Pharmacology Flashcards
Care and Maintenance of TPN
1.Verify prescription & solution with another nurse before giving.
2.Administer using an infusion pump.
3.Weigh daily.
4.Monitor I&O and track fluid balance.
5.Check blood glucose every 4-6 hours.
6.Watch for infection signs.
7.Change gauze dressing every 2 days, transparent every 7.
8.Change IV tubing & fluid every 24 hours.
9.If TPN is unavailable, give 10% dextrose in water to prevent low blood sugar.
Antidote for Acetaminophen
Acetylcysteine
Antidote for Benzodiazepine
flumazenil
Antidote for Heparin and Enoxaparin
protamine sulfate
Antidote for Magnesium Sulfate
Calcium gluconate 10%
Antidote for Narcotics
Naloxone
Antidote for Warfarin
Vitamin K (phytonadione)
Antidote for Digitalis
digoxin immune FAB
Antidote for Cyanide Poisoning
Methylene Blue
Therapeutic Drug Level of Lithium
0.4-1.4
Therapeutic Drug Level of Phenytoin
10-20
Ca+ channel blocker suffix and Medications
-dipine
Nifedipine
Verapamil
Diltiazem
Amlodipine
-afil
Erectile dysfunction
anesthetics suffix
-caine
Ace inhibitors suffix
-pril
ARBs suffix
-sartan
Benzodiazepines suffix
-pam, -lam
Antilipemic suffix
-statin
corticosteroids suffix
-asone, -solone
Beta Blocker suffix
-olol
Penicillin suffix
-cillin
-ide suffix
oral hypoglycemic
proton pump inhibitor suffix
-prazole
Antiviral suffix
-vir
Thrombolytic suffix
-ase
Antiemetic suffix
-azine
Bronchodilator suffix
-phylline
Anticoagulant suffix
-arin
Antiulcer suffix
-dine
Antibiotic suffix
-cylcine
-floxacin
Aminoglycoside suffix
-mycin
Tricyclic Antidepressants suffix
-tyline
SSRIs suffix
-pram, -ine
Ciprofloxacin side effect
tendon ruptures
Doxycycline side effect
tooth discoloration
Furosemide side effect
Hypokalemia
Lithium side effect
Tremors
Tobramycin side effect
Ototoxicity
Valacyclovir side effect
Thrombotic thrombocytopenia purpura
Nursing Interventions: HTN
1: Assess weight, vitals signs, and hydration status
2. Assess BP in supine, sitting, and standing positions
3. Assess lab profiles: renal function, coagulation
4. Teach clients to take meds at same time each day
5. avoid hot tubs and saunas
6. Don’t discontinue meds abruptly
7. Prevent orthostatic hypotension
ACE inhibitors/ARBs: Therapeutic Use, Precautions, Side effects, Interventions & Education
ACE: -“pril”
ARBs: “-sartan”
**Therapeutic Use: **
HTN, HF, MI, Diabetic nephropathy
Precautions:
Use with caution if diuretic therapy in place
monitor K levels
**Side effects: **
persistent nonproductive cough w/ ACE
angioedema; hypotension
should not be used in second and third trimester of pregnancy
**Nursing Interventions & Education: **
Catopril should be taken 1 hr before meals
Monitor BP
Monitor for angioedema and promptly administer epinephrine Subq
Ca Channel Blockers: Medications, Therapeutic Use, Precautions, Side effects, Interventions & Education
Hint:
A Damn Very Nice Drug
Medications: A Damn Very Nice Durg
“-dipine”
Amlodipine, Diltiazem, Verapamil,Nifedipine
Therapeutic Use:
Angina, HTN
Verapamil and Diltiazem can be used for A fib, A flutter, or SVT
Precautions:
careful with digoxin and beta blockers
Contraindicated for clients who have HF, heart block, or bradycardia
Do not consume grapefruit juive (toxic effects)
Side Effects:
Constipation
Reflex Tachycardia
Peripheral edema
Toxicity
Nursing Interventions:
Do not crush or chew sustained-release tablets
Administer IV injection over 2-3 min
Slowly taper dose if discontinuing
Monitor HR and BP
Beta Blockers: Therapeutic Use, Precautions, Side effects, Interventions & Education
Hint:
BATT,
ABCDs & Don’t MIX,
BAND, Rebound
1-2 Dont’s, Check
-olol”
Therapeutic Use: BATT
BP: Hypertension (Primary HTN)
Angina
Tachycardia (Tachydysrhythmias)
Target: Heart failure (HF), Myocardial Infarction (MI)
Precautions: ABCDs, Dont Mix
AV block or Bradycardia = Contraindicated
Caution in asthma, bronchospasm, HF with nonselective beta blockers (e.g., Propranolol).
DM = Propranolol may mask hypoglycemia.
Don’t mix: Labetalol with Furosemide (IV line).
Side effects: Band, Rebound
Bradycardia, Bronchospasm
AV block
Nasal stuffiness
Dizziness or fatigue
Rebound effect if stopped suddenly (heart could overreact)
**Nursing Interventions & Education: **
1-2, Dont’s, Check–>
1-2 times daily as prescribed.
Don’t stop abruptly—always consult provider.
Don’t crush/chew extended-release tablets.
Check: Hold if systolic BP <100 or pulse <60.
Monitor DM patients for hypoglycemia.
Vasodilators: Action, Medications, Therapeutic Use, Precautions, Side effects, Interventions & Education
Hint:
NEN-H
HERE
Dizzy Head Problem + toxic
Protect, Dont MIx, 24 Hr Rule
**Action: **
Vasodilators = Open Vessels, Lower BP!
Medications: NEN-H
Nitroglycerin, Enalaprilat, Nitroprusside, Hydralazine
Therapeutic Use:
Hypertensive emergencies
Precautions HERE
Hepatic (liver) issues
Electrolyte imbalances
Renal issues
Elderly (older adults)
Side effects:
Dizziness
HA
profound HTN (rebound)
Cyanide toxicity (nitroprusside)
Nursing Interventions and Client Education
Protect Nitroprusside (keep it covered from light)
Don’t mix Nitroprusside with other medications
24-Hour Rule: Discard unused solution after 24 hours
Vasodilator Medications
Nitroglycerin
Enalaprilat
Nitroprusside
Hydralazine
Digoxin: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education, Management of Digoxin Toxcity
Action:
Increase the force and velocity of myocardial contractions to improve stroke volume and cardiac output; slow the conduction rate allowing for increased ventricular filling
Therapeutic Use:
HF
A fib
Precautions:
Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
ACE and ARBs increase risk of hyperkalemia
Verapamil increases risk of toxicity
Side effects:
Digoxin toxicity:
GI effects (anorexia, N/V, abdominal pain)
CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects)
Nursing Interventions and Client Education:
Assess apical pulse for 1 min prior to administration
Notify provider if HR is <60 (adult) <70 (child) or <90 (infant)
Monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia
Notify provider of any sudden increase in pulse rate that previously had been normal or low
Maintain therapeutic level (0.8-2.0)
Management of Digoxin toxicity:
Discontinue digoxin and potassium-wasting meds
Treat dsyrhtmias w/ phenytoin (or lidocaine)
Treat bradycardia with atropine
For excess overdose, administer digoxin immune FAB to prevent absorption
Organic Nitrates Medications
Sublingual tablet
Sustained-release tablet
Transdermal ointment
Transdermal patch
Organic Nitrates: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education
Action:
Relax peripheral vascular smooth muscles, resulting in dilation of arteries and veins, thus reducing venous blood return (reduced preload) to the heart, which leads to decreased oxygen demands on the heart
Therapeutic Use:
Acute angina attack
Prophylaxis of chronic stable or variant angina
Precautions:
Contraindicated in clients with head injury
Hypotensive risk with antihypertensive medications
Contraindicated if taking erectile dysfunction me –> life threatening hypotension
Side effects:
HA
orthostatic hypotension
Reflex tachycardia
Tolerance
Interventions & Education:
Nitrostat/Nitrolingual
-administer sublingual, rest for 5 min. If pain not relieved by first table call 911, then take a second tablet. May use up to 3 tablets taken 5 min apart.
