Term
|
Definition
reduce the formation of fibrin
two mechanisms of action: inhibit the synthesis of clotting factors and inhibit the activity of clotting factors
category: coagulation modifiers |
|
|
Term
category: coagulation modifiers
classification: anticoagulant |
|
Definition
| prototypes: heparin (unfractionated heparin), enoxaparin (low molecular weight heparin), warfarin, dabigatran |
|
|
Term
| heparin (unfactionated heparin) pharmacokinetics |
|
Definition
route: IV
onset of action: immediate
peak plasma concentration: immediate
half-life: 1-2 hours
duration of action: dependent on infusion duration
route: subcut
onset of action:20-30 min
peak plasma concentration: 2-4 hours
half-life: 1-2 hours
duration of action: 8-12 hours |
|
|
Term
| enoxaparin (low molecular weight heparin) pharmacokinetics |
|
Definition
**also known as Lovenox
route: subcut
onset of action: 3-5 hours
peak plasma concentration: 4-5 hours
half-life: 4-5 hours
duration of action: 12 hours |
|
|
Term
| unfactionated heparin (heparin) indications |
|
Definition
DVT
MI
unstable angina
atrial fibrillation
mechanical heart valves
post-op orthopedic procedures/immobility |
|
|
Term
| unfactionated heparin (heparin) mechanism of action |
|
Definition
| suppreses coagulation by inhibiting activation of thrombin and factor Xa --> inhibition of fibrin formation = inhibition of clot formation |
|
|
Term
| unfactionated heparin (heparin) contraindications |
|
Definition
thrombocytopenia
uncontrollable bleeding
during and immediately after surgery of the eye, brain, or spinal chord |
|
|
Term
| unfactionated heparin (heparin) adverse effects |
|
Definition
hemorrhage
heparin-induced thrombocytopenia
hypersensitivity reactions
**protamine sulfate is the antidote for OD |
|
|
Term
| low molecular weight heparin (enoxaparin/lovenox) indications |
|
Definition
prevention of DVT following surgery (including knee and hip replacement)
treatment of established DVT
prevention of ischemic complications (including patients with unstable angina, non-Q wave MI, and STEMI) |
|
|
Term
| low molecular weight heparin (enoxaparin/lovenox) mechanism of action |
|
Definition
| inactivate factor Xa --> prevention of prothrombin being converted to thrombin which ultimately prevents fibrin formation and therefore clot formation |
|
|
Term
| low molecular weight heparin (enoxparin/lovenox) nursing implications |
|
Definition
administered subcut dosage based on body weight costs more than unfractionated heparin does not require monitoring/can be given at home
monitor APTT - should be 1.5 - 2 times normal |
|
|
Term
| low molecular weight heparin (enoxparin/lovenox) adverse effects |
|
Definition
bleeding (less than with unfractionated heparin)
immune-mediated thrombocytopenia
severe neurologic injury for patients undergoing spinal puncture or spinal epidural anesthesia
**protamine sulfate is the antidote OD |
|
|
Term
| warfarin (coumadin) pharmacokinetics |
|
Definition
route: PO
onset of acton: 24-72 hours
peak plasma concentration: 4 hours
half-life: 0.5-3 days
duration of action: 2-5 days |
|
|
Term
| warfarin (coumadin) indications |
|
Definition
not useful in emergency situations
long term prophylaxis of thrombosis:
- prevention of DVT and pulmonary embolism
- prevention of thromboembolism in patients with prosthetic heart valves
- prevention of thrombosis during atrial fibrillation |
|
|
Term
| warfarin (coumadin) mechanism of action |
|
Definition
| decreases production of clotting factors VII, IX, X and prothrombin inhibiting vitamin K synthesis in the intestine thereby preventing clot formation |
|
|
Term
| warfarin (coumadin) adverse effects |
|
Definition
hemorrhage
fetal hemorrhage and teratogenesis from use during pregnancy
**vitamin K is the antidote for OD |
|
|
Term
| warfarin (coumadin) drug interactions |
|
Definition
heparin, aspirin, acetaminophen
increase anticoagulant effects
promote bleeding
decrease anticoagulant effects |
|
|
Term
| dabigatran (pradaxa) pharmacokinetics |
|
Definition
**class: anti-coagulant AND direct thrombin inhibitor
route: PO
onset of action: 0.5-2 hours
peak plasma concentration: 1-2 hours
half-life: 12-17 hours
duration of action: 12-24 hours |
|
|
Term
