Nursing exam pharm - Exam #2 Flashcards
what are the 6 NSAIDs
Salicylates, Para-chlorobenzoic acid, propionic acid derivatives, Fenamates
Aspirin
toxic serum salicylate level is >300 mcg/mL
NSAID salicylate class
dosing max is 3900 mg/d
diagnosis for arthritic conditions, lower temperature
Reasons not to give:
do not give to children as it increases the risk of reye syndrome, can be toxic to kidneys do not give to patients in renal failure
Side effects: dizziness, headache, dyspepsia, n/v, abdominal pain
Adverse reactions: tinnutus, hearing loss, hyperkalemia, Hypernatremia, elevated hepatic enzymes
Education to patient: warn parents to not administer to children when they are experiencing flu-like symptoms, take with food, if patient has been observed taking a large amount call the poison control center immediately, stop taking 7 days before surgery
antidote: lavage, monitor electrolytes, VS
Evaluation: decreased inflammatory symptoms and decreased pain level
Para- chlorobenzoic acid (indomethacin)
highly protein bound, must take with food, may cause dizziness N/V/D, used for treatment of Rheumatoid arthritic/ gout/ osteoarthritis, may cause sodium retention and increased blood pressure
Ibuprofen
class: NSAIDs propionic acid derivative
dosing max 3200 mg/d
reasons not to give: is patient is on lithium, bleeding disorders, peptic ulcer, gi bleeding
Education:
for female patients do not 1-2 days before mestrual period to avoid heavy flow, advise pregnant patients to avoud NSAIDs, do not take Ibuprofen and acetaminophen with other NSAIDS, avoid alcohol can result in gastric ulcer
Evaluation: decrease in pain, decrease in swollen joints, and increase in mobility
Antidote: lavage and induce diuresis
Propionic acid derivatives NSAIDS what to know
do not take with other nsaids take with food, increased bleeding, increased side effects of lithium, steven johnsons syndrome
Fenamates what to know
Potent medication, avoid alcohol, higher rates of GI irritation, do not take if you have peptic ulcer disease, prescribed medication for moderate pain, dysmenorrhea, osteoarthritis
Ketorolac
do not take with other NSAIDs, first injectable NSAID, use for less than 5 days, typically used post-surgical `
Oxicams
(the term is in the medication)
What to know
they have a long half-life, oral, once daily, highly protein bound, may take up to 2 weeks to work, long term use for RA/OA, do NOT take with other NSAIDs, may cause GI distress/ulcerations
Celecoxib
class: NSAIDs selective cox-2 inhibitors
dosage max in adult is 800 mg/d
max in older adults
400 mg/d
used to treat OA/RA, dysmenorrhea, and moderate to severe pain for ankylosing spondylitis, migraines
Reasons to not give to patients: patients with renal or hepatic dysfunction, peptic ulcer disease, GI bleeding, alcohol abuse
Side effects: headache, dizziness, drowsiness, sinusitis, pharyngitis, cough, anorexia, abdominal pain
Adverse reactions: Gi bleeding/obstruction/ulcer/perforation, hypertension, hearing loss, dyspnea, tendon rupture
Education to patient:
stop taking before procedure and surgery, if you experience hearing loss, Gi bleeding, hypertension call us immediately or visit your nearest emergency center, this drug can affect certain lab values such as INR, can increase toxicity to lithium, nasal sprays such as fluconazole and ketoconazole can increase the drug levels in your system
evalate: relieve inflammatory symptoms and pain and migraine.
