Uworld Pharmacology Flashcards
alteplase
Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage
Trimethoprim-sulfamethoxae
(Bactrim) is a sulfonamide antibiotic, commonly referred to as a sulfa drug.
- These antibiotics are prescribed to treat bacterial infections (eg, urinary tract infections).
- Contraindications include hypersensitivity to sulfa drugs, and pregnancy or breastfeeding.
Glyburide
used to treat diabetes mellitus, and it can cause significantly low blood sugar if ingested by a client who does not have diabetes
- is a sulfonylurea and has the potential to cause a sulfa cross-sensitivity reaction.
- The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain.
- Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur.
- Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.
- carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)
Common diuretics that can cause sulfa allergies
thiazides, furosemide are sulfa derivatives and can cause cross-sensitivity reaction.
Crystalluria is a potential adverse effect
of sulfa medications.
- Clients should drink at least 2-3 L of water daily to prevent crystalluria.
What foods decrease the effects of warfarin
Warfarin - works by inhibiting vitamin K-dependent clotting factors
- Consumption of foods rich in vitamin K will decreases the effectiveness of warfarin
- clients must be taught to eat the same amount of or avoid dark, green, leafy vegetables.
Clients are not instructed to remove those foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach.
Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter its anticoagulant effects.
nifedipine
- Peripherally acting calcium channel block
- used to treat hypertension and do not worsen bronchoconstriction
- cause vasodilation, and clients may develop peripheral edema
- — This is an expected, frequent side effect and is not an allergic reaction.
- – Clients are advised to elevate the legs when lying down and to use stockings.
- also used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.
- avoid grapefruit juice!! - cause severe hypotension
The following should be taught to clients taking tetracyclines (eg, tetracycline, doxycycline, minocycline):
- Take on an empty stomach – for optimum absorption, tetracyclines should be taken 1 hour before or 2 hours after meals
- Avoid antacids or dairy products – tetracyclines should not be taken with iron supplements, antacids, or dairy products as they bind with the drug and decrease its absorption
- Take with a full glass of water – tetracyclines can cause pill-induced esophagitis and gastritis; the risk can be reduced by taking with a full glass of water and remaining upright after pill ingestion
- Photosensitivity – severe sunburn can occur with tetracycline. The client should use sunblock
- Medications such as tetracycline and rifampin can decrease the effectiveness of oral contraceptives; additional contraceptive techniques will be needed
Drug of choice to treat SVT
Adenosine is the drug of choice to treat SVT and has a 5- to 6-second half-life (the time it takes for the drug to be reduced to half of its original concentration).
- Placing the IV line as close as possible, not distal, to the heart is essential for the drug to have full effect.
- Adenosine is given rapidly over 1-2 seconds and then followed by a rapid 20-mL normal saline flush.
- Transient asystole is common, and clients often experience flushing and dizziness.
- Repeat boluses of 12 mg may be given twice if the rapid rhythm persists
benztropine
(Cogentin) - Anticholinergic
- used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide.
- given for tremors for parkinsons
- Give IV for a dystonic reaction –Severe neck spasms in an individual taking haloperidol (and other psychotropic medications)
- a common side effect is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat
- in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode
radioactive iodine (RAI)
- the primary treatment for nonpregnant adults with hyperthyroid disorders such as Graves’ disease (a type of autoimmune hyperthyroid disease).
- RAI damages or destroys the thyroid tissue, thereby limiting thyroid secretion, and can result in hypothyroidism. Clients need to take thyroid supplementation (levothyroxine) for life.
- The use of RAI is contraindicated in pregnancy and could cause harm to a fetus. Pregnancy results should therefore be confirmed using a valid pregnancy test in all clients who still have menstrual cycles rather than using a subjective form of assessment such as asking when the last menstrual period occurred
- Radiation thyroiditis and parotitis, which cause dryness and irritation to the mouth, may occur after RAI treatment.
- -The nurse can teach the client to take sips of water frequently or to use a salt and soda gargle solution 3-4 times daily to relieve these symptoms.
levothyroxine
- thyroid replacement supplement for hypothyroidism
- used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid removed.
- These clients must understand that this medication must be taken for the rest of their lives
- A client’s dose is adjusted based on serum TSH levels to prevent too much or too little hormone. Clients must be taught to report signs of excess thyroid hormone such as heart palpitations/tachycardia, weight loss, and insomnia
- safe to take during pregnancy
- best to take this medication first thing in the morning as it is best absorbed on an empty stomach (1 hour before or 2 hours after a meal)
Several medications impair the absorption of levothyroxine (Synthroid). Common offenders are antacids, calcium, and iron preparations. Some of these could be present in several over-the-counter multivitamin and mineral tablets. Therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications.
The client’s therapeutic response to levothyroxine (Synthroid) is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood, higher energy levels, and a heart rate that is within normal limits. The nurse should consult the health care provider if the heart rate is >100/min, or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect
alprazolam =
Xanax - Benzodiazepine
- commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
clonazepam
Benzodiazepines - commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
lorazepam =
Ativan - Benzodiazepine
- commonly used antianxiety drugs.
- considered standard treatment to control agitation in the client in alcohol withdrawal
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
- has a long half-life (10-17 hours). Side effects include drowsiness, dizziness, ataxia, and confusion
- IV used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic
Eliminating aged cheeses and processed meats is necessary with?
monoamine oxidase inhibitors (eg, tranylcypromine, phenelzine), which are used for depressive disorders.
aged cheeses and processed meats contain tyramine
tranylcypromine
monoamine oxidase inhibitor - used for depressive disorders.
phenelzine
(Nardil) monoamine oxidase inhibitor - used for depressive disorders.
