Drug Cards MOD C Part 2 Flashcards
Trade Names for Insulin
Humulin N & R, Novolin N & R, Apidra, Humalog, Novolog, Lantus, Levemir
Therapeutic Classification for Insulins
Antidiabetic Hormones
Pharmacologic Classification for Insulins
Pancreatics
Preg. Category for Insulins
B or C
Indications for Use for Mixtures, Long-Acting, and Rapid-Acting?
Control of hyperglycemia in Type 1 & Type 2 Diabetics
Indications for Use for NPH & Regular Insulins
Control of hyperglycemia in diabetics
Contraindications for insulins
- hypoglycemia
- allergy/hypersensitivity to a particular type of insulin
- preservatives or other additives
Precautions for insulins
- Stress & infections
(may temporarily increase insulin requirements) - renal/hepatic impairments
(may decrease insulin requirements)
Routes for Insulin
SUBQ & IV
AR/SE of Insulins
Hypoglycemia Erythema Lipodystrophy Pruritis Swelling Allergic Reactions including Anaphylaxis
Nursing Implications for Insulins
- Assess for symptoms of hypo/hyperglycemia periodically during therapy
- Monitor weight
- Monitor blood glucose q6hr
- Available in diff. strengths & types (Check x 2)
- Use only insulin syringes
- Rotate SQ injection sites (abd. wall, thigh, arm)
- Instruct proper admin. technique
- Pt. should carry a source of glucose (candy, glucose gel)
Trade name for Heparin
Hepalean, Hep-Lock, Hep-Lock U/P
Therapeutic Classification for Heparin
Anticoagulants
Pharmacologic Classification for Heparin
Antithrombotics
Indications for use for Heparin
- Prophylaxis & Tx of various thromboembolic disorders including..
- venous thromboembolism
- pulmonary emboli
- arterial fib w/ embolization
- acute & chronic consumptive coagulopathies
- peripheral arterial thromboembolization
- used in low doses to maintain potency of IV cath (heparin flush)
Contraindications of Heparin
- Hypersensitivity
- Uncontrolled bleeding
- Severe thrombocytopenia
- Open wounds (full dose)
- Avoid use of products containing benzyl alcohol in premature infants
Precautions of Heparin
- Severe kidney/liver disease
- Retinopathy
- Untreated HTN
- Ulcer disease
- Spinal cord/brain injury
- Hx of congenital/acquired blood disorder
- GERI: women >60yrs old ^ risk of bleeding
Routes of Heparin
IV & SQ (NEVER PO or IM)
AR/SE of Heparin
- Drug-induced Hepatitis
- Alopecia (long-term use)
- Bleeding
- Heparin-induced thrombocytopenia (HIT) w/ or w/o thrombosis
- Anemia
- Pain @ injection site
- Osteoporosis (long-term use)
Nursing Implications for Heparin
- Assess for signs of bleeding/hemorrhage
- *Notify MD Immediately
- Assess for evidence of additional or ^ thrombosis
- Monitor hypersensitivity
- Monitor platelet count q2-3 days thru out therapy
- No meds containing Aspirin or NSAIDs
- Use soft toothbrush & electric razor
Antidote for Heparin
Protamine Sulfate
Trade Names for Warfarin
Coumadin, Jantoven
Therapeutic classification for Warfarin
Anticoagulants
Pharmacologic classification for Warfarin
Coumarins
Preg. Category for Warfarin
X
What does X mean with Preg. Category?
Contraindicated in Pregnancy: positive evidence of fetal abnormalities or risk which clearly outweighs any possible benefits to the patient
Indications for use for Warfarin
- Prophylaxis & Tx of venous thrombosis
- Pulmonary embolism
- Atrial Fib w/ embolization
- Mgmt of MI
- Decrease risk of death
- Decrease risk of future thromboembolic events
- Prevt. of thrombus formation & embolization after prosthetic valve placement.
