Drug Cards Flashcards
potassium chloride
HIGH ALERT MED
Normal range for K+ is 3.5-5
*BRAND:
Klor-Con, K-Tab
*GENERIC:
potassium chloride
*CLASS:
T- mineral and **electrolyte replacements/supplements
*INDICATIONS:
Treatment/prevention of potassium depletion
*MECHANISM OF ACTION:
-Maintain acid-base balance, isotonicity, and electrophysiological balance of cell
-Activator in enzyme reactions - essential for nerve impulses, cardiac/skeletal/smooth muscle contractions, gastric secretion, kidney function, tissue synthesis, and carbohydrate metabolism
*ADMIN ROUTE:
PO, IV
*SIDE EFFECTS:
**Arrhythmias, ECG changes, abd pain/GI upset, N/V/D, paralysis, confusion, weakness, phlebitis of IV site, rash
*NURSING IMPLICATIONS:
-Assess for s/sx of hypokalemia and hyperkalemia
-Monitor labs (serum **potassium, magnesium, chloride, renal function)
-Monitor for toxicity overdose (hyperkalemia: arrhythmias, fatigue/ weakness, confusion, ECG changes, resp changes, decreased DTR’s, palpitations, bradycardia, paralysis) - If hyperkalemia is suspected, stop infusion and notify provider.
- Administer w/ or ac (after meals) to decrease GI upset
-Tabs and caps should be taken w/ meal and full glass of water
-Report suddent decrease in urine output to provider.
*DESIRED OUTCOMES:
Prevention and correction of serum potassium depletion
metoprolol
HIGH ALERT MED
*BRAND:
Lopressor, Toprolol XL, Kapspargo Sprinkle
*GENERIC:
metoprolol
*CLASS:
T- Class II Antihypertensives
P- Beta blockers
*INDICATIONS:
HTN, angina, MI prevention, decreased mortality in pt’s with recent MI, dysrhythmias
*MECHANISM OF ACTION:
-Blocks stimulation of beta1 adrenergic (myocardial) receptors
-Blocks adrenaline from binding to these receptors
-Causes heart to beat slower and w/ less force, therefore, lowering BP
*ADMIN ROUTE:
PO, IV, NG
*SIDE EFFECTS:
**Bradycardia, HF, pulmonary edema, **hypotension, N/V/D/C, dry mouth, drug-induced hepatitis, **ED (erectile dysfunction), polyuria, **fatigue, weakness
*NURSING IMPLICATIONS:
-Monitor BP, pulse, and ECG
-Monitor I&O’s and daily weights
-Assess for s/sx of HF (dyspnea, rales/crackles, weight gain, peripheral edema, JVD)
-Assess for angina, frequency and characteristics of attacks
-Monitor labs
-TAKE APICAL PULSE BEFORE ADMIN, IF <50BMP OR ARRHYTHMIAS HOLD MED AND NOTIFY PROVIDER
-Slow position changes, notify provider of dizziness
-Do not stop med abruptly, do not double dose if one is missed
*DESIRED OUTCOMES:
- Decrease in BP
- Reduces frequency of anginal attacks
- Prevention of MI
insulin glargine
LONG-ACTING INSULIN
HIGH ALERT MED
*BRAND:
Basaglar, Lantus, Toujeo
*GENERIC:
insulin glargine
*CLASS:
T- hormones, antidiabetics
P- pancreatics, long-acting-insulin
*INDICATIONS:
-Control of hyperglycemia in pt’s with DMI and DMII
*MECHANISM OF ACTION:
-Lowers BG by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic (liver) glucose production
*ADMIN ROUTE:
SQ
*SIDE EFFECTS:
Hypoglycemia, hypokalemia, hypersensitivity reactions (anaphylaxis)
*NURSING IMPLICATIONS:
-Assess for hypo/hyperglycemia
-Monitor weight
-Monitor labs: BG, A1C, serum potassium
-Monitor of overdose/toxicity: manifested by signs of hypoglycemia
-CHECK TYPE, DOSE, AND EXP DATE WITH ANOTHER LICENSED NURSE
-DO NOT ADMINISTER IV OR USE WITH INSULIN PUMPS
*DESIRED OUTCOMES:
-Control of hyperglycemia in diabetic pt’s w/o appearance of hypo/hyperglycemic episodes
furosemide
Body is FURiously getting rid of urine
*BRAND:
Lasix
*GENERIC:
furosemide
*CLASS:
T- diuretics
P- loop diuretics
*INDICATIONS:
-Edema due to HF, hepatic (liver) impairment, renal( kidney) disease
-HTN
*MECHANISM OF ACTION:
-Inhibits reabsorption of sodium and chloride from loop of Henle