| dabigatran (pradaxa) indications |
|
Definition
| atrial fibrillation (DVT prevention after hip or knee surgery) |
|
|
Term
| dabigatran (pradaxa) mechanism of action |
|
Definition
| directly inhibits clotting factor II - thrombin |
|
|
Term
| dabigatran (pradaxa) adverse effects |
|
Definition
bleeding
hemorrhage
dyspepsia
nausea
upper abdominal pain
diarrhea |
|
|
Term
| dabigatran (pradaxa) drug interactions |
|
Definition
rifampin
keoconazole
verapamil
amiodaron
quinidine
clarithromycin |
|
|
Term
category: antiplatelet drugs
classification: cyclooxygenase inhibitor |
|
Definition
prototype: acetylsalylic acid (aspirin)
route: PO
onset of action: 15-30 min
peak plasma concentration: 0.25-2 hours
half-life: 2-3 hours
duration of action: 4-6 hours |
|
|
Term
| acetylsalylic acid (aspirin) indications |
|
Definition
antiplatelet prophylaxis for embolic events such as MI and stroke
antiinflammatory
analgesic
antipyretic |
|
|
Term
| acetylsalylic acid (aspirin) mechanism of action |
|
Definition
| inhibits cyclooxygenase through acetylation in the platelet irreversibly --> loss of ability to regenerate the enzyme --> inhibition of TXA = decreased aggregation of platelets in vessels |
|
|
Term
| acetylsalylic acid (aspirin) adverse effects |
|
Definition
bleeding
GI bleeding and hemorrhagic stroke
enteric-coated tablets may not reduce the risk of GI bleed |
|
|
Term
| acetylsalylic acid (aspirin) toxicity |
|
Definition
in general watch for bleeding tendencies, tinnitus, stomach pain, thrombocytopenia
toxicity:
increased temp
nausea/vomiting
tinnitus
hyperventilation leading to respiratory alkalosis
severe toxicity:
metabolic acidosis
seizures |
|
|
Term
category: antiplatelet drugs
classification: ADP inhibitor |
|
Definition
prototype: clopidrogel (plavix)
route: PO
onset of action: 1-2 hours
peak plasma level: 1 hour
half-life: 8 hours
duration of action: 7-10 days |
|
|
Term
| clopidrogel (plavix) indications |
|
Definition
| decrease incidence of vascular clotting, MI, stroke, prevents stenosis of stents, and acute coronary syndrome |
|
|
Term
| clopidrogel (plavix) mechanism of action |
|
Definition
| inhibits platelet aggregation by irreversibly blocking ADP on platelet surface |
|
|
Term
| clopidrogel (plavix) contraindications |
|
Definition
thrombocytopenia
active bleeding
leukemia
traumatic injury
GI ulcer
vitamin K deficiency
recent stroke |
|
|
Term
| clopidrogel (plavix) what to watch for |
|
Definition
skin disorder URI flu-like symptoms
abdominal pain
dyspepsia
diarrhea
cautious use with: HTN hepatic/renal problems history of bleeding |
|
|
Term
category: antiplatelet
classification: glycoprotein IIb/IIIa antagonists |
|
Definition
prototypes: tirofiban (aggrastat), eptifibatide (integrilin), abciximab (reopro)
route: IV
onset of action: 1 hour
peak plasma concentration: unknown
half-life: 2-2.5 hours
duration of action: 4 hours |
|
|
Term
| tirofiban (aggrastat) indications |
|
Definition
prophylaxis of clot formation
short term to prevent acute coronary syndrome |
|
|
Term
| tirofiban (aggrastat) mechanism of action |
|
Definition
| causes reversible blockade of platelet GPIIb/IIIa receptorts --> prevention of the final step in aggregation |
|
|
Term
category: thrombolytics
classification: tissue plasminogen activator |
|
Definition
prototypes: alteplase (tPA, activase), tenectaplaxe (TNKase), streptokinase (streptase), urokinase (abbokinase)
route: IV
onset of action: 30 min
peak plasma concentration: 1 hour
half-life: 26-50 min
duration of action: dependent on infusion duration |
|
|
Term
|
Definition
MI
DVT
pulmonary emboli
"clot busters" |
|
|
Term
| thrombolytic mechanism of action |
|
Definition
promote conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi --> increase profusion and decrease viscosity and aggregation of RBCs
**give 2-6 hours after MI and 4.5 hours after a stroke |
|
|
Term
| thrombolytic what to look for |
|
Definition
allergic reactions
spontaneous bleeding
oozing from any fresh wound site |
|
|
Term
| heparin nursing implications |
|
Definition
doses usually double checked with another RN
do not give subcut doses within two inches of umbilicus, abdominal incisions, or unhealed wounds
do not aspirate subcut injections
