Pulmonary

Question 1

Diltiazem

Answer 1

Trade Names: Cardizem, “ CD, “ LA, Cartia XT, Taztia XT, Tiazac

Classification: Ca+ Channel Blocker; antianginal, antiHTN, antiarrhythmic

Common Use: HTN, angina

Common Side/Adverse Effects: peripheral edema, arrhythmias, HF

Nursing Interventions: Assist w/ ambulation, assess for peripheral edema, monitor pulse rate for bradycardia

Teaching points: Change positions slowly. Avoid tasks that require alertness. How to monitor pulse and contact HCP if pulse rate is <50

Question 2

Cisplatin

BLACK BOX ALERT

Answer 2

Trade Name: n/a

Classification: Platinum coordination complex; antineoplastic

Common Use: Metastatic testicular/ovarian tumors, head and neck cancer, lung cancer (both non-small and small)

Common Side Effects: N&V, myelosuppression, anaphylactic reaction
Black Box Warning: Cumulative renal toxicity may be severe. Dose-related toxicities include myelosuppression, nausea vomiting. Ototoxicity noted by tinnitus, loss of high frequency hearing, deafness.

Nursing Interventions: Monitor I&O, if 750ml/8hr notify physician. Assess vitals during infusion. Monitor renal function tests, CBC, platelet count, urinalysis, electrolytes

Teaching Points: Report signs of ototoxicity (tinnitus, hearing loss). Don’t have immunizations w/o physician’s approval. Avoid contact w/ those who have taken oral polio vaccine recently.

Question 3

Methotrexate

BLACK BOX WARNING

Answer 3

Trade Names: Otrexup, Rasuvo, Trexall, Xatmep

Classification: Antimetabolite; Antineoplastic, antiarthritic, antipsoriatic

Common Use: Rheumatoid arthritis, psoriasis; cancer of the lung, head and neck, blood, bone, breast,

Common Side Effects: N&V, low blood count, kidney toxicity
Black Box Warning: May cause fetal abnormalities or death. May produce fatal chronic hepatotoxicity. Do not use for psoriasis or rheumatoid arthritis treatment in pregnant women.

Nursing Interventions: Monitor CBC, LFT, urinalysis, chest XR, uric acid hematologic toxicity. Assess skin for dermatologic toxicity.

Teaching Points: Strictly maintain oral hygiene. Don’t have immunizations w/o physician’s approval. Avoid crowds (risk of infection). Avoid alcohol, aspirin, UV light.

Question 4

5-fluorouracil (5-FU)

Black Box Alert

Answer 4

Trade Names: Carac, Efudex, Fluoroplex, Tolak

Classification: Antimetabolite; antineoplastic

Common Use: Cancer of colon, rectum, breast, stomach, pancreas, head/neck, esophageal

Common Side Effects: Alopecia, dematitis, anorexia, stomatitis

Teaching Points: Maintain strict oral hygiene. Report s/s of infection, unusual bruising/bleeding, visual changes, nausea, diarrhea, palpitations. Avoid sunlight, wear protective clothing and sunscreen.

Question 5

Cetuximab

Black Box Alert

Answer 5

Trade Names: Erbitux

Classification: Antineoplastic

Common Use: Colorectal cancer, head and neck cancer

Common Side Effects: Acneiform, rash, malaise, anemia

Teaching Points: Don’t have immunizations w/o physician’s approval. Avoid crowds, risk of infection. Avoid pregnancy.

Question 6

Tyrosine kinase inhibitors

Answer 6

TKIs stops cancer enzymes from spreading and growing.

Most names end with “-nib”

Common Side Effects: N&v, diarrhea,
musculoskeletal pain

Teaching Points: Avoid grapefruit products. Do not skip doses to avoid side effects. Tell HCP all meds or supplements you take - certain drugs and herbal supplements may interact with drug.

Question 7

Kinase inhibitors

Answer 7

Blocks protein kinases, enzymes that send signals for growth and division to cells, like cancer cells.

Most names end with “-nib”

Common Side Effects: N&v, diarrhea,
musculoskeletal pain, rash, fever

Teaching Points: Avoid grapefruit products. Do not skip doses to avoid side effects. Tell HCP all meds or supplements you take - certain drugs and herbal supplements may interact with drug.

Question 8

Nivolumab

Answer 8

Trade Names: Opdivo

Classification: Antineoplastic

Common Use: Different types of cancer

Common Side/Adverse Effects: fatigue, dyspnea, musculoskeletal pain, anemia, lymphopenia

Teaching Points: Blood levels will be monitored routinely. Serious adverse reactions may affect lungs, GI tract, kidneys, or hormonal glands. Avoid pregnancy (may cause birth defects or miscarriage), do not breastfeed.

Question 9

Non-narcotic analgesics

Answer 9

OTC and prescribed medications for pain. First choice of therapy as an opioid alternative.

