Notes

​Sanchez Review

ANTIARRYTHMIC MEDICATION

Control rate and rhythm of heart.

ANTIHPERTENSIVE

Lowers BP

ANTIANGINAL

Controls chest pain

VASODILATORS

More blood go into the cardiac muscle pt for pt with CHF and CAD

DIURETICS

Increase urine output. Get rid of fluids. Nursing implication: monitor electrolytes, I/O, vital signs. Ex: furosemide(Lasix), Bumix.  

ANTICOAGULANTS

Reduce the formation of blood clots: ex: Heparin(Check PTT), Lovenox, Coumadin (check PT and INR). If blood clots is there thrombolytics

VASODIALATORS

Ca Channel Blockers

BRONCHODIALATORS

Relax smooth muscle to open bronchioles

ANTITUSSIVE (ANTI COUGH)

Suppress cough

ANTIPYRETICS

Reduce fever

ANALGESICS

Reduce pain.  Potentiates 1+1=3 (ex: Visteral, Phenergan)Narcotics: morphine, Percocet, Demerol. Non narcotics: ASA, ibuprofen.

ANTICONVULSANTS

Control seizures.

ANTIEMETIC

Control nausea and vomiting.

ANTACIDS

Neutralize the pH.

LAXATIVES

Aide in fecal elimination. Some bulk forming, irritants, and osmotic

ADRENERGIC BLOCKERS

Block affects of adrenaline in body

ANTIHISTAMINES

Reduce symptoms of allergies, which decrease congestion

ANTIPSYCHOTIC MEDS (MAJOR TRANQUILIZERS)

Used in control behavior, mood, thought process ex: Haldol

ANTIDEPRESSANTS

Elevate mood. Used to treat endogenous depression. Trycyclic, SSRI, MOI

ANTIMANIC

Meds to stabilize moods, prevent depressive periods. Manic disorders. Ex: Cyprexa, Abilify, lithium

ANTIDOTE (ANTAGONIST)

Opposite. Ex: Coumadin (vit K), analgesics (Narcan), (benzodiazepine) flumazicon,

ANTIBIOTICS

Kill bacteria

CEPHALOSPORINS

Potentialities that have allergies to penicillin but may have cross sensitivity

SULFANOMIDES

Bacteriostatic

CORTICOSTEROIDS

Used to suppress the immune system and inflammation

• Techniques
1) Role of LPN IV therapy without IV certification
​a) Monitor the IV site for symptoms of infiltration

​b) d/c hep lock

​c) monitor flow rates, infusion times, adjust flow increase or decrease, turn ​off

​d) IV site care, discontinue (dc) IVs. Change IV bag. Change tubing

​e) Hang plain hydrating fluids(without any additives) examples would ​include. They cannot have ELECTROLYES OR VITAMINS.

​i) D5W

​ii) D5 ½ NS

​iii) RL

​iv) 0.9 NS

​v) D5RL

​vi) D5NS etc(no KCL, no vitamins)

2) S/S of infiltration
​a) infiltration is unintended infusion of IV fluid into the SQ layers; this ​could ​result in serious patient injury even loss of patients limb

​b) Pain, swelling, shiny tight skin

​c) redness, or pallor

​d) warmth or coolness

​e) tender at palpation

3) Nursing implication for IV infiltration

​a) first intervention is to stop IV

​b) elevate arm

​c) warm compress and advice the nurse

4) IV therapy infection control protocol

​a) Change bag q24h

​c) Date and change IV tubing q96 h(4 days)

​

5) PO meds that should not be crushed

​a) substance release( time release)

​b) enteric

​c) buccal

​d) sublingual

6) Suppository insertion place patient in left lateral position with upper right leg flexed

7) Transdermal patches

​a) assess the skin. Skin not impact don’t.

