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Benzoyl Perioxide, sulfur, resorcinol, salicylic acid for acne?
- Action: kerolysis for mild to moderate acne
- Contrindication: sensitivity
- Adverse reactions: peeling dryness and redness
- Nursing consideration: Adjust dose or use milder solution to reduce side effects
Tretinoid (Retin A)
- Action: Used to reduce inflammation and decreases formation of acne and dissolves
- Indications: Mild to moderate acne
- Contraindications: DO not use in areas around mouth, eyes and mucous membrances. Avoid angles of nose as well
- Adverse side effects: photosensitivity, burning, itching, erythema
- Pt teaching: wash hands after application
Topical antibiotics for acne?
- Tetracycline (#1), erythromycin, and clindomycin
- Indication: moderate to severe acne
- Contra: allergies
- Adverse reactions: photosensitivity, burning, and erythema
- Considerations: avoid eyes and mucous membranes. Wash area before application
Systemic oral antibiotics for severe acne? adverse side effects for each and pt teaching
- Tetracycline: Not for children because can cause brownish yellow discoloration of teeth, contraindicated in renal failure and preg/lactation
- Erythromycin: Contraindicated for renal/liver disease. Take with meals!
- Used cautiously for severe acne regulated by iPLEDGE program
- Action: decreases sebum formation and secretion, decreases inflammation and promote keratolysis
- Contraindications: preg and lactation, people who may become pregnant or blood donors. Not good for obese people those with diabetes or IBS patients
- Adverse reations: BIRTH DEFECTS, pruitis, conjuctivitis, epistaxis (nose bleeds) dry mouth and N/V. Also increases cholesterol and triglycerides. Can cause back joint and muscle pain
- Nursing considerations: monitor CBC, blood glucose and lipid levels regularly
What is Psoriasis? When does it typically onset?
- A chronic condition in which papules form and are covered with silvery scales
- Onsets 10-30 years old
- common places include scalp, elbows, palms, knees and soles
Salicylic acid (clear away, Compound W)
- Indication: common warts
- Adverse reactions: skin irritation and may not work if wart is cause by virus
- Can also cause systemic effects when large areas are invloved including: peripheral neuropathy, blood dsycrasias and kidney impairment
- indication: genital warts
- Adverse reactions: peripheral neuropathy, blood dyscrasias, kidney impairment, and teratogenic effects to fetus
Treatment of contact dermatitis?
wet dressings (burrows solution), lotions (calamine), glutocorticoid creams (dexamethasone and hydrocortisone), benadryl and oatmeal baths
Considerations when using glucocorticoids for contact dermatitis?
can cause thinning of the skin
What is impetigo? who is generally effected and what med is used to treat it?
- Caused by staph aureus
- toddlers 2-5
- Mupriocin (bactroban)
- Indications: hair loss
- Action: Vasodialation promoting hair growth
- considerations: ones medication stops so does hair growth effect.
- Indication: hair loss
- Contrindicated in women, those with hepatic impairment and obstructive uropathy
- Adverse side effect: sexual dysfunction
- Nursing considerations: Not effective in women only 50% of men, continued use important, also used for BPH (Proscar)
What to use for first degree burns?
- Cold wet compress and non prescription antibiotic
- Considerations: Dont use greasy ointments
Mafenide Acetate (Sulfamylone)
- Indication: 2nd or 3rd degree burns
- Class: carbonic anhydrase inhibitor a broad spectrum antibacterial
- Contraindications: inhalation injury and renal failure
- Adverse side effects: metabolic acidosis/Respiratory alkalosis, hypokalemia, and a burning sensation
- Pt teaching: apply a 1/8th inch strip on site and cover with dressing 1-2xs daily. Important to monitor VS!
Silver Sulfadiazadine (Silvadene)
- indication: 2nd or 3rd degree burns
- Contrindications: Sulfa allergy, infants, late pregnancy, impaired renal or hepatic function
- Adverse reactions: photosensitivity, burning, and skin discoloration.
Flurescein and rose bengal?
- Diagnostic aids that make corneal and conjuctivial injuries more visible. aid in removing foreign bodies
- Contraindications: allergy
- Adverse reactions: stinging, ocular irritation, redness and contact dermatitis
Proparicaine (ophthaine, ophthetic) and Tetracaine (pontocaine)?
- Topical anesthetics
- Action: corneal anesthetic
- Side effect: loss of blinking reflex temporarily
- Nursing considerations: Patient must lubricate or wear eye patch temporarily, NOT for long term use
What are the anti-inflamatories (nonsteriodal and coticosteriods) used for eyes?
- Nonsteriodal: Diclofenac (voltaren) and keterolac (acular)
- Corticosteroids: Dexamethasone (decadron) and prednisolone
- Indications: management of pain/inflammation after surgery, allergic conjuctivitis
- Contraindications: mixing with systemic anticoagulants, NSAIDs, or thrombolytics can increase bleeding!
