NSG 118 - Pharmacology Final

Interaction of oral pain/headache medication and anticoagulant medication

The most complication that can occur is bleed, localized or systemic bleeding, due to the anticoagulation therapy and high-dose aspirin (antiplatelet therapy). Aspirin can be administered with heparin or warfarin, but a nurse would have to watch the dosage carefully.

A patient newly diagnosed with depression has been prescribed fluoxetine, a selective serotonin reuptake inhibitor (SSRI). Why would the physician order an SSRI for a newly diagnosed patient?

SSRIs usually produce fewer and milder adverse effects than other antidepressants.

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Salami

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?

Serotonin

Short Acting Insulin Onset and Peak Times:

Short Onset: 30 mins. Peak: 2 hours

Adverse effects r/t insulin:

The most common adverse effects related to insulin use are hypoglycemia and ketoacidosis. Local reactions at injection sites. With inhaled insulin, the most common adverse effects also include cough and throat pain or irritation.

Glyburide (DiaBeta, Micronase):

onset: 1 hour; Duration 24 hours

Glargine (lantus):

onset: 60-70 mins; Peak: None

Lispro (Humalog) :

onset: less than 15 mins; peak 30-90 mins

Aspart (Novolog)

rapid acting insulin onset: 10-20 mins duration: 1-3 hours

A client newly diagnosed with HIV is receiving client teaching from the clinic nurse about antiretroviral medications. The nurse should teach the client to report what adverse effect to a healthcare provider most promptly?

full body rash

Common adverse effects of SSRIs

headache, drowsiness, dizziness, insomnia, anxiety, activation of mania/hypomania, tremor, agitation, suicidal ideation.

The nurse is assessing a client admitted with AIDS whose current antiretroviral regimen includes a nonnucleoside reverse transcriptase inhibitor. What nursing diagnosis related to drug therapy is most likely to be appropriate for this client?

imbalanced nutrition: less than body requirements, related to gastrointestinal (GI) effects of the drugs

While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:

tardive dyskinesia.

A client comes to the health care facility reporting flulike symptoms. After a thorough assessment, the client is diagnosed with influenza and is to receive oseltamivir. The nurse understands that this drug has been prescribed because the client been symptomatic for less than:

2 days.

Adverse effects of lithium (Lithobid)

Leukocytosis, polyuria/dipsia, dry mouth, hand tremors, confusion, decreased memory, headache, muscle weakness, ECG changes, nausea, vomiting

Client teaching with levothyroxine administration

Levothyroxine oral is taken by mouth. Levothyroxine injection is given as an infusion into a vein. Levothyroxine is usually given by injection only if you are unable to take the medicine by mouth. I would teach the client to take this medication 30-60 min before breakfast as close to the same daily time. If oral, swallow with 8 o.z of water as it may dissolve rapidly and cause swelling in the throat. If used in liquid medication form use provided syringe for accurate measurement. This medication may take several weeks to take effect, continue use even after feeling better; levothyroxine may be used for the rest of the patient's life. Regular medical testing may be needed and the patient must notify any doctor or surgeon that may be treating them that they are using this medication. For storage: keep at room temperature and do not share this medication with another person.

Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder?

Lithium

sumatriptan (Imitrex)-

Class: Triptan the first drug of this class, is used for the treatment of acute migraine attacks and for the treatment of cluster headaches in adults. It can be given orally, subcutaneously, or by nasal spray.

ACEs Action

Action: Blocks ACE from converting angiotensin I to angiotensin II, leading to decreased BP, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss.

furosemide (Lasix)

Action:Loop diuretics block the chloride pump in the ascending loop of Henle, where 30% of all filtered sodium is normally reabsorbed. This action decreases the reabsorption of sodium and chloride. The loop diuretics have a similar effect in the descending loop of Henle and in the distal convoluted tubule, resulting in the production of a copious amount of sodium-rich urine. These drugs work even in the presence of acid-base disturbances, renal failure, electrolyte imbalances, or nitrogen retention. Uses: cute HF, acute pulmonary edema, edema associated with HF or with renal or liver disease, and hypertension

Averse effects and uses for adrenergic agonists in general and specifically dopamine:

Acts directly and by the release of norepinephrine from the sympathetic nerve terminals, mediates dilation of vessels in the renal and splanchnic beds to maintain renal perfusion while stimulating the sympathetic response.

First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect?

Administer the dose at bedtime

Adverse effects of adrenergic agonists:

Tachycardia, ectopic beats, angina pain, hypotension, dyspnea, nausea, vomiting, hypotension, dyspnea, N/V, Headache (H/A)

The nurse admits a client newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason why the nurse includes the family when collecting the nursing history?

The client may not be able to provide a sufficient history.

Appropriate dosing of thyroid meds

levothyroxine (Synthroid): adult 50-200 mcg/d PO Pediatrics: 0.025-0.4 mg/d PO liothyronine (Cytomel): adult 25-100 mcg/d Po Pediatrics: 20-50 mcg/d PO liotrix (Thyrolar): adult 60-120 mg/d PO Pediatrics: 25-150 mcg/d PO

A client has just been diagnosed with HIV. When developing the teaching plan, what information would the nurse share with this client related to use of alternative or complementary therapies?

"Alternative therapies have benefits and risks. Are there any types of alternative or complementary therapies that you follow or are there any herbs or supplements that you take?"

A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for:

Blood in urine or stool

Stage 4 of Anesthesia

Medullary paralysis, is very deep CNS depression with loss of respiratory and vasomotor center stimuli in which death can occur rapidly. If a patient reaches this level, the anesthesia has become too intense, and the situation is critical.

Drug-drug interaction for Niacin

The risk for rhabdomyolysis increases if any of these drugs is combined with statins/ HMG-CoA Reductase inhibitors

An adult client, diagnosed with depression several weeks ago, began taking citalopram 10 days ago. The client has told the nurse of the intent to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the client's statement?

"I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."

The nurse is caring for a client who is taking adefovir to treat hepatitis B. The nurse's most recent assessment reveals that the client's skin and sclerae are visibly jaundiced. What is the nurse's bestaction?

Document the finding as expected in a client with hepatitis.

Indications for use and adverse effects of CNS stimulants

CNS stimulants are used to treat attention deficit disorder (ADD), Attention deficit hyperactivity disorder (ADHD) and narcolepsy. Adverse effects can include restlessness and blurred vision, and more serious adverse effects can include psychosis, seizures, and serious heart complications.

The nurse is writing a plan of care for a client receiving an alpha-specific adrenergic agonist. What is the priority component of the client's plan of care?

Monitor blood pressure and heart rate frequently

A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why both medications have been prescribed. What is the nurse's most accurate response?

"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."

What are the uses for and adverse effects of calcitonin salmon?

Calcitonin is used to treat osteoporosis, specifically post-menopausal. It works by slowing bone loss and maintaining calcium. Some adverse effects may include swelling or redness at the injection site, increased urination, loss of appetite, and rare but possible allergic reactions may occur.

Glucagon (GlucaGen):

Onset: 1 min; Peak: 15 mins

Insulin onset & Peak times:Rapid

Onset: 15 mins Peak: 1 Hour

Intermediate Acting Insulin On Set and Peak Times:

Onset: 2 hours Peak: 8 hours

What assessment should the nurse make before administering beta-adrenergic blocking agents?

Pulse and blood pressure

Which patient statement indicates the need for additional teaching about propranolol?

"I can stop the drug once my blood pressure is controlled."

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy?

"I may always have to take this medication."

The nurse is preparing a client for discharge who will receive a prescription for a hydroxymethylglutaryl-coenzyme A (HMG-CoA) inhibitor. What statement by the client demonstrates a clear understanding of the teaching provided by the nurse?

"I should plan to take this drug before bedtime, because my body makes lipids mostly at night."

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:

"I will take the digoxin about an hour before the cholestyramine."

Maraviroc (Selzentry)

(CCR5 coreceptor antagonist) Uses: Used in combination therapy with other antivirals for treatment of HIV. Client teaching: Take as prescribed, do not run out of medication, continue to take this medication even if you are feeling better Adverse effects: Dizziness, changes in consciousness, severe hepatotoxicity has been reported.

efavirenz (Sustiva)

(Nonnucleoside reverse transcriptase inhibitor) Uses: Treatment of adults and children with HIV in combination with other retroviral agents. Client teaching: Advise client to take as prescribed; if dose is missed take as soon as remembered; do not double dose, take on empty stomach with water/juice, to take at same time of the day, do not break tabs, to take with other antiretrovirals Adverse effects: Headache, dizziness, fatigue, impaired cognition, insomnia, abnormal dreams, depression, anxiety, drowsiness, odd feeling,suicidal thoughts/behaviors,diarrhea, constipation, n/v, abdominal pain, flatulence,hepatoxicity

Zidovudine (Retrovir)

(Nucleoside reverse transcriptase inhibitor) Uses: Combination therapy for the treatment of adults and children with HIV. Client teaching: Take as prescribed, do not run out of medication, continue to take this medication even if you are feeling better, do not take if pregnant, these medications should be used with caution or avoided in clients with renal or hepatic impairment, bone marrow suppression can be aggravated with these medications. Adverse effects: Hypersensitivity reactions, pancreatitis, hepatomegaly, and neurological problems.

Fosamprenavir (Lexiva)

(Protease inhibitor) Uses: Part of combination therapy for the treatment of HIV. Client teaching: Take this medication with food, do not take if pregnant, take with caution if hepatic dysfunction, could raise blood sugar levels if diabetic, mild to severe dermatologic reactions including Steven-Johnson syndrome can occur. Adverse effects: Take as prescribed, do not run out of medication, continue to take this medication even if you are feeling better, nausea/vomiting, diarrhea, anorexia, changes in liver function

oseltamivir (Tamiflu)

(Treatment for Influenza A and respiratory viruses) Uses: To combat influenza A & B and respiratory syncytial virus (RSV) Client teaching: -Teach client to avoid hazardous activities if dizziness occurs. -Advise client to take as soon as symptoms appear, take full course of medication even if feeling better. -Advise client to take missed dose as soon as remembered if within two hours of next dose. - Teach client to stop product immediately and report to subscriber any skin rash, delirium, psychosis, hallucinations (child.) - Advise client that medication is not a replacement for the flu shot - Inform client to avoid other products without approval of provider. -Identify if pregnancy is planned or suspected or if breastfeeding. Adverse effects: CNS: Headache, fatigue, insomnia, dizziness, seizures, delirium, self-injury (children.) GI: N/V, Integumentary: Toxic epidermal necrolysis, Stevens-Johnson Syndrome, erythema multiforme, Respiratory: Cough

Nursing Considerations (assessment data, etc..) for nonselective adrenergic blocking agents;

-Assess for contraindication or cautions -Perform a physical assessment to establish baseline data for determining the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy, assess the level of orientation and for any complaints of dizziness , paresthesia's or vertigo. -Monitor vital signs and assess to evaluate for possible cardiac effects, obtain an electrocardiogram (ECG) as ordered to assess for possible irregularities in rate or rhythm, assess respiratory rate and auscultate lungs to determine the presence of any adventitious sounds, observe for ease of breathing and report any signs and symptoms of bronchospasm or respiratory distress , and monitor GI activity to determine the need for interventions to deal with increased activity. - Monitor the results of laboratory tests such as renal and liver function studies and electrolyte levels to determine the need for possible dose adjustment, monitor blood glucose levels to evaluate for hyperglycemia or hypoglycemia.

Assessment for Neuro Blocking Agents

-Assess for contraindications or cautions -Perform a physical assessment, including weighing the patient -Assess the patient's neurological status, including level of consciousness, affect, reflexes, and pupil size and reaction, and evaluate muscle tone and response to monitor CNS depression and provide appropriate support as needed. -Monitor vital signs -Obtain an electrocardiogram (ECG) to evaluate for underlying cardiac problems that may be exacerbated by the drug. -Assess skin color and lesions to monitor for potential skin breakdown -Auscultate the abdomen for bowel sounds to evaluate GI motility. -Monitor the results of laboratory tests, including renal and liver function tests,to determine the possible need for a reduction in dose and evaluate for possible toxicity.

