NURS 323 Final Exam Focus Review Topics for Spring 2019 OLD Material (70 items)

NURS 323 Final Exam Focus Review Topics for Spring 2019 OLD Material (70 itemsNURS 323 Final Exam Focus Review Topics for Spring 2019 OLD Material (70 items) ATLEAST 12/day Introduction to Nursing Pharmacology (Safety, Nursing Process, Pharmacokinetics, Pharmacodynamics) Know and understand the mechanism of action of drugs on this list 1. Know the principles of pharmacokinetics: absorption, distribution, metabolism and excretion Pharmacokinetics is how drugs move through the body/what the body does to the drug. Dynamic equilibrium is the “pathway” of the drug through the body via pharmacokinetics. 1. Absorption from where the medication is entered via passive or active diffusion such as - By mouth would be GI. - Parental such as IV, IM, SQ, intradermal would be absorbed by the blood. - Rectally, vaginally, sublingual, ears, eyes would be mucous membranes to the blood. - Topical would be through the skin absorption. 2. Distribution to the active site such as getting to an infection in the body i.e. brain infection would need a lipid soluble medication in order for it to be distributed to the site. 3. Metabolism/Biotransformation occurs in the liver and this is where the medication is broken down to be excreted to detoxify the body to less harmful chemicals/levels. - First-pass effect: Medication that is metabolized by the liver during the first time it passes (hence, first-pass) breaks down the drug as much as possible and the rest goes into the body. Eventually, it’ll filter through the liver again. - AST, ALT labs test for liver function. 4. Excretion is the drug finally getting out of the body pretty much via anything the body excretes like saliva, teats, etc. but the kidneys are the main method to excretion. Think: urine drug tests. Grr. 2. Know the difference between loading and maintenance doses - Loading dose is the largest dose to reach therapeutic effect – quick in the body. Think: patient has infection or and Rocephin 1 gm is ordered and is prescribed antibiotics to maintain therapeutic effects OR EpiPen during an asthma attacks; just one of those big doses to make reach therapeutic effects QUICKLY. - Maintaining the levels at therapeutic levels? 3. Why do nurses need to know about pharmacology 4. 5 patient rights of drug administration 1. Right patient – do not want to give to wrong patient. 2. Right med – do not want to give the wrong patient, can cause adverse reaction to wrong medication. 3. Right dose – too much or too little is not beneficial nor therapeutic for the patient. 4. Right time – make sure medication is administered at a certain time because it usually is at the lower therapeutic effect. 5. Right route – can be toxic for a patient or else might not be absorbed. 5. Pregnancy categories (i.e., C, X, etc.) - Category A: no testing shows that there is risk for adverse effects in later trimesters. - Book: Adequate studies on pregnant women have no demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters. - Category B: Studies have been preformed on animals and show adverse effects, but no adverse effects in pregnant women. - Book: Animal studies have no demonstrated a risk to the fetus but no adequate studies in pregnancy women, or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during first trimester of pregnancy, and there is no evidence in later trimesters. - Category C: Animals have been tested and show adverse effects but there have not been enough evidence or studies on pregnant women to determine whether or not they would exhibit any adverse effects. OR no studies have been performed – period/Medication use benefits outweigh the adverse effect. - Book: Animal studies on animals show adverse effect on fetus but no adequate studies in humans the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans. - Category D: There are studies that have shown there are fetal risks, but the benefits outweigh the risks and/or are acceptable. - Book: The evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks. - Category X: There are adverse effects and very bad risks, abnormalities have been shown in both animals and humans. The risk of taking this medication outweighs the benefit. - Book: Studies in animals or humans demonstrate fetal abnormalities or adverse reaction report indicted evidence of fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit. - All in all, no drug is safe unless it is medically necessary and the benefits outweigh the risk. 6. Nursing process and drug administration - Assessment – checking the patient when they are first admitted for their condition. - Diagnoses – nursing diagnosis must have evidence to back up from the assessment. - Plan – follow up care for patient, rx the patient needs, referrals. - Implementation – Patient needs to follow through and take Rx. Visit as needed. - Evaluation – end goal. 7. Why is evaluation phase important? What are the phases and some possible nursing interventions associated with these phases when administering drugs. - Evaluation is important to know if the patient has any adverse effect or if the medication was effective. ?? - 8. Priority actions for nurses to take in the event of a medication error - Assess the patient, document adverse effects, file an incident report ?? 9. Signs of an anaphylactic reaction - Anaphylactic is something we should be able to assess by swelling, hypertension, SOB, rash, itching, tachycardia, sever, anxiousness. 10. Teaching about medications during each administration 11. Danger with crushing of extended release medications - Administering a bolus which is not indicated for the mechanism of the medication to be effective. Can be too strong got he patient? 12. Schedules of medications (i.e., I, II, III, IV) - DEA is the Drug Evaluation Agency is in control and enforces the Controlled Substance Act of 1970. - Schedule I (C-I) = High abuse protentional and has no medical use that is beneficial such as heroin, LSD, “marijuana”. - Book: High abuse potential and no accepted medical use. - - Schedule II (C-II): High potential for abuse and high level of dependency but it is prescribed such as narcotics, amphetamines, barbiturates. - - Schedule III (C-III): Less abuse potential and less addictive than level II drugs such as nonamphetamine stimulants, nonbarbiturate sedatives, and SOME narcotics). - - Schedule IV (C-IV): Less abuse potential and less addictive than level III drugs such as nonnarcotitis analgesics, antianxiety meds, some sedatives. - - Schedule V (C-V) Limited abuse potential. Does not need prescription or need to be dispensed by pharmacist. 18+ can order with an ID. Think: Target scans card, which is why they scan when we buy Nyquil. Chemotherapeutic Agents 13. Differentiate between narrow-spectrum antibiotics and broadspectrum antibiotics and state when one or the other would be preferred as a therapeutic approach and why - Anti-Infective Activity selectivity types = broad spectrum – positive and negative gram, narrow spectrum = only effective for a few number of organisms/particular gram stain organisms. - Narrow Spectrum of Activity = Effective against only a few microorganisms with a very specific metabolic pathway or enzyme such as only one type of gram stain - Type of bacteria that is difficult to kill = gram-negative due to their 3rd cell wall - Broad Spectrum of Activity = Useful in treating a wide variety of infections in terms of gram staining - We would want a narrow spectrum medications for a medication in which we know the cause of the patient’s infection depending on the specific gram stain and type of pathogen. - We would want broad for treatment of an infection we do not yet know the cause of the infection such as when we are waiting for a urine culture to return. There is a word for this??? 14. Explain the fundamental difference between bactericidal and bacteriostatic drugs. - Bactericidal medications = Aminoglycosides, Carbapenems, Fluoroquinolones, Penicillin. know what this means! It KILLS! -static slows the growth of bacteria. - inhibits the growth of mycobacteria; bacteriostatic. 