Nursing Pharmacology Test – Flashcards

- Category: Cardiovascular/Antiarrhythmics; Antihypertensives; Antianginals - Action: blocks stimulation of beta1-adrenergic receptors - Use: decreased BP & heart rate, decreased attacks of angina - Side Effects: bradycardia, fatigue, weakness, HF, pulmonary edema, erectile dysfunction - Nursing Measures: monitor BP/ECG/Pulse; Monitor q5-15 min after parenteral administration; I/O; Daily weights; S/s of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular vein distention); increase in BUN/lipoprotein/potassium/triglycerides/uric acid - Examples: metoprolol (Lopressor); atenolol (Tenormin)

- Category: Cardiovascular; Antiarrhythmics; Inotropics - Action: Increases the force of myocardial contraction, prolongs refractory period of the AV node, decreases conduction through the SA and AV nodes; increased cardiac output and slowing of the HR - Use: HF, Afib, Atrial flutter, paroxysmal atrial tachycardia - Side Effects: fatigue, arrhythmias, bradycardia, anorexia, nausea, vomiting - Nursing Measures: therapeutic range (0.5-2 ng/ml); Monitor apical pulse for 1 min (withhold less than 60 bpm); monitor BP; monitor ECG throughout IV admin and 6 hr after each dose; observe for infiltration; falls risk in geriatric; electrolyte levels (potassium, magnesium, calcium); s/s toxicity (ab pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, arrhythmias)

- Category: Cardiovascular; Antihypertensives - Action: block the conversion of angiotensin I to the vasoconstrictor angiotensin II. Prevent the degradation of bradykinin and other vasodilatory prostaglandins. Increase plasma renin levels and decrease aldosterone levels. Results in systematic vasodilation - Use: HTN, symptomatic HF, Slowed progression of asymptomatic left ventricular dysfunction to overt HF - Side Effects: cough, hypotension, proteinuria, hyperkalemia, angioedema - Nursing Measures: Administer over 5 minutes; Monitor BP and pulse; assess for s/s of angioedema (swelling of face, extremities, eyes, lips, or tongue; difficulty swallowing or breathing); monitor renal function (increased in BUN & Creatinine); monitor CBC (decrease Hbg & Hct) - Examples: enalapril (Vasotec), lisinopril

- Category: Cardiovascular; Antianginals; Nitrates - Action: increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. Produces vasodilation (venous > arterial); decreases left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload); reduces myocardial oxygen consumption; increased cardiac output; reduction of BP - Use: management of angina pectoris; production of controlled hypotension during surgical procedures; treatment of HF associated with acute MI - Side Effects: dizziness, headache, hypotension, tachycardia, contact dermatitis - Nursing Measures: administer 1 h before or 2 h after meals with a full glass of water; do not break; monitor BP and pulse before and after administration; urine catecholamine; false increase serum cholesterol levels

- Category: Cardiovascular; Inotropics, Vasopressors - Action: small doses (0.5-3 mcg) stimulate dopaminergic receptors producing renal vasodilation; larger doses (2-10 mcg) stimulate dopaminergic and beta1-adrenergic receptors producing cardiac stimulation and renal vasodilatior; doses greater than 10 mcg stimulate alpha-adrenergic receptors and may cause renal vasoconstriction; increased cardiac output, increased BP, improved renal blood flow - Use: Improve BP, cardiac output, urine output in tx of shock unresponsive to fluid replacement; increase renal perfusion - Side Effects: arrhythmias, hypotension, irritation at IV site, ECG change, vasoconstriction - Nursing Measures: extravasation may cause severe irritation, necrosis, and sloughing tissue; dilute 200-800 mg of dopamine in 250-500 ml of NS, D5W, D5/LR, D5 0.45 % NaCl, D5NS, or LR; Monitor BP, HR, Pulse pressure, ECG, pulmonary capillary wedge pressure, cardiac output, CVP & urinary output; Palpate peripheral pulses and assess appearance of extremities - Examples: dopamine infusion (Intropin); albuterol, epinephrine

- Category: Calcium Channel Blocker, Antianginals, Antiarrhythmics (Class IV), Antihypertensives, Vascular headache suppressants - Action: inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction; Decreases SA and AV conduction and prolongs AV node refractory period in conduction tissue; Systemic vasodilation resulting in decreased BP; Coronary vasodilation resulting in decreased angina; Reduction of ventricular rate during afib or flutter - Use: Management of HTN, angina pectoris, and/or vasospastic angina; Management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter or fibrillation - Side Effects: arrhythmias, HF, stevens-johnson syndrome, extrapyramidal reactions, epistaxis, cough, SOB, bradycardia, syncope, palpitations - Nursing Measures: Administer with meals or milk to minimize gastric irritation; Do not crush; Monitor BP & pulse; Monitor ECG (may cause prolonged PR interval); S/s of HF; Assess for rash (Stevens-Johnson Syndrome); Monitor serum potassium, renal and hepatic functions

- Category: Antidiabetic; Pancreatics - Action: lower blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. Inhibition of lipolysis and proteolysis, enhanced protein synthesis - Use: control of hyperglycemia in patients with type 1 or type 2 DM - Side Effects: Hypoglycemia, anaphylaxis, pruritis, erythema - Nursing Measures: assess for s/s of hypoglycemia and hyperglycemia; monitor body weight changes; decrease serum phosphate, magnesium, and potassium; monitor glucose q6h - Onset: 30 min; Peak 4-8 hour; Duration: 24 hour - Examples: Humulin 70/30; Novolin 70/30