​b) remove other patches

​c) rotate the site b/c it decreases absorption and cause irritation

​d) label date and time

​e) apply gentle pressure for 10 seconds so patch adheres to skin

8) Opthalmic medication is applied in the lower conjunctival sac inner canvus to outer canvus. As patient closes eye press down on lacrimal duct

9) When giving otic meds what maneuver do you do

​a) older than 3 years old: up and back

​b) infants: down and back

10) What instructions do you give a patient after giving otic medications.

​a) turn to side stay in positions so drops reach inside of ear canal. ​Wait 5 minutes

11) What can you do to improve meds to reach ear canal when administering otic

​a) pulling ear,  staying in sideline position apply gentle pressure in the ​tragus

12) SQ injection

​a) gauge: 25 gauge average adult

​b) length: 5/8 average

​c) ½-5/8: range length

​d) range gauge: 25-31​

​e) inject no more than 1 mL

13) What is the rational to rotate SQ injections

​a) irritation

​b) inflammation

​c) absorption

​d) tissue damage: lipodistrophy

14) SQ Heparin or Lovonox must be administered in the abdomen

15) IM injections

​a) average gauge: 21 or 22 average

​b) gauge needle: 1 ½ inches

​c) gauge range: 20-23 needle: length range: 1-2

​d) can give up to 3 mL and 1 mL in the deltoid

16) Different sites for IM injection and anatomical landmarks

​a) Deltoid: the acromium process

​b) Ventral gluteal: greater trochantar palm of hand the index finger at ​the anterior superior iliac spine middle finger aligned with iliac crest ​and that triangle you inject.

​c) vastus lateralis: find greater trochanter lateral femoral condyl in ​knee and hip . Divide the thigh in three and its in the middle 3rd where ​you inject

​d) rectus fermoris: anterior aspect of thigh put  one hand above the ​knee and the other above the hip joint divide three and its in middle.

​e) dorso gluteal; posterior superior iliac spine find trochanter draw ​imaginary line you inject above the imaginary line

17) What is the name of technique to prevent citrus of medication.

Med stays within muscle tissue= Z tract

18) BUCCAL

For cheek - enteral route

19) WHICH MUSCLE IS USED TO GIVE IMMUNIZATIONS

Deltoid

20) PERFORMING A TB TEST OR ALLERGY TEST

Intradermal and angle < 15 degrees

21) BEFORE GIVING DIABETIC MED YOU NEED TO

Have blood glucose levels. If pt hypoglycemic may not give it.

22) PROCEDURE TO GIVE MEDS THROUGH NG TUBE PLACEMENT

​a) check for placement do not put anything in tube

​b) you auscultate to listen

​a) aspirate stomach content. Check pH. Should be acidic

​b) flush before and after administering meds. In between meds

23) WHEN YOU GIVING IM INJECTION

You should aspirate before

24) BEFORE GIVING DIGOXEN

Check apical pulse for one full minute

25) AFTER USING GLUCOCORTICOSTEROID INHALANTS

Rinse the mouth

26) THE DIAMETER OR BOARD SIZE OF A NEEDLE IS

The Gauge

26) AFTER INSERTION OF VAGINAL SUPPOSITORY

Stay laying supine for 5 to 10 minutes to absorb med

27) WHEN ADMINISTERING INSULIN

You must do Regular first

28) THIS MUSCLE IS USED FOR CHILDREN IM INJECTION

​a) vastus lateralis (<7)

29) LABEL UP AND EYE LEVEL

When medication administration (liquid).

Pharmacological principles rules and definitions

1) PHARMACODYNAMICS
How a drug works and when in the body ex: distribution, absorption, metabolism.

2) BIOTRANSFORMATION
Metabolism. The liver metabolizes.

3) INDICATION
Officially approved use of drug to treat a disease. FDA approved medications

4) INTERACTIONS
How the drug modifies with another drug. Ex Visteral with Demorol is potentiated

5) DOSE THAT DOCTOR PRESCRIBES IS BASED ON WHAT VARIABLES
​a) age

​b) weight

​c) height

​d) sex

​e) renal functions. Kidney and liver functions

6) DEFINE DURATION OF ACTION

​a) how long the medication takes into affect in the body

7) PEAK

is max affect drug has

8) CONTRAINDICATIONS

Situation when certain drugs should not be used if used need to be used with caution

9) ABSORPTION

Drug transferred from blood and lymph. Inject IV its already there.

