Nursing Drug Reference Weeks 8 and 9

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sisterbarley
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176519
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Nursing Drug Reference Weeks 8 and 9
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2012-10-22 01:44:53
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Medications
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NUR151 - Medication Flashcards - Module 8 and 9
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  1. What is the generic name for Wellbutrin?
    buPROPion (Rx)
  2. What is the trade name for buPROPion
    • Wellbutrin (depression)
    • Zyban (smoking cessation)
  3. For buPROPion (Rx) Wellbutrin, what is the functional class?
    • Antidepressant
    • Miscellanious smoking deterrent
  4. For buPROPion (Rx) Wellbutrin, what is the action?
    • Inhibits reuptake of DOPamine
    • (PROP DOPE)
  5. For buPROPion (Rx) Wellbutrin, what are the uses?
    • Depression (Wellbutrin)
    • Smoking cessation (Zyban) 
    • Seasonal affective disorder
  6. For buPROPion (Rx) Wellbutrin, what are the contraindications?
    • Hypersensitivity
    • Eating disorders
    • Seizure disorders
  7. For buPROPion (Rx) Wellbutrin, what are the contraindication precautions?
    • Pregnancy (C)
    • Breastfeeding
    • Geriatric patients
    • Renal/hepatic disease
    • Recent MI
    • Cranial trauma
    • Seizure disorder
  8. For buPROPion (Rx) Wellbutrin, what is the BLACK BOX WARNING?
    Children < 18 years, suicidal thinking/behavior (young adults)
  9. For buPROPion (Rx) Wellbutrin, what are the side effects to the CNS?
    • Common: Headache, agitation, dizziness, akinesia, bradykinesia, confusion, insomnia, sedation, tremors
    • Life threatening: Seizures and suicidal ideation
  10. For buPROPion (Rx) Wellbutrin, what are the side effects to the CV?
    • Common: Dysrhythmias, hypertension, tachycardia
    • Life threatening: Complete AV block, QRS prolongation (overdose)
  11. For buPROPion (Rx) Wellbutrin, what are the side effects to the EENT?
    • Common: Blurred vision and auditory disturbance
    • Life threatening: NONE
  12. For buPROPion (Rx) Wellbutrin, what are the side effects to the GI?
    • Common: Nausea, Vomiting, dry mouth, and constipation
    • Life threatening: NONE
  13. What is dopamine?
    • A catecholamine neurotransmitter in the central nervous system, retina, and sympathetic ganglia,acting within the brain to help regulate movement and emotion
    • NOTE: its depletion may cause Parkinson's disease.
    • Pharmacology:  A dopamine preparation may be used to increase the force of contraction of the heart in the treatment of shock
  14. For buPROPion (Rx) Wellbutrin, what are the side effects to the GU?
    • Common: Menstrual irregularities
    • Life threatening: NONE
  15. For buPROPion (Rx) Wellbutrin, what are the side effects to the INTEG?
    • Common: Rash and sweating
    • Life threatening: Stevens-Johnson syndrome
  16. For buPROPion (Rx) Wellbutrin, what are the miscellaneous side effects?
    • Common: Weight loss or gain
    • Life threatening: NONE
  17. For buPROPion (Rx) Wellbutrin, what are the pharmacokinetics?
    • Onset: 2-4 weeks
    • Half-life: 14 hr
    • Extensively metabolized by the liver, some conversion to active metabolites
    • Steady state: 5-8 days
    • Protein binding: 84%
    • Excreted in urine and feces
  18. For buPROPion (Rx) Wellbutrin, what is the assessment black box warning?
    Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms
  19. For buPROPion (Rx) Wellbutrin, what is involved in the NURSING ASSESSMENT?
    • Hepatic/renal function in patients with hepatic, kidney impairment
    • For increased risk of seizures; if patient has excessively used CNS depressants and OTC stimulants, dosage of buPROPion should not be exceeded
    • For smoking cessation after 7-12 wk; if progress has not been made, product shold be discontinued
    • BLACK BOX WARNING: Mental status: mood, sensorium, affect, suicidal tendencies, increasein psychiatric symptoms
  20. For buPROPion (Rx) Wellbutrin, what is involved in the PERFORM/PROVIDE?
    • Assistance with ambulation during beginning therapy because sedation occurs
    • Safety measures, primarily for geriatric patients
  21. For buPROPion (Rx) Wellbutrin, what is involved in the NURSING EVALUATION?
    Therapeutic response: decreased depression, ability to perform daily activities, ability to sleep throughout the night, smoking cessation
  22. For buPROPion (Rx) Wellbutrin, what is involved in the NURSE TEACHING OF PATIENT/FAMILY?
    • That therapeutic effects may take 2-4 wk; not to increase dose without prescriber's approval; that treatment for smoking cessation lasts 7-12 wk
    • To use caution when driving, performing other activities that require alertness; sedation, blurred vision may occur
    • To avoid alcohol, other CNS depressants; alcohol may increase risk of seizures
    • Not to use with nicotine patches unless directed by prescriber; may increase B/P
    • To notify prescriber immediately if urinary retention occurs
    • That risk of seizures increased when dose exceeded, if patient has siezure disorder
    • That suicidal ideas, behaviors, hostility, depression may occur in children or young adults
    • To notify prescriber if pregnancy is suspected, planned: pregnancy (C)
  23. For buPROPion (Rx) Wellbutrin, what is involved in the TREATMENT OF AN OVERDOSE?
    ECG monitoring; lavage, activated charcoal; administer anticonvulsant
  24. For buPROPion (Rx) Wellbutrin, what are the unlabeled uses?
    • Neuropathic pain
    • Enhancement of weight loss
    • ADHA (attention-deficit/hyperactivity disorder)
  25. What is the trade name for FLUoxeine (Rx)?
    Prozac
  26. What is the generic name for Prozac?
    FLUoxeine (Rx)
  27. For FLUoxetine (Rx) Prozac, what is the functional class?
    Antidepressant, SSRI (selective serotonin reuptake inhibitor)
