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104 Cards in this Set
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What do you need to know about meds you are giving ? (7)
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Medication Trade & Generic Names
Pharmaceutical & Therapeutic Classification Recommended Dosage Range & Route Indications, basic drug action, & therapeutic effect Why is your patient getting the drug? Nursing Implications including: Monitoring required before & after, potential drug/food interactions, contraindications, precautions Potential side effects, ADRs |
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What is the trade name for digoxin?
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Lanoxin and Digitek
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digoxin classifications?
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Therapeutic (Functional) antiarrhythmic, inotropic
Pharmacological (Chemical) – digitalis glycoside |
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digoxin route? (2)
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po or IV Note which for your pt.
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digoxin recommended dosage range? (3)
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Look at maintenance dose unless you are giving first dose
Loading dose at 4-8h intervals, then Maintenance dose daily 0.063-0.5mg/d tablets (0.125-0.25mg most common) 0.35-0.5mg/d gelcaps (Lanoxicaps bioavailability) |
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digoxin indications?
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Indicated for treatment of CHF, tachyarrythmias, Atrial fib & flutter, PAT
Note why your pt. is taking ! |
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digoxin actions?
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Increases force of myocardial contraction
Prolongs refractory period of AV node |
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digoxin therapeutic effects?
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Increases cardiac output (+ inotropic effect)
Slows HR (neg chronotropic effect) |
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digoxin contraindications?
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*hypersensitivity, uncontrolled ventricular arrhythmias, AV Block
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digoxin caution use?
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electrolyte abnormalities (increases toxicity), elderly, MI, renal impairment, pregnancy
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digoxin drug / food interactions?
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Any drugs that dec. K+ may increase risk of toxicity e.g. thiazides & loop diuretics, penicillins, ampho, corticosteroids, licorice
Beta blockers, other antiarrhythmics may bradycardia or risk of toxicity St. John’s Wort effect High fiber meal may absorption |
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digoxin nursing assessment?
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Check AP for full minute. Hold dose & notify Dr. if pulse <60 adult, <70 child, <90 infant because this med acts on the CNS, slows contractility and can cause bradycardia
Check labs – electrolytes (K, Mg, Ca), occ. renal & hepatic function because dig can because dig depletes K+ and it goes almost unchanged through the kidneys...renal impairment is a concern - looking for toxicity Monitor I & O, daily weights, lungs for crackles to look for fluid retention Don’t take antacids or antidiarrheals or eat high fiber meal within 2h of dig. because it decreases the GI absorption |
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digoxin has a narrow therapeutic index. What does this mean?
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The ratio between the toxic dose and the therapeutic dose of a drug, used as a measure of the relative safety of the drug for a particular treatment.
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What are you going to observe and teach patient for with digoxin?
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Abdominal pain, anorexia, N, V, visual disturbances, bradycardia, arrhythmias
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What should the nurse do if patient has sx of from digoxin?/
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contact the Dr. and depending on the symptom you will withhold the med until contacting the Dr.
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what is the therapeutic drug level for digoxin?
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0.5 - 2 ng/ml
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when should a labs be drawn when on digoxin?
when should digoxin level be drawn? |
4-10h after dose or right before next dose
can be 6 -8 hours after a dose but typically drawn immediately before a dose |
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what are the side effects of digoxin?
Be able to determine which are most significant. |
CNS: fatigue, HA, weakness
EENT: blurred or yellow vision CV: arrythmias, bradycardia, EKG changes GI: anorexia, N, V, diarrhea Endo: gynecomastia Hemat: thrombocytopenia |
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what is the generic name for Coumadin?
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warfarin
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what are the classifications for warfarin?
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Therapeutic (functional) – anticoagulants
Pharmacological (chemical) – coumarins |
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what are the routes for warfarin?
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po, IV (rarely used)
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what is the po dosage for warfarin?
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2.5-10mg/day x 2-4d, then adjust based on PT/INR
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what is the half life, peak & duration of warfarin?
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Half-life & peak is 0.5-3d
duration 2-5d |
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why is the half life, peak and duration important to someone who is having surgery or has a blood clot?
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because you want to maintain the peak therapeutic level for an individual with a blood clot and you do not want someone to have high levels of warfarin in their system prior to surgery for risk that they will bleed out
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what are the indications for warfarin?
Know why your patient is taking this med!! |
treatment or prophylaxis of venous thrombosis, embolization, or pulmonary emboli
atrial fib or other conditions prosthetic valve replacement Management of MI risk of death, recurrence |
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warfarin actions?
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Interferes with hepatic synthesis of Vit K dependent clotting factors
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warfarin therapeutic effects?
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Reduces risk of thromboembolitic events
“blood thinner” |
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warfarin contraindications?
