an adsorbent

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59
Q

What is the class for loperamide and diphenoxylate?

A

Antimotility

*anti-diarrheal

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60
Q

What is the MOA for loperamide and diphenoxylate?

A

slows peristalsis
Drying effect (anti-cholinergic)

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61
Q

Adverse reactions for loperamide and diphenoxylate?

A

Urinary retention
Headache/dizziness/drowsiness
Anxiety
Bradycardia/hypotension
Dry skin
Flushing

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62
Q

Nursing considerations for loperamide and diphenoxylate?

A

Used alone or in combination with adsorbents and opiates

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63
Q

What is the class for bacid, culturelle, and florastor?

A

probiotics

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64
Q

what is the MOA for bacid, culturelle, and florastor?

A

replenish bacteria and restore normal gut flora
suppresses growth of diarrhea causing bacteria

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65
Q

What is the indication for florastor? What bacteria does it specifically replenish compared to bacid and culturelle?

A

C.Diff

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66
Q

What kind of laxative is psyllium?

A

bulk-forming

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67
Q

what is the MOA for psyllium?

A

act similar to dietary fiber
absorbs water into the intestine

68
Q

what is the indication for psyllium?

A

constipation

69
Q

Adverse reaction of psyllium?

A

Impaction above strictures
Fluid/electrolyte imbalance
Gas formation
Esophageal blockage

70
Q

Nursing considerations for psyllium

A

OKAY for long-term use

71
Q

What kind of laxative are docusate sodium and mineral oil?

72
Q

What is the MOA for docusate sodium?

A

lubricates fecal material and walls

Promotes fat absorption into fecal mass

73
Q

Indication for docusate sodium?

A

prevent opioid induced constipation

74
Q

Adverse reactions for docusate sodium?

A

Skin rashes
Decreased absorption of vitamins

75
Q

Nursing considerations for docusate sodium?

76
Q

MOA for mineral oil?

A

lubricates intestines

77
Q

Indications for mineral oil?

A

fecal impactions

78
Q

Adverse reactions for mineral oil?

A

Skin rashes
Decreased absorption of vitamins

79
Q

Nursing considerations for mineral oil?

A

PO and PR (rectal)

80
Q

Class for glycerin, lactulose, polyethylene glycol?

A

Hyperosmotic

81
Q

MOA for glycerin, lactulose, polyethylene glycol?

A

Increasing water content in feces
Promotes distention, peristalsis, and evacuation

82
Q

Indication for glycerin, lactulose, polyethylene glycol?
But which is most common?

A

Evacuate bowels before Dx testing and surgical procedures

Polyethylene glycol is most commonly used

83
Q

Adverse reactions for glycerin, lactulose, polyethylene glycol?

A

Abnormal bloating
Rectal irritation
Electrolyte imbalance

84
Q

What are the different types of magnesium salts?

A

Magnesium citrate
Magnesium hydroxide
Magnesium sulfate

85
Q

What class of laxative are magnesium salts?

86
Q

What is the MOA for magnesium salts?

A

Increase osmotic pressure and draw water into the colon

87
Q

Indication for magnesium salts?

A

constipation

88
Q

Adverse reactions for magnesium salts?

A

Magnesium toxicity
Electrolyte imbalance
Cramping
Diarrhea

89
Q

What is the difference between magnesium salts and sodium salts?

A

NOTHING!!

Sodium salts = fleet enema

90
Q

What class of laxatives are bisacodyl and senna?

A

Stimulants

91
Q

Indication for bisacodyl and senna?

A

Constipation
Whole bowel evacuation

92
Q

Adverse reactions for bisacodyl and senna?

A

Nutrient malabsorption
Gastric irritation
Electrolyte imbalance

93
Q

Route for bisacodyl?

A

PO and PR

*OTC

94
Q

Route for senna?

A

PO ONLY

*OTC

95
Q

Class for Epinephrine?

A

Vasopressor
Bronchodilator
Anti-asthmatic
Vasoconstrictor

96
Q

MOA for epinephrine?

A

Inhibits release of mediators form mast cells

97
Q

Indication for epinephrine?

A

Severe allergic reactions
Cardiac arrest
Severe asthmatic attack

98
Q

Adverse effects of epinephrine in the CV system?

