functions of calcium in the body

• bone growth
• cardiac & vascular tone
• blood coagulation
• regulates:
  • nerves
  • muscles
  • glands

normal calcium intake & level

• 1500mg/day(3 glasses of milk) 
• 9-11 mg/dl

will need extra calcium if:

• on bedrest
• have osteoporosis
• hypocalcemic

Vit D given with what to increase absorption

• given with Ca & phosphorus

Active form of vit d3

• need cholesterol to convert D2toD3
• cholecalciferol- from cholesterol
• calcifeol
• calcitriol

facts about vit. d

• vit. d3 more absorpable
• need 15/min/day of sunlight
• dark skinned need 30-45 min/day

ASA-names for

• asprin
• acetylsalicylic acid
• salicylate

action of ASA

• inhibits Cox 1 & 2
• antipyretic
• analgesic
• anti-inflammatory
• anti-coagulant
• NSAID

anti-pyretic

Cox 1

• protective enzyme 4 blood vessels, kidneys, stomach.

cox 2

• anti-inflammatory enzyme assoc. w/pain

ASA dosages ( pain & antiflammatory)

• 81-650 mg po q4h prn

ASA dosage for anticoagulant

• 81-325mg once a day(no more)

ASA dosage for analgesic/antipyretic

• 650-1000mg q6-8h

limit for ASA& tylanol

• 4grams or 4000mg daily limit

drug preperatins for ASA

• buffered ASA- wont eat stomach
• alka-seltzer
• ecotrin-enteric coated
• dolobid/diflunisal
• anacin- asprin +caffine
• exedrin-aspirin+acetaminophen+caffeine
• plavix

enteric coated

• waits to break down in small intestines- not stomach

Adverse effects of ASA

• reyes syndrome-under 15
• GI upset
• CNS deppresant
• toxicity
  • early- n,v,tinnitus (ringing in ears)
  • late_ hemmorrage, coma, death

contraindications for ASA use

• Never give to children(cause reyes syndrome)
• caution ETOH use: decrease liver function
• caution on anticoagulants: blood can thing too much

reyes syndrome

• fatty infiltrates of liver
• encepholopathy
• 80% mortlity
• Give tylanol or motrin to kids NOT ASA

guidlines for ASA

• dont use antacid sooner thatn 1-2 hrs after enteric coated ASA
• give with full glass of h2o
• stop 1-3 wks  (at least 7 days)prior to surgery

zantak

• antagonist of side effects of ASA

What are some drug preperations for calcium

• calcium gluconate
• "        " citrate
• "        " chloride
• "        " carbonate (tums)
• fosamax
• miacalcin (calcitonin)

what is fosamax

• Alendronate sodium
• bisphosphonate,regulator of bone metabolism

what does fosamax do?

• inhibits reabsorption >minimize loss of bone density
• can reverse osteoporosis
• taken po

NSAIDS

• Non ASA Nonsteroidal anti-inflammatory medications
• works at muscular level

action of NSAIDS

• analgesic
• anti-pyretic
• anti-inflammatory
• short acting platlet aggregation
• on lasts about 24 hrs

adverse effects of NSAIDS

• GI upset
• CNS effects-dizziness,drowsiness,lethargy,tinnitus,vision changes
• allergic reaction-anaphylaxis
• blood dyscrasias-how blood cells operate
• renal damage-nephrotoxicity

Drug preperations for NSAIDS

• Ibpofen( motrin, advil, nuprin) 200-400q4-6h
• naproxen( naprosyn, aleve) <1000mg/day
• oxaprozin (daypro)
• indomethacin( indocin)
• ketorolac (toradol) use < 5 days
• nabumetone(relafen)

nrsng implications w/ NSAIDS

• take w meals/food
• monitor clottin/renal function

Acetaminophen

• tylenol
• non-salicylate/narcotic analgesic&anti-pyretic
• inhibit synthesis of prostaglandins that mediate pain/fever
• Not anti-inflammatory or anti-aggregate
• Non- NSAID-

usual dose of ancetaminophen

• 325-650mg q 4h
• limit: 4 grams/day

Side effects of acetominophen

• early OD: anorexia, NV
• Later: liver failure, encephalopathy, coma, death
• hepatoxicity w/ ETOH abuse
• 45 xtra strength will cause death

what is colchincine

• used to treat gout
• given for several weeks to prevent attacks
• given w/ @ least 2000cc/h2o/day to maintain kidney function

what does cochincine do?

