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Tuesday, September 30, 2008

Advisory For Nov. 29 & 30 Nursing Board Exam 2008

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Applicants for the Nurse Licensure Examination (NLE) are advised to follow a new scheme in the processing of their applications.

The issuance of the pre-numbered Nurses Application Forms (NAFs) is coursed through the deans of the colleges of nursing. The applicants may secure a copy from their respective colleges. This procedure will assist the applicants to have time to read and properly accomplish the NAF, prepare the requirements and minimize the long queue and congestion in the filing areas as observed during the filing period.

Likewise, the students may correctly enter their respective school codes to assist the PRC and the Board of Nursing in the accurate recording and reporting of the performance of the colleges of nursing in the Nurse Licensure Examinations.

As a control measure in the issuance of the NAF, the deans of the colleges of nursing shall submit the following to the Application Division of PRC central or regional offices:

* Letter of request signed by the Dean of the College of Nursing
* List of graduates taking the NLE
* Commitment letter stating that NO fee shall be charged to the applicant for the issuance of the NAF

Filing of the NAF and the accompanying requirements shall be undertaken personally by the applicant. The PRC Central Office and any of the Regional Offices will not accept and/or process application unless personally filed by the applicant.

The PRC Application Division is now accepting applications for the November 29-30, 2008 Nurse Licensure Examination. The deadline for the submission of application complete with all requirements is on October 17, 2008.

SOURCE: Filipino Nurse


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Nclex & Cgfns Study Guide: Common Herbal Medication

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Chamomile
Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea
Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.

Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort
Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress.

Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic
Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.")

Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin.

Feverfew
Uses: Most commonly used for migraine headaches.

Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba
Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking.

Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital.

Ginseng
Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.")
Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis.

Ginger
Uses: Ginger has been used as a treatment for nausea and bowel spasms.

Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Saw Palmetto
Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections.

Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")
This listing represents only a small portion of herbal treatments. Nevertheless, the popularity of herbal therapies is unquestionable. Doctors routinely confront the unknown with their patients who are using herbs. Doctors simply do not have any way of helping you to decide whether these herbs are helpful or harmful for you, or whether they are interacting with your current medications. There are no data.

Black Cohosh

Claims, Benefits: A natural way to treat menopausal symptoms.
Bottom Line: Little is known about its benefits and its risks. If you try it, tell your physician, since it might interact with other medications you are taking.



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Kaplan Question Of the Day : Nclex RN Test

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The nurse is leading an inservice about management issues. The nurse would intervene if another nurse made which of the following statements?

REWORDED QUESTION: What are the nurse's responsibilities regarding obtaining consent?

STRATEGY: Think about each answer. Does it describe the nurse's responsibility for consent?

NEEDED INFO: Requirements: capacity-age (adult), competence, voluntary; info must be given in understandable form. Legal responsibility: physician's responsibility to get consent form signed; when nurse witnesses a signature it means there's reason to believe client is informed about upcoming treatment.

CATEGORY: Evaluation/Safe and Effective Care

(1) "It is my responsibility to ensure that the consent form has been signed and attached to the patient's chart prior to surgery."
Describes the nurse's responsibility

(2) "It is my responsibility to witness the signature of the client before surgery is performed."
Signature indicates that the nurse saw the patient sign the form

(3) "It is my responsibility to provide a detailed description of the surgery and ask the patient to sign the consent form."
CORRECT: Physician should provide explanation and obtain signature

(4) "It is my responsibility to answer questions that the patient may have prior to surgery."
Describes the nurse's responsibility




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Antimalarials Updates (nclex pharmacology tutorial)