- Adverse reactions: irritation, headache
- pt teaching: Avoid contact use
What are the different classes of drugs used to treat glaucoma?
Cholenergic agents, beta blockers, carbonic anhydrase inhibitors, osmotics, anticholinergics.
Cholenergics anti-glaucoma agents?
- Direct acting: pilocarpine (isopto carpine)
- Indirect: physostigmine (isopto eserine) and Demecarium (Humorol)
- Indications: OAG, counteraction of midriatics
- Action: Miosis decreasing IOP
- Contraindications: acute eye infection, CAG, acute asthma and bradycardia
- Adverse reactions: systemic absorption = bronchospasms, sweating, increased salivation and urination, N/V, flushing bradycardia and hypotention.
- Considerations: Apply pressure to lacrimal duct to reduce systemic absorption, Monitor VS, check breath sounds. Antidote = Atropine
- Indication: glaucoma and ocular hypertension
- Contraindication: Asthma
- Adverse side effects: if systemic absorbed can cause effect of beta blocker
- Nursing considerations: avoid systemic absorption (lacrimal pressure)
Lanaprost (Xalatan) and Bimatoprost (lumigan and Latisse)
- Prostaglandin analogues anti-glaucoma agents
- Action: reduces IOP by increasing AH outflow
- Adverse side effects: local irritation/ foreign body sensation, eyelash growth, may change eye color to brown, may precipitate with thimerosol products
- Considerations: wait 5 minutes between drops
Acetazolamide (Diamox) and Dorzolamide (trusopt)
- Carbonic anhydrase inhibitors anti-glaucoma agents
- Action: decrease IOP
- indication: OAG when other treatments are unsuccessful and other forms of ocular hypertension
- Contraindications: Renal insufficiency and kidney stones, sulfanamides
- Adverse reactions: Eye discomfort, unusual tastem photosensitivity, N/V, hypokalemia, depression
- Considerations: non compliance is high, contrindicated during 1st trimester of pregnancy
Osmotics anti-glaucoma meds?
- Glycerin, Isosorbide (ismotic) and Mannitol (osmitrol)
- Indications: Preop and postop, increased IOP, emergent
- ContraindicationsL Glycerin is contraindicated for diabetics
Anticholenergics Mydriatics and cycloplegics?
- Atropine, epinephrine, phenylephrine
- Contraindications: COG
- Considerations: african americans may not tolerate as well filipinos may be difficult to assess
- Indication: wet or dry Macular degeneration
- Contraindications: ocular/periocular infections, pregnancy and lactation
- Adverse side effects: conjunctival hemmorrage, eye pain, increased IOP, intraocular inflammation, and "floaters"
- Nursing considerations: For intravitral injection only, requires adequate anasthesia and a broad spectrum antibiotic
What are four categories of drugs for ear disorders?
- anti-infectives, antihistamine-decongestants, combination products, and ceruminolytics
What is the most common pathogen causing acute otitis media (AOM)?
- Streptococcus pneumonia
What is included in a plan of care for AOM?
- relieve pain
- eliminate cause
- administer antibiotics
What are some ceruminolytics?
Boric acid (ear dry), carbaminde perioxide (debrox) trolamine (cerumenex)
- Indications: hypogonadism, growth delay
- action: normal growth and development of male sex organs and characteristics
- Contraindications:breast or prostate cancer, severe renal, hepatic or cardiac disease
- Adverse reactions: deep voice, change in libido, ED, gynecomastia, oliospermia, priapism
- Considerations: Gl may increase, increases effects of anticoagulants, need for regular follow up exams. Do not use for under 14 y/o
Anabolic steroid definition? names?
- Synthetic derivatives of testosterone
- Androstenediol, androstenedione and DHEA
Androstenediol, androstenedione and DHEA?
- Synthetic testosterone
- Action: maximizes anabolic effects of androgens, resulting in buildup of cellular tissue
- Adverse reactions: aggressive behavior, acne, water retention, hypertension, hepatic damage, and decrease HDL
Phosphodiesterase (PDE) inhibitors?
- viagra, Levitra and Cialis
- Action: increases penile blood flow
- Contraindications: priapism, nitrates, cardiovascular disease
- Considerations: seek medical help for erection > 4hrs do not use with sublingual nitrates
- Adverse reactions: headache, flushing, nasal congestion, dyspepsia, and priapism
Finaseride (proscar) for BPH
- Action: shrinks prostate by lowering DHT
- Contraindications: hepatic impairment or obstructive uropathy
- Adverse reaction: decreased sexual function
- Nursing considerations: 6-12 months of therapy before symptom relief
Alpha-Adrenergic blockers for BPH?
- Tamsulosin (flomax), doxazonsin (cardura) and terazosin (Hytrin)
- Action: blocks alpha receptors in prostate causing constriction
- Adverse reations: dizziness, headache, and orthostatic hypertension
- Considerations: potential for hypotension, avoid meds that cause urinary retention (anticholinergics, antihistamines and decongestants)
- hormone secreted from pancreatic beta cells
- anabolic hormone that counteracts glucagon
- Action: controls hyperglycemia by stimulating glucose uptake and inhibiting hepatic glucose production
- contraindications: hypoglycemia
- Adverse reactions: hypoglycemia, erythema, lipodystrophy, pruritis and swelling
Nursing considerations for insulin?
