CNUR 202

Cannabis

Main components: tetra-hydro-cannabionol (THC) and cannabidilol (CBD). THC: Psychoactive effects (stimulate CB1 & CB2 receptors in nervous system. CBD counteracts psychoactive effects of THC (has non psychoactive effects)Medical cannabis products : ↑ CBD content than recreational cannabis. Cannabis is rarely the first drug taken by patients for pain management. Subjective pain relief from cannabis may not match objective measurements of pain relief. Need for additional scientific evidence to evaluate the effectiveness of cannabis as an analgesic, balance for therapeutic/adverse effects, may be used to lower opioid dose, Low to moderate evidence to support use of cannabis for the following conditions: Chronic pain. Some treatment resistant epilepsies. Nausea and vomiting r/t chemotherapy. Only medicinal cannabinoids should be used for medicinal purposes- balance of THC to CBD (medicinal has higher concentrations), AIDS complications- appetite stiumlant. Synthetic cannabinoids are typically used for medicinal purposes. Non-medicinal CBD products are legal and widely available from retailers. Contraindications- Unstable angina-cannabinoids can cause hypotension, tachycardia and may increase the risk of myocardial infarction in the immediate post-ingestion/inhalation period) Further research is needed, other concerns may be known in the future, History of psychosis or recent delirium; Cannabis-induced hyperemesis syndrome; Pregnancy. Nursing Responsibilities-Cannabis Act and the Cannabis Regulations (October 17, 2018) is the primary law governing cannabis in Canada RNs in SK may assist with providing and/or administering medical cannabis to a patient receiving publically funded healthcare services and who is currently under medical treatment. Patient must posses medical document issued by MD with following info:Authorized HCP license information, Patient's name and DOB, A period of use (up to 1 year), A daily quantity of medical cannabis. Necessary knowledge and competence to safely administer or assist in administering medical cannabis Consultation with other members of the healthcare team prior to administration (if necessary) Valid order from authorized HCP Labelling requirements, Medication reconciliation profile, Appropriate documentation

Ipratropium (atrovent)

Maintenance therapy in COPD Synergistic effect when used with adrenergics, Route: MDI: 2 inhalations 3-4 x/day Safety not established in children < 12, Classifications:Pharm - anticholinergic, Therapeutic - bronchodilator

Anticholinergics

Mechanism of Action- Chronic inflammation increases vagal tone -> acetylcholine stimulation -> increases PNS response, Bronchoconstriction and increased mucous secretion, Anticholinergics, Block's acetylcholine effects (bronchoconstriction) of bronchial smooth muscles= bronchodialation, Result: prevention of bronchoconstriction, Maintenance rather than emergent treatment- slow and progressed, not for acute symptoms, Have a slow and prolonged action, Prevent bronchoconstriction, NOT used for acute asthma exacerbations, Examples- ipratropium (Atrovent), tiotropium (Spiriva), Adverse effects- Dry mouth or throat Constipation, Abdominal pain, Headache, dizziness, Anxiety/nervousness, Use cautiously in patients with narrow angle glaucoma and BPH-benign prostate hypertrophy, Metallic taste - Atrovent, OCT allergy meds, ask about med hx

Metformin

Mechanism of action: Production, Absorption, Sensitivity Contraindications- Liver disease, Alcoholism, Heart failure Does not stimulate insulin secretion, risk for lactic acidosis, decreased hepatic relation, increase glucose receptor, peripheral, increased insulin receptor, sensitivity, Mechanism of action:Production, Absorption, Sensitivity, Contraindications- Liver disease, Alcoholism, Heart failure, Adverse effects- Abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea, Metallic taste, hypoglycemia, and a reduction in vitamin B12 levels after long-term use, Lactic acidosis is an extremely rare complication, Interactions Iodinated radiology contrast- day of- 48 hr stop medication

Indications of Adrenergic Drugs

Medical emergencies- Cardiac arrest, hypotension, shock states, anaphylaxis, Ex: phenylephrine: potent alpha 1- shock, peripheral vasoconstriction, young person with head/spinal injury, epinephrine (Adrenalin®): 1st in cardiac arrest, inhaled, endotracheal tube, EpiPen (IM), IV 1 mg 3-5 min until code is over, doesn't prolong survival, increase return of spontaneous blood flow Respiratory Disorders- Asthma, pneumonia, COPD, Acute bronchospasm Colds, sinusitis, seasonal allergies- Ex: ephedrine, Sudafed® Ophthalmology (Eye gtt)- Diagnostic procedures (mydriasis) Reduces intraocular pressure in open angle glaucoma

Medication Errors

Medications must be prepared, dispensed and administered safely, collaborative approach, grave consequences and legal repercussions, lack of pediatric formulations, dosage forms and guidelines, confusion between adult and pediatric formulations, confusion of concentration of oral liquids, calculation errors, errors c measuring device, medication reconcilation- prevent errors, bar codes- contain drug identification number (DIN), linked to charts, minimize distractions, high alert medications- K+, Cl-, heparin, insulin, morphine, neuromuscular, chemotherapy- Independent double check

Analgesics

Medications that relieve pain without causing loss of consciousness, Categories- Opioids, Non-opioids, Adjuvant medications, Antidepressants, Anticonvulsants, Corticosteroids

Adrenergic Drugs- MOA, contraindications, adverse effects

Mimic or potentiate the effects of the sympathetic nervous system MOA- Direct Acting Adrenergic Drugs bind directly to the receptor in effector tissue and causes a physiological response i.e. epinephrine, Indirect Acting Adrenergic Drugs stimulate release of endogenous neurotransmitters i.e. appetite suppressants- stimulates nerve to release NE, Mixed Acting Adrenergic Agonists have direct and indirect stimulation i.e. Sudafed (pseudoephedrine)- colds, decongestant, vasoconstriction Contraindications- Used cautiously in patients with severe cardiac insufficiency( <40% when normal is 50-65%), Hypertension (precipitate), Hyperthyroidism, Known hypersensitivity, narrow angle glaucoma, Hypovolemic shock untreated with fluids- vasodilate, shock, inadequate tissue perfusion AE- Central Nervous System-stimulate, Tremors, insomnia, nervousness, headache, excitement, euphoria, Cardiovascular System Tachycardia, HTN, palpitations, chest pain, heart failure, Hyperglycemia (less insulin release= increased glucose production), Sweating, dry mouth, nausea and vomiting, Nasal solution - develop tolerance, rebound congestion, stinging, burning, Ophthalmic solutions: blurred vision, transitory stinging

Cholinergic Drugs: MOA, drug effects, adverse effects

Mimic or stimulate the effects of the Parasympathetic nervous system MOA- Direct-acting: Bind to cholinergic receptors, Indirect-acting: Inhibit the enzyme acetylcholinesterase, which breaks down acetylcholine (reuse and reuptake), Results in more acetylcholine being available at the receptors, Reversible - bind to cholinesterase briefly, Irreversible - bind to cholinesterase to form a permanent bond (poison), mysthogravis does not have enough ACh/ AchE need meds Drug effects: "Rest and Digest" SLUDGE:Salivation, Lacrimation (tears), Urinary incontinence, Diarrhea, Gastrointestinal cramps, Emesis, stimulate digestive inhibit everything else AE- CNS: headache, dizziness, gait disturbances, CVS: bradycardia, hypotension, heart block Respiratory: bronchospasm, SOB, increased secretions, pneumonia GI: nausea, vomiting, cramps, increased secretions, Other: lacrimation, sweating, salivation- do not discontinue because of this

Adrenergics

Mimic the SNS Stimulate beta2-adrenergic receptors- acute asthma attack, NE on B receptors=dilate airways, Results in bronchodilation of the smooth muscle, Short-acting bronchodilator (SABAs), Used for the prevention & treatment of acute bronchoconstriction, Albuterol (Ventolin- rescue, Salbutamol) first line for asthma attacks- treatment, Route: nebulizer, MDI, ventilator, IV & IM (adults), Frequency depends upon route, Caution: tolerance develops with overuse, Long Acting beta2 adrenergic agonists Used for prophylaxis only Exception: Symbicort ® Salmeterol (Serevent), Route: Inhalation powder (diskhaler) q12h, Nonselective Adrenergics, Stimulates beta1 & beta2 receptors Used for acute bronchoconstriction Epinephrine, Route: SQ injection, Onset: 5 min, not for rescue, B1- cardiac, b2- respiratory, Mechanism of Action- Begins at the specific receptor stimulated, Ends with the dilation of the airways, Activates cAMP, Relaxes smooth muscle, Dilates bronchials, Increases airflow, B2- cAMP- relax smooth muscles= bronchodilation= increased airflow, adverse effects- Insomnia, Restlessness, Anorexia, Vascular headaches, Hyperglycemia, Tremors, Cardiac stimulation, alpha and beta- most adverse effects- nonselective, B2- hypo/hyper tension, headache, Precautions: Cardiovascular disorders Diabetes (increases glucose synthesis), Contraindicated: Tachydysrhythmias, High risk of stroke, MOAIs

Affective disorders medication

Mood stabilizing drugs- lithium- potentiates serotonergic neurotransmission, narrow therapeutic range- blood level monitoring- antidepressant drugs- not just for depression, increase the levels of concentration of neurotransmitters- biogenic amine hypothesis (BAH)- depression is from a deficiency of neuronal and synaptic catecholamines, mania is from excess of amines at the adrenergic receptor sites, permissive hypothesis- decrease concentration of serotonin is predisposing factor in pt with affective disorders, depression- decrease in serotonin and catecholamine, mania- increase dopamine and NE, decrease of serotonin- dysregulation hypothesis- failure to regulate BAH, acute phase

What could happen if a client has an abnormally low serum albumin level and is taking a medication which is highly protein bound?

More drug is freely flowing, more pass through capillaries to target tissue- pt at risk for drug toxicity

Preparing Injections

More quickly absorbed than oral medications- used when pt is vomitting (can't swallow), when rapid onset of a medication is needed, when pt cannot have oral fluids, subcutenous, IM, ID, IV, minimize pt discomfort, insure proper angle, slowly into skin, hold steady, withdraw smoothly, needlestick prevention mechansims, equipment- need and syringe, determine size, length, gauge of needle, volume of solution, medication route, syringes- single use, disposable, (not) Leur-Lok- needles are twisted onto tip, prevent accidental removal, 0.5-60 mL, needles- can be attached to syringes, hub (fits onto tip of syringe), shaft (connects to the hub), bevel (slanted tip), barrel holds medications, MUST BE STERILE, length 1/4-3 in, based on pt weight, smaller gauge = larger needle diameter, disposable injection units- prefilled, barrel first in holder, plunger rod turned to left (CCW), and then to lock to the right (CW) until it clicks,\

Type 2 Diabetes

Most common type (90% of all cases), Caused by insulin deficiency and insulin resistance, Many tissues are resistant to insulin, Reduced number of insulin receptors, Insulin receptors less responsive, Several comorbid conditions, Obesity, Coronary heart disease, Dyslipidemia, Hypertension, Microalbuminemia (protein in the urine), Increased risk for thrombotic (blood clotting) events. These comorbidities are collectively referred to as metabolic syndrome or cardiometabolic syndrome. Genetic/ environment conditions

Prednisone

Most commonly used oral glucocorticoid for anti-inflammatory or immunosuppressant purposes- intermediate-acting glucose Also used to treat exacerbations of chronic respiratory illnesses such as asthma and chronic bronchitis , minimal mineralscorticoid so cannot be used on its own c undersecretion (Addison's disease), PO- unknown onset of action, 1-2 hr peak plasma concetration, 2-3 hr half life, 8-36 hr duration of action

Metabolism

Most often occurs in the liver (must be intact) by enzymatic activity (cytochrome p450)- deficiency diagnosed by genetic testing The process of breaking down a drug into: A less active or inactive metabolite A more soluble compound that can be excreted by the kidneys A more potent metabolite (conversion of a prodrug to a drug, i.e. simvastatin), increase cholesterol, metabolic process that makes drug more active Metabolism can also occur in the kidneys, lungs, plasma and GI tract- pancreatits, drugs can cause toxicity if liver disease, thyroid disease

Rapid acting insulin

Most rapid onset of action (10 to 15 minutes) Peak: 1 to 2 hour s Duration: 3 to 5 hours Patient must eat a meal after injection Insulin lispro (Humalog®) Action similar to that of endogenous insulin Insulin aspart (NovoRapid®) Insulin glulisine (Apidra®) Not IV