-keep in dark container; Don’t shake (forms bubbles)
-Nitrolingual may be used prophylactically 5 go 10min before exercise
-replace every 6 months
-wear medical alert identification
Nitro-Bid (topical)
-wear gloves for administration
-do not massage or rub area
-apply to area without hair (chest, tank, or upper arm preferable)
-cover the area where the patch is placed with a clear plastic wrap and tape in place
-gradually reduce the dose and frequency of application over 4-6 weeks
Nitro-Dur (transdermal)
-skin irritation may alter med absorption
-optimal locations for patch are upper chest or side; pelvis; and thinner, upper arm
-rotate skin sites, usually worn for 12-14 hr then removed
Antidysrhtmic Agents: Medications, precautions
Medications:
Adenosine, Amiodarone, Atropine
Precautions:
Toxicity major concern due to additive effects
Caution is needed when used with an AV block
Caution Is needed when using anticholinergic meds
Adenosine: Therapeutic Use, Side Effects, Nursing Interventions
Therapeutic Use:
convert SVT to sinus rhythm
Side Effects:
flushing, nausea
bronchospasm, prolonged asystole
Nursing Interventions:
rapid IV (1-2 seconds) push
flush immediately w/ normal saline
Amiodarone: Therapeutic Use, Side Effects, Nursing Interventions
Therapeutic Use:
V fib, unstable V tach
Side Effects:
bradycardia
cardiogenic shock
pulmonary disorders
Nursing Interventions:
incompatible with heparin
may be given in PO maintenance dose
monitor for respiratory complications
Atropine: Therapeutic Use, Side Effects, Nursing Interventions
Therapeutic Use:
bradycardia, known exposure to chemical nerve agent, reduce secretions
Side Effects:
when used for life-threatening emergency, has no contraindications
Nursing Interventions:
monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation
Antilipemic Medications: Action, Therapeutic Use, Precautions, Side effects, Interventions & Education
Action: Aid in lowering LDL levels and increase HDL levels. Therapy includes, diet exercise, and weight control
Types of Medications:
-Statin
-cholesterol absorption inhibitors
Therapy Uses:
-primary hypercholesterolemia
-prevention of coronary events
-protection against MI and stroke in clients who have DM
Precautions:
-should be discontinued during pregnancy
-use with caution in renal dysfunction
Side effects:
-Muscle aches
-Hepatotoxicity
-Rhabdomyolysis
-Peripheral neuropathy
Interventions & Client Education:
-take meds in the evening (cholesterol synthesis increases)
-Monitor liver profile. Monitor renal profile if rhabdomyolysis is present
-Low-fat/High fiber diet
Statin Medications: Action, Precautions, Nursing Interventions & Education
Action:
interfere with hepatic enzyme HMG-CoA to reduce formation of cholesterol precursors
Precautions:
-prolonged bleeding in client taking warfarin
-multiple drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDs, tetracycline, beta-blockers, gemfibrozil, glipizide glyburide, oral contraceptives, phenytoin
Interventions & Education:
-do not administer w/ grapefruit juice
Cholesterol Absorption Inhibitors: Action, Medications, Interventions & Education
Action:
Inhibits the absorption of cholesterol secreted in the bile and from food. Often used in combination with other antilipemic meds
Medications:
Ezetimibe
Interventions & Education
-take 2 hr before or 4 hr after other antilipemics
-risk of liver damage increased when combined with statins
Respiratory Inhalation Medication Guidelines
- Advise to take the beta2 agonist before the inhaled glucocorticoids to increase steroid absorption
- Instruct on procedures for inhalation
- remove the mouthpiece cap
-if appropriate for medication, shake containers stand up or sit upright; exhale deeply
-place the mouthpiece bw teeth, and close lips tightly around the inhaler
- while breathing in, press down on the inhaler to activate and release the medication; continue breathing in slowly for several more seconds (slow, long, steady inhalation is better than quick, short breaths)
-Hold breath for 5-10 seconds
-Breathe in/out normally - Examine for mouth irritation
- Perform frequent oral care
Beta2 Adrenergic Agonists: Action, Medications, Precautions, Side effects, Interventions & Education
Action:
-promote bronchodilator by activating beta2 receptors in bronchial smooth muscle
Medications:
Albuterol, Formoterol/Salmeterol, Terbutaline
Precautions:
-contraindicated for clients w tachydysrhythmias
-caution: DM, hyperthyroidism, heart disease, HTN, angina
-Beta blockers will reduce effects
-MAOIs will increase effects
Side effects:
-tachycardia, palpitations
-tremors
Interventions & Client Education:
-caution against using salmeterol more frequently than every 12 hr
Albuterol: Route/Onset, Use
Route/Onset:
inhaled (short-acting)
5-15 min
Use:
acute bronchospasm
Formoterol/Salmeterol: Route/Onset, Use
Route/Onset:
inhaled (long-acting)
Formoterol: onset- 1-3 min; duration 10 hr
Salmeterol: onset: 10-20 min; duration: 12 hr
Use:
long-term control of asthma
Terbutaline: Route/Onset, Use
Route/Onset:
oral (long-acting)
Use:
long-term control of asthma
Methylxanthines: Action, Medications, Therapeutic Use, Precautions, Interventions & Education
Action:
Relaxation of bronchial smooth muscle, resulting in bronchodilation
Medications:
-aminophylline
-theophylline
Therapeutic Use:
-relief of bronchospasm
-long term control of asthma
Precautions:
-contraindicate w/ active peptic ulcer disease
-caution: DM, hyperthyroidism, heart disease, HTN, angina
-do not mix parenteral form with other meds
-phenobarbital and phenytoin decrease theophylline levels
-caffeine, furosemide, cimetidine, fluoroquinolone, acetaminophen, and phenylbutazone falsely elevate therapeutic levels
Side effects:
-irritability and restlessness
-toxic effects: tachycardia, tachypnea, seizures
Interventions & Education:
-monitor therapeutic levels for aminophylline and theophylline
-avoid caffeine
- monitor for signs of toxicity (toxic >20)
-smoking will decrease effects
-alcohol abuse will increase effects
Tx of Toxicity:
1. stop parenteral infusion
2. Activated charcoal to decrease absorption in oral overdose
3. Lidocaine for dysrhtmias
4. Diazepam to control seizures
Inhaled Anticholinergics: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education
Action:
muscarinic receptor blocker resulting in bronchodilation
Medications:
-ipratroprium
-tiotroprium
Therapeutic Uses:
-prevent bronchospasm
-manage allergen or exercise induced asthma
-COPD
Precautions:
-contraindicated for clients with peanut allergy (contains soy lecithin)
-Use extreme caution with narrow-angle glaucoma and BPH
-Do not use for tx of acute bronchospasms
Side effects:
-Dry mouth
-Urinary retention
Interventions & Client Education:
-instruct client that max effects may take up to 2 weeks
-shake inhaler well before administration
-when using 2 different inhaled medications, wait 5 min in bw
-if administered via nebulizer, use within 1 hr of reconstitution
-troprium suffix
Inhaled Anticholinergics
Glucocorticoids: Action, Medications, Therapeutic Uses (short and long term), Precautions, Side effects, Interventions & Education
Action:
precent inflammatory response by suppression of airway mucus production, immune responses, and a adrenal function
Short Term Therapeutic Uses:
-IV agents: status asthmaticus
-Oral: tx of symptoms following an acute asthma attack
Long Term Therapeutic Uses:
-Inhaled: prophylaxis of asthma
-Oral: tx of chronic asthma
Precautions:
-clients who have DM may require higher doses
-never stop medication abruptly
Side effects:
-euphoria, insomnia, psychotic behavior
-hyperglycemia
-peptic ulcer
-fluid retention
-withdrawal symptoms
-increased appetite
Interventions & Education:
-assess client activity and behavior
-administer medication w/ meals
-teach symptoms to report
-do not take with NSAIDs
-teach client about gradual reduction of does to prevent Addisonian Crisis
Leukotriene Modifiers: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education
Action:
Prevent effects of leukotriene, resulting in decreased inflammation, bronchoconstriction, airway edema, and mucus production
Medications:
Montelukast
Zileuton
Zafirlukast
Therapeutic Uses:
1.Long-term management of asthma in adults and children
-monetelukast can be given to clients over age 1
-zileuton can be given to clients 12 years and older
-zafirlukast can be given to clients 5 years and older
2. Prevention of exercise-induced bronchospasm
Precautions:
-do not use for acute asthma attack
-zileuton or zafirlukast: high risk of liver disease, increased warfarin effects, and theophylline toxicity
-phenobarbital will decrease circulating levels of mentelukast
-chewable tablets contain phenylalanine
Side Effects:
-Elevated liver enzymes (zileuton or zafirlukast)
-Warafrin and theophylline toxicity (zileuton or zafirlukast)
-May increase levels of beta blockers leading to hypotension and bradycardia (propranolol)
Interventions & Education:
-Never abruptly substitute for corticosteroid therapy
-teach client to take daily in the evening
-do not decrease or stop taking other prescribed asthma drugs until instructed
-if using oral granules, pour directly into mouth or mix with cold soft foods (never liquids)
-use open packets within 15 min of taking medication
Antiussives, Expectorants, Mucolytics : Precautions, Side effects, Interventions & Education
Precautions:
-only saline solutions should be used in children younger than 2 years
-opioid antitussives have potential for abuse
-caution with OTC meds (potentiate effects)
Side Effects:
-drowsiness
-dizziness
-aspiration and bronchospasm risk with mucolytics
- constipation
Interventions & Education:
-Monitor cough frequency, effort, and ability to expectorate
-monitor character and tenacity of secretions
-auscultate for adventitious lung sounds
-teach client why multiple therapies are needed
-promote fluid intake
Antiussives: Action, Medications Therapeutic Use
Action:
suppress cough through action in the CNS
Medications:
hydrocodone, codeine
Therapeutic Use:
chronic nonproductive cough
Expectorant: Action, Medication Therapeutic Use
Action:
promote increased mucus secretion to increase cough production
Medication:
guaifenesin
Therapeutic Use:
often combined with other agents to manage respiratory disorders
Mucolytics: Action, Medications Therapeutic Use
Action:
Enhance the flow of secretions in the respiratory tract
Medications:
acetylcysteine, hypertonic saline
Therapeutic Use:
-acute and chronic pulmonary disorders with copious secretions
-cystic fibrosis
-antidote for acetaminophen poisoning
Decongestants: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education
Action:
stimulate alpha1 adrenergic receptors, causing reduced inflammation of nasal membranes
Medications:
phenylephrine, pseudoephedrine, naphazoline
Therapeutic Use:
-allergic rhinitis
-sinusitis
-common cold
Precautions:
-products contain pseudoephedrine should not be used longer than 7 days
-contraindicated in clients with closed-angle glaucoma
-use cautiously for clients who have HTN, CAD, or dysrhythmias
Side Effects:
-dry mouth
-restlessness
-insomnia
Interventions & Education:
-use no longer than 3-5 days to avoid rebound congestion
-topical agents work faster and have a shorter duration
Antihistamines: Action, Medications, Therapeutic Uses, Precautions, Side effects, Interventions & Education
Actions:
decrease allergic response by competing for histamine receptor sites
Medications: diphenhydramine, loratadine, cetirizine, fexofenadine, desloratadine
Therapeutic Use:
Relieve/prevent hypersensitivity reactions
Precautions:
-use cautiously in clients with HTN, glaucoma, peptic ulcer disease, and urinary retention
-children may have symptoms of excitation, hallucinations, incoordination, and seizures
-avoid alcohol intake
Side Effects:
-anticholinergic effects
