Kaplan Pharmacological Parenteral Therapy A Answers

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Eye Medication Administration
Client supine with head turned to affected side 2. Place drops in the conjunctival sac 3. Put gentle pressure on the inner canthus, take contact lenses out first, wash hands first, do not touch tip to anything, put eye drops in infected eye last. i. Assist client into supine position ii. Need clean gloves, sterile cotton balls soaked in sterile normal saline, and med iii. Don clean gloves and use sterile cotton balls to clean by wiping from the inner canthus to the outer canthus iv. Have client look up to ceiling b. Eye Drops i. Expose lower conjunctival sac ii. Approach eye from side iii. Hold dropper 1-2 cm above conjunctival sac iv. Instill drops into lower third of lower conjunctival sac ensuring that dropper does not touch cornea v. Have client close eye vi. Apply gentle pressure to nasolacrimal duct for 30 seconds if medication causes systemic effects c. Eye Ointment i. Apply ointment along inner edge of lower eyelid from inner canthus to outer canthus ii. Unless contraindicated, rub closed eye lid in circular motion with cotton
a. Sympathomimetic b. Short-acting beta2 agonist c. Stimulate beta2 receptors in bronchioles and relieves bronchospasms, increases ciliary activity, and blocks histamine release d. Most useful when about to enter environment or begin activity likely to induce asthma attack e. SE i. Tachycardia ii. Angina iii. Headache iv. Hyperactivity v. Tremors f. NC i. Monitoring for increased glucose after administration ii. Monitoring HR iii. Monitoring for presence of chest pain and tremors g. CE i. Instruction of inhaler use ii. Use as first inhaler if corticosteroid inhaler is used iii. Rinse after use iv. Do not exceed the prescribed dose
Aluminum Hydroxide
antacid. Constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy, seizures a. Antacid that neutralizes gastric acids, raises gastric pH, inactivates pepsin b. SE i. Constipation that may lead to impaction, phosphate depletion, acid rebound between doses, metabolic acidosis c. NC i. Monitor bowel patterns ii. Encourage fluids iii. Monitor for signs of phosphorus deficiency 1. Malaise 2. Weakness 3. Tremors 4. Bone pain iv. Assess whether client is on sodium-restricted diet 1. Medication contains sodium v. Advise client to take between meals and at bedtime
Penicillin: wider−spectrum than pen G, susceptible to penicillinases unless used with sulbactam. Activity similar to pen G, plus E coli, H influenzae, P mirabilis, Shigella. Synergy with aminoglycosides versus enterococci and listeria. Tox: penicillin allergy; more adverse effects on GI tract than other penicillins; maculopapular skin rash
Angiotensin Converting Enzyme (ACE) Inhibitors
prevent conversion of angiotensin I to angiotensin II 2. Examples of drugs a. Captopril (Capoten) b. Enalapril, enalaprilat (Vasotec) c. Benazepril (Lotensin) d. Fosinopril (Monopril) e. Lisinopril (Prinivil, Zestril) f. Ramipril (Altace) Side effects / nursing care 1. Orthostatic hypotension and dizziness. a. Blood pressures should be taken both supine and upright b. Teach clients to change positions slowly. c. Teach patients to avoid very hot baths and showers. d. Avoid alcohol. 2. Drowsiness- beta blockers particularly 3. Rebound hypertension when discontinued abruptly
Beta1−selective blocker: low lipid solubility, less CNS effect; used for HTN. (Note mnemonic for beta1−selective blockers: their names start with A through M. [Exceptions: carteolol & labetalol are not selective]) a. Beta blocker that selectively blocks beta1 adrenergic receptors b. Decreases CO and contractility and thereby cardiac oxygen consumption c. Decreases renin secretion d. Uses i. HTN ii. Angina iii. AMI iv. Migraine prophylaxis e. SE i. Bradycardia ii. HF iii. Bronchospasm iv. Dizziness v. Fatigue vi. Dyspnea f. NC i. Checking the apical pulse before administration and holding drug is <60 ii. Monitoring BP iii. Drug may mask signs and symptoms of hypoglycemia in pts with DM g. CE i. Change positions slowly
Closely follow prescribed diet, Avoid overexposure to sun, Don’t take when pregnant, Limit alcohol consumption, If dose missed take as soon as possible, report muscle pain. Liver function tests and eye exams.
muscle relaxant. Drowsiness. Avoid alcohol a. Antispasmodic and muscle relaxant b. Decreases hyperactive reflexes, muscle spasms, resistance to movement c. SE i. Oral preparation 1. Drowsiness 2. Fatigue 3. Weakness 4. Constipation 5. Urinary Retention ii. Intrathecal 1. Coma 2. Seizures d. NC i. Safety measures ii. Monitoring response iii. Monitoring for respiratory depression, constipation and urinary retention iv. Taper dose before discontinuation v. Overdose requires supportive care e. CE i. Info about drowsiness and fatigue, urinary retention and constipation ii. Avoid hazardous activities iii. Do not discontinue medication suddenly iv. Avoid ETOH and other CNS < v. Medication will decrease seizure threshold
Centrally acting antimuscarinic prototype for parkinsonism 22 y/o female confused, disoriented, dry mouth, dilated unresponsive pupils. Likely ingested: a. Anticholinergic b. Antiparkinsonian agent c. SE i. Drowsiness ii. Blurred vision iii. Nausea iv. Constipation v. Urinary retention vi. Dry mouth vii. Agitation d. NC i. Monitor I&O, muscle weakness or inability to move certain muscle groups ii. Monitor for central nervous system depression or stimulation iii. Sugarless gum or lozenges for dry mouth
