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NR 105 Drugs Flashcards

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1
Q

Codeine

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.
  • Indication- To treat mild pain to moderate pain. To treat cough from mechanical or chemical irritation of respiratory system
  • Side effect/Adverse reaction- CNS- sedation, dizziness CV- bradycardia, hypotension EENT- blurred visioin, dry mouth GI- constipation, nausea, vomiting GU- urine retention, urinary hesitancy RESP- respiratory depression, apnea SKIN- flushing, urticaria, pruritis
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2
Q

Codeine

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Opioid analgesic
  • Assessment/Implementation/Evaluation- Assess type, location, and intensity of pain before and 1 hr after administration. Assess blood pressure, pulse, respiration before and periodically after administration. Notify prescriber immediately if respiratory rate drops below 10 breaths/min. Assess urine output to detect retention. Assess bowel function routinely due to constipation. Decrease in severity of pain without a significant alteration in LOC or respiratory status.
  • Patient teaching- Take exactly as prescribed. Avoid alcohol and other CNS depressants during drug therapy. To minimize nausea, suggest that patient take with food. Avoid potential hazardous activities during morphine therapy. report shortness of breath or difficulty breathing. Change position slowly.
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3
Q

Morphine

Main action, Indication, Side effect/Adverse reaction

A
  • Main action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli whil producing generalized CNS depression.
  • Indication- Relieve acute or chronic moderate to severe pain. Pulmonary edema. Pain associated with MI.
  • Side effect/Adverse reaction- CNS- sedation, dizziness CV- bradycardia, hypotension EENT- blurred visioin, dry mouth GI- constipation, nausea, vomiting GU- urine retention, urinary hesitancy RESP- respiratory depression, apnea SKIN- flushing, urticaria, pruritis
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4
Q

Morphine

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Opioid analgesic
  • Assessment/Implementation/Evaluation- Assess type, location, and intensity of pain before and 1 hr after administration. Assess blood pressure, pulse, respiration before and periodically after administration. Notify prescriber immediatelyif respiratory rate drops below 10 breaths/min. Assess urine output to detect retention. Assess bowel function routinely due to constipation. Decrease in severity of pain without a significant alteration in LOC or respiratory status.
  • Patient teaching- Take exactly as prescribed. Avoid alcohol and other CNS depressants during drug therapy. To minimize nausea, suggest that patient take with food. Avoid potential hazardous activities during morphine therapy. report shortness of breath or difficulty breathing. Change position slowly.
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5
Q

Asprin

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Produce analgesia and reduce inflammation and fever by inhibiting the production of prostglandins.
  • Indication- Inflammatory disorders including: rheumatoid arthritis, osteoarthritis, mild to moderate pain, fever. Prophylaxis of TIA and MI.
  • Side effect/Adverse reaction- Confusion, hearing loss, tinnitus, GI bleeding, heartburn, hepatotoxicity, thrombocytopeni a, prolonged bleeding time, Reye’s syndrome.
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6
Q

Asprin

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Nonsteroidal Anti-Inflammatory Drug (NSAID’s)
  • Assessments/Implementation/Evaluation- Don’t crush timed release of controlled release asprin unless directed. Ask about tinnitus,This reaction usually occurs whenblood asprin levels reaches or exceeds maximum for therapeutic effect. Effective in treatment for mild to moderate pain.
  • Patient teaching- Advise patients not to give to a child or adolescent with chicken pox or flu symptoms because of risk of rye’s syndrome. Advise adult patient taking low dose asprin not to take ibuprofen because it may reduce the cardioprotective and stroke preventative effects of ASA. instruct patient to take ASA with food or after meals because it may cause GI upset. Tell patient to consult doctor before taking ASA with any prescription drug for blood disorder, diabetes, gout, or arthritis.
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7
Q

Motrin (Ibuprofen)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Nonsteroidal Anti-inflamatory Drug
  • Assessments/implementation/Evaluation- Use with extreme caution in patients with a history of ulcer disease or GI bleeding. Elderly are at greater risk for GI problems. Give drug with food. Drug may causehypertensionor worsen it. NSAIDs increase risk of events such as MI and stroke. Control of mild to moderate pain, fever, and various inflammatory conditions.
  • Patient teaching- instruct patient to take with full glass of water. Take drug with food or after meals. Urge patient to not take more than prescribed. Advise patient to avoid taking two different NSAIDs at the same time, unless directed. Urge patient to avoid alcohol, asprin, and corticosteroids whiletaking this med unless prescribed. Advise patient to report flulike symptoms, rash, signs of GI bleeding, swelling, vision changes, and weight change.
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8
Q

Motrin (Ibuprofen)

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- The basic mechanism of the pharmacological actions of ibuprofen, like other NSAIDs, has not been precisely determined. It is generally thought to be related to the inhibition of prostyglandin synthesis.
  • Indication- To relieve pain in rhumatoid arthritis and osteoarthritis. To relieve mild to moderate pain. To relieve acute migraine pain. To relieve minor aches, pains, and to deduce fever dysmenorrhea.
  • Side effect/Adverse reaction- Epigastric discomfort, GI bleeding, hepatic failure, thrombocytopenia, anemia, prolonged bleeding time, and bronchospasms.
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9
Q

Tylenol (Acetominophen)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- NOT AN NSAID
  • Assessments/Implementation/Evaluation- Before and during long-term therapy, monitor liver function and renal function tests. Expect to reduce dosage for patient with renal dysfunction. Effective in treatment of mild to moderate pain.
  • Patient teaching- Read manufacturers label and follow doseage guidelines precisely. Teach patient to recognize the signs of hepatotoxicity, such as bleeding, easy bruising, and malaise.
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10
Q

Tylenol (Acetominophen)

Main action, Indication, Side effects/Adverse reaction

A
  • Main action- Also acts directly on temperature regulating center in the hypothalamus.
  • Indication- To relieve mild to moderate pain associated with headache, muscle ache, backache, minor arthritis, common cold, toothache, reduce fever, and mentrual cramps. Interferes with pain impulse generation.
  • Side effects/Adverse reaction- Abdominal pain, hepatotoxicity, thrombocytopenia, and jaundice.
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11
Q

Isoniazid (INH)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Antituberculars.
  • Assessments/Implementation/Evaluation- Liver function tests (AST, ALT, & serum bilirubin) before and periodically throughout therapy. May be administered with food or antacids if GI irritation occurs. Resolution of signs and symptoms of tuberculosis. Negative sputum cultures. Prevention of activation of tuberculosis in persons known to have been exposed.
  • Patient teaching- Complete and continue drug therapy even when TB symptoms are gone. Avoid use of alcohol. Emphasize regular follow-up. Notify health care provider if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, dark urine, excessive fatigue, numbness and tingling occur in extremities.) Emphasize importance of regular follow up.
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12
Q

Isonizaid (INH)

Main action, Indication, Side effect/Adverse reaction

A
  • Main action- Inhibits mycobacterial wall synthesis and metabolism.
  • Indication- First line therapy of active tuberculosis, in combination with other agents. Prevention of tuberculosis in patients exposed to active disease.
  • Side effect/Adverse reaction- Drug induces hepatitis, peripheral neuropathy.
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13
Q

Pyridoxine (Vitamin B6)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Water soluble vitamins/vitamins.
  • Assessments/Implementation/Evaluation- Assess for signs of vitamin B6 deficiency (anemia, dermatitis, irritability, seizures, nausea, vomiting.) Decrease in the symptoms of vitamin B6 deficiency.
  • Patient teaching- Do not take more pyridoxine than is prescribed for you or than is directed on the package. Encourage patients to comply with diet recommendations. Foods high in vitamin B6 include bananas, whole-grain cereals, potatoes, lima beans, and meats. Emphasize the imprtance of follow-up exams to evaluate progress.
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14
Q

Pyridoxine (Vitamin B6)

