CBC Values, Meds 2017 part one 19 medications lagcc

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Lymphs25-33%Eos1-4%Monos3-7%ANC>1000Formula for ANCTotal WBC count X (Segs% + Bands%)Formula for Corrected Retic. Ct.Retic. Ct. X (pt.'s Hct%/0.45)Diazepam Trade NameValiumDiazepam ClassBenzodiazepineDiazepam ActionBinds to type A GABA receptors causing sedationDiazepam IndicationsAnxiety, seizuresDiazepam ContraindicationsHypersensitivityDiazepam Dose2 - 10 mg IV, IM, IO, PO, RectalDiazepam Side EffectsHypotension, sedation, amnesia, respitory depression, vomitingDiazepam OtherIncompatible with other medications because not as water soluble. can cause irritation at injection site Flumazenil is an antagonistMeperidine Onset:IV (5 min), IM (10-15 min)Meperidine Duration:2-4 hrMeperidine Trade Name:DemerolMeperidine Classification:Narcotic Analgesic, Opioid AnalgesicMeperidine Action/Effects:Addictive narcotic that depresses the CNS & may relieve painMeperidine Indication:Relief of moderate to severe painMeperidine Contraindication:Hypersensitivity, Non-localized injury (cranial, abdomen), hypotension, bradycardia, patient taking MAO or selective serotonin reuptake inhibitorsMeperidine Side Effects:Nausea, CNS depression, hallucination, seizures, headache, hypotension, comaMeperidine Adult Dose:50-100mg IM/IV/IOMeperidine Expected Dose:50mg followed by an anti-emetic slow IVPMeperidine Pediatric Dose:1-2mg/kgMeperidine Cautions:May mix with promethazine for increase and potentiate analgesics, protect from light, May aggravate seizures especially in patients with renal insufficiency, use with caution in patients with asthma and COPDNitrostat-Other NameNitroglycerinNitrostat-ClassNitrateNitrostat-Descriptionnitroglycerin is a rapid smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workloadNitrostat-Indicationschest pain associated with angina and acute myocardial infarction, and acute pulmonary edemaNitrostat-Contraindicationshypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking ED drugs, glaucoma, and shockNitrostat-Precautionsmay induce headache that is sometimes severe, nitroglycerin is light sensitive and will lose potency when exposed to the airNitrostat-Dosage/Route1 tablet (0.4 mg/ 1-150gr) SL. May be repeated/3-5 min up to 3 dosesMedication (generic)Docusate sodiumTrade nameDulcolax stool softenerType classificationStool softener, surfactantNormal dosageCap: 50mg-250mg. Liquid : 150mg/15ml. Syrup:50mg/15ml-150mg/15ml. Tab: 100mg.ContraindicationsHypersensitivity to drug abdominal pain nausea vomiting intestinal obstructionSide effectsEENT: throat irritation GI: nausea diarrhea mild cramps rash. Other: bitter taste decreased appetite and dependencePatient teachingDrink plenty of fluids with each dose consume more fiber fruits and brand excessive use mainly to dependenceRapid acting insulinInsulin lispro- humalograpid acting onset5-30 minrapid acting peak30-120 minrapid acting duration3-5 hoursInsulin mixerNavolin 70/30mixer onset15-30 minmixer peak2-12 hoursmixer duration10-24 hoursShort acting insulinRegular insulin - Humalin Rshort acting onset30 min-1 hourshort acting peak1-3 hoursshort acting duration6-8 hourslong acting insulinGlargine - lantuslong acting onset1-8 hourslong acting peak8-10 or nonelong acting duration18-<24 hoursIntermediate insulinNPHintermediate onset1.0-2.5 hoursintermediate peak4-15 hoursintermediate duration<4 hoursRapid ActingLispro Aspart GlulisineShort ActingRegular insulinIntermediate ActingNPHLong ActingGlargine DetemirRapid Acting OPD15 min; 1 hour; 3 hoursShort Acting OPD30 mins; 1 hour; 6 hoursIntermediate Acting OPD60 mins; 6 hours; 16 hoursLong Acting OPD70 