study guide 2
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| Tetracyclines: ↓ efficacy oral BC; Interaction w/ milk products, Ca or iron supp, laxatives containing Mg such Mg hydroxide and antacids → formation of nonabsorable chelates (empty stomach w/full glass of water; Admin 1 hr ā or 2 hrs ṕ food) |
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| Macrolides: Erythromycin inhibits metabolism of antihistamines, theophylline, carbamazepine, and warfarin, which can lead to toxicity |
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| Macrolides: Verapamil and diltiazem, HIV protease inhibitors, antifungal meds, and nefazodone inhibit hepatic drug-metabolizing enzymes, which can lead to erythromycin toxicity, causing tachydysrthythmia and possible cardiac arrest. Don’t take together! |
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| Aminoglycosides: Penicillin will inactivate aminoglycosides when mixed in same IV solution; When admin w/ other ototoxic meds (IE: loop diurectics) the risk for ototoxicity greatly ↑ (assess frequently) |
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| pt teaching: Tetracyclines: Not be taken when pregnant, < 8 yrs of age, have them observe for S/S of diarrhea. Not be taken w/ food; S/S of hepatoxicity, photosensitivity. |
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| pt teaching: Macrolides: ⊘ in pts w/pre-existing liver disease; hepatotoxicity; GI discomfort; Empty stomach |
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| pt teaching Aminoglycosides: Ototoxicity (report S/S of HA, hearing loss, nausea, dizziness, vertigo); Nephrotoxicity (✓ BUN & I/O); Neuromuscular blockage resulting in respiratory depression; Measure peak 30 mins ṕ admin and trough right ā next dose. |
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| Macrolides: Observe for GI Sx; hepatotoxicity (abdominal pain, lethargy, jaundice) |
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| Aminoglycosides: ✓ for ototoxicity. |
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| Assessing Allergic reaction: Pencillins: ⊘ for pts w/ severe Hx of allergies to pencillin, cephalosporin, and/or imipenem. Interview pts for ā allergy, | advise pts to wear an allergy identification bracelet. Observe pt for 30 minutes following admin of parenteral pencillin.
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| Assessing Allergic reaction: Cephalosporins: If S/S of allergy appear (urticaria, rash, hypotension, and/or dyspnea) stop cephalosporin immediately and notify HCP.... | Question pt carefully regarding past Hx of allergy to a pencillin or other cephalosporin and notify HCP if present.
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| Cephalosporans and warfarin use: Avoided in pts w/ bleeding disorders and those taking anticoagulants. Observe for S/S of bleeding. | ✓ pts for prothrombin time and bleeding time. Abnormal levels may require discontinuation of med. Admin parenteral vitamin K.
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| Proper Injection Technique: Pencillins: IM injection should be done cautiously to avoid injection into a nerve or an artery. |
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| Proper Injection Technique: Cephalosporins: Admin IM injection deep in large muscle mass; Thrombophlebitis w/ IV infusion; Rotate... | injection sites; admin as a diluted intermittent infusion or, if a bolus dose is prescribed, admin slowly over 3- 5 mins in a dilute solution.