Corticosteroids
end in -sone
used to treat acute pain, decreased mobility, activity intolerance
do not take with caffeine as adverse reactions can occur such as facial swelling/ hypersensitivity reactions/ serizures/ increased joint pain, shoould be taken in the morning due to long half-life and must be taken with food, continuously monitor blood glucose levels
Evaluation:
able to take as prescribed with minimal complications, decreased pain/ swelling/ inflammation
what are some examples of immunosuppressive agents
Azathioprine, Cyclophosphamide, Methotrexate
what are the classes of Disease-Modifying Anti-Rheumatic Drugs
Immunisuprressive agents, Immunomodulators, Antimalarials
what are some examples of Immunomodulators
Infliximab (IV), Adalimumab (SubQ), Leflunomide (oral)
what are antimalarials
these are taken when other methods have failed can take 4 - 12 week for noticeable effects
what do disease-modifying anti-rheumatic drugs treat and do
alleviate RA/OA/ severe psoriasis/ Crohns/ ulcerative colitis
Infliximab
immunomodulator
used to treat arthritic conditions, ulcerative colitis and Crohn’s disease
Drug lab - interactions:
can put person at an increased risk of infection
Side effects: headache, dizziness, cough, fatigue, chills, flushing, fever,nausea
adverse reactions: hypo/hypertension, chest pain, dyspnea, seizures, bone fractures, anemia, pulmonary edema
education: do not drive until you are adjusted to the drug, report to physician if infection occurs
what are the different anti-gout drugs
colchicine, xanthine oxidase inhibitors, Probenecid
the different types of pain
acute, chronic, cancer, somatic, superficial, vascular, visceral
Febuxostat
antigout: xanthine oxidase inhibitors
Contraindications: patients with hypersensitivity to xanthine oxidase inhibitors, hepatic/renal disorders, cardiac disease, stroke, chemotherapy
Side effects: Dizziness, headache, blurred vision, dry mouth, abdominal pain
Adverse reactions: bradycardia, gout exacerbations, Guillan-Barre syndrome, dyspnea, chest pain
Education: avoid alcohol, do not double dose, flares can occur during the 6 weeks of treatment talk to your provider
Evaluation: decreased pain in joints, decreased formation of stones in kidneys
Colchicine
first anti inflammatory gout medications, used for acute attacks, GI irritation, nto to be used with patient with severe renal, cardiac, GI dysfunctions
Probenecid
uricosuric increases uric acid excretion,
used for chronic gout,
not for acute attacks, can be used with other anti-gout medications, Highly protein bound, Gi irritation make sure to take with food and increase fluid intake
Allopurinol
antigout: xanthine oxidase inhibitor
used for treatment of gout
not to be given to pregnant patients or patients that have renal/hepatic disorders
side effects: N/V/D, rash, anorexia,
adverse reaction: renal failure and HF
Education: encourage patinets to have regular blood tests to monitor for blood dyscrasias (CBC), increase fluid intake can increase excretion and uric acid excretion
evaluation decreased pain in joints, decreased stone formation in kidneys, decreased uric acid levels,
possible hemodialysis
Nonopioid analgesics
NSAIDs, Acetaminophen
What are the different Opiod anlagesics
codeine, hydrocodone, oxycodone, morphine, methadone, Fentanyl, Hydromorphone, Meperidine, Nalbuphine
Acetaminophen
analgesic not an anti inflammatory
Therapeutic uses: to decrease pain and fever
reasons not to give: renal/ hepatic disorder, hypertension, diabetes Mellitus, alcohol use disorder, Older adults
Side effects: headache, insomnia, anxiety, fatigue, anorexia, nausea, vomiting, constipation, peripheral edema
adverse reactions: oliguria, hearing loss, hypomagnesemia, elevated hepatic enzymes
education: teach patients to read the label of the OTC drug make sure to not exceed the limit of 4g/d to avoid hepatic damage, avoid alcohol when taking the prescription, teach parents of patient to not self-medicate acetaminophen for no more than 5 days for adults no more than 10 days without a heath care providers approval
Do call posion control center if ingested large amount or unknown amount of acetaminophen
Evaluation: lower pain scale rating, decreased temperature reading
Antidote: acetylcysteine
NSAIDs
These are anti-inflammatory drugs,
it can affect clotting, GI irritation, reyes syndrime in children,
DO not give with other nsaids due to being highly protein bound, the antidote is sodium bicarbonate
what are some adjuvant therapies for analgesics?
