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JACKSON COLLEGEASSOCIATE DEGREE NURSING

COURSE SYLLABUS

2015 – 2016

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JACKSON COLLEGE

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NURSING DEPARTMENT COURSE SYLLABUS

COURSE NUMBER NUR 121

COURSE TITLE Pharmacology

DEPARTMENT Nursing

CREDITS Three credits

CONTACT HOURS 15x3 = 45

COURSE FACULTY Julie Bullinger Ballow MSN, RN, Course CoordinatorWhiting Hall, 218 517-796-8510Email: [email protected]

Darlene LoPresto MSN, RNWhiting Hall 223, 517-796-8516Email: [email protected]

Darlene Bryant MSN, RNEmail: [email protected] Bailey, MSN, RNEmail: [email protected] Albrecht, MSN, RN, ACNP-BCEmail: [email protected]

COURSE DESCRIPTION

Students are introduced to basic knowledge and skills needed to safely administer medications to clients with self-care needs. This coure includes medication action, use, side effects, nursing implications, and client education for major drug groups.

PERFORMANCE OUTCOMES

Provider of Care:

1. Define the terms used in the study of pharmacology.2. Identify and describe the principles of drug action including absorption,

distribution, metabolism and excretion; drug-receptor interactions and categories of adverse effects.

3. Demonstrate an understanding of common characteristics of drug classes: mechanisms of action, uses, side effects, examples of

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mailto:[email protected]

common drugs in each category and nursing responsibilities related to the administration of drugs in each class.

4. Explain the use of the nursing process in drug therapy.5. Demonstrate accuracy in calculating dosages of drugs and intravenous

drip rates.6. Describe a teaching plan for a patient learning to use a new medication.7. Describe the alterations in drug effect on the elderly patient.8. Demonstrate ability to think critically during class and small group

discussions.

Manager of Care:

1. Identify members of the health team who collaborate with the nurse in providing care for patients receiving medications.

Member of Profession:

1. Describe the legal and ethical responsibilities of the professional nurse when administering medications.

ASSOCIATE DEGREE OUTCOMES

The Board of Trustees has determined that all JCC graduates should develop or enhance certain essential skills while enrolled in the college. The Associate Degree Outcome addressed in this class is:

Demonstrate computational skills and mathematical reasoning.

BASIC COMPETENCIES REQUIREMENTS

Ability to read an above average amount of technical materialAbility to compute simple algebraic problemsAbility to use the metric system of measurement

PREREQUISITES

Math: MAT 131 or 133 (preferred)Anatomy and Physiology: This Prerequisite is Program Specific. BIO 132 OR BIO 253 and 254 OR Body Structure and Function LPN 141 or MOA 141Chemistry recommendedSTUDENT RESPONSIBILITIES

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1. Be present and on time for class.2. If absence is unavoidable, obtain lecture notes and other information shared

in class from a fellow student prior to returning to class. Students are responsible for all information shared in class regardless of attendance.

3. Complete all assigned readings. Assignments should be read before coming to class. Online pre-quizzes are due before class. Be prepared for discussion of the assigned topic.

4. Review the behavioral objectives for each unit frequently and use them as a study guide when preparing for tests.

5. If you need to drop the class for any reason, be sure to do so before the last date to drop. Your instructor must issue a grade for any un-dropped class.

6. Seek instructor guidance as needed.

CELL PHONE POLICY

While the nursing faculty recognizes that communication with family and friends is important, the use of cell phones and beepers in class is very distracting to other students and to your instructor. Please keep all electronic devices on either vibrate or voice mail mode during class. If you are experiencing a family emergency and must keep a cell phone on, please let your instructor know prior to class. We appreciate your cooperation in providing an environment conducive to learning for all students.

Cell phones are not permitted in place of calculators on exams.

All types of electronic devices must be turned off and put away during an exam or an exam review. Failure to abide by this policy will result in dismissal from the course. No exceptions!

DIVERSITY

Our classrooms are becoming more and more diverse, and this may or may not be evident as we look around the classroom. We can all learn from each other. As your instructor, I invite you to share your unique perspectives on class topics based on your background. I expect that students and instructor will be considerate of one another’s differences.

ONLINE COURSE MANAGEMENT (JetNet)

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Your instructor will use the online course management system (JetNet) to communicate with you via email, post grades, or to post messages about upcoming classes or exams.

Online quizzes will be due weekly, prior to class. Your 10 best quiz scores will be used as part of your final grade.

CHECKING YOUR COURSE GRADE OR TRANSCRIPT

Report cards are no longer mailed from JCC. All grades and transcript information can be accessed online. Following are instructions.

1. Go to www.jccmi.edu.2. Click on e-Services.3. Choose the Students tab.4. Find transcripts and grades.

INSTRUCTIONAL METHODS

Assigned and optional readingsLectureClass DiscussionGroup Exercises

PowerPoint presentationsVideosHomework assignmentsQuizzes/Exams

TEXTBOOKS

Required Textbook

Rosenjack Burchum, J., Rosenthal, L.D. Lehne’s Pharmacology for Nursing Care, 9th ed. Saunders, 2016.

Be sure to check out the student disk and website included with your text – printable pharmacology flashcards are provided for you, as well as other resources.

Optional Resources

Craig, G. Clinical Calculations Made Easy: Solving Problems using Dimensional Analysis, Lippincott

STUDENT EVALUATION CRITERIA

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http://www.jccmi.edu/

1. Each student is evaluated on satisfactory knowledge of theory as demonstrated by the grade averaged from tests and class assignments.

a. Tests are given periodically and are scheduled at least one week in advance.

b. Testing will be based on the behavioral objectives identified in the lecture outlines. Tests will consist primarily of multiple choice, matching and short answer questions.

c. Any test question determined by the instructor to be unworthy of counting against the grade (i.e., bad question) will be cheerfully adjusted by giving credit for any answer on that question.

d. Any student who chooses to cheat on a test will receive a maximum grade of 1.5 in the course. (See Academic Honesty policy.)

e. Upon completion of the medication calculations unit, students will be given a medication calculations exam. Because the ability to accurately calculate medication dosages is vital to safe nursing practice, all students will be required to pass this exam with a minimum of 90%. If it is not passed with a 90% grade, students are advised to use the calculations web resource available on JetNet or purchase the calculations text and complete it independently. The calculations exam may be retaken until it is passed with a 90% grade. If the calculations exam is not passed at 90% by the last day of the course, the student will receive a maximum 1.5 grade in the course. Once the competency is met, the average of all medication calculations exams taken will be used to figure the final grade.

2. This course will contain three grading components. One component will consist of tests. The second component will consist of quizzes, group work, papers, or other activities. The third component will be the medication calculations competency exam. A student must earn a minimum of 78% in the test component and a 78% average in the course and a 90% on the calculations exam in order to pass the course. Although the student may pass the course with less than 78% average on quizzes, group work, or other activities, the student should be aware that the grade in these components will still be averaged into the final grade and could cause a failure. A student who earns less than a 78% average on the test component or less than a 78% average on all components averaged together, or less than 90% on the math competency will receive a maximum grade of 1.5 for the course.

Summary

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The following requirements must be met to pass NUR 121 with a 2.0 grade:1. Minimum of 78% average on all exams2. Minimum of 90% on medication calculations competency exam (may be

retaken until 90% grade is achieved)3. Minimum of 78% average on all course requirements combined

Note: other assignments vary and will be averaged into total course requirements.

3. A final grade of 2.0 (78%) or above is required for entering or continuing in the nursing program.

4. Each student is expected to keep a record of grades so he/she will be aware of his/her grade at all times.

5. Please note that it is the policy of the nursing department that extra credit assignments are inappropriate sources of points for students wishing to enter a health field.

ADVICE FROM STUDENTS

Math Advice

I have never used unit analysis before this class ... but I did buy the "Clinical Calculations Made Easy: Solving Problems Using Dimensional Analysis" book from the book store. I used that book to practice on a variety of questions and found it extremely helpful. I think if other people are having difficulties they should consider buying it. It was definitely worth the cost and time. I have to admit that I had a lot of fun with them ... it became kind of like a game. I used to have problems with unit conversions in general but this makes sense to me. I am so glad I learned it using this method that you recommended ... I think it will be very helpful in the future (with nursing as well as other areas).

Note from your faculty – we also now have a free web based tutorial in the course that does an excellent job teaching unit analysis.

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Regina’s Study Plan

The most helpful study tip is repetition. I reviewed each outline section at least 10 times. This was fairly easy to do, as the sections were small. Sometimes my review was done 15 minutes before I went to bed, other times I was able to review more thoroughly, spending more time on difficult concepts ( like RAAS ). I also made flash type cards for the drugs and committed them to memory by breaking it into quantity per day. I learned 5 drugs (class, generic name and trade name, plus pertinent information like serious side effects or contraindications) per day. It's not so overwhelming of a task if it is broken down in such a way. Some sections required that only 2 or 3 per day be memorized. This was, for me, the most time consuming part of the class because it is straight memorization of words that are difficult to pronounce and thus remember. By memorizing a few per day, I recalled most of them without having to review again. Additionally, I read the chapters, but only for general information or to clarify a concept introduced in class. The outline provided was very complete and was what I used for studying for the tests.

NURSING DEPARTMENT ACADEMIC HONESTY POLICY

Honesty and integrity are essential qualities in the profession of nursing. Any student found to be cheating on an exam, quiz, or other assessment will receive a maximum grade of 1.5 in the course. Lack of integrity in the classroom or clinical setting may result in failing a course or removal from the program.

Cheating can take on many forms. These may include but are not limited to: bringing an answer source to the testing site. copying from another student’s test. changing an answer after a test has been submitted. sharing information about a test with someone who has not yet taken

it.

Plagiarism is another form of cheating. This may involve but is not limited to: submitting a paper written by someone else (obtained from the web or

a fellow student). using direct quotes from any source without crediting the source.

