Pharm 2 Analgesics

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mthompson17
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Pharm 2 Analgesics
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2013-06-12 20:18:30
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pharmacology analgesics nursing
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pharmacology for nursing
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  1. 3 types of drugs to Tx pain?
    • 1. strong narcotic - morphine
    • 2. mild narcotic - codeine
    • 3. mixed agonist-antagonists - pentazocine/Talwin
  2. Advantages of morphine use other than for pain?
    • 1. can relieve anxiety
    • 2. can decrease workload of the heart

    EX:  pulmonary edema
  3. 2 drug classifications for pain management?
    1. opiod analgesics / narcotics

    2. NSAIDS
  4. Action of opioid analgesics?
    act on CNS to interfere with the pain experience
  5. Use for opioid analgesics?
    Tx moderate to severe pain
  6. Action of NSAIDS?
    act in the PNS - interferes with prostaglandin synthesis and prevents the transmission of pain impulses
  7. Why does morphine cause resp depression?
    CNS depressant
  8. Morphine should be given cautiously/contraindicated with what types of drugs?
    CNS depressants including alcohol
  9. Important consideration when giving narcotics r/t CNS effects?
    should not drive etc until know how the drug will effect person
  10. WHO 3 step analgesic ladder?
    • 1. mild pain med:  EX ASA, acet
    • 2. moderate:  codeine, hydrocodone
    • 3. severe:  nonopioid- opiod:   morphine, fentanyl
  11. What is the standard measure of pain relief?
    10 mg parenteral morphine = analgesic dose
  12. 2 actions that must be taken when giving narcotic analgesics?
    • 1. document # of doses on hand
    • 2. document partial/wasted doses
  13. What must be documented when giving a pain med?
    • 1. pain scale, location, and description
    • 2. pain reassessment
  14. 4 types of pain morphine is used for?
    • 1. moderate - severe acute or chronic pain
    • 2. postoperative pain
    • 3. pain non-responsive to non-narcotics
    • 4. MI pain
  15. Most important consideration with methotrexate/Rheumatrex and other DMARDS?
    causes bone marrow dysfunction:  anemia, thrombocytopenia, and leukopenia

    risk for infection and bleeding
  16. Non-pain uses for morphine?
    • 1. dyspnea r/t acute L ventricular failure & pulmonary edema
    • 2. preoperative
    • 3. sedation
    • 4. anxiety relief
    • 5. facilitate induction anesthesia
    • 6. reduce amnt of anesthetic needed
  17. Routes of admin for morphine?
    may be used by almost any route - may be used in PCA
  18. Imp consideration for pt on morphine PCA pump?
    only pt should admin dose
  19. Onset of action for morphine?
    15 to 30 min
  20. Duration of action for morphine?
    3 to 7 h
  21. What will occur if ibu is taken with lithium?
    lithium toxicity is increased
  22. 5 contraindications/precautions for morphine?
    • 1. pre-existing respiratory depression
    • 2. acute or severe bronchial asthma
    • 3. upper airway obstruction
    • 4. increased intracranial pressure
    • 5. CNS depression
  23. Why is morphine contraindicated with increased ICP?
    morphine has a stimulatory effect on the SC
  24. 8 adverse effects of morphine?
    • 1. resp depression - LIFE THREATENING
    • 2. bradycardia
    • 3. hypotension
    • 4. constipation
    • 5. CNS effects
  25. Antidote for opiates?
    narcan/naloxone
  26. Onset of action for naloxone?
    IV 2 min
  27. Imp consideration about half life of naloxone/Narcan?
    has a short half life - may wear off before the opiate does and have CNS depressant effects again
  28. How does narcan/naloxone affect pain control?
    will reverse effects of pain control if dose is sufficient
  29. 2 key issues of morphine admin?
    • 1. maintain RR w/in 12 to 20 BPM
    • 2. minimal effects of constipation
  30. How can being immobile in the hospital exacerbate AE of morphine?
    can exacerbate constipation
  31. What 2 things should be assessed before admin of morphine?
    RR & BP
  32. What will the RR & BP of a person in pain be like?
    may be high
  33. 6 nursing interventions to prevent respiratory depression?
    • 1. pulse ox
    • 2. turn, cough, deep breathe
    • 3. reposition frequently
    • 4. maintain on side but if supine remove pillow
    • 5. have emergency respiratory equip available
    • 6. keep naloxone on hand
  34. Drug of choice for infants and CH with flu or flu-like S/S?
    acet
  35. 3 nursing interventions for constipation?
    • 1. increase fiber and water/fluid intake
    • 2. ambulate (with assistance)
    • 3. stool softeners or laxatives prn
  36. When should morphine not be used during pregnancy?
    not to be used during labor if expecting a premature infant and not to be used with a premature infant
  37. Drug interactions with morphine?
    other CNS depressants

