NURS 2465 Medication Review

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Unasyn

1. Anti-infective
2. Binds to bacterial cell wall resulting in cell death
3. Route: IVPB
4. 1.5-3 g over 10-15 min
5. Hold if allergy to PCN
6. Rash, diarrhea, anaphlaxis, superinfection, pain at injection site
7. May > AST, ALT, bilirubin, alkaline phosphatase, BUN, createnine
8. May < Hgm, Hct, RBC, WBC, neutorphils, lymphocytes
9. Obtain specimen for culture before therapy
10. Assess pt for infection (VS, wound appearance, sputum, urine, stool, and WBCs)
11. May decrease effectiveness of oral contraceptives

Heparin

1. Anticoagulant
2. Prophylaxis and tx of venous thrombosis, PE, Afib w/embolism, and MI
3. Route: IVP, SQ
4. IVP max dose: 10,000 units
5. IVP rate of admin: 5,000 units/min
6. SQ 5,000 units q 8-12 hr
7. Check compatibility w/other drugs
8. NEVER piggyback other drugs into a line of heparin
11. DO NOT give IVP unless continuous drip IV ready to hang
12. Assess for bleeding (gums, bruises, nosebleeds, melena, tarry stools, blood in urine)
13. If continuous IV comes out, try to get restarted immediately as effects wears off quickly
14. Labs: PLT, Hct, aPTT (anticoagulation is present when values are 1.5-2 times the control value)
15. Thrombocytopenia, anemia, HIT, pain at injection site

Digoxin (Lanoxin)

1. Cardiac glycoside
2. Increased cardiac output and slowing of HR
3. CHF, afib, atrial flutter, PAT
4. Route: IVP, PO
5. IVP max dose: 0.25 mg
6. IVP rate of admin: all doses should be given over minimum of 5 min
7. PO Digitalizing 0.75-1.5 mg (50% initially and 1/4 in 2 subsequent doses at 6-12 hr intervals)
8. PO Maintenance 0.125-0.5 mg/day
9. Hypothyroid pts are very sensitive to cardiac glycosides Hyperthyroid pts may need increases doses
10. Obtain baseline data before first dose (HR and rhythm, BP, Lytes, BUN, serum creatinine)
11.Take apical pulse for full minute before administering dose (hold if < 60 bpm or significant change in rate, rhythm, or quality of pulse)
12. Labs: serum potassium (hypokalemia may make pt more suceptible to dig toxicity) and dig levels (therapeutic dig levels are 0.5-2.5 mg/ml)
13. Give only maintenance doses on the MedSurg units. If dose requested is a loading dose or the intent is to initially digitalize, the pt should be on a heart monitor and in a critical care area
14. Monitor serum K and dig levels )therapeutic dig levels are 0.5 to 2.5mg/dl
15. Older adults at increased risk for toxicity (abdominal pain, anorexia, N/V, vision disturbances, arrhythmias) and falls (implement prevention strategies)

Lasix (Furosemide)

1. Diuretic
2. Inhibits reabsorption of NA and chloride from loop of Henle and distal renal tubule
3. Edema, hypertension
4. Route: IVP, PO
4. IVP max dose: 80 mg
5. IVP rate of admin: 10 mg over 1 min
7. PO 20-80 mg/day q 6-8 hr
9. Can lead to profound diuresis w/water and lyte depletion
10. May potentiate untoward effects when used w/ NSAIDS
11. Strict I & O
12. Monitor lytes (especially potassium), BP, BS
13. Daily weights
14. Use carefully in pts allergic to sulfonamides

Lovenox (Enoxaparin)