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Required for amino acid, carbohydrate, and lipid metabolism. Preventions of pyridoxine deficiency. Prevention or reversal of neuropathy associated with isoniazid therapy.
  • Indication- Treatment and prevention of neuropathy which may develop from isoniazid, penicillamine, or hydralazine therapy.
  • Side effect/Adverse reaction- Adverse reactions listed are seen with excessive doses only: numbness, paresthesias, unsteady gait.
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15
Q

Metronidazole (Flagyl)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Antidiarrheal.
  • Assessments/Implementation/Evaluation- Obtain specimins for culture and sensitivity before initiating therapy. Administer on an empty stomach, or may administer with food or milk to minimize GI irritation. Resolution of the signs and symptoms of infections. Length of time for complete resolution depends on organism and site of infection.
  • Patient Teaching- Instruct patient to take medication exactly as directed. Do not skip or double missed doses. May cause unpleasant metallic taste. May cause urine to darken. Consult health care professional of no improbements in a ‘few’ days. Caution use of alcohol during treatment. May cause dizziness and light headedness.
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16
Q

Metronidazole (Flagyl)

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Disrupts DNA and protein synthesis in susceptible organisms. Most notable for activity against anaerobic bacteria, including bacteroides, clostridium.
  • Indication- Management of amebic dysentery (see also antiulcer info).
  • Side effect/Adverse reaction- Seizures, dizziness, headache, abdominal pain, anorexia, nausea.
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17
Q

Dipenoxylate/Atropine(Lomotil)

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Antidiarrheal.
  • Assessments/Implementation/Evaluation- Assess the frequency and consistency of stools and bowel sound prior to and throughout therapy. Assess patients fluid and electrolyte balance and skin turgor for dehydration. Risk of dependance increases with high-dose, long-term use. Decrese in diarrhea.
  • Patient Teaching- Instruct patient to avoid alcohol and other CNS depressants. Take medications exactly as directed. May cause drowsiness.
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18
Q

Dipenoxylate/Atropine (Lomotil)

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Inhibits excess GI motility. Decresed GI motility with subsequent decrease of diarrhea.
  • Indication- Adjunctive therapy in the treatment of diarrhea.
  • Side effect/Adverse reaction- Dizziness, confusiton, constapation, blurred vision, dry mouth, urinary retention.
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19
Q

Psyllium (Metamucil) Bulk Forming Agents

Classification, Assessments/Implementation/Evaluation, Patient teaching

A
  • Classification- Laxatives.
  • Assessments/Implementation/Evaluation- Assess patient for abdominal distention, presence of bowel sounds, and usaul pattern of bowel function. Administer with a full glass of water or juice, followed by an additional glass of liquid. A soft-formed bowel movement usaually within 12-24 hr. May require 3 days of therapy for results.
  • Patient Teaching- Encourage patient to use other forms of bowel regulation, such as increasing bulk in diet, increasing fluid intake, and increasing mobility.
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20
Q

Psyllium (Metamucil) Bulk Forming Agents

Main action, Indication, Side effect/Adverse reaction

A
  • Main Action- Combines with water in the intestinal contents to form and emollient gel or viscous solution that promotes peristalsis and reduces transit time.
  • Indication- Management of simple or chronic constipation, particularly if associated with a low-fiber diet.
  • Side effect/Adverse reaction- Cramps, constipation.
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21
Q

Bisacodyl (Dulcolax) Stimulant Laxative

Main Action, Indication, Side Effects/Adverse Reactions

A
  • Main Action - Stimulate peristalsis, alters fluid and electrolyte transport, peoducing fluis accumulation in the colon
  • Indication - Treatment of constipation
  • Side Effects/Adverse Reaction - Abdominal cramps, nausea
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22
Q

Bisacodyl (Dulcolax) Stimulant Laxative

Therapeutic Classification, Assessments/Implementation/Evaluation, Patient Teaching

A
  • Therapeutic Classification- Laxatives
  • Assessments/Implementation/Evaluation- Assess patient for abdominal distention, presence of bowel sounds and usual pattern of bowel function./May be administered at bedtime for morning results. Take on an empty stomach; will produce more rapid results. Take with a full glass of water./The patient having a soft formed bowel movement when used for constipation.
  • Patient Teaching- Advise patients that laxatives should be used only for short term therapy. Increase fluid intake 1500-2000 mL/day during therapy. Encourage other forms of bowel regulation. Do not use when experiencing abdominal pain, nausea, vomiting or fever is present.
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23
Q

Docusate (Colace) Stool Softener

Therapeutic Classification, Assessment/Implementation/Evaluation, Patient Teaching

A
  • Therapeutic Classification - Laxatives
  • Assessments/Implementation/Evaluation - Assess patient for abdominal distention, presence of bowel sounds and usual pattern of bowel function./Administer with a full glass of water. Do not administer within two hours of other laxatives./A soft formed bowel usually within 24-48 hours.
  • Patient Teaching - Advise patients that laxatives should be used only for short term therapy. Long term therapy may cause electrolyte imbalance and dependence. Encourage other forms of bowel regulation. Do not use when experiencing abdominal pain, nausea, vomiting or fever is present.
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24
Q

