Pharm Test 2
Inhalation
GENERAL volatile liquids or gases- mixed with oxygen Inhaled gas: nitrous oxide (laughing gas) Inhaled volatile liquid: desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?
Rapid pulse
Opioid toxicity traid
Respiratory depression, coma, pinpoint pupils -Monitor VS -Mechanical ventilation -Administer naloxone
Opioid agonists: Complications
Respiratory depression: monitor VS, stop if RR less than 12/min call dr. stop infusion give naloxone Constipation: teach- fluids, fiber, laxatives/stool softener/exercise Orthostatic hypotension: sit/lie down if dizzy Urinary retention: I&O, assess for bladder distension; void every 4 hours Cough suppression: auscultate lungs for crackles, fluids to liquefy secretions Sedation: avoid driving and operating heavy machinery Biliary colic: avoid morphine if hx: use meperidine Nausea/vomiting: antimetics Opioid toxicity triad
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Start of notes
A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?
Peptic ulcer disease can cause gastric bleeding
Gastrointestinal
Peptic ulcer disease Nausea Constipation Diarrhea Irritable bowel Inflammatory bowel
A nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects?
Prevents straining a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining
DMARDS: nursing administration
Teach that the effects are delayed can take 3-6 weeks for therapeutic effect DMARD II -Adalimumab give SQ q 2 weeks -Etanercept: SQ weekly
A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron?
The drug is prescribed to female clients who have IBS-D lasting more than 6 months
A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?
Thrombocytopenia The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae.
Prophylaxis agents misoprostol
decreases potential for ulcers -Take with food or 8 oz glass of water or milk -Avoid alcohol -Monitor for blood/stools/vomiting
Commonly used NSAIDS include
naproxen and celecoxib
Adjuvant meds
Given with opioid agonist -To increase pain relief and reducing opioid agonist dose Helps decrease adverse reactions -Respiratory depression -Sedation -Constipation
Antimetics
Glucocorticoids: dexamethasone Substance P/neurokinin antagonists: aprepitant
DMARD III
Gold salts: auranofin -blood dyscrasias, hepatitis Immunosuppressant medications: cyclosporine -for transplants
methadone
-Drug of choice for detoxing opioid addicts -Bound to tissues in liver, kidneys, and brain -Half life is longer than duration of action -Prolonged half life is cause of unintentional OD and death
Polypharmacy/Elderly
Make take several medications at a time- increased risk of drug interactions React as if given 3-4x dose given to younger patients Titrate!
Complications Opioids
#1 respiratory arrest: monitor RR below 12 hold Use sedation scale
misoprostol
(Cytotec) decreases acid secretion -reduces gastric ulcers in pts taking NSAIDS -Pregnancy category X
Opioid Antagonist: naloxone
(Narcan) Routes: IV, IM, SQ, Intranasal Onset: 2 min Peak: 5-15 min Duration: 45 min Half life: 30-81 min Initial dose: small increments of 0.1 to 0.2 mg IV Can be given every 30 mins Evaluate: RR 12-20, reduced euphoria
Foods to Avoid for gout
-Alcohol, beer -Meat, poultry, fish -Fats -High fructose corn syrup
Antigout Drugs
-First line therapy is NSAID -Specific anti gout meds: allopurinol, colchicine, probenecid
Sedation scale
1 - awake, alert 2 - occasionally drowsy but easy to arouse 3 - frequently drowsy, drifting off to sleep during conversation 4 - somnolent with minimal response to stimuli S- sleep, easy to arouse
Agonist-antagonist opioids: therapeutic uses
-Moderate to severe pain -Opioid dependence (buprenorphine) -Adjunct to balanced anesthesia -Relief of labor pain
A nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions?
A positive pregnancy test is a teratogenic drug
Herbal substances that may interact with NSAIDS include:
Feverfew and ginger
Opioid Agonist
Morphine Sulfate -Hydrophilic -No dose ceiling -Fentanyl -Meperidine (Demerol) -Methadone -Codeine -Oxycodone -Hydromorphone (8xs more potent than MS)
Antihistamines
Sedation, dry mouth
OLD CART
Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment
Agonist
binds to receptor causes a response
Assessments for anesthetics
-ABCs -History of alcohol use -Smoking history -Weight and height -Neuro baseline -Swallowing and gag reflexes -Watch for slight changes in VS and labs
Migraine: nursing administration
-Abortive meds should not be used more than 2 days a week -Avoid tyramine foods (wine, aged cheese, smoked meat) -Know that lying down in a dark quiet place can help -Monitor apical pulse before taking propranolol dose -Take with food to reduce GI distress
Antacids Contraindications
-Allergy -Renal failure -Electrolyte disturbances -GI obstruction
Kappa receptors
-Analgesia -Sedation -Decreased GI motility
Mu receptor
-Analgesia -Respiratory depression -Euphoria -Sedation -May cause physical dependence
Therapeutic uses for DMARDs
-Analgesia for pain, swelling and joint stiffness -Maintenance of joint function -Slowing of disease progression (DMARDS, glucocorticoids) -Prevention of organ rejection for transplants revopients (glucocorticoids, immunosuppressants) -Managment of inflammatory bowel disease (glucocorticoids, immunosuppressants DMARDS)
simethicone
Antiflatulent Breaks up gas bubbles Dosed up to 4-6 times daily
Parenteral
GENERAL Etomidate, ketamine, propofol, thiopental
Mild pain
Ibuprofen
Migraine headaches
Inflammation and vasodilation of cerebral blood vessels
Omeprazole is in which classification of drugs?