Distribution

Movement of drug from the bloodstream to its site of action Rapid distribution Heart, brain (25%), kidneys(20%)- vital organs receive higher CO Slow distribution Skin, fat, muscle- less vascular Poor distribution occurs when: The tissue has a poor blood supply, i.e. bone A physical barrier is present, i.e. the blood-brain barrier Protein binding- Many drugs bind to albumin- colloid osmotic pressure, Only drugs that are not bound to albumin are active, free, and capable of exerting a physiological response- enter target tissue, increase affinity for protein, problem when two drugs bind

Neurotransmitters

Neurotransmitters incite, inhibit or modify the response of another neuron, SNS: Norepinephrine stimulates adrenergic receptors on target cells Hence, SNS is termed ADRENERGIC, PNS: Acetylcholine stimulates muscarinic and nicotinic receptors on target cells Hence, PNS is termed CHOLINERGIC, Target Cells: Smooth muscle, cardiac muscle, glands Cathocolemeans- dopamine, NE, E

Indications for Direct Acting Cholinergics

Non-obstructive urinary retention and bladder atonyi.e. bethanechol (Urecholine), Promotes micturition by stimulating the detrusor muscle to contract the bladder,The client will void 30 - 90 minutes after taking an oral dose, Increases peristalsis, therefore the drug should be taken on an empty stomach, Can cause hypotension, bradycardia, bronchospasm, blurred vision, excessive salivation, increased GI acids, abdominal cramps and diarrhea, flaccid bladder- no tone, stay on- access to bathrooms, work with detrusor muscle (stimulate)- pt can empty bladder, increased bladder capacity, continence

NSAIDs

Nonsteroidal Anti-Inflammatory Drugs, A large and chemically diverse group of drugs that have: Analgesic activities, Anti-inflammatory activities, Antipyretic activities, aspirin-platelet inhibition. Types- Salicylates, Acetic Acid, Derivatives, Propionic Acids, Cyclooxygenase- 2 Inhibitors, Enolic Acid Derivatives. MOA- Inhibition of leukotriene pathway, prostaglandin pathway, or both Cyclooxygenase (COX) enzymes- blocks enzyme, COX-1-synthesis of prostaglandins, intact intestinal mucosa, COX- 2, COX- 2 Inhibitors- just 2 not 1, Leukotriene pathway inhibited by some anti-inflammatory drugs, but not by salicylates- more specific= fewer adverse effects (GI ulcers), GI bleeding. Use- Relief of mild to moderate headaches, Relief of muscle pain, Relief of nerve pain, Relief of joint pain, Relief of postoperative pain, Relief of pain associated with arthritic disorders such as rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and osteoarthritis, Treatment of gout and hyperuricemia. Contraindications- Known drug allergy, Conditions that place the patient at risk for bleeding, Kidney disease, Renal disease, Safe during pregnancy (avoid after 32 weeks gestation), Not recommended for nursing mothers, Patients undergoing elective surgery (stop 1 week in advance), pt with hemorrhagic stroke, aspirin allergy, adverse effects- Heartburn to severe GI bleeding- most fatalities, Acute kidney injury- dehydration, Noncardiogenic pulmonary edema, Altered hemostasis, Hepatotoxicity, Skin eruption, sensitivity reaction, Tinnitus, hearing loss (ASA toxicity overdose). Kidney Function- Kidney function depends partly on prostaglandins. Disruption of prostaglandin function by NSAIDs is sometimes strong enough to precipitate acute or chronic kidney injury or failure.Use of NSAIDs can compromise existing kidney function. Kidney toxicity can occur in patients with dehydration, heart failure, or liver dysfunction, or with the use of diuretics or angiotensin-converting enzyme inhibitors- inhibit CO2, decrease prostaglandins for renal blood flow. Nursing Implications- Before beginning therapy, observe for and assess conditions that may be contraindications to therapy, especially, GI lesions or peptic ulcer disease, bleeding disorders, Perform laboratory studies as indicated (cardiac, kidney, and liver function studies; complete blood count; platelet count), drug interactions, pt teaching- Take NSAIDs after meals or with food to minimize GI upset, Notify prescriber adverse effects become severe, unusual bleeding or GI pain Enteric-coated tablets should not be crushed or chewed.

Normal Insulin Metabolism

Normal insulin metabolism Produced by the Beta cells Islets of Langerhans Released continuously into bloodstream in small increments with larger amounts released after food Stabilizes glucose range to 4-6 mmol/L Insulin promotes glucose transport, limits glucose in blood stream

Steady state

Occurs when the amount of drug administered = the amount of drug eliminated Results in a constant serum drug level and MAXIMUM THERAPEUTIC BENEFIT = therapeutic window Usually occurs after 4-5 half lives If a drug has a short half-life then it will reach a steady state quickly, more frequent drug doses If a drug has a long half life then it will take days - weeks to reach a steady state- thyroid meds, goal, serum steady state- therapeutic window

Diabetes

Often regarded as a syndrome rather than a disease, Two types- Type 1, Type 2, Miscellaneous (drug induced/ gestational diabetes)-carb, fat, protein metabolism are affected Signs and symptoms Elevated fasting blood glucose (higher than 7 mmol/L) or a hemoglobin A1c (HbA1c) level greater than or equal to 6.5%, Polyuria, Polydipsia, Polyphagia, Glycosuria, Weight loss, Fatigue Blurred vision

Drug Effects: Onset, Peak, Duration of Action

Onset- How long does it take of the drug to work? Peak- How long does it take to reach the maximum therapeutic effect? Duration- How long will the therapeutic effects last? Time medication administration prior to procedure

Adrenocortical hormones

Oversecretion: Cushing's syndrome- moon face, ATCH dependent, hyperplagia, tumor, steroids, Na/H20 retention, muscle weakness Undersecretion: Addison's disease- vague, chronic abnormal lab (electrolyte) levels, anemia, dehydration, weakness, anorexia, weight loss

Acute pain

Pain that is sudden in onset, usually subsides when treated, and typically occurs over less that an 6-week period, Onset: sudden (minutes to hours), sharp, localized, physiological response, Duration: limited (end point)Ex: stub your toe, post op, dental procedures, appendicitis

Nursing Care Beta blockers

Perform VS (HR always goes with BP)before and after administration - auscultate the apical pulse for 1 full minute, Examine VS trends, Assess weights daily, Assess for the presence of drug interactions, i.e. antacids decrease absorption, Give with food, Monitor side effects: Hypotension, tachycardia, bradycardia, signs of heart failure/decompensation, SOB, bronchospasm, lethargy, blood glucose levels (diabetics), Monitor for expected therapeutic benefits: Primary health care provider may or may not provide VS targets, client education: Details about taking the drug, Time of day; don't crush ER tablets; side effects, Don't double doses when doses are missed (depends on 1/2 life), Change positions slowly, Never stop the drug abruptly, May cause significant rebound HTN, Do not take OTC drugs without first consulting with M.D. or pharmacist, Avoid alcohol, hot tubs, excessive exercise, Monitor weight, BP and pulse at home, Advise to wear a medical alert bracelet, Seek medical attention if: Palpitations, severe vertigo, dyspnea, weight gain, edema, confusion, depression, sexual dysfunction, pt retain fluids BP decrease, NEVER GIVE IBUPROFEN TO HF

Why are corticosteroids used in the treatment of respiratory disorders? A- Decrease inflammation B- Dilation of the bronchi C- Stimulates immune system D- Increases gas exchange in the alveoli

A

Medication Error

A medication incident is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer, distractions or interruptions as the most common contributing factor, The 3 drug products most commonly involved with reported incidents were: Insulin, Hydromorphone, Heparin ( HIGH ALERT)

Which of the following drugs are used for acute asthma attacks? Select all that apply. A- Salbutamol (Ventolin) nebulizer solution (adrenergic) B- Zafirlukast (antileukotriene) tablet C- Budesomide MDI (corticosteriods) D- IV epinephrine (adrenergic) E- Fluticasone (corticosteriod)

A, D

Nursing Process for Pyschotherapeutic drugs

A- head-to-toe, mental health status, LOC, mental alertness,level of motor/ cognitive functioning, MMSE, other assessment tools, suicidal ideation/tendency- IS PATH WARM ( Ideation, Substance Use, Purposelessness, anxiety, trapped, hopelessness, withdrawal, anger, restlessness, mood changes), deterioration of health status, weight loss/gain, sleep habits, nutritional intake, bp, pulse, lab tests, oral mucosa, snellen chart, neuromuscular, GI, liver function studies

Nursing process for CNS depressants

A- insomnia, concerns of sleep disorders/patterns/ difficulty, time pt wakes up, and how they feel vs physical, neurofindings, med hx, CBC, kidney functions studies I- pt safety measures, interrupt therapy

Status Asthmaticus

Acute - requires hospitalization Prolonged asthma attach - nonresponsive to typical treatment Symptoms:Acute anxiety, labored breathing, wheezing, tachycardia, diaphoresis, Rising PaCO2- impaired gas exchange, Absent breath sounds are an warning sign, Alveolar hypoventilation with hypoxemia can lead to death.Medical emergency, acute, unresponsive

Indications for Opioid Analgesics

Acute conditions: Trauma, Post-procedural pain, Intra-operatively and post-operatively (surgery- maintain pain and analgesic, Cancer: Immediate release, i.e. MSIR and continuous release formulations, i.e. MS Contin; methadone (longer half life- used to use methodone, MRSI-cancer, Chronic conditions: i.e. severe rheumatoid arthritis, SR formulations of hydromorphone, morphine or methadone often used Harm reduction strategy, i.e. treatment of opioid addictions, suppress medullary cough center- codiene, hydrocone, decrease GI motility, constipation- antidiarrheal, amodivim

Drug Interactions

Additive Effects: 1 + 1 = 2 Example: Tylenol #3 Synergistic Effects: 1 + 1 = Greater than 2 Antagonistic Effects: 1 + 1 = Less than 2 Example: antacids are a common antagonist. Incompatibility- Example: dilantin IV is incompatible with all other IV solutions, filter IV tubing

Golden Rules of Medication Administration

Adhere to ethical standards of practice at all times- honest, truthful, know limitations, never (assume) administer a medication without a written order, clarify orders that seem incorrect, or are missing elements, NEVER administer a medication that you do not know, seek assistance when unsure- NEVER guess, only administer medications that you have prepared, NEVER administer medications to clients that you have not assessed, document promptly, clearly, and accurately

Adrenal Gland

Adrenal cortex- outer, hormone driven, corticosteriods Adrenal medulla- inner, hormone and ANS driven, E, NE Each portion has different functions and secretes different hormones. Feedback process of hormone regulation, Adrenal medulla secretes catecholamines, Epinephrine, Norepinephrine, Adrenal cortex secretes corticosteroids- different layers, Glucocorticoids, Mineralocorticoids (primarily aldosterone)- electrolytes, normal Na+ levels by absorbing from urine and replacing with K+ and H+

Factors that affect drug metabolism

Age- Neonates have immature microsomal enzyme systems; thus, drugs are metabolized slowly Children age 1-12 years metabolize drugs much more quickly than adults - small dosages, Older adults metabolize drugs more slowly Diet- Grapefruit inhibits metabolism of many drugs, Vitamin and mineral deficiencies inhibit the metabolic activity of enzymes Gender- Likely related to hormonal differences, i.e. women metabolize benzodiazepines (sedative/ hypnotic) more slowly than men Liver function- What are the implications of administering medications to a patient with impaired liver function? Genetic factors- (cytochrome p450 deficiency)

Opioid Analgesics: Interactions

Alcohol, Antihistamines,Barbiturates, Benzodiazepines, Promethazine, Monoamine oxidase inhibitors, Others

Adrenergic Receptors

Alpha1- Located on the post-synaptic effector cells (the tissue that the nerve stimulates), periphery, vasoconstriction, increase BP Alpha2- Located on the pre-synaptic terminals; which control the release of epi, norepi, and dopamine, a sub categories, safety net, decrease sympathetic flow, manage release of NE, E so you don't have over stimulation, located on different spots on the nerve Stimulation- fight or flight

Alpha Adrenergic Stimulation

Alpha1- Vasoconstriction, decreased renin secretion, CNS stimulation, Pupil dilatation, Glycogenolysis & gluconeogenesis (release of glucose and glucose producing other tissues- brain needs glucose) Contraction of pregnant uterus, improve circulation Alpha2- centrally acting, Inhibit release of norepinephrine, Vasoconstriction, Inhibits insulin secretion, increased stickiness of platelets, clotting- do not wait for pt to be ill, improve blood flow, can become ischemic, blood goes to vital organs

