Term
|
Definition
reduce the formation of fibrin two mechanisms of action: inhibit the synthesis of clotting factors and inhibit the activity of clotting factors
category: coagulation modifiers |
|
|
Term
category: coagulation modifiers classification: anticoagulant |
|
Definition
prototypes: heparin (unfractionated heparin), enoxaparin (low molecular weight heparin), warfarin, dabigatran |
|
|
Term
heparin (unfactionated heparin) pharmacokinetics |
|
Definition
route: IV onset of action: immediate peak plasma concentration: immediate half-life: 1-2 hours duration of action: dependent on infusion duration
route: subcut onset of action:20-30 min peak plasma concentration: 2-4 hours half-life: 1-2 hours duration of action: 8-12 hours |
|
|
Term
enoxaparin (low molecular weight heparin) pharmacokinetics |
|
Definition
**also known as Lovenox
route: subcut onset of action: 3-5 hours peak plasma concentration: 4-5 hours half-life: 4-5 hours duration of action: 12 hours |
|
|
Term
unfactionated heparin (heparin) indications |
|
Definition
DVT MI unstable angina atrial fibrillation mechanical heart valves post-op orthopedic procedures/immobility |
|
|
Term
unfactionated heparin (heparin) mechanism of action |
|
Definition
suppreses coagulation by inhibiting activation of thrombin and factor Xa --> inhibition of fibrin formation = inhibition of clot formation |
|
|
Term
unfactionated heparin (heparin) contraindications |
|
Definition
thrombocytopenia uncontrollable bleeding during and immediately after surgery of the eye, brain, or spinal chord |
|
|
Term
unfactionated heparin (heparin) adverse effects |
|
Definition
hemorrhage heparin-induced thrombocytopenia hypersensitivity reactions
**protamine sulfate is the antidote for OD |
|
|
Term
low molecular weight heparin (enoxaparin/lovenox) indications |
|
Definition
prevention of DVT following surgery (including knee and hip replacement) treatment of established DVT prevention of ischemic complications (including patients with unstable angina, non-Q wave MI, and STEMI) |
|
|
Term
low molecular weight heparin (enoxaparin/lovenox) mechanism of action |
|
Definition
inactivate factor Xa --> prevention of prothrombin being converted to thrombin which ultimately prevents fibrin formation and therefore clot formation |
|
|
Term
low molecular weight heparin (enoxparin/lovenox) nursing implications |
|
Definition
administered subcut dosage based on body weight costs more than unfractionated heparin does not require monitoring/can be given at home
monitor APTT - should be 1.5 - 2 times normal |
|
|
Term
low molecular weight heparin (enoxparin/lovenox) adverse effects |
|
Definition
bleeding (less than with unfractionated heparin) immune-mediated thrombocytopenia severe neurologic injury for patients undergoing spinal puncture or spinal epidural anesthesia
**protamine sulfate is the antidote OD |
|
|
Term
warfarin (coumadin) pharmacokinetics |
|
Definition
route: PO onset of acton: 24-72 hours peak plasma concentration: 4 hours half-life: 0.5-3 days duration of action: 2-5 days |
|
|
Term
warfarin (coumadin) indications |
|
Definition
not useful in emergency situations long term prophylaxis of thrombosis: - prevention of DVT and pulmonary embolism - prevention of thromboembolism in patients with prosthetic heart valves - prevention of thrombosis during atrial fibrillation |
|
|
Term
warfarin (coumadin) mechanism of action |
|
Definition
decreases production of clotting factors VII, IX, X and prothrombin inhibiting vitamin K synthesis in the intestine thereby preventing clot formation |
|
|
Term
warfarin (coumadin) adverse effects |
|
Definition
hemorrhage fetal hemorrhage and teratogenesis from use during pregnancy
**vitamin K is the antidote for OD |
|
|
Term
warfarin (coumadin) drug interactions |
|
Definition
heparin, aspirin, acetaminophen increase anticoagulant effects promote bleeding decrease anticoagulant effects |
|
|
Term
dabigatran (pradaxa) pharmacokinetics |
|
Definition
**class: anti-coagulant AND direct thrombin inhibitor
route: PO onset of action: 0.5-2 hours peak plasma concentration: 1-2 hours half-life: 12-17 hours duration of action: 12-24 hours |
|
|
Term
dabigatran (pradaxa) indications |
|
Definition
atrial fibrillation (DVT prevention after hip or knee surgery) |
|
|
Term
dabigatran (pradaxa) mechanism of action |
|
Definition
directly inhibits clotting factor II - thrombin |
|
|
Term
dabigatran (pradaxa) adverse effects |
|
Definition
bleeding hemorrhage dyspepsia nausea upper abdominal pain diarrhea |
|
|
Term
dabigatran (pradaxa) drug interactions |
|
Definition
rifampin keoconazole verapamil amiodaron quinidine clarithromycin |
|
|
Term
category: antiplatelet drugs classification: cyclooxygenase inhibitor |
|
Definition
prototype: acetylsalylic acid (aspirin)
route: PO onset of action: 15-30 min peak plasma concentration: 0.25-2 hours half-life: 2-3 hours duration of action: 4-6 hours |
|
|
Term
acetylsalylic acid (aspirin) indications |
|
Definition