Clients taking MAOIs must avoid high-tyraminefoods to prevent life-threatening hypertensive crisis. Foods and beverages to avoid include aged cheeses (eg, most cheeses except for cream and cottage cheese); protein-rich foods; and foods that have been processed (eg, hot dogs), pickled, fermented (eg, sauerkraut, pepperoni), or smoked (eg, smoked salmon). Most fruits and vegetables (eg, salad, broccoli) contain little to no tyramine
tenecteplase
Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage
reteplase
Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage
amlodipine
(Norvasc) - Peripherally acting calcium channel blockers
- used to treat hypertension and do not worsen bronchoconstriction
- cause vasodilation, and clients may develop peripheral edema
- — This is an expected, frequent side effect and is not an allergic reaction.
- – Clients are advised to elevate the legs when lying down and to use stockings.
felodipine
- Peripherally acting calcium channel blockers
- cause vasodilation, and clients may develop peripheral edema
- — This is an expected, frequent side effect and is not an allergic reaction.
- – Clients are advised to elevate the legs when lying down and to use stockings.
diazepam
Benzodiazepine - commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
- considered standard treatment to control agitation in the client in alcohol withdrawal
- IV diazepam used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic
Vancomycin
(Vancocin) is a potent antibiotic used to treat gram-positive bacterial infections (eg, Staphylococcus aureus, Clostridium difficile).
- strong antibiotics that can cause nephrotoxicity and ototoxicity
- To lower the risk of dose-related nephrotoxicity, especially in clients with renal impairment and those who are >60 years of age, serum vancomycin trough levels should be monitored to assess for therapeutic range (10-20 mg/L).
- normal levels of creatinine (0.6-1.3 mg/dL) and BUN (6-20 mg/dL) are necessary in clients receiving vancomycin.
omeprazole
proton pump inhibitor that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach. In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during surgery or a major illness.
- Although evidence has shown that two-thirds of clients who receive PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by their “-prazole” ending (eg, pantoprazole, lansoprazole, esomeprazole).
- used for GERD, also used for ulcer tx, and prevention
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
- associated with increased risk of pneumonia, Clostridium difficile diarrhea, and calcium malabsorption (osteoporosis
proton pump inhibitors =
prazoles
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
lansoprazole
proton pump inhibitor
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
pantoprazole
proton pump inhibitor
- used for GERD, also used for ulcer tx and prevention
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
rebeprazole
proton pump inhibitor
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
Metronidazole
(Flagyl)
first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile
is the initial drug of choice for STIs.
- Clients should avoid alcohol while taking metronidazole and for 24 hours after completion of the therapy due to a reaction that includes flushing, nausea/vomiting, and abdominal pain.
- The medication can cause a metallic taste and turn the urine a deep red-brown color.
- med of choice for c.diff
- used for bacterial vaginosis, an overgrowth of vaginal bacterial flora
phenytoin
- (Dilantin) is an anticonvulsant drug used to treat generalized tonic-clonic seizures.
- The therapeutic serum phenytoin reference range is between 10-20 mcg/mL.
- Good oral hygiene is necessary to avoid the potential complication of gingival hyperplasia
- induce hepatic metabolism, which decreases the effectiveness of many other drugs, including oral contraceptives. - Use of alternative birth control methods is recommended
- should not be stopped abruptly as this increases the risk of seizure
- Early signs of toxicity include horizontal nystagmus and gait unsteadiness. These may be followed by slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with intravenous phenytoin.
- Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. Administration of phenytoin concurrent with certain drugs (eg, antacids, calcium) and/or enteral feedings can affect the absorption of phenytoin. - so stop tube feedings for 1-2 hrs before administering
dicloxacillin
antistaphylococcal antibiotic
cephalexin
antistaphylococcal antibiotic
drugs used for v fib
epinephrine, vasopressin, amiodarone
Epoetin
(Procrit) is a synthetic hormone that stimulates the production of erythropoietin and is used to treat anemia associated with chronic kidney disease.
- stimulates the body to make additional red blood cells
Sodium polystyrene sulfonate
(Kayexalate) is a sodium exchange resin administered to reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia.
- works by exchanging sodium for potassium, and the excess potassium is excreted through the stool.
In clients without normal bowel function (eg, post surgery, constipation, fecal impaction), there is a risk for intestinal necrosis. During sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy, cramping) can develop. Frequent monitoring of electrolyte status is required. Because potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium). The client should be monitored for signs of fluid overload (eg, crackles, jugular venous distension, edema) and have daily weights and intake and output assessment.
when discontinuing heparin and using warfarin
- Warfarin is started about 5 days before a continuous heparin infusion is discontinued.
- An overlap of the parenteral and oral anticoagulant is required for about 5 days as this is the time it takes warfarin to reach therapeutic level.
Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effect. Therefore, an overlap of a parenteral anticoagulant like heparin with warfarin is required. The typical overlap is 5 days or until the INR reaches the therapeutic level. The nurse will need to explain this overlap of the 2 medications to the client and the spouse.
Carbidopa-levodopa
(Sinemet) - used for Parkinson’s
- Levodopa is converted to dopamine in the brain, but much of this drug is metabolized before reaching the brain. Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect. This combination medication is particularly effective in treating bradykinesia (generalized slowing of movement). Tremor and rigidity may also improve to some extent.
- once started should never be stopped suddenly as this can lead to akinetic crisis (complete loss of movement). However, prolonged use can also result in dyskinesias (spontaneous involuntary movements) and on/off periods when the medication will start or stop working unpredictably.
