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Nursing 111 & Pharmacology > Pharm Test #4 > Flashcards

Pharm Test #4 Flashcards

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1
Q

this is a condition in which heart fails to effectively pump blood throughout the body

A

congestive heart failure

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2
Q

this usually involves dysfunction of the cardiac muscle

A

congestive heart failure

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3
Q

heart failure can occur with any of the disorders that damage or overwork the heart muscle - 5

A

CAD
cardiomyopathy
hypertension
valvular heart disease
right sided heart failure v left sided heart failure

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4
Q

venous return is decreased and causes backup in blood —> jugular vein distention

what is this

A

right sided heart failure

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5
Q

this causes dyspnea, tachycardia, pulmonary crackles

A

left sided heart failure

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6
Q

underlying problems for heart failure – 3 kinds

A
  1. muscle damage - atherosclerosis or cardiomyopathy
  2. increase in workload to maintain efficient output — hypertension or valvular disease
  3. structural abnormality — congenital cardiac defects
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7
Q

compensatory mechanisms of heart failure (medication)

A

cardiotonic drugs
—-cardiac glycosides

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8
Q

what is a cardiac glycoside drug

A

digoxin

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9
Q

this increases the force of a myocardial infarction

A

digoxin

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10
Q

this is used to treat heart failure and rapid/irregular heart rates

A

digoxin

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11
Q

this increases the force of a myocardial contraction, cardiac output and renal perfusion and output and decreases blood volume to slow heart rate and conduction velocity through the AV node

A

cardiac glycosides

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12
Q

adverse effects of cardiac glycosides

A

-headache, weakness, drowsiness and vision changes
-gi upset and anorexia
-arrhythmia development
-digoxin toxicity

**know

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13
Q

rn Assessments for digoxin

A

-lab values including digoxin level,kidney function, ventricular tachycardia, heart block, sic sinus syndrome
-electrolye abnormalities, weight, cardiac status, skin and mucus membranes, affect, orientation, and reflexes

monitor K level if low call MD before giving Digoxin.** know

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14
Q

what is the therapeutic digoxin level

***** know

A

0.5-2 ng/mL

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15
Q

What are the symptoms of digoxin toxicity?

A

Nausea Vomiting diarrhea
Visual disturbances
Headache
Confusion
Atrial arrythmias
Ventricular tachycardia

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16
Q

What is the antidote for digoxin?

A

Digoxin Immune Fab
(Digifab)

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17
Q

what are the side effects of electrolyte abnormalities - 6

and which of those are digoxin toxicity

A

bradycardia
dysrhythmias
N/V/D - digoxin toxicity
visual disturbances - dig toxcitiy
headache - dig toxicity
confusion - dig toxicity

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18
Q

what precipitates digoxin toxicity

A

hypokalemia

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19
Q

what do you do if K+ level is low and you need to give digoxin

A

if low, call MD before giving digoxin

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20
Q

rn interventions for digoxin

A
  1. frequently check dig level and K+ level
  2. .monitor HR, and HOLD if bradycardia (HR below 60)
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21
Q

the primary treatment for congestive heart failure is to make the heart beat harder and faster

true or false

A

false

primary treatment involves increasing muscle contractility, bringing system back into balance

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22
Q

What are the condraindications for Digoxin use?

A

Allergy
Ventricular Tachycardia or fibrillation
Sic sinus syndrome
Acute MI (because strengthens force of myocardial contractions)
renal insufficiency
Electrolyte imbalance

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23
Q

what is the primary treatment for congestive heart failure

A

allow the heart muscle to contract more efficiently in an effort to bring the system back into balance

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24
Q

blood pressure is determined by what 3 things

A
  1. heart rate
  2. stroke volume
  3. total peripheral resistance
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25
Q

amount of blood pumped out of ventricle with each heartbeat

A

stroke volume

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26
Q

risks for coronary artery disease related to hypertension

A

-thickening of heart muscle
-increased pressure generated by muscle on contraction
-increased workload on heart

