Meds Flashcards
Alteplase (t-PA)
Alteplase (t-PA)
class: thrombolytics
Indication: MI, acute ischemic stroke, occluded central lines
Action: converts plasminogen to plasmin which degrades the fibrin found
Nursing Considerations:
- contraindicated in active bleeding
-monitor for anaphylaxis
- use caution with uncontrolled hypertension
Atorvastatin
Atorvastatin (Lipitor)
class: lipid-lowering agent
Indication: management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease
Action: lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation
Nursing Considerations
- contraindicated in active liver disease
- may cause rhabdomyolysis
- monitor serum cholesterol
- monitor liver function tests, renal function
Lipitor
Atorvastatin (Lipitor)
class: lipid-lowering agent
Indication: management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease
Action: lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation
Nursing Considerations
- contraindicated in active liver disease
- may cause rhabdomyolysis
- monitor serum cholesterol
- monitor liver function tests, renal function
Acetaminophen
Acetaminophen (Tylenol)
class: antipyretic, non-opioid analgesic
Indication: pain, fever
Action: inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response
Nursing Considerations:
- do not exceed 4g of acetaminophen per day
- overdose will lead to hepatotoxicity
- Acetadoteis the antidote for overdose
- may increase risk for bleed with warfarin therapy
Tylenol
Acetaminophen (Tylenol)
class: antipyretic, non-opioid analgesic
Indication: pain, fever
Action: inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response
Nursing Considerations:
- do not exceed 4g of acetaminophen per day
- overdose will lead to hepatotoxicity
- Acetadoteis the antidote for overdose
- may increase risk for bleed with warfarin therapy
Acyclovir
Acyclovir (Zovirax)
class: antiviral, purine analogues
Indication:genital herpes, herpes zoster, chicken pox
Action: interferes with viral DNA synthesis
Nursing Considerations:
- may cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea
- monitor renal function
- assess lesions
- instruct patient to use proper protection during sexual intercourse
Zovirax
Acyclovir (Zovirax)
class: antiviral, purine analogues
Indication:genital herpes, herpes zoster, chicken pox
Action: interferes with viral DNA synthesis
Nursing Considerations:
- may cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea
- monitor renal function
- assess lesions
- instruct patient to use proper protection during sexual intercourse
Proventil
Albuterol (Proventil)
class: bronchodilator ,adrenergic
Indication:bronchodilator used to prevent airway obstruction in asthma and COPD
Action: binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways
Nursing Considerations:
- may decrease the effectiveness of Beta Blockers
-use caution with: heart disease, diabetes, glaucoma, seizure disorder
- overuse of inhalers can lead to bronchospasm
- monitor for chest pain and palpitations
- can decrease digoxin levels
Albuterol
Albuterol (Proventil)
class: bronchodilator ,adrenergic
Indication:bronchodilator used to prevent airway obstruction in asthma and COPD
Action: binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways
Nursing Considerations:
- may decrease the effectiveness of Beta Blockers
-use caution with: heart disease, diabetes, glaucoma, seizure disorder
- overuse of inhalers can lead to bronchospasm
- monitor for chest pain and palpitations
- can decrease digoxin levels
Alendronate
Alendronate (Fosamax)
class: bone resorption inhibitor, biphosphnates
Indication: osteoporosis (aging, menopause, corticosteroid induced)
Action: inhibits osteoclast activity leading to inhibition of resorption of bone
Nursing Considerations:
- take first thing in the morning with full glass of water 30 min prior to eating
- assess serum calcium and vitamin D
- may lead to muscle pain
Fosamax
Alendronate (Fosamax)
class: bone resorption inhibitor, biphosphnates
Indication: osteoporosis (aging, menopause, corticosteroid induced)
Action: inhibits osteoclast activity leading to inhibition of resorption of bone
Nursing Considerations:
- take first thing in the morning with full glass of water 30 min prior to eating
- assess serum calcium and vitamin D
- may lead to muscle pain
Alprazolam
Alprazolam (Xanax)
class: benzodiazepine, anti-anxiety agent
Indication:anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis
Action: works in CNS to produce anxiolytic effect causing CNS depression.
Nursing Considerations:
- may cause CNS depression, drowsiness, lethargy
- may lead to physical dependence
- assess anxiety and mental status
- Flumazenil is the antidote for overdose
- Grapefruit juice may increase blood levels
Xanax
Alprazolam (Xanax)
class: benzodiazepine, anti-anxiety agent
Indication:anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis
Action: works in CNS to produce anxiolytic effect causing CNS depression.
Nursing Considerations:
- may cause CNS depression, drowsiness, lethargy
- may lead to physical dependence
- assess anxiety and mental status
- Flumazenil is the antidote for overdose
- Grapefruit juice may increase blood levels
Amiodarone
Amiodarone (Cordarone)
class: Antiarrhythmic class III, Potassium channel blocker
Indication: ventricular arrhythmias, SVT, ACLS protocol for v-fib and vTACH
Action: prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation
Nursing Considerations:
- may lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension
- increases risk for QT prolongation
- increases digoxin levels
- increases activity of warfarin
- monitor EKG
- assess for signs and symptoms of ARDS
- monitor liver function test
- check dosage with another RN
- avoid drinking grapefruit juice
Cordarone
Amiodarone (Cordarone)
class: Antiarrhythmic class III, Potassium channel blocker
Indication: ventricular arrhythmias, SVT, ACLS protocol for v-fib and vTACH
Action: prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation
Nursing Considerations:
- may lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension
- increases risk for QT prolongation
- increases digoxin levels
- increases activity of warfarin
- monitor EKG
- assess for signs and symptoms of ARDS
- monitor liver function test
- check dosage with another RN
- avoid drinking grapefruit juice
Amitryptiline
Amitryptiline (Elavil)
class: tricyclic antidepressant
Indication: depression, anxiety, insomnia
Action: increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects
Nursing Considerations:
- contraindicated in MI, heart failure, QT prolongation, glaucoma
- may increase risk for suicidal ideation
- may cause arrhythmias, hypotension, EKG changes
- may cause alterations in blood glucose levels
- may lead to general sedation and lethargy
- do not use within 2 weeks of MAOIs
- monitor for orthostatic hypotension
- may lead to photosensitivity, instruct patient to use sunscreen
- may turn urine blue/green color
Elavil
Amitryptiline (Elavil)
class: tricyclic antidepressant
Indication: depression, anxiety, insomnia
Action: increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects
Nursing Considerations:
- contraindicated in MI, heart failure, QT prolongation, glaucoma
- may increase risk for suicidal ideation
- may cause arrhythmias, hypotension, EKG changes
- may cause alterations in blood glucose levels
- may lead to general sedation and lethargy
- do not use within 2 weeks of MAOIs
- monitor for orthostatic hypotension
- may lead to photosensitivity, instruct patient to use sunscreen
- may turn urine blue/green color
Amlodipine
Amlodipine (Norvasc)
class: Ca channel blocker, antihypertensive
Indication: hypertension, angina
Action: blocks transport of calcium into muscle cells inhibiting excitation and contraction
Nursing Considerations:
- may cause gingival hyperplasia
- grapefruit juice may increase drug level
- monitor blood pressure and pulse
- monitor intake and output
- assess for signs of CHF
- assess characteristics of angina
- instruct patient of interventions for hypertension and how to take BP
Norvasc
Amlodipine (Norvasc)
class: Ca channel blocker, antihypertensive
Indication: hypertension, angina
Action: blocks transport of calcium into muscle cells inhibiting excitation and contraction
Nursing Considerations:
- may cause gingival hyperplasia
- grapefruit juice may increase drug level
- monitor blood pressure and pulse
- monitor intake and output
- assess for signs of CHF
- assess characteristics of angina
- instruct patient of interventions for hypertension and how to take BP
Amoxicillin
Amoxicillin (Moxatag)
class: anti-infectives, antiulcer agent, aminopenicillins
Indication: skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lime disease
Action: Inhibits synthesis of bacterial cell wall leading to cell death.