- Orthostatic hypotension and neuropsychiatric disturbances (eg, confusion, hallucinations, delusions, agitation, psychosis) are serious and important adverse effects
donepezil
(Aricept) - treatment of Alzheimer disease
- used to improve cognition and memory
used to prevent worsening of symptoms in Alzheimer dementia, and it does not decrease agitation. It is a preventive medication and so would be a lower priority.
rivastigmine
- treatment of Alzheimer disease
- used to improve cognition and memory
when on warfarin need to avoid
avoid aspirin, drugs containing aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and alcohol when taking warfarin due to an increased risk for bleeding
- Clients should be taught to avoid trauma or injury to decrease the risk for bleeding. Preventive measures include gently brushing teeth with a soft-bristled toothbrush, avoiding use of alcohol-based mouthwash, avoiding contact sports or rollerblading, and using a straight razor. Flossing should also be avoided in general, but waxed dental floss may be used with care in some clients.
Dicyclomine hydrochloride
(Bentyl) is an anticholinergic medication.
- Anticholinergics are used to relax smooth muscle and dry secretions.
- Anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation.
- Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention.
carvedilol
(Coreg) beta blocker for treatment of chronic heart failure
- block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload.
- However, they can worsen heart failure if used in the acute setting of this condition.
beta blocker major side effects
bradycardia, bronchospasm, hypotension, depression, impotence
captopril
angiotensin-converting enzyme inhibitor
- can cause hyperkalemia
- Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)
angiotensin-converting enzyme inhibitor major side effects
dry cough, hypotension, reflex tachycardia, hyperkalemia, angioedema
glipizide
sulfonylurea
- The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain.
- Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur.
- Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.
sulfonylurea major side effects
hypoglycemia (diaphoresis, headache, hunger, tachycardia, confusion), a disulfiram-like reaction may occur if combined with alcohol
thyroid replacement major side effects
symptoms of hyperthyroidism (diarrhea, weight loss, palpitations, tachycardia, sweating, heat intolerance)
diphenhydramine =
(Benadryl) - antihistamine
- can prevent pruritus.
Losartan is
an angiotensin II receptor blocker (ARB) prescribed to treat hypertension.
- teratogenic, causing renal and cardiac defects or death of the fetus. there is a black box warnings that indicate contraindication in pregnancy.
- can cause hyperkalemia so avoid with hyperkalemic pts
- Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)
- They are used in clients who cannot take ACE inhibitors (eg, lisinopril, ramipril)
safe antihypertensives that are safe during pregnancy
labetalol, methyldopa
labetalol
(Trandate), antihypertensive
- used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg)
- safe during pregnancy - can use for preeclampsia
methyldopa
(Aldomet), antihypertensive
- used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg)
- safe during pregnancy - can use for preeclampsia
clopidogrel
(plavix) - Antiplatelet agent prescribed to prevent thromboevimbolic events in clients with increased risk for stroke or myocardial infarction.
- Laboratory values are monitored periodically as these drugs increase bleeding time (normal, 2-7 minutes [120-420 seconds]) and, rarely, may lower platelet count (normal, 150,000-400,000/mm3 )
- should be discontinued 5-7 days before surgery to decrease the risk for excessive bleeding.
- prevent platelet aggregation and are given to clients to prevent stent re-occlusion.
- They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage.
- Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.
prednisone
corticosteroid
- can increase glucose levels. Glucose levels should be monitored periodically for clients receiving this medication
- when taken in combination with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, can increase the risk of gastrointestinal ulceration and bleeding. The client should report black, tarry stools (ie, melena) to the health care provider as they could indicate gastrointestinal bleeding
- Clients taking corticosteroids should increase calcium and vitamin D intake to prevent bone loss, engage in physical activity to prevent weight gain, and watch for signs of infection as corticosteroids cause immunosuppression. Corticosteroids should not be stopped suddenly, especially in situations in which higher (stress)-dose steroids are required (eg, infection, trauma, surgery).
Tiotropium
(Spiriva)
- an inhaled anticholinergic drug that inhibits receptors in the smooth muscles of the airways.
- It is prescribed daily for the long-term management of bronchospasm in clients with chronic obstructive pulmonary disease
- is a long-acting, 24-hour, anticholinergic, inhaled medication used to control chronic obstructive pulmonary disease (COPD). It is administered most commonly using a capsule-inhaler system called the HandiHaler. The powdered medication dose is contained in a capsule. The client places the capsule in the inhaler device and pushes a button on the side of the device, which pokes a hole in the capsule. As the client inhales, the powder is dispersed through the hole.
- Unlike most inhaled medications, tiotropium looks like an oral medication because it comes in a capsule. Therefore, it is important to teach the client proper administration prior to the first dose, emphasizing that the capsule should not be swallowed and that the button on the inhaler must be pushed to allow for medication dispersion. During future appointments, the nurse should assess/reassess the client’s ability to use this medication correctly.
- Clients should rinse the mouth after using tiotropium and inhaled steroids (eg, beclomethasone, budesonide, fluticasone) to remove any medication remaining in the mouth, which decreases the risk of developing thrush.
- Tiotropium is a controller medication for COPD with a peak effect of approximately 1 week; therefore, it should not be used as a rescue medication. Instead, short-acting bronchodilators (eg, albuterol and/or ipratropium) should be used for symptom rescue. Clients must discontinue ipratropium before taking tiotropium as both are anticholinergic.
- Anticholinergic inhaled medications (eg, ipratropium, tiotropium, umeclidinium) do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions.
- a common side effect of tiotropium (Spiriva) and other anticholinergics (eg, ipratropium, benztropine) is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat
permethrin
- used for scabies
- applied to all body areas below the head.