- Category: Antidiabetic, pancreatics - Action: Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. - Use: control of hyperglycemia - Side Effects: hypoglycemia, anaphylaxis, lipodystrophy - Nursing Measures: assess for s/s of hypoglycemia and hyperglycemia; monitor body weight periodically; monitor blood glucose q6h - Onset: 2-4 hr; Peak 4-10 hr; Duration 10-16 hr - Examples: Humulin N, Novolin ge NPH, Novolin N

- Category: antidiabetics, pancreatics - Action: Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. - Use: control of hyperglycemia - Side Effects: hypoglycemia, anaphylaxis, lipodystrophy - Nursing Measures: assess for s/s of hypoglycemia and hyperglycemia; monitor body weight periodically; monitor blood glucose q6h - Insulin detemir (Levemir): Onset 3-4 hr; Peak 3-14 hr; Peak 6-24 hr - Insulin glargine (Lantus): Onset 3-4 hr; Peak None; Duration 24 hr

- Category: antidiabetics, pancreatics - Action: Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. There are rapid-acting insulins with a more rapid onset and shorter duration than regular insulin; should be used with an intermediate- or long-acting insulin - Use: control of hyperglycemia - Side Effects: hypoglycemia, erythema, lipodystrophy, anaphylaxis - Nursing Measures: assess for s/s of hypoglycemia and hyperglycemia; monitor body weight periodically; monitor blood glucose q6h - Insulin aspart (Novolog): Onset 10-20 min; Peak 1-2 hr; Duration 3-4 hr - Insulin glulisine (Apidra): Onset within 15 min; Peak 1-2 hr; Duration 3-4 hr - Insulin lispro (Humalog): Onset within 15 min; Peak 1-2 hr; Duration 3-4 hr

- Category: antidiabetics, biguanides - Action: decreases hepatic glucose production. Decreases intestinal glucose absorption. Increases sensitivity to insulin - Use: management of type 2 DM - Side Effects: lactic acidosis, hypoglycemia, GI upset (n/v/d), decreased B12, metallic taste - Nursing Measures: s/s of hypoglycemic reactions, observe for ketoacidosis or lactic acidosis; monitor serum glucose or glycosylated Hgb; false-positive urine ketones; renal function before and annually; monitor serum folic acid and vitamin B12 - Examples: Glucophage, Fortamet, Riomet

- Category: Sulfonylureas, antidiabetic - Action: lower blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production. - Use: control of blood glucose in type 2 DM when diet therapy fails. Require some pancreatic function - Side Effects: aplastic anemia, photosensitivity, hypoglycemia, GI, agranulocytosis, leukopenia, thrombocytopenia, drug-induced hepatitis, dizziness, drowsiness - Nursing Measures: s/s of hypoglycemic reactions; assess for allergy to sulfonamides; concurrent beta-blocker therapy may have subtle signs of hypoglycemia; monitor CBC periodically; increase in AST, LDH, BUN, creatinine - Examples: DiaBeta

- Category: opioid agonists; analgesic; Schedule II - Action: binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Suppresses the cough reflex via a direct central action. - Use: Moderate to severe pain; extended release product for opioid-tolerant patients requiring around-the-clock management of persistent pain. Antitussive - Side Effects: confusion, sedation, hypotension, constipation, respiratory depression, flushing, dependence - Nursing Measures: assess BP, pulse, and respirations before and during administration esp geriatric; assess bowel function; assess pain type, location, and intensity prior to and 1 hour following IM or PO and 5 min following IV admin; continuous infusion should have additional bolus doses provided every 15-30 min for breakthrough pain; if taking sustained-release hydromorphone may require short-acting opioid doses for breakthrough pain - Examples: Dilaudid, Hydrostat IR

- Category: opioid analgesic, opioid agonist, Schedule II - Action: binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression - Use: Severe pain, pulmonary edema, pain associated with MI - Side Effects: respiratory depression, confusion, sedation, hypotension, constipation, dizziness, sweating, hallucinations, urinary retention - Nursing measures: assess type, location, and intensity of pain prior to and 1 hr following PO, suncut, IM, and 20 min following IV admin; on continuous, should have additional bolus every 15-30 min for breakthrough pain; equianalgesic chart; assess level of consciousness, BP, pulse, and respirations before and during administration; prolonged use may lead to physical and psychological dependence and tolerance; assess bowel function routinely; increase plasma amylase and lipase levels - Antidote: Narcan - Examples:

- Category: opioid analgesic, opioid agonist, Schedule II - Action: binds to opiate receptors in the CNS. alters the perception of and response to painful stimuli, while producing generalized CNS depression - Use: Moderate to severe pain - Side Effects: respiratory depression, confusion, sedation, constipation, orthostatic hypotension, urinary retention, dependence - Nursing Measures: Assess type, location and intensity of pain prior to and 1 hr after admin; may be given short-acting opioid doses for breakthrough pain; equianalgesic chart should be used; assess BP, pulse, and respirations before and during admin; assess bowel function routinely; increase plasma amylase and lipase levels - Antidote: Narcan - Examples: Oxycontin, Roxicodone

- Category: Thiazide diuretic; antihypertensives - Action: increases excretion of sodium and water by inhibiting sodium resorption in the distal tubule. Promotes excretion of chloride, potassium, magnesium, and bicarbonate. May produce arteriolar dilation - Use: Management of mild to moderate HTN. Treatment of edema d/t HF, renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy - Side Effects: Stevens Johnson Syndrome, hypokalemia, dizziness, hypotension, acute angle-closure glaucoma, photosensitivity, hypovolemia, hypercholesterolemia - Nursing Measures: Monitor BP, intake, output, and daily weights; assess feet, legs, and sacral area for edema; assess for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; assess patient for skin rash frequently, discontinue immediately; monitor BP before and during; Monitor potassium, glucose, BUN, and creatinine before and during; increase in serum urine glucose - Example: Esidrix

