Assess the 6 rights of medication administration:
- Right medication
- Right dose
- Right client
- Right route
- Right time
- Right documentation
Medication Administration: techniques of administration:
- Assess the medication prescription
- Compare the client’s medication prescription with all medications that the client was previously taking (medication reconciliation)
- Ask the client about a history of allergies
- Assess the client’s current condition and the purpose for the medication or intravenous solution
- Determine the client’s understanding of the purpose of the prescribed medication and about self administration at home
- Identify and address concerns (social, cultural, religious) that the client may have about taking the medication
- Assess the need for conversion when preparing a dose of medication for administration to the client
- Assess the 6 rights of medication administration
Magnesium Sulfate: Antidote
Calcium Gluconate
Cholinergic Medications (Myesthenic Bradycardia): Antidote
•Atropine
Methotrexate: Antidote
Leucorvorin
Generic Name: Acetaminophen (Tylenol): Medication category, purpose, side effects, and nursing considerations
Generic Name: Acetaminophen (Tylenol):
Medication Category: Analgesics, Nonopioid Analgesics
Purpose:
- Treatment of mild pain or fever
Side Effects: - Anemia
- Liver and kidney failure
- Dyspnea
- Angioedema
- Hives, itching
Nursing Considerations: - PO: onset less than 1 hour, peak 30 minutes to 2 hours, duration 4-6 hours
- Rectal: onset slow, peak 1-2 hours, duration 3-4 hours
- Take crushed or whole with full glass of water
- Can give with foods or milk to decrease GI upset
- Signs of chronic poisoning: rapid, weak pulse; dyspnea, cold, clammy extremeties
- Signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat, anorexia, jaundice
- OTC
Generic Name: Codeine: Medication category, purpose, side effects, and nursing considerations
Generic Name: Codeine
Medication Category: Analgesics, Opioid Analgesics
Purpose: Treatment of moderate to severe pain, nonproductive cough
Side Effects:
- Drowsiness, sedation
- Nausea, vomiting, anorexia
- Respiratory depression
- Constipation
- Orthostatic hypotension
- Dysuria
- Hives
- Dyspnea
- Syncope
- Angiodema
- Seizures
Nursing Considerations: - PO: onset 30-45 minutes, peak 60-120 minutes, duration 4-6 hours
- IM/SubQ: onset 10-30 minutesm, peak 30-60 minutes, duration 4-6 hours
- Do not give if respirations are less than 12 per minute
- Avoid use with alcohol, CNS depressants
- Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
- Physical dependency may result from long-term use
- Rx-C II, III, IV, V (depends on route)
Generic Name: Diclofenac (Voltaren): Medication category, purpose, side effects, and nursing considerations
Generic Name: Diclofenac (Voltaren)
Medication Category: Musculoskeletal Medications, Nonsalicylate NSAIDS, Antirheumatics
Purpose: Used in arthritic conditions, dysmenorrhea
Side Effects:
- Dizziness
- Blood dycrasias
- Headache
- Nephrotoxicity
- Hypersensitivity
- GI distress, bleeding, or ulcer
- Rash
Nursing Considerations - Used in arthritic conditions, dysmenorrhea
- Opthalmic: reduce inflammation after cataract extraction
- PO: take with full glass of water and food and remain upright for 30 minutes
- If dose missed, take within 2 hours
- Use sunscreen to prevent photosensitivity
- May increase risk of cardiovascular thrombotic events
- Possible cross-allergy with aspirin and other NSAIDS
- May increase risk of elevated liver tests
- Rx
Digoxin’s Therapeutic Range:
0.5-2 mg
Generic Name: Digoxin (Lanoxin): Medication category, purpose, side effects, and nursing considerations
Generic Name: Digoxin (Lanoxin)
Medication Category: Cardiovascular Medications, Digitalis Glycosides
Purpose: Used in treatment of CHF; atrial fibrillation/flutter, or tachycardia
- Increases the contractility of cardiac muscle
- Slows heart rate and conduction
Side Effects: - Headache
- Hypotension
- Fatigue
- Bradycardia
- Nausea
- Dizziness
- Mental disturbances
- Vomiting
Nursing Considerations: - Check pulse, if less than 60 beats per minute, hold the med and contact the clinician
- PO: with our without food; may crush tablets and mix with food/fluids
- Do not open, chew, or crush capsule
- Contact clinician if loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression
- Eat a sodium-restricted and potassium rich (bananas, orange juice) diet to keep potassium level normal
- Avoid OTC meds and herbal meds; many adverse reactions can occur
- Rx
Generic Name: Heparin: Medication category, purpose, side effects, and nursing considerations
Generic Name: Heparin
Medication Category: Anticoagulants
Purpose: Prophylaxis and treatment of thromboembolic disorders in very low doses (10-100 units) to maintain patency of IV catheters (heparin flush)
Side Effects:
- Hemorrhage from any body site
- Tissue irritation/pain at injection site
- Anemia
- Thrombocytopenia
- Fever
Nursing Considerations: - Therapeutic PTT @1.5-2.5 times the control without signs of hemorrhage
- IV: peak 5 minutes, duration 2-6 hours (give over 1 minute)
- Injection: give deep subQ; never IM (danger of hematoma), onset 20-60 minutes, duration 8-12 hours
- Antidote: protamine sulfate within 30 minutes
- Signs of hemorrhage: bleeding gums, epistaxis (nose bleed), unusual bleeding, black or tarry stools, hematuria, fall in hematocrit or blood pressure, guaic positive stools
- Avoid ASA-containing products and NSAIDS
- Wear medical information tag
- Abrupt withdrawal may precipitate increased coagulability
- Rx
Generic Name: Lisinopril (Prinvil, Zestril): Medication category, purpose, side effects, and nursing considerations
Generic Name: Lisinopril (Prinivil, Zestril)
Medication Category: Cardiovascular Medications, ACE Inhibitors
Purpose: Treatment of mild to moderate hypertension, systolic CHF, acute MI
Side Effects:
- Headache
- Dizziness
- Nausea, vomiting, diarrhea
- Hypotension
- Tachycardia
- Fatigue
- SIADH
- Cough
Nursing Considerations: - Avoid changing positions (lying/sitting/standing) rapidly
- May take without regard to food
- Avoid high-sodium foods (canned soups, lunch meats, cheese)
- Avoid high-potassium foods (bananas, citrus fruits, raisins)
- Rx
Signs of Digitalis toxicity:
- Bradycardia
- Tachycardia
- Dysrhythmias
- Nausea
- Vomiting
- Headache
Generic Name: Omeprazole (Prilosec): Medication category, purpose, side effects, and nursing considerations
Generic Name: Omeprazole (Prilosec)
Medication Category: Gastrointestinal Medications, Antisecretory
Purpose: Treatment of active duodenal ulcers
Side Effects:
- Headache
- Nausea
- Vomiting
- Diarrhea
- Flatulence
Nursing Considerations: - Treatment of active duodenal ulcers
- Treatment of GERD in patients over age 2 years
- Take 30 minutes before eating
- May be taken at the same time as antacids
- OTC, Rx
Generic Name: Phenytoin (Dilantin): Medication category, purpose, side effects, and nursing considerations
- Phenytoin
- Generic Name: Dilantin
- Medication Category: Anticonvulsants
- Purpose: Management of seizures, migraines, trigeminal neuralgia, Bell’s palsy
- Side Effects:
- Drowsiness, ataxia
- Nystagmus
- Blurred vision
- Hirsutism
- Lethargy
- Nursing Considerations:
- PO: take divided doses, with or immediately after meals, to decrease adverse effects
- May color urine and sweat pink/red/brown
- May cause increase in blood sugar
- IV administration may lead to cardiac arrest-have resuscitation equipment available, never mix IV with ant other drug or dextrose
- Avoid abrupt withdrawal to prevent convulsions
- Do not use antacids or antidiarrheals within 2 hours of med
- Use caution with hazardous activities until stabilized
- Folic acid supplements are indicated for long term use
- Wear medical information tag
- Rx
Generic Name: Propanolol (Inderal): Medication category, purpose, side effects, and nursing considerations
- Propanol
- Generic Name: Inderal
- Medication Category: Cardiovascular Medications: Beta Blockers
- Purpose: Used in the treatment of stable angina, hypertension, dysrhythmias, migraine, prophylaxis MI, essential tremor, alcohol withdrawal, atrial fibrilation
- Side Effects:
- Weakness
- Hypotension
- Bronchospasm
- Bradycardia
- Depression
- Nursing Considerations:
- Teach patient how to take radial pulse
- Check pulse, if less than 50 beats per minute, hold the med and contact clinician
- PO: take with full glass of water at the same time each day
- Do not open, chew, crush, extended-release capsule
- Do not stop abruptly; taper over 2 weeks; may precipitate life threatening arythmias
- Do not use aluminum-containing antacid; may decrease absorption
- May cause cardiac failure
- May cause hypoglycemia in diabetics
- May mask hyperthyroidism
- Rx
Generic Name: Spironolactone (Aldactone): Medication category, purpose, side effects, and nursing considerations
- Spironolactone
Generic Name: Aldactone
Medication Category: Cardiovascular Medications: Potassium Sparing/Combination Diuretics
Purpose: Used in treatment of edema and hypertension, primary hyperaldosteronism
Side Effects: - Hyperkalemia
- Hyponatremia
- Vomiting, Diarrhea
- Bleeding
- Rash, pruritus
- Gynecomastia
Nursing Considerations: - Diuresis onset 24-48 hours, peak 48-72 hours
- Take in the morning to avoid interference with sleep
- Take with meals or just after to decrease gastric symptoms
- Avoid foods high in potassium: oranges, bananas, salt substitutes, dried apricots, dates
- Weigh daily to determine fluid loss; effect of drug may be decreased if used daily
- Contact clinician if cramps, lethargy, menstrual abnormalites, deepening voice, breast enlargement
- Avoid potassium supplements
- Monitor electrolytes
- Rx
Generic Name: Tamoxifen: Medication category, purpose, side effects, and nursing considerations
- Tamoxifen
- Medication Category: Antineoplastics
- Purpose: Management of advanced breast cancer not responsive to other therapy in estrogen-receptor positive patients
- Side Effects:
- Nursing Considerations:
- Peak 4-7 hours
- To decrease GI upset, take after antacid, after evening meal, before bedtime, or take antiemetic 30-60 minutes ahead
- Vaginal bleeding, pruritus, hot flashes are reversible after stopping med
- Contact clinician if decreased visual acuity, which may be irreversible
- Tumor flare (increase in tumor size and increased bone pain) may occur, but will decrease rapidly; may take analgesics for pain
- RX
Generic Name: Vancomycin (Vancocin): Medication category, purpose, side effects, and nursing considerations
- Vancomycin
- Generic Name: Vancocin
- Medication Category: Anti-infectives
- Purpose: Treatment of resistant staph infections, colitis, staph enterocolitis, endocartitis prophylaxis for dental procedures (used for c.difficile)
- Side Effects:
- Liver damage
- Nephrotoxicity
- Tinnitus or hearing loss
- Nursing Considerations:
- Treatment of resistant staph infection, colitis, staph enterocolitis, endocarditis prophylaxis for dental procedures (used for C.deficile)
- PO: poor absorption
- IV: peak 5 minutes, duration 12-24 hours
- Give atleast 60 minutes (IV); do not infuse with other drugs
- Give antihistamine if “red man syndrome”: decreased blood pressure, flushing of face and neck
- Contact clinician if signs of superinfection: sore throat, fever, fatigue
- Rx
Generic Name: Warfarin (Coumadin): Medication category, purpose, side effects, and nursing considerations
- Warfarin
- Generic Name: Coumadin
- Medication Category: Anticoagulants
- Purpose: Management of pulmonary emboli, deep vein thrombosis, MI, atrial dysrhythmias, postcardiac valve replacement
- Side Effects:
- Hemmorhage
- Diarrhea
- Rash
- Fever
- Angina Syndrome
- Nursing Considerations:
- Therapeutic PT @ 1.5-2.5 times the control, INR @ 2.0-3.0
- Onset: 12-24 hours, peak 1.5 to 2.5 times the control, INR @ 2.0-3.0