- important to inform the parents and child that itching will continue for several weeks after proper treatment is given
gentamicin
aminoglycoside - strong antibiotic
- can cause nephrotoxicity and ototoxicity.
- should monitor the client’s renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage.
- Muscle cramping can occur occasionally with use of gentamicin but is not an indication to stop the infusion
- Tinnitus (ringing in the ears) should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss.
amikacin
aminoglycoside - strong antibiotic
- can cause nephrotoxicity and ototoxicity.
- should monitor the client’s renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage.
tobramycin
aminoglycoside - strong antibiotic
- can cause nephrotoxicity and ototoxicity.
- should monitor the client’s renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage.
- Tinnitus (ringing in the ears) should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss.
methotrexate
- cancer drug
- can cause decrease in the RBC count that may be evidence of bone marrow suppression
(Rheumatrex) is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis and psoriasis.
Methotrexate is an immunosuppressant and can cause bone marrow suppression. Clients are at risk for infection. They should avoid crowded places and individuals with known infection and should receive appropriate killed (inactivated) vaccines (eg, influenza, pneumococcal). Live vaccines (eg, herpes zoster) are contraindicated.
Adverse effects include hepatotoxicity, bone marrow suppression, infection risk, and fetal congenital abnormalities. Alcohol intake and live vaccines (eg, intranasal influenza vaccine) should be avoided. Killed/inactivated vaccines (eg, IM influenza injection) can be administered.
Clients should not become pregnant while taking methotrexate or for at least 3 months after it is discontinued as the drug is teratogenic and can cause congenital abnormalities and fetal death.
Clients taking methotrexate should avoid alcohol as the prescription drug is hepatotoxic and drinking alcohol increases the risk for hepatotoxicity.
Valproate
(Depakote)
- a medication used to control seizures
- FDA pregnancy category D drug that can cause neural tube defects such as spina bifida
A laboring client may experience lower back pain with contractions, or “back labor,” when the fetus is
- in the right occiput posterior (ROP) position.
- variation of vertex presentation causes the fetal occiput to exert added pressure on the woman’s sacrum during contractions.
- Positioning the woman on her hands and knees often helps decrease back pain and facilitates fetal rotation into an anterior position.
Oxybutynin
(Ditropan) is an anticholinergic medication that is frequently used to treat overactive bladder.
- also used for bladder spasms
Common side effects include:
- -New-onset constipation
- -Dry mouth
- -Flushing
- -Heat intolerance
- -Blurred vision
- -Drowsiness
- -Decreased sweat production may lead to hyperthermia. The nurse should instruct the client to be cautious in hot weather and during physical activity
- -Sedation is a common side effect of anticholinergic drugs. Clients should be taught not to drive or operate heavy machinery until they know how the drug affects them.
The therapeutic serum phenytoin reference range is between
10-20 mcg/mL.
nitroprusside
(Nitropress, Nipride) is a vasodilator given via infusion and can be titrated to keep the BP within a desired parameter.
- used IV in hypertensive crisis
Nystatin
- used to treat oral candidiasis, or thrush, that can be caused by medications such as antibiotics, corticosteroids, or oral contraceptive pills.
- available in the form of powders, suspensions, creams, ointments, and lozenges.
- Oral suspensions are the more common form of nystatin used for oral candidiasis. The client should be directed to swish the solution within the mouth, making contact with all the mucous membranes, and then swallow the solution after several minutes. Swallowing would help to clear any unseen esophageal candidiasis.
Codeine
- is an opioid drug prescribed as an analgesic to treat mild to moderate pain and as an antitussive to suppress the cough reflex.
- Although the antitussive dose (10-20 mg orally every 4-6 hours) is lower than the analgesic dose, clients can still experience the common adverse effects (eg, constipation, nausea, vomiting, orthostatic hypotension, dizziness) associated with the drug.
- decreases gastric motility, resulting in constipation. Increasing fluid intake and fiber in the diet and taking laxatives are effective measures to prevent constipation
- Changing position slowly is effective in preventing the orthostatic hypotension associated with codeine, especially in the elderly
- Taking the medication with food is effective in preventing the gastrointestinal irritation (eg, nausea, vomiting) associated with codeine
- Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty. In general, sedatives (eg, narcotics, benzodiazepines) can also depress the respiratory center and effort; therefore, they should not be given to clients with respiratory diseases (eg, asthma, COPD).
Spironolactone
- potassium-sparing diuretic and an aldosterone inhibitor
- In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss.
- can cause hyperkalemia so avoid with hyperkalemic pts
- it is typically used in a client with liver failure, ascites, and edema to promote diuresis and to prevent fluid retention. If more diuresis is needed, then intravenous furosemide is used, often in combination with albumin infusion
triamterene
- potassium-sparing diuretic.
- In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss.
- can cause hyperkalemia so avoid with hyperkalemic pts
amiloride
- potassium-sparing diuretic.
- In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss.
- can cause hyperkalemia so avoid with hyperkalemic pts
eplerenone
- potassium-sparing diuretic.
- In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss.
- can cause hyperkalemia so avoid with hyperkalemic pts
metoprolol
beta blocker for heart failure
- block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload.
- However, they can worsen heart failure if used in the acute setting of this condition.
- can be used for heart rate control in tachyarrhythmias - can decrease HR
Beta-adrenergic blockers are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism
atenolol
beta blocker
Beta-adrenergic blockers are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism
can decrease HR
Ipratropium
(Atrovent) is a short-acting inhaled anticholinergic often used in combination with a short-acting beta-agonist (eg, albuterol) to promote bronchodilation and reduce bronchospasm
- used for symptom rescue
- do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions.
