NR 293 Exam 1 Review PDF

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NR 293 Exam 1 Review 1. Review medication administration-errors, six rights a. Right client - always confirm that you are treating patient b. Right route - Confirm the appropriateness of the prescribed route while also making sure the patient can take/receive the medication by the prescribed route. If medication order does not include the route be sure to ask the prescriber to clarify it. NEVER ASSUME THE ROUTE c. Right drug - make sure you administer the correct drug to the patient. If doubt exists or an error is deemed possible, contact the prescriber and/pharmacist immediately. d. Right dose - always confirm that the dosage amount is appropriate for the patient’s age and size. NEVER ASSUME THE DOSAGE e. Right time - Each health care setting or institution has a policy regarding routine medication administration times, be sure to follow them and commit them to memory. f. Right Documentation - Document how that whole thing went according to how it actually went g. Medication errors - any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. 2. Review types of Treatment, empiric, prophylactic palliative etc a. Acute Therapy - includes more intense drug treatment and is implemented in the acutely ill or critically ill. Needed to sustain life or treat disease. b. Maintenance Therapy - does not eradicate pre-existing problems, but will prevent progression of a disease or condition. Used for treatment of chronic illnesses such as hypertension. c. Supplemental Therapy - supplies the body with a substance needed to maintain normal function. d. Palliative Therapy - The goal of palliative therapy is to make the patient as comfortable as possible. Focuses on providing patients with relief from symptoms, pain, and stress of a serious illness. e. Supportive Therapy - maintains the integrity of body functions while the patient is recovering from illness or trauma. An example would be providing fluids and electrolytes to a patient in order to prevent dehydration who is losing fluids by constant vomiting and diarrhea. f.

Prophylactic Therapy - drug therapy provided to prevent illness or other undesirable outcomes during planned events.

g. Empiric Therapy - treating presenting symptoms before knowing what it is 3. Review age related drug administration a. Infants

perform the injection swiftly and safely while the infant is safely and securely positioned by parent. ii. Allow self-comforting measures (use of pacifier, fingers in mouth, selfmovement) b. Toddlers i. Offer a brief explanation within the toddlers range of understanding while their guardians are present. Make sure they are securely held ii. Provide comfort measures immediately after the procedure (touching, holding) iii. Help toddler understand treatment with use of puppets, stuffed animals, or hospital equipment iv. Provide healthy ways to release aggression c. Preschoolers i. Offer a brief explanation within the toddlers range of understanding while their guardians are present. ii. Provide comfort measures immediately after the procedure (touching, holding) iii. Make use of magical thinking (using ointments or “special medication” to make discomfort go away) iv. Note that role of parent in providing comfort and understand is important d. School-age children i. Explain the procedure, and allow for some control over body and situation ii. Provide comfort measure iii. Explore feelings and concepts through the use of therapeutic play iv. Set age appropriate behavior limits (okay to cry or scream, but no hitting or biting) and provide age appropriate activities for releasing aggression and anger. v. Use this opportunity to teach about the relationship between receiving medication and body function and structure (what a seizure is and how medication can help) vi. Offer the complete picture (need to take medication, relax with deep breaths; medication will help prevent pain) e. Adolescents i. Prepare the patient in advance for procedure, minus scare tactic ii. Allow for expression in a way that does not cause losing face, such as giving the adolescent time alone after the procedure and giving adolescent time to discuss his or her feelings iii. Explore with the adolescents any current concepts of self, hospitalization, and illness, and correct any misconceptions iv. Encourage self-expression, individuality, and self-care v. Encourage participation in procedures as appropriate 4. Review your drug categories in pregnancy and classifications a. Category A - No risk is demonstrated in the first trimester and there is no evidence of a risk in later trimesters; fetal harm appears remote. i.

b. Category B - There is no risk to animal fetus when information on human fetus is not available. c. Category C - Adverse effects reported in the animal fetus: information for humans is not available. d. Category D - Potential risk to human fetus exists; use with pregnant women only if benefit outweighs risk. e. Category X - Fetal abnormalities reported in humans and confirmed in animal or human studies. Do not use the drug with pregnant women. 5. Review cultural implications Cultural Group

Common Health Beliefs and Alternative Healers

Verbal and Nonverbal Communications; Touch/Time

Family

Biologic Variations

African

Practice folk medicine, employ “root doctors” as healers, spiritualists Used herbs, oils, and roots

