med cards unit 2 exam

Ondansetron

5 HT3 serotonin antagonist used for chemotherapy and postoperative nausea and vomiting. Major concern is QT prolongation.

Ondansetron MOA

Blocks serotonin 5 HT3 receptors involved in the vomiting response.

Ondansetron adverse effects

Headache, dizziness, constipation, diarrhea, and QT prolongation.

Metoclopramide

Dopamine antagonist and prokinetic medication that treats nausea and vomiting and increases gastric emptying.

Metoclopramide major complication

EPS and tardive dyskinesia. Monitor for abnormal or involuntary movements.

Metoclopramide teaching

Report involuntary movements, tremors, rigidity, or restlessness.

Scopolamine

Anticholinergic that blocks signals from the inner ear to the vomiting center. Used for motion sickness.

Scopolamine patch

Apply behind the ear. Wash hands after application and avoid touching the eyes.

Scopolamine adverse effects

Dry mouth, blurred vision, drowsiness, urinary retention, constipation, and tachycardia.

Promethazine

Antiemetic with antihistamine and anticholinergic effects. Can cause sedation.

Promethazine major complication

IV infiltration can cause severe tissue injury, necrosis, and gangrene.

Promethazine administration

Give IM using Z track when appropriate or dilute IV and administer slowly through a large patent vein.

Dronabinol

Synthetic THC used for refractory chemotherapy induced nausea and vomiting and appetite stimulation.

Dronabinol adverse effects

CNS effects, tachycardia, and potential dependence.

Psyllium

Bulk forming laxative. Take with adequate water to prevent intestinal obstruction.

Bulk forming laxatives

Add bulk and water to stool and promote bowel movement. Adequate hydration is essential.

Docusate

Stool softener used to prevent constipation. It does not effectively treat constipation that is already present.

Bisacodyl and senna

Stimulant laxatives that increase intestinal motility. Use short term because chronic use can cause dependence.

Osmotic laxatives

Magnesium hydroxide, magnesium citrate, lactulose, and polyethylene glycol. They pull water into the bowel.

Osmotic laxative complications

Dehydration and electrolyte problems. Magnesium products can cause magnesium toxicity, especially with renal impairment.

Laxative contraindications

Suspected obstruction, fecal impaction, acute abdomen, active diarrhea, or unexplained nausea, vomiting, or abdominal pain.

Penicillins

Beta lactam antibiotics that weaken and destroy the bacterial cell wall.

Penicillin prototype

Penicillin G potassium.

Penicillin name clue

Many penicillins end in cillin.

Penicillin major complication

Allergy and hypersensitivity including anaphylaxis.

Penicillin allergy nursing action

Ask about previous allergies before administration and monitor for allergic reactions.

Penicillin cross sensitivity

A client allergic to penicillin can have cross sensitivity to cephalosporins.

Penicillin teaching

Complete the entire course even if symptoms improve.

Cephalosporins

Beta lactam antibiotics that destroy bacterial cell walls.

Cephalosporin prototype

Cephalexin is a first generation cephalosporin.

Cephalosporin generations

There are five generations. Subsequent generations are generally more effective against gram negative organisms and less susceptible to beta lactamase destruction.

Cephalosporin allergy

Assess for cephalosporin and penicillin allergy because cross sensitivity can occur.

Cephalosporin complications

Allergy, GI upset, superinfection, C difficile, thrombophlebitis with IV administration, and pain with IM injection.

Cefotetan and ceftriaxone

Can increase bleeding tendencies. Monitor for bleeding.

General antibiotic rule

Obtain ordered cultures before the first antibiotic dose when possible.

Antibiotic course teaching

Complete the entire prescribed course even if symptoms resolve.

Antibiotic superinfection

Antibiotics can destroy normal flora and allow resistant organisms or yeast to overgrow.

Signs of superinfection

Diarrhea, C difficile, oral thrush, black furry tongue, or vaginal yeast infection.

Antibiotics and probiotics

Give probiotics at least 2 hours apart from antibacterial or antifungal medications.

Aminoglycoside prototype

Gentamicin.

Other aminoglycosides

Tobramycin, neomycin, streptomycin, and paromomycin.

Aminoglycoside MOA

Bactericidal antibiotics that destroy microorganisms by disrupting protein synthesis.

Aminoglycoside major toxicities

Ototoxicity and nephrotoxicity.

Aminoglycoside ototoxicity

Tinnitus, hearing loss, vertigo, dizziness, nausea, or balance problems.

Aminoglycoside nephrotoxicity

Increased BUN and creatinine, proteinuria, casts in urine, and dilute or cloudy urine.