- Always pack in 100u/ml packets
- check rights with other RN
- IV: regular insulin ONLY
- cannot be given orally but inhallative insulins do exist
What are the rapid acting insulins? onset peak duration and pt teaching?
- Insulin lispro (humalog) and human insulin aspart (Novolog)
- Onset: 5-15 minutes Peak: 30-60 minutes Duration: 3-4hrs
- Considerations: Never give more than 5 minutes before a meal, pt will likely need a intermediate acting insulin too
Short acting insulins? onset peak duration and pt teaching?
- Regular insulin (Humulin R, Novolin R)
- Onset: 30-60 minutes Peak: 2-3 hrs Duration: 4-8 hrs
- PT teaching: IV or SC, given 30 minutes before meals
Intermediate acting insulins? onset, peak, duration and pt teaching?
- NPH, Lente, Humulin N, Humalin L
- onset:1-2hrs peak: 4-12 hrs duration:12-24 hrs
- Pt teaching: administer 30-60 minutes before meals, solution is cloudy, draw up clear insulins first when mixing
Insulin Glargine (lantus) onset peak duration?
- Long lasting insulin
- onset: 1 hr with no peak
- duration: 24 hrs
Insulin Detmir(levemir)? Onset peak duration?
- Long lasting insulin
- onset: 1hr
- duration: 24 hrs
Nursing considerations and pt teaching for long lasting insulin?
- Administer 1 time daily
- nocturnal hypoglycemia uncommon
- increased site pain for some pts
Insulin Pumps? advantages?
- REGULAR INSULIN ONLY!!!
- can be portable or implantable
- Advantages: fewer hypoglycemic episodes with better control of glucose
- shoot insulin directly through skin into fatty tissue
- not for children
- very expensive and can cause burning, stinging, pain or bruising
Generations of oral antidiabetics?
- first: tolbutamine, tolazamide and chlorpropamide
- second: glipizide, glyburide, glimepiride
- 1st and 2nd generation oral antidiabetics
- Actions: stimulates pancreatic beta cells to produce more insulin
- O:60 mins P:4-6hrs D:6-24hrs
- Indication: type 2 diabetes
- Contraindications: Type 1 DM, sulfa allergy, renal or hepatic disease, uncontrolled infection, serious burns, trauma, preg/lactation
- Adverse: hypoglycemia
- Metformin (Glucophage)
- Action: affects hepatic and GI production of glucose
- Contraindication: stress, surgery, infection, alcoholism, preg/lac
- Adverse reactions: abdominal bloating, diarrhea, NV
- Considerations: given AFTER meals, hold for 48 hours before and after IV contrast
- Rosiglitazone (avandia) and Pioglitazone (Actos)
- Action: decrease insulin resistance and improve BG control
- Indication: as adjuct or monotherapy
- Contraindications: liver and renal disease, preg and lac
- Considerations: increase risk of heart attack ffor rosiglitazone, does NOT cause hypoglycemia when given alone
- Acatbose (Precose) and Migilitol (Glyset)
- Action: inhibits GI absorption of glucose and increases insulin sensitivity
- Adverse reactions: abdominal pain diarrhea and flatulence
- Considerations: Does NOT cause hypoglycemia
- Treats hypoglycemia
- Action: simulates hepatic conversion of glucose from glycogen stores
- Adverse reaction: N&V
- considerations: BG starts to increase 5-20 minutes after admin, admin carbs at same time
50% dextrose (D50) for hypoglycemia?
- comes in 50 ml ampule ready to push
- use largest IV available
- flush well before and after use
Somatrem (Protropin�), somatropin (Genotropin�)?
- Indication: Growth failure secondary to growth hormone deficiency of the pituitary gland
- Contraindications: Closure of epiphysis, active neoplasia, acute critical illness, Obesity of resp impairment r/t Prader-willi syndrome
- Adverse reactions: none for kids, ACROMEGALY with adults, hyperglycemia with high doses
- Considerations: Discourage use for increaing althletic performance
Octreotide (Sandostatin) and bromocriptine (Parlodel)?
- Indications: pituitary gland GH EXCESS- Gigantism (childhood), Acromegaly (puberty)
- Contrindications: Gall bladder disease, renal impairment, fat malabsorption
- Adverse reactions: gall stones, diarrhea, fat malabsorption, N&V, headache, bradycardia, edema, and orthostatic hypotension
- considerations: Admin between meals and at bedtime, since its refridgerated allow to reach room temp prior to injection
Goiters and Graves
- Indication: hyperthyroidism
- Action: inhibits conversion of T3 and T4
- Contraindications: decreased bone marrow reserve
- Adverse reactions: N/V, rash and hepatotoxicity
- Considerations: give with food, caution with dietary sources of iodine
Strong iodine solution (Lugols solution, potassium iodid solution)?