15. Explain main mechanisms by which microbes develop resistance to antimicrobial drugs. - Natural or acquired resistance = Ability over time to adapt to an anti-infective drug via mutation and evolutionary changes and produce cells that are no longer affected by a particular drug that causes *superbugs*. Know about what are the mechanisms of resistance. - Prevention of resistance/superbugs = take the whole course of anti-biotics as prescribed even if they are feeling better. this is on the test - Anti- infectives act on specific enzyme system or biological process = many microorganisms that do not act on this system are not affected by this particular drug - Acquired Resistance = Microorganisms that were once sensitive to the particular drug have begun to develop acquired resistance. - Importance of giving the right antimicrobial to the patient and to avoid resistance = If drug resistant microbe is present antibiotics will create selection by killing off sensitive organisms which allows microbes then do not have to compete with each other for available nutrients. - Ways Anti-Infective Agents Resistance Develops = o Producing an enzyme that deactivates the antimicrobial drug o Changing cellular permeability to prevent the drug from entering the cell o Altering transport systems to exclude the drug from active transport into the cell o Altering binding sites on the membranes or ribosomes, which then no longer accept the drug!!!! Asked about this one specifically. What can alter the effect of drugs from attaching and entering the cell.  Producing a chemical that acts as an antagonist to the drug. know about the different ways of resistance. The question has answers that were the total opposite of developing resistance. 16. Explain prophylactic antimicrobial therapy. - Prophylactic used of anti-malarial drugs = Drug needs to be taken before traveling and at least 1-2 weeks after returning from traveling due to the paslmodium life cycle. Question on that exam asks for how a patient should take prophylactic. - Educating patients about anti-malarial drugs = Need to Administer the complete course of the drug to get the full beneficial effects. Mark a calendar for prophylactic doses. Question asks about how should patient’s adhere to treatment. 17. Nursing considerations for penicillins (pre-administration assessment, implementation, ongoing evaluation and monitoring, and patient teaching). Check culture and sensitivity reports to ensure that this is the drug of choice for this patient. • Monitor renal function tests before and periodically during therapy to arrange for dose reduction as needed. • Ensure that the patient receives the full course of the penicillin as prescribed, in doses around the clock, to increase effectiveness. • Explain storage requirements for suspensions and the importance of completing the prescribed therapeutic course even if signs and symptoms have disappeared to increase the effectiveness of the drug and decrease the risk of developing resistant strains. • Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site. Arrange to continue drug therapy for at least 2 days after the resolution of all signs and symptoms to reduce the risk of development of resistant strains. • Provide small, frequent meals as tolerated, ensure frequent mouth care, and offer ice chips or sugarless candy to suck if stomatitis and sore mouth are problems to relieve discomfort and ensure nutrition. • Provide adequate fluids to replace fluid lost with diarrhea. • Monitor the patient for any signs of superinfection to arrange for treatment if superinfections occur. • Monitor injection sites regularly, and provide warm compresses and gentle massage to injection sites if they are painful or swollen. If signs of phlebitis occur, remove the IV line and reinsert it in a different vein to continue the drug regimen. • Instruct the patient regarding the appropriate dosage regimen and possible adverse effects to enhance the patient’s knowledge about drug therapy and promote compliance. • Provide the following patient teaching: • Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur. • Report difficulty breathing, severe headache, severe diarrhea, dizziness, weakness, mouth sores, and vaginal itching or sores to a health care provider. Box 9.5 contains a teaching checklist for penicillins. 18. Nursing considerations for tetracyclines (pre-administration assessment, implementation, ongoing evaluation and monitoring, and patient teaching). - Tetracyclines = Developed as *semisynthetic antibiotics* based on the structure of a common soil mold - Sulfonamides Most common medications = o Tetracycline (generic) o demeclocycline (generic) o doxycycline (Doryx, Vibromycin) o minocycline (Arestin, Minocin) - How to determine Tetracyclines = ends with “-mycin.” - Tetracyclines Action = Inhibits *protein synthesis* in susceptible bacteria, preventing cell replication; broad spectrum - Tetracyclines Indications = o Treatment of various infections caused by susceptible strains of bacteria; *acne* when penicillin is contraindicated for eradication of susceptible organisms and when penicillin is contraindicated, chlamydia, syphilis - Tetracyclines Contraindications = o Known allergy to tetracyclines or to tartrazine,* ***pregnancy, ***, lactation and renal and hepatic dysfunction, Penicillin G, ***oral contraceptive therapy, methoxyflurane, digoxin - Tetracyclines and pregnancy = highly toxic and must be cautious to give to child-bearing women. Question asks about who you would not give this medication to. - Tetracyclines and children under 8 years old = not to be given! Can cause deposits and damage in developing bones and strain the teeth. - Tetracyclines in patients who have renal or hepatic dysfunction =They are concentrated in the bile and excreted in the urine. - Tetracyclines Adverse Effects = Most GI such as *diarrhea due to c. diff!*, but possible damage to the ***teeth and ***bones, photosensitivity Understand that diarrhea is an adverse effect of antibiotics. - Tetracyclines Drug-to-Drug Interactions = penicillin G, oral contraceptives, Digoxin, not to be used with anacids. - Prototype Summary: Tetracycline = Tetracyclines. Given in *lower doses* because of hepto- and renotoxicity. 