10) EXCRETION

Elimination. Organ responsible kidneys.

11) DISTRIBUTION

How it transfers to body. Ex: Cardiovascular.​

12) THE DIFFERENT ROUTES FOR PARENTERAL ANYTHING WITH NEEDLE

​a) ID

​b) IV

​c) Sub Q

​d) IM

 

13) ROUTES FOR ENTERNAL

​a) oral

​b) Buccal

​c) suppository- anal

​d) sublingual

​e) NG tube

14) PHARMACOTHERAPEUTIC

Diagnose, treat, cure and prevent

15) PROPHYLAXIS

To prevent ex: vaccines

16) DIAGNOSTIC

To diagnose a disease process. What causes the symptoms?

      17) 10 RIGHTS OF ADMINISTERING A MEDICATION​

​a) Right medication

​b) Right dose

​c) Right time: you guarantee the right time by giving all medications 30 ​minutes before and after.

​d) Right route

​e) Right client

​f) Right documentation

​g) Right to refuse

​h) Right assessment

​i) Right education

​j) Right evaluation

 

18) PALLIATIVE

Alleviates symptoms relief. Ex pt with terminal Ca, disease process

19) DEFINE HIGH ALERT MEDS

Medications that have potential to cause serious illness or even death  ex: Heparin, insulin,  IV narcotics, and IV electrolytes. NOT PO ELECTROLYTES

21) SYSTEMIC EFFECT

Drug affects which take place away from site of administration. ALL OVER.

22) LOCAL AFFECT

Occurs at same site of application.  Ex: topical, lidocaine

23) TOXIC EFFECT

Poisonous after being in therapy for a long time

24) PARADOXICAL

Is the opposite effect of medication

25) SIDE EFFECT OR ADVERSE EFFECT

Drug induced illness or nauseas undesired response to a medication..

26) ALLERGIC REACTION

Is a negative response immediated by immune system

27) MILD REACTION

Could be a rash

28) ANAPHYLACTIC ALLERGY

Is severe allergic reaction. Life threatening with extensive swelling.

29) PEAK

Is max effect. At highest blood levels

30) THERAPEUTIC/ PHARMACOLOGICAL

How meds are classified. Brief medical term used to describe the action of the drug

31) IF YOU MAKE A MISTAKE WRONG MEDICATION

MUST REPORT IT!

32) DIFFERENT TYPES OF ORDERS

Standing order, verbal, phone, written

33) NURSING IMPLICATIONS

Nurse things can do for patients to receive maximum affect for drug therapy

34) PRN:  means needed meds. Must assess and check when last one was given. (ex: Percocet, Visteral)

35) Express for % or ratio you DO NOT MANIPULATE

36) You can refuse to give a medication to a patient if you don’t feel its safe.

37) COMPLIANCE: is adherence to therapy. Follow MD order

38) PARTNERING WITH PATIENT: collaborating with patient. Listening to patient communicating with patient.

39) CONTROL SUBSTANCE: a medication in which is scheduled drug potential for addiction. Procedure: have another witness; check order 3 times, double lock

 

