Med Cards

Front 1

ipratropium bromide 0.5 mg/albuterol sulfate 3.0 mg -
DuoNeb

Classification: Bronchodilator

Route: Nebulization

Mechanism of Action: DuoNeb is expected to maximize the response to treatment in patients with COPD by reducing bronchospasm through two distinctly different mechanisms: sympathomimetic (albuterol sulfate) and anticholinergic/parasympatholytic (ipratropium bromide). Simultaneous administration of both an anticholinergic and a β2-sympathomimetic is designed to produce greater bronchodilation effects than when either drug is utilized alone at its recommended dosage.

Uses: This medication is used to treat severe breathing trouble caused by ongoing lung diseases (COPD, which include chronic bronchitis and emphysema).

Side Effects: Nausea, diarrhea, constipation, blurred vision, dizziness, headache, nervousness, dry mouth, dry/sore throat, or voice changes may occur. Rarely, this medication has caused severe (possibly fatal), sudden worsening of breathing problems (paradoxical bronchospasm).

Back 1

Nursing Implications: Take baseline vitals. Auscultate lungs before and after administration of medication. Observe patient for side-effects.

Patient Education:Read the patient information completely every time your prescription is filled as information may have changed. Keep these instructions with your medication as you may want to read them again. Instruct patient in proper use of inhaler, nebulizer, or nasal spray and to take medication as directed. Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses.

Front 2

tamsulosin (tam-soo-loe-sin) - Flomax

Classification -
Therapeutic: none assigned
Pharmacologic: peripherally acting antiadrenergics

Route(s): PO (Adults): 0.4 mg once daily after a meal; may be increased after 2-4 wk to 0.8 mg/day.

Mechanism of action: Decreases contractions in smooth muscle of the prostatic capsule by preferentially binding to alpha1-adrenergic receptors.
Uses: Management of outflow obstruction in male patients with prostatic hyperplasia.

Side Effects:
CNS: dizziness, headache.
EENT: rhinitis.
CV: orthostatic hypotension.
GU: retrograde/diminished ejaculation.

Back 2

Nursing Implications: Assessment
Assess patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency) before and periodically throughout therapy.
Assess patient for first-dose orthostatic hypotension and syncope. Incidence may be dose related. Observe patient closely during this period and take precautions to prevent injury.
Monitor intake and output ratios and daily weight, and assess for edema daily, especially at beginning of therapy. Report weight gain or edema.

Teaching Needs: Emphasize the importance of continuing to take this medication, even if feeling well. Instruct patient to take medication at the same time each day. If a dose is missed, take as soon as remembered unless almost time for next dose. Do not double doses.
May cause dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to change positions slowly to minimize orthostatic hypotension.
Advise patient to consult health care professional before taking any cough, cold, or allergy remedies.
Emphasize the importance of follow-up visits to determine effectiveness of therapy.

Front 3

enoxaparin (e-nox-a-pa-rin) - Lovenox

Classification -
Therapeutic: anticoagulants
Pharmacologic: antithrombotics

Routes: Subcut (Adults): VTE prophylaxis in patients undergoing joint (knee, hip) replacement surgery--30 mg q 12 hr starting 12-24 hr postop for 7-10 days. Additional prophylaxis value. Refer to drug guide.

Mechanism of Action: Potentiate the inhibitory effect of antithrombin on factor Xa and thrombin.

Uses: Prevention of thrombus formation.

Side Effects: CNS: dizziness, headache, insomnia.
CV: edema.
GI: constipation, nausea, reversible increase in liver enzymes, vomiting.
GU: urinary retention.
Derm: ecchymoses, pruritus, rash, urticaria.
Hemat: BLEEDING, anemia, thrombocytopenia. Local: erythema at injection site, hematoma, irritation, pain. Misc: fever.

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Nursing Implications: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from surgical site. Assess for evidence of additional or increased thrombosis. Monitor neurological status frequently for signs of neurological impairment.
Monitor for hypersensitivity reactions (chills, fever, urticaria). Monitor patients with epidural catheters frequently for signs and symptoms of neurologic impairment. .
Subcut: Observe injection sites for hematomas, ecchymosis, or inflammation.
Lab Test Considerations: Monitor CBC, platelet count, and stools for occult blood periodically during therapy. If thrombocytopenia occurs (platelet count <100,000/mm3), discontinue therapy. If hematocrit ↓ unexpectedly, assess patient for potential bleeding sites.

