Inhibits growth of microorganisms but does not kill them.
Examples: Mercurochrome and betadine (topical applications)
Nursing Precautions (Observations that must be made to protect the patient before and after administration) Check for Iodine or shellfish allergy. Disease-Causing Organism
Disinfectant/Bacteriocidal/Germicidal: Disease-Causing Organism
Chemical agent that kills harmful microorganisms on non living objects.
Use only on inanimate objects.
Avoid patient contact with solutions
Wear gloves (Cidex and Virex are carinogenic)
Prevents growth of, destroys or weakens microorganisms.
Penicillin, ampicillin, tetracycline, gantrisin, keflex, sulfonamides (sulfa drugs), omnicef.
Ampicillin often used to treat respiratory infections if not allergic to penicillin.
Sulfa drugs can cause kidney damage.
Benemid is often added to penicilllin injection to increase strength and duration of penicillin. (Especially in treatment of some STDs).
Observe for allergic reactions.
Force Fluids (especially with sulfa drugs)
Disease Causing Organisms
Used to treat fungal infections.
Nystatin: used to treat oropharyngeal candidiasis (thrush) or vaginal candidiasis.
Maybe administered as topical (on skin), oral suspension or lozenges/ tablets, or vaginal creams/suppositories.
Systemic fungal infections can be treated by IV antifungals; such as, diflucan.
Central Nervous System (CNS)
Stimulants:Central Nervous System (CNS)
Activates or stimulates the (CNS)
Improves ability to concentrate
Used to treat ADD (attention deficit disorder)
Amphetamines (dexedrine), caffeine, ritalin
Central Nervous System (CNS)
Monitor patient closely.
Anti-Parkinson's: Central Nervous System(CNS)
Enhances the delivery of dopamine to the brain cells. Medicine takes several weeks before any benefit is seen. Slows the development of symptoms and progression of the disease.
Current drug of choice:
(2) Senimet (combination of Carbidopa/levodopa)
Contraindicated in angle-closure glaucoma.
Must be approved for use in anyone with history of glaucoma.
Side Effects: depends on stage of the disease.
Nausea/vomiting, Chewing motion
Orthostatic hypotension, Bobbing/facial grimacing, Dizziness/weakness Rocking motion
Adverse Effect: Dyskinesias. Neurologic syndrome marked by slow, rhythmical, automatic stereotyped movements.
Levodopa can cause orthostatic hypotension.
Most anti-parkinson medications have the potential to cause psychotic episodes.
Depressants: Central Nervous System (CNS)
Slows or depresses the central nervous system Purpose of analgesics: Relieves pain
Relieves anxiety in special conditions such as pre-op or post myocardial infarction (MI or heart attack)
Examples: Opiates, Morphine sulfate
Demerol (merperidine), Codeine
Can be habit forming, Monitor patient closely
Depresses respirations, Monitor respiration prior to and after administration.
If respiration too low < 12) do not give medication and call physician.
If a patient overdoses or is given too much opiate (narcotics) give NARCAN
Opiate overdose treatment:
Narcan, an opiate antagonist, can be given to reverse the effects of the narcotics.
Aspirin [Acetysalicylic acid (ASA) or salicylates]
Aspirin is also a mild anticoagulant, anti-inflammatory and antipyretic drug.
Can cause gastric mucosal (GI) bleeding
Ulcer patients should not take this drug.
Use cautiously in patients with severe liver disease, renal disease, alcohol abuse or malnutrition. Monitor for bleeding
Monitor urinary output
Monitor Hemaglobin/Hematocrit (H/H) levels
Can Mask signs/symptoms (s/s) of fever
Opiate antagonist: Reverse the effects of narcotics
Nursing Precautions: Monitor vital signs
Monitor level of consciousness (LOC)
Anxiolytics (anti-anxiety): Central Nervous System (CNS)
Calms without causing confusion or dullness.
Valium, Librium, Xanax, Haldol
Vistaril (minor), Thorazine (major)
Do not mix with alcohol.
May cause drowsiness.
Do not mix with alcohol.
Do not operate equipment or drive.
Implement fall precautions
Antipsychotics: Thorazine Central Nervous System (CNS)
Works to calm the agitated patient and reduce the psychotic symptoms.
