Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NCLEX Prep > Pharmacology > Flashcards

Pharmacology Flashcards

You may prefer our related Brainscape-certified flashcards:
NCLEX-PN® flashcards NCLEX-RN® flashcards
1
Q

Care and Maintenance of TPN

A
  1. Before administer, verify prescription and solution with another nurse
  2. Administer via infusion pump
  3. Monitor weight daily
  4. Monitor and record I &), noting fluid balance
  5. Monitor serum glucose levels every 4-6 hours
  6. Monitor for signs of infection
  7. Change gauze dressing every 2 days; transparent every 7 days
  8. Change. IV tubing and fluid every 24 hours
  9. If TPN solution temporarily unavailable, administer dextrose 10% in water to prevent hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antidote for Acetaminophen

A

Acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antidote for Benzodiazepine

A

flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Antidote for Heparin and Enoxaparin

A

protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Antidote for Magnesium Sulfate

A

Calcium gluconate 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Antidote for Narcotics

A

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antidote for Warfarin

A

Vitamin K (phytonadione)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antidote for Digitalis

A

digoxin immune FAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Antidote for Cyanide Poisoning

A

Methylene Blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Therapeutic Drug Level of Lithium

A

0.4-1.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Therapeutic Drug Level of Phenytoin

A

10-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ca+ channel blocker suffix and Medications

A

-dipine

Nifedipine
Verapamil
Diltiazem
Amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

-afil

A

Erectile dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

anesthetics suffix

A

-caine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ace inhibitors suffix

A

-pril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ARBs suffix

A

-sartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Benzodiazepines suffix

A

-pam, -lam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Antilipemic suffix

A

-statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

corticosteroids suffix

A

-asone, -solone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Beta Blocker suffix

A

-olol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Penicillin suffix

A

-cillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

-ide suffix

A

oral hypoglycemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

proton pump inhibitor suffix

A

-prazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antiviral suffix

A

-vir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Thrombolytic suffix

A

-ase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Antiemetic suffix

A

-azine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bronchodilator suffix

A

-phylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Anticoagulant suffix

A

-arin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Antiulcer suffix

A

-dine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Antibiotic suffix

A

-cylcine
-floxaxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Aminoglycoside suffix

A

-mycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tricyclic Antidepressants suffix

A

-tyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SSRIs suffix

A

-pram, -ine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Ciprofloxacin side effect

A

tendon ruptures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Doxycycline side effect

A

tooth discoloration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Furosemide side effect

A

Hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lithium side effect

A

Tremors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Tobramycin side effect

A

Ototoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Valacyclovir side effect

A

Thrombotic thrombocytopenia purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Nursing Interventions: HTN

A

1: Assess weight, vitals signs, and hydration status
2. Assess BP in supine, sitting, and standing positions
3. Assess lab profiles: renal function, coagulation
4. Teach clients to take meds at same time each day
5. avoid hot tubs and saunas
6. Don’t discontinue meds abruptly
7. Prevent orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

ACE inhibitors/ARBs: Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Therapeutic Use:
HTN, HF, MI, Diabetic nephropathy

Precautions:
Use with caution if diuretic therapy in place
monitor K levels

Side effects:
persistent nonproductive cough w/ ACE
angioedema; hypotension
should not be used in second and third trimester of pregnancy

Nursing Interventions & Education:
Catopril should be taken 1 hr before meals
Monitor BP
Monitor for angioedema and promptly administer epinephrine Subq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Ca Channel Blockers: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action:
slows movement of calcium into smooth-muscle cells, resulting in arterial dilation and decreased BP

Therapeutic Use:
Angina, HTN
Verapamil and Diltiazem can be used for A fib, A flutter, or SVT

Precautions:
Use cautiously in clients taking digoxin and beta blockers
Contraindicated for clients who have HF, heart block, or bradycardia
Do not consume grapefruit juive (toxic effects)

Side Effects:
Constipation
Reflex Tachycardia
Peripheral edema
Toxicity

Nursing Interventions:
Do not crush or chew sustained-release tablets
Administer IV injection over 2-3 min
Slowly taper dose if discontinuing
Monitor HR and BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Beta Blockers: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action:
Inhibit stimulation of receptor sites, resulting in decreased cardiac excitability, cardiac output, myocardial oxygen demand; lower BP by decreased release of renin in kidney

Therapeutic Use:
Primary HTN
Angina
Tachydysrhythmias, HF, MI

Precautions:
Contraindicated in clients who have AV block and sinus bradycardia
Do not administer nonselective beta blockers to clients who have asthma, bronchospasm, or HF
Propranolol may mask effects of hypoglycemia in clients who have DM
Do not administer labetalol in same IV line with furosemide

Side effects:
Bradycardia
Nasal stuffiness
AV block
Rebound myocardium excitation if stopped abruptly
Bronchospasm

Nursing Interventions & Education:
Administer 1-2 time daily as prescribed
Don’t discontinue w/o consulting provider
Do not crush or chew extended-release tablets
Hold meds and notify provider if systolic BP is <100 or pulse is <60
Monitor clients who have DM for indications of hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Vasodilators: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action: Direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload)

Therapeutic Use:
Hypertensive emergencies

Precautions
Clients who have hepatic or renal disease
Older adults
Electrolyte imbalances

Side effects:
Dizziness
HA
profound HTN
Cyanide toxicity
Thiocyanate poisoning

Nursing Interventions and Client Education
Nitroprusside may not be mixed with any medication
Apply protective cover to container
Discard unused fluid after 24 hr
Provide continuous ECG and BP monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Vasodilator Medications

A

Nitroglycerin
Enalaprilat
Nitroprusside
Hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Digoxin: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action:
Increase the force and velocity of myocardial contractions to improve stroke volume and cardiac output; slow the conduction rate allowing for increased ventricular filling

Therapeutic Use:
HF
A fib

Precautions:
Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
ACE and ARBs increase risk of hyperkalemia
Verapamil increases risk of toxicity

Side effects:
Digoxin toxicity:
GI effects (anorexia, N/V, abdominal pain)
CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects)

Nursing Interventions and Client Education:
Assess apical pulse for 1 min prior to administration
Notify provider if HR is <60 (adult) <70 (child) or <90 (infant)
Monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia
Notify provider of any sudden increase in pulse rate that previously had been normal or low
Maintain therapeutic level (0.8-2.0)

Management of Digoxin toxicity:
Discontinue digoxin and potassium-wasting meds
Treat dsyrhtmias w/ phenytoin (or lidocaine)
Treat bradycardia with atropine
For excess overdose, administer digoxin immune FAB to prevent absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Organic Nitrates Medications

A

Sublingual tablet
Sustained-release tablet
Transdermal ointment
Transdermal patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Organic Nitrates: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action:
Relax peripheral vascular smooth muscles, resulting in dilation of arteries and veins, thus reducing venous blood return (reduced preload) to the heart, which leads to decreased oxygen demands on the heart

Therapeutic Use:
Acute angina attack
Prophylaxis of chronic stable or variant angina

Precautions:
Contraindicated in clients with head injury
Hypotensive risk with antihypertensive medications
Contraindicated if taking erectile dysfunction me –> life threatening hypotension

Side effects:
HA
orthostatic hypotension
Reflex tachycardia
Tolerance

Interventions & Education:
Nitrostat/Nitrolingual
-administer sublingual, rest for 5 min. If pain not relieved by first table call 911, then take a second tablet. May use up to 3 tablets taken 5 min apart.
-keep in dark container; Don’t shake (forms bubbles)
-Nitrolingual may be used prophylactically 5 go 10min before exercise
-replace every 6 months
-wear medical alert identification
Nitro-Bid (topical)
-wear gloves for administration
-do not massage or rub area
-apply to area without hair (chest, tank, or upper arm preferable)
-cover the area where the patch is placed with a clear plastic wrap and tape in place
-gradually reduce the dose and frequency of application over 4-6 weeks
Nitro-Dur (transdermal)
-skin irritation may alter med absorption
-optimal locations for patch are upper chest or side; pelvis; and thinner, upper arm
-rotate skin sites, usually worn for 12-14 hr then removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Antidysrhtmic Agents: Medications, Action

A

Medications:
Adenosine, Amiodarone, Atropine

Action:
complex agents with multiple mechanisms of actions. they are classified according to their effects on the electrical conduction system of the heart (Class I, II, II, IV)

Precautions:
Toxicity major concern due to additive effects
Caution is needed when used with an AV block
Caution Is needed when using anticholinergic meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Adenosine: Therapeutic Use, Side Effects, Nursing Interventions

A

Therapeutic Use:
convert SVT to sinus rhythm

Side Effects:
flushing, nausea
bronchospasm, prolonged asystole

Nursing Interventions:
rapid IV (1-2 seconds) push
flush immediately w/ normal saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Amiodarone: Therapeutic Use, Side Effects, Nursing Interventions

A

Therapeutic Use:
V fib, unstable V tach

Side Effects:
bradycardia
cardiogenic shock
pulmonary disorders

Nursing Interventions:
incompatible with heparin
may be given in PO maintenance dose
monitor for respiratory complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Atropine: Therapeutic Use, Side Effects, Nursing Interventions

A

Therapeutic Use:
bradycardia, known exposure to chemical nerve agent, reduce secretions

Side Effects:
when used for life-threatening emergency, has no contraindications

Nursing Interventions:
monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Antilipemic Medications: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action: Aid in lowering LDL levels and increase HDL levels. Therapy includes, diet exercise, and weight control

Therapy Uses:
-primary hypercholesterolemia
-prevention of coronary events
-protection against MI and stroke in clients who have DM

Types of Medications:
-Statin
-cholesterol absorption inhibitors

Precautions:
-should be discontinued during pregnancy
-use with caution in renal dysfunction

Side effects:
-Muscle aches
-Hepatotoxicity
-Rhabdomyolysis
-Peripheral neuropathy

Interventions & Client Education:
-take meds in the evening (cholesterol synthesis increases)
-Monitor liver profile. Monitor renal profile if rhabdomyolysis is present
-Low-fat/High fiber diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Statin Medications: Action, Precautions, Nursing Interventions & Education

A

Action:
interfere with hepatic enzyme HMG-CoA to reduce formation of cholesterol precursors

Precautions:
-prolonged bleeding in client taking warfarin
-multiple drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDs, tetracycline, beta-blockers, gemfibrozil, glipizide glyburide, oral contraceptives, phenytoin

Interventions & Education:
-do not administer w/ grapefruit juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Cholesterol Absorption Inhibitors: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education

