Final imbedded
The nurse provides medication teaching for a client with a diagnosis of hypertension who is prescribed a clonidine patch. Which statement is most important for the nurse to include in the teaching?
"Apply the patch to a clean, dry, hairless sire in the upper arm, outer arm, or upper chest"
The nurse provides education for a young adult client being treated for trichomoniasis with metronidazole. Which instruction by the nurse is the most appropriate?
"Avoid sexual intercourse during the use of metronidazole for trichomoniasis unless a condom used"
The nurse instructs a group of pregnant clients about Lamaze techniques. During class, the nurse hears one participant tell another participant, "taking medication during pregnancy is very risky, so you should stop taking the medication your health care provider prescribed". Which response by the nurse is best?
"Depending on the medication and trimester of pregnancy, appropriate choices can be made"
The nurse instructs a client prescribed immediate realize lovastatin for treatment of hypercholesterolemia. The nurse determines teaching is successful if the client makes which statement?
"I always take this medication with food to help avoid an upset stomach"
A client takes quinine sulfate. The nurse determines further teaching is required if the client makes which statement?
"I enjoy a glass of tonic water in the evening with dinner"
A client with a diagnosis of multiple sclerosis is prescribed baclofen 10mg PO four times a day for muscles spasms. When caring for the client, the nurse is most concerned if the client makes which statement?
"I have not been able to have a bowel movement for 3 days and I feel so bloated"
A client with a diagnosis of urinary tract infection is receiving phenazopyridine. The nurse determines the client understands the treatment when the client makes which statement?
"I know it is expected for my urine to turn orange?"
the nurse instructs a client with a diagnosis of epilepsy who is prescribes phenytoin sodium. The nurse determines teaching is successful if the client makes which statement?
"I should avoid drinking alcohol while taking this medication"
A clients plans to stop smoking and has a prescription for bupropion. Which client statement indicates to the nurse that medication education is successful?
"I should not stop smoking until I have taken the medication for at least one week"
the nurse learns a client has been taking simvastsin for seven months. Which statement by a colleague does the nurse correct?
"I should take the client's BP in supine, sitting, and standing positions"
The nurse instructs a client taking lansoprazole for the first time. The nurse determines teaching is effective if the client makes which statement?
"I should take this medication before meals"
The nurse assesses a client taking the contraceptive medroxyprogesterone. The nurse is most concerned if the client makes which statement?
"I take my blood pressure once or twice a week"
The home care nurse receives a phone call from a client diagnosed with hypertension and arthritis. The client reports taking aspirin every morning for a year to reduce the pain experienced in both knees upon arising. The client states the aspirin relieves the pain, but the clients spouse noticed that the clients eyes and skin look yellow. Which statement made by the nurse is most appropriate?
"I will contact your health care provider to obtain a prescription for lab work to determine why you are jaundiced"
A client diagnosed with venous thromboembolism (VTE) is prescribed warfarin at discharge. The nurse provides education too about the medication and determines the client understands the teaching if the client makes which statement?
"I will need to have blood drawn periodically to ensure my dosing is effective"
A client reports multiple watery bowel movements after taking a prescribed antibiotic for several days. The client is prescribed loperamide. It is most important for the nurse to follow up on which client statement?
"I will stop taking this antibiotic until this diarrhea stops"
The nurse instructs a client diagnosed with African fibrillation about lisinopril. Which client statement indicates teaching is effective?
"I will use spices to season my food and avoid table salt and salt substitute"
The nurse provides medication education for a client with a prescription for digoxin 0.125mg PO daily. The nurse determines teaching is effective if the client makes which statement?
"If my pulse is under 60 beats per minute, I should hold the medications NF notify my healthcare provider"
The nurse teachers a client about the use of a stool softener following surgery. Which instruction is most important for the nurse to include?
"It is very important for you to drink plenty of liquids while you are taking this medication"
An older adult client with a diagnosis of angina has been prescribed sustained-release nitroglycerin tablets. The home health nurse provides medication information to the client. Which information is most important for the nurse to include?
"Keep the medication dry in a tightly sealed container out of the reach of children"
The nurse provides care for a client diagnosed with degenerative joint disease. The nurse reviews the clients medications and notes the client takes acetaminophen and celecoxib. The nurse is most concerned if the client makes which statement?
"My urine is dark even though I drink plenty of fluids"
The nurse provides care for a client with a diagnosis of gout who has received a prescription for allopurinol. The nurse provides medication teaching to the client. It is most important for the nurse to make which statement?
"Notify the health care provider if you develop any skin rash"
A client diagnosed with neuralgia has been prescribed gabapentin. The nurse teaches the client about the medication. Which information is most important for the nurse to include?
"Take the medication two hours before or after taking an antacid"
The nurse provides care for a client with a diagnosis of depression who has been receiving fluoxetine for eight months. The client reports, "since I have been on the medication i feel less depressed, but I have frightening dreams and want to stop taking it", which response by the nurse is most appropriate?
"The dosage of medication must be reduced gradually id you may experience severe adverse effects"
The nurse provides care for a client with a diagnosis of gastroesophageal reflux disease (GERD) who is receiving famotidine. The client reports muscle weakness and dark urine. Which response by the nurse is best?
"The symptoms you describe could indicate liver impairment. I will notify the healthcare provider"
the nurse provides care for a client who is prescribed sertaline. Which statement is most important for the nurse to make?
"This medication may make it more effective for you to sleep at night"
A client diagnosed with peptic ulcer disease has been instructed to take cimitidine once per day. The client states, "I have difficult remembering to take my medication every day". Which instruction is most appropriate for the nurse to give the client?
"Try taking the medication once a day at bedtime"
A client with a diagnosis of herpes zoster has taken acyclovir for one week. The clients calls the clinic and reports to the nurse, "I am bruising so easily and I have started running a fever". Which statement by the nurse is most appropriate?
"You need to be seen by the healthcare provider immediately"
A client with a diagnosis of heart failure is prescribed oral furosemide. When providing medication teaching, which information is most important for the nurse to include?
"You will need to get up slowly from the bed or chair"
The nurse teaches a pregnant client about taking carbonyl iron. It is most important for the nurse to include which statement?
"Your stool may turn black or dark green"
a client with a history of asthma and bronchitis is prescribes montelukast. The nurse determines the client understands teaching about the medication when the client makes which statement?
"it will take several weeks for this medication to lessen the effects of chronic asthma"
the nurse provides medication education for a client receiving lovastatin. Which information is most important for the nurse to include?
"notify to healthcare provider if you experience muscle pain"
Which instruction by the nurse is best to include when teaching a client about amlodipine?
"report any swelling of the face or extremities to the healthcare provider"
the nurse provides care for a client diagnosed with rheumatoid arthritis who reports cramping and abdominal discomfort after taking prescribed hydrocortisone. which instruction by the nurse is best?
"take hydrocodone with food and not on an empty stomach"
A client diagnosed with hypertension and heart failure has been prescribed captopril. Which statement is most important for the nurse to include when providing medication education to the client?
"you should avoid salt substitutes while you are taking this medication"
Long-Acting Insulin
- "basal insulin" -CLEAR appearance
Short- Acting *Regular Insulin*
- 30-60 minute onset -iv, bolus, iv infusion, or im
Rapid- Acting Insulin
- 5-15 minute onset -Eat immediately after given -sub q, or sub q insulin pump
Carbonic Anhydrase Inhibitors
- Acetazolamide (Diamox) - Mechanism of Action: Inhibits formation of carbonic acid, help move fluid - Primary Use: Decrease intraocular fluid pressure in patients with open angle glaucoma Adverse Effects: allergic reaction (contain sulfa), fluid and electrolyte imbalances
Octreotide (Sandostatin)
- Antagonists to gh (anti-growth hormone) - used in patients with acromegaly - watch for blood glucose, renal impairment -iv, im, sub q •Similar to the natural hormone, somatostatin. •Potent inhibitor of growth hormone, glucagon, and insulin. •Suppresses luteinizing hormone (LH) response to GnRH •Decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. •Used to treat the symptoms associated with metastatic carcinoid tumors (flushing and diarrhea), and Vasoactive Intestinal Peptide (VIP) secreting adenomas (watery diarrhea). •Octreotide substantially reduces and in many cases can normalize growth hormone and/or IGF-1 (somatomedin C) levels in patients with acromegaly.
Fasting blood glucose
- Blood test to see levels of glucose in the blood - impaired: 100mg/dl - 126 mg/dl -NORMAL: 70 - 100 mg/dl
Condition of HYPOthyroidism
- Cretinism (in kids) -myxedema (in adults)
Advantages of prescription drugs
- Health care provider examines the patient and orders the proper drug. Amount and frequency of drug is controlled. Instructions on use and side effects of drug are discussed.
Cushing Syndrome
- Prolonged use of steroids - Metabolic disorder from over production of steroids.
Assessment for Anterior/posterior pituitary drugs
- Renal function -Examine epiphyseal plates -Liver function -DONT stop drugs right away because it could cause a carcinoid crisis
Statins (HMG-CoA Reductase Inhibitors)
- Take with evening meal or at bedtime (cholesterol is highest at night) - Side effects: Hepatotoxicity, myopathy, muscle pain or tenderness - Rhabdomyolysis (muscle breaking down) - releases creatinine and kidneys get overloaded trying to get out (kidney can shut down) - Jaundice, Edema (from not enough albumin and not enough clotting factors)
Pioglitazone
- classified as a thiazolidinediones
Cretinism symptoms
- low mb rate -stunted sexual development -mental retardation
Pitocin
- mimics oxytocin -increases contractions
Drugs elicit different responses depending on individual factors:
-Age -Sex -Body mass -Health status -Genetics
Enteral route of administration
-By mouth: Tablets, capsules -Via nasogastric tube or gastrostomy tube
Parenteral Advantages
-Bypasses first-pass effect and enzymes -Available to patients unable to take medication orally
Enteral advantages
-Convenient -Overdose can be countered -Safest route because skin barrier not compromised -Uses vast absorptive surfaces
Factors that can cause a patient to deviate from compliance:
-Cost of drug -Forgetting doses -Annoying side effects -Self-adjustment of doses Fear of dependency
Type 2
-Decrease or defective insulin receptors -high levels of endogenous insulin EARLY in disease, but low levels LATER. -accounts for 90% of cases -1/3 of patients need insulin -early use of insulin = improved outcomes
Enteral disadvantages
-Difficulty swallowing -May be inactivated if tablets crushed or opened or by enzymes -Depends on patient gastrointestinal First-pass metabolism
Pharmacotherapy is the application of drugs for
-Disease treatment -Alleviation of suffering
Polymorphism
-Enzyme function changes -Genetic polymorphisms appear more frequently in specific ethnic groups
Three-Legged stool
-Exercise -Nutrition -Medication
Gestational Diabetes
-Hyperglycemia in pregnancy -treated w/diet and insulin
Metabolic activity may be decreased in some patients:
-Infants and elderly -Patients with severe liver disease -Patients with certain genetic disorders
Type 1
-Lack of insulin section of beta cells of the pancreases.. -Insulin receptors are NORMAL -autoimmune disease -Juvenile onset accounting for 10% of cases
Plasma Half-Life of Drugs
-Length of time needed to decrease drug plasma concentration by one half -The greater the half-life, the longer it takes to excrete -Determines frequency and dosages
therapeutic index
-Measure of a drug's safety margin -The higher the value, the safer the drug
Niacin
-Nicotinic Acid -Not sure how it works -effective and inexpensive causes flushing, itching, GI distress (oral med) - start on very low dosage and work them up - use aspirin or NSAID after taking, will not get as much flushing or itching - Vitamin B3 - Niacin flush dilates the capillaries and may be painful - Painful flush, hives, rash, sweating, blurred vision, liver damage, impaired glucose tolerance - some people take niacin to get color/tan
Parenteral Disadvantages
-Only small doses can be used -Possible pain and swelling at injection site
Disadvantages of OTC drugs
-Patient may choose wrong drug -Patient may not know reactions or interactions -Ineffective treatment may result in progression of disease
Community and Environmental Influences on Pharmacotherapy
-Population growth -Complex technology advances -Evolving globalization patterns -Population density -Age distribution -Occupational patterns -Industrial growth -Access to health care
Sulfonylureas (Class of oral anti diabetic medication)
-Release of insulin -Decreases glucagon -Must have functioning beta cells -Hypoglycemia
disadvantages of prescription drugs
-Require a prescription -Need appointment
Somatropin (Genotropin, Humatrope)
-Stimulates growth -Mimics Gh (growth hormone) -Cant use once epiphyseal plates are used -watch for blood glucose, renal impairment •Treatment •Dwarfism and growth failure •Maintain muscle mass in wasting due to AIDS •Used experimentally to treat multiple sclerosis, to enhance weight loss in obesity, as well as in fibromyalgia, heart failure, Crohn's disease and ulcerative colitis, and burns.
