Adult Health II - Exam 2 Medications

albuterol causes tachycardia because...

---adrenergic agonists can lose their selectivity when given at higher doses.***

When using a MDI teach the patient to wait how long between each puff

1 minute between puffs

Teriparatide (forteo) max duration of use

2 years bc risk for osteosarcoma

Fluticasone/salmeterol directions

2x a day Inhale rapidly bc this is a dry powder inhaler (pt doesn't need good hand-lung coordination since its dry power) *** Wash mouth

Peak of tiotropium is around

3 hours

A patient may not have more than ______ gram of acetaminophen

4g of acetaminophen ( 1g every 6 hours) --- do not want liver damage

Budesonide/formoterol (symbicort) directions

80mcg/4.5mcg 2 inhales 2x day 160mcg/4.5mcg 2x day

ACUTE ATTACKS AIM your treatment

A:Albuterol first (bronchodilator) I: Ipratropium second (anticholinergeric) M: Methyl-prednisolone "Solu mederol" (steroid)

Calcitonin class

Parathyroid agent (calcium regulator) ---derived from salmon

Warfarin, heparin, and enoxaparin

Anticoagulant post-op for hip and knee arthroplasty

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?

Reassure the patient that these are expected side effects.

Alendronate class

Biphosphonate--bone reabsorption inhibitor

fluticasone is a good choice for...

CHILDREN does not suppress growth in children

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? A. "You may have another dose in 4 hours." B. "You may need to take two inhalations instead of one." C. "You should have peak effects in about 6 hours." D. "You should see improved effects within the next week."

D. "You should see improved effects within the next week."

Which patient statement indicates that a patient admitted with acute asthma may need teaching regarding medication use? A. I have not had any acute asthma attacks during the past year B. I became short of breath an hour before coming to the hospital C. I've been taking acetaminophen every 6 hours for chest wall pain D. I've used my albuterol inhaler frequently over the last 4 days

D. I've used my albuterol inhaler frequently over the last 4 days

The nurse completes an admission assessment on a patient with asthma. Which information indicates a need for discussion with the health care provider about a change in therapy? A. The patient uses an albuterol inhaler before aerobic exercise. B. The patient's only medications are albuterol and salmeterol inhalers. C. The patient's heart rate increases slightly after using the albuterol inhaler. D. The patient used albuterol more often when symptoms were worse in the spring.

D. The patient used albuterol more often when symptoms were worse in the spring.

A patient is taking alendronate [Fosamax] to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to: A. reduce the likelihood of atrial fibrillation. B. maximize bone resorption of calcium. C. minimize the risk of esophageal cancer. D. prevent hyperparathyroidism.

D. prevent hyperparathyroidism

A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: A. adding roflumilast [Daliresp] once daily. B. changing to oral theophylline twice daily. C. prescribing oral steroids once daily. D. using an ipratropium/albuterol combination twice daily.

D. using an ipratropium/albuterol combination twice daily.

What drug can be used for the treatment of hypercalcemia

Denosumab ***

Budesonide/formoterol (symbicort) side effects

FLU LIKE SYMPTOMS cough, chills, congestion, headache, muscle aches, pain around eyes etc.

Budesonide/formoterol (symbicort) class

Glucocoticoid/laba duo

Protamine sulfate is the antidote for

Heparin

Teriparatide (forteo) side effects

Hypercalcemia, hypercaluria

Ipratropium (atrovent): how to remember

I comes before T in the alphabet which is how to remember we use it first for acute exacerbation

A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

Intravenous glucocorticoids nebulized albuterol and ipratropium oxygen

ANTICHOLINERGICS examples

Ipratropium Tiotropium

Budesonide/formoterol (symbicort) patho

Long-acting beta 2 agonist Bronchodilates and anti-inflammatory

Tiotropium (Spiriva) is used for use it ______ daily

Maintenance use once daily... more long-term than ipratropium

Antidote for Opioid overdose

Naloxone (Narcan)

Fluticasone/vilanterol (breo ellipta) directions

ONLY GIVEN ONCE A DAY Dry poweder inhaler

Calcitonin routes

Oral Intranasal - rotate nares SubQ

NSAIDS can be used in Risk for

Osteoarthritis, Herniated Disks, Carpal Tunnel, and Headaches for Pain Management risk for GI bleed

Calcitonin is used in PT's with

Osteoporosis

Alendronate is taken what route

PO

How often should you take Raloxifene

PO 1x daily

KCl (potassium chloride)

Pre-Post Op consideration Electrolyte imbalance protocol

Budesonide/Formoterol is used as

Preventative and long-term maintenance of asthma/copd --- Only med that can be both

Hydrocodone/Acetaminophen/Hydromorphone risk of

Risk of sedation / respiratory depression / constipation

Morphine PCA

Risk of sedation and respiratory depression

Ipratropium (atrovent) use

Short-acting ---works in minutes so can be used for ACUTE exacerbation of COPD

Alendronate teaching

Sit upright for 30 minutes post administration to avoid esophageal irritation Take with plenty of water *** If you miss a dose, just skip it Take in AM before food and other meds// avoid food and drink other than water 30 min prior Avoid calcium for 2 hours after admin Use sunscreen because of photosensitivity

Teriparatide (forteo) teaching

Sub Q SELF injection daily orthostatic hypotension take calcium and vitamin d when taking the medication rotate injection site store pen in fridge Symptoms of hypercalcemia; excessive thirst, urination, nausea/vomiting, muscle weakness

Drug that can be used to treat osteoporosis in men ***

Teriparatide

Tiotropium shows therapeutic effects in about ________ with improved broncodilation occuring with subsequent dose up to

Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. --- this is why it takes a week to see improvments when starting

Ipratropium (atrovent) directions use - duration is about -

Use 3-4x a day DURATION: 6 hrs

Corticosteroids

Used in respiratory conditions like COPD, and Cervical Herniated Disks/ Low back pains Long-term use can contribute to secondary osteoporosis

it is important to assess what with pts on PCA pumps?