Adverse Effects of Osmotic Diuretics:

-Convulsions, Thrombophlebitis, and pulmonary congestion

Adverse Effects of Potassium Sparing Diuretics:

-Dizziness, headache, cramps, nausea, vomiting, diarrhea, urinary frequency, weakness, hyperkalemia

Adverse Effects of Loop Diuretics:

-Hypokalemia, hyperglycemia, hyperuricemia -dizziness, headache, tinnitus, blurred vision -Nausea, vomiting, diarrhea - Thrombocytopenia, neutropenia

Nursing Diagnoses for Neuro Blocking Agents

-Impaired gas exchange related to respiratory depression -Impaired skin integrity related to immobility secondary to effects of positioning during anesthesia and immobility -Risk for injury related to CNS-depressive effects of the drug -Disturbed thought processes and disturbed sensory perception related to CNS depression -Deficient knowledge regarding drug therapy

Implementation for Neuro Blocking Agents

-Keep in mind that the drug must be administered by trained personnel (usually an anesthesiologist) because of the potential risks associated with its use. -Have emergency equipment to maintain airway and provide mechanical ventilation readily available when patient is not able to maintain respiration because of CNS depression. -Monitor temperature for prompt detection and treatment of malignant hyperthermia. Maintain dantrolene on standby. -Monitor pulse, respiration, blood pressure, ECG, and cardiac output continually during administration to assess systemic response to CNS depression and provide appropriate support as needed. -Monitor temperature and reflexes because dose adjustment may be needed to alleviate potential problems and to maximize overall benefit with the least toxicity. -Institute safety precautions, such as side rails, and monitor patient until the recovery phase is complete and the patient is conscious and able to move and communicate to ensure patient safety. -Provide comfort measures to help the patient tolerate drug effects. Provide pain relief as appropriate, along with reassurance and support, to deal with the effects of anesthesia and loss of control; skin care and turning to prevent skin breakdown; and supportive care for conditions such as hypotension and bronchospasm. -Offer support and encouragement to help the patient cope with the procedure and the drugs being used. -Provide preoperative patient teaching, realizing that most patients who receive the drug will be unconscious or will be receiving teaching about a particular procedure:Information about the anesthetic (e.g., what to expect, rate of onset, time to recovery) -Patient should not drive or operate machinery the day of the procedure. -Patient should not sign any legal documents and/or make any significant decisions for 24 hours after the sedation procedure. -Patient and caregiver should be informed it is normal for the patient to be drowsy for 12 to 24 hours postprocedure but should always be arousable. If the patient is not arousable, a provider should be called.

Adverse Effects of Carbonic Anhydrase Inhibitors (CAIs):

-Metabolic abnormalities (acidosis and hypokalemia) -Drowsiness, anorexia, paresthesia (pins and needles), hematuria, urticaria (hives), photosensitivity, melena (blood in the stool)

Evaluation of Neuro Blocking Agents

-Monitor patient response to the drug (analgesia, loss of consciousness). -Monitor for adverse effects (respiratory depression, hypotension, bronchospasm, slowed GI activity, skin breakdown, malignant hyperthermia). -Evaluate the effectiveness of the teaching plan (patient can relate anticipated effects of the drug and the recovery process). -Monitor the effectiveness of comfort and safety measures.

Client teaching for clients taking diuretics:

-Patients taking diuretics need to maintain proper nutritional intake and fluid volume and eat potassium rich foods (except when on K- sparing diuretics) -Sources of potassium include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, legumes, Frequent lab tests in the beginning and during diuretic therapy -Encourage patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness or fainting. -Keep daily journal with daily weight, how patient feels, and dose of diuretics taken -Report any adverse effects to HCP , report excessive dizziness, syncope, weakness, or muscle aches, nausea, anorexia, lethargy, mental confusion, hypotension -Educate the patient to monitor about signs and symptoms of hypokalemia, K+ normal range(3.5-5)

Planning for Neuro Blocking Agents

-The patient will receive the best therapeutic effect from the drug therapy. The patient will have limited adverse effects to the drug therapy. -The patient will have an understanding of the drug therapy, adverse effects to anticipate, and measures to relieve discomfort and improve safety.

A nurse is to administer 175 mg of a medication intramuscularly. The label on the multidose vial states that the concentration is 100 mg/mL. What volume of the drug should the nurse administer? (Record your answer using two decimal places.)

1.75

The nurse is providing discharge teaching for a client who has been prescribed 600 mg of an oral liquid medication. The mother shows the nurse the label of the medication, which reads: 250 mg/mL. The nurse would instruct the mother to give how many milliliters?

2.4 mL

A client weighs 110 lb. What is this weight in kilograms?

50 kg

Management of a patient-controlled analgesia (PCA)

A PCA gives the patient the power to control their own pain. To manage this, the nurse will teach the patient that the medication provides a baseline infusion of the medication and will prevent overdose. It is timed creating a lockout of extra doses until the specific time has lapsed. Monitor vitals including pain and for adverse effects of the medication; CNS effects (multiple), respiratory depression, rash, skin changes, GI depression, constipation.

Management of a client with opioid overdose

A client that is experiencing opioid overdose show signs of decreased respiration and blood pressure, drowsiness, slurred speech, and psychomotor retardation. An opioid antagonist, such as Naloxone, can be administered if an overdose is suspected. Management of this client would include symptoms include insomnia, irritability, rhinitis, chills, fever, nausea, vomiting, muscle aches, abdominal cramping and diarrhea

Uses and Adverse effects of ACE's: (prils)

ACE's: used for treatment of Hypertension, CHF, Diabetic Neuropathy, left ventricular dysfunction following an MI

When the nurse is engaging in teaching with clients taking anti-psychotic medications and their families, what would be important to include to decrease adverse effects of the medication?

