Unit 6 Drug Cards

Front 1

Pancuronium
(Pavulon)

Back 1

Pancuronium (Pavulon). L Ch16, D p.917
CLASSIFICATION: Neuromuscular blocking agent
ACTION/USES: Prevents neuromuscular transmission by blocking Ach at the myoneural junction. Does not cause depolarization
Uses-Skeletal muscle paralysis
ROUTES/DOSES: IV
0.15 mg/kg initially, incremental doses of 0.15mg/kg given q20-60min prn to maintain paralysis or as a continuous infusion of 0.02-0.04mg/kg/hr
SIDE EFFECTS: Bronchospasm, hypertension, tachycardia, allergic rxns – including ANAPHYLAXIS. Note – too big to cross blood/brain barrier, so no effect on CNS.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
CI- Hypersensitivity esp to bromides. Products with benzyl ETOH should be avoided in neoates.
Drug/Drug-Intensity & duration of paralysis prolonged by pretx w/ succinylcholine, general anesthesia, aminoglycosides, vancomycin, tetracyclines, polymycin B, colistin, cyclosporine, Ca channel blockers, clindamycin, lidocaine & other local anesthetic, lithium, quinidine, procainamide, B blockers, K losing diuretics, or Mg. Inhalation anesthics including enflurane, isoflurane, halothane, desflurane, sevoflurane may enhance effects. Higher infusion rates may be required and duration of action may be shorter in pts receiving long term carbamazepine, steroids (chronic), azathioprine, or phenytoin.
NURSING IMPLICATIONS: Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These should be used only to facilitate intubation or in patients already intubated. Monitor ECG, HR, and BP throughout administration. Observe the patient for residual mm weakness and respiratory distress during the recovery period

Front 2

Succinylcholine chloride
(Anectine)

Back 2

Succinylcholine chloride (Anectine). L Ch16
CLASSIFICATION: Neuromuscular blocking agent
ACTION/USES: Binds to nicotinic receptors on motor end plates and causes depolarization. Stays bound, so cannot repolarize.
Uses-Flaccid muscle paralysis. Ultra-short acting (4-10 mins). Used for short procedures (endotracheal intubation, endoscopy).
ROUTES/DOSES: IV, IM
Individualized & application specific dosing- Brief procedures-25-75mg (IV); Prolonged procedures- 2.5-4.3 mg/min (IV)
SIDE EFFECTS: Malignant hyperthermia, post-op. muscle pain, hyperkalemia
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Cholinesterase inhibitors intensify effects by ↓pseudocholinesterase activity. Antibiotics intensify effects.
NURSING IMPLICATIONS: Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These should be used only to facilitate intubation or in patients already intubated. Monitor ECG, HR, and BP throughout administration. Observe the patient for residual mm weakness and respiratory distress during the recovery period

Front 3

Vecuronium bromide
(Norcuron)

Back 3

Vecuronium bromide (Norcuron). L Ch16
CLASSIFICATION: Neuromuscular blocking agent
ACTION/USES: Prevents neuromuscular transmission by blocking Ach at the myoneural junction. Does not cause depolarization.
Uses- Mm relaxant –flaccid paralysis. Intermediate acting.
ROUTES/DOSES: IV
SIDE EFFECTS: Apnea (respiratory depression). Prolonged paralysis in pts w/ liv dysfxn or obesity.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Certain antibiotics like aminoglycosides and tetracyclines can intensify effects.
NURSING IMPLICATIONS: Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These should be used only to facilitate intubation or in patients already intubated. Monitor ECG, HR, and BP throughout administration. Observe the patient for residual mm weakness and respiratory distress during the recovery period

Front 4

Atracurium besylate
(Tracrium)

Back 4

Atracurium besylate (Tracrium). L Ch16
CLASSIFICATION: Neuromuscular blocking agent
ACTION/USES: Prevents neuromuscular transmission by blocking Ach at the myoneural junction. Does not cause depolarization
Uses- Mm relaxant –flaccid paralysis during surgery, intubation & mechanical ventilation. Intermediate acting.↓BP (b/c release of histamine)
ROUTES/DOSES: IV
SIDE EFFECTS: Respiratory arrest, hypotension, bradycardia, dysrthymia, cardiac arrest
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Certain antibiotics like aminoglycosides and tetracyclines can intensify effects.
NURSING IMPLICATIONS: Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These should be used only to facilitate intubation or in patients already intubated. Monitor ECG, HR, and BP throughout administration. Observe the patient for residual mm weakness and respiratory distress during the recovery period

Front 5

Atracurium besylate
(Tracrium)