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Antimalarials Updates (pharmacology tutorial) Slideshow Transcript
Slide 1: Antimalarial, Antiprotozoal, and Antihelmintic Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Protozoal Infections Parasitic protozoa: live in or on humans • malaria • leishmaniasis • amebiasis • giardiasis • trichomoniasis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Malaria • Caused by the plasmodium protozoa. • Four different plasmodium species. • Cause: the bite of an infected adult mosquito. • Can also be transmitted by infected individuals via blood transfusion, congenitally, or via infected needles by drug abusers. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Malarial Parasite (plasmodium) Two Interdependent Life Cycles • Sexual cycle: in the mosquito • Asexual cycle: in the human – Knowledge of the life cycles is essential in understanding antimalarial drug treatment. – Drugs are only effective during the asexual cycle. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Plasmodium Life Cycle Asexual cycle: two phases • Exoerythrocytic phase: occurs “outside” the erythrocyte • Erythrocytic phase: occurs “inside” the erythrocyte Erythrocytes = RBCs Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Antimalarial Agents Attack the parasite during the asexual phase, when it is vulnerable • Erythrocytic phase drugs: chloroquine, hydroxychloroquine, quinine, mefloquine • Exoerythrocytic phase drug: primaquine May be used together for synergistic or additive killing power. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Antimalarials: Mechanism of Action 4-aminoquinoline derivatives chloroquine and hydroxychloroquine • Bind to parasite nucleoproteins and interfere with protein synthesis. • Prevent vital parasite-sustaining substances from being formed. • Alter pH within the parasite. • Interfere with parasite’s ability to metabolize and use erythrocyte hemoglobin. • Effective only during the erythrocytic phase Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Antimalarials: Mechanism of Action 4-aminoquinoline derivatives quinine and mefloquine • Alter pH within the parasite. • Interfere with parasite’s ability to metabolize and use erythrocyte hemoglobin. • Effective only during the erythrocytic phase. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Antimalarials: Mechanism of Action diaminophyrimidines pyrimethamine and trimethoprim • Inhibit dihydrofolate reductase in the parasite. • This enzyme is needed by the parasite to make essential substances. • Also blocks the synthesis of tetrahydrofolate. These agents may be used with sulfadoxine or dapsone for synergistic effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Antimalarials: Mechanism of Action primaquine • Only exoerythrocytic drug. • Binds and alters DNA. sulfonamides, tetracyclines, clindamycin • Used in combination with antimalarials to increase protozoacidal effects Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Antimalarials: Drug Effects • Kill parasitic organisms. • Chloroquine and hydroxychloroquine also have antiinflammatory effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Antimalarials: Therapeutic Uses • Used to kill plasmodium organisms, the parasites that cause malaria. • The drugs have varying effectiveness on the different malaria organisms. • Some agents are used for prophylaxis against malaria. • Chloroquine is also used for rheumatoid arthritis and lupus. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Antimalarials: Side Effects • Many side effects for the various agents • Primarily gastrointestinal: nausea, vomiting, diarrhea, anorexia, and abdominal pain Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Antiprotozoals • atovaquone (Mepron) • metronidazole (Flagyl) • pentamidine (Pentam) • iodoquinol (Yodoxin, Di-Quinol) • paromomycin (Humatin) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Protozoal Infections • amebiasis • giardiasis • pneumocystosis • toxoplasmosis • trichomoniasis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Protozoal Infections Transmission • Person-to-person • Ingestion of contaminated water or food • Direct contact with the parasite • Insect bite (mosquito or tick) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Antiprotozoals: Mechanism of Action and Uses atovaquone (Mepron) • Protozoal energy comes from the mitochondria • Atovaquone: selective inhibition of mitochondrial electron transport • Result: no energy, leading to cellular death Used to treat mild to moderate P. carinii Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Antiprotozoals: Mechanism of Action and Uses metronidazole • Disruption of DNA synthesis as well as nucleic acid synthesis • Bactericidal, amebicidal, trichomonacidal Used for treatment of trichomoniasis, amebiasis, giardiasis, anaerobic infections, and antibiotic- associated pseudomembranous colitis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Antiprotozoals: Mechanism of Action and Uses pentamidine • Inhibits DNA and RNA • Binds to and aggregates ribosomes • Directly lethal to Pneumocystis carinii • Inhibits glucose metabolism, protein and RNA synthesis, and intracellular amino acid transport Mainly used to treat P. carinii pneumonia and other protozoal infections Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Antiprotozoals: Mechanism of Action and Uses iodoquinol (Yodoxin, Di-Quinol) • “Luminal” or “contact” amebicide • Acts primarily in the intestinal lumen of the infected host • Directly kills the protozoa Used to treat intestinal amebiasis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Antiprotozoals: Mechanism of Action and Uses paromomycin • “Luminal” or “contact” amebicide • Kills by inhibiting protein synthesis Used to treat amebiasis and intestinal protozoal infections, and also adjunct therapy in management of hepatic coma Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Antiprotozoals: Side Effects atovaquone • nausea, vomiting, diarrhea, anorexia metronidazole • metallic taste, nausea, vomiting, diarrhea, abdominal cramps iodoquinol • nausea, vomiting, diarrhea, anorexia, agranulocytosis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Antiprotozoals: Side Effects pentamidine • bronchospasms, leukopenia, thrombocytopenia, acute pancreatitis, acute renal failure, increased liver function studies paromomycin • nausea, vomiting, diarrhea, stomach cramps Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Antihelmintics • diethylcarbamazine (Hetrazan) • mebendazole (Vermox) • niclosamide (Niclocide) • oxamniquine (Vansil) • piperazine (Vermizine) • praziquantel (Biltricide) • pyrantel (Antiminth) • thiabendazole (Mintezol) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Antihelmintics • Drugs used to treat parasitic worm infections: helmintic infections • Unlike protozoa, helminths are large and have complex cellular structures • Drug treatment is very specific Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Antihelmintics • It is VERY IMPORTANT to identify the causative worm • Done by finding the parasite ova or larvae in feces, urine, blood, sputum, or tissue – cestodes (tapeworms) – nematodes (roundworms) – trematodes (flukes) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Antihelmintics: Mechanism of Action and Uses diethylcarbamazine (Hetrazan) • Inhibits rate of embryogenesis thiabendazole (Mintezol) • Inhibits the helminth-specific enzyme, fumarate reductase Both used for nematodes (tissue and some roundworms) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Antihelmintics: Mechanism of Action piperazine (Vermizine) and pyrantel (Antiminth) • Blocks acetylcholine at the neuromuscular junction, resulting in paralysis of the worms, which are then expelled through the GI tract Used to treat nematodes (giant worm and pinworm) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Antihelmintics: Mechanism of Action mebendazole (Vermox) • Inhibits uptake of glucose and other nutrients, leading to autolysis and death of the parasitic worm Used to treat cestodes and nematodes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Antihelmintics: Mechanism of Action niclosamide (Niclocide) • Causes the worm to become dislodged from the GI wall • They are then digested in the intestines and expelled Used to treat cestodes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Antihelmintics: Mechanism of Action oxamniquine (Vansil) and praziquantel (Biltricide) • Cause paralysis of worms’ musculature and immobilization of their suckers • Cause worms to dislodge from mesenteric veins to the liver, then killed by host tissue reactions Used to treat trematodes, cestodes (praziquantel only) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Antihelmintics: Side Effects niclosamide, oxamniquine, praziquantel, thiabendazole, piperazine, pyrantel • nausea, vomiting, diarrhea, dizziness, headache mebendazole • diarrhea, abdominal pain, tissue necrosis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Antimalarial, Antiprotozoal, Antihelmintic Agents: Nursing Implications • Before beginning therapy, perform a thorough health history and medication history, and assess for allergies. • Check baseline VS. • Check for conditions that may contraindicate use, and for potential drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Antimalarial, Antiprotozoal, Antihelmintic Agents: Nursing Implications • Some agents may cause the urine to have an asparagus-like odor, or cause an unusual skin odor, or a metallic taste; be sure to warn the patient ahead of time. • Administer ALL agents as ordered and for the prescribed length of time. • Most agents should be taken with food to reduce GI upset. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Antimalarial Agents: Nursing Implications • Assess for presence of malarial symptoms. • When used for prophylaxis, these agents should be started 2 weeks before potential exposure to malaria, and for 8 weeks after leaving the area. • Medications are taken weekly, with 8 ounces of water. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Antimalarial Agents: Nursing Implications • Instruct patient to notify physician immediately if ringing in the ears, hearing decrease, visual difficulties, nausea, vomiting, profuse diarrhea, or abdominal pain occur. • Alert patients to the possible recurrence of the symptoms of malaria so that they will know to seek immediate treatment. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Antimalarial, Antiprotozoal, Antihelmintic Agents: Nursing Implications Monitor for side effects: • Ensure that patients know the side effects that should be reported. • Monitor for therapeutic effects and adverse effects with long-term therapy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




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Monday, September 29, 2008

Antivirals Updates (teaching nclex pharmacology terminology for lpn nursing students)

