NMNC 1230 Final Exam Study Guide 11.23 (1)
dotx
keyboard_arrow_up
School
Central New Mexico Community College *
*We aren’t endorsed by this school
Course
1230
Subject
Health Science
Date
Feb 20, 2024
Type
dotx
Pages
20
Uploaded by pmunoz2
NMNC 1230 Final Exam Study Guide
The Final Exam is cumulative and includes approximately 25% of content on Nutrition and Elimination concepts. Please see your course agenda for chapters and concepts. The final contains 60 questions of multiple choice, select all that apply, and fill in the blank (dosage). You have 1 hour and 30 minutes to complete the exam. Focus on the prototype drugs in your McCuistion et al (2023) [Pharmacology] assigned reading chapters, the Nursing Process/Clinical Judgement Measurement Model sections, as well as the study guide content below.
Chapter 13: Vitamins and Mineral Replacements
vitamin A (use, side effects)
Fat soluble vitamin that can cause night blindness with deficient amounts, and can stay stored in the liver for months to years
ferrous sulfate (iron) therapeutic use, pharmacodynamics
Mineral needed for proper red blood cell development (and to treat anemia); adequate fluid needed to prevent constipation.
vitamin C (use, pharmacodynamics)
A water-soluble vitamin essential for collagen formation and tissue repair; can cause kidney stones with excessive amounts
water soluble vs fat soluble vitamins (pharmacokinetics, pharmacodynamics)
Water soluble: Not usually toxic unless taken in excessive amounts; not stored by the body and
excreted in the urine.
Fat soluble:
A, D, E, K.
Metabolized and excreted through urine slowly; can be stored in fatty tissue, liver, and muscle and can be toxic if taken in excessive amounts.
Chapter 45: Gastrointestinal Drugs
psyllium (bulk laxative) (use, side effects, patient teaching)
Electrolyte imbalances, abdominal cramping, flatulence, adverse effect of bowel obstruction if not taken with adequate fluid
ondansetron (serotonin 5-HT3 antagonist) (use, side effects)
For postoperative and chemo- and radiation-induced nausea and vomiting. May cause dizziness, drowsiness, agitation, headache, fatigue, malaise, diarrhea, hypotension, urinary retention, fever, and constipation.
promethazine (phenothiazine) contraindications, side effects
Central nervous system (CNS) depression increases with other CNS depressants like alcohol, narcotics, sedative- hypnotics; due to anticholinergic effects this drug is contraindicated with glaucoma.
diarrhea & nonpharmacologic measures
Brat diet, toast, apple sauce,
This includes use of clear liquids and oral solutions such as Gatorade (for adults) and Pedialyte or Rehydralyte (for children) and IV electrolyte solutions.
diphenoxylate with atropine nursing interventions, patient teaching
CNS depressants or sedatives may increase CNS depression such as respiratory depression and hypotension, do not ingest fried food or milk until diarrhea stopped. Check for signs and symptoms of dehydration resulting from persistent diarrhea. Fluid replacement may be necessary. With prolonged diarrhea, check serum electrolytes. Recognize that a drug may need to be withheld if diarrhea continues for more than 48 hours or acute abdominal pain develops.
Chapter 46: Antiulcer Drugs
H2 blocker (patient teaching, side effects)
Vitamin B-12 deficiency, erectile dysfunction is reversible when discontinued.
proton pump inhibitor (use, drug interactions)
May interfere with absorption of digoxin or ampicillin. To treat duodenal ulcers, GERD, esophagitis, dyspepsia, pyrosis, Helicobacter pylori infection, and Zollinger-Ellison syndrome and
to prevent NSAID-induced ulcers.
h. pylori pharmacologic treatment
A common treatment protocol is the triple therapy of metronidazole (or amoxicillin), omeprazole (or lansoprazole), and clarithromycin (MOC). The drug regimen eradicates more than 90% of peptic ulcers caused by H. pylori. If triple therapy fails to eradicate H. pylori, quadruple therapy using two antibiotics, a PPI, and a bismuth or histamine2 (H2) blocker is recommended. After completion of the treatment regimen, 6 weeks of standard acid suppression—such as H2 blocker therapy—is recommended.
