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Pharmacology: Exam 3
| Question | Answer |
|---|---|
| Lower Respiratory Tract Consists of- | Larynx down |
| Upper Respiratory Tract Consists of- | Larynx up |
| Pulmonary Medications used are determined by- | -which part of system is affected |
| Bronchodilators are- | Adrenergic agonist (Sympathetic, Fight-or-Flight-CNS Stimulant) |
| Bronchodilator Examples: | Albuterol (asthma, Formoterol (asthma), and Salmeterol (COPD) |
| You CANNOT take these with Bronchodilators: | MAOI's and TCA (tricyclic antidepressants) |
| Bronchodilators are used with Caution/+ Rational | Diabetes (Increases glucose levels), Heart diseases (Increases HR), Hypertension (Increases HR), Angina and Hyperthyroidism (CNS amplifier) |
| When a person uses an inhaler they must- | -slowly breathe in for 3-5 seconds and hold their breath for 10 seconds, and then exhale slowly |
| Short-Acting Broncholdilators: | albuterol, levalbuterol |
| Inhaled Long-Acting Bronchodilators: | salmeterol, formoterol |
| Oral Bronchodilating Agents: | albuterol, terbutaline |
| Short-acting bronchodilators treat- | -acute exacerbations of asthma; prevent exercise-induced bronchospasm |
| Long-acting bronchodilators treat- | -COPD; In patients with asthma they are NOT first-line therapy, but must be combined with a GLUCOCORTICOID |
| Oral Bronchodilating Agents are used for- | -long term control of asthma; NOT first-line therapy |
| Side Effects of Bronchodilators: | Headache, Nausea, Restlessness, Nervousness, Tremors |
| Adverse/Toxic Effects of Bronchodilators: | Palpitations, Tachycardia, Chest pain, Seizures, Tremor (w/ oral preparations) |
| Nursing Implications with Bronchodilators: | Evaluate patient's respiratory status and VS, Explain which are short/long-term, Teach way to correctly use |
| Advair (Fluticasone/Salmeterol) Bronchodilator: | Contains a corticosteroid to decrease inflammation, Long-acting beta2 agonist |
| Spiriva (Tiotropium) Bronchodilator: | Anticholinergic prevents bronchospasms |
| Things to Remember with Long-Term Bronchodilators: | Long-term maintenance and prevention of bronchospasm, Remember 30 and 3-therapeutic effect in 30 minutes and peak effect in 3 hours |
| For Advair and Spiriva (bronchodilators) you CAN'T- | -use either one for rescue breathing. Keep the albuterol handy for acute bronchospasm |
| Do not take medications (bronchodilators) by mouth- | -only by inhalation. Encourage increased fluids. Rinse mouth well after inhalation. |
| Advair and Spiriva (bronchodilators) can cause: | Headache, Fever, Throat irritation, Cough, Pharyngitis, Diarrhea, NV, Pain |
| Advair and Spiriva (bronchodilators) Promote: | Decrease of severity and decreased asthma attacks |
| Advair and Spiriva should be used- | -EVERY day, Rinse mouth out |
| A Spacer is Indicated for: | Can help medication be easier to breathe in and out, Someone who is having a bad asthma attack and needs an increase of effective drug delivery |
| Metered-Dose Inhaler (MDI): | Medication is delivered via a pressurized container |
| Dry Powder Inhaler (DPI): | A capsule or tablet is crushed in the inhaler container. The dry form of the medication is inhaled. |
| Nebulizer: | Converts liquid medication to a mist. It is inhaled from a mouthpiece or a mask |
| Mast Cell Stabalizers: | Inhibit allergens binding to mast cells (type of white blood cell) from releasing substances that causes inflammation, Prevent or decrease occurrence of asthma attacks, DO NOT help acute attacks, Administered via MDI, Nebulizer, or Intranasal |
| Examples of Mast Cell Stabilizers: | Cromolyn sodium, Nedocromil sodium (CROMO-NEDO) |
| Mast Cell Stabilizer: Cromolyn | Prevents mast cells from breaking down, Used for asthma prophylaxis, Bronchial inflammation, Administered 15 minutes prior to exercise, Use on a fixed schedule |
| Side effects of Cromolyn (Mast Cell Stabilizer): | Cough and Bronchospasm |
| Respiratory Stimulant | Used for patients with apnea, Medications stimulate the respiratory center of the brain, Most common patients used on are PREMATURE INFANTS whose brains are immature |
| Examples of Respiratory Stimulants: | Caffeine citrate (Cafcit), Theophylline |
| Asthma | Inflammation of the bronchioles (Caused by allergens, Environmental, and Chemical reactions) |
| Clinical Findings of Asthma: | Difficulty breathing, Wheezing, Cough, Chest tightness, Anxiety, Prolonged expiratory phase, and Use of accessory muscles |
| Nursing Focus for Asthma: | During an attack assess and maintain ABC's, Notify RT/MD, and Implement collaborative care such as meds and IV/fluid, Stay with patient, Monitor VS |
| Asthma Risks/Clinical Findings: | Hypersensitivity, Increased occurrence in males, Familial, Cough, Increased mucus, SOB, Onset before age 12 years, Expiratory wheeze, Increased CO2 retention, Retractions, Prolonged expiration |
| Asthma and Hypoxemia: | Tachycardia, Increased Restlessness, Tachypnea |
| If symptoms do NOT respond to usual treatment ____ minutes, client should seek medical attention. | 30 minutes (or after first treatment fails) |
| Retractions with Asthma | When breathing in the ribs get sucked in (Accessory use) |
| Anticholinergics (parasympatholytics) | Blocks action of acetylcholine, which causes bronchospasms, Used to prevent bronchospasm, not treat it in progress, Expect "fight-or-flight" response |
| Examples of Anticholinergics: | Ipratropium bromide (Atrovent); Inhalation Mist, Tiotropium (Spiriva): Inhaled as a powder (BOTH ARE LONG TERM) |
| Gluccorticoids: | Suppress the immune system, Inflammation is decreased, Taken daily as oral or inhalation as prophylaxis to prevent asthma attacks |
| Glucocorticoid Examples: | beclomethasone (Beclovent, Vanceril), budesonide (Pulmicort), flunisolide (Aerobid), fluticasone (Flovent) |
| Glucocorticoids for Severe Acute Asthma Attacks: | methylprednisolone (Solu-Medrol): IV to dilate airways (WORKS FAST) |
| Glucocorticoids should be taken at- | -the smallest dose for the shortest period possible (Prevent dependence) |
| 3 Types of COPD: | Asthma, Chronic Bronchitis, Emphysema |
| Nursing Focus for COPD: | Position patient to maximize ease of breathing (HOB 30-45 degrees), Teach "Pursed-lipped" breathing, Conserve energy and decrease oxygen demand, Encourage frequent, small feedings of high-calorie foods/liquids to maximize calorie intake |
| COPD patients retain- | -CO2 |
| Retaining CO2 leads to- | Higher CO2 levels, Lower O2 level |
| Normal healthy patients breathe in response to _____ CO2 levels, and COPD patients breathe in response to _____ O2 | Rising, Lower (IF GIVEN TOO MUCH OXYGEN THEY MAY STOP BREATHING) |
| Treating COPD: | Bronchodilators, Corticoid steroids, Pneumonia/Influenza Vaccine |
| Pneumonia | Fluid/Infection of the lungs |
| Treating Pneumonia: | Antibiotics/Antivirals, Analgesics, Bronchodilators, Antipyretics |
| Montelukast | Leukotriene Receptor blocker - treats Allergic Rhinitis and therapy for Asthma Prophylaxis, and is used for Exercise-Induced Bronchospasms (TAKEN ORALLY) |
| Side Effects of Montelukast: | Fatigue, Headache, Mood changes, and sometimes even Suicidal thoughts |
| Montelukast Memory Trick: | 3 L's: LUKE likes to SING (airway open), LONG term management, LONG onset (1-2 weeks to reach therapeutic range) |
| Aspirin and NSAIDS can block the action of- | -Montelukast |
| Nursing Considerations with Montelukast: 1- Assess | Respiratory status |
| Nursing Considerations with Montelukast: 2- Labs | Liver function tests |
| Nursing Considerations with Montelukast: 3- Patient education | Medication does NOT treat acute asthma attacks |
