Medications

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Preparing medication

Wash hands 2. Check medication order 3. Check expiration date 4. Check label 5. Check patient identity

5 Rights of Medication Administration

Right dose 2. Right drug 3. Right patient 4. Right time 5. Right route C. Teach patient about drug D. Stay with patient until drug is taken E. Give medication within 30 minutes of prescribed time F. Chart immediately G. Observe for therapeutic and adverse effects

Intramuscular

18-23 gauge; 1-2 inch needle 2. Pull skin taut 3. Inject at 90-degree angle 4. Sites a. Vastus lateralis- between the greater trochanter and the knee cap b. Rectus femoris c. Dorsal gluteal 1) Locate greater trochanter and posterior aspect of the superior iliac crest 2) Draw a diagonal line between the two 3) Inject in the upper aspect of the area - avoid sciatic nerve, avoid arteries d. Ventral gluteal 1) Locate the greater trochanter and the anterior aspect of the iliac crest 2) Make a V with the fingers and administer in that area

Subcutaneous

25-29 gauge; 3/8 to 1 inch needle 2. Pinch skin 3. 45 degree angle; insulin degree is 90 degree except for those who are extremely emaciated. 4. Sites a. Outer aspect of upper arm b. Anterior thigh c. Abdomen: at least one inch from umbilicus

Intradermal

25-27 gauge; 3/8 to one inch needle 2. Stretch skin taut 3. Do not massage 4. Sites a. Ventral forearm (Tb test) b. Scapula and upper chest (allergy testing)

Rectal

Use glove 2. Moisten suppository with water soluble lubricant 3. Insert tapered end 2 inches 4. Pinch buttocks 5. Retain for at least 10-20 minutes

Eye medications

Client supine with head turned to affected side 2. Place drops in the conjunctival sac 3. Put gentle pressure on the inner canthus

Ear Medications

Client on unaffected side 2. Clean outer ear 3. Straighten ear canal a. Adults and older children: up and back b. Infants and toddlers: down and back 4. Instill drops 5. Have person stay on side for 5-10 minutes on unaffected side 6. Alternatively, put cotton moistened with the medication in the ear

General Rules for Antimicrobials

Culture before giving B. Give at regular intervals - Example: QID 6 hour intervals C. Check for superimposed infections yeast infection, body has hard time determining good and bad microbes D. Teach patient "Take all of the medication."

Aminoglycosides (Mycins) Except for Erythromycin

Used primarily for gram-negative organisms in serious infections. B. Examples of drugs 1. Gentamicin (Garamycin) 2. Streptomycin 3. Kanamycin (Kantrex) 4. Neomycin C. Method of Administration 1. Given I.V. or I.M. for systemic action. 2. Oral administration for bowel disinfection only (neomycin and Kanamycin)- prep for bowel surgery, people in liver failure to kill off the bacteria that cause ammonia D. Side effects 1. Eighth cranial nerve damage- otto toxic; auditory nerve damage 2. Nephrotoxicity a. Gentamycin- Monitor renal function tests: serum creatinine, BUN b. Intake and output 3. Peaks and troughs a. Troughs: Draw blood just before next dose; lowest concentration of drugs in the blood b. Peaks: Draw blood 1 hr after I.M. and 30 min. after IV administration; peak level- too high= toxicity c. Peaks above 12 mcg/ml and troughs above 2 mcg/ml are associated with higher toxicity. 4. Neuromuscular blockade- do not give drugs to people with neuromuscular blockades

Vancomycin (Vancocin)

General Information 1. Unrelated to any other drug. 2. Use is reserved for severe infections because of its toxicity. a. Given IV for severe staphylococcal infections resistant to methicillin or penicillin allergic patients. b. Given PO for treatment of pseudomembranous colitis caused by antibiotics. B. Side effects / nursing care 1. Ototoxicity. 2. Nephrotoxicity. Monitor BUN and serum creatinine.

Penicillins (cillins)

Used to treat Gram + and - infections 1. Gonococcus- gonorrhea 2. Meningococcus-meningitis 3. Pneumococcus-pneumonia 4. Streptococcus -strep throat 5. Treponema (syphilis) B. Side effects / nursing care 1. Allergic reactions / anaphylaxis a. Ask re: allergic reactions- hives and a rash to anaphylactic b. Skin test if indicated- history of reaction to penicillin 2. Gastrointestinal upset in orally administered drugs. 3. Give oral forms 1-2 hours before or 2-3 hours after eating (on an empty stomach) better absorption 4. Probenecid (Benemid) may be given to increase blood levels of penicillin. Rarely get an allergic reaction the first time you take penicillin

Cephalosporins

20-25% cross allergy (if allergic to penicillin can also be allergic to Cephalosporin) A. Used to treat both gram - and gram + organisms. B. Side effects / nursing care 1. Penicillin cross allergy; ask about penicillin allergy. 2. Nephrotoxicity may occur with high doses.

Erythromycins

Uses 1. Persons who are allergic to penicillin. 2. Legionnaire's Disease- resp. infection 3. Mycoplasma infections- pneumonia (walking) 4. Chlamydia 5. Borrelia (carried by the deer tick) 6. Haemophilus influenzae 7. Helicobacter pylori- sensitive to erythromycin B. Method of Administration 1. Oral 2. Enteric coated tablets- will not dissolve in the acid environment of the stomach a. Acid decreases the activity of erythromycin. b. Do not crush enteric coated tablets. 3. Don't give with meals or with acids 4. Do not give with meals; food decreases absorption. Take on an empty stomach with a full glass of water.

Tetracyclines

Uses 1. Rickettsial infections (Rocky Mountain Spotted Fever and Lyme Disease) 2. Mycoplasma infections- walking pneumonia 3. Chlamydia infections 4. Low dose tetracycline used to treat acne 5. Helicobacter Pylori B. Side effects / nursing care 1. Do not give with any product containing calcium, aluminum, iron, magnesium or zinc as these interfere with absorption. 2. Photosensitivity- rashes 3. Gray tooth syndrome. a. Do not give during the last trimester of pregnancy or during lactation b. Do not give to children under 8 years of age.