Nursing Considerations:
- Contraindicated with penicillin allergy
- may cause seizures
- assess for rash, anaphylaxis
- excreted by kidneys - monitor renal labs
- monitor patient for diarrhea - bloody stool should be reported immediately
Moxatag
Amoxicillin (Moxatag)
class: anti-infectives, antiulcer agent, aminopenicillins
Indication: skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lime disease
Action: Inhibits synthesis of bacterial cell wall leading to cell death.
Nursing Considerations:
- Contraindicated with penicillin allergy
- may cause seizures
- assess for rash, anaphylaxis
- excreted by kidneys - monitor renal labs
- monitor patient for diarrhea - bloody stool should be reported immediately
Ampicillin
Ampicillin (Principen)
class: aminopenicillin, anti-infective
Indication: skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia
Action: bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death
Nursing Considerations:
- contraindicated in penicillin allergy, use caution in renal insufficiency
- may lead to seizures, diarrhea, anaphylaxes, super infection
- monitor liver function tests
- instruct patient on signs of super infection: fury over growth on tongue, vaginal itching, loose and foul smelling stool
- pt should not use with oral contraceptive use.
Principen
Ampicillin (Principen)
class: aminopenicillin, anti-infective
Indication: skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia
Action: bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death
Nursing Considerations:
- contraindicated in penicillin allergy, use caution in renal insufficiency
- may lead to seizures, diarrhea, anaphylaxes, super infection
- monitor liver function tests
- instruct patient on signs of super infection: fury over growth on tongue, vaginal itching, loose and foul smelling stool
- pt should not use with oral contraceptive use.
Atenolol
Atenolol (Tenormin)
class: beta blocker,
antianginal, antihypertensive
Indication: hypertension, angina, prevention of MI
Action: blocks the stimulation of beta1 receptors in the SNS with minimal effect on beta2 receptors
Nursing Considerations:
- Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block
- monitor hemodynamic parameters (HR, BP)
- May cause bradycardia, CHF, pulmonary edema
- Masks symptoms associated with diabetes mellitus
- advise to change positions slowly to prevent orthostatic hypotension
- instruct patient on how to take blood pressure
Tenormin
Atenolol (Tenormin)
class: beta blocker,
antianginal, antihypertensive
Indication: hypertension, angina, prevention of MI
Action: blocks the stimulation of beta1 receptors in the SNS with minimal effect on beta2 receptors
Nursing Considerations:
- Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block
- monitor hemodynamic parameters (HR, BP)
- May cause bradycardia, CHF, pulmonary edema
- Masks symptoms associated with diabetes mellitus
- advise to change positions slowly to prevent orthostatic hypotension
- instruct patient on how to take blood pressure
Atropine
Atropine
class: antiarrhythmic, anticholinergic, antimuscarinic
Indication: decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm
Action: Atropine is an anticholinergic which means that it inhibits the effects of the parasympathetic nervous system, specifically acetylcholine. This inhibition causes increase in HR, bronchodilation, decreased GI and respiratory secretions.
Nursing Considerations:
- Avoid in acute hemorrhage, tachycardia, and angle closure glaucoma
- monitor patient for tachycardia and palpitations
- may cause urinary retention in elderly patients
- patients may experience constipation due to slowed GI motility
Azithromycin
Azithromycin (Zithromax)
class: agents for atypical mycobacterium, anti-infectives
Indication: URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis
Action: inhibits bacterial protein synthesis
Nursing Considerations:
-may lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema
- may increase risks for warfarin toxicity
- monitor patient for signs of anaphylaxis
- instruct patient to notify physician for diarrhea, or blood or pus in stool
- instruct patient to take medication exactly as prescribed
Zithromax
Azithromycin (Zithromax)
class: agents for atypical mycobacterium, anti-infectives
Indication: URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis
Action: inhibits bacterial protein synthesis
Nursing Considerations:
-may lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema
- may increase risks for warfarin toxicity
- monitor patient for signs of anaphylaxis
- instruct patient to notify physician for diarrhea, or blood or pus in stool
- instruct patient to take medication exactly as prescribed
Benzotropine
Benzotropine (Cogentin)
class: Anticholinergic, Antiparkinson agent
Indication: anticholinergic properties in the CNS to reduce rigidity and tremors
Action: treatment for Parkinson’s disease,
Nursing Considerations:
- may lead to arrhythmias, hypotension, palpitations, and tachycardia
- anticholinergic effects like constipation, dry mouth
- assess for extrapyramidal symptoms
- instruct patient to take as directed
- instruct patient to maintain good oral hygiene
Cogentin
Benzotropine (Cogentin)
class: Anticholinergic, Antiparkinson agent
Indication: anticholinergic properties in the CNS to reduce rigidity and tremors
Action: treatment for Parkinson’s disease,
Nursing Considerations:
- may lead to arrhythmias, hypotension, palpitations, and tachycardia
- anticholinergic effects like constipation, dry mouth
- assess for extrapyramidal symptoms
- instruct patient to take as directed
- instruct patient to maintain good oral hygiene
Bismuth Subsalicylate
Bismuth Subsalicylate (Kaopectate, Pepto-Bismol)
class: antidiarrheal, antiulcer
Indication: diarrhea, heartburn, indigestion, H. pylori associated ulcer
Action: Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins
Nursing Considerations:
-contraindicated in aspirin hypersensitivity
- increase risk for impaction with geriatric and pediatric patients
- monitor liver profile
- bismuth may interfere with radiologic exams
Kaopectate
Bismuth Subsalicylate (Kaopectate, Pepto-Bismol)
class: antidiarrheal, antiulcer
Indication: diarrhea, heartburn, indigestion, H. pylori associated ulcer
Action: Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins
Nursing Considerations:
-contraindicated in aspirin hypersensitivity
- increase risk for impaction with geriatric and pediatric patients
- monitor liver profile
- bismuth may interfere with radiologic exams
Ducolax
Biscodyl (Ducolax)
class: stimulant laxatives
Indication: treatment of constipation, bowel regimen
Action: stimulates peristalsis leads to fluid accumulation in the colon
Nursing Considerations:
-may lead to hypokalemia