Biphosphonates should be taken with an empty stomach and full glass of water. Patient should stay upright for 30 minutes after taking pill a. Inhibits bone resorption and osteoclast activity b. Use for TX of osteoporosis, Paget’s disease, hypercalemia due to malignancy c. SE i. Gastric upset ii. Esophagitis iii. Ocular inflammation iv. Osteonecrosis of jaw v. Hypomagnesemia vi. Hypocalcemia d. NC i. Monitor for gastric upset and esophageal irritation, vision changes, or musculoskeletal pain ii. Administer with 6 to 8 ounces on empty stomach iii. Do not administer with antacids or other medications iv. Avoid food and beverage for 60 minutes after administration v. Instruct client to sit or stand for 30 to 60 minutes after administration vi. Do not administer if pt has history of swallowing disorders vii. Administer analgesics if bone pain occurs e. CE i. Take on an empty stomach ii. Do not eat or drink for30 to 60 minutes after taking medication iii. Sit or stand for 30 to 60 minutes after administration iv. Report heartburn or worsening heartburn, visual changes, musculoskeletal pain to HCP v. Do not take with antacids or other medications vi. Increase daily intake of calcium and vitamin D
used for both depression and smoking cessation. side effects: headache, dry mouth, nausea, vomiting, decrease reuptake of dopamine in CNS. adverse: seizures, suicidal thoughts, tremor, agitation, change in appetite, photosensitivity, mania, SIADH. Nursing: frequent oral care, take at the same time each day, take early for insomnia, take with food, do not crush or chew, avoid activities requiring mental alertness until know effects, avoid alcohol, do not stop abruptly, no pregnancy, use sunscreen a. Antidepressant b. Action i. Decrease reuptake of dopamine in CNS ii. Diminished uptake of serotonin and norepinephrine c. Uses i. Depression ii. Smoking cessation d. SE i. Seizures ii. Suicidal thoughts/behavior iii. Tremor iv. Dry mouth v. Agitation vi. Headache vii. N/V viii. Weight L or G ix. Change in appetite x. Photosensitivity xi. Mania xii. Psychosis xiii. Hostility xiv. SIADH xv. Hyper-or hypoglycemia e. NC i. Monitor mood changes from depression to suicide or worsening of depression ii. Frequent oral care f. CE i. Take at same time daily ii. Take with food or milk to decrease gastrointestinal irritation iii. Take early in the day to decrease insomnia effect iv. Do not chew or break sustained release form of medication v. Avoid activities requiring mental alertness until effect of medication is known vi. Avoid ETOH vii. Such on hard candy or chew gum for dry mouth viii. Inform HCP if pregnancy is desired or suspected ix. Needs to be tapered/do not stop abruptly
ACE inhibitor. Potent effect in first dose stay in bed for 3 hours. Gastric irritation, orthostatic hypotension, dizziness, tachycardia, myocardial infarction, cough, agranulocytosis. monitor complete blood cell count, educate client to change position slowly, eat small frequent meals and practice good mouth care a. Antihypertensive i. ACE Inhibitor b. SE i. Gastric irritation ii. Orthostatic hypotension (particularly with first dose) iii. Dizziness iv. Tachycardia v. Myocardial infarction vi. Cough vii. Agranulocytosis c. NC i. Monitor complete blood count d. CE i. Change position slowly ii. Eat small frequent meals iii. Practice frequent mouth care
Anticonvulsant. Side effects: myelosuppression, dizziness, drowsiness, ataxia, diplopia, rash. Nursing: monitor I&O’s, supervise ambulation, monitor CBC. client education: take with meals, wear protective clothing from sun, do not decrease dose or stop abruptly. a. Anticonvulsant b. SE i. Myelosuppression ii. Dizziness iii. Drowsiness iv. Ataxia v. Diplopsia vi. Rash c. NC i. Monitor I&O ii. Supervise ambulation iii. Monitor CBC iv. Client education 1. Take with meals 2. Wear protective clothing due to photosensitivity 3. Do not decrease dose or discontinue abruptly
A treatment for cancer that uses drugs to destroy rapidly dividing cancer cells. a. Alkylating agents, antimetabolites, antitumor antibiotics, hormonal agents, vinca alkaloids b. SE i. Bone marrow suppression ii. Nausea and vomiting iii. Altered immunologic response iv. Impaired oral mucous membrane v. Stomatitis vi. Fatigue vii. Hyperkalemia viii. Hyperphosphatemia ix. Hypocalcemia x. Cardiac toxicity xi. CHF xii. Pulmonary fibrosis xiii. Peripheral neuropathies xiv. Loss of DTR xv. Paralytic ileus xvi. Hearing loss xvii. Fatigue xviii. Infection xix. Alopecia xx. Chronic pain c. NC i. Monitor bleeding ii. Avoid injections and rectal temperatures iii. Press venipuncture sites iv. Monitor: 1. Appetite and nutrition 2. I&O 3. Prophylactic antiemetic 4. Blood cell counts v. Provide small, frequent meals vi. Prevent infection vii. Monitor oral hygiene viii. Administer antifungals and anesthetics as ordered ix. Monitor and treat for stomatitis d. CE i. Signs and symptoms of infection ii. Methods to prevent infection iii. Avoid hot and spicy foods iv. Methods to preserve rest and conserve energy
H2 blocker prototype: inhibit gastric acid secretion and decreases total pepsin output. side effects: diarrhea, confusion, dizziness, headache, dysrhythmias, hepatic abnormalities. Nursing: single dose may be better for compliance, monitor for confusion, rapid infusion can cause bradycardia/cardiac arrest; large doses produces confusion in the elderly. Client education: avoid antacids within 1 hour of dose, bedtime dose suppresses nighttime acid production. a. Histamine (h2) antagonist b. Action i. Inhibit gastric acid secretion and decrease total pepsin output c. SE i. Diarrhea ii. Confusion iii. Dizziness iv. Headache v. Dysrhythmias vi. Hepatic abnormalities d. NC i. Compliance may increase with single dose regimen ii. Monitor for confusion iii. Rapid infusion causes bradycardia or cardiac arrest iv. Large doses produce confusion in the elderly e. CE i. Avoid antacids within 1 hour of dose ii. Bedtime dose suppresses nocturnal acid production
antihypertensive, analgesic. use: hypertension and adjunct therapy for severe pain. side effects: drowsiness, hypotension, tachycardia, bradycardia, rash, insomnia, depression, severe rebound hypertension. Nursing: monitor depression, client eduction: apply patch to dry non hairy area. change position slowly, lie down if dizzy, don’t stop abruptly.