anticonvulsants, antidepressants, corticosteroids, antidysrhythmic, Anesthetics
Meperidine
Class of medication: Opiod Analgesic
CSS II
Uses: moderate to severe pain preoperatively, post operatively, general anesthesia maintenance, sedation induction,
Reasons not to give: if the patient has chronic pain, severe liver dysfuntion, sickle cell disease, history of seizures, Severe Coronary artery disease, or cardiac dysrhythmias
Side effects: decrease in blood pressure, drowsiness, dizziness, sedation, confusion, headache,
Adverse reactions: respiratory depression (rr is 8 a minute), anaphylaxis ( rash/ swelling), Increased intracranial pressure
Drug/lab test: increased amylase and lipase
teachings to patient: do not stop this medication abruptly as it cna cause withdrawal symptoms, do not drive or operate vehicle under this medication, do not use long term this is very addictive, when moving positions do it very slowly to prevent becoming unconscious when standing up,
Evaluation: decrease in pain
Antidote: Naloxone, vasopressors, O2, Iv fluids
Nalbuphine
Opioid agonist-antagonist
analgesic
used to relieve moderate to severe pain and for anesthesia induction and maintenance.
Reasons not to give to patient: Patients with addictive disorder, respiratory insufficiency, head injury can increase intracranial pressure, renal or hepatic disorder cation in older adults
Side effects: sizziness, drowsiness, headache, dry mouth, nausea, vomiting, diaphoresis, erestile dysfunction
Adverse reactions: Bradycardia, hypo/hypertension, dyspnea
Teachings to patient: do not use alcohol while taking nalbuphine can cause passing out due to SOB in patient, suggest nonpharmacological methods to lessen pain such as ambulation changing positions, Can be very addictive
Evaluation: lower pain scale rating after 1 hour after medication administration
Antidote: Naloxone, iv fluids, O2, vasopressors,
what are the different types of headaches
migraine and cluster
what anticonvulsant is used as adjuvant therapy for analgesics
Gabapentin
used for neuropathic pain, inhibits neural excitability.
what is used as adjuvant therapy for analgesics antidepressants?
Amitriptyline
prevents the reuptake of serotonin, effective in treating neuropathy
what is a antidysrhythmic used as adjuvant therapy for analgesics?
Mexiletine
suggested in the management of neuropathic cancer pain
what is an anesthetic used as adjuvant therapy for analgesics?
Lidocaine
interrupts the transmission of pain signals to the brain
what is the antidote for opiods?
Naloxone
what is the antidote for Acetaminophen?
Acetylcysteine
what is the antidote for NSAIDs?
Sodium Bicarbonate
what are the differences between migraine/ cluster headaches
a migraine is unilateral throbbing head pain unlike cluster headaches that are non throbbing around the eye
migraine include nausea, vomiting and light sensitivity unlike cluster headaches that do not induce nausea and vomiting
time suration of migraine is hours to days and cluster is it can last several weeks
Sumatriptan
Selective Serotinin receptor agonist: antimigraine
Uses: to treat migraine and cluster headaches
Reasons not to give:
renal or hepatic dysfunction, disarrhythmias, intracranial bleeding, obesity, Smoking, seizures, older adults,
Side effects: dizziness, headache, blurred vision, parathesia, fatigue, flushing, drowsiness, myalgia,
Adverse reactions: hypotension, hypertensive crisis, angina, dysrhythmias, bradycardia, tachycardia, seizures, hearing loss, ocular hemorrhage
Teachings to patient:
this product does not reduce the number of migraines is for acute migraines that occur, Report if any adverse reaction occur such as cardiac arrest or suicidal idealations
Evaluation: decrease in severity and frequency of migraines
what does the central nervous system compose of
Brain and spinal cord
what are the CNS stimulants
Amphetamines, Analeptics, Anorexiants
what are the CNS depressants
Barbiturates, Benzodiazepines, Non-benzodiazepines , general and local anethesia
what are some nonpharmacological options for sleep
1 tablespoon of unfiltered apple cider vineagar, tart cherry juice,
what are the different type of drug classes for anticnonvulsant therapy?