• some anti-coagulant effects
• relieves jnt. pain & edema
• anti-inflammatory
• NO effect of uric acid

what meds are used to treat RA?

• plaquenil sulfate
• gold sodium thiomalate
• methotrexate
• auranofin
• aurothioglucose
• azathioprine
• leflunomide
• penicillamine
• sulfasalazine

what is plaquenil

• also hydroxychloroquine 
• anti-malarial
• very toxic-retinopathy blindness

what does plaquenil do?

• slow acting for RA
• used
  • in confirmed RA only
  •  to reduce remission
  •  for limited time-only for 6 mo

Gold sodium thiomalate

• Anti-inlammatory, anti-arthritic
• injectected directly into jnt-lay down 10-15 min after admn.
• immune suppressing
• lasts weeks to months

methotrexate

• reduces jnt swelling
• used when unresponsive to other therapy-last resort
• very toxic- side effects=death

what is imuran & what its used for

• also Azathioprine, azasan
• immuno suppresant, anti-inflammatory
• treatment of RA

what is gout

• uric acid crystal deposits in jnts.
• once you have -- have it 4 ever
• from over production of purines

Drug treatment for gout

• allopurinol
• colchincine
• probencid

allopurinol

• also zyloprim
• increases urinary excretino of uric acid
• prevents attacks of gout
• often given with cochicine

probenecid

• also benemid
• increases renal excretion of uric acid
• prevents hyperuricemia
• maintnance drug-helps w/flairups

 drug therapies for oseteoporosis

• Ca & vit. d
• Estrogen replacement therapy
• "          " receptor modulators
• statins
• slow release sodium fluoride
• biphosphonates
• calcitonin

side effects to biphosphonates

• abdn. pain, NV, esophageal irritation

medications for acne

• benzoyl peroxide
• tretinoin( retin-A)-for really bad
• ethinyl estradiol(estinyl)
• isotretinoin/13-cis-retonic acid (accutane)
• tertracylcine HCI

topical antibiotics for acne

• tretinoin (Retin-A)
• adapalene(Differin)
• azelaic acid( Alzelex)
• sulfacetamide sodium(AK-Sulf, Cetamide)

Somatic pain

• Originates from skeletal muscles
• responds to NSAIDS

Visceral pain

• Originates from organs or smooth muscle
• responds to opiates

Superficial pain

• skin or mucus membranes
• respond to opiates

Opiates

• also Opioid or narcotic
• analgesic
• Cns depressant
• 3 for clinical use
  • morphine
  • codeine
  • papaverine

 agonist

• binds to receptor site
• causes response

antagonist

• binds to receptor site & prevents response

nociceptive drugs

• somatic and visceral nervous systen

neuropathic

• Non-nocicptive
• central & peripheral nervous system

chemical classification of opioids

• Mophine like drugs
• meperidine like drugs
• methadone like drugs

 morphine like drugs

• morphine
• heroin
• hydromorphone
• codiene
• oxycodone

meperidine like drugs

• meperidine
• fentenyl
• sufentenyl

methadone like drugs

• methadone
• propoxyphene

Desirable effects of opioids

• releive moderate to severe pain

Undesireable effects of opioids

• Bradycardia
• blood pressure
• anorexia
• constipation
• RESPIRATORY DISTRESS

what are nursing assessments goint to include for  pain

• pain is whatever client says it is
• evaluate VS be 4 & after medicating

Nursing responsibilities for opioids

• VS b4 and after medicating
• medicate be-4 pain is intense
• monitor response to narcotic: CNS depression

Antagonist of opioid

• Narcan (Nalaxone)
• A pure opioid>displace narcotic @ receptor site
• do not need dr. order
• will bring out of respiratory depression

renal labs include

• BUN (blood urea nitrogen)
• creatine levels
• will be elevated if going into renal failure

Morphine

• Narcotic agonist
• used for sever pain

dosage and route of morphine

• 5-20mg
• sq,po,im,PCA

MSO₄

Codeine

• Narcotic agonist
• cough suppressant (antitussive)
• Mayjor side effect _ constipation

Usual dose & route

• 15-60 mg
• given PO,SQ,IM

Hydromorphone

• also dilaudid
• synthetic narcotic agonist
• for severe pain (7-10x stronger than morphine)

usual dose & routefor dilaudid(hydromorphone)

