NURS3813 Exam I Review
primary long term goal for type I diabetics
maintaining normal blood sugar levels (normoglycemia) > decreases risk for complications such as neuropathy, retinopathy, and atherosclerosis
over secretion of adrenocortical hormones: Cushing's syndrome
moon face hump back hypertension hypokalemia abnormal glucose intolerance muscle atrophy
adrenal drugs: prednisone
most commonly used oral glucocorticoid for anti inflammatory or immunosuppressive purposes > also used to treat exacerbations of chronic respiratory illness > inadequate for the treatment of addison's disease
areas of slower distribution
muscle skin fat
oseltamivir: adverse effects
nausea and vomiting
acyclovir: adverse effects
nausea, vomiting, diarrhea
signs of hyperthyroidism
nervousness/anxiousness/irritability hyperactivity difficulty sleeping muscle weakness heat intolerance excessive sweating hunger fatigue palpations abnormal heart rate irregular menstruation weight loss diarrhea hair loss hand tremor
schedule I
no accepted medical use; high abuse potential example: heroin, LSD, ecstasy
antivirals: oseltamivir
non-HIV antiviral anti-flu must start within 2 days of onset of symptoms
antivirals: acyclovir
non-HIV antiviral well tolerated
adverse drug reaction
any reaction that is unexpected and undesirable and occurs a therapeutic dosages
antibiotics: macrolides > ______________________
azithromycin clarithromycin erythromycin
a child is prescribed insulin glargine before breakfast. which instruction is most appropriate for the nurse?
" offer the child a snack to prevent hypoglycemia during the night" > insulin glargine is a long acting insulin (24 hr duration) > bedtime snack will prevent hypoglycemia during the night; when hypoglycemia develops, the child will be asleep
antidiabetic medications: metformin > mechanism of action?
#1 choice for diabetes treatment > usually used when A1C reaches 6.5+ > increases tissue response to insulin; acts as an insulin sensitizer; decreases glucose production in the liver *** does NOT cause hypoglycemia***
when are peak levels drawn?
30-60 mins after the infusion is complete
antidiabetic medications: sodium glucose cotransporter (SGLT2) inhibitors > mechanism of action?
>decreases blood glucose by increasing renal glucose excretion (pee out sugar) *** usually contraindicated in normal circumstances, but here it is a good indication*** > prevents glucose reabsorption from the glomerular filtrate > may make insulin receptors more sensitive *** does NOT cause hypoglycemia***
what to watch for when using: Isoniazid (INH)
need to take vitamin B6 (pyridoxine) to prevent peripheral neuropathy
ADPIE: octreotide
Assessment: abd pain, carcinoid tumors, glucose, kidney function, esophageal varices (bleeding) Diagnosis: low fluid levels, carcinoid tumor/crisis, esophageal varices Planning: maintain fluid status and reduce bleeding in varices Implementation: maintain BG levels (esp. in diabetics), report any abd pain (problem with gallbladder), strict I&O, monitor weight, BP Evaluation: no varices (bleeding stopped), normal BP, fluid balance, decreased diarrhea
antidiabetic medications: metformin > discontinue with use of __________________ due to possible renal effects
contrast dye
signs and symptoms of sulfonamides
crystalluria photosensitivity N/V/D steven johnson syndrome agranulocytosis thrombocytopenia nephrotoxicity peripheral neuritis
drugs commonly involved in severe medication errors
CNS drugs anticoagulants chemotherapeutic drugs
antidiabetic medications: sodium glucose cotransporter (SGLT2) inhibitors > examples?
Canagliflozin Dapagliflozin Empagliflozin
factors that affect blood sugar
infections stress/trauma NPO nausea/vomiting lactating or pregnant diet exercise/activity levels
when are trough levels drawn?