-drowsiness
Interventions & Education:
-assess for hypokalemia
-monitor BP
-teach client to manage anticholinergic effects
-advise to take at night
Oral Hypoglycemics: Precautions, Side effects, Interventions & Education
used in conjunction with diet and exercise to control glucose levels in clients who have type 2 DM
Precautions:
-caution in clients with renal, hepatic, or cardiac disorders
-generally avoided during pregnancy and lactation (instruct client to discuss with prescriber)
Nursing Interventions:
-teach signs and management for hypoglycemia, especially sulfonylureas
-encourage diet and exercise to follow American Diabetes Associate recommendations
-monitor HbA1c
-refer to diabetic nurse educator
Oral Hypoglycemic: Acarbose & Miglitol—Action & Precautions
Action:
slows carbohydrate absorption and digestion
Precautions:
contraindicated in clients w/ intestinal disease due to increased gas formation
Oral Hypoglycemic: Metformin—Action & Precautions
Action:
reduces gluconeogenesis; makes muscle tissue more sensitive to insulin
Precautions:
-withold 48 hr prior to and 48 hr after a test with contrast media
-contraindicated in clients with severe infection, shock, hypoxic conditions
Oral Hypoglycemic: Sitagliptin—Action & Precautions
Action:
promotes release of insulin, lowers glucagon secretion, and slows gastric emptying
Precautions:
caution with impaired renal function–dose will be reduced
Oral Hypoglycemic: Repaglinide, Nateglinide—Action & Precautions
Action:
stimulates beta cells to release insulin
Precautions:
caution with impaired renal function–dose will be reduced
Oral Hypoglycemic: Glipizide, Glyburide—Action & Precautions
Action:
promotes release of insulin from the pancreas
Precautions:
-extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders
-can cause disulfiram-like reaction with alcohol ingestion
Oral Hypoglycemic: Rosiglitazone, Pioglitazone—Action & Precautions
Action:
decreases cellular insulin resistance
Precautions:
exacerbations of HF
Insulin: Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Therapeutic Uses:
1.Glycemic control of DM to prevent complications
2. Clients taking oral hypoglycemic agents may require insulin therapy when:
-undergoing diagnostic tests; NPO status
-Pregnant
-severe kidney or liver disease is present
-oral agents are inefficient
-tx of hyperkalemia
Precautions:
-when mixing regular w/ NPH insulin, draw up regular first
-do not mix other insulins with lisper, glargine, or combination 70/30
-only regular insulin is given IV (only in normal saline)
-administer glargine at bedtime
Side Effects:
-hypoglycemia/hyperglycemia
-lipodystrophy
Interventions & Client Educations:
-monitor serum glucose levels before meals and at bedtime or patterned schedule–specific to client
-roll vial of insulin (except regular) to mix; do not shake
-instruct client to rotate injection sites to prevent lipodystrophy
-teah signs and management for hypo/hyperglycemia
-encourage diet and exercise to follow ADA recommendations
- monitor HbA1c
-refer to diabetic nurse educator
Forms of insulin: onset, peak, duration
Rapid-Acting (Lispro)
-onset: 15-30 min
-peak: 0.5-2.5 hr
-duration: 3-6 hr
Short-Acting (regular)
-onset: 0.5-1 hr
-peak: 1-5 hr
-duration: 6-10 hr
Intermediate: NPH
-onset: 1-2 hr
-peak: 6-14 hr
-duration: 16-24
Long-Acting (Glargine)
-onset: 70 min
-peak: None
-duration: 24 hr
Glucagon: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
indicates regulatory processes to promote breakdown of glycogen to glucose in the liver, resulting in increased serum glucose levels
Therapeutic Uses:
Emergency tx of severe hypoglycemia
Precautions:
N/V
Rebound hypoglycemia
Interventions & Education:
-administer meds for unresponsive client
-monitor blood glucose levels
-instruct client to self-monitor for early signs of hypoglycemia
-instruct client to wear medical alert ID
-advise client to teach family how to administer med
-provide carbs when client awakens from hypoglycemic reaction
Levothyroxine/T4: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
stimulate metabolism of all body system by accelerating the rate of cellular oxygenation
Therapeutic Uses:
-hypothyroidism
emergency tx of myxedema coma
Precautions:
overmedication can result in signs of hyperthyroidism
Side Effects:
-Tachycardia
-Restlessness
-Diarrhea
-Weight loss
-Decreased bone density
-Heat intolerance
-Insomnia
Nursing Interventions & Education
-monitor cardiac system
-therapy initiated w/ low doses; advance to higher dosages while monitoring lab values
-monitor T4 and TSH levels
-take in early morning
Methimazole: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
inhibits synthesis of thyroid hormone
Therapeutic Uses:
-Hyperthyroidism
-Preoperative thyroidectomy
-Thyrotoxic crisis
-Thyroid Storm
Precautions:
-administer with caution to clients who have bone marrow depression, hepatic disease, or bleeding disorders
-discontinue prior to radioactive iodine uptake testing
Side Effects:
-skin rash, pruritis
-abnormal hair loss
-GI upset
-paresthesias
-preorbital edema
-joint and muscle pain
-jaundice
-agranulocytosis
-thrombocytopenia
Interventions & Education:
-administer w/ food at the same time each day
-increase fluids to 3 L/day
-instruct client to avoid OTC products containing iodine
-instruct client to take med as prescribed
-if discontinued, must be tapered off
-monitor client for therapeutic response: weight gain, decreased pulse, BP, and T4 levels
-monitor client for signs of overdose and sighs of hypothyroid: periorbital edema, cold intolerance, mental depression
Posterior Pituitary Hormones/ Growth Hormones: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
Increase production of insulin-like growth factor throughout the body
Therapeutic Use:
-Tx growth hormone deficiencies
-Turner’s syndrome
Precautions:
-contraindicated in clients who are severely obese
-therpay must be discontinued prior to epiphyseal closure
-avoid concurrent use of glucocorticoids
Side Effects:
-hyperglycemia
-hypothyroidism
Nursing Interventions:
-monitor growth patterns
-reconstitute meds per manufacturer instructions
-administer subq per protocol
-dose is individualized
Posterior Pituitary Hormones/ Antidiuretic Hormones: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
promote reabsorption of water with the kidneys; vasoconstriction of vascular smooth muscle
Medications:
-Desmopressin (DDAVP): oral, intranasal, Subq, IV
-Vasopressin: intranasal, Subq, IV
Therapeutic Uses:
-Diabetes insipidus
-Cardiac arrest
-Nocturnal enuresis
-Hemophilia (Desmopressin)
Precautions:
contraindicated in clients with chronic nephritis or high risk for myocardial infarction
Side Effects:
-hyponatremia
-seizures
-coma
Interventions & Education:
-monitor urine specific gravity
-monitor BP
-monitor urinary output
-prevent hyponatremia due to water intoxication
-instruct for use of nasal spray
Adrenal Hormone Replacement: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
anti-inflammatory, suppresses immune response
Medications:
Dexanethasone, Hydrocortisone sodium succinate, Fludrocortisone acetate, Prednisone
Therapeutic Uses:
-acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
-Inflammation, allergic reactions, cancer
Precautions:
-contraindicated in clients who have systemic fungal infection
-caution in clients who have HTN, gastric ulcers, diabetes, osteoporosis
-requires higher doses in acute illness or extreme stress
Side effects
-adrenal suppression when administered for inflammation, allergic reactions
-infection
-hyperglycemia
-osteoporosis
-GI bleeding
-fluid retention
Interventions & Education
-do not skip doses
-monitor BP
-monitor fluid and electrolyte balance, weight, and output
-monitor for signs of bleeding and GI discomfort
-teach client to take calcium supplements and maintain vitamin D levels
-give wit food
-taper off dose regimen when discontinuing
-provide immunoprotection
Administration of Blood Products: Interventions & Education
- Client ID, name, and blood type must be verified by two nurses
- Prior to administration, assess baseline vital signs, including temp
- Establish IV access, 18-20 gauge catheter
- Must have 0.9% sodium chloride primed tubing
- For the first 15 min, stay with the client and infuse slowly, monitoring for any reaction. If a reaction occurs, perform the following interventions
- stop blood immediately and take vital signs
-infuse 0.9% sodium chloride
-notify the provider
-follow the facility policy (send urine sample, CBC, and bag and tubing to lab for analysis)
-Complete infusion of product within 4 hr
Administration of Whole Blood: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction
Time Completed:
2-4 hours
Action/Therapeutic Use:
Replace Volume, Hemorrhage, Surgery, Trauma, Burns, Shock
Monitor for Reaction:
-acute hemolytic
-febrile
-anaphylactic
-mild allergic
-hypovolemia
-sepsis
Administration of Packed RBCs: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction
Time Completed:
2-4 hrs
Action/Therapeutic Use:
-increase available RBC
-severe anemia
-hemolytic anemia
Monitor for Reaction:
-acute hemolytic
-febrile
-anaphylactic
-mild allergic
-sepsis
Administration of Platelets: Time Completed, Action/ Therapeutic Use, What to Monitor for Reaction
Time Completed:
-15-20 minutes
Action/Therapeutic Use:
-increase platelet count
-active bleeding
-thrombocytopenia
-aplastic anemia
-bone marrow suppression
Monitor for Reaction:
-febrile
-sepsis
Administration of Albumin: Action/ Therapeutic Use, What to Monitor for Reaction
Action/Therapeutic Use:
5%- expand volume via oncotic changes, hypovolemia, hypoalbuminemia
10%- Burns, severe nephrosis, hemolytic disease of the newborn
Monitor for Reaction:
Risk for hypervolemia and pulmonary edema
Epoetin Alfa: Action, Therapeutic Uses, Side Effects, Interventions
Action:
stimulate the bone marrow to synthesize the specific blood cells
Therapeutic Uses:
-stimulate RBC production
-anemia r/t to: chronic kidney disease, Retrovir therapy, chemotherapy
Side Effects:
HTN
Interventions:
Subq IV
Dp not agitate vial
-monitor hematocrit and hemoglobin\
Iron Preparation: Action & Medications– Oral & Parenteral
Action: Treat iron deficiency
Medications/Therapeutic. Uses:
1. Oral
-Ferrous sulfate
-Ferrous gluconate
-Ferrous fumarate
-dilute liquid preparations with juice or water and administer with a plastic straw or medication dosing syringe (avoid touching teeth)
-encourage orange juice fortified with vitamin C (facilitates absorption)
-avoid antacaids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hr after administration due to decreased absorption
-monitor the client for constipation and GI upset
2.Parenteral
-Iron dextran
-used for client unable to take oral meds
-intramuscular: use large-bore needle (10-20 gauge, change needle after drawing up from vial, Z-track-ventrogluteable preferable, never in deltoid muscle
-do not massage injection site
-IV (preferred over IM, administer over a small test does–25 mg over 5 min, observe pt for 15 min, then slowly administer additional preparation, use manufacturer’s recommendation for specific product
Anticoagulant: Medications & Therapeutic Uses
Medications & Therapeutic Uses
1. Parenteral (enoxaparin, heparin)
-stroke, pulmonary embolism, DVT, cardiac Cath, MI, DIC
2. Oral (warfarin)
-Venous thrombosis, prevent thrombus formation for clients who have A fib or prosthetic heart valves, prevent current MI, prevent TIA
3. Oral (rivaroxaban)
-reduce risk of stroke/embolism for client with nonvalvular A Fib
4. Oral (dabigatran etexilate)
–reduce risk of stroke/embolism for client with nonvalvular A Fib
-prevention of DVT and PE in clients undergoing total hip or knee arthroplasty
Anticoagulant: Precautions & Side Effects
- Parenteral
-administer Subq or IV
-incompatible with many meds (any bicarb bas)
