Lecture Notes Review

Analgesic Review

• Tylenol has analgesic and antipyretic properties.
• Mixing opioids with other "downers" such as other opioids, benzodiazepines, and hypnotics can put you at risk for respiratory depression.
• If you overdose on opioids, you can administer naloxone.
• If you are withdrawing from opioids, you can administer methadone.
• Opioid side effects include constipation, sedation, drowsiness, nausea/vomiting, itching, and respiratory depression.
• NSAIDs have a black box warning regarding the high risk of stroke/MI, except for aspirin.
• NSAIDs like ibuprofen have analgesic, antipyretic, and anti-inflammatory properties.
• Aspirin should not be given to children due to the risk of Reye's Syndrome.
• Aspirin side effects include ototoxicity (ringing of ears), GI bleeds, and an increased risk of bleeding.

Thyroid/Adrenal/Endocrine Review

True/False Statements:

• PTU is for hypothyroidism, and dairy should be avoided when on this medication. FALSE
• Synthroid is known for its adverse effects of bone marrow suppression and liver toxicity. FALSE
• You can discontinue corticosteroids as soon as you feel relief of symptoms. FALSE - DO NOT DISCONTINUE ABRUPTLY, TAPER OFF
• Corticosteroids might cause a drop in blood sugar. FALSE
• NPH is a rapid-acting insulin that should be given 15 minutes prior to eating. FALSE

Insulin Administration & Hypoglycemic Protocol

Nursing Interventions for Insulin Administration:

• Roll vial between palms.
• Check blood sugar before giving insulin.
• Rotate injection sites.
• Administer SubQ into fat tissue.
• Never freeze insulin.

Hypoglycemic Protocol:

• If blood sugar is low, hold insulin.
• If awake: Take PO 15gm carbs and recheck blood sugar.
• If unconscious/AMS: Administer Glucagon or IV Dextrose 50%.

Cardiac Review

• ACE inhibitors (-PRILS) are known to cause dry cough, hyperkalemia, and angioedema.
• Alpha adrenergic blockers (Doxazosin) can cause dizziness, sedation, orthostatic hypotension, and first-dose syncope. Take this medication at evening/bedtime.
• ARBs (-SARTAN) can cause dizziness, UTI, hyperkalemia, diarrhea, and weakness.
• Verapamil is a CCB for HTN and dysrhythmias that can cause hypotension/dizziness, so the client should change positions slowly. It also causes constipation, so the client should eat high-fiber foods and hydrate.
• Digoxin is used as a last resort for heart failure due to the high risk of toxicity.
• Milrinone is a potent inotrope used in emergency situations for acute heart failure and is only available via the IV route.
• For acute chest pain, take a sublingual nitroglycerin and place it under the tongue. If it does not relieve chest pain, call 911 and take another dose in 5 minutes, repeating at 5-minute intervals (max of 3 doses).
• Nitroglycerin is effective when it relieves chest pain and decreases workload & activity intolerance.

Anticoagulants

Heparin:

• Monitor PTT every 6 hours.
• Antidote is protamine sulfate.
• Used SubQ to treat and prevent DVTs.

Enoxaparin:

• Used SubQ to treat and prevent DVTs.

Warfarin:

• Monitor PT/INR.
• Be careful not to eat too much Vitamin K foods such as spinach, broccoli, kale, collard greens.
• Antidote is Vitamin K.

Diuretics

Spironolactone:

• Potassium-sparing diuretic.
• Important pt education: Monitor K^+, Na^+, avoid foods high in potassium.

Mannitol:

• Diuretic primarily used to treat cerebral edema.
• Important pt education: Can crystallize when exposed to cold temperatures! Inspect for crystals—if present, discard & get a new one.

Hydrochlorothiazide (HCTZ):

• The 1st line diuretic for treating high blood pressure.
• Important pt education: Monitor electrolytes, orthostatic hypotension.

Furosemide:

• Diuretic known for potent rapid diuresis and to treat heart failure. Loop Diuretic.
• Important pt education: Monitor electrolytes, orthostatic hypotension. Give in the AM.

Respiratory Review

• Albuterol: A SABA rescue inhaler that opens up airways and can be used for exercise-induced asthma.
• Albuterol and Salmeterol have side effects of tremors, nervousness, tachycardia, and palpitations. TRUE
• Isoniazid: This TB drug has an adverse effect of jaundice.
• Rifampin: This TB drug has an adverse effect of red-orange body secretions.
• Theophylline: A xanthine derivative is taken orally and might cause adverse effects such as palpitations and dysrhythmias. TAKEN DAILY
• Diphenhydramine: An antihistamine that causes constipation, dry mouth, urinary retention, dizziness, and drowsiness and can be taken closer to the evening if drowsiness occurs.
• Montelukast: This oral pill is a non-bronchodilating medication used for maintenance tx of asthma/reduces nasal congestion and can cause behavioral issues.

Muscle Relaxants / Antiepileptic / AntiParkinson Review

• Two medications used to treat muscle spasms: Baclofen & Cyclobenzaprine.
• Key pt education regarding baclofen and cyclobenzaprine: Causes a lot of drowsiness - do not mix w/ alcohol, heavy machinery, or driving. Do not mix w/ other drugs that cause drowsiness.
• All antiepileptics carry a black box warning/risk for suicidal ideation.
• Phenytoin therapeutic levels: 10-20 mcg/ml
• AST/ALT must be monitored with Valproic Acid/Divalproex as it is very hepatotoxic.
• Two medications used to treat Parkinson's: Carbidopa-Levodopa, Benztropine.
• Benztropine has an anticholinergic effect. Key pt education: Increase fiber and fluid intake, chew/suck on hard sugarless candy, move around.

Acid Reducing Drugs

• Antacids are used to decrease the production of acid in the stomach. FALSE
• Medications may be taken at the same time as antacids. FALSE (SEPARATE BY 1 HR FROM OTHER MEDS)
• Simethicone can be taken if antacids (calcium carbonate) give too much gas.
• Famotidine: Which acid reducing H2 blocking drug has a side effect of confusion?
• PPIs (-prazoles): Long term use of this drug class can lead to brittle bones and C. diff.
• PPIs should be taken at the same time with meals. FALSE (30 min before)

Antiemetic + Bowel Drugs Review

• Antiemetics should be given 30-60 minutes before scheduled medications or chemotherapy.
• Ondansetron impacts the heart adversely by causing QT prolongation.
• Ondansetron CNS side effect: Headaches
• Metoclopramide's purpose is to accelerate gastric emptying.
• Excess laxative use may cause damage to bowels.
• Emollient laxative: Which type of laxative is best for opioid induced constipation?
• Probiotics (Lactobacillus acidophilus) should be given for antibiotic-induced diarrhea.
• Antibiotic-induced diarrhea should always be treated with antidiarrheals. NO. ANTIDIARRHALS PRIMARILY FOR noning, IF ABX inb-> PROBIOTICS & TX
• Lactulose is used to treat constipation but also to reduce ammonia levels.

Psych Drugs Review

• Benzodiazepines (-PAMS, -Lams) are used as a PRN medication to treat anxiety of all levels.
• Benzodiazepine side effects include drowsiness, sedation, dizziness, and confusion.
• Benzo pt education: Fall precautions, do not drive, do not operate heavy machinery, do not mix with other downers.
• Be careful with patients with liver damage (hepatic).
• Antidepressants take weeks to achieve a therapeutic effect.
• Antidepressants have a black box warning of suicide.
• The patient is at risk for serotonin syndrome when mixing an SSRI with St. John's Wort or other antidepressants.
• When taking an MAOI (phenelzine), tyramine-based foods should be avoided, including aged cheese, aged/cured meats like salami/pepperoni, and soy sauce (salted, fermented, aged, processed).
• Bupropion: This atypical antidepressant is also used for smoking cessation and appetite suppression (weight loss).
• CNS Stimulant (methylphenidate/phentermine) side effects include tachycardia, insomnia, weight loss & growth/developmental delays!
• Sumatriptan: This CNS stimulant is used for migraines.
• Modafinil: This CNS stimulant is used for narcolepsy.
• Lithium levels: 0.6-1.2 mEq/L
• Signs of lithium toxicity: Blurred vision, ataxia, tinnitus, tremors, severe N/V, diarrhea, vomiting, strenuous exercise, heavy sweating, diuretics.
• What makes you more toxic? Lose SALT & LOSE H_2O
• Disulfuram= Don't drink alcohol!