high risk medications Flashcards
risk of high risk medications
-higher potential for harm
-more devastating consequences
-requires additional precautions (indep double check, automatic stop dates, tall man lettering)
when can errors occur
-prescribing
-dispensing
-administering
-monitoring
what are inotropes
-inotropic drugs are high risk meds that affect the force or energy of muscular contractions, particularly contraction of the heart muscle
-improves CO and tissue perfusion
what is a positive inotrope
increases the force of myocardial contraction
-inc CO by inc SV by increasing preload, afterload, and contractility
-drug of choice d/t dec side effects
what conditions are positive inotropes used in
-cardiogenic shock
-severe heart failure
-cardio surgery pts
what drugs are positive inotropes
-digoxin
-dobutamine
-dopamine
what are negative inotropes
reduce the force of myocardial contraction to reduce straining of heart muscle
what conditions are negative inotropes used with
-hypertension
-heart failure
-chest pain
-arrythmias
examples of negative inotropes
B-blockers
Ca2+ channel blockers
antiarrhythmics
how are pressors different from inotropes
pressors cause vasoconstriction (inc SVR) to ELEVATE map
inotropes increase contractility to MAINTAIN map
what do alpha vasopressors do
increase contractility d/y vasoocnstriction
what do beta vasopressors do
increase heart rate, conduction of the AV node, and force of contraction
how are pressors and inotropes given
infusion via CVAD d/t risk of extravasation in peripheral IV
why do inotropes require a continous infusion
onset of <2s and duration of <10s
what is needed for administration of inotropes
-indep double check
-compatible fluids (D5, NS, 1/2 Ns &D5)
-Iv label (high alert, flow rate, time, 2 signitures)
actual side effects of inotropes
-ARRHYTHMIAS
-palpitations
-angina
-HA
-HTN
- peripheral numbness
milirnone: inc LFTs, arrythmias
potential side effects of inotropes
-bacteremia
-line/exit site infections
-drug interactions (gen anesthetics, tricyclic antidepressants, beta blockers)
side effects of pressors
-seizures
-extreme HTN
-peripheral numbness/cold
what to do if someone is having an adverse effect to an inotrope
titrate infusion down (cannot stop abruptly)
call doctor
history and assessment for inotropes
-med list
-need to know baseline of everything
-cardiac and resp assess
-periph pulses
-postural BP
-full vitals
-recent activity intolerance
-ABGs
-skin assessment
-urine output
-renal or liver issues
nursing responsibilities for implementation of inotropes
-critical care
-check Iv site, rate, and lines hourly
-cardiac monitor
-vitals
nursing responsibilities for evaluation of inotropes
-inc perfusion
-inc CO
-inc urine
-normal vitals
-warm extremities
-peripheral pulses
-LOC
fluid status and inotropes
monitor I&O, weight, edema, hypovolemia
-hypovolemia may impair hemodynamic instability and impede medication delivery
patient and family education for inotropes (dobutamine)
-report any dyspnea, HA, discomfort at site, chest pain, and/or numbness in extremities
-assess for S&S of infection
-notify nurse if any worsening/change in condition
