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Med Surg Nursing Drug Cards Combo

Terms in this set (68)

*Classification: Glucocorticoid, fast acting
*Generic name: methylprednisolone
*Trade/Brand name: Solu-Medrol
*Action: Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization.
*Use: Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis.
*Safe Dose: Anti-inflammatory, Immunosuppressive: IV: 10-40mg. May repeat q 4-6hrs prn. PO 2-60mg/day in 1-4 divided doses. IM (methylprednisolone acetate): 10-80mg q 1-2wks. Intra-articular, intralesional: 20-60mg q 1-5wks. Status Asthmaticus: IV: Initially 2mg/kg/dose, then 0.5-1mg/kg/dose q6hrs. Spinal Cord Injury: IV Bolus: 30mg/kg over 15min, followed by 5.4mg/kg/hr over 23hrs; given within 45 min of bolus dose.
**Methylprednisolone acetate IV should be reconstituted with D5W, 0.9% NaCl; Should give IV push over 3-15min. Give IV piggyback dose of 250mgover 15-30min; dose of 500-999 over at least 30 mine; dose of 1g over 1hr.
-Administer PO with food or milk to decrease GI symptoms. IM use a 21G needle in a large muscle mass; avoid deltoid.
*Common/Life Threatening SE: Insomnia, heartburn, anxiety, abdominal distension, diaphoresis, acne, mood swings, increased appetite, facial flushing, GI distress, delayed wound healing, increases susceptibility to infection, diarrhea, and constipation. Life threatening: Circulatory collapse, thrombophlebitis, embolism, GI hemorrhage, and thrombocytopenia. Occasional: Headache, edema, tachycardia, change in skin color, frequent urination, depression. Rare: Psychosis, hallucinations, increased blood coagulability.
*AKA: Apo-Diltiaz, Diltiazem, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Matzim LA, Novo-Diltiazem, Taztia XT, Tiazac
*Action: Inhibits calcium movement across cardiac, vascular smooth-muscle cell membranes (causes dilation of coronary arteries, peripheral arteries, arterioles). Therapeutic Effect: Decreases heart rate, myocardial contractility; slows SA, AV conduction; decreases total peripheral vascular resistance by vasodilation.
*Uses: PO: Treatment of angina due to coronary artery spasm (Prinzmetal's variant angina), chronic stable angina (effort-associated angina). Extended-release: Treatment of essential hypertension, angina. Cardizem LA: Treatment of chronic stable angina. Parenteral: Temporary control of rapid ventricular rate in atrial fibrillation/flutter. Rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm. OFF-LABEL: Stable narrow complex tachycardia, recurrent SVT, pediatric hypertension.
*Precautions: pregnant, breast feeding, kids, geriatrics, CHF, aortic stenosis, bradycardia, GERD, hepatic disease, hiatal hernia, ventricular dysfunction
*Dose & RTE:
Angina - PO (IMMEDIATE-RELEASE) (CARDIZEM): ADULTS, ELDERLY: Initially, 30 mg 4 times a day. Range: 120-320 mg/day; PO (EXTENDED-RELEASE) ADULTS, ELDERLY: Initially, 120-180 mg once daily. Range: 120-320 mg. Maximum: 480 mg/day.
(EXTENDED-RELEASE) (TIAZAC, TAZTIA XT): ADULTS, ELDERLY: Initially, 120-180 mg once daily. Range: 120-320 mg/day. Maximum: 540 mg/day.
(EXTENDED-RELEASE) (CARDIZEM LA): Initially, 180 mg/day. Range: 120-320 mg. Maximum: 360 mg/day.
Hypertension - PO (CARDIZEM CD, CARTIA XT, DILACOR XR, DILT-CD, DILTIA XT, TIAZAC): ADULTS, ELDERLY: Initially, 180-240 mg/day. Range: 180-420 mg/day, Tiazac: 120-540 mg/day.
PO (SUSTAINED-RELEASE): ADULTS, ELDERLY: Initially, 60-120 mg twice a day. May increase at 14-day intervals. Maintenance: 240-360 mg/day.
PO (CARDIZEM LA): ADULTS, ELDERLY: Initially, 180-240 mg/day. May increase at 14-day intervals. Range: 120-540 mg/day.
Temporary Control of Rapid Ventricular Rate in Atrial Fibrillation/Flutter; Rapid Conversion of Paroxysmal Supraventricular Tachycardia to Normal Sinus Rhythm
IV PUSH: ADULTS, ELDERLY: Initially, 0.25 mg/kg (average dose: 20 mg) actual body weight over 2 min. May repeat in 15 min at dose of 0.35 mg/kg (average dose: 25 mg) actual body weight. Subsequent doses individualized; IV INFUSION: ADULTS, ELDERLY: After initial bolus injection, may begin infusion at 5-10 mg/hr; may increase by 5 mg/hr up to a maximum of 15 mg/hr. Infusion duration should not exceed 24 hrs.

*Nurs Consids:
Assess - Record onset, type (sharp, dull, squeezing), radiation, location, intensity, duration of anginal pain, precipitating factors (exertion, emotional stress). Assess baseline renal/hepatic function tests. Assess B/P, apical pulse immediately before drug is administered.
Evaluate - ist with ambulation if dizziness occurs. Assess for peripheral edema behind medial malleolus (sacral area in bedridden pts). Monitor pulse rate for bradycardia. Assess B/P, renal/hepatic function tests, EKG with IV therapy. Question for asthenia (loss of strength, energy), headache.
Teach - Do not abruptly discontinue medication. Compliance with therapy regimen is essential to control anginal pain. To avoid hypotensive effect, rise slowly from lying to sitting position, wait momentarily before standing. Avoid tasks that require alertness, motor skills until response to drug is established. Contact physician if palpitations, shortness of breath, pronounced dizziness, nausea, constipation occurs. Avoid alcohol (may increase risk of hypotension or vasodilation).