- Indication: hyperthyroidism
- Action: supresses thyroid function
- Contraindications: impaired renal function, hyperkalemia, pulonary edema + preg and lac
- Adverse side effects: Diarrhea and Gi bleeding
- Considerations: Avoid foods high in Iodine (shellfish iodized salt)
Levothyroxine (Levothroid, Synthroid)
- Indication: hyperthyroidism
- Action: replaces T3 and T4
- Contraindications: MI, severe renal disease, and cardiovascular disease
- Adverse reactions: headache, insomnia, angina, arrhythmia, GI distress, sweating, mentrual irregularities, and weight loss
- Considerations: Important labs are TSH, T3 and T4
- IndicationsL hypocalcemia secondary to hypoparathyroidism
- Action: promotes absorption of Ca, decreases PTH
- Contraindications: malabsorption syndrome, excess Ca, vit D or phosphate
- Adverse reactions: hypercalcemia= weakness, arrhythmias, hypertension, pruritis, hyperthermia, bone and muscle pain, and hematuria
- Considerations: Monitor Ca levels, assess for symptoms of hypo/hyper Ca
- Action: Anti inflammatory, anti-allergic, immune suppressant
- Indications: trauma, surgery, infections, emotional upset/anxiety
- Adverse reactions: increase Gl, abnormal fat deposits, muscle wasting, edema, sodium and water rentention, thinned skin, peptic ulcers, masking of infection, increased IOP, Adrenal atrophy (cushings syndrome)
Mineralocorticoid Flufrocortisone (Florinef)
- Action: secrete aldosterone which promotes reabsorption of Na from renal tubules
- indications: adrenocoritical insufficiency, Addison's disease
- Contraindications: CHF
- Adverse reactions: simular but less severe then glucocorticoids
- Considerations: may be given with glucocorticoid, maintain high protein diet to fight negative nitrogen balance, monitor potassium level
Estrogen-Progestin Combinations? aka? effectiveness?
- AKA COCs
- 98-99.9% effective
What is the main drug for estrogen?
Ethinyl estradiol (EE)
What are the main drugs for progestin?
levonorgestrel, desogestrel, norgestimate, and medroxyprogesterone (injectable)
Ethinyl estradiol (EE)?
- Action: inhibits ovulation by preventing the formation of the dominant follicle; stabalizes the endometrium
- Since the dominant follicle is needed for the estrogen peak there is no LH surge meaning no ovulation
- Changes quality and thinkess of the cervial mucous creating a "mucus plug"
- makes implantation difficult
- decreases paristalsis of the fallopian tubes slowing ovum transport
What are the benifits of COC?
- shorter lighter perios, decrease blood loss and uterine cramps, eliminates mittelschmerz, reduces symptoms of benign breast disorders,
- prevents breast and ovarian cyst formation, reduces incidence of PID, reduces endometrial and ovarian cancer. reduces osteoporosis
Side effects of increased progestin?
increased appetite, oily skin and scalp, excess hair growth, depression, fatigue and decrease libido
Side effects of decreased progestin?
breakthrough bleeding, dysmenorrhea, headaches
side effects of increased estrogen?
N/v, dizzinesss, fluid rentention, breast tenderness and enlargement, cyclic breast changes, leg cramps, dysmenorrhea, menorrhagia, choloasma, VTE
Side effects of decreased estrogen?
Amenorrhea, spotting, and dyspareunia
Monophasic vs Biphasic vs triphasic?
- Monophasic - fixed ratio of estrogen to progestin through the cycle
- Biphasic - fixed estrogen but varying amounts of progestin
- Triphasic - varying doses of both hormones
- place for 3 weeks remove for 1
- 99.7% effective
- fewer ectopic pregnancies
- adverse side effects: skin irritation, vision changes and increased clot risk
- not for women >198lbs
- Place in vag 3 weeks remove for 1
- 98% effective, less ectopic pregnancies
- Adverse effects: vag discharge, irritation or infection
- Used for women who cannot use estogen (hx of VTE, breastfeeding women smokers older than 35, uncontrolled HTN and migraines)
- increases irregular bleeding and spotting, depression, mood changes and fatigue
Oral progestin only minipill?
- 28day pack no counters
- breakthrough bleeding an issue
- 97% effective
- take pill same time everyday
Depo-provera progestin only
- Im injection 1x every 3 months
- ovulation inhibited
- irregular bleeding breast tenderness increased depression and weight gain
What is the black box warning with depo-provera?
- May cause bone density loss
- D/C after 2 yrs
- encourage vit D and calcium intake
- weight bearing exercises
Implantable progetin only?
norplan, implanon and nexaplanon
- 99.9% effectiveness
- adverse effects: PID
- Paraguard- contains copper good for 10 years
- Mirena- releases levonorgestrel good for 5 years
Medical abortion drugs?
