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pharm exam3 4-2

pharm exam 3 4-2

Differentiate between acute and chronic pain Acute: Sudden onset, usually subsides when treated; Chronic: persistent or recurring, lasts 3-6 months, often difficult to treat
Identify priority nursing assessments prior to administration of morphine Respiratory, Bowel Sounds, Pain Allergies, liver/kidney function, orientation, VS, Cardiac
Identify priority nursing intervention following administration of morphine Have Naloxone (narcan) available emerg equip ready or assisted vent. Monitor inj site for extravasation, Monitor resp status, comfort/safety Bowel program, Reassure risk of addiction is minimal, pt void before d/t urinary retention
Identify education measures for oxycodone (Oxycontin) Tolerance,dependence&addiction,no drive.No alcohol or CNS depr,take before pain is out of control, Safety measures,help w/ambulating,patches – rotate sites , do not crush, cut or chew tablet d/t entire dose is released at once, Wait 4-6 hrs to breast feed
Describe appropriate measures for administration of acetylcysteine (Mucomyst) Nebulizer or by direct into trachea. Give orally to protect liver from acetaminophen toxicity Do not combine other drugs, Dilute concentrate with sterile water for inj, Wipe face mask and face with plain water to prevent breakdown, Rinse mouth
Identify indications for giving anticonvulsants with and without a history of a seizure disorder Barbiturates can be used for seizures, anxiety, and insomnia, and pre-anesthesia, tetanus, eclampsia, meningitis, tonic-clonic.
Identify indications for giving anticonvulsants with and without a history Benzodiazepines can be used for seizures, Anxiety, alcohol withdrawal, muscle relaxant, antiepileptic, antitetanus, preoperative anxiolytic
Identify indications for giving anticonvulsants with and without a history Hydantoins can be used for tonic-clonic seizures, prevention of short-term status epilepticus,
Identify indications for administration of dantrolene (Dantrium) Direct acting skeletal muscle relaxant, Prevention/tx of malignant hyperthermia, Affects peripheral muscle contraction & spascity associated with neuromuscular diseases (not for musculoskeletal or rheumatic disorders), Dantrolene acts within muscle fibers
Identify indications for giving anticonvulsants with and without a history Succinimides for absence seizures, Some drugs that are used for seizures are also used for neuropathic pain
Identify antidote for succinylcholine Dantrolene, Depolarizing NMJ blocker, Cholinesterase inhibitor
Identify priority nursing interventions prior to administration of vecuronium Have emergency equip ready (mechanical ventilation, heart etc), sedate pt before admin,Do not mix with any alkaline solutions, Monitor temp for malignant hyperthermia, peripheral nerve stimulator
Identify indications for the use of diazepam (Valium) Anxiety, alcohol withdrawal, muscle relaxant, antiepileptic, antitetanus, preoperative anxiolytic
Identify side effects of Phenobarbital CNS- somnolence, insomnia, vertigo, nightmares, nervousness, hallucinations, anxiety, CV – dizziness, bradycardia, hypotension, syncope, Respiratory – resp depression, hypoventilation, GI – N/V, Other- tissue necrosis at injections site, withdrawal syndr
Identify nursing interventions for a client with barbiturate overdose No antidote, Interventions should be directed at symptomatic and supportive care, Maintain adequate airway, Assisted ventilation/oxygen therapy, Fluids, Pressor support (BP), Activated charcoal
Identify contraindications for the administration of barbiturates pt with GI probs, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism or hyperthyroidism. No preg/lactation, Used rarely d/t s/e & drug-drug interactions, Used for relief of bronchial asthma, bronchospasm associated with COPD
Identify indications for administration of eszopiclone (Lunesta) Hypnotic – used for insomnia