Used for the treatment of severe mental illness: hallucinations (visual & auditory), bizarre, aggressive or harmful behavior.
Monitor for EPS (extrapyramidal symptoms)
Distorted body posture.
Tardive dyskinesia (s/s can become permanent if not recognized early and medication stopped or changed)
Anticonvulsants: Respiratory System
Used to control seizures.
Examples: Dilantiin (causes hyperplasia of gums)
Phenobarbital, Tegretol, Mysoline
Monitor for Hyperplasia of gums with prolonged use of dilantin.
Give meticulous oral care with this medication (dilantin). Place on seizure precautions.
Antitussives: Respiratory System
Examples: cough syrups containing
Non-opiate: pertussin, benylin
Do not give medication with water or follow with water. Opiate antitussives contains a narcotic and must be controlled
Bronchodilators: Respiratory System
Reduces resistance to airflow by relaxing smooth muscles and increasing diameter of the bronchus or bronchioles.
When administering bronchodilator and steroid inhaler: administer the bronchodilator first then the steroid inhaler.
Examples: Atrovent, Epinephrine
Proventyl (albuterol) Alupent
Warn patient that bronchodilators may cause headache, flushing or increase heart rate (tachycardia)
Expectorants: (decongestants)Respiratory System
Breaks up thick mucus secretions.
Relieves symptoms, does not cure the disease.
Examples: Robitussin (Guafenesin)
Triaminic, SSKI Gtts
Give with extra fluids (water) to help thin secretions.
Antihistamines: Respiratory System
Works against the effects of histamine, so they help treat allergic conditions.
Examples: Benadryl, Dimetapp
May cause drowsiness
Do not mix with alcohol, sedatives or tranquilizers.
Anti-tubercular: Respiratory System
Used to treat tuberculosis.
Isoniazid, Ethambutol, Rifampin
Isoniazid should be given with vitamin B6 and the patient must be watched for seizures.
Used to relieve pain and stiffness in arthritis
Example: Aspirin (ASA) (works as anti-inflammatory,anti-pyretic, analgesic and anticoagulant)
Nursing Precautions: May cause GI distress or bleed.
Muscle relaxants:Musculoskeletal System
Examples: Robaxin, Soma, Flexeril, Lioresal
May produce drowsiness, Do not mix with alcohol
Anti-depressants: Central Nervous System (CNS)
Elevate mood and reduce the symptoms of depression.Takes several weeks before benefits of medication seen.
Examples: MAOIs, Lithium (antidepressant/
antimanic) used to treat bipolar disorder. Nardil, TCAs, Tofranil
Selective Serotonin Reuptake Inhibitors (SSRI):
Examples: Lexapro, Prozac, Paxil, Zoloft
Does not cause the side effects seen in other antidepressants.
Takes several weeks to take effect.
MAOI: patients should avoid eating foods high in tyramines (red wine, liver, pickled herring, sauerkraut, overripe bannas, figs, avocados, chicken livers, aged cheeses, yeast extract and beer)
Note: cream cheese and cottage cheese have no detectable levels of tyramine.
MAOIs: (tricyclic antidepressant)
Tyramine (in the patient on MAOIs) causes hypertensive crisis: Prodromal (early symptoms) of hypertensive crisis: Severe occipital headache
Stiff neck, Sweating, Nausea, Vomiting
Sharply elevated blood pressure.
MAOIs: do not play well with others.
Increases the hypotensive effect of general anesthesia, diuretics and antihypertenive medications. (monitor B/P)
Increases the hypoglycemic effect of insulin and oral hypoglycemics (monitor accu-ck)
Demerol (meperidine) given to patient on MAOI causes hyperpyrexia, restlessness, hypertension, convulsions and coma
Anti-inflammatory: Cardiovascular System
Used to reduce inflammation thus relieve pain.
Example: Ibuprofen (motrin), Aspirin
May cause GI distress or bleed on an empty stomach. Should not be given to patients with ulcers; can cause bleeding.
Vasoconstrictors: Cardiovascular System
Raises the blood pressure by causing vasoconstriction.
Examples: Adrenalin, Levophed, Dopamine
Check B/P frequently
Administered in critical care units. (ICU or ER)
Dilates blood vessels
Lowers B/P by causing vasodilation. (antihypertensive effect) Causes a headache.