aluminum hydroxide (side effects, nursing interventions)
This drug neutralizes acid, and in liquid form is more effective if taken 1-3 hours after meals with a small amount of water; may cause constipation.
magnesium hydroxide (side effects, nursing interventions)
This drug is contraindicated with renal disease; labs such as BUN, creatinine, and magnesium should be monitored with excessive use; may cause diarrhea May cause chalky taste, nausea,
vomiting, diarrhea, dehydration, and hypermagnesemia. Hypermagnesemia can result from continuous use of magnesium salts, causing symptoms such as drowsiness, weakness, paralysis, complete heart block, hypotension, flush, and respiratory depression
. Monitor fluid intake and output, signs and symptoms of fluid and electrolyte imbalances that may result from watery stools. Habitual use of laxatives can cause fluid volume deficit, electrolyte losses, and loss of the urge to defecate.
antacid medication administration (mechanism of action, how to administer)
Antacids are given orally as a chewable or liquid
.
nonpharmacologic treatment/patient teaching for GERD
Encouraging small, frequent fluids or meals, Avoiding tobacco products, Lying down with
HOB elevated, Taking NSAIDS with food Review of Content from Weeks 2 – 11
Chapter 1: CJMM
Identifying steps within the Clinical Judgement Measurement Model
c. Recognize Cues [Assessment]1
b. Analyze Cues [Analysis] 2
d. Prioritize Hypothesis [Analysis]3
a. Generate Solutions [Planning]4
f. Take Action [Intervention]5
e. Evaluate Outcomes [Evaluation]6
Chapter 3: Pharmacokinetics and Pharmacodynamics
pharmacodynamic interaction definitions: additive effect, synergistic effect, antagonistic
effect
Chapter 6: Pediatric Considerations (know these)
pediatric considerations with med administration (pharmacokinetics & pharmacodynamics)
Chapter 7: Drug Therapy in Older Adults (know these)
geriatric considerations with med administration (pharmacokinetics & pharmacodynamics)
Chapter 9: Safety & Quality
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
high alert drugs (know examples)
patient’s rights/rights of medication administration
Right dose, route, time, medication, documentation, patient. Chapter 10: Drug Administration
drug administration: forms and routes
Chapter 13: Vitamin and Mineral Replacement (see first page)
Chapter 15: Adrenergic Agonists and Antagonists
adrenergic agonists and antagonists: side effects and
patient teaching
Ø
Therapeutic use:
o
Improve heart pressure
o
Improve breathing pattern
o
Improve cardiac output
Ø
Side effects: o
Rapid heart rate, palpitations, rash, itching, flushing, chest pain, irregular heartbeat, vomiting, numbness of fingers and toes. Hypertension, restlessness, tremors, dysrhythmia, dizziness, urinary retention, nausea, dyspnea, pulmonary edema.
REPORT TO A HEALTH CARE PROVIDER because dose may require adjustment
Chapter 17: Stimulants
methylphenidate (amphetamine-like): patient teaching
Chapter 19: Anti-seizure Drugs
status epilepticus and seizure/epilepsy pharmacotherapy
Phenytoin (Hydantoin Anticonvulsant)
Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms
cyclobenzaprine (skeletal muscle relaxant) indications/use and side effects
Chapter 22: Antipsychotics and Anxiolytics
haloperidol/antipsychotic: adverse effects, assessment with medication use
Therapeutic Effects/Uses
To treat acute psychoses, schizophrenia, Tourette syndrome
Mechanism of Action:
Alters the effect of dopamine on the CNS; mechanism for antipsychotics is unknown.
Side Effects
Drowsiness, edema, headache, blurred vision, depression, confusion, euphoria,
cataracts, lethargy, tremor, dry mouth, constipation, weight gain/loss, restlessness, hyperhidrosis, erectile dysfunction, urinary retention.
Adverse effects:
Tachycardia, orthostatic hypotension, EPS, hyper/hypoglycemia, hyponatremia,
seizures, retinopathy, osteopenia.