A

Action:
Inhibits the absorption of cholesterol secreted in the bile and from food. Often used in combination with other antilipemic meds

Medications:
Ezetimibe

Interventions & Education
-take 2 hr before or 4 hr after other antilipemics
-risk of liver damage increased when combined with statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Respiratory Inhalation Medication Guidelines

A
  1. Advise to take the beta2 agonist before the inhaled glucocorticoids to increase steroid absorption
  2. Instruct on procedures for inhalation
    - remove the mouthpiece cap
    -if appropriate for medication, shake containers stand up or sit upright; exhale deeply
    -place the mouthpiece bw teeth, and close lips tightly around the inhaler
    - while breathing in, press down on the inhaler to activate and release the medication; continue breathing in slowly for several more seconds (slow, long, steady inhalation is better than quick, short breaths)
    -Hold breath for 5-10 seconds
    -Breathe in/out normally
  3. Examine for mouth irritation
  4. Perform frequent oral care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Beta2 Adrenergic Agonists: Action, Medications, Precautions, Side effects, Interventions & Education

A

Action:
-promote bronchodilator by activating beta2 receptors in bronchial smooth muscle

Medications:
Albuterol, Formoterol/Salmeterol, Terbutaline

Precautions:
-contraindicated for clients w tachydysrhythmias
-caution: DM, hyperthyroidism, heart disease, HTN, angina
-Beta blockers will reduce effects
-MAOIs will increase effects

Side effects:
-tachycardia, palpitations
-tremors

Interventions & Client Education:
-caution against using salmeterol more frequently than every 12 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Albuterol: Route/Onset, Use

A

Route/Onset:
inhaled (short-acting)
5-15 min

Use:
acute bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Formoterol/Salmeterol: Route/Onset, Use

A

Route/Onset:
inhaled (long-acting)

Formoterol: onset- 1-3 min; duration 10 hr
Salmeterol: onset: 10-20 min; duration: 12 hr

Use:
long-term control of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Terbutaline: Route/Onset, Use

A

Route/Onset:
oral (long-acting)

Use:
long-term control of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Methylxanthines: Action, Medications, Therapeutic Use, Precautions, Interventions & Education

A

Action:
Relaxation of bronchial smooth muscle, resulting in bronchodilation

Medications:
-aminophylline
-theophylline

Therapeutic Use:
-relief of bronchospasm
-long term control of asthma

Precautions:
-contraindicate w/ active peptic ulcer disease
-caution: DM, hyperthyroidism, heart disease, HTN, angina
-do not mix parenteral form with other meds
-phenobarbital and phenytoin decrease theophylline levels
-caffeine, furosemide, cimetidine, fluoroquinolone, acetaminophen, and phenylbutazone falsely elevate therapeutic levels

Side effects:
-irritability and restlessness
-toxic effects: tachycardia, tachypnea, seizures

Interventions & Education:
-monitor therapeutic levels for aminophylline and theophylline
-avoid caffeine
- monitor for signs of toxicity (toxic >20)
-smoking will decrease effects
-alcohol abuse will increase effects

Tx of Toxicity:
1. stop parenteral infusion
2. Activated charcoal to decrease absorption in oral overdose
3. Lidocaine for dysrhtmias
4. Diazepam to control seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Inhaled Anticholinergics: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education

A

Action:
muscarinic receptor blocker resulting in bronchodilation

Medications:
-ipratroprium
-tiotroprium

Therapeutic Uses:
-prevent bronchospasm
-manage allergen or exercise induced asthma
-COPD

Precautions:
-contraindicated for clients with peanut allergy (contains soy lecithin)
-Use extreme caution with narrow-angle glaucoma and BPH
-Do not use for tx of acute bronchospasms

Side effects:
-Dry mouth
-Urinary retention

Interventions & Client Education:
-instruct client that max effects may take up to 2 weeks
-shake inhaler well before administration
-when using 2 different inhaled medications, wait 5 min in bw
-if administered via nebulizer, use within 1 hr of reconstitution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

-troprium suffix

A

Inhaled Anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Glucocorticoids: Action, Medications, Therapeutic Uses (short and long term), Precautions, Side effects, Interventions & Education

A

Action:
precent inflammatory response by suppression of airway mucus production, immune responses, and a adrenal function

Short Term Therapeutic Uses:
-IV agents: status asthmaticus
-Oral: tx of symptoms following an acute asthma attack

Long Term Therapeutic Uses:
-Inhaled: prophylaxis of asthma
-Oral: tx of chronic asthma

Precautions:
-clients who have DM may require higher doses
-never stop medication abruptly

Side effects:
-euphoria, insomnia, psychotic behavior
-hyperglycemia
-peptic ulcer
-fluid retention
-withdrawal symptoms
-increased appetite

Interventions & Education:
-assess client activity and behavior
-administer medication w/ meals
-teach symptoms to report
-do not take with NSAIDs
-teach client about gradual reduction of does to prevent Addisonian Crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Leukotriene Modifiers: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education

A

Action:
Prevent effects of leukotriene, resulting in decreased inflammation, bronchoconstriction, airway edema, and mucus production

Medications:
Montelukast
Zileuton
Zafirlukast

Therapeutic Uses:
1.Long-term management of asthma in adults and children
-monetelukast can be given to clients over age 1
-zileuton can be given to clients 12 years and older
-zafirlukast can be given to clients 5 years and older
2. Prevention of exercise-induced bronchospasm

Precautions:
-do not use for acute asthma attack
-zileuton or zafirlukast: high risk of liver disease, increased warfarin effects, and theophylline toxicity
-phenobarbital will decrease circulating levels of mentelukast
-chewable tablets contain phenylalanine

Side Effects:
-Elevated liver enzymes (zileuton or zafirlukast)
-Warafrin and theophylline toxicity (zileuton or zafirlukast)
-May increase levels of beta blockers leading to hypotension and bradycardia (propranolol)

Interventions & Education:
-Never abruptly substitute for corticosteroid therapy
-teach client to take daily in the evening
-do not decrease or stop taking other prescribed asthma drugs until instructed
-if using oral granules, pour directly into mouth or mix with cold soft foods (never liquids)
-use open packets within 15 min of taking medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Antiussives, Expectorants, Mucolytics : Precautions, Side effects, Interventions & Education

A

Precautions:
-only saline solutions should be used in children younger than 2 years
-opioid antitussives have potential for abuse
-caution with OTC meds (potentiate effects)

Side Effects:
-drowsiness
-dizziness
-aspiration and bronchospasm risk with mucolytics
- constipation

Interventions & Education:
-Monitor cough frequency, effort, and ability to expectorate
-monitor character and tenacity of secretions
-auscultate for adventitious lung sounds
-teach client why multiple therapies are needed
-promote fluid intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Antiussives: Action, Medications Therapeutic Use

A

Action:
suppress cough through action in the CNS

Medications:
hydrocodone, codeine

Therapeutic Use:
chronic nonproductive cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Expectorant: Action, Medication Therapeutic Use

A

Action:
promote increased mucus secretion to increase cough production

Medication:
guaifenesin

Therapeutic Use:
often combined with other agents to manage respiratory disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Mucolytics: Action, Medications Therapeutic Use

A

Action:
Enhance the flow of secretions in the respiratory tract

Medications:
acetylcysteine, hypertonic saline

Therapeutic Use:
-acute and chronic pulmonary disorders with copious secretions
-cystic fibrosis
-antidote for acetaminophen poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Decongestants: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education

A

Action:
stimulate alpha1 adrenergic receptors, causing reduced inflammation of nasal membranes

Medications:
phenylephrine, pseudoephedrine, naphazoline

Therapeutic Use:
-allergic rhinitis
-sinusitis
-common cold

Precautions:
-products contain pseudoephedrine should not be used longer than 7 days
-contraindicated in clients with closed-angle glaucoma
-use cautiously for clients who have HTN, CAD, or dysrhythmias

Side Effects:
-dry mouth
-restlessness
-insomnia

Interventions & Education:
-use no longer than 3-5 days to avoid rebound congestion
-topical agents work faster and have a shorter duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Antihistamines: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education

A

Actions:
decrease allergic response by competing for histamine receptor sites

Medications: diphenhydramine, loratadine, cetirizine, fexofenadine, desloratadine

Therapeutic Use:
Relieve/prevent hypersensitivity reactions

Precautions:
-use cautiously in clients with HTN, glaucoma, peptic ulcer disease, and urinary retention
-children may have symptoms of excitation, hallucinations, incoordination, and seizures
-avoid alcohol intake

Side Effects:
-anticholinergic effects
-drowsiness

Interventions & Education:
-assess for hypokalemia
-monitor BP
-teach client to manage anticholinergic effects
-advise to take at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Oral Hypoglycemics: Precautions, Side effects, Interventions & Education

A

used in conjunction with diet and exercise to control glucose levels in clients who have type 2 DM

Precautions:
-caution in clients with renal, hepatic, or cardiac disorders
-generally avoided during pregnancy and lactation (instruct client to discuss with prescriber)

Nursing Interventions:
-teach signs and management for hypoglycemia, especially sulfonylureas
-encourage diet and exercise to follow American Diabetes Associate recommendations
-monitor HbA1c
-refer to diabetic nurse educator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Oral Hypoglycemic: Acarbose & Miglitol—Action & Precautions

A

Action:
slows carbohydrate absorption and digestion

Precautions:
contraindicated in clients w/ intestinal disease due to increased gas formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Oral Hypoglycemic: Metformin—Action & Precautions

A

Action:
reduces gluconeogenesis; makes muscle tissue more sensitive to insulin

Precautions:
-withold 48 hr prior to and 48 hr after a test with contrast media
-contraindicated in clients with severe infection, shock, hypoxic conditions

75
Q

Oral Hypoglycemic: Sitagliptin—Action & Precautions

A

Action:
promotes release of insulin, lowers glucagon secretion, and slows gastric emptying

Precautions:
caution with impaired renal function–dose will be reduced

76
Q

Oral Hypoglycemic: Repaglinide, Nateglinide—Action & Precautions

A

Action:
stimulates beta cells to release insulin

Precautions:
caution with impaired renal function–dose will be reduced

77
Q

Oral Hypoglycemic: Glipizide, Glyburide—Action & Precautions

A

Action:
promotes release of insulin from the pancreas

Precautions:
-extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders
-can cause disulfiram-like reaction with alcohol ingestion