19. Nursing considerations for cephalosporins (cephalexin) and vancomycin (required assessments, implementation, ongoing evaluation and monitoring and patient teaching). Cephalosporins Contraindications = – Allergies to cephalosporins or penicillin, hepatic or renal impairment because of the 10% Cephalosporins Adverse Effects = Most significant in GI tract such as: - pseudomembranous collits; superinfection in terms of the *3rd gen Cephalosporins. * - *Alcohol* consumption can cause a *disulfiram reaction* drug can cause sickness. - Photosensitivity. Cephalosporins Drug-to-Drug Interactions = – Aminoglycosides – oral anticoagulants – ETOH ** Cephalosporins with oral anticoagulants = not safe. Can cause the patient to be more susceptible to bleeding by inhibiting the effect of it Prototype Summary: Cefaclor (2nd gen) = Cephalosporins. Used for respiratory, derm, urinary, ear infections. Stops the synthesis of bacterial cell walls, causing cell death. A nurse is teaching a nursing student what is meant by *“generations”* of cephalosporins. Which statement by the student indicates understanding of the teaching? = - Vancomycin antibiotic classification = glycopeptide not an Aminoglycoside, but they are similar. - Adverse effect of Vancomycin = ***Red man syndrome Question asks what is an effect of administering this medication within less than one hour. It’s phrased as “reddened face and body” or something like that. - How red man synfrom occurs with Vancomycin = associated with rapid infusion of the first dose of the drug less than an hour - Red man syndrome symptoms = hives, rash, flushing, itching, low BPQuestion asks what are the symptoms associated with this syndrome. It was “select all that apply*. - Aminoglycosides Contraindications = Known allergies, *renal or hepatic disease*, hearing loss - Aminoglycosides Adverse Effects = *****Ototoxicity and nephrotoxicity* are the most significant. There was a question that I do not remember what medication it asks for, but it asks which is the adverse effect of this medication. I chose hearing. - There was another question that asks what would you do if you had to administer a medication and the patient complains that they are hard of hearing? It was all Administer medication and… but I chose the “hold and call the provider.” 20. Contraceptive use and antimicrobials - Tetracyclines Contraindications = o Known allergy to tetracyclines or to tartrazine,* ***pregnancy, ***, lactation and renal and hepatic dysfunction, Penicillin G, ***oral contraceptive therapy, methoxyflurane, digoxin - Antiprotozoal effect in child-bearing, pregnant and nursing women = do not take these drugs unless the benefit outweighs the potential risk. Contraceptives should be used. Protozoal infections should be educated that it can affect the fetus. - Tetracyclines and pregnancy = highly toxic and must be cautious to give to child-bearing women. Question asks about who you would not give this medication to. 21. Peak and trough levels - Make sure doses are *high enough* when taking antimicrobials = to prevent resistance because it is directed to take accordingly because it is taken at the lowest therapeutic effect. We want to maintain the adequate blood levels. know about what time to monitor the next dose for peak and trough levels. There was a question about medication being administered for their next dose at 800 and it takes 60 min to complete admin. Answers were like 700 and 830, 700 and 930, 730 and 830 and 730 and 1030. - Nephrotoxicity monitor for Aminoglycosides = peak and trough to ensure that the medication is the highest and the next dose is lowest therapeutic effect. We are responsible for communicating the next dose by testing levels after 30 minutes. - Especially in vancomycin 22. Nursing considerations for macrolides (erythromycin, azithromycin) (required assessments, implementation, ongoing evaluation and monitoring, and patient teaching). - What to watch out for with macrolides = statins drug to drug interaction with cholesterol meds because they want to reach the cytochrome p50 which decreases the adverse effect of rhabdomyolysis (muscle pain and..) - Macrolides = that bind to the subunit of the ribosome within the bacterial cell and interfere with protein synthesis within the cell. - Macrolides adverse effects = QT prolongation. - Macroldies drug-to-drug interactions = -statin drugs, cholesterol medications because these medications will always bind first; antagonists. Patient will experience muscle aches. - Prototype Summary: Aztreonam = Monobactam antibiotic. Treatment of lower respiratory, dermatological, urinary tract, intra-abdominal, and gynecological infections caused by susceptible strains of gram-negative bacteria. - What would you teach your patient taking a macrolide antibiotic? = Avoid grapefruit juice. - Prototype Summary: Erythromycin = Macrolides. Treatment of respiratory, dermatological, urinary tract, and gastrointestinal infections caused by susceptible strains of bacteria. Do not take with grape fruit juice because of the interaction with the p450! - azithromycin 23. Nursing considerations for aminoglycosides such as gentamycin (assessments, implementation, ongoing evaluation and monitoring, and patient teaching). - Aminoglycosides = A group of powerful antibiotics used to treat serious infections caused by *gram-negative* aerobic bacilli - How to identify Aminoglycosides/macrolides = they end with “-mycin” - Bactericidal medications = Aminoglycosides, Carbapenems, Fluoroquinolones, Penicillin. know what this means! It KILLS! -static slows the growth of bacteria. - Aminoglycosides Indications = Treatment of serious infections caused by susceptible bacteria - Aminoglycosides mechanism of Actions: *Inhibits protein synthesis* in susceptible strains of *gram-negative bacteria* causing cell death - Aminoglycosides Pharmacokinetics = o Poorly absorbed from the GI tract, but rapidly absorbed after IM injection, reaching peak levels within 1 hour o Widely distributed throughout the body, crossing the placenta and entering breast milk o Excreted unchanged in the urine and have an average half-life of 2 to 3 hours o *Depend on the kidney for excretion and are ***toxic to the kidney * there was a question that asks what we would monitor with idk which medication, but the answers were AST, ALT, serum creatine, hematocrit and hemoglobin. I chose creatinine. - Nephrotoxicity monitor for Aminoglycosides = peak and trough to ensure that the medication is the highest and the next dose is lowest therapeutic effect. We are responsible for communicating the next dose by testing levels after 30 minutes. - Toxicity of antimicrobials occurs at what pharmacokinetic = at the cumulative effect, not in the trough level. 24. Nursing considerations for sulfonamides such as Bactrim DS (assessments, implementation, ongoing evaluation and monitoring, and patient teaching). - Sulfonamides = Drugs that inhibit folic acid synthesis - Sulfonamides Most common medications = o sulfadiazine (generic) o sulfasalazine (Azulfidine) o *cotrimoxazole (Septra, Bactrim)* - how to identify Sulfonamides = ends with “-azine” for the most part. - Bacteriostatic antibiotics = Sulfonamides, Tetracyclines - Sulfonamides Action- = block *para-aminobenzoic acid* to prevent the synthesis of *folic acid in susceptible bacteria* There was a question about a antibiotic with the inhibition of folic acids - Sulfonamides Indications = Treatment of infections caused by *gram-negative and gram-positive bacteria*; broad spectrum - Sulfonamides Contraindications = o Known allergy to any sulfonamide, *thiazide diuretics* and pregnancy - *thiazide diuretics* and Sulfonamides = not safe if patient is allergic to either one because of cross sensitivity. - Sulfonamides Adverse Effects = GI symptoms; Renal effects related to the filtration of the drug, photosensitivity - Sulfonamides Drug-to-Drug Interactions = o tolbutamide, tolazamide, glyburide, glipizide, or chlorpropamide and cyclosporine - Nursing Considerations for Patients Receiving Sulfonamides = o Abdomen o Renal function tests o *Complete blood count* o Make sure the patient is hydrated. o Encourage patient to wear sunscreen. know which needs to monitor CBC and which medications make a patient photosensitive. - Purpose of CBC with Sulfonamides = can cause hemolytic anemia. - Sulfonamides should not be given with thiazide diuretics because of a cross sensitivity of the drugs. = True I think this question was on the test - Prototype Summary: ***Cotrimoxazole = AKA bractim, septra. Sulfonamides that treat UTI, ear infections in children, exacerbations of chronic bronchitis in adults, traveler’s diarrhea, pneumonia. - A patient is taking cotrimoxazole (Sulfonamides) for a UTI and is going on a cruise. What education would be appropriate for the nurse to give? = Wear a hat and sunscreen know which medications make a patient photosensitive. 