Untitled Flashcards Set

1. Understanding Pain

   1. How do we perceive pain? With all of our senses 

   2. What is pain? Unpleasant sensory and emotional experience associated with tissue damage 

   3. Nociceptors trigger messages sent to _____ allows perception of ____? Brain;pain

   4. What is the pain threshold? The smallest amount of tissue damage that makes a person aware of having pain

   5. What is pain tolerance? Person’s ability to endure pain intensity 

2. Analgesics 

   1. What are analgesics? Drugs of any class that control pain

   2. What is included in analgesics? Opioids, Nonopoid miscellaneous drugs

   3. How often are analgesics usually given? On a PRN basis, on a schedule, or can be “patient controlled analgesia (PCA)

   4. What to check before giving analgesics? Pain intensity using preferred pain scale, and when the pt last received the drug

   5. What to check after giving analgesics? Amount of pain relief (check in 30 min, then hourly)

   6. Teaching priorities for analgesics? Best pain relief occurs when drugs are taken on a regular schedule rather than PRN, reduce dose but maintain schedule ifo pain is lessened 

3. Controlled Substances

   1. Drugs that are most likely to lead to addiction? Schedule 1

   2. Drugs with the least potential for addiction? Schedule 5

4. Opioid Agonists 

   1. How do opioid agonists work? Work by binding to opioid receptor sites in the brain and other areas 

   2. What are the main opioid receptors? Mu (OP3), Kappa (OP2), Delta (OP1)

   3. S/E of opioid agonists? Constipation, N/V, drowsiness, flushing/itching

   4. A/E of opioid agonists? Respiratory depression, addiction, dependence, withdrawal 

   5. Check before giving opioid agonists? Dose, drug name, resp. rate, O2 sat (ABC’s - Airway, Breathing, Circulation (in that order))

   6. Check after giving opioid agonists? Resp. rate and O2 sat hourly, ask about constipation

   7. If severe respiratory depression occurs, administer? Narcan if needed 

   8. Teaching priorities for opioid agonists? Take with food, do not drive, change positions slowly, and take stool softeners/laxatives before constipation occurs

   9. Pediatric considerations? Dosage is based on age, size (wt in kg), health, pain severity

   10. Pregnancy/Lactation considerations? Newborn addiction.withdrawal can occur, if opioids are given during labor then the baby may need dose of opioid antagonist, avoid breastfeeding if taking opioids for more than 2 days 

       1. During childbirth, if mother given morphine (Or any other opioid) make sure to watch respirations

   11. Signs and symptoms of overdose? Pinpoint pupils, decreased respirations, neurological abnormalities (confusion)

   12. When should one hold morphine? If respirations are 10 bpm, patient’s LOC is compromised from narcotic, and/or O2 sat low

   13. What are ethical implications of Patient Controlled Analgesia (PCA) pumps? Patient receiving it must be fully alert and oriented (legally making decisions) Who can press the button? The patient only NOT THE FAMILY OR NURSE.

5. Non Opioid Pain-Control Drugs 

   1. What is another term for these? Adjuvant drugs 

   2. Acetaminophen 

      1. Effective for? Pain relief 

      2. How is acetaminophen given? PO in tabs, capsules or liquid or by suppository (PR)

      3. When is acetaminophen toxic? At high doses, too often, or with alcohol

      4. Risk for what when toxic? Nephrotoxicity and hepatotoxicity 

      5. Pediatric considerations? Toxic to liver and kidneys at high doses, and parents MUST read label to determine strength and correct dose 

6. NSAIDs

   1. Where do NSAIDs act? At the tissue where the pain starts

   2. NSAIDs help manage pain associated with? Inflammation, bone pain, cancer paani, and soft tissue trauma 

   3. Why would person need to stop taking NSAID for a period of time before surgery? Usually order patient to stop taking NSAID one week prior to surgery due to risk of bleeding during surgery. 

   4. Teach a client taking high-dose aspirin:

      1. Gastric erosion can occur

      2. Report signs of bleeding: bleeding gums, tarry stool, blood in urine, excessive bruising

      3. Report ringing in ears 

      4. High dose aspirin can be nephrotoxic (hard on kidneys)

      5. Can cause Reye syndrome in children-not for children usually 

   5. NSAIDS include ibuprofen and aspirin 

7. Antidepressants for pain control

   1. Reduces some types of which pain? Chronic and Cancer Pain

   2. Dosing will be different from times where it is used to treat depression

   3. Antidepressants help increase the quantity of what in the brain? Natural opioids

   4. How long must a pt take antidepressants before feeling pain relief? 1-2 weeks

8. Antiepileptics for pain relief 

   1. Antiepileptics help with? Neuropathic pain, and migraine headaches

   2. Common antiepileptics for pain? Gabapentin (Neurontin) & Pregabalin (Lyrica)

   3. Doses for pain control are often higher than those used to control seizures 

9. Muscle relaxants 

10. Medical Marijuana (cannabinoids) 

    1. Now legal in some states and used for? Pain management, seizure disorders, Parkinson's disease, chemo-therapy induced N/V

11. Migraine headaches

    1. What are the two stages? Constriction of arteries and dilation of arteries 

    2. What often occurs with migraine headaches? N/V, extreme sensitivity to light and sound

    3. What are the older migraine drugs? Triptans (Sumatriptan), NSAIDs, Ergotamine

    4. Biologic agents (“Biologics”)? Onobotulinumtoxin A (Botox), calcitonin gene-related peptide (CGRP) antibodies 

    5. Calcitonin Gene-Related Peptide (CGRP) Antibodies 

       1. Intended Responses? Reduce frequency and intensity of headaches, increase ability to participate in ADL’s, improve quality of life 

       2. S/E? Constipation, fatigue, N, weight and hair loss

       3. A/E? Hypersensitivity, elevated liver enzymes 

       4. Drugs in this class? atopegant (QULIPT), eptinezumab (Vyepti), erenumab (Aimovig), galcanezumab-gnlm (Emgality), rimegepant (NURTEC ODT), ubrogepant (Ubrelvy) 

