NUR 138 ECPI Drug Cards Questions With
Complete Solutions
Trade Name/Generic Name: Demerol (meperidine)* correct answer: Classifications: Opioid
Uses/Actions: For the treatment of severe pain requiring an opioid analgesic and for which alternative treatments are inadequate.
Contraindications: Meperidine is contraindicated for use in patients with significant respiratory depression and in patients with acute or severe asthma (e.g., status asthmaticus) in unmonitored care settings or in the absence of resuscitative equipment. Additionally, avoid coadministration with other CNS
depressants when possible, as this significantly increases the risk
for profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate; if concurrent use is necessary, use the lowest effective dosages and minimum treatment durations needed. Monitor patients closely for signs or symptoms of respiratory depression and sedation. In patients with chronic obstructive pulmonary disease (COPD), cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, respiratory insufficiency, upper airway obstruction,
or preexisting respiratory depression, it is recommended that non-opioid analgesics be considered as alternatives to meperidine, as even usual therapeutic doses may decrease respiratory drive and cause apnea in these patient populations. Extreme caution should also be used in patients with chronic asthma, kyphoscoliosis (a type of scoliosis), hypoxemia, or paralysis of the phrenic nerve. Patients with advanced age, debilitation, or sleep apnea are at an increased risk for the development of respiratory depression associated with meperidine. Use with caution in patients with obesity as this is a risk factor for obstructive sleep-apnea syndrome and/or decreased respiratory reserve. Meperidine should not be used during impaired consciousness or coma, as significant decreases in respiratory drive may lead to adverse intracranial effects from
carbon dioxide retention. Respiratory depression, if left untreated, may cause respiratory arrest and death. Symptoms of respiratory depression include a reduced urge to breathe, a decreased respiratory rate, or deep breaths separated by long pauses High addiction rate.
Nursing Implications: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify, administer metoprolol with meals or directly after eating.
Usual Dosage and Route: IM or SC (25 to 100 mg q3 to 4 hours ); IV direct 10 to 30 mg given over at least 1 minute, titrated every 6 to 10 minutes until analgesia achieved (usual maximum 60 mg/hour), or pill 50-150 mg every 3-4 hours PRN
Information Patient Needs: High risk for addiction; get emergency help if signs of allergic reaction occur; opoid medicines can slow or stop breathing
Trade Name/Generic Name: Tylenol (acetaminophen)* correct answer: Classifications: Therapeutic:antipyretics, nonopioid analgesics
Uses/Actions: acts on hypothalamus--->dilates peripheral blood vessels
Contraindications: Hepatotoxic Side Effects: CNS: agitation ( children) (IV), anxiety (IV), headache (IV), fatigue (IV), insomnia (IV).Resp:atelectasis (children) (IV), dyspnea (IV).CV: hypertension (IV), hypotension (IV). GI: HEPATOTOXICITY (DOSES), constipation (children) (IV),qliver enzymes, nausea (IV), vomiting (IV). F and E: hypokalemia (IV). GU: renal failure (high doses/chronic use). Hemat: neutropenia, pancytopenia. MS: muscle spasms (IV), trismus (IV). Derm: acute generalized exanthematous pustulosis, Stevens-Johnson Syndrom, toxic epidermal, necroysis, rash, urticaria.
Usual Route Dosage and Route: Baby Drops(babies), Liquids (children), tablet (adults)
Information Patient Needs: do not drink alcohol, make sure patient isn't on anticoagulants
Trade Name/Generic Name: Ketalar (ketamine)* correct answer:
Classification: Anesthetic
Uses/Actions: the sole anesthetic agent for cardiac catheterization, skin grafts, orthopedic procedures, diagnostic procedures on the eye, ear, nose, and throat most commonly for short procedures (used in animals as well)
Contraindications: hypertension, glaucoma, hepatic or renal impairment
Side Effects: low blood pressure, nausea, vomiting, loss of appetite, dream-like feeling, blurred vision, double vision, dizziness, drowsiness, sleep problems (insomnia), or hallucinations.
Nursing Implications: Use requires patient monitoring, chronic alcoholic patients or acutely intoxicated, too rapid administration may cause respiratory depression Usual Dosage and Route: 10mg/mL, 50mg/mL, 100mg/mL-- IM
or IV Information Patient Needs: May cause dependence and tolerance
with prolonged use, do not operate machinery within 24 hr of administration
Trade Name/Generic Name: Xylocaine (lidocaine)* correct answer: Classification: Therapeutic:anesthetics (topical/local), antiarrhythmics (class IB)
Uses/Actions: used parenterally to treat acute, life-threatening ventricular arrhythmias. stop itching and pain from certain skin conditions (e.g., scrapes, minor burns, eczema, insect bites, hemorrhoids. *shingles treatment* works by causing temporary numbness/loss of feeling in the skin and mucous membranes.
Contraindications: Broken skin/infection, heart disease, liver disease, Hypersensitivity; cross-sensitivity may occur; Third-
degree heart block. Use Cautiously in: Liver disease, HF, patients weighing 50 kg, and geriatric patients (pbolus and/or maintenance dose); Respiratory depression; Shock; Heart block; OB, Lactation:Safety not established; Pedi:Safety not established for transdermal patch.
Side Effects: hypotension, edema, redness at injection site, small
red or purple spots on skin, constipation, nausea.
Nursing Implications: constant EKG monitoring, effects increased by beta-blockers, use caution in pregnant women
Usual Dosage and Route: 1-1.5 mg/kg slow IV and 10-20mg/100mL Injectable.