Role of Insulin drugs
-Substitute for endogenous hormone -metabolizes carbohydrates, fats, and proteins -stores glucose in liver -converts glycogen to fat stores
addiction
-The overwhelming feeling that drives someone to use a drug repeatedly
Levothyroxine
-Treatment of HYPOthyroidism -mimics T3 and T4 -Take every morning w/empty stomach -A/E: angina, heart palpitations from increased metabolic rate, insomnia, anxiety) -Monitor for weight loss *decreases serum digoxsin levels
Hemoglobin A1C
-Used to measure the three-month average plasma glucose concentration -Less than 7% is goal -glycosylated = when sugar molecules become stuck to hemoglobin
when educating the patient, provide:
-Written, age-appropriate handouts -Audiovisual teaching aids, hands-on training -Contact information in case of adverse reaction
Metformin
-classified as a bigunide -A/E - causes diarrhea
Acarbose
-classified as an alpha glucosidase inhibitor
Glipizide, glyburide, glimepiride
-classified as sulfonylureas -take 30 minutes before meals
Bigunide (Class of oral antidiabetic medication)
-decreases glucose production -decreases intestinal absorption -Gi complaints -No hypoglycemia or weight gain
Assessment for thyroid drugs
-glucose levels -weight loss in hypothyroid medication -dont stop drugs abruptly -heart conditions
Conditions of HYPERthyroidism
-graves disease (autoimmune) -plummers disease (older people) -thyroid storms (acute, life threatening, caused from untreated or underrated hypothyroidism)
myxedema symptoms
-hair loss -edema -yellow/dullness
Thyroid gland function
-metabolizes T3 and T4 -releases calcitonin (reduces blood-calcium levels and opposes parathyroid hormones)
Desmopressin
-mimics anti diuretic hormone -used for bed wetting, diabetes insipidus, hemophilia A, von willebrand -
Vasopressin (adh)
-mimics anti diuretic hormone -A/E include: vomiting and muscle crams Functions: -decrease urine production -decrease sweating -increase BP
Adrenal gland function
-outer = cortex = steroids are made (aldosterone, cortisol) -Inner = medulla = catecholamines (epinephrine, norepinephrine)
Parathyroid gland function
-regulates blood-calcium levels -bone growth, muscle contraction -Pth (parathyroid hormone)
Thiazolidinediones aka glitazones (Class of oral anti diabetic medications)
-regulates genes -cautious use in heart failure, kidney disease, liver disease -Edema is a side effect
Intermediate- acting
-slow onset, prolonged duration -CLOUDY appearance
Propylthiouracil (PTU)
-treatment of HYPERthyroidism -inhibits production of Iodine (which the thyroid needs to make T3 and T4) -given after surgeries *avoid shellfish, soy, and tofu (foods high in iodine)
Alpha glucosidase inhibitors (Class of oral anti-diabetic medications)
-used with oral hypoglycemics -GI effects
the nurse in the cardiac rehabilitation knows the maintenance dose of digoxin for adults is in which range?
0.125 to 0.5 mg
Digoxin
0.5-2.0 ng/mL (narrow)
a client is prescribed 0.25mg digoxin PO daily. Digoxin is available in 0.5mg per mL. How many mL does the nurse administer to the client?
0.5mL
Three checks of drug administration
1. Checking the drug with the MAR or the medication information system when removing it from the medication drawer, refrigerator, or controlled substance locker 2. Checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag 3. Checking the drug before administering it to the patient
Anticoagulation therapy
1.5-2.5x the control (in seconds)
A client receives ibuprofen 400mg orally qid. The nurse knows the client receives how many grams of ibuprofen per day?
1.6 grams
The home health care nurse provides care for a client diagnosed with type 1 diabetes. The nurse injects regular insulin subcutaneously at 1130. The nurse knows the peak action of this insulin will occur at which time?
1230 to 1630
Sodium
135-145
Platelets
150,000-400,000
A client is recieving 40 drops per minute of dextrose 5% in water. The iV set delivers 10 drops per millimeter. If the nurse starts the IV infusion at 1200 with 1000mL, how many mL will remain at 1530?
160 mL
INR
2.0-3.0 (therapeutic range)
Potassium
3.5-5.0 mEq/L
aPTT
30-40 sec (activated partial thromboplastin time)
Cefaclor 10mg/kg every 12 hours is prescribed for a child weighing 44lbs. The medication comes in an oral suspension that contains 250mg/5mL. How many mL does the nurse administer for each dose?
4mL
PTT
60-70 sec (partial thromboplastin time)
A client receives aminophylline 400mg every 6 hours. The ampule contains 500mg in 20mL of fluid. How many mL does the client receive in 24 hours?
64mL
Thrombocytopenia
<100,000
Critical PTT
> 100 seconds
Critical aPTT
>70 seconds
Oxytocin
A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.
IV bolus
A large volume of medication or solution that is delivered in a relatively short period of time
Hyperkalemia
Above 5 mEq/L Causes: high consumption of potassium, potassium-sparing diuretics, renal disease Most serious are dysrhythmias and heart block Other symptoms are muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea Restrict dietary sources Decrease dose of potassium-sparing diuretics Administer glucose and insulin Administer calcium to counteract potassium toxicity on heart Administer polystyrene sulfonate (Kayexalate) and sorbitol to decrease potassium levels
Diuretics
Acetazolamide, Mannitol, Hydrochlorothiazide, Furosemide, Spironolactone
Which antiviral drug should you assess lesions before and after therapy?
Acyclovir
Which antiviral med should be administered via IV pump over 1 hour to prevent neurotoxicity?
Acyclovir
Which medication should you take 24-48 hrs after first symptoms to be most effective
Acyclovir
A client is prescribed morphine per patient controlled analgesia (PCA pump) to control pain following surgery. The nurse assessed the client and notes the client is lethargic, the respiratory rate is 6 per minute, and the clients pupils are pinpoint. Which intervention does the nurse provide immediately?
Administers naloxone hydrochloride
Potassium Chloride
Administration Alerts - Always give oral medication while the patient is upright to prevent esophagitis. - Do not crush tablets or allow the patient to chew tablets. - Dilute liquid forms before giving P O or through a nasogastric tube. - Never administer IV push or in concentrated amounts, and do not exceed an IV rate of 10mEq/h. (cause heart to stop) - Be extremely careful to avoid extravasation and infiltration. - Pregnancy category A.
Sodium Bicarbonate
Administration Alerts Do not add oral preparation to calcium-containing solutions. ◦The two compete Give oral sodium bicarbonate 2 to 3 hours before or after meals and other medications. ◦When given orally it tamps down the HCl acid in the stomach/affects absorption Pregnancy category C.
Addisons disease
Adrenocortical insufficiency
The nurse in the mental health clinic understands which foods must be avoided by clients taking phenelzine sulfate?
Ages cheeses, lunch meats, tofu
Colloids
Albumin and Dextran Increased oncotic pressure Move fluid from the interstitial space into the vessel Can impair platelet function Albumin: made in liver: reason why we keep fluid in vascular space, keeps the correct amount of fluids in an area Dextran: sugar based protein, increase oncotic pressure, keeps fluid in vascular space, too much in blood - more fluid in blood, increase urine output
This medication can cause capillary leak syndrome
Aldesleukin (Interleukin)
Phenylephrine (Neo-Synephrine)
Alpha - 1 Intense vasoconstriction with an increase MAP Decreases heart rate due to a reflex reaction to the increase arterial pressure Used to treat SVT In included in cold remedies as a decongestant due to nasal vasoconstriction (no more than three days - rebound)
Epinephrine
Alpha 1, Beta 1, and Beta 2 LOOK AT PPT
What benzodiazepine should be given at its highest dose at bedtime to avoid daytime sedation?
Alprazolam
What drug benzodiazepine should you taper by 0.5 mg every 3 days to prevent withdrawal?
Alprazolam
A client is diagnosed with systemic lupus erythematous (SLE). The nurse understands which is an adverse effect of prednisone prescribed for this client?
Alteration in mental status, poor wound healing, and muscle wasting
The client has filled a prescription for dorzolamide for newly diagnosed glaucoma. The nurse knows the client needs additional education if the client makes which statement?
Although I had a reaction to sulfa medications, I dont need to worry about eye drops
Which antifungal drug needs to be pretreated with antipyretic, antiemetic, and antihistamine?
Amphotericin
Which antifungal drug should you monitor VS every 15 min during test dose, and every 30min for 2-4 hrs after admin
Amphotericin
Which antifungal drug will always have fever, hypotension and chills as a side effect?
Amphotericin
A client is diagnosed with a severe exacerbation of COPD and is prescribed dexamethasone. While the client is taking this medication, which symptoms would the nurse expect to observe?
An increase in blood glucose
Teratogenic Drug Classification X
Animal and human studies have shown fetal abnormalities The drug is contraindicated in women who are or may become pregnant
Teratogenic Drug Classification B
Animal reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women
Magnesium Hydroxide
Antacid (milk of magnesia) Neutralizes stomach acid using aluminum hydroxide, sodium bicarbonate, and magnesium hydroxide Treats PUD, GERD, constipation, can cause diarrhea. *Not used in patients with renal disease. *Take before bed Given PO (chewable or liquid) 1-3 hrs. after meals 8oz of water Adverse effects: Diarrhea, hypermagnesemia. Assess: Usual bowel pattern Bowel sounds Distension Color/consistency/amount of stool Heartburn Indigestion Gastric pain
Sulfonamides
Antibiotic Prevent synthesis of folic acid which slows bacterial growth Treats gram+ and gram- bacteria. WATCH FOR SULFA ALLERGY and use caution with other sulfa drugs (i.e. loop diuretics) *Interacts with anticoagulants *Must drink with a lot of water (2000-3000mL per day) toxic to kidneys! *Can take with food. *Monitor CBC and blood glucose Adverse effects: anorexia, N/V/D, crystalluria (kidney stones), renal failure, skin rashes, bone marrow suppression
Tetracycline
Antibiotic: Tetracyclines Inhibit bacterial growth by inhibiting protein synthesis Treats chlamydia, Lyme Disease, Pneumonia, Rocky mountain spotted fever. Also used to treat H. Pylori infections in PUD. *High affinity to Ca, Mg, Fe. Given PO. Do not take with dairy, iron, or antacids (will decrease absorption) *Take with 6-8 oz of fluid. DO NOT GIVE if pregnant or under age 8 - stains teeth Adverse effects: photosensitivity, steven's johnson, hepatotoxicity, C-diff diarrhea.
