test 3 pharmicolomakemepukeagy

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test 3 pharmicolomakemepukeagy
2012-10-28 02:22:05
test Pharm

test 3 pharm wip
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  1. Acute Pain
    • usually r/t an injury, such as a recent injury, trauma, or infection,
    • and ends within an expected amount of time
  2. Addiction
    • psychologic dependence;
    • the desperate need to have and use a drug for a non-medical reason.
  3. Chronic Pain
     any pain that continues beyond the usual course of an acute injury process
  4. Dependence
    a state in which the body shows withdrawal symptoms when the drug is stopped or a reversing drug or antagonist is given
  5. Hydration
    the amount of fluid in body tissue
  6. Miosis
    the pupil of the eye constricts or gets smaller
  7. Narcotic
     any substance that produces stupor associated with analgesia
  8. Opioids
     used to treat severe pain
  9. Pain
    an unpleasant sensation or emotion that produces or might produce tissue damage
  10. Tolerance
    drug related problem that is seen when the same amount of drug produces less effect over time
  11. Withdrawal Symptoms
    changes in the body or mind, such as nausea or anxiety that occur when a drug is stopped or reduced after regular use.
  12. Narcotic agonist analgesics are used to treat moderate to severe acute pain
    • CLASS: Narcotic agonist analgesics
    • i.    Codeine
    • ii.    fentanyl (Duragesic)
    • iii.    hydromorphone (Dilaudid)
    • iv.    meperidine (Demerol)
    • v.    methadone (Dolophine)
    • vi.    morphine (Duramorph)
    • vii.    oxycodone (OxyContin)
  13. Codeine
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  14. fentanyl (Duragesic)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  15. hydromorphone (Dilaudid)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  16. meperidine (Demerol)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  17. methadone (Dolophine)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  18. morphine (Duramorph)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  19.  morphine (Duramorph)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  20. oxycodone (OxyContin)
    Narcotic agonist analgesic used to treat moderate to severe acute pain
  21. Nursing implications for Narcotic Agonists
    • .Determine the cause/source of pain
    • .Have pt describe the pain and history of the pain: when it started, where it is, what it's like, how often it occurs, and what makes is worse or what helps relieve it.
    • .Have pt rate the pain on a scale regularly
    • .Accept that the pt has pain
    • .Medication history - allergies, past ability to deal with pain, any reason to think narcotic abuse might be a problem.
    • .Pain relief is best if the drug is given before the pt has intense pain
    • .Follow rules in giving these drugs
    • .Pt controlled analgesia unit may be used
    • .Oral opioids given by mouth are less effective than those given by injection. However, oral produce pain relief for a longer time
    • .Check on pt often - meds may cause respiratory depression
    • .Assess pt's behavior on the drug - are they addicted?
    • .teach pt and family: take med as ordered, if not feeling as much pain you can use other methods, do not take any other meds without telling the physician, do not take with alcohol, side effects (dizziness, nausea, drowsiness, etc), do not drive or operate heavy machinery, increase fluids and fiber to prevent constipation, get up slowly to prevent postural hypotension, lie down to prevent nausea when taking first doses of opioid, make effort to wait for longer periods of time between doses if med is taken for a long time, and keep out of reach of children and all others for whom it is not prescribed.
  22. adverse reactions for Narcotic agonists analgesics
    • bradycardia,
    • hypotension,
    • anorexia,
    • constipation,
    • confusion,
    • dry mouth,
    • euphoria,
    • nausea, vomiting,
    • pruritus,
    • skin rash,
    • skin itch,
    • slow breathing,