Contraindications for Warfarin
- Uncontrolled bleeding
- Open wounds
- Active ulcer disease
- Recent brain, eye, spinal cord injury of surgery
- Severe liver/kidney disease
- uncontrolled HTN
Precautions for Warfarin
- Malignancy
- Pts. w/ Hx of ulcer/liver disease
- Hx of poor compliance
- Women w/ childbearing potential
- GERI: due to >expected anticoagulant response
- initiate & maintain @ lower doses
AR/SE of Warfarin
- Cramps
- Nausea
- Dermal Necrosis
- Bleeding
- Fever
Nursing Implications for Warfarin
- Assess for bleeding/hemorrhage
- Additional or ^ thrombosis
- GERI: pts >60yrs. exhibit > expected PT/INR response.
- Lg. # of meds capable of significantly altering warfarin effects
- Administer med @ same time each day
- Review foods high in Vit. K
- Consistent limited intake of food w/ Vit. K
Patient Teaching of Warfarin
- Avoid cranberry juice/products during therapy
- Pts. should try to avoid IM inj. & activities leading to injury
- Use soft toothbrush, no floss, & electric razor
- Report to DR any signs of unusual bleeding/bruising & pain, color, or temp changes to any area of the body
- Do not drink alcohol/take any RX, OTCs, or herbal products or stopping & starting any new meds during therapy
- Inform DR before labs, Tx, or surgery that pt is taking warfarin
Antidote for Warfarin
Vitamin K
Trade Name for Hepatitis B Vaccine
HepB, Engerix-B, Recombivax HB
Indications for use for HepB Vaccine
*High Risk patients:
-Household contacts/sex partners of persons with chronic HepB virus infection
-IV drug users
-Sexually active persons not in a long-term monogamous relationship having >1 sex partner in past 6 mo.
-Men who have sex w/ men, HIV, STDs
-End-stage renal disease, Hemodialysis
-H/C workers
-Inmates
-Chronic liver disease
*Patients who travel to endemic areas
*All unvaccinated adolescents
*Unvaccinated adults (19-59) w/ diabetes
(admin @ prescriber’s discretion to adults >60yrs w/ diabetes)
Contraindications/Precautions for HepB Vaccine
Anaphylactic Allergy to Yeast
Routes of HepB Vaccine
IM
AR/SE of HepB Vaccine
Local soreness
Nursing Implications for HepB Vaccine
- Assess previous immunization Hx & Hx of hypersensitivity
- Assess for latex allergy
- Some syringes (prefilled) may use latex components & should be avoided w/ hypersensitivity
- Inform pt. of potential & reportable side effects of immunizations
- Review next scheduled immunizations w/ pt or parent
With HepB, what signs do you Notify DR about?
- Fever higher than 39.4C (103F)
- Diff. breathing (dyspnea)
- Hives
- Itching
- Swelling of eyes, face, or inside nose
- Sudden, severe tiredness
- Weakness
- Convulsions
Trade Name for Ondansetron
Zofran, Zofran ODT, Zuplenz
Therapeutic classification of Ondansetron
Antiemetics
Pharmacologic classification of Ondansetron
5-HT3 antagonists
Preg. Category for Ondansetron
B
Indications for use for Ondansetron
- Prevt. of N & V assoc. w/ highly/moderately emetogenic chemotherapy
- PO: Prevt. of N/V assoc. w/ radiation therapy
- Prevt. & Tx of post-operative N/V
Contraindications for Ondansetron
- Hypersensitivity
- ODT contains aspartame & should not be used in patients w/ phenylketonuria
- Congenital long QT syndrome
- Concurrrent use of apomorphine
Precautions for Ondansetron
- Hepatic impairment (daily dose not to exceed 8mg)
- Abd. surgery (may mask ileus)
Routes for Ondansetron
PO, IM, IV
AR/SE of Ondansetron
- HA
- Torsade De Pointes
- QT interval prolongation
- Constipation
- Diarrhea
- ^ liver enzymes
- extrapyramidal reactions
Nursing Implications for Ondansetron
- Assess for N, V, abd. distention & bowel sounds
- Prior to & following admin. assess for extrapyramidal effects
- Monitor ECG in Pts. w/ hypokalemia or hypomagesemia
- HF
- Bradyarrhythmias
- Pts. taking concomitant meds that prolong QT interval
Patient Teaching with Ondansetron
- PO: (ODT)
- do not attempt to push through foil backing
- w/ dry hands, peel backing & remove tablet
- immediately place tablet on tongue, tablet will dissolve in seconds, then swallow with saliva
- Instruct pt. to take as directed
- Notify DR if symptoms of irregular heartbeat or involuntary mvmt of eyes, face, or limbs occur.
