NCLEX Medications
A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin. The client asks the nurse what the heparin is for. How should the nurse respond?
"Heparin will keep the current clot from getting bigger and help prevent new clots from forming" no hep doesn't dissolve clots, the body does that itself over time
An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. What is a statement made by them that NEEDS to be reported to the HCP?
"My tongue feels thicker than normal" Angioedema is swelling that usually affects areas of the face (lips, tongue), larynx, extremities, gastrointestinal tract, and genitalia. The swelling often starts in the face and can quickly become life-threatening as it progresses to the airways. Angioedema is an adverse effect of ACE inhibitors (eg, enalapril, lisinopril, captopril) and occurs more commonly in African American clients. Unlike other typical drug allergies, this side effect can occur any time after starting the medication. The nurse should immediately report angioedema to the health care provider and carefully monitor the client
bismuth subsalicylate
(Pepto Bismol) but also the same class as aspirin so this bitch can cause reye syndrome
What are calcium channel blockers?
(nifedipine, amlodipine, felodipine, nicardipine but also randomly diltiazem) are vasodilators used to treat hypertension and chronic stable angina. They promote relaxation of vascular smooth muscles leading to decreased systemic vascular resistance and arterial blood pressure. prevents calcium from entering the cells of heart and arteries, therefore lowering blood pressure. Calcium causes heart and arteries to contract strongly. By blocking it, it allows blood vessels to relax and open.
esophageal atresia (EA) w/ Tracheoesophageal fistula (TEF)
* be careful of choking and cyanosis during feeding
Signs and symptoms of digoxin toxicity?
- GI problems (nausea, vomiting, abd pain) - Neurologic manifestations - Visual symptoms - Cardiac arrhythmias - most dangerous
What are interventions that are appropriate to provide client comfort for a pt with ascites, peripheral edema, shortness of breath, fatigue, and generalized discomfort?
- Place in Semi-fowler position - Provide alternating air pressure mattress - Use music to provide a distraction
What are instructions you must include in the teaching of a client who is prescribed rifampin?
- Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Client should wear eyeglasses instead of soft contact lenses while taking this medication. - Women should use nonhormonal birth control methods while taking this drug as it can decrease the effectiveness of oral contraceptives.
Cisplatin (Platinol)
- Treatment for cancer. Cisplatin is an antineoplastic medication that can cause renal toxicity. *this is from the question but its on a nice to know basis* The client's elevated BUN (normal 6-20 mg/dL [2.1-7.1 mmol/L]) may be due to dehydration (prerenal disease) or decreased kidney function. The creatinine is also elevated (normal 0.6-1.3 mg/dL [53-115 µmol/L]), an indication of kidney injury. In addition to laboratory results, the health care provider will also need to know urine output. The medication dosage may then be adjusted or discontinued.
Herbal supplement Saw Palmetto
- Used to treat benign prostatic hyperplasia
Things to ask your client to answer/do to determine if they have hepatic encephalopathy?
- ask them if they know what day it is - ask the client to extend the arms
What will prevent dumping syndrome?
- consuming meals high in fat, protein and fiber, which takes more time to digest and therefore will remain in the stomach longer - avoid fluids with meals bc it'll cause stomach contents to move faster - consume small, frequent meals - AVOID high carb meals - Lie down after a meal (the complete opposite of a hiatal hernia)
Adverse effects of PPI's include what?
- decreased bone density (PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist) - increased risk for C. Diff (not even they know why yet) - increased risk for pneumonia (PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract.)
Things to teach your pt when they take their sublingual nitroglycerin (NTG) to treat angina?
- headache and flushing are common SE - The client should lie down before taking the pill as it can cause dizziness from possible orthostatic hypotension. - do not swallow the tablet
Tell what to the pts who have had a dose of radioactive iodine for treatment of hyperthyroidism?
- ur a monster to pregnant women dont go near them - try to use a separate toilet from the rest of your family and flush 2 or 3 times after - use disposable plates and shit and no sharing food no no - wash your clothing separately from the rest of the laundry in your home
Dumping syndrome S/S
-Drunk -Shock -Acute abdominal distress
Ferrous Sulfate (Iron)
-Ferrous Sulfate is a iron preparation used to treat anemia. -Increase fiber and iron, take on empty stomach, spread throughout day. -Vitamin C increases absorption. -OD = admin deferoxamine. -IM = test dose, monitor B/P, epinephrine, use z track.
Bilirubin
0.2-1.2
INR
0.8-1.1
Isotonic crystalloid fluids are what?
0.9% sodium chloride, Lactated Ringer solution
What are side effects of sulfa drugs?
1. Crystalluria 2. Photosensitivity 3. Folic acid deficiency 4. Leukopenia (Agranulocytosis) 5. Stevens-Johnson Syndrome (its a rash and the med should be stopped)
nice to know card All NSAIDs (eg, indomethacin, ibuprofen) are associated with the following:
1. Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. 2. Kidney injury - long-term use is associated with kidney injury 3. Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension 4. Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.
Side effects of thiazide diuretics
1. Hypokalemia - manifests as muscle cramps 2. Hyponatremia - manifests as altered mental status and seizures 3. Hyperuricemia (An excess of uric acid in the blood) - may precipitate or worsen gout attacks 4. Hyperglycemia - may require adjustment of diabetic medications
Absolute contraindications to thrombolytics?
1. Prior intracranial hemorrhage 2. Structural cerebrovascular lesion (eg, arteriovenous malformation, aneurysm). 3. Ischemic stroke within 3 months (except within 3 hr). 4. Suspected aortic dissection. 5. Active bleeding or bleeding diathesis. 6. Significant head trauma within 3 months. no menstruation is NOT a contraindication
Drugs commonly associated with orthostatic hypotension are (5)?
1. antihypertensive 2. antipsychotics and antidepressants 3. diuretics 4. vasodilators 5. narcotics - these pts should take their meds at bedtime - rise slowly - avoid activities that worsen orthostatic hypotension - maintain adequate hydration
How do you put on PPE?
1. gown 2. mask 3. goggles 4. gloves
Magnesium range
1.5-2.5 mEq/L
Prothrombin Time (PT)
11-16 seconds
Ammonia
15-45
Platelets
150,000-400,000
What is a normal platelet count?
150,000-400,000
Therapeutic level for clients on warfarin?
2-3
Regular insulin is a short acting insulin that reaches its peak effect within how many hours?
2-5
Phosphorus
2.5-4.5
How much level of bilirubin makes a client go kernicteric?
20
What is the typical dosage of hydromorphone?
2mg
Albumin
3.5-5
Normal PaCO2
35-45
What is a normal HGB A1C?
4%-6%
How long does it take for transdermal nitroglycerin patches to work?
40-60 minutes
What is the therapeutic PTT for a client on Heparin?
46-70 seconds
What is the regular WBC count?
5,000-10,000
A vaginal ring (etonogestrel and ethinyl estradiol vaginal ring) needs how many days to fully absorb into the body?
7 days. It is necessary for the first 7 days to use a barrier method until hormones produce their full contraceptive effect.
LDL target levels
<100 optimal 100-129 near optimal 130-159 borderline 160-189 high >190 very high
Triglycerides level
<150 mg/dL
Total cholesterol levels
<200 desirable 200-239 borderline high >240 high
What is a positive response to a PPD/ Mantoux test?
> 15mm means you possibly have TB, but a chest x-ray, positive sputum samples, presence of symptoms will have to confirm it
How much chest tube drainage needs happen in order for it to have to be reported to the HCP?
>100 mL/hr
HDL target level
>40
What is a partial gastrectomy?
A gastrectomy is a partial or total surgical removal of the stomach
Lisinopril
ACE inhibitor - It can treat high blood pressure and heart failure. It can also reduce the risk of death after a heart attack. often prescribed to clients after an MI to prevent ventricular remodeling and progression of heart failure. Lisinopril may cause hyperkalemia and hypotension, and should be administered only to clients with normokalemia and normotension.