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| Antilipidemics: ✓ for side effects: Fibrates: Gallbladder stones (Observe for Sx of gallbladder disease, right upper quadrant pain, fat intolerance, bloating; notify HCP); Myopathy (Muscle pain, tenderness, pain; obtain baseline creatine kinase level; | ✓ CK levels during Tx; ✓ for Sx and notify HCP; stop meds if CK levels are elevated); Hepatotoxicity (obtain baseline LFT and ✓; advise pts to ✓ for Sx of liver dysfunction (anorexia, N/V jaundice)
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| Antilipidemics: ✓ side effects: Statins: Hepatotoxicity; Myopathy, peripheral neuropathy (weakness, numbness, tingling, and pain in hands/feet) |
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| Antilipidemics: ✓ side effects: Cholesterol Absorption Inhibitor: Hepatitis, myopathy |
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| Antilipidemics: ✓side effects: Bile-Acid Sequestrants: Gi distress and decrease absorption of fat-soluble vitamins; constipation. |
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| Antilipidemics: ✓side effects: Nicotinc Acid, Niacin: GI Distress, Facial flushing, hyperglycemia, hepatotoxicity, hyperuricemia. |
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| Controlled Substances: Discarding/Witness Waste: Needs to be kept in a locked area, Discarding of an excess of a controlled substance should be witnessed by a licensed health care HCP. |
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| Teach: SSRIs: Needs to be taken in the am, avoid chocolate/caffeinated beverages; ✓ pt wt; encourage pts to participate in regular exercise and to follow a healthy, well-balanced diet.Serotonin syndrome may being 2-72º ṕ starting Tx, Taper off | Do not use w/ tricyclic antidepressants and lithium. MAOIs should be DC for 14 days ā to starting SSRI; if already taking fluoxetine, pts should wait 5 wks ā taking MAOI. ✓ for S/S of bleeding when taking w/ NSAIDs or warfarin.
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| Cardiac Glycosides: ⊘indication to admin: Disturbances in ventricular rhythm including ventricular fibrillation, ventricular tachycardia, and second-and third-degree heart block. |
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| Cardiac Glycosides: Interactions: Thiazide diurectics, such as hydrochlorothiazide and loop diuretics, such as furosemide (Lasix) may lead to hypokalemia... | which ↑ risk of developing dysrhythmias (✓ K+ level and maintain between 3.5 to 5.0 mEq/L. Hypokalemia can be treated w/ K+ supp or a K+-sparing diurectic)
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| Cardiac Glycosides: Interactions:ACE inhibitors and ARBs ↑ the risk of hyperkalemia, which can lead to ↓ therapeutic effects of digoxin (use cautiously if these meds are used w/K+ supp or a K+-sparing diuretic, maintain K+ levels) |
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| Cardiac Glycosides: Interactions: sympathomimetic meds such as dopamine (Intropin) complement the inotropic action of digoxin and ↑ the rate and force of heart muscle ⊘ction. (✓ ECG, instruct pts to measure heart and report palpitations |
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| Cardiac Glycosides: Interactions: Quinidine ↑ the risk of digoxin toxicity when used concurrently, don’t use together. |
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| Cardiac Glycosides: Interactions: Verapamil (Calan) ↑ plasma levels of digoxin. (If used concurrently, digoxin should be ↓. Usually avoided) |
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| Cardiac Glycosides: Recognizing toxicity Digoxin levels: 0.5 to 2.0 ng/mL; Observe Sx of toxicity (Anorexia, fatigue, weakness) HR < 60/min in adult, < 70/min in children. Hypokalemia. |
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| Chemotherapy agents: ⊘indications: Methotrexate – Pregnancy X, psoriasis, rheumatoid arthritis, liver failure, alcoholism, immunodefiencies, or blood dyscrasis |
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| Chronic Neurological Disorders: Identifying interactions: Atropine counteracts the effects of neostigmine (✓ pt closely and provide mechanical ventilation until the pt has regained full muscle function) |
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| Chronic Neurological Disorders: Identifying interactions: Neostigmine reverses neuromuscular blockade caused by neuromuscular blocking agents ṕ surgical procedures and overdose. (✓ the pt for return of respiratory function; support function if necessary) |
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| Chronic Neurological Disorders: Identifying interactions: Succinylcholine ↑ neuromuscular blockade (avoid concurrent use) |
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| Depression Pt Teaching: orthostatic hypotension; ways to minimize anticholinergic effects (chewing sugarless gum, sipping on water, wearing sunglasses when outdoors, eating foods ↑ in fiber, participating in regular exercise... | ↑ fluid intake to 2-3 L/d from beverages/food sources; Sedation (Avoid driving, take at bedtime); Excessive sweating (inform pt of side effect and frequent linen △s); ✓ for suicidal idealation; Sexual dysfunction may occur w/SSRI’s
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| Diabetes Mellitus: Discharge Teaching Teach injection: rotate, 1” between injection sites: glucose ✓ing and not to relay on S/S & Sx of hypo/hyperglycemia; admin w/15 g of carbohydrates (4 oz OJ, 2 oz grape, 8 oz milk or glucose tabs)... | Avoid alcohol, establish regular eating schedule, exercise
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| Endocrine Disorders; Documenting Adverse Effects; document exactly what happens, don’t insert any personal insight/justification, just the event, reaction, site, etc... | Overmed can result in S/S of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, and menstrual irregularities)
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| Endocrine Disorders: Thyroid Replacement: Levothyroxine (Synthroid, Levothroid); MOA: Synthetic form of thyroxine (T4) that ↑ metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use... | body temp, blood volume, and growth processes; Tx: Hypothyroidism. ✓ T4 and TSH levels. Take daily on empty stomach. ✓ vital S/S, weight, and height through Tx.