Additional areas of concern specific to nursing include but are not limited to: covering up or not reporting a clinical error. charting something that was not done.

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altering any legal documentation.

Not everything is cheating. Some examples of acceptable practices include: studying together prior to an exam. sharing notes from class. using quotes in papers and referencing them appropriately.

If you are unsure if a practice might be considered cheating, please check with an instructor and/or do not engage in that practice. Please remember that failing a course may mean permanent dismissal from the program.

THE BEST POLICY IS ALWAYS HONESTY AND INTEGRITY.

MAKE-UP POLICY:

If a student is absent on the day of a test, it must be made up before the next class. A student may take one late test (within the one-week window) without penalty. Five percent will be deducted from any subsequent test taken late, ten percent from the third late test, and so on. Any test that is not made up prior to the next class will receive an automatic grade of 0 (zero), unless previously arranged with the instructor. (This is to discourage you from getting behind – doing so will harm your chances for success in the course!)

If a student misses an online quiz, those points will be lost. Quizzes and other non-test work may not be made up for credit. If a student arrives late to a test, he or she will have the remaining (reduced) time to do the test, but must finish within the time allotted to the rest of the class.

If a test must be missed, the student should contact the instructor for make-up arrangements. Remember, the test must be taken prior to returning to class the following week in order to receive credit. Make up tests will be placed in the Testing Center in Atkinson Hall. Check the Library page on the JCC web site for Testing Center hours.

AVAILABLE LEARNING SERVICES:

Tutors may be available and are free of charge. The Center for Student Success can also offer general course assistance.

1. Go to www.jccmi.edu2. Click on Departments tab.3. Scroll down to College Offices and Services.4. Choose Center for Student Success5. Click on Tutor Schedule, located on Right tab menu6. Select campus and course for available tutors and times.

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http://www.jccmi.edu/

The student should contact the instructor if help is needed. Don’t wait until it is too late.

GRADING SCALE:

4.0 = 94 -100%3.5 = 90 - 93% 1.5 = 74 - 77%3.0 = 86 - 89% 1.0 = 70 - 73%2.5 = 82 - 85% 0.5 = 66 - 69%2.0 = 78 - 81% 0.0 = < 66%

COURSE OUTLINE:

Drug action, measurement, administration, use, side effects, nursing implications, and client education related to the following drug categories will be covered:1. Drugs used to treat infections2. Drugs used in cancer treatment3. Drugs that affect the autonomic nervous system4. Drugs that affect the central nervous system5. Drugs that affect the cardiovascular system6. Drugs that affect the endocrine system7. Drugs that affect the respiratory system8. Drugs that affect the digestive system

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JACKSON COMMUNITY COLLEGEASSOCIATE IN APPLIED SCIENCE – NURSING

TESTING AGREEMENT

Student

Student please review each statement and initial agreement. ____ No study aids (textbooks, notebooks, etc.) are allowed in the testing room.

____ No papers, books, food or drink, pens, purses, wallets, watches, beepers, cell phones or any other electronic devices are allowed in the testing room.

____ No hats, scarves, or coats may be worn in the testing room.

____ One sheet of blank paper and one pencil may be taken into the testing room. The paper must be turned in to the proctor upon leaving the room.

____ Candidates must present a photo ID prior to testing. The ID will be returned when the test is submitted.

____ Candidates may not leave the testing room without the test proctor’s permission. If the candidate must leave the room for a restroom break, the photo ID and exam will be left with the proctor until the student’s return.

____ Irregular behavior – for example not listening to proctor, talking during the test, or rude behavior may result in dismissal from the center and test failure.

____ Accessing the internet or any other item on the computer (other than the assigned test) during a test is prohibited.

____ Removing any paper or other resources from the testing area is prohibited.

____ CANDIDATES WILL NOT UNDER ANY CIRCUMSTANCES DISCLOSE ANY EXAMINATION MATERIALS INLCUDING THE NATURE OR CONTENT OF EXAMINATION ITEMS BEFORE, DURING, OR AFTER THE EXAMINATION. VIOLATION WILL RESULT IN IMPLEMENTATION OF THE NURSING DEPARTMENT ACADEMIC HONESTY POLICY AND MAY RESULT IN A ZERO GRADE ON THE EXAM AND/OR THE COURSE.

I understand that failure to comply with any of the above regulations before, during, or after a test may result in dismissal from the testing area and/or test and/or course failure.

SIGNED Student Date

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********************************************************************************************Objectives in italics. Master for test.********************************************************************************************

1. Identify “The Big Three” in drug therapy. Lehne Chapter 1.

A. Effectiveness

B. Safety

C. Selectivity

2. Identify the Therapeutic Objective in drug therapy.

3. Identify how drugs are classified.

A. Based on body systems

B. Based on action

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****************************************************************************************************

Master objectives for exam. Objectives are in italics.***************************************************************************************************

*

1. List and define the five phases of the nursing process. Lehne Chapter 2.

A. Assessment

B. Diagnosis

C. Planning

D. Implementation

E. Evaluation

2. Identify subjective and objective data the nurse should collect when assessing the patient requiring drug therapy.

A. Subjective data

B. Objective data

3. List at least three nursing diagnoses appropriate for the patient receiving drug therapy.

A. Risk for injury

B. Knowledge deficit

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C. Ineffective self health management

4. Describe the planning process for the client receiving drug therapy.

A. Develop goals

B. Set Priorities

C. Identify interventions

5. State the responsibilities of the nurse during the implementation stage of drug therapy.

A. Six Rights of drug administration.

Right patient

Right drug

Right dose

Right time

Right route

Right documentation

B. Promoting therapeutic effects

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C. Minimizing adverse effects and interactions

D. Making PRN decisions

E. Patient Education

1. Drug name and class

2. Dose

3. Schedule

4. Route and technique of administration

5. Reason for taking/expected effects

6. Duration of treatment

7. Drug storage

8. Side effects

9. Precautions/Interactions

10. When to notify the provider

11. Importance of using one pharmacy

6. List four key questions to be answered when evaluating drug therapy.

A. Is the patient receiving the expected therapeutic benefit from the drug?

B. Is the patient experiencing any side effects or adverse reactions?

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C. Is the patient using the drug correctly? (Was teaching effective?)

D. Is the patient satisfied with the drug?

7. Apply the nursing process in administering medications to patients from diverse cultures.

A. Assessment

B. Planning/Intervention

C. Evaluation

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********************************************************************************************Master objectives for exam. Objectives are in italics.

********************************************************************************************

1. Discuss the need for drug legislation and identify the agency responsible for the enforcement of laws pertaining to drugs. Lehne Chapter 3.

2. Briefly describe the provisions of the federal Food, Drug, and Cosmetic Act of 1938 (with amendments).

3. State where to access your state Nurse Practice Act.

http://www.michigan.gov/mdch/0,1607,7-132-27417_27529_27542---,00.html

Public Health Code Sec. 17201.

(a) “Practice of nursing” means the systematic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.

(b) “Practice of nursing as a licensed practical nurse” or “l.p.n.” means the practice of nursing based on less comprehensive knowledge and skill than that required of a registered professional nurse and performed under the supervision of a registered professional nurse, physician, or dentist.

(c) “Registered professional nurse” or “r.n.” means an individual licensed under this article to engage in the practice of nursing which scope of practice includes the teaching, direction, and supervision of less skilled personnel in the performance of delegated nursing activities.

4. State briefly the provisions of the Controlled Substance Act and describe implications for nursing practice.

A. Controlled Substance Act

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http://www.michigan.gov/mdch/0,1607,7-132-27417_27529_27542---,00.html

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B. Schedule Categories

Schedule Examples Description

I heroin, marijuana, ecstasy

II morphine oxycodone (OxyContin) methylphenidate (Ritalin)

III acetaminophen with codeine (Tylenol # 3) acetaminophen with hydrocodone (Vicodin)

IV phenobarbital diazepam (Valium) alprazolam (Xanax) zolpidem (Ambien)

V diphenoxylate/atropine (Lomotil)cough syrups with codeine (Robitussin AC)

5. Explain the process for new drug development.

A. Animal studies (Preclinical testing)

B. Human studies (Clinical testing)

Phase I – small number of healthy volunteers

Phase II – small number of volunteers who have the condition being treated; determines safety and efficacy

Phase III – controlled double blind placebo studies

Phase IV – post marketing studies

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6. Describe how drugs are named

A. Chemical name

B. Generic name

C. Trade or brand name

7. Define pregnancy safety categories.

A = No risk to fetus

B = No risk in human studies, possible risk in animal studies

C = Adverse effects in animals, insufficient data in women

D = Human fetal risk demonstrated, benefits may outweigh risks

X = Human fetal risk clearly documented and outweigh any benefit

8. Discuss the significance of over-the-counter (OTC) drugs.

9. Describe the drug information available in each of the following sources of information.

A. Physician’s Desk Reference (PDR)

B. Package inserts

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C. Clinical pharmacist

D. Handbook of non prescription drugs

E. United States Pharmacopeia (USP) and National Formulary

F. The internet

http://www.nlm.nih.gov/medlineplus/druginformation.htmlhttp://www.fda.gov/http://www.mayoclinic.org http://www.nutrition.gov/dietary-supplements

These are just a few sites to get you started – there are hundreds more!

10. Discuss ethical considerations for administering medications.

A. Legal and ethical principles

1. beneficence

2. nonmalfeasance

3. autonomy

4. justice

5. veracity

6. confidentiality

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http://www.nutrition.gov/dietary-supplements

http://www.mayoclinic.org/

http://www.fda.gov/

http://www.nlm.nih.gov/medlineplus/druginformation.html

B. American Nurses Association Code of Ethics

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*

ABSORPTION

1. Define absorption. Lehne Chapter 4.

2. List factors affecting drug absorption.

A. Rate of dissolution

B. Surface area

C. Blood Flow

D. Lipid solubility

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E. pH

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3. List routes of drug absorption, with advantages and disadvantages of each.