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Uncontrolled bleeding Open wounds
Active ulcer disease Severe liver disease Recent brain, eye, or spinal cord injury or surgery Uncontrolled hypertension Pregnancy Category X (See appendix L in Davis) Don’t give if D or X |
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warfarin cautions?
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Use cautiously in malignancy, hx of liver or ulcer disease, hx poor compliance, women of childbearing age
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warfarin interactions?
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sulfonamides, quinidine, NSAIDS, ASA, etc. (See Davis)
Alcohol, barbiturates, hormones with estrogen also response to warfarin effect with anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice, Vitamin E effect w/ St. John’s Wort |
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what would you want to teach your patient about with re Vit K and warfarin?
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foods w/ high amts vit K will antagonize anticoagulant effect
Dark green veges, cauliflower, milk, yogurt, green tea. Must eat fairly consistent amount each day or PT/INR will be affected |
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warfarin therapeutic index?
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very narrow
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when should you administer warfarin?
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every day at the same time
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what should you assess for on your patient that is taking warfarin?
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BLEEDING!!
Gums, nosebleed, hematuria, black tarry stools, bruising, H & H, BP, occult blood in stool, NG aspirate Assess for s/sx thrombosis |
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with warfarin...what do we aboid IM injections?
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because the patient could have uncontrolled bleeding...if necessary to do IM injection...apply firm pressure for a long period
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why do we check PT/INR on patients that are taking warfarin?
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because it tells us their clot factors.
If pt. not on anticoagulants, INR should be about 1.0 w/Coumadin, INR should be 2-3, sometimes 3-4.5 if major risk of clot (e.g. post valve replacement) Hold med if INR is too high or if pt. has bleeding sx & notify MD |
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what is the antidote for warfarin?
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Vit K
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what other things can we instruct the patient to do in order to avoid bleeding?
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use soft toothbrush, no flossing, electric razor, avoid cuts & bruises, notify Dr. if unusual bleeding, lab monitoring is critical
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what are some side effects to warfarin?
determine which are most significant. |
GI: cramps, nausea
Derm: dermal necrosis Hemat: bleeding Misc: fever |
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what is the trade name for morphine?
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MS, MSIR, MS Contin, Duramorph, MSO4, Roxanol Kadian or Avinza (many brand names)
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what are the classifications for morphine?
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Therapeutic –opioid analgesic
Pharmacological – opioid agonist |
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morphine route?
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PO, IM, IV, SQ, rectal, epidural, intrathecal (Doses differ-See Appendix O)
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morphine dose?
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No maximum dose except Avinza.
PO or Rectal 30mg every 3-4h & increase gradually as ordered to control pain Once 24h dosage is established, change to more long-acting form & use short-acting for breakthrough |
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morphine indications?
Know why your patient is taking!! |
Indicated for tx of severe pain due to malignancy, MI, trauma, other. Also used in the treatment of pulmonary edema.
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morphine actions?
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Binds to opiate receptors in CNS & alters perception & response to painful stimuli, depresses CNS
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morphine therapeutic effects?
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Decreases severity of pain
Half-life is 2-3h. Onset, peak, duration vary depending on route & form. Onset is unknown with po, peak is 60-120min & duration is 4-5h |
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morphine contraindications?
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hypersensitivity.
Some products contain tartrazine, bisulfites, or alcohol |
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morphine cautions?
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Use cautiously in head trauma, increased intercranial pressure, severe kidney, liver disease, or pulmonary disease, geriatric pts, undiagnosed abdominal pain, prostatic hypertrophy, pregnancy
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morphine drug interactions?
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MAO inhibitors – use extreme caution
CNS depression with alcohol, sedatives, barbiturates, tricyclic antidepressants, antihistamines, etc. anticoagulant effective of warfarin CNS depression kava, valerian, skullcap, chamomile, hops |
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morphine antidote?
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Narcan is antidote if severe resp. depression or coma occur. Titrate to avoid withdrawal, severe pain
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what would you want to assess on patient that is taking morphine?
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Assess PAIN prior to and 1 hour following oral, rectal, or injectable administration or 20min after IV administration (Pattern, Area, Intensity, Nature)
Assess LOC, BP, P, & RR before & after administration. If RR<10-12, assess level of sedation Assess PAIN prior to and 1 hour following oral, rectal, or injectable administration or 20min after IV administration (Pattern, Area, Intensity, Nature) Assess LOC, BP, P, & RR before & after administration. If RR<10-12, assess level of sedation |
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prolonged use of morphine may lead to...?
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physical and psychological dependency
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which 2 drugs do you not want to confuse morphine with?
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hydromorphone (Dilaudid) and
meperidine (Demerol) |
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Other facts?
