NUR 516 > black box warnings > Flashcards

black box warnings Flashcards

(53 cards)

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1
Q
A
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2
Q

Key side effects of digoxin? Any black box warnings?

A

Has very narrow therapeutic margin:
- normal: 0.5-2.0
- desired level: 0.8

Digoxin toxicity:
- vision changes, N/V, dizziness
- increased risk of hypokalemia
- can be life-threatening

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3
Q

Key side effects of ACE inhibitors? Any black box warnings?

A
  • generally well tolerated and absorbed
  • hyperkalemia
  • dizziness
  • cough (“ACE cough”)
    – related to kinins and activation of arachidonic pathway and prostaglandin production
    – begins 1-2 weeks of initiation; typically resolves within few days of stopping med
  • angioedema

BLACK BOX WARNING:
- serious fatal abnormalities: not given in pregnancy and caution in childbearing-age women
- esp in 3rd trimester
- contraception very important

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4
Q

Any black box warnings for Leukotriene modifiers (singulair)?

singulair can make you psycho?

A

black box warning: psychiatric side effects such as aggression, depression, agitation, sleep disturbances, suicidal thoughts, and suicide.

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5
Q

Any black box warnings for immunosuppressant monoclonal antibodies (xolair)?

A

<0.1% anaphylaxis

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6
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): any black box warnings?

A

May cause tardive dyskinesia

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7
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): any black box warnings?

A

elderly patients with dementia-related psychosis

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8
Q

Anti-emetics: phenothiazines: Prochlorperazine (compazine) - any black box warnings?

A

is a vesicant

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9
Q

Anti-emetics: Olanzapine (zyprexa) - any black box warnings?

A

elderly patients with dementia-related psychosis

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10
Q

Long- acting Beta Agonist: Black-box warning and information

A

salmeterol (Serevent) and formoterol (Foradil) should not be used without a steroid in asthma for all ages
Need to weigh the risk vs benefits

NEVER USE AS A RESCUE INHALER
- SHOULD NOT BE USED IN CHILDREN LESS THAN AGE 4 and NEVER WITHOUT A STEROID

USE WITH A STEROID!!

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11
Q

What should be avoided when taking Levothyroxine/ Armour Thyroid

A

Calcium containing medications, antacids, or iron supplements

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12
Q

Phenytoin (Dilantin): what type of med? How does it work? Indications?

A

Sodium channel blocker
- works to stabilize the neurons from becoming too excited
- stops the spread of seizure activity in the motor cortex
- highly (90%) protein-bound drug: increased risk of drug interactions

Indications:
- tonic-clonic seizures
- status epilepticus
- prophylaxis for surgery

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13
Q

Carbamazepine: What needs to be monitored?

A

Labs:
- CBC: especially WBC
- Drug level: 4-12 mcg/mL

Monitor drug levels, sodium, CBC, LFTs, and BUN/Cr especially in those with renal impairment

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14
Q

Valproic Acid/Valproate (Depakote): Administration and monitoring
Can give with? Monitor what? Therapeutic range?

A
  • can be given with phenytoin
  • take with food
  • can cause liver toxicity, need to monitor LFTs
  • narrow therapeutic range
    – need to check levels (50-100 mcg/mL)
  • must be diluted when given IV with at least 50mL NSS or D5W
    – give over an hour (no more than 20mg/min)
  • avoid sudden withdrawal
  • monitor CBC because can cause thrombocytopenia
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15
Q

Nursing considerations for pt on anti-platelets - how long to stop before surgery? take how often? who can stop med?

Who should not be on anti-platelets (6)

A

Should be stopped at least 2-5 days before surgery
Must take everyday unless told otherwise
Only provider can stop medication

DO NOT GIVE-
* Known bleeding disorder
* * Active bleeding
* * Closed head injuries
* * CVA until prove no bleed
* * Pregnancy (risk benefit)
* * Lactation

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16
Q

Nursing considerations for warfarin? How long does it take to clear the body?

A

-Takes 4-7 days to take effect
-Should be taken in the evening
-Requires frequent lab monitoring (PT/INR)
-Narrow therapeutic range
-Works slowly compared to heparin

online: After being stopped, warfarin takes 5–7 days to clear the body.

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17
Q

Aspirin Drug interactions

A

Oral anticoagulants, Heparin, Methotrexate, oral DM meds, and Insulin – can increase the risk of toxicity when taken with ASA
* Steroids may decrease the ASA effect and cause ulcers
* ACE and Beta Blockers
* NSAIDS

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18
Q

Contraindication for tPA (7)

A
  • Uncontrolled BP (185/110)
  • History of Hemorrhagic Stroke, aneurysm, or AV
    malformations
  • Heparin in the last 48 hours
  • Current oral anticoagulant
  • DOAC use
  • Surgery within 3 months
  • Platelet count <100,000
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19
Q

What specific actions does the nurse need to take for loop diuretics? Any labs, vitals, nursing considerations?

