Skills Meds

Question 1

Digoxin

Answer 1

1. Trade: Lanoxin
2. Family: Anti-arrhytmic
3. Therapeutic effect:
   
   1. Increase strength of Heart contractions,
   2. Control Rate and Rhythm, (Pts with CHF, Afib, Aflutter)
4. Side effects:
   
   1. CAREFUL ADMIN,
   2. Dizziness,
   3. N/V/D,
   4. Visual disturbances
5. Nursing issues:
   
   1. Check APICAL HR - Hold if <60,
   2. Monitor for toxicity (N/V/D, vision issues),
   3. Narrow Therapeutic range
6. Patient teaching:
   
   1. Call if HR <60 or >110,
   2. Report weight gain of >2lb,
   3. No OTC without approval

Question 2

Furosemide

Answer 2

1. Trade: Lasix
2. Family: Loop Diuretic
3. Therapeutic effect:
   
   1. Lower fluid retention,
   2. Inhibit reabsorb of Na & Cl
   3. (pts w/edema, liver or kidney disease)
4. Side effects:
   
   1. Tinnitus,
   2. Jaudice,
   3. Severe stomach pain (N/V/D)
5. Nursing issues:
   
   1. BP and vital,
   2. S&S hypkalemia,
   3. I&O dehydration
   4. Check K and electrolyte levels,
   5. SJSyndrome,
   6. Anemia
6. Patient teaching:
   
   1. dizziness,
   2. high K diet,
   3. BGL - can rise,
   4. Don’t take at night to avoid urinating at night

Question 3

Heparin

Answer 3

1. Family: Anticoagulent
2. Therapeutic effect:
   
   1. Prevent blood clots
   2. Prophylaxis and treatment for DVT and PE
3. Side effects:
   
   1. Easy bleed and bruise,
   2. Pain,
   3. erythema,
   4. irritation
4. Nursing issues:
   
   1. Labs on Hct, Hgb, RBC, platelets
   2. Coag draw 30 mins b/f SC/IV dose
   3. Monitor - fever, Drop in BP, Increased HR, other signs of hemorrhage
5. Patient teaching:
   
   1. Call HCP if urine not yellow,
   2. Menstruation may be long,
   3. No smoke or alcohol

Question 4

Insulin H

Answer 4

1. Generic: Humulin N, L, Novoliln, NPH (intermediate acting, cloudy)
2. Family: Antidiabetic, Pancreatics
3. Therapeutic effect: Low BG, Control BG
4. Side effects:
   
   1. Drop in BG
   2. Headache
   3. sweating
   4. irritability
5. Nursing issues:
   
   1. monitor BG depending on type
   2. Call HCP if acetone and sugar in urine,
   3. Monitor for hypoglycemia,
   4. check IO hourly with IV
6. Patient teaching:
   
   1. Injection technique,
   2. Inject in abdomen,
   3. hypoglycemia response,
   4. carry fast acting carbs,
   5. notify HCP of diabetic ketoacidosis

Question 5

Insulin R

Answer 5

1. Generic: Humulin R (Fast acting, clear)
2. Family: Antidiabetic, Pancreatics
3. Therapeutic effect: Low BG, Control BG
4. Side effects:
   
   1. Drop in BG,
   2. Headache,
   3. sweating,
   4. irritability
5. Nursing issues:
   
   1. monitor BG depending on type,
   2. Call HCP if acetone and sugar in urine,
   3. Monitor for hypoglycemia,
   4. check IO hourly with IV
6. Patient teaching:
   
   1. Injection technique,
   2. Inject in abdomen,
   3. hypoglycemia response,
   4. carry fast acting carbs,
   5. notify HCP of diabetic ketoacidosis

Question 6

Pilocarpine

Answer 6

1. Trade: Pilocar
2. Family: Miotic (cholinergic)
3. Therapeutic effect: Reduce ocular hypertension (Glaucoma)
4. Side effects:
   
   1. Increase Sweating,
   2. N/V/D
5. Nursing issues:
   
   1. Drops in conjunctiva,
   2. Monitor Interocular pressure with tonometric test,
   3. Monitor pain and vision changes
6. Patient teaching:
   
   1. Must adhere - prevent blindness,
   2. Discontinue if worsening

Question 7

Nexterone

Answer 7

1. Generic: Amiodarone
2. Family: Anti-arrhythmic
3. Therapeutic effect: Restore normal heart rhythm (Vfib, Vtac, Prophylaxis for heart rhythm disorders)
4. Side effects:
   
   1. Lower effects of Digoxin,
   2. Check eyes - lens opacity/spots,
   3. Respiratory distress,
   4. Depressed HR/BP,
   5. N/V/C,
   6. Photosensitivity,
   7. Syncope in Bradycardia,
   8. Not in iodine allergy,
   9. Liver fx
5. Nursing issues:
   
   1. Caution in Digoxin pts (reduced dose),
   2. Caution in Warfarin (reduce dose),
6. Patient teaching:
   
   1. No grapefruit juice or St. Johns Wort,
   2. Monitor pulse daily - report HR <60,
   3. Wear sunscreen,
   4. Take with food

Question 8

Aspirin

Answer 8

1. Generic: Family: Analgesic (nonopiod), antipyretic
2. Therapeutic effect:
   
   1. Blood thinner - prevents clots,
   2. Lower Pain and Fever and headache and MI risk
3. Side effects:
   
   1. Stomach Pain,
   2. Tinnitus
4. Nursing issues:
   
   1. Ask if on any other blood thinners,
   2. Caution w/platelet and bleeding disorders,
   3. Avoid 1-2 weeks b/f surgery (excessive bleeding)
5. Patient teaching:
   
   1. Signs of allergic reaction,
   2. Signs of bleeding (coffee ground vomit, tarry stools, bleeding gums, bruising)

Question 9

Metoprolol

Answer 9

1. Trade: Lopressor
2. Family: Beta blocker
3. Therapeutic effect: Lower BP and Reduce angina (Pts with Hyper tension and angina)
4. Side effects:
   
   1. Drowsiness,
   2. Slow HR,
   3. Heartburn
5. Nursing issues:
   
   1. BP/HR and rhythm (BP <60BPM or SBP <90 hold and call),
   2. High BP and CHF (worsening),
   3. CNS impact - depression,
   4. Diabetes - monitor for glycemic spikes
6. Patient teaching:
   
   1. Sit after dose,
   2. No abrupt withdrawal,
   3. Check HR/BP - HR<60 call,
   4. no smoking,
   5. Report vision trouble,
   6. Can give pts nightmares

Question 10

Insulin Glargine

Answer 10

1. Trade: Lantus (Extended long-acting analogue, clear)
2. Family: Antidiabetic, Pancreatics
3. Therapeutic effect: Low BG, Control BG
4. Side effects:
   
   1. Drop in BG,
   2. Headache,
   3. sweating,
   4. irritability
5. Nursing issues:
   
   1. monitor BG depending on type,
   2. Call HCP if acetone and sugar in urine,
   3. Monitor for hypoglycemia,
   4. check IO hourly with IV
6. Patient teaching:
   
   1. Injection technique,
   2. Inject in abdomen,
   3. hypoglycemia response,
   4. carry fast acting carbs,
   5. notify HCP of diabetic ketoacidosis

Question 11

Tylenol

Answer 11

1. Generic: Acetaminophen
2. Family: Analgesic (nonopiod), antipyretic
3. Therapeutic effect: Reduce pain and fever (minor aches and pains)
4. Side effects:
   
   1. HEPATOTOXIC,
   2. N/V,
   3. Stomach pain,
   4. Headache
5. Nursing issues:
   
   1. Check liver fx labs,
   2. MAX dose 3g per day,
   3. Aspirin allergy,
   4. hemostatic disturbances,
   5. bleeding,
   6. Upper GI disease,
   7. Gout-arthritis,
   8. Arthritis and rheumatic disorders involving musculoskeletal pain
6. Patient teaching:
   
   1. DO NOT EXCEED recommended dose (no longer than 10 days),
   2. Not an anti-inflammatory,
   3. DO NOT take with other acetaminophen containing drugs

Question 12

Naprosyn/ Aleve

Answer 12

1. Gerneric: Naproxen
2. Family: Analgesic (nonopiod), antipyretic NSAID
3. Therapeutic effect: Reduce fever, pain AND inflammation
4. Side effects:
   
   1. GI,
   2. Dizziness,
   3. Headache
5. Nursing issues:
   
   1. Caution - low Hgb, kidney or liver fx,
   2. Caution - allergic to NSAIDS/aspirin,
   3. Prolongs bleeding time
6. Patient teaching:
   
   1. Effects may take 3-4wk,
   2. Avoid alcohol and aspirin while taking

Question 13

Isosorbide

Answer 13

1. Trade: ISMO
2. Family: Nitrate
3. Therapeutic effect:
   
   1. Prevent angina,
   2. Manage long term angina pectoris (Pts with angina, coronary artery disease),
   3. Lower BP - Up Blood flow
4. Side effects:
   
   1. Headache,
   2. N/V/C/D,
   3. Dizziness/lightheaded
5. Nursing issues:
   
   1. Orthostatic hypotension,
   2. Monitor pain relief,
   3. Use analgesic to treat headaches,
   4. Monitor BP/HR
6. Patient teaching:
   
   1. Move slowly - lightheadedness,
   2. No Alcohol (dizziness),
   3. Headache common - treat with analgesic - do not change dose,
   4. Take last dose of day before 7pm,
   5. Call if blurred vision or dry moutn

Question 14

Cardiazem

Answer 14

1. Generic: Diliazem
2. Family: Calcium channel blocker, (Antianginal, antiarrhythmic, antihypertensive)
3. Therapeutic effect: Lower HR (Afib, Aflutter, Supraventricular tachycardia, Chest pain)
4. Side effects:
   
   1. Headache,
   2. N/V/D/C,
   3. Angina,
   4. SJSyndrome (skin peel),
5. Nursing issues:
   
   1. Check BP and ECG and monitor throughout,
   2. HOLD IF MAP <65,
   3. Monitor Liver and renal fx,
   4. Monitor for s&S of CHF
6. Patient teaching:
   
   1. Sit after taking,
   2. Move slowly (orthostatic hypotension),
   3. No driving,
   4. Monitor pulse (under 50 call),
   5. no grapefruit juice,
   6. sunscreen

Question 15

Docusate Sodium

Answer 15

1. Trade: Colace
2. Family: Stool softener
3. Therapeutic effect: Lower surface tension in bowel, Prophylactic for pts to avoid straining while defecating
4. Side effects: N/D, Abdominal cramps
5. Nursing issues:
   
   1. W/H if diarrhea - notify HCP,
   2. Effect takes 1-3 days
6. Patient teaching:
   
   1. Take with liquid and increase liquid in take,
   2. No mineral oil,
   3. Only for prescribed time period - monitor diet

Question 16

Percocet

Answer 16

1. Generic: Oxycodone/acetaminophen
2. Family: Analgesic (narcotic) combination
3. Therapeutic effect: Lower pain and lower fever
4. Side effects:
   
   1. HIGH ABUSE POTENTIAL 24-48 hours after admission,
   2. Respiratory depression,
   3. N/V,
   4. constipation,
   5. drowsiness
5. Nursing issues:
   
   1. Monitor for pain relief and N/V/C,
   2. Monitor vitals,
   3. Monitor for hepatic and renal fx,
   4. CNS signs
6. Patient teaching:
   
   1. Increased effect with alcohol, antihistimine - avoid,
   2. high abuse potential,
   3. warning in pregnancy

Question 17

Iron sulfate

Answer 17

1. Family: Dietary Supplement
2. Therapeutic effect: Iron Deficiency anemia (w/chronic renal failure)
3. Side effects:
   
   1. Anaphylactic RXN,
   2. Low HR,
   3. Dyspnea,
   4. N/V/D,
   5. Constipation,
   6. Black stool
   7. (can be addictive)
4. Nursing issues:
   
   1. W/H and notify HCP if serum ferritin levels meet guidelines,
   2. W/H if OD (Low HR, edema, Headache),
   3. Monitor for 30 mins for Hypersensitivity RXN
5. Patient teaching:
   
   1. Itching rash dizzy - report,
   2. No breast feeding

Question 18

Calcium and Vitamin D

Answer 18

1. Trade: Os Cal +d
2. Family: Dietary supplement
3. Therapeutic effect:
   
   1. Prevent osteoperosis,
   2. treat low calcium levels
4. Side effects: Tingling, Drop in HR/BP with rapid infusion
5. Nursing issues:
   
   1. Assess for burning with IV,
   2. Monitor for hypo and Hyper calcemia
6. Patient teaching:
   
   1. S&S of hypercalcemia,
   2. Drink milk,
   3. Ca absorb lowered with zinc rich foods (nuts & legumes)

Question 19

Morphine

Answer 19

1. Family: Analgesic (Opioid), Narcotic
2. Therapeutic effect:
   
   1. Lower Pain,
   2. Lower Dyspnea r/t Acute LV failure,
   3. Pulmonary edema
3. Side effects:
   
   1. HIGH ABUSE POTENTIAL,
   2. GI pain,
   3. Drowsiness,
   4. Mood Change
4. Nursing issues:
   
   1. Caution - cardiac pts on MAO inhibitors,
   2. Check breathing -Respiratory Depression possible,
   3. PAIN on injection - rub to ease,
   4. Monitor Ins/Outs
5. Patient teaching:
   
   1. Faint after sit for a bit,
   2. Drowsiness - call for assistance,
   3. No driving,
   4. Potential abuse,
   5. Move slowly - orthostatic hypotension,
   6. Constipation prevention

Question 20

Norco, Vicodin

Answer 20

1. Generic: Hydrocodone/Acetaminophen
2. Family: Analgesic (narcotic) combo
3. Therapeutic effect:
   
   1. Reduce non-productive cough,
   2. Reduce pain
4. Side effects:
   
   1. HIGH ABUSE POTENTIAL,
   2. N/V,
   3. Constipation,
   4. Dizzy,
   5. Drowsy
5. Nursing issues:
   
   1. Respiratory Depression,
   2. N/V,
   3. check for pain relief,
   4. BM (constipation likely),
   5. Caution in MAO inhibitor pts
6. Patient teaching:
   
   1. Take with food,
   2. No other alcohol or CNS depressant,
   3. Drink fluids