Pathoharm final

you got this girl

The nurse follows legal practice guidelines when preparing medications by:

* teach client about medication
* monitor adverse effects
* lock components for controlled substances

Metformin, a diabetic drug that lowers blood sugar, has this adverse effect:

somnolence

Desmopressin, an antidiuretic to treat diabetes, has this adverse effect:

headache

The nurse administers insulin lispro IV to a patient who had an order for insulin IV. The nurse should:

stop the infusion and call the provider

The nurse administers propranolol for a client who has dysrhythmias. The nurse should:

assist the client with sitting up or standing after taking the medication

Use and mechanism of digoxin

Treats heart failure by increasing the heart’s contractions. It causes a forceful, slow heart beat

What should the nurse do before administering digoxin?

Listen to the apical pulse for 1 full minute and withhold the medication and contact the provider if under 60 bpm. Check the serum digoxin levels (1.8 ng/mL)

Adverse effects of digoxin

Neutropenia, dysrhythmias, digitalis toxicity

Overdose treatment for digoxin

IV digiband

The herbal remedies ma huang and ephedra cause:

dysrhythmias, therefore they shouldn’t be used with digoxin

Use and mechanism of furosemide

treats heart failure and hypertension by preventing reabsorption of sodium and chloride in the loop of hence

For furosemide, diureses starts in __ minutes when given IV

5

What should you check before administering furosemide?

Serum potassium

Adverse effects of furosemide

Hypokalemia, hypotension, tinnitus

Rare - ototoxicity

Drug-drug interactions for furosemide

Digoxin + furosemide = dysrhythmias

corticosteroids + furosemide = hypokalemia

**H**awthorn shouldn’t be used with furosemide or spironolactone since it causes

**h**ypotension

Overdose treatment for furosemide

vasopressor, replace fluids and electrolytes

Use and mechanism of spironolactone

treats hypertension and reduces peripheral edema by blocking sodium and aldosterone

Spironolactone should be administered with:

food, to prevent GI stress

Adverse effects of spironolactone

hypokalemia, GI disturbances, gynecomastia

Overdose treatment for spironolactone

replace fluid and electrolytes

Drug-drug interactions with spironolactone:

ammonium chloride causes acidosis

Use and mechanism of enalapril

treats *hypertension* and heart failure because it’s an ace inhibitor (inhibits angiotensin ll and aldosterone to decrease blood pressure)

The nurse should look out for first-dose phenomenon/hypotension for:

enalapril

Adverse effects of enalapril

*neutropenia*, hyperkalemia, orthostatic hypotension

Black box warning for enalapril

Fetal death

A pregnant client is prescribed enalapril. Can she have it?

No

Can antihypertensives be used together? (enalapril, metoprolol, nifedipine)

No

The nurse should teach a client on enalapril not to use __, because it can cause hyperkalemia

sodium supplements

Overdose treatment for enalapril

IV normal saline

Use and mechanism of metoprolol

treats hypertension and heart failure by being a beta-adrenergic blocker (reduces sympathetic stimulation of the heart)

When administering metaprolol, the nurse should first

check the apical pulse to and withhold the medication if it’s under 60 bpm. The nurse can’t crush the tablet either

Contraindications for metoprolol

Hypotension, asthma

Adverse effects of metoprolol

abnormal sexual function, insomnia

The nurse shouldn’t abruptly withdraw __ because it exacerbates angina and can cause an MI

metoprolol

Drug-drug interactions for metoprolol

metoprolol + digoxin = bradycardia

metoprolol + verapamil = heart block

Overdose treatment for metoprolol

vasopressor, atropine

Use and mechanism of nifedipine

treats hypertension and angina by blocking calcium ion channels, causing vasodilation which decreases blood pressure

The nurse knows that __ causes rebound hypotension, so it should be gradually discontinued

nifedipine

Nifedipine shouldn’t be taken..

within 2 weeks of an MI

Nifedipine must be taken:

whole, do not crush the tablets

Contraindications for nifedipine

no grapefruit juice

Drug-drug interactions for nifedipine

digoxin + nifedipine = toxicity

Use and mechanism of heparin

low doses - prevents thromboembolic events

high doses - treats conditions (like DVT)

by binding to antithrombin lll, stopping clotting factors and inhibiting thrombin activity

When administered subcutaneously, heparin onset is within _ hour

1

Heparin shouldn’t be given __ since it’s a bleeding risk

intramuscular (IM)

Adverse effects of heparin

abnormal bleeding, heparin-induced thrombocytopenia (HIT) occurs in 30% of patients

Black box warning for heparin:

patients with spinal anesthesia or lumbar puncture are at risk for epidural/spinal hematoma

Drug-drug interactions for heparin

heparin + warfarin = bleeding

heparin + aspirin = bleeding

heparin + ibuprofen = bleeding

Nicotine inhibits __, so it shouldn’t be used with anticoagulants (heparin and warfarin)

anticoagulation

Ginger, garlic, green tea, feverfew, and ginkgo increase __ risk for anticoagulants (heparin and warfarin)

bleeding

Overdose treatment of heparin:

protamine sulfate IV

Use and mechanism of warfarin

prevents thromboembolic events for patients after an MI or atrial fibrillation by being a vitamin k antagonist (inhibits vitamin K, which suppresses clotting factors)