antiplatelet prophylaxis for embolic events such as MI and stroke antiinflammatory analgesic antipyretic |
|
|
Term
acetylsalylic acid (aspirin) mechanism of action |
|
Definition
inhibits cyclooxygenase through acetylation in the platelet irreversibly --> loss of ability to regenerate the enzyme --> inhibition of TXA = decreased aggregation of platelets in vessels |
|
|
Term
acetylsalylic acid (aspirin) adverse effects |
|
Definition
bleeding GI bleeding and hemorrhagic stroke enteric-coated tablets may not reduce the risk of GI bleed |
|
|
Term
acetylsalylic acid (aspirin) toxicity |
|
Definition
in general watch for bleeding tendencies, tinnitus, stomach pain, thrombocytopenia
toxicity: increased temp nausea/vomiting tinnitus hyperventilation leading to respiratory alkalosis severe toxicity: metabolic acidosis seizures |
|
|
Term
category: antiplatelet drugs classification: ADP inhibitor |
|
Definition
prototype: clopidrogel (plavix)
route: PO onset of action: 1-2 hours peak plasma level: 1 hour half-life: 8 hours duration of action: 7-10 days |
|
|
Term
clopidrogel (plavix) indications |
|
Definition
decrease incidence of vascular clotting, MI, stroke, prevents stenosis of stents, and acute coronary syndrome |
|
|
Term
clopidrogel (plavix) mechanism of action |
|
Definition
inhibits platelet aggregation by irreversibly blocking ADP on platelet surface |
|
|
Term
clopidrogel (plavix) contraindications |
|
Definition
thrombocytopenia active bleeding leukemia traumatic injury GI ulcer vitamin K deficiency recent stroke |
|
|
Term
clopidrogel (plavix) what to watch for |
|
Definition
skin disorder URI flu-like symptoms abdominal pain dyspepsia diarrhea cautious use with: HTN hepatic/renal problems history of bleeding |
|
|
Term
category: antiplatelet classification: glycoprotein IIb/IIIa antagonists |
|
Definition
prototypes: tirofiban (aggrastat), eptifibatide (integrilin), abciximab (reopro)
route: IV onset of action: 1 hour peak plasma concentration: unknown half-life: 2-2.5 hours duration of action: 4 hours |
|
|
Term
tirofiban (aggrastat) indications |
|
Definition
prophylaxis of clot formation short term to prevent acute coronary syndrome |
|
|
Term
tirofiban (aggrastat) mechanism of action |
|
Definition
causes reversible blockade of platelet GPIIb/IIIa receptorts --> prevention of the final step in aggregation |
|
|
Term
category: thrombolytics classification: tissue plasminogen activator |
|
Definition
prototypes: alteplase (tPA, activase), tenectaplaxe (TNKase), streptokinase (streptase), urokinase (abbokinase)
route: IV onset of action: 30 min peak plasma concentration: 1 hour half-life: 26-50 min duration of action: dependent on infusion duration |
|
|
Term
|
Definition
MI DVT pulmonary emboli "clot busters" |
|
|
Term
thrombolytic mechanism of action |
|
Definition
promote conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi --> increase profusion and decrease viscosity and aggregation of RBCs
**give 2-6 hours after MI and 4.5 hours after a stroke |
|
|
Term
thrombolytic what to look for |
|
Definition
allergic reactions spontaneous bleeding oozing from any fresh wound site |
|
|
Term
heparin nursing implications |
|
Definition
doses usually double checked with another RN do not give subcut doses within two inches of umbilicus, abdominal incisions, or unhealed wounds do not aspirate subcut injections do not massage subcut injection sites anticoagulant effects seen immediately labs are done daily to monitor coagulation effects (APTT) protamine sulfate can be given as an antidote in case of excessive anticoagulation |
|
|
Term
warfarin nursing implications |
|
Definition
may be started while the patient is still on heparin until PT times indicate adequate coagulation full therapeutic effect takes several days monitor PT and PT-INR regularly antidote is vitamin K many herbal products such as capsicum pepper, garlic, ginger, ginko, ginseng, and feverfew may have potential interactions (increased bleeding) avoid eating foods high in vitamin K (green leafy veggies, avocado, kiwi, grapes, tomatoes, bananas, fish)
INR should be 2-3 |
|
|
Term
antiplatelet drugs nursing implications |
|
Definition
nicotine causes vasoconstrictions, which alters the effectiveness of antiplatetlet agents drug-drug interactions adverse reactions to report monitor for abnormal bleeding |
|
|
Term
thrombolytic agent nursing implications |
|
Definition
follow strict manufacturer guidelines for preparation and administration monitor IV sites for bleeding, redness, and pain monitor for bleeding from gums, mucous membranes, and nose observe for signs of internal bleeding (decreased BP, restlessness, increased pain) |
|
|
Term
patient education for anticoagulants |
|
Definition
should include: importance of regular lab testing signs of abnormal bleeding measures to prevent bruising, bleeding, or tissue injury wearing a medical alert bracelet avoiding foods high in vitamin K (tomatoes, dark leafy greens, bananas, fish) consulting physician before taking other meds or OTC products/herblas |