Chloramphenicol (Chloromycetin)

Uses 1. Because of its severe toxicity chloramphenicol is used only for infections that do not respond to other drugs. 2. Hemophilus influenzae meningitis 3. Typhoid fever 4. Rickettsial infections such as Rocky Mountain Spotted Fever 5. Some types of salmonella infections B. Side effects / nursing care 1. Aplastic anemia, granulocytopenia - most serious. Monitor blood tests (CBC and platelets) - baseline and every 2 days.

Quinolones

Uses: Active against gram (-) bacteria including Pseudomonas and some gram (+) organisms. B. Examples of Drugs (Note the oxacin ending.) 1. Norfloxacin (Noroxin) a. Used for urinary tract infections 2. Ciprofloxacin (Cipro) a. Used for systemic infections b. Achieves good serum levels C. Adverse Effects / Nursing Care 1. GI disturbances: nausea, abdominal pain, and diarrhea. a. Give on empty stomach with full glass of water. b. Milk and yogurt decrease absorption of Cipro. 2. CNS irritation: dizziness, headache 3. Hypersensitivity reactions, rash, pruritus, fever. No cross sensitivity with penicillins. 4. Encourage cranberry juice to acidify urine.

Sulfonamides

Uses 1. Urinary tract infections. 2. Ulcerative colitis and Crohn's disease. 3. Bowel prep before colon surgery to kill intestinal bacteria. B. Examples of Drugs (Note the Sulfa and Gant) 1. Sulfisoxazole (Gantrisin) 2. Sulfasalazine (Azulfidine) a. Sulfasalazine (Azulfidine)(contains salicylate) 3. Sulfamethoxazole (Gantanol) is given primarily in combination with Trimethoprim (Proloprim) as Septra or Bactrim. C. Side effects / nursing care 1. Photosensitivity- rash 2. Nausea and vomiting 3. Kidney stones- push fluids 4. Tell patients to avoid direct sunlight while taking sulfonamides. 5. Encourage fluids to avoid crystal formation and renal dysfunction.

Urinary Anti-infectives

In acid urine methenamine drugs are converted to ammonia and formaldehyde, which is antibacterial. Nitrofurantoin is bacteriostatic. A. Used to treat urinary tract infections. They do not achieve blood levels high enough to treat systemic infections. B. Examples of Drugs 1. Methenamine mandelate (Mandelamine) 2. Nitrofurantoin (Macrodantin) D. Side effects / nursing care 1. Must have acid urine; give cranberry juice 2. Obtain a clean catch urine before starting therapy and prn thereafter. 3. Intake and output. Be sure there is adequate fluid intake.

Antitubercular Drugs

Two to four drugs are given for a period of months to prevent development of resistance B. Method of Administration 1. Usually given orally. 2. The mycins as discussed earlier are given I.M. C. Side effects / nursing care 1. Streptomycin: Given IM several times a week 2. Isoniazid (INH) a. Liver toxicity: Monitor liver function tests before and during drug therapy b. Peripheral neuritis. Give Vitamin B6 (pyridoxine) with INH to prevent. 3. Paraaminosalicylate sodium (PAS) a. GI disturbances. Give with meals. b. Liver toxicity c. Interferes with absorption of Rifampin. If Rifampin is being given in conjunction with PAS, the drugs should be given 8 to 12 hours apart. 4. Rifampin (Rimactane) a. Red - orange body secretions. b. Affects the actions of many drugs. Negates birth control pills. Decreases the action of steroids, anticoagulants and digitoxin. 4. Ethambutol a. Optic neuritis b. Red-green color blindness c. Elevated uric acid can cause gout 5. Streptomycin is given IM; PAS is given with food; other drugs on an empty stomach 3-4 drugs for 9-12 months

Antiviral Agents

Acyclovir (Zovirax); Famciclovir (Famvir) and others 1. Used to treat Herpes Simplex 1- fever blister and 2- genital 2. Does not cure herpes 3. Does not prevent transmission 4. Used to treat initial and recurrent genital herpes, cold sores and shingles (herpes zoster). At the first sign of an outbreak, the patient should take several tablets (5 - 10) per day as ordered and continue until the lesions go away. 5. Side effects a. Oral 1) Headache 2) Arthralgia

Nucleoside Analogues

Nucleoside Analogues 1. Inhibit replication of HIV virus by inhibiting the transcription of RNA and DNA. 2. Drugs a. Didanosine (Videx) (ddl) b. Lamivudine (3TC) (Epivir) c. Stavudine (d4T) (Zerit) d. Zidovudine (AZT) (Retrovir) 3. Major adverse effect is bone marrow suppression 4. Teach patient and family a. Drugs do not cure AIDS but will control symptoms b. Call physician if signs of other infections such as sore throat or swollen lymph nodes c. Patient is still infective and must use methods to prevent transmission of AIDS virus • d. Avoid OTC products because of the many incompatibilities.

Non Nucleoside Analogues

Inhibit replication of HIV virus; do not cure AIDS 2. Drugs a. Delavirdine (DLV) (Rescriptor) b. Nevirapine (NVP) (Viramune) 3. Side effects / nursing care a. Monitor liver enzymes b. Nevirapine decreases effectiveness of oral contraceptives c. Nevirapine is always given with at least one other antiviral to prevent resistance. d. Severe rash

Protease Inhibitors

. Inhibit replication of HIV virus; do not cure AIDS- slow down the replication of virus 2. Drugs a. Indinavir (Crixivan) b. Nelfinavir (Viracept) c. Ritonavir (Norvir) d. Saquinavir (Invirase) 3. Adverse Effects / Nursing Care a. Use cautiously with other drugs.. b. Take with food.

