HESI pharmacology remediation

Asprin

-prevents platelet aggregation by inhibiting enzymes within the platelet -given daily to pt after myocardial infarction -reduces the recurrent of MI and cardiovascular death -low doses to prevent cardiovascular disease -after transient ischemic attack, use to prevent further clotting -do not take with warfarin or other anticoagulants -dose: oral 65 to 325 mg daily

powder

-promotion of dryness -lubricates skinfold areas to prevent irritation -base for anti fungal preparations -protect pt from inhaling

As heart failure progresses...

-pt develop diuretic resistance with refractory edema -HCP prescribes hydrochlorothiazide and metolazone -or IV infusion of furosemide or bumetanide or rotating loop diuretics

ACE inhibitor or ARBs + diuretic

-pt develops hyperkalemia (+5 K) if kidneys do not work -review pt serum creatine level prior (+1.8 do not give, call HCP before giving potassium supplement)

zanamivir & oseltamivir (Tamiflu)

-shorten the duration of influenza A and B -prevent viral spread in the respiratory tract by inhibiting a viral enzyme that allows the virus to penetrate respiratory cells -take within 24 to 48 hours after the onset of symptoms -CAUTION with zanamivir and COPD or asthma pt -increase fluid intake -saline gargles ease sore throat pain -antihistamines may reduces rhinorrhea (excess drainage from nose)

hydrochlorothiazide (HCTZ)

-thiazide diuretic -older adults with mild volume overload -decreases after edema fluid is lost -does not have dehydration -gradual onset of diuresis (increased urine)

first generation antipsychotics

-used less in schizophrenia because of their minimal impact on negative symptoms and their wide range of side effects -they are effective against positive symptoms and are much less expensive than second generation antipsychotics -dopamine antagonists in both the limbic and motor centers -dopamine receptors in the motor areas causes extrapyramidal side effects (acute dystonia, akathisia, pseudoparkinsonism) -lowering dosages can usually minimize EPSs

specific side effects of first generation anti psychotics

-weight gain -sexual dysfunction -endocrine disturbances -drooling -tardive dyskinesia

first generation antipsychotics...

are divided into low potency and high potency drugs on the basis of their anticholinergic side effects, EPS and sedative profiles

third generation antipsychotic

aripiprazole

second generation antipsychotics treat positive and negative symptoms

asenapine, clozapine, iLoperidone, lurasidone, olanzapine, paliperidone, quetapine, risperidone, ziprasidone

1st gen low potency antipsychotics

chlorpromazine, thioridazine

loop diuretics

most effective for treating fluid volume overload -furosemide -torsemide -bumetanide

akathisia

psychomotor restlessness evident as pacing or fidgeting, sometimes pronounced and very distressing to patients -lorazepam (benzodiazepine) help reduce -use relaxation exercises reduces

diuretics and venous vasodilators

reduce preload

Abnormal Involuntary Movement Scale (AIMS)

tool used to screen for symptoms of movement disorders (side effects of neuroleptic medications)

amantadine & rimantadine

treat influenza A amantadine -increases dopamine release, blocks dopamine reuptake -provides mild relief for Parkinson's disease

ribavirin

treat influenza B

1st gen high potency antipsychotics

trifluoperazine, thiothixene, fluphenazine, haloperidol, pimozide

paste

-mixture of powder and ointment -used when drying effect necessary because moisture is absorbed

gel

-nongreasy combinations of propylene glycol and water -may contain alcohol

ointment

-oil with differing amounts of water added in suspension -lubrication and prevention of dehydration -petrolatum most common

hypokalemia

-potassium deficiency -from diuretic therapy -s/s: generalized weakness, depressed reflexes, irregular heart rate

spironolactone*

-potassium sparing diuretic -for pt at risk for dysrhythmias from hypokalemia -retains potassium -decreases risk for ventricular dysrhythmias -used in stage III/IV heart failure -monitor for hyperkalemia and renal failure -stop medication if K (+5) or creatinine (+1.8) levels rise

bumetanide

-loop diuretic -for acute heart failure -IV push (IVP) -dose of 1 to 2 mg once or twice daily -often given continuous infusion of 10mg over 24 hr

A client diagnose with scabies has been prescribed lindane lotion. What is the recommended method of administration of this medicated lotion? (Select of that apply.) -Apply to affected areas twice a day for one week. -Avoid placing lotion on skin areas when crusts are present. -After the application of lotion, cover the affected areas. -Leave the lotion on the skin for 8 to 12 hours and then wash off. -Apply a thin layer of lotion on the skin from the neck to soles of the feet.

-Leave the lotion on the skin for 8 to 12 hours and then wash off. -Apply a thin layer of lotion on the skin from the neck to soles of the feet. Rationale: To use lindane lotion: caregivers should wear gloves when applying lotions to clients; cream/ointment and lotion are used for scabies only; skin should be clean before application; wait one hour after bathing or showering before application; apply a thin layer of the lotion from the neck to soles of feet; pay attention to rubbing lotion in between fingers and toes; leave in place for 8 to 12 hours, then wash off with soap and water

The nurse reviews in the client's medical history the following: congestive heart failure, weight gain of 15 pounds (6.8kg) in the last 72 hours, crackles in lungs bilaterally, shortness of breath at rest, respiration at 24 breaths per minute, O2 saturations 96% on 2 lpm of oxygen (O2), and pedal edema +3. The admitting lab values are Na: 139mEq/L, K: 2.9mEq/L, Cl : 98mEq/L, and Mg: 1.7mEq/L. Which client outcomes indicate that spironolactone is effective? Select all that apply -Repiration at 18 breaths per minute. -Pedal edema +1. -Potassium level of 5.2mEq/L. -Weight loss 5 pounds (2.3kg). -O2 saturations 96% on 3 lpm O2.

-Repiration at 18 breaths per minute. -Pedal edema +1. -Weight loss 5 pounds (2.3kg). Rationale: spironolactone is a potassium sparing diuretic. Positive outcomes include less pedal edema, improved respiratory effort, and weight loss indicating fluid volume decrease

furosemide

-loop diuretic -for acute heart failure -IV push (IVP) -doses of 20 to 40 mg -increase by 20 mg every 2 hours until the desired diuresis (increased or excessive production of urine) is obtained

documentation

-all prescriptions & over the counter -reason for medication -dosage -length of time the medication has been taken -ask about herbal products & nutrition supplements

topical medication

-apply a thin film on clean skin -spread evenly in a downward motion (direction of hair growth) -if secondary dressing will be used, apply medication directly onto a dressing -use plastic wrap with corticosteroids or simple emollients -apply socks over plastic wrap -keep wraps inlace for 2 to 8 hours

metolazone

-diuretic -older adults with mild volume overload -long acting -give every second, third, or fourth day, depending on pt need and tolerance

reproductive system assessment

-diuretics (premenstrual edema) -psychotropic agents (interfere w/ sexual performance) -antihypertensives (erectile dysfunction -amlodipine, lisinopril, propranolol, clonidine -alcohol, marijuana, barbiturates, amphetamines, phencyclidine hydrochloride -document contraceptives

viral infections

-do not respond to traditional antibiotic therapy -antiviral agents may be effective for prevention and treatment of some types of influenza

cholecystitis & hepatitis

-do not take oral contraceptives -chronic active inflammation of the liver blocks estrogen

COPD

-do not take oral contraceptives -progesterone thickens respiratory secretions

cream

-emulsions of oil and water -most common base for topical medications -lubrication and protection -thick creams spread easier if skin is still damp

lotion

-emulsions of water, alcohol, and/or oil -cooling and drying -some leave residual power film after evaporation of water -useful in subacute pruritic eruptions

antiparkinsonian drugs

-enhance the release dopaminergic -or anticholinergic effects in the striatum Carbidopa/Levodopa -monitor for signs of dyskinesia -effects may be delayed for several weeks to months -instruct patient or caregiver to report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands, or legs; mental changes; palpitations; severe nausea and vomiting; difficulty urinating -use ropinirole or pramipexole (dopaminergic receptor agonist) with combination Bromocriptine -should not be used as first line treatment because of possible serious side effects (high blood pressure, seizure, heart attack, stroke) -pt may become dizzy or faint due to orthostatic hypotension, especially after the first dose -notify hep immediately if a severe headache develops that does not improve or get worse Amantadine -increases dopamine release, blocks dopamine reuptake Trihexyphenidyl & benztropine (anticholinergic) -balance between dopaminergic and cholinergic Antihistamines -have anticholinergic properties may be used to manage tremors Selegiline & rasagiline (MAO-B) -combine with Carbidopa/Levodopa

medroxyprogesterone acetate

-estrogen and progestin -increases risk of stroke, breast cancer, deep vein thrombosis, gallbladder disease, urinary incontinence in postmenopausal women -women who use tobacco have higher risk for clotting disorders

venous vasodilator

-example: nitrates -for pt with heart failure who has dyspnea -constriction of veins and arteries to make up for lost CO2 -reduces the blood volume, increases preload -may benefit by... -returning venous vasculature to more normal capacity -decreasing the volume of blood returning to the heart -improving left ventricular function

morphine sulfate

-for acute heart failure -to reduce anxiety -decrease preload/after load -reduce pain associated with myocardial infarction (MI)

antiacids

-for peptic ulcer disease -increase gastric pH by neutralizing the hydrochloric acid -bind to bile salts, decreases damaging effects of bile on gastric mucosa (aluminum hydroxide) -take on empty stomach, last 20-30 min -take after meals, last 3-4 hours -may be given hourly or through NG tube -if NG tube in place, remove stomach juice and test pH, if -5 suction may be used, or frequency or antacid or anti secretory is increased -sodium citrate (high in sodium) CAUTION in pt with liver cirrhosis, hypertension, heart failure, and renal disease -pt with renal failure should not take magnesium preparations -antacid of aluminum and Mg decreases the side effects -enhance absorption of dicoumarol and amphetamines -Ca and Mg antacids potentiate the effects of digoxin -decrease absorption rates of tetracycline

nitrates

-given IV, orally, topically -IV for acute heart failure -dilate veins and arteries -initial headache, but tolerance will make it go away -give acetaminophen for headache relief -to prevent tolerance the HCP may prescribe 12 hr nitrate free period out of every 24 hr -isosorbide is a nitrate!!

hyperphosphatemia

-high serum phosphate -common in pt with acute kidney injury or chronic kidney disease, alters the kidney ability to excrete phosphate -excess phosphate intake from the use of phosphate containing laxatives or enemas -possible shift of phosphate from ICF to ECF -can occur in pt with tumor lysis syndrome or rhabdomyolysis -hypoparathyroidism and vit D intoxication cause increased kidney phosphate reabsorption

side effects of conventional antipsychotics: rare and toxic effects

AGRANULOCYTOSIS sore throat, fever, malaise, mouth sores, increased infections, reduced white blood cell and neutrophil counts, flulike symptoms; first 12 weeks of therapy Potentially dangerous blood dyscrasia: Clozaril blood work usually done every week for 6 months, then less frequently. Physician may order blood work to determine presence of leukopenia or agranulocytosis. If test results are positive, the drug is discontinued, and reverse isolation may be initiated. Mortality is high if the drug is continued and treatment is not initiated. CHOLESTATIC JAUNDICE rare, reversible, and usually benign if caught in time, early symptoms are fever, malaise, nausea, and abdominal pain; jaundice appears after 1 week possible medication change, bed rest and high protein, high carbohydrate diet if ordered NEUROLEPTIC MALIGNANT SYNDROME: rare, potentially fatal Severe extrapyramidal: severe muscle rigidity, oculogyric crisis, dysphasia, flexor extensor posturing, cog wheeling, decreased responsiveness Hyperpyrexia: temperature over 103 F Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence Acute, life threatening medial emergency stop neuroleptic, bromocriptine can relive muscle rigidity and reduce fever. Dantrolene may reduce muscle spasms

The charge nurse at an assisted-living facility receives report from an emergency department (ED) nurse about one of the resident clients. The client was sent to the ED with a fever, chills, muscle aches, and headache. The ED nurse reports the client's rapid influenza report came back from the laboratory positive for influenza A. What action by the nurse at the assisted-living facility is most appropriate? A. Prepare to administer antibiotics. B. Have the resident eat meals in his room. C. Provide oseltamivir (Tamiflu) to the staff. D. Arrange a follow-up chest x-ray in 2 weeks.

B. Have the resident eat meals in his room.

hypophosphatemia causes

CAUSES malabsorption syndromes, chronic diarrhea, malnutrition, vit D deficiency, parenteral nutrition, chronic alcoholism, phosphate binding antacids, diabetic ketoacidosis, hyperparathyroidism, reseeding syndrome respiratory alkalosis MANIFESTATION CNS depression (confusion, coma), muscle weakness, including respiratory muscle weakness, polyneuropathy, seizures, cardiac problems (dysrhythmias, heart failure), osteomalacia, rickets, rhabdomyolysis

hyperphosphatemia causes

CAUSES renal failure, phosphate enemas, excessive ingestion (laxatives), rhabdomyolysis, tumor lysis syndrome, thyrotoxicosis, hypoparathyroidism, sickle cell anemia, hemolytic anemia, hyperthermia MANIFESTATIONS hypocalcemia, numbness and tingling in extremities and region around mouth*, hyperflexia, muscle cramps, tetany, seizures, calcium phosphate precipitates in skin, soft tissue, cornea, viscera, blood vessels often asymptomatic unless calcium binds with phosphate, leading to manifestations of hypocalcemia -tetany, muscle cramps, paresthesias, seizures -long term increased phosphate levels result in the development of calcified deposits outside of the bones -these calcium deposits can be found in soft tissues such as joints, arteries, skin, corneas, and kidney and produce organ dysfunction, notably renal failure PT TEACHING high foods and fluids in phosphorus (dairy products) should be restricted. oral phosphate binding agents (calcium carbonate) limit intestinal phosphate absorption and increase phosphate secretion in the intestine -loop diuretic may increase phosphate excretion

