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IV Therapy - Complications

Assessment for:
Infiltration
Edema
Pain
Coolness in area
Significant decrease in flow rate
Apply tourniquet above infusion site; if infusion continues to drip, it is infiltrated
IV Therapy - Complications

Nursing care for:
Infiltration
1. D/c IV
2. Apply warm compresses to site
3. Apply sterile dressing
4. Elevate arm
5. Start IV at new site proximal to infiltrated site if same extremity used; may use different vein distal to infiltrated site (basilic or cephalic)
IV Therapy - Complications

Assessment for:
Phlebitis
Reddened, warm area around insertion site or on path of vein
Tenderness
Swelling
IV Therapy - Complications

Nursing care for:
Phlebitis
1. D/c IV
2. Apply warm, moist compresses
3. Restart IV at new site
IV Therapy - Complications

Assessment for:
Thrombophlebitis
Pain, Swelling, Redness & warmth around insertion site or along path of vein, fever, leukocytosis
IV Therapy - Complications

Nursing care for:
Thrombophlebitis
1. D/C IV
2. Apply warm compress
3. Elevate extremity
4. Restart the IV in the opposite extremity
IV Therapy - Complications

Assessment for:
Hematoma
Ecchymosis
Immediate swelling at site
Leakage of blood at site
IV Therapy - Complications

Nursing care for:
Hematoma
1. D/C IV
2. Apply pressure w/ sterile dressing
3. Apply cool compresses (or ice bag) for 24 h to site, followed by warm compresses
4. Restart IV in opposite extremity
IV Therapy - Complications

Assessment for:
Clotting
Decreased IV flow rate
Back flow of blood into IV tubing
IV Therapy - Complications

Nursing care for:
Clotting
1. D/C IV
2. Do not irrigate or milk tubing
3. Do not increase IV flow rate or hang soln higher
4. Do not aspirate clot from cannula
5. Urokinase may be injected into cath to clear occlusion
IV therapy:

Percutaneous central cath - Triple-lumen central cath lines & what do they infuse?
Distal lumen (16-gauge): infuses or draws blood samples

Middle lumen (18-G): TPN infusion

Proximal port (18-G): infuse or draw blood & admin meds
Norepinephrine (Levophed)

S/E
Nursing Considerations
S/E: H/A, palpitations, nervousness, epigastric distress, angina, HTN, tissue necrosis w/ extravasation

NC: Vasoconstrictor to increase BP & cardiac output; Reflex bradycardia may occur w/ rise in BP; Pt. should be attended at all times; Monitor output; Infuse w/ DEXtrose soln, not saline; Monitor BP; Protect from light
General indications, S/E, & nursing considerations for agents used to tx shock, cardiac arrest, & anaphylaxis
I: Hypovolumic shock, cardiac arrest, anaphylaxis

S/E: Serious rebound effect may occur; Balance btwn underdosing & overdosing

NC: Monitor VS; Measure urine output; Assess for extravasation; Observe extremities for color & perfusion
Dopamine (Inotropin)

S/E
Nursing considerations
S/E: Increased ocular pressure; ectopic beats; nausea; tachycardia, chest pain, dysrhythmias

NC: Low-dose-dilates renal & coronoary arteries; High-dose-vasoconstrictor, increases myocardial oxygen consumption; H/A early symptom of drug excess; Monitor BP, peripheral pulses, urinary output; Use infusion pump
Epinephrine (Adrenalin)

S/E
Nursing considerations
S/E: Nervousness; restlessness; dizziness; local necrosis of skin

NC: Stimulates alpha & beta adrenergic receptors; Monitor BP; Carefully aspirate syringe b4 IM & SC doses; inadvertent IV admin can be harmful; Always check strength: 1: 100 only for inhalation, 1: 1,000 for parenteral admin (SC or IM); Ensure adequate hydration
Isoproterenol (Isuprel)

S/E
Nursing considerations
S/E: H/A; palpitations; tachycardia; changes in BP; Angina, bronchial asthma

NC: Stimulates beta 1 & 2 adrenergic receptors; Used for heart block, ventricular arrhythmias, & bradycardia; Bronchodilator used for asthma & bronchospasms; Don't give at hs - interrupts leep patterns; Monitor BP, pulse
Phenlyephrine (Neo-Synephrine)

S/E
Nursing considerations
S/E: Palpatations; tachycardia; H/A; Dysrhythmia; Angina; Tissue necrosis w/ extravsation

NC: Potent alpha 1 agonist; used to tx hypotension
Dobutamine hydrocholoride (Dobutrex)

S/E
Nursing considerations
S/E: HTN; PVCs; asthmatic episodes; H/A

NC: Stimulates beta 1 receptors; incompatible w/ alkaline solns (sodium bicarb); Admin through central venous cath or large peripheral vein using an infusion pump; Don't infuse through line w/ other meds (incompatible); Monitor EKG, BP, I&O, serum K+
Milrinone (Primacor)

S/E
Nursing considerations
S/E: Dysrhythmia; thrombocytopenia; jaundice

NC: (+)tive inotropic agen; smooth muscle relaxant use dto tx severe heart failure
Sodium nitroprusside (Nitropress)

S/E
Nursing considerations
S/E: Hypotension

NC: Dilates cardiac veins & arteries; Decreases preload & afterload; Increase myocardial perfusion
Diphenhydramine HCl (Benadryl)

S/E
NC
S/E: Drowsiness; confusion; insomnia; H/A; vertigo; photosensitivity

NC: Blocks effects of histamine on bronchioles, GI tract, & blood vessels
ANTIANXIETY AGENTS

General action, indications, s/e, & nursing considerations
A: affects neurotransmitters

I: Anxiety d/o; insomnia; petit mal seizures; panic attacks, acute manic episodes

S/E: sedation; depress, confusion; anger, hostility; H/A; dry mouth, constipation; bradycardia; elevations in LDH, AST (SGOT), ALT (SGPT); urinary retention

NC: Monitor liver function & therapeutic bl lvls; AVOID alcohol; caution when performing tasks requiring alertness; benzodiazepines are used as muscle relaxants, sedatives, hypnotics, anticonvulsants
Chlordiazepoxide (Librium)
&
Diazepam (Valium)

S/E
NC
*Benzodiazepine Derivative

S/E: Lethargy, hangover; respiratory depression; hypotension

NC: CNS depressant; Use - anxiety, sedation, alcohol w/d; seizures; May result in toxic build-up in elderly; Potential for physiological addiction/OD; Can develop tolerance & cross-tolerance; Cigarette smoking increases clearance of drug; Alcohol increases CNS depression
Alprazolam (Xanax)
Clonazepam (Klonopin)
Lorazepam (Ativan)
Oxazepam (Serax)

S/E & NC
S/E: Drowsiness, light-headedness, hypotension, hepatic dysfunction; increased salivation; Orthostatic hypotension; Memory impariment & confusion

NC: CNS depressant; Safer for elderly; Don't combine w/ alcohol; or other depressants; Check renal & hepatic; Don't d/c abruptly (true for all antianxiety agents); Teach addictive potential
Midazalam (Versed)

S/E & NC
S/E: Retrograde amnesia; Euphoria; Hypotension; Dysrhythmia; Cardiac arrest; Respiratory depression

NC: CNS depressant; Use- preop sedation, conscious sedation for endoscopic procedures & diagnostic tests
Buspirone (BuSpar)

S/E & NC
S/E: Light-headedness; Confusion; Hypotension, palpitations

NC: Anti-anxiety; Little sedation; requires >= 3 wks to be effective; Cannot be given as a PRN med; Particularly useful for generalized anxiety d/o (GAD); No abuse potential; Used for clients w/ previous addiction; Avoid alcohol & grapefruit juice; Monitor for worsening depression or suicidal tendencies
Hydroxyzine (Vistaril) (Atarax)

S/E & NC
S/E: Drowsiness, ataxia; Leukopenia, hypotension

NC: Produces no dependence, tolerance, or intoxication; Can be used for anxiety relief for indefinite periods
Kava

S/E & NC
S/E: Impaired thinking, judgment, motor reflexes, vision decreased plasma proteins, thrombocytopenia, leukocytopenia, dyspnea, & pulmonary HTN