    EX:  versed and morphine
  38. What will occur if ibu is taken with loop diuretics like furosemide?
    reduces antidiuretic effect
  39. What should the nurse know the location of before giving a med>?
    reversal drug
  40. If RR is < ____, hold morphine and call MD
    10
  41. Tolerance?
    body accustomed to effects and need increased dose to get therapeutic effect

    may switch meds
  42. Cross-tolerance?
    abuse of alc, Rx drugs, or illicit drugs can increase tolerance to pain meds

    may need increased dose
  43. Physical dependence?
    W/D or abstinence syndrome occurs when med is stopped
  44. When is physical dependence usually seen in morphine?
    when taking longer than 3 months
  45. 4 S/S of W/D from an opiate?
    • 1. restless - may say don't feel right
    • 2. tachypnea
    • 3. hypertension
    • 4. tachycardia
  46. What will occur if ibu is taken with aminoglycoside antibiotics?
    GFR is reduced and the aminoglycoside will accumulate
  47. What will occur if ibu is taken with a beta blocker?
    impairs antihypertensive effects of the beta blocker
  48. Addiction?
    compulsive use for secondary gain, not for pain control
  49. Stoic cultures?
    3 EX?
    tolerate pain w/out verbal complaints

    British, German, & Asian
  50. 4 Expressive cultures?
    • 1. Spanish
    • 2. Italian
    • 3. Latin
    • 4. white American adults
  51. Hydromorphone info?
    same risks and info as morphine
  52. Oxycodone is combined with either ___ or ___.
    ASA or acet
  53. Serious adverse effect of oxycodone?

    Nursing intervention?
    can cause adverse effects r/t acet and ASA content

    calculate daily intake of ASA & acet
  54. What pt teaching needs to be done about oxycodone?
    teach pt about risk for liver toxicity if they take too much
  55. Type of pain fentanyl is used for?
    persistent, moderate to severe chronic pain
  56. When will a pt obtain full pain relief after a fentanyl patch has been applied?
    TAKES APPROX 24 H
  57. 3 drug to drug interactions with fentanyl?

    What will occur?
    • 1. P450 inhibitors
    • 2. ketoconazole - antifungal
    • 3. Clarithromycin/Biaxin - anti-infective

    all increase levels of fentanyl and increase AE and resp depression
  58. 6 considerations when applying fentanyl/Duragesic patch?
    • 1. wear gloves
    • 2. tear - don't cut
    • 3. Apply to non-irritated, smooth, and hairless skin
    • 4. Clip - don't shave
    • 5. No soap, creams, alc, oils, or lotions
    • 6. hold patch in place X 30 seconds
  59. Why should fentanyl not be applied to irritated or broken skin?
    can increase absorption and AE
  60. 4 application sites for fentanyl/Duragesic patch?
    • 1. chest
    • 2. back
    • 3. flank
    • 4. upper arm
  61. How often should a fentanyl patch be replaced?
    q 72 h
  62. What occurs when acet is taken with warfarin?
    serum warfarin levels are increased
  63. Pt teaching for fentanyl/Duragesic patch?
    avoid heat:  heating pads, sun lamps, elec blankets, heated water beds, hot tubs, and saunas

    can increase absorption of the drug
  64. How should removed duragesic/fentanyl patch be discarded?
    flush down toilet, put in sharps, or put plastic from container on the patch and throw away
  65. Most important consideration when applying a duragesic/fentanyl patch?
    make sure to take off the old patch
  66. What should be documented when applying a duragesic patch?
    where it was placed
  67. IONSYS?
    iontopohoretic transdermal system

