Today we're going to talk about adverse effects,
contraindication, side effects,
and interactions of pharmacological meds again.
So, we've talked about what are
expected. Now, we're talking about all of the
things that are either expected but
aren't good or unexpected. My name is Diana Shenefield.
Let's get started.
Again, why do we need to know this? Because
on NCLEX, you need to know your
medications, not only why they're given,
but you need to be prepared for side
effects, adverse effects, and any other
contraindications that might be going on
with the patient. One, so that I can be
watching forward as the nurse, but two, so
that the patient can be educated on what to
watch for at home. Look at your learning outcomes.
Make sure that you understand each one of
the outcomes and make sure that you're
prepared educationally to answer any questions
that deal with those outcomes.
If you have questions, make sure you'd go
back to your pharmacology book, and make
sure you'd go to your NCLEX review books.
So, we're going to start with a question to
get you thinking. A patient is admitted for
pulmonary embolism, receives heparin
1500 units per hour IV. In case of a serious
bleeding reaction, what are you
going to give? You need to know antidotes.
You need to know antidotes of all your
medications, especially the ones that can
be life-threatening. And we know bleeding
from heparin can be life threatening. So,
what are you going to give? Are you going to give
vitamin K? Are you going to give protamine
sulfate? Are you going to give promethazine?
Or are you going to give protamine? So think
back to your heparin and what is the antidote?
And hopefully, you picked protamine sulfate.
Again, if you can't remember, go
back and review that because it's very
important to know. Second question, we've got
a 14-year-old prescribed amphetamine,
again, a combination, Adderall.
How many kids do you know that are on
amphetamine kind of medications for ADHD?
What does a nurse need to watch for? What
is the adverse effect? Is it weight
gain? Is it depression? Is it somnolence?
Or is it bradycardia? Again, it's really important. You're
going to have a lot of
patients that are going to come in for
other reasons but are on ADHD meds.
And so, what do you need to watch for? And the
answer to this question is somnolence.
If you've got a child that's on that
medication, it seems very sleepy and
doesn't respond, or just wants to sit
and talk to nobody. We need to be concerned
about that. So let's dive into what is the review
of unintended responses.
We know there's lots of things to be
watching for. And so let's review some of
our terminologies. Side effects.
Lot of people get side effects and adverse
drug reactions mixed up. But as a
nurse, you need to know what those are.
A side effect is unavoidable
secondary things that happen. When you
take a medication, unfortunately, it
doesn't just go to the part of the body
that needs to be fixed. It affects the
whole body. The things that happen
because of that are side effects.
Some side effects can be very mild. Some side
effects can be more severe. But again,
it's something that happens because the
body is going systemically.
Adverse effects, we need to watch for those,
whether it's toxic, and toxicity means
that they have too much of the drug. Allergic
reaction. Are they developing
anaphylaxis? Or is it just kind of a weird
effect that happens just because
of their genetic makeup? Again,
side effects are things that happen just
because the medicine is going
systemic. Adverse effects are things that
are happening that we didn't plan on.
And then you have iatrogenic, which are medications
that cause disease. One thing
we think of is diseases that are caused
from medications that cause birth
defects. That would fall underneath that,
or teratogenic. Again, if it causes a
birth defect or it causes another kind
of effect to happen, that is not
good at all. And then carcinogenic. We
usually think of chemotherapy drugs
may treat one kind of cancer, but in the
treatment, cause another kind of cancer.
Again, these are all terminology that the
nurse needs to know and that you need to
understand so when you're talking to
your patient about the side effects or
the adverse effects,
that you can speak intelligently and be able
to watch for the different effects,
and what to warn them about, and maybe what
to just keep an eye on. So, side
Again, they're unavoidable. Some of the
common side effects are things like
nausea, vomiting, maybe dizziness, things
that once they've been on the medication
for a while will probably go away. Those are
things that want the body get used
to getting that medication. You can adjust
to that. Or maybe it's just
something that the patient is going to
have to get used to. One of the things
that come to mind is your ACE inhibitors.
And if you remember, one of
the side effects for an ACE inhibitor is
that nagging dry cough. That would be a
side effect. Some patients can't tolerate
that, and we need to switch. But that's a
common side effect. We need to educate our patients.
Now sometimes, nurses will
say, "Oh, but if I tell patients everything that
could happen, they'll imagine it."
And that's not really true. So make sure that
you educate them on common side effects.
And then, they also need to know when do they
need to call the doctor. If they're
dizzy all the time after taking a medicine, it
may be a common side effect,
but you can't drive and you can't work when
you're dizzy. So you need to let
them know when do they need to notify the
physician, just because it's an explained
side effect or an expected side effect,
when do they need to call the physician.