25. Nursing considerations for anti-tubercular drugs (PZA, Isoniazid, rifampin, ethambutol (pre-administration assessment, implementation, ongoing evaluation and monitoring and patient teaching) - Nursing considerations for anti-tubercular drugs for antimycobacterial drugs (PZA, Isoniazid, rifampin, ethambutol): pre-administration assessment = - History and examination: contract indications such as allergies, renal or hepatic disease. - CNS dysfunction such as seizures. - pregnancy status. - Physical examination for baseline data. - Examine skin. - Culture and sensitivity. - CNS orientation, respiratory status. - Renal and Liver function. - Nursing considerations for anti-tubercular drugs for antimycobacterial drugs (PZA, Isoniazid, rifampin, ethambutol): Implementation =  Check culture and sensitivity results.  Monitor liver and renal function while on these meds.  Ensure the patient takes the full course as directed.  D/C if hypersensitivity occurs.  *Encourage patient to eat small, frequent meals, dental hygiene, drink lots of fluids.*  Purpose of appropriate drug regimen and the purpose of combination of drugs.  Use back-up contraception  *orange colored urine and tears!* question asks about what is something you should educate your patient about rifampin.  Report difficulty breathing, hallucinations, numbness and tingling, worsening of condition, fever and chills, or changes in color of urine or stool. - Nursing considerations for anti-tubercular drugs for antimycobacterial drugs (PZA, Isoniazid, rifampin, ethambutol): ongoing evaluation, monitoring and education =  response to drug  Adverse effects  Effectiveness of teaching plan  Effectiveness of comfort and safety measures to comply with regimen.  Pyrazinamide, PZA mechanism of action = Used in combination with other drugs to prevent emergence of resistant strains and to affect the bacteria at various phases during their *long and slow life cycle* by lowering the pH environment.  Pyrazinamide, PZA, Isonizaid, Rifampin indications = Treatment of M. tuberculosis.  Pyrazinamide, PZA pharmacokinetics = PO; wide distribution: high concentration in the CNS, excreted in breast milk; Protein-binding 50%, metabolized in the liver and excreted by the kidneys.  Pyrazinamide, PZA contraindications = Hypersensitvity, *severe liver impairment*, cross-sensitivity with ethionamide, isoniazid, niacin, or nicotinic acid may exist  Pyrazinamide, PZA most common adverse reactions = Hepatotoxicity, hyperuricemia.  Pyrazinamide, PZA important drug–drug interactions. = Use with rifampin can cause life-threatening hepatotoxicity, cyclosporine and gout agents reduces effectiveness  Isoniazid mechanism of action = To inhibit mycobacterial cell wall synthesis and interferes with metabolism.  Isoniazid Indications = Treatment for active M. tuberculosis with other agents.  Isoniazid pharmacokinetics = PO and IM; widely distributed: *blood-brain barrier, crosses the placenta, enters breast milk in concentrations equal to plasma.* Metabolized by liver and excreted by the kidneys.  Isoniazid contraindications = hypersensitivity, renal impairment, malnourished patients, diabetic patients, chronic alcoholics: risk for neuropathy.  Isoniazid most common adverse reactions = peripheral neuropathy, drug-induced hepatitis, pancreatitis.  Isoniazid and important drug–drug interactions = Aluminum contraining antacids decrease absorption, alcohol: hepatotoxicity  Rifampin mechanism of actions = Inhibits *RNA synthesis* by blocking RNA transcription in susceptible organisms, broad spectrum  Rifampin indications =  Active tuberculosis (with other agents).  Elimination of meningococcal carriers.  Rifampin pharmacokinetics = PO, widely distributed: enders the *CSF, crosses placents, enters breast milk; metabolized by the liver and *excreted in feces*.  Rifampin contraindications = hypersensitivity; Concurrent use of atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, or ritonavir-boosted saquinavir; liver disease, diabetes, other hepatotoxic agents, pregnancy or nursing.  Rifampin most common adverse reactions = red discoloration of ears; GI: abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting; *red discoloration of urine*.  Rifampin important drug–drug interactions = increase hepatotoxicity with other hepatotoxic agents such has *alcohol, ketoconazole, isoniazid, pyrazinamide (concurrent use withpyrazinamide*.  ethambutol mechanism of action = inhibits the growth of mycobacteria; bacteriostatic.  ethambutol indications = treatment for M. tuberculosis with at least one other drug. important to understand that antibiotics and antimycobacterials need to be taking in combo with other medication of the same category to prevent resistance.  ethambutol pharmacokinetics = PO, absorbed by the *GI tract*; wide distribution: blood brain barrier *in small amounts*, placenta, breast milk; liver and excreted by the kidneys.  ethambutol contraindications = hypersensitivity, *optic neuritis*, renal and hepatic impatiement know the medications that effect the eyes.  ethambutol most common adverse reactions = optic neuritis/blindness.  ethambutol important drug–drug interactions = other neurotoxic agents and aluminum hydroxide can decrease the absorption. 26. Nursing considerations for fluoroquinolones. Focus on ciprofloxacin (Cipro) (pre- administration assessment, implementation, ongoing evaluation and monitoring and patient teaching).  Fluoroquinolones = Relatively new class of antibiotics with a *broad spectrum* of activity.  Fluoroquinolones Common medications = o ***ciprofloxacin (Cipro), which is the most widely used o fluoroquinolone, gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox),norfloxacin (Noroxin), ofloxacin (Floxin, Ocuflox), and finafloxacin (Xtoro)  How to identify Fluoroquinolones = ends with “-floxacin”.  Fluoroquinolones Indications = Treating infections caused by susceptible strains of *gram-negative bacteria*.  Fluoroquinolones treats infections including = urinary tract, respiratory track, and skin infections  Fluoroquinolones Actions = Interferes with *DNA replication* in susceptible *gram-negative* bacteria, preventing cell reproduction.  Fluoroquinolones Contraindications = Known allergy, pregnancy, or lactating women and renal dysfunction.  Fluoroquinolones Adverse Effects = Most common: Headache, dizziness, insomnia and depression, *tendon rupture*, AT prolongation; arrythmias.  Adverse reaction unique to Fluoroquinolones = tendon rupture; any tendon but commonly in the elbows and heels.  Fluoroquinolones Drug-to-Drug Interactions = o Antacids, quinidine, theophylline. o Take this medication without food; 1 hour before or 2 hours after.  Prototype Summary: Ciprofloxacin = Fluoroquinolones. Specific to this medication, given for typhoid fever, which is commonly seen in places with lush foresty.  Which of the following symptoms would the nurse expect be an adverse side effect of a Fluoroquinolones? = Pain in the elbows, ankles and heels  Prototype Summary: Ciprofloxacin = Fluoroquinolones. Specific to this medication, given for typhoid fever, which is commonly seen in places with lush foresty.  