| Nursing Considerations with Montelukast: 4- May lead to | Suicidal ideations and behaviors |
| #1 Anti-inflammatory Corticosteroids end in ______ | -ONE (Prednisone, Cortisone, Dexamethasone) |
| Inhaled steroids can take 1-4 weeks to take effect, but- | -are more effective than oral steroids |
| Steroids can decrease _______ _______ | immune response |
| Steroids are a stimulant so; | Increases HR, Increase BS, and cause Bone loss (take calcium and Vit-D) |
| You do NOT want to start on a big dose with- | -steroids |
| Stopping the use of Steroids can cause a- | -rebound effect |
| Side Effects of Corticosteroids: | Increase risk of new infection, Mask development of infection, Delayed wound healing |
| Antitussives | Suppress cough (intended for a dry, nonproductive cough), Allows patient to rest (especially at night) |
| Antitussive Example: | Codeine (is an opioid, CNS depression) |
| Expectorants | Clear secretions in upper respiratory by thinning them |
| Expectorant Examples: | Guaifenesin (Duratuss, Mucinex, Robitussin) |
| Expectorants are Given: | By mouth as syrup, tablet, or capsule |
| Hydration is important with Expectorants because- | -it helps loosen mucus to help cough it out (and keep you hydrated) |
| Expectorant Precaution: | Asthmatics (can cause spasms) |
| Muculytics | Liquefy VERY thick lung secretions, (decreases occurrence of lung infections) |
| Mucolytics are commonly used in patients with- | -cystic fibrosis |
| Mucolytic Example: | acetylcysteine (Mucomyst) |
| Mucomyst Can Cause: | Hypotension, Tachycardia, Dizziness, and Hepatotoxicity |
| What can we not do with OXYGEN without a doctors order? | CAN NOT GIVE MORE THAN 2 L OF O2 W/OUT ORDER |
| Oxygen Use: | Treat hypoxia, Chronic use in management of COPD |
| Decogestants | Constrict blood vessels in mucous membranes of nose, Reduce nasal passage drainage |
| Decongestants are Available as- | -nasal sprays and oral medications |
| Topical Nasal Spray Recovery Indications | Immediate relief; short-term use |
| Decongestants are NOT for use in children younger than- | -2 years old |
| Decongestant Examples: | phenylephrine, pseudoephedrine |
| Nasal sprays can cause- | -rebound congestion problems if used long-term |
| We have to make sure that decongestants are used with care when using- | -allergy and cold remedies (acetaminophen and ibuprofen OD) |
| Antitussive, Expectorants, and Mucolytic OVERALL Side Effects: | Dizziness, Drowsiness, and Bronchospasms (always delivered by inhalation) |
| Antihistamines | Benadryl, Allegra and Zyrtec both sold OTC |
| diphenhydramine (Benadryl) | Freedom from nausea, vomiting, and severe allergic reactions (can also make you sleepy) |
| fexofenadine (Allegra) | Freedom from drowsiness and seasonal allergic rhinitis |
| cetirizine (Zyrtec) | Freedom from sneezing, runny nose, and urticaria |
| Cannot drink _____ with Allegra | Juice (BUT STAY HYDRATED) |
| Do not administer antihistamines before- | -4 days of a skin test (allergy test) |
| How to Use a Nasal Spray | Blow nose, Shake, Prime (point away until it produces a fine mist), Tilt head forward, Spray opposite hand into opposite nostril |
| What should you not do when using a nasal spray? | Snort, Do not lean back |
| Cardiovascular Medications Function by- | -Increasing HR, Slow HR, Making the heart function more efficiently, Making the heart less irritable, Making the environment less hostile for heart to function |
| Diuretics Used for Treatment of- | -Swilling, High BP and HF |
| Side Effects of Diuretics- | -Muscle weakness, Frequent urination, and Dizziness/light-headedness |
| When to Call Your Doctor When Using Diuretics: | Extreme weakness or muscle cramps, fever, or rapid and excessive weight loss |
| Different Kinds of Diuretics: | Loop, Thiazide, and Potassium Sparing Diuretics |
| Diuretic Delivery Routes: | Delivery routes PO, IV, and IM |
| Two Main Purposes of Diuretics: | Decrease Hypertension and Decrease Edema |
| With Diuretics, we watch for: | Dec BP, Dec Na+, Dec Cl+, Dec K+, Dec weight, I&O imbalance, Dehydration, Hyperglycemia |
| Loop Diuretics inhibit- | -Sodium and Chloride reabsorption (Kicks the salt out of our body) |
| Most Frequent Side Effects with Loop Diuretics: | Dehydration, Hyponatremia, Hypochloremia, Hypokalemia, Unusual tiredness, Weakness, Orthostatic hypotension, Hyperglycemia, Hyperuricemia |
| Important Nursing Implications with Loop Diuretics: | Monitor for adequate I&O and K+ loss, Monitor patient's weight and VS, Monitor for S/S of hearing loss, which may last from 1-24 hours |
| Patient Teaching with Loop Diuretics: | Teach patient to take medication early in the day to decrease nocturia, Teach patient to report any hearing loss or signs of gout |
| Contraindications/Precautions with Loop Diuretics: | Use with caution in patients taking Digitalis (herb), Lithium, NSAIDs, and other Antihypertensive medications (Can go too low), Dangle feet before getting out of bed |
| MOA of Loop Diuretics: | Prevent reabsorption of Sodium, Water, Potassium, and Chloride |
| Loop Diuretics are the most _____ Diuretics | -POTENT (act on loop of Henle to inhibit sodium and chloride reabsorption) |
| Loop and Thiazide Diuretics cause loss of valuable potassium, so; | Require supplemental potassium |
| LASIX (LAsts SIX) | Can hang around in the body for 6 hours |
| Oral Diuretic Ingestion Time | Diuresis occurs 30-60 minutes after ingestion |
| IV Diuretic Absorption Time | Diuresis occurs 2-5 minutes after administration, Peaks 30 minutes, Tapers after 2 hours |
| furosemide (LASIX) Is Used for: | Edema, Hypertension, Ascites |
| Side Effects of furosemide (LASIX): | Dec BP, Photosensitivity, Inc Blood Glucose level, Dec K+ |
| What candy can increase Potassium loss? | Liquorish |
| Reasons we Give Loop Diuretics: | To decrease edema in HF, Pulmonary edema, Hepatic failure, Hepatic cirrhosis, and Chronic renal failure, and to Treat Hypertension |
| Side Effects/Nursing Considerations/Contraindications of Loop Diuretics: | Electrolyte imbalance, Hyponatremia (Lithium toxicity, CNS changes), Hypokalemia (Cardiac arrhythmias, Digoxin toxicity), Hypochloremia SO ---> Monitor electrolytes (Na+, K+, Cl+, Mg + and Ca+) |
| Use of Loop Diuretics can lead to: | Hypotension (Fainting, Dizziness), Dehydration (Thirst, Dry mouth, Weight loss, Low urine output), Ototoxicity (Tinnitus) |
| Loop Diuretic Examples | ***Furosemide***, Torsemide, Bumetanide, Etacrynic acid |
| Hydrochlorothiazide Upsides: | Normalizes BP when used alone or in combination with other hypotensive meds, Mobilizes Edema in HF |
| Hydrochlorothiazide Downsides: | Hypokalemia, Hypochloremia, Hyperuricemia, Hyponatremia, Hyperglycemia, Dehydration, Promotes renal calcium retention |
| Hydrochlorothiazide should NOT be taken with people who have- | -Had issues with RENAL FUNCTION |
| Hydrochlorothiazide Action: | Works on our arterioles causing vasodilation and works to have our sodium/water excreted, Takes about 2 hours to start working |
| NEW Nursing Implication with Hydrochlorothiazide: | Teach patient to take medication with or other meals if GI upset occurs |
| Potassium Sparing Spironolactone (Aldactone) | Saves the K+ - Gets rid of the water, Blocks action of aldosterone in the kidney, Gets RID OF Na+ and SAVES the K+ |
| With Spironolactone (Aldactone) We Watch for: | Hyperkalemia, Headache/dizziness, GI disturbances, Fatigue, Cramps |
| Nursing Implications with Spironolactone (Aldactone) | Monitor I&O and watch for Cardiac dysrhythmias, Monitor levels of electrolytes; Do not administer K+ supplements or salt substitutes containing Potassium Chloride |