    PCA
  68. Each activation of IONSYS provides ____ mcg fentanyl over a ____ min period.
    • 40 mcg
    •  10 min
  69. What will occur if ibu is taken with a selective serotoinin reuptake inhibitor?
    increases risk of upper GI bleed
  70. How is the IONSYS operated?
    • 1. press top button twice firmly w/in 3 seconds
    • 2. hear beep sounds and red light comes on to indicate dose released
    • 3. red light remins lit during 10 min dosing time
  71. Max dose of fentanyl IONSYS?
    max of 6 - 40mcg doses per hour
  72. How long does each IONSYS system work?
    24 h or 30 doses whichever comes first
  73. IONSYS is for ____ use only.
    `hospital
  74. 3 uses for methadone?
    • 1. pain control
    • 2. prevent W/D S/S from heroin
    • 3. maintenance Tx for narcotic abuse
  75. 2 types of mild narcotic agonists?
    codeine and hydrocodone
  76. 2 uses for codeine?
    • 1. control mild to moderate pain in adults and CH
    • 2. cough suppressant and dries up secretions
  77. 2 routes for codine?
    oral and parenteral
  78. What 2 drugs is codeine co-admin with?
    ASA & acet
  79. Why is codeine co-admin with other analgesics?
    provides additive analgesic effect and permits lower dose of codeine
  80. 3 contraindications and precautions with codine?
    • 1. asthma and emphysema
    • 2. avoid if delivery of premature infant is expected
    • 3. increase intracranial pressure (head injury)
  81. What will occur is ibu is taken with salicylates?
    increases risk for GI or bleeding probs
  82. Why is asthma, emphysema, & post surgery pt contraindicated with codeine?
    can lead to accumulation of secretions and loss of resp reserve

    codeine has drying effect on mm and can increase viscosity of secretions
  83. AE of codeine?
    same as morphine

    less AE with low doses required for antitussive
  84. Drug to drug interaction with codine?
    histamine-2 receptor antagonists (cimetidine/Tagamet) increases risk for resp depression
  85. Nursing assessment before admin codine?
    RR less than 10 need to hold med
  86. Hydrocodone may be co-admin with what drugs?
    ASA, acet, ibu
  87. What will occur if acet is taken with sulfinpyrazone/Anturane or hydantoin meds like dilantin?
    increases risk for hepatotoxiciy
  88. Imp consideration with prolonged hydrocodone admin?
    ASA, ibu, and acet co-admin can cause kidney and liver toxicity with prolonged use
  89. Analgesic of choice during preg/lactation?
    acet
  90. 3 narcotic agonist-antagonists?
    • 1. pentazocine/Talwin
    • 2. butorphanol/Stadol
    • 3. nalbuphine/Nubain
  91. Pentazocine/Talwin 5 uses?
    • 1. moderate to severe pain
    • 2. postop pain
    • 3. pain during labor
    • 4. premedication for anesthesia
    • 5. supplement to surgical anesthetics
  92. Pharmacokinetics consideration with pentazocine/Talwin?
    high first-pass effect of hepatic met. -
  93. Imp consideration when giving pentazocine/Talwin to a person who abuses opiates?
    may precipitate a W/D syndrome b/c of antagonistic effect
  94. 2 contraindications/cautions with Talwin/pentazocine?
    • 1. increase intracranial pressure
    • 2. MI r/t increased workload of heart
  95. 2 AE of pentazocine/Talwin?
    • 1. causes little resp depression b/c of antagonist action
    • 2. euphoria
  96. Antidote for salicylate poisoning?
    there is no antidote
  97. Street name for pentazocine/Talwin in ppl who abuse it?
    Why is it abused?
    T's and blues used as substitute for heroin and injected IV
  98. Complication of abuse of pentazocine/Talwin?
    pulmonary disease r/t blocking pulm arteries with particles from the tabs
  99. Butorphanol/Stadol main difference from pentazocine/Talwin?
    AE is somnolence

    somnolence - state of near sleep, a strong desire for sleep, or sleeping for unusually long periods of time
  100. Nalbuphine/Nubain is essentially the same as ____.

    It has less _____ effects than morphine and less ____ AE than pentazocine.
    morphine

    CNS depressant

    CV AE
  101. What will occur if ibu is taken with an antifungal med like diflucan?
    increases NSAID adverse effects
  102. Important consideration when evaluating the effectiveness of mucomyst admin?
    need to make sure if giving for mucous or to protect liver and kidneys as in acet OD
  103. What type of pain is ASA especially used for?
    inflammatory pain
  104. Special uses for ASA?
    • 1. neuralgia, myalgia, and arthralgia
    • 2. postpartum pain
    • 3. dental or oral surgery
    • 4. dysmenorrhea
    • 5. any arthritis
    • 6. pleurisy
    • 7. pericarditis in pt with sytemic lupus erythematosus SLE
  105. When is ASA used in cardiac pt?

    What is its action?
    prevent or reduce risk of TIA, MI, & ischemic CVA

    antiplatelet and anti-inflammatory effects
  106. 3 pharmacotherapeutic actions of ASA?
    • 1. anti-pyretic
    • 2. anti-inflammatory
    • 3. pain relief
  107. 2 most imp contraindications of ASA?

    4 others?
    • 1. bleeding disorders
    • 2. CH with varicella/flu-like illness - Reye Syndrome

    • 1. peptic ulcer disease
    • 2. not given to pt on anticoagulation therapy except MI pt
    • 3. gout
    • 4. renal or liver impairment
  108. 2 adverse effects of ASA?
    • 1. salicylism
    • 2. salicylate poisoning
  109. Salicylism?
    mild ASA toxicity r/t long-term or high-dose therapy
  110. Salicylate poisoning?
    life-threatening event that has no antidote
  111. 3 Tx for salicylate poisoning?
    • 1. gastric lavage
    • 2. activated charcoal
    • 3. life support
  112. 8 S/S of salicylate poisoning?
    • 1. resp distress
    • 2. F&E & pH imbalance
    • 3. seizures
    • 4. high temp
    • 5. shock
    • 6. coma
    • 7. death
  113. GI AE of prostaglandin inhibition that occurs with ASA and ibuprofen?
    • 1. ulceration
    • 2. perforation
    • 3. bleeding
  114. Pt education that should be done with sumatriptan/Imitrex?
    • 1. instruct on S/S of ischemic events: MI & stroke
    • 2. avoid driving or other activities that require alertness until response to med is known
  115. Hematology AE that may occur with prostaglanding inhibition from ASA or ibu?
    abnormal bleeding
  116. How long does the antithrombotic action of ASA last?
    for the life of the platelet - 8 days
  117. Admin of ASA in ER if having MI?
    will chew the tablet
  118. What 2 things should be checked before giving ASA?
    • 1. platelets
    • 2. active bleeding
  119. When may heptotoxicity occur with ASA?
    high doses
  120. Why may renal toxicity occur with ASA or ibu?
    prostaglandins that are inhibited by ASA & ibu normally inhibit vasoconstrictors

    taking ASA vasoconstricts renal BF
  121. What drug can cause induction of multiple sclerosis and optic neuritis?
    etanercept/Enbrel
  122. CH < __ years of age should not take ASA.
    16
  123. When should ASA not be taken during pregnancy?
    during the 3rd trimester r/t increased risk of maternal hemorrhage and AE fetal effects
  124. What pt should be monitored carefully during ASA therapy?
    pt over 60
  125. Difference b/t salsalate/Disalcid & ASA?
    same for anti-inflammatory but has no antiplatelet or antipyretic effects
  126. Use for salsalate/Disalcid?
    may be used by pt who cannot tolerate GI AE of ASA & pt at risk for anticoagulation
  127. Action of NSAIDs?
    inhibit COX 1 & 2 and prostaglandin synth
  128. What will occur is ibu is taken with heparin?
    increases risk of bleeding
  129. How is the therapeutic efficacy of NSAIDs found?
    based on pt response and cannot be predicted before use
  130. Therapeutic uses for NSAIDs?
    • 1. antiinflammatory
    • 2. analgesic
    • 3. antipyretic
  131. Black Box Warning with ALL NSAIDs?
    CV Thrombotic Events:  increases risk for MI & stroke

    Risk increases with duration of therapy
  132. NSAIDs I don't know very well?