Which of the following symptoms would the nurse expect be an adverse side effect of a Fluoroquinolones? = Pain in the elbows, ankles and heels 27. Nursing considerations for metronidazole (Flagyl)  Metronidazole (Flagyl, MetroGel, Noritate) = Treats amebiasis, trichomoniasis, bacterial vaginosis and giardiasis.  antiprotozoal prototype drug metronidazole mechanism of action = Inhibits *DNA synthesis* of specific anaerobes, causing cell death; mechanism of action as an antiprotozoal and amoebicidal is not known.  antiprotozoal prototype drug metronidazole indications = Acute intestinal amebiasis, amebic liver abscess, trichomoniasis, acute infections caused by susceptible strains of anaerobic bacteria, and preoperative and postoperative prophylaxis for patients undergoing colorectal surgery.  antiprotozoal prototype drug metronidazole pharmacokinetics = well absorbed orally, reaching peak levels in 1 to 2 hours. It is metabolized in the liver with a half-life of 8 to 15 hours. Excretion occurs primarily through the urine.  antiprotozoal prototype drug metronidazole contraindications =  Alcohol until 3 days after treatment; disulfiram reaction. – there was a question about what should the patient avoid while taking this meciation.  Anticoagulants can cause more bleeding.  Psychotic reactions if combined with disulfiram. Need to wait at least 2 weeks after treatment.  antiprotozoal prototype drug metronidazole proper administration = Oral, vaginal gel or IV.  antiprotozoal prototype drug metronidazole most common adverse reactions = Headache, dizziness, ataxia, nausea, vomiting, *metallic taste*, diarrhea, darkening of the urine.  antiprotozoal prototype drug metronidazole important drug–drug interactions = alcohol, cimetidine can decrease metabolism, phenobarbital and rifampin can increase metabolism and decrease effectiveness; psychosis with alcohol ingestion.  antiprotozoal prototype drug metronidazole nursing considerations = patient needs to take prescription and prescribed, urine will become dark, *metallic taste*, do not take with alcohol. 28. Nursing considerations for antihelminthic (mebendazole) - prototype drug mebendazole - Anthelminthic prototype drug mebendazole (Vermox) = chewable tablet convenient for use of children for treatment of pinworms, roundworms, whipworms, and hookworms. - mebendazole (Vermox) nursing considerations =  Assess for worms in perineal area.  Test kidney and liver function.  CBC – risk for leukopenia and thrombocytopenia.  Since this medication is not absorbed it can cause transient abdominal pain, diarrhea, and fever.  No special diets, fasting, laxatives, or enemas before taking this.  Chewed or swallowed whole. - Nursing Considerations for Antimalarial Agents = - Assess: o History of allergy o Physical status o *Ophthalmic and retinal examinations and auditory screening* o Liver function, including liver function tests o *Blood culture* to identify the causative,* Inspect the skin* closely for color, temperature, texture, and evidence of lesions - Education for taking mebendazole (Vermox); anthelmintic =  Take it as directed and continue *the full course, even if symptoms resolve*.  If you forget, take dose as soon as your remember; 2 doses regimen; take doses 4-5 hours apart or double dose.  Hygienic precautions – hand hygiene, wash all veggies, wear shoes).  Dizziness – no heavy machinery.  Advise doctor if no improvement.  Follow-up exams to determine if med worked.  Wash everything; do not shake! 29. Prevention of pinworm infection - Discuss the clinical presentation of pinworm infection - clinical presentation of pinworm infection =  Itching of the perineal area.  Perivaginal itching.  General irritability.  Restlessness. - Pinworms = nematode that causes a common helminthic infection in humans; lives in the intestine and causes anal and possible vaginal irritation and itching - Discuss managing pinworm infections. - Managing pinworm infections =  Strict handwashing (sing happy birthday) – question asks about what should be educated to the parents about to prevent the spread of infection.  Showering the child every morning, cleaning bedding and undergarments in hot water, with chlorine if possible.  Cleaning the toilet area daily.  Sanitization of toys and other objects.  Trim finger nails.  3-day treatment. • Anthelminthic prototype drug mebendazole (Vermox) = chewable tablet convenient for use of children for treatment of pinworms, roundworms, whipworms, and hookworms. Fungal Infections 30. Nursing considerations for amphotericin B (assessment, implementation, ongoing evaluation and monitoring and patient teaching). 31. Identify drug to drug interactions with azole group of antifungal medications. 32. Differentiate superficial and systemic mycoses. Viral Infections 33. Mechanism of action of antiviral drugs - Mechanisms of action of anti-infective agents o Interfere with biosynthesis of the bacterial *cell wall* o *Prevent the cells of the invading organism* by using substances essential to their growth and development o Interfere with steps involved in *protein synthesis* o Interfere with *DNA synthesis* o Alter the *permeability of the cell membrane* to allow essential cellular components to leak outunderstand which antibiotic does what. There was a question that asked about the different methods of mechanisms of actions. The question had other answers that described the opposite of what the medication does like different methods of resistance. 34. Nursing considerations for non HIV antiviral. Focus on acyclovir (assessment, implementation, ongoing evaluation and monitoring and patient teaching). - Acyclovir mechanism of actions = Interferes with viral DNA synthesis for HSV infectiom; stop viral replication, decreases viral shedding, and reduce time for healing lesions. - Acyclovir indications = Treatment of HSV 1 and 2, HSC encephalitis, acute treatment of shingles and chickenpox, ointment for treatment for HSV2 and cold sores. - There as a question about how this medication would be administered if it was a topical medication. There were apply before bed, in the morning or with gloves. I chose with gloves. - Acyclovir pharmacokinetics = poor absorption PO and Iv, CSF, crosses placenta, breask milk, liver, kidneys. - Acyclovir contraindications = hypersensitivity to acyclovir and valacyclovir, milk protein concentrate (buccal only). - Acyclovir most common adverse reactions = headache, vertigo, tremors, nausea, vomit, rash, renal failure, seizures, stevens-johnsons syndrome. - Acyclovir important drug–drug interactions = - Probenecid, theophylline can increase blood levels of this medication. - Valporic acid, phenytoin decrease the effectiveness. Other nephrotoxic drugs. - Zidovudine and IT methotrexate increase CNS side effects. • Nursing measures to implement for preventing renal adverse effects when administering anti-viral agents = hepatic function, renal function testing and CBC tests need to be done periodically. CBC tests for bone marrow suppression. 35. Know Interferon Alfa - Immune Stimulant: Interferon prototype = Interferon Alfa-2b - Interferon Alfa-2b indications = Hairy cell leukemia, malignant melanoma, AIDS-related Kaposi sarcoma, chronic hepatitis B and C, follicular lymphoma, intralesional treatment of condylomata acuminata in patients 18 years of age or older. - Interferon Alfa-2b Actions = INHIBITS the growth of tumor cells and enhances the immune response in cells that *HAVE NOT* been infected by virus. - Interferon Alfa-2b routes of administration = parenterally; IV and IM. - Interferon Alfa-2b Adverse Effects = Dizziness, confusion, rash, dry skin, anorexia, nausea, bone marrow suppression, flu-like syndrome. - If a medication can cause *bone marrow suppression*, consider these. = infections, decreased WBC, anemia. 