Antifungals

Used to fungi or yeast infections that may be systemic such as histoplasmosis, vaginal such as candida or affect the skin such as tinea (ringworm). B. Amphotericin B (Fungazone) Treatment of systemic fungal infections such as histoplasmosis 1. Given IV 2. Very toxic a. Fever b. Hypokalemia c. Azotemia- renal damage d. Blood dyscrasias due to bone marrow suppression 3. Give acetaminophen, diphenhydramine (Benadryl) and steroids prior to infusion to prevent adverse reactions C. Nystatin (Mycostatin) 1. Used to treat gastrointestinal and vaginal candida (yeast) infections. 2. Can be given orally as tablets, oral suspension (for thrush) or as vaginal tablets. 3. Tell patient to take medication for 2 weeks after symptoms improve to prevent reinfection.

Local Anesthetics

Uses 1. "Caines block pain." 2. Dental or minor surgical procedures such as suturing lacerations. 3. Regional anesthesia B. Response to local anesthetic 1. Skin veins dilate 2. Brief sense of warmth 3. Loss of temperature sensation 3. Pain sensation blocked 4. Touch sensation lost 5. Motor function lost 6. Sensory functions return in reverse order motion, touch, pain, temperature 7. Epinephrine may be given with local anesthetics to prolong action or to control bleeding. Epinephrine is a peripheral vasoconstrictor.

Epidural anesthesia

Anesthesia is injected into the epidural space. 2) No cerebrospinal fluid is lost. 3) Patient is not likely to develop headaches. 4) Patient does not need to remain flat.

Spinal anesthesia

Needle inserted into the spinal canal 2) Cerebrospinal fluid is lost. 3) Keep patient flat for 8 hours to prevent headache. fluids

Side Effects of Aspirin, Tylenol, NSAIDS

Side effects 1. Bleeding a. Seen primarily with salicylates and NSAIDs. b. Salicylates may be prescribed therapeutically to prevent clot formation in patients on long term bed rest with fractures or in the prevention of heart attacks. 2. Gastrointestinal Disturbances a. Salicylates and NSAIDs can cause gastritis and GI bleeding. b. Contraindicated for persons with ulcer disease. c. Give with food. 3. Liver a. Acetaminophen can cause liver toxicity, especially with an overdose or when alcohol is being consumed. b. NSAIDs can affect liver enzymes. Monitor blood values. 4. Renal toxicity: a. High doses of salicylates can cause renal failure. b. NSAIDs can cause hematuria and acute renal failure. 5. Hearing: Tinnitus (ringing in the ears) is the first sign of salicylate toxicity. 6. Allergic reaction: Allergies to salicylates are quite common. Causes asthma symptoms. Patients who are allergic to salicylates may also be allergic to Naprosyn. 9. Antidote for acetaminophen overdose is acetylcysteine (Mucomyst)

Antiheadache

Sumatriptan (Imitrex) 2. Actions: Constricts cerebral arteries 3. Teach patient to look for triggers for migraine headaches; Avoid tyramine foods

Narcotic Analgesics

alter the perception of and the response to pain. B. Side effects CNS drugs; CNS side effects 1. Respiratory depression 2. Decreased alertness 3. Cough suppression 4. Drop in blood pressure and pulse 5. Decreased peristalsis- bowel sounds 6. Constricts pupils 7. Vomiting 8. Increased intracranial pressure- no head injury 9. Urinary retention 10. Alcohol potentiates CNS depressant effects of narcotics. 11. Addictive potential C. Oral and parenteral dosages are not the same. Oral doses are higher than I.M. doses. D. Examples of Drugs 1. Morphine 2. Codeine 3. Meperidine (Demerol) 4. Methadone (Dolophine) 5. Hydromorphone HCl (Dilaudid) 6. Pentazocine HCl (Talwin) 7. Oxycodone HCl 8. Oxycodone and acetaminophen (Percocet) 9. Oxycodone and aspirin (Percodan) E. Codeine is combined with empirin, fiorinal or Tylenol. F. Patient Controlled Analgesia (PCA) 1. A type of intravenous pump that allows the client to administer his own narcotic analgesic on demand within preset dose and frequency limits. 2. Nurse must instruct patient in use of PCA pump and assess client for pain, pain relief and signs of side effects frequently.

Narcotic Antagonists: Naloxone (Narcan)

Narcotic antagonists act by blocking opiate receptors B. Uses 1. Opiate induced respiratory depression 2. Acute opiate overdose C. Side effects / nursing care 1. Withdrawal in patients who are addicted to opiates. 2. Recurrence of pain- pain level will increase 4. Assess for recurrence of respiratory depression.

Barbiturates

Actions and uses a. Sedation b. Anticonvulsants 2. Examples of Drugs a. Phenobarbital Sodium (Luminal) b. Amobarbital Sodium (Amytal) c. Butabarbital Sodium (Butisol) d. Pentobarbital Sodium (Nembutal) e. Secobarbital Sodium (Seconal) f. Thiopental Sodium (Pentothal Sodium)

Benzodiazepines (Antianxiety Agents)

Actions and uses a. Antianxiety b. Sedation c. Light anesthesia d. Skeletal muscle relaxation e. Anticonvulsant 2. Examples of Drugs a. Diazepam (Valium) b. Alprazolam (Xanax) c. Midazolam (Versed) used for conscious sedation d. Oxazepam (Serax) e. Temazepan (Restoril) f. Alzapam (Ativan) g. Flurazepam (Dalmane) h. Triazolam (Halcion) i. Chlorazepate (Tranxene) j. Chlordiazepoxide (Librium)

Nonbenzodiazepines

Act similarly to other sedative hypnotics and have similar side effects. 2. Examples of Drugs a. Chloral Hydrate b. Ethchlorvynol (Placidyl)

Side effects of sedative / hypnotic drugs

Addiction / cross addiction 2. Drowsiness, lethargy, confusion 3. Respiratory depression