Docusate (Colace) Stool Softener

Main Action, Indication, Side Effect/Adverse Reaction

A
  • Main Action - Promotes incorporation of water into stool resulting in softer fecal mass.
  • Indication - Prevention of constipation (in patients who should avoid straining)
  • Side Effects/Adverse Reaction - Mild cramps
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25
**_Ondansetron (Zofran)_** Main Action, Indication, Side Effect/Adverse Reaction
* **Main Action** -Blocks serotonin receptors in the intestine. This action reduces nausea and vomiting by preventing serotonin release in the small intestine. * **Indication** - Prevention of nausea and vomiting associated with chemotherapy or radiation therapy. Prevent postoperative nausea and vomiting. * **Side Effect/Adverse Reaction** - Headaches, constipation, diarrhea, dizziness, drowsiness, dry mouth and extrapyramidal reactions.
26
**_Ondansetron (Zofran)_** Therapeutic Classification, Assessmnent/Implementation/Evaluation, Patient Teaching
* **Therapeutic Classification** - Antiemetic * **Assessments/Implementation/Evaluation** - Assess patient for nausea, vomiting, abdominal distention and bowel sounds prior to and following administration. Assess patient for extrapyramidal effects periodically during therapy./Prevention of nausea and vomiting due to chemotherapy, postoperative issues and radiation therapy. * **Patient Teaching** - Take med as directed. Advise patient to notify health care professional immediately if involuntary movement of eyes, face or limbs occurs.
27
**_Metoclopramide (Reglan)_** Main Action, Indication, Side Effect/Adverse Reaction
* **Main Action** - Acts centrally and peripherally on dopamine receptors to reduce nausea and vomiting. * **Indication** - To stimulate motility of and increase the tone of gastric contractions of the upper GI tract and to prevent emesis. * **Side Effect/Adverse Reaction** - 10-20 % of patients experience CNS side effects ranging from anxiety to hallucinations. Extrapyramidal side effect including tremor and dyskinesia similar to Parkinson's Disease may also occur.
28
**_Metoclopramide (Reglan)_** Therapeutic Classification, Assessment/Implementation/Evaluation, Patient Teaching
* **Therapeutic Classification** - Antiemetic * **Assessments/Implementation/Evaluation** - Assess nausea, vomiting, bowel sounds and abdominal pain before and after administration of this drug. Monitor intake and output. Assess for signs of dehydration. Stay balert for depression and other adverse CNS effects./Prevention or decreased severity of nausea and vomiting, vertigo or motion sickness. * **Patient Teaching** - Tell patient to take 30 minutes before meals. Instruct patient to report involuntary movements of face, eyes or limbs. May cause drowsiness. Inform patient that med may cause dry mouth. Caution patient to avoid alcohol and other CN depressants when using this med.
29
**_Omeprazole (Prilosec) Proton Pump Inhibitor_** Main Action, Indication, Side Effect/Adverse Reaction
* **Main Action** - Blocks release of HCI * **Indication** - To treat gastroesophageal reflux disease (GERD)/To treat duodenal or gastric ulcer associated with Helicobacter Pylori * **Side Effect/Adverse Reaction** - Abdominal pain, constipation and elevated liver function tests.
30
**_Omeprazole (Prilosec) Proton Pump Inhibitor_** Therapeutic Classification, Assessments/Implementation/Evaluation, Patient Teaching
* **Therapeutic Classification** - Antiulcer * **Assessments/Implementation/Evaluation** - Give med before meals, preferably in the morning for once daily dosing. Because drug can interfere with absorption of vitamin B-12, monitor for macrocytic anemia./May be administered concurrently with antacids.?Decrease in abdominal pain or prevention of gastric irritation and bleeding. Decrease in symptoms of GERD. * **Patient Teaching** - Tell patient to take drug before eating - usually before breakfast and to swallow delayed release capsules or tables whole. Report onset of black tarry stools, diarrhea or abdominal pain.
31
**_Ranitidine (Zantac)_** Main action, Indication, Side effects/Adverse reaction
* **Main action**- Inhibits the action of histamine resulting in inhibition of gastric secretion. * **Indication**- Short term treatment of active duodenal ulcers and benign gastric ulcers. * **Side effect/Adverse reaction**- Arrythmias**,** confusion, altered taste, constpation.
32
**_Ranitidine (zantac)_** Classification, Assessment/Implementation/Evaluation, Patient teaching
* **Classification-** Antiulcer * **Assessment/Implementation/Evaluation-** Assess geriatric and debilitated patients routinely for confusion. Administer with meals or immediately afterwards and at bedtime for proloned effect. Decreased symptoms of aesophogeal reflux. Treatment of heartburn, acid indigestion, and sour stomach. * **Pa****tient teaching-** Smoking interferes with the effects of this meds. May cause dizziness, drowsiness. Report black tarry stools, fever, sore throat, diarrhea, dizziness, rash, confusion, hallucination.
33
**_Magnesium & Aluminiun salts (Maalox)_** Assessment/ Implementation, Evaluation, Patient teaching
* **Classification**- Antacids * **Assessment/ Implementations/Evaluation**- Doses should be saparated from other medications by at least one hour to ensure proper absorption of the othe drugs. Decrease in heartburn, acid indigestion, sour stomach, upset stomach. * **Patient teaching**- Advice the patient not to take this meds within 2 hrs of taking other madications.
34
**_Magnesium & Aluminiun salts (Maalox)_** Main action, Indication, Side effects/Adverse reaction
* **Main action-** Neutralize Gastric acid. * **Indication-** useful for variety of GI complaints like; hyperacidity, indigestion, GERD, heartburn. * **Side effect/ adverse reaction-** constipation , diarrhea
35
**_Metronidazole (Flagyl)_** Classification, Assessment/ Implementation/Evaluation, Patient teaching
* **Classification**- antiulcer agent, anti-infective, antiprotozoal * **Assessment/Implementations/Evaluation**- Administer on an empty stomach, or may administer with food or milk to minimize GI irritation. Resolution of the signs and symtoms of infections. * **Patient teaching**- Caution use of alcohol during treatment. Advise patient that urine may turn dark. Consult health professional if no imrpovement in a few days.
36
**_Metronidazole (Flagyl)_** Main action, indication, Side effects/Adverse reaction
* **Main action-** Activity against anaerobic bacteria. * **Indication-** Treat peptic ulcer diease caused by Helicobactor pylori * **Side effect/ adverse reaction-** Seizures, dizziness, abdominal pain.
37
_**Influenza vaccine (nasal**)_ Classification, Assessment/Implementation/Evaluation, Patient teaching
* **Classification-** Vaccines/immunizing agents * **Assessment/Imlepentation/Evaluation-** Assess previous immunization history and history of hypersensitivity. Administer immunization by approriate route. Hypersensitivity to egg products. Decreased influenza illness, with fewer days lost from school or work. * **Patient teaching-** Inform the patient of the possible and reportable side effects of immunization. Notify physician if patient develops high fever difficulty breathing, hives itching, swelling of face.
38
**_Influenza vaccine (nasal)_** Main action, Indication, Side effects/Adverse reaction
* **Main action**- Virus replicates causing production of antibodies. * **Indication-** Immunization for prevention of disease. * **Side effect/Adverse reaction-** Injection- local soreness, fever, myalgia, possible neurologic toxicity. Immunosupperssion may decrease antibody response to injection.
39
**_Pneumococcal vaccine( Pneumovax)_** Assessment/ Implementation, Evaluation, patient teaching
* **Classification**- Vaccines/immunizing agent * **Assessment/Implementation/Evaluation-** pneumococcal vaccine may be administered at the same time as influenza vaccine. All persons aged 65 or older who have not received the vaccine within 5 yrs( and were * **Patient teaching-** Teach patient of possible & reprotable side eefects of immunization. Notify physician if patient develops high fever, difficulty breathing, hives, itching, swelling of face.
40
**_Pneumococcal vaccine (Pneumovax)_** Main action, Indication, Side effects/Adverse reactions
* **Main action**- Helps protect against serious infections (e.g. meningitis, bacteria in the blood) due to certain bacteria(streptococcus pneumoniae). * **Indication**- Everyone \>65, and high risk patients with chronic illnesses. * **Side effect/Adverse reaction**- Injection site reactions( e.g. pain, redness, swelling, hard lump), muscle/joint aches or fever may occur.
41
**_Hydrochlorthyiazide (Hydrodiuril)_** Main Action, Indication, Side Effect/Adverse Reaction
* **Main Action** - Increase excretion of water & sodium by inhibiting reabsorption in the early distal tubules. Diuretic effects initiate in 2 hrs. Peak action 4-6 after oral med. Increased urinary excretion of Na & H20 reduces blood Vol. and BP. * **Indication** - Management of mild to moderate hypertension. Used in long-term Tx of CHF & hypertension. * **Side Effcts** - * Electrolyte imbalances * Dehydration hypokalemia (arrythmias) * Hyperglycemia * Hypotension, Dizziness & Hyperuricemia