  28. For FLUoxetine (Rx) Prozac, what is the action?
    Inhibits CNS neuron uptake of serotonin but not of norepinephrine
  29. For FLUoxetine (Rx) Prozac, what are the uses?
    • Major depressive disorder
    • Obsessive-compulsive disorder (OCD)
    • Bulimia nervosa
    • Sarafem: premenstrual dysphoric disorder (PMDD) and panic disorder
  30. For FLUoxetine (Rx) Prozac, what are the unlabeled uses?
    • Alcoholism
    • Anorexia nervosa
    • Borderline personality disorder
    • Obesity
    • Posttramatic stress disorder
    • Autism
    • Fibromyalgia
    • Orthostatic hypotension
    • Premature ejaculation
  31. For FLUoxetine (Rx) Prozac, what are the contraindications?
    Hypersensitivity
  32. For FLUoxetine (Rx) Prozac, what are the contraindication precautions?
    • Pregnancy (C), breastfeeding, geriatric patients, diabetes mellitus, narrow-angle glaucoma, cardiac malformations in infants (exposed to FLUoxetine in utero)
    • BLACK BOX WARNING: Children, suicidal ideation
  33. For FLUoxetine (Rx) Prozac, what is the black box warning?
    Children, suicidal ideation
  34. For FLUoxetine (Rx) Prozac, what are the side effects to the CNS?
    • Common: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziess, fatigue, sedation, poor concertration, abnormal dreams, agitation
    • Life threatening: Seizures, suicidal ideation, neuroleptic malignant syndrome-like reactions
  35. For FLUoxetine (Rx) Prozac, what are the side effects to the CV?
    • Common: Hot flashes and palpitations
    • Life threatening: Tachycardia, 1st degree AV block, bradycardia, MI, and thrombophlebitis
  36. For FLUoxetine (Rx) Prozac, what are the side effects to the GI?
    • Common: Nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, tast changes, flatulence, decreased appetite
    • Life threatening: NONE
  37. For FLUoxetine (Rx) Prozac, what are the side effects to the GU?
    • Common: Dysmenorrhea, decreased libido, urinary frequency and UTI
    • Life threatening: NONE
  38. For FLUoxetine (Rx) Prozac, what are the side effects to the HEMA?
    • Common: NONE
    • Life threatening: Hemorrhage
  39. For FLUoxetine (Rx) Prozac, what are the side effects to the INTEG?
    • Common: Sweating, rash, and pruritus
    • Life threatening: Angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
  40. For FLUoxetine (Rx) Prozac, what are the side effects to the MS?
    • Common: Pain
    • Life threatening: NONE
  41. For FLUoxetine (Rx) Prozac, what are the side effects to the RESP?
    • Common: Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, and bronchitis
    • Life threatening: NONE
  42. For FLUoxetine (Rx) Prozac, what are the side effects to the SYST?
    • Common: Asthenia, viral infection, fever, allergy, and chills
    • Life threatening: NONE
  43. For FLUoxetine (Rx) Prozac, what are the pharmacokinetics?
    • PO: Peak 6-8 hr
    • Metabolized: in liver
    • Excreated: in urine
    • Terminal half-life: 2-3 days
    • Norfluoxetine active metabolite (transforms to this drug)
    • Half-life: 4-16 days
    • Steady state: 28-35 days
    • Protein binding: 94% (need albumin labs)
  44. For FLUoxetine (Rx) Prozac, what is involved in the NURSING ASSESSMENT?
    • BLACK BOX WARNING: Mental status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic; monitor for seizures, seisure potential increased
    • Bulimia nervosa: appetite, weight daily, increase nutritious foods in diet, watch for bingeing and vomiting
    • Alleric reactions/serious skin reactions: angloedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, rash, uticaria; product should be discontinued, may need to give antihistamine
    • B/P (lying/standing), pulse q4hr, if systolic B/P drops 20 mm Hg, hold product, notify prescriber; ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
    • Blood studies: CBC, leukocytes, differential, cardic enzymes if patient is receiving long-term therapy; check platelets; bleeding can occur, thyroid function, growth rate, and weight
    • Hepatic studies: AST, ALT, bilirubin, creatinine, weight weekly; appetite may decrease with product
    • Alcohol consumption
    • NOTE: If alcohol is consumed, hold dose until the AM
  45. For FLUoxetine (Rx) Prozac, what is involved in the NURSING PERFORM/PROVIDE?
    • Storage at room temp; do not freeze
    • Safety measures, primarily for geriatric patients
  46. For FLUoxetine (Rx) Prozac, what is involved in the NURSING EVALUATION?
    Therapeutic response: decreased depression, symptoms of OCD
  47. For FLUoxetine (Rx) Prozac, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • That therapeutic effect may take 1-4 weeks
    • To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
    • To avoid alcohol and other CNS depressants
    • To notify prescriber if pregnant, planning to become pregnant, or breastfeeding
    • To change positions slowly because orthostatic hypotension may occur
    • To avoid all OTC products unless approved by prescriber
    • BLACK BOX WARNING: That suicidal thoughts/behaviors may occur in young adults and children
  48. What is the generic name for Cymbalta?
    DULoxetine (Rx)
  49. What is the trade name for DULoxetine (Rx)?
    Cymbalta
  50. For DULoxetine (Rx) Cymbalta, what is the functional class?
    Antidepressant
  51. For DULoxetine (Rx) Cymbalta, what is the action?
    May potentiate serotonergic noradrenergic activity in the CNS; in studies, DULoxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake
  52. For DULoxetine (Rx) Cymbalta, what are the uses?
    • Major depressive disorder (MDD)
    • Neuropathic pain associated with diabetic neuropathy
    • Generalized anxiety disorder
    • Fibromyalgia
    • Chronic low back pain
    • Oseoarthritis pain
  53. For DULoxetine (Rx) Cymbalta, what are the unlabeled uses?
    • Stress
    • Urinary incontinence
  54. For DULoxetine (Rx) Cymbalta, what are the contraindications?
    Alcohol intoxication, alcoholism, closed-angle glaucoma, hepatic disease, hepatitis, jaundice, hypersensitivity
  55. For DULoxetine (Rx) Cymbalta, what are the contraindication precautions?
    • Pregnancy (C), breastfeeding, geriatric patients, mania, hypertension, renal/cardiac disease, seizures, increased intraocular pressure, anorexia nervosa, bleeding, dehydration, diabetes, hyponatremia, hypotension, hypovolemia, orthostatic hypotension, abrupt product withdrawal