- may cause abdominal pain and cramps
- use caution with milk
- assess for abdominal distention and bowel function
- instruct patient to drink 1500-2000 mL/day during therapy
- monitor fluid and electrolyte levels
- instruct patient to take as ordered
Biscodyl
Biscodyl (Ducolax)
class: stimulant laxatives
Indication: treatment of constipation, bowel regimen
Action: stimulates peristalsis leads to fluid accumulation in the colon
Nursing Considerations:
-may lead to hypokalemia
- may cause abdominal pain and cramps
- use caution with milk
- assess for abdominal distention and bowel function
- instruct patient to drink 1500-2000 mL/day during therapy
- monitor fluid and electrolyte levels
- instruct patient to take as ordered
Pepto-Bismol
Bismuth Subsalicylate (Kaopectate, Pepto-Bismol)
class: antidiarrheal, antiulcer
Indication: diarrhea, heartburn, indigestion, H. pylori associated ulcer
Action: Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins
Nursing Considerations:
-contraindicated in aspirin hypersensitivity
- increase risk for impaction with geriatric and pediatric patients
- monitor liver profile
- bismuth may interfere with radiologic exams
Buspirone
Buspirone (BuSpar)
class: Antidepressants, smoking deterrents
Indication:management of anxiety
Action: relieves anxiety by binding to dopamine and serotonin receptors
Nursing Considerations:
- do not administer concurrently with MOAI or grapefruit juice
- may lead to dizziness, drowsiness, fatigue, and weakness
- patient may experience chest pain, palpitations, tachycardia
- instruct patient to take as directed
- instruct patient to avoid alcohol and other CNS depressants
Bupropion
Bupropion (Wellbutrin)
class: Antidepressants, smoking deterrents
Indication: depression, smoking cessation, treat ADHD in adults
Action:
Nursing Considerations:
- may lead to seizures, suicidal thoughts
- do not administer if patient is taking MAOI
- use caution with renal and liver impairment
- assess mental status
- instruct patient to avoid alcohol while taking bupropion
Wellbutrin
Bupropion (Wellbutrin)
class: Antidepressants, smoking deterrents
Indication: depression, smoking cessation, treat ADHD in adults
Action:
Nursing Considerations:
- may lead to seizures, suicidal thoughts
- do not administer if patient is taking MAOI
- use caution with renal and liver impairment
- assess mental status
- instruct patient to avoid alcohol while taking bupropion
BuSpar
Buspirone (BuSpar)
class: Antidepressants, smoking deterrents
Indication:management of anxiety
Action: relieves anxiety by binding to dopamine and serotonin receptors
Nursing Considerations:
- do not administer concurrently with MOAI or grapefruit juice
- may lead to dizziness, drowsiness, fatigue, and weakness
- patient may experience chest pain, palpitations, tachycardia
- instruct patient to take as directed
- instruct patient to avoid alcohol and other CNS depressants
Butorphanol
Butorphanol (Stadol)
class: Opioid Analgesic
Indication: moderate to severe pain, labor pain, sedation
Action: alters perception and response to pain by biding to opiate receptors in CNS
Nursing Considerations:
-use caution with concurrent use of MAOIs
- may cause confusion, hallucinations, sedation
- monitor for CNS depression
- assess blood pressure pulse and respirations during administration
- administer slowly through IV line
Stadol
Butorphanol (Stadol)
class: Opioid Analgesic
Indication: moderate to severe pain, labor pain, sedation
Action: alters perception and response to pain by biding to opiate receptors in CNS
Nursing Considerations:
-use caution with concurrent use of MAOIs
- may cause confusion, hallucinations, sedation
- monitor for CNS depression
- assess blood pressure pulse and respirations during administration
- administer slowly through IV line
PhosLo
Calcium acetate (PhosLo)
class: antacids
Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD
Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation
Nursing Considerations:
- may cause cardiac arrest and arrhythmias
- phlebitis at site of insertion
- monitor hemodynamics
- may causes hypotension, bradycardia, and arrhythmias
- hypercalcemia can increase risk for digoxin toxicity
- administer slowly
- instruct pt on foods that contain Vitamin D and encourage adequate intake.
- monitor parathyroid hormone
Calcium acetate
Calcium acetate (PhosLo)
class: antacids
Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD
Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation
Nursing Considerations:
- may cause cardiac arrest and arrhythmias
- phlebitis at site of insertion
- monitor hemodynamics
- may causes hypotension, bradycardia, and arrhythmias
- hypercalcemia can increase risk for digoxin toxicity
- administer slowly
- instruct pt on foods that contain Vitamin D and encourage adequate intake.
- monitor parathyroid hormone
Calcium carbonate
Calcium carbonate (Tums / Rolaids)
class: antacids
Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, used as antacid
Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation
Nursing Considerations:
- may cause cardiac arrest and arrhythmias
- monitor hemodynamics
- may causes hypotension, bradycardia, and arrhythmias
- hypercalcemia can increase risk for digoxin toxicity
- instruct pt on foods that contain Vitamin D and encourage adequate intake.
- monitor parathyroid hormone
Tums / Rolaids
Calcium carbonate (Tums / Rolaids)
class: antacids
Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, used as antacid
Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation
Nursing Considerations:
- may cause cardiac arrest and arrhythmias
- monitor hemodynamics
- may causes hypotension, bradycardia, and arrhythmias
- hypercalcemia can increase risk for digoxin toxicity
- instruct pt on foods that contain Vitamin D and encourage adequate intake.
- monitor parathyroid hormone
Captopril
Captopril (Capoten)
class: ACE Inhibitor, antihypertensives
Indication: hypertension, management of CHF, decrease progression of DM neuropathy
Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
Nursing Considerations:
- can cause neutropenia - check WBCs regularly
- use cautiously with potassium supplements and potassium sparing diuretics.
- use cautiously with diuretic therapy
- administer 1 hour before meals
- monitor blood pressure often
- monitor weight and fluid status
- monitor renal profile
- monitor CBC frequently
- May lead to Rhabdomyolysis
- Dry cough
Capoten
Captopril (Capoten)
class: ACE Inhibitor, antihypertensives
Indication: hypertension, management of CHF, decrease progression of DM neuropathy
Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
Nursing Considerations:
- can cause neutropenia - check WBCs regularly
- use cautiously with potassium supplements and potassium sparing diuretics.