36. Nursing considerations for anti-neoplastic agents (assessments, implementation, ongoing evaluation and monitoring, and patient teaching). - Antineoplastic drugs = Alter human cells in a variety of ways. Their action is intended to target the abnormal cells that compose the neoplasm or cancer, having a greater impact on them than on normal cells. Unfortunately, normal cells also are affected by antineoplastic agents. - Adverse effects of antineoplastic cells = no specificity!  Nausea and vomting  Alopecia  Skin changes  Hepatic toxicity  Cardio toxicity  Anemia from bone marrow suppression  Infection from bone marrow suppression. - Alkylating Agents = antineoplastic agent; Reacts chemically with portions of the RNA, DNA, or other cellular proteins - Antimetabolites = antineoplastic agent; o Have chemical structures similar to those of natural types. o Participates in biochemical reactions in cells but different enough to interfere with the normal division and functions of cells. - Antineoplastic Antibiotics = antineoplastic agent; o Not selective only for bacterial cells; *toxic to human cells* we worry about specificity. Asked on the test. - Mitotic Inhibitors = antineoplastic agent; o Drugs that kill cells as the process before it begins. - Hormones and Hormone Modulators = antineoplastic agent; o Used in cancers that are sensitive to *estrogen stimulation*. i.e., breast CA. - Cancer Cell Specific Agents = antineoplastic agent; o Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST). There was a question about CD4 and this is being effected by antineoplastic meds. IDK why but I chose this instead of CD5. Drugs acting on the immune system 37. Know acetaminophen, aspirin and celecoxib - acetaminophen actions = o Acts directly on the thermoregulatory cells of the hypothalamus o Mechanism of action unknown but related to analgesic effects in CNS o Used to treat pain and fever (vasodilation decreases heat) - acetaminophen indications = Treatment of mild to moderate pain, fever, or signs and symptoms of the common cold or flu; musculoskeletal pain associated with arthritis and rheumatic disorders. - acetaminophen pharmacokinetics = o Absorbed from GI tract o Peak ½ to 2 hours o Metabolized in the liver o Excreted in the urine - acetaminophen contraindications =  Known allergy o Use with caution in pregnancy and lactation o Hepatic dysfunction or chronic alcoholism There was a question that asks who you would not give a certain medication to which was this answer. - acetaminophen most common adverse reactions = Rash, fever, chest pain, liver toxicity and failure, bone marrow suppression. - acetaminophen important drug–drug = o *Oral anticoagulants increase bleeding o Hepatotoxicity with barbiturates, carbamazepine, hydantoins, or rifampin - acetaminophen nursing considerations = - Assess- o Known allergies o Baseline status before beginning therapy and for any potential adverse effects o Pregnancy or lactation; hepatic or renal disease; CV dysfunction; hypertension; and GI bleeding or peptic ulcer o Presence of any skin lesions; temperature; orientation, reflexes, and affect; pulse, blood pressure, and perfusion; respirations and adventitious sounds; liver evaluation; bowel sounds; and CBC, liver and renal function tests, urinalysis, stool guaiac, and serum electrolytes. Multiple questions that ask about what would be assessed as a priority to giving different anti-infective to a patient, which were all assess the allergy. - Allowed maximum dose for health adults taking acetaminophen = 3 grams. - Allowed maximum does for alcoholics taking acetaminophen = 2 grams. - salicylates prototype drug aspirin actions = Inhibits the synthesis of prostaglandins; blocks the effects of pyrogens at the *hypothalamus to act on fever*; *inhibits platelet aggregation* by blocking thromboxane A2. - salicylates prototype drug aspirin indications = Treatment of mild to moderate pain, fever, inflammatory conditions; reduction of risk of transient ischemic attack or stroke; reduction of risk of myocardial infarction. - - salicylates prototype drug aspirin pharmacokinetics = *absorbed from the stomach* reaching peak levels with in 5 to 30 minutes. Liver, urine. Cross placenta and breast milk, not safe during pregnancy, bleeding risk for mother. - salicylates prototype drug aspirin contraindications = hypersensitivity, bleeding disorders, *Reye’s syndrome in children*, GI bleeding or ulcers, alcohol use, hepatitis or renal disease, increase risk of GI bleed in geri, sensitive to toxic levels. - salicylates prototype drug aspirin most common adverse reactions = Nausea, vomiting, heartburn, epigastric discomfort, occult blood loss, dizziness, *tinnitus!*, acidosis. - salicylates prototype drug aspirin important drug–drug = other anticoagulants to cause increased risk of bleeding. Ibuprofen. this is important to note and is a question about the adverse effect. - - Question asks about what shows a patient would need further education about taking some sort of NSAID and there was an answer that stated they if they have a GI upset, they should eat. I forget the rest of the answers. - celecoxib 38. Know Cox 1 and Cox 2 mechanism of action 39. COX 1 and COX 2 = Cyclooxygenase enzyme released during the process of inflammation. 40. COX 1 = turns arachidonic acid into prostaglandins as needed in a variety of tissues. - COX 2 = active at sites of trauma or injury when more prostaglandins are needed, but it does not seem to be involved in the other tissue functions. understand what is the purpose of these sites. - Nonselective anti-inflammatory can cause = The common side effect of GI bleed and ulcers due to the blockage of COX 1 and COX 2. - *Cyclooxygenase enzyme that is GI protectant and beneficial for the body (emphasized)* = COX 1. - Arachidonic acids released during the inflammation process, it releases this. = COX 1 and COX 2. - Blocking COX 1 Enzymes can lead to which of the following? = GI bleeding due to prostaglandin decrease. Renal failure. - When are NSAIDs COX -2 contraindicated? = Allergy to sulfonamides. - To reduce inflammation, what inhibition is desirable? = COX-2 only. - To prevent effects in the GI, renal tract, platelet function, and macrophage differentiation. What Inhibition is undesirable for prolonged use? = COX-1 for the homeostatic functions. - There was another question about what would indicate further education for the patient in their understanding how acetaminophen work? Something about how it only blocks cox-2. I might bleed more from taking this medication, which would not be true since this is not ASA I believe. 