Digoxin and Furosemide
cardiac glycoside administered once per day and can be administered within 12 hours of the scheduled time. Take pulse for 1 full minute before administering. hold if pulse less than 60. and loop diuretic; **monitor potassium levels and HR. Digoxin should be 0.125 to 0.5 mg
Digoxin: Infant
rarely above 0.05mcg/1ml
antihistamine. side effects: drowsiness, dizziness, disturbed coordination, dry mouth, blurred vision, nasal stuffiness, photosensitivity. may be given IM, oral, IV. Be cautious when operating equipment, ambulate with care, sunscreen, consume fluids. take with food, avoid alcohol. a. Antihistamine b. Use i. Allergic symptoms ii. Anaphylaxis iii. Dytonic reactions from medications c. SE i. Drowsiness ii. Nausea iii. Dry mouth iv. Photosensitivity d. CE i. Administer with food ii. Use sunscreen iii. Do not combine with ETOH
1. Life threatening respiratory depression can occur if taken in patients that are not opioid tolerant – should only be used in patients with breakthrough pain with opioid tolerance; patients should never take more than 2 doses to treat an episode of breakthrough pain, must wait a minimum of 4 hrs after second dose before additional dose; cannot substitute for Actiq without lowering dose a. Use i. Chronic pain or pain that does not respond to other opiate analgesia b. NC i. Monitor resp and GI function ii. Administer w/ caution to pt with impaired renal function or rapid weight loss iii. Contraindicated for pts under 2 or less than 18 who weigh less than 110 iv. Do not cut patch or expose it to heat 1. Avoid hot baths or thermal therapy c. CE i. Storage of patch in secure place ii. Fold removed patch with med sides together and flush down toilet immediately after removal iii. Clean skin with water only iv. Avoid lotion, soap, and etoh on application area v. Apply to upper torso on hairless area after cleaning with water vi. Increased effect when used with other CNS or ETOH and/or grapefruit juice vii. No therapeutic effect for 8 to 12 hours viii. Avoid hot baths or hot tubs/saunas ix. Report fever to HCP
Loop diuretic. diuresis in 30 minutes. side effects: hypotension, hypokalemia, GI upset, weakness. Nursing: monitor BP, pulse, I&O’s, potassium, weigh client daily do not give at hour of sleep. Educate client on potassium rich foods. a. Loop diuretic b. Inhibits reabsorption of sodium and chloride in the loop of Henle and distal renal tubules c. After oral dose, diuresis occurs in about 30 minutes d. SE i. Hypotension ii. GI upset iii. Weakness e. NC i. Monitor BP and P and I&O ii. Monitor K iii. Weight daily iv. Do not give at bedtime f. CE i. Potassium containing foods
Aminoglycoside prototype: bactericidal inhibitor of protein synthesis (30S); active against many aerobic gram−negative bacteria. Narrow therapeutic window; dose reduction required in renal impairment. Tox: renal dysfunction, ototoxicity; once−daily dosing is effective (post−antibiotic effect) and less toxic a. Aminoglycoside b. SE i. N/V ii. Ototoxicity iii. Ataxia iv. Diarrhea v. Nephrotoxicity vi. Hypersensitivity reaction vii. Vertigo viii. Superinfection c. NC i. C&S 1st ii. Evaluate 8th cranial nerve for hearing loss iii. Assess hydration status iv. Monitor I&O v. Monitor renal function vi. Have lab obtain blood for trough level prior to administration and peak level after administration vii. Administer deep into well-developed muscles alternation sites viii. Infuse IV slowly over at least 30 minutes to 2 hours d. CE i. Drink 1500 mL fluid a day ii. S/S of superinfection iii. Take full course of treatment iv. Take as directed
Ginkgo Biloba
Increased bleeding risk, a. Herbal supplement b. Enhances cerebral and peripheral blood circulation c. Antidepressant d. Used for dementia, short term memory loss, vertigo, PVD, depression, sexual dysfunction e. SE i. Headache ii. GI upset iii. Contact dermatitis iv. Dizziness f. NC i. May potentiate drugs and herbs used to prevent clotting and MAOIs ii. May decrease effectiveness of anticonvulsants
Antipsychotic. side effects: EPS, muscle rigidity, tremors, tongue protrusion, slowing of voluntary movement, abnormal posturing, tardive dyskinesia, blurred vision, dry mouth. nursing: dystonic reactions treated with IV bendadryl. Can also treat tourettes. a. Antipsychotic b. SE i. Extrapyramidal reactions 1. Muscle rigidity 2. Tremors 3. Tongue protrusion 4. Slowing of voluntary movement 5. Abnormal posturing ii. Tardive dyskinesia iii. Blurred vision iv. Dry mouth c. NC i. Dystoric reactions treated with IV diphenhydramine
anticoagulant. used for short term. given IV or sub Q. dosage adjusted according to PTT. therapeutic range is 1.5 to 2 times normal value. nursing: leave needle in place 10 seconds after injection, don’t massage. side effects: hemorrhage, thrombocytopenia, hypersensitivity. antidote: protamine sulfate a. Anticoagulant b. Used for short term therapy, given IV or subcutaneous c. Action i. Inactivates thrombin and prevents conversion of fibrinogen to fibrin ii. Dosage is adjusted according to PTT 1. Therapeutic range is 1.5-2 times normal value d. SE i. Hemorrhage with excessive dosage ii. Thrombocytopenia iii. Hypersensitivity reactions e. NC i. Leave needle in place for 10 seconds after injection ii. Do not massage f. Antagonist i. Protamine sulfate
Insulin: Administration
Upper arm, thigh, abdomen. Rotate spots to avoid skin irritation. (Vial and syringe, insulin pen, insulin pump)
Insulin: Rapid-Acting
onset 5-15 minutes, peak 1 hour, duration 3 hours. rarely given IV. side effects: hypoglycemia, allergic reaction, lipidodystrophy, administer sub Q 0-15 minutes before meals. monitor for hypoglycemia for 30 to 90 minutes after. draw up rapid acting insulin first before intermediate. use same injection site rotating in the area approximately an inch from last site.
Iron Supplements
ferrous sulfate. stay upright 15 to 30 minutes after administering. nausea, constipation, black stools. monitor hemoglobin and hematocrit and give with Vitamin C to increase absorption. a. Iron salt b. Action i. Increase availability of iron for hemoglobin c. Use i. Iron deficiency anemia d. SE i. Black or dark green stools e. NC i. Monitor hemoglobin and hematocrit ii. Dilute liquid preparation in juice but not milk or antacids iii. Administer iron absorption but may be necessary to reduce gastrointestinal effects
Hepatotoxicity & peripheral neuritis, rash, fever, don’t give with phenytoin, blood dyscrasias, GI upset, local injection site redness. Take on empty stomach take B6 for neuritis. monitor liver function tests. Antimycobacterial: primary drug in combination regimens for tuberculosis; used as sole agent in prophylaxis.