- Category: Potassium-sparing diuretic - Action: inhibition of sodium reabsorption in the kidney while saving potassium and hydrogen ions by antagonizing aldosterone receptors. - Use: Counteract potassium loss caused by other diuretics. Used with other agents (thiazides) to treat edema or HTN. Primary hyperaldosteronism. Unlabeled: HF in low doses - Side Effects: Stevens Johnson Sydrome, Toxic epidermal necrolysis; hyperkalemia; clumsiness, headache, erectile dysfunction, breast tenderness, gynecomastia, irregular menses, voice deepening, agranulocytosis - Nursing Measures: Monitor intake and output ratios and daily weights; monitor BP before administering if with an antihypertensive; monitor for s/s of hypokalemia; ECG for prolonged therapy; skin rash assessment; serum potassium before and during; BUN, creatinine, and electrolytes before and after; discontinue 3 days before glucose tolerance test; platelet count and total and differential leukocyte count - Example: Aldactone

- Category: loop diuretic - Action: inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function - Use: Edema d/t HF, hepatic impairment or renal disease. HTN - Side Effects: Stevens-Johnson syndrome, toxic epidermal necrolysis, aplastic anemia, agranulocytosis, dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis - Nursing Measures: assess fluid status; monitor BP and pulse before and during; Geri: risk for falls; assess for digoxin toxicity; assess for tinnitus and hearing loss; assess for sulfa allergy; assess for skin rash; monitor electrolytes - Examples: Lasix

- Category: hormones; thyroid preparation - Action: Replacement of or supplementation to endogenous thyroid hormone. Principal effect is increasing metabolic rate of body tissues: Promote gluconeogenesis, increase utilization and mobilization of glycogen stores, stimulate protein synthesis, promote cell growth and differentiation, aid in the development of the brain and CNS - Use: Thyroid supplementation in hypothyroidism. Tx or suppression of euthyroid goiters. Adjunctive tx for thyrotropin-dependent thyroid cancer - Side Effects: heat intolerance, weight loss, headache/insomnia/irritability, angina, arrhythmias, tachycardia, hyperthyroidism - Nursing Measures: Assess apical pulse and BP prior to and during therapy; assess for tachyarrhythmias and chest pain; monitor thyroid function; monitor blood and urine glucose (insulin or oral hypoglycemic dose may need to be increased); Overdose, withhold for 2-6 days - Antidote: induction of emesis or gastric lavage, followed by activated charcoal - Example: Synthroid, Levothroid, Levoxyl

- Category: antidepressants; SSRI - Action: Selectively inhibits the reuptake of serotonin in the CNS - Use: Major depressive disorder, OCD, Bulimia nervosa, Panic disorder, depressive episodes associated with bipolar I. Treatment-resistant depression. - Side Effects: Neuroleptic malignant syndrome, seizures, suicidal thoughts, serotonin syndrome, anxiety, drowsiness, headache, insomnia, nervousness, diarrhea, sexual dysfunction, increased sweating, pruritis, tremor - Nursing Measures: Monitor mood changes; assess for suicidal tendencies, especially early; monitor appetite and nutritional intake; assess for sensitivity reactions; assess for sexual side effects; monitor for neuroleptic malignant syndrome; assess for serotonin syndrome; monitor CBC and differential during; proteinuria and mild increase in AST; increase in serum alkaline phosphate, ALT, BUN, creatinine; hypoglycemia or hyperglycemia, and hyponatremia - Example: Prozac, Sarafem

- Category: anesthetic adjunct, antianxiety agent, sedative/hyponotic, benzodiazepine, Schedule IV - Action: Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. - Use: anxiety disorder. preoperative sedation. decreases preoperative anxiety and provides amnesia. Unlabeled: antiemetic prior to chemotherapy. insomnia - Side Effects: Apnea, cardiac arrest, dizziness, drowsiness, lethargy, respiratory depression, bradycardia, hypotension, constipation - Nursing Measures: renal, hepatic, and hematologic function; Assess CNS depression and reactions; fall risk - Example: Ativan - Antidote: flumazenil (Romazicon) except for patients with seizure disorder

- Category: anti-infectives; aminopenicillins - Action: binds to bacterial cell wall, resulting in cell death - Use: treatment of: skin and skin structure infections, soft-tissue infections, otitis media, sinusitis, respiratory infections, genitourinary infections, Meningitis, Septicemia, Endocarditis prophylaxis - Side Effects: Seizures, pseudomembranous colitis, anaphylaxis, serum sickness, diarrhea, rash - Nursing Measures: assess for infection; obtain hx before; obtain specimens for culture and sensitivity; observe for s/s of anaphylaxis; monitor bowel function; assess skin for "ampicillin rash"; may cause increase in AST and ALT; decrease in estradiol in pregnant women; false-positive direct Coombs' test result; false-positive urinary glucose

- Category: anti-infectives; first-generation cephalosporins - Action: bind to bacterial cell wall membrane, causing cell death - Use: Tx of infections: skin and skin structure infections (burn wounds), pneumonia, urinary tract infections, bone and joint infections, septicemia. Perioperative prophylaxis, biliary tract infections, genital infections, bacterial endocarditis prophylaxis for dental and upper respiratory tract - Side Effects: Anaphylaxis, serum sickness, seizures, pseudomembranous colitis, Stevens-Johnson syndrome, diarrhea, nausea, vomiting, rashes, pain at IM site, phlebitis at IV site - Nursing Measures: assess for infection; obtain hx; obtain specimens; observe patient for s/s of anaphylaxis; monitor bowel function; assess for skin rash; positive results for Coombs' rest; increase in serum AST, ALT, bilirubin, LDH, BUN, creatinine; leukopenia, neutropenia, agranulocytosis, thrombocytopenia, or eosinophilia - Examples: Ancef (discontinued), Kefzol

