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200 Cards in this Set
- Front
- Back
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Requires close monitoring because of a narrow therapeutic range
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Coumadin
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Requires frequent dose adjustments because of individual dose response
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Coumadin
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High potential for interactions involving food and drugs
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Coumadin
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Requirements can lead to ineffective therapy or toxicity
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Coumadin
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Slow onset, full effect is not seen for a week
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Coumadin
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Usually given in the evening following careful attention to lab results
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Coumadin
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PR (1.5 to 2.5 x control)
INR (2.0 to 3.0 OR 3.0 to 4.5) |
Coumadin
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Therapy duration can range from several months to lifelong
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Coumadin
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Increased effects seen with chondroitin and garlic
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Coumadin
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There is an increased bleeding risk seen with cayenne, feverfew garlic, ginger, and Gingko biloba
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Coumadin
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Decreased effectiveness of the medication is seen with the use of green tea, ginseng, and goldenseal
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Coumadin
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Foods high in vitamin K should be avoided or used sparingly during therapy
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Coumadin
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The use of alcohol should be restricted if not avoided to maintain effective drug therapy
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Coumadin
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Referral to a dietitian is always indicated
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Coumadin
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Bleeding is the major adverse effect and is usually seen at higher dosage levels
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Coumadin
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Monitor for GI side effects
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Coumadin
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If client experiences adverse effects or toxicity, withhold dose
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Coumadin
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Antidote is phytonadione (Vitamin K)
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Coumadin
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Can be administered IV or sub cut
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Heparin
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Activated partial thromboplastin time (APTT)
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Heparin
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Infusion pump
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Heparin, Meds for hypertensive emergencies
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It should be infused through a dedicated IV line b/c of its incompatibility profile
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Heparin
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Antidote: protamine sulfate
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Heparin
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do not give antidote more than 50 mg in 10 minutes
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Heparin
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Significant drug interactions: ASA, NSAIDs, and antiplatelet agents can potentiate the effect
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Heparin
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Allergy to pork products may indicate a potential hypersensitivity
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Heparin
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Obtain daily weight for client on weight-based protocol
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Heparin
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normal adult dosage range of 20,000 to 40,000 units/24 hr
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Heparin
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Rotate injection location
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Heparin
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Not to be given in children b/c of association with Reye's syndrome
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ASA
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Use of these should be stopped for at least 7 days prior to a planned surgery
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Antiplatelet meds
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children, pregnant women, and lactating women should not take these
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Antiplatelet meds
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used in pregnancy only when benefit to mother outweighs risk to fetus
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Antiplatelet meds
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lactating women should be informed of risks to infant if this therapy is considered
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Antiplatelet meds
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Instruct client to wear Medic-alert bracelet
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Antiplatelet meds
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adequate fluid intake
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Antiplatelet meds
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can lead to iron deficiency anemia in female clients
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ASA
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Continuous monitoring of BP, mental status, and response to therapy should be documented
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Thrombolytics
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report any signs of chest pain, dizziness, headache or evidence of bleeding to health care provider
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Thrombolytics
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Place client on a cardiac monitor during administration
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Thrombolytics
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The antidote is aminocaproic acid (Amicar)
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Thrombolytics
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IM route for medication administration is contraindicated
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Thrombolytics
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Major side effect: Hemorrhage
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Thrombolytics
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Monitor client for vs changes, as there may be variations in pulse, BP and temp
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Thrombolytics
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Watch for signs of shock
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Thrombolytics
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Maintain adequate IV site for med admin; observe closely for s/s of infiltration
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Thrombolytics
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If client is found to be bleeding, med should be stopped; plasma or RBCs may be ordered
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Thrombolytics
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Monitor for dysrhythmias
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Thrombolytics
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Support client and family during acute-care management period
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Thrombolytics
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Administered via oral or IV route; close continuous monitoring of the client is required
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Systemic hemostatics (aminocaporoic acid and tranexamic acid)
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Contraindicated with coagulapathy (DIC), postpartum bleeding, upper urinary tract bleeding, or new burns
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Systemic hemostatics (aminocaproic acid)
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Food interactions: dietary sources of vitamin K
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Systemic hemostatics
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Monitor baseline labs r/t renal and liver function
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Systemic hemostatics
