Gu Clinical Drug Cards

Front 1

PROTONIX

Pharmacologic Class:
Proton pump inhibitor (inhibits production of gastric acid)

Back 1

Mechanism of Action:
Shuts down many of the stomachs acid producing pumps to help maintain a lower level of acid, preventing acid in the stomach from traveling to the esophagus and causing damage.

Indication:
Treatment for erosive esophagitis associated with GERD and associated s/s such as heartburn and stomach acid backup. Tx for hypersecretory symptoms

Desired therapeutic effect:
Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing duodenal ulcers and esophagitis, decreased acid aecretion in hypersecretory conditions.

Nursing Considerations:
Assess adequate hepatic,renal,GI functioning. Monitor v/s, especially BP (can cause HTN)

Lab values to be aware of:
May cause abnormal LFT, including elevated AST, ALt, Alkaline phosphatase,and billirubin.

Normal Doses:
PO Adults: GERD - 40 mg once daily; gastric hypersecretory conditions - 40 mg twice daily, up to 120 mg twice daily.

Side Effects:
Hyperglycemia

Front 2

REGLAN

Pharmacologic Class:
Antiemetics

Back 2

Mechanism of Action:
Blocks dopamine receptors, stimulates motility of upper GI tract and accelerates gastric emptying.

Indication for patient:
TX and prevention of N/V, TX of postsurgical and diabetic gastric stasis, Mgt. of esophageal reflux, TX for hiccups.

Desired therapeutic effect:
Decreased nausea and vomiting, decreased symptoms of gastric stasis.

Nursing considerations:
Assess for N/V, abd distention, B/S before and after admin., Assess for extrapyramidal s/e's (dystonia, tardive dyskinesia, etc.), monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, alt. consciousness, irregular pulse or BP, tachycardia, and diaphoresis.

Lab test considerations:
May alter hepatic function test results, may increase serum prolactin and aldosterone concentrations.

Normal doses:
Post-op N/V: 10 mg at the end of a surgical proceedure, repeat in 6-8 hr. if needed.

Side effects:
Arrhythmias (tachycardia, bradycardia), HTN, Hypotension

Front 3

PLAVIX

Pharmacologic Class:
Platelet Aggregation Inhibitor

Back 3

Mechanism of Action:
Keeps platelets from sticking together and forming clots, which protects from future heart attack or stroke.

Indication for patient:
Heart attack, Stroke, PAD, Acute coronary syndrome, PVD

Desired therapeutic effect:
Decreased occurence of atherosclerotic events in patients at risk.

Nursing Considerations:
Assess for s/s stroke, renal dysfunction, monitor for bleeding

Lab values to be aware of:
Monitor PT, PTT (bleeding time should be prolonged), CBC with differential and platelet count, may cause increased serum billirubin, hepatic enzymes, total cholesterol, nonprotein nitrogen, and uric acid concentrations.

Normal doses:
Recent MI, stroke, PVD - 75 mg once daily; Acute coronary syndrome - 300 mg initially, then 75 mg once daily; aspirin 75-325 mg once daily should be given concurrently.

Side effects:
GI bleeding,hypercholesterolemia,chest pain, HTN, edema

Front 4

SYNTHROID

Pharmacologic Class:
Thyroid preparation

Back 4

Mechanism of Action:
Replacement of endogenous thyroid hormones, increases metabolism and restores normal hormone balance.

Indication for patient:
Thyroid supplementation in hypothyroidism, Tx for goiters and thyroid cancer.

Desired therapeutic effect:
Replacement in hypothyroidism to resotre normal hormonal balance, suppression of thyroid cancer.

Nursing considerations:
Assess apical pulse and BP prior to and during therapy. Assess for tachycardia and chest pain.

Lab Values:
Monitor thyroid function studies, monitor blood and urine glucose levels in diabetic pt. Insulin or oral hypoglycemic dose may need to be increased.

Normal doses:
PO: 50 mcg as a single dose initially, usual maintenance dose is 75-125 mcg/day (1.5 mcg/kg/day).

Side effects:
Arrhythmias, HTN, tachycardia, dysphagia

Front 5

NORVASC

Pharmacologic Class:
Calcium Channel Blocker

Back 5

Mechanism of Action:
Inhibits transport of calcium into heart muscle, resulting in inhibition of excitation-contraction coupling, leading to reduced blood pressure

Indication:
HTN, Angina pectoris, and vasopastic angina

Desired therapeutic effect:
Vasodilation resulting in decreased blood pressure.

