PHARM FINAL
NURSING CARE- ANTICHOLINERGICS (prt 2)
•Provide mouth care- ice or hard candy to relieve dry mouth •Encourage patient to avoid hot environments and excess physical activity •Darkened room, sunglasses for eye comfort •Instruct not to drive or operate machinery if vision is blurred
Quick-Relief Medications
•Short-acting beta2 adrenergic agonists (inhaled) •Anticholinergics (inhaled) •Corticosteroids- (inhaled & IV)
Diuretics classes
•Thiazide diuretics •Loop diuretics •Osmotic diuretics •Potassium Sparing diuretics
Fluoroquinolones ("-acin" suffix)
•Tings to Note with this "-acin" drug Cipro can increase serum levels of caffeine***; •***Avoid antacids, iron supplements, and dairy products for at least 6 hours after taking medicine; they can decrease absorption of Cipro •Administer IV over 60 minutes*** •Patients should wear sunscreen & protective clothing when in sunlight***
Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin)
•azelastine (Astelin)- nasal spray •olopatadine (Patanol)- ophthalmic drops
Three major lipoproteins
▪High density lipoprotein (HDL)- contains less fat ▪Low density lipoprotein (LDL)- contains more fat ▪Very low density lipoprotein (VLDL)- carries mostly triglycerides and less cholesterol
Statins: pravastatin (Pravachol); simvastatin (Zocor)
▪Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis, so decrease cholesterol, decrease LDL, and slightly increase HDL ▪Have been found to decrease coronary artery disease and mortality rates
Coronary Artery Disease
▪Lumens of the blood vessels become narrowed due to plaque (cholesterol or fatty deposits) ▪Decreases oxygenated blood supplying myocardium ▪Angina pectoris "suffocation of heart muscle"; chest pain
pravastatin (Pravachol); simvastatin (Zocor) = aka Statins
▪May be combined with other drugs for better results ▪Positive effects may be seen in 2 wks, but it takes 2 to 4 wks for therapeutic effect to be achieved
Be aware- Statins: pravastatin (Pravachol); simvastatin (Zocor)
▪May cause an *increase in liver enzyme levels*- should be checked for the first few months; avoid use with alcohol*
Coronary Artery Disease (prt 2)
▪Myocardial infarction: when area of the myocardium becomes ischemic and then necrotic ▪Severe pain, often described as "crushing" or "suffocating"; usually nausea, diaphoresis, feeling of "pending doom", anxiety; epigastric pain ▪Women may experience atypical symptoms, including no complaint of actual chest pain
3 types of drugs that address Chest Pain
▪Nitrates ▪Beta blockers ▪Calcium channel blockers
Cholesterol Absorption Inhibitors
▪Prototype: ezetimibe (Zetia)- (PO)
Fibric Acid Agents: Gemfibrozil (Lopid)
▪Reduces triglyceride and VLDL levels ▪Drug of choice for extremely high triglyceride levels
Nitrates: nitroglycerin (Nitrostat)
▪Relax & dilate veins, arteries, & capillaries; dilation of coronary arteries, bringing more blood and oxygen to myocardium ▪Reducing amount of blood returning to the heart (reduces workload of heart)
Pulmonary Circulation
▪Right side of heart sends blood to the lungs ▪Carbon dioxide & some waste products are removed from blood ▪Oxygen is picked up by RBCs
Non-pharmacologic Methods of treating cholesterol
▪Saturated fats and cholesterol in the diet should be reduced ▪Total fat intake should be 30 percent or less of caloric intake, cholesterol intake 300 mg/day or less ▪Choose lean meats, especially chicken and fish ▪Exercise is important in reducing cholesterol and increasing HDL ▪Smoking should be eliminated- increases LDL and decreases HDL
Side effects of Statins: pravastatin (Pravachol); simvastatin (Zocor)
▪Side effects: HA, flatulence, abdominal pain, cramps, constipation, rhabdomyolysis with acute renal failure, rash ▪Observe for muscle tenderness or weakness** (rhabdomyolysis) ▪Avoid use in pregnancy
Side effects of Fibric Acid Agents: Gemfibrozil (Lopid)
▪Side effects: dyspepsia, diarrhea, abdominal pain, nausea, and vomiting (GI distress); muscle pain ▪Taking with meals reduces GI symptoms ▪*Contraindicated in patients with hepatitis or gallbladder disease*
Drugs Used to Treat Chest Pain accomplish their primary goal by.....
▪Slow heart rate ▪Dilate veins so heart receives less blood-reduced preload ▪Dilate coronary arteries ▪Decrease force of contraction-reduced contractility ▪Lower blood pressure so less resistance-reduced afterload
Drugs for Hyperlipidemia
▪Statins (HMG-CoA reductase inhibitors) ▪Bile acid sequestrants ▪Fibric acid agents ▪Nicotinic acid Cholesterol absorption inhibitors
diuretics are used for....,.
◦Hypertension ◦Heart failure ◦Kidney failure ◦Liver failure or cirrhosis ◦Pulmonary edema
Sympathetic
"Fight or Flight" •Activated under conditions of stress •Readies the body for an immediate response to a potential threat •Heart rate and BP increase, more blood is shunted to skeletal muscles, liver produces glucose for energy, bronchi dilate for more oxygen, pupils dilate for better vision •Neurotransmitter is norepinephrine
syncope
"Passing out", loss of consciousness or fainting NOTE: this is a side effect for Barbiturates (- "tal" suffix)
Parasympathetic
"Rest and Digest" •Activated under non-stressful conditions •Digestive processes promoted, heart rate and BP decline, bronchi constrict since no extra oxygen needed, bladder contracts, pupils constrict •Neurotransmitter is acetylcholine
Side effects of Beta Blockers: carvidolol olol (Coreg) metoprolol (Lopressor)
"olol" Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression Can *mask symptoms of hypoglycemia
Beta Blockers
"olol" suffix
Tetracyclines
("-CLINES" SUFFIX) Prototype- tetracycline (Sumycin) (po, TOP) OTHERS: DOXYCYCLINE MINOCYCLINE •Inhibits bacterial protein synthesis •Broad spectrum; BUT Much drug resistance IN RECENT YEARS •Used for Rocky Mountain spotted fever, typhus, cholera, Lyme disease, H. pylori, chlamydia, acne (a substitute for penicillin allergies)
Tetracyclines
("-CLINES" SUFFIX) •SIDE EFFECTS: Gastric distress is common-N/V/D, BONE MARROW SUPPRESSION, RASH, & SUPERINFECTION, PHOTOSENSITIVITY •May cause permanent brown discoloration of permanent teeth in young children- Don't give to children under 8 yrs old***** •Affects fetal bone growth and teeth development**** (Preg Cat. D)
Fluoroquinolones
("-acin" suffix) Prototype- ciprofloxacin (Cipro) (PO, IV) Others: levofloxacin (Levaquin), finafloxacin (xtoro) •Interfere with bacterial DNA enzyme synthesis; Broad spectrum •Four generations •Well absorbed orally and may be administered once or twice daily, well tolerated •Used for many types of infections including UTI, Resp, skin, as well as anthrax (germ warfare)
Fluoroquinolones
("-acin" suffix) THIS DRUG: •Interfere with bacterial DNA enzyme synthesis; Broad spectrum •Side effects: GI upset, n/v/d; dizziness, headaches, and restlessness; photosensitivity* •Black box warning: tendon rupture; Report any tendon pain or inflammation*
Penicillins
("-cillins" suffix) Prototype: amoxicillin (Amoxil) (PO,...other IM or IV) Others: penicillin G, ampicillin, or oxacillin •Disrupt bacterial cell walls •Amoxicillin is broad spectrum, some other penicillins are narrow spectrum
Penicillins
("-cillins" suffix) •Indicated for many types of infections, often strep & staph •broad-spectrum (ex. Amoxil) and extended-spectrum (ex. Zosyn) •Safe antibiotics- allergy is most common adverse effect- may have rash, itching, fever- possibly severe reaction- observe 30 minutes after injectable administration
Aminoglycosides ("-cin" suffix)
("-cin" suffix) •Prototype- gentamicin ( opth, top, IV, & IM) •Others: neomycin, streptomycin •Inhibit bacterial protein synthesis; bactericidal •Used for serious systemic infections caused by aerobic gram-negative microorganisms •Sometimes given concurrently with another antibiotic
Aminoglycosides
("-cin" suffix) •May cause serious adverse effects-***** •Ototoxicity •Nephrotoxicity •Neuromuscular blockade leading to flaccid paralysis & fatal respiratory depression
Aminoglycosides
("-cin" suffix) •Serum therapeutic range is 5-10 mcg/ml •Inhibit bacterial protein synthesis; bactericidal
Macrolides
("-mycin" suffix) •Prototype: azithromycin (Zithromax) (PO, IV) •Others erythromycin; clarithromycin (Biaxin), fidaxomicin (dificid) Bactericidal/bacteriostatic; protein synthesis; broad spectrum
Macrolides
("-mycin" suffix) •Treats a lot of respiratory infections, derm, uti, & GI •few adverse effects, when they do occur, mostly gi related •Adverse effects: n/v/d, anorexia, pseudomembranous colitis, confusion, cns changes, rash, superinfection
LINCOSAMIDES
("-mycin" suffix) •Use cautiously with liver or renal impairment •Adverse effects: severe gi reactions, n/v/d, fatal pseudomembranous colitis, bone marrow suppression
LINCOSAMIDES
("-mycin" suffix) •Prototype: clindamycin (Cleocin) (PO, IM, IV, Top) •Others lincomycin •Bactericidal; protein synthesis •Treat serious infections such as septicemia, bone/joint infections
Carbapenems
("-nem" suffix) •Prototype: imipenem-cilastin (Primaxin) (IM or IV) •Others: ertapenem, doripenem •inhibiting construction of cell wall; Bactericidal; very broad spectrum •Treats intra-abdominal, UTI, skin, bone, joint and gyne infections Can only be given parenterally
Carbapenems
("-nem" suffix) •inhibiting construction of cell wall; Bactericidal; very broad spectrum •Can only be given parenterally •Adverse effects- N/V/D, pseudomembranous colitis, rash, thrombophlebitis at injection site, superinfections, HA, dizziness
Oxazolidinones
("-olid" suffix) •Effective against many resistant strains (vre & mrsa) •Avoid maoi drugs and foods containing tyramine; may cause life-threatening hypertension •Adverse effects: cns effects (HA, dizziness), n/v/d, thrombocytopenia, risk for pseudomembranous colitis
Oxazolidinones
("-olid" suffix) •Prototype: linezolid (zyvox) (PO, IV) •Others: tedizolid (Sivextro) •Bactericidal; protein synthesis
Cephalosporins
("cef-" prefix) •Prototype: cefaclor (Ceclor) (PO.....but others given IM & IV) •Similar mechanism of action as penicillin •Inhibit bacterial cell wall synthesis •Used to treat a variety of infections (gram +/-)
Cephalosporins
("cef-" prefix) •Several generations of cephalosporins- the later the generation, the more effective and/or broader the spectrum- fourth and fifth-generation are effective against microorganisms that have developed drug resistance to earlier drugs (such as MRSA) •5-10% of people allergic to penicillin will also be allergic to cephalosporins (cross hypersensitivity)
Sulfonamides
("sulfa-" prefix) Prototype- trimethoprim-sulfamethoxazole/cotrimoxazole (Bactrim, Septra) (PO) Others- sulfadiazine, sulfasalazine •Suppress bacterial growth by inhibiting synthesis of folic acid •Broad spectrum; but lots of drug resistance to sulfa drugs •Cheap drugs; Used for otitis media, uTI's; some std's
Sulfonamides
("sulfa-" prefix) •***teratogenic (avoid in pregnancy & BREASTFEEDING) •Adverse effects- N/V/D, LIVER TOXICITY, allergic reactions, BONE MARROW SUPPRESSION, STEVENS-JOHNSON SYNDROME, RASH, HIVES, PHOTOPHOBIA** •POSSIBLE TOXIC NEPHROSIS (KIDNEYS) FROM CRYSTALS IN THE URINE, TEACH PATIENTS TO INCREASE FLUID INTAKE •TEACH PATIENTS TO AVOID SUN EXPOSURE
Barbiturates
(- "tal" suffix)
Angiotension II Receptor Blockers (ARBs)
(-"sartan" suffix)
Typical Antipsychotics Phenothiazines
(1st Gen) Prototype- chlorpromazine (Thorazine) (IM , PO, or IV)
atypical antipsychotics
(2nd Gen) Side/adverse effects- drowsiness, sedation, seizures, weight gain*, headache, dry mouth, photosensitivity, orthostatic hypotension, hyperglycemia*, fever, neuroleptic malignant syndrome
Celebrex
(Cox-2 Inhibitor) prototype: celecoxib (Celebrex) is the only drug in the class Function: To decrease bone/joint pain and inflammation USED FOR: Most NSAIDS are nonselective inhibitors for both COX-1 and COX-2.
Adverse effects: somatrem (Genotropin)
(Growth Hormone Deficiency) Adverse effects: development of antibodies to growth hormone, insulin resistance, swelling, joint pain, HA, injection-site pain Pt teaching: monitor blood glucose; child's nutritional needs must be monitored
prototype: somatrem (Genotropin)
(Growth Hormone Deficiency) Replaces the GH; stimulates skeletal growth & growth of internal organs
Pt teaching: monitor blood glucose; child's nutritional needs must be monitored
(Growth Hormone Deficiency) somatrem (Genotropin)
pt teaching
(Growth Hormone Deficiency) somatrem (Genotropin) = monitor blood glucose; child's nutritional needs must be monitored
Parenteral routes of administration
(Injection of medication into the body tissues) 1. Intradermal (ID) 2. Subcutaneous (SubQ) 3. Intramuscular (IM) 4. Intravenous (IV)
Prednisone
(PO, IM, IV) Have various uses; a) treat Addison's disease, and b)suppress severe inflammation & they do so by acting on many of the chemical mediators; do a great job with severe inflammation*
TRAP
(Tremor, Rigidity, Akinesia, Postural instability); an acronym for symptoms of Parkinson's disease
Acetaminophen
(Tylenol) Has no anti-inflammatory effect but does treat pain & is often combined with narcotics/opioids; does NOT affect platelet aggregation; does NOT cause GI bleeding or ulcers* •Pregnancy Category B •Do NOT administer to people to drink alcohol regularly because of liver damage**
partial agonist
(agonist-antagonist): produces a weaker or less efficacious response
Benzodiazepine
(anxiolytic w/ sedative properties) --- "pam/lam" suffix
COPD
(chronic obstructive respiratory disease)-chronic condition that occurs over time; of result of chronic bronchitis, emphysema; obstruction is not fully reversible
avoid what foods and stimulants when taking Methylxanthines: aminophylline (Theophylline)
**Avoid caffeine, nicotine, chocolate, and other stimulants
be aware that Direct Vasodilators such as hydralazine (Apresoline)
*May cause reflex tachycardia*- can be prevented by administering a beta blocker with the direct vasodilator
OSMOTIC DIURETICS: MANNITOL (OSMITROL) is NOT the best drug for....
*NOT BEST DRUG FOR HEART FAILURE*-DUE TO MASSIVE PULL OF FLUID INTO VASCULAR SPACE
Aspirin Implications
*Never give children/teens aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye's syndrome* •*Avoid activities that may cause or promote bleeding*; stop at least a week before surgery •Preg Category D in last trimester (or 'non-classified')
local anesthetic: lidocaine (Xylocaine)
*Note*: sometimes epinephrine is added to or used in conjunction with lido to decrease bleeding; lidocaine with epinephrine should NEVER be injected into fingers, toes, ears, noes, or penis*
for a patient exhibiting hypoglycemia symptoms
*Prepare to administer 50% Dextrose IV for acute hypoglycemia of the client with decreased LOC*
Parenteral drugs
- Given by a route other than the GI tract - Drugs administered by injectable routes - Means "excluding the intestines" - Administered by needle and syringe
Pure opioid agonists
-Activate mu receptors and kappa receptors -Can produce analgesia, euphoria, sedation, respiratory depression, physical dependence, constipation, and other effects Morphine: Strong opioid agonists and moderate to strong opioid agonists Codeine: Moderate to strong agonists
Dextromethorphan
-Antitussive (antagonizes NMDA glutamate receptors). -Synthetic codeine analog. Has mild opioid effect when used in excess. -Naloxone can be given for overdose. Mild abuse potential. -May cause serotonin syndrome if combined with other serotonergic agents
OmniPod
-Fill with insulin -Deliver insulin via cannula -Uses wireless PDM
parasympathetic responses
-Rest-and-digest response. -Conserve and restore body energy. -↑ digestive and urinary function. -↓ body functions that support physical activity.
Paul Ehrlich
-developed concept of selective toxicity -identified dyes that effectively treated African sleeping sickness (African trypanosomiasis)
acute imflammation
-immediate onset; 8-10 days to resolve typically
chronic inflammation
-slower onset for prolonged periods; usually worsens over time (rheumatoid arthritis, systemic lupus, etc.)
Common Conversions
1 meter = 1000 mm 1 meter = 1 mcg .001 mg = 1 mcg 1 gram = 1000mg 1000 g = 1 kg 1tbs (T) = 15mL 1 tsp = 5 mL 20 drops = 1mL 2.2lb = 1 kg 1 lb = 453.6 gm 1 oz = 30 gm 1 mL = 1 cc 1 dL = 100 mL
Package inserts
1) FDA regulates content and format (FDA approves of package insert) 2) must contain a summary of scientific info that is needed for SAFE and EFFECTIVE use 3) info must be infomrative, accurate and not promotional in tone and canNOT be FALSE or MISLEADING 4)MUST have SPECIFIC info under the listed headings in a SPECIFIC order
right sided heart failure
1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement)
Left sided heart failure
1. Pnea, SOB 2. Crackles 3. Oliguria 4. Frothy Sputum 5. Displaced Apical Pulse (Hypertrophy)
alklating agents
1. busulfan 2. nitrosureas (carmustine) 3. cyclophosphamide
Insulin Concentrations
100 units/ml or 500 units/ml
High risk blood sugar
100-125 mg/dL
Diabetes
126 mg/dL or HIGHER
Typical Antipsychotics Nonphenothiazines
1st Gen Prototype- haloperidol (Haldol)
Drugs for Pituitary Disorders
2 Lobes- Anterior Drug- growth hormone Posterior Drugs- desmopressin and oxytocin
Patient-controlled analgesia (PCA)
2 nurses must assess and document amount used and wasted when discontinued*** Usually a max dose, a lockout interval, & 4-hour limit programmed into the machine
sympathetic
4 GROUPS OF DRUGS IN AUTONOMIC NERVOUS SYSTEM: •Adrenergic agonists (sympathomimetics) •Adrenergic antagonists or blockers (sympatholytics)
parasympathetic
4 GROUPS OF DRUGS IN AUTONOMIC NERVOUS SYSTEM: •Cholinergic agonists (parasympathomimetics) •Cholinergic antagonists or anticholinergics (parasympatholytics)
Hemaglobin A1C
4-6% NORMAL: <5.7%
High risk Hemaglobin A1C
5.7%-6.4%
Diabetes Hemaglobin A1C
6.5% or HIGHER
Normal range for blood glucose
60-100mg/dL (70-110; 80-120) HbA1c should be less than 7%
Normal blood glucose
70-110 LESS THAN (<100 mg/dL)
competition for resources
A cause of conflict that occurs when the demand for resources is greater than the resources available. Think of foreign bacteria against your bodies normal flora (protective bacteria)
fever
A client has recently been started on an SSRI drug. Which of the following if reported by the client might lead the nurse to suspect that the client is suffering from serotonin syndrome? 1.Severe nausea & diarrhea 2.Somnolence 3.Bradycardia 4.Fever
status epilepticus
A condition in which seizures recur every few minutes or last more than 30 minutes. POWERPOINT: V administration of diazepam or lorazepam is preferred treatment THINK: Benzodiazepines
anemia
A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.
Dysrhythmia
A disruption in the cardiac rate or rhythm Sinoatrial Node is the "pacemaker" of the heart
Neuroleptic Malignant Syndrome
A life-threatening idiosyncratic reaction (a reaction that occurs rarely & is unpredictable) to many antipsychotic & neuroleptic (& some other drugs affecting the nervous system)
HMO (Health Maintenance Organization)
A managed care organization that provides comprehensive medical services for a predetermined annual fee per enrollee. Health insurance that requires a PCP and wants you to use only in-network doctors
Pseudoparkinsonism
A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles.
Psychosis / Schizophrenia
A mental condition characterized by abnormal behaviors. Thought processes are disturbed, as evidenced by: positive and negative symptoms
bipolar disorder
A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
nucleus
A part of the cell containing DNA and RNA and responsible for growth and reproduction
First pass effect
A phenomenon in which drugs given orally or carry directly to the liver after absorption, or they may be largely in activated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses then drugs given by other routes because of this early break down
Phase 1 study
A pilot study of a potential drug using a small number of selected, usually healthy human volunteers
medication reconciliation
A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. UP TO DATE
Neuroleptic Malignant Syndrome (NMS)
A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus.
Negative Feedback System
A reaction that causes a decrease in function in response to some kind of stimulus.
anaphylactic reaction
A serious allergic reaction that requires immediate treatment
vesicant
A severe ____ - can cause tissue necrosis if it infiltrates (see picture)
narcolepsy
A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.
isotonic solution
A solution in which the concentration of solutes is essentially equal to that of the cell which resides in the solution RBC in this solution will RETAIN its shape
hypertonic solution
A solution in which the concentration of solutes is greater than that of the cell that resides in the solution RBC places in this solution will SHRINK and SHRIVEL up as water moves OUT of the cell
Avoirdupois system
A system of measure used in pharmacy. In the avoirdupois system units such are the fluid ounce and the pound are used.
continuous bladder irrigation
A three-way (lumen) irrigation is used to decrease bleeding and to keep the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation (inflow); one lumen is for outflow.
Phagocytosis
A type of endocytosis in which a cell engulfs large particles or whole cells
Pinocytosis
A type of endocytosis in which the cell ingests extracellular fluid and its dissolved solutes.
Extrapyramidal Syndrome (EPS)
A variety of signs and symptoms, including muscular rigidity, tremors, drooling, shuffling gait, restlessness, peculiar involuntary postures, and many other neurological disturbances. Often a side-effect of antipsychotic medications.
Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
ACE Inhibitors (-"pril" suffix)
aptopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
ACE Inhibitors (-"pril" suffix)
POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)
ACT IN THE COLLECTING DUCT AND LATE DISTAL TUBULE TO ENHANCE SECRETION OF SODIUM AND RETENTION OF POTASSIUM (OPPOSITE OF ALDOSTERONE)
LOOP DIURETICS: FUROSEMIDE (LASIX)
ACT ON THE LOOP OF HENLE TO BLOCK REABSORPTION OF SODIUM AND CHLORIDE- SODIUM AND WATER ARE LOST
Antidiuretic Hormone Deficiency
ADH- secreted by posterior pituitary ADH-Promotes water reabsorption from the renal tubules to maintain water balance (helps to hold on to water), is hemostatic & has vasopressor properties
administration of ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
ADMINISTERED SQ OR IV; DON'T SHAKE SOLUTION
Adverse effects of beta blockers
ADRENERGIC ANTAGONISTS (BLOCKERS) Prototype: propranolol; metoprolol (Lopressor, Toprol)- drug names end in "olol" ______ _______: Prototype: propranolol; metoprolol (Lopressor, Toprol)- drug names end in "olol"
Alpha blockers
ADRENERGIC ANTAGONISTS (BLOCKERS) act on vascular smooth muscle to decrease BP.
Beta blockers
ADRENERGIC ANTAGONISTS (BLOCKERS) decrease rate and force of contraction of the heart and slow electrical conduction through the AV node; primary use is to treat hypertension.
Adverse effects of alpha blockers
ADRENERGIC ANTAGONISTS (BLOCKERS): Alpha blockers Prototype- prazosin (Minipress)- drug names end in "zosin" ____ ______: HA, dizziness, tachycardia, hypotension, nausea, dyspepsia, diarrhea
prazosin
ADRENERGIC ANTAGONISTS (BLOCKERS): Alpha blockers prototype: _____ (Minipress)- drug names end in "zosin"
propranolol & metoprolol
ADRENERGIC ANTAGONISTS (BLOCKERS): Beta Blockers Prototype: _____ & _____ (Lopressor, Toprol)- drug names end in "olol"
ADVERSE EFFECTS of THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)
ADVERSE EFFECTS: DIZZINESS, VERTIGO, ORTHOSTATIC HYPOTENSION, N/V/D, MUSCLE CRAMPS, MUSCLE SPASMS
cytophosphamide
ALKYLATING AGENTS Prototype- ______ (Cytoxan)**** •Others: chlorambucil •Interfere with DNA to prevent cancer cells from dividing Effective against many types of cancer •Adverse effects: bone marrow suppression; N/V/D; anorexia, alopecia, hepatic & renal toxicity; hemorrhagic cystitis
Cytoprotectant
ALKYLATING AGENTS mesna (Mesnex) helps reduce chance of hemorrhagic cystitis
true
ALL drugs are potentially dangerous
SHAMPOO FOR LICE
ALLOW MEDICATION TO REMAIN ON HAIR & SCALP FOR AT LEAST 10 MINUTES BEFORE REMOVAL; USE A FINE COMB TO REMOVE LICE EGGS
secondary action
ALMOST ALL DRUGS HAVE THIS effects in addition to the desired effect Benadryl causes drowsiness
phenylephrine (Neo-Synephrine); oxymetazoline (Afrin)•(PO, IV, and Topically)
ALPHA-ADRENERGIC AGONIST DRUGS
Topical/Intra-nasally (Afrin)
ALPHA-ADRENERGIC AGONIST DRUGS causing vasoconstriction in nose to decrease congestion THINK: oxymetazoline or Afrin
Topically/Eye drop
ALPHA-ADRENERGIC AGONIST DRUGS pupil dilation for eye exam
Injection/IV
ALPHA-ADRENERGIC AGONIST DRUGS to treat shock and shock-like symptoms (highly vesicant)
PO
ALPHA-ADRENERGIC AGONIST DRUGS used in many cold/allergy products
acarbose (Precose)
ALPHA-GLUCOSIDASE INHIBITORS
COMPLICATIONS OF RENAL FAILURE (prt 1)
ANEMIA-IMPAIRED ERYTHROPOIETIN PRODUCTION HYPERKALEMIA-UNABLE TO ADEQUATELY EXCRETE POTASSIUM HYPERPHOSPHATEMIA-UNABLE TO ADEQUATELY EXCRETE PHOSPHAT
mebendazole
ANTHELMINTIC AGENTS Prototype: ______ (Emverm) (PO) Others: ivermectin (Stromectol) Interfere with metabolic processes causing death •Treats nematode infections (whipworm, pinworm, roundworm, & hookworm) •Mebendazole is not systemically absorbed (fewer side effects) •Adverse effects: transient abdominal pain, diarrhea, fever
clotrimazole
ANTIFUNGAL ("-AZOLE" SUFFIX) Prototype: _______ (Lotrimin/Mycelex) (topical creams, lozenges, vaginal) •Treatment of tinea pedis, tinea cruris, and tinea corporis; treatment of oral & vaginal candidiasis •Damages fungal cell wall causing cell death •Not absorbed systemically; not very dangerous; available OTC Adverse effects: •Topical- stinging, redness, rash, swelling •Vaginal-burning/irritation, urinary frequency, lower abdominal pain •Oral- N/V, abnormal liver function tests
amphotericin B
ANTIFUNGAL: AMPHOTERICIN B _____ ____ (AmBisome) (IV only) •A very potent IV antifungal reserved for the most severe systemic mycoses; reserved for progressive, potentially fatal infections due to high prevalence of dangerous side effects •Would only be used during pregnancy in life-threatening situations •Side effects: severe renal impairment, bone marrow suppression, GI irritation with N/V/D (severe), anorexia, weight loss, pain at IV site
fluconazole
ANTIFUNGALS ("-AZOLES" SUFFIX) Prototype: ______ (Diflucan) (PO, IV) Others: itraconazole (Sporonox), ketoconazole •Binds to sterols in cell membrane; fungicidal/fungistatic •Treats oropharyngeal, esophageal & vaginal candidiasis •Use w/ caution in liver or renal impairment; pregnancy •Adverse effects: HA, N/V/D, abdominal pain, rash
leucovorin calcium
ANTIMETABOLITES (Fusilev)- sometimes used as "rescue drug" to prevent serious toxicity; rescues "normal cells" by infusing folic acid
methotrexate
ANTIMETABOLITES Prototype- ______** (MTX, Rheumatrex)- also used for inflammatory disorders •Resemble natural metabolites; enter into normal cellular processes- antimetabolites disrupt nutrient or nucleic acid metabolism of rapidly growing tumor cells •Drugs are classified according to nutrients with which they interfere, such as folic acid, purine, and pyrimidine •Adverse effects: Bone marrow suppression**, N/V/D, anorexia, mucositis, renal toxicity, fatigue, malaise
doxorubicin
ANTINEOPLASTIC ANTIBIOTICS Prototype is _____ (Adriamycin)**** •Isolated from microorganisms and have antitumor properties; Interfere with DNA in a similar mechanism to alkylating agents; also have similar actions and adverse effects •More cytotoxic than traditional antibiotics •Must be administered IV or via a catheter into a body cavity •May cause vesication- blistering of the tissue •Adverse effect: * cardiac toxicity* {dexrazoxane (Zinecard) is a cytoprotectant}; alopecia, N/V/D, *red urine*, fever, chills, rash, bone marrow suppression
chloroquine
ANTIPROTOZOAL: ANTIMALARIAL("-QUIN" SUFFIX) Prototype: _______ (Aralen) (PO) •Others: quinine (Qualaquin); hydroxychloroquine •Blocks parasitic DNA reproduction •Avoid in pts with liver disease, alcoholism, pregnancy, or retinal disease •Side effects: HA, dizziness, fever, chills, malaise, N/V/D, anorexia, hepatic dysfunction, rash, pruritus, hypotension, retinal changes
metronidazole
ANTIPROTOZOAL: MULTIPLE USE Prototype: ______ (Flagyl) (PO, IV) Treats intestinal amebiasis, amebic liver abscess, trichomoniasis, some anaerobic bacteria •Bacterial cell death; prevents reproduction in protozoa •Side effects: HA, dizziness, ataxia, common GI upset, N/V/D, *metallic taste*, *darkening of urine*, *alcohol intolerance* •Alcohol causes disulfram-type reaction: facial flushing, sweating, N/V, severe headache, slurred speech, palpitations, psychosis
acyclovir
ANTIVIRAL: HERPESVIRUS Prototype: ______ (Zovirax) (PO, IV, Top) Others: famciclovir, valacyclovir •Family of DNA viruses; causes repeated blister-like lesions on the skin, genitals, and other mucosal surfaces. Ex.: shingles, fever blister, genital herpes
rimantadine
ANTIVIRAL: INFLUENZA Prototype: ______ (Flumadine) Others: amantadine (Symmetrel), oseltamivir (Tamiflu) •Unknown mechanism; prevents viral replication •Teratogenic; caution with renal impairment •Affects dopamine levels in brain •Side effects: light headedness, dizziness, insomnia, nausea, orthostatic hypotension, depression, Stevens-Johnsons
herpesvirus
ANTIVIRAL: _____ Prototype: Acyclovir (Zovirax) (PO, IV, Top) Antiviral drugs lower frequency of acute herpes virus episodes and diminish intensity of acute disease •Relieve acute symptoms, prevent recurrences• DO NOT provide cure •Recommended: Zoster vaccine (Zostavax), especially for those over 50 years old
adefovir
ANTIVIRALS: HEPATITIS B Prototype: ______ (Hepsera) (PO) Others: entecavir, telbivudine •Blocks DNA replication in the treatment of chronic Hep B •Caution in pt with liver or renal disease •Adverse effects: HA, asthenia, nausea, fatal hepatomegaly, nephrotoxicity, lactic acidosis
Nevirapine
ANTIVIRALS: HIV & AIDS HIV virus attacks helper T cells within the immune system •Prevent viral DNA replication •Adverse effects: HA, N/V/D, rash, liver dysfunction, chills, fever •Flu-like syndrome occurs often with anti-HIV drugs
nevirapine
ANTIVIRALS: HIV & AIDS Several different classes Prototype: _____ (Viramune) (PO) •Others: zidovudine (Retrovir); there are many
CREAM/LOTION FOR SKIN (SCABIES)
APPLIED TO ENTIRE SKIN AND ALLOWED TO REMAIN FOR 8-14 HOURS BEFORE BATHING; A SINGLE APPLICATION CURES 95% OF PATIENTS, ALTHOUGH ITCHING MAY CONTINUE FOR SEVERAL WEEKS
myalgia
AS NURSES WE MUST MONITOR FOR THIS ADVERSE EFFECT: Muscular pain, "muscle aches" THINK: Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)
rhabdomyolysis
AS NURSES WE MUST MONITOR FOR.... dissolution of striated muscle (muscle tenderness or weakness**) side affect of Statins: pravastatin (Pravachol); simvastatin (Zocor)
Hyperreflexia
Abnormally increased reflexes resulting from nervous system damage NOTE: this is an adverse affect for monoamine oxidase inhibitors (MAOIs)
consumer awareness
Access to information has become so broad in the past decade that consumers are often overwhelmed with details, facts, and choices that affect their health care.