| Spironolactone Patient Teaching | Teach patient to restrict intake of potassium-rich foods (Nuts, Dried fruits, Spinach, Citrus fruits, Potatoes, Bananas) |
| Atherosclerosis | Fatty plaques in the arteries |
| Chronic Hypertension reduces Kidney's ability to- | -Remove excess fluids, Straining circulatory organs |
| Hypertension: High BP caused by: | Poor heart action, Atherosclerosis, Kidney failure, Narrowed blood vessels, Chronic stress |
| Antihypertensive Drugs | Ace Inhibitors (PRIL), Beta-blockers (OLOL), Calcium Channel Blockers |
| Important Nursing Implications with Antihypertensive Drugs | Initial drug selection starts with a thiazide diuretic, Typically followed by beta-adrenergic blocker or an ACE inhibitor or CCB |
| Patient Teaching with Antihypertensive Drugs | Take medication as prescribed: Do NOT stop abruptly, Do NOT double up, Change position slowly, Avoid OTC medications, Take caution with hot weather, hot showers, hot tub baths, or prolonged sitting/standing because these may aggravate low BP |
| Most Frequent Side Effects of Antihypertensives | Hypotension, Sedation, MOST SERIOUS is Bronchoconstriction |
| Angiotensin Converting Enzyme (ACE Inhibitor) Used for Treatment of: | HF, High BP and protection kidneys in diabetics |
| Side effects of ACE Inhibitor | Dry cough and Dizziness, Orthostatic hypotension, Fetal injury, Hyperkalemia, MOST SERIOUS is Angioedema |
| When to call your doctor while using ACE Inhibitors | Persistent cough, or Swelling of face, lips or tongue |
| ACE Inhibitor Action | Decrease Peripheral vascular resistance WITHOUT: Increased cardiac output, Increased cardiac rate, Increased cardiac contractility |
| ACE Inhibitor Examples | catoPRIL (Capoten), enalaPRIL (Vascotec), fosinoPRIL (Monopril) |
| Beta-Blockers Used for Treatment of: | HF, High BP, and Prevention of abnormally fast heart rates |
| Side Effects of Beta-Blockers: | Dizziness, light-headedness, Fatigue, and Cold arms and legs |
| When to call your doctor when taking Beta-Blockers: | When experiencing extreme fatigue, dizziness or diarrhea |
| Beta-Blocker Examples | propranOLOL (Inderal), atenOLOL (Tenormin), metoprOLOL (Lopressor) |
| Beta-Blockers can Cause | Hypotension, Bradycardia (AV block), Symptoms of HF, and Drowsiness/Depression |
| Important Nursing Implications with Beta-Blockers | Assess VS; monitor closely if given with calcium channel blocker, Monitor patients with DM; Increased risk of hypoglycemia- tachycardia is often masked because of the beta, blockade |
| Calcium Channel Blockers Used for treatment of: | High BP and Atrial fibrilization |
| Side Effects of Calcium Channel Blockers | Dizziness/light-headedness, Swelling and Constipation, Dec BP, Bradycardia |
| When to call your doctor when taking Calcium Channel Blockers | Dizziness and/or fainting |
| Calcium Channel Blockers action | Blocks calcium access to cells causing: Decreased contractility, Decreased conductivity to the heart, Decreased demand for oxygen |
| Non-Medicinal ways to Decrease BP | Weight reduction, Tobacco cessation, Decreased sodium and alcohol intake, Reduced stress and increased exercise |
| Way to Remember Calcium Channel Blockers | V- ery N- ice D- rugs, (verapamil, nifedipine, diltiazem) |
| Things to Note with Calcium Channel Blockers | Most are sustained released so DO NOT crush or chew, Watching for swelling in the feet, Monitor weight, Increase fiber/fluid |
| Angiotensin II Receptor Blockers (ARBS) Used for treatment of | HF and high BP and protection of kidneys in diabetes |
| Side Effects of Angiotensin II Receptor Blockers (ARBS) | Dizziness/light-headedness and fatigue |
| When to call your doctor when using Angiotensin II Receptor Blockers (ARBS) | If you develop any facial or tongue swelling, or difficulty breathing |
| Angiotensin Receptor Blockers (ARBs) Action | Block action of angiotensin, thus preventing constriction of blood vessels, Used when ACE Inhibitors NOT tolerated. |
| Angiotensin Receptor Blocker (ARBs) Examples | irbeSARTAN (Avapro), isoSARTAN (Cozaar), valsARTAN (Diovan) |
| Important Nursing Implications with ARBs | Monitor effect of medication on BP, Assesses for angioedema on initial administration-discontinue immediately if it occurs, Monitor kidney function, Monitor potassium levels |
| Angine | Acute cardiac pain caused by inadequate bloodflow to the myocardium, mostly due to plaque or spasms of the coronary arteries |
| Strategies to Help Treat Angina | Decrease dietary fats, Lower BP, Develop coping mechanisms for stress, Exercise, Decrease alcohol consumption, Stop smoking, Decrease dietary sodium |
| Most Common way to Take Nitroglycerin | Sublingual |
| Nitroglycerin Side Effects | Orthostatic hypotension, headache, reflex tachycardia |
| Patient teaching with Nitroglycerin | Patients with angina should carry nitro with them at all times, Teach proper storage for freshness, Discard unused medication after 24 months |
| Important Nursing Implications with Nitro | Rotate transdermal patches and remove after 12 to 14 hours to have a "Patch free" interval of 10 to 12 hours daily, In hospitalized patients check BP before adminstration |
| Nitro Drug Interactions | Beta-blockers, Calcium-channel blockers, Vasodilators, and alcohol |
| With Nitro we start on- | -the lowest dose possible |
| Heart Failure S/S | Anxiety, restlessness, Cyanotic and clammy skin, Tachycardia, tachypnea, persistent cough, Lower-leg edema, forward leaning posture |
| What is heart failure? | Heart muscle fails to push normal amount of blood through body (Leads to fluid backup which increases workload on the heart, Otherwise known as Congestive Heart Failure (CHF)) |
| Treating Congestive Heart Failure | ACE Inhibitors/ARBs, Beta-Blockers, Diuretics, Inotropic, Sympathomimetics, Vasodilators, Antidysrhythmic |
| Vasodilators Action | Decrease pressure heart has to exert thus decreases oxygen demand |
| Vasodilator Examples | isorbid dinitrate (Iso-Bid, Isotrate, Sorbitrate), isobird mononitrate (IMDUR), hydralazine (Apresoline) |
| Cardiac Glycosides Action | Help the heart beat stronger and more efficiently, Combining with medications that decrease peripheral vascular resistance |
| Cardiac Glycoside Example | digoxin (Lanoxicaps, Lanoxin) |
| Patient teaching with Digoxin | Includes checking HR and holding medication for HR less than 60 BPM |
| Digitalis Important Nursing Implications | Monitor digoxin serum levels: check for toxicity, Digoxin has NARROW therapeutic range, Monitor pulse, Administer IV doses slowly over 5 minutes |
| Digitalis Most Frequent Side Effects | Fatigue, Hypokalemia, Bradycardia, MSOT SERIOUS is dysrhythmias |
| Patient Teaching with Digitalis | Do not double up on misses doses, Teach patients to check their own pulse |
| Treating Myocardial Infarction | Analgesia, Vasodilation, Fibrinolytic Therapy, Antidysrhythmic, Beta-Blockers, ACE Inhibitors, Anticoagulants |
| Causes of Abnormal rhythms | Hypertension, Cardiac valve disease, Coronary artery disease, Potassium level alterations, HF, DM, Stroke OR MI |
| Treating Atrial Fibrillation | Antidysrhythmic, Beta-Blockers, Calcium Channel Blockers, Anticoagulants |
| Anti-Dysrhythmic Medications | flecainide (Tambocor TM), propafenone (Rhythmol), quinidine (Cardioquin) |
| Supraventricular Rhythms | Originate above the ventricles |
| Sodium Channel Blockers (Class I anti-arrhythmics) | Slow rate of electrical conduction by blocking sodium transfer, Treat supraventricular rhythms |