|
|
Term
category: hematopoetic growth factors classification: antianemic |
|
Definition
prototype: epoetin alfa (procrit, epogen) |
|
|
Term
epoetin alfa (procrit, epogen) indications HIV-infect patients taking zidovudine
chemo-inuced anemia patients facing surgery **basically just anemia |
|
Definition
anemia secondary to chronic renal failure |
|
|
Term
epoetin alfa (procrit, epogen) mechanism of action |
|
Definition
stimulates the production of RBCs in the bone marrow of severely anemic patients |
|
|
Term
category: hematopoetic growth factors classification: granulocyte stimulating colony factor |
|
Definition
prototypes: filgrastim (neupogen) and pepfilgrastim (neulasta) |
|
|
Term
prefilgrastim (neupagen) indications |
|
Definition
neutropenia reduces the incidence of infection need for hospitalization need for intravenous antibiotics |
|
|
Term
prefilgrastim (neupagen) mechanism of action |
|
Definition
stimulates myeloid cells to increase production of neutrophils produces dose-dependent increase in circulating neutrophils |
|
|
Term
filgrastim (neupogen) indications |
|
Definition
reduces the incidence of severe neutropenia produces dose-dependent increases in circulating neutrophils reduces the incidence of infection, need for hospitalization, and need for intravenous antibiotics |
|
|
Term
filgrastim (neupogen) mechanism of action |
|
Definition
colony-stimulating factor leukopoietic growth factor --> used for recombinant DNA technology |
|
|
Term
filgrastim (neupogen) adverse effects |
|
Definition
bone pain leukocytosis edema --> contraindicated in patients with heart failure cough dyspnea sore throat anorexia N/V diarrhea alopecia rash at injection site fever headache |
|
|
Term
category: hematopoietic growth factor classification: granulocyte-macrophage colony stimulating factor |
|
Definition
prototype: sargramostim (leukine) |
|
|
Term
sargramostin (leukine) indications |
|
Definition
adjunct to autologous bone marrow transplantation treatment of failed bone marrow transplants patients with a cute myelogenous leukemia (AML) |
|
|
Term
sargramostin (leukine) mechanism of action |
|
Definition
acts on bone marrow to increase production of neutrophils, monocytes, and eosinophils acts on mature cells to enhance their actions |
|
|
Term
sargramostin (leukine) adverse effects |
|
Definition
diarrhea weakness malaise bone pain leukocytosis thrombocytosis |
|
|
Term
category: hematopoietic growth factor classification: thrombopoietic growth factor |
|
Definition
prototype: oprelvekin (interleukin-11) |
|
|
Term
oprelvekin (interleukin-11) indications |
|
Definition
myelosuprresive chemotherapy prevent platelet transfusions |
|
|
Term
oprelvekin (interleukin-11) mechanism of action |
|
Definition
stimulates platelet proginator cells to increase platelet production |
|
|
Term
oprelvekin (interleukin-11) adverse effects |
|
Definition
fluid retention (contraindicated in patients with heart failure) cardiac dysrhytmias conjuctival infections visual blurring papilledema |
|
|
Term
hematopoietic growth factor CAUTION |
|
Definition
epoetin alfa, filgrastim, sargramostim, and oprelvekin stimulate proliferation of bone marrow cells
****use with great caution, if at all, for patients with cancer of bone marrow origin |
|
|
Term
category: analgesic classification: opioid |
|
Definition
prototypes: codeine sulfate, fentanyl citrate, morphine sulfate, morphine sulfate continuous release (MS contin), oxycodone, oxycodone CR (oxycontin), meperidine HCl (demerol), methadone HCl (dolophine) |
|
|
Term
opioid analgesia indications |
|
Definition
to alleviate moderate to severe pain |
|
|
Term
opioid analgesia mechanism of action |
|
Definition
mimicks actions of endogenous opioid peptides primarily at the Mu1 opiod sites |
|
|
Term
opioid analgesia contraindications |
|
Definition
known drug allergy severe asthma or other respirator insufficiency increased intracranial pressure pregnancy |
|
|
Term
opioid analgesia adverse effects |
|
Definition
euphoria CNS depression pupil constriction (miosis) diaphoresis flushing bradycarida hypotension respiratory distress nausea vomiting constipation urinary retention itching wheal formation |
|
|
Term
category: opiate antagonists classification: opiates |
|
Definition
prototypes: naloxone (narcan) and naltrexone (revia) --> narcan is the drug of choice |
|
|
Term
|
Definition
used for complete or partial reversal of opiod-induced respiratory depression |
|
|
Term
opiate mechanism of action |
|
Definition
bind to opiate receptors and prevent a response |
|
|
Term
|
Definition
tolerance physical dependence psychological dependence |
|
|
Term
opiate physical dependence |
|
Definition
seen when the opioid is abruptly discontinued or when an opiod antagonist is administered
narcotic withdrawal/opioid abstinence syndrome |
|
|
Term
narcotic withdrawal/opioid abstinence syndrome |
|
Definition
