TRICKY THURSDAY
The ABCD side effects of Barbituates
- A - Ataxia
- B - Behavioral disturbances
- C - decrease in Concentration, Coma
- D - Depression, Drowsiness, Diplopia
MED REVIEW MONDAY
Naloxone aka Narcan is an opioid antagonist, it works by blocking the opioid receptor and therefore can counteract the depression of the CNS and respiratory system caused by opioids. This is the drug you push when you suspect a morphine overdose (I believe the guideline is less than 8 respirations per minute). It is often made available by public health agencies to heroin users in case of accidental overdose. The drug also blocks pain-lowering endorphins which register in the same receptor as opioids. Narcan is used in a combination pill that aids in the detox of opioid users.
MED REVIEW MONDAY Vancomycin is an antibiotic that is used to treat gram-positive infections. It works by inhibiting cell wall synthesis in bacteria. It is used prophylactically during surgery, if a MRSA or C. dif infection is suspected, and commonly with catheter infections. It is mainly given through IV. The drug can cause pain and thrombophlebitis during administration so it is given very slowly (10 mg/min) and ideally through a central line, PICC or infusion port. One side effect that is essential to know is red man syndrome: a rash that can occur on the face, neck and upper torso of a patient receiving Vanco - as seen in this picture. For this reason, the med is almost always ordered with an antihistamine such as Benadryl.
MED REVIEW MONDAY: Streptokinase (aka Streptase)
What is it? A thrombolytic drug (it breaks up clots) administered intravenously
How does it work? Plasmin is a blood component that normally acts to break fibrin bonds after a regular blood clot has completed its job in stopping a bleed. Streptokinase increases the production of plasmin so that “bad” clots break up.
When is it used? During an MI to break up blockages in the heart and prevent damage to the muscle tissue, during a pulmonary embolism to break up a clot in the lungs, during an ischemic stroke but NEVER hemorrhagic
What do I need to know about it? Because it’s made from a bacteria material, we develop resistance to it and can have a severe (even anaphylactic) allergic reaction the second time the drug is given. Therefore, it is only indicated during a patient’s first heart attack. TPA is used instead if there is a future need. Do not administer concurrently with an anticoagulant or aspirin. Thrombin time is monitored during use. Heparin therapy should follow the use of Streptokinase.
MED REVIEW MONDAY
Penicillin is a very popular antimicrobial which works by interfering with the synthesis of bacteria cell walls. It was first made available to the public in the early 1940’s and was sort of a “silver bullet” drug - it worked on most gram positive infections. Unfortunately, there can be severe side effects, ranging from a rash or GI upset to a full anaphylactic reaction. Over 10% of the population is allergic to the drug! Penicillin has been used so widely for the past seven decades that many bacteria have developed resistance, so scientists went right on ahead and started producing combination therapies that included resistance inhibitors in the same dosage (haha, evolution - take that!) NCLEX tip: Penicillin should be taken on an empty stomach (one hour before meals or two hours after) because it is destroyed by gastric acid.
Polypharmacy is a term that refers to when a patient is taking more medications than necessary. It can lead to increased side effects due to drug interactions and noncompliance - would you want to take 15+ pills a day? It can also be hella expensive and leads to medication errors and sometimes even addiction. It usually effects psych, geriatric and HIV/AIDS patients, since it occurs when a patient is suffering from multiple chronic health issues. It can happen when a patient’s case is not being carefully monitored by their physician/nurses or when a patient uses clinics or goes to multiple physicians that may not have records of their current prescriptions. There are many ways to prevent harmful polypharmacy. The #1 solution (in my opinion) is patient education. As nurses, it is our role to advocate for the patient when we see things like this happening, but it would be way more practical if the patient understood what each pill was for and was able to question prescriptions for themselves. Other solutions include trying combination drugs or using an alternative drug that may have a less frequent dosage.
Keep in mind that not all suspected cases of polypharm are necessarily bad for the patient. The physician may have performed trial-and-error tests and found that a certain combination of multiple drugs was the best thing for the patient. However, the next time you see a patient record with two beta-blockers, a calcium channel blocker and an ace inhibitor - awaken those critical thinking skills and try to figure out why your patient may require multiple meds for the same problem OR what you’re going to do about it.
MED REVIEW MONDAY: Acetylcysteine aka Mucomyst
- Classified as mucolytic (muco = mucus, lytic = breaks up)
- Used to break up mucus in respiratory conditions such as cystic fibrosis, pneumonia, TB and COPD
- Administered through a nebulizer
- Distinct rotten egg smell
- In the oral form, it acts as an antidote for acetaminophen overdose
TRICKY THURSDAY
“One Heart and Two Lungs”
This saying serves as a reminder of Beta receptor activity. Beta-1 receptors are cardiac and Beta-2 receptors are airway.
MED REVIEW MONDAY
Zolpidem aka Ambien is hypnotic that works by potentiating the GABA neurotransmitter. It is used for the short term treatment of insomnia, however it is also prescribed as a muscle relaxant and anticonvulsant. The pill works quickly (within 15 minutes) so it should be taken shortly before going to bed. There have been many adverse cognitive reactions reported such as hallucinations (“Ambien dreams”), amnesia, and extreme cases of sleep walking (including sleep-eating and even sleep-driving). These side effects are worse in the elderly. Long term use of the drug may create a dependence, and abrupt discontinuation of use may cause delusions. Ambien is on its way to becoming the most popular drug used in date rape because of its quick action time and tasteless quality. New research reports that the drug evidently improves the reversal rate of aphasia in stroke victims.
MED REVIEW MONDAY
Diocytl sodium sulfosuccinate aka Docusate is a widely used stool softener. It is also known by brand names Colace or Ex-Lax. The drug has emulsifying/surfactant properties, allowing it to break up fats. It also works by inhibiting absorption and increasing secretion in the small intestine. It is prescribed to treat acute constipation. I have seen this as a standard order for all recently delivered maternity patients. It is also given to patients receiving opioids, as constipation is a side effect. When taken in oral form, it may take 1-3 days to see results as opposed to the suppository or enema forms which may take 5-20 minutes. Side effects include diarrhea or stomach cramps, and rarely rectal bleeding.
Alternatively, the drug is used as a pesticide and to irrigate earwax.
In the movie Girl, Interrupted Brittany Murphy’s character has an eating disorder and trades her meds with other patients for Colace in order to increase her intestine motility.
