Nclex meds

Fluticasone/salmeterol (Advair)

contains corticosteroid and bronchodilator

Long acting agonist that promotes relaxes smooth muscle over 12 hours.

NOT an emergency drug for asthma.

education: after inhalation, rinse mouth with water without swallowing (reduce risk of candidiasis), avoid smoking, and receive pneumococcal and flue vaccines if there is a risk of infection.

Albuterol, Atrovent, Ipratopium, & sole-medrol

rescue asthma drugs

Albuterol & Atrovent: short acting beta agonist

Ipratopium: anticholinergic agent

solu-medrol: steroid to control underlying inflammation (not immediate)

Admin Q20 mins

NORMAL to habe tremors and palpitations

Capasaicin (Zostrix)

over the counter analgesic used for minor pain.

Education: wait at least 30 mins after massaging cream into hands before washing them to ensure adequate absorption, avoid contact with eyes, nose, and mouth (contains pepper contents), wear gloves when applying, avoid HEATING pads (vasodilation increases absorption and can cause a chemical burn), NORMAL to have burning, stinging, or erythema and will subside in a week, and can be used with tylenol or nonsterodial anti-inflammatory drugs to effectively treat osteoarthritis pain.

Use regularly (3-4x/day)for week to months.

Montelukast (singulair)

given with beta agonist and steroid (fluticasone or budesonide) to provide long term asthma control

Tobramycin

antibiotic

mostly used with aerosolized form to treat CF exacerbation when Pseudomonas is the predominant organism causing the lung infection

Rifaximin

antibiotic

used with hepatic enceph r/t to increased ammonia levels.

Meperidine (Demerol)

Opioid

CONTRAindicated in sickle cell r/t large frequent doses that can cause toxic metabolite (tremors -> seizure)

Most effective PCA

morphine or hydromorphone (Dilaudid)

Clopidogrel (PLavix)

antiplatelet

Naproxen (Naprosyn)

NSAID

Ginko Biloba

can increased risk for bleeding!

Vancomycin

antibiotic

Nephrotoxic (BUN and creatinine) , monitor trough levels before the 4th dose (15-20),

Promethazine

antiemetic

Duloxetine (Cymbalta)

serotonin-noreip reuptake inhibitor

Used: antidepressant and pain-relieving effect for fibromyalgia

Amitriptyline (Elavil)

Tricyclic antidepressant

use: antidepressant and pain relief for fibromyalgia

Pregabalin

tricyclic antiD

use: depression and fibromyalgia

Isotretinoin (accutane)

Acne medication

NEED TWO negative pregnancy test before starting medication

Educate: use two forms of brith control

Can NOT donate blood for at least one month to ensure preggos do not receive donation

Pregnancy X category

Lithium

mood stabilization to treat bipolar

Worry about the D's:

Dehydration, Decreased NA diet (increase NA in diet) , Decreased renal fnx (elderly), and Drug interactions (Diuretics (thiazide) and NSAIDs)

therapeutic level is NARROW (0.6-1.2) >1.5 is REPORTABLE

LOOK OUT FOR : ataxia, confusion,agitation, neuromuscular excitability, and DI (polyuria and polydipsia)

Phenytoin (dilantin)

Anticonvulsant

provide good ORAL CARE to prevent gingival hyperplasia (no reason to d/c)

d/c: fever, skin rash, and lymphadenopathy

risk for gait disturbance

Death Rattle treatment

Anticholingeric (atropine) OR Scopolamine patch

Dries up secretions that dying patient can no longer manage on their own.

Helps comfort the family

Ondansetron (Zofran)

antiemetic

Omeprazole (Prilosec)

PPI decreases stomach acid production

risk for long term use:

decrease bone density (r/t decrease intestinal calcium absorption) -> increased risk of fractures

decrease in acid production increases risk for pneumonias and c.diff

Prasugrel (Effient)

antiplatelet

Ace inhibitors, isotretinoin, and doxycycline

NO for preggos

Ace: bad for fetal kidney development

Isotretinion: major birth defects

Doxy: impair bone maturation of fetus.

