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Nur 172 Final Exam
Exams 1-8
Undergraduate 2

Additional Nursing Flashcards




assists in maintaining sobriety
S: n/v flushing, diaphoresis, hypotension, seizure, MI, death
Take at night, avoid all forms of alcohol
wear medic alert bracelet, periodic LFT
C:pt who have consumed alcohol w/in past 12 hr
cardiac disease, psychotic disorders,hypersensitivity
drug interactions: phenytoin, warfarin, watch drug levels, low dose of dilantin
treats urinary or bladder problems, hello empty the bladder and increases urination
Primarily affects urinary and GI system
stimulates detrusor muscle in bladder
stimulates lower GI tract causing defection
Salivation, Lacrimation, Urination, Diarrhea(diaphoresis), GI cramps Emesis. (SLUDGE) may be a sign of toxicity.
WATCH FOR BP changes.
toxic effects are chollingeric crisis.
treats MG, enhanced muscle contractions
slows down the enzyme that breaks down Ach. increases levels of Ach at receptor sites.
given orally and parenterally
C: GI and urinary track obstruction
S: cholinergic crisi, N/V, diarrhea, mitosis, salivation, diaphoresis, bradycardia, and bronchospasm
Drug interactions: Atropine
watch their ability to move. don't give with a pt w/ asthma.
ineffective airway clearance cant cough stuff out of lungs.
administer at regular interval throughout the day (very strict dose at bedside)
position on side so secretions can run out. keep atropine on the floor.
myasthenia or cholinergic crisis??
Metoprolol (all beta blockers) (all end in –alol, -ilol-, or –olol.)
blocks the effects of sympathetic nervous system (fight or flight) look for asthma, COPD, cardia conduction disorders (dont want the heart to slow down)
Aspirin/ Acetylsalicylic Acid (salicylate)
treats mild to moderate pain, prevent platelet aggregation (reduce risk of MI), anti inflammatory, antipyretic, analgesic, anti platelet.
*absorbed in the stomach and sm intestines.
sm doses used to prevent heart attack, can be taken daily.
can be taken long term w/ arthritis
S: Large dose, renal failure, abnormal bleeding disorders, GI upset, drowsiness, and confusion (elderly)
C: hypersensitivity, peptic ulcer disease, or bleeding disorders, and children with illness (<16), pregnancy.
Drug interactions: drugs that are highly protein bound. can enhance bleeding.
Disturbed sensory perception (ringing in the ears, toxic level)
Check for renal and hepatic disease, ask about OTC meds (WATCH)
DONT take if pregnant.
when used for the heart, use uncoated pill
Monitor for GI distress or bleeding, anemia, hepatotoxicity, and renal failure
Toxicity: take to much or build up effects!
common symptoms tinnitus, hearing loss (early) blurred vision
may cause acidosis (heavy breathing, unbalanced pH)
treat w/ d/c of meds, pump stomach, add activated charcoal (acute)
NSAIDs in general (Ibuprofen):
arthritis, mild to moderate pain, primary migraine headache and fever (kids), painful menstruation
inhibits prostaglandins synthesis
**prostaglandins keep shape.
** dont give to ppl w/ ULCERS!
** bad for KIDNEYS drink lots of water
BBW: heart attack and stoke
S: increase for MI, stroke, GI upset and bleeding, hepatotoxicity, acute renal failure.
good for kids
C: GI distress (bleeding, ulceration, and perforation of stomach and intestines), renal disease, asthma and allergic rhinitis (enhances the allergic response), impaired renal function, pregnancy , chronic alcohol abuse (gastric bleeding), children and adolescents (presences of viral infection, and chickenpox)
dont give if allergic to ASA (aspirin)
find out what they are taking, ask about their pain, what they have done for it.
infective protecting (BMD)
give with milk or food
** for long term use: check stool for occult blood twice yearly.
teach patient about cardiovascular risk for medication, MI and stroke
Acetaminophen (Tylenol): (para-aminophenol)
used to treat fever or mild pain
not anti-inflammatory and anti platelet
**works only in the brain
C: hepatic disease, hepatitis or alcoholism (damage to the liver)
S: generally well tolerated, overdose can be fatal (slow)
drug interactions: activated charcoal, antacids (tums slows down), ethanol, hydantoins, warfarin, and sulfinpyrazone
assess pain level, can cause BMD
Pregnancy cat B, ask about OTC meds.
Do periodic CBC, platelet count, liver, and kidney function test for patient on long term use.
** maximum daily use is 4 g
OD causes hepatotoxicity, watch liver and draw blood
look for jaundice, vomiting, CNS simulation w/ excitement and delirium follow by coma and death
treatment: gastric lavage and activated charcoal (less than 4 hr)
antidote * actylcysteine, smells like rotten eggs 8-10 hr. LD 140mg/kg, then 70mg/kg q4 hr up to 17 doses.