1. Anticoagulant
2. Prevention of thrombus formation (VTE, DVT, PE,), unstable angina, MI
3. Route: IV, SQ
4. SQ VTE 30-40mg (timing of dose depends on type of surgery)
5. SQ DVT/PE 1-1.5mg/kg q 12-24 hr minimum of 5 days (INR > 2 for two consecutive days); Warfarin should be started within 72 hrs
6. SQ Unstable angina 1 mg/kg q 12 hr for 2-8 days
7. SQ MI (adults >75 yrs) 0.75 mg/kg q 12 hrs (max 75 mg) 2-8 days
8. IV bolus MI (adults <75 yrs) of 30 mg plus 1 mg/kg SQ (max 100mg) 2-8 days
9. Assess for bleeding (gums, nose, bruising, black/tarry stools, hematuria, decrease in Hct or BP, Guaiac positive stools), hypersensitivity (chills, fever, urticaria), injection site (hematoma, ecchymosis, inflammation)
10. Labs: INR/PT, CBC, PLT, Hct, stools for occult blood, AST, ALT, hyperkalemia, toxicity
11. Antidote: protamine sulfate 1 mg for each mg of Lovenox administered by slow IV injection

Coumadin (Warfarin)

1. Anticoagulant
2. Prophylaxis and tx of venous thrombosis, PE, afib w/embolization, management of MI, prevention of thrombus formation after prosthetic valve placement
3. Route: IV, PO
4. IV/PO 2-5 mg/day for 2-4 days; adjust dose by results of INR
5. Assess for bleeding (gums, nosebleed, bruising, tarry/black stool, hematuria, decrease in Hct or BP, guaiac positive stools, urine, or nasogastric aspirate)
6. Labs: PT, INR, AST, ALT, CBC, toxicity
7. Therapeutic range PT: 1.3-1.5 times control
8. Normal INR (not on anticoagulants): 0.8-1.2
9. Therapeutic range INR: 2-4.5 (depends on low/high risk)
10. Antidote: vitamin K (phytonadione)

Cefazolin (Ancef, Kefzol)

1. Anti-infective (first generation cephalosporin)
2. Binds to bacterial wall resulting in cell death (gram +)
3. Perioperative prophylaxis, biliary tract infections, genital infections, bacterial edocarditis prophylaxis for dental and upper respiratory
4. Route: IVPB
5. 500mg-2g/dose q 8hrs (infuse over 15-30min)
5. Assess for infection, allergy to penicillin or cephalosporins and obtain specimen for culture before therapy
6. Observe for anaphylaxis (rash, pruritus, laryngeal edema, wheezing); keep epi, antihistamine, and resuscitation equipment close by
7. Monitor bowel function (diarrhea, abdominal cramping, fever, bloody stools)
8. Labs: AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, creatinine, may cause positive COOMBS
9. Adverse reactions/SE: Seizures, pseudomembranous colitis, Stevens-Johnson syndrome, agranulocytosis, pain at injection site or phlebitis at IV site
10. Concurrent use with loop diuretics or aminoglycosides may increase risk of renal toxicity
11. Check Y-site compatibility/incompatibility
12. Must take ATC at evenly spaced times and finished completely
13. Use cautionary in renal impairment
14. Drug-Drug: Probenecid decreases excretion and increases serum levels
15. IV: change sites every 4-72 hrs to prevent phlebitis
16. Excreted in kidneys

Rocephin (ceftriaxone)

1. Anti-infective (third generation cephalosporin)
2. Binds to bacterial wall to cause cell death (gram -)
3. Meningitis and bone/joint infections, intra-abdominal infections, septicemia, perioperative prophylaxis, Lyme disease
4. Route: IVPB
5. 500mg-2g/dose Q 24hrs over 15-30min
6. Assess for infection, allergy to penicillin or cephalosporins and obtain specimen for culture before therapy
7. Observe for anaphylaxis (rash, pruritus, laryngeal edema, wheezing); keep epi, antihistamine, and resuscitation equipment close by
8. Monitor bowel function (diarrhea, abdominal cramping, fever, bloody stools)
9. Labs: AST, ALT, aslaline phosphatase, bilirubin, LDH, BUN, and creatinine, may cause positive COOMBS
10. Adverse reactions/SE: Seizures, pseudomembranous colitis, Stevens-Johnson syndrome, agranulocytosis, pain at injection site or phlebitis at IV site, choleliasis
11. Observe for anaphylaxis (rash, pruritus, laryngeal edema, wheezing); keep epi, antihistamine, and resuscitation equipment close by
12. Concurrent use with loop diuretics or aminoglycosides may increase risk of renal toxicity
13. Should not be administered concomitantly w/calcium containing solutions
14. Drug-Drug: Probenecid decreases excretion and increases serum levels
15. Use cautiously in renal impairment
16. IV Change sites every 4-72 hrs to prevent phlebitis
17. Check Y-site compatibility/incompatibility
18. Metabolized and excreted in urine