mins; 12 hours; 18 hoursGlargineCannot be mixedpharmacologicpenicillinFirst massed produced antibiotic (1941)→a lot of antibiotic resistance built up against it (beta lactamase developsed to break the ring and make it ineffective) Has beta-lactam ring surrounding itResistance!!its rarely given by itself since theres a lot of resistance to itAllergic reactions!big issue in antibiotics (ask pts)super infections→ also big across the board of antibiotics→ where the antibiotic not only kills the invading bacteria but also causes host flora in GI tract to be destroyed as well (can also have yeast in the mouth or vaginal infections)cross sensitivity with...cephalosporinsadverse effectsGI (N&V, diarrhea)→ may affect compliance PMC (pseudomembranous colitis): very severe form of diarrhea C.diff: super infection that can occur w/ pt on antibioticscaution..renal impairment (b/c of excrement, check BUN and creatinine), oral contraceptives (makes them ineffective)pregnancy categoryBactionspenicillin interfere with the creation and repair of the cell wall of bacteriausesbroad-spectrum, oral or injectableadverse reaction*neuropathy, fixed drug eruptions, nausea, vomiting, epigastric distress, anemia, and blood dyscrasias. *Allergy to penicillin include rash, erythemia, urticaria (hives), angioedema, and anaphylaxis.drug interactionscross-sensitivity to cephalosporins, bacteriostatactic antiboiotics may decrease the bactericidal effect. use of ampicillin and oral contraceptives has caused unplanned pregnancy.nursing implication and patient teachingbe alert for worsening infection. Ask for prior history of allergies, asthma or hypersensitivity to procaine or tartrazine, and find out if the patient is pregnant or breastfeeding.penicillin G (bicillin)IM penicillin, long acting, oral is not recommended for routine use.penicillin V ( beepen VK, penicillin VK)blood levels are higher, stable in gastric juicesamoxicillin (augmentin)more powerful penicillin, used in more severe infectionsCommon trade namesAVINza, Kadian, Astramorph, oramorphClassificationOpioid agonistTherapeutic OutcomeDecreased painActiondepresses pain impulse transmission at the spinal cord level by interacting with opioid receptorsIndicationsModerate to severe painRoutesPO, PO XR, IV, IM, intrathecal, epidural, subcutaneous, rectalDosage range and freqAdult: IV: 2.5-15mg q2-6h as needed, titrate or a loading dose of 0.05-.1mg/hr IV Geri or adult <50kg: may require lower doses Child/infant >6mo: 0.05-.2mg/kg q2-4h neonate/infant <6mo: 0.03-0.05mg/kg q3-8hr, titrate to reliefContraindicationshypersensitivity, addiction, hemorrhage, bronchial asthma, increased ICP, paralytic ileus, hypovolemic shock, MAOI therapy (depression treatment)PharmacodynamicsOnset IV: Rapid Peak IV: 20m Duration IV: 4-5hr Onset PO: Variable Peak PO: 1hr Duration PO: 4-5hrPharmacokineticsAbsorption: PO variably absorbed, IV completely absorbed Distribution: widely distributed, crosses placenta Metabolism: Liver, extensively Excretion: kidneys Half-life: 1 1/2-2hr, IM 3-4h, AVINza 24h, Kadian 11-13hAdverse effectsCNS: drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, seizures CV: palpitations, bradycardia, change in BP, shock, cardiac arrest, chest pain, hypo/hypertension, edema, tachycardia EENT: blurred vision, miosis(excessive constriction of pupil), diplopia Endo: gynecomastia GI: nausea, vomiting, anorexia, constipation, cramps, biliary tract pressure GU: Urinary retention, impotence, gonadal suppression HEMA: Thrombocytopenia (low platelet, inability to clot) INTEG: rash, urticaria(hives and swelling) bruising, flushing, diaphoresis, pruritis RESP: respiratory depression, resp. arrest, apneaClient