Pain

An unpleasant sensory and emotional experience associated with either actual or potential tissue damage.Physical, psychological and ethnocultural factors, Most common reason that patients seek health care, Pain management is individualized for each patient's needs, Nociceptors (pain fibers), Pain threshold (physiological)- similar for everyone, Pain tolerance (psychological)- individual, environment, personality, cultural, social, etc., physiology of pain- tissue injury, release of histamine, prostaglandins, bradykinin, substance P, or serotonin which stimulates nociceptors in peripheral sensory nerves which transmit signals to the spinal cord and brain, physiology of pain- Nociceptors are found in large numbers in: Skin, underlying soft tissue, muscle fascia, joint surfaces, arterial walls, periosteum, Nociceptors are scarce in most internal organs, Sources of Pain: heat, cold, pressure, stretch, spasm, ischemia, Pain threshold is the level of stimulus need to produce a perception of pain - physiological response

Drug

Any chemical that affects the physiological processes of a living organism

Acetylsalicyclic acid

Aspirin, MOA- Irreversible inhibitor of COX-1 receptors within the platelets themselves, Reduced formation of thromboxane A2, a substance that normally promotes platelet aggregation (also known as antiplatelet activity), Other NSAIDs lack these antiplatelet effects. (WHICH NSAID HAS ANTI-PLATELET EFFECTS), Therapeutic class: antipyretic, non opioid analgesic, Pharm class: salicylate Dose dependent for therapeutic effectsAntiplatelet effect: less than 300mg/day, Antipyretic/ Analgesic effect: 300-2400mg/day, Anti inflammatory effect: greater than 2400mg/day, Shown to reduce cardiac death after myocardial infarction (MI), Should be administered at the first sign of MI Do not give salicylates to children and teenagers because of the risk of Reye's syndrome-give tynelol, cross effects with other NSAIDs

Nursing Care for Anticholinergic drugs

Assess for allergies and prior medical history, Baseline assessment of VS and physical, Assess for therapeutic and adverse effects, Drug interactions - antihistamines, digoxin can cause additive effects, Monitor for Toxicity and Overdose, Hyperthermia, tachycardia, ileus, delirium to...Seizures, coma, respiratory arrest, Tx: Activated charcoal absorbs drug, Benzodiazepines can decrease excessive CNS stimulation, Cooling measures for hyperthermia, client education: Consult with primary health care provider before taking other drugs, Blurred vision may causes issues with driving or other tasks, Sunglasses with minimize light sensitivity, Identify measures to reduce the risk of heat stroke (older adults), Dry mouth may be relieved by hard candy, Practice good dental hygiene,Tooth decay can result from long term drug use, Institute preventative measures for constipation, Provide specific drug information in writing

Nursing Care for Cholinergic Drugs

Assess vital signs, Administer on regularly scheduled intervals Administer with food or milk to decrease the risk of gastric distress and ulceration, Monitor for therapeutic effects, Alleviated signs and symptoms of primary disease process, In postoperative patients with decreased GI peristalsis, look for: Increased bowel sounds, Passage of flatus, Occurrence of bowel movements, Bladder retention should be relieved within 60 min, Monitor for widespread adverse effects, is the drug doing the intended purpose, client education: Wear medical alert bracelet, Take oral meds with food to decrease nausea, Drugs taken for treatment of urinary retention work fast! Report adverse reactions: Abd. cramps, diarrhea, excessive salivation, Difficulty breathing, Muscle weakness, Specific drugs interact with herbals and dietary changes

Nursing Process for Drug therapy

Assessment- A holistic assessment involves gathering of data about the whole individual, including physical and emotional realms, religious preference, health beliefs, sociocultural characteristics, race, ethnicity, lifestyle, stressors socioeconomic status, education level, motor skills, a, cognitive ability, support systems, lifestyle, and use of any complementary and alternative therapies, why are they taking medication, vitamins, marijuana use, illegal drugs Subjective Data- Includes information about any and all drug use, including prescription medications, home remedies, herbals, alcohol, tobacco, caffeine, over-the counter medications, and illicit drugs Performed upon admission, this process is known as Medication Reconciliation- process of reviewing meds on administration for safety Must include an assessment of: the patient's health history presence of allergies understanding of each drug and how/when it is taken barriers to drug adherence Objective data: Objective Data Age Past medical history Pharmaceutical Information Program (PIP) Physical assessments (i.e. allergies, weight, vital signs, odors, client's reported symptoms (i.e. adverse effects or failure to improve) Laboratory data (i.e. drug levels, coagulation studies, WBCs, microbiology reports) Diagnostic tests (i.e. CXR, MRI) "Performing a thorough ethnocultural assessment surrounding medications is important for holistic care- cultural influences Diagnoses: Common nursing diagnoses related to drug therapy develop from data associated with: Deficient knowledge Risk of injury Nonadherence (compliance) Various disturbances, deficits, excesses, or impairments in bodily function, Specific examples: Clients receiving insulin are at risk for hypoglycemia Clients receiving warfarin are at risk for bleeding, Clinical Tip: Be sure to include nursing diagnoses related to medication therapy on your concept maps. Planning- This phase includes prioritizing nursing diagnoses, identifying SMART goals, and outcome criteria, Goals Reflect expected and measurable changes in behavior and are developed in collaboration with the client Individualized Outcome criteria Standard of measuring attainment of goals May address special storage and handling techniques, administration procedures, required equipment, drug interactions, adverse effects, and contraindications Planning also includes time for the nurse to prepare, i.e. review procedures, obtain equipment, and gather teaching materials such as pre-printed medication teaching sheets Implementation- Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria Based upon the nurses clinical knowledge and judgement The nurse MUST know the client and the details of each medication prior to administration Ethics and Safety matter. If you don't know a medication, be honest and look it up! Public attitudes and beliefs surrounding medication use is highly variable Nurses support individual rights to informed consent and choice Nurses must explain the risks and benefits to clients so that they make may meaningful decisions Nurses must adhere to safe medication practices Evaluation- The nurse must answer important questions: Has the desired therapeutic response been achieved? In other words, is the drug doing what it is intended to do? Are there any adverse or toxic effects present? What is the impact of the adverse effects upon the patient? In other words, do the risks outweigh the benefits? Does the client continue to require the medication? What is the client's understanding of his/her medications?Are there any barriers to drug adherence?

Nursing Process for Adrenal Drugs

Assessment- Baseline nutritional, hydration, immune status, weight, intake and output, vitals (especially BP ranges) and integumentary assessment, muscle strength and body stature, pre-existing edema, cardiac disease, Note prescription drugs, OTC drugs and natural health supplements, Lab values: serum sodium, serum potassium, serum glucose, Glucocorticoid: serum potassium ↓ and blood glucose levels usually ↑ Lifespan considerations: Pregnancy and lactation Children: growth suppression Older adults: more prone to adrenal suppression with prolonged adrenal therapy. muscle weakness, osteoporosis, vision changes- risk of injury, risk of falls Diagnoses- Disturbed body image related to the physiological effects of diseases of the adrenal gland on the body or the cushingoid appearance caused by glucoscorticoid therapy (e.g. prednisone), Excess fluid volume related to fluid retention associated with glucocorticoid and mineralocorticoid use Risk for infection related to the anti-inflammatory, immunosuppressive, metabolic, and dermatological effects of long-term glucocorticoid therapy, Impaired skin integrity related to the adverse effects of glucocorticoids. Planning- Patient will experience minimal body image disturbances Patient will exhibit normal fluid volume status during treatment with glucocorticoid or mineralocorticoid therapy, Patient will remain free from infection during adrenal drug therapy Implementation- Adrenal hormone production follows diurnal pattern: Peak: 0600-0800, Decrease during the day, Lower peak: 1600-1800 Cortisol levels ↑ in response to emotional and physical stress Cortisol levels ↑ when endogenous levels ↓ due to a physiological negative feedback loop- do not abruptly stop- hormone output needs to respond, Give exogenous glucocorticoids early am to minimize adrenal suppression, Give oral prednisone with milk or food to help minimize GI upset Long term glucocorticoids: alternate day dosing if possible Delayed wound healing: flulike symptoms, sore throat, fever, anti-ulcer agent, alternate day dosing, Monitor for signs and symptoms of Addison's disease Fatigue, headache, confusion, fever, nausea, vomiting, abdominal pain, tachycardia, diaphoresis, dehydration, Adrenal crisis: life threatening, Intra- acticular adrenal drug forms are not administered by the nurse, Topical preparations (skin, eyes, inhalation) administer as ordered, Dermatological preparations: apply to clean, dry skin, Notify the doctor if the patient experiences: shortness of breath (possible heart failure), joint pain, fever, mood swings, or other unusual symptoms. Evaluation- Therapeutic response: resolution of disease or underlying pathology- why are you giving it, ↓ inflammation, ↑ feelings of well being, ↓ pain and discomfort in the joints, ↓ lymphocytes, other signs of improvement, Adverse effects: Weight gain, ↑ BP, ↑ Sodium, ↓Potassium, Mental health status changes, Abdominal distention, Ulcer related symptoms, Changes in vision, Cushing's syndrome, moon facies- prolonged/frequent use of glucocorticoid, Belly fat, ↑ in blood glucose and sodium levels, ↓ serum potassium, Wasting muscle mass, Buffalo hump (fat behind the neck). Teaching- Patients must not alter dosing or abruptly discontinue medication without consulting a health care provider, Avoid alcohol, caffeine, aspirin and other NSAIDS to minimize GI upset and possible gastric bleeding, Glucocorticoid inhalers: risk for oral fungal infections. Teach patient to rinse with lukewarm water after each use- check mouth.Corticosteroids decrease immune function. Monitor for s/s infection, avoid contact with people with known infections, report fever, increased weakness, fatigue or sore throat to HCP. If once a day dose of glucocorticoid is missed, take the dose as soon as possible after remembering the dose was missed. Stress importance of bone health and fall prevention strategies Contact HCP if experiencing any S/S of adrenal insufficiency Maintain low sodium and high potassium diet, if ordered. Medic alert bracelet

Nursing Process for Pain

Assessment- OPQRSTUV, pain is the biggest reason ppl seek health care, scale is typically not used because you need a better understanding of their pain, pain as the 5th vs- objective(pain is a symptom, you cannot take objective data)- not used anymore but Purpose: make pain assessment and measurement as important a measure of patient well-being as the existing four vital signs. Findings suggest that "pain as the 5th vital sign" campaign with its reliance on the numerical pain scale (NPS) directly contributed to the prescribed opioid crisis in American, WHO analgesic ladder- advocate appropriately, not used anymore used for all pain management, now just for cancer pain, pt may not need presribed opioids anymore (nonopioids +/- adjuvant- pain persisting or increasing- opioids for mild to moderate pain +/- nonopioid/adjuvant- pain persisting or increasing- opioids for moderate to severe pain +/- nonopioid/ adjuvant- freedom from pain), Diagnosis- Acute pain related to... Risk for injury related to...Risk for respiratory depression, Risk for falls, Acute confusion, Risk for bleeding, Risk for constipation, Knowledge deficit, other meds= CNS depression = increased risk of respiratory distress. Planning- General guidelines: Opioids: Start low and go slow, Medicate patients before the pain becomes too severe as to provide adequate analgesia, Patients with opioid tolerance may require higher doses, Offer both pharmacological and non-pharmacological methods- attitudes and beliefs i.e. ice packs, music, repositioning, etc. Prevent adverse effects: All patients on opioids should have routine bowel care orders! (stool softeners, laxatives) May need anti emetics, Administer food/milk with NSAIDs, Side rails up; call light within reach- fall prevention, baseline pain control as appropriate- idiopathic (breakthrough). Implementation- Administer the (HIGH ALERT)medication according to best practice guidelines, Independent double check procedures, Withhold dose if excessively drowsy, change in LOC, or RR less than 10, Oral formulations should be taken with food, General Diet: high fluids and fiber, Teaching: Patients commonly have fears about addiction, May believe that pain is normal, expected, and to be tolerated- chronic, ADLs, Set realistic goals- pt acceptance (what they find)- chronic pain-pain journal- identifying patterns, Change positions slowly to prevent orthostatic hypotension. Evaluation- Monitor for therapeutic effects- reduced pain, therapeutic goal. Is the medication meeting the therapeutic goals? Decreased reports of pain and/or intensity of pain. Increased periods of comfort Improved activities of daily living, appetite, and sense of well-being Decreased fever- antipyretic, not everyone metabolizes the same- different genes (mutations), Call physician immedieately if- Respiratory depression (opioids) hypoxemia, restlessness, dyspnea, slow, shallow breathing, decreased ability to cough, RR less than 10 Administer naloxone, Abrupt change in VS, Condition deteriorates, Pain persists