just before the medication is administered, when the medication is at its lowest
primary organ responsible for elimination
kidney
primary organ responsible for metabolism
liver
schedule IV
low potential for abuse example: lorazepam, diazepam, midazolam, temazepam
exercise/physical activity _________________ blood sugar
lowers
Absorption: Parenteral Route
SQ, IM, IV, ID bypassess the GI tract IV is 100% bioavailable advantages: rapid onset, direct control over drugs disadvantages: high cost, difficult to give, irreversible
only drugs that are ___________________ to plasma proteins can freely distribute to extravascular tissue to reach their site of action and play a therapeutic role at receptors
NOT bound
____________ is the only insulin that can be administered IV
Regular Insulin
a client is taking thyroxine to manage hypothyroidism. which developments indicate to the nurse that the dosage should be reduced? select all that apply a. diaphoresis b. weight gain c. tachycardia d. nervousness e. cold intolerance
a. diaphoresis c. tachycardia d. nervousness looking for signs of HYPERthyroidism; too much thyroxine therapy for the management of hypothyroidism can lead to hyperthyroidism symptoms
tolerance
decreasing response to repeated drug use
treatment of oral thrush (caused by candida albicans)
nystatin (antifungal agent)
nursing implications: cephalosporins
> assess for penicillin allergy, may have cross allergy > give oral forms with food to decrease GI upset
acyclovir: nursing considerations
> assess the extent of the rash/outbreak > does the medication help with discomfort? >initiate prophylactic use for non-herpes
metronidazole: nursing considerations
> avoid alcohol > give with food for GI upset > interacts with and may cause toxicity. lithium and calcium channel blockers
tetracyclines: mechanism of action
> bacteriostatic > inhibits protein synthesis
Sulfonamides: mechanism of action
> bacteriostatic (does not kill) > prevents synthesis of folic acid > does not affect human cells > only affects organisms that synthesize their own folic acid
sulfonamides: adverse effects
> blood: hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia > integumentary: photosensitivity, exfoliative dermatitis, steven-johnson syndrome, epidermal necrolysis > GI: nausea, vomiting, diarrhea, pancreatitis > other: hepatotoxicity, convulsions, crystalluria, toxic nephrosis, peripheral neuritis *** important to encourage pt to drink lots of fluids to avoid crystalluria****
cephalosporins: 5th generation > ceftaroline (teflaro)
> broader spectrum antibacterial activity > very effective against a wide variety of organisms (e.g. MRSA)
cephalosporins: 4th generation > cefepime (maxipime)
> broader spectrum antibacterial activity than 3rd generation, esp against gram (+) bacteria > uncomplicated and complicated UTI
adrenal medulla: catecholamines
epinephrine and norepinephrine
Controlled Substances Act of 1970
established rules for the manufactures, distribution, and dispensing of drugs considered to have abuse potential restricted persons who have dispensing privileges classified controlled substances according to the use and abuse potential
most important factors to monitor when using steroids
fluid balance potassium (decreases) glucose (increases)
antibiotics: aminoglycosides > ______________
gentamycin tobramycin amikacin **** nephrotoxicity / ototoxicity ****
______________ determines dosing intervals
half life *** the shorter the half-life, the more frequently a drug is administered without loss of effect***
pharmaceutics
the study of how various dosage forms influence the way in which drugs affect the body
neonatal and pediatric considerations: excretion
> immature kidney affects GFR (decreased) and tubular secretion (decreased) > decreased perfusion rate of the kidneys may reduce excretion of drugs
factors that contribute to reduced renal medication excretion in infants
1. renal blood flow (perfusion is reduced) 2. decreased GFR 3. decreased tubular secretion
antidiabetic medications: alpha-glucosidase inhibitors > mechanism of action?
delays CHO absorption from the small intestines (reducing the rise of blood glucose after meals) *** does NOT cause hypoglycemia***
sulfonamides: nursing considerations
> 2-3 liters of water/day to avoid crystalluria > take with food > can cause hypoglycemia with oral antidiabetic agents
goal of antidiabetic treatment
> Hgb A1C less than 7 > fasting blood sugar glucose 70-100 mg/dL > estimated average glucose less than 154 mg/dL
quinolones: adverse effects
> QT interval prolongation, heart dysrhythmias > peripheral neuropathy
HIPAA
Health Insurance Portability and Accountability act (1996) requires all health related organizations/schools to maintain privacy of protected health information
anti-tubercle (RIPE)
Rifampin Isoniazid (INH) Pyrazinamide (PZA) Ethambutol
anti-tubercle: R.I.P.E
Rifampin Isoniazid (INH) Pyrazinamide (PZA) Ethambutol
Sulfonamides and contraception
Sulfonamides decrease the effectiveness of oral contraceptions
macrolides: adverse effects
diarrhea, nausea, vomiting, heartburn
TB assessment
TB symptoms TB test (quantiferon gold blood test) cough blood tinged sputum
bacterioSTATIC antibiotics
sulfonamides tetracyclines
which descriptions explain why medications behave differently in toddlers vs. adults? select all that apply a. gastric emptying is slowed in children b. meds are more likely to enter the brains of children c. gastric pH is more acidic in children d. first-pass elimination by the liver is increased e. GFR is slower in younger pts
a. gastric emptying is slowed in children b. meds are more likely to enter the brains of children e. GFR is slower in younger pts > gastric pH in children is less acidic due to immature acid-producing cells > gastric emptying is slowed due to slow/irregular peristalsis >BBB in children is immature > GFR is slower due to immature kidney > first pass elimination in the liver is reduced due to immaturity of the liver
schedule III
abuse may lead to moderate to low physical dependence or high psychological dependence. anabolic steroids and various compounds containing limited quantities of narcotic substances such as codeine are included example: tylenol + codeine; buprenorphine, ketamine, anabolic steroids
antidiabetic medications: alpha-glucosidase inhibitors > example?
acarbose
a sulfonamide preparation is being used to treat a UTI. what nursing responsibility is a priority when administering this medication?
administering the medication at the prescribed times > for the desired blood level to be maintained, the medication must be administered at the exact times directed; if the blood level of the medication falls, the microorganisms have the opportunity to build resistance to the medication
potential adverse effect of Ceftriaxone?
