Pharm Flashcards
anticholinergic effects
dry mouth, urinary retention, blurry vision
Symptoms – dry mouth, dysphagia, urinary retention, impotence, nasal congestion
Nursing:
o Sugarless lozenges
o Good mouth care
o Void before taking medication
Adrenergics
Levophed (Norepinephrine), Intropin (Dopamine), Adrenalin (epinephrine)
Uses: cardiac arrest, COPD
Action: stimulate beta-2 receptors in lungs (so increase peripheral resistance and cause bronchodilation)
S/E: dysrhythmias, tremors, anticholinergic effects
Nursing: Monitor bp, peripheral pulses, and output
pt possibly drowsy
Anti-anxiety
(Benzodiazepines, Nonbenzodiazepines, Herbals)
Librium (chlordiazepoxide), xanax (alprazolam), ativan (lorazepam), vistaril (hydroxyzine), Equanil
Uses: anxiety disorders, panic attacks, manic episodes
Action: affect neuro transmitters
S/E: sedation, confusion, hepatic dysfunction (remember CNS depressant)
Nursing: potential for addiction/overdose
- avoid alcohol (CNS depressant)
- monitor liver functions ( AST, LST) (LDH)
- DC med very slowly
- smoking or drinking caffeine will decrease effectiveness of meds (complete in depth assessment)
Antacids
Amphojel (aluminum hydroxide), Milk of Magnesia (magnesium hydroxide), Maalox (both)
Uses – peptic ulcer, indigestion (prevent or treat), reflex esophagitis
Action – neutralize gastric acids
S/E: constipation, diarrhea, acid rebound
Nursing:
• Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives
• Monitor bowel function – can cause bowel addiction
• Timing – given 1-2 hours after eating and other medications
• Fluid and electrolyte balance important bc affecting GI tract – so monitor labs!
Antidysrhythmics
Atropine sulfate, Lidocaine, Pronestyl (procainamide), Quinidine, Isuprel (Isoproterenol)
Uses – atrial fibrillation/flutter, tachycardia, PVCs (Decrease myocardial irritability)
Action – interfere with electrical excitability of the heart
S/E: light headedness, bradycardia, hypotension, urinary retention
Nursing
• monitor vitals signs (especially pulses and bp)
• monitor cardiac rhythm
• move positions slowly
with beta blockers worry about
broncospasms so affects airway
General S/E with antibiotics
Allergies – mild to anaphylaxis
Super-infection - Kill abnormal as well as normal flora in the body
Organ toxicity – liver and kidneys
General teaching with antibiotics
o take until gone
o do not culture and sensitivity first
o encourage fluids – hard on kidneys so need more fluids
o check expiration date
Aminoglycosides
(mycin) - Antibiotics
Gentamycin, Neomycin, Streptomycin, Tobramycin
Uses – Pseudomonas, E. coli
Action – inhibits protein synthesis in gram-negative bacteria
S/E: ototoxicity, anorexia, nausea, vomiting, diarrhea, nephrotoxic (kidneys)
Nursing: • Check 8th cranial nerve (hearing) • Check renal function (BUN, urinary output 1200 ml per day) • Take 7-10 days – until med complete • Encourage fluids – 3000 ml/day
Cephalosporins
antibiotics
Ceclor (Cefaclor), Ancef (cefazolin), Keflex (chephalexin), Rocephin (Ceftriaxone), Mefoxin (cefoxitin)
Uses – tonsillitis, otitis media, peri-operative prophylaxis, meningitis
Action – inhibits synthesis of bacterial cell wall
S/E: bone marrow depression, super-infections, rash
Nursing:
• Take with food – cause GI upset
• Cross allergy with PCN!!!