A. Intravenous

B. Intramuscular

C. Subcutaneous

D. Oral

Tablets

Enteric-coated preparations

Sustained-release

E. Other

4. Define bioavailability.

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DISTRIBUTION

5. Describe how drugs are distributed within the body.6. Explain how the effectiveness of a drug is based on distribution.

A. Protein binding

B. Distribution to central nervous system (Blood-brain barrier)

C. Distribution from mother to fetus (Placental drug transfer)

METABOLISM / BIOTRANSFORMATION

7. Describe the process and sites of metabolism.

A. Process

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B. Sites of metabolism

1. Liver

2. Kidneys

3. Lungs

4. Other/None

B. Cytochrome p-450 system

C. First pass effect

EXCRETION

8. Identify the sites of drug excretion; state which site is most important.

A. Kidneys

B. Skin

C. Lungs

D. Bowel

E. Breast milk

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9. Identify and explain factors that can affect the excretion of drugs.

10. Define half-life. Describe the importance of half-life to medication administration.

A. Half life (t ½ ) definition

B. Excretion

C. Steady state

11. Define onset, peak, and duration of drugs. Explain significance for drug administration.

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12. Identify and briefly explain receptor theories that explain how drugs bring about their effects or actions (pharmacodynamics). Lehne Chapter 5.

.Drug - receptor interaction

1. agonist

2. antagonist

3. partial agonists

13. Define therapeutic index. Identify how to determine if a drug is safe based on the TI.

14. Define peak and trough levels and their significance.

15. Identify factors that modify drug response.

A. Body weight

B. Age

C. Pathophysiology

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D. Tolerance

E. Placebo affect

F. Bioavailability

G. Genetics

H. Gender

I. Race

J. Adherence

K. Drug interactions

L. Diet

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*1. Differentiate between a side effect and an adverse reaction.

2. Identify types of adverse drug reactions; describe symptoms and prevention.

A. Toxicity

B. Hypersensitivity or allergy

C. Anaphylaxis

D. Idiosyncratic effect

E. Iatrogenic disease

F. Physical dependence

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G. Carcinogenic effect

H. Teratogenic effect

I. Tissue and organ damage

1. Hepatotoxicity

2. Cardiotoxicity

3. Nephrotoxicity

3. Discuss types, causes, prevention, and reporting of medication errors.

A. Types

B. Causes

C. Prevention

D. Reporting

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*************************************************************************************Objectives in italics. Master objectives for test. *************************************************************************************1. Recognize abbreviations commonly used in medication administration. (See

Lehne Appendix C)

Abbreviation Meaning Abbreviation MeaningIM Intramuscular oz OunceIV Intravenous Tbsp TablespoonOD Right eye tsp TeaspoonOS Left eye ac Before mealsOU Both eyes Ad lib As desiredPO By mouth bid Twice dailySC or sq Subcutaneous hs BedtimeSL Sublingual pc After mealscc Cubic centimeter prn When neededG Gram Q4h Every 4 hoursgr Grain Qid Four times a daygt/gtt Drop/drops ATC Around the clockmg Milligram STAT Immediately mL Milliliter tid Three times a day

JOINT COMMISSION “Official Do Not Use” list http://www.jointcommission.org/patientsafety/donotuselist/

Abbreviation Potential Problem Preferred Term

U (for unit) Mistaken as zero, four or cc. Write "unit"

IU (for international unit) Mistaken as IV (intravenous) or 10 (ten)

Write "international unit"

Q.D., QD, qd,Q.O.D., QOD, qod

(Latin abbreviation for once daily and every other day)

Mistaken for each other. The period after the Q can be

mistaken for an "I" and the "O" can be mistaken for "I"

Write "daily" and "every other day"

Trailing zero (X.0 mg),

Lack of leading zero (.X mg)

Decimal point is missed Never write a zero by itself after a decimal point (X mg), and always use a zero before

a decimal point (0.X mg)

MSMSO4

MgSO4

Confused for one anotherCan mean morphine sulfate or

magnesium sulfate

Write "morphine sulfate" or "magnesium sulfate"

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http://www.jointcommission.org/patientsafety/donotuselist/

2. Describe the information included in a medication order.

A. client’s name

B. date

C. drug

D. dose

E. route

F. frequency

G. signature

3. Describe commonly used drug distribution systems.

A. Unit dose

B. Controlled drugs

C. Stock drugs

D. Computer controlled dispensing

4. List and describe common types of medication orders.

A. STAT

B. ASAP

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C. single

D. standing

E. PRN

5. Describe guidelines for administering medications.

A. Preparation

B. Administration

C. Recording

D. What to avoid

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6. Distinguish among different medication forms for oral administration.7. Define enteral medication routes.

A. tablet/capsule

B. solution

C. elixir

D. emulsion

E. suspension

F. syrup

G. Zydis

H. Nasogastric/Peg

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8. Define the following non-enteral routes.

A. sublingual / buccal

B. rectal

C. vaginal

D. topical

E. transdermal

F. otic

G. optic

H. Inhalants

I. Intra-osseous

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9. Define each parenteral injection type and rationale for use.10. List advantages and disadvantages of each parenteral route.11. State the criteria for selecting appropriate syringes and needles for injections.

A. Intradermal

B. Subcutaneous

C. Intramuscular

1. vastus lateralis

2. ventrogluteus

3. dorsogluteus

4. deltoid

D. Intravenous

12. Describe appropriate safety precautions to take when handling needles.

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********************************************************************************************Objectives in italics. Master objectives for test. ********************************************************************************************

1. Identify and use correctly the symbols and abbreviations used in the metric, household, and apothecary systems of measurement.

2. Explain units, International units, and milliequivalents.

3. Distinguish between measure of weight and measure of volume.

4. Make conversions within and between the metric, apothecary, and household measurement systems.

Measurements to Remember

Metric Equivalents1cc = 1mL 1 mg = 1000 mcg1L = 1000 milliliters (mL) 1g = 1000 mg1L = 100 centiliters (cL) 1g = 100 centigrams (cg)1L = 10 deciliters (dL) 1g = 10 decigrams (dg)

Liquid ConversionsMetric Apothecary / Household5 mL 1 tsp.30 mL 1 fluid ounce / 2 Tbsp.240 mL 8 fluid ounces / 1 cup 1000 mL (1 liter) 32 ounces

Solid Conversions1 gram (g) 15 grains (gr)60 – 65 mg 1 grain1 kg 2.2 lb

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5. State the common drop factors of standard and microdrip IV sets.

Standard (macrodrip) sets:

10 gtt/mL or 15 gtt/mL (see package)

Microdrip (minidrip) sets:

60 gtt/mL

6. Identify safety checks that reduce errors in calculations.

a. Estimate first – is the answer close to your estimate?

b. Are the units in the answer correct?

c. Does the answer make sense?

7. Demonstrate ability to calculate dosages of medications.

8. Use appropriate rounding rules.

Note: you may use any mathematical method you wish to calculate dosages, as long as it is mathematically sound. You must be able to show all your work on your exam. Following is the Unit Analysis method, which we recommend if you are not already comfortable with another method.

General instruction:

In any medication calculation problem, you are basically just changing, or converting, units. For example, if the physician orders a medication in milligrams, and you have it available in tablets, you need to convert milligrams to tablets. If an IV is ordered in milliliters per hour, but you need to infuse it with tubing that delivers drops per minute, you need to convert your volume – liters to drops, and your time – hours to minutes.

What is a conversion factor?

A conversion factor is a known ratio. For example, we know that 1 g = 1000 mg. A conversion factor just places this ratio in the form of a fraction. It could be written as

1 g = 1 or as 1000 mg = 11000 mg 1 g

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Each way of expressing this ratio is equal to 1, whether 1 g is in the numerator or the denominator. The trick (an easy trick, really) is simply to figure out which value you want to place in the numerator. And that is determined by which units you need to cancel in order to come up with your desired units in the end.

Sometimes, your conversion is given to you on your medication package. For example, there may be 100 mg per tablet, or 50 mg per milliliter. Again, this can be expressed as

50 mg or as 1 mL1 mL 50 mg

depending on which works in order to end up with the correct units.

The following is a simple method for converting.

1. Set up a grid into which you can plug your numbers.

2. THINK: about what units you are starting out with (your order) and what units you want to end up with (the dose form you will administer).

For example, if you have an order for Solumedrol 40 mg IV push, and you have on hand Solumedrol 125 mg in 2 mL, you are starting out with milligrams, and you need to end up with milliliters. You know you need to end up with milliliters because mg is a measure of weight, and cannot be measured in a syringe. A syringe measure volume, usually in milliliters.

3. Plug in your order, and the units you decided you want to end up with.

40 mg = mL

4. Plug in appropriate conversion(s), making sure to place the units so they can be cancelled.

40 mg 2 mL = mL125 mg

5. Cancel like units in the numerator and denominator.

40 mg 2 mL = mL125 mg

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6. Cancel numbers if you like/are able. Not applicable in this problem.

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7. Multiply the numerator across.

40 2 mL = 80 mL125 125

8. Multiply the denominator across, if applicable.

9. Divide, reduce, and round to appropriate number.

80 mL = 0.64 = 0.6 mL125

10. Confirm that the correct units that you need to administer are in your answer, and that the answer makes sense.

11. Rounding rules: round to the smallest unit you can measure with the device you are using. If you are using a syringe that measures 10 th mLs, round to the nearest 10th mL. If you are using tubing that measures drops, round to the nearest whole number. If you are using scored tablets that can be cut in half, round to the nearest half tablet. Any number lower than 5 rounds down, and 5 and over round up.

We determined that we wanted mL in the beginning, and that is what we ended up with. ML can be measured in a syringe, which will be needed for the injection, and 0.6 mL is a reasonable amount to inject. So our answer makes sense.