NC: Similar activity to benzos; Suppresses emotional excitability & prodcues mild euphoria; Do not take w/ CNS depressants; Should not be taken by women who are pregnant or lactating or by children < 12 yo.
Melatonin

S/E & NC
S/E: Sedation, confusion, H/E & tachycardia

NC: Influences sleep-wake cycles (lvls are high during sleep); Used for prevention & tx of "jet lag" & insomnia; Use cautiously if given w/ benzos & CNS depressants; Contraind in hepatic insfficiency, hx of cerebrovascular dz, depression, & neurologic d/o
ANTACID MEDS

General action, indications, S/E, NC
A: Neutralizes gastric acids; raises gastric pH; inactivates pepsin
I: Peptic ulcer; Indigestion; Reflex esophagitis; Prevent stress uclers

S/E: Constipation, diarrhea; Acid rebound btwn doses; Metabolic acidosis

NC: Use meds w/ sodium content cautiously for clients w/ cardiac & renal dz; Absorption of tetracyclines, quinolones, phenothiazides, iron preparations, isoniazid reduced when given w/ antacids; Effectiveness of oral contraceptives & salicylates may decrease when given w/ antacids
Aluminum hydroxide gel (Amphojel)
Calcium carbonate (Titralac)
Aluminum hydroxide & mag trisilicate

S/E & NC
S/E: Constipation that may lead to impaction, phosphate depletion

NC: Monitor bowel pattern; compounds contains sodium; check if pt is on sodium-restricted diet; Aluminum & Mag antacid compounds interfere w/ tetracycline absorption; Encourage fluids; Monitor for signs of phosphate deficiency - malaise, weakness, tremors, bone pain; Shake well; Careful use advised for kidney dysfunction
Magnesium hydroxide (Milk of Magnesia)

S/E & NC
S/E: Excessive dose can produce N/V/D

NC: Store at room temp w/ tight lid to prevent absoprtion of CO2; prolonged & frequent use of cathartic dose can lead to dependence; Admin w/ caution to clients w/ renal dz
Aluminum hydroxide & Magnesium hydroxide (Maalox)

S/E & NC
S/E: Slight laxative effect

NC: Encourage fluid intake; Admin w/ caution to clients w/ renal dz
ANTIBIOTICS/ANTI-INFECTIVES: Aminoglycosides

Actions, indications
A: Bacteriocidal; inhibits protein synthesis in gram-negative bacteria

I: Tx of severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues, acute pelvic inflammatory dz (PID), TB (streptomycin)
ANTIBIOTICS/ANTI-INFECTIVES: Aminoglycosides

Gentamincin (Garamycin)
Neomycin
Streptomycin
Tobramycin (Tobrax)
Amikacin (Amikin)

S/E & NC
S/E: Ototoxicity, nephrotoxicity; Anorexia, N/V/D

NC: Check VIII CN function (hearing); Check renal function (BUN, creatinine); Usually prescribed for 7-10 days; Encourage fluids; Small, frequent meals
ANTIBIOTICS/ANTI-INFECTIVES: Cephalosporins

Actions, Indications
A: Bacteriocidal; Inhibits synthesis of bacterial cell wall

I: Pharyngitis; tonsilitis; otitis media; upper & lower respiratory tract infections; dermatological infections; Gonorrhea; Septicemia; Meningitis; Perioperative prophylaxis; UTI
ANTIBIOTICS/ANTI-INFECTIVES: Cephalosporins

Ceclor, Ancef, Suprax, Keflex, Rocephin, Cefoxitin

S/E & NC
S/E: Diarrhea; nausea; Dizziness, abd pain; Eosinophilia, superinfections; Allergic rxns; bone marrow suppression; thrombophlebitis (IV)

NC: Can cause false+ glucose in urine or proteinuria & false+ Coombs' test (which will complicate transfusion cross-matching procedure); Cross-sensitivity w/ PCN; Take careful hx of PCN rxn; Obtain C&S b4 admin; Take w/ FOOD (only abx class taken w/ food); Avoid alcohol; monitor renal & hepatic function
ANTIBIOTICS/ANTI-INFECTIVES: Fluoroquinolones

Actions, Indications
A: Bactericidal; interferes w/ DNA replication in Gram-negative bacteria

I: Tx of infection caused by E. coli & other bacteria, chronic bacterial prostatisi, acute sinusitis, postxposure inhalation Anthrax
ANTIBIOTICS/ANTI-INFECTIVES: Fluoroquinolones

Cipro, Levofloxacin (Levequin), Norfloxacin (Noroxin)

S/E & NC
S/E: Seziures; Gi upset; Rash; Elevated BUN, AST, ALT, serum creatinine, alkaline phosphatase; Decreased WBC & Hct; H/A; Photosensitivity

NC: Contraind in children < 18 yo; Give 2 hrs pc or 2 hrs b4 an antacid or iron preparation; Avoid caffeine; Encourage fluids. Don't give Iron w/ Cipro.
ANTIBIOTICS/ANTI-INFECTIVES: Glycopeptides

Actions, Indications
A: Bacteriocidal; binds to bacterial cell wall, stopping its synthesis

I: Tx of resistant staph infections, pseudomembranous enterocolitis d/t C.diff infection
ANTIBIOTICS/ANTI-INFECTIVES: Glycopeptides

Vancomycin (Vancocin)
S/E & NC
S/E: Thrombophlebitis; abscess formation; Nephrotoxicity; Ototoxicity

NC: Monitor renal function & hearing; Poor absorption orally; admin IV: peak 5 min, duration 12-24 hrs; Give antihistamine if "red man syndrome" : decreased BP, flushing of face & neck; Contact clinician if signs of superinf: sore throat, fever, fatigue
ANTIBIOTICS/ANTI-INFECTIVES:
Lincosamides

Actions, Indications
A: Both bacteriostatic & bactericidal, it suppresses protein synthesis by preventing peptide bond formation

I: Staph, strep, and other infections
ANTIBIOTICS/ANTI-INFECTIVES: Lincosamides

Clindamycin HCl Phosphate (Cleocin)
S/E & NC
S/E: Diarrhea; Rash; Liver toxicity

NC: Admin oral med w/ full glass of water to prevent esophageal ulcers; Monitor for persistent vomiting, diarrhea, fever, or abd pain & cramping, superinfections
ANTIBIOTICS/ANTI-INFECTIVES:
Macrolides

Actions, Indications
A: Bacteriostatic; bactericidal; binds to cell membrane & causes changes in protein function

I: Acute infections; Acne & skin infections; Upper respiratory tract inf; Prophylaxis b4 dental procedures for pts allergic to PCN w/ valvular heart dz
ANTIBIOTICS/ANTI-INFECTIVES:
Macrolides

Erythromycin (Erythrocin)
Azethromycin (Zithromax)
S/E & NC
S/E: Abd cramps, diarrhea; CONFUSION*, uncontrollable emotions; Hepatotoxicity; Superinf

NC: Take oral med 1 h b4 or 2-3 h after meals w/ full glass of water; NO Fruit juice; Take around clock to maximize effectiveness; Monitor liver function; Take full course of therapy

**Used as alternate to PCN & Cephalosporin allergy.
Increases effectiveness of coumadin & Theophylline (resp. med)
Does not effect kidneys or ears.
ANTIBIOTICS/ANTI-INFECTIVES:
Penicillins

Actions, Indications
A: Bactericidal; inhibit synthesis of cell wall of sensitive organisms

I: Effective against gram(+) organisms; Moderate to severe inf; Syphilis; Gonococcal inf; Lyme dz
ANTIBIOTICS/ANTI-INFECTIVES:
Penicillins

Amoxicillin (Amoxil), Ampicillin (Omnipen), Methicilin, Nafcillin (Unipen); Penicillin G & V
S/E & NC
S/E: Glossitis, stomatitis; Gastritis; Diarrhea; Superinf; Hypersensitivity rxn (mild, moderate, severe anaphylaxis)