Nursing Process of Diabetes

Assessment- Patient's knowledge about the disease and recommended treatment, Head to toe assessment- comprehensive, Current medications (prescriptions and OTC), Lab test (Plasma glucose, fasting plasma levels, A1c levels) Prescriber's order (correct drug, route, type of insulin and dose), Asses blood glucose levels prior to administering insulin, Monitor for signs and symptoms of hypoglycemia and hyperglycemia Effectiveness of therapeutic regimen and patient adherence to treatment, economic- collab c social work (multidisciplinary approach), Planning- Patient will maintain adequate and balanced nutrition, stabilizing weight and improving dietary habits in support of the overall management of diabetes.Patient and family will state the importance of adherence to medication regimes, lifestyle changes, dietary restrictions, and avoidance of high risk behaviours. Patient will begin to understand the etiology of unstable glucose levels and learn management strategies. Diagnoses- Imbalanced nutrition, less than body requirements, related to the body's inability to use glucose (type 1 diabetes) Ineffective family therapeutic regimen management related to lack of experience with a significant daily treatment regimen for diabetes Risk for unstable glucose due to recent onset of possible signs and symptoms of diabetes. Implementation- Asses blood glucose levels prior to administering oral ant hyperglycemic drugs or insulin Correct medication administration: Rolling pre mixed insulins Administer at room temperature SC injection: 90-degree angle (45-degree if patient is emaciated) Insulin must be administered in an insulin syringe, If mixing insulins: Inject the appropriate amount of air into the vials (prescribed # of units) Clear (rapid acting) then cloudy (intermediate acting), Understand types of insulin and their pharmacokinetic properties onset, peak, duration, independent double check- HIGH ALERT MEDICATION, Always double check the prescriber's orders, and clarify when unclear, Dosage, Drug Dietary changes (i.e. NPO), Avoid time lapse between administration of insulin and meals, Understand sliding scale and basal bolus insulin methods, Monitor plasma blood glucose levels several times/ day with these regimes, Oral antidiabetic drugs: administer 30 minutes before meals, Metformin (contrast dye) Current best practice recommendations (continuing competency), Patient education Follow organizational policies and procedures for high alert medications, increased mortality. Evaluation- Diagnostic criteria for diabetes: hyperglycemia fasting plasma glucose 7mmol/L or higher, Non fasting plasma blood glucose 11mmol/L, Therapeutic response to insulin and ant hyperglycemic drugs: decrease plasma blood glucose (acceptable range from HCP or near normal levels ), Optimizing glycemic control decreases risk for diabetes complications, Monitor glucose levels closely. Teaching- Medic alert jewelry, Instructions and demonstrations: Monitor BGM at home, Insulin storage, Necessary equipment, Drawing up and mixing insulin, Injection technique, Evaluation..., Patient journal: diet & BGM, Exercise, hygiene, foot care, diet, weight, Factors affecting plasma blood glucose levels Medication compliance, Finances Avoid smoking & alcohol, illness, fever, stress, increased activity, emotional distress, Hypoglycemia versus Hyperglycemia, Signs and symptoms, Treatment and management, Carry fast acting glucose at all times (espcially t 1), Monitor BGM before taking insulin, Vacation: plan for necessary supplies and equipment (carry on luggage, not checked baggage), Importance of A1C monitoring, Sun protection- photo sensitivity

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteriod. What instructions should the nurse give the patient regarding these inhalers? A- the corticosteriod should be taken first B- The bronchodilator should be taken first C- the two drugs must be take 2 hours apart D- The order of administration does not matter

B

What types of drugs might be considered for a patient with COPD? Select all that apply. A- Diuretics B- anticholinergics C- corticosteriods D- Antihistamines E- Antitussive F- B-agonist

B, C, F

Frequent use of bronchodilators may cause which adverse effects? Select all that apply. A- Blurred vision B- increased HR C- Decresed HR D- Nausea E- nervousness F- tremors

B, D, E, F,

Beta Adrenergic Receptors/ Stimulation

Beta1- located on the post- synaptic effector cells of the heart (heart), Significant cardiac effects, + inotrope (Increased contraction), + chronotrope (increased contraction), + dromotrope (increased conduction- faster), Increased renin release, enzyme Beta2- located on the smooth muscles of bronchioles, arterioles, and viscera (lungs), Bronchodilation, Vasodilation (airways), Relaxation of pregnant uterus, decreased motility and tone of GI tract, ↑glycogenolysis and gluconeogenesis

Monoclonal Antibody Asthmatic

Binds to IgE, Prevents the inflammatory response omalizumab (Xolair), Uses: Moderate - severe asthma Clients inadequately controlled on steroids, Route: subcutaneous injection, Pediatrics: Over age 12 Classification: Pharm. Class: monoclonal antibodies Therapeutic: Antiasthmatic SQ

Anticholinergic drugs: MOA, indications, contradictions

Block or inhibit the effects of the parasympathetic nervous system, common is Beta blockers and these, MOA: decrease parasympathetic response, Competitive antagonists Prevents acetylcholine from binding to receptor sites, Most drugs block muscarinic receptors, Brain, secretory glands, heart, and smooth muscle, Drug effects are widespread and multisystem, Block the parasympathetic response thereby allowing the SNS to dominate Indications: Cardiovascular Symptomatic Bradycardia - Atropine (code cart, emergency med, IV, blocks parasympathetic effects), 0.5 mg administered rapidly IV push q3-5min to a max of 3 mg, Subtherapeutic and high doses lower the HR even more- is HR sufficient to meet metabolic needs of body- confusion, palpation, LOC, cyanosis, SOB, treat pt not # Indications- Respiratory, not long term, Bronchoconstrictive disorders (COPD, chronic bronchitis), Decreases airway resistance= bronchodilation i.e. Ipratropium inhaler (sabatomol, combivent), Decreases secretions from nose, mouth & bronchi (bubbly airway), Glycopyrrolate: IV or IM "Antisecretory" medication, palliative, diagnostic reasons, block bronchoconstriction = bronchodilation, productive cough, increased lung sounds, Gastrointestinal- Antisecretory and antispasmodic effects, Perioperatively, Glycopyrrolate or atropine given to decreased bronchial & GI secretions Irritable Bowel Syndrome - reduces GI motility, Pancreatitis - reduces pancreatic and gastric secretions, unchecked leads to necrosis of pancreas, Genitourinary System- urgency relax bladder, Relaxes the detrusor muscle of the bladder (antispasmodic), increased constriction of urinary sphincter, oxybutynin (Ditropan XL or IR) Used for urinary frequency; bladder spasms, incontinence, nocturia and treatment of neurogenic bladder Increases bladder capacity resulting in urinary retention; delayed desire to void; decrease incidence of frequency and urinary incontinence, B & O suppository: useful in patients who "bypass" urinary catheters, opium and benos, Central Nervous System- Treatment of Parkinson's Disease: decreased salivation, spasticity, and tremors, Used for patients who don't respond to or can't tolerate L-dopa, May relieve extrapyramidal symptoms in those taking antipsychotic drugs i.e. benztropine (Cogentin) movement disorders caused by meds, Ophthalmology, Cause pupillary dilation (mydriasis) or paralysis of the ocular lens (cycloplegia) to facilitate eye exams or eye surgery, left unchecked-irreversible, shuffling gait, poor posture Contraindications- Conditions that would be aggravated by these drugs:Severe myocardial insufficiency, Respiratory distress or acute asthmatic episode, Myasthenia gravis, Hyperthyroidism, Conditions causing reflux esophagitis, i.e. hiatal hernia - relax the cardiac sphincter & delay GI emptying, Glaucoma BPH: causes urinary retention Adverse Effects- CNS stimulation followed by depression, Dilated pupils, increased IOP and photophobia increased myocardial oxygen demand - tachycardia, dysrhythmias, Respiratory: thickened & decreased secretions, decreased GI motility, secretions, salivation, decreased sweating: intolerance to heat can cause heat stroke Older Adults:blurred vision (dilated pupils), confusion, hallucinations, heat stroke, constipation, urinary retention

Adrenergic Blocking Drugs

Block or inhibit the effects of the sympathetic nervous system Bind to adrenergic receptors and block the effects of: sympathetic nerve stimulation endogenous catecholamines adrenergic drugs (antidote), Classifications: Adrenergic antagonists, sympatholytics, Alpha blockers, B blockers, and alpha and beta blockers, antihypertensives, Have the opposite effect of adrenergic agents, GOAL of THERAPY: To block the pathological stimulation of the SNS, NOT to inhibit normal sympathetic responses, not so blocked that there is no response, opposite effect of adrenergic drugs, direct receptor interaction

Respiratory Drugs

Bronchodilators- B-adrenergic agonists, Anticholinergics, Anti-inflammatory agents- Antileukotrienes, Corticosteroids Monoclonal Antibody

A patient has been prescribed an inhaled respiratory medication, what should the nurse tell this patient about the proper method for taking this medication? A- rinsing the mouth after using the inhaler or nebulizer is recommended B- Nebulizer tubing and mouthpiece should be cleaned only with hot water C- Inhale the medication deeply, with the head tipped forward to maximize opening of the airway D- after administering an inhaler medication, patient should remove the inhaler and hold their breath for at least 20 sec

C

Discharge teaching to a patient receiving a B-agonist bronchodilator should emphasize reporting which of the following adverse effects: A- Sedation B- Hypoglycemia C- Tachycardia D- Nonproductive cough

C

Patient teaching regarding the use of antileukotriene agents such as zafirlukast include which of the following statements? A- Take the medication as soon as you begin wheezing B- It will take about 3 weeks before you notice a therapeutic effect C- This medication works by preventing the inflammation in an asthma attack D- Increase fiber and fluid in your diet to prevent the common adverse effects of constipation

C

Adrenal Drugs

Can be either synthetic or natural Many different drugs and forms, Glucocorticoids, Topical, systemic, inhaled, nasal, Mineralocorticoid, Systemic, natural vs synthetic, moa- Most corticosteroids exert their effects by modifying enzyme activity, Glucocorticoids differ in their potency, duration of action, and the extent to which they cause salt and fluid retention, Glucocorticoids inhibit or help control inflammatory and immune responses.Stimulate erythroid cells- RBCs, Catabolism of proteins Glycogen in the liver (glycogenesis) Redistribute fat from peripheral to central areas of the body, bind to receptor- steroid receptor-complex decrease in WBC to inflamed area, stimulate mast cell production. Indications- Adrenocortical deficiency, Adrenogenital syndrome Allergic disorders, Autoimmune blistering diseases, Bacterial meningitis, Cancer, Cerebral edema Collagen diseases (e.g., systemic lupus erythematosus), Dermatological diseases (e.g., exfoliative dermatitis, pemphigus) Endocrine disorders (thyroiditis) Gastrointestinal diseases (e.g., ulcerative colitis, regional enteritis) Exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease Hematological disorders (reduction of bleeding tendencies), Nonrheumatic inflammation Ophthalmic disorders (e.g., nonpyogenic inflammations) Organ transplantation (decrease immune response to prevent organ rejection), Leukemias and lymphomas (palliative management), Nephrotic syndrome (remission of proteinuria) Spinal cord injury Rheumatic disorders: rheumatoid arthritis, psoriatic arthritis, acute gouty arthritis, ankylosing spondylitis (adjunctive therapy) Thyroiditis. Administration- Glucocorticoids:By inhalation for control of steroid-responsive bronchospastic states, Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal, Topically for inflammations of the eye, ear, and skin. Contraindications- Drug allergies Cataracts, glaucoma, peptic ulcer disease mental health problems, and diabetes, Often avoided with serious infections, including septicemia, systemic fungal infections, and varicella However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory central nervous system damage, gastric, liver, kidney, alterations. Adverse effects- Moon facies (long term use), Hyperglycemia, Psychosis Most serious: adrenal suppression, cautious c HF. Interactions- check lab values,Multiple drug interactions, Non-potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypocalcemia and hypokalemia.Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and other ulcerogenic medications produce additive gastrointestinal effects and an increased chance of gastric ulcer development.Anticholinesterase medications produce weakness in patients with myasthenia gravis. Immunizing biologics inhibit the immune response to the biological. Antidiabetic drugs may reduce the hypoglycemic effects and result in elevated blood glucose levels.