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27
Q

Conditions related to untreated hypertension

A

CAD and cardiac death
Stroke
Renal failure
Loss of vision

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28
Q

for risks of CAD - what do you need to know or do

A
  1. why pt is taking drug
  2. what assessing
  3. assess after…. ?
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29
Q

resistance of the muscular arteries to the blood being pumped through

A

total peripheral resistance

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30
Q

what is stage 1 hypertension

A

130-139 / 80-89

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31
Q

what is stage 2 hypertension

A

> 140 / >90

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32
Q

what factors are known to increase blood pressure

A
  1. high levels of psychological stress
  2. exposure to high frequency noise
  3. high salt diet
  4. lack of rest
  5. genetic predisposition
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33
Q

what can lead to shock

A

hypotension

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34
Q

___ ___ = decreased perfusion to organs

A

low BP

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35
Q

what is the first organ to shut down due to poor perfusion

A

kidneys

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36
Q

when the heart muscle is damaged and unable to pump effectively

A

BP is too low

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37
Q

with severe blood or fluid loss, when volume drops dramatically

A

hypotension

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38
Q

this causes extreme stress and the body’s levels of norepinephrine are depleted, leaving the body unable to respond to stimuli to raise BP

A

hypotension

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39
Q

antihypertensive agents - 6

A

ACE inhibitors
angiotension II receptor blockers
calcium channel blockers
vasodilators
diuretics
sympathetic nervous system blockers

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40
Q

what meds end in “ARTAN”

A

angiotension II receptor bockers

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41
Q

what meds end in “PRIL”

A

ACE inhibitors

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42
Q

what meds end in “PINE”

A

calcium channel blockers

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43
Q

ACE inhibitor drugs we are to know - 2

A

benazepril
lisinopril

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44
Q

RN considerations for ACE inhibitors

A
  1. ACE’s can HOLD potassium in body
    ———-Assess K+ levels
  2. Dry Cough —– hacking

PRIL = dry hacking cough **

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45
Q

What should RN assess for ACE inhibitors

A
  1. History and physical exam
  2. CV assessment AND re-assessment *****
  3. impaired kidney function
  4. salt/volume depletion and HF
  5. baseline status before beginning therapy
    ——-VS, weight, skin, ECG, CBC with ultrasound and electrolytes
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46
Q

side/adverse effects of ACE’s

A

dry cough
hyperkalemia
contraindicated in worsening renal function
photosensitivity

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47
Q

What are the condraindications of Ace inhibitors and Angiotensin II receptor blockers?

A

Known Allergies
Impaired renal function
Pregnancy and lactation
Caution CHF

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48
Q

what are the lifestyle changes you need to make for hypertension

A

weight reduction
smoking cessation
increasing aerobic exercises
low sodium diet

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49
Q

where are angiotensions metabolized

A

in the liver

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50
Q

what do you assess for angiotensions

A

HR and BP ——- no stopping BP meds

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51
Q

what are the drug to drug interactions for angiotensin II receptor blockers

A

phenobarbital (anti-seizure)

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52
Q

nursing considerations for angiotension II receptor blockers

A
  1. impaired renal and hepatic function
  2. hypovolemia,
  3. assess baseline status before beginning therapy including - skin, VS, LS, baseline ECG and renal and hepatic function tests
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53
Q

calcium channel blockers - what do they do

A

Inhibits movement of calcium ions across the membranes of cardiac and arterial muscle cells decreasing myocardial contractility

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54
Q

how do the names of calcium channel blockers medciations end..

