Adult Health II - Exam 2 Medications
albuterol causes tachycardia because...
---adrenergic agonists can lose their selectivity when given at higher doses.***
When using a MDI teach the patient to wait how long between each puff
1 minute between puffs
Teriparatide (forteo) max duration of use
2 years bc risk for osteosarcoma
Fluticasone/salmeterol directions
2x a day Inhale rapidly bc this is a dry powder inhaler (pt doesn't need good hand-lung coordination since its dry power) *** Wash mouth
Peak of tiotropium is around
3 hours
A patient may not have more than ______ gram of acetaminophen
4g of acetaminophen ( 1g every 6 hours) --- do not want liver damage
Budesonide/formoterol (symbicort) directions
80mcg/4.5mcg 2 inhales 2x day 160mcg/4.5mcg 2x day
ACUTE ATTACKS AIM your treatment
A:Albuterol first (bronchodilator) I: Ipratropium second (anticholinergeric) M: Methyl-prednisolone "Solu mederol" (steroid)
Calcitonin class
Parathyroid agent (calcium regulator) ---derived from salmon
Warfarin, heparin, and enoxaparin
Anticoagulant post-op for hip and knee arthroplasty
A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?
Reassure the patient that these are expected side effects.
Alendronate class
Biphosphonate--bone reabsorption inhibitor
fluticasone is a good choice for...
CHILDREN does not suppress growth in children
A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? A. "You may have another dose in 4 hours." B. "You may need to take two inhalations instead of one." C. "You should have peak effects in about 6 hours." D. "You should see improved effects within the next week."
D. "You should see improved effects within the next week."
Which patient statement indicates that a patient admitted with acute asthma may need teaching regarding medication use? A. I have not had any acute asthma attacks during the past year B. I became short of breath an hour before coming to the hospital C. I've been taking acetaminophen every 6 hours for chest wall pain D. I've used my albuterol inhaler frequently over the last 4 days
D. I've used my albuterol inhaler frequently over the last 4 days
The nurse completes an admission assessment on a patient with asthma. Which information indicates a need for discussion with the health care provider about a change in therapy? A. The patient uses an albuterol inhaler before aerobic exercise. B. The patient's only medications are albuterol and salmeterol inhalers. C. The patient's heart rate increases slightly after using the albuterol inhaler. D. The patient used albuterol more often when symptoms were worse in the spring.
D. The patient used albuterol more often when symptoms were worse in the spring.
A patient is taking alendronate [Fosamax] to treat Paget's disease. The patient asks the nurse why calcium supplements are necessary. The nurse will tell the patient that calcium supplements are necessary to: A. reduce the likelihood of atrial fibrillation. B. maximize bone resorption of calcium. C. minimize the risk of esophageal cancer. D. prevent hyperparathyroidism.
D. prevent hyperparathyroidism
A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: A. adding roflumilast [Daliresp] once daily. B. changing to oral theophylline twice daily. C. prescribing oral steroids once daily. D. using an ipratropium/albuterol combination twice daily.
D. using an ipratropium/albuterol combination twice daily.
What drug can be used for the treatment of hypercalcemia
Denosumab ***
Budesonide/formoterol (symbicort) side effects
FLU LIKE SYMPTOMS cough, chills, congestion, headache, muscle aches, pain around eyes etc.
Budesonide/formoterol (symbicort) class
Glucocoticoid/laba duo
Protamine sulfate is the antidote for
Heparin
Teriparatide (forteo) side effects
Hypercalcemia, hypercaluria
Ipratropium (atrovent): how to remember
I comes before T in the alphabet which is how to remember we use it first for acute exacerbation
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?
Intravenous glucocorticoids nebulized albuterol and ipratropium oxygen
ANTICHOLINERGICS examples
Ipratropium Tiotropium
Budesonide/formoterol (symbicort) patho
Long-acting beta 2 agonist Bronchodilates and anti-inflammatory
Tiotropium (Spiriva) is used for use it ______ daily
Maintenance use once daily... more long-term than ipratropium
Antidote for Opioid overdose
Naloxone (Narcan)
Fluticasone/vilanterol (breo ellipta) directions
ONLY GIVEN ONCE A DAY Dry poweder inhaler
Calcitonin routes
Oral Intranasal - rotate nares SubQ
NSAIDS can be used in Risk for
Osteoarthritis, Herniated Disks, Carpal Tunnel, and Headaches for Pain Management risk for GI bleed
Calcitonin is used in PT's with
Osteoporosis
Alendronate is taken what route
PO
How often should you take Raloxifene
PO 1x daily
KCl (potassium chloride)
Pre-Post Op consideration Electrolyte imbalance protocol
Budesonide/Formoterol is used as
Preventative and long-term maintenance of asthma/copd --- Only med that can be both
Hydrocodone/Acetaminophen/Hydromorphone risk of
Risk of sedation / respiratory depression / constipation
Morphine PCA
Risk of sedation and respiratory depression
Ipratropium (atrovent) use
Short-acting ---works in minutes so can be used for ACUTE exacerbation of COPD
Alendronate teaching
Sit upright for 30 minutes post administration to avoid esophageal irritation Take with plenty of water *** If you miss a dose, just skip it Take in AM before food and other meds// avoid food and drink other than water 30 min prior Avoid calcium for 2 hours after admin Use sunscreen because of photosensitivity
Teriparatide (forteo) teaching
Sub Q SELF injection daily orthostatic hypotension take calcium and vitamin d when taking the medication rotate injection site store pen in fridge Symptoms of hypercalcemia; excessive thirst, urination, nausea/vomiting, muscle weakness
Drug that can be used to treat osteoporosis in men ***
Teriparatide
Tiotropium shows therapeutic effects in about ________ with improved broncodilation occuring with subsequent dose up to
Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. --- this is why it takes a week to see improvments when starting
Ipratropium (atrovent) directions use - duration is about -
Use 3-4x a day DURATION: 6 hrs
Corticosteroids
Used in respiratory conditions like COPD, and Cervical Herniated Disks/ Low back pains Long-term use can contribute to secondary osteoporosis
it is important to assess what with pts on PCA pumps?