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| Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Timolol (Timoptic, Betimol), Carteolol (Ocupress), Metipranolol (OptiPranolol), Levobunol (Betagan Liquifilm, AKBeta) |
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| Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: MOA: Decrease IOP by decreasing amount of aqueous humor produced. |
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| Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Side Effects: Temporary stinging discomfort in the eye immediately ṕ drop is instilled; Occasional conjunctivitis, blurred vision, photophobia, dry eyes... | Systemic effects of beta blockade on heart and lungs may occur;
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| Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: ⊘ for pts who have bradycardia and AV heart block |
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| Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Interactions: Oral beta blockers or a Ca channel blocker can ↑ cardiovascular and respiratory effects; Beta blockers can interfere w/ some effects of insulin. |
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| Med admin of older pt: Liver Kidney Function: ↓ GI function (↓er stomach acidity, s↓er GI motility & gastric emptying, ↓ blood f↓ (systemic), impaired memory, vision & hearing △s, ↓ motility/dexterity.... | ↓ hepatic enzyme function, ↓ kidney function and glomerular function; ↓ protein-binding sites; ↓ body water, ↑ body fat, and ↓ body fat.
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| Med Affecting Blood Pressure: Ca Channel Blockers: Nifedipine (Adalat, Procardia), Verapamil (Calan), Diltiazem (Cardizem): MOA: Block Ca channels in blood vessels leads to vasodilation of arteries/arterioles |
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| Med Affecting Blood Pressure: Verapamil & Diltiazem also works on myocardium, SA node & AV node decreasing force of ⊘ction & ↓er heart rate (s↓s rate of conduction through AV nodes) |
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| Med Affecting Blood Pressure: Nifedipine Side Effects: Reflex tachycardia (✓ for ↑ HR), peripheral edema (notify HCP), Acute toxicity (✓ vital S/S and ECG) |
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| Med Affecting BP: Verapamil & diltiazem Side effsinects: Orthostatic hypotension & peripheral edema (✓ pts BP, edema, and weight daily); Constipation (↑ intake of ↑ fiber food and oral fluids); Suppression of cardiac function (bradycardia, HF)... | (✓ ECG, pulse rate and rhythm); Dysrhythmias (✓ vital S/S and ECG); Acute toxicity resulting in hypotension, bradycardia, AV block, and ventricular tachydysrhythmias (✓ vital S/S, ECG)
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| Med Affecting Blood Pressure: Nifedipine Interactions: Avoid consuming grapefruit juice. |
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| Med Affecting Blood Pressure: Verapamil can ↑ digoxin levels. |
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| Med Affecting Blood Pressure: DC med: Diurectics 2-3 days ā to ACE; Dry mouth report & discontinue; rash & dysgeusia (altered taste); Angioedema; Infection (Sore throat, fever); Cough r/t inhibition of kinase II; |
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| Med Affecting BP: Documenting adverse effects: First dose orthostatic hypotension (✓ BP for 2 hrs ṕ initiation of Tx); Experiencing dry cough notify provide and DC; Hyperkalemia (✓ K+ levels to maintain a level of 3.5 to 5 mEq/L, avoid salt substitutes).. | Rash & altered taste (inform HCP and DC); Angioedema (Swelling of tongue/Oral pharynx; treat severe effects w/subcutaneous injection of epinephrine, should be DC); Neutropenia (✓ WBC counts q 2 weeks for 3 months)
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| Med Affecting Blood Pressure: Hypertensive Crisis: nitroprusside (Nitropress); Nitroglycerin (Nitrostat IV); Nicardipine (Cardene); Clevidipine (Cleviprex);... | Enalaprilat (Vasotec IV); Esmolol HCL (Brevibloc); MOA: Direct vasodilation of arteries and veins resulting in rapid reduction of BP