A client has been taking furosemide (Lasix) and valsartan (Diovan) for the past year. The hospital laboratory notifies the nurse that the client's serum potassium level is 6.2 mEq/L. What is the nurse's best action at this time? A. Assess the client's oxygen saturation level. B. Ask the laboratory to retest the potassium level. C. Give potassium as an IV infusion. D. Check the client's serum creatinine.

D. Check the client's serum creatinine.

diuretics

DRUG THERAPY -manage symptoms of heart failure -first line drug of choice in older adults with heart failure & fluid overload -enhance renal excretion of sodium and water by reducing circulating blood volume, decreasing preload, and reducing systemic and pulmonary congestion PATIENT CENTERED CARE -continue to work even after excess fluid is removed -can cause pt to become dehydrated -signs of dehydration: confusion, decreased urinary output, dizziness -risk for falls*

side effects of conventional antipsychotics: ANTICHOLINERGIC SYMPTOMS

DRY MOUTH provide frequent sips of water, ice chips, and sugarless candy or gum. If severe, provide Xero-Lube or other saliva substitute. URINARY RETENTION AND HESITANCY Check voiding, check for distended bladder. Try running water and warm towel on abdomen, and consider catheterization if no result CONSTIPATION Ensure adequate fluid and fiber intake. May use stool softener, laxative, or dietary laxatives (prune juice) BLURRED VISION Usually lessens in 1 to 2 weeks. May require use of reading or magnifying glasses. If intolerable, consider consult regarding medication change PHOTOSENSITIVITY Encourage patient to wear sunglasses, sunscreen, sunblocking clothing. Limit exposure to sunlight. DRY EYES Use artificial tears. Avoid wind exposure SEXUAL DYSFUNCTION Consult prescriber - pt may need alternative medication. Artificial lubricants for vaginal dryness ANTICHOLINERGIC TOXICITY dry mucous membranes, reduced or absent peristalsis, mydriasis, non reactive pupils, hot, dry, red skin, hyperpyrexia without diaphoresis; tachycardia; agitation; unstable vital signs; worsening of psychotic symptoms; delirium; urinary retention; seizure; repetitive motor movements Consult prescriber immediately. Hold all medications. Implement emergency cooling measures as ordered. Implement urinary catheterization prn. Administer benzodiazepines or other pro sedation as ordered. Physostigmine may be ordered.

side effects of conventional antipsychotics: alpha2 block cardiovascular effects

HYPOTENSION & POSTURAL HYPOTENSION Check blood pressure before giving agent. Hold dose and contact HCP if systolic BP is less than 80. rise slowly to prevent dizziness and to hold onto railings to reduce falls. Effects usually subside when drug is stabilized in 1 to 2 weeks. Hydrate you pt. TACHYCARDIA Always evaluate patients with existing cardiac problems before antipsychotic drugs are administered. Abnormal QT interval can be a contraindication for certain antipsychotics

side effects of conventional antipsychotics: EXTRAPYRAMIDAL SIDE EFFECTS

PSEUDOPARKINSONISM masklike facies, stiff and stooped posture, shuffling gait, drooling, tremor, "pill rolling" phenomenon Administer pro antiparkinsonian agent (trihexyphenidyl or benztropine). If intolerable, consult prescriber regarding medication change. Provide towel or handkerchief to wipe excess saliva.* Teach how to reduce risk fall; 5hr-30days ACUTE DYSTONIC REACTIONS acute contractions of tongue, face, neck, and back opisthotonos: titanic heightening of entire body, head and belly up oculogyric crisis: eyes locked upward laryngeal dystonia: could threaten airway; 1-5days give antiparkinsonian agent, consider diphenhydramine hydrochloride (Benadryl) AKATHISIA motor inner driven restlessness, tapping foot incessantly rocking forward and back, shifting weight side to side; 2hr-60days akathisia usually subsides when antipsychotic is discontinued, give propranolol, lorazepam, or diazepam; contributes to suicide TARDIVE DYSKINESIA face protruding and rolling lounge, blowing, smacking, licking, spastic facial distortion dramatic jerking movement; months to years; occurs when pt take these drugs for more than 2 years

benzodiazepines

a medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles

acute dystonia

acute sustained contraction of muscles, usually of the head and neck

1st gen medium potency antipsychotics

loxapine, molindone, perphenazine