- methotrexate- give once then again 5 days later
- bleeding changes, hot flashes begin, vaginal dryness
- insomnia, headaches, irratability, mood changes, memory lapses and decreased libido
- permenant end os spontaneous mentruation (~50yrs)
- no menses for 1 yr
decreased production of estrogen and progesterone but ovaries still produce androgens
Non pharmacological CAM meds for menopause?
- soy and derivatives, red clover extract, black cohosh, Vit E, evening primrose oil, st johns wart
- many of these are backed by no scientific evidence
Estrogen for menopause?
- gold standard for relief of menopause symptoms
- contraindicated for women with hx of breast cancer, coronary heart disease, VTE or stroke or those at high risk for these
When do you add in progestin to hormone therapy for menopause?
For women who have had a hysterectomy
- Progressice loss of bone mineral density leading to fractures
- over 50% of US women over 50
Non pharm for osteoporosis>?
- diet, exercise and smoking cessation
Menostar for osteoporosis
- Estrogen in a once a week transdermal patch- lowest dose available
- progestin only need every 6-12 weeks
- A biphosphate that prevents and treats osteopenia and osteoporosis
- can be taken daily or weekly
- take with 8oz water 30 minutes before any other liquid, food or meds
- must remain upright for the 30 minutes
- Side effects: abdominal pain and acid reflux
Ibandronate sodium (Boniva)?
- Biphosphonate that prevents and treats osteoporosis
- taken once a month
- side effects abdominal pain and acid reflux
- Biphosphonate that prevent (improves BMD), ? fracture risk and treats osteoporosis
- side effects: abdominal pain and acid reflux
Zoledronic acid (Reclast)?
- BMD and fracture risk and treats osteoporosis
- once yearly IV infusion
Nucleoside/Nucleotide reverse transcriptase inhibitors? aka? what step does it work in? What are the adverse effects? preg class?
- AKA NRTIs "nukes", "backbone" drugs
- Works in step 4 of the viral life cycle
- Adverse effects are related to MITOCHONDRIAL TOXICITY and include: lactic acidosis, hepatic steatosis "fatty liver", Peripheral neuropathy, pancreatits, and Lipoatrophy
- Preg class B and C
Nucleoside/Nucleotide reverse transcriptase inhibitor names?
- Videx EC/didanosine/ddl
- Retrovir/zidovudine/AZT, ZDV
Non-Nucleoside reverse transcriptase inhibitors? aka? what step does it work in? What are the adverse effects? preg class?
- AKA NNRTIs "non nukes" used first to reserve the PIs low pill burden
- Problems with viral resistance
- Works in step 4 in the viral life cycle
- Adverse effects: Rash, elevated liver functions and many drug interactions
- Preg class B C and D
Non-Nucleoside reverse transcriptase inhibitor names?
- Viramune, Viramune XR/nevirapine/NVP
- AKA PIs
- Works at step 10 in the viral life cycle
- Preg class B and C
- Adverse effects: Hyperglycemia, hypertriglyceridemia, lipodystrophy, elevated liver functions, many drug interactions
- Avoid st johns wort and PPIs
- Combo drug PO 1x daily
- preferred NNRTI-based regime
- Preg category D
- blocks HIV from attaching at the CCR5 receptorhepatotoxicity, cough, pyrexia, URTI, rash, abd pain and dizziness
- Increase in CV ischemia events including MI
- Fuzeon/enfuvirtide/T-20, ENF
- Prevents HIV from fusing into the CD4 cell after it is attached
- Salvage therapy
- SQ injection twice daily
- Adverse effects � injection site reactions, rash, diarrhea
- works in step 5 of the life cycle
- Adverse effects: Nausea, headache, diarrhea, pyrexia and increase in liver function
What are common bacteria opportunistic infections?
MAC, TB, pneumonia and septicemia
Common protozoal opportunistic infections?
Toxoplasmosis, cryposporidiosis, leishmaniasis
Common fungal opportunistic infections?
PCP, candidiasis, cryptococcosis
How would you treat MAC disease?
- One of the following:
- Azithromycin 1200mg PO once weekly
- Clarithromycin 500mg PO twice daily
- Azithromycin 600mg PO twice a week
When do you treat and with what do you treat toxoplasma Gondii encepalitits?
- Start med when CD4 is less than 100 or 14% AND toxoplasma IgG positive
- Septra/bactrim- TMP/SMX 1 DS or PO once daily
antiemetics antihistamines? side effects?
- Dimenhydrinate (Dramamine) and Diphenhydramine (Benadryl)
- Side effects: Drowsiness, dry mouth, constipation
Pepto Bismol and Reglan? actions and side effects?
- Both used as non prescription antiemetics
- Pepto Action: Acts directly on gastic mucosa to supress vomiting
- Reglan action and side effects: Blocks D2 receptos in chemoreceptor trigger zone; sedation, diarrhea and extrapyramidal symptoms
Serotonin receptor antagonist- Odansetron (Zofran)? Action side effects?