A

..PINE

ex: amiodipine

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55
Q

if drugs are ER, SR, XL, etc – what do you NOT do

A

do NOT crush

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56
Q

what are the indications for calcium channel blockers

A
  1. treatment of essential hypertension in the extended-release form
  2. used to treat angina, HTN, tachycardia
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57
Q

Can calcium channel blockers be chewed

A

NO

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58
Q

what is the route of calcium channel blockers

A

PO - they must be swallowed whole

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59
Q

drug to food interactions for calcium channel blockers

A

grapefruit juice - grapefruit juice interferes with so many drugs.

rule of thumb - don’t have pts take meds with grapefruit

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60
Q

nursing considerations for calcium channel blockers

A

CV assessment and RE-ASSESSMENT

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61
Q

what is the main reason to use calcium-channel blockers

A

treatment of angina

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62
Q

side/adverse effects of Ca+ channel blockers

A

hypotension (orthostatic)
bradycardia
peripheral edema
worsening heart failure in pts with HF
fall risk

*assess for edema

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63
Q

these are reserved for use in severe hypertension, malignant hypertension, or hypertensive emergencies

A

vasodilators

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64
Q

vasodilators _____ pressure

A

decrease

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65
Q

what vasodilator meds do we need to know - 3

A

hydralazine
minoxidil
nitroprusside

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66
Q

this maintains increased renal blood flow

A

hydralaine

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67
Q

what meds are last resort / used for emergencies

A

vasodilators

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68
Q

this is used for hypertensive crisis; maintain hypertension during surgery

A

nitroprusside

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69
Q

what is minoxidil used for

A

used only for severe and unresponsive hypertension

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70
Q

these increase excretion of sodium and water from the kidney to lower blood pressure

A

diuretics

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71
Q

this is potassium depleting — need to test before and after

A

furosemide

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72
Q

3 types of diuretics

A

loop diuretics
thiazide and thiazide like diuretics
potassium sparing diuretics

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73
Q

name the potassium sparing diuretic

A

spironolactone

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74
Q

what is the thiazine and thiazide like diuretics - 2

A

hydrochlorothiazide
metolazone

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75
Q

what is the loop diurectic

A

furosemide

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76
Q

what to be aware of if pt is on furosemide

A

K+ loss, Na+ loss, Mg- loss
Syncope- Fall risk
Elevated lipid levels

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77
Q

what does hypokalemia look like

A

irregular heart rhythm, muscle cramps, N/V, fatigue/weakness, weak pulses

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78
Q

waht does hyponatremia look like

A

confusion, convulsions, decreased mental status, irritability, muscle cramps, fatigue/weakness

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79
Q

nursing considerations for loop diuretics

A
  1. IV route must be pushed SLOWLY to prevent tinnitus (ototoxicity). IV push over 1-2 minutes
  2. teach pt to take med in AM
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80
Q

this slows down/turns off the salt pumps

A

thiazide diuretics

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81
Q

hydrochlorothiazide side effects

A

loss of K+, Na, Mg-

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82
Q

this diuretic is used to treat heart failure and HTN

A

spironolactone

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83
Q

these are used to treat angina, MI, HF, HTN, dysrhythmias with rapid heart rate

A

beta blockers

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84
Q

if HR is below ___ recheck before giving. dont give if it’s below this number

A

60

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85
Q

if systolic BP is below _____ don’t give.

A

100

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86
Q

this decreases HR, BP, workload of the heart and contractility

A

beta blockers

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87
Q

what beta blocker medication do we need to know

A

metoprolol

88
Q

rn considerations for beta blockers

A
  1. monitor BP and HR before & after admin
  2. “hold” medication if BP & HR too low
  3. teach pt to check pulse and BP periodically
  4. diabetics should monitor for hypoglycemia ** know
89
Q

this is essential to to producing healthy RBCs

A

adequate amounts of iron - to form hemoglobin rings to carry the oxygen

90
Q

who’s at risk for iron deficiency anemia

A
  1. menstruating women who lose RBCs monthly
  2. pregnant and nursing women who have increased demands for iron
  3. rapidly growing adolescents, those who don’t have a good diet
91
Q

3 types of anemia

A
  1. iron deficiency anemia
  2. megaloblastic anemia
  3. sickle cell anemia
92
Q

What is the cause of Iron deficiency Anemia?

