Benzodiazepines - ANSWER Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam, chlordiazepoxide, chlorazepate
Enhances GABA: increased
... [Show More] GABA means decreased neuron activity
Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia
Usually short term; if long term do NOT stop abruptly
Antidote is flumazenil
Side effects: CNS depression - sedation and respiratory depression, amnesia, dependency, and withdrawal effects
Atypical anxiolytic - ANSWER Buspirone
Can take 2-6 weeks to work, but can be long term!
Treats panic disorder, anxiety, OCD, and PTSD
Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen like in benzo)
Trick to remember difference between Benzodiazepine and buspirone - ANSWER "Pam" has anxiety, so she goes on a "benzo" and takes it for a long time but realizes that it is not healthy. So she takes a "bus" to a "pier" to sit "alone" and decides to treat her anxiety long term with "buspirone"
Selective Serotonin Reuptake Inhibitors (SSRIs) - ANSWER Usually end in "ine": paroxetine, sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine
Inhibits serotonin reuptake" increases serotonin
Treats anxiety, OCD, PTSD, and depression
Side effects: nausea, fatigue, sexual dysfunction, weight gain, insomnia (paroxetine), serotonin syndrome (agitation, hallucinations, tremors, fever, diaphoresis)
Takes about four weeks after treatment begins to take full effect.
Atypical Antidepressants - ANSWER Bupropion, Trazodone - more important
Others: Vilazodone, mirtazapine, reboxetine
Treats depression and aid for smoking cessation
Side effects: headache, GI distress, insomnia, nausea, weight loss, seizures
Tricyclic antidepressants - ANSWER Amitriptyline
Treats depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia
Side effects: Anticholinergic effects, Sedation, Seizures, Sweating (SSS)
"Amy tripped over a tricycle in the desert."
Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert.
Anticholinergic efffects - ANSWER dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia
Monoamine oxidase inhibitors - ANSWER Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline
Side effects: CNS stimulation, Orthostatic hypotension, hypertensive crisis (especially with phenelzine).
Tyramine rich foods can lead to hypertensive crisis
Foods that contain tyramine - ANSWER aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine
Mood stabilizer - ANSWER Lithium Carbonate
Treats bipolar disorder
Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, renal toxicity, hypothyroidism, electrolyte imbalance
Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion, tinnitus, seizures, hypotension, coma, possibly death.
Do not give with diuretics, NSAIDs, or anticholinergics
Need a balance of sodium and water.
Mood - stabilizing antiepileptic - ANSWER Carbamazepine, valproic acid
Treats Bipolar disorder and seizure disorder
Carbamazepine side effects: blood dyscrasias, hypo-osmolality
Valproic acid side effects: *hepatotoxicity,* pancreatitis, thrombocytopenia
Antipsychotics: First-generation (conventional) - ANSWER Chlorpromazine, Haloperidol
TONS of side effects-will only list important ones
Extrapyramidal side effects: Acute dystonia- spasms of tongue, neck, face, or back; Parkinsonism- rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia - involuntary movement of tongue and face
EPS effects may be able to be treated with anticholinergic medication if the patient does not have anticholinergic side effects.
Neuroleptic Malignant Syndrome: sudden high grade fever, dysrhythmias, muscle rigidity
There is a long lasting injection for non-compliant patients.
Antipsychotics: second and third generation (atypical) - ANSWER Risperidone and Clozapine - most important
Often first line in treating schizophrenia
Treats negative and positive symptoms
Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects
Do not take with alcohol.
IM every two weeks available for those who are not compliant
Central Nervous system stimulants - ANSWER Methylphenidate and Amphetamine mixture
Treats ADHD and Conduct disorder
Can cause insomnia, decreased appetite, weight loss, and growth suppression
Do not give at night. Give immediately before or after a meal. Monitor weight.
Medications to support withdrawal from alcohol - ANSWER Benzodiazepines:
Chlordiazepoxide, lorazepam, diazepam
First line treatment of alcohol withdrawal
Keeps vitals within expected limits, decreases risk of seizures
Clonidine and Propranolol depress autonomic response and decrease vitals
Carbamazepine Further decreases risk of seizure
Disulfiram - ANSWER Daily oral medication to sustain abstinence of alcohol; type of aversion therapy
Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed
Naltrexone - ANSWER Suppresses the craving and pleasurable effects of alcohol.
Can have monthly IM injection
Acamprosate - ANSWER Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety, restlessness
Medications to support withdrawal/abstinence from opiods - ANSWER Methadone Substitution
Slow weening process
Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a physical dependence
It prevents abstinence syndrome and removes the need for the client to obtain illegal substances.
Used for withdrawal and long term maintenance.
Withdrawal/abstinence from nicotine - ANSWER Bupropion
Nicotie gum, patch, or nasal spray
Varenicline: a nicotine receptor agonist. Reduces cravings as well as withdrawal effects. Depression and suicidal effects can occur.