42
**_Hydrochlorothyiazide (Hydrodiuril)_** Classification, Assesment/Implimentation/Evaluation, Patient Teaching
* **Therapuetic Classification** - Diuretic * **Assesment /Implementation/Evaluation-** Monitor BP before and after med admin. Assist w/ posture change. Monitor Intake and output, Daily wt. Auscultate lungs, monitor for edema, monitor electrolytes, monitor pulse (for arrythmias) and for hyperglycemia. Administer early in day to reduce disruption of sleep. Ensure bathroom access & respond to call light quickly. Decrease in BP, Increase in urine output. Decrease in edema and weight. * **Patient Teaching-** Instruct Pt to take med at the same time each day, to monitor weight biweekly and notify of significant changes. Caution Pt to change positions slowly (Orthostasis). Advise Pt to report muscle weakness, cramps, nausea, vomiting, diarrhea or dizziness. Instruct Pt to consult regarding Dr. regarding diet high in Potassium. Use sunscreen to prevent photosensitivity
43
**_Furosemide (Lasix)_** Main Action, Indication, Side Effects/Adverse Reaction
* **Main Action-** * Works by inhibiting the reabsorption of sodium, potassium, chloride and water primarily from the loop of Henle * Effect is greater and more rapid than thiazides diurectics. * Used for rapid diuresis; Effects within 1 hr & peak 1-2 hrs then Na is reabsorbed again * **Indication** * Used for rapid diuresis in clients with congestive heart failure and acute pulmonary edema * Generally Pt will be on potassium replacement therapy when taking this med. * **Side Effects** * Hypokalemia, Electrolyte imbalances * Orthostatic Hypotension, aplastic anemia, blood dyscrasias (blood disorders) and dehydration
44
**_Furosemide (_****_Lasix)_** Classification, Implementation/Assessment/Evaluation, Patient Teaching
* **Therapuetic Classification** - Diuretic * **Implementations/Assessment/Evaluation-** * Administer early in day to reuce disruption of sleep; ensure bathroom access and respond to call light quickly * Assist with ambulation * Monitor wt, report sudden gains or losses * Record I & O's, expect increased urine output * Assess for pulse, edema, skin integrity. * Assess for signs of fluid volume deficit (thirst, dry mouth, oliguria, weakness, crams and dizziness). * Lab values within normal limits, decreased BP, edema and weight. * **Patient Teaching-** * Instruct Pt to take med at the same time each day, monitor weight biweekly and notify Dr of significant changes * Caution Pt to change positions slowly (Orthostasis) * Advise Pt to report muscle weakness, crapmps, nausea, vomiting, diarrhea or dizziness. * Use sunscreen to prevent photosensitivity. * Caution older Pt about increased risk for falls. Do not change brands when refilling prescriptions
45
**_Spironolactone (aldactone)_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action**- Blocks the sodiumretaining effects of Aldosterone and interferes w/ sodium and water reabsorption at the distal tubules; thus decreasing potassium excretion. Increased urinary excretion of sodium and water. * **Indication**- Antihypertensive diuretic; to treat edema caused by heart failure, hepatic cirrhosis, or nephrotic syndrome. Reduces blood volume and blood pressure. May be given in combination with potassium wasting diuretics. * **Side/Adverse Effects-** Hyperkalemia is the major adverse effect. Also noted are Dizziness, increased intraocular pressure, nausea/vomiting, aplastic anemia.
46
**_Spironolactone (aldactone)_** Classification, Assessments/Implementation/Evaluation Patient Teaching
* **Therapuetic Class-** Diuretic * **Assesments/Evaluations-** Expect to evaluate pts serum potassium level. Notify prescriber if level exceeds 5 mEq/L or pts renal function deteriorates. Hyperkalemia may be fatal in pts w/ sever heart failure. Assess blood pressure and edema. Increase in diuresis & decrease in edema while maintaining serum potassium level in an acceptable range. Decrease in blood pressure. * **Patient Teaching-** Instruct pt to take med at same time each day.Caution pt to avoid salt substitutes and foods that contain high levels of K (Citrus fruits, bannans, potatoes, raisins, & sardines unless prescribed). Advise pt to report muscle weakness, cramps, nausea/vomiting, diarrhea or dizziness. Consult health care provider when purchasing OTC decongestants, cough suppressants, cold meds or appetite suppressants because of potential for increased blood pressure.
47
**_Clopidogrel (Plavix)_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. * **Indication-** Prevention of MI and /or stroke. * **Side Effects / Adverse Reactions-** GI Bleeding, Neutropenia, Incidence of adverse reactions similar to that of aspirin.
48
**_Clopidogrel (Plavix)_** Class, Assessments/Implementation/Evaluation, Patient teaching
* **Therapuetic Class-** Antiplatelet * **Assessment/Implementation/Evaluation-** Contraindicated in GI ulcers, active bleeding and recent surgery. Interact with use of NSAIDs, heparin, thrombolytics or warfarin. Assess for bleeding, bruising & black tarry stools. Prevention of stroke, MI and vascular death in pts at risk. * **Patient Teaching-** Take exactly as directed. Notify health care provider promptly of fever, chills, sore throat or if unusual bleeding bruising occurs. Do not take anticoagulant concurrently unless phsician is aware. Avoid aspirin & NSAIDs without consulting health care provider.
49
**_Aspirin (acetylsalicylic acid)_** Main action, Indication, Side Effects/Adverse reactions
* **Main action-** Produce analgesia, reduce inflammation and fever by inhibiting the production of prostaglandins. Decreases platelet aggregation * **Indication-** Prophylaxis of transient ischemic attacks and MI * **Side Effects/Adverse Reactions-** GI Bleeding, tinnitus, epigastric distress and increased bleeding time.
50
**_Aspirin (acetylsalicylic acid)_** Classification, Assessment/Implementation/Evaluation, Patient Teaching
* **Classification-** NSAID * **Assesment/Implementation/Evaluation**- Assess pain, limitation of movement and assess fever. Monitor hepatic function, prolongs bleeding time, monitor hematocrit periodically to assess for GI blood loss. Prevention of TIA, MI, relief of mild to moderate discomfort, reduction of fever. * **Patient Teaching**- Take aspirin once a day to prevent thrombus formation. If actue angina attack occurs chew on 325 mg tab of aspirin in addtion to taking nitroglycerin sub lingually. Advise pt to report tinnitus; unusual bleeding of gums, bruising, black tary stools or fever longer than 3 days. Take with a full glass of water.
51
**_Warfarin (Coumadin)_** Classification, Assessment/Implementation/Evaluation, Patient teaching
* **Classification-** Anticoagulants * **A/I/E-** Monitor INR (daily in acute care settings) and assess for therapeutic effects. Be aware of increased risk for intracranial hemorrhage if patient has cerebral ischemia (such as recent transient ischemic attack or minor ischemic CVA Monitor PT Vitamin K is antagonist; Use cautiously in patients with Gl ulcers, liver or kidney disease. monitor for black tarry stools, bleeding gums, protect from injury. * **Patient Teaching-** Periodic INR testing and PT testing, Advise patient to eat consistent amounts of vitamin K-rich foods, such as dark green, leafy vegetables, Urge patient to take precautions against bleeding, such as use soft toothbrush, electric razor, monitor for black tarry stools Caution patient to avoid activities that could cause traumatic injury or bleeding. Advise patient to consult prescriber before taking other drugs - including OTC drugs and herbal remedies-during therapy, Urge patient to carry medical identification that reveals they are taking Warfarin therapy.
52
**_Warfarin (Coumadin)_** Main action, Indication, Side effect/Adverse reaction
* **Main Action-** Interferes with the liver's ability to synthesize vitamin -dependent clotting factors. By depleting vitamin -dependent clotting factors and interfering with the clotting cascade, Warfarin prevent coagulation. * **Indication-** To prevent or treat pulmonary embolism; recurrent Ml; thromboembolic complications from atrial fibrillation, heart valve replacement, or Ml; and venous thrombosis (and its extension) * **Side effect/adverse reaction-** Hemorrhage, hematuria, anemia, ecchymosis, petechiae, bloody stools, thrombocytopenia.
53
**_Heparin_** Main Action, Indication, Side Effects/Adverse reaction
* **Main Action-** Prevents the conversion of prothrombin to thrombin. Thrombin is necessary for the conversion of fibrinogen to fibrin; without fibrin, clots can't form. At high doses, heparin inactivates thrombin, preventing fibrin * **Indication-** To prevent and treat deep vein thrombosis and pulmonary embolism, to treat peripheral arterial embolism, and to prevent thromboembolis ms before and after cardio * **Side Effect / Adverse Reaction-** Hemorrhage, hematuria, anemia, ecchymosis, petechiae, bloody stools, thrombocytopenia