Hydrochlorothiazide

thiazide diuretics

NO with lithium

used: HTN

SE: low K (muscle cramps) , low NA (mental status and seizures), high uric acid(worsen gout attacks), and hyperglycemia.

chlorthalidone

thiazide diuretics

no with lithium

SE: low K (muscle cramps and cardiac effects) low NA (mental status and seizures), high uric acid (worsen gout attacks) and hyperglycemia

Torsemide

loop diuretic

Bumetanide

loop diuretic

SARTANS

losartan, valsartan and candesartan

angiotension II receptor blockers

USED with patient who can not take ACE inhibitors or have adverse reactions to ACE inhibitors

V fib

EMERGENCY

CPR and dfib

just a bunch of up downs

Afib

irregularly irregular

GOAL of treatment is to lower ventricular rate <100

CCB, BB, and dig

V tach

no p waves and WIDE QRS

SVT

NARROW QRS

admin adenosine FAST (half life <5 seconds) can be given twice

should be given in the AC IV site

NORMAL to have period of ASYSTOLE!

PVC

wide and distored QRS and rhythm is all over the place

Serious complication of tonsillitis or pharyngitis

pertonsillar or retropharyngeal abscess

LOOK for: pot potato or muffled voice, trimus (inability to open mouth), pooling of saliva, deviation of uvula to one side.

#1 MAINTAIN AIRWAY

Dextromethorphan

cough suppressant

Lead poisoning

lead levels >5

Chelation therapy needed

education: home searched for lead sources, wash children hands frequently, increased intake of iron and vit C, hard surfaces should be wet dusted or mopped weekly, use COLD water to cook if pipes are source of lead.

Kawasaki Disease

lymph node syndrome

characterized by >5 days of fever, conjunctivitis, splenomegaly and extreme swelling.

#1 CONCERN: cornonary artery aneurysms -> MI and death

tX: IVIG with aspirin to prevent heart disease

education: CPR to parents, REPORT fever!! irritability is common for first 2 month, ROM and warm baths to prevent stiffness

Lactolose

Not digested or absorbed until it reaches large intestine

Produces an acidic environment and hyper osmotic effect

Education: can be given with water, juice or milk to improve flavor, can be administered as an enema, for faster results is can be administered on an empty stomach

THERAPEUTIC effects: 2-3 soft stools/day, improved mental status, and no dehydration, hypernatremia, or hypokalemia

Oxybutynin (Ditropan)

anticholinergic

tx: overactive bladder

S/sx: Cant eat, pee, shit, or spit, heat intolerance, blurred vision, and drowsiness

CVP

2-8

measures right ventricular preload and reflects fluid volume status

PA catheter use the blue (right proximal port)

low CVP: hypovolemia

High CVP: right ventricular failure or fluid volume overload

CVP is measured as a mean pressure and should be recorded at the end of expiration.

Wedge pressure

Use distal port of PA catheter

Nifedipine (Procardia)`

CCB

Pneumothorax chest tube on water seal suction

intermittent bubbling consistent with respirations (due to escaping from the pleural space) is expected until the lung has fully expanded

Water seal

NO continuous bubbling = air leak

bubbling with forceful cough or expiration is fine

water should rise and fall with respirations

Dry suction

NORAML to have gentle bubbling

chest tube chamber hooked to low wall suction setting

Medications before Dialysis

HOLD: antiHTN water soluble vits (B & C), antiB and dig

GIVE: CA ACETATE r/t high phosphorus levels that dialysis can not filter out either

Lispro insulin r/t fast acting and need to be given 15-30 mins before meals

FAT soluble vitmins (ADEK) not affected by dialysis

Epiglottis

life threatening

r/t HiB vaccination

s/x: tripod positioning, high grade fever, severe sore throat, followed by 4 D's: DROOLING, DYSPHONIA, DYSPHAGIA, and DISTRESSED AIRWAY (inspiratory stridor)

Education: Do NOT ask to open mouth it will occlude airway

nitrazine pH test

amniotic fluid is alkaline: blue-green or blue-gray = positive

Vaginal fluid is acidic: yellow or olive green = negative

Systemaic Lupus Erythematosis (SLE)

autoimmune disease that affect connective tissues

BUTTERFLY RASH across cheek and bridge of nose

s/sx: nephritis, arthritis, and vasculitis

Pyloris Stenosis

hypertrophy of the pylorus -> stenosis of the passage between the stomach and duodenum

s/sx: evident 2-8 weeks after birth. occasional vomiting -> forceful projectile vomiting.

dehydration and lyte imbalances.

