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ClassificationSide EffectsNRSG INTRV
ACE INHIBITORS (pril) lisinopril (Zestril, Prinivil) benazepril (Lotensin) catopril (Capoten) enalipril (Vasotec) quinapril (accupril) ramipril (Altace) 1. n/v/d 2. persistant dry hacking cough (ACE only) 3. hypotension 4. hyperkalemia 5. tachycardia 6. headache/dizziness 7. insomnia 8. bruising, petechiae, bleeding 9. diminished taste (ACE only) 1. inform pt the taste of food may be diminished during first month of therapy 2. report s/e of angioedema immediately to MD 3. instruct pt how to take BP
ANTIANGINAL (nitrates) amyl nitrate inhalant isosorbide dinitrate (Isordil) isosorbide mononitrate (Imdur, Monoket) nitroglycerin (NTG) 1. headache 2. hypotension 3. dizziness/weakness/faintess 4. flushing or pallor 5. tachycardia 1. caution pt to make position changes slowly to minimize orthostatic hypotension 2. inform pt headache is a common s/e
ANGIOTENSIN RECEPTOR BLOCKERS (sartan) *losartan (Cozaar)* candesartan (Atacand) eprosartan (Teveten) irbesartan (Avapro) olmesartan (Benicar) telmisartan (Micardis) valsartan (Diovan) 1. n/v/d 2. hypotension 3. hyperkalemia 4. tachycardia 5. headache/dizziness 6. insomnia 7. bruising, petechiae, bleeding 1. instruct pt how to take BP
BETA BLOCKERS (olol) *carvedilol (Coreg)* *propranolol (Inderal)* sotalol (Betaspace) timolol (Blocadren) *atenolol (Tenormin)* metoprolol (Lopressor, Toprol-XL) 1. bradycardia 2. hypotension 3. bronchospasm 4. weakness/fatigue/dizziness 5. hyperglycemia 6. agranulocytosis 7. behavioral or psychotic response 8. depression 9. nightmares 1. hold meds if pulse or BP is not within prescribed parameters 2. monitor signs or worsening of HF 3. advise pt taking insulin that beta blockers can mask early signs of hypoglycemia- tachycardia/nervousness 4. rise slowly to prevent hypotension 5.
LOOP ASCENDING DIURETICS *bumetanide (Bumex)* ethacrynic acid (Edecrin) furosemide (Lasix) torsemide (Demadex) 1. hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypochloremia 2. thrombocytopenia 3. hyperuricemia 4. ototoxicity and deafness 5. dehydration 6. orthostatic hypotension 1. monitor I&O, weight 2. check peripheral for edema 3. instruct pt to take meds in the AM to avoid nocturia 4. instruct pt to eat foods high in potassium
POTASSIUM-SPARING DIURETICS amiloride (Midamor) spironolactone (Aldactone) triamterene (Dyrenium) *eplerenone (Inspra)* 1. hyperkalemia 1. instruct pt to avoid foods high in potassium
THIAZIDE DIURETICS (thiazide) chlorothiazide (Diuril) chlorothalidone (Hygroton, Thalitone) hydrochlorothiazide (HydroDIURIL) quinethazone (Hydromox) 1. hypokalemia and hyponatremia 2. hypotension 1. check peripheral for edema 2. instruct pt to take meds in the AM to avoid nocturia 3. instruct pt to eat foods high in potassium
OSMOTIC DIURETICS mannitol (Osmitrol)= BRAIN, reduce ICP 1. fluid and electrolyte imbalance 2. transient plasma volume increase 3. pulmonary edema 4. cellular dehydration 1. monitor v/s including CVP hourly 2. insert foley, record urine output 3. monitor weight, I&O, sodium and potassium levels
OSMOTIC DIURETICS acetazolamide (Diamox)= EYES, tx glaucoma 1. hyperglycemia, hyperurecemia, hypercalcemia, hypokalemia 2. orthostatic hypotension 3. renal calculi 4. hemolytic anemia 1. monitor: v/s, weight, I&O, glucose, calcium, BUN, creatinine, mental status 2. instruct pt to monitor signs of renal calculi
ANTICOAGULANTS (in OR arin) warfarin (Coumadin)= ORAL 1. hemorrhage 1. monitor PT/INR 2. avoid salicylates 3. observe for any bleeding 4. teach pt of use soft toothbrush and electric razor 5. avoid foods high in vitamin K such as green leafy vegetables 6. ANTIDOTE: Vitamin K (phytonadione, aquaMEPHYTON)
ANTICOGULANTS (in OR arin) heparin (Lovenox)= IV, SUBQ argatroban (Acova) bivalirudin (Angiomax) dalteparin (Fragmin) desirudin (Ipravask) enoxaparin (Lovenox) fondaparinux (Atrixta) lepirudin (Refludan) tinzaparin (Innohep) 1. hemorrhage 1. monitor aPTT 2. avoid salicylates 3. observe for any bleeding 4. avoid foods high in vitamin K such as green leafy vegetables 5. ANTIDOTE: Protamine Sulfate
ANTIDEPRESSANTS (PaNaMa) tranylcypromine (Parnate) phenelzine (Nardil) isocarboxazid (Marplan) 1. orthostatic hypotension 2. restlessness 3. insomnia (Parnate) 4. dizziness, weakness, lethargy 5. dry mouth 6. anticholinergic effects 7. CNS= anxiety, agitation, severe depression 8. erection/orgasm difficulty; delay in ejaculation AVOID foods that contain TYRAMINE: avocados, bananas, beef or chicken liver, brewer's yeast, broad beans, no caffeine such as coffee, tea, chocolate, cheese, figs (fruit), overripe fruit, meat extracts, papaya, pickled herring, raisins, red wine, beer...