Warfarin takes __ to onset

1-3 days

Black box warning for warfarin

fatal bleeding, constantly monitor patient

Drug-drug interactions for warfarin

warfarin + heparin = bleeding

warfarin + aspirin = bleeding

warfarin + ciprofloxacin = bleeding

no OTC drugs unless doctor approves

The nurse instructs the patient to limit __ since it reduces warfarin’s effects

foods high in vitamin K

Overdose treatment for warfarin

IM or subcutaneous vitamin K1

Use and mechanism of atorvastatin

treats high cholesterol by inhibiting HMB-CoA reductase

Adverse effects of atorvastatin

fatigue, muscle/joint pain, heartburn

rare - rhabdomyolysis

The nurse knows to monitor _ for atorvastatin

liver function

Pregnant clients __ have atorvastatin

can NOT (pregnancy category X)

The nurse instructs the patient not to have any __ while on atorvastatin, since it raises the likelihood of adverse effects

grapefruit juice

The nurse should administer atorvastatin in the __

evening

Drug-drug interactions for atorvastatin

atorvastatin + digoxin = no

atorvastatin + erythromycin = increased rnhabdomylosis risk

no ethanol

Use and mechanism of nitroglycerin

treats MI by dilating coronary arteries, lowering oxygen demand

Adverse effects of nitroglycerin

hypotension, flushed face, dizziness, rash

Contraindications for nitroglycerin

hypotension, intracranial pressure, head trauma

The nurse knows to __ when administering nitroglycerin, since it can be absorbed through the skin

wear gloves

Drug-drug interactions with nitroglycerin

nitroglycerin + sildenafil = bad

no alcohol, no antihypertensives (cause hypotension)

Use and mechanism of levothyroxine

treats hypothyroidism by acting as a thyroid hormone (helps with weight loss, temperature tolerance, and increasing pulse)

Adverse effects of levothyroxine

hyperthyroidism (anxiety, insomnia, weight loss, heat intolerance), palpitations, dysrhythmias

menstrual irregularities and osteoporosis in women

Contraindications for levothyroxine

cardiac disease, adrenal insufficiency, impaired kidney function

The nurse should assess for fatigue, slow speech, hoarseness, and slow pulse for a patient taking __

levothyroxine

Antacids should be administered _ hours after levothyroxine

4

The nurse will administer levothyroxine in the __ to prevent insomnia

morning

Drug-drug interactions with levothyroxine

levothyroxine + warfarin = bleeding

must take antacids 4 hours after levothyroxine

Overdose treatment for levoxthyroxine

beta-adrenergic blocker

Use and mechanism of aspirin

treats inflammation and reduces mortality after an MI and stroke by inhibiting COX-1 and COX-2 (NSAID)

Can pregnant women take aspirin?

No (pregnancy category D)

Since aspirin increases bleeding time, it should not be used with _ and _

warfarin and heparin

Adverse effects of aspirin

irritates digestive system, bleeding, salicylic (tinnitus, dizziness, headache, excessive perspiration)

Drug-drug interactions for aspirin

aspirin + warfarin/heparin = bleeding

aspirin + other NSAIDs (ibuprofen) = no

alcohol increases risk for gastric ulcers

antacids decrease effect

The client has a prolonged prothrombin time and an inaccurate pregnancy test. The nurse knows that _ can cause this

aspirin

Overdose treatment for aspirin

activated charcoal, gastric lavage

A pregnant client asks for an aspirin. Should the nurse administer it?

No, because it’s pregnancy category D

Use and mechanism of ibuprofen

treats musculoskeletal disorders (arthritis), pain, and fever by inhibiting prostaglandin synthesis (NSAID)

The nurse instructs the patient that ibuprofen is pregnancy category C and category D after __ gestation

30 weeks

Adverse effects of ibuprofen

heartburn, epigastric pain, dizziness

chronic use - renal impairment

Black box warning for ibuprofen:

thrombotic events, MI, stroke

Drug-drug interactions for ibuprofen

ibuprofen + oxycodone = increased therapeutic effect

ibuprofen + other NSAIDS (aspirin) = no

no alcohol

A client asks if ibuprofen increases or decreases bleeding time. The nurse responds by saying:

increases

Overdose treatment for ibuprofen

alkaline drug to promote urinary excretion

Use and mechanism of prednisone

treats inflammation and chronic asthma by being metabolized to an active glucocorticoid (corticosteroid)

The nurse knows to go deep in the muscle to avoid atrophy for __

prednisone

The nurse instructs the client that prednisone needs to be slowly tapered off when used for more than __ days

10

Contraindication for prednisone

infections

Adverse effects of prednisone

weight gain

long term - Cushing’s syndrome (since it’s a corticosteroid)

Drug-drug interactions for prednisone

no anti fungal drugs, diabetics need adjusted insulin doses, barbiturates increase metabolism

Use and mechanism of celecoxib

treats inflammation for inhibiting COX-2, only remaining COX-2 inhibitor