- Category: aminoglycosides; anti-infectives - Action: Inhibits protein synthesis in bacteria at level of 30S ribosome - Use: Treatment of serious gram-negative bacillary infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated. In combination with other agents in the management of serious enterococcal infections. Prevention of infective endocarditis. Treatment of localized infections caused by susceptible organisms - Side Effects: ataxia, ototoxicity, nephrotoxicity, apnea, hypersensitivity reactions - Nursing Measures: assess for infections; obtain specimens; evaluate eighth cranial nerve function by audiometry before and throughout; monitor I&O and daily weight; assess for signs of superinfection; monitor for hepatic encephalopathy; monitor renal function by urinanalysis; increase in BUN, AST, ALT, bilirubin, creatinine, and LDH; decrease in calcium, magnesium, potassium, and sodium - Examples: Garamycin

- Category: intermediate-acting corticosteroids; antiasthmatics - Action: In pharmacologic doses, all agents suppress inflammation and the normal immune response. All agents have numerous intense metabolic effects (see Adverse Reactions/Side Effects). Suppress adrenal function at chronic doses - Use: prevention of organ rejection in transplant surgery. Asthma - Side Effects: Peptic ulceration, thromboembolism, depression, euphoria, HTN, anorexia, nausea, acne, decrease wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance - Nursing Measures: assess for adrenal insufficieny; I&O and daily weights; cerebral edema; ulcerative colitis; monitor electrolytes and serum glucose (cause hyperglycemia); decrease WBCs; decrease potassium and calcium, and increase sodium; increase cholesterol; test for Cushing's syndrome - Examples of methylprednisolone: Depo-Medrol, Medrol - Examples of prednisone: Prednisone Intensol

- Category: antiasthmatics, long-acting corticosteroid - Action: In pharmacologic doses, all agents suppress inflammation and the normal immune response. All agents have numerous intense metabolic effects (see Adverse Reactions/Side Effects). Suppress adrenal function at chronic doses - Use: Management of cerebral edema: Diagnostic agent in adrenal disorders - Side Effects: Peptic ulceration, thromboembolism, depression, euphoria, HTN, anorexia, nausea, acne, decrease wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance - Nursing Measures: assess for adrenal insufficieny; I&O and daily weights; cerebral edema; ulcerative colitis; monitor electrolytes and serum glucose (cause hyperglycemia); decrease WBCs; decrease potassium and calcium, and increase sodium; increase cholesterol; test for Cushing's syndrome - Example: Decadron (discontinued), DexPak

- Category: nonsteroidal anti-inflammatory agents - Action: analgesic and anti-inflammatory effects are due to inhibition of prostaglandin synthesis. Antipyretic action is due to vasodilation and inhibition of prostaglandin synthesis in the CNS. - Use: analgesic, antipyretic, anti-inflammatory - Side Effects: drug-induced hepatitis; GI bleeding; anaphylaxis; Stevens-Johnson Syndrome; dizziness; drowsiness; headache; constipation; dyspepsia; nausea; - Nursing Measures: assess for hypersensitivity reactions; assess pain and limitation of movement, note type/location/intensity before and during; assess fever and note associated signs; prolong bleeding time d/t suppresses platelet aggregation and may even cause prolonged PT - Examples: ibuprophen, Aleve

- Category: COX-2 inhibitors; antirheumatics, NSAID - Action: inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins. Has analgesic, anti-inflammatory, and antipyretic properties - Use: Relief of s/s of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and juvenile rheumatoid arthritis. Management of acute pain including dysmenorrhea. - Side Effects: MI, Stroke, Thrombosis, GI bleeding, Exfoliative dermatitis, Stevens-Johnson Syndrome, Toxic epidermal necrolysis - Nursing Measures: assess ROM, degree of swelling, and pain; assess for allergy to sulfas, aspirin or NSAIDs; assess for skin rash; increase in AST and ALT levels; hypophosphatemia and increase BUN - Example: celecoxib (Celebrex)

- Category: anticoagulants; antithrombotics - Action: potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. In low doses, prevents the conversion of prothrombin to thrombin by its effects on factor Xa. Higher doses neutralize thrombin, preventing the conversion of fibrinogen to fibrin. - Use: prophylaxis and tx of various thromboembolic disorders: Venous thromboembolism, Pulmonary emboli, Atrial fibrillation with embolization, Acute and chronic consumptive coagulopathies, Peripheral arterial thromboembolism. Used in very low doses (10-100 units) to maintain patency of IV catheters (heparin flush). - Side Effects: Bleeding, Heparin-induced thrombocytopenia (HIT), anemia, alopecia - Nursing Measures: assess for s/s of bleeding and hemorrhage; additional or increased thrombosis; monitor for hypersensitivity; hematomas, ecchymosis, or inflammation; aPTT and hematocrit prior to and during; monitor platelet q2-3 days; hyperkalemia and increase in AST and ALT levels - Antidote: protamine sulfate - Examples: Hep-Lock

- Category: anticoagulants, coumarins - Action: interferes with hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X). - Use: Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization. Management of myocardial infarction: Decreases risk of death, Decreases risk of subsequent MI, Decreases risk of future thromboembolic events. Prevention of thrombus formation and embolization after prosthetic valve placement. - Side Effects: bleeding, cramps, nausea, dermal necrosis, fever - Nursing Measures: s/s of bleeding and hemorrhage; additional or increased thrombosis; Geri: greater PT/INR response; Pedi: assess PT/INR frequently; Monitor PT/INR; monitor hepatic function and CBC before and throughout; monitor stool and urine for occult blood - Therapeutic INR: 2.5-3.5 - Antidote: Vitamin K (phytonadione, Aquamephyton) - Example: Coumadin