Hydantoins, Barbiturates, Benzodiazepines
how would you describe status epilepticus
seicure linger than 5 minutes or more than one seizure in 5 minutes
how are you supposed to treat status epilepticus
Benzidiazepine, hydantoin, correct the cause
Dextroamphetamine
Sulfate
end in -amine
amphetamine
prescribed for patients with ADHD or Narcolepsy
Contraindictations: hypersensitivity to sympathomimetic amines, hyperthyroidism, glaucoma, severe srteriosclerosis
Side effects: hyperactivity, restlessness, insomnia, palpitations, tachycardia,
Adverse effects: disarrhymias, rhabdomyolysis
Teachings: avoid OTC products unless discussed with provider, do not take at night to avoid insomnia, decrease caffeine consumption can cause increased irritability, tell parents that change in behavior may occur in beginning of treatment
Evaluation: in adhd patients increased focus,
in narcolepsy patients more alertness and less fatigued during the day
Amphetamine- like
endings are -idate for adhd and
-afinil
Uses of amphetamine-like drugs:
to increase a child’s attention span and cognitive performance, decease impulsiveness, hyperactivity and restlessness. in narcoleptic patients it is for increasing wakefulness in patients
teach patients:
how to take their heart rate, avoid alcohol, avoid driving when experiencing increased heart rate, do not abruptly discontinue the drug as withdrawal symptoms can occur, read OTC medication to make sure you know hoe much caffeine you are taking as medication such as pamprin includes caffeine
monitor the patients weight, report any weight loss, tachnycardia or palpitations report, monitor nutritional intake
Anorexiants
end in -ide and -ine
used for treatment of obesity in patient is meant to be used short term
side effects: restlessness, dizziness, headache, insomnia, dry mouth, constipation, diarrhea, hypertension, tachycardia, palpitation, tolerance
Education: monitor caffeine intake in otc medications and fluid consumption, teach patient how to assess their heart rate, if patient is diabetic to monitory their blood glucose levels continuously, if nausea or vomiting occurs follow up with provider and visit emergency room immediately
what to watch for:
Vital signs, adverse reaction symptoms
Analeptics
-ine
example caffeine citrate
used for mental alertness and neonatal sleep apnea
assess for signs of headache, insomnia, tachycardia, withdrawal, tremors
Barbiturates
end in -barbital
Long acting -> control seizures phenobarbital
short acting -> procedural sedation
intermediate acting -> sleep
what is this for? can be for sedation, long term seizures, sleep disorders.
What to look for in these patients?
respiratory depression
Benzodiazepines
ending in -epam
why would this be prescribed?
anxiety, insomnia, seizures
what should the nurse monitor for? ataxia, depression, bradycardia, hypotension, dizziness, confusion, drowsiness, headache, imparied judgement, nightmares, constipation
antidote: Flumazenil
what is a vagal response in children when they are experiencing tachycardia
they cough
Non-benzodiazepines
zolpidem
treats insomnia dhort term
assess vital signs, obtain drug history, find the patients problem with sleep disturbance.
ALWAYS look for alternatives that are non-pharmacological
what are some considerations for older adults
Polypharmacy, non pharmacological first,
use short to intermediate acting
what are the different types of anesthetics
general, deep, moderate, light
what are the different routes of anesthetics
inhalation, IV, topical, local, Spinal,
Anticonvulsants classes
Hydantoins, Barbiturates, Benzodiazepines,
Hydantoin
ending in -toin
what it is used for: to reduce seizure activity in maintenance drugs
what to monitor for:
headache, confusion/dizziness/ drowsiness/ tremor, Hypotension/bradycardia/tachycardia, hyperglycemia, depression/peripheral neuropathy/ injection site reaction (purple glove syndrome)/cerebral edema, monitor for life threatening reaction such as steven johnsons syndrome, vfib, suicida; idealations, agranulocytosis (lowered WBC count)
evaluation decreased seizure activity and verbalize understanding of provided efucation
what are the different types of fluids?