(Antigout Drug)
used to treat acute gout and as pre surgical prophylaxis to prevent gout.
toxic drug
C: cardiac disease, hepatic disease, and renal disease.
S: N/V diarrhea, abdominal pain, and paralytic ileum (portion of the sm intestine stops working)
Eat a low pureed diet, avoid shellfish, and alcohol and dehydration.
IV colchicine sets off a gout attack
pt ed: discuss side effects, importance of dietary restrictions. drink 2-3 L of water daily
give w/ full glass of water at evenly spaced intervals.
** start medication at the first sign of an attack. (stops the attack)
Give PO or IV, never IM or SC
Morphine and Opioid analgesics in general
used for moderate to severe pain, acute or chronic pain.
*onset 15-30 mins quicker in IV. give meds before they need it.
C: hypersensitivity and respiratory conditions.
S: respiratory depression, apnea, circulatory depression, shock, coma, constipation, itching
Drug interactions: any drug that causes CNS depression, such as alcohol
Assess for tolerances, and drug & alcohol habits, use side rails after administration in inpatient setting.
Ineffective breathing pattern, constipation, urinary retention (drying), orthostatic hypotension or sedation
end stage = big does
adequate pain relief, minimal side effects.
ask where it hurts?
conduct frequent exams, provide addition pain meds for breakthrough pain.
TCDB to prevent pneumonia, measures to prevent constipation.
Naloxone: (opioid antagonist)
kicks opioid out of receptors
used as antidote for narcotic overdose.
used to reverse narcotics after anesthesia
** has a short half life (keep another dose handy)
may cause abrupt w/ drawl symptoms in ppl who are addicted (regular users)
busers crush to get all available narcotic immediately slow release, do not crush
Fentanyl patch:
Rx for a person who have developed opioid tolerance, acute care.
equal effects of morphine with fewer side effects.
injection, épidural, transdermal (duragesic) chronic pain
full effect in 24 hrs *give something else for the 1st 24 hrs
duration is 72 hr
use quicker acting narcotic for “breakthrough” pain
*taper off
cox-2 inhibitors
BBW: cardiovascular effects
decreases inflammation
used to treat malignant hyperthermia
temp spike, claiming down of muscles, brakes down muscle tissue.
used if they have a family hx
relaxes muscles
C: liver disease (bad)
S: exacerbation of muscle weakness, fatal hepatitis, seizures, and pleural effusion with pericarditis. accumulation of fluid
Drug interactions: CNS depressants, clofibrate, estrogens, verapamil, and warfarin.
Disturbed body image, **photosensitivity, stay out of the sun.
administer w/ food or milk to avoid gastric distress
do not crush extend release capsule
advise the use of sunscreen
tribute dose to maximum effectiveness, frequent assessment
Vecuronium: (nondepolarizing neuromuscular blocking agents)
paralyze you
used with anesthesia to provide skeletal muscle relaxation, facilitation of intubation and mechanical ventilation
paralysis occurs in 2-4 mins 30-60 mins duration
C: MG, Eaton Lambert syndrome, hepatic disease, and decrease renal disease.
S: prolonged paralysis, and prolonged apnea
Impaired skin integrity, fear related to paralysis and helplessness.
relieve anxiety, monitor for pain distress: responses of pupils, pulse, BP
access to resuscitation equipment, change positions frequently.
Pt ed: sore muscles, constipation, difficultly moving and voiding may occur.
tell them it will wear off, stay with them
Imitrex (Sumatriptan):
uses for acute marine headache and cluster headaches
also relieves nausea, vomiting, photophobia, and phonophabia that accompany the migraine headache.
Phenytoin: (antiepiletic drug)
used to control partial and generalized seizures.
associated with hydention syndrome don't give to pregnant women.
S: nystagmus, ataxia, drowsiness, dysarthria, slurred speech, mental confusion, tremor, and gingival hyperplasia (big gums) when started during childhood
shake suspension well, take w/ food, not high in fat
take folic acid.
C: dont give if bradycardia and heart block.
only mix w/ full strength saline. Pregnancy D cat. Monitor blood levels of drugs 10-20
dont miss a dose. titrate dose up. drug compete w/ folic acid
*decrease activity in the heart
** narrow therapeutic index
** if on NG check stomach contents.
Risk for injury blood dyscrasia. (draw blood levels frequently)
if NPO take fosphenytoin
Diazepam and benzodiazepines in general:
used for seizures, usually with phenytoin
should only be mixed with normal saline
very hard on the vein wall. avoid using hand and wrist
can be given deep IM absorption is slow
have two line
works with GABA. seizures, and muscle relaxer or nerve pain. promotes the release of GABA.