- use cautiously with diuretic therapy
- administer 1 hour before meals
- monitor blood pressure often
- monitor weight and fluid status
- monitor renal profile
- monitor CBC frequently
- May lead to Rhabdomyolysis
- Dry cough
Carbamazepine
Carbamazepine (Tegretol)
class: Anticonvulsant
Indication: seizures, DM neuropathy, pain associated with trigeminal neuralgia
Action: affects Na channels in neurons leading to decreased synaptic transmission
Nursing Considerations:
- interferes with oral contraceptives
- do not use with MAOIs
- may cause suicidal thoughts
- may cause Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, thrombocytopenia
- do not consume grapefruit juice while taking this medication
- monitor CBC and platelet count
- monitor serum blood levels of medication often
Tegretol
Carbamazepine (Tegretol)
class: Anticonvulsant
Indication: seizures, DM neuropathy, pain associated with trigeminal neuralgia
Action: affects Na channels in neurons leading to decreased synaptic transmission
Nursing Considerations:
- interferes with oral contraceptives
- do not use with MAOIs
- may cause suicidal thoughts
- may cause Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, thrombocytopenia
- do not consume grapefruit juice while taking this medication
- monitor CBC and platelet count
- monitor serum blood levels of medication often
Carbidopa
Carbidopa / Levodopa (Sinemet)
class: Antiparkinson agent, Dopamine Agonist
Indication: Parkinson’s disease
Action: levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa
Nursing Considerations:
- may cause orthostatic hypotension
- may cause dark urine
- weeks to months to take effect
- do not use with MAOIs
- don’t use with glaucoma, melanoma
- assess for parkinsonian symptoms
- instruct patient to take as directed
Levodopa
Carbidopa / Levodopa (Sinemet)
class: Antiparkinson agent, Dopamine Agonist
Indication: Parkinson’s disease
Action: levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa
Nursing Considerations:
- may cause orthostatic hypotension
- may cause dark urine
- weeks to months to take effect
- do not use with MAOIs
- don’t use with glaucoma, melanoma
- assess for parkinsonian symptoms
- instruct patient to take as directed
Sinemet
Carbidopa / Levodopa (Sinemet)
class: Antiparkinson agent, Dopamine Agonist
Indication: Parkinson’s disease
Action: levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa
Nursing Considerations:
- may cause orthostatic hypotension
- may cause dark urine
- weeks to months to take effect
- do not use with MAOIs
- don’t use with glaucoma, melanoma
- assess for parkinsonian symptoms
- instruct patient to take as directed
Cefaclor
Cefaclor (Ceclor)
class: Cephalosporin 2nd generations
Indication: treatment of respiratory tract infections, skin infections, otitis media
Action: bacteriacidal, binds to bacterial cell wall causing cell death
Nursing Considerations:
contraindicated in cephalosporin and possibly penicillin allergies
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- may lead to super infection
Ceclor
Cefaclor (Ceclor)
class: Cephalosporin 2nd generations
Indication: treatment of respiratory tract infections, skin infections, otitis media
Action: bacteriacidal, binds to bacterial cell wall causing cell death
Nursing Considerations:
contraindicated in cephalosporin and possibly penicillin allergies
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- may lead to super infection
Cefdinir
Cefdinir (Omnicef)
class: Cephalosporin 2nd generations
Indication: treatment of skin infections, otitis media
Action: bactericidal, binds to bacterial cell wall causing cell death
Nursing Considerations:
- contraindicated in cephalosporin and possibly penicillin allergies
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- monitor for bleeding
- may lead to super infection
Omnicef
Cefdinir (Omnicef)
class: Cephalosporin 2nd generations
Indication: treatment of skin infections, otitis media
Action: bactericidal, binds to bacterial cell wall causing cell death
Nursing Considerations:
- contraindicated in cephalosporin and possibly penicillin allergies
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- monitor for bleeding
- may lead to super infection
Celecoxib
Celecoxib (Celebrex)
class: antirrheumatics/NSAID
Indication: osteoarthritis, rheumatoid arthritis, acute pain
Action: decreases pain and inflammation by inhibiting synthesis of prostaglandins
Nursing Considerations:
- use caution with cardiovascular disease
- increases risk for MI, CVA, thrombosis
- may cause GI bleeding, Stevens-Johnson syndrome, dermatitis
- notify provider for new-onset abdominal pain or black stool
Celebrex
Celecoxib (Celebrex)
class: antirrheumatics/NSAID
Indication: osteoarthritis, rheumatoid arthritis, acute pain
Action: decreases pain and inflammation by inhibiting synthesis of prostaglandins
Nursing Considerations:
- use caution with cardiovascular disease
- increases risk for MI, CVA, thrombosis
- may cause GI bleeding, Stevens-Johnson syndrome, dermatitis
- notify provider for new-onset abdominal pain or black stool
Cephalexin
Cephalexin (Keflex)
class: Cephalosporin 1st generations
Indication: skin infections, pneumonia, UTI, otitis media
Action: bactericidal: binds to bacterial cell wall leading to cell death
Nursing Considerations:
- contraindicated with cephalosporin and serious penicillin allergies.
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- may lead to super infection
- may cause elevated liver enzymes
Keflex
Cephalexin (Keflex)
class: Cephalosporin 1st generations
Indication: skin infections, pneumonia, UTI, otitis media
Action: bactericidal: binds to bacterial cell wall leading to cell death
Nursing Considerations:
- contraindicated with cephalosporin and serious penicillin allergies.
- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
- Assess infection and allergies
- obtain cultures prior to therapy
- monitor bowel function
- may lead to super infection
- may cause elevated liver enzymes
Chlorpromazine
Chlorpromazine (Thorazine)
class: Antipsychotic, antiemetic
Indication:second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op sedation, acute intermittent porphyria, headache, bipolar
Action: exhibits anticholinergic activity, alters effects of dopamine in CNS
Nursing Considerations:
- may cause neuroliptic malignant syndrome, sedation, tardive dyskineisa, hypotenstion, agranulocytosis
- assess mental status prior to and during treatment
- monitor blood pressure
- ensure patient is taking medication
- monitor CBC and liver function tests
- instruct patient not to skip doses or double dose
Thorazine
Chlorpromazine (Thorazine)
class: Antipsychotic, antiemetic
Indication:second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op sedation, acute intermittent porphyria, headache, bipolar
Action: exhibits anticholinergic activity, alters effects of dopamine in CNS
Nursing Considerations:
- may cause neuroliptic malignant syndrome, sedation, tardive dyskineisa, hypotenstion, agranulocytosis
- assess mental status prior to and during treatment
- monitor blood pressure
- ensure patient is taking medication
- monitor CBC and liver function tests
- instruct patient not to skip doses or double dose
Cimetidine
Cimetidine (Tagamet)
class: Histamine H2 antagonist, antiulcer agent
Indication: treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome, prevention of GI bleeding in critical patients.