Back 5

Atracurium besylate (Tracrium). L Ch16
CLASSIFICATION: Neuromuscular blocking agent
ACTION/USES: Prevents neuromuscular transmission by blocking Ach at the myoneural junction. Does not cause depolarization
Uses- Mm relaxant –flaccid paralysis during surgery, intubation & mechanical ventilation. Intermediate acting.↓BP (b/c release of histamine)
ROUTES/DOSES: IV
SIDE EFFECTS: Respiratory arrest, hypotension, bradycardia, dysrthymia, cardiac arrest
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Certain antibiotics like aminoglycosides and tetracyclines can intensify effects.
NURSING IMPLICATIONS: Assess respiratory status continuously throughout therapy with neuromuscular blocking agents. These should be used only to facilitate intubation or in patients already intubated. Monitor ECG, HR, and BP throughout administration. Observe the patient for residual mm weakness and respiratory distress during the recovery period

Front 6

Lidocane
(Xylocaine)

Back 6

Lidocane (Xylocaine) L Ch26, D 715-717
CLASSIFICATION: Local Anesthetics, Antiarrhythmics
ACTION/USES: Produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses.
Uses- Local anesthesia. Control of ventricular arrhythmias
ROUTES/DOSES: topical- 35g/day prn, mucosal (for oral surfaces) 20mg as 2 sprays/quadrant
IV/IM (Ht)- IM (autoinjector)-300mg/3ml; Direct IV injection- 10mg/ml (1%)
Note: there are many different types of combination of dosing available
SIDE EFFECTS: SEIZURES, CARDIAC ARREST, ANAPHYLAXIS, confusion, drowsiness, dizziness, nervousness, bradycardia, stinging
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Hypersensitivity (allergy). Toxicity could cause CNS & cardio toxicity. Advanced AV block.
NURSING IMPLICATIONS: Assess degree of numbness of affected part. For bupivacaine, assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, slow speech, cardiac dysrhythmias), orthostatic hypotension, and unwanted motor and sensory deficits.

Front 7

Bupivacaine
(Marcaine)

Back 7

Bupivacaine (Marcaine), L-Ch26, D p.452-4
CLASSIFICATION: Epidural local anesthetics
ACTION/USES: Inhibit initiation & conduction of sensory nerve impulses by altering the influx of Na and efflux of K in neurons, slowing or stopping pain transmission.
Uses- ↓ pn.↓ doses – min. effect on sensory or motor fxn.↑ doses – may produce complete motor blockade
ROUTES/DOSES: epidural IM, 0.0625-0.125% sln- dosage differs according to type of blockage
Injection (can be w/ or w/o preservative): 0.25%, 0.50%, 0.75% or in combination w/ epinephrine
SIDE EFFECTS: SEIZURES, CV COLLAPSE, headaches, irritability, slow speech, twitching, tinnitus, arrhythmias, bradycardia, hypotension, urinary retention.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Hypersensitivity (allergy), cross sensitivity to other amide local anesthetics may occur.
Drug-drug- additive toxicity w/ concurrent use of other amide local anesthetics including lidocaine, mepivacaine, & prilocaine.
NURSING IMPLICATIONS: Assess degree of numbness of affected part. For bupivacaine, assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, slow speech, cardiac dysrhythmias), orthostatic hypotension, and unwanted motor and sensory deficits.

Front 8

Isoflurane
(Forane)

Back 8

Isoflurane (Forane), L-Ch27
CLASSIFICATION: General Anesthetics
ACTION/USES: Enhance GABA receptors (main inhibitory transmitter in CNS). Inhibit neuronal nicotinic receptors (pn perception & memory).
Uses- Inhalation anesthesia – smooth & rapid. Moderate muscle relaxant & analgesic.
ROUTES/DOSES: Inhalation (admin given by docs & CRNAs)
SIDE EFFECTS: Respiratory depression, hypotension, post op N/V
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
None listed
NURSING IMPLICATIONS: Must take thorough med hx!! Assess resp & CV fxn – most ↓ resp & CV fxn. Assess return of CNS fxn & implement precautions until complete recovery. Bowel fxn may be compromised d/t surgery or drugs employed – constipation is common. Anesthetics can also disrupt urinary tract fxn – they can ↓ urine production by ↓ renal blood flow. Opioids & anticholinergic drugs can cause urinary retention. Monitor I&O. AS anesthesia wears off, make sure to monitor for post op. pain. Pt. may need an opioid.