PPI
A patient complains of constipation. The most likely order would be for
docusate
DMARDS
slow degeneration and progression of RA
Glucocorticoid: nursing administration
-Can be given orally or intra articular injections -Can be given short them; until DMARD start working
Contraindications: 1st generation NSAIDs
-Pregnancy (risk category D) -Peptic ulcer disease history -Older adults -Clients on ACE inhibitors and ARBs -History of bleeding disorder or use of anticoagulants (warfarin, heparin) -Hypersensitivity
Acetaminophen contraindications
-Pregnancy category B for oral rectal, C for IV -Avoid in those with liver impairment, kidney impairment, chronic alcohol disorder, malnutrition Slows warfarin metabolism: increases warfarin level Take with full glass of water, with or without food
Opioid: Evaluation of effectiveness
-Relief of moderate to severe pain -Cough suppression -Resolution of diarrhea
Opioid tolerance
A state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drugs effects over time Higher and higher doses are needed to achieve desired effect Develops less often than physical dependence Can occur in as little as 1 week
Assessment for Gout
ASA- asthma, wheezing, nasal polyps, rhinitis -Check bleeding/clotting times, pre existing peripheral edema -Check patients risk factors for bleeding -Antigout drugs- hydration status, urinary output at least 30/60 mL/hour
Acetaminophen
Action: slows production of prostaglandins in CNS (fever) Therapeutic uses: analgesics (pain relief), antipyretic (decreases temp), may be mixed with opioids for synergistic effect
A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the clients phosphorus levels when administering which of the following drugs?
Aluminum hydroxide can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
Aminocaproic acid
The nurse is caring for several clients who are receiving opioids for pain relief. Which client is at the highest risk of developing hypotension, respiratory depression and mental confusion?
An 86-year-old male, postoperative femur fracture repair.
Herbal safety
Anesthetics may be affect by: -Feverfew -Garlic -Ginger -Ginseng -Kava -St. John's Wort
A nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least 1 hr between taking ranitidine and which of the following over the counter drugs?
Antacids
Drugs used to treat stomach acid
Antacids H2 receptor blockers PPIs Antibiotics
colchicine
Antigout drug -Oldest therapy -Reduces inflammatory response to crystals -Can cause short term leukopenia Don't use in -severe renal, GI, hepatic or cardiac disease and if blood dyscrasias
1st generation NSAIDS
COX 1 and COX 2 inhibitors -Aspirin -Ibuprofen other drugs: -naproxen -indomethacin -diclofenac -meloxicam
NSAIDS complications: Salicylism
Can occur with aspirin Symptoms: tinnitus, sweating, headache, dizziness, and respiratory alkalosis Education: stop taking and notify provider if sx of salicylism- aspirin toxicity
A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX practically eliminates the risk for which of the following?
Creutzfeldt-Jakob disease it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources.
Immunosuppressant Medications
Cyclosporine -Given for anti rejection transplant -Monitor for infection -Hepatotoxicity -Nephrotoxicity
Antimalarial agent
DMARD I hydroxychloroquine Retinal damage: blindness
The action of antigout medication is to do all but which of the following:
Decrease serum cholesterol
A nurse is caring for a client who is taking ferrous sulfate to treat iron-deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication?
Deferoxamine Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.
A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should monitor the client for which of the following manifestations of hypersensitivity syndrome?
Fever
A nurse is caring for a client who is taking acetaminophen at regular intervals for mild discomfort. The nurse should tell the client to report which of the following early indications of acetaminophen toxicity?
Diaphoresis Nausea Diarrhea Acetaminophen toxicity can cause nausea, vomiting, and anorexia, and can lead to liver damage. can cause diarrhea, lethargy
A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?
Dietary modifications
A nurse is assessing a client who was administered ondansetron IV 1 hr ago. Which of the following findings should the nurse recognize as an adverse effect of this drug?
Dizziness Dizziness and lightheadedness are the most common adverse effects
Adverse effects of GE
Dose dependent -Hepatotoxicity -Respiratory depression: post op AIRWAY priority Malignant hyperthermia
Fentanyl opioid
Dosed in mcg short acting a synthetic opioid 0.1 mg of IV fentanyl= 10 mg IV M.S.
A nurse is teaching a client who is taking allopurinol about minimizing adverse effects. Which of the following instructions should the nurse include?
Eat a small meal before taking the drug Prevent upset stomach
A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?
Edema Can cause fluid retention and edema
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?
Enlarged spleen
Peptic Ulcer Disease
Erosive lesions of duodenum and stomach -Imbalance between gastric acid production and mucosal protection -Bicarbonate -Antagonistic (including H Pylori), gastric acid, pepsin, smoking -NSAIDS -When balance of acid and the lessening of mucosal protectant an ulcer can occur from the formation of a lesion -Severe lesions will go through several layers and cause bleeding and even perforation -H pylori is another factor
Local anesthetics: Ester vs Amide
Ester type: benzocaine (lanacane, solarcaine), cocaine, tetracaine, dibucaine (Nupercainal) Amide type: bupivacaine, lidocaine, prilocaine, prilocaine/lidocaine (EMLA) -Lidocaine may be mixed with epinephrine- epinephrine prolongs the duration of lidocaine through vasoconstriction
DMARD II
Etanercept, infliximab -SQ injection site irritation -IV infusion: infliximab: flu like symptoms possible anaphylaxis -Potential for severe skin reactions: SJS -Heart failure
A nurse is caring for a client who is about to begin factor VII therapy to treat hemophilia A. When administering factor VII, which of the following actions should the nurse take?