Opioid Analgesics: Adverse Effects

Cardiac and CNS depression respiratory depression (most common cause of death-pre-existing condition, COPD, asthma, sleep apnea), arrhythmias and coma- prescribed Narcan also dose is important, Nausea, vomiting, constipation, biliary tract spasm, Urinary retention (decrease PNS that stimulate irritate, trigger CNS, bladders Hypotension- falls (risk), palpitations, flushing, Itching, rash, wheal formation- not allergic reactions, slow peristalsis, absorb water, histamine release, vasodilation, Pinpoint pupils indicating a possible overdose

Adverse Effects of Alpha blockers

Cardiac:Orthostatic Hypotension, "First dose syncope" (naive to drug- never had before), May occur 30 min - 2 hours after initial dose and occasionally thereafter, Start with smaller doses and increase slowly to effect, Administer at bedtime, Reflex tachycardia (decreased blood flow to heart, increased HR), Palpitations, Edema, GI disturbances, CNS, Dizziness, headache, anxiety, depression, fatigue, weakness Impotence, Note: Drug tolerance may occur. This classification is often given in combination.

Classification of Pain

Central- tumors, disease, cancer, stroke, MS Referred- visceral fibers synapse near subcutaneous fibers Vascular- vascular tissue-migraine Neuropathic- damage to SNS, idiopathic Phantom- area removed, burning, itching, stabbing Cancer- acute/chronic, pressure against nerves, organs, tissues, effects of radiation

Diseases of the Respiratory System

Characteristics:Bronchial smooth muscle spasm, Mucosal edema Excessive mucous production, Infection, Include:Asthma, COPD Cystic fibrosis

Drug names

Chemical name- HOC6H4NHCOCH3 Generic name- acetaminophen, proper, lowercase/ different typeface, (), under trade Trade name- Tylenol, start, in all capitals, largest printed Lawfully must appear on labels

Chronic Pain

Chronic Pain: also known as persistent or long term pain is recurring, lasting 3-6 months. Onset is slow (days to months) Duration: long lasting, recurring (constant),May be characterized as dull, long-lasting, aching, Recognized by the World health Organization (WHO) as a disease in it's own right in the International Classification of Diseases (ICD-11) Ex: osteoarthritis, cancer, neuropathy (peripheral), more changes in nervous system, increase in medicine

COPD

Chronic exposure to airway irritants Bronchoconstriction, Persistent inflammation of large & small airways, Lung parenchyma- destruction of bronchioles= hyperinflation, decrease gas exchange, Vessels, Less reversible compared to asthma- TNF, I8, interleukin- damage, increase mucous and # of goblet cells, injury and repair- permanent scarring, smoking, air pollutants, impaired gas exchange, risk for infection, chronic limitation of airflow, Progressive Respiratory Disease, Chronic airflow limitation, Progressive dyspnea, Increase activity intolerance- exercise SOB, sleeping, SOB at rest/activity, Chronic inflammation, vaping, barrel chest, pursed lip breathing, middle-older adults, stage - mild, FEV 80%, 2- moderate, FEV 50-80%, 3- severe, FEV 30-50%, ischemia, 4- very severe

Asthma

Chronic inflammatory airway disease, Results from hyperresponsiveness to stimuli- triggers, Recurrent and reversible shortness of breath, Pathophysiology- Airways of the lungs become narrow as a result of...Bronchospasm, Inflammation of the bronchial tree mucosa- bronchonconstriction, Edema of bronchial mucosa- airway remodeling, Production of thick mucus, mast cell activation, aveoli remain open but blockages prevent wheezes (expiratory), Symptoms vary in incidence and severity Most common symptom is chronic cough, Acute Symptoms, Wheezing, dyspnea, shortness of breath, chest tightness, Common Triggers: Viral infections, Environmental allergens, Drugs- ASA, NSAIDs, Beta Blockers, Exercise, Emotions Cold air, short responds to medication, if not status asthmaticus- need hospitlization, well controlled- occassional, poor- can be difficult to manage, chronic

Epinephrine (Adrenalin)

Classification: sympathomimetic, inotrope, vasoactive adrenergic Actions: Alpha, beta1 and beta2 receptor agonist- stimulate Drug Effects: increased HR, increased BP, bronchodilation, vasoconstriction, and reduced effects of histamine and other inflammatory mediators Routes: Parenteral: IV, SC, IM, Intracardiac, Inhalation, Intraosseous (bones), Topical ( intranasal), alpha- vasoconstriction, B1- heart conductivity, rate, etc., B2- bronchodilator route- subcut: 5-10 min onset of action, 20 min peak plasma concentration, variable half life, unknown duration of action, IV- less than 2 min onset of action, rapid peak plasma concentration, less than 5 min half life, 5-30 min duration of action

Salbutamol (Ventolin)

Classifications: anti-asthmatic, bronchodilator, sympathomimetic Action: Selective Beta2 adrenergic agonist Drug Effects: bronchodilation and vasodilation at low doses Route: metered dose inhaler, nebulizer Caution: can develop tolerance Selective B2- helpful c pt who have underlying heart disease, look at cardiac hx, Drug Class: Bronchodilator, adrenergic, Mechanism of Action: Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium, which then relaxes smooth muscle airways. Safe Dose Range: 2.5-5 mg every 20 min for 3 doses and then 2.5-10 mg every 1-4 hours, side effects- Nervousness, restlessness, tremor, chest pain, palpitations , indications- asthama, COPD, teaching points- Instruct patient to notify HCP if there is no response to the usual dose or if the contents of one canister are used in less than 2 weeks. Advise patient to rinse mouth with water after each inhalation to minimize dry mouth. Advise patient to take this medication before other inhalation medications.

Vial administration

Clean top of vial before getting medication, eject air into vial before (same amount that you are taking out- air volume= fluid volume), needless adapter, can mix 2 drugs in a syringe, change needle (different one to remove medication and admin)

Can clients take their own medication in hospitals?

Clients may only take their own medications if first authorized by the primary HCP and a written order is provided. We don't usually unless order, not usually- overdose, could be reason why admitted, interactions, anti-coagulants, ADA, baby aspirin- STOP, mother/baby does, preference- side effects from others, inhalers

Nutritional therapy

Cornerstone of care for person with diabetes, Most challenging for many people, Recommended that diabetes nurse educator and registered dietitian with diabetes experience should be members of team, Type 1- unusual food, insulin, exercise, Type 2- glucose, lipid, BP goals, calorie reduction, weight loss, spacing meals

A patient has recently been placed on inhaled corticosteriods. Which of the following common adverse effects should the nurse discuss with the patient? A- fatigue and depression B- anxiety and peripheral vasoconstriction C- headache and rapid heart rate D- Oral Candidiasis and dry mouth

D

Ibuprofen

Decreases platelet effects, Therapeutic class: antipyrectic, antirheumatic, NSAID, Pharm class: non opioid analgesic, Action: inhibits prostaglandin synthesis Absorption: oral formulation 80% from GI tract, IV administration complete bioavailability, Metabolized by liver, Small amounts excreted by kidneys, common proprotic drug, safe, decrease pain, inflammation, fever, arthritis, dental pain, MSK injuries, Contraindications: Hx recent MI, Severe heart failure Geriatric population ↑ risk of adverse reactions due to age related decrease in renal and hepatic functions- increased comorbidities, concurrent illnesses and medications, Adverse reactions/ Side effects HF, MI, Stroke, GI bleeding, renal failure, Drug/ drug interactions: Chronic use with acetaminophen may increase risk of adverse renal reactions, May decrease effectiveness of diurectics, ACE inhibitors, other antihypertensives May increase hypoglycemic effects of insulin or oral antidiabetic meds

Principles of Opioid Administration

Dosing: prn - nurse or patient controlled analgesia (PCA)-reass, epidural, Breakthrough- cancer, take now, work faster, Oral doses undergo extensive first pass metabolism, IV or IM routes have a faster onset of action than orals, When opioids are combined with non-opioid analgesics...Significant synergistic benefit to patients- total effect of drug > individual effect of drug, Patients will use less opioids to control pain, Nursing Considerations: Why does the patient require analgesics? MSK pain- use non-pharmacological (non-opioid analgesics) first before opioids What is the goal of treatment? Does the patient experience chronic, non-cancer pain? Be selective, advocate, Is the patient opioid naïve or opioid tolerant?Start low and go slow! smaller doses for CNS depression/ sedative drugs Does the patient have respiratory disease, kidney or liver insufficiency?Is the patient receiving other CNS depressants?

Mechanism of Action: Non-selective interactions

Drug produces a therapeutic effect by targeting: cell membranes- penetrate into cell, break down cell wall or cell organisms- used for viruses (change the mechanics) intracellular metabolism or function Examples: chemotherapeutic agents- attack abnormal cells- act at different places antivirals anti-infectives

Mechanism of Action: Enzyme Interactions

Drug-enzyme interactions inhibit or enhance the action of specific enzymes, Examples: ACE-I (Ramipril); phosphodiesterase inhibitors (Viagra)

Mechanism of Action: Receptor Interactions

Drugs bind to receptors on the surface of cells Agonist: drugs that completely attach to the surface creating a response Antagonist: Drugs that attach but do not create a response; prevents binding of agonists, natural chemicals Partial agonist: The drug elicits some response and blocks other responses, opioids Autonomic drugs, stimulate/inhibit cell to act

Drug Classifications for ANS

Drugs that stimulate the SNS are called: Sympathomimetics Adrenergic agonists, mimic actions Drugs that inhibit the SNS are called: hyperstimulation Sympatholytics Adrenergic antagonists Anti-adrenergics Drugs that stimulate the PNS are called: Parasympathomimetics Cholinergic agonists Drugs that inhibit the PNS are called: Parasympatholytics Cholinergic antagonists Anticholinergics Drug response, therapeutic effects, and adverse effects are dependent upon the specific type of receptor stimulated or inhibited- risk, benefit lysis= breaks

What could happen if a client is taking two medications which are highly protein bound?

Drugs will not be as effective, toxicity from one drug, sub-therapeutic reactions, dosing adjustments- may not have toxicity

medication reconciliation

Ensure accurate communication at care transit points,avoid errors of transcription, omission, duplication of therapy or med- med interactions/ med-disease interactions, nurse pt partnership, verification, clarification,

Diabetes Exercise

Exercise Essential part of diabetes management ↑ insulin receptor sites Lowers blood glucose levels Contributes to weight loss 150 min/ week, moderate, aerobic, resistance training 3x/ week

B2 selective adrenergic agonsists are given for long term control of asthma

False

Fixed combination insulin

Fixed combinations Humulin 30/70 Novolin 30/70, 40/60, 50/50 NovoMix® 30 Humalog Mix25® Humalog Mix50® Intermediate and short/rapid, throw what pt was taking before hospital

Indications for Indirect Acting Cholinergics

Glaucoma, i.e. pilocarpine eye gtt, Causes constriction of the pupils which opens Schlemm's canal to promote drainage of aqueous humor(drainage to maintain normal pressure rang), Drug Effect: Reduction of intraocular pressure (constriction of pupil so cannot drain, decreased pressure without- pressure and fluid builds up), test intraocular pressure, Diagnosis and treatment of myasthenia gravis- results in MSK weakness resulting from a defect in the function of acetylcholine (swallowing), Reversal of neuromuscular blocking drugs, Antidote for anticholinergic poisoning i.e. neostigmine and pyridostigmine, Slows the progression of Alzheimer's disease, Low levels of acetylcholine are present in Alzheimer's disease, i.e. Aricept, improve memory, cross BBB- preserve not treat, only lasts 55 weeks

Routes that avoid first pass metabolism

Highly vascularized sites, local effect, Sublingual, buccal, inhalation, intravaginal, rectal, transdermal, IV, IM, SUBCUT

Opioids

IV, patch, injections, pill, LA- SR, SL, contin, base line-avoid peaks and vallies, IR, Narcotic, Synthetic drugs that bind to the opiate receptors to relieve pain, Mild agonists: codeine, hydrocodone, Strong agonists: morphine, hydromorphone hydrochloride, oxycodone, meperidine, fentanyl, methadone, moderate-severe pain, opioid poppies, synthetic, describe illegal drugs-heroin, classifications-Agonists: bind to opioid receptors, analgesic, decrease pain, morphine, Agonists-antagonists- bind to pain receptors, weaker pain response, neonatal absence, bumorphine, Antagonists (nonanalgesic), not make you feel good, reverse effects, no response, bind to pain receptor, Narcan, Opioid Tolerance- physiological, state of adaption, need larger, Physical Dependence- adaption of body, Psychological Dependence-addiction, pattern of drug use, continuous craving, effects other than pain relief, understand pt pain-pt take for pain

Corticosteriods (glucocorticoids)

