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5 Cards in this Set
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mannitol
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Osmitrol, Resectisol (diuretics)
Therapeutic Effect: • Mobilization of excess fluid in oliguric renal failure or edema • Reduction of intraocular or intracranial pressure • Increased urinary excretion of toxic materials • Decreased hemolysis when used as an irrigant after transurethral prostatic resection Action: • Increases the osmotic pressure of the glomerular filtrate, thereby inhibiting reabsorption of water and electrolytes • Causes excretion of » Water » Sodium » Potassium » Chloride » Calcium » Phosphorus » Magnesium » Urea » Uric acid Common SE: transient volume expansion RN Considerations: • Monitor vital signs, urine output, CVP, and pulmonary artery pressures (PAP) before and hourly throughout administration. Assess patient for signs and symptoms of dehydration (decreased skin turgor, fever, dry skin and mucous membranes, thirst) or signs of fluid overload (increased CVP, dyspnea, rales/crackles, edema) » Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Report signs of electrolyte imbalance Increased Intracranial Pressure • Monitor neurologic status and intracranial pressure readings in patients receiving this medication to decrease cerebral edema Increased Intraocular Pressure • Monitor for persistent or increased eye pain or decreased visual acuity Lab Test Considerations • Renal function and serum electrolytes should be monitored routinely throughout course of therapy |
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dexamethasone
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DexPak (anti inflammatories steroidal)
Therapeutic Effect: Suppression of inflammation and modification of the normal immune response Action: • In pharmacologic doses, suppresses inflammation and the normal immune response • Has numerous intense metabolic effects (see Adverse Reactions and Side Effects) • Suppresses adrenal function at chronic doses of 0.75 mg/day • Has negligible mineralocorticoid activity Common SE: depression, euphoria, hypertension, anorexia, nausea, acne, ↓ wound healing, ecchymoses, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance (moon face, buffalo hump) RN Considerations: • Indicated for many conditions. Assess involved systems before and periodically during therapy • Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy • Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify physician or other health care professional should these occur • Children should have periodic evaluations of growth Cerebral Edema • Assess for changes in level of consciousness and headache throughout therapy Lab Test Considerations • Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in patients with diabetes. Monitor hematologic values, serum electrolytes, and serum and urine glucose in patients on prolonged therapy. May cause ↓ WBC counts. May cause ↓ serum potassium and calcium and ↑ serum sodium concentrations » Guaiac test stools. Promptly report presence of guaiac-positive stools » May cause ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I » Suppresses reactions to allergy skin tests » Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy |
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pancuronium bromide
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Pavulon (neuromuscular blocking agents nondepolarizing)
Therapeutic Effect: Skeletal muscle paralysis Action: Prevent neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Have no analgesic or anxiolytic properties Common SE: (none listed as common) hypertension, tachycardia RN Considerations: • Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These medications should be used only to facilitate intubation or in patients already intubated • Neuromuscular response should be monitored with a peripheral nerve stimulator intraoperatively. Paralysis is initially selective and usually occurs sequentially in the following muscles: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, intercostal muscles, and the diaphragm. Recovery of muscle function usually occurs in reverse order • Monitor ECG, heart rate, and blood pressure throughout administration • Observe the patient for residual muscle weakness and respiratory distress during the recovery period • Monitor infusion site frequently. If signs of tissue irritation or extravasation occur, discontinue and restart in another vein Toxicity and Overdose • If overdose occurs, use peripheral nerve stimulator to determine the degree of neuromuscular blockade. Maintain airway patency and ventilation until recovery of normal respirations occurs » Administration of anticholinesterase agents (neostigmine, pyridostigmine) may be used to antagonize the action of neuromuscular blocking agents once the patient has demonstrated some spontaneous recovery from neuromuscular block. Atropine is usually administered prior to or concurrently with anticholinesterase agents to counteract the muscarinic effects » Administration of fluids and vasopressors may be necessary to treat severe hypotension or shock |
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baclofen
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Kemstro, Lioresal (antispasticity agents, skeletal muscle relaxants, centrally acting)
Therapeutic Effect: Decreased muscle spasticity; bowel and bladder function may also be improved Action: Inhibits reflexes at the spinal level Common SE: dizziness, drowsiness, fatigue, weakness, nausea RN Considerations: • Assess muscle spasticity before and periodically during therapy » Observe patient for drowsiness, dizziness, or ataxia. May be alleviated by a change in dose IT • Monitor patient closely during test dose and titration. Resuscitative equipment should be immediately available for life-threatening or intolerable side effects Lab Test Considerations • May cause ↑ in serum glucose, alkaline phosphatase, AST, and ALT levels |
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methylprednisone
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A-Methapred, Medrol, Solu-Medrol (anti inflammatories steroidal, immunosuppressants)
Therapeutic Effect: • Suppression of inflammation and modification of the normal immune response • Replacement therapy in adrenal insufficiency Action: • Suppresses inflammation and the normal immune response • Has numerous intense metabolic effects • Suppresses adrenal function at chronic doses of 4 mg/day • Has negligible mineralocorticoid activity Common SE: depression, euphoria, hypertension, acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance (moon face, buffalo hump) RN Considerations: • Indicated for many conditions. Assess involved systems before and periodically during therapy • Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy • Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur • Children should have periodic evaluations of growth Lab Test Considerations • Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May ↓ WBC counts. May ↓ serum potassium and calcium and increase serum sodium concentrations » Guaiac test stools. Promptly report presence of guaiac-positive stools » May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I » Suppresses reactions to allergy skin tests » Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy |
