final exam blueprint

adverse effects of captopril

Cough, unpleasant Gi distress and pancytopenia

Digoxin hold parameter

pulse less than 60 adult 70 kid 90 infant

arrhythmias

adverse effects of milrinone

Ventricular arrhythmias hypotension

and thrombocytopenia.

Quinidine most common adverse effects

•Dizziness, drowsiness, slurred speech

•n/v, changes in taste

•New arrhythmias

•Respiratory depression

quinidine contradinications

Bradycardia, heart block (minus pacemaker) HF hypotension shock and electrolyte disturbances

Patient teachings for nitroglycerin

Teach pt to lay or sit down prior to admin (risk of low bp)

Sublingual dose every 5 minutes if relief isn’t felt total of three times. If pain persistent the pt should go to the ER

nursing monitoring considerations for atorvastatin

Monitor serum cholesterol and LDL levels before and periodically during therapy to evaluate the effectiveness of this drug.

Monitor liver function tests before and periodically during therapy to monitor for liver damage; consult with the prescriber to discontinue the drug if the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) level increases to three times higher than normal.

Cholestyramine drug-drug interaction

•Malabsorption of fat-soluble vitamins

•Delayed absorption of thiazide diuretics, digoxin, warfarin, thyroid hormones, hormonal contraceptives, corticosteroids

•Separate by taking these drugs 1 hour before or 4-6 hours after bile acid sequestrants

Nursing assessment for drugs affecting coagulation

screen for hemorrhagic disorders recent traumas spinal puncture gi ulcers recent surgery intrauterine device placement TB indwelling cath threatened abortion

asses baseline status before beginning therapy: body temp, skin color lesions and temp; affect orientation and reflexes; pulse blood pressure perfusion respiration and adventitious sounds, clotting studies renal and hepatic function test CBC stool guaiac ECG

evaluate for therapeutic effects of warfarin INR 2-3 sxs of blood loss

iron deficiency anemia

▪See this in blood loss, GI bleeding

▪Menstruating people

▪Pregnant/lactating people (demands increased)

▪Rapidly growing adolescents

▪c/o being tired d/t insufficient O2 delivery to the tissues.

▪Usually treated with iron replacement therapy

Megaloblastic anemia

▪Insufficient folic acid or vitamin B12 which leads to slowing of nuclear DNA synthesis that results in larger, immature cells

▪They become crowded in the bone marrow and fewer RBCs are produced which leads to increased immature cells in circulation

▪Folic acid: leafy green veggies, milk, eggs, liver; treat with folic acid or folate

▪Vitamin B12: meats, seafood, eggs, and cheese; treat with vit B12

▪Pernicious anemia

hemolytic anemia

▪Can be inherited (sickle cell and thalassemia) or acquired

▪Sickle cell: abnormal Hgb, Hemoglobin S, gives RBCs a sickle-shaped appearance. Sickled RBCs can become lodged in tiny blood vessels causing occlusions and anoxia/infarction of tissue in that area= SEVERE pain

▪Thalassemia causes decreased synthesis of alpha- or bet—Hgb chains of hemoglobin. Ineffective maturation of the RBC leads to early lysis.

Nursing considerations for lorazepam

maintain pt who have received parental benzodiazepines in bed for at least 3 hours after admin

taper dose gradually (seizures in epileptic pts and withdrawal symptoms)

give IV slow (bc agent is associated with bradycardia hypotension and cardiac arrest

Contraindications of benzodiazepines

•Smaller doses in pts with liver disease

•Crosses placenta and breast milk; known to cause birth defects

•Glaucoma or alcohol intoxication heightened

•Black box: if combined with opioids, profound sedation, resp depression can lead to coma, death

•15-20% of African-Americans have delayed metabolism of benzos

•Caution with elderly – unpredictable reactions

Adverse effects of MAOI

•Dizziness, excitement, mania, tremors, agitation

•Liver toxicity

•n/v/d

•Fatal hypertensive crisis –occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, chest pain – leads to intracranial bleed/ fatal stroke

Adverse effects of TCA

•Drowsiness, sedation, sleep disturbances, fatigue, hallucinations, visual disturbances, difficulty concentrating, weakness, ataxia

•Dry mouth, constipation

•Hypo or hypertension

•Arrhythmias

•Withdrawal syndrome if stopped abruptly

•VERY lethal if taken in an OD

Therapeutic action of MAOI

•Reserved for pts not responding to other medications

•Inhibits MAO – an enzyme which breaks down norepinephrine, dopamine, and serotonin