- Action: Blocks serotonin receptors in chemoreceptor trigger zone and afferent vagal nerve terminals in upper GI
- Side effects: headache, diarrhea, dizziness, and fatigue
Antiemetics considerations and teaching?
Provide mouth care, Monitor VS and bowel sounds, monitor for dehydration, Do no use alcohol, not for preg women, do not drive
Ipecac (OTC) Action, Use, and Cautions?
- Toxic substance ingetion- emetic
- Action: stimulates chemoreceptor trigger zone and acts directly on gastic mucosa
- Use: induces vomitting after toxic substance (rarely used today)
- Caution: Avoid vomitting if substance is caustic or petroleum, if vomitting is contraindicated, activated charcoal is given instead
- opiates and opiate related agents such as paregoric, Diphenoxylate with atropine and loperamide
- Octreotide, pepto bismol,kaolin-pectin and parepectolin
Antidiarrheals nursing interventions?
- Monitor BP and respirations- report more than 10-15 mmHg decrease in BP
- monitor frquency of bowel movements and bowel sounds
- Assess for evidence of dehydration
- monitor electrolytes
- Avoid fried foods, milk and sedatives
- If diarrhea persists after 48 hrs notify MD
Types of laxatives?
Osmotic (saline), Stimulant (irritants), Bulk-forming, and Emollient (stool softeners
Contraindications for laxatives?
- Undiagnosed abdominal pain
- Inflammatory disorders of the GI tract
- Appendicitis, diverticulitis, ulcerative colitis
- Spastic colon
- Bowel obstruction
Osmotic (Saline) laxatives names? action and side effects?
- Names: Polyethylene glycol (GoLytely) and Lactulose (Chronulac)
- Action: Hyperosmolar salts pull water into colon, increase water in feces to increase bulk, which stimulates peristalsis
- Side Effects: Fluid and electrolyte imbalances, hypotension, weakness
Stimulant (Irritant) Laxatives? Names? Action? Results? and Side effects?
- Phenolphthalein (Ex-Lax, Correctol) and Bisacodyl (Dulcolax)
- Action: Increase peristalsis by irritating sensory nerve endings in intestinal mucosa
- Results:orally in 6-12 hrs, supp 15-60 min
- Side effects: Abdominal cramps, weakness, reddish brown urine, diarrhea
Bulk forming laxatives? Names? action? results? administration and side effects?
- Psyllium hydrophilic mucilloid (Metamucil) and Calcium polycarbophil (Fiber-Con)
- Action: Absorb water into intestines, increase bulk and peristalsis
- Results: 8-12 hrs
- Administration: Mix in glass of water or juice, stir, drink immediately, follow with 1 glass water
- Side effects: Abdominal cramps; Excess laxative: Nausea,vomiting, gas, diarrhea
Stool softener Docusate (Colace) Action? use? side effects?
- Action: Lowers surface tension, Promotes water accumulation in intestine and Emulsifies and lubricates feces for easier passage
- Use: Prevents constipation, Reduces straining post surgery or myocardial infarction
- Side effects: Abdominal cramping, nausea, vomiting, diarrhea
Anticholinergic anti-ulcer med?
- Propantheline (Pro-Banthine): Inhibits release of HCl by blocking acetylcholine and histamine
- Take with meals to decrease acid secretion
Antiulcer drugs antacids? action? systemic and nonsystemic effects?
- Aluminum hydroxide, Mg, Maalox, Tums, and Alka-Seltzer
- Action: Neutralize gastric acid, reduce pepsin activity
- Systemic side effects: Sodium excess, water retention, metabolic alkalosis, acid rebound
- Nonsystemic side effects: Mg-diarrhea; Al-constipation
Antiulcer drugs- PPIs? names? action? side effects? and considerations/pt teaching?
- Esomeprazole (Nexium), Pantoprazole (Protonix), Omeprazole (Prilosec), Lansoprazole (Prevacid)
- Action: Reduce gastric acid by inhibiting hydrogen/potassium ATPase
- Side effects: Headache, insomnia, dizziness, dry mouth, flatulence, d, abdominal pain
- Nursing Consideration/Patient Teaching: Counsel patient that onset of action will take 2-4 days, has to be taken continuously
Antiulcer drugs- Histamine2 blockers? names? action? side effects?
- Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)
- Action: Reduces gastric acid by blocking H2 receptors of parietal cells in stomach
- Promote healing of ulcer by eliminating cause
- Side effects: Headaches, dizziness, diarrhea, constipation, reversible impotence, gynecomastia
Antiulcer drugs- Pepsin inhibitor name? action? side effect? considerations?
- Sucralfate (Carafate)
- Action: Combines with protein to form thick paste covering ulcer, protects from acid and pepsin
- Side effects: Constipation
- Given 30 min before meals and bedtime
Activated Charcoal? use, action, contraindications and considerations?