NC: C&S b4 tx; Monitor serum electrolytes & cardiac status if given IV; Monitor & rotate injection sites; Good mouth care; Yogurt or buttermilk if diarrhea develops; Instruct pt. to take missed drugs as soon as possible; do not double dose; Cross allergy w/ CEPHALOSPORINS! - Hx of allergy & past exposure important to assess
ANTIBIOTICS/ANTI-INFECTIVES: Sulfonamides

Actions & indications
A: Bacteriostatic; competitively antagonize paraminobenzoic acid, essential component of folic acid synthesis, causing cell death

I: Ulcerative colitis, Crohn's dz*; Otitis media; Conjunctivitis; Meningitis; Toxoplasmosis; UTIs; Rheumatoid arthritis
ANTIBIOTICS/ANTI-INFECTIVES: Sulfonamides

Sulfisoxazole (Gantrisin); Sulfasalazine (Azulfidine); Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

S/E & NC
S/E: Peripheral neuropathy*; Crystalluria*, proteinuria; Photosensitivity; Gi upset; Stomatitis

NC: C/S b4 therapy; Take on an empty stomach w/ full glass of water; Take around clock; Encourage fluid intake (8 glasses/day); Protect from light exposure (sunscreen); Good mouth care; May turn urine red-orange temporarily**
ANTIBIOTICS/ANTI-INFECTIVES: Tetracyclines

Actions & indications
A: Bacteriostatic; inhibits protein synthesis of susceptible bacteria

I: Tx of syphilis, chlamydia, gonorrhea, malaria prophylaxis, chronic periodonitis, acne*; tx of Anthrax (Vibramycin); as part of combo therapy to eliminate H. pylori inf; drug of choice for stage 1 Lyme's dz (tetracycline HCl)
ANTIBIOTICS/ANTI-INFECTIVES: Tetracyclines

Doxycycline (Vibramycin), Minocycline (Minocin); Tetracycline Hcl (Panmycin)

S/E & NC
S/E: Discoloration & inadequate calcification of primary teeth of fetus if taken during prego*; Glossitis*; dysphagia; diarrhea; Phototoxic rxn*; rash; superinf

NC: Take 1 h b4 or 2-3 h after meals; Do not take w/ Antacids, milk, iron, preps (give 3 h after med)*; Note expiration date (becomes highly nephrotoxic**); Protect rom sunlight*; topical apps may stain clothing; Use contraceptive method in addition to oral conceptives
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Bacitracin ointment

S/E & NC
S/E: Nephrotoxicity; Ototoxicity

NC: Overgrowth of nonsusceptible organisms can occur
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Neosporin
S/E & NC
S/E: Nephrotoxicity; Ototoxicity

NC: Allergic dermatitis may occur
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Povidone-iodine soln
S/E & NC
S/E: Irritation

NC: Don't use around eyes; May stain skin; don't use full-strength on mucous membranes
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Silver sulfadiazine cream (Silvadene)
S/E & NC
S/E: Neutropenia; Burning

NC: Use cautiously if sensitive to sulfonamides
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Tolna flake cream (Tinactin)
S/E & NC
S/E: Irritation

NC: Use small amt of med; Use med for duration prescribed
ANTIBIOTICS/ANTI-INFECTIVES: Topical Antibacterials:

Nystatin cream (Mycostatin)
S/E & NC
S/E: Contact dermatitis

NC: Do not use occlusive dressings
ANTI-DYSRHYTHMICS: Class I-B Type drugs

Procainamide (Pronestyl)
Disopyramine (Norpace)

S/E & NC
S/E: Hypotension, Heart failure

NC: Monitor BP; Monitor for widening of PR, QRS or QT intervals; Toxic s/e have limited use
ANTI-DYSRHYTHMICS: Class II-B Type drugs

Lidocaine (xylocaine); Mexiletine hydrochloride (Mexitil); Tocainide hydrochloride (Tonocard)

S/E & NC
S/E: slurred speech, confusion, drowsiness, confusion, seizures hypotension & bradycardia

NC: Monitor for CNS s/e; Monitor BP & HR & cardiac rhythm
ANTI-DYSRHYTHMICS: Class I-C Type drugs

Flecainide (Tambocor)
Propafenone hydrochloride (Rythmol)

S/E & NC
S/E: Bradycardia; hypotension; dysrhythmais; CNS: anxiety, insomnia, confusion, seizures

NC: Monitor for increasing dysrhythmias; Monitor HR & BP; Monitor for CNS effects
ANTI-DYSRHYTHMICS: Class II Type drugs

Propanolol (Inderal); Acebutolol (Sectral); Esmolol hydrochloride; Sotalol hydrochloride (Betapace)

S/E & NC
S/E: Bradycardia & hypotension; Bronchospasm***; Increase in HF; Fatigue & sleep disturbances

NC: Monitor apical HR (for 1 min), cardiac rhythm & BP; Assess for SOB & wheezing; Assess for fatigue, sleep disturbances
ANTI-DYSRHYTHMICS: Class III Type drugs

Amiodarone hydrochloride (Cordarone); Ibutilide fumarate (Corvert); Dofetilide (Tokosyn)

S/E & NC
S/E: Hypotension; Bradycardia & AV block; Muscle weakness, tremors; Photosensitivity & photophobia; Liver toxicity

NC: Continous monitoring of cardiac rhythm during IV admin; Monitor QT interval during IV admin; Monitor HR, BP during initiation of therapy; Instruct client to wear sunglasses & sunscreen
ANTI-DYSRHYTHMICS: Class IV Type drugs

Verapamil (Calan); Diltiazem hydrochloride (Cardizem)

S/E & NC
S/E: Brady cardia; Hypotension; Dizziness & orthostatic hypotension; HF

NC: Monitor apical HR & BP; instruct clients about orthostatic hypotension; Instruct clients to report signs of HF to HCP
GENITOURINARY MEDS

Nitrofurantoin (Furadantin)
S/E & NC
S/E: Diarrhea, N/V, asthma attacks

NC: Anti-infective; Check CBC; GIve w/ FOOD or milk; Check I&O; Monitor pulmonary status
GENITOURINARY MEDS

Phenazopyridine (Pyridium)
S/E & NC
S/E: H/A, vertigo

NC: Urinary tract analgesic, spasmolytic; Inform pt. that urine will be bright ORANGE; Take w/ MEALS.
GENITOURINARY MEDS: Anticholinergics

Oxybutynin (Ditropan); Hyoscyamine (Anaspaz); Propantheline (Pro-Banthine); Darifenacin (Enablex); Solifenacin (VESIcare); Tolterodine (Detrol)
S/E & NC
S/E: Drowsiness; Blurred vision; Dry mouth; Constipation; Urinary retention (slows bladder)

NC: Used to reduce bladder spasms & tx urinary incontinence; Increase fluids & fiber in diet; Oxybutynin-older adults require higher dose & have greater incidence of side effects
GENITOURINARY MEDS: Anti-impotence

Sildenafil (Viagra); Vardenafil (Levitra); Tadalafil (Cialis)

S/E & NC
S/E: H/A, flushing, hypotension, priapism

NC: Tx of erectile dysf; Take 1 h b4 sexual activity; Never use w/ nitrates* - could have fatal hypotension; Do not take w/ alpha blockers, e.g. doxazosin (Cardura) - risk of hypotension; Do not drink GRAPEFRUIT JUICE - others include Lipitor & anticonvulsants.
GENITOURINARY MEDS: Testosterone inhibitors

Finasteride (Proscar, Propecia)

S/E & NC
S/E: Decreased libido; impotence; Breast tenderness

NC: Tx of BPH by Proscar; male hair loss by Propecia; Prego women should avoid contact w/ crushed durg or pt's semen - may adversely affect male fetus
ANTICHOLINERGICS:

Propantheline bromide (Pro-Banthine)

S/E & NC
S/E: Decreased gastric motility; Decreased effect of vagus nerve

NC: Used for urinary incontinence & peptic ulcer dz; Give 30 mins ac; Give hs dose at least 2 h after last meal; Monitor VS, I&O
ANTICHOLINERGICS:

Belladonna

S/E & NC
S/E: Dry mouth, vertigo

NC: Action peaks in 2 h
ANTICHOLINERGICS:

Atropine sulfate

S/E & NC
S/E: Tachycardia; H/A, blurred vision; Insomnia, dry mouth; Dizziness; Urinary retention; Angina, mydriasis