Common drugs: Acetaminophen, NSAIDs, aspirin, antidepressants, anticonvulsants

Common Side/Adverse Effects: Nausea, dizziness, dyspnea, headache

Question 10

Narcotic analgesics

Answer 10

Class of medications used to alleviate moderate to severe pain (acute and chronic). Also may be called opioids or opiates.

Common narcotics: codeine, fentanyl, morphine, hydrocodone

Common Side/Adverse Effects: Respiratory depression, ortho/hypo, dizziness, sedation

Question 11

NSAIDS

Answer 11

“Nonsteroidal Anti-Inflammatory Drugs.” Alleviates pain from inflammation in musculoskeletal disorders, low to moderate pain, and lowers fever.

Common NSAIDs: aspirin, celecoxib, ibuprofen, etodolac

Common Side/Adverse Effects: headache, indigestion, dizziness, abd discomfort

Question 12

Heparin

Answer 12

Trade Names: Hep-lock

Classification: Antithrombotics; anticoagulants

Common Use: Prevent DVT, pulmonary emboli, and emboli fr Afib. STEMI, NSTEMI, unstable angina.

Common Side/Adverse Effects: Bruising or bleeding easily, burning or itching on feet, major hemorrhage

Nursing Interventions: Bleeding precautions. Monitor PPT and aPTT (should be 1.5-2.5 times normal). Monitor/assess urine and stool for occult blood or hematuria. IV 30 min w/in admission.

Teaching points: Use electric razor and a soft toothbrush to prevent bleeding. Blow nose gently. Inform dentist and other physicians of heparin therapy.

Question 13

Coumadin

Black Box Alert

Answer 13

Generic Name: Warfarin

Classification: Coumarins; Anticoagulants

Common Use: Prophylaxis of venous thrombosis, pulmonary embolism, and Afib w/ embolization. Reduce risk of embolism after MI.

Common Side/Adverse Effects: Cramps, nausea, major bleeding
Black Box Warning: May cause major or fatal bleeding. Risk factors: history of GI bleeding, HTN, cerebrovascular disease, heart disease, malignancy, trauma, INR >4.

Nursing Interventions: Monitor INR closely. Assess for signs of bleeding or hemorrhage (hematuria, bruises, bleeding gums, black tarry stools, fall in BP). Vitamin K is an antidote.

Teaching points: Use electric razor and a soft toothbrush to prevent bleeding. Advise all HCP they are taking warfarin. Report symptoms of unusual bleeding or bruising. Frequent lab tests are needed to monitor coagulation factors.

Question 14

Enoxaparin

BLACK BOX ALERT

Answer 14

Trade Names: Lovenox

Classification: antithrombotics, low molecular weight heparins; anticoagulant

Common Use: Prevention of DVT, pulmonary embolism, ischemia complications fr unstable angina, MI, STEMI

Common Side/Adverse Effects: Immune-mediated thrombocytopenia, bleeding episodes

Nursing Interventions: Antidote is protamine sulfate. Monitor CBC esp platelet count. Monitor for bleeding.

Teaching points: Don’t take OTC meds esp aspirin w/o consulting HCP. Report unusual bleeding or bruising.

Question 15

Alteplase

High Alert

Answer 15

Trade Names: Activase, Cathflo Activase, tissue plasminogen activator, t-PA

Classification: plasminogen activators; thrombolytics

Common Use: Acute ischemic stroke, pulmonary embolism, acute MI, occluded catheters

Common Side/Adverse Effects: Decreased BP, bleeding

Nursing Interventions: Continuous cardiac monitoring for dysrhythmias. Check BP, pulse, resp every 15 min until stable.

Teaching points: Avoid activities that may increase risk of bleeding or injury.

Question 16

Sildenafil

Answer 16

Trade Names: Viagra, Revatio

Classification: erectile dysfunction agents, vasodilators

Common Use: Pulmonary arterial HTN (PAH), erectile dysfunction

Common Side/Adverse Effects: headache, heartburn, muscle aches, sensitivity to light, flushing

Nursing Interventions: Monitor cardiovascular status. Monitor diet (high fat meals can slow absorption)

Teaching points: Never take drug with nitrates. Report painful urination, dizziness, rash, loss of vision.

Question 17

Oxygen

Answer 17

Gas that’s administered can be administered via nasal cannula, simple mask, CPAP mask, non-rebreather mask, and other masks. Indicated for oxygenation of tissues and blood. Commonly used for hypoxemia and COPD.

Precautions: Store oxygen tanks in a secure location to prevent tampering or falling over. Keep at least 5ft away from electric appliances (fire hazard)

Question 18

Low-molecular-weight heparin

Answer 18

Anticoagulant that actives antithrombin III to inhibit factor Xa and thrombin. Commonly used for acute coronary syndromes.

Common LMWHs: Enoxaparin (Lovenox) and dalteparin (Fragmin)

Common Side/Adverse Effects: Uncontrolled bleeding, irritation and bruising at inj site, elevated liver enzymes

Question 19

Apixaban

Black Box Alert

Answer 19

Trade Names: Eliquis

Classification: Factor Xa inhibitor; anticoagulant

Common Use: prevent/treat blood clots, prevent stroke

Common Side/Adverse Effects: Increased risk for bleeding, jaundice, potentially fatal bleeding
Black Box Alert: Discont. in absence of alternative anticoagulation increases risk of thrombotic events.