Information Patient Needs: nausea, constipation, vomiting are normal side effects, consult doctor immediately if labored breathing occurs
Complete Solutions
Trade Name/Generic Name: Demerol (meperidine)* correct answer: Classifications: Opioid
Uses/Actions: For the treatment of severe pain requiring an opioid analgesic and for which alternative treatments are inadequate.
Contraindications: Meperidine is contraindicated for use in patients with significant respiratory depression and in patients with acute or severe asthma (e.g., status asthmaticus) in unmonitored care settings or in the absence of resuscitative equipment. Additionally, avoid coadministration with other CNS
depressants when possible, as this significantly increases the risk
for profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate; if concurrent use is necessary, use the lowest effective dosages and minimum treatment durations needed. Monitor patients closely for signs or symptoms of respiratory depression and sedation. In patients with chronic obstructive pulmonary disease (COPD), cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, respiratory insufficiency, upper airway obstruction,
or preexisting respiratory depression, it is recommended that non-opioid analgesics be considered as alternatives to meperidine, as even usual therapeutic doses may decrease respiratory drive and cause apnea in these patient populations. Extreme caution should also be used in patients with chronic asthma, kyphoscoliosis (a type of scoliosis), hypoxemia, or paralysis of the phrenic nerve. Patients with advanced age, debilitation, or sleep apnea are at an increased risk for the development of respiratory depression associated with meperidine. Use with caution in patients with obesity as this is a risk factor for obstructive sleep-apnea syndrome and/or decreased respiratory reserve. Meperidine should not be used during impaired consciousness or coma, as significant decreases in respiratory drive may lead to adverse intracranial effects from
carbon dioxide retention. Respiratory depression, if left untreated, may cause respiratory arrest and death. Symptoms of respiratory depression include a reduced urge to breathe, a decreased respiratory rate, or deep breaths separated by long pauses High addiction rate.
Nursing Implications: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify, administer metoprolol with meals or directly after eating.
Usual Dosage and Route: IM or SC (25 to 100 mg q3 to 4 hours ); IV direct 10 to 30 mg given over at least 1 minute, titrated every 6 to 10 minutes until analgesia achieved (usual maximum 60 mg/hour), or pill 50-150 mg every 3-4 hours PRN
Information Patient Needs: High risk for addiction; get emergency help if signs of allergic reaction occur; opoid medicines can slow or stop breathing
Trade Name/Generic Name: Tylenol (acetaminophen)* correct answer: Classifications: Therapeutic:antipyretics, nonopioid analgesics
Uses/Actions: acts on hypothalamus--->dilates peripheral blood vessels
Contraindications: Hepatotoxic Side Effects: CNS: agitation ( children) (IV), anxiety (IV), headache (IV), fatigue (IV), insomnia (IV).Resp:atelectasis (children) (IV), dyspnea (IV).CV: hypertension (IV), hypotension (IV). GI: HEPATOTOXICITY (DOSES), constipation (children) (IV),qliver enzymes, nausea (IV), vomiting (IV). F and E: hypokalemia (IV). GU: renal failure (high doses/chronic use). Hemat: neutropenia, pancytopenia. MS: muscle spasms (IV), trismus (IV). Derm: acute generalized exanthematous pustulosis, Stevens-Johnson Syndrom, toxic epidermal, necroysis, rash, urticaria.
Usual Route Dosage and Route: Baby Drops(babies), Liquids (children), tablet (adults)
Information Patient Needs: do not drink alcohol, make sure patient isn't on anticoagulants
Trade Name/Generic Name: Ketalar (ketamine)* correct answer:
Classification: Anesthetic
Uses/Actions: the sole anesthetic agent for cardiac catheterization, skin grafts, orthopedic procedures, diagnostic procedures on the eye, ear, nose, and throat most commonly for short procedures (used in animals as well)
Contraindications: hypertension, glaucoma, hepatic or renal impairment
Side Effects: low blood pressure, nausea, vomiting, loss of appetite, dream-like feeling, blurred vision, double vision, dizziness, drowsiness, sleep problems (insomnia), or hallucinations.
Nursing Implications: Use requires patient monitoring, chronic alcoholic patients or acutely intoxicated, too rapid administration may cause respiratory depression Usual Dosage and Route: 10mg/mL, 50mg/mL, 100mg/mL-- IM
or IV Information Patient Needs: May cause dependence and tolerance
with prolonged use, do not operate machinery within 24 hr of administration
Trade Name/Generic Name: Xylocaine (lidocaine)* correct answer: Classification: Therapeutic:anesthetics (topical/local), antiarrhythmics (class IB)
Uses/Actions: used parenterally to treat acute, life-threatening ventricular arrhythmias. stop itching and pain from certain skin conditions (e.g., scrapes, minor burns, eczema, insect bites, hemorrhoids. *shingles treatment* works by causing temporary numbness/loss of feeling in the skin and mucous membranes.
Contraindications: Broken skin/infection, heart disease, liver disease, Hypersensitivity; cross-sensitivity may occur; Third-
degree heart block. Use Cautiously in: Liver disease, HF, patients weighing 50 kg, and geriatric patients (pbolus and/or maintenance dose); Respiratory depression; Shock; Heart block; OB, Lactation:Safety not established; Pedi:Safety not established for transdermal patch.
Side Effects: hypotension, edema, redness at injection site, small
red or purple spots on skin, constipation, nausea.
Nursing Implications: constant EKG monitoring, effects increased by beta-blockers, use caution in pregnant women
Usual Dosage and Route: 1-1.5 mg/kg slow IV and 10-20mg/100mL Injectable.
Information Patient Needs: nausea, constipation, vomiting are normal side effects, consult doctor immediately if labored breathing occurs
