Wiki 4 Flashcards
Acetaminophen (Tylenol) is an effective analgesic for discomfort associated with headache, and musculoskeletal pain. This drug works by prostaglandin inhibition in the CNS and blocks generation of pain impulses in the peripheral tissue but has no anti-inflammatory activity. What else is it used for?
fever reduction
Ibuprofen (Advil) is used on to relieve pain and
inflammation
What is administered on arrival to the emergency department to those patients experiencing an acute MI?
aspirin
NSAIDs can put patients at risk for what serious adverse effects?
can cause gastrointestinal bleeding, hepatotoxicity, hives, rash, pruritis, facial swelling, nephrotoxicity and blood dyscrasias
The client presents to the outpatient clinic with a chief complaint of insomnia. The client’s medical history includes Alcohol dependence, Peptic Ulcer Disease, and Urinary Tract Infections. The client is allergic to antihistamines and Nonsteroidal anti-inflammatory drugs (NSAIDS).
What prescription medication is best to use for this client’s insomnia?
trazodone
The nurse administered Hydromorphone (Dilaudid) 2mg IV to the hospitalized client 30 minutes ago. When the nurse enters the room to complete a pain recheck the client is noted to have blue lips, heart rate is 45, and the client is making gurgling noises.
What is the priority nursing intervention for this client?
Blue lips, bradycardia, and gurgling are signs of an opioid overdose in this case of dilaudid. Therefore give naloxone (narcan) to reverse the effects and put the head of the bed in Fowler position if not contraindicated. Check their vital signs afterwards to make sure they are breathing properly.
The nurse is completing a home medication reconciliation on the client in the Emergency Department. The client reports taking the following medications daily:
Diphenhydramine 25mg P.O. TID PRN seasonal allergy symptoms Acetaminophen (Tylenol) 3 grams P.O. BID Omeprazole (Prilosec) 20mg P.O. Qday Which home medication is concerning? Why is it concerning?
Acetaminophen
This patient is ingesting a total of 6 grams of acetaminophen per day, and the maximum daily recommendation is 4g per day for an adult. The overdose can lead to hepatotoxicity which can be life threatening.
Administration of opiate agonists causes primary effects on the CNS including
analgesic pain relief effects, sedation, drowsiness, respiratory depression, euphoria, and constricted pupils
What common adverse effects of opiate agonists could impact patient safety?
Lightheadedness, dizziness, sedation, confusion, disorientation, addiction, withdrawal, abuse, dependence, orthostatic hypotension
What are early signs of opiate withdrawal? What intensifies over the next24 hours?
Early signs of opiate withdrawal are restlessness, diaphoresis, piloerection, lacrimation, runny nose and mydriasis. Over the next 24 hours, these early signs intensify. Muscular spasms, aching in the back, abdomen and legs, hot and cold flashes, insomnia, nausea, vomiting and diarrhea, severe sneezing and increases in body temperature, blood pressure, and respiratory rate and heart rate all may occur.
Which phase of pharmacokinetics is dependent on the route of administration?
absorption
If a patient has a history of liver disease which phase of pharmacokinetics is most effected?
metabolism
What is the desired therapeutic outcome when taking a benzodiazepine?
Decreased levels of anxiety to a managable level, produce mild sedation, to be used short term for sleep and also provide preoperative sedation with amnesia.
What is a serious adverse effect from excessive use of a benzodiazepine?
Physical and psychological dependence, leading to possible withdrawl which includes symptoms like anxiety, delirium, and siezures. Can also result in overdose or death.
What medications fall under the benzodiazepine classification?
Alprazolam(Xanax), Diazepam(Valium)
What type of device might a patient with sleep apnea use every night?
CPAP (Continuous Positive Air Pressure)
The presence of food, particularly food with a high fat content can slow the absorption of what medication?
zolpidem, zaleplon, eszopiclone, and ramelteon
What would be included in good sleep hygiene techniques?
Consistent wake/sleep schedule, relaxing bedtime routine, avoid tv/blue light (phone) 30-60 min. before bedtime, avoid caffeine and alcohol after 4pm, use the bed for sleep and sex only, avoid large meal before bedtime, dim lights 30-60 minutes before bedtime, cool bedroom down to 65 degrees
What antidepressant is prescribed in low dosages to assist patients with getting to sleep?
Trazodone, Remeron, and Doxepin
GABA Receptor Agonists such as ________ work similar to benzodiazepine but with have less withdrawal symptoms.
Zolpidem(Ambien)
What does the nurse do during the assessment phase of the nursing process?
The nurse will collect subjective and objective data, identify the patient’s actual or potential health problems, and analyze the assessment data
If a patient has a history of kidney disease which phase of pharmacokinetics is most effected?
Drug Excretion
Carbonic Anhydrase Inhibitors like dorzolamide (Trusopt) reduce intraocular pressure by
decreasing the production of aqueous humor
What drug classification is used to lower intraocular pressure by increasing the outflow of aqueous humor and produces mydriasis for ophthalmic examinations?
Alpha-Adrenergic agents
Beta-Adrenergic Blockers like timolol maleate (Timoptic) can have what serious cardiovascular adverse effects?
Bradycardia, dysrthythmias, hypotension
latanoprost (Xalatan) is a __________ that reduces IOP by increasing the outflow of aqueous humor
Prostglandin Analog (classification)
_________is an eye disease characterized by abnormally elevated intraocular pressure (IOP), which may result from excessive production of the ___________ or from diminished ocular fluid outflow. Increased pressure, if persistent and sufficiently elevated, may lead to permanent ______.
glaucoma
aqueous humor
blindness
The elderly client is diagnosed with seasonal allergies, open-angle glaucoma, osteoarthritis, and urinary incontinence at the Primary Care appointment. The client has a history of taking the following medications:
Ibuprofen (Motrin)
Loratidine (Claritin)
Oxybutynin (Ditropan XL)
Dorzolamide (Trusopt)
Which of these medications should be avoided in this client?
Why?
Oxybutynin (Ditropan XL)
can increase intraoccular pressure, which can worsen symptoms of glaucome and even lead to damaging the optic nerve
The nurse is reviewing the client’s home medication list which includes the following medications:
Tiotropium (Spiriva Respimat) 1.25 mcg inhaled BID
Salmeterol (Serevent Diskus) 50mcg inhaled Q12 hours
Albuterol (Proventil-HFA) 90 mcg two puffs inhaled Q4-6 hours PRN bronchospasm.
What is the client’s medical diagnosis?
COPD (chronic obstructive pulmonary disease) or asthma