A

A negative iron balance occurs

93
Q

What is another name for Megaloblastic anemia?

A

Pernicious anemia

94
Q

does iron cause diarrhea or constipation

A

constipation

95
Q

this is when the RBCs are crescent moon shaped and they clump together.

it impacts the liver

A

sick cell anemia

96
Q

this medication stimulate the bone marrow to make more RBCs

A

epoetin alfa – subq injection

97
Q

this acts like natural glycoprotein erythropoietin to stimulate the production of RBCs in the bone marrow

A

erythropoiesis stimulating agents

98
Q

contraindications of erythropoiesis stimulating agents

A

uncontrolled hypertension — this needs to be controlled in order to get medication

99
Q

adverse effects erythropoiesis stimulating agents

A

CV - hypertension, edema, possible chest pain

100
Q

nursing considerations for erythropoiesis stimulating agents

A

patients with cancer receiving the drugs to increase hematocrit after antineoplastic chemotherapy
Assess Neuro and CV status, respirations
Anemia and renal function

101
Q

iron deficiency anemia medications start with….

A

Iron=Iron

ferrous = iron
Ferrous Gluconate is the only IV med
***know

102
Q

this stimulates RBC production in the bone marrow

A

epoetin alfa

103
Q

adverse effects for medications used for iron deficency anemia

A

-constipation
-Oral – GI irritation and CNS toxicity
-parental iron - associated with severe anaphylactic reactions, local irritation, staining of tissues and phlebitis
Drug-Drug
Antacids, tetracycline, cimetadine
all the -oflaxins
Chloramphenicol

104
Q

what food interactions for iron deficiency anemia agents

A

eggs
milk
coffee
tea
acidic liquids

**know

don’t take meds within an hour of eating these foods

105
Q

nursing considerations for iron preparations

A

lab values - Hb & Hematocrit labs make sure they are sufficient amount

106
Q

Megaloblastic anemia occurs when there is insufficient folic acid or vitamin B12 to support stromal structure of RBC

true or false

A

true

megaloblastic anemia equals insufficient folic acid or vitamin B12 to create the stromal structure needed in a healthy RBC

107
Q

what is the medication for sickle cell anemia

A

hydroxyurea

108
Q

-this increases amount of fetal Hb produced in bone marrow
-dilutes formation of abnormal Hb S

-take multiple times a day

A

hydroxyurea

109
Q

what is the caution for sickle cell anemia meds

A

impaired liver or renal function

110
Q

adverse effects of sickle cell anemia meds

A

GI, headache, dizziness, disorientation(Usually seen in patients taking too high of a dose) **, increased cancer risk

111
Q

what are the modifiable risks for CAD

A
  1. gout
  2. cigarette smoking
  3. sedentary lifestyle
  4. high stress levels
  5. hypertension
  6. obesity
  7. diabetes
  8. untreated bacterial infections
  9. treatment with tetracycline and fluororoentgenography
112
Q

unmodifiable risks for CAD

A

age
gender
genetic predisposition

113
Q

enter circulation as loosely packed lipids

A

high density lipoproteins (HDL)

114
Q

enters circulation as tightly packed cholesterol, triglycerides and lipids

A

low density lipoproteins (LDL)

115
Q

carried by proteins that enter circulation ; broken down for energy or stored for future use as energy

A

low density lipoproteins (LDL)

116
Q

Enter circulation as loosely packed lipids

A

High Density Lipoproteins (HDL)

117
Q

used for energy, picks up remnants of fats and cholesterol left in periphery

A

high density lipoproteins (HDL)

118
Q

the excessive dietary intake of fats causes ___________

A

hyperlipidemia

119
Q

what are the actions of lipid lowering agents

A

-lower serum levels of cholesterol and lipids
-prevention of CAD

120
Q

genetic alterations in fat metabolism leading to a variety of elevated fats in blood causes what ……..