-avoid NSAIDs, aspirin, or meds containing salicylates - Oral (warfarin)
-not safe for pregnant women
-contraindications: thrombocytopenia, vitamin K deficiency, liver disease, alcohol disease disorder
-decreased effects with phenobarbital, carbamazepine phenytoin, and oral contraceptives
-food sources high in vitamin K may decrease effects - Oral (dabigatran)
-caution if changing anticoagulation med
-discontinue 1-2 days prior to surgical procedures - Oral (rivaroxaban)
-No antidote for severe bleeding (prepare to administer activated charcoal to prevent further absorption)
-wait 6 hr before restarting after removal of epidural catheters
Side Effects:
1. Parenteral
-Hemorrhage
-Heparin induced thrombocytopenia
-toxicity/overdose
- Oral (warfarin)
-hemorrhage
-toxicity/overdose
3.. Oral (dabigatran, rivaroxaban)
-bleeding
-GI discomfort (dabigatran)
-Bleeding, bruising, HA, or eye pain (rivaroxaban)
Anticoagulant: Interventions & Education
- Parenteral
-Heparin: Monitor aPTT every 4-6 hr for IV administration
-monitor for signs of bleeding
-safety precautions to prevent bleeding
-administer subs heparin to abdomen, 2 inches from umbilicus (do not aspirate or massage)
-rotate injection sites and observe for bleeding or hematoma
-administer protamine sulfate gor heparin toxicity (1 mg neutralizes 100 units of heparin) - Oral (warfarin)
-administer once daily
-monitor INR or PT
teach client that bleeding risk remains up to 5 days after discontinued therapy
-teach client to avoid NSAIDs and medications with asprin
-teach client to wear medical alert bracelet
-client may self-monitor for PT/INR using a coagulation monitor
-teach measures to prevent injury and bleeding
-administer vitam K for warfarin toxicity
-garlic, ginger, gingko (may increase bleeding), and ginseng (blocks effects of warfarin)
-glucosamine interferes with warfarin and increases bleeding risk
-avoid alcohol - Oral (dabigatran, rivaroxaban)
-teach client to take medication daily and avoid skipping doses
-if a dose is missed, it should not be taken within 6 hr of the next scheduled dose
-tablets should not be crushed, broken, or chewed
-teach client to avoid NSAIDs and meds with aspirin
teach clients to monitor for signs of GI bleeding
Anti-platelet Medications: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
prevent platelets from aggregating (clumping together) by inhibiting enzymes and factors that normally promote clotting
Medications:
aspirin, abciximab, clopidogrel, ticlopidine, pentoxifyline, dipyridamole
Therapeutic Uses:
-prevention of acute MI or acute coronary syndromes
-prevention of stroke
-intermittent claudication
Precautions:
-contraindicated in thrombocytopenia
-caution with peptic ulcer disease
Side Effects:
-prolonged bleeding
-gastric bleeding
-thrombocytopenia
Interventions & Education:
-monitor for signs of prolonged bleeding
-teach client o report tarry stool, ecchymosis
Thrombolytic Medications: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
dissolve clots that have already formed by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors
Medications:
alteplase, tenecteplase, reteplace
Therapeutic Uses:
-acute MI
-DVT
-massive pulmonary emboli (PE)
-Ischemic stroke (alteplase)
Precautions:
-contraindicated for intracranial hemorrhage, active internal bleeding, aortic dissection, and brain tumors
-use caution when using in clients who have severe HTN
-concrurent use of anticoagulants or anti platelet meds increases risk for bleeding
Side Effects:
-serious bleeding risks from recent wounds, puncture sites, weakened vessels
-hypotension
-possible anaphylactic reaction
Interventions & Education
-administration must take place within 4-6 hr of symptom onset
-continuous monitoring is required
-clients will begin anticoagulant therapy to prevent repeated thrombotic event
Antacids: Action, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
neutralize gastric acid and inactivate pepsin
Therapeutic Uses:
-peptic ulcer disease
-GERD
Precautions:
-prolonged use can result in hypophosphatemia
-can decrease absorption of certain medications
Interventions & Education
-clients who have renal impairment should only use albumin based preparations
-other meds should be taken 1 hr before or after antacids
-older adults with poor nutritional status are at high risk of hypophosphatemia
-do not self prescribe antacid use for longer than 2 weeks
Antacids Medications & Side Effects
Albumin hydroxide: side effects
-constipation
Hypophosphatemia
Magnesium Hydroxide (Milk of Magnesia): side effects
-diarrhea
-renal impairment
-hypermagnesemia
Sodium Bicarbonate: side effects
-constipation
Antisecretory/Blocking Agents: Action, Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Action:
Prevent or block selected receptors within the stomach
Medications:
-PPI (-“azole”)
-Histamine receptor agonists (-“idine)
Therapeutic Uses:
-gastric and duodenal ulcers
-GERD
-zollinger Ellison syndrom
Precautions
-can increase the risk of osteoporosis with long term use, pneumonia in COPD clients and acid rebound (PPI)
-decreased libido/impotence (H2 blocker)
-lethargy, depression, confusion (H2 blocker)
Interventions & Education
-teach client to seek appropriate care (may take OTC preparations)
-review meds regimen and teach client about precautions r/t to time of administration as required
-do not crush, chew, or break tablets
-notify prescriber of any sign of GI bleeding
-modify diet as prescribed
Sucralfate: Action, Therapeutic Use, Precautions, Interventions & Education
Action:
adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hr; has no systemic effects
Therapeutic Use:
-gastric and duodenal ulcers
-GERD
Precautions:
-chronic renal failure
Nursing Interventions:
-administer on an empty stomach at least 1 hr before meals
-do not administer within 30 min of antacids`
Antiemetics: Action, Therapeutic Use, Medications
Action:
multiple classifications of medications that affect the GI tract or the vomiting center of the brain to reduce n/v
Therapeutic Uses:
-postoperative
-chemotherapy
-n/v associated with disease process
Medications:
-promethazine, metoclopramide, ondansetron, scopolamine
Promethazine: Side Effects, Precautions, Interventions
Side Effects:
drowsiness, anticholinergic effects, severe respiratory depression in children <2, EPS, potentiate effects when given narcotics
Precautions:
cardiovascular and hepatic disease
Interventions:
Monitor VS, safety precautions, IM (large muscle)
Metoclopramide: Side Effects, Precautions, Interventions
Side Effects:
Drowsiness, diarrhea, restlessness, EPS, tardive dyskinesia
Precautions:
Seizures, cardiovascular disease, pheochromocytoma
Interventions:
instruct client about rapid GI emptying
discontinue with signs of EPS
Ondansetron: Side Effects, Precautions, Interventions
Side Effects:
Headache, EPS
Precautions:
Risk for dysthymia, do not administer to clients with prolonged QT interval
Interventions:
administer tablets 30 min prior to chemotherapy and 1-2 hr before radiation
Scopolamine: Side Effects, Precautions, Interventions
Side effects:
blurred vison, sedation, anticholinergic effects
Precautions:
-increased mydriatic effect causes increased ocular pressure
-use with caution for client with glaucoma
Interventions:
-apply transdermal patches behind ear
-use lubricating eye drops
Antidiarrheals: Action, Medications, Precautions, Side Effects, Interventions & Education
Action:
Activate opioid receptors in the GI tract to decrease intestinal motility and to increase the absorption of fluid and sodium in the intestine
Medications:
-Diphenoxylate plus atropine, Loperamide, Paregoric
Therapeutic Use:
-management of diarrhea
Precautions:
-increased risk ofmegacolon for clients who have IBS
-contraindicated in clients with COPD (paregoric)
Side Effects:
constipation, drowsiness, dry mouth, blurred vision
Interventions & Education:
-monitor F&E
-avoid caffein intake (increases GI motility)
Stool softeners: Action, Medications &Therapeutic Uses, Precautions, Side Effects, Interventions & Client Education
Action:
facilitates peristalsis and bowel movements
Medications and Therapeutic Uses:
-Psyllium: decrease diarrhea (bulk-forming)
-Docusate sodium: relieve contipation (surfactant)
-Bisacodyl: pre procedure colon evacuation (stimulant)
-Magnesium Hydroxid (Milk of Magnesia): prevent painful elimination (low-dose osmotic); promote rapid evacuation (high-dose osmotic)
Precautions:
-contraindicated in clients with fecal impaction, bowel obstruction
-most laxatives are contraindicated in clients with ulcerative colitis and diverticulitis (psyllium may be used)
Side Effects:
-F&E imbalances, GI irritation, can lead to toxic levels of Mg, fluid retention (laxative w/sodium)
Interventions & Client Education:
-contraindicated with fecal impaction, bowel obstruction, and acute surgical abdomen
-encourage regular exercise and promote regular bowel elimination
-monitor for chronic laxative use/abuse
-provide adequate fluid and fiber intake to avoid obstruction
Diuretics: Action, Medication, Therapeutic Use, Precautions, Side Effects, Interventions & Education
Action:
increase the amount of fluid excretion via the renal system
Medications:
Loop: furosemide, bumetanide
Thiazide: hydrochlorothiazide, chlorothiazide
Potassium sparing: spironolactone, triamterene
Therapeutic Use:
-pulmonary edema caused by HF
-edema unresponsive to other diuretics
-HTN unresponsive to other diuretics
Precautions:
-use cautiously in clients who have DM
-contraindicated in pregnancy
-NSAIDs reduce diuretic effect
Side Effects:
Loop and thiazide:
-hypovolemia, ototoxicity (loop), hypokalemia,, hyponatremia, hyperglycemia, digoxin toxicity, lithium toxicity
Potassium-sparing:
-hyperkalemia, endocrine effects (impotence, menstrual irregularities)
Interventions & Éducation
-Monitor I&O, VS, and F&E imbalances
-administer early morning to prevent nocturne
-instruct clients taking loop/thiazide to increase intake of foods high in potassium
-instruct clients taking potassium-sparing diuretics to avoid foods high in potassium such as salt substitutes
Osmotic Diuretic–Mannitol: Action, Medication, Therapeutic Use, Precautions, Side Effects, Interventions & Education
Action:
pull fluid back into the vascular and extravascular space by increasing serum osmolality to promote osmotic changes
Therapeutic Use:
prevent renal failure r/t hypovolemia
decrease ICP r/t to cerebral edema
decrease intraocular pressure
Precautions:
-ues with caution in HF
Side effects:
pulmonary edema, F&E imbalances, thirst, dry mouth
Interventions & Client Education:
-monitor daily weight, I&O, electrolytes, signs of hypovolemia, & neurological status
Urinary Hesitancy meds: Precaution, Side Effects, Interventions & Education
Precautions:
Tamulosin–
-must rule out bladder cancer prior to administering
-combined use with cimetidine may facilitate toxicity
-use cautiously with meds causing hypotension (such as sildenafil)
Bethanechol–
-contraindicated for clients who have UTI
-contraindicated for clients with hypotension or decreased cardiac output (may cause bradycardia)
Side Effects:
Tamulosin–
-decreased libido, HA, and dizziness
Bethanechol
-excessive salivation, abdominal cramps, diarrhea
Interventions & Éducation
Tamulosin–
-take 30 min after meal at same time each day
-if dose is missed for several days, restart at the lowest dose
-can cause orthostatic hypotension
Bethanechol–
-administer on empty stomach
Anticholinergic Medications for Overactive Bladder: Action: Precaution, Side Effects, Interventions & Education
Action:
antispasmodic actions to decrease detrusor muscle spasms and contractions
Meds:
-oxybutynin, tolterodine, darifenacin, solifenacin
Therapeutic Use:
Urinary incontinence
Urinary urgency and frequency
Precautions:
- Do not use for clients who have intestinal obstruction.