What to do if your units of measurement are not the same:

Remember that the units in your numerator and denominator must match in order to divide. For example, you can’t divide mg by grains. When this happens, you must add another conversion factor to convert mg to grains, or grains to mg.

Try again:

1. Set up your grid – but this time, you need space for an extra conversion factor.

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2. THINK: about what units you are starting out with (your order) and what units you want to end up with (the dose form you will administer).

For example, you have an order for Tylenol grains 10 po. You have on hand Tylenol tablets, 325 mg each. You are starting with grains, and you need to end up with tablets – but you know you can’t divide grains by mg.

3. Plug in your order.

gr 10 = tabs

4. Plug in appropriate conversion(s), making sure to place the units so they can be cancelled.

You know that 1 grain = 60 or 65 milligrams. You choose to use 65 for this problem, because it looks like it might fit better. (60 would also work – you would just have to round your answer in the end.) You place the grains in the denominator, so that you can cancel grains and end up with mg.

You also have to convert to tabs, and you know that one tablet is 325 mg.

gr 10 65 mg 1 tab = tabs1 gr 325 mg

5. Cancel like units in the numerator and denominator.

gr 10 65 mg 1 tab = tabs1 gr 325 mg

6. Cancel numbers if you like/are able.

10 65 1 1 tab = tabs1 325 5

7. Multiply the numerator across, then the denominator across.

10 1 1 tab = 10 tabs1 5 5

8. Divide/reduce and round to appropriate number.

10 = 2 tabs 5

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10. Confirm that the correct units that you need to administer are in your answer, and that the answer makes sense.

You started out wanting to end up with tablets, which you did. And you know that two tablets is a reasonable number to take. Congratulations, right again!

SAMPLE PROBLEMS

1. Oral medication example:

Your order reads: 650 mg of Tylenol poYou have on hand: 325 mg tabletsThink: You need to change from mg (your order) to tablets (what

you need to administer)

650 mg 1 tablet = 2 tablets

325 mg

2. Oral medication example with two different units of weight:

Your order reads: 10 mg of morphine sulfate IMYou have on hand: morphine sulfate gr ¼ per mLThink: You need to change two things – you need to change grains

to mg, and then you need to end up with number of mL – because you have to measure the mL in a syringe.

10 mg 1 gr 1 mL = 0.7 mL60 mg gr ¼

3. IV push medication example:

Your order reads: Lasix 40 mg IVPYou have on hand: Lasix 20 mg in 2 mLThink: You need to convert mg to mL

40 mg 2 mL = 4 mL20 mg

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4. Oral medication example using different metric measures:

Your order reads: Ceftin 1 g poYou have on hand: Ceftin 250 mg tabletsThink: You need to convert grams to mg, then to tablets

1 g 1000 mg 1 tablet = 4 tablets1 g 250 mg

5. Medication order based on weight:

Your order reads: Theophylline 6 mg per kg poYou have on hand: 100 mg tabletsYour patient weighs: 60 poundsThink: You need to figure 1) how many mg total based on your

patient’s weight – which includes 2) converting pounds to kg. Then you need to 3) convert the mg to tablets.

6 mg 1 kg 60 lbs 1 tab = 1.6 tablets (round to 1 ½ tabs)

1 kg 2.2 lbs 100 mg

6. IV drip rate:

Your order reads: Zinacef 1 g in D5W 100 mL over 1 hourYour tubing delivers 10 gtt per mLThink: You need to figure out how many drops to deliver per

minute – so you need to convert the volume from mL to drops, and the time from hours to minutes.

100 mL 1 hr 10 gtt = 16.66 or 17 gtt per minute1 hr 60 min 1 mL

7. IV flow rate:

Your order reads: Heparin 1300 units per hour on a pump that delivers mL per hour

You have on hand: Heparin 50,000 units in 500 mL of D5WThink: You need to convert units to mL

1300 units 500 mL = 13 mL per hour1 hr 50,000 units

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Practice Medication Calculations1. The physician orders Haldol 2 mg IM. The drug label reads Haldol 5

mg/mL. How many milliliters should the patient receive?

Mark the dose the patient is to receive on the syringe.

2. You have an order for Lanoxin 0.5 mg po. The following is what you have on hand. How many tablet(s) should the patient receive?

3. The physician orders furosemide oral solution 40 mg. The drug label reads furosemide 10 mg/mL. How many milliliters should the patient receive?

Mark the dose the patient is to receive on the oral syringe.

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4. A child weighing 60 pounds is to receive an IV medication with a normal range of 0.5 - 1 mg/kg/dose. An IV containing 20 mg of medication has been ordered. What will the range of safe dosages be for this child?

Is the ordered dose within this normal range?

5. Atropine 0.2 mg subcutaneously is ordered. You have the following on hand. How many milliliters should the patient receive?


6. Morphine 1/6 grain IM is ordered. You have the following on hand.How many milliliters should the patient receive?


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7. Cefpodoxime 0.17 g po is ordered. You have the following on hand.How many milliliters should the patient receive?

Mark the dose the patient is to receive on the cup.

8. Heparin 3,000 units subcutaneously is ordered. You have the following on hand. How many milliliters should the patient receive?

Select the appropriate syringe then mark the dose the patient is to receive.

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9. Calcium Gluconate 0.93 mEq is ordered IV push. You have the following on hand. How many milliliters should the patient receive? Over how much time should the medication be administered? (Check your drug reference.)

Mark the syringe with the correct dosage.

10. You need to infuse 1000 mL D5W intravenously over 6 hours. You have tubing that delivers 10 drops per mL. How many drops per minute will you infuse?

11. The physician orders an IV of D5 ½ NS at a rate of 50 mL per hour. The tubing has a drop factor of 10. How many drops per minute will you infuse?

12. You need to infuse 500 mL of normal saline IV over 8 hours. How many mL per hour will you set on the electronic controller?

13. You need to administer an IV piggyback of metronidazole 1.5 g in 100 mL dextrose and water over 60 minutes. You have tubing with a drop factor of 15. How many drops per minute should you infuse?

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14. You are infusing saline IV at 10 mL per hour. You are using mini-drip tubing. How many drops per minute should you infuse?

15. You need to administer heparin intravenously at 1000 units per hour. You have a bag of 50,000 units of heparin in 500 mL dextrose in water. How many mL per hour will you set on the electronic controller?

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Objectives in italics. Master for test.***************************************************************************************************

*

1. Discuss regulation of herbal remedies. Lehne Chapter 108.

2. Identify commonly used herbs, major actions, and side effects.

Herb Action/Use Side effects

Black Cohosh

Chamomile

Cinnamon

Echinacea

Ephedra (Ma Huang)

Garlic

Ginger Root

Gingko

Red Rice Yeast

Saw Palmetto

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St. John’s Wort

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3. Discuss nursing implications related to herbal therapy precautions.

A. Assessment

B. Patient teaching

For additional information, try http://www.herbalgram.org and www.mayoclinic.com.

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http://www.mayoclinic.com/

http://www.herbalgram.org/

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*1. Review the structure and function of the central and peripheral components of

the nervous system.

A. Parasympathetic Response Review

B. Sympathetic Response Review

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Nervous System

Central Nervous System Peripheral Nervous System

Brain Spinal Cord Somatic NS Autonomic NS

Sympathetic NS(Adrenergic)

Parasympathetic NS(Cholinergic)

2. Identify primary neurotransmitters of the autonomic nervous system and state where each is secreted.

3. Review the functions of the sympathetic and parasympathetic branches of the autonomic nervous system. See Lehne Chapter 13.

4. Identify primary receptors in the autonomic nervous system.

A. Parasympathetic Receptors

i. Muscarinic

ii. Nicotinic

B. Sympathetic Receptors

i. α1

ii. α2

iii. β1

iv. β2

v. Dopamine

In the following tables:

5. Identify specific physiologic responses to stimulation of the sympathetic nervous system; to stimulation of the parasympathetic nervous system. Chapters 14 – 19.

6. Describe the general drug action, uses, contraindications, and side effects of adrenergic, adrenergic blocker, cholinergic and cholinergic blocker drugs.

7. Explain nursing care of patients receiving ANS agents.

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Parasympathetic Nervous System Sympathetic Nervous SystemFunctional description Rest and Restore, Rest and Digest Fight or Flight

Stimulation Blocking Stimulation BlockingTerminology Parasympathomimetic

CholinergicParasympatholytic

AnticholinergicCholinergic blocker

SympathomimeticAdrenergic

(Dopaminergic)

SympatholyticAdrenergic blocker

(alpha blocker)(beta blocker)

Primary NeurotransmitterAcetylcholine Epinephrine, Norepinephrine, Dopamine

ReceptorsNicotinic, Muscarinic Alpha 1&2, Beta 1&2, Dopamine

Pupils

Bronchioles

Heart

Blood vessels

GI - Peristalsis

Kidney

Bladder

Uterus

Salivation

Constrict

Constrict

Rate decreases

Dilate

Increases

__

Contracts

---

Increases

Dilate

Dilate

Rate increases

Constrict

Slows

Dilates vessels(dopamine)

Releases renin(B1)

Relaxes

Relaxes

---

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Parasympathetic Nervous SystemNeurotransmitters/Receptors Acetylcholine / Nicotinic and Muscarinic Receptors

Cholinergic Agonists Cholinergic Blocking AgentsAssociated terms Parasympathetic, rest and digest, parasympathomimetic,

cholinergic agonist, (direct and indirect acting)Parasympathetic blocker, parasympatholytic,

anticholinergic, cholinergic blocker

Physiologic effects Pupil constriction; decreased heart rate; bronchial constriction; increased pulmonary secretions; contraction of bladder muscle and relaxation of sphincter; GI – salivation; increased gastric secretion and motility; sweating

Block parasympathetic activity to increase heart rate, relax bronchi, dilate pupils, relax bladder muscle and constrict sphincter; reduce gastric secretions and motility; reduce pulmonary secretions

Therapeutic uses Used to treat urine retention glaucoma gastroparesis myasthenia gravis