teachingreport symptoms of CNS changes or allergic reaction. Advise patient not to consume alcohol or sedatives for at least 24h. advise that dizziness, drowsiness, and confusion are common. Ask family to assist in standing up.Trade nameLasixClassificationloop diuretic, antihypertensiveindicationspulmonary edema, edema in CHF, nephrotic syndrome, ascites, hepatic disease, hypertensionDosagePO: 20-80mg/day in am, may give another dose in 6h, up to 600mg/day IM/IV: 20-40mg, increased by 20mg q2h until desired responseNursing responsibilitiesAssess: ototoxicity, hypokalemia, hyponatremia, hypochloremia, CHF, electrolytes, hypertension Take early in the day, keep record of weight weekly and notify HCP if loss of more than 5 poundsContraindicationsIndicationsrheumatoid arthritis, osteoarthritis, primary dysmenorrhea(menstrual pain), dental pain, MSK disorders, fever, migraine, patent ductus arteriosus(hole in heart)Contraindicationsavoid IV after 30wk of pregnancy, hypersensitivity to this product, NSAIDs, salicylates, asthma, severe renal/hepatic diseaseAdverse effectsCNS: headache, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression CV: tachycardia, peripheral edema, palpitations, dysrhythmias, CV thrombotic events, MI(myocardial infarction), stroke EENT: tinnitus, hearing loss, blurred vision, GI: nausea, anorexia, vomiting, diarrhea, jaundice, hepatitis, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI bleeding, ulceration, necrotizing enterocolitis, GI perforation GU: nephrotoxicity, dysuria,Client Teachinguse sunscreen sunglasses and protective clothing to prevent photosensitivity and photophobia - avoid alcohol injection - and other NSAIDsPharmacokineticsAbsorption - well absorbed Distribution - crosses placenta Metabolism - liver extensively Excretion - KIDNEYS unchanged 10%PharmacodynamicsOnset: 30m Peak: 1-2h Duration: 4-6hRoutePODosage200-400mg every 4 to 6 hoursActioninhibits COX1 and COX2 enzymes stopping synthesis of histamineCommon trade namesADVIL, motrinTherapeutic outcomereduction in pain, inflammation, feverClassNSAIDmagnesium hydroxide & aluminum hydroxideMaaloxClassification (therapeutic)antiulcer agentClassification (pharmacological)antacidAdministrationPOSide effectsconstipation, diarrhea, fluid & electrolyte imbalanceNursing implications-assess symptoms (heartburn, indigestion, gastric pain) -monitor labs (phosphate, potassium, calcium)Client teaching-signs & symptoms of gastric bleeding include black, tarry stools; coffee ground emesis -do not take within 2 hours of other medsActionneutralizes gastric acidAdditional infocommonly prescribed for a variety of GI complaintsMaaloxmagnesium hydroxide & aluminum hydroxide*TradeCoumadin*Warnings- black box alert - high alert*Action- Interferes w/ hepatic synthesis of vitamin k - dependent clotting factors - resulting in depletion of coagulation factors II, VII, IX, C (decrease formation of clots, prevent heart attacks and strokes)*Therapeutic Effectprevents further extension of new & formed existing clots*Side Effects**GI distress - nausea, anorexia, abdominal cramps, diarrhea*TreatsProphylaxis, thromboembolic disorders & embolic complications (a-fib) or valve replacement.