    • BLACK BOX WARNING: Children, suicidal ideation
  56. For DULoxetine (Rx) Cymbalta, what are the side effects to the CNS?
    • Common: headache
    • Life threatening: Neuroleptic malignant-like syndrome reaction, and seizures
  57. For DULoxetine (Rx) Cymbalta, what are the side effects to the CV?
    • Common: NONE
    • Life threatening: Thrombophlebitis and supraventricular dysrhythmia
  58. For DULoxetine (Rx) Cymbalta, what are the side effects to the EENT?
    • Common: Abnormal vision
    • Life threatening: NONE
  59. For DULoxetine (Rx) Cymbalta, what are the side effects to the GI?
    • Common: Nausea
    • Life threatening: Hepatic failure
  60. For DULoxetine (Rx) Cymbalta, what are the side effects to the INTEG?
    • Common: NONE
    • Life threatening: Stevens-Johnson syndrome
  61. For DULoxetine (Rx) Cymbalta, what are the side effects to the SYST?
    • Common: NONE
    • Life threatening: Anaphylaxis, angeioedema, serotonin syndrome
  62. For DULoxetine (Rx) Cymbalta, what are the pharmacokinetics?
    • Well absorbed
    • Extensively metabolized: in the liver to an active metabolite (ALT/AST)
    • Product recovered in the urine: 70%
    • Product recovered in the feces: 20%
    • Protein binding: 90% (need albumin labs)
    • Elimination half-life: 9.2-19.1 hr
  63. For DULoxetine (Rx) Cymbalta, what is involved in the NURSING ASSESSMENT?
    • BLACK BOX WARNINGDepression: Mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms; depression, and panic
    • B/P lying, standing: If systolic B/P drops 20 mm Hg, hold product, notify prescriber
    • Pulse q4hr
    • Take VS q4hr in patients with CV disease
    • Hepatic studies: AST, ALT, bilirubin
    • Weight weekly; weight loss or gain; appetite may increase; peripheral edema may occur
    • Sugarless gum, hard candy, frequent sips of water for dry mouth
    • Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness; not common unless product is discontinued abruptly
    • Malignant neuroleptic-like syndrome reaction
    • Serotonin syndrome: nausea/vomiting, dizziness, facial flush, shivering, and sweating
    • Sexual dysfunction: ejaculation dysfunction, erectile dysfunction, decreased libido, orgasm dysfunction
  64. For DULoxetine (Rx) Cymbalta, what is involved in the NURSING PERFORM/PROVIDE?
    • Storge in tight container at room temp; do not freeze
    • Assistance with ambulation during beginning therapy, since drowsiness, and dizziness occur
    • Confirmation that PO medication swallowed
  65. For DULoxetine (Rx) Cymbalta, what is involved in the NURSING EVALUATION?
    Therapeutic response: decreased depression
  66. For DULoxetine (Rx) Cymbalta, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • To report urinary retention; about signs and symptoms of bleeding (GI bleeding, nose bleed, ecchymoses, bruising)
    • To use with caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
    • To avoid alcohol ingestion, MAOIs, or other CNS depressants
    • Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise, taper
    • BLACK BOX WARNING: That clinical worsening and suicide risk may occur
    • To wear sunscreen or large hat, since photosensitivity may occur
    • To notify prescriber if pregnancy planned or suspected, or if breastfeeding
    • Improvement may occur in 4-8 wk or in up to 12 wk (geriatric patients)
  67. What are the three Antidepressant medications we are studying?
    • bupropion (Rx): Wellbutrin
    • fluoxetine (Rx): Prozac
    • duloxetine (Rx): Cymbalta
  68. What are the two Anti-Alzheimer's medications we are studying?
    • donepezil (Rx): Aricept
    • rivastigmine (Rx): Exelon
  69. What is the generic name for Aricept and Aricept (ODT)?
    donepezil (Rx)
  70. What is the trade name for donepezil (Rx)?
    • Aricept
    • Aricept (ODT)
  71. For donepezil (Rx) Aricept, what is the functional class?
    Anti-Alzheimer's agent
  72. For donepezil (Rx) Aricept, what is the chemical class?
    Reversible cholinesterase inhibiter
  73. For donepezil (Rx) Aricept, what is the action?
    • Elevates acetylcholine concentrations (cerebral cortex) by slowing degradation of acetylcholine released in cholinergic neurons
    • Does not alter underlying dementia (slows, does not cure)
  74. For donepezil (Rx) Aricept, what are the contraindications?
    Hypersensitivity to this poduct or piperidine derivatives
  75. For donepezil (Rx) Aricept, what are the contraindication precautions?
    Pregnancy (C), breastfeeding, children, sick sinum syndrome, hiistory of ulcers, GI bleeding, hepatic disease, bladder obstruction, asthma, seizures, COPD, abrupt discontinuation, AV block, GI obstruction, Parkinsson's  disease, and surgery
  76. For donepezil (Rx) Aricept, what are the side effects for the CNS?
    • Common: Dizziness, insomnia, headache
    • Life threatening: Seizures
  77. For donepezil (Rx) Aricept, what are the side effects for the CV?
    • Common: NONE
    • Life threatening: Atrial fibrillation, sinus bradycardia, and AV block
  78. For donepezil (Rx) Aricept, what are the side effects for the GI?
    • Common: Nausea, vomitng, diarrhea
    • Life threatening: GI bleeding (black tarry feces)
  79. For donepezil (Rx) Aricept, what are the pharmacokinetics?
    • Well absorbed PO
    • Metabolized by: CYP2D6, CYP3A4
    • Elimination half-life: 10 hr single dose
    • 70 hr: multiple doses
    • Protein binding: 96% (need albumin labs)
  80. For donepezil (Rx) Aricept, what is involved in the NURSING ASSESSMENT?
    • B/P: hypo/hypertension and heart rate
    • Mental status: affect, mood, behavioral changes, depression, complete suicide assessment; neurologic status
    • GI status: nausea, vomiting, anorexia, diarrhea; monitor weight
    • GU status: urinary frequency, incontinence, and I&O
  81. For donepezil (Rx) Aricept, what is involved in the NURSING PERFORM/PROVIDE?
    Assistance with ambulation during beginning therapy; dizziness and ataxia may occur