78
Q

Oral Hypoglycemic: Rosiglitazone, Pioglitazone—Action & Precautions

A

Action:
decreases cellular insulin resistance

Precautions:
exacerbations of HF

79
Q

Insulin: Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Therapeutic Uses:
1.Glycemic control of DM to prevent complications
2. Clients taking oral hypoglycemic agents may require insulin therapy when:
-undergoing diagnostic tests; NPO status
-Pregnant
-severe kidney or liver disease is present
-oral agents are inefficient
-tx of hyperkalemia

Precautions:
-when mixing regular w/ NPH insulin, draw up regular first
-do not mix other insulins with lisper, glargine, or combination 70/30
-only regular insulin is given IV (only in normal saline)
-administer glargine at bedtime

Side Effects:
-hypoglycemia/hyperglycemia
-lipodystrophy

Interventions & Client Educations:
-monitor serum glucose levels before meals and at bedtime or patterned schedule–specific to client
-roll vial of insulin (except regular) to mix; do not shake
-instruct client to rotate injection sites to prevent lipodystrophy
-teah signs and management for hypo/hyperglycemia
-encourage diet and exercise to follow ADA recommendations
- monitor HbA1c
-refer to diabetic nurse educator

80
Q

Forms of insulin: onset, peak, duration

A

Rapid-Acting (Lispro)
-onset: 15-30 min
-peak: 0.5-2.5 hr
-duration: 3-6 hr

Short-Acting (regular)
-onset: 0.5-1 hr
-peak: 1-5 hr
-duration: 6-10 hr

Intermediate: NPH
-onset: 1-2 hr
-peak: 6-14 hr
-duration: 16-24

Long-Acting (Glargine)
-onset: 70 min
-peak: None
-duration: 24 hr

81
Q

Glucagon: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
indicates regulatory processes to promote breakdown of glycogen to glucose in the liver, resulting in increased serum glucose levels

Therapeutic Uses:
Emergency tx of severe hypoglycemia

Precautions:
N/V
Rebound hypoglycemia

Interventions & Education:
-administer meds for unresponsive client
-monitor blood glucose levels
-instruct client to self-monitor for early signs of hypoglycemia
-instruct client to wear medical alert ID
-advise client to teach family how to administer med
-provide carbs when client awakens from hypoglycemic reaction

82
Q

Levothyroxine/T4: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
stimulate metabolism of all body system by accelerating the rate of cellular oxygenation

Therapeutic Uses:
-hypothyroidism
emergency tx of myxedema coma

Precautions:
overmedication can result in signs of hyperthyroidism

Side Effects:
-Tachycardia
-Restlessness
-Diarrhea
-Weight loss
-Decreased bone density
-Heat intolerance
-Insomnia

Nursing Interventions & Education
-monitor cardiac system
-therapy initiated w/ low doses; advance to higher dosages while monitoring lab values
-monitor T4 and TSH levels
-take in early morning

83
Q

Methimazole: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
inhibits synthesis of thyroid hormone

Therapeutic Uses:
-Hyperthyroidism
-Preoperative thyroidectomy
-Thyrotoxic crisis
-Thyroid Storm

Precautions:
-administer with caution to clients who have bone marrow depression, hepatic disease, or bleeding disorders
-discontinue prior to radioactive iodine uptake testing

Side Effects:
-skin rash, pruritis
-abnormal hair loss
-GI upset
-paresthesias
-preorbital edema
-joint and muscle pain
-jaundice
-agranulocytosis
-thrombocytopenia

Interventions & Education:
-administer w/ food at the same time each day
-increase fluids to 3 L/day
-instruct client to avoid OTC products containing iodine
-instruct client to take med as prescribed
-if discontinued, must be tapered off
-monitor client for therapeutic response: weight gain, decreased pulse, BP, and T4 levels
-monitor client for signs of overdose and sighs of hypothyroid: periorbital edema, cold intolerance, mental depression

84
Q

Posterior Pituitary Hormones/ Growth Hormones: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
Increase production of insulin-like growth factor throughout the body

Therapeutic Use:
-Tx growth hormone deficiencies
-Turner’s syndrome

Precautions:
-contraindicated in clients who are severely obese
-therpay must be discontinued prior to epiphyseal closure
-avoid concurrent use of glucocorticoids

Side Effects:
-hyperglycemia
-hypothyroidism

Nursing Interventions:
-monitor growth patterns
-reconstitute meds per manufacturer instructions
-administer subq per protocol
-dose is individualized

85
Q

Posterior Pituitary Hormones/ Antidiuretic Hormones: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
promote reabsorption of water with the kidneys; vasoconstriction of vascular smooth muscle

Medications:
-Desmopressin (DDAVP): oral, intranasal, Subq, IV
-Vasopressin: intranasal, Subq, IV

Therapeutic Uses:
-Diabetes insipidus
-Cardiac arrest
-Nocturnal enuresis
-Hemophilia (Desmopressin)

Precautions:
contraindicated in clients with chronic nephritis or high risk for myocardial infarction

Side Effects:
-hyponatremia
-seizures
-coma

Interventions & Education:
-monitor urine specific gravity
-monitor BP
-monitor urinary output
-prevent hyponatremia due to water intoxication
-instruct for use of nasal spray

86
Q

Adrenal Hormone Replacement: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
anti-inflammatory, suppresses immune response

Medications:
Dexanethasone, Hydrocortisone sodium succinate, Fludrocortisone acetate, Prednisone

Therapeutic Uses:
-acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
-Inflammation, allergic reactions, cancer

Precautions:
-contraindicated in clients who have systemic fungal infection
-caution in clients who have HTN, gastric ulcers, diabetes, osteoporosis
-requires higher doses in acute illness or extreme stress

Side effects
-adrenal suppression when administered for inflammation, allergic reactions
-infection
-hyperglycemia
-osteoporosis
-GI bleeding
-fluid retention

Interventions & Education
-do not skip doses
-monitor BP
-monitor fluid and electrolyte balance, weight, and output
-monitor for signs of bleeding and GI discomfort
-teach client to take calcium supplements and maintain vitamin D levels
-give wit food
-taper off dose regimen when discontinuing
-provide immunoprotection

87
Q

Administration of Blood Products: Interventions & Education

A
  1. Client ID, name, and blood type must be verified by two nurses
  2. Prior to administration, assess baseline vital signs, including temp
  3. Establish IV access, 18-20 gauge catheter
  4. Must have 0.9% sodium chloride primed tubing
  5. For the first 15 min, stay with the client and infuse slowly, monitoring for any reaction. If a reaction occurs, perform the following interventions
    - stop blood immediately and take vital signs
    -infuse 0.9% sodium chloride
    -notify the provider
    -follow the facility policy (send urine sample, CBC, and bag and tubing to lab for analysis)
    -Complete infusion of product within 4 hr
88
Q

Administration of Whole Blood: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction

A

Time Completed:
2-4 hours

Action/Therapeutic Use:
Replace Volume, Hemorrhage, Surgery, Trauma, Burns, Shock

Monitor for Reaction:
-acute hemolytic
-febrile
-anaphylactic
-mild allergic
-hypovolemia
-sepsis

89
Q

Administration of Packed RBCs: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction

A

Time Completed:
2-4 hrs

Action/Therapeutic Use:
-increase available RBC
-severe anemia
-hemolytic anemia

Monitor for Reaction:
-acute hemolytic
-febrile
-anaphylactic
-mild allergic
-sepsis

90
Q

Administration of Platelets: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction

A

Time Completed:
-15-20 minutes

Action/Therapeutic Use:
-increase platelet count
-active bleeding
-thrombocytopenia
-aplastic anemia
-bone marrow suppression

Monitor for Reaction:
-febrile
-sepsis

91
Q

Administration of Albumin: Action/ Therapeutic Use, What to Monitor for Reaction

A

Action/Therapeutic Use:
5%- expand volume via oncotic changes, hypovolemia, hypoalbuminemia
10%- Burns, severe nephrosis, hemolytic disease of the newborn

Monitor for Reaction:
Risk for hypervolemia and pulmonary edema

92
Q

Epoetin Alfa: Action, Therapeutic Uses, Side Effects, Interventions

A

Action:
stimulate the bone marrow to synthesize the specific blood cells

Therapeutic Uses:
-stimulate RBC production
-anemia r/t to: chronic kidney disease, Retrovir therapy, chemotherapy

Side Effects:
HTN

Interventions:
Subq IV
Dp not agitate vial
-monitor hematocrit and hemoglobin\

93
Q

Iron Preparation: Action & Medications– Oral & Parenteral

A

Action: Treat iron deficiency

Medications/Therapeutic. Uses:
1. Oral
-Ferrous sulfate
-Ferrous gluconate
-Ferrous fumarate
-dilute liquid preparations with juice or water and administer with a plastic straw or medication dosing syringe (avoid touching teeth)
-encourage orange juice fortified with vitamin C (facilitates absorption)
-avoid antacaids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hr after administration due to decreased absorption
-monitor the client for constipation and GI upset

2.Parenteral
-Iron dextran
-used for client unable to take oral meds
-intramuscular: use large-bore needle (10-20 gauge, change needle after drawing up from vial, Z-track-ventrogluteable preferable, never in deltoid muscle
-do not massage injection site
-IV (preferred over IM, administer over a small test does–25 mg over 5 min, observe pt for 15 min, then slowly administer additional preparation, use manufacturer’s recommendation for specific product

94
Q

Anticoagulant: Medications & Therapeutic Uses

A

Medications & Therapeutic Uses
1. Parenteral (enoxaparin, heparin)
-stroke, pulmonary embolism, DVT, cardiac Cath, MI, DIC
2. Oral (warfarin)
-Venous thrombosis, prevent thrombus formation for clients who have A fib or prosthetic heart valves, prevent current MI, prevent TIA
3. Oral (rivaroxaban)
-reduce risk of stroke/embolism for client with nonvalvular A Fib
4. Oral (dabigatran etexilate)
–reduce risk of stroke/embolism for client with nonvalvular A Fib
-prevention of DVT and PE in clients undergoing total hip or knee arthroplasty

95
Q

Anticoagulant: Precautions & Side Effects

A
  1. Parenteral
    -administer Subq or IV
    -incompatible with many meds (any bicarb bas)
    -avoid NSAIDs, aspirin, or meds containing salicylates
  2. Oral (warfarin)
    -not safe for pregnant women
    -contraindications: thrombocytopenia, vitamin K deficiency, liver disease, alcohol disease disorder
    -decreased effects with phenobarbital, carbamazepine phenytoin, and oral contraceptives
    -food sources high in vitamin K may decrease effects
  3. Oral (dabigatran)
    -caution if changing anticoagulation med
    -discontinue 1-2 days prior to surgical procedures
  4. Oral (rivaroxaban)
    -No antidote for severe bleeding (prepare to administer activated charcoal to prevent further absorption)
    -wait 6 hr before restarting after removal of epidural catheters

