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NUR1460 A7 Medications Module 1 SSRI- Selective Serotonin Reuptake Inhibitor USE- Anxiety, Panic disorders, Depression, OCD, PTSD (short term use) S/SX- Hypotension, teeth grinding, GI symptoms, weight loss/gain, nocturnal teeth grinding, tremors, sexual dysfunction. WARNING- takes 3-4 weeks, avoid St. Johns Wart, take w/ food. Escitalopram (Lexapro)-anxiety, depression Fluoxetine (Prozac)- Paroxetine (Paxil)- Sertraline (Zoloft)- SSNI- Selective Serotonin/Norepinephrine Reuptake Inhibitor USE-Anxiety, panic disorder, social phobia, depression (long term use) S/SX- GI symptoms, diaphoresis, visual changes, hypotension WARNING- avoid St. Johns Wart, take w/food, takes 3-4 weeks. Effexor (Venlafaxine) XR-, Duloxetine (Cymbalta) Benzodiazepines USE-Acute anxiety, alcohol withdrawal, seizures, S/SX-sedation, decreased BP, orthostatic, weight loss/gain, WARNING-serious effect on those w/ renal or liver disease, do not stop abruptly, dependency/abuse issues., avoid alcohol- w/ or w/out food. -LAM & _PAM Antidote: Flumazenil (Romazicon) “I FLU fast in my Mercedes BENZ” Lorazepam (Ativan)- pre-anesthesia (sweating, tight chest, no cardiac issues) Diazepam (Valium)- Alprazolam (Xanax)-Headache and dry mouth Midazolam (Versed)- pre-anesthesia sedation- slow heart rate and respiratory rate a light- headed feeling sedation, cause memory loss for uncomfortable procedure (SAFETY RAILS) Anxiolytic/Benzodiazepines USE- short term anxiety and long-term alcohol withdrawal S/SX-Dizziness and confusion in the elderly WARNING-Take V/S before giving, watch for orthostatic hypotension.
Chlordiazepoxide (Librium)
Anxiolytic Buspirone (Buspar) USE-anxiety and long-term panic attack6 years and older S/SX-Severe hepatic/renal hypersensitivity WARNING-AVOID GRAPEFRUIT JUICE, antifungal and herbal meds, St. Johns Wart, Kava Norepinephrine-dopamine reuptake inhibitor (NDRI) Bupropion (Wellbutrin, Zyban) USE-Depression, smoking cessation, ADHD/SAD S/SX-headache, seizures, hypertension, weight gain, agitation WARNING-not for children -takes 3-4 weeks, avoid TB meds. Beta Blocker USE- Short term anti-anxiety, blocks certain chemicals in body, such as epinephrine on the heart and blood vessels. S/SX- Dizziness, lightheaded, tired, depression/V, ab pain, bloating hypotension WARNING- check HR and BP daily Atenolol (Tenormin)Beta 1-hypertension, strokes, heart attacks, kidney problems, angina Propranolol (Inderal) Beta 2- tremors, angina (chest pain), HYN, prevent heart attack, heart rhythm disorders-check BP prior Metoprolol Tartrate (Lopressor)Beta 1- HTN< angina, strokes heart attacks, and kidney problems Module 2 Loop Diuretic
USE- potassium wasting diuretic, Severe edema, left sided heart failure.
S/SX - Electrolyte depletion decrease K+ and Na+, GI symptoms, Dizziness, headaches, blurred vision, Ototoxicity, Cold clammy skin, confusion, thirst d/t low serum Na+ WARNING- Increase food rich in K+, Do not give in patients with Sulfa Allergies. Furosemide (Lasix) Thiazide Diuretic USE- K+ and Na+ sodium wasting, produces diuresis and lowers BP. Tx- Hypertension, and Edema S/SX- Dizziness, headaches, blurred vision Cold clammy skin, confusion, thirst d/t low serum Na+
WARNING- Do not give in patients with Allergies to Sulfa +Thiazide Careful dosing w/
given with Lithium
Hydrochlorothiazide (HCTZ) (Apo-Hydro)
Potassium Diuretic USE- Block aldosterone, promotes Na+ and H2o excretion and spares K+
WARNING- Do not use HTN, DM, CAD, Seizures, or Glaucoma.