• Avoid alcohol – can cause flushing, dizziness, and muscle aches
• Obtain C&S before first dose
• May give false positive for protienuria or glucose in urine
Macrolide antibiotics
Erthromycin, Cleocin (clindamycin)
Uses – acute infections, acne, Upper respiratory infections, prophylaxis before dental procedures if allergic to PCN
Action – binds to cell membrane and changes protein function
S/E: diarrhea, confusion, hepatotoxicity, super-infections
Nursing:
• Take 1 H ac or 2-3 h pc – not with food, take with full glass of water not fruit juice
• Monitor liver function
• Increases effectiveness of Coumadin and theopaline (respiratory drug)
Penicillins
Amoxil (amoxicillin), Ampicillin , Augmentin (Amoxicillin/clavulanate)
Uses – moderate to severe infections, syphilis, gonococcus infections, Lyme disease
Action – inhibits synthesis of cell wall
S/E: stomatitis (breakdown in the mouth and along GI tract), diarrhea, allergic reactions, renal and hepatic changes
Nursing: • Check for hypersensitivity - multiple exposures cause reaction • Give 1-2 h ac or 2-3 h pc • Cross allergy with cephalosporins • Watch renal and hepatic labs
Sulfonamides
Gantrisin (acetyl sulfisonxazole), Bactrim (co-trimoxazole), Azulfidine (sulfasalazine)
Uses – ulcerative colitis, Crohn’s disease, otitis media, UTIs
Action – antagonize essential component of folic acid synthesis
S/E: peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis
Nursing:
• Take with meals or food
• Encourage fluids – bc of crystal formation 3000 ml/day
• Good mouth care
Tetracyclines
Vibramycin (doxycycline), Panmycin (tetracycline)
Uses – infections, acne, prophylaxis for ophthalmia neonatorum (given to every baby when born to prevent infection)
Action – inhibits protein syntheis
S/E: discoloration of primary teeth if taken my mom during pregnancy, glossitis, rash, phototoxic reactions
Nursing:
• Take 1 h ac or 2-3 h pc
• Do not take with antacid, milk, iron – decrease absorption
• Note expiration date – if taken beyond expiration is toxic
• Monitor renal function
• Avoid sunlight - Sunblock!
All antibiotics before and after meals except
cephalosporins and sulfonamides
Antimpotence
Viagra (sildenafil), levitra (vardenafil), Cialis (Tadalafil)
S/E: headache, hypotension, priapism
Contraindications: nitrates, alpha blockers - will cause hypotension
Nursing:
• Can not take with grapefruit juice
• Call PCP if erection lasting longer than 4 hrs
Meds that can’t be taken with grapefruit juice
lipitor, antimpotence drugs, anticonvulsants
Anticholinergics
– inhibit the action of acetcholine, block parasympathic nerve
Pro-Banthine (propanthekine), Atropine, Scopace (scopolamine)
Uses – ophthalmic exam, motion sickness, pre-operative (to reduce GI and bladder motility)
Action – dilates pupils, causes bronchodilation and decreased secretions, decreases mobility and GI secretions
S/E: blurred vision, dry mouth, urinary retention, change in heart rate
- Nursing • monitor output (1500 ml normal) • contraindicated with glaucoma • give 30 min ac, hs, or 2 h pc • not used with paralytic illeus – don’t want to slow down more, BPH – enlarged prostate and don’t want to slow down bladder
Anticonvulsants
Dilatin (phenytoin), Luminal (Phenobarbital), depakote (divalproex sodium), Tegretol (carbamazepine), Klonopin (clonazepam)
Uses – seizures
Action – decreases flow of calcium and sodium across neuronal membranes
S/E: respiratory depression, aplastic anemia, gingival hypertrophy, ataxia
Nursing • don’t discontinue abruptly • monitor I&O • caution with use medications that lower seizure threshold (MARI, antiphsychotics) • avoid alcohol – CNS depressant • pts become drowsy • may turn urine pink
Monamine oxidase inhibitors (MAOI)
Antidepressant
Marplan (isocarboxazid), parnate (tranylcypromine), nardil (phenelzine)
Uses – depression, chronic pain
Action – causes increased concentration of neurotransmitters
S/E: hypertensive crisis when taken with tyramine-containing foods, photosensitivity
• Hypertensive crisis – severe headache, palpitations, diaphoretic, stiff neck – can progress to intracranial hemorrhage
Nursing:
• Avoid foods containing tyramine (aged cheese, bologna, pepperoni, salami, bananas, raisins, beer) – can cause hypertensive crisis
• Monitor output
• Takes 4 weeks to work
• Can’t take with CNS stimulates and cold medications
Selective serotonin reuptake inhibitors
antidepressants
Prozac (Fluoxetiner), Paxil (paroxetine hydrochloride), Zoloft (sertraline)
Uses – depression, OCD, bulimia
Action – inhibits CNS uptake of serotonin
S/E: anxiety, GI upset, change in appetite and bowel function, urinary retention
Nursing: • Suicide precautions (Do you have a plan! – only yes/no question) • Takes 4 weeks for full effect • Take in AM • Monitor nutrition • Turn urine pink
Tricycilics
Antidepressants
Elavil (amitriptyline), Toranil (imipramine), Norpramin (desipramine)
Uses – depression, sleep apnea
Action – inhibits reuptake of neurotransmitters
S/E: sedation, anticholinergic effects, confusion, postural hypotension, urinary retention
Nursing: • Monitor for suicide • Takes 2-6 weeks to work • Take at night – bc sedative effect • Monitor vital signs • Tell pt to slowly get up and down • Wean off over time – headache, vertigo, weight gain if come off too quickly • No alcohol • Avoid exposure to the sun
Heterocyclics
Antidepressant
Wellbutrin (bupropion), Desyrel (trazadone)
Uses – depression and smoking cessation
Action – alter affects serotonin in the CNS
S/E:
• Wellbutrin – agitation
• Desyrel - sedation
Nursing:
• Avoid alcohol and CNS depressants
• Wean off slowly
Non insulin antidiabetic
Diabinease, Orinase, Dymelor, Micronase
Uses – Type II diabetes
Action – stimulates insulin release from beta cells in pancreas - Push pancreas to produce more insulin – only used in type II
S/E: hypoglycemia, allergic skin reactions, GI upset
Nursing:
• Taken before breakfast – take to tell pancreas to produce insulin before eating, take awhile to work
• Instruct pt that they need to eat if taken the medication
• Monitor glucose levels (70-110 normal)
• Avoid alcohol, aspirin, sulfamides, oral birth contro, MAOIs – increase chance of hypoglycemia
Antidiarrheal
Kaopectate (bismuth subsalicylate), Lomotil (diphenoxylate/atropine), Imodium (loperamide), Paregoric (tincure of opium)
Uses – diarrhea
Action – slows peristalsis, increase tone of sphincters
S/E: constipation, anticholinergic effects (dry mouth, urinary retention, blurry vision) dizziness, drowsiness
Nursing
• do not use with abdominal pain
• monitor for urinary retention – pay attention to output
• give 2 h before or 3 h after other meds
• encourage fluids
Antiemetics
Tigan (Trimethobenzamide), Compazine (Prochlorperazine), Reglan (metoclopramdie), Antivert (Meclizine), Dramamine
Uses – vomiting
Action – increases GI motility, blocks effect of dopamine in chemoreceptor trigger zone
S/E: sedation, anticholinergic effects
Nursing
• used before chemotherapy
• when used with viral infections may cause Rye’s syndrome (toxic encephalopy)
Antifungals
Amphotericin B (fungizone), Nystatin (mycostatin)
Uses – candidiasis, oral thrush, histoplasmosis
Action – impairs cell membrane of the fungus
S/E: hepatotoxicity (hard on the liver to metabolize), thrombocytopenia (decrease platelets, so monitor for bleeding and hemorrage), leucopenia (decreased WBC, increase risk for infection), pruritius (itching)
Nursing
• give with food
• monitor liver function (AST, ALT)
• good oral hygiene
Antigout
Colchincine (colsalide) (acute phase of gout), Probenecid (benemid) (chronic phase of gout), Allopurinol (Zyloprim)
Uses – gout
Action – decreases production and resorption of uric acid
S/E: agranulocytosis, GI upset, renal calculi
Nursing
• monitor for renal calculi (give fluids 3000 ml/day)
• give with milk, food, antacids
Antihistamines
Chlor-Trimeton, Benadryl (diphenhydramine), Phenergan (promethazine), Laratadine
Uses – allergic rhinitis, allergic reactions to blood, reactions to other meds
Action – block effects of histamine
S/E: drowsiness, dry mouth, photosensitivity, bronchospasm
Nursing • give with food • use sunscreen • avoid alcohol • assess respirations, mouth care
Antihyperlipidemic Agents
Questran (Cholestyramine) – block absorption, Lipitor (atorvastin) – inhibit synthesis of absorption of cholesterol and triglycerides