Unintended responses. Now, we're talking
about adverse effects. We're going to
start with CNS kind of problems. You know,
if your CNS is over-stimulated or under
stimulated, can cause seizures. We know a
lot of depression medications. One of the
side effects or the adverse things that
happen if some people feel like
they need to commit suicide, they would
need to make sure that the
physician knew about that. If it's a
medication that could cause seizures,
even though we kind of know that in the
back of our mind, seizures are a serious
adverse effect, so we'd want to
be prepared for that.
EPS. Hopefully, you remember what that
is, extrapyramidal symptoms.
That's when you get those tremors. If you
got a patient that develops that, one of the
medications that comes to mind and
should come to your mind is raglan.
If they're on that, again, that can cause a
lot of problems, the tremors, you know if
they have a job, that will affect
their job or just self-esteem.
What about anticholinergic effects? Things like
falls. Falls are a big thing. We don't want our
patients falling. We need to watch for
them. Or vision changes. If they're
having blurred vision, we want to make
sure that we know that before we send
them out driving or if they work somewhere
where that's going to be
detrimental. Cardiovascular changes. Again,
you give a patient a medication. If it
drops their blood pressure, we worry about falls.
Those are all things that we
need to make sure that we're keeping in mind,
especially for our beta blockers and
our ACE inhibitors, the first time they take a
dose. Those are adverse effects
that don't happen to everybody. But if they
do, we need to know about those.
And then GI problems. People always think
about nausea and vomiting, but don't forget a
lot of the antibiotics cause diarrhea. And so if
you have a patient that's
maybe emaciated or malnourished, you're
going to want to know if they're having
severe diarrhea. So make sure you review that.
And then you got hematological.
Blood. A lot of the medications will cause
a decrease in blood cells. And so
we need to be watching our labs. Hepatic system.
Because of that first past effect
that we talked about, if their liver is
compromised either from cirrhosis or
hepatitis or just age, we want to make sure
that we know that there's going to
be a build up of drugs. What about the
kidneys? We know that all of our
medications are excreted through the kidneys.
So, what do we need to watch for
in our patients with normal kidneys and our
patients that are already in kidney
failure? And then the skin. We're always
watching for rashes. We're always
watching for infection. So again, what do
I need to be thinking about with this
patient that could happen because of the
adverse effects of their medications?
So, toxicity. Some drugs should commonly
come to your mind on what are common
drugs that people get into little trouble
with by taking too many,
acetaminophen right at the top. We know that
a daily dose of acetaminophen
is 4000 grams.
We need to teach our patients that anything
over that causes toxicity to
the liver. It's not the Tylenol itself,
it's the too much Tylenol that causes
the problem. What about digoxin? You need
to review to make sure that you remember
what a digitoxic patient looks like. And
one of the easy ones to remember is
the halo. Do they see the halo when they
look into the lights?
Do they have nausea? Because dig has such a
small therapeutic response,
it's important that we don't have our patients become toxic.
NSAIDS and aspirin,
again, too much can cause a lot of GI bleeding.
So make sure you're reviewing
that and you're looking through your drugs and
seeing which ones become toxic the
easiest. And then allergic reactions. Sometimes,
people are just allergic to
medications. But just remember, if they've only
had the dose one time, they can
still have a reaction the second time. So, if you
have drugs like penicillins or sulfa
drugs that are more commonly causing problems
with allergic reactions,
make sure you're staying with your patient.
But know what those are and know
how do I spot if somebody is having an allergic reaction.
You know, if they start complaining
of their lips tingling, if they start complaining
like it feels like their
tongue is swelling, that should send up red flags.
And remember, what's the first
thing you do? You stop the medication and
then you assess your patient.
You know, do they have a runny nose? Do they have sneezing?
Are their eyes watering? All those
things you need to be watching for because
maybe it's not a full-blown
anaphylactic shock. But any kind of allergic
reaction should send up red
flags that maybe the next dose could be
anaphylactic shock. Looking for skin, you know,
hives. Are they itching? Do they have
blistering? Are they weeping? Do they
have wheezing? Again, if you can hear them
breathing when you come into the room
wheezing, you need to stop the medication.
And then, pain, nausea, diarrhea. We need to
evaluate, is this an allergic reaction or is
this a side effect of the medication?
So again, doing a good thorough assessment
and making sure that you know whether
it's an allergic reaction or not before you give
that next dose. Carcinogenic. We can't always
know which drugs are going to cause cancer
or which drugs cause birth
defects. But you want to make sure that you're
looking in your drug book and
know that each drug is categorized
for birth defects.