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| Med Affecting P: Hypertensive Crisis: Side Effects: Excessive hypotension (Admin med slowly because rapid admin will cause BP to ↓ rapidly, ✓ BP and ECG; Cyanide poisoning HA and drowsiness, and may lead to cardiac arrest... | ↓ by admin med at < 5 mcg/kg/min; and giving thiosulfate concurrently; DC if toxicity occurs; Thiocyanate poisoning (effect can be manifested as altered mental status; avoid prolonged use of nitroprusside; ✓ plasma levels if used for more than 3 days)
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| Med Affecting Blood Pressure: Hypertensive Crisis: Nitroprusside should not be admin in the same infusion as any other med |
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| Appropriate ways to admin Heparin Na: SC q12h; continuous or intermittent IV infusion; use a 20-22 gauge needle to w/drawal from vial; △ needle to smaller needle (Gauge 25 or 26) Admin deep SC in the abd ensuring a distance of 2in from umbilicus.... | Do not aspirate. Apply pressure for 1-2 min ṕ the injection. Rotate and record sites. ✓ for S/S of bleeding. Do not take OTC NSAIDs, aspirin, or meds containing salicylates; use electric razor and soft toothbrush.
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| Meds affecting coagulation: Instructions for adverse effects: Heparin Na: Observe for S/S/Sx of bleeding (↑ HR, ↓ BP, bruising, petechiae, hematomas, black tarry stools); |
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| Meds affecting coagulation: Identifying interactions: Anti-platelet agents such as aspirin, NSAIDs, and other anticoagulants may ↑ risk of bleeding; Do not use together. |
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| Meds affecting coagulation: Recognizing therapeutic levels: aPTT level 60 -80 seconds; PT 18-24 sec; INR 2-3 |
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| Meds affecting coagulation: SubQ admin: Rotate site, don’t massage, Deep in abdomen 2 inches from umbilicus |
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| Loop Diurectics: furosemide (Lasix) MOA: work in the ascending limb of loop of Henle: block reabsorption of Na & chloride to prevent reabsorption of H20; ✓ electrolyte levels: K+, Na+, Cl-; ✓ BP (Hypotension)... | Dig toxicity can occur in presence of hypokalemia (may use K+ sparing diurectic in conjuction w/loop diurectic to reduce risk of hypokalemia); ✓ I & O, weight
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| Meds affecting Urine Output: Effects of Diurectics; Thiazide diurectic: hydrochlorothiazide (Hydrodiruil) MOA: work in the early distal convoluted tubule: blocks reabsorption of Na & chloride, prevents reabsorption of H20; Same items to ✓ + hyperglycemia |
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| Meds affecting Urine Output: Effects of Diurectics: K+ sparing diurectics: spironolactone (aldactone) MOA: blocks action of aldosterone (Na & H20 retention), results in K+ retention & secretion of Na+ and H20; ✓ K+ levels, cardiac ✓ing |
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| Osmotic Diurectics: mannitol (Osmitrol) MOA:↓ ICP & IOP by ↑ serum osmolality & drawing fluid back into vascular & extravascular space; Cardiac ✓: HF (Dyspnea, weakness, fatigue, distended neck veins, weight gain); Renal failure: urine output < 30 mL/hr |
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| Misc CNS Meds: Malignant Hyperthermia: Succinylcholine: Neuromuscular blocking agents are used as adjuncts to general anesthesia to promote muscle relaxation; Depolarizing neuromuscular blocker |
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| CNS Meds: Malignant Hyperthermia: Succinylcholine: S/S: Muscle rigidity accompanied by ↑ temp, reaching levels as ↑ as 109.4 F. ✓ vitals, stop succinylcholine and other anesthetics.... | Ice or infusion of ice saline can be used to cool the pt. Admin dantrolene to ↓ metabolic activity of skeletal muscle.
