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Terms in this set (57)
Use: hypertensive crisis
MOA: reduces preload and afterload
S/E: hypotension, cyanide toxicity, thiocyinate toxicity, dizziness, GI upset
Teach: Black box warning
Nursing intervention: raise Pt. legs, dec dose, inc fluids (hosp policy)
MOA: vasodilation- dec preload and myocardial o2 demand
S/E: Orthostatic hypotension, HA, reflex tachycardia
Teach: subling-store in cool dark place. chest pain take 3 under tongue 15 min period. call 911 if chest pain not relieved after 1st pill.
Transdermal patch, remove old one, rotate sites, clean hairless site.
icy sorbet gives you HA bc so cold
Class: cardiac glycosides
Use: HF, A-fib, A-flutter
MOA: Positive inotropic effects = helps heart inc force and efficiency of, negative chronotropic effect = decreased HR
S/E: dysrhythmias - bradycardia (treat with atropine), toxicity - GI upset, sudden fatigue/ weakness, vision issues (digibind)
Teach: monitor carefully for toxicity. Hold medication if pulse <60
Hypokalemia inc risk for toxicity
Ther range = 0.5-2.0
>1.5 = TOXIC
Class: Sodium channel blocker
Use: ventricular dysrhythmia and SVT
S/E: hypotension, dysrhythmias, lupus, leukopenia, thrombocytopenia, black box warning
Teach: Monitor EKG, vitals, CVC, blood levels of procainamide (normal 4-8)
Class: Beta blockers
Use: dysthrythmias (a-fib, a-flutter), hypertension.
S/E: hypotension, bradycardia, weakness, fatigue, ED
Teach: Non-selective BB (propranolo) can cause bronchospasm (never give to asthma pt)
Metoprolol and atenolol are beta 1 (heart) selective
Propranolol, labetolol, carvedilol = non selective (heart & lungs) non-selective
Class: Potassium Channel Blockers
Use: Severe dysrhythmias (v-tach, v-fib).
S/E: hypotension, bradycardia, pulm toxicity, liver toxicity, thyroid dysfunction. black box warning.
Teach: NO grapefruit juice,
Class: Calcium channel blockers
Use: Antidysrhymthics (a-fib, a-flutter, SVT
S/E: hypotension, peripheral edema, bradycardia, HA, constipation
Teach: Monitor EKG, vitals, change positions slowly
Class: Class V antidysrthymic
S/E: arrhythmias, SOB, hypotension
Teach: monitor EKG, change positions slowly
Use: Arrhythmias (sinus brady, heart block, & dec secretions during surgery).
MOA: inhibits acetylcholine sites in smooth muscle and secretory glands and CNS, decreases vagal stimulation of heart allows for inc of heart.
S/E: Anticholinergic s/e (blurred vision, dry mouth, constipation, possibly tachycardia
Teach: Monitor for urinary retention, inc fiber intake.
"Atropine is the trampoline to get your heart rate up"
Heparin - IV or Sub Q
Enoxaparin (Lovenox) SubQ
Use: Stroke, DVT, PE
MOA: Activates antithrombin, to inhibit thrombus formation. Prevents new clots from forming and prevents existing clots from getting bigger. Does NOT break down existing clots.
S/E: bleeding, Heparin induced thrombocytopenia (forms microclots that travel adn cause ischemia to the appendanges. Clotting factor is all used up from microclots, pt at crazy increased risk for bleeding.) Hypersensitivity
Teach: Closely monitor aPTT, look for coffee ground emesis and tarry stools
ther level: 1.5-2x30-40 secs
antidote: protamine sulfate.
Class: Oral anticoag
Use: DVT, PE, A-fib w/ thrombis, following MI
MOA: Antagonizing vitamin k which prevents the formation of several clotting factors
S/E: bleeding, GI upset, hepatitis
Teach: Monitor PT-INR, maintain consistent level of vitamin k
ther INR = 2-3
takes 3-5 days to get to therapeutic elevels. start heparin and warfin concurrently. once warfarin is at therapeutic level can d.c heparin and continue warfarin.
Pt usually between 11-13 secs. When on warfarin, want PT level at 1.5-2x baseline. (17-26 sec).
antidote = vitamin K
"Warfarin is going to war on vitamin K"
Class: Anticoag Factor Xa inhibitors
Use: Prevent Stroke, DVT, or PE in pt's with A-fib
MOA: Inhibit factor Xa, which blocks coagulation cascade
S/E: Bleeding, possible elevated liver enzymes, black box warning (at risk for thrombotic events when discontinued abruptly)
Teach: Monitor liver function, monitor hemoglobin H&H during therapy.
