Nursing 204 Pharmacology Review

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Proventil (albuterol)

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is a bronchodilator used for prevention and long term treatment of asthma attacks. Inhaled agents have minimal side effects. Oral agents can cause tachycardia and angina. Advise clients to observe for signs and symptoms (chest, jaw, or arm pain or palpitations). Instruct clients on how to check pulse and to report an increase greater than 20 to 30 beats/min. Use cautiously in patients with diabetes, hyperthyroidism, heart disease, hypertension, and angina.

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is an SSRI used for depression, PTSD, OCD, and ADHD. Side effects: suicidal behavior, CNS stimulation (inability to sleep, agitation, anxiety), weight gain. Watch for serotonin syndrome it may begin 2 to 72hrs after starting treatment, and it can be lethal watch for: mental confusion, difficulty concentration, hallucinations, incoordination, tremors, fever, and diaphoresis. Asses for alcohol use, make sure they are not taking MAOIs or TCAs because that increases the risk of serotonin syndrome. It may take 1-3 weeks to take effect.

QVAR

is a glucocorticods that prevents inflammation in patients with chronic asthma. It does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks. The patient can experience difficulty speaking, and hoarseness. Monitor potassium levels, advise them to avoid NSAIDs, and may affect the use of hypoglycemic agents so make sure they check there BGMs.

Potassium

used to treat hypokalemia;
potassium less than 3.5 mEq/L
For clients receiving diuretics resulting in potassium loss, such as furosemide
For clients with potassium loss due to excessive or prolonged vomiting, diarrhea, abuse of laxatives, intestinal drainage, and GI fistulas
Side effects:GI distress and local GI ulceration, nausea, vomiting, diarrhea, abdominal discomfort, and esophagitis with oral administration
Monitor clients receiving IV potassium for
signs of hyperkalemia, such as bradycardia,
hypotension, ECG changes.
1) Mix powdered formulations in at least 4 oz of liquid.
2) Advise clients to take potassium chloride with a glass of water or with a meal to reduce the risk of adverse GI effects.
3) Instruct clients not to crush extended-release tablets.
4)Instruct clients to notify the provider if they have difficulty swallowing the pills.
IV administration
1)Never administer IV bolus. Rapid IV infusion can result in fatal hyperkalemia.
2)Use an IV infusion pump to control the infusion rate.
3)Dilute potassium and give no more than 40 mEq/L of IV solution to prevent vein irritation.
4)Give no faster than 10 mEq/hr.
5)Cardiac monitoring is indicated for serum potassium levels outside of normal parameters.
6)Assess the IV site for local irritation, phlebitis, and infiltration. Discontinue IV immediately if infiltration occurs.
7)Monitor the client's I&O to ensure an adequate urine output of at least 30 mL/hr.

SSRI

Paroxetine (Paxil )
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons.
Adverse effects: nausea, diaphoresis, tremor, fatigue, drowsiness, sexual dysfunction, weight gain, GI bleeding, serotonin syndrome, bruxism, withdrawal syndrome
Inform the patient that it may take up 1-3 weeks to feel the therapeutic effects of the medication.

Statins

Atorvastatin (Lipitor)
Simvastatin (Zocor)
Lovastatin (Mevacor)
Pravastatin sodium (Pravachol)
Rosuvastatin (Crestor)
Fluvastatin (Lescol, Lescol XL)
Decrease manufacture of LDL cholesterol.
Decrease manufacture of very low-density lipoproteins (VLDL)
Increase manufacture of high-density lipoproteins (HDL).
Side Effects: Hepatotoxicity, Myopathy, Peripheral neuropathy
Advise clients to limit the amount of grapefruit juice consumed each day

Dilantin

used to prevent seizures.
abrupt withdrawl after long use may precipitate seizures.
Maintain a patent airway.
protect head.
Turn pt on their side.
loosen constrictive clothing.
ease to floor.
May cause gingival hyperplasia.
Provide good dental hygiene, including regular toothbrushing and flossing.
Toxicity.
Therapeutic level: 10.0-20.0 mcg/mL. Toxic level: 30-50 mcg/mL.
Monitor blood levels.
Monitor for signs of toxicity: dizziness, slurred speech, lethargy.
Nursing:
May turn urine pink or red.
Assess location, duration, frequency, and characteristics of seizures.
Monitor CBC, serum calcium, albumin, and hepatic function.

Dopamine

Inotropic, vasopressor
Increases cardiac output, increase BP, improve renal blood flow
s.e. Arrhythmias, hypotension, headache
Monitor BP, HR, pulse, pulse pressure
Monitor urine output
Palpate peripheral pulses
Advise doctor if chest pain, dyspnea, numbness, tingling or burning of extremities occur
Advise doctor of any pain or discomfort.

Thrombolytics

Decrease risk of CHF or death
Decrease risk of neurological sequelae
Increase ventricular function
S.E. Intracranial hemorrhage, GI bleeding, anaphylaxis and hypotension

Monitor VS including temperature
Assess for bleeding
Assess neuro status
monitor EKG
Explain purpose of medication to family.
Advise patient to report any hypersensitivity reactions ( redness or rash)
Explain importance of bedrest to avoid injury.