41. Nursing considerations – patient teaching for vaccine administration - Immunoglobins mechanism of action = via vaccines in a form of an immunization will give *passive immunity*. Question asks what type of immunity are immunizations. - Immunization definition = The process of artificially stimulating *active immunity* - Question asks about what would indicate that the mother of a child would need further education about the administration of a vaccination? There were answers that were like take acetaminophen if child develops fever, ASA when child is fussy, child can develop fever after administration, and I forget the answer I chose but it was right. - Who would you give MMR to? Someone allergic to allergies, patient with organ transplant, patient who is immunocompromised or patient with cystic fibrosis? It was cystic fibrosis. - Recommendation of how often should one receive the influenza and TdAP vaccine. - Influenza recommendation for adults = every 10 years! Queston on the exa about how often to take this. - Influenza recommendation for peds = over 6 months and repeated 4 weeks after the initial administration. Administered yearly. Question asks why you would have a patient administer flu every year and the answer was because the type of virus has changed every year - TdAP in children = over the age of 7 years old, one dose at 11-12 years old. If administered younger than 12 month, second dose is 4 weeks after. Older than 12 months, second dose is 6 weeks after. Drugs acting on the cardiovascular system Lipid Disorders 42. Nursing considerations for HMG-coA Reductase inhibitors (statins), fibric acid derivatives, bile acid sequestrants and niacin (assessment, implementation, ongoing evaluation and monitoring and patient teaching). HMG-CoA reductase inhibitor highlighted in class = - last enzyme in reducing all cholesterol in the liver - these are your statins – no grapefruit! - most prescribed and most effective in controlling cholesterol. rest of medications are adjunct to this med. Patient education HMG-CoA reductase inhibitor highlighted in class = needs to be taken at night because of the absorption and processing occurs in the early AM between 3 am to 5 am. this is more for absorption. Bile acid sequestrants administration = given in a powder form mixed with 6 oz of any fluid and creates a bulk reaction to prevent cholesterol from binding in the intestine. HMG-CoA reductase inhibitor nursing considerations: assessment = - All the same as above except for labs: Monitor the results of laboratory tests, including renal and liver function tests, to identify possible toxicity and serum lipid levels to evaluate the drug’s effectiveness. HMG-CoA reductase inhibitor nursing considerations: implementation = – Administer the drug at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5 AM, and the drug should be taken when it will be most effective; give atorvastatin at any time during the day.  Monitor serum cholesterol and LDL levels before and periodically during therapy to evaluate the effectiveness of this drug.  Arrange for periodic ophthalmic examinations to monitor for cataract development.  Monitor liver function tests before and periodically during therapy to monitor for liver damage; consult with the prescriber to discontinue the drug if the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) level increases to three times normal.  Ensure that the patient has attempted a cholesterol-lowering diet and exercise program for at least 3 to 6 months before beginning therapy to ensure the need for drug therapy.  Encourage the patient to make the lifestyle changes necessary to decrease the risk for CAD and to increase the effectiveness of drug therapy.  Withhold lovastatin, atorvastatin, or fluvastatin in any acute, serious medical condition (e.g., infection, hypotension, major surgery or trauma, metabolic endocrine disorders, seizures) that might suggest myopathy or serve as a risk factor for the development of renal failure.  Suggest the use of barrier contraceptives for women of childbearing age because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy.  Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals to minimize nausea and vomiting; access to bathroom facilities to ensure adequate bowel evacuation; bowel program as needed to address constipation; use of food with the drug if GI upset is severe to decrease direct irritating effects; environmental controls, such as temperature and lighting controls, to help deal with headaches; and safety precautions, such as lighting control and activity restrictions, to protect the patient if vision changes and muscle effects occur.  Offer support and encouragement to help the patient deal with the diagnosis, needed lifestyle changes, and the drug regimen.  Provide thorough patient teaching, including the name of the drug, dosage prescribed, and administration at bedtime for best effectiveness; measures to avoid adverse effects, warning signs of problems, and the need for follow-up laboratory testing to monitor cholesterol and lipid levels; importance of follow-up renal and liver function testing; dietary and lifestyle changes for risk reduction; and monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.  Fibrate derivitatives – Gemfibrozil indication (Lopid – Other lipid-lowering agents) = Treatment of very high triglyceride levels with abdominal pain and potential pancreatitis in adults – Gemfibrozil action (Lopid – Other lipid-lowering agents) = inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. Should not be combined with statins. – Gemfibrozil adverse effect (Lopid – Other lipid-lowering agents) = o GI and muscle discomfort. Use for over 3 weeks to several months can cause rhabdomyolysis (muscle breakdown); increased when taken with a statin. o Caution with patient with renal impairment – avoid this! o Gallstones occur with this drug; pt should be screened carefully. o Increased bleeding can occur with warfarin use bile acid sequestrants and cholesterol absorption inhibitor nursing consideration: assessment = – Known allergies, impaired intestinal function, biliary obstruction (effectiveness), and current status related to pregnancy and lactation – Perform a physical assessment to establish a baseline – Weigh the patient to establish a baseline – Inspect the patient’s skin for color, bruising, and rash – Assess neurological status, including level of orientation and alertness – Monitor pulse and blood pressure – Inspect the abdomen for distention and auscultate bowel sounds (for changes in GI motility.) – Assess bowel elimination patterns, including frequency of stool passage and stool characteristics (to identify possible constipation and fecal impaction.) – Monitor the results of laboratory tests, including serum cholesterol and lipid levels. bile acid sequestrants nursing consideration: implementation = – Do not administer powdered agents in dry form; these drugs must be mixed in fluids to be effective. Mix with fruit juices, soups, liquids, cereals, or pulpy fruits. Mix colestipol, but not cholestyramine, with carbonated beverages. Stir, and encourage the patient to swallow all of the dose. – If the patient is taking tablets, ensure that tablets are not cut, chewed, or crushed because they are designed to be broken down in the GI tract; if they are crushed, the active ingredients will not be effective. Urge the patient to swallow tablets whole with plenty of fluid. – Give the drug before meals. – Administer other oral medications 1 hour before or 4 to 6 hours after the bile sequestrant to avoid drug–drug interactions. – Arrange for a bowel program as appropriate (help with constipation) – Provide comfort measures These include small, frequent meals to reduce the risk of nausea; ready access to bathroom facilities to prevent constipation; safety precautions to prevent injury if dizziness, CNS changes, or bleeding is a problem; replacement of fat-soluble vitamins; skin care as needed; and analgesics for headache. – Offer support and encouragement Patient teaching/education on bile acid sequestrants = Provide thorough patient teaching, including the name of the drug, dosage prescribed, and schedule for administration; method to administer the drug, such as mixing the powder form in fluids or taking tablets whole (without crushing, chewing, or cutting); appropriate fluids for mixing drug; measures to avoid adverse effects, warning signs of problems, and the need for follow-up laboratory testing to monitor cholesterol and lipid levels; dietary and lifestyle changes for risk reduction; and monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance. niacin adverse effects = - intense *cutaneous flushing* (common), nausea, and abdominal pain, making its use somewhat limited. It also increases the serum levels of uric acid – can cause patient to develop gout. - Mixing with bile acid sequestrants increase its effect Hypertension 43. Long term effects of HTN and why medication compliance is important - Untreated hypertension increases a person’s risk for the following conditions: CAD and cardiac death, stroke, renal failure, and loss of vision. o congestive heart failure/Left ventricular hypertrophy, pulmonary edema, myocardial infarction (discussed in class) - Patients do not want to adhere because of the adverse effects. Otherwise they feel fine and they feel like they should stop. - blood vessels, increased risk of atherosclerosis, and damage to small vessels in end organs. Because hypertension often has no signs or symptoms, it is called the silent killer. 