Asking personal questions of someone met for the first time seen as intrusive and not proper Direct eye contact seen as rude Present oriented

Have close extended family ties Women play important key role in making health care decisions

Keloid formation, sickle cell anemia, lactose intolerance, skin color

Asian

Believe in traditional medicine; hot and cold foods; herbs/teas/soups. Use of acupuncturist, acupressurist, and herbalist; Tai Chi; Qi Gong

High respect for others, especially individuals in positions of authority Not usually comfortable with custom of shaking hands with those of opposite sex Presented oriented

Have close extended family ties; family needs more important than individual needs

Many drug interactions, lactose intolerance, skin color, thalassemia

Hispanic

View health as a result of good luck and living right; see illness as a result of doing a bad deed Heat, cold, and herbs used as remedies

Expressing negative feelings seen as impolite Avoiding eye contact seen as respectful and attentive Touching acceptable

Have close extended family ties; all family members involved in health care decisions Past cultural experiences in the family with illness

Lactose intolerance, skin color

Native American

Use curandero, spiritualist

between two persons in conversation

and healing practices holds significant value Strong adherence to cultural practices

Believe in harmony with nature and ill spirits causing disease Use medicine man

Speak in low tone of voice Light touch of a person’s hand is preferred versus a firm handshake as greeting Present oriented

Have close extended family ties; emphasis on family

Racial or ethnic group

Drug classifications

Lactose intolerance, skin color, cleft uvula problems

Response

African American

Antihypertensive drugs

African Americans respond Better to diuretics than to beta blockers and angiotensinconverting enzyme inhibitors Less effectively to beta blockers Best to calcium channel blockers, especially diltiazem. Less effectively to single-drug therapy

Asians and Hispanics

Antipsychotic and antianxiety drugs

Asians Need lower dosages of certain drugs such as haloperidol Asians and Hispanics Respond better to lower dosages of antidepressants Chinese Require lower dosages of antipsychotics Japanese Requires lower dosages of antimanic drugs

6. Review OTC drugs - More than 300,000 OTC drugs available

a. Medications that are legally available without a prescription b. Analgesics i. Ibuprofen (advil, Motrin) ii. Naproxen, sodium (aleve, Naprosyn) c. Histamine Blockers, H1 Receptors i. Chlorpheniramine maleate (Chlor-Trimeton) ii. Diphenhydramine hydrochloride (benadryl) iii. Fexofenadine (allegra) iv. Loratadine (claritin) v. Cetirizine (zyrtec) d. H2 Receptors i. Cimetidine (tagamet HB) ii. Famotidine (Pepcid AC) iii. Nizatidine (Axid AR) iv. Ranitidine (Zantac) e. Nasal Steroids i. Flonase Allergy Relief (fluticasone propionate)

ii. Nasacort Allergy 24 HR (triamcinolone acetonide) f. Proton Pump Inhibitors i. Esomeprazole (Nexium-24) ii. Lansoprazole (Prevacid-24) iii. Omeprazole (Prilosec-OTC) g. Smoking Deterrents i. Nicotine polacrilex gum (nicorette) ii. Nicotine transdermal patches (Nicoderm) (other dosages forms available) h. Topical Medications i. Clotrimazole (lotrimin) ii. Butoconazol (Femstat) iii. Miconazole (monistat) iv. Minoxidil solution and hydrocortisone acetate 1% cream (Rogaine) v. Terbinafine (Lamisil AT) i. Weight Loss Products i. Orlistat (Alli) Types of OTC drug

Example

Acid-controlling drugs (H2 blockers), antacids, and proton pump inhibitors

Famotidine (pepcid AC), ranitidine (Zantac); aluminum- and magnesium- containing products (Maalox, Mylanta); calcium-containing products (Tums), esomeprazole (Nexium 24), lansoprazole (Prevacid-24), omeprazole (Prilosec-OTC)

Antifungal drugs (topical)

Clotrimazole (lotrimin), miconazole (monistat), terbinafine (lamisil AT)

Antihistamines and decongestants

Brompheniramine (Dimetapp), cetirizine (Zyrtec), chlorpheniramine (Theraflu), diphenhydramine (Benadryl), fexofenadine (allegra), guaifenesin (Robitussin), Loratadine (Claritin), pseudoephedrine) (sudafed)

