front 1 NMB Paralytics What safety equipment do you need to have in the room? | back 1 Crash cart, BVM "Ambubag", Oxygen "connection Christmas tree", Suction "set up w/ yanker" , Heart monitor and crash cart Spo2 |
front 2 What is the reversal medication for the paralytics? | back 2 Sugammadex |
front 3 Paralytics A/E's | back 3 They all might cause a drop in BP, Pt doesn't lose consciousness and is still mentally aware, do not decrease pain sensation. |
front 4 What do we give to calm there minds? | back 4 a sedative |
front 5 Two types of NMB'S/Paralytics: Nondeploarizing | back 5 Atracurium, Cisatracurium (Nimbex), Rocuronium (RSI Intubation), Vecuronium , Pancuronium |
front 6 Depolarizing | back 6 Succinylcholine |
front 7 Succinylcholine Specific AE's | back 7 can cause pt to go into malignant hyperthermia. SS: Muscle rigidity and increase in temp Tx: Dantrolene |
front 8 Sedative Benzodiazepines | back 8 AE: RR Depression and can lower BP "-Lam and -Pam" |
front 9 Propofol | back 9 AE: RR depression Low BP CI if allergic to Soy or Eggs RN: Change the IV tubing Q12hrs Use spiked infusion vials within 12hrs |
front 10 Barbiturates | back 10 AE: RR Depression, Low BP Physicians assistant suicide drugs "BARB" like barbie |
front 11 Ketamine | back 11 Hallucinations Good for BP concerns, and RR concerns (Asthma) |
front 12 Benzodiazepines : Eg | back 12 Lorazepam Midazolam Diazepam *Chlordiazepoxide |
front 13 What do Benzos tx and CI? | back 13 Acute Anxiety, Panic Attacks, Insomnia, Muscle spasms, ETOH WD, Drug withdrawal, CI: CNS depressants: Drowsiness, lethary Paradoxial Effects: Hyperactice, Euphoric Physical Dependence - taper off |
front 14 Reversal Agent for Benzo? | back 14 Flumazenil |
front 15 What is the risk for flumazenil? | back 15 it wears off very so pt can go back to RR depression very quick so it is important to monitor the pt for at least 2 hours (same for naloxone for opioids) |
front 16 *Anterograde Amnesia | back 16 pt wont be able to make NEW memories |
front 17 Retrograde Amnesia | back 17 pt can't remember PAST memories. |
front 18 RN considerations for Benzo | back 18 Can not drive home, Check BP and RR before and after, Midazolam: Pt on bedside HR monitor |
front 19 Non- Benzo for Chronic Anxiety | back 19 Buspirone |
front 20 Buspirone | back 20 Takes 3-6 weeks to work (not good for panic attack, Not for PRN) |
front 21 For insomnia | back 21 Ramelteon (also Zaleplon) Sleep ONset Used when it is difficult falling asleep |
front 22 Zolpidem | back 22 Used to maintain sleep **sleep Maintenance |
front 23 Other meds to help with insomnia | back 23 Antihistamine (Diphenhydramine) PRN insomnia (Benadryl) can help pt sleep |
front 24 Muscle Relaxants | back 24 Benzo Baclofen (most common in hospital) Cyclobenzaprine no more than 3 weeks Tizanidine Carisoprodol.. no more than 3 weeks Dantrolene - |
front 25 Baclofen | back 25 Makes pt really sleepy is CNS depressant , should not drive |
front 26 Cyclobenzaprine (Flexeril) | back 26 Should not use no more than 3 weeks |
front 27 Bethanechol (like cholinergic) | back 27 MOA: increase the bladder pressure and contraction of the detrusor muscle to help in the excretion of urine AE: SLUDGE, DUMBBELLS, Cholinergic Crisis |
front 28 Anticholinergics | back 28 Oxybutynin, Dicyclomine- AE: Dry as a bone (Dry mouth, dry eyes), Hyperthermia, flushing, Blind, Photophobia, delirium, Constipation, tachycardia CI: BPH, Glaucoma |