A patient is receiving an ACE inhibitor, what should the nurse assess priori to administration?
ACE inhibitors increase serum potassium by decreasing urinary potassium excretion. The nurse should assess blood pressure and serum potassium levels prior to administration
The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily. The client's blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago. The client reports a cold, a stuffy nose, and sneezing for 3 days. Which question is most appropriate for the nurse to ask? a. Are you taking any over-the-counter medicines for your cold? b. Are you taking extra vitamin C? c. Did you babysit your granddaughter this past week? d. Did you get a flu shot in the past week?
ANS: A
The nurse cares for a client who has oral candidiasis. The health care provider has prescribed nystatin oral suspension. Which of the following nursing actions are appropriate? Select all that apply. a. Assisted client in removing dentures and soaking them in Nystatin b. Inspect the oral mucous membranes thoroughly before administering Nystatin c. Instruct the client to discontinue the medication as soon as symptoms subside d. Instruct the client to switch the suspension in the mouth for several minutes e. Shake the bottle of suspension thoroughly before measuring the dose
ANS: A, B, D, E
The nurse is providing discharge teaching to several clients with new prescriptions. Which instructions by the nurse are correct in regard to medication administration? Select all that apply. a. Avoid salt substitutes when taking Valsartan for hypertension b. Take levofloxacin with aluminum antacid to avoid dash of irritation c. Take sucralfate after meals to minimize gastric irritation associated with a gastric ulcer d. When taking ethambutol notify the healthcare provider of any changes in vision e. When taking Rifampin notify the hcp if the urine turns red orange
ANS: A, D Both ACE inhibitors ("prils" - captopril, enalapril, lisinopril, ramipril) and angiotensin receptor blockers ("sartans" - valsartan, losartan, telmisartan) cause hyperkalemia. Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP) (Option 1). Ethambutol (Myambutol) is used to treat tuberculosis but can cause ocular toxicity, resulting in vision loss and loss of red-green color discrimination. Vision acuity and color discrimination must be monitored regularly (Option 4).
The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the health care provider before administering? Select all that apply. a. Bumetanide in the client with heart failure who has hypokalemia b. Calcium acetate in the client with chronic kidney disease who has hyperphosphatemia c. Carvedilol in the client with heart failure who has an elevated b-type natriuretic peptide level d. Isoniazid in the client with latent tuberculosis who has elevated liver enzymes e. Metronidazole in the client with Clostridium difficile infection who has leukocytosis
ANS: A, D Bumetanide is a potent loop diuretic (eg, furosemide, torsemide) used to treat edema associated with heart failure and liver and renal disease. The diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium. The nurse should question the bumetanide prescription as the client with heart failure has hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]) and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance (Option 1). Isoniazid is a first-line antitubercular drug used to treat latent or active tuberculosis. The nurse should question this prescription as increased liver function tests (eg, alanine aminotransferase, aspartate aminotransferase) can indicate development of drug-induced hepatitis (Option 4). (Option 2) Calcium acetate (PhosLo) is a phosphate binder used to treat hyperphosphatemia (normal phosphorous: 2.4-4.4 mg/dL [0.78-1.42 mmol/L]) in clients with chronic kidney disease. Calcium acetate lowers the serum phosphorous level by binding to dietary phosphate and excreting it in feces. (Option 3) Carvedilol (Coreg) is a beta blocker used to improve cardiac output and slow the progression of heart failure. B-type natriuretic peptide (BNP) (normal: <100 pg/mL [100 pmol/L]) is secreted from the ventricles in response to the increased ventricular stretch. Elevated BNP is expected in a client with heart failure; the nurse need not question this prescription. (Option 5) Metronidazole (Flagyl) is the first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile. Leukocytosis is expected with this bacterial infection.
The nurse reinforces medication teaching to a client prescribed metronidazole. Which client statement indicates a need for further education? a. I might have a metallic taste in my mouth when I'm taking this medicine b. I need to decrease the amount of alcohol I drink while taking this medicine c. I should not worry if my urine turns a dark color while taking this medicine d. I will immediately call the clinic if I get a new rash or have skin peeling
ANS: B ..don't decrease... stop lol freaking alcoholic
A parent brings a 6-month-old child to the primary health care provider after the child abruptly started crying and grabbing intermittently at the abdomen. The client's stool has a red, currant jelly appearance. What intervention does the nurse anticipate? a. Administer epoetin alfa b. Give air (pneumatic) enema c. Have the parent give 2 oz of extra juice a day for constipation d. Perform hemoccult test on stool
ANS: B A contrast enema is used for diagnostic purposes and often reduces the intussusceptions. An air enema is considered safer than a barium enema.
The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan? Select all that apply. a. Discontinue hydrocortisone if you know mood changes or disruptions in Behavior b. Make an appointment with an optometrist yearly to assess for cataracts c. Report even a low-grade fever to the healthcare provider immediately d. Report signs of hyperglycemia including increased urine hunger and thirst e. Take the medication on an empty stomach f. The dose of hydrocortisone may need to be decreased during times of stress
ANS: B, C, D
The nurse administers lactulose to a client diagnosed with cirrhosis and hepatic encephalopathy. Which nursing action is inappropriate when administering this medication? a. assess mental status and orientation b. give on an empty stomach for rapid effect c. hold if 3 soft stools occur in a day d. mix with fruit juice to improve flavor
ANS: C
The nurse is preparing to administer IV cefazolin to a client with cellulitis. The client's allergies are listed as amoxicillin, ciprofloxacin, and sulfa drugs. What should the nurse do first? a. Administer the medication as prescribed b. Clarify the prescription with the healthcare provider c. Inquire about the type of allergic reaction d. Notify the pharmacy that the drug is inappropriate
ANS: C
The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate? a. Administering PRN antiemetic prior to the infusion b. Administering via an infusion pump over at least 30 minutes c. Drawing a trough level just prior to administration of the Vancomycin d. Starting a new IV line before Administration
ANS: C
A client with uncontrolled hypertension is prescribed clonidine. What instruction is most important for the clinic nurse to give this client? a. Avoid consuming high sodium foods b. Change position slowly to prevent dizziness c. Don't stop taking this medication abruptly d. Use an oral moisturizer to remove dry mouth
ANS: C Clonidine is a highly potent antihypertensive. Abrupt discontinuation (including the patch) can result in serious rebound hypertension due to the rapid surge of catecholamine secretion that was suppressed during therapy. Clonidine should be tapered over 2-4 days. Abrupt withdrawal of beta blockers can also result in rebound hypertension and in precipitation of angina, myocardial infarction, or sudden death.
The nurse obtains a health history from a client who states, "I skip dinner most nights to lose weight. I don't want to get low blood sugar, so I don't take my evening dose of metformin when I skip dinner." Which response by the nurse is appropriate? a. Have your blood sugars been in the desired range when you skip doses b. Take half of the evening dose to prevent a low blood sugar level c. The risk of low blood sugar is minimal when metformin is taken without food d. Why are you skipping meals that is not a healthy weight loss strategy
ANS: C Metformin is an oral antidiabetic medication used to manage hyperglycemia in clients with type 2 diabetes. Metformin increases the sensitivity of insulin receptors in cells and reduces glucose production by the liver. These actions increase the efficacy of insulin present in the body and prevent large rises in blood glucose after meals. Because metformin does not stimulate insulin secretion by the pancreas, the risk of hypoglycemia is minimal (Option 3). Although skipping meals would cause a drop in blood glucose, metformin would not cause further hypoglycemia.