Front 9

Nitrous oxide

Back 9

Nitrous oxide, L-Ch27
CLASSIFICATION: General Anesthetics
ACTION/USES: Inhibit neuronal nicotinic receptors (pn perception & memory).
Uses- Inhalation anesthesia. Hi analgesic potency, low anesthesia potency. Freq. combined w/ other inhalation anesthesics.
ROUTES/DOSES: Inhalation (admin given by docs & CRNAs)
SIDE EFFECTS: No serious side effects at therapeutic levels. Post-op. N/V
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
none listed
NURSING IMPLICATIONS: Must take thorough med hx!! Assess resp & CV fxn – most ↓ resp & CV fxn. Assess return of CNS fxn & implement precautions until complete recovery. Bowel fxn may be compromised d/t surgery or drugs employed – constipation is common. Anesthetics can also disrupt urinary tract fxn – they can ↓ urine production by ↓ renal blood flow. Opioids & anticholinergic drugs can cause urinary retention. Monitor I&O. AS anesthesia wears off, make sure to monitor for post op. pain. Pt. may need an opioid.

Front 10

Thiopental sodium
(Pentothal)

Back 10

Thiopental sodium (Pentothal) L-C27, p.254, 370
CLASSIFICATION: Short Acting Barbiturates
ACTION/USES: Highly lipid soluble – enters brain rapidly. Activate GABA receptors –depress CNS.
Uses- Induction of anesthesia –short acting. Analgesic & muscle relaxant effects – weak
ROUTES/DOSES: Inhalation (admin given by docs & CRNAs)
SIDE EFFECTS: CV& resp depression, apnea
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
None listed.
NURSING IMPLICATIONS: Must take thorough med hx!! Assess resp & CV fxn – most ↓ resp & CV fxn. Assess return of CNS fxn & implement precautions until complete recovery. Bowel fxn may be compromised d/t surgery or drugs employed – constipation is common. Anesthetics can also disrupt urinary tract fxn – they can ↓ urine production by ↓ renal blood flow. Opioids & anticholinergic drugs can cause urinary retention. Monitor I&O. AS anesthesia wears off, make sure to monitor for post op. pain. Pt. may need an opioid.

Front 11

Fentanyl citrate
Sublimaze

Back 11

Fentanyl citrate/ Sublimaze
CLASSIFICATION: Opioid analgesics
ACTION/USES: Supplement in anesthesia. Binds to opiate receptors in the CNS, altering the response to and perception of pain. CNS
depression.Binds to opiate receptors in the CNS, altering the response to and perception of pain. CNS depression
ROUTES/DOSES:
Pre-op – IM, IV (>12yr): 50-100mcg, 30-60min before surgery
Adjunct to general anesthesia – IM, IV (>12yr): 2mcg/kg (low dose, minor surgery), 2-20mcg/kg (moderate dose, major surg), 20-50mcg/kg (high dose, major surg)
Adjunct to regional anesthesia – IM, IV (>12yr): 50-100mcg
Post-op – IM, IV (>12yr): 50-100mcg
General anesthesia – IV (>12yr): 50-100mcg/kg up to 150 mcg/kg
IV (1-12yr): 2-3mcg/kg
Sedation/Analgesia – IV (>12yr): 0.5-1mcg/kg/dose, may repeat after 30-60min.
IV (1-12yr): Bolus- 1-2mcg/kg/dose, may repeat at 30-60min intervals. Continuous infusion- 1-5mcg/kg/hr following bolus dose
IV (Neonates): Bolus- 0.5-3mcg/kg/dose. Continuous infusion- 0.5-
2mcg/kg/r following bolus dose. Continuous infusion during ECMO- 5-10mcg/kg bolus followed by 1-5mcg/kg/hr, may require up to 20mcg/kg/hr after 5 days of therapy.
SIDE EFFECTS: APNEA, LARYNGOSPASM, confusion, paradoxical excitation/delirium, post-op. depression and drowsiness.
CONTRAINDICATIONS:
Hypersensitivity; cross-sensitivity among agents may occur. Known intolerance.
NURSING IMPLICATIONS:
Monitor RR & BP frequently throughout therapy. Initial doses of other opioids should be reduced by 25-33% of the usually recommended dose.
Assess and implement geriatric pts for risk for falls
Naloxone (Narcan) is the antiidote for overdose
Opioid antagonists, O2, and resuscitative equipment should be readily available during the admin