do not massage subcut injection sites
anticoagulant effects seen immediately
labs are done daily to monitor coagulation effects (APTT)
protamine sulfate can be given as an antidote in case of excessive anticoagulation |
|
|
Term
| warfarin nursing implications |
|
Definition
may be started while the patient is still on heparin until PT times indicate adequate coagulation full therapeutic effect takes several days monitor PT and PT-INR regularly antidote is vitamin K many herbal products such as capsicum pepper, garlic, ginger, ginko, ginseng, and feverfew may have potential interactions (increased bleeding)
avoid eating foods high in vitamin K (green leafy veggies, avocado, kiwi, grapes, tomatoes, bananas, fish)
INR should be 2-3 |
|
|
Term
| antiplatelet drugs nursing implications |
|
Definition
nicotine causes vasoconstrictions, which alters the effectiveness of antiplatetlet agents
drug-drug interactions
adverse reactions to report
monitor for abnormal bleeding |
|
|
Term
| thrombolytic agent nursing implications |
|
Definition
follow strict manufacturer guidelines for preparation and administration
monitor IV sites for bleeding, redness, and pain
monitor for bleeding from gums, mucous membranes, and nose
observe for signs of internal bleeding (decreased BP, restlessness, increased pain) |
|
|
Term
| patient education for anticoagulants |
|
Definition
should include:
importance of regular lab testing
signs of abnormal bleeding
measures to prevent bruising, bleeding, or tissue injury
wearing a medical alert bracelet
avoiding foods high in vitamin K (tomatoes, dark leafy greens, bananas, fish)
consulting physician before taking other meds or OTC products/herblas |
|
|
Term
category: hematopoetic growth factors
classification: antianemic |
|
Definition
| prototype: epoetin alfa (procrit, epogen) |
|
|
Term
epoetin alfa (procrit, epogen) indications
HIV-infect patients taking zidovudine
chemo-inuced anemia
patients facing surgery
**basically just anemia |
|
Definition
| anemia secondary to chronic renal failure |
|
|
Term
| epoetin alfa (procrit, epogen) mechanism of action |
|
Definition
| stimulates the production of RBCs in the bone marrow of severely anemic patients |
|
|
Term
category: hematopoetic growth factors
classification: granulocyte stimulating colony factor |
|
Definition
| prototypes: filgrastim (neupogen) and pepfilgrastim (neulasta) |
|
|
Term
| prefilgrastim (neupagen) indications |
|
Definition
neutropenia
reduces the incidence of infection
need for hospitalization
need for intravenous antibiotics |
|
|
Term
| prefilgrastim (neupagen) mechanism of action |
|
Definition
stimulates myeloid cells to increase production of neutrophils
produces dose-dependent increase in circulating neutrophils |
|
|
Term
| filgrastim (neupogen) indications |
|
Definition
reduces the incidence of severe neutropenia
produces dose-dependent increases in circulating neutrophils
reduces the incidence of infection, need for hospitalization, and need for intravenous antibiotics |
|
|
Term
| filgrastim (neupogen) mechanism of action |
|
Definition
| colony-stimulating factor leukopoietic growth factor --> used for recombinant DNA technology |
|
|
Term
| filgrastim (neupogen) adverse effects |
|
Definition
bone pain leukocytosis
edema --> contraindicated in patients with heart failure
cough
dyspnea
sore throat
anorexia
N/V
diarrhea
alopecia
rash at injection site
fever
headache |
|
|
Term
category: hematopoietic growth factor
classification: granulocyte-macrophage colony stimulating factor |
|
Definition
| prototype: sargramostim (leukine) |
|
|
Term
| sargramostin (leukine) indications |
|
Definition
adjunct to autologous bone marrow transplantation
treatment of failed bone marrow transplants
patients with a cute myelogenous leukemia (AML) |
|
|
Term
| sargramostin (leukine) mechanism of action |
|
Definition
acts on bone marrow to increase production of neutrophils, monocytes, and eosinophils
acts on mature cells to enhance their actions |
|
|
Term
| sargramostin (leukine) adverse effects |
|
Definition
diarrhea
weakness
malaise
bone pain
leukocytosis
thrombocytosis |
|
|
Term
category: hematopoietic growth factor
classification: thrombopoietic growth factor |
|
Definition
