meds Flashcards
Reglan, also called Metoclopramide
class: antiemetic, GI prokinetic
Indications: treatment and prevention of postoperative nausea and vomiting when nasogastric suctioning is undesirable, gastropexies (slow emptying stomach), GERD.
CONTRAindications: epilepsy, Gi obstruction/hemorrhage, tardive dyskinesia
MOA: blocks dopamine receptors in the chemoreceptor trigger zone of the CNS.
therapeutic effects: decreased n/v.
ae’s: CNS: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME, anxiety, bradykinesia, cog-wheel rigidity, depression, irritability, tardive dyskinesia, tremor. CV: arrhythmias (supraventricular tachycardia, bradycardia), hypertension, hypotension. Endo: gynecomastia, hyperprolactinemia. GI: constipation, diarrhea, dry mouth, nausea. Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis.
serious side effects: tardive dyskinesia (irreversible and untreatable)
Important food/drug interactions: Additive CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, and sedative/hypnotics. May ↑ absorption and risk of toxicity from cyclosporine. May affect the GI absorption of other orally administered drugs as a result of effect on GI motility. May exaggerate hypotension during general anesthesia. ↑ risk of tardive dyskinesia, extrapyramidal reactions, or neuromalignant syndrome with antipsychotic agents; avoid concurrent use. Strong CYP2D6 inhibitors, including bupropion, fluoxetine, paroxetine, or quinidine may ↑ levels and risk of extrapyramidal reactions; ↓ metoclopramide dose. Opioids and anticholinergics may antagonize the GI effects of metoclopramide. Use cautiously with MAO inhibitors (causes release of catecholamines). May ↑ neuromuscular blockade from succinylcholine. May ↓ effectiveness of levodopa. May ↑ tacrolimus serum levels.
how to give: PO, IM, or IV
patient teaching: take as directed, no alcohol or other CNS depressants during this time, parents-read the label correctly, educate about drowsiness–don’t drive, risk of extrapyramidal symptoms CNS: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME, anxiety, bradykinesia, cog-wheel rigidity, depression, irritability, tardive dyskinesia, tremor. CV: arrhythmias (supraventricular tachycardia, bradycardia), hypertension, hypotension. Endo: gynecomastia, hyperprolactinemia. GI: constipation, diarrhea, dry mouth, nausea. Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis.
assessments and labs: no labs found per DDG.
Zofran
indications: prevention and treatment of postoperative nausea and vomiting.
Blocks the effects of serotonin at 5-HT3 receptor sites (selective antagonist) located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS. Therapeutic Effects: Decreased incidence and severity of nausea and vomiting following chemotherapy or surgery.
Compazine
moa: depressant action on chemoreceptor trigger zone, thereby controlling severe nausea and vomiting. can also be used as an antipsychotic for schizophrenia.
indications: nonpsychotic anxiety, severe n/v, schizophrenia.
contraindications: hypersensitivity to phenothiazines in the past, children under 20 pounds or 2 years of age, pts in comatose states, pediatric surgery, use with large doses of CNS depressant, (barbiturates/alcohol)
side effects: CNS: Neuroleptic Malignant Syndrome, extrapyramidal reactions, sedation, tardive dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: EEG changes, hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug induced hepatitis, ileus. GU: pink or brown discoloration of urine, urinary retention. Derm: photosensitivity, pigment change, rashes. Endo: galactorrhea. HEMAT: agranulocytosis, leukopenia. METAB: hyperthermia. Misc: allergic reaction.
more common side effects: agitation, chest pain, constipation, diarrhea, difficulty swallowing, dizziness, drowsiness, dry mouth, loss of appetite, stomach pain, unpleasant breath odor.
serious: prolonged QT interval, tardive dyskinesia.
Drug-Drug: Additive hypotension with antihypertensives, nitrates, or acute ingestion of alcohol. Additive CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, sedative/hypnotics, or general anesthetics. Additive anticholinergic effects with other drugs possessing anticholinergic properties, including antihistamines, some antidepressants, atropine, haloperidol, and other phenothiazines. Lithium ↑ risk of extrapyramidal reactions. May mask early signs of lithium toxicity. ↑ risk of agranulocytosis with antithyroid agents. ↓ beneficial effects of levodopa. Antacids may ↓ absorption.
Drug/natural products: contaminant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression. ↑ anticholinergic effects with angel’s trumpet, jimsonweed, and scopolia.
Route/Dosage:
nursing implications: Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
Assess for falls risk
Lab Test Considerations: CBC and liver function tests should be evaluated periodically during therapy. May cause blood dyscrasias, especially between wk 4 and 10 of therapy. Hepatotoxicity is more likely to occur between wk 2 and 4 of therapy. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy.