Cholinesterase inhibitors - ANSWER Neostigmine, Physostigmine, Edrophonium (dx MG)
Prevents the enzyme cholinesterase from inactivating acetylcholine thereby increasing the amount of ACh available.
Treats myasthenia gravis and parkinson's
Reversal for neuromuscular blocking agents
Excessive muscarinic stimulation: increased GI motility, diaphoresis, increased salivation, bradycardia, and urinary urgency (too moist)
Cholinergic crisis: give atropine!
Atropine reverses this!
Levodopa/Carbidopa - ANSWER Giving together to increase dopamine
Used for parkinson's
Decreases tremors and muscle rigidity
Levodopa is converted to dopamine in the CNS and carbidopa prevents the breakdown of levodopa
Side effects: quite a few: nausea, vomiting, drowsiness, dyskinesia, orthostatic hypotension, darkening of urine and sweat, possible psychosis
High protein meals decreases effectiveness.
Benztropine - ANSWER Decreases Acetylcholine
Used for Parkinson's, helps with muscle rigidity and tremors
Side effects relate to too little acetylcholine which means we will have anticholinergic side effects
Teach to chew gum, wear sun glasses, increase fiber and fluids
Antiepileptics - ANSWER Phenytoin, Carbmazepine, Valproic acid, lamotrigine
Phenytoin: Side effects: gingival hyperplasia!, diplopia, stigmas, rash, ataxia, hypotension
Closely monitor plasma levels! Narrow range! Range is 10-20 mcg/mL
Decreases effectiveness of oral contraceptives.
Neuromuscular Blocking Agent - ANSWER Succinycholine and Pancuronium
Blocks acetylcholine at the neuromuscular junction resulting in muscle relaxation and hypotension. They do not cross the blood brain barrier, so complete paralysis is achieved without loss of consciousness or decreased pain sensation. Used in anesthesia.
Side effects: respiratory depression, prolonged apnea, muscle pain, and malignant hyperthermia (MH)
MH: muscle rigidity with increased temperature. Need to give oxygen at 100%, initiate cooling measures and administer dantrolene.
Peripherally acting muscle relaxants - ANSWER Dantrolene
Treats: spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis
Inhibits muscle contraction by preventing release of calcium in skeletal muscles.
Side effects: drowsiness, muscle weakness, hepatic toxicity
Centrally Acting muscle relaxants - ANSWER Baclofen (diazepam, baclofen, cyclobenzaprine, tizanidine)
Used for muscle spasticity related to spinal injury cerebral palsy, multiple sclerosis, as well as malignant hyperthermia
Enhances effect of GABA
Drowsiness, GI upset, constipation (increase fiber and fluid)
Urinary Tract Stimulant - ANSWER Bethanechol (Cevimeline, pilocarpine, acetycholine)
"Beth has is shy and has a shy bladder"
Used for nonobstructed urinary retention. Stimulates the cholinergic receptors in GU tract.
Side effects: r/t cholinergic effects like flushing, sweating, urinary urgency, bradycardia, hypotension
One hour before or two hours after meal, not at meal time
Muscarinic antagonist - ANSWER Oxybutynin
(darifenacin, solifenacin, tolterodine, fesoterodine, trospium)
Used for overactive bladder symptoms: frequency, urgency, nocturia
Inihibts muscarinic receptors
Side effects: Anticholinergic!
Nonbenzodiazepines for insomnia - ANSWER Zolpidem
Enhances GABA
Can cause day time sleepiness and dizziness. Ensure they have eight hours of sleep.
Intravenous anesthetics - ANSWER Pentobarbital: Barbiturate
Medazolam: Benzo
Propofol
Initiate or maintain anesthesia, conscious sedation, intubation
Depresses CNS, promote loss of consciousness
Side effects: respiratory/cardiac depression. Propofol: pain at IV site, high risk of infection. Use within six hours
For all: have rescue equipment available and constantly monitor EKG and vitals.
Beta2-adrenergic agonist - ANSWER Albuterol and salmeterol
Bronchodilation
Treats COPD and asthma
Side effects: Tachycardia, angina, tremors
Albuterol - short acting; salmeterol - long acting
If using with a glucocorticoid, use beta2-adrenergic agonist first to dilate the bronchioles
MethylXanthines - ANSWER Theophylline
"Theo means God and if you use this, you may be seeing God sooner than you intended due to side effects."
Can be used long term for asthma or COPD
Side effects: GI upset, fatal dysrhythmia, and seizures
Narrow therapeutic range: frequent blood draws: 5-15 mcg/mL
Inhaled anticholinergics - ANSWER Ipratropium
Used for asthma or COPD; blocks acetylcholine to bronchodilate
Side effects: anticholinergic - dry mouth and hoarseness
Increase fluid intake and suck on sugarfree candy.