Uses – elevated cholesterol, reduce incidence of cardiovascular disease
Action – inhibits cholesterol and triglyceride synthesis
S/E: constipation, fat-soluble vitamin deficiency
Nursing
• take at hs or 30 min before ac
• administer 1 h before 4-6 h after other meds
• assess diet
ACE inhibitors
(A = arteries, decrease bp by affecting the arteries in the body) – the prils
Capoten (captoril), vasotec (enalpril)
Uses – HTN, CHF
Action – blocks ACE in lungs (so block angiotension I to angiotension II – causes vasoconstriction – so will have vasodilation if blocked)
S/E: GI upset, orthostatic hypotension, dizziness
Nursing:
• Give 1 h ac or 3 h pc – bc food decreases absorption
• Change positions slowly
• Monitor vitals
Beta adrenergic blockers
(B is for beats, affects heart beats itself – slows them down)
Tenormin (atenolol), Corgard (nadolol), Inderal (propranolol)
Uses – HTN, angina, SVT
Action – blocks beta-adrenergic receptors – decreases excitability of the heart
S/E: changes in heart rate, hypotension, bronchospasms
Nursing:
• Masks signs of shock and hypoglycemia
• Take with meals
• Do not discontinue abruptly – taper over 2 weeks
Calcium channel blockers
(C in the heart)
Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem)
Uses – angina, HTN, interstitial cystitis
Action – inhibits movement of calcium across cell membrane
S/E: orthostatic hypotension, renal failure, angioedema
Nursing:
• Caution about position changes
• Monitor for edema, (facial swelling and shortness of breath)
• Vital signs are important (pulse and bp)
Angiotensin II receptor blockers
(sartans)
Candesartan (Atacand), Losartan (Cozaar)
Uses – HTN, heart failure, MI, diabetic neuropathy, stroke prevention
Action – blocks vasoconstriction and aldosterone effects of angiotensin II
S/E: hypotensin, dizziness, GI distress
Nursing:
• Monitor vitals
• Do not chew or divide sustained release tablets
Alpha 1 adrenergic blockers
Doxazosin (Cardura), Prazosin (Minipress)
Uses – hypertension, benign prostatic hypertrophy, reflex tachycardia
Action – selective blockade of alpha 1 reception in peripheral blood vessels (affects peripheral system not heart itself)
S/E: reflex tachycardia, orthostatic hypotension, nasal congestion
Nursing:
• Administer 1st dose at bedtime to avoid fainting
• Monitor BUN, weight, and edema
• Change position slowly
Centrally acting alpha-andrenergics
Aldomet, Catapres
Uses – HTN
Action – stimulates alpha receptors in medulla (affecting CNS to tell the heart to do something different)
S/E: sedation, orthostatic hypotension
Nursing: • Don’t discontinue abruptly • Monitor for fluid retention • Change position slowly • Check blood pressure and pulses
Direct-acting vasodilators
Apresoline (hydralazine), Minoxidil
Uses – HTN
Action – relaxes smooth muscle
S/E: tachycardia, increase in body hair
Nursing:
• Teach pt to check pulse (if
Bipolar meds
Lithium, Tegretol (carbamazepine), Depakote (divalproex)
Uses – manic episodes
Action – reduces catecholamine release
S/E: GI upset, tremors, polydipsia, polyuria
- Nursing
• monitor serum levels (with lithium)
• give with meals
• increase fluids
Antineoplastc Agents
–chemo drugs
rapidly producing cells within the body (good or bad)
Cannot tell the good from the bad
General side effects: hepatotoxicity, bone marrow suppression (decreases WBC
Alkylating Agents
Cisplatin, Myleran (busulfan), Cytoxan (cyclophosphamide)
Uses – leukemia, multiple myeloma
Action – interferes with rapidly reproducing DNA (hair mucous membranes, blood cells (white and red) – cannot tell the good from the bad
S/E: hepatotoxicity, bone marrow suppression,
Nursing:
• Check hematopoietic function
• Force fluids
• Good mouth and skin care
Antimetabolites
5-FU (flurorouracil), Methotrexate
Uses – acute lymphatic leukemia, cancer of the colon, breast, pancreas
Action – inhibits DNA polymerase (stop DNA replication)
S/E: nausea, vomiting, oral ulceration, bone marrow suppression, alopecia,
Nursing:
• Monitor hematopoietic function
• Good mouth care
• Discuss body image changes
Antitumor antibiotics
Adriamycin, Bleomycin, Actinomycin D
Uses – cancer