Teaching Needs: Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately.
Instruct patient not to take aspirin or NSAIDs without consulting health care professional while on therapy.

Front 4

bisacodyl (bis-a-koe-dill)

Classification - Therapeutic: laxatives
Pharmacologic: stimulant laxatives

Mechanism of Action: Stimulates peristalsis.
Alters fluid and electrolyte transport, producing fluid accumulation in the colon.

Route: PO (Adults and Children ≥12 yr): 5-15 mg (up to 30 mg/day) as a single dose.
PO (Children 3-11 yr): 5-10 mg (0.3 mg/kg) as a single dose.
Rect (Adults and Children ≥12 yr): 10 mg single dose.

Uses: Evacuation of the colon.

Side Effects: GI: abdominal cramps, nausea, diarrhea, rectal burning.
F and E: hypokalemia (with chronic use). MS: muscle weakness (with chronic use).
Misc: protein-losing enteropathy, tetany (with chronic use).

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Nursing Implications: Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Teaching Needs: Advise patients, other than those with spinal cord injuries, that laxatives should be used only for short-term therapy. Prolonged therapy may cause electrolyte imbalance and dependence.
Advise patient to increase fluid intake to at least 1500-2000 ml/day during therapy to prevent dehydration.
Encourage patients to use other forms of bowel regulation (increasing bulk in the diet, increasing fluid intake, or increasing mobility). Normal bowel habits may vary from 3 times/day to 3 times/wk.
Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient that bisacodyl should not be used when constipation is accompanied by abdominal pain, fever, nausea, or vomiting.

Front 5

esomeprazole (es-o-mep-ra-zole) - Nexium

Classification: Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors

Mechanism of Action: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Route: PO (Adults): Healing of erosive esophagitis--20 mg or 40 mg once daily for 4-8 wks; maintenance of healing of erosive esophagitis--20 mg once daily; symptomatic GERD--20 mg once daily for 4 wks (additional 4 wks may be considered for nonresponders).

Uses: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. Healing of duodenal ulcers. Decreased incidence of gastric ulcer during continuous NSAID therapy.

Side Effects: CNS: headache.
GI: abdominal pain, constipation, diarrhea, dry mouth, flatulence, nausea.

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Nursing Implications: Assess patient routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
Lab Test Considerations: May cause ↑ serum creatinine, uric acid, total bilirubin, alkaline phosphatase, AST, and ALT.
May alter hemoglobin, WBC, platelets, serum sodium, potassium, and thyroxine levels.

Teaching Needs: Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly.

Front 6

bacitracin-polymyxin B topical (BAS-i-TRAY-sin/POL-ee-MIX-in) - Duospore; Polysporin

Classification: antibiotic ointment.

Mechanism of Action: It works by stopping or preventing bacterial infections by either killing susceptible bacteria or inhibiting their growth.

Route: Topical Bacitracin/Polymyxin Ointment is for external use only. Use as directed by physician. Check the label on the medicine for exact dosing instructions.

Uses: This combination product is used to treat minor wounds (e.g., cuts, scrapes, burns) and to help prevent or treat mild skin infections.

Side Effects: Burning, redness, or irritation of the skin may occur. Unlikely but serious side effects: balance/hearing problems, "hair bumps" (folliculitis), change in the amount of urine. Rarely, use of this medication for prolonged or repeated periods may result in a fungal infection or a different bacterial skin infection. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.

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Nursing Implications: Monitor site of application.
Assess patient for other illnesses, infections, or allergies (especially to antibiotics). bacitracin/polymyxin B Sulfate should be used only if clearly needed during pregnancy. It is not known if Bacitracin/polymyxin B Sulfate is found in breast milk.

Teaching Needs: Follow all directions on the product package, or use as directed by physician. Wash hands before using. Clean and dry the affected area as directed. Apply a small amount of the medication in a thin layer on the skin, usually 1 to 3 times daily or as directed by physician. Cover with a bandage if directed to do so. Wash your hands after use.

Do not use large amounts of this medication, apply it more often, or use it for a longer period than directed as the risk for side effects may be increased. If your condition does not improve or worsens after 1 week, or if a serious medical problem is suspected, contact your doctor promptly.

Front 7

diphenhydrAMINE (dye-fen-hye-dra-meen) - Benadryl

Classification: antihistamine

Mechanism of Action: Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic properties.