A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply. a. Atorvastatin b. Metformin c. Metoprolol d. Olanzapine e. Omeprazole
ANS: C,D
The nurse teaches a client about the use of regular and neutral protamine Hagedorn (NPH) insulin. Which statement by the client indicates that further teaching is needed? a. I will always check my blood glucose prior to using the sliding scale b. I will eat breakfast 30 minutes after taking my morning NPH and regular insulin c. I will use a new insulin syringe each time I give myself an injection d. I will use the sliding scale to determine my mph dose four times a day
ANS: D NPH is an intermediate-acting insulin with a duration of 12-18 hours; it is generally prescribed 2 times daily (morning and evening). Regular insulin and other rapid-acting insulins (lispro, aspart, glulisine) are typically used with a sliding scale for tighter control of blood glucose throughout the day. These are generally taken before meals and at bedtime.
What is acetylcholine?
Acetylcholine is an organic chemical that functions in the brain and body of many types of animals (and us) as a neurotransmitter.
Drug of choice for paroxysmal supraventricular tachycardia (PSVT)?
Adenosine Adenosine is the drug of choice for PSVT treatment. Due to its very short half-life, adenosine is administered rapidly via IVP over 1-2 seconds and followed by a 20-mL saline bolus. An increased dose may be given twice if previous administration is ineffective. Beta blockers, calcium channel blockers, and amiodarone can also be considered as alternatives. If vagal maneuvers and drug therapy are unsuccessful, synchronized cardioversion may be used.
What drug potentially causes suicidal ideation?
Amitriptyline
What is a small bowel follow-through (SBFT) for a client?
An SBFT examines the anatomy and function of the small intestine using x-ray images taken in succession. Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine
what are analgesic drugs?
An analgesic drug, also called simply an analgesic, pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain
What is proteinuria?
An excess of protein in the urine.
A client is 6 hours postoperative from hip surgery after receiving regional anesthesia and has epidural continuous anesthesia in place. Which is the most important reason for the nurse to contact the health care provider? a. Client reports paresthesia bilaterally since surgery b. Fondaparinux is prescribed for STAT administration c. Lower extremity muscle strength is 3/5 bilaterally d. Postoperative laboratory results show hemoglobin of 9.9
Ans: B Fondaparinux (Arixtra), unfractionated heparin, and low molecular weight heparin (eg, enoxaparin, dalteparin) are anticoagulants commonly used for deep vein thrombosis and pulmonary embolism prophylaxis after hip/knee replacement or abdominal surgery. However, fondaparinux is not administered until more than 6 hours after any surgery, and anticoagulants are not given while an epidural catheter is in place (Option 2). Fondaparinux is associated with epidural hematoma. Any bleeding in the tight epidural space, which does not expand, could result in spinal cord compression. Signs of epidural spinal hematoma can include severe back pain and paralysis. (Option D explanation why not) Major orthopedic surgery can result in significant blood loss, and it is not unusual for the client to have hemoglobin drop of 1-2 g/dL (10-20 g/L). Blood loss should be monitored over time; transfusion usually is not indicated unless hemoglobin is <7-8 g/dL (70-80 g/L).
A nurse in the cardiac intermediate care unit is caring for a client with acute decompensated heart failure (ADHF). The client also has a history of coronary artery disease and peripheral vascular disease. The nurse is preparing to administer medications. Based on the assessment data, the nurse should question which medication? BP 110/60 pulse 80/min resp 22/min ox 90% on room air a. Aspirin b. Atorvastatin c. Furosemide d. Metoprolol
Answer is "D" Beta blockers, or "lols" (metoprolol, carvedilol, bisoprolol, atenolol), are the mainstay of therapy for clients with chronic heart failure as these improve survival rates for both systolic and diastolic heart failure. However, in certain situations beta blockers can worsen heart failure symptoms by decreasing normal compensatory sympathetic nervous system responses and myocardial contractility. In this client with acute decompensated heart failure (ADHF), marginally low blood pressure (BP), crackles in the lungs, low oxygen saturation, jugular venous distension (JVD), and peripheral edema, the administration of beta blockers can cause the client to further deteriorate. Beta blockers at low doses may be able to be restarted after this client has stabilized and exacerbation of ADHF has resolved with diuresis
What medications impair the absorption of levothyroxine?
Antacids, calcium, and iron preparations
Sulfazalazine
Anti-inflammatory It can treat ulcerative colitis and rheumatoid arthritis
Amiodarone
Antiarrhythmic an antiarrhythmic medication used to treat life-threatening arrhythmias that cannot be controlled with other medications. Amiodarone therapy is used only if other treatments have failed, as it has many toxic, adverse effects that may be severe.
Adenosine
Antiarrhythmic It can treat irregular heartbeats (arrhythmias). It can also be used during a heart stress test.
Trimethoprim/Sulfamethoxazole (Bactrim)
Antibiotic, Sulfonamide sulfa drug what else is a sulfa drug? GLYBURIDE so if someone says glyburide makes them itch would you wanna give them this? NO
Isoniazid (INH)
Antibiotics It can treat and prevent tuberculosis (TB).
Why would you not give a pt with a bladder scan showing 500 mL of urine and anticholinergic?
Anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation. Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention.
Oxybutinin (Ditropan)
Anticholinergic used to treat overactive bladder key side effects: heat intolerance, blurred vision, dry mouth
What are anticholinergics?
Anticholinergics are substances that block the action of the neurotransmitter called acetylcholine at synapses in the central and peripheral nervous system.
Apixaban
Anticoagulant
Heparin
Anticoagulant
Fondaparinux (Arixtra)
Anticoagulant - unfractionated heparin
Rivaroxaban (Xarelto)
Anticoagulant. ex: Clients with atrial fibrillation are usually prescribed an anticoagulant, such as rivaroxaban (Xarelto), due to increased risk for blood clots that can lead to stroke.
Duloxetine (Cymbalta)
Antidepressant a serotonin-norepinephrine reuptake inhibitor that has both antidepressant and pain-relieving effects. It is used to relieve chronic pain that interferes with normal sleep patterns in clients with FM. With the restoration of normal sleep patterns, fatigue often improves as well
Pioglitazone (Actos)
Antidiabetic Thiazolidinediones (rosiglitazone [Avandia] and pioglitazone [Actos]) are used to treat type 2 diabetes mellitus. These agents improve insulin sensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin). These drugs can worsen heart failure by causing fluid retention and increase the risk of bladder cancer. Heart failure or volume overload is a contraindication to thiazolidinedione use. These medications also increase the risk of cardiovascular events such as myocardial infarction.
Octreotide
Antidiarrheal
sodium polystyrene sulfonate (Kayexalate)
Antidote for hyperkalemia - potassium is exchanged for sodium in the intestines and excreted in the stool
Metoclopramide (Reglan)
Antiemetic. Side effects: drowsiness, anticholinergic effects, restlessness, EPSs, tardive dyskinesia. Nursing interventions: instruct client about rapid GI emptying. Discontinue with signs of EPSs
Abciximab
Antiplatelet
Clopidegrel (Plavix)
Antiplatelet
Clopidogrel (Plavix)
Antiplatelet
olanzapine/fluoxetine
Antipsychotic
Valproic Acid (Depakote)
Antiseizure med. Precautions/interactions: contraindicated in liver disease, pregnancy. Side effects: hepatotoxicity, teratogenic effects, pancreatitis. dont take before an ECT... a seizure inducing therapy lol
Dextromethorphan
Antitussive (cough suppressant)
Sucralfate
Antiulcer Agent Antacids counteract stomach acid to relieve indigestion and heartburn Sucralfate (give before meals to avoid irritation of ulcer)
Sucralfate (Carafate)
Antiulcer Agent DO NOT TAKE WITH ANTACIDS
The home health nurse visits a client with hand osteoarthritis whose health care provider has recommended topical capsaicin for pain relief. What instruction about capsaicin should the nurse provide the client?
Apply cream to hands and wait at least 30 minutes before washing them
What do we check if a pt is on an opioid?