Life-threatening:
Laryngeal edema, bronchospasm, dysrhythmias, eosinophilia, aplastic anemia, hemolytic anemia, agranulocytosis, leukopenia, neutropenia, thrombocytopenia, pancytopenia, hepatic failure, NMS, rhabdomyolysis
Chapter 23: Antidepressants and Mood Stabilizers
venlafaxine (SNRI) use, side effects, adverse effects
Use: Depression & Pain
Generalized anxiety disorder Social anxiety disorder
Increases availability at the synapse.
Side effects:
Drowsiness, dizziness, insomnia, headache, amnesia, blurred vision, erectile/ejaculation dysfunction.
Adverse effects:
Hypertension, orthostatic hypotension, tachycardia, seizures, NMS, suicidal ideation.
MAOIs Monoamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin.
Chapter 25: Analgesics
opioid analgesics- indications for use, nursing assessment & interventions with use
1. Morphine (Opioid)
indications for use for pain:
to relieve moderate to severe pain.
Common side effects (opioids and non-opioids):
anorexia, dry mouth, nausea, abdominal pain, diarrhea, Constipation, flatulence, fever, drowsiness, dizziness, agitation, anxiety, dysgeusia, confusion, depression, urinary retention, rash, blurred vision, miosis, weakness, flushing, euphoria, peripheral edema, paresthesia, diaphoresis,
pruritus, infection, back pain, insomnia, erectile dysfunction.
Adverse effects (opioids and non-opioids):
orthostatic hypotension, bradycardia, tachycardia, palpitations, seizures, ileus, psychological dependence, dyspnea. Life threatening: respiratory depression, anemia, leukopenia, thrombocytopenia, pulmonary
edema, GI obstruction, dysrhythmias
Patient teaching on max dosage (acetaminophen): - administer morphine before pain reaches its peak to maximize effectiveness
- monitor vital signs at frequent intervals to detect respiratory changes and hypotension. Fewer than 10 respirations permanent can indicate respiratory distress.
-Record the patient's urine output because urinary retention is a side effect of morphine. Urine output should be at least 600 milliliters per day.
-Check bowel sounds for decreased peristalsis; constipation is a side effect of morphine. A dietary change or mild laxative might be needed.
-
Check for pupil changes in reaction. Pinpoint pupils can indicate morphine overdose.
-
Have naloxone available as an antidote to reverse respiratory depression if morphine overdose occurs.
-Validate the dose of morphine before administration.
-Encourage patients not to use alcohol or central nervous system depressants with any opioid analgesic such as morphine.
-suggest non pharmacologic measures to relieve pain as the patient recuperates from surgery.
-Alert patients that with continuous use, or opioids such as morphine can become a substance use disorder.
-Encourage patients to report dizziness while taking morphine -
teach patients to report difficulty in breathing, blurred vision, and headaches.
opioid reversal/antagonist
Chapter 28: Tetracyclines, Glycylcyclines, Aminoglycosides, and Fluoroquinolones
trough and peak drug serum levels: indications for lab
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Chapter 35: Anticancer Drugs
antineoplastic therapy: patient education on chemotherapy treatment & myelosuppression
cyclophosphamide (alkylating agent/nitrogen mustard) side effects, patient teaching
•
Side effects and adverse reactions
•
Anaphylaxis, hemorrhagic cystitis, cardiotoxicity
•
Syndrome of inappropriate antidiuretic hormone
•
Increased skin pigmentation, GI distress, stomatitis
•
Fever, alopecia
, weight loss, amenorrhea
•
Neutropenia, pneumonitis, •
Tumor lysis syndrome, nephrotoxicity, hepatotoxicity
Recognize cues
•
Assess baseline lab values.
•
Obtain baseline data about patient’s physical status.
Analyze cues and prioritize hypothesis
•
Decreased immunity, need for patient teaching Generate solutions
•
The patient will remain free from infection and hemorrhagic cystitis.
•
Monitor lab results.
•
Monitor patient’s IV site frequently for irritation and phlebitis.
•
Maintain strict medical asepsis during dressing changes and invasive procedures.
•
Encourage small, frequent meals high in calories and protein.
•
Maintain hydration before and during chemotherapy.