- a common side effect is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat
Methylprednisolone
(Solu-Medrol) is a systemic glucocorticoid that improves respiratory symptoms and overall lung function in clients experiencing an exacerbation of COPD.
- need to monitor blood glucose levels
- can be used to decrease airway inflammation and swelling associated with the allergic reaction
Nitroglycerin patches
- are transdermal patches used to prevent angina in clients with coronary artery disease.
- They are usually applied once a day (not as needed) and worn for 12–14 hours and then removed.
- Continuous use of patches without removal can result in tolerance.
- No more than one patch at a time should be worn. The patch should be applied to the upper body or upper arms.
- Clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused should be used.
- A different location should be chosen each day to prevent skin irritation.
tadalafil
- Phosphodiesterase inhibitors
- used in erectile dysfunction
- are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.
sildenafil
Sildenafil
- Phosphodiesterase inhibitors
- used in erectile dysfunction
- are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.
vardenafil
- Phosphodiesterase inhibitors
- used in erectile dysfunction
- are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.
Tamoxifen
- has mixed agonist and antagonist activity on estrogen receptors in various tissues.
- It is used for several years in estrogen-responsive breast cancer. - blocks estrogen so its helpful in inhibiting the growth of estrogen-receptive breast cancer cells
- However, it is associated with increased risk of endometrial cancer and venous thromboembolism. - irregular or excessive menstrual bleeding in premenopausal women or any bleeding in postmenopausal women can be a sign of endometrial cancer
- due to its estrogen- agonist actions, also poses a risk for thromboembilc events (stroke, pulmonary embolism, and DVT)
- Menopausal symptoms (eg, vaginal dryness, hot flashes, sexual dysfunction) are the most common side effect.
IV gamma globulin
- given for Kawasaki disease
- IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing).
Allopurinol
- prescribed to prevent gout attacks (pain and inflammation in joints caused by uric acid deposits).
- inhibits uric acid production and improves solubility.
- should be taken with a full glass of water, and it is very important for the nurse to educate the client about fluid intake with this medication.
- The client should also increase daily fluid intake as this will help prevent the formation of renal stones and promote diuresis (increase drug and uric acid excretion)
- also used is to decrease hyperuricemia caused by Tumor Lysis Syndrome.
- -Laboratory values of significance in TLS include rising blood uric acid, potassium, and phosphate levels, with decreasing calcium levels.
lispro
- (Humalog) - rapid-acting insulin used as a bolus insulin for meals.
- “see food” insulin and should not be administered until the food is in sight.
- A sliding insulin (correction) scale is used to prescribe rapid-acting
Magnesium sulfate
- central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia clients.
- During administration, the nurse should assess vital signs, intake and output, and monitor for signs of magnesium toxicity (eg, decreased deep-tendon reflexes, respiratory depression, decreased urine output). A therapeutic magnesium level of 4-7 mEq/L is necessary to prevent seizures in a preeclamptic client.
- also used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.
Hydralazine
(Apresoline) - antihypertensive
- used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg)
terbutaline
Tocolytic drug
- used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.
indomethacin
Tocolytic drug
- used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.
Nonsteroidal anti-inflammatory drug (NSAID) - inhibit prostaglandin synthesis and can be taken to decrease pain and inflammation or to reduce fever.
NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus. During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP).
All NSAIDs are associated with the following:
- Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food.
- Kidney injury - long-term use is associated with kidney injury
- Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension
- Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.
Desmopressin acetate (DDAVP)
is a synthetic form of Antidiuretic hormone, which can be administered intravenously, orally, or via nasal spray.
- Effectiveness of therapy with desmopressin would be manifested by decreased urinary output and increased urine specific gravity as the urine becomes less dilute
- used to treat nocturnal enuresis so it reduces urine production during sleep.
imipramine
- Tricyclic antidepressant
- improve functional bladder capacity so used to treat nocturnal enuresis
- The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision
amitriptyline
(Elavil)- Tricyclic antidepressant
- used to treat depression and neuropathic pain
- improve functional bladder capacity so used to treat nocturnal enuresis
- The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision
- can also be used for for diabetic neuropathy are usually given on a fixed, timed schedule
- used to treat pain in Fibromyalgia
desipramine
- Tricyclic antidepressant
- improve functional bladder capacity so used to treat nocturnal enuresis
- The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision
Sodium bicarbonate
is an electrolyte replenisher and is administered intravenously to correct moderate to severe metabolic acidosis (pH <7.2).
Enoxaparin
- low-molecular-weight heparin used in the prevention and treatment of DVT.
- It is administered as a deep subcutaneous injection and is usually given in the abdomen.
- The injection should be made on the right or left side of the abdomen, at least 2 in from the umbilicus. An inch of skin should be pinched up and the injection made into the fold of skin with the needle inserted at a 90-degree angle.
- The complete blood count (CBC) should be assessed periodically with the administration of enoxaparin, an anticoagulant. The nurse would want to assess the hemoglobin, hematocrit, and platelet count levels. If these levels are low, the client will be at risk for increased bleeding
levonorgestrel
[Plan B]
- should be taken within 5 days of intercourse; however, efficacy is reduced after 3 days (72 hours).
copper intrauterine device (IUD)
may be inserted for up to 5 days after intercourse as another form of emergency contraception.
etanercept
(Enbrel) Tumor Necrosis Factor Inhibitor
- block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body.
- reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response.
- The medication causes immunosuppression and increased susceptibility for infection and malignancies
- Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter.
- S/E: severe infections and bone marrow suppression
infliximab
(Remicade) Tumor Necrosis Factor Inhibitor
- block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body.
- reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response.