Used to treat nerve gas exposure spastic GI tract dysrhythmias motion sickness COPD, Ulcers

Used preoperatively to dry secretionsSide effects S

LUDGE

Drug examples Muscarinic receptors:bethanechol (Urecholine)pilocarpine (Pilocar)

atropinescopolaminedicyclomine (Bentyl)

Antidote Atropine NoneNursing care

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Sympathetic Nervous SystemNeurotransmitters/Receptors Epinephrine, Norepinephrine, Dopamine / Alpha 1&2, Beta 1&2 Receptors

Adrenergic Agents Adrenergic Blocking AgentsAssociated terms Sympathetic, fight or flight, sympathomimetic,

adrenergic agonistSympathetic blocker, sympatholytic, alpha blocker, beta

blockerPhysiologic effects (drug action) Alpha 1 – Constrict blood

vessels, contract prostate capsule, contract bladder sphincter, dilate pupils

Beta 1 – Increase heart rate and contractility; cause renin release from kidneyBeta 2 – Bronchodilation; uterine relaxation; liver glycogenolysis

Alpha 1– block receptors to relax vascular smooth muscle, relax prostate capsule and bladder sphincter

Beta 1 – block receptors to decrease rate and force of heart contraction; reduce renin release Beta 2 –constrict bronchioles, reduce uterine relaxation and liver glycogenolysis

Therapeutic uses HypotensionShockCardiac arrestPotentiation of local anesthesia

ShockAsthmaAnaphylaxisCardiac arrest

HypertensionBenign prostatic hypertrophy (BPH)Raynaud’s disease

HypertensionAnginaDysrhythmias, Post MIMigraineStage FrightGlaucoma

Side effects

Drug examples phenylephrine (Neo-Synephrine)tetrahydrozoline (Murine, Visine)

albuterol (Proventil, Ventolin)dobutamine (Dobutrex)

prazosin (Minipress)terazosin (Hytrin)tamsulosin (Flomax)

Beta1 selective:metoprolol (Lopressor)atenolol (Tenormin)

(nonselectives) epinephrine (Adrenalin), dopamine (Intropin) carvedilol (Coreg); nebivolol (Bystolic); propranolol (Inderal)Nursing care

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********************************************************************************************Objectives in italics. Master for test.********************************************************************************************1. Discuss the types, general action and uses of CNS stimulants. See Lehne

Chapter 36.

AMPHETAMINESAnorexiants Agents for ADHD

dextroamphetamine (Dexedrine) amphetamine mixture (Adderall)methylphenidate (Ritalin, Concerta)

Action/Uses Action/Uses

modafinil (Provigil) (miscellaneous non-amphetamine stimulant)Side Effects

2. Describe the nursing responsibilities associated with the administration of CNS stimulants.

A. Assessment

B. Planning and implementation

C. Evaluation

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***************************************************************************************************Objective in italics. Master for test.***************************************************************************************************

1. Define the following terms.

A. Sedative

B. Hypnotic

C. Sleep architecture/stages of sleep

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2. Describe the general drug action, uses, and side effects of sedatives and hypnotics. See Lehne Chapters 34 and 35.

SEDATIVE / ANTIANXIETY / HYPNOTIC AGENTSBarbituratesphenobarbitalbutabarbitalpentobarbital

Benzodiazepines alprazolam (Xanax)diazepam (Valium)lorazepam (Ativan)midazolam (Versed)temazepam (Restoril)Antidote - Romazicon (flumazenil)

Non-Benzo/Non-Barbszolpidem (Ambien)eszopiclone (Lunesta)

Action Action Action

Use Use Use

Toxicity/Overdose Toxicity/Overdoseflumazenil (Romazicon)

Side effects

3. Discuss the use of diphenhydramine (Benadryl, Tylenol PM) as a sleep aid.

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4. Describe the nurse’s responsibility when administering sedatives and hypnotics/anxiolytics.

A. Assessment


C. Evaluation

4. Identify Rules for Sleep Fitness.

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5. Identify the mechanism of action, uses, side effects and examples musculoskeletal relaxants. Lehne Chapter 25.

Muscle Relaxantsdiazepam (Valium)baclofen (Lioresal)cyclobenzaprine (Flexeril)carisoprodol (Soma)Action

Uses

Side Effects

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Objectives in italics. Master objectives for test.***************************************************************************************************

*

1. Define anesthesia. Lehne Chapter 27.

2. State the purposes for which anesthetics are administered.

3. Explain the concept of balanced anesthesia.

4. Define general anesthesia.

5. Describe the methods by which general anesthetics are administered.6. Identify the advantages and disadvantages of each method of administering

general anesthetics.7. State examples of each class of anesthetic agents.

ANESTHETICSInhalationisoflurane (Forane)sevoflurane (Ultane)nitrous oxide

Intravenouspropofol (Diprivan)ketamine (Ketalar)

Action Action

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Uses Uses

Adverse Effects

Hypotension

Respiratory Depression

Dysrhythmias

Malignant hyperthermia

Hepatotoxicity

Adverse Effects

Respiratory depression

Hypotension

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8. Identify five classes of drugs that may be administered to supplement anesthetics and state the purpose for which they are used. (Do not memorize specific agents in this chart – just classes.)

ANESTHESIA ADJUNCTSClass/examples UsesAntianxiety/Sedatives

midazolam (Versed)diazepam (Valium)

Pre-anesthesia, reduce tension and anxiety, promote amnesia

Anticholinergics

atropine Dry secretions, prevent aspiration

Neuromuscular Blockers

vecuronium bromide (Nocuron) Ease intubation

Opioid Analgesics

sublimaze (Fentanyl)morphine

Relieve pain

GI Agents

ranitidine (Zantac)sodium citrate and citric acid (Bicitra)ondansetron (Zofran)promethazine (Phenergan)

Reduce nausea, vomiting, aspiration

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10. Define local anesthesia. Lehne Chapter 26.

11. Identify commonly used local agents, their actions, and side effects.

Local Anestheticsprocaine (Novocain) – short actinglidocaine (Xylocaine) – moderate actingbupivacaine (Marcaine) – long acting

Action Side Effects

12. Identify five types of local anesthesia and describe uses of each.

A. Topical

B. Infiltration

C. Nerve block

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D. Epidural

E. Spinal

13. Describe nursing interventions to prevent spinal headache.

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Objectives in italics. Master for test. ***************************************************************************************************

*1. Define terms used in studying pain. Chapters 28, 29, 30, 71

A. Pain - is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is whatever the patient says it is, whenever the patient says it is. Margot McCaffery

B. Acute pain

C. Chronic pain

D. Agonist

E. Antagonist

F. Opioid

G. Opioid tolerance

H. Receptors

I. NSAID

2. Discuss State of Michigan guidelines for pain and symptom management.

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http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_45947_45949---,00.html

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3. Describe the general action of opioid analgesics on the central nervous system and the resulting effect on other parts of the body. Lehne Chapters 28-29.

4. Identify the two cardinal signs of morphine intoxication.

Strong Opioid Agonists Moderate Opioid Agonistsmorphine sulfate - Schedule II (Duramorph, Roxanol, MS Contin)

meperidine HCl - Schedule II (Demerol)

methadone – Schedule II

fentanyl – Schedule II (Sublimaze, Duragesic)

hydromorphone – Schedule II (Dilaudid)

acetaminophen/codeine – Schedule III (Tylenol #2,3,4)

hydrocodone (with ASA/acetaminophen) – Schedule III (Hycodan, Vicodin, Lortab, Lorcet, Norco)

oxycodone with ASA/acetaminophen – Schedule II (Percodan/Percocet)

Action

Uses Uses

Side effects:

Respiratory depression*

Constipation

Orthostatic hypotension

Urinary retention

Cough suppression

Emesis

Sedation

Miosis*

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5. Discuss the dangers of using meperidine (Demerol) in the elderly.

6. Discuss the action and use of opioid agonist-antagonists and antagonists.

Antagonistsnaloxone (Narcan)naltrexone (Trexan, Vivitrol)buprenorphine/naloxone (Suboxone)Action

Use

Side Effects

7. Differentiate between opioid tolerance and addiction. Lehne Chapter 40.

8. Describe symptoms that may occur when opioids are withheld from an addicted person.

9. Discuss treatment of opioid addiction

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10. Identify the nurse’s responsibilities and legal implications involved in the Administration of Opioids:

A. Assessment


E. Legal implications

Board Rule R 338.10601

An applicant for license renewal shall complete at least 1 continuing education contact hour in pain and pain symptom management in each renewal period. Continuing education contact hours in pain and pain symptom management may include, but are not limited to, courses in behavior management, psychology of pain, pharmacology, behavior modification, stress management, clinical applications, and drug interactions.

.

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11. Explain the process of inflammation.

12. Describe the general action, uses, and side effects of NON-OPIOIDS acetaminophen and NSAIDS. Lehne Chapter 71.

NSAIDS Non-NSAIDCOX-1/COX-2 Inhibitors COX-2 Inhibitors acetaminophen (Tylenol)

ASA (Bayer, Empirin)ibuprofen (Motrin)naproxen (Naprosyn, Aleve)ketorolac (Toradol)

celecoxib (Celebrex)meloxicam (Mobic)

acetaminophen (Tylenol, Panadol)

Action

Uses

Side Effects

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13. Describe at least three non-pharmacologic approaches to pain management.

A.

B.

C.

14. Discuss methods for assessment of pain.

15. Identify the nurse’s responsibilities involved in the administration of NSAID’s and acetaminophen:

A. Assessment


C. Evaluation

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*


A. Seizure

B. Generalized seizure

C. Partial seizure

2. Discuss the general action, uses, side effects, and examples of anticonvulsant drugs. Lehne Chapter 24.

Traditional Drugs Newer Drugs Emergency Drugsphenobarbitalphenytoin (Dilantin)carbamazepine (Tegretol)valproic acid (Depakene, Depakote)

lamotrigine (Lamictal) pregabalin (Lyrica)gabapentin (Neurontin)topiramate (Topamax)levetiracetam (Keppra)

lorazepam (Ativan)diazepam (Valium)

Uses – seizure prevention (neuropathic pain, psychiatric disorders)

Acute seizure treatment

Action

Side Effects

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3. Describe the nursing responsibilities associated with the administration of anticonvulsant drugs.