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Monitor PT levels and response to therapy
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Systemic hemostatics (vitamin K)
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Monitor coagulation profile for hypercoagulation
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Systemic hemostatics
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Rotate injection sites; assess for signs of local irritation
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Systemic hemostatics (vitamin K)
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Risk for volume overload
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Systemic hemostatics
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Use of dietary yogurt or buttermilk can help restore normal intestinal flora
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Systemic hemostatics
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Report difficulty urinating or reddish-brown urine while taking it
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Systemic hemostatics (aminocaproic acid)
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Report chest pain, arom or leg pain, or difficulty breathing
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Systemic hemostatics
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If client develops an allergic reaction to the product or if a reaction is anticipated, an antihistamine such as diphenhydramine (Benadryl) may be given
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Local absorbable hemostatic agents
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Switching from one material to another may facilitate a better response
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Local absorbable hemostatic agents
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Proper reconstitution and administration of the medication is required according to protocol
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DDAVP
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Document baseline vs during first 15 minutes of therapy and then according to protocol to monitor
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DDAVP
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Clients with defined factor deficiencies and their families will need anticipatory support and guidance during a lifetime of therapy
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DDAVP
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Clients who have hereditary factor antithrombin III deficiency ... are at risk for thrombosis
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DDAVP
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genetic transmission issues
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DDAVP
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Z-track admin required
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Iron salts
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Administered by straw to avoid discoloration of tooth enamel
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Iron salts (with elixir)
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Drug interactions: antacids, antibiotics, thyroid drugs
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Iron salts
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Decreased effect of tetracycline and penicillamine
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Iron salts
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Vitamin C can increase the absorption of oral med
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Iron salts
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Foods high in phytates (cereals) can cause decreased absorption
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Iron salts
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Not to be taken with milk
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Iron salts
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Lab studies: reticulocyte count
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Iron salts
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Dark and tarry stools
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Iron salts
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Give oral med on full stomach to minimize GI upset
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Iron salts
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Clients with GI surgeries that result in removal or anastomosis of the stomach and end the release of intrinsic factor will require these injections on a lifelong basis
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Vitamin B12 (Cyanocobalamin)
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Must be administered parenterally in clients who cannot manufacture intrinsic factor
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Vitamin B12 (Cyanocobalamin)
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Therapeutic level: Schilling test >30%
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Vitamin B12 (Cyanocobalamin)
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Rotate sites and use Z-track
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Vitamin B12 (Cyanocobalamin)
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protect from light
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Vitamin B12 (Cyanocobalamin)
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do not mix, give as separate injection
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Vitamin B12 (Cyanocobalamin)
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pernicious anemia
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Vitamin B12 (Cyanocobalamin)
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Food high in this: liver, kidney, fish, milk
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Vitamin B12 (Cyanocobalamin)
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Alcohol effects absorption
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Vitamin B12 (Cyanocobalamin)
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signs of deficiency: numbness and tingling in lower extremities, weakness, fatigue, anorexia, loss of taste, diarrhea, memory loss, and mood changes
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Vitamin B12 (Cyanocobalamin)
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If diarrhea significant, change in drug dosage may be required
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Vitamin B12 (Cyanocobalamin)
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Deficiency: neural tube defects in fetus
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Folic acid
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Deficiency: megaloblastic macrocytic anemia
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Folic acid
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Injections may contain benzyl alcohol
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Folic acid
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Injections not to be admin'd to neonates
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Folic acid
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Foods include: green leafy vegetables, yellow fruits and veg's, yeast, meats
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Folic acid
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Med is refrigerated, let warm to room temp before admin
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Epoetin alfa (Epogen, Procrit)
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Do not use med that is discolored or contains particulate matter
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Epoetin alfa (Epogen, Procrit)
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Do not shake, will lead to inactivation
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Epoetin alfa (Epogen, Procrit)
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no preservative, so must discard unused portion
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Epoetin alfa (Epogen, Procrit)
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Hematocrit indicates response (usu. 30-36%)
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Epoetin alfa (Epogen, Procrit)
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possible hypertension and seizures
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Epoetin alfa (Epogen, Procrit)
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Monitor for risk of thrombotic events
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Epoetin alfa (Epogen, Procrit)
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Clients on dialysis may requre adjusted dosages
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Epoetin alfa (Epogen, Procrit)
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Monitor iron stores
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Epoetin alfa (Epogen, Procrit)
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Premedicate if necessary with analgesics if bone pain is present or client becomes febrile
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Epoetin alfa (Epogen, Procrit)
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Do not drive or be involved in other hazardous activities during first 90 days of therapy
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Epoetin alfa (Epogen, Procrit)
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If no response in 3 months, notify prescriber