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Antivirals Updates (teaching pharmacology terminology for lpn nursing students) Slideshow Transcript
Slide 1: Antiviral Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Understanding Viruses Viral Replication • A virus cannot replicate on its own. • It must attach to and enter a host cell. • It then uses the host cell’s energy to synthesize protein, DNA, and RNA. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Understanding Viruses Viruses are difficult to kill because they live inside our cells. • Any drug that kills a virus may also kill our cells. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Viral Infections Competent immune system: • Best response to viral infections • A well-functioning immune system will eliminate or effectively destroy virus replication Immunocompromised patients have frequent viral infections • Cancer patients, especially leukemia or lymphoma • Transplant patients, due to pharmacological therapy • AIDS patients, disease attacks immune system Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Antivirals Key characteristics of antiviral drugs: • Able to enter the cells infected with virus. • Interfere with viral nucleic acid synthesis and/or regulation. • Some agents interfere with ability of virus to bind to cells. • Some agents stimulate the body’s immune system. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Antivirals Viruses killed by current antiviral therapy: • cytomegalovirus (CMV) • herpes simplex virus (HSV) • human immunodeficiency virus (HIV) • influenza A (the “flu”) • respiratory syncytial virus (RSV) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Antivirals: Mechanism of Action Inhibit viral replication • Inhibit viral attachment • Prevent genetic copying of virus • Prevent viral protein production Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Antivirals Synthetic Purine Nucleoside Analogues Two types of nucleosides: Purine nucleosides • guanine • adenosine Pyrimidine nucleosides • thymine • cytosine Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Antivirals: Purine Nucleosides Agent Antiviral Activity guanines acyclovir HSV 1 & 2, VZV ganciclovir (DHPG) CMV retinitis and systemic CMV infection ribavirin (RTCD) Influenza types A and B, RSV, LV, HV adenosines didanosine (ddl) HIV vidarabine (Ara-A) HSV, herpes zoster Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Antivirals: Pyrimidine Nucleosides Agent Antiviral Activity cytosines lamivudine (3TC) HIV zalcitabine (ddC) HIV thymine idoxuridine (IDU) HSV stavudine (d4T) HIV trifluridine HSV zidovudine (AZT) HIV Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Other Antivirals amantadine (Symmetrel) and rimantadine (Flumadine) • influenza A foscarnet (Foscavir) • CMV (retinitis and systemic) Neuraminidase Inhibitors: oseltamivir (Tamiflu) and zanamivir (Relenza) • influenza types A and B Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Antivirals: Side Effects acyclovir • Burning when topically applied, nausea, vomiting, diarrhea, headache amantadine and rimantadine • Anticholinergic effects, insomnia, lightheadedness, anorexia, nausea didanosine (ddl) • Pancreatitis, peripheral neuropathies, seizures Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Antivirals: Side Effects zidovudine (AZT) • Bone marrow suppression, nausea, headache foscarnet (Foscavir) • Headache, seizures, acute renal failure, nausea, vomiting, diarrhea ganciclovir (Cytovene) • Bone marrow toxicity, nausea, anorexia, vomiting Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Antivirals: Nursing Implications • Before beginning therapy, thoroughly assess underlying disease and medical history, including allergies. • Assess baseline VS and nutritional status. • Assess for contraindications, conditions that may indicate cautious use, and potential drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Antivirals: Nursing Implications • Be sure to teach proper application technique for ointments, aerosol powders, etc. • Emphasize hand washing before and after administration of medications to prevent site contamination and spread of infection. • Patients should wear a glove or finger cot when applying ointments or solutions to affected areas. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Antivirals: Nursing Implications • Instruct patients to consult their physician before taking any other medication, including OTC medications. • Emphasize the importance of good hygiene. • Inform patients that antiviral agents are not cures, but do help to manage symptoms. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Antivirals: Nursing Implications • Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment. • With zidovudine: • Inform patients that hair loss MAY occur so that they are prepared for this rare adverse reaction. • This medication should be taken on an empty stomach. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Antivirals: Nursing Implications Monitor for side effects: • effects are varied and specific to each agent Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Antivirals: Nursing Implications Monitor for therapeutic effects: • effects will vary depending on the type of viral infection • Effects range from delayed progression of AIDS and ARC to decrease in flu-like symptoms, decreased frequency of herpes-like flare-ups, or crusting over of herpetic lesions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




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Kaplan Question Of the Day : Nclex RN Review

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An elderly client is admitted with a diagnosis of dementia. He attempts several times to pull out his nasogastric tube. An order for cloth wrist restraints is received by the nurse. Which of the following actions by the nurse is MOST appropriate?

REWORDED QUESTION: What is appropriate care for a patient requiring restraints?

STRATEGY: "MOST appropriate" indicates there may be more than one correct response.

NEEDED INFO: Informed consent is needed to use restraints; if client is unable to consent, then consent of proxy must be obtained after full disclosure of risks and benefits; restraint of patient without informed consent or sufficient justification is false imprisonment. Assess and document need for restraints; consider use of alternative measures and document. Physician's order is required specifying duration and circumstances under which restraints should be used; cannot order restraints to be used PRN. Monitor patient closely and periodically reassess continued need for restraints, and document.

CATEGORY: Implementation/Safe and Effective Care

(1) Attach the ties of the restraint to the bed frame
CORRECT: Allows the raising and lowering of the side rail without causing injury to the patient

(2) Perform circulation checks to the extremities, which are restrained once a shift
Circulation checks should be done every 1-2 hours; vascular injury may result from poor circulation from a restraint that's too tight

(3) Remove the restraints when the patient is up in a wheelchair
Restraints should be secured when patient is at risk for harm to himself and is unattended; should be removed every 2 hours and skin assessed and area massaged; patient should not be left unattended when restraint is removed for care

(4) Explain the need for restraints only to the family
Restraints can increase patient's confusion or combativeness; patient and family should receive explanation for the need for the restraint, the type of restraint, and the anticipated duration of use





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Sunday, September 28, 2008

Antibiotics Updates (advanced nclex pharmacology for nurse practitioners)