    • shortness of breath.  
  23. What is hydromorphone (Dilaudid)
    • Is a potent synthetic compound that maximized analgesic effects and minimizes some of the common side effects of morphine?  Dilaudid has 7-10 times the analgesic action of morphine.
    • Overdosage may cause bradypnea, irregular, shallow breathing, sedation, coma, miosis, cyanosis, drop in blood pressure,oliguria, clammy skin and hypothermia. )
  24. what is used to reverse overdoses of narcotics.
    Diprenorphine (diprenorfin, Revivon, M5050) is an opioid antagonist used to reverse the effects of the super-potent opioid analgesics.
  25. What is excedrin?
    • A nonnarcotic analgesic combination (centrally acting)
    • Chemical components: Aspirin, acetaminophen, caffeine
    • Used mainly to control pain
    • Caffeine, a plant extract, has mild brain, lung, and heart stimulant effects, as well as some diuretic activity. It has no analgesic properties, but it is used to treat some types of headaches.
    • Nonnarcotic analgesics have CNS depressant effects that add to those of other depressants, including alcohol. Although these products have fewer chemical interactions than ] narcotics, they still interact with other drugs. 
    • On 1/19/12, Excedrin products were recalled with an expiration date of 12/20/14 or earlier by Novartis Consumer Health as a precautionary measure. Manufacturing problems may have resulted in chipped or broken tablets, or stray tablets or caplets from other Novartis products ending up in the wrong bottles. This could result in consumers taking an unintended product and/or receiving a higher or lower strength than intended.
  26. What is Morphine
  27. Morphine is a natural opioid that is used to treat severe pain. Natural opioids come from opium, which comes from unripe seed capsules of the poppy plant. Morphine is the “mother” of all synthetic (man-made) opioids. It is the main opioid drug to which all other pain management drugs are compared. It is used a great deal in acute care and also in hospice settings for dying patients who have severe pain.
  28. how does morphine work?
    • Of the primary receptors for Morphine, Most action occurs at he mu (strong agonist) and kappa (agonist) receptors in the CNS.
    • Narcotic agonist analgesics are thought to prevent painful feelings in the central nervous system (gray matter) of the spinal cord, brain stem, reticular formation, thalamus, and limbic system. The nerves responsive to the opiates in each of these areas interact with        autonomic nervous system nerves that carry pain messages (neurotransmitters), and this interaction produces changes in the person’s reaction to pain.
  29. What is Morphine? (not structuraly, but schedule, and a few other things)
    Morphine is a Schedule II drug. It produces sedation and euphoria when pain is       present. Traditionally used for preoperative sedation and postoperative analgesia. It is more effective against dull, continuous pain than sharp, spasmodic pain. IV medication should be given slowly over a 4 – 5 minute period. Protect drug from light and freezing.
  30. Abortifacients:
    Drugs used to stimulate uterine contractions & cause the uterus to empty.
  31. Androgens:
    male hormone testosterone & its related hormones; help develop &maintain the male sex organs at puberty and develop secondary sexcharacteristics in men.
  32. Corticosteroids:
    substances manufactured by the adrenal cortex that influences many organs, structures, and life processes of the body; composed of glucocorticoids and Mineralcorticoids
  33. Diabetes mellitus
    : disorder of carbohydrate metabolism that may result from a relativelack of insulin or an insensitivity of the body to the available insulin.Abnormalities in fat and protein metabolism also result from seriouscarbohydrate metabolism disruptions.
  34. Estrogen:
    principal female sex hormone, manufactured in the ovaries; responsible fordevelopment of the female reproductive organs and secondary sex characteristicsand involved with ovulation, pregnancy, and menstruation.
  35. Glucometer:

    hand-held machines used to measure the blood glucose level
  36. Hormones:
    chemicals made in an organ or gland and carried through the bloodstream toanother part of the body, where they stimulate the part of the body to increaseits activity or secretion
  37. Hyperglycemia:
    condition seen with fasting blood glucose levels greater than 150 mg/dL. Signsinclude glycosuria, ketonuria, Kussmaul’s respiration, tachycardia, and acetonebreath. People may have hyperglycemia for a variety of reasons; chronic highblood glucose levels are usually associated with diabetes mellitus.
  38. Hyperthyroidism:
    overproduction of thyroid hormone. Symptoms include weight loss, decreased orabsent menstruation, rapid or pounding heart, heat intolerance, nervousness,irritability, diarrhea, sweaty skin, inability to fall asleep, fever, and chestpain.
  39. Hypothyroidism:
    Condition in which there is a decrease of production of thyroid hormone.Symptoms include fatigue, weakness, and lethargy, moderate weight gain withminimal appetite, cold intolerance, menorrhagia, dry skin, coarse hair,hoarseness, impaired memory, and constipation.
  40. Incretins:
    Hormones that are released from the gut postprandially (after eating) and areoften in low concentrations in persons with type 2 diabetes.
  41. Insulin:
    Hormone necessary for the metabolism and use of glucose in the body; producedby the beta cells of the pancreas.
  42. Lipodystrophy:
    Shrinkage and loss of the fatty tissue when medication, particularly insulin,is given in the same spot too frequently.
  43. Myxedema:
    Severe form of hypothyroidism. Skin changes include nonpitting edema; doughyskin; puffy face; large tongue; decreased body hair; and cool, dry skin. Maylead to coma and death.
  44. Non-insulin-dependent diabetes mellitus
    : Former name for type 2 diabetes.
  45. Oral hypoglycemic
    Products that stimulate insulin release by the beta cells of thepancreas.
  46. Oxytocic agents
    : Drugs that cause the uterus to contract, produce narrowing of the bloodvessels, and stimulate the flow of breast milk; used to help labor move on todelivery.
  47. Progesterone:
    Sex steroid hormone produced by the ovaries, by the placenta, and in smallamounts by the adrenal cortex; helps prepare the uterus for implantation. Alongwith estrogen, it helps maintain normal uterine and mammary gland function.
  48. Sex hormones
    : Substances that influence many organs, structures, and life processesof the body as they prepare the body to reproduce. Produced in the adrenalcortex and gonads and include androgens and estrogens.
  49. Somogyi effect
    : Rebound increase in glucose levels that is caused by hypoglycemia.
  50. Steroids:
    A group of hormones that have powerful effects on cell sensitization, healing,and development. May by associate with adverse effects, particularly inpatients who must take them chronically.
  51. Systemic acidosis:
    A condition in which the basic fluid and electrolyte balance of thebody is disturbed, and the blood pH is decreased. Symptoms include nausea,vomiting, and changes in level of consciousness.
  52. Tocolytics:
    Agents that stop uterine contractions during labor.
  53. Type 1 diabetes
    : Insulin-dependent diabetes mellitus or juvenile diabetes; patientusually has little or no production of insulin by the pancreas.
  54.  Type 2 diabetes:
    Non-insulin-dependent diabetes mellitus or late-onset diabetes;patient usually has a functioning pancreas that can be encouraged by medicationto produce more insulin.
  55. Uterine relaxants:
    Agents that act on the beta-adrenergic receptors to stop uterinesmooth muscle contractions; used in the management of preterm or prematurelabor.
  56. Posterior pituitary hormones and what they do.