Assess respiratory status 60 min later for opioid induced respiratory depression
The nurse is providing discharge teaching to a client with a new prescription for warfarin. The nurse should instruct the client to avoid excess or inconsistent intake of which foods? Select all that apply. a. Bananas b. Broccoli c. Liver d. Oranges e. Spinach
B, C, E
INH (isoniazid) interferes with what vitamin?
B6! resulting in peripheral neuropathy
What lab tests measure the kidney function?
BUN and creatinine are measurements of kidney function.
Midazolam
Benzodiazepine Sedative It can help patients feel relaxed or sleepy before surgery or medical procedures.
Alprazolam (Xanax)
Benzodiazepine anxiolytic (treats anxiety)
Tamoxifen (Nolvadex)
Breast cancer medication Hormonal agent Stops growth of estrogen-dependent breast cancer cells Can cause endometrial cancer, hypercalcemia, N/V, PE, hot flushes, vaginal discharge or bleeding Increase Ca and vit D intake
albulterol
Bronchodilator
What inhibits the absorption of iron?
Calcium
A person needs their morning insulin doses bc their sugar is 328, but their potassium is 3.0, what do you do next?
Call the HCP bc insulin could make their hypokalemia worse
What are biphosphonates?
Class of drugs prescribed to treat Osteoporosis that helps prevent or slow down bone thinning adverse effect: jaw necrosis with long term use
Why do we give epoetin alfa?
Clients with chronic kidney disease often have anemia due to erythropoietin deficiency. Recombinant erythropoietin injections are often prescribed to treat anemia if their creatinine is higher than 1.2 they'll prob get this bc they have a problem with their kidneys
Why are patients with Peripheral Arterial Disease not suppose to apply direct heat to an extremity?
Clients with peripheral arterial disease (PAD) have decreased sensations from nerve ischemia or coexisting diabetes mellitus. They should never apply direct heat to the extremity due to the risk for a burn wound. Wound healing is impaired in these clients.
What is essential for Chronic Venous Insufficiency ?
Compression!
A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. What blood test trend is most important for the nurse to review when preparing to administer this medication?
Creatinine Vancomycin can cause nephrotoxicity, which occurs most often in clients who already have some degree of renal impairment. Serum creatinine levels should be monitored daily during IV vancomycin treatment to look for an increase in level over a few days.
A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the nurse would be concerning in relation to this new medication? Select all that apply. a. BP of 140/84 b. Heart Rate of 98/min c. Platelet count of 200,000 d. Report of Ginkgo biloba use e. Report of peptic ulcer disease
D, E
Disulfiram
Daily oral medication to sustain abstinence of alcohol; type of aversion therapy Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed
What is ototoxicity?
Damage to the hearing or balance functions of the ear by drugs or chemicals.
Dicylomine (Bentyl) is for IBS but it is contraindicated if the client develops what?
Dicyclomine is contraindicated in clients with paralytic ileus as it decreases intestinal motility and would exacerbate the condition
Hydrochlorothiazide
Diuretic - it can treat high blood pressure and fluid retention
What are extrapyramidal symptoms?
Dystonia - a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements. tardive dyskinesia - a movement disorder that causes a range of repetitive muscle movements in the face, neck, arms and legs akathisia - an inability to remain still
Which kind of feedings are indicated for clients who are intubated, sedated, and on a mechanical ventilator?
Enteral feedings! Clients are at increased risk when receiving bolus rather than continual enteral feedings. Bolus feedings should be avoided in critically ill clients, who are already at increased risk for aspiration.
When do you teach a client to take their statins?
Evening with a meal Statin drugs (eg, simvastatin, atorvastatin, rosuvastatin) are prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins (especially those that are short-acting; eg, simvastatin) are taken in the evening or at bedtime as opposed to during the day.
What is the nutritional value of fish oil?
Fish oil is an over-the-counter nutritional supplement often taken by clients with heart disease or individuals at risk. Fish oil contains omega-3 fatty acids, which may decrease blood triglyceride levels with consistent use.
Dicyclomine Hydrochloride
GI Antispasmodic anticholinergic (antimuscarinic) agent indicated for the treatment of functional bowel/irritable bowel syndrome
What fruit do you not mix when taking CCB and Statins?
GRAPEFRUIT
Sucralfate is usually prescribed to treat what? and taken when?
Gastric Ulcers and should be taken BEFORE meals
Hydromorhpone (Dilaudid)
Generic Name: Hydromorphone Brand Name: Dilaudid Broad Classification: Analgesic Specific Classification: Narcotic analgesic Pharmacological/ Mechanism of action: Potent opiate receptor agonist that changes pain perception in CNS Indications for Use: Relief of moderate to severe pain Side/ Adverse Effects: N/V, constipation, dizziness, sedation, drowsiness, hypotension, bradycardia, respiratory depression Expected Therapeutic Effect: Pain management Contraindications/ Precautions: Intolerance to opiate agonists; opiate naive patients; acute or severe asthma; hypercapnia; bronchial asthma, status asthmaticus; obstetrical analgesia Nursing Interventions/ Patient Education: -Monitor respiratory status -Monitor vitals -Assess pain 30 minutes after administration to determine effectiveness -Monitor carefully in elderly persons -Have pt cough to check for sputum production/effectiveness of cough Drug-Drug/ Drug-Food/ Herbal Interactions: Alcohol and other CNS depressants, St. Johns Wort Cultural Considerations: None Safe for breast feeding: No
What is the reversal agent for Warfarin and when do yo give it?
Give Vitamin K when it's >2-3
Colchicine
Give with meals -- anti gout, remember if diarrhea develops, stop the drug
Glipizide
Glucotrol for diabetes
What is digoxin used for?
HF, dysrhythmias
Which drug requires frequent eye exams?
Hydroxychloroquine (Plaquenil) bc it may cause retinal damage
Common, adverse effect of potassium-wasting diuretics (eg, furosemide, bumetanide)?
Hypokalemia
what electrolyte imbalance can potentiate digoxin toxicity?
Hypokalemia
What fluid is okay to give to a patient with a closed head injury who is exhibiting signs of increased intracranial pressure?
IV Mannitol. IV mannitol is an osmotic diuretic that reduces cerebral edema by pulling water from the cerebral cells into the vasculature.
How should adenosine be administered?
IV push quickly over 1-2 seconds
What is the recommended initial treatment for Kawasaki disease and what is it's primary goal? What should parents watch out for though?
IVIG along with aspirin is the recommended initial treatment for Kawasaki disease, with the primary goal of coronary disease prevention. Heart failure (signs of fluid overload and retention)
Azathrioprine
Immunosuppressant drug prescribed to treat autoimmune conditions or prevent organ transplant rejection. It however can cause bone marrow depression.
Atropine
Involuntary nervous system blocker IT WOULD LIFT THE HEART RATE given to the client experiencing symptomatic bradycardia. In symptomatic bradycardia, the heart rate is <60/min and is inadequate for the client's condition, causing symptoms such as hypotension, chest pain, or syncope. Atropine acts to increase the heart rate by inhibiting the action of the vagus nerve (parasympatholytic effect). A normal sinus rhythm and reversal of clinical symptoms indicate that the medication has had the desired effect.
What is cerebral arteriovenous malformation?
Is an abnormal connection between the arteries and veins in the brain—specifically, an arteriovenous malformation in the cerebrum.
stuff to know: A computed tomography (CT) scan is a noninvasive procedure that provides detailed x-ray images of the body. In some cases, iodinated contrast (eg, IV, PO) is administered during the CT scan to enhance visualization of blood vessels or certain organs. For clients with renal impairment, a potential complication of IV iodinated contrast is acute kidney injury (ie, contrast-induced nephropathy).
Lactic acidosis is a severe complication of metformin, an antidiabetic medication. Administration of IV iodinated contrast to a client who takes metformin can cause an accumulation of metformin in the bloodstream, which increases the risk for lactic acidosis. As a result, many health care providers will discontinue metformin 24-48 hours before administration of IV contrast and restart the medication after 48 hours, when stable renal function is confirmed
Make sure the pt didn't have what before giving them a TNF drug??