IV Flow Rate
a. Total Volume x Drop Factor / minutes = drops per minute b. Total solution / hours to run = mL per hour c. Wt in kg by dose/kg/min = dose per minute x 60 = dose per hour d. Med on hand over volume on hand = desired over x, solve for x = rate of infusion e. (mL per hour x drop factor) / 60 = drop per minute
IV Infiltration
the leaking of IV fluid into the tissue surrounding the vein. This occurs when IV fluids continue to be delivered even though the tip of the catheter is no longer in the vessel or is blocked.
IV Therapy
is an advanced life support procedure. In this procedure, an intravenous (IV) catheter is inserted into a vein so that blood, fluids, or medications can be administered directly into the patient’s circulation. a. Purpose i. Main purpose of IVs is to maintain or restore fluid and electrolyte balance ii. Secondary purpose is to provide a route for medication, nutrition, and blood components b. Type, amount, and sterility of fluid must be carefully checked and sterile technique maintained c. Delivered by macrodrip or microdrip d. Three types are isotonic, hypotonic, and hypertonic e. Flow rate needs frequent monitoring as does the insertion site, the site in particular being assessed for infiltration or phlebitis f. Tubing is changed every 72 hours, bottle every 24 hours g. If delivered through a peripheral vein in the arm or hand, it has to be a low-concentrated solution h. If delivered through a central vein, it can be a more concentrate solution
used for hypothyroidism. taken lifelong. hormone levels monitored periodically. side effects: nervousness, tremors, insomnia, tachycardia, dysrhythmias. monitor pulse and BP. instruct patient to report chest pain, palpitations, shortness of breath, sweating to physician.
Mood stabilizer. use: control manic episodes of bipolar. side effects: dizzy, hand tremor, impaired vision. nursing: monitor blood levels 2 to 3 times per week at start, then monthly while on maintenance. Client education: fluid intake 2,500 to 3,000 mL per day and adequate salt intake. a. Mood stabilizer b. Use i. Control manic episodes of bipolar psychosis c. SE i. Dizziness ii. Hand tremors iii. Impaired vision iv. Excessive thirst v. Unpleasant metallic-like taste vi. Frequency of urination vii. Drowsiness viii. Mild diarrhea ix. Weight gain x. Elevated thyroid-stimulating hormone d. NC i. Monitor blood levels 2 to 3 times a week when started and monthly while on maintenance 1. Make sure that blood levels are checked 8 to 12 hours after the first dose, two or three times a week for the first month, then weekly to monthly 2. Lithium overdose may be fatal 3. Target blood level is 1-1.5mEq/L e. CE i. Fluid intake of 2500 to 3000 mL/day and adequate salt intake
May causes drowsiness. Avoid alcohol. Medication may be habit-forming. a. Benzo b. Antianxiety, sedative, and hypnotic c. SE i. Drowsiness ii. Lightheadedness iii. Hypotension iv. Hepatic dysfunction v. Increased salivation d. NC i. Monitor real and hepatic function e. CE i. Avoid ETOH or other < ii. Do not discontinue abruptly iii. Explain addictive potential
Magnesium Sulfate
CNS depressant administered to a preeclamptic client to prevent seizures, may be used as a tocolytic to stop preterm labor contractions; adverse reactions: CNS depression: depressed RR, depressed DTRs, decreased urine output, pulmonary edema; hold if RR <12 or urine output <100ml/4hr; DTRs absent; monitor levels; therapeutic range 5-8mg/dl; remind client of warm, flushed feeling with IV administration; keep calcium gluconate antidote a. Anticonvulsant when given IV b. SE i. Weak or absent deep tendon reflexes ii. Hypotension iii. Respiratory paralysis iv. Depressed cardiac function v. Hypocalcemia c. NC i. Respirations should be over 16 per minute before medication is given IV ii. Test knee jerk and patellar reflexes before each dose iii. Monitor vital sign iv. Monitor I&O
Medication Administration
assess MD orders against MAR; prepare meds (5 rights); assess abdomen; allergies; check placement; elevate HOB 30 degrees or more; check residual and replace; pour meds into syringe and allow to flow by gravity; flush with 10cc H2O after each med; when complete flush with 30-60cc H2O
Medication Dosage Calculation
Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI)
aerosolized pressurized inhaler allows bronchodilators, mast cell stabilizers, and corticosteroids to go right to lungs and airways through the mouth. rapid onset of action. Give bronchodilators first, remove the cap, shake 5 or 6 times, breath out all the way, then put the inhaler in mouth or 1 to 2 inches in front of mouth, depress while inhaling deeply and slowly for 3-5 secs. hold breath, exhale slowly through pursed lips. wait 2 to 5 minutes to repeat if necessary. good oral care to prevent candida. hold breath for at least 10 seconds a. Aerosolized, pressurized inhaler allows bronchodilators, mast cell stabilizers, and corticosteroids to be applied directly to site of action (the lungs and airways) through the mouth b. Enables smaller doses and rapid absorption and onset of action c. Maintenance inhalers used daily to prevent acute respiratory distress d. Rescue inhalers of short-acting medications used for immediate relief of acute respiratory distress e. Administration i. Give bronchodilators first ii. Remove cap and shake inhaler vigorously five or six times immediately before use iii. Breathe out all the way, then put inhaler in mouth or 1 to 2 inches in front of the mouth and depress the inhaler while inhaling deeply and slowly three to five seconds iv. If using spacer, close mouth around mouthpiece, depress canister, and inhale deeply and slowly for three to five seconds v. Hold breath for several seconds after inhalation is complete vi. Exhale slowly through pursed lips vii. If repeating, wait 2 to 5 minutes viii. Rinse mouth with water after steroid inhalation to prevent oral candidiasis f. CE i. Explain purpose ii. Teach correct way iii. Inform them that overuse of inhaler may result in serious side effects and ineffective results iv. Clean inhaler at least weekly with warm water 1. Alternate cleaning it with vinegar solution soak for 20 minutes 2. Rinse with clean water and allow to air dry v. Advise patient to rinse mouth following inhalation of medicine to prevent infection vi. Advise patient to keep a second inhaler in case first runs out 1. And to order new inhaler once canister is almost empty