front 29 1st Generation NSAID's go to drugs for OA and early RA | back 29 AE: Kidney damage, GI Ulcers, Take with food! Aspirin- Stop 1 week before surgery: Reyes' Tinnitus (Salicylism) Ketorolac (used a lot in hospitals) : Only take for 5 days, don't use w/ other NSAID's Naproxen, Diclofenac, Ibuprofen, Indomethacin, Meloxicam |
front 30 Aspirin / ASA | back 30 AE: Gastric Ulcers, Bleeding, Kidney toxicity, Tinnitus CI: Avoid given it to pt with asthmas' OVERDOSE ON ASPIRIN (Salicylate Posining) S/S Rapid breathing, Tinnitus, Metabolic acidosis RX: IF within 60min give Activated Charcoal, then gastric lavage w/ warmed NS via Ewald tube (or salem sump) Charcoal: we give 5-10x the toxin amount |
front 31 Celecoxib | back 31 AE: CVA events, Heart Problems, MI, Kidney damage CI: Bad if Pt has hx of heart attack (MI) CI: Sulfa/ Sulfonamide allergy |
front 32 Acetaminophen : APAP | back 32 CI: Alcohol use DO, Cirrhosis AE: Liver damage RN: Max for most (relatively healthy) pts is 4g in 24hrs; RN: Antidote is Acetylcysteine |
front 33 DMARD Drugs | back 33 Methotrexate (MTX) can hurt the liver (Hepatic Fibrosis) , No ETOH, Drink 2L of water/day -Need to give Folic Acid Supplements , Leucovorin to help protect healthy cells from MTX Hydroxychloroquine AE: Blindness |
front 34 DMARD II Drugs | back 34 Adalimumab (SQ), Infliximab (IV) can reactivate TB test prior to starting, CI if any Hx of Hep B Make sure you get a neg TB test Rituximab + (Steriod before infusion) Should stay w .the pt for 15min and has resuscitative equipment ready, same reactivation for TB , need Neg Test CI if ever had Hep B before |
front 35 Cyclosporine A, Cyclophosphamide | back 35 AE: Nephrotoxic, Hepatoxic, Gingival Hyperplasia, Used in transplant pts, lifelong Organ Rejection If they have an organ transplant, they need to continue these meds for the rest of their lives. NO grapefruit juice. |
front 36 Gout/ Gouty Arthritis | back 36 Colchicine (Acute Attacks) TX: For acute attacks, AE: Rhabdomyolysis (we teach them to increase there fluid intake) RN: Take with food, but do not eat high purine foods - red meat, alcohol and fish Do not drink grapefruit juice, ETOH: Do increase fluid intake. |
front 37 Chronic Gout Attacks Meds | back 37 Allopurinol TX: Chronic gout Avoid high purine foods: ETOH, Red meats, |
front 38 Meds for Peripheral Neuropathy | back 38 Duloxetine, Pregabalin, Gabapentin, Pyridoxine (Vit B6) AE: Drowsiness |
front 39 Osteoporosis Meds - Calcium | back 39 All these drugs prevent bone loss, can cause Hyper Ca+ Constipation. Ca Acetate (Phoslo)*** CKD.. Reduces Phos in ESRD patients. |
front 40 Bisphosphonates | back 40 Alendronate, Ibandronate, Risedronate, Zoledronic Acid AE: Stomatitis, NV, Abd Pain, Jaw Necrosis and Dysphagia, Blur Vison, Muscle/joint pain Sit up for 30min Post Admin, Give on Empty Stomach 1st thing in the morning with water. |
front 41 SERMS Raloxifene, Tamoxifene | back 41 AE: Blood clots, DVT's, Hot flashes PT: Notify is planned immobilization (travel, surgery) |
front 42 Names of Drugs in Full Agonist and Antagonist | back 42 Full Agonist: Fentanyl, Hydromorphone Antagonist: Naloxone Make sure to monitor pt for RR Depression (12-20) |
front 43 Opioid Toxcity Triad | back 43 Pinpoint Pupils, RR Depression, Decreased LOC (Coma) Naloxone - You worry about it wearing off before the opioids do.. stay w patient for 2 hrs. |