Alcohol should be avoided.

Administration and client teaching for Amphetamine aspartate (Adderall)

Amphetamine aspartate otherwise known as Adderall is a central nervous system stimulant used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is best to take this medication in the morning and at the same times each day. Avoid taking at night to prevent insomnia. Adderall can be an addicting substance, so it is important to notify your doctor of any alcohol or drug addictions. Adderall may build a tolerance overtime. If you stop taking Adderall abruptly, withdrawal symptoms may occur such as severe tiredness, sleep problems, or mood problems like depression. Some common side effects of Adderall are skin rashes, nausea, insomnia, headache and blurred vision

Nursing considerations and lab values of anticoagulants

Assess for known allergies, hemorrhagic disorders, recent trauma, spinal puncture, GI ulcers, recent surgery, screening for pregnancy, lactation, hepatic disease, heart failure, and thyrotoxicosis. Assess their baseline status . This includes body temperature, skin color, lesions, and temperature, pulse, blood pressure, and perfusion, respirations, clotting studies, renal and hepatic function tests, CBC, stool guaiac, and ECG.

Client teaching with dietary and herbal supplements to avoid while using anticoagulants

Avoid eating Dong quai, fever few, garlic, ginger, ginkgo, St. John's wort, Kava, and Capsicum pepper. Also, avoid eating large amounts of Vitamin K. This includes things such as lettuce, collard, Brussel sprouts, chard, spinach, kale, and green tea.

Cyclobenzaprine (Amrix, Flexeril)

Class: Skeletal Muscle Relaxant use: adjunct relief for muscle spasms and pain in muscloskeletal condition Adverse Reactions: dizziness, weakness, drowsiness, headache, insomnia, postural hypotension, dysthymias, nausea, dry mouth Don't use: kava, chamomile, hops, valerian,à causes increased CNS depression

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis

The nurse should recognize that maraviroc belongs to what category of antiretroviral?

CCR5 antagonists

Serum levels of lithium <1.5 mEq/L

CNS problems, including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, which relates to renal toxicity; and beginning of gastric toxicity, with nausea, vomiting, and diarrhea

A client has been admitted to the cardiac unit for heart failure and has been ordered carvedilol (Coreg). The client's blood pressure is 80/50. What should the nurse do?

Call the provider and advise them of the client's blood pressure prior to administering the medication.

enoxaprin (Lovenox)

Class- Anticouagulant ,Thrombolytic agents Low-molecular-weight heparins Uses: break down the thrombus that has been formed by stimulating the plasmin system. This process is called clot resolution. Action:These drugs inhibit thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects. They also have been found to block angiogenesis, the process that allows cancer cells to develop new blood vessels

captopril (Capoten)

Class: ACE inhibitors Treatment of hypertension, heart failure, diabetic nephropathy, and left ventricular dysfunction after an MI. Actions: Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in BP, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss.

losartan (Cozaar)

Class: Angiotensin II Receptor Blockers (ARB) Use: hypertension and for the treatment of heart failure in patients who are intolerant to ACE inhibitors Action: The ARBs selectively bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone. These actions block the BP-raising effects of the renin-angiotensin system and lower BP.

Warfarin (Coumadin)

Class: Anticoagulant: Coumarin Derivative Uses: Prophylaxis/treatment of thromboembolic disorders and embolic complications arising from atrial fibrillation or cardiac valve replacement, Risk reduction of systemic embolism following an MI (i.e., recurrent MI, stroke). Off-label use: Adjunct treatment of TIAs. Action: Interferes with the hepatic synthesis of vitamin K-dependent clotting factors prothrombin [factor II], proconvertin [factor VII], Christmas factor [factor IX], and Stuart-Prower factor [factor X]. Prevents further extension of existing clots, prevents new clot formation and secondary complications.

Heparin

Class: Anticoagulant: High-Molecular-Weight Heparin; Antithrombotic Action: Prophylaxis and treatment of arterial embolism, pulmonary embolism, venous thrombosis, and extensions ■ Atrial fibrillation embolization ■ Prevention of clotting during arterial/heart surgery ■ Dx and treatment of acute/ chronic consumption coagulopathies (DIC) ■ Anticoagulant for use in blood transfusions, extracorporeal circulation, dialysis, laboratory blood samples ■ Off-label use: STEMI, non-STEMI, unstable angina. Anticoagulant used during PCI

Flumazenil (Romazicon)

Class: Antidote, benzodiazepine Uses: antagonizes the actions of benzodiazepine Adverse Reactions: Dizziness, agitation, emotional lability, confusion, seizures, panic attacks, abnormal vision, blurred vision, dysrhythmias, nausea, vomiting, rigors Contraindications: Hypersensitivity for medication, serious tricyclic overdoes

Niacin (Niacor, Niaspan)

Class: Antihyperlipidemic Agents Uses: Niacin is B-complex vitamin used to treat types IIA, and IIB hyperlipoproteinemia, Treatment of types IV, V hyperlipoproteinemia in pts at risk for pancreatitis, Slow progression of CAD and ↓ risk for recurrent, nonfatal MI, In combination with a bile acid sequestrant or HMG-CoA reductase inhibitor ("statin") to slow progression of atherosclerotic disease (ER tablet), Treatment and prevention of niacin deficiency and pellagra. Action:Required as a coenzyme for lipid metabolism, glycogenolysis, and tissue respiration ,Large doses ↓ lipoprotein and TG synthesis by inhibiting the release of free fatty acids from adipose tissue and ↓ hepatic lipoprotein synthesis.

clopidogrel (Plavix)

Class: Antiplatelet Agents Action: decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. Uses:These agents are used effectively to treat CV diseases that are prone to produce occluded vessels, for the maintenance of venous and arterial grafts, to prevent cerebrovascular occlusion, and as adjuncts to thrombolytic therapy in the treatment of myocardial infarction (MI) and the prevention of reinfarction after MI.

methimazole (Tapazole)