manifested as: anxiety irritability chills/hot flashes joint pain lacrimation rhinorrhea diaphoresis nausea vomiting abdominal cramps diarrhea |
|
|
Term
category: analgesias classification: non-opiod |
|
Definition
prototype: acetaminophen (tylenol) |
|
|
Term
non-opioid analgesia indications |
|
Definition
mild to moderate pain fever alternative for those who cannot take aspirin products |
|
|
Term
|
Definition
blocks pain impulses peripherally by inhibiting prostaglandin synthesis |
|
|
Term
|
Definition
available OTC, but lethal when overdosed overdose, whether intentional or due to chronic unintentional misuse, causes hepatic necrosis long-term ingestion of large doses also causes nephtropathy
**acetylcysteine is the recommended antidote |
|
|
Term
acetaminophen interactions |
|
Definition
dangerous interactions may occur if taken with alcohol should not be taken in the presence of: liver dysfunction possible liver failure when taking other hepatotoxic drugs |
|
|
Term
analgesic nursing implications |
|
Definition
perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and alleviating factors, type, remedies, and other pain treatments be sure to medicate patients before the pain becomes severe as to provide adequate analgesia and pain control pain management includes pharmacologic and non-pharmacologic approaches instruct patients to notify physician for signs of allergic reaction or adverse effects |
|
|
Term
opiod analgesic nursing implications |
|
Definition
withhold dose and contact physician if there is a decline in the patients condition of if VS are abnormal, especially if RR is < 12 breaths/min check dosages carefully --> follow proper administration guidelines for IM injections and follow guidelines for IV administration, including dilution, rate of administration, etc. constipation is a common side effect and may be prevented with adequate fluid and fiber intake instruct patients to follow directions for administration carefully, and to keep a record of their pain experience and response to treatments patients should be instructed to change positions slowly to prevent possible orthostatic hypotension |
|
|
Term
monitoring for analgesic adverse effects |
|
Definition
should VS change, patient's condition decline, or pain continue contact physician immediately respiratory depression may be manifested by RR of < 12 breaths/min, dyspnea, diminished breath sounds, or shallow breathing |
|
|
Term
monitoring for analgesic therapeutic effects |
|
Definition
decreased complaints of pain decreased severity of pain increased periods of comfort improved ADLs, appetite, and sense of well-being decreased fever (acetaminophen) |
|
|
Term
category: cyclooxygenase inhibitors classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)
FIRST GENERATION |
|
Definition
propionic acid derivatives: ibuprofen (advil, motrin), naproxen (naprosyn), naproxen plus lansoprazole, indomethacin (indocin), ketorolac (tordol), ketoprofen (oruvail)
others on ppt...a lot of fucking NSAIDS! |
|
|
Term
category: cyclooxygenase inhibitors classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)
SECOND GENERATION |
|
Definition
prototype: celecoxib (celebrex) |
|
|
Term
celecoxib (celebrex) indications |
|
Definition
osteoarthritis rheumatoid arthritis acute pain dysmenorrhea familial adenomatous polyposis |
|
|
Term
celecoxib (celebrex) mechanism of action |
|
Definition
reversible inhibition of the leukotriene or prostaglandin pathway or both more specifically blocks the action of cyclooxygenase II |
|
|
Term
celecoxib (celebrex) adverse effects |
|
Definition
moderate to severe noncardiogenic pulmonary edema FDA warning: may increase risk of thromboembolic event including MI and stroke (increased for patients who already have CVD and other risk factors) gastric ulceration bleeding renal impairment |
|
|
Term
celecoxib (celebrex) drug interactions |
|
Definition
warfarin may decrease diuretic effect of furosemide may decrease anti-hypertensive effect of ACE inhibitors may increase levels of lithium levels of celecoxib may be increased by fluconazole |
|
|
Term
category: insulin classification: rapid action |
|
Definition
prototypes: insulin lispro (humalog), insulin aspart (novolog), insuline glulisine (apidra) |
|
|
Term
category: insulin classification: short acting |
|
Definition
prototypes: regular insulin (humalin R, novolin R) |
|
|
Term
category: insulin classification: intermediate |
|
Definition
prototypes: neutral protamines hagedorn aka NPH (humalin N, novolin N) |
|
|
Term
category: insulin classification: long acting |
|
Definition
prototypes: insulin detemir (levemir) and insulin glargine (lantus) |
|
|
Term
|
Definition
principal: diabetes mellitus required by all type I and some type II patients IV insulin for DKA hyperkalemia: can promote uptake of potassium aids in the diagnosis of GH deficiency |
|
|
Term
insulin mechanism of action |
|
Definition
restores body's ability to metabolize carbohydrates, fats, and proteints --> to store glucose in the liver and to convert glycogen to fat stores |