54
**_Heparin_** Classification, Assessment/Evaluation/Implementation, Patient teaching
* **Classification-** Anticoagulants * **A/E/I-** Use heparin cautiously in alcoholics, menstruating women, patients over age 60, especially women; and patient with mild hepatic or renal disease or a history of allergies, asthma or Gl ulcer Monitor aPTT or PTT(daily in acute care settings) and assess for therapeutic effects. Also monitor for hematocrit, platelets, and occasional * **Patient Teaching-** Pt. will not go home on this medication.
55
**_Enoxaparin (Lovenox)_** Main Action, Indications, Side Effects/Adverse Reactions
* **Main Action-** Enoxaparin rapidly binds with and inactivates clotting factors. Without thrombin, fibrinogen can't convert to fibrin and clots can't form * **Indications-** To prevent deep vein thrombosis after hip and knee replacement and for continued prophylaxis after hospitalization for hip replacement * **Side Effects / Adverse reactions-** Hemorrhage, hematuria, anemia, ecchymosis, bloody stools, petechiae, Thrombocytopeni a, injection site erythema, hematoma, irritation and pain.
56
**_Enoxaparin (Lovenox)_** Classification, Assessment/Implementation/Evaluation, Patient Teaching
* **Classification-** Anticoagulants * **A/I/E-** Use with extreme caution in patients with a history of heparin-induced thrombocytopenia or increased risk of hemorrhage Drug is not recommended for patient with prosthetic heart valves Most patients will not need aPTT or PTT monitored. Keep protamine sulfate nearby in case of accidental overdose Check serum potassium level for elevation, especially in patients with renal impairment or concurrent use of potassium-sparing diuretics Does not require lab tests. * **Patient Teaching-** Instruct patient to seek immediate help for evidence of thromboembolism, such as neurologic changes and severe shortness of breath Stress the importance of complying with follow-up visits with prescriber Teach patient or family member how to give med at home To minimize bruising, cautions patient not the rub the site after giving the injection. Caution patient to avoid activities that could cause traumatic injury or bleeding. Urge patient to take precautions against bleeding, such as use soft toothbrush, electric razor, monitor for black tarry stools
57
**_Captopril (Capoten) ACE inhibitor_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Block conversion of angiotensin 1 to the vasoconstrictor angiotensin II, a potent vasoconstrictor that also stimulates the adrenal cortex to secrete aldosterone. Inhibiting aldosterone increases sodium and water excretion, reducing blood pressure * **Indication-** Alone or with other agents to manage hypertension. Management of heart failure. * **Side Effects / Adverse Reactions-** Most common side effect is a cough, (esp when diuretics are used), proteinurea, taste disturbance, hyperkalemia (due to decreased aldosterone levels). Hypotension Orthostatic
58
**_Captopril (Capoten) ACE inhibitor_** Classification, Assessment/Implementation/Evaluation, Patient Teaching
* **Classification-** Antihypertensives * **A/I/E-** Closely monitor patient's blood pressure, especially when therapy starts and dosage increases. Monitor renal function tests for signs of nephritic syndrome, such as proteinurea and increased BUN and serum creatinine levels. Also watch for renal symptoms such as oliguria, polyuria, and urinary frequency. Evaluation: decrease in BP without appearance of significant side effects. * **Patent Teaching-** Instruct patient to take med 1 hour before meals. Tell patient to rise slowly from sitting or lying down to minimize orthostatic hypotension Advise patient not to use salt substitutes that contain potassium Continue medication even if feeling well. Blood pressure checks.
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**Valsartan (Diovan) (angiotensin II receptor agonist)** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Blocks the hormone angiotensin II from binding to the receptor sites in vascular smooth muscle, adrenal glands, and other tissues. * **Indication-** To manage hypertension, alone or with other antihypertensives Patients who cannot tolerate ACE inhibitors. * **Side Effects / Adverse reactions-** Fatigue, headache, dizziness, hyperkalemia Orthostatic Hypotension Thrombocytopenia
60
**_Valsartan (Diovan) (angiotensin II receptor agonist)_** Classification, Assessment/Implementation/Evaluation, Patient Teaching
* **Classification-** Antihypertensives * **A/I/E-** Check patient's blood pressure often during therapy Monitor serum potassium level because drug may elevate potassium level Monitor for body fluid excess or deficit (daily wt, 1 & 0, lung sounds); For patients with diabetes - lab (BUN, creatinine, potassium) * **Patient Teaching-** Instruct patient to take med exactly as prescribed at the same time each day to maintain therapeutic effects Change position slowly. Avoid salt substitutes. Continue medication even if feeling well. Blood pressure checks
61
**_Propanolol (Inderal)_** Classificiation, Assessments/Implentation/Evaluation, PT Teaching
* **Classification-** Antihypertensives * **Assessments/Implementation/Evaluation-** Moniter blood pressure, apical and radial pulses, fluid intake and output, daily weights, respirations, and circulation in extremities before and during therapy. Monitor Apical HR for 60 seconds (hold and call physician if 100), stopping drug may cause myocardial ischemia, MI, ventricular arrythmias, or severe hypotension. Change position slowly * **PT Teaching-** Instruct PT to take med 1 hour before meals. Tell PT to rise slowly from siting or lying down to minimize orthostatic hypotension. Advise PT not to use salt substitutes that contain potassium. Continue medication even if feeling well. Blood pressure checks.
62
**_Propanolol (Inderal)_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action**: Prevents arterial constriction and inhibits rennin secretion, resulting in decreased blood pressure and relief of migraine headaches. Decreases heart rate myocardial contractility, Decreases myocardial oxygen deman (helps prevent angina pain and death of myocardial tissue) * **Indication**: To manage hypertension, angina, anxiety, arrythmias * **Side Effect/ Adverse Reaction**: Most common is a cough. (esp. when diuretics are used), proteinurea, taste disturbance, hyperkalemia (due to decreased aldosterone levels). Hypotension Orthostatic
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**_Diltiazem (Cardizem)_** Classification, Assess/Implentation/ Evaluation, PT Teaching
* **Classification-** Antihypertensive * **Assess/Implentation/Evaluation-** Use med cautiously in PTs with impaired hepatic or renal function and monitor liver and renal function test results. Monitor PT blood pressure, pulse rate and heart rate and rythm as appropriate during therapy. Assess PT of signs and symptoms of heart failuer. Monitor HR, Blood pressure, orthostatic hypotension, fluid accumulation, bowel elimination. * **PT Teaching-** Tell PT that stopping drug suddenly may cause life-threatening effects. Adivse PT to monitor Blood pressure and pulse rate regularly and to report significant changes to prescriber. UrgepT to report chest pain, difficulty breathing, dizziness, fainting, irregular heartbeat, rash or swollen ankles rapid weight gain. Change position slowly. Continue medication even if feeling well. Maintain adequate fluid and fiber intake Daily wt.
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**_Diltiazem (Cardizem)_** Main Action, Indication,Side Effects/Adverse Reaction
* **Main Action-** Inhibits smooth-muscle cell contractions. Decreased myocardial oxygen demand by relaxing coronaryand vascular smooth muscle, reducing peripheral vascular resistance and systolic and diastolic blood pressure * **Indication-** Hypertension, Angina * **Side Effects/Adverse Reactions-** HA, dizziness, flushing, pooling of blood (edema, crackles), constipation. Orthostatic Hypotension. Acute renal failure, Thrombocytopenia Cough, hyperglycemia
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**_Hydrochlorothiazide_** Main action, Indication, Side Effects/Adverse Reactions
* **Main Action-** (See Diuretics) Increasesexcretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. * **Indication-** Management of mild to moderate hypertension. * **Side Effects/Adverse Reactions-** Hypokalemia, dehydration, orthostatic hypotension, elevated blood glucose
66
**_Hydrocholorothiazide_** Classification, Assessment/Implentation/Evaluation, PT Teaching
* **Classification-** Antihypertensives (also Thiazide Diuretic) * **Assessment/Implentation/Evaluation-** Monitor BP, intake, output,and daily weight and assess feet, legs, and sacral area for edema daily. Assess especially if taking digoxin for anorexia, nausea, vomiting, muscle cramps, and confusion. Administer in morning to prevent diruption of sleep. May give with food or mild to minimize GI irritation. Monitor for elevated blood glucose. Evaluation: decrease BP if diabetic, decreased edema * **PT Teaching-** Monitor weight biweekly. Change positions slowly. Use sunscreen. Report rash,vomiting, diarrhea, or dizziness to HCP