Front 12

Morphine
Duramorph

Back 12

Morphine/ Duramorph
CLASSIFICATION:Opioid analgesics
ACTION/USES:Same as fentanyl. See above
Decrease in severity of pain.
ROUTES/DOSES:
Large dose might be required during chronic therapy
PO,Rect (adults>50kg): 30mg q3-4hr as starting dose for moderate to severe pain for opioid naïve pts, do not exceed 1600mg/day.
PO, Rec(adults&children<50kg): 0.3mg/kg q3-4hr as a starting dose
PO (children>1mo): 0.2-0.5mg/kg/dose q4-6hr PRN, prompt release tabs and solution, 0.3-0.6mg/kg/dose q12hr controlled release tabs
IM, IV, SQ (adults≥50lg): 4-10mg q3-4hr as usual starting dose, MI-8-15mg for very severe pain additional smaller dose may be given q3-4hr.
IM, IV, SQ (adults <50kg): 0.05-0.2 mg/kg q3-4hr, max 15mg/dose
IM, IV, SQ (neonates): 0.05mg/kg q4-8hr, max 0.1mg/kg use preservative-free formulation
IV, SQ (adults): 0.8-10mg/hr, may be preceded by a bolus of 15mg
IV, SQ (Children>1mo): 0.01-0.04mg/kg/hr postpo pain, 0.02-2.6mg/kg/hr CA pain
IV (neonates): 0.01-0.03mg/kg/hr continuous infusion
Epidural (adults): 5mg/day initially intermittent injection
Epidural (children>1mo): 0.03-0.05mg/kg, max 0.1/kg or 5mg/24hr
IT(adults): 0.2-1mg
SIDE EFFECTS:Confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, blurred vision, hypotension, constipation, RESPIRATORY DEPRESSION.
CONTRAINDICATIONS:Hypersensitivity. Some products contain tartrazine, bisulfites, or alcohol and should be avoided in pts w/known
hypersensitivity.
NURSING IMPLICATIONS:Assess LOC, BP, P, RR before and periodically during admin. If RR <10/min, assess level of sedation. Initial drowsiness will diminish with continued use.
Naloxone (Narcan) is the antidote.Do not confuse morphine w/ hydromorphone or meperidine.Do not crush, break, dissolve or chew extended-release and controlled-release tablets
Rinse mouth and swallow to assure ingestion of entire dose.Rapid admin may lead to increased respiratory depression, hypotension, and circulatory collapse.

Front 13

Ketamine
Ketalar

Back 13

Ketamine / Ketalar
CLASSIFICATION:
Dissociative anesthesia
ACTION/USES:
Especially good for anesthesia in young children undergoing minor surgery. Often used when changing burn dressings. Pt. feels dissociated from env. Causes sedation, immobility, analgesia, and amnesia.
ROUTES/DOSES:

SIDE EFFECTS:
During recovery- unpleasant psychologic rxns may occur- hallucinations, disturbing dreams, and delirium (maybe for weeks after).
CONTRAINDICATIONS:

NURSING IMPLICATIONS:
Adverse psychologic reactions can develop as the pt emerges from ketamine-induced anesthesia. To minimize there reactions, provide a calm and stimulus-free environment until recovery is complete.

Front 14

fentanyl and droperidol / Innovar

Back 14

fentanyl and droperidol / Innovar
This is a combination drug. Reference for each drug in Davis- fentanyl (511) & droperidol (435)
CLASSIFICATION:Neurolept anesthesia
ACTION/USES:Blocks receptors for dopamine.Diagnostic and minor surgeries. Indifference to surrounding, insensitivity to pain.
ROUTES/DOSES:
SIDE EFFECTS:Hypotension, respiratory depression
CONTRAINDICATIONS:Pts w/ existing QT prolongation. Should be used w/great caution in those at risk of developing QT prolongation.
Should not be given to pts w/Parkinson’s disease
NURSING IMPLICATIONS:Pt appears to be asleep but is not – complete loss of consciousness does not occur.

Front 15

dantrolene sodium / Dantrium

Back 15

dantrolene sodium / Dantrium
CLASSIFICATION:
Skeletal muscle relaxant (direct acting)
ACTION/USES:
Reduction of muscle spasticity. Prevention of malignant hyperthermia.
Acts on skeletal muscles, causing relaxation by decreasing Ca release from SR in muscle cells.
ROUTES/DOSES:
PO (adults): 25mg/day (initially for spasticity) max 100mg x 4times/day. 4-8mg/kg/day in 3-4 divided doses (prevention of malignant hyperthermia preop), 4-8mg/kg/day in 3-4 divided doses (1-3 days after IV treatment)
SIDE EFFECTS:
HEPATOTOXICITY, drowsiness, muscle weakness, diarrhea, confusion, dizziness, pleural effusions, excessive lacrimation, tachycardia, crystalluria, pruritus, eosinophilia, myalgia, chills
CONTRAINDICATIONS:
No contraindications to IV form in treatment of hyperthermia.
Pregnancy and lactation
Situations in which spasticity is used to maintain posture or balance