- Avoid foods high in vitamin K, many green leafy vegetables
- Do not interchange brands; potencies may not be equivalent
- Do not take any drug or herb without physician approval-may change affect
- Avoid ASA-containing products and NSAIDS
- Oral anticoagulants may cause red-orange discoloaration of alkaline urine, interfere with some lab tests
- Wear medical information tag
- RX
Generic Name: Ranitidine (Zantac): Medication category, purpose, side effects, and nursing considerations
- Ranitidine
- Generic Name: Zantac
- Medication Category: Gastrointestinal Medications: Antiulcer medications
- Purpose: Used to inhibit gastric acid secretion, ulcers (GI)
- Side Effects:
- Dizziness (esp in elderly)
- Drowsiness
- Headache
- Nursing Considerations:
- Used to inhibit gastric acid secretion, ulcers (GI)
- Take with or immediately following meals
- Do not take antacids within 1 hour before or after
- Do not smoke; it interferes with healing and drug’s effectiveness
- Avoid alcohol, ASA, and caffeine, which increase stomach acid
- False positive tests for urine protein may occur
- OTC, Rx
Generic Name: Risedronate (Actonel): Medication category, purpose, side effects, and nursing considerations
- Risedronate
- Generic Name: Actonel
- Medication Category: Bone Absorption inhibitors: Hormones/Synthetic Substitutes/Modifiers
- Purpose: Prevention and treatment of osteoperosis in women; treatment of osteoperosis in men; treatment of Paget disease
- Side Effects:
- Weakness
- Diarrhea, abdominal pain
- Bone Pain
- Back pain
- Joint pain
- Nursing Considerations:
- Onset: within days, peak 30 days, duration up to 16 months
- Take in A.M. before food or other meds with full glass of water; remain upright for 30 minutes
- Take with calcium and vitamin D if instructed by clinician
- May cause aytipical subtrochanteric femur fractures
- RX
Commonalities in Medication Classification Names: Androgens: Most names end with -terone (e.g., testosterone).
Androgens
Most names end with -pril (e.g., enalapril).
Angiotensin-converting enzyme (ACE) inhibitors
Most names end in -pressin (e.g., desmopressin).
Antidiuretic hormones:
Many end with -statin (e.g., atorvastatin).
Antilipemic medications:
Most contain vir (e.g., acyclovir).
•Antiviral medications
Although this class includes medications such as alprazolam and chlordiazepoxide, most names such as diazepam end in -pam. (Another tip for identifying a benzodiazepine: The name includes a vowel-z-vowel combination.)
•Benzodiazepines
Most names end with -lol (e.g., atenolol).
•Beta-adrenergic blockers:
Most names end in -pine (e.g., amiodipine); exceptions include diltiazem and verapamil.
•Calcium channel blockers
Most names end in -mide (e.g., dorzolamide). These medications are used to treat glaucoma.
•Carbonic anhydrase inhibitors:
Most names contain -est (e.g., estradiol or conjugated estrogen).
•Estrogens:
Most names end in -sone (e.g., prednisone
- Glucocorticoids and corticosteroids
Histamine H2 receptor antagonists
Most names end in -dine (e.g., cimetidine).
Most names contain nitr (e.g., nitroglycerin).
•Nitrates
Most names contain pancre (e.g., pancrealipase).
•Pancreatic enzyme replacements
Most names end in -zole (e.g., lansoprazole).
•Proton pump inhibitors
Most names include sulf (e.g., sulfasalazine).
•Sulfonamides
Most names end in -ide (e.g., glipizide). These medications are used to treat diabetes mellitus.
- Sulfonylureas
Most names end in -zide (e.g., hydrochlorothiazide).
•Thiazide diuretics
Most names include -ase (e.g., alteplase).
- Thrombolytics:
Most names contain thy (e.g., levothyroxine).
- Thyroid hormones
Most names end in -line (e.g., theophylline).
•Xanthine bronchodilators
Lithium’s therapeutic index
0.6-1.2 MEQ/L
Signs of lithium toxicity
Nausea, vomiting, ataxia, and tremors
Atypical (second-generation) antipsychotic medications (eg, risperidone [Risperdal], quetiapine [Seroquel], olanzapine [Zyprexa]) are used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders. The nurse should teach clients and caregivers about potential side effects of antipsychotic medications. Key teaching points include:
-Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait)
-These specific symptoms are important to watch for, as EPS is easily mistaken for agitation or negative schizophrenic symptoms.
-Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention .
-Clients may experience anticholinergic effects (eg, dry mouth, constipation).
-Clients should change positions slowly to prevent orthostatic hypotension
-Sedating effects (eg, drowsiness, hypersomnia [excessive sleeping]) are common.
-Symptoms are evaluated on an individual basis, and most minor symptoms can be managed with a decrease in dosage or change in medication. The health care provider may prescribe medications to treat EPS (eg, benzodiazepines, diphenhydramine
Generic Name: Magnesium Sulfate: Medication category, purpose, side effects, and nursing considerations
Generic Name: Magnesium Sulfate
Medication category:
-CNS depressant
Purpose:
-Stopping preterm labor to prevent pre term birth.
-Preventing and controlling seizures in preeclamptic and eclamptic clients.
Side effects:
-Maternal: Depressed respirations, depressed DTRs. hypotension, extreme muscle weakness, flushing, decreased urine output, pulmonary edema, serum magnesium levels > 7.5 mEq/L
-Newborn: Hypotonia and sleepiness
Nursing considerations:
-Magnesium sulfate can cause respiratory depression, depressed reflexes, flushing, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.
-Continuous IV infusion increases the risk of magnesium toxicity in the newborn
-IV administration should not be used for 2 hours preceding birth.
-Magnesium sulfate may be prescribed for the first 12 to 24 hours postpartum if it is used for preeclampsia
-High doses can cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest.