Action – interferes with DNA and RNA synthesis
S/E: bone marrow suppression (WBC, RBC, platelets), alopecia, stomatitis
Nursing:
• Monitor vital signs
• Give antiememetic before administration
• Infection, bleeding, oxygen, rest
Hormonal agents
Nolvadex (tamoxifen), Testosterone
Uses – cancer
Action – changes hormone input into sensitive cells (turns off cancer by changing hormones)
S/E: leucopenia, bone pain, hypercalcemia
• Testosterone - Fluid retention, increasing appetitive, mood swings, hair growth
Nursing:
• Check CBC
• Monitor serum calcium
Vinca alkaloids
Velban (vinblastine), Oncovin (vincristine)
Uses – cancer
Action – interfere with cell division – every rapidly producing cell in the body
S/E: stomatitis, alopecia, loss of reflexes, bone marrow suppression
Nursing: • Give antiemetic before administration • Check reflexes • Given with Zyloprim to decrease uric acid • Make sure IV patent before given
Antiparkinson Agents
Artane, Cogentin, L-Dopa (levodopa), Parlodel, Sinemet (carbidopa-levodopa) – work in different ways, may see multiple drugs used
Uses – Parkinson’s disease
Action – converted to dopamine, stimulates postsynaptic dopamine receptors
S/E: dizziness, ataxia, atropine like effects
- Nursing
• monitor for urinary retention
• large doses of vitamin B6 reveres effects
• avoid use of CNS depressants (alcohol, narcotics, sedatives)
Antiplatelet
Aspirin, Persantine (dipyridamole), Plavix (copidrogel)
Uses – venous thrombosis, pulmonary embolism
Action – interferes with platelet aggregations
S/E: hemorrhage, thrmbocytopenia
- Nursing
• check for signs of bleeding (urine, teeth, feces)
• give with food or milk – bc can cause GI upset
Antipsychotic Medications
Thorazine (chlorpromazine) – low traditional , Trilafon (perphenzine) – medium traditional, Haldol (haloperidol) –high traditional
o Low = high sedation, high = low sedation
Uses – acute and chronic psychoses
Action – blocks dopamine receptors in basal ganglia
S/E: akathisia, dyskinesia, dystonias, Parkinson’s syndrome, tardive dyskinesisas, leucopenia
Nursing:
o Check CBC
o Monitor vital signs
o Avoid alcohol and caffeine
Atypical Antipsychotic
Clozaril, Risperdal
Uses – acute and chronic psychoses
Actions – interferes with binding of dopamine in the brain
S/E: extrapyramidal, anticholinergic, sedative, orthostatic hypotension, dystonia – early sign tongue swelling, occluded airway – late sign
Nursing: • Monitor blood • Change positions slowly • Use sunscreen • Monitor airway status
Antipyretic Agents
Tylenol (acetaminophen)
Uses – fever
Action – antiprostaglandin activity in hypothalamus
S/E: GI irritation, liver dysfunction
- Nursing
• monitor liver function
• aspirin contraindicated for younger than 21 years old bc of risk for Rye’s syndrome
Antithyroid Agents
Tapazole (methimazole), SSKI (saturated solution potassium iodine)
Uses – hyperthyroidism, myxedema
Action – reduce vascularity of thyroid, inhibits release of thyroid into circulation
S/E: leucopenia, rash, thrombocytopenia
- Nursing • stop taking 2 weeks prior to any surgery • bitter taste • may cause burning in mouth • give with meals • check CBC
Thyroid Replacement Agents
Synthroid (Levothyroxine), Cytomel (liothyronine)
Uses – hypothyroidism, grave’s disease
Action – increases metabolic rate
S/E: nervousness, tachycardia, weight loss
- Nursing
• monitor weight
• take in AM – bc won’t be able to sleep
• monitor pulse and BP
• enhances effect of Coumadin and anitdepressants
• decrease effectiveness of insulin, digoxin
Antitubercular
1st line - INH (Isoniazid), Rifampin, Ethambutol, Stretomycin,
2nd line - PAS (para-amino-salicyclic acid), PZA (pyrazinamide)
Uses – tuberculosis, to prevent disease in person expose to organism
Action – inhibits cell and protein synthesis
S/E: hepatisis, peripheral neuritis
- Nursing
• check liver function tests
• Vitamin B6 given for peripheral neuritis
• Used in combination
• Avoid alcohol
• Watch for decreasing s/s fever, night sweats, rapid wt loss
Antitussive Agents/Expectorants
Benylin DM, Robitussin
Uses – coughs due to URI, COPD
Action – suppress cough reflex by inhibiting cough reflex in medulla, decrease viscosity of secretions