allergic reaction: > rash > urticaria > pruritus > angioedema
antibiotics: beta lactams > penicillins > ___________________
aminopenicillins - amoxicillin - ampicillin extended-spectrum penicillins - piperacillin - piperacillin / tazobactam penicillin natural combination - beta lactamase inhibitors - combination agents
insulin pumps
an attempt to mimic the way a healthy pancreas works glucose check is performed at least 4 times a day
antibiotics: metronidazole
antibacterial + antifungal
treatment of hypoglycemia: conscious/awake patient
ask to eat! > fast acting oral sugar (glucose tabs, orange juice, sugar cubes) > 15g CHO
Question: a patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain; the pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do? a. Crush the tablets and mix them with applesauce or pudding b. Call the pharmacy and ask for the liquid form of the medication c. Call the pharmacy and ask for the IV form of the medication d. Encourage the patient to try and swallow the tablets
b. Call the pharmacy and ask for the liquid form of the medication
propylthiouracil (PTU) and potassium iodide are prescribed for the pt with hyperthyroidism. which statement would the nurse include in the pt's care plan? a. admin on an empty stomach b. assess pt for signs of infection and bleeding every shift c. stop meds 2 weeks before thyroid surgery d. discontinue meds if heart rate is maintained within rage for next 48hrs
b. assess pt for signs of infection and bleeding every shift > PTU can cause depression of WBCs and platelets; creates an increased bleeding risk > PTU and potassium iodide should be given with milk, juice, or food to prevent gastric irritation
which complication is a priority of detecting when a pt is receiving and IV insulin infusion? a. hypovolemia b. hypokalemia c. hypernatremia d. hypercalcemia
b. hypokalemia > insulin causes K+ to move into cells, along with glucose, thereby reducing the serum K+ levels;
Question: during drug therapy for pneumonia, a female pt develops a vaginal superinfection, the nurse explains that this infection is caused by: a. the infection spreading from her lungs to a new site of infection b. large doses of antibiotics that kill normal flora c. an allergic reaction to antibiotics d. resistance of pneminia-casuing bacteria to drugs
b. large doses of antibiotics that kill normal flora normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and result in superinfections
Question: MRSA is typically associated with a. resistance to beta-lactam antibiotics b. skin infections c. failure to wash hands with soap and water d. UTIs
b. skin infections
Question: a patient presents with hypoglycemia. which of the following is consistent with this diagnosis? a. warm, dry skin b. weakness, headache c. polyphagia d. polydipsia
b. weakness, headache
Question: a diabetic patient receives daily NPH insulin 15 units SQ at 0730. at what time will the medication peak? a. 2230-2330 b. 1830-2030 c. 1330-1530 d. 0830-1030
c. 1330-1530 NPH peak time: 4-8 hours
Question: the nurse answer's a patient's call light and finds the patient sitting up in bed and requesting pain medication. what will the nurse do first? a. check the orders and give the pt the requested pain meds b. provide comfort measures to the pt c. assess the pt's pain and pain level d. evaluate the effectiveness of previous pain medications
c. assess the pt's pain and pain level always assess first before any interventions
a client receiving IV vancomycin reports ringing in both ears. which initial action would the nurse take? a. notify the HCP b. consult an audiologist c. stop the infusion d. doc finding and continue to monitor the client
c. stop the infusion > vancomycin: nephrotoxicity and ototoxicity ( can cause temporary/permanent hearing loss)
Question: when reviewing the medication orders for a pt who is taking penicillin, the nurse notes that the pt is also taking the oral anticoagulant warfarin (Coumadin). what possible side effect may occur as the result of an interaction between these two drugs? a. the warfarin will increase the effectiveness of the penicillin b. the warfarin will reduce the anti-infective action of the penicillin c. the penicillin will cause an enhanced anticoagulant on warfarin d. the penicillin will cause the anticoagulant effect of warfarin to decrease
c. the penicillin will cause an enhanced anticoagulant on warfarin administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur
HIV antivirals: zidovudine
can be used single/in combination
why do you avoid taking tetracyclines with milk and antacids before and after dosing?
can lead to decreased absorption of the medication
antibiotics: beta lactams > cephalosporins > ____________________
cefazolin (Ancef) cephalexin (Keflex) cefoxitin (Mefoxin) cefuroxime (zinacef) ceftazidime (Fortaz) cefdinir (Omnicef) ceftriaxone (Rocephin) cefepime (Maxipime) ceftaroline (Teflaro)
Question: The patient's medication administration record (MAR) lists two medications that are due at 0900, but the patient is NPO (nothing by mouth) for a procedure. The nurse's coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do? a. Give the medications PO with a small sip of water b. Give the medications via the IV route because the patient is NPO c. Hold the medications until after the test is completed d. Call the health care provider to clarify the instructions as needed
d. Call the health care provider to clarify the instructions as needed PO does not equal IV (have different absorption rates); always ask when you're unsure
Question: a glucocorticoid is prescribed for a patient. the nurse checks the patient's medical history knowing that glucocorticoid therapy is contraindicated in which disorder? a. central edema b. TB meningitis c. COPD d. PUD (peptic ulcer disease)