Phenytoin (Dilantin)

1. Anti-arrhythmic/anti-convulsants
2. Diminishes seizure activity; termination of ventricular arrhythmias
3. Tx/prevention of tonic-clonic seizures and complex partial seizures; arrhythmias associated w/digoxin toxicity, prolonged QT intervals, and surgical repair of congenital heart disease in children; management of neuropathic pain
4. Route: IVPB
5. 100mg q 6hrs no faster than 50mg/min (until arrhythmia is abolished or total of 15mg/kg given or toxicity occurs)
5. NOT COMPATIBLE W/DEXTROSE
6. Assess for notable changes in behavior (depression or suicidal thoughts), oral hygiene (gingival hyperplasia), Steven Johnson syndrome, seizures
7. Phenytoin hypersensitivity syndrome (fever, rash, lymphadenopathy), may lead to renal failure, rhabdomyolysis, or hepatic necrosis, may be fatal
8. Monitor BP, ECG, respiratory function, phenytoin toxicity (nystagmus, ataxia, confusion, N/V, slurred speech, dizziness)
9. Therapeutic levels 10-20mcg/ml (serum free 1-2mcg/ml)
10. Labs: CBC, serum calcium, albumin, AST, ALT, alkaline phosphatase, GGT, BG, folate
11. Check Y-site compatibility/incompatibility
12. Advise pt when to contact HCP (behavioral, skin irregularities, neurological)
13. Metabolized by the liver

Solu-Medrol (methyl-prednisolone)

1. Corticosteroid (intermediate acting)
2. Suppresses inflammation and normal immune response
3. Used w/other immunosuppressants in prevention of organ transplantation, adjunct therapy for hypercalemia, adjunct therapy for N/V from chemotherapy, acute spinal cord injury
4.Route: IVP
5. 40mg over 1min; max dose 250mg
6. Assess involved system (due to many uses), adrenal insufficiency (hypotension, weight loss, weakness, N/V, anorexia, lethargy, confusion), I & O, cerebral edema, ulcerative colitis (diarrhea, bleeding), hyperglycemia, hypokalemia
7. Labs: lytes, BG, CBC, WBCs, Na, Ca, K
8. Administer w/meals, avoid grapefruit juice
9. Check Y-site compatibility/incompatibility
10. Teach patient: do not stop medication suddenly (may cause adrenal insufficiency), avoid people with known contagious illnessess, and when to call HCP (severe abdominal pain or tarry stools, weight gain, non-healing sores, tiredness), avoid alcohol, grapefruit juice
11. May mask symptoms of infection (observe for s/s)
12. Monitor BG levels (diabetic pt may need higher doses of insulin), GI symptoms (administer antacids), potassium levels
13. Metabolized by the liver

Dilaudid (hydromorphone)