VS, O2, and CO2 levels
Raloxifene can only be used in
WOMEN ***
Vitamin K is the antidote for
Warfarin
albuterol is mostly used for...
acute, rapid symptomatic relief (asthma/COPD) ---rescue from ongoing attack & and exercise-induced bronchospasm (prevention)
Ipratropium is an anticholinergic used for
allergic rhinitis and colds and COPD exacerbations
Budesonide is a -- remember it can
corticosteroid -- remember it can stunt growth in children -- pts can also develop crushing symptoms (high glucose, hypertension, moon face, buffalo hump, large stomach etc...
Raloxifene is used for PT with
osteoporosis
Teriparatide (forteo) class - not on study guide
osteoporosis med
Fluticasone/vilanterol (breo ellipta) side effects
back pain, adrenal insufficiency, hypoglycemia, flu-like symptoms, headache
albuterol drug class
beta-2 agonist bronchodilator
Raloxifene osteoporosis use
binds to estrogen receptors to block or mimic actions of estrogen ---reduces reabsorption of bone and decreases bone turnover to prevent osteo in post menopause WOMEN
Teriparatide (forteo) contraindications
bone cancer, breastfeeding, pregnancy
Raloxifene protects against
breast cancer **
ANTICHOLINERGICS do what
bronchodilators that reduce secretions dry the body out by blocking secretions
Ipratropium is used to treat what in COPD patients
bronchospasms
when giving report on a PCA machine you should explain...
continuous rate _____ mg dose _____ mg lockout time ____ min 1 hour limit ____ mg
Calcitonin osteoporosis use
decrease bone reabsorption, increase deposit of calcium in bone ---opposes parathyroid hormone
Alendronate osteoporosis use
decrease rate of bone reabsorption, may directly block dissolution of dyroxyapatitie crystals of bone. Basically, inhibits the cells that breakdown bone
Teach pts taking alendronate to report
difficulty swallowing immediately --- r/t esophagitis
Raloxifene teaching
discontinue 72 hrs prior to prolonged immobilization bc risk of dvt **** Take CA & vit D increase exercise using weights stop smoking decrease alcohol Do not take if hx of thromboembolic events or preggo
Cyclobenzaprine main side effects ****
dry mouth blurred vision constipation
side effects of Ipratropium and Tiotropium
dry mouth, hoarseness (irritated throat)
albuterol is a...
first-line medication to reverse airway narrowing ex: for a pt having an asthma attack, the first medication to administer would be albuterol
Gabapentin
for nerve pain and sedating (anti-seizure med)
Metoclopramide
for post-op ileus Stimulates peristalsis
Alendronate side effects
generally well tolerated Esophagitis (main concern) Other side effects include a.fib, femoral fractures, ocular inflammation. Adverse effects increase w long use
Fluticasone/vilanterol (breo ellipta) class
glucocorticoid/long-acting beta 2 agonist combination
Metoclopramide side effects
hallucinations anxiety
Calcitonin side effects
headache, eye pain, nauesa/vomit/diarrhea/anorexia, bronchospasm/anaphylaxis, rash
Denosumab may delay ***
healing of fractures (suppress bone turnover)
you can also see what on a PCA pump?
how many mg did the pt take during your shift how many attempts did the pt have (pt pushes button but too soon to get another dose of pain meds)
always ask the PT about
how much albuterol they use
examples of corticosteroids
inhaled -Fluticasone - Beclomethasone - Budesonide oral - Prednisone - Prednisolone "Solu medrol"
Fluticasone/salmeterol is used as
long-acting beta-2-agonist and glucocorticoid --- provides long-term maintenance of asthma/COPD ---Relax smooth muscles
Fluticasone/vilanterol (breo ellipta) use
long-term asthma control
In children on MDI's you may notice
mood changes in the child
gold standard med for PCA pump
morphine hydromorphone (diludud)
Tiotropium is given
once daily -- inhalation of one capsule
Alendronate is for pts with
osteoporosis
Cyclobenzaprine is use for pts with ____________ and _________________ _____________
pain and muscle spasms (muscle relaxant) ---sedation more likely when used with hydrocodone
albuterol side effects
palpitations, tachycardia, dysrhythmias, headaches, dizziness, restlessness, tremors can cause mood changes in kids
PCA side effects
respiratory depression decreased LOC constipation confusion
When using an MDI ensure the patient always
rinses the mouth after each dose -- prevent oral candidias
Raloxifene class
selective estrogen receptor modulator (SERM)
Calcitonin teaching
signs of hypocalcemia (tetany, seizures). not used much bc long-term risks of cancer unpleasant side effects and better drugs out there***
Fluticasone/salmeterol side effects
tremors, anxiety, agitation, hyperactivity, irritability, hypersalivation, osteoporosis,
Raloxifene side effects
vasomotor symptoms are common side effects !!! *** hot flashes increased risk of DVT / PE