Toxic effects (overdose)
Acetaminophen: Effects & Implications: Hepatotoxicity**; risk of liver damage is a concern •Thrombocytopenia •Antidote- acetylcysteine (Mucomyst)** given IV, protects the liver from toxic metabolites
Methylxanthines: aminophylline (Theophylline)
Act as bronchodilators- also stimulate the CNS and respiration, chemically related to caffeine Infrequently used in the treatment of asthma and other chronic lung diseases- narrow margin of safety
CHOLINERGIC AGONISTS (prt 1)
Act in one of two ways: By activating a tissue response at the receptors (direct acting)
CHOLINERGIC AGONISTS (prt 2)
Act in one of two ways: By inhibiting the action of the enzyme cholinesterase (indirect acting)
Potassium-Sparing Diuretics: spironolactone (Aldactone)
Act in the collecting duct and late distal tubule to enhance secretion of sodium and retention of potassium (opposite of aldosterone)
Adrenergic agonists (sympathomimetics)
Act on adrenergic receptor sites to produce epinephrine-like symptoms Used to treat •Nasal congestion •Hypotension •Cardiac arrest, heart failure, shock •Asthma •Premature labor contractions
Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)
Act on distal convoluted renal tubule- block sodium reabsorption and increase potassium and water excretion
Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)
Act on distal convoluted renal tubule- block sodium reabsorption and increase potassium and water excretion Not effective for immediate diuresis; used often for hypertension, mild/mod heart failure
Antitussives: dextromethorphan (Robitussin DM; Delsym)
Act on the cough control center in the medulla to suppress the cough reflex
Loop Diuretics: furosemide (Lasix)
Act on the loop of Henle to block reabsorption of sodium and chloride- sodium and water are lost Used in heart failure pts & when emergent need to move fluid (ex: pulmonary edema); given PO, IV, and IM
ADRENERGIC ANTAGONISTS (BLOCKERS)
Act to block alpha and/or beta receptor sites; Most block either alpha or beta receptors
Anticholinergics (inhaled): ipratropium (Atrovent)
Act to dilate bronchioles in patient with chronic obstructive lung disease who have daily symptoms; maintenance treatment of bronchospasm associated with COPD
Decreases preload & afterload, which decreases cardiac workload & oxygen demand
Action of Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)
Thiazolidinediones: rosiglitazone (Avandia)
Action- decrease tissue resistance to insulin and improve blood glucose control
Cardiac Glycosides = digoxin (Lanoxin)
Action- exerts a cardiotonic or positive inotropic effect- improves pumping ability; also has negative chronotropic and dromotropic effects- slows the heart rate and rate of electrical conduction**
Incretin Enhancers
Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption THINK: GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)
ALPHA-GLUCOSIDASE INHIBITORS: acarbose (Precose)
Action- inhibits a digestive enzyme in the small intestine responsible for release of glucose from carbohydrates in the diet, so digestion of glucose is delayed
BIGUANIDES: metformin (Glucophage)
Action- reduces fasting and postprandial glucose levels by decreasing hepatic production of glucose, reducing insulin resistance*, & alter intestinal absorption of glucose
Meglitinides: repaglinide (Prandin)
Action- stimulate beta cells to release insulin* Similar action to sulfonylureas Can be used alone or with other oral hypoglycemic classes
ACETAMINOPHEN
Action: Inhibits prostaglandin synthesis Uses: Relieves pain, discomfort, fever Maximum dose: 4 g/day Side effects: Lower incidence of GI distress Toxic effects/overdose; Hepatotoxicity; Thrombocytopenia Antidote- acetylcysteine (Mucomyst) Sometimes mixed with narcotics
Acetaminophen (Tylenol)
Action: Inhibits prostaglandin synthesis; reduces fever by acting on hypothalamus Uses: Relieves pain, discomfort, fever Maximum dose: 4 g/day*
RAAS
Activated when blood flow to kidneys is decreased (hypotension) Kidneys release renin which is transported to the liver Angiotensinogen (produced in liver) is converted to Angiotensin I
Direct acting cholinergic agonists
Activates a tissue response at the receptors
warfarin (Coumadin)
Acts by inhibiting hepatic synthesis of vitamin K, inhibiting clotting factors
digoxin (Lanoxin) = Cardiac Glycosides
Acts to inhibit sodium-potassium pump, resulting in an influx of calcium into cardiac cells- end result is more efficient muscle fiber contraction
administration of Methylxanthines: aminophylline (Theophylline) by........
Administer IV infusions slowly to avoid adverse effects of stimulatio
Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums) administration
Administer at least 2 hrs before or after other meds- antacids interfere with absorption
right time
Administer on time; acceptable to administer 30 minutes before scheduled time up until 30 minutes after (policy)
administration of epoetin alfa; erythropoietin (Epogen; Procrit)
Administered SQ or IV; don't shake solution
administration of Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)
Administered by nasal spray, drops, tablet, capsule, or liquid form
Nursing responsibility
Administering drugs Assessing drug affects Intervening to make the drug regimen more tolerable Providing patient teaching about drugs and drug regiment Monitoring the overall patient care to prevent medication errors
Corticosteroids
Adrenal Disorder Drugs: glucocorticoids and mineralocorticoids) for adrenal dysfunction (adrenal insufficiency- Addison disease
Opioid agonist-antagonist (partial agonists) (prt 2)
Advantages are decreased risk of opioid abuse; butorphanol more often used for pain control during labor; less risk of respiratory depression for mom & baby
Penicillins ("-cillins" suffix)
Adverse Affects & other things to monitor for with this "-cillin" drug Monitor for bleeding- may lower RBC, WBC, and platelet counts (bone marrow suppression) •Monitor renal function in compromised patients. •Monitor closely during first couple doses for allergy •Rapidly absorbed in gi tract; Take on empty stomach (Take 1 hour before or 2 hours after meals) •Check for superinfection (yeast infections, hairy tongue)
meropenem
Adverse Affects GI toxicity: ______ almost always causes very uncomfortable GI effects the use of this drug has been associated with potential fatal pseudomembranous colitis furthermore, this drug results in headaches, dizziness, rash, and superinfections due to these adverse reaction this drug is only used in those infections with PROVEN sensitivity to the drug
red man syndrome
Adverse affect of vancomycin rash on the upper body caused by certain anti-infectives
adverse effects of Methylxanthines: aminophylline (Theophylline)
Adverse effects include nausea, vomiting, stomach pain, headache, nervousness, hypotension, dysrhythmias, convulsions
Ibuprofen
Adverse effects of a nonspecific inhibitor: Nausea, vomiting, heartburn, epigastric pain & dizziness; rash •GI ulcers & GI bleeding •Can lead to renal (kidney) impairment
monoamine oxidase inhibitors (MAOIs)
Adverse effects- constipation, dry mouth, orthostatic hypotension, delirium, CNS stimulation, mania, dizziness, vertigo, hyper-reflexia, potential for hypertensive crisis
Adverse effects of Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)
Adverse effects- headache, N/V/D**, rash, abdominal pain, vertigo, insomnia
adverse effects of Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)
Adverse effects: HA, N/V/D, dizziness; confusion (elderly); somnolence, cardiac arrhythmias, gynecomastia (Tagamet)
Adverse effects: Alpha Adrenergic Blockers - prazosin (Minipress); doxazosin (Cardura)
Adverse effects: HA, dizziness, tachycardia, hypotension, nausea, dyspepsia, diarrhea, edema, flushing, nasal congestion, priapism
Adverse effects of OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)
Adverse effects: bleeding**, bruising, HA, dizziness, rash, stomach upset, abdominal pain, diarrhea, thrombocytopenia
Opioid agonist-antagonist (partial agonists) (prt 3)
Adverse effects: dizziness, sedation, euphoria, N/V, constipation, palpitations, sweating, ureteral spasm, dependence
Anticonvulsants for Partial Seizures: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO)
Adverse effects: drowsiness, ataxia, dizziness, N/V, hepatitis, hematological disorders( anemia, agranulocytosis), Stevens-Johnson syndrome
benzodiazepines
Adverse effects: drowsiness, sedation, depression, abnormal heart rhythm; CNS depression (esp. respiratory)
Paralytic Agent: succinylcholine (Anectine)
Adverse effects: respiratory depression/arrest; apnea; bronchospasm, arrhythmias MUST have respiratory support (either by hand or mechanical ventilation); continuous oxygenation & cardiovascular monitoring; only administered in areas where ventilation is provided (ACLS)
Methylphenidate (Ritalin)
Adverse reactions include insomnia*, nervousness, anorexia*, weight loss, irritability, nausea, abdominal pain, tachycardia
Adverse reactions of heparin
Adverse reactions: hemorrhage (occult blood, hematuria, bleeding gums, bruising); thrombocytopenia; use cautiously with patients who have spinal anesthesia (bleeding at spinal site)
alteplase (Activase, tPA); streptokinase (Streptase) can cause allergic reaction....
Allergic reactions are possible with the drugs- more with streptokinase than the others THINK: THROMBOLYTIC DRUGS
Uses for steroids
Allergies Asthma Cancer Edema (hepatic, neurologic, renal disorders)Inflammatory bowel disease (& other inflammatory disorders)
prazosin (Minipress); doxazosin (Cardura)
Alpha Adrenergic Blockers
carvidolol olol (Coreg) metoprolol (Lopressor) = Beta Blockers
Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II Used in heart failure to decrease cardiac workload- slow the heart rate and decrease blood pressure; Use with caution in patients with asthma or heart failure (due to negative inotropic effect)
benzodiazepines
Also intensify effect of GABA (inhibit neurotransmitters) Used to treat various types of seizures, as well as acute status epilepticus (rapid sequence of seizures, no recovery period in between) May be administered IV to stop an acute seizure- beware of respiratory depression
Health Maintenance Organization (HMO)
Alternative means of health care in which people or their employers are charged a set amount and the HMO provides health care and covers hospital costs.
Preload
Amount of blood brought back to the heart to be pumped; degree to which myocardial fibers are stretched just prior to contraction
Muscle
An injection administered into _____ (IM) will usually be absorbed faster than a subcutaneous injection due to more capillaries in the muscle tissue
chemotherapeutic adverse reactions
Anemia- low RBC count*** Neutropenia- low WBC count*** Thrombocytopenia- low platelet count*** Anorexia, nausea, vomiting, diarrhea Mucositis (stomatitis)- changes in oral mucosa Alopecia- hair loss Fatigue Infertility
CAD symptoms
Angina, SOB, palpitations, tachycardia, nausea, sweating, tachycardia
RAAS (prt 2)
Angiotensin I travels to lungs where it is converted to Angiotensin II by angiotensin-converting enzyme (ACE) Angiotensin II causes widespread vasoconstriction (raising BP) Aldosterone is also released by adrenal cortex which causes retention of Na & water Also, antidiuretic hormone (ADH) from posterior pituitary is
losartan (Cozaar); valsartan (Diovan)
Angiotension II Receptor Blockers
losartan (Cozaar); valsartan (Diovan)
Angiotension II Receptor Blockers (ARBs)
Category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)
Antacids
systemic
Anti-infective agents ae used to treat ___ infections and sometimes as a mean of prophylaxis (to prevent infections BEFORE they occur)
natural resistance
Antibiotics act on specific enzyme systems or processes, so bacteria that don't use that particular system or process are said to be naturally resistant
atropine (Atropair)
Anticholinergic Drug: blocks acetylcholine at the muscarinic receptor
Most common side effects
Anticholinergic Drug: atropine (Atropair) = dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urinary retention, mydriasis (dilation)
Antiemetic Drugs: Prescription antiemetics
Anticholinergics and antihistamines Benzodiazepines- lorazepam (Ativan) Phenothiazines Serotonin (5-HT3) antagonists Corticosteroids- dexamethasone (Decadron) and methyprednisolone (SoluMedrol)- chemotherapy Cannabinoids- marijuanaAntimetics
benztropine (Cogentin) & diphenhydramine (Benadryl)
Anticholinergics to Treat Parkinsons: Adverse effects: Disorientation, confusion, memory loss, dizziness, depression, blurred vision, dry mouth, constipation, urinary retention & hesitation, flushing, decreased sweating Use with caution in clients taking drugs with other anticholinergic properties such as TCAs and phenothiazines
benztropine (Cogentin) & diphenhydramine (Benadryl)
Anticholinergics to Treat Parkinsons: Not as effective in treating Parkinson's as dopaminergic drugs but can be used as adjunct therapy to suppress the effects of acetylcholine dominance Can also be used to treat side effects from cholinergic drugs (again opposite acting)
desmopressin (DDAVP, Stimate) OR vasopressin (Pitressin)
Antidiuretic Hormone Deficiency
vasopressin (Pitressin)
Antidiuretic Hormone Deficiency administered IV has shorter half life & causes vasoconstriction
Adverse effects: desmopressin (DDAVP, Stimate) OR vasopressin (Pitressin)
Antidiuretic Hormone Deficiency: Adverse effects: HA, facial flushing, nausea, fluid retention, increase in BP, local reaction at injection site, possible water intoxication at high doses Monitor vital signs (esp. BP), monitor I&O, monitor electrolytes (esp. sodium)
antidote for Warfarin (Coumadin)
Antidote for Coumadin toxicity is Vitamin K; for acute bleeding, fresh frozen plasma
Acetylcysteine (Mucomyst)
Antidote for toxic effects of acetaminophen is ______ ** given IV, protects the liver from toxic metabolites
Antimetics: Diphenhydramine (Benadryl); scopolamine
Antihistamines and Anticholinergics Side effects: drowsiness, dizziness, dry mouth
A- Alpha1 blockers
Antihypertensives categories: Alpha2 agonists; Angiotensin converting enzyme (ACE) inhibitors; Angiotensin receptor blockers (ARBs)
Direct Vasodilators (diuretics)
Antihypertensives categories: Decrease the BP by relaxing vascular smooth muscle and reducing SVR.
Calcium Channel Blockers
Antihypertensives categories: agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension
B-Beta Blockers
Antihypertensives categories: decrease heart rate and dilate arteries by blocking beta receptors
Atypical
Antipsychotic Drugs (two major categories) block both dopamine & serotonin receptors; used to treat both positive and negative symptoms Less side effects than typical (balanced suppression) Seen frequently now as first line drugs
Conventional (Typical)
Antipsychotic Drugs (two major categories) block dopamine receptors & limit stimuli in the brain; more helpful for positive symptoms Phenothiazines & Nonphenothiazines
anticonvulsants
Antiseizure medications are sometimes called ______
dextromethorphan (Robitussin DM; Delsym)
Antitussives
influenza
Antiviral: _____ Best approach—vaccination for prevention***• ______ used to prevent illness, decreases severity of acute symptoms when infected •Flu type A, B, H1N1, RSV (respiratory viruses)
Herpesvirus
Antiviral: ______ Use drugs with extreme caution with pre-existing renal or hepatic disease; use caution in clients who are dehydrated •Side effects: HA, vertigo, tremors, N/V, rash •Judicious use is warranted during pregnancy •Emphasize compliance with antiviral therapy •Some drugs cause digestive distress and should be taken with food
Nursing Care for
Anxiolytics/Sedatives/Hypnotics: Fall safety precautions Watch for side/adverse effects: drowsiness, dizziness, respiratory distress
mechanical ventilation indications
Apnea Acute ventilatory failure/ acute respiratory failure: Insufficient spontaneous ventilation VC <1000 MIP <20 PCO2 >45
Supraventricular arrhythmias
Arrhythmia a.k.a. Dysrhythmia that originate in the atrium (above the ventricle)
Ventricular Arrhythmias
Arrhythmia a.k.a. Dysrhythmia that originate in ventricles; typically more dangerous because more likely to affect cardiac output
TYPES OF DRUGS AFFECTING COAGULATION
Aspirin & clopidogrel (Antiplatelets) Heparin, enoxaparin, warfarin, Pradaxa & others (Anticoagulants) Alteplase, reteplase, streptokinase (Thrombolytic agents) Protamine sulfate (reversal agent for heparin) Vitamin K (reversal agent for warfarin)
GENERAL NURSING CARE- ALL OPIOIDS
Assess for allergy Use a pain scale to evaluate effectiveness of drug Monitor for adverse effects (especially respiratory for agonists); also monitor for constipation Monitor vital signs
Nursing Care- Laxatives
Assess medical history to determine cause of bowel problems Encourage increased water intake and high fiber foods Remind that drug is not for long-term use Teach how to mix and take drugs correctly
Nursing Care/Implications- Anticonvulsants
Assess patient's knowledge about medication regimen and promote compliance Monitor lab tests that are indicated- such as serum levels, liver enzymes Teach patients about possible side/adverse effects of drugs, such as gingival hyperplasia, slurred speech, dizziness
Nursing Care for Thyroid Hormone Drugs (prt 2)
Assess thyroid and glucose levels Regulate environmental temp for comfort Dietary teaching- some foods inhibit thyroid secretion- hypo function can cause constipation; drink fluids
Drug to drug interactions
At the side of action One drug may be in antagonist of the other drug or may cause effects that oppose those of the other drug, leading to non-therapeutic effect
Drug to drug interactions
At the site of absorption One drug prevents work ceasing absorption of the other drug
Nursing Care- Drugs for Gastric Acid Disorders
Avoid giving antacids with other oral drugs- wait 1-2 hrs before administering Explain that treatment with PPIs and H2 blockers may take a few wks for therapeutic results Monitor fluid and electrolyte balance
Nonpharmacologic measures to treat gastric acid disorders should be used before drugs:
Avoid tobacco and alcohol Lose weight Avoid hot, spicy, greasy foods; also caffeine, chocolate, citric acids Elevate head of bed, don't eat before bedtime Wear loose-fitting clothes NOTE: Continue these measures after drugs have been used to prevent recurrence
prednisone should be avoid in pt with _______
Avoid use in pts with active infections (viral, bacterial, fungal or protozoal) because it suppresses the body's own immune system; can mask infection***
b/c POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) work like aldosterone....
BECAUSE WORK LIKE ALDOSTERONE CAUSE ANDROGEN EFFECTS: HIRSUTISM, GYNECOMASTIA, DEEPENING OF VOICE, IRREGULAR MENSES; OTHER MASCULINE SYMPTOMS
metformin (Glucophage)
BIGUANIDES
Anticholinergic effects
BLOCK the effects of acetylcholine in the PNS dry mouth constipation photophobia blurred vision Tachycardia
URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)
BLOCKS SPASMS OF URINARY TRACT CAUSED BY VARIOUS CONDITIONS SUCH AS CYSTITIS, PROSTATITIS, URETHRITIS
Direct Vasodilators = hydralazine (Apresoline)
BP decreases and sodium and water are retained- cause peripheral edema- may give diuretics to decrease edema
Intermediate-acting
Barbiturates (- "tal" suffix) Classified as: & used for sustained sedation
Long-acting
Barbiturates (- "tal" suffix) Classified as: such as phenobarbital USED FOR- sedation and may be used to treat seizures
Short-acting
Barbiturates (- "tal" suffix) Classified as: used to induce sedation or as adjunct to general anesthetic- THINK: thiopental (Pentothal)
addiction
Barbiturates (- "tal" suffix) have a higher potential for _____, dependence, & respiratory depression
Phenobarbital (Luminal)
Barbiturates: Adverse effects: drowsiness, somnolence, Vit D & B deficiencies; laryngospasms; can cause severe CNS depression, hypnosis, coma & death; hallucinations, nightmares, do NOT take with alcohol or other CNS depressants; hypoventilation, respiratory depression
phenobarbital (Luminol)
Barbiturates: Intensify the action of gamma-aminobutyric acid (GABA), a neurotransmitter that has inhibitory function; end result is CNS depression (decreased neuron firing) Used to treat various types of seizures
heparin
Before discontinuing ______, oral therapy with warfarin (Coumadin) or Plavix usually is begun
anxiety
Benzodiazepine (pam/lam) are used for ____ can also be used to enhance pre-anesthesia medication
flumazenil (Romazicon)
Benzodiazepine antagonist- this is a reversal agent for benzodiazepines*****
midazolam (Versed)
Benzodiazepine/Pre-Operative Sedative Prototype: _____ (versed) (PO, IM, or IV)
BEST USE for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)
Best when used within 4-6 hours of event (stroke)
atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)
Beta Blockers (- "olol" suffix)
carvidolol (Coreg) metoprolol (Lopressor)
Beta Blockers (- "olol" suffix)
carvidolol olol (Coreg) metoprolol (Lopressor)
Beta Blockers (- "olol" suffix)
albuterol (Proventil)
Beta2 Adrenergic Agonists- Bronchodilators
cholestyramine (Questran)
Bile Acid Sequestrant
Lithium (Eskalith; Lithobid)
Bipolar Disorder: Manic Mood Stabilizers Adverse effects- headache, lethargy, fatigue, memory loss, muscle weakness, hand tremors, tinnitus, blurred vision; N/V/D; if dehydrated can lead to cardiovascular collapse, coma
Lithium (Eskalith; Lithobid)
Bipolar Disorder: Manic Mood Stabilizers: Has a narrow therapeutic serum range- 0.6 to 1.5 mEq/L- greater than 1.5 to 2- toxicity Should be monitored biweekly until therapeutic level has been obtained, then monthly on the maintenance dose
lithium (Eskalith; Lithobid)
Bipolar Disorder: Manic Mood Stabilizers: Used to treat the manic symptoms of bipolar affective disorder Increases receptor sensitivity to serotonin Newer seizure drugs also used, such as valproic acid (Depakene)
Adequate
Bipolar Disorder: Manic Mood Stabilizers: Lithium (Eskalith; Lithobid) Caution in patients on diuretics; _____ fluid and sodium intake should be maintained
monitor sodium
Bipolar Disorder: Manic Mood Stabilizers: Lithium (Eskalith; Lithobid) Conditions where sodium is lost (sweating/dehydration) lithium toxicity can occur ____ ____
Adrenergic Antagonists/Blockers
Block by occupying the receptors or indirectly by inhibiting the release of the neurotransmitters norepinephrine and epinephrine
Phenothiazines (1st Gen)
Block dopamine receptors; limit brain stimuli; also have anticholinergic, antihistamine & alpha-adrenergic blocking effects
Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)
Block histamine receptors of parietal cells in stomach- reduce acid secretion Available over-the-counter
Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)
Block the calcium channel in vascular smooth muscle, promoting vasodilation (can also decrease heart rate) (smooth muscle relaxer-uterus) Many are used to treat chronic hypertension, angina, and dysrhythmias
Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)
Block the calcium channel in vascular smooth muscle, promoting vasodilation (can also decrease heart rate) (smooth muscle relaxer-uterus) Many are used to treat chronic hypertension, angina, and dysrhythmias
SSRIs
Block the reuptake of serotonin into the nerve terminal- enhancing its transmission at the synapse More costly than TCAs but have less side effects
Sliding Scale Insulin
Blood glucose checks are done and Insulin is ordered according to a scale
inflammation
Body's defense mechanism in response to toxic chemicals, extreme heat, invading microorganisms, or cell death
Types of laxatives
Bulk-forming Saline (Osmotic) Stimulants Stool softeners Herbal
mixed opioid agonist
Buprenorphine
TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) administration
CAN BE GIVEN PO OR IV; HOWEVER, NEVER, NEVER, NEVER GIVE POTASSIUM IV PUSH AS IT WILL CAUSE SUDDEN CARDIAC ARREST; NOT TO BE CONFUSED WITH IV DRIP SUCH AS D5W W/ 20 MEQ KCL
ACETAZOLAMIDE (DIAMOX)
CARBONIC ANHYDRASE INHIBITORS
CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX)
CARBONIC ANHYDRASE IS A COMPONENT IN THE FORMATION OF SODIUM BICARBONATE & THE EXCRETION OF HYDROGEN (WHICH IS WHY URINE IS USUALLY SLIGHTLY ACIDIC)
OSMOTIC DIURETICS: MANNITOL (OSMITROL) can cause cardiac.....
CARDIAC DECOMPENSATION IN PT WITH HEART FAILURE
THIAZIDE SIDE EFFECTS & NURSING CONSIDERATIONS
CAUSE CALCIUM REABSORPTION- HYPERCALCEMIA CAN OCCUR WATCH FOR DEHYDRATION, HYPOKALEMIA*, & HYPERGLYCEMIA (MAY ELEVATE BLOOD GLUCOSE)
Cytotoxic reactions (Type II)
CBC shows damage to blood cells treatment: D/C the drug
M phase (mitosis)
CELL DIVISION prophase, metaphase, anaphase, telophase
viruses
CHARACTERISTICS OF _____: nonliving intracellular parasite virions
Leukotrienes
CHEMICAL MEDIATORS Increased permeability of blood vessels, phagocytic attachment ***similar to histamines
complement
CHEMICAL MEDIATORS proteins; destroys the antigen; stimulates histamine
Cyclooxygenase (COX)
CHEMICAL MEDIATORS the enzyme responsible for converting arachidonic acid into prostaglandins and their products ***related to prostaglandins
Prostaglandins
CHEMICAL MEDIATORS Modified fatty acids that are produced by a wide range of cells. ***attract WBCs; cause pain & induce fever
histamine
CHEMICAL MEDIATORS a compound that is released by cells in response to injury and in allergic and inflammatory reactions, causing contraction of smooth muscle and dilation of capillaries ***cause vasodilation, smooth muscle constriction, tissue swelling & itching
bradykinin
CHEMICAL MEDIATORS a powerful vasodilator that increases capillary permeability and constricts smooth muscle ***vasodilator, also causes pain
Inflammation
CLINICAL PRESENTATION OF _______: Signs •Redness •Swelling (edema) •Heat •Pain •Loss of function •Fever (sometimes)
Prototype- methylphenidate (Ritalin)
CNS Stimulants: Drugs for ADHD
atomoxetine (Strattera)
CNS Stimulants: Drugs for ADHD Non-CNS stimulants are also used, but are more effective as adjuncts
Methylphenidate (Ritalin)
CNS Stimulants: Drugs for ADHD Schedule II controlled substances
paradoxical hyperactivity
CNS Stimulants: Drugs for ADHD: Prototype- methylphenidate (Ritalin) These drugs may create ___ ____
Nursing Care- Steroids s/e
CNS effects- euphoria, nervousness, insomnia, personality changes Acne Facial hair Menstrual changes Impaired ability to respond to stress Increased blood glucose levels
Norco/Vicodin
COMMON COMBINATION ANALGESICS: hydrocodone & acetaminophen
Percocet
COMMON COMBINATION ANALGESICS: oxycodone & acetaminophen
Percodan
COMMON COMBINATION ANALGESICS: oxycodone & aspirin
oral candidiasis
COMMON TYPE OF mycoses: a white deposit on the tongue which is EASILY scraped away, usually seen in immunocompromised patients
tinea pedis
COMMON TYPE OF mycoses: athlete's foot
Tinea curis
COMMON TYPE OF mycoses: jock itch. dermatophyte infection in groin (used topical agents or oral antifungals)
tinea corporis
COMMON TYPE OF mycoses: ringworm of the body
THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)
CONSIDERED MILD DIURETICS ACT ON DISTAL CONVOLUTED RENAL TUBULE- BLOCK SODIUM & CHLORIDE REABSORPTION (LOST); WHILE INCREASING POTASSIUM AND WATER EXCRETION
Purpose of heart is
CONTRACTION: its pumping action (think of heart as a pump)
OSMOTIC SIDE EFFECTS & NURSING CONSIDERATIONS
CRYSTALLIZATION IN THE VIAL WHEN EXPOSED TO LOW TEMPERATURE; *USE FILTER NEEDLE* WATCH KIDNEY FUNCTION, MONITOR POTASSIUM, CALCIUM, URIC ACID, AND GLUCOSE LEVELS
Prototype- nifedipine (Procardia); diltiazem (Cardizem)
Calcium Channel Blockers
nifedipine (Procardia); diltiazem (Cardizem)
Calcium Channel Blockers
Avoid grapefruit juice
Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem) inhibits metabolism of drug & may cause toxic levels
Peripheral edema may occur with what type of drug?
Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem) NOTE: since these drug lead to peripheral edema they may be taken with a diuretic
beta blockers = atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)
Can *mask symptoms of hypoglycemia*
diuretics can affect.....
Can affect one or more segments of the renal tubules
Benefit of Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)
Can be given at home because aPTT monitoring is not necessary
acetaminophen
Can interfere with Warfarin (Coumadin) and cause toxic levels of the anticoagulant to occur ****May increase liver enzymes*
antidote for Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)
Can still use Protamine Sulfate as antidote, if necessary
HEPARIN (ANTICOAGULANT) cannot be absorbed....
Can't be absorbed orally through the GI tract; given SQ for prophylaxis or IV for treatment of acute thrombosis; apply firm pressure after SQ administration and don't rub site
INSULIN ADMINISTRATION
Cannot be given orally Give subcutaneously at 90 degree angle with insulin syringe- do not rub after injection
digoxin (Lanoxin)
Cardiac Glycosides
What medication works best when patient achieves a steady state tissue concentration
Cardiac Glycosides = digoxin (Lanoxin) BE SURE TO - check therapeutic level
Opioid agonist-antagonist (partial agonists)
Cause analgesia but withdrawal symptoms or adverse effects are not as intense due to partial activity of receptor subtypes; work on either the mu or kappa receptors but not both
Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) = Cause calcium reabsorption
Cause calcium reabsorption- hypercalcemia can occur
hydrochlorothiazide (Microzide, HydroDIURIL, HCT) = Thiazide Diuretics
Cause calcium reabsorption- hypercalcemia can occur Watch for dehydration, hypokalemia*, & hyperglycemia (may elevate blood glucose) Uric acid levels may elevate and precipitate gout
Laxatives: stool softeners = docusate (Colace)
Cause more water and fat to be absorbed into stools; May be used to prevent constipation- example- hospitalized patients
Angiotension II Receptor Blockers (ARBs): losartan (Cozaar); valsartan (Diovan)
Cause vasodilation and decrease peripheral resistance- however, decrease in cough from bradykinin; less likely to cause angioedema
losartan (Cozaar); valsartan (Diovan) (ARBs)
Cause vasodilation and decrease peripheral resistance- however, decrease in cough from bradykinin; less likely to cause angioedema Side effects: dizziness, HA, diarrhea, abdominal pain, hypotension
celecoxib (Celebrex)
Celebrex (Cox-2 Inhibitor) Drug of choice for patients with severe arthritic conditions who need high doses of an antiinflammatory drug, because of the risk for GI ulcer and bleeding •Watch for dyspepsia, GI irritation, diarrhea
Easily
Cells that reproduce or are replaced rapidly such as bone marrow cells, Gastrointestinal cells, hair follicles are more_____ affected by these chemotherapeutic agents
baclofen (Lioresal)
Centrally Acting Muscle Relaxants Others: carisoprodol (Soma)•Work in the CNS to interfere with reflexes that are causing the muscle spasm; often referred to as spasmolytics Often used in addition to rest, physical therapy, & other treatments Adverse effects: drowsiness, dizziness, weakness, fatigue, constipation, HA, insomnia, hypotension, nausea, dry mouth, urinary frequency Avoid alcohol & other CNS depressants
Speed
Certain foods that increase stomach acid ID, such as milk products, alcohol, and protein, also _____ the breakdown of mini drugs This is why oral drugs are given typically one hour before or two hours after a meal
platyhelminths
Cestodes = tapeworms bilaterally symmetric, flat bodies, unsegmented, mouth but no anus
Meropenem (Merrem)
Ch. 8 Anti-infective Agents Drug List: carbapenem antibiotic
Vancomycin
Ch. 8 Anti-infective Agents Drug List: Blocks cell wall synthesis by sequestration Blocks peptidoglycan synthesis by binding to a portion of the bacterial cell wall, inhibiting bacterial cell wall synthesis
Bacitracin MOA
Ch. 8 Anti-infective Agents Drug List: Is an antibiotic ointment MOA: Inhibition of 2nd stage wall synthesis
Gentamicin
Ch. 8 Anti-infective Agents Drug List: MOA: Inhibit protein synthesis go inside cell, unlike all drugs we have talked about so far aminoglycoside antibiotic Aminoglycoside. Binds to 30s subunit. Gram +/- effective, better gram -. First line bacterial ocular tx. SE: SPK and delayed re-epithelialization.
Polymyxin B
Ch. 8 Anti-infective Agents Drug List: MOA: disrupts membrane structure and function injury to plasma membrane cationic detergent that disrupts bacterial membranes causes neurotoxicity and acute tubular necrosis
Parkinson's disease
Characteristics are tremors, muscle rigidity, bradykinesia (extreme slowness), difficulty with 'purposeful' movements, postural instability, & affective flattening, shuffling gait, mask-like facial appearance, difficulty swallowing
NMS
Characterized by fever, altered mental status/confusion, muscle rigidity, and autonomic dysfunction (variable blood pressure, heart rate and temperature)
hormones
Chemical messengers, mostly those manufactured by the endocrine glands, that are produced in one tissue and affect another
Drugs
Chemicals that are introduced into the body to bring about change
Fried rule
Child's dose (1-2 years) = child's age (months) / (150 x average adult dose)
Surface area rule
Child's dose = surface area of child (sq m) / (1.73 x average adult dose)
Clark Rule
Child's dose = weight of child (lb) / (150 x average adult dose)
small intestine
Cholesterol Absorption Inhibitors: Ezetimibe (Zetia) work in which intestine small or large???
cholinergic agonists
Cholinergic drugs are also used to treat anticholinergic toxicity (overdose of anticholinergic drug)
diuretic classes
Classes: ◦Thiazide diuretics ◦Loop diuretics ◦Osmotic diuretics ◦Potassium Sparing diuretics ◦Carbonic anhydrase inhibitors
Controlled substance act of 1970
Classifies 5 levels of drugs that have potential for abuse and are restricted in their distribution. The DEA was created by the CAS to enforce its regulations CII records must be kept for 7 years and stored separately
Pharmacotherapeutics
Clinical pharmacology this is the branch of pharmacology that deals with drugs; chemicals that are used in medicines for the treatment; prevention and diagnosis of disease in humans
Insulin isophane NPH 50/50
Combination insulin: NPH 50%, regular 50%
Humalog 75/25
Combination insulin: lispro protamine 75%, lispro 25%
Humulin 70/30
Combination insulin: (NPH/regular) NPH 70%, regular 30%
Helicobacter pylori Treatment
Combinations of drugs classes, usually 2 antibacterials and an acid blocking drug for 7-14 days
Pepsin inhibitor: sucralfate (Carafate
Combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin Side effect: sleepiness, dizziness, vertigo, insomnia, rash, N/VD, indigestion, dry mouth
Common side effects of ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
Common side effect is a persistent, dry cough****(increase in bradykinin causing inflammation); Watch for hyperkalemia*** (potassium sparing diuretics increase this risk)***; May cause angioedema (swelling of tongue & oral pharynx)
THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase) are commonly used in early minutes of......
Commonly used in early minutes of onset of symptoms of MI or thrombotic CVA to preserve tissue and prevents negative outcomes (may also be used to restore patency to central lines)
calculating dose
Concentration X duration of exposure X rate = dose
low molecular weight heparin: enoxaparin (Lovenox) is contraindicated in.....
Contraindicated in CVA, peptic ulcers, and blood anomalies- do not give if having eye, brain, or spinal surgery
Thiazolidinediones: rosiglitazone (Avandia) is contraindicated in patients with______
Contraindicated in patients with symptomatic heart disease and later stages of CHF May be used in combination with other oral hypoglycemic drugs
THROMBOLYTICS are contraindicated in.....
Contraindicated in recent major surgery patients and trauma patients****; intracranial hemorrhage is also concern; caution if hx of GI bleed THINK: this is part of your nursing care for this drug class!!
Stoke volume
Control of Blood Pressure: amount of blood that is pumped out of the ventricle with each heartbeat (volume of blood)
Peripheral resistance
Control of Blood Pressure: resistance of the muscular arteries to the blood being pumped
Baroreceptors (pressure receptors)
Control of Blood Pressure: sends info to the brain about blood pressure (feedback mechanism)
Coronary Circulation
Coronary blood vessels delivers oxygenated blood back to myocardium
OPIOID AGONISTS (prt 2)
Cough suppression (codeine) Most are Schedule II drugs Most are derived from opium poppy plant; some are synthetic Undergo first-pass metabolism- oral doses must be larger
WARFARIN/COUMADIN
Coumadin has a long half-life and very long duration = Drug accumulation can occur and cause bleeding
Nursing Implications & Care- Digoxin
Count apical pulse rate for 1 full minute before administering; hold if below 60 beats per minute Teach patient and family to take pulse and to seek health care provider's advice for rates less than 60 bpm or more than 100 bpm (adults). Monitor for hypokalemia- may cause dysrhythmias & toxicity Patients should maintain adequate dietary intake of potassium as directed by health care provider.
transdermal
Crossing through the skin. Example: The physician prescribed a transdermal nicotine patch for a patient participating in the smoking cessation program. BE SURE TO WEAR GLOVES
monoamine oxidase inhibitors
Currently not used often- MANY drug-drug & drug-food interactions CNS stimulants (vasoconstrictors, cold medicines) can cause adverse reaction when taken with MAOIs
URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM)
DIRECT TOPICAL ANALGESIC EFFECT ON THE URINARY TRACT MUCOSA TO REDUCE SYMPTOMS OF URINARY TRACT IRRITATION (FROM INFECTION, TRAUMA OR SURGERY)
Incretin enhancers
DRUGS FOR DIABETES: Mimics Glucagon Like Peptides-1 agonists (promotes release of insulin) Dipeptidyl Peptidase (P-4) inhibitors (therefore promoting release of insulin)
nursing considerations for pain medication (prt 2)
Decrease doses slowly in those who may have physical dependence
Beta Blockers: carvidolol olol (Coreg) metoprolol (Lopressor)
Decrease heart rate and myocardial contractility, reducing cardiac output & oxygen demand *Monitor HR & BP*
Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor)
Decrease heart rate and myocardial contractility, reducing cardiac output and therefore lowering BP *Monitor HR & BP* Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II
Beta Blockers: atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)
Decrease heart rate and myocardial contractility, reducing cardiac output and therefore lowering BP *Monitor HR & BP* Also block beta receptors in kidney to inhibit secretion of renin and formation of angiotensin II
Major responses of anticholinergics
Decrease in GI motility Decrease in salivation Dilation of pupils (mydriasis)
orthostatic hypotension
Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions NOTE: this is a adverse effect of the Tricyclic Antidepressants (TCAs) Imipramine (Tofranil)
orthostatic hypotension
Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions THINK: adverse reaction of Opiate Agonists
Local Anesthetics: lidocaine (Xylocaine)
Decreases pain by blocking conduction of pain impulses in a specific area; does NOT cause loss of consciousness Early symptom of toxicity is CNS excitement; irritability, confusion
Parkinson's Disease
Degenerative disorder of the CNS caused by death of neurons that produce the neurotransmitter dopamine
Teach about side effects of steroids
Delayed wound healing Masked infection Bone changes "Moon face" and weight gain Increased appetite
Circulation
Delivers blood containing oxygen & nutrients throughout the body
Subcutaneous injections
Deposit the drug just under the skin, where it is slowly absorbed into circulation With this method of injection the time of absorption varies depending on the fat content of the injection site in the state of local circulation
Nursing Care- Antimetics
Determine cause of illness and treat Use nonpharmacologic methods to relieve nausea Encourage rest Replace lost fluids
prednisone contradicted in
Diabetic patients will likely require more insulin (& non-diabetic patients may temporarily require it) When used with Amphoteracin B can cause increased potassium loss
dantrolene (Dantrium)
Direct Acting Skeletal Muscle Relaxants: Acts directly within the muscle fibers, interfering with the release of calcium; this prevents muscle contraction Can be liver toxic, especially if combined with estrogen Increase fluid intake because drug may cause crystalline urine and painful urination Adverse effects: drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, BP changes, rash, and urinary frequency
Mucolytic: acetylcysteine (Mucomyst)
Directly loosens thick bronchial secretions by inhalation; decreases viscosity in respiratory secretions; also protects liver from acetaminophen effects in overdose-PO administration
barbiturates
Discontinuance should be gradual to avoid recurrence of seizures Soft tissue irritant/inflammation when given IM; can cause tissue necrosis (vesicant) when given IV
what Promote water and electrolyte loss, which decreases extracellular fluid volume
Diuretics
DO NOTE GIVE IRON SUPPLEMENTS: ferrous sulfate (iron) with.....
Do NOT give with antacids or Tetracycline; DO take with Vitamin C to increase absorption*; liquid forms may stain teeth*; *iron overdose may be fatal in young children*** (causing CNS toxicity progressing to coma/death)
Potassium-Sparing Diuretics: spironolactone (Aldactone) do not cause.......
Do not cause a loss of potassium- patient does not require a potassium supplement, as with other diuretics that cause a loss
Potassium-Sparing Diuretic = spironolactone (Aldactone)
Do not cause a loss of potassium- patient does not require a potassium supplement, as with other diuretics that cause a loss Must be monitored for hyperkalemia- serum potassium should be 3.5 to 5mEq/L Used as mild diuretics or in combination with another diuretic
Intranasal Corticosteroids: fluticasone (Flonase) Do not cause...
Do not cause the systemic effects of steroids taken by other routes
DO NOT give w/i ..... for Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)
Do not give within an hour of antacids (decreases absorption)
Placebo effect
Documented effect of the mind on drug therapy; it's a person perceives that a drug will be effective, the drug is much more likely to actually be effective
Alpha-glucosidase inhibitors: acarbose (Precose)
Does not cause a hypoglycemic reaction This medication is for patients who do not achieve results with diet alone NOTE: Monitor liver function***; may also decrease absorption of iron
metformin (Glucophage) (PO)
Doesn't produce hypoglycemia**** Can cause GI disturbances*** (nausea, vomiting, diarrhea) Must have liver function tests performed regularly Lactic acidosis is a rare but potentially fatal adverse effect** THINK: BIGUANIDES
Dopaminergic drugs
Don't use in pt with possible melanoma or psychosis; don't use if has narrow-angle glaucoma; Lots of Vit B6 may interfere with drug Abrupt withdrawal may cause neuroleptic malignant syndrome
increase
Dosing schedules, or protocols _____ the effectiveness of chemotherapy
Generic drug
Drag sold by their generic name; not brand-name or tradename product
In other words-
Drug Treatment for Heart Failure: Increase cardiac output (unload heart) Reduce vasoconstriction (lower BP) Promote loss of excess fluid (diuresis)
A combination of drugs are used to
Drug Treatment for Heart Failure: Reduce preload Reduce afterload Inhibit renin-angiotensin-aldosterone system and vasoconstriction of sympathetic nervous system
Administration
Drug absorption is influenced by the route of _____
Adverse effects
Drug affects sometimes called side effects, that are not the desired therapeutic effect; maybe unpleasant or even dangerous
Alpha Adrenergic Blockers: prazosin (Minipress); doxazosin (Cardura)
Drug names end in "osin" Block alpha-1 adrenergic receptors; causes vasodilation resulting in fall of BP
Propylthiouracil (PTU) and methimazole (Tapazole)
Drug therapy to *decrease thyroid hormone* production
These drugs treat chest pain
Drugs Used to Treat Angina: ▪Nitrates ▪Beta blockers ▪Calcium channel blockers
Primary goal
Drugs Used to Treat Chest Pain: _______ is to reduce myocardial demand for oxygen
Men
Drugs administered to ______ via the IM route reach a peak level faster than they do in women
Hyperlipidemia (HLD)
Drugs for Lipid Disorders: an excess of one or more lipids in the blood
Posterior Drugs
Drugs for Pituitary Disorders: (2 Lobes) this one is desmopressin and oxytocin
Anterior Drug
Drugs for Pituitary Disorders: (2 Lobes) this one is growth hormone
CNS Stimulants
Drugs for Psychiatric Disorders ADHD& Narcolepsy
Mood Stabilizers
Drugs for Psychiatric Disorders Bipolar affective disorder (Mania)
Antipsychotics
Drugs for Psychiatric Disorders Psychosis & Schizophrenia
GI Drugs
Drugs for gastric acid disorders Laxative Antidiarrheal Antiemetics
oral route
Drugs given by ___ ___ are absorbed more SLOWLY than those given parenterally
Beta2 adrenergic agonists: epinephrine (Adrenalin)
Drugs may be given by aerosol or orally; ***Use with a spacer to help ensure better distribution of medication***
antihypertensives
Drugs may be used alone or in combination with others
Anticonvulsants
Drugs prescribed for prevention and control of seizures
CHOLINERGIC AGONISTS
Drugs stimulate the parasympathetic nervous system "Rest or Digest"; Mimic acetylcholine
Directly
Drugs that are injected IM are absorbed _____ into the capillaries in the muscle and sent into circulation
Toxic affects
Drugs that are injected IV reach their full strength at the time of injection They bypass initial breakdown and have an immediate onset as they are fully absorbed administration because they directly into the bloodstream These drugs or more likely to cause ____ _____ because the marginal for error in dose is much smaller
Mixed opioid agonist-antagonist
Drugs that bind to a receptor (and causes response) binds to another receptor and prevents response Pentazocine & Butorphanol
Orphan drugs
Drugs that have been discovered but would not be profitable for a drug company to develop; usually drugs that would treat only a small number of people; these orphans can be adopted by drug companies to develop
Nicotine, alcoho, glucocorticoids (cortisone)
Drugs that induce or increase activity in the side of chrome P450 hepatic enzyme system
Ketoconazole (Nizoral), Amiodarone (generic, Quinidine (generic)
Drugs that inhibit or decrease activity in the cytochrome P450 hepatic enzyme system
ANTICHOLINERGIC DRUGS
Drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors Anticholinergics and adrenergic agonists produce many of the same responses
Mitotic Inhibitors
Drugs that kill cells as the process of mitosis begins
ANALGESICS
Drugs that relieve pain
Drug to drug interactions
During bio transformation One drug stimulates or blocks the metabolism of the other drug
Drug to drug interactions
During distribution One drug competes for the protein binding site of another drug, so the second drug cannot be transported to the reactive tissue
Drug to drug interactions
During excretion One drug compete for excretion with the other drug, leading to accumulation and toxic effects of one of the drugs
Heart is distended
During heart failure: ______ becomes hypertrophied, sodium and water are retained, causing decreased renal blood flow
Loop Diuretics: furosemide cause K+ loss which leads to.....
Dysrhythmias may occur from potassium loss
loop diuretics = furosemide (Lasix)
Dysrhythmias may occur from potassium loss Ototoxicity is possible; watch for dehydration, hyponatremia, hypochloremia, hypotension*, hypokalemia*, hyperglycemia & increased uric acid
OSMOTIC DIURETICS: MANNITOL (OSMITROL) effects throughout the....
EFFECTS THROUGHOUT THE BODY, USED TO PREVENT KIDNEY FAILURE AND DECREASE INTRACRANIAL PRESSURE **- ALSO TO DECREASE INTRAOCULAR PRESSURE*
Ibuprofen
EFFECTS and IMPLICATION of what nonselective COX-1 and COX-2 inhibitor: Black Box: may cause an increased risk of serious thrombotic event, MI & stroke •Don't take if have ulcers; may increase the clotting time •Can significantly increase risk of bleeding if taken with aspirin
for either shampoo or cream/lotion treatment note....
EITHER MAY REPEATED IN 7-10 DAYS TO TREAT ANY NEWLY HATCHED LICE (FROM EGGS NOT REMOVED)
Teach patient safety precautions related to drug effects
ENERAL NURSING CARE- ALL OPIOIDS: •Do not get up out of bed without assistance •Use call light •Change positions slowly •Do not drive or use heavy machinery •Do not mix with alcohol or other CNS depressants (especially agonists)
Rough ER
ER that is dotted with ribosomes
EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC
OSMOTIC DIURETICS: MANNITOL (OSMITROL)
ESSENTIALLY IS A SUGAR THAT IS NOT REABSORBED BY TUBULES; PULLS LG AMOUNT OF FLUID INTO URINE
LOOP SIDE EFFECTS & NURSING CONSIDERATIONS
EXTREMELY POTENT DIURETICS- CAN CAUSE SEVERE FLUID AND ELECTROLYTE LOSSES** MAY CAUSE RAPID LOSSES OF FLUID AND ORTHOSTATIC HYPOTENSION DYSRHYTHMIAS MAY OCCUR FROM POTASSIUM LOSS
Insulin Pen Advantages
Ease of use Less pain Better compliance
Drug-food interaction for warfarin (coumadin)
Eating foods high in Vit. K (green leafy vegetables) can decrease effect of drug, therefore eat those foods consistently & in moderation
Signs Thyroid Hormone Deficiency (prt 2)
Edema Thick dry skin Cold intolerance Slow pulse Constipation Weight gain Abnormal menses
Narrow spectrum antibiotics
Effective against specific bacteria
imipramine (Tofranil)
Effective and less expensive than some other classes of antidepressants Block the reuptake of norepinephrine and serotonin
diuretics are Effective as....
Effective as first-line drugs for mild to moderate hypertension
Guidelines for Hypertension Management
Eighth Joint National Committee (JNC-8) report of the National High Blood Pressure Education Program Coordinating Committee recommendations: First line drugs: ▪ACE inhibitors ▪ARBs ▪Thiazide diuretics Second line drugs: ▪Beta blockers ▪Centrally acting alpha and beta blockers ▪Direct acting vasodilators ▪Direct renin inhibitors ▪Peripherally acting adrenergic neuron blockers
Cardiovascular System
Electrocardiogram (ECG/EKG): measure of electrical activity (But...no information about 'mechanical' activity of the heart)
Hormones
Endocrine system: chemical messengers, released into bloodstream to communicate a message
Glands
Endocrine system: organized groups of specialized cells that secrete hormones
active transport
Energy-requiring process that moves material across a cell membrane against a concentration difference
Expectorants: guaifenesin (Mucinex)
Enhances the output of respiratory tract fluids; facilitates the removal of viscous mucous (helps thin & loosen mucous so it can be coughed up); for productive coughs
Enteric coated aspirin
Enteric coated (helps reduce ulcers)
Laxatives: stimulants
Example- bisacodyl (Dulcolax)- OTC (PO or rectal)
Laxatives: stool softeners
Example- docusate (Colace) (PO)
examples of Helicobacter pylori Treatment
Examples: omeprazole (Prilosec), clarithromycin (Biaxin), and amoxicillin (Amoxil) omeprazole (Prilosec), clarithromycin (Biaxin), and metronidazole (Flagyl) omeprazole (Prilosec), bismuth subsalicylate (Pepto-Bismol), metronidazole (Flagyl), and tetracycline
Hypnosis
Extreme sedation; used to help people sleep
Loop Diuretics: furosemide (Lasix) is EXTREMELY POTENT DIURETIC
Extremely potent diuretics- can cause severe fluid and electrolyte losses**
furosemide (Lasix) = loop diuretics
Extremely potent diuretics- can cause severe fluid and electrolyte losses** May cause rapid losses of fluid and orthostatic hypotension
cardiovascular collapse
Failure of the heart and blood vessels; shock THINK: adverse effect of Lithium (Eskalith; Lithobid)
Food and Drug Administration (FDA)
Federal agency responsible for the regulation and enforcement of drug evaluation and distribution policies
Anxiety
Feeling of tension, nervousness, apprehension, or fear Involves unpleasant reactions to a stimulus whether known or unknown
Gemfibrozil (Lopid)
Fibric Acid Agents
diphenhydramine (Benadryl)
First Generation-Antihistamines
First Generation-Antihistamines: diphenhydramine (Benadryl)
First generation- sedating; many cause drowsiness and dry mouth
PAIN MANAGEMENT
First step in pain management is accurate pain assessment (i.e. umerical 0-10; Wong Baker "Faces" pain scale) & determine location (head, abdomen, etc) & quality (sharp, stabbing, aching, throbbing, etc.) Consider nonpharmacologic treatments first•Warmth (heat packs), massage, positioning, acupuncture, meditation, relaxation techniques
barbiturates
First used as a sedative in the 1900s CNS depressant causing sedation, hypnosis, anesthesia; can lead to coma
INSULIN USES:
For any patient who is at risk of developing elevated blood sugars (ex: pts taking high doses of corticosteroids) Safe for gestational diabetes (pregnant patients who have diabetes induced by pregnancy)
Drug Indications-Endocrine Disorders (prt 2)
For hormonal disorders of: Pituitary Thyroid Adrenals Pancreas
HEPARIN (ANTICOAGULANT) is used for.....
For prevention & treatment of venous thrombosis & pulmonary embolus; also used for surgical and critically ill patients to prevent blood clots
ADLs (activities of daily living)
For pt suffering from Parkinson's Disease: The goals of pharmacotherapy is to increase ability of the pt to perform normal _____; medication does not cure the disease***
acetylcholine
For pt suffering from Parkinson's Disease: Therapy attempts to restore balance b/w declining levels of dopamine (which are inhibitory in nature) and _______ (which become dominant)
IV
For the Benzodiazepines drugs when they are given by _____ and/or in HIGHER doses we may see amnesia, weakness, disorientation, ATAXIA, BP & HR changes, blurred vision, N & V; depression, CONSTIPATION, urinary retention
Frequent use of Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)
Frequent use of spray or drops can result in rebound nasal congestion; Do not use more than 3-5 days ***
Antitussives: dextromethorphan (Robitussin DM; Delsym) Frequently combined with.....
Frequently combined with other cold medications, such as Robitussin DM
Aspirin dosing
Full dose is 325 mg; baby aspirin dose 81 mg is enough to provide antiplatelet effects
phenothiazines (1st Gen)
Full therapeutic effects may not be evident for 3-6 wks, but observable therapeutic response may be seen in 7-10 days*** THINK: patient teaching
Precautions for Steroids
Fungal / bacterial infections Caution in patients who are at risk for infections- may mask symptoms* Caution in diabetes-often causes hyperglycemia* Caution in peptic ulcer disease
Incretin Enhancers include......
GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)
Insulin
GLUCOSE REGULATION: Pancreatic beta cells-Islets of Langerhans •Released in response blood glucose increasing •*Has the effect of DECREASING blood sugar
Glucagon
GLUCOSE REGULATION: •Released from alpha cells in the islets of Langerhans •Released in response to low blood glucose levels •Has the effect of INCREASING blood sugar
goal for ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
GOAL IS RETURN HGB LEVELS TO 10-11 G/DL AND HCT OF AROUND 33%
metoclopramide (Reglan)
Gastrointestinal Stimulants (Stomach Emptying)
propofol (Diprovan)
General Anesthetic: Often used in ICU for patients who are on the ventilator to keep them sedated Onset 40-60 seconds; duration 10-15 minutes; often used continuous IV drip
Oral route
Generally, drugs given by the ____ ____ are absorbed more slowly than those given parenterally
Nicotinic Acid: Niacin (vitamin B2)
Given in larger doses (2-3 grams/day) than what is recommended for daily dietary needs (25 mg)- maximum dose is 6 grams/day
Long acting insulin
Glargine (Lantus) Onset- Gradual 1-2 hrs; Peak- none; Duration- 24 hrs
INCRETIN ENHANCERS
Groups: GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza)- injectables**injected*** DPP-4 inhibitors- sitagliptin (Januvia)- oral drug
somatrem (Genotropin)
Growth Hormone Deficiency
octreotide (Sandostatin)
Growth Hormone Excess
Acromegaly
Growth Hormone Excess disorder excessive growth after puberty- bones become deformed
Gigantism
Growth Hormone Excess disorder excessive growth during childhood
GH antagonist
Growth Hormone Excess disorder suppresses growth hormone release
Adverse effects: octreotide (Sandostatin)
Growth Hormone Excess: HA, back pain, fatigue, abdominal pain; gallbladder disease; hyperglycemia Monitor patient response to drug Monitor for adverse effects
First Generation-Antihistamines: diphenhydramine (Benadryl) MOA
H1 antagonists compete with histamine for receptor sites
tamoxifen
HORMONES Prototype- ______ (Soltamox)- breast cancer*** •Used to treat hormone-sensitive tumors of the breast •Others- corticosteroids, gonadal hormones, estrogen antagonists, and androgen antagonists Side effects: Hot flashes, rash, N/V, vaginal bleeding, menstrual irregularities, edema, pain, CVA, pulmonary emboli
Corticosteroids
HORMONES ______ suppress inflammation, reduce cerebral edema, may slow tumor growth Side effects: Hot flashes, rash, N/V, vaginal bleeding, menstrual irregularities, edema, pain, CVA, pulmonary emboli
NOT
HORMONES Prototype- tamoxifen (Soltamox)- breast cancer*** ______ true chemotherapeutic agents, but are used as an adjunct to treatment (block estrogen @ the receptor; estrogen antagonist)
COMPLICATIONS OF RENAL FAILURE (prt 2)
HYPERVOLEMIA-UNABLE TO EXCRETE SODIUM & WATER (RETENTION) HYPOCALCEMIA-HYPERPHOSPHATEMIA LEADS TO LOSS OF CALCIUM METABOLIC ACIDOSIS-UNABLE TO ADEQUATELY EXCRETE METABOLIC ACIDS
CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX) can cause....