•Strict dietary regimen to prevent toxicity

Therapeutic action of TCA

•Inhibits reuptake of norepinephrine and serotonin – leading to increased concentrations in brain

•Anti-cholinergic effects

•Sedative effects – most effective for depressed pts with anxiety and sleep disturbances

•Clomipramine also used for OCD

•Treatment of enuresis

Nursing considerations and teaching needs for clozapine

warn about the risk of tardive dyskinesia and ither extrapyramidal side effects with continued use

asses temp skin color lesions CNS orientation affect reflexes bilateral grip strength bowel sounds and reported output pulse ascultation and blood pressure RR and adventitious sounds urinary output obtain liver and renal test BG levels thyroid function EKG CBC

Nursing considerations and teaching needs for lithium

frequent serum lithium lvl (specifically in renal cv disease dehydration debilitation and those taking diuretics monitor for toxic levels and arrange appropriate dose)

adequate intake of salt and water, risk of dehydration in hot weather

nurse monitoring and teaching needs for phenytoin

nurse monitoring and teaching needs for hydantoins

Dopaminergic agents

•Effective at increasing dopamine levels as long as dopamine receptors remain in the substantia nigra to respond

•Restores balance of inhibitory and stimulating neurons

•Relieves signs of Parkinson disease

•Apomorphine SQ

•Carbidopa added to increase effect

pediatric considerations for muscle rexlantants

safety not established

Metaxalone has established ped dose

other agents, dose, age and weight

Baclofen is indicated for muscle spasticity with cerebral palsy

Methocarbamol-treated tetanus

dantrolene upper motor neuron spasticity

centrally acting muscle relaxants indication

•Baclofen used for neuromuscular diseases

•Methocarbamol used for tetanus

•Other meds: use with other measures such as rest, ice/heat, NSAIDs

teaching points and nursing assessments for opiods

performing baseline and periodically pain assessment

assess CNS effects monitor resp rate sculate lungs for adventitious sounds to evaluate ae

monitor pulse bp and CO

institute comfort and safety measures

teach to avoid driving assistance with ambulation and avoid making important decisions

adult lifespan considerations for antimigraine and opioids

Migraine meds contraindicated in pregnancy, barrier contraceptive, no breastfeeding

opioids: used cautiously in pregnancy, neonatal opioid withdrawal

pt teaching for oral contraceptives

steps to take if a dose is misses/ lost

smoking cessation

indication of hydroxyprogesterone

Reduction of risk of preterm birth in patients with a single-fetus pregnancy who have a history of singleton spontaneous preterm birth

indications and therapeutic actions of androgens

•Growth and development of male sex organs and maintenance of secondary sex characteristics

•Increase retention of sodium, potassium, nitrogen, phosphorus, and decrease urinary excretion of calcium

•Increases protein anabolism, reduces protein catabolism

•Increase production of RBC

•Danazol – used for endometriosis and fibrocystic breast disease in females

phenylephrine contraindications and most common adverse effects

contraindication

• hypertension and glaucoma

• •Caution is pts with history of heart disease

• •Alpha2 drugs should not be used if hypotensive or bradycardia

adverse effects

• •Anxiety, restlessness, strange dreams

• •Arrhythmias

• •n/v, difficulty urinating

dose specific considerations for adrenergic antagonist

peds dose calculated by age and weight second check does with 2nd nurse

Anticholinergic agents therapeutic action

•Blocks Ach receptors

•Decreases secretions before anesthesia, treat Parkinsonism, restore heart rate & blood pressure after vagal stimulation, relieve motion sickness/vomiting, relaxes bladder muscles/tightens sphincters, inhaled agents for bronchospasms and relieving hay fever rhinitis