Latent TB bc it could reactivate with this drug
Which meds may contribute C. Diff vs which meds can you use FOR it?
Lincomycin, Azithromycin and Ampicillin were most often associated with the development of antibiotic-associated diarrhea. C difficile colitis is treated with metronidazole or vancomycin, depending on severity and number of relapses. Vancomycin is typically given orally in this situation, unlike other nonintestinal infections in which IV is the standard route.
Deconate or "D"
Long acting IM form of Phenothiazine given to non compliant patients ex: "thorazine D" - usually court ordered
Phenalzine
MAOI
Cyclobenzaprine (Flexeril)
Muscle Relaxant
Baclofen
Muscle Relaxant an antispasmodic drug commonly prescribed to clients with multiple sclerosis to relieve uncomfortable spasms and muscular pain. Dizziness when attempting to stand or changing positions (ie, orthostatic hypotension) is a common adverse effect but is not a contraindication.
Dantrolene (Dantrium)
Muscle Relaxant indicated in pts with Malignant hyperthermia
Celecoxib (Celebrex)
NSAID
Ketorolac (Toradol)
NSAID
Naproxen
NSAID However, the use of NSAIDs increases the risk of thrombotic events (eg, heart attack, stroke) in clients with cardiovascular disease (eg, coronary artery disease [CAD]), especially with long-term use.
Ketorolac (Toradol)
NSAID drug given to decrease inflammation and pain
Indomethacin, Ibuprofen, Naproxen, Meloxican
NSAIDS
Methadone (Dolophine)
Narcotic (can be used for back pain or like any pain) expected: itching sensation signs of toxicity: N/V and lethargy
What is isosorbide dinitrate?
Nitrate is a long-acting nitrate medication prescribed to prevent angina in clients with CAD.
Erectile dysfunction meds are contraindicated with what?
Nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.
What are NSAIDs?
Nonsteroidal anti-inflammatory drugs That have antipyretic, anti-inflammatory, and anti-platelet aggregation properties.
Norepinephrine
Norepinephrine is similar to adrenaline. It is used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. Norepinephrine is often used during CPR (cardio-pulmonary resuscitation). helps control alertness and arousal; undersupply can depress mood
Tetracycline for acne should be taken with what?
Nothing. Especially don't take with dairy products!
what is circumoral paresthesia
Numb/tingling lips
Fentanyl
Opioid Analgesic
Morphine Sulfate
Opioid Analgesic
Hydromorphone (Dilaudid)
Opioid Analgesic *class*: opioid agonist *Indication* moderate to severe pain *Action*: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex *Nursing Considerations*: -Assess BP, respirations, and pulse before and during administration - medication causes general CNS depression - Narcan is the antidote for overdose - use caution with concurrent use of MAOI - avoid use within 14 days of each other - may be used as an antitussive - advised to dilute with NS prior to administration and to administer slowly to decrease CNS depression
Running furosemide ran via IV too fast can lead towhat?
Ototoxicity
Clomiphene is a medication that treats infertility. What do you tell the patient when they ask how soon the drug can take effect?
Ovulation typically occurs 5-9 days after completing the medication. So 5 days after completing the medication is the best for the chance of successful conception.
Opioids are used to treat pain. If a patient is given Hydromorphone what will happen to their blood pressure?
Pain relief may cause reduced BP
Succinylcholine
Paralytic a synthetic compound used as a short-acting muscle relaxant and local anesthetic. It is an ester of choline with succinic acid.
How does hyperkalemia look like on an ekg?
Peaked T waves
Client with epigastric pain after an Endoscopic retrograde cholangiopancreatography (ERCP) is at risk for what?
Perforation or irritation of these areas during the procedure can cause acute pancreatitis, a potentially life-threatening complication after an ERCP. Signs and symptoms include acute epigastric or left upper quadrant pain, often radiating to the back, and a rapid rise in pancreatic enzymes (eg, amylase, lipase)
Tadalafil, sildenafil, vardenafil are what?
Phosphodiesterase inhibitors used in erectile dysfunction
What is pinworm?
Pinworms (ie, enterobiasis) are very common in childhood and easily transmitted when microscopic pinworm eggs, which can be found on contaminated food, drink, toys, and linens, are inhaled or swallowed. Once ingested, the eggs hatch in the intestines. During the night, the female pinworm lays thousands of microscopic eggs in the skin folds around the anus, resulting in anal itching and troubled sleep. When the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces. Pinworm infection is treated with antiparasitic medications
ACE inhibitors and ARBS are contraindicated in what?
Pregnancy! - they have black box warnings bc they are teratogenic (they cause renal and cardiac deaths or defects in infants)
What is an adverse effect of Amiodarone?
Pulmonary Toxicity Pulmonary toxicity is a life-threatening adverse effect of amiodarone, which is believed to cause direct cellular damage and activation of an immune response in the lungs. Clients who develop pulmonary toxicity may report respiratory symptoms such as dry cough, pleuritic chest pain, and dyspnea. Clients with clinical manifestations of pulmonary toxicity require immediate intervention to prevent fatal, irreversible lung damage
Rh immune globulin
Rh immune globulin (eg, RhoGAM) is administered to all Rh-negative pregnant clients at 28 weeks gestation and within 72 hours postpartum, as well as after any maternal trauma, to prevent the development of permanent Rh antibodies. RhoGAM is not effective once sensitization has occurred.
NSAIDS and anticoagulants should not be taken together why?
Risk of bleeding since NSAIDS make you bleed
Paroxetine (Paxil)
SSRI antidepressant
Clonidine
Sedative and Antihypertensive drug - It can treat high blood pressure. Certain formulations can also treat ADHD and cancer pain. make sure you tell ur pts not to stop taking this med abruptly bc it can lead to rebound hypertension
Signs of perforation after a colonoscopy?
Signs of perforation include abdominal pain (with shoulder tip pain), positive rebound tenderness, guarding, abdominal distension, tenesmus, and/or board like (rigid) abdomen.
How should patients take potassium pills?
Sitting upright with plenty of water.
What is an emergent adverse effect of ACE inhibitors?
Swelling of the lips and tongue bc that's angioedema and it can lead to airway obstruction
Desmopressin (DDAVP)
Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis Desmopressin (DDAVP®) is also used to help stop bleeding in patients with von Willebrand's disease or mild hemophilia A. DDAVP causes the release of von Willebrand's antigen from the platelets and the cells that line the blood vessels where it is stored.
A client with cancer pain is prescribed oxycodone. Which teaching is most essential to help prevent long-term complications?
Teach the client how to prevent constipation
Adverse affects of Calcium Channel Blockers?
The most important adverse effects of calcium channel blockers include dizziness, flushing, headache, peripheral edema, and constipation. The reduced blood pressure may initially cause orthostatic hypotension. The client should be taught to change positions slowly to prevent falls. Leg elevation and compression can help to reduce the edema. Constipation should be prevented with daily exercise and increased intake of fluids, fruits/vegetables, and high-fiber foods.
Teaching the client signs and symptoms of bleeding risk GO!:
The nurse should instruct the client to monitor for black, tarry stools, bleeding gums, and excessive bruising. The client should also use a soft bristle toothbrush, shave with an electric razor, and refrain from playing contact sports.
What are ACE inhibitors?
They are antihypertensives that relax the vein and arteries to lowers BP. ie: enalapril, lisinopril, captopril
Nitroglycerin needs to be stores where?
They should be stored away from light and heat sources, including body heat, to protect from degradation. Clients should be instructed to keep the tablets in the original container. Once opened, the tablets lose potency and should be replaced every 6 months. The car is not a good place to store NTG due to heat
What is dumping syndrome?
