Class: salicylate, NSAID, analgesic, anti-platelet
Use: mild to moderate pain, anti-inflammatory, prevention of MI, TIA, angina, ischemic CVA
SE: GI bleeding, tinnitis, salicylism
NI: Assess GI bleed (smokers, elderly, ETOH, ulcer disease), Avoid ETOH, NO children (Reyes syndrome), do not crush, assess toxicity/ ear ringing, Stop 5-7days pre-op, low sodium diet (long-term)
BBW: Pregnancy >20 wks, Increased GI in elderly Class: corticosteroid
Use: anti-inflammatory symptoms, immunosuppressive, antiallergic, and antistress (control symptoms but do not cure underlying disease processes). COPD, RA, Psoriasis, Allergic Reactions, Lupus
SE: Swollen/excess (water) weight gain (moon face), alter immune response/fever/sepsis, poor wound healing, hyperglycemia, Osteoporosis,, Risk cataracts, adrenal suppression/insufficiency (long term use) (slowly taper), depression, insomnia
NI: Report rapid weight gain (1lb/day) Assess for infection, Assess glucose (over 115) diabetes increase insulin, Assess bone fractures, Assess wound healing/assess infection , Eye appts, Teach pt not to stop drug abruptly/must taper, Increase dose with inc stress (surgery/stress). Assess for depression/psychotic episodes.. Teach patient report side effects.
Interactions: antacids, estrogen, oral contraceptives, antibiotics Class: Cephalosporin
Use: PO/IV Broad spectrum, Drug choice surgical prophylaxis (Single dose 60 min before skin incision), Respiratory/bronchitis, skin, soft tissue, bone, otitis media, UTI,
SE: Rash, GI disturbances ( N/V, diarrhea) super infections
NI: Take food/milk. no ETOH), no antacids, check Renal funx
Interactions: Aminoglycosides, Furosemide, Vancomycin- Increase nephrotoxicity Class: Aminoglycoside
Use: : Systemic infections: E.coli, pseudomonas, CNS, GI, respiratory, urinary, bone, Gram(-) IM, IV (no po), opthalmic
SE: ototoxicity, nephrotoxicity, Rash, edema itching, anorexia, N/V, diarrhea
NI: assess renal function, assess hearing, asses peak/trough, monitor superinfection
BBW: ototoxicity, nephrotoxicity Class: tetracycline
Use: antibiotic-Mycoplasma, Chlamydia, Rickettsia (PO)
SE: Hypersensitivity/Rash, GI(flatulence, diarrhea, N/V, Discolored teeth*, Photosensitivity, Renal/hepatic toxicity, Super infections-candidal/furry tongue
NI: Obtain Culture & Sensitivity prior to use, No Children < 8 (teeth discoloration, retardation bone growth), No pregnant, Photosensitivity/Sunscreen/protective clothing, Empty stomach ( 1hr ac/2 hr pc food ), Full Glass Water, No milk/dairy/antacids, iron. Check drug expiration date ( toxic breakdown), Assess Renal/hepatic
Interactions: oral anticoagulants, digoxin, iron, dairy Class: sulfonamide
Use: UTI, otitis media, prostatitis
SE: Hypersensitivity, Photosensitivity, Renal impairment, GI (diarrhea, N/V, pancreatitis)
NI: Assess renal function, Sunscreen/protective clothing, Full Glass Water, if stomach upset take with food. Check decreased glucose levels/diabetic. Assess renal, Assess super infections,
Drug/Food Interactions: 3 G's, St John Wort, Salicylates, NSAIDs, oral anticoagulants Class: Urinary Antiseptics
Use: Treatment and prophylaxis of UTI
SE: Hypersensitivity may develop when drug is used for long-term, dizziness, N/V,, anemia, tooth staining, anemia.