- The medication causes immunosuppression and increased susceptibility for infection and malignancies
- Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter.
- S/E: severe infections and bone marrow suppression
adalimumab
(Humira) Tumor Necrosis Factor Inhibitor
- block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body.
- reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response.
- The medication causes immunosuppression and increased susceptibility for infection and malignancies
- Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter.
- S/E: immunosuppression with severe infections and bone marrow suppression
bismuth subsalicylate
the nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate (same class as aspirin) and could possibly cause Reye syndrome. Reye syndrome can develop in children with a recent viral illness such as varicella or influenza. It can cause acute encephalopathy and hepatic dysfunction. Children with viral infections should not be given aspirin or products containing salicylates.
simvastatin
- statin
- avoid grapefruit juice!! - may result in myopathy
- prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease.
- Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day.
Nicardipine
(Cardene)
- calcium channel blocking vasodilator.
- takes effect within 1 minute of IV administration.
- essential to monitor that the blood pressure is not being lowered too quickly or too slowly as this would extend the stroke.
- Hypotension can occur with or without reflex tachycardia. The drug must be discontinued if hypotension or reflex tachycardia occurs.
Widening of the QT interval can increase the risk of life-threatening torsades de pointes. It is most commonly seen with
haloperidol (Haldol), methadone, ziprasidone (Geodon), and erythromycin
Cholestyramine
(Questran) may be prescribed to increase the excretion of bile salts in the feces, thereby decreasing pruritus.
- It is packaged in a powdered form, must be mixed with food (applesauce) or juice (apple juice), and should be given one hour after all other medications are administered.
Ethambutol
(Myambutol) is used in combination with other antitubercular drugs (eg, isoniazid, rifampin, pyrazinamide) to treat active tuberculosis.
- can cause ocular toxicity - The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect.
- The client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination.
rifampin
(Rifadin) - antitubercular
also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (eg, jaundice, anorexia). Ethambutol causes ocular toxicity, and clients will need frequent eye examinations.
A teaching plan for a client prescribed rifampin includes these additional instructions:
- -Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Client should wear eyeglasses instead of soft contact lenses while taking this medication. - changes to red/orange color
- -Women should use nonhormonal birth control methods while taking this drug as it can decrease the effectiveness of oral contraceptives.
- Clients should be advised to not consume alcohol and drugs that can increase the risk for hepatotoxicity (eg, acetaminophen) during long-term use of this drug.
pyrazinamide
- antitubercular
- Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis
Streptomycin
- aminoglycoside antibiotic, is a second-line drug sometimes used to treat multi-drug-resistant tuberculosis, with ototoxic and nephrotoxic adverse effects.
- Difficulty hearing (tinnitus, subjective hearing loss) is an adverse reaction to streptomycin
prasugrel
(Effient) antiplatelet
- prevent platelet aggregation and are given to clients to prevent stent re-occlusion.
- They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage.
- Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.
ticagrelor
[Brilinta] antiplatelet
- prevent platelet aggregation and are given to clients to prevent stent re-occlusion.
- They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage.
- Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.
furosemide
- loop diuretic
torsemide
- loop diuretic
bumetanide
- loop diuretic
- used to treat edema associated with heart failure and liver and renal disease. The diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium.
- The nurse should question the bumetanide prescription as the client with heart failure has hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]) and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance
rosuvastatin
(Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglycerides. It also increases HDL
- Baseline liver enzymes are obtained
- prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease.
- Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day.
- A serious complication associated with statin medication is rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances can be harmful to the kidney and often cause kidney damage. The client should immediately report any signs of muscle aches or weakness to the HCP. These could be early signs of rhabdomyolysis, which can be fatal.
- A serious adverse effect of statins, is myopathy with ongoing generalized muscle aches and weakness.
- -A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.
atorvastatin
(Lipitor) is a statin drug, or HMG-CoA reductase inhibitor, prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease
- Baseline liver enzymes are obtained
- prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease.
- Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day.
- Muscle cramps and liver injury, are the major adverse effects of statin medications
- A serious adverse effect of statins, is myopathy with ongoing generalized muscle aches and weakness.
- -A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.
methylphenidate
(Ritalin) - is a central nervous system stimulant used to treat ADHD and narcolepsy. It affects neurotransmitters (dopamine and norepinephrine) in the brain that contribute to hyperactivity and lack of impulse control.
- administered in divided doses 2 or 3 times daily, usually 30-45 minutes before meals.
- As a stimulant, methylphenidate may interfere with sleep and should be given no later than around 6:00 PM. - The sustained-release preparation should be given in the morning.
- The dosage in children is usually started low and titrated to the desired response.
- Children should be monitored closely during initial treatment for development of tics and continuously for adherence and response to therapy
A common side effect of methylphenidate is loss of appetite with resulting weight loss. Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. It is very important to compare weight/height measures from one well-child checkup to the next. If weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable.
Another side effect of methylphenidate is increased blood pressure and tachycardia. These should be monitored before and after starting treatment with stimulants.
The major problems with stimulant medications include:
- Decreased appetite and weight loss – can lead to growth delays
- Cardiovascular effects – hypertension and tachycardia (particularly in adults)
- Appearance of new or exacerbation of vocal/motor tics
- Excess brain stimulation – restlessness, insomnia
- Abuse potential – misuse, diversion, addiction
lisdexamfetamine
Stimulant - used in the treatment of ADHD
The major problems with stimulant medications include:
- Decreased appetite and weight loss – can lead to growth delays
- Cardiovascular effects – hypertension and tachycardia (particularly in adults)
- Appearance of new or exacerbation of vocal/motor tics
- Excess brain stimulation – restlessness, insomnia
- Abuse potential – misuse, diversion, addiction
dextroamphetamine
Stimulant - used in the treatment of ADHD
The major problems with stimulant medications include:
- Decreased appetite and weight loss – can lead to growth delays
- Cardiovascular effects – hypertension and tachycardia (particularly in adults)
- Appearance of new or exacerbation of vocal/motor tics
- Excess brain stimulation – restlessness, insomnia
- Abuse potential – misuse, diversion, addiction
Lithium
- mood stablizer used in the treatment of bipolar disorder.