Front 16

Phenothiazines, dolasetron, granisetron, metochopramide, trimethobenzamide, and ondansetron

Back 16

Phenothiazines, dolasetron, granisetron, metochopramide, trimethobenzamide, and ondansetron
General use: Phenothiazines, dolasetron, granisetron, metochopramide, trimethobenzamide, and ondansetron are used to manage nausea and vomiting of many causes, including surgery, anesthesia, and antineoplastic and radiation therapy.
Dimenhydrinate, scopolamine, and meclizine are used almost exclusively to prevent motion sickness.
General Action and Info:
Phenothiazines act on the chemoreceptor trigger zone to inhibit nausea and vomiting. Dimenhydrinate, scopolamine, and meclizine act as antiemetics mainly by diminishing motion sickness. Metoclopramide decreases nausea and vomiting by its effects on gastric emptying. Dolasetron, granisetron, and ondamsetron block the effects of serotonin at 5-HT3 receptor sites.
Nursing Implications: Assess nausea, vomiting, bowel sounds, and abdominal pain before and following administration. Monitor hydration status and I&O.

Front 17

psyllium/Metamucil

Back 17

psyllium/Metamucil
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – bulk-forming agent
ACTION/USES: Used to manage constipation, especially from low-fiber diet. Combines with water in the intestinal contents to form a viscous solution that promotes peristalsis and reduces transit time.
ROUTES/DOSES: PO 1-2 tsp/packet/wafer in or with a full glass of liquid 2-3 times per day. Up to 30 g daily in divided doses.
SIDE EFFECTS: GI-cramps, intestinal or esophageal obstruction, nausea, vomiting. Resp-bronchospasm.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Abdominal pain, nausea or vomiting (esp. when associated with fever). Serious adhesions. Dysphagia.
Drug-Drug: May decrease the absorption of warfarin, salicylates, or digoxins.
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced. May cause elevated blood glucose levels on labs with prolonged use of preparations containing sugar

Front 18

docusate sodium/Colace, DOSS

Back 18

docusate sodium/Colace, DOSS
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – stool softener
ACTION/USES: Used orally to prevent constipation (in patients who should avoid straining, such as after MI or rectal surgery. Can also be used rectally as enema to soften fecal impaction. Promotes incorporation of water into stool, resulting in softer fecal mass.
ROUTES/DOSES: PO 50-500 mg once daily. Rectal 50-100 mg.
SIDE EFFECTS: throat irritation, mild cramps, rashes.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Abdominal pain, nausea or vomiting (esp. when associated with fever or other signs of an acute abdomen).
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Front 19

bisacodyl/Dulcolax

Back 19

bisacodyl/Dulcolax
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – stimulant laxative
ACTION/USES: Used for tx of constipation. Evacuation of bowel before radiologic studies or surgery. Part of a bowel regimen in spinal cord injury patients. Stimulates peristalsis. Alters fluid and electrolyte transport, producing fluid accumulation in the colon.
ROUTES/DOSES: PO 5-15 mg (up to 30 mg/day) as a single dose. Rectally 10 mg single dose.
SIDE EFFECTS: abdominal cramps, nausea, diarrhea, rectal burning.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Abdominal pain or obstruction. Nausea or vomiting (esp. when associated with fever or others signs of an acute abdomen). Drug/Drug: Antacids, histamine H2-receptor antagonists, gastric acid-pump inhibitors may remove enteric coating causing gastric irritation/dyspepsia. May also decrease the absorption of other orally administered drugs because of increased motility and decreased transit time.
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Front 20

sennosides/Senekot, Ex-Lax

Back 20

sennosides/Senekot, Ex-Lax
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – stimulant laxative
ACTION/USES: Used for tx of constipation, esp. when associated with slow transit time, constipating drugs, irritable or spastic bowel syndrome, neurologic constipation. Sennosides alter water and electrolyte transport in the large intestine, resulting in accumulation of water and increased peristalsis.
ROUTES/DOSES: PO 12-50 mg 1-2 times daily.
SIDE EFFECTS: Cramping, diarrhea, nausea. Pink-red or brown-black discoloration of urine. Electrolyte abnormalities, laxative dependence (chronic use).
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Abdominal pain of unknown cause, esp. if associated with fever. Rectal fissures, ulcerated hemorrhoids, known alcohol intolerance (some liquid products). May decrease absorption of other orally administered drugs because of decreased transit time.
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Front 21