Have emergency equipment ready cause a hypersensitive reaction and anaphylaxis. The nurse should monitor the client for hives, fever, wheezing, and difficulty breathing and have emergency equipment and drugs readily available.
A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?
Headache Can cause intracranial bleeding
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
Hgb
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?
Hypertension
A nurse is caring for a client who takes low-dose aspirin to prevent cardiovascular events. The client asks the nurse about taking ibuprofen to treat rheumatoid arthritis. Which of the following responses should the nurse make?
Ibuprofen will reduce the cardioprotective effects of low dose aspirin NSAID reduces the cardioprotective effects on low dose aspirin
A nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions?
Inflammatory bowel disease Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in clients who have inflammatory bowel disease.
probenecid
Inhibits the reabsorption of uric acid in the kidney (increases excretion or uric acid) Do not use -Peptic ulcer disease, bood dyscrasias, renal impairment
Meperidine use has decreased because of what pharmacological property?
It has an active metabolite that is neurotoxic.
A nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurse should recognize that which of the following drugs interacts with ranitidine?
Ketoconazole Ranitidine reduces the absorption of ketoconazole.
Peripheral Anesthesia
LOCAL Infiltration Nerve block: deep injections to block nerve in a specific area Topical: eye gtts, creams, gells, suppositories
NSAIDS complications: Aspirin toxicity
Sweating high fever, acidosis, dehydration, electrolyte imbalance, coma and respiratory depression Treatment: medical emergency -Activated charcoal: decreases absorption -Hemodialysis -IV fluids to correct electrolyte imbalance -Reverse acidosis with bicarbonate -Gastric lavage
Lactulose is given for constipation and what other purpose?
To reduce serum ammonia
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?
Uncontrolled bleeding
Which of these is the best description of pseudo addiction?
Untreated or undertreated pain causes patients to become anxious and frequently request pain medication
A nurse should assess a client who has megaloblastic anemia for indications for which of the following vitamin deficiencies?
Vitamin B12
Treatment of acetaminophen overdose
acetylcysteine (Mucomyst) IV or oral
The nurse has prn medication orders that include ibuprofen po, morphine IV, colchicine po and hydrocodone with APAP po. Which medication would be most appropriate for a patient complaint of post-operative pain rated at 8:10?
morphine
Morphine overdose
naloxone
Migraine meds
prevent inflammation and dilation of intracranial blood vessels Abortive: NSAIDS and combo of NSAIDS and triptans and ergot alkaloids Prophylactic: beta blockers, anticonvulsants, amitriptyline and estrogens
Allopurinol
prevents uric acid production -oxypurinol is a metabolite available as an orphan drug for those that can't tolerate allo Adverse effects: -agranulocytosis, aplastic anemia, exfoliative dermatitis, SJS, and toxic epidermal necrolysis (TEN)
NSAIDS
provide rapid relief of inflammation and pain but do not slow disease progression
Antacids
-Nonprescription -only use days not weeks -Salts of aluminum, magnesium, calcium, and sodium -Calcium type can be added with simethicone -Magnesium counteracts constipating effect of aluminum/calcium
tramadol hydrochloride (Ultram)
-Not for use in pts greater than 75 years of age -Centrally acting -Seizures at risk at any dose -Oral form
Antacids- mechanism of action
-Neutralize gastric acid -Mucosal protection -Bicarbonate is a buffer- combines with gastric acid to form carbon dioxide= bloating and belching
NSAIDS Interactions
-Anticoagulants: (heparin and warfarin) -Glucocorticoids: (take antiulcer prophylaxis (misoprostol) -Alcohol: increase risk of bleeding; monitor labs PTT,PT, INR Supplements: (garlic, ginger, feverfew) increase risk for bleeding Ginkgo biloba suppresses coagulation Teach patients to notify provider of any over the counter meds including vitamins, herbal supplements
COX 2
-Decreases inflammation: pain/fever -Decreases pain -Decreases body temperature Inhibiting COX 2 is a positive effect
Fentanyl (Duragesic) patch
-ONLY use in patients who are already receiving opioid therapy equivalent to fentanyl 25 mcg/hr -Dont use in children under 2 -6-12 hours to reach steady state (1st patch) -Use only on intact skin -Clip, do not shave, excess hair at site -Avoid direct external head sources -Carefully monitor pts who develop a fever or who increase body temp -Alcohol increases absorption- do not prep area with alcohol -Do not wash hands with anything but clear water -Do not use patch if it is cut, damaged, or changed -Serum levels gradually increase; level off between 12-24 hours -Peak level at 24-72 hours -After removal, 50% out of system at 17 hours -Always remove old patch before apply new one
A nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug?