-The medication is contraindicated in clients with heart block, myocardial damage, or kidney failure
-The medication is used with caution in clients with kidney impairment
Generic Name: Nifedipine, Medication category, purpose, side effects, and nursing considerations
Generic Name: Nifedipine
Medication category:
-Calcium Channel Blocker
Purpose:
-Relaxes smooth muscles, including the uterus, by blocking calcium entry; in some healthcare agencies, this may be the first-line agent to halt preterm labor contractions
Side effects:
-Maternal: Tachycardia, hypotension, dizziness, headache, nervousness, facial flushing, fatigue, nausea
-Newborn: Hypotension
Nursing considerations:
-Follow agency protocol for administration
-Use with magnesium sulfate is avoided because severe hypotension can occur
-Monitor for adverse effects
Generic Name: Betamethasone and Dexamethasone: Medication category, purpose, side effects, and nursing considerations
Generic Name: Betamethasone & Dexamethasone
Medication category:
-Corticosteroids
Purpose:
-Corticosteroids that increase the production of surfactant to accelerate fetal lung maturity and reduce the incidence or severity of respiratory distress syndrome
-For a client in preterm labor between 28 and 32 weeks gestation whose labor can be inhibited for 48 hours without jeopardizing the mother or fetus
Side effects:
-May decrease the mother’s resistance to infection
-Pulmonary edema secondary to sodium and fluid retention can occur.
-Elevated blood glucose levels can occur in a client with diabetes mellitus
Nursing considerations:
-Monitor maternal vital signs and lung sounds, and for edema
-Monitor mother for signs of infection
-Monitor white blood cell count
-Monitor blood glucose levels
-Administer by deep intramuscular injection
Generic Name: Hydromorphone hydrochloride and Meperidine hydrochloride, Fentanyl and Sufentanil, & Butorphanol tartrate and Nalbuphine, Medication category: Opioid Analgesics, purpose, side effects, and nursing considerations
Generic Name (s):
-Hydromorphone hydrochloride and Meperidine hydrochloride, Fentanyl and Sufentanil, & Butorphanol tartrate and Nalbuphine,
Medication category:
-Opioid Analgesics
Purpose:
-Used to relieve moderate to severe pain associated with labor
Side effects:
-Regular use of opioids during pregnancy may produce withdrawal symptoms in the newborn (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures
Nursing Considerations:
-Monitor vital signs, particularly respiratory status; if respirations are 12 breaths/minute or less, withhold the medication and contact the HCP.
-Monitor the fetal heart rate and characteristics of uterine contractions
-Monitor for blood pressure changes (hypotension); maintain the client in recumbent position (elevate the hip with a wedge pillow or other device).
-Record the level of pain relief
-Monitor the bladder for distension and retention
-Have the antidote naloxone readily accessible, especially if delivery is expected to occur during peak medication absorption time.
Generic Name: Misoprostol & Dinoprostone Medication category, purpose, side effects, and nursing considerations
Generic Name: Misoprostol & Dinoprostone
Medication category:
-Prostoglandins
Purpose:
-Preinduction cervical ripening (ripening of the cervix before the induction of labor when the bishop score is <4 -Induction of labor -Induction of abortion (abortifacient agent) Side effects: -GI effects, including diarrhea, nausea, vomiting, and stomach cramps -Fever, chills, flushing, headache, and hypotension -Uterine tachysystole (>12 uterine contractions in 20 minutes without an alteration in the fetal heart rate pattern
-Hyperstimulation of the uterus
-Fetal passage of Meconium
Nursing considerations:
-Monitor maternal vital signs, fetal heart rate pattern, adverse effects, and status of pregnancy, including indications for cervical ripening or induction of labor, and the Bishop score.
-Have the client void before administration of medication and then have her maintain a supine with lateral tilt or side-lying position for 30 to 60 minutes (gel) up to 2 hours (insert) after administration
-Treatment is discontinued when the Bishop score is 8 or more (cervix ripens) or an effective contraction pattern is established (3 or more contractions in a 10-minute period); in addition, signs of adverse effects indicate that treatment needs to be discontinued
-Follow agency protocol for the induction of labor if cervical ripening has occured and labor has not begun; oxytocin can be initiated if needed 6-12 hours after discontinuation of prostaglandin therapy
Generic Name: Oxytocin Medication category, purpose, side effects, and nursing considerations
Generic Name: Oxytocin
Medication category:
-Oxytocics (Uterine Stimulants)
Purpose:
-Induces or augments labor
-Controls postpartum bleeding
-Manages an incomplete abortion
Side effects:
-Allergies
-Dysrythymias
-Changes in BP
-Uterine Rupture
-Water Intoxication
Nursing considerations:
-Monitor Maternal VS/15 minutes
-Monitor frequency, duration, and force of contractions and resting uterine tone/15 min
-Monitor Fetal HR /15 min
-Administered most commonly by IV Infusion via an infusion monitoring device
-Carefully monitor the dose being administered; do not leave the client unattended while the oxytocin is infusing
Generic Name: Methylergonovine maleate Medication category, purpose, side effects, and nursing considerations
Generic Name: Methylergonovine maleate
Medication category: Ergot Alkaloid
Purpose:
-Post-partum hemorrhage
-Post-abortal hemorrhage resulting from atony or involution
Side effects:
-Nausea
-Uterine Cramping
-Bradycardia
-Dysrhythymias
-Myocardial infarction
-Severe hypertension
Nursing considerations:
-Monitor maternal VS
-Monitor BP closesly; the medication causes vasoconstriction which causes an increase in BP, if noted withold the med and notify the HCP
-Monitor uterine contractions (frequency, strength, and duration)
-Assess for chest pain, h/a, SOB, itching, pale or cold hands or feet, nausea, diarrhea, and dizziness
-Assess the extremeties for color, warm, movement or pain
-Assess vaginal bleeding
-Notify HCP–Chest pain or other adverse effects
-Administer analgesics as prescribed; they may be required because the medication produces painful uterine contractions.