-Use with other anticholinergics can increase anticholinergic effects.
-Risk for cognitive impairment in older clients.
Side Effects:
Anticholinergic symptoms
Drowsiness
Dyspepsia
Interventions & Education:
-Instruct client to manage anticholinergic side effects.
-Instruct client to report constipation lasting longer than 3 days.
Sexual Dysfunction: Actions, Medications, Therapeutic Uses, Precautions, Interventions & Education
Action:
Enhances the effect of nitric oxide to promote relaxation of penile muscles, allowing increased blood flow to produce an erection
Medications:
Sildenafil
Tadalafil
Vardenafil
Therapeutic Uses:
-Erectile dysfunction
-Less commonly used in the treatment of pulmonary arterial hypertension
Precautions/Interactions:
1. Contraindicated for clients taking nitrate drugs, alpha blockers for BPH, or antihypertensives.
2. Contraindicated for clients who have history of stroke, hypo/hypertension, or heart failure.
Side/Adverse Effects:
Hypotension
Priapism (erection lasting longer than 4 hr)
Vision impairment
Hearing loss
Headache
Flushing
Interventions and Client Education
1. Administer 1 hr before sexual activity; do not use more than once daily.
2. Instruct client to notify provider of all medications currently taken, including herbal preparations.
3. Instruct client to avoid intake of any organic nitrates.
4. Instruct client to stop taking medication and notify prescriber immediately for erection lasting longer than 4 hr or any loss of vision.
Childhood Immunizations Include:
Dtap/Tdap, Hib, Rotavirus, IPV, MMR, Varicella, Seasonal influenza, Hep A & B, HPV–up to age 26
Childhood Immunizations: Side Effects & Contraindications
DTaP, Tdap:
Side Effects: Fever, Irritability, Seizures
Containdications: Occurrence of seizures within 3 days of vaccine
Hib:
SE: Low-grade fever
Contraindication: Age younger than 6 weeks
Rotavirus:
SE: Irritability, diarrhea, vomiting, and intussusception
Contraindication: History of intussusception; Maximum age for the final dose is 8 months, 0 days
IPV:
SE: Anaphylactic reaction to neomycin, streptomycin, or polymyxin B
MMR:
SE: Joint pain, Anaphylaxis, Thrombocytopenia
Contraindication: Allergy to eggs, gelatin, or neomycin; Immunocompromised, pregnancy
Varicella:
SE:Vesicles on skin, Pruritus
Contraindications: Pregnancy, Allergy to gelatin and neomycin, Immunocompromised
Seasonal Influenza:
SE: fever
Contraindication:Nasal spray contraindicated for children younger than 2, adults older than 50 years, and clients who are immunocompromised; History of Guillain-Barré
Hep A & B
SE: Anaphylaxis
Contraindication: pregnancy (A); allergy to yeast (B)
Meningococcal vaccine:
Contraindication:History of Guillain-Barré
HPV:
Contraindication: Pregnancy, allergy to yeast
Adult immunizations: Type and Schedule
- Tetanus booster:Every 10 years
- MMR: One or two doses at ages 19 to 49
- Varicella:Two doses if no history of disease
- Pneumococcal (PPSV): Once after age 65; Recommended for immunocompromised, COPD, living in long-term care facility
- Hepatitis A:Two doses for high-risk clients
- Hepatitis B:Three doses for high-risk clients
- Seasonal influenza:Annually
- Meningococcal vaccine: Students entering college;Adults older than 56 years; repeat every 5 years for high-risk clients
- Herpes zoster:Over age 60
Aminoglycosides: Medications, Therapeutic Use, Precautions
Medications:
Amikacin, Gentamicin sulfate, Streptomycin
Therapeutic Use:
Septicemia, meningitis, pneumonia
Precautions:
1. High risk for ototoxicity, nephrotoxicity
2. Monitor creatinine and BUN
3. Monitor trough levels
Cephalosporins: Medications, Therapeutic Use, Precautions
Medications:
Cephalexin, Cefaclor, Cefotaxime
Therapeutic Use:
-Upper respiratory, skin, urinary infections
-Used as prophylaxis for clients at risk
Precautions:
1.Cross-sensitivity with penicillins
2.Monitor for signs of Clostridium difficile
Ciprofloxacin, Levofloxacin: Therapeutic Use, Precautions
Therapeutic Use:
-Bronchitis, chlamydia, gonorrhea, PID, UTI, pneumonia, prostatitis, sinusitis
Precautions:
-Caution with hepatic, renal, or seizure disorders
Macrolides “thromycin”: Medications, Therapeutic Use, Precautions
Medications:
Azithromycin, Clarithromycin, Erythromycin
Therapeutic Use:
Upper respiratory infections, sinusitis, Legionnaires’ disease, whooping cough, acute diphtheria, chlamydia
Precautions:
1.Used for clients who have penicillin allergy
2.Administer with meals
Nitrofurantoin: Therapeutic Use, Precautions
Therapeutic Use:
UTI
Precautions:
-Broad-spectrum
-Contraindicated in renal dysfunction
-Urine will have brown discoloration
Penicillins: Therapeutic Use, Precautions
Therapeutic Use:
Pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic fever, GYN infections
Precautions:
Hypersensitivity with possible anaphylaxis
Sulfonamides: Medications, Therapeutic Use, Precautions
Medications:
-Trimethoprim/sulfamethoxazole
Therapeutic Use:
UTI, bronchitis, otitis media
Precautions:
-Consume at least 3 L/day of fluid
-Use backup contraceptives
-Avoid sun exposure
Tetracyclines: Medications, Therapeutic Use, Precautions
Medications:
-Doxycycline calcium, Tetracycline HCl
Therapeutic Use:
Fungal, bacterial, protozoal, rickettsial infections
Precautions:
1.Consume at least 3 L/day of fluid
2.Use backup contraceptives
3.Avoid sun exposure
4.Permanent tooth discoloration if given to children younger than 8 years
Vancomycin: Therapeutic Use, Precautions
Therapeutic Use:
MRSA, bacterial, C. difficile infections
Precautions:
1.Contraindication: Allergy to corn
2.Caution: Ototoxicity, nephrotoxicity
3.Administer over 1 hr IV to prevent red man syndrome
4.Monitor trough levels
Flucanazole: Therapeutic Use, Precautions
Therapeutic Use:
Candidiasis infections
Precautions:
1.Monitor hepatic and renal function
2.Refrigerate suspensions
3.Increased risk of bleeding for clients taking anticoagulants
Hydroxychloroquine/ Quinine sulfate: Therapeutic Use, Precautions
Therapeutic Use:
1.Prevent malarial attacks, rheumatoid arthritis
2.Systemic lupus
Precautions:
1.Increased risk of psoriasis
2.Monitor for drug-induced retinopathy
Metronidazole: Therapeutic Use, Precautions
Therapeutic Use:
Trichomoniasis and giardiasis, clostridium difficile, amebic dysentery, PID, vaginosis
Precautions:
1.Take with food
2.Do not consume alcohol during therapy or 48 hr after completion of regimen
Isoniazid/Rifampin: Therapeutic Use, Precautions
Therapeutic Use:
1.Prevention and treatment of TB
2.Latent TB INH: 6 to 9 months
3.Active TB: multiple therapy up to 24 months
Precautions:
1.Risk of neuropathies and hepatotoxicity
2.Consume foods high in vitamin B6
3.Avoid foods with tyramine (INH)
4.Increased risk of phenytoin toxicity (INH)
5.Avoid alcohol
6.Discoloration of urine, saliva, sweat, and tears (rifampin)
Acyclovir/Valacyclovir HCL: Therapeutic Use, Precautions
Therapeutic Use:
Genital herpes, shingles, HIV
Precautions:
1.Acyclovir and valacyclovir: administer with food
2.Increase fluid intake
3.Begin therapy with first onset of symptoms
Bisphosphonates “-dronate”: Action, Medications, Therapeutic Use, Precautions, Side Effects Interventions & Education
Action:
Decrease the number and action of osteoclasts, resulting in bone resorption
Medications:
Alendronate: daily or weekly
Risedronate: daily, weekly, monthly
Ibandronate: monthly or every 3 months
Zoledronate: IV annually
Therapeutic Use:
1.Prevention and treatment of osteoporosis
2.Paget’s disease
3. Hypercalcemia related to malignancy
Precautions/Interactions:
1.Contraindicated during lactation.
2.Clients who have esophageal stricture or difficulty swallowing may only use zoledronate.
3.Absorption is decreased when taken with calcium supplements, antacids, orange juice, and caffeine.
Side/Adverse Effects:
Musculoskeletal pain, Esophagitis and GI discomfort, Jaw pain (zoledronate), Atrial fibrillation (zoledronate)
Interventions and Client Education:
1.Administer medication in the morning on an empty stomach.
2.Instruct client to consume at least 8 oz water (not carbonated).
3.Client must remain upright (sitting or standing) for 30 min after taking medication.