| Beta-Adrenergic Blockers (Class II anti-arrhythmics) | Slow electrical conduction of the heart |
| Potassium Channel Blockers (Class III anti-arrhythmics) | Treat ventricular and supraventricular arrhythmias, Used in patients with internal defibrillators (Ventricular and supraventricular) , Last resort for dysrhythmias resistant to change |
| Potassium Channel Blockers (Class III anti-arrhythmics) Examples | amiodarone (Cordarone)***, bretylium tosylate, ibutilide (Covert), solatol (Betapace) |
| Calcium Channel Blockers (Class IV anti-arrhythmics) | Dilate blood vessels, Decrease workload of heart, Used for very rapid arrhythmias (Used in rapid arrhythmias, SVT, and to control ventricular rate in A-fib and A-flutter) |
| Antidysrhythmic Side Effects | Dizziness, Bradycardia, MOST SERIOUS is pulmonary toxicity |
| Patient Teaching with Antidysrhythmics | Instruct patient to take all prescribed doses and NOT to catch up on missed doses, Instruct patient to report SOB, pain: and irregular, fast, or slow HR |
| Shock | Collapse of the cardiovascular system |
| Cardiogenic Shock | Heart stops pumping |
| Hypovolemic Shock | Loss of blood volume |
| Neurogenic Shock | CNS system fails, leading to vasodilation |
| Septic Shock | Invasion of microorganism |
| Anaphylactic Shock | Overactive response to allergen |
| Treatment of shock | Target underlying cause, Support cardiovascular system |
| Shock affects every system of the body | Metabolism slows, Urine output decreases, BP lowers, HR increases, Respirations rapid and shallow, Anxiety, confusion, lethargy, and restlessness |
| Vasopressors/Cardiogenic | Increase BP (Epinephrine, Norepinephrine, Dopamine) |
| Inotropic Drugs/Cardiogenic | Strengthen heart contractions, dobutamine |
| Hypovolemic Shock Treatment | Plasma expanders (albumin) and other fluids |
| Septic Shock Treatment | Antibiotics |
| Anaphylactic shock Treatment | Epinephrine (EpiPen) |
| Drugs for Bradycardia and Decreased BP | IDEA --> I- soproterenol, D- opamine, E- pinephrine, A- tropine |
| Statins Used for Treatment of | High cholesterol; Prevention of heart attack and stroke |
| Statins Note with Doctor: | Your doctor will test your liver enzymes |
| Side Effects of Statins | Muscle pain, Joint pain |
| When to call your doctor when taking Statins | Severe muscle aches and tenderness |
| Medications for Lipid Disorders Action | HMG-Co-A Reductase Inhibitor (statins): Decrease blood levels of lipids, Encourages liver to make less cholesterol, Increase number of LDL receprtors (Grab more LDL from blood) |
| Medications for Lipid Disorders Examples | AtorVASTATIN (Lipitor), RosuVASTATIN (Crestor), SimVASTATIN (Zocor) |
| Important Nursing Implications with HMG-COA Reductase Inhibitors (Statins) | Monitor liver function studies, Administer medication in the evening without regard to meals, except for lovastatin, which is taken with the evening meal |
| Patient Teaching With HMG-COA Reductase Inhibitors (Statins) | Instruct patient to report unexplained muscle pain or tenderness, Inform women of childbearing age about the potential for fetal harm should they become pregnant, Instruct patient about dietary changes to reudce weight and cholesterol |
| Which assessment finding in the patient's chart demonstrates to the nurse that albuterol administration was effective? | Clear lung sounds, No evidence of side effects, Ambulating three times a day, Free from cardiac dysrhythmias |
| Which drug can be recommended to a patient for the treatment of the common cold? | Antihistamine |
| Which statement by the patient indicates an accurate understanding of when to administer salmeterol for the treatment of asthma? | "I will inhale one puff twice at 7:00 a.m. and 7:00 p.m." |
| Which drug would the nurse recommend to a patient with allergic rhinitis who needs to stay awake for 12-hour night shifts at work? | Fexofenadine (2nd generation antihistamine), "Nonsedating antihistamines" |
| Which time frame describes when a nurse can expect the onset of action of IV diphenhydramine to occur? | Immediately (Onset of action) |
| Which drug disrupts the inflammatory response and is indicated for the treatment of asthma? | Montelukast (Indicated for the treatment of asthma, and is effective in reducing inflammatory symptoms of asthma) |
| Which information will the nurse provide to a patient at risk of bronchial asthma who has been prescribed cromolyn sodium? | Administer it daily as per described dosage |
| A patient visits for follow-up care after 1 week of indacaterol and glycopyrrolate therapy for chronic obstructive pulmonary disease. Which cue reported by the patient would alert the nurse that the patient is experiencing a SE of combined therapy? | "I am unable to see things clearly." |
| Which condition is considered to be an adverse reaction of albuterol? | Chest pain, Tachycardia, Palpitations |
| Which action will the nurse take when a patient prescribed diphenhydramine experiences hypertension and palpitations? | Assess the patient for the use of any other medications (MAOI's can increase possibility of HTN or cardiac dysrhythmias) |
| Which action will the nurse take when caring for a patient with bronchospasm who has been prescribed metaproterenol to be taken by a metered-dose inhaler? | Teach patient to attach spacer, Instruct frequent dose can inc HR, Ask patient to report dryness in mouth, Explain importance of inhaling at proper intervals, Instruct not to use drug excessively |
| Which assessment question would the nurse ask before administering an albuterol inhaler to a patient with asthma? | "Do you have an allergy to milk?" |
| Which response is the most appropriate for a nurse to provide a patient with Type II Diabetes who asks for a recommendation for OTC decongestants? | "Let me contact your health care provider to discuss treatment options." |
| Which information would the nurse include when instructing a patient on how to address a common side effect of antitussives? | Avoid operating heavy machinery |
| Which assessment findings will a nurse immediately report to the Primary Health Care Provider in a patient with cough and difficulty breathing who is receiving an antitussive and decongestant? | Temp of 100.8 F, Change in color of sputum, Respiratory rate of 30 breaths per minutes |
| Which statement would a nurse make as part of medication teaching for a client who has been newly prescribed zafirlulkast? | "This drug will be taken 1 hour before or 2 hours after meals." -Blocks the inflammatory response of leukotrienes and thus the trigger for asthma attacks. NOT for acute asthma attacks |
| Which patient statement indicates a need for further education regarding interventions for the treatment of acute sinusitis and pharyngitis? | "My throat is sore so I need to take antibiotics." -Acute pharyngitis, or a 'sore throat' may be caused by a virus or bacteria; Antibiotics are NOT effective against viral pharyngitis |
| Which physiologic effect would the nurse anticipate occurring following the administration of formoterol to a patient with chronic obstructive pulmonary disease (COPD) | Bronchodilation |
| Which drug is an intranasal glucocorticoid spray? | Budesonide, Flunisolide, Beclomethasone |
| Which mode of action is associated with the drug tiotropium? | Dilates the bronchi, Antagonizes acetylcholine action, Relaxes smooth muscles of the bronchi, Blocks muscarinic cholinergic receptors |
| Which side effect would the nurse include in patient teaching regarding fluticasone and salmeterol for treatment of chronic obstructive pulmonary disease (COPD)? | Infection, Tachycardia, Blurred vision, Oral candidiasis, Musculoskeletal pain |