A
  • monitor potassium level!
    – monitor other electrolytes too, but potassium very important
  • monitor I&Os
  • monitor blood sugar
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20
Q

What specific actions does the nurse need to take with digoxin? Labs, vitals, nursing considerations?
Antidote? Check? Monitor? Caution in?

A

Antidote: digibind
- always check apical HR and call MD if less than 60
- monitor BUN/Cr and potassium
- rapid onset and absorption

caution in:
- pregnancy and lactation
- pediatric and geriatric
- renal insufficiency

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21
Q

Key side effects of ACE inhibitors? Any black box warnings?

A
  • generally well tolerated and absorbed
  • hyperkalemia
  • dizziness
  • cough (“ACE cough”)
    – related to kinins and activation of arachidonic pathway and prostaglandin production
    – begins 1-2 weeks of initiation; typically resolves within few days of stopping med
  • angioedema

BLACK BOX WARNING:
- serious fatal abnormalities: not given in pregnancy and caution in childbearing-age women
- esp in 3rd trimester
- contraception very important

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22
Q

What specific actions does the nurse need to take with ACE inhibitors? Labs, vitals, nursing considerations?
Be aware of…

Study These Flashcards
A
  • be aware of renal function and potassium
  • assess orthostasis
  • awareness of administration to childbearing women
  • NO NSAID use
  • should be taken on empty stomach

Labs: potassium, BUN, Cr
Vitals: BP

23
Q

What specific actions does the nurse need to take with thiazide diuretics? Labs, vitals, nursing considerations?

Study These Flashcards
A
  • anyone with allergy to sulfa should not take
  • should not be given to patients with history of gout
  • avoid in renal failure
    - digoxin toxicity
  • may decrease effect of diabetic medications
    - lithium toxicity
  • give early in morning b/c urination

Check potassium, glucose, BP, HR

24
Q

Patient education with thiazide diuretics? Any specific or key instructions? (Lifestyle type of recommendations)