lactulose/ Cephulac, Kristalose

Back 21

lactulose/ Cephulac, Kristalose
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – osmotic
ACTION/USES: Used for tx of chronic constipation in adults and geriatric patients. Adjunct in the management of portal-systemic (hepatic) encephalopathy (PSE). Increases water content and softens the stool. Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, reducing blood ammonia levels (this can improve mental status in PSE). Relieves constipation.
ROUTES/DOSES: PO 15-30 ml/day, up to 60 ml/day as liquid, or 10-20 g as powder for oral solution. For PSE, may be given rectally, 300 ml diluted and given as a retention enema q 4-6 hours.
SIDE EFFECTS: Belching, cramps, distention, flatulence, diarrhea. Hyperglycemia (diabetic patients).
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Patients on low-galactose diets.
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced. For PSE, assess mental status (orientation, LOC) before and during therapy

Front 22

polyethylene glycol /MiraLax

Back 22

polyethylene glycol /MiraLax
CLASSIFICATION: Therapeutic – laxative; Pharmacologic – osmotic
ACTION/USES: In solution acts as an osmotic agent, drawing water into the lumen of the GI tract. Evacuation of the GI tract without water or electrolyte imbalance.
ROUTES/DOSES: PO 17 g (heaping tablespoon) in 8 oz of water; may be used for up to 2 weeks.
SIDE EFFECTS: abdominal bloating, cramping, flatulence, nausea.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): GI obstruction, gastric retention, toxic colitis, megacolon.
NURSING IMPLICATIONS: Assess pt for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Front 23

sodium phosphate / Fleet Enema, Visicol

Back 23

sodium phosphate / Fleet Enema, Visicol
CLASSIFICATION: laxative (saline)
ACTION/USES: Preparation of the bowel prior to surgery or radiologic studies. Intermittent tx of chronic constipation. Visicol: Cleansing of the bowel as preparation for colonoscopy (age 18+). Osmotically active in the lumen of the GI tract. Produces laxative effect by causing water retention and stimulation of peristalsis. Stimulates motility and inhibits fluid and electrolyte absorption from the small intestine. Relieves constipation and empties the bowel.
ROUTES/DOSES: Rectally 118 ml Fleet Enema. PO 20-30 ml Phospho-Soda. Visicol: 3 tab q 15 minutes with at least 8 oz water, last dose will be 2 tabs (total of 20 tabs), on morning of colonoscopy starting 3-5 hours before procedure.
SIDE EFFECTS: Cramping, nausea, colonic aphtous ulcerations, hyperphosphatemia, hypocalcemia, hypokalemia, sodium retention. Visicol: dizziness, headache, abdominal bloating, abdominal pain, vomiting, ARRHYTHMIAS.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Abdominal pain, nausea or vomiting (esp. when associated with fever or other signs of an acute abdomen). Severe renal or CV disease. Intestinal obstruction. Pregnancy (at term). Visicol: CHF, ascites, unstable angina, acute colitis, toxic megacolon, or hypomotility syndrome. Visicol Drug-Drug Interactions: Concurrently administered oral medications may not be absorbed due to rapid peristalsis and diarrhea.
NURSING IMPLICATIONS: Assess pt for fever, abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced. May rarely cause arrhythmias. Monitor pts with underlying CV disease, renal disease, bowel perforation, misuse, or overdose.

Front 24

polyethylene glycol/Go LYTELY

Back 24

polyethylene glycol/ Go LYTELY
CLASSIFICATION: laxative
ACTION/USES: Osmotic agent – draws water into lumen of GI tract
ROUTES/DOSES: PO adults – 240ml q10min (up to 4L)
SIDE EFFECTS: abdominal fullness, diarrhea, bloating, cramps, nausea, vomiting
CONTRAINDICATIONS: GI obstruction, gastric retention, toxic colitis, megacolon.
NURSING IMPLICATIONS: assess for abdominal distention, presence of BTs and usual pattern of bowel function. Assess color, consistency, and amount of stool produced. Pt should fast 3-4 hr prior to administration. Only clear liquids after administration.

Front 25

phosphate/biphosphate, Fleet Phospho-Soda Enema

Back 25

phosphate/biphosphate, Fleet Phospho-Soda Enema
CLASSIFICATION: laxative (saline)
ACTION/USES: Relief of constipation. Causes water retention and stimulates peristalsis. Inhibits fluid/electrolyte absorption from small intestine.
ROUTES/DOSES: PO adults – 20-30 ml
SIDE EFFECTS: cramping, nausea
CONTRAINDICATIONS: hypersensitivity, abdominal pain/nausea/vomiting, pregnancy.
NURSING IMPLICATIONS: Assess for fever, distended abdomen, presence of BTs, and usual BM pattern. Administer on empty stomach for rapid results. Assess color, consistency, and amount of BM.