A

hyperlipidemia

121
Q

true or false

low density lipoproteins enter circulation as tightly packed unit consisting of cholesterol, triglycerides and lipids

A

true

122
Q

what type of drug is used to treat hyperlpidemia

A

bile acid sequestrants

123
Q

what do bile acid sequestrants do

A

decrease plasma cholesterol levels

124
Q

what medication is a bile acid sequestrants

A

cholestyramine

125
Q

what do you not give to a pt when giving cholestyramine

A

carbonated beverages. these will break down the medication and it becomes inactive.

**need to know this

126
Q

What should a patients daily fluid intake be when taking Bile Acid Sequestrants?

A

2-3L

127
Q

these bind bile acids in the intestine, allows excretion in feces instead of reabsorption, c auses cholesterol to be iodized in the liver, and serum cholesterol levels to fall

A

bile acid sequestrants

128
Q

what are the nursing considerations for bile acid sequestrants

A

assess:
-weight, skin, neurological status, pulse, BP and LS
-BS and elimination patterns and appropriate lab values
-want clients to eat more fiber to promote motility to get medication out*** important

129
Q

what are the indications for cholestyramine

A

reduction of elevated serum cholesterol in pts with primary hypercholesterolemia, pruritus associated with partial biliary obstruction

130
Q

adverse affects of cholestyramine

A

Most important:
Headache, fatigue drowsiness
Direct GI irritation- Nausea Constipation
Also:
anxiety, vertigo, exacerbation of hemorrhoids, cramps, increased bleeding tendencies, vitamin A and D deficiency

131
Q

if this enzyme is blocked, serum cholesterol and LDL decrease

A

HMG-CoA reductase

132
Q

waht medications are HMG-CoA Reductase inhibitors

A

“statins”

Lovastatin
rosuvastatin

133
Q

this medication makes ppl nauseous and give them gas pains ** Know this

A

lovastatin

134
Q

this medication you need to check the labs (liver enzymes, HDL/LDL) at least twice a year to make sure medication is effective and dosage doesn’t need reduced *** Know This

A

rosuvastatin

135
Q

what is the contraindications of HMG-CoA reductase inhibitors ** Know this

A

active liver disease or history of alcoholic liver disease

136
Q

what are the actions of HMG-CoA reductase inhibitors

A

inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels

137
Q

waht are the adverse effects of HMG-CoA reductase inhibitors

A

GI symptoms: gas, abdominal pain, cramps, nausea, vomiting, constipation

Liver failure
Muscle pain (Rhabdomylosis)

138
Q

Can a patient be easily changed from generic HMG-CoA Inhibitors to Brand?

A

No, people are very sensitive to the different formulations of these drugs and changing medication must be very carefully managed, even from brand to generic.

139
Q

What are the Drug to Drug interactions with HMG-CoA Inhibitors?

A

Erythromycin, cyclosporine,gemfibrozil, niacina
Digoxin or warfarin
Estrogen
Grapefruit juice

140
Q

what two things are used to lower lipid levels

A
  1. niacin (vitamin B3)
  2. fenofibrates
141
Q

-this causes skin to flush
-breaks down LDLs so don’t stick together

A

niacin

142
Q

-this increased uric acid secretion
-drink lots of water
-will build up in joints

A

fenofibrates

143
Q

this may stimulate triglyceride breakdown

A

increased uric acid secretion —- from fenofibrates

144
Q

**know

what type of medication can cause cataracts

A

HMG-CoA inhibitors

145
Q

the nurse is caring for a pt taking a HMG-CoA inhibitor. What would be an appropriate intervention for this pt?