Study These Flashcards
A
  • adherence!
  • watch diet, exercise
  • decrease alcohol, stop smoking
  • avoid NSAIDs which increase BP
25
What specific actions does the nurse need to take with ARBs? Labs, vitals, nursing considerations? Do not give with, monitor what
- do not give with an ACE inhibitor - drug interactions with diltiazem, oral anti-fungals - monitor renal function - some drug interactions related to the cytochrome P450 - can be given with or without foods Labs: creatinine; can increase due to possible decreased GFR; LFTs Vitals: I&Os, BP
26
What specific actions does the nurse need to take with calcium channel blockers: dihydropyridines? Labs, vitals, nursing considerations? What is important to consider with CCBs | CA-Pines (California pine trees)
- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice - check orthostasis no lab monitoring vitals: HR | Amlodipine Felodipine Nifedipine
27
Patient education with calcium channel blockers: dihydropyridines? Any specific or key instructions? | Diet alterations? Check..?
- do not drink grapefruit juice - increase fiber in diet - always check HR prior to taking and make sure not less than 60
28
What specific actions does the nurse need to take with calcium channel blockers: non-dihydropyridines? Labs, vitals, nursing considerations?
- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice (especially with diltiazem) - check orthostasis no lab monitoring vitals: HR
29
Key side effects of Beta Blockers? Any black box warnings?
- hypotension - **bradycardia** (why you check apical HR) - bronchospasm (don't want to give to COPD or asthma pt) - exacerbation of peripheral vascular disease - fatigue - depression - impotence - sleep issues adverse effects: - worsening of HF especially when first started; why you need to start at low dose
30
What specific actions does the nurse need to take with Beta Blockers? Labs, vitals, nursing considerations? | Caution in what patients? Check what? Starting dose considerations?
- always start at very low doses b/c can make HF worse - **always check apical heart rate** and call MD if less than 60 - caution use in chronic lung disease b/c may increase risk of asthma attacks (blocks B2 receptor) - may mask hypoglycemic episodes so monitor diabetics - caution in those with brady arrhythmias b/c will drop HR - check for orthostasis - make sure patient is given medication even when NPO - assess for side effects Labs: glucose level especially is patient is diabetic; no other major lab concerns Vitals: HR (check apical)
31
Patient education with Entresto (Sacubitril plus Valsartan)? Any specific or key instructions?
- contraindicated in pregnancy - DO NOT TAKE WITH NSAIDs (NSAIDs vasoconstrict so counteracts)
32
Patient education with nitrates? Any specific or key instructions? | Absolutely do not take with...?
- can 1 every 5 minutes up to 3 taken - pain continues call 911 - DO NOT take with viagra (sildenafil) - must be sitting or lying when taking it - keep medication in original bottle to protect from light
33
What specific actions does the nurse need to take with Alpha Blockers? Labs, vitals, nursing considerations?
- need to monitor patient very closely after giving first dose - avoid use in older adults due to increased sedation and confusion vitals: BP and HR
34
Patient education with Alpha Blockers? Any specific or key instructions?
- let them know about first dose effect and that adverse effects are significant
35
Meds to check for apical HR
Beta blockers: Carvedilol, metoprolol, bisopropolol DIGOXIN Calcium channel blockers
36
What specific actions does the nurse need to take with nitrates? Labs, vitals, nursing considerations?
Very rapidly absobed Tolerance developes easily Must have drug free periods **do not take with sildenafil
37
Nursing considerations for adrenergic medications | Avoid use with what 2 types of meds?
Avoid use with Beta-blockers and Nsaids
38
How do anticholinergics work? | Used after what? ## Footnote aka- anticholinergic
Blocks muscarinic cholinergic receptors by antagonizing the neurotransmitter acetylcholine in smooth muscle ## Footnote USED AFTER SABA
39
Side effects of Leukotriene modifiers (singulair)?
Headache, GI symptoms, liver dysfunction Generally, well tolerated BLACK BOX WARNING: Neuropsychiatric: agitation, aggression, depression, sleep disturbances, suicidal thoughts & behavior
40
Any black box warnings for Leukotriene modifiers (singulair)? | singulair can make you psycho?
black box warning: psychiatric side effects such as aggression, depression, agitation, sleep disturbances, suicidal thoughts, and suicide.
41
Constipation: osmotic stimulant laxatives - caution with?
- those with renal impairment - abuse concerns
42
Histamine 2 (H2) blockers: patient education
- smoking can decrease effectiveness; no smoking - should be taken 30 mins before meals - avoid overeating - **no NSAIDs**
43
Proton pump inhibitors (PPIs): drug interaction
Clopidogrel (which is a platelet inhibitor)
44
Anti-emetics: 5-HT3 (serotonin) antagonist - Ondansetron (Zofran): Contraindications
- patients taking anticonvulsants b/c can decrease seizure threshold Use lowest dose in hepatic and renal impairment
45
Anti-emetics: 5-HT3 (serotonin) antagonist - Ondansetron (Zofran): side effects
- headache - constipation - diarrhea - fatigue Serotonin syndrome from too much in body; can be mild or life-threatening
46
Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): contraindications
- patients with severe toxic CNS depression or comatose states from any cause - hypersensitivity to drug - Parkinson's disease - dementia
47
Anti-emetics: Cannabinoids: Dronabinol (marinol) - caution with?
- elderly patients due to increased risk of neuro-psychoactive effects - patients with a history of alcohol and/or substance abuse - patient with underlying psychiatric disorders (mania, depression, schizophrenia)
48
Anti-emetics: Neurokinin-1 Antagonist (NK-1): Arepitant (Emend) - side effects
- liver enzyme elevation - dehydration - hiccups - Steven-Johnson syndrome
49
Anti-emetic use across the lifespan: pediatrics
- should be used with caution - increased risk for adverse effects
50
What are extrapyramidal symptoms (EPS)?
Manifested primarily as acute dystonic reactions Dystonic reactions may include: - sudden onset of muscular spasms esp in head, neck, or opisthotonos - laryngospasm, dysphagia, oculogyric crisis - involuntary spasms of the tongue and mouth: difficultly speaking and swallowing - akathisia, restlessness, akinesia, other Parkinsonian-like symptoms (tremor)
51
Adrenergics- Long-acting Beta Agonists ## Footnote LABA
Maintenance Drug- allows airway to stay open -Seen as inhaler-metered dose or dry powder -**used in combination with steroid** Meds: Salmeterol (serevent)
52
Long- acting Beta Agonist: Black-box warning and information
**salmeterol (Serevent) and formoterol (Foradil) should not be used without a steroid in asthma for all ages Need to weigh the risk vs benefits** NEVER USE AS A RESCUE INHALER - SHOULD NOT BE USED IN CHILDREN LESS THAN AGE 4 and NEVER WITHOUT A STEROID ## Footnote USE WITH A STEROID!!
53
Nursing considerations for Leukotriene modifiers (singulair)?
Age limitations (Exercise-induced) - 1 tablet at least 2 hours before exercise for patients 6 years and older. Seasonal allergic rhinitis: Daily, age 2 and older Asthma – age 12 months and older ## Footnote Reduced effect if taken with phenytoin
NUR 516
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