DO NOT take with antacids, will impede absorption
**not metabolized by the liver
can be bad for kidneys, look or renal disease.
watch for BUN and creatin levels
suicidal thoughts?
Valproic acid:
effective against all typer of seizures
S: GI upset, tremors, and weight gain
May falsely elevate urine Ketone and thyroid levels
skin treating skin rash? ** steven johnson syndrome
manages muscle spasms associated w/ acute musculoskeletal disorders.
used short term
need a lot of precaution.
sedation and addictive
dont take if uncontrolled hypothyroidism. and anytime before the 14 day was out with MAOI b/c it can increase BP
S: CNS depression, anticholinergic (DRY), arrhythmias, seizures, and MI.
assess for past medical history and drug allergies. pregnancy cat B. used precaution in elderly.
avoid alcohol. combine w/ NASID for pain relief and reduction of inflammation
risk for injury and CNS depressant
take with full glass of water
coordinate physical therapy
assess for excessive sedation
Levetiracetam (keppra)
used a lot for head injuries.
used for kids with chronic seizures to lower dose for toxic meds
common medication administer prior to surgery or procedures
can be given to maintain sedation
** can be used in pediatric anesthesia
safe. induces see and prevents waking during the night
take the drug and go to bed
approved for long term use
leaves a nasty taste in mouth
headache and prolonged drowsiness
SSRIs (Also bupropion):
very effective
not useful for PRN
take it everyday with a regular dose
3-4 weeks TL
may take bento till effectiveness
better for ppl with attacks
less sedating
dizziness, and lightheadedness, should go away
** increase suicidal ideation in kids
** weight gain!
**bad for liver
use standard scales, 2 week flush out with MAOI’s
treats manic episodes, bipolar treatment and management
toxic, and a salt
prevents extreme mood swings
onset a few days, TL takes a week.
watch for cardiovascular and renal disease
coarse hand tremors (toxic effects)
narrow therapeutic index.
** regular blood test
drug interactions diuretics losing sodium and K
Preg cat D. watch alcohol and caffeine intake (fluid lost)
1 on 1 staff.
TL 0.6-1.2
1.5-2 toxicity, assess for dehydration
eat normal amount of sodium. low sodium risk for toxicity. high sodium trouble reading TL.
watch for muscle twitching!
avoid hot temps
Fluoxetine (Prozact)
antidepressants, but good for anxiety drugs.
4-6 weeks to meet TL,
causes more serotonin to be in the brain.
Duloxetine Cymbalta:
watch for hypertension
Phenelzine sulfate: (MAOI)
used to treat depression, last resort
C: decrease in liver function and CHF
dizziness is common in hight dose (risk for fall)
BMD, and reacts with any drug
tyramine, aged, preserved and pickled foods. MAOI prevents breakdown of these things (SOY SAUCE)
doesn't do well with other antidepressants and alcohol.
not recommend under the age of 16
weight gain. look for symptoms of hypersensitive crisis.
if they come in with headache, nausea, ask them what they ate!!
Nortriptyline TCA: (DRY)
helps activity of both serotonin and NE
used to treat depression and chronic pain, rarely sleep disorder
**assess carefully for cardiovascular
** confusion should not be happening (take off meds)
BMD is rare but serious.
chance effects of blood thinners.
more side effects in elderly
constipation, and diarrhea, disturbed sleep pattern, risk for poisoning.
single dose at BEDTIME.
drowsiness will subside after a few weeks.
TL is not immediate
Drug interactions: blood thinners, alcohol oral contraceptives.
** assess for suicidal thoughts
treat schizophrenia
look for extrapyramidal effects such as acute dystonia, akathisia, Parkinsonism (pill rolling), tardive dyskinesia. (tongue rolling)
used to treat schizophrenia, not given under the age of 6months
used preoperatively for restlessness and apprehension
S: extrapyramidal efect, cardiovascular, hematological effects, hypotension, dizzines, fatigue, faintness, respiratory depression, photosensitivity, and difficulty with temp regulation.
C: with liver damage, parkinsonism, BMD, severe hypo-hypertension, coma
Baseline EKG, dont take with antacids.
monitor renal and hepatic function, along with a CBC.
risk for falls. drink lots of fluid during hot weather. do not drive a care or operate dangerous machinery
if you go outdoors wear protective clothing use suncreen.
levodopa increase the dopamine levels
carbidopa prevents the breakdown of dopamine
used to relax muscles
C: with skin lesions which could lead to melanoma , glaucoma
S: N/V, blurred vision, orthostatic hypotension abnormal movements, cardiac arrhythmia, bruxism, and ballismus.
dry mouth, not sweating may cause heat stroke.
drug interactions: SSRI and MAOI(14 day flush out) may cause serotonin syndrome
Low food in Vit B6
protein can interfere with absorption
take on an empty stomach its palliate care.
