ATI Pharmacology Review for Medication Therapies

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• IV Infusions: Administration of fluids via an intravenous catheter (peripheral or central vein access) for the purpose of providing medication, fluid, electrolyte, or nutrient replacement • Gui... delines for Safe IV Administration • Infiltration • Extravasation • Phlebitis/Thrombophlebitis – Prevention: rotate sites every 72-96 hrs, secure catheter, use aseptic technique; for PICCs, avoid excessive activity with the extremity – Treatment: stop infusion, remove peripheral IV catheters, apply heat compress, insert new catheter in opposite extremity • Hematoma • Venous Spasm • TPN: Hypertonic solutions containing dextrose, proteins, electrolytes, minerals, trace elements, and insulin prescribed according to client’s needs and administered via central venous device (PICC line, subclavian, or internal jugular vein) • Care and Maintenance of TPN • Pneumothorax (during insertion) – Prevention: use ultrasound to locate veins, avoid subclavian insertion when possible – Treatment: administer oxygen, assist provider with chest tube insertion • Air Embolism – Prevention: have client lie flat when changing administration set or needleless connectors, ask client to perform Valsalva maneuver if possible – Treatment: place client in left lateral Trendelenburg, administer oxygen • Lumen Occlusion – Prevention: flush promptly with NS between, before, and after each medication – Treatment: use 10 mL syringe with a pulsing motion • Bloodstream Infection – Prevention: maintain sterile technique – Treatment: change entire infusion system, notify provider, obtain cultures, and administer antibiotics • Acetaminophen: acetylcysteine (Mucomyst) • Benzodiazepine: flumazenil (Romazicon) • Curare: edrophonium (Tensilon) • Cyanide Poisoning: methylene blue • Digitalis: digoxin immune FAB (Digibind) • Ethylene Poisoning: fomepizole (Antizol) • Heparin and Enoxaparin: protamine sulfate • Iron: deferoxamine (Desferal) • Lead: succimer (Chemet) • Magnesium Sulfate: calcium gluconate 10% (Kalcinate) • Narcotics (Opioid Overdose): naloxone (Narcan) • Warfarin: phytonadione (Vitamin K) • Cholinergics • Drug: Bethanechol – Action • Heart: slows HR • Exocrine glands (sweat, saliva, bronchi, gastric acid): increases secretions • Bladder: detrusor contractions, sphincter relaxation • Vascular smooth muscle: relaxation • Eye: miosis and accommodation – Therapeutic Use: non-obtrusive urinary retention – Adverse Effects – Nursing Implications • Monitor: I/O, BP, HR • Anticholinergics • General Function – Anticholinergic Drugs: produce selective blockade of muscarinic receptors; not all cholinergic receptors – Effects: result of muscarinic receptor blockade; most effects are seen in eyes, smooth muscle, exocrine glands, and heart • Dry mouth, constipation, urinary hesitancy/retention, blurred vision, photophobia, tachycardia – Nursing Interventions • Drug: Atropine – Action: for overactive bladder – Therapeutic Use: prevent or treat bradycardia, decrease GI motility, decrease secretions (salivary, bronchial, sweat glands, acid-secreting cells of stomach), dilate pupil, reverse muscarinic poisoning – Adverse Effects (BUDCAT) • Blurred vision, increased intraocular pressure • Urinary retention • Dry oral/bronchial secretions • Constipation • Anhidrosis • Tachycardia • Chloride • Sodium: 136-145 mEq/L • Potassium: 3.5-5 mEq/L • Chloride: 98-106 mEq/L • Calcium: 9.0-10 mg/dL • Magnesium: 1.3-2.1 mEq/L • Phosphorus: 3.0-4.5 mg/dL • Hematological • RBC • Hemoglobin • Hematocrit • Platelets • RBC – Female: 4.2-5.4 million/uL – Male: 4.7-6.1 million/uL • Hemoglobin – Female: 12-16 g/dL – Male: 14-18 g/dL • Hematocrit – Female: 37-47% – Male: 42-52% • Platelets: 150,000-400,000/mm3 • WBC: 5,000-10,000/mm3 – Leukopenia: < 4,500/mm3 – Leukocytosis: > 10,000/mm3 – Neutropenia: neutrophil count < 2,000/mm3 • PT: 11-12.5 seconds • INR: 0.7-1.8 • Renal • Serum BUN • Serum Protein • Serum Creatinine • Creatinine Clearance • Ammonia • Serum BUN: 10-20 mg/dL • Serum Protein: 6-8 g/dL • Serum Creatinine: 0.5-1.1 mg/dL • Creatinine Clearance – Females: 80-125 mL/min/m2 – Males: 90-139 mL/min/m2 • Aspartate Aminotransferase (AST): 5-40 units/L • Alanine Aminotransferase (ALT): 8-20 units/L; 3-35 IU/L • Alkaline Phosphatase (ALP): 30-120 units/L; 30-85 IU/L • Amylase: 56-90 IU/L – Elevation occurs with pancreatitis • Lipase: 0-110 units/L – Elevation occurs with pancreatitis • Direct (Conjugated) Bilirubin: 0.1-0.3 mg/dL • Indirect (Unconjugated Bilirubin): 0.2-0.8 mg/dL • Albumin: 3.5-5 g/dL – Decrease may indicate hepatic disease • Alpha-Fetoprotein: < 40 mcg/L – Elevated in liver cancer • Ammonia: 15-110 mcg/dL – Elevated in liver disease • Blood Glucose • Fasting Glucose: < 110 mg/dL – Determines blood glucose when no foods or fluids (other than water) have been consumed for the past 8 hours • Oral Glucose Tolerance Test: < 140 mg/dL – Determines ability to metabolize a standard amount of glucose • Glycosylated Hemoglobin (HbA1c) – Absence of DM: < 5% – Prediabetes: 5.7-6.4% – Diabetes: > 6.5% – Best indicator of an average blood glucose level for past 120 days – Assists in evaluating treatment effectiveness and compliance with the diet plan, medication regimen, and exercise schedule • Treatment for clients with HTN includes lifestyle modification and medications • Nursing Interventions (for all clients taking antihypertensive medications) • HTN Treatment: ABCD • Action – ACE Inhibitor: block conversion of angiotensin I to angiotensin II – ARBs: selectively block binding of angiotensin II to receptors found in tissue • Medications – ACE Inhibitor (-pril): Captopril, Enalapril, Enalaprilat (IV route), Fosinopril, Lisinopril – ARBs (-sartan): Losartan, Valsartan, Irbesartan • Therapeutic Use: HTN, HF, MI, diabetic neuropathy • Precautions/Interactions – Use with caution if diuretic therapy is in place – Monitor K+ levels (can cause hyperkalemia) • Side/Adverse Effects • Nursing Interventions and Client Education • Antihypertensives • Calcium Channel Blockers • Action: slows movement of Ca+ into smooth-muscle cells, resulting in arterial dilation and decreased BP • Medications (-dipine) • Therapeutic Use – Angina, HTN – Verapamil and Diltiazem may be used for atrial fibrillation, atrial flutter, or SVT • Precautions/Interactions – Use cautiously in clients taking digoxin and beta blockers – Contraindicated for clients who have HF, heart block, or bradycardia – Do not consume grapefruit juice (toxic effects) • Side/Adverse Effects – Constipation – Reflex tachycardia – Peripheral edema – Toxicity • Nursing Interventions and Client Education – Do not crush or chew sustained release tablets – Administer IV injection over 2-3 mins – Slowly taper dose if discontinuing – Monitor HR and BP • Antihypertensives • Alpha Adrenergic Blockers • (Sympatholytics; Alpha Antagonists) • Action: selectively inhibit alpha1 adrenergic receptors, resulting in peripheral arterial and venous dilation that lowers BP • Medications (-sin) – Prazosin – Doxazosin mesylate • Therapeutic Use – Primary HTN – Doxazosin mesylate may be used in treatment of benign prostatic hyperplasia (BPH) • Precautions/Interactions – Increased risk of hypotension and syncope (loss of consciousness due to fall in BP) if given with other antihypertensives, beta blockers, or diuretics – NSAIDs may decrease the effect of prazosin • Side/Adverse Effects – Dizziness – Fainting • Nursing Interventions and Client Education – Monitor HR and BP – Take medication at bedtime to minimize effects of hypotension – Advise to notify prescriber immediately about adverse reactions – Consult prescriber before taking any OTC medications • Antihypertensives • Centrally Acting Alpha2 Agonists • Action: stimulate alpha-adrenergic receptors (alpha2) in brain to reduce peripheral vascular resistance, HR, and systolic and diastolic BP • Medications – Clonidine – Guanfacine HCl – Methyldopa • Therapeutic Use – Primary HTN: may be used in combination with diuretics or other antihypertensives – Hypertensive crisis – Severe cancer pain (parenteral administration via epidural) • Precautions/Interactions – Contraindicated with anticoagulant therapy, hepatic failure – Do not administer to clients taking MAOIs – Do not administer methyldopa through IV line with barbiturates or sulfonamides – Use cautiously in CVA, MI, diabetes mellitus, major depression, or chronic renal failure – Do not use during lactation • Side/Adverse Effects – Dry mouth – Drowsiness and sedation (resolves over time) – Rebound HTN – Black or sore tongue – Leukopenia • Nursing Interventions and Client Education – Monitor for adverse CNS effects – Monitor CBC, HR, and BP – Assess for weight gain or edema – Monitor closely for rebound HTN when medication is discontinued (48 hr) – Instruct to never skip a dose – Take at bedtime to minimize effects of hypotension – Notify prescriber of any involuntary jerky movements, prolonged dizziness, rash, yellowing of skin • Antihypertensives • Beta Adrenergic Blockers (Sympatholytics) • Action: inhibit stimulation of receptor sites, resulting in decreased cardiac excitability, CO, myocardial oxygen demand; lower BP by decreasing release of renin in kidney – Beta1 receptors are primarily in cardiac and renal tissues – Beta2 receptors are found primarily in lungs, GI tract, liver, uterus, vascular smooth muscle, and skeletal muscle • Medications: may be selective or nonselective (-olol) – Cardioselective Beta1 Medications • Metoprolol • Atenolol • Metoprolol succinate – Nonselective (Beta1 and Beta2) Medications • Propranolol • Nadolol • Labetalol • Therapeutic Use – Primary HTN; angina; tachydysrhythmias, HF, and MI • Precautions/Interactions – Contraindicated in clients who have AV block and sinus bradycardia – Do not administer nonselective beta blockers to clients who have asthma, bronchospasm, or HF – Propranolol may mask effects of hypoglycemia in clients with diabetes mellitus – Do not administer labetalol in same IV line with furosemide • Side/Adverse Effects – Bradycardia – Nasal stuffiness – AV block – Rebound myocardium excitation if stopped abruptly – Bronchospasm • Nursing Interventions and Client Education – Administer 1-2X daily as prescribed – Do not discontinue without consulting provider – Do not crush (or chew) extended release tablets – Hold medication and notify provider if systolic BP < 100 mmHg or pulse < 60/min – Monitor clients with diabetes mellitus for indications of hypoglycemia • Antihypertensives • Vasodilators • Action: direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload) • Medications – Nitroglycerin • Enalaprilat • Nitroprusside • Hydralazine • Therapeutic Use: hypertensive emergencies • Precautions/Interactions – Clients who have hepatic or renal disease – Older adults – Electrolyte imbalances • Side/Adverse Effects – Dizziness – Headache – Profound hypotension – Cyanide toxicity – Thiocyanate poisoning • Nursing Interventions and Client Education – Nitroprusside may not be mixed with any medication – Apply protective cover to container – Discard unused fluid after 24 hr – Provide continuous ECG and BP monitoring • Cardiac Glycosides Used in treatment of clients who have cardiac failure or ineffective pumping mechanism of heart muscle • Action: increase force and velocity of myocardial contraction to improve SV and CO; slow conduction rate, allowing for increased ventricular filling • Medication: digoxin • Therapeutic Uses: HF; atrial fibrillation • Precautions/Interactions – Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity – ACE and ARBs increase risk of hyperkalemia – Verapamil increases risk of toxicity • Side/Adverse Effects – Digoxin toxicity: GI effects (anorexia, n/v, abdominal pain); CNS effects (fatigue, weakness, diplopia (double vision), blurred vision, yellow-green or white halos around objects) – Management of Digoxin Toxicity • Discontinue digoxin and potassium-wasting medications • Treat dysrhythmias and phenytoin or lidocaine • Treat bradycardia with atropine • For excess overdose, administer Digibind to prevent absorption • Nursing Interventions and Client Education – Assess apical pulse for 1 min prior to administration – Notify provider if HR < 60 (adult), < 70 (child), or < 90 (infant) – Monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia – Notify provider of any sudden increase in pulse rate that previously had been normal or low – Maintain therapeutic digoxin level • Antianginal Medications • Organic Nitrates – Action: relax peripheral vascular smooth muscles, resulting in dilation of arteries and veins, thus reducing venous blood return (reduced preload) to the heart, which leads to decreased O2 demands on the heart; increase myocardial O2 supply by dilating large coronary arteries and redistributing blood flow – Medications • Nitrostat (sublingual) • Nitrolingual (translingual spray) • Nitro-Bid (topical ointment) • Nitro-Dur (transderm patch) • Therapeutic Uses: acute angina attack; prophylaxis of chronic stable or variant angina • Precautions/Interactions: contraindicated in clients with head injury; hypotensive risk with antihypertensive medications; erectile dysfunction medications; life-threatening hypotension • Side/Adverse Effects – Headache – Orthostatic hypotension – Reflex tachycardia – Tolerance • Nursing Interventions and Client Education – Nitrostat/Nitrolingual (sublingual and translingual spray) • Administer sublingual; repeat in 5 mins if no relief and call 911; may take up to 3 doses • Keep Nitrostat in original dark container; Do not shake Nitrolingual canister (forms bubbles) • Nitrolingual may be used prophylactically 5-10 mins before exercise • Replace NTG tablets every 6 months • Wear medical alert ID – Nitro-Bid (topical ointment) • Wear gloves for administration • Do not massage or rub area; Apply to area without hair (chest, flank, or upper arm preferable) • Cover area where patch is placed with clear plastic wrap and tape in place • Gradually reduce dose and frequency of application over 4-6 weeks – Nitro-Dur (transderm patch) • Skin irritation may alter medication absorption • Optimal locations for patch are upper chest or side; pelvis; and inner, upper arm • Rotate skin sites daily • Antidysrhythmic Agents • Action: complex agents with multiple mechanisms of action; classified according to their effects on the electrical conduction system of heart (Class I, II, III, IV) • Medications – Adenosine: slows conduction time through AV node, interrupts AV node pathways to restore NSR • Therapeutic Use: convert supraventricular tachycardia (SVT) to sinus rhythm • Side/Adverse Effects: flushing, nausea; bronchospasm, prolonged asystole • Nursing Interventions: rapid IV (1-2 second) push; flush immediately with NS – Amiodarone: prolongs repolarization, relaxes smooth muscles, decreases vascular resistance • Therapeutic Use: ventricular fibrillation, unstable ventricular tachycardia • Side/Adverse Effects: bradycardia; cardiogenic shock; pulmonary disorders • Nursing Interventions: incompatible with heparin; may be given in PO maintenance dose; monitor for respiratory complications – Atropine: increases firing of SA node and conduction through AV node of heart, opposes actions of vagus nerve by blocking acetylcholine receptor sites (anticholinergic) • Therapeutic Use: bradycardia, known exposure to chemical nerve agent (AtroPEN) • Side/Adverse Effects: when used for life-threatening emergency, has no contraindications • Nursing Interventions: monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation • Precautions/Interactions – Toxicity is a major concern due to additive effects – Caution is needed when used with an AV block – Caution is needed when using anticholinergic medications • Antilipemic Medications • Overview • Action: aid in lowering LDL levels and increase HDL levels; therapy includes diet, exercise, and weight control • Therapeutic Uses – Primary hypercholesterolemia – Prevention of coronary events – Protection against MI and stroke in clients with diabetes • Precautions/Interactions – Should be discontinued during pregnancy – Use with caution in renal dysfunction • Side/Adverse Effects – Muscle aches – Hepatotoxicity – Myopathy – Rhabdomyolysis – Peripheral neuropathy • Nursing Interventions and Client Educations – Take medication in the evening (cholesterol synthesis increases) – Monitor liver and renal function laboratory profiles – Low fat, high fiber diet – Note dietary precautions with specific classes • Antilipemic Medications • Statin Medications • Cholesterol Absorption Inhibitor • Statin Medications – Action: interfere with hepatic enzyme HMG COA to reduce formation of cholesterol precursors – Medications • Simvastatin • Lovastatin • Pravastatin sodium • Rosuvastatin • Fluvastatin – Precautions/Interactions • Prolonged bleeding in clients taking warfarin • Multiple drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDs, tetracycline, beta-blocking agents, gemfibrozil, glipizide, glyburide, oral contraceptives, and phenytoin • Muscle pains, myalgia's, rhabdomyalagias – Nursing Interventions and Client Education • Do not administer with grapefruit juice • Monitor liver function • Cholesterol Absorption Inhibitor – Action: inhibits absorption of cholesterol secreted in bile and from food; often used in combination with other antilipemic medications – Medications • Ezetimibe – Nursing Interventions and Client Education • Take 1 hr before and 4 hr after other antilipemics • Risk of liver damage increased when combined with statins • Respiratory Medications • Beta2 Adrenergic Agonists • Methylxanthines • Inhaled Anticholinergics • Glucocorticoids • Leukotriene Modifiers • Antitussives, Expectorants, Mucolytics • Decongestants, Antihistamines • Respiratory Medications • Overview Medications used to treat chronic inflammatory conditions caused by asthma, bronchitis, and emphysema • Treatment for chronic respiratory disorders often includes multiple drug therapies. When administered as inhalation therapies, the following guidelines should be implemented – Advise to take beta2 agonist before inhaled glucocorticoid to increase steroid absorption – Instruct on procedures for inhalation • Remove mouthpiece cap • If appropriate for medication, shake container • Stand up or sit upright; exhale deeply • Place mouthpiece between teeth, and close lips tightly around inhaler • While breathing in, press down on inhaler to activate and release the medication; continue breathing in slowly for several more seconds (slow, long, steady inhalation is better than quick, short breaths) • Hold breath for 5-10 secs • Breathe in/out normally – Examine mouth for irritation – Perform frequent oral care • Beta2 Adrenergic Agonists • Action: promote bronchodilation by activating beta2 receptors in bronchial smooth muscle • Medications – Albuterol • Route/Onset: inhaled (short-acting); few mins • Use: acute bronchospasm – Formoterol, Salmeterol • Route/Onset: inhaled (long-acting); 15-20 mins, lasts 12 hrs • Use: long-term control of asthma – Terbutaline • Route/Onset: oral (long-acting) • Use: long-term control of asthma • Precautions/Interactions – Contraindicated for clients with tachydysrhythmias – Caution: diabetes mellitus, hyperthermia, heart disease, HTN, angina – Beta blockers will reduce effects – MAOIs will increase effects • Side/Adverse Effects – Tachycardia, palpitations – Tremors • Nursing Interventions and Client Education – Caution against using salmeterol more frequently than every 12 hrs • Methylxanthines • Action: relaxation of bronchial smooth muscle, resulting in bronchodilation • Medications – Aminophylline – Theophylline • Therapeutic Uses – Relief of bronchospasm – Long-term control of asthma • Precautions/Interactions – Contraindicated with active peptic ulcer disease (PUD) – Caution: diabetes mellitus, hyperthyroidism, heart disease, HTN, angina – Do not mix parenteral form with other medications – Phenobarbital and phenytoin decrease theophylline levels – Caffeine, furosemide, cimetidine, fluoroquinolones, acetaminophen, and phenylbutazone falsely elevate therapeutic levels • Side/Adverse Effects – Irritability and restlessness – Toxic effects: tachycardia, tachypnea, seizures • Nursing Interventions and Client Education – Monitor therapeutic levels for aminophylline and theophylline (10-20 mcg/mL) – Avoid caffeine intake – Monitor for signs of toxicity – Smoking will decrease effects – Alcohol abuse will increase effects • Treatment of Toxicity – Stop parenteral infusion – Activated charcoal to decrease absorption in oral overdose – Lidocaine for dysrhythmias – Diazepam to control seizures • Inhaled Anticholinergics • Action: muscarinic receptor blocker resulting in bronchodilation • Medications – Ipratropium – Tiotropium • Therapeutic Uses – Prevent bronchospasm – Manage allergen or exercise induced asthma – COPD • Precautions/Interactions – Contraindicated for clients with peanut allergy (contains soy lecithin) – Use extreme caution with narrow-angle glaucoma and BPH – Do not use for treatment of acute bronchospasm • Side/Adverse Effects – Dry mouth and eyes – Urinary retention • Nursing Interventions and Client Education – Instruct client that maximum effects may take up to 2 weeks – Shake inhaler well before administration – When using two different inhaled medications, wait 5 mins between – If administered via nebulizer, use within 1 hr of reconstitution • Glucocorticoids • Action: prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function • Medications – Oral: Prednisone, Prednisolone, Betamethasone – Inhalation: Beclomethasone dipropionate; Budesonide; Fluticasone propionate; Triamcinolone acetonide – IV: Hydrocortisone sodium succinate; Methylprednisolone sodium succinate; Betamethasone sodium phosphate • Respiratory Therapeutic Uses – Short-term • IV agents: status asthmaticus • Oral: treatment of symptoms following an acute asthma attack – Long-term • Inhaled: prophylaxis of asthma • Oral: treatment of chronic asthma • Precautions/Interactions – Clients who have diabetes mellitus may require higher doses – Never stop medication abruptly • Side/Adverse Effects – Euphoria, insomnia, psychotic behavior – Hyperglycemia – Peptic ulcer – Fluid retention (increased appetite) – Withdrawal symptoms • Nursing Interventions and Client Education – Assess client activity and behavior – Administer medication with meals – Teach symptoms to report – Do not take with NSAIDs – Teach client about gradual reduction of dose to prevent Addisonian crisis • Leukotriene Modifiers • Action: prevent effects of leukotriene resulting in decreased inflammation, bronchoconstriction, airway edema, and mucus production • Medications – Montelukast – Zileuton – Zafirlukast • Therapeutic Uses – Long term management of asthma in adults and children > 15 yrs – Prevention of exercise induced bronchospasm • Precautions/Interactions – Do not use for acute asthma attack – Zileuton or Zafirlukast: high risk of liver disease, increased warfarin effects, and theophylline toxicity – Phenobarbital will decrease circulating levels of montelukast – Chewable tablets contain phenylalanine • Side/Adverse Effects – Elevated liver enzymes (zileuton or zafirlukast) – Warfarin and theophylline toxicity (zileuton or zafirlukast) • Nursing Interventions and Client Education – Never abruptly substitute for corticosteroid therapy – Teach client to take daily – Do not decrease or stop taking other prescribed asthma drugs until instructed – If using oral granules, pour directly into mouth or mix with cold soft foods (never liquids) – Use open packets within 15 mins • Antitussives, Expectorants, Mucolytics • Action – Antitussives: hydocodone, codeine • Action: suppress cough through action in CNS • Therapeutic Use: chronic nonproductive cough – Expectorants: guaifenesin (Mucinex) • Action: promote increased mucous secretion to increase cough production • Therapeutic Use: often combined with other agents to manage respiratory disorders – Mucolytics: acetylcysteine, hypertonic saline • Action: enhance flow of secretions in respiratory tract • Therapeutic Use: acute and chronic pulmonary disorders with copious secretions; cystic fibrosis; antidote for acetaminophen poisoning • Precautions/Interactions – Only saline solutions should be used in children younger than 2 yrs – Opioid antitussives have potential for abuse – Caution with OTC medications  potentiate effects • Side/Adverse Effects – Drowsiness – Dizziness – Aspiration and bronchospasm risk with mucolytics – Constipation • Nursing Interventions and Client Education – Monitor cough frequency, effort, and ability to expectorate – Monitor character, tenacity of secretions – Auscultate for adventitious lung sounds – Teach client why multiple therapies are needed – Promote fluid intake • Decongestants, Antihistamines • Decongestants – Action: stimulate alpha1 adrenergic receptors, causing reduced inflammation of nasal membranes – Therapeutic Use: allergic rhinitis, sinusitis, common cold – Medications: phenylephrine, ephedrine, naphazoline, phenylpropanolamine • Antihistamines – Action: decrease allergic response by competing for histamine receptor sites – Therapeutic Use: relieve/prevent hypersensitivity reactions – Medications: diphenydramine (Benadryl), loratadine, cetirizine, fexofenadine, desloratadine • Precautions/Interactions – Use cautiously in clients with HTN, glaucoma, peptic ulcer disease, and urinary retention – Children may have symptoms of excitation, hallucinations, incoordination, and seizures – Avoid alcohol intake – Products containing pseudoephedrine should not be used longer than 7 days • Side/Adverse Effects – Anticholinergic effects – Drowsiness • Nursing Interventions and Client Education – Assess for hypokalemia – Monitor BP – Teach client to manage anticholinergic effects – Advise to take at night • Endocrine Medications • Oral Hypoglycemics • Insulin • Glycemic Agent • Thyroid Hormone • Thyroid Hormone Antagonist • Anterior Pituitary/Growth Hormones • Posterior Pituitary Hormones/Antidiuretic Hormones • Adrenal Hormone Replacement • Oral Hypoglycemics Used in conjunction with diet and exercise to control glucose levels in clients who have type 2 DM • Precautions/Interactions – Caution in clients with renal, hepatic, or cardiac disorders – Generally avoided during pregnancy and lactation; instruct client to discuss with prescriber • Medications – Alpha-glucosidase Inhibitors: Acarbose, Miglitol • Action: slows carbohydrate absorption and digestion • Precautions/Indications: contraindicated in clients with intestinal disease due to increased gas formation – Biguanides: Metformin • Action: reduces gluconeogenesis; increases uptake of glucose by muscles • Precautions/Indications: withhold 48 hr prior to and 48 hr after test with contrast media; contraindicated in clients with severe infection, shock, hypoxic conditions – Gliptins: Sitagliptin • Action: promotes release of insulin, lowers glucagon secretion and slows gastric emptying • Precautions/Indications: caution with impaired renal function – dose will be reduced – Meglitinides: Repaglinide, Nateglinide • Action: reduces production of glucose within the liver through suppression of gluconeogenesis; increases muscle uptake and use of glucose • Precautions/Indications: should not be used with NPH insulin due to risk of angina – Sulfonylureas: Glipizide, Glyburide • Action: promotes release of insulin from pancreas • Precautions/Indications: extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders – Thiazolidinediones: Rosiglitazone, Pioglitazone • Action: decreases insulin resistance • Precautions/Indications: high risk of CHF due to fluid retention • Nursing Interventions and Client Education – Teach signs and management for hypoglycemia, especially with sulfonylureas – Encourage diet and exercise to follow American Diabetes Association recommendations – Monitor glycosylated hemoglobin (HbA1C) – Refer to diabetic nurse educator • Insulin • Rapid-acting: Lispro (Humalog) – Onset: < 15 mins – Peak: 0.5-1 hr – Duration: 3-4 hrs • Short-acting: Regular (Humulin R) – Onset: 0.5-1 hr – Peak: 2-3 hrs – Duration: 5-7 hrs • Therapeutic Uses – Glycemic control of DM (type 1, type 2, gestational) to prevent complications; Clients taking oral hypoglycemic agents may require insulin when: undergoing diagnostic tests; pregnant; severe kidney or liver disease is present; oral agents are inefficient; treatment of hyperkalemia • Precautions/Interactions – When mixing regular with NPH insulin, draw up regular first – Do not mix other insulins with lispro, glargine, or combination 70/30 – Only regular insulin is given IV (only in NS) – Administer glargine at bedtime • Side/Adverse Effects – Hypoglycemia/hyperglycemia – Lipodystrophy • Nursing Interventions and Client Education – Monitor serum glucose levels before meals and at bedtime or patterned schedule-specific to client – Roll vial of insulin (except regular) to mix; do not shake – Instruct client to rotate injection sites to prevent lipodystrophy – Teach signs and management of hypoglycemia/hyperglycemia – Encourage diet and exercise to follow ADA recommendations – Monitor glycosylated hemoglobin (HbA1c) – Refer to diabetic nurse educator • Glycemic Agent • Action: initiates regulatory processes to promote breakdown of glycogen to glucose in the liver, resulting in increased serum glucose levels • Medications – Glucagon • Therapeutic Uses – Emergency treatment of severe hypoglycemia • Precautions/Interactions – Do not mix with sodium chloride or dextrose solutions • Side/Adverse Effects – Nausea and vomiting – Rebound hypoglycemia • Nursing Interventions and Client Education – Administer medication for unresponsive client – Monitor blood glucose levels – Instruct client to self-monitor for early signs of hypoglycemia – Instruct client to wear medical alert ID – Advise client to teach family members how to administer medication – Provide carbohydrates when client awakens from hypoglycemic reaction • Thyroid Hormone • Action: stimulates metabolism of all body systems by accelerating rate of cellular oxygenation • Medications – Levothyroxine/T4 • Therapeutic Uses – Hypothyroidism – Emergency treatment of myxedema coma • Precautions/Interactions – Overmedication can result in signs of hyperthyroidism • Side/Adverse Effects – Tachycardia – Restlessness – Diarrhea – Weight loss – Decreased bone density – Heat intolerance – Insomnia • Nursing Interventions and Client Education – Monitor cardiac system – Therapy initiated with low doses; advance to higher dosages while monitoring lab values – Monitor T4 and TSH levels – Take in early morning • Thyroid Hormone Antagonist • Action: inhibits synthesis of thyroid hormone • Medication – Methimazole • Therapeutic Uses – Hyperthyroidism – Preoperative thyroidectomy – Thyrotoxic crisis – Thyroid storm • Precautions/Interactions – Administer with caution to clients who have bone marrow depression, hepatic disease, or bleeding disorders – Discontinue prior to radioactive iodine uptake testing – Contraindicated with breastfeeding • Side/Adverse Effects – Skin rash, pruritus – Abnormal hair loss – GI upset – Paresthesias – Periorbital edema – Joint and muscle pain – Jaundice – Agranulocytosis – Thrombocytopenia • Nursing Interventions and Client Education – Administer with food at same time each day – Increase fluids to 3 L/day – Instruct client to avoid OTC products containing iodine – Instruct client to take medication as prescribed – If discontinuing dose must be tapered off – Monitor client for therapeutic response: weight gain, decreased pulse, BP, and T4 levels – Monitor client for signs of overdose: periorbital edema, cold intolerance, mental depression • Anterior Pituitary/Growth Hormones • Action: increase production of insulin-like growth factor throughout the body • Medications – Somatropin – Somatrem • Therapeutic Use – Treat growth hormone deficiencies – Turner’s syndrome • Precautions/Interactions – Contraindicated in clients who are severely obese – Therapy must be discontinued prior to epiphyseal closure – Avoid concurrent use of glucocorticoids • Side/Adverse Effects – Hyperglycemia – Hypothyroidism • Nursing Interventions and Client Educations – Monitor growth patterns – Reconstitute medication (Do not shake) – Administer subcutaneous per protocol – Dose is individualized • Posterior Pituitary Hormones/Antidiuretic Hormones • Action: promote reabsorption of water with the kidneys; vasoconstriction of vascular smooth muscle • Medications – Desmopressin (DDAVP): oral, intranasal, subcutaneous, IV – Pitressin (Vasopressin): intranasal, subcutaneous, IV • Therapeutic Uses – Diabetes insipidus – Cardiac arrest – Nocturnal enuresis • Precautions/Interactions – Contraindicated in client with chronic nephritis or high risk for myocardial infarction • Side/Adverse Effects – Hyponatremia – Seizures – Coma • Nursing Interventions and Client Education – Monitor urine specific gravity – Monitor BP – Monitor urinary output – Prevent hyponatremia due to water intoxication – Instruct for use of nasal spray • Adrenal Hormone Replacement • Action: anti-inflammatory suppresses immune response • Medications – Dexamethasone – Hydrocortisone – Fludrocortisone acetate – Prednisone • Therapeutic Uses – Acute and chronic replacement for adrenocortical insufficiency (Addison’s disease) – Inflammation, allergic reactions, cancer • Precautions/Interactions – Contraindicated in clients who have systemic fungal infection – Caution in clients who have hypertension, gastric ulcers, diabetes, osteoporosis – Requires higher doses in acute illness or extreme stress • Side/Adverse Effects – Adrenal suppression when administered for inflammation, allergic reactions – Infection – Hyperglycemia – Osteoporosis – GI bleeding – Fluid retention • Nursing Interventions and Client Education – Do not skip doses – Monitor BP – Monitor fluid and electrolyte (F&E) balance, weight, and output – Monitor for signs of bleeding and GI discomfort – Teach client to take calcium supplements and maintain vitamin D levels – Give with food – Taper off dose regimen when discontinuing medications – Provide immunoprotection • Hematologic Medications • Blood and Blood Products • Hematopoietic Growth Factors • Iron Preparations • Anticoagulants • Antiplatelets • Thrombolytics • Blood and Blood Products • Whole Blood • Packed RBCs (PRBCs) • Platelets • Whole Blood – Time Completed: 2-4 hrs – Action/Therapeutic Action • Replace volume • Hemorrhage • Surgery • Trauma • Burns • Shock – Monitor for Reaction: Acute hemolytic; Febrile; Anaphylactic; Mild allergic; Sepsis • Packed RBCs – Time Completed: 2-4 hrs – Action/Therapeutic Action • Increase available RBC • Severe anemia • Hemoglobinopathies • Hemolytic anemia • Erythroblastosis fetalis – Monitor for Reaction: Acute hemolytic; Febrile; Anaphylactic; Mild allergic; Sepsis • Platelets – Time Completed: 15-30 mins – Action/Therapeutic Action • Increase platelet count • Active bleeding • Thrombocytopenia • Aplastic anemia • Bone marrow suppression – Monitor for Reaction: Febrile; Sepsis • Blood and Blood Products • Frozen Fresh Plasma (FFP) • Pheresed Granulocytes • Albumin • FFP – Time Completed: 30-60 mins – Action/Therapeutic Action • Replace clotting factors • Hemorrhage • Burns • Shock • Thrombotic thrombocytepenic purpura (TTP) • Reverse effects of warfarin – Monitor for Reaction: Acute hemolytic; Febrile; Anaphylactic; Mild allergic; Hypervolemia; Sepsis • Pheresed Granulocytes – Time Completed: 45-60 mins – Action/Therapeutic Action • Severe neutropenia • Neonatal sepsis • Neutrophil dysfunction – Monitor for Reaction: Acute hemolytic; Febrile; Anaphylactic; Mild allergic; Hypervolemia; Sepsis • Albumin – Time Completed: 5% (1-10 mL/min); 25% (4 mL/min) – Action/Therapeutic Action • Expand volume via oncotic changes • Hypovolemia • Hypoalbuminemia • Burns • Severe nephrosis • Hemolytic disease of the newborn – Monitor for Reaction: risk for hypovolemia and pulmonary edema • Blood and Blood Products • Nursing Interventions and Client Education • Nursing Interventions and Client Educations – Client ID, name, and blood type must be verified by two nurses – Prior to administration, assess baseline v/s, including temperature – Establish IV access, 18 gauge or larger catheter – Must have 0.9% sodium chloride (NS) primed tubing – For first 15 mins, stay with client and infuse slowly, monitoring for any reaction; if reaction occurs, perform the following interventions • Stop blood immediately and take v/s • Infuse 0.9% sodium chloride • Notify the provider • Follow facility policy (send urine sample, CBC, and back and tubing to lab for analysis) – Complete infusion of produce within 4 hrs • Hematopoietic Growth Factors • Action: stimulate bone marrow to synthesize specific blood cells • Medications – Epoetin alfa (Procrit) • Therapeutic Uses – Stimulate RBC production – Anemia related to CKD, Retrovir therapy, chemotherapy • Side/Adverse Effects: HTN • Nursing Interventions – Subcutaneous or IV  do not agitate vial; monitor Hct – Filgrastim (Neupogen) injection; Pegfilgrastim (Neulasta) IV over 2-4 hours • Therapeutic Uses – Stimulate WBC production – Neutropenia related to cancer • Side/Adverse Effects: bone pain; leukocytosis (WBC > 10,000/mm3) • Nursing Interventions – Subcutaneous or IV; Do not agitate vial; Monitor CBC – Oprelvekin (Neumega) • Therapeutic Uses – Stimulate platelet production – Thrombocytopenia related to cancer • Side/Adverse Effects: fluid retention; papilledema; cardiac dysrhythmia • Nursing Interventions – Administer within 6-12 hrs after chemotherapy; subcutaneous • Iron Preparations • Oral • Intramuscular • Oral – Dilute liquid preparations with juice or straw and administer with a plastic straw or medication dosing syringe (avoid contact with teeth; stains teeth) – Encourage orange juice fortified with Vitamin C  facilitates absorption – Avoid antacids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hr after administration due to decreased absorption – Monitor client for constipation and GI upset • Intramuscular – Use a large bore needle (19-20 gauge, 3 inch) – Change needle after drawing up from vial – Z track (ventrogluteal preferable), never in deltoid muscle – Do not massage injection site • Anticoagulants • Heparin and Enoxaparin (Parenteral Medication) • Action – Modify or inhibit clotting factors or cellular properties to prevent clot formation – Enoxaparin prevents conversion of prothrombin to thrombin by inactivating coagulation enzymes • Therapeutic Uses – Evolving stroke – Pulmonary embolism – Massive DVT – Cardiac catheterization – MI – DIC • Precautions/Interactions – Must be given subcutaneous or IV – Incompatible with many medications (any bicarbonate base) – Avoid NSAIDs, aspirin, or medications containing salicylates • Side/Adverse Effects – Hemorrhage – Heparin-induced thrombocytopenia – Toxicity/overdose • Nursing Interventions and Client Education – Clients receiving heparin: monitor aPTT every 4-6 hrs for IV administration; aPTT ~ 60-80 seconds – Monitor for signs of bleeding – Safety precautions to prevent bleeding – Administer subcutaneous heparin to abdomen, 2 inches from umbilicus (do not aspirate or massage) – Rotate injection sites and observe for bleeding or hematoma – Administer protamine sulfate for heparin toxicity (1 mg neutralizes 100 units of heparin) • Anticoagulants • Warfarin (Oral Medication) • Action: prevents synthesis of coagulation factors VII, IX, X, and prothrombin • Therapeutic Uses – Venous thrombosis – Thrombus prevention for clients with atrial fibrillation or prosthetic heart valves – Prevention of recurrent MI – TIAs • Precautions/Interactions – Not safe for use during pregnancy – Contraindications: thrombocytopenia, Vitamin K deficiency, liver disease, alcohol use disorder – Decreased effects with phenobarbital, carbamazepine, phenytoin, oral contraceptives – Food sources high in Vitamin K may decrease effects • Side/Adverse Effects – Hemorrhage – Toxicity/overdose • Nursing Interventions and Client Education – Administer once daily – Monitor INR (most accurate) or PT • INR: Therapeutic  2-3; Clients with recurrent systemic embolism  3-4.5 • PT: Therapeutic  18-24 seconds – Teach client that bleeding risk remains up to 5 days after discontinued therapy – Teach client to avoid NSAIDs and medications with aspirin – Teach client to wear medical alert bracelet – Client may self monitor for PT/INR – Teach measures to prevent injury and bleeding – Administer Vitamin K for warfarin toxicity – Garlic, ginger, gingko, and ginseng may increase risk of bleeding • Anticoagulants • Dabigatran (Oral Medication) • Action: prevents thrombus formation by directly inhibiting thrombin formation • Therapeutic Use – Reduces risk of stroke and embolism for clients with nonvalvular atrial fibrillation • Precautions/Interactions – Caution when client is making a change in medication if currently receiving warfarin (must discontinue warfarin and start dabigatran when INR is below 2.0) – When possible, discontinue 1-2 days prior to surgical procedures • Side Effects/Adverse Effects – Bleeding – GI discomfort • Nursing Interventions and Client Education – Teach client to take medication daily and avoid skipping doses – If dose is missed, it should not be taken within 6 hrs of next scheduled dose – Tablets should not be crushed, broken, or chewed – Teach client to avoid NSAIDs and medications with aspirin – Teach client to monitor for signs of GI bleeding – Antiplatelets • Action: prevent platelets from aggregating (clumping together) by inhibiting enzymes and factors that normally promote clotting • Medications – Aspirin – Abciximab – Clopidogrel – Ticlopidine – Pentoxifylline – Dipyramidamole • Therapeutic Uses – Prevention of acute MI or acute coronary syndromes – Prevention of stroke – Intermittent claudication • Precautions/Interactions – Contraindicated in thrombocytopenia – Caution with peptic ulcer disease • Side/Adverse Effects – Prolonged bleeding – Gastric bleeding – Thrombocytopenia • Nursing Interventions and Client Education – Monitor for signs of prolonged bleeding – Teach client to report tarry stool, ecchymosis • Thrombolytics • Action: dissolve cloths that have already formed by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors • Medications (-plase) – Alteplase – Tenecteplase – Reteplase • Therapeutic Uses – Acute MI – DVT – Massive PE – Ischemic stroke (alteplase) • Precautions/Interactions – Contraindicated for intracranial hemorrhage, active internal bleeding, aortic dissection, brain tumors – Use caution when using in clients who have severe HTN – Concurrent use of anticoagulants or antiplatelet medications increases risk for bleeding • Side/Adverse Effects – Serious bleeding risks from recent wounds, puncture sites, weakened vessels – Hypotension – Possible anaphylactic reaction • Nursing Interventions and Client Education – Administration must take place within 4-6 hrs of symptom onset – Continuous monitoring is required – Clients will begin anticoagulant therapy to prevent repeated thrombotic event • Gastrointestinal Medications • Antacids • Antisecretory/Blocking Agents • Proton Pump Inhibitors • Histamine2 Receptor Antagonists • Mucosal Protectants • Antiemetics • Antidiarrheals • Stool Softeners/Laxatives • Antacids • Action: neutralize gastric acid and inactive pepsis • Medications – Aluminum hydroxide • Side/Adverse Effects: constipation; hypophosphatemia – Magnesium hydroxide (Milk of Magnesia) • Side/Adverse Effects: diarrhea; renal impairment; hypermagnesemia – Sodium bicarbonate • Side/Adverse Effects: constipation • Therapeutic Uses – Peptic ulcer disease – GERD • Nursing Interventions and Client Education – Do not administer to clients who have GI perforation or obstruction – Clients who have renal impairment should only use aluminum-based preparations – Other medications should be taken 1 hr before or after antacids – Require repeated doses up to 7 times/day: 1 hr and 3 hrs after meals and at bedtime • Antisecretory/Blocking Agents • Proton Pump Inhibitors • Action: Prevent or block selected receptors within the stomach • Therapeutic Uses – Gastric and peptic ulcers – GERD – Zollinger-Ellinson syndrome • Medications (-azole) – Omeprazole – Lansoprazole – Rabeprazole sodium – Esomeprazole • Precautions/Interactions – Omeprazole promotes increased risk of infection; use with caution in COPD – Digoxin levels may increase with omeprazole – Long-term therapy has increased risk of gastric cancer and osteoporosis • Side Effects/Adverse Effects – Low incidence of diarrhea, nausea, and vomiting – Can increase risk of fractures, pneumonia, and acid rebound • Nursing Interventions and Client Education – Do not crush, chew, or break tablets – Notify prescriber of any sign of GI bleeding – Teach client to take medication as scheduled • Antisecretory/Blocking Agents • Histamine2 Receptor Antagonists • Action: Prevent or block selected receptors within the stomach • Therapeutic Uses – Gastric and peptic ulcers – GERD – Zollinger-Ellinson syndrome • Medications (-tidine) – Ranitidine hydrochloride – Cimetidine – Nizatidine – Famotidine • Precautions/Interactions – May cause toxicity for clients taking phenytoin, warfarin, theophylline, and lidocaine – Cimetidine promotes increased risk of infection; use with caution in COPD • Side Effects/Adverse Effects – Decreased libido/impotence – Lethargy, depression, confusion • Nursing Interventions and Client Education – Instruct clients to seek appropriate care (many take OTC preparations) – Instruct client to follow medication regimen – Ranitidine can be taken with or without food – Instruct client to modify diet as prescribed – Mucosal Protectants • Sucralafate – Action: adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hrs; has no systemic effects – Therapeutic Uses • Gastric and duodenal ulcers • GERD – Nursing Interventions and Client Education • Administer on an empty stomach at least 1 hr before meals • Do not administer within 30 mins of antacids • Antiemetics • Action: multiple classifications of medications that affect GI tract or “vomiting center” of brain to reduce nausea/vomiting • Therapeutic Uses – Postoperative – Chemotherapy – Nausea/vomiting associated with disease process • Medications – Promethazine • Side/Adverse Effects: drowsiness; anticholinergic effects; extrapyramidal side effects (EPSs); potentiates effects when given narcotics • Nursing Interventions: monitor v/s; safety precautions; IM-large muscle – Metoclopramide • Side/Adverse Effects: drowsiness; anticholinergic effects; restlessness; EPSs; tardive dyskinesia • Nursing Interventions: instruct client about rapid GI emptying; discontinue with signs of EPSs – Ondanesetron • Side/Adverse Effects: headache; EPSs • Nursing Interventions: administer tablets 30 mins prior to chemotherapy and 1-2 hrs before radiation – Scopolamine • Side/Adverse Effects: blurred vision; sedation; anticholinergic effects • Nursing Interventions: do not use with angle-closure glaucoma; apply transdermal patches behind ear; use lubricating eye drops • Antidiarrheals • Action: activate opioid receptors in GI tract to decrease intestinal motility and to increase absorption of fluid and sodium in the intestine • Medications – Diphenoxylate plus atropine (Lomotil) – Loperamide (Imodium) • Precautions – Increased risk of megacolon for clients who have IBS – May cause drowsiness or dizziness • Nursing Interventions and Client Education – Monitor fluids and electrolytes – Avoid caffeine intake (increases GI motility) • Stool Softeners/Laxatives • Medications – Psyllium (Metamucil) • Therapeutic Uses: decrease diarrhea (bulk-forming) – Docusate sodium (Colace) • Therapeutic Uses: relieve constipation (surfactant) – Bisacodyl (Dulcolax) • Therapeutic Uses: preprocedure colon evacuation (stimulant) – Magnesium hydroxide (Milk of Magnesia) • Therapeutic Uses: prevent painful elimination (low-dose osmotic); promote rapid evacuation (high-dose osmotic) • Nursing Interventions and Client Education – Contraindicated with fecal impaction, bowel obstruction, and acute surgical abdomen – Encourage regular exercise and promote regular bowel elimination – Monitor for chronic laxative use/abuse – Provide adequate fluid intake to avoid obstruction • Urinary System Medications • Diuretics • Osmotic Diuretics • Alpha Adrenergic Blockers for Urinary Hesitancy • Anticholinergic Medications for Overactive Bladder • Sexual Dysfunction • Loop and Thiazide Diuretics • Action: increase amount of fluid excretion via renal system • Therapeutic Uses – Pulmonary edema caused by HF – Edema unresponsive to other diuretics • Medications – Loop Diuretics • Furosemide • Bumetanide – Thiazide Diuretics • Hydrochlorothiazide • Chlorothiazide • Precautions/Interactions – Use cautiously in clients who have DM – Contraindicated in pregnancy – NSAIDs reduce diuretic effect • Side/Adverse Effects – Hypovolemia – Ototoxicity – Hypokalemia, hyponatremia, hyperglycemia – Digoxin toxicity – Lithium toxicity • Nursing Interventions and Client Education – Monitor I&O – Monitor v/s – Monitor fluid and electrolyte imbalances – Administer early morning to prevent nocturia – Instruct clients to increase intake of foods high in potassium • Potassium Sparing Diuretics • Action: increase amount of fluid excretion via renal system • Therapeutic Uses – Pulmonary edema caused by HF – Edema unresponsive to other diuretics • Medications – Spironolactone – Triamterene • Precautions/Interactions – Use cautiously in clients who have DM – Contraindicated in pregnancy – NSAIDs reduce diuretic effect • Side/Adverse Effects – Hyperkalemia – Endocrine effects (impotence, menstrual irregularities) • Nursing Interventions and Client Education – Monitor I&O – Monitor v/s – Monitor fluid and electrolyte imbalances – Administer early morning to prevent nocturia – Instruct clients to avoid salt substitutes • Osmotic Diuretics • Action: pull fluid back into vascular and extravascular space by increasing serum osmolality to promote osmotic changes • Medication – Mannitol • Therapeutic Uses – Prevent renal failure related to hypovolemia – Decrease intracranial pressure related to cerebral edema – Decrease intraocular pressure • Precautions/Interactions – Use with caution in HF – May increase digoxin levels due to hypokalemia • Side/Adverse Effects – Pulmonary edema – Fluid and electrolyte imbalances – Thirst, dry mouth • Nursing Interventions and Client Education – Monitor daily weight, I&O, and electrolytes – Monitor for signs of hypovolemia – Monitor neurological status • Alpha Adrenergic Blockers • For Urinary Hesitancy • Tamsulosin (Flomax) – Action: inhibits smooth muscle contraction in prostate, which improves the rate of urine flow for clients with BPH – Precautions/Interactions • Must rule out bladder cancer prior to administering • Combined use with cimetidine may facilitate toxicity – Side/Adverse Effects: may cause decreased libido, reduced ejaculate – Nursing Interventions and Client Education • Take 30 mins after meal at same time each day • Teach client to contact prescriber if greater than 4 doses are missed • Bethanechol (Urecholine) – Action: increases detrusor muscle tone to allow strong start to voiding in clients with postoperative urinary hesitancy – Precautions/Interactions • Do not administer IV or IM • Contraindicated for clients with hypotension or decreased cardiac output – Side/Adverse Effects: excessive salivation, tearing – Nursing Interventions and Client Education • Administer on an empty stomach • Anticholinergic Medications • For Overactive Bladder • Action: antispasmodic actions to decrease detrusor muscle spasms and contractions • Medication – Oxybutynin – Tolterodine – Darifenacin – Solifenacin – Trospium – Fesoterodine • Therapeutic Uses – Urinary incontinence – Urinary urgency and frequency • Precautions/Interactions – Do not use for clients who have intestinal obstruction – Use with other anticholinergics can increase anticholinergic effects • Side/Adverse Effects – Anticholinergic symptoms – Drowsiness – Dyspepsia • Nursing Interventions and Client Education – Administer medication with a full glass of water – Instruct client that full effects may take 1-2 months – Instruct client to manage anticholinergic side effects – Instruct client to report constipation lasting longer than 3 days • Sexual Dysfunction • Action: enhances effect of nitric oxide to promote relaxation of penile muscles, allowing increased blood flow to produce an erection • Medication (-afil) – Sildenafil (Viagra) – Tadalafil – Vardenafil • Therapeutic Uses – Erectile dysfunction – Sexual dysfunction in women (unlabeled use) • Precautions/Interactions – Contraindicated for clients taking nitrate drugs, anticoagulants, alpha blockers for BPH, or antihypertensives – Contraindicated for clients who have history of stroke, uncontrolled DM, hypo/hypertension, or HF • Side/Adverse Effects – Headache, heartburn, flushing, nosebleeds – Diarrhea – Difficulty falling asleep or staying asleep – Paresthesias, muscle aches – Changes in color vision, sensitivity to light • Nursing Interventions and Client Education – Administer 1 hr before sexual activity; do not use more than once daily – Instruct client to notify provider of all medications currently taken including herbal preparations – Instruct client to avoid intake of any organic nitrates – Instruct to stop taking medication and notify prescriber immediately for any of the following: erection lasting longer than 4 hrs, any loss of vision, and unusual bleeding problems • Immune System Medications • Childhood Immunizations • Adulthood Immunizations • Antimicrobials • Childhood Immunizations • Dtap, Tdap • Hib • Rotavirus • Inactivated Poliovirus Vaccine (IPV) • MMR Action: stimulate production of antibodies to prevent illness • DTaP, Tdap – Side/Adverse Effects • Fever • Irritability • Seizures – Contraindication: occurrence of seizures within 3 days of vaccine • Hib – Side/Adverse Effects: low-grade fever – Contraindication: age younger than 6 weeks • Rotavirus – Side/Adverse Effects • Infant with diarrhea and vomiting • Immunocompromised – Contraindication: allergy to “mycin” drugs • Inactivated Poliovirus Vaccine (IPV) – Side/Adverse Effects: allergic reaction • MMR – Side/Adverse Effects • Joint pain • Anaphylaxis • Thrombocytopenia – Contraindication • Allergy to gelatin and neomycin • Immunocompromised • Childhood Immunizations • Varicella • Seasonal Influenza • Hepatitis A, B • Meningococcal Vaccine • HPV Action: stimulate production of antibodies to prevent illness • Varicella – Side/Adverse Effects • Vesicles on skin • Pruritis – Contraindication • Pregnancy • Allergy to gelatin and neomycin • Immunocompromised • Seasonal Influenza – Side/Adverse Effects: fever – Contraindication • Nasal spray contraindicated for children < 2 y/o and adults > 50 y/o • History of Guillain-Barre • Hepatitis A, B – Side/Adverse Effects: anaphylaxis – Contraindication • Hep A: pregnancy • Hep B: allergy to yeast • Meningococcal Vaccine – Contraindication: history of Guillain-Barre • HPV – up to age 26 – Contraindication • Pregnancy • Allergy to yeast • Adult Immunizations • Immunizations • Nursing Interventions and Client Education • Nursing Interventions and Client Education – Consult CDC guidelines for schedule of administration – Educate clients about purpose of immunizations and keeping records – Instruct parents to avoid administration of aspirin for management of adverse effects in children – Instruct clients regarding side/adverse effects and management • Antimicrobials: Multigenerational Antibiotics • Aminoglycosides • Cephalosporins Action: inhibit growth, destroy or otherwise control replication of microbes • Aminoglycosides (-mycin, -micin) – Medications • Amikacin • Vancomycin • Gentamycin sulfate • Streptomycin – Therapeutic Use: septicemia, meningitis, pneumonia – Precautions • High risk for ototoxicity, nephrotoxicity • Monitor creatinine and BUN • Peak and trough levels • Therapeutic range – Gentamycin: 4-12 mcg/dL – Vancomycin: 20-40 mcg/dL • Cephalosporins (Ceph-; Cef-) – Medications • Cephalexin • Cefaclor • Cefotaxime – Therapeutic Use: upper respiratory, skin, urinary infections; used as prophylaxis for clients at risk – Precautions • Cross-sensitivity with penicillins • Monitor for signs of Clostridium difficile • Antimicrobials: Multigenerational Antibiotics • Fluoroquinolones • Macrolides Action: inhibit growth, destroy or otherwise control replication of microbes • Fluoroquinolones (-floxacin) – Medications • Ciprifloxacin • Levofloxacin – Therapeutic Use: bronchitis, chlamydia, gonorrhea, PID, UTI, pneumonia, prostatitis, sinusitis – Precautions: caution with hepatic, renal, or seizure disorder; pregnancy, myesthenia gravis – Side Effect: Achilles tendon rupture; photosensitivity • Macrolides (-thromycin) – Medications • Azithromycin • Clarithromycin • Erythromycin – Therapeutic Use: upper respiratory infections, sinusitis, Legionnaires’ disease, whooping cough, acute diphtheria, chlamydia – Precautions • Used for clients who have penicillin allergy • Administer with meals • Can cause super infections (C. diff) • Prolonged QT interval • Antimicrobials: Multigenerational Antibiotics • Nitrofurantoin (Macrodantin) • Penicillins Action: inhibit growth, destroy or otherwise control replication of microbes • Nitrofurantoin – Therapeutic Use: UTI – Precautions • Broad-spectrum • Contraindicated in renal dysfunction • Urine will have brown discoloration • Penicillins – Medications • Amoxicillin • Ampicillin – Therapeutic Use: pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic fever, GYN infections – Precautions: hypersensitivity with possible anaphylaxis • Antimicrobials: Multigenerational Antibiotics • Sulfonamides • Tetracyclines Action: inhibit growth, destroy or otherwise control replication of microbes • Sulfonamides – Medications • Trimethoprim/sulfamethoxazole (Bactrim, Septra) – Therapeutic Use: UTI, bronchitis, otitis media – Precautions • Consume at least 3 L/day of fluid • Use backup contraceptives • Avoid sun exposure • Tetracyclines – Medications • Doxycycline calcium • Tetracycline HCl – Therapeutic Use: fungal, bacterial, protozoal, rickettsial infections – Precautions • Consume at least 3 L/day of fluid • Use of backup contraceptives • Avoid sun exposure • Permanent tooth discoloration if given to children younger than 8 years • Antimicrobials: Special Classes • Antifungal • Antimalarials • Antiprotozoal Action: inhibit growth, destroy or otherwise control replication of microbes • Antifungal – Medications: Fluconazole – Therapeutic Use: candidiasis infections – Precautions • Monitor hepatic and renal function • Refrigerate suspensions • Increased risk of bleeding for clients taking anticoagulants • Antimalarials – Medications • Hydroxychloroquine • Quinine sulfate – Therapeutic Use: prevent malarial attacks, RA, systemic lupus – Precautions • Increased risk of psoriasis • Monitor for drug-induced retinopathy • Antiprotozoals – Medications: metronidazole (flagyl) – Therapeutic Use: trichomoniasis and giardias, Clostridium difficile, amebic dysentery, PID, vaginosis – Precautions • Take with food • Do not consume alcohol during therapy or 48 hrs after completion of regimen • Antimicrobials: Special Classes • Antituberculars • Antiretrovirals Action: inhibit growth, destroy or otherwise