Crystalloids
-isotonic
-hypotonic
-hypertonic
Colloids
-blood
-blood products
what are crystalloids used for?
they contain fluids/ electrolytes that treat short term dehydration
Colloids
these are used as plasma expanders.
Isotonic
fluid does not enter or leave the cells
types of solutions
Lactated ringers - LR
0.9% NaCl - NS
5% dextrose in water- D5W
use with caution in cardiac & renal patients
Do not administer D5W to patient’s with increased intracranial pressure
Hypotonic
fluid moves into the cell and between the cells but not in the veins
used for treatment of cellular fluid by treating intracellular dehydration
types of solutions:
0.45% NaCl-1/2 NS
0.33% NaCl- 1/3 NS
0.25% NaCl - 1/4 NS
evaluate/ monitor for decreased blood pressure, decreased intravascular fluid volume monitor for fluid volume deficit
do not administer to paitnet that have trauma/shock/burn or suspected increased ICP
Hypertonic Solutions
used to correct sever hyponatremia and decreases ICP
fluid moves from interstitial space to the intravascular space, pulling fluid from the intracellular space with it
types of solutions
3% naCl
5% NaCl
5% dextrose in 0.45% NaCl- D5&1/2NS
5% dextrose in 0.9% NaCl
5% dextrose in LR
10% dextrose in water - D10W
always administer slowly and carefully with an infusion pump
do not administer to dehydrated patients or patients with cardiac or renal disease
what is the maximum rate of infusion for Blood products
4hours/unit
Blood Transfusions
assessment before blood transfusions before, during and after the transfusion for any type of transfusion reaction and fluid overload
how long does it take for transfusion reactions to occur?
10-15 minutes assess every 15 minutes for (S/S of reaction chills/shivering, low back ache, change in vital signs, fever, headache)
what do you do if a transfusion reaction is to occur
STOP the transfusion and maintain the iv line with normal saline
what are the main electrolytes to know in pharmacology
Potassium, Sodium, Calcium
sodium chloride/ diclofenac sodium
used for hyponatremia, prevents muscle cramps, restores moisture to the nose, decreases corneal edema
evaluations
baseline assessment prior to iv administration and monitor fluid balance throughout the shift
Potassium
treat/prevent hypokalemia
evaluation monitor for irregular heart rate muscle weakness, nausea, numbness, tingling
Calcium
used for calcium replacement therapy, emergency treatment of hyper magnesia, antacid, controls hypophosphatemia
evaluation: monitor labs specifically BUN / creatinine/ electrolytes and assess cardiac status before and after adminsitration
Tricyclic antidepressants
ending in -ptyline & -ine
used for major depression and agitated depression
interactions: do not take with MAOIs and do not take with alcohol
Side effects:
sedation/dizziness, Anticholinergic effects, weight gain, Gi distress, sexual dysfunction, orthostatic hypotension,
Adverse reactions: cardiotoxicity resulting in arrhythmias
education: rise slowly when standing to prevent a dop in your blood pressure, the response of the medication should be seen in 2-4 weeks,
do not withdraw this drug abruptly to prevent withdrawal symptoms,
AVOID USING THIS IN PATIENTS WITH CARDIAC DISEASE
SSRI selective Serotonin Reuptake Inhibitors
-endings
-xetine, -traline, -opram
used for depressive and anxiety disorders
Side effects: headache, insomnia, nervousness, restlessness, sexual dysfunction, GI distress
Adverse reactions: seizures,
SIDE EFFECTS OFTEN DECREASE OVER 2 TO 4 Weeks
BLACK BOX SUICIDAL IDEALATION
SNRI
Serotonin Norepinephrine Reuptake Inhibitors
endings are -faxine, prefixes dulox
Used for major depression as well as generalized anxiety disorder and social anxiety disorder
Interaction with St John Wort can increase risk of serotonin syndrome
side effects: drowsiness, dizziness, insomnia, headache,
Adverse reactions: suicidal idealations, and steven-johnsons syndrome
what antidepressants do you not take with MAOis
tricyclic antidepressants and Trazodone/ Bupropion
MAOIs
Monoamine Oxidase Inhibitors
-xazid and phenelzine sulfate
used for depression that cannot be controlled by TCAs and second-generation antidepressants
Food/drug interactions:
vasoconstrictors and cold medication that contain ending in -ephrine as it can cause a hypertensive crises
Food-> foods that contain tyramine such as cheeses, cream, coffee, chocolate, bananas, raisins, Italian green beans, soy sauce, beer and red wines.
Side effects: agitation, restlessness, insomnia, anticholinergic effects, orthostatic hypotension,
Adverse reactions: hypertensive crisis from food interaction of tyramine
Teach patients to read labels on OTC cold medication
what are the nursing interventions for antidepressant agents
monitor vital signs, monitor mood for drug effectiveness, monitor for seizures, warn patients on MAOIs to avoid foods containing tyramine to avoid a hypertensive crisis, encourage taking drug as prescribed, avoid alcohol, teach patient to take with food
MONITOR FOR SUICIDAL TENDENCIES
what herbal supplements can interact with antidepressants
St johns wort, ginseng, gingko biloba
can cause serotonin syndrome
what are some S/S of serotonin syndrome
Dizziness, headache, sweating, agitation
what are mood stabilizers and what do they treat
they treat bipolar disorder
anticonvulsants, lithium, antipsychotics
Lithium
used to treat manic episodes in bipolar psychosis
therapeutic serum range is 0.8-1.2 mEq/L if they are greater than 1.5 they are toxic
Interactions with haloperidol, NSAIDs, antidepressants, theophylline,
Side effects: heache, drowsiness, dizziness, restlessness, dry mouth, metallic taste, Gi distress,
Adverse reactions:
Hypotension, dysarrhthmias, blood dyscrasias
toxic side effects of lithium
persistent nausea, vomiting, severe diarrhea, blurred vision, tinnutus, ataxia, increasing tremors, may progress to confusion, dysarrhythmias, seizures, coma
what is psychosis
severe loss of contact with reality
the people at risk are
schizophrenia, bipolar disorders, medications
What symptoms characterize psychosis?
difficulty processing information, delusions, incoherent speech
antipsychotics
what are the 2 types of antipsychotic agents
Typical and atypical
typical antipsychotics contain what categories
Phenothiazine and nonphenothiazines
what are common side effects of antipsychotics
sedation, hypotension, anticholinergic effects, dermatologic, EPS
What is extrapyramidal syndrome
this is a major side effect of typical antipsychotics
characterized as stooped posture, masklike features, rigidity, tremors at rest, shuffling gait, bradykinesia, Pill-rolling morion of the hand
Acute dystonia, Akathasia, tardive dyskinesia
Phenothiazines
-azine
side effects:
sedation, orthostatic hypotension, moderate EPS,
Nonphenothiazines
Haloperidol
used for acute and chronic psychosis, treats schizophrenia, treats tourettes syndrome
Contraindications:
narrow angle glaucoma, CNA depression coma, cardiovascular disease
NMS
Neuroleptic Malignant syndrome
rare but potential fatal condition
Symptoms:
altered mental status, muscle rigidity, sudden high fever, BP fluctuations, tachycardia, dysarhythmias, rhabdomyolysis, acute renal failure, respiratory failure, coma
treatment: the immediate withdrawal of antipsychotic,
hydration/ hypothermic blankets/ antipyretics, BENZOdiazepines muscle relaxants (dantrolene)
ATypical antipsychotics
endings in -zapine, -tiapine, -peridone, -asidone, prefixes of -pip-
prefixes of -pip- are treatment in conjunction with antidepressants
less side effects than traditional
monitor for adverse reactions of
Agranulocytosis, weekly WBC counts, Hyperglycemia, Hyperlipidemia, weight gain
what class of drug mainly treats anxiety
Benzodiazipines
ending in -epam