Anticonvulsants

Used to treat seizure disorders B. Hydantoins: Phenytoin (Dilantin) 1. Therapeutic serum level 10-20 mcg/ml 2. Adverse effects a. Gum hyperplasia b. Lowered blood counts; monitor CBC c. Alcohol reduces effectiveness d. Kidney and liver damage e. Pink or red urine C. Benzodiazepines: Diazepam (Valium) D. Carbamazepine: (Tegretol) E. Barbiturates (Phenobarbital) F. Side effects 1. Sedation 2. Hypotension

Skeletal Muscle Relaxants

Uses 1. They are used to treat a wide range of skeletal muscle spasticity from lower back pain to multiple sclerosis. 2. Dantrolene is used to treat malignant hyperthermia and neuroleptic malignant syndrome. B. Examples of Drugs 1. Baclofen (Lioresal) 2. Carisoprodol (Soma; Soma compound contains aspirin; available with codeine) 3. Dantrolene (Dantrum) 4. Cyclobenzaprine (Flexeril) 5. Methocarbamol (Robaxin) C. Side effects 1. CNS side effects 3. Used in combination with nonnarcotic and narcotic analgesics.

Dopamine Agents

Carbidopa / Levodopa (Sinemet): Carbidopa inhibits peripheral use of dopamine making more available to the brain. Levodopa is converted to dopamine. 2. Levodopa (Levopa) 3. Amantadine (Symmetrel): increases the release of dopamine. 4. Parlodel: increases dopamine in the brain.

Cholinergic Blocking Agents

Examples of drugs a. Benztropine Mesylate (Cogentin) b. Trihexyphenidyl HCl (Artane): relieves rigidity but has no effect on tremor. c. Contraindicated in patients with glaucoma, tachycardia, duodenal ulcers, biliary obstruction and prostatic hypertrophy.

Side Effects of Antipakisonian drugs

Constipation. b. Dry mouth. c. Nausea. d. Tachycardia, hypotension. e. Dizziness, drowsiness. Safety. f. Blurred vision, photophobia, acute glaucoma. g. Urinary retention

Adrenergic Drugs

Used to treat a. Shock: epinephrine used b. Bronchospasm: Theophylline, aminophylline, epinephrine used 2. Side effects a. Tachycardia b. Urinary retention c. Nausea and vomiting

Adrenergic Blockers

Used frequently to lower blood pressure 2. Examples of Drugs a. Beta blockers: "olols" b. Alpha blockers: "zosins"

Cholinergics

Treatment of Myasthenia Gravis a. Neostigmine (Prostigmin) b. Ambenonium Chloride (Mytelase) c. Pyridostigmine (Mestinon) d. Edrophonium Chloride (Tensilon): Used in diagnosis of myasthenia gravis 2. Bethanechol Chloride (Urecholine) a. Treatment of postoperative urinary retention and abdominal distention- paralytic illeus. b. Urecholine is always given p.o.

Anticholinergic

Preanesthetic medication a. Atropine sulfate b. Scopolamine hydrobromide c. Glycopyrrolate (Robinul) 2. Parkinson's Disease a. Benztropine mesylate (Cogentin) b. Trihexyphenidyl (Artane) 3. Antiarrhythmic 4. Side effects a. Red, Hot, Dry, Blind, Mad b. Blurred vision, photophobia (pupils dilate). Do not give to persons with chronic glaucoma and unstable heart rhythms c. Urinary hesitancy and retention d. Tachycardia, palpitations. e. Dry mouth. f. Do not give to patients with myasthenia gravis

Antiarrhythmics

Drugs Used to Treat Ventricular Dysrhythmias 1. Examples of drugs a. Lidocaine (Xylocaine)- severe VD b. Procainamide (Pronestyl) Emergency c. Bretylium (Bretylol): Emergency drug d. Amiodarone (Cardarone)- Maintenance (can have arrhythmias) e. Phenytoin (Dilantin) f. Quinidine (Quinidex) g. Adenoside (Adenocard) h. Disopyramide (Norpace) 2. Side effects / nursing care a. Watch for bradycardia b. Isuprel or atropine - drugs used to speed up the heart - should be available in case of overdose. c. Give the drugs at equal intervals. d. Monitor vital signs and EKG for dysrhythmias.

Beta Blockers

Uses a. Hypertension b. Dysrhythmias 2. Examples of Drugs and Routes a. PO Only 1) Nadolol (Corgard) 2) Acebutolol (Sectral) b. PO and IV 1) Propranolol HCl (Inderal) 2) Metoprolol (Lopressor) 3) Atenolol (Tenormin) 3. Actions a. Decreases contractility of heart muscle b. Decreases pulse c. Decreases peripheral resistance d. Decreases blood pressure e. Decreases myocardial oxygen need 4. Side effects a. Severe bradycardia b. Increased airway resistance; do not give to asthmatics c. Peripheral vascular insufficiency

Atropine

Anticholinergic drug that blocks vagal stimulation increasing heart rate b. Acts throughout the body to block cholinergic activity causing side effects of dry mouth, dilated pupils and blurred vision. 2. Isoproteronol (Isuprel): Enhances cardiac conduction increasing the heart rate.

Heparin

Heparin blocks the conversion of prothrombin to thrombin and prolongs clotting time. 2. Heparin is destroyed by gastric juices and must be given parenterally - either IV or subcutaneous in the abdomen - at least one inch from the umbilicus. 3. The antidote for heparin is protamine sulfate. 4. PTT (partial thromboplastin time) or aPTT (activated partial thromboplastin time) is done to monitor heparin administration. Therapeutic levels are considered to be 1 1/2 to 2 times control values. 5. Clotting time is an older test to monitor heparin effectiveness

Warfarin (Coumadin, Dicumarol)

Warfarin blocks prothrombin synthesis 2. Given orally 3. Antidote is Vitamin K 4. Prothrombin time should be monitored. When warfarin is being administered the PT should be 1 1/2 to 2 times the control. Results may also be reported in INR (international normalized ratio) value; target is usually between 2-3. 5. Many drug and food interactions 6. Encourage patient to have consistent amounts of Vitamin K. 7. No aspirin unless ordered by physician

Antiplatelets

Prevent platelet aggregation and thus decrease clotting. 2. Examples of drugs a. Abciximab (ReoPro) b. Dypyridamole (Persantine) c. Ticlopidine (Ticlid)- sickle cell anemia 3. Side effects / nursing care a. Bleeding b. Avoid large quantities of Vitamin K foods c. Avoid salicylates d. Discontinue anticoagulants two weeks before surgery

Thrombolytic Drugs

Dissolve B. Examples of Drugs 1. Alteplase (tissue plasminogen activator recombinant, tPA, Activase) 2. Streptokinase 3. Urokinase C. Indications 1. MI 2. Strokes 3. Pulmonary embolus 4. DVT D. Side effects / nursing care 1. Bleeding 2. Heparin therapy may be started following thrombolytic treatment 3. When given for myocardial infarction should be given within 6 hours of episode. 4. When given for cerebrovascular accident should be given within 3 hours of episode.

