Med Cards for Exam 4 Flashcards
plus lab card information too
metamucil
laxative
expected pharmacological action: metamucil
Combines with water in the intestinal contents to form an emollient gel or viscous solution that promotes peristalsis and reduces transit time.
therapeutic use: metamucil
relief and prevention of constipation
complications: metamucil
bronchospasm, cramps, intestinal or esophageal obstruction, nausea, vomiting
contraindictions/precautions: metamucil
Hypersensitivity; Abdominal pain, nausea, or vomiting (especially when associated with fever); Serious adhesions; Dysphagia.
Use Cautiously in: Some dosage forms contain sugar, aspartame, or excessive sodium and should be avoided in patients on restricted diets
interactions: metamucil
May decrease absorption of oral medications
nursing interventions: metamucil
Assess client for abdominal distension, prescence of bowel sounds, and usual pattern of bowl movements.
Assess the stool for color, consistency, and how much stool was produced.
evaluation of med effectiveness: metamucil
A soft, formed bowel movment, usually within 12-24 hrs after administration. May require up to 3 days of taking it to see these results
client education: metamucil
Encourage client to also use other forms of bowel regulation, such as exercise, hydration, eating more food. Make sure the client knows what a normal bowel pattern is for them so they know if it is returning to abnormal
Advise not to take if client has any abdominal pain, vomiting, or nausea
report constant diarhea
docusate sodium
surfactant laxative/stool softner
therapeutic use: docusate sodium
Constipation
* Prevention of fecal impaction, straining during defecation, painful
elimination of hard stools
adverse drug reactions: docusate sodium
Diarrhea, mild abdominal cramps
* Throat Irritation
* Rashes
interventions: docusate sodium
- Monitor for abdominal distention severe diarrhea and dehydration.
- Administer with a full glass of water or juice, on an empty stomach for
best results - Assess stool color, consistency, and amount
admin: docusate sodium
give orally with at least 8 oz of fluid
expect soft stools serveral days after initiating therapy
client instructions: docusate sodium
Report severe diarrhea and stop taking the drug.
* Drink plenty of fluids.
* Advise clients to increase exercise and fluid intake (at least 2 to 3 L/day)
and consume high-fiber foods (bran, fresh fruits/vegetables).
contraindictions: docusate sodium
Gastrointestinal obstruction, perforation
* Concurrent use of mineral oil
* Fecal impaction
* Nausea, vomiting
* Undiagnosed abdominal pain
precautions: docusate sodium
Use cautiously with clients prone to developing a laxative dependency
interactions: docusate sodium
Do not administer within 2 hr of any other laxative, esp. mineral oil.
bisacodyl
laxative
expected pharma action: bisacodyl
Stimulating enteric nerves to cause peristalsis
therapeutic use: bisacodyl
To treat and help with constipation in SHORT term
complications: bisacodyl
nausea, vomiting, diarrhea, tetany, alkalosis, a sensation of buring of the recal mucosa and mild proctitis
med admin: bisacodyl
PO and rectally
PO: 5-15 mg
Rectally: 10 mg
contraindications/precautions: bisacodyl
Hypersensitivity to drug, intestinal obstruction, gastroenteritis, appendicitisUse cautiously in: hypersensitivity to tannic acid severe cardiovascular disease, anal or rectal fissures, pregnant or breastfeeding patients.
nursing interventions: bisacodyl
Do not give medication within 1 hours of consumption of dairy products or antacid; continue to assess stools for frequency and consistency; continue to monitor client for hydration status and electrolyte levels
interactions: bisacodyl
antacids and dairy products can cause gastric irritation, dyspepsia
client ed: bisacodyl
Do not take medication within 1 hour of consumption of dairy products or antacids
This is short term thearpy
Educate ways to allow good bowel movements, such as hydration, exercise, increase food in diet.
evaluation of med effect: bisacodyl
soft, formed bowel movements, typically with in 6-24 hrs post medication administration
gabapentin
anticonvulsant
expected pharm action: gabapetin
Affect the transportation of amino acids across and stabilize neuronal membranes
therapeutic use: gabapentin
Decrease of seizures, decrease pain, decrease leg restlessness
complications: gabapentin
Agitation, seizures, peripheral edema, aphasia, hypotension, hypertension, CNS tumors, delusions, , apathy, anxiety, angina, palpitations,
medication administration: gabapentin
PO
300 mg (3 times daily) for adults
contraindications/precautions: gabapentin
Hypersensitivity to gabapentin or to its components
nursing interventions: gabapentin
Monitor for a change in the client’s mood and interactions that would further indicate behaviors of suicidal thoughts, seizures, and restlessness
interactions: gabapentin
Hydrocodone- decreased hydrocodone exposure
Antacids- decreased gabapentin bioavailability
Morphine- increased CNS depression
Depressants- increased CNS depression
eval of med effect: gabapentin
Decrease in seizure frequency, an increase in stability, and an overally decrease in leg restlessness
client education: gabapentin
Client should take medication as directed, if missed dose, just take immediately.