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Fibric acid derivatives
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Monitor closely for right upper quadrant (RUQ) pain or vomiting
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Fibric acid derivatives
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Restrict carb and alcohol intake
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Fibric acid derivatives
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Notify prescriber if acute appendicitis or gallbladder disease occur
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Fibric acid derivatives
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Report immediately unexplained bleeding
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Fibric acid derivatives
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Take early in the day to avoid nocturia
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Loop diuretics, Thiazide diuretics, Potassium-sparing diuretics
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Administer slowly as hearing loss can occur if injected rapidly
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Loop diuretics (furosemide, Lasix IV)
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Interaction with aminoglycosides causing ototoxicity
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Loop diuretics
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Monitor for electrolyte imbalance especially sodium and potassium
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Loop diuretics
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Monitor vs for s/s hypotension and tachycardia
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Loop diuretics
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Daily weights
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All diuretics
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I and O
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All diuretics
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Restrict Na intake; do not use salt substitutes if taking potassium supplement
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Loop diuretics, Thiazide diuretics
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Change position slowly to avoid orthostatic hypotension
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Loop diuretics, Thiazide diuretics
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Report ringing in ears immediately
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Loop diuretics
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Hypersensitivity to sulfonamide derivatives
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Thiazide diuretics
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May alter serum electrolytes, esp. lowering potassium
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Thiazide diuretics
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Electrolyte imbalance, impaired glucose tolerance, jaundice, muscle cramps, photosensitivity, impotence, and hyperuricemia
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Thiazide diuretics
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Dizziness, vertigo, headache, and weakness
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Thiazide diuretics
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Dehydration, orthostatic hypotension,nausea and vomiting, abdominal pain, diarrhea, constipation, and freq urination
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Thiazide diuretics
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Dermatitis and rash
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Thiazide diuretics
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Assess indicators of dehydration: thirst, poor skin turgor, coated tongue
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Thiazide diuretics
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Avoid salt substitutes
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Potassium-sparing diuretics
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Contraindicated with serum levels greater than 5.5 mEq/mL
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Potassium-sparing diuretics
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Contraindications: anuria, acute and chronic renal insufficiency, diabetic nephropathy, hypersensitivity, and impaired hepatic function
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Potassium-sparing diuretics
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May potentiate hypotensive effects of antihypertensives
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Potassium-sparing diuretics
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Increased risk of hyperkalemia with other like meds
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Potassium-sparing diuretics
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Monitor electrolytes (especially) potassium, creatinine, and BUN
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Potassium-sparing diuretics
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Adverse effects/toxicity: Hyperkalemia
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Potassium-sparing diuretics
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Monitor vs and I&O
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Potassium-sparing diuretics
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Monitor for nausea, diarrhea, abdominal cramps, and tachycardia followed by bradycardia
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Potassium-sparing diuretics
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Triamterene may turn the urine blue
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Potassium-sparing diuretics
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Contraindications: narrow angle or acute glaucoma
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Diamox
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Adverse effect/toxicity: Thrombocytopenia purpura, hemolytic anemia, leukopenia, pancytopenia, and agranulocytosis
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Diamox
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Do not take aspirin
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Diamox
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Be aware of and avoid high-sodium foods and beverages; eat food high in potassium instead
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Diamox
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Used to decrease intracranial or intraocular pressure
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Osmotic diuretics
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Mannitol crystallizes at low temperatures
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Osmotic diuretics
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Adverse effects/toxicity: Thrombophlebitis
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Osmotic diuretics
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Adverse effects/toxicity: CHF
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Osmotic diuretics
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Report immediately pain in chest or legs, shortness of breath, or apnea
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Osmotic diuretics
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Tablet form should be taken with full glass of water
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Potassium supplements
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Powder form should be mixed with 4 ounces of water or other liquid
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Potassium supplements
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Should be taken with meals to decrease GI irritation
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Potassium supplements
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Parenterally should be given slowly, even with central line
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Potassium supplements
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Contraindications: severe renal impairment with oliguria, anuria, or azotemia
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Potassium supplements
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Use with potassium-sparing diuretics, ACE inhibitors or salt substitutes can cause sever hyperkalemia
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Potassium supplements
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Food interactions: apple juice, grapefruit, banans, oranges, peaches, pears, raisins, broccoli, peas, tomatoes, eggplant, chicken, liver, turkey, salmon, beef, low-fat yogurt, milk, and chocolate milk
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Potassium supplements
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Adverse effects/toxicity: dysrhythmias or cardiac arrest
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Potassium supplements
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Adverse effects/toxicity: Respiratory paralysis
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Potassium supplements
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Monitor side effects such as weakness, feeling of heaviness in legs, confusion, hypotension
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Potassium supplements
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Should not be given immediately postoperatively until urine flow is established