| Which side effect would the nurse assess for in a patient who has been prescribed ipratropium and albuterol? | Headaches, Pharyngitis, Hypokalemia, Hypertension, Hyperglycemia |
| Which instruction will the nurse provide to the parents of an 8-year-old patient prescribed montelukast for asthma? | Do NOT swallow the montelukast chewable tablets |
| Which type of drug would be administered first to a patient with a history of asthma presenting to the clinic with acute dyspnea, wheezing, hypercapnia, and hypoxemia? | Beta2-adrenergic agonists |
| Which medication increases the likelihood of Digitalis toxicity? | Theophylline (BUT decreases effect of lithium) |
| Which rationale explains why a nurse will teach a patient prescribed diphenhydramine to stop drinking alcohol while receiving therapy? | Alcohol increases central nervous system depression |
| Which teaching point would a nurse provide the family members of a child who has been prescribed diphenhydramine? | "Your child may experience nightmares and nervousness." -Causes nightmares, irritability, and nervousness in children |
| Which statement by the nurse explains the therapeutic uses of guaifenesin and codeine together? | "The use of guaifenesin and codeine will help with cough and common cold." -Opioid antitussive |
| Which statement is true about antihistamines? | Used to treat allergic rhinitis, Rapidly absorbed within 15 minute s |
| Which side effect may occur in a patient recieving tiotropium? | Myalgia, Insomnia, Dry mouth, Constipation |
| The health care provider recommends using a metered-dose inhaler for delivering albuterol. Correct order of steps. | 1. Shake the inhaler well, 2. Removal of the cap from the mouthpiece, 3. Breathe out through the oral passage, 4. Inhale and press the canister once |
| Which action would the nurse take when a patient previously diagnosed with a common cold reports yellow mucus a week later? | Contact the primary health care provider for a prescription for antibiotics |
| Which range reflects a normal theophylline level? | 5 to 15 mcg/mL |
| Which adverse reaction would the nurse include in patient teaching regarding the use of albuterol? | Tachycardia |
| Which dose of montelukast is the correct dose for an adult? | 10 mg |
| Which symptom may be managed through combination therapy with fexofenadine and pseudoephedrine? | Urticaria, Rhinitis, and Allergic rhinitis |
| Anti-Coagulants are used for- | -Prevention of blood clots |
| Side Effects of Anti-Coagulants | Bleeding and bruising |
| When to call a Doctor when using Anti-Coagulants | When you have abnormal bleeding and bruising |
| Embolus | Traveling blood clot |
| Thromboembolic Events | Myocardial Infarction (MI), Stroke (CVA), Pulmonary Emboli (PE), Deep Vein Thrombosis (DVT) |
| Thrombus | Blood clot that is stuck and inhibits blood flow and causes tissue ischemia |
| Anticoagulants Prevent ____ ____ | -Clot Formation (by interrupting production of cofactors that help in clotting process |
| Heparin and enoxaparin are given as subcutaneous injections in patients at risk for- | -developing Deep Vein Thrombosis (DVT) |
| What route is Warfarin given? | Warfarin is given orally |
| DVT Risk Factors: | Bedrest, Fracture to pelvis, Obesity, Recent surgery, Family history of blood clots |
| What labs do we keep an eye on when taking Heparin? | PTT, APTT |
| Anticoagulants are Indicated for- | -MI, Unstable angina, Atrial fibrillation, Indwelling devices (eg, mechanical heart valves), Major orthopedic surgery |
| Anticoagulants are Contraindicated with- | -Drug allergies, Any acute bleeding process or high risk for occurrence, Warfarin is STRONGLY contraindicated in pregnancy, |
| Low Molecular Weight Heparin are CONTRAINDICATED in patients with- | -Stroke, Ulcers, Eye/Brain/Spinal surgery, Indwelling epidural catheter risk of epidural hematoma |
| Heparin Interferes with- | -Activation of FIBRIN and FIBRINOGEN from THROMBIN that keeps clots from FORMING |
| Heparin is- | Rapid acting, Given IV or SubQ, Need to check partial thromboplastin time (aPTT), Need bleeding precautions |
| Side Effects of Heparin | Heparin-induced thrombocytopenia, Spontaneous bleeding |
| What should a nurse teach the patient with taking Heparin and other medications? | CAUTION patients NOT to take aspirin or any medication that decreases platelet aggregation (clopidogrel) unless ordered specifically by health care provider |
| Is Heparin prescribed in units or mg? | Prescribed in units |
| Antidotes for Anti-Coagulants? | Vitamin K for Warfarin, Protamine sulfate for Heparin |
| True or False: Enoxaparin (Lovenox) is a Low-molecular weight heparin (LMWH) | TRUE (Lovenox is a LMWH) |
| Enoxaparin (Lovenox) Monitoring for Bleeding: | Guaiac stools for occult blood, Hematuria, Bleeding gums, Excessive bruising, Does NOT require activated partial thromboplastin time (aPTT) monitoring |
| LOVENOX Acronym | L (ower doses for renal impairment) O (rthopedic surgeries) dV (T phyphylaxis, immobility) lE (ave bubble in syringe) N (ever by IM, only SubQ), nO (rubbing after administered) X (out for park allergies) |
| Medications to Stop the Clotting Process | Anticoagulants (at home), Avoid bleeding with anticoagulants (Use electric razor, Reduce foods high in Vitamin K to help effectiveness of medication management, Watch for signs of abnormal bleeding/bruising, Have blood drawn to monitor effects |
| aPTT for Heparin | 60-80 seconds for our Heparin |
| Warfarin Sodium (Coumadin) is used to- | -prevent clot formation with DVT, PE, Atrial fibrillation, TIA, and Coronary occlusive problems |
| An overdose of Coumadin can cause- | -Hemorrhage, Headache, Bruising, Back pain, Increased pulse, and a Decreased BP |
| Warfarin is used for- | -Long-term prophylaxis |
| Prophylaxis | Action taken to prevent disease |
| WARFARIN Acronym | W (atach PT and platelet count) A (ssess VS) R (eview bleeding protocol) F (oods to avoid: Inc Vit K) A (void ASA; may use acetaminophen) R (eview antidote) I (NR=2-3) N (ote: many drug interactions) |
| Treatment: Toxic Effects of Warfarin | Discontinue the warfarin, May take 36-42 hours to reverse effects, Vitamin K antidote, High doses of Vitamin K (10 mg) given IV will reverse the anticoagulation within 6 hours) |
| IV Vitamin K puts at risk of anaphylaxis, BUT- | -Risk is diminished by diluting it and giving it over 30 minutes |
| True/False: Warfarin is Safe for Pregnancy | False (Warfarin is not safe for pregnancy) |
| True/False: Heparin is Safe for Pregnancy | True (Heparin is safe for pregnancy) |
| Antidote for Warfarin: | Vitamin K and Fresh Frozen Plasma |
| Antidote for Heparine: | Protamine Sulfate |
| What to Monitor with Warfarin? | INR is monitored with Warfarin |
| What to Monitor with Heparin? | aPTT is monitored with Heparin |
| Vitamin K Rich Foods | Asparagus, Beans, Broccoli, Brussel sprouts, Cauliflower, Green tea, Kale, Milk, Cabbage, Spinach, Yogurt |
| Anticoagulants for Atrial Fibrillation | Rivaroxaban (Xarelto) and Dabigatran (Pradaxa) |
| Rivaroxaban (Xarelto) and Dabigatran (Pradaxa) Prevent- | -Stroke, Have a rapid onset, Fewer bleeding problems, Fixed oral dosage, Fewer drug iteractions |
| With Dabigatran; Rivaroxaban; Apixaban; Edoxaban we must teach the patient to TAKE a- | -missed dose as soon as possible, but not within 6 hours of next scheduled dose |
| With Dabigatran, after the container is opened, the medication should be- | -Used within 30 days; It is sensitive to moisture and should not be stored in weekly pill organizers, Take with food |