Used to treat hypertension (HTN) and/or angina
Maybe given sublinqual (SL), Oral, topical or transdermal.
Example: Nitroglycerine (NTG)
Nitrobid ointment, Nitro-dur
Do not touch with bare hands. Nurse may absorb some of the medication.
Patient may carry NTG SL tablets or spray at all times if history of angina (chest pain) (May give Q5min x 3 for CP if SBP >90)
May cause headache, flushing, and drop in B/P. (Expected side effects if medication is working)
Place transdermal patch or disc on any skin surface without hair.
Rotate sites used for transdermal applications.
Do not rub NTG ointment into skin.
Do not place transdermal applications over bony areas. Used with patients who are hypertensive to lower blood pressure.
Some also have antianginal effect; such as, isordil, nitroglycerine, procardia, metoprolol.
Example: Aldomet, Isordil, Apresoline Nitroglycerine, , Inderal, Procardia
Metoprolol (Lopressor), Minipress
Catapres or Catapress TTS
Nursing Precautions: Take B/P before administering, if systolic blood pressure (SBP) <100 (some agencies say <90) do not give and notify staff and/or physician.
Diuretics are also given to lower blood pressure by decreasing circulating fluid volume.
Check B/P, Monitor I&O, Daily weight
Monitor pulse rate
Cardiotonics: Cardiovascular System
Strengthens the contraction of the heart muscle; so that the heart is able to empty and fill more effectively. Decreases the heart rate.
Examples: Digitalis (purple foxglove)
Digitoxin, Digoxin (lanoxin)
Nursing Precautions: Take apical pulse before giving the medication. Give only if apical pulse is 60 or above. If the apical pulse is < 60, hold medication and report.
Medication has cumulative effect so toxicity can develop. (digoxin toxicity: Pulse <60)
Monitor serum drug levels; especially, in elderly because of impaired renal function.
Anti-arrhythmics: Cardiovascular System
Decreases the irritability of the heart muscle so it doesn't flutter,beat rapidly or erratically.
Example: Inderal (also lowers the blood pressure), Quinidine, Pronestyl, Lidocaine (IV)
Nursing Precautions: Monitor BP & P closely
Anticoagulants: Cardiovascular System
Slows down the clotting of the blood.
Example: Coumadin (oral) , Lovenox (SQ)
Heparin (parenteral), (given only SQ, IVP or IV infusion)
Heparin is the only anticoagulant that can be given IV. Used to prevent deep vein thrombosis (DVT)
Nursing Precautions: Monitor for bleeding; internal or external. Observe for blood in urine, sputum, emesis or stool. Observe for bleeding from skin, nares, mouth, rectum or mucous membranes. (bruising)
Teach patient to observe for signs of internal or external bleeding: blood in urine, sputum, emesis or stool. Bleeding from nares, mouth, rectum or ecchymosis. Teach patient to use electric razor for shaving and avoid razor blades.
Instruct patient to limit foods containing vitamin K when taking coumadin. (foods that are green)
Coagulants: Cardiovascular System
Assist in the formation of clots to reduce or control bleeding.
Examples: Vitamin K (Aqua Mephyton, Synkavite),
Nursing Precautions: Monitor for bleeding.
Monitor peripheral circulation
Monitor complaint of pain especially chest pain or extremities. Monitor for changes in LOC, irregular heart beat or neurovascular status.
Hematinics: Cardiovascular System
Given for low RBC count or hemoglobin (anemia), Used to treat anemia
Provides building blocks for making red blood cells.
Examples: Iron preparations,
Ferrous sulfate (FeS04), Ferosol,
Vitamin B12 (cyanocobalamin)
Vitamin B9 (folic acid)
Give liquid (hematinics) iron preparation through a straw. (Liquid iron preparation stains teeth) Warn patients that Iron preparations cause black tarry stools. (It should be expected)
Do not give on an empty stomach.
Injectable iron is given via Z-track method.
Monitor hemoglobin and hematocrit level.
Urinary Anti-Microbials/Anti-infective: (Sulfonamides)
Eliminates a bacterial infection.
Antiseptic effect on urine and urinary passages.