AVOID foods that contain TYRAMINE cont: sherry, sausage, bologna, pepperoni, salami, sour cream, yogurt, soy sauce
RAPID/FAST ACTING INSULIN lispro (Humolog) aspart (NovoLog) glulisine (Aprida) ONSET: <15 min PEAK: 0.5-1 hour DURATION: 3-5 hours 1. given with food during breakfast
SHORT ACTING INSULIN Humalin R regular insulin (Novolin R) Velosulin BR ONSET: 0.5 PEAK: 2.4 hours DURATION: 6-8 hours; 8hrs only for Novolin R and Velosulin BR
INTERMEDIATE INSULIN NPH (Neutral Protamine Hagedorn) Lente ONSET: 1-2 hours PEAK: 7-12 hours DURATION: 24-30 hours
LONG ACTING INSULIN protamine zinc (Ultra Lente) detemir (Levimir) glargine (Lantus) ONSET: 4-6 hours; Lantus immediate PEAK: 18+ hours; Lantus constant DURATION: 30-36 hours; Lantus 24 hours 1. contraindicated for children under 6 y/o 2. given @ BEDTIME 3. cannot be given IV, cannot be mixed with other insulin
COMBINATION INSULIN 70 NPH _________ 30 regular
HERBAL kava kava USED FOR: UTI, menstrual changes (ABD pain), migraines, chronic cystitis, antianxiety, skeletal muscle relaxant, sedative effect TX for gonorrhea
HERBAL ginger USED FOR: antiemetics
NARCOTIC/OPIOID ANALGESICS codeine, meperidine hydrochloride (Demerol) morphine sulfate 1. respiratory depression 2. hypotension 3. bradycardia 4. sedation, drowsiness 5. n/v 6. constipation, urinary retention 7. tremors 1. monitor resp, BP, and pulse 2. Naloxone (Narcan) is used to reverse narcotic respiratory depression
ORAL HYPOGLYCEMICS; BIGUANIDES metformin (Glucophage) 1. diarrhea (most common) 2. lactic acidosis (most serious) 1. it suppresses hepatic production of glucose and increases insulin sensitivity 2. if hypoglycemia occurs, advise pt to take glass of orange juice or 2-3 tsp of sugar, honey or corn syrup dissolved in water
ORAL HYPOGLYCEMICS; GLUCOSIDASE INHIBITORS acarbose (Precose) miglitol (Glyset) 1. given with 1st bite of meal @ breakfast** 2. will not cause hypoglycemia when given alone
ANTIANEMICS; IRON DEFICIENCY ANEMIA ferrous sulfate (Feosol) 1. nausea 2. constipation 3. black tarry stools ANTIDOTE: EDTA (edetate disodium) 1. absorption best if given between meals 2. GI upset, give w/ meals or orange juice 3. Vitamin C may increase absorption 4. teach pt to increase fiber, fluids, exercise 5. LIQUID P.O- use straw to prevent staining teeth 6. PARENTERAL-Ztrack air lock
HERBAL Saw Palmetto (antiestrogen activity) USED FOR: UTI & benign prostatic hypertrophy (BPH) BPH & UTI
MANIC/BIPOLAR DISORDER lithium carbonate (Eskalith, Lithobid) NORMAL LEVELS: 0.5-1.2 1.5=TOXICITY!!! 1. polyuria, polydipsia (dry mouth) 2. anorexia, nausea 3. weight gain, ABD bloating 4. fine hand tremors, muscle weakness 5. inability to concentrate 6. lethargy, fatigue, headache 7. hair loss, hypothyroidism 1. serum lithium levels should be checked q 1 to 2 months 2. monitor suicidal pt 3. maintain fluid intake 6-8 glasses of h20 4. avoid coffee, tea, cola 5. do not administer diuretics 6. notify MD if polyuria, prolonged vomiting, diarrhea/fever occur
LITHIUM TOXICITY MILD 1.5 mEq/L 1. apathy 2. lethargy 3. diminished concentration 4. ataxia 5. coarse hand tremors 6. slight muscle weakness MODERATE to SEVERE 1.5-2.5 mEq/L 1. n/v/d 2. slurred speech 3. tinnitus 4. blurred vision 5. muscle twitching 6. irregular temors 7. nystagmus 8. impaired LOC