Class: Antithyroid Agents.Feb Use: treating hyperthyroidism Action:used to treat overactive thyroid (hyperthyroidism). It works by stopping the thyroid gland from making too much thyroid hormone

levothyroxine (Synthroid, Levoxyl, Levothroid)

Class: Thyroid hormones Uses: sed to treat an underactive thyroid gland (hypothyroidism). The thyroid gland makes thyroid hormone which helps to control energy levels and growth. Action: It replaces or provides more thyroid hormone, which is normally produced by the thyroid gland

metoprolol (Lopressor, Toprol XL)

Class: Beta1-selective adrenergic blocking agents Use: hypertension, angina, and some cardiac arrhythmias Notes on Action: have an advantage over the nonselective beta-blockers in some cases. Because they do not usually block beta2-receptor sites, they do not block the sympathetic bronchodilation that is so important for patients with lung diseases or allergic rhinitis. Consequently, these drugs are preferred for patients who smoke or who have asthma, any other obstructive pulmonary disease, or seasonal or allergic rhinitis.

Cholestyramine (generic)

Class: Bile Acid Sequestrants Uses: Adjunct in the management of type II hyperlipo-proteinemia (LDL) Relief of pruritus associated partial biliary obstruction (cholestyramine resin), which prevents reabsorption and facilitates removal via the feces, resulting in ↑ oxidation of cholesterol and ↓ serum levels of cholesterol and β-lipoproteins Action: is an oral anticoagulant, a drug that inhibits the clotting of blood. It prevents the formation of blood clots by reducing the production of factors by the liver that promote clotting, factors II, VII, IX, and X, and the anticoagulant proteins C and S

calcitonin salmon (Fortical, Miacalcin)

Class: Calcium Metabolism Modifiers Uses: used to treat osteoporosis in women who are at least 5 years past menopause and cannot or do not want to take estrogen products. Action: inhibits bone resorption by osteoclasts (bone remodeling cells) and promotes bone formation by osteoblasts. This leads to a net increase in bone mass and a reduction in plasma calcium levels

Atorvastatin (Lipitor)

Class: HMG-CoA Reductase Inhibitors (also known as "Statins") Uses: HMG-CoA reductase inhibitors are potent and reversible inhibitors of the rate limiting step in cholesterol synthesis. The enzyme HMG-CoA reductase converts Actions: When used as an adjunct to dietary changes, increased exercise, and smoking cessation, statins reduce the risk of first CV events and death in patients with multiple risk factors for CHD or type 2 diabetes mellitus.

glucagon (GlucaGen)

Class: Hypoglycemia Antidotes Use: emergency medical treatment to treat very low blood sugar. Glucagon is also used in diagnostic testing of the stomach and other digestive organs. Action: To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogenolysis.

carvedilol (Coreg)

Class: NONSELECTIVE ADRENERGIC BLOCKING AGENTS Uses: treatment of hypertension and HF in adults, alone or as part of combination therapy Action: block both alpha- and beta-adrenergic receptors are primarily used to treat cardiac-related conditions

spironolactone (Aldactone)

Class: Potassium-sparing diuretics Use:Adjunctive tretemnt of edema caudes by HF, liver disease, or renal disease, hypertension, hyperkalemia, and hyperaldosterone Special consideration: Can be used in children with careful monitoring of electrolytes **only diurectic is the only potassium sparing diurectic to be used in children.**

propylthiouracil (PTU)

Class: antithyroid agents Use: used to treat hyperthyroidism Action: Propylthiouracil inhibits the production of new thyroid hormone in the thyroid gland. [2] It acts by inhibiting the enzyme thyroid peroxidase, which usually functions to convert iodide to iodine molecule and incorporate the iodine molecule into amino acid tyrosine.

naloxone (Evzio)

Class: narcotic antagonists The narcotic antagonists block opioid receptors and reverse the effects of opioids, including respiratory depression, sedation, psychotomimetic effects, and hypotension

dopamine (generic)

Class: naturally occurring catecholamine Uses: treatment for shock Action: It stimulates the heart and blood pressure but also causes a renal and splanchnic arteriole dilation that increases blood flow to the kidneys, preventing the diminished renal blood supply and possible renal shutdown that can occur with epinephrine or norepinephrine, which are also naturally occurring catecholamines that interact with both alpha- and beta-adrenergic receptors and are used for the treatment of shock and to stimulate the body after cardiac arrest and for immediate relief of anaphylaxis

sodium iodide (generic radioactive iodine)

Class: norganic compounds known as alkali metal iodides Use: use in performance of the radioactive iodide (RAI) uptake test to evaluate thyroid function. Action:taken by mouth, readily absorbed into the body and is trapped within the thyroid gland. The trappedsodium iodideI 131 irradiates the thyroid gland thereby damaging it. As a result, the activity of the thyroid gland (that is, the production and release of thyroid hormone) is reduced

propranolol (Inderal, Hemangeol)

Class; NONSELECTIVE BETA-ADRENERGIC BLOCKING AGENTS Use: Treatment of hypertension, angina, idiopathic hypertrophic sbaortic stenosis-induced palpitations, angina and syncope, cerain cardiac arrhythmias induced by catecholamines or digoxin, prophylaxis for migraine headaches, prevention of stage fright, treatment of essential tremors, treatment of proliferating infantile hemangioma Action: effective in blocking all of the beta-receptors in the SNS and was one of the first drugs of the class

Serum levels >2.5 mEq/L:

Complex multiorgan toxicity with a significant risk of death

A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to:

Consider safety measures to prevent bleeding and be alert for signs of bleeding.

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet

Extrapyramidal symptoms of haloperidol (Haldol)

Dystonia- spasms of certain parts of the body, excessive salivation, unnatural positioning of the neck. Akathisia- extreme restlessness, feels like they are crawling out of their skin. Pseudoparkinsonism- shuffling gait, slow movements, muscle tremorsTardive Dyskinesia- abnormal muscle movements, lip smacking, tongue hanging from their mouth, chewing movements, slow and aimless arm and leg movements.