Palpate the pyloric muscle and confirmed through ultrasound

how many calories burn loose a pound

3500

Cyclophosphamide

immunosuppressant and chemo agent

common SE: hemorrhagic cystitis (bladder inflammation)

education: drink fluids, IV hydration, and mesna therapy

St. Johns Wart

antidepressant herbal supplement

education: do NOT take with tricyclic, MAOI, SSRI/SNRI

-> increase side effects and lead to serotonin syndrome

Serotonin Syndrome

mild: shivering and diarrhea

severe: muscle rigidity, fever, and seizures

Increased ICP in infant

sunset eyes (sclera visible above the iris)

wide bulging fontanelle, prominent scalp veins, increased head circumference

normal output for infant

2ml/kg/hr

6-10 diapers/day OR 1 diaper/4hours

COPD levels and common dx

SAt: 90-93%

Pao2: 60-70

polycythemia

body tries to compensate by creating more RBC for o2 carrying capcaity

Terazosin

Alpha-adrenergic blocker

tx: relieve urinary rentention in clients with BPH

education: ortho hypotension, admin at bedtime, avoid erectile dysfunction medications that can bottom out BP

Sildenafil

viagra

no nitro or trazosin r/t bottoming out BP

NO grapefruit juice

CCB

no GRAPEFRUIT JUICE

MAP

>60 for adequate perfusion

Normal: 70-105

Duchenne Muscular Dystrophy

2-5 years old

Lower extremities affected first

Gower signs: use of hands to rise from squat or from chair to compensate for weak lower muscles

Wheelchair bound and die by 20-30 y/o

education:

prevents falls, exercise with swimming nothing more strenuous,

Coumadin and Heparin

Need 5 day overlap before switch from hep to coumadin

this ensures coumadin to reach therapeutic level before d/c of hep.

PTT>100 is criteria for D/C

Coumadin: no grapefruit or cranberry juice or green tea.

Avoid vit K NOT POTASSIUM VIT K!!!

ASthma triggers

tobacco smoke, beta blockers, aspirin, and NSAIDs

URI are #1

molds, pollen, dust mites, cockroaches, and animal danger

Rheumatic Fever

#1 questions: have you recently had strep

2-3 weeks post infix

s/sx: joint arthritis, carditis, subQ nodules, fever, prolonged PR intervals, increased sedimentation rate

CAN LEAD TO mitral regard/stenosis

Tx: penicillin

Levetiracetam (Keppra)

treats seizures

methotrexate (Rheumatrex)

immunosuppressant

tx: RA and psoriasis

s/sx: bone marrow suppression, increased risk for infection,

education: avoid large groups, people with infections, receive inactivated vaccines (flue and pneumococcal) NO live (herpes voter)

NO preggos, and NO ETOH r/t hepatotoxic side effects

Hydroxyxholoroquine (Plaquenil)

Antimalarial

Eye checked Q 6months r/t possbile retinal damage

Palidermin (Kepivance)

human growth factor

prevents oral mucositis in patietns dx with hematologic malgiance

Cane walking

hold can on stronger side

ascending stairs: first step with stronger leg, next bare weight on stronger leg, move cane, and finally step with weaker leg

potty training

18-24 months

ability to communication and follow directions

Promethazine (Phenergan)

Antiemetic

Do NOT use IV-- can cause damage to tissues including necrosis and gangrene

IM is the preferred rout

Tumor Necrosis Factor drug

Infliximab, adalimumab, and etanercept

suppress the inflammatory response in autoimmune disease such as RA, crohn and psoriasis

education: Do NOT take these drugs if you have a current, recent, or chronic infection, need a TB skin test Q year, only get INACTIVE vaccines (flu and pneumo)

Bishop Score

Score for induction of labor

Score cervix 0,1,2,3

Score of >8 = induction of labor

Steroids

increase blood sugar (increase insulin dose for Dm)

Increase risk of peptic ulcer with NSAIDS

start at a high dose and then slowly tapper to reduce the risk of sudden adrenal crisis

Can cause fluid retention and worsening HTN

Pericarditis

Normal: pain with deep inspiration, ST elevation (not MI), and friction rub heard on auscultation.

