1231 Final BP

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Special Teaching about expectorants:

pt should be aware that these drugs will make sputum more liquid, use a humidifier and drink at least 2qts of water daily. This will help get mucus out. Notify if cough is present w/high fever, or persistent HA or if cough returns!

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Decongestents along with HTN

Decongestants increase BP and HR

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Antitussives may cause

drug dependence. Some are Schedule 2 Controlled Substances. They should only be used a short time.

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Give oral doses of antihistamines with

meals or milk to limit GI s/e.

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Start the amount of dose of antihistamines as

low as tolerated and needed. With ELDERLY start low and stay low.

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Antihistamines have what kind of effect on the CNS

Sedative effect. and it is increased when other CNS depressants are used along with antihisamines.

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How are antibiotics chosen?

depends on the infectious organism (identified by cultures or smears)

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Important Patient teaching for Differin Gel

Wash face then apply a thin film of gel once daily to affected areas. An exacerbation of acne may initially be seen; therapeutic results usually seen in 8-12wk.

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Agents that are Bactericidal

kill bacteria

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Aderse reactions to anti-infectives?

Neuropathy (nerve damage), fixed drug eruptions (single spot that itches), N/V, epigastric distress, anemia, blood dyscrasias, rash, Erythema, urticaria, angina, edema, swelling of skin and mucous membranes, laryngeal edema and anaphylaxis

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What is the treatment for active TB

Rifampin and Isoniazid - 6mo - 1 year, most be compliant

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Penicillin Action

Broad spectrum, interferes with creation of cell wall.

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Penicillin is used to

treat infections.

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Adverse reactions of Penicillin

neuropathy, fixed drug eruptions, NV, epigastric distress, blood dyscrasias, rash, urticaria, edema, anaphylaxis.

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Drug interactions of Penicillin

bacteriostatic antibiotics, bacteriocidal antibiotics, birth control produces menstrual irregularities, and unplanned pregnancies

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Thiazide diuretics

Keeps the kidneys from reabsorbing Sodium, Potassium, and Chloride. First treatment for HTN.

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Treatment for HTN diabetics

ACE inhibitors

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Special teaching for pts on antibiotics and birth control medications

Use backup contraceptive, antibiotics lessens the affects.

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Use of ampicillin and oral contraceptives together has produced

menstrual irregularites and unplanned pregnancies.

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Cephalosporin and penicillin with allergies causes

nephrotoxicity >incidence in elderly or pt w/poor renal function.

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What are broad spectrum antibiotics?

Antiinfective drugs effective against a wide variety of organisms.

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Tetracycline special teaching

take on an empty stomach, avoid sunlight, DO NOT take w/milk, grayed teeth, black hairy tongue, avoid milk iron supplements and antacids.

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Teaching needed with all antibiotic medications

Take until prescription is over, add another form of contraceptive, antibiotics provide an overgrowth of yeast, could cause superinfection and bacterial changes in bowel

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Adverse reactions to Penicillin

hypersensitivity reactions, hematological reactions, transient neutropenia, leucopenia, thrombocytopenia, bleeding can occur with high dose extended-spectrum penicillins

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Cromolyn sodium helps treat asthma by

slowing down the destruction of sensitized mast cells

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Cromolyn and nedocromil sodium, a drug with actions similar to those of cromolyn, are used to manage

bronchial asthma in some pts.

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Penicillin, amoxicillin, cloxacillin

Common Penicillins

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How do you know if aminoglycosides are working

▼BP, HR, WBC, when symptoms subside and pt starts feeling better.

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Zovirax (acyclovir) Purpose

For initial and recurrent mucosal and cutaneous HSV1, HSV2, and varicella-zoster infections in immunocompromised individuals. Severe acute and recurrent genital herpes in pts not immunocomprimised. Acute treatment of herpes zoster and chickenpox lesions.

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Zovirax (acyclovir) Dosage

Initial parenteral infusion followed by oral therapy. Dosage depends on condition, acuity, and severity. Dose is usually 800mg PO 5times daily for 7-10 days.

