https:\/\/learnexams.com\/search\/study?query=NR<\/a><\/p>\n\n\n\nwhat are analgesics? medications that relieve pain without loss of consciousness
What is nociception? perception of pain
what is a pain threshold? stimuli needed to produce the sensation of pain
what is a pain tolerance? different for everyone, amount of pain a person can endure without interfering with normal functioning
somatic pain originates from skeletal muscle, ligaments, and joints
referred pain pain that is felt in a location other than where the pain originates
visceral pain originates from organs and smooth muscle
central pain marked by chronic pain stemming from damage to CNS
bradykinin causes vasodilation
What are adjuvant drugs? assist primary drugs in relieving pain
what are opioid drugs? synthetic drugs that bind to the opiate receptors to relieve pain
mild agonist opioid drugs codeine and hydrocodone
strong agonists morphine, hydromorphone, oxycodone, meperidine, fentanyl, and methadone
Can a nurse dilute opioid drugs in an iv? No, not unless the pharmacy specifically says to and opioids should not be given through a normal saline device
what is the opioid ceiling effect? drug reaches a maximum analgesic effect
If you take 5 mg of a medication for pain, that 5 mg will go to receptor sites to block pain signals but let’s say you take 10 mg, What will happen? . Even if you increase the dose, it will have the same effect no matter how much you take, can have more of an adverse effect (why the pt may take more and more of something and then take more and then they begin to overdose.
what do opioid agonists do? bind to an opioid pain receptor site to block pain
what do opioid agonists-antagonists do? bind to a pain receptor but causes a mixed response, weaker than full agonist
what do opioid antagonists do? blocks or takes out the agonist effects ex: narcan reverses opioid overdose
what is Equianalgesia? ability to provide equivalent pain relief by calculating dosages that provide comparable analgesia.
opioid analgesics contraindications known drug allergy, severe asthma, COPD\/respiratory insufficiency, pregnancy
opioid analgesics indications moderate to severe pain (7+), cough center suppression, diarrhea, balanced anesthesia
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?A.PulseB.Blood pressureC.TemperatureD. Respirations D. respirations
opioid analgesics adverse effects CNS depression, GI upset, urinary retention (check bladder distention), diaphoresis\/flushing, pupil constriction, constipation, itching
what is a common opioid medication given for overdose? Naloxone (Narcan)
what do opioid analgesics interact with? alcohol, antihistamines, barbiturates, benzos
codeine sulfate less effective, more commonly used as an antitussive
fentanyl narrow therapeutic window; injection, patch, lozenges
Methadone Hydrochloride (Dolophine) synthetic opioid analgesic, choice for detoxification for opioid addicts, prolonged QT interval and causes cardiac dysrhythmias
morphine sulfate opioid analgesic, prototype; used for severe pain
Naxolone (Narcan) opioid antagonist; for complete or partial reversal of opioid induced respiratory depression
Acetaminophen (tylenol) non-opioid analgesic; can alter liver function, antipyretic and analgesic effects
Acetaminophen MOA blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Acetaminophen indications mild to moderate pain (3-5), fever, alternative to aspirin
Acetaminophen max dosage <3000 mg\/day <2000 mg\/day for older adults Acetaminophen Contraindications drug allergy, liver dysfunction, liver failure A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would beA.1000 mg.B.2000 mg.C.3000 mg.4000 mg. B. 2000 mg Implications for Analgesics -obtain thorough health history, medications, including herbals -monitor I and O -monitor liver enzymes -monitor pain -oral taken with food -monitor vitals, hold meds if abnormal WATCH RR what are sedatives? CNS depressant drugs that have an inhibitory effect on the CNS; reduce:nervousnessexcitability irritability what do hypnotic sedatives do? cause sleep; these are dose dependent what are benzodiazepines? CNS depressant drugs commonly prescribed for sedation or sleep benzodiazepines sedative hypnotic types (3) long acting, intermediate acting, short acting what are the long acting benzodiazepines? Clonazepam (Klonopin) and Diazepam (Valium) what are the short acting benzodiazepines? Midazolam (Versed), Eszopiclone (Lunesta) what are the intermediate acting benzodiazepines? Alprazolam (Xanax), lorazepam (Ativa) when is clonazepam used? for alcohol withdrawal or extreme anxiety when is xanax used? reduce anxiety when is ativan used? clinical setting, sleep when is Versed used? clinical setting, outpatient procedures, puts patient to sleep for 20-30 minutes Benzodiazepines MOA depresses CNS activity Benzodiazepines: Drug Effects calming on CNS, not a direct muscle relaxant Benzodiazepines: Indications sedation, skeletal muscle relaxation, anxiety relief, acute seizure disorders, agitation Benzodiazepines adverse effects headache, drowsiness, dizziness, “hangover effect or daytime sleepiness When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?A.These medications have little effect on the normal sleep cycle.B.Using this medication may cause drowsiness the next day.C.It is safe to drive while taking this medication.D.These drugs are safe to use with alcohol. B which is more common with Benzodiazepines- overdose or respiratory depression? overdose what is the antidote for Ativan ? Flumazenil (Romazicon) Benzodiazepines interactions can heighten effects of other suppressants , grapefruit juice, other CNS depressants when is diazepam (valium) used? anxiety or alcohol withdrawal When is Eszopiclone (Lunesta) used? hypnotic effect, keeps you asleep, provide full 8 hour when is Zolpidem (Ambien) used? short acting hypnotic, low incidence of daytime sleepiness but can sleepwalk not given to older adults Kava should not be taken with which Benzodiazepines? Ambien, Lunesta, and Sonata Barbiturates MOA Increase the DURATION of GABA-mediated chloride ion channels Barbiturates Drug effects sedative or hypnotic effects, narrow therapeutic window; lowers resp rate Barbiturates indications sedation, chronic seizures, anesthesia for surgery Barbiturates adverse effects GI upset, hypotension, vasodilation, respiratory suppression, SJS, reduced REM An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, the nurse should expectA.a decrease in dosages of the other medications.B.the patient will experience increased amounts of REM sleep.C.to administer half of the usual dose of the barbiturate.D.total relief of anxiety. C What is the antidote for barbiturates? THERE ISN’T ONE, in event of overdose all we can do is provide airway support by maintaining an adequate airway and assisting with ventilation or oxygen therapy barbiturates drug interactions alcohol, benzodiazepines Pentobarbital (Nembutal) long acting, clinical use, prevent tonic-clonic seizures Barbiturates have a low therapeutic index. This meansA.low doses are not therapeutic.B.the toxic range is narrow.C.they are habit forming.the effective, safe dosage range is narrow. D common barbiturates Phenobarbital and Pentobarbital what are the 2 types of muscle relaxants? direct and indirect indications of muscle relaxants painful musculoskeletal conditions, back spasms, cerebral palsy muscle relaxants adverse effects dizziness, drowsiness, fatigue, common muscle relaxants Cyclobenzaprine (Flexaril) and Dantrolene (Dantrium) Which statement regarding muscle relaxants does the nurse identify as being accurate?A.Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.B.Cyclobenzaprine (Flexeril) produces little sedation.C.Patients taking muscle relaxants are at high risk of developing hypertension.D.Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy. A what are CNS stimulants? drugs that stimulate a specific area of the brain or spinal cord CNS stimulant MOA stimulate areas of the brain associated with mental alertness what conditions are CNS stimulants used for? ADHD, Narcolepsy, migraines, neonatal apnea what are the drug effects of CNS suppressants? relaxation of bronchial smooth muscle, increased respiration, dilation of pulmonary arteries adverse effects of CNS suppressants tachycardia, palpitations, angina, anxiety, urinary frequency, nausea, vomiting, dry mouth, insomnia What is an amphetamine used to treat? ADHD and narcolepsy -go to is amphetamine aspartate (Adderall) What is atomexetine? What is it used for? It is an amphetamine CNS depressant used to treat Adderall -has a black box warning for suicidal thoughts A teenage boy will be receiving atomoxetine (Strattera) as part of treatment for ADHD. Which statement about this drug therapy is accurate?A.Strattera is highly addictive.B.Psychotherapy is rarely helpful in cases of ADHD.C.The patient should be monitored for possible suicidal thoughts and behaviorD.Strattera is used to treat narcolepsy as well as ADHD. C What is methylphenidate? what is it used for? Ritalin, CNS suppressant, first drug of choice for treating ADHD ; can cause insomnia- give at least 6 hrs before bed, baseline height and weight what is Modafinil (Provigil) and what is it used for? CNS suppressant used for narcolepsy\/ excessive daytime sleepiness, less abuse potential, promotes wakefulness what suffix should you look for for Antimigraine drugs? 7 triptans Before administering a serotonin agonist, it is most important for the nurse to assess the patient for a history ofA.hypertension.B.allergy to penicillin.C.chronic bronchitis.D.cataracts. A Triptans MOA cause vasoconstriction in cerebral arteries Triptans adverse effects vasoconstriction, irritation at injection site, tingling, flushing What is Sumatriptan (Imitrex)? It is a antimigraine medication used for headaches. what are analeptics? used for neonatal apnea ; caffeine; used for bronchodilation Analeptics-Caffeine (what does it do) increases HR and can cause palpitations what are adverse effects of Analeptics? muscle tension and tremors nursing implications for analeptics assess for euphoria what is a seizure brief episode of abnormal electrical activity in nerve cells of the brain what is a convulsion involuntary spasms of voluntary muscles-skeletal, facial, and ocular what is epilepsy? chronic, recurrent pattern of seizures what does idiopathic mean? no know cause what is secondary epilepsy? underlying cause (ex-trauma, infection) During a seizure, what happens to the respiratory system? SaO2 decreases due to ineffective breathing during the seizure Status Epilepticus emergency situation, multiple seizures with no recovery time in between, can become hypoxic and have a tendency to choke; results in hypoxia, brain damage, and death What are antiepileptic\/anticonvulsant drugs used for? prevent seizures; *likely to be on these for the rest of life what is the therapeutic drug level of valproic acid (Depakote) 50-100 mcg\/mL ; want to keep the therapeutic drug level at all time to prevent the seizure activity Antiepileptic drug effects (MOA unknown) reduces nerve’s ability to be stimulated-raise threshold ; suppress transmission of impulses from one nerve to another; decrease speed of impulses Antiepileptic adverse effects black box warning (suicidal thoughts\/behavior); long term therapy with phenytoin (Dilantin); gingival hyperplasia; therapeutic range 10-20 mcg\/mL what is Levetiracetam (Keppra) used for? antiepileptic, Head trauma ; prophylactic what is Tiagabine (Gabitril) used for? binds to GABA receptors to stop seizure Common antiepileptic meds Topiramate (Topamax), gabapentin (Neurontin)*, and pregabalin (Lyrica) What do amobarbital and pentobarbital do? barbiturates that help to break or stop seizures; serum drug levels 10-40 mcg\/mL ; monitor liver ; no antidote what does phenytoin (Dilantin) do? IV hydantoin; first line, prototype; therapeutic levels 10-20 mcg\/mL ; stop seizures what are adverse effects of phenytoin (Dilantin)? gingival hyperplasia, birth defects, osteoporosis what is carbamazepine (Tegretol) antiepileptic; second most common; watch liver enzymes and for signs of jaundice A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result inA.toxic levels of carbamazepine (Tegretol).B.lower than expected drug levelsC.gingival hyperplasia.cessation of seizure activity. B What is autoinduction? speeding up of drug clearance what does gabapentin (Neurontin) do? increases synthesis of GABA between neurons; for seizures and neuropathic pain what is Lamotrigine (Lamictal) seizure and bipolar disorder med; calms sensitivity of nerves; can cause SJS The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patientA.is unaware of his own disease history.B.has been taking his wife’s medication by mistake.C.may be taking this drug for neuropathic pain.D.is reluctant to admit to having a seizure disorder. C Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?A.High white blood cell countB.Low serum albumin levelsC.Low platelet levelsD High hemoglobin levels B (phenytoin is highly protein bound) If there is more albumin in the blood what does this mean for a drug? Low albumin means that drug concentration is higher and has more in free circulation; once it is bound to protein, the med is ineffective nursing implications for antiepileptic drugs take regularly at the same time each day, take with meals to reduce GI upset, no grapefruit juice, only mix IV meds with normal saline, assess for extravasation, report sore throat to provider and maintain the airway, facial swelling is common A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg\/mL. Which administration technique will the nurse use?A.Administer the drug by rapid IV push.B.Infuse slowly, not exceeding 50 mg\/min.C.Mix the medication with dextrose solution.Administer via continuous infusion B (mix only with normal saline and do it slow) Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy?A.If you feel sleepy when taking the drug, decrease the dose by half.B.Take the drug on an empty stomach.C.Call your health care provider if you experience a sore throat or fever.D.Patients with epilepsy are not able to hold a job and work, so you should apply for benefits. c what do cholinergics do? stimulate the parasympathetic nervous system what are the 2 types of cholinergic receptors Muscarinic: affect smooth muscle Nicotinic: affect skeletal muscle what are the effects of cholinergic drugs? pupil constriction, bronchoconstriction, contract smooth muscle, vasodilate, increase salivation\u2026 what do direct acting cholinergic drugs do? stimulate receptors ; selective to muscarinic receptors examples of direct acting cholinergic drugs metoclopramide (Reglan)– increases gastric emptying ;and pilocarpine (Pilocar) –constricts pupils what is the antidote for Bethanechol (Urecholine) -a direct acting cholinergic drug? Atropine what are indirect cholinergic drugs? stimulate skeletal muscles; activate muscarinic and nicotinic receptors what do anticholinergic drugs do, MOA? occupy ACh receptors ; increase HR and have drying effects effects of anticholinergics bronchodilation, dry up fluids, dilate pupils, relax smooth muscle what is Atropine? an anticholinergic med; decreases motility of GI , decreases saliva;side effects\/adverse: tachycardia, nasal congestion, urinary retention\/hesitancy cholinergic drug effects recommended dose-primarily affects muscarinic receptors; at high doses it stimulates nicotinic receptors The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin and orthostatic blood pressure changes and is complaining of abdominal cramps and nausea. The nurse recognizes that the patient is most likely experiencingA.early signs of a cholinergic crisis.B.late signs of a cholinergic crisis.C.an allergic reaction to the drug.expected adverse effects. A contraindications of cholinergic drugs obstructions(GI), bradycardia, hypotension adverse effects of cholinergic drugs bradycardia, hypotension, cardiac arrest, headache, convulsions, abdominal cramps, increased bronchial secretions, bronchial spasms what is a cholinergic crisis? circulatory collapse, hypotension, bloody diarrhea; SLUDGE- salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis excessive fluid treat with atropine what do beta 1 adrenergics do? increase HR, heart contraction renin secretion what do Beta 2 adrenergics do? decrease GI tone and motility, bronchiodilation, relaxes uterus, activates glycogenesis central and peripheral A1 blockers MOA block A1 adrenergic receptors; dilate arterial and venous vessels doxazosin (Cardura) prototype for A1 blockers indications for doxazosin hypertension, BPH, HF adverse effects of Alpha 1 blockers orthostatic hypotension, possible GI upset non-selective peripherally acting alpha blockers indications hypertension, IV extravasation non-selective peripherally acting alpha blockers adverse effects tachycardia, dizziness, edema, necrosis from extravasation non-selective peripherally acting alpha blockers drugs of choice phentolamine (Regitine) and reserpine (Serpasil) non-selective peripherally acting alpha blockers drug interactions erectile dysfunction drugs, increased hypotension with beta blockers non-selective peripherally acting alpha blockers drug side effects drowsiness, dizziness, depression, GI upset what do centrally acting alpha 2 receptor agonists do? stimulate A2 receptors, vasodilation What do A1 antagonists do? reduce BP beta blockers MOA reduce BP by reducing heart rate, reduced secretion of renin B1 cells act on the heart B2 cells act in the lungs Beta blockers end in olol Dual-action alpha1 and beta receptor blockers MOA decrease BP Dual-action alpha1 and beta receptor blockers drug of choice carvedilol (Coreg) When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of:A.hypotension.B.hyperkalemia.C.oliguria.D.respiratory distress. A what do Angiotensin-Converting Enzyme (ACE) Inhibitors do? affect the RAAS system to control fluid volume ACE inhibitors indications hypertension, HF, left ventricular hypertrophy after MI, reduce BP ACE inhibitors end in “pril” ACE inhibitors MOA reduce production of angiotensin, causing vasodilation, excretion of sodium and water, retention of K; prevent breakdown of bradykinin (for vasodilation) what is a prodrug? a drug that needs liver enzymes to become active ACE inhibitor drugs of choice captopril and lisinopril ACE inhibitors adverse effects fatigue, dizziness, dry, nonproductive cough, angioedema A patient with type II diabetes has a new prescription for the angiotensin-converting enzyme (ACE) inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order?A.The doctor knows best.B.The patient is confused.C.This medication has cardioprotective properties.D.This medication has a protective effect on the kidneys for patients with type II diabetes D A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient?A.clonidineB.prazosinC.diltiazemD.captopril D. captopril does not need to be metabolized by the liver to be effective Angiotensin II Receptor Blockers indications hypertension, adjuvant for HF Angiotensin II Receptor Blockers MOA allow Angiotensin I to be converted to angiotensin II but block receptors that receive it ; block vasoconstriction Angiotensin II Receptor Blockers adverse effects upper respiratory infections, increases potassium Angiotensin II Receptor Blockers end in “sartan” Angiotensin II Receptor Blockers drugs olmesartan (Benicar), valsartan (Diovan) Which statement about angiotensin II receptor blockers does the nurse identify as being true?A.Hyperkalemia is more likely to occur than when using ACE inhibitors.B.Cough is more likely to occur than when using ACE inhibitors.C.Upper respiratory infection is a common adverse effect.D.Overdose is usually manifested by hypertension and bradycardia. C direct renin inhibitors binds with renin to reduce Angiotensin I, II ,and aldosterone calcium channel blockers indications dysrhythmias, angina, hypertension, raynaud’s calcium channel blockers MOA cause smooth muscle RELAXATION by blocking the binding of calcium to its receptors and preventing muscle contraction vasodilators MOA directly relaxes arteriolar and\/or venous smooth muscle vasodilators drug of choice sodium nitroprusside (Nipride, Nitropress) what is nitroprusside reserved for? hypertensive emergencies what do diuretics do? decrease plasma and ECF volumes What do loop diuretics do? Increased urinary excretion of sodium, potassium, and water Choice loop diuretic medications Bumetanide (Bumex) and Furosemide (Lasix) What do thiazide diuretics do? inhibit Na+ and Cl- reabsorption, reduces fluid volume implications for blood pressure medications monitor BP as it can drop quickly; assess for chronic conditions; don’t stop meds abruptly; hypotension and tachycardia are risks if reduced too quickly; hot tubs, baths,showers, and weather, physical activity, and alcohol can aggravate low BP leading to fainting or injury what is angina? pain in the chest caused by decreased oxygen what is ischemia? poor blood supply to an organ when does chronic, stable angina occur? occurs with activity or emotional stress but if the activity is stopped, so does the pain when does chronic unstable angina occur? when at rest- this is an emergency! when does vasospastic angina occur? while at rest, in the early am or at night A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be?A.Take his nitroglycerin tabletB.Stop mowing and sit or lie downC.Go inside the house to cool off and get a drink of waterD Call 911 B what do nitrates\/nitrites do? rapid vasodilation ; comes in transdermal patch, IV, translingual spray, tablet, sublinguals how many nitrate pills should you take? take 3 5 minutes apart, if pain does not stop- call 911 and go to hospital nitrates MOA increase blood and oxygen to heart to reduce angina ; pills have first pass effect A patient with extremely high blood pressure is in the emergency department. The physician will be ordering therapy with nitroglycerin to manage the patient’s blood pressure. Which form of nitroglycerin is most appropriate?A.Sublingual sprayB.Transdermal patchC.Oral capsuleD IV infusion D Nitrates adverse effects headaches and reflex tachycardia A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911?A.ImmediatelyB.If the pain becomes more severeC.If one sublingual tablet does not relieve the pain after 5 minutesD.If the pain is not relieved after three sublingual tablets, taken 5 minutes apart C Beta Blockers drugs of choice atenolol (Tenormin)-selective and metoprolol (Lopressor)-selective Beta blockers MOA decrease HR resulting in decreased myocardial oxygen demand and increase oxygen delivery ; decreases contractility- negative inotrope; blocks catecholamines Inotropes Strengthen\/weaken cardiac contraction chronotropes anything that affects heart rate Dromatrope affect conduction beta blockers indications angina, antihypertensive, cardioprotective beta blockers adverse effects bradycardia, dizziness, fatigue, impotence, hyper\/hypoglycemia A patient who has had a myocardial infarction is on a beta blocker. What is the main benefit of beta blocker therapy for this patient?A.Vasodilation of the coronary arteriesB.Increased force of cardiac contractionC.Slowing of the heart rateD Maintaining adequate blood pressure C calcium channel blockers MOA cause coronary artery vasodilation and reduce heart workload ; RELAX calcium channel blockers adverse effects peripheral edema*, hypotension, GI upset antianginal drug implications complete health history, baseline vitals (including RR), assess drug interactions, report adverse effects to provider (P <60 and weight gain >2lbs\/day)
what occurs in the heart with RHF loss of elasticity, peripheral edema
what occurs in the heart with LHF blood pumps out but left side cannot, back up of blood causing pulmonary edema (crackles, difficulty breathing)
potent vasodilators for HF do what decrease afterload
ACE inhibitors assist with HF by decreasing preload
beta blockers assist with HF by reducing HR
what does the aldosterone antagonist spironolactone (Aldactone) do helps the body not hold onto Na and water, potassium sparing diuretic
what ethnicity is hydralazine\/isosorbide dinitrate (BiDil) geared towards african americans
what does hydralazine\/isosorbide dinitrate (BiDil) do PRN med for uncontrolled hypertension if hypertensive between doses of beta blocker
what does dobutamine do B1 selective that increases the squeeze of heart= more CO but no increase in HR (positive inotrope)
B-type Natriuretic Peptides MOA increase perfusion by vasodilation and suppression of renin-angiotensin system
what is the B type natriuretic peptide nesiritide (Natrecor) used for improve CO in an acute emergency
Which patient is the best candidate to receive nesiritide therapy?A.A patient with atrial fibrillation who has not responded to other drugsB.A patient needing initial treatment for heart failureC.A patient with reduced cardiac outputD.A patient with acutely decompensated heart failure who has dyspnea at rest D
B type natriuretic peptides adverse effects hypotension, headache, abdominal pain Phosphodiesterase Inhibitors MOA inhibit enzyme phosphodiesterase to increase vasodilation; positive inotrope what is the Phosphodiesterase Inhibitor drug of choice milrinone (Primacor) Phosphodiesterase Inhibitors indications short term HF management Phosphodiesterase Inhibitors adverse effects dysrhythmia, hypotension, angina, hypokalemia, tremor, thrombocytopenia Cardiac Glycosides drug of choice digoxin -negative chronotropic effect – CO Cardiac Glycosides MOA increase myocardial contractility , decrease electrical conduction (negative) Cardiac Glycosides drug effects pos ino- increase force w\/o increase in oxygen consumption neg chrono- reduced HR neg dromo- decrease AV node conduction increase SV Cardiac Glycosides heart failure, Afib and Aflutter A patient is in the emergency department with new onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?A.Digoxin 0.25 mg PO dailyB.Digoxin 1 mg PO now, then 0.25 mg PO dailyC.Digoxin 0.5 mg IV push dailyD.Digoxin 1 mg IV push now, then 0.25 mg IV daily D digoxin therapeutic blood level 0.5-2 ng\/mL (lowers potassium levels) Cardiac Glycosides adverse effects slow HR- bradycardia, headaches, fatigue, confusion, halo vision digoxin toxicity life threatening, dysrhythmias, hyperkalemia A patient is receiving digoxin 0.25 mg daily as part of treatment for heart failure. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern?A. Apical heart rate of 58 beats\/minB. Ankle edema +1 bilaterallyC. Serum potassium level of 2.9 mEq\/LD. Serum digoxin level of 0.8 ng\/mL cx (hypokalemia) what occurs during the P wave of an EKG\/ECG SA node fires an impulse what occurs during the QRS complex of an EKG\/ECG AV node firing what occurs during the T wave of an EKG\/ECG ventricular repolarization what occurs during a supraventricular dysrhythmia HR goes up, BP goes down, occurs quickly, extreme-looks like you have passed out class I Antidysrhythmic drugs work on what electrolyte? sodium, slows from getting in and out of cell in order to slow conduction what is the drug of choice for class I Antidysrhythmic drugs? procainamide what is procainamide (Pronestyl) used for? atrial and ventricular tachydysrhythmias procainamide (Pronestyl) adverse effects ventricular dysrhythmias, blood disorders, GI upset, maculopapular rash, flushing, prolonged QT interval Class IB Antiarrhythmics drugs of choice phenytoin and lidocaine what do Class IB Antiarrhythmics drugs do? block sodium channels lidocaine is used for ventricular dysrhythmias only adverse effects of lidocaine convulsions<\/em>, twitching, confusion, respiratory depression\/arrest
what do Class IC Antiarrhythmics drugs do? block sodium channels; flecainide
what does flecainide (Tambocor) do? first line for a-fib treatment
Class II beta blockers MOA reduce or block SNS stimulation ; slows HR
Class II beta blocker: atenolol (Tenormin) blocks B1 primarily in the heart; noncardioselective also blocks in the lungs
Class III beta blockers amiodarone; used for life threatening ventricular dysrhythmias
Amiodarone (Cordarone) can last a long time in the system-monitor drug levels; blocks B and A receptors ; interacts with warfarin and digoxin
class IV beta blockers calcium channel blockers-RELAX
class IV BB Diltiazem (Cardizem) temporary control of a rapid ventricular response in Afib
contraindications of Diltiazem wide QRS,pulmonary congestion, hypotension
antidysrhythmics drug interactions grapefruit juice, coumadin, amiodorone
adenosine antidysrhythmic, slows conduction
A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next?A.Check the patient’s pulse.B.Prepare to administer cardiopulmonary resuscitation.C.Set up for defibrillation.D.Continue to monitor the patient. D
A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next?A.Assess the patient for diaphoresis.B.Check the IV lock to see if it is functioning properly.C.Repeat the dose of diltiazem (Cardizem).D.Restart the IV in another location. B
A patient is receiving oral quinidine. Which assessment finding is of most concern?A.NauseaB.Prolonged QT intervalC.DiarrheaD. Occasional palpitations B
what are antilipemic statins used for ? lowering LDL levels and raising HDL (work in the liver)
antilipemics drugs of choice atorvastatin (Lipitor) and rosuvastatin (Crestor)
HMG-CoA Reductase Inhibitors MOA inhibit the production of cholesterol
HMG-CoA Reductase Inhibitors indications first line therapy for hypercholesterolemia
HMG-CoA Reductase Inhibitors adverse effects elevation of liver enzymes and liver disease, rash, GI upset, myopathy
What is rhabdomyolysis? muscle breakdown; monitor input,output, and edema
atorvastatin (Lipitor) most commonly used, works in liver, HDLs go up, LDLs go down
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason isA.the medication is better absorbed at this time.B.this timeframe correlates better with the natural diurnal rhythm of cholesterol production.C.there will be fewer adverse effects if taken at night instead of with the morning meal.D. this timing reduces the incidence of myopathy. B
what do Bile Acid Sequestrants do? stop bile acids from absorbing
Bile Acid Sequestrants MOA prevent bile from reabsorbing nutrients
Bile Acid Sequestrants indications high cholesterol, pruritus
Bile Acid Sequestrants adverse effects constipation, heartburn, nausea, belching, bloating
Bile Acid Sequestrants considerations all other drugs must be taken 1 hr before or 4-6 hrs after admin; high doses decrease absorption of water soluble vitamins
A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true?A.The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time.B.The powder should be dissolved and immediately administered.C.The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication.D. The colestipol should be administered with meals C
Niacin (nicotinic acid) lowers lipids, side effect of flushing ; assess for GOUT
Niacin (MOA) increase activity of lipase to break down lipids, helps body with normal activities
Niacin indications lowering triglyceride, increase HDL levels
Niacin adverse effects flushing, pruritus, GI distress
A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be toA.take the medication at bedtime.B.take the medication with a small dose of a steroid.C.take the medication with a full glass of water on an empty stomach.D.start with a low initial dose and then increase it gradually. D
Fibric Acid derivatives MOA helps lipase break down cholesterol
Fibric Acid derivatives indications hyperlipidemias
Fibric Acid derivatives contraindications drug allergy, cirrhosis of the liver, severe liver or kidney disease, gallbladder disease
Fibric Acid derivatives adverse effects abdominal discomfort, GI upset, increased bleeding, blurred vision
Fibric Acid derivatives interactions statins,
A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication?A.HypertensionB.Bowel obstructionC.Sinus infectionD. Scheduled surgery D. (garlic has antiplatelet properties)
Before administering niacin, it is most important for the nurse to assess the patient forA.allergy to erythromycin.B.gout.C.coronary artery disease.D.hypothyroidism. B
how does nasal congestion work? capillaries vasodilate and become permeable which causes congestion
antihistamines directly compete with histamine for specific receptors (H1 and H2)
H1 antihistamines referred to as antihistamines ; Benadryl
H2 blockers\/antagonists antihistamine; reduce gastric acid in peptic ulcer disease; ranitidine (Zantac)
antihistamines indications management of nasal allergies, allergic reactions, motion sickness, parkinson’s, sleep disorder, common cold symptoms
antihistamines MOA block action of histamines at H1 receptor sites ; prevents vasodilation, increased GI and respiratory secretions, and increased capillary permeability
antihistamines effects reduce dilation of blood vessels, reduce salivary, gastric secretions, prevent histamine response, reduce itching, drying effect, drowsiness
antihistamines adverse effects paradoxical (more nervous); dry mouth, constipation, mild drowsiness
1st generation antihistamines have drowsiness effect ; Benadryl
2nd generation antihistamines no drowsy effect, fewer effects ; claritin, allegra, zyrtec
antihistamine implications monitor for adverse effects-such as dizziness, chew gum to resolve dry mucous membranes,
A client tells the nurse that he has started to take OTC antihistamine, diphenhydramine. In teaching him about side effects, it is most important for the nurse to tell the client:A.Not to take this drug at bedtime to avoid insomnia.B.To avoid driving a motor vehicle until stabilized on the drug.C.That nightmares and nervousness are more likely in an adult.D.To limit use to 1-2 puffs\/sprays 4-6 times per day to avoid rebound congestion. B
what do nasal decongestants do? shrink engorged nasal mucous membranes, decrease inflammation
what is an anticholinergic effect? drying
what do oral decongestants do? no rebound congestion, decrease congestion but take longer to have effect; pseudoephedrine (sudafed)
topical nasal decongestants end in “ephrine” ; or “sone”, sprays or nose drops ; phenylephrine (neo-synephrine) ; can cause excessive dryness
nasal decongestants MOA constricts small blood vessels, nasal secretions better able to drain nasal steroids-antiinflammatory effect also in lower respiratory center
nasal decongestant adverse effects steroids-excessive dryness; nervousness, insomnia, palpitations, irritation
The patient has been prescribed beclomethasone inhaler for allergic rhinitis. The nurse teaches the client that the most common side effect from continuous use is:A.DizzinessB.RhinorrheaC.HallucinationsD.Dry nasal mucosa D
what do antitussives do? stop the cough reflex when the cough is nonproductive and harmful (hydrocodone, codeine, benzonatate, dextromethorphan)
antitussive MOA opioids-suppress the cough reflex by direct action on the cough center in the medulla nonopioids-numb the stretch receptors in the respiratory tract
antitussives adverse effects dizziness, drowsiness, nausea, lightheadedness, constipation, dry mouth.
antitussives implications report to HCP: cough lasting more than 1 week, persistent headahce, fever, rash
what do expectorants do? help to expel mucus by thinning; need to also increase fluids ; used for productive cough (common cold, bronchitis, pertussis, measles, etc..)
expectorants drug effects loosening and thinning sputum and secretions
What type of drug classification would you expect to be used for a “productive” cough? expectorants
What type of drug classification would you expect to be used for “non-productive” cough? antitussive
expectorants drug of choice guaifenesin
expectorants adverse effects guaifenesin: GI upset and gastric irritation, generally well tolerated
The goal of care for a client is to loosen bronchial secretions so they can be eliminated by coughing. The nurse knows that the best drug for this condition is:A.BenzonatatateB.GuaifenesinC.HydrocodoneD.Phenylephrine B
what do adrenergic drugs do stimulate the SNS ; mimic catecholamine effects
B1 heart ; HR increases
B2 lungs ; bronchodilation
A1 vasoconstrict
A2 vasodilate
what affect does Alpha 1 have on adrenergic receptor sites increases cardiac contractility, vasoconstriction, dilate pupils, increase bladder contraction
what affect does Alpha 2 have on adrenergic receptor sites inhibit norepinephrine release, vasodilation, decrease GI motility
what affect does Beta 1 have on adrenergic receptor sites increase cardiac contractility, increase renin secretion, BP
what affect does Beta 2 have on adrenergic receptor sites decrease GI tone and motility, bronchodilation, increase blood flow to skeletal muscles
Alpha-Adrenergic Agonist Responses vasoconstriction, CNS stimulation
Beta-Adrenergic Agonist Responses bronchial, gastrointestinal, and uterine smooth muscle relaxation, glycogenesis, cardiac stimulation
Dopaminergic Receptors cause dilation of vessels and more squeeze to the heart
What are catacholamines? (norepinephrine, epinephrine, and dopamine) produce a sympathomimetic response; synthetic: dobutamine and phenylephrine
Noncatecholamines longer duration; used for ICU, code, HF, and sepsis (catecholamines too)
epinephrine nonselective; (adrenaline) , A12 increases BP, B1 increases HR, B2 bronchodilation used for anaphylactic shock, bronchospasms, cardiac arrest *need filter needle ; interacts with digoxin ;
nursing implications for epinephrine monitor IV site for infiltration, monitor for dysrhythmias, may have reflex tachycardia
considerations for adrenergic agonists record VS to compare, check I and O, check blood glucose
non catecholamine- Albuterol (Proventil) acts on B2 adrenergic receptors ; bronchodilation; activated in liver ; side effects-tremors, nervousness,tachycardia (excitability)
A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator; the other is a corticosteroid. Which inhaler should the patient take first?A.The bronchodilatorB.The corticosteroidC.It does not matter which one is taken first. A-will result in a more open airway
A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time?A.albuterolB.salmeterolC.fluticasoneD.salmeterol and fluticasone combination (Advair Diskus) A-bronchodilation and for acute bronchospasms
indications for adrenergic agonists asthma, nasal congestion, conjunctival congestion, reduction of intraocular pressure and dilating pupils
what is dobutamine man made dopamine
what does dobutamine do? B1 selective; increase CO by increasing contractility (positive inotropy), increases SV
what does epinephrine (adrenalin) do? acts directly on A and B adrenergic receptors ; nonselective; emergency situations; vasoactive
what does norepinephrine do? stimulates alpha-adrenergic receptors; vasoconstriction; take to get BP up but small vessels in hands will not get perfusion and can die
what does phenylephrine (Neo-synephrine) do? works exclusively on the alpha-adrenergic receptors ; short term treatment for patient in shock ; vasoconstriction
A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first?A.Slow the intravenous infusion.B.Stop the intravenous infusion.C.Inject the area with phentolamine.D.Notify the physician health care provider. B
alpha adrenergic adverse effects headache, palpitations, tachycardia, dry mouth, decreased peristalsis
beta adrenergic adverse effects mild tremors, headache, nervousness, increased HR, sweating, GI upset
A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first?A.Check the infusion site for possible extravasation.B.Increase the infusion rate.C.Check the patient’s vital signs.D. Order an electrocardiogram. C
Adrenergic drug implications check IV site for infiltration, use an infusion pump, monitor cardiac rhythm, encourage fluids (up to 3000 mL\/day), educate pt about proper dosages, overuse of nasal decongestants can cause rebound congestion, monitor for therapeutic effects
A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. The nurse’s immediate assessment priority would be toA.determine the time of the child’s last meal.B.monitor Spo2 with a pulse oximeter.C.monitor the child’s temperature.D.provide education on asthma management. B
what do adrenergic blockers do ? bind to adrenergic receptors but inhibit or block stimulation of the SNS; also known as adrenergic antagonists (A blockers, b- blockers, or alpha-beta blockers)
indications of alpha blockers used for BPH; arterial and venous dilation reducing BP; hypertension; raynaud’s disease
what is the drug of choice alpha blocker adrenergic antagonist? Phentolamine
what does phentolamine do? quickly reverses vasoconstrictive effects of vasopressors (epinephrine and norepinephrine), restores blood flow and prevents tissue necrosis
When phentolamine is used to diagnose the presence of pheochromocytoma, the nurse will assess for what indicative finding?A.Rapid decrease in blood pressureB.Steady increase in blood pressureC.Slower heart rateD. Reduced cardiac ectopy A
Alpha blockers adverse effects orthostatic hypotension, tachycardia, GI upset
When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development ofA.renal failure.B.hypotension.C.blood dyscrasia.D.dysrhythmias. B
common alpha blockers phentolamine, Tamsulosin (Flomax), Doxazosin (Cardura)
what does tamsulosin (Flomax) do? a-blocker; treats mainly BPH, exclusive for male patients; contra-concurrent use of ED meds ; adverse- headache, abnormal ejaculation, rhinitis
what do beta blocker adrenergic antagonists do? block stim of beta receptors in SNS ; compete with norepinephrine and epinephrine; decrease BP by slowing HR ; usually end in “olol”
indications for beta blocker adrenergic antagonists angina, dysrhythmias, migraines, heart failure, *glaucoma
A 58-year-old patient is recovering in the intensive care unit after a myocardial infarction (MI). The nurse notes an order for the beta blocker metoprolol (Lopressor). The purpose of this drug is toA.dilate the coronary arteries.B.inhibit stimulation of the myocardium by circulating catecholamines.C.provide a positive inotropic effect.D.maintain the patient’s BP. B
what does atenolol (Tenormin) do? cardioselective beta blocker; primarily used to prevent future heart attack, treats hypertension and angina
what does carvedilol (Coreg) do? non selective bb, ablocker, calcium channel blocker; used for HF, HTN, and angina
what does Esmolol (Brevibloc) do? strong, short acting B1B ; acute situations to provide rapid control of ventricular rate; IV
The nurse knows that the adverse effects of a nonselective BETA blocker are likely to be the most immediately life threatening in which patient?A.Patient with type I diabetesB.Patient with asthmaC.Patient with gastroesophageal reflux diseaseD.Patient with hypertension A
adrenergic blocking drug implications assess for allergies and COPD, hypotension, avoid OTC meds, take meds are prescribed, never stop abruptly, change positions slowly, avoid caffeine, watch for rebound hypertension, watch for water retention (weight >2lbs\/day or 5\/bs\/week)
A patient with type 2 diabetes is taking a beta blocker as part of treatment for hypertension. Which complication is most likely to develop?A.HypertensionB.HyperkalemiaC.HypoglycemiaD.Angina C
what are diuretic drugs drugs that accelerate urine formation ; remove H2O and Na, BP tends to decrease
diuretics- COLT pee C:carbonic anhydrase inhibitors O:osmotic diuretics L: loop diuretics T: thiazides P: potassium sparing
loop diuretic MOA inhibits chloride and sodium resorption; dilation of blood vessels; treatment of edema
loop diuretic effects Decreased BP and pulmonary vascular resistance ; K+ decreases (cardiac changes), Na decreases (LOC changes)
loop diuretic indications edema associated with HF, hepatic or renal disease, increase renal secretion of calcium (hypercalemia)
loop diuretic adverse effects tinnitus, hypertension, SJS, agranulocytosis, thrombocytopenia, hyperuricemia Patients who take Loop Diuretics long-term should be assessed for what conditions?A. Abnormal BleedingB. Increased A1C levelsC. Increased risk for infectionsD. Cardiac DysrhythmiasE. Gout-like SymptomsF. All of the above F When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug?A.lithium (Eskalith)B.acetaminophen (Tylenol)C.penicillinD.theophylline A (NSAIDS) loop diuretic drugs of choice bumetanide (Bumex) and furosemide (Lasix) thiazide and thiazide-like drugs MOA diuretic, inhibit reabsorption of Na, Cl, and K; watch for drop in potassium thiazide and thiazide-like drug of choice hydrochlorothiazide (Esidrix) thiazide and thiazide-like drug effects lower peripheral vascular resistance ; should not be used if creatinine is <30-50 mL\/min (normal is 125 mL\/min) thiazide and thiazide-like drugs indications HTN, diabetes insipidus, HF thiazide and thiazide-like drugs adverse effects dizzy, headache, jaundice, leukopenia, photosensitivity, hypokalemia, hyperglycemia potassium sparing diuretics spirolactone (Aldactone); also called aldosterone inhibiting diuretics; MOA potassium sparing diuretics not as strong, interfere with potassium-sodium exchange, competitively bind to aldosterone receptors, block reabsorption of sodium and water potassium sparing diuretics drug effects prevent potassium excretion, promote Na and water secretion potassium sparing diuretics indications hyperaldosteronism , HTN potassium sparing diuretics adverse effects ;cramps, urinary frequency,amenorrhea (absence of menstruation), irregular mensespremenopausal bleeding osmotic diuretics pulls water out due to osmosis effect ; water goes from area of lesser tm greater concentration osmotic diuretics MOA pulls water into the renal system from surrounding tissues, inhibit H20 reabsorption osmotic diuretics drug effects prevent kidney damage during acute renal failure, reduces ICP, reduces excessive intraocular pressure osmotic diuretics indications kidneys not pulling out waste, not<\/em> for peripheral edema
osmotic diuretics adverse effects pulmonary congestion, convulsions, thrombophlebitis; need filtered need-watch it can create sugar crystal
mannitol (Osmitrol) (think Manray from spongebob (osmotic because he lives in the ocean)) IV infusion only, may crystallize need filter needle
While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. The most appropriate action by the nurse is toA.administer the infusion slowly.B.discard the solution and obtain another bag of medication.C.obtain a filter, and then infuse the solution.D.return the fluid to the IV bag to dissolve the crystals. B
what are Carbonic Anhydrase Inhibitors (CAIs) used for ICU, life threatening situations
Carbonic Anhydrase Inhibitors (CAIs) MOA Carbonic Anhydrase helps make H+ ions available for exchange with Na and water ; CAN DEVELOP METABOLIC ACIDOSIS ; increased secretion of HCO3, Na, H2O, and K due to inhibition of CA
Carbonic Anhydrase Inhibitors (CAIs) indications open angle glaucoma, lower IOP, edema; edema due to HF
Carbonic Anhydrase Inhibitors (CAIs) adverse effects metabolic acidosis, photosensitivity, hypokalemia, drowsiness
nursing implications of Carbonic Anhydrase Inhibitors (CAIs) monitor serum K levels, maintain foods high in potassium (raisins are highest); monitor digitalis toxicity if taking with a diuretic; keep daily weight log ; licorice can lead to additive hypokalemia with thiazides
what can bronchitis result from? progressive lung infections, increased mucus
what is emphysema? air transport issue, air trapped in alveoli ; bronchioles must be dilated to allow air through
Bronchodilators: beta agonists B1-heart, HR increases, blockage=HR down B2 lungs Both increase HR and vasodilate
beta agonists MOA specific receptor stimulated; relaxation of smooth muscles
beta agonists indications relief of bronchospasms, treatment and prevention of acute asthma attacks, hypotension, uterine relaxation
beta agonists adverse effects metaproterenol-tremor-angina-vascular headachehypotensionAlbuterol-tremor-HTN or hypotension
beta agonists implications adequate fluid intake, avoid excessive fatigue, extreme temps, caffeine; central cyanosis; assess that patient can administer inhaler properly
anticholinergics prevent bronchoconstriction, NOT for acute asthma exacerbation ; dry you up! not for emergencies
anticholinergics MOA ACh causes bronchial constriction and narrowing of airways-Anticholinergics bind to ACh receptors and prevent ACh from binding
anticholinergics adverse effects dry mouth, nasal congestion, palpitations, GI distress, anxiety
bronchodilators-Xanthine derivatives stimulate CNS, dilates coronary and pulmonary vessels, causes diuresis *aminophylline (Somophyllin) and theophylline (Theo-dur) -end in “phylline”
Xanthine derivatives MOA smooth muscle relaxation and increases airflow
Xanthine derivatives drug effects can also cause cardiovascular stimulation-CO increase, bronchodilation, CNS stimulation
Xanthine derivatives indications for chronic stable asthma, adjuvant for COPD
Xanthine derivatives adverse effects GI upset, gastroesophageal reflux, sinus tachycardia, increased urination
Xanthine derivatives implications caution with cardiac disease, should not be crushed or chewed
Leukotriene Receptor Antagonists (LTRAs) not emergency inhalers, asthma meds; montelukast (singulair) and zileuton (zyflo)
Leukotriene Receptor Antagonists (LTRAs) MOA prevent leukotrienes from attaching to receptors in lungs and in circulation, block inflammation in the lungs
Leukotriene Receptor Antagonists (LTRAs) drug effects prevent smooth muscle contraction, decrease mucus secretions, prevent vascular permeability, prevent inflammation; prophylactic
Leukotriene Receptor Antagonists (LTRAs) adverse effects zileuton: dyspepsia, dizziness, insomnia, liver dysfunction montelukast: fewer effects
Corticosteroids anti-inflammatory; for chronic asthma; end with “sone”
Corticosteroids MOA stabilize cell membranes that release harmful bronchoconstriction substances
inhaled corticosteroid meds beclomethasone (beclovent, vanceril)fluticasone (flovent, flonase)-this is a steroid
Corticosteroids indications not meant for acute asthma attack, treatment of bronchospastic disorders
Corticosteroids adverse effects pharyngeal irritation, cough, dry mouth, oral fungus
what do NSAIDs do reduce temperature, inhibit platelets sticking together, reduce inflammation, decrease pain
NSAIDs: Salicylates aspirin , diflunisal (dolobid) inhibit platelet aggregation, increase HR
NSAIDs: Acetic Acid Derivatives ketorolac (Toradol) ; Antiinflammatory, temporary max 5 days, comparable to narcoticsadverse effects: renal impairment, edema, GI pain, dyspepsia, nausea
Aspirin NSAID, relieves platelet aggregation after MI; daily tablet (81 mg to 325 mg) ;can cause Reye’s syndrome
NSAIDs MOA block COX cells (GI) Aspirin -irreversible inhibitor of COX1 receptors
NSAIDs contraindications allergy, GI issues, decreased potassium (can cause excessive bleeding)
NSAIDs adverse effects heartburn, GI bleed,m acute renal failure, tinnitus, increase RR, hearing loss
what is Misoprostol (Cytotec) GI bleeds due to aspirin or other NSAIDs
The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g\/day). The nurse understands that the indication for the 325 mg of aspirin once daily is:A. pain management.B. fever reduction.C. treatment of OA.D. thromboprevention. D (doses for pain are typically higher)
A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this?A.The patient’s pain should subside by that time.B.There are concerns about addiction to the drug.C.The drug can cause severe renal and GI effects.D.The drug loses its effectiveness over time. C
Propionic Acid Derivatives Ibuprofen (Motrin, Advil) ; most common NSAID, analgesic effect for RA, OA, gout, dental pain, musculoskeletal disorders, antipyretic
NSAIDs adverse effects overall GI bleed,mucosal lesions (misoprostol (Cytotec) can be used to reduce these effects)
An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy?A.Blood sugarB.Liver function studiesC.Assessment of hearingD.Renal function studies D
A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?A.BradycardiaB.HypoventilationC.ConstipationD.Hyperglycemia D
Salicylate toxicity metabolic acidosis + respiratory alkalosis, hyperthermia, tinnitus, vertigo
Antigout drugs allopurinol (zyloprim) and probenecid (Benemid )
Allopurinol (Zyloprim) indications antigout; prevent uric acid production
probenecid (Benemid) indications inhibits the reabsorption of uric acid
Colchicine antigout; reduces accumulation of uric acid
Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis?A. probenecidB. colchicineC. febuxostat (Uloric)D. allopurinol (Zyloprim) allopurinol (Zyloprim)
A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?A. Increased bleeding tendenciesB. Increased chance for GI bleedingC. Increased nephrotoxic effectsD.Reduced antiinflammatory effects of the NSAID B
what is hematopoiesis formation of new blood cells
Erythropoiesis-Stimulating Agents Epoetin alfa (Epogen) stimulate bone marrow to create more RBCs; prevent kidney disease, slow IV
Epoetin alfa (Epogen) adverse effects hypertension, fever, headache,m tinnitus, pruritus, rahs, injection site reaction
Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result?A.Blood urea nitrogenB.WBC countC.Hemoglobin levelD.Urine specific gravity C ; contraindicated when hemoglobin levels are above 10g\/dL for cancer pts and 12 g\/dL for renal patients
Which food will the nurse teach the patient to avoid when ingesting an iron supplement?A.EggsB.VealC.Orange juiceD.Fish A
Iron toxicity suction and maintain airway, IV fluids, blood, oxygen, vasopressors; deferiprone used for iron overload
IV iron is ordered for a patient. Which of the following statements by the new nurse requires the experienced nurse to intervene?A.”Administer a test dose of iron dextran, with the remaining dose given an hour later if no adverse reaction occurs.”B.”IV iron dextran must be given after the IV line is flushed with 2 mL of normal saline.”C.”Premedicate the patient with morphine sulfate.”D.”Ambulate the patient immediately after infusion of IV iron to prevent complications of hypertension.” A. must be given after the IV has been flushed with 10 mL saline
The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have the patient remain in the recumbent position for how long?A.10 minutesB.30 minutesC.60 minutesD.90 minutes B
The use of folic acid to prevent fetal neural tube defects should be started:A.during a woman’s adolescence.B.at least 1 month before pregnancy.C.when a pregnancy is first discovered.D.at the beginning of the last trimester of pregnancy. B
what is Cyanocobalamin (Vitamin B12) used for? treatment of pernicious anemia, deep IM or nasal spray
Nursing implications for anemia drugs baseline lab values, keep away from children, don’t mix meds unless label says to, use straw for liquid iron to avoid tooth discoloration, take pills with OJ, remain upright for 15-30 minutes to avoid esophageal erosion, for injections use Z track method, determine anemia cause before administering folic acid,
Which action does the nurse perform when administering iron intravenously?A.Premedicate the patient with an antihistamine to prevent anaphylaxis.B.Administer the iron with a running dextrose solution.C.Flush the IV line with 10 mL of normal saline.D.Have available Regitine to reverse vasoconstriction at the site should infiltration occur. C<\/p>\n","protected":false},"excerpt":{"rendered":"Exam 2: NR293 \/ NR 293 (Latest Update 2024\/2025) Pharmacology Review| Complete Guide with Questions and Verified Answers| 100% Correct -Chamberlain Exam 2: NR293 \/ NR 293 (Latest Update2024\/2025) Pharmacology Review| CompleteGuide with Questions and Verified Answers|100% Correct -ChamberlainQ: What are adjuvant drugs?Answer:assist primary drugs in relieving painQ: what are opioid drugs?Answer:synthetic drugs that bind […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-132073","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/132073","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=132073"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/132073\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=132073"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=132073"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=132073"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}