Medications Used to Manage Post-partum Hemorrhage:
-Methylergonovine
-Oxytocin
-Prostaglandine: Carboprost tromethamine
What is the indication for metoclopramide/reglan?
Prevention of chemotherapy-induced emesis and diabetic gastroparesis
Side effects of metoclopramide/reglan
Drowsiness, EPS such as tremors
Notify MD if what occurs when using metoclopramide/reglan
Tremors
What is the indication xenical (orlistat, Alli)
For PTs with BMI of 30+; LT weight control
SE of xenical (orlistat or alli)
Oily stool and flatulence
Nursing implications for a pt on xenical (orlistat or alli)
Ask pt to describe dietary intake since SE are increased if greater than 30% of fat is in diet.
What can decrease side effects of xenical (orlistat or alli)
Fiber laxatives like Metamucil help decrease SE by binding to the fat.
Which type of fluids need plenty of water?
Bulk forming laxatives
Why do you need plenty of fluids when taking bulk forming laxatives
Because they can produce esophageal and or intestinal obstruction
Laxative use assessment
Last BM and characteristics, abdominal pain, fever and obstruction. Assess dietary and fluid intake.
With laxative use the nurse should
Encourage fluids, fiber and exercise as tolerated/indicated
Laxative use and result in
Lack of bowel tone which can lead to dependency
what is ondansetron (zofran)
antiemetic
What is ondansetron (zofran)used for?
Prevention of N/V associated with chemotherapy and radiation therapy.
Who should you use caution with when giving ondansetron/zofran?
PTs with liver failure
Drugs for ulcerative colitis and crohns
5 aminosalicylates; mesalamie, sulfasalazine.
How do 5 aminosalicylates; (mesalamie, sulfasalazine) work?
They decrease GI inflammation
Side effects of 5 aminosalicylates; (mesalamie, sulfasalazine)
Nausea, rash, arthralgia, hematological disorders
Which drug can cause colitis/c.diff
Linezolid/zyvox
What kind of infection is c.diff
Suprainfection
What is azithromycin/zithromax?
An antibiotic
What does azithromycin/zithromax treat?
STDs such as: gonorrhea and chlamydia
How much azithromycin/zithromax is usually required?
One dose of 1g or 2g.
If a female pt has trichomonas (any STI) and is asymptomatic does the male need to be tested?
Yes!
azithromycin/zithromax can cause what?
Hepatotoxicity- elevated liver enzymes
What is nitrofurantoin/cipro used for?
An antibiotic for UTI
nitrofurantoin/cipro side effect
Hepatotoxicity, skin reactions, neuropathy
nitrofurantoin/cipro nursing considerations
Give with milk or meals check LFTs. Watch for numbness or tingling of extremities this can be an irreversible peripheral neuropathy
Drug of choice for treating c.diff?
Metronidazole/flagyl
When is metronidazole/flagyl to be taken?
With food and around the clock
What should be avoided when taking metronidazole/flagyl and why?
Alcohol; can cause a disulfiram-like reaction
aminoglycosides examples
gentamicin(garamycin), neomycin, tobramycin(nebcin)
how are aminoglycosides ,(-mycin, -micin), administered?
given IV for several days
what is an adverse effect of aminoglycosides (-mycin, -micin)
decreased hearing/ototoxicity and nephrotoxicity
what labs need to be evaluated when given aminoglycosides (-mycin, -micin)?
BUN and creatinine
DOC for MRSA
vancomycin
what is MRSA
severe staph infections that have become resistant to most antibiotics
implications for giving vancomycin
acute care requires frequent monitoring og serum drug level for dose adjustment. peak and trough schedule. trough is drawn just prior to next dose.
risks when using vancomycin
nephrotoxicity and ototoxicity
SE of vancomycin
thrombophlebitis, red man syndrome if infused too rapidly: flushing or rash of upper body, dyspnea, itching, hypotension- can be lethal
how long should IV vancomycin infuse?
greater than 60 minutes
what is trimethoprim/sulfamethoxazole?
it is a sulfonamide for treatment of UTI. combination increases efficacy and inhibits metabolism of folic acid at two different points
what is trimethoprim/sulfamethoxazole known for?
sulfa allergy
nursing implications for trimethoprim/sulfamethoxazole
assess for rash due to potential for stevens johnson syndrome
penicillins have a _ to _
cross-sensitivity; cephalosporins. they are structurally similar.
nursing considerations for penicillins
observe respiratory status for first 30 minutes when administering for the first time. watch for anaphylaxis if allergic to one or the other may have cross sensitivity
what can a nurse treat penicillin anaphylaxis with?
epinephrine
nursing considerations for antibiotics
do not take for viral illnesses. take entire prescription as ordered. don’t take if not needed as it can produce resistance.
what is ribavirin(copegus) indicated for?
antiviral for treatment of hepatitis C that has failed other treatment
ribavirin(copegus) SE
hemolytic anemia
what is ticarcillin/clavulanic acid (timentin)?
broad spectrum/extended spectrum penicillins
nursing considerations for ticarcillin/clavulanic acid (timentin)
do not administer in same infusion with aminoglycosides
what is the indicated use for rifampin?
antitubercular for treatment of TB
rifampin SE
turns: body fluids; tears, saliva, urine, soft contacts red/orange/brown. (ADVISE PT THIS IS NORMAL). Teratogenic- may decrease effectiveness of oral contraceptives; advise to use nonhormonal form of conception throughout therapy. Hepatotoxicity
what labs need to be monitored with rifampin?
LFTs
what is the indicated use for isoniazid (INH)
TB
what does isoniazid (INH) interact with?
foods containing tyramine; can produce life-threatening hypertensive crisis.
what should be used with isoniazid (INH)?