This is when the stomach empties quickly after eating and the client experiences uncomfortable to severe side effects. Usually secondary to gastric bypass, gastrectomy or gall bladder disease "when gastric contents empty too rapidly into the duodenum, causing a fluid shift into the small intestine. This results in hypotension, abdominal pain, nausea/vomiting, dizziness, generalized sweating, and tachycardia."
Aspirin Toxicity may cause what?
Tinnitus
What is magnesium sulfate used for?
To prevent seizures and slow down labor
A patient who is taking morphine sulfate for acute pain is worried about the nausea and vomiting that occurs with the medication what do you tell them as their nurse?
Tolerance develops quickly and persistent nausea is rare
Dopamine (Intropin) is treatment for what?
Treatment for hypotension, shock, low cardiac output, poor perfusion to vital organs; monitor EKG for arrhythmias and monitor BP it enhances cardiac output by increasing myocardial contractility, increases heart rate, and elevating blood pressure through vasoconstriction. Renal perfusion is also improved, resulting in increased urine output.
What is sulfasalazine used for? and why is it continued after symptoms reside?
Ulcerative colitis The prescribed sulfasalazine should be continued even when symptoms subside to prevent relapse. Because sulfasalazine hinders the absorption of folate, folic acid supplements are encouraged.
Nitrogylcerin
Vasodilators widening blood vessels leading to increased blood flow with flushing and warmth *sublingual is faster *transdermal patch takes 40-60 min *can lower BP don't give it to someone with hypotension lol
Pts on a vegan diet are at a risk for what deficiency?
Vitamin B12 (primarily supplied by animal products) loss of B12 can lead to - peripheral neuropathy - neuromuscular impairment - memory loss/dementia
how long does it take for warfarin to take effect?
Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effect. Therefore, an overlap of a parenteral anticoagulant like heparin with warfarin is required. The typical overlap is 5 days or until the INR reaches the therapeutic level.
They say you should never stop Phenytoin bc stopping it can cause seizure recurrence and status epilepticus, but what is the only exception?
When the patient develops a rash. it may be rare but Stevens-Johnson Syndrome (SJS is a rare and potentially life-threatening hypersensitivity reaction)
Metoprolol
a beta blocker prescribed to clients after MI to reduce the risk of reinfarction and heart failure. Metoprolol lowers blood pressure and heart rate; therefore, the nurse should hold the medication and notify the health care provider of hypotension or a heart rate <50/min.
Cefazolin
a bone-penetrating cephalosporin antibiotic that is active against skin flora (Staphylococcus aureus); it is given prophylactically before and after surgery to prevent infection used for a lot of open fractures
Propofol is considered standard treatment for
a client that needs to be sedated while receiving mechanical ventilation to provide ventilator control, prevent accidental extubation, and promote comfort
Spironolactone
a potassium-sparing diuretic
Wtf is an endoscopic retrograde cholangiopancreatography (ERCP)?
a procedure in which an endoscope is passed through the mouth into the duodenum to assess the pancreatic and biliary ducts. Using fluoroscopy with contrast media, the ducts can be visualized and treatments including removal of obstructions, dilation of strictures, and biopsies can be performed.
What is sumatriptan?
a selective serotonin agonist prescribed to treat migraine headaches
What is atorvastatin?
a statin drug prescribed to lower cholesterol, which can reduce the risk of atherosclerosis and coronary artery disease.
Docusate Sodium
a stool softener that reduces straining during bowel movements, thereby decreasing the workload on the heart. Straining can also cause bradycardia due to vagal response
what is the therapeutic range for aPTT on heparin ? what about normal?
aPTT therapeutic 46-70 aPTT normal 25-35
What does betamethasone so for the baby when given to a mother in preterm labor?
administering IM antenatal glucocorticoids (eg, betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development
Thrombolytic Therapy does what?
aims to stop the infarction process, dissolve the thrombus in the coronary artery, and reperfuse the myocardium. This treatment is used when facilities do not have an interventional cardiac catheterization laboratory or when such a facility is too far away to transfer the client safely. Client selection is important because all thrombolytics lyse the pathologic clot but may also lyse other clots (eg, at a postoperative site). Minor or major bleeding can be a complication.
If a pt can't handle an ACE inhibitor what are they given?
an ARB For clients unable to tolerate ACE inhibitors, angiotensin II receptor blockers (ARBs) such as valsartan or losartan are recommended. ARBs prevent the vasoconstrictor and aldosterone-secreting effects of angiotensin II by binding to the angiotensin II receptor sites.
Aspirin
an antiplatelet agent, inhibits platelet aggregation, prevents thrombus formation, and reduces heart inflammation. Clients without signs of bleeding or low platelet levels may safely receive aspirin
Tetanus and diphtheria toxoid
an immunization given prophylactically to prevent infection (Clostridium tetani) if immunizations are not up to date (>10 years), unavailable, or unknown
Azathioprine
an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. It is prescribed to treat autoimmune conditions such as inflammatory bowel diseases (eg, Crohn disease) and to prevent organ transplant rejection. Leukopenia can be a severe adverse effect of the drug so dont be giving this shit to ppl with leukopenia
The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate? a. Clarify vegetable consumption with the client b. Decrease the Heparin rate c. Decrease the warfarin dose d. Obtain an order for vitamin K injection
ans: B
The nurse is preparing to administer medications to a client admitted with atrial fibrillation. The nurse notes the vital signs shown in the exhibit. Which medications due at this time are safe to administer? Select all that apply. given: temp 98.4 bp 124/78 hr 46 resp 22 a. Diltiazem extended release- PO b. Heparin Subcutaneous injection c. Lisinopril PO d. Metoprolol PO e. Timolol opthalmic
ans: B, C
Do not take misoprostol with what?
antacids
Azithromycin (Zithromax)
antibiotic
Levofloxacin
antibiotic
Rifaximin
antibiotic It can treat traveler's diarrhea and irritable bowel syndrome with diarrhea. It can also help prevent recurrence of certain liver problems.
Amoxicillin/Clavulanate
antibiotic that is often used to treat respiratory infections
Tolterodine
anticholinergic medications used for overactive bladder and urge incontinence.
Apixaban, rivaroxaban, dabigatran
anticoagulants
Diphenhydramine (Benadryl)
antihistamine
Baclofen
antispasmodic prescribed to MS clients to relieve uncomfortable spasms and muscular pain. orthostatic is common adverse effect.
phenytoin toxicity manifestation?
ataxia (gait disturbance)
Opsthotonos
babies hyper extend due to irritation of the meninges with the bilirubin (kernicterus)
Why is Methylergonovine [Methergine] contraindicated for clients clients with high BP?
because the primary mechanism of action is vasoconstriction. If administered to a hypertensive client, it can lead to further blood pressure elevation, seizure, or stroke
Atenolol
beta blocker - It can treat high blood pressure and chest pain (angina). It can also reduce the risk of death after a heart attack.
What is kernicterus? difference with jaundice??
bilirubin induced brain dysfunction jaundice is bilirubin in the skin
Tumor necrosis factor (TNF) inhibitor drugs
block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. These drugs reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. The medication causes immunosuppression and increased susceptibility for infection and malignancies.
Clindamycin
broad spectrum antibiotic found when a mother with postpartum endometritis needed antibiotic
The presence of wheezing in a client taking propranolol may indicate what?
bronchoconstriction or bronchospasm
"-dipine"
calcium channel blocker
Amlodipine
calcium channel blocker (nifedipine, amlodipine, felodipine, nicardipine but also randomly diltiazem) are vasodilators used to treat hypertension and chronic stable angina. They promote relaxation of vascular smooth muscles leading to decreased systemic vascular resistance and arterial blood pressure.
What is diltiazem?
calcium channel blocker its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate.
Nifedipine
calcium channel blocker used to treat hypertension
The treatment goals are to reduce the ventricular rate to <100/min and prevent stroke. Ventricular rate control is the priority. Medications used for rate control include:
calcium channel blockers (ie, diltiazem), beta blockers (ie, metoprolol), and digoxin.