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| Pain Meds: teach adverse effects: Colchicine: Mild GI distress (Take PO meds w/food; provide antidiarrheal agents; if severe Sx of GI distress occur stop:... | Thrombocytopenia, suppressed bone marrow (notify HCP of bleeding, bruising or sore throat); Hepatic necrosis (✓ liver enzymes)
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| Misc Pain Meds: teach adverse effects: Allopurinol: Hypersensitivity reaction, fever, rash (If via IV infusion, stop; Severe reaction may require hemodialysis or glucocorticoids);... | Renal injury (Alkalinize the urine and encourage intake of 2-3L fluids/day. ✓ I&O, BUN, and creatinine); hepatitis (✓ liver enzymes); GI distress (Nausea and vomiting, give w/ food).
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| Misc Pain Meds: Interactions w/ provenosed: ↓ w/ aspirin use, may precipitate gout |
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| Mycobacterial/fungal/protozoan: ✓ing long term use of Antimycobacterial/Antituberculois: long term admin 6 months/ up to 24 months, use 2 different meds concurrently for most effective Tx |
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| Mycobacterial/fungal/protozoan: ✓ing long term use of Isoniazid (INH)- ✓ LFT & ✓ for hepatoxicity, avoid alcohol INH inhibits metabolism of phenytoin, lead to build up & toxicity (ataxia & incoordination), phenytoin dosage may be ↓ered. |
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| Opioids: Agnoist/Antagonist (respiratory depression (which cause/make worse): butorphanol (Stadol): compared to pure opioid agnoists, agonist-antagonists have: less respiratory depression; Have naloxone (Narcan) available. |
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| Opioids: Agnoist/Antagonist (respiratory depression (which cause/make worse): naloxone (Narcan): is an opiod antagonist. |
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| Psychosis: Documenting Adverse Effects: Acute dystonia: severe spasms of tongue, neck, face, or back... | (begin to ✓ for side effects anywhere from 5 hr to 5 days ṕ admining first dose. Treat w/ anticholinergic agents, such as benztropine (Cogentin) or diphenhydramine (Benadryl).