|
|
Term
|
Definition
subcut injections: syringe and needle pen injectors jet injectors
inhalation: exubera --> withdrawn in 2007
subcut infusion: portable insulin pumps implanted insulin pumps
IV infusion |
|
|
Term
|
Definition
unopened vials should be stored in refrigeration until needed should not be frozen can be used until expiration date if kept in refrigerator after opening, can be kept up to one month without significant loss of activity keep out of direct sunlight and extreme heat mixtures of insulin in vials are stable for one month at room temperature and three months in refrigeration mixtures in prefilled syringes should be stored in refrigeration for up to one week and should be stored vertically with needle pointing up |
|
|
Term
complications of insulin therapy |
|
Definition
hypoglycemia lipodystophies allergic reactions hypokalemia drug interaction: hypoglycemic agents hyperglycemic agents beta andrenergic blocking agents |
|
|
Term
category: oral antidiabetic agents classification: sulfonylureas |
|
Definition
prototypes: chlorpropamide (diabinese), tolazamaide (tolinase), tolbutamide (orinase), glimepiride (amaryl), glipizide (glucotrol), glyburide (diabeta) |
|
|
Term
sulfonylureas indications |
|
Definition
type II diabetes - non insulin dependent |
|
|
Term
sulfonylureas mechanism of action |
|
Definition
stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels |
|
|
Term
sulfonylureas what to watch for |
|
Definition
epigastric fullness, diarrhea, hypoglycemia, heartburn, pruritus
**do not use when pregnant |
|
|
Term
category: oral antidiabetic drugs classification: biguanides |
|
Definition
prototype: metformin (glucophage) |
|
|
Term
|
Definition
type II diabetes - non insulin dependent |
|
|
Term
biguanides mechanism of action |
|
Definition
decrease production of glucose increase uptake of glucose by tissues do not increase insulin secretion from the pancreas |
|
|
Term
category: oral antidiabetic agents classification: meglitinides |
|
Definition
prototype: repaglinide (prandin) |
|
|
Term
|
Definition
|
|
Term
meglitinides mechanism of action |
|
Definition
similar to sulfonylureas --> stimulate insulin secretion from pancrease good choice for patients with erratic eating habits |
|
|
Term
category: oral antidiabetic drugs classification: alpha-glucosidase inhibitors |
|
Definition
prototypes: acarbose (precose) and miglitol (glyset) |
|
|
Term
alpha-glucosidase inhibitors indications |
|
Definition
|
|
Term
alpha-glucosidase inhibitors mechanism of action |
|
Definition
reversibly inhibit the enzyme alpha-glucosidase in the small intestinge --> delayed absorption of glucose must be taken with meals to prevent excessive postprandial blood glucose elevations |
|
|
Term
category: oral antidiabetic drugs classification: thiazolidinediones |
|
Definition
prototypes: pioglitazone (actos) and rosiglitazone (avandia)
**sept. 23, 2010 - avandia restricted by FDA due to heart risk |
|
|
Term
thiazolidinediones indications |
|
Definition
|
|
Term
thiazolidinediones mechanism of action |
|
Definition
decrease insulin resistance (insulin sensitizing agents) increase glucose uptake and use in skeletal muscles inhibit glucose and triglyceride production in the liver |
|
|
Term
sulfonylureas adverse effects |
|
Definition
hypoglycemia hematologic effects nausea epigastric fullness |
|
|
Term
biguanides adverse effects |
|
Definition
abdominal bloating nausea cramping diarrhea metallic taste reduced vitamin B12 levels |
|
|
Term
alpha-glucosidase inhibitors adverse effects |
|
Definition
flatulence diarrhea abdominal pain |
|
|
Term
thiazolidinediones adverse effects |
|
Definition
moderate weight gain edema mild anemia hepatic toxicity |
|
|
Term
category: oral antidiabetic drugs classification: incretin memetics |
|
Definition
prototype: sitagliptin (januvia) |
|
|
Term
incretin memetics indications |
|
Definition
|
|
Term
incretin memetics mechanism of action |
|
Definition
enhances the actions of incretin hormones stimulates glucose dependent release of insulin suppresses postprandial release of glucagon |
|
|
Term
incretin memetics adverse effects |
|
Definition
headache, URI inflammation (throat and nasal passages) |
|
|
Term
|
Definition
preferred treatment is IV glucose --> immediately raises blood glucose level glucagon can be used if IV glucose isn't available --> delayed elevation of blood glucose; will not work in starvation (promotes glycogen breakdown and the malnourished have little glycogen left) |
|
|
Term
insulin nursing implications |
|
Definition
when insulin is ordered ensure correct route, correct type of insulin, timing of dose, correct dosage insulin order and prepared dosages are second-checked with another RN check blood glucose before administration ensure correct timing of insulin dose with meals when drawing up two types of insulin in one syringe, always withdraw the regular insulin first provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucoses, and injection site rotations |