Gentamicin
Antibiotics: Aminoglycosides Inhibit protein synthesis Treat mostly gram negative infections where penicillin is contraindicated. (E. Coli, pseudomonas, klebsiella.) Treats some gram positive. Treats serious urinary, respiratory, nervous, or GI infections when less toxic meds are contraindicated. *Very poor PO absorption, given mainly IV, IM. *Very potent antibiotics. *Monitor peaks and troughs of t this medication. Must be drawn within 30 minutes of ordered time. *Withhold if peak lvls are above normal range: 5-10 mcg/mL. *Watch for Nephrotoxicity, Ototoxicity, respiratory paralysis. Adverse effects: headache, pruitits, urticaria, superinfection, seizures, weakness, twitching, balance issues, hearing loss.
Penicillin
Antibiotics: Penicillins Kill bacteria by disrupting the cell wall Treats gram positive infections, streptococci, pneumococci, and staphylococci. Also treats gonorrhea and syphilis. *Primarily administered IV/IM. *After admin watch for an allergic rxn for 30 minutes especially after first dose. *Do not take with NSAIDs, oral contraceptives, Warfarin. *Give with water, not juice. *Can take with food if GI upset. *IM injections should be large Muscle (gluteal) Adverse effects: GI distress, oral/vaginal candidiasis, super infections, rash.
Phenelzine (Nardil)
Antidepressants: MAO Inhibitors Inhibits MAO from destroying NE, allowing more NE to remain in the synaptic cleft. Treats Parkinsons, major depression. Given PO No other drugs 2 weeks prior to starting treatment Do not give in the evening Can be crushed *Do not take any other SSRis with MAOIs. Do not take with antihypertensives, OTC. *Could make insulin more effective, monitor for hypoglycemia. *Caution patient not to eat tyramine: pickles, aged cheese, milk, wines, preserved meats. Could cause hypertensive crisis. *MAOI 14 day washout before starting other antidepressants. Adverse effects: Headaches, sweating, palpitations, HTN, tachycardia, N/V.
Fluoxetine
Antidepressants: SSRIs Block reuptake of Serotonin, allowing more serotonin to remain in the synaptic cleft Treats depression, OCD, panic disorder *Do not take anticoagulants or St. Johns wort. *Do not stop taking abruptly due to risk for Serotonin Syndrome: HTN, confusion, tremors, sweating, fever, lack of muscle coordination, rhabdomyolysis, renal failure. *Can treat with heparin. *Monitor liver function. Adverse effects: Headache, nausea, lethargy, low libido, weight gain, dizziness, drowsiness, insomnia. Black box warning: SUICIDE
Bismuth Subsalicylate
Antidiarrheal: Adsorbents Coats GI tract and eliminates in the stool binds and absorbs toxins. Given PO *Has aspirin, DO NOT GIVE TO CHILDREN OR TEENAGERS with chickenpox/influenza due to risk of Reye's syndrome. *Use with care in elderly and patients with decreased bleeding time. Adverse effects: constipation, nausea, tinnitus, impaction.
Lomotil (diphenoxylate)
Antidiarrheal: Antimotility Drugs Slows peristalsis down Opioid mixed with atropine (anticholinergic). Allows more electrolyte and fluid absorption in the large intestine. Given PO Can be taken with food Tablets may be crushed *Available OTC. *CNS depression at high doses. *Do not administer in patients with GI obstruction. Adverse effects: constipation, dizziness, drowsiness, dry mouth.
Amphotericin B
Antifungal Treats progressive, potentially fatal fungal infections. Bind to fungal cell membrane, allowing leakage of cellular contents. *Treats SEVERE infections *Given IV only. Typically treated for weeks to months. Pretreat with antipyretic, antiemetic and antihistamine *Monitor vital signs every 15 min during test dose and every 30 min for 2-4 hrs after administration. *Monitor CBC, BUN, creatinine, CMP. Adverse effects: hypotension, chest pain, hypoxia, nephrotoxicity, hypocalcemia, hypokalemia, anemia/thrombocytopenia.
Sumatriptan
Antimigraine Drugs Treats migraine attacks. Works as a selective agonist at specific vascular serotonin receptor sites, causing vasoconstriction in large intracranial arteries. *For mild migraines, typically want to start with OTC NSAIDs. If no relief, then treat with triptans. *Administer at the start of migraine. MAX 2 doses per day *Watch for allergy to latex when administering subq. *Contraindicated in: uncontrolled HTN, stroke/TIAs, MI, PVD. *Caution use in patients with renal/hepatic impairment. *Pregnancy category C *Drug-drug interactions: MAOIs, SSRIs, ginkgo, St. Johns wort. Adverse effects: GI upset, dizziness, vertigo, MI, tingling/warm sensation, chest tightness/pressure, angina, burning/cool sensation, flushing.
Bleomycin
Antineoplastics: Antitumor antibiotics Antibiotics that can kill some cancer cells by inhibiting DNA/RNA synthesis Treats lymphomas, squamous cell carcinoma, testicular carcinoma. Given IV, IM, Sub Q Dilute with 0.9% NaCl or D5W Administered slowly over 10 min Watch for pulmonary fibrosis and pneumonitis. *Monitor CBC *Produced by mold Streptomyces. Adverse effects: bone marrow suppression *Does not produce as much bone marrow suppression, N/V, changes in rectal mucosa, thrombocytopenia, leukopenia. Nursing Considerations: Wear PPE Baseline ECG Monitor respiratory status Monitor IV site Give through large bore IV Monitor for changes in rectal mucosa Labs: CBC (before admin)
Aldesleukin
Antineoplastics: Biologic response modifiers Enhance body's ability to remove cancer cells Stimulates or restores immune response by activating killer cells/T cells to destroy cancer cells. Treats metastatic renal carcinoma or melanoma, also used to treat non Hodgkin's lymphoma. Given IV, q8h 15-min infusion 14 doses Contraindications: Hypersensitivity Hx of cardiac or pulmonary disease Use cautiously in: Hepatic/renal disease Hx of seizures Drugs: Corticosteroids Antihypertensives Hepatotoxic/nephrotoxic drugs *Monitor for capillary leak syndrome: severe toxicity to the aldesleukin. Capillaries lose ability to retain vital colloids (albumin/protein), then will have a fluid shift from vascular to the tissues. Results in respiratory distress, HF, MI, dysrhythmias. *Reversible after discontinuation of therapy. Nursing considerations: Monitor BP, HR, O2, RR and ECG Monitor weight daily Assess skin for rash Monitor for change in mental status S/S of infection S/S of anemia Labs: CBC, Platelets, BUN, Serum Creatinine
Interferons
Antineoplastics: Biologic response modifiers Enhance body's ability to remove cancer cells by increasing phagocytosis, enhancing cytotoxic T- cell activity Natural in the body, protects uninfected cells from virus attacks by interfering with the virus/cancer and inactivating it. Also enhances the immune system. Treats hair cell leukemia, Kaposi's sarcoma, non-Hodgkin's lymphoma, chronic hep B and C infections Given IM, Sub Q, IV *Monitor CBC. Administer subQ if patient is at risk for bleeding. *Risk for: immunosuppression, hepatotoxicity, and neurotoxicity in long-term use. *Do not give to infants. Adverse effects: Flu-like symptoms, N/V, the "penias", anemia, dizziness, mood changes, seizures
Tamoxifen
Antineoplastics: Hormones Slow growth of hormone-dependent tumors Selective estrogen receptor modulator. Blocks estrogen receptors in the breast. Prevents and treats breast cancer. Depo-Provera- used in abnormal uterine bleeding Given PO Give with food DO NOT CRUSH Avoid antacids 1-2hrs after PO *Monitor CBC, platelets, calcium levels, cholesterol, liver function. *Ensure patient is up to date on pap smears. Do not give if pt is pregnant/breastfeeding Adverse effects: blood clots, hot flashes, leg cramps, thromboembolic disease BLACK BOX: increased risk of uterine cancer
Vincristine
Antineoplastics: Natural products From periwinkle plants, prevent division of cancer cells Mitotic inhibitors- Used to treat testicular, small cell lung, breast, ovarian, non-small cell lung cancers. Also treats kaposi's sarcoma, acute leukemia. Given IV only Push over 1 minute *Assess allergies to plants or flowers. *Monitor blood pressure. *Monitor for SI. *Antidote: Hyaluronidase *Monitor CBC, liver function, uric acid, neuro status. Adverse effects: nervous system toxicity (weakness, numbness), constipation, hypotension, anemia. Nursing Considerations: Have pt. fluid and fiber intake Monitor BP, HR, RR, Neuro, I&O Labs: CBC AST ALT Bilirubin BUN Creatinine
Metronidazole
Antiprotozoals Works by disrupting DNA and protein synthesis in susceptible organisms. Treats anaerobic bacterial infections (skin, intraabdominal, gynecologic, lower respiratory tract infections, etc). Given PO, IV, topically, vaginally PO - on empty stomach Non-XR can be crushed *Assess for rash periodically *Do not drink alcohol. *May cause dizziness/lightheadedness, caution the patient to avoid driving until reaction is known. *May cause an unpleasant metallic taste. Contraindications: Hypersensitivity 1st trimester of pregnancy Use caution in: Hepatic impairment Hx blood dyscrasias Hx of seizures Adverse effects: seizures, Stevens-Johnson, superinfection, GI upset, leukopenia, phlebitis at the IV site.
Cimetidine
Antiulcer Agent Histamine H2 Blocker (located in gastric parietal cells) Inhibiting gastric acid secretion Short-term treatment of active duodenal ulcers and benign gastric ulcers. Unlabeled Use: Management of GI symptoms associated with the use of NSAIDs. Management of urticaria. Given PO Not usually given IV - can cause hypotension. Instances of cardiac arrhythmias and hypotension have been reported following the rapid administration by intravenous bolus. Usually administered after meals Do not give to children under 12 Changes pH, can interfere with absorption Geriatric patients are more susceptible to adverse CNS reactions (lower dose recommended). adverse effects: confusion, drowsiness, gynecomastia, arrhythmias Do not take with calcium channel blockers or warfarin Avoid administration of antacids within 30 min- 1 hr of cimetidine Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
Acyclovir
Antivirals treats herpes and chicken pox by interfering with viral DNA synthesis. Given PO, IV, buccal, topical IV: Use pump! Administer over 1hr Adequate hydration after *Monitor BUN, creatinine before and during therapy. *Monitor elderly to prevent falls, IV administration can be neurotoxic Adverse effects: seizures, Steven-Johnson, blood clots, renal failure.
A client is prescribed morphine sulfate 4mg IV every 4 hours PRN for pain after surgery. The nurse assesses the client 30 minutes after giving the medication for a report of pain of 8 on the 1-10 numeric scale. The client's VS are: BP: 172/88mmHg, pulse 92BPM, and RR 22/min. The client reports pain at a level of 8. Which action by the nurse is most appropriate?