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Antibiotics Updates (advanced pharmacology for nurse practitioners) Slideshow Transcript
Slide 1: Anti-Infective Agents Antibiotics: Sulfonamides Penicillins Cephalosporins Tetracyclines Aminoglycosides Quinolones Macrolides Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Antibiotics • Medications used to treat bacterial infections • Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Antibiotics • Empiric therapy: treatment of an infection before specific culture information has been reported or obtained • Prophylactic therapy: treatment with antibiotics to prevent an infection, as in intra- abdominal surgery Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Antibiotics • Bactericidal: kill bacteria • Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Antibiotics: Sulfonamides One of the first groups of antibiotics • sulfadiazine • sulfamethizole • sulfamethoxazole • sulfisoxazole Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Sulfonamides: Mechanism of Action • Bacteriostatic action • Prevent synthesis of folic acid required for synthesis of purines and nucleic acid • Does not affect human cells or certain bacteria—they can use preformed folic acid Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Sulfonamides: sulfamethoxazole Therapeutic Uses Azo-Gantanol • Combined with phenazopyridine (an analgesic-anesthetic that affects the mucosa of the urinary tract). • Used to treat urinary tract infections (UTIs) and to reduce the pain associated with UTIs. Bactrim • Combined with trimethoprim. • Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis, gonorrhea, etc. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Sulfonamides: sulfisoxazole Therapeutic Uses Azo-Gantrisin • Combined with phenazopyridine • Used for UTIs Pediazole • Combined with erythromycin • Used to treat otitis media Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Sulfonamides: Side Effects Body System Effect Blood Hemolytic and aplastic anemia, thrombocytopenia Integumentary Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Sulfonamides: Side Effects Body System Effect GI Nausea, vomiting, diarrhea, pancreatitis Other Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Antibiotics: Penicillins • Natural penicillins • Penicillinase-resistant penicillins • Aminopenicillins • Extended-spectrum penicillins Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Antibiotics: Penicillins Natural penicillins • penicillin G, penicillin V potassium Penicillinase-resistant penicillins • cloxacillin, dicloxacillin, methicillin, nafcillin, oxacillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Antibiotics: Penicillins Aminopenicillins • amoxicillin, ampicillin, bacampicillin Extended-spectrum penicillins • piperacillin, ticarcillin, carbenicillin, mezlocillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Antibiotics: Penicillins • First introduced in the 1940s • Bactericidal: inhibit cell wall synthesis • Kill a wide variety of bacteria • Also called “beta-lactams” Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Antibiotics: Penicillins • Bacteria produce enzymes capable of destroying penicillins. • These enzymes are known as beta-lactamases. • As a result, the medication is not effective. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Antibiotics: Penicillins • Chemicals have been developed to inhibit these enzymes: – clavulanic acid – tazobactam – sulbactam • These chemicals bind with beta-lactamase and prevent the enzyme from breaking down the penicillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Antibiotics: Penicillins • Penicillin-beta-lactamase inhibitor combination drugs: – ampicillin + sulbactam = Unasyn – amoxicillin + clavulanic acid = Augmentin – ticarcillin + clavulanic acid = Timentin – piperacillin + tazobactam = Zosyn Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Penicillins: Mechanism of Action • Penicillins enter the bacteria via the cell wall. • Inside the cell, they bind to penicillin-binding protein. • Once bound, normal cell wall synthesis is disrupted. • Result: bacteria cells die from cell lysis. • Penicillins do not kill other cells in the body. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Penicillins: Therapeutic Uses • Prevention and treatment of infections caused by susceptible bacteria, such as: – gram-positive bacteria – Streptococcus, Enterococcus, Staphylococcus species Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Penicillins: Adverse Effects • Allergic reactions occur in 0.7% – 8% of treatments – urticaria, pruritus, angioedema • 10% of allergic reactions are life-threatening and • 10% of these are fatal Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Penicillins: Side Effects • Common side effects: – nausea, vomiting, diarrhea, abdominal pain • Other side effects are less common Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Antibiotics: Cephalosporins • First Generation • Second Generation • Third Generation • Fourth Generation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Antibiotics: Cephalosporins • Semisynthetic derivatives from a fungus • Structurally and pharmacologically related to penicillins • Bactericidal action • Broad spectrum • Divided into groups according to their antimicrobial activity Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Cephalosporins: First Generation • cefadroxil • cephalexin • cephradine • cefazolin • cephalothin • cephapirin – Good gram-positive coverage – Poor gram-negative coverage Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Cephalosporins: First Generation cefazolin cephalexin (Ancef and Kefzol) (Keflex and Keftab) IV and PO PO used for surgical prophylaxis, URIs, otitis media Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Cephalosporins: Second Generation • cefaclor • cefonicid • cefprozil • ceforanide • cefamandole • cefmetazole • cefoxitin • cefotetan • cefuroxime – Good gram-positive coverage – Better gram-negative coverage than first generation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Cephalosporins: Second Generation Cefoxitin cefuroxime (Mefoxin) (Kefurox and Ceftin) IV and IM PO Used prophylactically for Surgical prophylaxis abdominal or colorectal surgeries Does not kill Also kills anaerobes anaerobes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Cephalosporins: Third Generation • cefixime • ceftizoxime • cefpodoxime proxetil • ceftriaxone • cefoperazone • ceftazidime • cefotaxime • moxalactam – Most potent group against gram-negative – Less active against gram-positive Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Cephalosporins: Third Generation cefixime (Suprax) • Only oral third-generation agent • Best of available oral cephalosporins against gram-negative • Tablet and suspension ceftriaxone (Rocephin) • IV and IM, long half-life, once-a-day dosing • Easily passes meninges and diffused into CSF to treat CNS infections Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Cephalosporins: Third Generation ceftazidime (Ceptaz, Fortaz, Tazidime, Tazicef) • IV and IM • Excellent gram-negative coverage • Used for difficult-to-treat organisms such as Pseudomonas spp. • Eliminated renally instead of biliary route • Excellent spectrum of coverage Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Cephalosporins: Fourth Generation cefepime (Maxipime) • Newest cephalosporin agents. • Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Cephalosporins: Side Effects • similar to penicillins Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Antibiotics: Tetracyclines • demeclocycline (Declomycin) • oxytetracycline • tetracycline • doxycycline (Doryx, Doxy-Caps, Vibramycin) • minocycline Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Antibiotics: Tetracyclines • Natural and semi-synthetic • Obtained from cultures of Streptomyces • Bacteriostatic—inhibit bacterial growth • Inhibit protein synthesis • Stop many essential functions of the bacteria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Antibiotics: Tetracyclines • Bind to Ca2+ and Mg2+ and Al3+ ions to form insoluble complexes • Thus, dairy products, antacids, and iron salts reduce absorption of tetracyclines Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Tetracyclines: Therapeutic Uses • Wide spectrum: – gram-negative, gram-positive, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease • Demeclocycline is also used to treat SIADH, and pleural and pericardial effusions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Tetracyclines: Side Effects Strong affinity for calcium • Discoloration of permanent teeth and tooth enamel in fetuses and children • May retard fetal skeletal development if taken during pregnancy Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Tetracyclines: Side Effects Alteration in intestinal flora may result in: • Superinfection (overgrowth of nonsusceptible organisms such as Candida) • Diarrhea • Pseudomembranous colitis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Tetracyclines: Side Effects May also cause: • Vaginal moniliasis • Gastric upset • Enterocolitis • Maculopapular rash Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Antibiotics: Aminoglycosides • gentamicin (Garamycin) • kanamycin • neomycin • streptomycin • tobramycin • amikacin (Amikin) • netilmicin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Aminoglycosides • Natural and semi-synthetic • Produced from Streptomyces • Poor oral absorption; no PO forms • Very potent antibiotics with serious toxicities • Bactericidal • Kill mostly gram-negative; some gram-positive also Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Aminoglycosides • Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp. • Often used in combination with other antibiotics for synergistic effect. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Aminoglycosides • Three most common (systemic): gentamicin, tobramycin, amikacin • Cause serious toxicities: – Nephrotoxicity (renal failure) – Ototoxicity (auditory impairment and vestibular [eighth cranial nerve]) • Must monitor drug levels to prevent toxicities Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Aminoglycosides: Side Effects Ototoxicity and nephrotoxicity are the most significant • Headache • Paresthesia • Neuromuscular blockade • Dizziness • Vertigo • Skin rash • Fever • Superinfections Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 45: Antibiotics: Quinolones • ciprofloxacin (Cipro) • enoxacin (Penetrex) • lomefloxacin (Maxaquin) • norfloxacin (Noroxin) • ofloxacin (Floxin) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 46: Quinolones • Excellent oral absorption • Absorption reduced by antacids • First oral antibiotics effective against gram-negative bacteria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 47: Quinolones: Mechanism of Action • Bactericidal • Effective against gram-negative organisms and some gram-positive organisms • Alter DNA of bacteria, causing death • Do not affect human DNA Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 48: Quinolones: Therapeutic Uses • Lower respiratory tract infections • Bone and joint infections • Infectious diarrhea • Urinary tract infections • Skin infections • Sexually transmitted diseases Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 49: Quinolones: Side Effects Body System Effects CNS headache, dizziness, fatigue, depression, restlessness GI nausea, vomiting, diarrhea, constipation, thrush, increased liver function studies Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 50: Quinolones: Side Effects Body System Effects Integumentary rash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) Other fever, chills, blurred vision, tinnitus Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 51: Antibiotics: Macrolides • erythromycin • azithromycin (Zithromax) • clarithromycin (Biaxin) • dirithromycin • troleandomycin – bactericidal action Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 52: Instructors may wish to insert EIC Image #102: Erythromycin Formulations Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 53: Macrolides: Therapeutic Uses Strep infections • Streptococcus pyogenes (group A beta-hemolytic streptococci) Mild to moderate URI • Haemophilus influenzae Spirochetal infections • Syphilis and Lyme disease Gonorrhea, Chlamydia, Mycoplasma Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 54: Macrolides: Side Effects GI effects, primarily with erythromycin: • nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia • Newer agents, azithromycin and clarithromycin: fewer side effects, longer duration of action, better efficacy, better tissue penetration Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 55: Antibiotics: Nursing Implications • Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab studies. • Be sure to obtain thorough patient health history, including immune status. • Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use. • Assess for potential drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 56: Antibiotics: Nursing Implications • It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 57: Antibiotics: Nursing Implications • Patients should be instructed to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better. • Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 58: Antibiotics: Nursing Implications • For safety reasons, check the name of the medication carefully since there are many agents that sound alike or have similar spellings. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 59: Antibiotics: Nursing Implications • Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed and monitored. • The most common side effects of antibiotics are nausea, vomiting, and diarrhea. • All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 60: Antibiotics: Nursing Implications Sulfonamides • Should be taken with at least 2400 mL of fluid per day, unless contraindicated. • Due to photosensitivity, avoid sunlight and tanning beds. • These agents reduce the effectiveness of oral contraceptives. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 61: Antibiotics: Nursing Implications Penicillins • Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after its administration. • The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 62: Antibiotics: Nursing Implications Cephalosporins • Orally administered forms should be given with food to decrease GI upset, even though this will delay absorption. • Some of these agents may cause an Antabuse-like reaction when taken with alcohol. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 63: Antibiotics: Nursing Implications Tetracyclines • Milk products, iron preparations, antacids, and other dairy products should be avoided because of the chelation and drug-binding that occurs. • All medications should be taken with 6 to 8 ounces of fluid, preferably water. • Due to photosensitivity, avoid sunlight and tanning beds. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 64: Antibiotics: Nursing Implications Aminoglycosides • Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity. • Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. • Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 65: Antibiotics: Nursing Implications Quinolones • Should be taken with at least 3 L of fluid per day, unless otherwise specified Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 66: Antibiotics: Nursing Implications Macrolides • These agents are highly protein-bound and will cause severe interactions with other protein-bound drugs. • The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many agents are taken after a meal or snack. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 67: Antibiotics: Nursing Implications Monitor for therapeutic effects: • Disappearance of fever, lethargy, drainage, and redness Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