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**_Nitroglycerin_** Classification, Assessment/Implentation/Evaluation ,PT Teaching
* **Classificiation**- Antianginals * **Assessment/Implentation/Evaluation-** Monitor BP; Hold other BP meds before holding nitroglycerin. Use nitro cautiously in elderly PTs, especially those who are volume depleted or taking several medications, because of the increased risk of hypotension and falls. Check Vitals signs before every dosage adjustment and frequently during therapy. Evaluation: Decrease in frequency and severeity of angine attacks. Increasein activity intolerance. * **PT Teaching-** Teach PT to recognize signs and symptoms of angina pectoris, including chest fullness, pain, and pressure, possibly with sweating and nausea. In supine position: Take one tablet sublingually (do not swallow) for acute attack; if no relief, take another in five minutes; repeat times three. Call EMS if chest pain continues after 3rd pill (15 minutes). Do not take if Viagra was taken within 24 hours. Do not touch ointment when administering. Inform PTs that tablets should be kept in original glass container or in specially made metal containers, but not next to body (shirt poket) or in glove compartment of car. Caution PTs to change positions slowly to minimize othorstatic hypotesnion. Teach PT that transcient burn/tingling and headache may occur. And to replace tablets after 6 months.
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**_Nitroglycerin_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Vasodilator; decreases preload and afterload deacreasing myocardial workload and oxygen demand. It also dilates coronary arteries, increasing blood flow to ischemic myocardial tissue * **Indication-** To prevent or treat angina * **Side Effects/AdverseReactions-** Headache, dizziness, orthostatic hypotension transcient burning under tongue, flushing of face and neck
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**_Digoxin (Lanoxin)_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Increase the force of myocardial contraction. Slows heart rate and strengthens contractility of heart. * **Indication-** Atrial fibrillation; CHF, tachyarryhtmias, atrial flutter * **Side Effects/Adverse Reaction-** Narrow threapuetic range assess for toxicity: arrythmias, bradycardia, or other arrythmias, or anorexia, nausea, vomiting
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**_Digoxin (Lanoxin)_** Classification, Assessments/Implentation/Evaluation, PT Teaching
* **Classifications-** Antiarrythmics, inotropics. Pharmacologic: digitalis glycosides * **Assessments/Implentation/Evaluation-** Monitor apical pulse for 1 full minute before administereing. Hold forHR less than 60bpm; monitor for anorexia. Monitor Intake and output ratios Digoxin use has been associated with an increased riskof fallsin the elderly. Older adults are at increased risk for toxis effects of digoxin due to age-related decreased renal clearance- observe for signs and symptoms of digoxin toxicity. Evaluation: Decrease in severeity of CHF, Increase in cardiac output, Decrease in ventricular response in atrial tachyarrhymias, Terminationof paroxysmal atrial tachycardia * **PT Teaching-** Teach PT to take pulse and contact physician if 100. Review S&S of txicity. Teach PT to take medication as directed, at the same time each day. Instruct PT to keep digoxin tablets in their original container and not to mix pill boxes with other medications. Advise PT to avoid taking antacids or antidiarrheals within 2 hours of digoxin PT taking digoxin should carry identification describing disease process.
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**_Atorvastatin (Lipitor) Simvastatin (Zocor)_** Main action, Indication, Side effects/Adverse reactions.
* **Main Action-** Prevents synthesis of cholesterol by the liver. * **Indication**- Adjunctive management of primary hypercholesterolemia and mixed dyslipidemia. Primary prevention of coronary heart disease and in asymptomatic patients with increased total and LDLs, and decreased HDLs. * **Side effects/Adverse reactions**- Liver toxicity, GI disturbances, rhabdomyolysis.
72
**_Atorvastatin (Lipitor) Simvastatin (Zocor)_** Therapeutic classification, Assessments/Implementation/evaluation, Patient teaching
* **Therapeutic classification**- Lipid Lowering Agents * **Assessments/Implementation/evaluation**- Moniter for abdominal cramps, flatus, heartburn, diarrhea and constipation, rashes, muscle pain and weakness; some may need to be given with evening meal to decrease GI upset. Evaluation: decrease in LDL and total cholesterol levels, increase in HDL. * **Patient teaching**- Instruct patient to notify HCP if unexplained muscle pain, tenderness, or weakness occurs. Instruct female patients to notify HCP if pregnancy is planned or suspected or if they are breastfeeding. Do not drink more than one quart of grapefruit juice per day. Report muscle aches and dark colored urine. Have periodic liver function test. Do not take if breastfeeding or pregnant.
73
**_Diphenhydramine_** Therapeutic classification, Assessments/Implementation/evaluation, Patient teaching
* **Therapeutic classification**- Antihistamines * **Assessments/Implementation/evaluation**- When used for insomnia, administer 20 minutes before bedtime and schedule activities to minimize interruption of sleep. Drugs in this class may cause idiosyncratic CNS stimulation, causing hyperactivity- more commonly in children. Elderly patients should be monitered for profound sedation and altered consciousness, which may contribute to falls or other injuries. Improved sleep when used as a sedative/hypnotic. * **Patient teaching**- Take as directed. Do not exceed recommended amounts. May cause drowsiness. Their effectiveness may diminish with long-term use.
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**_Diphenhydramine_** Main action, Indication, Side effects/Adverse reactions
* **Main Action-** Blocks the actions of histamine at the H1 receptor. Significant CNS depressant and anticholinergic properties. * **Indication**- These are widely used OTC for relief of allergy symptoms, motion sickness, and insomnia. Mild nightime sedative. * **Side effects/Adverse reactions**- Drowsiness, anorexia, dry mouth.
75
**_Diazepam_** Main action, Indication, Side effects/Adverse reactions
* **Main action**- Depresses the CNS. These drugs intensify the effects of GABA, which is a natural inhibitory neurotransmitter found throughout the brain. * **Indication**- Drug of choice for various anxiety disorders, insomnia, alcohol (ETOH) withdrawl, and seizures. * **Side effects/Adverse reactions**- Dizziness, drowsiness, lethargy, constipation, physical dependence, and psychological dependence.
76
**_Diazepam_** Therapeutic classification, Assessments/Implementation/evaluation, Patient teaching
* **Therapeutic classification**- Benzodiazepines * **Assessments/Implementation/evaluation-** Moniter vital signs, observe respiratory patterns, especially during sleep. Assess risk for falls in elderly. Prolonged high dose can lead to psychological and physical dependence. Assess degree of anxiety and level of sedation. * **Patient teaching**- Take as prescribed. Abrupt withdrawl may cause insomnia, nervousness, and seizures. Do not drive or preform hazardous activities until effects of drug are known. Avoid taking OTC sleep-inducing medications, antihistimines. Avoid consuming alcohol (ETOH).
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**_Zolpidem_** Main action, Indication, Side effects/Adverse reaction
* **Main action**- Produces CNS depression by binding to GABA receptors. * **Indication**- Insomnia * **Side effects/Adverse reactions**- Amnesia, daytime drowsiness, physical and psychological dependence.
78
**_Zolpidem_** Therapeutic classification, Assessments/Implementation/evaluation, Patient teaching
* **Therapeutic classification**- Benzodiazepine receptor like agents * **Assessments/Implementation/evaluation**- Assess mental status, sleep patterns, and potential for abuse prior to administration. Assess patient for pain- untreated pain decreases sedative effects. Before administration, reduce external stimuli. Protect patient from injury. Relief of insomnia. * **Patient teaching-** Instruct patient to take medications as directed. Because of rapid onset, advise patient to go to bed immediatly. May cause daytime drowsiness. Avoid driving until response to this medication is known.
79
**_Pilocarpine (Isopto Carpine)_** Classification, Assessments/Implementation/Evaluation, Patient Teaching
* **Classification-** Cholinergic agent (Miotic) * **Assessment/Implementation/Evaluation**- Try to space the eye drops 6 hours apart, morning, lunch, dinner, bedtime if four times a day is required. Instruct on proper eye drop installation techniques. Compressing the lacrimal sac by pinching the bridge of the nose for 1 to 2 minutes after the instillation od the drugs minimizes the systemic absorption and effects of the drug. Lower intraocular pressure with minimal or no side effects * **Patient Teaching**- Patients should be instructed that ocular solutions, if handled improperly or if the tip of the dispensing container contacts the eye or surrounding structures, can become contaminated by common bacteria known to cause ocular infections. Cautions patient about decreased visual acuity caused by miosis, particularly in dim light.