Assess the level of sedation
Antihistamines: Nursing Process
Assess: data about the condition or allergic reactions Contraindicated in the presence of acute asthma attacks and lower respiratory diseases Use with caution in increased intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy First Generation: sedation and drying Second Generation: no sedation but still drying Asthma: inflammation, bronchiole constriction, increased mucous Cardiac and Renal Disease: increase heart rate, get to the heart/has drying effect but we do not want drying in the kidney Glaucoma: increased intraocular pressure
Nursing Process
Assessment Diagnosis Planning Implementation Evaluation
Adrenergic Drugs
Autonomic Nervous System: Sympathetic "fight/flight" Agonists: dopamine, dobutamine, epinephrine, norepinephrine, phenylephrine
Pharmacologic Classification of Drugs
Based on the way a drug works at the molecular, tissue, or body system level
Therapeutic Classification of Drugs
Based on therapeutic usefulness in treating particular diseases or disorders ex. influence blood clotting, lower blood cholesterol, treat angina
What class of drugs are the best choice for short-term treatment of insomnia caused by anxiety?
Benzodiazepines
Alprazolam (Xanax)
Benzodiazepines Inhibits neurotransmitter release, intensifies the effect of GABA Treats GAD and panic disorder. Can also treat IBS, PMS, insomnia, acute mania and psychosis. Given PO Can be taken with food Give highest dose at bedtime to avoid daytime sedation *Caution inpatients with hepatic or renal dysfunction. *Do not take with other CNS depressant medications (opioids) or alcohol. *Assess CNS effects and risks for falls in elderly patients. *Taper by 0.5 mg every 3 days to prevent withdrawal. Adverse effects: short term- dizziness, drowsiness, lethargy, aggression, sexual dysfunction, blurred vision, dry mouth, constipation. Long term use: addiction, mental/sleep disorders, risk for cancer, immune system depression.
Midazolam
Benzodiazepines Inhibits neurotransmitter release, intensifies the effect of GABA Treats pre-procedural sedation (I don't put you to sleep but you won't remember a thing) and anxiolysis in peds patients. Specific adverse effects: apnea, laryngospasm, respiratory depression, cardiac arrest, SI. *Monitor BP, pulse, and respirations continuously during administration. Adverse effects: short term- dizziness, drowsiness, lethargy, aggression, sexual dysfunction, blurred vision, dry mouth, constipation. Long term use: addiction, mental/sleep disorders, risk for cancer, immune system depression.
Diazepam (Valium)
Benzodiazepines Inhibits neurotransmitter release, intensifies the effect of GABA Treats seizure disorders, including seizures resulting from alcohol withdrawal. Also used to treat status epilepticus and anxiety disorders. Given PO, IM, IV *15-20% of Asian patients and 3-5% of Caucasian and black patients may be poor metabolizers. *Caution in patients with hepatic or renal dysfunction. Caution for respiratory depression. *Caution for overdose *Antidote: Flumazenil can reverse effects. *Contraindicated in patients with narrow angle glaucoma. *If taken long term, do not stop suddenly, could cause seizures. Adverse effects: short term- dizziness, drowsiness, lethargy, aggression, sexual dysfunction, blurred vision, dry mouth, constipation. Long term use: addiction, mental/sleep disorders, risk for cancer, immune system depression.
Adverse Effects of Antitussives
Benzonatate: dizziness, HA, sedation, nausea, and others Dextromethorphan: dizziness, drowsiness, nausea Opioids: sedation, nausea, vomiting, lightheadedness, constipation
What Parkinsons drug should you administer with food or right after meals?
Benztropine
What Parkisons drug is poorly tolerated in older adults?
Benztropine
What anticholinergic drug treats parkinsons?
Benztropine
What drug is centrally acting to block acetylcholine?
Benztropine
What drug should be reduced if muscle weakness occurs?
Benztropine
What drug used to treat parkinsons should you monitor I&O's?
Benztropine
Dobutamine
Beta 1 selective vasoactive adrenergic drug Used for heart failure
Ethnicity
Biologic and genetic similarities
Do not give this drug to teens/children that exhibit signs of viral infection due to risk of Reyes syndrome
Bismuth Subsalicylate
This drug can cause grey-black stools
Bismuth Subsalicylate
This drug coats the stomach but cant be given to children
Bismuth Subsalicylate
No bone marrow suppression is caused by this drug
Bleomycin
This medication can cause pulmonary fibrosis and pneumonitis (monitory resp status)
Bleomycin
This medication needs to be diluted with 0.9% NaCl or DSW and needs to be administered slowly over 10 min
Bleomycin
Psyllium (Metamucil)
Bulk-Forming laxatives Contains fiber which absorbs water and ↑size of fecal mass. Treats and prevents chronic constipation. Given PO May be taken on a regular basis. Longer onset, not used for rapid treatment. Drink plenty of fluids while taking these medications (at least 8 oz with and after the medication) Adverse effects: hypoglycemia, esophageal obstruction, aspiration. Decreases absorption of warfarin, salicylates, and digoxin
A client with a diagnosis of anxiety and depression comes to the community mental health center and reports having feelings of overwhelming anxiety following the loss of a job. The client has a history of drug and alcohol abuse but now reports sobriety for over two years. Which antianxiety medication does the nurse expect to be prescribed for the client?
Busipirone
Electrolyte Imbalances
Calcium: 9-11 mEq/L (Hyper/Hypocalcemia) Chloride: 95-112 mEq/L (Hyper/Hypochloremia) Magnesium: 0.8-4 mEq/L (Hypo/Hypermagnesemia) Phosphate: 3.0-4.5 mEq/L (Hyper/Hypophosphatemia) Potassium: 3.5-5 mEq/L (Hyper/Hypokalemia) Sodium: 135-145 mEq/L (Hyper/Hyponatremia)
The home care nurse teaches a client using a metered-dose inhaler. Which method does the nurse teach the client to use to determine when to replace the canister?
Calculate the number of doses used, and compare to the number available.
What Parkinsons drug can cause dark urine/saliva/sweat, as well as vivid dreams/hallucinations?
Carbidopa/Levodopa
What Parkinsons drug should be taken at the same time everyday?
Carbidopa/Levodopa
What Parkinsons drug should not be started until patient has performed MAOI washout (2 weeks)?
Carbidopa/Levodopa
What Parkinsons drug should not be stopped abruptly?
Carbidopa/Levodopa
What drug works to increase synthesis of dopamine, and the other drug aids in preventing the breakdown of the combination drug?
Carbidopa/Levodopa
The nurse provides care for a client admitted with a diagnosis of respiratory tract infection. The client tells the nurse of an allergy to penicillin. The nurse is most concerned if which medication is prescribed?
Cephalexin
Which antibiotic drug group is broad spectrum?
Cephalosporins
Which drug group has multiple generations?
Cephalosporins
Which drug group treats gram negative bacteria?
Cephalosporins
Which drug group would be ideal for someone that cant afford penicillin?
Cephalosporins
Cardiac arrhythmias and hypotension can be caused if given by rapid IV bolus
Cimetidine
This is the only GI med which causes impotence/loss of libido in men
Cimetidine
This medication inhibits gastric acid secretion from parietal cells (histamine H2 blocker)
Cimetidine
This medication should not be given to children under 12
Cimetidine
The nurse receives a phone call from the radiology department. The department staff member will come in 30 minutes for a client schedule for abdominal X-rays. It is essential that the nurse administer which medication to the client prior to leaving the unit?
Ciprofloxacin 400mg IV
Which antibiotic drug can cause C. diff?
Clindamycin
Which antibiotic drug should you monitor bowel elimination?
Clindamycin
Diabetes Mellitus
Complex disorder of carbohydrate, fat, and protein metabolism. -Lack of insulin secretion by beta cells of the pancreas or defects in the insulin receptors.
Teratogenic Drug Classification A
Controlled studies in women fail to show a risk to the fetus, and the possibility of fetal harm appears unlikely
An adult male client takes finasteride. The nurse knows the most likely adverse effect of finasteride includes which finding?
Decreased libido and impotence
Continuing Assessment During Implementation of IV Fluid and Electrolyte Replacement Therapy
Desired therapeutic effects Monitor VS, urine output, LOC as appropriate Adverse effects
What benzodiazepine is used to treat status epilepticus?
Diazepam
What benzodiazepine should you monitor for respiratory depression?
Diazepam
What drug should you observe patient, potentially place them on bedrest for 3 hrs after admin?
Diazepam
What antimotility drug cannot be used in conjunction with MAOI's?
Diphenoxylate/atropine (Lomotil)
What antimotility/antidiarrheal drug is contraindicated in glaucoma and bowel obstruction?
Diphenoxylate/atropine (Lomotil)
What drug has a small amount of opioid? (low risk of addiction)
Diphenoxylate/atropine (Lomotil)
a client is struggling with alcohol abuse and wants assistance to stop drinking. The nurse knows which medication will most likely be prescribed for this client?
Disulfiram
How should you mix NPH and regular insulin?
Draw from regular insulin bottles FIRST then the NPH
the nurse provides information to a client with a diagnosis of anemia about good dietary sources of folic acid and folate. Which food is included in the teaching plan?
Dried beans, Bran, Citrus fruits, Fresh vegetable's
Benztropine
Drugs for Parkinson's Disease: Anticholinergic agent Centrally acting, blocks acetylcholine to inhibit overactivity in brain Controls symptoms of Parkinson's disease and treats extrapyramidal symptoms. Suppresses tremors but does not relieve tardive dyskinesia. *Pt may need assistance with administration. *Can split the dose throughout the day or take once at bedtime. *Reduce dose if muscle weakness occurs. *Avoid antidiarrheals, OTC cold meds. *Do not stop abruptly. *Antidote: physostigmine *Administer with food or immediately after meals. Adverse effects: dry mouth, constipation, urinary retention, dizziness, blurry vision, confusion, tachycardia, orthostatic hypotension.
Carbidopa-Levodopa
Drugs for Parkinson's Disease: Dopamine agonists Treats parkinsons, parkinsonism, restless leg syndrome. Levodopa increases synthesis of dopamine. Carbidopa prevents breakdown of dopamine. *Can take several months to see therapeutic effects. *Pt may need assistance with administration. *Can interact with MAOIs, antipsychotics, metoclopramide, methylphenidate, and iron. *Caution in patients with: PUD, psychotic disorders, hepatic/renal impairment, respiratory disease. *Contraindicated in pregnancy. *Do not abruptly stop taking this medication. Adverse effects: orthostatic hypotension, dry mouth, dark saliva/urine/sweat, uncontrolled movements (dyskinesia), nausea, anorexia, dementia, psychotic disorders (vivid dreams, hallucinations).
Teratogenic Drug Classification C
Either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available
Mimics or Inhibits
Endocrine System Drugs
Potassium Balance
Essential for proper nerve and muscle function Maintaining acid-base balance Influence by aldosterone: when it increases Na, it decreases K Imbalances can be serious, even fatal. Can cause cardiac issues if too high/too low 3.5-5.0 mEq/L
What sedative/hypnotic drug must you take right before bed and avoid high fat meals?
Eszopiclone
Polyphagia
Excessive hunger
Polydipsia
Excessive thirst
Polyuria
Excessive urination
Cholesterol Absorption Inhibitors
Ezetimibe (Zetia) Inhibits absorption of cholesterol secreted in bile and food NOT if pregnant Take 1 hour before or 4 hours after bile acid sequestrants
anterior pituitary
F- fsh (Follicle Stimulating hormone) L- Lh (Luteinizing hormone) A- ACth (adrenocorticotropic hormone) T P- Prolactin G- Gh (growth hormone)
Gemfibrozil (Lopid)
Fibric Acid Derivative decreases LDL, increase HDL Watch signs in liver function tests
What SSRI drug has a black box warning for teen suicide?