control replication of microbes • Antituberculars – Medications • Isoniazid (INH) • Rifampin – Therapeutic Use • Prevention and treatment of TB • Latent TB INH: 6-9 months • Active TB: multiple therapy up to 24 months – Precautions • Risk of neuropathies and hepatotoxicity • Consume foods high in Vitamin B6 • Avoid foods with tyramine (INH) • Increased risk of phenytoin toxicity (INH) • Avoid alcohol • Discoloration of urine, saliva, sweat, and tears (rifampin) • Antiretrovirals (-vir) – Medications • Acyclovir • Valacyclovir • Zidovudine – Therapeutic Use: genital herpes, shingles, HIV – Precautions • Acyclovir and valacyclocir: administer with food • Zidovudine: empty stomach; can cause anemia  monitor Hgb • Increase fluid intake • Begin therapy with first onset of symptoms • Antimicrobials • Nursing Interventions and Client Education • Nursing Interventions and Client Education – Assess history of medication allergies and treatment – Monitor for signs of medication reaction – Monitor for signs of secondary infections – Administer medications at appropriate time intervals to maintain therapeutic effects – If C&S is ordered, perform test before initiating therapy – Instruct client to complete entire medication regimen • Musculoskeletal Medications • Bisphosphonates • Antirheumatics • DMARDs • Glucocorticoids • NSAIDs • Antigout • Bisphosphonates • Action: decrease the number and action of osteoclasts, resulting in bone resorption • Medications (-dronate) – Alendronate: daily or weekly – Risedronate: daily, weekly, or monthly – Ibandronate: monthly or every 3 months – Zoledronic acid: IV annually • Therapeutic Use – Prevention and treatment of osteoporosis – Paget’s disease – Hypercalcemia related to malignancy • Precautions/Indications – Contraindicated during lactation – Clients who have esophageal stricture or difficulty swallowing may only use zoledronate – Absorption is decreased when taken with calcium supplements, antacids, orange juice, and caffeine • Side/Adverse Effects – Musculoskeletal pain – Esophagitis and GI discomfort – Jaw pain and zoledronate • Nursing Interventions and Client Education – Administer medication in the morning on an empty stomach – Instruct client to consume at least 8 oz water (not carbonated) – Client must remain upright (sitting or standing) for 30 mins after taking medication – Consume adequate amounts of Vitamin D • Antirheumatics • Disease Modifying Antirheumatic Drugs (DMARDs) • Action: interrupt complex immune responses, preventing disease progression • Medications – Methotrexate – Hydroxychloroquine – Etanercept – Infliximab – Adalimumab • Therapeutic Use: slow joint degeneration and progression of RA • Precautions/Interactions – Methotrexate: contraindicated in pregnancy, kidney or liver failure, psoriasis, alcohol use disorder, or hematologic dyscrasias • Side/Adverse Effects – Methotrexate: increased risk of infection, bone marrow suppression, GI ulcerations – Hydroxychloroquine: retinal damage (blindness; retinopathy) • Nursing Interventions and Client Education – Instruct client about measures to prevent infection – Monitor liver function tests – Instruct client to use reliable contraception – Instruct client that initial effects may take 3-6 weeks, and full therapeutic effects may take several months – Administer with food – Instruct clients taking hydroxychloroquine about the critical importance of retinal examination every 6 months • Antirheumatics • Glucocorticoids • Action: decrease inflammation by suppressing leukocytes and fibroblasts, and reversing capillary permeability • Medications – Prednisone – Prednisolone • Therapeutic Use: provide symptomatic relief of inflammation and pain • Precautions/Interactions – Contraindicated in systemic fungal infection – Do not administer liver virus vaccines during therapy – Should only be used for a short duration • Side/Adverse Effects – Risk of infection, osteoporosis, adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia • Nursing Interventions and Client Education – Do not skip doses – Monitor BP – Monitor fluid and electrolytes and weight – Monitor for signs of bleeding, GI discomforts – Teach client to take calcium supplements and maintain Vitamin D levels – Give with food – Never stop abruptly – Provide immunoprotection • Antirheumatics • NSAIDs • Action: Inhibit prostaglandin synthesis resulting in decreased inflammatory responses • Medications – Ibuprofen – Diclofenac – Indomethacin – Naproxen – Celecoxib • Therapeutic Use: provide rapid, symptomatic relief of inflammation and pain • Precautions/Interactions – Hypersensitivity to aspirin or other NSAIDs – May increase risk of MI and stroke • Side/Adverse Effects – GI discomforts and ulceration – Renal impairment – Photosensitivity • Nursing Interventions and Client Education – Administer with food and full glass of water – Avoid lying down for 30 mins after administration – Instruct client to use only as needed for symptoms to reduce risk of GI ulceration – Instruct client to use sunscreen • Antigout • Medications – Allopurinol • Action: inhibits uric acid production • Therapeutic Use: chronic gouty arthritis – Colchicine • Action: inhibits processes to prevent leukocytes from invading joints • Therapeutic Use: acute gouty arthritis • Precautions/Interactions – Use caution in clients who have renal, cardiac, or GI dysfunction – Should not be combined with theophylline • Side/Adverse Effects – GI distress – Hepatitis • Nursing Interventions and Client Education – Instruct client to avoid foods high in purines to reduce uric acid – Monitor CBC and uric acid levels – Instruct clients to avoid aspirin – Administer with meals • Nervous System Medications • Antianxiety • Antidepressants • Bipolar Disorder • Antipsychotics • ADHD • Sedative/Hypnotic • Abstinence Maintenance • Chronic Neurological Disorders • Antianxiety • Action: increase the efficacy of GABA to reduce anxiety • Medications – Alprazolam – Buspirone – Chlordiazepoxide – Clonazepam – Diazepam – Lorazepam • Therapeutic Use – Generalized anxiety disorder and panic disorder – Insomnia – Alcohol withdrawal – Induction of anesthesia • Precautions/Interactions – Diazepam and buspirone are used with caution in clients who have substance use disorder and liver disease – Buspirone is contraindicated for clients taking MAOIs • Side/Adverse Effects – CNS depression – Paradoxical response (insomnia, excitation, euphoria) – Withdrawal symptoms (not with buspirone) – Risk of abuse and potential overdose • Nursing Interventions and Client Education – Monitor v/s – Instruct clients to never abruptly discontinue medication – Monitor clients for side/adverse effects – Instruct clients to avoid alcohol – Treat overdose with flumazenil • Antidepressants • Action – SSRI inhibits serotonin reuptake – Tricyclic blocks reuptake of norepinephrine and serotonin – MAOI increases norepinephrine, dopamine, and serotonin by blocking MAO-A • SSRI (-xetine) – Medications: Duloxetine, Fluoxetine, Escitalopram, Fluvoxamine, Paroxetine, Sertraline – Precautions/Interactions: Avoid alcohol; Do not discontinue abruptly; Monitor for serotonin syndrome (agitation, confusion, hallucinations) within first 72 hrs; takes awhile for it to work (several weeks; 3-4 weeks) – Side/Adverse Effects: weight gain, sexual dysfunction (decreased libido), fatigue, drowsiness • Tricyclic – Medications: Amitriptyline, Clomipramine, Doxepin, Imipramine – Precautions/Interactions: Do not administer with MAOIs or St. John’s wort; Must avoid alcohol; Contraindicated for clients with seizure disorder – Side/Adverse Effects: anticholinergic effects, sedation, toxicity, decreased seizure threshold • MAOI – Medications: Isocarboxazid, Tranylcypromine, Phenelzine – Precautions/Interactions: Avoid foods containing tyramine; Antihypertensives have additive hypotensive effect; Contraindicated with SSRIs, tricyclics, HF, CVA, renal insufficiency – Side/Adverse Effects: CNS stimulation, orthostatic hypotension, hypertensive crisis with intake of tyramine, SSRIs, and tricyclics • Nursing Interventions and Client Education – Assess client for suicide risk (can cause increased risk of suicide) – Instruct client to take on daily basis and never miss a dose – Instruct client about therapeutic effects and time of onset – Instruct client to avoid discontinuing drug abruptly – Instruct client to take SSRIs in morning to minimize sleep disturbances – Provide clients taking MAOIs a list of foods containing tyramine – Advise clients to avoid taking other medications without consulting provider • Bipolar Disorder • Action: produce neurochemical changes in the brain to control acute mania, depression and incidence of suicide • Medication: Lithium carbonate • Therapeutic Uses – Bipolar disorder – Alcohol use disorder – Bulimia – Schizophrenia • Precautions/Interactions – Use cautiously in clients who have renal dysfunction, heart disease, hyponatremia, and dehydration – NSAIDs will increase lithium levels – Monitor serum sodium levels (reduced Na due to diuretics  reduced lithium excretion  risk of lithium toxicity) • Side/Adverse Effects – GI distress – Fine hand tremors – Polyuria – Weight gain – Renal toxicity • Nursing Interventions and Client Education – Monitor therapeutic levels (therapeutic  < 1.5; toxicity > 1.5) – Monitor serum sodium levels – Instruct clients that therapeutic effects begin in 7-14 days – Doses must be administered 2-3 times daily per prescriber – Provide nutritional counseling to include food sources for sodium – Administer with food to decrease GI distress • Antipsychotics • Action: block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery • Medications – Conventional: Chlorpromazine, Fluphenazine, Haloperidol, Thiothixene – Atypical (less severe side/adverse effects): Aripiprazole, Clozapine, Olanzapine, Paliperidone, Quetiapine, Ziprasidone • Therapeutic Uses – Acute and chronic psychosis – Schizophrenia – Manic phase of bipolar disorder – Tourette’s syndrome – Delusional and schizoaffective disorders – Dementia • Precautions/Interactions – Contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, and severe hypotension – Use with caution in clients who have glaucoma, paralytic ileus, prostate enlargement, or seizure disorder • Side/Adverse Effects – Sedation – EPSs (administer benzatropine) – Anticholinergic effects – Tardive dyskinesia – Agranulocytosis – Neuroleptic malignant syndrome – Seizures (may require increased dose of antiseizure medications) • Nursing Interventions and Client Education – Monitor for side effects within 5 hrs to 5 days of administration – Advise client of potential side effects – Monitor CBC, encourage fluids, stop medication for signs of neuroleptic malignant syndrome • ADHD • Action: increase attention span; reduce impulsive behavior and hyperactivity – Stimulants increase levels of norepinephrine, serotonin, and dopamine into the CNS – Nonstimulants increase levels of norepinephrine into the CNS • Stimulants – Medication • Dextroamphetamine and Amphetamine (Adderall) • Methylphenidate (Daytrana (transdermal), Ritalin) – Side Effects: mood changes, insomnia, anxiety – Nursing Interventions and Client Education • Administer in early morning • Do not abruptly discontinue • Monitor for signs of abuse • Monitor for signs of agitation • Nonstimulants – Medication • Atomoxetine • Guanfacine (may be used in treatment of Asperger’s syndrome) – Side Effects: GI upset, constipation, fatigue – Nursing Interventions and Client Education • Take medication daily • Do not crush or chew • Instruct client to immediately report worsening of anxiety, agitation • Do not take with MAOIs • Sedative/Hypnotic • Action: slow neuronal activity in the brain to induce sedation/sleep • Medications – Eszopiclone – Temazepam – Zolpidem tartrate • Therapeutic Uses – Short term insomnia – Difficulty falling or staying asleep • Precautions/Interactions – Use