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Pain scales
FACES pain scale can be used for children 4 and older
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Pregnancy risk scale for medications
A,B,C,D,X
- A=safest for pregnant women
- B=no fetal risk in animals but no studies have been done on humans
- X=most dangerous
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Peak and trough
- Peak blood draw should be done when medication is the strongest in the body
- trough should be done right before the next medication dose
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Antimicrobial agents
- tx:bacterial, viral, and fungal infections,
- classified:according to micro organisms they treat.
- adverse reactions: allergy/hypersensitivity;suprainfection(emerge from the treatment of the primary infection)
- if full coarse is not taken it could develop a resistant microorganism.
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penicillins G (Bicillin LA)
-amoxicillin(broad spectrum)
-methicillin (antistaph)
- -destroy bacteria by weaking cell wall
- TX:pneumonia,meningitis
- SE:Allergy/hypersensitivity, Renal impairment, Hyperkalemia
- CONTRA:aminoglycosides(penicillin inactivates aminoglycosides) Oral contraceptives
- TEACH:give with full glass of water 1 hr before meal or 2 hours after meal.
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Cephalosporins (broad spectrum)
-cephalexin(Keflex)
- similar to penicillins where it destroys the bacterial cell wall, more able to reach cerebrospinal fluid.
- TX:UTI, meningitis, postop infections.
- SE:bleeding tendencies, thrombophlebitis, antibiotic associated psedomembranous colitis
- CONTRA:renal impairment, cautiously in pt with anticoagulants
- FOOD/MED:alcohol use, proenecid,
- TEACH: take with food, store in fridge
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Monobactams
-vancomycin(Vancocin)
(Azactam, Monurol)
- destroy bacterial cell wall
- TX:staph and MRSA and C Diff
- SE:Ototoxicity(hearing), infusion reaction(rash, tachcardia, hypotension)thrombophlebitis.
- TEACH:peak levels between 30-40ug/ml
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Tetracycline
-tetracycline hydrochloride(Sumycin)
- broad spectrum prevent bacterial protin synthesis
- TX:chlymidia, Lyme disease,anthrax
- SE:GI, yellow brown discoloartion of teeth, photosensitivity, hepatoxicity, suprainfection of the bowel
- FOOD/MED: milk products, antacids, laxatives, oral contraceptives.
- TEACH:take on an empty stomach and with a full glass of water
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Bacteriostatic inhibitors
-erthromicin(E-mycin)
-Zithromax
- inhibit protein synthsis
- TX:legionnaires disease, whooping cough, chlamydia, strep
- SE:GI, thrombophlebitis
- FOOD/MED:toxicity could result if taking asthma meds, anticonvulsant, warfarin
- TEACH: give on an empty stomach, with full glass of water
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Aminoglycosides
gentamicin(Geramycin)
- TX:Ecoli, tapeworm
- SE:Ototoxicity, Nephrotoxic, respiratory depression,
- CONTRA: penicillins
- TEACH:peak should be taken 30 minutes after administration and trough right before next dose
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Sulfonamides
- TX: UTI, bronchitis, pneumonia
- SE:blood dyscrasias(hemolytic anemia, aplastic anemia)notify PCP if has pallor, sore throat, bleeding. crystalluria, Kernicterus(jaundice), photosensitvity
- CONTRA:folate deficient, creatinine clearance<15ml/min
- MED/FOOD:warfarin, dilantin, orinase
- TEACH:take on an empty stomach with full glass of water
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vaccinations
- CONTRA: with patients that have high fever, and allergic reactions on the past, any past seizure activity within one week of recieving vaccination.
- Do not give live virus vaccine to those recieving chemotherapy and other immunosuppresants
- Tetanus shots would need to be given in those who haven ot had a booster within 10 of injury.
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Analgesics
- given to relieve pain, Narcotics, NSAIDs, antimigraine agents.
- NSAIDs=reduce fever and platelet aggregation, risk for ulcers,
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Anti-inflammatory agents
- reduce inflammation, Salicylates, Glucocorticoids, antigout and DMARDs(disease modifying antirheuatic drugs.
- salicylates=reduce fever and platelet aggregation risk for ulcers.
- Glucocorticoids=risk for ulcers,
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NSAIDs
-aspirin, Celebrex, ibuprofen
- inhibition of cyclooxygenase which decreases inflammation, pain, fever and platelet aggreagation
- SE:risk for ulcers, bleeding, renal dysfunction and reye syndrome in children
- CONTRA:ulcers, bleeding conditions, pregnancy, chickenpoxs
- FOOD/MED:warfarin, glucocorticoids, alcohol, ibuprofen
- TEACH:take with food and full glass of water or milk to prevent stomach upset
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Acetaminophen(Tylenol)
- slows production of prostaglandins in the CNS
- TX:analgesic and antipyretic
- SE:acute toxicity (ANTIDOTE=acetylcysteine(Mucomyst)
- CONTRA:habitual alcohol use
- FOOD/MED:alcohol, warfarin
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Morphine (Opioid agonists)
codeine, oxycodone, methadone
NARCAN is antidote to SE of opioid overdose
- TX:relief of moderate to severe pain, sedation and cough suppression
- SE:respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, sedation, biliary colic, emesis, opioid overdose triad
- CONTRA:after biliary surgery, premature infants,
- MED/FOOD:CNS depressants, anticholinergic, MAOIs, Antihypertensives
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Migraine meds
-Ergostat, Imitrex, propanolol(Inderal)
- px dilation and inflammation of the intracranial blood vessels, thereby relieving pain
- Ergot alkaloids=abortion physical dependance, GI discomfort
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antigout
make sure to notify physician if experiencing nausea vomiting diarrhea =gi toxicity
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Cholinesterase inhibitors
-neostigmine(Prostigmin)
- prevent the enzyme cholinestrase from inactivating acetylcholine thereby increaseing the amount of ACh available at the receptor sites and increasing the transmission of nerve impulses at all sites responding to ACh as a transmitter
- -increase muscle strength because increase in ACh of motor nerons in myasthenia
- SE: increase in GI motility, cholinergic crisis
- MED/FOOD:atropine(antedote to overdose)
- TEACH:to keep record of dosages wear med alert bracelet
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Neuromuscular agents
-succinylcholine(Anectine)
- block ACh thereby resulting in muscle relaxation, and hypotension
- SE:malignant hyperthermia, hyperkalemia, prolonged apnea,
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