NC: Used for bradycardia; When given PO give 30 min b4 meals; Check for hx of glaucoma*, asthma, HTN; Monitor I&O, oreintation; When given in non-emergency situations make certain client voids b4 taking drug; Educate client to expect dry mouth, increased respiration & HR; Client should avoid heat (perspiration is decreased);

Antidote**-physostigmine salicylate
ANTICHOLINERGICS:

Iproproprium (Atrovent); Tiotropium (Spiriva); Iprotropium + Albuterol (Atrovent, DuoNeb)

S/E & NC
S/E: Dry mouth; irritation of pharynx

NC: Used for bronchospasm & long-term tx of asthma; Iprop admininstered in powder form by HandiHaler
ANTICHOLINERGICS:

Benztropine (Cogentin); Trihexyphenydil (Artane)

S/E & NC
S/E: Urinary retention; Blurred vision; Dry mouth; Constipation

NC: Used for Parkinson's Dz; Increase fluids, bulk foods & exercise; Taper b4 d/c; orthostatic hypotension precautions
ANTICHOLINERGICS:

Scopolamine (Transderm-Scop)

S/E & NC
S/E: Urinary retention; blurred vision; dry mouth, constipation; confusion & sedation

NC: Used for motion sickness; Contraind in acute angle glaucoma
ANTICHOLINERGICS:

General Actions, Indications, S/E, NC
A: Competes w/ ACh at receptor sites in ANS; causes relaxation of ciliary muscle (cycloplegia) & dilation of pupil (mydriasis); causes bronchodilation & decreases bronchial secretions; decreases mobility & GI secretions

I: Atropine - bradycardia, mydriasis for ophthalmic exam, preop to dry secretions
Scopolamine - motion sickness, vertigo, mydriasis for ophthalmic exam, preop to dry secretions

S/E: blurred vision, dry mouth urinary retention; changes in HR

NC: monitor for urinary retention; contraind for clients w/ glaucoma
ANTI-COAGULANT:

Heparin
S/E & NC
S/E: Can produce hemorrhage from any body site (10%) ; Tissue irritation/ain at injection site; Anemia; Thrombocytopenia; Fever; Hematuria

NC: Monitor therapeutic PTT at 1.5-2.5 x the control w/o signs of hemorrhage; Normal range 20-39 sec; For IV admin: use infusion pump, peak 5 min, duration 2-6 h; For injection: give deep SQ; never IM (danger of hematoma), onset 20-60 mins, duration 8-12 hrs; Antidote: protamine sulfate w/n 30 mins; Can be allergenic
ANTI-COAGULANT:

Enoxaparin (Low-molecular wt heparin) (Lovenox)
S/E & NC
S/E: same as heparin

NC: Less allergenic than heparin; Must be given deep SQ, never IV or IM. Does not require lab test monitoring
ANTI-COAGULANT:

Warfarin (Coumadin)
S/E & NC
S/E: Hemorrhage; Diarrhea; Rash; Fever; ALopecia*

NC: Monitor therapeutic PT 1.5-2.5x control or monitor INR. Normal PT 9.5-12 sec; normal INR 2.0-3.5; Onset: 12-24 h, peak 1.5-3 days; duration: 3-5 days; Antidotes**: vitamin K, whole blood, plasma
Teach measures to avoid venous stasis; Emphasize importance of regular lab testing; Pt. should avoid foods high in vitamin K: many green veggies, pork, rice, yogurt, cheeses, fish, milk
ANTI-COAGULANT:

General Action, indications, S/E & NC, herbal & vitamin interactions
A: Heparin blocks conversion of fibrinogen to fibrin; Coumadin interferes w/ liver synthesis of vitamin K-dependent clotting factors

I: For hep: prophylaxis & tx of thromboembolic d/o; in very low doses (10-100 units)
For coumadin: management of pulm emboli, DVT, MI, atrial dysrhythmias, post cardiac valve replacement

S/E: nausea, alopecia, urticaria, hemorrhage, bleeding/heparin-induced thrombocytopenia (HIT)

NC: Check for signs of hemorrhage; Pt. should avoid IM injections, ASA-containing products & NSAIDs; Wear med-alert tag; Pt. use soft toothbrush, electric razor, to report bleeding gums, petechiae or bruising, expistaxis, black tarry stools; Monitor platelet counts & s/s of thrombosis during heparin therapy

Herbal: Avoid 3 G's: garlic, ginger, & ginkgo - may increase bleeding when taken w/ warfarin.
Vitamin: Avoid Vitamin C - may slightly prolong PT; Vitamin E will increase warfarin's effect
ANTI-CONVULSANT:

General Actions, Indications, S/E, & NC
A: Decreases flow of Ca2+ & Na+ across neuronal membranes

I: Partial seizures: Luminal, Ysoline, Tegretol, Neurontin, Lamictal;
Generalized tonic-clonic seizures: Lumninal , Mysoline, Tegretol;
Absence seizures: Zarontin; Status epilepticus: Valium, Ativan, Dilantin
S/E: Cardiovascular depression; respiratory depression*; agranulocytosis; aplastic anemia

NC: Tolerance develops w/ long-term use; don't d/c abruptly; caution w/ use of meds that lower seizure threshold (MAOIs)**; Barbiturates & benzos also used as anticonvulsants; increased risk adverse rxn w/ older adults; may turn urine color
ANTI-CONVULSANT:

Clonazepam (Klonopin)
(also used for anti-anxiety)

S/E & NC
S/E: Drowsiness*; dizziness; confusion; respiratory depression*

NC: Is a benzodiazepine; do not d/c suddenly*; avoid activities that require alertness
ANTI-CONVULSANT:

Diazepam (Valium)

S/E & NC
S/E: Drowsiness*, ataxia; Hypotension; tachycardia; resp depression*

NC: IV push doses shouldn't exceed 2 mg/min; monitor VS - resuscitation equipment available if given IV; Alcohol increases CNS dep; after long-term use, w/drwal leads to symptoms such as: vomiting, sweating, cramps, tremors, & possibly convulsions
ANTI-CONVULSANT:

Fosphenytoin (Cerebyx)

S/E & NC
S/E: Drowsiness*; dizziness; confusion; leukopenia; anemia

NC: Use for tonic-clonic seizures, status epilepticus; highly protein-bound; contact healthcare provider if rash develops
ANTI-CONVULSANT:

Levetiracetam (Keppra)

S/E & NC
S/E: Dizziness; suicidal ideation

NC: Avoid alcohol; avoid driving & activities that require alertness
ANTI-CONVULSANT:

Phenytoin sodium (Dilantin)

S/E & NC
S/E: Drowsiness, ataxia; nystagmus; blurred vision; hirsutism; lethargy; GI upset; gingival hypertrophy

NC: Give PO meds w/ at least 1/2 glass of water, or w/ meals to minimize GI irritation; Inform client that red-brown or pink discoloration of sweat & urine may occur**; IV admin may lead to cardiac arrest - have resusc equipment at hand!**; Never mix w/ any other drug or dextrose IV!**; Instruct in oral hygiene; Increase vitamin D intake & exposure to sunglight may be necessary w/ long-term use; Alcohol increases serum lvls; Increased risk toxicity older adults
ANTI-CONVULSANT:

Phenobarbital (Luminal)

S/E & NC
S/E: Drowsiness*, rash; GI upset; initially constricts pupils; Resp. depression*; ataxia

NC: Monitor VS - resusc equipment should be available if given IV; Drowsiness diminishes after initial weeks of therapy; Don't take alcohol or perform hazardous activities; nystagmus may indicate early toxicity; Sudden d/c may lead to w/drawal; Tolerance & dependence result from long-term use; Folic acid suppl are indicated for long-term use; Decreased cognitive fx older adults
ANTI-CONVULSANT:

Primidone (mysoline)

S/E & NC
S/E: Drowsiness*; Ataxia, diplopia; N/V

NC: Don't d/c abruptly; Full therapeutic response may take 2 wks; shake liquid suspension well; take w/ food if experiecing GI distress; Decreased cognitive fx older adults
ANTI-CONVULSANT:

Magnesium sulfate

S/E & NC
S/E: Flushing; sweating; extreme thirst; hypotension; sedation, confusion

NC: Monitor I&O; before each dose knee jerks (DTRs) should be tested; VS should be monitored often during parenteral admin; used for prego-induced HTN
ANTI-CONVULSANT:

Valproic acid (Depakote)

S/E & NC
S/E: sedation*; tremor, ataxia; N/V; prolonged bleeding time

NC: Agent of choice in many seizure d/o of young children; Do not take w/ carbonated beverage**; Take W/ FOOD**; Monitor plat, bleeding time, & liver fx test
ANTI-CONVULSANT:

Carbamazepine (Tegretol)

S/E & NC
S/E: Myelosuppression; dizziness, drowsiness*; ataxia; diplopia, rash

NC: Monitor I&O; supervise ambulation; Monitor CBC; Take W/ MEALS*; Wear protective clothing d/t photosensitivity*; Multiple drug interactions*
ANTI-CONVULSANT:

Ethosuximide (Zarontin)

S/E & NC
S/E: GI symptoms; drowsiness*; ataxia, dizziness

NC: Monitor for behavioral changes; Monitor wt. weekly
ANTI-CONVULSANT:

Gabapentin (Neurontin)

S/E & NC
S/E: Increased appetite; ataxia; irritability; dizziness; fatigue

NC: Monitor wt & behavioral changes; Can also be used to tx postherpetic neuralgia
ANTI-CONVULSANT:

Lamotrigine (Lamictal)

S/E & NC
S/E: Diplopia; H/A; Dizziness; Drowsiness*; Ataxia; N/V; Life-threatening rash when given w/ valproic acid

NC: Take divided doses W/ MEALS or just afterward to decrease adverse effects
ANTI-CONVULSANT:

Topiramate (Topamax)

S/E & NC
S/E: Ataxia; Confusion; Dizziness; Fatigue; Vision problems

NC: Adjunct therapy for intractable partial seizures; Increased risk for renal calculi; Stop drug immediately if eye problems - could lead to permanent damage**
ANTI-DEPRESSANTS: Monoamine Oxidase (MAO) Inhibitors

Phenelzine sulfate (Nardil); Isocarboxazid (Marplan); tranylcypromine (Parnate)

Actions; Indications
A: Interferes w/ MAO, allowing for increased concentration of NTs (epinephrine, NE, serotonin) in synaptic space, causing stabilization* of mood

I: Depression; chronic pain syndromes
ANTI-DEPRESSANTS: Monoamine Oxidase (MAO) Inhibitors

Phenelzine sulfate (Nardil); Isocarboxazid (Marplan); tranylcypromine (Parnate)

S/E
S/E: HTNsive Crisis** when taken w/ tyramine foods (aged cheese, bologna, pepperoni, salami, figs, bananas, raisins, beer, Chianti red wine) or OTC meds containing ephedrine, pseudoephedrine; Photosensitivity**; wt gain; sexual dysf; orthostatic hypotension

HTN crisis s/s: severe H/A, palpitations, stiff neck, diaphorectic; may progress to intracranial hemorrhage if untreated
ANTI-DEPRESSANTS: Monoamine Oxidase (MAO) Inhibitors

Phenelzine sulfate (Nardil); Isocarboxazid (Marplan); tranylcypromine (Parnate)

Nursing considerations:
NC: Not 1st line drugs for depression; should not be taken w/ SSRIs; Admin antiHTNsive meds w/ caution; Avoid use of other CNS depressants, including alcohol & cold meds; D/C 10 days b4 general anesthesia; Meds lower seizure threshold; Monitor for urinary retention; Takes 2-4 wks to work
ANTI-DEPRESSANTS: SSRIs

Fluoxetine (Prozac), Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft)

Actions & Indications
A: Inhibits CNS neuronal uptake of serotonin; acts as stimulant counteracting depression & increasing motivation

I: Depression; OCD; Obesity; Bulimia
ANTI-DEPRESSANTS: SSRIs

Fluoxetine (Prozac), Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft)

S/E
S/E: H/A, dizziness; nervousness; insomnia, drowsiness; anxiety*; tremor; dry mouth; GI upset*; taste changes; sweating; rash; URI; painful menstruation; sexual dysf; wt. gain*; change in appetite & bowel fx*; urinary retention*
ANTI-DEPRESSANTS: SSRIs

Fluoxetine (Prozac), Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft)

NC
NC: Take in AM;
Takes 4 wks for full effect;
Monitor wt.
Good mouth care
Do not admin w/ MAOIs - risk of SEROTONIN SYNDROME
Monitor for thrombocytopenia, leukopenia, & anemia
Suicide precautions!*
ANTI-DEPRESSANTS: Tricyclics

Amitriptyline (Elavil); Imipramine (Tofranil)

Actions & Indications
A: Inhibits presynaptic reuptake of NTs NE & serotonin; anticholinergic action at CNS & peripheral receptors

I: Depression; obstructive sleep apnea
ANTI-DEPRESSANTS: Tricyclics

Amitriptyline (Elavil); Imipramine (Tofranil)

S/E
S/E:
Sedation* (Take @ night! do not take w/ sedative meds!)
Anticholinergic effects* (dry mouth, blurred vision)
Confusion* (esp in elderly)
Photosensitivity
Disturbed concentration
Orthostatic hypotension
Bone marrow depress
Urinary retention
ANTI-DEPRESSANTS: Tricyclics

Amitriptyline (Elavil); Imipramine (Tofranil)

NC
NC: Therapeutic effect in 1-3 wks; maximum response in 6-9 wks;
May be administered in daily dose or at NIGHT to promote sleep & decrease s/e during the day;
Orthostatic hypotension precautions;
Instruct pt that s/e will decrease over time;
Sugarless lozenges for dry mouth;
Do not abruptly stop taking med* (H/A, vertigo, nightmares, malaise, wt change)
Avoid alcohol, sleep-inducing drugs, OTC drugs**;
Avoid exposure to sunlight*, wear sunscreen;
Older adults: strong anticholinergic & sedation effects;
Monitor for suicide;
Monitor VS
ANTI-DEPRESSANTS: Heterocyclics

Bupropion (Wellbutrin, Zyban); Trazodone (Desyrel)

Actions & indications
A: Does not inhibit MAO; has some anticholinergic & sedative effects; alters effects of serotonin on CNS

I: Tx of depression & smoking cessation**
ANTI-DEPRESSANTS: Heterocyclics

Bupropion (Wellbutrin, Zyban) - S/E

Trazodone (Desyrel) - S/E

Nursing considerations for both
Bupropion (Wellbutrin, Zyban) s/e: agitation & insomnia**

Vs

Trazodone (Desyrel) s/e: sedation, orthostatic hypotension**

NC: May require gradual reduction b4 stopping; Avoid use w/ alcohol, other CNS depressants for up to 1 wk after end of therapy**
ANTI-DEPRESSANTS:

Herbals: St. John's Wort

S/E & NC
S/E: Dizziness, HTN, allergic skin rxn, phototoxicity

NC: Avoid use of St. John's wort & MAOI w/n 2 wks of each other; Do not use alcohol; Contraind in prego; Avoid exposure to sun & use sunscreen; D/c 1-2 wks b4 surgery
ANTI-DEPRESSANTS:

General Herbal Interactions include:
St. John's wort - interacts w/ SSRIs; do not take w/n 2 wks of MAOI
Ginseng may potentiate MAOIs;
Avoid Ma huang or ephedra w/ MAOI;
Kava should not be combined w/ benzos or opioids d/t increased sedation;
Increase use of Brewer's yeast w/ MAOIs can INCrease BP
ANTI-DIABETIC AGENTS/INSULIN:

General Action, Indications, S/E,
A: Reduces bl glucose lvls by increasing glucose transport across cell membranes; enhances conversion of glucose to glycogen

I: Type 1 diabetes; type 2 diabetes not responding to PO hypoglycemic agents; gestation diabetes not responding to diet

S/E: Hypoglycemia*
ANTI-DIABETIC AGENTS/INSULIN:

NC & Herbal interactions
NC: Teach pt. to rotate sites to prevent lipohypertrophy, fibro fatty masses at inj sites; do not inject into these masses; Only regular insulin can be given IV; all can be given SQ

Herbal interactions: Bee pollen, ginkgo biloba, glucosamine may increase bl glucose;
Basil, bay leaf, chromium, echinacea, garlic, ginseng may DECrease blood glucose
ANTI-DIABETIC AGENTS/INSULIN:

Rapid-acting include:
Lispro (Humalog)
Aspart (Novolog)

often given as a combo
ANTI-DIABETIC AGENTS/INSULIN:

Rapid-acting: Lispro & Aspart

Onset of action?
Peak?
Duration?
Onset: Lispro (5-15 min); Aspart (5-15 min)

Peak: Lispro (1 h); Aspart (40-50 min)

Duration of Action: Lispro (3 h); Aspart (4-6 h)
ANTI-DIABETIC AGENTS/INSULIN:

Rapid-acting: Lispro & Aspart

Time of adverse rxn?
Characteristics?
Time of adverse rxn:
Midmorning: trembling, weakness

Characteristics: Pt should eat w/n 5-15 min after inj; also used in INSULIN PUMPs.
ANTI-DIABETIC AGENTS/INSULIN:

Short-acting include:
Regular (Humulin R, Novolin R, Iletin II Regular)
ANTI-DIABETIC AGENTS/INSULIN:

Short-acting: Regular (Humulin R, Novolin R)

Onset of action?
Peak?
Duration?
Onset: 30-60 min
Peak: 2-3 h
Duration: 4-6 h
ANTI-DIABETIC AGENTS/INSULIN:

Short-acting: Regular

Time of adverse rxn?
Characteristics?
Time of adverse rxn: midmorning, midafternoon: weakness, fatigue

Charct: Clear soln; given 20-30 min b4 meal; can be alone or W/ other insulins
ANTI-DIABETIC AGENTS/INSULIN:

Intermediate-acting include:
Isophane (NPH)
ANTI-DIABETIC AGENTS/INSULIN:

Intermediate: Isophane (NPH)
Onset of action?
Peak?
Duration?
Onset: 2-4 h
Peak: 6-12 h*
Duration: 16-20 h
ANTI-DIABETIC AGENTS/INSULIN:

Intermediate: Isophane (NPH)

Time of adverse rxn?
Characteristics?
Time of adverse rxn: If given in AM early evening: weakness, fatigue

Characteristics: White & cloudy soln; can be given after meals
ANTI-DIABETIC AGENTS/INSULIN:

Very long-acting include:
Glargine (Lantus)
ANTI-DIABETIC AGENTS/INSULIN:

Very-long acting: Glargine (Lantus)

Onset of action?
Peak?
Duration?
O: 1 h
P: Continuous (no peak)
D: 24 h
ANTI-DIABETIC AGENTS/INSULIN:

Very-long acting: Glargine (Lantus)

Time of adverse rxn?
CHaracteristics?
Time of adverse: N/A

Charc: Maintains bl glucose lvls regardless of meals; cannot be mixed w/ other insulins***; given @ bedtime
ANTI-DIABETIC AGENTS/INSULIN:

Very-long acting: Glargine (Lantus)

Onset of action?
Peak?
Duration?
O: 1 h
P: Continuous (no peak)
D: 24 h
ANTI-DIABETIC AGENTS/INSULIN:

Very-long acting: Glargine (Lantus)

Time of adverse rxn?
CHaracteristics?
Time of adverse: N/A

Charc: Maintains bl glucose lvls regardless of meals; cannot be mixed w/ other insulins***; given @ bedtime
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Sulfonyureas include:
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Micronase)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Sulfonyureas: Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Micronase)

S/E & NC
S/E: GI symptoms & dermatologic rxns

NC: Only used if some pancreas beta-cell fx; Stimulates release of insulin from pancreas; Many drugs can potentiate or interfere w/ actions; Take w/ food if GI upset occurs
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Biguanides include:
Metformin (Glucophage)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Biguanides: Metformin (Glucophage)

S/E & NC
S/E: Nausea; Diarrhea; Abdominal discomfort

NC: No effect on pancreatic beta cells; decreases glucose production by liver; Not given if renal impairment; Can cause lactic acidosis; Avoid alcohol; Do not give w/ alpha-glucodiase inhibitors
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Alpha glucosidase inhibitors include:
Acarbose (Precose)
Miglitol (Glyset)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Alpha glucosidase inhibitors: Acarbose (Precose); Miglitol (Glyset)

S/E & NC
S/E: Abd discomfort; diarrhea - flatulence

NC: Delays digestion of carbs; must be taken immediately b4 a meal**; Can be taken alone or w/ other agents
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Thiazolidinediones include:
Rosiglitazone (Avandia)
Pioglitazone (Actos)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Thiazolidinediones: Rosiglitazone (Avandia)
Pioglitazone (Actos)

S/E & NC
S/E: INfection; H/A; Pain; Rare cases of liver failure

NC: Decreases insulin resistance & inhibits gluconeogenesis; Regularly scheduled liver-function studies; Can cause resumption of ovulation in perimenopause
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Meglitinides include:
Repaglinide (Prandin)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Meglitinides: Repaglinide (Prandin)

S/E & NC
S/E: Hypoglycemia; GI disturbances; URIs; back pain; H/A

NC: INcreases pancreatic insulin release; Med should NOT be taken if meal skipped
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Gliptins include:
Sitagliptin (Januvia)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Gliptins: Sitagliptin (Januvia)

S/E & NC
S/E: Upper resp infections; hypoglycemia

NC: Enhances action of incretin hormones
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Incretin mimetics include:
Exanatide (Byetta)
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

Incretin mimetics: Exanatide (Byetta)

S/E & NC
S/E: GI upset; hypoglycemia; pancreatitis

NC: interacts w/ many meds; admin 1 h b4 meals
ANTI-DIABETIC MEDS: Oral hypoglycemics agents

General Indications, NC, & Herbal interactions
Ind: Type 2 DM

NC: Monitor serum glucose lvls; Avoid alcohol, aspirin, sulfonamides, oral birth control pills; Teaching for dz: dietary control, symptoms of hypoglycemia & hyperglycemia; Good skin care

Herbal interactions: Bee pollen, ginkgo biloba, glucosamine may increase blood glucose; Basil, bay leaf, chromium, echinacea, garlic, ginseng may decrease blood glucose
ANTI-Hypoglycemics:

include
Glucagon
ANTI-Hypoglycemics:

Glucagon: Action, indications, S/E & NC
A: Hormone produced by alpha cells of the pancreas to simulate the liver to change glycogen to glucose

I: Acute management of severe hypoglycemia

S/E: Hypotension (Circulation)*; Bronchospasm* (respiratory); dizziness

NC: May repeat in 15 mins if needed; IV glucose must be given if pt fails to respond; Arouse pts from coma as quickly as possible & give carbs PO to prevent 2ndary hypoglycemic rxns
ANTI-DAIRRHEAL:

Bismuth subsalicyclate (Pepto-Bismol, Kaopectate)

S/E?
S/E: Darkening of stools & tongue constipation ( from too much slowing of GI tract)
ANTI-DAIRRHEAL:

Bismuth subsalicyclate (Pepto-Bismol, Kaopectate)

Nursing considerations?
NC: Give 2 h b4 or 3 h after other meds* to prevent impaired absorption;
Encourage fluids*;
Take after each loose stool until diarrhea controlled;
Notify physician if diarrhea not controlled in 48 h;
Absorbs irritants & soothes intestinal muscle;
Do not admin for more than 2 days in presence of fever or in pts < 3 yo.;
Monitor for salicylate toxicity; monitor for urinary retention;
Use cautiously if already taking aspirin;
Avoid use b4 x-rays (is radiopaque);
Do not use w/ Abd pain!
ANTI-DAIRRHEAL:

Diphenoxylate hydrochloride & Atropine sulfate (Lomotil)

S/E
S/E:
Sedation
Dizziness
Tachycardia
Dry mouth
Paralytic ileus
ANTI-DAIRRHEAL:

Diphenoxylate hydrochloride & Atropine sulfate (Lomotil)