Blood coagulation results from the activation of one of two pathways: one pathway occurs in tissue, and the other occurs in the vascular system. What are the names of these pathways?

Extrinsic and intrinsic pathways

A client is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what?

Fatty streaks

Management of overdose of benzodiazepines

Flumazenil, a GABA receptor antagonist, is an antidote for a benzodiazepine overdose. Assess airway, breathing and circulation. Good supportive care and continued monitoring of cardiac, and supplemental oxygen support

A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity?

Foods rich in vitamin K

The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?

Giving intramuscular injections

A client taking atorvastatin presents to the clinic reporting acute muscle pain not associated with exercise or injury. The nurse asks questions to determine if this client has been taking what contraindicated substance?

Grapefruit juice

Adverse Effect of ARBs

Headache, dizziness, syncope, weakness, GI complaints of diarrhea and abdominal pain, skin rash and dry skin, hypotension.

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?

Heart disease

Uses for radioactive iodine

Hyperthyroidism, or abnormally high levels of thyroid hormones, and cancer of the thyroid may be treated with radioiodine therapy. The goal is to get rid of overactive thyroid cells or shrink an enlarged thyroid gland.

The nurse is taking a health history on a 58-year-old client who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug?

How many alcoholic drinks do you have in a typical day or week?"

A nurse is giving medication instruction to a client who is taking metoprolol (Lopressor). Which statement by the client would indicate that teaching has been effective?

I should never stop taking this drug abruptly.

What statement by the client indicates that the client understands the nurse's teaching about diuretics?

I will weigh myself daily and report significant changes.

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

Increased risk for bleeding

Serum levels of 1.5 to 2 mEq/L:

Intensification of all of the foregoing reactions, with ECG changes

Uses and benefits of low molecular weight heparin

It inhibits thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects. They also have been found to block angiogenesis, the process that allows cancer cells to develop new blood vessels. These drugs are indicated for specific uses in the prevention of clots and emboli formation after certain surgeries or prolonged bed rest. Caution must be used to avoid combining these drugs with standard heparin therapy; serious bleeding episodes and deaths have been reported when this combination was used.

The black box warning associated with warfarin concerns its risk of causing what condition?

Major or fatal bleeding

Administration and client teaching for methylphenidate hydrochloride (Ritalin)

Methylphenidate hydrochloride otherwise known as Ritalin is a central nervous stimulant used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is best to take this medication in the morning, to prevent sleep difficulties. Some common side effects of Ritalin are skin rashes, nausea, insomnia, headache and blurred vision. This medication can be associated with sudden cardiac death, so it will be important to do heart tests to determine what the normal function of your heart is like to have something to compare it to just in case something was to go wrong. Notify your doctor if you are experiencing any heart issues such as chest pain or irregular heartbeat. Physical and psychological dependence can occur when taking this drug. It is important to notify your doctor of any alcohol or drug problems you have had previously. It is also important to notify your doctor if you are taking MAOIs. Ritalin and MAOIs together are an undesired combination with potentially serious side effects and should be avoided.

Management of Diuretics:

Monitor Vital signs, Blood sugar, daily weight, and Labs

Long Acting Insulin Onset and Peak Times:

Onset 2 hours

Transition from IV coagulation therapy to oral route

Oral anticoagulant Warfarin is prescribed, the patient is still receiving IV heparin. This is done to allow the time for blood levels of warfarin to rise so when the heparin is discontinued the therapeutic anticoagulation levels of warfarin will be achieved. This is done for 5 days until the INR is above 2. The dose of the oral drug is the initial dose amount and then the prescriber uses the PT/INR levels to figure out which is the next dosage for warfarin.

A group of students are reviewing information about antiviral agents used to treat influenza and respiratory virus infections. The students demonstrate understanding of the material when they identify which drug as appropriate for treating Avian flu?

Oseltamivir

A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?

PT and INR

Client teaching r/t statins

Patients needs to be cautioned to avoid drinking grapefruit juice while taking these drugs. Grapefruit juice alters the metabolism of the drugs.o Let them know their serum cholesterol, triglyceride, and LDL levels will periodically be checked to evaluate the effectiveness of this drug. Pt will be monitored for liver function before drug therapy and periodically during therapy to detect possible liver damage Encourage the patient to make the lifestyle changes necessary to decrease the risk of CAD and to increase the effectiveness of drug therapy. Suggest the use of barrier contraceptives for women of childbearing age if the drug is being used in combination with a statin because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy.

Serum levels of 2 to 2.5 mEq/L:

Possible progression of CNS effects to ataxia, clonic movements, hyperreflexia, and seizures; possible CV effects such as severe ECG changes and hypotension; large output of dilute urine secondary to renal toxicity; fatalities secondary to pulmonary toxicity

An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?

Potassium levels

A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?

Presence of blood in urine or stools

The client has been ordered a nonselective beta-blocking agent called propranolol, PO. Propranolol is used in the treatment of which disorders?

Propranolol is a nonselective beta-blocking agent with indications that include hypertension, angina, cardiac arrhythmias, hypertrophic subaortic stenosis, migraine prophylaxis, and myocardial infarctio

The nurse is caring for a client who is going home on warfarin. What lab test(s) will the client require to evaluate therapeutic effects of the drug?

Prothrombin time (PT) and international normalized ratio (INR)

Iodine Solutions: Dosages

Sodium iodide (generic, radioactive iodine): adult (>30 y) 4-10 mCi PO as needed Strong iodine solution, potassium iodide (Thyro-block): adult one tab or 2-6 drops (gtt) PO daily to t.i.d. Pediatric: (>1 y) adult dose. Pediatrics: (<1 y): a half tablet or 3 gtt Po daily to t.i.d

When assessing a client's medication history, the use of which herb would alert the nurse to the potential for adverse reactions when taken with antidepressants?