Trade Names for Penicillin G or V
Pfizerpen, Permapen, Crystapen
Therapeutic classification of PCN G/V
Anti-infectives
Pharmacologic classification of PCN G/V
Penicillins
Preg. Category for PCN G/V
B
Indications for use for PCN G/V
- Tx of wide variety of infections including:
- Pneumococcal pneumonia
- Streptococcal pharyngitis
- Syphilis
- Gonorrhea strains
- Tx of enterococcal infections (requires addition of amino glycoside)
- Prevt. of rheumatic fever
- should not be used as single agent to treat anthrax
Contraindications for PCN G/V
-Previous hypersensitivity to PCN
(cross-sensitivity to cephalosporins)
-Hypersensitivity to procaine/benzathine
-some products may contain tartrazine & avoid w/ hypersensitivity
Precautions for PCN
- Severe renal insufficiency (dose decrease recommended)
- GERI:
- consider decrease body mass
- age-related decrease in renal, hepatic, & cardiac function
- Comorbidities & concurrent drug therapy when prescribing & dosing
Routes for PCN
IM IV <—-V
AR/SE of PCN
- Seizures
- pseudomembranous colitis
- allergic reactions including anaphylaxis & serum sickness
- D, N, V
- epigastic distress
- rashes
- pain @ IM site
- phlebitis @ IV site
Nursing Implications for PCN
- Assess for infection
- Obtain Hx to determine previous use of & reactions to PCN, Cephalosporins, Beta-Lactam antibiotics
- Obtain Specimen for C&S
- Observe S/S of anaphylaxis
- Use calibrated measuring devices
- Admin. around the clock, Finish ALL Meds
- oral contraceptives need additional non hormonal method of contraceptives
Patient teaching for PCN
- Report any signs of super infections & allergy.
- Pt should carry an ID w/ allergy info
- If fever, diarrhea develop, especially if stool contains blood, pus, or mucus –Notify DR
What are the signs of a superinfection?
- black, furry overgrowth on tongue
- vaginal itching/discharge
- loose foul-smelling stools
Trade name for Metformin
Glucophage, Glucophage XR, Glumetza, Riomet, Portamet
Therapeutic classification for Metformin
Antidiabetics
Pharmacologic classification for Metformin
Biguanides
Preg. Category for Metformin
B
Indications for use for Metformin
- Mgmt of Type 2 Diabetes
- May be used w/ diet, insulin, or sulfonylurea oral hypoglycemics
Contraindications for Metformin
- Hypersensitivity
- Metabolic acidosis
- Dehydration
- Sepsis
- Hypoxemia
- Hepatic impairment
- Excessive alcohol use
- Renal dysfunction
- HF
- Radiographic studies requiring IV iodinated contrast media (w/hold metformin)
Precautions for Metformin
- Concurrent renal disease
- GERI:
- decrease doses may be required
- avoid in pts.>80yrs unless renal funct. is normal
- chronic alcohol use/abuse
- serious medical conditions (stroke, MI)
- Pts. undergoing stress (infections/surgical procedures)
- Hypoxia
- Pituitary deficiency
- Hyperthyroidism
Routes for Metformin
PO
AR/SE of Metformin
- Abd. bloating
- D, N, V
- Unpleasant metallic taste
- hypoglycemia
- lactic acidosis
- decrease VitB12 levels
Nursing Implications for Metformin
-pts. who have been well controlled on metformin who develop illness/lab abnormalities should be assessed for ketoacidosis/lactic acidosis
(if acidosis– d/c metformin)
-Assess Renal Fnct before & yearly during therapy
-D/C if stress, fever, trauma, infection, surgery
-Admin. w/ meals to minimize GI effects
Patient Teaching for Metformin
XR: swallow whole -do not crush,chew,break
- instruct pt. to take @ same time every day
- Does not cure diabetes, helps control hyperglycemia, long-term therapy
- Review S/S of hyperglycemia & hypoglycemia
- IF hypoglycemia occurs: Take w/ glass of OJ or 2-3 tsp of honey, sugar, or corn syrup dissolved in water & notify DR
- Instruct proper testing of blood glucose & urine ketones