Indications: Acute & Chronic Asthma, COPD, Actions- Suppress airway inflammation, Decreased secretion of mucus, Decreased airway edema, Repair of damaged epithelium, Enhances the effectiveness of beta 2 adrenergic bronchodilators (B-agonists), Inhaled- Beclomethasone dipropionate (Beclovent), Fluticasone (Flovent), Budesonide (Pulmicort) Oral- Prednisone, IV, Methylprednisolone (Solu-medrol), Hydrocortisone (Solu-cortef), advantages-topical sites in lungs- limit systemic effects, Acute severe asthma, High dose of systemic steroid IV or po, Improvement seen in 6 hours, Drug continued for 7-10 days, Side effects: HTN, weight gain, fluid retention, mood changes, Chronic asthma, Lowest effective dose of drug by inhaler, Drug acts locally and therefore produces less systemic effects, Often used in combination, COPD, Early Stage, Steroids not likely beneficial, Later Stages, Short course therapy for episodes of respiratory distress, End-Stage COPD- steroid dependent, CMO, Often require daily dosing & become "steroid dependent", Given orally or IV. Adverse effects- Pharyngeal irritation, Coughing, Dry mouth- artificial saliva , Oral fungal infections, Systemic effects are fewer with inhalation therapy Nursing Care- Inhaled- Contraindicated: psychosis, fungal infections, AIDS, TB, Use with caution: diabetes, glaucoma, osteoporosis, PUD, renal disease, HF, edema, Inhaler Use: Bronchodilator is administered FIRST - Why- need to open airways Risk of oral fungal infections- after corticosteroid, rinse and clean mouth, do not stop abruptly, weaned off 1-2 weeks, If physician discontinues medication- pt is dependent (adrenal insufficiency) Report any weight gain of more than 2.5 kg a week or the occurrence of chest pain

Intermediate-acting insulin

Insulin isophane suspension (also called Humulin N, Novolin ge NPH) Cloudy appearance Often combined with regular insulin Onset: 1 to 3 hours- slower Peak: 5 to 8 hours Duration: up to 18 hours- longer not as much of long acting

HumaLog

Insulin lispro, rapid acting, most like endogenous insulin after a meal, facilitates uptake of excess glucose, subcut, 10-15 min onset of action, 1-1.5 hr/ 1-2 hr peak plasma concentration, 60-80 min half life, 3-5 hr duration of action

Insulin

Insulin ↑ insulin after a meal Stimulates storage of glucose as glycogen in liver and muscle Inhibits gluconeogenesis Enhances fat deposition ↑ protein synthesis Overnight fasting- muscle, adipose tissue (insulin dependent) liver cells are not, Exogenous insulin:substitute for endogenous insulin- for hormone restore metabolism of carbs, fat, protein, Can be used to treat Type 1 and Type 2 diabetes, Restore ability to metabolize carbohydrates, fats, and proteins, Store glucose in the liver, Convert glycogen to fat stores, Cannot reverse defects in insulin receptor sensitivity, careful austomization, rapid acting, short, intermediate, long acting, onset, peak, duration Contraindications: Known drug allergy to a specific product, Hypoglycemia- check bgl Adverse effects (hypoglycemia), Confusion, Coma, Seizure mild cognitive impairment Insulin therapy: Weight gain, lipodystrophy from repeated injections, Allergic reactions (rare)- hard bump of tissue under skin

Beta blockers: MOA, indications, contraindications, Types, Adverse Effects

Known as the "olols" Propranolol, atenolol, metroprolol (B1), labetalol (nonselective), carvedilol, Inhibitory effect on the CV system (why we give them), Decrease the rate and force of contraction of the heart, Decreases the electrical conduction through the AV node (MI, heart attack, reduce 02 consumption and work load), Balance myocardial oxygen supply and demand by reducing cardiac workload, B1- cardioselective, direct cardiac effects, B2- effects on pulmonary system, block- lungs constrict- not for COPD Indications: Therapeutic Uses: Hypertension, Angina, Cardiac dysrhythmias, Prevention of reinfarction post MI Glaucoma, Prophylaxis for migraine, Essential tremors, Acute stress, migraine- vasoconstriction/ vasodilation to brain-vascultare tissue is where the pain is Contraindications- Known hypersensitivity, CV Disorders:Bradycardia, heart block, cardiogenic shock, acute and symptomatic heart failure, hypotension, Respiratory Disorders: Asthma, emphysema, bronchospasm, bronchoconstrictive disorders, Pregnancy: fetal effects Types- Non-selective beta blockers: block both beta1 and beta2 receptors, Act upon smooth muscle in the bronchi and blood vessels Adverse effects of beta2 blockage include bronchoconstriction and interference with glycogenolysis i.e. sotalol, slow conduction, decrease HR, Cardioselective beta blockers: block only beta1 Preferred agents in the setting of COPD, peripheral vascular disease and diabetes mellitus, Alpha and beta blockers: block all receptors; also produces vasodilation by decreasing PVR Treatment of both hypertension and heart failure, Less bradycardia but more postural hypotension, Less reflex tachycardia, attempt homeostasis if meds slow things down too much Adverse Effects- CV, Bradycardia, hypotension, acute heart failure, dysrhythmias, Decreased exercise tolerance, Fatigue, Myocardial infarction if acute drug withdrawal, Altered blood glucose levels, Reduction in serum glucose levels, Masks the normal signs of hypoglycemia (tremors, nervousness, tachycardia), Non-selective B blockers may impair insulin release, leading to hyperglycemia, Bronchospasm, GI Disturbances, GU, Impotence, decreased libido, drug adherence- decrease blood flow for male

Opioid Analgesics: Contraindications

Known drug allergy, Severe asthma, Use with extreme caution in patients with the following:Respiratory insufficiency, Elevated intracranial pressure, Morbid obesity or sleep apnea, Paralytic ileus, Pregnancy

Contraindications of Cholinergic agonsists

Known hypersensitivity, COPD, GI and urinary obstructions Peptic ulcer disease, Inflammatory bowel disease, Bradycardia; dysrythmias (slow HR already), Hyperthyroidism, Hypotension, Pregnancy

Contraindications for Alpha blockers and alpha 2 agonists

Known hypersensitivity, CV diseases: do not want to reduce perfusion, angina, MI, heart failure, Stroke(cerebral MAD), Sepsis( increased vasodilation= decreased perfusion, Peptic ulcer disease, Drugs will increase GI motility and secretion of hydrochloric acid, Liver and kidney disease

Montelukast sodium (singulair)

LTRA, block leukotriene D4 receptors to augment the inflammatory response, fewer adverse effects/drug interactions , PO- 30 min onset of action, 3-4 hr peak plasma concentration, 2.7 hr- 5 hr half life, 24 hr duration of action

Type 1 Diabetes

Lack of insulin production, or production of defective insulin Affected patients need exogenous insulin. Fewer than 10% of all cases are type 1. Complications Diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic state (HHS), autoimmune

Leukotriene receptor antagonists (LTRAs)

Leukotrienes- Chemical mediators of bronchoconstriction & inflammation, Cause sustained bronchoconstriction & hypersensitivity in response to a trigger- chemical reactions- mucus secretion- coughing, wheezing, SOB, Increase mucus secretion & edema, Mechanism of Action- Block the action of leukotrienes from attaching to receptors on circulating immune cells in lungs. Resulting in: Prevent smooth muscle contraction of the bronchial airways, Decrease mucus secretion, Prevent vascular permeability, Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation, and smooth muscle contraction, anti-leukotriene drugs, drug effects just in lungs, Prophylaxis & chronic treatment of asthma, Adults & children over 1 year, Adjunct treatment with other medications improve symptoms Not as effective as low doses of inhaled steroids, prevent asthma attacks from allergens and environment, Montelukast (Singulair)- headache, n/v, allergy to inactive substances & Zafirlukast (Accolate)- metabolized in liver, oral, need to have rescue medications

Inflammation

Localized protective response stimulated by injury to tissues, which serves to destroy, dilute, or wall off (sequester) both the injurious agent and the injured tissue, Pain, fever, loss of function, redness, and swelling, , Inflammation occurs as a protective physiological response to injury. The inflammatory response caused by the release of: Proteins, Histamine, Serotonin, Bradykinin, Leukotrienes, Prostaglandins, Drugs block the effects of the these endogenous mediators to reduce inflammation, Endogenous compounds, including proteins of the complement system, histamine, serotonin, bradykinin, leukotrienes(bronchospasm), and prostaglandins- mediation inflammation- vasodilation, vaso-permeability, simple pain occurs as painful

Long- acting insulins

Long acting Insulin glargine (Lantus®) Clear, colourless solution Constant level of insulin in the body Usually dosed once daily Can be dosed every 12 hours- lower dose Referred to as basal insulin Onset: 90 minutes Peak: none Duration: 24 hours- dose dependent, understand properties so pt is not at risk for hypoglycemia

Tiotropium (Spiriva)

Long acting - taken once/day by inhaler, not PO, needs to be inhaled First line agent for maintenance therapy in COPD Safety not established in children < 12, Classifications: Pharm - Therapeutic -

Lantus

Long acting- clear, colourless, ph of 4, absorbed in 24 hr, does not cause blood levels to rise and fall, once a day, subcut, 90 min onset of action, no peak plasma concentration, unknown half life, 24 hr duration of action

Hypoglycemia

Low blood glucose, Occurs when Too much insulin in proportion to glucose in the blood, Blood glucose level less than 4 mmol/L Common manifestations (autonomic- early), Anxiety, Nervousness, Diaphoresis, Tremors, Hunger, Pallor, Palpitations, irritability, confusion, difficulty speaking- later, mimic alcohol intoxication, culturally competent care, Hypoglycemic unawareness Person does not experience warning signs/symptoms, increasing risk for decreased blood glucose levels, Related to autonomic neuropathy, Causes- Mismatch in timing, Food intake and peak action of insulin or oral hypoglycemic agents, don't aim for tight bg control- more unsafe for patient to have low they do not know about, peak of action of insulin or daily activities are altered w/o adjusting anything, too much insulin, exercise, not enough food, treatment- Test blood glucose using blood glucose monitor. Call lab to draw stat blood glucose if blood glucose monitoring result is less than 3mmol/L (RGH and PH sites only) If alert enough to swallow: 15 grams of glucose, glucose tablets, 15 mL honey, 3 packets of sugar dissolved in water, 175 mL of fruit juice or regular soft drink Recheck blood glucose level in 15 minutes, If less that 4.0 mmol/L, retreat

Nonparental medications

MDI, spacer, take at time, be aware if pt wants to self-administer, allow adequate time for administration, remove mouthpiece cover, shake inhaler, mouthpiece in between teeth, over tongue, 2-4 cm in front of widely open mouth, deep breath, 3 point/bilteral hand position, inhale 3-5 sec, hold breath 10 sec, exhale through nose slowly, wait 20-30 sec in between inhalations, do not repeat before schedule, rinse mouth and inhaler, count doses, DPI medications- no propellant, less manual dexerity, more medications to lung, no spacer, fully exhale, inhale quick and deep, hold 10 sec, may not taste powder/slight sweet taste, rinse, small volume nebulizers- add medications/moisture to inspired air to clear pulmonary secretions, mist

Acetaminophen

MOA: Is NOT an NSAID- analgesic and antipyretic but not anti-inflammatory, Similar to that of salicylates (NSAID)- well absorbed, Blocks pain impulses peripherally by inhibiting prostaglandin synthesis, Metabolized by the liver (85-95%), Excreted by the kidneys, Indications- Mild to moderate pain, Fever- children, Reyes Syndrome-swelling of the brain, Inability to take aspirin products, Adverse effects- Effective and relatively safe, Generally well tolerated, Possible side effects include rash,, nausea and vomiting, Most serious: hepatotoxicity, Much less common:Blood disorders, 85-95% metabolized in the liver, excreted by kidney, contraindications- should not be taken in the presence of following: Drug allergy, Liver dysfunction, Possible liver failure, G6PD deficiency-males, enzyme for function of RBC, Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic. Toxicity- Even though available OTC, lethal when overdosed, Dosage- Maximum daily dose for healthy adults is 4 000 mg/day, but Health Canada is considering lowering that to 3 000 mg/day.* 2 000 mg for older adults and those with liver disease Inadvertent excessive doses may occur when different combination drug products are taken together. Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription). *Note: Health Canada had not yet made this decision. Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity. Long-term ingestion of large doses also causes nephropathy. Recommended antidote: acetylcysteine regimen

Complications of Diabetes

Macrovascular (atherosclerotic plaque), Coronary arteries, Cerebral arteries, Peripheral vessels Microvascular (capillary damage), Retinopathy, Neuropathy, Nephropathy

Drug Excretion

Main Routes:Kidneys, Remove water-soluble drugs and their metabolites, Dependent upon GFR, urine flow, urine pH, Bile, Some drugs pass through the liver unchanged and are excreted in the bile: Excreted in feces, Reabsorbed and recycled- reused, effect now and later Minor Routes: Saliva, sweat, breast milk, tears, exhalation- alcohol, monitor and care for kidney failure