Antilipemic Agents

Antilipemic drugs are always used in conjunction with diet, weight control and exercise to reduce atherosclerosis. B. Examples of Drugs 1. Cholestyramine (Questran): Acts by reducing absorption of fats in the intestinal tract 2. Gemfibrozil (Lopid): Acts by inhibiting lipolysis and triglyceride synthesis 3. Lovastatin (Mevacor), Atorvastin (Lipitor), Simvastin (Zocor): Act by inhibiting HMG-CoA reductase 4. Niacin in high doses C. Side effects / nursing care 1. May need water soluble forms of fat-soluble Vitamins A, D, K. 2. Observe for bleeding tendencies due to decreased Vitamin K. High fiber low fat diet 3. Teach patient to follow a diet low in cholesterol and saturated fats and high in fiber. 4. Myalgia in clients taking statins. Muscle pain 5. Monitor liver function tests. 6. Antilipemics should not be taken at the same time as other medications because they may interfere with medication absorption. Other medications should be taken 1 hour before or 4 hours after antilipemics. 7. Patients should not self medicate with high dose niacin because of liver toxicity.

Angiotensin Converting Enzyme (ACE) Inhibitors

prevent conversion of angiotensin I to angiotensin II 2. Examples of drugs a. Captopril (Capoten) b. Enalapril, enalaprilat (Vasotec) c. Benazepril (Lotensin) d. Fosinopril (Monopril) e. Lisinopril (Prinivil, Zestril) f. Ramipril (Altace) Side effects / nursing care 1. Orthostatic hypotension and dizziness. a. Blood pressures should be taken both supine and upright b. Teach clients to change positions slowly. c. Teach patients to avoid very hot baths and showers. d. Avoid alcohol. 2. Drowsiness- beta blockers particularly 3. Rebound hypertension when discontinued abruptly

Diuretics

Uses 1. Mild hypertension 2. Edema 3. Congestive heart failure B. Side effects / nursing care for all diuretics 1. All diuretics can cause orthostatic hypotension. Patients should be taught to change positions slowly. 2. Monitor output 3. Monitor weights 4. Monitor serum electrolytes

Thiazine Diuretics

Hydrochlorothiazide (Hydrodiuril, Esidrex) 3. Thiazide diuretics inhibit sodium reabsorption in the ascending loop of Henle. 4. Side effects / nursing care a. Hypokalemia, hyperuricemia (gout), hyperglycemia b. Teach patient high potassium foods to include in diet. e. Thiazides are related chemically to the sulfonamides; cross allergies can occur

Loop Diuretics

Examples a. Furosemide (Lasix) b. Bumetanide (Bumex) 2. Loop diuretics inhibit reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle, increasing water excretion. 3. Side effects / nursing care a. Hypokalemia, hypochloremic alkalosis, hyperuricemia (gout), hyperglycemia b. Teach high potassium foods to include in diet. c. Sulfonamide sensitive patients may have allergic reaction to furosemide.

Osmotic Diuretics

Mannitol (Osmitrol) 2. Osmotic diuretics increase the osmotic pressure of the glomerular filtrate inside the renal tubules. 3. Used to prevent acute renal failure, to reduce intraocular and intracranial pressure, and to promote diuresis in drug intoxication. 4. Side effects / nursing care a. Solutions above 15% have tendency to crystallize. Do not give solutions with undissolved crystals. Warm solution to dissolve crystals.

Potassium Sparing Diuretic

Examples a. Spironolactone (Aldactone) b. Amiloride Hydrochloride (Midamor) 2. These drugs block the sodium retaining effects of aldosterone causing increased elimination of sodium and fluid but not potassium. 3. Useful in combination with other diuretics when it is important to avoid hypokalemia. 4. Side effects / nursing care a. Hyperkalemia. b. Maximum hypotensive effect may not be seen for 2 weeks. c. Give with meals to improve absorption.

Sodium polystyrene sulfonate (Kayexalate)

Exchanges sodium ions for potassium ions in the large intestine. 2. Used in the treatment of severe hyperkalemia. 3. Can be given PO or by 6 hour retention enema B. Side effects / nursing care 1. Needs to be in contact with GI tract for 6 hours to be most effective. 3. Monitor for hypokalemia and loss of magnesium and calcium 4. Monitor for sodium overload. 1/3 of sodium is retained. 5. Rectal administration helps to prevent constipation. 6. Stop resin administration when serum potassium is 4 - 5 mEq.