Nursing considerations:
Monitor pulse and BP before therapy, I & O's, Daily wt., assess for s/s CHF (peripheral edema, rales/crackles, dyspnea, wt.gain, jvd).

Lab values to be aware of:
CCB's do not affect total serum calcium concentrations.

Normal doses:
PO (Adults): 5-10 mg once daily

Side effects:
peripheral edema, angina, bradycardia, hypotension, palpitations

Front 6

LASIX

Pharma-Cologic:
Loop diuretic

Back 6

Action:
Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions -escape of fluid into pleural cavities).Decreased blood pressure

Indication:
Edema due to: CHF, hepatic or renal disease,Hypertension

Desired Therapeutic effect:


Nursing considerations:
Assess fluid status during therapy. DW, I&O, amount and location of edema, lung sounds, skin turgor and mucous membranes.· Monitor blood pressure and pulse before and during admin. Assess falls risk and implement fall prevention. Administer medication in the morning to prevent disruption of sleep cycle.

Labs:
monitor electrolytes (may decrease),renal, hepatic function, serum glucose. May increase BUN, glucose, creat., uric acid.

Normal Doses:
PO adults - 20-80mg/day

Side Effects:
Insomnia, hypotension,hyperglycemia, dehydration

Front 7

HEPARIN

Pharmacologic Class:
Antithrombotics

Back 7

Mechanism of Action:
Prevents blood clot formation

Indications:
Prophalyxis and tx of thromboembolic do's.

Desired therapeutic effects:
prevention of thrombus formation.

Nursing considerations:
Assess for s/s bleding and hemorrhage (bleeding gums,nosebleed,unusual bruising, black tarry stools).

Lab values:
monitor aPTT, PT, and HCT, Platelet count,monitor for hyperkalemia and increased ALT and AST

Usual dose:
10-100units (inject at 45 or 90, do not aspirate, in abdomen)

Side effects:
Anemia, bleeding

Front 8

LOVENOX

Pharmacologic Class:
Antithrombotic (Anticoagulant)

Back 8

Action:
Prevents thrombus (blood clot)formation

Indications:
Prevention of DVT, VTE, Pulmonary Embolism

Desired Therapeutic Effect:
Prevention of blood clots

Nursiing Considerations:
Assess for bleeding/hemorrhage,fall in HCT or BP

Lab Values:
Monitor CBC,platelet count,and stools, may cause increased AST and ALT levels

Normal Doses:
30mg q12 hr

Side Effects:
Bleeding, anemia, thrombocytopenia

Front 9

Morphine

Pharmacologic class:
Opiod Analgesic

Back 9

Action:
Binds to pain receptors and alters perception and response to pain while producing CNS depression.

Indications:
Severe pain, pulmonary edema

Desired therapeutic effect:
Decreased severity of pain

Nursing Considerations:
Check pain level before and after administration, assess LOC, BP, Pulse, Resp before and during admin., Assess bowel function routinely, fall precautions

Labs:
May increase plasma amylase and lipase levels

Normal Doses:
IV: Dilute with at least 5ml sterile water or NS. Administer 2.5-15mg over 5 min.

Side effects:
Respiratory depression, hypotension, bradycardia, constipation, dependence

Front 10

COREG

pharmacologic Class:
Beta Blocker

Back 10

Mechanism of Action:
Blocks Beta 1 and Beta 2 adregernic receptor sites.

Indications:
HTN,CHF

Desired Therapeutic Effects:
Decreased heart rate and BP, imporved cardiac output

Nursing Considerations:
Monitor Bp and Apical pulse frequently, Assess for ortho Hypotension, I&O, DW, monitor for fluid overload (peripheral edema,dyspnea,rales/crackles, JVD)

Lab Values;
May increase BUN,lipoprotein,potassium,triglyceride,uric acid,and glucose levels

Normal Doses:
6.25 mg twice daily up to 25 mg twice daily

Side effects:
Bradycardia,CHF,Pulmonary edema,Hyperglycemia,Hypoglycemia, bronchospasm,wheezing

Front 11

COUMADIN

Pharmacologic Class:
Coumarins

Therapeutic Class:
Anticoagulant

Back 11

Action:
Interferes with hepatic synthesis of vitamin K dependent clotting factors

Indications:
Prophylaxis and tx. of venous thrombosis, pulmonary emoblism,atrial fibrillation with embolization. Management of myocardial infarction.

