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Anaphylatic Shock

Life threatening, acute allergic reaction. Look for sudden constriction of bronchiolar muscles, sense of impending doom, sweating, weakness, edema of the pharynx and larynx, and severe weezing and SOB. Priorities:ABC's and give O2. WEAR IDENTIFICATION BRACELET to identify allergies.

Peak

The time it takes for a medication to reach its highest effective concentration.

Trough

The minimum blood serum concentration of medication reached just before the next scheduled dose.

Sublingual

Oral medication administration route where med is absorbed after being placed under the tongue to dissolve. Do not swallow med.

Buccal

Oral medication administration route where solid med is in the mouth and against the mucous membranes of the cheek until it dissolves. Alternate cheeks to avoid irritation. Do not chew, swallow, or take with liquid.

Intradermal (ID)

Parenteral administration route of med injected into the dermis just under the epidermis.

Subcutaneous (SQ)

parenteral route injection into fatty tissue just below the dermis. Sites: Abdomen, Upper arm, Thigh, scapular area of back, and upper ventrodorsal gluteal. (growth hormone, insulin, epinephrine)

Intramuscular (IM)

Parenteral route injection into the muscle. Sites: Deltoid, gluteal, vastus lateralis

Intravenous

Parenteral route injection into the vein

Epidural

parenteral route med is administred in the epidural space via a catheter, place by nurse anesthesiologist.

Intrathecal

parenteral, admin med through a catheter placed in subarachnoid space or one of the ventricles of the brain.

Intraosseous

parenteral, admin of med directly into bone marrow (usually tibia). Common in infants and toddlers with poor access to IV space.

Intraperitoneal

parenteral, admin med into peritoneal cavity are absorbed into circulation. (chemo, insulin, and antibiotics)

Intrapleural

Parenteral, injection or chest tube is used to admin med. Most common is chemotherapeutic agents.

Intraatrial

Parenteral, admin med directly into arteries. Common in clients with atrial clots.

Topical administration

Meds have localized effects

Transdermal patch/disk

Left in place for as little as 12h or as long as 7 days

Antibiotics

natural substances produced by microoragnisms that can kill other microorganisms.

6 Rights of Med Admin

Client, Med, Dose, Route, Time, Documentation

3 Checks of Med Admin

Check when taking from cart, Check while preparing, Check before giving

Heparin Administration

Must be given via SQ of through IV bolus injection or continuous infusion. NEVER aspirate or massage skin

Prednisone

Antinflammatory agent/glucocorticoid, therapy commonly limited to 4-10 days, do not STOP abruptly.

Codeine

Opiod used for pain management, effective at suppressing cough reflex and slowing GI motility, can be habit forming narcotic. CONSTIPATION

FeSO4:Ferrous Sulfate

antianemic agent - AE: GI upset (take it w/ food) Iron preparation MAY DARKEN STOOL, constipation (increase fiber)

St. John's Wort

Interacts with oral contraceptives, warfarin, digoxin, and cuclosporine. -don't take with other antidepressant meds. - primarily used to reduce depression, anxiety, and inflammation. - Don't give to pregnant women, may harm fetus by crossing placenta barrier.

Antibiotic resistance

-Caused by prescribing antibiotics when they are not needed, contributes to emergence of resistant strain organisms - prematurely stopping antibiotics allows some pathogens to survive allowing resistance - stress importance of taking all meds to patient.

Bioavailibility

Physiological ability of the drug to reach its target cells and produce its effect. - Short half-life - the amount of drug available to be used by the body after drugs go through hepatic first pass or bind to protein receptors.

Topical Antifungal

topical route may cause drying of the skin, and stinging sensation at site of application including redness, rash, burning, and itching.

Orlistat (Alli, Xenical)

AE: Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, fecal incontinence - used for weight loss

Phenergan (promethazine HCL)

Antiemetic - AE:respiratory depression, apnea, drowsiness, constipation, agranulocytosis, hypotension, dry mouth, urinary retention

Baclofen

SKELETAL MUSCLE RELAXANT - reduces skeletal muscle spasm caused by upper motor neuron lesions. - used for treating spasm of skeletal muscles that cause muscle clonus, rigidity, and pain due to MS.

Dilaudid (hydromorphone HCL)

NARCOTIC ANALGESIC - AE: nausea, vomiting, constipation, hypotension, bradycardia or tachycardia, RESPIRATORY DEPRESSION - similar to morphine, but more potent, rapid onset/shorter duration

Spiriva (TIOTROPIUM)

Relaxes the muscles in your airways so more air can enter in and out of the lungs. This is NOT a rescue med Should not be used for treating sudden breathing problem. - For patient's with COPD - AE: constipation

Heparin

ANTICOAGULANT - Admin INTRAVENOUSLY - Direct: give undiluted (give single dose over 60 sec.) Intermittent/Continuous: may add any amount of NS, D5W, or LR for injection, INVERT IV SOLUTION 6x's to ensure mixing (use infusion pump and give over 4-24h)

Tekturna (aliskiren hemifunarate)

RENIN INHIBITOR/ANTIHYPERTENSIVE - AE: diarrhea, chronic dry cough, rash - ED: high fat meals interfere with drug absorption and lower drug effectiveness.

Digoxin

ANTIARRHYTHMIC - take apical pulse for full min. DO NOT GIVE if HR less than 60bpm. - primary benefit is its ability to increase the contractility or strength of myocardial contraction. Directly increase cardiac output.

Aricept (donepezil HCL)

ANTIDEMENTIA?CHOLINESTERASE INHIBITOR - slows the progression of disease, but does not cure. Use for 1 yr. - Improves global function, cognition, and behavior of patients with mild to moderate Alzheimer's

Ocusert (pilocarpine HCL, pilocarpine nitrate)

ANTIGLAUCOMA/DIRECT ACTING CHOLINERGIC - Open-angle and angle-closure glaucomas, to reduce intraoccular pressure

Nitroglycerin (NTG)

ANTIANGINAL/NITRATE VASODILATOR - Apply transdermal unit (patch) at the same time each day, preferably to skin site free of hair and not subject to excessive movement, change application site each time to prevent skin irritation and sensitization. - Prophylaxis, treatment, and management of angina pectoris (patch used in patients who have not responded to nitrate or beta-blocker therapy)

Avandia (rosiglitazone maleate)

AE: increased risk of heart attack, edema, anemia, headache, back pain, hyperglycemia. - reduces hyperglycemia and hyperlipidemia in type II DM, improving hyperinsulinemia without stimulating pancreatic insulin secretion.

PTU (propylthiouracil)

ANTITHYROID - Interferes with use of iodine and blocks synthesis of thyroxine (T4) and triiodothyronine (T3) in thyroid gland - Drug induced hormone reduction results in compensatory release of thyrotropin (TSH), causing marked hyperplasia and vascularization of thyroid gland.

Celebrex (celecoxib)

ANTINFLAMMATORY - AE: GASTRITIS, abdominal pain, diarrhea, nausea. Erosive gastritis involves both inflammation and wearing away of the stomach lining.

Protonix (pantoprazole sodium)

ANTIULCER/PROTON PUMP INHIBITOR - SHORT-TERM treatment of erosive esophagitis assoc. with gastroesophageal refulx disease (GERD). - Gastric acid secretion is decreased by inhibiting the H+, K+ ATPase enzyme system responsible for acid production

Zantac (ranitidine HCL)

ANTIULCER/H2-RECEPTOR ANTAGONIST - reduces gastric acid release in response to food. - Can give to coma patient through IV to reduce stomach acid secretion

Fosamax (alendronate sodium) Boniva

BONE METABOLISM REGULATOR - keep patient sitting up or ambulating for 30 min after taking drug. Admin in AM at least 30 min before food, bev, or medication. - decreases bone reabsorption minimizing loss of bone density

Demopressin Acetate

ANTIDIURETIC HORMONE (ADH) - INTRANASAL: give initial dose in the evening, and observe antidiuretic effect. Morning dose is started and adjusted daily until urine volume does not exceed 1.5-2L/24h. ROTATE NARES.

Zofran (ondanestron HCL)

ANTIEMETIC - prevention of nausea and vomiting associated with initial and repeated courses of cancer chemotherapy, postoperative nausea and vomiting. ADMIN: give tablets 30 min prior to chemo and 1-2hr prior to radiation therapy

INH (isoniazid acid hydrazide)

ANTIBIOTIC/ANTITUBERCULOSIS - exerts bacteriostatic action against actively growing tubercle bacilli. - RIFAMIN is an antibiotic/anti TB agent - used primarily as adjuvant with other antiTB agents in initial treatment retreatment

Topamax (topiramate)

ANTICONVULSANT - decrease seizure activity, AE: GINGIVAL HYPERPLASIA- appears most commonly in children and adolescents and never occurs in patients w/out teeth.

Dilantin (phyenytoin)

ANTICONVULSANT - inhibits seizure activity, AE: GINGIVAL HYPERPLASIA- appears most commonly in children and adolescents and never occurs in patients w/out teeth.

Oxybutin chloride

ANTISPASMODIC/ANTICHOLINERGIC - AE: tachycardia, flushing, nausea, vomiting, CONSTIPATION, urinary hesitancy or retention - relieves symptoms assoc. with voiding, relieves pain of bladder spasm following transurethral surgery

Urecholine (bethanechol chloride)

CHOLINERGIC - used for myasthenia gravis, AE: profuse salivation, increased muslce tone, bradycardia, bronchoconstriction - increases tone and peristaltic activity of E, S, I, to initiate micturition

Prednisone

GLUCOCORTICOID - Long term therapy is ordinarily interrupted when patient undergoes major surgery, but dosage may be increased. Monitor for withdrawal symptoms with abrupt discontinuation (should be gradual). Be alert for hypocalcemia. Med suppresses early classic signs of inflammation. When patient is on extended therapy regimen, incidence of oral candida infection is HIGH.

Tetracycline HCL

ANTIBIOTIC - decreases effectiveness of birth control - Dairy products and iron, zinc supplements decrease tetracycline absorption. Teach client NOT to eat dairy

Zosyn (piperacillin/tazobactam)

ANTIBIOTIC - AE: EDEMA (mouth, tongue, pharynx, larynx) - Check for renal status CREATININE LEVEL

Amphojel (aluminum hydroxide)

ANTACID - binds with phosphate - neutralizes stomach acid by raising pH - monitor periodic serum calcium and phosphorus levels with prolonged high-dose therapy (chronic renal failure and kidney disease)

Accutane (isotretinoin)

ANTIACNE/ANTINEOPLASTIC - causes retinoid hypersensitivity, avoid UV exposure, pregnancy X, females of childbearing age, lactation

Inderal (propanolol HCL)

ANTIHYPERTENSIVE/BETA BLOCKER - blocks cardiac effects of beta-adrenergic stimulation. Reduces HR and force of contraction. AE: fast, slow, or uneven heartbeats, feeling light-headed, fainting, SOB, swelling of ankles or feet, fever, sore throat and headache w/ severe blistering, peeling, and red skin rash, nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice, depression, confusion, hallucinations; or cold feeling in your hands and feet.

Theophyllin (aminophylline)

BRONCHODILATOR/RESPIRATORY SMOOTH MUSCLE RELAXANT - xanthine derivative that relaxes smooth muscle in the airways of the lungs and suppresses the response of the airways to stimuli that constrict them AE: chest pain, SEVERE HYPOTENSION

Tofranil (imipramine HCL)

TRICYCLIC ANTIDEPRESSANT (TCA) - antiphyschotic drug, patient will have Parkinson like movements - AE: dry mouth, sedation, constipation, weight gain, dizziness, sex dysfunct., tremor, tachycardia, blurred vision, urinary retention - Orthostatic hypotension, withdrawal symptoms, seizures, blood dyscrasias- ONSET 1-3 weeks, avoid stopping med suddenly, should not take with MAO-B inhibitors

Thorazine (chlorpromazine)

ANTIPSYCHOTIC/ANTIEMETIC - decrease psychotic symptoms - mechanism that produces strong antipsychotic effects. - used to control manic phase of manic-depressive illness, for symptomatic management of psychotic disorders, including schizophrenia- can be used for severe behavior problems in children (ADD)

Penicillin G (Pentids)

Kill bacteria by disrupting their cell walls - AE: diarrhea, nausea, vomiting, superinfections, anaphylaxis. - AVOID CEPHALSPORINS

Viagra (sildenafil citrate)

IMPOTENCE - Do not use concurrently w/ nitroglycerin. Don't give within 24h of taking any medication with nitrates.- NITRATES INCREASE RISK of serious HYPOTENSION; if used within 4h

Tylenol (acetaminophen)

NONNARCOTIC ANALGESIC/ANTIPYRETIC - increase pain threshold, reduces fever. - AE: onset of hepatotoxicity-elevation of serum tranaminases (ALT, AST...LIVER FUNCTION TESTS) and bilirubin; hypoglycemia - Monitor for signs of HEPATOTOXICITY - 3200 MAX daily dose

Lipitor (atorvastatin)

reduces serum lipid levels. AE: watch for MUSCLE or JOINT PAIN. - Obtain blood samples, assess lab test: triglycerides, total cholesterol, LDL, HDL levels. Watch for signs of GI upset, MONITOR LIVER FUNCTION TEST.

Solu-Medrol (methylprednisilone sodium succinate)

ANTINFLAMMATORY - used for autoimmune disorders - AE: edema (sodium and water retention) muscle wasting, decreased adrenal gland function. - CHECK SERUM CALCIUM

Carafate (sucralfate)

PEPSIN INHIBITOR - protects damaged mucosa against further destruction from ulcerogenic secretions. Coats ulcer and protects from further erosion. SHORT-TERM USE (up to 8wks) - AE: constipation, ADMINISTER PRIOR TO MEALS

Calcitonin (miacalicin)

BONE METABOLISM REGULATOR - effective in symptomatic hypercalcemia by rapidly lowering serum clacium - AE: RHINITIS(nasal irritation), nausea, vomiting, diarrhea, muscle aches, rashes, urinary frequency

Muscarinic

Agents that block action of acetylcholine are known as anticholinergics, cholinergic blockers, or muscarinic agents. The effects of Ach causes symptoms of SNS activation to be predominate. - dilation of pupils, increase HR, drying of secretions, and relaxation of the bronchi - USE: GI disorders (decrease secretion of gastric acid in peptic ulcer disease, SLOW INTESTINAL MOTILITY...stools), cardiac rhythm abnormalities: used to increase HR for bradycardia, asthma (has ability to dilate bronchi)

Succinycholine (anectine)

NEUROMUSCULAR BLOCKER - skeletal muscle relaxant AE: can cause complete paralysis of the diaphragm and intercostal muscles, bradycardia and respiratory depression is expected. Tachycardia and hypotension can also occur.

Bactrim (trimethoprim)

ANITBIOTIC/SULFONAMIDES - AE: skin rashes, nausea, vomiting, agranulocytosis, thrombocytopenia, diarrhea, fatigue, dizziness, photosensitivity - inhibits synthesis of folic acid in bacteria thus stopping bacterial growth.

Vitamin B12 (cyanocobalamin)

VITAMIN - essential component that is required for normal cell growth and DNA replication. Only bacteria can make this substance. - Found in: fortified soy milk, organ meats, clams, oysters, egg yolk, crab, salmon, sardines, muscle meat, milk, and dairy products. - AE: PERNICIOUS ANEMIA which affects hematologic and nervous system. Med given IM. - advanced anemia S&S: chest pain, difficulty breathing, and pallor

Ritalin (methylphenidate hydrochloride)

effects are more prominent on mental rather than motor activities - to avoid insomnia, give last dose BEFORE 6PM and give 30-45min before meals - causes heightened alertness, associated with focus and attention. Improves physchosocial interactions.

Lasix (furosemide)

LOOP DIURETIC - treatment for CHF. Capable of removing large amounts of excess fluid from client in short amount of time. Prevents reabsorption of sodium and chloride in the loop of Henle. Beneficial when cardiac output and renal flow are severely diminished. AE: potential electrolyte imblance, HYPERKALEMIA ED: ingest postassium rich foods daily (bananas, oranges, peaches, dried dates) Report muscle cramps or weakness.

PhosLo (calcium acetate)

FLUID and ELECTROLYTE REPLACEMENT/ANTACID - treatment of HYPERPHOSPHATEMIA(phosphate intake is too low) in patients with chronic renal failure - decreases gastric acidity - AE: constipation, hypercalcemia with alkalosis, hyperphosphatemia - ED: DO NOT USE calcium carbonate wiht foods high in vitamin D (such as milk) or sodium bicarbonate, as it may cause milk-alkali syndrome

Paxil

ANTIDEPRESSANT/SSRI - Efficacious in depression resistant to other antidepressants. ED: use caution when operating hazardous machinery or equipment until drug response is known. Use of alcohol may increase risk of adverse CNS affects. Do not stop therapy after improvement of emotional status.

Narcan (naloxone)

OPIOID ANTAGONIST - reverses the effect of opiates, including respiratory depression, sedation, and hypotension. - ADMIN: if RR is < 10 breaths/min

Glaucoma

drugs that activate cholinergic receptors in the eyes produce MIOSIS, constriction of the pupil, and contraction of the pupil, and contraction of the cilliary muscle allowing greater outflow of the aqueous humor and lowering the IOP. Most common med in PILOCARPINE and is usually used only in patient with open-angle glaucoma.

Thrombolytics

(Altepase) administered for disorders in which a clot already exists (MI, pulmonary embolism, actue ischemic CVA, and DVT) - goal is to quickly restore blood flow to the tissue, delays may result in tissue damage or ischemia, best when clot is resoved within 4h - thrombolytic has a NARROW SAFETY margin, vitals should be done continuously. Watch for signs of bleeding.

Aminophylline

BRONCHODILATOR - causes dilation of the bronchioles which relieves bronchial constriction. Also stimulates the CNS and respiration. Diliates coronary and pulmonary vessels. May also cause diuresis if given systemically. Monitor: Low serum levels=bronchospasm, High serum levels=toxicity - Monitor CBC, blood glucose, and Pt, Ptt, and INR.

Small pox vaccination

Contraindications: person w/ atopic dermititis or eczema, persons w/ acute, active, or exfoliative skin conditions, persons w. altered immune states (HIV, AIDS, leukemia, lymphoma), pregnancy, breast feeding, or children < 1yr, persons with allergies to any part of vaccine

Antihistamine

block the action of histamine at the H1 receptor, often combined with decongestants and antitussives in OTC, not effective for long-term use - AE: excessive drying of mucous membranes and can lead to dry mouth, drowsiness, can worsen symptoms of narrow angle glaucoma

Garamycin (gentamicin)

ANTIBIOTIC - broad spectrum - AE: otoxicty - watch for: proteinuria, reduced kidney function, elevated BUN and creatinine levels

Ambien (zolpidem)

CNS DEPRESSANT - used to treat insomnia and anxiety AE: tolerance, sedation, depression, nausea, vomiting. - Give right before bed due to rapid onset

Diflucan

(-azole=interfere with fungal reproduction) ANTIFUNGAL - able to penetrate most body membrane to reach infection (CNS, bones, eyes, respiratory tract, and urinary tract) AE: hypersensitivity, nausea, diarrhea, rash, headache, rarely hepatotoxic

Cogentin (benzotropine)

ANTICHOLINERGIC - inhibit release of acetylcholine. suppresses tremors assoc. with parkinson's. - encourage increase fluids and fiber to decrease risk of constipation. report abnormal urinary output or changes in pulse rate. Get routine eye exams. Avoid alcohol, smoking, and caffeine. Wear sunglasses. ORAL HYGIENE, HARD CANDY, ICE CHIPS, RINSING MOUTH will help reduce dry mouth.

Codiene

ANTIDIARRHEALS - AE: CONSTIPATION, dry mouth, nausea, vomiting, ileus, drowsiness, dizziness, allergic reactions.

Mucomyst (acetylcysteine)

MUCOLYTIC/EXPECTORANT - antidote for acetaminophen - decreases buildup of a hepatotoxic metabolite in acetaminophen overdosage. Degrades mucus, allowing easier mobilization and expectoration. - AE: ANAPHYLAXIS, ANGIOEDEMA, drowsiness, vasodilation, rhinorrhea, bronchospasm, broncho/trach irritation, increased secretions - MONITOR: LFT, RFT, ECG, glucose, and electrolytes

Insulin Regular (Humalin R, Novolin R, Velosulin BR)

O: 0.5-1h, P: 2-4hr, D: 5-7hr; give 30 before meals, SQ, refridgerate

NPH Insulin (humalin N)

O: 60-120min P: 6-14hr D: 16-24 hr
Draw up clear(regular) before cloudy(NPH).

Insulin glargine (Lantus)

O: 70min P: none D: 6.5hr

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