What oral hypoglycemic agent should be used with caution in patients with CHF because it causes lactic acidosis? a. Oral hypoglycemic agent/ biguaride b. Use for DMII c. SE i. Dizziness ii. N/V/D iii. Abdominal discomfort iv. Lactic acidosis d. NC i. Do not give with R or H impairment ii. Monitor urine and serum glucose and ketone levels iii. Instruct client to take with food iv. Swallow ER tablet whole v. Avoid ETOH
Antineoplastic, DMARD. use:psoriasis, cancer, RA. side effects: pulmonary fibrosis, aplastic anemia, N&V, arachnoiditis, osteonecrosis, nephropathy, fever, chills, soft tissue necrosis, stomatitis, anorexia, hepatotoxicity, infertility, alopecia, photosensitivity. nursing: CBC, renal and liver function, daily weights, s/s of gout, nuchal rigidity,frequent oral care, hair loss strategies, teach client bleeding infection precautions and change position slowly, drink 1/2 gallon per day, use sunscreen, avoid alcohol and NSAIDs a. Antineoplastic b. Disease modifying antirheumatic drug c. Immunosuppressant d. Antimetabolite e. Uses i. Severe psoriasis ii. Rheumatic arthritis iii. Cancer f. Action i. Inhibits cell reproduction by interfering with the folic acid component of DNA synthesis in the cell-cycle S-phase, kills rapidly reproducing cells g. SE i. Pulmonary fibrosis ii. Aplastic anemia iii. N/V iv. Arachnoiditis v. Osteonecrosis vi. Nephropathy vii. Fever viii. Chills ix. Soft tissue necrosis x. Stomatitis xi. Anorexia xii. Hepatoxicity xiii. Infertility xiv. Alopecia xv. Photosensitivity xvi. Pruritus xvii. Skin ulcerate xviii. Urticarial xix. Hyperuricemia xx. Headache xxi. Malaise xxii. Visual disturbances h. NC i. Monitor CBC and R&L function tests ii. Daily weights iii. Monitor for S/S of gout iv. Obtain nutritional/pt consults v. Assess nuchal rigidity vi. 2x dosage and orders for any neoplastic medication vii. All med for IM or IV or IT injection should be prepared in biologic cabinet viii. Frequent oral care ix. Discuss hair loss and strategies to deal with it i. CE i. Bleeding and infective precautions ii. Change positions slowly iii. Drink at least ½ gallon of liquid a day iv. Take as directed v. Inform HCP is pregnant vi. Use contraceptive while on med and for at least 3 months after completing therapy vii. Avoid alcohol and NSAIDs
Opioid analgesic prototype: strong mu receptor agonist. Poor oral bioavailability. Effects include analgesia, constipation, emesis, sedation, respiratory depression, miosis, and urinary retention. Tolerance may be marked; high potential for psychologic and physical dependence. Additive effects with other CNS depressants
Naproxen side effects
NSAID gastritis, GI bleeding, renal failure a. NSAID b. Action i. Prohibits prostaglandins c. SE i. Headache ii. Dizziness iii. Epigastric distress d. NC i. Administer with food e. Contraindications i. Use cautiously in client with history of aspirin allergy f. CE i. Optimal therapeutic response takes 2 weeks of treatment
Calcium channel blocker prototype: vasoselective (less cardiac depression); used in angina, HTN. Tox: constipation, headache
Headache, postural hypotension, facial flushing; circulatory collapse Sit down when taking sub-lingual tablet to avoid lightheartedness and fainting. Keep tablets in original container. Close tightly after use. Tablets should taste bitter, if not replace with new ones. If angina is not relieved 5 minutes after 1st tablet, may take a 2nd one and then a third. If not relieved by 3rd tablet call physician. a. Nitrate b. Use i. Angina pectoris c. Action i. Dilate veins and arteries and thereby reducing ischemia and relieving pain by decreasing myocardial O2 consumption d. SE i. Throbbing headache ii. Flushing iii. Hypotension iv. Tachycardia e. CE i. Appropriate administration (time, technique, dosage) ii. Storage iii. Expected pain relief iv. Possible side effects v. Ointment is applied to skin vi. Rotate sites to avoid skin imitation vii. Prolonged effect up to 24 hours
Use: Stimulates labor, uterin contractions, milk let-down, controls uterine hemorrhage
Pancreatic Enzyme Replacement
Anorexia, nausea, vomiting, diarrhea, hypersensitivity, sneezing, lacrimation, skin rashes a. Pancreatic enzymes (pancreatin and pancrelipase) b. Action i. Aid in digestion of starches, fats, protein c. SE i. Anorexia ii. Hypersensitivity iii. Sneezing iv. Lacrimation v. Skin rashes d. NC i. Do not use with antacids ii. Avoid inhaling powder e. Client education i. Take with meals .
anticonvulsant. side effects: drowsiness, ataxia, nystagmus, blurred vision, GI upset, lethargy, gingival hypertrophy, Never mix with any other IV med or dextrose, educate client take with at least 1/2 glass of water or food, don’t drink alcohol, may make sweat/urine red/brown or pink. good oral hygiene.