** watch for heatstroke
used to treat Alzheimers, costly, slow down progress
treats mild to moderate dementia
S: weight loss due to GI effects, dizziness, headaches, chest pain, peripheral edema, vertigo, joint pain, agitation , and coughing (dry)
**watch for weight loss!!
Imbalanced nutrition: LESS! risk of injury due to sedation (lower dose)
detect correctable factors. offer small, frequent meals
monitor weight.
calm, quiet environment, give them something to do
distract when missing someone.
Central nervous stimulants in general:
transmission of nerve impulses that excite the cell
improve academic performance, behavior, and interpersonal relationships.
improve performance of daily activities
Baclofen: Centally Acting Spasmolytic
don’t give with parkinson and post stroke
used to relieve spinal spasticity
S: drowsiness, weakness, dizziness, lightheadedness, headache, N/V, hypotension, constipation, fatigue, confusion, insomnia, and increase urinary frequency.
older patient are more susceptible to sedation
ND: Acute pain related to whatever caused the problem, risk for disturbed sensory perception
** take with a full glass of water at evenly spaced intervals
GI distress occurs coordinate with light meals.
teach importance of safety, caution the patient about the concurrent use of alcohol
monitor for the emergence of hallucinations of psychotic episodes. asses for improved symptoms of spasticity
low risk of abuse and dependence
BBW: suicidal ideation may occur
used for ADHA and narcolepsy
allows for once a day dosing, has a longer half life
check BS
baseline high, weight, EKG
no a caffeine
take in the morning or 6hr before bed.
Tracylcypromine (MAOI):
used to treat depression
avoid Tyramine, aged pickled foods
weight gain hypertensive crisis ask what they ate?
similar to atropine with fewer side effects
treats Parkinson’s and side effects of psychtrophic meds
anticholinergic (dry)
used for cardiac arrhythmias, preoperatively, mydriasis, irritable bowel syndrome, bradycardia, treatment of cholinergic poisoning.
C: MG, men with BPH
S: blurred vision, dry mouth, constipation, and urinary retention
NO pee, see, poop, spit
assess for peptic ulcer disease, take as prescribed
used for schizophrenia
check BS often.
BBW seizures, fatal agranulocytosis, and hyperglycemia
*weight gain, increase appetite
risk for injury so safety issue.
monitor BS, and take at bed time.
*bld draws, don't drive,
used to treat trigeminal neuralgia
used as adjuvant to some antipsychotic and mood altering drugs
may require dosage increase excuse of auto induction (speeds up its own metabolism)
TL 4-12
used less for seizure disorders, adjuvant to nerve pain
antidote for acetaminophen, given 8-10 hrs after ingestion.
does not reverse damage already sustained. LD 140mg/kg
then 70 mg/kg q4h up to 17 dose
smell like rotten eggs.
6-rights of medication administration
Right drug, Right time, Right documentation, Right patient, Right dosage, Right Route
speeds up its own metabolism after the patient has been taking it for a while. Carbamazepine is an example of this drug. (per notes from lecture)
rapid lack of response to drug. happens with chloral hydrate.
*Imbalance of acetylcholine and dopamine causes Parkinson’s disease
*Dietary changes to make when taking codeine is increase Fiber
*Main side effect of Fluphenazine is extrapyramidal effects
*Diazepam and Lorazepam are used for status epilepticus seizures
*25% of drug in system after 2 half lives
*St. Johns wart causes serotonin syndrome when given with SSRI
*Give naloxone if overdose on opioids (remember give frequently because it has short half life)
*10-20 mcg/mL is therapeutic range for dilantin
*Side effects of opiate: respiratory depression, constipation, urinary retention, CNS depression
*Check height and weight and grades should improve when on methylphenidate
*Dopaminergics and anticholinergics are contraindicated with glaucoma
*50-100 mcg/mL are therapeutic range for valproic acid
*gold standard treatment for PD is Levodopa-Carbidopa
*Increase inhibitory action to GABA receptors is effect of benzodiazepines
*No beer or sardines when taking MAOIs
*Do not drink alcohol when taking acetaminophen (it destroys liver)
*Vastus lateralis is preferred injection site for kids
*Benztropine treats Parkinson’s and side effects of psychotropic meds
*Carbidopa allows more levodopa to reach nerve endings
*Phenytoin causes gingival hyperplasia
*Cirrhosis of the liver is a contraindication for carbamazepine
*Because I said so is how you know I’m in pain
*Hot, dry skin, thirst, irritability, hungry, weight loss are signs of ketoacidosis
*Avoid alcohol if drug is hepatotoxic
*Narrow safety margin means narrow therapeutic index
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