Inhaled Glucocorticoids - ANSWER Beclomethasone
Used for asthma; can be used alone or with beta 2 agonist
Decrease inflammation locally
Side effects: hoarseness and candidiasis
Rinse mouth out after the medication is used
Oral glucocorticoids - ANSWER *Prednisone*
Used for asthma, autoimmune disorders and a variety of inflammatory disorders
Suppresses inflammation and immune response
Side effects: weight gain, bone loss, immune suppression, fluid retention, hyperglycemia, hypocalcemia, infection, muscle weakness, peptic ulcer disease, and adrenal gland suppresion
Periods of stress may require a higher dose
NEVER stop this medication abruptly, it will need to be tapered
Monitor for signs and symptoms of infection
Avoid NSAIDs
Leukotriene modifiers - ANSWER Montelukast (Zafirlukast, Zileuton)
Treats exercise induced asthma
"Lukast will decrease the effect of Leukotrienes"
Reduces airway inflammation and bronchoconstriction by decreasing leukotrienes
Side effects: increased liver enzymes with Zafirlukast
Take in the evening or two hours before exercise
Antitussives: Opioid - ANSWER Codeine (hydrocodone)
Used for non-productive cough
Decreases cough reflex
Side effects: sedation, respiratory depression, GI upset, possible dependency
Change positions slowly, increase fluid and fiber, and avoid alcohol
Expectorants - ANSWER Guaifenesin
"Guaif sounds like cough"
Used for non-productive cough associated with respiratory infections; thins secretions to enable patient to cough up mucous
Side effects: GI upset, possible rash, drowsiness
Want patient to drink more fluids to help liquefy secretions
Mucolytics - ANSWER Acetylcysteine
Used for pulmonary disorders where there are thick mucous secretions such as in cystic fibrosis; improves flow of secretions
Also used for acetaminophen toxicity
Side effects: bronchospasm, rash, nausea, vomiting
Use cautiously in patients with asthma
Decongestants - ANSWER Phenylephrine (pseudoephedrine, ephedrine, naphazoline)
Used for rhinitis
Causes vasoconstriction and decreases mucous in nose
Side effects: agitation, nervousness, palpitations, increased heart rate, rebound congestion
Antihistamines - ANSWER 1st gen: diphenhydramine
2nd gen: Loratadine
Used for nasal congestion, mild allergic reactions, and motion sickness
Blocks histamine release which helps reduce mucous secretion
With 2nd gen - less side effects
Side effects with 1st gen: anticholinergic effects and sedation
Nasal glucocorticoids - ANSWER Mometasone (fluticasone, triamcinolone, budesonide)
Used for rhinitis; decreases inflammation in nasal passages
Side effects: burning, headache, sore throat
Loop diuretics - ANSWER Furosemide
Blocks re-absorption of sodium and water at ascending loop of henle causing rapid diuresis.
Used for pulmonary edema, heart failure, and hypertension
Side effects: hypotension, hyponatremia, and hypokalemia, ototoxicity, dehydration and hypergllycemia
Administered in the morning or during day, not at night
Infuse IV at 20 mg/min
Weigh daily
Monitor I&Os
Watch electrolyte labs
Encourage high potassium foods
Thiazide Diuretics - ANSWER Hydroclorothiazide
Blocks re-absorption of water and sodium at distal convoluted tubule.
Used for Hypertension, edema
side effects: dehydration, hypokalemia, hyperglycemia
Admin during day, \
Monitor I&Os
Watch electrolyte labs
Encourage high potassium foods
Potassium sparing diuretics
(Aldosterone Antagonist) - ANSWER Spironolactone
Blocks aldosterone promoting excretion of sodium and water ONLY
Used for heart failure, hypertension
Contraindication in severe kidney failure
Side effects: hyperkalemia, issues with menstruation, gynecomastia or impotence in men
Monitor potassium closely and avoid salt substitutes
Osmotic Diuretics - ANSWER Mannitol
Treats Edema, increased ICP, increased IOP
Contraindicated in intracranial hemorrhage
"Oh man I had a bad headache because of increased cranial pressure, but man it all went away when I took mannitol"
Reduces ICP and IOP by increasing serum osmolality
Side effects: Heart failure, pulmonary edema, renal failure, dehydration, electrolyte imbalances
Use filter needle and tubing when admintering
Monitor weight, I&Os, and electrolytes
Angiotensin - converting enzyme inhibitors - ANSWER Captopril "-pril"s
Blocks conversion on angiotensin one into angiotensin two, which vasodilates
Treats HTN, HF, MI, diabetic retinopathy
Side effects: Angioedema, Cough, Elevated potassium (A.C.E.), rash, hypotension
Closely monitor blood pressure
Change position slowly
Angiotensin II Receptor Blockers - ANSWER Losartan "Sartans"
Blocking action of angiotensin II; results in vasodilation
Heart failure, HTN, MI, diabetic retinopathy
Side effects: angioedema, GI upset, hypotension
Direct Renin Inhibitors - ANSWER Aliskiren
Calcium Channel Blockers - ANSWER Diltiazem, Nifedipine, Verapamil
Used for HTN and angina; block calcium channels in the blood vessels and heart cause vasodilation and decreased heart rate
Side effects: hypotension, bradycardia, dysrhythmias, constipation, edema
Patient should NOT consume grapefruit juice
Monitor blood pressure and heart rate regularly
Alpha adrenergic blockers - ANSWER Prazosin
Centrally Acting Alpha2 agonist - ANSWER Clonidine (do not confuse with clonzapine)
Activate Alpha II receptors which cause decrease in heart rate and blood pressure
Treats HTN
Side effects: drowsiness and dry mouth
Beta Blockers - ANSWER Metoprolol "lol"
HTN, angina, heart failure, MI; blocks beta 1 receptors in heart which decreases heart rate and blood pressure
Side effects: hypotension, bradycardia, decrease output, fatigue, erectile dysfunction
Teach to take pulse and change position slowly.