Fluoxetine
What drug should we monitor for NMS and serotonin syndrome?
Fluoxetine
Which sedative/hypnotic should not be stopped abruptly?
Fluoxetine
Loop Diuretics***
Furosemide (Lasix) - diuresis occurs/lasts 6 hours - IV: occurs in 2-5 minutes - Oral: occurs 30-60 minutes Bumetanide (Bumex) Side effects of both: lower BP from lesser fluid, lower potassium (most patients will be on K supplement), increase blood glucose level Should monitor daily weight (call if 2.2 lbs in 24 hours or 5 lbs in a week) Talk to pt. about orthostatic hypotension Cause ototoxicity (hearing loss) Can take with or without food (think about the fluid shifting and diuresing) LOOK AT POWERPOINT FOR MORE INFORMATION
Gabapentin
GABA potentiators Treats seizures, chronic pain, and nerve pain. Mechanism of action unknown, but may affect transport of amino acids across neuronal membranes. *Can cause rebound seizures if stopped abruptly. *May increase risk of SI. Adverse effects: rhabdomyolysis, SI, confusion, depression, dizziness, drowsiness, sedation, leukopenia.
What seizure medication can cause false positive readings for protein urine tests?
Gabapentin
What seizure medication can cause rebound seizures if stopped abruptly?
Gabapentin
What seizure medication treats restless leg syndrome and nerve pain?
Gabapentin
Which antibiotic drug could be used to treat serious gram (-) infections for a pt with penicillin allergy
Gentamicin
Which antibiotic drug do you need to pay attention to peak & trough?
Gentamicin
Which antibiotic drug has poor oral absorption and is given mainly IV or IM?
Gentamicin
Which antibiotic drug must you draw w/in 30min to maintain therapeutic levels?
Gentamicin
Which antibiotic drug should you monitor for ototoxicity and nephrotoxicity?
Gentamicin
Histamines
H1 receptor: brain, heart, blood H2 receptor: in the gut Stop histamine release, reduce allergic response
the nurse recognizes which antipsychotic is used as a treatment for Tourette syndrome?
Halperidol
Initial Assessment if IV Fluid and Electrolyte Replacement Therapy
Health History/medication history Baseline Physical Exam: focus especially on heart/cardiac Labs: Na, K, Ph, Mg (heart)
Hydration Status Using Hematocrit
Hematocrit: measures solutes to fluid/plasma Fluid Excess: more plasma/fluid and less solutes Dehydration: less plasma/fluid and more solutes
What is the antidote for lithium toxicity?
Hemodialysis
Hyperglycemia
High blood sugar levels
Atropine Overdose & Anticholinergics
Hot as a Hare (increased temp) Mad as a Hatter (confusion, delirium) Red as a Beet (flushed face) Dry as a Bone (decreased secretions, thirsty) Blind as a bat (mydriasis)
The nurse provides care for a client with asthma. Which medication prescription would the nurse question for a client with asthma?
Hydrocodone
the nurse counsels a client prescribed cromolyn to treat bilateral conjunctivitis. The nurse intervenes if the client makes which statement?
I put the eye drops in after I put my contact lens in"
The nurse instructs a client diagnosed with bipolar disorder and receiving lithium 300mg three times a day. The nurse determines that teaching is effective if the client makes which statement?
I will need to switch to decaffeinated coffee; I will eat a moderate amount of sodium; I need to drink between 2 and 3 liters of fluid daily
The nurse provides medication teaching for a client prescribed spironolactone for treatment of hypertension. The nurse determines that further teaching is necessary if the client makes which statement?
I will use a salt substitute instead of iodized salt; I limit my fluids so I don't have to run to the bathroom.
Calcium/Phosphorus Relationship
If one goes up the other goes down and vice versa
Impacts of Diabetes Mellitus on the body
Increased glucose means.... -fluid weight -kidney failure -eye damage -ulcers -heart disease -gallstones -acidosis
Vancomycin
Inhibits cell wall synthesis. Treats MRSA, C. Diff, other staph infections. Given IV, PO Must be given orally for staph and C-Diff *Complete an oral culture sensitivity before starting. Ototoxic and nephrotoxic. *If Red man syndrome occurs (flushing, erythema, pruitis all over body; dyspnea, hypotension), stop infusion, administer antihistamine, and restart infusion at slower rate. Watch for black furry tongue Adverse: Fever, chills, flushing, phlebitis at injection site, hearing loss, neutropenia, Red Man Syndrome
Isoniazid
Inhibits mycobacterial wall synthesis and interferes with metabolism. Treats TB. Given PO, IM. Can be taken with food Do not take within 1 hour of antacids *MUST take medication exactly as ordered. *Must be taken for at least 6 months, up to 24 months. *Contraindicated in patients with liver disease, hepatotoxic. *Take Vitamin B6 supplement (Pyridoxine) Adverse effects: Pancreatitis, Hepatitis, Peripheral neuropathy due to vitamin B6
Clindamycin
Inhibits protein synthesis. Treats community acquired pneumonia, strep meningitis, pelvic inflammatory disease, severe sinus/inner ear infections, necro fasc. *Multiple administration routes (PO, IM, IV, Topical) PO - full glass of water Topical - avoid contact with eyes/mucous membranes IV - dilute with NS, LR or D5W Contraindications: Ulcerative colitis Previous C-Diff Severe liver impairment Diarrhea Alcohol intolerance *Caution for kidney and liver issues. *Monitor CBC Adverse effects: Cdiff, fever, rash, N/V/D.
Which nursing measure is included in the teaching plan for a client regarding the use of beclomethasone?
Instruct the client on proper use of the inhaler
This biologic response modifier (cancer med) can be given SQ, IM, and IV
Interferon
This cancer med is contraindicated in infants
Interferon
This medication can cause dose-related fatigue and flu-like symptoms
Interferon
Insulin Isophane Suspension (NPH)
Intermediate insulin drug
Dopamine
Intropin Mechanism of Action: dopamine receptors and Beta-1 Vascular Effects: low dose constricts vessels in sites other than the kidneys or brain, high dose constricts all vessels Cardiac Effects: increases contractility and increase systolic BP Pulmonary Effects: NONE Special Characteristics: used to treat shock related to underperfusion and reflex vasoconstriction
the nurse provides care for a client with a new diagnosis of active tuberculosis. The nurse anticipates which medication will be prescribed for the client's treatment?
Isonazid and Rifampin
Which TB antibiotic can cause peripheral neuropathy?
Isoniazid (INH)
Which TB antibiotic drug can cause B6 deficiency requiring use of pyridoxine?
Isoniazid (INH)
Which TB antibiotic should you perform liver panel prior to admin?
Isoniazid (INH)
Which antibiotic drug is first-line TB therapy?
Isoniazid (INH)
Cholinergic Drugs: Acetylcholine
LOOK AT PPT
What antidiarrheal drug can cause hyperglycemia?
Lactulose
What antidiarrheal drug helps remove excess ammonia?
Lactulose
What antidiarrheal drug should you monitor ammonia levels?
Lactulose
What drug can be given via enema?
Lactulose
What drug increases water content to soften stool?
Lactulose
Lactulose
Laxative: Saline Cathartics Hyperosmotic Increases water content and softens the stool. Helps remove excess ammonia Treats chronic constipation. *Can prescribe in management of hepatic encephalopathy. Given PO - mix with water, juice or milk Give tablets whole With full glass of water or juice (240mL) *Can cause hyperglycemia, care in diabetes. *↓pH of the colon, ↓ blood ammonia levels. Milk of magnesia (magnesium hydroxide) Adverse effects: urticaria, abdominal bloating, cramping, flatulence, nausea.
Bisacodyl
Laxative: Stimulants Promotes peristalsis by irritating bowel mucosa. Treats constipation. Used prior to radiologic studies or surgery for bowel evaluation. *Drug/Drug interactions: antacids, H2-receptor antagonists. *Affects the brain so dependence can occur. *Do not take with milk, take with water only. *Do not crush or chew. Adverse effects: abdominal cramps, N/D, hypokalemia, muscle weakness.
Nonbronchodilators
Leukotrienes cause inflammation and allergy like responses, when there is a trigger of an allergy, leukotrienes are released, lead to inflammation, bronchoconstriction, mucous production Leukotriene Receptor Antagonists (LRTA's) - block release •Prophylaxis and long-term treatment and prevention •Montelukast •Black box warning issued in 2009 for neuropsychic events •HA, nausea
Hypernatremia
Level above 145 mEq/L Most commonly caused by kidney disease Sodium accumulates Elevated sodium increases osmolality of plasma: water moves in S/S: thirst, fatigue, weakness, muscle twitching, convulsions, altered mental status Can be treated with low-salt diet Acute treated with hypotonic IV fluids (if hypovolemic) or diuretics (if hypervolemic) One cause: dehydration: sodium looks high because plasma is low (hypo) One Cause: ratio is the same but all numbers are higher (fluid and electrolytes)
Hyponatremia
Level below 135 mEq/L Caused by excessive dilution of plasma Early symptoms: nausea, vomiting, anorexia, abdominal cramping Later Signs: altered neurological function Hyponatremia cause by excessive dilution Treat w/ loop diuretics to cause an isotonic diuresis Hyponatremia caused by sodium loss Treat with oral sodium chloride or IV fluids containing salt Can be drinking tons of water and not getting electrolytes
Hypokalemia
Level below 3.5 mEq/L Causes: loop diuretics, Strenuous muscle activity, Severe vomiting or diarrhea Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest. Mild—Increase dietary intake Severe—Give oral or parenteral potassium supplements
What drug affects sodium transport across cell membranes?
Lithium
What drug has a narrow therapeutic range of 0.8-1.1mmols/L?
Lithium
What drug toxicity level of 2.0+ causes impaired consciousness and convulsions?
Lithium
What drug toxicity of 1.5-2.0 causes anorexia, vomiting, diarrhea, tremor, ataxia, confusion and sleepiness?
Lithium
What mood stabilizer must you closely monitor blood levels to ensure therapeutic range and monitor for toxicity?
Lithium
When taking this drug, a change in sodium intake can cause tremors and cardiac issues
Lithium
What is the brand name for Diphenoxylate/atropine?
Lomotil
Glargine, Determir
Long-Acting Insulin Drugs
a client asks the nurse, "how does lovastatin work?" Which is the nurse's best response?
Lovastatin prevents an enzyme in the liver from making more cholesterol
Hypoglycemia
Low blood sugar levels
This antacid/laxative needs to be taken with 8oz of water, 1-3 hours after meals
Magnesium Hydroxide
This medication can be considered an antacid and a laxative
Magnesium Hydroxide
This is the only chewable antacid/laxative
Magnesium hydroxide
single order
Medication that is to be given only once, and at a specific time, such as a preoperative order.
What stimulant drug should monitor HR and BP, as well as rhabdomyolysis?
Methlphenidate
What drug can you take a "drug holiday"?
Methylphenidate
What drug should you administer to children <6 before breakfast/lunch, but give to adults in the evening (not right before bed)?
Methylphenidate
What stimulant drug has a high abuse potential?
Methylphenidate
What stimulant drug is a schedule 2 (speedy)?
Methylphenidate
What stimulant drug is used to treat ADHD or narcolepsy?
Methylphenidate
What antiemetic drug blocks dopamine receptor and stimulates peristalsis of stomach/gut?