- Use: to prevent toxic substance absorption
- Action: Absorbs toxic substants or irritants thus inhibiting GI absorption
- Contraindications: not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol, lithium
- Considerations/pt teaching: adding sorbitol has a laxative effect, repetitive doses are useful to enhance the elimination of certain drugs, and ensure accessible airways and patient is conscious as this may cause vomitting
What is the antidote for opiates? Action? Side effects? and considerations?
- Action: Competes and displaces narcotics at opioid receptor sites
- Side effects: WITHDRAWAL, BP changes, arrhythmias, seizures
- Considerations: lower doses in opiate dependance, elimination half life is only 60-90 minutes therefore repeated admin may be neccessary, Titrate patient slowly until resp rate is stabalized.
What is the antidote for Benzodiazepines? Action? contraindications? adverse effects?
- Flumazentil (Ramazicon)
- Action: Benzodiazepine antagonist
- contraindications: increased ICP and status epilipticus
- Adverse reactions: N&V, arrhythmias, convulsions
What is the treatment for for Acetaminophen overdose?
- Activated charcoal within 4 hours of ingestion
- may reduce absoption by 50-90%
Aloe Vera indications and considerations?
- Indications: minor burns, insect bites, sunburn and constipation
- considerations: fresh aloe leaves are the best, PO is a powerful laxative, can increase menstual flow
Black Cohosh? indications? considerations?
- Indication: hot flashes, palpitations, irritability
- Considerations: potentiates effects of insulin, oral antidiabetics and antihypertensives, do not confuse with blue cohost that is use to induce labor
Chamomile? Action? indications? considerations?
- Action: antispasmodic and anti-inflammatory
- indications: digestive and GI complaints including IBS and infant colic- also can be used as a sedative
- Considerations: ragweed allergy may be a contraindication, may increase effects of sedatives, and decreases action of anticoagulants
Dong Quai? indication? considerations?
- Indication: menstrual cramps
- Considerations: Contains vit b12, recommended to avoid this herb, increases effects of anticoagulants so may increase risk of bleeding
Ecchinacea? Indications? action? considerations?
- Indications: enhances immune system, resp infections and UTIs for PO and topical= antifungal, canker sores, fungal infections, and snakebites
- Action: increases leukocytes and spleen cells, activates granulocytes
- Considerations: should be avoided if immunocompromised, begin treatment at onset of symptoms, may counteract corticosteroids and can cause immunosuppression with extended use.
Eucalyptus? indications? considerations?
- Indications: resp problems, congestion
- Considerations: freq added to OTC cough meds, NOT for children under 3 because it can cause laryngospasms!
Feverfew? indication? action? considerations?
- Indications: migraine headaches
- action: serotonin antagonist
- considerations: local irritation may occur, wide variation in compound= potential dosing problem, increases effects of anticoagulants so may increase bleeding risk
Garlic? Indications? nursing considerations?
- Indications- lower cholesterol and triglyceride levels, decreases BP reduces clotting capability of blood, antibiotic
- Consdierations: recommend only acid-resistant oral formulas, alert MD of use, may cause heartburn, flatulence and GI irritation, may cause premature labor or infant colic, increases effects of anticoagulatns
indications: migraine headache, motion sickness, nausea
Ginkgo biloba? indications? action? considerations?
- Indications: hypoxia, dementia, intermittent claudation, vertigo, tinnitus when related to diminished blood flow
- Action: increases cerebral arterial dialation and uptake of O2 and glucose
- considerations: may help alzheimers pts, increases effects of anticoagulants, most commonly prescribed herb
- Side effects: mild transient headaches, mild GI distress
St johns wort?
- Indications: depression, anxiety, insomnia
- Considerations: herbal prozac, avoid tyramine rich foods, may enter breast milk, may decrease effect of digoxin, may interfere with MAOIs and other antidepressants, avoid drugs that increase serotonin concentrations.
- Indication: BPH and other urinary conditions
- Considerations: May render PSA false negative, may cause headache, dysuria and back pain, may decrease effects of anti-inflamatories and immunostimulants
- Indication: anxiety, insomnia
- Considerations: herbal "valium", foul smell, may cause drowsiness
- side effects: CNS depression, headache
Iron in pregnancy?
- Iron needs are doubled in pregnancy (27mgs), normal diet supplies 18mgs/day
- 325mgs of ferrous sulphate contains 60mgs elemental iron
- Watch for side effects including melena
Folic Acid during pregnancy?
Folic acid- deficiency leads to abortions and neural tube defects, usual dose of folic acid is 400mcg/day
Prenatal vitamin considerations?
take with meals, remember cultural practices, encourage healthful diet
Medications for minor disorders during pregnancy? N/v? heartburn? constipation? pain?