NI: Give with food or milk to minimize GI distress and improve absorption Obtain urine specimen for culture and sensitivity tests before giving, Teach pt urine turn dark yellow-brown, Do not crush, chew, open tablets Assess renal/Liver function, (renal, pulmonary, hepatic toxicity), No antacids, Assess superinfections Class: Macrolides Antibiotic
Use: URI, prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in newborns (ophthalmic ointment), Legionnaires disease
SE: Rash, reversible hearing loss, GI distress (N/V, , cramps) hepatic toxic
NI: PO empty stomach ( 1hr PC 2 AC meals) Take with 8 oz water, NO antacids/dairy (2hrs) , Assess for hyper infections. Assess liver function, PO, IV, topical
Interactions- grapefruit juice and St. John's wort decrease absorption of the Class: anti-TB
Use: TB treatment
SE: rash, GI upset, hepatotoxicity, acute renal failure, flu-like symptoms, *red-orange discoloration of urine, tears, sweat, and other body fluids (stain soft contact lenses)
NI: asses GI distress, take on empty stomach w/ full glass water, assess hepatotoxicity (yellowing of skin, etc), use back-up contraceptive
Increases metabolism of other drugs Class: 5 Alpha reductase inhibitor
Use: erectile dysfunction
SE: MI, sudden death, Cardiovas collapse, HA, nasal congestion, dizziness, blurred vision
NI: contradicted in CVD, onset 20-60min, duration 4-6h, report erection >4h, sudden loss of vsion/hearing, best on empty stomach, does NOT prevent STDs
Caution: liver & hepatic dysfunction
Do not give with other vasodilating drugs (Nitrates)-hypotension, MI, stroke
Herb/medication interactions Alcohol, AVOID FATTY FOODS, grapefruit juice, antihypertensive, erythromycin Class: Combination Estrogen& Progestin
Use: OCP, Inhibits ovulation, suppress FSH & LH, thins endometrium and treats menstrual disorders
SE: N/V, HA, breakthrough bleeding, dizziness, contact lens intolerance,
Risk factors: Cigarette smoking INCREASES clots in legs, heart, lung, brain
NI: No protection- STD/HIV, TAKE SAME TIME Q Day, Teach Breast self exam, edema (report > 5lb/week gain). Assess jaundice, clay stool, dark urine (gallbladder/liver failure), Discuss the increased thromboembolic risk (ACHES), Chest pain, dyspnea, blurred vision( DVT,PE, MI, ↑ dementia) Assess Lipid profile, increases glucose in diabetics
Contraindications- Cigarette smoking, > 35 years , HX thromboembolic problems, cirrhosis/ viral hepatitis, diabetes mellitus, hypertension, or migraine with aura. When estrogen is contraindicated, it is permissible to use a progestin-only contraceptive. Class: Anticoagulant
Use: Prophylaxis/TX of thrombosis DVT, PE.
Route: IV, IV bolus/Hospitalization only
SE: bleeding/hemorrhage, heparin induced thrombocytopenia, heparin induced platelet aggregation, drug induced hepatitis, risk for osteoporosis (Heparin > 6 months).
Antidote: Protamine sulfate (30 minutes)
NI: Anticoagulant effect begins within 20 mins of IV administration. Heparin starts quickly, gone quickly. Contraindicated with active bleeding, Monitor PTT, Bleeding precautions (hematuria, bleeding gums, stool, urine, epistaxis). Wear med alert. Interactions: aspirin, NSAIDs. Heparin drug of choice for labor/pregnant women (short half life and does not cross the placenta).
SAFETY PRECAUTIONS- Various doses. Heparin & Warfarin given together to allow time for warafarin to reach therapeutic levels.
Two practitioners should independently check Heparin order, calculate diose, set infusion pump .Two practitioners sign MAR. PTT -1.5 -2.5 times normal/46-70 range for a patient on Heparin , Class: Anticoagulant (LMWH)
Use: Prevention of DVT after surgery
SE: Bleeding/hemorrhage (less bleeding than heparin) , heparin induced thrombocytopenia, angioedema, anaphylaxis, rash, urticaria
Antidote: Protamine sulfate.
NI: SQ, Assess for Bleeding/Hemorrhage, teach bleeding precautions, heparin induced thrombocytopenia (low platelets less then 50,000- lower risk then heparin). Assess Platelets/Hold less than 50,000 (not INR or PTT) Teach patient to administer SubQ (2 in umbilicus) Report to HCP drop BP-20 points of dec H&H) Interactions: aspirin, NSAIDs, antiplatelet med. Not approved for children.