Side Effects:
1. Parenteral
-Hemorrhage
-Heparin induced thrombocytopenia
-toxicity/overdose

  1. Oral (warfarin)
    -hemorrhage
    -toxicity/overdose

3.. Oral (dabigatran, rivaroxaban)
-bleeding
-GI discomfort (dabigatran)
-Bleeding, bruising, HA, or eye pain (rivaroxaban)

96
Q

Anticoagulant: Interventions & Education

A
  1. Parenteral
    -Heparin: Monitor aPTT every 4-6 hr for IV administration
    -monitor for signs of bleeding
    -safety precautions to prevent bleeding
    -administer subs heparin to abdomen, 2 inches from umbilicus (do not aspirate or massage)
    -rotate injection sites and observe for bleeding or hematoma
    -administer protamine sulfate gor heparin toxicity (1 mg neutralizes 100 units of heparin)
  2. Oral (warfarin)
    -administer once daily
    -monitor INR or PT
    teach client that bleeding risk remains up to 5 days after discontinued therapy
    -teach client to avoid NSAIDs and medications with asprin
    -teach client to wear medical alert bracelet
    -client may self-monitor for PT/INR using a coagulation monitor
    -teach measures to prevent injury and bleeding
    -administer vitam K for warfarin toxicity
    -garlic, ginger, gingko (may increase bleeding), and ginseng (blocks effects of warfarin)
    -glucosamine interferes with warfarin and increases bleeding risk
    -avoid alcohol
  3. Oral (dabigatran, rivaroxaban)
    -teach client to take medication daily and avoid skipping doses
    -if a dose is missed, it should not be taken within 6 hr of the next scheduled dose
    -tablets should not be crushed, broken, or chewed
    -teach client to avoid NSAIDs and meds with aspirin
    teach clients to monitor for signs of GI bleeding
97
Q

Anti-platelet Medications: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
prevent platelets from aggregating (clumping together) by inhibiting enzymes and factors that normally promote clotting

Medications:
aspirin, abciximab, clopidogrel, ticlopidine, pentoxifyline, dipyridamole

Therapeutic Uses:
-prevention of acute MI or acute coronary syndromes
-prevention of stroke
-intermittent claudication

Precautions:
-contraindicated in thrombocytopenia
-caution with peptic ulcer disease

Side Effects:
-prolonged bleeding
-gastric bleeding
-thrombocytopenia

Interventions & Education:
-monitor for signs of prolonged bleeding
-teach client o report tarry stool, ecchymosis

98
Q

Thrombolytic Medications: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
dissolve clots that have already formed by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors

Medications:
alteplase, tenecteplase, reteplace

Therapeutic Uses:
-acute MI
-DVT
-massive pulmonary emboli (PE)
-Ischemic stroke (alteplase)

Precautions:
-contraindicated for intracranial hemorrhage, active internal bleeding, aortic dissection, and brain tumors
-use caution when using in clients who have severe HTN
-concrurent use of anticoagulants or anti platelet meds increases risk for bleeding

Side Effects:
-serious bleeding risks from recent wounds, puncture sites, weakened vessels
-hypotension
-possible anaphylactic reaction

Interventions & Education
-administration must take place within 4-6 hr of symptom onset
-continuous monitoring is required
-clients will begin anticoagulant therapy to prevent repeated thrombotic event

99
Q

Antacids: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
neutralize gastric acid and inactivate pepsin

Therapeutic Uses:
-peptic ulcer disease
-GERD

Precautions:
-prolonged use can result in hypophosphatemia
-can decrease absorption of certain medications

Interventions & Education
-clients who have renal impairment should only use albumin based preparations
-other meds should be taken 1 hr before or after antacids
-older adults with poor nutritional status are at high risk of hypophosphatemia
-do not self prescribe antacid use for longer than 2 weeks

100
Q

Antacids Medications & Side Effects

A

Albumin hydroxide: side effects
-constipation
Hypophosphatemia

Magnesium Hydroxide (Milk of Magnesia): side effects
-diarrhea
-renal impairment
-hypermagnesemia

Sodium Bicarbonate: side effects
-constipation

101
Q

Antisecretory/Blocking Agents: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Action:
Prevent or block selected receptors within the stomach

Medications:
-PPI (-“azole”)
-Histamine receptor agonists (-“idine)

Therapeutic Uses:
-gastric and duodenal ulcers
-GERD
-zollinger Ellison syndrom

Precautions
-can increase the risk of osteoporosis with long term use, pneumonia in COPD clients and acid rebound (PPI)
-decreased libido/impotence (H2 blocker)
-lethargy, depression, confusion (H2 blocker)

Interventions & Education
-teach client to seek appropriate care (may take OTC preparations)
-review meds regimen and teach client about precautions r/t to time of administration as required
-do not crush, chew, or break tablets
-notify prescriber of any sign of GI bleeding
-modify diet as prescribed

102
Q

Sucralfate: Action, Therapeutic Use, Precautions, Interventions & Education

A

Action:
adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hr; has no systemic effects

Therapeutic Use:
-gastric and duodenal ulcers
-GERD

Precautions:
-chronic renal failure

Nursing Interventions:
-administer on an empty stomach at least 1 hr before meals
-do not administer within 30 min of antacids`

103
Q

Antiemetics: Action, Therapeutic Use, Medications

A

Action:
multiple classifications of medications that affect the GI tract or the vomiting center of the brain to reduce n/v

Therapeutic Uses:
-postoperative
-chemotherapy
-n/v associated with disease process

Medications:
-promethazine, metoclopramide, ondansetron, scopolamine

104
Q

Promethazine: Side Effects, Precautions, Interventions

A

Side Effects:
drowsiness, anticholinergic effects, severe respiratory depression in children <2, EPS, potentiate effects when given narcotics

Precautions:
cardiovascular and hepatic disease

Interventions:
Monitor VS, safety precautions, IM (large muscle)

105
Q

Metoclopramide: Side Effects, Precautions, Interventions

A

Side Effects:
Drowsiness, diarrhea, restlessness, EPS, tardive dyskinesia

Precautions:
Seizures, cardiovascular disease, pheochromocytoma

Interventions:
instruct client about rapid GI emptying
discontinue with signs of EPS

106
Q

Ondansetron: Side Effects, Precautions, Interventions

A

Side Effects:
Headache, EPS

Precautions:
Risk for dysthymia, do not administer to clients with prolonged QT interval

Interventions:
administer tablets 30 min prior to chemotherapy and 1-2 hr before radiation

107
Q

Scopolamine: Side Effects, Precautions, Interventions

A

Side effects:
blurred vison, sedation, anticholinergic effects

Precautions:
-increased mydriatic effect causes increased ocular pressure
-use with caution for client with glaucoma

Interventions:
-apply transdermal patches behind ear
-use lubricating eye drops

108
Q

Antidiarrheals: Action, Medications, Precautions, Side Effects, Interventions & Education

A

Action:
Activate opioid receptors in the GI tract to decrease intestinal motility and to increase the absorption of fluid and sodium in the intestine

Medications:
-Diphenoxylate plus atropine, Loperamide, Paregoric

Therapeutic Use:
-management of diarrhea

Precautions:
-increased risk ofmegacolon for clients who have IBS
-contraindicated in clients with COPD (paregoric)

Side Effects:
constipation, drowsiness, dry mouth, blurred vision

Interventions & Education:
-monitor F&E
-avoid caffein intake (increases GI motility)

109
Q

Stool softeners: Action, Medications &Therapeutic Uses, Precautions, Side Effects, Interventions & Client Education

A

Action:
facilitates peristalsis and bowel movements

Medications and Therapeutic Uses:
-Psyllium: decrease diarrhea (bulk-forming)
-Docusate sodium: relieve contipation (surfactant)
-Bisacodyl: pre procedure colon evacuation (stimulant)
-Magnesium Hydroxid (Milk of Magnesia): prevent painful elimination (low-dose osmotic); promote rapid evacuation (high-dose osmotic)

Precautions:
-contraindicated in clients with fecal impaction, bowel obstruction
-most laxatives are contraindicated in clients with ulcerative colitis and diverticulitis (psyllium may be used)

Side Effects:
-F&E imbalances, GI irritation, can lead to toxic levels of Mg, fluid retention (laxative w/sodium)

Interventions & Client Education:
-contraindicated with fecal impaction, bowel obstruction, and acute surgical abdomen
-encourage regular exercise and promote regular bowel elimination
-monitor for chronic laxative use/abuse
-provide adequate fluid and fiber intake to avoid obstruction

110
Q

Diuretics: Action, Medication, Therapeutic Use, Precautions, Side Effects, Interventions & Education

A

Action:
increase the amount of fluid excretion via the renal system

Medications:
Loop: furosemide, bumetanide
Thiazide: hydrochlorothiazide, chlorothiazide
Potassium sparing: spironolactone, triamterene

Therapeutic Use:
-pulmonary edema caused by HF
-edema unresponsive to other diuretics
-HTN unresponsive to other diuretics

Precautions:
-use cautiously in clients who have DM
-contraindicated in pregnancy
-NSAIDs reduce diuretic effect

Side Effects:
Loop and thiazide:
-hypovolemia, ototoxicity (loop), hypokalemia,, hyponatremia, hyperglycemia, digoxin toxicity, lithium toxicity
Potassium-sparing:
-hyperkalemia, endocrine effects (impotence, menstrual irregularities)

Interventions & Éducation
-Monitor I&O, VS, and F&E imbalances
-administer early morning to prevent nocturne
-instruct clients taking loop/thiazide to increase intake of foods high in potassium
-instruct clients taking potassium-sparing diuretics to avoid foods high in potassium such as salt substitutes

111
Q

Osmotic Diuretic–Mannitol: Action, Medication, Therapeutic Use, Precautions, Side Effects, Interventions & Education

A

Action:
pull fluid back into the vascular and extravascular space by increasing serum osmolality to promote osmotic changes

Therapeutic Use:
prevent renal failure r/t hypovolemia
decrease ICP r/t to cerebral edema
decrease intraocular pressure

Precautions:
-ues with caution in HF

Side effects:
pulmonary edema, F&E imbalances, thirst, dry mouth

Interventions & Client Education:
-monitor daily weight, I&O, electrolytes, signs of hypovolemia, & neurological status

112
Q

Urinary Hesitancy meds: Precaution, Side Effects, Interventions & Education

A

Precautions:
Tamulosin–
-must rule out bladder cancer prior to administering
-combined use with cimetidine may facilitate toxicity
-use cautiously with meds causing hypotension (such as sildenafil)
Bethanechol–
-contraindicated for clients who have UTI
-contraindicated for clients with hypotension or decreased cardiac output (may cause bradycardia)

Side Effects:
Tamulosin–
-decreased libido, HA, and dizziness
Bethanechol
-excessive salivation, abdominal cramps, diarrhea

Interventions & Éducation
Tamulosin–
-take 30 min after meal at same time each day
-if dose is missed for several days, restart at the lowest dose
-can cause orthostatic hypotension
Bethanechol–
-administer on empty stomach

113
Q

Anticholinergic Medications for Overactive Bladder: Action: Precaution, Side Effects, Interventions & Education

A

Action:
antispasmodic actions to decrease detrusor muscle spasms and contractions

Meds:
-oxybutynin, tolterodine, darifenacin, solifenacin

Therapeutic Use:
Urinary incontinence
Urinary urgency and frequency

Precautions:
- Do not use for clients who have intestinal obstruction.
-Use with other anticholinergics can increase anticholinergic effects.
-Risk for cognitive impairment in older clients.