Front 26

heparin

Back 26

heparin
CLASSIFICATION: anticoagulant (parenteral)
ACTION/USES: Tx of various thromboembolic disorders such as venous thromboembolism, pulmonary emboli, atrial fibrillation with embolization, and peripheral arterial thromboembolism.
ROUTES/DOSES: For therapeutic anticoagulation : IV (adults) continuous infusion – 5000 units followed by 20,000-40,000 units infused over 24 hr.
SIDE EFFECTS: bleeding, anemia, thrombocytopenia
CONTRAINDICATIONS: hypersensitivity, uncontrolled bleeding, open wounds.
Drug-drug: Drugs that affect platelet function (aspirin, NSAIDs) may increase risk of bleeding. Digoxin, tetracyclines, nicotine, and antihistamines may decrease anticoagulant effect of heparin.
Drug-Natural Products: Anise, cloves, garlic, ginger, and chamomile may increase risk of bleeding.
NURSING IMPLICATIONS: Assess for bleeding and hemorrhage and notify MD if these occur. aPTT, HCT, and platelets should be monitored. Inform all personnel caring for pt of heparin therapy. Advise pt to report any symptoms of unusual bleeding.

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enoxaparin/ Lovenox

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enoxaparin/ Lovenox
CLASSIFICATION: anticoagulant
ACTION/USES: Prevention of DVT and PE
ROUTES/DOSES: Subcut (adults) : DVT prophylaxis before knee/hip surgery – 30mg Q12hr for knee surgery starting 12-24 hr postop. 40mg Q12hr for hip surgery starting 12hr before surgery.
SIDE EFFECTS: anemia, thrombocytopenia
CONTRAINDICATIONS: uncontrolled bleeding, hypersensitivity to specific agents or pork products. Extreme caution in spinal/epidural anesthesia, severe uncontrolled HTN, hemorrhagic stroke.
Drug-drug: Warfarin or drugs that affect platelet function (aspirin, NSAIDs) may increase risk of bleeding.
Drug-Natural Products: clove, garlic, ginger, and chamomile may increase risk of bleeding.
NURSING IMPLICATIONS: assess for signs of bleeding and hemorrhage. Monitor CBC, platelet count, and stools for occult blood periodically. Inject enoxaparin into L or R anterolaterial or posterolateral abdominal wall only.

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warfarin sodium/ Coumadin

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warfarin sodium/ Coumadin
CLASSIFICATION: anticoagulant (oral)
ACTION/USES: Tx of venous thrombosis, pulmonary embolism, atrial fibrillation with embolization. Interferes with hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X)
ROUTES/DOSES: PO, IV (adults) : 2.5-10mg/day for 2-4 days then adjust daily dose by results of PT/INR
SIDE EFFECTS: Bleeding, cramps, nausea, dermal necrosis, fever.
CONTRAINDICATIONS: uncontrolled bleeding, open wounds, active ulcer disease, recent brain/eye/or spinal cord injury/surgery, severe liver/kidney disease, uncontrolled HTN, pregnancy.
Drug-Food: Ingestion of large quantities of foods high in Vitamin K may antagonize the anticoagulant effect of warfarin.
Drug-drug: NSAIDs and aspirin may increase response to warfarin. Chronic acetaminophen use may increase risk of bleeding. Chronic alcohol abuse may decrease warfarin action.
Drug-Natural products: St. John’s wort decreases effect. Anise, clove, garlic, etc increase bleeding risk.
NURSING IMPLICATIONS: Assess pt for signs of bleeding and hemorrhage. Before administering, evaluate recent INR or PT results and have second practitioner independently check original order.

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clopidogrel/ Plavix

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clopidogrel/ Plavix
CLASSIFICATION: anti-platelet
ACTION/USES: Reduction of atherosclerotic events (MI, stroke) in patients at risk (recent MI, CVA, or peripheral vascular disease). Inhibits platelet aggregation.
ROUTES/DOSES: PO (adults) with recent MI/stroke 75mg once daily ; PO (adults) acute coronary syndrome 300mg initially then 75mg once daily
SIDE EFFECTS: GI bleeding, bleeding, neutropenia, thrombotic thrombocytopenic purpura.
CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding, lactations.
Drug-Drug: Concurrent abciximab, eptifibatide, tirofiban, aspirin, NSAIDs, heparin, heparanoids, thrombolytic agents, ticlopidine, or warfarin may increase risk of bleeding. May decrease metabolism and increase effects of phenytoin, tolbutamide, and many NSAIDS.
Drug-Natural products: Clove, garlic, ginger, etc may increase bleeding risk.
NURSING IMPLICATIONS: Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). Monitor bleeding time during therapy. Provlonged bleeding time, which is time- and dose-dependent expected. Monitor CBC with differential and platelet count periodically during therapy. Neutropenia and thrombocytopenia may rarely occur.

