NURS pharm 180 Final WCU

what needs to be taken with psyllium and how much?

8 oz of water to prevent obstruction of esophagus

how long till psyllium to take effect?

24 hours

what needs to be increased in pt taking psyllium?

fluids

docusate sodium side effects?

diarrhea, nausea, cramps, dizziness, PALPITATIONS, syncope (sign of dehydration)

what should pt report when using docusate sodium?

unrelieved constipation

what is diphenoxylate and atropine used for?

slowing peristalsis to alleviate diarrhea

why is diphenoxylate atropine for short term use?

b/c schedule V drug so preventing dependency

priority nursing assessment for vomiting?

symptoms that precipitate it and electrolyte status

with pancreatitis when does it hurt most and where is the pain located?

after a meal, pain in the epigastric area that radiates to the back

what do you give pancrelipase with?

food

nursing assessments for pancrelipase?

pork allergy/ religious beliefs

what should you see with effective pancrelipase treatment?

decrease in steatorrhea

omeprazole is used for what and how long is therapy?

for peptic ulcers & GERD

short term use: 4-8 wks

with continued use of omeprazole what is the pt at risk for and what should you teach them to prevent this?

-osteoporosis

-increase calcium and vit. D

When should omeprazole be taken?

30 mins before 1st meal of day

side effects of ranitidine?

HEADACHE

what can occur in men taking ranitidine?

impotence, loss of libido

what should be avoided taking within an hour of ranitidine administration

antacid

when should ranitidine be given?

at bedtime with no regard to food

common side effect of aluminum hydroxide?

constipation

what symptoms can indicate a more serious disease when on ranitidine therapy?

epigastric pain, bloody tarry stools, heartburn

what does sucralafate do?

coats ulcer and prevents erosion

can sucralafate be taken with antacids?

no

when should sucralafate be administered?

take on empty stomach before meals and before bedtime

what should pt increase with sucralafate?

fluids and fiber

misoprostol is dangerous for which individual?

pregnant because category X

what is prochlorperazine used for?

anti-emetic

what are does related side effects of prochlorperazine?

anticholinergic effects-->dry mouth, sedation, constipation

orthostatic hypotension, tachycardia

when should you discontinue use of prochlorperazine?

extrapyramidal symptoms occur including tremors, stoop slow gait, drooling, pill rolling

can you administer omeprazole at the same time as antacids?

yes

what should you avoid with omeprazole?

NSAIDs (gastric irritation)

Ondansetron side effects

- Headache (common)

- electrolyte imbalance

- Sensation of warmth or flushing, pruritus

- Dysrhythmias

Lab values for hypothyroidism

Decreased T3 and T4

Increased TSH

therapeutic effect of levothyroxine?

increased t3 and t4

decreased TSH

side effects of levothyroxine?

hyperthyroidism, wt loss, heat intolerance, insomnia, diarrhea, anxiety

what time of day should you administer levothyroxine?

morning

how long till therapeutic effects of levothyroxine?

1-3 weeks

serious adverse effect of propylthiouracil?

agranulocytosis (infection risk)

what does radioactive iodide do?

destroy follicular cells to treat hyperthyroidism

pt teaching for radioactive iodide therapy

-they will need thyroid hormone replacement after

-avoid pregnant women/children for 1 week

insulin side effects

hypoglycemia

hypokalemia (inverse relationship with insulin)

insulin glargine

long acting

up to 24 hr

onset at 1.1 hr

insulin lispro

onset 15 min

peak 1 hr

duration 3 hr

insulin regular

onset 30-60 min

peak 1-5 hr

duration 6-10 hr

NPH insulin

onset: 1.5 hours

peak: 6-14 hours

duration: 16-24 hours

mixing insulin steps

NPH air then regular air then regular draw then NPH draw

How does glipizide work?

Stimulates insulin secretion from pancreatic islets

what should pt avoid with glipizide

alcohol

does metformin stimulate insulin secretion?

no

how does metformin work?