- Category: low molecular weight heparin; anticoagulants; antithrombotics - Action: potentiate the inhibitory effect of antithrombin on factor Xa and thrombin. - Use: Prevention of venous thromboembolism (VTE) (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) in surgical or medical patients. Treatment of DVT with or without PE (with warfarin). Treatment of acute ST-segment-elevation MI (with thrombolytics or percutaneous coronary intervention). - Side Effects: Bleeding, anemia, edema, n/v, urinary retention, thrombocytopenia - Nursing Measures: s/s of bleeding and hemorrhage; additional or increased thrombosis; monitor for hypersensitivity; monitor pts with epidural catheters for s/s of neurologic impairment; observe for hematomas, ecchymosis, or inflammation; monitor CBC, platelet count, and stools for occult blood; anti-Xa for obese or renal dysfunction; increase in AST and ALT levels - Antidote: protamine sulfate 1 mg for each mg of enoxaparin - Example: Lovenox

- Category: low molecular weight heparin; anticoagulants; antithrombotics - Action: potentiate the inhibitory effect of antithrombin on factor Xa and thrombin. - Use: Prevention of venous thromboembolism (VTE) (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) in surgical or medical patients. Extended treatment of symptomatic DVT and/or PE in patients with cancer. - Side Effects: Bleeding, anemia, edema, n/v, urinary retention, thrombocytopenia - Nursing Measures: s/s of bleeding and hemorrhage; additional or increased thrombosis; monitor for hypersensitivity; monitor pts with epidural catheters for s/s of neurologic impairment; observe for hematomas, ecchymosis, or inflammation; monitor CBC, platelet count, and stools for occult blood; anti-Xa for obese or renal dysfunction; increase in AST and ALT levels - Antidote: protamine sulfate 1 mg for each 100 anti-factor Xa IU of dalteparin should by admin by slow IV injection - Example: Fragmin

- Category: Histamine H2 Antagonists; antiulcer agents - Action: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in the inhibition of gastric acid secretion - Use: Short-term treatment of active duodenal ulcers and benign gastric ulcers. Maintenance therapy for duodenal and gastric ulcers after healing of active ulcers. Management of GERD. Treatment of heartburn, acid indigestion, and sour stomach (OTC use). Management of gastric hypersecretory states (Zollinger-Ellison syndrome). Prevention and treatment of stress-induced upper GI bleeding in critically ill patients. - Side Effects: arrhythmias, agranulocytosis, aplastic anemia, confusion, gynecomastia, thrombocytopenia, erectile dysfunction & decreased sperm count - Nursing Measures: assess for epigastric or ab pain and frank or occult blood in the stool, emesis, or gastric aspirate; Geri: confusion; Monitor CBC with differential during; false-negative results in skin rests using allergenic extracts; increase in serum transaminases and creatinine; increase in prolactin; decrease in parathyroid concentration; false-positive results for urine protein - Example: Pepsid

- Category: anti-ulcer agents, proton-pump inhibitors - Action: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen - Use: GERD/maintenance of healing in erosive esophagitis. Duodenal ulcers (with or without anti-infectives for Helicobacter pylori). Short-term treatment of active benign gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Reduction of risk of GI bleeding in critically ill patients. OTC: Heartburn occurring twice/wk. - Side Effects: abdominal pain, drowsy/fatigue, chest pain, n/v, flatulence, itching - Nursing Measures: assess for epigastric or ab pain and frank or occult blood in the stool, emesis, or gastric aspirate; monitor CBC with differential through; increase in AST, ALT, alkaline phosphatase and bilirubin; increase in serum gastric concentration during first 1-2 weeks; monitor INR and PTT with patients taking warfarin; hypomagnesemia before and during - Examples: Prilosec

- Category: antiemetics; 5-HT3 antagonists - Action: blocks the effects of serotonin at 5-HT3-receptor sites (selective antagonist) located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS - Use: Prevention of nausea and vomiting associated with highly or moderately emetogenic chemotherapy. PO: nausea associated with radiation. Prevention and treatment of postoperative nausea and vomiting - Side Effects: Torsade de pointes, headache, constipation, diarrhea, QT interval prolongation - Nursing Measures: Assess for nausea, vomiting, abdominal distention, and bowel sounds prior to and following administration; assess for extrapyramidal effects during; monitor ECG in patients with hypokalemia or hypomagnesemia, HF, bradyarrhythmias, or patients taking concomitant medications that prolong the QT interval; increase in bilirubin, AST, and ALT levels - Example: Zofran, Zuplenz

-Category: antiarrhythmics, anticonvulsants, hydantoins - Action: limits seizure propagation by altering ion transport. May also decrease synaptic transmission. Antiarrhythmic properties as a result of shortening the action potential and decreasing automaticity. - Use: treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures. As an antiarrhythmic, ventricular arrythmias associated with digoxin toxicity, prolonged QT interval, and surgical repair of congenital heart diseases in children. Management of neuropathic pain, including trigeminal neuralgia - Side Effects: suidical thoughts, agranulocytosis, aplastic anemia, Stevens-Johnson syndrome, ataxia, diplopia, nystagmus, hypotension, gingival hyperplasia, nausea, hypertrichosis, rash - Nursing Measures: monitor for changes in behavior; assess oral hygiene; assess for phenytoin hypersensitivity syndrome; observe for skin rash; assess mental status; seizures: assess location, duration, frequency, and characteristics of seizure activity; monitor BP, ECG and respiratory function; monitor CBC, serum calcium, albumin, and hepatic function; increase in serum alkaline phosphatase, GGT, and glucose levels - Therapeutic levels: 10-20 mcg/mL; free phenytoin levels are 1-2 mcg/mL - Example: Dilantin