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| Psychosis: Documenting Adverse Effects: Parkinsonism: Bradykinesia, rigidity, shuffling gait, drooling and tremors (observe for S/S and Sx w/in 1 month of initiation of therapy. Treat w/benztropine, diphenhydramine, or amantadine (Symmetrel) |
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| Psychosis: Documenting Adverse Effects: Akathisia: Pt unable to stand still or sit, and is continually pacing and agitated (observe for S/S and Sx w/in 2 months of the initiation of Tx. Manage w/ beta-blockers, benzodiazepine or anticholinergic med) |
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| Psychosis: Documenting Adverse Effects: Late Extrapyramidal Sx (EPS), tardive dyskinesia (TD): Manifestations include involuntary movements of the tongue and face, such as lip-smacking, which cause speech and/or eating disturbances. ... | TD may also include involuntary movements of arms, legs, or trunk. (Manifestation may occur months to years ṕ the start of therapy; admin the lowest dose possible)
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| Psychosis: Documenting Adverse Effects: Neuroleptic malignant syndrome: Sx include sudden ↑-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and △ in LOC developing into coma... | Stop antipsychotic meds, ✓ vital S/S, apply cooling blankets, admin antipyrectics, ↑ fluid intake
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Methotrexate (cytotoxic agents): ↑ risk of infection (report fever and/or sore throat; observe for anorexia, abdominal fullness & jaundice report)... | Avoid use during pregnancy; Obtain CBC and platelet counts; GI ulceration (take w/food or full glass of water; stop if Sx occur)
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Antimalarial agents (Hydroxychloroquine): Retinal damage (blindness)-report blurred vision |
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Sulfasalazine: GI discomfort (nausea, vomiting, diarrhea, abdominal pain); hepatic dysfunction (✓ LFT); Bone marrow suppression (✓ CBC and platelet counts) |
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| Rheumatoid arthritis: ✓Side Effects/Findings to report: Biologic response modifiers-Etanercept, infliximab: SC-site irritation (redness, swelling, pain, itching/ ✓ injection site and stop if irritation occurs); | Risk of infection, especially TB (✓ for infection, report fever,sore throat, inflammation); Severe skin reactions; HF (✓ for development or worsening of HF); Blood dyscrasias (✓ for S/S of bleeding, bruising, or fever
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| Rheumatoid arthritis: ✓Side Effects/Findings to report: Gold Salts (Aurothioglucose): Toxicity (report severe pruritus, rashes, stomatitis); Renal toxicity such as proteinuria (✓ I&O, BUN, creatinine, and UA);... | Blood dyscrasias (✓ CBC, WBC, and platelet count); Hepatitis (✓ LFT); GI discomfort (report nausea, vomiting, abdominal pain)
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Pencillamine: Bone marrow suppression (obtain baseline CBC and platelet counts, repeat q 3 to 6 months); Toxicity (report severe pruritus, rashes) |
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Cyclosporine: Risk of infection (report fever and/or sore throat); Hepatotoxicity (✓ liver function and adjust dosage); Nephrotoxicity (✓ BUN and creatinine and measure I&O); Hirsutism |
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| Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Glucocorticoids (Prednisone): Risk of infection (report fever and/or sore throat); Adrenal suppression (report Sx);... | Fluid retention (✓ for S/S of fluid excess such as crackles, weight gain, edema); GI Discomfort (report Sx); Hyperglycemia (✓ blood glucose level); Hypokalemia (✓ serum K+ levels, eat K+ rich foods)
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| Acute Alcohol w/d: Effects usually start w/in 4-12 h of the last intake, peak ṕ 24-48 and then suddenly disappear, unless alcohol w/drawal delirium occurs: Sx N/V, tremors, restlessness, and inability to sleep, depressed mood or irritability, ↑HR/BP/ | Resprate/temp;and tonic-alcohol seizures. Illusions, W/drawal delirium may occur 2-3 days ṕ cessation & may last 2-3 days; medical emergency. Findings: severe disorientation, psychotic Sx (hallucinations), severe HTN, and cardiac dysrhythmias → death.