front 44 Transdermal Fentanyl Patch (Duragesic) | back 44 It takes 12-24 hrs to achieve the desired therapeutic affect. |
front 45 Migraine Medications | back 45 Triptans: Sumatriptan, Rizatriptan (Maxalt) - can take first dose 2hrs before and if it does not work after 2hrs they can take another dose and that is it, In pt w/ MI history, because litter arteries vasoconstrict so it decreases heart flow. Ergots (Ergotamine) If patient take this med, they cannot take a Triptan. drugs ending in - Caine are local anesthetics. we commonly add epinephrine to the local anesthetic. - it extends the action, will make it work longer and decrease the potential for side affects. |
front 46 What is the most common hypo or hyperthyroid? | back 46 Hypothyroid |
front 47 What are the S/S of Hypothyroid? | back 47 metabolism is low, weight goes up, everything else goes down, HR,BP,RR |
front 48 What is the common drug that is prescribed for hypothyroidism? | back 48 levothyroxine (Synthroid) |
front 49 what are the A/E for levothyroxine? | back 49 hyperthyroidism, HTN, Increased HR, Seizures, tremors, insomnia, PO - 30-60min in the morning before breakfast on an empty stomach once they take it they have to take it forever; hold if HR is over 110 |
front 50 Hyperthyroidism | back 50 it is less common and harder to treat. If it is bad they will need surgery. They can take Methimazole or PTU (if preggo) |
front 51 Endocrine disorders hyperthyroidism Methimazole, PTU | back 51 Indications: Euthyroid state before/after surgery A/E: Agranulocytosis/Pancytopenia S/S Monitor sore throat, fever Hypothyroidism (drowsiness, depression, weight gain, edema, bradycardia, cold intolerance, low bp) RN: Monitor for bradycardia |
front 52 Pituitary Deficiency - low growth hormone Somatropin | back 52 Indications: Deficiency, AIDS wasting, Cachexia A/E: Hyperglycemia S/S Renal Calculi RN: Adjust insulin, monitor for flank pain, drink plenty of fluids, rotate injection sites. |
front 53 Who should not get Vasopressin/Desmopressin? | back 53 it is a synthetic ADH hx of heart attack, bad angina, heart problems, pt should be on ekg because it constricts pt coronary arteries. |
front 54 What can vasopressin do? | back 54 can make the brain swell (water intoxication) , S/S decreased Na Low Na can cause Seizures. interactions: Lithium monitor serum Na; monitor I&O closely, monitor urine SG |
front 55 What helps you response to stress? | back 55 cortisol, Cortisone (Glucocorticoids), w/o cortisol the stress can kill you. |
front 56 Glucocorticoids (steriods) | back 56 Beclomethasone, Fluticasone, Budesonide MOA: Synthetic version of body's natural cortisol made in adrenal gland we need to increase dosing in times of stress, illness, and injury or surgery. It can suppress adrenal gland function (if po), Ask the MD @ Q OD Dosing, Do not stop abruptly, taper off |
front 57 The most common GI issue | back 57 H. Pylori, it can create ulcers, it can live in the acid in the stomach test with urea breath test, |
front 58 How do you tx H. Pylori? | back 58 with 3 medications, clarithromycin, amoxicillin, metronidazole, tetracycline Probiotics: Saccharomyces Boulardii Prophylactically helps prevent diarrhea, C. Diff |
front 59 What causes consipation? | back 59 calcium and aluminum |
front 60 what causes diarrhea? | back 60 magnesium |