S/E: bradycardia, respiratory depression, drowsiness, dizziness, anticholinergic effects (dry mouth, urinary retention, blurry vision)
- Nursing
• monitor pulse and respiratory status
• monitor cough
• avoid alcohol
Antiviral
Zovirax, AZT, Videx, Famvir, Cytovene
Uses – recurrent HSV (herpes), HIV infections
Action – inhibits DNA and RNA replication
S/E: headache, dizziness, GI symptoms
- Nursing
• encourage fluids
• not a cure, but relieves symptoms
Attention Disorder Agents
Ritalin (methlyphenidate), Dexedrine (dextroamphetamine)
Uses – ADD, narcolepsy
Action – increases level of catecholamines - so stimulant
S/E: restlessness, insomnia, tachycardia, palpitations
- Nursing
• monitor growth rate
• monitor liver enzymes
• give in AM
Biophosphonates
Bone-Reabsorption Inhibitors
Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva)
Uses – Osteoporosis, Paget’s Disease
Action – inhibits resorption of bone
S/E: esophagitis, Arthralgia
Nursing:
• Sit upright for 30 mins after taking
• Take med in the morning
Bronchodilators
Aminophylline, Brethine, Atrovent, Proventil, Primatene mist
Uses – COPD, preterm labor (Terbutaline)
Action – decreases activity of phosphodiesterase
S/E: tachycardia, dysrhythmias, palpitations, anticholinergic effects
- Nursing
• monitor BP and heart rate
• When used with steroid inhaler, use bronchodilator first
• May aggravate diabetes
Used for preventative treatment for travel to environment where could have reaction – singular, albuteral, terbutaline
Used for acute bronchospams – aminophyline, epinerphrine
Carbonic Anhydrase Inhibitors
Diamox
Uses – open angle glacoma
Action – decreases production of aqueous humor in ciliary body
S/E: blurred vision, lethargy, depression
- Nursing
• monitor for systemic effects – lethargy, depression, anorexia
• elevate mental status of pt before given for glaucoma
Cardiac Glycosides
Lanoxin (digoxin)
Uses – left sided HF
Action – increases force of myocardial contraction, slows rate
S/E: bradycardia, nausea, vomiting, visual disturbances
- Nursing • Take apical pulse before administering for full minute • Notify MD if adult 70 • Monitor potassium levels (3.4-5) • Antidote - digabind • 0.5-2 normal levels of dig
Cytoprotective Agents
Carafate (sucralfate)
Uses – duodenenal ulcer
Action – forms a barrier on ulcer surface
S/E: constipation, vertigo
- Nursing
• take 1 hr before meals (ac)
• give 2 hr before or after other medications
Diuretics
HydroDIURIL (hydochlorothiazide), Aldactone (sprionlactone), Lasix (furosemide), Mannitol
Uses – CHF, renal disease
Action – inhibits reabsorption of sodium and water, blockes effects of aldosterone
S/E: dizziness, orthostatic hypotension, leukopenia
- Nursing
• taken with food or milk
• Take in the morning
• Monitor fluid and electrolytes - Thiazide diuretics – hydrocholorothiazide - monitor electrolytes (especially potassium)
- Potassium sparing – Aldactone – avoid large amounts of potassium
- Loop diuretics – Lasix – can be given IV and see diuresing in 1-2 mins, if PO then see in 30 mins
- Osmotic – mannitol – increase fluid in central nervous system
Electrolytes
Os-Cal (Calcium), Slow Mag (Magnesium), K-dur (potassium), sodium chloride (sodium)
Uses – fluid and electrolyte imbalances, osteoporosis
Action – replaces needed electrolytes
S/E: electrolyte imbalances
- Nursing
• monitor fluid and electrolytes - Calcium – see bone issues
- Magnesium – see nerve, muscle, and enzyme reactions effective
- Potassium – cell growth, muscle – heart and skeletal
Iron Preparations
Feosol (ferrous sulfate), Imferon (iron dextran)
Uses – iron deficiency anemia
Action – increase availability of iron for hemoglobin
S/E: constipation, dark stools, tachycardia
- Nursing • take on empty stomach • Vitamin C increases absorption, Vitamin E delays absorption • Monitor Hct and Hgb • Can be mixed with juice, but not milk! • Drink with straw to not stain teeth
Eye Medications
Tearisol, Liquifilm, Visine, Timoptic
Uses – ocular irritaion
Action – lubricant, causes vasoconstriction by local adrenergic action
S/E: headache, dizziness, blurred vision, pupillary dilation
- Nursing