d. PUD (peptic ulcer disease) contraindications of glucocorticoids include: cataracts, drug allergy, glaucoma, PUD, mental health problems, and DM; other options are indications for glucocorticoids
Question: when selecting the ideal antibiotic for an infection, the nurse must ensure: a. medications are able to replace host defenses b. to administer the ordered medication within 30 mins of the order c. medications are given without regard to therapeutic levels d. cultures are taken before initiation of the drug
d. cultures are taken before initiation of the drug
Question: the nurse notes in a patient's medication history that the patient has been taking desmopressin (DDAVP). based on this finding, the nurse interprets that the patient has which disorder? a. adrenocortical insufficiency b. carcinoid tumor c. Diabetes Mellitus d. diabetes insipidus
d. diabetes insipidus desmopressin prevents and/or controls polydipsia, polyuria, and dehydration; symptoms are caused by deficiency in ADH diabetes insipidus: can't regulate fluids; increase in thirst and urination
which outcome would the nurse expect to find when caring for a child receiving adrenocorticosteroid therapy? a. accelerated wound healing b. development of hyperkalemia c. increased antibody response d. suppressed inflammatory system
d. suppressed inflammatory system > steroid decrease the inflammatory system (have anti-inflammatory properties) >would see decreased wound healing > steroids cause hypokalemia due to the retention of sodium and fluid > would see decrease antibody production
older adults; advancing age contributes to _____________________
decline in organ function (drug therapy is more likely to result in adverse effects and toxicity)
under secretion of adrenocortical hormones: Addison's disease
decreased blood sodium and glucose levels increased potassium levels dehydration weight loss
areas of rapid distribution
heart liver kidneys brain
adrenal drugs: methylprednisolone
most commonly used injectable glucocorticoid drug; primarily used for antiinflammatory and immunosuppression
carbapenems: cross allergy
penicillin (only anaphylactic reactions should avoid carbapenems)
antidiabetic medications: metformin > encourage increase in _______________ and ____________ in the diet
vitamin B12 and folic acid
aminoglycosides: interactions
warfarin and furosemide
antivirals: HIV antivirals >
zidovudine
antibiotics: beta lactams > carbapenems > _______________
imipenem/cilastatin (Primaxin)
steroid increase ______________ and decrease ___________________
increase blood glucose and decrease immune response
macrolides: mechanism of action
inhibits protein synthesis by binding to 50S ribosomes
treatment of type I diabetes
insulin ONLY; don't use oral medications (since very little or no insulin is produced)
penicillins: mechanism of action
> enter the bacteria via the cell wall and disrupt cell wall synthesis > result: bacteria die from cell lysis
anterior pituitary: octreotide > uses?
> esophageal varices (bleeding) > carcinoid tumors (diarrhea, HTN, flushing)
schedule II
example: hydromorphone, methadone, oxycodone, fentanyl, morphine, codeine, hydrocodone
drugs are first distributed to areas with _______________________
extensive blood supply
signs of hypothyroidism
fatigue/lethargic cold intolerance delayed puberty/growth hair loss brittle nails constipation enlarged thyroid slow heart rate weight gain
peak level v. trough level
highest blood level; lowest blood level
thyroid gland > control over: > secretes: > function:
> control over: metabolism and thermoregulation > secretes: T3, T4, and calcitonin > function: - regulates metabolism - growth and development - thermoregulation
posterior pituitary: ADH > deficiency causes? > symptoms?
> deficiency causes: diabetes insipidus (unable to regulate fluids) > symptoms: polyuria and polydipsia
metronidazole: adverse effects
> dizziness, headache, neutropenia, thrombocytopenia
neonatal and pediatric considerations: metabolism
> does not produce enough microsomal enzymes due to immature liver > older children may have increased metabolism (requiring higher doses than infants)
Antibiotic Classes
1. sulfonamides 2. penicillins (beta-lactam) 3. cephalosporins (beta-lactam) 4. macrolides 5. quinolones 6. aminoglycosides 7. tetracyclines 8. miscellaneous (vancomycin + metronidazole)
vancomycin: peak and trough > when is trough drawn? > what to monitor levels for?
> draw trough immediately before the next dose > monitor levels for nephrotoxicity and ototoxicity
geriatric considerations: excretion
> GFR is decreased by 40-50% due to decreased blood flow > drugs are cleared less effectively due to decreased excretion *** accumulation of drugs secondary to decreased renal excretion is the most important cause of adverse drug reactions in older adults*** *** look a serum creatinine clearance and NOT serum creatinine levels***
cephalosporins: 3rd generation > ceftazidime (fortaz, ceptaz) > cefdinir (omnicef) > ceftriaxone (rocephin)
> MOST POTENT group against gram (-) bacteria > less active against gram (+) bacteria > used to treat difficult organisms (e.g. pseudomonas spp.)
penicillins: interactions
> NSAIDs: can prolong bleeding time > oral contraceptives: can decrease effectiveness of contraceptives > warfarin + penicillin: leads to prolonged bleeding time since penicillin decreases vitamin K (need to monitor INR if using together)
antidiabetic medications: metformin > side effects?
> SE: N/V/D; decreased appetite, decreased absorption of vit B12 and folic acid
posterior pituitary: ADH > mechanism of action?
> acts on the kidneys to cause resorption of water; helps retain fluid > stimulates contraction of vascular smooth muscle
antidiabetic medications: metformin > contraindications?