    NSAIDs I know about?
    • 1. diclofenac sodium/Voltaren
    • 2. meloxicam/Mobic
    • 3. nabumetone/Relafen
    • 4. indomethacin

    • 1. celecoxib/Celebrex
    • 2. naproxen
    • 3. ibuprofen/Motrin/Advil
    • 4. ketorolac/Toradol
  133. What type of pain is ibuprofen for?
    mild - moderate
  134. What is the drug misoprostol/Cytotec used for?
    can be used to reduce GI upset with long-term NSAID therapy
  135. 4 common uses of ibu?
    • 1. all types of arthritis
    • 2. primary dysmenorrhea
    • 3. migraine HA
    • 4. fever
  136. 6 contraindications/cautious use of ibu?
    • 1. active GI disease
    • 2. renal or hepatic impairment
    • 3. hemopoietic dysfunction
    • 4. pre-existing coagulopathy
    • 5. cardiac impairment
    • 6. age > 60
  137. Drug to drug interactions with ASA?

    What will occur?
    • 1. anticoagulants
    • 2. oral hypoglycemics
    • 3. insulin

    ASA will increase the effects of this drug by binding to protein
  138. 2 illness EX that should not take ibu (cardiac)?
    CV, CAD
  139. Why can ibu not be taken with active GI disease?
    ibu can cause gastritis, GI bleeds, and ulceration
  140. Why can ibu not be taken with hemopoietic dysfunction?
    has effect on platelet functions & prolongs bleeding
  141. Why can ibu/NSAIDs not be taken with cardiac impairment?
    increased risk for MI and stroke
  142. 4 long-term AE effects of ibuprofen?
    • 1. PUD - peptic ulcer disease
    • 2. gastritis
    • 3. GI bleed
    • 4. GI perforation
  143. Common GI AE of ibu?
    have IBD S/S
  144. What drug may be used to reduce NSAID GI upset in long-term NSAID therapy?
    misoprostol/Cytotec r/t it increasing bicarbonate and mucous production in GI tract- inhibits gastric acid secretion
  145. 8 drug to drug interactions of ibu?
    • 1. salicylates
    • 2. aminoglycoside antibiotics
    • 3. beta blockers
    • 4. lithium
    • 5. loop diuretics
    • 6. selective serotonin reuptake inhibitors
    • 7. antifungal agents
    • 8. heparin
  146. Who is at increased risk for GI bleeds with ibu?
    ppl over 60
  147. What type of pt may be on long-term NSAID therapy?
    arthritis pt
  148. Imp consideration with ibu and pre-surgery pt/
    must educate pt not take ibu close to surgery time (7 days?)
  149. What type of drug is tylenol?
    para-aminophenol derivative
  150. Action of acet?
    inhibits synth of prostaglandins that serve as mediators of pain and fever but has no anti-inflammatory effects
  151. 2 uses for acet?
    • 1. analgesia - mild to moderate
    • 2. antipyretic
  152. 3 routes used for acet?
    oral, rectal, and IV
  153. When is IV acet used?
    if oral or rectal cannot be tolerated and as adjunct to IV opiods
  154. 3 contraindications/cautious uses of acet?
    • 1. hepatic disease
    • 2. viral hepatitis
    • 3. alcoholism
  155. Serious AE of acet?
    hepatic or renal toxicity
  156. Drug to drug interactions with acet?  (3)
    • 1. warfarin
    • 2. sulfinpyrazone/Anturane
    • 3. hydantoins- dilantin, etc
  157. What must be monitored when acet is taken with warfarin?
    monitor PT & INR & S/S of bruising or bleeding
  158. What education needs to be given to all pt about acet including those taken acet combination opiods?
    acet is heptotoxic when take too much
  159. Antidote for acet overdose?
    acetylcysteine/Mucomyst
  160. Serotonin-selective drugs AKA?
    triptans
  161. Uses for triptans?
    relieve pain and inflammation r/t migraine HA

    first line Tx in migraine HA
  162. 3 types of triptans?
    • 1. sumatriptan/Imitrex
    • 2. rizatriptan/Maxalt
    • 3. zolmitriptan/Zomig
  163. Action of sumatriptan/Imitrex?
    works as an agonist for 5HT 1d & 1B receptors on cranial arteries and veins

    stim of these receptors = vasoconstrictions of BV in brain and decreses vascular inflammation
  164. 4 routes of admin for sumatriptan/Imitrex?
    • 1. oral
    • 2. intranasal
    • 3. SQ
    • 4. needleless injection - Sumavel DosePro
  165. Pt taking sumatriptan/Imitrex are at increased risk for ____ & _____ r/t vasoconstriction of BV in brain?
    stroke and MI
  166. Onset of action for oral, intranasal, and SQ sumatriptan/Imitrex?
    • oral - 1 h with complete relief up to 4 h
    • intranasal 1 - 15 min
    • SQ - 10 min with complete pain relief in 2 h
  167. Needless sumatriptan/Imitrex?