NC?
NC: Onset 45-60 min.;
Monitor F&E
INcreases intestinal tone & decreases peristalsis
May potentiate action of barbiturates, depressants**
ANTI-DAIRRHEAL:

Ioperamide (Imodium)

S/E?
S/E: Drowsiness
Constipation
ANTI-DAIRRHEAL:

Ioperamide (Imodium)

NC?
NC: Monitor children closely for CNS effects
ANTI-DAIRRHEAL:

Optium alkaloids (Paregoric)

S/E
S/E: Narcotic dependence, nausea
ANTI-DAIRRHEAL:

Optium alkaloids (Paregoric)

NC?
NC: Acts on smooth muscle to increase tone;
Admin w/ glass of water
D/c as soon as stools are controlled
ANTI-DAIRRHEAL:

General Action; indications; S/E & NC
A: Absorbs water, gas, toxins, irritants, & nutrients in bowel; slows peristalsis; increases tone of smooth muscles & sphincters

Ind: diarrhea

S/E: Constipation, fecal impaction; Anticholinergic effects

NC: Not used w/ abd pain of unknown origin; Monitor for urinary retention
ANTIEMETIC:

Trimethobenzamide HCl (Tigan)

S/E & NC?
S/E: Drowsiness; H/A

NC: Give IM deep into upper outer quad of gluteal muscle to reduce pain & irritation
ANTIEMETIC:

Prochlorperazine diamaleate (Compazine)

S/E & NC?
S/E: Drowsiness; orthostatic hypotension; Diplopia, photosensitivity

NC: Check CBC & liver funct w/ prolonged use;
Wear protective clothing when exposed to sunlight
ANTIEMETIC:

Ondansetron (Zofran)

S/E & NC?
S/E: H/A, sedation; Diarrhea, constipation; Transient elevations in liver enzymes

NC: New class of antiemetics-serotonin receptor antagonist;
Admin 30 min prior to chemotherapy**
ANTIEMETIC:

Thiethylperazine maleate (Torecan)

S/E & NC?
S/E: Tansient leukopenia; EPS*; orthostatic hypotension; blurred vision, photosensitivity; dry mouth; constipation, urine retention

NC: Give deep IM; Stay in bed for 1 h after receiving drug; Wear protective clothing when exposed to sunlight
ANTIEMETIC:

Metoclopramide (Reglan)

S/E & NC?
S/E: Restlessness, anxiety, drowsiness*, EPS**, Dystonic rxns**

NC: Monitor BP; Avoid activities requiring mental alertness; Take B4 Meals; used w/ tube feeding to decrease residual & risk of aspiration; Admin 30 min prior to chemotherapy
ANTIEMETIC:

Meclizine (Antivert, Bonine)

S/E & NC?
S/E: Drowsiness, dry mouth; blurred vision; excitation, restlessness

NC: Contraind w/ glaucoma; Avoid activities requiring mental alertness
ANTIEMETIC:

Dimenhydrinate (Dramamine)

S/E & NC?
S/E: Drowsiness; palpitations, hypotension; blurred vision

NC: Avoid activities requiring mental alertness
ANTIEMETIC:

Promethazine (Phenergan)

S/E & NC?
S/E: Drowsiness; dizziness; constipation; urinary retention; dry mouth

NC: If used for motion sickness, take 1/2 to 1 hr b4 traveling; Avoid activities requiring alertness; avoid alcohol, other CNS depressants
ANTIEMETIC:

Droperidol (Inapsine)

S/E & NC?
S/E: Seizures; arrhythmias; hypotension; tachycardia

NC: Often used either IV or IM in ambulatory care settings; observe for EPS (dystonia, extended neck, flexed arms, tremor, restlessness, hyperactivity, anxiety), which can be reversed w/ anticholinergics
ANTIEMETIC:

General Actions, indications
A: Blocks effect of dopamine in chemoreceptor trigger zone; increases GI motility

I: N/V caused by surgery, chemotherapy, radiation sickness, uremia
ANTIEMETIC:

General S/E, NC & herbal interactions
S/E: Drowsiness, sedation; Anticholinergic effects

NC: When used for viral infections may cause Reye's syndrome in clients < 21 yo**;
Phenothiazine meds are also used as antiemetics

Herbals: Ginger- used to tx minor heart burn, n/v; may increase risk of bleeding if taken w/ anticoag., antiplat, thrombolytic med; instruct to stop med if easily bruised or other sings of bleeding noted, report to physician; not approved for morning sickness during prego
ANTI-FUNGALS:

Amphotericin B (Fungizone)

S/E
IV: nicknamed "Amphoterrible"
GI upset
Hypokalemia - induced muscle pain
CNS disturbances in vision, heaing;
Peripheral neuritis;
Seizures;
Hematological, renal, cardiac, hepatic abnormalities;
Skin irritation & thrombosis if IV infiltrates
ANTI-FUNGALS:

Amphotericin B (Fungizone)

NC?
NC:
Refridgerate med & protect from sunlight;
Monitor VS; report febrile rxn or any change in function, esp. nervous system dysfunction;
Check for HYPOkalemia;
Meticulous care & observation of injection site
ANTI-FUNGALS:

Nystatin (Mycostatin)

S/E & NC
S/E: Mild GI distress; Hypersensitivity

NC: D/c if redness, swelling, irritation occurs; Instruct pt. in good oral, vaginal skin hygiene
ANTI-FUNGALS:

Flucanozal (Diflucan)

S/E & NC
S/E: N/V, diarrhea, elevated liver enzymes

NC: Drug excreted unchanged by kidneys; dosage reduced if creatine clearance is altered d/t renal failure; Admin after hemodialysis
ANTI-FUNGALS:

Metronidazole (Flagyl)

S/E & NC?
S/E: H/A, vaginitis, nausea; flu-like symptoms (systemic use)

NC: Reduce dosage heaptic dz; Monitor CBC, LFTs, cultures; Give tab w/ FOOD or MILK*
ANTI-FUNGALS:

General Action, Indications, S/E & NC
A: Impairs cell membrane of fungus, causing increased permeability

Ind: Systemic fungal infections (e.g. candidiasis, oral thrush, histoplasmosis)

S/E: Hepatotoxicity**; Thrombocytopenia*; Leukopenia*; Pruritus*

NC: Admin W/ FOOD to decrease GI upset; Small, frequent meals; Check hepatic fx; teach client to take full course of med, may be prescribed for prolonged period
ANTI-GOUT:

Colchicine (Colsalide)

S/E & NC
S/E: GI upset; agranulocytosis*; peripheral neuritis

NC: Analgesic, anti-inflammatory; Give W/ MEALS; Check CBC, I&O; For acute gout in combo w/ NSAIDs
ANTI-GOUT:

Probenecid (Benemid)

S/E & NC
S/E: Nausea, constipation; Skin rash

NC: For chronic gout*; Reduces uric acid; Check BUN, renal fx tests; Encourage Fluids*; Give w/ MILK, FOOD, ANTACIDs; Alkaline urine helps prevent renal stones
ANTI-GOUT:

Allopurinol (Zyloprim)

S/E & NC?
S/E: GI upset; H/A, Dizziness, drowsiness

NC: Blocks formation of uric acid; Encourage fluids; Check I&Os; Check CBC & renal fx tests; Give w/ meals; Alkaline urine helps prevent renal stones; Avoid ASA b/c it inactivates drug
ANTI-GOUT:

General Action, Indications
A: Decreases production & reabsorption of uric acid

Ind: Gout; uric acid stone formation

S/E: Aplastic anemia; agranulocytosis*; Renal calculi**; GI irritation*

NC: Monitor for renal calculi*; Take w/ Milk, Food, Antacids ***;
Fluids Fluids Fluids! 1500 cc at least/day to 3000 cc/day
ANTI-HISTAMINES:

General Action, Ind
A: Blocks effects of histamine at peripheral H1 receptor sites; anticholinergic, antipruritic effects

Ind: Allergic rhinitis; Allergic rxns; Chronic idiopathic urticaria
ANTI-HISTAMINES:

S/E, NC?
S/E: Depression; nightmares; sedation* (think safety measures); dry mouth; GI upset; Bronchospasm* (assess resp.); Alopecia

