Unit 2: Ch 73-75, 31 Flashcards by Taya Schreiter

What are histamines?

Endogenous compound
Important role in: Allergic reactions (H1) and regulation of gastric acid secretion (H2)
High levels are found in skin, lungs, and GI tract

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What do H1 antagonists do?

Produce selective blockade of mild allergic disorders.
Bind to muscarinic receptors

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What is an example of a H1 antagonist?

Diphenhydramine

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What do H2 antagonists do?

Used for treatment of gastric and duodenal ulcers

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Where are H1 receptors mainly found?

Skin, nose, lungs, and blood vessels

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Where are H2 receptors mainly found?

Stomach lining

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What are the roles of H1 receptors?

Vasodilation
Increased capillary permeability
Bronchoconstriction

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What are the roles of H2 receptors?

Secretion of gastric acid

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What are the therapeutic uses of H1 antagonists?

Mild and severe allergies
Motion sickness
Insomnia
Common cold

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What are the adverse effects of H1 antagonists?

Sedation
Nonsedative CNS effects
GI effects
Anticholinergic effects
Severe respiratory depression
Severe local tissue injury

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What is the main use for Diphenhydramine?

Urticaria (acute hives)

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What is the main adverse effect on Diphenhydramine overdose?

Convulsions

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What is the main drug interaction with H1 antagonists?

CNS depressants

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What is the treatment for H1 antagonist toxicity?

Drug removal and managing symptoms.
e.g. activated charcoal (traps toxins in gut)
IV benzodiazepines (help relieve convulsions)

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What is the main use for 2nd gen. H1 antagonists?

urticaria (chronic hives)
seasonal allergy rhinitis

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What are some nursing interactions to take while a patient is taking H1 antagonists?

Educate pt on avoiding taking CNS depressants
avoid driving (due to sedative effects)
use sunblock (due to increased photosensitivity)
and take 20 minutes before bed

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A pt with asthma is prescribed an antihistamine for an allergy reaction. The nurse should tell the pt to:
A. take this medication daily and stop if feeling drowsy
B. to decrease secretion viscosity, you need to increase fluid intake
C. Use this medication when you are using your rescue inhaler to treat an acute attack
D. Decrease your fluid intake to decrease the amount of mucus

B
Antihistamines have an anticholinergic effect which will thicken secretions that will make it more difficult to breathe

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A pt has chronic idiopathic urticaria. Which medication would be appropriate for the nurse to administer for this condition?
A. Fexofenadine (Allegra)
B. Atropine (Atropen)
C. Azelastine (Astelin)
D. Diphenhydramine (Benadryl)

A
Fexofenadine is a 2nd gen H1 antagonist, which is use for chronic hives.

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What is Cyclooxygenase?

COX: an enzyme that converts arachidonic acid into prostanoids (prostaglandins)

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What are Prostaglandins?

A group of lipid compounds that control inflammation, blood flow, blood clot formation, and labor induction

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What is the purpose of COX-1?

Provides gastric mucosa protection
Renal vasodilation
Promote platelet aggregation

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What is the purpose of COX-2?

Produce inflammation and pain at the site of injury
Induce Fever
Affects perception of pain

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What occurs in the body with the inhibition of COX-1?

Gastric ulceration
Bleeding
Renal impairment

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What is a beneficial effect of inhibiting COX-1?

Protection against MI and stroke

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What occurs in the body with the inhibition of COX-2?

Inflammation suppression Reduction of fever Alleviation of pain

What drug can protect the body from MI and stroke?

Aspirin

Which 1st gen. NSAIDs inhibit COX-1 and COX-2?

Aspirin Ibuprofen

Which 2nd gen. NSAIDs inhibit COX-2?

Celecoxib

Who may not be able to take Acetaminophen?

Those with liver disease

Who may not be able to take NSAIDs?

Those with kidney or liver disease

What is the mechanism of action of Aspirin?

inhibitor of COX-1 and COX-2

What are the therapeutic uses of Aspirin?

Analgesic antipyretic anti-inflammatory Suppression of platelet aggregation

What are the contraindications of Aspirin?

PUD Bleeding disorders

What are the adverse effects of Aspirin?

GI effects Bleeding Renal impairment

What are the drug interactions of Aspirin?

Warfarin Glucocorticoids Alcohol Ibuprofen

How do you treat acute poisoning of Aspirin?

pH partitioning

What are the 1st gen. NSAIDs?

Ibuprofen Naproxen Aspirin (note: these all have an increased risk of GI bleeding) (note: do not protect against MI and stroke)

Are 2nd gen. NSAIDs as effective as traditional NSAIDs in suppressing pain and inflammation?

Yes!

What are some adverse effects of 2nd gen. NSAIDs?

Impair renal function HTN Edema (note: increased risk of MI and stroke)

What is Celecoxib?

2nd gen. COX-2 inhibitor

Why is Celecoxib the last-choice drug for long-term management of pain?

Cardiovascular risks

What are the therapeutic uses of Celecoxib?

Osteoarthritis Rheumatoid arthritis Acute pain

What are the adverse effects of Celecoxib?

Abdominal pain GI ulceration CV events!!!!!!!! Renal impairment

What are drug interactions of Celecoxib?

Warfarin Furosemide ACE inhibitors Lithium

What is the use of Acetaminophen?

Analgesic Antipyretic

What is the action of Acetaminophen?

inhibit prostaglandin synthesis in CNS

What should be cautioned when taking Acetaminophen?

Monitor Liver function Do not mix with alcohol!

What are the adverse effects of Acetaminophen?

Steven Johnson Syndrome (SJS) Hepatotoxicity

What is the treatment for Acetaminophen OD?

Acetylcysteine Note: must be given w/in 24hrs of OD

A pt is prescribed celecoxib and warfarin. The nurse should monitor the pt for: A. renal toxicity B. bleeding C. stroke symptoms D. dysrhythmias

A pt drinks 5-6 alcoholic beverages per day and takes acetaminophen (Tylenol) for pain relief. The nurse should caution the pt to: A. limit the intake of acetaminophen to less than 2000 mg/day B. avoid taking acetaminophen for pain. C. take acetaminophen with food to decrease the risk of liver damage D. avoid taking any pain reliever other than acetaminophen

What are glucocorticoid drugs?

Also known as corticosteroids, very similar to steroids produced by the adrenal cortex

What are the physiologic effects of glucocorticoid drugs?

Occur at low doses, modulate glucose metabolism in adrenocortical insuffieciency

What are the side effects of glucocorticoids dependent on?

Dosage Duration of treatment

What is cortisone?

Glucocorticoid with anti-inflammatory and immunosuppressive actions

What is the mechanism of action of cortisone?

Suppress immune responses and inflammation

What are the therapeutic uses of cortisone?

Rheumatoid arthritis Allergies Asthma Dermatologic disorder

What are the metabolic effects of glucocorticoid physiology?

Elevates blood glucose Promotes storage of glucose in the form of glycogen Reduce muscle mass Decreases the protein matrix of bone Causes thinning of skin Negative nitrogen balance (decrease in total body protein) Lipolysis Redistribution of fat

What are the adverse effects of cortisone?

Adrenal insufficiency Osteoporosis Infections Glucose intolerance Cushing's syndrome Hypokalemia HTN

What causes Cushing's Disease?

Body is exposed to increased levels of cortisol for a long period of time

What are the drug interactions of glucocorticoids?

NSAIDs Insulin and oral hypoglycemics Live vaccines Interactions r/t potassium loss

What are the contraindications/precautions of glucocorticoids?

Pts with systemic fungal infections Pts receiving live virus vaccines Caution pts that are pregnant, breast feeding, and pediatric

When tapering doses of glucocorticoids, do you want to stop abruptly or wean gradually?

Wean gradually

What education should the nurse provide to the pt about glucocorticoids?

Don't stop the drug abruptly Avoid NSAIDs- can increase risk for GI ulceration Avoid prolonged use of corticosteroids Inform provider of any adverse effects

A patient taking pharmacologic doses of glucocorticoids should be instructed to: A. increase intake of dietary sodium. B. take antibiotics to prevent infections. C. never abruptly withdraw therapy. D. have an eye examination every year.

C. can cause adrenal insufficiency

What are the therapeutic uses of Morphine?

relieves pain w/o affecting other senses

What are the main adverse effects of Morphine?

Respiratory depression Constipation Cough suppression

What is the morphine adverse effect mneumonic?

Myosis Out of if (sedation) Respiratory depression (serious ADR) Pneumonia (aspiration) Hypotension Infrequency (constipation, urinary retention) Nausea Emesis

What is the clinical manifestation of Morphine toxicity?

Classic triad: Coma Respiratory depression Pinpoint pupils

What is the treatment for Morphine toxicity?

ventilation support Naloxone

What is the therapeutic action of Codeine?

Pain relief cough suppression

What is the purpose of opioid antagonists?

treat opioid overdose relief of opioid-induced constipation reversal of post-op opioid effects management of opioid addiction

What is Naloxone?

Competitive opioid antagonist that treats OD Note: opioid antagonists have a short 1/2 life, so it is important to prepare a 2nd narcan to help with symptoms

A patient has received an opioid for abdominal pain level of 10/10. What is the important step after administering this medication? A. Assess patient’s vital signs B. Educate patient about opioids C. Place all side rales up for patient’s safety D. Assess and document the patient’s response

A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct? A. Administer the ibuprofen as ordered. B. Contact the provider to discuss nonpharmacologic pain measures. C. Request an order for Hydrocodone D. Request an order for morphine sulfate.