Route: PO -Antihistaminic/antiemetic/antivertiginic--25-50 mg q 4-6 hr, not to exceed 300 mg/day. Antitussive--25 mg q 4 hr as needed, not to exceed 150 mg/day. Antidyskinetic--25-50 mg q 4 hr (not to exceed 400 mg/day). Sedative/hypnotic--50 mg 20-30 min before bedtime

IM IV - 25-50 mg q 4 hr as needed (may need up to 100mg dose, not to exceed 400 mg/day).

Uses: Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness, urticaria). Relief of acute dystonic reactions. Prevention of motion sickness. Suppression of cough.

Side Effects: CNS: drowsiness, dizziness, headache, paradoxical excitation (increased in children).
EENT: blurred vision, tinnitus.
CV: hypotension, palpitations.
GI: anorexia, dry mouth, constipation, nausea.
GU: dysuria, frequency, urinary retention.
Derm: photosensitivity.
Resp: chest tightness,, thickened bronchial secretions, , wheezing.
Local: pain at IM site.

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Nursing Implications: Diphenhydramine has multiple uses. Determine why the medication was ordered and assess symptoms that apply to the individual patient. Unless contraindicated, maintain fluid intake of 1500-2000 ml daily to decrease viscosity of bronchial secretions.
Lab Test Considerations: Diphenhydramine may decrease skin response to allergy tests. Discontinue 4 days before skin testing.

Teaching Needs: Instruct patient to take medication as directed; do not exceed recommended amount. Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine, including products used topically.
May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to drug is known. .
Inform patient that this drug may cause dry mouth.
Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoidance of nicotine and caffeine) to patients taking diphenhydramine to aid sleep.
Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Caution patient to avoid use of alcohol and other CNS depressants concurrently with this medication.

Front 8

hydrocodone/acetaminophen
Anexsia, Co-Gesic, Lorcet-HD, Lortab, Norco, Vicodin, Zydone

Classification: opioid agonists/nonopioid analgesic combinations

Mechanism of Action: Bind to opiate receptors in the CNS. Alter the perception of and response to painful stimuli while producing generalized CNS depression

Route: PO (Adults): Analgesic--2.5-10 mg q 3-6 hr as needed; if using combination products, acetaminophen or aspirin dosage should not exceed 4 g/day

Uses: Decrease in severity of moderate pain.

Side Effects: CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams.
EENT: blurred vision, diplopia, miosis.
Resp: respiratory depression.
CV: hypotension, bradycardia.
GI: constipation, dyspepsia, nausea, vomiting. GU: urinary retention. Derm: sweating.
Misc: physical dependence, psychological dependence, tolerance.

Back 8

Nursing Implications: Assess blood pressure, pulse, and respirations before and periodically during administration. Assess bowel function routinely. Assess type, location, and intensity of pain prior to and 1 hr (peak) following administration. Lab Test Considerations: May cause ↑ plasma amylase and lipase concentrations.

Teaching Needs: Advise patient to take medication exactly as directed and not to take more than the recommended amount. Doses of nonopioid agents should not exceed the maximum recommended daily dose.
Instruct patient on how and when to ask for pain medication.
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
Advise patient to change positions slowly to minimize orthostatic hypotension.
Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication.

Front 9

aluminum hydroxide/magnesium hydroxide/simethicone - Mylanta

Classification: Antacid

Mechansism of Action: An antacid and antiflatulent combination that neutralizes or reduces stomach acid and treats too much gas in the stomach and intestines.

Route: Oral suspension or tablets. Follow the directions on the prescription label.

Uses: An antacid and antigas medicine. It is used to relieve the symptoms of indigestion, heartburn, sour stomach, and the discomfort caused by gas. This medicine may be used for other purposes.

Side Effects: allergic reactions like skin rash, itching or hives; swelling of the face, lips, or tongue;
bone or joint aches and pains; confusion or irritability; headache; loss of appetite; nausea, vomiting; unusually weak or tired

Back 9

Nursing Implications: bowel, intestinal, or stomach disease; constipation
diarrhea; kidney disease;
liver disease; on a sodium (salt) restricted diet;
stomach bleeding or obstruction; an unusual or allergic reaction to aluminum hydroxide, magnesium hydroxide, simethicone, other medicines, foods, dyes, or preservatives; pregnant or trying to get pregnant;
breast-feeding

Teaching needs: Take this medicine by mouth. Follow the directions on the label. Shake well before using. Use a specially marked spoon or container to measure your medicine. Household spoons are not accurate. Antacids are usually taken after meals and at bedtime or as directed by your doctor or health care professional. After taking the medication, drink a full glass of water. Take doses at regular intervals. Do not take medicine more often than directed.