Abdominal Pain can cause ischemic colitis
sucralfate
Acts as mucosal protectant -Used for active stress ulcers, PUD -Dosed QID, 1 hour before meals -Take other drugs 2 hours before sucralfate
A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
Administer via IV bolus over 1 to 3 min
Constipation
Adverse drug effects: opioids Lifestyle: -BM habits -Diet: low fluid intake, low fiber, iron -Stress anexity Metabolic and endocrine disorders DM, hypothyroidism, pregnancy Neurogenic disorders: MS, spinal cord, parkinsons
Response to opioids
Agonist (causes a response)- may be strong or weak -Strong: morphine, Demerol, fentanyl -Moderate: hydrocodone, oxycodone, codeine -Weak: codeine when mixed in cough syrup
A nurse is reviewing the medical record of a client who reports taking acetaminophen at home. The nurse should identify that which of the following client conditions is a contraindication for acetaminophen?
Alcohol use disorder Can cause liver toxicity
PPI contraindications
Allergy Adverse effects: -Risk for pneumonia with COPD pts -Long term use proven to not be r/t malignant gastric tumors -Possible osteoporosis -Possible reduction of acid-related antimicrobial protection -Hypomagnesemia (tremors, muscle)
A nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider?
Allopurinol delays the conversion of azathioprine and can lead to toxicity
Which of the following drugs has protocols that require clients to meet specific risk management criteria and sign a treatment agreement before the nurse can administer the drug?
Alosetron can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis.
Psychological dependence/addiction
A primary, chronic, neurobiological disease, with genetic, psychosocial and environmental factors 3 Cs -Craving -Loss of control -Use despite adverse consequences
For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication a) as needed. b) around the clock. c) on schedule during waking hours only. d) around the clock, with additional doses as needed for breakthrough pain.
Around the clock, with additional doses as needed for breakthrough pain
A nurse is caring for a child who has a viral infection. The nurse should identify that which of the following drugs can increase the risk of Reye syndrome in children who have viral infections?
Aspirin
A nurse should recognize that sulfasalazine is contraindicated for clients who have which of the following conditions?
Aspirin sensitivity
A nurse is providing teaching to a client who has a new prescription for loperamide. Which of the following instructions should the nurse include?
Avoid activities that require alertness Loperamide, an opioid agonist, can cause sedation and dizziness
A nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include?
Avoid driving or activities requiring alertness
A nurse is teaching a client who has a new prescription for allopurinol. Which of the following instructions should the nurse include?
Avoid driving or activities that require mental alertness Can cause drowsiness
A nurse is caring for a client who has a new prescription for prednisone for long-term treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following adverse drug reactions?
Bone loss
Antivonvulsants
Bone marrow suppression, GI distress, drowsiness, rash
Gout
Caused by hyperuricemia too much uric acid in blood -overproduction of uric acid -decreased uric acid excretion Gout crystals are end product of purine metabolism Crystals are like small needles (collect in tissue and joints)
A nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell the client to report which of the following adverse drug reactions?
Chest pain COX-2 inhibitor, can cause cardiovascular or cerebrovascular events. Report chest pain, SOB, headache, numbness, weakness, or confusion.
A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?
Clarify the prescription with the provider The client's sodium level is below the expected range of 136 to 145 mEq/L.
A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?
Clopidogrel Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days).
Stress Ulcers
Common in ICU pts Risk factors -Hx of PUD or GI bleed -Sepsis -Use of steroids -ICU stay of over 1 week (NG tubes, ventilation) -Occult bleeding
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?
Constipation
Opioid Teaching
Constipation prevention: fluids, fiber, exercise, stool softener, laxatives Do not discontinue medications suddenly (withdraw slowly over at least 3 days)
A nurse is caring for a client who is about to begin taking aspirin. The nurse should instruct the client to report which of the following manifestations of salicylism?
Fever Tinnitus Diaphoresis Dizziness
Adverse effects of NSAIDS may include:
GI bleed Tinnitus Acute renal failure
NSAIDs complications: Gastrointestinal (GI)
GI bleeding esp with long term use -Risk increased in older adults, smokers, alcohol use or history of peptic ulcers -Monitor for black dark stools, abdominal pain, nausea/vomiting -Give proton pump inhibitor (omeprazole to decrease ulcer formation)
A nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor for manifestations of which of the following conditions?
Gout An adverse effect of methotrexate is hyperuricemia, which causes gout. The nurse should instruct the client to drink plenty of fluids to minimize this effect, and to report edema or pain in the joints.
Helicobacter pylori
H-Pylori (gram-neg bacillius) Treat with antibiotics and Proton pump inhibitors (decrease acid secretion) + H2 antagonist
Metronidazole (Flagyl)
H-prlori antibiotic Give with food Teach patient to take whole course of meds Nausea and diarrhea are common adverse effects
Ranitidine, cimetidine and famotidine are which classification of drugs?
H2 receptor blocker
H2 Receptor Antagonists
H2 receptor blockers Reduce acid secretion: by stopping Ranitidine (Zantac) once daily Cimetidine (Tagamet) first, 1977 Famotidine (Pepcid) Nizatidine po only (dine)= h2 receptor ranitidine can be given to children greater than 1 mo
Central or spinal Anesthetic
LOCAL Intrathecal: goes into cerebrospinal fluid Epidural: labor and delivery sits next to spinal sac
NSAIDS contraindications: 2nd generation (celecoxib)
Last choice for chronic pain -Increased risk for myocardial infarction (MI), stroke suppresses vasodilation -Do not give with patients with history of allergy to sulfonamides
A nurse is caring for an older adult who has renal impairment and new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestations?
