UWORLD meds Flashcards
sodium polystyrene sulfonate
KAYEXALATE
- used to treat hyperkalemia
- works in GI tract to trade sodium for potassium, eliminating excess in stool and decr serum levels
- *does not impact creatinine, phosphorus or calcium levels**
- must have normal bowel function to avoid the risk of intestinal necrosis assess for s/s of constipation, signs of impaction and recent bowel patterns
methotrexate
for rheumatoid arthritis
adverse effects:
bone marrow suppression (can lead to anemia, leukopenia and thrombocytopenia (characterized by petechiae, purpura and other signs of bleeding)
hepatotoxicity
GI irritation
BM suppression is managed by dose reduction or discontinuation of med
caffeine + folic acid decreases effectiveness
TERATOGENIC !!
dopamine
outcome: increases HR, BP, CO + UO
Closely monitor VS –> higher doses can lead to dangerous tachycardia and tachyarrhythmias
Tamoxifen
prescribed to pts with breast cancer and prevent reoccurance
- common side effects similar to menopause (hot flashes, vag dryness, menstrual irregularities)
- serious side effects: thromboembolic events and endometrial cancer
clopidogrel (plavix)
antiplatelet medication, should be discontinued 5-7 days before surgery to decr risk for excessive bleeding
** meds (anticoagulants, antiplatelets, NSAIDS, herbal drugs) that incr risk for bleeding should be discontinued 5-7 days before surgery)
lactulose
given to pts with liver complications such as hepatic encephalopathy (high serum ammonia levels)
med reduces the ammonia by trapping it in the gut and then expelling it
–> improved MS
antiplatelet medications
prasugrel (effient)
clopidogrel (plavix)
ticagrelor (brilinta)
niacin (nicotinic acid/B3)
used in large doses for lipid-lowering poroperties
- may produce cutaneous vessel vasodilation
transdermal fetanyl patch
indicated to treat moderate to severe CHRONIC PAIN
- not recommended to treat acute postoperative, temporary or intermittent pain as it does not provide immediate analgesia when applied
esomeprazole
long term use of PPI may decrease the absorption of calcium and promote osteoporosis
increased risk of diarrhea caused by c. diff PPIs can suppress acid that would have prevented pathogens from more easily colonizing the upper GI tract… increased risk for pneumonias
phenothioZinews
1 ND = safety + educating about s/s of infection, report to HCP
major tranquilizers
for our ZANY pts
SEs –> ABCDEFG
anticholinergic, blurred vision, constipation, drowsiness, EPS (tremors, parkinson), foto-sensitivity, aGRANULOCYTOSIS
names of tricyclic antidepressants + major info
elavil, trofranil, aventyl, desyrel
ELEVATES MOOD, HAPPY PILLS!
med takes 2-4 weeks for beneficial effects
SE of tricyclic antidepressants
ABCDE
anticholinergic (esp dry mouth) blurred vision constipation drowsiness euphoria
benzos info, uses, ending
always have ZEP in the name
valium is the prototype (induction of anesthetic, muscle relaxant, alcohol)
uses: seizures medications preop induction of anesthesia muscle relaxants etOH withdrawal med ventilation (med to relax and calm down pts on vent)
REMEMBER THESE ARE MINOR ANTIPSYCHOLITCS
“what do you find at a zeppelin concert? minors on transquilizers”
why administer major and minor antipsychotics at the same time?
major –> take longer to work
minor –> start right away
pt usually on valium and elavil at same time, then valium is discontinued
similar to heparain and coumadin
SE of benzos
ABCD anticholinergic blurred vision constipation drowsiness
MAOIs uses, teaching points, med beginning
antidepressant, thought to be caused by norepi, dopamine and serotonin in brain
all the beginnings of MAOIs rhyme “MARplan, NARdil, PARnate”
AVOID TYRAMINE-CONTAINING FOODS –> MAY CAUSE HYPERTENSIVE CRISIS
- BAR bananas, avacados, raisins
- grains except yeast
- meats - no organ liver, kidney, tripe, heart, preserved
- dairy - no cheese except mozz, cottage cheese
- no ETOH, elixers, tinctures, caffeine, chocolate, licorice, soy sauce
MAOIs SEs
*** same as benzos ABCD anticholinergic blurred vision constipation drowsiness
litium
uses, SEs
used for treating bipolar disorder, decreases mania
**se’s act more like an electrolyte - think potassium/lithium
3 P’s
peeing (polyuria)
pooping (diarhea)
parasthesia (earliest sign of electrolyte imbalance)
what is the earliest sign of electrolyte imbalance
PARESTHESIAS
NUMBNESS AND TINGLING
toxic effects of lithium
tremors
metallic taste
severe diarrhea
1 NI for pt on lithium pooping and peeing all the time
GIVE FLUIDS!!