- Antidote for: heparin overdose - Category: antiheparin - Action: strong base that forms a complex with heparin (an acid) - Use: acute management of severe heparin overdose. used to neutralize heparin received during dialysis, cardiopulmonary bypass, and other procedures - Side Effects: anaphylaxis, angioedema, pulmonary edema - Nursing Measures: assess for bleeding and hemorrhage; assess for allergy to fish (salmon); s/s of hypersensitivity; assess for hypovolemia; monitor clotting factor, ACT, aPTT, TT 5-15 min after therapy and again as necessary

- Antidote for: opioids - Category: opioid antagonist - Action: Competitively blocks the effects of opioids, including CNS and respiratory depression, without producing any agonist effects - Use: Reversal of CNS depression and respiratory depression because of suspected opioid overdose. Unlabeled: management of refractory circulatory shock - Side Effects: ventricular arrhythmias, HTN, hypotension, nausea, vomitting - Nursing Measures: monitor respiratory rate, rhythm, and depth; pulse, ECG, BP and LOC for 3-4 hr after peak; Dilute and administer carefully (patients extremely sensitive); Assess for level of pain after admin since it reverses analgesia; assess for s/s of opioid withdrawal; lack of significant improvement indicates symptoms are caused by a disease process or other non-opioid CNS depressants

- Antidote for: warfarin (Coumadin), anticoagulants - Category: antidotes, fat-soluble vitamin - Action: Required for hepatic synthesis of blood coagulation factors II (prothrombin), VII, IX, and X. - Use: Prevention and tx of hypoprothrombinemia which may be associated with: excessive doses of oral anticoagulants, Salicylates, anti-infective agents, nutritional deficiencies, prolonged parenteral nutrition,. Prevention of hemorrhagic disease of the newborn - Side Effects: gastric upset, unusual taste, pain at injection site, hypersensitivity - Nursing Measures: monitor for frank and occult bleeding; Pedi: sensitive to the side effects and adverse reactions; monitor PT prior to and during tx

- Antidote for: Benzodiazepines - Category: antidote - Action: a benzodiazepine derivative that antagonizes the CNS depressant effects of benzodiazepine compounds. It has no effects on CNS depression from other causes, including opioids, alcohol, barbiturates, or general anesthetics - Use: Complete/partial reversal effects of benzodiazepines used a general anesthetic or during diagnostic or therapeutic procedures. Management of OD of benzodiazepines - Side Effects: seizures, dizziness, nausea, vomiting - Nursing Measures: assess LOC and respiratory status before and during; attempt to determine the time of ingestion and type of benzodiazepine taken. Knowledge of agent ingested allows an estimate of duration of CNS depression.

- Category: potassium supplements, mineral and electrolyte replacements/supplements - Action: maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell. Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism - Use: treatment/prevention of potassium depletion; arrhythmias d/t digoxin toxicity - Side Effects: arrhythmias, abdominal pain, diarrhea, flatulence, nausea, vomiting - Nursing Measures: s/s of hypokalemia and hyperkalemia; monitor pulse, BP, and ECG during IV therapy; monitor serum potassium before and during; s/s of toxicity are those of hyperkalemia; tx includes discontinuation of potassium, administration of sodium bicarbonate to correct acidosis, dextrose and insulin to facilitate the passage of potassium into cells, calcium salts to reverse ECG effects, sodium polystyrene as an exchange resin, and/or dialysis for patient with impaired renal function

- Category: minerla and electrolyte replacement/supplements - Action: Sodium is a major cation in extracellular fluid and helps maintain water distribution, fluid and electrolyte balance, acid-base equilibrium, and osmotic pressure. Chloride is the major anion in extracellular fluid and is involved in maintaining acid-base balance. Solutions of NaCl resemble extracellular fluid. Reduces corneal edema by an osmotic effect. - Use: Replacement in deficiency states and maintenance of homeostasis - Side Effects: HF, pulmonary edema, extravasation - Nursing Measures: assess fluid balance; assess for s/s of hyponatremia or hypernatremia; monitor serum sodium, potassium, bicarbonate, and chloride concentrations; monitor serum osmolarity in patients receiving hypertonic saline solutions

- Potentiates effects of anticoagulants, thrombolytics, antiplatelet agents, and MAOIs. Increased risk of bleeding. Decreases effectiveness of anticonvulsants. - Category: antiplatelet, CNS stimulant - Action: improves tolerance to hypoxemia. Inhibits development of cerebral edema and accelerates its regression. Improves memory, blood flow, compensation of disequilibrium, and rheological properties of blood. Inactivates toxic oxygen radicals. Antagonizes platelet-activating factor. Interferes with bronchoconstriction and phagocyte chemotaxis - Use: Symptomatic relief of organic brain dysfunction. Intermittent claudication. Vertigo and tinnitus of vascular origin. Improvement of peripheral circulation. Premenstrual syndrome. - Side Effects: cerebral bleeding, stomach upset, bleeding, hypersensitivity - Nursing Measures: exclude other options before using gingko to tx dementia; assess cognitive function throughout; assess frequency, duration, and severity of muscle cramps; assess for headache and neurosystem changes (thromboembolism)

5

2.54 cm

pain assessment, treatment, comfort level achieved (the pain goal for that patient), interventions when treatment is inadequate, and new outcomes from those interventions

Must use 2 forms of identification: patient's ID Band (a must!); asking patient's name, MR number, date of birth, phone number, photo license, etc.