Lethargy can cause CNS effects, such as lethargy, depression, confusion, and seizures, especially in older adults
Patient teaching on Anti-gout drugs
May take 7 days for ibuprofen to work; 30-60 mins for analgesic effects NSAIDS- report ringing in ears, persistent GI or abdominal pain, easy bruising 3 main adverse effects of NSAIDS -GI intolerance -Bleeding -Renal impairment misoprostol (Cytotec) may be given to prevent GI intolerance (pregnancy category X)
A nurse is planning care for a client who has started taking prednisone. Which of the following interventions should the nurse include?
Monitor the client's blood glucose Prednisone can cause hyperglycemia
2nd generation NSAIDS
Selective COX 2 inhibitor -Celecoxib
An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder?
Severe asthma
A nurse is teaching a client who has a new prescription for allopurinol. The nurse should instruct the client to report which of the following adverse drug reactions?
Sore throat Vertigo Bruising Vision changes
Local anesthetics: nursing administration
Spinal or epidural -Monitor VS, hypotension, anaphylaxis, seizure dura puncture -Lie flat 12 hr follow spinal to minimize HA, monitor I&O, urinary retention procedure without pain pain relieved
Local anesthetics: complications
Spinal: monitor for HA lie flat for 12 hr post procedure, urinary retention -Can cross placenta causing fetal bradycardia and CNS depression Do not use in fingers, nose, other body parts with end arteries: esp if epinephrine used
A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons?
Sucralfate interferes with the absorption of phenytoin
A nurse is reviewing the medical record of a client who has a new prescription for celecoxib. The nurse should identify that which of the following conditions is a contraindication to celecoxib?
Sulfonamide allergy those allergic to sulfonamides can have severe allergic reactions to celecoxib
A nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include?
Swallow the capsules whole
Glucocorticoids
adrenal insufficiency, osteoporosis, glucose intolerance, PUD, avoid infectious diseases
Bismuth subsalicylate is which kind of medication?
adsorbent
Reyes syndrome may result from children consuming
aspirin during a viral illness
Antagonist
attaches to receptor site and prevents response
Agonist-antagonist
binds and causes a response in one receptor and binds and prevents a response in another receptor: less effect than agonist
Local anesthetics
block motor and sensory neurons to specific areas -topically, injected directly into an area or given regionally, epidurally or in the subarachnoid (spinal) space
buprenorphine
different can be given for opioid addiction -antagonist on MU and agonist on kappa
Severe pain
fentanyl
The herb often taken for inflammation is
feverfew
Stevens-Johnson syndrome
from DMARD II -fever -unexplained widespread skin pain -a red or purple skin rash that spreads -Blisters on your skin and the mucous membranes of your mouth, nose, eyes, and genitals -Shedding of your skin within days after blisters
propofol (Diprivan)
general anesthetic Known drug allergy -emulsion contains soy and egg products
Motilins
increase peristalsis GERD food is digested more quickly Methoxlopramide (Reglan) Erythromycin
Serotonin antagonists: Ondansetron
-Chemotherapy, radiation therapy, postoperative AE: VT, SJS, headache, dizziness, constipation, diarrhea Teach: report severe, persistent HA, assist with dizziness and have them sit or lie down, diarrhea monitor for dehydration Oral or IV Chemo: 30 mins before then every 4-8 hrs Post op: every 8 Radiation: 1-2 hrs pre-rad then 8 hrs Give slowly over 15 mins IV Interactions with serotonin meds: serotonin syndrome
Agonist-antagonist opioids: Contraindications, interactions
-Caution for patients with history of MI, kidney, liver, respiratory depression, head injury or those physically dependent on opioids -CNS depressants and alcohol, monitor respirators
Glucocorticoid complications
-Risk for infection: report fever, sore throat -Osteoporosis: if long term -Adrenal suppression: n/v hypotension, confusion -GI discomfort -Hyperglycemia: high sugar -Hypokalemia: low potassium
Adjuvant meds: nursing administration
-Self report of pain: subjective -Pain management plan -Elderly need careful monitoring greater risk for adverse effects -Explain to patients why they are receiving these meds with their pain meds
A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction?
-Skin integrity -Temperature -CBC
A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?
Alteplase a thrombolytic drug, meaning it can dissolve existing thrombi. An acute ischemic cerebrovascular event is often caused by the occlusion of a cerebral vessel by a thrombus
A nurse is reviewing the medical record for a client who is taking heparin following an acute myocardial infarction (MI). Which of the following drugs should the nurse expect the client to be taking in conjunction with the heparin?
Alteplase thrombolytic drug, meaning it can dissolve already-formed thrombi
Several patients have standard orders for acetaminophen as needed for pain. When the nurse reviews their histories and assessments, the nurse discovers that one of the patients has a contraindication to APAP therapy. Which patient is the one who should receive an alternative medication?
A patient admitted with severe hepatitis Bc of liver
A nurse is caring for a group of postoperative clients. The nurse should identify that morphine is contraindicated for which of the following clients?
A client who had a cholecystectomy can cause biliary colic
Systemic lupus erythematosus
Most common type of lupus immune system attacks own tissues joints, skin, brain, lungs, kidneys, and blood vessels
3 main pain receptors
Mu Kappa Delta -found in CNS and other body tissues
Pancuronium (Pavulon)
NMBDs Used in long surgical procedures (long acting) 45-60 mins
Vercuronium (Norcuron)
NMBDs intermediate (25-40) min most common
Ketrolac
NSAIDS contraindications -not given in patients with advanced kidney disease can cause damage
A nurse is caring for a client who is taking lubiprostone. The nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions?
