NURS 341 Fa24 Final Exam Review PDF

Pharmacodynamics First pass effect: Medication undergoes metabolism at a specific location in the body Half life: The amount of time it takes for the drug’s active substance in your body to reduce by half ADME: absorption, distribution, metabolism, excretion Drug rights: Right...

Pharmacodynamics First pass effect: Medication undergoes metabolism at a specific location in the body Half life: The amount of time it takes for the drug’s active substance in your body to reduce by half ADME: absorption, distribution, metabolism, excretion Drug rights: Right patient, drug, dose, route, time, documentation ○ Right reason, response, and to refuse  Anti-Seizure Medications Phenytoin Gabapentin Therapeutic Level: 10-20 ug/ml MOA: neurotransmitter inhibiting MOA: decrease nerve response to impulses, slows down nerve impulses, Side effects: dizziness, nausea, decreases speed of conduction drowsiness, edema, Side effects: GI upset, confusion, drowsiness, gingival hyperplasia, hirsutism, nystagmus Also used for neuropathy Teaching: dental hygiene is important.  Parkinson’s & Alzheimer’s Carbidopa/Levodopa Donepezil MOA: reverses acetylcholinesterase, increases levels of ACh, used in the MOA: Carbidopa blocks conversion of levodopa to dopamine outside the CNS, tx of alzheimer’s Levodopa converted to dopamine Education: monitor for SLUDGE, may take several weeks to see effects, Education: take with food to prevent GI upset (low protein), take at the same not curative, take with food, do not stop abruptly time, don’t crush, do not stop abruptly *protein can slow/prevent the absorption Contraindications: allergy, PUD, GI bleed, hypotension, COPD, bradycardia Contraindications: angle closure glaucoma, use with caution open angle glaucoma, undiagnosed skin condition can activate malignant melanoma Memantine Amantadine MOA: NMDA receptor agonist; Improves cognitive function and MOA: increase dopamine release, blocks dopamine reuptake, quality of life. Education: non curative, give with low protein snack. CI: cautious in liver, kidney, and/or seizure disorders. Do not use while pregnant or lactating. Contraindications: allergy, ESRD Education: Not a cholinergic  Cardiac ACE - Inhibitors Beta Blockers- metoprolol, carvedilol Ex. lisinopril, captopril, enalapril MOA: Prevent catecholamine-mediated actions on the heart by reducing SNS stimulation to the heart and heart’s conduction system MOA: prevents AT-1 conversion to AT-2 Indications: HF, hypertension, reduction in HR Indications: HTN, HF (cardioprotective effects & renal) Contraindications: Hypotension, bradycardia, COPD, Contraindications: AV stenosis, hypovolemia, renal failure, hyperkalemia, asthma pregnancy, lactation, bilateral renal stenosis Implications: monitor VS, monitor for potential masking of Implications: hypoglycemic symptoms, monitor for respiratory effects, monitor for orthostatic hypotension Side Effects: cough, hyperkalemia, hypotension, angioedema, fatigue, first dose phenomenon Side Effects: Bradycardia, hypotension, impotence, bronchospasms, increased risk of hypoglycemia ARBs- losartan Interactions: NSAIDs, other antihypertensives, diuretics, and lithium MOA: blocks angiotensin receptors Indications: HTN, HF, used in conjunction with diuretics Contraindications: hyperkalemia, renal failure Implications: monitor VS Side Effects: angioedema, , hypotension, fatigue, weakness Interactions: NSAIDs, high potassium, spironolactone, lithium  Cardiac Cont. Nitro Digoxin Indications: chest pain Indications: HF, A-fib Side Effects: headache, orthostatic hypotension, systemic vasodilation Labs: Narrow therapeutic window (0.5-2.0), must monitor electrolytes, can affect HR, renal function Interactions: sildenafil, other HTN meds Implications: Low K+ increases its toxicity, **SL, give 1 every 5 min, max 3 doses. Amiodarone Calcium Channel Blockers EX. diltiazem, amlodipine, verapamil, nifedipine, cardizem Indications: afib, aflutter MOA: smooth muscle relaxation by blocking the binding of calcium to its Teaching: take as scheduled receptors, preventing muscle contraction Implications: monitor VS, rhythm, monitor Indications: HTN, angina, dysrhythmias pulmonary, thyroid, and liver function. Side Effects: bradycardia, can cause edema, hypotension, constipation Interactions: grapefruit juice, beta blockers, digoxin  Cardiac Cont. Aspirin Warfarin Indication: antiplatelet, used for patients w Indication: MI, PE, DVT, valve replacement, AF afib, prevent platelet aggregation Labs: INR 2.0-3.0, 2.5-3.5 MVR