• apply light pressure on lacrimal sac for 1 min after instilling drops
• monitor BP and pulse
Glucocorticoids
Solu-Cortef (hydrocortisone), Decadron (dexamethasone), Prednisone
Uses – Addison’s disease, Crohn’s disease, COPD, leukemias
Action – stimulate formation of glucose, alters immune response
S/E: susceptible to infection and masks infection, insomnia, hypoglycemia, hypokalemia, psychoses, depression, stunted growth
- Nursing
• monitor fluid and electrolyte balance – especially glucose and potassium
• don’t discontinue abruptly – will see severe headache, swelling of eyes, nausea and vomiting
• monitor for signs of infection
• effected by stress – might need to increase dosage
Mineralocorticoids
Florinef
Uses – adrenal insufficieny
Action – increases sodium reabsorption, potassium and hydrogen ion secretion in kidney
S/E: hypertension, edema, hypokalemia
- Nursing
• monitor BP, I&O, weight, and electrolytes
• give with food
• Low sodium, high protein, high potassium diet
Heavy Metal Antagonist
Desferal mesylate, BAL in Oil (dimercaprol), EDTA
Uses – gold and arsenic poisoning, acute lead encephalopathy
Action – forms stable complexes with metals
S/E: tachycardia, pain and induration at injection site
- Nursing
• Monitor I&O and kidney function – med toxic to kidneys
• Administer with local anesthetic – very painful injection
• Seizure precautions - pulling the lead out rapidly increases risk of seizures
Immunosuppressants
Sandimmune (cyclosporine)
Uses – prevent rejection for transplanted organ
Action – prevents production of T cells and their response to interleukin-2
S/E: hepatotoxicity, nephrotoxicity, leucopenia, thrombocytopenia
- Nursing • take once daily in AM • Used with adrenal corticosteroids • Monitor renal and liver function tests • Can be combined with milk or juice • Teach pt how to limit exposure of infections
Laxatives/Stool softeners
Cascara, Dulcolax (bisacodyl), Colace (docusate), Milk of magnesia
Uses – constipation, preparation for surgery and procedures
Action – absorb water increasing bulk, lubricate surface of stool, stimulate peristalsis
S/E: diarrhea, dependence, abdominal cramps, hypermagnesemia (CNS depressant – so respiratory function)
- Nursing • contraindicated with symptoms of acute abdomen • Monitor fluid and electrolytes • Chronic uses may cause hypokalemia • Encourage fluids
Miotic Eye Medications
Isopto-Carpine, Eserine, Carbacel
Uses – ocular surgery, open-angle glaucoma
Action – causes constriction of sphincter muscles of iris
S/E: headache, photophobia, hypotension, bronchoconstriction
- Nursing
• apply pressure on lacrimal sac for 1 min – decreases likelihood for systemic circulation
• avoid sunlight
• may experience transient brow pain and myopia
Mydriatics
Atropine sulfate, Cyclogyl
Uses – diagnostic procedures, acute iritis, uveitis
Action – anticholinergic actions leaves pupil under unopposed adrenergic influence
S/E: tachycardia, blurred vision, photophobia, dry mouth
- Nursing
• Contraindicated with glaucoma – because of pupil dilation
• Apply pressure on lacrimal sac for 1 min
• Wear dark glasses
Narcotics
Morphine sulfate, Codeine, Demerol (meperidine), Dilaudid (hydromorphine), Percodan (oxycodone)
Uses – moderate to severe pain, preoperative, postoperative
Action – acts on CNS receptor cells
S/E: dizziness, sedation, respiratory depression, hypotension, constipation
- Nursing
• Safety precautions
• Avoid alcohol
• Monitor respiratory rate before given and vital signs
• Use narcotic antagonist if necessary (Narcan)
Antianginals
Nitroglycerine, Isordil (Isosorbide)
Uses – angina, peri-operative hypertension, HF
Action – relaxes smooth muscle, decreases venous return
S/E: hypotension, tachycardia, headache, dizziness
- Nursing
• Check expiration date – should fizz, if doesn’t then out of date
• Teach when to take medication – take at first onset of pain
• May take q 5 min x 3 doses
• Wet with saliva and place under tongue
• Wear gloves, can’t put over hair, remove old patch before put new one on, take off before defib
Nonsteroidal Anti-Inflammatory (NSAIDS)
Motrin (ibuprofen), Indocin (indomethacin), Naprosyn