HYPOKALEMIA MAY OCCUR
Intranasal Corticosteroids: fluticasone (Flonase)
Have an anti-inflammatory action- decrease allergic rhinitis symptoms and congestion; direct local effect
Drug labels
Have specific information that identifies a specific drug These labels identify the brand and generic names for the drug, the drug dosage, expiration date, and specific drug warnings
Hypotonic
Having a lower concentration of solute than another solution RBC placed in this solution will SWELL and BURST as water moves into the cell
teratogenic
Having adverse effects on the fetus
adverse effects of Nitrates: nitroglycerin (Nitrostat)
Headache**;Hypotension***; Nausea, vomiting; Dizziness; Reflex tachycardia; Flushing
Drugs Used for Heart Failure
Heart Failure = ACE inhibitors and ARBs Beta blockers Diuretics Cardiac glycosides vasodilators Phosphodiesterase inhibitors
What is heart failure?
Heart fails as a "pump"; fails to pump blood effectively
Signs of Thyroid Hormone Hypersecretion (prt 2)
Heat intolerance Nervousness Exophthalmos Weight loss Confusion Behavioral changes
Schedule II (C-II)
High abuse potential with severe dependence liability (narcotics, amphetamines, and barbiturates) (i.e. narcotic opioids, amphetamines, barbiturates, cocaine, methamphetamine, opium, morphine, codeine)
limits
High doses, to the ____ of tolerance of normal tissues are usually most effective
Nicotinic Acid have a High incidence of adverse effects such as
High incidence of adverse effects*- flushing, nausea, pruritus, headache, bloating, diarrhea, palpitations- take aspirin 30 minutes before to reduce symptoms
famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)
Histamine Blockers (H2 antagonists)
Toxicity
Human Immune Response: It is difficult to treat an immunocompromised individual because.... 1. anti-infective drugs cannot totally eliminate the pathogen without causing severe _____ in the host
inflammatory
Human Immune Response: It is difficult to treat an immunocompromised individual because.... 2. these patient lack the ____ or immune response in place to deal with even a few invading organisms
Antiinfective Therapy
Human Immune Response: the goal of ___ ___ is reduction of the population of the invading organism to a point at which the human immune response can take care of the infection
Laxatives: saline (osmotic) = polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)
Hyperosmolar salts pull water into the colon to increase bulk to stimulate peristalsis
Diuretics are Used for:
Hypertension Heart failure Kidney failure Liver failure or cirrhosis Pulmonary edema
Ibuprofen
IMPLECATIONS of ____ (a nonspecific COX -1 & COX-2 Inhibitor) May give on empty stomach if tolerated; with food if not •Pt's with asthma or allergies to aspirin may experience a hypersensitivity reaction
first pass effect
IMPORTANT NOTE: FROM THIS PROCESS it explains why many doses taken ORALLY must be a lot HIGHER than doses administered IV
LOOP DIURETICS: FUROSEMIDE (LASIX): think increased hydrogen ion loss can lead to.....
INCREASED HYDROGEN ION LOSS MAY LEAD TO METABOLIC ALKALOSIS
OSMOTIC DIURETICS: MANNITOL (OSMITROL) increases.....
INCREASES OSMOLALITY (CONCENTRATION) AND SODIUM REABSORPTION IN THE PROXIMAL TUBULE AND LOOP OF HENLE
GLP-1 agonists
INCRETIN ENHANCERS: exenatide (Byetta) and liraglutide (Victoza)- injectables**injected*** Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption
DPP-4 inhibitors
INCRETIN ENHANCERS: sitagliptin (Januvia)- oral drug Action- increase the level of incretin (metabolic) hormone to increase insulin secretion and block liver production of glucagon- lowers blood glucose levels Also decrease food intake by increasing feeling of fullness, slow gastric emptying to delay glucose absorption
tinnitus
INDICATES ear damage ringing in the ears
ferrous sulfate (iron)
IRON SUPPLEMENTS
General Anesthetic: propofol (Diprovan)
IV general anesthesia Used to induce general anesthesia for surgery (in conjunction with other meds)
Nursing Care- Antidiarrheals (prt 1)
Identify and treat underlying cause Monitor for and treat dehydration and electrolyte loss Monitor vital signs
Antidiarrheals: Nonpharmacologic treatment-
Identify cause and treat Clear liquids and electrolyte solutions
Pharmacokinetic
In clinical practice, ______ considerations include the onset of drug action (i.e. how long it will take to see the beginning of the therapeutic effect), drug half-life, timing of the peak affect (i.e. how long it will take to see the maximum effect of the drug), duration of the drug affects (i.e. how long the patient will experience the drug effects), metabolism or biotransformation of the drug, and the side of excretion
Cultural Considerations
In the United States, African Americans are at highest risk for hypertension Men are at greater risk than women
Laxatives: stimulants = bisacodyl (Dulcolax)- OTC
Increase peristalsis by irritating nerve endings in the intestinal mucosa
Major responses of anticholinergics (prt 2)
Increased heart rate Decreased bladder contraction (may cause urinary retention) Decreased rigidity and tremors
Anticholinergic Drug: atropine (Atropair)
Increases heart rate by blocking vagus stimulation Dilates pupils by paralyzing the iris sphincter Most common side effects are dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urinary retention, mydriasis (dilation)
TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia) increases the amount of......
Increases the amt of fetal hemoglobin produced in the bone marrow & dilutes the formation of abnormal hemoglobin S; results in less clogging of small vessels
GLP-1 agonists- exenatide (Byetta) and liraglutide (Victoza) & DPP-4 inhibitors- sitagliptin (Januvia)
Incretin Enhancers
donepezil (Aricept)
Indirect-Acting Cholinergic Agonists: cholinesterase inhibitor •Alzheimer's disease-helps improve memory •Adverse effects: insomnia, N/V/D, dyspepsia, abdominal pain, muscle cramps
pyridostigmine (Mestinon)
Indirect-Acting Cholinergic Agonists: cholinesterase inhibitor •Myasthenia gravis -increases muscle strength •Adverse effects: bradycardia, tearing, salivation, N/V, urinary frequency/incontinence
anti-inflammatory agents
Inhibit biosynthesis of prostaglandin & COX (inflammation suppression) •Relieve mild to moderate pain (analgesic)
MAOIs
Inhibit monoamine oxidase- causes levels of norepinephrine, dopamine, epinephrine, and serotonin to rise Effective as antidepressants, but adverse reaction (hypertensive crisis) may occur from eating certain foods when taking the drugs Many foods that contain tyramine interact
Hydantoins: Phenytoin
Inhibit sodium influx, preventing disruptive neuron firing Stabilize cell membranes, reducing repetitive neuronal firing, so limiting seizures Also acts as an antidysrhythmic Small sedation effect, is non-addictive
Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)
Inhibits absorption of cholesterol, also reduces LDL and triglycerides- need to combine with a statin for maximum effectiveness
ASPIRIN (ANTIPLATELET): aspirin
Inhibits platelet aggregation; reduces risk of stroke; reduces risk of fatal MI; MI prophylaxis (also an anti-inflammatory, analgesic & antipyretic)
Intramuscularly (IM)
Injection into large muscles
Nursing Implications & Care- Digoxin (prt 2)
Instruct patient to take digoxin at same time each day to ensure steady-state dosing and to contact health care provider for instructions if dose is missed. Emphasize importance of regular follow-up exams to determine effectiveness and to monitor for toxicity. Caution patient to avoid taking OTC medications without consulting health care provider. Antacids and antidiarrheals slow absorption of digoxin.
NURSING CARE- ALPHA ADRENERGIC AGONISTS (prt 2)
Instruct patient to watch OTC drug labels for cold and diet medications- many have sympathetic drugs •Explain caution in using nasal sprays that adrenergic agonists- rebound effect •Instruct use of medications (nasal spray) •Instruct about side/adverse effects
Type 1- (IDDM aka juvenile)
Insulin is treatment
fluticasone (Flonase)
Intranasal Corticosteroids
PAIN
Is a subjective experience; described as an unpleasant sensation & emotional experience
Opiate Agonists (Narcotic Analgesics) (prt 2)
Itching •Nausea & vomiting* (common) •Constipation***, urinary retention •Respiratory depression******; apnea •Tolerance and dependence (cross-tolerance), withdrawal symptoms •Possible anaphylaxis
Research studies have shown that African Americans are (prt 3)
LESS responsive to ACE inhibitors, ARBs, renin inhibitors & beta-blockers
Topical
LOCAL ANESTHETICS ROUTES: creams, sprays, suppositories, lozenges; applied to mucous membranes (ex: throat spray)
Infiltration
LOCAL ANESTHETICS ROUTES: direct injection into tissue or surgical site; blocks specific group on nerves in small area (ex: mole removal)
Spinal anesthesia
LOCAL ANESTHETICS ROUTES: injected into cerebral spinal fluid in the spine (ex: to work on legs)
Epidural
LOCAL ANESTHETICS ROUTES: injected into the epidural space of the spinal cord (ex: for childbirth)
Nerve Block
LOCAL ANESTHETICS ROUTES: injected into tissue proximal to surgical site; effects bundles of nerves; larger area (ex: to work on hand/foot
FUROSEMIDE (LASIX)
LOOP DIURETICS
Prototype: enoxaparin (Lovenox) (SQ)
LOW MOLECULAR WEIGHT HEPARIN (LOVENOX)
Lab test for warfarin (Coumadin)
Lab tests to monitor Coumadin are prothrombin time (PT) and international normalized ratio (INR) NOTE: PT is measured in seconds and adjusted (standardized) to derive the INR
labs for heparin
Labs: Monitor the PTT/aPTT
psyllium (Metamucil)
Laxatives: Bulk-forming
polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)
Laxatives: saline (osmotic)
bisacodyl (Dulcolax)- OTC
Laxatives: stimulants
docusate (Colace)
Laxatives: stool softeners
Systemic Circulation
Left side of heart send oxygenated blood out to the cells of the body
Schedule III (C-III
Less abuse potential than schedule II drugs and moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics) (i.e nonbarbiturate sedatives, nonstimulant amphetamines, and limited amounts of certain narcotics, some codeine mixtures, anabolic steroids)
Schedule IV (C-IV)
Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics) (i.e. some sedatives, antianxiety agents, nonnarcotic analgesics)
Nonphenothiazines (1st Gen)
Less sedation and anti-cholinergic effects than phenothiazines but similar action- EPS may still occur May be given in a decanoate form- injectable slow release form (called depot injections)
Signs Thyroid Hormone Deficiency
Lethargy Apathy Memory impairment Emotional changes Slow speech Deep course voice
Leukotriene Modifiers: montelukast (Singulair)
Leukotriene is a chemical mediator that can cause inflammatory changes in the lung
Preventing Resistance
Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used Make sure doses are high enough, and the duration of drug therapy long enough Be cautious about the indiscriminate use of anti-infectives
Schedule V (C-V)
Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. The purchaser must be at least 18 years of age and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist. (i.e small amount of codeine, such as in cough medicines)
intravenous solutions
Liquids infused into the blood of a vein; most are isotonic so that blood cells do not rupture or shrink.
Rapid acting insulin
Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Onset- <15 min; Peak- 30-90 min; Duration- 3-5 hrs
lidocaine (Xylocaine)
Local Anesthetics: Adverse effects: HA, convulsions, urinary retention, respiratory depression, hypotension, bradycardia & cardiac arrest NOTE: **these are NOT common when used topical, field block or nerve block; more common when used as epidural/spinal
furosemide (Lasix)
Loop Diuretics
Act on the loop of Henle to block reabsorption of sodium and chloride- sodium and water are lost
Loop Diuretics: furosemide (Lasix)
Sedation
Loss of awareness; may be desirable in clients who are restless, nervous, irritable or overreacting; or those undergoing surgery
Opioids and the Law
Lost, wasted, or contaminated doses must be accounted for (or disposed of) on the record and signed by 2 nurse •Shift change count by 2 nurses Nurse should check for a valid prescription that has not expired (time stop policy)
Barbiturates
Low margin for safety, high potential for dependence (Schedule IV)
Barbiturates
Low margin for safety, high potential for dependence (Schedule IV), cause severe CNS depression, but inexpensive, long acting, high incidence of adverse effects
cellular defenses
Lymphocytic and Myelocytic
THROMBOLYTIC DRUGS
Lyse (break down) existing clots Clot Busters
RENAL SYSTEM 4 major functions
MAINTAIN VOLUME/COMPOSITION OF BODY FLUIDS W/IN NORMAL RANGE REGULATION OF VITAMIN D AND CALCIUM LEVELS REGULATION OF BLOOD PRESSURE THROUGH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM REGULATION OF RED BLOOD CELL PRODUCTION (ERYTHROPOIETIN)
SKIN DISORDERS: SCABIES OR PEDICULOSIS = PERMETHRIN (NIX)
MAY BE ADMINISTERED AS A CREAM, LOTION OR SHAMPOO TO KILL HEAD LICE, CRAB LICE AND MITES
KAYEXALATE
MAY BE GIVEN FOR HYPERKALEMIA. USUALLY A LIQUID GIVEN PO ALONG WITH A LAXATIVE; SODIUM IS EXCHANGED FOR POTASSIUM IN THE GI TRACT; CAUSES LARGE BOWEL MOVEMENT AND BASICALLY POTASSIUM IS EXCRETED THROUGH THE EVACUATION OF FECES
CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX) may be used to treat....
MAY BE USED AS ADJUNCTS TO OTHER DIURETICS; ALSO OFTEN USED TO TREAT GLAUCOMA BECAUSE INHIBITION OF CARBONIC ANHYDRASE DECREASES SECTION OF AQUEOUS HUMOR
CARBONIC ANHYDRASE INHIBITOR SIDE EFFECTS & NURSING CONSIDERATIONS
MAY CAUSE ACID-BASE DISTURBANCES METABOLIC ACIDOSIS IS RELATIVELY COMMON & POTENTIALLY DANGEROUS
repaglinide (Prandin)
MEGLITINIDES
vincristine
MITOTIC INHIBITOR/ PLANT ALKALOIDS Prototype is _____ (Oncovin)** •Leukemia, Hodgkin, lymphoma, etc •Derived from natural products and block cell division •Three subdivisions- vinca alkaloids (periwinkle plant), taxanes (yew plant), topoisomerase inhibitors (May apples) •Side effects: may cause peripheral nerve damage and neurotoxicity*** (nerve toxicity)*, ataxia, alopecia, muscle wasting, leukopenia
NOTE when taking TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) monitor....
MONITOR FOR HYPERKALEMIA
GENERAL NURSING CARE DIURETICS
MONITOR INTAKE AND OUTPUT* MONITOR LAB VALUES- ESPECIALLY ELECTROLYTES AND BLOOD GLUCOSE MONITOR FOR SYMPTOMS OF ELECTROLYTE IMBALANCE- LEG CRAMPS, WEAKNESS, DIARRHEA, TACHYCARDIA MONITOR FOR DEHYDRATION** AND COMPLIANCE WITH DRUG
THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) first line for hypertension.....
MOSTLY FIRST LINE FOR HYPERTENSION, MILD/MOD HEART FAILURE ; INEFFECTIVE IN PATIENTS WITH SEVERE RENAL FAILURE
POTASSIUM SPARING SIDE EFFECTS & NURSING CONSIDERATIONS
MUST BE MONITORED FOR HYPERKALEMIA- SERUM POTASSIUM SHOULD BE 3.5 TO 5.0 MEQ/L
prednisone (prt 2)
MUST TAPER off doses, do not stop suddenly** Pregnancy Category C
hypertension
Main objective of ______ treatment is to attain & maintain goal BP
Major adverse effect for Heparin
Major adverse effect is bleeding- antidote is protamine sulfate
major complication for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)
Major complication is hemorrhage
Insulin quick facts
Manufactured by DNA technology Human insulin has a low incidence of allergic effects and insulin resistance Analogs are modifications of human insulin with alterations in onset and duration of action
Anticonvulsants classes
Many classes of drugs are used- •Hydantoins / hydantoin-like drugs •Barbiturates •Benzodiazepines •Valproate
Proteins
Many drugs are bound to ______ and are not liquid soluble These drugs cannot be distributed to the central nervous system CNS because of the effective blood brain barrier which is highly selective and allowing lipid soluble substances to pass into the CNS
Placenta
Many drugs readily passed through the _____ affecting the developing fetus in pregnant woman It is best not to administer any drugs to pregnant woman because of the possible rest of the fetus
warning for warfarin (coumadin)
Many other drugs may interact with Coumadin
Imipramine (Tofranil) class
Many side/adverse effects- sedation, orthostatic hypotension*, cardiac toxicity, seizures, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia), sexual dysfunction, bone marrow suppression
virions
Mature virus particles.
acetaminophen (Tylenol)
Maximum dose: 4 g/day*
Vasodilators: hydralazine (Apresoline) isosorbide dinitrate- (Isordil)
May be combined to act synergistically- hydralazine with isosorbide dinitrate (BiDil)- especially effective in treating HF in African American patients
Drug Indications-Endocrine Disorders
May be for: Replacement therapy To shrink hormone-sensitive tumors To produce an exaggerated response To block the action of endogenous hormones
Antitussives: dextromethorphan (Robitussin DM; Delsym) can be mixed with....
May be mixed with a narcotic for cough suppression
Note: heart failure might be......
May be right or left-sided heart failure- many times is a combination
Expectorants: guaifenesin (Mucinex) may be used with or without....
May be used with or without other medications; Found in many OTC cold medications
serotonin syndrome
May begin 2-72 hours after starting treatment with SSRI (or any drug affecting serotonin) Withhold medication if any of the following develop: Mental confusion, difficulty concentrating Fever Agitation or anxiety Hallucinations Incoordination or hyper-reflexia Diaphoresis Tremors
phenytoin (Dilantin)
May cause local site irritation and sloughing; (vesicant) give in large vein or central line Flush line with saline before & after giving**
Loop Diuretics: furosemide (Lasix) can cause.....
May cause rapid losses of fluid and orthostatic hypotension
Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil) may cause........
May cause reflex tachycardia*- can be prevented by administering a beta blocker with the direct vasodilator
ACE Inhibitors (-"pril" suffix): Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
May produce first-dose phenomenon (start w/ low dose & monitor closely) Drugs inhibit ACE- inhibits formation of angiotensin II (blocks vasoconstriction) and blocks the release of aldosterone (sodium and water are excreted and potassium is retained)
ACE Inhibitors: captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
May produce first-dose phenomenon (start w/ low dose & monitor closely) Drugs inhibit ACE- inhibits formation of angiotensin II (blocks vasoconstriction) and blocks the release of aldosterone (sodium and water are excreted and potassium is retained) End result is decreased peripheral resistance and diuresis; used for HTN and heart failure
Mechanism of action of HEPARIN (ANTICOAGULANT)
Mechanism of action- prolongs clotting time; Indicated for rapid anticoagulant effect
Psychotic symptoms
Mechanisms of Action of Drugs: result from an imbalance of dopamine in the brain
NURSING CARE FOR NON-INSULIN DIABETIC DRUGS (prt 2)
Medic Alert card, tag, or bracelet No alcohol Report vomiting, diarrhea, fever, inability to eat **Consider holding meds if patient is not able to eat or take anything by mouth**
partial agonist
Medication that produces a weaker, or less efficacious, response than an agonist.
ORAL DIABETIC DRUGS (TYPE II DIABETES) (prt 2)
Meglitinides Incretin enhancers such as- GLP- 1 agonists & DPP-4 inhibitors
aminophylline (Theophylline)
Methylxanthines
acquiring resistance
Microorganisms develop resistance in a number of way: 1.) Mutations that allow an enzyme to inactivate the antibiotic (lactem Ring) 2.) Mutations to make protein that binds to antibiotic 3.) Mutation to decrease up take of drug or to eject it from cells more 4.) Transformation from other bacteria 5.) Gene transfer from conjugation and transfer of R plasmids a.) MRSA became Vancomycin resistant from plasmid (with transposons) transfer b.) From Vancomycin resistant Entrococcus (VRE)
mix Bulk-forming laxatives = psyllium (Metamucil) in????
Mix in a glass of water or juice, followed by another glass of liquid
NURSING CONSIDERATIONS/IMPLICATIONS FOR PAIN MEDS
Monitor & document pain frequently; document response Take VS; If resp rate < 12/minute, notify physician & hold medication Have naloxone & resuscitation equipment available When giving IV push, give over 4-5 minutes Always ensure removal of old patch when using transdermal route
NURSING CARE- THROMBOLYTICS (prt 1)
Monitor bleeding studies before administration Watch for complications, such as hemorrhage, reperfusion dysrhythmias, allergic reaction- bleeding may occur up to 24 hrs after therapy
Nursing Care for Pituitary Hormone Disorders
Monitor for desired effect of the drug based on reason for administering: I and O and urine specific gravity (specific gravity may be low in diabetes insipidus indicating dilute urine) Monitor physical growthMonitor vital signs (signs of dehydration) Assess for thirst, other signs of dehydration with ADH Monitor blood sugar and electrolytes Monitor correct use of medications and adverse effects
Nursing Care- Typical Antipsychotics
Monitor for fluctuations in BP and tachycardia avoid skin contact w/ liquid meds Admin oral drugs WITH food or milk Amin IM DEEP into muscle Observe for EPS Assess for NMS Record urine output Teach pt to use sunscreen or to wear long sleeves and hat high fiber foods, plenty of liquids hand candy or lozenges for dry mouth teach pt about time it take to reach therapeutic affect DON'T stop abruptly
Nursing Care- Laxatives (prt 2)
Monitor for fluid and electrolyte loss Monitor bowel sounds and vital signs Teach to report any blood in stools Teach possible side/adverse effects- N&V, diarrhea, abdominal cramping, weakness, dizzines
Nursing Care- Diuretics
Monitor intake and output* Monitor lab values- especially electrolytes and blood glucose Monitor for symptoms of electrolyte imbalance- leg cramps, weakness, diarrhea, tachycardia Monitor for dehydration** and compliance with drug
NURSING CARE- ADRENERGIC BLOCKERS (prt 2)
Monitor urine output •Monitor for nasal stuffiness due to vasodilation •Teach how to take medication and to take own pulse and BP •Instruct to report mood changes and depression •*Do NOT stop taking abruptly.
Nursing Care- Antimetics monitor
Monitor vital signs Monitor for dehydration and electrolyte imbalance
NURSING CARE- ALPHA ADRENERGIC AGONISTS
Monitor vital signs and EKG •Monitor urine output and assess for bladder distention •Evaluate blood glucose levels (hyperglycemia)
Nursing Care- Drugs for Heart Failure
Monitor vital signs and teach patient to take own BP and pulse Observe for peripheral and pulmonary edema Monitor serum digoxin level and electrolytes Teach low sodium diet and fluid limitations
Nursing Care for Thyroid Hormone Drugs
Monitor vital signs, EKG, weight Monitor other medications for interactions
Nursing Care- Antihypertensives
Monitor vital signs- teach patients to take own BP and keep a log Teach side/adverse effects of drugs, such as cough, angioedema, peripheral edema Monitor fluid and electrolyte balance, especially if combined with a diuretic
Research studies have shown that African Americans are (prt 2)
More responsive to diuretics, calcium-channel blockers & alpha-adrenergic blockers
Expectorants
Most common is guaifenesin (Mucinex) (PO)
Methylxanthines: aminophylline (Theophylline) most commonly used....
Most commonly used- theophylline, aminophylline; therapeutic levels are 5-15 mcg/mL***
Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) most effective....
Most effective drugs at blocking acid; available OTC
Research studies have shown that African Americans are
Most responsive to single-drug therapy (instead of combinations)
anticonvulsants for partial seizures
Most work by blocking sodium channels; decrease seizure activity, particularly in partial or focal seizures. Teratogenic*-(spina bifida & cleft palate); Preg Cat. D
Distribution
Movement of a drug to body tissues; the places were drug may be distributed depend on the drugs solubility, perfusion of the area, cardiac output, and the binding of the drug to plasma proteins
diffusion
Movement of solutes from an area of higher concentration to an area of lower concentration to reach equilibrium
osmosis
Movement of water from an area of high concentration to an area of low concentration in an attempt to equalize the concentration
Not
Moving forward drugs will ______ have a pregnancy category listed but will have a risk level for affects on fertility, pregnancy, and when used in breast-feeding
Guaifenesin
Mucinex (generic name is ???)
acetylcysteine (Mucomyst)
Mucolytic
Neuromuscular Abnormalities
Muscle Spasms & Muscle Spasticity
intracellular parasites
Must be in host cell to replicate and cause infection •Many viruses infect specific host cells
Cardiovascular System
Myocardium: heart muscle Diastole: cardiac muscle at rest Systole: cardiac muscle contracts
succinylcholine (Anectine)
NEUROMUSCULAR JUNCTION BLOCKER(AKA "PARALYTIC AGENT")
COX-2 inhibitors
NONOPIOID ANALGESICS: Celecoxib (Celebrex)
Acetaminophen
NONOPIOID ANALGESICS: Tylenol
Salicylates
NONOPIOID ANALGESICS: acetylsalicylic acid, ASA (Aspirin)
NSAIDS and Related Drugs
NONOPIOID ANALGESICS: •ibuprofen (Advil) •ketorolac (Toradol) •meloxicam (Mobic) •naproxen (Aleve)
THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) is NOT an effective......
NOT EFFECTIVE FOR IMMEDIATE DIURESIS;
SIDE EFFECTS of URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)
NOTE MOST SIDE EFFECTS ARE R/T ANTICHOLINERGIC ACTIVITY SIDE EFFECTS: DROWSINESS, DIZZINESS, BLURRED VISION, TACHYCARDIA, DRY MOUTH, NAUSEA, URINARY HESITANCY, DECREASED SWEATING
excretion
NOTE: most significant means of excretion occurs through the KIDNEYS Other methods of excretion: skin saliva lungs bile and feces
Intermediate acting insulin
NPH (Humulin N, Novolin N) Onset- 1-1.5 hrs; Peak- 4-12 hrs; Duration- 18-24 hrs
NONOPIOID ANALGESICS
NSAIDs, Salicylates, COX-2 inhibitors and acetaminophen
Brand-name
Name given to a drug by the pharmaceutical company that developed it; also called a trade name or proprietary name
Chemical name
Name that reflects the chemical structure of a drug
OPIOIDS AND THE LAW
Narcotic drugs must be secured with 2 locks or secured computerized system- only licensed people have access Dose recorded on a special record, as well as patient record
oxymetazoline (Afrin) (intranasal spray)
Nasal and Systemic Decongestants
Laxatives: Bulk-forming = psyllium (Metamucil)
Natural fibrous substances- promote large soft stools by absorbing water into intestine- increases bulk and peristalsis; preferred drug for chronic constipation
Laxatives: herbal
Natural products available OTC Most commonly used is senna (PO)- a potent herb that irritates the bowel and increases peristalsis Newer drugs to treat constipation of IBS (lubiprostone- Amitiza) and Opioid-induced constipation (methylnaltrexone- Relistor; noloxegol- Movantik)
IRON SUPPLEMENTS: ferrous sulfate (iron)
Necessary for the production of hemoglobin and RBCs Often prescribed for or to prevent anemia
intestine invading worms
Nematodes: pinworms whipworm threadworm ascaris hookworms OR Platyhelminths: Cestodes (tapeworm)
Phenylephrine
Neo-Synephrine
Polymyxin B
Nerve damage caused by antiinfective agent: this drug can be toxic to human hosts leading to nephrotoxicity, neurotoxicity (facial flushing, dizziness, ataxia, paresthesia and drowsiness) and drug fever and rashes Therefore, this drug is reserved for use in acute situations when the invading bacterium has been PROVEN to be sensitive to the drug and less sensitive to other less toxic antibiotics
NMS
Neuroleptic Malignant Syndrome Onset-days/weeks after taking dopamine agonist or after sudden withdrawal of dopaminergic Rigid "lead pipe-like" muscles; hyporeflexia High fever Usually no GI symptoms Recovery days to weeks; higher mortality rate Tx: benzodiazepines; levodopa; bromocriptine
Muscle Spasms
Neuromuscular Abnormalities: Often result from injury to the musculoskeletal system Caused by flood of sensory impulses Impulses stimulate painful and intense muscle contraction
muscle spasticity
Neuromuscular Abnormalities: Result of damage to neurons within the CNS; which is permanent May lead to excessive stimulation of muscles called hypertonia May result in contractures or permanent structural changes
Nicotinic Acid
Niacin (vitamin B2)- reduces VLDL and LDL & inhibits release of free fatty acids from adipose tissue
diabetics
Nicotinic Acid: Niacin (vitamin B2) is not prescribed to pt that are diagnosed with _______ b/c it can ELEVATE blood glucose
nitroglycerin (Nitrostat)
Nitrates
SCHEDULE II PRESCRIBING LIMITATIONS IN MISSOURI (prt 2)
No refills allowed Prescription valid for 6 months only Quantity limited for 30 days in most cases In Missouri nurse practitioners can prescribe 5 days of hydrocodone only
Ibuprofen (Advil/Motrin)
Non-selective COX -1 & COX-2 Inhibitor: Aspirin-like but have stronger effects and less gastric irritation (may still have gastric upset) •Blood dyscrasias (& bleeding) not as common' OTC in lower doses than prescription form (200 mg) •If taken with aspirin, ibuprofen's effect may be decreased & increase risk of bleeding •May have many other drug interactions
haloperidol (Haldol)
Nonphenothiazines (1st Gen): Elderly should have decreased dose Drugs may lower seizure threshold- may need increased dose if on seizure drugs
Normal INR
Normal INR is 1.3 to 2- if on Coumadin, patient is maintained at an INR of 2 to 3 or higher for anticoagulation THINK: important lab for warfarin (Coumadin)
blood pressure categories
Normal: <120/80 mmHg Prehypertension: 120-139/80-89 mmHg High blood pressure: >140/90 mmHg
Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT)= Not effective for immediate diuresis
Not effective for immediate diuresis; used often for hypertension, mild/mod heart failure
Leukotriene Modifiers: montelukast (Singulair) are NOT recommended for treatment of.....