front 61 cimetidine, famotidine, nizatidine | back 61 MOA: Decreases acid production Indications: Peptic ulcers, GERD A/E: CNS Effects Cimetidine= Gynocomastia, ED, PNA stop smoking because it delays wound healing, vasoconstrictor so it decreases blood flow, no alcohol can irritate the Ulcer, avoid taking NSAID's |
front 62 proton pump inhibitor - omerprazole, pantoprazole, lansoprazole | back 62 A/E: can decrease Vit D, Absorption, which can cause osteoporosis, also lower B12 pernicious anemia - tongue gets inflamed. |
front 63 what is a mucosal protectant | back 63 Sucralfate, forms a barrier over the ulcer S/S Bleeding RN: Increase dietary fiber and fluid intake |
front 64 Misoprostol | back 64 relieves symptoms of ulcers, CI: Pregnancy Makes sure you do pregnancy test before giving it |
front 65 Types of Laxatives | back 65 bulk forming - Psyllium Husks (Metamucil) Need to drink H2O Surfactant Laxatives - Docusate Sodium makes poop soft
"stool softener" Osmotic - Really makes you go, magnesium hydroxide (MOM) Mag citrate, sodium phosphate PEG, Lactulose, Sorbitol, Sodium Polystyrene Sulfonate (Kayexalate) |
front 66 pro-Kinetics Metoclopramide (Dopamine Antagonist) | back 66 Indications: Constipation, Emesis CI: GI Obstruction, w/ seizure history, pheochromocytoma, parkinsons A/E: EPS (Tardive Dyskinesia), NMS, Sedation RN Teaching: monitor for involuntary movements, do not drink ETOH |
front 67 Anti-Diarrheals Diphenoxylate + Atropine | back 67 A/E: Atropine, added so pts do not take high doses of this drugs Interactions: ETOH and other CNS Depressants monitor dehydration, Avoid drinking 3 things: ETOH, Caffeine, water |
front 68 loperamide | back 68 not a controlled substance CI: UC, Bloody stools, Diarrhea w/ high fever, or caused by ABX Indications: Often used to reduce amount of stool in people w/ ileostomy Monitor dehydration Avoid drinking: ETOH, Caffeine, water, tonic water, grapefruit juice |
front 69 Antiemetics | back 69 Anticholinergic: scopolamine; A/E: Anti-ach, not for BPH/Glaucoma pts H1 antihistamines: Dimenhydrinate (Motion sickness) Give 30-60min prior to activity; not for BPH/glaucoma pts Serotonin antagonists: Ondansetron (Zofran) Has aspartame (CI in PKU); AE prolonged QT interval, headache, Dizziness Dopamine Antagonists: Prochlorperazine, Metoclopramide |
front 70 Banana Bag | back 70 TX: For ETOH use DO Certain malnutrition pts contains: multivitamins, B Vit. Folic acid/Thiamine, magnesium |
front 71 TPN | back 71 Used when won't be able to eat more than 7 days. A.E: Infection RN: Give through a filter, start infusion slowly, do not stop abruptly as can cause fatal hypoglycemia, if bag empty or no replacement available then hang D10%W Change tubing every Q24hrs for TPN Q12 hrs for lipids. |
front 72 what is insulin? what does it do? | back 72 increase glucose and potassium A/E: Hypoglycemia, Hypokalemia, lipodystophy How do you store the vials? unopened: in fridge until expiration date opened: room temp for 1 month. |
front 73 Rapid acting (Lispro insulin) | back 73 onset: 15-30min Peak: 30min - 2.5 hrs Duration: 3-6hr |
front 74 Short acting (regular insulin) | back 74 onset: 30min - 1hr Peak: 1-5hr duration 6-10hr |
front 75 Intermediate acting (NPH Insulin) | back 75 Onset: 1-2hr Peak: 6-14hr Duration: 16-24hr |
front 76 Long Acting (insulin glargine) | back 76 onset: 70min Peak: none- levels are steady Duration: 18-24hr |