monitor sodium, sodium must be normal
too high = ineffective
too low = toxic
prozac (fluoxetine) SEs and special considerations
SSRI - MOOD ELEVATOR SEs ABCDE anticholinergic blurred vision constipation drowsiness euphoria ** causes insomnia so give before noon, if 2x daily then 6am and noon ** when changing doses assess suicidal risk in ADOLESCENTS
haldol (haloperidol) SEs
tranquilizers (basically same as thorazine)
ABCDEFG
anticholinergic, blurred vision, constipation, drowsiness, EPS, fotosensitivity, aGranulocytosis
**teach pts how to look out for s/s of infection, report to HCP
** first gen antipsychotics
haldol might develop what from overdose and risk factors
NMS (neuroleptic malignant syndrome) from OD
** this is a lifethreatening idiosyncratic reaction to antipsychotic drugs characterized by fever, AMS, muscle rigidity and autonomic dysfunction **
SEEN IN ELDERLY + YOUNG WHITE SCHIZO PTS
HIGH FEVER OVER 105
DOSE SHOULD BE 1/2 USUAL ADULT DOSE
also safety concerns r/t SEs
how to differentiate NMS from EPS
both present with anxiety and tremors
NMS will have high fever, 102 and rising call EMRT
+ NOTIFY HCP
clozaril (clozapine) SE and med type
atypical antipsychotic
aGRANULOCYTOSIS !
** IT IS WORSE THAN CANCER DRUGS AND CAN TRASH PTS BONE MARROW
Geodine (ziprasidone)
BLACK BOX WARNING
PROLONGED QT INTERVAL CAUSE CAUSE SUDDEN CARDIAC ARREST
DON’T USE IN PTS W CARDIAC CONDITIONS
ending of second gen antipsychotics
- zapine
** metabolic changes as SEs *like weight gain, high chol, high BP, high BG
1 NI for clozaril (clozapine)
monitor WBCs
Zoloft (sertraline) SEs and drug interactions to avoid
SEs "SAD Head" sweating apprehension *impending sense of doom* dizziness headache *can also cause insomnia
interact with StJohn’s wort and can cause serotonin syndrome
warfarin and cause bleeding
** d/t these meds not being metabolized in liver
which meds should the nurse anticipate a lower dose for if on st johns wort and warfarin
ZOLOFT
serotonin syndrome manifestations
TOO MUCH SEROTONIN IN BRAIN! mental changes tachycardia tightness in muscles difficulty walking incr in BP and temp
tocolytics
STOP CONTRACTIONS, STOP LABOR
given to women in premature labor, must be stopped
terbutaline (brethine)
tocolytic
SE: maternal tachycardia (don’t give with cardiac disease)
magnesium sulfate
tocolytic
treatment will induce hypermagnesemia, which will cause everything to go down
HR down, BP down, REFLEXES DOWN, RR DOWN, LOC down
NI for hypermagnesia
monitor RR, <12 decrease dose of mag sulfate
assess for reflexes
normal reflexes 2+
reflexes 0 or 1+ –> decrease dose of mag sulfate
reflexes 3+ or 4+ increase dose of mag sulfate
oxytocics
stimulate and strengthen labor
pitocin (oxytocin)
SE: utermine hyperstimulation (longer than 90 seconds, closer than 2 mins)
NI: lower dose
methergine
oxytocic
causes HTN: increases BP
betamethasone
steroid, fetal/neonate lung med
- give to mother IM, can repeat as long as baby is in utero
SE: increase glucose (steroid)
surfactant (survanta)
lung med
given to baby via transtracheal route
given after birth
humalin 70/30
mix of insulin N and R… 70% = N 30% = R
to remember the bigger number, think of a fraction… the numerator N is on top, therefore insulin is the bigger number
can you mix insulin in same syringe and how?
• Yes, insulin can be mixed in the same
syringe
• How do you mix insulin?
(1) Pressurize vial and (2) Draw up insulin
(1) To pressurize the vial … Inject air into N, then into R, Draw up R
(2) To draw up insulin … Think of RN
needle for injections IM
o Pick answer in which both answers
have a “1” in them
o “I” in IM looks like the “#1”
o Use a 21-gauge, 1-inch long needle
needle for subq injection
o 5 looks like an “S” in “SubQ”
o Pick the answer that has “5s” in it
o Use a 25-gauge, 0.5 inch needle
max amount of time heparin can be given for?
3 weeks, 21 days
after 21 days body starts making antibodies against heparin
antidote and labs for heparin
protamine sulfate
PTT
** can be used during pregnancy, class c med
coumadin info, antidote, labs
given only PO takes few days to a week to work (likely 4-5 days) pts can be on coumadin for entire life antidote: vitamin K labs: PT/INR NOT USED DURING PREG
what is the only antipsychotic given to preg women
HALDOL!
diuretics
k wasting, k sparing
any diuretic ending in X, XES OUT K
if it does not end in X it is a sparer
lasix –> wastes K and Diuril is k wasting
Brand vs Generic o Aldactone Spinorolactone** o Adactazide Spinorolacone-Hydrochlorothiazide o Modurectic Amiloride-Hydrochlorothiazide o Lasix** Furosemide o Bumex Bumetanide** o Clotrix Clotrimazole o Esidrex Hydrochlorothiazide** o Demadex Torsemide o Diuril Chlorothiazide
2 muscle relaxants to know
SEs + teaching points
brand/generic
lioresal/baclofen
flexeril/cyclobenzaprine
SE: fatigue/drowsiness, muscle weakness (paresis) Teaching: don't drink don't drive don't operate heavy machinery