What drugs have interactions with grapefruit?
calcium channel blockers and sildenafil (ED drugs that cause vasodilation)
All macrolide antibiotics (eg, azithromycin, erythromycin, clarithromycin) can cause a what?
can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an electrocardiogram (ECG) should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval (eg, amiodarone, sotalol, haloperidol, ziprasidone, azole antifungals) will further increase this risk.
What is digoxin?
cardiac glycoside = treats HF, atrial fibrillation
Nitrates are effective if what?
client is able to do activities without the incidence of chest pain.
Filgrastim (Neupogen)
colony stimulating factor stimulates neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it
Sulfasalazine
contains sulfapyridine and aspirin (5-ASA) and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD).
Prednisone
corticosteroid (glucocorticoid) need to check sugar bc this can cause hyperglycemia
What does a high specific gravity mean?
dehydration
Which colostomy do you irrigate?
descending and sigmoid colostomies! Stool produced in the ascending and transverse colon is semiliquid, which eliminates the need for irrigation. Irrigation to promote a bowel regimen may be useful for descending or sigmoid colostomies because the stool is more solid.
What do anticholinesterases so?
drugs that prolong the existence of acetylcholine after it is released from cholinergic nerve endings by inhibiting both acetylcholinesterase and butyrylcholinesterase.
Thiamine is used to treat _____________
encephalopathy
Pancreatic enzymes usually come in:
enteric coated beads designed to dissolve only in an alkaline environment similar to that of the small intestine.
epoetin alfa
erythropoietin stimulates bone marrow to form red blood cells and is used to combat the effects of chemotherapy (due to bone marrow suppression) and/or kidney disease (erythropoietin is secreted by the kidneys). is a synthetic hormone that stimulates the production of erythropoietin and is used to treat anemia associated with chronic kidney disease.
wtf is an esophagogastroduodenoscopy (EGD)?
examination of the lining of the esophagus, stomach, and duodenum with a flexible endoscope for diagnostic and/or therapeutic purposes, such as biopsy, excision of lesions, removal of swallowed objects, dilation of obstructions, stent placement, measures to control hemorrhage, etc. "involves passing an endoscope down the esophagus to visualize the upper gastrointestinal structures (eg, esophagus, stomach, duodenum)."
Lorazepam for a client who is
extremely agitated with alcohol withdrawal
Benzodiazapines (diazepam, lorazepam)
first line for status epilepticus works by increaes GABA action. SE: sedation, tolerance, dependence, respiratory depression. May also be used in eclampsia seizures although first line is Magnesium sulfate there
What is the expected adverse drug effect of atenolol?
first-degree atrioventricular (AV) heart block bc the drug delays conduction at the AV node. ONLY SECOND DEGREE or THIRD DEGREE heart block should be a priority.
Antidote for midazolam is ______________
flumazenil
Phenytoin (dilantin) signs of toxicity
gait unsteadiness and horizontal nystagmus
Propofol (Diprivan)
general anesthetic -Strong sedative -Lowers BP -- discontinue if hypotension -Short half life -Sedative-hypnotic -May be given with paralytics to avoid undue anxiety and stress -Good for daily interruptions in sedation. -May induce hypotension -- should be monitored carefully. If patient becomes hypotensive DC proprfol
Sulfonylureas
glipizide, glyburide, glimepiride adverse effects: hypoglycemia and weight gain Clients taking glyburide should be taught to use sunscreen and protective clothing as serious sunburns can occur.
how do you take off PPE
gloves, goggles, gown, mask alphabetically
What is Sodium Nitroprusside?
highly potent vasodilator. Nitroprusside begins to act within 1 minute and can produce a sudden and drastic drop in blood pressure (symptomatic hypotension) if not monitored properly. Therefore, the client's blood pressure should be monitored closely (every 5-10 minutes). This client's lightheadedness and cold clammy skin are likely due to hypotension. Nitroprusside metabolizes to cyanide, and clients with renal disease can occasionally develop fatal cyanide toxicity.
sodium polystyrene sulfonate treats what?
hyperkalemia It works in the gastrointestinal tract to trade sodium for potassium, thereby eliminating excess potassium through the stool and reducing the serum potassium level.
drunk features + shock is
hypoglycemia
When you combine Licorice and a diuretic it can potentially lead to what?
hypokalemia
Clients with hypovolemia from GI losses (shitting and vomiting a lot) will often have what?
hyponatremia, hypokalemia, and elevated blood urea nitrogen (BUN) (poor renal perfusion) Hypovolemia can cause hypotension and renal failure, and electrolyte abnormalities can cause cardiac arrhythmias; therefore, these are priority to report. Fluid resuscitation and electrolyte replacement should be initiated promptly to prevent complications.
Methotrexate
immunosuppressant drug used to treat rheumatoid arthritis and psoriasis . risk for infection bc of immunosuppression
Adverse effects of beta blockers?
include bradycardia, bronchospasm, depression, and decreased libido with erectile dysfunction.
What is cellulitis?
infection of the dermis and subcutaneous tissue
Tiotropium
inhaled anticholinergic drug that inhibits receptors in the smooth muscles of the airways. It is prescribed daily for the long-term management of bronchospasm in clients with chronic obstructive pulmonary disease.
Metformin (Glucophage) (part 2)
is a first-line drug for the control of blood sugar in clients with type 2 diabetes mellitus.
Atorvastatin
is a lipid-lowering medication given to clients to lower cholesterol levels (ie, LDL cholesterol), which reduces plaque and reinfarction risk. However, statins may cause rhabdomyolysis and require monitoring for muscle weakness and pain.
Sodium polystyrene sulfonate (Kayexalate, Kionex)
is a medication used to treat hyperkalemia that works by exchanging sodium for potassium across the mucous membranes of the bowel and then excreting potassium via stool. Sodium polystyrene sulfonate is not indicated if potassium is within normal limits.
Phenazopyridine Hydrochloride
is a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection. The urine will turn bright red-orange while on this medication; other body fluids can be discolored as well.
Memantine
is used to ease the symptoms of moderate to severe Alzheimer disease (AD), thereby improving the quality of life for clients and caregivers.
Digoxin is excreted almost exclusively via the _____
kidneys Decreased kidney function usually requires decreased digoxin dosage and frequent drug level monitoring. BUN and creatinine are measurements of kidney function.
Lactulose
laxative that also promotes ammonia excretion
Tiotropium (Spiriva)
long-acting anticholinergic bronchodilator
Hypokalemia may cause what?
may cause muscle cramps, weakness, or paresthesia. Unmanaged hypokalemia can lead to lethal cardiac dysrhythmias and paralysis.
Sevelamer
mealtime phosphate binders to prevent the absorption of the additional nutritional phosphorus
normal side effects of metronidazole are what?
metallic taste and dark urine
How many hours after surgery do you wait to give Fondaparinux?
more than 6 hours!!!! but also anticoagulants are not given while an epidural catheter is in place so remember that
Common adverse effect of statins?
muscle cramps A serious adverse effect of statins, including atorvastatin and rosuvastatin (Crestor), is myopathy with ongoing generalized muscle aches and weakness. A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.
What is paresis?
muscle weakness
Vancomycin may cause
nephrotoxicity and ototoxicity
gentamicin may cause
nephrotoxicity and ototoxicity
what drugs are usually given for unstable angina?
nitrates
should someone take antibiotics for mono?
no bc it can cause a rash
do you ask pts to take their valproic acid before an ECT? why?
no bc its an anticonvulsant and it would affect the procedure
Do you give a person with a high creatinine sulfasalazine?
no bc sulfa can crystallize in the kidney if the client is dehydrated Normal urine specific gravity is 1.003-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration
Do we give NSAIDS to a pt with a creatinine of 2.8?
no bc they have kidney disease (normal 0.6-1.2) and NSAIDs are NEPHROTOXIC and should be avoided in clients with kidney disease
Can a patient with hypertension take an NSAID?
no bih wtf Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can cause cardiovascular side effects, including heart attack, stroke, high blood pressure, and heart failure from fluid retention. These drugs also decrease the effectiveness of diuretics and other blood pressure medications.