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| HIV, Expected Outcomes of anti-retroviral therapy: Improvement of findings such as healed genital lesions, ↓ inflammation and pain, and improvement in vision |
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| Safety admin: ✓ plasma lithium levels; effects begin w/in 7-14 days; Importance of adequate fluid (2,000 to 3,000 mL) and Na intake; give lowest dose possible; admin w/meals or milk; 2 to 3 doses daily; Adhere to lab appointments due to narrow thera range |
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| Lithium Lab values: Therapeutic level 0.4 – 1.0 mEq/L: Early S/S of toxicity: < 1.5 mEq/L (gi upset): Advanced S/S: 1.5 to 2.0 mEq/L (all early + poor coordination & tremors): Severe toxicity: > than 2.0 to 2.5 mEq/L (polyuria, tinnitus, blurred vision.. | hypotension): >than 2.5 mEq/L (Rapid progression of Sx leading to death/hemodialysis)
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| Proper documentation Med Error: Report all errors and implement corrective measures immediately; Complete an unusual occurrence report w/in specified time frame usually 24 hrs: pt’s identification, time and place of incident... | an accurate account of the event, who was notified, what actions were taken, signature of person completing the report, Six rights of med admin
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| IV K+ infusion: 10 mEq/hr Fastest IV infusion, 40 mEq/L maxium |
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| Pt Ed: (Beta2-Adrenergic) -teach how to check pulse and report ↑ of > 20 to 30 beats/min; Avoid caffeine; Use of beta-adrenergic blockers (propanolol) can negate effects of both meds should not be used concurrently. |
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| Pt Ed: (Methylxanthines)- Avoid consuming caffeinated beverages; watch for S/S of toxicity (GI distress, restlessness, dysrhythmias, seizures); |
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| Pt Ed: (inhaled anticholinergics)- Peanut allergies avoid; rinse mouth ṕ inhalation; |
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| Pt Ed: (glucocorticoids)- Avoid using w/ NSAIDS; concurrent use w/ hypoglycemic agents will counteract the effects; oral forms used short term, 3 to 10 days ṕ acute attack; K+ levels need to be monitored. |
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| Pt Ed: (mast cell stabilizers)- take med 15 min ā exercise or exposure to allergen; not a bronchodilator and not intended for aborting an asthmatic attack; |
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| Pt Ed: (leukotriene modifiers)-zafirlukast should not be given w/ food, administer it 1 hr ā or 2 hr ṕ meals; take montelukast qhs |
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| Pt teaching MDI’s: (Inhaled anticholinergics)- Usual adult dose is 2 puffs, wait the length of time directed between puffs; if prescribed 2 inhaled meds, instruct pts to wait at least 5 mins between meds; |
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| Pt teaching MDI’s: (glucocorticoids) advise pt to inhale the beta2-agonist (promotes bronchodilation and enhances absorption) ā inhaling glucocorticoid. |
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| Managing Asthma: (methlxanthines): Long-term control of asthma |
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| Managing Asthma: (Inhaled anticholinergics): Used for allergen-induced and exercise induced asthma, relieve bronchospasm in COPD; |
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| Managing Asthma: (Glucocorticoids): Promotes ↓ frequency and severity of exacerbations and acute attacks; acute attacks |
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| Managing Asthma: (Mast Cell Stabilizers): management of chronic asthma, exercise-induced asthma, allergen-induced asthma |
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| Managing Asthma: (Leukotriene Modifiers): Long-term therapy of asthma in < 15 yrs, and to prevent exercise-induced bronchospasm |
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| Nitro Self Admin: stop activity, Take dose of Nitro immediately, If pain is unrelieved in 5 mins, call 9-1-1, Pt can take up to 2 more doses at 5 min intervals, Transdermal patch removed at night, applied to hair free clean site, rotate patch site, do not |
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| Managing Asthma: (Beta2-Adrenergic Agonists): Albuterol: inhaled, short-acting. oral, long-acting. (prevention of asthma attack, Tx ongoing attack, long-term control of asthma). |
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| Managing Asthma: (Beta2-Adrenergic Agonists): Formoterol/Salmeterol: Inhaled, long acting (long-term control of asthma). |
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| Managing Asthma: (Beta2-Adrenergic Agonists): Terbutaline: oral, long-acting (Long term control of asthma) |
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| serotonin syndrome: mental confusion, difficulty concentrating, agitation, anxiety, hallucinations, incoordination, hyperreflexia, tremors, fever, diaphoresis |
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| Behavior Disorders: Pt Teaching: TCAs: ✓ pt weight; do not use w/ MAOIs, antihistamines/other anticholinergic agents, epinephrine, ephedrine, amphetamine, alcohol, benzodiazepines, opiods, and | antihistamines cause additive CNS depression; therapeutic effect may not be experienced for 1-3wks, up to 2-3 mos for full effect; △ positions slowly;
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| Bipolar Disorders: Evaluating Pt Teaching: Return for serum lab values 2-3 days then 1-3 months, lithium toxicity, diet w/good salt intake; effects begin w/in 7-14d; | fluid and Na intake; ✓ for S/S of toxicity (diarrhea, vomiting, or excessive sweating); avoid NSAIDs and Anticholinergics (antihistamines, TCAs)
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| Bone: Bisphosphonates: alendronate Na (Fosamax); ↓ the number and action of osteoclasts, inhibits bone resorption; SA: Esophagitis, GI Disturbances: Sit upright for 30 mins and take w/full glass of water; Musculoskeletal pain (Take mild analgesic); | blurred vision, eye pain; notify HCP; Bisphosphonate-related osteonecrosis of the jaw w/IV infusion (Avoid dental work during admin of med); Risk for hyperparathyroidism at higher dose used for Paget’s disease (✓ parathyroid hormone (PTH) levels.