Action: inhibits action of histamine leading to inhibition of gastric acid secretion
Nursing Considerations:
- increases serum level of warfarin
- can lead to respiratory infection (green sputum)
- monitor for arryhtmias
- may cause agranulocytosis, aplastic anemia
- monitor CBC during therapy
- take medication as directed
- instruct patient to increase fluid and fiber intake to decrease constipation
Tagamet
Cimetidine (Tagamet)
class: Histamine H2 antagonist, antiulcer agent
Indication: treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome, prevention of GI bleeding in critical patients.
Action: inhibits action of histamine leading to inhibition of gastric acid secretion
Nursing Considerations:
- increases serum level of warfarin
- can lead to respiratory infection (green sputum)
- monitor for arryhtmias
- may cause agranulocytosis, aplastic anemia
- monitor CBC during therapy
- take medication as directed
- instruct patient to increase fluid and fiber intake to decrease constipation
Ciprofloxacin
Ciprofloxacin (Cipro)
class: Fluoroquinolone, anti-infectives
Indication: urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections
Action: inhibits bacterial DNA synthesis
Nursing Considerations:
- contraindicated in allergies
- may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
- can cause seizures, arrythmias, pseudomembranous colitis, anaphalaxis, Stevens Johnson
syndrome
- may decreased of phenytoin
- monitor renal panel
- assess for infection, obtain cultures prior to therapy
- monitor liver function tests
Cipro
Ciprofloxacin (Cipro)
class: Fluoroquinolone, anti-infectives
Indication: urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections
Action: inhibits bacterial DNA synthesis
Nursing Considerations:
- contraindicated in allergies
- may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
- can cause seizures, arrythmias, pseudomembranous colitis, anaphalaxis, Stevens Johnson
syndrome
- may decreased of phenytoin
- monitor renal panel
- assess for infection, obtain cultures prior to therapy
- monitor liver function tests
Clindamycin
Clindamycin (Cleocin)
class: Anti-infectives
Indication: skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis
Action: inhibits protein synthesis
Nursing Considerations:
- arrythmias, pseudomembranous colitis, diarrhea, phlebitis
- monitor bowel function
- assess for infection, obtain cultures prior to therapy
- monitor liver function tests.
- monitor CBC
Cleocin
Clindamycin (Cleocin)
class: Anti-infectives
Indication: skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis
Action: inhibits protein synthesis
Nursing Considerations:
- arrythmias, pseudomembranous colitis, diarrhea, phlebitis
- monitor bowel function
- assess for infection, obtain cultures prior to therapy
- monitor liver function tests.
- monitor CBC
Clopidogrel
Clopidogrel (Plavix)
class: Antiplatelet agent
Indication: atherosclerotic events, MI, CVA, PVD, acute coronary syndrome
Action:
Nursing Considerations:
- may cause GI bleeding, neutropenia, hypercholesterolemia
- may increase risk for bleeding in warfarin, aspirin, heparin
- can increase risk for bleeding with garlic, ginkgo, ginger
- monitor for signs of bleeding
- monitor bleeding times
- monitor CBS and platelet count
- discontinue use 5-7 days before surgery
Plavix
Clopidogrel (Plavix)
class: Antiplatelet agent
Indication: atherosclerotic events, MI, CVA, PVD, acute coronary syndrome
Action:
Nursing Considerations:
- may cause GI bleeding, neutropenia, hypercholesterolemia
- may increase risk for bleeding in warfarin, aspirin, heparin
- can increase risk for bleeding with garlic, ginkgo, ginger
- monitor for signs of bleeding
- monitor bleeding times
- monitor CBS and platelet count
- discontinue use 5-7 days before surgery
Codeine
Codeine (Paveral)
class: opioid agonist
Indication: management of pain, diarrhea, cough suppressant
Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.
Nursing Considerations:
- may cause alterations in mentation, hypotension, constipation, nausea, vomiting
- assess BP, pulse, and respiratory rate prior to administration and frequently during
administration
- use caution if patient is receiving MAO Inhibitors
- Narcan (naloxone) is the antidote for opioid agonists
Paveral
Codeine (Paveral)
class: opioid agonist
Indication: management of pain, diarrhea, cough suppressant
Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.
Nursing Considerations:
- may cause alterations in mentation, hypotension, constipation, nausea, vomiting
- assess BP, pulse, and respiratory rate prior to administration and frequently during
administration
- use caution if patient is receiving MAO Inhibitors
- Narcan (naloxone) is the antidote for opioid agonists
Cortisone
Cortisone (Cortone)
class: antiasthmatics, corticosteroids
Indication: management of adrenocortical insufficiency (Addison’s Disease).
Action: Replace cortisol in states of deficiency, suppress inflammation and normal immune response.
Nursing Considerations:
- Excreted by the liver - monitor liver profile
- Avoid in active untreated infections
- may cause CNS alterations
- may cause peptic ulcers
- may cause Cushingoid appearance (buffalo hump, moon face)
- Weight gain
- Osteoporosis
- Decrease wound healing
- May elevate blood sugars
- May increase cholesterol and lipid values
Cortone
Cortisone (Cortone)
class: antiasthmatics, corticosteroids
Indication: management of adrenocortical insufficiency (Addison’s Disease).
Action: Replace cortisol in states of deficiency, suppress inflammation and normal immune response.
Nursing Considerations:
- Excreted by the liver - monitor liver profile
- Avoid in active untreated infections
- may cause CNS alterations
- may cause peptic ulcers
- may cause Cushingoid appearance (buffalo hump, moon face)
- Weight gain
- Osteoporosis
- Decrease wound healing
- May elevate blood sugars
- May increase cholesterol and lipid values
Cyclosporine
Cyclosporine (Sandimmune)
class: immunosuppresants, antirheumatics (DMARD)
Indication: prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis
Action: inhibits normal immune response
Nursing Considerations:
-may cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia
- increases immune suppression with corticosteroids
- avoid grapefruit juice while taking this medications
- assess for signs of organ rejection
- monitor renal panel, liver enzymes
- take medication as directed
- lifelong therapy required for transplant patients
- instruct pt on how to take blood pressure
Sandimmune
Cyclosporine (Sandimmune)
class: immunosuppresants, antirheumatics (DMARD)
Indication: prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis
Action: inhibits normal immune response
Nursing Considerations:
-may cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia
- increases immune suppression with corticosteroids
- avoid grapefruit juice while taking this medications
- assess for signs of organ rejection
- monitor renal panel, liver enzymes
- take medication as directed
- lifelong therapy required for transplant patients
- instruct pt on how to take blood pressure
Dexamethasone
Dexamethasone (Decadron)
class: antiasthmatics, corticosteroids
Indication:Manage cerebral edema, assess for Cushing’s Disease
Action: Suppress inflammation and normal immune response. Used in inflammatory states to decrease inflammation.