Chapter 39: Lower Respiratory Disorders
montelukast (leukotriene receptor antagonist): indications for use, therapeutic effects
inhaler medication administration patient teaching (order of inhaler administration)
albuterol (alpha agonist): indications, administration, patient teaching
beclomethasone (corticosteroid) indications, administration, patient teaching
Chapter 40: Cardiac Glycosides, Antianginals, and Antidysrhythmics
digoxin: side effects, patient teaching Ø
Therapeutic effect of drug- o
Heart Failure- to improve CO
o
Atrial fibrillation and flutter
Ø
Side effects/adverse reactions-
o
Dizziness, headache, malaise, fatigue
o
Nausea, vomiting,
diarrhea, abdominal pain, dizziness, weakness, confusion, anxiety. visual disturbances (blurred or yellow vision: halos around dark objects), anorexia
-frequently foreshadow serious toxicity.
o
Hypokalemia
(most common reason for digoxin-related dysrhythmias is diuretic-induced hypokalemia), dysrhythmias,
Ø
Adverse Reactions
:
o
Bradycardia, hallucinations, bowel necrosis, palpitations, LIFE THREATENING
: Dysrhythmias, thrombocytopenia.
Ø
Patient teaching/nursing interventions:
o
Get baseline vital signs, full minute apical pulse (60 bpm minimum if low consult with provider)
o
Check laboratory findings
for digitalis and potassium levels. If lower than 3.5 mEq/L report to provider.
o
Monitor digoxin serum levels.
Greater than 2ng/mL is considered toxic. NARROW therapeutic range)
o
Teach patients how to check their pulse. o
Administer IV doses slowly over 5 minutes
o
Teach patients not to double up with missed doses
o
Teach patients to recognize hypokalemia (muscle weakness) and digoxin toxicity (nausea, vomiting, anorexia, diarrhea, blurred or yellow visual disturbances, halos around dark objects, and notify HCP)
o
Explain importance of adherence to drugs
o
Advise patients to avoid adverse drug interactions
o
Keep drugs out of reach of small children
o
Inform of possible herb interactions
o
Instruct patients to report side effects nausea vomiting headache diarrhea visual disturbances like diplopia.
o
Advise to eat foods high in potassium such as fresh and dried fruits, fruit
juiced and vegetables including potatoes.
nitroglycerin (antianginal): patient teaching/nursing interventions (including transdermal)
Therapeutic Effects/Use:
To control angina, AMI, hypertensive emergency, pulmonary edema, and heart failure.
Ø
Patient teaching/nursing interventions: o
Monitor vital signs
o
Position patient sitting or lying down when administering a nitrate for the
first time. After administration, check vital signs sitting and lying down and then have patient rise slowly to standing position
o
Offer sips of water before giving sublingual nitrates: dryness may inhibit drug absorption.
o
Monitor effects of IV nitroglycerin. Report persistent angina.
o
Apply nitroglycerin ointment to a designated mark on paper. Do not use fingers because drug can be absorbed: use tongue blade or gloves. When using a nitroglycerin patch, do not touch the medication portion.
o
Do not apply nitroglycerin ointment or a nitroglycerin patch in any area on the chest in the vicinity of defibrillator-cardioverter paddle placement.
Explosion and skin burns may result. o
Administer SL nitroglycerin tablet if chest pain occurs. If pain does not get better in 5 min call 911
o
Advise patients not to ingest alcohol while taking nitroglycerin to avoid hypotension, weakness, and faintness.
o
Advise patients to notify a health care provider if chest pain is not completely alleviated. Tolerance to nitroglycerin can occur.
o
Inform patients not to discontinue beta blockers and calcium blockers without a health care provider’s approval. Withdrawal symptoms (reflex tachycardia and pain) may be severe. o
Topical
Rotate sites of topical application to prevent skin irritation. Remove patch or ointment from previous site before application.
o
Doses may be increased to the highest dose that does not cause symptomatic hypotension.
o
Apply ointment by using dose-measuring application papers supplied with ointment. Squeeze ointment onto measuring scale printed on paper. Use paper to spread ointment onto nonhairy area of skin (chest, abdomen, thighs; avoid distal extremities) in a thin, even layer, covering a 2–3-in. area. Do
not allow ointment to come in contact with hands. Do not
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
massage or rub in ointment; this will increase absorption and
interfere with sustained action. Apply occlusive dressing if ordered.
o
Transdermal patches may be applied to any hairless site (avoid distal extremities or areas with cuts or calluses). Apply firm pressure over patch to ensure contact with skin, especially around edges. Apply a new dose unit if the first one becomes loose or falls off. Units are waterproof and not affected by showering or bathing. Do not cut or trim system to adjust dosage. Do not alternate between brands of transdermal products; dose may not be equivalent. Remove patches before MRI, cardioversion or defibrillation to prevent
patient burns. Patch may be worn for 12–14 hr and removed for 10–12 hr at night to prevent development of tolerance.