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| Adverse effects of phenytoin: CNS effects (nystagmus, sedation, ataxia, double vision); Gingival hyperplasia; Maintain good oral hygiene; stop med if skin rash develops; Teratogenic (cleft palate, heart defects); avoid use in pregnancy; | Cardiovascular effects (dysrhythmias, hypotension); Endocrine and other effects (coarsening of facial features, hirsutism, and interference w/ vit D metabolism)
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| effectiveness Tx of myasthenia gravis: Cholinesterase inhibitors prevent the enzyme cholinesterase (ChE) from inactivating achetylcholine (Ach), | thereby ↑ the amount of Ach available at receptor sites. Transmission of nerve impulses is ↑ at all sites responding to Ach as a transmitter.
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| Antihistamines: Diphenhydramine (Benadryl); Promethazine (Phenergan); Dimenhydrinate (Dramamine): |
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| Antihistamines: MOA: is on H1 receptors, which results in blocking of histamine release in the small blood vessels, capillaries, and nerves during allergic reactions |
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| Antihistamines: SE: Sedation (Take med at pm; avoid driving, no alcohol and CNS depressants); Anticholinergic effects/dry mouth & constipation (Advise to take sips of water, suck on sugarless candy and maintain 2-3 L of water/d GI/N/V/C (w/ meal); | Acute toxicity/Flushed face, ↑ fever, tachycardia, dry mouth, urinary retention, pupil dilation (Notify HCP, induce vomiting to remove antihistamine, admin activated charcoal, admin acetaminophen for fever, apply ice packs or sponge baths);
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| Antihistamines: ⊘ during 3rd trimester of pregnancy, mothers breastfeeding and for newborns; |
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| Antihistamines: Interactions: CNS depressants/alcohol cause additive CNS depression; avoid concurrent use |
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| Vit: Cyanocobalamin B12 pt teachings: intranasal should be admin 1hr ā or ṕ eating hot foods, which can cause the med to be removed from nasal passages w/out being absorbed; ✓ for beefy red tongue, pallor, neuropathy S/S of B12↓; Observe for K+↓; | Intake of foods ↑ in vit B12; Advise pts to adhere to prescribed lab tests (blood counts and B12 levels should be ✓ q3-6 mos); Obtain baseline B12, Hgb, Hct, RBC and reticulocyte counts; Receive adequate doses of vit B12 when using folic acid
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| Angina Pt Teaching: Nitroglycerin dilates veins & ↓ venous return (preload) ↓ cardiac oxygen demand: causes HA treat w/aspirin/acetaminophen. Should sit down when taking med, can cause hypotension (use caution w/antihypertensive | ie: beta blockers, calcium channel blockers & diurectics), do not take w/sildenafil (Viagra). Can repeat if not relieved in 5 mins; If HA do not resolve in a few weeks notify HCP; do not drink alcohol
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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