Desired therapeutic effect:
Prevention of blood clots

Nursing Considerations:
Assess for s/s bleeding/hemorrhage (fall in BP, HCT)

Lab Values:
Monitor PT,INR,Hepatic function,CBC,Stool,Urine

Normal Doses:
PO,IV: 2.5-10mg/day for 2-4 days and then adjust by PT or INR.

Side Effects:
Bleeding

Front 12

LOPRESSOR

Pharmacologic Class:
Beta Adrenergic Blocker

Back 12

Mechanism of Action:
Competes with adrenergic neurotransmitters (epinephrine & norepinephrine) for adrenergic receptors. Results in vasodilation, ↓ pulse Bronchconstriction may occur

Indications:
Treatment of hypertension, angina, tachyarrhythmias, prevention of MI, CHF and some are used for migraine headaches preventionContraindications:uncompensated CHF, bronchospasm, bradycardia, heart block. Use with Caution in Diabetes

Desired therapeutic effect:
Decreased heart rate and BP

Nursing Considerations:
Monitor pulse and B/P, I&OHold med if pulse< 50 Instruct pt to monitor B/PDo not abruptly stop medicationEncourage pt. to comply with other treatments of HTN( diet, exercise, smoking cessation, decreased ETOH, stress managementCaution use of other OTC medsChange position slowly to prevent orthostatic hypotensionDiabetics monitor glucose closelyCarry ID and med list

Lab Values:
May increase BUN,serum lipoprotein,potassium,triglyceride, and uric acid levels. May increase ANA titers, may increase blood glucose levels, may increase serum alkaline phosphatase, LDH, AST, and ALT levels.

Normal doses:
Po: 25-100mg/day. Increase Q7days up to 450mg/day.

Side effects:
Bradycardia, CHF, hypotension, impotence, bronchospasm, wheezing, fatigue

Front 13

DILAUDID

pharmacologic Class:
Opiod Agonists

Back 13

Action:
Binds to opiate receptors in CNS. Alters perception and response to pain, generalized CNS depression, cough suppression.

Indication for patient:
Moderate to severe pain,Antitussive

Desired therapeutic effect:
Decreased in moderate to severe pain. Suppression of cough.

Nursing considerations:
Assess BP,Pulse,and respirations before and during admin. If resp. rate<10/min, assess level of sedation.. Dose may need to be decreased by 25-50%. Assess bowel function routinely.

Lab values:
May increase plasma amylase and lipase concentrations.

Normal Doses:
PO (Adults):4-8mg q3-4 hr initially.
IV,IM,sub-q (Adults):1.5mg q3-4 hours as needed initially.

Side effects:
Hypotension,bradycardia,respiratory depression,urinary retention,dependence.

Front 14

INSULIN

Pharmacologic Class:
Antidiabetic Agent

Back 14

Action:
Lowers blood glucose by increasing transport into the cell. Increases conversion of glycogen. Controls blood sugars in diabetics.

Indications:
Indicated for Management of Type 1 DiabetesManagement of type 2 diabetes that is resistant to diet/ exercise/ and oral hypoglycemics

Desired therapeutic effects:
Control of hyperglycemia in diabetic patients.

Nursing Considerations:
Assess S&S of hypo & hyper glycemiaMonitor blood glucose/ Hgb A1CTreat hypoglycemia with glucose/ glucagonsUse only insulin syringesMix insulins properlyStore in cool placeAdminister at proper time in relation to foodPatient teaching on all of the aboveType Onset Peak Duration
ExuberaInhaled <15-20 min 2 hours 6 hrs.
Lispro (Humalog) <15 min 1-3 hrs 3-5 hrs.
Glulisine=Apidra < 15 min. 1 hour 2-4 hrs.
Regular sc 0.5-1 hr. 2-4 hrs. 5-7 hrs
NPH 1-2 hrs. 6-12 hrs. 18-24 hrs.
Glargine (Lantus) Detemir=Levemir 1 hr. None > 24 hrs

Lab values to be aware of:
Monitor for blood glucose q 6hr during therapy, may decrease serum inorganic phosphate, magnesium, and potassium levels.

Normal doses:
Dose depends on blood glucose,response, and many other factors.