|
|
Term
oral antidiabetic drugs nursing implications |
|
Definition
always check blood glucose levels before giving usually given 30 min before meals alpha-glucosidase inhibitors are given with the first bite of each main meal biguanides are taken with meals to reduce GI effects monitor for therapeutic response assess for signs of hypoglycemia
if hypoglycemia occurs: give glucagon have the patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink have the patient eat a small snack such as crackers or half a sandwhich monitor blood glucose levels |
|
|
Term
category: thyroid replacement classification: thyroid hormone |
|
Definition
prototypes: levothyroxine (syntrhoid, levoxyl), liothyronine (cytomel), liotrix (thyrolar), thyroid |
|
|
Term
thyroid hormone indications |
|
Definition
hypothyroidism dx hyperthyroidism prevention of goiters |
|
|
Term
thyroid hormone mechanism of action |
|
Definition
thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid)
**thyroid drugs work the same as thyroid hormones |
|
|
Term
thyroid hormone contraindications |
|
Definition
known drug allergy recent MI adrenal insufficiency hyperthyroidism |
|
|
Term
thyroid hormone adverse effects |
|
Definition
insomnia, headache, anxiety, tremors, cardiac dysrhythmias, angina, hypertension, palpitations, nausea, diarrhea, weight loss, menstrual irregularities, heat intolerance |
|
|
Term
thyroid hormone interactions |
|
Definition
oral anticoagulants digitalis glycosides cholestyramine patients with diabetes may need to increase their doses of hypoglycemic agents |
|
|
Term
category: antithyroid classification: thionamides |
|
Definition
prototypes: methimazole (tapazole) and propylthiouracil (PTU) |
|
|
Term
category: antithyroid classifications: radioactive iodine |
|
Definition
prototype: iodine-131 (iodotope) |
|
|
Term
|
Definition
hyperthyroidism graves disease |
|
|
Term
iodine-131 mechanism of action |
|
Definition
emits beta particles which destroy the thyroid tissue |
|
|
Term
|
Definition
blocks action of thyroid synthesis by preventing oxidation of iodine, thereby inhibiting incorporation of iodine into tyrosine and by preventing the coupling of tyrosines and suppresses the conversion of T4 to T3, the active form of thyroid hormone |
|
|
Term
methimazole mechanism of action |
|
Definition
|
|
Term
thyroid agent nursing implications --> patient teaching |
|
Definition
take thyroid agents once daily in the morning to decrease the likelihood of insomnia take the medication at the same time every day don't switch brands without MD approval report any unusual symptoms, chest pain or heart palpitations, therapeutic effects may take several months to occur too high of a dose of a thyroid agent will result in nervousness, irritability, and insomnia |
|
|
Term
antithyroid nursing implications |
|
Definition
better tolerate when given with food give at the same time each day to maintain consistent blood levels never stop these medications abruptly avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt) |
|
|
Term
thyroid agent nursing implications |
|
Definition
monitor for therapeutic response monitor for adverse effects s/s of thyroid hormone OD include cold intolerance, depression, and edema |
|
|
Term
antiepileptic agents goals |
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Definition
to control or prevent seizures while maintaining a reasonable quality of life to minimize side effects and drug induced toxicity
**therapy is usually lifelong |
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Term
antiepileptic agents indications |
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Definition
prevention or control of seizure activity long-term maintenance therapy for chronic, recurring seizures acute treatment of convulsions and status epilepticus |
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Term
classification of antiepileptic agents |
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Definition
traditional AEDs: phenytoin, carbamazepine, valproic acid, primidone, and ethosuximide
newer AEDs: oxcarbazepine, gabapentin, zonisamide, lamotriginr, levetiracetam, pregablin, tigabine, topiramate |
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Term
antiepileptic agent safety |
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Definition
very narrow therapeutic index toxic levels can be reached quickly monitor therapeutic drug levels with phenobarbital, phyenytoin, carbamazepine, valproic acid |
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Term
category: antiepileptic agents classification: anticonvulsant barbituates |
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Definition
prototypes: phenobarbital (solfoton, luminal) and primidone (mysoline) |
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Term
anticonvulsant barbituates indications |
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Definition