2nd form of birth control
flu vaccine SE
for anyone 6 months and older every season; soreness, redness and swelling at site of injections, low grade fever, aches.
what is the indicated use for fluconazole (diflucan)?
antifungal for vaginal candidiasis
what labs should be monitored with fluconazole (diflucan)?
many antifungals can cause liver injury monitor LFTs
what is antifunal terbinafine (lamisil) used to treat?
superficial dermatologic infections (athlete’s foot) and onychomycosis (nail fungus).
nursing considerations for terbinafine (lamisil)
avoid alcohol, monitor LFTs, report: nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools and jaundice
how do you know if an antibiotic is effective?
decrease in WBC, decrease in fever, better cultures, pt feels better
nursing considerations for antidepressants.
can cause addiction, pts experience withdrawal symptoms. ALWAYS GET MEDICATION HISTORY SINCE MANY DRUGS CAN INTERACT WITH ANTIDEPRESSANTS
what is the indicated use for benztropine/cogentin?
parkinson’s disease and treatment of extrapyramidal symptoms (EPS) AKA parkinsonism
what is benztropine/cogentin?
anticholinergic
SE of benztropine/cogentin
blurry vision, urinary retention
how does levodopa-carbidopa (sinemet) work?
stimulates dopamine production or increases sensitivity of dopamine receptors
what does levodopa-carbidopa (sinemet) treat?
parkinson’s
S/S of levodopa-carbidopa (sinemet) toxicity
involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of the tongue. NOTIFY PRESCRIBER.
what foods should a pt on levodopa-carbidopa (sinemet) avoid?
high protein meals! can impair effects!
what is lithium (lithobid, lithotabs) indicated for?
to treat pts with bipolar disorder.
what kind of therapeutic index does lithium have?
low/narrow; toxicity can occur at blood levels only slightly greater than therapeutic levels monitoring lithium is mandatory
lithium (lithobid, lithotabs) levels
below 1.5 mEq/L; anything greater causes toxicity
initial lithium therapy levels
0.8-1.4 mEq/L
maintenance lithium levels
0.5-1.5 mEq/L
when should lithium levels be drawn?
in the morning 12 hours after evening dose
how often during maintenance therapy should lithium levels be checked?
every 3-6 months
normal sodium level
136-145 mEq/L
how does an increased sodium level effect serum lithium levels?
increase in sodium causes increase in renal excretion which will lower serum lithium levels
early S/S of lithium toxicity
D/N/V, drowsiness, muscle weakness.
what happens with lithium toxicity?
life-threatening dysrhythmia, coma, convulsions, and death
nursing considerations for lithium
keep salt consistent in diet; no diuretic
haloperidol/haldol produces what?
severe extrapyramidal symptoms (EPS) or reactions including tardive dyskinesia
what are EPS
movement disorders resulting from effects of anypsychotic drugs on the extrapyramidal motor system.
what is the extrapyramidal system?
same neuronal network whose malfunction is responsible for movement disorders of parkinson’s disease.
early reaction of haloperidol(haldol).
acute dystonia, parkinsonism, akathisia/constantly moving/tapping the foot
late haloperidol(haldol) symptoms
tardive dyskinesia- the most troubling EPS
what is tardive dyskinesia characterized by?
involuntary choreoathetoid (twisting writing wormlike) movements of the tongue and face. pts may present lip-smacking movements and their tongues may flick out in a fly-catching motion.
earliest manifestation of TD
slow worm-like movement of the tongue
what may result with TD
malnutrition and weight loss; movements can interfere with chewing, swallowing and speaking
what may be used to treat EPS?
benztropine(cogentin) and diphenhydramine (benadryl)
selective serotonin reuptake inhibitors
prozac, zoloft, paxil
assessment when using selective serotonin reuptake inhibitors (prozac, zoloft, paxil)
neuromuscular and GI symptoms
selective serotonin reuptake inhibitors (prozac, zoloft, paxil) nursing considerations
may take 4-6 weeks to see therapeutic effects. take meds as prescribed. carefully monitor pt for self-harm or suicide. obtain list of all other meds
what is olanzapine/zyprexa? what is it used to treat?
antipsychotic medication that affects chemicals in the brain. it is used to treat symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression) in adults and children who are at least 13 years old. can be used with other antipsychotics or antidepressants
common side effects of zyprexa
asthenia, dizziness, drowsiness, extrapyramidal reactions, hyperkinesia, akinesia, cogwheel rigidity, drug-induced parkinson’s disease, dyspepsia, mask-like face, xerostomia, abnormal gait, back pain, constipation, fever, orthostatic hypotension, weight gain, myoclonus and personality disorder
examples of opioids
barbiturates (barbital), benzodiazepines (lam/pam), antiepileptics (AEDs), skeletal muscle relaxants
what is clonazepam/klonopin? what does it treat?
anticonvulsant, benzodiazepine to treat panic disorder
SE of clonazepam/klonopin
drowsiness, CNS depression, dizziness, nightmares, dry mouth, constipation, weight gain, withdrawal phenomenon and hang over effect
antidote for benzodiazepines
flumazenil/romazicon
DOC for treating alcoholic delirium tremens (DTs)
lorazepam (ativan)
what is lorazepam (ativan) used for?
anxiety and withdrawal symptoms
lorazepam (ativan) nursing considerations
after IV administration keep patient supine for 8 hours and observe closely
what is penytoin/dilantin used for?
to treat seizures
therapeutic plasma levels
10-20 mcg/ml
plasma levels above 20mcg/ml
toxicity; nystagmus (back and forth movements of the eyes), ataxia (staggering gait), diplopia (double vision) and cognitive impairment- suicidal thoughts. EPS
side effects of phenytoin/dilantin
gingival hyperplasia- teach good oral hygiene including flassing and gum massage. measles-like rash, hirsutism, stevens johnsons or toxic epidermal necrolysis (TEN) especially in pts of asian decent with genetic mutation HLA-B*1502.
carbamazepine/tegretol serum level
4-12 mcg/ml
avoid which drink when taking carbamazepine/tegretol
grapefruit juice
topiramate may _ effects of phenytoin
increase
what is lioresal/baclofen?
a muscle relaxant and CNS depressant
lioresal/baclofen pt teaching
move carefully and slowly when rising/walking; assess LOC
how is lioresal/baclofen given?
