Module 5 Flashcards
Sodium Bicarbonate
MOA
Dissociates to provide ion to neutralize ion concentration which raised blood and urinary pH.
Also increases concentration of Na in plasma
Sodium bicarbonate
Indications
Metabolic acidosis
Hyponatremia
Sodium bicarbonate
Side effects
Edema, cerebral hemorrhage, electrolyte abnormalities, metabolic alkalosis, flatulence, tetany, pulmonary edema, heart failure exacerbation
Sodium bicarbonate
Nursing considerations
PO ONLY!
Monitor cardiac ABGs and electrolytes
Give 1-3 hours before or after meals
Lots of drug interactions if given with anything that includes Na
Potassium chloride (KCl)
MOA
Adds K and Cl
Potassium chloride (KCl)
Indications
Treat/prevent K depletions when dietary measures fail
Hypokalemia
Potassium chloride (KCl)
Side effects
Renal failure
May cause phlebitis, N/V, GI ulcers, bleeding
Potassium chloride (KCl)
Nursing Considerations
Pt must have urine output!!!Never give IV Push!!!!!!
IV must be given slowly!!! 10-20 mEq/hr
PO must be diluted to lower GI distress, tastes awful, very large pills
Think Potassium (K) think
Heart
Sodium polystyrene sulfonate (Kayexalate)
MOA
Binds to K in digestive tract replacing K ions for Na ions. Potential to drop K by 0.5-1.0 mEq/L in 4-6 hrs
Sodium polystyrene sulfonate (Kayexalate)
Indications
Hyperkalemia
Sodium polystyrene sulfonate (Kayexalate)
Side effects
Constipation, N/V/D, hypokalemia
Serious- intestinal obstruction or necrosis
Sodium polystyrene sulfonate (Kayexalate)
Nursing Considerations
Pt must have normal bowel functions
Pt will poop a lot!!!
D50/insulin
MOA
Shifts K into the cells temporarily
D50/insulin
Indications
Hyperkalemia
D50/insulin
Side effects
Hypokalemia
D50/insulin
Nursing considerations
For emergencies!!!!!
Check glucose levels before and after administering
Called a Lytic cocktail
Magnesium sulfate & magnesium oxide
MOA
Replaces magnesium
Magnesium sulfate & magnesium oxide
Indications
Hypomagnesemia
Prevent/treat seizures I. Pre-eclampsia, treat cardiac rhythm disturbances
Constipation
Magnesium sulfate & magnesium oxide
Side effects
Hypermagnesemia
Presents as confusion, sluggish, slow movements, SOA, nausea, dizzy (from low calcium) and abnormal heart rhythm
Magnesium sulfate & magnesium oxide
Nursing considerations
Can burn when given by IV
Mag Oxide (antacid) can be give for long term low mag
Think Magnesium think
Muscle and movement
Think sodium (Na) think
Brain
Calcium (Ca)
MOA
Replaces calcium
Calcium (Ca)
Indications
Hypocalcemia
Calcium (Ca)
Side effects
Hypercalcemia
Acts like a sedative, fatigue, lethargy, confusion, weakness, leading to seizures and coma, can also cause kidneys stones
Calcium (Ca)
Nursing considerations
IV - given thru central line
Oral - elemental, calcium carbonate (tums), may also need vitamin D
Phosphate
MOA
Replaces phosphate
Phosphate
Indications
Hypophosphatemia
Phosphate
Side effects
Increased risk of calcifications
Take care with CVD or Hypercalcemia
Phosphate
Nursing considerations
IV/Oral - given over a long time
Increase oral intake
Calcium & phosphate are linked oppositely
Low calcium = high phosphate
High calcium = low phosphate
nystatin (Mycostatin)
Class
Polyene
nystatin (Mycostatin)
Indication
Treatment of superficial candida infections of mouth (thrush), oral mucosa, vagina & skin
nystatin (Mycostatin)
Side effects
Toxic if given parental
Mild skin irritation, N/V/D when given orally w poor GI absorption
nystatin (Mycostatin)
Nursing considerations
Many forms - creams, powder, topical, vaginal, liquid (swish & spit or swish & swallow)
amphotericin B
Class
Polyene
amphotericin B
MOA
Bind to ergosterol in fungal cell membranes & cause then to become leaky & destroys cell wall of the fungus
amphotericin B
Indications
Agent of choice for most systemic mycoses
amphotericin B
Side effects
Hard on Kidneys
amphotericin B
Nursing considerations
Route: PO or parental (usually IV)
MUST be diluted & infused slowly
Monitor BUN & creatine
Pt must be on cardiac monitor
Given every other day for several months (7 weeks to leave body)
Pretreat w diphenhydramine, acetaminophen or aspirin to decrease infusion symptoms : fever, pain, nausea & headache
flucytosine (Ancobon)
Class
Pyrimidine
flucytosine (Ancobon)
MOA
Inhibits fungal DNA synthesis
flucytosine (Ancobon)
Indication
Allows for a lower dose of amphotericin B to be used
flucytosine (Ancobon)
Nursing considerations
Helps decrease the side effects related to amphotericin B.
Rarely given alone
fluconazole (Diflucan)
Class
Azole
fluconazole (Diflucan)
MOA
Interrupts the integrity of the cell wall by interfering w the synthesis of ergosterol
fluconazole (Diflucan)
Indications
Used for both superficial and less serious systemic fungal infections
fluconazole (Diflucan)
Side effects
Topical - redness, burning, itching
Systemic- severe GI upset N/V/D, liver toxicity
fluconazole (Diflucan)
Nursing Considerations
Monitor AST & ALT for liver function
Take with food
Wait 2 hrs before or after admin to give antacids. Needs acidic environment to absorb
grisefulvicin (Fulvicin)
MOA
Inhibits fungal mitosis by binding to keratin. Has no effect on cell wall
grisefulvicin (Fulvicin)
Indications
Resistant dermatophyte infection of scalp, ski. & nails
grisefulvicin (Fulvicin)
Side effects
Bone marrow suppression, rash, CNS changes, N/V/D, anorexia
grisefulvicin (Fulvicin)
Nursing consideration
Inexpensive older drug
filgrastim (Neupogen)
Class
Hematopoietic agent
filgrastim (Neupogen)
MOA
Promotes proliferation, differentiation, activation of cells that make granulocytes
filgrastim (Neupogen)
Indications
Malignancies, chemo induced leukopenia, bone marrow transplant, harvesting of hematopoietic stem cells, chronic neutropenia
filgrastim (Neupogen)
Side effects
Bone pain
Leukocytosis
filgrastim (Neupogen)
Nursing considerations
IV or subq (most frequent)
Drug is made with recombinant DNA tech
pegfgrastim (Neulasta)
Class
Hematopoietic agent
pegfgrastim (Neulasta)
MOA
Increased production of neutrophils
pegfgrastim (Neulasta)
Indications
Malignancies, chemo induced leukopenia, bone marrow transplant, harvesting of hematopoietic stem cells, chronic neutropenia
pegfgrastim (Neulasta)
Side effects
Bone pain
pegfgrastim (Neulasta)
Nursing considerations
Subq
Pegylated = delayed excretion by kidneys
Long acting version of filgrastim