Septra (Bactrim), Ganstrisin, Furadantin
Nursing Precautions: Sulfa drugs can cause kidney damage, Must force fluids.
Keep accurate I&O
Avoid acid urine for bactrim or septra
Monitor for crystal formation in urine
Antibiotic/anti-protozoal Urinary System
Used to treat systemic anaerobic infections.
Clostridium difficile (c-diff)
Administer over one hour. Does not play well with others. Must be given through dedicated IV line. Not mixed with anything.
Diuretics: Urinary System
Increases the production of urine.
Removes excess water from the body.
Increase urinary output
Examples: Diuril Hydrochlorothiazide (HCTZ) loses (K+), Aldactone (potassium (K) sparing) does not lose (K+),Lasix (furocemide) (potassium (K) losing) Loses (K+). Effect last six hours. Prevents the reabsorption of sodium chloride.
Nursing Precautions: Monitor I&O, Monitor B/P, Measure daily weight, Give early in day to prevent nocturia. (nocturnal voiding), Monitor potassium levels and replace as ordered. (k-dur, KCL, Koan)
Urinary analgesics: Urinary System
Decreases urinary tract pain (dysuria).
Examples: Pyridium (relieves pain caused by UTI symptoms)
B&O suppository (bladder spasm)
Nursing Precautions: Pyridium turns urine reddish orange; can stain clothing. (inform patient)
Antacids: Digestive System
Lowers the acidity of gastric secretions by neutralizing the HCL.(Neutralizes stomach acid).
Can interfere with antibiotic absorption.
Examples: Gelusil, Milk of Magnesia
Maalox, Nylanta, Tums
Nursing Precautions:Liquids: Shake (bottle) well before administering dosage.
Tablets: Chew tablets well. Should only take for 2 weeks (if not under the care of physician) for indigestion.
Carminatives (Anti-flatulent): Digestive System
Defoaming agents that break up gas bubbles.
Relieves gas Active ingredient: simethicone
Examples: Mylicon, Phazyme, Gas-x
Nursing Precautions: Assess the patient for abdominal distention, pain and bowel sounds before and during therapy.
Check for belching and passing of flatus.
Use Room deodorizers as needed.
" patients and pilots are authorized to pass flatus."
Emetics: Digestive System
Produces vomiting. Used in cases of poisoning.
Example: syrup of ipecac.
Nursing Precautions: Follow administration with large glass of water. Provide emesis basin.
Give only under the direction of an MD
Antiemetics: Digestive System
Used to prevent or treat nausea and vomiting.
Example: Zofram, Dramamine, Antivert
Tigan, Compazine, Marinol
Nursing Precautions: Watch for drowsiness.
Give before vomiting occurs for best effect.(prevention), Can potentiate depressants.
Pain can cause nausea. Observe for presence of blood in emesis (bright red or coffee ground)
Anti-diarrheals: Digestive System
Used for the treatment of diarrhea
Provides relief from the incapacitation and discomfort of diarrhea.
Examples: Kaopectate, Immodium
Nursing Precautions: Monitor bowel movements closely. Report number, color and consistency of stools to staff/physician.
Collect any ordered stool samples
Record number, color and consistency of stools; especially, presence of blood: Bright red color, maroon color, black tarry stools.
Remember diarrhea is usually a symptom of an underlying problem
Cathartics (laxatives) Digestive System
Used to treat constipation. Promotes bowel movement.
Types of Laxatives: Stimulant/Irritant: [Stimulates the bowels to empty by causing irritation that promotes peristalsis (wave like motion) and evacuation]
Produces a bowel movement
Saline: (Causes water to be retained in the intestinal tract, distending the bowel and producing peristalsis.)
Magnesium citrate, Milk of Magnesia (MOM)
Bulk Forming: (Increases bulk in the stool which causes peristalsis.), Fiber Con, Metamucil
Lubricants: Lubricates and softens feces for easier passage. Mineral oil
Stool Softners: used to prevent straining at stool
Draws water into the stool, causing it to soften.
Does not stimulate peristalsis.
Known as "wetting agent"
Types of stool softners.
Colace (docusate sodium), Surfak (docasate calcium)
Nursing Precautions: Stimulants: do not give if abdominal pain is present. Monitor stools.