Try to avoid taking medication with driving and within 2 hours after taking antacid.
aspirin
NSAID
therapeutic use: aspirin
Inflammation suppression
* Analgesia for mild to moderate pain
* Fever reduction
* Dysmenorrhea
- Inhibition of platelet aggregation (aspirin)
adverse drug reactions: aspirin
Gastric upset, heartburn, nausea, gastric ulceration
* Bleeding (less with non-aspirin NSAIDs)
* Kidney dysfunction
* Salicylism (aspirin)
* Reye’s syndrome (aspirin)
* Thromboembolic events (non-aspirin NSAIDs)
interventions: aspirin
Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, abdominal pain, nausea, hematemesis).
* Test for and treat Helicobacter pylori infection prior to long-term therapy.
* For clients at high risk for gastric bleeding, recommend a proton pump inhibitor.
* Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from
minor injuries).
* Monitor intake and output; watch for low urine output and fluid retention.
* Monitor for rapid rises in BUN and creatinine.
* Monitor for tinnitus, diaphoresis, headache, dizziness, and respiratory alkalosis.
Stop aspirin therapy for clients reporting these symptoms.
* Recommend acetaminophen (Tylenol) and not aspirin or NSAIDs for children and
adolescents under age 18 who have viral infections, particularly chickenpox and
influenza.
* Recommend non-aspirin NSAIDs for short periods and in low doses only.
* Recommend low-dose aspirin to prevent these events if prescribed by provider.
* Monitor for signs of myocardial infarction and cerebrovascular accident.
admin: aspirin
Make sure clients swallow enteric-coated or sustained-release forms whole and
do not crush or chew them.
* Discontinue 1 week before scheduled surgery.
* Monitor for initial and continued therapeutic effects.
nifedipine
calcium channel blocker
therapeutic use: nifedipine
Treats mild to moderate hypertension
* Treats stable (exertional) angina and variant (vasospastic) anginas
adverse drug reactions: nifedipine
Reflex tachycardia causing increased angina pain in clients with angina
Note: This effect is most likely with faster-acting tablets than the
sustained release form.
* Headache, Lightheadedness, dizziness (caused by vasodilation)
* Facial flushing, perception of heat (caused by vasodilation)
* Peripheral edema of feet and legs
* Arrhythmias
* Gingival hyperplasia (growth of gum tissue, bleeding gums) – rare
interventions: nifedipine
Give nifedipine along with an ordered beta-blocker to prevent reflex
tachycardia
* Monitor heart rate
* Monitor for and report this effect
* Assist with ambulation as needed
* Inform client that facial flushing may occur
* Monitor for and report edema (a diuretic may be prescribed if edema
occurs)
* Monitor blood pressure carefully as starting dosage is established
* Notify provider and withhold dose for BP below 90 mm Hg systolic or
for prearranged parameter
* Advise regular dental care
admin: nifedipine
Available for oral use in capsules and sustained-release tablets;
sustained release form is approved to treat hypertension
* Sustained-release form must be swallowed whole and not chewed or
crushed
* To prevent reflex tachycardia, nifedipine may be combined with a betablocker
client instructions: nifedipine
Report rapid heartbeat, increase in angina pain to provider
* Do not perform hazardous activities such as driving until effects are
known
* Be aware that this side effect may occur
* Report swelling of feet and legs to provider
* Advise client to take as prescribed and not increase dosage
* Report dizziness, syncope to provider
* Report HR less than 50 bpm
* Report bleeding gums, gum tissue growth to provider
* Obtain regular dental care
cimetidine
histamine h2 antagonist
therapeutic use: cimetidine
Gastric and duodenal ulcers
* Heartburn, dyspepsia
* Erosive esophagitis
* Gastrointestinal reflux disease (GERD)
* Aspiration pneumonitis
* Hypersecretory disorders such as Zollinger-Ellison syndrome (gastrin),
systemic mastocytosis (histamine)
adverse drug reactions: cimetidine
Impotence, reduced libido with cimetidine (Tagamet)
* Confusion, aplastic anemia, agranulocytosis, and arrhythmia
* Increased susceptibility to pneumonia
interventions: cimetidine
For clients who report impotence, reduced libido, or CNS effects,
recommend that they discuss with their provider.
