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Get Quizlet's official HESI A2 - 1 term, 1 practice question, 1 full practice test
Terms in this set (153)
increases force of contraction
What is the positive inotrope for Digoxin do?
decreases heart rate
What is the negative chronotrope for Digoxin do?
take apical pulse for one full minute
How do you assess for the positive inotrope and negative chronotrope of digoxin?
Normal digoxin level
Normal serum potassium (K+) level
Do low potassium or magnesium levels increase the risk for dig toxicity?
S/S of dig toxicity
-visual distrubances (blurred, yellow, halo vision)
if apical pulse is lower than 60 bpm
When do you want to hold digoxin?
If a client has had a long history of digoxin and furosemide (lasix) use it could creates a high risk for what?
Furosemide (lasix) can cause _______ which can lead to dig toxicity.
Verapamil (Calan) and Diltiazem (Cardizem)
-These 2 calcium channel blocker also affect the heart. So you wnat to monitor BP and for a decrease in HR.
-Avoid grapefruit juice
-dipine ending drugs (like amlodipine)
-these calcium channel blockers affect vessels only (vasodilation)
-SE: dizziness, facial flushing, edema, hypotension
-used foe rapid diuresis in emergencies (Pulmonary embolism)
-may produce hypokalemia (assess for muscle craps or weakness)
-Hypotension, F/E abnormalities, dehydration,
SE of furosemide (Lasix)
-Nausea, vomiting, diarrhea
-ototoxicity with aminoglycosides (-mycin drugs)
Potassium sparing diuretics
-can cause increased potassium
-blocks receptors for aldosterone
-inhibits sodium and water reabsorption
-take in the morning (diuretics in morning if possible)
-avoid salt substitutes, ACE inhibitors, ARBs
-often take with other (thiazide) diuretics to treat edema, hypertension, heart failure
-can be taken with other meds that lower potassium
what do you want to teach a patient who is on a potassium sparing diuretic?
What is the stimulation of alpha 1?
you always want to check the apical pulse, hold if less than 60
What do you want to always check when giving a beta blocker (-lol)
Since a beta blocker is cardio- selective you want to also assess what prior to administering?
agents used to produce dilation of pupils for eye exams and ocular surgery
-alpha 1 adrenergic blocker
-decreases smooth muscle contraction of prostate capsules and bladder neck
- used to treat BPH
Alpha one blockers -zosin - antihypertensives
What drug is the only drug that can activate dopamine in the body?
Catecholamines (epinepherine, norepinepherine, dopamine, doubutamine, ect.) must be watched carefully for what?
use a soft tooth brush, use electric razors, do not got without shoes
What do you want to teach those on warfarin (Coumadin) to do to avoid bleeding?
teaching for those on warfarin (coumadin)
-maintain vitamin K foods (greens, mustard greens,) in diet; do not increase or decrease them
-avoid activities that may cause bleeding
-you want to hold 7-10 days before the surgery (may not have to hold aspirin, contact MD)
-for intermittent claudication
-treats ischemic pain
-a high alert medication
-requires another nurse to check the dosage
-a potential SE would be bleeding
What is the antidote/reversal agent for Heparin?
What is morphine sulfate continued release used for?
produce CNS depression and respiratory depression
What can opioids do?
What do you want to give as the antidote for opioids (like to reverse respiratory depression and analgesia)?
-may need to be titrated
SE of opioids
-decreased BP and heart rate
treatment of breakthrough pain. Half-life is longer than duration of action. With repeated doses drug accumulates in the tissues, which is then slowly released. Allows for 24-hour dosing.
-cautions with peptic ulcer disease (PUD)
-cautions with children younger than the age of 18 with recent viral illness (Reyes syndrome)
-interacts with other antiplatelets, anticoagulants, NSAIDs (etc)
WATCH FOR BLEEDING!!!!
-Nonopioid analgesic for peripheral neuropathy, postherpetic (shingles) neuralgia, fibromyalgia.
-SE: suicidal thoughts, dizziness, drowsiness, edema, dry mouth, abdominal pain, constipation.
-NSAID (causes gastric irritation)
-should e]be given with meals or snacks
-has pain relief like morphine but is not a opioid
-it is used for post-op pain not chronic pain
-do not give this med for more than 5 days
-can increase LFTs (hepatotoxicity)
-like other NSAIDs may increase the risk of MI and stroke
-SE are the same as NSAIDs, including GI bleeding
-S/S of anemia
-COX-2 inhibitor (NSAID) for decreasing inflammation, reducing pain and fever
-has a cross sensitivity reaction if someone is allergic to sulfa drugs
-there is a increased risk of MI and stroke
coffee-ground emesis or black stool
What may indicate a GI bleed?
Topical/inhaled adrenergics (decongestants)
-do not want to use longer than 3-5 days
-can produce rebound congestion
-taper by alternating nostrils
bronchodilator used in LT maintenance of COPD; given by inhaler; rinse mouth after inhaler use
produce ease of breathing and decrease wheezing
What should bronchodilators do?
-This is a anti-inflammatory that can be given to children greater than 2 years of age
-take PO once daily in the evening
-SE: headache and dizziness
-ex: diphenhydramine (Benadryl)
-dcreases nasopharyngeal secretions by blocking H1 receptors
-use cautiously with elderly, COPD, asthma, pneumonia
-A major SE is sedation
theophylline (methylxanthine bronchodilator)
-indicted for treatment of COPD
-IV form (aminophylline) for status asthmaticus
-avoid caffeinated beverages, as caffeine is a methylxanthine
-Monitor plasma drug levels
-Toxicity can produce life threatening dysrhythmias
-given for thyroid gland ablation
-given as large capsules that are odorless and tasteless
-can dry up salivary glands
-excreted in urine, so FORCE FLUIDS!!!
-patient is radioactive until this is removed from the body
-you want to double flush toilets, etc.
-administered by the nuclear medicine physician
Methimazole (Tapazole) or Propylthiouracil (PTU)
-These are for the treatment of hyperthyroidism (Graves disease).
-May be referred to as "antithyroid" medication. -Take at same time every day with meal or snack. -Avoid foods high in iodine (iodized salt; seafood). -May take 2 weeks to be effective.
-SE: hypothyroidism symptoms (sluggish, tired, weight gain, cold intolerance, constipation).
-Take one hour apart from Lugol's solution (potassium iodide) for treatment of severe hyperthyroidism (thyroid storm/thyroid crisis).
Rapid acting insulin
-lispro, aspart, glulisine
-onset: 5-10 minutes, peak: 1 hr, duration: 2-4 hrs
-take immediately before eating
-short acting insulin
-given IV for emergencies
-peak: 2-3 hours
-give 30-60 minutes before meals
-when giving this make sure patients breakfast is on the way
an insulin syringe (measured in units)
What is the ONLY type of syringe that can be used when giving insulin?
Glargine (Lantus) insulin
-flat effect (last 24 hours)
-once a day dosing at bed time
SE of second generation Sulfonylureas
Glucagon Emergency Kit
-elevates blood sugar; used when a diabetic patient becomes hypoglycemic and becomes unconscious
-it is a powder that is mixed with the liquid given and then administered as an injection by someone else
teaching for glucagon emergency kit
-once injection is given, patient should be placed on their left sides, as it is not uncommon for the patient to vomit
-patient should become conscious within 15 minutes; if not 2nd injection can be given
-go to ER
-oxymetholone (Anadrol-50), oxandrolone (Oxandrin), nandrolone (Deca-Durabolin)
-stimulates growth and development of male sex organs and secondary sex characteristics; stimulates production of erythropoientin by the kidney
-Administration of exogenous adrogens inhibits the release of endogenous androgens, which suppresses sperm production as well as can cause shrinking of testicles and gynecomastia
H2 antagonists (blockers)
-tidine drug endings (Cimetidine [Tagamet], and ranitidine [Zantac[)
-prevents irritation of stomach from too much acid (PUD, GERD)
-this is the first choice drug for gastric and duodenal ulcers
-take 30 to 60 minutes before meals Take at least 1 to 2 hours before antacids (antacids decrease absorption)
-proton pump inhibitor (PPI)
-antacid for erosive esophagitis, PUD, ST treatment for GERD
-healing and risk reduction in NSAID-associated gastric ulcers
-proton pump inhibitor (PPI) for GERD, erosive esophagitis, Zollinger-Ellison syndrome
-decrease risk of gastric ulcer during continuous NSAID therapy
drugs for PUD
-take at least one hour apart from other drugs and antacids,
Proton Pump Inhibitors (PPIs)
What are the only drugs that can be taken with antacids?
-prevents ulcers in those with LT NSAID use
-produces uterine contractions
-pregnancy category X
-used after delivery to expel products of conception
-may delay absorption of PPIs
-should be taken on empty stomach; take other drugs 2 hours before sucrlfate
-typically taken before meals and at bedtime
-needs a pH of 4 or less to bind to the ulcer
-prevention of chemotherapy-induced emesis
-SE: drowsiness, EPS such as tremors (notify MD if tremors are present
Xenical (Orlistat, Alli)
-use for long term weight control
-BMI of 30 or more
-patient has oily stool and flatulence
-ask patient to describe their dietary intake (SE are increased if greater than 30% of fat in the diet)
-fiber laxatives (like metamucil) help to decrease SE (binds to fat)
-bulk forming need to be given with plenty of fluid--> can produce esophogeal and/or intestinal obstruction
-ASSESS: last BM and characteristics, abdominal pain, fever, obstruction
-ASSESS: dietary and fluid intake
-encourage fluids, fiber and exercise
-for constipation and to LOWER serum ammonia levels in patients with liver disease (cirrhosis)-hepatic encephalopathy (monitor ammonia levels 15-45 mg)
- this medication is effective if the patient is having mroe frequent BM's or has more improved mentation (less confusion) and DECREASED serum ammonia levels
-prevention of nausea and vomiting associated with chemotherapy and radiation therapy
-use cautiously with liver failure
-antibiotic for treatment of STDs such as gonorrhea and chlamydia
-usually requires one(1g or 2g) dose
-male partner should be treated if woman has trichomonas (any STI), even if asymptomatic
Hepatotoxicity--> elevated liver enzymes
-broad spectrum antibiotics for treating UTIs
-SE: heaptotoxicity, skin reactions, neuropathy
-Nursing consideration: give with milk or meals
watch for numbness and tingling of extremities (irreversible peripheral neuropathy)
-drug of choice for treating C-Diff
take with food, take around the clock, avoid alcohol and products contain alcohol
-gentamincin (garamycin), neomycin, tobramycin (Nebcin)
-given IV for several days
-adverse effects: decreased hearing (ototoxicity) and nephrotoxicity (check BUN and creatinine)
-drug of choice for MRSA
-acute care may require frequent monitoring of serum drug levels for dose adjustment
-peak and trough schedule (trough usually just before the next dose)
-Red man syndrome if infused to rapidly
-IV infusion should be greater than 60 minutes
oral contraceptive pills (OCPs)
-have decreased efficacy while on antibiotics
-use a second method of birth control
What do penicillin's have a cross-sensitivity with?
Give epinephrine to open airway
If a patient id wheezing after the first dose of penicillin what do you want to do to treat it?
-beat blocker for hypertension
-notify prescriber for a low pulse rate and do NOT give the med
-SE: weight gain (fluid retention)
-monitor weight is the best thing you can do to know if there has been a fluid gain or loss
ticarcilline/clavulanic acid (Timentin)
-broad spectrum (extended spectrum penicillin)
-do NOT administer in same infusion with aminoglycosides
-Antitubercular (treatment of TB)
-may turn soft contacts orange
-advise the patient that the discoloration is a normal response to the drugs
-hepatotoxic--> check LFTs
turns all body fluids red/orange/brown
drug has a teratogenic properties that may decrease effectiveness of oral contraceptives; counsel patient to use a nonhormonal form of contraception throughout therapy
-interacts with food containing tyramine
-can produce life-threatening hypertensive crisis; know foods to avoid
-use a second for of birth control
-GI SE such as nausea
-antiviral for treatment of HSV-1 and HSV-2, varicella zoster virus (shingles) & chickenpox.
-Patient's with HSV-2 (genital herpes) should avoid sexual intercourse.
-typically given IM in the deltoid (upper arm) muscle
-recommended for everyone 6 months and older
-does not contain the flu virus
-SE: soreness, redness, and swelling at the site of injection; low grade fever; aches
-antifungal for vaginal candidiasis (yeast infection)
-many antifungals can cause liver injury (hepatotoxicity)
-for treatment of superficial dermatologic infections (athletes foot) and onychomycosis (nail fungus)
-report nausea, upper stomach pain, itching, loss of appitite, dakr urine, clay-colored stools, jaundice
can cause addiction, patients experience withdrawal symptoms
what can happen with long term use of antidepressants?
get a medication history because many drugs can interact with antidepressants
When giving antidepressants what do you ALWAYS want to do?
for Parkinson's disease and treatment of extrapyramidal symptoms (EPS) also called parkinsonism
-common SE include blurred vision, urinary retention (Parkinson's meds).
Levedopa - Carbidopa (Sinemet)
-stimulates dopamine production or increases sensitivity of dopamine receptors; to treat parkinson's
-toxicity includes involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue, etc.
-do not consume high protein meals because it can impair effects
Lithium (Lithobid, lithotabs)
-mood stabilizing drug used to treat bipolar disorder
-low therapeutic index
-toxicity can occur at blood levels that are slightly greater than therapeutic levels
-monitor lithium levels
-this is the drug of choice for treating manic phase of patients with BPD.
-lithium levels must be kept below 1.5 mEq/L; levels greater can produce toxicity
-initial therapy levels= 0.8 to 1.4 mEq/L; maintenance levels= 0.5 to 1.5 mEq/L
-draw the levels in the morning, 12 hours after the evening dose, during maintenance therapy levels should be checked every 3 to 6 months
-produces severe extrapyramidal symptoms (EPS) or reactions to include tardive dyskinesia
-treatment of depression, anxiety, panic disorder, anorexia, nervosa, OCD, etc.
-also used to treat diabetic neuropathic pain
-DO NOT USE WITH MAOIs
-affects the chemicals in the brain
-used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression) in adults and children who are at least 13 years old
-common SE: asthenia, dizziness, drowsiness, extrapyramidal reaction, hyperkinesia, akinesia, cogwheel rigidity, drug-induced parkinson's disease, dyspepsia, mask-like face, xerostomia
-other SE: abnormal gait, back pain, constipation, fever orthostatic hypotension, WEIGHT GAIN, myoclonus, and personality disorders
-not an NSAID
-MAX daily dose 4,000 mg; 3,000 mg for the elderly and those with liver disease
-long term use can produce nephrotoxicity
-overdonse/frequent use can produce hepatotoxicity
Symptoms of hepatotoxicity
What is the antidote for acetaminophen (tylenol)?
take the first puff then wait 1 to 2 minutes and take the next (2nd) puff
How do you take 2 puffs of inhalers with the same med?
take the bronchodilator first then wait 2 to 5 minutes before you take the other one
how do you take 2 puffs of inhalers with two different meds?
replacement therapy (levothyroxine)
what is the treatment of hyperthyroidism?
antidiuretic hormone (ADH)
-prevents excess fluid loss
-patients with diabetes have insufficient amounts of this and produce large amounts of very dilute urine
should have decreases urine output
-watch for fluid overload; renal assessment
What is the antidote for benzodiazepines?
-Anticonvulsant, benzodiazepine to treat panic disorder
-SE: drowsiness, CNS depression, dizziness, nightmares, dry mouth, constipation, weight gain
-can produce withdrawl phenomenon and hangover effects
What do benzodiazepine drugs end with?
-this is the drug of choice for treating alcoholic delirium tremors (DT)
-after the IV administration, keep the patient supine for 8 hours and observe closely
-used for anxiety and withdrawal symptoms
10 to 20 mcg/mL
What are the therapeutic plasma levels for Phenytoin (Dilantin)?
- very narrow therapeutic index
-used to treat seizures (anticoagulant)
-at plasma levels above 20mcg/mL, toxicity can occur
-toxicity: nystagmus, ataxia, diplopia, and cognitive impairment
-suicidal thoughts and extrpyramidal symptoms (EPS)
-A common side effect is gingival hyperplasia (teach good oral hygiene)
-other SE: measles like rash, hirsutism, steven-johnsons, toxic epidermal necrolysis
WHat is carbamazepine (Tegretol) serum level?
What do you NOT want to give with carbamazepine (Tegretol)?
-muscle relaxant and CNS depressant
-advise the patient to move carefully and to rise and walk slowly
-assess the LOC
-given intrathcally by pump (use test dose 1st)
-SE: CNS depression, drowsiness, dizziness, hypotension
centrally acting muscle relaxant
-direct acting muscle relaxant
-does not produce CNS depression
-used to also treat malignant hyperthermia (severe genetic SE from general anesthesia)
Hypnotics (CNS Depressants)
-very short half-life
-can be repeated at night
-can produce somnambulism
use cautiously in elderly
For all hypnotics what do you want to do?
-used for the treatment of ADHD
-time of dosage is once in the morning and then about 5 hours later
-do NOT give at bedtime (insomnia)
-XR is given once daily in the morning (half dose is released immediately and the remainder 4 hours later)
Ergotamine (Ergomar) , Dihydroergotamine (D.H.E 45, migranal)
-treatment of vascular headaches, including migraines with or without aura, cluster headaches
-produces vasoconstriction of dilated blood vessels
-used for migraine relief
-serotonin receptor agonist (triptan) for relief of migraine headaches
-contraindications: don' take within 24 hours of ergot alkaloids
-can cause coronary vasospasms
-contraindicated in stroke (CVA)
-best if taken on empty stomach 30-45 minutes before eating
-stimulant which produces insomnia (don't take at bedtime)
-schedule 2 drug
Which drug is linked with increased suicidal thinking and behaviors in adolescents?
-used for antiinflammatory properties
-treatment of migraines, menstural cramps, inflammation and fever
-given to enhance mental alertness and improve memory
-may increase the risk of bleeding with anticoagulants, antiplatelets, and NSAIDs
-SE: allergic skin reactions and irritated mucous membranes
St. John's Wort
-used to treat depression and anxiety
-decrease benifits of immunosuppressant drugs for patients with kidney transplants
Glucosamine and Chondroitin
What drugs are used for osteoarthritis?
Vitamin A deficiency
What causes night blindness/visual changes (NUTRITION)?
restless leg syndrome (RLS)
What is caused by iron deficiency and vitamin D deficiency?
-nasal spray to decrease bone loss from osteoporosis
-instruct pt. to alternate nostrils each day when administering the nasal spray to decrease rhinitis
Calcitriol (Rocaltrol, vitamin d3)
-management of hypocalcemia in pts. on chronic renal dialysis or pts. with moderate to severe renal insufficiency with secondary hyperparathyroidism; -improved calcium and phosphorous homeostasis in these pts.
epoetin alfa (Epogen, Procrit)
-for patients with chronic kidney disease (CKD), increases RBC production
-treats anemia in patients with ESRD(CKD) or from HIV or chemotherapy
-need the normal iron levels
-monitor H & H, monitor for signs of bleeding and clotting as a dvt
-teach a diet high in iron
SE of bisphosphonates
-risk of esophogeal burns if me becomes lodged in esophegus
-ostenecrosis of the jaw
A measure of the extent of drug absorption for a given drug and route (from 0% to 100%).
1 hour before or 2 hours after meals
When taking medications on a empty stomach you want to take.......
take within 30-60 minutes after eating
When taking medications that are ordered after a meal....
Pilocarpine (Pilocar, Isopto)
-topical muscarinic agonist (choinergic) for glaucoma
-produces miosis (constriction of pupil) and contraction of ciliary muscle
-SE: decreased visual activity, local irritation, eye pain, brow ache\
-may produce bradycardia, bronchospasm, hypotension, urinary urgency, dirrhea, hypersalivation, and sweating
-cause pupil contriction (glaucoma)
-reducing night vision; risk for injury
-to treat urinary retention in postop and postpartum pts
-relaxes the trigone and sphincter muscles and increases voiding pressure (by contracting the detrusor muscle, which composes the bladder wall)
-like bethanechol but used to relieve xerostomia (Dry mouth) in patients with Sjogren syndrome
-may slow progression of alzhemiers disease over next year (12 months)
-improvement may be seen in quality of life and cognitive function; these improvements are only modest and short-lasting
-no evidence of marked improvement or significant delay of disease progression
patients with Alzheimer's
-safety is a potential problem
-enhances the effects of acetylcholine at the skeletal muscle receptors
-used in patients with myasthenia gravis
-effective if improvement in pt. muscle strength (e.g. opening of eyes, improved swallowing, etc.). -NOTE: An anticholinesterase drug has cholinergic effects!
A anticholinesterase drug has what kind of effects?
-this is the antidote for cholinergic crisis (OD) and drug-induced bradycardia
-also the antidote for nerve gas poisoning and organophosphate poisoning found in insecticides
-for prostate and testicular cancer (Lupron); decreases production of testosterone;
-SE include decreased libido and gynecomastia. -Work on the premise that tumors arising from tissue influenced by the hormones estrogen and progesterone/androgen show regression (tumors shrink) when treated with a drug which produces the opposite hormonal effect/environment.
-In men with prostate cancer, estrogens act on the pituitary to suppress secretion of luteinizing hormone, which in turn decreases testicular androgen secretion.
-Estrogen therapy causes feminization in men, manifested by gynecomastia and impotence. -Women may experience decreased libido and breast tenderness.
N/V, amenorrhea, spotting, edema, weight gain or loss, rash fever, insomnia, depression
most serious is liver dysfunction and thromboembolic disorders such as PE
what are the adverse effects of Medroxyprogesterone (Depo-Provera)?
-hormone necessary to development and maintenance of female reproductive system and 2ndary sex characteristics
-hormone replacement therapy (HRT) for treating postmenopausal symptoms
-adverse effects: HTN, thromboembolic events (most serious), edema, N (most common) /V/D, constipation, amenorrhea, breakthrough uterine bleeding, chloasma, hirsutism, alopecia, tender breasts, fluid retention, HA.
Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)
What are the drugs that are used for erectile dysfunction?
drugs for erectile dysfunction
-contraindicated with nitrates/nitroglycerin (potent vasodilator) to include isosorbide dinitrate (Isodil) and isosorbide mononitrate (Imdur)
Cyclosporine (Gengraf, Neoral, Sandimmune)
-immunosupressant drugs indicated for the prevention of organ rejection (kidney, liver, heart transplant)
-can cause nephrotoxicity and post-transplant diabetes millitus
-avoid grapefruit juice
-administered to increase WBC count in neutropenic patients
-white blood cells increase from 2500/mm3 to 5500/mm3--- meaninf the desired effect is reached
-give before infection develops
-SE: include fever, muscle aches, bone pain, and flushing
-give nonopioid or opioid analgesics; stops when med is D/C
-depolarizing nerumuscular blocker (NMB) and used during surgery (produces paralysis)
-may cause v-tach/dysrhythmias
-check respiratory status
-used for treatment of several nodulocystic acne
-severe photosensitivity (avoid sun)
-teratogenesis (preg. category X)
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