prevention of seizures control of seizures seizure types used for: partial seizures secondary general generalized tonic clonic |
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Term
anticonvulsant barbituates mechanism of action |
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Definition
potentiates the activities of GABA --> increased response to GABA |
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Term
anticonvulsant barbituates adverse effects |
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Definition
drowsiness, dizziness, lethargy, paradoxical restlessness, excitement, nausea, vomiting, rash, stevens-johnson syndrome, urticaria |
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Term
category: antiepileptic agents classification: valproate |
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Definition
prototypes: divalproex sodium (depakote), valproate sodium (depacon), vaproic acid (depakene) |
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Term
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Definition
partial and secondary generalized seizures bipolar disorder migraines |
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Term
valproate mechanism of action |
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Definition
suppression of high frequency neuronal firing through blockade of sodium channels --> cell membrane stabilization suppreses Ca+ influx into neural cell --> cell membrane stabilization augments inhibitory action of GABA |
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Term
valproate adverse effects |
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Definition
pancreatitis, irregular menses, secondary amenorrhea, weight gain, galactorrhea
**rarely breast enlargement...not exactly "adverse" to get tig ole' bitties |
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Term
category: antiepileptic agents classification: hydantoins |
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Definition
prototypes: phenytoin (dilantin) and fosphenytoin (cerebyx) |
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Term
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Definition
partial seizures tonic clonic seizures |
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Term
hydantoins mechanism of action |
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Definition
selective inhibition of Na+ channels --> suppression of action potentials and decreased irritability of neuron --> decreased firing |
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Term
hydantoins adverse effects |
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Definition
dysrhytmias, hypotension, exfoliative dermatitis, lupus, stevens-johnson syndrome, bone marrow suppression, neuropathies, gingival hyperplasia |
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Term
category: antiepileptic agents classification: newer AEDs |
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Definition
prototypes: gabapentin (neurontin) and pregabalin (lyrica) |
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Term
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Definition
partial seizures neuropathic pain |
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Term
newer AEDs mechanism of action |
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Definition
chemical analog of GABA inhibits neuronal action |
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Term
newer AEDs adverse effects |
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Definition
dizziness, somnolence, visual changes, fatigue, nausea, vomiting |
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Term
category: antiepileptic classification: imostilbenes |
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Definition
prototypes: carbamezapine (tegretol) and oxcarbazepine (tripeptal) |
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Term
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Definition
partial seizures generalized tonic clonic seizures |
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Term
imostilbenes mechanism of action |
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Definition
blocks voltage sensitive Na+ channels --> stabilization of hyperactive neuronal cell membranes |
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Term
imostilbenes adverse effects |
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Definition
visual disturbances, nystagmus, blurred vision, ataxia, vertigo, headache, leukopenia, anemia, thrombocytopenia, rash, stevens-johnson syndrome, toxic epidermal necrolysis, audoinducer of hepatic enzymes |
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Term
category: antiepileptic agents classification: succinimide |
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Definition
prototype: ethosuximide (zarontin) |
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Term
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Definition
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Term