A. monitor CBC blood tests before and periodically during therapy
B. Arrange for periodic ophthalmic examinations
C. Admin drug at breakfast
D. Monitor for adverse effecst

A

B. Arrange for periodic ophthalmic examinations

146
Q

name two blood disorders

A
  1. thromboembolic disorder
  2. hemorrhagic disorder
147
Q

this interferes with the clotting cascade and thrombin formation

A

anticoagulants

148
Q

this alters the formation of the platelet plug

A

antiplatelets

149
Q

this breaks down the thrombus that has been formed by stimualting the plasmin system

A

thrombolytic drugs

150
Q

this is a disorder in which excess bleeding occurs

A

hemorrhagic disorder

151
Q

conditions that predispose a person to the formation of clots and emboli

ex: caused by afib

A

thromboembolic disorder

152
Q

name two antiplatelet medications

A

aspirin
clopidogrel

153
Q

this breaks down plaque

A

clopidogrel

154
Q

this prevents pts at risk for CVA

A

aspirin

155
Q

what is the adverse effect of antiplatelets

A

bleeding

156
Q

this blocks the production of platelets in the bone marrow

makes you at risk for hemorrhage

A

anagrelide

157
Q

inhibits platelet adhesion and aggregation by blocking receptors sites on the platelet membrane

A

actions of antiplatelets

158
Q

what are the nursing considerations for antiplatelets

A

-baseline status including body temp, skin color, lesions, and temperature ;
-affect, orientation, and reflexes;
-pulse, BP, and perfusion, ;
-RR and adventitious sounds;
-CBC;
-clotting studies

document skin to notice changes

159
Q

4 anticoagulant medication

A
  1. heparin
  2. warfarin
  3. rivaroxaban
  4. apixaban
160
Q

these two medications you monitor for bruising/bleeding

no lab values for these meds

A

rivaroxaban & apixaban

161
Q

use soft bristle toothbrush ; no open razors to shave

which type medications would this apply to

A

anticoagulants

162
Q

lab is PTT
use 25-30 gauge
antidote is protamine sulfate

A

heparin

163
Q

lab is PT/INR
don’t eat leafy green vegys
vitamin K is the antidote

A

warfarin

164
Q

what are the adverse effects of anticoagulants

A

gi upset - can develop ulcers
hepatic dysfunction
-dont want pt to have gastric or duodenal ulcers in history

165
Q

drug to drug interactions for anticoagulants

A

heparin and nitroglycerine — can cause more bleeding

166
Q

this medication — the dose is based on weight
-you put subq in love handles
-no antidote

A

enoxaparin

167
Q

nursing considerations for anticoagulants

A

-recent history of surgery
-active internal bleeding
-CVA within last 2 mos

168
Q

this anticoagulant doesn’t cross breast milk so mom can breastfeed while on it

A

heparin

169
Q

this breaks down thrombus that has been formed by stimulating the plasmin system

A

thrombolytic agents

170
Q

thrombolytic agent medication to know

A

urokinase

–this breaks down clot

171
Q

how long should you monitor for bleeding when on urokinase

A

24-48 hrs

172
Q

activating plasminogen to plasmin, which in turn breaks down fibrin threads in clot to dissolve a formed clot

A

thrombolytic agents

173
Q

this inhibits thrombus and clot production by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin

A

heparin

174
Q

adverse effects of thrombolytic agent

A

bleeding
cardiac arrhythmias
hypotension
hypersensitivity

175
Q

this prevents and treats of VTE and PE, treatment of AF with embolization, diagnosis and treatment of DIC, prevention of clotting in blood samples and heparin lock sets

A

heparin

176
Q

nursing considerations for thrombolytic agents

A

-recent surgery, active internal bleeding, CVA within last two months, aneurysm, obstetrical delivery, organ biopsy, recent serious GI bleeding, rupture of non-compressible blood vessel, recent major trauma
-known blood clotting defects, cerebrovascular disease, uncontrolled hypertension, liver disease
-baseline status to include VS, Skin, orientation, appropriate lab values and ECG

177
Q

use this for lysis of PE or PE with unstable hemodynamics in adults

A

urokinase

178
Q

what is an inflammatory response ?