| prototype: oprelvekin (interleukin-11) |
|
|
Term
| oprelvekin (interleukin-11) indications |
|
Definition
myelosuprresive chemotherapy
prevent platelet transfusions |
|
|
Term
| oprelvekin (interleukin-11) mechanism of action |
|
Definition
| stimulates platelet proginator cells to increase platelet production |
|
|
Term
| oprelvekin (interleukin-11) adverse effects |
|
Definition
fluid retention (contraindicated in patients with heart failure)
cardiac dysrhytmias conjuctival infections visual blurring papilledema |
|
|
Term
| hematopoietic growth factor CAUTION |
|
Definition
epoetin alfa, filgrastim, sargramostim, and oprelvekin stimulate proliferation of bone marrow cells
****use with great caution, if at all, for patients with cancer of bone marrow origin |
|
|
Term
category: analgesic
classification: opioid |
|
Definition
| prototypes: codeine sulfate, fentanyl citrate, morphine sulfate, morphine sulfate continuous release (MS contin), oxycodone, oxycodone CR (oxycontin), meperidine HCl (demerol), methadone HCl (dolophine) |
|
|
Term
| opioid analgesia indications |
|
Definition
| to alleviate moderate to severe pain |
|
|
Term
| opioid analgesia mechanism of action |
|
Definition
mimicks actions of endogenous opioid peptides
primarily at the Mu1 opiod sites |
|
|
Term
| opioid analgesia contraindications |
|
Definition
known drug allergy
severe asthma or other respirator insufficiency
increased intracranial pressure
pregnancy |
|
|
Term
| opioid analgesia adverse effects |
|
Definition
euphoria
CNS depression
pupil constriction (miosis)
diaphoresis
flushing
bradycarida
hypotension
respiratory distress
nausea
vomiting
constipation
urinary retention
itching
wheal formation |
|
|
Term
| category: opiate antagonists classification: opiates |
|
Definition
| prototypes: naloxone (narcan) and naltrexone (revia) --> narcan is the drug of choice |
|
|
Term
|
Definition
| used for complete or partial reversal of opiod-induced respiratory depression |
|
|
Term
| opiate mechanism of action |
|
Definition
| bind to opiate receptors and prevent a response |
|
|
Term
|
Definition
tolerance
physical dependence
psychological dependence |
|
|
Term
| opiate physical dependence |
|
Definition
seen when the opioid is abruptly discontinued or when an opiod antagonist is administered
narcotic withdrawal/opioid abstinence syndrome |
|
|
Term
| narcotic withdrawal/opioid abstinence syndrome |
|
Definition
manifested as:
anxiety
irritability
chills/hot flashes
joint pain
lacrimation
rhinorrhea
diaphoresis
nausea
vomiting
abdominal cramps
diarrhea |
|
|
Term
category: analgesias
classification: non-opiod |
|
Definition
| prototype: acetaminophen (tylenol) |
|
|
Term
| non-opioid analgesia indications |
|
Definition
mild to moderate pain
fever
alternative for those who cannot take aspirin products |
|
|
Term
|
Definition
| blocks pain impulses peripherally by inhibiting prostaglandin synthesis |
|
|
Term
|
Definition
available OTC, but lethal when overdosed
overdose, whether intentional or due to chronic unintentional misuse, causes hepatic necrosis
long-term ingestion of large doses also causes nephtropathy
**acetylcysteine is the recommended antidote |
|
|
Term
| acetaminophen interactions |
|
Definition
dangerous interactions may occur if taken with alcohol
should not be taken in the presence of:
liver dysfunction
possible liver failure
when taking other hepatotoxic drugs |
|
|
Term
| analgesic nursing implications |
|
Definition
perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and alleviating factors, type, remedies, and other pain treatments
be sure to medicate patients before the pain becomes severe as to provide adequate analgesia and pain control
pain management includes pharmacologic and non-pharmacologic approaches
instruct patients to notify physician for signs of allergic reaction or adverse effects |
|
|
Term
| opiod analgesic nursing implications |
|
Definition
withhold dose and contact physician if there is a decline in the patients condition of if VS are abnormal, especially if RR is < 12 breaths/min
check dosages carefully --> follow proper administration guidelines for IM injections and follow guidelines for IV administration, including dilution, rate of administration, etc.