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Regularly administered doses maintain a therapeutic level better than prn doses
DC gradually after long-term use Don’t crush or break extended release Kadian & Avinza can have capsules opened & sprinkle pellets in applesauce. MS Contin & Oramorph SR can be administered rectally if pt. has difficulty swallowing Don’t give PCA IV doses to sleeping patients Why not? Avoid concurrent use of other CNS depressants |
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morphine side effects?
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CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating, hallucination, HA, unusual dreams
EENT: blurred vision, diploplia Pulm: respiratory depression CV: hypotension, bradycardia GI: constipation, N,V GU: urinary retention Derm: flushing, itching, sweating Misc: physical dependence, psychological dependence, tolerance |
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generic name for protonix?
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pantoprazole
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pantoprazole classifications?
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Therapeutic – antiulcer agent
Pharmacological – gastric acid pump inhibitor |
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pantoprazole route?
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po, IV
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pantoprazole dose for GERD?
Gastric hypersecretory conditions? |
GERD - 40 mg daily
Gastric hypersecretory condition - 40-120 mg bid |
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pantoprazole indications?
know why your patient is taking med!! |
Indicated for tx of erosive esophagitis R/T GERD
heartburn R/T GERD Tx of pathologic gastric hypersecretory conditions |
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pantoprazole action?
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Binds to enzyme in presence of acidic gastric pH, prevents final transport of H+ ions into gastric lumen
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pantoprazole therapeutic effects?
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Diminished acid in gastric lumen & less reflux
Healing of abdominal ulcers & esophagitis |
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pantoprazole contraindications?
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hypersensitivity, lactation
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pantoprazole cautions?
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use in pregnancy and children
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pantoprazole interactions?
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Affects absorption of drugs that are pH dependent
Increases risk of bleeding with warfarin |
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pantoprazole assessment?
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Assess pt. for epigastic or abdominal pain, s/sx GI bleed
Abnormal liver function tests: AST,ALT, alk phos, & bilirubin |
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pantoprazole side effects / adverse reactions?
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CNS: HA
GI: abdominal pain, diarrhea, eructation, flatulence GU: excessive urination, BUN. Creatinine Endo: hyperglycemia |
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what is hypertension?
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it is the product of cardiac output x systemic vascular resistance
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how does an antihypertensive work?
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Anti-hypertensive meds work by affecting one or both of these factors
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what are the 2 types of HTN?
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Primary/idiopathic/essential HTN:
Elevated BP for which no specific cause can be found (90%) Secondary hypertension: BP associated w/ primary diseases (10%) renal, pulmonary, endocrine, vascular |
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How many people in the US have HTN?
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over 50 million
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What can HTN lead to and what are the risk factors?
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Leads to CAD, CV disease and death
Risk factor for stroke and heart failure Risk factor for renal failure and peripheral vascular disease (PVD) |
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what are the HTN guidelines?
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Normal BP <120/80
Pre-hypertension SBP 120-139/ or DBP 80-89 Stage I Hypertension SBP 140-159/ or DBP 90-99 Stage II Hypertension SBP>160 or DBP>100 |
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what pharm. class of drugs is more effective in caucasians?
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ACE inhibitors and Beta blockers
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what pharm class of drugs is more effective in geriatrics and african americans?
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calcium channel blockers and diuretics
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what are the 4 common antihypertensive meds?
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diuretics
beta blockers ace inhibitors calcium channel blockers |
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what type of antihypertensive med is used as a first line antihypertensive?
why? |
diuretic
Used alone or in conjunction with other meds Accelerate removal of water & sodium from the body by different mechanisms |
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what are the indications for a diuretic?
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hypertension and heart failure
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what is the general therapeutic effect of diurectics?
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Decrease plasma & extracellular fluid volume
Decrease workload of heart by decreasing cardiac output and peripheral resistance |
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what is the generic name for Lasix?
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furosemide
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furosmide classifications?
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Therapeutic – diuretic
Pharmacological – loop diuretic |
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furosemide route?
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po, IM, IV
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furosemide dose for edema?
hypertension? |
Edema: 20-80mg/d, may repeat in 6-8 h
by 20-40mg q 6-8h until desired response Up to 2g/d may be used to tx CHF or renal disease Hypertension: 40mg bid – dec. dose of other antihypertensives by 50% when Lasix added |
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furosemide indications?
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Indicated for tx of edema due to CHF, hepatic, or renal disease; tx of hypertension; Hypercalcemia of malignancy.
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furosemide actions?
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Inhibits reabsorption of Na & Cl from loop of Henle & distal renal tubule
renal excretion of H2O, & electrolytes May have renal & periphery dilating effects |
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furosemide therapeutic effects?
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Diuresis & elimination of excess fluid
Decreases blood pressure |
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furosemide contraindications?
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hypersensitivity
Possible cross-sensitivity w/ thiazides & sulfonamides Contraindicated in electrolyte imbalance, hepatic coma, anuria |
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furosemide cautions?