Not recommended for treatment of an acute asthma attack- used for prevention of symptoms
Antineoplastic Antibiotics
Not selective only for bacterial cells; toxic to human cells
BP
Nursing Care for Anxiolytics/Sedatives/Hypnotics: Monitor vital signs- especially respirations and ____
drug abuse
Nursing Care for Anxiolytics/Sedatives/Hypnotics: Watch for ____ ____
DO NOT
Nursing Care for Anxiolytics/Sedatives/Hypnotics: ___ ____ drive/operate machinery or mix alcohol NOTE: the nurse needs to withdraw drugs slowly
Teach about Thyroid Hormone medications
Nursing Care for Thyroid Hormone Drugs: Do not stop abruptly or switch name brands Take on empty stomach at the same time each day
Morphine
OPIOID AGONISTS-Contraindications: ____ can cause biliary tract spasms so not preferred for gallbladder disease/gallstones* (increases tone at the sphincter of Oddi); meperidine (Demerol) is preferred for gallbladder pain
Fentanyl
OPIOID AGONISTS: 50-100 times more potent than morphine
Contraindications
OPIOID AGONISTS: Head injuries, increased intracranial pressure Respiratory disorders (however, may see used for pulmonary edema and congestive heart failure) Shock or hypotension
Codeine
OPIOID AGONISTS: often mixed with other medications
MANNITOL (OSMITROL)
OSMOTIC DIURETICS
Antiemetic Drugs: Nonprescription antiemetics
OTC for motion sickness, such as dimenhydrinate (Dramamine); diphenhydramine (Benadryl); bismuth subsalicylate (Pepto-Bismol)
Prototype- clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid) (PO)
OTHER ANTIPLATELET DRUGS
LOOP DIURETICS: others
OTHER LOOPS: BUMETANIDE (BUMEX); TORSEMIDE (DEMADEX)
URINARY TRACT ANTISPASMODICS: others
OTHER MEDS: TROSPIUM (SANCTURA); TOLTERODINE (DETROL)
POTASSIUM SPARING DIURETICS: others
OTHER POTASSIUM SPARING DRUGS: TRIAMTERENE (DYRENIUM); AMILORIDE (MIDAMOR)
CARBONIC ANHYDRASE INHIBITORS: others
OTHER SIMILAR DRUGS: DICHLORPHENAMIDE (KEVEYIS)
THIAZIDE DIURETICS: other
OTHER THIAZIDE & THIAZIDE-LIKE MEDS: METHYCLOTHIAZIDE; INDAPAMIDE
LOOP DIURETICS: FUROSEMIDE (LASIX) can cause....
OTOTOXICITY IS POSSIBLE; WATCH FOR DEHYDRATION, HYPONATREMIA, HYPOCHLOREMIA, HYPOTENSION*, HYPOKALEMIA*, HYPERGLYCEMIA & INCREASED URIC ACID
NURSING CARE- CHOLINERGIC AGONIST DRUGS (prt 2)
Observe for general cholinergic side/adverse effects, such as gastric pain, diarrhea, increased salivary or bronchial secretions, bradycardia, and orthostatic hypotension
Nursing Care- Antidiarrheals (prt 2)
Observe for side/adverse effects of drugs Limit fried foods or milk products until diarrhea stops Avoid alcohol Teach proper hand washing and handling of foods
NURSING CARE- ANTICOAGULANTS (prt 1)
Obtain a history for any abnormal clotting or associated health problems Monitor lab values (RBCs, H&H, Platelets) Observe for bleeding and teach patient signs/symptoms of bleeding and to report Monitor vital signs Instruct to use a soft toothbrush and electric razor
Nursing Care- Antidepressants
Obtain a medication history to prevent interactions Assess for suicidal tendency (increased energy levels) Instruct patient that it may take 2-4 weeks to see improvement in symptoms
Passive diffusion
Occurs across a concentration gradient When there is a greater concentration of the drug on one side of a cell membrane the drug will move through the membrane to the area of lower concentration This process does not require any cellular energy
Respiratory depression
Of the following which is of the greatest concern to the nurse in a client who is taking a benzodiazepine? 1.Tachycardia 2.Sedation 3.Depression 4.Respiratory depression
Niacin (vitamin B2) = aka Nicotinic Acid
Often used in lower doses with a statin or bile acid-binding drug
caution with Drugs for Gastric Acid Disorders
Older patients may need reduced doses of acid blockers- watch for confusion, headache in H2 blockers Caution in renal failure patients who take antacids containing aluminum and sodium
1 month
Once opened, insulin may be kept at room temperature for _______
Heparin onset
Onset is immediate when IV with a peak within minutes Does not cross placenta; but DOES enter breast milk
neuroleptic malignant syndrome
Onset usually occurs within a few weeks of someone who has started taking antipsychotics/neuroleptics but can happen at anytime Immediately stop causative med; symptomatic treatment (cooling, management of BP & HR)
naloxone (Narcan)
Opioid Antagonists: Antidote for opiate overdose Reverse effects of opiates, including respiratory depression, sedation, hypotension; Respiratory distress, respiratory depression
analgesics two classes
Opioids-work in the CNS Nonopioids-work on nociceptors/chemical (COX)
delayed
Optimum dosing schedule may be _____ at times until the patient recovers from drug toxicities (usually due to bone marrow suppression)
Type 2- (NIDDM aka adult onset)
Oral diabetic drugs, sometimes insulin
right route
Oral, IV, topical, subcutaneous, IM
Adrenergic Antagonists Blockers
Other uses- migraines, angina pectoris, dysrhythmias, heart failure, myocardial infarction, glaucoma
Other Intranasal Corticosteroids
Others- mometasone (Nasonex), budesonide (Rhinocort)
phase 1 biotransformation
Oxidation, reduction, hydrolysis
alpha cells of pancreas
PANCREATIC CELLS: Secrete/produce glucagon which raises blood sugar
beta cells of pancreas
PANCREATIC CELLS: secrete insulin in response to high levels of glucose. Insulin decreases blood glucose by promoting its uptake into body cells
pt taking POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) do NOT require....
PATIENT DOES NOT REQUIRE A POTASSIUM SUPPLEMENT, AS WITH OTHER DIURETICS THAT CAUSE A LOSS
NOTE GENERAL NURSING CARE DIURETICS
PATIENT MAY BE ON FLUID RESTRICTION MONITOR PULSE AND BP- SIT AND STAND SLOWLY UNTIL
SPIRONOLACTONE (ALDACTONE)
POTASSIUM SPARING DIURETICS
patient safety
PRIMARY GOAL for a nurse
THIAZIDE DIURETICS
PROTOTYPE- HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) (PO)
POTASSIUM SPARING DIURETICS
PROTOTYPE- SPIRONOLACTONE (ALDACTONE) (PO)
CARBONIC ANHYDRASE INHIBITORS
PROTOTYPE: ACETAZOLAMIDE (DIAMOX) (PO, IV)
ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC
PROTOTYPE: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
LOOP DIURETICS
PROTOTYPE: FUROSEMIDE (LASIX) (PO, IM, IV)
antitubercular drugs
PROTOTYPE: Isoniazid (INH Can cause: dose-related peripheral neuropathy (PARESTHESIA; NUMBNESS/TINGLING), clumsiness, unsteadiness, muscle ache; GI distress, jaundice, BONE MARROW SUPPRESSION, *drug-induced hepatitis* •Take on empty stomach either 1 hr before or 2 hr after meals •RIFAMPIN WHEN USED CAN CAUSE DISCOLORATION OF SWEAT & TEARS; CAN INTERFERE WITH ORAL BIRTH CONTROL
ANTITUBERCULIN DRUGS
PROTOTYPE: Isoniazid (INH) (po) •Used to treat tuberculosis (TYPICALLY in combinations w/ other drugs) •STRIPE (streptomycin; rifampin; isoniazid; pyrazinamide; ethambutol) •Bacteriostatic/bactericidal •TREATMENT PROTOCOL LASTS FROM 6 MO UP TO 2 YRS •Use w/ caution in people with alcohol or liver problems Depletes vitamin B6
URINARY TRACT ANTISPASMODICS
PROTOTYPE: OXYBUTYNIN (DITROPAN) (PO; PATCH)
SKIN DISORDERS: SCABIES OR PEDICULOSIS
PROTOTYPE: PERMETHRIN (NIX) (SHAMPOO, LOTION)
URINARY TRACT ANALGESIC
PROTOTYPE: PHENAZOPYRIDINE (PYRIDIUM) (PO)
TREATMENT FOR HYPOKALEMIA
PROTOTYPE: POTASSIUM CHLORIDE (KCL) (PO, AND MIXED IN IV FLUIDS)
patient
Pain is whatever the _____ says it is.
Hypoglycemia S/S
Pallor Cool, clammy skin Diaphoresis Nausea /vomiting Tachycardia Low blood glucose reading (less than 50 mg/dl)•Irritability, nervousness•Headache Change in level of consciousness (LOC) Seizures Death
HEPARIN DOSING
Partial thromboplastin time (PTT) and activated partial thromboplastin (aPTT) are lab tests used to monitor heparin therapy
Important note for THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)
Patient may be placed on anticoagulant/antiplatelet drug once thrombotic event has been corrected to prevent recurrence
Hemorrhagic cystitis
Patient should be well hydrated to prevent ____ ____
Patients taking Nitrates: nitroglycerin (Nitrostat) must be taught.....
Patients are taught to take 1 SL every 5 minutes up to 3 tablets- if pain not relieved within 10-15 minutes of first dose, seek medical care
Warning for low molecular weight heparin: enoxaparin (Lovenox)
Patients should not take other anticoagulant drugs with LMWH or heparin (unless transitioning to oral drug)
Heavier
People who are much ____ may require larger doses to get a therapeutic effect from a drug because they have increased tissue to perfuse and increased receptor sites in some reactive tissue
Pepsin Inhibitor & Prostaglandin Analogue
Pepsin inhibitor: sucralfate (Carafate) PO - Combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin & Prostaglandin analogue: misoprostol (Cytotec) - Suppresses gastric acid secretion and increases cytoprotective mucus in GI tract
PO
Per Os (by mouth)
nifedipine (Procardia); diltiazem (Cardizem) = calcium channel blockers
Peripheral edema may occur*- may be taken with a diuretic Do not give with beta blockers- both decrease myocardial contractility (unless treating reflex tachycardia)
myelocytic
Pertaining to blood cells formed in the bone marrow Neutrophils •Eosinophils •Monocytes/macrophages
Antimetics: Prototype- prochlorperazine (Compazine); promethazine (Phenergan)
Phenothiazine antiemetics- may cause EPS Side effects: drowsiness, dystonia, photophobia, blurred vision
milrinone (Primacor)
Phosphodiesterase Inhibitors
sublingual
Placed under the tongue, where it dissolves and is absorbed into the bloodstream. DO NOT CHEW OR SWALLOW
spironolactone (Aldactone)
Potassium-Sparing Diuretics
Weaker diuretics than thiazides and loop diuretics; given PO
Potassium-Sparing Diuretics: spironolactone (Aldactone)
Must be monitored for hyperkalemia
Potassium-Sparing Diuretics: spironolactone (Aldactone) MONITOR ______ (NOTE: serum potassium should be 3.5 to 5mEq/L)
hydralazine (Apresoline) = Direct Vasodilators
Potent antihypertensive drugs Act by relaxing the smooth muscles of arteries, causing vasodilation; often used to address severe hypertension that hasn't responded to other drugs
cephalosporins
Potential Adverse Affects: •Watch for hypersensitivity reactions: rash, itching (pruritic), fever •May cause anorexia, N/V/D; superinfection •Notify HCP if diarrhea occurs-may lead to Clostridium difficile infection •Refrigerate oral solutions
Insulin pen injectors
Prefilled and reusable Examples: Humulin 70/30 and Humalog 75/25, Lantus
methylphenidate (Ritalin)
Primary drug treatment is with CNS stimulants The drugs reverse many of the symptoms, helping patients focus on tasks; can also be used to treat narcolepsy
selective serotonin reuptake inhibitors
Primary use is for major depression, but may also be used to treat anxiety disorders Takes several wks for therapeutic effect
Excretion
Process by which metabolic wastes are eliminated from the body
Genetic engineering
Process of altering DNA, usually of bacteria: to produce a chemical to be used as a drug
DIURETICS
Produce increased urine flow Used to reverse abnormal fluid retention in the body
Diuretics
Produce increased urine flow; Can affect one or more segments of the renal tubules; Used to reverse abnormal fluid retention in the body; Fluid loss == lower BP
Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox) produces more....
Produce more stable responses at recommended doses so frequent lab tests (aPPT) are not required
Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)
Promote ulcer healing by neutralizing hydrochloric acid
pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)
Proton Pump Inhibitors
Meds for Gastric Acid Disorders
Proton pump inhibitors Histamine2 receptor blockers Antacids Helicobacter pylori (H. pylori) treatment Other drugs: Carafate & Cytotec
Treating Thyroid Hormone Hypersecretion
Prototype- Propylthiouracil (PTU) and methimazole (Tapazole)
Beta2 Adrenergic Agonists- Bronchodilators
Prototype- albuterol (Proventil)
Antacids
Prototype- aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums); (PO)-come in chewable or liquid
Atypical Antipsychotics (2nd Gen)
Prototype- aripiprazole (Abilify); clozapine (Clozaril); risperidone (Risperdal) (PO, IM)
direct acting cholinergic agonists
Prototype- bethanechol (Urecholine)- stimulates receptor directly & Prototype: pilocarpine (Pilocar)•PO=treats dry mouth from salivary gland issues
ACE Inhibitors (-"pril" suffix)
Prototype- captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil) (PO)
Bile Acid Sequestrant
Prototype- cholestyramine (Questran)- (PO)
OTHER ANTIPLATELET DRUGS
Prototype- clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid) (PO)
Antidiuretic Hormone Deficiency
Prototype- desmopressin (DDAVP, Stimate) (PO, Nasal) Also, vasopressin (Pitressin); administered IV has shorter half life & causes vasoconstriction
Antidiarrheals: Prescription drugs
Prototype- diphenoxylate with atropine (Lomotil) less potential for dependence than other opiates slows GI motility- Schedule V drug
Histamine Blockers (H2 antagonists)
Prototype- famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid ); [ranitidine (Zantac)*-off market] (PO, IV)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Prototype- fluoxetine (Prozac);sertraline (Zoloft); paroxetine (Paxil) (PO)
Intranasal Corticosteroids
Prototype- fluticasone (Flonase)
Fibric Acid Agents
Prototype- gemfibrozil (Lopid)- (PO)
Direct Vasodilators
Prototype- hydralazine (Apresoline)
Thiazide Diuretics
Prototype- hydrochlorothiazide (Microzide, HydroDIURIL, HCT)
Tricyclic Antidepressants (TCAs)
Prototype- imipramine (Tofranil) (PO)
Anticholinergics (inhaled)
Prototype- ipratropium (Atrovent)- (Inhaled)
Treating Thyroid Hormone Deficiency
Prototype- levothyroxine (Synthroid)
Bipolar Disorder: Manic Mood Stabilizers
Prototype- lithium (Eskalith; Lithobid)
BIGUANIDES
Prototype- metformin (Glucophage) (PO)
CNS Stimulants: Drugs for ADHD
Prototype- methylphenidate (Ritalin)
Phosphodiesterase Inhibitors
Prototype- milrinone (Primacor)- (IV drip)
Opioid Agonists
Prototype- morphine (Duramorph); codeine, fentanyl, hydromorphone (Dilaudid) (most available PO, IM, IV, or via patch)
Opioid Antagonists
Prototype- naloxone (Narcan)***** (IV) Antidote for opiate overdoses****
Calcium Channel Blockers
Prototype- nifedipine (Procardia); diltiazem (Cardizem) (PO)
Nitrates
Prototype- nitroglycerin (Nitrostat) (SL, PO, IV, Spray, Topical)
Proton Pump Inhibitors
Prototype- pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) (PO)
Monoamine Oxidase Inhibitors (MAOIs)
Prototype- phenelzine (Nardil); tranylcypromine (Parnate); isocarboxazid (Marplan) (PO)
Barbiturates
Prototype- phenobarbital (Luminol) (PO, IM, IV)
ALPHA-ADRENERGIC AGONIST DRUGS
Prototype- phenylephrine (Neo-Synephrine); oxymetazoline (Afrin)•(PO, IV, and Topically)
Hydantoins
Prototype- phenytoin (Dilantin); fosphenytoin (Cerebyx) (PO/IV)
Hydantoin (Dilantin)
Prototype- phenytoin (_____): Usually given PO, if given IV should NEVER mix with dextrose (causes precipitate)****; only give with IV saline
Statins
Prototype- pravastatin (Pravachol); simvastatin (Zocor) (PO)
Alpha Adrenergic Blockers (-"osin" suffix)
Prototype- prazosin (Minipress); doxazosin (Cardura)- (PO)
Laxatives: Bulk-forming
Prototype- psyllium (Metamucil) (PO)
Potassium-Sparing Diuretics
Prototype- spironolactone (Aldactone)
Vaproate
Prototype- valproic acid (Depakene/Depakote) (PO)
ALPHA-GLUCOSIDASE INHIBITORS
Prototype: acarbose (Precose)
Mucolytic
Prototype: acetylcysteine (Mucomyst) (Inhalation & PO)
THROMBOLYTIC DRUGS (CLOT-BUSTERS)
Prototype: alteplase (Activase, tPA); streptokinase (Streptase) (IV)
Methylxanthines
Prototype: aminophylline (Theophylline)
ASPIRIN (ANTIPLATELET)
Prototype: aspirin (PO)
anticholinergic drugs
Prototype: atropine (Atropair) blocks acetylcholine at the muscarinic receptor
Centrally Acting Muscle Relaxants
Prototype: baclofen (Lioresal) (PO)
Anticholinergics to Treat Parkinsons
Prototype: benztropine (Cogentin); diphenhydramine (Benadryl) (PO)
Anticonvulsants for Partial Seizures
Prototype: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO)
Beta Blockers (- "olol" suffix)
Prototype: carvidolol (Coreg) metoprolol (Lopressor) (PO)
Beta Blockers (- "olol" suffix)
Prototype: carvidolol olol (Coreg) metoprolol (Lopressor) (PO)
Second Generation-Antihistamines
Prototype: cetirizine (Zyrtec), loratadine (Claritin) (PO)
Direct Acting Skeletal Muscle Relaxants
Prototype: dantrolene (Dantrium) (PO or IV)
Antitussives
Prototype: dextromethorphan (Robitussin DM; Delsym) (PO)
Cardiac Glycosides
Prototype: digoxin (Lanoxin) (PO, IV)
First Generation-Antihistamines
Prototype: diphenhydramine (Benadryl) (PO, IM, IV)
Serotonin Norepinephrine Inhibitors
Prototype: duloxetine (Cymbalta); venlafaxine (Effexor) (PO)
LOW MOLECULAR WEIGHT HEPARIN (LOVENOX)
Prototype: enoxaparin (Lovenox) (SQ)
ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC
Prototype: epoetin alfa; erythropoietin (Epogen; Procrit) (SQ)
IRON SUPPLEMENTS
Prototype: ferrous sulfate (iron) (PO)
Loop Diuretics
Prototype: furosemide (Lasix)
Loop Diuretics
Prototype: furosemide (Lasix) (PO, IV, & IM)
Sulfonylureas
Prototype: glipizide (Glucotrol); glyburide (Micronase) (PO)
TREATMENT FOR SICKLE CELL ANEMIA
Prototype: hydroxyurea (Droxia) (PO)
Dopaminergic
Prototype: levodopa-carbidopa (Sinemet); bromocriptine (Parlodel) (PO)
LOCAL ANESTHETICS
Prototype: lidocaine (Xylocaine) (various location of injections; patch)
Angiotension II Receptor Blockers (ARBs)(-"sartan" suffix)
Prototype: losartan (Cozaar); valsartan (Diovan) (PO)
Gastrointestinal Stimulants (Stomach Emptying)
Prototype: metoclopramide (Reglan) (PO, IM, IV)
Leukotriene Modifiers
Prototype: montelukast (Singulair)
Growth Hormone Excess
Prototype: octreotide (Sandostatin) (SQ)
Nasal and Systemic Decongestants
Prototype: oxymetazoline (Afrin) (intranasal spray)
barbiturates (- "tal" suffix)
Prototype: phenobarbital (Luminal); pentobarbital (Nembutal) (PO, IM, IV) THINK: (- "tal" suffix)
GENERAL ANESTHETIC
Prototype: propofol (Diprovan)
MEGLITINIDES
Prototype: repaglinide (Prandin)
THIAZOLIDINEDIONES
Prototype: rosiglitazone (Avandia)
Growth Hormone Deficiency
Prototype: somatrem (Genotropin) (IM, SQ)
NEUROMUSCULAR JUNCTION BLOCKER(AKA "PARALYTIC AGENT")
Prototype: succinylcholine (Anectine) (IV)
ANTIMIGRAINE: "TRIPTANS"
Prototype: sumatriptan (Imitrex); zolmitriptan (Zomig) (PO/SQ/Nasal spray)
WARFARIN (COUMADIN) (ANTICOAGULANT)
Prototype: warfarin (Coumadin) (PO) oral* anticoagulant
Sedative/Hypnotic
Prototype: zolpidem (Ambien)* (PO)
OPIOID AGONIST-ANTAGONISTS (PARTIAL AGONISTS)
Prototypes: nalbuphine HCl (Nubain); butorphanol (Stadol); pentazocine (Talwin)
Benzodiazepines
Prototypes:- clonazepam (Klonopin); lorazepam (Ativan); diazepam(Valium)
Orphan drug act of 1983
Provided incentives for the development of orphan drugs for treatment of rare diseases
Negative symptoms
Psychosis / Schizophrenia apathy, poor personal hygiene, withdrawn, poverty of speech
Positive symptoms
Psychosis / Schizophrenia delusions, hallucinations, bizarre behavior
pt teaching for OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)
Pt teaching: report any abnormal bleeding/bruising; stop 7-10 days before surgical procedures
contain
Purpose of inflammation is to _____ the injury or destroy the microorganism
OSMOTIC DIURETICS: MANNITOL (OSMITROL) leads to rapid......
RAPID FLUID AND ELECTROLYTE LOSS*; PROMOTES LOSS OF WATER WHILE RETAINING SODIUM
OSMOTIC DIURETICS
ROTOTYPE: MANNITOL (OSMITROL) (IV)
alpha-adrenergic antagonists
Rapid onset, peak, and duration of action; works on alpha receptors (vasoconstriction) Injection/IV-to treat shock and shock-like symptoms (highly vesicant) Topically/Eye drop- pupil dilation for eye exam
Neuroleptic Malignant Syndrome
Rare but potentially fatal condition associated with antipsychotic drugs Muscle rigidity, sudden high fever, altered mental status, BP fluctuations, tachycardia, dysrhythmias, incontinence, seizures, organ failure
NOTE about Proton Pump Inhibitors
Recent studies have suggested an increase in fractures because the drug interferes with calcium absorption Don't crush, chew or break sustained release Take once a day prior to eating in the morning
anti-inflammatory agents
Reduce body temperature (antipyretic) •Inhibit platelet aggregation-aspirin (anticoagulant) •dysmenorrhea
TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia)
Reduces the frequency of painful sickle cell crisis; decreases need for blood transfusions in sickle cell clients
Liver
Referred to in the text as a sewage treatment plant where everything that is absorbed from the G.I. tract first enters into this organ to be treated
Short acting insulin
Regular (Humulin R, Novolin R) Onset- 30-60 min; Peak- 2-4 hrs; Duration- 6-12 hrs
NURSING CARE FOR NON-INSULIN DIABETIC DRUGS
Regulate diet, exercise, medications Follow-up for lab tests Teach signs/symptoms of hypoglycemia and action to take Teach self-blood glucose monitoring
INSULIN
Released from beta cells of islets of Langerhans in response to an increase in blood glucose
OPIOID AGONISTS
Relieve moderate to severe pain Reduce pain perception in the brain Produce sedation, euphoria Reduce anxiety often caused with pain Produce miosis (pupillary constriction
pain medication mechanism of action
Relieve pain by binding to opioid receptors in the brain and spinal cord; some receptors have been found in the periphery Bind in different ways to different receptors to varying degrees- different actions are classified on this basis
Excretion
Removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, or feces
Drugs usually work 1 in 4 ways
Replace or act as substitutes for missing chemicals (i.e. insulins) Increase or stimulate certain cellular activities Depress or slow cellular activities (seizure patients) Interfere with functioning of foreign cells, such as invading microorganisms or neoplasm (antibiotics)
zolpidem (Ambien)
Requires: Schedule IV Also works on GABA/CNS depression Used for insomnia / sleeping pill Give immediately before bedtime; onset 7-27 minutes
Antiemetics Nonpharmacologic measures
Rest Weak tea Flattened carbonated beverage Gatorade, Pedialyte Crackers, dry toast
Heart failure results in
Results in increased cardiac workload, myocardial dysfunction, and worsening heart failure
reversal agent for heparin
Reversal agent: Protamine Sulfate
Uses for steroids (prt 2)
Rheumatic disorders Shock Skin disorders Transplant rejection prophylaxis
Neuroleptic Malignant Syndrome (NMS)
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (e.g., bromocriptine). THINK: abrupt withdrawal of Dopaminergic drugs may cause this
parentally
Route of administration in which a drug is injected
Adverse effects: Propylthiouracil (PTU) and methimazole (Tapazole)
S/Sx of hypothyroidism; bradycardia, anemia, slowed body movements, emotional dullness, weight gain, constipation
Aspirin
SALCYLATES Adverse Reactions: •Tinnitus (ringing in the ears)* •Gastric ulceration and bleeding* •Anaphylaxis Blood dyscrasias & thrombocytopenia* •Hyperventilation •Sweating & fever* •Dehydration & ULCERS
Low dose aspirin
SALICYLATES (baby aspirin 81mg) used for antiplatelet effect (for lifespan of platelets 8-11 days)*
aspirin
SALICYLATES is a prostaglandin inhibitor- anti-inflammatory, antipyretic, & antiplatelet properties (decreases platelet aggregation) •Gastric distress* is a common problem due to large doses needed for anti-inflammatory effect
Aspirin (ASA)
SALYCYLATES Common Side Effects: Anorexia •N/V/D •Dizziness •Confusion •Hearing loss •GI burning; epigastric pain; heartburn •Increase in bleeding time*** & ULCERS
Type I hypersensitivity reaction
SEVERE reaction and can be Life-threatening TREATMENT: Immediately D/C the drug a& administer epinephrine
URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM) discontinuation.....