    3 step admin?
    Sumavel DosePro

    • 1. snap
    • 2. flip
    • 3. press
  168. 6 contraindications/precautions of sumatriptan/Imitrex?
    • 1. coronary artery disease
    • 2. arteriosclerosis
    • 3. ischemic cardiac disease
    • 4. seizures
    • 5. CVA, TIA, and intracranial bleeding
    • 6. PVD - Raynaud disease
  169. 4 EX of ischemic cardiac disease that are contraindicated with sumatriptan/Imitrex?
    • 1. uncontrolled HTN
    • 2. angina pectoris
    • 3. acute MI or Hx of MI
  170. Common AE of sumatriptan/Imitrex?
    • dizziness & vertigo
    • tingling, warm, sensation
  171. 3 life-threatening AE of sumatriptan/Imitrex?
    • 1. vasospasm effects leading to ischemia
    • 2. MI
    • 3. cerebrovascular disorders:  stroke/ seizures, intracranial hemorrhage
  172. What must be done prior to admin of sumatriptan/Imitrex?
    must have a cardiac workup
  173. 3 assessments that should be done prior to sumatriptan/Imitrex admin?
    • 1. Hx of CV or cerebrovascular disorder
    • 2. obtain BP before and 1 h after admin
    • 3. asses for S/S of cardiovascular event
  174. DMARDS?
    disease-modifying antirheumatic drugs
  175. 3 DMARDS drugs?
    • 1. methotrexate/Rheumatrex
    • 2. adalimumab/Humira
    • 3. hydroxycholoroquine/Plaquenil
  176. Use for DMARDS?
    arrest progression/induce remission of RA
  177. DMARDS may be used as monotherapy or in combination with ______, _____ or _____.
    • 1. glucocorticoids
    • 2. NSAIDS
    • 3. other DMARDS
  178. RA?
    autoimmune disease with systemic inflammtion of joints, tissues, and body organs & joint destruction
  179. Action of methotrexate/Rheumatrex?
    interferes with FA metabolism -> inhibits DNA synthesis and cell reproduction
  180. Methotrexate/Rheumatrex may be used for what 2 things?
    • 1. RA
    • 2. malignancies
  181. 2 routes for methotrexate/Rheumatrex?
    • 1. oral
    • 2. IM
  182. Contraindications & precautions with methotrexate/Rheumatrex?
    • 1. immunosuppression
    • 2. pre-existing blood dyscrasias
    • 3. impaired bone marrow function
    • 4. alcoholism
    • 5. chronic liver disease
  183. Most important thing to teach pt about methotrexate/Rheumatrex?
    causes immunosuppression
  184. Common AE of methotrexate?
    • 1. methotrexate fog - HA, fatigue, and feeling wiped out
    • 2. photosensitivity
    • 3. GI s/s
    • 4. hematologic: anemia, leukopenia, and thrombocytopenia
  185. 2 Life threatening AE of methotrexate/Rheumatrex?
    • 1. severe myelosuppression
    • 2. pulmonary fibrosis or interstitial pneumonitis
  186. Assessments to monitor with methotrexate?
    • 1. CBC
    • 2. Fe
    • 3. breath sounds
    • 4. fever
    • 5. bleeding S/S
  187. Assessments to make prior to admin of methotrexate/Rheumatrex? (4)
    • 1. CBC & platelets
    • 2. renal & hepatic function tests
    • 3. hepatitis B & C serologies
    • 4. chest x-ray
  188. Methotrexate/Rheumatrex requires follow up q ___ to ___ wks with what 4 tests?
    q 4 to 6 weeks