Side Effects:
Anticholinergic symptoms
Drowsiness
Dyspepsia

Interventions & Education:
-Instruct client to manage anticholinergic side effects.
-Instruct client to report constipation lasting longer than 3 days.

114
Q

Sexual Dysfunction: Actions, Medications, Therapeutic Uses, Precautions, Interventions & Education

A

Action:
Enhances the effect of nitric oxide to promote relaxation of penile muscles, allowing increased blood flow to produce an erection

Medications:
Sildenafil
Tadalafil
Vardenafil

Therapeutic Uses:
-Erectile dysfunction
-Less commonly used in the treatment of pulmonary arterial hypertension

Precautions/Interactions:
1. Contraindicated for clients taking nitrate drugs, alpha blockers for BPH, or antihypertensives.
2. Contraindicated for clients who have history of stroke, hypo/hypertension, or heart failure.

Side/Adverse Effects:
Hypotension
Priapism (erection lasting longer than 4 hr)
Vision impairment
Hearing loss
Headache
Flushing

Interventions and Client Education
1. Administer 1 hr before sexual activity; do not use more than once daily.
2. Instruct client to notify provider of all medications currently taken, including herbal preparations.
3. Instruct client to avoid intake of any organic nitrates.
4. Instruct client to stop taking medication and notify prescriber immediately for erection lasting longer than 4 hr or any loss of vision.

115
Q

Childhood Immunizations Include:

A

Dtap/Tdap, Hib, Rotavirus, IPV, MMR, Varicella, Seasonal influenza, Hep A & B, HPV–up to age 26

116
Q

Childhood Immunizations: Side Effects & Contraindications

A

DTaP, Tdap:
Side Effects: Fever, Irritability, Seizures
Containdications: Occurrence of seizures within 3 days of vaccine

Hib:
SE: Low-grade fever
Contraindication: Age younger than 6 weeks

Rotavirus:
SE: Irritability, diarrhea, vomiting, and intussusception
Contraindication: History of intussusception; Maximum age for the final dose is 8 months, 0 days

IPV:
SE: Anaphylactic reaction to neomycin, streptomycin, or polymyxin B

MMR:
SE: Joint pain, Anaphylaxis, Thrombocytopenia
Contraindication: Allergy to eggs, gelatin, or neomycin; Immunocompromised, pregnancy

Varicella:
SE:Vesicles on skin, Pruritus
Contraindications: Pregnancy, Allergy to gelatin and neomycin, Immunocompromised

Seasonal Influenza:
SE: fever
Contraindication:Nasal spray contraindicated for children younger than 2, adults older than 50 years, and clients who are immunocompromised; History of Guillain-Barré

Hep A & B
SE: Anaphylaxis
Contraindication: pregnancy (A); allergy to yeast (B)

Meningococcal vaccine:
Contraindication:History of Guillain-Barré

HPV:
Contraindication: Pregnancy, allergy to yeast

117
Q

Adult immunizations: Type and Schedule

A
  1. Tetanus booster:Every 10 years
  2. MMR: One or two doses at ages 19 to 49
  3. Varicella:Two doses if no history of disease
  4. Pneumococcal (PPSV): Once after age 65; Recommended for immunocompromised, COPD, living in long-term care facility
  5. Hepatitis A:Two doses for high-risk clients
  6. Hepatitis B:Three doses for high-risk clients
  7. Seasonal influenza:Annually
  8. Meningococcal vaccine: Students entering college;Adults older than 56 years; repeat every 5 years for high-risk clients
  9. Herpes zoster:Over age 60
118
Q

Aminoglycosides: Medications, Therapeutic Use, Precautions

A

Medications:
Amikacin, Gentamicin sulfate, Streptomycin

Therapeutic Use:
Septicemia, meningitis, pneumonia

Precautions:
1. High risk for ototoxicity, nephrotoxicity
2. Monitor creatinine and BUN
3. Monitor trough levels

119
Q

Cephalosporins: Medications, Therapeutic Use, Precautions

A

Medications:
Cephalexin, Cefaclor, Cefotaxime

Therapeutic Use:
-Upper respiratory, skin, urinary infections
-Used as prophylaxis for clients at risk

Precautions:
1.Cross-sensitivity with penicillins
2.Monitor for signs of Clostridium difficile

120
Q

Ciprofloxacin, Levofloxacin: Therapeutic Use, Precautions

A

Therapeutic Use:
-Bronchitis, chlamydia, gonorrhea, PID, UTI, pneumonia, prostatitis, sinusitis

Precautions:
-Caution with hepatic, renal, or seizure disorders

121
Q

Macrolides “thromycin”: Medications, Therapeutic Use, Precautions

A

Medications:
Azithromycin, Clarithromycin, Erythromycin

Therapeutic Use:
Upper respiratory infections, sinusitis, Legionnaires’ disease, whooping cough, acute diphtheria, chlamydia

Precautions:
1.Used for clients who have penicillin allergy
2.Administer with meals

122
Q

Nitrofurantoin: Therapeutic Use, Precautions

A

Therapeutic Use:
UTI

Precautions:
-Broad-spectrum
-Contraindicated in renal dysfunction
-Urine will have brown discoloration

123
Q

Penicillins: Therapeutic Use, Precautions

A

Therapeutic Use:
Pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic fever, GYN infections

Precautions:
Hypersensitivity with possible anaphylaxis

124
Q

Sulfonamides: Medications, Therapeutic Use, Precautions

A

Medications:
-Trimethoprim/sulfamethoxazole

Therapeutic Use:
UTI, bronchitis, otitis media

Precautions:
-Consume at least 3 L/day of fluid
-Use backup contraceptives
-Avoid sun exposure

125
Q

Tetracyclines: Medications, Therapeutic Use, Precautions

A

Medications:
-Doxycycline calcium, Tetracycline HCl

Therapeutic Use:
Fungal, bacterial, protozoal, rickettsial infections

Precautions:
1.Consume at least 3 L/day of fluid
2.Use backup contraceptives
3.Avoid sun exposure
4.Permanent tooth discoloration if given to children younger than 8 years

126
Q

Vancomycin: Therapeutic Use, Precautions

A

Therapeutic Use:
MRSA, bacterial, C. difficile infections

Precautions:
1.Contraindication: Allergy to corn
2.Caution: Ototoxicity, nephrotoxicity
3.Administer over 1 hr IV to prevent red man syndrome
4.Monitor trough levels

127
Q

Flucanazole: Therapeutic Use, Precautions

A

Therapeutic Use:
Candidiasis infections

Precautions:
1.Monitor hepatic and renal function
2.Refrigerate suspensions
3.Increased risk of bleeding for clients taking anticoagulants

128
Q

Hydroxychloroquine/ Quinine sulfate: Therapeutic Use, Precautions

A

Therapeutic Use:
1.Prevent malarial attacks, rheumatoid arthritis
2.Systemic lupus

Precautions:
1.Increased risk of psoriasis
2.Monitor for drug-induced retinopathy

129
Q

Metronidazole: Therapeutic Use, Precautions

A

Therapeutic Use:
Trichomoniasis and giardiasis, clostridium difficile, amebic dysentery, PID, vaginosis

Precautions:
1.Take with food
2.Do not consume alcohol during therapy or 48 hr after completion of regimen

130
Q

Isoniazid/Rifampin: Therapeutic Use, Precautions

A

Therapeutic Use:
1.Prevention and treatment of TB
2.Latent TB INH: 6 to 9 months
3.Active TB: multiple therapy up to 24 months

Precautions:
1.Risk of neuropathies and hepatotoxicity
2.Consume foods high in vitamin B6
3.Avoid foods with tyramine (INH)
4.Increased risk of phenytoin toxicity (INH)
5.Avoid alcohol
6.Discoloration of urine, saliva, sweat, and tears (rifampin)

131
Q

Acyclovir/Valacyclovir HCL: Therapeutic Use, Precautions

A

Therapeutic Use:
Genital herpes, shingles, HIV

Precautions:
1.Acyclovir and valacyclovir: administer with food
2.Increase fluid intake
3.Begin therapy with first onset of symptoms

132
Q

Bisphosphonates “-dronate”: Action, Medications, Therapeutic Use, Precautions, Side Effects Interventions & Education

A

Action:
Decrease the number and action of osteoclasts, resulting in bone resorption

Medications:
Alendronate: daily or weekly
Risedronate: daily, weekly, monthly
Ibandronate: monthly or every 3 months
Zoledronate: IV annually

Therapeutic Use:
1.Prevention and treatment of osteoporosis
2.Paget’s disease
3. Hypercalcemia related to malignancy

Precautions/Interactions:
1.Contraindicated during lactation.
2.Clients who have esophageal stricture or difficulty swallowing may only use zoledronate.
3.Absorption is decreased when taken with calcium supplements, antacids, orange juice, and caffeine.

Side/Adverse Effects:
Musculoskeletal pain, Esophagitis and GI discomfort, Jaw pain (zoledronate), Atrial fibrillation (zoledronate)

Interventions and Client Education:
1.Administer medication in the morning on an empty stomach.
2.Instruct client to consume at least 8 oz water (not carbonated).
3.Client must remain upright (sitting or standing) for 30 min after taking medication.
4.Consume adequate amounts of vitamin D.