  82. For donepezil (Rx) Aricept, what is involved in the NURSING EVALUATE?
    Therapeutic response: decrease in confusion and improved mood
  83. For donepezil (Rx) Aricept, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • To report side effects: twitching, nausea, vomiting, sweating, dizziness; indicates cholinergic crisis or overdose
    • To use product exactly as prescribed
    • To notify prescriber of nausea, vomiting, diarrhea (dose increase or beginning treatment), or rash
    • Not to increase or abruptly decrease dose; serious consequences may result
    • That product is not  cure and relieves symptoms
  84. What is the generic name for Exelon, Exelon Patch?
    rivastigmine (Rx)
  85. What is the trade name for rivastigmine (Rx)?
    • Exelon
    • Exelon Patch
  86. For rivastigmine (Rx) Exelon, Exelon Patch, what is the functional class?
    Anti-Alzheimer Agent
  87. For rivastigmine (Rx) Exelon, Exelon Patch, what is the chemical class?
    Cholinesterase inhibitor
  88. For rivastigmine (Rx) Exelon, Exelon Patch, what is the action?
    • Potent
    • Selective inhibitor of brain acetylcholinesterase (AChE) and butyrylcholinesterase (BChE)
  89. For rivastigmine (Rx) Exelon, Exelon Patch, what are the uses?
    • Mild to moderate Alzheimer's dementia
    • Mild to moderate parkinson's disease dementia (PDD)
  90. For rivastigmine (Rx) Exelon, Exelon Patch, what are the unlabeled uses?
    • Vascular dementia: Changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage.
    • Demetia with Lewy bodies: Abnormal structures that build up in the brain
    • Pick's disease: Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain.
  91. For rivastigmine (Rx) Exelon, Exelon Patch, what are the contraindications?
    Hypersensitivity to this product and other carbamates (Effective insecticides which exert their effect by temporarily inhibiting cholinesterase activity. They are also capable of poisoning. Clinical signs are pupillary constriction, muscle tremor, salivation, ataxia and dyspnea)
  92. For rivastigmine (Rx) Exelon, Exelon Patch, what are the contraindication precautions?
    Pregnancy (B), breastfeeding, children, respiratory/cardiac/renal/hepatic disease, seizure disorder, peptic ulcer, urinary obstruction, asthma, increased intracranial pressure, surgery, GI bleeding, and jaundice
  93. For rivastigmine (Rx) Exelon, Exelon Patch, what are the side effects for the CV?
    • Common: NONE
    • Life threatening: QT prolongation, AV block, cardiac arrest, and MI
  94. For rivastigmine (Rx) Exelon, Exelon Patch, what are the side effects for the CNS?
    • Common: Tremors, confusion, and insomnia
    • Life threatening: NONE
  95. For rivastigmine (Rx) Exelon, Exelon Patch, what are the side effects for the GI?
    • Common: Nausea, vomiting, anorexia, abdominal distress, and flatulence
    • Life threatening: GI bleeding/obstruction and pancreatitis
  96. For rivastigmine (Rx) Exelon, Exelon Patch, what are the pharmacokinetics?
    • Rapidly and completely absorbed
    • Metabolized to: decarbamylated metabolite
    • Half-life: 1.5 hr
    • Excreted via: kidneys (metabolites)
    • Clearance: lowered in geriatric patients, hepatic disease and increased with nicotine use
    • Protein binding: 40% (need albumin labs)
  97. For rivastigmine (Rx) Exelon, Exelon Patch, what is involved in the NURSING ASSESSMENT?
    • Hepatic studies: AST, ALT, alk phos, LDH, bilirubin, CBS
    • Sever GI effects: nausea, vomiting, anorexia, weight loss, and diarrhea
    • Vitals: B/P, heart rate, respiration during initial treatment;  hypo/hypertension should be reported
    • Cognitive/mental status: Affect, mood, behavioral changes, depression, insomnia; complete suicide assessment
  98. For rivastigmine (Rx) Exelon, Exelon Patch, what is involved in the NURSING PERFORM/PROVIDE?
    Assistance with ambulation during beginning therapy; dizziness may occur
  99. For rivastigmine (Rx) Exelon, Exelon Patch, what is involved in the NURSING EVALUATION:
    Therapeutic response: Improved mood/cognition
  100. For rivastigmine (Rx) Exelon, Exelon Patch, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • About the procedure for giving oral sol; use instruction sheet provided; how to apply transdermal product, to fold in half and throw away, not to get in eyes, to wash hands after application; not to use heating pad, sauna, or tanning bed
    • To notify prescriber of sever GI effects
    • That product may cause dizziness, anorexia, and weight loss
    • That effect may take weeks or month
    • To notify prescriber if pregnancy is planned or suspected
  101. What is the generic name for Ativan?
    LORazepam (Rx)
  102. What is the trade name for LORazepam (Rx)?
    Ativan
  103. For LORazepam (Rx) Ativan what is the functional class?
    Sedative, hypnotic; antianxiety
  104. For LORazepam (Rx) Ativan what is the chemical class?
    Bensodiazepiine, short acting
  105. For LORazepam (Rx) Ativan what is the action?
    Potentiates the actions of GABA, especially in the limbic system and the reticular formation
  106. Is LORazepam (Rx) Ativan a controlled substance?
    If yes, what schedule?
    • Yes
    • Controlled substance schedule IV
  107. For LORazepam (Rx) Ativan what are the uses?
    • Anxiety
    • Irritability with psychiatric or organic disorders
    • Preoperatively
    • Insomnia
    • Adjunct for endoscopic procedures
    • Status epilepticus (A common, life-threatening neurologic disorder. It is essentially an acute, prolonged epileptic crisis)
  108. For LORazepam (Rx) Ativan what are the unlabeled uses?
    • Antiemetic prior to chemotherapy
    • Rectal use
    • Alcohol withdrawal
    • Seizure prophylaxis
    • Agitation
    • Insomnia
    • Sedation maintenance
  109. For LORazepam (Rx) Ativan what are the contraindications?
    Pregnancy (D), breastfeeding, hypersensitivity to bensodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea
  110. For LORazepam (Rx) Ativan what are the contraindication precautions?
    Children < 12 yr, geriatric patients, debilitated, renal/hepatic disease, addition, suicidal ediation, abrupt discontinuation