A. Assessment


C. Evaluation

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*

1. Define psychosis.

4. Discuss the three types of symptoms of schizophrenia.

Positive

Negative

Cognitive

5. Discuss the general action, uses, and side effects of antipsychotic drugs. Lehne Chapter 31.

Antipsychotic Agentsaripiprazole (Abilify)quetiapine (Seroquel)

Action

Use

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Side effects – Extrapryamidal

Acute dystonia

Parkinsonism

Akathisia

Tardive dyskinesia

Side effects - Other

4. Describe nursing responsibilities associated with the administration of antipsychotic agents.

A. Assessment


C. Evaluation

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A. Depression

B. Bipolar affective disorder

2. Describe the general actions, uses, and side effects of each type of antidepressant: SSRIs, SNRIs, SDRO, and lithium. Lehne Chapters 32 and 33.

SSRIs SNRIs SDRI

fluoxetine (Prozac, Sarafem)sertraline (Zoloft)citalopram (Celexa)escitalopram (Lexapro)paroxetine (Paxil)

duloxetine (Cymbalta)venlafaxine (Effexor)desvenlafaxine (Pristiq)

bupropion (Wellbutrin, Zyban)

ActionSelective Serotonin Reuptake Inhibitors

Serotonin Norepi Reuptake Inhibitors

Selective Dopamine Reuptake Inhibitor

Use

Side effects

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3. List treatment options for bipolar disorder.

Antiepileptic agents

Antidepressant agents

Antipsychotic agents

Lithium

4. Describe nursing responsibilities associated with the administration of antidepressant agents.

A. Assessment


C. Evaluation

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*

I. Define terms related to infections and antibiotics.

C. Antibiotic / antimicrobial / antibacterial

D. Bacteremia

E. Bactericidal

D. Bacteriostatic

E. Broad – spectrum antibiotic

F. Empiric therapy

G. Infection

H. Narrow - spectrum antibiotic

I. Hospital Acquired Infection (Nosocomial) infection

J. Sepsis

K. Suprainfection /superinfection

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2. List common clinical uses of anti-infective drugs.

A. Treatment of infections

B. Prophylactic use in high risk situations

3. Identify factors the prescriber must take into consideration when choosing antiinfective agents.

A. Identification of infecting agent

1. gram stain

a. gram positive

b. gram negative

2. acid fast

3. aerobes

4. anaerobes

B. Selection of appropriate medication

1. Culture

2. Sensitivity

3. Infection site

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4. Cost

.

5. Adverse effects

6. Allergies

4. Discuss the impact of antibiotic – resistant infections in health care.

5. List the CDC’s 12 steps to prevent antimicrobial resistance among hospitalized adults. Lehne page 1049, Figure 83-1.

A. Vaccinate

B. Get the catheters out

C. Target the pathogen

D. Access the experts

E. Practice antimicrobial control

F. Use local data

G. Treat infection, not contamination

H. Treat infection, not colonization

I. Know when to say “no” to vanco

J. Stop treatment when infection is cured or unlikely

K. Isolate the pathogen

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L. Break the chain of contagion

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6. Identify nursing responsibilities associated with the administration of antimicrobial agents.

A. Assessment


C. Evaluation

7. Describe the action, therapeutic uses, and side effects of each class of antibiotics.

See attached table.

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PENICILLINS CEPHALOSPORINS VANCOMYCINAction Weakens cell wall/ bactericidal Weakens cell wall/ bactericidal Weakens cell wall/ bactericidal

UsesBroad spectrum; useful against Staphylococcus, Streptococcus, gram positive bacteria

Related to penicillins; may be cross-sensitive.Broad spectrum; earlier generations effective against primarily gram-positive infectious agents. Later generations more effective against gram-negative agents.

Serious infections such as hospital-acquired MRSA, C. difficile

Side effects

Nursing responsibilities

Examples penicillin Gpenicillin V (Pen-Vee K)amoxacillin

Extended spectrum: piperacillin/tazobactam (Zosyn)Amoxicillin/clavulanic acid (Augmentin)

cefazolin (Kefzol) 1st gencephalexin (Keflex)

cefuroxime (Zinacef) 2nd gen

ceftriaxone (Rocephin) 3rd gen

vancomycin (Vancocin)

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MACROLIDES TETRACYCLINES AMINOGLYCOSIDESAction Inhibits protein synthesis/bacteriostatic Inhibits protein synthesis/bacteriostatic Inhibits protein synthesis/bactericidal

UsesAcne, legionnaires’ disease, diphtheria, Chlamydia Acne, peptic ulcers, rickettsial diseases, Chlamydia IV – serious gram-negative infections such as

Pseudomonas and Klebsiella; some Staph and Strep strains

Side effects


Examples erythromycin (E-mycin)clarithromycin (Biaxin)azithromycin (Zithromax)fidaxomicin (Dificid)

tetracyclinedoxycycline (Vibramycin)

Gentamycin (Garamycin)Tobramycin (Nebcin)

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SULFONAMIDES FLUOROQUINOLONES CYCLIC LIPOPEPTIDESAction Inhibits DNA synthesis/bacteriostatic Inhibits DNA synthesis/bactericidal Impairs cell membrane, inhibits synthesis or

RNA, DNA and proteins/b actericidalUses

Urinary tract infections, other infections Respiratory, urinary, GI, skin, other infections All gram positive bacteria, including MRSA

Side effects


Examples sulfamethoxazole/trimethoprim (Bactrim)

(related drugs = some hypoglycemics, some diuretics)

ciprofloxacin (Cipro)levofloxacin (Levaquin)moxifloxacin (Avelox)

daptomycin (Cubicin)

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METRONIDAZOLE OXAZOLIDINONE ANTIFUNGAL AGENTSAction Inhibits DNA synthesis/bactericidal Inhibits protein synthesis, bacteriostatic Varies

UsesAnaerobic bacteria: “deep belly bugs,” C. Difficile, bone and joint infections, skin, other

VRE, MRSA Fungal infections

Side effects


Examples Metronidazole (Flagyl) linezolid (Zyvox) amphotericin B (Fungizone) – IV, po, topicalfluconazole (Diflucan) – oral, IVnystatin (Mycostatin) – oral, topicalmiconazole (Monistat) – topicalketoconazole (Nizoral) – oral, topical

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*

1. Define terms related to cancer chemotherapy. Lehne Chapter 101.

A. Benign

B. Cancer

A. Dose limiting side effects

D. Emetic potential

E. Extravasation

F. Malignant

G. Nadir

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1. Describe the phases of the cell cycle and their significance in cancer chemotherapy. Lehne Figure 100-1.

3. Describe the unique characteristics of tumor cells.

A. Persistent proliferation

B. Invasive growth

C. Formation of metastases

D. Immortality

4. Explain why combination therapy is better than single-agent therapy.

5. List precautions to observe when handling chemotherapeutic agents.

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6. Describe side effects of chemotherapy, including signs and symptoms, health risks, and nursing care.

Side Effect Nursing CareBone marrow suppression – neutropenia

Bone marrow suppression – thrombocytopenia

Bone marrow suppression – anemia

Stomatitis

Diarrhea

Nausea and vomiting

Alopecia

Reproductive disturbances

Hyperuricemia

Local injury from extravasation

Organ toxicities

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7. List the action, major uses, dose limiting side effects, and examples of drugs in each class of chemotherapeutic agents.

Class/Agent Action Dose-limiting side effectsAlkylating agentscyclophosphamide (Cytoxan)

Damage DNAInterfere with cell replication

MyelosuppressionRenal failure

Antimetabolitesmethotrexate (Folex PFS) fluorouracil (Adrucil, 5-FU)cytarabine (Ara-C)

Replace natural metabolitesDisrupt metabolic processes

MyelosuppressionOrgan toxicity

Antibiotics doxorubicin (Adriamycin)bleomycin (Blenoxane)

Block transcription of new DNA and RNA

MyelosuppressionCardiotoxicityLiver and kidney toxicity

Mitotic Inhibitorsvincristine (Oncovin)vinblastine (Velban)paclitaxel (Taxol)

Mitotic poisonStop cell division

Neurotoxicity: neuropathy, numbness, tingling, motor difficulties

Monoclonal Antibodiestrastuzumab (Herceptin)rituximab (Rituxan)

Block receptor sitesTurn off growth signals

CardiotoxicityHypersensitivity

Topisomerase inhibitorsirinotecan (Camptosar)topotecan (Hycamtin)

Impair DNA replication Myelosuppression

Angiogenesis inhibitorsbevacizumab (Avastin)

Inhibit growth of new vessels

Interfere with wound healingInterfere with growth in children

Hormonesprogesterone (Gesterol 50)goserelin acetate implant (Zoladex)tamoxifen (Nolvadex)

Act on receptor sites on target tissuesEffect depends on hormone

Depends on hormone

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8. Discuss nursing responsibilities associated with administration of antineoplastic agents.

A. Assessment


C. Evaluation

9. List the action, therapeutic uses, and side effects of the different biologic response modifiers. Lehne Chapter 56.

Class/Agent Action Side effectsErythropoietic Growth Factorepoetin alpha (Epogen, Procrit)

Stimulates production of RBCs

HypertensionHeart failure, stroke, MI

Leukoopoietic Growth FactorsG-CSF (filgrastim - Neupogen)GM-CSF (sargramostim/Leukine)

Stimulate production of leukocytes

Muscle achesBone painLeukocytosis

Thrombopoietic Growth Factorinterleukin-11 (oprelvekin/Neumega)

Stimulate platelet production

Sodium and water retentionCardiac dysrhythmiasAllergic reaction

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10. Discuss nursing responsibilities associated with administration of hematopoietic agents.