133
Q

DMARDS: MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education

A

Medication:
Methotrexate, Hydroxychloroquine, Etanercept, Infliximab, Adalimumab

Therapeutic Use:
Slow joint degeneration and progression of rheumatoid arthritis

Precautions/Interactions:
Methotrexate: Contraindicated in pregnancy, kidney or liver failure, alcohol use disorder, or hematologic dyscrasias.

Side/Adverse Effects:
1.Methotrexate: Increased risk of infection, bone marrow suppression, GI ulceration
2. Hydroxychloroquine: retinal damage (blindness)

Interventions and Client Education:
1.Instruct client about measures to prevent infection.
2.Monitor liver function tests.
3.Instruct client to use reliable contraception.
4.Instruct client that initial effects may take 3 to 6 weeks, and full therapeutic effects may take several months.
5.Administer with food.
6.Instruct clients taking hydroxychloroquine about the critical importance of retinal examination every 6 months.

134
Q

Glucocorticoids (anti rheumatic): MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education

A

Medications:
Prednisone, Prednisolone

Therapeutic Use:
Provide symptomatic relief of inflammation and pain.

Precautions/Interactions:
1.Contraindicated in systemic fungal infection.
2.Do not administer live virus vaccines during therapy.
3.Should only be used for a short duration.

Side/Adverse Effects:
Risk of infection
Osteoporosis
Adrenal suppression
Fluid retention
GI discomfort
Hyperglycemia
Hypokalemia

Interventions and Client Education:
Do not skip doses.
Monitor blood pressure.
Monitor F&E balance and weight.
Monitor for signs of bleeding, GI discomfort.
Teach client to take calcium supplements and maintain vitamin D levels.
Give with food.
Never stop abruptly.
Provide immunoprotection.

135
Q

NSAIDS (anti rheumatic): MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education

A

Medications:
Ibuprofen, Indomethacin, Naproxen, Celecoxib

Therapeutic Use:
Provide rapid, symptomatic relief of inflammation and pain.

Precautions/Interactions:
1.Hypersensitivity to aspirin or other NSAIDs.
2.May increase the risk of MI and stroke (non-aspirin NSAIDS).
3.Nasal polyps increases risk of hypersensitivity reaction

Side/Adverse Effects:
GI discomfort
GI ulceration
Renal impairment
Photosensitivity

Interventions and Client Education:
Administer with food and full glass of water.
Avoid lying down for 30 min after administration.
Instruct client to use only as needed for symptoms to reduce risk of GI ulceration.
Instruct client to use sunscreen.

136
Q

Antigout: Medication &Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Therapeutic Use:
Chronic gouty arthritis (Allopurinol)
Acute gouty arthritis (Colchicine)

Precautions/Interactions:
1.Use caution in clients who have renal, cardiac, or gastrointestinal dysfunction.
2.Should not be combined with theophylline.

Side/Adverse Effects:
1.GI distress
2.Rash and fever (discontinue immediately)
3.Decreases the metabolism of warfarin

Interventions and Client Education:
1.Instruct client to avoid foods high in purines to reduce uric acid.
2.Monitor CBC and uric acid levels.
3.Instruct clients to avoid aspirin.
4.Administer with meals.

137
Q

Anti-anxiety: Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education

A

Medications:
1.Benzo: Alprazolam, Chlordiazepoxide, Diazepam, Lorazepam
2.Buspirone
3.Antidepressants: Venlafaxine, Duloxetine, Paroxetine, Escitalopram

Therapeutic Use:
1.Generalized anxiety disorder and panic disorder
2.Insomnia
3.Alcohol withdrawal
4.Induction of anesthesia

Precautions/Interactions:
1.Benzodiazepines are used with caution in clients who have substance use disorder and liver disease.
2.Venlafaxine, an SNRI, is contraindicated for clients taking MAOIs.

Side/Adverse Effects:
1.CNS depression
2.Paradoxical response (insomnia, excitation, euphoria)
3.Withdrawal symptoms (not with buspirone)
4.Risk of abuse and potential for overdose (benzodiazepines)

Interventions and Client Education:
1.Monitor vital signs.
2.Instruct clients to never abruptly discontinue medication.
3.Monitor clients for side/adverse effects.
4.Instruct clients to avoid alcohol.

138
Q

SSRI & SNRI: Medications, Precautions, Side Effects

A

Medications:
1. SSRI:Citalopram, Fluoxetine, Paroxetine, Sertraline
2.SNRI:Duloxetine,Venlafaxine

Precautions:
1.Avoid alcohol
2.Do not discontinue abruptly
3.Monitor for serotonin syndrome (agitation, confusion, hallucinations) within first 72 hr

Side/Adverse
Effects:
1.Weight gain
2.Sexual dysfunction
3.Fatigue
4.Drowsiness

139
Q

Tricyclic: Medications, Precautions, Side Effects

A

Medications:
Amitriptyline, Imipramine

Precautions:
1.Do not administer with MAOIs or St. John’s wort
2.Must avoid alcohol
3.Contraindicated for clients with seizure disorder

Side/Adverse
Effects:
1.Anticholinergic effects
2.Orthostatic hypotension
3.Cardiac dysrhythmias
4.Decreased seizure threshold

140
Q

MAOI:Medications, Precautions, Side Effects

A

Medications:
Isocarboxazid, Tranylcypromine, Phenelzine

Precautions:
1.Avoid foods containing tyramine
2.Antihypertensives have additive hypotensive effect
3.Contraindicated with SSRIs, tricyclics, heart failure, CVA, renal insufficiency

Side/Adverse
Effects:
1.CNS stimulation
2.Orthostatic hypotension
3.Hypertensive crisis with intake of tyramine, SSRIs, and tricyclics

141
Q

Antidepressants: Interventions & Client Education

A

1.Assess client for suicide risk.
2.Instruct client to take on daily basis and never miss a dose.
3.Instruct client about therapeutic effects and time of onset.
4.Instruct client to avoid discontinuing drug abruptly.
5.Instruct client to take SSRIs in the morning to minimize sleep disturbances.
6.Provide clients taking MAOIs a list of foods containing tyramine.
7.Advise clients to avoid taking other medications without consulting provider.

142
Q

Lithium Carbonate: Therapeutic Uses, Precautions, Side Effects, Intervention & Education

A

Therapeutic Uses:
1.Bipolar disorder
2.Alcohol use disorder
3.Bulimia
4.Schizophrenia

Precautions/Interactions:
1.Use cautiously in clients who have renal dysfunction, heart disease, hyponatremia, and dehydration.
2.NSAIDs will increase lithium levels.
3.Monitor serum sodium levels.

Side/Adverse Effects:
1.GI distress
2.Fine hand tremors
3.Polyuria
4.Hypothyroidism
5. Renal toxicity

Interventions and Client Education:
1.Monitor therapeutic levels.
2.Monitor serum sodium levels.
3.Instruct clients that therapeutic effects begin in 7 to 14 days.
4.Doses must be administered 1 to 3 times daily per provider prescription.
5.Provide nutritional counseling to include food sources for sodium.
6.Administer with food to decrease GI distress.

143
Q

Antipsychotic Medications: Medications Therapeutic Uses, Precautions, Side Effects, Intervention & Education

A

Medications:
1.Typical-Chlorpromazine, Fluphenazine, Haloperidol, Thiothixene
2.Atypical-Aripiprazole, Clozapine, Olanzapine, Paliperidone, Quetiapine, Ziprasidone

Therapeutic Use:
1.Acute and chronic psychosis
2.Schizophrenia
3.Manic phase of bipolar disorders
4.Tourette syndrome
5.Delusional and schizoaffective disorders
6.Dementia

Precautions/Interactions:
1.Contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, and severe hypotension.
2.Use with caution in clients who have glaucoma, paralytic ileus, prostate enlargement, or seizure disorder.

Side/Adverse Effects:
1.Typical:
-Sedation
-Extrapyramidal effects
-Anticholinergic effects
-Tardive dyskinesia
-Agranulocytosis
-Neuroleptic malignant syndrome
-Seizures
2.Atypical:
-Agranulocytosis
-Weight gain
-Diabetes
-Dyslipidemia
-Orthostatic hypotension
-Extrapyramidal effects

Interventions and Client Education:
Monitor for side effects within 5 hr to 5 days of administration.
Advise client of potential side effects.
Monitor CBC.
Encourage fluids.
Stop medication for signs of neuroleptic malignant syndrome.

144
Q

ADHD-Stimulants: Medications, Side Effects, Interventions & Client Education

A

Medications:
Dextroamphetamine and amphetamine, Methylphenidate

Side Effects:
Insomnia, Headache, Suppressed appetite,Abdominal pain

Interventions and client education:
1.Administer in early morning; give with or after meals.
2.Do not abruptly discontinue.
3.Monitor for signs of abuse.
4.Monitor for signs of agitation.

145
Q

ADHD-NonStimulants: Medications, Side Effects, Interventions & Client Education

A

Medications:
1.Atomoxetine
2.Guanfacine: may be used in treatment of Asperger’s syndrome

Side Effects:
GI upset, Insomnia, Mood swings

Interventions and client education:
1.Take medication daily.
2.Do not crush or chew.
3.Instruct client to immediately report worsening of anxiety, agitation.
4.Do not take with MAOIs.

146
Q

Sedative/Hypnotic Meds: Action, Medications, Therapeutic Use, Precautions, Side Effects, Intervention & Education

A

Action:
Slow neuronal activity in the brain to induce sedation/sleep

Medications:
1.Benzodiazepines-Lorazepam &Temazepam
2.Benzodiazepine-like medications-Zolpidem, Eszopiclone

Therapeutic Use:
1.Short-term insomnia
2.Difficulty falling or staying asleep

Precautions/Interactions:
1.Use cautiously in clients who have severe mental depression.
2.Avoid combined use with alcohol and medications that depress CNS function.

Side/Adverse Effects:
1.Amnesia
2.Respiratory depression
3.Daytime drowsiness and dizziness

Interventions and Client Education:
1.Instruct client to take immediately before bedtime because medication has abrupt onset of sleep.
2.Instruct client to avoid alcohol.
3.Warn client and caregivers of potential for sleep activities without recall; notify prescriber immediately.

147
Q

Disulfiram: Therapeutic Use, Precautions, Side Effects, Intervention & Education

A

Therapeutic Use:
Adjunct to maintain sobriety in treatment of alcohol use disorder

Precautions/Interactions:
1.INH will increase risk of adverse CNS effects for clients taking disulfiram.
2.Ingestion of large amounts of alcohol may cause respiratory depression, dysrhythmias, and cardiac arrest.
3.Adjust medication doses of warfarin and phenytoin.