> acute CHF, alcohol use, liver/kidney disease
penicillins: adverse effects
> allergic reactions (e.g. urticaria, pruritus, angioedema) > pt's who are truly allergic to penicillin have an increased risk for allergy to other beta-lactams (e.g. cephalosporins) *** only pt's with a history of throat swelling or hives from penicillin should not receive cephalosporins***
quinolones: mechanism of action
> alters cell DNA so it can't duplicate > bactericidal
things to include in the medication profile
> any and all drug use (not just prescribed meds) > prescriptions > OTC meds > vitamins, herbs, and supplements > compliance and adherence
carbapenems : mechanism of action
> broadest antibacterial action of any antibiotic > bactericidal (kills) > inhibits cell wall synthesis; breaks down cell wall
adrenal drugs: adverse effects > cardiovascular: > CNS: > endocrine: > gastrointestinal: > integumentary: > musculoskeletal:
> cardiovascular: - HF, edema (due to fluid retention) and HTN > CNS: - insomnia - mood swings > endocrine: - growth suppression - cushing's syndrome - hyperglycemia (due to glucose intolerance) > gastrointestinal: - peptic ulcers - pancreatitis - ulcerative esophagitis > integumentary: - poor wound healing - fragile skin - petechiae > musculoskeletal: - muscle weakness/atrophy - osteoporosis (seen in long term use)
tetracyclines: indications
> chlamydia > gram (+)/(-) bacteria > mycoplasma pneumonia > acne > H. pylori infections
adrenocorticosteroid indications: > collagen diseases: > dermatologic disease: > gastrointestinal diseases: > exacerbations of chronic respiratory illness > organ transplantation: > leukemias and lymphomas > spinal injury > TB meningitis > cerebral edema
> collagen diseases: - systemic lupus erythematous > dermatologic disease: - exfoliative dermatitis - pemphigus > gastrointestinal diseases: - ulcerative colitis - regional enteritis > exacerbations of chronic respiratory illness - asthma - COPD > organ transplantation: - decreases immune response to prevent organ rejection > leukemias and lymphomas: - palliative treatment > spinal injury > TB meningitis > cerebral edema
Insulin Lispro (short duration, rapid acting) > color: > onset: > peak: > duration:
> color: clear > onset: 15mins (MUST give with food/have food near by) > peak: 1-2hrs (watch for hypoglycemia) > duration: 3-5hr
Regular Insulin (short duration, slower acting) > color: > onset: > peak: > duration:
> color: clear > onset: 30-60mins > peak: 2.5hrs > duration: 6-10hrs
Insulin Glargine & Insulin Detemir (long duration) > color: > onset: > peak: > duration:
> color: clear > onset: 60-120mins > peak: NONE (don't need t give with food) > duration: 24hrs
NPH Insulin (intermediate) > color: > onset: > peak: > duration:
> color: cloudy > onset: 60-120mins > peak: 4-8hrs > duration: 10-18hrs
medication administration considerations for the older adult
> commonly take multiple medications on the daily basis due to more frequent occurrence of chronic disease/ multiple drug options > existence of polypharmacy > self-medication practices (alternative medicines, herbals, supplements) > visual acuity and manual dexterity = more prone to self medication errors > general rule: start with lowest possible dose and increase the dose slowly, based on patient response
health care associated infections
> contracted within a health care environment (e.g. hospital, long term care facility, etc.) > result from treatment (e.g. surgery, medications) > may or may not be caused by a medication-resistant microorganism
mineralocorticoids > example? > uses? > mechanism of action?
> example: aldosterone (promotes sodium reabsorption, secretion of K+ and hydrogen, increases water absorption) > uses: treat adrenocortical insufficiency (addison's disease) > mechanism of action: inhibits inflammatory and immune responses
antibiotic class: quinolones > examples: > treats gram ___________ > black box warning:
> examples: ciprofloxacin and levofloxacin - ciprofloxacin: very bioavailable - levofloxacin: only have to take once daily > treats both gram (-) and (+) - treats complicated UTI, respiratory, skin, GI and joint infections > black box warning: ruptured tendons, tendonitis
antibiotic class: aminoglycosides > examples: > treats gram _______ > what to monitor
> examples: gentamycin, tobramycin, and amikacin > treats both gram (-) and (+), but never used to treat gram (+) alone > monitor serum levels to avoid nephrotoxicity and ototoxicity ***nephrotoxicity: watch BUN and creatinine levels*** *** ototoxicity: watch for nausea/dizziness with motion***
antidiabetic medications: alpha-glucosidase inhibitors > side effects?
> flatulence, cramps, abdominal pain, distention > borborygmus > diarrhea *** due to bacterial fermentation of unabsorbed CHO***
antidiabetic medications: thiazolidinediones > side effects?