       5. Check before giving? Know when to take the drug, and when to contact the provider 

       6. How to mix the solutions? Gently, don't shake!

       7. Teaching priorities? Take as prescribed, avoid grapefruit, monitor for jaundice

       8. Pregnancy/lactation? Not recommended

12. Muscle spasms

    1. What are they? Involuntary contraction of a single muscle, group of related muscles, part of a muscle

    2. Causes? Pressure on nerve, inflammation and swelling, electrolyte imbalance, irritation, injury

13. Skeletal muscle relaxants 

    1. How do they work? Depress the CNS which reduces motor nerve depolarization

    2. Intended responses? Reduce muscle spasms, pain; increase mobility/function of affected muscles; improve sleep/rest

    3. S/E? Drowsiness/sedation, H/N, hypotension, dry mouth, dizziness, constipation, muscle weakness, frequent urination

    4. A/E? Interacts with more than 100 drugs 

    5. Meds involved? Baclofen (Enova, Equipto, Gablofen, Lioresal, Ozobax), carisoprodol (Soma, Vanadium), cyclobenzaprine (Amrix, Fexmid, Flexeril), methocarbamol (Robaxin), tizanidine (Zanaflex) 

    6. Check before giving? Level of consciousness, cognition, skeletal muscle reactivity, ask about seizure disorders, obtain a list of all drugs the pt takes, assess vital signs

    7. Check after giving? Level of consciousness, cognition, skeletal muscle reactivity, BP/vitals (especially when changing positions-orthostatic hypotension)

    8. Teaching priorities? Only take on short-term basis, don't drink, don't drive, take with food/milk, monitor for interactions, avoid sun

    9. Pregnancy/Lactation? Most are NOT recommended 

    10. Older adult considerations? NONE recommended 

    11. Work by? Depressing the CNS

    12. T/F: Used in combo with other drugs for pain control when part of the pain experience includes muscle spasms? TRUE

    13. PRODUCES SIGNIFICANT SEDATION 

1. Inflammation

   1. S/S? Warmth, redness, swelling, pain, decreased function

   2. Stage 1? (vascular)- involves WBCs and changes in blood vessels 

   3. Stage 2? (exudate)- large #s of WBCs created; exudate (tissue drainage) called pus is formed 

   4. Stage 3? (tissue repair)- healthy cells divide to replace damaged cells; scar tissue may form 

2. Corticosteroids

   1. Corticosteroid Meds? betamethasone (Adbeon, Celestone), cortisone (Cortone), dexamethasone (Baycadron, Decadron, Solurex), hydrocortisone (Solu-Cortef), methylprednisolone (Duralone, Medalone, Solu-Medrol), prednisolone, prednisone

   2. What are corticosteroids used to treat? 

   3. Drug forms/routes? Oral, Parenteral, Inhalation, Topical, Injection into joints, Rectal, Drops

   4. Intended responses? Reduced redness, pain, swelling at site; increased function

   5. S/E? HTN, weight gain, acne, nervousness, insomnia, hypernatremia, Cushingoid appearance 

   6. A/E? Adrenal gland suppression, reduced immune function, delayed wound healing

   7. Check before? Dose, specific drug name, symptoms of infection, BP/weight

   8. Check after? Vital signs at least once per shift, weekly weights

   9. Teaching priorities? Don’t stop suddenly, take with food, avoid crowds 

   10. What can happen with abrupt discontinuation? Adrenal insufficiency

   11. Peds Considerations? At risk for same side effects as adults 

   12. Preg/Lact Considerations? Drugs cross placenta and are excreted in breast milk

   13. Older adult considerations? Extra precaution to avoid infections, monitor blood glucose levels

3. NSAIDs

   1. How do they work? Prevent or limit tissue/blood vessel responses to injury or invasion by slowing the production of one or more inflammatory mediators 

   2. What are the two different groups? Cyclo-oxygenase 1 (COX-1) and COX-2

   3. Salicylates? aspirin, diclofenac, diflunisal, salsalate

   4. Propionic acids? flurbiprofen, ibuprofen, naproxen

   5. Acetic acids? oxaprozin, indomethacin, nabumetone, piroxicam 

   6. Enolic acid? Piroxicam

   7. Pyrazole? Celecoxib

   8. Enolic acid? Meloxicam 

YELLOW=NON SELECTIVE INHIBITORS OF COX-1 and COX-2

GREEN=SELECTIVE INHIBITORS OF COX-2 

9. Intended responses? Reduced redness pain, swelling and warmth at site of inflammation; increased function; reduced fever 

10. S/E? Bleeding, GI ulcers, GI pain, fluid retention, HTN

11. A/E? Possible kidney damage, induction of asthma and allergic reactions

12. Check before? Any problem with NSAIDs including OTCs, give after meals with full glass of water or milk, monitor BP

13. Check after? Bleeding even with one dose, sensitivity reaction

14. Teaching priorities? Don’t take on empty stomach, monitor for bleeding, AVOID WARFARIN

15. Peds considerations? ONLY ibuprofen- Aspirin causes Reye’s syndrome 

16. Preg/lact considerations? Avoid during last tri

17. Older adult considerations? Cardiac problems 

4. Drugs for Allergic Inflammation

   1. Antihistamines

      1. What meds are included? cetirizine, diphenhydramine, fexofenadine, loratadine

      2. How do they work? Cause changes that lead to inflammatory responses (decrease histamine response)  

      3. S/E? Sleepiness, dry mouth, dilated pupils, increased HR and BP, urinary retention

      4. A/E? Seizure (rare), increased IOP

      5. Check before? Glaucoma, high BP, prostate enlargement, other prescribed drugs 

      6. Check after? Pulse, BP, resp. rate 

      7. Teaching priorities? Avoid alcohol/driving within 6 hrs of administration

   2. Leukotriene Inhibitors

      1. What meds are included? montelukast sodium, zafirlukast, zileuton

      2. How do they work? Limit or prevent allergy episodes in various ways 

      3. S/E? Headache, abdominal pain

      4. A/E? Allergic reactions, including hives and anaphylaxis (rare)

      5. Check before? Liver problems/jaundice

      6. Check after? S/S of decreased liver function

      7. Teaching priorities? Report jaundice, symptoms of liver problems 

   3. Intended response? Reduce blood vessel dilation and swelling, reduce mucus/nasal/eye/resp. secretions, widen narrow airways, decrease size/itchiness of hives

5. Disease-Modifying Antirheumatic Drugs (DMARDs)

   1. How do they work? Reduce the progression and tissue destruction of inflammatory disease; inhibits tumor necrosis factor

   2. Meds in this class? azathioprine, hydroxychloroquine, leflunomide, methotrexate, sulfasalazine (HIGH ALERT DRUGS)

   3. Intended responses? Reduce pain and other symptoms, improve function (used for rheumatoid arthritis, lupus) 

   4. S/E? N/V, rash, headache, thinning hair, weight loss

   5. A/E? Anemia, increased risk for infection, liver impairment, vaccine efficacy is reduced, many drug interactions 

   6. Check before? Assess liver function; check for infection; ensure negative pregnancy test; possible drug interactions; use “no-touch” technique 