  111. For LORazepam (Rx) Ativan what are the side effects for the CNS?
    • Common: Dizziness and drowsiness
    • Life threatening: NONE
  112. For LORazepam (Rx) Ativan what are the side effects for the CV?
    • Common: Orthosttic hypotension
    • Life threatening: ECG changes, tachycardia, apnea, and cardiac arrest (IV, rapid - NEVER dump, push slowly)
  113. For LORazepam (Rx) Ativan what are the side effects for the EENT: 
    • Common: Blurred vision
    • Life threatening: NONE
  114. For LORazepam (Rx) Ativan what are the pharmacokinetics?
    • Metabolized by liver
    • Excreted: by the kidneys
    • Crosses: placenta
    • Excreted: in breastmilk
    • Half-life: 14 hr
    • PO: Onset 1/2 hr, peak 1-6 hr, duration 12-24 hr
    • IM: Onset 15-30 min, peak 1-1 1/2 hr, duration 6-8 hr
    • IV: Onset 5-15 min, peak unknown, duration 6-8 hr
  115. For LORazepam (Rx) Ativan, what is involved in the NURSING ASSESSMENT?
    • ANXIETY: decrease in anxiety; mental status: mood, sensorium, affect, sleeping patter, drowsiness, dizzines, suicidal tendencies
    • Renal/hepatic/blood status: if receiving high-dose therapy
    • Physical dependency, withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness, tremors, seizures, after long-term, excessive use
  116. For LORazepam (Rx) Ativan, what is involved in the NURSING PERFORM/PROVIDE?
    • Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
    • Check to confirm that PO medication has been swallowed
    • Refrigerate parenteral form
  117. For LORazepam (Rx) Ativan, what is involved in the NURSING EVALUATION?
    Therapeutic response: decreased anxiety, restlessness, and insomnia
  118. For LORazepam (Rx) Ativan, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • That product may be taken with food
    • Not to use product for everyday stress or for >4 mo unless directedby prescriber
    • Not to take more than prescribed amount; may be habit forming
    • To avoid OTC preparations (cough, cold, hay fever) unless approved by prescriber
    • To avoid driving, activities that requie alertness, since drowsiness may occur
    • To avoid alcohol, other psychotropic medications unless directed by prescriber
    • Not to discontinue medication abruptly after long-term use
    • To rise slowly brcause fainting may occur, especially among geriatric patients
    • That drowsiness may worsen at beginning of treatment
    • To use birth control if of child-bearing age (pregnancy [D])
  119. What is the generic name for Lanoxin?
    digoxin
  120. What is the trade name for digoxin (Rx)?
    Lanoxin
  121. For digoxin (Rx) Lanoxin, what is the alert level?
    HIGH ALERT!
  122. For digoxin (Rx) Lanoxin, what is the functional class?
    Cardiac glycoside, inontropic, antidysrhythmic
  123. For digoxin (Rx) Lanoxin, what is the action?
    • Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect)
    • Increases force of contractions
    • Decreases heart rate (negative chronotropic effect)
    • Decreases AV conduction speed
  124. For digoxin (Rx) Lanoxin, what are the uses?
    • Heart failure
    • Atrial fibrillation
    • Atrial flutter
    • Atrial tachycardia
    • Cardiogenic shock,
    • Paroxysmal atrial tachycardia
    • Rapid digitalization in these disorders
    • NOTE: Power to control cardiac output and ventricular response in atrial fibrillation
  125. For digoxin (Rx) Lanoxin, what are the unlabeled uses?
    • Atrial flutter
    • Paroxysmal suprabentricular tachycardia (PSVT) treatment/prophylaxis
  126. For digoxin (Rx) Lanoxin, what are the contraindications?
    Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd or 3rd-degree heart block
  127. For digoxin (Rx) Lanoxin, what are the contraindication precautions?
    Pregnancy (C), breastfeeding, geriatric patients, renal disease, acute MI, AV block, severe respiratory disease, hypothyroidism, sinus nodal disease, and hypokalemia
  128. For digoxin (Rx) Lanoxin, what are the side effects on the CNS?
    • Common: Headache
    • Life threatening: NONE
  129. For digoxin (Rx) Lanoxin, what are the side effects on the CV?
    • Common: Hypotension
    • Life threatening: Dysrhythmias and AV block
  130. For digoxin (Rx) Lanoxin, what are the pharmacokinetics?
    • Half-life: 1.5 days
    • Excreted: in urine
    • Protein binding: 20-30%
    • PO: Onset 1/2 - 2 hr, peak 6-8 hr, duration 3-4 days
    • IV: Onset 5-30 mn, peak 1-5 hr, duration variable
  131. For digoxin (Rx) Lanoxin, what is involved in the NURSING ASSESSMENT?
    • Apical pulse for 1 min before giving product; if pulse <60 in adult or <90 in infant, take again in 1 hour; if <50 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose
    • Electrolytes: K, Na, Cl, Mg, Ca
    • Renal function studies: BUN, creatinine
    • Blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically thereafter
    • I&O ratio, daily weights; monitor turgor, lung sounds, edema
    • Monitor product levels; therapeutic level 0.5-2 ng/ml
    • Cardiac status: apical pulse, character, rate, rhythm
    • NOTE: Get baseline vital signs; get a full one minute apical pulse (must have a minimum of >60 bpm); check labs for digitalis and potassium levels
    • Watch for hypokalemia, visual disturbances, fatigue, arrhythmias, anorexia
  132. For digoxin (Rx) Lanoxin, what is involved in the NURSING PERFORM/PROVIDE?
    Storage protected from light
  133. For digoxin (Rx) Lanoxin, what is involved in the NURSING EVALUATION?
    Therapeutic response: decreased weight, edema, pulse, respiration, crackles; increased urine output; serum digoxin level (0.5-2 ng/ml)
  134. For digoxin (Rx) Lanoxin, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • Not to stop product abruptly; about all aspects of product; to take exactly as ordered; how to monitor heart rate
    • To avoid OTC medications, herbal remedies because many advers product interactions may occur; not to take antacid at same time
    • To notify prescriber of loss of appetite, lowe stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity
    • About the toxic symptoms of this product; when to notify prescriber
    • To maintain a sodium-restricted diet as ordered
    • To report shortness of breath, difficulty breathing, weight gain, edema, persistent cough
  135. For digoxin (Rx) Lanoxin, what is involved in the NURSING TREATMENT OF AN OVERDOSE?
    Discontinue product; give potassium; monitor ECG; give adrenergic-blocking agent, digoxin immune FAB
  136. What are the functions of Cardiac Glycosides?
    • Positive Inotropic action
    • Negative chronotropic action
    • Negative dromotropic action
    • Increases stroke volume
    • NOTE: Gives your heart a little umph!