- It has expected, mild side effects as well as potentially serious ones related to drug toxicity. Drowsiness, weight gain, dry mouth, and gastrointestinal upset are expected, mild side effects.
- Lithium toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs, thiazide diuretics). Lithium and sodium are closely related in the body. Acute viral gastroenteritis (stomach flu) presents with abrupt onset of diarrhea, nausea, vomiting, and abdominal pain. Clients with vomiting and diarrhea are at risk of developing dehydration and/or low serum sodium, increasing the risk for lithium toxicity
- Drowsiness is an expected side effect. The nurse should advise the client to avoid hazardous activities and driving until the effects of lithium are known or this side effect subsides.
- Weight gain is an expected side effect. The nurse should provide client education about healthy food choices and proper exercise and/or provide for a dietary consult.
- Dry mouth is an expected side effect. The nurse should provide client teaching about measures to counteract this side effect (eg, ice chips, sugarless gum or candy, drinking plenty of water). However, excessive urination and polydipsia indicate nephrogenic diabetes insipidus from lithium toxicity.
It has a very narrow therapeutic serum range of 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are considered toxic. Lithium toxicity usually occurs with the following:
- Dehydration
- Decreased renal function (eg, elderly clients)
- Diet low in sodium
- Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide diuretics)
Lithium is cleared renally. Even a mild change in kidney function (as seen in elderly clients) can cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (eg, NSAIDs) should be avoided. Acetaminophen would be a better choice for pain relief
Several medications can cause increased lithium levels, including thiazide diuretics (eg, hydrochlorothiazide), nonsteroidal anti-inflammatory drugs, and antidepressants. Thiazide diuretics have demonstrated the greatest potential to increase lithium concentrations, with a possible 25%-40% increase in concentrations
Lithium is excreted through the kidneys. To prevent toxicity the nurse should hold doses and clarify prescriptions for clients who have:
- Conditions/illnesses in which the kidneys try to conserve sodium (eg, hyponatremia, dehydration) as sodium and lithium are absorbed in proximal tubules simultaneously
- Decreased glomerular filtration rate (eg, severe renal dysfunction) as less of the drug is filtered into the urine
Consistent amounts of fluid (2-3 L/day) and sodium prevent fluctuations in serum lithium. Clients should report signs (eg, weight changes, dizziness) and precipitating factors (eg, vomiting, diarrhea, increased sweating) of fluid and electrolyte imbalance.
Flumazenil
is the appropriate antidote for a benzodiazepine overdose.
calcium gluconate
antidote for magnesium toxicity
- recommended only in the event of cardiorespiratory compromise.
- Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence. Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis)
Amoxicillin/clavulanate
belongs to aminopenicillin group and is often used to treat respiratory infections.
Instructions for parents about amoxicillin include:
- The medication may be taken with or without food as food does not affect absorption
- The most common side effects of this medication are nausea, vomiting, and diarrhea. If nausea or diarrhea develops, the medicine may be administered with food to decrease the gastrointestinal side effects
- Shake the liquid well prior to administration. Administer at evenly spaced intervals throughout the day to maintain therapeutic blood levels
- Ensure that the child receives the full course of therapy; do not discontinue the medication if the child is feeling better or symptoms have resolved
Lactulose
- is the most common treatment for hepatic encephalopathy.
- syruplike liquid that decreases intestinal ammonia absorption in pts with liver disease and hepatic encephalopathy
- not digested or absorbed until it reaches the large intestines where it is metabolized, producing an acidic environment and a hyperosmotic effect (laxative). In this acidic environment, ammonia (NH3) is converted to ammonium (NH4+) and excreted rapidly.
- Lactulose can be given orally with water, juice, or milk (to improve flavor) or it can be administered via enema
- For faster results, it can be administered on an empty stomach
- The desired therapeutic effect of lactulose is the production of 2-3 soft bowel movements each day; therefore, the dose is titrated until the therapeutic effect is achieved.
- This therapeutic dose should not be held but instead should be maintained until the desired outcomes are reached (improved mental status, decreased ammonia levels)
- The client’s electrolyte levels should be closely monitored during therapy as lactulose is a laxative that can cause dehydration, hypernatremia, and hypokalemia.
transdermal fentanyl patch
- prescribed for clients suffering from moderate to severe chronic pain.
- The patch provides continuous analgesia for up to 72 hours. However, the drug is absorbed slowly through the skin into the systemic circulation and can take up to 17 hours to reach its full analgesic effect.
- Therefore, it is not recommended for treating acute postoperative, temporary, or intermittent pain as it does not provide immediate analgesia when applied.
lidocaine 5% transdermal patch
- provides a localized, topical anesthetic to intact skin.
- commonly prescribed for clients with chronic postherpetic neuralgia, a painful, debilitating condition that can develop following a herpes zoster (shingles) infection.
IV infusion of potassium chloride (KCL).
- The infusion rate should not exceed 10 mEq/hr (10 mmol/hr).
- Therefore, IVPB KCL must be given via an infusion pump so the rate can be regulated.
- IV KCL should be diluted and never given in a concentrated amount. Furthermore, too rapid infusion can cause cardiac arrest.