Eyedrops

Artificial Tears (moisture eyes)

Hair growth drugs (topical), Pain-relieving drugs

Minoxidil (Rogaine)

Analgesics

Acetaminophen (Tylenol)

Nonsteroidal antiinflammatory drugs

Aspirin, ibuprofen (Advil, Motrin), naproxen sodium (Aleve)

Nasal steroids

Fluticasone (Flonase), triamcinolone (Nasacort)

Chamomile

Increased risk of bleeding with anticoagulants

Cranberry

Decreased elimination of many drugs that are renally excreted

Echinacea

Possible interference with or counteracting to immunosuppressant drugs and antivirals

Evening primrose

Possible interactions with antipsychotic drugs

Garlic

Possible interference with hypoglycemic therapy and the anticoagulant warfarin (Coumadin)

Gingko

May increase risk for bleeding with anticoagulants (warfarin, heparin) and anti platelets (aspirin, clopidogrel)

Ginger root

At high dosages, possible interference with cardiac, antidiabetic, or anticoagulant drugs

Grapefruit

Decreases metabolism of drugs used for erectile dysfunction, estrogen, and some psychotherapeutic drugs. Increases risk for toxicity of immunosuppressants, HMG-CoA reductase inhibitors and some psychotherapeutic drugs. Increases intensity and duration of effects of caffeine.

Hawthorn

May lead to toxic levels of Cardiac glycosides (e.g., digitalis)

Kava

May increase the effect of barbiturates and alcohol

Saw palmetto

May change the effects of hormones in or contraceptive drugs, patches, or hormonal replacement therapies

St. John's wort

May lead to serotonin syndrome if used with other serotonergic drugs (e.g.,selective serotonin reuptake inhibitors. May interact with many drugs, including antidepressants, antihistamines, dioxin, immunosuppressants, theophylline, and warfarin.

Valerian

Increases central nervous system depression if used with sedatives.

7. Review nursing implications for tetracycline a. Should not be used in children younger than age 8 years or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth b. Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug- binding that occur. c. Take all medications with 6 to 8 oz of fluid, preferably water. d. Because of photosensitivity, avoid sunlight and tanning beds. e. Check signs of superinfection; check tongue and mouth for thrush (redness/rash type)

f. Withhold if superinfection occurs 8. Review drug interactions with penicillin Drug Interacting with Penicillins

Mechanism

Result

Aminoglycosides (IV) and clavulanic acid

Additivity

More effective killing of bacteria

methotrexate

Decreased renal elimination of methotrexate

Increased methotrexate levels

NSAIDs

Compete for protein binding

More free and active penicillin (may be beneficial)

Oral contraceptives

Uncertain

May decrease efficacy of the contraceptive

Probenecid

Competes for elimination

Prolongs the effects of penicillins

Rifampin

Inhibition

May inhibit the killing activity of penicillins

Warfarin

Reduced vitamin K for gut flora

Enhanced anticoagulant effect of warfarin

9. Review secondary infections caused by antibiotic usage a. Superinfection- can occur when antibiotics reduce or completely eliminate the normal bacterial flora b. Vaginal yeast infection c. Pseudomembranous colitis or C. difficile infection d. Viral respiratory infection 10. Review different generations of cephalosporins and their indications a. First generation i. Good gram-positive coverage and Poor gram-negative coverage ii.

Examples 1. cefadroxil (Duricef, Ultracef) 2. cephradine (Velosef) 3. cefazolin (Ancef)

4. cephalexin (Keflex) b. Second generation i. Good gram-positive coverage and Better gram-negative coverage than first

generation ii.

Examples

▶ cefaclor (Ceclor) (used to be used for children) ▶ cefprozil (Cefzil) ▶ cefoxitin (Mefoxin) (IV or IM) ▶ cefuroxime (Zinacef) ▶ cefotetan (Cefotan) ▶ loracarbef (Lorabid): no longer available in the U.S. c. Third generation i. Most potent group against gram-negative bacteria and Less active against gram-positive bacteria ii.