  137. What do diuretics do to the body?
    • Inhibits Na+ & H20 reabsorption in renal tubules
    • Decreased reabsorption of other electrolytes is also common with use of diuretics (k+)
  138. Decribe the process for inhibiting Na+ and H20 reabsorption in the renal tubules.
    • Decreased Na+ reabsorption
    • Increased Na+ exretion through the kidneys
    • Increased H20 excretion through the kidneys (H20 usually follows Na+)
  139. Diuretics are mainly used to do what?
    • Decrease edema
    • Decrease HTN (indirectly)
  140. Potassium wasting vs. sparing, what does this mean?
    • A potassium wasting diuretic allows the potassium to be elliminated through urine (possible hypokalemia can occur)
    • A potassium sparing diuretic allows the  potassium to be recirculated through the system to be utilized.
  141. What is the generic name for Lasix?
    furosemide (Rx)
  142. What is the trade name for furosemide (Rx)?
    Lasix
  143. For furosemide (Rx) Lasix, what is the functional class?
    Loop diuretic
  144. For furosemide (Rx) Lasix, what is the chemical class?
    Sulfonamide derivative
  145. For furosemide (Rx) Lasix, what is the action?
    Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle
  146. For furosemide (Rx) Lasix, what are the uses?
    Pulmonary edema; edema with CHF, hepatic disese, nephrotic syndrome, ascites, hypertension
  147. For furosemide (Rx) Lasix, what are the unlabeled uses?
    Hypercalcemia with malignancy, hypertensive emergency/urgency, pulmonary edema or prevention of hemodynamic effects associated with blood product transfusion, ascites
  148. For furosemide (Rx) Lasix, what are the contraindication?
    Breastfeeding, infants, anuria, hypovolemia, electrolyte depletion
  149. For furosemide (Rx) Lasix, what are the contraindication precautions?
    Pregnancy (C), diabetes mellitus, dehydration, severe renal disease, cirrhosis, ascites, hypersensitivity to sulfonamides/thiazides
  150. For furosemide (Rx) Lasix, what are the side effects for the CV?
    • Common: NONE
    • Life threatening: Circulatory collapse
  151. For furosemide (Rx) Lasix, what are the side effects for the ELECT?
    • Common: Hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, and hyponatremia
    • Life threatening: NONE
  152. For furosemide (Rx) Lasix, what are the side effects for the ENDO?
    • Common: Hyperglycemia
    • Life threatening: NONE
  153. For furosemide (Rx) Lasix, what are the side effects for the GI?
    • Common: Nausea
    • Life threatening: NONE
  154. For furosemide (Rx) Lasix, what are the side effects for the GU?
    • Common: Polyuria
    • Life threatening: Renal failure
  155. For furosemide (Rx) Lasix, what are the side effects for the HEMA?
    • Common: NONE
    • Life threatening: Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia
  156. For furosemide (Rx) Lasix, what are the side effects for the INTEG?
    • Common: Rash and pruritus
    • Life threatening: Stevens-Johnson syndrome
  157. For furosemide (Rx) Lasix, what are the pharmacokinetics?
    • PO: Onset 1 hr, pek 1-2 hr, duration 6-8 hr, absorbed 70%
    • IV: Onset 5 min; peak 1/2 hr; duration 2 hr (metabolized by the liver 30%); excreated inurine, some as unchanged roduct, and feces; crosses placenta; excreted in breast milk; half-life 1/2-1 hr
  158. For furosemide (Rx) Lasix, what is involved in the NURSING ASSESSMENT?
    • CHF: weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
    • Hypertension: B/P lying, standing, postural hypotension may occur
    • Metabolic alkalosis: drowsiness, restlessness
    • Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness
    • Rashes, temp elevation daily
    • Confusion, especially in geriatric patients; take safety precautions if needed
    • Hearing: including tinnitus and hearing loss, when giving high doses for extended periods
    • Rate, depth, rhythm of respiration, effect of exertion, lung sounds
    • Electrolytes (potassium, sodium, chloride); include BU, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid
    • Glucose in urine if patient diabetic
    • Allergies to sulfonamides, thiazides
  159. For furosemide (Rx) Lasix, what is involved in the NURSING PERFORM/PROVIDE?
    Increased fluid intake 2-3 L/day unless contraindicated
  160. For furosemide (Rx) Lasix, what is involved in the NURSING EVALUTION?
    Therapeutic response: improvement in edema of feet, legs, sacral are (CHF); increase urine output, decreased B/P, decreased calcium levels (hypercalcemia). 
  161. For furosemide (Rx) Lasix, what is involved in the NURSE TEACHING PATIENT/FAMILY?
    • To discuss the need for a high-potassium diet or potassium replacement with prescriber
    • To rise slowly from lying or sitting position because orthostatic hypotension may occur
    • To recognize adverse reactions that may occur; muscle cramps, weakness, nausea, dizziness
    • About the entire treatment regimen, including exercise, diet, stress relief for hypertension
    • To take with food or milk for GI symptoms
    • To use sunscreen or protective clothing to prevent photosensitivity
    • To take early in the day to prevent sleeplessness
    • To avoid OTC medications unless directed by prescriber
  162. For furosemide (Rx) Lasix, what is involved in the NURSING TREATMENT OF OVERDOSE?
    Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status
  163. What are the different types of Antihypertensives?
    • ACE Inhibitors (medications have the PRIL ending - APRIL)
    • Beta Blockers (medications have the OLOL ending)
    • Calcium Channel Blockers
  164. How do Beta Blockers work?
    • Decreased sympathetic nervous system response
    • Decreased Vascular resistance
    • Decreased BP
  165. How do ACE Inhibitors work?
    • Inhibits formation of angiotensin II (vasoconstrictor)
    • Blocks the release of Aldosterone(promotes Na+ retention)
    • Lose Na+ and H20
  166. How do the Calcium Channel Blockers work?
    • Decreased calcium levels and thus . . . 
