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describe what digoxin does to the heart, what to assess before giving the medication?
positive inotrope (increases force of contraction) and negative chronotrope (decreases heart rate)
-always take apical pulse for a full minute before giving med
what to check before giving digoxin?
apical pulse and potassium level
-hypokalemia increases risk for dig toxicity
which diuretic taken with digoxin can increase risk for dig toxicity, why?
furosemide (lasix) because it can cause hypokalemia
what is the normal dig level?
what are the signs of dig toxicity?
anorexia, nausea vomiting, confusion, visual disturbance
-serious signs: cardiac dysrhythmias
what is the antidote for dig toxicity?
Digoxin immune Fab (Digibind) only when potassium is high
What do calcium channel blockers do?
what is their ending?
-the cause vasodilation and reflex tachycardia
(decreased BP but increases HR)
What do verapamil and diltiazem do?
produce vasodilation and cardiosuppresion (lowers bp and HR) there is no reflex tachycardia
what is the biggest concern with beta blockers if we do not know if its cardioselective?
respiratory conditions (asthma, emphysema, COPD)
patient teaching for beta blockers
-always check AP and BP before giving
-do not give if HR is less than 60
-never stop abruptly
-must taper medication because it could lead to angina or an MI
what is a SE of labetalol?
-what should you assess if a pt is taking this medication?
weight gain (fluid retention)
-pulmonary assessment and monitor weight gain, intake and output
what to do if a patient is getting a nitro drip and they become hypotensive?
-slow down the drip
what is furosemide used for?
-what are side effects of this?
-used for rapid diuresis in emergencies (pulmonary edema)
-may produce hypokalemia (muscle cramps/weakness)
-can cause ototoxicity with aminoglycosides (-mycins)
`what are foods containing potassium?
dried fruits, fish, leafy veggies, squash, beans, nuts, meats, bananas, potatoes, dairy products
how to give IV potassium?
-never given bolus or iv push
-infusion rate must not be greater than 10mEq/hr
what is the normal potassium range?
What is spironolactone used for?
-what to teach pt?
HTN, edema, HF
-this drug increases potassium levels, take drug in the a.m, avoid salt substitutes, ace inhibitors, and arbs
how to know if a -statin drug is effective?
-diet for these medications
HDL should increase and LDL and total cholesterol decreases
-low fat diet, and a diet high in fiber
what to teach a patient taking warfarin?
-use a soft toothbrush
-electric razor instead of a straight razor
-do not go barefoot
-maintain Vitamin K steady in their diet (dont increase or decrease)
What labs are used to monitor Warfarin?
what is enoxaparin (lovenox) used for?
where is this drug given?
- for DVT prophylaxis
-only given in the abdomen subq
what is pentoxifylline (rental) used for?
what does it produce?
used for treating intermittent claudication and ischemic pain
-produces platelet inhibition (anti platelet) and vasodilation
are heparin and hep-lok interchangeable?
NOT interchangeable bc the dosages are significantly different
what to do before giving heparin?
-what to assess for in a patient taking heparin?
always have another nurse check your dosage because it is a high alert medication
-assess for bleeding (bleeding of the gums, epistaxis, black stools, easy bruising, headaches)
what are the labs to monitor heparin? what is the antidote for heparin?
labs: PTT and platelets
antidote: protamine sulfate
what to assess for a patient taking an opioid? what is the antidote and how to give?
assess for respiratory depression and be aware of safety for patients attempting to ambulate
narcan is the antidote, give in titrate dosages
What is fentanyl patch used for?
used for chronic pain, only for patients who are opioid tolerant
-best for patients who have strong pain and renal impairment
what is meperidine (demerol) used for?
treats pain of pancreatitis
What is pregabalin (Lyrica) used for?
treats pain in peripheral neuropathy, shingles, fibromyalgia
what is acetaminophen? what is the maximum daily dosage of this medication and what are signs of hepatotoxicity when taking this med? what is the antidote?
-non-opioid analgesic, not an NSAID
-max: 4,000mg, 3,000mg for elderly and ppl with liver disease
-hepatotoxicity: jaundice, abdominal pain, clay-colored stools, dark urine
if a patient has pneumonia, why would they be given mucomyst (acetylcysteine)?
it will break up the mucous so the patient can cough it up
what is ketorolac? whats it used for and what is a main side effect of this drug?
an NSAID (should be given with food) its used for post-op pain and cannot be given for more than 5 days. SE: causes gastric irritation
What is ibuprofen used for?
taken with anti-acids to decrease GI distress
what is montelukast (Singulair) used for? how to give this med? what labs need checked?
used for asthma, administer orally at bedtime. check LFT's
what is the highest priority assessment for a patient taking prednisone?
risk for infection
what are side effects of glucocorticoids?
cushings syndrome (moon face), hump back, weight gain, thin fragile skin, hyperglycemia, osteoporosis (may need vitamin D and Calcium)
what are the signs and symptoms of levothyroxine overdose?
-increases metabolism, tachycardia, weight loss, diarrhea, over heating, perspiration, insomnia, angina
what is methimazole (tapazole) and used for?
-what can this cause and if so what does a patient take for it?
hyperthyroidism (graves disease)
-may cause thyroid storm/crisis, if so patient will take this medication and lugol's solution 1 hour apart
what is vasopressin used for?
diabetes insipidus and for nocturnal enuresis (bed wetting)
-pt will have to get up less to go to the bathroom at night while on this medication
how to change sites for insulins, and when you have a cloudy and clear which do you draw up first?
change sites like a clock and drug up clear before cloudy
which insulin can be given IV?
-nursing consideration for giving these insulins
rapid like lispro, aspart, and glulisine and regular short acting
-make sure patient eats food within 15 min of getting this insulin
what is the peak of regular insulin, pt teaching regarding this
peak: 2-3 hours, make sure patient eats breakfast or a mid-morning snack
how to give glargine insulin?
given once a day at bedtime (do not mix)
-there is no peak
what is the glucagon emergency kit? how to give this?
used when a diabetic becomes hypoglycemic and becomes unconscious.
-place pt on left side because the patient may vomit, pt should become conscious within 15 min of injection
what to do if a patient is on an oral anti diabetic agent and the patient is NPO?
contact physician if patient is not receiving intravenous infusion of dextrose
what is glimepiride used for? what does a patient need to have in order for this medication to work, and nursing consideration for this medication
used for type 2 DM.
pt must have to have functioning beta cells for this to work.
-may be a cross sensitivity if a patient is allergic fo sulfa drugs
what can metformin cause?
can decrease absorption of vitamin B12 and folic acid, it can produce lactic acidosis
when should -tidine and -prazoles be taken?
30-60 minutes before meals
what is misoprostol used for?
prevents ulcers from long term NSAID use
(may produce uterine contractions, pregnancy category X)
how to take sucralfate (carafate)?
on an empty stomach, not with any other meds or foods
nursing considerations for metoclopramide (raglan)
may case tremors, restlessness, foot tapping, abnormal movements (notify provider if tremor develops)
nursing considerations for a patient taking trimethobenzamide (Tigan)
may cause extrapyramidal symptoms, liver toxicity, and cause sedation
What is Xenical (orlistat)?
-how to decrease the side effects of this drug?
used for weight loss, patient will have oily stool, flatulence.
-to decrease symptoms pt can take Metamucil or decrease fat intake to less than 30% of total intake
patient teaching for a patient taking bulk-forming laxatives?
drink plenty of fluids, increase fiber and exercise
What is lactulose used for?
for constipation and to lower serum ammonia levels in patients with liver disease (cirrhosis)
how to know lactulose is being effective?
-pt will have more frequent bowel movements
-improves mentation (less confusion)
-decreased ammonia levels (between 15-45)
what is the biggest concern for a patient takin nitrofurantoin?
watch for numbers and tingling of extremities (can cause irreversible peripheral neuropathy)
nursing consideration for a patient being treated for an STD?
patients partner must be treated as well no matter what drug they are being treated with
what is metronidazole (flagyl) used for? pt teaching regarding this?
used for treating C. diff
-take with food, take around the clock, avoid alcohol
what is vancomycin?
-what to assess for a patient on this medication?
drug of choice for treating MRSA
-risk for nephro and ototoxicity (BUN and Creatinine)
what to give if a patient is wheezing after the first dose of penicillin?
what if Rifampin?
-side effect of this med?
-turns all body fluids red/orange/brown
nursing considerations for tetracycline?
-do not give to pregnant women or children under the age of 8
-can cause permanent discoloration of teeth
-affects growth of teeth
-avoid dairy products
-causes photosensitivity (use sunscreen)
what is ribavirin used for?
what can this cause?
-used for hepatitis C when no other treatment has worked
-can cause orthostatic hypotension
What is Terbinafine (Lamisil)?
-pt teaching and what labs to monitor?
-antifungal used to treat athletes foot and nail fungus
how do you know if an antibiotic is effective?
no fever, decrease in pain, swelling, and redness
-improved WBC count
what is the drug for treating Parkinson's disease?
what is levodopa-carbidopa?
-pt teaching for this med
stimulates dopamine to treat parkinsons
-do not consume high protein meals with levodopa
discharge teaching for a patient taking paroxetine (Paxil)
-may take 4-6 weeks to see therapeutic effects
-may cause suicidal thoughts
what is olanzapine (zyprexa)?
-what are side effects?
antipsychotic medication used to treat schizophrenia and bipolar disorder
-SE: weight gain
what is lithium?
-patient teaching for taking this drug
-what to do if pt is in lithium toxicity
mood stabilizing drug for patients with bipolar disorder
-maintain sodium levels (135-145)
-if pt is in lithium toxicity we need to vigorously hydrate
What is haloperidol used for?
what can this drug produce?
what is the antidote?
-can produce extrapyramidal symptoms like akathisia (constant tapping of the feet), decreased thirst, difficulty urinating, dizziness, lightheadedness, or fainting
What can benzodiazepines cause? (-lam and -pam)
CNS depression, stay away from other CNS depressants
what is the drug of choice for treating alcoholic delirium tremens?
what can ambien cause?
cognitive impairment including amnesia and should be used with caution in the elderly
what is phenytoin used for? what to monitor when taking this? what are common side effects?
-used to treat seizures
-monitor plasma levels (10-20)
-SE: cognitive impairment, suicidal thoughts, EPS, and gingival hyperplasia
what is lioresal (baclofen)?
-nursing considerations for this drug
Muscle relaxant (CNS depressant)
-advise pt to move slowly, assess LOC
what is the epidural priority?
-make sure you assess LOC, ABC's and for any bleeding, make sure they can feel and move before getting patient up
-make sure the tube in their back is labeled as "epidural"
What are triptans used for?
what is methylphenidate (Ritalin) used for?
-pt teaching for this
-take on empty stomach 30-45 min before eating
-take in the morning (bc it causes insomnia)
-take with meal if its causing weight loss
what can ginkgo biloba do?
improves memory and may increase risk of bleeding
What can vitamin A deficiency cause?
-what foods increase Vitamin A?
-can cause night blindness
-eat more yellow/orange veggies
what vitamin deficiency may cause restless leg syndrome?
iron or vitamin D deficiency
what can Vitamin D OD cause?
what lab to check?
can cause increase calcium levels
-calcium lab should be 8.4-10.5
what is calcitonin? pt teaching for this medication
nasal spray to decrease bone loss from osteoporosis
-teach pt to alternate nostrils
what is phenazopyridine?
-urinary tract analgesic (decreases pain in UTI's)
patient teaching for bisphononates?
-take first thing in the morning with water only, at least 8oz
-remain upright for at least 30 min following the dose
What does Cholinergic drugs do?
-improves urinary retention
-causes miosis (pupillary constriction)
what is donepezil (aricept)?
slows progression of Alzheimers
what is pilocarpine?
used for glaucoma
-causes pupil constriction (do not drive at night)
what is edrophonium?
anti cholinesterase for myasthenia gravis, pt will have improved muscle strength
what are -stigmines for?
for myasthenia gravis
-antidotes for muscular blocking drugs
Side effects of atropine
Hot as a hare (inc body temp)
Dry as a bone (dry mouth, skin)
Red as a beet (flushed skin)
Blind as a bat (cycloplegia, mydriasis)
Mad as a hatter (delirium)
Bloated as a toad (constipation, urinary retention)
what is the scopolamine patch?
patch for motion sickness
-put on patch 4 hours before activity
-stays on for 72 hours (3 days)
What is Oxybutinin (Ditropan)?
used to treat people with an overactive bladder, may cause urinary retention
what are the side effects of estrogen?
nausea, thromboembolic events, photosensitivity, chloasma (brown spots on face, neck, and cheeks)
What is tamsulosin (Flomax) used for?
BPH and can lower BP
nursing considerations for -zosins even when being used to treat BPH
have the first dose effect (severe hypotension)
-make sure pt stays in bed
what can hydroxychloroquine cause
tinnitus, hearing loss, visual disturbances
what is cyclosporine?
-nursing considerations for this
an immunosuppressant, used to prevent organ rejection
-can cause nephrotoxicity, pt needs to avoid grapefruit juice
what does epoetin alfa do? what is needed in order for this drug to work?
-increases RBC production, need normal iron levels to be effective
what is sevelamer?
what is the desired outcome of this drug?
calcium free phosphate binder for patients with chronic kidney disease
-desired outcome is a decrease in serum phosphorous level to less than 6.
what do the drugs that end in -stim do?
-side effects of these drugs
increase WBC production.
SE: fever, muscle aches, bone pain, flushing
what does it mean to take a medication on an empty stomach?
take 1 hour before or 2 hours after eating
if a med is ordered after a meal when should it be given to the patient?
30-60 minutes after eating.
what is succinylcholine?
Depolarizing neuromuscular blocker
it paralyzes a person, they will need to be intubated
what is isotretinoin (accutane)?
use for treatment of acne, causes severe photosensitivity, pregnancy category X
What to teach a patient who is taking Prevacid for GERD?
It takes a few weeks to work (no immediate results)
If a patient takes iron, what should they drink with it to increase the affects?
Take in the morning with OJ
When a patient is taking pilocarpine for glaucoma, what is the biggest concern?
It causes pupil constriction, which will make it difficult to see at night
How to evaluate the effectiveness of antitussives?
Pt will have decreased cough
A patient is taking cyclosporine after a kidney transplant, and they have a headache, which vital sign is more important to check?
What to monitor for a patient on long term use of aspirin?
Monitor for GI distress
What medication can cause akasthesia?
Why would a patient be taking lactulose if they just had a bowel movement yesterday?
Because the ammonia was excreted in their stool
What is Tigan used for?
What to do if a patient is taking levodopa-carbidopa and they start grimacing?
When should a patient stop taking isotrerinion if they are trying to get pregnant?
2 months before they conceive
What should a patient do if they are experiencing dry mouth while taking oxybutin?
Suck on candy
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