What is the action of Antacids?
Neutralize hydrochloric acid and reduce pepsin activity
Identify (4) side effects of the systemic antacid, sodium bicarbonate
Hypernatremia, water retention, metabolic alkalosis, acid rebound
Identify the antacid used to treat hyperphosphatemia related to renal failure
Aluminum hydroxide
Describe the appropriate timing for administering antacids.
Not with alcohol, other meds, or food. (wait 1-3 hours)
Compare the action of H-2 receptor blockers and proton pump inhibitors
H-2 receptor blockers treat peptic (gastric) and duodenal ulcers. Prevent acid reflux in the esophagus. Blocks effects of histamine
Proton pump inhibitors (PPI) suppress gastric acid secretion by inhibiting the pumping
End result of both = less free gas i
Identify the primary lab studies to monitor for clients taking proton pump inhibitors.
AST/ALT
Describe the action of serotonin (5-HT3) receptor anatgonists, e.g. odansetron (Zofran).
antiemetic - stops vomiting
Identify the most common use of these antiemetics.
Used to treat nausea and vomiting associated with cancer chemotherapy
Identify (4) common side effects of these antiemetics.
Headache, diarrhea, dizziness, and fatigue
Describe the action of opiate-related antidiarrheals such as diphenoxylate with atropine (Lomotil).
Slow GI motility and slows intestinal motility
Identify the common side effects related to being opiate-related and anticholinergic side effects (atropine additive).
Atropine additive side effects: drowsiness, dizziness, constipation, dry mouth, blurred vision, and urine retention
Opiate-related side effects: ????
Discuss the major adverse reaction, paralytic ileus.
life threatening, paralyzed small intestines
Identify the primary contraindications for using opiate-related antidiarrheals.
glaucoma
Describe the action of diphenhydramine (Benadryl)
bloacks histamines
Discuss the rationale for using Benadryl as a "sleep-aid.
Diphenhydramine is the ingredient
Most common side effect is fatigue
Review the outcome (effect) of stimulating beta-2 receptors on bronchiolar smooth muscle
relaxation causing bronchodialation
Describe the rationale for using albuterol (Proventil) as the DOC for an acute asthma attack.
MOI or nebulizer, short lasting, bronchioles constrict and inflame during asthma attack
All bronchodilators are CNS stimulants. Therefore, they can cause serious ventricular dysrhythmias.
serious adverse reactions=ventricular dysryhthmias
Describe the action of montelukast (Singulair) in the prevention of asthmatic attacks
DO NOT GIVE for attack, they are used for prevention, bind with leukotriene receptors to inhibit smooth muscle contraction and bronchocontriction
Describe: leukotriene
chemical mediators that can cause inflammatory changes in luncgs
Leukotriene - Which lab values should be monitored?
AST/ALT
Describe the primary action of glucocorticosteroids.
antinflamitory, acts as cortisol from adrenal cortex, used for prevention
Describe the side effects associated with orally inhaled glucocorticosteroids
throat irritation, hoarseness, dry mouth, coughing
Discuss the client teaching to help prevent Candida albicans infection associated with the use of ICS.
rinse mouth after each use
Describe the action of acetylcysteine (Mucomyst) as a mucolytic
liquifies and loosens secretions
Describe the administration of acetylcysteine (Mucomyst) as a mucolytic
nebulizer (but give bronchodilator first so bronchiles will be open)
Discuss the specific cultural considerations for African-Americans taking medications for treatment of hypertension.
They respond well to diuretics as initial monotherapy for hypertension (they respond well to calcium channel blockers & alpha blockers).
Because African-Americans are susceptible to low-renin-hypertension, which drugs do they not respond well to for treatment of HTN?
Beta Blockers and ACE Inhibitors
Which drug classification do African-Americans respond well to as initial monotherapy?
Diuretics
Describe the action of Beta Blockers in lowering B/P.
block beta 1 receptors which lower HR which lowers BP
Why is it potential dangerous to administer a beta-blocker to a client diagnosed with asthma?
Beta Blockers are adrenergic blockers which means they constrict the bronchioles making it difficult for an asthmatic to breath
Identify serious adverse reactions of beta-blockers
Bradycardia, decreased BP, bronchospasms (with the noncardioselective beta1 and beta2 blockers)
Describe client teaching for a client taking beta-blockers
teach clients to monitor HR, dont stop abruptly
Describe the action of the alpha adrenergic blocker, prazosin (Minipress).
Dialates peripheral blood vessels
Describe (4) adverse reactions of prazosin (Minipress).
Orthostatic hypertension, pancreatitis, sodium and water retention, monitor for morning edema
Describe: orthostatic hypotension and appropriate nursing interventions to prevent client injury.
Low blood pressure that happens when you stand up from sitting or lying down. Can make you feel dizzy or lightheaded, and maybe faint.
Nursing interventions: raise/move slowly, allow feet to dangle from bed for a few minutes, monitor blood pressure & morn
Describe the action of ACE Inhbitors.
