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herbal supplements
1. feverfew
2.glucosamine
3. st. johns wart
4. valerian
5.Ginko
1. migraines
2. joints
3. depression
4. sleep
5. memory
what is a medication reconciliation?
a list of medications up to date as possible including prescription medications, herbal, and OTC.
Routes of administration
nonparenteral:
parenteral:
nonparenteral: oral, topical, sublingual, transdermal, vaginal, rectal, optic, intranasal
parenteral: IM, IV, SC, ID
What should be included on a prescription order?
MD signature, medication, time, route, dose, patients name
medication administration- how do you confirm identity?
beclomethasone
steroid, monitor blood glucose-give after albuterol
what medication is for hyperthyroidism?
Methimazole ADR
(everything low, weight high) agranulocytosis, sore throat, fever, fatigue, liver injury
Types of med orders:
Stat
PRN
standing
one time
stat- immediately
PRN-as needed
standing- routine/ around the clock
one time- one time (used for prophylaxis)
1)how many checks are to be done prior to medication administration?
2)when are they checked?
3) what are you checking for?
1. 3
2. MAR and doctors order, when pulling the medication, at the bedside
3. right route, right dose, right time, right medication, right patient, right documentation, right education, right to refuse
safe medication administration: which medications have to be double checked when administering?
heparin, opioids, and insulin
Montelukast class and when to take
leukotriene modifier take in the evening or 2 hours prior to exercise.
MDI
Meter dosed inhaler
Dosage calculation practice: 8lbs 12oz
find in kgs
3.9kgs
mcg=mg?
mg=mcg?
1/1000mg
1000mcg
How do you administer eye drops?
1. don gloves, get eye drops and paper towel
2. lower the head of the bed and advise client to tilt head back
3. using non dominant hand expose the lower conjunctival sac and administer drops
4. have client gently close eye and open- wipe away excess.
5. hold patients nasal lacrimal duct for 15-30 second
controlled substances
schedule one and two
schedule one-substance use disorder *not for medical use
schedule two- opioids need prescription but if taking opioids more than needed=substance abuse
Warfarin classifications, normal PT/INR range, interactions
Vitamin K inhibitor
Normal PT 11-12.5 also 18-24 Normal INR 2-3 prothrombin times
elevated report to provider
interactions: g's- increase bleeding
anti-anxiety medication
Alprozolam (Xanax) benzodiazepine CNS depressant
ADR:drowsiness, dizziness, hypotension, tachycardia , respiratory depression, sedation
Nursing admin: monitor for falls, monitor vitals, no alcohol, no driving when drowsy, no other CNS depressants with this medication
Dosage calculation: Digoxin 40mgs prescribed and available 50mg/5ml.. how many mLs will you give?
4mLs
1. Which diuretic is the most effective to get fluids off fast?
2. what is some client education, interactions, and nursing administration for this drug?
furosemide- loop diuretic Ce: report any hearing changes, take potassium, increase fluid/sodium intake
nursing admin: potassium 3.5-5, sodium 135-145, increase fluid intake to avoid dehydration
interactions: Digoxin toxicity 0.8-2.0, Antihypersensitives, Lithium, NSAIDS
1. What drug has increased risk to ototoxicity when concurrently with another with loop diuretics, ethacrynic acid, and aminoglycoside antibiotics?
2. what is this drugs use and ADR?
3. nursing admin
vancomycin
ADR: Red man syndrome, renal toxicity (failure), ototoxicity
uses: c-diff, MRSA
nursing admin: administer vancomycin slowly over 60 minutes to prevent red man syndrome
digoxin [nursing admin, toxicity, interactions]
Nursing admin: auscultate apical pulse for 1 minute, do not give if HR less than 60, check lab values 0.8-2=normal
toxicity: anorexia, nausea, vomiting, cardiac dysrhythmias, tachycardia/ over 2.4= toxicity
interactions: st johns wart
transdermal nitroglycerin [common areas, client education]
chest, upper arm, back, sides
advise client do not cut, take patch off at night-leave patch in place for 10-12 hours, place on hairless dry area, rotate sites, wash area with soap and water- do not apply patch when client has an attack
morphine
respiratory depression, sedation, constipation
Breaths per minute less than 12= naloxone
ear drops
pull ear up and back for adults, pull ear down and back for children
basic formulas
lbs-kg= x/2.2
kg-lbs= x*2.2
When writing out drugs which is the correct format?
A) .12
B)0.12
C)12.0
0.12
L=ml
ml=L
1000ml
1/1000ml
MAOI
monoamine oxidase inhibitor
hypertensive crisis, avoid food rich in tyramine, and expect 3-4 months for full therapeutic effect, avoid OTC medications, taper medication, monitor suicidal thoughts.
a nurse is calculating a patients I&O over an 8 hour period. The patient has had 14oz of water, 8ml of juice, 1/2 cup of gelatin, a cup of strawberries. how many ml did the patient intake?
548ml
g<--> mg
g-->mg x*1,000mg
mg-->g x/1,000g
sulfa drugs [name, use, and ADR]
sulfonamides
uses: UTI, thrombocytopenia, anemia, allergic reaction
Nursing admin: report rash, report pregnancy, report pallor, infection, pain in mouth, vaginal burning, report watery/bloody diarrhea, inform client to take back up contraceptive
ADR: Steven-johnson syndrome
feeding tube
mix medications individually
antibiotics:
1. penicillin contra and how to reverse
1. allergies/anaphylaxis reversal: epinephrine
medication for hypothyroidism?
levothyroxine
everything is increased [hyper], weight loss
1. What drug has an expected orange color in urine, saliva and sweat. Complications include liver function (Hepatotoxicity), and G.I. discomfort?
2. what are the uses and client education to this drug?
rifampin
CE: use back up contraceptives, no alcohol, expect urine red/orange urine, saliva, and sweat.
Uses: treat TB combination therapy with isoniazid
1. how to draw up regular and NPH insulin?
2. Lispro- rapid acting insulin Onset
3. NPH insulin Onset
1. One syringe for mixing- short acting first (regular) then long acting(NPH)
2. 15-30 minutes/ eat food within 15 minutes
3. 90-120 minutes
medications related to nephrotoxicity?
1. What diuretic retains potassium and excretes sodium and water?
2. ADR:
1. spironolactone [potassium-sparing diuretic]
2. hyperkalemia
fluticasone [uses, nursing admin, ADR]
steroid
nursing admin: monitor blood glucose level
uses: asthma
ADR: sedation, bloody nose
mL to administer:
tsp=x ml?
tbsp=x ml?
ounce=x ml?
cup=x ml?
tsp=5ml
tbsp=15ml
ounce=30ml
cup=240ml
Abbreviations
mL-milliliter tsp- teaspoon
lb-pounds tbsp-tablespoon
oz-ounce
mcg-microgram
g-gram