Steroid-long-acting beta-agonists (LABAs) -LOL Fluticasone/Salmeterol (Advair) USE-COPD, prevents asthma, decreases inflammation of the lungs. S/SX-N/V, glaucoma, increased eye pressure, cataracts and vision problems, increased eye pressure WARNING- RINSE MOUTH AFTER INHALING CAN CAUSE CANDIDIASES Antiviral-neuraminidase inhibitor – Oseltamivir (Tamiflu) USE - infection with influenza S/SX- N/V, dizzy, headache, nosebleed, red eyes, insomnia WARNING- take w/in 48 hours of flu symptoms. Nifedipine (Procardia) - A-Fib and A-flutter , Raynaud’s, Burgers-to protect the heart Neuraminidase inhibitors Zanamivir (Relenza) USE- treating and preventing influenza -It helps shorten the time you have flu symptoms. S/SX-headache, dizzy, V/N, diarrhea, cough, wheezing, trouble breathing, ear pain, cold, runny nose. Methylxanthine:
Theophylline (Elixophyllin)
Use- asthma COPD
S/SX- GI problems, rapid IV administrate, insomnia, GERD.
Caffeine can increase risk for toxicity.
Leukotriene receptor antagonists (LTRAs) Montelukast (Singular)
Use- asthma, allergic rhinitis,
S/SX- Tooth pain, tired feeling, Stomach pain, heartburn, upset stomach, nausea, diarrhea. It must be taken simultaneously daily, even if your asthma seems better. Corticosteroids- anti-inflammatory agent Prednisone (Deltasone) USE-control inflammation of the joints and organs. It is often used to treat various inflammatory conditions, including redness, swelling, and pain. S/SX-: Increased BS, immunosuppression by decreasing WBC count, Stimulant.
Increases blood sugar Loss of bone density-long-term use = Osteoporosis Cushing’s Syndrome, increase in fluid retention = to increase in blood pressure, Weight gain SAFETY- FALLS Mucolytics Guaifenesin (Mucinex) USE-COPD S/SX- increases the water content of the mucus, thinning it out so it can be coughed up. Increase fluid intake to further thin secretions. ACE-INHIBITOR Lisinopril (Prinivil) USE- hypertension HTN, heart failure, and supportive treatment in patients that suffer a myocardial infarction (heart attack) S/SX- DRY COUGH, Dizziness , lightheadedness, tiredness, or headache may occur as your body adjusts to the medication, HYPOTENSION. Take in the AM due to diuresis, Rise slowly from lying or sitting to avert orthostatic hypotension Low K+ Diet. Angiotensin Receptor Blocker (ARB) Losartan (Cozaar) USE- HTN S/SX- upper respiratory infections, such as the common cold, Dizziness, stuffy nose, Back pain, diarrhea, fatigue, low blood sugar and chest pain, may increase potassium, Hypotension. Monitor BS, Take in AM due to diuresis, Low K+ Diet. Antiplatelet- platelet inhibitor Acetylsalicylic acid (ASA) Use- fever, pain, inflammation in the body, prevention of blood clots, and reduced risk of strokes and heart attacks. S/SX- Upset stomach, heartburn; drowsiness; or mild headache May result in gastric irritation that leads to bleeding. Antiplatelet- platelet inhibitor Clopidogrel (Plavix) USE- - PAD, Prevent heart attacks and strokes in persons with heart or blood circulation disease (peripheral vascular disease). S/SX- Itching, eczema, rash, head or joint pain. Bruising, upper or lower GI bleeding Diarrhea, fever, skin redness. AVOID GRAPEFRUIT CAN LEAD TO ACUTE KIDNEY FAILURE=Bleeding precautions care when brushing teeth and shaving Antidote is Vitamin K
S/SX- Diarrhea, back pain, Stomach or abdominal pain, Numbness or tingly feeling, Tired feeling, Headache, dizziness, Depressed mood, Serious effects: liver disease. myopathy/rhabdomyolysis. Renal impairment. Liver Functions – AST/ALT BEFORE STARTING THERAPY Grapefruit and grapefruit juice may interact effects. B- complex vitamin Niacin (Niaspan) USE- reduce elevated TC, LDL-C, Apo B, and TG levels and to increase HDL-C S/SX- Flushing (sudden warmth, redness, or tingly feeling ) abnormal liver function tests; itching, dry skin; skin discoloration; or headache Liver Functions – AST/ALTBEFORE STARTING THERAPY Low-fat diet, No EtOH, Avoid EtOH Direct Oral Anticoagulants Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis)
USE- Non-valvular atrial-fib, PO Dosing x 2 daily because of short half-life
S/SX- bleeding, Routine monitoring of renal and hepatic function, REVERSAL AGENT: Prothrombin complex concentrate (PCC), Vitamin Cobalamin cyanocobalamin (B12)- Use-help RBCs, aids in the functioning of the nervous system, S/SX- tingling, weak, fatigue, anorexia, loss of taste, memory loss, mood change Food-liver, kidney, fish, dairy, eggs, chicken, meat Ferrous Sulphate (Iron) Use- to prevent or treat iron deficiency anemia. S/SX-stain teeth, green tarry stools, cyanosis, shock, coma May increase bilirubin; and decrease calcium. Folate (Folic Acid) Use- for patients that may have poor nutrition and malabsorption. S/SX-confusion, depression, irritability, anorexia, bitter taste, rash Bronchospasm, anaphylaxis (rare). It is needed for erythropoiesis to increase RBC, WBC, and platelet formation. Cardiac Glycoside Digoxin
Use- Atrial Fib/Atrial Flutte r, DO NOT GIVE WITH < 60 bpm- Digoxin levels should be between 0.8 and 2.0 ng/ml. S/SX- can interfere and result in change in Na+/K+-ATPase pump. Digoxin Toxicity Use-Heart S/SX- Early signs: Visual changes- halos around lights-early signs, Lack of appetite, N&V, Headache, confusion, anxiety Restlessness, weakness, Changes in heart rhythm Immune fab for reversal of toxicity. Take only as directed, do not stop taking digoxin abruptly, Do not take herbal medications, Follow-up with PCP regularly WEAR A MEDICAL ALERT JEWELRY Module 4 Antiemetic Ondansetron (Zofran) Use- anti-vomiting blocks serotonin both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone. S/SX- fullness, loss of appetite headache, constipation, diarrhea, and malaise/fatigue, Hypotension, confused. SLOW IV PUSH to prevent agitation. Metoclopramide (Reglan) Use- GERD, to decrease gastroparesis (motility of the stomach). S/SX- restlessness, drowsiness, diarrhea, weakness, insomnia, depression, and tardive dyskinesia. Hypotension Tardive dyskinesia, suicidal ideation, seizures, neutropenia, leukopenia, and agranulocytosis. Dolasetron Mesylate (Anzemet) Use- treat nausea and vomiting prevention of chemotherapy-induced and postoperative n/v. S/SX- Headache, dizziness, fatigue, drowsiness, hypo/hypertension, tachycardia, and bradycardia, Diarrhea, constipation, increased AST/ALT, abdominal pain, anorexia, urinary retention, oliguria. Increases QT prolongation-thiazide/loop diuretics, Serotonin syndrome with used with SSRI, SNRIs, MAOIs Antihistamine Promethazine (Phenergan) Use- of allergy symptoms, GI symptoms post-surgery, N&V, pain-sedative S/SX- dizziness, drowsiness, excitation, fatigue, insomnia, photosensitivity reactions, N/V, and constipation, Hypotension
tissue injury when infiltrated via IV infusion.
Confusion-disorientations and agitation may follow the sudden withdrawal of medication. Check for infection if LOC Atrovent (Ipratropium Bromide)- short acting muscarinic antagonist) medication which opens up the medium and large airways in the lungs.COPD can cause heart palpations. Aldactone- Spironolactone HTN avoid bananas. Thrombocytopenic no enemas, laxatives w/ low WBC or platelets . Module 5 Dantrolene (Dantrium) Use- Malignant Hyperthermia, skeletal muscle relaxant S/SX- muscle weakness, drowsiness, dizziness This is a life-saving medication: Increased risks with known liver impairment- Medication is to be MIXED ONLY with Sterile Water for IV PUSH INJECTION Succinylcholine (Anectine) Use- Before breathing tube for tracheal intubation-SUCC-SKELETAL .A skeletal muscle relaxant, indicated as an adjunct to general anesthesia, S/SX- muscle weakness, drowsiness, dizziness Lead to addiction, severe drowsiness, fast heartbeat, mental/ mood changes, and seizures. Trouble breathing Etomidate (Amidate) Use- Short-acting intravenous anesthetic agent used for the induction of general anesthesia and sedation for short procedures such as reduction of dislocated joints, tracheal intubation, S/SX- Temporary skeletal muscle movements Changes in vital signs Not used for renal or hepatic impaired patients check ALT/AST & BUN & CRE Rocuronium (Zemuron) Use-Sleep ZZZZZ produce muscle relaxation to help facilitate surgery and ventilation of the lungs in elective and emergent situations. S/SX- Hypotension, Nausea, vomiting Prolonged sleepiness, Monitor GI upset post-op
Cephazolin (Ancef, Kefzol) Use- reduces the incidence of surgical wound infection Timing of antibiotic administration is critical to efficacy. The first dose should always be given before the procedure, preferably within 30- 60 minutes before the incision. S/SX- Headache, GI upset It must be diluted with sterile water. Can be given IV push 3-5 minutes. Naloxone (Narcan) Use- reversal of opioid overdose , including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid. S/SX- Increased heart rate, respiratory rate & BP, Tremors, GI upset Vancomycin Use- an infection of the intestines caused by Clostridium difficile. S/SX- reddish rash on face and upper body, bitter taste, Low blood pressure accompanied by flushing, ototoxicity, nephrotoxicity. Trough levels are collected just prior to a person's next vancomycin dose. [10- mcg/mL] Peak levels are collected 1 to 2 hours after the completion of the intravenous vancomycin dose. Monitor BUN and creatinine Slow IV administer. Atropine Sulfate Antimuscarinic agent, anticholinergic- cholinergic toxicity Use- Aspiration , pre-op to reduce saliva production and bronchial secretions. S/SX- tachycardia, dry mouth, blurred vision
“We don’t have time to CHAT we have A Toxic situation” CH= cholinergic AT= Atropine
Module 6 Metformin (Glucophage) Use- Type II Diabetes Blocks glucose production from the liver and prevents glucose reabsorption in the intestines. S/SX- IT DOES NOT CAUSE HYPOGLYCEMIA- GI upset. Hold 48 hours before a procedure using contrast dye and wait 48 hours after the procedure to resume medication. WARNING- Glucose Monitoring, Multi-day dosing Base-line BUN & creatinine before Rx. Encourage a healthy diet and exercise, Avoid EtOH, may induce Lactic Acidosis Micronase (Glyburide) Use- Type II Diabetes Stimulates the pancreas to produce more insulin. S/SX- Hypoglycemia, Weight Gain, Severe effects for those with liver/renal disease
oil in your stool; gas and oily discharge. loose stools, or an urgent need to go to the bathroom, inability to control bowel movements, Sleepy, tired, dizzy, or exhausted Confusion. Levothyroxine (Synthroid) Use- Thyroid Hormone Replacement, Tx- Hypothyroidism S/SX- Severe side effects- abnormal ECG---MI, General: fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating. Central nervous system: headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, insomnia. Musculoskeletal: tremors, muscle weakness. Thyroid level-THS-T3 & T Propylthiouracil (PTU) Use- Hyperthyroidism, Graves’ Disease, Thyrotoxic Crisis, Severe Alcoholic Liver Disease S/SX- stomach upset, nausea, vomiting, mild rash or itching, headache, dizziness, joint or muscle pain, Interacts with Warfarin (Increasing the anticoagulant effect) Can lower WBC levels- more prone to infections, Refrain from EtOH, Minimal fat intake d/t GI upset. Minimize iodine-containing foods. Gabapentin (Neurontin) Use- Seizures, Neuropathic Pain, Migraines, Post-herpetic neuralgia- following Shingles, Fibromyalgia S/SX-Headaches, dizziness, drowsiness, may be a risk for fall in early treatment fluid retention. Not recommended for those with COPD Or other respiratory problems/ issues taking narcotics, antidepressant medication, antianxiety medications, and antihistamines: can increase the risk of severe respiratory depression. Report Mood changes, Increased risk of suicidal ideations, taken w/or w/out food, Confusion-disorientations and agitation may follow the sudden withdrawal of medication. Exam # 2 Questions Which is classified for vitamins and minerals required in minimal amounts, lack nutrition lead to neuropathy and erectile dysfunction?
- Micro nutrients Which is classified as kilocalories, energy containing sources of carbs, proteins and fats?
- Macro nutrients
A pt just received an IV contrast, which med will the nurse hold until kidneys have filtered out the contrast? -Metformin Patient presented with tachycardia, sweating, chest tightness with no cardiac issues, which med do you think the provider will order? -Ativan The patients has a platelets count of 98,000, what should he do to promote patient safety? -Call the nurses station when he needs to go to the restroom. Your pt has cancer and is experiencing anemia with a low platelet count, what action would make the nurse intervene? -Using a hard bristled toothbrush and flossing How long after radiation should pt avoid sun exposure? -1 year Hemoglobin are packed red blood cells, what is their main function? -Carrying oxygen through the blood When should a radiation/chemotherapy patient shop for a wig? -Before treatment begins You have just given your pt Phenergan for nausea, which statement needs further education? -I will go for a walk once I am feeling better How often should you check your patients port of entry for infiltration when infusing chemotherapy? -Every hour A woman is being treated for breast cancer, when they find another tumor in the lung, this is what type of cancer? -Secondary cancer What should the nurse consider when doing patient teaching? -Education level, literacy, culture What age should men begin rectal exams? -40-50 years old When caring for a patient receiving brachy therapy, what percautions should the nurse take? -clustering all care into one time if possible -not turning their back on the patient -wear a led shield -limiting time spent with the patient Cervical breast exam are an example of? -Secondary prevention When handling chemotherapy medications, it is important to use what protection? -Chemo gloves or double gloves Which type of tumor is tightly bound and stabilized? -Benign tumor A patient is experiencing neutropenia, what medications do u think the provider will order?
-Humidifier -Rest -Go outside at night What is the best method of preventing the spread of RSV at daycare? -Handwashing Patient come into the ER having an asthma attack, which med do you expect to give? -Albuterol Your pt is experiencing Shortness of breathe(SOB),what should u do first? -Raise the head of the bed Which lab value would u notify the surgeon of before surgery? -PT: 22 seconds The doctor has ordered both Heparin and Warfarin, what should the nurses action be? -Give BOTH medications A pt is taking Nicotinic acid ( Niaspan)what side effect should u warn the pt about that is normal? -Flushing Simvastatin (Zocor) is a med for cholesterol, this med can harm which organ? -Liver Your pt has a blood glucose of 60 and is awake , what should u give him to help his BG? -4 oz of OJ The nurse notes that the handgrip of a client with Hypokalemia has diminished since the prior assessment 1 hour ago, What is the nurses primary intervention? -Assess the patients rate, rhythm, and depth of respirations The acid-base balance status of a pt is dependent on normal gas exchange. What pt would the nurse identify as having an increased risk for development of respiratory acidosis? -A patient with chest trauma A patient has started to vomit. His vomit resembles coffee grounds, what does it indicate? -Dried blood that is vomited up What is not an indicator of nutritional status? -Albumin level & Stature of patient A dialysis patient is asking for something to drink, what should the UAP give him to adhere to his clear liquid diet? -Apple juice A patient with Anemia should choose which of the following foods? -Beans -Liver & red meats -Greens, spinach and leafy veggies A patient taking Aldactone should avoid which foods? -Bananas A patient just had a Cerebrovascular accident or stroke (CVA) and has garbled speech. Which of the following should be implemented with the patient? -Clear, liquids only A patient on you floor is on a cardiac diet, which foods does this limit? -Sodium ( eat low sodium, grilled fish or chicken and veggies)
Your patient has just had open heart surgery and is having dysrhythmia’s, what should u administer? -Calcium, milk, cheese, yogurt A pt on external feedings should be positioned at what degree to avoid aspiration? -30 degrees A pt is awakening from anesthesia and is asking for ice chips, what should the nurse do? -Check his gag reflexes before administering ice chips What is the BEST choice for post-op nausea and vomiting? -Promethazine What lab values indicate wound healing could be at risk? -Albumin 2 Select all that describes a patient with COPD? -Barrell chest -Clubbing of fingers What is the nursing priority of a PACU nurse? =Monitor pulse ox A pt is experienced Peritonitis which of the following are expected? -Rigid abdomen -Absent or hyperactive bowel sounds A nurse in pre-op is responsible for what? -Consent form signed and, on the chart, -Patient goes to the bathroom BEFORE sedation -Verify the correct surgical site If u are planning to give Warfarin which meds should always be on the unit? -Vitamin K The elderly are at risk for complications post-op because of. -Decreased Oxygenation -Decreased cardiac output -Nocturia The nurse and UAP should perform oral care every 4 hours to prevent what complication? -Aspiration leading to Pneumonia Which test would u check if Vancomycin is to toxic to a certain organ? -BUN & Creatinine “ Kidney” Which test would u run to see if Vancomycin is therapeutic to the patient? -Peak & Trough You have given your patient Morphine, which statement by the patient needs further education? -I will go for a walk now A patient with Pneumonia is turning BLUE in the palms, what should the nurse do first? -Connect to Pulse Ox What happens during a surgery time out? -Verify the hospital ID number on the chart -Client states name and DOB -Client states surgery
Type 1- • Skin is intact (unbroken) • No blanchable redness • Swollen tissue • Darker skin → may appear blue / purple Type 2- • Skin is NOT intact • Partial thickness loss •No fatty tissue is visible Superficial Ulcers Type 3- Skin is NOT intact Type 4- Skin is NOT intact Full thickness TISSUE loss → Destruction of tissue → Bone, muscle, or tendon exposed. Deep pockets of infection & tunneling Deep Tissue Injury (DTI) Skin is intact (unbroken) Tissue beneath the surface is damaged Appears purple or dark red Ulcer treatments Chemical Debridement –enzymatic preparation applied to wound bed Surgical Debridement- incision-cut into tissue, cut away to get to viable beefy red tissue Mechanical Debridement- wet to dry damp dressing Delay healing, obesity, diabetics, circulation, steroid therapy (immune=no suppress) limited activity – healing goal should be weeks not days Wound Irrigation Remove contaminants, debris that can become reservoir for bacteria, cleansing agent to clean wound (Dakin’s, iodine, acidic acid, hydrogen peroxide) Cold irrigation-use a room temp, decrease activity. ENSURE WOUND IS DRY BEFORE APPLYING DRESSING – do not leave moisture it won’t help healing Altered Structure of the Skin Dehiscence- partial separation of tissue layers during the healing process, connection w/surgical incisions OFTEN FELT LIKE POPPING- COVER W/STERILE SALINE GUAZE AND CALL SURGEON (purple)
Evisceration- total separation of tissue layers, COVER W/STERILE SALINE GUAZE AND CALL SURGEON…. Emergency (ab or bowel coming out) Fistula- an abnormal connection b/w two internal organs and through the skin, the outside of the body- naturally occurring. Pressure Ulcer-Localized injury to skin or underlying tissue usually over bony prominences, result of pressure or pressure in combination with shear. Sterile Wounds Sterile dressing sutures, stipes or staples Clean area first-incision area -middle and work out. Heal ulcers- clean technique-work out =side to inside Full thickness SKIN loss → Damage to or necrosis of sub Q tissue → No bone, muscle, or tendon exposed • Ulcer extend down to the underlying fascia, but not through it Deep crater with or without tunneling. n