Metoclopramide (Reglan)
What antiemetic drug do you need to monitor for tardive dyskinesia?
Metoclopramide (Reglan)
What antiemetic drug is contraindicated in MAOI's use?
Metoclopramine (Reglan)
What drug could potential cause EPS?
Metoclopramine (Reglan)
What drug could potentially mask the toxicity of other drugs?
Metoclopramine (Reglan)
Which antifungal drug should not be taken with ANY alcohol products? (cough meds, etc)
Metronidazole
Which drug is antiprotozoal?
Metronidazole
What benzodiazepine "won't put you to sleep, but you wont remember anything"
Midazolam
What benzodiazepine has adverse effects of suicidal thoughts, cardiac arrest, and laryngospasm?
Midazolam
What benzodiazepine is considered a "high-risk" med?
Midazolam
What benzodiazepine is used for preprocedural sedation?
Midazolam
Bronchodilators: Key Points
Mode of Action: dilates bronchi and bronchioles to decrease resistance and allow for easier passage of air Uses: Asthma, COPD, Bronchitis Short-Acting: for rescue breathing Long-Acting: for maintenence
Lithium
Mood stabilizer Alters cation transport (sodium) in the nerve and muscle. Treats acute manic/mixed episodes associated with Bipolar. *Monitor electrolytes, CBC, kidney function, cardiovascular/GI status. *Monitor for excessive loss of sodium, drink lots of fluids *Narrow therapeutic index 0.8-1.1 (0.5-1.5 in drug guide). *Hemodialysis is antidote. *Lithium toxicity: N/V, weakness, lightheadedness, confusion, coma, seizure. *Many drug-drug interactions: CCBs, phenytoin, diuretics, NSAIDs, metronidazole. Adverse effects: leukocytosis, insipidus, tremor/teratogenic, hypothyroidism, seizures, serotonin syndrome
Advantages of OTC drugs
No health care provider appointment required Often less expensive than prescription drugs
The home health care nurse visits an older adult client receiving quetiapine tablets three times a day. The client's spouse states. "My spouse just seems so restless and moves constantly". Which statement by the nurse is most appropriate?
Notify the healthcare provider
A client diagnosed with a stroke has taken phenobarbital for seizure control for 2 years. The clients partner calls the clinic and tells the nurse that the clients speech is slurred and the client is making confused statements. The clients neurologic baseline is alert and oriented with clear, appropriate speech. Which nursing action is most appropriate?
Obtain a prescription for a blood specimen
black box warnings
One of the primary alerts for identifying extreme adverse drug reactions discovered during and after the review process
Antitussives: Anti-Coughing
Opioid: codeine and hydrocodone: work in brain, might get cough signals but cuts them off, sedations Non-Opioid: dextromethorphan, benzonatate: work in brain, cough syrup (teens) - non opioid side effect: numbness especially in back of throat, can lead to aspiration Should only be used in nonproductive coughs (dry coughs)
Osmitrol (mannitol)
Osmotic Diuretic: pulls water into the nephron, increases excretion of almost all electrolytes Primary Uses: Intracranial pressure and intraocular pressure Used for Oliguric Phase, decreased GFR, and pressure Can worsen edema: if in kidney failure and cannot urinate, fluid gets put into tissue
A client receives promethazine for reports of nausea following surgery. The nurse will monitor the client for which adverse effect after administering this medication?
Over sedation, uncontrolled eye movement, tinnitus
Nonbronchodilators- Corticosteroids
PO: prednisone IV or PO: methylprednisolone Inhaled: budesonide, fluticasone Reduce inflammation and enhance beta agonists Slow working, do not use if having asthma attack
Which IV antibiotic must you rotate IV sites every 48 hrs to prevent phlebitis?
Penicillin
Which antibiotic drug can increase risk of bleeding if taken with warfarin or NSAIDs?
Penicillin
Which antibiotic drug must you verify allergy and teach on decreased oral contraceptive effects?
Penicillin
What MAOI should not be given in the evening?
Phenelzine
What MAOI drug should not be taken when eating foods with tyramine (aged cheeses, meats, wine, pickles, etc)?
Phenelzine (Nardil)
With what MAOI drug should no other drugs be taken 14 days prior to starting medication?
Phenelzine (Nardil)
A client who is diagnosed with obesity seeks assistance with weight loss. The nurse understands which medication is most likely to be prescribed for the client?
Phentermine
What seizure medication has a therapeutic window of 10-20mg/mL?
Phenytoin
What seizure medication has side effects HOTMAIL G AND K?
Phenytoin
What seizure medication is contraindicated in the use with warfarin (increases bleeding), digoxin, and furosemide?
Phenytoin
What seizure medication must be given at the same time each day?
Phenytoin
What is the antidote for Benztropine overdose?
Physostigmine
What seizure drug can cause increased creatinine and low platelet counts?
Pregabalin
What seizure drug should the patient promptly report muscle pain or weakness?
Pregabalin
What seizure drug should you monitor weight gain due to edema?
Pregabalin
Reglan (metoclopramide)
Prokinetic Blocks dopamine receptors in chemoreceptor trigger zone. Increases peristalsis of the stomach and gut Treats PUD, severe N/V, GERD Given IV, PO (30 min before meals), IM Contraindications: GI obstruction Seizure disorders Hx of tardive dyskinesia Parkinson's disease Drugs: CNS depressants Strong CYP2D6 inhibitors MAOI's Adverse effects: CNS, drowsiness, confusion, arrhythmias, lip smacking, neuroleptic malignant syndrome, constipation, blood pressure issues, the penias, agranulocytosis Nursing Considerations: May effect absorption of other oral medications May cause mild hepatic impairment May alter hepatic function test results Monitor for tardive dyskinesia Instruct patient to avoid driving (drowsiness)
A client asks the nurse why diphenhydramine may be prescribed. The nurse understands that diphenhydramine may be prescribed if a client reports which symptom?
Pruritis, motion sickness, rhinitis
What bulk forming drug decreases effect of warfarin, salicylates, and digoxin?
Psyllium
What drug can cause esophageal obstruction/aspiration?
Psyllium
What drug should be taken with 8oz of water, followed by another 8oz after admin?
Psyllium
What drug would you take if you aren't getting enough fiber in your diet?
Psyllium
Which laxative is considered bulk-forming?
Psyllium
Lispro, Aspart, gluisine (LAG)
Rapid- Acting Insulin Drugs
Expectorants
Reduce viscosity of secretions, thins the mucous, does not stop coughing Guaifenesin Used for the relief of productive coughs associated with: - common cold, bronchitis, laryngitis, pharyngitis, coughs caused by chronic paranasal sinusitis, pertussis (whooping cough), influenza, measles Important to stay well hydrated so they have fluid available to loosen up the mucous
Herbal Products: Echinacea
Reduces symptoms of the common cold and recovery time Adverse effects: dermatitis, GI disturbance, dizziness, HA Do not take if allergic to many flowers/in daisy family
Pancreas function
Regulates blood sugar levels = Insulin/ glucagon
Food, Drug, and Cosmetic Act of 1938
Requires new drugs must be proven safe before marketing
Which TB antibiotic drug can cause red/orange discoloration of body fluids?
Rifampin
Which TB antibiotic would you need to warn pt about ineffectiveness of oral contraceptives?
Rifampin
6 rights of medication administration
Right dose, right time, right patient, right route, right documentation, right medication
Cholinergic Drugs: Effects
SLUDGE: salivation, lacrimation, urination, diarrhea, GI distress, emesis DUMBBELLS: diarrhea, urination, miosis, bradycardia, bronchorrhea, emesis, lacrimation, lethargy, salivation
Electrolytes Solutions
Saline Solutions: NaCl 0.9% normal saline in solution (isotonic) NaCl 0.45% saline called half normal saline (hypotonic) Hypertonic Saline Solution: 3% saline solution, high risk drug, can cause irreversible brain damage, treatment for varicose veins
The nurse instructs a client with a diagnosis of pernicious anemia to increase the amount of vitamin B12 in the diet. Which food contains the greatest amount of B12?
Seafood.
Peripherally Acting Antihistamines
Second Generation: work longer, work more peripherally, do not get as drowsy, H1 Eliminate unwanted adverse effects Work peripherally to block the actions of histamine Longer duration of action - Ex: fexofenadine, loratadine, cetirizine (Zyrtec)
Zolpidem (Ambien)
Sedative/Hypnotic Produces CNS depression by binding to GABA receptors Treats insomnia with difficulties in sleep initiation. *Contraindicated in patients with sleep apnea and severe liver disease *Raise the bed rails, assist pt with ambulation, remove cigarettes. *Go to bed immediately after administration. Adverse effects: complex sleep behaviors, daytime drowsiness, dizziness, agitation, hallucinations, blurred vision. Prolonged use (>7-10 days) may lead to dependence
Eszopiclone
Sedative/Hypnotic Interacts with GABA-receptor complexes - treats insomnia. Given PO Rapid onset TAKE RIGHT BEFORE BED Avoid high fat/heavy meals before or with admin DO NOT CRUSH *Drug-drug interactions: antihistamines, opioids, antidepressants *Don't stop taking abruptly. Prolonged use (>7-10 days) may lead to dependence Adverse effects: complex sleep behaviors, behavior changes, hallucinations, headache, chest pain, edema, dry mouth.
Pregabalin (Lyrica)
Seizure medications: GABA potentiator Treats neuropathic pain, anxiety, and seizures. Binds to calcium channels in CNS. *Do not stop taking abruptly. *Monitor patient for weight gain related to edema. *promptly report unexplained muscle pains, weakness. *Caution use in patients with renal impairment. Adverse effects: dizziness, drowsiness, SI, edema, dry mouth, blurred vision, thrombocytopenia.
Dilantin (phenytoin)
Seizure medications: Hydantoins Treats tonic-clonic seizures and antidysrhythmic. Desensitizes sodium channels. *Black box warning: careful cardiac monitoring required for IV- may cause severe hypotension if rapidly administered *Drug interactions: digoxin, warfarin, oral contraceptives, furosemide. *Serum lvls: 10-20 *Must take at the same time everyday due to narrow therapeutic range. *Vitamin K deficiency *Monitor CBC, CMP Adverse effects: gingival (gum) hyperplasia, agranulocytosis, aplastic anemia, Stevens Johnson Syndrome.
Classifications of Drugs used for elevated cholesterol (antilipidemic)
Statins, Bile Acid Sequestrates, Niacin, Fibric Acid Derivatives, Cholesterol absorption inhibitors
Methylphenidate (Ritalin)
Stimulants Treats ADHD by activating the reticular activating system, causing heightened alertness. Given PO On an empty stomach Not right before bed *High abuse potential, schedule II drug. *Pregnancy category C. *Caution in use with MAOIs and patients with hypertension. *Take in the evenings, but not right before bed. *Can take a "drug holiday" during the summer if it is not necessary to take it. *Monitor blood pressure and respirations prior to administration. *Monitor weight. Adverse effects: decreased appetite (anorexia), dry mouth, trouble sleeping, dizziness, stomach ache, headache, irregular heart beat, high blood pressure, liver toxicity, rhabdomyolysis.
The nurse recognizes which medication is ineffective for the treatment of pulmonary emboli?
Streptomycin
This medication coats the stomach to PREVENT further ulcers
Sucralfate
This medication must be taken 4 times a day
Sucralfate
This medication should be taken on empty stomach (1 hr before meals)
Sucralfate
Which antibiotic drug group can increase clotting time?