Teaching: bleeding precautions, hold before procedures, no children 1.5, monitor sodium levels Insulin Diabetic Agents Rapid-Acting Insulin (Aspart & Lispro) Onset: 5-15 minutes Peak: 1 -2 hours Oral Duration: 3-5 hours s/s Hyperglycemia: *must have food available at time of Metformin, Glyburide injection Thirst, dry mouth, blurry vision, Teaching: checking blood sugar, weakness, headache, confusion A1C, diet, may cause weight gain Regular Insulin (humulin) - Only one IV Interactions: steroids Onset: 30-60 min (hyperglycemia), beta blockers Peak: 2.5 hours (mask sx), hold metformin prior to Duration: 6hr IV contrast (CT, MRI) s/s Hypoglycemia: IV route is immediate onset, duration Sweaty, shaking, confusion, of 6-10 hours. difficulty concentrating Glyburide: stimulate insulin Insulin isophane suspension (NPH) secretion from the beta cells of the Onset 1-2 hours pancreas— beta cells must be Peak: 4-8 hours present. Duration: 10-18 hours Long Acting (lantus, glargine, degludec) Onset: 1-2 hour Peak: none Duration: 24 hours Can also be called basal insulin.  Decongestant LABA Inhaled Corticosteroids Ex. pseudoephedrine (sudafed), ephedrine Ex. salmeterol Ex. budesonide, fluticasone Respiratory Indications: common cold, rhinitis, sinusitis, Indications: COPD MOA: Anti-inflammatory properties. seasonal allergies Side Effects: palpitations, anxiety, Used for chronic asthma. n/v, tremors Side Effects: nervousness, insomnia, tremors, Teaching: use before steroid Side Effects: pharyngeal irritation, dry palpitations mouth, cough, fungal infection *never to be used for acute tx. Teaching: avoid maoi, avoid caffeine, report Teaching: rinse mouth, wait 3-5 after symptoms lasting > 1 week, do NOT use for bronchodilator to use more than 3 days (rebound effect) SABA Antihistamines Ex. albuterol, levalbuterol Suppressants Ex. 2nd gen- loratadine, cetirizine; 1st gen- Ex. codeine/hydrocodone and benzonatate and diphenhydramine MOA: relaxes smooth muscle in the dextromethorphan airway resulting in bronchial dilation Indications: rhinitis, insect bite, urticaria, treatment and increased airflow. MOA: works on the cough center in the medulla anaphylaxis, angioedema, pruritus Indications: rescue inhaler, asthma DON'T SUPPRESS A PRODUCTIVE COUGH Side Effects: vasodilation, decreased secretions, Side Effects: nervousness, tremors, increased capillary permeability, dry mouth, vision cramps, palpitations SE: CNS depression (only opioid suppressants) changes, DROWSINESS (first gen). Teaching: rinse mouth after, use Teaching: Avoid operating heavy machinery, Teaching: caution driving, increased effect with other bronchodilator 3-5 minutes before driving and report a cough greater than 1 week CNS depressants corticosteroid.  Antibiotics & Anti-Infectives PCN Amphotericin B Fluconazole TB Meds Antivirals Teaching: take with a Teaching: pretreat with Teaching: handwashing Teaching: GI upset take Teaching: doesn’t kill full glass of water, acetaminophen and to prevent spread, wear with food, monitor for virus, take with 48-72 monitor for drug diphenhydramine, can give gloves if applying cream, s/s liver issue, 2nd form hours, can take prior to reaction after meperidine for rigors, can use alternative birth of birth control, long outbreak to prevent administration cause extravasation, control, report clay term treatment, may report any weight gain. stools, jaundice, or dark take multiple *cross sensitivity with urine medications, can cause cephalosporins if allergic orange-red urine color, patient education is critical w/ compliance Indications: Indications: systemic fungi- Indications: fungal Indications: Tuberculosis Indications: RSV, CMV, gram-positive bacteria usually first choice, IV only infections, usually used - active or latent HSV (strep, staph) with candida infections. Side Effects: N/V/D, Side Effects: fever, chills, Side Effects: renal Side Effects: ototoxicity, Side Effects: N/V/D, bone abdominal pain, rigors, nephrotoxic, toxicity, N/V/D, dizziness, nephrotoxicity, marrow toxicity allergic reaction nausea, HA liver dysfunction, rash, hepatotoxicity, optic GI upset neuritis,  Pain Medications/ Anesthesia NSAIDs General Side effects: respiratory and myocardial depression, Teaching: check with other OTC meds, monitor for s/s bleeding (GI) dry mouth, n/v, constipation, malignant hyperthermia, vasodilation Implications: Assess renal function, GI bleeds, do not give to children, take with food or milk Teaching: hydration, monitor I/O, monitor ambulation Side Effects: GI bleed, renal impairment, tinnitus