    • a.       ACTION& USES: Produces ADH vasopressin, as well as oxytocin, a hormone thatstimulates the uterus.
    • b.      Vasopressinregulates reabsorption of water by the kidneys. This hormone is specificallyreleased whenever brain senses that urine is becoming concentrated because pthas had severe diarrhea or vomiting or has become dehydrated through some othercondition.
    • c.       Vasopressinmay be given when body loses water when it should not do so, as in diabetesinsipidus, or when pituitary fails to secrete vasopressin because of disease orsurgical removal. Vasopressin is also used in some GI problems and in tx ofnighttime bedwetting. Pituitary extract is also given to increase smooth musclecontraction of digestive tract & blood vessels. Information on vasopressin& desmopressin is provided.
    • d.      Oxytocinacts directly on smooth musculature of uterus to produce firm, regularcontractions.
    • e.      ACTHusually is reserved for testing & replacement therapy. It stimulatesadrenal cortex to secrete cortisol, corticosterone, aldosterone, & severalother weaker substances.
    • f.       PT TEACHING: Watch for signs of dehydration(failure to urinate, dry skin and mouth, complaint of thirst, & furrowedtongue).
  57. What is Vasopressin

    • (aka ADH) regulates the reabsorption of water by the kidneys. This hormone isspecifically released whenever the brain senses that the urine is becomingconcentrated because the patient has had severe diarrhea or vomiting or hasbecome dehydrated through some other condition.
    • a.       Vasopressinmay be give when the body loses water when it should not do so, as in diabetesinsipidus, or when the pituitary fails to secrete vasopressin because ofdisease or surgical removal. Vasopressin is also used in some GI problems andin the treatment of nighttime bedwetting. Pituitary extract is also given toincrease smooth muscle contraction of the digestive tract and blood vessels.
    • b.      Adversereactions to small doses of vasopressin include abdominal cramps, anaphylaxis,bronchial constriction, circumoral pallor, diarrhea, flatus, intestinalhyperactivity, nausea, pounding headaches, sweating, tremors, urticaria,uterine cramps, vertigo, and vomiting.
    • c.       Vasopressingiven in larger doses may produce death.
  58. what Byetta is and how it works.

    • a.       Madefrom part of the saliva of the Gila monster lizard. It is approved asadjunctive therapy for type 2 diabetes.
    • b.      Bindsto GLP-1 receptors and stimulates insulin secretion when blood sugar is high.
    • c.       Firstdrug that has been shown to restore first-phase insulin secretion, which ismissing in type 2 diabetes.
    • d.      Givenas an injection before the morning and evening meals.
    • e.      Adverseeffects include nausea, vomiting, diarrhea, and upper respiratory symptoms.
    • f.       Many patients lose weight when taking this drug.
  59. what may increase insulin needs
    Insulin requirements increase when the patientis under stress or becomes ill, especially with an infection.
  60. Humulin N
    Humulin N is intermediateacting insulin. Onset is 1-2 hours, peak is 6-14 hours, and duration is 16-24hours. Subcutaneous use only, may mix with aspart or lispro. Draw aspart/lisprofirst. May mix with regular insulin, draw regular insulin first. Give 15minutes before meals if giving with aspart/lispro or 30 minutes before meals ifgiving with regular insulin.
  61.  nursing implications and patient teaching for immunological meds
    • a.      Health history/ allergies especially to eggs orfeathers
    • b.     Patients previous immunization status andreaction to biologic agents
    • c.      Results of any know allergy testing;
    • d.     The presence of underlying disease or concurrentinfections
    • e.     The use of immunosuppressant drugs, immuneserums, blood, or blood products;
    • f.       Pregnancy.
    • g.      If the patient plans to travel fide out if theyrequire any special immunizations before departure.
  62.  Know about the varicella vaccine      
    • Chicken pox vaccine
    • b.     Varicella Vaccine (minimum age: 12 months),
    • c.      Administer second dose at age 4-6 years: may beadministered 3 months or more after first dose.
    • d.     Do not repeat second dose if administered 28days or more after first dose. 
  63. Know interventions after administrations to increase discomfort.
    Localized discomfort may be relieved by treatingthe symptoms: use warm compresses on the area, acetaminophen, and rest.  The health care provider may recommendantihistamines.  
  64.  about a PPD

    • Uses: An additional group of biological agents(e.g., purified protein derivative [PPD], histoplasmin, and coccidoidin) isused in screening procedures to identify people who have been exposed to aspecific disease of who may have an active disease such as tuberculosis.
    • There are 3 types of purified proteinderivatives or PPD that are In Vivo Diagnostic Biologic Agents they are: Tuberculin PPD multiple-puncture deviceits used to identify persons with active tuberculosis, exposure totuberculosis, or needing further testing, TuberculinOld, multiple-puncture device is the same as the tuberculin PPDmultiple-puncture device, Tuberculinpurified protein derivative (Mantoux) is designed to identify persons withactive tuberculosis, exposure to tuberculosis, or needing further testing; 0.1mL of intermediate-strength PPD given by Intradermal injection and evaluated in24-48 hrs.  Positive reaction: area oferythema and indurations 9 mm or more; areas 5 to 9 mm considered questionable;areas under 5 mm are negative.
  65. 1.      What needs to be known before administering immunizations