A

Angina
Arrhythmias
Hypertension
Tachycardia

99
Q

Adverse effects of epinephrine in the CNS system?

A

Nervousness
Restlessness
Tremor

100
Q

Nursing considerations for epinephrine

A

SQ preferred
MONITOR: VS, reversal of symptoms

TEACH:
Contact clinician immediately after use
Take EXACTLY as directed

101
Q

Dosing for epinephrine?

A

Adult: 0.2-1mg
Peds: 0.01/mg/kg

102
Q

Class for phenazopyridine?

A

Urinary tract Analgesic

103
Q

MOA for phenazopyridine?

A

UNKNOWN

BUT it exerts a topical analgesic effect on mucosa of urinary tract

104
Q

Indication for phenazopyridine?

A

RELIEF of PAIN due to a UTI

105
Q

Adverse effect of phenazopyridine?

A

Reddish-Orange urine

106
Q

Class for mirabegron?

A

Antispasmodic (urinary)

107
Q

MOA for mirabegron?

A

Selectively stimulates beta-3 adrenergic receptors
RELAXES BLADDER SMOOTH MUSCLE

108
Q

Adverse effects of mirabegron?

A

HTN
Urinary retention
UTI
Headache

109
Q

Lower UTI medications?

A

Trimethoprim-sulfamethoxazole
Ciprofloxacin
Nitrofurantoin

110
Q

We cannot give Trimethoprim-sulfamethoxazole for what allergy?

Which lower UTI med do we give instead?

A

Sulfa allergy

Give instead: Ciprofloxacin

111
Q

Nitrofurantoin is given for what recurring urinary infection?

A

Recurring lower UTIs

112
Q

Class of oxybutynin?

A

Anti-cholinergic meds

113
Q

MOA of oxybutynin?

A

Block the action of acetylcholine
(acetylcholine activates smooth muscle contraction)

114
Q

Indication for oxybutynin?

A

overactive bladder incontinence

115
Q

Adverse effects of oxybutynin?

A

Dry mouth
Constipation

116
Q

What additional form can oxybutynin come in?

A

Extended release form

117
Q

Fluoxetine is what class of medication?

A

Antidepressant

(Selective Serotonin Reuptake Inhibitor)
*SSRI

118
Q

MOA of fluoxetine?

A

Inhibitors of serotonin at nerve endings
More serotonin is available at the nerve endings

119
Q

Indication for fluoxetine?

A

Depression and anxiety

120
Q

Adverse effects of fluoxetine?

A

Weight gain
GI: N/V/D, constipation, dry mouth
CNS: headache, nervousness, insomnia
Sexual dysfunction
Serotonin syndrome
Withdrawal syndrome
Suicidal risk
Neonatal effect

121
Q

Nursing considerations for fluoxetine?

A

AVOID USE WITH MAOIs
Therapeutic benefit 3-4 weeks

122
Q

Class of med for vanlafazine?

A

Antidepressant

Serotonin and Norepinephrine Reuptake Inhibitor
**SNRI

123
Q

MOA of venlafazine?

A

Blocks neuronal activity of serotonin and norepinephrine

124
Q

Indication for venlafazine?

A

Depression and anxiety

125
Q

Adverse effects of venlafazine?

A

Nausea
Insomnia
Headache
Anorexia
Somnolence
Sexual dysfunction
Withdrawal syndrome
Sweating
Blurred vision

126
Q

Nursing considerations for venlafazine?

A

CONTRAINDICATED – MAOIs

DO NOT GIVE IF PT IS TAKING MAOIs

127
Q

Class of med for amitryptaline?

A

Tricyclic Antidepressants (TCA)

128
Q

MOA of amitryptaline?

A

Block reuptake of 2 monoamine transmitters: norepinephrine and serotonin (intensify effect)

*makes more available in the synapse

129
Q

Indication for amitryptaline?

A

Depression and anxiety
Also used to treat neuropathic pain and nocturnal enuresis

130
Q

Adverse effects of amitryptaline?

A

Sedation
Orthostatic hypotension
Anticholinergic effects
Sexual dysfunction
Cardiac toxicity

131
Q

Nursing considerations for amitryptaline?

A

FATAL OVERDOSES

Older drug, inexpensive

SIGNIFICANT drug/drug interactions with MAOIs

With MAOIs = HTN crisis

132
Q

Drug class of phenelzine?