*Teach- Take meds same time every day - Routinely monitor blood levels - Don't take or d/c other meds - Avoid alcohol, aspirin & drastic dietary changes - Avoid/minimize signif. body trauma - Don't change brands - Urine may become red-orange - Report bleeding/bruising/red-brown urine/black stools. - Use electric razorsoft toothbrush to prevent bleeding - Don't use OTC medsAssesslabs, bleeding, petechiae, black stools, feverNormal Dose2.5-10mg/day PO for 2-4 days then titrated to INR/PTantidotevitamin kGeneric nameAcetylsalicylic acidTrade nameAspirin ASA, Ecotrin,ClassificationAntiplatelet effect, anti-inflammatory agentActions/KineticsPrevents platelets from clumping together or aggregating and forming emboliIndicationsNew onset of chest pain of suspected cardiac originContraindicationsHypersensitivity to drug. Relatively contraindicated in patients with active ulcer disease. Possible stroke.Adverse EffectsBleeding gums, signs of GI bleeding, and petechiae (read dots on the face). Aspirin will increase bleeding time.How SuppliedSupplied as baby aspirin chewable 81 mg each.DosageGive 4 baby aspirin chewable for a total dose of 324mg. (chewing is preferable to swallowing) give within minutes of arrival.Special ConsiderationsGive prior to NTG dose for chest pain/AMI patients. OK to administer to patients who have already taken daily dose of ASAClassAnticoagulantPharmacology and ActionsHeparin is a rapid onset anticoagulant. It exerts direct effect on blood coagulation by inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin to thrombin to fibrinIndicationsTo prevent thrombus formation in acute MIContraindicationsActive bleeding Pregnancy HemophiliaPrecautions and Side EffectsSpontaneous bleeding Hypertension Headache Nasal congestion bronchospasmDosageAdult 5000 units followed by 20,000 to 40,000 units IV over approximately 24 hours Not recommended for pediatricsCommon trade namestylenol, TPAINolActionblocks pain impulses peripherally that refer in response to inhibition of PG synthesistherapeutic outcomedecreased pain/feverindicationsmild to moderate pain or fever, dental pain, dysmenorrhea, OA, arthralgia(joint pain)contraindicationshypersensitivity to this medication, pregnancy C(may or may not harm fetus)adverse effects:GI: nausea, vomiting, abdominal pain, hepatotoxicity, hepatic seizure if u OD, GI bleeding GU: renal failure, (high prolonged doses) HEMA: leukopenia, neutropenia, hemolytic anemia(LT use), thrombocytopenia, pancytopenia INTEG: rash, urticaria(hives) SYSTEM: hypersensitivity TOX: cyanosis, anemia, neutropenia, jaundice, cytopenia, CNS stimulation, delirium followed by vascular collapse, seizures, coma, deathPKA: well absorbed PO, variably rectally D: widely distributed, crosses placental border in low concentrations M: liver 85-95%, metabolites are toxic at high levels E: kidneys, metabolites, breast milk Half-life: 3-4hPDOnset: PO, rectally: 0.5-1h, Peak: 1-3h Duration: 3-4hClassnon-opioid analgesicClient teachingteach patient not to exceed rec dosage, toxicity might happen, dont use with alcoholroutesPO rectalDosage>12yr: 325-650mg >2 <50kg: IV 15mg/kg per dose q6h, 12.5mg/kg q4h 1-12yr: PO 10-15mg/kg per dose q4-6h, max 5 doses per day neonate: rectal 10-15mg/kg q6-8hCardiac Glycoside: digoxin (Lanoxin) General Info- Also known as digitalis gylcosides - Extracted from a plant - They have a positive *inotropic effect* on the heart - Cardiac outputCardiac Glycoside: digoxin (Lanoxin) Mechanism of Action*Inhibits* the sodium/potassium *ATP* (enzyme that pumps sodium ions out of myocardial cells in exchange for potassium ions) As sodium ions accumulate in the myocardial cells, *calcium ions are released* from their storage area in the cell *to activate a contraction*.Cardiac Glycoside: digoxin (Lanoxin) Adverse Effects*Dysrhythmias* - ventricular = sudden cardiac death -> r/t changes in potassium levels, *hyperkalemia and hypokalemia (both can cause dysrhythmias...has to be just the right level of potassium*) -drug interactions -Visual disturbances: -*Halos* -Change in color perception -PhotophobiaCardiac Glycoside: digoxin (Lanoxin) Adverse