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Kaplan Question Of the Day : Passing Nclex

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A nursing team consists of an RN, an LPN/LVN, and a nursing assistant. The nurse should assign which of the following patients to the LPN/LVN?

REWORDED QUESTION: Which patient is an appropriate assignment for the LPN/LVN?

STRATEGY: Think about the skill level involved in each patient's care.

NEEDED INFO: LPN/LVN: assists with implementation of care; performs procedures; differentiates normal from abnormal; cares for stable patients with predictable conditions; has knowledge of asepsis and dressing changes; administers medications (varies with educational background and state nurse practice act).

CATEGORY: Planning/Safe and Effective Care

(1) A 72-year-old patient with diabetes who requires a dressing change for a stasis ulcer
CORRECT: stable patient with an expected outcome

(2) A 42-year-old patient with cancer of the bone complaining of pain
Requires assessment; RN is the appropriate caregiver

(3) A 55-year-old patient with terminal cancer being transferred to hospice home care
Requires nursing judgment; RN is the appropriate caregiver

(4) A 23-year-old patient with a fracture of the right leg who asks to use the urinal
Standard unchanging procedure; assign to the nursing assistant





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Saturday, September 27, 2008

Bronchodilators Updates (ati nclex pharmacology topic descriptors)

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Bronchodilators Updates (ati pharmacology topic descriptors) Slideshow transcript
Slide 1: Bronchodilators and Other Respiratory Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Drugs Affecting the Respiratory System • Bronchodilators – Xanthine derivatives – Beta-agonists • Anticholinergics • Antileukotriene agents • Corticosteroids • Mast cell stabilizers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Instructors may want to use EIC Image #94: Airway Restrictive Factors Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Bronchodilators: Xanthine Derivatives • Plant alkaloids: caffeine, theobromine, and theophylline • Only theophylline is used as a bronchodilator Examples: aminophylline dyphilline oxtriphylline theophylline (Bronkodyl, Slo-bid, Theo-Dur,Uniphyl) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Bronchodilators: Xanthine Derivatives Mechanism of Action • Increase levels of energy-producing cAMP* • This is done competitively inhibiting phosphodiesterase (PDE), the enzyme that breaks down cAMP • Result: decreased cAMP levels, smooth muscle relaxation, bronchodilation, and increased airflow *cAMP = cyclic adenosine monophosphate Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Bronchodilators: Xanthine Derivatives Drug Effects • Cause bronchodilation by relaxing smooth muscles of the airways. • Result: relief of bronchospasm and greater airflow into and out of the lungs. • Also causes CNS stimulation. • Also causes cardiovascular stimulation: increased force of contraction and increased HR, resulting in increased cardiac output and increased blood flow to the kidneys (diuretic effect). Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Bronchodilators: Xanthine Derivatives Therapeutic Uses • Dilation of airways in asthmas, chronic bronchitis, and emphysema • Mild to moderate cases of asthma • Adjunct agent in the management of COPD • Adjunct therapy for the relief of pulmonary edema and paroxysmal nocturnal edema in left-sided heart failure Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Bronchodilators: Xanthine Derivatives Side Effects • Nausea, vomiting, anorexia • Gastroesophageal reflux during sleep • Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias • Transient increased urination Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Bronchodilators: Beta-Agonists • Large group, sympathomimetics • Used during acute phase of asthmatic attacks • Quickly reduce airway constriction and restore normal airflow • Stimulate beta2 adrenergic receptors throughout the lungs Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Bronchodilators: Beta-Agonists Three types • Nonselective adrenergics – Stimulate alpha1, beta1 (cardiac), and beta2 (respiratory) receptors. Example: epinephrine • Nonselective beta-adrenergics – Stimulate both beta1 and beta2 receptors. Example: isoproterenol (Isuprel) • Selective beta2 drugs – Stimulate only beta2 receptors. Example: albuterol Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Bronchodilators: Beta-Agonists Mechanism of Action • Begins at the specific receptor stimulated • Ends with the dilation of the airways Activation of beta2 receptors activate cAMP, which relaxes smooth muscles of the airway and results in bronchial dilation and increased airflow. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Bronchodilators: Beta-Agonists Therapeutic Uses • Relief of bronchospasm, bronchial asthma, bronchitis, and other pulmonary disease. • Useful in treatment of acute attacks as well as prevention. • Used in hypotension and shock. • Used to produce uterine relaxation to prevent premature labor. • Hyperkalemia—stimulates potassium to shift into the cell. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Bronchodilators: Beta-Agonists Side Effects Alpha-Beta Beta1 and Beta2 Beta2 (epinephrine) (isoproterenol) (albuterol) insomnia cardiac stimulation hypotension restlessness tremor vascular headache anorexia anginal pain tremor cardiac stimulation vascular headache tremor vascular headache Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Respiratory Agents: General Nursing Implications • Encourage patients to take measures that promote a generally good state of health in order to prevent, relieve, or decrease symptoms of COPD. – Avoid exposure to conditions that precipitate bronchospasms (allergens, smoking, stress, air pollutants) – Adequate fluid intake – Compliance with medical treatment – Avoid excessive fatigue, heat, extremes in temperature, caffeine Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Respiratory Agents: General Nursing Implications • Encourage patients to get prompt treatment for flu or other illnesses, and to get vaccinated against pneumonia or flu. • Encourage patients to always check with their physician before taking any other medication, including OTC. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Respiratory Agents: General Nursing Implications • Perform a thorough assessment before beginning therapy, including: – Skin color – Baseline vital signs – Respirations (should be <12>24 breaths/min) – Respiratory assessment, including PO2 – Sputum production – Allergies – History of respiratory problems – Other medications Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Respiratory Agents: General Nursing Implications • Teach patients to take bronchodilators exactly as prescribed. • Ensure that patients know how to use inhalers, MDIs, and have the patients demonstrate use of devices. • Monitor for side effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Respiratory Agents: Nursing Implications • Monitor for therapeutic effects – Decreased dyspnea – Decreased wheezing, restlessness, and anxiety – Improved respiratory patterns with return to normal rate and quality – Improved activity tolerance • Decreased symptoms and increased ease of breathing Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Bronchodilators: Nursing Implications Xanthine Derivatives • Contraindications: history of PUD or GI disorders • Cautious use: cardiac disease • Timed-release preparations should not be crushed or chewed (causes gastric irritation) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Bronchodilators: Nursing Implications Xanthine Derivatives • Report to physician: Palpitations Nausea Vomiting Weakness Dizziness Chest pain Convulsions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Bronchodilators: Nursing Implications Xanthine Derivatives • Be aware of drug interactions with: cimetidine, oral contraceptives, allopurinol • Large amounts of caffeine can have deleterious effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Bronchodilators: Nursing Implications Beta-Agonist Derivatives • Albuterol, if used too frequently, loses its beta2-specific actions at larger doses. • As a result, beta1 receptors are stimulated, causing nausea, increased anxiety, palpitations, tremors, and increased heart rate. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Bronchodilators: Nursing Implications Beta-Agonist Derivatives • Patients should take medications exactly as prescribed, with no omissions or double doses. • Patients should report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Anticholinergics: Mechanism of Action • Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways. • Anticholinergics bind to the ACh receptors, preventing ACh from binding. • Result: bronchoconstriction is prevented, airways dilate. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Anticholinergics • Ipratropium bromide (Atrovent) is the only anticholinergic used for respiratory disease. • Slow and prolonged action • Used to prevent bronchoconstriction • NOT used for acute asthma exacerbations! Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Anticholinergics: Side Effects Dry mouth or throat Gastrointestinal distress Headache Coughing Anxiety No known drug interactions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Antileukotrienes • Also called leukotriene receptor antagonists (LRTAs) • New class of asthma medications • Three subcategories of agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Antileukotrienes Currently available agents: • montelukast (Singulair) • zafirlukast (Accolate) • zileuton (Zyflo) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Antileukotrienes: Mechanism of Action • Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body. • Leukotrienes cause inflammation, bronchoconstriction, and mucus production. • Result: coughing, wheezing, shortness of breath Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Antileukotrienes: Mechanism of Action • Antileukotriene agents prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation. • Inflammation in the lungs is blocked, and asthma symptoms are relieved. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Antileukotrienes: Drug Effects By blocking leukotrienes: • Prevent smooth muscle contraction of the bronchial airways • Decrease mucus secretion • Prevent vascular permeability • Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Antileukotrienes: Therapeutic Uses • Prophylaxis and chronic treatment of asthma in adults and children over age 12 • NOT meant for management of acute asthmatic attacks • Montelukast is approved for use in children age 2 and older Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Antileukotrienes: Side Effects zileuton zafirlukast Headache Headache Dyspepsia Nausea Nausea Diarrhea Dizziness Liver dysfunction Insomnia Liver dysfunction montelukast has fewer side effects Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Antileukotrienes: Nursing Implications • Ensure that the drug is being used for chronic management of asthma, not acute asthma. • Teach the patient the purpose of the therapy. • Improvement should be seen in about 1 week. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Antileukotrienes: Nursing Implications • Check with physician before taking any OTC or prescribed medications—many drug interactions. • Assess liver function before beginning therapy. • Medications should be taken every night on a continuous schedule, even if symptoms improve. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Corticosteroids • Anti-inflammatory • Used for CHRONIC asthma • Do not relieve symptoms of acute asthmatic attacks • Oral or inhaled forms • Inhaled forms reduce systemic effects • May take several weeks before full effects are seen Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Corticosteroids: Mechanism of Action • Stabilize membranes of cells that release harmful bronchoconstricting substances. • These cells are leukocytes, or white blood cells. • Also increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Inhaled Corticosteroids • beclomethasone dipropionate (Beclovent, Vanceril) • triamcinolone acetonide (Azmacort) • dexamethasone sodium phosphate (Decadron Phosphate Respihaler) • flunisolide (AeroBid) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Inhaled Corticosteroids: Therapeutic Uses • Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators. • NOT considered first-line agents for management of acute asthmatic attacks or status asthmaticus. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Inhaled Corticosteroids: Side Effects • Pharyngeal irritation • Coughing • Dry mouth • Oral fungal infections Systemic effects are rare because of the low doses used for inhalation therapy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Inhaled Corticosteroids: Nursing Implications • Contraindicated in patients with psychosis, fungal infections, AIDS, TB. • Cautious use in patients with diabetes, glaucoma, osteoporosis, PUD, renal disease, CHF, edema. • Teach patients to gargle and rinse the mouth with water afterward to prevent the development of oral fungal infections. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Inhaled Corticosteroids: Nursing Implications • Abruptly discontinuing these medications can lead to serious problems. • If discontinuing, should be weaned for a period of 1 to 2 weeks, and only if recommended by physician. • REPORT any weight gain of more than 5 pounds a week or the occurrence of chest pain. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Mast Cell Stabilizers • cromolyn (Nasalcrom, Intal) • nedocromil (Tilade) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Mast Cell Stabilizers • Indirect-acting agents that prevent the release of the various substances that cause bronchospasm • Stabilize the cell membranes of inflammatory cells (mast cells, monocytes, macrophages), thus preventing release of harmful cellular contents • No direct bronchodilator activity • Used prophylactically Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 45: Mast Cell Stabilizers: Therapeutic Uses • Adjuncts to the overall management of COPD • Used solely for prophylaxis, NOT for acute asthma attacks • Used to prevent exercise-induced bronchospasm • Used to prevent bronchospasm associated with exposure to known precipitating factors, such as cold, dry air or allergens Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 46: Mast Cell Stabilizers: Side Effects Coughing Taste changes Sore throat Dizziness Rhinitis Headache Bronchospasm Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 47: Mast Cell Stabilizers: Nursing Implications • For prophylactic use only • Contraindicated for acute exacerbations • Not recommended for children under age 5 • Therapeutic effects may not be seen for up to 4 weeks • Teach patients to gargle and rinse the mouth with water afterward to minimize irritation to the throat and oral mucosa Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




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Kaplan Question Of the Day : Nclex Help

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The nurse on postpartum is preparing four clients for discharge. It would be MOST important for the nurse to refer which of the following patients for home care?