Again, they're never going to ask you what the
level is of a certain drug, but
you need to understand that there are drugs
out there and how you would know.
So make sure you review your drug book for that.
So not only do I need to understand
as a nurse and you need to understand as a nurse
what the benefits and the
detriments are to medications. We need to make sure
we're telling our patients for
them to make informed decisions about what's
going to happen to them,
what's going to happen to their unborn children.
They need to have all the information.
And sometimes, it can be kind of scary talking
about secondary cancers or birth
defects. But again, my job as a nurse and your
job as a nurse is to make sure that
your patient understands the pros and cons
of that medication. Not all
medications are detrimental to the point of
causing birth defects or causing
cancer, but as a nurse, I need to know
which ones are, and I know that by
reading in my drug book. Chemotherapy, again,
causing cancer. We know that a lot
of chemotherapeutic drugs cause secondary cancers.
Why? Because it goes to stomach, and
it can't just target the cancer cells. It targets
other cells. So again, before your
patient starts chemotherapeutic meds, you need
to make sure that they know the
consequences, that they know what the outcomes could be.
And then, drug and food
interactions. The big one that should come to
your mind is Coumadin, Warfarin.
Can't be taken with green leafy vegetables,
a lot of the medicines you
can't take with grapefruit juice. If there
are certain medications that point
out in the drug book of what they can and
can't be eaten or drink with, you
need to make sure that you make note
of those because those are
easy questions on NCLEX to make sure that you
catch that. Drug interactions. We know
we've studied polypharmacy. We know
there is a lot of people out there that
are on a lot of different meds.
When you're taking a lot of different
medications, they have to interact one
way or another. So, which ones are big
no no's to put together? Again, you'll
know that from your drug book. And the
incompatibilities. When we think about
incompatibilities, usually, we think about IV
medications. You need to make sure you know
which IV medications can't be mixed.
And what's the danger there? Crystallization.
We don't want crystals
going into the bloodstream. So again, there
are some drugs that are common
drugs that can't be mixed. So make sure you're
looking in your drug book for that.
Okay. So we talked a little bit about grapefruit
juice. You want to make sure
you know that. We talked a little bit about
Coumadin and vitamin K. But don't
forget your tyramines, your cheeses that
go with MAOIs. So again, you
want to review your drug book and review
the drugs that very commonly say,
don't take it with this food or take it
with that drink. Again, it's not all of
them, but certain ones, I know that you've
learned in nursing school and you need
to make sure you keep those in mind.
Again, combination drugs. You know,
you can't give a drug that's going to raise
a blood pressure and a drug that's
going to lower a blood pressure at the same
time. That's an easy one to figure
out, but just remember that you're watching
the medications that you're
giving. And you need to have enough of an
understanding to know are they
going to contradict each other. And then,
don't forget your over-the-counter
medicines. Don't forget your herbal remedies.
Again, many patients don't think
that if you can buy it at the local grocery
store that it's a medication.
And we need to do good education to make sure
that they are telling us what
they're on and that they are medications and
that they can contraindicate with other
the medications that they're already on.
So make sure you're checking on that
Again, make sure what you can mix into syringes
and IVs, very very important.
Review your body systems.
Again, patients with liver and kidney
lot of the side effects and adverse reactions
are going to be multiplied if
their liver isn't
working right in metabolism and their kidneys
can't excrete. So, you need to make
sure you know the history of your patient
and you need to make sure you're
looking at your liver labs and your kidney
labs to see if they're going to
be able to clear these medicines out, because
again, especially drugs that cause
toxicity, if they can't clear it out of their
body, the toxicity level is going to go
up a lot faster. And I as a nurse and you as
a nurse, we need to keep that in mind
so that we're watching for those side effects.
Looking at some of your drugs, you'll notice
that some of them aren't approved
for pediatric patients, and it's because of
their livers and their kidneys.
Other drugs you need to really watch in your
older client. Again, just because of the
normal aging process, the liver and the kidneys
don't function like they did before.
So make sure you're watching for these
adverse effects in the little ones
and in the older patients as well. So, we
talked about a lot, a lot of review. And a
lot of times, students, I know, my
students as well,
think that there's no way that they can
know every drug in the drug book.
Remember, NCLEX doesn't expect you to
know every drug in the drug book.
What they're looking for is, are you safe
in giving your drugs? And the way that
you're safe is, is that you understand
how drugs are given, and you understand
side effects and adverse reaction so that
you can watch for those in your
patient and you can either prevent them
or you can catch them in time that it
doesn't cause injury to your patient.
So make sure you're reading your
pharmacology book and good luck on NCLEX.
I'm Diana Shenefield. See you later.