A. Assessment


C. Evaluation

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Review normal structure and physiologic function of the respiratory system.

2. Describe the histamine response to allergen exposure.

3. Describe the action, therapeutic uses, and side effects of H1 blockers. Lehne

Chapter 70.First Generation antihistaminesdiphenhydramine (Benadryl)hydroxyzine (Vistaril)

Second generation antihistamines (non-sedating)loratadine (Claritin) fexofenadine (Allegra)cetirizine (Zyrtec)

Action

Uses

Side effects

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4. Identify the actions, therapeutic uses, side effects and nursing care related to each of the agents in the following table. Lehne Chapter 77.

9/11/2023 JMB 110

Nasal decongestants Intranasal glucocorticoids Antitussives Expectorantspseudoephedrine hcl (Sudafed) oxymetazoline (Afrin)phenylephrine (Neo-Synephrine)

The “D” in Claritin D, etc.

beclomethasone (Beconase)fluticasone (Flonase)

dextromethorphan hydrobromide (the “DM” in Robitussin DM)(non opioid CNS drug)hydrocodone /guaifenesin (Vicotuss)codeine (the “AC” in Robitussin AC)(Scheduled)

guaifenesin (Robitussin, Mucinex)

ActionVasoconstrictionReduce nasal congestion

Anti-inflammatory Depress cough center (central)Decrease sensitivity of airways (peripheral)

Stimulate flow of respiratory secretions

UsesStuffy nose Allergic rhinitis Nagging cough Nonproductive but congested cough

Side effects Sympathetic effects

Rebound congestionDry nasal mucous membranesSystemic side effects rare

Nausea, sedation GI upset

Nursing care Monitor blood pressure

Caution in heart diseaseTeach re rebound

Rinse mouth after use Assess cough, sputum, lung soundsAvoid with productive cough

Assess lung sounds, cough, sputumTeach to cough and deep breatheHydrate

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5.. Describe briefly the pathophysiology of the following disorders.

A. Asthma

B. Chronic bronchitis

C. Emphysema

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6. Describe the mechanism of action, uses, side effects, and nursing responsibilities associated with the administration of bronchodilators. Lehne Chapter 76.

Sympathomimetic agents Anticholinergic agents Short acting: albuterol (Proventil, Ventolin)levalbuterol (Xopenex)epinephrine (Adrenalin, Bronkaid, Primatene Mist) Long acting: salmeterol (Serevent – no longer recommended)formoterol (Foradil)

ipratropium bromide (Atrovent)tiotropium (Spiriva)

Combination agents albuterol/ipratropium (DuoNeb, Combivent)Action

Uses

Side effects

Nursing Care

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7. Describe the action, uses, side effects, and nursing responsibilities associated with the administration of prophylactic asthmatic drugs.

Antileukotriene agents Glucocorticoids Combination Agentszafirlukast (Accolate)montelukast (Singulair)

beclomethasone (QVAR)fluticasone (Flovent)prednisone (Deltasone)methylprednisolone (Solu-Medrol)

salmeterol /fluticasone (Advair)formoterol/budesonide (Symbicort)

Action

Uses

Side effects

Nursing Care

9/11/2023 JMB 114

8. Describe correct use of a metered dose inhaler.

9. Discuss the use of IV morphine for severe respiratory distress.

10. Identify the nursing responsibilities associated with administration of drugs that affect the respiratory system.

A. Assessment


D. Evaluation

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********************************************************************************************Objectives in italics. Master for test.********************************************************************************************

1. Review normal structure and function of the heart and blood vessels. Lehne Chapter 43.

A. Structure of the heart

B. Determinants of cardiac output

1. Heart rate

2. Stroke volume

3. Preload

4. Afterload

D. Blood supply to the heart

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1. Review normal structure and function of the kidney.

Describe the action, uses, side effects and nursing responsibilities associated with administration of diuretics. Lehne Chapter 41.

9/11/2023 JMB 118

DiureticsLoop Thiazide Potassium sparingfurosemide (Lasix)bumetanide (Bumex)

hydrochlorothiazide (Hydrodiuril)metolazone (Diulo, Zaroxolyn)

spironolactone (Aldactone)triamterene/hydrochlorothiazide (Dyazide)

Action

Uses

Side effects

Identify essential precautions to take when administering potassium supplements.

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4. Identify the nursing responsibilities associated with the administration of diuretics.

A. Assessment


D. Evaluation

1. Describe the action, uses, side effects and nursing responsibilities associated with administration of agents that affect the RAAS. Lehne Chapter 44.

9/11/2023 JMB 120

RAAS Agents

ACE Inhibitors Angiotensin II receptor blockers

Aldosterone antagonists Renin Inhibitor

captopril (Capoten)enalapril (Vasotec)lisinopril (Prinivil, Zestril)

losartan (Cozaar)valsartan (Diovan)

spironolactone (Aldactone)eplerenone (Inspra)

aliskiren (Tekturna)

Action

Use

Side effects

Nursing care

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1. Define supraventricular vs. ventricular dysrythmia.

2. Describe the action, therapeutic uses, side effects and nursing responsibilities when administering cardiac glycosides. Lehne Chapter 48.

Cardiac Glycosidedigoxin (Lanoxin)

antidote: digoxine immune Fab (Digibind)

Action Positive inotrope

Negative chronotrope

Negative dromotrope

Uses

Atrial fibrillationHeart failure

Side effects

AnorexiaVision changesHeadacheBradycardiaHypokalemia

Nursing care

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1. Describe the action, uses, side effects and nursing responsibilities associated with administration of calcium channel blockers and vasodilators. Lehne Chapters 45 and 46.

Cacium channel blockers Vasodilatorsdiltiazem (Cardizem)amlodipine (Norvasc)

nitroglycerin (Nitrostat, Nitrobid, Transderm-nitro)isosorbide mononitrate (Imdur)

Action

Use

Side effects

Nursing care

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1. Review normal regulation of blood pressure. (Lehne Chapter 43.)

The primary regulated variable in the cardiovascular system is arterial blood pressure. Arterial blood pressure (BP) is dependent on cardiac output (CO) and total peripheral resistance (TPR):

B/P = CO x TPR

Cardiac output is determined by both stroke volume (SV) and heart rate (HR):

CO = SV x HR normal CO = 4-8L/min; normal SV = 70mL for adult

These two equations can also be combined to include all of the major variables that directly influence arterial blood pressure:

BP = (SV x HR) x TPR

These equations indicate that BP is determined by 3 variables: Heart rate, stroke volume & total peripheral resistance. Any change in BP must result from changes in one ore more of these three variables.

Body systems that help regulate these variables include: ANS: sympathetic and parasympathetic nervous system, baroreceptor reflex

(affect HR and blood vessels) RAAS: Renin-Angiotensin-Aldosterone system (affect blood vessels and fluid

volume) Kidneys: affect blood volume

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2. Define hypertension and prehypertension.

BP Classification SBP mmHg DBP mmHg

Normal < 120 and < 80

Prehypertension 120-139 or 80-89

Stage 1 Hypertension 140-159 or 90-99

Stage 2 Hypertension > 160 or > 100

Describe the mechanism of action and nursing implications for each type of antihypertensive drug. Lehne Chapter 47.

Drugs to lower blood pressure

Class Mechanism of action Nursing implicationsDiuretics

Beta blockers

ACE inhibitors, ARBS

Calcium Channel blockers

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4. Describe the nursing responsibilities associated with the administration of antihypertensive drugs.

A. Assessment


C. Evaluation

1. Describe heart failure pathophysiology, signs and symptoms. Lehne Chapter 48.

9/11/2023 JMB 128

2. Discuss drugs used to treat heart failure.

Heart Failure Agents

Class Mechanism of action Nursing implicationsACE inhibitors, ARBS

Diuretics

Aldosterone antagonists

Beta blockers

Digoxin

Other inotropes

Vasodilators

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1. Describe the pathophysiology, signs, and symptoms of angina.

2. Describe the mechanism of action, uses, and side effects of each class of antianginal agents. Lehne Chapter 51.

Antianginal AgentsClass Mechanism of action Nursing implicationsNitrates

Beta blockers

Calcium channel blockers

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1. Describe normal cardiac electrical function.

2. Define dysrhythmia. Differentiate supraventricular from ventricular dysrhythmias.

Describe the action, uses, and side effects associated with the administration of each of the four classes of drugs used to treat cardiac dysrhythmias. Lehne Chapter 49.

Antidysrhythmic AgentsClass Mechanism of action Nursing implicationsBeta blockers

propranolol (Inderal)sotalol (Betapace)

Calcium channel blockers

diltiazem (Cardizem)

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Summary

Hypertension Angina Heart failure Dyshrythmias Diuretics

Nitrates

Beta blockers

Calcium Channel blockers

RAAS Agents

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1. Describe normal hemostasis.

2 . Identify laboratory tests used to monitor clotting; differentiate between normal and therapeutic values.

TEST NORMAL VALUE THERAPEUTIC VALUE

DRUG MONITORED

Prothrombin Time (PT)

12 -15 seconds

International Normalized Ratio (INR)

0.7 – 1.3

Partial Thromboplastin Time (PTT)

30 - 45 seconds

Whole Blood Clotting Time

5 - 15 minutes

Heparin Units

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3. Describe the action, therapeutic uses, laboratory monitoring, antidotes, and side effects of anticoagulant agents. Lehne Chapter 52.

AnticoagulantsHeparin Low molecular weight

heparinsOral anticoagulant

Heparin

Antidote – protamine sulfate

enoxaparin (Lovenox)

Antidote – protamine sulfate

warfarin (Coumadin)Antidote – vitamin K (Mephyton, Aqua mephyton)rivaroxaban (Xarelto)

Action

Use

Side effects

Lab monitoring

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4.Describe the action, therapeutic uses, laboratory monitoring, and side effects of antiplatelet and thrombolytic agents. Lehne Chapter 52.