Saline: Usual dose is 30 ml as a laxative . Manesium citrate is sometimes used in larger amounts for pre-procedural bowel prep.
Bulk Forming: Mix at bedside. Must mix well with a full glass of water. Can cause bowel obstruction if not given with enough water.
Stool Softner: May take several days to work.
Histamine Blockers or H2 receptor antagonist (H2 blockers)GI
Blocks histamine (H2) receptors in stomach; resulting in a decrease in the volume of hydrochloric acid (HCL) being secreted by the stomach. Relieves discomfort, reduces frequency of heartburn, and heals irritated tissue.
Examples; tagament, pepcid and zantac.
Do not give at the same time as antacids.
Administer antacids 1 hour before or 2 hours after these medications.
Watch for symptoms of mental confusion, slurred speech and disorientation if patients also have liver or renal disease
Anti-diabetics: Insulin Endocrine System
Insulin is a hormone produced by the pancreas that is a key regulator of metabolism.
Insulin is required to move glucose into cells to be used for metabolism.
Insulin is given in an insulin syringe; measured in units. Rotate insulin injection sites for better absorption. Never shake insulin. (Rotate gently between hands)
Must always monitor for s/s of insulin shock.
Novolog: Humalog, Apidra
Onset:0.2-0.3 hours, Peak: 0.5-3 hr
Short Acting: (clear) Regular Insulin (Only insulin that can be given IV),
Humulin R, Novolin R
Onset: 0.5-4 hr, Peak: 2.5-5 hrs
Duration: 1-5 hours
Humulin N, Novolin N
Mixed Insulins: (NPH and Regular insulin)
Onset: 0.5-4 hours, Peak: 4-12 hrs
Duration: 12-28 hrs
Long Acting: Lantus
Onset:1 hr, Peak: unknown
Duration:up to 24 hrs
Exubera: Insulin inhalation powder.
Lowers blood glucose
New form of insulin available for use only for adults at this time. Action similar to regular insulin.
Onset: 10-20 min, Peak: 2 hr
Duration: 6 hrs.
Antidiabetics (oral): Endocrine System
Lowers blood sugar by stimulating the beta cells in the pancreas to produce insulin.
Can be used by type 2 diabetics if pancrease can still secrete insulin.
Example: Diabenese, Orinase, Amaryl
Nursing Precautions: Expect nausea, vomiting, anorexia and abdominal cramps with initial dose of medication. (when med first started)
Educate the patient about the possible side effects. Patient should not stop medication unless instructed to stop by physician.
Thyroid Replacement Hormone: Endocrine System
Returns a patient to a normal thyroid state (euthyroid), Synthroid (levothyroxine) is considered the drug of choice for hormone replacement in hypothyroidism and post operative thyroidectomy.
Nursing Precautions: Watch and report S/S of hyperthyroidism to MD:
Tachycardia, Diarrhea, Anxiety, Palpitations
Weight loss, Angina, Abdominal cramps/ fever
Thyroid replacement therapy for the elderly, cardiovascular disease or chronic hypothyroidism
Should be ordered at a reduced dose and then gradually raised to therapeutic level as tolerated.
Corticosteroid: Endocrine System
Have anti-inflammatory, antiallergenic and immunosuppressant effect.
When discontinued, must be tapered off.
Maybe given IV, PO, topical or by injection.
Examples: Solu-Medrol (IV)
Deltasone, Predisone , Prednisolone
Nursing Precautions: Does not cure disease.
Relieves symptoms of tissue inflammation.
Use with caution because of side effects.
Mask symptoms of infection or disease
Cause fluid retention
Causes weight gain and moon face
May experience psychotic behavioral problems; especially with long term use. (agitation, hallucination, paranoia) are considered unexpected events or idiosyncratic. (Record/report/and monitor)
Side Effects: Cause hyperglycemia
Delay wound healing, Cause GI bleed
Cause increased appetite, Cause gynecomastica in men, Must taper off dose. Do not stop medication abruptly
Estrogen: Reproductive System
Secreted from the ovaries (primarily) and adrenal glands. Stimulates the maturation of female sex organs.
Research is still being done on effects in men.
Used as palliative treatment for some prostate and breast cancers. Also used for postmenopausal osteoporosis. Increases risk for uterine cancer.