VS, O2, and CO2 levels

Raloxifene can only be used in

WOMEN ***

Vitamin K is the antidote for

Warfarin

albuterol is mostly used for...

acute, rapid symptomatic relief (asthma/COPD) ---rescue from ongoing attack & and exercise-induced bronchospasm (prevention)

Ipratropium is an anticholinergic used for

allergic rhinitis and colds and COPD exacerbations

Budesonide is a -- remember it can

corticosteroid -- remember it can stunt growth in children -- pts can also develop crushing symptoms (high glucose, hypertension, moon face, buffalo hump, large stomach etc...

Raloxifene is used for PT with

osteoporosis

Teriparatide (forteo) class - not on study guide

osteoporosis med

Fluticasone/vilanterol (breo ellipta) side effects

back pain, adrenal insufficiency, hypoglycemia, flu-like symptoms, headache

albuterol drug class

beta-2 agonist bronchodilator

Raloxifene osteoporosis use

binds to estrogen receptors to block or mimic actions of estrogen ---reduces reabsorption of bone and decreases bone turnover to prevent osteo in post menopause WOMEN

Teriparatide (forteo) contraindications

bone cancer, breastfeeding, pregnancy

Raloxifene protects against

breast cancer **

ANTICHOLINERGICS do what

bronchodilators that reduce secretions dry the body out by blocking secretions

Ipratropium is used to treat what in COPD patients

bronchospasms

when giving report on a PCA machine you should explain...

continuous rate _____ mg dose _____ mg lockout time ____ min 1 hour limit ____ mg

Calcitonin osteoporosis use

decrease bone reabsorption, increase deposit of calcium in bone ---opposes parathyroid hormone

Alendronate osteoporosis use

decrease rate of bone reabsorption, may directly block dissolution of dyroxyapatitie crystals of bone. Basically, inhibits the cells that breakdown bone

Teach pts taking alendronate to report

difficulty swallowing immediately --- r/t esophagitis

Raloxifene teaching

discontinue 72 hrs prior to prolonged immobilization bc risk of dvt **** Take CA & vit D increase exercise using weights stop smoking decrease alcohol Do not take if hx of thromboembolic events or preggo

Cyclobenzaprine main side effects ****

dry mouth blurred vision constipation

side effects of Ipratropium and Tiotropium

dry mouth, hoarseness (irritated throat)

albuterol is a...

first-line medication to reverse airway narrowing ex: for a pt having an asthma attack, the first medication to administer would be albuterol

Gabapentin

for nerve pain and sedating (anti-seizure med)

Metoclopramide

for post-op ileus Stimulates peristalsis

Alendronate side effects

generally well tolerated Esophagitis (main concern) Other side effects include a.fib, femoral fractures, ocular inflammation. Adverse effects increase w long use

Fluticasone/vilanterol (breo ellipta) class

glucocorticoid/long-acting beta 2 agonist combination

Metoclopramide side effects

hallucinations anxiety

Calcitonin side effects

headache, eye pain, nauesa/vomit/diarrhea/anorexia, bronchospasm/anaphylaxis, rash

Denosumab may delay ***

healing of fractures (suppress bone turnover)

you can also see what on a PCA pump?

how many mg did the pt take during your shift how many attempts did the pt have (pt pushes button but too soon to get another dose of pain meds)

always ask the PT about

how much albuterol they use

examples of corticosteroids

inhaled -Fluticasone - Beclomethasone - Budesonide oral - Prednisone - Prednisolone "Solu medrol"

Fluticasone/salmeterol is used as

long-acting beta-2-agonist and glucocorticoid --- provides long-term maintenance of asthma/COPD ---Relax smooth muscles

Fluticasone/vilanterol (breo ellipta) use

long-term asthma control

In children on MDI's you may notice

mood changes in the child

gold standard med for PCA pump

morphine hydromorphone (diludud)

Tiotropium is given

once daily -- inhalation of one capsule

Alendronate is for pts with

osteoporosis

Cyclobenzaprine is use for pts with ____________ and _________________ _____________

pain and muscle spasms (muscle relaxant) ---sedation more likely when used with hydrocodone

albuterol side effects

palpitations, tachycardia, dysrhythmias, headaches, dizziness, restlessness, tremors can cause mood changes in kids

PCA side effects

respiratory depression decreased LOC constipation confusion

When using an MDI ensure the patient always

rinses the mouth after each dose -- prevent oral candidias

Raloxifene class

selective estrogen receptor modulator (SERM)

Calcitonin teaching

signs of hypocalcemia (tetany, seizures). not used much bc long-term risks of cancer unpleasant side effects and better drugs out there***

Fluticasone/salmeterol side effects

tremors, anxiety, agitation, hyperactivity, irritability, hypersalivation, osteoporosis,

Raloxifene side effects

vasomotor symptoms are common side effects !!! *** hot flashes increased risk of DVT / PE