If beta blocker is non-selective: it will cause bronchospasm and should not be used in asthma. These include Propranolol and Nadoll
Hypertensive Crisis - ANSWER Nitroprusside
Directly vasodialates arteries and veins which rapidly decreases blood pressure by acting on preload and afterload
Side effects: hypotension, cyanide poisoning, thiocyanate toxicity
Cardiac glycocides - ANSWER Digoxin
Used for heart failure and A-fib
Positive inotropic effect: increase in force and efficiency of heart contractions
Negative chronotropic effect: decreases heart rate
Side effects: dysrhythmias, bradycardia
Toxicity: GI upset, vision changes, and fatigue/weakness
Always check apical pulse for full minute before giving and hold if under 60
Monitor serum levels: should be between 0.5 - 2.0
Hypokalemia increases risk for digoxin toxicity
Treat bradycardia with atropine and overdose with activated charcoal, cholestyramine, or digoxin immune Fab (digibind)
Adrenergic agonist - ANSWER Epinephrine, dopamine, and dobutamine (PT: Catecholamines)
Epinephrine: Stimulates Alpha-1, Beta-1, and Beta-2 receptors.
Used for cardiac arrest or asthma. Bronchodilates, vasoconstriction, increased cardiac output, and increases heart rate
Dopamine: Used for shock and heart failure. Increases renal blood flow at low to moderate doses. Increase heart rate and cardiac output.
Dobutamine: Primarily stimulates Beta-1 receptors and acts on heart. Used for heart failure. Increases cardiac output. Less effect on blood pressure and heart rate
Side effects: hypertensive crisis, dysrythmias, angina
Organic Nitrates - ANSWER Nitroglycerin (NTG)
Used for angina by vasodilating to decrease preload and myocardial oxygen demand
Side effects: headache, orthostatic hypotension, reflex tachycardia
If someone is having chest pain you have them stop and sit down. You put one sublingual tablet under tongue and rest for five minutes. If they are still have chest pain they should call an ambulance and take a second. Five minutes later they can take a third but NO more!
If patch: place on hairless area and rotate sites. Remove old patch and clean with soap and water and dry well before applying new patch.
Wear gloves when applying!
Antidysrhythmic medications
Class One - ANSWER Procainamide, Lidocaine
Used for Supraventricular tachycardia (SVT), ventricular tachycardia, atrial flutter, atrial fibrillation. "If you were 'ProMcCain' when he was running for President, you might have gotten really upset and developed 'tachycardia' when he lost. Then you would need to take 'Procainamide'
Sodium channel blocker
Side effects: hypotension, lupus, leukopenia, thrombocytopenia, and arrhythmias
Antidysrhythmic Medications
Class Two - ANSWER Propranolol
Non-selective beta blocker
A-fib, A-flutter, paroxysmal SVt, HTN, angina
Impact Beta-1 and Beta-2 receptors in both heart and lungs. Which means it can cause bronchspasm and cannot be used in asthma
Side effects: hypotension, bronchospasm, fatigue, weakness
Antidysrhythmic Medications
Class Three - ANSWER Amiodarone
Used for A-fib, A-Flutter, Ventricular fibrillation, Ventricular tachycardia
Potassium channel blocker. Very serious med with serious side effects
Side effects: hypotension, bradycardia, pulmonary toxicity, visual disturbances, liver toxicity, GI upset, thyroid dysfunction
Antidysrhythmic Medications
Class Four - ANSWER Verapamil, Diltiazem
Calcium channel blockers
Used for hypertension, A-fib, A-flutter, SVT, angina
Side effects: Hypotension, bradycardia, GI upset
HMG-CoA Reductase Inhibitors - ANSWER (Statins) Atorvastatin
Lowers cholesterol and decreases risk of MI by increasing HDL and decreasing LDL.