Rapid Acting Insulins: Regular

Onset: 1/2 to 1 hr 2) Peak: 2 to 4 hrs 3) Duration: 6 to 8 hrs

Intermediate Acting Insulins: NPH

Onset: 2-4 hrs 2) Peak: 6 - 8 hrs 3) Duration: 24-48 hrs

Side Effect/ Nursing Care of Insulins

Teach patient how to give injections 1) Ninety degree angle unless emaciated 2) Rotate injection sites: arm, abdomen, thigh 3) When mixing insulins draw up regular insulin first and then NPH. 4) When preparing insulin for injection swirl the bottle gently or rotate between the palms; do not shake 5) Pat, don't rub after injection. b. Teach patient how to do blood and urine testing c. Teach patient about the diet d. Teach patient signs of hypoglycemia 1) Irritability, pale, cold, clammy, hunger 2) Onsets rapidly. 3) Treatment of hypoglycemia: give glucose e. Teach patient signs of hyperglycemia; flushed, warmed, dry f. No alcohol: alcohol potentiates the hypoglycemic effect of insulin. g. No smoking; smoking decreases absorption of SC insulin

Oral antidiabetic agents

Sulfonylureas (glipizide, glyburide) stimulate insulin release AE making patient hungry 2. Thiazolidinediones (rosiglitazone maleate [Avandia]) improve insulin receptor activity 3. Alpha-glucosidose inhibitors (acarbose [Precose]) delay digestion of carbohydrates 4. Side effects / nursing care a. Hypoglycemia 1) Teach patient to monitor blood sugar regularly 2) Treat with oral glucose b. Do not give sulfonylureas to patients who are allergic to sulfa

Corticotrophin (ACTH)

Used primarily to diagnose adrenocortical insufficiency. 2. If corticotrophin is given over a period of time Cushing syndrome may occur.

Desmopressin (DDAVP); Vasopressin (ADH, Pitressin); Lypressin spray

Used in the treatment of diabetes insipidus.

Glucocorticoids (sugar)

organic effects regulating carbohydrate, fat and protein metabolism and are antiinflammatory and immunosuppressant

Mineralocorticoids (salt)

produce inorganic effects regulating water and electrolyte metabolism.

Corticosteroids

Prednisone (Deltasone) b. Prednisolone (Cortalone) c. Methylprednisolone (Solu Medrol) d. Cortisone (Cortone) e. Dexamethasone (Decadron) f. All of the above have glucocorticoid actions. g. Fludrocortisone (Florinef). Has mineralocorticoid actions. 2. Uses a. Replacement for deficient hormone production b. Decrease inflammation c. Treat allergic conditions d. Reduce cerebral edema e. Respiratory disease / asthma f. With antineoplastics in the treatment of cancer. 3. Side effects / nursing care a. Cushing's syndrome with long term administration of steroids. b. Taper steroids if they are to be discontinued c. Fluid and electrolyte disturbances. d. GI effects. Antacids usually prescribed to reduce ulcer formation. Giving oral doses with food may reduce gastric symptoms. e. Hyperglycemia g. infection 4. Dosage equivalents. Steroid dosages are not interchangeable.

Thyroid Hormones

Uses a. After thyroidectomy b. Hypothyroidism 2. Examples a. Desiccated thyroid b. Thyroglobulin (Proloid) c. Levothyroxine (Levothroid) d. Liothyronine sodium (Cytomel) e. Usually given po once daily. 2. Side effects and nursing care a. Usually results from overdose. b. Manifested as signs and symptoms of hyperthyroidism 1) Tachycardia- angina, chest pain 2) Tremors 3) Insomnia

Thyroid Antagonists

Uses a. Hyperthyroidism b. Preparation for thyroid surgery or radioactive iodine therapy. 1. Examples of Drugs a. Methimazole (Tapazole) b. Propylthiouracil (PTU) before thyroid surgery to shrink thyroid gland c. These drugs are given orally. 2. Side effects / nursing care a. Very non-toxic. b. Agranulocytosis

Testosterones

Indications a. Replacement therapy in androgen deficient males. b. Breast cancer c. Fibrocystic breast disease. d. Endometriosis. 2. Examples of Drugs a. Testosterone (Depo Testosterone) b. Fluoxymesterone (Halotestin) c. Danazol (Cyclomen) 3. Side effects a. Acne b. Gynecomastia c. Change in libido (increase or decrease) d. Edema e. Virilization in females. Deep voice f. Priapism (penis stays erect) in males. Erections that won't go away

Estrogens

Uses a. Replacement therapy in menopause b. Androgen dependent tumors - prostate cancer. c. Contraception (in combination with progesterone). 2. Examples of Drugs a. Diethylstilbestrol (DES) b. Estradiol (Estrace) c. Conjugated estrogens (Premarin) 3. Side effects a. Chloasma (Mask of pregnancy) b. Nausea c. BP increases d. Thrombophlebitis and pulmonary emboli. Do not give to persons with a history of phlebitis or thromboembolic disorders.

Progestins

Uses a. Amenorrhea b. Abnormal uterine bleeding caused by hormonal imbalance. c. Endometrial cancer. d. Contraception 2. Examples of Drugs a. Hydroxyprogesterone (Duralutin) b. Medroxyprogesterone (Provera) c. Progesterone (Gestrol) 3. Side effects a. Breakthrough bleeding b. Changes in menstrual flow c. Edema d. Thromboembolic disorders - Do not give to persons with thrombo-embolic conditions. e. Increased blood pressure

Oral Contraceptives

Progestin only - taken every day of the menstrual cycle. 2. Combination pill - taken days 5 - 24 of menstrual cycle 3. Side effects / Nursing Care a. Same as for estrogens and progestins b. Discontinue 1 week before surgery to reduce risk of thromboembolism. c. Patients who smoke more than 15 cigarettes a day should not take oral contraceptives. d. If one tablet missed: Take 2 tablets the next day e. If two tablets missed: Take 2 tablets for 2 days f. If more than two tablets missed, stop medication, use other means of contraception and start over with next cycle g. Side effects worse for first few months

Fertility Agents

Examples of Drugs a. Clomiphene (Clomid) b. Menotropin (Pergonal) c. Gonadorelin (Factrel) 2. Action: Stimulate ovulation 3. Side effects: multiple births; ovarian cysts

Oxytocics

Action: stimulate the smooth muscle of the uterus. 2. Uses a. To decrease postpartum bleeding 1) Ergotrate- after delivery 2) Methergine 3) Pitocin b. Pitocin used to induce labor or intensify uterine contractions during labor 2. Adverse effects / nursing care a. Notify physician and stop IV pitocin if 1) Contractions occur more frequently than every 2 minutes 2) Contractions last longer than 60 seconds 3) Less than 30 second rest period between contractions

Histamine (H2) Antagonists

Histamine antagonists decrease the acidity of the stomach by blocking the action of histamine. B. Examples of Drugs 1. Cimetidine (Tagamet) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Roxotidine (Roxin) 5. Nizatidine (Axid) (Used for gastroesophageal reflux) C. Side effects / nursing care 1. Diarrhea 2. Dizziness 3. Confusion (elderly) 4. Impotence may occur with prolonged use of cimetidine 5. Liver damage 6. Cimetidine should be taken with meals for best absorption. 7. Zantac does not have to be taken with meals. 8. Smoking decreases effectiveness of histamine antagonists.