Sulfonamides
Which antibiotic drug group should you have pt drink 2000-3000ml of water/day?
Sulfonamides
Which antibiotic group can cause kidney stones and renal failure?
Sulfonamides
Which antibiotic group decreases effects of oral contraception?
Sulfonamides
Which antibiotic group should you take with meal/snack?
Sulfonamides
A nurse reviews the adverse effects of medications that are used to treat client diagnosed with type 2 diabetes mellitus. Which class of medication is most likely to cause adverse effect of moderate to severe hypoglycemia?
Sulfonylureas
If over the counter drugs for migraines fail, what drug would you try next?
Sumatriptan
What drug should you inquire about latex allergy if administering Sub Q?
Sumatriptan
What migraine drug can potentially cause MI or coronary vasospasm?
Sumatriptan
What migraine drug can you only give 2 doses per day?
Sumatriptan
What migraine drug works by constricting intracranial vessels?
Sumatriptan
What migraine medication is used at the first sign of migraine?
Sumatriptan
The nurse provides medication teaching to a client prescribed Ibandronate. Which is most important information for the nurse to include?
Swallow the medication with a glass full of water and remain upright for 30 minutes
Cephalosporins
Synthetic antibiotic Kill bacteria (Bactericidal) by disrupting the cell wall. *Primary used for gram negative infections and patients who can't afford penicillin. Effectiveness increases with generations. Broad spectrum. *Primarily given orally. Can give with food if needed. 1st generation- cephalexin 2nd- cefoxitin 3rd- ceftriaxone. Strong med Adverse effects: Diarrhea, abdominal pain, rash, super infection, renal/hepatic impairment, pruritus.
"Tumor flare" is associated with this hormone antagonist
Tamoxifen
This medication can increase risk of uterine cancer or thromboembolic disease
Tamoxifen
You shouldn't take antacids w/in 1-2 hours of this medication
Tamoxifen
Which antibiotic drug should not be given with dairy products or antacids?
Tetracycline
Which antibiotic drug can bind to calcium and turn baby teeth gray?
Tetracylcine
The nurse teaches a client diagnosed with Type I diabetes mellitus how to administer both regular and intermediate acting insulin in one syringe. Which actions by the client indicate the client understands how to correctly administer these medications?
The client draws up the regular insulin firsts then the intermediate acting insulin
A client diagnosed with acute gout has been taking daily ibuprofen as prescribed for four weeks. The client tells the nurse that a ringing sound has developed in the ears. Which is the best interpretation by the nurse?
The client has signs of toxicity and should discontinue the medication until the health care provider in contacted
A client with a diagnosis of metastatic lung cancer is prescribed a transdermal fentanyl patch. Which information must the nurse understand to ensure the client achieves effective pain relief?
The client will require administration of pain medication for several hours after application of the patch
A client has just been diagnosed with rheumatoid arthritis and prescribed prednisone. Which information is most important for the nurse to include when teaching the client about this medication?
The dose of prednisone must be increased and decreased gradually
Pharmacokinetics
The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.
Pharmacoeconomics
The study of economic factors impacting the cost of drug therapy.
Teratogenic Drug Classification D
There is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk
a client diagnosed with gastroenteritis is instructed to take loperamide for episodes of diarrhea. Which information does the nurse include when teaching the client about this medication?
This medication may cause you to have dry mouth
Decongestants
Three classes - ADRENERGIC (sympathomimetic) - pseudoephedrine - associated with rebound congestion (only use for about three days, if longer you can become more congested), helps stop a lot of mucous from being produced - Do not give sympathomimetic drugs and nasal sympathomimetic decongestants - Side effects: heart rate increased - ANTICHOLINERGIC (parasympathetic) - Ipratropium - no rebound congestion, causes drying out, take as nasal spray without rebound - CORTICOSTEROIDS (intranasal steroids) - no rebound congestion, have to slowly wean off of these
the nurse understands which occurrence is an adverse effect or toxic effect of aspirin?
Tinnitus, nausea, vomiting
The nurse prepares care for a client with a central venous access device who is receiving intermittent infusions of intravenous antibiotics. When a dose of medication is completed, the nurse flushes the catheter with 10mL of saline and 10 units of heparin. The nurse understands the heparin is prescribed for which reason?
To ensure the central venous catheter remains patent
Basics of Hydration
Too little body fluid: high temp, high sodium, increased specific gravity Too much body fluid: decreased sodium, decreased temp, decreased specific gravity
Difference between trade name and generic name?
Trade name is the brand, generic is nonproprietary name chosen by council
Rifampin
Treats TB by inhibiting RNA synthesis by block transcription. Given PO, IV On an empty stomach 1 hr before meals Full glass of water Use caution in: Liver disease Diabetes Vitamin K deficiency *Must be taken for at least 6 months, up to 24 months. *Monitor CBC, CMP, LFTs. *MUST take medication exactly as ordered. *Can cause oral contraception to be ineffective. Adverse effect: Thrombocytopenia, interstitial nephritis, hepatitis, Stevens Johnson, red-orange colored body fluids.
Sucralfate
Treats peptic and duodenal ulcers. *Coats/lines the stomach, adheres to the ulcer sites and protects them from acids. Must be taken PO 4 times/day on empty stomach 1 hour before meals At bedtime Use cautiously in: Renal Failure Diabetes Adverse effects: constipation, dizziness, drowsiness, hyperglycemia, dry mouth. May decrease absorption of fat-soluble vitamins, phenytoin, tetracycline and fluroquinolones. Have patient increase fluid and dietary bulk intake
The nurse identifies which medication is used for the treatment of Parkinson disease?
Trihexyphenidyl
Which antibiotic drug do you need to watch for Red Man Syndrome?
Vancomycin
Which antibiotic drug should you assess for black, furry tongue?
Vancomycin
Which antibiotic drug should you closely monitor infusion rate?
Vancomycin
Which antibiotic drug should you perform culture sensitivity and renal function prior to admin?
Vancomycin
Hyaluronidase is the antidote for extravasation of this drug
Vincristine
This cancer med can cause constipation & peripheral neuropathy
Vincristine
This is a "natural product" derived from periwinkle plant to treat cancer
Vincristine
Upper Respiratory Infection (URI)
Virus invades, stimulates excessive mucous production, inflammatory and vasoactive Over the counter and some prescription treatments: FDA recommendations, has reduced ER visits and deaths in toddlers Most treatments do not cure Antiviral treatments must be targeted to the virus Herbal products: use with caution, drug-drug and drug-disease interactions Antivirals: just shortens the length of the virus, does not get rid of immediately
The nurse provides care for the client receiving colestipol. The nurse encourages the client to eat foods rich in which vitamins?
Vitamin A, D, K
A client who receives methadone as a part of maintenance treatment for narcotic addiction is transported to the emergency room with a diagnosis of severe abdominal pain. Which symptoms would the nurse expect to observe if the client were in a state of withdrawal from methadone?
Vomiting and chills
The nurse observes another nurse administer a parental injection. The nurse pulls the clients skin to one side, holds the skin, inserts the needle at a 90 degree angle, injects the medication, withdrawals the needle, and releases the skin. The nurse is using which technique to administer the medication?
Z-track injection
a client has a history of migraine headaches. The nurse recognizes which medication is used to treat the client's migraine headaches?
Zolmitriptan
Which sedative/hypnotic drug must you take right before bed and to help initiate sleep?
Zolpidem
Antagonist
a drug that neutralizes or counteracts the effects of another drug by blocking the receptor
agonist
a molecule that, by binding to a receptor site, stimulates a response
the nurse provides care for a client diagnosed with schizophrenia who is taking chlorpromazine. When providing medication education to the client, the nurse includes information about which common adverse effects?
abnormal motor movements and dry mouth
The emergency department nurse is notified that a client is being brought in with a probable acetaminophen overdose. Which medication does the nurse prepare to administer?
acetylcysteine
efficacy
amount of response that can be produced
sentinel event
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
Drug Schedules
are scheduled in five categories with Schedule I being the most dangerous.
Status Asthmaticus
asthma attack with no relief for greater than 5 minutes
Anticholinergics
block/inhibit acetylcholine in the parasympathetic nervous system (rest and digest) Atropine Scopolamine Tolterodine (use if someone has overactive bladder) Dry everything out, constipation, opposite effects of cholinergic drugs
the nurse understands which are similarities between a Schedule I drug and a Schedule V drug?
both schedule I and V have some abuse potential
Antihistamines
competes for receptor sites directly also called histamine antagonists - looking for histamine receptor and competes for site H2 blockers: cimetidine, ranitidine H1 blockers: allergies, cold symptoms, vertigo, motion sickness, insomnia for sedative and anticholinergic effects, discontinue 4 days before allergy testing
Therapeutics
concerned with -Prevention of disease -Treatment of suffering
Crystalloids - IV Fluids
contains fluid and electrolytes normally found in the body, saline used for treating dehydration and hypovolemic shock Used as a maintenance fluid Can be Hypo, Hyper, or Isotonic Fluid overload happens especially in isotonic May leak into interstitial and intracellular compartments Use with caution when there is an additive to the fluid or when the patient cannot tolerate (fluid overload) Usually Saline or Dextrose
LDL (low density lipoprotein)
deliver cholesterol to cells for storage The bad kind of cholesterol
HDL (High Density Lipoprotein)
deliver cholesterol to the liver to be excreted, good kind! excreted in bile
Hydrochlorothiazide (HCTZ)
diuretic used to lower blood pressure Usually used for hypertension Can use with other hypertensives Mobilizes edema in heart failure Down Side: hypokalemia, Hyponatremia, hypochloremia, hypoglycemia, hyperuricemia, dehydration, promotes renal calcium retention Keep an eye on electrolyte balance Take this in the morning (usually for all diuretics)
PRN
drug is administered as required by the patient's condition
ASAP
drug should be available for administration within 30 minutes of the written order
Sodium
essential for maintaining osmolality, water balance, acid-base balance works hand in hand with potassium
Q12h
every 12 hours
What is the antedote for benzodiazepine overdose?
flumazenil
Large volume infusion
for fluid maintenance, replacement, or supplementation
STAT
immediately
Gonad function
makes sex hormones testosterone and estrogen
After a drug is administered, it is called a
medication
Traditional Antihistamines
older, work both peripherally and centrally, have anticholinergic effect examples: diphenhydramine (Benadryl) meclizine, promethazine (prevent vomiting) - works in brain and muscle Drying Effect: dry out the mucous membranes
Monoclonial Antibody Antiasthmatic
omalizumab (Xolair) -Selectively binds to the immunoglobulin IgE, which in turn limits the release of mediators of the allergic response -Omalizumab is given by injection -Potential for producing anaphylaxis -Monitor closely for hypersensitivity reactions The suffix "umab:" always a monoclonial antibody
posterior pituitary
oxytocin Adh (antidiuretic hormone)
Acidosis
pH < 7.35 Acids lower, bases higher: CNS depression Coma
Alkalosis
pH > 7.45 Acids higher, bases lower: CNS stimulation Convulsions
Spironolactone (Aldactone)
potassium sparing diuretic get rid of water, blocks the action of aldosterone (works with Na) in the distal nephron Gets rid of sodium and water but saves potassium Watch for: hyperkalemia (cardiac dysrhythmias), HA, diarrhea, electrolyte imbalance, gynecomastia, irregular menses Too little or too much potassium will cause weakness in muscles including the heart Give with food, can cause stomach upset (think about foods that contain potassium and sodium)
Rx
prescription, take, treatment
10 days after beginning to use beclomethasone nasal spray due to seasonal allergies, a client reports to the nurse that even though the medication is being used correctly, only slight relief has been experienced. Which action by the nurse is most important?