front 77 Metaformin (XR) - 1st in line for DM | back 77 A/E: Lactic Acidosis CI: ETOH, Renal impairment CT scan with contrast, usually stop before test, and hold for 48hrs afterwards and until normal BUN/CR |
front 78 Oral Sulfonylureas Glipizide, Glyburide, Glimepiride | back 78 RN: NO ETOH |
front 79 Oral Glucosidase inhibitor Acarbose | back 79 RN: Is a PO med that does not need insulin/pancreas to function |
front 80 Brand Names, what are there generic names? Versed Tylenol | back 80 Generic name: Midazolam Acetaminophen |
front 81 USP | back 81 U.S. Pharmacopeia |
front 82 OTC Drugs | back 82 Non prescription drugs |
front 83 Controlled substances | back 83 Placed into one of five schedules |
front 84 What is a schedule 1 drug? | back 84 Marijuana (Cannabis) |
front 85 What is a schedule 2 drug? | back 85 Cocaine |
front 86 What does inidcation mean? | back 86 what is the med given for? |
front 87 What does dopamine antagonist cause to a pt? | back 87 Like prochlorperazine and metoclopramide have weird tics and twiches, might never go away |
front 88 what is the contraindication? | back 88 reason to NOT give/prescribe the drug to pt |
front 89 What is docustate sodium used for? | back 89 to prevent constipation in pt receiving opioids |
front 90 Off-Label? | back 90 Prescribed for a different use than what it was made for |
front 91 what prevents the tetracycline antibiotic to absorb? | back 91 calcium it is called a drug interaction |
front 92 What causes increased bleeding? | back 92 cinnamon, garlic, gingko, ginger, ginseng |
front 93 A drug is NOT absorbed until it leaves __ _____ and enters bloodstream | back 93 GI Tract |
front 94 Metabolism | back 94 gets broken down 10 to 4mg - first pass effect, it happens in the liver when taken PO What effects metabolism? Grapefruit juice, other drugs, pt body size/weight, age, activity level |
front 95 Distribution | back 95 Gets delivered through the blood |
front 96 Excretion | back 96 exit the body |
front 97 what are teratogens? | back 97 drugs/chemicals that cause birth defects |
front 98 long half life vs short half life | back 98 long stays in body for long times, short half-life stops working quickily. |
front 99 tachyphylaxis | back 99 Rapid decrease in pt response to drug |
front 100 Additive vs synergistic effects | back 100 Unexpected increase in effects when 2 drugs are given together |
front 101 Sludge BBB / DUMBBBELLS | back 101 Salivation/Sweating, Lacrimation, Urination, Diarrhea, GI Upset, Emesis, Bradycardia, Bronchoconstriction, Bronchorrhea Diarrhea, urination, Miosis, bradycardia, bronchoconstriction, bronchorrhea, emesis, lacrimation, salivation, sweating |
front 102 LOOP Diuretics Furosemide (Lasix), Bumetanide, Ethacrynic Acid | back 102 A/E: Dehydration, Drop BP, Hyponatremia, Hypokalemia, Hypocalcemia, Hypomagnesemia, Hyperglycemia, Hyperuricemia, Ototoxicity/ Tinnitus RN: Check BP before give, Daily weights, weigh at same time everyday, same amt of clothing/bedding Do not take in evening (Nocturia) Get up slowly, be aware of ortho hypotension risk Request Potassium Supplement |
front 103 Low k+ makes Digoxin toxic, Low Na+ Makes lithium toxic, Low Ca+ levels cause Chvostek (Tap there face and have ticks) & Trousseau's (when inflate bp cuff there arm contracts like a spasm) | back 103 Causes of Loop Diuretics |
front 104 Ortho BP | back 104 Lay down 5min, Standing 1min, Standning 3min |