Nursing Care for Respiratory Medication

Perform a thorough assessment before beginning respiratory therapy:Skin color- baseline, cyanosis, Baseline vital signs Respirations (developmental norms)- SOB, AMU- intercostal, neck, wheeze, labour, postition Respiratory assessment, including ABGs & peak flow test (spirometry), Sputum production- infection, Allergies, History of respiratory & CV problems, Other medications- everything, Monitor for therapeutic effects, Decreased dyspnea, Decreased wheezing, restlessness, & anxiety, Improved respiratory patterns with return to normal rate and quality, Improved activity tolerance. Toxicity- Common in acute & chronic broncho-constrictive disorders due to overuse in attempt to relieve dyspnea, Recognition of Signs & Symptoms, Excess cardiac & CNS stimulation, Agitation, anxiety, insomnia, Low K, high BS, Discontinue drug causing toxicity, lavage. Pt Teaching- Identify triggers- causing bronchospasms, Take medications as prescribed- do not stop taking them- adrenal insufficiency,Take prophylactic medications- why are they not taking? Feel better, cost, lack of understanding, how far is drug store, Carry a short acting bronchodilator, Keep hydrated, Caffeine may increase CNS effects- increased heart palpations, Recommend the flu vaccine yearly- more susceptible to respiratory infections, Do not take OTC drugs, Inhalers- Shake well-upright, Seal the lips around the inhaler..Slowly inhale the drug for 3 sec..press down, Hold the breath for 10 sec...exhale slowly through nose, Wait 1minute ... wait 30-60 sec in between pumps, Rinse mouth; clean mouthpiece...Ensure that the client is able to self-administer the medication, Provide demonstration & observe return demo, Return to the Physician If...Insomnia, agitation, restlessness, palpitations, chest pain, or any change in symptoms, Go to the ER if symptoms are acute & not relieved by short acting bronchodilators, Nursing Process- Assessment- Assess rate & characteristics of respirations, skin color, ABG's- SOB, cough, characteristics, Nursing Diagnosis- Impaired gas exchange r/t altered oxygen supply, Goals: Patient will maintain optimal gas exchange evidenced by: resps are easy, non-laboured, what is causing it, Interventions- Assess respiratory system- auscultate, Identify S & S of acute respiratory distress, Administer bronchodilators and anti-inflammatory, Oxygen therapy, Evaluation- RR, no S & S of distress, ECG, O2 Sat's 99% on RA, etc. Less anxious, normal resps- rate and characteristics, keep 02> 90%, acute respiratory distress

Basal-Bolus Insulin Dosing

Preferred method of treatment for hospitalized patients with diabetes Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus Basal insulin is a long-acting insulin (insulin glargine). Bolus insulin (insulin lispro or insulin aspart

Types of Medication Prescriptions

Prn order- pro re nata "as the thing is needed", administered only as determined by assessment and upon pt request, verbal order- time sensitive or emergent situations, write them down and read back to prescriber, prescriber must sign within 24 hr, single order- one time dose of medication, stat order- must be administered within 30 min of when the order is given, usually one time but not always, pre-printed orders and clinical pathways- standarized approach, best practice, trade name and generic name, Unit dose- 24 hr supply for each patient, each med is wrapped individually MAR

Narcan and opioid oversdose

Pure opioid antagonist Drug of choice for the complete or partial reversal of opioid-induced respiratory depression Indicated in cases of suspected acute opioid overdose Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose- morphine IV, rapid onset, 20 min peak, 4-5 hour duration, naloxone IV, onset 1-2 min, unknown peak, 45 min duration, short drug effects, multiple doses, always prescribed with morphine, What are the implications when treating morphine overdose? The half life of the opioid may be significantly longer than that of the antidote; thus, ongoing patient monitoring is critical Patient may need multiple doses of naloxone

Components of medication presciptions

RNS CANNOT PRESCRIBE MEDICATIONS Client's full name- addressograph, date and time the order was written, name of the medication, dosage of the medication, route of administration, frequency of administration, signature of the person writing the order, tall man lettering,

Monoamine Oxidase inhibitors

Rarely for antidepressants- Parkinson's atypical depression, mood disorder c phobic trait, can cause hypertensive crisis, phenelzine sulphate and tranylcypromine sulfate- inhibitor type A and B, selegiline hydrochloride- inhibits B, Parkinson's, increased levels of amines, interact with food, OTC drugs (cough/cold), sympathomimetic, meperidine hydrochloride, SSRIs, toxicity- cardiovascular or neurological- tachycardia, circulatory collapse, seizures, coma, hyperthermia, miosis, hemodialysis

Short- Acting insulin

Regular insulin (Humulin R®, Novolin ge Toronto®) Routes of administration: intravenous (IV) bolus, IV infusion, intramuscular, subcutaneous Onset (subcutaneous route): 30 minutes Peak (subcutaneous route): 2 to 3 hours Duration (subcutaneous route): 6.5 hours

Muscle Relaxants

Relieve pain associated with skeletal muscle spasms, CNS is site of action, moa/de- excitation contraction coupling (decrease response to stimuli, amount of calcium from SR), depress CNS (brain stem, thalamus, basal ganglia, spinal cord), adverse effects- euphoria, lightheadedness, dizziness, drowsiness, fatigue, confusion, muscle weakness, toxicity- no specific antidote, gastric lavage, adequate airway

10 rights of medication administration

Right Medication Right Dose Right Time Right Route Right Patient Right Reason Right Documentation Right Evaluation Right Education Right to Refuse

Trycyclic Depressants

Second line to SSRIs, moa/de- correct imbalance in the concentration of serotonin, NE at nerve endings in the CNS, blocks presynaptic reuptake of neurotransmitter, indications- neuropathic pain, insomnia, adverse effects- anticholinergic effects- constipation, urinary retention, toxicity-lethal especially c alcohol, CNS, cardiovascular system (death from seizures or dysrhythmias), no specific antidote, interactions- anticholinergics, phenothiazines, MAOIs

Sliding- Scale Insulin Dosing

Subcutaneous rapid-acting (lispro or aspart) or short-acting (regular) insulins are adjusted according to blood glucose test results. Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings Subcutaneous insulin is ordered in an amount that increases as the blood glucose increases. Disadvantage: Delays insulin administration until hyperglycemia occurs, resulting in large swings in glucose control. Recent research does not support sliding-scale use; nonetheless, sliding scale is still commonly used. Feeding tubes not have tight glycemic control

Second Generation Antidepressants

Superior to TCA/ MAOIs, moa/de- inhibit serotonin reuptake, indications- depression, bipolar disorder, obesity, eating disorders, BCD, panic attacks/disorders, social anxiety disorder, PTSD, premenstrual dysphoric disorders, myoclonus, substance misuse, adverse effects, insomnia, weight gain, sexual dysfunction, serotonin syndrome, interactions- drugs that bind to proteins

Autonomic Nervous System

Sympathetic Nervous system (sns) "Fight or flight" (emergency, internal response to an event-stimulate), BP & blood flow to vital organs, bronchial dilation and respiratory rate, metabolic rate,breakdown of muscle, blood glucose, mental activity, muscle strength, clotting, pupil dilation and visual acuity sweating, Bladder relaxation (decrease in urination), increased clotting time Parasympathetic nervous system (pns) "rest and digest" (function, restoration, inhibitory), internal homeostasis- Achieved when the SNS and PNS cooperate, dilation of blood vessels in skin, decreased HR, bradycardia, increased secretion of digestive, enzymes, increased GI motility, bronchial constriction, increased glandular secretions, constricted pupils, bladder contraction, skeletal muscle contraction Homeostasis may be achieved by changing one or both branches of the ANS For Example: HR can by increased by stimulating the SNS or by inhibiting the PNS

Pharmacotherapeutics

The clinical use of drugs to prevent and treat disease, Involves: Setting realistic therapeutic goals in collaboration with the client Ongoing monitoring of the client's clinical response to drug therapy, including evaluating drug efficacy and identifying adverse effects and toxicity, types of therapy- acute, maintenance, supplmental, palliative, prophylactic-replacements, prevent infection from dentist, in acute care- pt unintended reactions, bc

Morphine

The opioid to which all others are compared, Metabolized by the liver, Excreted by the kidney, Routes: enteral (po, PR), parenteral, renal insufficiency- hydromorphine natural, rectal, injectable, pill, alter pain response, bind to CNS, SR-baseline, IR- going to physio, etc. (medicate appropriately), severe pain, high abuse potential, IM- rapid onset of action, 30-60 peak plasma concetration, 1.7-4.5 hr half life, duration 6-7 hr

Therapeutic Index

The range of drug concentration in which a drug is effective, Determines the safety of a drug, Drug concentrations may rise leading to toxicity in the presence of underlying patient disorders, The larger the therapeutic index, the SAFER the drug, Rarely associated with overdose, The narrower the therapeutic index, the greater risk of drug TOXICITY digoxin, warfarin, phenytoin Amount drug is effective- therapeutic effect- amount of drug is toxic

Pharmacodynamics

The study of how a drug affects its target(s)/ body, Drugs act by modifying the actions of cells/tissues, The drug's mechanism of action produces a therapeutic effect by one of three methods: Receptor interactions Enzyme interactions Non-selective interactions, risk-benefit analysis (surveillance/ monitoring)

Pharmacokinetics

The study of how drugs move into, through, and out of the body Phases: Absorption Distribution Metabolism Excretion

Half Life

The time required for 50% of the drug to be eliminated from the body, how quickly the drug moves, major determinant of: The duration of action of a single dose of medication, The time required to reach steady state, Dosing frequency

Drug Classifications

Therapeutic use- anti hypertensives Primary disease treated- anti-seizure, Chemical structure- B lactam antibiotics

Forms of Medications

Topcial- administered on the surface of the body, lotions, creams, ointments, gels, drops, patches Oral- pills, capsules (gel or microparticles), syrups, liquids, or suspensions, sustained release (SR), extended release (XL), delayed release (DR), scored- what is available in a single tablet can break- score, NEVER BREAK AN UNSCORED TABLET, pill cutter, crusher Sublingual and buccal medications- absorbed through the oral mucosa and are provided in rapid absorption forms such as liquid or small tablets, enteric coated- coating that protects it from GI system, buccal- under the tongue Suppositories- semi solid or gel like medications that can be administered into the rectum, stoma, or vagina Enternal medications- can be liquid- NG tube, gastric tube, or liquid enemas administered into the rectum Parenteral medications- bypass the skin and mucous membranes, administered outside of the GI tract, IM, SQ, IV Instillation, inhalation, intranasal, medicine cup- liquid meds, souffle cup- paper for pills, calibrated dropper, nipple, oral syringe, parenteral syringe

Gliclazide

Trade name: Diamicron® Second generation sulfonylureas Binds to specific receptors on ß- cells- need to be functioning, stimulate insulin release, Most effective for early stages of Type 2 diabetes, Not used for Type 1 diabetes management Second step drug- if metaformin is not effective, Not used with insulin, Antiplatelet & antioxidant properties Glucose from cells to liver, msucle, adipose tissue, Contraindications Known drug allergy, Type 1 diabetes Hypoglycemia, Conditions placing patients at risk for hypoglycemia- if they don't eat, alcohol use, increased age, Potential for cross-allergy in patients allergic to sulfonamide antibiotics, Adverse effects: hypoglycemia, weight gain, skin rash, nausea, epigastric fullness, and heartburn, not contraindicated in kidney failure, 30 mins before meal

Gate Control Theory

Transduction- stimuli into energy Transmission- spread along pain, sensory nerve fibers, A and C, spinothalamic tract Perception- subjective phenomenon of pain Modulation- neurons, endogenous, endorphins, stop gates NSAIDs- target prostaglandins, pain receptors= nociceptors, gates in dorsal horn, close A, open C, threshold, decreased sensitivity- more fibers

Alpha blockers: indications

Treatment of Hypertension- Act upon vascular smooth muscle to produce relaxation and vasodilation (relaxation of vasculature= spiking of BP in hospital Used alone or in combination with other antihypertensivesi.e. Cardura; prazocin (selective alpha1 blocker); i.e. clonidine (alpha2 agonist) - reduces sympathetic outflow in the CNS which prevents vasoconstriction, Treatment of Benign Prostatic Hyperplasia-Decreases resistance to urinary outflow by reducing smooth muscle contraction of the bladder neck i.e. tamsulosin; terazosin, Vascular diseases characterized by vasospasm- i.e. Raynaud's disease (cold, white hands), Frostbite, Reduces vasoconstriction, Antidote for extravasated- intravenous vasopressors i.e. phentolamine(around site, decrease vasodilation, and tissue necrosis), Restores blood flow and prevents tissue necrosis, Must be injected subcut into the affected tissue within 12 hours