-Increases excretion of water, sodium, chloride, magnesium, potassium, and calcium from kidneys - causes rapid diuresis
*ADMIN ROUTE:
PO, IV, IM
*SIDE EFFECTS:
Hypotension, hyperglycemia, dehydration, rash, hearing loss/tinnitus, electrolyte imbalances, muscle cramps, polyuria, blurred vision, dizziness, N/V/D/C, dry mouth, headache, paresthesia
*NURSING IMPLICATIONS:
-Assess fluid status
-Monitor I&O’s, daily weight, edema, skin turgor, lung sounds
-Monitor BP and pulse
-Increased risk of falls with diuretics - assess fall risk and implement fall preventions
-Assess for hearing loss/tinnitus
-Monitor labs - electrolytes
-Increase potassium rich foods
-Monitor before 5pm if possible, due to diuresis
-Administer slowly, 20mg/min
*DESIRED OUTCOMES:
-Decrease in edema: Decrease in weight and abd girth, increase in urination
-Decrease in BP
prednisone
*BRAND:
Deltasone, Rayos
*GENERIC:
prednisone
*CLASS:
T- Anti-inflammatories (steroidal), immune modifiers, immunosupressant
P- corticosteroid
*INDICATIONS:
Used systemically and locally in wide variety of chronic conditions: inflammatory, allergic, hematologic, neoplastic, autoimmune disorders
*MECHANISM OF ACTION:
-Suppresses inflammation and normal immune response
-Suppresses adrenal function at chronic doses of 5mg/day
-Replaces cortisol in deficiency
*ADMIN ROUTE:
PO
*SIDE EFFECTS:
HTN, acne, decreased wound healing, adrenal suppression, thromboembolism, muscle wasting, osteoporosis, cushingoid appearance, increased susceptibility to infection, hyperglycemia, peptic ulceration, anorexia, depression, euphoria, ecchymoses(bruising), petechiae(bleeding under the skin), hirsutism(Male-like hair growth of women, chin, back, face)
*NURSING IMPLICATIONS:
-Assess involved systems
-Assess for signs of adrenal insufficiency (hypotension, weight loss, N/V, weakness, confusion, etc.)
-Monitor I&O’s and daily weights
-Monitor for peripheral edema, lung sounds, steady weight gain, or dyspnea
-Monitor labs: electrolytes, glucose, cortisol level, blood counts
-Administer in morning to follow body’s natural secretion of cortisol
-Admin with meals to limit GI upset
*DESIRED OUTCOMES:
-Decrease in present symptoms with minimal systemic side effects
-Management of sxs in adrenal deficiency
-Suppression of inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms
quinapril
*BRAND:
Accupril
*GENERIC:
quinapril
*CLASS:
T- antihypertensives
P- ace inhibitors
*INDICATIONS:
-Management of HTN alone or in addition to other agents (meds)
-Management of HF
*MECHANISM OF ACTION:
-Angiotensin-converting enzyme (ACE) inhibitors block conversion of angiotensin I to the vasoconstrictor angiotensin II
-Increase renin production of kidneys and decrease aldosterone production - which results in systemic vasodilation
https://www.youtube.com/watch?v=17MQFVLnpxA&t=99s
*ADMIN ROUTE:
PO
*SIDE EFFECTS:
“CAPTOPRIL”
Cough
Angioedema
Pregnancy problems
Taste changes
Other (rash, fatigue)
Proteinuria
Renal insufficiency
Increased potassium
Low blood pressure
*NURSING IMPLICATIONS:
-Monitor BP and pulse
-Monitor weight and signs of fluid overload (peripheral edema, lung sounds, JVD, dyspnea)
-Assess for signs of angioedema (facial swelling, difficulty swallowing or breathing)
-Monitor labs: CBC, BUN, creatinine, and electrolyte levels **ACE inhibitors can cause hyperkalemia – warn pt to avoid salt alternatives that contain potassium
*DESIRED OUTCOMES:
-Decrease of BP in hypertensive pt’s without appearance of excessive side effects
-Decrease in s/sx of HF
heparin
HIGH ALERT MED
*BRAND:
Hep-Lock
*GENERIC:
heparin
*CLASS:
T- anticoagulants
P- antithrombitics
*INDICATIONS:
-Prevention and treatment of many thromboembolic disorders
-Enhances inhibitory effect of antithrombin on factor Xa and thrombin.