Nursing Considerations:
-Excreted by the liver
- monitor liver profile
- Avoid in active untreated infections
- may cause CNS alterations
- may cause peptic ulcers
- may cause Cushingoid appearance (buffalo hump, moon face)
- Weight gain
- Osteoporosis
- Decrease wound healing
- May elevate blood sugars
- May increase cholesterol and lipid values
Decadron
Dexamethasone (Decadron)
class: antiasthmatics, corticosteroids
Indication:Manage cerebral edema, assess for Cushing’s Disease
Action: Suppress inflammation and normal immune response. Used in inflammatory states to decrease inflammation.
Nursing Considerations:
-Excreted by the liver
- monitor liver profile
- Avoid in active untreated infections
- may cause CNS alterations
- may cause peptic ulcers
- may cause Cushingoid appearance (buffalo hump, moon face)
- Weight gain
- Osteoporosis
- Decrease wound healing
- May elevate blood sugars
- May increase cholesterol and lipid values
Diazepam
Diazepam (Valium)
class: Benzodiazepine
Indication: anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal
Action: depresses the CNS
Nursing Considerations:
- contraindicated in hepatic dysfunction
- use caution with renal impairment
- can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance
- instruct patient to take as directed
- caution to avoid alcohol use
- Romazicon is the reversal agent
Valium
Diazepam (Valium)
class: Benzodiazepine
Indication: anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal
Action: depresses the CNS
Nursing Considerations:
- contraindicated in hepatic dysfunction
- use caution with renal impairment
- can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance
- instruct patient to take as directed
- caution to avoid alcohol use
- Romazicon is the reversal agent
Digoxin
Digoxin (Lanoxin)
class: antiarrhythmic, inotropics
Indication: CHF, A-fib, A-flutter
Action: Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate.
Nursing Considerations:
- Excreted by kidneys
- Assess patient for hypersensitivity
- Contraindicated with uncontrolled ventricular arryhtmias
- Hypokalemia increase risk for toxcicity
- Hypercalcemia ↑ risk for toxicity
- Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to
toxicity
- Assess patient for cardiac arrythmias including bradycardia
- Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances)
- Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)
Lanoxin
Digoxin (Lanoxin)
class: antiarrhythmic, inotropics
Indication: CHF, A-fib, A-flutter
Action: Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate.
Nursing Considerations:
- Excreted by kidneys
- Assess patient for hypersensitivity
- Contraindicated with uncontrolled ventricular arryhtmias
- Hypokalemia increase risk for toxcicity
- Hypercalcemia ↑ risk for toxicity
- Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to
toxicity
- Assess patient for cardiac arrythmias including bradycardia
- Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances)
- Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)
Diltiazem
Diltiazem (Cardizem)
class: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive
Indication: hypertension, angina, SVT, a-fib, aflutter
Action: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure.
Nursing Considerations:
- contraindicated in 2nd and 3rd AV block
- may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia
- increases digoxin levels
- don’t drink grapefruit juice
- assess for signs of CHF
- monitor EKG continuously
- tell patient to change positions slowly
- monitor serum potassium
- instruct pt on how to take blood pressure
Cardizem
Diltiazem (Cardizem)
class: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive
Indication: hypertension, angina, SVT, a-fib, aflutter
Action: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure.
Nursing Considerations:
- contraindicated in 2nd and 3rd AV block
- may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia
- increases digoxin levels
- don’t drink grapefruit juice
- assess for signs of CHF
- monitor EKG continuously
- tell patient to change positions slowly
- monitor serum potassium
- instruct pt on how to take blood pressure
Diphenhydramine
Diphenhydramine (Benadryl)
class: antihistamine, antitussive
Indication: allergy, anaphylaxis, sedation, motion sickness, antitussive
Action: antagonizes effects of histamine, CNS depression
Nursing Considerations:
-may cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache
- anticholinergic effects
- assess purpose of medication prior to giving it
- assess allergies, sleep patterns, cough and lung sounds
- patient should avoid other over-the-counter cough and cold remedies
Benadryl
Diphenhydramine (Benadryl)
class: antihistamine, antitussive
Indication: allergy, anaphylaxis, sedation, motion sickness, antitussive
Action: antagonizes effects of histamine, CNS depression
Nursing Considerations:
-may cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache
- anticholinergic effects
- assess purpose of medication prior to giving it
- assess allergies, sleep patterns, cough and lung sounds
- patient should avoid other over-the-counter cough and cold remedies
Diphenoxylate
Diphenoxylate / Atropine (Lomotil)
class: anticholinergic, antidiarrheal
Indication: Treatment for diarrhea
Action: Inhibits GI motility via anticholinergic effects
Nursing Considerations:
- Contraindicated with angle-closure glaucoma, dehydration
- Structurally related to opioids so use caution with patients that have allergies to opioids
- Side effects: constipation, tachycardia, dizziness, ileus
- Monitor liver function as medication is excreted by the liver
- Insure that client is taking medication as prescribed and not double dosing
Atropine
Diphenoxylate / Atropine (Lomotil)
class: anticholinergic, antidiarrheal
Indication: Treatment for diarrhea
Action: Inhibits GI motility via anticholinergic effects
Nursing Considerations:
- Contraindicated with angle-closure glaucoma, dehydration
- Structurally related to opioids so use caution with patients that have allergies to opioids
- Side effects: constipation, tachycardia, dizziness, ileus
- Monitor liver function as medication is excreted by the liver
- Insure that client is taking medication as prescribed and not double dosing
Lomotil
Diphenoxylate / Atropine (Lomotil)
class: anticholinergic, antidiarrheal
Indication: Treatment for diarrhea
Action: Inhibits GI motility via anticholinergic effects
Nursing Considerations:
- Contraindicated with angle-closure glaucoma, dehydration
- Structurally related to opioids so use caution with patients that have allergies to opioids
- Side effects: constipation, tachycardia, dizziness, ileus
- Monitor liver function as medication is excreted by the liver
- Insure that client is taking medication as prescribed and not double dosing
Divalproex
Divalproex (Depakote)
class: Anticonvulsant, vascular headache suppressants
Indication: seizures, manic episodes, prevention of headache
Action: increases the level of GABA in CNS
Nursing Considerations:
- may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis
- increases risk for bleeding with Warfarin
- use caution with MAOIs
- monitor liver function tests
Depakote
Divalproex (Depakote)
class: Anticonvulsant, vascular headache suppressants
Indication: seizures, manic episodes, prevention of headache
Action: increases the level of GABA in CNS
Nursing Considerations:
- may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis
- increases risk for bleeding with Warfarin
- use caution with MAOIs
- monitor liver function tests
Dobutamine
Dobutamine (Dobutrex)
class: beta-adrenergic agonist, inotropic
Indication: short term management of heart failure
Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart.
Nursing Considerations:
- Monitor hemodynamics: hypertension, ↑HR, PVCs
- Skin reactions may occur with hypersensitivity
- Beta blockers may negate therapeutic effects of dobutamine
- Monitor cardiac output
- Monitor peripheral pulses before, during, and after therapy
- DO NOT confuse dobutamine with dopamine
Dobutrex
Dobutamine (Dobutrex)
class: beta-adrenergic agonist, inotropic
Indication: short term management of heart failure
Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart.