Side/Adverse Effects
1.Drowsiness
2.Headache
3.Metallic taste
4.Hepatotoxicity

Interventions and Client Education:
1.Must wait 12 hr between time of last alcohol intake and starting medication.
2.Instruct client that consumption of alcohol while taking disulfiram will result in flushing, throbbing in head and neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion.
3.Instruct client that undesirable effects last 30 min to several hours when alcohol is consumed.
4.Instruct client the effects of disulfiram may stay in the body for weeks after therapy is discontinued.
5. Instruct client that therapy may last months to years.

148
Q

Methadone: Therapeutic Use, Precautions, Side Effects, Intervention & Education

A

Therapeutic Use:
Prevents withdrawal symptoms in clients who were addicted to opiate drugs.

Precautions/Interactions:
1.Do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury.
2.Avoid in clients with QT syndrome.

Side/Adverse Effects:
1.Sedation
2.Respiratory depression
3.Paradoxical CNS excitation

Interventions and Client Education:
1.Monitor clients for signs of drug tolerance and psychological dependence.
2.Monitor for respiratory depression.
3.Instruct client that methadone must be slowly reduced to produce detoxification.
4.Client must be monitored through treatment center.

149
Q

Cholinesterase Inhibitors: Action, Therapeutic Use, Precautions, Side Effects, Intervention & Education

A

Action:
Prevent cholinesterase from inactivating acetylcholine, resulting in improved transmission of nerve impulses

Medications:
Neostigmine, Ambenonium, Edrophonium

Therapeutic Use:
Myasthenia gravis

Precautions/Interactions
1.Do not administer if heart rate is less than 60/min.

Side/Adverse Effects
1.Slow heart rate
2.Chest pain, weak pulse, increased sweating, and dizziness
3.Client feeling like they might pass out
4.Weak or shallow breathing
5.Urinating more than usual
6. Seizures
7.Trouble swallowing

Interventions and Client Education:
1.Dose must be individualized.
2.Instruct client to keep individual diary to record side effects.
3.Advise client to wear medical alert bracelet.
4.Monitor for cholinergic crisis.

150
Q

Anti-parkinson’s : Action, Therapeutic Use, Precautions, Side Effects, Intervention & Education

A

Action:
Increase dopamine to minimize tremors and rigidity

Medications:
Benztropine, Carbidopa/levodopa, Levodopa

Therapeutic Use:
Parkinson’s disease

Precautions/Interactions:
1.Do not use levodopa within 2 weeks of MAOI use.
2.Pyridoxine (vitamin B6) decreases effects of levodopa.
3.Benztropine is contraindicated in clients who have narrow-angle glaucoma.
4.Must discontinue 6 to 8 hr before anesthesia.

Side/Adverse Effects:
1.Muscle twitching (especially eyelid spasms)
2.Headache
3.Dizziness
4.Dark urine
5.Orthostatic hypotension

Interventions and Client Education:
1.Instruct family members to assist with medication regimen.
2.Instruct client to notify prescriber if sudden loss of the medication effects occurs.
3.Instruct client that maximum therapeutic effects may take 4 to 6 weeks.
4.Monitor closely for signs of adverse reactions.
5.Instruct client to avoid high-protein meals and snacks.
Keep medication away from heat, light, and moisture. If pills become darkened, they have lost potency and must be discarded.

151
Q

Antiseizure: Medications, Interventions & Client Education

A

Medications:
Carbamazepine, Gabapentin, Phenobarbital, Phenytoin, Valproic acid

Interventions & Client Education:
1.Monitor for therapeutic effects.
2.Monitor clients taking phenytoin for toxic effects, including serum levels for toxicity.
3.Instruct clients regarding the importance of compliance; medication is treatment, not a cure.
4.Individualize treatment regimen.
Instruct client regarding side/ adverse effects.
5.For status epilepticus: diazepam or lorazepam IV push followed by IV phenytoin or fosphenytoin.

152
Q

Carbamazepine: Precautions & Side Effects

A

Precautions:
1.Contraindicated in clients who have bone marrow suppression or bleeding disorders
2.Decreases the effectiveness of oral contraceptives and warfarin

Side/Adverse
Effects:
Anemia, leukopenia, Stevens-Johnson syndrome

153
Q

Gabapentin: Precautions & Side Effects

A

Precautions:
Do not abruptly discontinue

Side/Adverse
Effects:
1.Headaches, weight gain, nausea
2.Report CNS depression, seizures, visual changes, and unusual bruising

154
Q

Phenobarbital: Precautions & Side Effects

A

Precautions:
Contraindicated in history of substance use disorder

Side/Adverse
Effects:
Drowsiness, hypotension, respiratory depression

155
Q

Phenytoin: Precautions & Side Effects

A

Precautions:
Causes increased excretion of digoxin, warfarin, oral contraceptives

Side/Adverse
Effects:
Gingival hypertrophy, diplopia, drowsiness, hirsutism

156
Q

Valproic Acid: Precautions & Side Effects

A

Precautions:
Contraindicated in liver disease, pregnancy

Side/Adverse
Effects:
Hepatotoxicity, teratogenic effects, pancreatitis

157
Q

Antiglaucomoa: Medications, Precautions, Side Effects, Interventions & Education

A

Medications:
Levobunolol, Timolol, Pilocarpine, Latanoprost

Precautions/Interactions:
Use caution in clients taking oral beta blocker or calcium channel blocker.

Side/Adverse Effects:
1.Systemic effect of beta blockers: bradycardia, heart failure, bronchospasm
2.Brown discoloration of the iris (latanoprost)
3.Retinal detachment (pilocarpine)

Interventions and Client Education:
1.Instruct client to use sterile technique when handling applicator portion of the container.
2.Hold gentle pressure on the nasolacrimal duct for 30 to 60 seconds immediately after instilling drops.
3.Monitor pulse rate/rhythm for clients taking oral beta or calcium channel blocker.

158
Q

Acetaminophen: Therapeutic Use, Precautions, Side Effects, Interventions & Education

A

Therapeutic Use:
Analgesic, Antipyretic

Precautions/Interactions:
1.Use caution in clients who consume three or more alcoholic beverages per day.
2.Concurrent use of rifampin, INH, carbamazepine, and barbiturates may increase hepatotoxic effects.
3.Slows the metabolism of warfarin.

Side/Adverse Effects:
1.Nausea and vomiting
2.Long-term therapy: hemolytic anemia, leukopenia, neutropenia, and thrombocytopenia

Interventions and Client Education:
1.Monitor liver function.
2.Monitor kidney function.
3.Be aware of OTC sources of acetaminophen.
4.Instruct client to take as prescribed and do not exceed 3,000 mg/24 hr.
5.Instruct client about risk of hepatotoxicity.
6.Administration to children should be based on age, not to exceed five doses per day (read labels carefully).
7.Treat acetaminophen overdose with acetylcysteine.

159
Q

Opioids: Medications, Therapeutic Uses, Precautions, Side Effects, Intervention & Education

A

Medications:
Fentanyl, Hydromorphone, Morphine sulfate, Meperidine, Codeine, oxycodone

Therapeutic Use:
1.Relief of moderate to severe pain
2.Sedation

Precautions/Interactions:
1.Meperidine is preferred for clients with biliary associated pain.
2.Monitor for potentiation of effects when given with barbiturates, benzodiazepines, phenothiazines, hypnotics, and sedatives.

Side/Adverse Effects:
1.Orthostatic hypotension
2.Constipation
3.Urinary retention
4.Blurred vision
5.Respiratory depression
6.Abstinence syndrome

Interventions and Client Education:
1.Monitor vital signs.
2.Monitor for respiratory depression.
3.Instruct client regarding administration with PCA pump.
4.Administer naloxone for clients who have respiratory depression.
5.Prevent constipation.
6.Monitor for urinary retention.

160
Q

Oral Contraceptives: Considerations For Use, Client Education

A

Considerations
for Use:
1.Pill is taken daily
2.Adverse effects: breast tenderness, bleeding, nausea/vomiting

Client Education:
1.Antibiotic therapy, phenytoin and rifampin, reduce effectiveness
2.Avoid smoking

161
Q

Emergency Contraception: Considerations For Use, Client Education

A

Considerations
for Use:
1.A larger-than-normal dose of oral contraceptive
2.Taken no later than 72 hr after unprotected sex
3.Second dose is repeated 12 hr later
4.Antiemetics may be needed

Client Education:
1.Should discuss options with provider
2.Should never be used as the primary method of birth control

162
Q

IUD: Considerations for Use, Client Education

A

Considerations
for Use:
1.A larger-than-normal dose of oral contraceptive
2.Taken no later than 72 hr after unprotected sex
3.Second dose is repeated 12 hr later
4.Antiemetics may be needed

Client Education:
1.Should discuss options with provider
2.Should never be used as the primary method of birth control

163
Q

Cervical Diaphragm: Considerations for Use, Client Education

A

Considerations
for Use:
1.Use with spermicide
2.Fit by prescriber
3.Refitted after childbirth or weight gain/loss

Client Education:
1.Insert 6 hr prior to and leave in for 6 hr after intercourse
2.May be inserted up to 6 hr prior to intercourse; must be left in 6 hr after intercourse
3.Refit size with 10 lb or more weight change and following childbirth

164
Q

Cervical Ripening: Action, Medications, Precautions, Side Effects, Intervention & Client Education

A

Action:
Prostaglandins cause cervical softening in preparation for cervical dilation and effacement

Medication:
1.Dinoprostone cervical gel
2.Misoprostol ( unlabeled use)

Precautions/Interactions:
1.Contraindicated in clients who have acute PID, history of pelvic surgery, abnormal fetal position.

Side/Adverse Effects:
1.Nausea
2.Headache
3.Tremor, tension
4.Feeling of warmth in the vaginal area
5.Elevated temperature

Interventions and Client Education:
1.Maintain client on bed rest for at least 2 hr (30 min for the gel) after insertion.
2.Monitor and record maternal vital signs and fetal heart rate.
3.Monitor for uterine contractions.
Oxytocin augmentation may be initiated as needed.
4.Major adverse effect is tachysystole.

165
Q

Oxytocin: Action, Medications, Precautions, Side Effects, Intervention & Client Education

A

Action:
Stimulates uterine contractions for the purpose of induction or augmentation of labor and prevents postpartum hemorrhage

Therapeutic Use:
1.Antepartum for contraction stress test (CST)
2.Intrapartum for induction or augmentation of labor
3.Postpartum to promote uterine tone

Precautions/Interactions:
1.Contraindicated with placental abnormalities, fetal malpresentation, previous uterine surgery, and fetal distress.
2.Bishop Score of 6 and greater when planning induction.