Chapter 42: Antihypertensives
beta blocker patient teaching-
Monitor vital signs: BP and pulse.
Monitory laboratory results: BUN, serum creatinine, AST, LDH
Encourage patients to comply with drug regimen. ABRUPT discontinuation of antihypertensive drugs may cause rebound hypertension.
Inform patients that herbs can interfere with beta blockers.
Advise patients to avoid over-the-counter drugs without first checking with a health care provider. Many OTC drugs carry warnings against use in presence of hypertension
or concurrent use with antihypertensives.
Suggest patients wear MedicAlert bracelet or carry a card indicating their health problem and prescribed drugs.
Teach patients in trauma situations to inform a health care provider of drugs taken daily,
such as a beta blocker. Beta blockers block compensatory effects of the body to the shock state. Glucagon may be needed to reverse the effects so the patient can be resuscitated.
Advise patients to rise slowly from lying or sitting to a standing position.
Teach patient to take a radial pulse or BP and report abnormal findings.
Report dizziness, slow pulse rate, changes in BP, heart palpitation, confusion, or gastrointestinal upset to health care provider.
Alert patients with diabetes mellitus to possible hypoglycemic symptoms.
Inform patients that antihypertensives may cause sexual dysfunction.
Teach patients and family members nonpharmacologic methods to decrease BP: low salt diet, relaxation techniques, exercise, smoking cessation, decreased alcohol ingestion.
Advise patients to report constipation. Foods high in fiber, stool softener, increased water intake are indicated. angiotensin converting enzyme (ace) inhibitor: indications for use, side effects:
Ø
Therapeutic effect of drug: o
Hypertension
o
Heart failure
Ø
Side effects/adverse reactions: o
Dizziness, lightheadedness during 1
st
week of therapy of captopril. If dizziness persists, contact health provider
.
o
Monitor patient for following side effects: angioedema, cough dysgeusia, weakness, hyperkalemia, orthostatic hypotension, renal impairment
o
Advise patients to report any bleeding.
o
Teach patients to take captopril 20 min-1 hr before meal. Decrease 35% of captopril absorption.
o
Warn patients that the taste of food may be diminished during first month of drug therapy.
o
Advise patients to avoid foods high in potassium because hyperkalemia is
an adverse effect of ACE inhibitor.
Chapter 43: Anticoagulants, Antiplatelets, and Thrombolytics
heparin (anticoagulant): drug interactions:
Risk of bleeding may be ↑ by concurrent use of
drugs that cause hypoprothrombinemia
, including
quinidine
,
cefotetan
, and
valproic acid
.
Concurrent use of
thrombolytics
↑ risk of bleeding.
Heparins affect the prothrombin time used in assessing the response to
warfarin
.
Digoxin
,
tetracyclines
,
nicotine
, and
antihistamines
may ↓ anticoagulant effect of
heparin.
Drug-Natural Products:
↑ risk of bleeding with
arnica
,
anise
,
chamomile
, clove,
dong quai
, fever few,
garlic
,
ginger
, and Panax ginseng .
warfarin (anticoagulant): pharmacokinetics, indications for use, labs to monitor
Therapeutic Effects/Use: Warfarin:
To prevent thrombosis associated with PE, MI, unstable angina, prosthetic heart valves, DVT, and PCI; to treat atrial fibrillation
Pharmacokinetics:
Absorption:
Well absorbed from the GI tract after oral administration.
Distribution:
Minimally distributed to tissues.
Protein Binding:
99%.