intrathecally with baclofen pump; use test dose 1st
SE of lioresal/baclofen
CNS depression, drowsiness, dizziness and hypotension
adderall generic name
amphetamine/dextroamphetamine mixture
adderall time of dosage
once in the morning and then 5 hours later. DO NOT GIVE AT BEDTIME
How is adderal XR given?
once daily in the morning. DO NOT GIVE AT BEDTIME
how does adderall XR work
half dose is released immediately and the remainder 4 hours later
what does adderall treat>
ADHD
what does ergotamine and dihydroergotamine treat?
vascular headaches including migraine with or without aura, cluster headaches
how does ergotamine and dihydroergotamine work?
by producing vasoconstriction of dilated blood vessels
what is sumatriptan/imitrex?
serotonin receptor agonist; a triptan
what is sumatriptan/imitrex used for?
relief of migraine headaches
sumatriptan/imitrex contraindications
do not take within 24 hours of ergot alkaloids;(can cause coronary vasospasms) CVA
what is methylphenidate/ritalin
stimulant that can produce insomnia DO NOT TAKE AT BEDTIME
when should methylphenidate/ritalin be taken?
best if taken on an empty stomach 30-45 minutes before eating; DO NOT TAKE AT BEDTIME
methylphenidate/ritalin schedule
schedule II drug
what can echinacea produce?
topical agent; dermatitis/skin rash
echinacea can have an effect on
the immune systems. it increases the number of white blood cells which fight infection
who should avoid using echinacea?
pts with autoimmune diseases (lupus, multiple sclerosis and collagen disorders) since it has a nonspecific stimulatory effect which can worsen symptoms of the disease
what is gingko bioba used for?
mental alertness and improved memory
gingko bioba may increase the risk of what?
bleeding with:
anticoagulants warfarin, heparin.
antiplatelets (aspirin, clopidogrel) and
NSAIDs
what is st john’s wort
herb for depression and anxiety
which drugs can st john’s wort interact with?
immunosuppressant drugs for patients with kidney transplants
what is glucosamine and chondroitin used for?
osteoarthritis
meg vitamin C dosage
1000 mg or more daily
indications of use for Meg vitamin C
ascorbic acid deficiency
excess doses of meg vitamin C can lead to
diarrhea and urinary stone formation
foods high in ascorbic acid
citrus fruits, tomatoes, strawberries, cantaloupe and raw peppers
what can happen if meg vitamin c is abruptly withdrawn?
rebound deficiency
vitamin A foods
yellow, orange and leafy veggies
vitamin A deficiency
night blidness/visual changes
what happens when a pt ODs on vitamin D
increases serum calcium levels; excess vitamin D intake leads to excessive calcium absorption
normal Ca levels
8.4-10.5 mg/dl
what is calcitonin (mitacalcin)
nasal spray to decrease bone loss from osteoporosis
calcitonin (mitacalcin) pt teaching
instruct pt to alternate nostrils each day when administering the nasal spray to decrease rhinitis
what is calcium acetate (phoslo) and calcium carbonate (tums) used for?
management of hypocalcemia and hypophosphatemia in pts on chronic renal dialysis or pts with moderate to severe insufficiency with secondary hyperparathyroidism
when does calcium acetate (phoslo) and calcium carbonate (tums) show desired effects?
decrease in phosphorus and increase in calcium levels
phosphate normal levels
2.7-4.5 mg/dl
what is epoetin alfa (epogen, procrit) used for?
patients with chronic kidney disease (CKD)
what does epoetin alfa (epogen, procrit) do?
increase RBC production; treats anemia in pts with ESRD (CKD) or from HIV or chemotherapy
what levels need to be assessed with epoetin alfa (epogen, procrit)
iron and H&H; monitor for signs of bleeding or clotting such as with a DVT
epoetin alfa (epogen, procrit) pt teaching
have a diet high in iron
what is risedronate (actonel), alendronate (fosamax) used for?
bisphosphonate (bone resorption inhibitor)> used for treatment of postmenopausal and corticosteroid-induced osteoporosis.
risedronate (actonel), alendronate (fosamax) pt teaching
take first thing in the morning with 8oz of water at least 30 minutes prior to other medications, food or beverages. remain upright for 30 minutes following doses.
why should a pt remain upright for 30 mins after receiving risedronate (actonel), alendronate (fosamax)
to facilitate passage to stomach and minimize risk of esophageal irritation (heartburn)
ibandronate (boniva) pt teaching
take first thing in the morning with 8oz of water at least 60 minutes prior to other medications, food or beverages. remain upright for 60 minutes following doses.
SE of biphosphonates
HA, GI upset, risk of esophageal burns if med becomes lodged in esophague, osteonecrosis or the jaw
biphosphonates interactions
calcium supplements and antacids; can infere with absorption
how far apart should biphosphonates and calcium supplements/antacids be spaced?
1-2 hours
what is pilocarpine (isopto, pilocar)?
a topical muscarinic agonist for glaucoma
how does pilocarpine (isopto, pilocar) work?
produces miosis (constriction of the pupil) and contraction of the ciliary muscle
side effects of pilocarpine (isopto, pilocar)?
decreased visual acuity, local irritation, eye pain, brow ache, bradycardia, bronchospasm, hypotension, urinary urgency, diarrhea, hypersalivation, sweating
miotics cause pupil _ making pts be at risk for _
constriction (reduces night vision making driving at night dangerous), injury
what is bethanechol (urecholine) used to treat?
urinary retention in postop and postpartum pts
how does bethanechol (urecholine) work?
relaxes the trigone and sphincter muscles and increases voiding pressure by contraction the detrusor muscle which composes the bladder wall
what is edrophonium (tensilon)
an anticholinesterase that enhances effects of acetylcholine at the skeletal muscle receptors. has cholinergic effects!
who is edrophonium (tensilon) used for?
pts with myasthenia gravis
how do you know is edrophonium (tensilon) is effective?
improvement in pt muscle strength: opening eyes, improved swallowing, etc
what is pyridostigmine (mestinon) and neostigmine (prostigmine) used for
myasthenia gravis
how does pyridostigmine (mestinon) and neostigmine (prostigmine) work?