What happens when a patient has a high central venous pressure (CVP)?
norm 2-8, any higher indicates increased systemic circulation volume and increased right ventricular preload.
What is the normal CVP?
normal central venous pressure is 2-8 anything higher indicates
what is paresthesia
numbness and tingling
dilation is the
opening of the cervix
Naloxone (Narcan)
opiate antagonist it is the ANTIDOTE for opioid overdose reverses opioid induced respiratory depression
Metformin (Glucophage)
oral antidiabetic agent used to treat DM II by decreasing glucose production in the liver, facilitates decreased glucose production; monitor for adverse effects muscle pain, agitation, GI manifestation such as bitter or metallic taste
What is mannitol?
osmotic diuretic used to treat cerebral edema
gentamiCIN tobramyCIN amikaCIN can all cause what?
ototoxicity and nephrotoxicity Tinnitus and vertigo are early signs of ototoxicity. The nurse should carefully assess for changes in the client's hearing, balance, and urinary output.
Milrinone
phosphodiesterase inhibitor is a phosphodiesterase-3 inhibitor given via IV infusion to increase contractility and promote vasodilation. Milrinone, an inotropic agent, is often prescribed to clients with heart failure unresponsive to other pharmacologic therapies. The medication is usually infused over 48-72 hours in a hospital setting; however, home infusion through a central line is becoming more common as a palliative measure for end-stage heart failure. Milrinone infusion requires central venous access (eg, peripherally inserted central catheter) as the medication is a vesicant and can cause extravasation if infused through a peripheral IV line.
Spironolactone
potassium sparing diuretic
In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent what?
prevent stress ulcers from developing during surgery or a major illness.
Allopurinol
prevent the formation of uric acid
What is the reversal agent for heparin?
protamine sulfate
What is albumin?
protein in blood; maintains the proper amount of water in the blood Albumin helps move many small molecules through the blood, including bilirubin , calcium, progesterone, and medicines. It plays an important role in keeping the fluid in the blood from leaking into the tissues.
Pantoprazole (Protonix)
proton pump inhibitor for GERD
IV hydromorphone should be administered over how many seconds?
rapidly over 2-3 seconds
Terazosin
relieves urinary retention in pts with benign prostatic hyperplasia. relaxes smooth muscle in the bladder neck and prostrate gland. - However, it also relaxes smooth muscle in the peripheral vasculature, which can cause orthostatic hypotension, syncope (blacking out), and falls. This is particularly common when the drug is started (first-dose hypotension) or when the dosage is increased. The serious effects can be avoided by instructing the client to take the medication at bedtime, change positions slowly when going from lying to standing, and avoid any medications that also increase smooth muscle relaxation
sodium polystyrene sulfonate (Kayexalate)
retention enema is a medicated enema administered to clients with high serum potassium levels The resin in Kayexalate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level.
What is an adverse effect for use of hydroxychloroquine?
retinal toxicity and visual disturbances can occur with hydroxychloroquine. Therefore, clients are instructed to undergo regular ophthalmologic examination every 6-12 months
What meds turn your saliva like.. red?
rifampin and carbidopa-levodopa
Olanzapine for a client who is
schizophrenic showing signs of violent behavior (antipsychotic)
What does diazepam do?
stops seizures
Infliximab, adalimumab, and etanercept are tumor necrosis factor (TNF) inhibitors that what?
suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis. Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection. ***A client with current, recent, or chronic infection should not take a TNF inhibitor
paracentesis
surgical puncture to remove fluid from the abdomen; reduce symptoms of ascites
levothyroxine is okay to take during pregnancy because the body is supposed to already naturally make it, what else should you tell your pt?
symptoms begin improving within 4 weeks of starting levothyroxine
What are 4 benzodiazepines widely used in clinical anesthesia?
the agonists midazolam, diazepam and lorazepam and the antagonist flumazenil.
Prior to starting therapy with statin medications (eg, rosuvastatin, simvastatin, pravastatin, atorvastatin) what should be assessed?
the client's liver function tests should be assessed. The drug is metabolized by the hepatic enzyme system and could cause drug-induced hepatitis and increased liver enzymes. Liver function tests should be assessed prior to the start of therapy.
Who are the greatest risk for respiratory depression related to opioid use for analgesia?
the elderly; those with underlying pulmonary disease, history of snoring (with or without apnea), obesity, or smoking (more than 20-pack-year history); the opiate naïve, especially if treated for acute pain; and post surgery (first 24 hours).
Why are NSAIDS contraindicated in pts with Coronary artery disease?
the use of NSAIDs increases the risk of thrombotic events (eg, heart attack, stroke) in clients with cardiovascular disease (eg, coronary artery disease [CAD]), especially with long-term use.
Why are NSAIDS contraindicated in the use of chronic heart failure?
they contribute to sodium retention, and therefore fluid retention
Chlorthalidone
thiazide diuretic
effacement is
thinning of the cervix
Levothyroxine (Synthroid)
thyroid hormone used to replace the thyroid hormone in pts with hypothyroidism and for those who have had their thyroid removed. make sure they know the med is taken for the rest of their ******* lives.
Magnesium Sulfate
to correct hypomagnesemia (under the normal mag reference range of 1.5-2.5) also treats torsades de pointes and seizures associated with eclampsia
Why do we administer antibiotics to preterm birthing mothers?
to prevent group B Streptococcus infection in the newborn if preterm birth occurs
Ethambutol (Myambutol)
to treat active tuberculosis SE - Optic neuritis, decrease in visual acuity Notes - Routine vision test (monthly), Serum Creatine
permethrin cream
treatment for scabies
What is radioactive iodine used for?
treats hyperthyroidism by partially damaging or destroying the thyroid gland. RAI has a delayed response, requiring up to 3 months for maximal effect. After treatment, the client emits radiation, and excreted bodily fluids are radioactive. The nurse teaches home precautions to protect those who come in contact with the client.
Rifampin is used to treat what?
tuberculosis
Calcium acetate (PhosLo)
used to control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the intestines and excreting it in the stool.
Filgrastim
used to increase neutrophil count in clients with certain malignancies and those undergoing chemotherapy.
Methotrexate (Rheumatrex)
used to treat rheumatoid arthritis and psoriasis it can cause bone marrow suppression resulting in anemia, leukopenia, and thrombocytopenia. so it has a higher risk for infection
What antibiotics do we usually give for c. diff?
usually vancomycin or metronidazole
What does sumatriptan do?
vasoconstricts cranial arteries-- therefore it is contraindicated in pts with uncontrolled hypertension and CAD
Opioids may also have the chance of causing histamine release which may lead to ?
vasodilation and hypertension
Nitroprusside (Nipride)
vasodilator
What are nitrates?
vasodilators: Nitrate medications prevent angina by causing vasodilation of the peripheral vessels (decreasing cardiac workload) and the coronary arteries (improving coronary artery perfusion)
What is a colonoscopy?
visual examination of the colon
Clients receiving desmopressin must have their fluid and electrolyte status closely monitored for symptoms of what?
water intoxication/hyponatremia (eg, headache, mental status changes, weakness). The nurse should immediately notify the health care provider (HCP) of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death
How should a patient take their allopurinol for their gout??
with a full glass of water and increase their fluids during the day
Is ampicillin contraindicated in pts with a penicillin allergy?
yea bc that bih is a penicillin antibiotic.
Misoprostal (Cytotec)
• Prostaglandin Analogues - decreases gastric acid production It can prevent stomach ulcers caused by anti-inflammatories (NSAIDs).