• 2-4 mg
• PO,SQ,IM,IV

Meperidine

• Also demerol
• synthetic narcotic agonist
• less potent than morphine

Usual dose & route for meperidine

• 50-150 mg
• PO,SQ,IM

 Methadone

• Synthetic narcotic agonist
• used mainly for detoxification of heroin addicts
• also for sever pain

Normal dose & route for methadone

• 2.5-10mg
• PO,SQ,IM

Oxycodone

• Narcotic agonist-similar in strength to morphine
• mod-severe pain

 Usual dose & route of oxycodone

• 1-2 tabs
• PO

OXYCODONE preperations

• Percodan
• tylox
• percocet
• vicodin

Narcotic potentiators

• Non-narcotic analgesics & other meds
• promote the effectiveness of opioids

Some narcotic potentiators

• NSAIDS
• antihistamines

ranking for pain meds

1. Hydromorophone: strongest: severe pain
2. Methadone, morphine
3. meperdine, oxycodone
4. codiene

Sedatives

• reduce anxiety w/o causing sleep
• cns depressent
• shouldnt use longer than 14 days

Hypnotic

• Low doses- calm & sooth CNS
• High doses cause sleep

Barbituates

• cns depressant
• sedative & hypnotic
• reduce nerve impulses traveling to cerebral cortex

uses for barbituates

• anesthetic for short procedures
• anesthesia induction
• anticonvulsant

side effects of barbituates

• drowsiness, lethargy
• interruption of sleep patterns
• lasts 2-4 hrs.

Barbituate preperations

• Phenobarbital
• pentobarbital(nembutal)
• secobarbital(seconal)
• sodium pentathol ( truth serum)

benzodiazepines

• most frequent prescrived sedative-hypnotic
• different chemically than barbituates

valium

• benzodiazepine
• covered with psychotheraputic drugs
• must ween off- or will go into cardiac arrest

benzodiazepine preperations

• dalamage
• restoril
• halicion
• ambien

action of benzodiazepines

• CNS depressent
• specifically thalamic/hypothalamic systems
• dont inhibit rem sleep

side effects of benzodiazepines

• heavily sedating
• may interfere with normal sleep
• addictive
• headache,dizziness, vertigo
• NV

Antagonist of benzodiazepine

• flumazenil- romazicon
• has caused many deaths

vistaril

• also hydroxyzine
• antihistamine-antipruretic
• used for mainly antianxiety & sedative

tylenol # 3

• combination drug
• narcotic analgesic
•  300mg acetaminophen mixed W/ 60 mg codiene

Benadryl

• also diphenhydramine
• antahistamine
•  h1-receptor blocker

what does benadryl do

• treats symptoms of allergies & the common cold.
• treats rashes

zyloprim

• also allopurinol
• antigout agent

what does zyloprim do?

• lowers urinary uric acid levels
• prevents hyper uricemia

probenecid

• also benemid, benuryl
• anti gout agent, uricosuric agent

what does probenecid do?

• prevents uric acid buildup
• also added to penecillan to increase & prolong the serum concentration.

silvadene

• also silver sulfadiazine
• topical anti-infective, anti-fungal

what does silvadene do

• broad anti-microbial activity for bacteria/yeast\
• prevention & treatment of spesis in burns

darvocet

• narcotic analgesic
• combonation of propoxyphene napsylate & acetaminophen

neosporin

•  antibiotic
• combination of neomyacin sulfate & polymyxin sulfate

retinoid

• also accutane 
• antiacne agent

what does retinoid do

• regulates skin growth & turnover
• used in cystic acne or sever keratinization disorders

santyl

•  collagenase
• sterile enzymatic debriding ointment
• used for wound care

topical agents for fungal infections

• silvadene
• nystatin
• butenafine
• butoconazole
• ciclopirox olamine
• clotrimazole
• econazole
• haloprogin
• miconazole
• naftifine
• oxiconazole
• sertaconazole
• terbinafine
• terconazole
• tioconazole         ????
• tolnaftate
• undecylenic

anasthesia drugs

• alter cns
• skeletal muscle relaxant
• reflex reduction

inhaled agent are

• vaporized in O2, either liquids or gases

examples of inhaled agents are

• nitrous oxide
• halothane
• isoflurane
• enflurane

 Injectable anasthesia drugs

• administered IV
• used to induce/maintain general anasthesia

Examples of injectable anasthesics

• ketamine
• versed
• thiopental sodium (pentathal)