SHOULD DISCONTINUE DRUG IF SCLERA OR SKIN BECAUSE YELLOW TINGED
SIDE EFFECTS of OSMOTIC DIURETICS: MANNITOL (OSMITROL)
SIDE EFFECTS: DEHYDRATION-DIZZINESS, HEADACHE, HYPOTENSION, NAUSEA, DRY MOUTH, THIRST; SUDDEN DROP IN FLUID LEVELS
SIDE EFFECTS of LOOP DIURETICS: FUROSEMIDE (LASIX)
SIDE EFFECTS: DIZZINESS, VERTIGO, ORTHOSTATIC HYPOTENSION, N/V, PARESTHESIA
side effects of URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM)
SIDE EFFECTS: GI UPSET, HEADACHE, RASH, *REDDISH-ORANGE COLORING OF URINE, SKIN, & SCLERA (EYES) STAINING OF CONTACT LENSES*, RENAL OR HEPATIC TOXICITY
side effects of POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)
SIDE EFFECTS: HYPERKALEMIA (LETHARGY, CONFUSION, ATAXIA, MUSCLE CRAMPS, CARDIAC ARRHYTHMIAS), DIZZINESS, HA, DIARRHEA, HIRSUTISM, GYNECOMASTIA
side effects of ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
SIDE EFFECTS: HYPERTENSION RELATED TO INCREASING HEMATOCRIT LEVEL; RISK FOR THROMBOTIC EVENT (MI, STROKE, DVT); HEADACHE & BODY ACHES; SEIZURES
side effects of CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE (DIAMOX)
SIDE EFFECTS: WEAKNESS, FATIGUE, PARESTHESIA OF EXTREMITIES, CONFUSION, DROWSINESS, RAPID SHALLOW BREATHING, ANOREXIA, BONE MARROW SUPPRESSION
PERMETHRIN (NIX)
SKIN DISORDERS: SCABIES OR PEDICULOSIS
NOTE for URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN)
SPASMS CAN LEAD TO DYSURIA, URGENCY, INCONTINENCE, NOCTURIA
SKIN DISORDERS: SCABIES OR PEDICULOSIS
SYMPTOMS OFTEN OCCUR DUE TO THE BURROWING OF THE MITE & LAYING OF EGGS; CAUSES SEVERE ITCHING & MAY LEAD TO SECONDARY INFECTIONs
Aspirin
Salicylates *Not recommended for children/adolescents; especially w/ viral infections (Reye's syndrome)
Benzodiazepine (pam/lam)
Schedule IV (schedule 4) due to risk of dependence/addiction Potentiates the effects of GABA which is an inhibiting neurotransmitter
cetirizine (Zyrtec), loratadine (Claritin)
Second Generation-Antihistamines
Zolpidem (Ambien)
Sedative/Hypnotic
70%
Seizures are controlled in about _____ of patients with the drugs Usually taken throughout the person's lifetime May trial a discontinuance if no seizure in several years
SELECTION OF PAIN MEDICATION
Selection of an analgesic is based on: •Effectiveness of the agent •Duration of action •Desired duration of therapy •Ability to cause drug interactions •Hypersensitivity of the patient •Available routes of drug administration
celecoxib (Celebrex)
Selective COX-2 inhibitors
ATIENT-CONTROLLED ANALGESIA (PCA)
Self-administration of IV doses of opioid analgesics using a special infusion pump Used for acute pain after surgery Also for chronic pain in an outpatient setting (IV or possibly through an epidural catheter)
Stevens-Johnson Syndrome (SJS)
Serious disorder characterized by ocular and/or genital lesions in addition to skin involvement usually triggered by a drug; young adults and 10% of body surface involved THINK: adverse effect of Anticonvulsants for Partial Seizures: carbamazepine (Tegretal); oxcarbazepine (Trileptal); topiramate (Topamax) (PO
SS
Serotonin Syndrome Onset-within minutes to hours of taking any serotonin drug Hyperreflexia; agitation Elevated temp Hyperactive bowels (N/V/D)•Usually resolved w/in 24 hours Tx: benzodiazepines; SSRI, SNRIs
Antimetics: Prototype: ondansetron (Zofran) (PO/IV)
Serotonin receptor antagonists- most effective for chemotherapy- related N & V- no EPS effects, less drowsiness Side effects: HA, dizziness, drowsiness, myalgia, urinary retention, constipation
What measurements are usually part of screening performed for lipid disorders
Serum cholesterol and triglyceride measurements
MEGLITINIDES: repaglinide (Prandin)
Short acting drugs Watch for hypoglycemic episodes Monitor liver function
antidepressants
Should not be taken with MAOIs and should not be used within 14 days after discontinuing MAOI
side effects of Loop Diuretics: furosemide (Lasix)
Side effect: ototoxicity is possible; watch for dehydration, hyponatremia, hypochloremia, hypotension*, hypokalemia*, hyperglycemia & increased uric acid
Opioid Antagonists: naloxone (Narcan)
Side effects •Tremors, sweating •Erratic BP Hypo- then Hypertension, tachycardia, hyperventilation •Nausea, vomiting •Reversal of analgesia Usually administered for respirations < 10; keep resuscitation equipment close by; may require several doses for full reversal
side effects of Nasal and Systemic Decongestants
Side effects (PO): anxiety, restlessness, HA, dizziness, nervousness, hypertension
Antimigraine: Triptans
Side effects/adverse effects: chest pressure (heavy arms or chest tightness); coronary artery vasospasm/angina; dizziness, vertigo, hypertension Use caution in people with liver disease; cardiac disease* & hypertension*
Opiate Agonists (Narcotic Analgesics)
Side effects/adverse reactions •Hypotension; orthostatic hypotension** •Sedation, confusion, blurred vision, euphoria •Lightheadedness, dizzines
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Side effects/adverse reactions: N/V, constipation, tachycardia, sweating, erectile dysfunction, *serotonin syndrome*; hypertension, urinary retention Black box warning: increased risk of suicide thoughts & behaviors, especially with children, adolescents, and young adults
ACETAMINOPHEN
Side effects: Generally safe in appropriate doses •Rash •Low incidence of GI distress
Side effects of Bile Acid Sequestrant: cholestyramine (Questran)
Side effects: Bloating and constipation may occur; flatulence, exacerbation of hemorrhoids May interfere with absorption of vitamins and minerals
Side effects of Leukotriene Modifiers: montelukast (Singulair)
Side effects: HA, dizziness, N/V, respiratory infection, pharyngitis, cough
side effects of Antacids: aluminum hydroxide (Amphojel; AlternaGel); sodium bicarbonate; calcium salts (Tums)
Side effects: May cause constipation (aluminum preparations); systemic alkalosis; gastric acid rebound when stopped NOTE: Do not block acid- they are acid neutralizers!
side effects of Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)
Side effects: Mild abdominal pain; *myalgia,*hepatitis, URI, arthralgia, and diarrhea are the most common adverse effects.
general anesthetic: propofol (Diprovan)
Side effects: apnea; respiratory depression/arrest; hypotension Must use other means of ventilation*** and respiratory support
side effects of milrinone (Primacor) = Phosphodiesterase Inhibitors
Side effects: arrhythmias, hypotension, N/V, thrombocytopenia
side effects of THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)
Side effects: bleeding***, HA, hypotension, rash, bronchospasm, pain, fever, *Reperfusion dysrhythmias can occur*
Side effects of Warfarin (Coumadin)
Side effects: bleeding***, petechiae, ecchymosis, tarry stools, hematemesis, hematuria
Side effects of Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor)
Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression Can *mask symptoms of hypoglycemia*
sedative zolpidem (Ambien)*
Side effects: daytime sedation, confusion, amnesia, dizziness, depression w/ suicidal thoughts Adverse effects: severe neuropsychiatric reactions; hallucinations, sensory distortion, sleepwalking, nocturnal eating
side effects of Bulk-forming laxatives = psyllium (Metamucil)
Side effects: diarrhea, abdominal cramps, bloating
side effects of Laxatives: stool softeners = docusate (Colace)
Side effects: diarrhea, abdominal cramps, bloating
side effects of saline (osmotic) laxative = polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema)
Side effects: diarrhea, abdominal cramps, bloating
Side effects of Angiotension II Receptor Blockers (ARBs): losartan (Cozaar); valsartan (Diovan)
Side effects: dizziness, HA, diarrhea, abdominal pain, hypotension
Side effects of Calcium Channel Blockers: nifedipine (Procardia); diltiazem (Cardizem)
Side effects: dizziness, HA, peripheral edema*, bradycardia, flushing
calcium channel blockers = nifedipine (Procardia); diltiazem (Cardizem)
Side effects: dizziness, HA, peripheral edema*, bradycardia, flushing **Avoid grapefruit juice*** (may cause toxic level of medication)
side effects of TREATMENT FOR SICKLE CELL ANEMIA: hydroxyurea (Droxia)
Side effects: dizziness, HA, rash, erythema, anorexia, N/V, stomatitis, bone marrow depression
Side effects of First Generation-Antihistamines: diphenhydramine (Benadryl)
Side effects: drowsiness, sedation, dizziness, epigastric distress, thickening of bronchial secretions, urinary retention, rash, bradycardia
Side effects of Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin)
Side effects: drowsiness, tiredness, dry mouth; stomach pain (but less drowsiness/tiredness than 1stgeneration)
side effects for epoetin alfa; erythropoietin (Epogen; Procrit)
Side effects: hypertension related to increasing hematocrit level; risk for thrombotic event (MI, stroke, DVT); headache & body aches; seizures, dizziness, edema, N/V/D
Side effects of Intranasal Corticosteroids: fluticasone (Flonase)
Side effects: local burning & irritation, stinging & drying of the nasal mucosa, HA, increase in risk of infection
side effects of Antitussives: dextromethorphan (Robitussin DM; Delsym)
Side effects: nausea, dizziness, drowsiness, respiratory depression
side effects Mucolytic: acetylcysteine (Mucomyst)
Side effects: nausea, stomatitis, urticaria, bronchospasm, rhinorrhea
Side effects of IRON SUPPLEMENTS: ferrous sulfate (iron)
Side effects: nausea, vomiting, constipation*, may cause *dark/tarry stools* often mistaken for GI bleed
Dopaminergic: levodopa-carbidopa (Sinemet); bromocriptine (Parlodel) (PO)
Side effects: nausea, vomiting, drowsiness; dyskinesias (head bobbing, tics, grimacing, tremors-may be signs of toxicity); orthostatic hypotension; cardiovascular effects (tachycardia, irregular heartbeat, palpitations); psychosis; harmless discoloration of sweat & urine (dark brown or red)
Side effects of Expectorants: guaifenesin (Mucinex)
Side effects: nausea, vomiting, headache, dizziness
Side effects of Anticholinergics (inhaled): ipratropium (Atrovent)
Side effects: nervousness, dizziness, HA, nausea, GI distress, palpitations
side effects of Beta2 adrenergic agonists: epinephrine (Adrenalin)
Side effects: nervousness, tremor, tachycardia , palpitations, dysrhythmias, angina, elevated BP, and hyperglycemia*
side effects of Gastrointestinal Stimulants (Stomach Emptying): metoclopramide (Reglan)
Side effects: restlessness, drowsiness, fatigue, extra-pyramidal effects, Parkinson-like reactions, nausea, diarrhea
Vaproate: valproic acid (Depakene/Depakote)
Side effects: sedation; drowsiness; GI upset** (nausea, vomiting, indigestion); prolonged bleeding time; hepatotoxicity*; pancreatitis; HA, tinnitus
Phenytoin (Dilantin)
Side effects: slurred speech, ataxia, tremor, confusion, thrombocytopenia, leukopenia, agranulocytosis; and gingival hyperplasia**; dysrhythmias; hypotension; hyperglycemia; Stevens Johnsons syndrome; if toxicity occurs may see nystagmus Drug inhibits release of insulin if taken for long periods of time; interferes with folic acid absorption
Side effects of ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
Side effects: tachycardia, arrhythmias, rash, gastric irritation, peptic ulcers, bone marrow suppression, hypotension
Side effect of low molecular weight heparin: enoxaparin (Lovenox)
Side effects: watch for hemorrhage/bleeding (occult blood, hematuria, bruising, bleeding gums); thrombocytopenia; use cautiously in patients with spinal anesthesia
side effects of ASPIRIN (ANTIPLATELET): aspirin
Side effects: watch for s/sx of aspirin toxicity; nausea, dyspepsia, heartburn, GI bleed, dizziness, tinnitus, urticaria, anaphylaxis, sweating, fever, hyperventilation, acidosis, increased risk of bleeding/bruising, blood dyscrasias
SCHEDULE II PRESCRIBING LIMITATIONS IN MISSOURI
Signed in original ink if written Verbal orders in an emergency by doctor only May fax if injectable, to long term care facility or hospice
ARBs: losartan (Cozaar); valsartan (Diovan)
Similar to ACE inhibitors- prevent angiotensin II from reaching receptors (bind with the receptors), causing same effect as ACE inhibitors
Angiotension II Receptor Blockers (ARBs)(-"sartan" suffix): losartan (Cozaar); valsartan (Diovan)
Similar to ACE inhibitors- prevent angiotensin II from reaching receptors (bind with the receptors), causing same effect as ACE inhibitors
Serotonin Syndrome
Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity NOTE: this is something to look for with Selective Serotonin Reuptake Inhibitors (SSRIs)
Since heparin is naturally occurring....
Since naturally occurring, there are few drug interactions (but of course, use cautiously with other anticoagulants)
barrier defenses
Skin-1st line of defense •Mucous membranes-cilia and/or mucous •Gastric acid-destroys many pathogens •Antigens-identifies "self"
NOTE smoking and its effects on Histamine Blockers (H2 antagonists): famotidine (Pepcid); cimetidine (Tagamet); nizatidine (Axid)
Smoking reduces the effectiveness
apsirin implications
Some come enteric-coated so they are designed to dissolve in the intestines instead of the stomach •Increased risk of bleeding: older than 60, use of other anticoagulants or corticosteroids, smoking, & alcohol use
diuretics are Sometimes administered.....
Sometimes are administered with other antihypertensive drugs examples- ▪Potassium sparing- spironolactone (Aldactone) ▪Thiazide- hydrochlorothiazide (Microzide)- research has shown a decrease in mortality and morbidity with use of this class for hypertension ▪Loop- furosemide (Lasix)
Antidepressants
Sometimes called mood elevators These drugs are used for depression accompanied by sadness, hopelessness and helplessness
Receptor sites
Specific areas on cell membranes that react with certain chemicals to cause and effect within the cell
INSULIN USES: prt 2
Standard treatment for Type 1 diabetics Sometimes temporarily used for Type II diabetics who may be under stress due to illness or medications & may need insulin coverage temporarily
anticonvulsants
Start on low dose and gradually increase until control is achieved Stabilize nerve cell membranes by manipulating ion influx into neurons and suppress the abnormal electric impulses in the cerebral cortex Prevent seizures but do not eliminate the cause or provide a cure Many are used for other pathologies, such as bipolar disorders, migraines, and neuropathic pain
pravastatin (Pravachol); simvastatin (Zocor)
Statins
Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray)
Stimulate adrenergic receptors to cause vascular constriction of the capillaries in the nasal mucosa- results is shrinking of the nasal mucous membranes and a reduction in fluid secretion
Nasal and Systemic Decongestants: oxymetazoline (Afrin) (intranasal spray) MOA
Stimulate adrenergic receptors to cause vascular constriction of the capillaries in the nasal mucosa- results is shrinking of the nasal mucous membranes and a reduction in fluid secretion
Adrenergic Agonists
Stimulate the sympathetic nervous system- "Fight or Flight" •Mimic norepinephrine and epinephrine
Gastrointestinal Stimulants (Stomach Emptying): metoclopramide (Reglan)
Stimulates movement of the upper GI tract without stimulating secretions; increases sensitivity to acetylcholine prevention of operative nausea & vomiting; stimulates gastric emptying
Sympathetic Nervous System Influence
Stimulates the heart Increase heart rate Speeds conduction Increase in force of contraction
Anxiety
Stimulation of SYMPATHETIC nervous system: sweating, tachycardia, tachypnea, hypertension Mild ____ can be useful BUT severe can be debilitating
Category X
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
Category B
Studies indicate no risk to the animal fetus; information for humans is not available
Category A
Studies indicate no risk to the human fetus
ORAL DIABETIC DRUGS (TYPE II DIABETES)
Sulfonylureas Biguanides Alpha-glucosidase inhibitors Thiazolidinediones
Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid)
Suppress gastric acid secretion by inhibiting the hydrogen/potassium ATPase enzyme system in gastric parietal cells- final step of acid production
Prostaglandin analogue: misoprostol (Cytotec)
Suppresses gastric acid secretion and increases cytoprotective mucus in GI tract May be used for patients on NSAIDS who experience gastric distress Side effect: N/V/D*, flatulence, hypermenorrhea, bleeding/spotting, *miscarriage* (Pregnancy Category X**)
effects of thrombocytopenia
Symptoms Easy or excessive bruising (purpura) Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs. Prolonged bleeding from cuts. Bleeding from your gums or nose. Blood in urine or stools. Unusually heavy menstrual flows. Fatigue. Enlarged spleen.
extrapyramidal syndrome (EPS)
Symptoms of abnormal posture and movement secondary to use of antipsychotic drugs
food interactions with MAOIS
Symptoms: Sweating, tremors Bounding heart rate Increased BP Increased temperature
Chemotherapeutic agents
Synthetic chemicals used to interfere with the functioning foreign foreign cell populations, causing cell death This term is frequently used to refer to the drug therapy of neoplasms, but it also refers to drug therapy affecting any foreign cell
preventing resistance
TAKE ALL OF THE PRESCRIPTION
URINARY TRACT ANALGESIC: PHENAZOPYRIDINE (PYRIDIUM) pt teaching
TEACH PATIENT ABOUT URINE DISCOLORATION & STAINING OF CLOTHING
GENERAL NURSING CARE DIURETICS TEACHING
TEACH PATIENT TO READ LABELS AND WATCH SODIUM AND POTASSIUM INTAKE- IF ON POTASSIUM WASTING DRUG- EAT POTASSIUM-RICH FOODS TEACH TO TAKE DRUG IN THE AM
Drug allergy
THEORETICALLY it should NOT happen the very 1st time exposed Be sure to assess for "true" allergies; many listed allergies by patients are other side effects and not tur allergies
challenges
THERAPY _______ FOR VIRAL INFECTIONS: Difficult for drug to find virus without injuring normal cells •Each antiviral drug specific to one particular virus
HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT)
THIAZIDE DIURETICS
rosiglitazone (Avandia)
THIAZOLIDINEDIONES
Barbiturates
THINK: -tal Side effects: somnolence, agitation, confusion, ataxia, CNS depression, hallucinations, bradycardia, hypotension, syncope, N/VD, or constipation, hypoventilation, apnea
Selective Serotonin Reuptake Inhibitors
THINK: SSRIs May cause cholinergic effects, insomnia, headache, dizziness, nervousness, tremor, seizures, anorexia, nausea, diarrhea, sexual dysfunction, suicidal ideation, & weight changes Watch for Serotonin Syndrome
adverse effects of glipizide (Glucotrol); glyburide (Micronase)
THINK: SULFONYLUREAS *hypoglycemia, weight gain, hypersensitivity reactions, GI distress, N/V/D, heartburn and hepatotoxicity Alcohol ingestion may cause disulfiram-like reaction- flushing, palpitations, nausea
Grapefruit juice inhibits drug metabolism
THINK: Statins: pravastatin (Pravachol); simvastatin (Zocor) what is a food that SHOULD NOT be taken with this drug???
Fluoroquinolones ("-acin" suffix)
THIS DRUG SHOULD BE MONITORED FOR: •Dysrhythmias and hepatotoxicity are the most serious adverse effects; tendon rupture •Monitor for prolonged QT interval in cardiac patients •**Not approved for children under 18 because of potential for affecting cartilage development* •Avoid use in pregnancy or if breast feeding
alteplase (Activase, tPA); streptokinase (Streptase)
THROMBOLYTIC DRUGS (CLOT-BUSTERS)
POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) treats....
TREAT EDEMA ASSOCIATED WITH HEART FAILURE, LIVER DISEASE, OR RENAL DISEASE; TREATS HYPERALDOSTERONISM
POTASSIUM CHLORIDE (KCL)
TREATMENT FOR HYPOKALEMIA
hydroxyurea (Droxia)
TREATMENT FOR SICKLE CELL ANEMIA
Antimigraine Agents
TRIPTANS: Used to stop a migraine headache; vasoconstriction of cranial vessels; usually works within 10-20 minutes
Adrenergic
TYPES OF RECEPTORS: •Alpha1- constricts blood vessels, dilates pupils •Alpha2- inhibits release of norepinephrine •Beta1- increases heart rate and force of contraction, releases renin •Beta2- inhibits smooth muscle
Cholinergic
TYPES OF RECEPTORS: •Nicotinic- stimulates smooth muscle and gland secretions •Muscarinic- decreases heart rate and force of contraction, stimulates smooth muscle and gland secretions
Alpha 1
TYPES OF RECEPTORS: Adrenergic constricts blood vessels, dilates pupils
Beta 1
TYPES OF RECEPTORS: Adrenergic increases heart rate and force of contraction, releases renin
Alpha 2
TYPES OF RECEPTORS: Adrenergic inhibits release of norepinephrine
Beta 2
TYPES OF RECEPTORS: Adrenergic inhibits smooth muscle
Muscarinic
TYPES OF RECEPTORS: Cholinergic decreases heart rate and force of contraction, stimulates smooth muscle and gland secretions
Nicotinic
TYPES OF RECEPTORS: Cholinergic stimulates smooth muscle and gland secretions
Problems related to OTC drug use
Taking these drugs could mess the signs and symptoms of underlining disease, making diagnoses difficult Taking these drugs with prescription medication could result in drug interactions and interfere with drug therapy Not taking these drugs as directed could result in serious overdoses
Nursing Care- Steroids
Teach appropriate use of drugs- on time and as directed Alert other care givers about use Don't stop drug abruptly Avoid infection
Nursing Care- Drugs for Gastric Acid Disorders pt teaching
Teach nonpharmacologic methods for reducing pain from gastric acid secretion Teach how to take drugs and explain side/adverse effects Teach to report any GI bleeding
NURSING CARE- ANTICOAGULANTS (prt 2)
Teach not to smoke during therapy- increases metabolism and need for more Coumadin No aspirin; avoid NSAIDS Avoid large amounts of green leafy vegetables if taking Coumadin (be consistent & consume in moderation) Encourage patient to wear a Medic-Alert bracelet Use cautiously in trauma patients; need to stop most anticoagulants/antiplatelets 7-10 days prior to scheduled surgery
Nursing Care- Antihypertensives (prt 2)
Teach other nonpharmacologic methods to lower BP- stress reduction, weight control, no smoking or caffeine, etc. Teach to sit or stand slowly until used to drug Teach adherence to drug regimen- don't stop or miss doses Lab tests may be necessary- such as BUN, creatinine, blood glucose levels
Nursing Care/Implications- Anticonvulsants (prt 2)
Teach patient and family about environmental protection from injury in case seizures occur Teach to avoid alcohol and other CNS depressants Patient should have medic-alert bracelet/necklace Do not abruptly stop drug therapy Teach to keep dental appointments at regular intervals (phenytoin)
teach pt using Mucolytic: acetylcysteine (Mucomyst) to.....
Teach patient appropriate use of drug nebulizer
NURSING CARE- THROMBOLYTICS (prt 2)
Teach patient bleeding precautions Monitor vital signs Avoid using aspirin, NSAIDS
Nursing Care- Drugs for Heart Failure (prt 2)
Teach patient to monitor daily weights- report if 2 lb/day or 5 lbs/week No smoking, alcohol, limit caffeine Teach to report dyspnea, frothy sputum, excessive fatigue, edema
nursing care for antidepressants
Teach patient to not stop abruptly; ***taper off of medications***
Nursing Care- Diuretics (prt 2)
Teach patient to read labels and watch sodium and potassium intake- if on potassium wasting drug- eat potassium-rich foods Patient may be on fluid restriction Teach to take drug in the AM Monitor pulse and BP- sit and stand slowly until becoming used to the drugNursing Care- Diuretics
Nursing Care- Antimetics pt teaching
Teach to avoid alcohol Safety precautions if driving, operating machinery, etc.
Hydantoins: Prototype- phenytoin (Dilantin) & fosphenytoin (Cerebyx)
Teratogenic to fetus during pregnancy***;cleft palate & heart defects; (cat. D); & can interfere with birth control Serum drug level should be in therapeutic range- 10-20 mcg/ml*****
vaproate: valproic acid (Depakene/Depakote)
Teratogenic** (cleft palate & heart defects) (Cat. D & X) Interferes with many drugs
Smooth ER
That portion of the endoplasmic reticulum that is free of ribosomes.
Liver
The _____ is the most important site of drug metabolism, or bile transformation, the process by which drugs are changed them to new, less active chemicals Think of this organ as a sewage treatment plant: everything that is absorbed from the G.I. tract first enters this organ to be treated then this organ detoxifies many chemicals and uses others to produce needed enzymes and structures
Half life
The absorption rate, the distribution to the tissues, the speed of bio transformation, and how fast the drug is excreted are all taken into consideration when determining the ______ of the drug
Urine
The acidity of ______ can play an important role and drug excretion
Dynamic equilibrium
The actual concentration that a drug reaches in the body results from a _______ _______ involving the rate of several processes: Absorption from the side of entry Distribution to the active site Biotransformation or metabolism in the liver Excretion from the body
combination therapy
The administration of two or more antimicrobial medications simultaneously to prevent the growth of mutants that might be resistant to one of the antimicrobials
aminocaproic acid (Amicar)
The anti-thrombolytic drug _____ _____ may be used to stop the hemorrhage
immune response
The body's defensive reaction to invasion by bacteria, viral agents, or other foreign substances.
3.It is possible that this medication may cause discoloration of your urine and sweat.
The client is taking levodopa-carbidopa (Sinemet). Which of the following should the nurse include in his patient teaching? 1.This drug has been shown to be a very effective cure for Parkinson's disease. 2.On occasion, clients normally develop a fever while taking this medication. 3.It is possible that this medication may cause discoloration of your urine and sweat. 4.You should try to add additional Vitamin B6 to your diet.
Hyponatremia
The client is taking lithium (Eskalith). In order to decrease the risk of toxicity, it is important for the client to avoid what condition? 1.Hyperkalemia 2.Hypoglycemia 3.Hypernatremia 4.Hyponatremia
Gluconeogenesis
The combination of small carbon containing compounds to yield glucose.
Critical concentration
The concentration of a drug must reach in the tissues that respond to the particular drug to cause the desired therapeutic affect
patient teaching
The drug class Barbiturates (- "tal" suffix) must include important ____ ____ to AVOID alcohol or other CNS depressant drugs when taking this medication if not there is risk for respiratory depression, comma , & death
Conical pharmacology address is two key concerns
The drugs affect on the body in the body's response to the drug
G1 phase
The first gap, or growth phase, of the cell cycle, consisting of the portion of interphase before DNA synthesis begins.
renal injury
The glomerulus in the kidney has a very small capillary network that filters the blood into the renal tubule. Some drug molecules are just the right size to get plugged into the capillary network, causing acute inflammation and severe renal problems. Some drugs are excreted from the kidney unchanged; they have the potential to directly irritate the renal tubule and alter normal absorption and secretion processes.
first pass effect
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.
Receptor site
The interactions between the chemical and the ____ ____ affects enzyme systems within the cell The activated enzyme system then produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations and cellular metabolism
trough level
The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.
peak level
The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring.
Protein
The more bound to the _____, the more difficult it can be for the medication to be released and able to cross membranes to get to the tissue cells The drug must be freed from the proteins binding site to act on the tissues
Active transport
The movement of substances across a cell membrane against the concentration gradient; this process requires the use of energy
Cheese
The nurse would tell the client who is taking an MAOI to avoid which of the following foods? 1.Peanut butter 2.Carrots 3.Cheese 4.Romaine lettuce
Generic name
The original designation that I drug is given when the drug company that developed it applies for the approval process
Fast pass effect
The portion of the drug that gets through the ______ ______ ____ is delivered to the circulatory system for transport throughout the body
glucose metabolism
The process by which cells commonly obtain energy by breaking the chemical bonds of glucose molecules and use this energy to form ATP
150
The recommended dose of a drug is based on drug evaluation studies and is targeted at a ______ pound person
Exocytosis
The removal of large amounts of material from a cell by pushing them through the cell membrane
G2 phase
The second growth phase of the cell cycle, consisting of the portion of interphase after DNA synthesis occurs.
Pharmacodynamics
The study of the interactions between the chemical components of living systems and the foreign chemicals, including drugs, that inter-living organisms; the way a drug affects the body
S phase
The synthesis phase of the cell cycle; the portion of interphase during which DNA is replicated.
Half life
The time it takes for the amount of drug in the body to decrease to 1/2 of the peak level it previously achieved
Pharmacokinetics
The way the body deals with the drug, including absorption, distribution, bio transformation, and excretion
Antiinfectives
Therapeutic Actions: Some _____ interfere with BIOSYNTHESIS of the pathogen cell wall bacterial cells have a slightly different composition than human cells this is an effective way to destroy the bacteria without affecting the host Ex. penicillin
antiinfectives
Therapeutic actions: many ______ interfere with the steps involved in PROTEIN SYNTHESIS which is a process necessary to maintain the cell and allow for cell division ex. aminoglycosides and macrolides
antiinfectives
Therapeutic actions: some _____ interfere with DNA synthesis in the cell which leads to the inability to divide and eventually cell death ex. fluoroquinolones
Antiinfectives
Therapeutic actions: some ______ PREVENT the cells of the invading organism from using substances essential to their growth and development This inhibits cell division which leads to the invading organisms death ex. sulfonamides and antimycobacterial drugs
Category D
There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.
P450 system (cytochrome P450)
These enzymes are found in most cells but are especially abundant in the liver
Orphan drugs
These may be useful in treating a rare disease, or they may have potentially dangerous adverse effects
prednisone
They are a natural hormone (adrenal cortex); and when given can actually suppress the body's own production of corticosteroids (may cause adrenal insufficiency)
hydrochlorothiazide (Microzide, HydroDIURIL, HCT)
Thiazide Diuretics
Watch for dehydration, hypokalemia*
Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) WATCH FOR ______ and hyperglycemia (may elevate blood glucose) b/c this drug affects these things
Tetracyclines ("-CLINES" SUFFIX)
Things to monitor and other adverse affects of this "-clines" drug: •Alteration of vaginal & intestinal flora cause diarrhea, GI upset, risk of yeast infection; Monitor for diarrhea (might develop into C. diff) •***Often causes photosensitivity! Instruct to wear sunscreen & protective clothing*** •**Take on an empty stomach; Only take antacids, milk products, and iron supplements at least 2 hours after dose was taken (ALL AFFECT ABSORPTION)
cytotoxic reaction
This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days.
serum sickness reaction
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug
Kidney dysfunction
This can lead to toxic levels of a drug in the body because the drug cannot be excreted
Curare
This drug is said to be a competitive antagonist of acetylcholine
Oral route
This is the most frequently used drug in ministration route and clinical practice It is not invasive and as a rule it is less expensive than drug in ministration by other routes It is also considered the safest way to deliver drugs
delayed allergic reaction
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.
GI upset
This was the stared side effect for Vaproate: valproic acid (Depakene/Depakote)
Very low density lipoprotein (VLDL)
Three major lipoproteins: carries mostly triglycerides and less cholesterol
High density lipoprotein (HDL)
Three major lipoproteins: contains less fat
Low density lipoprotein (LDL)
Three major lipoproteins: contains more fat
Signs of Thyroid Hormone Hypersecretion
Thyroid Hormone Excess-: known as Graves disease Tachycardia Palpitations Dysrhythmias Diaphoresis
drug half life
Time required for one-half of an administered drug to be lost through metabolism and elimination. the time required for the amount of drug in the body to decrease by 50%
Drug
To become a ________, a chemical must have a demonstrated therapeutic value or efficacy without severe toxicity or damaging properties
How drugs work
To depress or slow cellular activities
How drugs work
To increase our stimulate certain cellular activities
How drugs work
To interfere with the functioning of foreign cells, such as invading micro organisms or neoplasms leading to cell death Drugs at acting this way or called chemotherapeutic agents
How drugs work
To replace or act as substitutes for missing chemicals
levothyroxine
To treat thyroid deficiency-(replaces hormones) T4 and T3 are the primary hormones
Synthetically
Today, many drugs are developed _________ after chemicals and plants, animals, or the environment have been tested and found to have therapeutic activity
Ototoxicity
Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is likely to be permanent.
levothyroxine (Synthroid)
Treating Thyroid Hormone Deficiency
Prototype- Propylthiouracil (PTU) and methimazole (Tapazole)
Treating Thyroid Hormone Hypersecretion
inflammation
Treatment Strategies for ____: ____ is a nonspecific process •Identify cause and remove it if possible •Most of the time it is mild and self-limiting •Use topical agents (creams, ointments, patches, intranasal sprays) when possible•Goal of treatment is to reduce intensity of inflammatory response •Common diseases that benefit from anti-inflammatory meds: allergic rhinitis, anaphylaxis, contact dermatitis, Crohn's disease
systemic infections
Treatment of ____ ____: Factors of treatment must include the identification of the CORRECT pathogen and then selecting the drug that is MOST likely to cause the LEAST complications for the patient and be the the MOST effective against the pathogen involved
Second Generation-Antihistamines: cetirizine (Zyrtec), loratadine (Claritin) used for.....