1. Opioid analgesics (moderate to severe pain); antitussive
2. Binds to opioid receptors in CNS (alters perception/response to severe pain, CNS suppresion); suppresses cough reflex
3. Route: IVP, epidural (DILUTE IN 5cc NS BEFORE ADMINISTERING)
4. IVP 1mg slowly over 2-5min (no more than 2mg at a time)
5. O= 10-15min P= 15-30min D= 2-3hrs
6. Observe guidelines for IVP narcotic analgesics on MedSurg floor includes PCA thereapy)
7. Potentiated by phenothiazides and other CNS depressants
8. Use w/caution in elderly or debilitated patients, those w/impaired renal or hepatic function, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture, MAOIs
9. Assess pain (type, location, intensity) before and after therapy; breakthrough pain
10. Assess LOC, BP, P, RR (<8/min assess LOSedation), bowel function (increase fluid/bulk/laxative for constipation)
11. Assess cough and lung sounds during antitussive use; use cautiously in postoperative and pulmonary disease pts
12. Adverse reactions/SE: sedation, N/V, urinary retention, respiratory depression (hold if <8/min), confusion, hypotension, constipation (administer stool softener prn)
13. Labs: amylase and lipase
14. Antidote: Narcan
15. Should not be administered unless a narcotic antagonist and facilities for assisted or controlled ventilation are immediately avialable
16. May cause drug dependence
17. Administer PO w/food or milk to minimize GI irritation
18. Check syringe and Y site compatibility/incompatiability
19. Incompatible w/valium, decadron, dilantin, compazine, and Kefzol
20. Patient teaching: Call for assistance when ambulating and change positions slowly; constipation prevention; how and when to ask for pain relief
21. HIGH ALERT
22. Metabolized by the liver

Morphine

1. Opioid analgesic (moderate to severe pain)
2. Binds to opioid receptors in CNS (alters perception/response to severe pain, CNS depression)
3. Assess pain (type, location, intensity) before and after therapy; breakthrough pain
4. Route: IVP, epidural
5. IVP 5mg over 45min (DILUTE DOSE IN 5cc NS BEFORE ADMINISTERING)
6. O= 5min P= 20min
7. Max respiratory depression occurs about 7min after IV injection and can remain depressed for 4-5hrs
8. Too rapid administration can result in increase frequency of opiate induced adverse drug reactions (respiratory depression, apnea, hypotension)
9. Assess pain (type, location, intensity) before and after therapy; breakthrough pain
10. Assess LOC, BP, P, RR (<8/min assess LOSedation), bowel function (administer stool softener prn)
11. Caution in elderly (more sensitive to effects of sedation); MAOIs
12. Adverse reactions/SE: sedation, respiratory depression, confusion, hypotension, constipation, N/V, ileus, urinary retention
13. May cause drug dependence
14. Use w/caution in pts receiving other tranquilizers, sedatives, hypnotics, alcohol, tricyclic antidepressants, MAOIs, antihistamines
15. Labs: amylase and lipase
16. Antidote: Narcan
17. Should not be administered IV unless a narcotic antagonist and facilities for assisted or controlled ventilation are immediately available
18. Observe guidelines for IVP narcotic analgesics on MedSurg floors (includes bolus doses for PCA therapy)
19. Administer PO w/food or milk to minimize GI irritation
20. Check syringe and Y site compatibility/incompatibility
21. Patient teaching: call for assistance when ambulating and change positions slowly; constipation prevention; how and when to ask for pain relief
22. HIGH ALERT
23. Instruct family members not to administer epidural doses to sleeping patient
24. Metabolized by the liver

Zofran (ondansetron)

1. Antiemetic
2. Blocks the effects of serotonin at 5-HT3 receptor sites located in vagal nerve terminals and chemoreceptor trigger zone in CNS
3. Post-op nausea and vomiting (higher doses given IVPB for post chemo nausea)
3. Route: IVP, IVPB
4. IVP 4mg over 2-5min; IVPB 12mg/dose q 8hrs over 3min
5. Not necessary to dilute if taken form single dose vial
6. Not compatible with other alkaline base drugs (may precipitate)
7. Rare instances of tachycardia, angina, bradycardia, hypotension, syncope, and EKG changes
8. May cause constipation
9. Rare cases of hypokalemia and grand mal seizures have been reported
10. Transient blurred vision and transient dizziness haev occurred
11. Assess bowel status and use stool softeners as necessary
12. Monitor IV site (pain, burning, redness)
13. Adverse reactions: extrapyramidal reactions (involuntary movements, facial grimacing, rigidity, shuffling walk, trembling of hands)
14. Labs: biliruben (transient increases), AST, ALT
15. Check y-site compatibility/incompatibility
16. Metabolized by liver