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Nystatin Action

Most commonly used polyene antibiotic with fungistatic or fungicidal activity. Drug may allow intracellular components to leak through fungal cell membrane by binding to sterols in cell membrane.

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Nystatin Uses

Used to treat intestinal, vaginal, and oral fungal infections caused by susceptible strains of Candida albicans and other Candida species.

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Nystatin Adverse Effects

Nausea, vomiting, diarrhea.

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What is a superinfection?

Viral infection in addition to the infection the pt is on medication for, yeast being the most common, diarrhea and other GI symptoms are common.

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When would you develop a superinfection?

Results when using broad spectrum antibiotics.

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Atineoplastic Adverse Reactions

Depend on the dose given. NV, Anorexia, and diarrhea are seen w/almost all products. Other common reactions include alopecia, and bone marrow depression. Renal tox, Hepatic tox, ototox, ocular effects, peri neurotox, and hypersensitivity are common.

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Antineoplastic agents are some of the most dangerous drugs given to pts. However, they may save the pts life, so the benefit outeighs the risk. You must always watch the

pt and look for changes that might be the onset of serious adverse reactions.

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What are common treatments for nausea associated with atineoplastic meds?

Antiemetics may be prescribed for nausea, special skin care may be needed and analgesics or narcotics may be required.

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Why get immunizations?

to Decrease chance of getting diseases

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What is PPD?

PPD: TB test, if PPD is positive you have been exposed to TB

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What are toxoids?

Part of the disease altered.

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artifically acquired passive immunity

the type of immunity you get from vaccines

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Muscle relaxants are used in treatment of

spasticity.

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Muscle relaxants Adverse Effects

nervousness, insomnia, weakness, speech disturbance, photosensitivity, urinary frequency or retention, nocturnal diuresis, erectile dysfunction, depression, seizures.

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Quinine is for

leg cramps.

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Dantrium treats

spasticitiy

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Colchicine Treats

gout. Antiinflammatory; effects specific for gout.

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Colchicine Adverse Effects

NV, diarrhea, abdominal pain

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NSAIDs treats

pain

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allopurinol prevents

gout

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Adverse reactions, side effects, and precautions to ASA

GI bleeding, ototoxicity, gums bleeding, check all products for aspirin, visual disturbances, edema

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Gout is

for of arthritis where uric acid accumulates in increased amounts in the blood and is often deposited in joints.

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Metotrexate is used for

varoius cancerous and psoriatic conditions. Decreases joint swelling and tenderness in 3-6 weeks. Has many contraindications, used for RA, malaria, abortion.

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anorectal preps: dibucaine (Nupercainal)

Pt should apply ointment morning and night after each bowel movement. For suppositories, one should be inserted after each bowel movement.

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anorectal preps: hydrocortisone acetate (anusol-HC)

contains hydrocortisone

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anorectal preps: zinc sulfate monohydrate (anusol, preparation H)

Suppository should be inserted in the morning and at bedtime for 3-6 days or until inflamation subsides; or cream may be applied to anal area and gently rubbed in 3-04 times daily for 3-6 days

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anorectal preps: hydrocortisone foam (Proctofoam-hc)

steroid used for antiinflammatory treatment of ulcerative proctitis and distal ulcerative colitis. Contains hydrocortisone. Pt would insert one applicatorful in rectum daily or twice daily for 2-3wks. Then every other day, decreasing gradually.

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Anorectal preparations include

emollients, foams, and gels for topical anesthesia or healing of the rectal area. They are used for symptomatic relief of discomfort of hemorrhoids. They may be used for short term or long term.

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Use the pain intensity scale for

adults.

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Use the wong-baker face scale for

children and pts with a language barrier.

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Flomax treats

symptoms of BPH by selective inhibition of alpha1A receptors

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Flomax Adverse Effects

postural hypotension, dizziness, somnolence, rhinitis, diarrhea, abnormal ejaculation.

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Flomax drug interactions

potentiates other alpha adrenergic blcoking agents

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Flomax Nursing Imps and pt teaching

take at the same time every day, approx 1/2 hour AFTER eating, may take 2-4wks before response is seen.