St. John's wort

Uses for sumatriptan (Imitrex)

Sumatriptan is an antimigraine agent for acute treatment of migraines that occur with cluster headaches in adults

Stage 3 of Anesthesia

Surgical anesthesia, involves relaxation of skeletal muscles, return of regular respirations, and progressive loss of eye reflexes and pupil dilation. Surgery can be safely performed in stage 3.

Stage 1 of Anesthesia

The analgesia stage, refers to the loss of pain sensation with the patient still conscious and able to communicate.

A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug?

The client has hepatitis C and a history of heavy alcohol use.

Drug-drug interaction with ergot drugs

The drug-drug interaction with ergot drugs are medications for depression. Both increase serotonin, which if taken together can cause too mush serotonin. Effects can be heart problems and anxiety.

Stage 2 of Anesthesia

The excitement stage, is a period of excitement and often combative behavior with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes).

Adverse effects of statins:

The most common adverse effects associated with these drugs reflect their effects on the GI system: flatulence, abdominal pain, cramps, nausea, vomiting, and constipation. CNS effects can include headache, dizziness, blurred vision, insomnia, fatigue, and cataract development and may reflect changes in the cell membrane and synthesis of cholesterol. Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and Fluvastatin. Rosuvastatin is associated with increased occurrence of rhabdomyolysis in Asian American patients

Adverse effects of and uses for cyclobenzaprine (flexeril)

The most frequently seen adverse effects associated with these drugs relate to the associated CNS depression: drowsiness, fatigue, weakness, confusion, headache, and insomnia. Gastrointestinal (GI) disturbances, which may be linked to CNS depression of the parasympathetic reflexes, include nausea, dry mouth, anorexia, and constipation. In addition, hypotension and arrhythmias may occur, again as a result of depression of normal reflex arcs. Urinary frequency, enuresis, and feelings of urinary urgency reportedly may occur. Chlorzoxazone may discolor the urine, becoming orange to purplish-red when metabolized and excreted. Patients should be warned about this effect to prevent any fears of blood in the urine. Tizanidine has been associated with liver toxicity and hypotension in some patients.

Uses for statins

These drugs are indicated as adjuncts with diet and exercise for the treatment of increased cholesterol and LDL levels that are unresponsive to dietary restrictions alone.

Client teaching r/t glyburide

They are indicated as an adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes mellitus. They have the off-label use of being an adjunct to insulin and metformin to improve glucose control in type 2 diabetics. These drugs are not for use during pregnancy. The most common adverse effects related to the sulfonylureas are hypoglycemia (caused by an imbalance in levels of glucose and insulin) and GI distress Care should be taken with any drug that acidifies the urine because excretion of the sulfonylurea may be decreased. Caution should also be used with beta-blockers Caution must also be used with many herbal therapies that could alter blood glucose levels. Adverse Effects: GI discomfort, anorexia, heartburn, vomiting, nausea, hypoglycemia.

Uses for and adverse effects of thyroid hormone replacement therapy

Thyroid hormone replacements are used for hypothyroidism and cancer or removal of the thyroid due to illness. Adverse effects may include chest pain, increased HR, excessive sweating, heat intolerance, nervousness, insomnia, diarrhea, vomiting, weight loss and fever. Some women may experience irregular menstrual cycles.

buprenorphine (Buprenex)

Use: narcotic agonists-antagonists stimulate certain opioid receptors but block other such receptors. These drugs, which have less abuse potential than the pure narcotic agonists, exert a similar analgesic effect as morphine. Like morphine, they may cause sedation, respiratory depression, and constipation. They have also been associated with more psychotic-like reactions, and they may even induce a withdrawal syndrome in patients who have been taking narcotics for a long period.

Ezetimibe (Zetia)

Uses: It's used to treat high blood cholesterol. Action: Ezetimibe inhibits the absorption of cholesterol from the small intestine and decreases the amount of cholesterol normally available to liver cells. This leads them to absorb more cholesterol from circulation and thus causes lowering levels of circulating cholesterol.

Adverse effects of, uses for and contraindications of dantrolene (Dantrium)

Uses: Muscle spasticity multiple sclerosis Adverse Effects: CN: drowsiness, fatigue, weakness, confusion, headache, insomnia GI: diarrhea, constipation and abdominal cramps Direct hepatocellular damage and hepatitis GU: urinary frequency Contraindications: Hypersensitivity, hepatic disease, hepatitis

Adverse effects of, uses for and contraindications of baclofen (Lioresal):

Uses: Spasticity in spinal cord injury, multiple sclerosis Adverse Reactions: CN: drowsiness, dizziness, fatigue, weakness, seizures, disorientation, insomnia GI: nausea, constipation, anorexia GU: urinary frequency CV: hypotension, bradycardia, edema Contraindications: Hypersensitivity, epidural, IM, IV, subcut use

acyclovir (Sitavig, Zovarax),

Uses: Treatment of herpes virus and cytomegalovirus Client teaching: Teach client that medication may be taken orally before infection occurs or when itching or pain occur, usually before eruptions; that partners need to be told that the client is infected; they can become infected, so condoms must be worn to prevent reinfection. Adverse effects: N/V, headache, depression, paresthesias, neuropathy, rash, and hair loss.

Uses of ARBs

Uses: bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone. These actions block the BP- raising effects of the renin-angiotensin system that lowers BP.

haloperidol (Haldol)

Uses: psychotic disorders, control tics, vocal utterances, limbic system which control activity and aggression, blocks neurotransmission produced by dopamine at synapse, exhibits strong adrenergic, blocking action, mechanism for antipsychotic effects unclear. **Increased fatality in elderly patients** Adverse reactions: pseudoparkinsonism, tardive dyskinesia, dystonia, akathisia, hyperpyrexia, laryngospasm, respiratory depression

Client teaching r/t eye drop administration:

Wash hands thoroughly before administering; do not touch the dropper to the patient's eye or to any other surface. Have the patient tilt the head backward or lie down, and have the patient stare upward. Gently grasp the lower eyelid and pull the eyelid away from the eyeball; instill drops into the pouch formed by the eyelid. Release the lid slowly; have the patient close the eye and look downward. Apply gentle pressure to the inside corner of the eye for 3 to 5 minutes to retard drainage. Do not rub the eyes; do not rinse the eyedropper. Do not use eye drops that have changed color; if more than one type of eye drop is used, wait at least 5 minutes between administrations.