Drug medications

Reglan: cholinergic and antiemetic

Syrup of Ipecac: emetic

Compazine, Dramamine, Vistaril.. ect

Laxatives: bulk forming Metamucil, Citrucel. Stool softners: Surfaca and colace

ANTIDIARHEAL MEDS: pepto-bismol, lomotil, Imodium, motifen

ANTIDIABETIC: Metformin, glipize, Humulin, lispro

BENZOs: are hypnotics and sedatives. antidote flumazicon

Temazepam, Dalmane, Halcion, Ambien: HYPONTICS

           Lorazepam(Ativan: SEDATIVE OR ANTIANXIETY

          Ativan, clorazepate, valium, xanax, clonopine : SEDATIVES

          Demorol, oxycodone, Daulaudid: NARCOTIC ANALGESICS

          Percocet, tykenol 2, 3,4, Darvocet: NARCOTIC COMBINATIONS

          ANTIDOTE FOR NARCOTIC: Narcan

         Visteral or Phenergan POTENTIATE NARCOTICS

         Ibuprofen, ASA, NSAIDS, teradol: NON- NARCOTIC ANALGESICS

Clorpamzine, Meneril, Respirdol, Haldol: ANTIPSYCHOTIC, PSYCHOTROPIC MAJOR TRANQUILIZERS. Side effect they have: anticholinergic effects(dry mouth, blurred vision, constipation), and extrapyramidal side effect(pseudo-parkinsons)

Amitriplin, doxepin, topramil, prozac , celexa: ANTIDEPRESSANTS

Abilify, lithium, cyprexa: ANTIMANIC

Cillin: antibiotic, penicillin

chephalexin, CEPHS: cephalosporins

CYCLIN: monocyclin, doxycycline: tetracycline

FLOXIN: fluroquinilone

acyclovir antiviral

Diflucan: antifungal

Bactrim: SULFA drug

Benadryl: antihistamine

Dexamethosone: glucocorticosteroid

Digoxin: cardiotonic or inotropic​    

Verapamil, procardia, propanolol, atenelol, metroprolol: antiarrythmics

Nitroglycerine, isosorbide: vasodialators

furosimide, bumix: Diuretics

PRIL-Captopril, enalapril: ACE inhibitors

Coozar, Daloban, Arcan: ARBs angiotensin receptor blockers ANTIHYPERTENSIVE

Heparin(LOOK FOR PTT), warfarin(LOOK for INR and PT), lovenox, fragmine: anticoagulants

asprin, plavix: antiplatelets

altiplase: thrombolytics

theophyllin, aminophyllin: bronchodialators

 

Drugs and nursing implications

Side effect of antiacid: rebound acidity

Regular insulin short acting peak can cause hypoglycemia.

To treat hypoglycemia you give orange juice(DO NOT ADD SUGAR) or if unconscious give dextrose IV or glucagon. Once recover give something with protein

The insulin used in the sliding scare are Regular insiline, Humalog and Novolog

Metformin: hold for 48 hours for diagnostic procedure

Peak and trough for an antibiotic they are testing excretion and metabolism, liver and kidney function

Bacteriostatic: Sulfa med. Complication is that can cause kidney stones. Give them force fluids

Receiving antibiotics teach: not to share, finish the whole prescribtion

Prolonged antibiotics lead to : yeast infections.

Antifungal and antiviral meds share a common life theatning side effect BONE MARROW DEPRESSION

When giving antibiotics check for culture and sensitivity and let the doc know

Common SE of bronchodialators: tachy, increase BP, restlessness, irritability

Most important long term use in corticosteroids: immune system low, adrenal crisis

Levels Theophylin: 10-20

Levels Digoxin: 0.9-2.1

Paradoxical effect for hypnotics  restlessness and confusion

Hypnotics cause hangover because they interfere with REM sleep

Define pain: whatever the patient says.

Pain in the elderly: don’t want to get addicted to meds this its normal policy, vague symptoms interpret pain differently. Fatigue, anorexia.. ect..

Nurses do not cause addiction.

Main principle of pain management: give it before pain is severe.

How someone can be in pain level: grinning teeth, grimacing, sweating, abnormal VS

SE of narcotics: hypotension, respiratory depression, constipation

Symptoms of narcotic toxicity: severe resp depression, pinpoint pupil

SE of ASA: GI bleeding, Reyes Syndrome do not give the kids, tinnitus  

Signs of digitalis toxicity: anorexia, bradycardia, yellow vision

BP meds teach the patient to change position slowly because can develop orthostatic hypotention

Must monitor electrolytes after administering diuretics especially potassium