| Anti-Platelets are Used for Treatment of- | -Prevention of blood clots, Stroke, Heart attack, and other vascular events |
| Anti-Platelet Side Effects | Bleeding and/or bruising (Same as Anticoagulant) |
| Antiplatelet Medications Prevent- | -Platelets from clumping together to form clots |
| Examples of Antiplatelet Medications | Aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat) |
| Antiplatelet Promise | Promise in increasing survival rate of heart attack if taken with initial symptoms, Promise in preventing subsequent heart attacks |
| So... with new purpose and strength she became... ASPIRIN WOMAN! New antipower (Aspirin indications) | Anti-inflammatory, Antipain (mild to moderate), Antipyretic, Antiplatelet aggregation |
| With Aspirin we Watch For: | Bleeding tendencies, Tinnitus, Stomach pain, and Renal impairment |
| Use of Aspirin in children with recent history of viral infection has been associated with- | -Reye syndrome (acute increase of pressure in the brain and other organs) |
| Aspirin potential for toxicity is higher in- | -Older adults and children |
| When Platelets gather together, use ____ for crowd control | Clopidogrel (Plavix) (Inhibits platelet aggregation. Is used to decrease the incidence of vascular clotting, MI's, Stroke, and Acute coronary syndrome |
| Clopidogrel (Plavix) (antiplatelet) should be HELD at least 1 _____ before surgery | 1 Week (before surgery) |
| Antifibrinolytic medications help to- | -FORM clots when patient is hemorrhaging, Provide hemostasis (stop bleeding) |
| Examples of Antifibrinolytic | Aminocaproic acid (Amicar) and Tranexamic acid (Cyklokapron) |
| Clot Busters: Thrombolytic Medications can- | -Dissolve blood clots |
| An Embolus clot that breaks loose and travels can cause: | MI, CVA, or Pulmonary embolus |
| Symptoms of DVT | Pain and swelling of extremity |
| Thrombolytic Drug Indicated for: | Acute MI, Arterial thrombolysis, DVT, Occlusion f shunts or catheters, Pulmonary embolus, Acute ischemic stroke |
| Tissue Plasminogen Activator (tPA) | Given IV for acute stroke, Frequent testing required to monitor clotting times (PT, aPTT), International Normalized Ratio (INR) |
| Thrombolytic: Alteplase (tPA) is used for | MI, Ischemic stroke, and Pulmonary emboli (Medication used for) |
| Tenecteplase (TNKase) and Reteplase (Retavase) are used for: | ONLY MI (Medication used for) |
| Thrombolytics are Administered ______ after the event for better outcome, preferably within 2-4 hours | IMMEDIETELY (Thrombolytics) |
| A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Explain why. | The heparin provides anticoagulation until therapeutic levels of warfarin are reached |
| Hematopoietic Stimulant Medications- | -Stimulate the growth of blood cells |
| Hematopoietic Stimulant Medications are Used to Treat: | Anemias (Sickle cell and pernicious anemia's), Low blood iron levels, Patients on chemo |
| What patients have a lowered blood level due to bone marrow suppression? | Patients who are on Chemotherapy |
| Hematopoietic Stimulant Medication Examples: | Ferrous sulfate (Taken orally for iron deficiency), Cyanocobalamin (Injection for those with pernicious anemia) Filgrastim, pelfilgrastim, and sargramostin Stimulate blood cell development |
| Taking Iron Supplements, we watch for: | Tarry stools, Nausea, Bloating, Constipation, Heartburn |
| Iron poisoning can be FATAL to ____ ____ | Young Children (store iron out of reach and in childproof container) |
| What Vitamin promotes the absorption of iron supplements? | Vitamin C (ascorbic acid) promotes absorption of iron (Orange juice) |
| What do you NOT give with Iron Supplements? | Do NOT give with antacids or tetracyclines, or crush or chew sustained-release medications |
| Liquid iron supplements can discolor teeth, so recommend- | -drinking with a straw (or dilute) |
| Iron Rich Foods | Liver, Eggs, Meat, Fish, and Fowl |
| Epoetin (iron) Alfa (Procrit) is a synthetic- | -erythropoietin, which increases RBC's, Used to treat anemia with renal failure and chemo |
| With Epoetin (iron) Alfa we Watch for: | Hypertension, Headache, and Nausea (Epoetin) |
| What do we MONITOR with Epoetin (iron) Alfa? | Monitor the BP and CBC with differential: maintain serum iron at normal level-Watch those platelets!, GIVEN SUBQ OR IV |
| Cardiac Events you can see as a side effect when taking Epoetin (iron) Alfa (Procrit) | Cardiac arrest, HF, Thrombotic events (Stroke, MI) |
| DO NOT SHAKE THIS SOLUTION | Epoetin (iron) Alfa is a solution that should NOT be shook; it may denature the glycoprotein. (Do NOT mix with other medications)(Seizure precaution) |
| Types of Blood Products: | Packed Red Blood Cells, Platelets, Cryoprecipitate, Fresh Frozen Plasma |
| We do NOT give a blood transfusion UNLESS they are below- | -below 7 g/dl (<7.0 g/dl) |
| Platelets are given when someone is- | -when someone is Thrombocytopenic(not enough platelets) (<50k/microliter) |
| We can give Cryoprecipitate when- | -there is a major hemorrhage (Fibrinogenemia is a protein involved in forming blood clots) |
| Blood Administration Process: PREPARATION | Supplies, VS, Verification, Education |
| Blood Administration Process: ADMNISTRATION | Independent Double Check (one alone each time), Stay with patient 1st 10-15 minutes, Monitor for reaction, VS after first 10-15 minutes |
| Blood Administration Process: OBSERVATION | After initial 10-15 minutes, monitor per policy, Final set of VS post-transfusion, Pass on in report |
| Transfusion Reactions | Most common in first 10-15 minutes, Treat similarly to Anaphylaxis, Can happen within 24 hr Post-Transfusion, Risk inc. with subsequent transfusions |
| What kind of solution do we give with Blood Transfusions? | Normal Saline (ALWAYS) --> Primary, Blood is B-Port (tubing) |
| Is there a consent needed for a patient to get blood? | YES (there is required consent, Doctor/Nurse/Patient sign), Explain the different kinds of toxicity (SOB, Headache, Itch, Back Pain (kidney area), RR, Temperature, Vital spike |
| How often do we return to the patients room to ask about side effects after a Blood Transfusion? | Return every 30 minutes (Advise to let you know if anything changes) |
| How long can blood be transfused until it is no longer viable? | 4 hours (from time it was released from the blood bank) |
| First thing we do before treating a Blood Transfusion Reaction | STOP THE BLOOD |
| Massive Transfusion Protocol | Protocol created to rapidly replace blood and blood products in a patient with acute blood loss (Trauma, Surgery, Hemorrhage) (SIMILAR TO CODE BLUE) |
| What kind of blood is transfused to decrease the risk of a reaction? | O- blood to decrease the risk of a reaction |
| Key Points of Blood Transfusion: | 1. Types of Products 2. Transfusion Reactions 3. Blood Safety 4. Continued Monitoring |
| The Gastrointestinal System: ALEMENTARY CANAL | Begins at mouth and ends at anus |
| The GI System is Responsible for: | Ingestion, Digestion, Absorption, Excretion |
| The GI System: DIGESTION | Process of converting food into chemical substances used by the body |
| The GI System: PERISTALSIS | Wavelike movements in a small and large intestine that push food through |
| If the GI Process is impeded- | -toxic substances can build up, leading to infection |
| The stomachs environment is HIGH in- | -Hydrochloric Acid (HCl) (Helps break down food for absorption) |
| Reflux is a backflow of- | -Backflow of HCl (Can lead to ulcers (mucosal breakdown)) |