4.Consume adequate amounts of vitamin D.
DMARDS: MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education
Medication:
Methotrexate, Hydroxychloroquine, Etanercept, Infliximab, Adalimumab
Therapeutic Use:
Slow joint degeneration and progression of rheumatoid arthritis
Precautions/Interactions:
Methotrexate: Contraindicated in pregnancy, kidney or liver failure, alcohol use disorder, or hematologic dyscrasias.
Side/Adverse Effects:
1.Methotrexate: Increased risk of infection, bone marrow suppression, GI ulceration
2. Hydroxychloroquine: retinal damage (blindness)
Interventions and Client Education:
1.Instruct client about measures to prevent infection.
2.Monitor liver function tests.
3.Instruct client to use reliable contraception.
4.Instruct client that initial effects may take 3 to 6 weeks, and full therapeutic effects may take several months.
5.Administer with food.
6.Instruct clients taking hydroxychloroquine about the critical importance of retinal examination every 6 months.
Glucocorticoids (anti rheumatic): MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education
Medications:
Prednisone, Prednisolone
Therapeutic Use:
Provide symptomatic relief of inflammation and pain.
Precautions/Interactions:
1.Contraindicated in systemic fungal infection.
2.Do not administer live virus vaccines during therapy.
3.Should only be used for a short duration.
Side/Adverse Effects:
Risk of infection
Osteoporosis
Adrenal suppression
Fluid retention
GI discomfort
Hyperglycemia
Hypokalemia
Interventions and Client Education:
Do not skip doses.
Monitor blood pressure.
Monitor F&E balance and weight.
Monitor for signs of bleeding, GI discomfort.
Teach client to take calcium supplements and maintain vitamin D levels.
Give with food.
Never stop abruptly.
Provide immunoprotection.
NSAIDS (anti rheumatic): MedicationsTherapeutic Use; Precautions, Side Effects, Interventions & Education
Medications:
Ibuprofen, Indomethacin, Naproxen, Celecoxib
Therapeutic Use:
Provide rapid, symptomatic relief of inflammation and pain.
Precautions/Interactions:
1.Hypersensitivity to aspirin or other NSAIDs.
2.May increase the risk of MI and stroke (non-aspirin NSAIDS).
3.Nasal polyps increases risk of hypersensitivity reaction
Side/Adverse Effects:
GI discomfort
GI ulceration
Renal impairment
Photosensitivity
Interventions and Client Education:
Administer with food and full glass of water.
Avoid lying down for 30 min after administration.
Instruct client to use only as needed for symptoms to reduce risk of GI ulceration.
Instruct client to use sunscreen.
Antigout: Medication &Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Therapeutic Use:
Chronic gouty arthritis (Allopurinol)
Acute gouty arthritis (Colchicine)
Precautions/Interactions:
1.Use caution in clients who have renal, cardiac, or gastrointestinal dysfunction.
2.Should not be combined with theophylline.
Side/Adverse Effects:
1.GI distress
2.Rash and fever (discontinue immediately)
3.Decreases the metabolism of warfarin
Interventions and Client Education:
1.Instruct client to avoid foods high in purines to reduce uric acid.
2.Monitor CBC and uric acid levels.
3.Instruct clients to avoid aspirin.
4.Administer with meals.
Anti-anxiety: Medications, Therapeutic Uses, Precautions, Side Effects, Interventions & Education
Medications:
1.Benzo: Alprazolam, Chlordiazepoxide, Diazepam, Lorazepam
2.Buspirone
3.Antidepressants: Venlafaxine, Duloxetine, Paroxetine, Escitalopram
Therapeutic Use:
1.Generalized anxiety disorder and panic disorder
2.Insomnia
3.Alcohol withdrawal
4.Induction of anesthesia
Precautions/Interactions:
1.Benzodiazepines are used with caution in clients who have substance use disorder and liver disease.
2.Venlafaxine, an SNRI, is contraindicated for clients taking MAOIs.
Side/Adverse Effects:
1.CNS depression
2.Paradoxical response (insomnia, excitation, euphoria)
3.Withdrawal symptoms (not with buspirone)
4.Risk of abuse and potential for overdose (benzodiazepines)
Interventions and Client Education:
1.Monitor vital signs.
2.Instruct clients to never abruptly discontinue medication.
3.Monitor clients for side/adverse effects.
4.Instruct clients to avoid alcohol.
SSRI & SNRI: Medications, Precautions, Side Effects
Medications:
1. SSRI:Citalopram, Fluoxetine, Paroxetine, Sertraline
2.SNRI:Duloxetine,Venlafaxine
Precautions:
1.Avoid alcohol
2.Do not discontinue abruptly
3.Monitor for serotonin syndrome (agitation, confusion, hallucinations) within first 72 hr
Side/Adverse
Effects:
1.Weight gain
2.Sexual dysfunction
3.Fatigue
4.Drowsiness
Tricyclic: Medications, Precautions, Side Effects
Medications:
Amitriptyline, Imipramine
Precautions:
1.Do not administer with MAOIs or St. John’s wort
2.Must avoid alcohol
3.Contraindicated for clients with seizure disorder
Side/Adverse
Effects:
1.Anticholinergic effects
2.Orthostatic hypotension
3.Cardiac dysrhythmias
4.Decreased seizure threshold
MAOI:Medications, Precautions, Side Effects
Medications:
Isocarboxazid, Tranylcypromine, Phenelzine
Precautions:
1.Avoid foods containing tyramine
2.Antihypertensives have additive hypotensive effect
3.Contraindicated with SSRIs, tricyclics, heart failure, CVA, renal insufficiency
Side/Adverse
Effects:
1.CNS stimulation
2.Orthostatic hypotension
3.Hypertensive crisis with intake of tyramine, SSRIs, and tricyclics
Antidepressants: Interventions & Client Education
1.Assess client for suicide risk.
2.Instruct client to take on daily basis and never miss a dose.
3.Instruct client about therapeutic effects and time of onset.
4.Instruct client to avoid discontinuing drug abruptly.
5.Instruct client to take SSRIs in the morning to minimize sleep disturbances.
6.Provide clients taking MAOIs a list of foods containing tyramine.
7.Advise clients to avoid taking other medications without consulting provider.
Lithium Carbonate: Therapeutic Uses, Precautions, Side Effects, Intervention & Education
Therapeutic Uses:
1.Bipolar disorder
2.Alcohol use disorder
3.Bulimia
4.Schizophrenia
Precautions/Interactions:
1.Use cautiously in clients who have renal dysfunction, heart disease, hyponatremia, and dehydration.
2.NSAIDs will increase lithium levels.
3.Monitor serum sodium levels.
Side/Adverse Effects:
1.GI distress
2.Fine hand tremors
3.Polyuria
4.Hypothyroidism
5. Renal toxicity
Interventions and Client Education:
1.Monitor therapeutic levels.
2.Monitor serum sodium levels.
3.Instruct clients that therapeutic effects begin in 7 to 14 days.
4.Doses must be administered 1 to 3 times daily per provider prescription.
5.Provide nutritional counseling to include food sources for sodium.
6.Administer with food to decrease GI distress.
Antipsychotic Medications: Medications Therapeutic Uses, Precautions, Side Effects, Intervention & Education
Medications:
1.Typical-Chlorpromazine, Fluphenazine, Haloperidol, Thiothixene
2.Atypical-Aripiprazole, Clozapine, Olanzapine, Paliperidone, Quetiapine, Ziprasidone
Therapeutic Use:
1.Acute and chronic psychosis
2.Schizophrenia
3.Manic phase of bipolar disorders
4.Tourette syndrome
5.Delusional and schizoaffective disorders
6.Dementia
Precautions/Interactions:
1.Contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, and severe hypotension.
2.Use with caution in clients who have glaucoma, paralytic ileus, prostate enlargement, or seizure disorder.
Side/Adverse Effects:
1.Typical:
-Sedation
-Extrapyramidal effects
-Anticholinergic effects
-Tardive dyskinesia
-Agranulocytosis
-Neuroleptic malignant syndrome
-Seizures
2.Atypical:
-Agranulocytosis
-Weight gain
-Diabetes
-Dyslipidemia
-Orthostatic hypotension
-Extrapyramidal effects
Interventions and Client Education:
Monitor for side effects within 5 hr to 5 days of administration.
Advise client of potential side effects.
Monitor CBC.
Encourage fluids.
Stop medication for signs of neuroleptic malignant syndrome.
ADHD-Stimulants: Medications, Side Effects, Interventions & Client Education
Medications:
Dextroamphetamine and amphetamine, Methylphenidate
Side Effects:
Insomnia, Headache, Suppressed appetite,Abdominal pain
Interventions and client education:
1.Administer in early morning; give with or after meals.
2.Do not abruptly discontinue.
3.Monitor for signs of abuse.
4.Monitor for signs of agitation.
ADHD-NonStimulants: Medications, Side Effects, Interventions & Client Education
Medications:
1.Atomoxetine
2.Guanfacine: may be used in treatment of Asperger’s syndrome
Side Effects:
GI upset, Insomnia, Mood swings
Interventions and client education:
1.Take medication daily.
2.Do not crush or chew.
3.Instruct client to immediately report worsening of anxiety, agitation.
4.Do not take with MAOIs.
Sedative/Hypnotic Meds: Action, Medications, Therapeutic Use, Precautions, Side Effects, Intervention & Education
Action:
Slow neuronal activity in the brain to induce sedation/sleep
Medications:
1.Benzodiazepines-Lorazepam &Temazepam
2.Benzodiazepine-like medications-Zolpidem, Eszopiclone
Therapeutic Use:
1.Short-term insomnia
2.Difficulty falling or staying asleep
Precautions/Interactions:
1.Use cautiously in clients who have severe mental depression.
2.Avoid combined use with alcohol and medications that depress CNS function.
Side/Adverse Effects:
1.Amnesia
2.Respiratory depression
3.Daytime drowsiness and dizziness
Interventions and Client Education:
1.Instruct client to take immediately before bedtime because medication has abrupt onset of sleep.
2.Instruct client to avoid alcohol.
3.Warn client and caregivers of potential for sleep activities without recall; notify prescriber immediately.
Disulfiram: Therapeutic Use, Precautions, Side Effects, Intervention & Education
Therapeutic Use:
Adjunct to maintain sobriety in treatment of alcohol use disorder
Precautions/Interactions:
1.INH will increase risk of adverse CNS effects for clients taking disulfiram.