Inhibits formation of angiotensin II and blocks release of aldosterone
Identify the primary side effect of ACE Inhibitors
dry constant cough
ACE Inhibitors can cause which electrolyte imbalance?
hyperkaemia
What should the nurse instruct the client about regarding the "first dose" of ACE inhibitors?
First dose adverse effects: hypotension & hyperkalemia
Patient should monitor BP
Discuss the positive inotropic and negative chronotropic effects of digoxin.
Positive inotropic effects: increases myocardial contraction (stroke volume)
Negative chronotropic effect: decreases heart rate
Describe the critical premedication assessment for digoxin
Obtain a drug & herbal history
Obtain baseline pulse rate (apical should be greater than 60 beats/min)
Assess for s/s of digitalis toxicity
Identify the normal therapeutic range for digoxin
0.5-2
What are the (2) primary causes of digoxin toxicity?
Overdose or accumulation of digoxin
Identify the antidote for digoxin toxicity.
digoxin immune Fab (Digibind)
What are the primary signs/symptoms [especially the early S/S!] of digoxin toxicity?
Anorexia
Nausea/Vomiting
Bradycardia
Cardiac dysrhythmias
Visual disturbances
Discuss myocardial ischemia related to coronary artery disease.
Myocardial ischemia - lack of blood supply to the heart muscle
DOC is Nitroglycerin to treat Angina Pectoris (acute cardiac pain caused by inadequate blood flow to myocardium)
What is the most common side effect of nitroglycerin?
headache
Why is nitroglycerin called the "universal vasodilator?
Vasodialates arteries and veins all over body
Discuss: reflex tachycardia.
Heart rate increases greatly because its overcompensating for the cardiovascular system
Describe client teaching regarding: SL nitroglycerin and transdermal nitroglycerin.
SL nitroglycerin:
Take 1 tablet every 3-5 minutes over 15 minutes (if having chest pain)
If pain doesn't subside or gets worse call 911
Tolerance can occur
Replace bottle of nitro every 3 months
Do NOT discontinue without doctor's approval
Keep med bottle
Describe the action of thiazide diuretics.
Promotes sodium, potassium, and water excretion
Identify the common electrolyte imbalances related to thiazide diuretics.
Hypokalemia or hyperglycemia
What lab value should be monitored closely especially if a diabetic client is taking a thiazide diuretic? Why?
blood glucose level - hypoglycemia may occur, potassium, uric acid, and cholesterol
Which electrolyte imbalance is most profound with furosemide (Lasix) administration?
Potassium - hypokalemia
Describe the S/S of hypokalemia.
Hypokalemia (less than 3.5mEq/L) - muscle weakness, abdominal distention, leg cramps, and cardiac dysrhythmias
Which VS is most affected by furosemide (Lasix)?
BP
Which dietary instructions should the client be given?
eat foods high in potassium
Why is this group of diuretics called aldosterone antagonists?
Because they block the action of aldosterone
Which electrolyte imbalance is most profound with these diuretics?
hyperkalemia
What change on an ECG/EKG rhythm strip would indicate hyperkalemia?
peaked narrow T wave
Which dietary instructions should the client be given?
avoid potassium rich foods
Compare the action of anticoagulants to the action of thrombolytics!!
Anticoagulants prevent blood clots while thrombolytics dissolve existing blood clots
Describe the specific action of heparin.
prevents conversion of fibrinogen to fibrin
Discuss the routes of administration for heparin and safety considerations.
SubQ or IV, NEVER Aspirate
Discuss the route of administration for warfarin (Coumadin).
PO
If a client is receiving heparin which lab values MUST be monitored?
PTT/aPTT Checked before administering
If a client is receiving warfarin(Coumadin) which lab values MUST be monitored?
PT (prothrombin time)
INR (international normalized ration)
What are the antidote for heparin?
Protamine sulfate
what is the antidote for warfarin?
Vitamin K
Discuss the S/S of bleeding and/or hemorrhage.
Occult bleeding
Melena - black, tarry, sticky stools
"Coffee grounds"
Hematuria - blood in urine
Ecchymosis
Which dietary instructions should be given the client receiving warfarin (Coumadin)?
Decrease diet rich in vitamin k, ex. don't eat a lot of green, leafy foods
Describe the action of HMG CoA Reductase inhibitors.
Lowers hepatic cholesterol production in liver
Which lab value should be monitored?
AST/ALT
Identify the common GI side effect of this group
Constipation
Discuss the pathophysiology, S/S of the rare but life-threatening adverse effect of this group.
Rhabdomyolysis- skeletal muscle break down, glomeruler filtration resulting in renal failure
Describe the action of this drug. Ezetimibe (Zetia)
Inhibits cholesterol absorption in small intestines
This drug is often combined with which drug group?
Statin (ex. Vytorin)
Discuss the "very bothersome" side effect of this drug.Nicotinic acid/ Niacin / Vitamin B2
skin flushing - burning from the inside out, maybe turning red
What instructions can be given the client to lessen the side effect in Nicotinic acid/ Niacin / Vitamin B2?
take aspirin about 30 minutes prior