REWORDED QUESTION: Who is the most unstable patient?

STRATEGY: Think ABCs.

NEEDED INFO: Need to meet the client's needs. Physical stability is the nurse's first concern. Most unstable patient should be seen first.

CATEGORY: Implementation/Safe and Effective Care

(1) A 15-year-old primipara who delivered a 7-lb male two days ago
Stable situation, no indication of problems with mother or baby

(2) An 18-year-old multipara who delivered a 9-lb female by cesarean section two days ago
Stable situation, no indication of problems with mother or baby

(3) A 20-year-old multipara who delivered 1 day ago and is complaining of cramping
Stable patient, cramping due to uterine contraction

(4) A 22-year-old who delivered by cesarean section and is complaining of burning on urination
CORRECT: unstable patient, indicates urinary tract infection, requires follow-up





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Friday, September 26, 2008

Kaplan Question Of the Day: Nclex Assessment Guide

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Which of the following actions, if performed by the nurse, would be considered negligence?

REWORDED QUESTION: What is an incorrect behavior?

STRATEGY: Think about the consequence of each action.

NEEDED INFO: Negligence is the unintentional failure of nurse to perform an act that a reasonable person would or would not perform in similar circumstances; can be an act of commission or omission. Standards of care: the actions that other nurses would do in the same or similar circumstances that provide for quality client care. Nurse practice acts: state laws that determine the scope of the practice of nursing.

CATEGORY: Analysis/Safe and Effective Care

(1) Obtaining a Guthrie blood test on a 4-day-old infant
Obtain after ingestion of protein, no later than 7 days after delivery

(2) Massaging lotion on the abdomen of a 3-year-old diagnosed with Wilm's tumor
CORRECT: manipulation of mass may cause dissemination of cancer cells

(3) Instructing a 5-year-old asthmatic to blow on a pinwheel
Exercise that will extend expiratory time and increase expiratory pressure

(4) Playing kickball with a 10-year-old with juvenile arthritis (JA)
Excellent moving and stretching exercise





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Antihistamines (Clinical Nclex Pharmacology)