front 105 Thiazide Diuretics Hydrochlorothiazide (HCTZ), Metolazone | back 105 A.E: Dehydration, Hypotension, Hyponatremia, Hypokalemia, Hyperglycemia, Hyperuricemia, Hypercalcemia *good for pt w. tinnitus |
front 106 Potassium Sparing Diuretics Spironolactone also Trimterene | back 106 A/E: Hyperkalemia , Hyponatremia A/E: Endocrine effects, deep voice, hirsute, irreg menstrual cycle; gynecomastia, impotence Triamterene causes Blue Urine Ka levels go up, it is dangerous when taking concurrently that also cause ka to rise. CI if Kidney failure, pregnant |
front 107 TX for Hyperkalemia | back 107 Ca Chloride IV: Sodium Bicarbonate Iv Insulin: D50 IV Loop Diuretics Neb Beta-agonist (Albuterol) PO or Supp Sodium Polystyrene Sulfonate (Kayexylate) |
front 108 Osmotic Diuretics Mannitol | back 108 TX: Reduce intracranial and intraocular pressure A/E: HF (Fluid overload) Can form crystals, draw up in syringe using filter needle, or use a filter IV tubing set, see if visible crystals in the vial then warm and agitate |
front 109 Iron Supp Ferrous Sulfate, Iron Dextran | back 109 A/E: GI distress Take 1hr before meals, on an empty stomach. but food greatly decreases absorption. Teeth Staining Dilute liquid with water or juice and use a straw w/ liquid form (teeth) rinse mouth afterwards. Do not keep on teeth because it can stain them. Stools can become black or dark green. |
front 110 What does Iron dextran cause? | back 110 anaphylaxis and you tx it with Epinephrine 1 to 1,000 concentration IM but can be given subcu as well. know antidote is deferoxamine |
front 111 Vit B12 (Cyanocobalamin) | back 111 it tx pernicious anemia monitor for S/S of B12 deficiency (Red beefy tongue) pallor, neuropathy, encourage to eat foods high in B12 |
front 112 Folic Acid | back 112 Tx: Supplement for alcohol use DO (due to poor dietary intake and injury to the liver) |
front 113 Banana Bag | back 113 TX: ETOH DO TX: Certain malnutrition pts, homeless, pysch |
front 114 Potassium Supplements Potassium chloride, potassium gluconate | back 114 TX: Hypokalemia, concurrent w/ Diuretics or steroids; replacement after prolonged diarrhea, laxatives, vomiting etc. CI: Renal Disease Assess ability to swallow - PILL IS HUGE, don't dissolve tablet in mouth, take w. meals, never give IV push, IV Infusion give peripheral no faster than 10mEq/hr. central...20mEq/hr. |
front 115 Magnesium Supplements Magnesium Sulfate | back 115 Torsade de pointes: IV Magnesium is first line tx If administering IV magnesium, then put on monitor (any electrolyte) |
front 116 IV Infiltration | back 116 S/S Pallor/Swelling, site feels cool stop the infusion, remove the bad IV |
front 117 IV extravasation | back 117 vesicant medication EG: Epi, Potassium chloride, Dopamine Stop the infusion, leave bad IV to infuse antidote, Notify the M.D. |
front 118 Blood aka PRBC's | back 118 (Packed red blood cells) we get the blood from blood bank |
front 119 Blood transfusions | back 119 Blood tubing, has 2 filters, with NS only. start admin of blood within 30min of pickup at the blood blank, never administer any medications in a line that is infusing blood product. finish within 4hrs |
front 120 Blood tranfusion reaction | back 120 Temp increase to >1.8 deg, other concerning S/S: SOB, Drop SBP, Hives if it occurs: stop the infusion, notify MD, save blood and old tubing for blood bank (they will test) |
front 121 MALE HRT Testosterone | back 121 Tx: pt who gave AIDS, Cachexia and other muscle wasting conditions. instruct clients use gel formulas to wash their hands after every application due to the Possibility of skin-to-skin transfer to others. |