   7. Check after? S/S of decreased liver function or infection; sufficient fluid intake

   8. Teaching priorities? Don’t touch drug directly, report signs of liver toxicity, avoid alcohol

   9. Ped considerations? Used for severe pediatric inflammatory autoimmune disorders 

   10. Preg/lact considerations? Breastfeeding is not recommended

       1. Azathioprine, leflunomide, methotrexate cause? Birth defects

       2. Hydroxychloroquine and sulfasalazine can only be used when? Benefits must outweigh the risk

1. Overview

   1. Air with oxygen enters the nose and mouth and moves through the airway into air sacs called? Alveoli

   2. The open center of the hollow part of the airway is called? Lumen

   3. Common method to measure airway function? Peak expiratory flow rate (PERF)

2. Asthma 

   1. What is and isn’t affected? Airways are affected, not the alveoli

   2. Occurs in? Episodes or attacks with no symptoms inbetween 

3. COPD

   1. COPD is a combo of? Chronic bronchitis and emphysema 

   2. Blue bloaters? Chronic bronchitis

   3. Pink puffers? Emphysema

   4. What is chronic bronchitis? chronic inflammation of the airways

   5. What is emphysema? normal elastic tissue in the alveoli become loose and flabby 

   6. COPD symptom course? Never goes away completely 

4. Drug Therapy for Asthma

   1. Rescue drugs stop acute attacks, and prevention drugs prevent chronic attacks 

   2. Biologics, bronchodilators, anti-inflammatories 

   3. Therapy goals? Improve airflow, reduce symptoms, and prevent asthma attacks

5. Drug Therapy for COPD

   1. Cannot be reversed and is the same as asthma with higher/more frequent doses 

   2. Mucolytics, bronchodilators, anti-inflammatories 

6. Bronchodilators

   1. MOA? Beta2-adrenergic agonists bind to the beta2-adrenergic receptors and act like adrenalin, causing an increase in cyclic adenosine monophosphate

   2. Short-acting? Rapid, short-term relief; rescue drugs

   3. Long-acting? Need time to build up an effect; used in COPD to maintain open airways 

   4. Cholinergic Agonists

      1. Block the? Parasympathetic nervous system

      2. AKA? Controller drugs

      3. Must be taken? Daily to prevent asthma attacks and reduce airway blockage in COPD 

      4. Intended responses? Pulmonary muscles relax, airway lumens widen, wheezing decreases, PERF increases 

      5. S/E’s? Urinary retention, blurred vision, eye pain, nausea, headache

      6. Meds include? Ipratropium, tiotropium, aclidinium 

   5. S/E’s? Rapid HR, increased BP, nervous, tremors, difficulty sleeping

   6. Check before? Ask about inhaler use, and listen to lungs 

   7. Check after? breathing, compare pts HR/BP within 15 min after giving the drug, and ask about chest pain

   8. Pt. Ed.? carry SABA inhaler at all times for attacks

   9. Ped considerations? Nebulized form with tight face mask usually used, children experience insomnia with beta2-adrenergic agonists

   10. Older adult considerations? Check pulse rates before/after taking, report tremors and insomnia

   11. SABAs include? Albuterol, levalbuterol, 

   12. LABAs include? Formoterol, salmeterol

   13. Selected bronchodilator combo agents? BEVESPI, Duaklir, STIOLTO 

7. Anti Inflammatory Drugs

   1. Includes? Corticosteroids, mast cell stabilizers, leukotriene inhibitors 

   2. S/E’s? Cough, bad taste, mouth dryness, increased risk of infection, HYPERglycemia

   3. Inhaled corticosteroids? Beclomethasone, budesonide, fluticasone, mometasone

   4. Mast cell stabilizer? Cromolyn sodium 

   5. Selected anti inflammatory/Bronchodilator combo agents? Advair Diskus, Breo, Dulera, Symbicort, Breztri Aerosphere, Trelegy Ellipta 

   6. Check before? Pts mouth for infection/thrush, pt knows correct technique for using inhaler/spacer, and give bronchodilator first and wait at least 5 min before giving the antiinflammatory 

   7. Check after? Help pt rinse mouth with water or mouthwash

   8. Pt. Ed.? Take as prescribed, take daily with COPD, rinse mouth after using, check gums/mouth/throat daily for redness or white patches 

8. Biologics

   1. What are they? Complex inflammatories derived from living sources

   2. Meds included?

      1. Interleukin-4 (IL-4) and Interleukin-13 (IL-13) Antagonists: dupilumab (Dupixent)

      2. Interleukin-5 (IL-5) Antagonists: benralizumab (Fasenra), mepolizumab (Nucala), reslizumab (CINQAIR)

      3. Immunoglobulin E (IgE) Antagonists: omalizumab (Xolair)

      4. *****END IN “-MAB” 

   3. S/E’s? Headache, injection site reactions

   4. A/E’s? Allergic rxn, worsening of pre-existing infections (especially helminth and TB), decreased effect of vaccinations 

   5. Check before? Test for TB a week before first dose, have epi ready incase anaphylaxis, allow med to reach ROOM TEMP before administering

   6. Check after? Don’t massage inject site, watch pt for 30-60 min, watch for allergy

   7. Pt. Ed.? S/S of allergy (call 911 if occurs), teach method for injection, monitor for infection, keep all appts for lab testing, avoid crowds and people who are ill 

9. Mucolytics

   1. Meds include? Guaifenesin and Acetylcysteine 

   2. Which of those is the antidote for Tylenol overdose? Acetylcysteine 

   3. MOA? Breaks down mucus

   4. Forms? PO or nebulizer

   5. S/E’s? Med has an unpleasant odor, and N/V 

10. Pulmonary artery hypertension 

    1. What is it? Lungs blood vessels severely constrict, resulting in reduced blood flow and higher pressures 

    2. RARE, occurs mostly in WOMEN 20-40 yrs of age 

    3. Treated with? 

       1. Prostanoids: Epoprostenol (Flolan, Veletri), treprostinil (Remodulin, Tyvaso) 

          1. MOA? Inhibits thromboxane AA2 and increases cAMP in blood vessel and smooth muscle 

          2. Preg/Lact? Mod likelihood of increasing the risk for birth defects or fetal damage; breastfeeding not recommended 

       2. Endothelin-Receptor Antagonists: ambrisentan (Letairis), bosentan (Tracleer), macitentan (Opsumit)

          1. MOA? Block endothelin receptors on blood vessel cells 

          2. Preg/Lact? Known to cause birth defects; no breastfeeding

       3. Guanylate Cyclase Stimulators: riociguat (Adempas) 

          1. MOA? Increase the amount of cyclic guanosine monophosphate in smooth muscles of pulmonary blood vessels 

          2. Preg/Lact? Known to cause birth defects; no breastfeeding

       4. S/E’s of all? Headache, severe hypotension, dizziness, flushing

       5. A/E’s of all? Severe bleeding, elevated liver enzymes 

    4. Meds result in? Reducing pulmonary pressures and slowing development of HF

    5. Check before giving? BP, respiratory/cardiac status, inspect vial for discoloration/particles, neg pregnancy

    6. Check after giving? Ensure no interruptions of continuous parenteral therapy and that drugs are given on time; monitor ABG levels; assess bleeding and liver enzymes 