Pyridostigmine
(Mestinon) is a first-line drug that inhibits acetylcholine breakdown and is prescribed to temporarily increase muscle strength in clients with Myasthenia gravis.
Acetylsalicylic acid
(Aspirin) is prescribed daily to prevent ischemic attacks and myocardial infarction in clients with coronary artery disease and ischemic stroke
Metformin
(Glucophage) is an anti-hyperglycemic drug that can cause lactic acidosis in clients with kidney disease
- Major side effects of metformin are lactic acidosis and gastrointestinal disturbances (metallic taste in the mouth, nausea, and diarrhea).
Iodinated contrast used for CT scan or cardiac catheterization can cause kidney injury. Metformin (Glucophage) can worsen lactic acidosis in the presence of kidney injury. Metformin should be withheld prior to the contrast exposure and can be resumed when kidney function is within normal limits.
IV furosemide may cause
ototoxicity, particularly when high doses are administered in clients with compromised renal function.
- The rate of administration should not exceed 4 mg/min in doses >120 mg.
To determine the correct rate of administration for the dose above, use the following formula:
(Dose = mg) / (4 mg/min) = ___ min
Topical capsaicin cream
(Zostrix) is an over-the-counter analgesic that effectively relieves minor pain (eg, osteoarthritis, neuralgia).
- The nurse should instruct the client to wait at least 30 minutes after massaging the cream into the hands before washing to ensure adequate absorption
- The client should avoid contact with mucous membranes (eg, nose, mouth, eyes) or skin that is not intact, as capsaicin is a component of hot peppers and can cause burning.
- When applying cream to other areas of the body (eg, knee), the client should wear gloves or wash hands immediately after application.
- The application of heat with capsaicin is contraindicated as heat causes vasodilation, which increases medication absorption and can possibly lead to a chemical burn.
- Capsaicin should be used regularly (3-4 times daily) for long periods (eg, weeks to months) to achieve the desired effect.
naproxen
nonsteroidal anti-inflammatory drugs - to effectively treat osteoarthritis pain.
- when taken in combination with Glucocorticoids (eg, prednisone), can increase the risk of gastrointestinal ulceration and bleeding. The client should report black, tarry stools (ie, melena) to the health care provider as they could indicate gastrointestinal bleeding
NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus. During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP).
All NSAIDs are associated with the following:
- Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food.
- Kidney injury - long-term use is associated with kidney injury
- Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension
- Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.
celecoxib
(Celebrex), a COX-2 inhibitor, nonsteroidal anti-inflammatory drugs
- to effectively treat osteoarthritis pain.
has a black box warning for increased risk of cardiovascular complications. Myocardial infarction symptoms, which can be vague in female clients, include nausea and upper back and shoulder pain. These symptoms would be the priority to assess first, and immediate testing (ie, ECG, cardiac enzymes) would be warranted
penicillin allergy and cephalosporin antibiotics.
A client with a penicillin allergy may be allergic to cephalosporin antibiotics. Cephalosporins may be safely administered to clients with a history of mild allergic reaction, such as rash, but they are contraindicated in clients with a history of penicillin anaphylaxis.
cefazolin
(Ancef) Cephalosporin antibiotic
- a bone-penetrating cephalosporin antibiotic that is active against skin flora (Staphylococcus aureus)
- it is given prophylactically before and after surgery to prevent infection
D5W
hypotonic fluid
- decreases the circulatory volume.
- may be more appropriate for a client with hypoglycemia
normal saline
isotonic solution
- will increase circulatory volume
lactated Ringer
isotonic solutions
- will increase circulatory volume
Norepinephrine
(Levophed)
- causes vasoconstriction and improved heart contractibility/output.
- When the medication is stopped suddenly, its effects end quickly. It should be tapered slowly to avoid the progression or relapse of shock.
dopamine
(Intropin) vasoactive medication
- is a sympathomimetic inotropic medication often used to treat hypotension not caused by hypovolemia.
- It enhances cardiac output by increasing myocardial contractility, increasing heart rate and elevating blood pressure through vasoconstriction.
- Renal perfusion is also improved, resulting in increased urine output.
- The lowest effective dose of dopamine should be used as dopamine administration leads to an increased cardiac workload.
- Significant adverse effects include tachycardia, dysrhythmias, myocardial ischemia, nausea, and vomiting
Signs and symptoms of digoxin toxicity include
- Gastrointestinal symptoms (eg, anorexia, nausea, vomiting, abdominal pain) are frequently the earliest symptoms
- Neurologic manifestations (eg, lethargy, fatigue, weakness, confusion)
- Visual symptoms are characteristic and include alterations in color vision, scotomas, or blindness
- Cardiac arrhythmias – most dangerous
- Digoxin is a cardiac glycoside administered to clients with heart failure to improve cardiac output and efficiency by increasing cardiac contractility and decreasing heart rate. Early signs of toxicity include gastrointestinal disturbances (eg, nausea, vomiting, diarrhea, anorexia). Bradycardia (<60/min in adults) and visual disturbances (seeing yellow-green halos around lights) are later signs of digoxin toxicity
- Drug levels are frequently monitored until a steady state is achieved and when changes are expected, such as in clients with chronic kidney disease and electrolyte disturbances (eg, hypokalemia, hypomagnesemia).
- Digoxin toxicity can result in bradycardia and heart block. Clients are instructed to check their pulse and report to the HCP if it is low or has skipped beats.
- Digoxin toxicity can be seen with levels >2 ng/mL. Potassium levels should also be monitored in the client receiving digoxin. Hypokalemia can potentiate digoxin toxicity
senna
stimulant for bm