Local Side effects: local reaction Teaching: can be combined with epi to decrease local blood loss (do not give on tips) Sedation Narcotics Side effects: forgetfulness Teaching: tolerance, falls, move positions slowly Teaching: Doesn’t cause complete loss of consciousness or typically resp. arrest. Anxiety and pain are reduced. No Implications: narcan - nasal, IV, ET tube, monitor respirations, monitor for abuse driving after procedure. Pt. usually can’t recall the procedure. Side Effects: sedation, resp depression, constipation  Antineoplastics General Safety: neutropenic precautions General Education: no live flowers raw fruits/veggies, mask up, avoid crowds and large populations, frequent handwashing, monitor WBC General Side Effects: Nausea, hair loss, stomatitis, immunosuppression,  GI Meds Ondansetron Anti-Diarrheals Side effects: drowsiness, mouth dryness, blurred vision, MOA: adsorbents, antimotility, probiotic prolonged QT interval, headache Side effects: Constipation, increased bleeding Teaching: increase fluids, change positions slowly, caution time, drowsiness, hypotension, urinary retention driving, take preventative dose 30-60 minutes prior Teaching: Avoid CNS depressants Implications: identify factors that precipitate nausea, s/s of dehydration Implications: monitor bowels, monitor I/O Pantoprazole (protonix) Laxatives MOA: prophylaxis, block gastric acid formation Side effects: impaction, diarrhea, Side effects: osteoporosis dehydration, bloating Teaching: 30-60 minutes before meals Teaching: assess for laxative abuse (elderly/adolescents) Implications: do not crush/chew tablet form Implications: monitor I/O, bowels  Immunosuppressants & Immunizations Cyclosporine Immunizations Indications: organ transplant, decrease Weak or dead bacteria/virus is introduced into the body so antibodies immune system can form. Side Effects: leukopenia, thrombocytopenia, Contraindications: Active infection - fever > 101, pt’s < 6 months, nephrotoxicity, opportunistic infections, HTN, immunocompromised w/ chemo or steroids. bone marrow suppression Side Effects: site reaction, low grade fever, malaise, soreness Teaching: adhere to schedule, mix in glass container, monitor for thrush, avoid Teaching: ibuprofen or tylenol prior, warm compress to injection site, grapefruit juice, NO vaccines, reduce severe effects need to be reported: >103 temp, seizures, dyspnea, infection risk, immediately report fever/sore allergic reaction, there is NO link to autism. throat. **Lifelong therapy for organ transplants.  Hematopoietic Medications Filgrastim Erythropoietin Indications: stimulates WBC Interferons Indications: stimulates RBC production production Indications: antiviral, antitumor, Teaching: SQ - watch for site immunomodulation Teaching: SQ - watch for site reaction, do not give w/i 24 hr reaction, pt’s receiving epoetin Teaching: monitor for s/s infection, chemo med, labs for baseline alfa need to also receive an oral monitor CBC/CMP or IV iron supplement Contraindications: active Contraindications: drugs infection, caution in Contraindications: Hgb >10 metabolized by CYP450, some immunosuppression, presence cancer pts, caution in antivirals, some of more than 10% myeloid immunosuppression, immunosuppressants, pregnancy blasts (will stimulate tumor uncontrolled HTN, risk of (use two forms of BC) growth) thrombosis, head and neck cancers Side Effects: flu-like symptoms, Side Effects: flushing, muscle neutropenia, seizure, myalgia, aches, bone pain, decreased Side Effects: edema, N/V, confusion plt count headache, fever, arthralgia, and injection site reaction Can pretreat before giving. *in severe cases DVT, stroke, MI Men’s & Women’s Health Estrogens Androgens Indications: hormone replacement, Indications: development of male characteristics, bone/muscle contraception, osteoporosis, dysmenorrhea, development uterine bleeding, ovarian failure/removal, menopause symptoms Side Effects: sterility, liver cancer, CV disease, mood changes Side Effects: HTN, embolic events, breast Teaching: high abuse potential, risk of blood clots, stroke, MI tenderness, increased risk of breast cancer decreased menstrual bleeding or amenorrhea Contraindications: liver, cardiac, or renal disease, male breast cancer, prostate cancer Teaching: take same time daily, avoid TCA, backup birth control with antibiotics Contraindications: hx DVT or embolic event, pregnancy, estrogen dependent cancers, abnormal vaginal bleeding, liver disease  Substance Use General Considerations for Use, Withdrawal, Overdose