Metabolism and Excretion:
Primarily metabolized by the liver via the CYP2C9 isoenzyme, with some metabolism via the CYP3A4 isoenzyme;
the CYP2C9 isoenzyme exhibits genetic polymorphism (intermediate or poor metabolizers may have significantly ↑ (S)-warfarin concentrations and an ↑ risk of adverse reactions).
Half-life:
42 hr.
Labs:
Monitor PT, INR,
alteplase (thrombolytic): administration & reversal drug
Therapeutic Effects/ Use: To promote fibrinolysis associated with thrombosis in patients with AMI, PE, ischemic stroke, occluded IV catheter. o
Examine the patient for active bleeding for 24 hours after thrombolytic therapy has been discontinued, this should be done every 15 minutes for the first hour, then every 30 minutes until the 8th hour, and then hourly.
o
Observe for signs and symptoms of active bleeding from the mouth or rectum. Hemorrhage is a serious complication of thrombolytic treatment. Aminocaproic acid can be given as an intervention to stop bleeding.
Chapter 45: Gastrointestinal Tract Disorders (see first page)
Chapter 46: Antiulcer Drugs (see first page)
Chapter 49: Pituitary, Thyroid, Parathyroid, and Adrenal
Disorders
levothyroxine ( indications, side effects)
Levothyroxine sodium Ø
Drug of choice for replacement therapy
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Ø
Increases the levels of T
4
Ø
Also treats simple goiter and chronic lymphocytic thyroiditis
Ø
Action
-
Increase metabolism, body growth
Take before breakfast- 30 min before food intake ADD SIDE EFFECTS
Chapter 50: Antidiabetics
factors contributing to hyperglycemia or hypoglycemia
insulin and drug treatment for hyperglycemia (subcut and iv) and hypoglycemia (oral or im/iv)
Chapter 55: Women’s Reproductive Health
oral contraceptive use & patient teaching
Guidelines for Missed Doses of
Combined Hormonal Contraceptives
One Tablet
Take the tablet as soon as the missed dose is realized
Take the next tablet as scheduled.
Two Tablets
Take two tablets as soon as the missed dose is realized and two tablets
the next day.
Use a back-up method of contraception for the rest of the cycle.
Three Tablets
Discontinue the present pack and allow for withdrawal bleeding. Start a
new package of tablets 7 days after the last tablet is taken. Use another form of contraception until tablets have been taken for 7 consecutive days.
Progestin-Only Pills
One or More Tablets
Take the tablet as soon as the missed dose is realized and follow with the next tablet at the regular time plus use a back-up method of contraception for 48 hours
Contraindications:
Pregnancy (known or suspected)
Venous thrombosis, history or risk factors
Vascular disease, including coronary artery disease and cerebrovascular accident (CVA) and past or current history of deep venous thrombosis DVT or pulmonary embolism
• liver disease, including cirrhosis, viral hepatitis, and benign or malignant liver tumors
•
Undiagnosed vaginal bleeding or known or suspected endometrial cancer.
•
Breast cancer
•
Tobacco use of more than 15 cigarettes per day in a patient older than 35 vears of age
Cautious Use
•
Hypertension with associated vascular disease
•
Hypertension with blood pressure greater than 160/100 mm Hg
•
Hyperlipidemia
•
Diabetes mellitus complicated by neuropathy, retinopathy, nephropathy, or vascular disease
•
Diabetes mellitus for more than 20 years' duration
•
Postpartum fewer than 3 weeks
•
Lactation fewer than 6 weeks
•
Age greater than 35 years and smoking fewer than 15 cigarettes per day
•
Hyper coagulation disorders
•
Prolonged immobility
•
Use of drugs that affect liver enzymes.
Drugs That Interact With Combined Hormonal Contraceptives
Drugs That Decrease the Effectiveness of Combined
Hormonal Contraceptives
Use a higher-dose pill or an alternative form of contraception if the drug is continuous.
Use a back-up method for the duration of treatment plus 7 days if drug
is short term.
