Transcript NUR292 NCLEX REVIEW

NUR292 NCLEX REVIEW
Pharmacology Guidelines and
Strategies
Five Medication Rights
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Right client
Right medication
Right dose
Right time
Right route
Assessment Guidelines
ALWAYS:
• Assess for allergies or hypersensitivity
• Assess for existing medical disorders that
might cause med to be contraindicated
• Assess for potential interactions
• Check pertinent labs
• Check vs, esp. if antihypertensive or
cardiac med
• Assess for intended effects, side effects,
adverse effects, or toxic effects
• Assess client’s response to med
General Guidelines
• Med absorption, distribution, metabolism &
excretion affected by age – older & neonate at
greater risk for toxicity
• Many meds contraindicated during pregnancy &
breastfeeding
• Antacids not usually administered with meds –
affect absorption
• Grapefruit juice not usually administered –
affects absorption & can cause toxicity
• Enteric-coated & sustained release tabs should
not be crushed; capsules should not be opened
• Nursing interventions always include monitoring
for intended, side, adverse or toxic effects &
client education
• Nurse or client should never adjust or change a
med dose, abruptly stop taking or discontinue a
med
• Nurse may withhold a med if adverse or toxic
effect is suspected; nurse must immediately
contact the physician if either occur
• Client should avoid OTC meds or herbal meds
unless approved by health care provider
• Client needs to know how to correctly administer
meds
• Client needs to be aware of side effects of meds
& how to check own temp., pulse & BP
• Client needs to take prescribed dose for
prescribed length of therapy & understand need
for compliance
• Client needs to avoid smoking & consuming
alcohol
• Client should wear ID if taking anticoagulants,
OHAs, insulin, certain cardiac meds, steriods,
anti myasthenics, anticonvulsants & MAOs
• Client needs to follow up with health care
provider
Medication Effects
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Intended
Side
Adverse
Toxic
Intended Effect
• Desirable effect
• Example – intended effect of morphine
sulfate is pain relief
Side Effect
• Not a desired effect
• Not usually life-threatening
• Can usually be alleviated with specific
measures
• Example – side effect of antihistamine is
drowsiness
Adverse Effect
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More severe than a side effect
Always an undesirable effect
Always reported to the health care provider
Example – adverse effect of sulfonamide is
hypersensitivity evidenced by rash, fever,
SOB
• Can range from mild to severe
(anaphylaxis)
Toxic Effect
• Medication level in the body exceeds the
therapeutic level
• Client will usually exhibit signs/symptoms
that indicate toxicity. Nurse monitors for
these s/s
Medication Names
• Both generic name & trade name will
appear in NCLEX question
• Identifying the med will help determine
action or what med is used for
• Try to break name of med into parts & use
medical terminology to determine action of
drug
Medication Classifications
• Learn meds by classification & be able to
recognize common side effects, then relate
appropriate nursing interventions to each
side effects
• Example – if side effect is hypertension
then monitor BP. If side effect is
hypokalemia, then monitor K+ blood level
Identify Classification
• -terone Androgens (testosterone)
• -pril ACE inhibitor
• -pressin antidiuretic hormones
(desmopressin – DDAVP)
• -statin antilipemics (atorvastatin –
Lipitor)
• -vir antivirals
• -pam benzodiazepines or -lam
• -lol beta-blockers
• -pine Ca+ channel blockers – exceptions –
diltiazem (cardizem) & verapamil (Calan)
• -est estrogens
• -sone glucocorticoids & corticosteroids
• -dine histamine H2 receptor antagonists
(cimetidine – Tagamet)
• nitr nitrates (nitroglycerin)
• -zine phenothiazines (chlorpromazine –
Thorazine)
• -zole proton pump inhibitors (lansoprazole –
Prevacid)
• sulf sulfonamides
• -mide sulfonylureas (OHAs)
• -zide thiazide diuretics
• -ase thrombolytics (alteplase – Activase)
• thy thyroid hormones
• -line xanthine bronchodilators (aminophylline)
Angiotensin II Receptor
Antagonists (ARBS)
• -sartan lowers BP , less K+ retention than
ACE inhibitors
• Losartan (Cozaar)
• Olmesartan (Benicar)
Antibiotics
• cef cephalosporins
• -cillin penicillins
• -mycin macrolides (Biaxin, ERC, Zithromycin
lincosamides (Vancomycin, clindamycin
aminoglysides
• -cycline tetracyclines
• -xacin fluoroquinolones (Cipro, Levaquin)
Common Herbal Remedies/Drug
Interactions
Herbal Remedies That Might
Help
• Astragalus – increases resistance to
disease & restores immune function
(oncology pts)
• Echinacea – preventive & treatment for
colds & flu. May interfere with
immunosuppressive therapy
• Feverfew – headaches – migraine.