Nursing Considerations:
- Monitor hemodynamics: hypertension, ↑HR, PVCs
- Skin reactions may occur with hypersensitivity
- Beta blockers may negate therapeutic effects of dobutamine
- Monitor cardiac output
- Monitor peripheral pulses before, during, and after therapy
- DO NOT confuse dobutamine with dopamine
Dopamine
Dopamine (Intropin)
class: inotropic, vasopressor, adrenergic
Indication: used to improve blood pressure, cardiac output, and urine output
Action:
-Smaller doses result in renal vasodilation
-Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors
-Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR)
Nursing Considerations:
-Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available
- Obtain parameters for hemodynamic values
- Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)
- Irritation may occur at IV site
- Beta blockers may counteract therapeutic effects
Intropin
Dopamine (Intropin)
class: inotropic, vasopressor, adrenergic
Indication: used to improve blood pressure, cardiac output, and urine output
Action:
-Smaller doses result in renal vasodilation
-Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors
-Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR)
Nursing Considerations:
-Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available
- Obtain parameters for hemodynamic values
- Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)
- Irritation may occur at IV site
- Beta blockers may counteract therapeutic effects
Enalapril
Enalapril (Vasotec)
class: ACE Inhibitor, antihypertensives
Indication: hypertension, management of CHF
Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
Nursing Considerations:
- can cause neutropenia - check WBCs regularly
- use cautiously with potassium supplements and potassium sparing diuretics.
- use cautiously with diuretic therapy
- administer 1 hour before meals
- monitor blood pressure often
- monitor weight and fluid status
- monitor renal profile
- monitor CBC frequently
- dry cough
Vasotec
Enalapril (Vasotec)
class: ACE Inhibitor, antihypertensives
Indication: hypertension, management of CHF
Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
Nursing Considerations:
- can cause neutropenia - check WBCs regularly
- use cautiously with potassium supplements and potassium sparing diuretics.
- use cautiously with diuretic therapy
- administer 1 hour before meals
- monitor blood pressure often
- monitor weight and fluid status
- monitor renal profile
- monitor CBC frequently
- dry cough
Enoxaparin
Enoxaparin (Lovenox)
class: antithrombotic
Indication: prevention of VTE, DVT, and PE
Action: prevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin
Nursing Considerations:
- contraindicated in pork hypersensitivity
- monitor for signs of bleeding
- administer in subcutaneous tissue
- DO NOT eject air bubble prior to injection
- DO NOT aspirate or massage site
Lovenox
Enoxaparin (Lovenox)
class: antithrombotic
Indication: prevention of VTE, DVT, and PE
Action: prevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin
Nursing Considerations:
- contraindicated in pork hypersensitivity
- monitor for signs of bleeding
- administer in subcutaneous tissue
- DO NOT eject air bubble prior to injection
- DO NOT aspirate or massage site
Adrenalin
Epinephrine (Adrenalin, EpiPen)
class: adrenergic agonist, antiasthmatic, bronchodilator, vasopressor
Indication: Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct
Action: Affects both beta1 and beta2 also has alpha agonist properties. Results in bronchodilation, increases in HR and BP
Nursing Considerations:
- Side effects include: angina, tachycardia, hypertension, restlessness, nervousness, hyperglycemia
- Use with MAOI may lead to hypertensive crisis
- Patients should not use stimulants (caffeine, guarana, etc)
- Excessive use may cause bronchospasm
- Assess lung sounds, pulse, BP, and other hemodynamic parameters
- Monitor for chest pain
- Instruct patient to use as directed
- Patient should insure adequate fluid intake to liquefy secretions
- Mouth should be rinsed after inhalation
- Beta blocker may negate effects
- May increase blood glucose levels
Epinephrine
Epinephrine (Adrenalin, EpiPen)
class: adrenergic agonist, antiasthmatic, bronchodilator, vasopressor
Indication: Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct
Action: Affects both beta1 and beta2 also has alpha agonist properties. Results in bronchodilation, increases in HR and BP
Nursing Considerations:
- Side effects include: angina, tachycardia, hypertension, restlessness, nervousness, hyperglycemia
- Use with MAOI may lead to hypertensive crisis
- Patients should not use stimulants (caffeine, guarana, etc)
- Excessive use may cause bronchospasm
- Assess lung sounds, pulse, BP, and other hemodynamic parameters
- Monitor for chest pain
- Instruct patient to use as directed
- Patient should insure adequate fluid intake to liquefy secretions
- Mouth should be rinsed after inhalation
- Beta blocker may negate effects
- May increase blood glucose levels
Epoetin
Epoetin (Epogen)
class: antianemics, hormones
Indication anemia
Action: stimulates erythropoesis
Nursing Considerations:
- contraindicated in albumin hypersensitivity
- may cause seizures, CHF, MI, CVA, HTN
- monitor blood pressure during therapy
- monitor for signs of anemia
- assess dialysis shunts
- monitor bleeding times
- initiate seizure precautions
- do not shake vial
Epogen
Epoetin (Epogen)
class: antianemics, hormones
Indication anemia
Action: stimulates erythropoesis
Nursing Considerations:
- contraindicated in albumin hypersensitivity
- may cause seizures, CHF, MI, CVA, HTN
- monitor blood pressure during therapy
- monitor for signs of anemia
- assess dialysis shunts
- monitor bleeding times
- initiate seizure precautions
- do not shake vial
Erythromycin
Erythromycin (E-Mycin)
class: macrolide, anti-infective
Indication useful in place of penicillin when patient cannot take penicillin, upper and lower respiratory tract infections, otitis media, skin infections, pertussis, syphilis, rheumatic fever
Action: suppresses bacterial protein synthesis, bacteriostatic
Nursing Considerations:
- Causes QT prolongation, ventricular arrhythmias
- diarrhea
- asses infection
- monitor liver function tests
- instruct patient to finish medication dosage even if they are feeling better
- medication should not be shared
Escitalopram
Escitalopram (Lexapro)
class: SSRI, antidepressant
Indication major depressive disorder, anxiety disorder, PCD, PTSD, social phobia
Action: selectively inhibits reuptake of serotonin
Nursing Considerations:
-contraindicated with MAOI
- may cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea, serotonin syndrome
- may cause QT prolongation with certain medications
- assess for sexual dysfunction
- may take 4-6 weeks for full affect to take place
Lexapro
Escitalopram (Lexapro)
class: SSRI, antidepressant
Indication major depressive disorder, anxiety disorder, PCD, PTSD, social phobia
Action: selectively inhibits reuptake of serotonin
Nursing Considerations:
-contraindicated with MAOI
- may cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea, serotonin syndrome
- may cause QT prolongation with certain medications
- assess for sexual dysfunction
- may take 4-6 weeks for full affect to take place
Famotidine
Famotidine (Pepcid)
class: Histamine H2 antagonist