fat-soluble vitamin: essential for liver synthesis of clotting factors used to prevent hemorrhagic disease of the newborn, vitamin K deficiency from warfarin
Muscarinic agonist prototype: tertiary amine alkaloid. May cause paradoxical hypertension by activating excitatory muscarinic EPSP receptors in postganglionic sympathetic neurons. Used in glaucoma. Tox: muscarinic excess
Potassium (K+)
3.5-5.0 essential for allowing muscles to contract (heart) and conduction of nervous impulses
short acting steroid. side effects: hyperglycemia, peptic ulcers, muscle wasting, fluid retention, moon face, hypokalemia, osteoporosis, depression, increased ICP, psychoses, cataracts, petechiae, oral candida. monitor intake and output, LOC, daily weight, BP, with food, do not break or chew. don’t drink grapefruit juice. don’t stop abruptly needs to be tapered up or down. a. Short acting synthetic steroid b. Action i. Suppress severe inflammation or immune response ii. Decrease release of inflammatory mediators (leukotrienes, histamine, prostaglandins) iii. Decrease infiltration of inflammatory cells (eosinophils, leukocytes) iv. Decrease edema and hyperactivity of airways and mucous production c. SE i. Hyperglycemia ii. Peptic ulcers iii. Muscle wasting iv. Fluid retention v. Hypokalemia vi. Moon face vii. Depression viii. Euphoria ix. Osteoporosis x. Thromboembolism xi. Weight gain xii. Increased risk of infection and fluid and electrolyte disturbances xiii. Buffalo hump xiv. ^ ICP xv. Anorexia xvi. Acne xvii. Delayed wound healing xviii. Psychoses xix. Restlessness xx. Joint avascular necrosis xxi. Hypokalemic alkalosis xxii. Increased intraocular pressure xxiii. Cataracts xxiv. Hypertension xxv. Ecchymoses xxvi. Petechial xxvii. Thrombophlebitis xxviii. Muscle pain xxix. Personality changes xxx. Hirsutism xxxi. Fragility xxxii. Agitation xxxiii. Churg-Strauss syndrome xxxiv. Dry mouth xxxv. Oral and/or esophageal Candidiasis xxxvi. Nasal congestion xxxvii. Dizziness xxxviii. Insomnia xxxix. Hoarseness xl. Bronchospasm xli. Cough xlii. Dyspepsia xliii. Allergic reaction xliv. Growth suppression xlv. Rash xlvi. Urticarial xlvii. Sneezing xlviii. Epistaxis xlix. Eye tearing l. Pharyngitis li. Sinusitis lii. Rhinorrhea liii. Dysphonia liv. Skin atrophy and burning and dryness and irritation lv. Allergic contact dermatitis lvi. Hypopigmentation lvii. Malaria lviii. Striae lix. Folliculitis lx. Irritation of the airways lxi. Hypertrichosis lxii. Maceration lxiii. Hyperglycemia lxiv. Osteoporosis lxv. Psychosis lxvi. Weakness lxvii. Purple skin striations lxviii. Psychological depression lxix. Truncal obesity lxx. Masculinization in females lxxi. Hypocalemia d. NC i. Monitor BP, lab values, I&Os, daily weights, LOC, 1. Continued growth in children ii. Administer in the morning with food or milk iii. Do not crush or break or chew tablets iv. Ensure accurate dosing in chidren v. Shake suspension well vi. Provide emotional support for body image changes vii. Maintain skin integrity viii. Apply ointments or creams or aerosol foam or lotions or solutions wearing gloves ix. Monitory for bruising x. Monitor for clinical signs of infection such as malaise or anorexia or delayed healing as classic signs of inflammation are suppressed xi. Nightmares often first indication of steroid psychosis e. CE i. Stress will increase the need for higher dosage ii. Do not drink grapefruit juice iii. Take as directed iv. Use inhaler on regular daily basis v. Do not stop taking abruptly vi. Taper medication before discontinuation vii. Medication masks signs and symptoms of infection viii. Avoid contact with person with known infections and crowd ix. Do not receive any vaccinations without HCP consultation x. Need continual regular medical follow up xi. Carry medical alert identification xii. Avoid alcohol xiii. Eat diet high in protein, calcium, and potassium and low in carbohydrates and sodium xiv. Proper technique to administer/take medication xv. Do not smoke xvi. Rinse mouth after using inhaler xvii. Use a bronchodilator metered dose inhaler before taking this medication as an inhaler xviii. Not to be used for acute bronchospasm xix. Avoid smoky areas xx. Discuss with HCP if pregnancy is suspected or desired xxi. Inform HCP if breastfeeding xxii. Take single dose before 0900 or multiple doses are evenly space intervals
What antitubercular agent causes a red-orange tinge to tears and urine?
atypical antipsychotic. improves negative symptoms of schizo. Side effects: EPS, insomnia, agitation, headache, anxiety, orthostatic hypotension, dry mouth, rhinitis, photosensitivity, sexual dysfunction, dysrhythmias, NMS. Nursing: monitor for NMS: sweating, rigidity, confusion, autonomic dysfunction. Education: lie down when dizzy, gum or lozenges for dry mouth, change position slowly, protect from sun. A client is diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication administered addresses this positive symptom?
Salicylate Poisoning
indication of poisoning may be sense of **fullness or ringing in the ears, acute or chronic tinnitus, hyperventilation, hypoglycemia, respiratory alkalosis, hypovolemia, bleeding, convulsions, respiratory failure in kids
Schedule Drugs
substance that has the potential for physical addiction, psychological addiction, and/or abuse. Schedule 1 is so high it is unacceptable just used for research. schedule 5 has less potential for abuse. but all these have potential for abuse.
Sodium Polystyrene Sulfonate
What treatment is used to remove potassium from the body? At 0900 a nurse is preparing the clients medications based on the chart findings which of the following medications should the nurse administer first
inflammation of the mucosa of the mouth
Systemic Lupus Erythematosus (SLE)
an autoimmune disorder characterized by a red, scaly rash on the face and upper trunk. also attacks the connective tissue in other body systems, especially in the joints. Prednisone can cause alterations in mental status.
Transfusion Reaction
a serious, and potentially fatal, complication of a blood transfusion in which a severe immune response occurs because the patient’s blood and the donated blood do not match a. Immunogenic or nonimmunogenic response to blood products b. May cause reactions in all major body systmes c. Symptoms and specific treatments vary according to causes d. Generalized standard procedures include: i. Stop the blood ii. Restart the saline iii. Notify HCP iv. Provide supportive care e. Types of reactions are: i. Allergic 1. Hypersensitivity to donor antibodies 2. Urticarial 3. Pruritus 4. Fever 5. Anaphylactic shock ii. Hemolytic 1. Incompatibility 2. Nausea 3. Vomiting 4. Pain in lower back 5. Hypotension 6. Hematuria iii. Febrile 1. Antibodies to donor platelets or leukocytes 2. Fever 3. Chills 4. Nausea 5. Headache 6. Flushing 7. Tachycardia iv. Bacterial 1. Contaminated blood products 2. Tachycardia 3. Hypotension 4. Fever 5. Chills 6. Shock v. Circulatory overload may also occur from infusion of blood at too rapid a rate for client size and condition 1. Cough 2. Dyspnea 3. Pulmonary congestion 4. Tachycardia 5. Headache 6. Sudden anxiety 7. Hypertension 8. Distended neck vein f. Transfusion reactions occur within first 50 mL of transfusion, which is usually within first 15 minutes, so nurse should remain with client during that time
Vitamin B1 (Thiamin)
the morale vitamin; deficiency leads to depression, irritability, fatigue, Beriberi (cannot move easily), and Wernicke-Korsakoff (associated with alcoholism);
anticoagulant. interferes with synthesis of vitamin K dependent clotting factor. side effects: hemorrhage, alopecia. nursing: monitor prothrombin test, therapeutic level is 1.5 to 2 times control, observe for bleeding gums, dark stool, petechiae. antidote is vitamin K
antiviral. use: HIV, prevention of maternal transmission to fetus. side effects: anemia, GI upset, paresthesias, dizziness, insomnia, headache, agranulocytosis. Client eduction: comply strictly with dosing schedule. insomnia only at start of therapy.