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Caution w/ severe liver disease, electrolyte depletion, geriatric pts, diabetes mellitus, pregnancy
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Loop diuretic interactions?
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Aminoglycosides or Vancomycin
neurotoxicity (exp. ototoxicity) NSAIDS - diuretic activity Sulfonylureas - glucose tolerance/ Hyperglycemia hypotension w/ antihypertensive, nitrates, alcohol hypokalemia with other drugs that deplete K+ (diuretics, ampho, steroids, laxatives, piperacillin) risk of dig or lithium toxicity, esp. if electrolytes effectiveness of warfarin, other anticoagulants |
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diurectic implications?
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Monitor I & O, daily wts, lungs for crackles - checking for fluid
Assess fluid status, s/sx dehydration Check BP & P before giving Lab tests – electrolytes, renal & hepatic function, glucose, uric acid levels May K+, Ca, Mg May BUN, Creatinine, glucose, uric acid Observe for sx dig toxicity if on digoxin. |
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furosemide adverse reactions / side effects?
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CNS: dizziness, HA, encephalopathy, insomnia, nervousness
EENT: hearing loss, tinnitus CV: hypotension GI: constipation, N,V,D, dry mouth, dyspepsia GU: excessive urination, BUN, Creatinine Derm: photosensitivity, rash Endo: hyperglycemia F & E: dehydration, K, Cl, Na, Mg, metabolic acidosis Metab: hyperglycemia, hyperurecemia Hemat: blood dyscrasias MS: arthralgia, muscle cramps, myalgia |
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what are some common beta blockers?
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atenolol (Tenormin), metoprolol (Lopressor)
Propanolol (Inderal) end in –olol |
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beta blocker therapeutic effect?
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Both antihypertensive & antidysrythmic
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beta blocker action?
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Block beta-1 receptors resulting in HR
Reduce renin secretion vasodilatation |
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beta blocker side effects?
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Neuro: Drowsiness, sedation, dizziness, HA, sleep disturbances
CV: bradycardia w/ reflex tachycardia, orthostatic, postural and postexercise hypotension, palpitations, first dose syncope, rebound hypertension if dc’d abruptly Resp: alpha-beta blockers or non-cardiac selective drugs bronchoconstriction, GI: dry mouth, nausea, constipation GU: impotence, change in libido Derm: rash Endocrine: hypo or hyperglycemia Hemat: some may cause electrolyte imbalance, WBC or Hct, impaired renal function (proteinuria) |
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what does ACE stand for?
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Angiotensin Converting Enzyme
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what are some common ACE inhibitors?
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captopril - Capoten
combined w/ HCT Capozide *lisinopril - Zestril combined w/ HCT Zestoretic enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, trandolapril |
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Captopril and Lisinopril are the most common ACE Inhibitors and are NOT prodrugs. What is a prodrug?
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Prodrugs are given in an inactive form & must be biotransformed by liver to their active form
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ACE Inhibitor action?
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Block conversion of angiotensin 1 to angiotensin 2
peripheral vasoconstriction aldosterone secretion |
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ACE indications?
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Hypertension
Heart failure (adjuvant to inotropic & diuretics) preload & afterload; morbidity & mortality Left ventricular hypertrophy Used after MI (decrease pre/after load) Protective effect on kidneys by glomerular filtration pressures Drug of choice for diabetics w/ hypertension |
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ACE contraindications?
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Known Drug Allergy (laryngeal swelling)
Pt. w/ untreated asthma, sinus brady., cardiogenic shock, 2nd or 3rd degree heart block Do not give to children or lactating women |
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ACE cautions?
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Caution w/ pregnancy
Pregnancy category C in 1st trimester D in 2nd & 3rd Causes fetal morbidity & mortality Renal or liver impairment Patients w/ K+ level 5.0 or greater - can promote hyperkalemia |
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ACE side effects?
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Dizziness, fatigue, mood changes, H/A
*Dry cough (reverse w/ DC med.) 1st dose hypotension Loss of taste, proteinuria, hyperkalemia, rash, anemia, neutropenia, agranulocytosis, thrombocytosis Acute renal failure if used in pt. w/ severe CHF Monitor K+ levels closely esp. if used w/ potassium-sparing diuretics Angioedema may be life-threatening |
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ACE interactions?
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Antihypertensives, diuretics, increase antihypertensive effects
ASA & NSAID decrease hypotensive effect ACE inhibitors increase hypoglycemic effects if used w/ insulin & oral antidiabetics Use w/ K+ sparing diuretics or K+ supplements should be avoided hyperkalemia ACE inhibitors may increase diuretic effects & increase risk of hyperkalemia risk of lithium toxicity, monitor levels |