Anticonvulsant Drugs
Carbamazepine
Hydantoins (ethotoin, mephenytoin, phenytoin)
Succinimide anticonvulsants (ethosuximide,
Antituberculin Drugs
Rifampin
Antifungal Drugs
Griseofulvin
Antibiotics
Amoxicillin
Ampicillin
Doxycvcline
Metronidazole
Minocycline
Neomycin
Nitrofurantoin
Penicillin
Tetracycline Barbiturates
Phenobarbital
Primidone
Hypnotics and Sedatives
Benzodiazepines
Migraine Drugs
Topiramate
Drugs That May Increase Combined Hormonal
Contraceptive Activity
Acetaminophen
Ascorbic acid
Fluconazole
Other Drug Interactions
An alternative method of contraception is necessary.
Anticoagulants: CHCs increase clotting factors and decrease the effectiveness of anticoagulants.
Anticonvulsants: CHCs may increase the risk for seizure.
Nursing Process
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
•
Obtain a record of the patient's drug, supplement, and complementary and alternative medicine (CAM) use.
•
Obtain baseline vital signs that include temperature, pulse, and respirations; blood pressure (BP); weight, and height. Calculate body mass index (BMI) and report any abnormal findings.
•
Obtain a complete menstrual history that includes age at menarche, menstrual pattern, cycle length, duration, and amount of bleeding and the first day of the last menstrual period (LMP).
•
Determine the patient's pregnancy status.
•
Obtain a family medical history specific to contraindications for combined hormonal contraceptives (CHCs) and progestin contraceptives.
•
Obtain a family history of premenopausal breast cancer.
•
Assess for domestic violence, intimate partner violence, and past or recent sexual abuse/assault.
•
Obtain a complete sexual history that includes sexual expression and sexual risk practices, history of sexually transmitted infections (STIs) and treatment, and past or present sexual abuse and/or assault.
•
Recognize the need for periodic reassessment of baseline data and side effects. Most patients should be seen 1 to 3 months after beginning a contraceptive regimen.
•
INSTRCUT THE PATIENT NOT TO SMOKE TOBACCO BECAUSE OF INCREASED CARDIO RISKS
•
BRAIDED method discusses benefits (advantages, positive aspects, and both theoretic and actual effective rates of the method), risks (dangers, complications, disadvantages. and failure rates), alternatives (other contraception options available) inquiries (opportunity for the patient to ask questions about options pro-posed), decision (deciding on a method with opportunity to change the decision as needed), explanation (health care teaching specific to the method chosen), and documentation.
•
The patient will verbalize the dosing schedule and use of contraceptive method chosen.
•
(ACHES acronym: abdominal pain [severe]; chest pain or shortness of breath; headaches [severe], dizziness, weakness, numbness, or speech difficulties: eye disorders, which includes blurring
or loss of vision; and severe leg pain or swelling in the calf or thigh).
•
The patient will take oral contraceptives (OCs) as prescribed and
report adverse side effects to the HCP.
•
The patient will verbalize the specific scheduling needs for progestin-only pills.
•
The patient will verbalize the initiation and scheduling of depot medroxypro-gesterone acetate (DMPA) injections and the need for weight-bearing exercises and calcium supplementation.
•
The patient will be instructed to schedule follow-up appointments as
Take Action [Nursing Interventions]
• Assist the patient with obtaining informed consent for the initiation of
contraceptives through the BRAIDED method.
•
•
Instruct the patient that HCPs should be advised of CHC use before surgery in which immobilization for an extended period may be needed.
•
Encourage the patient to report any irregular bleeding to the HCP, this may require a change in dose or another type of hormonal contraceptive.
method
•
Advise the patient to always report use of hormonal contraceptives when
•
Seeing a HCP because of possible synergistic or antagonistic responses to other drugs and therapies.
•
Advise the nursing mother that the use of CHCs may decrease the quantity and quality of breast milk.
Side Effects
Advise the patient that rare but serious side effects can occur, including venous thromboembolism (VTE), myocardial infarction (MI), cerebral vascular accident (CVA), and retinal vein thrombosis.
Instruct the patient in the ACHES acronym for reporting symptoms of dangerous cardiovascular side effects to their health care provider (abdominal pain, chest pain, headaches, eye problems, swelling and /or aching in the legs and thighs).
•
Advise the patient that menstrual flow may be less in amount and duration because of thinning of the endometrial lining with CHCs and progestin contra-ceptives.