Toradol (ketorolac)

1. Nonopioid analgesic, non-steroidal anti inflammatory agent
2. Inhibits prostaglandin synthesis producing peripherally mediated analgesia
3. Short term management of pain
4. Route: IVP
5. 30mg over at least 15sec q 6hr (max 120mg/day)
6. Do not mix w/other medication
7. Avoid use with aspirin or other NSAIDs
8. MCGH automatic stop order is 2days (physician order needed beyond that time)
9. DO NOT USE FOR MORE THAN 5 DAYS
10. Monitor urine output, observe for GI pain, upset or bleeding
11. Observe for post-op bleeding or hematomas
12. Use cautiously in CVD, history of GI bleeding (Beers list), renal impairment
13. Adverse reactions/side effects: drowsiness, GI bleeding, exfoliative dermatitis, Steven's-Johnson syndrome, epiderma necrolysis, analphylaxis
14. Assess pain, type, location, intensity prior to and 1hr after therapy
15. Assess for rhinitis, asthma, and urticarria (increased risk for hypersenitivity)
16. Labs: AST, ALT, PT, BUN, creatinine, potassium
17. Check syringe and y-site compatibility/incompatibility
18. 50% metabolized by liver; 92% excreted by kidney

Lipitor (atorvastatin)

1. Anti-lipid (< LDL and triglycerides)
2. HMG-CoA reductase inhibitor
3. Prevention of CVD (< risk of MI or stroke) in pts w/multiple risk factors for CHD or type 2 diabetes
4. Route: PO
5. 10-200mg q day
6. Use cautiously in liver disease and alcoholism
7. Patient teaching: Avoid grapefruit juice
8. Adverse reactions/side effects: abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes
9. Labs: serum cholesterol and triglyceride levels before and during therapy, AST, ALT, alkaline phosphatase, bilirubin
10. If pt develops muscle tenderness monitor CK levels (discontinue >10)
11. Patient teaching: use in conjunction w/diet restrictions, exercise, and cessation of smoking
12. Metabolized by liver

Ace inhibitors (angiotensin-converting enzyme inhibitors)

1. Antihypertensives ("pril")
2. Blocks the conversion of angiotensin l to angiotensin ll
3. Lowers BP through systemic vasodilation
4. IV, PO
5. Selection/dosage depends of indications and co-morbidities
6. Use cautiously in elderly, severe hepatic/renal impairment, concurrent diuretic therapy, black pts w/hypertension, hypovolemia and hyponatremia
7. Monitor BP and P frequently initially and during therapy
8. Assess for signs of angioedema (dysphasia, facial swelling)
9. Monitor for fluid overload (peripheral edema, crackles, JVD)
10. Adverse reactions/side effects: cough, hypotension, taste disturbances, agranulocytosis, angioedema, dizziness
11. Labs: BUN, creatinine, lites (>K, <Na), CBC, AST, ALT, bilirubin, uric acid, BG
12. Check y-site compatibility/incompatibility
13. Patient teaching: avoid salt substitutes and OTC cold remedies, change positions slowly
14. Instruct pt when to contact HCP (rash, mouth sores, fever, swelling of hands/feet, irregular heart beat, chest pain, dry cough, swelling of face, eyes, lips or tongue, difficulty swallowing or breathing)
15. Encourage pt to comply w/ interventions for hypertension (wt reduction, cessation of smoking, moderate alcohol consumption, regular exercise, stress management)

Cardizem (diltiazem)