Important teaching points for anticholinergic

Avoid driving and operating heavy machinery

stay hydrated

Monitor heat exposure

Avoid OTC meds

follow up

important teaching points: lifespan

doxycycline antibiotics lifespan

can cause pitting enamel and calcium deposits in growing bones

barrier contraceptive

Adverse Reactions: Vancomycin 

•n/v/d, taste alterations

•C. diff

•Nephrotoxicity

•Red man syndrome

Important teaching for Zidovudine 

important teaching points for topical antifungals

correct method of admin

length of time necessary to treat infection

clean dry socks

keep infected area clean, mild soap and pat dry keep dry

avoid scratching, use cool coompress

avoid occlusive dressings and applying to open skin b/c risk of systemic aborbption

report local irritation, burning oer worsening of infection

drug drug interactions of Amphotericin B 

nephrotoxic meds

Drug drug interactions Dextromethorphan 

MAOIs

Patient education drugs acting on the Upper respiratory tract

drug drug interactions of Theophylline 

caffeine

cig

patient teachings and nursing intervention of Methotrexate  

Adverse effects: Salicylates 

dyspepsia

bleeding

salicylism- tinitus, dizziness n/v/d

salicylate toxicity → cardiac and respiratory collapse

 

Therapeutic Action: Acetaminophen 

•Acts directly on thermoregulatory cells in hypothalamus to cause sweating and vasodilation

 

Indications: NSAIDs 

•Start with these for rheumatoid arthritis (ibuprofen)

Nursing interventions: Immune Suppressant

protect pt from expsure to infections and mainain strict aseptic technique

instruct on the use of barrier contraceptive

Contraindications: Vaccines 

acute illness

immune deficiency

caution pregnancy

allergies and hypersensitivity

recieved immune globuins/ blood products within 3 mo

adverse effects of Furosemide 

hypokalemia

hypocalcemia

hypotension

ototoxicity

alkalosis

adverse effects of Spironolactone 

•Hyperkalemia – lethargy, confusion, ataxia, muscle cramps, arrhythmias

•Androgen effects – hirsutism, gynecomastia, deepening of voice, irregular menses

Contraindications of Furosemide 

severe renal failure

hepatic coma

caution pregnancy, lupus, peds gout

contraindication of Spironolactone 

hyperkalemia severe renal disease caution pregnancy

patient teachings of phenazopyridine 

causes reddish orange urine

measures to prevent UTIs

patient teaching of antacids

importance on maintaing fluid and nutritional intake if GI upset occurs

Bowel training to deal with diarrhea/ constipation

Caution with prolonged use and rebound acid

periodic monitoring

Therapeutic Action: H2 Anatagonist

•H2 blockers

•Blocks h2 receptors – reducing 70% of hydrochloric acid release

•Used for short-term treatment of duodenal ulcers, prophylaxis of stress-induced ulcers in critical patients, treatment of erosive GERD, relief of heartburn, acid indigestion, and sour stomach

•Famotidine approved for pediatrics

Therapeutic Actions Chemical stimulant

•Directly stimulates the nerve plexus in intestinal wall to increase movement

•Castor oil – blocks absorption of fats but can lead to constipation due to lack of stimulus

Adverse Effects Chemical stimulant

•Diarrhea, abdominal cramping, nausea (GI upset)

•Dizziness, headache

•Sweating, palpitation, fainting (sympathetic stress reaction to the GI stimulation)

•Cathartic dependence – overuse of laxatives; GI tract becomes dependent, leading to constipation, impaction

Adverse Effects Loperamide

Constipation, N/

fatigue weakness

Therapeutic Actions Loperamide

Slow motility of GI tract

Relieve symptoms of diarrhea reduce output on ileostomies.

reduces cramping

contraindication of Hydroxyzine 

nursing assessment for Dronabinol  

assess CNS effects, don’t combine with hCNS suppressants

can alt mental status safety precautions.

nursing considerations of Octreotide 

assess abd

arrange for baseline ultrasound evaluation of the gallbladder to detect the presence of gallstones before treatment.

desmopressin indication

patient teachings of Prednisone 

Protect the patient from exposure to infection

Drug-drug interactions Adrenocortical Agents

glucocorticoids (methylprednisolone, prednisolone, prednisone, budesonide)

•Effects increase when combined with erythromycin, ketoconazole

•Effects decreased when combined with salicylates, barbiturates, phenytoin, rifampin

•With NSAIDs or etoh can increase GI distress/bleeding

•Use with K-depleting agents can cause hypoK

•With vaccines can reduce antibody response

mineralocorticoids

•Effects decreased when combined with salicylates, barbiturates, phenytoin, rifampin

•Decreased effectiveness of antidiabetic meds

indication of radioactive iodine

indications of Glargine

indication of Metformin

•Improves insulin sensitivity of peripheral cells

•Used off label for PCOS

Therapuetic action and indications of epinephrine

dilation of the bronchi increase rate and depth of respirations

drug of choice in acute bronchospasms