Aminoglycoside monitoring

Monitor intake and output, BUN, creatinine, hearing, and medication levels.

Aminoglycoside peak

With divided doses obtain about 30 minutes after IM administration or 30 minutes after completion of IV infusion.

Aminoglycoside trough

Obtain immediately before the next dose.

Aminoglycosides and penicillin

Do not mix in the same IV solution because penicillin inactivates aminoglycosides.

Vancomycin

Cell wall inhibitor used for serious gram positive infections including MRSA. Oral vancomycin can treat C difficile.

Vancomycin major toxicities

Nephrotoxicity and ototoxicity.

Vancomycin infusion reaction

Red Man Syndrome can occur when vancomycin is infused too rapidly.

Red Man Syndrome manifestations

Rash, itching, flushing, tachycardia, and hypotension.

Preventing Red Man Syndrome

Infuse vancomycin slowly over at least 60 minutes.

Vancomycin monitoring

Monitor renal function and vancomycin trough levels.

Tetracycline prototype

Tetracycline.

Other tetracyclines

Doxycycline, minocycline, and demeclocycline.

Tetracycline MOA

Broad spectrum bacteriostatic antibiotics that inhibit bacterial protein synthesis.

Tetracycline major adverse effects

GI discomfort, permanent tooth discoloration, enamel hypoplasia, hepatotoxicity, photosensitivity, and superinfection.

Tetracyclines in children

Avoid in children younger than 8 years because of permanent tooth discoloration.

Tetracyclines in pregnancy

Avoid because they can affect fetal teeth and bone.

Tetracycline photosensitivity

Wear protective clothing and use sunscreen with SPF 30 or higher.

Tetracycline interactions

Calcium, milk, dairy, iron, magnesium containing antacids, and other chelating agents decrease absorption.

Tetracycline administration

Take with 8 ounces of water and do not take immediately before lying down because of esophageal ulceration risk.

Macrolide prototype

Erythromycin.

Other macrolides

Azithromycin and clarithromycin.

Macrolide MOA

Inhibits bacterial protein synthesis.

Macrolide major concern

QT prolongation can cause dysrhythmias.

Fluoroquinolone prototype

Ciprofloxacin.

Fluoroquinolone MOA

Inhibits bacterial DNA gyrase and topoisomerase IV.

Fluoroquinolone major complication

Tendinitis and tendon rupture especially involving the Achilles tendon.

Fluoroquinolone teaching

Report tendon pain or swelling immediately.

Metronidazole

Anti infective medication that has a major interaction with alcohol.

Metronidazole and alcohol

Avoid alcohol because it can cause a disulfiram like reaction.

Amphotericin B

Antifungal used for serious systemic fungal infections.

Amphotericin B major toxicity

Nephrotoxicity.

Amphotericin B other complications

Infusion reactions, hypokalemia, and bone marrow suppression.

Amphotericin B nursing care

Premedicate if prescribed, infuse slowly, and monitor renal function and potassium.

Acyclovir

Antiviral medication. IV administration can cause nephrotoxicity and neurotoxicity.

IV acyclovir nursing care

Monitor renal function and hydration.

Rapid acting insulin prototype

Lispro.

Lispro timing

Onset 15 to 30 minutes, peak 30 minutes to 3 hours, duration 3 to 5 hours.

Short acting insulin prototype

Regular insulin.

Regular insulin timing

Onset 30 minutes to 1 hour, peak 1 to 5 hours, duration 6 to 10 hours.

Intermediate acting insulin prototype

NPH.

NPH timing

Onset 1 to 2 hours, peak 4 to 14 hours, duration 14 to 24 hours.

Long acting insulin prototype

Glargine.

Glargine timing

Onset 1 to 4 hours, no peak, duration about 24 hours.

Clear insulin

Regular and rapid acting insulin are clear.

Cloudy insulin

NPH is cloudy.

Mixing Regular and NPH

Draw up clear before cloudy. Regular before NPH.

Glargine mixing

Never mix glargine with another insulin.

Insulin that can be given IV

Regular insulin.

IV regular insulin

Flush approximately 50 mL through the IV tubing as directed because insulin binds to the tubing.

Insulin syringe safety

Match the syringe concentration to the insulin concentration. U100 insulin requires a U100 syringe.

Unopened insulin storage

Refrigerate.

Opened insulin storage

Can generally be kept at room temperature away from excessive heat and light. Course material emphasizes discarding after about 1 month.

Hypoglycemia

Blood glucose below 70 mg per dL.

Abrupt hypoglycemia manifestations

Sympathetic signs include tachycardia, sweating, tremor, and anxiety.

Gradual hypoglycemia manifestations

Headache, confusion, fatigue, and drowsiness.