NSG 251 Final Exam
(ketorolac) Toradol- what is the drug and what do you monitor? - Correct Answer -is the only IV NSAID
-used for severe pain
-commonly used post-op
-given routinely several days after surgery to decrease pain, so it also decreases
1st Generation and 2nd Generation antipsychotics - Correct Answer 1st Gen = "typical" agents
-Phenothiazines
-Nonphenothiazines
2nd gen = new
-Nonphenothiazines
Abortive therapy for migraines - Correct Answer triptans/serotonin agents
-sumatriptan (Imitrex), zolmitriptan (Zomig)
-Contraindications: CAD, HTN, pregnancy, do not give within 24 hours of ergot alkaloids
ACE inhibitors - Correct Answer lisinopril (Prinivil, Zestril) and catopil (Capoten)
ACE inhibitors adverse - Correct Answer severe hypotension, renal tubular damage, cough, hyperkalemia,
angioedema
ACE inhibitors contra - Correct Answer -renal disorders
-do not take if pregnant
-Do not use when on ARB
ACE inhibitors mechanism/uses - Correct Answer -Inhibit conversion of angiotensin I to angiotensin II.
-decrease BP, decrease afterload
-Use: heart failure, HTN, MI
ACE inhibitors nursing - Correct Answer Monitor weight, I&O, BP.
-Risk of rebound if stop abruptly- taper.
-Monitor K.
-Do not mix w/ NSAIDs
Acetaminophen adverse - Correct Answer -hepatic failure w/high doses
-4 g. Limit per day
-Tylenol overuse = #1 cause for liver failure
-causes nephrotoxicity w/overdoses (harms kidneys)
Acetaminophen nursing implications - Correct Answer -no more than 4 g (4000 mg per day)
-drug of choice for febrile children, elderly, and impaired renal function and when pregnant
-don't take more than 10 days in a row
-avoid ETOH consumption d/t drug being damaging to liver
-alternate Tylenol and Ibuprofen for children's fever (more effective than monotherapy at lowering fever)
Acetaminophen uses - Correct Answer -Commonly given OTC
-Antipyretic effects = good for fever but NO anti-inflammatory or platelet effect
-Used for mild pain relief and bringing down fever
-may used w/pt w/GI problems b/c no caustic gastric problems that we have w/ASA for example
-also used and packaged w/other opioids (Ex. acetaminophen w/hydrocodone = Norco so there's 325 mg Tylenol and
has an additive effect = does better w/pain relief)
Acne medications - Correct Answer Benzoyl peroxide- OTC
Retin A (vitamin A)
isotretinoin (Accutane)- inhibits inflammation
,--significant black box warning; if female need to go into a program with a physician where the patient signs a form,
needs to have two negative pregnancy tests and be on two methods of birth control
--Pregnancy class X drug- significant harm
Acute pain - Correct Answer results from injury, trauma, some sort of dz process that damaged the body tissue; pain
amount is usually proportional to amount of tissue damage; may be called "fast pain" b/c it's felt quickly right after
pain stimulus is applied
Adverse effects of all nonsteroidals - Correct Answer 1) GI
-ranges from very mild symptoms (ex. heartburn) to extreme abdominal pain and GI bleeding and ulceration
formation
2) Cardiovascular Adverse Effects
-increased thrombotic events, especially MI and stroke
-the longer drugs are used or the higher the dose puts ppl at risk
-some effects can even be early on, so much that FDA issued BLACK BOX WARNING for cardiovascular adverse
effects (2006); in 2015 warning increased to include heart attack and stroke
-the cardiovascular effects aren't an issue w/ASA use b/c ASA has antiplatelet effect (no other nonsteroidals have);
it's protective so we use low dose ASA to prevent HA and stroke (ASA doesn't fall into this category of adverse
effects)
Adverse effects of anti thyroid drugs - Correct Answer Hypothyroidism, iodine toxicity, agranulocytosis.