Treats allergy symptoms, hay fever, hives & itching, watery itchy eyes, sneezing
tissue invading worm infections
Trichinosis (lung, heart, brain) Filariasis (lymphatic tissue) Shistosomiasis (liver, spleen, CNS, cardiac)
4 groups of antidepressants
Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) Serotonin norepinephrine inhibitors (SNRIs)
SULFONYLUREAS
Two generations of drugs --- Second generation drugs are effective at lower doses, have a longer duration of action, and cause fewer side effects Has similar side effects as insulin-( hypoglycemia)
Short-Acting
Types of corticosteroids: Cortisone & hydrocortisone
Long-Acting
Types of corticosteroids: Dexamethasone & betamethasone
Intermediate Acting
Types of corticosteroids: Prednisone & methylpredmisolone
Food interactions with MAOIs
Tyramine: Cheese Bananas, raisins, papaya Avocados, figs Pickled foods Red wine, beer Sour cream, yogurt Chocolate, coffee Fava beans Beef or chicken liver Meat extracts Pepperoni, salami, sausage Bologna, sausages, hot dogs Yeast Soy sauce Symptoms: Sweating, tremors Bounding heart rate Increased BP Increased temperature
LOOP DIURETICS: FUROSEMIDE (LASIX) increase urine.....
UNLIKE THIAZIDE DIURETICS, FUROSEMIDE CAN INCREASE URINE OUTPUT EVEN WHEN BLOOD FLOW TO THE KIDNEYS IS DIMINISHED; AKA "HIGH CEILING DIURETICS" DUE TO GREATER DEGREE OF DIURESIS
THIAZIDE DIURETICS: HYDROCHLOROTHIAZIDE (MICROZIDE, HYDRODIURIL, HCT) elevate.....
URIC ACID LEVELS MAY ELEVATE AND PRECIPITATE GOUT
PHENAZOPYRIDINE (PYRIDIUM)
URINARY TRACT ANALGESIC
OXYBUTYNIN (DITROPAN)
URINARY TRACT ANTISPASMODICS
POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE) used as.....
USED AS MILD DIURETICS OR IN COMBINATION WITH ANOTHER DIURETI
LOOP DIURETICS: FUROSEMIDE (LASIX) used in.....
USED IN ACUTE HEART FAILURE PTS & IN KIDNEY PATIENTS; ALSO WHEN EMERGENT NEED TO MOVE FLUID (EX: PULMONARY EDEMA); GIVEN PO, IV, AND IM
TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL)
USED TO TREAT OR PREVENT HYPOKALEMIA; OFTEN PRESCRIBED FOR CLIENTS TAKING POTASSIUM DEPLETING DIURETICS
ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT)
USES: *ANEMIA RELATED TO CHRONIC RENAL FAILURE; (DIALYSIS PATIENTS); ANEMIA RELATED TO CHEMOTHERAP
Damage
Unfortunately, most other chemotherapeutic agents also ______ normal human cells, causing many of the adverse effects associated with anti-pathogen and anti-neoplastic chemotherapy
room temperature
Unopened insulin may be stored at _____ NOTE: avoid sunlight and excessive heat
Monitor Thiazide Diuretics: hydrochlorothiazide (Microzide, HydroDIURIL, HCT) for......
Uric acid levels may elevate and precipitate gout
nursing considerations for pain medication
Use schedule as opposed to PRN for cancer patients & those in severe pain (trauma injuries)
use Nasal and Systemic Decongestants cautiously in clients with....
Use with caution in clients with HTN, cardiac disease, hyperthyroidism, and diabetes
atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic) = beta blockers
Use with caution in patients with asthma or heart failure Side effects: bradycardia, decreased cardiac output, AV block, orthostatic hypotension & rebound myocardium excitation (*discontinue over 1-2 weeks); heart failure, arrhythmias, bronchospasm, N/V/D, decreased libido, depression
Paralytic Agent: succinylcholine (Anectine)
Used as an adjunct to sedation in some types of surgical procedures, during intubation, or during mechanical ventilation to cause temporary flaccid paralysis (rapid onset/short duration)
spironolactone (Aldactone) = Potassium-Sparing Diuretics
Used as mild diuretics or in combination with another diuretic
First Generation-Antihistamines: diphenhydramine (Benadryl) Used for
Used for allergic & seasonal rhinitis; cold symptoms to decrease nasopharyngeal secretions; May decrease nasal itching and tickling that cause sneezing
Proton Pump Inhibitors: pantoprazole (Protonix); omeprazole (Prilosec); lansoprazole (Pravacid) used for...
Used for gastric & duodenal ulcers, erosive esophagitis, GERD
Anticoagulants are used for......
Used for venous and arterial disorders that put patients at high risk for clot formation •Deep vein thrombosis (DVT); including post-operatively •Pulmonary embolism (PE) •Coronary thrombosis (MI) •Artificial heart valves •Cerebrovascular accident (CVA)
Anticholinergic Drug: atropine (Atropair)
Used for- •Preoperative medication to decrease salivation •Antispasmodic to treat peptic ulcers •To increase heart rate when bradycardia is present
Loop Diuretics: furosemide (Lasix)
Used in heart failure pts & when emergent need to move fluid (ex: pulmonary edema); increase cardiac output by reducing fluid volume and decreasing BP; Effective in increasing urine output and decreasing peripheral edema and pulmonary congestion; Used in combination with other classes of drugs for heart failure treatment when there is evidence of fluid retention
Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil)
Used in heart failure to decrease cardiac workload- dilate vessels and reduce preload
Beta Blockers (- "olol" suffix): carvidolol (Coreg) metoprolol (Lopressor) are used in heart failure to ........
Used in heart failure to decrease cardiac workload- slow the heart rate and decrease blood pressure; Use with caution in patients with asthma or heart failure (due to negative inotropic effect)
Cardiac Glycosides: digoxin (Lanoxin)
Used in heart failure to improve cardiac output- increase the force of contraction of the heart; increased cardiac output & renal perfusion
ACE Inhibitors: Captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil)
Used in heart failure to increase cardiac output by lowering BP and decreasing blood volume Studies have shown these drugs can slow the progression of heart failure and reduce mortality Reduces preload, afterload, and blood volume to decrease workload on the heart
Phosphodiesterase Inhibitors: milrinone (Primacor)
Used in heart failure to increase cardiac output- increase the force of myocardial contraction Block the enzyme phosphodiesterase in cardiac and smooth muscle- increases available calcium for contraction and vasodilates
ANTICOAGULANTS
Used to inhibit clot formation by prolonging bleeding time Do not dissolve clots that have already formed- act to prevent clots from forming or growing larger
Drugs for Lipid Disorders
Used to maintain or decrease blood lipid (cholesterol) concentrations
warfarin (Coumadin) is used to.....
Used to prevent thromboembolic conditions- also for atrial fibrillation (high risk for clots); onset is delayed so usually given as follow up to Heparin/Lovenox; used for more long-term treatment
OTHER ANTIPLATELET DRUGS: clopidogrel (Plavix); ticagrelor (Brilinta); ticlopidine (Ticlid)
Used to prevent thrombosis in the arteries by suppressing platelet aggregation
Low Molecular Weight Heparin (LMWH): enoxaparin (Lovenox)
Used to prevent venous thromboembolism Lower risk of bleeding than regular heparin; do not affect thrombin, clotting, or PT as MUCH and cause fewer systemic effects
THROMBOLYTIC DRUGS (CLOT-BUSTERS): alteplase (Activase, tPA); streptokinase (Streptase)
Used to promote conversion of plasminogen to plasmin, which destroys fibrin of blood clot and results in breakdown of clot- also called fibrinolytic drugs (clot busters)
ADH
Used to treat Diabetes insipidus- a deficiency of ADH- large amounts of water and electrolytes excreted- very dilute urine (low specific gravity); loses lots of urine; *has increased thirst***
atypical antipsychotics (2nd Gen)
Used to treat both positive and negative symptoms Not as likely to cause EPS; Several drugs in the class Weight gain is a common side effect*
somatrem (Genotropin) (Growth Hormone Deficiency)
Used to treat growth failure in children (dwarfism) Should be given before epiphyses have closed Start early in life for best results Must monitor glucose tolerance and thyroid function
sliding scale insulin
Used to treat temporary anticipated blood glucose elevations; ***sometimes patients must temporarily be on insulin during illness even though they have previously been managed or oral medications***
Uses for epoetin alfa; erythropoietin (Epogen; Procrit)
Uses: *Anemia related to chronic renal failure; (dialysis patients); anemia related to chemotherapy
dopaminergic
Uses: restores neurotransmitter dopamine; relieving some symptoms such as tremor bradykinesia, gait, & muscle rigidity
octreotide (Sandostatin) (Growth Hormone Excess)
Usually caused by pituitary tumor GH antagonist- suppresses growth hormone release Gigantism- excessive growth during childhood Acromegaly- excessive growth after puberty- bones become deformed Treatment- surgery, radiation, medication
Anticholinergics (inhaled): ipratropium (Atrovent) is usually given by.....
Usually given by metered dose inhaler 3-4 times a day Fewer side effects with inhaled drugs, as opposed to PO anticholinergics
Autonomic Nervous System Influence
Vagus nerve-slows heart conduction
valproic acid (Depakene/Depakote)
Vaproate: Widespread anti-seizure action; GABA & calcium channels•Used to treat a variety of seizures & migraines
Drugs for Gastric Acid Disorders
Various classes of drugs are used to treat medical conditions caused/aggravated by stomach acid
BP decreases and sodium and water are retained- cause peripheral edema- may give diuretics to decrease edema
Vasodilators: hydralazine (Apresoline) & isosorbide dinitrate- (Isordil)
Plant Alkaloids
Vincristine sulfate (oncovin), vinblastine sulfate (velban); indicated for ALL, Hodgkin, Wilms tumor, sarcoma, breast cancer, testicular cancer; adverse reactions: bone marrow suppression, neurotoxicity, weakness, paresthesia, jaw pain, constipation, stomatitis, alopecia, headaches, minimal NV; administer antiemetic, monitor for neurotoxicity
URINARY TRACT ANTISPASMODICS SIDE EFFECTS & NURSING CONSIDERATIONS
WATCH FOR POTENTIAL INCREASE IN INTRAOCULAR PRESSURE (DEVELOPING OF GLAUCOMA) MONITOR I&O; OFFER SIPS OF WATER OR HARD CANDY TO HELP WITH DRY MOUTH
weaker diuretic - POTASSIUM SPARING DIURETICS: SPIRONOLACTONE (ALDACTONE)
WEAKER DIURETICS THAN THIAZIDES AND LOOP DIURETICS; GIVEN PO
TREATMENT FOR HYPOKALEMIASIDE EFFECTS & NURSING CONSIDERATIONS
WHEN GIVEN PO CAN IRRITATE ESOPHAGUS SO GIVE DILUTED AND WHILE THE PATIENT IS UPRIGHT; CAN CAUSE VENOUS IRRITATION WHEN GIVEN IV
Gemfibrozil (Lopid) = aka Fibric Acid Agents
WITH THIS DRUG you do NOT use in combination with statins, may increase risk of rhabdomyolysis & liver damage
URINARY TRACT ANTISPASMODICS: OXYBUTYNIN (DITROPAN) works by.....
WORK BY BLOCKING PARASYMPATHETIC ACTIVITY & SUPPRESSING OVERACTIVITY
ERYTHROPOIETIC GROWTH FACTORS: FOR THE BUILDING OF RBC: EPOETIN ALFA; ERYTHROPOIETIN (EPOGEN; PROCRIT) works on....
WORKS ON THE BONE MARROW TO INCREASE THE PRODUCTION OF RBCS;
Warning about Thiazolidinediones: rosiglitazone (Avandia)
Warning about greater risk for cardiac events with use- may cause fluid retention May be used in combination with other oral hypoglycemic drugs
Cardiac Glycosides Digoxin/Lanoxin (cont'd)
Watch for dysrhythmias, especially bradycardia *Hypokalemia increases risk of digoxin toxicity** Monitor digoxin level; Digoxin level- 0.5 to 1.8 (2.0) ng/ml therapeutic range; Do not re-dose if part of the dose is not ingested
Cardiac Glycosides Digoxin/Lanoxin (cont'd prt 2)
Watch for toxicity: bradycardia; GI effects (anorexia, nausea, vomiting, & abdominal pain); CNS effects (vision changes-double vision, blurred vision, yellow/green halos around objects)****
Potassium-Sparing Diuretics: spironolactone (Aldactone)
Weaker diuretics than thiazides and loop diuretics; given PO Act in the collecting duct and late distal tubule to enhance secretion of sodium and retention of potassium (opposite of aldosterone)
Factors affecting the body's response to a drug
Weight Age Gender Psychological factors Pathological factors Genetic factors Physiological factors Immuno logical factors Environmental factors Drug tolerance Accumulation effects Interactions
acarbose (Precose)
What ALPHA-GLUCOSIDASE INHIBITOR medication is usually well tolerated- may cause abdominal cramping & distention, diarrhea, flatulence Monitor liver function***; may also decrease absorption of iron
Midazolam (Versed)
What Benzodiazepine/Pre-Operative Sedative Produces unconsciousness/amnesia; given as a pre-operative sedative; eases induction of anesthesia; conscious sedation
midazolam (Versed)
What Benzodiazepine/Pre-Operative Sedative has side effects including..... Side effects: **respiratory depression; hypotension; amnesia; potential cardiac arrest *Use continuous respiratory & cardiac monitoring*
metformin
What drug also lowers triglyceride and total and low-density lipoprotein (LDL)cholesterol level and promotes weight loss? THINK: BIGUANIDES
Systemic decongestants
What drug can relieve congestion longer than nasal decongestants ; Intranasal decongestants act more rapidly and cause less side effects
Avoid aspirin
What drug should we avoid using in children/teens with fever; stop at least a week prior to surgical procedures
Absorption
What happens to the drugs from the time it enters the body until it enters the circulating fluid; intravenous administration causes the drug to directly enter the circulating blood, bypassing the many complications of absorption from other routes
hydration
What is a very important natural expectorant; encourage fluids
Glucose
What is converted to glycogen for future glucose needs in the liver and muscle, thereby lowering blood glucose level
Glucocorticoids (cortisol)
What they do... Have significant anti-inflammatory effect Have significant immunosuppressive effects Some have mineralocorticoid activity and affect potassium, sodium, and water levels in the body
glucocorticoids
What they do... Stimulate increase in glucose levels for energy Increase rate of protein breakdown (preserves energy) Causes formation & storage of fat in the body
when given IV HEPARIN (ANTICOAGULANT) .......
When given IV, may be given as an IV bolus or continuous infusion (often via weight-based protocol)
warfarin (coumadin) cannot be given with______
Which anticoagulants drug do you not give aspirin with????
1.You should be sure to have regular dental check ups
Which of the following patient teaching points should the nurse reinforce with a patient taking phenytoin (Dilantin)? 1.You should be sure to have regular dental check ups 2.This medication does have a risk for addiction 3.You should take this medication with milk 4.This drug is safe during pregnancy
imipramine
With the Tricyclic Antidepressants (TCAs) prototype _____ (Tofranil) should.... Have a clinical response in 2-4 wks* & Should be discontinued slowly*
epoetin alfa; erythropoietin (Epogen; Procrit)
Works on the bone marrow to increase the production of RBCs; goal is return Hgb levels to 10-11 g/dL and Hct of around 33%
aspirin toxicity
____ ___ treated by correcting acidosis* (salicylic acid); activated charcoal can be given to decrease absorption• *Never give children/teens aspirin when they have flu symptoms, fever, or chickenpox due to the risk of Reye's syndrome*
COX-2
_____ Inflammatory prostaglandins: •Inflammation •Pain •Fever •Decreased platelet aggregation
helminthic infections
_____ _____ infections in GI tract or other tissues from worm infestation •Most common types in humans are the nematodes (roundworms) & the platyhelminths (flatworms)
Insulin syringes
_____ ______ are marked in units of 100 units per 1 ml for insulin U100
Opioids
_____ are narcotics (controlled substances) •Derived from opium or opium-like compounds •Potent analgesic effects •Possible significant alteration of mood and behavior •Potential for dependence and tolerance
high
_____ dose chemotherapy results in better tumoricidal effects
chemotherapy
_____ drugs are more effective against neoplastic cells that have a high growth fraction
candida
_____ is a fungus that is normal flora in our mucous membranes; generally only cause trouble when there is an imbalance
Coughing
_____ is a natural protective mechanism to clear the airway; antitussives should only be used for nonproductive coughs
malaria
_____ is a parasitic disease; vector transmission via Anopheles mosquito
Leukotriene antagonists
______ _____ and modifiers are effective in reducing inflammation triggered by allergic* and environmental stimuli
fungi
______ are unaffected by most antibiotics
Heparin; Coumadin
______ can be used during pregnancy- does not cross placental barrier- ______does, so should not be used during pregnancy
Antihypertensives
______ drugs are used when nonpharmacologic means to decrease blood pressure have not been successful (stress-reduction, exercise, salt restriction, decreased alcohol consumption, and weight reduction)
goal
______ for treatment of systemic infections is to reduce bacterial load so that the immune system can handle it
combinations
______ of anticancer agents-more effective tumoricidal activity than single-dose therapy •Two or more drugs act in several cell cycle phases & more effective at killing cells •Frequently used in conjunction with radiation and/or surgery
Anticancer
______ rugs are not selective, so both cancer cells and normal cells are affected •Side effects are related to toxic effects on normal cells
COX-1
_______ Cytoprotective prostaglandins: Gastroprotection •Increased platelet aggregation •Renal protection •Vasodilation •Bronchodilation
Insulin promotes uptake of glucose, amino acids, and fatty acids
__________ and converts them to substances that are stored in body cells (the key that allows glucose into cells)
chemical mediators
a chemical released in the body during an inflammatory response or immune response
triptans
a class of drugs commonly used to treat migraines, they work by causing dilated (enlarged) blood vessels to constrict (become smaller)
phase II study
a clinical study of a proposed drug by selected physicians using actual patients who have the disorder the drug is designed to treat; patients must provide informed consent
cost comparison
a comparison of the relative cost of the same drug provided by different manufacturers to determine the costs to the consumer
Physician's Desk Reference (PDR)
a comprehensive book listing of drug products for medical professionals
Cushing's syndrome
a condition caused by prolonged exposure to high levels of cortisol
Thrombocytopenia
a condition in which there is an abnormally small number of platelets circulating in the blood
spina bifida
a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it THINK: Anticonvulsants for Partial Seizures
shistosomiasis
a disease that results from eggs that penetrate the walls of veins of the small intestine or urinary bladder and cause tissue damage and bleeding liver, spleen, CNS< cardiac
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
Phenothiazines
a group of antihistamine drugs that became the first group of effective antipsychotic medications
renin-angiotensin-aldosterone system (RAAS)
a hormone cascade pathway that helps regulate blood pressure and blood volume
GABA (gamma-aminobutyric acid)
a major inhibitory neurotransmitter
agonist
a molecule that increases a neurotransmitter's action
HEPARIN (ANTICOAGULANT)
a natural substance in the liver that prevents clot formation; given (SQ or IV)
first pass effect
a phenomenon in which drugs given orally are carried directly to the liver after absorption, where they may be largely inactivated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses than drugs given by other routes because of this early breakdown
mechanical ventilator
a positive- or negative-pressure breathing device that supports ventilation and oxygenation OR breathing assistance provided by a ventilator, one of various types of devices that support and maintain respiratory function
Reye's syndrome (RS)
a potentially fatal condition that has been linked to giving aspirin to children suffering from viral infections
negative feedback system
a process that results in a response that reverses the original stimulus
Schizophrenia
a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression
Electrocardiogram
a record of the electrical activity of the myocardium
false (correct answer is not secondary effect but actually allergic reaction)
a secondary effect occurs when a body forms antibodies to a particular drug causing an immune response
Blood Brain Barrier (BBB)
a selective mechanism that protects the brain from toxins and infections Almost all antibiotics are not lipid soluble and cannot cross the blood brain barrier
Golgi apparatus
a series of FLATTENED sacs in the cytoplasm that prepare HORMONES or other substances for secretion and may produce lysosomes and store other synthesized proteins Package Center
nasogastric
a soft flexible tube introduced through the nose into the stomach for gavage, lavage, or suction USUALLY SHORT TERM
precipitate
a solid that forms and settles out of a liquid mixture THINK: Hydantoin (Dilantin)
apothecary system
a very old system of measure that was specifically developed for use by apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid measure
cancer
a.k.a "neoplasms" •Antineoplastic agents: a branch of chemotherapy that act on, kill, or alter human cells •Anticancer drugs are those used to kill, damage, or slow the growth of cancer cells, as well as those drugs used to prevent or treat adverse drug effects •Anticancer drug therapy is commonly known as chemotherapy •Chemotherapy causes cell death by interfering with cell replication
a PTT normal range
aPTT normal range is 25 to 35 seconds- anticoagulant effect should be 1 ½ to 2 times higher than the patient control (pre-treatment value); therapeutic aPTT is usually around apparox. 40-70 THINK: important factor for heparin dosing
resistance
ability of pathogens over time to adapt to an anti-infective to produce cells that are NO longer affected by a particular drug
blood dyscrasia
abnormal blood cell production DECREASED hematocrit (anemia)
hypertension
abnormally high blood pressure
hypotension
abnormally low blood pressure
Topical
absorbed through the skin
mucous membranes
absorbed through thin mucous membranes (mouth, vagina, etc)
drug abbreviations
ac= before meals bid=twice a day cap=capsule gtt=drop h or hr= hou rIM= intramuscular IV=intravenous
acetylcysteine (Mucomyst)
acetaminophen antidote
Vasodilators: hydralazine (Apresoline)
acts primarily on arterioles
vasodilators: isosorbide dinitrate
acts primarily on veins (Isordil)
montelukast (Singulair)
acts to inhibit bronchoconstriction by reducing inflammation
acute dystonia
acute sustained contraction of muscles, usually of the head and neck Facial grimacing involuntary upward eye movement muscle spasms of the tongue, face, beck, and back laryngeal spasms
Young rule
age of child(in yrs)/ ((age of child + 12)x adult dose)
young rule
age of child(in yrs)/age of child + 12 hrs x adult dose
adrenergic agonists (sympathomimetics)
agents that activate adrenergic receptors in the sympathetic nervous system
Alkaline substances
aluminum, magnesium, sodium, or calcium THINK: antacids treatment
gentamicin (POTH, TOP, IV & IM)
aminoglycosides (-cin) inhibit bacterial protein synthesis (BACTERICIDAL) ***Serious adverse effects: ototoxicity, nephrotoxicity, neuromuscular blockage (leads to flaccid paralysis and fatal respiratory depression)
lymphocytic
an agranulocytic leukocyte formed in lymphatic tissue Natural killer cells •B cells •T cells
ratio and proportion
an equation in which a ratio containing two known equivalent amounts is on one side and a ratio containing the amount desired to convert and its unknown equivalent is on the other side
intramuscular injection
an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm
MU cell receptor
analgesia decreased GI motility respiratory depression sedation physical dependence
Kappa cell receptor
analgesia decreased GI motility sedation
Acetaminophen (Tylenol)
analgesic, antipyretic Pain control
broad spectrum antibiotics
antibiotics that affect a broad range of gram-positive or gram-negative bacteria
ADH
antidiuretic hormone secreted by posterior pituitary Promotes water reabsorption from the renal tubules to maintain water balance (helps to hold on to water), is hemostatic & has vasopressor properties
Bacterialcidal
antimicrobial agent that directly kills bacteria
arrhythmia/dysrhythmia
any of several kinds of irregularity or loss of rhythm of the heartbeat
instillations and irrigations
applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina
inhalations
applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing
dermatological preparations
applied to the skin
salicylates
aspirin is a prostaglandin inhibitor- anti-inflammatory, antipyretic, & antiplatelet properties (decreases platelet aggregation) •Gastric distress* is a common problem due to large doses needed for anti-inflammatory effect
NSAIDS
aspirin-like drugs that inhibit COX, which is needed for biosynthesis of prostaglandins; Primarily used to relieve inflammation and pain
Beta Blockers (- "olol" suffix)
atenolol (Tenormin); metoprolol (Lopressor); nebivolol(Bystolic)
P wave
atrial depolarization
ANS
autonomic nervous system (sympathetic and parasympathetic)
Non-competitive antagonist
binds to an allosteric (non-agonist) site on the receptor to prevent activation of the receptor.
metabolism
biotransformation PIRMARY SITE = LIVER breakdown of drugs occur to change them into non-toxic substances and more easily accessed to use and excrete
Coagulation
blood changing from fluid state to solid state
leukopenia
blood dyscrasia- Abnormally low white blood cell count
anemia
blood dyscrasia- decreased hematocrit
pancytopenia
blood dyscrasia- deficiency of all types of blood cells
thrombocytopenia
blood dyscrasia- low platelet count
blood dyscrasia
bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen
Lower respiratory tract
bronchi & alveoli that make up the lungs
Intravenously (IV)
by vein, in reference to administration of drugs or nutrients
Antipsychotic drugs block dopamine
called dopaminergic antagonists- block dopamine receptors
Diastole
cardiac muscle at rest
Systole
cardiac muscle contracts
Beta2 adrenergic agonists
cause dilation of the bronchioles
mitosis
cell division resulting in TWO identical daughter cells
G phase
cell grows and synthesizes structures other than DNA
CNS
central nervous system; brain and spinal cord
attention deficit disorder
characterized by a short attention span and impulsive behavior that is inappropriate for the child's developmental age
Bio transformation (metabolism)
chemical inactivation of a drug through conversion to a more water soluble compound that can be excreted from the body
Chemical mediators of inflammation
chemical mediators can act on the local level or systemic level. Some local mediators can move into the blood stream and have systemic effects as they work at longer distances.
Agonists
chemical substances that mimic or enhance the effects of a neurotransmitter on the receptor sites of the next cell, increasing or decreasing the activity of that cell
ANTIMETABOLITES
chemicals that prevent cell division by inhibiting formation of substances necessary to make DNA; used in cancer chemotherapy
Ezetimibe (Zetia)
cholesterol absorption inhibitor
Combination therapies
combine 2 or more drugs to treat an infection
Renin-Angiotensin-Aldosterone System
compensatory process that leads to increased blood pressure and blood volume to ensure perfusion of the kidneys; important in the continual regulation of blood pressure
toxic range
concentration at which drug level is too high
SL/buccal
considered either ENTERAL or TOPICAL
Phase II biotransformation
consists of a coupling or conjugation of a variety of endogenous compounds to polar chemical groups of the drug
Chronic pain
constant/intermittent pain that keeps occurring
Phase 4 study
continual evaluation of a drug after it has been released for marketing
antidysrhythmic
controls and prevents cardiac dysrhythmias(abnormal rhythm) THINK: Hydantoins or prototype- phenytoin (Dilantin)
codeine
cough suppressant
liver injury
darkening of urine
depot injection
decanoate form: a slow-release, injectable form of antipsychotic medication for maintenance therapy THINK: Nonphenothiazines (haloperidol (Haldol))
COX-1 inhibitors
decrease protection of the stomach lining and prevents blood clotting
Coronary artery disease (CAD)
decreased blood flow to heart
hypokalemia
deficient level of potassium in the blood
Afterload
degree of pressure in the aorta that must be overcome for blood to be ejected from the left ventricle; resistance/pressure against which the heart has to beat
microdrip
delivering 60 drops per milliliter of fluid
perfusion-vascular system (bloodstream)
delivers drugs to cells/tissues if poor perfusion, it impedes ability for drug to reach target ex. poor circulation
Enteric-coated tablets
designed to dissolve in the alkaline environment of the small intestine
rate of absorption
determines how soon and effects will begin Determined by the site of administration and the drug formulation.
alpha adrenergic antagonists
dilate the arterioles and veins. These drugs can lower blood pressure quickly, but their use is limited because of frequent and bothersome side effects.
bethanechol (Urecholine)
direct acting cholinergic agonists: stimulates receptor directly •Atonic bladder post operative or post partum •Adverse effects: Abdominal discomfort, salivation, N/V/D, sweating, flushing
pilocarpine (Pilocar)
direct acting cholinergic agonists: •PO=treats dry mouth from salivary gland issues •Eye drops=treats glaucoma •Adverse effects: (eye drops) stinging, burning, tearing, red eyes, HA
IV (intravenous)
direct entry to the VENOUS SYSTEM
trichinosis
disease caused by eating raw or undercooked meat, usually pork, infected with Trichinella larvae lung, heart, brain
mycoses
diseases caused by fungi
Asthma
disorder characterized by recurrent & reversible episodes of bronchospasm leading to narrowed or obstructed airways
DAW
dispense as written
organelles
distinct structures found WITHIN the cell cytoplasm
When mixing inculin
draw up fastest acting first- clear to cloudy if regular and NPH) **Remember "R" before "N" Clear to Cloudy = withdrawing meds Cloudy to Clear = injecting air into vial
first pass metabolism
drug metabolism that occurs in the intestines and liver during oral absorption of drugs into the systemic circulation
Dopaminergic
drug treatment for Parkinson's Disease is either anticholinergic or ____ referring to cells that use dopamine as their synaptic transmitter (i.e. increases dopamine)
anticholinergic
drug treatment for Parkinson's Disease is either dopaminergic or ______ blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane) DECREASE effects of acetylcholine
Hypoglycemia
drugs can affect metabolism and the use of glucose causing LOW serum blood glucose concentration (_____)
hyperglycemia
drugs can simulate the breakdown of glycogen or alter metabolism in such a way that the cause HIGH serum glucose levels (_____)
over-the-counter (OTC) drugs
drugs that are available without a prescription for self-treatment of a variety of complaints; deemed to be safe when used as directed
Anticoagulants
drugs that block or inhibit any step of the coagulation process; preventing or slowing clot formation
Parkison-like syndrome
drugs that directly and indirectly affect DOPAMINE (neurotransmitter MESSENGERS) levels in the bran that can cause a syndrome that resembles Parkinson disease
Schedule One controlled substance
drugs that have a high potential for abuse, has no currently accepted medical use, and lack of safety (i.e heroin, LSD, marijuana, ecstasy)
Antiplatelet agents
drus that interfere with the aggregation or clumping of platelets to form the platelet plug
anticholinergic effects
dry mouth constipation photophobia blurred vision Tachycardia NOTE: this is a adverse effect of the Tricyclic Antidepressants (TCAs) Imipramine (Tofranil)
programmed
each cell is ______ by the genes
Dromotropic
electrical conduction
lysosomes
encapsulated digestive enzymes found within a cell they DIGEST old damaged areas of the cell and are responsible for destroying the cell when the membrane ruptures and the cell dies
sensitivity testing
evaluation of pathogens obtained in a culture to determine the anti-infectives to which the organisms are sensitive and which agent would be appropriate for treatment of a particular infection
Laxatives: saline (osmotic)
example- polyethylene glycol with electrolytes (MiraLax), sodium biphosphate (Fleet enema); (PO or enema)
Hypersensitivity
excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response
Drug conversions
finding the equivalent values between two types of measure within each system of measure and between systems of measure
Endoplasmic Reticulum (ER)
fine network of interconnected channels know as cisternae found in the cytoplasm; site of CHEMICAL reactions within the cell
tiotropium (Spiriva)
first long-acting inhaled anticholinergic drug for treatment of COPD; also supplied in combination with a bronchodilator- ipratropium with albuterol (Combivent)- more effective and longer duration of action
Rivaroxaban (Xarelto) (PO)
first oral anticoagulant indicated for DVT that directly *inhibits Factor X*- also used in patients with atrial fibrillation -Does not require aPTT or Protime; no antidote -Given orally by tablet -Side effects: bleeding; GI upset
Inotropic
force of contraction
drug allergy
formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug
P450 system
group of enzyme families in the liver which metabolize drugs and endogenous compounds
Hypertension
heart has to work harder to pump against high pressures
Myocardium
heart muscle
hyperkalemia
high levels of potassium in the blood
Insulin type is prescribed based on unique patient characteristics such as
how brittle their blood sugars are; typical diet; exercise level; all these are considered when choosing an insulin based on the insulin's onset & duration**** Note: Mix type will determine onset, peak & duration
subcutaneously
how is insulin generally administered?