All telephone orders must be completely read back to the physician as soon as they are recorded on the medical record and BEFORE they are executed. Order read-back includes: patient's name, date and time of the order, the name of the med, the dose, the route, the frequency of administration, any parameters or criteria for administration

Can only be accepted in an emergency situation and must be read back to the Physician. An emergency situation is one in which the health of the patient would be compromised if there was a delay in administering the medication.

patient's name, date and time of the order, the name of the med, the dose, the route, the frequency of administration, any parameters or criteria for administration

1. Use a leading zero in front of the decimal dose of a medication. Ex. 0.35 mg 2. Do not use a "trailing zero" after a whole number. Ex. 4, not 4.0 3. Never use a range of doses or times. Ex. Percocet 1 tab. po q4h; Not Percocet 1-2 tabs q3-4 hours

Contact the physician to clarify what is best for the patient. When a medication dose is missed (e.g. the patient is off the unit), the nurse should not assume that the patient can wait until the next dose is due. The decision about the missed dose belongs to the physician.

U, IU, ug, QD/OD, QOD, sc or sq, QID, MS/MSO4, MgSO4, OS/OD/OU, AS/AD/AU

Under the direction of a RN, Physician, or Dentist. Can administer via oral, subcutaneously, IM, and ID routes

- Method: 90 degree angle, Z-track method, aspirate (except for vaccines) - Sites (adults): Ventrogluteal, Vastus lateralis, Deltoid muscle (less than 2 ml of medication) - Sites (children): Ventrogluteal, vastus lateralis (infants and toddlers), deltoid (over 18 months) - Weight: 1. thin = 5/8-1 in; 2. average = 1 in; 3. >154 lb (70kg) = 1-1.5 in; 4. > 198 (90kg) = 1.5 - Age: Adults (vastus = 5/8-1 in; ventrogluteal = 1.5in; deltoid = 1-1.5in); Infants = 1in; Toddlers = 1-1.25in; Older children = 1.5-2in

- Has patient taken medication before - Allergies - Review medication, dose, route, time, and reason - Explain medication's name, purpose, and potential adverse effects to patient - Observe for changes, esp during first 15 minutes

Record drug, dose, route, and time immediately after.

- Draw up: Regular insulin first, then intermediate-acting; Rapid-acting first, then intermediate-acting. Do not mix insulin glargine (Lantus) or insulin determir (Levemir) with any other types - Administer: 1. store in refrigerator. Keep currently used at room temperature. Do not inject cold insulin.; 2. Inspect vials before each use; 3. Preferred injection site (outer upper arms, abdomen, anterior aspect of thighs); 4. Have patient self-administer when possible; 5. Carry carbohydrates (4 oz fruit juice, 4 oz soft drink, 8 oz skim milk, 6-10 hard candies) - 25 gauge 5/8-inch at 45 degrees; 0.5 in at 90 degrees

- Subcutaneously or intravenously - Subcutaneously on the right or left side of the abdomen, at least 5 cm (2 inch) away from the umbilicus - Do not expel the air bubble in the syringe before giving the medication

- Lovenox/Fragmin: CBC, platelet count, and stools. Platelet normal (150,000-450,000); risk of thrombocytopenia (<100,000). - Heparin: aPTT (normal 25-39 sec), hematocrit (M: 43-49%; F: 38-44%), platelets (150,000-450,000). Potassium (3.5-5), AST (M: 15-40; F: 13-35), ALT (10-40 Units) - Coumadin: PT (normal 10-13 sec) & INR (0.8-1.2). INR Therapeutic range 2-3.

- Topical: 1. Wash, rinse, and dry affected area before applying medication. 2. If skin is dry, then apply medication while skin is damp. 3. Soften medication by rubbing between hands. 4. apply to thickness specified - Nitroglycerin: 1. remove previous dose paper. 2. wipe off residual with tissue. 3. write date, time, and initials on new application paper. 4. Apply desired number of inches of ointment to paper-measuring guide - Transdermal patches: 1. remove old patch and clean area. 2. Date and initial outer side of new patch. 3. choose a new site that is clean, dry, and free of hair. 4. hold patch by edge without touching adhesive edges. 5. apply patch and hold for 10 sec. (Do not apply patch to previously used sites for at least 1 week)

1. select injection port of IV tubing closest to patient 2. Clean injection port with antiseptic swab and allow to dry 3. connect syringe to IV line 4. occlude IV line by pinching tubing just above injection port. Pull back to aspirate for blood return 5. release tubing and inject medication within amount of time recommended by agency policy 6. If IV line that is currently hanging is a medication, disconnect it and administer IV push medication IV Push (IV Lock) 1. Prepare flush solutions (2 syringes with 2-3 ml of NS) 2. Clean injection port with antiseptic swab 3. Pull back gently on syringe plunger and check for blood return 4. Flush IV site with NS 5. Inject medications within time recommended 6. clean injection port 7. flush injection port 8. stay with patient for several minutes and observe for allergic reactions

Adults: 1. hold cotton ball or clean tissue in nondominant hand on patient's cheekbone just below lower eyelid 2. gently press down with thumb or forefinger against bony orbit, exposing conjunctival sac 3. ask patient to look at ceiling 4. rest dominant hand on patients forehead; hold filled medication eyedropper approximately 1-2 cm (0.5-0.75 in) above conjunctival sac 5. drop into conjunctival sac 6. after instilling, ask patient to close eyes gently Pediatrics: 1. place the drops at the nasal corner where the lids meet with the infant supine. 2. when the infant opens the eye, the medication will flow into it.