Omeprazole (Prilosec)

Blocks formation of gastric acid.; inflammation, GERD B. Side effects / nursing care 1. Abdominal pain 2. Instruct patient to swallow capsules whole and not crush or open capsule.

GI Anticholinergics

Uses: 1. Peptic ulcers 2. Ulcerative colitis 3. Irritable bowel syndrome B. Examples of Drugs 1. Belladonna 2. Methaneline bromide (Banthine) 3. Propantheline bromide (Probanthine) B. Side effects / nursing care "Red, Hot, Dry, Blind, Mad"

Sucralfate (Carafate)

Action: Sucralfate forms a highly condensed paste - like substance after reacting with gastric acid that binds to gastric and duodenal ulcers forming a protective barrier allowing the ulcer to heal. B. Side effects / nursing care 1. Binds with other medications. 2. Wait at least two hours after giving other medications before giving sucralfate. C. Remember to administer: 1. Sucralfate (Carafate) before meals 2. Omeprazole (Tagamet) before meals 3. Cimetidine (Tagamet) with meals 4. Antacids after meals

Drugs Used to Treat Helicobacter Pylori

Metronidazole (Flagyl) 1. Alcohol causes nausea and vomiting (Antabuse like reaction) in patients taking metronidazole B. Amoxicillin or Tetracycline, Biaxin or some other antibiotic C. Omeprazole (Prilosec) or Ranitidine (Zantac) D. Peptobismol sometimes

Antacids

Antacids neutralize gastric acidity and help control ulcer pain. Ph to 3-3.5 B. Magnesium containing antacids 1. May cause diarrhea. C. Aluminum Containing Antacids: Aluminum hydroxide (Amphojel) 1. May cause constipation and phosphorus depletion. 2. In renal failure aluminum hydroxide is given to bind phosphates reducing serum phosphate. D. Dihydroxyaluminum sodium carbonate (Rolaids) 1. High sodium content. 2. Not to be used by patients on low sodium diets or pregnant women E. Calcium carbonate (Tums)

Antidiarrheals

Bismuth subsalicylate (Peptobismol) 1. Contains salicylates. 2. Bismuth is a heavy metal and should not be used in patients who are receiving radiation therapy. Heavy metals may block radiation. Can cause stools to become black B. Kaolin - Pectate (Kaopectate) C. Loperamide (Imodium) D. Diphenoxylate with atropine (Lomotil) 1. Opium derivative and a controlled substance. 2. Check respirations, can cause respiratory depression E. Opium tincture (Paregoric) 1. Opiate derivative and a controlled substance. 2. Observe for respiratory depression. F. General comments 1. Antidiarrheals should not be used for more than 48 hours. 2. They should not be used in acute diarrhea due to poisons

Laxatives

Do not give laxatives in patient has symptoms of appendicitis or intestinal obstruction B. Teach how to prevent constipation: fluid, fiber, opportunity, activity C. Laxatives are for short term use only

Bulk forming

Safest of all laxatives. b. Examples of bulk forming laxatives 1) Methylcellulose (Cologel) 2) Psyllium Hydrophilic Muciloid (Metamucil)

Emollient (stool softener)

Reduces the surface tension of feces. b. Used to prevent constipation, not to treat it. c. Used when straining at stool is contraindicated: MI, rectal surgery, eye surgery, postpartum hemorrhage. d. Examples of stool softeners: Docusate salts. (Colace, Surfak)

Hyperosmolar or saline cathartics

Examples of saline cathartics 1) Magnesium citrate 2) Milk of Magnesia 3) Potassium citrate 4) Glycerin b. Used to induce diarrhea and clean bowel before surgery and diagnostic tests

Stimulant

Examples of stimulant laxatives more rapid peristalsis 1) Bisacodyl (Dulcolax) 2) Castor oil

Antiemetics

All are central nervous system depressants B. Side effects 1. Anticholinergic 2. Central nervous system a. Drowsiness b. Hypotension; dry mouth; difficult voiding C, Examples: 1. Benzquinamide (Emete-Con) 2. Dimenhydrinate (Dramamine) 3. Prochlorperazine (Compazine) 4. Metoclopramide HCl (Reglan) 5. Ondansetron (Zofran) 6. Ganisetron (Kytril)

Emetics

Apomorphine B. Ipecac syrup 1. Given in an oral syrup. 2. Doses of 30 cc or less cause no systemic adverse effects. 3. Emesis occurs 20 - 30 minutes after administration of ipecac syrup. 4. 200 - 300 ml of water or clear liquid may facilitate the emetic action C. Contraindications for use a. Semiconscious or unconscious patients b. Patients having seizures. c. Patients who have ingested corrosives or caustic substances d. Patients who have ingested petroleum distillates.

Pancreatic Enzymes

Information 1. Pancreatic enzymes replace exocrine pancreatic enzymes and aid digestion of starches, fats, and proteins. 2. Used in cystic fibrosis and pancreatitis B. Examples of Drugs 1. Pancreatin (Donnazyme) 2. Pancrelipase (Pancrease, Viokase, Ilozyme) C. Side effects / nursing care 1. Give with food 2. Do not give enteric coated preparations with antacids 3. If enteric coated do not crush or chew tablets.