> fluid retention (weight gain; can lead to CHF) > increased LDL/HDL; decreased triglycerides
neonatal and pediatric considerations: absorption
> gastric pH is less acidic due to immature acid-producing cells (mature 1-2yo) > gastric emptying: slow > IM absorption is faster and irregular
adrenal cortex: corticosteroids
> glucocorticoids (cortisol) > mineralocorticoids (mainly aldosterone)
cephalosporins: 2nd generation > cefoxitin (mefoxin) > cefuroxime (zinacef and ceftin)
> good gram (+) coverage > better gram (-) coverage than 1st gen > cefoxitin (mefoxin): used prophylactically for abd or colorectal surgeries; kills anaerobes > cefuroxime (zinacef and ceftin): surgical prophylaxis; does NOT kill anaerobes
cephalosporins: 1st generation > cefazolin (ancef and Kefzol) > cephalexin (Keflex)
> good gram (+) coverage > poor gram (-) coverage > PO and parenteral forms > used for surgical prophylaxis and for susceptible staphylococcal infections
Sulfonamides: indications
> gram +/- bacteria that cause UTIs enterobacter E.coli Klebsiella Proteus vulgaris S. aureus > upper respiratory tract infections > pneumocystis jiroveci pneumonia (PJP)
neonatal and pediatric considerations: distribution
> greater total body water/ lower fat content > decreased level of protein binding (due to immature liver) > immature BBB (allows more drugs to enter the brain)
macrolides: interactions
> highly protein bound > metabolized in the liver > warfarin/carbamazepine: toxicity
geriatric considerations: distribution
> increased body fat% (storage depot for lipid soluble drugs, decreasing plasma levels of drugs) > decreased lean body mass (water soluble drugs distributed in smaller volume, resulting in increasing concentration) > decreased total body water (leads to increased concentration of water soluble drugs) > reduced concentration of serum albumin (due to aging liver and reduced protein intake - allows rise of free drug levels)
antidiabetic medications: thiazolidinediones > mechanism of action?
> increases insulin sensitivity of adipose tissue, skeletal muscle, liver (decreases insulin resistance at the receptor sites) > inhibits glucose and triglyceride production in the liver *** does NOT cause hypoglycemia*** *** can also be used to treat HIGH CHOLESTEROL since it affects triglyceride production***
metronidazole: mechanism of action
> interferes with microbial DNA
metronidazole: what does it treat?
> intrabdominal and gynecologic infections (deep tissue infections) > some types of vaginal infections
drugs to take without food
> levothyroxine (due to drug-to-drug interactions) - phenytoin and antacids decrease the effectiveness - levothyroxine can increase anticoagulant effects - levothyroxine can decrease the effect of antidiabetic meds > tetracyclines (take on an empty stomach) > quinolones > macrolides > penicillins (take with a glass of water)
Insulin
> lowers blood glucose > monitor for hypoglycemia during peaks > Insulin Lispro (short duration) > Regular Insulin (short duration) > NPH Insulin (intermediate) > Insulin Glargine and Detemir (long duration)
anterior pituitary: octreotide > nursing implications?
> may impair gallbladder function (tell pt to report abdominal pain) > use with caution in pt with renal impairment > may cause hyperglycemia (monitor BG in diabetic pts)
zidovudine: nursing considerations
> may need to switch if BMD occurs > monitor HIV labs: CD4 less than 200 (start treating prophylactically for opportunistic infection) > low CD4 count could indicate progression to AIDS
drugs to take with food/ can be taken with food
> metformin (decreases GI upset) > sulfonylureas (decreases GI upset) > alpha glucosidase inhibitors (taken with first bite of each meal) > adrenal drugs (decreases GI upset) > sulfonamides > cephalosporins (decreases GI upset) > quinolines > metronidazole
basal bolus insulin dosing > basal insulin: > bolus insulin:
> mimics a healthy pancreas by delivering basal insulin constantly as a basal then as needed as a bolus > basal insulin: long-acting insulin (eg. insulin glargine) > bolus insulin: short-acting insulin (eg. insulin lispro)
synthetic ADH: desmopressin > nursing implications?
> monitor I&O > EKG and electrolytes (excess K+ can cause cardiac arrhythmias) > assess for CP, MI, HTN, SOB
adrenal drugs: drug interactions: > non-potassium sparring diuretics > aspirin, other NSAIDs, and other ulcerogenic drugs
> non-potassium sparring diuretics - example: thiazides and loop diuretics - can lead to severe hypokalemia - steroids decrease K+ levels, don't want to further decrease them by using non-potassium sparring diuretics > aspirin, other NSAIDs, and other ulcerogenic drugs - produce additive GI effects and increased chance of gastric ulcer development - steroids can cause ulcers, don't want to increase risks by using other meds that also cause ulcers
considerations for older adults
> older adults: 65+ yo > high use of medications/polypharmacy > noncompliance/nonadherence > increased incidence of chronic illness > sensory and motor deficits
Mixing Insulin > only ________ can be administered with_____________ insulin > draw up _________ first, then ___________
> only NPH insulin can be administered with short acting insulin (e.g Regular Insulin) > draw up short acting insulin first, then NPH *** want clear days before cloudy days***
geriatric considerations: absorption
> percentage of oral dose absorbed does not change > rate of absorption may slow due to reduced GI blood flow > gastric acidity is reduced (due to decreased production of HCL) and may alter absorption of drugs > movement through GI tract is slowed due to decreased muscle tone/activity > absorptive surface of GI tract is reduced
adrenal drugs: nursing implications
> perform a baseline assessment of weight, immune status, blood pressure > record I&O > assess for edema > contraindications (e.g PUD) > alteration of blood glucose (increases), and electrolyte levels (K+ decreases) > oral forms should be given with food to minimize GI upset > rinse mouth after using an inhaled corticosteroid to prevent possible oral fungal infections > avoid infected persons, aspirin, other NSAIDs, other ulcerogenic agents > take in the AM to avoid insomnia > do NOT suddenly discontinue, slower taper doses
tetracyclines: adverse effects
> permanent teeth discoloration > do not take during pregnancy > photosensitivity > diarrhea > vaginal yeast infections
synthetic ADH: vasopressin
> potent vasoconstrictor > used in hypotensive emergencies (e.g. septic shock) > helps elevate blood pressure
Classifications of children according to age: > premature infants: > full term infants: > neonates: > infants: > children: > adolescents:
> premature infants: < 36 weeks gestational age > full term infants: 36 to 40 weeks gestation > neonates: first 4 postnatal weeks > infants: 5 to 52 weeks postnatal > children: 1-12 yo > adolescents: 12-16 yo
aminoglycosides: mechanism of action
> prevent protein synthesis by binding to ribosomes > bactericidal (kill)
geriatric considerations: metabolism
> rates of hepatic metabolism decrease with age - reduced hepatic blood flow, reduced liver mass - decreased levels of microsomal enzymes - drug half lives may increase
vancomycin: adverse effects
> red man syndrome (occurs due to too rapid infusion- treatment: slow down infusion rate)
propylthiouracil (PTU) prescribed to treat hyperthyroidism - after 2mo the pt calls and complains of feeling tired and looking pale. what action should the nurse take?