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Potassium supplements
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Report diarrhea or vomiting b/c of increased risk for hypokalemia
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Potassium supplements
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Monitor stools for evidence of blood
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Potassium supplements
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May cause syncope within 30 minutes to 1 hour after first dose; effect is transient and may be diminished by giving at bedtime
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Alpha and alpha/beta blockers
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monitor apical pulse for increased risk of bradycardia; signs of hypoglycemia may be masked
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Beta-blockers
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Side effects: first dose syncope, headache, drowsiness, hypotension, palpitations, impotence, nasal congestion, n/v, tachycardia
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Alpha-blockers
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Side effects: fatigue, orthostatic hypotension, dizziness, n/v, diarrhea, bronchospasm, muscle spasm, transient scalp tingling, hyperglycemia, upper respiratory infections, impotence, and arthralgias
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Alpha/beta blockers
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Side effects: heart failure, agranulocytosis, bronchospasm
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Beta blockers
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Interactions: potassium-sparing diuretics or potassium supplements (hyperkalemia)
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ACE inhibitors
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Side effects: n/v, abdominal pain, constipation, persistent dry nonproductive cough, and dyspnea
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ACE inhibitors
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Adverse effects/toxicity: angioedema, leukopenia, agranulocytosis
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ACE inhibitors
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Take BP before giving dose and monitor regularly
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ACE inhibitors
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Report peripheral edema, signs of infection, facial swelling, loss of taste, or difficulty breathing
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ACE inhibitors
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Do not skip dose or stop taking drug; may cause serious rebound BP
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ACE inhibitors
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Notify provider if persistent, dry cough occurs
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ACE inhibitors
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Side effects: hypotension and dizziness, cough, GI upset, insomnia, nasal congestion or pharyngitis, myalgia/arthralgia, flu-like symptoms
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Angiotensin II antagonists
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Monitor client taking diuretics for additive hypotension
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Angiotensin II antagonists
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Notify prescriber immediately if pregnancy is suspected
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Angiotensin II antagonists
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Use nonhormonal birth control methods
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Angiotensin II antagonists
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Withhold medication if BP less than 90/60
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Calcium channel blockers
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Do not take with grapefruit, may increase drug level and adverse effects
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Calcium channel blockers
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Side effects: constipation (esp w/ oral and sustained-release forms)
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Calcium channel blockers
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Side effects: postural hypotension
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Calcium channel blockers
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Evaluate BP and ECG before initiation of treatment and monitor them closely during medication adjustment
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Calcium channel blockers
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Take radial pulse before each dose; report irregular pulse or pulse slower than base level
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Calcium channel blockers
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Increase renal blood flow directly
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Vasodilators
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Headache and palpitations may occur 2-4 hours after the first dose and should subside spontaneously
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Vasodilators
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Monitor BP and apical pulse regularly
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Vasodilators
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Headache, palpitations, and rapid pulse may occur but should be gone in about 10 days
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Vasodilators
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Side effects: bradycardia, orthostatic hypotension, aggravation of angina, edema
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Anti-adrenergic meds (Other antihypertensives)
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Transdermal systems are applied to dry, hairless areas on skin of chest or upper
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Anti-adrenergic meds (Other antihypertensives)
[Clonidine] |
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Restrict sodium if ordered and lost weight as needed; report weight gain of greater than 5 lb per week
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Anti-adrenergic meds (Other antihypertensives)
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Relieve dry mouth by sipping water or chewing sugarless gum
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Anti-adrenergic meds (Other antihypertensives)
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Do not drive care or perform hazardous activities if drug causes drowsiness
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Anti-adrenergic meds (Other antihypertensives)
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Do not administer solutions that have darkened or contain particle matter
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Meds for hypertensive emergencies
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Intravenous infusion titrated to BP
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Meds for hypertensive emergencies
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IV is given undiluted by rapid direct IV injection over 10-30 seconds
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Meds for hypertensive emergencies
[Diazoxide] |
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Client should be recumbent while receiving IV and should remain in bed for at least 30 minutes following administration
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Meds for hypertensive emergencies
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A diuretic should be prescribed to prevent CHF after administering med since it causes sodium and water retention
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Meds for hypertensive emergencies
[Diazoxide] |
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Side effects: dizziness, weakness, headache, malaise, flushing, palpitations, insomnia, paresthesia, arrhythmia, tachycardia, hypotension, angina, diaphoresis
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Meds for hypertensive emergencies
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Side effects: Sodium and water retention, visual disturbances, GI disturbances, azotemia, decreased urinary output, rash
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Meds for hypertensive emergencies
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Adverse effects/toxicity: Thrombocytopenia, increased intracranial pressure, thiocyanate toxicity, methemoglobinemia, cyanide toxicity
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Meds for hypertensive emergencies
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Monitor BP every 5 minutes for 15-30 minutes, then hourly until client is stable
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Meds for hypertensive emergencies
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Check thiocyanate levels every 72 hours
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Meds for hypertensive emergencies
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Monitor blood glucose levels, esp diabetic clients
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Meds for hypertensive emergencies
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