Side effects:
Hypoglycemia, Anaphylaxis, Lipodystrophy

Front 15

FLAGYL

Phrmacologic Class:
Anti-infectives, antiulcer

Back 15

Action:
Disrupts DNA and protein synthesis in susceptible organisms.

Indication:
Treatment of anaerobic infections such as: intra-abdominal infect., gynecologic infection, skin infections, bone and joint infections, and respiratory tract infections.

Desired therapeutic effect:
Resolution of s/s of infection.

Nursing considerations:
Assess pt. for infecion at beginning and throughout therapy, obtain specemines for c&s, I&O, DW

Lab values:
May alter AST,ALT, and LDH tests

Normal Doses:
Anaerobic infections: 7.5 mg/kg q 6hr (not to exceed
4g/day)

Side effects:
seizures, superinfections,peripheral neuropathy, abd pain

Front 16

PHENERGAN

Pharmacologic Class:
Phenothiazines

Back 16

Mechanism of action:
Blocks the effects of histamine, blocks chemoreceptor zone resulting in antiemetic properties, CNS depressant.

Indications:
Various allergic reactions and motion sickness, preoperative sedation, tx and prevention of N/V, adjunct to anesthesia and analesia.

Desired therapeutic effect:
Relief from allergic symptoms,prevention of motion sickness,sedation,relief from n/v.

Nursing considerations:
Monitor BP,pulse, resp. frequently, assess for s/s of sedation after administration, assess for s/s of extrapyramidial s/e's, assess for anticholinergic s/e's

Lab values:
CBC (blood dyscrasis may occur), may increase serum glucose

Normal doses:
Antiemetic: PO, Rect, IM, IV
12.5-25 mg q4 hr as needed; initial po dose should be 25 mg.

Side effects:
Neuroleptic malignant syndrome,blood dyscrasias,bradycardia,hypertension,hypotension,tachycardia

Front 17

ASPRIN

Classification:
Antipyretics

Back 17

Mechanism of action:
Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins

Indication:
Inflammatory disorders: RA, Osteoarthritis, Mild to moderate pain

Desired therapeutic effect:
Reduction of fever and inflammation, decreased incidence of transient ischemic attacks and MI, relief of mild to moderate discomfort.

Nursing Considerations:
Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions. Assess pain and limitation of movement; note type, location, and intensity before and at the peak after admin. Assess fever and note associated signs.

Lab test considerations:
Monitor hepatic function, may increase serum AST,ALT, may prolong PT time, monitor HCT during high-dose therapy to assess for GI blood loss.

Side effects:
Anemia,Noncardiac pulmonary edema

Front 18

ZOSYN

Pharmacologic Class:
Extended spectrum penicillins

Back 18

Action:
Binds t bacterial cell wall membrane, causing cell death.

Indications:
Appendicitis, peritonitis, skin infections, gynecologic infections, community-acquired and nosocomial pneumonia

Desired therapeutic effect:
Death of susceptible bacteria

Nursing considerations:
Assess for infection,observe of s/s of anaphylix, c&s, patient hx

Lab values:
Evaluate CBC, serum potassium,hepatic function and bleeding times prior to and routinely during therapy. May increase BUN,Creat.,AST,ALT, serum bilirubin,Alkaline phosphatase, and LDH

Normal Doses:
IV: 3.375 g q 6hr

Side effects:
seizures,bleeding,anaphylaxis,serum sickness,fever,superinfection,bleeding

Front 19

TYLENOL

Pharmacologic Class:
Antipyretics, Nonopiod analgesics

Back 19

Action:
Inhibits pain and fever primarily in CNS

Indication:
Mild fever, pain

Desired therapeutic effect:
Reduction of pain and fever

Nursing Considerations:
Assess overall health status and alcohol usage before administering·Pt. who is malnourished is at higher risk of developing hepatotoxicity with chronic use.Assess amt, freq, and type of drugs used when self medicating.Assess pain type, location, intensity

Lab values to be aware of:
Evaluate hepatic,renal, and hematologic function periodically during high dose admin. Increased serum billirubin,LDH,AST,ALT, and prothrombin may indicate hepatotoxicity.

Normal doses:
PO: 325-650 mg q 4-6 hr or 1g 3-4 times daily or 1300 mg q 8 hr (not to exceed 4g or 2.5 g/24 hr in pt. with hepatic/renal impairment).

Side effects:
Hepatic failure, Renal failure, Rash, Urticaria