Used as hormone replacement therapy
Examples: premarin and estrace.
Premarin and provera is often given in combination to decrease risk of endometrial (uterine) cancer.
Nursing Precautions: Ensure patient is not pregnant prior to taking. May cause weight gain, edema, breast tenderness, nausea.
Can cause gynecomastia in men.
Progestins: Reproductive System
Associated with body changes that favor (1) Implantation of the fertilized ovum
(2) Continuation of pregnancy
(3) Preparation of the breast for lactation (production of milk)
Plays a role in cardiac function in men.
Example: Progesterone, provera
Ensure Patient is not pregnant prior to taking unless under MD supervision.
May cause weight gain, edema, nausea/vomiting, diarrhea, tiredness and oily scalp.
Testosterone: Reproductive System
Secreted from the testes (primarily) and adrenal glands. Stimulates the development of
(1) Male sex organs (reproductive system)
(2) Male characteristics: voice, hair distribution and male body form.
In women, thought to decrease libido.
May cause gastric irritation and edema.
Patients should report weight gain of more than 2 pounds per week.
Monitor women for signs of masculinization
(deepening of voice, hoarseness, growth of facial hair, clitoral enlargement, menstrual irregularities.
Miotics (eye) Sensory System
Constricts pupils (miosis)
Must be labeled opthalmic and must be sterile.
Mydriatics (eye) Sensory System
Example: Atropine used for eye exams.
Nursing Precautions: Must be labeled ophthalmic and be sterile
Used to dilate pupil for eye exam.
Wax softners (Ear) Sensory System
Softens ear wax to make it easier to remove.
Example: Cerumenex and Debrox
Must straighten ear canal to administer drops.
Drops should be at room temperature.
Administered into the external ear canal
Antibuse (disulfiram): Alcohol Abuse Deterrent
Used in the treatment of alcoholism.
Alcohol in any form will cause violent reaction. (respiratory depression, arrhythmias and cardiac arrest).
Acts as a deterrent to alcohol use and to maintain sobriety.
Instruct patients to read labels and avoid alcohol containing substances; such as, vinegar, cough syrup, sauces, mouth wash or after shave lotions.
Anti-pyretic (relieves fever)
Anti-inflammatory (relieves inflammation)
Anti-rheumatic (relieves inflammation and pain)
Analgesic (relieves pain)
Anticoagulant (thins the blood)
Important that the patient understands why he/she must take the medication. The purpose of drug standards is to protect the consumer. When a drug cannot be excreted completely from the body, the drug accumulates in the body.(can cause renal failure)
Can cause gastric bleeding.
Labs for meds
Lab data provides information about cardiac, renal, liver, blood chemistries, metabolic and hematologic function.
Development of a rash, urticaria (itching), swelling after receiving medication are symptoms of an allergic reaction.
If patient has symptoms of an allergic reaction hold the medication and notify staff immediately
Use of the 6 rights, awareness of nursing responsibility and practicing within the policies/guidelines of the employing agency decreases medical errors.
Medication Administration Record (MAR) includes: scheduled, IV and PRN/Stat/now/one-time medications. Medication orders must include date, drug, dosage, route, and time to be given. Stat orders must be given immediately.
Recording medication administration is completed after medications are given. If a medication is not given it must be circled and initialed. To ensure the right drug is given, you must check the medication three times. The 1st time when the medication is selected from the cart. 2nd time when it is prepared. 3rd time when it is given to the patient.
Remember: use only approved abbreviations (per agency policy) no trailing 0 etc.
Medications are not considered late if given ½ hour before or after scheduled time. If Medical error occurs: check the patient, report the event, fill out the incident report and follow agency policy.
IV route has the fastest onset and greatest risk.
Administer otic drops in the external auditory (ear) canal.
Antihypertensive medications: lowers B/P (Obtain baseline assessment/know oral fluid intake/and don't forget to identify patient)
CNS stimulants can be habit forming:
Amphetamine, ritalin, dexedrine.
Decongestants relieve symptoms but do not cure the cause.
Overuse of nasal sprays or drops can cause a rebound effect. (Return of symptoms)
Medications that require two nurses to check dosage preparation before administration (because of high med error rate): Insulin/heparin or any medication per agency determination and policy.