| When treating the GI System, we- | Treat specific GI system disorders, Control S/S of the GI System, Increase/Decrease the function of the system, Timing of medication is important |
| Assessment Findings of GERD: | Burning sensation behind breastbone (heartburn), Chest pain, NV, Dysphagia (diff. swallowing), Coughing, Wheezing, Weight loss |
| Diagnostics for GERD | Upper Endoscopy, pH testing of emesis, EKG to rule out cardiac source of chest pain |
| Nursing Priorities for GERD | Promote comfort, Patient Education, Optimize Nutritional Status |
| Therapeutic Management of GERD | Diet & Lifestyle changes (Weight loss, Avoid irritant foods), Smoking Cessation (Don't lay down within 2 hours of eating, Elevated HOB when sleeping) |
| Medication Therapy for GERD | Proton Pump Inhibitor, Antacids, H2 Antagonist, Erythromycin (improves gut motility) |
| GERD | Cardiac Sphincter is loose, allowing acid to move upward into esophagus causing irritation and damage |
| Antacids | Decrease hydrochloric acid (HCl) in stomach, Relieves pain and destruction, Most do NOT alter pH of body, Contain aluminum, calcium, magnesium, sodium, or combination |
| What Antacids are sold OTC? | Tums and Rolaids are OTC antacids |
| Stomach Acid Reduced Used for Treatment of: | Acid reflux, Prevention of ulcers |
| Side Effects of Stomach Acid Reducers | Stomach upset, Headache, Diarrhea, Constipation (SAR) |
| Proton Pump Inhibitor Drugs and pH | Reduce the acidity of the stomach by binding stomach enzymes; short-term treatment for GERD, Inhibit hydrogen and potassium ions , SHORT-TERM TREATMENT (4-8 week use ONLY) |
| Side Effects of Proton Pump Inhibitor Drugs (pH) | Abdominal pain, Headache, Constipation, Diarrhea, and Nausea (PPID) |
| Examples of Proton Pump Inhibitor Drugs (pH) | (-prazole) Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec) All PO or IV |
| Long-Term Use of Proton Pump Inhibitor Drugs can put a patient to the risk of- | -osteoporosis and fractures (PPI) |
| Proton Pump Inhibitors should be used with- | -Vitamin D and Calcium, and take before meals (Without meals), Lowest dose possible |
| Gastric Stimulants (Prokinetic agents) | Decrease esophageal sphincter pressure and increase gastric emptying |
| Gastric Stimulants (Prokinetic agents) are used if patient is at risk for- | -aspiration of stomach contents (GS) |
| Example of Gastric Stimulants (Prokinetic agents) | Metoclopramide (Reglan) IV, IM, or PO |
| Side Effects of Gastric Stimulants | Drowsiness, Restlessness, Headache, Dry mouth |
| Peptic Ulcers | Hydrochloric acid (HCl) may erode mucosal layer leading to peptic ulcer or duodenum |
| Patients at risk for Peptic Ulcers | Type O Blood, Cigarette smokers, H. pylori infections, Difficulty dealing with stress |
| An ULCER is a- | -Perforation of the mucosa |
| Medications Used to Treat Peptic Ulcers | Antibiotics (Fight H. Pylori bacterium (causes 75% of gastric ulcers and 90% duodenal ulcers) |
| Antibiotic Medications Used to Treat Peptic Ulcers | Amoxicillin (Amoxil), Clarithromycin (Biaxin), Metronidazole (Flagyl), Tetracycline |
| Antipasmodics | Decrease secretions and gastric mobility, reduce gastric spasms |
| Examples of Antipasmodics | Dicyclomine (Bentyl): PO, IM Glycopyrrolate (Robinul): PO, IM, IV |
| H2 Receptor Antagonist | Block histamine, thus prevent secretion of HCl |
| H2 Receptor Antagonist Examples | (-tidine) Cimetidine, Famotidine, Nizatidine (NOT given within 1 hour of antacid) |
| Signs of Hypomagnesemia | Muscle cramps, Seizures, Tremors, Dysrhythmias |
| Zantac, Acid, Pepcid, & Tagamet help with | -Painful duodenal ulcer and bury gastroesophageal reflux |
| H2-Receptor Antagonist (H2RA) may cause a Decrease in stomach acid, which may- | -may increase growth of Candida and bacteria in the stomach |
| H2-Receptor Antagonist Side Effects: | Diarrhea, Confusion (H2) |
| Mucosal Protectants | Cover and protect ulcer, Taken on empty stomach, 30 minutes before or after antacids (NEVER WITH) |
| Mucosal Protectant Example | sucralfate (Carafate) |
| Mucosal Protectant Side Effects: | Dry mouth, Headache, Drowsiness, Dizziness, and Constipation (MP) |
| Aluminum Hydroxide | Reduces acid concentration and pepsin activity by raising pH of gastric secretions |
| Aluminum Hydroxide binds to- | -binds to Tetracyclines, Warfarin, and Digoxin and may reduce their effect |
| With Aluminum Hydroxide we Monitor: | Monitor serum calcium, phosphate, magnesium, and sodium levels |
| Aluminum Hydroxide is taken- | -before meals when stomach acidity is highest |
| Medications to Treat Nausea and Vomiting (Antiemetics) | Decrease nausea and vomiting (emesis) and treat motion sickness |
| Phenothiazines | Block dopamine receptors that stimulate comiting, For chemotherapy-associated N&V |
| Phenothiazine Examples | (-azine) Chlorpromazine, Prochlorperazine (Prescription only) |
| 5-Hydroxytryptamine-3 Receptor Antagonist | Used to prevent and treat nausea and vomiting associated with chemotherapy, Block chemical serotonin produced in brain and stomach |
| Examples of 5-Hydroxytryptamine-3 Receptor Antagonist | (-setron) Dolasetron (Anzemet), Ondansetron (Zofran), Granisetron (Kytril), Palonosetron (Aloxil) (Prescription only) |
| Anti-Nausea used for Treatment of: | N&V (AN) |
| Side Effects of Anti-Nausea | Drowsiness, fatigue, headache, confusion (AN) |
| ondansetron (Zofran) (Serotonin Receptor Antagonist) Used for | Food poisoning, Chemotherapy, Gallbladder problems, Gastritis, Intestinal obstruction, Postoperative nausea |
| Antihistamines | Block signals to the brain's movement center, Tend to work best on nausea associated with motion sickness |
| OTC Antihistamines | Dimenhydrinate (Dramamine), Diphenhydramine (Benadryl), Meclizine (Antivert) |
| Prescription Antihistamine | Promethazine (Phenergan) |
| Anticholinergic Medications | Block effects of acetylcholine, which can stimulate vomiting |
| Prescription Anticholinergics | Trimethobenzamide (Tigan), Scopolamine (Scopace) |
| Scopolamine is a- | -Transdermal disk placed behind ear prior to exposure to motion sickness |
| Promethazine (Phenergan): Prescription Antihistamine is used for | Motion sickness, Vertigo, N&V, Postoperatively and from Chemotherapy |
| With Promethazine (Phenergan): We watch for: | Drowsiness, Restlessness, Hypotension, Confusion, Urinary retention, RESPIRATORY STATUS |
| Laxatives/Stool Softeners are Used for Treatment of: | Constipation (L/SS) |
| Side Effects of Laxatives/Stool Softeners | Nausea, Cramping, Diarrhea, Bitter taste (L/SS) |
| What is Constipation? | Infrequent, hard stool, Occurs when peristalsis slows, Diuretics can contribute |
| Medications to Treat Constipation | Laxatives (Bulk-forming, osmotic, stimulants, stool softeners), and Cathartics |
| Laxatives promote a ______ stool, Cathartics can have a ______ / ____ | Soft, Soft-Watery stool (With cramping) |
| When would we NOT use Laxatives/Cathartics? (Stool softeners) | IF THERE IS AN OBSTRUCTION (will NOT help and will likely require surgery) |
| Psyllium (Metamucil) | Bulk-forming laxative, Acts similar to dietary fiber, Does NOT digest or absorb, Keeps water in stool |
| TRUE/FALSE: Metamucil is meant for Long-term Treatment | FALSE: Metamucil is meant for Short-term Treatment, Administer at least 2 hours before or after medications |
| When using Laxatives we Instruct the patient to- | -drink at least 8 ounces of water after each dose and drink at least 6-8 glasses of water each day to facilitate peristalsis and to prevent obstruction (Bowel movement in 12-36 hours) |
| Stool Softeners | Decrease consistency of stool, Attract water and fat to the stool to soften, Used in bedridden patients or those with limited mobility |