Gold Salts

Information 1. Gold salts alter immune response. 2. Gold is used to treat rheumatoid arthritis not responding to other therapy as well as to treat other autoimmune conditions B. Examples of Gold Salts 1. Auranofin (Ridaura) 2. Aurothioglucose (Solganol) 3. Gold sodium thiomalate (Myochrysine) C. Side effects / nursing care 1. Given orally or deep IM 2. Oral compounds are less toxic than IM and better tolerated. 3. Therapeutic effects may not be seen for several months.

Antimalarials

Information 1. These drugs are used to treat malaria. 2. They are also useful in the treatment of rheumatoid arthritis that is unresponsive to NSAIDs. B. Examples of Drugs 1. Chloroquine (Aralen) 2. Hydroxychloroquine (Plaquenil) C. Side effects 1. Epigastric discomfort. Drug should be taken with meals. 2. Hematologic

Antimetabolite

Methotrexate suppresses immune function in autoimmune conditions such as rheumatoid arthritis B. Side effects 1. GI 2. Bone marrow depression

Gout Drugs

Allopurinol (Zyloprim) 1. Inhibits xanthine oxidase and prevents production of uric acid. 2. Used in the treatment of primary and secondary gout. 3. Used to prevent attacks; NOT useful for acute attacks. 4. Side effects / nursing care a. Minimize GI side effects by giving with meals b. Force fluids to at least 2 liters per day.

Colchicine

Information a. Reduces inflammatory response to deposition of monosodium urate crystals. b. Drug of choice in acute attacks of gout. 2. Side effects / nursing care a. During acute attack colchicine is administered every hour until pain relief or toxicity (nausea and vomiting or diarrhea) occurs. b. GI effects: nausea and vomiting

Probenecid (Benemid)

Used to prevent recurrence of gouty arthritis 2. Administer with food or antacid to minimize gastric irritation.

Antineoplastic Agents

Cancer is cell division gone wild. Anti cancer drugs destroy cancer cells by interfering with their cell division. B. Side effects / nursing care 1. Bone marrow Suppression is usually the dose limiting adverse effect. a. Low white blood count causes immunosuppression b. Low red count causes anemia c. Low platelet count (thrombocytopenia) causes bleeding 2. Stomatitis 3. Nausea, vomiting, anorexia 4. Diarrhea or constipation 5. Hyperuricemia (Gout)- allopurinal 6. Liver toxicity 7. Alopecia 8. Extravasation

Antimetabolites

Antimetabolites interfere with protein synthesis 2. Examples of Antimetabolites a. Methotrexate (Folex PFS) b. Cytarabine (Cytosine, Arabinoside) c. 5-Fluorouracil (5FU) d. Hydroxyurea (Hydrea) e. Mercaptopurine (Purinethol) f. 6-Mercaptopurine (6MP) g. Vidarabine (Vira-A)

Alkylating Agents

Settle in the cell nucleus and attack DNA causing cross-linking of strands of cellular DNA causing an imbalance of growth that leads to cell death. 2. Examples of Alkylating Agents a. Cisplatin (Platinol) b. Busulfan (Myleran) c. Cyclophosphamide (Cytoxan) d. Mechlorethamine HCl (Mustargen) e. Thiotepa 3. To prevent hemorrhagic cystitis a. Push fluids b. Empty bladder frequently

Antibiotic Antineoplastic Agents

Mechanism of action. a. Isolated from naturally occurring microorganisms that inhibit bacterial growth. b. Differ from the other aminoglycosides in that they disrupt the functioning of the host cells as well as the bacterial cells. 2. Examples of Antibiotic Antineoplastic Agents a. Bleomycin sulfate (Blenoxane) b. Dactinomycin (Actinomycin D) c. Daunorubicin HCl d. Doxorubicin HCl (Adriamycin) e. Mithramycin (Plicamycin) f. Mitomycin (Mutamycin) g. Procarbazine HCl (Matulane)

Vinca Alkaloids

Information a. Derivatives of the periwinkle plant, a ground cover. b. Used to treat leukemias, lymphomas, sarcomas and some carcinomas. d. Taxol is used for advanced ovarian cancer and small cell lung carcinoma. 2. Examples of Vinca alkaloids a. Vinblastine sulfate (Velban) b. Vincristine sulfate (Oncovin) c. Vindesine sulfate (Eldesine) d. Etoposide (VePesid) e. Paclitaxel (Taxol) 3. Side effects / nursing care a. In addition to the usual side effects of chemotherapy the vinca alkaloids cause neurological damage b. Constipation may be a sign of neurological damage.

Antineoplastics affecting hormonal balance

Organ specific 2. Tamoxifen blocks form of estrogen that stimulates breast cancer 3. Estramustine phosphate sodium blocks male hormone function and slows prostate cancer 4. Side effects / nursing care a. Adverse effects are related to the organ affected. b. Loss of libido may occur with drugs used to treat prostate cancer c. Tamoxifen can cause blood clots

Immunosuppressants

Azathioprine (Imuran) 1. Used for immunosuppression in transplants. 2. Causes bone marrow suppression. 3. Causes severe liver damage. B. Cyclosporine (Sandimmune) 1. Cyclosporine inhibits the T-lymphocytes. 2. Used in combination with corticosteroids to prevent rejection in kidney, liver and heart transplants. 3. Causes bone marrow suppression, nausea and vomiting and liver and renal toxicity.

Immunity

Active immunity 1. Client's own antigen antibody response stimulated 2. Takes time to develop 3. Long lasting 4. Vaccines and toxoids B. Passive immunity 1. Antibodies come from outside the host 2. Act immediately 3. Short term 4. Immune serum globulin

RhoGam

RhoGam prevents the development of maternal RH antibodies. 2. RhoGam is given to Rh-negative mothers who have an Rh-positive fetus and who have not developed antibodies to Rh factor. 3. It is also given to Rh-negative women who have abortions or miscarriages even if the Rh factor of the fetus is not known. 4. RhoGam must be given within 72 hours of delivery or abortion. 5. RhoGam is also given at 28 weeks gestation.

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