Side effects: Hepatotoxicity, Muscle pain, GI upset, Rhabdomyolysis
Administer in the evening with a meal because cholesterol is synthesized at night
Monitor liver function and CK labs
Patient should avoid alcohol
Cholesterol Absorption Inhibitors - ANSWER Ezetimibe
Lowers cholesterol by inhibiting absorption in small intestine
"eZetimibe causes cholesterol to Zip on through"
Side effects: hepatotoxicity and muscle pain
Monitor liver function and CK levels
Bile-acid Sequestrants - ANSWER Colesevelam, Colestipol
Used to lower cholesterol by binding bile acids in intestine which causes more cholesterol to be pulled from the blood stream to be used for new bile
Side effects: constipation!
Take with food and full glass of water
Can interfere with absorption of fat soluble vitamins (DEKA) and oral contraceptives
Nicotinic Acid - ANSWER Niacin
Used to lower cholesterol by decreasing lipoprotein and triglyceride synthesis which lowers LDL and triglycerides
Side effects: flushing, hepatotoxicity, GI distress, hyperglycemia
Monitor liver function and blood glucose
Fibrates - ANSWER Gemfibrozil
Lowers cholesterol by decreasing triglyceride production and transport and increases HDL
Side effects: GI upset, Gallstones, hepatotoxicity, and muscle pain
Give 30 minutes before breakfast and dinner
Monitor liver function and CK levels
Parenteral Anticoagulation - ANSWER Heparin, enoxaparin
Used for stroke, PE, DVT
Prevents new clots from forming but does not break up clots that are already formed
Side effects: BLEEDING, heparin induced thrombocytopenia (HIT), hypersensitivity
HIT- decreased platelets and formation of clots in the body
Monitor aPtt levels: Normally 30-40 seconds but therapeutic levels will be 1.5-2 times the baseline. Max should be 80. If higher than 80, blood is way too thin
Antidote is protamine
Monitor for signs of bleeding like black tarry stools or coffee ground emesis
Use soft toothbrush and electric razor
Oral anticoagulants - ANSWER Warfarin (Coumadin)
Used for Venous thrombosis, A-fib with thrombosis, prevention of TIA, PE, MI, and DVT
Antagonist of vitamin K which prevents the formation of several clotting factors
Side effects: BLEEDING, GI upset, hepititis
Monitor PT: 11-13 but 18-24 for therapy and INR: 2-3
It takes 3-5 days for therapeutic level to be achieved. This means that they will be on Warfarin and heparin at the same time until warfarin can catch up.
Antidote: vitamin K
Maintain consistent intake of vitamin K
Monitor for signs of bleeding, use soft toothbrush, etc.
Direct inhibitor of factor Xa - ANSWER Rivaroxaban (Xarelto)
"Make your blood flow like a river"
Prevention of DVT, PE, and stroke by selectively inhibiting factor Xa which blocks coagulation
Side effects: BLEEDING, elevated liver enzymes
Monitor liver enzymes, hemoglobin, and hematocrit levels
Antiplatelets - ANSWER Aspirin, Abciximab, Clopidogrel
Inhibit platelet aggregation to prevent MI, strokes
Side effects: GI upset, BLEEDING, and with aspirin tinnitus
Do not give aspirin to children with fever do to risk of Reye's Syndrome
Do not give in patients with bleeding disorders
Thrombolytic medications - ANSWER Alteplase (tPA) "-ase"
"If you're trying to break up clots you've come to the right "plase"
Break us clots by converting plasminogen to plasmin which breaks up fibrinogen
Used with MI, Stroke, PE, clogged PICC lines
Side effects: BLEEDING
Do not give with patients with internal bleeding, hemorrhagic stroke, recent trauma or surgery, or severe HTN
Given within three hours of onset of symptoms of MI or stroke (ischemic only!)