* Monitor older clients for confusion.
admin: cimetidine
Give orally, IM, or IV.
* Give with or without food (given with meals, immediately afterwards, or
at bedtime does prolong effect).
* Administer IV preparation slowly to avoid bradycardia.
* Do not give antacids within 1 hr of administration.
* Make sure clients dissolve effervescent tablets in water and do not
chew them, swallow them whole, or allow them to dissolve on the
tongue.
client instructions: cimetidine
Take all medication as prescribed
* Avoid smoking
* Avoid foods or medications that irritate GI tract
* Tell clients to report any signs of obvious or occult gastrointestinal
bleeding, such as coffee-ground emesis.
contraindications: cimetidine
Known sensitivity
* Some products may contain aspartame so avoid in clients with PKU
precautions: cimetidine
Hepatic or renal dysfunction
* Acute porphyria
* Older adults
interactions: cimetidine
Antacids can reduce absorption of histamine H2 receptors.
* Cimetidine increases levels of warfarin, also called Coumadin;
phenytoin, also called Dilantin; lidocaine, also called Xylocaine; and
theophylline, also called Theolair
aluminum hydroxide
antacid
therapeutic use: aluminum hydroxide
Peptic ulcer disease
* Gastrointestinal reflux disease (GERD)
adverse drug reactions: aluminum hydroxide
Constipation (aluminum and calcium antacids)
* Diarrhea (magnesium antacids)
* Hypophosphatemia
interventions: aluminum hydroxide
Monitor bowel function.
* Administer stool softeners.
* Monitor for severe diarrhea.
* Monitor phosphorus and magnesium levels.
admin: aluminum hydroxide
- Administer orally up to four times a day.
- Make sure clients chew tablets thoroughly and follow with at least 8 oz
of water - Do not give within 1 to 2 hr of administering drugs that interact with
antacids.
client instructions: aluminum hydroxide
Increase fluid and fiber intake.
* Increase activity and exercise.
* Report abdominal pain.
* Report severe diarrhea.
* Educate client on monitoring phosphate and sodium intake.
* Tell clients to report any signs of obvious or occult gastrointestinal
bleeding, such as coffee-ground emesis.
* Instruct clients to not take aluminum hydroxide with 1 to 2 hr of other
medications.
contraindications: aluminum hydroxide
Severe abdominal pain of unknown origin
precautions: aluminum hydroxide
Hypercalcemia and hypophosphatemia
interactions: aluminum hydroxide
- Interferes with absorption of many drugs including: tetracyclines,
digoxin, fluoroquinolones, iron salts, salicylates, and chlorpromazine
diazepam
benzodiazepine
therapeutic use: diazepam
Anxiety and anxiety disorders (alprazolam, diazepam)
* Skeletal muscle spasm and spasticity (diazepam)
* Seizure disorders – treats status epilepticus (diazepam)
* Acute alcohol withdrawal symptoms (diazepam)
* Induction of anesthesia (diazepam)
adverse drug reactions: diazepam
Drowsiness, slurred speech
* Impaired recall of events
* Paradoxical reaction (confusion, anxiety)
* Hypotension, tachycardia, respiratory depression
* Tolerance and physical dependence (especially with alprazolam)
* Withdrawal symptoms – insomnia, anxiety, tremors, diaphoresis, dizziness, panic, hypertension, seizures
* Overdose/toxicity
* Oral – sedation, confusion
* Parenteral – possibly life-threatening sedation, hypotension, respiratory
depression, cardiac arrest
interventions: diazepam
Monitor clients to prevent falls and other injury following administration.
* Assess client’s memory following administration.
* Monitor clients, especially older adults, for a paradoxical reaction.
* Monitor vital signs, especially with IV administration.
* Monitor clients for signs of tolerance and dependence.
* Taper over 1 to 2 weeks to prevent or minimize withdrawal.
* Monitor for signs of withdrawal.
* Reverse sedation with IV flumazenil.
* Provide airway and blood pressure support as needed for parenteral
overdose.
admin: diazepam
Give alprazolam orally.
* Take oral benzodiazepines with food if gastrointestinal symptoms develop.
* Give diazepam orally, rectally, IM, or IV.
* Administer IV diazepam slowly and have emergency resuscitation equip- ment nearby.
* Be aware that IV diazepam precipitates in solution with some diluents
and drugs.
* Do not give the emulsion form IM (IV only).
* Avoid IM diazepam due to inconsistent absorption; if necessary, inject
slowly into a large muscle.