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**_Pilocarpine (Isopto Carpine)_** Main Action, Indication, Side effect/Adverse Reaction,
* **Main Action**- Stimulates iris sphincter contraction, casusing miosis and opening of trabecular meshwork, facillitating aqueous humor outflow * **Indication-** Opthalmic solution is indicated for the treatment of primary open-angle glaucoma and also to lower intraocular pressure prior to suregery for acute-angle closure glaucoma * **Side effect/Adverse reaction-** Blurred vision, altered vision, stinging, eye pain, headache, browache. If significant systemic absorption occurs, bronchospasm, sweating, increased unrination and salivation may occur
81
**_Timolol Maleate (Timoptic)_** Classification, Assessments/Implementation/Evaluation, Patient Teaching
* **Classification-** Beta-adrenergic blocker * **Assessment/Implimentation/Evaluation-** Instruct on proper eye drop installation techniques. Compressing the lacrimal sac by pinching the bridge of the nose for 1 to 2 minutes after the instillation of the drugs minimizes the systemic absorption and effects of the drug. Lower intraocular pressure with minimal or no side effects * **Patient Teaching-** Patients should be instructed that ocular solutions, if handled improperly or if the tip of thr dispensing container contacts the eye or surrounding structures, can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions.
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**_Timolol Maleate (Timoptic)_** Main Action, Indication, Side effect/ Adverse Reaction,
* **Main Action-** Decreases the formation of aqueous humor * **Indication-** Management of chronic open-angle glaucoma and other forms of ocular hypertension * **Side Effects/Adverse Reactions-** Decreased visual systemic absorption resulting in bradycardia, hypotension, photophobia, bronchospasm. Contraindicated in patients with asthma or severe COPD
83
**Baciguent (Bacitracin)** Classification, Assessments/Implementation/Evaluation, Patient teaching
* **Classification-** Dermatologic * **Assessment/Implementation/Evaluation-** Not for extended use. This medication is for topical use only. Clean and dry the affected area as directed. Then apply a small amount of the medication on the skin. A thin layer is all that is needed. Cover with a bandage if directed to do so. Do not use large amounts, apply this more often or use this for a longer period than directed. Avoid contact in or around the eyes. Do cultures prior to starting medical therapy. -Condition should improve and rashes/lesions resolve. * **Patient Teaching-** Use medication as directed through full course of therapy. Report skin irritation or lack of therapeutic response to MD.
84
**_Baciguent (Bacitracin)_** Main Action, Indication, Side Effects/Adverse Reactions
* **Main Action-** Attacks cell wall of bacteria causing skin disorder. It works by stopping the growth of certain bacteria. It will not work for virus or fungus infections. * **Indication-** Skin lesions or rashes due to bacteria that are not self limiting. This medication is used to treat or prevent a skin infection caused by small cuts, scrapes, or burns. * **Side Effects/Adverse Reactions-** Rash, Itching or redness, burning anaphylactic reaction rare. Risk for otoxicity if extended use.
85
**_Mycostatin (Nystatin)_** Main Action, Indication, Side effects/Adverse reaction
* **Main Action-** Binds to fungal cell membrane, allowing leakage of cellular contents. Limits growth if fungal cell membranes. Not active against bacteria. * **Indication-** Skin/mucosal lesions or rashes due to fungal infection * **Side Effects/Adverse Reaction-** Local mild burning or stinging to skin or vaginal area
86
**_Mycostatin (Nystatin)_** Classification, Assessment/Implementation/Evalutation, Patient Teaching
* **Classification-** Dermatologic * **Assessment/Implementation/Evaluation-** Inspect areas frequently during therapy. Increased skin irritation may indicate need to discontinue med. Monitor renal and hepatic labs for signs of toxicity with extended use. Get cultures prior to treatments. Condition should improve and rashes/lesions should subside after full treatment. * **Patient Teaching-** Use med as directed through full course of therapy. Report skin irritation or lack of therapeutic response to MD. Long term therapy of 2 weeks to 3 months may be needed.
87
**_Zovirax (Acyclovir)_** Main action, Indication, Side effect/Adverse reactions
* **Main Action**- Interferes with viral DNA synthesis that is needed for viral reproduction * **Indication**- Recurrent herpes simplex (cold sores), herpes genitalia, or herpes zoster (shingles) * **Side Effects/Adverse Reactions**- Seizures, renal failure, dizziness, headache, diarrhea, nausea, and vomiting
88
**_Zovirax (Acyclovir)_** Therapeutic classification, Assessments/Implementation/Evaluation, Patient Teaching
* **Therapeutic classification**- Dermatologic * **Assessments/Implementation/Evaluation**- Standard precautions should be started as soon as possible after symptoms appear. Topical, IV, and oral administration. May be administer with food or on an empty stomach. * **Patient teaching**- Use medication as directed through full course of therapy. Report skin irritation or lack of therapeutic response to MD.
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**_Hydrocortisone (Cortaid)_** Therapeutic classification, Assessments/Implementation/Evaluation, Patient Teaching
* **Therapeutic classification**- Dermatologic * **Assessments/Implementation/Evaluation**- Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Choice of vehicle depends on site and type of lesion. Avoid use with dressings unless specified by physician. May cause increase serum and urine glucose concentrations. A resolution of skin inflammation, pruritus, or other dermatologic conditions. * **Patient teaching-** Instruct patient on correct technique of medication administration. Use medication as directed through full course of therapy. Caution women who are pregant not to use extensively, in large ammounts, or for protracted periods of time. diabetics should monitor blood glucose levels during therapy.
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**_Hydrocortisone (Cortaid)_** Main action, Indication, Side effects/Adverse reactions
* **Main actions**- Has anti-inflammatory, antiprutitic and vasoconstrictive properties. Decreases edema, erythema, and pruritus. Reduces fast skim turnover associated with psoriasis. * **Indication**- Management of various allergic/immunologic skin problems and psoriasis. * **Side effect/Adverse rea​ction**- Pruritus, stinging, dry skin, folliculitis, hyperglycemia, thinning of skin.
91
**_Metformin (Glucophage)_** Main action, Indication, Side effects/Adverse reactions
* **Main Actions**- Decreases hepatic glucose production. Decreases intestinal glucose absorption. Increases sensitivity to insulin. * **Indication**- Management of type 2 diabetes mellitus, may be used with diet, insulin, or sulfonylurea oral hypoglycemics. * **Side effects/Adverse reactions**- Abnormal bloating, diarrhea, nausea, vomiting, hypoglycemia, lactic acidosis.
92
**_Metformin (Glucophage)_** Therapeutic classifications, Assessments/Implementation/evaluation, Patient teaching
* **Therapeutic classifications**- Antidiabetics * **Assessment/Implementaion/Evaluation-** Observe for signs and symptoms of hypoglycemic reactions (abnormal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety) when combined with oral sulfonylurea's. Stop day of kidney dye study (and sometimes before surgery) (need good kidney and liver function, good oxygen use, good hydration). Restart when adequate kidney function verified. Do not use in patients with renal or hepatic dysfunction, or in patients with active alcoholic disease. Patients who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin. Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes. * **Patient teaching**- Instruct patient t take mediction at same time each day. Do not take if unable to eat, Review signs and symptoms of hypoglycemia and hyperglycemia. Emphasize the improtance of routine follow-up exams. Encourage patiente to follow prescribed diet, medication, and exercise regimen. Take with meals to minimize GI effects
93