    • Decreased cardiac contractility
    • Promotes vasodialation
  167. What are the antihypertensive actions, for ACE inhibitors?
    ACE inhibitors: act by selectively suppressing renin-angiotensin I to angiotensin II; dilation of arterial and venous vesels occurs.
  168. What are the antihypertensive actions, for Beta Blockers?
    Produce a fall in blood pressure without reflex tachycardia or reduction in heart rate through mixture of B-blocking effects; elecated plasma renins are reduced
  169. What are the antihypertensive actions, for Calcium Channel Blockers?
    Act by inhibiting calcium ion influx across the cell membrane in cardiac and vascular smooth muscle. This action produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction, and dilates peripheral arteries
  170. What are the antihypertensive uses, for ACE inhibitors?
    • Used for hypertension.
    • Some products are used for heart failure not responsive to conventional therapy. 
    • Some products are used in hypertensive crisis, angina, and for some cardiac dysrhythmias
  171. What are the antihypertensive uses, for Beta Blockers?
    Hypertension, ventricular dysrhythmias, and prophylaxis of angina pectoris
  172. What are the antihypertensive uses, for Calcium Channel Blockers?
    Used for chronic stable angina pectoris, vasospastic angina, dysrhythmias, hypertension, and unstable angina
  173. What are the antihypertensive contraindications, for ACE Inhibitors?
    • Hypersensitive reactions may occur, and allergies should be identified before these products are given.
    • Antihypertensives should not be used in children or in patients with heart block
  174. What are the antihypertensive contraindications, for Beta Blockers?
    • Hypersensitive reactions may occur, and allergies should be identified before these products are given.
    • B-Adrenergic Blockers should not be used heart block, congestive heart failure, or cardiogenic shock
  175. What are the antihypertensive contraindications, for Calcium Channel Blockers?
    Persons with 2nd-/3rd-degree heart block, sick sinus sundrome, hypotension of <90 mm Hg systolic, Wolff-Parkinson-White syndrome, or cardiogenic shock shoudl not use these products since worsening of those conditions may occur.
  176. What are the antihypertensive contraindication precautions, for ACE Inhibitors?
    Antihypertensives should be used with cautin in geriatric and dialysis patients and in the presence of hypovolemia, leukemia, and electrolyte imbalances.
  177. What are the antihypertensive contraindication precautions, for Beta Blockers?
    • Beta Blockers shoudl be used with caution in geriatric patients, or in renal/thyroid disease, COPD, coronary artery disease, diabetes mellitus, prenancy, and asthma
    • Administer: PO before meals and at bedtime; tabs may be crushed or swallowed whole; reduced dosage in renal dysfunction
  178. What are the antihypertensive contraindication precautions, for Calcium Channel Blockers?
    • Congestive heart failure since edema may be increased. hypotension may worsen since B/P is decreased. patients with renal/hepatic disease should use these products cautiously since they are metabolized in the liver and excreted by the kidneys.
    • Administer: PO before meals and at bedtime
  179. What are the antihypertensive side effects, for ACE Inhibitors?
    The most common side effects are hypotension, bradycardia, tachycardia, headache, nausea, and vomiting. Side effects and adverse reactions may vary widely between classes and specific products
  180. What are the antihypertensive side effects, for Beta Blockers?
    The most common side effects re orthostatic hypotension, bradycardia, diarrhea, nausea, and vomiting. Serious adverse reactions include blood dyscrasias, bronchospasm, and congestive heart failure
  181. What are the antihypertensive side effects, for Calcium Channel Blockers?
    The most common side effects are dysrhythmias and edema. Also common are headache, fatigue, drowsiness, and flushing.
  182. What are the antihypertensive NURSING ASSESSMENTS, for ACE Inhibitors?
    • Blood studies: neutrpphil; decreased platelets occur with many of the products
    • Renal studies: protein, BUN, creatinine; watch for increased level that may indicate nephrotic syndrome; obtain baselines in renal and hepatic function studies before beginning treatment
    • Edema in feet and legs daily
    • Allergic reaction, including rash, fever, pruritus, urticaria: product should be discontinued if antihistamines fail to help 
    • Symptoms of congestive heart failure: edema, dyspnea, wet crackles, B/P
    • Renal symptoms: polyuria, oliguria, frequency
  183. What are the antihypertensive NURSING ASSESSMENTS, for Beta Blockers?
    • Renal studies: protein, BUN creatinine; watch for increased levels that may indicate nephrotic syndrome; obtain baselines in renal/hepatic function studies before beginning treatment
    • I&O, weight daily
    • B/P during beginning treatment and periodically thereafter; pulse q4hr, note rate, rhythm, quality
    • Apical/radial pulse before administration; notify prescriber of significant changes
    • Edema in feet and legs daily
  184. What are the antihypertensive NURSING ASSESSMENTS, for Calcium Channel Blockers?
    Cardiac system: B/P, pulse, respirations, ECG intervals (PR, QRS, QT)
  185. What are the antihypertensive NURSING PERFORM/PROVIDE, for ACE Inhibitors?
    Supine or Trendelenburg position for severe hypotension
  186. What are the antihypertensive NURSING EVALUATION, for ACE Inhibitors?
    Therapeutic response: decrease in B/P in hypotension; decreased B/P, edema, moist crackles in congestive heart failure
  187. What are the antihypertensive NURSING EVALUATION, for Beta Blockers?
    Therapeutic response: decrease in B/P in hypotension; decreased B/P, edema, moist crackles in congestive heart failure
  188. What are the antihypertensive NURSING EVALUATION, for Calcium Channel Blockers?
    Therapeutic response: decreased anginal pain; decreased B/P, dysrhythmias
  189. What are the antihypertensive NURSE TEACHING PATIENT/FAMILY, for ACE Inhibitors?
    • To comply with dosge schedule, even if feeling better
    • To rise slowly to sitting or standing position ot miniize orthostatic hypotension