Indication short term treatment of active ulcer, GERD, treatment of heartburn, indigestion, management of Zollinger Ellison syndrome, prevention of GI bleeding in critically ill patients, management of symptoms associated with overuse of NSAIDs
Action: blocks action of histamine located in gastric parietal cells, inhibits gastric acid secretion
Nursing Considerations:
- may cause arrythmias, agranulocytosis, aplastic anemias
- assess for abdominal pain and occult blood
- monitor CBC
- instruct pt to increase fluid and fiber intake to prevent constipation
Pepcid
Famotidine (Pepcid)
class: Histamine H2 antagonist
Indication short term treatment of active ulcer, GERD, treatment of heartburn, indigestion, management of Zollinger Ellison syndrome, prevention of GI bleeding in critically ill patients, management of symptoms associated with overuse of NSAIDs
Action: blocks action of histamine located in gastric parietal cells, inhibits gastric acid secretion
Nursing Considerations:
- may cause arrythmias, agranulocytosis, aplastic anemias
- assess for abdominal pain and occult blood
- monitor CBC
- instruct pt to increase fluid and fiber intake to prevent constipation
Fentanyl
Fentanyl (Sublimaze)
class: Opioid Analgesic
Indication supplement to general anesthesia, continuous IV infusion for purpose of analgesia
Action: binds to opiate receptors in CNS altering perception of pain, producing CNS depression
Nursing Considerations:
- use caution with increased ICP, head trauma, adrenal insufficiency
- avoid use with MAOIs
- may cause apnea, laryngospasm, decreased respirations, bradycardia, hypotension
- do not consume grapefruit while taking this medication
- monitor hemodynamics during administration
- assess patient pain scale frequently
Sublimaze
Fentanyl (Sublimaze)
class: Opioid Analgesic
Indication supplement to general anesthesia, continuous IV infusion for purpose of analgesia
Action: binds to opiate receptors in CNS altering perception of pain, producing CNS depression
Nursing Considerations:
- use caution with increased ICP, head trauma, adrenal insufficiency
- avoid use with MAOIs
- may cause apnea, laryngospasm, decreased respirations, bradycardia, hypotension
- do not consume grapefruit while taking this medication
- monitor hemodynamics during administration
- assess patient pain scale frequently
Ferrous sulfate
Ferrous sulfate (Feosol)
class: iron supplements
Indication prevention and treatment of iron-deficiency anemia
Action: Iron is essential for hemoglobin, myoglobin and enzymes, it is transported to organs where it becomes part of iron stores
Nursing Considerations:
- may cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis
- assess nutritional status, bowel function
- monitor hemoglobin, hematocrit, iron levels
- may cause elevated liver enzymes
- take on an empty stomach to increase absorption/vitamin c helps with absorption
- use z-track for IM injections
Feosol
Ferrous sulfate (Feosol)
class: iron supplements
Indication prevention and treatment of iron-deficiency anemia
Action: Iron is essential for hemoglobin, myoglobin and enzymes, it is transported to organs where it becomes part of iron stores
Nursing Considerations:
- may cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis
- assess nutritional status, bowel function
- monitor hemoglobin, hematocrit, iron levels
- may cause elevated liver enzymes
- take on an empty stomach to increase absorption/vitamin c helps with absorption
- use z-track for IM injections
Fluoxetine
Fluoxetine (Prozac)
class: SSRI, antidepressant
Indication depressive disorder, OCD, bulimia, panic disorder, bipolar, anorexia, ADHD, DM neuropathy, obesity
Action: inhibits reuptake of serotonin
Nursing Considerations:
- do not use while taking MAOIs
- may cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction, insomnia, palpitations
- monitor closely for serotonin syndrome
- concurrent use with certain medications may lead to QT prolongation
- monitor mood changes and assess for suicidal ideation
- monitor nutrition status
- may cause elevated liver enzymes
- instruct pt to maintain good oral hygiene
Prozac
Fluoxetine (Prozac)
class: SSRI, antidepressant
Indication depressive disorder, OCD, bulimia, panic disorder, bipolar, anorexia, ADHD, DM neuropathy, obesity
Action: inhibits reuptake of serotonin
Nursing Considerations:
- do not use while taking MAOIs
- may cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction, insomnia, palpitations
- monitor closely for serotonin syndrome
- concurrent use with certain medications may lead to QT prolongation
- monitor mood changes and assess for suicidal ideation
- monitor nutrition status
- may cause elevated liver enzymes
- instruct pt to maintain good oral hygiene
Fluticasone
Fluticasone (Flovent)
class: corticosteroids, anti-asthmatics, anti-inflammatory (steroid)
Indication prophylactic asthma treatment
Action: locally acting anti-inflammatory
Nursing Considerations:
- use cautiously with untreated infections and suppressed immune function
- may cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression
- monitor patient’s respiratory status
- may lead to decreased bone density
- instruct patients using corticosteroids and bronchodilators that they need to use
bronchodilators first.
- instruct patient to stop smoking
Flovent
Fluticasone (Flovent)
class: corticosteroids, anti-asthmatics, anti-inflammatory (steroid)
Indication prophylactic asthma treatment
Action: locally acting anti-inflammatory
Nursing Considerations:
- use cautiously with untreated infections and suppressed immune function
- may cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression
- monitor patient’s respiratory status
- may lead to decreased bone density
- instruct patients using corticosteroids and bronchodilators that they need to use
bronchodilators first.
- instruct patient to stop smoking
Furosemide
Furosemide (Lasix)
class: loop diuretics
Indication edema, hypertension
Action: prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium.
Nursing Considerations:
- use caution with liver disease
- may cause hypotension, dry mouth, excessive urination, dehydration, electrolyte abnormalities,
metabolic alkalosis
- hypokalemia may lead to increase risk of digoxin toxicity
- monitor renal panel
- use caution with other anithypertensives
- causes arthritic symptoms/do not administer with aminoglycosides due to ototoxicity
Lasix
Furosemide (Lasix)
class: loop diuretics
Indication edema, hypertension
Action: prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium.
Nursing Considerations:
- use caution with liver disease
- may cause hypotension, dry mouth, excessive urination, dehydration, electrolyte abnormalities,
metabolic alkalosis
- hypokalemia may lead to increase risk of digoxin toxicity
- monitor renal panel
- use caution with other anithypertensives
- causes arthritic symptoms/do not administer with aminoglycosides due to ototoxicity
Gabapentine
Gabapentine (Neurontin)
class: analgesic adjuncts, therapeutic, anticonvulsants, mood stabilizers
Indication seizures, peripheral neuropathy, neuropathic pain, prevention of migraines
Action: exact method of action unknown
Nursing Considerations:
- may cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial edema, hypertension
- monitor pt closely for changes in behavior and depression
- assess seizure activity
- assess pain level
- patient should take medications exactly as prescribed