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Antihistamines (Clinical Pharmacology) Slideshow Transcript
Slide 1: Drugs Affecting the Respiratory System Antihistamines, Decongestants, Antitussives, and Expectorants Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Understanding the Common Cold • Most caused by viral infection (rhinovirus or influenza virus—the “flu”) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Understanding the Common Cold • Virus invades tissues (mucosa) of upper respiratory tract, causing upper respiratory infection (URI). • Excessive mucus production results from the inflammatory response to this invasion. • Fluid drips down the pharynx into the esophagus and lower respiratory tract, causing cold symptoms: sore throat, coughing, upset stomach. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Understanding the Common Cold • Irritation of nasal mucosa often triggers the sneeze reflex. • Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Treatment of the Common Cold • Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants. • Treatment is SYMPTOMATIC only, not curative. • Symptomatic treatment does not eliminate the causative pathogen. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Instructors may want to use EIC Image #83: Upper Respiratory Tract Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Treatment of the Common Cold • Difficult to identify whether cause is viral or bacterial. • Treatment is “empiric therapy,” treating the most likely cause. • Antivirals and antibiotics may be used, but viral or bacterial cause may not be easily identified. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Antihistamines Drugs that directly compete with histamine for specific receptor sites. • Two histamine receptors: – H1 histamine-1 – H2 histamine-2 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Antihistamines H2 Blockers or H2 Antagonists – Used to reduce gastric acid in PUD – Examples: cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Antihistamines H1 antagonists are commonly referred to asantihistamines • Antihistamines have several effects: – Antihistaminic – Anticholinergic – Sedative Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Antihistamines: Mechanism of Action BLOCK action of histamine at the receptor sites • Compete with histamine for binding at unoccupied receptors. • CANNOT push histamine off the receptor if already bound. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Antihistamines: Mechanism of Action • The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation: – Vasodilation – Increased gastrointestinal and respiratory secretions – Increased capillary permeability Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Antihistamines: Mechanism of Action • More effective in preventing the actions of histamine rather than reversing them • Should be given early in treatment, before all the histamine binds to the receptors Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Histamine vs. Antihistamine Effects Cardiovascular (small blood vessels) • Histamine effects: – Dilation and increased permeability (allowing substances to leak into tissues) • Antihistamine effects: – Prevent dilation of blood vessels – Prevent increased permeability Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Histamine vs. Antihistamine Effects Smooth Muscle (on exocrine glands) • Histamine effects: – Stimulate salivary, gastric, lacrimal, and bronchial secretions • Antihistamine effects: – Prevent salivary, gastric, lacrimal, and bronchial secretions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Histamine vs. Antihistamine Effects Immune System (Release of substances commonly associated with allergic reactions) • Histamine effects: – Mast cells release histamine and other substances, resulting in allergic reactions. • Antihistamine effect: – Binds to histamine receptors, thus preventing histamine from causing a response. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Antihistamines: Other Effects Skin: • Block capillary permeability, wheal-and-flare formation, itching Anticholinergic: • Drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itching eyes) Sedative: • Some antihistamines cause drowsiness Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Antihistamines: Therapeutic Uses Management of: • Nasal allergies • Seasonal or perennial allergic rhinitis (hay fever) • Allergic reactions • Motion sickness • Sleep disorders Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Antihistamines 10 to 20% of general population is sensitive to various environmental allergies. • Histamine-mediated disorders: – Allergic rhinitis (hay fever, mold and dust allergies) – Anaphylaxis – Angioneurotic edema – Drug fevers – Insect bite reactions – Urticaria (itching) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Antihistamines: Therapeutic Uses Also used to relieve symptoms associated with the common cold: • Sneezing, runny nose • Palliative treatment, not curative Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Antihistamines: Side effects • Anticholinergic (drying) effects, most common: – Dry mouth – Difficulty urinating – Constipation – Changes in vision • Drowsiness – (Mild drowsiness to deep sleep) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Antihistamines: Two Types • Traditional or • Nonsedating/Peripherally Acting Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Antihistamines: Traditional • Older • Work both peripherally and centrally • Have anticholinergic effects, making them more effective than nonsedating agents in some cases Examples: diphenhydramine (Benadryl) chlorpheniramine (Chlor-Trimeton) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Antihistamines: Nonsedating/Peripherally Acting • Developed to eliminate unwanted side effects, mainly sedation • Work peripherally to block the actions of histamine; thus, fewer CNS side effects • Longer duration of action (increases compliance) Examples: fexofenadine (Allegra) loratadine (Claritin) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Nursing Implications: Antihistamines • Gather data about the condition or allergic reaction that required treatment; also, assess for drug allergies. • Contraindicated in the presence of acute asthma attacks and lower respiratory diseases. • Use with caution in increased intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Nursing Implications: Antihistamines • Instruct patients to report excessive sedation, confusion, or hypotension. • Avoid driving or operating heavy machinery, and do not consume alcohol or other CNS depressants. • Do not take these medications with other prescribed or OTC medications without checking with prescriber. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Nursing Implications: Antihistamines • Best tolerated when taken with meals— reduces GI upset. • If dry mouth occurs, teach patient to perform frequent mouth care, chew gum, or suck on hard candy (preferably sugarless) to ease discomfort. • Monitor for intended therapeutic effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Decongestants Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Nasal Congestion • Excessive nasal secretions • Inflamed and swollen nasal mucosa • Primary causes: – Allergies – Upper respiratory infections (common cold) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Decongestants Two main types are used: • Adrenergics (largest group) • Corticosteroids Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Decongestants Two dosage forms: • Oral • Inhaled/topically applied to the nasal membranes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Oral Decongestants • Prolonged decongestant effects, but delayed onset • Effect less potent than topical • No rebound congestion • Exclusively adrenergics • Examples: phenylephrine pseudoephedrine (Sudafed) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Topical Nasal Decongestants • Both adrenergics and steroids • Prompt onset • Potent • Sustained use over several days causes rebound congestion, making the condition worse Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Topical Nasal Decongestants • Adrenergics: ephedrine (Vicks) naphazoline (Privine) oxymetazoline (Afrin) phenylephrine (Neo Synephrine) • Intranasal Steroids: beclomethasone dipropionate (Beconase, Vancenase) flunisolide (Nasalide) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Nasal Decongestants: Mechanism of Action Site of action: blood vessels surrounding nasal sinuses • Adrenergics – Constrict small blood vessels that supply URI structures – As a result, these tissues shrink and nasal secretions in the swollen mucous membranes are better able to drain – Nasal stuffiness is relieved Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Nasal Decongestants: Mechanism of Action Site of action: blood vessels surrounding nasal sinuses • Nasal steroids – Anti-inflammatory effect – Work to turn off the immune system cells involved in the inflammatory response – Decreased inflammation results in decreased congestion – Nasal stuffiness is relieved Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Nasal Decongestants: Drug Effects • Shrink engorged nasal mucous membranes • Relieve nasal stuffiness Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Nasal Decongestants: Therapeutic Uses Relief of nasal congestion associated with: • Acute or chronic rhinitis • Common cold • Sinusitis • Hay fever • Other allergies May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal/pharyngeal membranes before surgery or diagnostic procedures. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Nasal Decongestants: Side Effects Adrenergics Steroids nervousness local mucosal dryness and irritation insomnia palpitations tremors (systemic effects due to adrenergic stimulation of the heart, blood vessels, and CNS) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Nursing Implications: Nasal Decongestants • Decongestants may cause hypertension, palpitations, and CNS stimulation—avoid in patients with these conditions. • Assess for drug allergies. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Nursing Implications: Decongestants • Patients should avoid caffeine and caffeine- containing products. • Report a fever, cough, or other symptoms lasting longer than a week. • Monitor for intended therapeutic effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Antitussives Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Cough Physiology Respiratory secretions and foreign objects are naturally removed by the • cough reflex – Induces coughing and expectoration – Initiated by irritation of sensory receptors in the respiratory tract Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Two Basic Types of Cough • Productive Cough – Congested, removes excessive secretions • Nonproductive Cough – Dry cough Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 45: Coughing Most of the time, coughing is beneficial • Removes excessive secretions • Removes potentially harmful foreign substances In some situations, coughing can be harmful, such as after hernia repair surgery Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 46: Antitussives Drugs used to stop or reduce coughing • Opioid and nonopioid (narcotic and non-narcotic) Used only for NONPRODUCTIVE coughs! Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 47: Antitussives: Mechanism of Action Opioid • Suppress the cough reflex by direct action on the cough center in the medulla. Examples: codeine (Robitussin A-C, Dimetane-DC) hydrocodone Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 48: Antitussives: Mechanism of Action Nonopioid • Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated. Examples: benzonatate (Tessalon) dextromethorphan (Vicks Formula 44, Robitussin-DM) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 49: Antitussives: Therapeutic Uses • Used to stop the cough reflex when the cough is nonproductive and/or harmful Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 50: Antitussives: Side Effects Benzonatate • Dizziness, headache, sedation Dextromethorphan • Dizziness, drowsiness, nausea Opioids • Sedation, nausea, vomiting, lightheadedness, constipation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 51: Nursing Implications: Antitussive Agents • Perform respiratory and cough assessment, and assess for allergies. • Instruct patients to avoid driving or operating heavy equipment due to possible sedation, drowsiness, or dizziness. • If taking chewable tablets or lozenges, do not drink liquids for 30 to 35 minutes afterward. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 52: Nursing Implications: Antitussive Agents • Report any of the following symptoms to the caregiver: – Cough that lasts more than a week – A persistent headache – Fever – Rash • Antitussive agents are for NONPRODUCTIVE coughs. • Monitor for intended therapeutic effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 53: Expectorants Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 54: Expectorants • Drugs that aid in the expectoration (removal) of mucus • Reduce the viscosity of secretions • Disintegrate and thin secretions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 55: Expectorants: Mechanisms of Action • Direct stimulation or • Reflex stimulation Final result: thinner mucus that is easier to remove Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 56: Expectorants: Mechanism of Action Direct stimulation: • The secretory glands are stimulated directly to increase their production of respiratory tract fluids. Examples: terpin hydrate, iodine-containing products such as iodinated glycerol and potassium iodide (direct and indirect stimulation) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 57: Expectorants: Mechanism of Action Reflex stimulation: • Agent causes irritation of the GI tract. • Loosening and thinning of respiratory tract secretions occur in response to this irritation. Examples: guaifenesin, syrup of ipecac Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 58: Expectorants: Drug Effects • By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 59: Expectorants: Therapeutic Uses Used for the relief of nonproductive coughs associated with: Common cold Pertussis Bronchitis Influenza Laryngitis Measles Pharyngitis Coughs caused by chronic paranasal sinusitis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 60: Expectorants: Common Side Effects guaifenesin terpin hydrate Nausea, vomiting Gastric upset Gastric irritation (Elixir has high alcohol content) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 61: Nursing Implications: Expectorants • Expectorants should be used with caution in the elderly, or those with asthma or respiratory insufficiency. • Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions. • Report a fever, cough, or other symptoms lasting longer than a week. • Monitor for intended therapeutic effects. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




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