Side/Adverse Effects:
1.Intense uterine contractions
2.Uterine hyperstimulation
3.Uterine rupture
4.Water intoxication

Interventions and Client Education:
1.Administer as secondary infusion via infusion pump for induction or augmentation.
2.Continuously monitor uterine contractions and fetal heart rate.
3.Discontinue oxytocin with any signs of uterine hyperstimulation or signs of maternal or fetal distress.
4.Administer oxygen via face mask 10 L for signs of hyperstimulation.
When used in postpartum, monitor client for uterine bleeding.

166
Q

Methlyergonovine: Action, Therapeutic Use, Precautions, Side Effects, Interventions & Education

A

Action:
Acts directly on the uterine muscle to stimulate forceful contractions

Therapeutic Use:
1.Postpartum hemorrhage

Precautions/Interactions:
1.Use with extreme caution in clients with hypertension, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, cardiovascular, hepatic or renal impairment.

Side/Adverse Effects:
1.Potent vasoconstriction
2.Hypertension
3.Headache

Interventions and Client Education:
1.Continuously monitor blood pressure.
2.Assess uterine bleeding and uterine tone.

167
Q

Tocolytics: Action, Medications, Therapeutic Use

A

Action:
Act on uterine muscle to cease contractions

Therapeutic Use:
Stop preterm labor

Medications:
Terbutaline sulfate, Nifedipine, Magnesium sulfate

168
Q

Terbutaline Sulfate: Side Effects & Interventions

A

Side Effects:
Nervousness, Tremulousness, Headache, Nausea and vomiting, Hyperglycemia, Severe palpitations, Chest pain, Pulmonary edema

Interventions:
1.Monitor contractions and FHT
2.Monitor vital signs
3.Do not administer if pulse rate greater than 130/min or client has chest pain
4.Administer beta blocking agent as antidote

169
Q

Nifedipine: Side Effects & Interventions

A

Side Effects:
Hypotension, Headache, Nausea, Flushing

Interventions:
1.Monitor BP
2.Avoid concurrent use with magnesium sulfate
3.Monitor contractions and FHT
4.Prevent complication with hypotension

170
Q

Magnesium Sulfate: Side Effects & Interventions

A

Side Effects:
Warmth, Flushing, Respiratory depression, Diminished DTRs, Decreased urine output, Pulmonary edema

Interventions:
1.Monitor vital signs and DTRs
2.Monitor magnesium levels (therapeutic range 4 to 8 mg/dL)
3.Administer via infusion pump in diluted form
4.Use indwelling catheter to monitor urinary elimination
5.Administer calcium gluconate 10% for signs of toxicity

171
Q

Betamethasone: Action, Therapeutic Use, Side Effects, Interventions & Client Education

A

Action:
Stimulate production of surfactant in fetus between 24 and 34 weeks gestation

Therapeutic Use:
Promote fetal lung maturity in preterm labor when delivery is likely

Side/Adverse Effects:
1.Fluid retention
2.Elevated blood pressure
3.Maternal hyperglycemia and transient increase in WBC

Interventions and Client Education:
1.Administer two doses (usually IM) 24 hr apart (repeat doses not recommended).
2.Provide emotional support to family.

172
Q

Rho(D) Immune Globulin (RhoGAM): Action, Therapeutic Use, Precautions, Interventions & Education

A

Action:
Suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter the maternal circulation at the time of delivery

Therapeutic Use:
Rh factor incompatibility to prevent sensitization for subsequent pregnancies

Precautions:
1.Confirm that the mother is Rh-negative.
2.Never administer the IGIM full-dose or microdose products intravenously.
3.Never administer to a neonate.

Interventions and Client Education:
1.RhoGAM is administered within 72 hr after birth, if indicated (woman is Rh negative, newborn is Rh positive, and Coombs test is negative).
2.RhoGAM is also administered as an injection prophylactically at 28 weeks gestation and after any event where fetal cells can mix with maternal blood.
a.Miscarriage
b.Ectopic pregnancy
c.Induced abortion
d.Amniocentesis
e.Chorionic villus sampling (CVS)
f.Abdominal trauma

173
Q

Medications for Postpartum Client: Varicella Vaccine

A

1.Women who are not immune to varicella should be immunized in the postpartum period.
2.Instruct client to use reliable form of contraception and avoid pregnancy for 3 months.

174
Q

Saw Palmetto: Use, Side Effects, Interactions, Considerations

A

Use:
Treats and prevents benign prostatic hypertrophy (BPH)

Side/Adverse Effects:
1.Headache
2.Altered platelet function
3.Herb/Medication Interactions
Additive effect with anticoagulants

Nursing Considerations:
1.Allow 4 to 6 weeks to see effects.
2.Discontinue use prior to surgery.

175
Q

Valerian Root: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Insomnia
2.Migraines
3.Menstrual cramps

Side/Adverse Effects:
1.Drowsiness
2.Headache, nervousness with prolonged use

Herb/Medication Interactions:
Additive effect with barbiturates and benzodiazepines

Nursing Considerations:
1.Advise client against driving or operating machinery.
2.Advise client against long-term use.
Discontinue valerian at least 1 week prior to surgery.

176
Q

St. Johns Wort: Use, Side Effects, Interactions, Considerations

A

Uses:
1. Mild to Moderate Depression
2.Seasonal affective disorder
3.Anxiety

Side/Adverse Effects:
1.Headache
2.Sleep disturbances
3.Phototoxicity (long-term use)
Constipation

Herb/Medication Interactions:
Many interactions with other medications–>
a.Oral contraceptives
b.Cyclosporine
c.Warfarin
d.Reduced antiretroviral effects
e.Digoxin
f.Calcium channel blockers
g.Antidepressants

Nursing Considerations:
1.St. John’s wort has many medication interactions and should not be taken with other medications.
2.Should not be used to treat severe depression.
3.Should only be used with medical guidance.

177
Q

Echinacea: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Prevents and treats the common cold
2.Stimulates the immune system
Promotes wound healing

Side/Adverse Effects:
1.Fever and nausea (rare)
2.Anaphylaxis in susceptible individuals

Herb/Medication Interactions:
1.May reduce the effects of immunosuppressants
2.May increase serum levels of alprazolam, calcium channel blockers, and protease inhibitors

Nursing Considerations:
Long-term use may cause immunosuppression.

178
Q

Garlic: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides
Suppresses platelet aggregation and disrupts coagulation
2.Acts as a vasodilator (can lower blood pressure)

Herb/Medication Interactions:
1.An increased risk of bleeding in clients taking NSAIDs, warfarin, and heparin
2.Decreases levels of saquinavir (a medication for HIV treatment) and cyclosporine

Nursing Considerations:
1.Question clients about concurrent use of NSAIDs, heparin, and warfarin.
2.Have clients who are taking antiplatelet or anticoagulant medication, cyclosporine, or saquinavir contact their provider prior to taking garlic as a supplement.

179
Q

Ginger Root: Use, Interactions, Considerations

A

Uses:
1.Relieves vertigo and nausea
2.Increases intestinal motility
3.Increases gastric mucus production
4.Decreases GI spasms
5.Produces an anti-inflammatory effect
6.Suppresses platelet aggregation
7.Used to treat morning sickness, motion sickness, nausea from surgery
8.Can decrease pain and stiffness of rheumatoid arthritis

Herb/Medication Interactions:
1.Use cautiously in clients who are pregnant because high doses can cause uterine contractions
2.Interacts with medications that interfere with coagulation (NSAIDs, warfarin, and heparin)
3.Can increase hypoglycemic effects of diabetes

Nursing Considerations:
1.Question clients about concurrent use with NSAIDs, heparin, and warfarin.
2.Monitor for hypoglycemia if the client takes insulin or other medication for diabetes.

180
Q

Gingko Biloba: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Improves cerebral circulation to treat dementia and memory loss
2.Decreases pain with walking in clients who have PAD

Side/Adverse Effects:
1.Dizziness
2.Stomach upset
3.Vertigo

Herb/Medication Interactions:
1.May increase the effects of MAOIs, anticoagulants, and antiplatelet aggregates
2.May reduce the effectiveness of insulin

Nursing Considerations:
1.Discontinue 2 weeks prior to surgery.
2.May cause seizures with overdose.
Keep out of the reach of children.

181
Q

Glucosamine: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Relieves osteoarthritis
2.Promotes joint health

Side/Adverse Effects:
1.Nausea
2.Heartburn

Herb/Medication Interactions:
1.May increase resistance to antidiabetic agents and insulin
2.May increase risk of bleeding. Use cautiously with clients on anticoagulants

Nursing Considerations:
1.Use glucosamine with caution in clients who have a shellfish allergy.
2.Monitor glucose frequently in clients who have diabetes mellitus.
3.Allow extended time to see the effects of glucosamine.
Used often in combination with chondroitin.

182
Q

Omega-3 Fatty Acids: Use, Side Effects, Interactions, Considerations

A

Uses:
1.Improves hypertriglyceridemia
2.Helps maintain cardiac health

Side/Adverse Effects:
1.Nausea
2.Diarrhea

Herb/Medication Interactions:
1.May increase risk of vitamin A or D overdose

Nursing Considerations
1.Omega-3 fatty acids are found in fish oils, nuts, and vegetable oils.
2.Some fish contain methylmercury and polychlorinated biphenyls (PCBs) that can be harmful in large amounts, especially in women who are pregnant or nursing.

183
Q

Melatonin: Use, Side Effects, Interactions, Considerations

A

Use:
Treats insomnia and jet lag

Side/Adverse Effects:
1.Morning grogginess
2.Lower body temperature
3.Vivid dreams

Herb/Medication Interactions:
1.Beta blockers
2.Warfarin
3.Steroids

Nursing Considerations:
Pregnant or nursing women should not take melatonin.

184
Q

Nursing Assessments for Herbal Medications

A

A. Ask the client specifically about herbal medications, vitamins, or other supplements during the client interview.

B. Over-the-counter medications are often not considered medications by the client.

C. Nursing Interventions
1. Instruct the client that herbal medications and supplements are not regulated by the FDA, often interact with other medications, and may cause serious adverse effects.
2. Instruct the client that it is important to use herbal medications and supplements cautiously and with medical supervision.
3. Discourage use in pregnant and nursing mothers, infants, young children, and older adults who have cardiovascular or liver disease.

NCLEX Prep (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions