NCLEX-RN ATI COMPRHENSIVE

NCLEX-RN ATI COMPRHENSIVE

REVIEW PART 4B PHARMACOLOG Y

Respiratory, Endocrine, & Blood

RESPIRATORY MEDICATIONS

• Beta 2 Adrenergic Agonist • Methylxanthines • Inhaled Anticholinergics • Glucocorticoids • Leukotriene Modifiers • Antitussives, Expectorants, Mucolytics • Decongestants, Antihistamines

General Instructions • Take Beta 2 before inhaled steroid • Inhalation drugs − Remove mouth piece cap − Shake container − Stand up/sit upright and exhale completely − Place mouth piece between teeth and close lips tightly around inhaler − Breathe in and press down on inhaler. Continue breathing in for few more seconds − Hold breath for 10-15 seconds − Breathe in/out normally

Beta 2 Adrenergic Agonist *beta 1= 1 heart; beta 2= 2 lungs*

• PROMOTES BRONCHODILATION

• Albuterol- short acting, inhaled • Salmeterol- long acting, inhaled • Terbutaline- long acting, orally • Contraindications- tachydysrhythmias • Side effects- tachycardia, palpitations, tremors

Methylxanthines • Relax the bronchial smooth muscle by causing bronchodilation • Aminophylline • Theophylline • Contraindication- active peptic ulcers • Levels can be decreased by phenytoin and phenobarbital

• Side effects- irritability and restlessness • Toxic effect- tachycardia, tachypnea, seizures (Tx would be to stop infusion, give activated charcoal and treat the symptoms) • Avoid caffeine, smoking, and alcohol Inhaled Anticholinergics • Muscarinic receptor blockers that causes bronchodilation • Ipratropium, Tiotropium • Do not use for bronchospasms, ONLY TO PREVENT • Contraindication- pt. with peanut butter allergy, BPH, narrow angle glaucoma • Side effects- dry mouth/eyes, urinary retention • Can take up to 2 weeks to see full effects • Shake the inhaler before • If taking 2 medications, wait 5 minutes between each one

Glucocorticoids • They prevent the inflammatory response by suppressing the mucus production, immune response, and adrenal function. Can be given orally, inhaled, or IV • Prednisone, betamethasone, fluticasone, triamcinolone, methylprednisolone • Uses

− Short term: status asthmaticus, acute asthma attack

− Long term: prophylaxis of asthma, chronic asthma

• Side effects- hyperglycemia, increased appetite, withdrawal symptoms, fluid retention, peptic ulcer, insomnia/euphoria/psychotic behavior

• DO NOT STOP ABRUPTLY, GIVE WITH MEALS, DO NOT TAKE WITH NSAIDS

Leukotriene Modifiers • Decreases bronchoconstriction, airway edema, and mucus production • Montelukast, Zileuton, Zafirlukast

• Uses: long term management of asthma

• DO NOT USE WITH PHENOBARBITAL

Antitussives, Expectorants, & Mucolytics • Antitussives- (suppress cough) hydrocodone, codeine • Expectorants- (promote mucus secretions to increase cough production) guaifenesin • Mucolytics- (increase flow of secretions in the respiratory tract) acetylcysteine, hypertonic saline • Side effects- drowsiness, dizziness, aspiration, bronchospasm, constipation • Promote fluid intake, monitor secretions and cough, auscultate lung sounds

Decongestants and Antihistamines • Decongestants- (reduce inflammation of nasal membranes) phenylephrine, pseudoephedrine, naphazoline • Antihistamines- (decrease allergic response/hypersensitivity reactions) diphenhydramine, loratadine, cetirizine, fexofenadine

• Side effects- anticholinergic effects, drowsiness (children may have excitability, hallucinations, and seizures) • Take at night, monitor BP, and assess for hypokalemia. No alcohol

ENDOCRINE MEDICATIONS

• Oral hypoglycemics • Insulin • Glycemic agents • Thyroid hormone/& antagonist • Anterior pituitary/growth hormone • Posterior pituitary hormone/antidiuretic hormone • Adrenal hormone replacement

Oral Hypoglycemics • Alpha glucosidase inhibitors- Acarbose, Miglitol

− Contraindication: pt. w/ intestinal diseases

• Biguanides- Metformin − Withhold 48hrs before and 48hrs after test with contrast

− Contraindications: pt. w/ severe infection, shock, hypoxic conditions

• Gliptins- Sitagliptin • Meglitinides- Repaglinide, Nateglinide − Short acting; give before meals; hypoglycemic risk • Sulfonylureas- Glipizide, Glyburide − High risk hypoglycemia − Disulfiram like reaction with alcohol • Thiazolidinediones- Rosiglitazone, Pioglitazone − Can exacerbate HF • DIET, EXERCISE, MONITOR HbA1C

Insulin • Can be used with oral hypoglycemics for specific conditions • Side effects- hypoglycemia/hyperglycemia, lipodystrophy (missing fat somewhere) • Mixing insulin RN (regular before NPH; inject cloudy to clear → withdraw clear to cloudy)

• NEVER MIX WITH LISPRO OR GLARGINE

• Regular is the only one given IV • Roll vial (not regular) to mix, NO SHAKING

Glycemic Agents • Glucagon

• Used for severe hypoglycemia • Side effects- nausea, vomiting, rebound hypoglycemia • Given to unresponsive pt.

Thyroid Hormone • Levothyroxine (T4)- Synthroid • Uses- hypothyroidism, myxedema coma • Side effects- tachycardia, restlessness, diarrhea, weight loss, decreased bone density, heat intolerance, insomnia (like all the symptoms of speeding up) • Interventions- monitor cardiac, start with low dose and increase, monitor T4 and TSH levels; take in the morning

Thyroid Hormone Antagonist • Methimazole • Uses- hyperthyroidism, preop thyroidectomy, thyrotoxic crisis, thyroid storm

• DISCONTINUE BEFORE RADIOACTIVE IODINE UPTAKE TESTING

• Contraindication- breastfeeding, bone marrow depression, hepatic disease, bleeding disorder • Side effect- skin rash, pruritis (itching), abnormal hair loss, GI, paresthesia, periorbital edema, muscle pain, jaundice, agranulocytosis, thrombocytopenia • Give with food, same time every day. Increase fluids to 3L. Avoid iodine products.

Anterior Pituitary/Growth Hormone

• Somatropin (tip: ‘soma’ is the body= growth hormone)

• Uses- deficiency in growth hormone, turner syndrome • Contraindications- severe obesity, glucocorticoids • Side effects- hyperglycemia, hypothyroidism

Posterior Pituitary Hormone/Antidiuretic Hormone • Desmopressin (DDVAP) • Vasopressin • Uses- DI, cardiac arrest, nocturnal enuresis, hemophilia (desmopressin) • Contraindications- pt. with chronic nephritis or high risk for MI • Side effects- hyponatremia, seizures, coma • Interventions- monitor specific gravity, BP, urinary output

Adrenal Hormone Replacement • Dexamethasone, Hydrocortisone, Prednisone • Uses- to replace adrenocortical insufficiency (Addison’s Disease) • Other- need higher dose in stress or illness time • Side effects- infections, hyperglycemia, osteoporosis, GI bleed, fluid retention