Adrenergic drugs are also called sympathomimetic bronchodilators

True

Anticholinergics are administered for maintains therapy for COPD

True

The therapeutic classification of B-adrenergic and anticholinergic drugs is bronchodilators

True

status asthmaticus is treated as an emergency with adrenergic drugs

True

Treatment for Diabetes

Type 1- Insulin therapy Type 2- Lifestyle changes, Oral drug therapy, Insulin when the above no longer provide glycemic control HbA1c- < 7 %

Nonpharmacological treatment

Type 1: Always requires insulin therapy Type 2:Weight loss, Improved dietary habits, Smoking cessation, Reduced alcohol consumption, Regular physical exercise

Administering a Subcutaneous Injection

Under dermis, more slowly than IM, contraindicated c physical exercise/application of hot/cold, only administer small volumes, outer aspect of upper arms, abdomen (below umbilicus), anterior aspect of thighs, free of lesions, bones, muscles/nerves, if you grasp 5 cm 90 degrees, 2.5 cm 45 degrees, injection pen- prime first, do not inject in area with bruises, or infection, can apply ice prior, needle length- 1/2 of skin fold, do not move syringe, do no massage site

Medication Distribution Systems

Unit dose systems, decrease preparation time (meds are prepared in pharmacy and then dispensed c generic and trade name), placed in pt drawer, not all medications, can be computerized, computer-controlled dispensing systems- supplied daily from pharmacy, controlled substances, nurse needs security code and password/fingerprint scan, Pyxis med station, can store vials and premixed IVs, bar codes, bar code medication delivery systems- enhances pt safety, verifies right dose, med, route, time, pt wristband

Respiratory Tract

Upper- Nose, Pharynx, Larynx, Lower- Trachea, Bronchi, Bronchioles, to breathe, gas exchange, accessory- diaphragm, oral cavity, rib cage, muscle of the rib cage, speech, pH, sense of smell

Oral Antidiabetic drugs

Used for type 2 diabetes Effective treatment involves several elements: Lifestyle changes Careful monitoring of blood glucose levels Therapy with one or more drugs Treatment of associated comorbid conditions such as high cholesterol and high blood pressure, metformine, Diabetes is not existing in independence, other things are associated Biguanide- metformin (Glucophage®)- First-line drug and the most commonly used oral medication for the treatment of type 2 diabetes, Not used for type 1 diabetes- need insulin Economic status- don't blame ppl

Absorption

What body does to the drug- liver is the main drug for metabolism Bioavailability-The amount of drug that enters the circulation unchanged- not broken down and metabolized by the liver, Highly dependent upon route of administration: Enteral, parenteral and topical, Drug absorption is rapid in highly vascular spaces, IV medications are 100% bioavailable (dosage is lower) Subcutaneous drugs absorb slowly(insulin), First Pass Metabolism- Drugs absorbed by the GI tract are metabolized by liver enzymes, As a result, most of the active drug does not exit the liver- drug does not need to circulate to target, dose is higher

Nursing Care for Adrenergic Drugs

What is the therapeutic goal? Conduct a thorough patient assessment- Review prior medical history, current medication regimen, kidney and liver function, Complete physical assessment is required due to the systemic effects of most drugs, Assess client's knowledge and understanding of disease process and treatment plan, i.e. COPD, Identify relevant, priority nursing diagnoses and expected outcomes, Plan carefully prior to administration- place lines so tissue nephro doesn't happen Is data required to make an informed decision about administering the drug? Central venous access devices preferred for infusions of vasopressors Ensure that no drug interactions are present, Evaluate therapeutic benefits, presence of adverse effects, client adherence- cost, BP diameters, MAP, use lowest dose, in hospital, pt on new meds that they may not use at home Client Education: Must include non-pharmacological methods of managing the client's disease process, Take as prescribed, Directions on how to self-administer, Do not exceed recommended dosage (consult medical opinion), Don't double up when doses missed, Side effects- vertigo, insomnia, anxiety, tachycardia, Numerous drug interactions- cause bleeding, check before taking OTCs or herbal products, Report- CP, dizziness, irregular HR, difficulty breathing, productive cough, failure to respond, Diabetic Clients- monitor glucose levels frequently, met goals, BGM, nonpharmacolgical methods

Biochemical imbalance theory

abnormal endogenous chemicals in brain (neurotransmitters), NE, E, dopamine, histamine, GABA, drugs block/stimulate the release of these, substance use, stigma, treatment of mental health disorders-psychotherapies

Ipratropium bromide (Atrovent)

anticholinergic bronchodilator, inhalation- 5-15 min onset of action, 1-2 hr peak plasma concentration, 1.6 hr half life, 4-5 hr duration of action

Benzodiazepines/ miscellaneous hypnotic drugs

antihistamine diphenhydramine hydrochloride, trazone hydrochloride, and amitriptyline hydrochloride, moa/de- depress CNS (hypothalamic, thalamic, limbic systems of the brain, gamma-aminobutyruc acid (GABA) (let Cl- into cell, cell is negatively charged) receptors- inhibit stimulation, indications- insomnia, sedation, relief of agitation/anxiety, treatment of anxiety-related depression, sleep induction, skeletal muscle relaxation, acute seizure disorders, decreased memory of painful procedures, treatment/prevention of alcohol withdrawal symptoms, contraindications- drug allergy, narrow angle glaucoma, pregnancy, adverse effects- confusion, ataxia, amnesia, drowsiness, headache, paradoxical excitement/nervousness, dizziness/vertigo, lethargy, toxicity- somnolence, confusion, coma, diminished reflexes (hypotension and respiratory depression with alcohol and other CNS depressants), flumolzenil is antidote

Anxiety disorders medication

anxiolytic drugs- benzodiazepine, buspirone, selective serotonin reuptake inhibitors (SSRIs), trycyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), antipsychotics, propanolol, antihistamine hydroxyzine hyrdochloride, moa/de- decrease overreacting activity in the CNS, indications- withdrawal, insomnia/muscle spasms, seizure disorders, adjuncts in anesthesia/ depression, short term, quick treatment of anxiety, adverse effects- CNS depression, hypotension, hyperactivity/aggressive disorder, toxicity- excessive sedation, hypotension, seizures, cholinergic drugs may be used, generally not life-threatening, unless taken with alcohol/ CNS depression

Sedatives/ Hypnotics

calming effect, depress CNS, sedative- decrease nervousness, excitability and irritability w/o causing sleep, hypnotic- cause sleep, more potent

Anxiety

feeling on edge/restless, easily fatigued, muscle tension, difficulty sleeping, problems with concentration, agoraphobia, affective disorders- mania, depression-bipolar disorder, hypomania, psychosis, schizophrenia, depressive/ drug-induced psychosis- dopamine hypothesis-psychosis is caused by excessive amounts of dopaminergic activities in the brain, psychotropic drugs

Principles of Drug Administration: Parental Drugs, Ampules

gloves not recommended for injections if skin is intact, removing medications from ampules- take top off lightly and quickly until all fluid moves to the bottom portion, use a sterile filter needle if available (NOT for administration), place a small gauze pad/ dry alcohol swab around neck of ampule to protect hand, snap neck quickly and firmly away from body when drawing up- set open ampule on flat surface or hold ampule upside down- insert filter needle, gently pull back on plunger to draw up medication- needle tip below fluid, tap upside down syringe for air bubbles-slow push air out, excess fluid into sink, remove needle filter and replace with appropriate needle for admin, sterility, dispose in sharps

Considerations for Older Adults

high risk med consumers, physiological changes, slowed down body functions, decrease circulation, slower absorption, slower metabolism, decreased excretory functions, decrease ability to respond to stress, decreased body weight, mental status changes, polypharmacy, smaller med dosages, visual/hearing problems, omission of med

Humulin N

intermediate acting, sterile suspension of of zinc insulin crystals and protamine sulphate in buffered opaque (white), subcut- 1-3 hr onset of action, 4-10 hr peak plasma concentration, unknown half life, up to 18 hr duration of action

Barbiturates

low therapeutic index, many adverse effects, moa/de- act on brain stem (reticular formation), decrease nerve impulses travelling to cerebral cortex, indications- hypnotics, sedatives, anticonvulsants, anaesthesia, counterindications- drug allergy, pregnancy, significant respiratory difficulties, severe kidney/liver disease, adverse effects- drowsiness, lethargy, dizziness, hangover, paradoxical restlessness/exctiement, toxicity- sleep- coma-death, cheyne-stokes repirations, hypoventiliation, cyanosis, cold clammy skin, hypothermic, fever, areflexia, tachycardia, hypotension, maintain adequate airway, assisted ventilation, O2 admin, charcoal, phenobarbital-alkalization, diuresis, interactions- many drugs are metabolized quicker, addictive if c alcohol, antihistamines, benzodiazepines, opioids, tranquilizers

Golden Rules for drug dosages

metric abbreviations follow the amount, symbols are in lowercase lowers (except L), not pluralized, space between number and unit, fractional units expressed as decimals, no unnecessary 0s, always place 0 before decimal, write per instead of slash, Rounding- child/adult- pt weight (kg) to the nearest tenth prior to placing in formula, adults- carry division to the nearest hundredth throughout calculation then round answer to nearest tenth, pediatrics- doses less than 1 mL are rounded to the nearest hundredth, doses greater than 1 mL are rounded to the nearest tenth, conversions, desired dose over available dose (dose you have on hand) multiplied by quantity equals x, make sure answer makes sense

Insulin syringes

narrow, 0.5 mL- 1 mL, hundredths and tenths, very small amounts, peds, diagnostics, vaccines, can mix two types in one syringe (cautiously- some do not mix)- Insulin glargine (lantus)

Metformin

only biguanide oral antihypertensive drug, inhibits hepatic glucose production and increases the sensitivity of peripheral tissues to insulin, do not use with liver or kidney failure, PO, over 6 hr onset of action, 1-3 hr peak plasma concentration, 1.5- 5 hr half life, 24 hr duration of action

Factors that influence the absorption of oral medications

pH of the stomach- acidic, alkaline-vomitting, Tums Presence or absence of food- food protects the GI tract Medical Conditions: Malabsorption syndromes- celiac, chrons, increased GI transit time- food moves more quickly Poor perfusion to the GI tract Rate of GI motility Drug Forms Enteric coated (EC) Designed to protect the stomach from the drug or to prevent gastric acid and enzymes from destroying the drug, Aspirin, some forms of Tylenol Controlled Release (CR) Drug is coated with wax or water-insoluble substances, absorb slowly, anti-hypertensives drugs, does not need to take multiple doses in a day

3 checks for med administration

presrciber, pharmacy, nurse

Naloxone

pure opioid antagonist, no agonist morphinelike properties, blocks opioids, no analgesia, or respiratory depression, reversal of opioid- induced respiratory depression (overdose), injectable (IV)-< 2 min onset of rapid, rapid peak plasma concentration, 64 min elimination half life, duration of action is variable

Administering continuous subcut meds

rate of medication absorption, osmotic pressure, decrease risk of IV med administration, diabetes, teflon cannula, rotate sites, computerized pump c safety features, common sites are subclavicular and abdomen, clean site, pinch skin, 45-90 degrees, release skin and apply tape over "Wings" of needle, transparent dressing, attach tubing, inspect site, observe for allergies, removal

Gliclazide

second generation sulfonylurea, rapid onset, short duration, stimulates pancreas to release insulin, excess glucose goes from blood into the cells of the muscles, liver, and adipose tissue, antiplatelet and antioxidant properties, don't use with allergy or type 1 diabetes, 30 min before meals, PO, 1 hr onset of action, 6 hr peak plasma concentration, 16 hr half life, 4-6 hr duration of action

Humulin R

short acting, made from human insulin sources, subcut, 30 min onset, 2-3 hr peak plasma concentration, elimination half life 1.5 hr, duration of action 6.5 hr

Pharmacology

study of drugs and encompasses: Absorption Chemical action Metabolism Distribution Excretion Mechanism of action Physical and chemical properties Therapeutic effects Toxic effects

Physiology of sleep

transient, reversible, periodic state of rest, decrease in physical activities and consciousness, cyclic, repetitive, decrease response to stimuli, REM/NREM- different drugs affect different stages, REM interference (decrease cumulative amount of REM), REM rebound (large amounts of REM)- frequent/ vivid dreams, melatonin

Drugs Affecting the PNS

vagus nerve, vasovagal reaction- external stim, vagus nerve stim, decrease HR, decrease LOC, happens when vomiting, removing catheters, etc.