- N & V- comfort measures, ginger tea, promethazine (phenergan 12.5-25 mgs po/IV or IM), treat dehydration, ondansetron (Zofran) 4mgs IV/PO, vitamin B6 50mgs
- Heartburn- relaxation of cardiac sphincter- Antacids
- Constipation- increase dietary fiber and po liquids
- Pain- acetaminophen/tylenol, avoid NSAIDs and aspirin
4 Stages of labor?
- First (3 sub-phases): Effacement and dilation, Latent 0-4 cm, Active 4-7 cm, Transition 8-10 cm
- Second: Complete dilation and delivery
- Third: Placental separation and delivery
- Fourth: Stabilization and bonding
What are nonpharmacological measure to reduce pain during labor?
Ambulation, supportive positioning, touch.massage, hygiene and comfort measures, support persons, breathing and relaxation, TENS, hypnosis, acupuncture, hydrotherapy, and herbal supplement (avoid black cohosh)
Sedative tranquilizer during labor?
- Zolpidem (Ambien) 5-10mg po for latent labor
- Zolpidem is a benzodiazepine-like drug
- Potentiates action of GABA (gamma-aminobutyric acid) by binding to specific receptors in the cell membrane making post-synaptic receptors more sensitive to GABA (Page 297-300)
- Depresses CNS at multiple sites- reduce anxiety and promote sleep
Opioids during labor?
- Given at onset of contractions to ? fetal exposure- cause respiratory depression in the fetus
- meperidine (Demerol), fentanyl (Sublimaze), morphine sulfate, nalbupine (Nubain) and butorphanol (Stadol)
Side effects of opioids?
nausea, vomiting, constipation, drowsiness, dizziness, sedation, confusion, urinary retention, rashes and bradycardia
Anestestic agents during labor?
- All end in -Caine
- act by blocking sodium channels in the axonal membrane
- can be used for infiltration, nerve block, epidural or spinal anesthesia
What are the risks of a pudendal block during labor?
Hematoma, infection, trauma to sciatic nerve, rectal puncture
When will a spinal headache occur during labor?
If the dura is punctured
Nursing considerations for analgesia admin during labor?
Make sure your client is well-hydrated. Placed in side-lying position/sitting for administration. Monitor BP every 1-2 minutes for the first 10 minutes after administration. Assess analgesia.
What are the areas blocked by epidual/spinal?
- Umbilicus to toes (vaginal)
- Xyphoid process to toes (C-section)
What positions avoid hypotension during labor?
- Left lateral position
- Inferior vena cava and aortic compression
What are drugs that enhance uterine contractability/ripen the cervix?
- Titrated based on uterine and fetal response
- Need to establish adequate contraction pattern which promotes labor progress
- Contractions every 2-3 minutes lasting 50-60 seconds/moderate intensity
- Prevents uterine atony after delivery
- Synthesized in hypothalamus and transported to posterior pituitary from where it is released
- Stimulates smooth muscle contractions
- Increased pain
- Compromised FHT patterns
- Must use infusion pump
- Half life is 1-9 minutes
- Onset: 3-5 minutes unless IV then immediate
- Duration: 2-3 hours
When is Ergot Alkaloids given? how is it given when should you NOT give it?
- after delivery to prevent or control postpartum hemorrhage and promote uterine involution (return to pre pregnancy size).
- DO NOT give if client has HTN or PVD
Side effects of Ergot Alkaloids?
- Uterine cramping
- Hypertension (IV administration)
- Chest pain,
- Sudden and severe headache
Ergotism? ergot toxicity signs?
- Pain in arms, legs, lower back
- Numbness, cold hands and feet
- Blood hypercoagulation
what is the antidote for Mag sulfate?
Corticosteroids in preg?
- Given 24-34 weeks gestation if at risk for preterm delivery.
- Betamethasone (Celestone) 12mgs IM X 2 doses
- Stimulates surfactant production in the preterm fetus
- Decreases infant mortality from RDS and increases survival
- Prevents the development of respiratory distress syndrome
- Surfactant-keeps alveoli open during expiration
- Also given in clients already diagnosed with RDS to prevent severity.
Active vs Passive immunity?
- Active immunity: Antibodies (immunoglobulins) are produced; Natural�genetically determined; Acquired�vaccines
- Passive immunity:Antibodies received from another source; Example: newborn infants
Flu vaccine side effects? contraindications?
- Side effects: Runny nose, wheezing, soreness at site
- Contraindicated: Allergic to eggs, Have flu-like symptoms already, Age less than 6 months
Flu mist contraindications, drug interactions? ages?
- Contraindications: Same as flu vaccine plus Wheezing
- Drug interactions: Contraindicated if taking aspirin
- Ages 2-49 only
Where do nurses report adverse reactions to vaccines?
The adverse event reporting system (VAERS)
Vaaince Varicella (Chickenpox)
- Ususally results in complete protection
- Contraindications: malignancies, high dose steriods, immunosuppressive therapy, and pregnancy.
What are the latest recommendations for childhood immunizations?
DTaP, tetanus & diphtheria (Td), polio (IPV), varicella, measles-mumps-rubella (MMR), Hib, Hep-A, Hep-B, pneumococcal conjugate, meningococcal congugate, human papillomavirus, rotavirus.