succinimide mechanism of action |
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Definition
suppression of thalamus hyperexcited neurons by suppression of Ca+ channels --> stabilization of neuronal cell membrane |
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Term
succinimide adverse effects |
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Definition
drowsiness, dizziness, lethargy, nausea, vomitting |
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Term
succinimide adverse effects |
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Definition
drowsiness, dizziness, lethargy, nausea, vomiting |
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Term
succinimide adverse effects |
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Definition
drowsiness, dizziness, lethargy, nausea, vomiting |
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Term
AED nursing implications - assessment |
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Definition
health history, including current medications drug allergies liver function studies, CBC baseline vital assessments |
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Term
AED nursing implications - oral agents |
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Definition
take regularly, same time each day take with meals to reduce GI upset do not crush, chew, open extended-release forms |
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Term
AED nursing implications - IV forms |
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Definition
follow manufacturer's recommendations for IV delivery - usually given slowly monitor VS during administration avoid extravasation of fluids use only normal saline with IV phenytoin (know this!!) |
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Term
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Definition
should not be discontinued abruptly driving may be impaired until drug levels stabilize patients need to know that therapy is long term, and possibly lifelong - not a cure |
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Term
AED nursing implications - monitoring for therapeutic response |
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Definition
seizure activity is decreased or absent |
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Term
AED nursing implications - monitoring for adverse effects |
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Definition
change in mental status, mood, LOC, or sensorium eye problems, visual disorders sore throat fever blood dyscrasias may occur with hydantoins |
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Term
AED nursing implications - pregnancy |
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Definition
teratogenesis: hydantoins carbamazepines
birth defects: valproates phenobarbital oxcarbamazepine gabapentin/pregabalin |
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Term
hydantoins drug interactions |
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Definition
hepatic enzyme inducer --> decrease in therapeutic effect of other drugs increase/decrease levels of phenytoin CNS depression |
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Term
carbamazepine drug interactions |
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Definition
hepatic enzyme inducer grapefruit juice |
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Term
valproate drug interactions |
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Definition
phenobarbital phenytoin topiramate |
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Term
phenobarbital drug interactions |
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Definition
hepatic enzyme inducer CNS depression valproates |
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Term
newer AED drug interactions |
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Definition
oxcarbazepine (trileptal) --> oral contraceptives gabapentin (neurontin) pregablin (lyrica) |
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Term
dabigatrin (pradaxa) nursing implications |
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Definition
makes the stomach acidic
monitor people with GERD
can't be taken with a meal
very expensive...but don't have to monitor as much
expires 30 days after opening
not for patients over 75 |
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Term
epoetin alfa adverse effects |
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Definition
headache, insomnia, edema, MI, stroke, heart failure, joint/muscle aches, pains, soreness, nausea, vomiting, diarrhea, stomach pain constipation indigestion, blindness |
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Term
epoetin alfa contraindications |
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Definition
any history of heart problems cautious use in patients with bone marrow cancer monitor Hgb twice a week --> should not exceed 12 |
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