PROTON PUMP INHIBITORS (prazole) omeprazole (Prilosec)* esomeprazole (Nexium) lansoprazole (Prevacid) pantoprazole (Protonix) rabeprazole (Aciphex) common s/e 1. headache 2. diarrhea 3. ABD pain 4. nausea other: confusion, arrhythmias, agranulocytosis, aplastic anemia 1. DECREASES GASTRIC ACID SECRETIONS 2. short-term tx of active duodenal and benign gastric ulcers 3. may cause drowsiness/dizziness. advise pt to report: black tarry stools, fever, sore throat, rash, or confusion 4. watch s&s of drowsiness
H2 INHIBITOR (tidine) cimetidine (Tagamet)* famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac)* 1. drowsiness 2. dizziness 3. blurred vision 1. DECREASES GASTRIC ACID SECRETIONS and protects surface of ulcer 2. prevents c/o peptic ulcers 3. cimetidine and antacids should be administered at least 1 hour apart! 4. antacids can DECREASE the absorption of oral cimetidine. food also slows it
HERBAL Echinacea USED FOR: stimulates/boosts Immune System
ANTIMICROBIALS; prevent or tx secondary infections metronidazole (Flagyl)* ^causative agent-Giardia Lamblia (Giardiasis) diarrhea from contaminated h20 1. dizziness 2. headache 3. ABD pain 4. anorexia, nausea s/s of alcohol deterrent: flushing, n/v, palpitations, and tachycardia >>> 1. urine may turn brownish/black 2. teach pt NOT to apply cologne after shave lotion, bath splashes, ingest ETOH products (anything containing alcohol) to avoid disulfiram (Anatabuse) type reaction 3. *cough drops contain alcohol*
ANTITUBERCULAR; drug of choice for TB* isoniazid (INH)* 1. hepatotoxicity & peripheral neuropathy* 2. n/v 3. dry mouth 4. dizziness 5. hyperglycemia 6. vision changes (color, disturbances)* 7. hepatitis 1. MONITOR LIVER FUNCTION TESTS* 2. notify MD for loss of appetite, fatigue, malaise, jaundice, & dark urine 3. give pyridoxine (Vitamin B6) to prevent peripheral neuropathy**
ANTITUBERCULAR; pulmonary tuberculosis ethambutol (Myambutol) 1. vision loss and loss of color discrimination* 1. evaluate pts visual acuity and color discrimination before and during therpay NOTE: (E)thambutol= EYE PROBLEMS
ANTITUBERCULAR: pulmonary tuberculosis rifampin (Rifadin)* 1. hepatotoxicity= liver damage 2. red-orange color in urine & feces. also shown in tears and body secretions (pt do not wear contacts)** 3. drowsiness 1. monitor liver function tests 2. may require ^doses of warfarin, corticosteroids, and hypoglycemic
ANTIVIRAL (vir) acyclovir (Zovirax) *tx of: genital herpes, infections of localized cutaneous herpes Zoster, shingles, and chicken pox (Varicella) 1. seizures 2. dizziness 3. headache 4. hallucinations 5. trembling 6. renal failure 1. asses lesions before and daily 2. monitor BUN and creatinine (^ or v=renal failure 3. instruct women w/genital herpes to have yearly PAP 4. rubber gloves are used to apply ointment to prevent spread of infection
ANTIVIRAL; prevents HIV cells from multiplying in your body ritonivir (Norvir) 1. n/v/d/anorexia 2. asthenia, parathesia 3. taste changes 4. dizziness 5. vasodilation 1. should be taken with food. can be mixed with CHOCOLATE milk or nutrition shake such as Ensure** drink within 1 hour of mixture 2. do not take disulfiram (Antabuse) to prevent alcoholic reaction
CALCIUM CHANNEL BLOCKERS (dipine) amlodipine (Norvasc) diltiazem (Cardizem) felodipine (Plendil) isradipine (DynaCirc) nicardipine (Cardene) nifedipine (Procardia, Adalat) nimodipine (Nimotop) nisoldipine (Sular) verapamil (Calan, Isoptin, Covera 1. bradycardia 2. hypotension 3. headache 4. dizziness/lightheadedness 5. peripheral edema 6. constipation 7. flushing of the skin 1. monitor: v/s, HF, kidney function, live enzymes 2. instruct how to take pulse 3. encourage pt to change positions or get up slowly to avoid orthostatic hypotension
Created by: kcainglet