Minimal level of 0.2% parthenolide needed
• Garlic – decrease cholesterol & lower BP,
inhibits platelet aggregation, antiinfective
• Ginger – stimulate digestion & relieve
nausesa
• Ginkgo – treatment of arterial
insufficiency in brain & extremities,
allergic responses & memory impairment
• Ginseng root – acts on CNS, CV system &
endocrine secretion. Promotes immune
function & antistress activity. Those with
hypertension should not use.
• Green tea – act protectively CV disease &
liver disorders. Has hypolipidemic,
antioxidant, fibrinolytic effect
• Milk thistle – prevent liver from damage
by toxins (treat heptatis/cirrhosis
• St. John’s Wort – treat mild to moderate
depression
• Shark Cartilage – antiinflammatory
(arthritis), possible antineoplastic
properties
• Valerian – sleep problems & mild sedating
& tranquilizing effect. No dependency risk
Herb/Drug Interactions
Increase Bleeding Potential
Increased risk with concurrent use of aspirin,
coumadin, heparin, NSAIDs
• Feverfew
• Garlic
• Ginger
• Ginkgo
Decrease Action of
Anticoagulants
• Ginseng
• Valerian
Interact with MAO Inhibitors
May cause hypertension or hypertensive
crisis
• Ephedra – weight loss, body building
• Ginseng
• Green tea
• St. John’s Wort
• SAMe – antioxidant, antidepressant,
arthritis, fibromyalgia, migraines
Inhibit Iron Absorption
• Camomile (teas) – appetite stimulant,
antispasmodic (also cause skin
hypersensivity)
• Feverfew
• St. John’s Wort
Potentiates sedation
Used with barbiturates, BZDs, CNS
depressants
• Kava-Kava – anxiety, stress, insomnia,
menstrual cramps, PMS
• Valerian
Increase hypoglycemic effects of
OHAs & insulin
• Ginseng
• Garlic
SHOCK
• Physiologic state in which there is
inadequate blood flow to tissues & cells of
body
Types of Shock
Hypovolemic shock – decreased
intravascular volume due to fluid loss
Cardiogenic shock – results from
impairment or failure of myocardium
Circulatory or distributive shock –
displacement of blood volume creating a
relative hypovolemia & inadequate
delivery of oxygen to cells
– Anaphylactic shock – severe allergic reaction
producing overwhelming systemic
vasodilation & relative hypovolemia. Causes:
medication or latex sensitivity, bee sting,
transfusion reaction.
Circulatory shock
– Neurogenic shock – loss of sympathetic tone
causing relative hypovolemia. Causes: spinal
cord injury, spinal anesthesia, depressant
actions of meds, glucose deficiency.
– Septic shock – overwhelming shock causing
relative hypovolemia. Causes:
immunosuppression, extremes of age,
malnourishment, chronic illness, invasive
procedures.
Treatment of shock
• Fluid replacement to restore intravascular
volume
• Vasoactive meds to restore vasomotor tone
& improve cardiac function
• Nutritional support to address increased
metabolic requirements increased in shock
Vasoactive meds (Chart p. 303)
Sympathomimetics
• Amrinone (Inocor)
• Dobutamine (Dobutrex)
• Epinephrine (Adrenalin)
• Milrinone (Primacor)
Vasodilators
• Nitroglycerine
• Nitroprusside
Vasoconstrictors
• Norepinephrine (Levophed)
• Phenylehrine (Neo-Synephrine)
• Vasopressin (Pitressin)
Multiple Organ Dysfunction
Syndrome (MODS)
• Organ dysfunction in acutely ill &
compromised client occurs to extent that
normal homeostasis is unable to be
preserved without medical intervention.
• Inadequate resuscitation accounts for about
half of all MODS cases
• MODS accounts for about 70-80% ICU
fatalities
• Septic shock – hemodynamic changes that
occur may result in inadequate perfusion &
development of MODS
• Systemic inflammatory response syndrome
(SIRS) may lead to MODS.
• An initial event triggers – usually an event
that results in low blood pressure.
• Within 72 hrs may develop respiratory
failure – ARDS – on vent
• Develops hypermetabolic state –
hyperglycemia
• Liver failure
• Renal failure
Systemic Inflammatory Response
Syndrome (SIRS)
• May result from infectious & noninfectious
trauma – burns, pancreatitis, ischemia,
multitrauma.
• SIRS – uncontrollable inflammatory response to
different clinical insults
• Defined by 2 of following: temp > 38° C or <
36° C, HR > 90 bpm, RR > 20/min, PaCO2 < 32,
& WBC > 12,000 or < 4000
• Sepsis correct term when SIRS result of active
infection