cautiously in clients who have severe mental depression – Avoid combined use with alcohol and medications that depress CNS function • Side/Adverse Effects – Dry mouth – Decreased libido – Respiratory depression • Nursing Interventions and Client Education – Instruct client to take immediately before bedtime because medication has abrupt onset of sleep – Instruct client to avoid alcohol – Warn client and caregivers of potential for sleep activities without recall; notify prescriber immediately • Abstinence Maintenance • Disulfiram • Action: interferes with hepatic oxidation of alcohol, resulting in elevation of blood acetaldehyde levels • Therapeutic Use: adjunct to maintain sobriety in treatment of alcohol use disorder • Precautions/Interactions – INH will increase risk of adverse CNS effects for clients taking disulfiram – Ingestion of large amounts of alcohol may cause respiratory depression, arrhythmias, and cardiac arrest – Adjust medication doses of warfarin and phenytoin • Side/Adverse Effects: drowsiness, headache, metallic taste • Nursing Interventions and Client Education – Must wait 12 hrs between time of last alcohol intake and starting medication – Instruct client that consumption of alcohol while taking disulfiram will result in flushing, throbbing in head and neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion – Instruct client that undesirable effects last 30 mins to several hours when alcohol in consumed – Instruct client the effects may stay in the body for weeks after therapy is discontinued – Instruct client that therapy may last months to years • Abstinence Maintenance • Methadone • Action: binds with opiate receptors in CNS to produce analgesic and euphoric effects • Therapeutic Use – Prevents withdrawal symptoms in clients who were addicted to opiate drugs • Precautions/Interactions – Do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury • Side/Adverse Effects – Sedation – Respiratory depression – Paradoxical CNS excitation • Nursing Interventions and Client Education – Monitor clients for signs of drug tolerance and psychological dependence – Monitor pancreatic enzymes because medication may cause biliary spasms – Instruct client that methadone must be slowly reduced to produce detoxification – Client must be monitored through treatment center • Chronic Neurological Disorders • Cholinesterase Inhibitors • Action: prevent cholinesterase from inactivating acetylcholine, resulting in improved transmission of nerve impulses • Medications – Neostigmine – Ambenonium – Edrophonium • Therapeutic Use: myasthenia gravis • Precautions/Interactions: do not administer if systolic BP < 90 mm Hg • Side/Adverse Effects – Slow HR – Chest pain, weak pulse, increased sweating, and dizziness – Client feeling like he or she might pass out – Weak or shallow breathing – Urinating more than usual – Seizures – Trouble swallowing • Nursing Interventions and Client Education – Dose must be individualized – Instruct client to keep individual diary to record side effects – Advise client to wear medical alert bracelet – Monitor for cholinergic crisis (excessive muscarinic stimulation and respiratory depression from neuromuscular blockade; increased salivation, gastric secretions and GI motility, urinary urgency, eye spasms, bradycardia; can be treated with atropine) • Chronic Neurological Disorders • Anti-Parkinson’s • Action: increase dopamine to minimize tremors and rigidity • Medications – Benztropine – Carbidopa/Levodopa – Levodopa • Therapeutic Use: Parkinson’s disease • Precautions/Interactions – Do not use levodopa within 2 weeks of MAOI use – Pyridoxine (Vitamin B6) decreases effects of levodopa – Benztropine is contraindicated in clients who have narrow-angle glaucoma – Must discontinue 6-8 hrs before anesthesia • Side/Adverse Effects – Muscle twitching (especially eyelid spasms) – Headache – Dizziness – Dark urine – Agitation • Nursing Interventions and Client Education – Instruct family members to assist with medication regimen – Instruct client to notify prescriber if sudden loss of medication effects occurs – Instruct client that maximum therapeutic effects may take 4-6 weeks – Monitor closely for signs of adverse reactions – Instruct client to avoid high-protein meals and snacks – Keep medication away from heat, light, and moisture; if pills become darkened, they have lost potency and must be discarded • Chronic Neurological Disorders • Antiseizure / Antiepileptic • Action: slows rates of neuronal activity in the brain by blocking specific channels responsible for neuron firing, which results in an elevation of the seizure threshold • Medications – Carbamazepine • Precautions/Interactions: contraindicated in clients who have bone marrow suppression or bleeding disorders; warfarin therapy decreases effectiveness • Side/Adverse Effects: anemia, leukopenia, Stevens-Johnson syndrome – Gabapentin • Precautions/Interactions: do not abruptly discontinue • Side/Adverse Effects: dizziness, ataxia, somnolence, HTN, bruising – Phenobarbital • Precautions/Interactions: contraindicated in history of substance use disorder • Side/Adverse Effects: drowsiness, hypotension, respiratory depression – Phenytoin • Precautions/Interactions: causes increased excretion of digoxin, warfarin, oral contraceptives • Side/Adverse Effects: gingival hypertrophy, diplopia, drowsiness, hirsutism – Valproic Acid • Precautions/Interactions: contraindicated in liver disease, pregnancy • Side/Adverse Effects: hepatotoxicity, teratogenic effects, pancreatitis • Therapeutic Use: prevent and/or control seizure activity • Nursing Interventions and Client Education – Monitor for therapeutic effects – Monitor client taking phenytoin for toxic effects, including serum levels for toxicity – Instruct clients regarding importance of compliance; medication is treatment, not a cure – Individualize treatment regimen – Instruct client regarding side/adverse effects – Medication therapy for status epilepticus: IV phenytoin and diazepam • Chronic Neurological Disorders • Ophthalmologic (Antiglaucoma) • Action: reduction of aqueous humor • Medications – Levobunolol – Pilocarpine HCl – Timolol maleate • Precautions/Interactions: use caution in clients taking oral beta blocker or calcium channel blocker • Side/Adverse Effects – Blurred vision – Photophobia – Dry eyes – May have systemic effects of beta blockade • Nursing Interventions and Client Education – Instruct client to use sterile technique when handling applicator portion of the container – Hold gentle pressure on the nasolacrimal duct for 30-60 seconds immediately after instilling drops – Monitor pulse rate/rhythm for clients taking oral beta or calcium channel blocker • Pain and Inflammation Medications • NSAIDs (see Musculoskeletal Meds) • Acetaminophen • Opioid Analgesics • Acetaminophen • Action: slows production of prostaglandins in CNS • Therapeutic Use – Analgesic – Antipyretic • Precautions/Interactions – Use caution in clients who consume 3+ alcoholic beverages per day – Concurrent use of rifampin, INH, carbamazepine, and barbiturates may increase hepatotoxic effects – Slows metabolism of warfarin • Side/Adverse Effects – Nausea and vomiting – Long term therapy: hemolytic anemia, leukopenia, neutropenia, and thrombocytopenia • Nursing Interventions and Client Education – Monitor liver function – Monitor kidney function – Instruct client to not exceed single dose of 325 mg (adult 4,000 mg/24 hrs) – Instruct client about risk of hepatotoxicity – Administration to children should be based on age, not to exceed 5 doses per day (read labels carefully) – Treat acetaminophen overdose with acetylcysteine • Opioid Analgesics • Action: bind with opiate receptors in CNS to alter perception of an emotional response to pain • Medications – Fentanyl (Sublimaze, Duragesic) – Hydromorphone (Dilaudid) – Morphine sulfate – Meperidine (Demerol) – Codeine, oxycodone (OxyContin) • Therapeutic Use: relief of moderate to severe pain; sedation • Precautions/Interactions – Morphine is contraindicated after biliary tract surgery – Meperidine is contraindicated in clients who have kidney failure – Monitor for potentiate effects when given with barbiturates, benzodiazepines, phenothiazines, hypnotics, and sedatives • Side/Adverse Effects: orthostatic hypotension, constipation, urinary retention, blurred vision, respiratory depression, abstinence syndrome • Nursing Interventions and Client Education – Monitor v/s – Monitor for respiratory depression – Instruct client regarding administration with PCA pump – Administer naloxone (Narcan) for clients who have respiratory depression • Reproductive Medications • Contraception • Oxytocic • Methylergonovine (Methergine) • Tocolytics • Antenatal Steroids – Betamethasone (Celestone) • Postpartum Medications • Contraception • Rhythm Method • Oral Contraceptives • Ethinyl Estradiol and Norelgestromin (Ortho Evra) Patch • Medroxyprogesterone (Depo-Provera) • Emergency Contraception • Etonogestrel, Ethinyl Estradiol Vaginal Ring (NuvaRing) • Rhythm Method – Considerations for Use: develop “fertile awareness” by noting cervical mucus changes, menstrual cycle pattern, basal temperature – Client Education: do not have sexual intercourse during fertile periods; low reliability for preventing pregnancy • Oral Contraceptives – Considerations for Use: pill is taken daily; adverse effects include breast tenderness, bleeding, n/v – Client Education: antibiotic therapy reduces effectiveness; avoid smoking • Ethinyl Estradiol and Norelgestromin (Ortho Evra) Patch – Considerations for Use: replace patch each week for 3 weeks – Client Education: apply patch to buttocks, abdomen, upper torso, upper/outer arm; period will begin on week 4 (no patch) • Medroxyprogesterone (Depo-Provera) – Considerations for Use: injection is administered every 3 months during menstrual cycle – Client Education: use backup form of birth control for 7 days after first injection; fertility returns approximately 1 year after stopping • Emergency Contraception – Considerations for Use: larger than normal dose of oral contraceptive; taken no later than 72 hrs after unprotected sex; second dose repeated 12 hrs later; anitemetics may be needed – Client Education: should discuss options with provider; should never be used as primary method of birth control • Etonogestrel, Ethinyl Estradiol Vaginal Ring (NuvaRing) – Considerations for Use: placed deep into vagina once every 3 weeks – Client Education: one size fits most women; if falls out, rinse in warm water and replace within 5 hrs; remove ring during week 4, menses should begin • Contraception • Intrauterine Device (IUD) • Cervical Cap • Cervical Diaphragm • Condom • Spermicides • Nursing Interventions and Client Education for All Contraception • Intrauterine Device (IUD) – Considerations for Use: contraindicated for women with diabetes or history of pelvic inflammatory disease (PID); high risk of infection; may have cramping and heavier periods – Client Education: hormonal IUD effective for up to 7 years; copper IUD effective up to 12 years; must monitor for signs of infection; verify string is present • Cervical Cap – Considerations for Use: use with spermicide; fit by prescriber; pap smear every 3 months; increased risk of vaginal infections – Client Education: leave in place 6 hrs after intercourse, but not longer than 48 hrs • Cervical Diaphragm – Considerations for Use: use with spermicide; fit by prescriber; refitted after childbirth or weight gain/loss – Client Education: leave in place 6 hrs after intercourse; refit size with 10 lb or more weight change • Condom – Considerations for Use: use with spermicide – Client Education: protects against STDs; apply and remove correctly; use only water-soluble lubricants • Spermicides – Considerations for Use: available as cream, foam, gel, suppository, film – Client Education: should use with barrier method; can insert up to 1 