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Flomax is an alpha-adrenergic antagonist

a non-diuretic drug used to treat urinary problems

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Lopressor

anti HTN, anti-anginal, prevents MI

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Pyridium

treats UTI, orange urine

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Diuretics and hypertension

First choice for treatment

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Elderly pts are more susceptible to to the development of the adverse reactions associated with diuretics such as

postural hypotension, impaired mentation, hypokalemia (except with potassium sparing diuretics), and increased serum glucose levels.

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Lower doses of diuretics are advised in the

elderly population, with dosage increases based on the pts individual therapeutic response and/or the development of adverse reactions.

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Pts taking diuretics must be observed for symptoms of Potassium loss. This is often seen when the pt develops

muscle weakness and other symptoms of dehydration. Many pts require potassium replacement while taking diuretics and digitalis.

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Diuretics indirectly reduce blood pressure by

producing sodium and water loss and lowering the tone or rigidity of the arteries

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Zocor Side Effects

Abdominal cramps, GI problems

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Statin Medications

Hyperlipidema - lowers cholesterol

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Ativan

aka Lorazepam treats anxiety disorders

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Teaching when taking migraine meds

take with meals or milk, keep arms and legs warm, lay down in a dark room

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Elavil

antimigraine, tension HA

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Valium

aka Diazepam. Sedative, status epilepticus

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Imitrex

antimigraine

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Dilantin

treat tonic clonic and psychomotor seizure, increased ventricular force, dental care - massage gums to prevent hyperplasia.

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Aircept

used in alzheimers mild/moderate dementia

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What are some common Parkinson meds and what is the goal of treatment?

anticholinergic and dopaminergic are used to control parkinsons by changing the transmitters produced in the braine. Levedopa and Carbidopa, early signs of blephrospasms and muscle twitching.

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Elimite

pediculocyte, use again 7-10 days, use in 1-2 applications, don't use on pets and babies. report to school nurse.

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Nicotine patches special teaching

don't smoke, alternate application site

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Antipsoriatics

accelerates scaling in chronic psoriasis

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Miotic drugs

open-angle glaucoma, constricts pupils

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Mydriatic drugs

dilate pupils, contraindicated in glaucoma

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Treatment of calluses

salicylic acid

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Proparacaine

topical anesthetic used for cataract surgery

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Codeine

narcotic antitussive

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Mucomyst

(acetylcholine) antidote for acetaminophen overdose

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When to take pain meds?

First sign of pain.

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Timoptic

beta blocker that decreases intraocular pressure

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Accutane

treats severe acne, avoid sun and pregnancy

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Anticoagulants

prevent clots

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Thrombolytics

break down clots

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protamine sulfate

antidote for heparin

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vitamin k

antidote for coumadin

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coumadin (norms 1.5-2.5)

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PTT

Heparin (norms 2.5-3x the control volume)

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Protonix

proton pump inhibitor for gastric and duodenal ulcers take 1 hour before meals

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Antispasmodics and anticholinergics

work antacids in continuing the therapeutic benefits of both (irritable bile syndrome) (dry up)

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Simethicone ACtion

Antiflatulents! defoaming action

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simethicone use

relief for excess gas (takes air out of stomache

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Simethicone adverse effects

typically causes diarrhea

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Disulfiram action

(antialcoholic) used only for the mgmt of alcoholism, discourage alcohol intake and force pt to be sober.

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Disulfiram Side effects

drowsiness, fatigue, HA, psychoses, optic neuritis, hepatic toxicity, metallic/garlic like taste, erectile dysfunction,

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Disulfiram: Notify dr of signs of

hepatoxicity, yellow eyes or skin, dark urine, light-gray colored stools or severe stomach pain

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Strokes and ASA

dose 1xday for men

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Foods that affect coagulation

green leafy veggies

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Heparin

short term IV use, prevention of clots

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Coumadin

most often used for long term use

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Corticosteroid therapy

used to control long term asthma

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Hormone replacement therapy

increased risk for cancer

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Progestin action

transform proliferate endometrium into secretory endometrium (causes early menopause) Necessary for the development of the placenta and inhibits the secretion of pituitary ganadotropins, preventing maturation of the ovarian follicle and ovulation.