constipation is a common side effect and may be prevented with adequate fluid and fiber intake
instruct patients to follow directions for administration carefully, and to keep a record of their pain experience and response to treatments
patients should be instructed to change positions slowly to prevent possible orthostatic hypotension |
|
|
Term
| monitoring for analgesic adverse effects |
|
Definition
should VS change, patient's condition decline, or pain continue contact physician immediately
respiratory depression may be manifested by RR of < 12 breaths/min, dyspnea, diminished breath sounds, or shallow breathing |
|
|
Term
| monitoring for analgesic therapeutic effects |
|
Definition
decreased complaints of pain
decreased severity of pain
increased periods of comfort
improved ADLs, appetite, and sense of well-being
decreased fever (acetaminophen) |
|
|
Term
category: cyclooxygenase inhibitors
classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)
FIRST GENERATION |
|
Definition
propionic acid derivatives:
ibuprofen (advil, motrin), naproxen (naprosyn), naproxen plus lansoprazole, indomethacin (indocin), ketorolac (tordol), ketoprofen (oruvail)
others on ppt...a lot of fucking NSAIDS! |
|
|
Term
category: cyclooxygenase inhibitors
classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)
SECOND GENERATION |
|
Definition
| prototype: celecoxib (celebrex) |
|
|
Term
| celecoxib (celebrex) indications |
|
Definition
osteoarthritis
rheumatoid arthritis
acute pain
dysmenorrhea
familial adenomatous polyposis |
|
|
Term
| celecoxib (celebrex) mechanism of action |
|
Definition
reversible inhibition of the leukotriene or prostaglandin pathway or both
more specifically blocks the action of cyclooxygenase II |
|
|
Term
| celecoxib (celebrex) adverse effects |
|
Definition
moderate to severe noncardiogenic pulmonary edema
FDA warning: may increase risk of thromboembolic event including MI and stroke (increased for patients who already have CVD and other risk factors)
gastric ulceration
bleeding
renal impairment |
|
|
Term
| celecoxib (celebrex) drug interactions |
|
Definition
warfarin
may decrease diuretic effect of furosemide
may decrease anti-hypertensive effect of ACE inhibitors
may increase levels of lithium
levels of celecoxib may be increased by fluconazole |
|
|
Term
category: insulin
classification: rapid action |
|
Definition
| prototypes: insulin lispro (humalog), insulin aspart (novolog), insuline glulisine (apidra) |
|
|
Term
category: insulin
classification: short acting |
|
Definition
| prototypes: regular insulin (humalin R, novolin R) |
|
|
Term
category: insulin
classification: intermediate |
|
Definition
| prototypes: neutral protamines hagedorn aka NPH (humalin N, novolin N) |
|
|
Term
category: insulin
classification: long acting |
|
Definition
| prototypes: insulin detemir (levemir) and insulin glargine (lantus) |
|
|
Term
|
Definition
principal: diabetes mellitus
required by all type I and some type II patients
IV insulin for DKA
hyperkalemia: can promote uptake of potassium
aids in the diagnosis of GH deficiency |
|
|
Term
| insulin mechanism of action |
|
Definition
| restores body's ability to metabolize carbohydrates, fats, and proteints --> to store glucose in the liver and to convert glycogen to fat stores |
|
|
Term
|
Definition
subcut injections:
syringe and needle
pen injectors
jet injectors
inhalation:
exubera --> withdrawn in 2007
subcut infusion:
portable insulin pumps
implanted insulin pumps
IV infusion |
|
|
Term
|
Definition
unopened vials should be stored in refrigeration until needed
should not be frozen
can be used until expiration date if kept in refrigerator
after opening, can be kept up to one month without significant loss of activity
keep out of direct sunlight and extreme heat
mixtures of insulin in vials are stable for one month at room temperature and three months in refrigeration
mixtures in prefilled syringes should be stored in refrigeration for up to one week and should be stored vertically with needle pointing up |
|
|
Term
| complications of insulin therapy |
|
Definition
hypoglycemia
lipodystophies
allergic reactions
hypokalemia
drug interaction:
hypoglycemic agents
hyperglycemic agents
beta andrenergic blocking agents |
|
|
Term
category: oral antidiabetic agents
classification: sulfonylureas |
|
Definition
| prototypes: chlorpropamide (diabinese), tolazamaide (tolinase), tolbutamide (orinase), glimepiride (amaryl), glipizide (glucotrol), glyburide (diabeta) |
|
|
Term
| sulfonylureas indications |
|
Definition
| type II diabetes - non insulin dependent |
|
|
Term
| sulfonylureas mechanism of action |
|
Definition
| stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels |
|
|
Term
| sulfonylureas what to watch for |
|
Definition
epigastric fullness, diarrhea, hypoglycemia, heartburn, pruritus
**do not use when pregnant |
|
|
Term
category: oral antidiabetic drugs
classification: biguanides |
|
Definition
| prototype: metformin (glucophage) |
|
|
Term
|
Definition
| type II diabetes - non insulin dependent |
|
|
Term
| biguanides mechanism of action |
|
Definition
decrease production of glucose
increase uptake of glucose by tissues
do not increase insulin secretion from the pancreas |
|
|
Term
category: oral antidiabetic agents
classification: meglitinides |
|
Definition
| prototype: repaglinide (prandin) |
|
|
Term
|
Definition
|
|
Term
| meglitinides mechanism of action |
|
Definition
similar to sulfonylureas --> stimulate insulin secretion from pancrease
good choice for patients with erratic eating habits |
|
|
Term
category: oral antidiabetic drugs
classification: alpha-glucosidase inhibitors |
|
Definition
| prototypes: acarbose (precose) and miglitol (glyset) |
|
|
Term
| alpha-glucosidase inhibitors indications |
|
Definition
|
|
Term
| alpha-glucosidase inhibitors mechanism of action |
|
Definition
reversibly inhibit the enzyme alpha-glucosidase in the small intestinge --> delayed absorption of glucose
must be taken with meals to prevent excessive postprandial blood glucose elevations |
|
|
Term
category: oral antidiabetic drugs
classification: thiazolidinediones |
|
Definition
prototypes: pioglitazone (actos) and rosiglitazone (avandia)