2.Ingestion of large amounts of alcohol may cause respiratory depression, dysrhythmias, and cardiac arrest.
3.Adjust medication doses of warfarin and phenytoin.
Side/Adverse Effects
1.Drowsiness
2.Headache
3.Metallic taste
4.Hepatotoxicity
Interventions and Client Education:
1.Must wait 12 hr between time of last alcohol intake and starting medication.
2.Instruct client that consumption of alcohol while taking disulfiram will result in flushing, throbbing in head and neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion.
3.Instruct client that undesirable effects last 30 min to several hours when alcohol is consumed.
4.Instruct client the effects of disulfiram may stay in the body for weeks after therapy is discontinued.
5. Instruct client that therapy may last months to years.
Methadone: Therapeutic Use, Precautions, Side Effects, Intervention & Education
Therapeutic Use:
Prevents withdrawal symptoms in clients who were addicted to opiate drugs.
Precautions/Interactions:
1.Do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury.
2.Avoid in clients with QT syndrome.
Side/Adverse Effects:
1.Sedation
2.Respiratory depression
3.Paradoxical CNS excitation
Interventions and Client Education:
1.Monitor clients for signs of drug tolerance and psychological dependence.
2.Monitor for respiratory depression.
3.Instruct client that methadone must be slowly reduced to produce detoxification.
4.Client must be monitored through treatment center.
Cholinesterase Inhibitors: Action, Therapeutic Use, Precautions, Side Effects, Intervention & Education
Action:
Prevent cholinesterase from inactivating acetylcholine, resulting in improved transmission of nerve impulses
Medications:
Neostigmine, Ambenonium, Edrophonium
Therapeutic Use:
Myasthenia gravis
Precautions/Interactions
1.Do not administer if heart rate is less than 60/min.
Side/Adverse Effects
1.Slow heart rate
2.Chest pain, weak pulse, increased sweating, and dizziness
3.Client feeling like they might pass out
4.Weak or shallow breathing
5.Urinating more than usual
6. Seizures
7.Trouble swallowing
Interventions and Client Education:
1.Dose must be individualized.
2.Instruct client to keep individual diary to record side effects.
3.Advise client to wear medical alert bracelet.
4.Monitor for cholinergic crisis.
Anti-parkinson’s : Action, Therapeutic Use, Precautions, Side Effects, Intervention & Education
Action:
Increase dopamine to minimize tremors and rigidity
Medications:
Benztropine, Carbidopa/levodopa, Levodopa
Therapeutic Use:
Parkinson’s disease
Precautions/Interactions:
1.Do not use levodopa within 2 weeks of MAOI use.
2.Pyridoxine (vitamin B6) decreases effects of levodopa.
3.Benztropine is contraindicated in clients who have narrow-angle glaucoma.
4.Must discontinue 6 to 8 hr before anesthesia.
Side/Adverse Effects:
1.Muscle twitching (especially eyelid spasms)
2.Headache
3.Dizziness
4.Dark urine
5.Orthostatic hypotension
Interventions and Client Education:
1.Instruct family members to assist with medication regimen.
2.Instruct client to notify prescriber if sudden loss of the medication effects occurs.
3.Instruct client that maximum therapeutic effects may take 4 to 6 weeks.
4.Monitor closely for signs of adverse reactions.
5.Instruct client to avoid high-protein meals and snacks.
Keep medication away from heat, light, and moisture. If pills become darkened, they have lost potency and must be discarded.
Antiseizure: Medications, Interventions & Client Education
Medications:
Carbamazepine, Gabapentin, Phenobarbital, Phenytoin, Valproic acid
Interventions & Client Education:
1.Monitor for therapeutic effects.
2.Monitor clients taking phenytoin for toxic effects, including serum levels for toxicity.
3.Instruct clients regarding the importance of compliance; medication is treatment, not a cure.
4.Individualize treatment regimen.
Instruct client regarding side/ adverse effects.
5.For status epilepticus: diazepam or lorazepam IV push followed by IV phenytoin or fosphenytoin.
Carbamazepine: Precautions & Side Effects
Precautions:
1.Contraindicated in clients who have bone marrow suppression or bleeding disorders
2.Decreases the effectiveness of oral contraceptives and warfarin
Side/Adverse
Effects:
Anemia, leukopenia, Stevens-Johnson syndrome
Gabapentin: Precautions & Side Effects
Precautions:
Do not abruptly discontinue
Side/Adverse
Effects:
1.Headaches, weight gain, nausea
2.Report CNS depression, seizures, visual changes, and unusual bruising
Phenobarbital: Precautions & Side Effects
Precautions:
Contraindicated in history of substance use disorder
Side/Adverse
Effects:
Drowsiness, hypotension, respiratory depression
Phenytoin: Precautions & Side Effects
Precautions:
Causes increased excretion of digoxin, warfarin, oral contraceptives
Side/Adverse
Effects:
Gingival hypertrophy, diplopia, drowsiness, hirsutism
Valproic Acid: Precautions & Side Effects
Precautions:
Contraindicated in liver disease, pregnancy
Side/Adverse
Effects:
Hepatotoxicity, teratogenic effects, pancreatitis
Antiglaucomoa: Medications, Precautions, Side Effects, Interventions & Education
Medications:
Levobunolol, Timolol, Pilocarpine, Latanoprost
Precautions/Interactions:
Use caution in clients taking oral beta blocker or calcium channel blocker.
Side/Adverse Effects:
1.Systemic effect of beta blockers: bradycardia, heart failure, bronchospasm
2.Brown discoloration of the iris (latanoprost)
3.Retinal detachment (pilocarpine)
Interventions and Client Education:
1.Instruct client to use sterile technique when handling applicator portion of the container.
2.Hold gentle pressure on the nasolacrimal duct for 30 to 60 seconds immediately after instilling drops.
3.Monitor pulse rate/rhythm for clients taking oral beta or calcium channel blocker.
Acetaminophen: Therapeutic Use, Precautions, Side Effects, Interventions & Education
Therapeutic Use:
Analgesic, Antipyretic
Precautions/Interactions:
1.Use caution in clients who consume three or more alcoholic beverages per day.
2.Concurrent use of rifampin, INH, carbamazepine, and barbiturates may increase hepatotoxic effects.
3.Slows the metabolism of warfarin.
Side/Adverse Effects:
1.Nausea and vomiting
2.Long-term therapy: hemolytic anemia, leukopenia, neutropenia, and thrombocytopenia
Interventions and Client Education:
1.Monitor liver function.
2.Monitor kidney function.
3.Be aware of OTC sources of acetaminophen.
4.Instruct client to take as prescribed and do not exceed 3,000 mg/24 hr.
5.Instruct client about risk of hepatotoxicity.
6.Administration to children should be based on age, not to exceed five doses per day (read labels carefully).
7.Treat acetaminophen overdose with acetylcysteine.
Opioids: Medications, Therapeutic Uses, Precautions, Side Effects, Intervention & Education
Medications:
Fentanyl, Hydromorphone, Morphine sulfate, Meperidine, Codeine, oxycodone
Therapeutic Use:
1.Relief of moderate to severe pain
2.Sedation
Precautions/Interactions:
1.Meperidine is preferred for clients with biliary associated pain.
2.Monitor for potentiation of effects when given with barbiturates, benzodiazepines, phenothiazines, hypnotics, and sedatives.
Side/Adverse Effects:
1.Orthostatic hypotension
2.Constipation
3.Urinary retention
4.Blurred vision
5.Respiratory depression
6.Abstinence syndrome
Interventions and Client Education:
1.Monitor vital signs.
2.Monitor for respiratory depression.
3.Instruct client regarding administration with PCA pump.
4.Administer naloxone for clients who have respiratory depression.
5.Prevent constipation.
6.Monitor for urinary retention.
Oral Contraceptives: Considerations For Use, Client Education
Considerations
for Use:
1.Pill is taken daily
2.Adverse effects: breast tenderness, bleeding, nausea/vomiting
Client Education:
1.Antibiotic therapy, phenytoin and rifampin, reduce effectiveness
2.Avoid smoking
Emergency Contraception: Considerations For Use, Client Education
Considerations
for Use:
1.A larger-than-normal dose of oral contraceptive
2.Taken no later than 72 hr after unprotected sex
3.Second dose is repeated 12 hr later
4.Antiemetics may be needed
Client Education:
1.Should discuss options with provider
2.Should never be used as the primary method of birth control
IUD: Considerations for Use, Client Education
Considerations
for Use:
1.A larger-than-normal dose of oral contraceptive
2.Taken no later than 72 hr after unprotected sex
3.Second dose is repeated 12 hr later
4.Antiemetics may be needed
Client Education:
1.Should discuss options with provider
2.Should never be used as the primary method of birth control
Cervical Diaphragm: Considerations for Use, Client Education
Considerations
for Use:
1.Use with spermicide
2.Fit by prescriber
3.Refitted after childbirth or weight gain/loss
Client Education:
1.Insert 6 hr prior to and leave in for 6 hr after intercourse
2.May be inserted up to 6 hr prior to intercourse; must be left in 6 hr after intercourse
3.Refit size with 10 lb or more weight change and following childbirth
Cervical Ripening: Action, Medications, Precautions, Side Effects, Intervention & Client Education
Action:
Prostaglandins cause cervical softening in preparation for cervical dilation and effacement
Medication:
1.Dinoprostone cervical gel
2.Misoprostol ( unlabeled use)
Precautions/Interactions:
1.Contraindicated in clients who have acute PID, history of pelvic surgery, abnormal fetal position.
Side/Adverse Effects:
1.Nausea
2.Headache
3.Tremor, tension
4.Feeling of warmth in the vaginal area
5.Elevated temperature
Interventions and Client Education:
1.Maintain client on bed rest for at least 2 hr (30 min for the gel) after insertion.
2.Monitor and record maternal vital signs and fetal heart rate.
3.Monitor for uterine contractions.
Oxytocin augmentation may be initiated as needed.
4.Major adverse effect is tachysystole.
Oxytocin: Action, Medications, Precautions, Side Effects, Intervention & Client Education
Action:
Stimulates uterine contractions for the purpose of induction or augmentation of labor and prevents postpartum hemorrhage
Therapeutic Use:
1.Antepartum for contraction stress test (CST)
2.Intrapartum for induction or augmentation of labor
3.Postpartum to promote uterine tone
Precautions/Interactions:
1.Contraindicated with placental abnormalities, fetal malpresentation, previous uterine surgery, and fetal distress.