A

Protects the body from injury and pathogens
Uses chemical mediators to producea reaction that helps destroy pathogens and promotes healing

179
Q

What is the purpose of antiinflammatory drugs?

A

They prevent or limit the inflammatory response due to injury and are prescribed to increase comfort

180
Q

What are the types of antiinflammatory drugs?

A

Corticosteroids
Antihistamines
Immune-modulating agents
OTC aniinflammatories (NSAIDS)

181
Q

What special considerations do we need to think about for children?

A

Dosage is often weight based
No Aspirin and Trisalicylate drugs because it can cause Reyes syndrome

182
Q

What are the therapeutic uses/indications for salicylates?

A

Block inflammatory response
Have antipyretic properties
Have analgesic properties
considered anti-platelet drug (used in stroke and heart patients)
Used to treat mild to moderate pain and fever

183
Q

Which are the common Salicylates?

A

Aspirin
Bayer

184
Q

What are the two dosages of aspirin?

A

81mg/324mg

185
Q

What Labs should the Nurse be checking for a patient taking Salicylates?

A

Labs relating to bleeding:
* PT/INR
* PTT
* Platelets
Labs relating to Liver and Kidney Function

186
Q

What are the Drug-Drug interactions for Salicylates?

A
  • Should not take Aspirin while taking other anticoaugulants such as Warfarin or Heparin
  • Need to be aware of any over the counter medications such as alka seltzer and ecotrin that may also contain aspirin
187
Q

What are the condraindications for taking salicylates?

A
  • Chicken pox/influenza (risk of reyes in children)
  • Known allergy
  • Bleeding abnormalities
  • impaired renal function
  • Surgery or other procedures scheduled within one week (bleeding Danger)
  • Pregnancy and lactation (crosses placenta and into breast milk)
188
Q

What are the actions of salicylates

A

Inhibits synthesis of prostaglandin

189
Q

Should Aspirin be taken with food?

A

Yes, to offset GI irritation

190
Q

What adverse effects should the nurse be assessing for in a patient taking Salicylates?

A
  • Bruising
  • Bleeding such as Nosebleeds, Gum bleeding/clotting problems
  • Tinnitus or ringing in the ears
  • Loss of Kindey function (I&O)
  • GI bleeding or discomfort
  • Liver function
191
Q

What are the pharmacokinetics of Salicylates?

A

Absorbed in the stomach
Metabolized in the liver
Excreted in the urine

192
Q

True or False

A person who does not respond to one Salicylate may respond to a different one

A

True

193
Q

What is the action of NSAIDs?

A

Blocks two enzymes known as COX -1 and COX-2

194
Q

What are the Indications for NSAIDs?

A

Antiinflammatory
Analgesic
Antipyretic
Rheumatoid Arthritis
Primary Dysmenorrhea
Osteoarthritis

195
Q

What are the Pharmacokinetics of NSAIDs?

A

Rapidly absorbed in the GI tract
Metabolized in the Liver
Excreted in the Urine

196
Q

What are the condraindications for NSAIDs

A
  • Allergy to any NSAID or salicylate
  • allergy to sulfonamides
  • CV dysfunction or hypertension
  • peptic ulcer, GI bleeding
  • pregnancy, lactation
  • renal and hepatic dysfunction
  • Do not combine Salicylates and NSAIDs
197
Q

What adverse effects is the nurse assesing for in Patients takin NSAIDs?

A
  • GI irritation, pain or bleeding
  • Kidney compromise
  • allergic reactions
  • Bleeding in gums/epistaxis/bruising/platelet inhibition
  • Nausea, dyspepsia
  • Constipation, diarrhea or flatulencecaused by GI effects from drug
  • Dizzines, somnolence
  • Hypertension
  • Bone marrow depression
198
Q

What are the Drug to Drug interaction for NSAIDs?