  190. What are the antihypertensive NURSE TEACHING PATIENT/FAMILY, for Beta Blockers?
    • To comply with dosage schedule even if feeling better
    • To rise slowly to sitting or standing position to minimize orthostatic hypotension
    • To report bradycardia, dizziness, confusion, depression, and fever
    • To take pulse at home; advise when to notify prescriber
    • To comply with weight control, dietary adjustment, modified exercise program
    • To wear support hose to minimize effects of orthostatic hypotension
    • Not to discontinue product abruptly; taper over 2 wk; may precipitate angina
  191. What are the antihypertensive NURSE TEACHING PATIENT/FAMILY, for Calcium Channel Blockers?
    • How to take pulse before taking product; ptient should record or graph pulse to identify changes
    • To avoid hazardous activities until stabilized on this product since dizziness commonly occurs
    • The need for compliance in all areas of medical regimen, including diet, exercise, stress reduction, and product therapy
  192. What type of drug is glipizide (Rx) Glucotrol?
    An Anti-diabetic
  193. Which diabetes does this drug work on?
    Type 2 diabetes mellitus (stable non-insulin dependent diabetes)
  194. How does glipizide (Rx) Glucotrol work?
    • Stimulates functioning B cells in the pancreas to release insulin
    • May improve insulin to bind with it's receptors
    • May increase number of insulin receptors
  195. In order for glipizide (Rx) Glucotrol to work, what must a patient have?
    A patient must have functioning B cells in order for this medication to be effective
  196. Where is insulin produced?
    • In the pancreas
    • Beta cells in the islets of Langerhans
  197. Why do we need insulin?
    • Metabolism of carbs, fats, proteins
    • It is the key that opens the cell door, so glucose can move in 
  198. Why do we need glucagon?
    It stimulates the conversion of glycogen into glucose, in the liver
  199. What is the normal adult sugar level?
    70 to 110 mg/dL
  200. What are the four different types of Insulin we are studying?
    • "Without insulin you will SLIR your words!"
    • Short Acting
    • Long Acting
    • Intermediate Acting
    • Rapid Acting
  201. What are the trade names of the short acting insulins (insulin, regular [OTC]) and what are the pharmacokinetics?
    • Names: Regular, Humulin R, Novolin R
    • Given: 1/2 - 1 hour before a meal
    • Onset: 30 min
    • Peak: 2 and 1/2 - 5 hours
    • Duration: up to 6 hours
  202. What is the trade name of the long acting insulin (insulin glargine [Rx]), and what are the pharmacokinetics?
    • Name: Lantus
    • Given: Usually once at bedtime
    • Onset: 1 and 1/2 hours
    • Peak: No peak identified (sustained release)
    • Duration: ~ 24 hours
    • NOTE: NEVER mixed with another insulin!!
  203. What are the trade names of the intermediate acting insulins (isophane suspension (NPH) and insulin) and what are the pharmacokinetics?
    • Names: Humulin N, Novolin, Lente
    • Onset: 1 and 1/2 - 4 hours
    • Peak: 6 - 12 hours
    • Duration: 12 - 18 hours
    • NOTE: Cloudy
  204. What are the trade names of the rapid acting insulins (insulin aspart [Rx] and insulin lispro) and what are the pharmacokinetics?
    • Names: Novolog and Humalog
    • Given: Right before a meal
    • Onset: 15 - 30 minutes
    • Peak: 1/2 to 1 and 1/2 hours
    • Duration: 3 - 4 hours
    • NOTE: Clear
  205. Due to the quick onset, what do you want to ensure you have ready prior to giving Humulin R (onset 1/2 to 1 hour) and Humulog (15 to 30 minutes)?
    Have food ready to be ingested
  206. What can Regular Insulin mix with?
    • All other insulins
    • (except Lantus - which is never mixed with another insulin)
  207. insulin lispro (Rx) Humalog can only mix with what insulins?
    • insophane insulin suspension (NPH)
    • Lente
    • ultralente
  208. Which two insulins are matched for the glucose control (sliding scale)?
    • regular (OTC) Humulin R
    • insulin lispro (Rx) Humalog
  209. Which insulin can be given via IV?
    • regular (OTC) Humulin R
    • No other insulins can be give via IV!
  210. Describe how you would mix insulins (cloudy and clear)?
    • Draw back the total amount needed in air
    • Insert the amount of air needed in the cloudy insulin (NPH)
    • Insert the amount of air needed in the clear insulin (Reg)
    • Draw up the amount of insulin needed from the clear (Reg)
    • Draw up the amount of insulin needed from the cloudy (NPH)
  211. What are the signs and symptoms of hypoglycemia?
    • I'm TIRED2!
    • Tachycardia
    • Irritability
    • Restless
    • Excessive hunger
    • Diaphoresis
    • Depression
  212. How do you determine whether a person is having a hyperglycemic or hypoglycemic episode?
    • Hot and Dry = Sugar high -->Hyperglycemic
    • Cold and Clammy = Need some candy -->Hypoglycemic
  213. Where are the insulin injection sights?
    • Poke the Back LAST!
    • Back (just below the shoulder blades)
    • Love handles (just above the bottom, at the hips)
    • Arms (back side)
    • Stomach (each side of the umbilicus)
    • Thighs
  214. For insulin, what is the alert level?
    HIGH ALERT!
  215. What is the trade name for enoxaparin?
    Lovenox
  216. What is the generic name for Lovenox?
    enoxaparin (Rx)
  217. What type of drug is enoxaparin (Rx) Lovenox?
    • Low molecular weight Heparin
    • Anticoagulants
    • Used to prevent deep venous thrombosis after hip, knee, or abdominal surgery
    • Also used for clients at risk for thromboembolus secondary to prolonged bed rest due to acute illness
  218. How is enoxaparin (Rx) Lovenox administered?
    • Subcutaniously: once a day or q12hr (do NOT give via IM)
    • Position: Client should be lying down for administration
    • Do NOT: Expel the air bubble in the prefilled syringe
    • Manufacturer recommends: Injection into the right or left anterior lateral or posterior lateral aspect of the abdominal wall for best absorption (alternate sides)
    • Do NOT: Massage the injection site to minimize bruising
    • Do NOT: Mix with other injections
    • Lovenox and Regular heparin: CANNOT be used interchangeably
    • Assess baseline lab data: (CBC, liver function, and coagulation)
    • Observe: Early signs/symptoms of bleeding
    • Administer: Same time every day
    • AVOID: Aspirin or NSAIDS

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