Antithyroid Agents: Dosages

methimazole (Tapazole): Adult 15 mg/d PO initially, up to 30-60 mg/d may be needed.; maintenance, 5-15 mg/d PO Pediatrics: 0.4 mg/kg/d PO initially, maintenance 15-20 mg/m^2/d PO in three divided doses. propylthiouracil (PTU): Adult 300-900 mg/d PO initially, maintenance 100-150 mg/d PO

Lithium (Lithobid)

mood stabilizer used for bipolar disorder

Common adverse effects of MAOIs

more fatal than other antidepressants), dizziness, nervousness, mania, tremors, confusion, insomnia, agitation, blurred vision. Liver toxicity and potentially hypertensive crisis can occur which can lead to stroke.

Common adverse effects TCAs

sedation, sleep disturbances, fatigue, suicidal ideation, visual disturbances, blood pressure changes, fetal toxicity, loss of libido, urinary retention

morphine (Roxanol, Astamorph)

uses: relief of moderate to severe acute or chronic pain; preoperative medication; component of combination therapy for severe chronic pain; intraspinal to reduce intractable pain. Actions: Acts as an agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, and sedation.

Adverse Effects of ACE's :

vasodilation and alterations in blood flow , GI irrigation , Renal insufifciency, cough ( Drug to Drug is Allopurinol)

The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What medication should the nurse expect to administer to reduce the risk of maternal to fetal transmission of the virus?

zidovudine

Effects of Anesthesia on Adults

· Adults require a considerable amount of teaching and support when receiving anesthetics, including what will happen, what they will feel, how it will feel when they recover, and the approximate time to recovery. · Adults should be monitored closely until fully recovered from general anesthetics and should be cautioned to prevent injury when receiving local anesthetics. It is important to remember to reassure and talk to adults who may be aware of their surroundings yet unable to speak. · Most of the general anesthetics are not recommended for use during pregnancy because of the potential risk to the fetus. Short-onset and local anesthetics are frequently used at delivery. Use of a regional or other local anesthetic is usually preferred if surgery is needed during pregnancy. During lactation, it is recommended that the mother wait 4 to 6 hours to feed the baby after the anesthetic is used

Effects of Anesthesia on Older Adults

· Older patients are more likely to experience the adverse effects associated with these drugs, including CNS, CV, and dermatological effects. Thinner skin and the possibility of decreased perfusion to the skin make them especially susceptible to skin breakdown during immobility. Because older patients often also have renal or hepatic impairment, they are also more likely to have toxic levels of the drug related to changes in metabolism and excretion. The older patient should have safety measures in effect, such as side rails, a call light, and assistance to ambulate; special efforts to provide skin care to prevent skin breakdown are especially important with older skin. The older patient may require longer monitoring and regular orienting and reassuring. After general anesthesia, it is important to promote vigorous pulmonary toilet to decrease the risk of pneumonia.

Bupivacaine (Marcaine, Sensorcaine)

· Use: Bupivacaine injection is used to numb an area of your body during or after surgery or other procedures, childbirth, or dental work. This medicine is also used to numb your shoulder after surgery for up to 72 hours. It is a local anesthetic. · On set 5-20 min · Duration: 2-7 hr · Administration routes: local, epidural, dental, caudal, subarachnoid, sympathetic, retrobulbar -Don't use Bier block, deaths have occurred

Lidocaine (Dilocaine, Lidoderm, etc.)

· Use: Lidocaine is a local anesthetic (numbing medication) that is used to numb an area of your body to help reduce pain or discomfort caused by invasive medical procedures such as surgery, needle punctures, or insertion of a catheter or breathing tube. · On set 5-15 min · Duration 30-90 min · Route: caudal, epidural, spinal, cervical, dental, skin, mucous membrane, topical patch Special consideration: short-acting, preferred for short procedures, dangerous if absorbed systemically

Pancuronium (generic)

· Use: surgical procedures, mechanical ventilation · Special consideration: vagolytic effect, associated with increased heart-rate; long term use for mechanical ventilation, monitor for prolonged adverse effects

Effects of anesthesia on Children

· greater risk for complications after anesthesia—laryngospasm, bronchospasm, aspiration, and even death. They require careful monitoring and support, and the anesthetist needs to be skilled at calculating dosage and balance during the procedure. Propofol is widely used for diagnostic tests and short procedures in children older than 3 years of age because of its rapid onset and metabolism and generally smooth recovery. Sevoflurane has a minimal impact on intracranial pressure and allows a rapid induction and recovery with minimal sympathetic reaction. It is still quite expensive, however, which may limit its use. The dosage of anesthetics may need to be higher in children, and that factor will be considered by the anesthetist. · Nursing care after general anesthesia should include support and reassurance; assessment of the child for any skin breakdown related to immobility; and safety precautions until full recovery has occurred. · Local anesthetics are used in children in much the same way that they are used in adults. · Bupivacaine and tetracaine do not have established doses for children younger than 12 years of age. Benzocaine should not be used in children younger than 1 year of age. · When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. · Tight diapers can act like occlusive dressings and increase systemic absorption. Children need to be cautioned not to bite themselves when receiving dental anesthesia.

Signs and Symptoms of hypoglycemia

• CNS: Headache, blurred vision, diplopia; drowsiness progressing to coma; ataxia; hyperactive reflexes• Neuromuscular: Paresthesias; weakness; muscle spasms; twitching progressing to seizures• CV: Tachycardia; palpitations; normal to high blood pressure• Respiratory: Rapid, Shallow respirations• GI: Hunger, nausea• Other: Diaphoresis; cool & clammy; normal eyeballs• Laboratory tests: Urine glucose negative; blood glucose low• Onset: Sudden; patient appears anxious drunk; associated with the overdose of insulin missing a meal, increases stress