hr before intercourse • Nursing Interventions – Discuss conception and contraceptive plans with client to include reliability, benefits, and risks – Instruct client to maintain regular health screening visits – Instruct client about measures to prevent PID, STIs – Explain contraceptive decisions may change over life span – Teach client unreliable forms of birth control including coitus interruptus (withdrawal), douching, and breastfeeding • Oxytocic • Cervical Ripening • Action: prostaglandins cause cervical softening in preparation for cervical dilation and effacement • Medication – Dinoprostone cervical gel (Cervidil) • Precautions/Interactions – Contraindicated in clients who have genital herpes, ruptured membranes, or placenta previa • Side/Adverse Effects – Nausea – Stomach pain – Back pain – Feeling of warmth in vaginal area • Nursing Interventions and Client Education – Maintain client on bed rest for 1-2 hrs after insertion – Monitor and record maternal v/s and fetal HR – Monitor for uterine contractions – Remove by gently pulling netted string and discard – Oxytocin augmentation may be initiated as needed – Assess Bishop score for 6 and greater to begin induction • Oxytocic • Oxytocin (Pitocin) • Action: stimulates uterine contractions for purpose of induction or augmentation of labor • Therapeutic Use – Antepartum for contraction stress test (CST) – Intrapartum for induction or augmentation of labor – Postpartum to promote uterine involution • Precautions/Interactions – Contraindicated with placental insufficiency – Bishop Score of 6 and greater when planning induction • Side/Adverse Effects – Intense uterine contractions – Uterine hyperstimulation (contraction longer than 90 secs) – Uterine rupture • Nursing Interventions and Client Education – Administer as secondary infusion via infusion pump for induction or augmentation – Continuously monitor uterine contractions and fetal HR – Discontinue oxytocin with any signs of uterine hyperstimulation – Administer oxygen via face mask 10 L for signs of hyperstimulation – When used in postpartum, monitor client for uterine bleeding • Methylergonovine (Methergine) • Action: acts directly on uterine muscle to stimulate forceful contractions • Therapeutic Use – Postpartum hemorrhage • Precautions/Interactions – Use with extreme caution in clients with HTN, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, or hepatic or renal impairment • Side/Adverse Effects – Potent vasoconstriction – HTN – Headache • Nursing Interventions and Client Education – Continuously monitor BP – Assess uterine bleeding and uterine tone • Tocolytics • Action: act on uterine muscle to cease contractions • Therapeutic Use – Stop preterm labor • Medications – Terbutaline sulfate, Ritodrine HCl • Side/Adverse Effects: nervousness, tremulousness, headache, n/v, hyperglycemia, severe palpitations, chest pain, pulmonary edema • Nursing Interventions and Client Education: monitor contractions and FHT; monitor v/s; do not administer if pulse > 130/min or client has chest pain; administer a beta blocking agent as an antidote – Nifedipine • Side/Adverse Effects: hypotension, fatigue, nausea, flushing, uteroplacental perfusion complications • Nursing Interventions and Client Education: monitor BP; avoid concurrent use with magnesium sulfate; monitor contractions and FHT; prevent complication with hypotension – Magnesium sulfate • Side/Adverse Effects: warmth, flushing, respiratory depression, diminished DTRs, decreased urine output, pulmonary edema • Nursing Interventions and Client Education: monitor v/s and DTRs; monitor magnesium levels (therapeutic range 4-8 mg/dL); administer via infusion pump in diluted form; use indwelling catheter to monitor urinary elimination; administer calcium gluconate 10% if available for signs of toxicity • Antenatal Steroids – Betamethasone (Celestone) • Action: stimulate production of surfactant in fetus between 24-34 weeks gestation • Therapeutic Use – Promote fetal lung maturity in preterm labor when delivery is likely • Side/Adverse Effects – Fluid retention – Elevated BP • Nursing Interventions and Client Education – Administer two doses (usually IM) 24 hrs apart (repeat doses not recommended) – Provide emotional support to family • Postpartum Medications • Rho(D) Immune Globulin (RhoGAM) – Action: suppresses stimulation of active immunity by Rh+ foreign RBCs that enter maternal circulation at time of delivery – Therapeutic Use • Rh factor incompatibility to prevent sensitization for subsequent pregnancies – Precautions • Confirm that the mother is Rh- • Never administer IGIM full-dose or microdose products IV • Never administer to a neonate – Nursing Interventions and Client Education • RhoGAM is administered as an injection after any event where fetal cells can mix with maternal blood – Miscarriage – Ectopic pregnancy – Induced abortion – Amniocentesis – Chorionic villus sampling (CVS) – Abdominal trauma • Varicella Vaccine – Women who are not immune to varicella should be immunized in postpartum period – Instruct client to use reliable contraception and avoid pregnancy for 3 months • Complementary and Alternative Therapies • Safety and Efficacy • Saw Palmetto • Valerian Root • St. John’s Wort • Echinacea • Ginkgo Biloba • Ginseng • Glucosamine • Chondroitin Sulfate • Omega-3 Fatty Acids • Melatonin • Nursing Assessments for Herbal Medications • Safety and Efficacy • The Dietary Supplement Health and Education Act limits the U.S. Food and Drug Administration’s (FDA) control over dietary supplements – Many herbal drug companies make claims based on their own studies, indicating health benefits from using herbal drugs • These studies are not approved by the FDA • Labels on the herbal medications must include a disclaimer, stating that the FDA has not approved the product for safety and effectiveness – Herbal medications may interact with other medicines and produce serious side effects • Saw Palmetto • Purported Use – Treats and prevents BPH • Side/Adverse Effects – Prolonged bleeding time – Altered platelet function • Herb/Medication Interactions – Additive effect with anticoagulants • Studies – Several well-conducted studies support use of saw palmetto for reducing symptoms of BPH • Nursing Considerations – Allow 4-6 weeks to see effects – Discontinue use prior to surgery • Valerian Root • Purported Use – Insomnia – Migraines – Menstrual cramps • Side/Adverse Effects – Drowsiness – Anxiety – Hepatotoxicity (long-term use) • Herb/Medication Interactions – Additive effect with barbiturates and benzodiazepines • Studies – Several studies support the use of valerian for mild to moderate sleep disorders and mild anxiety • Nursing Considerations – Advise client against driving or operating machinery – Advise client against long-term use – Discontinue valerian at least 1 week prior to surgery • St. John’s Wort • Purported Use – Depression – Seasonal affective disorder – Anxiety • Side/Adverse Effects – Headache – Sleep disturbances – Hepatotoxicity (long-term use) – Constipation • Herb/Medication Interactions – May reduce effects of many medications • Theophylline • HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors • Cyclosporine • Diltiazem and Nifedipine • Studies – Several well-conducted studies support use of St. John’s wort for mild to moderate depression • Nursing Considerations – St. John’s wort has many medication interactions and should not be taken with other medications – Should not be used to treat severe depression – Should only be used with medical guidance • Echinacea • Purported Use – Prevents and treats the common cold – Stimulates immune system – Promotes wound healing • Side/Adverse Effects – Headache – Epigastric pain – Constipation • Herb/Medication Interactions – May reduce the effects of immunosuppressants – May increase serum levels of alprazolam (Xanax), calcium channel blockers, and protease inhibitors • Studies – Well-conducted studies have conflicted as to the effectiveness of Echinacea in treatment of the common cold • Nursing Considerations – Long-term use may cause immunosuppression • Ginkgo Biloba • Purported Use – Improves cerebral circulation to treat dementia and memory loss • Side/Adverse Effects – Dizziness – Palpitations • Herb/Medication Interactions – May increase effects of MAOIs, anticoagulants, and antiplatelet aggregates – May reduce effectiveness of insulin • Studies – Studies conflict as to effectiveness of gingko in all purported uses • Nursing Considerations – Discontinue 2 weeks prior to surgery – May cause seizures with overdose – Keep out of reach of children • Ginseng • Purported Use – Improves strength and stamina – Prevents and treats cancer and DM • Side/Adverse Effects – Insomnia – Nervousness • Herb/Medication Interactions – May decrease effectiveness of anticoagulants and antiplatelet aggregates – May increase effectiveness of antidiabetic agents and insulin • Studies – Conflict as to the effectiveness of ginseng in all purported uses • Nursing Considerations – Contraindicated for women who are pregnant and/or lactating • Glucosamine • Purported Use – Relieves osteoarthritis – Promotes joint health • Side/Adverse Effects – Itching – Edema – Headache • Herb/Medication Interactions – May increase resistance to antidiabetic agents and insulin • Studies – Several studies support the use of glucosamine in reducing the symptoms of osteoarthritis in the knees • Nursing Considerations – Use glucosamine with caution in clients who have a shellfish allergy – Monitor glucose frequently in clients who have DM – Allow extended time to see effects of glucosamine – Use it often in combination with chondroitin • Chondroitin Sulfate • Purported Use – Relieves osteoarthritis • Side/Adverse Effects – Headache – Hives – Photosensitivity – HTN – Constipation • Herb/Medication Interactions – May increase effects of anticoagulants • Studies – Several studies support use of chondroitin sulfate in reducing symptoms of osteoarthritis in the knees • Nursing Considerations – Do not administer to women who are pregnant or breastfeeding – Often used in combination with glucosamine – Allow extended time to see effects • Omega-3 Fatty Acids • Purported Use – Improves hypertriglyceridemia – Helps maintain cardiac health • Side/Adverse Effects – Nausea – Diarrhea – Hypotension • Herb/Medication Interactions – May increase risk of Vitamin A or D overdose • Studies – Several well-conducted studies support use in reducing blood triglyceride levels, preventing cardiovascular disease in clients who have a history of heart attack, and slightly reducing BP • Nursing Considerations – Found in fish oils, nuts, and vegetable oils – Some fish contain methylmercury and polychlorinated biphenyls (PCBs) that can be harmful in large amounts, especially in women who are pregnant or nursing • Melatonin • Purported Use – Treats insomnia and jet lag • Side/Adverse Effects – Morning grogginess – Lower body temperature – Vivid dreams • Herb/Medication Interactions – Beta blockers – Warfarin – Steroids • Studies – Several studies support antioxidant effects • Nursing Considerations – Pregnant or nursing women should not take melatonin • Nursing Assessments for Herbal Medications • Ash the client specifically about herbal medications, vitamins, or other supplements during the client interview • OTC medications are often not considered medications by the client • Nursing Interventions – Instruct client that herbal medications and supplements are not regulated by the FDA, often interact with other medications, and may cause serious adverse effects – Instruct the client that it is important to use herbal medications and supplements cautiously and with medical supervision – Discourage use in pregnant and nursing mothers, infants, young children, and older adults who have cardiovascular or liver disease [Show More]

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