Nursing Interventions: Monitor CBC, occult blood in stool. Assess for any signs of bleeding. Be alert for complaints of abd pain, headache, confusion, weakness, and vision changes.

Teaching points: Avoid NSAIDs, alcohol, aspirin. Use soft-bristled toothbrush and electric razor to prevent bleeding. Report blood-tinged mucus, heavy menstrual bleeding, frequent bruising, weakness, bloody urine/stools, and joint pain or swelling.

Question 20

Dabigatran

Black Box Alert

Answer 20

Trade Name: Pradaxa

Classification: Thrombin inhibitor; anticoagulant

Common Use: Reduce risk of stroke, reduces/treats DVT and PE

Common Side/Adverse Effects: Dyspepsia, severe, sometimes fatal, hemorrhagic events

Nursing Interventions: Asses for any signs of bleeding. Don’t get BP from lower extremities. Monitor aPTT, PT, and platelet count.

Teaching points: Use soft-bristled toothbrush and electric razor to prevent bleeding. Don’t chew/crush/cut/open capsules. Report any red or dark urine, black or red stool, red mucus.

Question 21

Tissue plasminogen activator (tPA)

Answer 21

“Clot-busting” medication used for ischemic strokes to free blood flow. Administered via IV for an hour within 3 hrs of stroke symptoms.

Common names: alteplase, reteplase, and tenecteplase

Common Side/Adverse Effects: bleeding at puncture site, decrease in BP, severe internal hemorrhage

Nursing Interventions: Continuous cardiac monitoring for arrhythmias. Check BP, pulse, RR every 15 min until stable. Monitor for chest pain relief.

Question 22

Calcium channel blockers

Answer 22

Group of drugs that inhibits calcium from entering the arteries and cells of the heart. Often used for HTN, angina, CAD, dysrhythmias.

Common CCBs: Verapamil, diltiazem, amlodipine

Common Side/Adverse Effects: Constipation, dizziness, palpitations, fatigue, HoTN

Teaching: Avoid ingesting grapefruit products. Avoid alcohol.

Question 23

Vasodilators (inhaled & parenteral)*

Answer 23

Class of medications that widen/dilate the blood vessels, letting the blood flow more freely. This decreases high BP and increases the amount of O2 getting to the heart. Often used for HTN, CHF, angina, and prevention of stroke, MI, or HF after an MI.

Common vasodilators: nitroglycerin, alprostadil, lisinopril

Common Side/Adverse Effects: headache, fatigue, HoTN, edema

Question 24

Digitalis

Answer 24

Trade Name: Crystodigin

Classification: cardiac glycoside

Common Use: CHF, dysrhythmias

Common Side/Adverse Effects: muscle weakness, fatigue, loss of appetite, drowsiness

Teaching: Take drug with food or milk to avoid GI upset.

Question 25

Tacrolimus

Black Box Alert

Answer 25

Trade Name: Prograf

Classification: Immunologic agent; immunosuppressant

Common Use: Prevent organ rejection in pts who received a transplant

Common Side/Adverse Effects: Headache, tremor, insomnia, paresthesia, diarrhea
Black Box Alert: Increased susceptibility to infection and potential development of lymphoma.

Nursing Interventions: Monitor pts w/ renal impairment. Monitor serum creatinine, K+, CBC, LFT. Monitor I&O.

Teaching Points: Avoid crowds (risk for infection). Report cp, dizziness, unusual bleeding/bruising, decreased urination. Avoid exposure to sun or artificial light.

Question 26

Mycophenolate mofetil

Black Box Alert

Answer 26

Trade Name: CellCept

Classification: Immunosuppressant

Common Use: Prevent organ rejection for pts who receive a kidney, heart, or liver transplant.

Common Side/Adverse Effects: HTN, anemia, peripheral edema, UTI
Black Box Warning: Increased risk of congenital malformation, spontaneous abortion. Increased risk for infection. Increased risk for development of lymphoma.

Nursing Interventions: Monitor skin lesion healing. If skin reacts, stop and clean area, notify HCP.

Teaching Points: External use only. Report skin reactions/irritations. Avoid contact with eyes.

Question 27

Prednisone

Answer 27

Trade Names: Rayos, Sterapred

Classification: adrenal corticosteroid; glucocorticoid

Common Use: Arthritis, immune system and blood disorders, allergies

Common Side/Adverse Effects: Insomnia, heartburn, abd distention, diaphoresis

Nursing Interventions: Monitor BP, electrolyte levels, glucose, bone mineral density, height and weight in children. Be alert for s/s of infection. Assess oral cavity for signs of candida.

Teaching Points: Report any fever, sore throat, aching muscles, swelling, loss of appetite, or sudden weight gain. Avoid alcohol. Strictly maintain good oral hygiene.