patho test #1 drugs Flashcards
1
Q
opioid agonist analgesics
A
binds to opioid receptor and causes an analgesic response
2
Q
opioid agonist analgesics indication
A
moderate to severe pain
3
Q
opioid agonist analgesics top 3 worries
A
CNS/resp depression, constipation, urinary retention
4
Q
opioid agonist analgesics side effects
A
nausea due to CTZ, histamine release which can cause itching, and strong abuse potential
5
Q
MS contin
A
ER form of morphine
6
Q
morphine sulfate class
A
opioid agonist analgesic
7
Q
morphine sulfate nursing considerations
A
Hypotension and caution with renal disease because it has a metabolite that the kidney needs to get rid of.
8
Q
hydromorphone is also called
A
dilaudid
9
Q
1 mg dilaudid = how many mg morphine
A
7 mg
10
Q
exalgo
A
ER of dilaudid
11
Q
can you give dilaudid to a kidney pt
A
yes
12
Q
fentanyl
A
very strong opioid
13
Q
what can you not do to a fentanyl patch
A
expose it to heat or cut it because1 both can accelerate the diffusion of the drug
14
Q
who do you want to be mindful with in giving opioids
A
geriatric population
15
Q
indication of fentanyl
A
pain control, balance anesthesia, conscious sedation
16
Q
fentanyl patches
A
for chronic pain management and can be used for 72 hours
17
Q
can you give opioid naive patients fentanyl patches
A
no only for opioid tolerant because it is like having 8 mg dilaudid or 60 mg of morphine
18
Q
IV fentanyl considerations
A
comes in a glass container so need to use a filtered needed to suck up
19
Q
Percocet
A
oxycodone with acetaminophen
20
Q
percodan
A
oxycodone with aspirin
21
Q
oxycontin
A
sustained release of oxycodone
22
Q
how long does oxy IR take to work
A
10-15 min
23
Q
Norco
A
hydrocodone with acetaminophen
24
Q
is oxy or hydrocodone weaker
A
hydrocodone
25
if patient have liver disease we don't want them have more than ______ Tylenol
2000 mg
26
which opioid is a cough suppressant
hydrocodone
27
methadone hydrochloride is also called
dolophine
28
how long of duration does methadone have
long - 24-48 hours
29
methadone indication
cancer, chronic back pain, treatment for addicts,
30
methadone onset
30-60 min
31
where is methadone absorbed
GI tract
32
methadone half life
longer than its duration because as you repeat dose it accumulates in the tissues and is slowly released thus allowing for 24 hour dosing
33
where is methadone eliminated from
the liver so it is a safer choice than others for renal impaired pt
34
concerns with methadone
cardiac dysrhythmia with prolonged QT interval so should not be given to pt with cardiac history
35
opiate antagonist
CNS stimulator and reverses opioids
36
example of opiate antagonist and what else is it called
naloxone also called narcan
37
naloxone has a higher affinity for
Mu receptor
38
indication of naloxone
opioid OD such as respiratory depression
39
adverse effects of naloxone
opioid withdrawal
40
half life and duration of naloxone
has a short half life with a duration of 0.5-2 hour
41
nursing considerations for naloxone
rebound toxicity
42
what could happen after giving naloxone
ventricular tachycardia if you are giving it to someone addicted to opioids. opioid withdrawal
43
osmotic diuretics nursing considerations
can crystallize in low temp, so store in warmer. in glass vial so always use filter needle. visually inspect for precipitants
44
what do osmotic diuretics do
increase osmotic pressure in glomerulus and bring fluid in from interstitial space
45
where does osmotic diuretics work
along entire nephron so it causes a major impact
46
osmotic diuretics example
manitol
47
osmotic diuretic indication
cerebral edema from trauma, AKI, oliguric phase, increased renal blood flow. promotes excretion of toxins
48
when is osmotic diuretics not indicated
peripheral edema or chronic heart failure
49
are osmotic diuretics absorbable or nonabsorbable
non absorbable so decreases cellular edema
50
if loop diuretics are pushed too fast what can happen
can cause permanent hearing loss so control rate
51
what does the patient need to be on if on loop diuretics
potassium supplement
52
how do loop diuretics work
activate renal prostaglandins which causes vessel dilation in the kidney, pulmonary, and systemic and causes a decrease in preload and central venous pressure
53
indication of loop diuretics
pulmonary edema, HTN, renal/hepatic/cardiac failure
54
if a patient has this allergy we do not give them a loop diuretic
sulfa allergy
55
potassium sparing diuretics MOA
aldosterone inhibitors and are competitive antagonist that excretes water and sodium but reabsorbs potassium
56
potassium sparing diuretics should not be given to
end stage renal pt and should not be given with ace inhibitors because of the increase risk of hyperkalemia
57
potassium sparing diuretics are commonly used
in heart failure because they are cardio protective
58
thiazides are usually given for
HTN and heart failure often in a hydrochlorothiazide combo
59
do not give thiazides to pt with
sulfa allergy or decrease renal function
60
thiazide MOA
arteriole dilation so decreases preload and after load. potassium, magnesium, and NaCl depletion but reabsorbs calcium
61
what do you want to watch with thiazides
calcium levels
62
thiazides have what sort of effect
ceiling effect so giving more drugs will not cause a greater effect
63
nursing considerations for diuretics
want to monitor daily weight, I&Os, electrolytes, BP, weakness, ALOC, constipation
64
if patient becomes constipated
can be given psyllium-based, bulk forming laxative
65
calcium carbonate can cause
GI upset - fro, production of CO2
66
calcium carbonate should be given with
vit D 30 minutes before meal
67
how much calcium is in calcium gluconate
4.65 mEq Ca+/gm
68
calcium glutinate does what to potassium
pushes it back into the cell temporarily
69
what does insulin do to potassium
binds with it and brings it into the cell
70
permanent treatment for hyperkalemia
hemodialysis
71
how much calcium is in calcium chloride
13.6 mEq Ca+/gm
72
what do you need for calcium absorption
vitamin D
73
what does calcium gluconate cause
increase force of contraction in heart
74
indication for calcium replacement
hypocalcemia and cardiac resuscitation
75
nursing considerations for calcium replacement
prevent extravasation, need to correct Mg first, too much too fast can cause cardiac syncope, peripheral vasodilation, irritating to veins so use vessel high on the arm
76
if you don't correct the Mg first when administering calcium replacement what can happen
increased resistance to Ca+ replacement
77
cardiac syncope
temporary loss of consciousness from decrease blood flow to the brain
78
magnesium sulfate does what
smooth muscle relaxant
79
magnesium sulfate indication
preterm labor/preeclampsia, asthma, hypothermia protocol
80
magnesium oxide is for
supplementation
81
magnesium citrate is used for
laxative
82
hypothermia protocol
bringing pt temp down = cooling pt after MI increases the survival
83
torsades de points
ventricular tachycardia that is characterized by party streamer EKG. most commonly associated with hypomagnesium
84
why give antilipemics
help decrease the fat
85
DMARDs
disease modifying anti rheumatic arthritis drugs
86
DMARDs MOA
inhibit movement of neutrophils/macrophages into the joints
87
onset of DMARDs
onset of several weeks so we want to give NSAIDs or corticosteroids while waiting for the DMARD to kick in
88
what do you want to watch for while taking DMARDs
sign of infection because they knock out immune system
89
example of DMARDs
Etanercept
90
what does Etanercept do
it is biologic and binds to tumor necrosis factor and stops communication with it
91
administration of Etanercept
weekly subQ for RA
92
Etanercept adverse effects
infection, weakness, site reaction
93
Etanercept BBW
risk for infection and cancer in 6/10,000
94
methotrexate is a
folic acid antagonist and is anticancer
95
adverse effects and BBW of methotrexate
pregnancy X drug, hepatotoxic so watch liver enzymes, bone marrow suppression. watch CBC and platelets
96
administration of methotrexate
weekly admin IM or PO
97
NSAIDs
nonsteriodal anti-inflammatory drugs
98
NSAIDs MOA
inhibit prostaglandins which causes vasodilation, protecting gastric mucosa, platelet aggregation
99
why would you use NSAIDs over corticosteroids
because they have a more favorable AE profile than corticosteroids
100
AE for NSIADs
they inhibit mucus secretion which can cause GI bleeding and ulcerogenic (produce ulcers), nephrotoxicity in those who are dehydrated, and CV events related to clotting
101
what type of effects do NSAIDs have
analgesic, antipyretic, anti-rheumatic, anti platelet, and ceiling effect
102
aspirin MOA
inhibits platelet aggregation and reduces thromboxane
103
what does thromboxane do?
promotes aggregation and is a vasoconstrictor
104
adverse effect of aspirin
GI intolerance, bleeding, and renal toxicity
105
indication for aspirin
CV/CVA/DVT prophylaxis
106
doses of aspirin
81 mg - baby aspirin (maintenance) vs 325 mg - chest pain/event
107
commonly used NSAIDs
Ketorolac and Ibuprofen
108
ketorolac is also called
toradol
109
administration of ketorolac
PO, IM, or IV push and for short term use only (5 days) due to adverse effects on renal/GI tract
110
ketorolac has
powerful analgesic effects
111
Ibuprofen indication
anti-inflammatory which effects may take up to 7 days and analgesia which effects will take 30-60 minutes
112
naproxyn
aleve - almost the same drug as ibuprofen
113
if pt has history of ulcers and needs Ibuprofen what can we give them?
misoprostol (cytotec) which coats the stomach to help with preventing ulcers
114
Allopurinol is also called
zyloprim
115
allopurinol is for and MOA
gout by inhibiting xanthine oxidase with prevents uric acid formation
116
adverse effects of allopurinol
agranulocytosis, aplastic anemia, potentially fatal skin reaction
117
selective estrogen receptor modulator (SERMs) drug
raloxifene
118
raloxifene is also called
Evista
119
selective estrogen receptor modulator (SERMs) MOA
stimulate estrogen receptors on bone to decrease effectiveness of RANKL and increase bone density
120
indication for selective estrogen receptor modulator (SERMs)
postmenopausal osteoporosis when there is a RANKL dominance. also can be used for breast cancer prophylaxis
121
selective estrogen receptor modulator (SERMs) has positive effects on
cholesterol
122
adverse effects of selective estrogen receptor modulator (SERMs)
hot flashes, DVT, PE, leukopenia
123
pt on selective estrogen receptor modulator (SERMs) should stop taking if
they have periods of venous stasis because the drug increases risk of clotting
124
Bisphosphonate drug
alendronate
125
alendronate is also called
fosamax
126
alendronate is used for
is a non hormonal option to potentially reverse bone loss and can reduce fracture risk by 50%
127
alendronate MOA
inhibits osteoclastic bone resorption
128
alendronate adverse effect
hypocalcemia because the calcium is staying in the bones, esophageal erosion, osteonecrosis of jaw, severe pain
129
nursing considerations for alendronate
regurgitation causes bleeding and erosion of esophagus so do not let pt lay down for awhile after taking it. It is a miracle drug for about 5 years and then pain and necrosis will happen
130
half like of alendronate
long half life of greater than 10 years so pt doesnt need to take it all the time
131
highest risk of pulmonary embolism
raloxifene
132
pt with increase risk of thrombotic event would have the highest risk from which drug
ibuprofen
133
pt who is sick should not have
etanercept