Examples

▶ cefotaxime (Claforan) ▶ ceftazidime (Fortaz) ▶ cefdinir (Omnicef) ▶ ceftizoxime (Cefizox) ▶ ceftriaxone (Rocephin) (very broad spectrum) (single dosage) ▶ cefpodoxime ▶ ceftibuten (Cedax) ▶ ceftazidime (Ceptaz, Fortaz, Tazidime)

– – –

IV and IM forms

– –

Excellent spectrum of coverage

Excellent gram-negative coverage Used for difficult-to-treat organisms such as Pseudomonas spp. (it’s like c-diff in the lungs lmfao)

Resistance is limiting usefulness. d. Fourth generation i. Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria ii. cefepime (Maxipime) - Uncomplicated and complicated UTI e. Fifth generation i. ceftaroline (Teflaro) (especially know this) 1. Broader spectrum of antibacterial activity 2. Effective against a wide variety of organisms

a. MRSA 11. Review adverse effects of aminoglycosides a. Cause serious toxicities i.

Nephrotoxicity, occurs in 5% to 25% of patients (renal damage) (kidney damage)

ii.

Ototoxicity, occurs in 3% to 14% of patients (auditory impairment and vestibular impairment, hearing loss [eighth cranial nerve])

b. Symptoms include i.

Dizziness, tinnitus, a sense of fullness in the ears, hearing loss, fever, superinfections.

c. Lesser symptoms are i. Headache, paresthesia, vertigo, skin rash, fever, 12. Review vancomycin in detail. a. Treatment of choice for MRSA and other gram-positive infections b. Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis. c. Must monitor blood levels to ensure therapeutic levels and prevent toxicity d. May cause ototoxicity and nephrotoxicity e. Red man syndrome may occur

f.

i.

Flushing or itching of head, neck, face, upper trunk

ii.

Antihistamine may be ordered to reduce these effects

Should be infused over 60 minutes

g. Rapid infusions may cause hypotension. 13. Review the drug ribavirin (antiviral) a. Antiviral drug (Non-HIV) b. Synthetic nucleoside analog c. Given orally or nasal inhalation d. Inhalation form (Virazole) used for hospitalized infants with RSV infections 14. Review the drug retrovir (antiviral) adverse reactions, indications etc a. Adverse reactions i. bone marrow suppression, opportunistic infection, headaches, nausea b. Indication i. HIV infections 15. Review the pathophysiology for antivirals. a. 16. Review the antiviral drug Tamiflu a. Preferred to be taken two days before showing symptoms of flu 17. Review the antifungal (fluconazole) diflucan a. Fluconazole: passes into the cerebrospinal fluid and inhibit the growth of cryptococcal fungi, effective in the treatment of cryptococcal meningitis

b. Fluconazole (diflucan) i.

Nausea, vomiting, diarrhea, stomach pain

ii.

Increased liver enzymes

iii.

Use with caution in patients with renal and liver dysfunction

Antibiotics Sulfonamides ➔ One of the first groups of antibiotics ➔ Often combined with another antibiotic ◆ Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic), known as Bactrim: 5:1 ratio of Sulfamethoxazole to trimethoprim ➔ Bacteriostatic action - they don’t kill bacteria, but stop its growth ➔ Prevent synthesis of folic acid required for synthesis of purines and nucleic acid ➔ Effective against both gram-positive and gram-negative bacteria ➔ Treatment of urinary tract infections (UTIs) ➔ Upper respiratory tract infections Penicillins (Beta-Lactam) -

Can be divided into four categories a. Natural penicillins i.

penicillin G

ii.

penicillin V

b. Penicillinase-resistant drugs i.

nafcillin

ii.

cloxacillin

iii. oxacillin c. Aminopenicillins i.

amoxicillin - that good tasting one

ii.

ampicillin - group B strep, found in the vagina, not a STI or STD

d. Indications i. Prevention and treatment of infections caused by susceptible bacteria, such as: 1. Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., Staphylococcus spp. 2. know this one) ii.

Not all end in “cillin” (e.g., Zosyn, Augmentin)

e. Adverse effects i. Common adverse effects 1. Nausea, vomiting, diarrhea, abdominal pain ii.

Other adverse effects are less common.

f.

Interactions i.

Nonsteroidal antiinflammatory drugs

ii.

Oral contraceptives

iii.

Warfarin

iv.

Others Cephalosporins (Beta Lactam)

-

Bactericidal action +Broad spectrum g. Adverse Effects i. Similar to penicillins 1. Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema ii. Potential cross-sensitivity with penicillins if allergies exist iii. h. First generation i. Good gram-positive coverage + Poor gram-negative coverage ii.

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