-
Bisphosphonates administered at high doses (especially those given intravenously, such as zoledronic acid (Reclast) and pamidronate (Andreia)), have been linked to the complication of
jaw necrosis
-
Patients taking a bisphosphonate, such as alendronate (Fosamax) must take the medication on an empty stomach (enhances absorption) with 8 ounces of WATER only (prevents pill from getting stuck). To prevent the complication of esophagitis, what else should the patient be instructed to do?
Remain in an upright position for 30-60 minutes, before eating.
-
Which four classes of medications taken over a long period of time may affect calcium metabolism and bone metabolism, and thus cause secondary osteoporosis:
- loop diuretics
- corticosteroids
- thyroid meds
- anticonvulsants
-
Celecoxib (Celebrex) is an NSAID COX-2 Inhibitor. Patients with a history of what should not receive celecoxib?
- GI issues (ulcers, GERD)
- renal impairment
- cardiovascular disease
-
NSAIDS are nephrotoxic. Four signs and symptoms of NSAID-related impaired kidney function are as follows:
- decreased urine output
- weight gain from fluid retention
- increased BUN (7-20)
- increased creatinine (0.6-1.2 (M) / 0.5-1.1 (F))
-
What type of drugs are used to stimulate production of red blood cells and platelets is common in clients with chemotherapy-induced anemia and thrombocytopenia.
Growth Factors
-
The growth factor, ? is used to stimulated red blood cells
Erythropoietin (Epogen, Procrit, Aranesp)
-
? is an example of a growth factor to stimulate the production of platelets.
oprelvekin (Neumega)
-
Antiemetic medications to relieve chemotherapy-induced nausea and vomiting (CINV) are usually given when?
-
Name a Serotonin antagonists are a classification of medications used to treat CINV (Chemo-induced N/V)
ondansetron (Zofran)
-
What are the serious adverse effects associated with serotonin antagonists (Zofran) that make the patient a fall risk?
- Bradycardia
- Hypotension
- Vertigo
-
What education should you provide for the client on a serotonin antagonist to decrease his risk for a fall?
Change positions slowly
-
Hormonal agents are noncytoxic medications that are effective against tumors that are ? by hormones.
SUPPORTED or SUPPRESSED
-
Androgen receptor blockers are hormone antagonists used to suppress ?
prostate cancer
-
An example of an androgen receptor blocker that blocks testosterone at the receptor site is ?
Flutamide (Eulexin)
-
Men taking flutamide should be warned about the following adverse effects related to decreased testosterone:
- hot flashes
- decreased libido
- gynecomastia
-
Tamoxifen (Nolvadex) is an estrogen receptor antagonist that is mainly used for the treatment of
estrogen receptor-positive breast cancer
-
A serious potential complication associated with tamoxifen
endometrial cancer
-
? is a disease-modifying antirheumatic drug (DMARD) that has both cytoxic properties and immunomodular properties.
Methotrexate (Trexall)
-
There are numerous potential adverse effects/complications related to methotrexate use, name some:
- Increased risk for infection
- Hepatic toxicity
- Bone Marrow SUPPRESSION
- Ulcerative stomatitis
- Fetal death/congenital abnormalities
-
There are MANY adverse effects/complications associated with glucocorticoid use, name some
- Immunosuppression
- Osteoporosis
- Adrenal suppression – taper off
- Fluid retention
- Weight gain
- GI issues – take H2 blocker (Pepcid)
- Hyperglycemia
- Hypokalemia
-
What is the appropriate client education related to the complication of osteoporosis from steroids?
- Calcium and Vit D supplements
- Bisphosphonates
-
What are the nursing considerations related to the complications of fluid retention with steroid use?
- Monitor for S/S
- Weight gain
- Edema
- Crackles
-
What are the nursing considerations related to the complications of GI issues with steroid use?
- observe for S/S
- take H2 blocker (Pepcid, zantac…)
- watch for GI bleed (coffee ground emesis, black tarry stools)
-
What are the nursing considerations related to the complications of Hyperglycemia with steroid use?
- observe for S/S
- Monitor BS
- May need to adjust hypoglycemic meds
-
What are the nursing considerations related to the complications of Hypokalemia with steroid use?
- Observe for S/S
- Monitor potassium labs
- Increase potassium-rich foods
- Admin potassium supplements
-
The dosage of glucocorticoids is always adjusted and withdrawn
gradually (tapered)
-
The "pril's" are what type of drugs and name an example
ACE Inhibitors lisinopril
-
What is the mechanism of action for ACE Inhibitors?
- cause VASODILATION
- block the conversion of angiotensin I to angiotensin II
-
What are the therapeutic uses of ACE Inhibitors?
-
What are the complications of ACE Inhibitors?
- orthostatic hypotension
- cough
- hyperkalemia
- rash
- dysgeusia (altered taste)
- angioedema
- neutropenia – rare (captopril)
-
What education should be given regarding ACE Inhibitors and orthostatic hypotension?
- change positions slowly
- lie down if feeling dizzy, light-headed, or faint
-
In regard to ACE Inhibitors, what are the nursing considerations related to the complication of hyperkalemia?
