Pharm test 3 study guide PDF

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Test 3 New ATI Exam Review •

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Therapeutic Touch, Acupuncture, massages are all complementary alternative therapies. These types of therapy can be used instead of the main treatment or in conjunction as an adjuvant therapy, Complementary alternative therapies can be used as adjuvants because they help decrease side effects as well as allowing lower doses of the main pharmacotherapy. Oral medications have less side effects than IV medications. This is also due to the fact that a good amount of the oral dosage is lost through the hepatic metabolism (first pass effect)…thus we must take that into consideration as we explain to patients why one route vs. another. As patients go home with pain medication, doctors will order for transitioning IV to oral (PO) meds. Opioids analgesics like morphine are contraindicated for patients that are positive for brain hemorrhage or in situation where patient is presenting increased intracranial pressure. The reason why opioids should be avoided is due to the need to closely monitor the LOC. Analgesic Opiates will decrease LOC thus disrupting appropriate assessment. Remember that Opioids are central nervous system (CNS) depressants and can mask the patient's level of consciousness; this is dangerous when the patient has a head injury. Nausea is a common side effect of Opiate analgesics Adverse effect is something we do not expect while side effect is expected Older adults are at an increased risk for increased bleeding with nonsteroidal antiinflammatory drug (NSAID) therapy. Nurse must educate patient to report any unusual bleeding Systemic glucocorticoids are great anti-inflammatory but should be reserved for the short-term treatment because of potentially serious adverse effects. If used for prolonged time it can lead to Cushing’s syndrome. Tylenol is hepatotoxic and should be avoided for patients who have liver issues or for patients that are alcoholics. Tylenol as it is metabolized, its byproducts is hepatotoxic, thus why there is a ceiling dosage (Max dose/ day) associated with Tylenol. Histamine dilates blood vessels causing capillaries to become more permeable. Thus, helping with the inflammatory process/ causes vasodilation. This is what leads to the swelling that takes place in the inflammatory process. Inflammatory processes will lead to the release of histamine. Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin). Opioid agonists stimulate mu and kappa receptors, resulting in a variety of effects, including analgesia. It can cause constipation, nausea, decreased respiratory rates, sedation. In toxic levels the nurse may observe miosis, which is small pinpointed pupils/ Review side effects for opiate analgesics. One of the medications that are commonly prescribed to manage the constipation associated with opioid therapy is Colace (Docusate Sodium). Colace is not a laxative, rather the nurse must explain to the patient that Colace is a stool softener. Mydriasis refers to dilated pupils / Miosis- excessive constriction of the pupil in the eye.

Test 3 New ATI Exam Review Too much opioid leads to Miosis •

Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity (salicylism).

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Tylenol Infant drops should be used for babies; they are different concentrations of medication than the liquid preparations which can be given to children (no switching)

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage and taking the medication with food will help prevent GI Irritation. Keep in mind that NSAIDs will lead to GI irritation.

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All centrally acting agents like Flexeril (a centrally acting muscle relaxer) have the potential to cause sedation/drowsiness because it works in the central nervous system. The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing drowsiness and CNS depression

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If patient complaints of pain, the first intervention of the nurse should be assessment.

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Naloxone (Narcan) is an opioid antagonist and will reverse the effects of the narcotic if an overdose occurs. 

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D/H x Q V (ml)/T (hr)= Rate in Ml/hr gr = grain = 65 mg Please review roman numerals since that is how your grain order will be> Example: gr Vgrain 5 = 5 x 65mg = 325mg Review the function of COX 1 and COX 2. What happens when these enzymes are inhibited. If a patient who is taking aspirin starts to display salicylism (High levels of ASA= aspirin) remember that the one of the first interventions that the nurse must educate the patient on is to stop the use of aspirin. Review the signs of salicylism. Toxicity occurs at a salicylate level are 400 mcg/mL or higher. If ASA is stopped notify the MD Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. Remember that Aspirin works in inhibiting platelet aggregation (Antiplatelet) Keep in mind that aspirin should not be used for infants and the pediatric population up to the age of 18 years of age whenever they present with symptoms related to a viral infection. Think Reye’s syndrome! In the case of Tylenol overdose, the nurse should anticipate giving acetylcysteine (Mucomyst), because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed (medication is still in the stomach).

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Test 3 New ATI Exam Review • •

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One of the findings associated with morphine administration is respiratory depression and that is a priority as far as nursing assessments and interventions. Remember ABC. Opioid dependence is more likely to occur in patients who have conditions that require chronic use of opioid or that requires frequent opioid usage during crises such as cancer and sickle cell anemia patients. An alternate option for patients that are taking aspirin if having GI symptoms is to use the enteric coated aspirin like Ecotrin. Review signs of inflammation Review analgesics that are used for mild pain: NSAIDS and Tylenol ( Non NSAID/ Non Opioid Analgesic) Opioid tolerance will lead to a decrease in the analgesic effect. Patient will need more to produce same effect. NSAIDS cause GI side effects due to the non-selective blockage of COX 1 and Cox 2. Thus, if patient has history of GI peptic ulcer, NSAIDS should be used only with extreme caution. If after administering a medication to treat pain the nurse assesses that the drug was ineffective based on patient’s response, the nurse’s next action is to report to the physician that drug therapy for analgesia was ineffective. NSAIDS due to the blockage of COX 1, can lead to renal impairment, bleeding and decreased GI mucous production. It decreases prostaglandin production. NSAIDS can also help decrease dysmenorrhea pain by decreasing uterine contraction. Nevertheless, it may increase bleeding. Chronic pain can not easily be detected, as patients will not always show it overtly. You may also not see any changes in vital signs. Nevertheless, the nurse is still responsible for reporting and addressing the pain with appropriate interventions. Bisphosphonates such as Alendronate (Fosamax) requires that the nurse educate patient to take the medication on empty stomach, with a full glass of water and they must sit upright for at least 30 minutes after taking the medication. This is due to the GI irritation and side effects caused by this class of medications. Allopurinol is a prophylactic medication used in the prevention of gout attack. It helps by decreasing Uric Acid formation. Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding. Hypercalcemia due to calcium supplements can cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.

Once again, I want to remind all of you to listen to the end portion of the recording at least to get the med math education in there. Hopefully, you can listen to the entire recording on the link for the mindmeinster, but if you cannot…at least the end part for the med math. Good Luck Everyone!...