Corticosteroids in adrenal drugs; Antiepileptic drugs; benzodiazepines (Week 6) Flashcards
Dexamethasone Classification
Corticosteroid and anti-inflammatory
Movement of Dexamethasone
Orally Distribution: Widely distributed, crosses the placenta M/E: Metabolized by the liver
Action of Dexamethasone
Supresses inflammation and the normal immune response. Supresses adrenal function at chronic doses. Theraputic effects: Supresses inflammation of normal immune responses
-Decreasing the migration of white blood cells, promote the break down protein and ultimately increasing sugars in the body
Nursing Considerations
AE
Contraindications
AE: ** MOON FACE** is common ae for longterm use
CNS- depression, euphoria, CV: hypertension GI: peptic ulcers, anorexia, nausea DERM: acne, slow wound healing, ENDO: adrenal suppression, Cushing’s syndrome MS: muscle wasting, osteoporosis,
Contraindications: Active untreated infections, known alcohol hypersensitivity or intolerance
Use cautiously:
in chronic treatment as it can lead to adrenal suppression
Stress; surgery or infections
What to assess for in dexamethasone?
● Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy
● Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea
● Cerebral Edema: Assess for changes in level of consciousness and headache throughout therapy
–Adrenal suppression symptoms include:
muscle weakness, fatigue, worsened osteoporosis, peptic ulcer, glaucoma, cataracts and increased intraocular pressue
Dexamethasone Indications?
Chronic diseases, allergic, hematologic, endocrine, neoplastic , dermatologic, autoimmune, managing cerebral edema,
Administration ( focused on what to do than amounts)
PO: Administer with meals to minimize GI irritation
For IV/ IM/ PO the duration will last for 72 hours
For cortricosteroids, what lab values are important to consider?
-Pay attention to these lab values: sodium, potassium and glucose.
Why potassium and glucose are important?
A: when potassium levels decrease, glucose levels increase
Nursing Diagnoses for cortico steroids
- Excess fluid volume d/t fluid retention
- @ risk for infection related to anti-inflammatory immunosuppression
- Impaired skin integrity related to adverse effects of this drug
Patient Teaching for corticosteroids
- Medication must be taken exactly as ordered and not to be skipped abruptly; abrupt withdrawal may precipitate to adrenal crisis
- If you missed a dose, take the medication as soon as you remember
- *If a pt if the patient does not remember if they have taken the does, advise the patient to take it the next day to avoid double dosing
- Emphasize the importance of bone health and. Suggest the pt to take calcium and vitamin D3
- Taking this med increases the risk for infection. Educate the pt for them to avoid contact to those who are sick
- Contact health care provider immediately if you see signs of adrenal insufficiency (dehydration and weight loss)
- Ecourage pt to keep a journal to document responses to treatment, bp, daily weight measurements, mood changes, and any adverse effects
phenytoin
Classification
Antiepileptic and antiarrhythmic
Phenytoin Movement
A: absorbed slowly through GI tract D: CSP/ other body fluids. Enters breast milk and placenta M/E: metabolized by the liver and small amounts are exacreted by urine
Action
Phenytoin Action
Limits seizure propagation by altering transport
Decreases synaptic transmissions
Antiarrythmic properties of shortening the action potential to decrease automaticity
Theraputic effects: diminish seizure activity
Phenytoin Nursing Considerations
AE
Contraindications
AE: Most common is rashes and immune reactions CNS: SUICIDAL THOUGHTS, DROWSINESS, ATAXIA (INVOLUNTARY MOVEMENTS) CV: HYPOTENSION GI: Nausea.
Contraindications- hypersensitivity
Use cautiously with those who have thoughts /behaviors of suicide, pts with severe cardiac or resp disease
What to assess for in phenytoin?
● Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy).
Observe patient for development of rash. Discontinue phenytoin at the first sign of skin reactions.
● Seizures: Assess location, duration, frequency, and characteristics of seizure activity. EEG may be monitored periodically throughout therapy.
● Monitor BP, ECG, and respiratory function continuously during administration of IV phenytoin and throughout period when peak serum phenytoin levels occur (15– 30 min after administration).
Phenytoin Inidcations
Treatment and prevention of seizures
Adminstration of Phenytoin
PO:With or without meals and with 180-240 ml of fluid
Do not chew
Phenobarbital
Class
Antiepileptic drug and barbituate
Phenobarbital Movement
A: slow absorption D: Unknown M/E: metabolized by liver and execreted in kidneys
For all routes can last for 4/6hrs
Action of Phenbarbital
Depresses the sensory cortex/ motor activity and alters cerebellar function. Inhibits transmission in the nervous system and raises seizure threshold. Therapeutic effects: sedation
Nursing Considerations Phenbarbital
AE
Contraindications
AE: Common adverse effects: dizziness, lethargy, paradoxical restlessness
Contraindications: Known drug allergy, porphyria (disorder of producing heme), liver kidney impairment, and respiratory illness
What are we monitoring for in phenbarbital?
Monitor respiratory status, pulse, and BP and signs and symptoms of angioedema (swelling of lips, face, throat, dyspnea) frequently in patients receiving phenobarbital IV. Equipment for resuscitation and artificial ventilation should be readily available. Respiratory depression is dosedependent.
What is phenobarbital indicated for?
Febrile seizures, tonic-clonic and partial seizures
Phenobarbital Administration
PO: may be crushed or chewed with foods or fluids (do not administer dry)
IM: Inject into gluteal muscle. DO NOT INJECT >5 ML INTO SITE D/T SKIN IRRITATION
Patient Education for Phenobarbital
Take medications as soon as remembered. No double dosing
- Advise them to not discontinue medication without speaking to a health care provider
- Medication may cause day time drowsiness. Avoid high alert activites
- Advise patient to report signs of angioedema
- Teach pt sleep techniques
What are we assessing for in antiepileptic drugs?
-Watch for steven-johnson syndrome that could occur 1-3 weeks after the drug has started
(Blisters, malaise, fever, sore throat, chills, malaise
-Assess for autonomic system signs of stress
(cold clammy hands, excessive sweating)
-Assess lab values which include: WBC, RBC, KIDNEY OR LIVER FUNCTIONS
-Assess urinary output (atleast 30ml/hr)
-Most common adverse effects is suicidal thoughts, GI upset, immune reactions and rashes on skin
Nursing Diagnoses for antiepileptic drugs
Lack of knowledge of drugs
Misuse of drugs and lack of understanding of seizure drugs
Chronic low-self esteem
Additional patient teaching for antiepileptic drugs
- Medication has sedative effects so avoid activity that requires alertness
- Report any suicidal thoughts
- Medication can never be abruptly discontuned
- Med is a lifelong treatment, share also community resources
- Encourage pt to wear a med bracelet
- Keep a journal and include date and time of any seizures, details of omitted drug overdoses, illnesses, and so on.