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aspirin

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aspirin
CLASSIFICATION: anti-platelet, antipyretic, nonopioid analgesic
ACTION/USES: Inflammatory disorders such as rheumatoid arthritis, osteoarthritis. Mild to moderate pain. Fever. Prophylaxis of TIAs and MI. Produce analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins. It only decreases platelet aggregation.
ROUTES/DOSES: PO, Rect (adults) 325-500mg q3hr
SIDE EFFECTS: dyspepsia, epigastric distress, heartburn, nausea
CONTRAINDICATIONS: hypersensitivity to aspirin or other salicylates. May increase the risk of bleeding with warfarin, heparin, heparin-like agents, etc. May increase activity of penicillins, phenytoin, sulfonamides, etc. Urinary acidification increases reabsorption and may increase serum salicylate levels. Foods capable of acidifying the urine may increase serum salicylate levels.
NURSING IMPLICATIONS: Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions. Assess pain or fever. Aspirin, in large doses, may cause prolonged PT time. Monitor HCT in high-dose therapy.

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atropine

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atropine
Classification: Anticholinergics,antiarrhymics
Action: Inhibits action of Ach at postganlionic sites located in: smooth muscles, secretory glands, CNS (antimuscarinic activity).
Uses: Given pre-op. to decrease oral and respiratory secretions. Reversal of muscarinic effects
Side Effects: Drowsiness, confusion, hyperpyrexia, blurred vision, tachycardia, dry mouth, urinary hesitancy
Nursing Implications: Assess vital signs and ECG frequently during IV drug therapy. Monitor I and O - may cause urinary retention.
Assess for abdominal distention and auscultate for bowel sounds. Constipation may be a problem.

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diazepam (Valium)

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diazepam (Valium)
Classification:Sedative/Hypnotic,Anti-anxiety, Anti-convulsant,Skeletal mm relaxant
Action:Depresses CNS, probably by potentiating GABA, an inhibitory neurotransmitter
Uses:Sedation, amnesia, skeletal muscle relaxation, decrease seizure activity
Side effects:Dizziness, drowsiness, lethargy, respiratory depression, constipation
Nursing Implications – Sedatives/hypnotics: Monitor BP, pulse, and respiratory status frequently throughout IV administration. Supervise ambulation and transfer of patients following administration of hypnotic doses.

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propofol (Diprivan)

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propofol (Diprivan)
Classification: General anesthetics
Action:Short acting hypnotic. Mechanism of action is unknown.
Uses:Induction and maintenance of anesthesia. Note – has no analgesic properties
Side effects:Dizziness, headaches, APNEA, bradycardia, hypotension, skin – burning, pain, stinging
Nursing Implications – Sedatives/hypnotics: Monitor BP, pulse, and respiratory status frequently throughout IV administration. Supervise ambulation and transfer of patients following administration of hypnotic doses.

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midazolam hydrocholoride (Versed)

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midazolam hydrocholoride (Versed)
Classification:Sedative/Hypnotic
Action:Acts at many levels of the CNS to produce generalized CNS depression
Uses:Short-term sedation.
Post-op. amnesia
Side effects:Agitation, drowsiness, excess sedation, headache, APNEA, LARYNGOSPASM, RESP. DEPRESSION, CARDIAC ARREST, phlebitis at IV site
Nursing Implications – Sedatives/hypnotics: Monitor BP, pulse, and respiratory status frequently throughout IV administration. Supervise ambulation and transfer of patients following administration of hypnotic doses.

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flumazenil (Romazicon)

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flumazenil (Romazicon)
Classification:Antidotes
pharmcologic: benzodiazepine
Action:Benzodiazepine derivative that antagonizes the CNS depressant effects of benzodiazepine cmpds.
Uses:Reversal of benzodiazepine effects.
Side effects:SEIZURES, dizziness, agitation, confusion, drowsiness, emotional lability, fatigue, nausea, vomiting.
Nursing Implications – Sedatives/hypnotics: Monitor BP, pulse, and respiratory status frequently throughout IV administration. Supervise ambulation and transfer of patients following administration of hypnotic doses.