**sept. 23, 2010 - avandia restricted by FDA due to heart risk |
|
|
Term
| thiazolidinediones indications |
|
Definition
|
|
Term
| thiazolidinediones mechanism of action |
|
Definition
decrease insulin resistance (insulin sensitizing agents)
increase glucose uptake and use in skeletal muscles
inhibit glucose and triglyceride production in the liver |
|
|
Term
| sulfonylureas adverse effects |
|
Definition
hypoglycemia
hematologic effects
nausea
epigastric fullness |
|
|
Term
| biguanides adverse effects |
|
Definition
abdominal bloating
nausea
cramping
diarrhea
metallic taste
reduced vitamin B12 levels |
|
|
Term
| alpha-glucosidase inhibitors adverse effects |
|
Definition
flatulence
diarrhea
abdominal pain |
|
|
Term
| thiazolidinediones adverse effects |
|
Definition
moderate weight gain
edema
mild anemia
hepatic toxicity |
|
|
Term
category: oral antidiabetic drugs
classification: incretin memetics |
|
Definition
| prototype: sitagliptin (januvia) |
|
|
Term
| incretin memetics indications |
|
Definition
|
|
Term
| incretin memetics mechanism of action |
|
Definition
enhances the actions of incretin hormones
stimulates glucose dependent release of insulin
suppresses postprandial release of glucagon |
|
|
Term
| incretin memetics adverse effects |
|
Definition
| headache, URI inflammation (throat and nasal passages) |
|
|
Term
|
Definition
preferred treatment is IV glucose --> immediately raises blood glucose level
glucagon can be used if IV glucose isn't available --> delayed elevation of blood glucose; will not work in starvation (promotes glycogen breakdown and the malnourished have little glycogen left) |
|
|
Term
| insulin nursing implications |
|
Definition
when insulin is ordered ensure correct route, correct type of insulin, timing of dose, correct dosage
insulin order and prepared dosages are second-checked with another RN
check blood glucose before administration
ensure correct timing of insulin dose with meals
when drawing up two types of insulin in one syringe, always withdraw the regular insulin first
provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucoses, and injection site rotations |
|
|
Term
| oral antidiabetic drugs nursing implications |
|
Definition
always check blood glucose levels before giving
usually given 30 min before meals
alpha-glucosidase inhibitors are given with the first bite of each main meal
biguanides are taken with meals to reduce GI effects
monitor for therapeutic response
assess for signs of hypoglycemia
if hypoglycemia occurs:
give glucagon
have the patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink
have the patient eat a small snack such as crackers or half a sandwhich
monitor blood glucose levels |
|
|
Term
category: thyroid replacement
classification: thyroid hormone |
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Definition
| prototypes: levothyroxine (syntrhoid, levoxyl), liothyronine (cytomel), liotrix (thyrolar), thyroid |
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Term
| thyroid hormone indications |
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Definition
hypothyroidism
dx hyperthyroidism prevention of goiters |
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Term
| thyroid hormone mechanism of action |
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Definition
thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid)
**thyroid drugs work the same as thyroid hormones |
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Term
| thyroid hormone contraindications |
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Definition
known drug allergy
recent MI
adrenal insufficiency
hyperthyroidism |
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Term
| thyroid hormone adverse effects |
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Definition
| insomnia, headache, anxiety, tremors, cardiac dysrhythmias, angina, hypertension, palpitations, nausea, diarrhea, weight loss, menstrual irregularities, heat intolerance |
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Term
| thyroid hormone interactions |
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Definition
oral anticoagulants
digitalis glycosides
cholestyramine
patients with diabetes may need to increase their doses of hypoglycemic agents |
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Term
category: antithyroid
classification: thionamides |
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Definition
| prototypes: methimazole (tapazole) and propylthiouracil (PTU) |
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Term
category: antithyroid
classifications: radioactive iodine |
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Definition
| prototype: iodine-131 (iodotope) |
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Term
|
Definition
hyperthyroidism
graves disease |
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Term
| iodine-131 mechanism of action |
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Definition
| emits beta particles which destroy the thyroid tissue |
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Term
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Definition
| blocks action of thyroid synthesis by preventing oxidation of iodine, thereby inhibiting incorporation of iodine into tyrosine and by preventing the coupling of tyrosines and suppresses the conversion of T4 to T3, the active form of thyroid hormone |
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Term
| methimazole mechanism of action |
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Definition
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Term
| thyroid agent nursing implications --> patient teaching |
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Definition
take thyroid agents once daily in the morning to decrease the likelihood of insomnia
take the medication at the same time every day
don't switch brands without MD approval
report any unusual symptoms, chest pain or heart palpitations,
therapeutic effects may take several months to occur
too high of a dose of a thyroid agent will result in nervousness, irritability, and insomnia |
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Term
| antithyroid nursing implications |
