Exam 4

• Chloroquine- malaria tx

  Side effects: retina damage (color vision changes, blurry vision, red eye)

  Nursing actions: monitor liver enzymes (ALT, AST), monitor for vision changes
• Mefloquine- tx malaria

  Side effects: anxiety, depression, suicidal thoughts, hallucinations

  Nursing actions: monitor renal function, monitor liver enzymes, monitor for vision changes

  Pt education: report vision changes, use as prophylaxis before, during, and after travel
• Anthelmintics- tx parasitic worms

  Side effects: GI upset

  Pt education: hand hygiene, take showers instead of baths, change sheets, avoid contact with family
• Serotonin antagonists- tx nausea and vomiting caused by chemo

  Drugs: ondanestron, dolasetron, guanisetron
• What patient conditions should you avoid laxative use in?

  Undiagnosed abd pain, inflammatory GI disorders, bowel obstructions, pregnancy
• Laxatives- tx constipation
• Bulk forming laxatives- psyllium, polycarbophil, methylcellulose

  Nursing actions: monitor bowel sounds, I&O, monitor for electrolyte imbalances

  Pt teaching: mix with water immediately before use, do not swallow dry, do not inhale, do not overuse
• Stimulant laxatives- senna, castor oil, bisacodyl

  Side effects: abd cramps, N/V/D, fluid and electrolytes imbalances

  Nursing actions: I&O, monitor electrolyte imbalances

  Pt teaching: increase water intake, avoid overuse, swallow tablets whole, take with just water
• Antidiarrheals- Diphenoxylate with Atropine, Bismuth subsalicylate, Difenoxin with Atropine, Loperamide hydrochloride

  Nursing actions: monitor vitals, monitor bowel movements, monitor for dehydration and electrolyte imbalances
• What medications are used to treat ulcers caused by H. pylori?

  Triple therapy: metronidazole/ amoxicillin, omeprazole/ lansoprazole, clarithromycin
• Protein pump inhibitors- omeprazole, lansoprazole, esomeprazole

  Action: inhibit hydrogen potassium ATPase to reduce gastric acid to allow ulcer to heal
• Histamine2 blockers- famotidine, cimetidine

  Action: block H2 receptors in stomach to reduce gastric acid secretion, allowing ulcer to heal

  Nursing actions: give lower dose to older adults, monitor renal function, assess pain

  Pt teaching: report pain, cough, or hemoptysis, avoid smoking, do not drive, do not take with iron supplements
• Antacids- sodium bicarb, calcium carbonate, aluminum hydroxide

  Action: neutralize HCl and reduce pepsin activity

  Nursing actions: monitor renal function, assess for pain and electrolyte imbalances, avoid administering with other oral drugs

  Pt teaching: report pain and cough, do not take with milk or vit D, take 1-3 hours after meals, follow with 2oz of water
• Pepsin inhibitor- sucralfate

  Action: forms thick paste to cover ulcer and protect it from acid and pepsin

  Nursing actions: monitor renal function, assess pain, administer on an empty stomach

  Pt education: keep taking even if you feel better, ulcer takes 4-8wks to heal, take on empty stomach, take 1-2 hours before other meds
• Growth hormone deficiency drug- somatropin

  Action: replaces growth hormones that body fails to produce

  Side effects: paresthesia, weakness, hyperpigmentation, hypothyroidism, glucose fluctuations, joint pain
• Desmopressin- treats antidiuretic hormone deficiency and diabetes insipidus

  Side effects: Hyponatremia, hypotension, seizures, diarrhea, nausea, vomiting

  Monitor: vitals, daily weight, urinary output
• What patient conditions prevent taking thyroid medications?