Identify conditions that would necessitate caution with the use of caffeine Use in any pt with GI probs, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism or hyperthyroidism. No preg/lactation, Used rarely d/t s/e & drug-drug interactions, Used for relief of bronchial asthma, reversal of bronchospasm
Identify nursing education for the administration of Ritalin Ensure diagnoses before starting therapy, Take before 6pm, Safety measures such as side rails & assistance w/ambulation, Avoid caffeine, If you miss a dose take as soon as you remember but do not double dose, May cause growth suppression in children
Identify nursing assessments prior to the administration of Ritalin Hypersensitivity/allergies, Liver/kidney function, VS, Cardiac, Urinary output, Hx of contraindications (hypersensitivity, marked anxiety, agitation, tension, severe fatigue, glaucoma, hx of seizures, drug dependence, alcoholism, hypertensi
Identify side effects of ergot derivatives CNS- numbness & tingling, muscle pain, CV- pulselessness, weakness, chest pain, arrthymias, MI, localized edema & itching, GI – upset, N/V, diarrhea, Ergotism – syndrome causes n/v, severe thirst, hypoperfusion, chest pain, BP changes, confusion, drug dep
Identify education measures related to the administration of Triptan injections Administer first sign of headache, Arrange for safety precautions, Comfort measures-dark room, Monitor blood pressure, Notify Dr for adverse effects, avoid driving, Avoid overdose, Not used for prevention, tx only
Identify appropriate administration techniques for administration of phenytoin (Dilantin) Give with .9 NS to avoid precipitation; do not combine with other meds (cant mix), Check BS if diabetic, Take w/food if GI upset (oral doses), CHECK DRUG LEVELS, Therapeutic level is 10-20mcg/L
Identify education measures for the administration of zolpidem (Ambien) Take tablet whole before bed, Allow 8 h for sleep, Safety – help getting out of bed, Elderly – half dose effective, No IV for children or oral for children <12
Identify indications for the administration of gabapentin (Neurontin) Partial seizures medicine that blocks stimulus increases, PO only 3 times a day in DIVIDED doses, Take with food, Lab – Liver/Renal/CBC tests , Used as adjunct in treating partial seizures, treatment of postherpetic pain in adults and children ages 3-12;
Identify indications for the administration of buspirone (Buspar) Reduces s/s of anxiety w/out severe CNS & adverse effects, Used for PMST, Use caution in liver & renal pts, elderly. Can cause dry mouth & HA
Identify drug reactions related to amitriptyline (Elavil)Tricyclic antidepressant MAOIs-risk of severe hyperpyretic crisis w/convul, hypertensive episodes &death cimetidene, fluoxetine,or ranitidine inc in TCA level, anti-coag=higher levels of anti-coag-inc risk of bleeding, w/sympathmim or clonidine increased heart affects
Identify drug reactions related to administration of St. John’s wort MAOI/SSRI’s risk of severe reaction, incr sensitivity to light, Serotonin syndr: delirium, tachycardia hyperreflexia, shiver,agitat,sweating,muscle spasms, tremors;severe:hypertherm,seizures renal, rhabdomyolysis, dysrhythmias, DIC (blood clotting prob)
Identify priority nursing assessments after administration of selective serotonin reuptake inhibitors (SSRI) No antidote. Watch for serotonin syndrome, suicidal thoughts, pregnancy,&renal/hepatic impairment. Serotonin syndr is when too much serotonin -causes symptoms that can range from— shivering and diarrhea — to severe muscle rigidity, fever&seizures, death
Identify education measures related to selective serotonin reuptake inhibitors (SSRIs) Recognize behavioral changes that may indicate suicidal ideation, Do not stop abruptly, Limit caffeine intake, No Alcohol, May take 4 weeks for therapeutic effects, Caution w/driving, Use barrier contraceptives
Identify dietary restrictions for the client taking a Monoamine Oxidase inhibitor Tyramine foods or pressor amines causes hypertensive crisis; Types of tyramine foods: Aged, mature cheese (cheddar, blue, swiss), Smoked or pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, fava beans