Nausea
Succinylcholine
Onset: less than 1 min Duration: 4-6 mins Route: IV Uses: intubation Side effects -Hyperkalemia -Dysrhythmias -Muscle fasciculations: hands, feet, face -Muscle pain (12-24 hrs po) -Myoglobinuria (muscle breakdown) -Increased intraocular, intragastric and intracranial pressure -Malignant hyperthermia
The broad general categories of pain medications include:
Opioids and NSAIDS
Tricyclic antidepressnats
Orthostatic hypotension, anticholinergic effects (blurred vision, dry mouth, urinary retention and constipation)
Which type of medication stops the most acid production?
PPI
NMBDs
Paralyze the patient by blocking nerves to skeletal and smooth muscles, including intercostal and diaphragm (affecting breathing mechanical ventilation): RESPIRATORY ARREST primary concern -mind is alert -does not relieve pain or anxiety High alert drugs (death due to error)- sound a lot like other drugs
Anesthesia: general
Parenteral Inhalation
Ketamine
Parenteral: General -Dissociative anesthetic -Used in veterinary medicine -Common drug of abuse/club drug similar to PCP -Referred to as a date rape drug -AE include hypertension and tachycardia
Most acid-lowering drugs work on which cells?
Parietal cells of the stomach
Dopamine antagonist
Prochlorperazine Metoclopramide (Reglan) given for N/V related to chemotherapy, radiation, opioids, GERD (increases tone of lower esophageal sphincter) Increases peristalsis so food is digested more quickly No driving if sedated, report diarrhea
Comparison of Durations
meperidine (Demerol): 3-9 hrs morphine: 12-24 hrs fentanyl: 2-3 hrs Naloxone antagonist: 45 min, IV give over 30 secs
Meperidine (Demerol)
metabolizes to normeperidine, which is a neurotoxic- increases risk of seizures may see confusion -Limit dose to 600mg in 48 hours -Used post-operatively, short term
Heroin withdrawl
methadone
DMARD I
methotrexate (cytotoxic agent/immunomodulatory) -Risk for infection: support sore throat, fever -Hepatic toxicity: Monitor liver function -Bone marrow suppression: monitor CBC with platelet -Ulcerative stomatitis or GI ulceration: monitor gums, throat; take with food/water avoid in pregnancy
Glucocorticoids action
provide relief of pain and inflammation -delay disease progression
A nurse is providing teaching for a client who has gout and a new prescription for allopurinal. For which of the following adverse effects should the client be taught to monitor? Select all that apply.
rash increased gout pain nausea
Sulfasalazine
safe for pregnancy -Do not give if sulfa allergy
Stoped notes
stoped notes
CNS stimulants
weight loss, insomnia
Labs to check pre-op
-Kidney and liver function -Serum K (NMBDs) -Hbg, Hct, WBC with diff -PT, aPTT, INR, platelet count -Serum electrolytes: potassium, sodium, chloride, phosphorous, magnesium, and calcium -Pregnancy test for females -Renal BUN creatinine
Antacids Interactions
-Affect solubility and absorption of many oral drugs -Weak acids are less readily absorbed: NSAIDS, sulfonylureas, salicylates, warfarin, barbiturates, isoniazid, digoxin -Results in chelation or chemical inactivation of some drugs -Enteric coated dissolve in small intestine -Can reduce absorption of quinolone antibiotics (give antacid 2 hrs before or 2 hrs after)
Opioid Contraindications
-After biliary tract surgery -Premature infants -Pregnancy risk c -Use caution with patients with (Asthma, emphysema), head injuries, infants, older adults -Clients with IBD, enlarged prostate, hepatic or renal disease
PPI drug interactions
-Digoxin, phenytoin (Dilantin) -Increased serum levels of diazepam and phenytoin and dig -Increased effect of warfarin
General anesthetic is effective if...
-LOC, loss of body reflexes, elimination of pain throughout entire body, smooth muscle paralysis -Produces progressive reduction of sensory and motor CNS functions -Initially: loss of senses of sight, touch, taste, smell and hearing, alone with LOC -Cardiac and pulmonary functions are last to be interrupted -Mechanical ventilation: airway priority
Acetaminophen Complications
-Liver damage: hepatic failure monitor labs -Diarrhea, sweating, abdominal discomfort can lead to coma/ death -Dose ceiling= 3 grams per day -Elderly= 3 grams per day -No alcohol
Considerations in the elderly/opioid use
-May impair drug absorption, distribution, metabolism, and elimination -Should be slowly titrated and closely monitored -Increased risk of falls
NSAIDS complications: Impaired Kidney Function
-Monitor output -weight for gain and fluid retention -monitor labs BUN and creatinine
Opioid Nursing Administration
-Monitor pain level regularly -If RR less than 12 notify -Administer IV opioids slowly over 4-5 min -Have naloxone available -Monitor pCA pump: dose, lock out, 4 hr limit
Disease Modifying antirheumatic drugs
-NSAIDS -DMARDS I,II,III -glucocorticosteroids
Which statement is true about NSAIDS?