Closely monitor labs and vitals
Limit venipunctures and IM injections
Epoetin alfa (Epogen) - ANSWER Used in anemias to help increase production of RBCs in patients with chronic kidney disease, chemotherapy, or HIV by stimulating bone marrow
Side effects: HTN (due to increased hematocrit), risk of DVT, stroke, or MI
Do not agitate vial
Monitor blood pressure for HTN
Monitor Hgb and Hct twice a week
Ensure the patient has sufficient iron levels or med will not work
Filgrastim - ANSWER Used with neutropenia to increase production of neutrophils and decreases risk of infection. Usually for those on chemo
Stimulates bone marrow to increase production of neutrophils
Side effects: bone pain, leukocytosis, enlarged spleen
Do not agitate vial
Monitor CBC twice a week
Types of Blood Products - ANSWER Whole blood: Includes everything: RBCs, WBCs, Platelets, Plasma. Given to those with blood loss due to trauma or surgery, dehydration, shock. Helps to bring overall blood volume up
Packed Red Blood Cells: Administered to those with anemia who need the extra RBCs, not the extra blood volume
Platelets: For thrombocytopenia or low platelets
Fresh Frozen Plasma: For missing clotting factors
Administration of Blood Products - ANSWER Get baseline lab values. Get signed consent. Assess for risk of fluid overload like HF. Get baseline vitals right before administration and Q15min for first hour and every hour until infusion is complete. Use 20g or larger catheter. Use 0.9% NS. Always confirm with two nurses. Document type of blood, blood bank number, total volume infused, time started, time finished, any reactions, and vital signs. If whole blood or packed RBC: given in 2-4 hour period. Platelets are 15-30 minutes per unit. Fresh frozen plasma is 30-60 minutes.
Reactions to Blood Products - ANSWER First STOP the infusion immediately. Disconnect existing tubing hook them up to normal saline. Call provider. Send blood and tubing back to blood bank for analysis. Obtain Urine specimen.
Acute hemolytic reaction: fever, low back pain, tachycardia, hypotension, tachypnea. Ensure you have checked ABO type and Rh factors with extra nurse.
Febrile nonhemolytic reaction: Most common. Fever, chills, possible headache, fever will increase greater than 1 degree of baseline.
Anaphylactic Reaction: Wheezing, shock, cardiac arrest. Do normal Rx protocol as well as initiate code, give epi, intiate CPR
Mild allergic reaction: Have flushing, itching, urticaria. Can give antihistamine prior to transfussion if hx of this reaction. May need to stop, notify provider, and continue infusion slowly after antihistamine is given.
Circulatory overload: especially with CHF. Crackles, cough, SOB, HTN, tachycardia, distended neck veins. Infuse slowly. Wait two hours before infusion of additional units. Sit patient upright with feet down. Administer diuretics and oxygen as appropriate
Treatment of H.pylori - ANSWER Leading cause of peptic ulcer disease
Antibiotics: (Two - three different types to increase effectiveness and prevent resistance) Amoxicillin, Clarithromycin, metronidazole
H2 receptor Antagonist
Proton Pump Inhibitor
Mucous Protectant
Antacid
Histamine 2 Receptor Antagonists - ANSWER Ranitidine and Famotidine
"If you take this medication, you will feel better when you 'dine'"
Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by blocking H2 receptors in the stomach which reduces gastric acid secretion
Side effects: increases risk of bacterial colonization in stomach because of reduced pH.
Advis patient not to over eat, reduce stress, stop smoking, avoid aspirin and NSAIDs
Proton Pump Inhibitors - ANSWER Omeprazole and Pantoprazole
Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by inhibiting enzyme needed for gastric acid secretion
Side effects: GI upset, osteoporosis with long term use
Mucosal Protectant - ANSWER Sucralfate (Carafate)
Used for duodenal ulcers. Reacts with stomach acid to form paste that cover ulcers
Side effects: Constipation
Want to give one hour before meals and at bedtime
Antacids - ANSWER Magnesium Hydroxide, Sodium Bicarbonate, Aluminum Hydroxide, Calcium Carbonate *Know All*
Used for peptic ulcer disease and GERD by neutralizing stomach acid
Side effects: Vary depending. Aluminum or Calcium can cause constipation. Mg based causes diarrhea.
One hour before and three hours after meals and at bedtime. Leave one hour before or after any medications.
Prostaglandins - ANSWER Misoprostol
Used to prevent gastric ulcers in patients taken NSAIDs long term and to induce labor by ripening cervix. Decreases stomach acid production, increases protective mucous and bicarbonate.
Side effects: dysmenorrhea, miscarriage or GI upset.
DO NOT give in pregnancy or it causes miscarriage. Run pregnancy test first.
Antiemetics - ANSWER Ondansetron - Used for nausea and vomiting for those receiving chemo, radiation, and post-op by blocking serotonin receptors in the CTZ.
Side effects: headache, dizziness, GI upset.
If giving to patient receiving chemotherapy give prior to chemo treatment
Laxatives - ANSWER Psyllium: Bulk forming, helps to soften stool and increase bulk
Docusate Sodium: Surfactant laxative, softens stool by increasing the water content
Bisacodyl: Stimulant laxative. Stimulates peristalsis. A little harsher than the rest.
Magnesium hydroxide: Osmotic laxative, draws water into the intestine and promotes peristalsis. Check for Mg toxicity and dehydration
Key points: Constipation r/t bowel obstruction. Increase fiber, fluid, and exercise.