| Stool Softener Example: | Docusate sodium (Colace) |
| Laxatives | Help promote bowel movements, Bulk-forming laxatives (Increase bulk and water, Come as power to be added to liquid, capsules, or a wafer to be eaten |
| Laxatives take ____ hours to ____ days to work | 12, 3 |
| Example of a Laxative: | Psyllium (Metamucil) |
| Lubricant Laxatives | Increase water to fecal mass to ease passage of stool (Suppositories) , Takes 6-8 hours to work |
| Osmotic Laxatives | Draw water INTO the stool and irritate the bowel to increase peristalsis (To make the body work hard to get it out) |
| Osmotic Laxative Examples: | Lactulose, Salt/Saline/Glycerin , Magnesium citrate |
| What do we do for bowel preps? | Colostomy (To look at bottom part of bowel) |
| Stimulant Laxatives | Stimulate peristalsis by irritating the bowel, Effective within 6-8 hours, Short-term use for constipation due to opiate use or slow GI tract |
| Examples of Stimulant Laxatives: | Bisacodyl, Castor oil (NOT to be used in pregnancy or lactation) |
| Side Effects of Stimulant Laxatives | Cramp, Diarrhea, Flatulence, Nausea (SL) |
| Castor oil may cuuse- | -premature labor or diarrhea in breastfed infant |
| Bowel Evacuators | Cleansing solutions used before diagnostic tests to remove stool, Patients drink 1 gallon of fluid mixed with medication within 2-3 hours |
| Side Effects of Bowel Evacuators | Bloating, Nausea, Fullness (BE) |
| Examples of Bowel Evacuators | Polyethylene glycol electrolyte solution, Polyethylene glycol 3550 |
| Lactulose is good for when your- | -liver is NOT working right, and helps flush the ammonia out of the GI tract (osmotic laxative) |
| Side Effects of Lactulose (Osmotic Laxative): | Belching, Abdominal distention, Flatulence, N&V, and Diarrhea (Check ammonia labs) (LL) |
| Diarrhea is a- | -symptoms, not a disease |
| Opioid-Related Antidiarrheals | Used for most serious cases, Inhibit GI motility, Decrease peristalsis, Slow function of the GI system |
| Examples of Antidiarrheals | Loperamide (Imodium): Oral medication available in differing strengths, both OTC and prescription Diphenoxylate with atropine (Lomotil): Oral prescription medication |
| Absorbents | Taken after every bowel movement to absorb toxins or bacteria and coat walls of GI tract |
| Absorbent Examples | Bismuth (Pepto-Bismol): Stools, tongue may turn black Kaolin and pectin (Kaopectate) |
| Normal interaction of Bismuth (Pepto-Bismol) and sulfide in GI tract causes- | -black color of stool and tongue with Pepto-Bismol use |
| Antibiotics: Used for Traveler's Diarrhea | Ciprofloxacin (Cipro), Ofloxacin (Floxin), Azithromycin (Zithromax Z-Pak) |
| Traveler's Diarrhea is caused by- | -exposure to water or contaminated food in foreign countries causing bacterial, viral, or parasitic infections (Most common bacteria of cause is E. coli) |
| Hemorrhoids | Swollen varicose veins in the rectal area |
| Fissures | Cracks in the area of Hemorrhoids |
| How to treat Fissures (Crack near hemorrhoid) | Anorectal preparations used to decrease swelling and sooth cracks |
| Medications to Treat Hemorrhoids | Pramoxine/phenylephrine/glycerin/petrolatum (Preparation H): Topical to shrink swelling Pramoxine combined with zinc oxide (Anusol, Tucks): Numbs pain and itching, promotes healing |
| Flatulence | Gas released by GI tract |
| Treating Flatulence | Dietary changes may help, Most available OTC and all are oral medications |
| Medication to Treat Flatulence | Simethicone (Gas-X, Mylicon) |
| Syrup of ipecac | Induces vomiting in 80% to 90% of patients with 20-30 minutes, Controversial use at present time, May cause more harm than good |
| Activated charcoal | Attracts toxin and inactivates poison, Poison excreted in the stool |
| Medications to Induce Vomiting and Treat Drug Overdose | Syrup of ipecac, Activated charcoal (IVTDO) |
| Digestants are used for people who have- | -difficulty digesting food due to: Food allergy, Genetic disorder, Lactaid for lactose intolerance, Digestive enzymes (Enzymatic Digestant Oral) for patients with cystic fibrosis |
| Mouthwashes and Other Oral Treatments | Mouthwashes, Mary's Magic Mouthwash, Fluoride, Saliva substitutes, Oral topical anesthetics |
| Halitosis | Bad breath |
| Stomatitis | Inflammation of the mouth |
| Fluoride preparations prevent- | -tooth decay |
| A Well-Balanced Diet should consist of- | -Proteins, Fats, Carbohydrates, Vitamins, Minerals, Amino acids, Lipids |
| Supplements are used if a patient is unable to- | -maintain a healthy diet |
| Supplements which can be Prescribed: | Powders, Capsules, Lipids, Tablets |
| Organic Vitamins | Carbon-containing nutrients, Essential to regulate chemical processes in the body, Recommended daily allowances (RDA's), Deficiencies lead to illness, Megadoses can lead to illness or death |
| Which Vitamin is more beneficial for our immune system? | Vitamin D (Sunlight, OJ) |
| Vitamin Doses vary based on- | -based on Age, Sex, and sometimes Health conditions |
| Urine color changes with Vitamins | Bright yellow, Strong odor, If dosage is within recommended range this is NOT a concern |
| What health issues would be a concern with too large Vitamin dosages? | Kidney, Liver, Heart, Nerve Damage. Bladder/kidney stones, Increased risk of diabetes and gout (VD) |
| Fat-Soluble Vitamins | Stored in fatty tissue, NOT excreted, Can build up to toxic levels |
| Fat-Soluble Vitamin: A | Healthy skin, teeth, bone and soft tissue, essential for vision, reproductive and immune health (A) |
| Fat-Soluble Vitamin: D | Healthy development of bone and retention and absorption of calcium and phosphorus (D) |
| Fat-Soluble Vitamin: E | Formation of red blood cells and muscles, supports immune system (E) |
| Fat-Soluble Vitamin: K | Essential to clotting of blood (K) |
| Vitamins A, D, and K are stored in the- | --liver (ADK) |
| Vitamin E is spread throughout- | -fatty tissue (E) |
| Water-Soluble Vitamins | B-Complex (B1,2,3,4,5,7,9,12) Thiamine, (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5), Pyroxidine (B6), Biotin (B7), Folic acid (B9), Cobalamin (B12) |
| Water Soluble Vitamins are NOT- | -NOT stored; ARE excreted by body, NEED to be ingested daily |
| Vitamin B-Complex Support- | -Supported the immune and nervous system, Improve metabolism, Maintain healthy skin and muscles, Help with stress, depression, and cardiac disease |
| Vitamin C: | Ascorbic acid, (Production and maintenance of connective tissue, bones, and teeth |
| Minerals are- | -Important to health and maintenance of body's biological processes, Required for almost every single function in body, Act as catalysts for essential vitamins |
| Major Minerals (Needed in large amounts) | Calcium (Bone, Magnesium, Phosphorus, Potassium (Heart), Sodium, Chloride |
| Some Major Miners can be- | -DANGEROUS when: Taken in the wrong quantity, When interacting with medications (St. John's wort), Affects the way the liver metabolized some meds, Can make hormonal birth control less effective, Discuss herbal use |
| Administration Routes for Major Minerals | Tablets, Teas, Roots, Topical applications, Aromatherapy, Burned and aroma inhaled |
| Vitamin B12 (Cobalamin Deficiency) | Anemia or nervous system injury from lower than normal amounts of Vitamin B12 |
| Treatments for Vitamin B12 Deficiency | Dietary changes, B12 shots, or supplements |
| potassium chloride (IV and PO) | Watch potassium levels, "Life hangs in the potassium balance" |
| Side effects of potassium chloride (IV and PO) | GI discomfort-nausea, vomiting, diarrhea |
Created by:
AdrianMtz42