A

Monoamine Oxidase Inhibitors
(MAOIs)

133
Q

MOA for phenelzine?

A

Inhibits MAO (enzyme found in the liver, intestinal walls, and terminals of neurons)
MAO converts norepi, 5-HT, and dopamine to inactive product

*Decreased MAO increases availability of neurotransmitters at the nerve endings

134
Q

Indication for phenelzine?

A

Refractory depression (other meds don’t work)

Works better for atypical depression

135
Q

Adverse effects of phenelzine?

A

Food/drug interactions (aged cheese, smoked meats, yeast, red wine)
CNS stimulation
Orthostatic hypotension
SIG drug/drug interactions (antihypertensives, SSRI, TCA, meperidine)
Can lead to rapid increase in BP, stroke, coma

136
Q

Nursing considerations for phenelzine?

A

HTN CRISIS when taken with Tyramine

137
Q

Drug class for buproprion?

A

Atypical Antidepressant

138
Q

Indication for buproprion?

A

Depression and anxiety

139
Q

Adverse effects of buproprion?

A

Seizure
Agitation
Headache
Dry mouth
Constipation
Weight loss
GI upset
Dizziness/tremors

140
Q

How long does buproprion take to see effect?

141
Q

Ketamine drug class?

A

Atypical Antidepressants

142
Q

Indication for ketamine?

A

Rapidly helps with suicidality and other serious symptoms of depression

Treat extreme pain

143
Q

Adverse effects of ketamine?

A

Perceptual disturbances
Dissociation

144
Q

Nursing consideration for ketamine?

A

LOW DOSE
Intranasal admin

145
Q

Drug class of trazadone?

A

Atypical Antidepressant

146
Q

MOA of trazadone?

A

Blockade of 5-HT reuptake

147
Q

Indications for trazadone?

A

Insomnia
Anxiety

148
Q

Nursing considerations for trazadone?

A

Second line agent
Minimal effectiveness for depression

149
Q

Drug class of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

Benzodiazepines

150
Q

MOA of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

Enhance inhibitory effects of GABA in the CNS

151
Q

Antidote for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

Flumazenil

152
Q

Indication for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

Generalized anxiety disorder
Panic disorder

153
Q

Adverse effects of alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

CNS depression
Withdrawal effects
Memory loss
Respiratory depression (more common with IV use)

154
Q

Nursing consideration for alprazolam (Xanax), Diazepam (Valium), and lorazepam (Ativan)?

A

TERATOGENIC
Schedule 4 med
DO NOT MIX with other meds that can cause decreased LOC (Benadryl, alcohol, opioids, barbiturates)
Avoid eating with grapefruit juice or fatty foods (inhibits absorption)

155
Q

MOA of methadone?

A

Synthetic opioid analgesic
Mu agonist

156
Q

Indication for methadone?

A

Medication-assisted treatment (MAT) for heroin and Rx painkillers

157
Q

Adverse reactions for methadone?

A

Lightheaded
Hives
Chest pain
Tachycardia
Hallucinations
Confusion

158
Q

Nursing considerations for methadone?

A

Reduces symptoms of withdrawal r/t opioid use
Helps ppl avoid use of opioids
Addictive, but potential is lower

Methadone clinics = once daily dose

159
Q

MOA of buprenorphine and naloxone (Suboxone)?

A

Combination of agonist/antagonist
Helps pts recover more quickly from addiction

160
Q

Indications of Suboxone?

A

Opioid addiction

161
Q

Adverse effects of Suboxone?

A

Headache, nausea
Opioid withdrawal syndrome
Anxiety, insomnia
Sweating
Depression
Constipation

162
Q

Nurisng considerations for Suboxone?

A

Potential for abuse (less than methadone and buprenorphine)

Sublingual and buccal

163
Q

MOA of Naloxone?

A

Opioid ANTAGONIST (blocks opioid receptors)

164
Q

Adverse effects of Naloxone?

A

Opioid withdrawal symptoms

165
Q

MOA for buprenorphine (Subutex)?

A

Partial opioid AGONIST (helps block receptors to prevent craving)

166
Q

Adverse effects of buprenorphine?

A

Opioid withdrawal symptoms

NUR 325 PHARM (1 decks)

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