front 122 BPH: Finasteride, Dutasteride, etc. | back 122 A/E: Decreased libido, Gynecomastia, decreases PSA levels. RN/Teaching is usually lifelong therapy, female clients shouldn't handle medication (wear gloves!) avoid semen. therapeutic effects can take 6 months or longer: SLOW. |
front 123 Tamsulosin, Doxazosin | back 123 A/E: Hypotension, Dizziness, retrograde ejaculation CI: Client start using sildenafil or NTG; Hx of syncope RN/Teaching: Monitor BP, especially at the start of therapy and with changes of dose. usually lifelong meds, take tamsulosin 30min after meals, works fast 48hrs! |
front 124 Sildenafil, Tadalafil, Vardenafil | back 124 A/E: MI, sudden death, OH, Priapism, sudden hearing loss and visual char CI: **Any client taking Nitroglycerin NTG, or nitrate drug such as isosorbide dinitrate** do not drink grapefruit juice report erection lasting >4hrs teach pt to avoid hot showers, because giving NTG ask if pt has used male enhancement in last 48hrs |
front 125 Estrogens CEE (Premarin), Estradiol, Ethyl Estradiol | back 125 TX: contraception CI if >35+ and smoker A/E: Endometrial, breast, and ovarian CA PO: Do not place patch near breast, waistline A/E: Hypercoagulability (DVT, Stroke, MI) Avoid Cig smoking/ nicotine products. |
front 126 Progesteronea Drospirenone (if synthetic progesterone) | back 126 A depot injection Releases slowly overtime RN: Use gloves if you are or could be pregnant Implants (Nexplanon) must be replaced in 3yrs IUDs lasts 3-10yrs |
front 127 local anesthetics Lidocaine**, tetracaine, Procaine, bupicicaine (exparel) | back 127 A/E: Last syndrome Local anesthetic systemic toxicity RN: know that Epinephrine is added to the local to extend the action of the drug and prevent it spreading away from the site of incision .. helps prevent LAST |
front 128 Asthma What if the acute attack is not being reversed? | back 128 Medical emergency "status asthmaticus" |
front 129 Early vs Late signs of Hypoxia | back 129 Early signs - anxiety, confusion and restlessness Late signs - cyanosis, hypotension (sys. failure) |
front 130 Is COPD reversible ? | back 130 no, they will take drugs daily to improve breathing, but it is nonreversible. chronic meds are maintaince meds |
front 131 Lower Respiratory Drugs = BAM SLaM | back 131 B - Beta Adrenergic Agonists A - Anticholingerics M - Methylxanthines S- Steroids L - Leukotriene M- Mast cells |
front 132 BAMs vs. SLaM | back 132 BAMs are primarily Bronchodilators and SLaMs are primarily anti inflammatory. |
front 133 Albuterol, Levalbuterol, Terbutaline (Short acting) | back 133 tx: prn for acute asthma attacks, acute breathing problems, bronchospasms **Use B2 agonist first, wait 5min before using steroid inhaler** Status Asthmatics meds IV terbutaline - Peds IV Epinephrine (B1 & B2) , IV Isoproterenol (B1 & B2) affect the heart increase HR We also give IV steroid during status - Methylprednisolone |
front 134 Formoterol, Salmeterol, Vilanterol (LONG acting) | back 134 Not used for PRN acute breathing problems |
front 135 A/E for both SABA and LABA | back 135 A/E: Tachy, Angina, MI A/E: Hyperglycemia, hypokalemia A/E: insomnia, tremors Avoid use of caffeine report HR >20-30/min |