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Definition
better tolerate when given with food
give at the same time each day to maintain consistent blood levels
never stop these medications abruptly
avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt) |
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Term
| thyroid agent nursing implications |
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Definition
monitor for therapeutic response
monitor for adverse effects
s/s of thyroid hormone OD include cold intolerance, depression, and edema |
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Term
| antiepileptic agents goals |
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Definition
to control or prevent seizures while maintaining a reasonable quality of life
to minimize side effects and drug induced toxicity
**therapy is usually lifelong |
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Term
| antiepileptic agents indications |
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Definition
prevention or control of seizure activity
long-term maintenance therapy for chronic, recurring seizures
acute treatment of convulsions and status epilepticus |
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Term
| classification of antiepileptic agents |
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Definition
traditional AEDs:
phenytoin, carbamazepine, valproic acid, primidone, and ethosuximide
newer AEDs:
oxcarbazepine, gabapentin, zonisamide, lamotriginr, levetiracetam, pregablin, tigabine, topiramate |
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Term
| antiepileptic agent safety |
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Definition
very narrow therapeutic index
toxic levels can be reached quickly
monitor therapeutic drug levels with phenobarbital, phyenytoin, carbamazepine, valproic acid |
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Term
category: antiepileptic agents
classification: anticonvulsant barbituates |
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Definition
| prototypes: phenobarbital (solfoton, luminal) and primidone (mysoline) |
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Term
| anticonvulsant barbituates indications |
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Definition
prevention of seizures
control of seizures
seizure types used for:
partial seizures
secondary general
generalized tonic clonic |
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Term
| anticonvulsant barbituates mechanism of action |
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Definition
| potentiates the activities of GABA --> increased response to GABA |
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Term
| anticonvulsant barbituates adverse effects |
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Definition
| drowsiness, dizziness, lethargy, paradoxical restlessness, excitement, nausea, vomiting, rash, stevens-johnson syndrome, urticaria |
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Term
category: antiepileptic agents
classification: valproate |
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Definition
| prototypes: divalproex sodium (depakote), valproate sodium (depacon), vaproic acid (depakene) |
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Term
|
Definition
partial and secondary generalized seizures
bipolar disorder
migraines |
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Term
| valproate mechanism of action |
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Definition
suppression of high frequency neuronal firing through blockade of sodium channels --> cell membrane stabilization
suppreses Ca+ influx into neural cell --> cell membrane stabilization
augments inhibitory action of GABA |
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Term
| valproate adverse effects |
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Definition
pancreatitis, irregular menses, secondary amenorrhea, weight gain, galactorrhea
**rarely breast enlargement...not exactly "adverse" to get tig ole' bitties |
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Term
category: antiepileptic agents
classification: hydantoins |
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Definition
| prototypes: phenytoin (dilantin) and fosphenytoin (cerebyx) |
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Term
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Definition
partial seizures
tonic clonic seizures |
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Term
| hydantoins mechanism of action |
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Definition
| selective inhibition of Na+ channels --> suppression of action potentials and decreased irritability of neuron --> decreased firing |
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Term
| hydantoins adverse effects |
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Definition
| dysrhytmias, hypotension, exfoliative dermatitis, lupus, stevens-johnson syndrome, bone marrow suppression, neuropathies, gingival hyperplasia |
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Term
category: antiepileptic agents
classification: newer AEDs |
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Definition
| prototypes: gabapentin (neurontin) and pregabalin (lyrica) |
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Term
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Definition
partial seizures
neuropathic pain |
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Term
| newer AEDs mechanism of action |
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Definition
| chemical analog of GABA inhibits neuronal action |
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Term
| newer AEDs adverse effects |
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Definition
| dizziness, somnolence, visual changes, fatigue, nausea, vomiting |
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Term
category: antiepileptic
classification: imostilbenes |
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Definition
| prototypes: carbamezapine (tegretol) and oxcarbazepine (tripeptal) |
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Term