  Myocardial infarction, adrenal insufficiency, thyrotoxicosis
• Thyroid drug interactions

  Increased effect of anticoagulants, decreased effect of insulin, digoxin and lithium increase action of thyroid drugs
• Hypothyroid drugs- levothyroxine sodium, liothyronine, desiccated thyroid

  Nursing actions- monitor for bradycardia, hypotension, and weight loss. Test thyroid function

  Pt teaching: avoid soy, broccoli, iodized salt, shellfish, and coffee. Take at same time each day in relation to meal time
• Hyperthyroid drugs- thioamides (PTU, methimazole)

  Nursing actions: monitor for tachycardia and weight gain. Monitor TSH, T3, T3, CBC

  Pt teaching: avoid soy, broccoli, iodized salt, shellfish, and coffee. Contact provider if sore throat or fever
• Calcitriol- promotes calcium absorption and secretion of calcium from bone to blood to treat parathyroid hormone deficiency

  Side effects: hypercalcemia (fatigue, weakness, nausea, vomiting, diarrhea, cramps, dizziness, constipation)

  Nursing actions: monitor calcium, assess for tetany

  Pt teaching: inform provider of pregnancy status, check OTC drugs for calcium
• Glucocorticoids- prednisone, hydrocortisone, dexamethasone

  Side effects: hyperglycemia, muscle wasting, abnormal fat deposits, edema, euphoria, psychosis, thin skin, peptic ulcers

  Interactions: Increase potency of aspirin and NSAIDs, increase potassium loss with furosemide

  Nursing actions: monitor BP and weight, administer as ordered, monitor glucose, sodium, and potassium

  Pt teaching: must be tapered, take with food, eat food rich in potassium
• Mineralcorticoid- fludrocortisone

  Side effects: fluid imbalance, fluid overload, HTN
• Insulin lispro:

  Rapid acting

  Onset: 15-30 min

  Peak: 30-90 min
• Insulin Aspart:

  Rapid acting

  Onset: 10-20 min

  Peak: 40-50 min
• Insulin Glulisine:

  rapid acting

  Onset: 20-30 min

  Peak: 50 min
• Oral inhalation:

  Rapid acting

  Onset: 12-15 min

  Peak: 53 min
• Regular insulin:

  Short acting

  Onset: 30 min

  Peak: 1.5-3.5 hrs
• NPH:

  Intermediate acting

  Onset: 1-2 hrs

  Peak: 4-12 hrs
• Insulin Glargine:

  Long acting

  Onset: 1-1.5 hrs

  Peak: none
• Insulin Detemir:

  Long acting

  Onset: 1-2 hrs

  Peak: 6-8 hrs
• Insulin Degludec:

  Long acting

  Onset: 1 hr

  Peak: 12 hrs
• Insulin nursing actions


  Monitor vitals, monitor glucose and hemoglobin A1C, teach patient
• Patient teaching for insulin

  Immediately report hypoglycemia (which is most likely to occur at peak), eat candy or sugary drinks for hypoglycemia
• Insulin storage- good for 1 month at room temp and 3 months refrigerated
• Drugs that increase effects of insulins(hypoglycemia)

  Beta blockers, MAOIs, aspirin, alcohol
• Drugs that decrease effects of insulins (hypergylcemia)

  Thiazide diuretics, glucocorticoids, thyroid drugs, furosemide, estrogen
• Sulfonylureas- Glimepiride, glipizide, tolbutamide, tolazamide, chlorpropamide

  Action: Stimulate beta cells to secrete more insulin, increase tissue response to insulin, and decrease glucose response

  Side effects: hypoglycemia, hyponatremia, blurred vision, nausea, vomiting, weight gain
• Biguanides- metformin

  Action: decrease production of glucose from stored glycogen, which diminishes increase in glucose after meals

  Side effects: GI distress, headaches, anorexia, flushing, NO hypoglycemia
• Alpha-glucosidase inhibitors- acarbose, miglitol

  Action: Inhibits digestive enzyme in small intestine that releases glucose from carbohydrates to delay absorption of carbohydrates

  Side effects: GI distress, anemia, weight loss, edema, elevated hepatic enzymes