Antiplatelet and Thrombolytic AgentsOral antiplatelet agents IV thrombolytic agentsaspirin - 1 a dayclopidogrel (Plavix)aspirin/dipyridamole (Aggrenox)

tPA, alteplase (Activase)tenecteplase (TNKase)

Antidote - aminocaproic acid (Amicar)Action

Use

Side effects

Lab monitoring

9/11/2023 JMB 135

5. Describe the nursing responsibilities associated with the administration of anticoagulant, antiplatelet, and thrombolytic agents.

A. Assessment


C. Evaluation

1. Describe the lipoproteins found in the body.

Total Cholesterol Below 200 mg/dL

LDL Cholesterol Below 70 mg/dL for high risk patientsBelow 100 mg/dL for lower risk patients

HDL Cholesterol 60 mg/dL or greater

Triglycerides Below 150 mg/dL

2. Define and state the risks of hyperlipidemia.

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3. Describe the action, therapeutic uses, and side effects of antihyperlipidemic drugs. Lehne Chapter 50.

Statins Other Psyllium

atorvastatin (Lipitor)simvastatin (Zocor)rosuvastatin (Crestor)

ezetimibe (Zetia)simvastatin/ezetimibe (Vytorin)

Metamucil

Action

Inhibit liver synthesis of cholesterol

Reduces amount of cholesterol absorbed in digestive tract

Increases cholesterol excretionMay decrease intestinal absorption

Use

Side effects

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.

4. Describe the nursing responsibilities associated with administration of antihyperlipidemic agents.

A. Assessment


C. Evaluation

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********************************************************************************************Objectives are in italics. Master for test.********************************************************************************************

1. Discuss the pathophysiology of nausea and vomiting.

2. Describe the action, therapeutic uses, and side effects of each type of antiemetic agent. Lehne Chapter 80.

3. State contraindications for use of antiemetics.

4. Describe the nursing responsibilities associated with administration of antiemetic agents.

A. Assessment


C. Evaluation

9/11/2023 JMB 139

Antiemetic AgentsAnticholinergics Cholinergics Neuroleptic agents

(Phenothiazines)Tetracannabinoids Serotonin (5-HT3)

Receptor Antagonistscopolamine (Transderm-Scop)hydroxyzine pamoate (Vistaril)meclizine (Antivert)

metoclopramide (Reglan)

promethazine (Phenergan)

dronabinol (Marinol) ondansetron (Zofran)granisetron (Kytril)

Action

Uses

Side effects

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1. Discuss causes of diarrhea.

1. Describe the action, therapeutic uses, and side effects of antidiarrheal drugs. Lehne Chapter 80.

Antidiarrheal AgentsOpioids Adsorbents Intestinal flora modifierdiphenoxylate/atropine (Lomotil)loperamide (Imodium)

kaolin/pectin (Kaopectate) lactobacillus acidophilus (yogurt cultures)

Action

Use

Side effects

9/11/2023 JMB 142

3. Describe the nursing responsibilities associated with antidiarrheal drugs.

A. Assessment


C. Evaluation

1. Describe the action, therapeutic uses, and side effects of each type of laxative and cathartic. Lehne Chapter 79.

2. Describe contraindications for the use of laxatives and cathartics.

9/11/2023 JMB 143

Laxatives and CatharticsBulk formers Surfactants

(softeners)Stimulants Osmotics

psyllium hydrophilic mucilloid (Metamucil)wheat dextrin (Benefiber)

docusate sodium (Colace)

bisacodyl (Dulcolax)senna (Senokot)

lactulose (Cephulac)magnesium salts (Milk of Magnesia)polyethylene glycol (Miralax)

Action

Use

Side effects

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3. State the nursing responsibilities associated with the administration of laxatives and cathartics.

A. Assessment


C. Evaluation

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1. Describe gastric acid production and function.

2. Discuss pathophysiology and causes of peptic ulcer disease.

3. Define gastroesophageal reflux disease (GERD).

4. Describe the action, therapeutic uses, and side effects of each of the anti-ulcer drugs listed. Lenhe Chapter 76.

9/11/2023 JMB 146

Antiulcer AgentsAntibiotics H2 Receptor antagonists Proton pump inhibitors Antacids

bismuth (Pepto-Bismol)metronidazole (Flagyl)clarithromycin (Biaxin)Plus a PPI

cimetidine (Tagamet - OTC)ranitidine (Zantac)famotidine (Pepcid)

omeprazole (Prilosec)lansoprazole (Prevacid)esomeprazole (Nexium)

aluminum, magnesium (Maalox, Maalox Plus)calcium carbonate (Tums)

Action

Use

Side effects

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5. Describe the use of simethicone in conjunction with antacids.

6. Describe the nursing responsibilities associated with the administration of antiulcer agents.

A. Assessment


C. Evaluation

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********************************************************************************************Master objectives for test. Objectives in Italics.********************************************************************************************

1. Review the function of the endocrine system.

1. Describe normal function of insulin, glucagon, and incretins.

a. Insulin

b. Glucagon

c. Incretins

2. Explain the pathophysiology and signs and symptoms of diabetes mellitus.

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3. Differentiate between Type 1 and Type 2 diabetes.

A. Type 1 B. Type 2Patho-physiology

Patient profile

Treatment

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4. Discuss the action, uses, and side effects of short, intermediate, and long acting insulins.

5. Compare onset, peak, and duration of action of each type of insulin.

Very short duration

Short duration Intermediate duration

Long duration (basal)

Insulin lispro (Humalog, Novolog)Insulin glulisine (Apidra)

R, Regular N, NPH insulin glargine (Lantus)insulin detemir (Levemir)

Onset – peak – duration

Action

Use

Side effects

6. Discuss the action, therapeutic uses, and side effects of oral hypoglycemic agents.

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ORAL HYPOGLYCEMIC AGENTSLiver: Reduces Glucose ProductionBiguanideThiazolidinediones

Pancreas: Stimulates Insulin SecretionSulfonylureasMeglitinide

Muscle and Adipose Tissue: IncreasesPeripheral Glucose UptakeThiazolidinedionesBiquanide

Kidney: Blocks reabsorption of glucose by kidneySGLT2 inhibitor

Intestine: Slows Digestion and Absorption of Carbohydratesa- Glucosidase Inhibitors

Intestines: Secrete IncretinsDDP-4 Inhibitor

BiguanideReduces glucose production by liver.Increases tissue sensitivity to insulin.First line choice in most patients.

metformin (Glucophage)

Less likely to cause hypoglycemia.Hold for tests with iodine dye.

DPP – 4 Inhibitor Inhibits DPP-4 to allow more incretin action. Increases insulin secretion and reduces glucagon release.

Sitagliptin (Januvia)Linagliptin (Tradjenta)Saxagliptin (Onglyza)

Less risk of hypoglycemia

ThiazolidinedionesReduce glucose production by liver. Increase tissue sensitivity to insulin.

Rosiglitazone (Avandia)

Watch liver function studies.May need change in contraceptive.

SulfolynureasStimulate insulin production by pancreas.Reduce glucose production by liver.Increase tissue sensitivity to insulin.

Glipizide (Glucotrol), glyburide (DiaBeta, Micronase)

Avoid alcohol.Watch for hypoglycemia.

MeglitinideStimulates insulin production by pancreas.

Repaglinide (Prandin)

Take only with meals. Watch for hypoglycemia.

Alpha-glucosidase inhibitorsSlow CHO absorption in intestine.

Acarbose (Precose) Give with first bite of meal. May cause GI disturbances. Treat hypoglycemia with dextrose.

Sodium-glucose co-transporter 2 (SGLT2) inhibitorBlocks reabsorption of glucose by kidneys

canaglifozin (Invokana)

Not for use with type 1 DM or kidney disease. Watch for

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UTI/ yeast infection.7. Explain the action and use of an incretin mimetic injectable agent for diabetes,

exenatide (Byetta).

8. List the nursing responsibilities associated with administering oral hypoglycemic agents and insulin.

A. Assessment


Patient Education

Injection sites

Insulin storage

Oral medication administration

Self-monitoring of blood glucose

Hypo and hyperglycemia

Diet

Exercise

9/11/2023 JMB 153

C. Evaluation

9. Explain the use of glucagon for hypoglycemic emergencies.

1. Describe normal function of the thyroid gland.

2. Describe the pathophysiology and major signs and symptoms of hypothyroidism.

3. Discuss the action, therapeutic uses, and side effects of thyroid agents.

Agents for Hypothyroidismthyroid USP levothyroxine (Synthroid) Action

Uses

Side Effects

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4. Describe the nursing responsibilities associated with the administration of thyroid and antithyroid drugs.

A. Assessment


C. Evaluation

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1. Describe normal function of the following adrenal hormones.

A. Catecholamines (epinephrine/norepinephrine) (these are covered in the ANS and cardiovascular units).

B. Glucocorticoid (cortisol)

Mediate Stress Response Reduce Inflammation Influence CHO And Protein Metabolism Mobilize Fatty Acids Suppress Immune System

C. Mineralocorticoid (aldosterone)

Causes sodium and water retention and potassium loss

2. Discuss the actions, therapeutic uses, and side effects of corticosteroids.

Glucocorticoidshydrocortisone (Solu - Cortef) prednisone (Deltasone)dexamethasone (Decadron)methylprednisolone (Solumedrol)fluticasone (Flovent) - inhaledAction

Mediate Stress Response Reduce Inflammation Influence CHO And Protein Metabolism Mobilize Fatty Acids Suppress Immune System

Uses

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Side effects

3. Describe the nursing responsibilities associated with the administration of glucocorticoids and mineralocorticoids.

A. Assessment


C. Evaluation

9/11/2023 JMB 157

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