44. DASH dietary recommendations - Lower in sodium as well as foods that are rich in potassium, magnesium and calcium — nutrients that help lower blood pressure. - Vegetables, fruits and low-fat dairy products, as well as whole grains, fish, poultry and nuts. It offers limited portions of red meats, sweets and sugary beverages. a. Modifiable and non-modifiable risk factors/ Non-pharmacologic therapy for HTN 45. - Modifiable risk • Overweight = Weight reduction • Smoker = Smoking cessation • ETOH consumptions = Moderation of alcohol intake • Diet = Reduction of salt in diet • Sedentary lifestyle = Increase in physical activity - Non-modifiable would be genetics 46. Nursing considerations for calcium channel blockers Calcium channel blocker common adverse effect (highlighted in class) = - Reflex tachycardia (commonly given with beta-blocker such as nifedipine and diltiazem to offset this from happening.) - Peripheral edema in the feet (given with other class of antihypertention medication if this occurs). Calcium channel blocker common adverse effects (in addition to ones mentioned in class) = - Dizziness related to the effects of vasodilatation and alterations in blood flow - GI irritation - Renal insufficiency Medications that cause reflex tachycardia = calcium channel blocker and nitrite (both discussed during lecture but not in the book. Nursing Considerations: Assessment for Calcium Channel Blockers = - History and Physical Exam, known allergy - Impaired liver or kidney function - Pregnancy and lactation - Baseline status, skin, complaint of pain, including onset, duration, intensity, and location, and measures used to relieve the pain - Cardiopulmonary status, baseline ECG, respirations, LS and appropriate lab values Nursing Considerations: Implementation for Calcium Channel Blockers = - Monitor BP – especially, rhythm, cardiac output. Periodically measure if on long-term. - Comfort measures, support, encouragement, patient teaching of med. Calcium Channel Blockers Contraindications = - Allergy - *Heart block or sick sinus syndrome* (worsens these by the conduction-slowing effects of this med). - Renal or hepatic dysfunction - Pregnancy or lactation 47. (dihypropyridine and non-dihydropyridines) (administration assessment, Non-dihydropyridine (highlighted in class) calcium channel blockers such as *verapamil and diltiazem* cause = less vasodilation and more cardiac depression than dihydropyridine CCBs. Most common side effect of the CCB – especially in the dihydropyridine group (ends in -pine) (highlighted in class) = reverse tachycardia. Someone who is prescribed this is given a beta-blocker to offset this. dihydropyridine group CCBs function = affects the smooth muscles in the form of the nifeDIPINE (not an antiarrhythmic) amlodipine (Norvasc); affects the *peripheral resistance* (highlighted in class) dihydropyridine group CCBs = need to know: amlodipine and nifedipine nondihydropyridine group CCBs = need to know: diltiazem, verapamil (also antiarrhythmics in addition to contrining BP. nondihydropyridine group CCB function = direct effect of heart in terms of *AV conduction in the heart* (highlighted in class). 48. Nursing considerations for beta-blockers (metoprolol/atenolol) (assessment, implementation, ongoing evaluation and monitoring and patient teaching). metoprolol indication (Beta-blocker and HTN drugs - sympathetic nervous system drugs) = Treatment of angina in adults; prevention of reinfarction within 3–10 d after MI, decrease BP & HR, decreases frequency of heart attacks. metoprolol indication (Beta-blocker and HTN drugs - sympathetic nervous system drugs) = Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-adrenergic receptor sites. Beta-blocker nursing consideration: assessment = - History and Physical Exam and known allergy - Physical Assessment to determine baseline - Monitor CV: HR, BP, cardiac output - Monitor renal, liver, electrolyte labs Beta-blocker nursing consideration: implementation = - Monitor BP, pulse, rhythm, cardiac output. - Safety precautions/ - Small frequent meals if GI upset. - Arrange supportive care and comfort measures. - Offer support and encouragement. - Patient teaching of drug. Beta-blocker Contraindications & Cautions = - Bradycardia, Heart block, Cardiogenic shock (blocking sympathetic response could worsen these conditions.) - DM, PVD, Asthma, COPD, Thyrotoxicosis (blocking sympathetic response blocks normal reflexes in maintaining homeostasis in these patients). - Pregnancy and lactation 49. Effect of anti-platelet medication with MI. Focus on aspirin and Plavix. Antiplatelet = decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. Aspirin highlights from class = ASA 81mg for prophylactic, 325 mg for MI, comes enteric coated with give this with food because it can cause gastric ulcerations Aspirin action antiplatelet prototype) = Inhibits platelet aggregation by inhibiting platelet synthesis of thromboxane A2. Aspirin indication (antiplatelet prototype) = Reduction of risk of recurrent TIAs or strokes in men with a history of TIA due to fibrin or platelet emboli; reduction of death or nonfatal MI in patients with a history of infarction or unstable angina; MI prophylaxis; also used for its anti-inflammatory, analgesic, and antipyretic effects. Clopidogrel indication (Plavix - Antiplatelet agents) = Treatment of patients who are at risk for ischemic events; patients with a history of MI, peripheral artery disease, or ischemic stroke; and patients with acute coronary syndrome Angina and MI 50. Nursing considerations for nitroglycerin (assessment, implementation, ongoing evaluation and monitoring and patient teaching). Patient teaching on how to self- administer nitroglycerin in the event of an angina attack. Nitroglycerin (Nitro-Bid, Nitrostat, and others) indication = Nitrate of choice for treatment of acute angina attack; prevention of anginal attacks, angina not responsive to beta-blockers or organic nitrates, peri-op HTN, HF associated with MI; controlled hypotension during surgery. PRN - Preferred versus isosorbide mononitrate. Nitroglycerin (Nitro-Bid, Nitrostat, and others) actions = Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial blood pressure, reducing the left ventricular workload and decreasing myocardial oxygen consumption. Nitroglycerin (specific) PRN implementation (highlighted in class) = - administer at onset of chest pain only can be administered 3 times, 5-minute intervals. If taken 3 times, go to ER without relief. - Keep out of sunlight. - Fizzing effect under the tongue is normal. Shows it is not expired and is potent. - Kee