-NSAIDS are category D throughout pregnancy. -All NSAIDS have a dose ceiling.
Drug dependent contraindications for general anesthetics
-Pregnancy -Narrow-angle glaucoma -Known susceptibility to *malignant hyperthermia*
Agonist-antagonist opioids: nursing administration
-RR less than 12 hold -Have naloxone available -Assess for opioid use can use withdrawal -Relief of pain
Improvement of RA
-Reduced swelling of joints -Absence of stiffness -Ability to maintain joint function -Absence of pain -Decrease in systemic complications (weight loss and fatigue)
Migraine: evulation
-Reduction in frequency and intensity -Termination of migraine -Reduction in size and frequency of medication doses used
Opioid Therapeutic Uses
-Relief of moderate to severe pain -Sedation -Reduction of bowel motility -Cough suppression (codeine)
Lidocaine transderml
-Used in patches -Can use up to 3 patches if large area -Patches worn for no longer than 12 hours/day to avoid systemic toxicity
Proton Pump Inhibitors
-omeprazole (Prilosec) first available -lansoprazole (Prevacid) come in combo pill with amoxicillin and clarithromycin (Prepac or Omeclamox-pak) -pantoprazole (Protonix) 1st available IV- used for GI bleed
Opioid Interactons
Any other substance that can cause sedation or respiratory depression: any opioid CNS depressants: alcohol, benzodiazepines
A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?
Inhibiting cyclooxygenase action in platelets work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.
A nurse is caring for a client who has a new prescription for alosetron. The nurse should recognize that alosetron therapy is effective when the client reports which of the following?
One formed stool per day
Local anesthetics: meds/action
Prototype: Lidocaine Others: -Ester: tetracaine -Amide: EMLA: mixture of lidocaine and prilocaine Block conduction of pain impulses Pain management -dental, minor surgery, L&D, and diagnostic procedures Regional: spinal and epidural Topical: skin/mucus membranes -Minor procedures: IV insertion, injection, wart removal
Mixed agonist-antagonist, AKA partial agonist or mixed agonist
Prototype: butorphanol, (Stadol) (IV, IM, Intranasal) others pentazocine (Talwin), nalbuphine (Nubaine) buprenorphine mixed= not as strong
A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?
Reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis
NSAIDS complications: Reye's syndrome
Risk if aspirin is given with viral illness in children and adolescent Can cause CNS issues, brain issues
A nurse is reviewing the medical record of a client who has a new prescription for tramadol. The nurse should identify that which of the following conditions is a contraindication for tramadol?
Seizure disorder
A nurse is reviewing the drug list for a client who has a new prescription for allopurinol. The nurse should identify that which of the following drugs interacts with allopurinol?
Warfarin Allopurinol can increase the effectiveness of warfarin
A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The nurse should instruct the client to report which of the following adverse drug reactions?
Weight gain renal impairment, can cause retention of salt and water
Antacids Application
-Antacids should be taken 2 hours before or after meals with a full glass of water -Do not take other medications with unless directed to -Monitor for effectiveness of drug -Acts within 15 mins and lasts 2 hrs
NSAIDS: Therapeutic uses
-Anti-inflammatory: decreases inflammation -Antipyretic: decreases temperature -Analgesic: mild to moderate pain -Aspirin: platelet aggregation: anticoagulant Celecoxib suppresses inflammation, relieves pain, decreases fever and protect against colorectal cancer
Rheumatoid arthritis
-Chronic progressive -Systemic, autoimmune disease -Sx: affects joints and potentially connective tissue -Joint stiffness, pain, deformity, swelling -Drug therapy prevents, pain, inflammation and joint deformities
A nurse is teaching a client who has a new prescription for prednisone. Which of the following instructions should the nurse include?
-Discontinue the drug gradually -Report illness or infection -Increase intake of calcium and vitamin D -Monitor for signs of gastric bleeding
A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include?
-Eat iron enriched foods -Spread the dosage across each day -Take the drug on an empty stomach -Increase dietary fiber intake
Local anesthetic is effective if...
-Eliminates pain sensation in tissues innervated by anesthetized nerves -Does not paralyze respiratory system
Naloxone potential adverse reactions
-Excitement -Hypotension -Hypertension -Ventricular tachycardia -Fibrillation -Pulmonary edema -Weakness
What increases acid secretion
-Food, caffeine, chocolate, and alcohol stimulate HCL acid secretion -Excessive large, fatty meals or alcohol and/or emotional stress= hyperproduction of HCL acid
Implementation of pain meds
-Give meds before pain is at peak -Give meds with food if GI upset -Give natimetics prn -Take safety measures like bed alarms, call bell and phone within reach -Consider which route to use -Always individualize pain treatment
Cyclosporine
-IV dose over 2-6 hours -Monitor for hypersensitivity; stay with patient for 30 mins -Oral: mix with milk or orange juice -Life time drug for organ rejection
Patient/family teaching of anesthetics
-Importance of NPO -Can still hear -Arise slowly and dangle legs before ambulation; call for help -PCA by proxy
A nurse is teaching a client who has a new prescription for tramadol. Which of the following instructions should the nurse include?
-Increase fiber and fluid intake -Take the drug with food -Avoid driving after taking the drug -Change positions gradually Can cause sedation, dizziness, drowsiness
A nurse is caring for a client who is taking naloxone to treat acute morphine toxicity. The nurse should monitor the client for which of the following adverse drug reactions?