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin
Vasodilators two primary drugs-
hydralazine (Apresoline)-acts primarily on arterioles isosorbide dinitrate- (Isordil)-acts primarily on veins
cushing's syndrome
hyperglycemia, redistribution of fat to the shoulders & face, muscle weakness, bruising, ****monitor potassium
sensory distortions and hallucinations
hypnotized subjects may be led to experience auditory or visual hallucinations NOTE: this is an adverse effect for the sedative zolpidem (Ambien)*
immunocompromised
impaired immunologic defenses caused by an immunodeficiency disorder or by therapy with immunosuppressive agents
Indirect-Acting Cholinergic Agonists
inactivate the enzyme cholinesterase, permitting acetylcholine to accumulate at the receptor site (hence the name "cholinesterase inhibitors" Prototype- pyridostigmine (Mestinon)-cholinesterase inhibitor & Prototype- donepezil (Aricept)- cholinesterase inhibitor
alternative therapy
includes herbs and other "natural" products as often found in ancient records; these products are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication
Sympathetic nervous system is stimulated
increased heart rate, force of contraction, and blood pressure
Nonphenothiazines
indicated to control psychotic bejhavior, less sedative than penothiazines; adverse reactions include severe extrapyramidal reactions, leukocytosis, blurred vision, dry mouth, urinary retention; teach to avoid alcohol; orap is used only for touretts syndrome
filariasis
infection of the blood and tissues of healthy individuals by worm embryos or filariae lymphatic tissue
superinfections
infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy
superinfection
infections that occur when opportunistic pathogens that were kept in check by the "normal" bacteria have the opportunity to invade tissues and cause infections because the normal flora bacteria have been destroyed by antibiotic therapy
Sinusitis
inflammation of the epithelial lining of the sinus cavities
Pneumonia
inflammation of the lungs that can be caused by bacterial or viral invasion of the tissue; or by aspiration of foreign substances
stomatitis
inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems
Inhalation
inhaled and absorbed through lung capillaries
Pre-clinical trials
initial trial of a chemical thought to have therapeutic potential; uses laboratory animals, not human subjects
parenteral
injected via needl
intradermal administration
injection of a drug in between the epidermis and dermis.
FASTER
insulin injected into the abdominal is absorbed _____ than other SQ sites****
tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors protrusion and rolling to the tongue sucking and making smacking movements of the lips chewing motion facial dyskinesis involuntary movements of the body and extremities
Penicillin (antibiotics)
is one such drug that cause bacterial cell death w/o disrupting most human cell functioning
meperidine (Demerol)
is preferred for gallbladder pain
epinephrine (Adrenalin)
is sometimes given in an acute asthma attack to dilate bronchioles and increase airway patency**
distribution
is the movement of a drug to the body's tissues
culture and sensitivity (C&S)
laboratory test that grows a colony of bacteria removed from infected area in order to identify the specific type of bacteria and then determine its sensitivity to a variety of antibiotics
Rectal drug administration
left side lying (Sim's position) water soluble lubricant to assist ask pt. to take deep breath
cytoplasm
lies within the cell membrane contains organelles fro producing proteins, energy, and so on
cell cycle
life cycle of a cell, which includes the phases G0, G1, S1, G2, and M During the M phase, the cell DIVIDES into two identical daughter cells
cell membrane
lipoprotein structure that separates the interior of a cell from the external environment; regulates what can enter and leave a cell
vaginal drug administration
lithotomy position (supine with knees bent and separated)
Hepatic microsomal system
liver enzymes tightly packed together in the hepatic intracellular structure, responsible for the biotransformation of chemicals, including drugs
Jaundice
liver failure/disease ALSO rising amounts of bilirubin in the blood Signs to look for: yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood
Antidiarrheals: OTC drugs
loperamide (Imodium)- similar to opiates- no narcotic effects bismuth subsalicylate (Pepto-Bismol) Probiotic- Lactobacillus
benzodiazepine prototypes
lorazepam (Ativan); alprazolam (Xanax); diazepam (Valium) (PO, IM, IV) THINK: "pam/lam" suffix
LMWH
low molecular weight heparin: enoxaparin (Lovenox) Given SQ once or twice a day, depending on regimen; do not rub site of injection Average treatment period- 7 to 14 days
heparin infusion
low platelet count is bad, monitor and report (normal platelet count is 150,000-400,000)
rashes, hives
many drugs are know to cause skin reactions HOWEVER, it is important to determine weather a rash or skin reaction is an allergy or a side effect/adverse effect of a drug
Protein bound drugs
many drugs bind to proteins to be carried this makes it difficult for drugs to be released which inhibits them from crossing membranes since most membranes do not let proteins pass
eye damage
many drugs such as hydroxchlorquine can damage the retina
Simethicone
may be added as an antiflatulent THINK: antacids treament
nephrorenal
means kidneys
metric system (SI)
measuring system that uses the powers of ten
medical history
medical conditions and drug use, allergies, level of unedrstandingand family support
right dose
medication dosage ***3 TIMES be sure to ask yourself: is this a typical dosage range for the drug If not question/verify order
right drug
medication name; check label ***3 TIMES leave in package until time to administer
diuretics
medications administered to increase urine secretion in order to rid the body of excess water and salt
ribosomes
membranous structures that are the sites of protein production WITHIN a cell
Synthetic opioids
meperidine (Demerol) hydromorphone (Dilaudid) Use •Relief of severe pain •Antitussive (especially codeine); cough suppressant* (except meperidine)
Nursing Care- Antidepressants (prt 2)
monitor for BP changes Monitor for anticholinergic effects- teach about foods/liquids to prevent constipation Observe for seizures if has a known seizure disorder Monitor for drug/food interactions and adverse effects of drugs Observe for herbal use- many interact
media influence on drugs
more drug advertising in mass media but is regulated in part by federal guidelines
chemotherapeutic drugs
most _____ drug DO NOT have selective toxicity
resistance
most commonly, the development of ____ depends on the degree to which the drug act to ELIMINATE the invading microorganisms that are most SENSITIVE to its effects
placenta
most drugs readily cross ___ and enter into breast milk
suppressed
most serious fungal infections occur in patients with ____ immune systems ex. patients with HIV
self-limiting
most viruses are _____; and require no pharmacotherapy ex. rhinovirus that causes common cold
akathisia
motor restlessness restless trouble standing still paces the floor feet in constant motion (rocking back and forth)
Passive diffusion
movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy
filtration
movement through pores in cell membrane either by concentration gradient or from the pull of plasma proteins hydrostatic, blood, or osmotic pressure
Cardiomyopathy/cardiomegaly
muscle alterations & ineffective pumping
pure opioid agonists
naloxone
azelastine (Astelin)
nasal spray
Side/adverse effects of adrenergic agonist drugs
nervousness, hypertension, tachycardia, palpitations, restlessness, tremors, dysrhythmias, dizziness, urinary retention, dry mouth, nausea, vomiting, dyspnea, and pulmonary edema; hyperglycemia THINK: phenylephrine (Neo-Synephrine) OR oxymetazoline (Afrin)
street drugs
nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure
Upper respiratory tract
nose, mouth, pharynx, larynx, & trachea
Role of the Nurse
nurse is the one most FREQUENTLY administering drugs Must know and watch for side effects (PATIENT SAFETY) Must teach patient and family about drugs How to INTERVENE when a side effect occurs
CoQ10
nutritional supplement; lipid enzyme that helps in moving electrons along electron transport chain; also acts as an antioxidant; increases mitochondrial function; levels decline with age THINK: Statins: pravastatin (Pravachol); simvastatin (Zocor) when using Statins these supplements may be indicated
depression
occurs because of a deficiency of norepinephrine, dopamine, or serotonin
superinfection
often exhibited as overgrowth of yeast; in mucous membranes (mouth, vagina) or sometimes in the GI tract Provide symptomatic care and antifungals when needed
household system of measurement
older system of measurement that uses teaspoons, tablespoons, and cups
MAINTAIN VOLUME/COMPOSITION OF BODY FLUIDS W/IN NORMAL RANGE
one of the 4 major renal system functions: •CLEARING OF NITROGENOUS WASTE •MAINTAIN ACID-BASE BALANCE & ELECTROLYTE LEVELS •EXCRETING VARIOUS DRUGS
milliequivalent
one-thousandth of an equivalent, which is the chemical combining power of a substance mEq
Beta2 Adrenergic Agonists- Bronchodilators: albuterol (Proventil)
onset in 30 minutes- duration of action 2-6- for acute attacks and maintenance (Inhaled)
olopatadine (Patanol)
ophthalmic drops
milrinone (Primacor) = Phosphodiesterase Inhibitors
or short term therapy of advanced heart failure- only given IV Very short half-life; therapy limited to acute patients and only 2-3 days- have risk for ventricular dysrhythmias and hypotension
Routes of Absorption
oral (GI tract), subcutaneous/intramuscular, mucous membranes
antiinfectives
other ____ alter the PERMEABILITY of the cell membrane to allow essential cellular components to leak out which leads to cell death ex. antibiotics, antifungals and antiprotozoal drugs
poisoning
overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions
gingival hyperplasia
overformation of gum tissue THINK: Hydantoin --> Phenytoin (Dilantin)
PCA pump
patient controlled analgesic administered intravenously with a machine NOTE: teach the patient and family use and philosophy of the PCA system BUT only the patient should push the button
self-care
patients self-diagnosing and determining their own treatment needs
drug abbreviations
pc= after meals PO=by mouth prn=as needed qid=four times per day q2h= every 2 hour q4h=every 4 hourq6h= every 6 hour q8h=every 8 hour q12h= every 12 hour STAT=immediately tid= three times a day
OTHER ANTIPLATELETS & ANTICOAGULANTS
pentoxifylline (Trental) (PO) & Rivaroxaban (Xarelto)-(PO)
PR
per rectum
PNS
peripheral nervous system BREAKS into ANS & Somatic nervous system
chlorpromazine (Thorazine)
phenothiazines (1st Gen) adverse effects- sedation, drowsiness, vertigo, dizziness, HA, dry mouth, orthostatic hypotension, EPS, NMS, photophobia
Other Nasal and Systemic Decongestants
phenylephrine (Neo-Synephrine), pseudoephedrine (Sudafed) (PO)
Blood Brain Barrier (BBB)
physiological barrier between the circulatory system and the central nervous system that establishes a privileged blood supply, restricting the flow of substances into the CNS
buccal
placed between the cheek and gum
insulin pen
portable device that contains a prefilled cartridge of insulin
insulin pump
portable, battery-powered device that delivers insulin through the abdominal wall in measured amounts
Bacteriostatic
prevent microbes from growing
kidneys
primary excretion organ
Enzyme induction
process by which the presence of a chemical that is biotransformed by a particular enzyme system in the liver causes increased activity of that enzyme system
diaphoresis
profuse sweating NOTE: this is something to note when looking for the presentation of Serotonin Syndrome
Laxatives
promote a bowel movement
Selective toxicity
property of a chemotherapeutic agent that affects only systems found in foreign cells without affecting healthy human cells (e.g., specific antibiotics can affect certain proteins or enzyme systems used by bacteria but not by human cells)
Platelet aggregation
property of platelets to adhere to injured surface & then attract other platelets; which then clump together
histocompatibility antigens
proteins found on the surface of the cell membrane; they are determined by the genetic code and provide cellular identity as a self-cell (i.e., a cell belonging to that individual)
The Medical Letter on Drugs and Therapeutics
provides cost comparisons on drugs that are reviewed in each issue
Drug Classes for Asthma Management
quick-relief medication v. long acting medication
spectrum
range of bacteria against which an antibiotic is effective
Chronotropic
rate of contraction
Opioid receptors
receptor sites that respond to naturally occurring peptides, endorphins other chemicals
electrocardiogram
record of the electrical activity of the heart
right documentation
record the administration of the med in the patient record
COX-2 inhibitors
reduce pain and inflammation and don't have negative effects of COX-1 inhibition
Niacin (vitamin B2)
reduces VLDL and LDL & inhibits release of free fatty acids from adipose tissue THINK: drug class Nicotinic Acid
pentoxifylline (Trental) (PO)
reduces viscosity of red blood cells and increases their flexibility(antiplatelet)- to increase circulation in patients with *intermittent claudication* -Given orally, may cause GI upset
Convulsions
refer to tonic-clonic muscle contractions
enteral
refers to meds administered at ANY point through the GI tract stomach (PO or through tube)
affect
refers to people's feelings in response to their environment; state of mind
neuropsychiatric
relating to organic and functional diseases of the nervous system NOTE: this is an adverse effect for the sedative zolpidem (Ambien)*
interferons
released by host in response to viral invasion
sympathetic nervous system stimulation
releases norepinephrine and initiates a cyclic AMP second-messenger system to increase contractility
Teach about medications: Nursing Care for Thyroid Hormone Drugs
report adverse effects Synthroid: ,(possible thyrotoxocosis) such as *tachycardia*,increased BP, heat intolerance, diarrhea, cramps, angina tremors, nervousness, insomnia, headache, weight loss, nausea and vomiting (Synthroid)
Acute pain
response to recent tissue damage or injury; makes person aware
Cathartics
result in a stronger and more complete bowel emptying- used for diagnostic procedures of the GI tract
mitochondria
rod-shapes organelles that produce ENERGY within the ell in the form of ATP Powerhouse of the cell
For cloudy insulin
roll (don't shake) to mix
culture
sample of the bacteria to be grown in a laboratory to determine the species of bacteria that causes an infection
partial seizure
seizure involving only limited areas of the brain with localized symptoms POWERPOINT: involves only one hemisphere of brain
Generalized seizures
seizures that involve the entire brain POWERPOINT: involves both hemispheres of brain
Pain
sensory & emotional experience associated with actual or potential tissue damage
genes
sequences of DNA that control basic cell functions and allow for cell division
SNRI
serotonin-norepinephrine reuptake inhibitor Affect serotonin, norepinephrine, or dopamine reuptake to elevate mood
Myxedema
severe deficiency in adults THINK: Treating Thyroid Hormone Deficiency Prototype- levothyroxine (Synthroid)
Cretinism
severe deficiency in children THINK: Treating Thyroid Hormone Deficiency Prototype- levothyroxine (Synthroid)
liver
sewage treatment plant
sustained release
should NOT be crushed
Prednisone (generic) (PO, IM, IV)
should ONLY use short term due to side effects (around 4-10 days) when treating inflammation Often referred to as corticosteroids/glucocorticoids
right preparation
should it be crushed, diluted, reconstituted (added water or saline)?
side effects of Laxatives: stimulants = bisacodyl (Dulcolax)- OTC
side effects: diarrhea, abdominal cramping, fluid & electrolyte imbalance, and laxative dependence
fungus
single-celled or multicellular organisms •More complex than bacteria Include mushrooms, yeasts, molds •Decompose dead organisms •Humans exposed by handling contaminated soil or inhaling spores
dermatological reactions
skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis
barrier defenses of innate immunity
skin, mucous membranes, secretions
somnolence
sleepiness NOTE: this is a side effect for Barbiturates (- "tal" suffix)
biological weapons
so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to incapacitate or destroy a population
gastrostomy
soft flexible tube surgically placed directly into patient's stomach; long term placement
Atypical antipsychotics
some block dopamine and some block other receptors, such as serotonin- cause fewer side effects
right storage
some drugs require specific storage environments
scored pills
sometimes the desired dose of a medication will be a fraction of the tablet or capsule so this method is used on the pill to help aid in cutting correctly
enteric coated
special coating on drug that prevents absorption until drug reaches the small bowel
Intravenous (IV)
specific techniques depend on whether it is IV push, IV bolus, or IV infusion
aspirin
stop taking a week before surgery
Lipoproteins
structure composed of proteins and lipids; the bipolar arrangements of the lipids monitors substances passing in and out of the cell
vesicant
substance that can cause tissue necrosis and damage THINK: Hydantoin (Dilantin)
bactericidal
substance that causes the death of bacteria, usually by interfering with cell membrane stability or with proteins or enzymes necessary to maintain the cellular integrity of the bacteria
Bacteriostatic
substance that prevents the replication of bacteria, usually by interfering with proteins or enzyme systems necessary for reproduction of the bacteria
kidney injury
sufficient urine output is NOT occurring
sustained release
tablets or capsules designed to dissolve slowly over an extended time
Side effects of ACE Inhibitors (captopril (Capoten); enalapril (Vasotec); lisinopril (Prinivil))
tachycardia, arrhythmias, rash, gastric irritation, peptic ulcers, bone marrow suppression, hypotension Common side effect is a persistent, dry cough****(increase in bradykinin causing inflammation) Watch for hyperkalemia*** (potassium sparing diuretics increase this risk)*** May cause angioedema (swelling of tongue & oral pharynx)
Get into the habit of always asking a patient
tell me your name, DOB , and do you have any allergies Follow up question: What types of symptoms do you experience
cell
the ____ is the basic structural unit of the body
freely
the _____ moving nature of the cell membrane allows it to adjust to the changing shapes of the cell so that areas of the membrane an move together to repair the membrane
selective toxicity
the ability to affect certain proteins or enzyme systems that are used by the infecting organism but not by human cells
Glycolysis
the breakdown of glucose to pyruvate to yield energy.
critical concentration
the concentration a drug must reach in the tissues that respond to the particular drug to cause the desired therapeutic effect
tolerance
the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect
sympathetic nervous system
the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations FIGHT OR FLIGHT
parasympathetic nervous system
the division of the autonomic nervous system that calms the body, conserving its energy REST AND DISEST
somatic nervous system
the division of the peripheral nervous system that controls the body's skeletal muscles
cleft palate
the failure of the palate to close during the early development of the fetus THINK: Anticonvulsants for Partial Seizures
liver injury
the first pass effect of drugs exposes the liver cells to the full impact of the drug BEFORE it is broken down for circulation throughout the body SINCE most drugs are METABOLIZED in the liver many metabolites that are irritating or toxic will affect the liver's INTEGRITY
peak
the highest plasma concentration of the drug at a specific time INDICATES THE RATE OF ABSORPTION
ataxia
the loss of full control of bodily movements
oral drugs
the most commonly used route of admin. it is usually the most convenient and comfortable for the pt. drug action has a slower onset and a more prolonged, but less potent, effect.
passive diffusion
the movement of drugs from an area of higher concentration to lower concentration
Glomerular filtration
the passage of water and water-soluble components from the plasma into the renal tubule
Minimum effective concentration (MEC)
the plasma drug level below which therapeutic effects will not occur the blood concentration needed for a drug to produce a response
Endocytosis
the process of engulfing substances and moving them into a cell by extending the cell membranes AROUND the substance;
Glycogen synthesis and breakdown
the storage and recovery of glucose from glycogen polymer.
Pharmacology
the study of drugs and their interactions with living systems
Pharmacogenomics
the study of genetically determined variations in the response to drugs
adverse reactions
these affects can occur as a result of antiinfective therapy: kidney damage, GI toxicity, neurotoxicity, hypersensitivity reactions, and superinfections
receptor site
these sites are very important in the functioning or neurons, muscle cells, endocrine glands, and other cell types and they play a very important role in clinical pharmacology
drowsiness/sedation**
this affect may DECREASE w/ time and tolerance for the drug class Benzodiazepines
lysosomes
this cell structure becomes very important clinically when cell death (from disease of drug effect) leads to the death of neighboring cells, causing those cells to die and release their lysozymes THINK: decubitus ulcer
cholestyramine (Questran) = aka Bile Acid Sequestrant
this drug is often combined with statins
primary actions
this is an extension of the DESIRED effect but too much Ex. BP meds but leads to hypotension
nitroprusside (Nipride)
this is used for hypertensive emergency; given IV drip in ICU (watch for severe hypotension) THINK: Direct Vasodilators = hydralazine (Apresoline)
oral route
this route of administration is NOT invasive Is less expensive Easy for the patient to continue dosing at home BARRIERS: Acidic stomach environment Some food (Increase acidity or block absorption)
receptor site
this site imbedded in the cell membrane reacts with specific chemicals OUTSIDE of the cell to stimulate a reaction with the cell
Aspirin toxicity
tinnitus (ringing of ears), dizziness, headache, & excessive sweating; fever; initial respiratory alkalosis then metabolic acidosis*
discharged
to save cost, patients are being ____ from hospitals far earlier than ever before and many are not even admitted into hospitals as a result less monitoring is occurring and more of the care needs fall directly to the patient
Digoxin toxicity
treated with digoxin immune fab (DigiFab; Digibind)
prophylaxis
treatment to prevent an infection before it occurs, as in the use of antibiotics to prevent bacterial endocarditis in high-risk patients OR antiprotozoals to prevent malaria
levothyroxine (Synthroid) s/e
tremors, HA, nervousness, palpitations, tachycardia, loss of hair, N/V/D, weight loss
Subcutaneous drug administration
under the skin
Loading dose
use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner
phase 3 study
use of a proposed drug on a wide scale in the clinical setting with patients who have the disease the drug is thought to treat
Z-track method
used to minimize local skin irritation by sealing the medication in muscle tissue pull overlying sking and sub Q tissue laterally to the side 1 -1.5 inches, inject the needle into the muscle leaving in for 10 seconds after injection, then release the skin.
off-label use
uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA Off-label use may lead to new indication for the drug
Neuroleptic Malignant Syndrome
usually related to anesthesia drugs and drugs affective neurotransmitters symptoms: slow reflexes high fever hypertension (HTN) tachycardia
Valvular disease
valves do not work effectively, causes blood to leak & backflow
adverse affects
vancomycin (vancocin) ____ ___: highly toxic it can cause renal failure, ototoxicity, superinfections, and a condition called "red man syndrome"
Lipoglycopeptides
vancomycin (vancocin) was the 1st drug in a class called
QRS complex
ventricular depolarization and atrial repolarization
T wave
ventricular repolarization
right patient
verify patient ID using 2 identifiers, NAME AND DOB, ID/medical record # EVERY TIME you administer medication ---Use bracelet, verbal and/or picture ---ALLERGIES ---Bar code scanning
Common cold
viral infection of the upper respiratory tract that initiates the release of histamine & prostaglandins & causes an inflammatory response
mutate
viruses ___ rapidly,, and drugs eventually become ineffective
aspirin
warn patient to watch for excessive bruising, blood in stools, or any abnormal or excessive bleeding when taking ____
Benzodiazepine (pam/lam) IV
what drug and what form of administration must we watch respirations closely for respiratory depression***??
IMPORTATN NOTE ABOUT- Fibric Acid Agents: Gemfibrozil (Lopid)
what drug class is *Contraindicated in patients with hepatitis or gallbladder disease*
SUDDEN CARDIAC ARREST
what is the result of administrating TREATMENT FOR HYPOKALEMIA: POTASSIUM CHLORIDE (KCL) through IV push????
Prednisone Often causes
what often causes --- hyperglycemia (High blood sugar)*, mood changes, irritability, cataracts, peptic ulcers, electrolyte imbalances & osteoporosis Long term use can result in Cushing's syndrome: hyperglycemia, redistribution of fat to the shoulders & face, muscle weakness, bruising, monitor potassium
Rotate sites
what should you do to avoid lipodystrophy when injecting insulin?
Heart failure
when the heart cannot pump enough blood to meet tissue oxygen and nutrient demands
Seizures
when there is a sudden discharge of excessive electrical energy from nerve cells located within the brain
Clark Rule
which accounts for eight in the dose formila
Fried rule
which considers age for a child under the age of 2 years
Regular insulin
which insulin is is the only one that can be given IV***
intravenous (IV)
which route of absorption basically by passes the absorption process?
Endocrine system
works to maintain homeostasis Glands: organized groups of specialized cells that secrete hormones Hormones: chemical messengers, released into bloodstream to communicate a message
Bile Acid Sequestrant: cholestyramine (Questran)
}Binds with bile acids in intestine (which are then excreted) to reduce LDL) Are not absorbed systemically (which is why few side effects)
Insulin injection sites
• Arm • Abdomen -best • Thighs *Rotate around same site to decrease lipodystrophy 2-3 weeks *heat them up to increase aborption
drugs act as:
•-RNA synthesis inhibitors • -Protein synthesis inhibitors • -Antimetabolites • -DNA synthesis inhibitors • -Cell wall synthesis inhibitors
glipizide (Glucotrol); glyburide (Micronase)
•Action- directly stimulates working beta cells to secrete insulin* THINK: Sulfonylureas
Antihistamines: Indications for Use (prt 1)
•Allergic rhinitis •Anaphylaxis •Allergic conjunctivitis •Drug allergies
Drugs for Upper Respiratory Disorders
•Antihistamines •Decongestants •Corticosteroids •Antitussives •Expectorants and Mycolytics
NURSING CARE- CHOLINERGIC AGONIST DRUGS (prt 3)
•Auscultate bowel and breath sounds for abnormality •Have IV atropine available as an antidote- early signs of toxicity include flushing, salivation, sweating, nausea, and abdominal cramps
Antihistamines: Indications for Use (prt 2)
•Blood/blood product transfusion reactions •Dermatologic conditions •Miscellaneous- motion sickness, vertigo, nausea and vomiting, sedation
Nursing Care- Antihistamines
•Caution if driving a vehicle or performing tasks due to drowsiness •Avoid alcohol and CNS depressants •Watch for confusion, hypotension, dizziness, drowsiness, urinary retention, blurred vision •May cause paradoxical excitation in children
Lipoglycopeptides
•Check C&S before therapy •Administer over 1 to 2 hours IV (slowly) •Peak and trough drug levels must be monitored*** •Monitor renal function tests and hearing- may cause nephrotoxicity and ototoxicity**** •Red Man Syndrome- may occur from histamine release from drug infusion- flushing and rash of upper body- can be caused by infusing drug too rapidly************
Long-Acting Medications
•Corticosteroids (inhaled or PO) •Leukotriene modifiers •Long-acting beta2 adrenergic agonists •Methylxanthines
Nursing Care- Upper Respiratory Disorders (prt 2)
•Get adequate rest •Watch for OTC medications that contain similar ingredients- caution if diabetic, cardiac, hyperthyroid, etc. •Teach use of medications- •Nasal sprays- 1 or 2 puffs as directed- watch for rebound congestion with adrenergic agonists
Non-selective COX -1 & COX-2 Inhibitors
•Ibuprofen (Advil/Motrin) •Indomethacin (Indocin) •Meloxicam (Mobic) •naproxen (Naprosyn); naproxen sodium (Aleve) •diclofenac (Voltaren, Cataflam, Cambia, Zipsor) •ketoralac
Preventing resistance
•Limit the use of antibiotics unless it is known that they have a bacterial infection (not viral) •Make sure does is high enough, for long enough to eradicate the bacterial illness it is treating •Around the clock dosing •Culture when possible •Take exactly as prescribed (even if feeling better), for the current illness only ***take all of the prescription***
Nursing Care- Upper Respiratory Disorders (prt 1)
•Monitor temperature and use antipyretics properly •Prevention of spread of infection •Hydration Don't drive or operate machinery if drowsy
NURSING CARE- ADRENERGIC BLOCKERS
•Monitor vital signs (HR & BP) and EKG •Assess for respiratory difficulty •Monitor for dizziness, insomnia, depression, chest pain •Assist with ambulation from orthostatic hypotension
NURSING CARE- CHOLINERGIC AGONIST DRUGS
•Monitor vital signs and urine output •Monitor liver enzymes, bilirubin, and serum amylase
NURSING CARE- ANTICHOLINERGICS
•Monitor vital signs, especially heart rate •Assess urine output- retention may occur •Encourage adequate fluid intake and high fiber foods •Monitor and record bowel sounds- may cause paralytic ileus
Aminoglycosides ("-cin" suffix)
•Peak & trough levels should be drawn (blood lab sample); ototoxicity is associated with troughs that are too high, rather than peaks being too high* •Monitor kidney (renal) function by watching labs (BUN and creatinine levels) •Instruct patient to report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness, and vertigo •If toxic, administer IV calcium gluconate for treatment of neuromuscular blockade
Cephalosporins ("cef-" prefix)
•Prototype: cefaclor (ceclor) •Examples of generations of cephalosporins •First-generation •cephalexin (Keflex), cefazolin (Kefzol) •Second-generation •cefaclor (Ceclor), cefoxitin (Mefoxin)
cephalosporins ("cef-" prefix)
•Prototype: cefaclor (ceclor) •Examples of generations of cephalosporins •Third-generation •cefoperazone (Cefobid), ceftriaxone (Rocephin) •Fourth-generation •cefepime (Maxipime) •Fifth-generation •Ceftaroline (Teflaro)
Lipoglycopeptides
•Prototype: vancomycin (PO, IV) •Others: telavancin (Vibativ), oritavancin (Orbactiv) •Bactericidal; disrupt cell membrane •Usually reserved for severe infections from gram-positive organisms, often when bacteria have become drug resistant, such as MRSA •Check C&S before therapy