NOT normal: cardiac tampanda s/s JVD and distant heart sounds, and decreased BP

Hirschsprung Disease

newborn with missing nerve cells of distal bowel

s/sx: no peristalsis and stool is passes, distended abdomen and will not pass meconium within 24-48hours, vomit GREEN BILE,

tx> surgical removal of defective bowel and colostomy is required

REPORT: increasing abdominal girth and foul-smelling diarrhea and fever

Sulfa AntiB

tx: RA and ulcerative Colitis

MOA: inhibits production of prostaglandins in body

SE: Crystaluria-- kidney injury EDU: drink 8 glasses of water and maintain output 1200-1500ml/day

photosensitivity-- sunscreen and avoid sun

Folic acid deficiency-- eat folate rich food and take 1mg folic acid sup

agranulocytosis (leukopenia)-- monitored for CBC at start of therapy and report fever or sore throat ASAP

Steven-johnson-- DC is rash develops

EDU: pee with turn orange-yellow this is NORMAL

Trendelenburg

mod trendelenburg

TREN: head up ass down (crany)

mod tren: head down ass up (shock)

Bowel Irrigation for colostomy

fill irrigation container with 500-1000ml of luke warm water, flushing irrigation tubing, and reclamp.

hang the container on a hook to IV pole

instruct patient to sit on toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet and place place irrigation container approximately 18-24 in above the stoma

lub the cone tipped irrigator, insert the cone and attach catheter gentle into stoma and hold in place

slowly open the roller clamp and allow irrigation solution to flow for 5-10 mins

clamp the tube if cramping occurs and until it subsides

once the desired amount is instilled, the cone is removed and feces are allowed to drain through the sleeve into the toilet.

IRRIGATION allows for regulated bowel regimens

Lef to right shunting heart defects

(Patent ductus arteriosus, artial septal defect, and ventricular septal defect)

pulmonary congestion

increased work to breath and decrease lung compliance

increase RR, HR, and metabolic rate (poor wt. gain) diaphoresis during feeding, heart murmur and signs of congestive heart failure

Right to left shunt heart defects (yet, transposition)

cyanotic defects

clubbed fingernails or cyanosis with crying

NSAID long term use

can cause MI, stroke, HTN, and possible heart failure!

decrease diuretic and Bp medication effect!

Increase chronic kidney disease and peptic ulcer

Thiazoildinediones (GLITAZONE)

tx: type II DM

improves insulin sensitivity but does NOT release excess insulin

NO NO for heart failure or volume over load!

increase risk for bladder cancer

HbA1c goal

<7

Isoniazid (INH)

TB med

Hepatotoxic and peripheral neuropathy

NO ETOH, take vit b6 (prevent neuropathy), NO alum-containing antacids, Report changes in vision, numbness or tingling in extremities, and yellowing of skin,

Rifampin

TB med

body fluids will turn orange-red

Black Cohosh

tx: menopausal hot flashes

can cause thickening of the uterine lining and potential liver toxicity

Ginko, ginger, garlic, and ginseng (all start with g)

increase risk of bleeding

Metoformin (Glucophage)

NO before CT and 48 hours after r/t kidney injury

Low pressure alarm for an art line

#1 check for bleeding at the tube connection

low pressure indicates hypotension

excessive chest tube drainage for adults and children

>100ml within first hour

>5-10ml/kg/hr with children

tinea corporis

ringworm

contagious

tx: antifungals (tolnaftate, haloprogin, miconazole, and clotrimazole)

Scerloderma

overproduction of collagen that causes tightening and hardening of the skin and connective tissue

progressive disease without a cure

tx: managing s/sx

#1 concern is renal crisis that causes malignant HTN due to narrowing of the vessels that provide blood to the kidneys

s/sx: Raynauds phenomenon (blue and cold finger tips), pulmonary fibrosis (dry cough and dyspnea), heartburn, and dysphagia.

Guillain- Barre

acute immune-mediated polyneuropathy

GOLD SIGN: ASCENDING muscle paralysis and absence reflexes.

#1 concern: neuromuscular respiratory failure (rate and depth of RR) GOLD STANDARD TEST: spirometry

s/sx: ortho hypotension, paralytic ileus, urinary rentention, diaphoresis, absent reflexes (including gag), CN II, III, IV, and VI abnormal.

1kg= __mL of fluid

1kg=1,000ml

fifth disease

SLAPPED FACE

viral illness that affects SCHOOL AGED

spread via respiratory secretion MOST communicable before onset of s/sx.

GOLD SIGN: SLAPPED face (rash on cheeks) spread to extremities and maculopap. rash develops from prox. to distal surfaces.

s/sx: fatigue and joint pain (ibuprofen) ONCE symptoms develop they are no longer infectious.

recover with 7-10 days

biphosphonate

alendronate risedonate

RISK for jaw necrosis

educate: drink a lot of water with med admin and sit up for at least 30 minutes

late decels

uteroplacental insufficiency

1.give o2 by facemask

2.reposition on right or left side

3.oxytocin stopped

4. provide IV bolus

prepare for deliver is decelerations persist