    • 1. CBC
    • 2. liver profile
    • 3. albumin
    • 4. creatinine
  189. Why does albumin need to be monitored with methotrexate/Rheumatrex?
    malnutrition increases risk of immunosuppression and blood dyscraisas
  190. 5 pt teachings for pt taking methotrexate/Rheumatrex?
    • 1. limit intake of caffeine
    • 2. wear sun protection
    • 3. adequate nutrition
    • 4. s/s of myelosuppression
    • 5. take vitamin B/folic acid 1mg qd
  191. Why do pt taking methotrexate/Rheumatrex not need to take any caffeine?
    can decrease effectiveness of drug
  192. S/S of myelosuppression to teach pt taking methotrexate/Rheumatrex?
    • 1. sore throat
    • 2. weakness
    • 3. dry, nonproductive cough
    • 4. nose bleed or bleeding gums
  193. Why do pt taking methotrexate/Rheumatrex need to take folic acid supplement?
    decreases the potential for AE
  194. What is the biggest concern with a pt taking methotrexate/Rheumatrex?
    risk for infection - if have fever need to take care of it immediately
  195. What type of drug is etanercept/Enbrel?
    tumor necrosis factor inhibitor
  196. Action of etanercept/Enbrel?
    binds to TNF & makes it inactive
  197. Admin of etanercept/Enbrel?

    (route and time)
    SQ injection weekly
  198. Uses for etanercept/Enbrel?
    delay structural damage & s/s of RA
  199. Contraindication with etanercept/Enbrel?
    current active infection
  200. Precaution with the use of etanercept/Enbrel?
    can induce multiple sclerosis and optic neuritis
  201. 4 common AE of etanercept/Enbrel?
    • 1. HA
    • 2. upper resp tract infections
    • 3. sinusitis
    • 4. rhinitis
  202. 3 life threatening effects of etanercept/Enbrel?
    • 1. severe infections
    • 2. blood dyscrasias
    • 3. induction of multiple sclerosis and optic neuritis
  203. What is TNF?
    tumor necrosis factor - mediator of inflammatory response that leads to release of destructive enzymes that destroy the joint in RA
  204. 2 things to teach pt taking etanercept/Enbrel?
    • 1. no live virus vaccines:  MMR, varicella
    • 2. monitor for s/s of infection & call MD immediately
  205. Important functions of the adrenal glands?
    metabolism and F&E balances
  206. 2 things primarily secreted by the adrenal cortex?
    glucocorticoids and mineralocorticoids
  207. Addison's disease?
    primary adrenal insufficiency esulting from the destruction of the adrenal cortex caused by infection or hemorrhage
  208. Secondary adrenal insufficiency?
    deficiency of cortisol secretion r/t insufficient secretion of ACTH by the ant pit
  209. Cushing syndrome?
    increased adrenocortical secretion of cortisol that causes chronic elevation in glucocortocoid and adrenal androgen hormones
  210. 2 primary glucocorticoids produced by the adrenal gland?
    cortisol (hydrocortisone) & cortisone
  211. What can abrupt disontinuation of a glucocoricoid following prolonged admin cause?
    acute adrenal insufficiency
  212. What type of drug is prednisone?
    glucocorticoid
  213. 2 uses for prednisone?
    anti-inflammatory & immunosuppressive effects
  214. Precaution/contraindication for prednisone?
    systemic fungal infections
  215. What medical condition can further increase risk for fungal infection with prednisone?
    DM r/t sugary blood
  216. IV form of prednisone?
    solumedrol
  217. What med taken with prednisone can increase risk for fungal infection?
    ABX because it increases fungus also
  218. 2 important considerations with prednisone use in diabetics?
    • 1. can increase risk of fungal infections
    • 2. prednisone raises BG - may need to increase insulin dose
  219. AE of prednisone?
    • 1. anxiety
    • 2. mood swings
    • 3. insomnia
    • 4. HA
    • 5. GI
    • 6. menstrual irregularities
    • 7. hyperglycemia
  220. Imp consideration when giving prednisone to a pt experiencing dyspnea r/t airway issues/
    pt is already anxious and prednisone increases anxiety
  221. Most important considerations with prednisone?
    • 1. suppesses immune system
    • 2. raises BG
    • 3. can decrease serum K+
  222. 2 interventions for fungal/yeast infections?
    • 1. eat yogurt
    • 2. diflucan
  223. What is the best time to take daily or alternate-day doses of glucocorticoids?
    early in the am
  224. Prednisone effect on serum K+?
    can decrease levels

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