1. warm medication to room temperature by running warm water over bottle 2. position patient on side with ear to be treatment facing up, or patient may sit in chair or at bedside 3. stabilize patient's head with his or her own hand 4. straighten ear canal by pulling pinna up and back to 10 o'clock position (adult or child over 3) or down and back to 6-9 o'clock position (under 3) 5. If cerumen or drainage occludes outermost portion, wipe out gently with cotton-tipped applicator 6. instill prescribed drops by holding dropper 1 cm (0.5 in) above ear canal 7. Ask patient to remain in side-lying position for a few minutes. Apply gentle massage or pressure to tragus of ear with finger

- S/s: anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait - Tx: Mild = ingestion of oral glucose; Severe = IV glucose, glucagon, or epinephrine

Pain Management 1. Prepare patient's environment 2. Teach how to use pain rating scale 3. Set pain-intensity goal with patient (when able) 4. Prepare and administer 5. Remove or reduce painful stimuli 6. Teach patient how to splint over the site of pain 7. Reduce or eliminate emotional factors 8. Document pain assessment, treatment, comfort level achieved (pain goal for that patient), interventions when treatment is inadequate, and new outcomes for those interventions 9. Within 1 hour of an intervention, ask patient to describe the level of relief using a scale Pain Scales 1. Numeric scale: 0-10 (0 = no pain, 5 = moderate pain, 10 = worst pain) 2. Wong-Baker FACES pain rating scale for infants and children 3. Oucher pain scale 4. FLACC pain scale (Face, Legs, Activity, Cry, Consolability) for ages 2 months to 7 years

1. inspect 2:1 CPN solution for particulate matter. inspect 3:1 CPN solution for separation of solution 2. Attach appropriate filter to IV tubing. Prime tubing with CPN solution. Open roller clamp to rate that maintains patency of line 3. Place IV tubing into IV infusion pump, open roller clamp completely and regulate flow on pump. 4. Increase rate gradually to prevent metabolic and electrolyte abnormalities 5. Infuse all medications or blood through an alternative IV line. 6. Do not interrupt infusion (during showers, transport, blood transfusion) and be sure that the rate does not exceed the order 7. Change infusing tubing and filter using strict aseptic technique 8. Evaluation: monitor flow rate hourly; I&O q8h; daily weights; assess for fluid retention; monitor patient's glucose q6h; monitor for temperature, elevated WBC, and malaise

1. Prepare IV tubing for PPN solution; run solution through tubing. turn roller clamp to "off" position. Add sterile capped needle or place sterile cap on end of tubing 2. Connect PPN solution to patient's functional peripheral IV. Open roller clamp. Allow solution to run to ensure patency. then regulate IV drip rate using electronic infusion pump 3. Clean needleless peripheral line tubing port with antimicrobial swab 4. Insert needleless valve at end of fat emulsion infusion tubing into injection port of main IV, closest to patient but below infusion filter on main parenteral nutrition line. Label tubing 5. Open roller clamp completely and check flow rate on infusion pump 6. Infuse lipids initially at 1 ml/min for adults and 0.1 ml/min for child for first 15-30 min; increase as ordered 7. Evaluation: monitor flow rate hourly; measure vital signs and patient's comfort every 10 minutes for first 30 minutes; monitor labs (triglycerides, liver function) daily and perform blood glucose monitoring as ordered. Monitor serum lipids 4 hours after discontinuing infusion; monitor temperature q4h and inspect for phlebitis or infiltration; assess weight, I&O, condition of extremities (edema), and breath sounds

1. Determine if medication interacts with enteral feeding. If so, hold feeding for 30 minutes prior to administration 2. Prepare medications for instillation. Fill graduated container with 50-100 ml of tepid water. Use sterile water for immunocompromised or critically ill patients 3a. Tablets: crush each into a fine powder. Dissolve each tablet in separate cup of 30 ml of warm water. 3b. Capsules: ensures contents can be expressed from covering. Open capsule and empty into 30 ml of warm water. Gel caps dissolve in warm water but take 15-30 minutes 4. Elevate HOB 30-45 degrees 5. If tube feeding is infusing, adjust infusion pump to hold tube feeding. 6. Check placement of feeding tube by observing gastric contents and checking pH of aspirate contents 7. Check gastric residual volume. Draw up 10 to 30 ml of air into a 60 ml-syringe and connect syringe to feeding tube. Flush tube with air and pull back slowly to aspirate gastric contents. 8. irrigate the tubing. pinch or clamp the tube and remove syringe. draw up 30 ml of water and flush. clamp again and remove syringe. 9. administer first dose of liquid or dissolved medication by pouring into syringe. Allow to flow by gravity. Follow last dose with 30-60 ml of water 10. If medications are not compatible with feeding solution, then hold feeding for 30-60 minutes 11. Keep HOB elevated for 1 hour 12. Evaluation: return within 30 minutes

- Diluted in 100-1000 ml of IV solution - Usually limited to 80 mEq/L via peripheral and 200 mEq/L via central - Infuse slowly at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children. Use an infusion pump - Do not administer concentrations of >1.5 mEq/ml undiluted; fatalities occur - May be diluted in dextrose, saline, Ringer's, LR, dextrose/saline, dextrose/Ringer's, and dextrose/LR.

- Ex.: Dopamine, digoxin, promethazine, sodium bicarbonate, antineoplastics (anticancer), calcium salts - Monitor: pain, redness, irritation, inflammation, necrosis, sloughing of tissue - Treatment: discontinue IV, elevate, NS, warm compresses, lidocaine or hyaluronidase, restart in new vein to avoid damage to tissue