NC: Admin w/ FOOD**; good mouth care, sugarless lozenges for dry mouth; Good skin care (use sunscreen); Use caution when performing tasks requiring alertness (e.g., driving car); Avoid alcohol* (d/t systemic effect of med); Assess respirations!
ANTI-HISTAMINES:

Chlorpheniramine maleate (Chlor-Trimeton)

S/E & NC
S/E: Drowsiness*, dry mouth

NC: Most effective if taken b4 onset of symptoms
ANTI-HISTAMINES:

Diphenhydramine HCl (Benadryl)

S/E & NC?
S/E: Drowsiness*, Nausea, dry mouth; Photosensitivity

NC: Don't combine w/ alcoholic bev; Give w/ FOOD**; Use sunscreen; Older adults: greater risk of confusion & sedation
ANTI-HISTAMINES:

Promethazine HCl (Phenergan)
(also an anti-emetic)

S/E & NC
S/E: Agranulocytosis; Drowsiness*; dry mouth; Photosensitivity

NC: Give w/ FOOD*; Use sunscreen
ANTI-HISTAMINES:

Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)

S/E & NC
S/E: Drowsiness*

NC: reduce dose or give every other day for pts w/ renal or hepatic dysfunction
ANTI-LIPEMIC AGENTS: Bile acid sequestrants

Cholestyramine (Questran); Colestipol (Colestid); HMG-COA reductase inhibitors; Folic acid derivaties; Nicotinic acid

S/E
S/E: Constipation*; Rash; Fat-soluble vitamin deficiency*; Abd pain & bloating
ANTI-LIPEMIC AGENTS: Bile acid sequestrants

Cholestyramine (Questran); Colestipol (Colestid); HMG-COA reductase inhibitors; Folic acid derivaties; Nicotinic acid

NC?
NC: INcreases loss of bile acid in feces; decreases cholesterol; Sprinkle powder on noncarbonated bev or wet food, let stand 2 min, then stir slowly; Admin 1 h b4 or 4-6 h after other meals to avoid blocking absorption; Instruct pt. to report constipation immediately
ANTI-LIPEMIC AGENTS:

General Action, Indications,
A: INhibits cholesterol & triglyceride synthesis; decreases serum cholesterol & LDLs

I: Elevated total & LDL chol.; Primary hypercholesterolemia; Reduce incidence of cardiovascular dz
ANTI-LIPEMIC AGENTS:

S/E, NC; Herbals used to lower cholesterol
S/E: Varies w/ med

NC: Medications should be used w/ dietary measures, physical activity, & cessation of tobacco use*; Lipids should be monitored every 6 wk w/ normal, then every 4-6 mo

Herbals: Flax or flax seed - decreases the absorption of other meds; Garlic - increases effects of anticoag.; increases the hypoglycemic effects of insulin; Green tea - produces a stimulant effect w/ the tea contains caffeine ;
Soy
ANTI-LIPEMIC AGENTS: HMG-CoA reductase Inhibitors (statins)

Lovostatin (Mevacor), Pravastatin (Pravachol); Simvastatin (Zocor); Atorvastatin (Lipitor); Fluvastatin (Lescol); Rosuvastatin (Crestor)

S/E & NC
S/E: Myopathy; Increased liver enzyme lvls

NC: Decreases LDL cholesterol lvls; causes peripheral vasodilation; Take W/ FOOD*; absorption is reduced by 30% on an empty stomach; avoid alcohol**; Contact clinician if unexplained muscle pain, esp w/ fever or malaise; Take at NIGHT or 30 min AC**; Give w/ caution w/ decreased liver fx.
ANTI-LIPEMIC AGENTS: Nicotinic Acid:

Niacin (Niacor, Niaspan)

S/E & NC
S/E: Flushing; hyperglycemia; Gout ; Upper GI distress; Liver damage

NC: Decreases total chol, LDL, triglycerides, increases HDL; FLushing will occur several h after med is taken, will decrease over 2 wk; Also used for pellagra & peripheral vascular dz; Avoid alcohol**
ANTI-LIPEMIC AGENTS: Folic Acid derivatives

Fenofibrate (Tricor); Gemfibrozil (Lopid)

S/E & NC?
S/E: Abd pain; increased risk of gallbladder dz; Myalgia & swollen joints

NC: Decreases total chol, VLDLs & triglycerides; Admin b4 meals; Instruct clients to notify HCP if muscle pain occurs.
ANTI-HTNSIVES: ACE inhibitors

Include:
Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Zestril, Prinivil)
Benazepril (Lotensin)
Fosinopril (Monopril)
Quinapril (Accupril)
Ramipril (Altace)
ANTI-HTNSIVES: ACE inhibitors

General Actions, Indications?
A: Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor); causes decreased BP, decreased aldosterone secretion, sodium & fluid loss

Ind: HTN & CHF
ANTI-HTNSIVES: ACE inhibitors

S/E & NC?
S/E: Gastric irritation*, peptic ulcer, orthostatic hypotension; Tachycardia; Myocardial Infarct; Proteinuria; Rash, pruritis; Persistent dry nonproductive cough**; Peripheral edema; Dizziness*

NC: Decreased absorption if taken w/ food - give 1 h ac or 2 h pc**; Small, freq. meals; change position slowly; monitor VS; May cause lethargy but is normal effect; Can be used w/ thiazide diuretics*

UNIQUE: ACE - think Affects the Arteries by Vasodilating!
ANTI-HTNSIVES: Beta-Adrenergic Blockers

Examples include:
Atenolol (Tenormin)
Nadolol (Corgard)
Propranolol (Inderal)
Metoprolol (Lopressor)
Acebutoolol (Sectral)
Carvedilol (Coreg)
Pindolol (Visken)
ANTI-HTNSIVES: Beta-Adrenergic Blockers

Actions, Indications
A: Blocks beta-adrenergic receptors in heart; decreases excitability of heart; reduces cardiac workload & oxygen consumption; decreases release of renin; lowers BP by reducing CNS stimuli

Ind: HTN (used w/ diuretics); Angina; SVT; Prevent recurrent MI; Migraine H/A (propranolol); Stage fright (propranolol); Heart failure
ANTI-HTNSIVES: Beta-Adrenergic Blockers

S/E
S/E: gastric pain; bradycardia/tachycardia; hypotension*; acute severe HF; cardiac dysrhythmias; impotence; decreased exercise tolerance; nightmares, depression; dizziness; bronchospasm** (nonselective beta blockers)
ANTI-HTNSIVES: Beta-Adrenergic Blockers

NC
NC: Do not d/c abruptly, taper gradually over 2 wks or else result in rebound HTN!;
Take W/ MEALS**; provide rest periods;
For diabetic pts, masks normal signs of hypoglycemia (sweating, tachycardia)***; monitor blood glucose;
Meds have antianginal & antiarrhythmic actions;
Not 1st line drug for African Americans
ANTI-HTNSIVES: Calcium-channel blockers

Examples?
Nifedipine (Procardia)
Verapamil (Calan)
Diltiazem (Cardizem)
Amlopidine (Norvasc)
Felodipine (Plendil)
ANTI-HTNSIVES: Calcium-channel blockers

Actions & Indications
A: Inhibits movement of calcium ions across membrane of cardiac & arterial muscle cells; results in slowed impulse conduction, depression of myocardial contractility, dilation of coronary arteries; decreases cardiac workload & energy consumption, increases oxygenation of myocardial cells

Ind: Angina*; HTN; dysrhythmias; interstitial cystitis*; migraines.
ANTI-HTNSIVES: Calcium-channel blockers

S/E
Dizziness; orthostatic hypotension*; angioedema*/ peripheral edema; renal failure; H/A; nervousness; angina; bradycardia; AV block; flushing, rash; impotence
ANTI-HTNSIVES: Calcium-channel blockers

NC:
Monitor VS
Do not chew or divide sustained-release tablets
Meds also have antianginal actions
Contraind in heart block
Contact HCP if BP < 90/60
INstruct client to avoid GRAPEFRUIT JUICE (verapamil)**
Monitor for signs of HF - edema facial swelling & SOB