a. Cardiac Glycoside b. Action i. Decreases HR ii. Increases force of contraction c. Side Effects i. Bradycardia ii. Anorexia iii. Fatigue iv. Dysrhythmias v. Diaphoresis d. NC i. Know baseline VS ii. Check for Toxicity 1. Anorexia 2. Nausea 3. Vomiting 4. Diarrhea 5. Confusion 6. Visual disturbances (Halo) iii. Take apical pulse for 1 full minute noting rate, rhythm, and quality iv. Withhold the medication and notify health care provider if rate falls below 60 v. Observe K+ levels
`Lorazepam (ativan)
a. Benzodiazepine, antianxiety agent, sedative and hypnotice b. Use i. Anxiety ii. Preanesthetic medication c. SE i. Drowsiness ii. Lightheadedness iii. Hypotension iv. Hepatic dysfunction v. Increased salvation d. NC i. Monitor renal and hepatic function ii. Client education 1. Avoid alcohol or other depressants 2. Do not discontinue abruptly 3. Explain addictive potential
Zidovudine (azidothymidine, AZT) (Retovir)
a. Antiviral b. Use i. HIV infection ii. Prevention of maternal to fetal HIV transmission c. SE i. Anemia ii. Headache iii. Paresthesia iv. Dizziness v. Insomnia vi. Agranulocytosis d. Client education i. Comply strictly with dosage schedule
Trazodone (Desyrel)
a. Antidepressant b. SE i. Frequent and often intense sedation ii. Hypotension iii. Photosensitivity iv. Bone marrow depression v. Priapism c. NC i. Falls preventive measures d. CE i. Avoid alcohol and other central nervous system depressants and over-the-counter medications for up to 1 week after end of therapy ii. Taper dose to discontinue iii. Wear sunscreen and protective clothing
a. Anticoagulant b. Action i. Interferes with synthesis of vitamin K-dependent clotting factors c. SE i. Hemorrhage ii. Alopecia d. NC i. Monitor prothrombin test 1. Therapeutic level is 1.5-2 times the control ii. Observe for petechiae, bleeding gums, bruises, and dark stools e. Antidote – Vitamin K
Blood Transfusions
17. ABO compatibility a. Most important system for classifying human blood based on antigenic components of the RBC b. Identified by presence or absence or two different antigens, A or B on surface of erythrocyte c. Four blood types in this grouping are A, B, AB, and O i. O is universal donor but can receive only O ii. A can donate to A and AB and can receive from O and A iii. B can donate to B and AB can receive from O and B iv. AB is universal recipient but can only donate to AB v. Essential to consider Rh factor when determining compatibility d. If incompatible, the following may occur i. Fever ii. Chills iii. Low back pain iv. Nausea v. Chest tightness vi. Dyspnea vii. Anxiety e. Treatment i. Maintain blood volume and renal perfusion ii. Prevent and manage disseminated intravascular coagulation (DIC) f. NC i. Compare current and past ABO typing and crossmatching to detect mistaken ID ii. Carefully check labeling on blood components iii. Encourage patient to carry a blood group identification card iv. Stop transfusion and maintain saline administration v. Assess patient for changes in vital signs g. Tests to confirm ABO compatibility i. Forward and reverse ABO blood typing ii. Crossmatching iii. Rh blood typing
24. Pilocarpine (Isopto Carpine, Pilocar)
a. Miotic eye preparation b. Action i. Pupil constriction opens channels for aqueous humor drainage c. Use i. Relieve pressure of glaucoma ii. Counteract effects of mydriatic medications used in surgery and opthalmoscopic exams d. SE i. Painful eye muscle spasm ii. Blurred or poor vision in dim light iii. Photophobia e. CE i. How to instill eye drops ii. Apply light pressure on lacrimal sac for 1 minute after medication instilled iii. Avoid hazardous activities until temporary blurring disappears iv. Avoid sunlight and driving at night
phytonadione (vitamin K)
a. Fat-soluble vitamin b. Action i. Essential for liver synthesis of clotting factors c. Use i. Prevent hemorrhagic disease of the newborn ii. Vitamin K deficiency from warfarin iii. Hypothromboinemia from vit K deficiency not caused by warfarin d. SE i. Hypersensitivity reaction ii. Rash iii. Flushing iv. Unusual taste v. Hemolytic anemia vi. Urticarial vii. Hernicterus viii. Hyperbilirubinemia ix. Gastric upset x. Bronchospasm xi. Pain at injection site e. NC i. Apply gentle pressure to the site after injection ii. Monitor prothrombin time
a. Narctoic agonist, analgesic, synthetic derivative similar to morphine b. Use i. Detoxification and temporary maintenance treatment of narcotic addiction ii. Relief of severe pain c. SE i. Dizziness ii. Sedation or paradoxic excitement iii. Nausea iv. Respiratory depression v. Constipation vi. Miosis vii. Hypotension d. NC i. Administer in smallest effective dose ii. Observe for development of dependence iii. Monitor: 1. Respiratory status 2. Vital signs 3. I&O iv. Encourage fluids and high-bulk food
a. Diuretic; potassium-sparing b. Use i. Hypertension c. Action i. Blocks sodium reabsorption in the kidney ii. Saves potassium and hydrogen ions from being excreted d. SE i. Hyperkalemia ii. Hyponatremia iii. Rash iv. Dizziness v. Headache vi. Deeping of voice vii. Hirsutism e. NC i. Monitor for electrolyte imbalance ii. Monitor I&Os f. CE i. Take with meals ii. Do not take at bedtime iii. Avoid salt substitutes containing potassium iv. Limit intake of foods high in potassium v. Weigh daily
a. Nitrate vasodilator b. Use i. Treatment and prevention of angina c. SE i. Headache ii. Dizziness iii. Weakness iv. Postural hypotension v. Syncope vi. Flushing vii. Nausea viii. Vomiting d. CE i. To use sublingual tablet 1. Sit and place tablet under tongue or in buccal pouch 2. Do not chew or swallow until tablet dissolves completely 3. If pain not relieved with first tablet, can repeat at 5 to 10 minute intervals to maximum of 3 doses 4. If not relieved, get emergency help 5. Change position slowly 6. Lie down if lightheaded
Propranolol Hydrochloride
a. Beta blocker b. Action i. Block sympathetic impulses to the heart c. Use i. Hypertensive ii. Dysrhythmia iii. Angina d. SE i. Weakness ii. Fatigue iii. Hypotension iv. Bronchospasm v. Bradycardia vi. Heart failure vii. Psychological depression viii. Confusion ix. Gastric pain x. Impotence xi. Vivid dreams xii. Visual hallucinations e. NC i. Monitor for depression and psychological disturbance ii. Provide rest periods f. CE i. Take pulse before each dose ii. Hold if under 60 beats per minute iii. Taper dose before discontinuing iv. Take with meals v. Monitor blood glucose because blocks normal signs of hypoglycemia vi. Warn males of impotence potential
Atorvastatin calcium
a. Antihypertensive b. HMG-CoA inhibitos c. Used to lower serum cholesterol LDLs and increase HDLs and to lower triglyceride levels d. SE i. Headache ii. Abdominal pain iii. Rash iv. Myalgia v. Rhabdomyolysis e. NC i. Monitor for muscle pain, tenderness, or weakness ii. Advise client to take medication at same time each day iii. Monitor liver function tests
clonidine Hydrochloride
a. Antihypertensive b. Analgesic c. Use i. Hypertension and adjunct therapy for severe pain d. SE i. Drowsiness ii. Hypotension iii. Tachycardia iv. Bradycardia v. Rash vi. Insomnia vii. Psychological depression viii. Severe rebound hypertension e. NC i. Monitor for depression f. CE i. Apply patch to dry, nonhairy area ii. Change position slowly iii. Lie down if dizzy iv. Do not discontinue drug abruptly
schedule II Drugs
a. High potential for abuse and severe psychological or physical dependence b. Require nonrenewable prescription c. Have legitimate medical use d. Examples i. Dilaudid, methadone, Demerol, oxycontin, Percocet, fentantyl
a. Calcium channel blocker b. Use i. Hypertensive ii. Angina c. SE i. Dizziness ii. Headache iii. Hypotension iv. Nervousness v. Cough vi. Dysrhythmias d. NC i. Monitor BP during dosage adjustments ii. Advise to change position slowly
a. Antituberculosis agent b. Anti-infective antibiotic c. Use i. Treatment of TB in combination with other anti-TB agents d. SE i. Headache ii. Drowsiness iii. Pruritus iv. Hepatitis v. Thrombrocytopenia vi. Reddish orange or orange discoloration of tears, urine, saliva, sweat, sputum, and feces e. NC i. Monitor liver function tests f. CE i. Avoid soft contact lenses as they may become permanently stained from reddish orange or orange discoloration ii. If using hormonal contraceptive, use or add barrier contraceptive to ensure contraception
Levothyroxine Sodium
a. Thyroid hormone b. Action i. Increases metabolic rate of body c. SE i. Nervousness ii. Tremors iii. Tachycardia iv. Palpitations v. Dysrhythmias vi. Angina vii. Weight loss viii. Sweating d. CE i. Monitor pulse before each dose during dosage adjustment (notify HCP if >100) ii. Monitor weight iii. S/S of toxicity
Risperidone (Risperdal)
a. Atypical antipsychotic b. Action i. Appears to improve negative symptoms of schizophrenia, such as blunted affect and emotional withdrawal and apathy c. SE i. Headache ii. Drowsiness iii. Orthostatic hypotension iv. Dry mouth v. Rhinitis vi. Photosensitivity vii. Sexual dysfunction viii. Dysrhythmias ix. Neuroleptic malignant syndrome d. NC i. Monitor for neuroleptic malignant syndrome 1. Rigidity 2. Fever 3. Sweating 4. Autonomic dysfunction 5. Confusion 6. Seizures e. CE i. Change position slowly ii. Lie down if dizzy iii. Wear sunscreen or sun protective clothing iv. Use sugarless gum or lozenges for dry mouth
IV Potassium
a. Uses i. Severe hypokalemia b. SE i. Nausea ii. Vomiting iii. Diarrhea iv. Abdominal pain v. Confusion vi. Paresthesias vii. Muscle weakness viii. Flaccid paralysis ix. Oliguria x. Respiratory distress xi. Dysrhythmias xii. Cardiac arrest c. NC i. Monitor I&O, electrocardiogram, serum electrolytes
a. Anti-TB agent b. SE i. Toxic hepatitis ii. Peripheral neuritis iii. Rash iv. Fever v. Blood dyscrasias vi. GI upset vii. Local irritation c. NC i. Give in combo with other anti-tb drugs ii. Administer vitamin B6 to prevent peripheral neuritis iii. Monitor for resolution of TB symptoms iv. Check liver function tests d. CE i. Signs of hepatitis ii. Take before meals on empty stomach iii. Give vit B6 as ordered
Cystic Fibrosis meds
bronchodilators, anitboitcs, mucolytics Inherited disease that affects sodium channels in the body and causes respiratory and digestive problems. Pulmozyme,
Epilepsy Meds
medicaitons to prevent seizures: adverse effects: dizziness, drowsiness, visua changes, ataxia Carbamazepine: adverse effects: myelosuppression, rash Nursing considertaion: monitor intake and output, supervise amulation, CBC, client education: take with meals, protect from sun, do not decreasse dose or discountinue abruptly. Phenytoin, Valporic acid, Gabapentin, mag sulfate

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