Identify common side effects of antidepressants Dry mouth, n/v/d, constipation, change in sexual function, thoughts of suicide, orthostatic hypotension, arrhythmias, angina, change in weight, flushing, chills, nasal congestion. Others: Sedation, sleep disturbances, fatigue, hallucinations, disorientati
Identify side effects related to the use of nasal decongestants Local burning, stinging, irritation, Dryness of mucosa, HA, Increased risk for infection, Adrenergic effects – nervousness, insomnia, palpitations, tremors, Steroidal – local mucosa dryness & irritation, Rebound congestion if used greater than 3-5 days
Identify indications for the use of guaifenesin (Humibid) Relief of productive cough for common cold, acute bronchitis, influenza, resp conditions characterized by dry non productive cough, Increases productive cough to clear airways & liquefy lower resp tract secretions
Identify benefits of the herbal supplement Echinacea Reduces symptoms of common cold & recovery time, A/E – dermatitis, GI disturbance, Dizziness, HA
Identify common side effects of theophylline Related to theophylline levels in the blood (therapeutic level 10-20 mcg/ml), >20-25 = N/V/D, insomnia, HA, irritability, >30-35 = hyperglycemia, hypotension, arrthymias, tachycardia, seizures, brain damage or death! Other symptoms: restlessness, dizzines
Identify nursing interventions for the client experiencing side effects of theophylline w/food for GI upset, Monitor response to drug , comfort incl rest periods, quiet enviro, no caffeine, blood tests for serum levels, No smoking as it incr blood level, If quits smoking must be monitored for therap blood levels d/t severe xanthine toxicity
Identify education measures for use of a metered dose inhaler Rinse mouth after application to reduce fungal infections or other issues, Hold for 10 secs in lungs after inhaling, Breath out, then breath in med
Identify common side effects of inhaled steroids Sore throat, hoarseness, coughing, dry mouth, pharyngeal & laryngeal fungal infections, Infection risk!
Identify indications for the use of lorazepam (Ativan).(benzodiazepine) First choice for status epilepticus , Anxiety disorder, Alcohol withdrawal, Hyper excitability & agitation, Pre-operative anxiety
Identify education measures related to administration of sulcralfate (Carafate) coats stomach for PUD, stress ulcers, Administer on empty stomach 1hr before or 2 hrs after mealtimes and at bedtime, Monitor for GI pain (use antacids for pain), Administer antacids or antibiot between doses of sulcrafate not w/in 30 mins
Identify adverse reactions related to the administration of sodium bicarbonate Gastric rupture, systemic alkalosis (HA, Nausea, irritability, weakness, tetany, confusion), hypokalemia (intracell shift of K+),gastric acid rebound (stomach produces more acid d/t alkaline environ, HF & fluid retention
Identify mechanism of action of Lithium salts Anti-manic drug/Bipolar, Alters sodium transport in nerve & muscle cell (competes w/sodiujm for reabsorption in proximal renal tubules), Inhibits release of norepinephrine & dopamine
Identify side effects of Requip anxiety, nervousness, HA, malaise, fatigue, confusion, mental changes, blurred vision, muscle twitching, ataxia, increased hand tremor, dizziness, numbness, weakness, agitation, Nausea, dry mouth, anorexia, dysphagia, urinary retention, increased sweating
Identify education measures related to cyclobenzaprine (Flexaril) Additional relief measures – massage, stretching, heating pad, biofreeze, PT, Taper slowly (do not abrubtly stop), Give with food to reduce GI upset, No alcohol or other depressants, Safety, Change positions slowly if dizzy, Bowel program, Avoid OTC drugs
Identify education measures related to the administration of esomeprazole (Nexium) Proton pump inhibitor – suppresses secretion of HCL, take 30-60 minutes before meals, swallow hole, safety & comfort measures d/tCNS effects, Monitor for diarrhea or const, ssmall frequent meals, Get follow-up care (might be masking serious disease
Created by: rivabard