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Progestin uses:

amenorrhea, endometriosis, functional uterine bleeding, contraception

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Progestin adverse effects:

breakthrough bleeding, spotting, changes in menstrual flow, amenorrhea, tender breast, edema, wt increase or decrease, acne, chloasma, melasma, depression

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Levothyroxin

used for hypothyroidism

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ACE inhibitors

interfere with renin-angiotensin-aldosterone-system, decrease BP.

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Ace Inhibitor drugs

catapril, benzapril, enalapril, quinapril, ramipril, lisinopril

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Ace inhibitors adverse effects

most common dry hacking cough, HA dizziness, tachycardia, palpations, 1st dose syncope

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Lanoxin (digoxin)

used for arrythmias. Monitor closely, check apical pulse if <60 hold meds.

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Nitroglycerin

keep in a dark bottle, out of sun

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What does a narrow margin for digoxin mean

.5 to 2 ngmg

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Paxil treats

depression, panic and eating disorders, obsessive compulsion, premenstrual dysphoria, ptsd, bipolar, alcohol dependence, premature ejac, diabetic neuropathy.

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Paxil adverse effects

GI complaints, HA, dizziness, somnolence, sexual dysfunction, tremors, less common: tender breast or enlargement, fever, palpations, wt gain or loss, rash, hieves, itching

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Lithium

an antimanic acts by altering sodium transport in nerve and muscle cells and inhibits the norepinephrine and dopamine release

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lithium adverse effects

metallic taste, dizziness, ha, confusion, recent memory loss, drying and thinning , wt loss or gain, edema of hands and ankles, reversible leukocytosis, cardiac dysrhythmias, nephrotox, toxicity

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Lithium special teaching

Monitor sodium levels carefully! encourage fluid intake.

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When a diuretic is discontinued it is recommended that the drug be

reduced gradually to avoid the development of serious edema.

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Thiazides work to prevent the reabsorption of

sodium and chloride through direct action on the end of the ascending loop and the beginning of the distal tubule of the loop of Henle.

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Thiazides block the sodium and chloride

reabsorption and slightly limit carbonic anhydrase.

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Thiazides have a long half-life that may lead to the loss of large amounts of

potassium.

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Thiazides also act directly to dilate the smooth muscles in the

arterioles, the smallest vessels in the areterial system.

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When the arterioles are made larger, the heart does not have to pump so hard to get blood into them. This helps keep

blood pressure lower.

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permethrin (Elimite, Nix, Acticin) is a

scabicide/pediculicide. Sprinkle lotion into dry hair and rub into scalp.

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Permethrin (Elimite) action

causes repolarization and paralysis in lice by disrupting sodium transport in normal nerve cells. DEATH TO PARASITES!!!

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proparacaine (Alcaine) is a

local opthalmic anesthetic. Use 1-2 drops immediately before tonometry, 2-3 minujtes before suture removal or removal of foreign body.

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codeine (Codeine Phosphate, Codeine Sulfate) is a

Narcotic Agonist Analgesic. Schedule 2 drug.

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Codeine indications

management of mild to moderate pain. Antitussive (in smaller doses).

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Codeine Actions

Binds to opiate receptors in the CNS. ALters the perception of and response to painful stimuli while producing generalized CNS depression. Decreases cough reflex and GI motility.

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Codeine Side Effects

confusion, sedation, hypotension, constipation, nausea, vomiting

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Codeine Nursing Imps include checking vital signs regularly and assess sedation if respiratory rate is <10/min. Assess bowel function regularly. Assess type, location and intensity of pain before and

1 hour (peak) after administration. Prolonged use may lead to dependance and tolerance.

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Codeine overdose antidote

Narcan

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Morphine (Duramorph, MS Contin, MSIR) is a schedule

2 drug that is a narcotic agonist analgesic.

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Morphine is the primary narcotic analgesic used for relief of

severe pain. Morphine is the narcotic analgesic against which all others are compared.