inhibits action of cholinesterase (cholinergic drugs)
how do we know pyridostigmine (mestinon) and neostigmine (prostigmine) is effective?
improvement in eye opening, improved ease of swallowing
what is physostigmine (antilirium) and rivastigmine (exelon) used to treat?
alzheimer’s and parkinson’s they are cholinergic medications
anticholinergic saying
dry as bone, red as a beet, mad as a hatter, hot as a hare
anticholinergics and also treat
bradycardia
transderm scopolamine (transderm-scop) use
anticholinergic for motion sickness. dries secretions and reduces nausea postoperatively
atropine is a __
anticholinergic
oxybutynin (ditropan) and tolterodine (detrol) indications for use
urinary tract antispasmodics; treats over active bladder
oxybutynin SE
constipation, dry mouth, urinary retention, mydriasis, tachycardia, HA, insomnia, angina, overheating
anticholinergic SE
constipation, dry mouth, urinary retention, mydriasis, tachycardia, HA, insomnia, angina, overheating
what does an androgen block treat
prostrate and testicular cancer (Lupron)
SE of androgen blockers
decreased libido and gynecomastia
what premise should you work on when giving androgen blockers
that tumors arising from tissue influenced by the hormones estrogen and progesterone/androgen show regression (tumors shrink) when treat with a drug that produces the opposite hormonal effect/enviroment
why are estrogens prescribed for men with prostate cancer
estrogens act on the pituitary to suppress secretion of luteinizing hormone which in turn decreases testicular androgen secretion
SE of estrogen therapy in men
feminization; gynecomastia and impotence.
SE of estrogen therapy in women
decreased libido and breast tenderness
estrogen hormone replacement therapy (HRT) treats
postmenopausal symptoms
estrogen hormone replacement therapy SE
nausea, thromboembolic events, photosensitivity, chloasma (brown spots on face, neck and cheeks)
drugs for erective dysfunctions
sildenafil (viagra), tadalafil (cialis) and vardenafil (levitra)
drugs for erective dysfunction are contraindicated with
nitrates/nitroglycerin (potent vasodilator), isosorbide dinitrate (isordil) and isosorbide mononitrate (imdur)
osymetholone, oxandrolone, nandrolone
anabolic steroids
how does anabolic steroids (osymetholone, oxandrolone and nandrolone) work?
stimulates growth and development of male sex organs and secondary sex characteristics. stimulates production of erythropoietin by the kidney
SE of anabolic steroids
administration of exogenous androgens inhibits the release of endogenous androgens which suppresses sperm production leading to infertility as well as shrinking of the testicles and gynecomastia
glucocorticoids (steroid drugs) decrease the __
immune system; the pt is at risk of infection
what is cyclosporine (gengraf, neoral, sandimmune)
immunosuppressant drugs
what is the indicated use for cyclosporine (gengraf, neoral, sandimmune)
prevention of organ rejection (kidney, liver, heart transplants)
cyclosporine (gengraf, neoral, sandimmune) can cause _ and __
nephrotoxicity and posttransplant diabetes mellitus.
what should be avoided with cyclosporine (gengraf, neoral, sandimmune)
grapefruit juice
what is the indicated use for interferons
multiple sclerosis and other autoimmune disorders; makes flares happen less often. may also slow down how quickly symptoms get worse and help people have less physical disability.
avonex
interferon; given once a week IM. pt who start taking it in early stages of MS may be able to go longer before any physical disabilities begin or get worse
betaseron
interferon; subq injection every other day.
SE of interfon medications
flu-like symptoms (fatigue, chills, fever, muscle aches and sweating) during first week of treatment
when should interfons be taken
at bedtime to prevent symptoms from slowing you down
to relieve SE of interferons
take acetaminophen or ibuprofen before each injection during the 24 hours after it was administered. swelling, redness and pain at injection site. if the site gets hard, call your doctor and do not give shot at that site. Sadness, anxiety, irritability, guilt, trouble concentrating, confusion, hard time sleeping or eating. Notify MD.
iron (fe/ ferrous sulfate) nursing considerations
dilute oral liquid dosage and sip through a straw to avoid discoloration of teeth. take supplements with meals or food to decrease GI upset.
when should antacids or milk products be taken with iron?
1-2 hours before or after oral dosage forms of iron
after taking iron the pt should
remains upright for 30 minutes to help minimize esophageal irritation
how is IM iron given
Z-track method
vitamin C __ absorption of iron
enhances
why would filgrastim(neupogen) be prescribed?
to increase the WBC in neutropenic pts
how do we know filgrastim(neupogen) is effective?
WBC increase from 2500-5500 mm
when should filgrastim(neupogen) be given?
before infection occurs
SE of filgrastim(neupogen)
fever, muscle aches, bone pain, and flushing; give nonopioid or opioid analgesic. SE stops when med is D/C
what is bioavailability?
the rate at which the drug is available in the body
different forms and routes of same drug have _ bioavailability
different
directions for taking medications on an empty stomach
1 hour before or 2 hours after eating
directions for taking medications after a meal
30-60 minutes after eating
when are peak and trough levels drawn
initially then every 5-7 days
when should peak level be drawn?
30 minutes after IV infusion
when should trough levels be drawn?
immediately before (less than 30 minutes) the next dose
elevated trough level signifies
toxicity
which drugs need peak and trough levels assessed
vancomycin and aminoglycosides
what is succinylcholine (anectine) and why is it used?
depolarizing neuromuscular blocker; used during therapy
SE of succinylcholine (anectine)
ventricular tachycardia/dysrhythmias
succinylcholine (anectine) has an added NMB action when added with
vancomycin
what needs to be assessed with succinylcholine (anectine)
respiratory status
what is isotretinoin (accutane) used for?
treatment of several nodulocystic acne
SE of isotretinoin (accutane?)
severe photosensitivity (avoid the sun hoe) and teratogenesis (pregnancy category X)
calculate IV mL/hr on infusion device
mL divided by minutes times 60
calculate IV drip rates
ml to be infused x drop factor divided by minutes