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Definition
partial seizures
generalized tonic clonic seizures |
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Term
| imostilbenes mechanism of action |
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Definition
| blocks voltage sensitive Na+ channels --> stabilization of hyperactive neuronal cell membranes |
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Term
| imostilbenes adverse effects |
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Definition
| visual disturbances, nystagmus, blurred vision, ataxia, vertigo, headache, leukopenia, anemia, thrombocytopenia, rash, stevens-johnson syndrome, toxic epidermal necrolysis, audoinducer of hepatic enzymes |
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Term
category: antiepileptic agents
classification: succinimide |
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Definition
| prototype: ethosuximide (zarontin) |
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Term
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Definition
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Term
| succinimide mechanism of action |
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Definition
| suppression of thalamus hyperexcited neurons by suppression of Ca+ channels --> stabilization of neuronal cell membrane |
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Term
| succinimide adverse effects |
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Definition
| drowsiness, dizziness, lethargy, nausea, vomitting |
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Term
| succinimide adverse effects |
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Definition
| drowsiness, dizziness, lethargy, nausea, vomiting |
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Term
| succinimide adverse effects |
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Definition
| drowsiness, dizziness, lethargy, nausea, vomiting |
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Term
| AED nursing implications - assessment |
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Definition
health history, including current medications
drug allergies
liver function studies, CBC
baseline vital assessments |
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Term
| AED nursing implications - oral agents |
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Definition
take regularly, same time each day
take with meals to reduce GI upset
do not crush, chew, open extended-release forms |
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Term
| AED nursing implications - IV forms |
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Definition
follow manufacturer's recommendations for IV delivery - usually given slowly
monitor VS during administration
avoid extravasation of fluids
use only normal saline with IV phenytoin (know this!!) |
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Term
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Definition
should not be discontinued abruptly
driving may be impaired until drug levels stabilize
patients need to know that therapy is long term, and possibly lifelong - not a cure |
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Term
| AED nursing implications - monitoring for therapeutic response |
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Definition
| seizure activity is decreased or absent |
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Term
| AED nursing implications - monitoring for adverse effects |
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Definition
change in mental status, mood, LOC, or sensorium
eye problems, visual disorders
sore throat
fever
blood dyscrasias may occur with hydantoins |
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Term
| AED nursing implications - pregnancy |
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Definition
teratogenesis:
hydantoins
carbamazepines
birth defects:
valproates
phenobarbital
oxcarbamazepine
gabapentin/pregabalin |
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Term
| hydantoins drug interactions |
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Definition
hepatic enzyme inducer --> decrease in therapeutic effect of other drugs
increase/decrease levels of phenytoin
CNS depression |
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Term
| carbamazepine drug interactions |
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Definition
hepatic enzyme inducer
grapefruit juice |
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Term
| valproate drug interactions |
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Definition
phenobarbital
phenytoin
topiramate |
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Term
| phenobarbital drug interactions |
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Definition
hepatic enzyme inducer
CNS depression
valproates |
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Term
| newer AED drug interactions |
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Definition
oxcarbazepine (trileptal) --> oral contraceptives
gabapentin (neurontin)
pregablin (lyrica) |
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Term
| dabigatrin (pradaxa) nursing implications |
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Definition
makes the stomach acidic
monitor people with GERD
can't be taken with a meal
very expensive...but don't have to monitor as much
expires 30 days after opening
not for patients over 75 |
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Term
| epoetin alfa adverse effects |
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Definition
| headache, insomnia, edema, MI, stroke, heart failure, joint/muscle aches, pains, soreness, nausea, vomiting, diarrhea, stomach pain constipation indigestion, blindness |
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Term
| epoetin alfa contraindications |
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Definition
any history of heart problems
cautious use in patients with bone marrow cancer
monitor Hgb twice a week --> should not exceed 12 |
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