-Heparin flushes (used in very low doses (10-100 units) to maintain patency of IV catheters)
*MECHANISM OF ACTION:
-Prevention of thrombus formation
-Prevention of worsening of existing thrombi, but DOES NOT DECREASE SIZE OF CLOTS THAT HAVE ALREADY FORMED
-LOW DOSES: prevents conversion of prothrombin to thrombin by its effects on factor Xa.
-HIGH DOSES: neutralizes thrombin, preventing conversion of fibrinogen to fibrin
*ADMIN ROUTE:
Subcutaneous, IV
*SIDE EFFECTS:
Rash, drug-induced hepatitis, bleeding, heparin-induced thrombocytopenia (HIT), anemia, hypersensitivity reaction
*NURSING IMPLICATIONS:
-Assess for signs of bleeding/hemorrhage
-Monitor for hypersensitivity reactions
-Observe injection sites for hematomas, bruising, inflammation
-Monitor labs: (aPTT, normal: 1.5-2 times the baseline), hematocrit, platelets, calcium, and liver function levels
-Monitor for toxicity/overdose
-HAVE SECOND NURSE CHECK ORDER, DOSE CALCULATION, AND INFUSION PUMP SETTINGS
-Review med list - UNFRACTIONATED HEPARIN AND LOW MOLECULAR HEPARINS SHOULD NOT BE ADMINISTERED AT SAME TIME
-Avoid IM injections, IV/injection sites require pressure to prevent bleeding or hematoma
*DESIRED OUTCOMES:
-PTT of 1.5-2 times the baseline
-Prevention of DVT and PE
-Patency of IV catheters
hydrocodone-acetominophen (Norco) 5/325 mg
HIGH ALERT MED
REMS DRUG
*BRAND:
Norco, Lortab
*GENERIC:
hydrocodone-acetominophen
*CLASS:
T- opioid analgesics, antitussive (allergy, cough, and cold remedies)
P- opioid agonists, nonopioid analgesic combinations
*INDICATIONS:
-Management of moderate to severe pain
-Antitussive (usually in combination with decongestants)
*MECHANISM OF ACTION:
-Alters the perception and reaction to pain by binding to opiate receptors in the CNS
-Suppresses the cough reflex
*ADMIN ROUTE:
PO
*SIDE EFFECTS:
Hypotension, sweating, constipation, nausea, dyspepsia, confusion, dizziness, sedation, respiratory depression, medication dependence, medication tolerance
*NURSING IMPLICATIONS:
-Assess BP, pulse, and respirations before and periodically during administration
-Assess pain level during treatment
-Assess bowel function routinely to minimize constipating effects
-DO NOT exceed 4g of acetaminophen per day
-Assess cough and lung sounds during use if prescribed as antitussive
-Assess risk for opioid addiction
-Monitor for toxicity - naloxone is the antidote
*DESIRED OUTCOMES:
-Decrease in severity of pain without a significant alteration in LOC or respiratory status
-Suppression of nonproductive cough
digoxin
HIGH ALERT MED
BEERS DRUG
“When you DIG a hole, you want to dig SLOW and DEEP”
*BRAND:
Lanoxin
*GENERIC:
digoxin
*CLASS:
T- antiarrhythmics, inotropics
P-cardiac glycosides
*INDICATIONS:
HF, Afib/Aflutter
*MECHANISM OF ACTION:
-Provides positive inotropic effect (enhances force and efficiency of contraction)
-Provides negative chronotropic effect (results in decreased HR)
-Increases cardiac output and slows heart rate
*ADMIN ROUTE:
PO, IM, IV
*SIDE EFFECTS:
Arrhythmias, bradycardia, ECG changes, vision changes, anorexia, N/V/D, fatigue, electrolyte imbalances with acute digoxin toxicity
NURSING IMPLICATIONS:
-Have second practitioner check order and dose calculations
-MONITOR APICAL PULSE X1 MIN BEFORE ADMIN, hold dose and notify provider if <60bpm*
-Monitor BP, HR, IV site
-Monitor ECG if given IV
-Monitor I&O’s, daily weights, peripheral edema, lung sounds
-Prior to first admin, ask pt if they have taken digoxin in the past 2-3wks
-Monitor labs: electrolytes (esp. potassium, magnesium, and calcium), kidney and liver function –Hypokalemic, hypomagnesemia, or hypercalcemia may make pt more susceptible to toxicity
-Monitor therapeutic levels
-**Monitor for toxicity
*DESIRED OUTCOMES:
-Decrease in severity of HF
-Increase in cardiac output
-Termination of paroxysmal atrial tachycardia
*THERAPEUTIC BLOOD LEVELS:
0.5-2ng/mL (levels may be drawn 6-8hrs after a dose is administered, usually drawn immediately before next dose
“When you DIG a hole, you want to dig SLOW and DEEP”
levofloxacin
“That FOX likes to eat TENDONS”
Med has black-box warning due to risk of tendon rupture
*BRAND:
Levaquin
*GENERIC:
levofloxacin
*CLASS:
T-anti-infectives
P-fluroroquinolones
*INDICATIONS:
Used to treat infections such as:
UTI’s, gonorrhea, respiratory tract infections, skin/joint/ bone infections, anthrax
*MECHANISM OF ACTION:
Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme
*ADMIN ROUTE:
PO, IV
*SIDE EFFECTS:
Nausea, GI upset, C. Diff, photosensitivity, vaginitis, hypersensitivity reactions (rash, facial swelling, anaphylaxis), elevated liver enzymes, ELEVATED RISK OF TENDON RUPTURE
*NURSING IMPLICATIONS:
-Assess for infection and obtain specimens for culture and sensitivity before therapy - therapy may be started before receiving results
-Assess for s/sx of anaphylaxis
-Monitor bowel function (diarrhea, abd cramping, bloody stools, fever should be reported to physician bc they may be a sign of C. Diff)
-Monitor liver function test and renal panel
-Increases the risk for tendinitis or tendon rupture
-May decrease plasma concentration of phenytoin
-may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
*DESIRED OUTCOMES:
Resolution of s/sx of bacterial infection
enoxaparin
*low molecular weight heparins
HIGH ALERT MED
*BRAND:
Lovenox
*GENERIC:
enoxaparin
*CLASS:
T- anticoagulants
P- antithrombitics
*INDICATIONS:
-Prevention of VTE, DVT, and/or PE in surgical or medical patients
-Treatment of DVT (w/ warfarin)
-Angina
*MECHANISM OF ACTION:
-Enhances the inhibitory effect of antithrombin on factor Xa and thrombin
-Prevention of thrombin formation
*ADMIN ROUTE:
Subcutaneous
*SIDE EFFECTS:
Bleeding, anemia, hyperkalemia, elevated liver enzymes, injection site irritation or hematoma
*NURSING IMPLICATIONS:
-Assess for signs of bleeding
-Monitor labs: CBC, platelet count, occult blood, electrolytes and liver enzymes
-Monitor for toxicity
*DESIRED OUTCOMES:
insuline regular
SHORT ACTING INSULIN
HIGH ALERT MED
*BRAND:
Humulin R, Novolin R
*GENERIC:
insulin regular
*CLASS:
T- antidiabetics, hormones
P- pancreatics
*INDICATIONS:
-Control of hyperglycemia in pt’s with DM
-Unlabeled use: treatment for hyperkalemia
*MECHANISM OF ACTION:
Lowers BG by enhancing glucose uptake in skeletal muscle and fat
*ADMIN ROUTE:
Subcutaneous
*SIDE EFFECTS:
Hypoglycemia (which may include: diaphoresis, HA, dizziness weakness, tachycardia), hypokalemia, hypersensitivity reactions
*NURSING IMPLICATIONS:
-Assess for s/sx of hypoglycemia
-Monitor body weight periodically
-Rotate sites to prevent lipohypertrophy
-Monitor labs: glucose, electrolytes, and A1C q3m
-Ensure that meal tray is at least on the floor and will be brought to pt pretty soon
*DESIRED OUTCOMES:
-Control of BG level in diabetic pt’s without the presence of hypoglycemic or hyperglycemic episodes
warfarin
“warfarin is going to WAR on vitamin K”
HIGH ALERT MED
*BRAND:
Coumadin
*GENERIC:
warfarin
*CLASS:
T- anticoagulants
P-coumarins
*INDICATIONS:
-DVT, PE, Afib
-Can be used post MI to prevent complications
*MECHANISM OF ACTION:
-Works by antagonizing vitamin K, which prevents formation of several clotting factors
*ADMIN ROUTE:
PO
*SIDE EFFECTS:
Bleeding, GI upset, Hepatitis
*NURSING IMPLICATIONS:
-Assess for bleeding
-Monitor for coffee ground emesis or tarry stools (also signs of bleeding)
-Monitor PT/INR ((normal levels btwn 2-3, takes about three to five days to get to therapeutic level - so pt is started on heparin (fast acting) and warfarin concurrently. When levels are met, pt can be taken off heparin)
-Advise pt to maintain steady intake of VitK - don’t want to rapidly increase/decrease intake
*HEALTHY/NORMAL INR LEVEL:
- 1.1 or below
*THERAPEUTIC BLOOD LEVELS OF SOMEONE ON WARFARIN:
- 2 to 3