Lactulose - ANSWER Laxative used for hepatic encephalopathy by decreasing ammonia levels and improve the mental status. Lowers pH in colon to promote ammonia excretion.
Side effects: GI upset, electrolyte imbalances, hyperglycemia.
Treats encephalopathy and decreases ammonia levels!!!
Antidiarrheal agents - ANSWER Loperamide and diphenoxylate/atropine
Stimulate opioid receptors in the intestines cause a decrease in motility and increased absorption of water and sodium
Side effects: Constipation, drowsiness, Diphen/atropine at high doses causes opioid and anticholinergic effects. (Put the two together to decrease abuse potential)
Prokinetic Agents - ANSWER Metoclopramide (Reglan)
Used for nausea and vomiting as well as GERD and gastroparesis by accelerating gastric emptying and blocks dopamine and serotonin receptor in CTZ
Side effects: Drowsiness, extrapyramidal symptoms
Irritable Bowel Syndrome with Diarrhea - ANSWER You can have IBS with or without diarrhea
Alosetron: Blocks 5-HT3 receptors which increases firmness of stool and decreases urgency
Side effects: Constipation
Irritable Bowel Syndrome with Constipation - ANSWER Lubiprostone
Increases fluid secretion in intestine and increase intestinal motility
Side effects: diarrhea or nausea
5-aminosalicylates - ANSWER Sulfasalazine
Used for IBS, Crohn's disease, and ulcerative colitis
Inhibits prostaglandin synthesis which decreases colon inflammation
Side effects: Blood dyscrasia, GI upset, rash, headache
Iron Preparations - ANSWER Ferrous Sulfate (Oral), Iron Dextran (IV or IM)
Used for iron deficiency anemia
Side effects: Oral: GI upset, constipation, teeth staining (use straw), dark green or black stool (harmless). IV: Staining at IV site, hypotension, flushing
Vitamin C increases absorption. Take on empty stomach one hour before meals.
Increase fluid and fiber intake
If IM, use z-trac method
Keep out of reach of children
Increase intake of iron rich foods
B-12 - ANSWER Cyanocobalamin
Treats Megaloblastic anemia if they are lacking intrinsic factor
Folic Acid - ANSWER Given in pregnancy to prevent neural tube defects. Can also be given to alcoholics to treat poor dietary intake. Used for megaloblastic anemia when issue is too little folic acid.
Never give to someone who is lacking in B-12
Potassium - ANSWER Given for hypokalemia who are on diuretics, have prolonged vomiting or diarrhea
Watch for hyperkalemia
Never want to give a rapid infusion as it can cause fatal hyperkalemia
Magnesium - ANSWER Can increase Mg levels
IV - stops preterm labor or anticonvulsant during labor and delivery
Watch for increased Mg: muscle weakness, paralysis, respiratory depression
Calcium Gluconate
Herbal Supplements - ANSWER Black Cohosh: estrogen substitute, tx symptoms of menopause
Echinacea: Used to help stimulate immune system
***Garlic, Ginger, and Ginkgo Biloba: All start with G and increase bleeding. Antiplatelet qualities***
Glucosamine: Stimulates cells to make cartilage and synovial fluid. Can help patients with osteoarthritis
St. John's Wort: Mild depression
Saw Palmetto: Helps prostate symptoms
Valerian: increases GABA, helps anxiety
Estrogens - ANSWER Conjugated equine estrogens and estradiol
Used for contraception in combination with progesterone or PMS symptoms, post menopausal osteoporosis, dysmenorrhea, and prostate cancer
Side effects: increased risk of embolic effects: DVT, PE, MI, Stroke; risk for HTN, edema, weight gain, and estrogen dependent cancer
Contraindicated patients who smoke***, HTN, and high risk for embolic effects or estrogen dependent cancer
Progesterone - ANSWER Norethindrone
Used in birth control pills, to maintain pregnancy, and counters some adverse effects of estrogen
Side effects: increased risk of embolic events, menstrual changes, edema, increase risk of breast cancer
Patients should delay conception for three months after progesterone therapy
Contraindicated in patient who have a high risk of embolic events
Birth control - ANSWER Often estrogen and progesterone therapy
Side effects: same as estrogen and progesterone
If used properly it will prevent ovulation, thicken cervical mucous, and alter endometrial lining to reduce chance of fertilization
Androgens - ANSWER Testosterone
Used in boys with delayed puberty, hypogonadism, post-menopausal breast cancer
Side effects: acne, increased cholesterol, edema, liver dysfunction, polycythemia, premature epiphyseal closure, deepening of voice and abnormal hair growth in women
Contraindicated in prostate cancer
High abuse potential
5-Alpha reductase inhibitors - ANSWER Finasteride (Proscar)
Dutasteride (Avodart)
"Proscar looks like 'pro-car' and that guy has a 'fine ride' ... but he does have BPH.