    7. Pt. Ed.? Do not stop abruptly, take on time, don’t skip doses, teach pts how to use pumps, assess daily for liver impairment, keep all follow-up appts

11. Pulmonary fibrosis 

    1. A previous lung injury causes inflammation in the lungs, leading to? Excessive cell division and replacement of normal lung cells with fibrotic scar tissue 

    2. Even with proper trtmt, most pts usually survive only 1-2 years after diagnosis 

    3. Drug therapy focuses on? Slowing the fibrotic process

    4. Mainstay meds of therapy? Corticosteroids and other immunosuppressants 

1. Overview

   1. Functions of the GI system? Taking in and breaking down food, absorbing useful nutrients and eliminating waste 

   2. Small bowel function? Absorbing nutrients

   3. Large bowel (colon) function? Processes waste and absorbs fluid

   4. Rectum function? Where stools are stored before BM

2. Nausea and Vomiting

   1. Defenses of? GI system

   2. Signs of? Altered body function

   3. Vomiting results from? Powerful contractions of the abdominal wall and chest wall muscles 

   4. Mechanoreceptors initiate? vomiting

   5. Chemoreceptors respond to? Toxins 

   6. Vomiting center is located in the? Medulla And is responsible for? Initiating the vomiting reflex 

3. Antiemetic drugs

   1. What do they do? Control N/V

   2. Phenothiazines? promethazine (Phenergan), prochlorperazine (Compazine) 

   3. Anticholinergics? scopolamine (L-hyoscine) 

   4. Antihistamines? cyclizine (Cyclivert, Marezine), meclizine (Antivert, Dramamine) 

   5. 5HT3-Receptor Antagonists? granisetron (Kytril, Granisol, Sustol), ondansetron (Zofran) 

   6. Dopamine Antagonists? metoclopramide (Gimoti, Metozolv, Reglan), trimethobenzamide (Navogan, Tebamide, Tigan, Triamzide) 

   7. S/E’s? Vary with drug type, insomnia, double vision, tinnitus, HTN, photosensitivity, ECG changes 

   8. A/E’s? Neuroleptic malignant syndrome, coma, seizures, tardive dyskinesia, neutropenia, resp. depression 

   9. Check before? Baseline vitals, LOC (level of consciousness, weight, electrolytes, bowel sounds; abdominal distention, obtain complete list of drugs

   10. Check after? N/V, VS (Vital signs), daily weight, abdomen, immediately report signs of resp. depression, watch for S/E’s and A/E’s

   11. Pt. Ed.? Caution about driving, sunscreen, S/S of malignant neuroleptic syndrome and tardive dyskinesia, eat foods w/ increased bull, increase fluids 

   12. Peds? Children may have muscle spasm of the jaw, neck, and back, along with jerky movements of the head and face, balance disturbance 

   13. Preg/Lact? Consult prescriber; avoid while breastfeeding

   14. Older adults? More likely to experience confusion, dizziness, shaky hands, balance disturbance 

4. Constipation

   1. Must include? Less than three bowel movements per week for 3+ months 

   2. Common causes? Low-fiber diet, sedentary lifestyle, decreased fluid intake, delaying nature, laxative misuse, certain drugs affect nerve activity of the colon and fluids 

   3. Types of drugs that treat? Bulk-forming laxatives (Psyllium, methylcellulose), stool softeners (Docusate), Lubricants (Castor oil, glycerin suppository), Osmotic laxatives (Magnesium hydroxide, Polyethylene glycol, lactulose, lubiprostone, sodium phosphate), Stimulant laxatives (Bisacodyl, senna)

   4. S/E’s? Diarrhea, skin rash, stomach cramps, abdominal distention, N, gas, headache, reflux 

   5. A/E’s? Rare but PSYLLIUM and DOCUSATE may cause allergic reactions

   6. Check before? Complete list of current drugs, current bowel habits, bowel sounds/abdominal distention, baseline vitals, get 6 oz of fluid for PO forms

   7. Check after? Recheck abdomen for distention/bowel sounds, monitor for bowel movements, assess quality of stools  

   8. Pt. Ed.? Take w/ 8 oz of fluid, daily record of BMs, drink at least 1500-2000 mL fluids daily, short-term use, DON’T take within 1 hour of taking an antacid!!

   9. Peds? Usually 1/2 the adult dose, don't give w/o specific instructions from HCP

   10. Preg/Lact? Most are safe; prescriber must assess benefits 

   11. Older adults? Risk for diarrhea/fluid imbalance due to higher dose/longer period taking

5. Diarrhea

   1. Can cause what in infants? Dehydration 

   2. Most common cause? Inflammation of the small bowel 

   3. Most cases of infectious diarrhea caused by? viruses/bact from contaminated food/water 

   4. Four types include? Osmotic, secretory, exudative, motility disorder

   5. Types of meds to treat? Antimotility, adsorbent/absorbent, antisecretory

   6. S/E’s? Uncommon in healthy adults, vary by drug, constipation

   7. A/E’s? Fever, abdominal pain, rapid HR, dehydration

   8. Antimotility drugs? difenoxin with atropine (Motofen), diphenoxylate with atropine (Lomotil, Lenox, Vi-Atro), loperamide (Imodium), paregoric (Camphorated Opium Tincture)

   9. Adsorbent/absorbent drugs? bismuth subsalicylate (Kaopectate, Kaopectolin), calcium polycarbophil (FiberCon)

      1. Calcium polycarbophil A/E? Intestinal obstruction 

   10. Antisecretory drugs? bismuth subsalicylate (Pepto-Bismol) 

   11. Check before? Complete list of meds, baseline weight/vitals, abdomen, skin turgor for dehydration

   12. Check after? Reassess for bowel sounds/distention, watch for signs of toxic megacolon, monitor vital signs/diarrhea stools/skin turgor 

   13. Pt Ed.? Do not double-dose, avoid driving, avoid alcohol and CNS depressants

   14. Peds? Avoid bismuth subsalicylate bc it has aspirin, inf/children- dehydration risk

   15. Preg/Lact? Contact prescriber

   16. Older adults? Dehydration risk, DON'T use bismuth subsalicylate (Kaopectate) 

1. Gastrointestinal Ulcers

   1. Peptic ulcer disease? Gastric ulcer (stomach-pain when eating), Duodenal ulcer (Duodenum-pain 3 hrs after eating), Esophageal ulcer (lower part of esophagus) 

   2. Causes of ulcers? Helicobacter pylori bacteria and/or lifestyle (stress, diet, excess acids) 

   3. Open sores develop on the? Duodenum 

   4. Symptoms? Burning, gnawing pain from stomach acid in contact with ulcer, vomiting, dark stools, weight loss, chest pain 

   5. What is important in treating PUD? Antibiotics 

   6. Treatment involves both? Drugs and lifestyle changes

   7. Avoid what in gastric ulcers? NSAIDS

2. GERD (gastroesophageal reflux disease)

   1. Causes? Lower esophageal sphincter (LES) isn’t working correctly, regurgitated contents can cause esophagus inflammation, and chronic condition with lifelong treatment

   2. Treatment? Drug therapy, lifestyle changes (smoking cessation, decrease of dietary fat intake, weight reduction, avoid large meals)

   3. ***Talk to patients about causative factors 

3. Inflammatory Bowel Diseases 

   1. What are they? Chronic inflammation of the GI tract resulting from defective immune system

   2. Crohn disease? 

      1. Most commonly occurs in? the final section of the small intestine and colon

   3. Ulcerative Colitis

      1. What is it? Inflammation in the large intestine (colon)

4. General issues for drugs for PUD, GERD, and IBD

   1. Check before? list of current meds, baseline vitals and weight, bowel habits, appearance of stools, vomiting, bleeding, reflux, abdomen for distention, pain

   2. Check after? Vital signs, daily weight, monitor for abnormal heart rhythms, track BM frequency/consistency 

   3. Pt Ed.? DO NOT double dose, increase fluid intake/fiber-containing food, exercise can prevent constipation,h2 avoid alcohol/aspirin products/NSAIDs/irritating foods

5. Types of drugs for PUD

   1. Histamine H2 Blockers

      1. What do they do? Decrease acid in stomach

      2. Intended responses? Decrease secretion of gastric acid, GERD symptoms, and heal/prevent ulcers 

      3. S/E’s? Confusion, dizziness, drowsiness, headache, altered taste, nausea, diarrhea, constipation

      4. A/E’s? Dysrhythmias, seizures, agranulocytosis, aplastic anemia

      5. Meds included? cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac) 

      6. Check before? Baseline consciousness, give with meals, check IV site every 2-4 hours

      7. Check after? Watch for S/E and A/E

      8. Pt Ed.? Contact prescriber is pt is requiring more than 2 weeks of therapy, avoid smoking and driving, and do NOT take a double dose, 

      9. Preg/Lact? Consult HCP before taking, and avoid while breastfeeding

      10. Older adults? Increased dizziness/confusion, AVOID FALLS, avoid driving

      11. (Cimetidine) Why does this drug interfere with many other drugs and needs to be given at diff time from many other meds? Changes pH and absorption of different drugs

   2. Proton pump inhibitors

      1. What do they do? Block secretion of gastric acid

      2. ***Most powerful drug for treating PUD or GERD

      3. Used when? H2 blockers are ineffective 

      4. Intended responses? Lower gastric acid secretion/acid reflux, heal ulcers

      5. S/E’s? Diarrhea, constipation, belching, gas, abdominal pain, headache 

      6. Meds included? dexlansoprazole (Dexilant, Kapidex), esomeprazole magnesium (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) 

      7. Check before? Take before eating in AM, check for IV patency and signs of infection

      8. Check after? Assess for black, tarry stools

      9. Pt Ed.? Report black/tarry stools, diarrhea, abd pain, persistent headache

      10. Preg/Lact? DON'T take omeprazole, pantoprazole, and rabeprazole while pregnant and breastfeeding is not recommended 

      11. Older adults? Higher risk of S/E’s, may decrease absorption of calc;higher risk of hip/bone fractures, may decrease absorption of vit B12

   3. Antibiotics

      1. What do they do? Kills H. pylori when associated with ulcer 

   4. Cytoprotective drugs

      1. What do they do? Form a thick coating on open sores 

         1. ***Sucralfate reacts with stomach acids to form a thick coating that covers the surface of an ulcer

         2. ***Bismuth subsalicylate also coats the stomach and intestine, protecting the mucosa 

      2. Intended responses? Ulcers protected to prevent tissue damage; ulcers healed 

      3. S/E’s? Constipation, dizziness, drowsiness, dry mouth, rashes 

      4. Meds included? bismuth subsalicylate (Pepto-Bismol), sucralfate (Carafate) 

         1. Sucralfate

            1. ***Give on empty stomach, safe in pregnancy 

            2. For sucralfate: don’t take with other meds

      5. Pt Ed.? Increase fluid/dietary fiber, and make sure to exercise

6. Types of drugs for GERD

   1. Histamine H2 Blockers

   2. PPIs

   3. Antacids

      1. What do they do? Neutralize acidity of stomach contents 

      2. Intended responses? Neutralize gastric acids, relieve heartburn & indigestion, lower GERD symptoms and ulcer pain, promote ulcer healing 

      3. S/Es? Constipation (calcium, aluminum salts), diarrhea (magnesium salts)

      4. Check before? Ensure that antacids are given 1 hr before or 2 hrs after other drugs 

      5. Meds included? aluminum hydroxide (AlternaGEL, Amphojel), calcium carbonate (Rolaids, TUMS), magnesium hydroxide/aluminum hydroxide/simethicone (Maalox, Milk of Magnesia, Mylanta) 

      6. Pt Ed.? Contact HCP if therapy is still needed after 2 weeks, don’t take an aluminum hydroxide or calcium antacid within 1-2 hrs of other drugs, talk about s/e’s of constipation/diarrhea, antacids should be avoided if any signs of appendicitis or inflamed bowel are present 

      7. Peds? DO NOT GIVE unless directed by prescriber

      8. Preg/Lact? Generally safe but long-term use may cause birth defects

      9. Older adults? Avoid aluminum-containing drugs with bone problems, and Alzheimer disease 

   4. Promotility drugs

      1. What do they do? Speed up emptying time of stomach 

      2. Meds included? metoclopramide (Reglan)

         1. ***Should be given 30 min before meals for 4-12 weeks 

7. Types of drugs for IBD

   1. Aminosalicylates

      1. What do they do? Reduce inflammation in intestine lining 

      2. Intended responses? Decrease inflammation, induce/maintain remission in UC, improve symptoms, absence of pain/bleeding, reduced diarrhea

      3. S/E’s? Headache, N/V, abd pain/cramping, loss of appetite, rash, fever 

      4. A/E’s? Kidney injury, decreased sperm production, diarrhea, pancreatitis 

      5. Meds included? balsalazide (Colazal, Gyazo), mesalamine 5-ASA (Apriso, Asacol, Canasa, Delcizol), olsalazine (Dipentum), sulfasalazine (Azulfidine, Sulfazine) 

      6. Check before? Ask about kidney issues, kidney function tests, assess stool, glass of water with each dose

      7. Check after? Monitor for allergic reactions, stool, abd discomfort, renal function tests, signs of toxicity 

      8. Pt Ed.? If enema form is prescribed then hold in rectum for 20-40 min,  photosensitivity precautions, 

      9. Preg/Lact? Considered safe, take 2 mg of folate daily if pregnant or planning to become pregnant 

   2. Corticosteroids

      1. What do they do? Lower activity of immune system; lowers inflammation

      2. Intended responses? Decreased inflammation, improved symptoms

      3. S/E’s? Increased infection risk (especially yeast), dry mouth, bad taste

      4. A/E’s? Infections, HTN, diabetes, osteoporosis, avascular necrosis, myopathy, cataracts, glaucoma

      5. Meds included? Prednisone (Deltasone), budesonide (Entecor), hydrocortisone (Cortef, Solu-Cortef), budesonide (Uceris)

      6. Check before? mouth/throat for signs of thrush, check for signs of infection, assess skin, obtain baseline vitals and glucose levels 

      7. Check after? Monitor stool for infection, assist pt to brush teeth/rinse oral cavity, monitor vitals and glucose and potassium levels

      8. Pt Ed.? Don’t suddenly stop, notify HCP if infection signs occur, brush teeth/rinse mouth to remove leftover drug from oral cavity, short-term use only, consult with HCP before taking OTC meds or herbal supplements 

      9. Preg/Lact? May increase risk of complications, no A/E’s w/ breastfeeding

      10. Forms? PO- prednisone, budesonide, hydrocortisone

             Rectal- budesonide, hydrocortisone

             Suppositories- hydrocortisone

             Enemas- hydrocortisone  

3. Immunomodulators

   1. What do they do? Maintain remission of Crohn disease and UC

   2. Intended responses? Decreased inflammation, immunosuppression, decreased need for long-term steroids and episodes of flares

   3. S/E’s? Headache, N/V/D, mouth sores, increased risk of infection, rash, flu-like symptoms

   4. A/E’s? Pancreatitis, bone marrow suppression, lymphoma, hepatotoxicity, seizures, encephalopathy, nephrotoxicity, HTN, prolonged QT

   5. Meds included? azathioprine (Imuran), 6-mercaptopurine (6-MP, Purinethol), cyclosporine (Sandimmune), methotrexate (Rheumatrax), tacrolimus (Progal)

   6. Check before? Lab results, ask about liver/kidney issues, ask about recent vac, assess for signs of liver toxicity, obtain baseline weight/vitals 

   7. Check after? Monitor vital signs/lab results, weight daily, monitor I&O, monitor for signs of infection and nervous system changes

   8. Pt Ed.? Avoid crowds/sick people, notify HCP of infection signs, report mouth inflammation, protect from sun, avoid live vaccines/alcohol/grapefruit, drink 10-12 oz of fluid per day

   9. Preg/Lact? Avoid in pregnancy; avoid tacrolimus when breastfeeding

   10. Older adults? Higher risk for A/Es & have lower treatment responsiveness 

4. Biologics? 

   1. These are used when? Other drugs have been ineffective or S/E’s are unmanageable 

   2. ***Not a first-line treatment 

   3. Intended responses? Improve GI symptoms, induce/maintain remission, prevent flares, decrease need for hospitalization and surgery

   4. S/E’s? Injection site reaction, headache, fevers, chills, N, couch, aches, sore throat 

   5. A/E’s? Increased infection risk or reactivation, increased lymphoma risk

   6. Meds included? 

      1. Anti-TNF Drugs

         1. adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), infliximab (Remicade) 

      2. Integrin Receptor Antagonists

         1. natalizumab (Tysabri), ustekinumab (Stelara), vendolizumab (Entyvio) 

   7. Check before? Ask about prior infections (especially TB and Hep B), test for TB a week before first dose, ask about recent vaccines for flu and pneumonia, allow drug to come to room temp before administering 

   8. Check after? Check for TB or Hep B infection or reactivation, do not massage after injection, observe pt for 30-60 min, monitor oxygenation and BP every 5-10 min

   9. Pt Ed.? Notify HCP about s/s of infection, get vaccinated for flu/pneumonia, teach self-administration techniques, consult with HCP about OTC meds or herbal supplements, avoid crowds

   10. Peds? Long term safety is unknown

   11. Preg/Lact? Appear safe early on, low level risk during lactation but not recommended 

   12. Older adults? Increased risk of malignancy and infection 

1. Psychiatric Disorders

   1. Major psychiatric illnesses? Depression, anxiety, psychosis

   2. Check before giving psychiatric meds? Med list, vs, fall risks, IV patency, mental status, suicidal thoughts

   3. Check after giving psychiatric meds? Monitor BP/abnormal heart rhythms, dizziness, drowsiness, reassess mental status

   4. Main s/e of psychiatric meds? Sedation 

   5. Pt Ed. for psychiatric meds? Take as prescribed, keep appts, avoid activities that require alertness, change positions slowly, avoid alcohol, tell HCPs about drugs before surgery, wear MA bracelet

2. Depression

   1. Involves? Body, mood, and thoughts 

   2. Interferes with? Ability to function normally, causes pain/suffering 

   3. Treatment? Counseling, psychotherapy, antidepressants/other meds

   4. May be caused by? neurotransmitters imbalance

   5. SSRI’s work by? Increasing serotonin in brain

   6. TCAs inhibit reuptake of? Norepinephrine, dopamine, and serotonin

3. Antidepressant Drugs

   1. Intended responses? Correct depression, lower symptoms of depressed mood

   2. S/E’s? N/V/D, weight gain, drowsiness, decreased libido 

   3. A/E’s? Increased suicidal thoughts in children/adolescents/young adults, allergic reaction, serotonin sydrome

   4. Check before? fam Hx of depression, usual BMs, fluid intake, St Johns wort 

   5. Check after? Reassess mental status, watch for S/E’s, A/E’s and allergic reactions, assess for suicidal thoughts 

   6. Pt ed? Not a cure, 1-8 weeks for symptoms to improve, discontinue gradually, frequent mouthwashes for dry mouth 

   7. Peds? Risk of increased suicidal thoughts

   8. Tricyclic antidepressants (TCAs)- increased risk of overdose 

      1. Meds included? amitriptyline (Elavil), amoxapine (Amoxapine Tablets), clomipramine (Anafranill), desipramine (Norpramin), doxepin (Prudoxin), imipramine (Tofranil) 

      2. Check before? smoking 

      3. Preg/lact? CONTRAINDICATED 

      4. How long before they start working? 4-8 weeks 

      5. Black box warning for? Suicide 

      6. Other considerations? Dry mouth! Drink plenty of water and do NOT smoke

   9. SSRIs- first line treatment for psychiatric problems 

      1. Serotonin syndrome? Happens within 2-72 hours, includes palpitations, anxiety, confusion, agitation, high BP, restlessness, seizures

      2. Meds included? citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) 

      3. Peds? Fluoxetine may cause unusual excitement, restlessness, irritability, insomnia

Preg/lact? SSRIs not tested, avoid paroxetine in pregnancy 

Older adults? May require lower doses, especially with kidney/liver issues

Other considerations? digoxin/warfarin interaction, and take early in the day bc of insomnia risk 

10. SNRIs- more $ and can also cause serotonin syndrome 

    1. Meds included? Desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), venlafaxine (Effexor)

    2. Peds? Venlafaxine may cause slow growth and weight gain 

11. NDRIs

Meds included? mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel) 

12. Aminoketones- atypical antidepressant 

    1. Meds included? bupropion (Wellbutrin) 

13. Monoamine oxidase inhibitors

    1. Should not be taken with? TCAs or SSRIs

    2. Avoid what kind of foods? Tyramine-rich foods (meats, cheese, yogurt, red wine, banana, beer)

    3. ***Can cause hypertensive crisis!

4. Anxiety 

   1. Common ones? Panic disorders, generalized anxiety disorder, phobias, ocd, ptsd

   2. Causes/factors? Mental conditions, physical conditions, effect of drugs

   3. Intended response anxiety meds? Anxiety relieved, decreased symptoms, sense of well-being improved 

   4. Check before? Hx of drug dependencies

   5. Check after? Gait for steadiness, anxiety level, suicidal ideation 

   6. Pt ed? Take as prescribed, avoid alcohol and sleeping pills, wean off gradually 

   7. Older adults? More sensitive to effects, greater risk for s/e’s, monitor for resp depression, use low doses

   8. Benzos

      1. ***Reduce alcohol withdrawal

      2. MOA? Increase the inhibitory actions of GABA in the brain 

      3. ***Can be PRN

      4. Meds included? Alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax)

      5. S/E’s? Related to CNS effects

      6. A/E’s? Seizures, coma- clonazepam can cause suicidal ideation 

      7. Pt ed? Don't take with antacids 

      8. Peds? Sensitive to effects, s/e’s more likely- clonazepam may cause decreased physical and mental growth 

      9. Preg/lact? AVOID 

      10. Antidote? flumazenil

   9. SSRIs

      1. MOA? Affect the action of the neurotransmitter serotonin

      2. ***On a schedule 

      3. Preg/lact? AVOID 

   10. Buspirone 

       1. MOA? Increases norepinephrine metabolism to relieve anxiety 

       2. S/E’s? Dizziness, drowsiness

       3. A/E’s? Hallucinations, HF

   11. Anxiolytics

       1. Meds included? buspirone (BuSpar) 

   12. Anticonvulsants

       1. Meds included? pregabalin (Lyrica)

   13. Antihistamines 

       1. Meds included? hydroxyzine (Atarax)

   14. Beta Blockers

       1. Meds included? propranolol (Inderal) 

5. Psychosis

   1. ***loss of contact with reality 

   2. Common symptoms? Illusions, delusions, hallucinations 

   3. Treatment? Psychological therapies, antipsychotic drugs 

6. Antipsychotic drugs

   1. MOA? Blocks dopamine receptors in the dopamine pathways in the brain

   2. Intended responses? s/s of psychosis, behavior/schizophrenic behavior, suicidal thoughts decreased 

   3. S/E’s? Sedation, drowsiness, dizziness, lethargy, restlessness, insomnia, GI upset 

   4. A/E’s? Tardive dyskinesia (TD), neuroleptic malignant syndrome, lithium toxicity 

   5. Check before? suicidal thoughts, orientation/mood/behavior, I&O, baseline weight 

   6. Check after? Daily weight, I&O, bowel function, reassess mental status, monitor sedation, monitor for suicidal thoughts 

   7. Pt ed? S/E’s and A/E’s, importance of psychotherapy, avoid alcohol/CNS depressants, monitor bowel function, take with food if GI upset, photosensitivity precautions 

   8. Peds? side/adverse effects more likely 

   9. Preg/Lact? Avoid antipsychotics and lithium 

   10. Older adults? More sensitive to effects, start with low doses especially with renal insufficiency- can cause rapid BP falls, lithium can cause excessive urination leading to dehydration

   11. Typical antipsychotic drugs 

       1. Meds included? chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), molindone (Moban), perphenazine (Trilafon), thioridazine (Mellaril), thiothixene (Navane), trifluoperazine (Stelazine)

   12. Atypical antipsychotic drugs

       1. Meds included? aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)

       2. A/E’s? Clozapine (neutropenia, myocarditis), risperidone and quetiapine (risk of death in those with dementia),  

   13. Other drugs

       1. Meds included? lithium carbonate (Eskalith), prochlorperazine (Compazine) 

       2. A/E’s? prochlorperazine (risk of death in those with dementia) 

7. Lithium

   1. Normal serum level? 0.6-1.5

   2. ***Lithium is like salt in the body. When salt gets too low, the body will start to conserve salt leading to lithium toxicity. 

      1. ***Dilute urine could be a sign that lithium toxicity is occurring 

   3. ***Low lithium=High sodium                     High lithium=Low sodium 

1. Insomnia

   1. What is it? Inability to sleep, or remain asleep throughout the night 

   2. Symptoms? Difficulty falling asleep, waking up often, not feeling rested after

   3. What is sleep deprivation? Shortage of undisturbed sleep 

2. Education for insomnia

   1. Wake up and go to bed at the same time, even on weekends

   2. Make bedroom into a dark, cool sanctuary

   3. Be physically active with regular exercise, perform breathing exercises

   4. Avoid stimulants (e.g., caffeine) at night

   5. Avoid frequent naps during day

   6. Reserve bed for sleep 

   7. Avoid blue light 30 min before bedtime

   8. Avoid eating large meals close to bedtime

   9. Relax by practicing yoga or meditation, listening to soothing music, or reading

   10. Consider cognitive or massage therapy

   11. Release daily worries before sleeping 

3. Drugs for insomnia

   1. Most commonly prescribed? Sedatives 

   2. ***Relieve insomnia by either stimulating an increase in GABA or acting as an agonist at GABA receptor 

   3. Intended responses? Insomnia relieved, sleep improved, person sedated, sleep induced, length of time to fall asleep is decreased, sleep duration increased 

   4. Common S/E’s? confusion/amnesia, drowsiness, dizziness 

   5. A/E’s? Reduced liver and kidney function

   6. Benzodiazepine receptor agonists (Z-drugs) 

      1. MOA? Turn on receptors to induce sleep 

      2. Meds included? eszopiclone (Sonata, Lunesta), zolpidem (Ambien), zopiclone (Imovane) 

      3. A/E’s? Sleepwalking/eating/driving- life threatening

      4. Pt ed? Ambien (need 2-4 hrs of sleep), Lunesta (need 5-7 hrs of sleep)

      5. Preg/lact? Generally safe if benefit outweighs the risk 

   7. Benzodiazepines

      1. MOA?  Depress the CNS by binding to GABA receptors 

      2. Meds included? estazolam (ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion)

      3. A/E’s? Potentially addictive 

      4. Preg/lact? DON'T TAKE 

   8. Barbiturates

      1. MOA? Depress all CNS functions

   9. Antihistamines

      1. ***Some have sedating effects 

      2. Meds included? diphenhydramine (Benadryl)

   10. Sedating antidepressants

       1. F

   11. Skeletal muscle relaxants

       1. MOA? Depress CNS 

   12. Melatonin- herbal supplement 

4. Administering drugs for insomnia 

   1. Check before? Usual sleep patterns and specific difficulty, ask about Hx of depression/falls, assess mental status 

   2. Check after? VS, consciousness, watch for changes in BP/HR/consciousness 

   3. Pt ed? Take as prescribed, keep appts, never double dose, taken short-term, go to bed immediately after, don't take on overnight types, avoid alert activities 

5. Life span considerations

   1. Peds? Watch for unusual or paradoxical responses

Older adults? Give lower doses; increased risk of falls 

1. Diuretics

   1. Overview

      1. Increases urine output

      2. Sometimes called? Water pills 

      3. *** ”where sodium goes, water follows” 

      4. Used for? High BP, HF, kidney and liver disease 

      5. Left sided HF backs up to? Lungs 

      6. Right sided HF back up to? Rest of the body 

2. General issues in diuretic therapy

   1. Pt ed? Take in early morning, never double dose, report hypotension s/s, manage orthostatic hypotension (dangle legs before getting up), weigh daily, drink normal amounts of fluid (don’t avoid or have too much) 

3. Types of diuretics

   1. Natriuretic

      1. Increases sodium excretion

      2. Part of? Thiazide, loop, and potassium-sparing diuretics 

      3. Thiazide diuretics

         1. Meds included? chlorothiazide, hydrochlorothiazide, metolazone

         2. Intended response? Increase urine output, lower BP, lighter urine color

         3. S/E’s? Fluid/electrolyte imbalances- less likely with lower dosages 

         4. A/E’s? “Passing out” or falling, muscle weakness, blurred vision, skin cancer 

         5. Check before? Potassium levels, Hx of allergic response

         6. Check after? Electrolyte levels 

         7. Pt ed? Hypokalemia s/s, take all Rx potassium supplements or increase intake of potassium-rich foods (bananas, nuts, avocado) 

         8. Peds? Dosages are based on weight

         9. Preg/lact? Not recommended 

         10. Older adults? Dizziness/light-headedness/hypokalemia more common

      4. Loop diuretics

         1. Meds included? furosemide, bumetanide, torsemide

         2. Intended responses? Increase urine output, lighten urine color, lower BP

         3. S/E’s? Ortho hypotension, decreased blood levels of sodium/potassium, sun sensitivity (furosemide) 

         4. A/E’s? fainting/falling when changing positions, muscle weakness, irregular heart rhythms, hyperglycemia, ototoxicity

         5. Check before? Potassium levels, other ototoxic drugs

         6. Check after? Give potassium supplements as ordered, monitor for hearing loss

         7. Pt ed? Limit alcohol/sun exposure, take potassium supplements, eat foods high in potassium, report ototoxicity

         8. Preg/lact? Not recommended

         9. Older adults? More sensitive to effects, all a/e’s and s/e’s more likely to occur 

      5. Potassium-sparing diuretics

         1. Meds included? Spironolactone, triamterene, amiloride 

         2. MOA? Conserves potassium!

         3. Intended responses? Increase urine output, lighten urine color, lower BP, serum potassium level stays normal 

         4. *** careful with foods high in potassium 

         5. S/E’s? Postural hypotension, hyponatremia, N/V/D, stomach cramps (menstrual irregularities, abnormal hair growth, deep voice)

         6. A/E’s? fainting/falling, hyperkalemia leading to dysrhythmias (symptoms of hyperkalemia=palpitations, irregular pulse)

         7. Check before? Electrolyte levels

         8. Check after? Monitor for hyperkalemia, and hyponatremia 

         9. Pt ed? Avoid excessive amounts of high-potassium foods, and NO salt substitutes 

         10. Preg/lact? Spironolactone is not recommended but triamterene and amiloride are low risk 

   2. Osmotic diuretics? 

      1. Increases blood flow to the kidneys

      2. Usually for critical care 

   3. Carbonic anhydrase inhibitors

      1. Primarily used for glaucoma 

   4. Overactive bladder (OAB)

      1. What is it? Sudden, involuntary contraction of the muscle in the bladder wall that causes a sudden, unstoppable need to urinate 

      2. *** Smooth muscle surrounding bladder contracts spastically 

      3. Drugs for OAB? Urinary antispasmodics 

      4. Urinary antispasmodics

         1. Meds included? Oxybutynin, tolterodine, darifenacin

         2. Intended responses? Decrease urinary frequency, urgency, and incontinence 

         3. S/E’s? Dry mouth/eyes, headache, dizziness, constipation

         4. A/E’s? Chest pain, fast/irregular HR, SOB, edema, weight gain, confusion, hallucinations, higher risk for heat stroke

         5. Pt ed? Swallow capsules whole, take on empty stomach with water, avoid overheating/dehydration, weigh self daily, report s/e’s, avoid driving and alcohol within 2 hours of taking 

         6. Preg/lact? oxybutynin (low risk), other OAB drugs (not recommended)

****Diuretics 

• Watch for electrolyte imbalances