Aminoglycoside adverse - Correct Answer nephrotoxic and ototoxic
Aminoglycoside contra - Correct Answer pregnancy
Aminoglycoside drugs - Correct Answer tobramycin (Nebcin)
gentamicin (Garamycin)
Aminoglycoside nursing - Correct Answer Check Blood levels for peak and trough levels, test 30-60min after drug
admin
Aminoglycoside uses - Correct Answer Bactericidals, Inhibit protein synthesis
--used for serious gram neg. infections, preoperatively for GI/GU tract surgeries
Aminoglycosides contra - Correct Answer pregnancy
Antacids - Correct Answer -Are alkaline substances that neutralize stomach acids
-Are aluminum, magnesium or calcium based
-Available OTC
-Used for peptic ulcer dz. and GERDs (when stomach acid refluxes back up into esophagus and backwash irritates
lining
-Adverse: if magnesium based = diarrhea; aluminum based = constipation; calcium based = intestinal gas,
constipation and acid rebound
Antacids nursing implications - Correct Answer -Magnesium antacids can't be given to pts w/renal insufficiency b/c
pts w/renal problems can't excrete Mg++ so we don't want to give them any additional Mg++
-Many antacids interfere w/many drugs by binding in GI tract and b/c of that they are given 1-3 hours AFTER meals
and at bedtime
-Mg++ acts rapidly, highly neutralizing and has long duration
-It's important to assess what abdominal pain pt has
-Ca+ is the most effective for heartburn
-Many antacids contain some kind of glucose, so check blood sugars of diabetic pts.
Antibacterial eye drops - Correct Answer erythromycin (Ilotycin)- newborns- born to mothers with chlamydia may
have conjunctivitis
ciprofloxacin (Ciloxan)- bacterial conjunctivitis, corneal ulcers
Anticholinergic drug adverse - Correct Answer Tachycardia (high doses, HR >100), blurred vision
Anticholinergic drug name - Correct Answer Atropine
, Anticholinergic drug nursing implications - Correct Answer Monitor vitals, urinary retention, bowel sounds, blurred
vision
Anticholinergic drug uses - Correct Answer Bradycardia, pre-anesthesia
Anticholinergic mechanism - Correct Answer -Blocks the effect of acetylcholine
-Depresses salivary and bronchial secretions
-Dilates bronchi
-inhibits vagal influences on heart
ARB adverse - Correct Answer severe hypotension, less cough risk
ARB contra - Correct Answer liver failure, do not take if pregnant
ARB mechanism/uses - Correct Answer Comete with angiotensin II for tissue binding sites
Use: HTN, heart failure
ARB names - Correct Answer lorsartan (Cozaar), valsartan (Diovan)
ARB nursing implications - Correct Answer monitor BP, weight
aspirin (ASA) - Correct Answer -prototype for NSAID group
-used for moderate pain, fever (is antipyretic), inflammation (is anti-inflammatory, and lowers risk of thrombus (is anti-
platelet)
-low dose of ASA has become main stay of Tx for many of the thrombotic event type of dzs.(ex. MI, angina, stroke;
used to treat thromboembolism [blood clot that breaks off and is carried by bloodstream to plug another vessel] after
surgery).
-Pts will be on low dose ASA as maintenance drug to keep MI from occurring
-low dose ASA= 81-325 mg
-ASA is a non-selective COX inhibitor; ASA inhibits both COX 1 and COX 2
aspirin adverse - Correct Answer major adverse is stomach irritation and bleeding; this is why it comes in enteric
coated = protect stomach lining
aspirin contra - Correct Answer Children (Reye's syndrome)
Pregnant (risk of bleeding)
aspirin nursing implications - Correct Answer -can become toxic on ASA= Salicylate Toxicity = tinnitus
-teach pts to avoid other OTC preparations that contain ASA
--numerous cold meds have a pain relief type effect of med which may contain ASA or Tylenol
-stop use of ASA 2 weeks before and after an invasive procedure (b/c ASA will increase risk of bleeding)
-take w/food b/c ASA is really hard on the gut
-drink plenty of fluids.
-ASA is highly bound to albumin (malnourished pts can become toxic pretty easily)
-teach pt to watch for signs of bleeding (need to look at stool = look for blood or black, tarry stool)
-teach pt that when taking ASA other drugs increase effects of ASA ( ETOH, anticoagulants, opioids, steroids = all
can cause increase in bleeding)
Benzodiazepines/nursing - Correct Answer **diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), midazolam
(Versed)**
-Used for sleep, anxiety, preop, and alcohol withdraw
-Adverse effects are oversedations, hangover effect, and decreased respirations
-Persists for days after discontinued
-Can cause opposite responses in elderly!!!!----excited, aggressive, anxious
-Safety--decreased consciousness---fall risk
-Flumazenil (Romazicon) is the reversal agent
-Give with food, abstain from ETOH, watch OTC medications for sedation
-Taper medication----withdraw will occur if stopped suddenly
-Dependence can occur----short term use only
-"Nerve pills"----taken for anxiety to treat symptoms