Used to treat BPH or baldness
Prevents conversion of 5-alpha reductase which prevents conversion of testosterone
Side effects: erectile dysfunction and gynecomastia
Pregnant women and women of child bearing age should not come into contact with this medication
Alpha1- adrenergic antagonists - ANSWER Tamsulosin (Flomax) "-osin"
Used for BPH. Antagonises alpha1-adrenergic receptors in prostate and veins. Relax smooth muscle of bladder neck and prostate
Adverse effects: hypotension (relaxes veins), dizziness, nasal congestion, sleepiness, faintness, ejaculation failure
Take 30 minutes after meals or same time every day
Monitor blood pressure
Phosphodiesterase type 5 inhibitors - ANSWER Sildenafil (-afil)
"A fills up the penis"
Enhances the effects of nitric oxide released during sexual stimulation resulting in increased blood flow in corpus
Side effects: prolonged erection, increase risk of MI
Do NOT take with of nitrates! and use cautiously in men with cardiovascular disease.
Oxytocics - ANSWER Oxytocin (Pitocin)
Used to induce or enhance labor, deliver placenta, or stop postpartum hemorrhaging
Side effects: Painful contractions, uterine rupture
Closely monitor contractions: less than 60 seconds and every 2-3 minutes
Monitor maternal and fetal blood pressure and pulse
Magnesium can be used to relax the uterus.
Tocolytic medications - ANSWER Terbutaline
Used for preterm labor
Delays but does not prevent labor. Also used for COPD and asthma because to activates beta 2 adrenergic receptors in uterus and lungs.
Side effects: angina, tachycardia, restlessness, tremor
Contraindicated in gestation of 34 weeks or greater (Risk outweighs benefits) and cervical dilation greater than 6 cm.
Opioid analgesics (for pregnancy) - ANSWER Fentanyl, Butorphanol, nalbuphine
Used for severe pain during labor by decreasing pain without causing significant respiratory depression in mom or baby
Side effects: dry mouth, GI upset, sedation, hypotension, decrease fetal heartrate
Labor should be well established: cervix should be 4cm
With respiratory depression, administer naloxone
Hydroxychloroquine - ANSWER Used for malaria
Side effect: retinal damage
Advise patient to have eye exams every six months
Medications that end in -mab - ANSWER Infliximab, adalimumab
Immune suppressants for cancer or autoimmune
Infections are a huge risk
NSAIDs and prednisone can treat.... - ANSWER Rheumatoid arthritis
NSAIDs: help with pain
Prednisone: suppresses immune response
Methotrexate - ANSWER Used for rheumatoid arthritis, psoriasis, and some cancers
Inhibits folic acid production which inhibits cell reproduction which causes effects of rapidly replicating cells and has immunosuppressive properties
Side effect: INFECTION, hepatotoxicity, bone marrow suppression and GI upset
Do not give them fresh fruits or veggies, use protective precautions
Notify the provider immediately if they have signs of infection
Monitor liver labs and CBC
Cyclosporine - ANSWER Ulcerative colitis and rheumatoid arthritis, psoriasis, prevention of graft-versus-host disease in transplant patients (transplant rejection)
inhibits normal immune response by blocking interleukon-2
Side effects: infection, hepatotoxicity, nephrotoxicity, unusual hair growth
Notify provider of signs of infection, monitor renal and liver function labs.
Calcium Citrate - ANSWER Used in hypocalcemia
Ensure that patient has sufficient vitamin D - needed for absorption
Look for hypercalcemia: abdominal pain, fatigue, constipation, muscle weakness
Selective estrogen receptor modulators - ANSWER Raloxafene
Used for postmenopausal osteoporosis and reduces risk of breast cancer by binding to estrogen receptors and decreases bone reabsorption (keeps calcium inside the bone)
Side effects: increase risk of embolic events: PE, DVT, stroke, hot flashes, leg cramps
Encourage patient to increase calcium and vitamin D intake
Engage in weight bearing exercise
Monitor bone density through scans
"Raloxafene: I can 'relax' now that I am taking raloxafene for osteoporosis
Bisphosphonates - ANSWER Alendronate
Used for post-menopausal osteoporosis, Paget's disease by preventing bone reabsorption by inhibiting osteoclasts activity
Side effects: *esophagitis* GI upset, muscle pain, visual disturbances
Need to take on empty stomach in the morning with at least 8 ounces of water and you need to sit upright for 30 minutes or more.
Encourage intake of calcium and vit D
Increase weight bearing exercises
Monitor bone density via scans
Calcitonin - ANSWER Used for post-menopausal osteoporosis and hypercalcemia
Preventing bone reabsorption by inhibiting osteoclasts activity
Side effects: GI upset, nasal irritation
Encourage intake of calcium and vit D [Show Less]