> schedule the pt for an appointment > PTU can cause bone marrow toxicity, leading to low WBC and anemia
glucocorticoid contraindications > serious infections such as_____________ > use with caution in patients with____________________
> serious infections such as septicemia, systemic fungal infections, and varicella (steroids lower the immune response) > use with caution in patients with: - gastritis, reflux disease, ulcer disease (steroids can cause ulcers) - diabetes (steroids increase BG) - cardiac/renal/liver dysfunction
macrolides: indication
> sexually transmitted diseases (e.g. syphilis) > upper respiratory tract infections
cephalosporins: adverse effects
> similar to penicillins (mild diarrhea, abdominal cramps, rash, redness, edema) > potential cross sensitivity with penicillins if allergies exist
acyclovir: mechanism of action
> suppresses HSV-1 and HSV-2
treatment of hypothyroidism: levothyroxine
> synthetic preparation of T4 > used to replace lacking thyroid hormone > montor T3, T4, and TSH *** take on an empty stomach due to drug-to-drug interactions *** > phenytoin and antacids decrease effects of levothyroxine > levothyroxine may increase activity of anticoagulants > levothyroxine may decrease effects of antidiabetic meds > action: increase basal metabolic rates/ stimulates protein synthesis
nursing implications: penicillins
> take oral doses with water ( NOT juices) > monitor for allergic reaction for at least 30 minutes after administration
nursing implications: sulfonamides
> take with 2-3 liters of fluid every 24 hours to avoid crystalluria > assess RBC before beginning therapy > take oral doses with food
treatment of hyperthyroidism: methimazole and propylthiouracil (antithyroid drugs)
> treats hyperthyroidism and prevents surge that usually occurs: after surgical treatment/during radioactive iodine treatment > may cause liver and bone marrow toxicity (monitor for low WBC) manifested as fever, sore throat, lesions
synthetic ADH: desmopressin > uses?
> used in the management of nocturnal enuresis (bed wetting) > used in post-op pituitary removal
vancomycin: indications
> used to MRSA, C.diff > treat serious IV infections, gram (+) bacteria
penicillins: contraindications
> usually safe and well tolerated > not all penicillins end with "-cillin" (e.g. Augmentin, Zosyn, Unasyn...)
antidiabetic medications: sulfonylureas > watch for s/s of?
> watch for s/s of hypoglycemia: fatigue hunger cool/moist skin anxiety dizziness palpations *** treat with 15g of CHO***
antivirals: non-hiv antivirals > _____________________
Acyclovir Oseltamivir
ADPIE: Insulin
Assess: blood glucose and potassium levels Diagnosis: hyperglycemia, diabetes mellitus, hyperkalemia Planning: maintain blood glucose levels/ maintain potassium levels Interventions: given insulin WITH food to avoid severe hypoglycemia; assess for hypoglycemia during peaks; teach patient s/s of hyper and hypoglycemia; encourage lifestyle changes Evaluation: A1C less than7; lowered blood glucose levels; normal potassium levels
assessment findings during adverse allergic reaction to IV penicillin
hives itching skin rash SOB
corticosteroids have a ________glycemic effect
hyperglycemic effect (raise blood sugar)
antidiabetic medications: sulfonylureas > examples?
Glipizide and Glyburide
antidiabetic medications: sulfonylureas > side effects?
hypoglycemia weight gain skin rash nausea epigastric fullness heartburn
which issue related to antibiotic use is an increased risk for the older adult? a. allergy b. toxicity c. resistance d. superinfection
b. toxicity the older adult is at increased risk for toxicity related to antibiotic use due to reduced metabolism and excretion of medications
delayed absorption in newborns is partly due to low _________________ through the muscle during the first days of postnatal life
blood flow
zidovudine: adverse effects
bone marrow depression (BMD)
antibiotics: Beta Lactams > ______________
cephalosporins monobactams carbapenems penicillins
initial action to take when checking up on a type II diabetic patient
check blood glucose level for hypoglycemia
antibiotics: quinolones > _________________
ciprofloxacin levofloxacin
antibiotics: beta lactams > penicillins > combination > beta lactamase inhibitors > ________________________
clavulanic acid (clavulanate) tazobactam
carbapenems: indications
complicated infections in acute hospitalized patients
IV vancomycin is scheduled to be infused over 30 mins. ten minutes after the start of infusion, the pt appears flushed and complains of palpations. what action should the nurse take?