2.Bishop Score of 6 and greater when planning induction.
Side/Adverse Effects:
1.Intense uterine contractions
2.Uterine hyperstimulation
3.Uterine rupture
4.Water intoxication
Interventions and Client Education:
1.Administer as secondary infusion via infusion pump for induction or augmentation.
2.Continuously monitor uterine contractions and fetal heart rate.
3.Discontinue oxytocin with any signs of uterine hyperstimulation or signs of maternal or fetal distress.
4.Administer oxygen via face mask 10 L for signs of hyperstimulation.
When used in postpartum, monitor client for uterine bleeding.
Methlyergonovine: Action, Therapeutic Use, Precautions, Side Effects, Interventions & Education
Action:
Acts directly on the uterine muscle to stimulate forceful contractions
Therapeutic Use:
1.Postpartum hemorrhage
Precautions/Interactions:
1.Use with extreme caution in clients with hypertension, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, cardiovascular, hepatic or renal impairment.
Side/Adverse Effects:
1.Potent vasoconstriction
2.Hypertension
3.Headache
Interventions and Client Education:
1.Continuously monitor blood pressure.
2.Assess uterine bleeding and uterine tone.
Tocolytics: Action, Medications, Therapeutic Use
Action:
Act on uterine muscle to cease contractions
Therapeutic Use:
Stop preterm labor
Medications:
Terbutaline sulfate, Nifedipine, Magnesium sulfate
Terbutaline Sulfate: Side Effects & Interventions
Side Effects:
Nervousness, Tremulousness, Headache, Nausea and vomiting, Hyperglycemia, Severe palpitations, Chest pain, Pulmonary edema
Interventions:
1.Monitor contractions and FHT
2.Monitor vital signs
3.Do not administer if pulse rate greater than 130/min or client has chest pain
4.Administer beta blocking agent as antidote
Nifedipine: Side Effects & Interventions
Side Effects:
Hypotension, Headache, Nausea, Flushing
Interventions:
1.Monitor BP
2.Avoid concurrent use with magnesium sulfate
3.Monitor contractions and FHT
4.Prevent complication with hypotension
Magnesium Sulfate: Side Effects & Interventions
Side Effects:
Warmth, Flushing, Respiratory depression, Diminished DTRs, Decreased urine output, Pulmonary edema
Interventions:
1.Monitor vital signs and DTRs
2.Monitor magnesium levels (therapeutic range 4 to 8 mg/dL)
3.Administer via infusion pump in diluted form
4.Use indwelling catheter to monitor urinary elimination
5.Administer calcium gluconate 10% for signs of toxicity
Betamethasone: Action, Therapeutic Use, Side Effects, Interventions & Client Education
Action:
Stimulate production of surfactant in fetus between 24 and 34 weeks gestation
Therapeutic Use:
Promote fetal lung maturity in preterm labor when delivery is likely
Side/Adverse Effects:
1.Fluid retention
2.Elevated blood pressure
3.Maternal hyperglycemia and transient increase in WBC
Interventions and Client Education:
1.Administer two doses (usually IM) 24 hr apart (repeat doses not recommended).
2.Provide emotional support to family.
Rho(D) Immune Globulin (RhoGAM): Action, Therapeutic Use, Precautions, Interventions & Education
Action:
Suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter the maternal circulation at the time of delivery
Therapeutic Use:
Rh factor incompatibility to prevent sensitization for subsequent pregnancies
Precautions:
1.Confirm that the mother is Rh-negative.
2.Never administer the IGIM full-dose or microdose products intravenously.
3.Never administer to a neonate.
Interventions and Client Education:
1.RhoGAM is administered within 72 hr after birth, if indicated (woman is Rh negative, newborn is Rh positive, and Coombs test is negative).
2.RhoGAM is also administered as an injection prophylactically at 28 weeks gestation and after any event where fetal cells can mix with maternal blood.
a.Miscarriage
b.Ectopic pregnancy
c.Induced abortion
d.Amniocentesis
e.Chorionic villus sampling (CVS)
f.Abdominal trauma
Medications for Postpartum Client: Varicella Vaccine
1.Women who are not immune to varicella should be immunized in the postpartum period.
2.Instruct client to use reliable form of contraception and avoid pregnancy for 3 months.
Saw Palmetto: Use, Side Effects, Interactions, Considerations
Use:
Treats and prevents benign prostatic hypertrophy (BPH)
Side/Adverse Effects:
1.Headache
2.Altered platelet function
3.Herb/Medication Interactions
Additive effect with anticoagulants
Nursing Considerations:
1.Allow 4 to 6 weeks to see effects.
2.Discontinue use prior to surgery.
Valerian Root: Use, Side Effects, Interactions, Considerations
Uses:
1.Insomnia
2.Migraines
3.Menstrual cramps
Side/Adverse Effects:
1.Drowsiness
2.Headache, nervousness with prolonged use
Herb/Medication Interactions:
Additive effect with barbiturates and benzodiazepines
Nursing Considerations:
1.Advise client against driving or operating machinery.
2.Advise client against long-term use.
Discontinue valerian at least 1 week prior to surgery.
St. Johns Wort: Use, Side Effects, Interactions, Considerations
Uses:
1. Mild to Moderate Depression
2.Seasonal affective disorder
3.Anxiety
Side/Adverse Effects:
1.Headache
2.Sleep disturbances
3.Phototoxicity (long-term use)
Constipation
Herb/Medication Interactions:
Many interactions with other medications–>
a.Oral contraceptives
b.Cyclosporine
c.Warfarin
d.Reduced antiretroviral effects
e.Digoxin
f.Calcium channel blockers
g.Antidepressants
Nursing Considerations:
1.St. John’s wort has many medication interactions and should not be taken with other medications.
2.Should not be used to treat severe depression.
3.Should only be used with medical guidance.
Echinacea: Use, Side Effects, Interactions, Considerations
Uses:
1.Prevents and treats the common cold
2.Stimulates the immune system
Promotes wound healing
Side/Adverse Effects:
1.Fever and nausea (rare)
2.Anaphylaxis in susceptible individuals
Herb/Medication Interactions:
1.May reduce the effects of immunosuppressants
2.May increase serum levels of alprazolam, calcium channel blockers, and protease inhibitors
Nursing Considerations:
Long-term use may cause immunosuppression.
Garlic: Use, Side Effects, Interactions, Considerations
Uses:
1.Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides
Suppresses platelet aggregation and disrupts coagulation
2.Acts as a vasodilator (can lower blood pressure)
Herb/Medication Interactions:
1.An increased risk of bleeding in clients taking NSAIDs, warfarin, and heparin
2.Decreases levels of saquinavir (a medication for HIV treatment) and cyclosporine
Nursing Considerations:
1.Question clients about concurrent use of NSAIDs, heparin, and warfarin.
2.Have clients who are taking antiplatelet or anticoagulant medication, cyclosporine, or saquinavir contact their provider prior to taking garlic as a supplement.
Ginger Root: Use, Interactions, Considerations
Uses:
1.Relieves vertigo and nausea
2.Increases intestinal motility
3.Increases gastric mucus production
4.Decreases GI spasms
5.Produces an anti-inflammatory effect
6.Suppresses platelet aggregation
7.Used to treat morning sickness, motion sickness, nausea from surgery
8.Can decrease pain and stiffness of rheumatoid arthritis
Herb/Medication Interactions:
1.Use cautiously in clients who are pregnant because high doses can cause uterine contractions
2.Interacts with medications that interfere with coagulation (NSAIDs, warfarin, and heparin)
3.Can increase hypoglycemic effects of diabetes
Nursing Considerations:
1.Question clients about concurrent use with NSAIDs, heparin, and warfarin.
2.Monitor for hypoglycemia if the client takes insulin or other medication for diabetes.
Gingko Biloba: Use, Side Effects, Interactions, Considerations
Uses:
1.Improves cerebral circulation to treat dementia and memory loss
2.Decreases pain with walking in clients who have PAD
Side/Adverse Effects:
1.Dizziness
2.Stomach upset
3.Vertigo
Herb/Medication Interactions:
1.May increase the effects of MAOIs, anticoagulants, and antiplatelet aggregates
2.May reduce the effectiveness of insulin
Nursing Considerations:
1.Discontinue 2 weeks prior to surgery.
2.May cause seizures with overdose.
Keep out of the reach of children.
Glucosamine: Use, Side Effects, Interactions, Considerations
Uses:
1.Relieves osteoarthritis
2.Promotes joint health
Side/Adverse Effects:
1.Nausea
2.Heartburn
Herb/Medication Interactions:
1.May increase resistance to antidiabetic agents and insulin
2.May increase risk of bleeding. Use cautiously with clients on anticoagulants
Nursing Considerations:
1.Use glucosamine with caution in clients who have a shellfish allergy.
2.Monitor glucose frequently in clients who have diabetes mellitus.
3.Allow extended time to see the effects of glucosamine.
Used often in combination with chondroitin.
Omega-3 Fatty Acids: Use, Side Effects, Interactions, Considerations
Uses:
1.Improves hypertriglyceridemia
2.Helps maintain cardiac health
Side/Adverse Effects:
1.Nausea
2.Diarrhea
Herb/Medication Interactions:
1.May increase risk of vitamin A or D overdose
Nursing Considerations
1.Omega-3 fatty acids are found in fish oils, nuts, and vegetable oils.
2.Some fish contain methylmercury and polychlorinated biphenyls (PCBs) that can be harmful in large amounts, especially in women who are pregnant or nursing.
Melatonin: Use, Side Effects, Interactions, Considerations
Use:
Treats insomnia and jet lag
Side/Adverse Effects:
1.Morning grogginess
2.Lower body temperature
3.Vivid dreams
Herb/Medication Interactions:
1.Beta blockers
2.Warfarin
3.Steroids
Nursing Considerations:
Pregnant or nursing women should not take melatonin.
Nursing Assessments for Herbal Medications
A. Ask the client specifically about herbal medications, vitamins, or other supplements during the client interview.
B. Over-the-counter medications are often not considered medications by the client.
C. Nursing Interventions
1. Instruct the client that herbal medications and supplements are not regulated by the FDA, often interact with other medications, and may cause serious adverse effects.
2. Instruct the client that it is important to use herbal medications and supplements cautiously and with medical supervision.
3. Discourage use in pregnant and nursing mothers, infants, young children, and older adults who have cardiovascular or liver disease.