Uses – arthritis, mild to moderate pain, fever
Action – inhibits prostaglandin synthesis
S/E: FI upset, dizziness, headache, bleeding, fluid retention
- Nursing • Take with food or after meals – bc can cause GI upset • Monitor liver and renal function • Use cautiously with aspirin allergy • Check for bleeding
Thrombolytics
Streptokinase, Urokinase, Tissue plasminogen Activator (TPA)
Uses – acute pulmonary emboli, thrombosis, MI
Action – dissolves or lyses blood clots
S/E: bleeding, bradycardia, dysrhythmias
- Nursing
• Contraindicated in hemophilia, bleeding irregularity, recent trauma (sx included), 75 or older, on heprin or Coumadin
• Monitor for bleeding
• Have amino caproic acid available – antagonist for these meds
• Check pulse, color, sensation of extremities
• Monitor EKG
• Do neuro checks every 30 mins when started on meds
• Monitor urine and feces for bleeding
H2 Receptor Blockers
Tafamet, Zantac
Uses – ulcers, gastroesophageal reflux
Action – inhibits action of histamine and gastric acid secretion
S/E: dizziness, confusion, hypotension, impotence
- Nursing • Take with meals and hs • Smoking will decrease effectiveness • Monitor liver functions and CBC • Can interfere with production of RBC and WBC
Oral Contraceptives
prevent pregnancy, hormone control
HA, dizziness, nausea breakthrough bleeding, wt gain, horomonal mood swings
Nursing: • No smoking • Condom use • If missed dose take as soon as possible, use protection • Take at the same time each day • Do no protect against STDs
Estrogens
treat menopausal symptoms, cancers, osteoporosis
Estrace (esstradiol), Premarin (estrogen)
S/E: Nausea, gynecomastia, contact lens difficulty
Call MD if breast lumps, vaginal bleeding, edema, dark urine, blurred vision, chest pain
Alpha 1 adrenergic blockers
decrease urinary urgency, hesitancy, nocturia, prostatic hyperplasia
Terazosin (hytrin), Tamsulosin (Flomax)
HA, dizzy, orthostatic hypotension
Nursing: • Watch position changes • Avoid alcohol • Avoid CNS depressants • Give at bedtime
Anaphylaxis
Symptoms – hives, rash, difficulty breathing, diaphoresis
Nursing:
o Epinephrine 0.3 ml of 1:1000 solution SQ
o Massage site
o May repeat in 15-20
Delayed allergic reaction
Symptoms – rash, hives, swollen joints
Nursing: o Discontinue medication o Topical antihistamines o Corticosteroids o Comfort measures
Dermatologic Reactions
Symptoms – hives, exfoliative dermatitis, erythema multiform excidativum (stevens johnsons – dark red papules all over body)
Nursing:
o Good skin care – gentle!
o Antihistamines
o Topical corticosteroids
Stomatitis
Symptoms – swollen gums and tongue, difficulty swallowing, bad breath, mouth pain
Nursing: o Good mouth care – frequent rinses, soft tooth brush o Small feedings, non spicy foods o Antifungals o Local anesthetic
Super infections
Symptoms – fever, diarrhea, black hairy tongue, glossitis, vaginal itching and discharge
Nursing:
o Good mouth and skin care
o Antigungals
Bone Marrow Depression
Symptoms – fever, chills, sore throat, back pain, dark urine, anemia, thrombocytopenia, leucopenia
Nursing:
o Monitor CBC
o Protect from infections
o Avoid injury
Liver Impairment
Symptoms – fever, malaise, jaundice, light stools, dark urine, abdominal pain, elevated AST and ALT, altered PTT
Nursing:
o Good skin care
o Comfort measures
o Rest
Renal Impairment
Symptoms – elevated BUN and Creatinine, decreased HCT, altered electrolytes, fatigue, edema, altered outputs
Nursing: o Diet and fluid restrictions o Electrolyte replacement o Dialysis o Rest
Ocular Impairment
Symptoms – blurred vision, color vision changes, blindness
Nursing:
o Monitor vision
o Monitor exposure to light
Auditory Impairment
Symptoms – dizziness, ringing in ears, loss of hearing, loss of balance
Nursing:
o Monitor hearing
o Safety measures to prevent falls
CNS Impairment
Symptoms – confusion, insomnia, drowsiness, hallucination
Nursing:
o Safety measure to prevent injury
o Avoid activities that require alertness
o Frequent orientation to surroundings
Supplements that should not be taken near time of surgery
(may affect anesthesia or coagulation) o Echinacea o Garlic o Ginger o Ginseng o Kava o St john’s wart