1. Antihypertensive, antianginal, antiarrhythmic
2. Calcium channel blocker: blocks transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation/contraction
3. Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Reduction of ventricular rate in A-fib or A-flutter
4. Route: IV, PO
5. IV 0.25mg/kg (may repeat a dose of 0.35 mg/kg). May follow w/continuous infusion at 5-15mg/hr for up to 24hr (titrate to pt HR and BP)
6. PO 30-120mg 3-4xs daily or 60-120mg 2xs daily as SR capsules or 180-240mg 1x daily as CD or XR capsules or LA tablets
7. Use cautiously in elderly and severe hepatic impairment
8. Monitor BP, HR (<50), P prior to and during therapy, ECG (prolonged PR intervals), I & O, daily wt, dig levels (if concurrent therapy)
9. Assess for signs of CHF (peripheral edema, crackles, wt gain, JVD), angina (location, duration, intensity), arrhythmias (EKG)
10. Report bradycardia or prolonged hypotension
11. Labs: total serum calcium, K (hypokalemia > risk of arrhythmias), ALT, AST, BUN, creatinine
12. Patient teaching: avoid grapefruit juice, change positions slowly, avoid OTC cold remedies, use of sunscreen, and when to call HCP
13. Adverse reactions/side effects: arrythmias, CHF, peripheral edema, Steven's-Johnson Syndrome, dizziness
14. Avoid grapefruit juice
15. Check Y-site compatibility/incompatibility
16. Metabolized by liver

Procardia (NIFEdipine)

1. Antihypertensive, antianginal
2. Calcium channel blocker: blocks transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation/contraction
3. Systemic vasodilation, resusting in <BP. Coronary vasodilation, resulting in < frequency and severity of attacks of angina
Route: PO
4. 10-30 mg 3xs daily (max 180mg/day) or 10-20mg 2xs daily as immediate release form or 30-90mg 1x daily as sustained release for (max 90-120mg/day)
5. Use cautiously in elderly, (> incidents of falls), hepatic impairment
6. Contraindicated in SBP <90mm Hg
7. Adverse reactions/side effects: headache, peripheral edema, arrhythmias, CHF, flushing, Steven's-Johnson Syndrome
8. Monitor BP and P before and during therapy, ECG (arrhythmias), I 7 O, daily weight, dig levels (if concurrent therapy)
9. Assess for s/s of CHG (peripheal edema, crackles, dyspnea, wt gain, JVD), fall risk (institute fall prevention strategies), angina (location, duration, intensity
10. Labs: total serum calcium, K (hypokalemia > risk of arrhythmias), ALT, AST, BUN, creatinine
11. Pateint teaching: avoid grapefruit juice, change positions slowly, avoid OTC cold remedies, when to contact HCP, use sunscreen
12. Metabolized by liver

Calan (verapamil)

1. Antihypertensive, antianginal, antiarrhythmic, vascular headache suppressant
2. Calcium channel blocker: blocks transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation/contraction
3. Use cautiously in elderly and severe hepatic impairment
4. Route: IV, PO
5. PO 80-120mg 3xs daily or 120-240mg/day as single dose ER (increase as needed)
6. IV 5-10mg (75-150mcg/kg); may repeat w/10mg (150mcg/kg) after 15-30min
7. Assess BP and pulse before and during therapy, ECG (arrythmias), angina (location, duration, intensity), I & O, daily wt, s/s CHF (peripheral edema, crackles, dyspnea, wt gain, JVD), dig levels (if concurrent therapy)
8. Labs: total serum calcium concentration, ALT, AST
9. Check Y-site compatibility/incompatibility
10. Patient teaching: avoid grapefruit juice, change positions slowly, avoid OTC cold remedies, when to contact HCP, use sunscreen
11. Metabolized by liver

Protonix (pantoprazole)