Effects r/t POTASSIUM-*Potassium competes with digoxin for binding to Na+ K+ and ATPase* - so if there's already hypokalemia in body then *digoxin and potassium together increase toxicity* and if there's hyperkalemia already happening in the body the binding of digoxin is blocked so you have a reduction in therapeudic effects of digoxin so you really want to keep *potassium levels WNL* as much as possible so that you would be *3.5 - 5 mEq.L*Cardiac Glycoside: digoxin (Lanoxin) Benefits-works really well to *decrease symptoms, increase exercise tolerance, decrease in hospitalizations* but has not been proven to prolong life. -*Decrease in sympathetic tone* -*Increase in urine production* -*Decrease in the electrical conduction* -*Decrease in HR* = Greater diastolic filling which is good -Potential to *reverse the manifestations of HF*Cardiac Glycoside: digoxin (Lanoxin) Nursing Considerations-*Long half life 1 1/2 days so...make sure too much is not given* -Administer carefully -*Narrow margin of safety* -Keep digoxin level *in blood* between *0.5-2 ng/mL* (very low margin) -Digoxin toxicity: increase in the dose = increase in risk -*Monitor potassium carefully* -Teaching plan: medication & dietary interactionsEpinephrine-ClassSympathomimeticEpinephrine-Trade NamesAdrenalin, EpinephrineEpinephrine-DescriptionA naturally occurring catecholamine that stimulates the sympathetic nervous system.Epinephrine-Actions•Increase heart rate, conduction, and contractility. •Increase cardiac output, and blood pressure. •Relaxes bronchial smooth muscle, and reduce airway secretions.Epinephrine-Indications•Cardiac Arrest •Refractory bradycardia •Life threatening bronchoconstriction •Anaphylaxis/Allergic reactionsEpinephrine-ContraindicationsNone with the indicated conditionsEpinephrine-Side effectsCNS - Anxiety, headache, CVA (stroke) CV - Chest pain, Acute MI, Tachyarhythmias MISC - Vomiting, diaphoresis and pallor, local tissue necrosisEpinephrine-AdministrationADULT ARREST-IV/IO(1:10,000) 1mg every 3-5 min. No Subcutaneous injection for arrest. Endotracheal (1:1,000) 2-2.5 mg in 5-10cc normal saline every 3-5 min. ADULT ALLERGIC REACTION/BRONCHOSPASM - IV/IO .1-1mg every 10-15 min. Subcutaneous .3-.5 mg every 5-15. Endotracheal (1:1,000) 2-2.5 mg in 5-10 cc NS every 3-5 min. PEDIATRIC ARREST-IV/IO 0.1mg per kg (.1 ML/kg) every 3-5 min. No Subcutaneous. Endotracheal .1mg per kg (.1mL/kg) May exceed adult dose. PEDIATRIC ALLERGIC REACTION/BRONCHOSPASM - IV/IO .01 mg per kg every 10-15 min. Subcutaneous .01mg per kg (.01mL/kg) Endotracheal Same.Epinephrine-Onset/DurationIV/ET <2min. SC 3-10min with longer duration.Epinephrine-NotesNon-arrest IV doses for severe, or refractory symptoms only. High risk of acute coronary syndromes in individuals with risk factors. Adult bradycardias are rarely treated with IV infusion of 2-10 µg/min.Albuterol-ClassSympathomimetic bronchodilatorAlbuterol-Trade namesProventil, VentolinAlbuterol-DescriptionAlbuterol is a synthetic sympathomimetic that is selective for beta 2 adrenergic receptors.Albuterol-ActionsCauses prompt bronchodilation.Albuterol-IndicationsAlbuterol is indicated for the treatment of bronchospasms associated with: asthma, COPD, allergic reactions, and toxic inhalation.Albuterol-ContraindicationsHypersensitivityAlbuterol-Side EffectsTachycardia, hypertension, dizziness, tremors, headache, and arrhythmias.Albuterol-Adult Administration/DoseNEBULIZER: 2.5mg albuterol in 2-3 mL of normal saline or METERED-DOSE INHALER: 2 Inhalations 90 micrograms (mcg)Albuterol-Pediatric Administration/DoseNEBULIZER W/O₂: 0.15mg/kg in 2-3 mL of normal saline, repeat as needed.Albuterol-Onset5-15 min