    •  i.      Find out as much as you can about thepatient’s health history, including the patient’s pervious immunization statusand reaction to biologic agents.                                                           
    •  ii.     History of allergies,especially to eggs or feathers; results of any known allergy testing.                                                          
    • iii.     The presence ofunderlying disease or concurrent infections.                                                          
    • iv.     The use ofimmunosuppressant drugs, immune serums, blood, or blood products.                                                           
    •  v.     The possibility of beingpregnant.
    • The patient may have a history of exposure to aspecific organism or might plan to travel to areas where disease may becommon.  Find out if the person is atrisk for infection, as well as whether there children who require primaryimmunizations.  The U.S. State Departmentregularly issues travelers’ warnings, and you can call the embassy of a foreigngovernment to see if certain immunizations are required for entry into thecountry.
  66. What is a pneumococcal vaccine

    • b.      There are pneumococcal vaccines that arebacterial vaccine these two vaccines are: Pneumococcal vaccine, polyvalent andPneumococcal 7-valent conjugate vaccine (Prevnar).
    • c.       Pneumococcal vaccine, polyvalent: Producesimmunity against a variety of pneumococcal infections.  Vaccine: 0.5 mL IM or Sub Q; revaccinationsnecessary in 3 or more yrs.
    • d.      Pneumococcal 7-valent conjugate vaccine(Prevnar): Provides active immunization for infants and children againstStreptococcus pneumonia.  Vaccine: 3doses of 0.5 mL administered as IM injection at 2 mo. intervals, followed by afourth dose of 0.5 mL at 12-15 mo.  ofage.  Shake suspension vigorouslyimmediately before use.
    • e.       Pneumococcal vaccine: (Minimum age: 6 weeks forpneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharidevaccine [PPV]).  Administer one dose ofPCV to all healthy children aged 24-59 months having any incompleteschedule.  Administer PPV to childrenaged 2 years and older with underlying medical conditions.
    • f.       Pneumococcal polysaccharide vaccine (PPV):Administer PPV to certain high risk groups.
  67. Arthritis:

    Painful, swollen, and stiffened joints caused by more than 100 types ofjoint disease in which destruction or inflammation is present.
  68. Gold Compounds:
    Gold salts that, when used as a drug, interfere with a widerange of biochemical reactions on a cellular level (also called chrysotherapy);used primarily in preventing joint destruction in rheumatoid arthritis.
  69. Gout:
    Aform of arthritis caused by overproduction or under excretion of uric acid.
  70. Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
    Agents that have analgesic, anti-inflammatory, and antipyretic effects; used in treating rheumatic diseases, degenerative joint disease, osteoarthritis, and acute musculoskeletal problems.
  71. Osteoarthritis:

    Common form of arthritis with localized joint destruction, particularly in weight-bearing joints or stressed joints, resulting gradually from overuse and increasing age.
  72. Rheumatoid Arthritis:
    A systemic disease that involves an autoimmune response causedby failure of the body to recognize its own tissue, resulting in destruction ofthe joint.
  73. Salicylates:
    Agents used to treat mild to moderate pain and reduce fever. They haveanalgesic, antipyretic, and anti-inflammatory effects.
  74. Skeletal Muscle Relaxants:
    Drugs used to decrease muscle tone and involuntarymovement without loss of voluntary motor function. They inhibit thetransmission of impulses in motor function. They inhibit the transmission ofimpulses in the motor pathways at the level of the spinal cord and thebrainstem or interfere with the mechanism that shortens the skeletal musclefibers so they contract.
  75. Slow-Acting
    Antirheumatic Drugs (SAARDs): Agents used in limiting joint destruction insignificant cases of rheumatoid arthritis.
  76. Uric Acid:
    A metabolite of protein present in the blood within a very specificrange. Increased levels may precipitate as crystals in tissues, causing thecondition known as gout.
  77. Uricosuric Agents:
    Drugs that increase the excretion of urate salts by blocking theirrenal tubular reabsorption. Also used to decrease the amount of circulatingurate and the deposition of urate and promote reabsorption of urate deposits.
  78. Muscle Relaxants:
    Help reduce muscle tone andinvoluntary movement without loss of voluntary motor function. Other actionsinclude mild sedation, reduction of anxiety and tension, and changes in painperception. They are used to relieve pain. Long-term use is not recommendedbecause they can become habit forming.
  79. NSAIDs: 
    Have analgesic, anti-inflammatory, andantipyretic effects and are used to treat rheumatic disease, degenerative jointdisease, osteoarthritis, and acute musculoskeletal problems.
  80. Penicillamine:
    Is a chemical breakdown productof penicillin. It relieves the symptoms of arthritis and in some way stops thedisease progression. Only about 30% of patients who are prescribed this agentget any benefit from its use. The patient should be warned of this beforestarting the agent.
  81. Probenecid:
    Inhibits tubular reabsorption ofurate, increasing uric acid excretion. Often used with penicillin to treat ventraldisease. Cross-sensitivity to phenylbutazone and other pyrazoles.
  82. Probenecid –  
    (ANTIGOUT) inhibits tubular reabsorptionof urate, increasing uric acid excretion Increasesurate excretion, often used with penicillin to treat venereal disease. Cross –sensitivity to phenylbutazone and other pyrazoles.
  83. Sulfinpyrazone – (Anturane)
    (ANTI GOUT) Drug reserved forpatients refractory modality of therapy.
  84. allopurinol -   (Zylporim)
     (ANTI GOUT) inhibitsthe production of uric acid by decreasing the production of Xanthine Oxidase.Dose required treating gout AND hyperuricemia is variable.
  85. colchicines – (Colchicine) 
    (ANTI GOUT) special drugused to treat acute gouty attacks not an anti inflammatory, analgesic oruricosuric agent.  Acute attack ofgout: Therapy should be started at first warning of acute attack.
  86. What are the antigout meds
    • Uricosuric drugs:
    • Probenecid
    • Sulfinpyrazone
    • allopurinol
    • colchicines
  87. Probenecid
    • Uricosuric Drug
    • – inhibits tubular reabsorption of urate,
    • increasing uric acid excretion
  88. Sulfinpyrazone
    • Uricosuric Drug
    • – (Anturane) Drug reserved for patients refractory
    • modality of therapy
  89. allopurinol
    • Anti gout Analgesic Preparation
    • (Zylporim) inhibits the production of uric acid by decreasing the production of Xanthine Oxidase
  90. colchicines
    • Anti gout Analgesic Preparation
    • (Colchicine) special drug used to treat acute
    • gouty attacks not an anti inflammatory, analgesic or uricosuric agent
  91. Uricosuric agents:
    increase the excretion of urate salts in the urine by blocking tubularreabsorption of these salts in the kidneys. They also decrease the amount ofcirculating of urate and the disposition of urate, and promote the reabsorptionof urate deposits
  92. Aspirin:
    • is a Salicylate
    • stronger and more potent in stopping prostaglandin synthesis than are other salicyilates
    • has a greater antiinflamitory affect than other salicylates is used for mild treatment of pain
    • is the only salicylate that cans irreversibly platelet aggregation for the life of the palette (7 to
    • 10 days).
    • Because of this, it is used to reduce the risk of strokes and TIA attacks in men who have had TIA’s because of fibrin platelet emboli. It doesn’t
    • help men who have already had strokes. Aspirin doesn’t seem to have any effect
    • on strokes or TIA’s in women.
  93. Whay can small doses of asperine do?
    • Small daily doses of aspirin are also used to reduce the reduce of death or non fatal myocardial infarction in patients who have previous infarctions or unstable angina pectoris. Lower doses are just as are just as affective and have fewer side effects than large doses.  Unlabeled uses of aspirin in low doses also include prevention of cataracts  d prevention of toxemia during
    • pregnancy.