-Increased respiratory rate -Increased pain -Ventricular arrhythmias -Hypertension
A nurse is planning care for a client who is receiving chemotherapy and has a new prescription for ondansetron. Which of the following actions should the nurse plan to take?
-Infuse the drug 30 min prior to chemotherapy -Infuse the drug slowly over 15 min -Repeat the dose 4 hr after chemotherapy
COX 1
-Inhibits gastric mucosa development: Ulcer development -Decreases platelet aggregation: anticoagulation effect: bleeding/bruising -Impairs renal perfusion: decreased urine output and increase creatinine and BUN Inhibiting COX 1 causes adverse effects
NSAIDS Nursing Administration
-Ketorolac short term -Administer IV ibuprofen over 30 mins -Stop ASA 1 week before surgery/ childbirth -Take with food/water/milk -Do not chew enteric coated or sustained release aspirin Monitor: -Reduction in inflammation, fever, pain, absence of injury
Agonist-antagonist opioids: complications
-Stop opioids such as MS before giving -Respiratory depression, sedation -Dizziness -Headache
A nurse is providing teaching to a client who has a new prescription for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include?
-Take the drug 30 to 60 min before activities that trigger nausea -Avoid activities that require alertness -Increase fluid and fiber intake
A nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include?
-Take the drug with at least 8 oz of fluid -Increase fluid and fiber intake
PPI Nursing Application
-Taken before meals -Encourage lifestyle changes -Keep food diary -Full effects may take days or weeks -Teach patient to immediately report severe abdominal pain or blood in emesis or stools -Monitor respiratory status -Report infection -do not take drug 3-4 months unless directed by doctor
The nurse is administering a proton pump inhibitor during morning medication rounds. Which statement about proton pump inhibitors are true? (Select all that apply.)
-They are part of the treatment of patients with H. Pylori infections. -There are very few adverse effects with these drugs -They should be taken 30 to 60 minutes before meals
A nurse is caring for a client who asks about taking acetaminophen. The nurse should identify that acetaminophen is indicated for which of the following conditions?
-To reduce fever -To relieve mild pain
Bowel Disorder Drugs
-Treat or prevent nausea/vomiting -Motion sickness -Diarrhea -Constipation -Treatment of gastroesophageal reflux disorder (GERD)
Neuromuscular blocking drugs
-Used as adjuncts with general anesthetics for surgical procedures= facilitates controlled ventilation -Used prior to intubation -Used prior to laryngoscopy, bronchoscopy, esophagoscopy -Reduced spasms from tetanus -Prevent bone fractures during electroconvulsive therapy
Antiemetics
Cannabinoids: dronabinol Anticholinergics: scopolamine Antihistamines: dimenhydrinate, hydroxyzine Helps: Motion sickness Vertigo and nausea Dizziness, sedation constipation, dry mouth, blurry vision, urinary retention Dry mouth, suck on hard candy
NMBDs interations
Cause a release of histamine -bronchospasm -hypotension -excessive bronchial and salivary secretion Seldom affect GI tract -constipation or ileus possible Elderly at higher risk bc of polypharmacy PTs taking benzodiazepines, opioids Antihypertensives and beta-blockers have additive effects with general anesthetics: enhance anesthetics NPO
A nurse is caring for a client who currently takes furosemide and has a new prescription for prednisone. The nurse should monitor the client for which of the following manifestations during concurrent use of the two drugs?
Hypokalemia The risk for this electrolyte imbalance increases when the client is taking potassium-depleting diuretics, such as furosemide. The nurse should clarify the prescription with the provider and monitor the client's potassium levels.
A nurse is caring for a client who has a new prescription for butorphanol. The nurse should monitor the client for which of the following adverse drug reactions?
Nausea Dizziness Headache
Non-opioids
Non-steroidal anti-inflammatory drugs (NSAIDS) Acetaminophen
Toxic Epidermal Necrolysis (TEN)
Occurs when the liver fails to properly break down a drug, which then cannot be excreted normally -risk of death decreases if the offending drug is quickly withdrawn and supportive care is maintained -severe and deadly drug-induced allergic reaction -Widespread epidermal sloughing caused by massive disintegration of keratinocytes -Multisystem organ involvment
A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make?
Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn
H pylori- antibiotics used
Using 2 or more decreases potential for resistance: 14 days eradicates bacteria -Amoxicillin -Bimuth -Clarithromycin (Biaxin) -Metronidazole (Flagyl) -Tetracycline -Tinidazole
A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should monitor the client for which of the following adverse drug reactions?
Urinary retention Respiratory depression Sedation Orthostatic hypotension
A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to a client?
Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.
A nurse is caring for a client who is opioid dependent and has a new prescription for butorphanol. The nurse should monitor the client for which of the following manifestations of abstinence syndrome?
Vomiting Abdominal cramps
Malignant hyperthermia
s/s: rapid rise in body temp, tachycardia, tachypnea, muscular rigidity -Treated with dantrolene (a muscle relaxant) and cardiorespiratory support -Highest risk: pediatric pts, pts with preexisting musculoskeletal abnormalities, genetic predisposition MEDICAL EMERGENCY
A nurse is taking a history for a client who reports that he is taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin?
warfarin
NSAIDs complications: Increased risk for heart attack and stroke
with non aspirin NSAIDs -use smallest effect dose for those with cardiovascular disease