1. Anti-ulcer agent
2. Proton inhibitor
3. Decreased acid secretion in the gastric lumen
4. Route: IV, PO
5. IV GERD 40mg once daily 7-10 days; gastric hypersecretions 80mg q 12hr (max 240mg/day)
6. PO GERD 40mg 1x daily; gastric hypersecretions 40mg 2xs daily (max 120mg 2xs daily)
7. Adverse reactions/side effects: headache, abdominal pain, diarrhea, eructation, flatulence, hyperglycemia
8. Assess epigastric or abdominal pain , frank or occult blood (stool, emesis, or gastric aspirate)
9. Labs: AST, ALT, alkaline phosphatase, and bilirubin
10. Check Y-site compatibility/incompatibility
11. Patient teaching: avoid aspirin, NSAIDs, alcohol
12. Metabolized by liver

Zithromax (azithromycin)

1. Anti-infective
2. Inhibits protein synthesis of bacterial ribosomes
3. Tx for upper/lower respiratory infections, strep, bronchitis, tonsillitis, community acquired pneumonia, otitis media, skin infections, urethritis, cervicitis, gonorrhea, chancroid, sinusitis
4. Route: IV, PO
5. Route/dosage depends on diagnosis and comorbidities
6. Contraindicated in hypersensitivity to arithromycin, erythromycin, or other macrolide anti-infectives
7. Use cautiously in liver impairment
8. Adverse reactions/side effects: pseudomembranous colitis, abdominal pain, diarrhea, nausea, Steven's-Johnson Syndrome, toxic epidermal necrolysis, angioedema
9. Assess for infection (v/s, appearance of wound, sputum, urine)
10. Obtain specimen for C & S before initiating therapy
11. Observe for s/s of anaphylaxis (rash, pruritis, laryngeal edema, wheezing)
12. Assess for skin rash frequently (Steven's-Johnson syndrome or toxic epidermal necrolysis may develop)
13. Labs: WBCs, AST, ALT, alkaline phosphatase, BUN, creatinine, BG
14. Advise pt to take as directed and finish the completely; notify HCP if fever and diarrhea develop and not to tx w/o advice of HCP
15. Excreted in bile

Betablockers

1. Antihypertensives ("lol")
2. Compete with adrenergic (sympathetic) neurotransmitters (epinephrine and norepinephrine for adrenergic receptor sites
3. Beta 1 receptor sites: located in the heart
4. Beta 2 receptor sites: located in bronchial, vascular smooth muscle, and the uterus
5. Route: IV, PO
6. Route/dosage depends on diagnosis and co-morbidities
7. Contraindications: uncompensated CHF, acute bronchospasm, some forms of valvular heart disease, bradyarrhythmias, and heart block
8. Precautions: pregnant and lactating women (fetal bradycardia and hypoglycemia), any form of lung disease or underlying compensated CHF, diabetics and pts w/severe liver disease
9. Do not discontinue abruptly in pts w/cardiovascular disease
10. Interactions: may cause additive myocardial depression and bradycardia (digoxin and some antiarrhythmics), may antagonize therapeutic effects of bronchodilators, may alter requirements for insulin or hypoglycemic agents in diabetics, Cimetidine may decrease the matabolism and increase the effects of some beta blockers
11. Monitor BP and P frequently, I & O ratios and daily wt, s/s of CHF (dyspnea, crackles, wt gain, peripheral edema, JVD)
12. Take apical pulse prior to administering (hold if <50 bpm or if arrhythmias occur)
13. Patient teaching: take medication even if feeling well, comply w/additional interventions for hypertension (wt reduction, low sodium diet, regular exercise, smoking cessation, moderation of alcohol), change position slowly, may cause increased sensitivity to cold, monitor BG (diabetics), carry identification describing disease process and medication regimen

Nitroglycerin

1. Acute and long term prophylactic management of angina pectoris; adjunct tx of CHF
2. Relief or prevention of anginal attacks, > cardiac output, < BP (ncreases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions)
3. Translingual, SL, IV, PO, transdermal
4. Route/dosage depends on diagnosis and co-morbidities
5.
Metabolized by liver and enzymes in blood

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