Rivaroxaban helps your blood flow like a river
Class: Platelet aggregation inhibitors
Use: Prevent MI or stroke in pt's with Acute Coronary Syndrome
MOA: inhibit platelet aggregation
S/E: Bleeding, (abciximab)- hypotension and dysrhythmias, GI upset and rash
Teach: Assess for bleeding, watch EKG and vitals for aciximab
Class: Thrombin Inhibitors
Use: DVT, PE, prevent stroke, Heparin Induced Thrombocytopenia
MOA: Block thrombin receptors which prevent activation of clotting factors and formation of clot
S/E: Bleeding, (Argatroban) - hypotension, (Dabigatran) - GI upset, angio edema
Teach: Assess for bleeding
Class: Fibrinolysis Inhibitor (Hemostatic agent)
MOA: Inhibits activation of plasminogen which inhibits fibrinolysis which allows for clot formation
S/E: GI upset, hypotension
Teach: Regularly assess for bleeding, assess for thromboembolism- hyper coagulation is a risk
Use: Stroke, MI, PE, occluded central line. PICC line that's clotted
MOA: Break up clots by converting plasminogen to plasmin and breaks up fibrinogen
Teach: Contraindicated in Pt's who have had a hemorrhagic stroke. ONLY used for pt's with ischemic stroke. Would not used for internal bleeding, recent trauma or surgery, or who have sever HTN.
If using for ischemic stroke- want to administer within 3 hours of onset of symptoms of ischemic stroke.
Monitor labs and vitals, limit blood draws or IM injections bc of bleeding.
Reteplace will go to the place where the clot is and break it up
Class: Erythropoiesis Growth Factor
MOA: Stimulates bone marrow to inc production of red blood cells
S/E: Hypertension, inc risk for DVT, stroke, MI, seizures, black box warning
Administration; DO not shake vial, monitor vitals and H&H.
Make sure they're getting sufficient iron also.
Class: Leukopoietic Growth Factor
MOA: Causes bone marrow to increase production of neutrophil
S/E: Bone pain, leukocytosis, splenomegaly
Teach: Do not shake vial, monitor CBC levels during therapy
Fills you up with white blood cells
Use: Severe allergic reactions - anaphylaxis, advanced cardiac life support
MOA: Stimulates alpha 1 receptors which results in vasoconstriction, stimulates beta 1 receptors in the heart to increase HR, also stimulates beta 2 receptors in the heart which results in bronchodilation
S/E: Hypertension, dysrhythmias, angina, nervousness, tremors
Teach: Closely monitor vitals and heart rhythm, watch EKG
Use: Shock, severe hypotension
MOA: Stimulate alpha 1 receptors which results in vasoconstriction. Has minor beta 1 activity- inc cardiac output to certain extent
S/E: Hypertension, dysrhythmias
Teach: Monitor vitals as well as heart rhythm
Class: Adrenergic (inotropic, vasopressor)
Use: Shock, Sepsis, HF, Renal Failure
MOA: Stimulates alpha 1 receptors which causes vasoconstrictors. Stimulates beta 1 receptors which increases cardiac output and HR. Stimulates dopaminergic receptors which helps to increase renal perfusion.
S/E: Dysrhythmias, angina
Teach: Monitor vitals and EKG
Class: Adrenergic (inotrope)
Use: HF, cariogenic shock
MOA: Stimulates beta 1 receptors to help increase cardiac output, but has less effect on the HR and BP
S/E: HTN, Dysrhythmias, angina
Teach: Monitor vitals and EKG. HF- hemodynamic monitoring (PAWP, CVP)
Class: Colloid (Volume expander)
Use: Shock, Hemmorhage, Burns
MOA: Helps maintain osmotic pressure in the plasma. Draws fluid from extravascular space into intravascular space.
S/E: Fluid overload, pulmonary edema, HTN
Teach: Assess for signs of fluid overload (edema, pulm. edema, crackles in lungs) contraindicated for HF pt's who already have those issues with fluid.
Use: hypercholesteremia, prevention of Coronary Heart Disease
MOA: Decrease LDL. Increase production of HDL
S/E: Hepatotoxicity, muscle pain, rhabdomyolysis, GI upset.
Teach: Take med with evening meal bc cholesterol is synthesized at night. Monitor liver function d/t hepatotoxicity. Monitor creatinine kinase d/t risk of rhabdomyolysis. Avoid alcohol and grapefruit juice
"Take your statin before you crawl into your satin (sheets)."
Class: Cholesterol Absorption Inhibitor
Use: Prevent hypercholesteremia
MOA: Inhibits absorption of cholesterol in small intestine
S/E: Hepatotoxicity, muscle pain
Teach: Monitor liver and CK levels
Ezetimibe helps cholesterol zip through the small intestine and not get absorbed.
Class: Bile Acid Sequestrants
MOA: Binding to acids in intestine which heps increase excretion of cholesterol and lower LDL levels.
S/E: Constipation, GI upset
Teach: High fiber diet, increase fluid intake, take with food and full glass of water. Can interfere with fat soluble vitamin absorption (ADEK)
Class: Fibric Acid Derivatives
MOA: Decrease triglyceride production and transport. Also increase levels of HDL
S/E: GI upset, galstones, hepatotoxicity, muscle pain
Teach: Take meds 30 mins before breakfast and dinner. Monitor liver function
Class: Water soluble vitamin B3
Use: In large doses treats hypercholesteremia
MOA: Decreases lipoprotein and triglyceride synthesis
S/E: Flushing of the face, GI upset, pruitis, heptatoxicity, possible hyperglycemia
Teach: Monitor liver function, use cautiously in diabetes Pt because of hyperglycemia
Use: Prevent neural tube defects, Megaloblastic Anemia. body produces abnormally large immature RBCs, Microcytic anemia,
MOA: Stimulates production of RBCs, WBCs, and platelets
S/E: rash, make urine more yellow
cyanocobalamin (B12) (nasal route)
Use: Tx of pernicious anemia (doesn't produce intrinsic factor in stomach. intrinsic factor is needed for absorption of B12. B12 deficient)
MOA: Through Nasal route
S/E: Hypokalemia, hypersensitivity
Teach: Higher doses of folic acid can mask B12 deficiency -> cognitive decline. Deficiency can occur in vegetarians.
"cynthia babblin about her pernicious anemia. Just take cyanobalamin."
Ferrous sulfate (oral)
iron dextran (IV, IM)
Class: Iron supplement
Use: Iron deficiency
S/E: GI upset- constiptation, teeth staining (give through straw), Dark green/ black stool.
Iron dextran (IV) can cause staining at the IV site, hypotension, flushing, Give using z-track method (pull skin, give injection, let skin go).
Teach: Vitamin C is very important for iron absorption. Give iron 1 hour before meals or 2 hours after. Increase fluid and fiber intake to help prevent constipation. Keep out of reach of children. Eat iron rich foods with supplement.
"Furious my teeth were stained with Ferrous sulfate"
1. Calcium Carbonate
2. Calcium Citrate
3. Calcium gluconate
Class: Calcium Supplements
Use: (1 &2) are used for hypocalcemia, prevent menopausal osteoporosis. (Calcium gluconate) emergency Tx of hyperkalemia and hypermagnesemia.
MOA: important for bone and teeth formation, nerve and muscle formation, and clotting
S/E: Constipation, bradycardia
Teach: Need sufficient vitamin D to absorb calcium
Ther level (9-10.5)
Class: Potassium Supplement
MOA: Needed to maintain intracellular fluid volume, important for nerve, muscle, and heart function Can give orally or IV.
Teach: Oral route is huge pill, or powder which tastes bad OR IV route which burns at IV site. Can request your doctor order it mixed with lidocaine so it doesn't burn so much.
Class: Alkalinizing Agent/ Antacid
Use: metabolic acidosis, PUD, Code Blue cardiac arrest and acidosis
MOA: Promotes acid base balance in the body by releasing bicarbonate ions
S/E: Metabolic alkalosis
Teach: monitor ABGs
Ther level 22-26
sodium polystyrene sulfonate (Kayexalate)
Class: Hypokalemic Agent
Use: Hyperkalemia (brings K level down)
MOA: Exchanging Na+ ions for K+ ions in intestine which helps increase excretion of K+ from the body.
S/E: Constipation, fecal impaction, N/V, possible hypokalemia
Teach: Maintain therapeutic range, monitor stool for fecal impaction, may need laxative concurrently
Class: Magnesium Supplements
Use: Hypomagnesemia, Torsades de Pointes, preterm labor (slows uterine contractions)
MOA: Needed for nerve and muscle function as well as bone formation. Critical for many biochemical reactions in the body
S/E: Diarrhea, magnesium toxicity (dec deep tendon reflexes, urine output >30 mls/hr, resp depression, cardiac depression, hypotension).
Teach: For magnesium toxicity ->give calcium gluconate. Watch mag levels
Ther level (1.3-2.1)
"Too much magnesium brings Maggie to her knees"
Class: Anti-seizure medications
S/E: Gingival Hyperplasia, vision issues, GI upset, possible Rash
Teach: Frequent blood draws.
Ther level (10-20)
S/E: vision issues, dizziness, sedation, metabolic acidosis
Teach: Monitor Bicarb levels during therapy
S/E: Behavioral abnormalities, Fatigue, agranulocytosis (drop in WBC inc risk of infection)
Teach: Monitor CBC levels, and signs of infection
S/E: Drowsiness, GI upset, blood discrazias
Teach: Narrow ther range -> freq blood draws
Ther range 5-12mcg/mL
MOA: Increase GABA in CNS, which helps to promote sedation and sleep
S/E: Daytime sleepiness, dizziness, possible abnormal thinking and behavior. black box warning
Teach: Allow for 8 hours of sleep. Melatonin can be used to regulate sleep wake cycle
"both these meds can help you catch some zzzs"
Use: Pre-op sedation. Tx of seizures, help induce coma in Pt's with high ICP.
MOA: Inc GABA which results in CNS depression
S/E: Lethargy, hypotension, resp depression, constipation
Teach: Closely monitor vitals and have resuscitation equipment at the bedside.
"Climbed over barbed wire to get to pentagon and got knocked out with pentobarbital"
Class: General Anesthetic
Use: Induction and maintenance of gen anesthesia. provides sedation for intubated patients
MOA: potentiate effect of GABA
S/E: Amnesia, bradycardia, Hypotension, resp depression.
Teach: Continuously monitor vitals, remember it does not treat pain, use unused portions of propofol within 6 hrs bc of risk of bacterial contamination.
Class: Neuromuscular Blocking agents
Use: adjunct to anesthesia to anesthesia during surgery or during intubation.
MOA: Blocks acetylcholine at neuromuscular junction resulting in skeletal muscle paralysis.
S/E: Resp arrest, apnea, malignant hyperthermia (muscle rigidity, fever), muscle pain d.t use of meds, black box warning for cardiac arrest with rhabdomyolysis.
Teach: If malignant hypothermia -> admin O2, give dantrolene (skeletal muscle relaxant), provide cooling measures.
Class: Muscle Relaxant
Use: Muscle Relaxant, Prevent and treat malignant hyperthermia, muscle spasticity, cerebral palsy, MS
MOA: Prevents release of calcium in Muscles. inhibits muscle contractions and muscle spasticity
S/E: Drowsiness, muscle weakness, GI upset, hepatotoxicity, black box warning - hepatotoxicity
Teach: Monitor liver enzymes, s/s of liver damage
Class: Centrally acting muscle relaxant
Use: Muscle spasticity r/t spinal injury, cerebral palsy, MS
MOA: Enhancing effect of GABA in CNS which reduces muscle spasticity.
S/E: Drowsiness, nausea, constipation
Teach: Increase fluid and fiber intake.
Use: Acute Gout Attack
MOA: Reduce pain and inflammation in acute gout attack by interfering with the WBC initiation of inflammatory response
S/E: GI upset, thrombocytopenia
Teach: Inc fluid initate. Should NOT consume grapefruit juice
Use: Treat hyperuricemia w/ chronic gout
MOA: Inhibiting renal reabsorption of uric acid. Helps to improve excretion of uric acid
S/E: GI upset, renal calculi (kidney stone)
Teach: Inc fluid intake to prevent kidney stones, monitor uric acid levels, and kidney functions during therapy.
Use: hyperuricemia with chronic gout
MOA: inhibits uric acid production
S/E: GI upset, rash, hepatotoxicity, nephrotoxicity
Teach: inc fluid intake, monitor liver and renal function during therapy. takes 2-6 weeks before seeing improvement in Sx.
Rapid acting (Insulin lispro -humolog) (insulin aspart - Novolog
MOA: Very rapid onset 15 mins. Peak 1 hr. duration 2-4 hrs
Teach: if you give rapid acting- make sure their meal tray is right in front of them
"for insulins that end in log: log rolling rapidly down a hill"
Short Acting humulin R or Novolin R
MOA: 30 mins. Peak 2-3 hrs. Duration 3-6 hrs.
Teach: Make sure meal trays are on the floor
"R stands for Regular insulin"
MOA: 2-4 hrs. Peak 4-12 hrs. Duration 12-18 hrs.
Long acting (Insulin glargine- Lantus) (insulin detimer- Levimir)
MOA: onset 3-4 hrs. no peak peak. duration 24 hrs.
hypoglycemia (tachycardia, diaphoresis, shakiness, HA, weakness)
Teach: Monitor for s/s and teach s/s. May need extra doses of insulin during times of stress or illness. should not skip insulin when sick. if experience hypoglycemia and are fully conscious can provide orange juice or milk 15 grams of glucose 4 oz juice 8 oz milk. if not conscious- give glucagon.
Rotate sites to prevent lipohypertrophy (scar tissue from injection in same spot)
When mixing insulin always draw up clear first then cloudy. inject air into cloudy insulin, remove needle, inject air into clear insulin, don't remove needle and draw up short acting insulin (clear), then draw up cloudy insulin.
Draw up RN: Regular insulin before NPH
Gently rotate vile before administration. If short acting insulin looks cloudy or discolored dispose of it.
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