- monitor potassium level
- avoid salt substitutes containing potassium
- monitor for hyperkalemia – numbness and tingling and paresthesia in hands/feet
-
A client taking an ACE Inhibitor should be advised to notify a provider if any of the following develop
- cough
- rash
- dysgeusia (altered taste)
- S & S of infection
-
What are the therapeutic uses of verapamil and diltiazem?
- Angina pectoris
- Hypertension
- Dysrhythmias (a-fib, a-flutter, SVT)
-
What are the common complications related to nifedipine, verapamil, or diltiazem?
- orthostatic hypotension
- peripheral edema
-
This class of drugs are the "lol's"
Beta-adrenergic blockers (beta-blockers)
-
How do cardioselective beta blockers differ from nonselective beta blockers?
- Selective beta blockers affect the heart only
- Non-selective beta blockers affect the heart AND LUNGS
-
Name a cardiac glycoside
digoxin
-
The expected pharmacological action of digoxin is to:
- Increase the force of contraction
- Decrease the heart rate
-
Digoxin is a second line medication to treat?
- heart failure
- atrial fibrillation
-
Conditions that increase the risk of developing digoxin-induced dysthymias are?
HYPOKALEMIA increased serum digoxin levels.
-
Patients taking digoxin concurrently with what must be monitored closely to avoid hypokalemia?
diuretics
-
Loop diuretics, such as furosemide (Lasix) are associated with the following complications?
- Dehydration, hyponatremia, hypochloremia
- Hypotension
- Ototoxicity – report tinnitus
- Hypokalemia
- Other: hyperglycemia, hyperuricemia, hypocalcemia, hypomagnesemia, decrease in HDL, increase in LDL
-
Potassium sparing diuretics, such as spironolactone, reduce blood volume by blocking aldosterone receptors in the kidney, thus promoting excretion of?
- sodium and water
- retention of potassium.
-
A complication associated with the use of potassium sparing diuretics is?
HYPERKALEMIA
-
Nursing consideration for hyperkalemia are as follows
- Monitor K+ level and all other electrolytes
- Initiate cardiac monitoring for serum K+ >5.0
- Monitor for manifestations of hyperkalemia (weakness, fatigue, dyspnea, dysrhythmias)
- Treat hyperkalemia – D/C med, restrict K+ in diet
- Do not administer K+ supplements or other K+ sparing diuretics with spironolactone
- Caution with ACE inhibitors, ARB’s, and direct renin inhibitors because they can cause elevated K+ levels
-
Short-acting beta2 adrenergic agonists (SABAs) provide
rapid short-term relief
-
Short-acting beta2 adrenergic agonists (SABAs) are most useful when:
- an attack begins (rescue therapy)
- premedication when the patient is going to begin an activity that is likely to induce an attack
-
What do we need to teach asthma patients regarding rescue inhalers?
always carry a relief inhaler ensure that it has enough med in it to deliver a quick dose when needed.
-
Long-acting beta2 adrenergic agonists (LABAs) need time to
build up an effect
-
Long-acting beta2 adrenergic agonists (LABAs) are useful in ? an asthma attack, but of no value ?
Preventing during an attack (rescue)
-
How do beta2 adrenergic agonists (SABA's and LABA's) ACT?
Selectively activate beta2-receptors in the bronchial smooth muscle = bronchodilation (relaxes bronchiolar smooth muscle)
-
Is INHALED ALBUTEROL a SABA or LABA?
SABA
-
Is PO ALBUTEROL a SABA or LABA?
LABA
-
Is INHALED LEVALBUTEROL a SABA or LABA?
SABA
-
Is INHALED SALMETEROL a SABA or LABA?
LABA
-
Is INHALED FORMOTEROL a SABA or LABA?
LABA
-
Is PO TERBUTALINE a SABA or LABA?
LABA
-
Name the common side effects of both PO and inhaled beta2 adrenergic agonists:
-
What nursing education should be given to patients regarding tachycardia while taking PO or inhaled beta2 adrenergic agonist?
- monitor their pulse
- report and increase of 20 to 30 beats per minute
-
Ipratropium and Tiotropium are examples of
inhaled anticholinergics (AKA cholinergic antagonists)
-
Two side effects/complications of inhaled anticholinergics (Ipratropium and Tiotropium) are:
-
The use of glucocorticosteroids for treatment of exacerbation and acute asthma attacks promotes
- decreased frequency
- severity
-
What is used to treat status asthmaticus?
Glucocorticosteroids via the IV route
-
Complications related to inhaled glucocorticosteroids, such as beclomethasone, include:
- Difficulty speaking
- hoarseness
- candidiasis
-
Nursing considerations in regard to complications of inhaled glucocorticosteroids, such as beclomethasone include:
- Rinse mouth or gargle with water after use
- monitor for redness, sores, white patches for thrush
- treat with nystatin oral suspension
-
Concurrent use of potassium-depleting diuretics and prednisone increase the risk of
hypokalemia
-
Concurrent use of NSAIDS and prednisone increases the risk of
GI Ulceration
-
Concurrent use of glucocoricosteroids and hypoglycemic agents results in ?
hyperglycemic serum glucose level because the effects of hypoglycemic agents are counteracted
|
|