A
  • Decreased diuretic effect when combined with loop diuretics such as Furosemide
  • Decreased antihypertensive effect when combined with Beta Blockers such as Metoprolol
  • Lithium toxicity especially when combined with ibuprofen
199
Q

What are the main NSAIDs?

A

Ibuprofen
Ketorolac
Naproxen
Celecoxib

200
Q

What are the Nursing Interventions for NSAIDS?

A
  • Teach patient to take with food
  • Do not chew capsule or tablet
  • Check urine and feces for blood
  • Check gums, Inform dentist
  • Shouldnt take with warfarin – interferes with clotting labs
  • Check labs that relate to bleeding.
  • Check kidney function (BUN & Creatinine) & I/O’s
  • Vitals signs (BP since NSAIDS can retain Na+ and H20)
  • Assess for allergic reactions and check for sulfa allergies
201
Q

when are NSAIDs Condraindicated?
A. Allergy to penicillin
B. Allergy to sulfonamides
C. Allergy to antihistamines
D. Allergy to thiazines

A

B. Allergy to sulfonamides

They are also condraindicated in the prescence of an allergy to any NSAID, Salicylate or Celecoxib
202
Q

What are the actions of Acetaminophen?

A

Acts directly on the thermoregulatory cells of the hypothalamus

203
Q

What are the indications for Acetominophen?

A
  • Treat pain and fever associated with a variety of conditions, including influenza
  • Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
  • Relief of musculoskeletal pain associated with arthritis
204
Q

What are the pharmacokinetics of acetaminophen

A

Absorbed from the GI tract
Metabolized in the liver
Excreted in the liver

205
Q

What are the condraindications for Acetaminophen ?

A
  • Known allergy
  • Use with caution in pregnancy and lactation
  • Hepatic dysfunction or chronic alcoholism
206
Q

What adverse effects is the Nurse assesing for with patients taking acetaminophen?

A
  • Headache
  • hemolytic anemia
  • renal dysfunction
  • liver failure
  • skin rash
  • fever
  • Hepatotoxicity (usually associated with chronic use and overdose)
207
Q

Which Adverse effect of Acetaminophen is usually associated with Overdose or chronic overuse?

A

Hepatotoxicity

208
Q

What is the recommended maximum daily dose of Acetaminophen?

A

4000mg

209
Q

What is the antidote for Acetaminophen overdose?

A

Mucomyst

210
Q

What are the drug to drug interactions for Acetaminophen?

A

Nurses to be aware and educate patients that acetaminophen is contained in other medications such as:
Percocet (oxycodone with acetaminophen)
Guafenisin
Nyquil
Alka-selzter plus

211
Q

A potentially debilitating inflammatory process

A

Arthritis

212
Q

What is the Indication for Antiarthritis agents

A

Prevent and supress arthritis in selected patients with rheumatoid arthritis

213
Q

Which medications are examples of antiarthritis agents

A

Gold Compounds
Adalimumab (Humira)
Etanercept (Enbrel)
Tofacitnib (Xeljanz)

214
Q

What are the adverse effects of all Anti-Arthritis drugs?

A

CV effects
Gingivitis/Stomatitis (inflammation of the mucus membranes in the mouth)
Bone marrow depression- risk of infection

215
Q

WHich Anti- Arthritis medications are Tumor Necrosis Factor Blockers?

A

Adalimumab (Humira)
Etanercept (Enbrel)

216
Q

What are the specific Adverse effects associated with Tumor Necrosis Factor Blockers?

A

Risk of serious fatal infections
Development of Lymphomas and other cancers

217
Q

Drug to Drug interactions for Tumor Necrosis Factor Blockers

A

Immune supressant drugs and live vaccines

Nursing 111 & Pharmacology (12 decks)

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