front 136 Using an MDI | back 136 Shake MDI, Exhale, Put MDI in mouth, Press button and inhale slowly and deeply at same time, try and hold breath for 10 secs, exhale - wait 1-2 min between puffs same med - wait 5min between different meds |
front 137 Anticholinergic (inhaled) Ipratropium, Tiotropium, | back 137 A/E: Dry mouth CI: Soy peanut allergies, caution BPH Glaucoma Do not swallow capsules. |
front 138 Anaphylactic reaction tx | back 138 Epinephrine IM 0.5mg of 1:1,000 |
front 139 Methylxanthines Theophylline, Aminophylline | back 139 A/E: Dysrhythmias, tachycardia CI: not with caffeine Therapeutic range 5 to 15 mcg Smoking increases theophylline metabolism |
front 140 Steroids aka Glucocorticoids -ONE Beclomethasone, Fluticasone, Budesonide | back 140 tx: inhaled Q daily for long term prophylaxis in COPD, chronic severe asthma Status Asthmaticus (IV Methylprednisolone) A/E: Candidiasis/ Hoarseness, Prevent by rinse in mouth with water treat with Nystatin preparation (swish and spit/swallow) avoid eating for 15min |
front 141 Leukotriene Modifiers MonteLUKast, SiLEUton, ZafirLUkast | back 141 TX: long term asthma maintenance therapy in adults and children 1yr+ seasonal allergies maintenance is a PO chewable pill A/E: SuicudaLLL ideation, LLiverr injury CI: Cirrhosis Obtain : LLLL (Lfts ALT/AST) PO once daily at bedtime |
front 142 Mast Cell Stabilizers Cromolyn | back 142 TX: Exercise Induced Bronchospasm adults A/E: Metallic taste, burns throat. 15-30min before exercise |
front 143 Upper respiratory DO's Acetylcysteine | back 143 Used to thin mucus., give zofran (Ondansetron) before giving. A/E: Bronchospasm RN/Teaching: Suction setup for emesis/aspiration Smells like rotten eggs, |
front 144 Codeine (AC), Hydrocodone cough Suppressant | back 144 Tx: Chronic non-productive ("dry") cough CI: Etoh and CNS depressants, No codeine in children <12 yo , breastfeeding |
front 145 Dextromethorphan (DM) | back 145 Mimic an opioid but is not one. Potential abuse as can instill euphoria in high doses but no prescription us required. |
front 146 Benzonatate (Tessalon Perles) | back 146 MOA: Numbing certain nerves in the lungs and airways, lessening the urge to cough. Might cause mucus to build up in these areas. |
front 147 Decongestants EPHedrine, PhenylEPHrine, PseudoEPHedrine, Oxymetazoline. | back 147 MOA: Sympathomimetic A/E: Rebound congestion, CNS stimulation, agitation, can keep you awake. RN: Short term therapy no more than 3-5 days! |
front 148 Expectorants (Losens Secretions) Guaifenesin | back 148 for "Wet" cough take with full glass of water drink lots of fluids |
front 149 Glucocorticoids Nasal Momertasone, Fluticasone, Budesonide | back 149 moa: Decrease inflammation Clear blocked nasal passages with a topical decongestant prior to glucocorticoid admin |
front 150 H1 Antihistamineds Diphenhydramine, Promethazine, Meclizine | back 150 TX: Itching, sneezing, seasonal allergic reactions, rhinorrhea, motion sickness, CNS: Drowsy, confusion Anticholinergic like effects - Dry mouth, dry eyes GI: GI upset (can take with food to minimize) AVOID CNS depressants avoid driving, increase fluid intake. |
front 151 Promethazine specific | back 151 A/E: RR depression ci: <2yr YO or breafastfeeding <6yr COPD, OSA |
front 152 2nd gen H1- TADINE -ZINE - STINE Loratadine, desloratadine, cetirizine, levocetirizine, fexofenadine, Azelastine | back 152 tx: allergies, itching, sneezing, rhinorrhea, urticaria, lacrimation, redeyes RN: Take with water, do not take with fruit juices |