  94. Salicylates
    (Group of medications into whichaspirin belongs.) have analgesic, antipyretic, and antiinflamitory affects.Salicylates stop the production of prostaglandins which affect the pain andinflammatory response through a depressant affect on the central and peripheralpain response.  They do this by blockingthe production of prostaglandins.
  95. nursing implications and patient teaching for
    • Learn all you can about the patients health history,
    • check for the presence of hyper sensitivity to aspirin. Or other NSAIDs, history of asthma or na al polyps, GI problems or ulcer disease, current use of other drugs,  that may cause interactions, or hepatic/renal disease. The health care provider may ask you to check for occult blood in the patients stool. Before beginning the medication. – This is the only way to know if the patient had blood in the stool before the medication was started. Anti-inflammatory analgesics are affective for mild to moderate pain of a musculoskeletal nature and in conditions causing mild fever. They are useful in any of the condtions for which NSAID’s are used.
  96. nursing implications for skeletal muscle relaxants
    • i.     Learn as much as possible about the healthhistory including allergies, use of other drugs that might produce druginteractions and history of respiratory renal, hepatic or cardiac dysfunction.                                                           
    •  ii.     Do not give to women who are pregnant orbreastfeeding                                                          
    • iii.     History\ of pain caused by acute muscular traumaor inflammation, low back syndrome, arthritis, multiple sclerosis, musculartension with or without intermittent relief, headache and muscle rigidity
  97. 1.      patient teaching for skeletal muscle relaxants
    • i.     Pt should take med as advised and not stop taking
    • it suddenly or increase dosage without knowledge of the HCP
    • ii.     Pt should avoid driving, operating heavy
    • machinery, or doing tasks requiring alertness while taking skeletal muscle
    • relaxants
    • iii.     Pt should avoid taking other meds that depress
    • CNS function at the same time
    • iv.     If a dose of medication is missed, it may be taken
    • within an hour of when it was scheduled.
    • v.      HCP should be contacted immediately if any of the
    • following side effects occur: dizziness, fainting, mental depression, unusually fast heartbeat, wheezing, shortness of breath, difficult breathing, abdominal pain, high fever, nausea, diarrhea, sore throat, malaise, mucosal ulceration, or petechiae
  98. Gold compounds – pg 386

    • a.      Therapy with gold compounds is also calledchrysotherapy. The exact mechanism of action of gold is not known. Gold is aheavy metal that interferes with a wide range of biochemical reactions on acellular level                                                              
    • i.     Inhibit lysosomal enzyme activity in macrophagesa      
    • ii.     Decrease their phagocytic activity
  99. Most common side effects of Gold compounds:
    • i.     Gold dermatitis                                                           
    •  ii.     Pruritic                                                          
    • iii.     Rash most commonly around the eyes and on thepals and the dorsa of the hands                                                          
    • iv.     Stomatitis                                                            v.     Painful ulcers on the buccal mucosa, tongue,palate or pharynx                                                          
    • vi.     Metallic taste
  100.  methotrexate –