•
Advise the patient of menstrual changes that can occur at the start of combined estrogen-progestin contraception use, when changing types of hormonal contraception products, and with progestin contraceptives.
•
Determine whether the patient wears contact lenses and discuss alterations in the shape of the cornea and dry eyes that may
occur due to decreased tearing. If this occurs, the patient should consult their optometrist.
•
Instruct the patient who experiences post-CHC amenorrhea that 95% of women have regular periods within 12 to 18 months. Advise the patient that those who participate in endurance fitness activities may have increased post-CHC amenorrhea.
•
Advise the patient of a possible decrease in libido caused by an alteration in vaginal secretions and decreased levels of testosterone.
•
Ensure the patient understands the ability to return to fertility after discontinuing a hormonal contraception product and the time frame in which pregnancy can be expected.
•
Skill
•
Instruct the patient in breast health awareness and self-
examination.
•
Instruct the patient how to inspect genitalia for abnormalities and note changes in vaginal secretions.
•
Advise the patient to return for a DMPA injection within the 13-
week time frame.
Diet
•
Counsel the patient to moderate caffeine intake because elimination of caffeine may be decreased as a result of prescribed CHC
products.
•
Instruct the patient to take OCs with a snack or after meals to help eliminate nausea.
•
Advise the patient using DMPA to increase calcium and vitamin D intake and to do 15 to 30 minutes of weight-bearing exercises 3 to 4 times per week.
Discuss foods that increase iron and iron absorption.
Clomiphene Citrate
Drug Class
Ovulation stimulant
Contraindications
Drug-Lab-Food Interactions
Pregnancy, undiagnosed vaginal bleeding, depression, fibroids, hepatic
dysfunction, thrombophlebitis, primary pituitary or ovarian failure
Drug: None are significant; danazol may inhibit response; drug decreases effects of ethinyl estradiol.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Lab: Increases serum thyroxine
Therapeutic Effects/Uses
To stimulate ovarian follicle growth
Mechanism of Action: Stimulates release of follicle-stimulating hormone and luteinizing hormone.
Side Effects
Breast discomfort, fatigue, dizziness, depression
anxiety, nausea, vomiting, constipation, increased appetite, headache, flatulence, multiple gestation, hot flashes, fluid retention
Adverse Reactions
Visual disturbances, abdominal pain, weight gain, hair loss, Ovarian hyper stimulation, anxiety, ovarian cysts, ectopic pregnancy
Specific
•
Instruct the patient to report adverse effects such as abdominal pain or visual disturbances to the infertility specialist at once and to be
cautious with tasks that require alertness. If a dose of the drug is missed, the patient should call the infertility specialist.
•
Advise the patient that treatment increases the chance of multiple births.
•
Ensure that the patient understands the risks, benefits, and alternatives to pharmacologic therapy.
PATENT SAFETY
Do not confuse...
• Combined hormonal contraceptive (CHC) products with HT prod-ucts.
Oral, transdermal, and vaginal ring preparations for contraception and Hi are dispensed in packages and boxes that are very similar. Once opened, CHC products and HT products may have the same disc-
dispensing systems and splintered packaging and may have similar-
appearing skin patches and vaginal rings.
FDA BLACK BOX WARNING
Combined Hormonal Contraceptives (CHCs) and Hormone Therapy Products
CHCs: "Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite
marked in women over 35 years of age. Women who use oral contraceptives should be strongly advised not to smoke."
Ethinyl estradiol and norelgestromin transdermal patch: "Do not use this transdermal patch if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects (heart and blood vessel problems) from hormonal contraceptives, including death from heart attack, blood clots, or stroke. The risk increases with age and the number of cigarettes you smoke.'
Ethinyl estradiol and etonogestrel transvaginal ring: "Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age.
Women who use combination hormonal contraceptives, including the trans-vaginal ring, should be strongly advised not to smoke.
Hormone replacement therapies with estrogen and estrogen plus progesterone: "Warning: Cardiovascular disorders, breast cancer, endometrial cancer and probable dementia [can occur]
....
Estrogens, with or without progestins, Should be prescribed at the lowest effective
doses and for the shortest auld tion consistent with treatment goals and risks for the individual woman.
Dosage Questions: 4 questions total on simple dosage DA (review rounding rules)