contact the HCP and obtain a prescription to decrease infusion rate > pt is experiencing Red Man's Syndrome (not an allergic rxn) due to too rapid infusion; need to slow down infusion rate to treat syndrome
drugs cross the placenta by __________________
diffusion
antibiotics: tetracyclines > ___________________
doxycycline tigecycline minocycline
Isoniazid (INH) and alcohol
drinking alcohol daily while taking INH can cause medication-induced hepatitis
adverse effects of cortisone therapy
edema (due to fluid retention) hypertension behavioral changes/ mood swings insomnia hyperglycemia nervousness growth suppression cushing's syndrome peptic ulcers ulcerative esophagitis fragile skin petechiae poor wound healing muscle weakness/atrophy osteoporosis
Question: what are the risk factors for osteoporosis?
european/asian descent slender body build early estrogen deficiency smoking alcohol consumption
schedule V
example: Robitussin + codeine; Phenergan + codeine
nonadherence vs. noncompliance
nonadherence: accidental failure to take medications (e.g. i left my pills in the bedroom and forgot to take them with my breakfast) noncompliance: deliberate failure to take medications (e.g. skipping because you don't like the taste, saw the side effects on tv, can't afford to pay for them)
what to watch for when using: Ethambutol
optic neuritis (ask pt if they have any vision problems or changes in vision, blurred vision, etc.)
factors underlying altered responses to medications in the geriatric population
organ system degeneration multiple and severe illness multidrug therapy poor adherence
what to watch for when using: Pyrazinamide (PZA)
overt gout hepatotoxicity joint pain (arthralgia)
bacteriCIDAL antibiotics
penicillins cephalosporins carbapenems aminoglycosides quinolones
dependence
physiologic or psychological need for a drug
antidiabetic medications: thiazolidinediones > example?
pioglitazone
____________ levels lower with insulin use
potassium (K+)
examples of adrenal drugs: glucocorticoids ("-one" indicates steroid)
prednisone methylprednisolone betamethasone cortisone dexamethasone hydrocortisone prednisolone triamcinolone
a child is given 15 mg of prednisone twice daily after a severe asthma attack. what intervention is a priority for the nurse?
preventing exposure of the child to infection > prednisone is a steroid > steroids decrease the immune response
penicillins: indications
prevention and treatment from infections caused by susceptible bacteria such as: - gram (+) bacteria - streptococcus - enterococcus - staphylococcus
why is insulin prescribed for patients in renal failure?
promotes transfer of K+ into cells and lowered serum K+ levels in the blood too much K+ can lead to cardiac arrest
what to watch for when using: Rifampin
red/orange/brown urine and body fluids
six rights of medication administration
right patient right drug right route right dose right time right documentation
factors that affect pediatric drug doses
skin is thin/permeable stomach lacks acid to kill bacteria lungs have weak mucus barriers body temperature is less well regulated dehydration occurs easily liver and kidneys are immature (impairs drug metabolism)
why do we taper off steroid drugs instead of abrupt discontinuation?
slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed the body's natural corticosteroid production has been suppressed during treatment; avoiding abrupt cessation of the medication will give the body time to adjust to less and less of the exogenous source and resume secretion of the endogenous corticosteroid
treatment of hypoglycemia: unconscious (sleep) or non-intact gag
stab! > IV glucose > glucagon > stab with IV D50 (dextrose)
antidiabetic medications: sulfonylureas > mechanism of action?
stimulates the pancreas to release insulin AND increases tissue response to insulin *** CAN cause hypoglycemia***
antibiotics: sulfonamides > ________________
sulfamethoxazole + trimethoprim (Bactrim) SMX-TMP
why would an adolescent pt be prescribed an adult dose of acetaminophen?
the prescription can be metabolized at the adult dose adolescents have high metabolism capacity; declines at puberty
pharmacokinetics
the study of what the body does to the drug; study of what happens to a drug from the time it is put into the body until the parent drug and all its metabolites have left the body
pharmacodynamics
the study of what the drug does to the body; the mechanism of drug actions on living tissue
onset of action
the time required for the drug to elicit a therapeutic response
Absorption: Enteral Route
thought the intestinal/GI tract; drug is absorbed into the systemic circulation through the oral or gastric mucosa or small intestine drug absorbed through the intestine must first pass through the liver before it reaches systemic circulation advantages: convenient, safe, reversible, inexpensive, preferred route of administration disadvantages: variability in patient role, GI irritability food causes decreased rate of absorption (delays onset of effects) avoid grape juice
Antibiotics: Vancomycin
treats MRSA and antibiotic induced C.diff *** nephrotoxicity/ototoxicity***
antibiotics: beta lactams > penicillins > combination > combination agents > _________________
unasyn (ampicillin + sulbactam) augmentin (amoxicillin + clavulanic acid) zosyn ( piperacillin + tazobactam)
idiosyncratic effect
uncommon response resulting from genetic predisposition
Absorption: Sublingual Route
under the tongue; highly vascular area