Decreases the hepatic glucose production and increases peripheral glucose uptake (decrease resistance)

acarbose blocks enzymes where?

small intestine, Block enzymes in small intestine responsible for breaking down complex carbohydrates into monosaccharides

Rosiglitazone works by

Decreases the hepatic glucose production and increases peripheral glucose uptake (decrease resistance)

-same as metformin

how long till optimal lowering of glucose with rosiglitazone

3-4 months

common side effects of rosiglitazone?

weight gain, fluid retention, headache

repaglinide works by

stimulating insulin secretion from pancreatic islet cells

-same as glipizide

antithyroid drugs are hard on which organ so assess which labs?

-liver

-AST & ALT

most common side effect of morphine

constipation

most serious side effect of morphine

resp. depression

what should nurse monitor before giving morphine?

respirations

opioid overdose is treated with

naloxone

sumatriptan is used for

migraine headaches by vasoconstriction of blood vessels in brain

when should you take sumatriptan and how many times can you repeat?

take on onset or during aura.

-take once wait one hour if no relief take it again and if still no relief then contact provider

pt teaching about sumatriptan

-only to abort migraines not for daily routine

-do not chew

who should you avoid sumatriptan in?

pt with cardiac hx

lidocaine blocks which channels?

sodium channels

what should you monitor for when using isoflurane?

malignant hyperthermia

other side effects of isoflurane?

shivering (not cold)

Cyclobenzaprine is used to treat

muscle spasms

biggest side effect of cyclobenzaprine

CNS depression

pt teaching with cyclobenzaprine

avoid driving/hazardous activites

take with food

assess home environment to see if they need assistance with ADLs

if you abruptly stop cyclobenzaprine it can result in?

seizures

which labs do you monitor with dantrolene?

ast and alt

antiinflammatory and NSAIDs should be taken with

FOOD

what do you monitor when using acetaminophen?

liver, jaundice

Does acetaminophen have anti-inflammatory effects?

no

acetaminophen antidote

acetylcysteine

max dose of acetaminophen daily. what if older or liver disease?

4000 mg, 2000 mg

aspirin can reduce the risk of what? dose?

stroke or MI.

81 mg/day

aspirin can interact with which herbals

ginkgo, ginseng, garlic

side effects of asprin

gi irritation, diarrhea

what should you give with aspirin

food, milk, or large amount of water

who should you avoid aspirin in?

hx of peptic ulcer

is aspirin ototoxic

yes

Salicylate poisoning

tinnitus, bleeding, can cause seizures

common side effect of NSAIDs so give with?

GI irritation give with food, milk, large amount of water

NSAIDs are hard on which organ so what labs do you monitor

nephrotoxic (kidney), BUN, Creatinine

signs of hypercalcemia

Drowsiness, lethargy, headache, anorexia, increased urination and thirst, confusion, coma, renal stones (report dysuria, flank pain)

Most serious: Dysrhythmia/cardiac arrest

alendronate is used for

prevention and treatment of osteoporosis

side effects of alendronate

jaw pain, blurred vision, dysphagia r/t esophagitis

raloxifene works by

decreasing bone resorption and increasing bone mass/density

which herbal may interfere with raloxifene?

black cohosh

side effects of raloxifene

hot flashes, leg cramps, weight gain, thromboembolism

pt teaching when using hydroxchloroquine

GI disturbances (take with milk/food); avoid use with hepatotoxic drugs, eliminate use of alcohol, take everyday at the same time, photophobia is common-sunglasses

methotrexate watch for

bleeding (thrombocytopenia)

hydrochloroquine and methotrexate are used to

relieve severe inflammation

allopurinol is used for

gout, controls hyperuricemia

how long till uric acid levels back to normal with allopurinol treatment

1-3 weeks

what should pt increase with allopurinol?

fluid: 2-3L per day

what should you monitor with furosemide use?

-electrolytes

-BP

-Urine output

what time of day should you take furosemide?

morning