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41 terms

Medication classes, actions, side effects, nursing considerations

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Agents used to treat cardiac arrest, shock and prophylaxis
SE- serious rebound effect may occur, Balance between underdosing and overdosing

NC- monitor vital signs,
Measure Urine output
Assess for extravasation
Observe extremities for color and perfusion
Antianxiety Agents
Indications- anxiety disorders, insomnia, petit mal seizures, panic attacks, acute manic episodes

SE- sedation, depression, confusion, anger, headache, Dry moth, constipation bradycardia, elevated liver enzymes, urinary retention

NC- monitor Liver function,
monitor for therapeutic blood levels,
avoid alkohol, benzodiazepines are also used as muscles relaxants, sedatives hypnotics, anticonvulsants
Antacid Mediactions
Action- neutralizes gastric acids: raises gastric ph; inactivates pepsin

Indications- peptic ulcer, indigestion, reflex esophagitis prevent stress ulcer

SE- constipation, acid rebound between ulcers,
metabolic acidosis

NC- Use medications with sodium content cautiously for clients with cardiac and renal disease
Absorption of tetracycline, quinolones, phenothiazides, iron preparations, isoniazid reduced when given with antacids
effectiveness of oral contraceptives and solicylates may decrease when given with antacid
Aminoglycosides
Action- Inhibits protein synthesis in gram-negative bacteria

Indication- treatment of severe systemic infection of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues, acute pelvic inflammatory disease, tuberculosis (streptomycin)

SE- ototoxicity, nephrotoxicity, Anorexia, nausea, vomiting, diarrhea

NC- Check hearing, Check renal function
Usually prescribed for 7-10 days.encourage fluids, small frequent meals
Cephalosporins
Indications- Pharyngitis, Tonsillitis, Otitis media, Upper and lower respiratory tract infections, dermatological infections, gonorrhea, septicemia, meningitis, perioperative prophylaxis, UTI's

SE- Abdominal pain, nausea, vomiting, diarrhea, increased bleeding risk, hypoprothrombinemia, rash, superinfections, thrombophlebitic, abscess formation
Cephalosporins NC
NC- take with food, don't crush tablets, cross allergy with penicillin's, monitor renal and hepatic function
Penicillins SE
SE- Skin rashes, diarrhea, Allergic reactions, Renal, hepatic, hematological abnormalities, Nausea, vomiting
Penicillins NC
NC- Obtain C and S before first dose
Take careful history of penicillin reaction
Observe for 20 minutes post IM injection
Give 1-2 h ac or 2-3 h pc to reduce gastric acid destruction of drug
Monitor for loose, foul-smelling stool and change in tongue
Check for hypersensitivity to other drugs, especially cephalosporins
Sulfonamides SE
SE- Headache, GI disturbances Allergic rash Urinary crystallization
Sulfonamides NC
NC- Monitor I and 0, force fluids
Maintain alkaline urine
Bicarbonate may be indicated to elevate pH
Avoid vitamin C, which acidifies urine
Tetracylines SE
SE- Photosensitivity
GI upset, renal, hepatic, hematological
abnormalities
Dental discoloration of deciduous ("baby") teeth, enamel hypoplasia
Tetracylines
NC - Give between meals
If GI symptoms occur, administer with food EXCEPT milk products or other foods high in calcium (interferes with absorption)
Assess for change in bowel habits, perineal rash, black "hairy" tongue Good oral hygiene
Avoid during tooth and early development periods (fourth month prenatal to 8 years of age)
Monitor I and 0
Caution client to avoid sun exposure
Decomposes to toxic substance with age and exposure to light
Fluoroquinolones SE NC
SE- Seizures, GI upset, Rash
NC- Contraindicated in children less than 18 years of age
Give 2 hours pc or 2 hours before an antacid or iron preparation
Avoid caffeine
Encourage fluids
Macrolides
NC-Can be used in clients with compromised renal function because excretion is primarily through the bile
Glycopeptides SE NC
SE- Liver damage

NC- Poor absorption orally, but IV peak 5 minutes, duration 12-24 hours
Avoid extravasation during therapy-may cause necrosis
Give antihistamine if "red man syndrome": decreased blood pressure, flushing of face and neck Contact clinician if signs of superinfection: sore throat, fever, fatigue
Lincosamides
Clindamycin HC1 phosphate (Cleocin)
SE - Nausea Vaginitis,
Colitis may occur 2-9 days or several weeks after starting meds
NC - Administer oral med with a full glass of water to prevent esophageal ulcers
Monitor for persistent vomiting, diarrhea, fever, or abdominal pain and cramping
Bacitracin ointment
SE-Nephrotoxicity Ototoxicity
NC -Overgrowth of nonsusceptible organisms can occur
Neosporin cream
SE- Nephrotoxicity Ototoxicity
NC- Allergic dermatitis may occur
Povidone-iodine solution (Betadine)
SE-Irritation
NC -Don't use around eyes May stain skin

Don't use full-strength on mucous membranes
Silver sulfadiazine cream (Silvadene)
SE- Neutropenia Burning
NC -Use cautiously if sensitive to sulfonamides
Nitrofurantoin (Furadantin)
SE- Diarrhea, Nausea, vomiting, Asthma attacks
NC -Check CBC, Give with food or milk
Check I and 0
Monitor pulmonary status
Phenazopyridine
Pyridium)
SE-HeadacheVertigo
NC -Urinary tract analgesic, spasmolytic,
Take with meals
Anticholinergics
SE-Drowsiness, Blurred vision, Dry mouth Constipation, Urinary retention
NC -Used to reduce bladder spasms and treat urinary incontinence, Increase fluids and fiber in diet, Contraindicated for clients with glaucoma
Anti-impotence
SE-Headache, Flushing, Hypotension, Priapism
NC -Treatment of erectile dysfunction
Take 1 hour before sexual activity
Never use with nitrates-could have fatal hypotension
Do not take with alpha blockers, e.g., doxazosin
(Cardura)-risk of hypotension
Do not drink grapefruit juice
Atropine sulfate SE
Tachycardia, Headache, blurred vision, Insomnia, dry mouth, Dizziness, Urinary retention Angina, mydriasis
Atropine sulfate NC
Used for bradycardia
When given PO give 30 minutes before meals Check for history of glaucoma, asthma, hypertension
Monitor I and 0, orientation
When given in nonemergency situations make certain client voids before taking drug
Educate client to expect dry mouth, increased respiration and heart rate
Client should avoid heat (perspiration is decreased) Antidote-physostigmine salicylate
Heparin ,Lovenox SE
Can produce hemorrhage from any body site (10%) Tissue irritation/pain at injection site
Anemia, Thrombocytopenia, Fever
Heparin NC
Monitor therapeutic partial thromboplastin time (PTT) at 1.5-2.5 times the control without signs of hemorrhage Normal: 20-45 seconds
For IV administration: use infusion pump, peak 5 minutes, duration 2-6 hours For injection: give deep SQ; never IM (danger of hematoma), onset 20-60 minutes, duration 8-12 hours
Antidote: protamine sulfate within 30 minutes
Can be allergenic
Enoxaparin Low-molecular weight heparin (Lovenox) NC
Less allergenic than heparin
Must be given deep SQ, never IV or IM
Does not require lab test monitoring
Warfarin (Coumadin)
SE - Hemorrhage Diarrhea Rash Fever
NC- Monitor therapeutic prothombin time (PT) at 1.5-2.5 times the control, or monitor international normalized ratio (INR) at 2.0-3.0 Normal: 9-12 seconds
Onset: 12-24 hours, peak 1.5-3 days, duration: 3-5 days Antidotes: vitamin K, whole blood, plasma
Teach measures to avoid venous stasis Emphasize importance of regular lab testing Patient should avoid foods high in vitamin K: many green vegetables, pork, rice, yogurt, cheeses, fish, milk
anticoagulants and herbal
Garlic, ginger, ginkgo may increase bleeding when taken with warfarin (Coumadin)

Large doses of anise may interfere with anticoagulants

Ginseng and alfalfa my decrease anticoagulant activity

Black haw increases action of anticoagulant

Chamomile may interfere with anticoagulants
Phenytoin sodium (Dilantin) SE
Drowsiness, ataxia Nystagmus Blurred vision Hirsutism Lethargy GI upset

Gingival hypertrophy
Phenytoin sodium (Dilantin) NC
Give oral medication with at least 1/2 glass of water, or with meals to minimize GI irritation Inform client that red-brown or pink discoloration of sweat and urine may occur
IV administration may lead to cardiac arrest-have resuscitation equipment at hand
Never mix with any other drug or dextrose IV
Increase vitamin D intake and exposure to sunlight may be necessary with long-term use Alcohol increases serum levels
Anticonvulsant medications SE
Cardiovascular depression
Respiratory depression
Agranulocytosis
Aplastic anemia
Anticonvulsant medications NC
Tolerance develops with long-term use Don't discontinue abruptly

Caution with use of medications that lower seizure threshold (MAO inhibitors) Barbiturates and benzodiazepines also used as anticonvulsants
ANTIDEPRESSANTS: MAOI's SE
Hypertensive crisis when taken with foods containing tyramine (aged cheese, bologna, pepperoni, salami, figs, bananas, raisins, beer, Chianti red wine) or OTC meds containing ephedrine, pseudoephedrine
Photosensitivity, Weight gain, Sexual dysfunction Orthostatic hypotension
ANTIDEPRESSANTS: MAOI's NC
Not first-line drugs for depression
Should not be taken with SSRIs
Administer antihypertensive medications with caution
Avoid use of other CNS depressants, including alcohol
Discontinue 10 days before general anesthesia
Medications lower seizure threshold
Monitor for urinary retention
ANTIDEPRESSANTS: (SSRI) SE
Headache, dizziness
Nervousness
Insomnia, drowsiness
Anxiety
Tremor
Dry mouth
GI upset
Taste changes
Sweating
Rash
URI
Painful menstruation
Sexual dysfunction
Weight loss
ANTIDEPRESSANTS: (SSRI) NC
Suicide precautions
Take in am
Takes 4 weeks for full effect Monitor weight Good mouth care
Do not administer with MAOIs-risk of serotonin syndrome
Monitor for thrombocytopenia, leukopenia, and anemia
ANTIDEPRESSANTS: TRICYCLICS SE
Sedation
Anticholinergic effects (dry mouth, blurred vision)
Confusion (especially in elderly)
Photosensitivity
Disturbed concentration
Orthostatic hypotension
Bone marrow depression
Urinary retention
ANTIDEPRESSANTS: TRICYCLICS NC
Therapeutic effect in 1-3 weeks; maximum response in 6-9 weeks May be administered in daily dose at night to promote sleep and decrease
side effects during the day
Orthostatic hypotension precautions Instruct patient that side effects will decrease over time Sugarless lozenges for dry mouth
Do not abruptly stop taking medication (headache, vertigo, nightmares,malaise, weight change) Avoid alcohol, sleep-inducing drugs, OTC drugs Avoid exprosure to sunlight, wear sunscreen