Tamoxifen

Used to treat: Breast cancer treatment or prevention (by blocking the estrogen receptors)

Significant side effects: endometrial bleeding- monitor for abnormal bleeding and have yearly PAPs

hypercalcemia- monitor calcium levels

nausea and vomiting- assess fluid status, administer fluids and antiemetics as prescribed

pulmonary embolus- assess breath sounds and report any chest pain

vaginal bleeding or discharge- assess amount and type

hot flashes

Nursing measures:

contraindicated in warfarin patients and patients with a history of blood clots

Monitor calcium levels

Monitor PT and INR and adjust anticoagulants as needed

Antacids may alter absorption so allow 2 hours in between doses

Schedule yearly gynecological exams and PAP smears.

Monitor fluids

Teach about self-breast exams

TCAs

Used to treat: depression, depressive episodes in bipolar disorder, chronic pain and enuresis

Significant side effects: orthostatic hypotension- change position slowly, monitor BP and heart rate.

Dry mouth- chew sugarless gum, suck on mints or other hard candies, sip on water

sedation- take at bedtime and avoid hazardous activities

decreased seizure threshold- watch in patients with seizure disorder

cardiac toxicity- monitor for dysrhythmias, confusion, agitation, followed by coma, seizures and possibly death. Obtain a baseline and monitor vitals frequently

Nursing measures:

Teach to avoid alcohol, benzodiazepenes, opiods, and antihistamines because of increased risk for CNS depression

Avoid use of MAOIs, St. John's Wart

Terbutaline

selectively activates beta2-adrenergic receptors resulting in uterine smooth muscle relaxation.

SIDE EFFECTS Tachycardia,palpitationschest pains, tremors, anxiety, headache

NURSING CONSIDERATIONS Moniter the maternal pujse and blood pressure
Moniter the patient for symptoms of fetal distress

MAOIs

isocarboxazid (Marplan), phenelzine (Nardil),and tranylcypromine (Parnate)
ANTIDEPRESSANTS when other therapies have failed. For panic disorders,
social anxiety, and social phobias.
. Not for patients with elective surgery requiring anesthesia, should
be discontinued days before surgery.
. DONT PLAY WELL WITH OTHER MEDS. Just a few of the long list are:
SSRI's, SSNRI's, tricyclic antidepressants, fluoxetine (wait 5 weeks
aft d/c#, trazodone,and antihistamines. NO ST. JOHN'S WART, SAMe, or
GINSENG.
. DO NOT CONSUME TYRAMINE
. LIMIT CAFFEINE INTAKE
. Don't administer in the evening to help with insomnia
. May be crushed, or mixed with a liquid.
. Wait at least 2 weeks from stopping these meds #longer for certain
meds) before starting another med.
. Increased risk of hypoglycemia, seizures, dizziness, hypertensive
crisis, arrhythmias, diarrhea, and weight gain.
ASSESS mental status, anxiety level, suicidal tendancies, monitor I&O,
BP, Pulse, daily weights, and urine retention. Headache is the 1st
sign of hypertensive crisis, other S&S palaitations, chest or throat
tightness, sweating, dizziness, neck stiffness,and n/v.
LABS: Hepatic function, serum glucose
advise pt to carry ID describing med regimen at all times.

Medications for Acute Alcohol Withdrawal

Effects of alcohol withdrawal usually start within 4 to 12 hrs, and
peak at 24-48 hrs.
BENZODIAZEPINES: chlordiazepoxide (Librium#, diazepam #Valium#
(anticonvulsant#
and lorazepam # Ativan#.
. maintain vitals WNL, obtaining baselines.
. Neuro status
. Seizure precautions
. CNS depression
. Can lead to dependency
. Decreases effects of oral contraceptives
. Assess for tremors, agitation, delirum and hallucinations
. Protect patient from injury, increased risk of falls in elderly.
ADJUNCT MEDICATIONS; carbamazepine #Tegretol#, clonidine #Catapres#,
propranolol #Inderal#.
. Tegretol decreases seizures
. Inderal & Catapres decrease BP, HR, and diaphoresis
. Inderal decreases cravings

ANTABUSE #disulfiram#, ReVia #naltrexone), and acamprosate #Campral)
are all for maintenance following detoxification.

Medications for Diabetes Mellitus

Humalog-short acting
NPH (Humulin-N)-intermediate acting
Lantus-long

Insulin promotes cellular uptake of glucose
Insulin moves potassium into cells

SIDE EFFECTS Risk for hypoglycemia
THERAPEUTIC INTERVENTIONS
Draw the short-acting insulin up into the syringe first then the long acting insulin.
Teach the client the importance of proper diet and consistant exercise

ORAL HYPO GLYCEMICS

SULFONYLUREAS-tolbutamide, glipizide
Controls blood glucose levels in DMII
SIDE EFFECTS Hypoglycemia
TEACHING Consistent exercise and diet guidelines
MEGLITINIDES - repaglinide
Promotes insulin release from the pancreas
SIDE EFFECTS Hypoglycemia
TEACHING Instuct client to eat within 30 min. of taking a dose
Consistent exercise and diet guidelines
BIGUANIDES-metformin HCI
Reduces the production of glucose within the liver
SIDE EFFECTS Gastric effects (Anorexia N/V)
Vitamin b deficiency
Lactic acidosis (hyperventilation, myalgia, sluggishness)50%mortality

Nursing 204 Pharmacology Review

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