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Morphine produces

sedation and euphoria when pain is present. Traditionally used for preop sedation and post op analgesia.

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Morphine is more effective against

dull, continuous pain than sharp, spasmodic pain.

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IV meds of Morphine should be given

slowly over 4-5mins. Protect drug from light and freezing.

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Morphine adult dose

5-20mg subq or IM Q4hr as indicated. IV admin range from 2-15mg/5mL

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Morphine Child dose

0.1-0.2 mg/kg per dose subq q4hr max not to exceed 15mg.

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acetaminophen overdose antidote

Mucomyst!

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Silver sulfadiazine (Silvadene) is a

burn preparation. apply once or twice daily to a thickness of approx 1 1/16 inch. No dressing required.

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Timolol (Timoptic)is an

ophthalmic anti-glaucoma beta blocker. Use 1 drop .25% solution twice daily.

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Ophthalmic NSAIDs for cataracts

Voltaren, Ocufen, Acular, Profenal

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Special teaching with Cataract meds

minimize use of concurrent NSAIDs during topical therapy. Instruict to avoid covering lesion with occlusive dressing and to avoid applying sunscreen or cosmetics to the affected area. Advise t that it may take up to 1 mo for complete healing to occur.

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pantraprazole (Protonix) dosage

Adults dose: 40 mg delayed-release capsule once daily for 8wk also available as an IV infusion

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Protonix Indications

Erosive esophagitis a/w GERD. Decrease relapse rates of daytime and nighttime heartburn symptoms on pts with GERD. Atreatment of duodenal ulcers a/w Heliobacter pylori

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Protonix actions

Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

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Protonix Adverse Effects

aha, abdominal pain, diarrhea, eructation, flatulence

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Protonix Pt teaching

take as directed for full course of therapy. No booze or aspirin, NSAIDS, or food that would irritate GI. REport black, tarryt stools; diarrheal or abdominal pain to health care professional IMMEDIATELY!

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The most common adverse reaction from heparin is

excessive bleeding and thrombocytopenia.

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Early signs of overdosage or internal bleeding of heparin include

bleeding from gums while brushing teeth, excessive bleeding or oozing from cuts, unexplained bruising or nosebleeds, and unusually heavy or unexpected menses (in women).

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Heparin is the anticoagulant of choice when what effect is needed?

immediate!

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Low-intensity coumadin therapy greatly decreases the risk of

stroke from nonrheumatic atrial fibrillation and has few side effects.

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Foods that interfere with the anticoagulant effect:

green leafy vegetables: broccoli, cabbage, collard greens, lettuce, spinach. or consumption of a nutritional supplement or multiV containing vita.K.

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Estrogens are used for

hormone replacement therapy in menopause or other conditions in which the natural estrogens are decreased, such as ovarian failure, primary amenorrhea, and oophorectomy.

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Hormone replacement therapy may

increase risk for cancers.

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levothyroxine (Levothroid, Synthroid, Unithroid) are thyroid supplements or replacements.. dosage:

synthetic prep is the drug of choice because effect is predictiable. Initial therapy is .05-.1 po daily with increase of .05-.1mg at 2 week intervals until effect is achieved.

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Levthyroxine Evaluation

Response to therapy is not immediate. Most pt.s begin to feel better within to weeks and the therapeutic results are often seen in 3 months.

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If side effects on a thyroid supplement occur

therapy will be withdrawn for 2-6 days and then restarted at a lower dosage.

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Pts over 50 are sensitive to throid hormones and should be monitored closely for

Cardiovascular disease before dosage is increased.

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Laboratory tests for serum T4 and TSH are used to confirm

hypothyroidism

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Levothyroxine is usually the drug of choice for

thyroid replacement

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Alpha Adrenergic blocking agent:

dapiprazole (ophthalmic prep) use 2 drops follwed 5 min later by an additional 2 drops.

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Dapiprazole is used to

reverse mydriasis (dilation) after eye examination.

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Loop Diuretics

act by blocking active transport of chloride, sodium, and potassium in the thick ascending loop of Henle

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POtassium-sparing diuretcis

increase the exrcretion of water and sodium but save potassium.

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