**_Glipizide (Glucotrol)_** Therapeutic classification, Assessments/Implementation/Evaluation, Patient teaching
* **Therapeutic classification**- Antidiabetics * **Assessments/Implementation/Evaluation**- Observe for signs and symptoms of hypoglycemia (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety). Patients who are exposed to stress, fever, trauma, infection or surgery may require administraion of insulin. Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes. * **Patient teaching-** Instruct patient to take medications at same time each day. do not take if unable to eat. review signs and symptoms of hypoglycemia and hyperglycemia. Caution patient to use sunscreen. Emphasize the importance of routine follow-up exams. Encourage patients to follow prescribed diet, medication, and exerise regimen 30 minutes before meal.
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**_Glipizide (Glucotrol)_** Main actions, Indications, Side effects/Adverse reactions
* **Main actions**- Lower blood glucose by stimulation the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. * **Indications**- Control of blood glucose in adult-onset non-insulin dependent diabetes mellitus when diet therapy fails. Requires some pancreatic function. * **Side effects/Adverse-** Reactions-Hypoglycemia, constipation, diarrhea, photosensitivity, nausea, and vomiting.
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**_Humalog (Lispro) Rapid Acting_** Classification, Assessments/Implementaion/Evaluation, Patient Teaching
* **Classification-** Antidiabetics (Insulins) * **Assessment/Implementation/Evaluation-** * Asses patient for signs and symptoms of hypoglycemia and hyperglycemia periodically during therapy. * Monitor body weight periodically. * Use only insulin syringes to draw up does. * Rotate site injections. * Administer Insulin Lispro within 15 minutes before a meal. * The PDA does not give you the following information * Onset - 5-10 minutes * Peak - 0.5-1.5 hours * Duration 3-5 hours * Control of blood glucose without the appearance of hypoglycemic or hyperglycemic episodes. * **Patient teaching-** Instruct patient on signs and symptoms of hypo and hyperglycemia. Emphasize the importance of regular follow up. Instruct patient on proper technique for administration if indicated. Instruct patient in proper testing of serum glucose and ketones. Emphasize the importance of compliance with nutritional guidlines and regular exercise. Patients with diabetes mellitus should carry a source of sugar and identification describing their disease and treatment regimen at all times.
96
**_Humalog (Lispro) Rapid Acting_** Main action, Indication, Side effect/ Adverse reaction
* **Main action-**: Lowers blood sugar by increasing transport of blood glucose into cells; promotes conversion of glucose to glycogen in liver and muscle * **Indication-** Treatment of diabetes mellitus. These subcutaneous insulins have a more rapid onset and shorter duration than regular insulin. * **Side effect/ Adverse reaction-** Hypoglycemia, local or systemic allergy, lipodystrophy, weight gan, hypokalemia
97
**_Humulin R (Short Acting Regular)_** Main action, Indication, Side effect/ Adverse reaction
* **Main action-** Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat. * **Indication-** Diabetes Mellitus Type 1; Diabetes Type 2 in secondary failure * **Side effect/ Adverse reaction-** Hypoglycemia, local or systemic allergy, lipodystrophy, weight gain, hypokalemia
98
**_Humulin R (Short Acting Regular)_** Classification, Assessments/ Implementation/ Evaluation, Patient Teaching
* **Classification-** Antidiabetics (Insulins) * **Assessments/Implementation/Evaluation-** * Assess patient for signs and symptoms of hypoglycemia and hyperglycemia periodically during therapy. * Monitor body weight periodically. * Use only insulin syringes to draw up dose. * Rotate site injections. * May be stored in a cool place but does not need to be refridgerated. * Administer within 15-30 minutes before meal. * The PDA does not give you the following information * Onset - 1/2-1 hour * Peak - 2-4 hours * Duration - 10-12 hours * Is only insulin to be given IV. * Control of blood glucose without the appearance of hypoglycemic or hyperglycemic episodes. * **Patient teaching**- Instruct patient on signs and symptoms of hypo and hyperglycemia. Emphasize the importance of regular follow up. Instruct patient on proper technique for administration if indicated. Instruct patient in proper testing of serum glucose and ketones. Emphasize the importance of compliance with nutritional guidlines and regular exercise. Patients with diabetes mellitus should carry a source of sugar and identification describing their disease and treatment regimen at all times.
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**_Humulin N (Intermediate acting NPH)_** Main action, Indication, Side effect/ Adverse reaction
* **Main action-** * Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat. * Inhibiting hepatic glucose production. * **Indication-** * Treatment of diabetes mellitus. * Intermediate acting insulins can not be used for the acute treatment of ketoacidosis. * **Side effect/Adverse reaction-** * Hypoglycemia, local or systemic allergy, lipodystrophy, weight gain, hypokalemia.
100
**_Humulin N (Intermediate acting NPH)_** Classification, Assessment/ Implementation/ Evaluation, Patient Teaching
* **Classification-** * Antidiabetics (Insulins) * **Assessment/Implementation/Evaluation-** * Assess patient for signs and symptoms of hypoglycemia and hyperglycemia periodically during therapy. * Monitor body weight periodically. * Use only insulin syringes to draw up dose. * Rotate site injections. * May be stored in a cool place, but does not need to be refrigerated. * Administer within 30minutes before a meal. * (The PDA does not give you the following information) * Onset - 2 hours * Peak 6-8 hours * Duration - 10-12 hours * Gently roll or shake bottle to resuspend insulin. * If mixing with rapid or short acting insulin, draw up NPH insulin last. * Control of blood glucose without the appearance of hypoglycemic or hyperglycemic episodes. * **Patient teaching-** Instruct patient on signs and symptoms of hypo and hyperglycemia. Emphasize the importance of regular follow up. Instruct patient on proper technique for administration if indicated. Instruct patient in proper testing of serum glucose and ketones. Emphasize the importance of compliance with nutritional guidlines and regular exercise. Patients with diabetes mellitus should carry a source of sugar and identification describing their disease and treatment regimen at all times.
101
**_Glargine (Lantus) Long Acting_** Main action, Indication, Side effect/ Adverse reaction
* **Main action-** * Lowers blood glucose by stimulation glucose uptake in skeletal muscle and fat. * Inhibiting hepatic glucose production * **Indication-** * Treatment of diabetes mellitus. * Due to delayed and prolonged duration can not be used for the acute treatment of ketoacidosis * **Side effect/ Adverse reaction-** * Hypoglycemia, local or systemic allergy, lipodystrophy, weight gain, hypokalemia
102
**_Glargine (Lantus) Long Acting_** Classification, Assessments/ Implementation/ Evaluation, Patient Teaching
* **Classification-** * Antidiabetics (Insulins) * **Assessments/Implementation/Evaluation-** * Assess patient for signs and symptoms of hypoglycemia and hyperglycemia periodically during therapy. * Monitor body weight periodically * Use only insulin syringes to draw up dose. * Rotate site injections. * May be stored in a cool place but does not need to be refrigerated. * Administer glargine once daily at the same time each day. * The PDA does not give you the following information * Onset - 3 hours * Peak - no peak * Duration - 22+ hours * **Do not mix with other insulins.** Tall skinny bottle. * Always take at the same time of day within 2 hour window. * Discard after 28 days. * Is usually 50% of the Total Daily Dose. * Control of blood glucose without the appearance of hypo or hyperglycemic episodes. * **Patient teaching-** Instruct patient on signs and symptoms of hypo and hyperglycemia. Emphasize the importance of regular follow up. Instruct patient on proper technique for administration if indicated. Instruct patient in proper testing of serum glucose and ketones. Emphasize the importance of compliance with nutritional guidlines and regular exercise. Patients with diabetes mellitus should carry a source of sugar and identification describing their disease and treatment regimen at all times.
103
**_Any Insulin_** (Lispro, Regular, Glargine, Humulin) Patient Teaching
* Meal planning, exercise, blood sugar testing, proper administration of insulin, management of hypoglycemia, * Dosage increase may be required during infection, illness, stress, trauma, and pregnancy. * Dosage decrease may be needed with renal or hepatic dysfunction. * Some drugs potentiate the action of insulin; Salicylates, MAOIs, alcohol, sulfa drugs, some ACE inhjibitors, drugs that inhibit pancreatic function. * Some drugs antagonise the action of insulin; corticosteroids, isoniazid, niacin, thiazides, phenothiazines, sympathomimetics. * Store extra bottles in refrigerator. * Currently used bottle can be kept at room temperature. * Check expiration date. * Do not freeze or expose to extreme heat.

Pharmacology (2 decks)

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