    • a.      Medication that has been used for years to treatvarious cancerous and psoriatic conditions. The mechanism of action inrheumatoid arthritis is unknown. It may affect immune function. Reduces jointswelling and tenderness in 3 – 6 weeks, but there is no evidence that it causesremission of the disease or limits bone erosions.
    • b.     Used in cases of sever rheumatic arthritis thatunresponsive to other treatment. This product has a high possibility of severadverse reactions, including death. It is most toxic to the bone marrow, liver,kidney and lungs. It has many contraindications to use, drug interactions anddosage precautions. Consult the package insert for specific information.
  101.  anti‐inflammatory drugs
    • a.       3types                                                              
    • i.     Salicylates have analgesic antipyretic andanti-inflammatory effects. Aspirin is the strongest anti-inflammatory                                                            
    • ii.     Acetaminophen is an over the counter medicationcommonly used to decrease fever and mild pain
    • 1.       Acetaminophen
    • 2.       Acetylsalicylicacid
    • 3.       Diflunisal
    • 4.       Magnesiumsalicylates
    • 5.       Salsalate
    • 6.       Sodiumsalicylates                                                            
    • iii.     Nonsteroidal Anti-inflammatory drugs (NSAIDS) –have analgesic anti-inflammatory and antipyretic effects.
    • 1.       ibuprofen
  102. who should not receive narcotic agonist.
    • 1 elderly 
    • 2 pregenant Women
    • 3 physically weak
  103. what are non narcotic centrally acting analgesics.
    they are not as strong as narcotic analgesics, and have a lower risk for abuse. Include agents, such as acetaminophen, aspirin, and caffeine.
  104. Adverse reactions to non narcotic analgesics
    Postural Hypotension, disorientation, dizziness, euphoria, headache lightheadedness, minor visual disturbances, sleeplessness, slurring of speech, rashes N/V shills stuffy nose OD can lead to extreme sleepiness.
  105. propoxyphene
    • b.     Chemically similar to narcotic agents, but not
    • as strong.
    • c.       Schedule IV drug, a centrally acting opioid,
    • structurally related to methadone.
    • d.      Used primarily as a weak analgesic, but has
    • physical, and psychologic addictive properties
  106. nursing implications and teaching for non narcotic centrally acting analgesics.
    • Learn as much as possible about the patients
    • health history, including respiratory or hepatic disease,  if pregnant/ breastfeeding, if allergic to
    • said meds, and if they have emotional problems or has has problems with dependency
    • or drug abuse 

    • b.     Use Pain scale
    • c.       Any problems that could interfere with this
    • drugs usefulness?
    • d.      Concerns about moving around, sensory awareness
    • or level of alertness.
    • Teaching: 
    • g.      Take as ordered!
    • h.     If the patient starts to feel better, other methods
    • of pain reduction should be used. 
    • i.         If Patient has side effects, EG sleepiness dizziness
    • nausea vomiting, tell nurse or doctor.
    • j.       Don’t operate heave machinery
    • k.      Keep meds out of reach from children.
  107. What are Lorateb, Vicodin
    Lortab and Vicodin are Narcotic – Analgesic combination products.  Both are Hydrocodone bitartrate, acetaminophen.  Combination drugs are used for mild to saver pain of an acute origin
    • a.      OxyContin, Oxycodone
    • b.     Narcotic Agonist Analgesics
    • c.      These are similar in action and structure, but
    • are bot identical; they are opium alkaloids and are morphine like in action.
    • Used for moderate to saver acute pain.
  109. when are Adrenocortical hormones needed?
    • Replaces adrenal hormones; (Hydrocortisone, cortisone, ect.) Glucocorticoids are Given in normal or physiologic doses for replacing missing hormones.  
    • examples of when they migh tbe used :
    • allergic states
    • collagen disease
    • connective tissue disease
    • diagnostic testing of adrenalcortico disfunction
    • Edematous state
  110. Gluco corticoids:
    (short, medium, long)
    • Cortisone cortone
    • hydrocortisone------------------Coref
    • hydrocortisone------------------acetate
    • hydrocortisone sulfate---------Hydrocortisone Acetate
    • hydrocortisone sodium succinate----Solu-Cortef
    • methylprednisololone---------Depo-Medrol
    • prednisolone -------------------Delta-Cortif
    • prednisone----------------------Meticorten
    • triamcinolone------------------ Aristocort
    • triamcinolone diacetate ------ Aristocort Forte
    • betamethasone -----------------Celestone
    • dexamethasone ----------------Decadron
    • fludrocotisone acetate --------Floinef Acetate
  111. Nursing implications for adrenocorticohormones:
    May have contraindications and precautions to these drugs – learn about Pt. health history are they taking drugs that may interact badly with these meds.