remind the client that the peak and effect can take up to three weeks of regular use
Dietary Supplement Health and Education Act of 1994
requires clear labeling of dietary supplements. This act gives the FDA the power to remove supplements that cause a significant risk to the public. •Less rigid than the Food, Drug, and Cosmetic Act (F D&C Act) •Dietary supplements are exempted from F D&C Act standards
Bile Acid Sequestrates
resin binds to the bile (cholestyramine) - causes most fat to go out in stools Can be mixed into applesauce GI adverse effects, effects fat soluble vitamin absorption, effects on other medications
What group of medications can cause complex sleep related behaviors (i.e sleep driving, memory loss, etc)
sedatives/hypnotics
The nurse provides care for a client admitted with a diagnosis of diabetic ketoacidosis. The nurse anticipates the which type of insulin will be prescribed?
short-acting insulin.
intermittent infusion
small amount of IV solution arranged tandem with or piggybacked to primary large-volume infusion; used to instill adjunct medications
routine orders
standard order usually carried out within 2 hours of the time it was written by the physician
tab
tablet
a client diagnosed with depression is scheduled to begin electroconvulsive therapy (ECT) treatments. It is most important for the nurse to notify the healthcare provider about which information?
the client is being treated for glaucoma
therapeutic range
the lowest concentration of drug in the blood serum that produces the desired effect without causing toxicity
the nurse on the postsurgical unit reminds another nurse that both potassium chloride injectable concentrate and IV promethazine are "high alert" medications. the nurse understands that a "high alert" classification has which meaning?
the medications can pose a risk to clients if extra care is not used in their storage and administration
tid
three times a day
Cholesterol
transports fats, comes from liver, cell membranes, part of steroids We need it! It is not all bad
standing order
written in advance of a situation that is to be carried out under specific circumstances
Preschoolers and Pharmacotherapy
•3 to 5 years of age •Safe storage = out of reach •Can begin to assist with medications •Brief explanation followed by administration
Teratogen
•A substance, organism, or physical agent to which an embryo or fetus is exposed that causes permanent abnormality in structure or function and causes retardation or death •No absolute teratogens; risk increases with dose
Cultural competence
•Ability to provide care to people with diverse values, beliefs, and behaviors, including ability to adapt delivery of care to meet needs of these patients
Somatotropin (Genotropin, Humatrope) adverse effects
•Acromegaly •Fatigue •Headache •Muscle weakness •Sleep apnea •Joint pain, Swelling around joints •Hoarseness •Excessive sweating •Widened fingers and toes •Carpal tunnel syndrome
herbals
•Active Ingredient(s) in Herbs -Usually found only in specific part of the plant -May have multiple active ingredients -Potency •Chemicals -Work synergistically -May not have same activity if isolated
Documentation
•Administration of medication •Therapeutic and adverse effects •Patient statements •Objective assessment data
topical drugs
•Applications: -Dermatologic preparations -Instillations and irrigations -Inhalations -Sublingual/buccal • Purposes -Many intended for local effect -Fewer side effects -Some given for slow absorption into general circulation, designed for their systemic effects
School-Age Children and Pharmacotherapy
•Between 6 and 12 years old •Most children healthy •Offer longer, more detailed explanations •Encourage cooperation •Offer choices
Adolescents and Pharmacotherapy
•Between ages 13 and 16 years old •Need support, approval, and presence •Educate about -Tobacco and substance abuse -Sexual intercourse -Eating disorders •Provide important medication information •Allow time for questions •Allow privacy and control
Infants and Pharmacotherapy
•Birth to first 12 months •Safety of child is primary •Have child ingest all medication •Nurse/parent should be aware of special procedures for drug administration
Bronchodilators -Xanthines
•Caffeine, theophylline •Smooth muscle relaxation, bronchodilation •Can also stimulate CNS and cardiovascular system •Used in asthma, chronic bronchitis, emphysema •Adjunct management of COPD •Caffeine may be used in infants to prevent bradycardia •Potential for drug interactions and variable drug levels Slow acting, lasts long
Gender Behavior Differences
•Can affect success of medication treatment •Example: women seek health care earlier than males •Side effects of medication can be gender-specific and affect compliance •Different responses to medications
Metabolism
•Chemically converts drug so it can be easily removed from body •Involves complex biochemical reactions •Liver—primary site - P450 system •Addition of side chains makes drugs more water soluble and more easily excreted by the kidneys
Evaluation
•Compares patient current status with desired outcome -If goal met, focus may shift to next highest priority health need -If not met, plan may require revisions •Overall goal is safe, effective medication administration •Therapeutic outcome should be best possible; take steps to ensure success •Evaluation begins a new cycle
Factors Affecting Drug Absorption
•Drug formulation, dose, route •Digestive motility •Blood flow •Lipid solubility of drug •Degree of ionization of drug -In stomach acid, aspirin nonionized and easily absorbed by bloodstream -In small intestine alkaline, aspirin ionized and less likely to be absorbed •pH of local environment •Drug-drug/food-drug interactions •Dietary supplement/herbal product-drug interactions
holistic approach
•Each person: integrated biological, psychosocial, cultural, communicating whole person
Inhalers: Patient Education
•For any inhaler prescribed, ensure that the patient is able to self-administer the medication •Provide demonstration and return demonstration •Ensure that the patient knows the correct time intervals for inhalers •Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation •Ensure that the patient knows how to keep track of the number of doses in the inhaler device
breast milk
•Fortunately few instances of harm to infant •Dangerous drugs usually have safe alternatives •Drugs with high protein-binding ability are less likely to enter breast milk
Middle-Aged Adults and Pharmacotherapy
•Health changes begin around 45 years of age •Stress-related illnesses •Numerous life transitions •Positive lifestyle changes •Late middle age some chronic issues
Pharmacodynamics
•How a medicine changes the body •Helps to predict if drug will produce change •Will ensure that drug will provide safe, effective treatment •Combination of drug guides and intuitive experience will guide safe treatment
Bronchodilators: Anticholinergics
•Ipratropium bromide, tiotropium (very slow) •Used for increased frequency of asthma attacks •Slow prolonged action •Prevents bronchoconstriction •Used to treat COPD •May be used with beta2 agonist - Albuterol - Side Effects: drying
Intravenous Administration (IV)
•Medications and fluids administered directly into the bloodstream •Fastest drug onset action, but also most dangerous method -Contamination -Swift adverse reactions •Three types: -Large volume infusion -Intermittent infusion IV bolus (push)
Young Adults and Pharmacotherapy
•Minimal need for prescription drugs Positive medication compliance •Educate about -substance abuse -sexually transmitted diseases
Absorption
•Movement from site of administration, across body membranes, to circulating fluids •Primary pharmacokinetic factor determining length of time for drug to produce effect
Implementation
•Nurse applies knowledge, skills, and principles of nursing care to move patient toward desired goal and optimal wellness •Administer medication •Continue assessment of patient •Monitor drug effects •Carry out interventions in planning phase •Provide patient teaching •Documentation
Complementary and Alternative Medicine (CAM)
•Outside mainstream health care •Very diverse set of therapies and healing systems •Major characteristics -Treat as individual -Care of whole person -Integration -Promote disease prevention -Spirituality •Research -Rigorous research lacking Seeks effectiveness or lack of effectiveness
Toddlers and Pharmacotherapy
•Period from 1 to 3 years •Teach parent about proper storage of drugs •Give toddler short, concise explanations; provide comfort after •Oral drugs can be mixed with foods •Injections are given at specific locations
Older Adults and Pharmacotherapy
•Polypharmacy •Some predictable ailments •More adverse drug events •Reminder aids •Maintain independence and dignity
excretion
•Primary Site is kidneys •Free drugs, water-soluble agents, electrolytes, and small molecules are easily filtered •Drug-protein complexes and large substances are secreted into distal tubule of nephron •Secretion mechanism is less active in infants and older adults •Other sites: -Respiratory -Glands Biliary
Planning
•Prioritizes diagnoses, formulates desired outcomes, and selects nursing interventions that can assist patient to establish an optimum level of wellness •Based on nursing diagnosis •Focused on what patient will achieve or do •Prioritized •Discussed with patient or caregiver •Goals focused on -Safe and effective administration -Therapeutic outcome -Treatment of side effects -Provide specific, measurable criteria -Evaluate degree to which goal is met
Bronchodilators
•Selective (Beta2) adrenergic agonists (works with it) (mainly focus on B2) •Albuterol (short acting) •Levalbuterol (short acting) •Salmeterol (long acting) •Non-selective drugs •Epinephrine (Alpha and beta) - Metaproterenol(beta1 and beta2) Beta1: mainly in the heart Beta2: mainly in the bronchioles, some in heart and blood vessels Albuterol Inhalers Side effects: tachycardic, nervous, jittery
Octreotide drug interactions
•Serum concentration of Warfarin can be increased •Serum concentration of Atenolol can be increased •Metabolism of Atorvastatin can be decreased •Metabolism of Bupropion can be decreased •Serum concentration of Octreotide can be increased when it is combined with Caffeine. •Serum concentration of Octreotide can be increased when it is combined with Ibuprofen. •Serum concentration of Octreotide can be increased when it is combined with Acetaminophen
culture
•Set of beliefs, values, and norms that provide meaning for an individual or group
F D A Requires That Drug Research Studies Include
•Subjects of both genders •Analysis of clinical data by gender •Assessment of pharmacokinetic and pharmacodynamic differences •Studies specific to women's health
Assessment
•Systematic collection, organization, validation, and documentation of patient data •Health history and physical assessment •Baseline data gathered; will be compared to later information from observations •Subjective data—what patient describes •Objective data—physical assessment, laboratory tests, other diagnostic sources
Pharmacology
•The study of medicine -How drugs are administered -Where drugs travel in the body -Responses that drugs produce
medication reconciliation
•Tracking a patient's medications as they proceed from one health care provider to another •Very important for polypharmacy •Poor reconciliation = serious medication errors •Lists all medications that a patient is taking •Completed when patient is admitted, discharged, or moved between units
Distribution
•Transport of drugs throughout the body •Physical properties of drug •Tissue affinity •Drug-protein complexes •Competition for sites •Blood-brain and fetal-placenta barriers
Parenteral drugs
•Types: intradermal (15), subcutaneous (45), intramuscular (90), intravenous
Pharmacogenetics
•study of genetic variations that cause differences in the way patients handle medications
Potency
•therapeutic effect at a lower dose
physical dependence
▪An altered physical condition caused by the adaptation of the nervous system to repeated drug use
psychological dependence
▪Few signs of physical discomfort when drug is withdrawn, but intense compelling desire to continue drug use
Implementation
◦Ensure therapeutic effects ◦Frequent assessments ◦Food and fluids ◦Lifespan considerations ◦Patient teaching ◦Hydration ◦Daily weight (best way we can measure how water is being collected; 2.2 lbs in 24 hours or 5 lbs in a week give the doctor a call), BP (fluid goes away, BP drops), Pulse (weak, fast, bounding if overloaded w/ fluid) ◦Proper use of equipment ◦Minimize adverse effects ◦Signs of fluid volume excess or deficit ◦Electrolyte imbalance ◦Confusion ◦Changes in BP ◦Patient teaching ◦Changes in muscle strength or function ◦Food for hypo/hyperkalemia