No PTT blood test monitoring necessary with the LMWHs. Class: Anticoagulant
Use: PO/oral Long-term prophylaxis of venous thrombosis (DVT), atrial fibrillation, PE. and prothrombin
Antagonist: Vitamin K
SE: Bleeding, thrombocytopenia, n/v, diarrhea, Abd cramping, rash, "purple toe" jaundice, burning sensation feet,
NI: Prolonged onset (48-72 hrs.). Need to monitor PT/INR. INR Therapeutic 2-3 (3.5 value replacement) Teach Assess stool/urine for blood. Caution use- diverticulitis, colitis, hypertension, hepatic/renal disease). Teach/Maintain steady state of diet/Vit K foods Teach bleeding precautions No ETOH, No antiplatelet medications (Include alfalfa, garlic, ginger, ginkgo biloba, ginseng, and licorice). NO pregnancy-crosses placentae) Narrow therapeutic range,: PT and INR monitoring. frequently dose changes followed in beginning/restart of therapy. Antibiotics INCREASE risk for Bleeding( due to decrease GI/Vit K) Class: factor XA inhibitor
Use: Anticoagulant, prophylaxis of DVT which may lead to PE in patients undergoing to knee/hip surgery, atrial fibrillation
SE: bleeding Risk: intracranial hemorrhage- CNS-fatigue, syncope, ICP-, hepatitis, jaundice, agranulocytosis, anaphylaxis, angioedema, Steven Johnson syndrome
NI: PO /Take same time Q day, Avoid Aspirin/NSAIDS, Assess Renal function, Monitor for bleeding, Assess CBC, hypotension, NO need for routine clotting studies NO need to avoid Vit K foods( leafy greens). Teach Bleeding precautions Interactions: Vitamin E, Garlic, Ginger, Ginkgo.
Antidote: Andexxa
STOP 24h pre-op Class: Thrombolytic agent
Use: TX stroke, PE, degrades clots, MI, clearance of occluded central venous access devices.
SE: ecchymosis, MAJOR BLEEDING RISK . Intracranial hemorrhage, retroperitoneal bleeding, ecchymosis anaphylaxis, recurrent bleed,
NI: MUST be given within 2-3 hrs. of CVA, 6 hrs. of MI. IV drug Contraindicated clients active bleeding, severe HTN, bleeding tendencies. No new IV, Injections, ABGs. Only through compressible existing peripheral IV. prevent injury
Antidote: Aminocaproic acid (Amilcar). Class: Anti hyperlipidemics
Use: Prevention of CAD, Mi, stroke, angina, Reduces total/LDL cholesterol production.
SE: HA, Sore Muscles/rhabdomyolysis, Toxic LIVER (angioedema), anaphylaxis, GI upset, dyspepsia, flatulence, pins & needle
NI: Assess muscle soreness/tenderness Monitor LIVER function, total cholesterol, LDL, HDL, triglyceride , AVOID grapefruit juice, ETOH., Best Take with evening meal, Teach to Avoid antifungals, cyclosporine, erythromycin. NO pregnant/breast feeding (use contraception)
Teach pt to report to HCP unexplained muscle pain & tenderness, yellowing of skin/eyes, lack of appetite (liver toxicity).
Teach patient proper diet, weight control, exercise Class: Antihyperlipidemics-Bile Acid Sequestrates
Use: Decrease LDL cholesterol, Binds bile acids in GI tract, No effect on HDL
Route: Powder Mix with water, Do not give with other medications
SE: Constipation/fecal impaction, abd discomfort, bloating, reflux, Vitamin deficiencies (A,D, E,K)
NI: Never take in dry powder form (H2O, juice, milk) Oral hygiene (tooth damage) Increase bulk/fluids. Administer before meals. Other meds at least 1 hr/4hrs after cholestyramine. Best at bedtime . Never give to a patient with history of bowel obstruction or constipation. Eat high fiber foods . Check cholesterol/triglycerides 4 weeks/Q 6 months. Historically Poor patient compliance Class: Cholesterol absorption inhibitor
Use: Inhibits absorption of cholesterol in small intestine Lipid lowering agent
SE: angioedema, muscle pain, diarrhea, cholecystitis, URI, nausea, mild abdominal pain
NI: Take med same time Q day (no regard to meals) Notify HCP of muscle pain, weakness, difficulty breathing/swallowing. Frequently combined with HMG-COA inhibitor (Monitor liver functions if taken with HMG-CoA). Diet & aerobic exercise teaching. Can be taken 1 hr before/ 4-6 hrs after bile acid sequestrant (Cholestyramine).
Monitor total cholesterol, LDL, HDL, triglyceride levels before and during therapy. Class: Thyroid medication
Use: thyroid replacement agents , Increase metabolic rate, hypothyroidism, thyroid cancer, myxedema coma:
SE: Nervousness, N/V/D, weight loss, HA, insomnia, Tachycardia, palpations, ↑BP, arrhythmias, cardiac collapse
NI: Check Vital signs/ pulse> 100, chest pain, dizziness Call HCP (leading to MI, angina) Give in same time AM -30 mins-1 he before eat Empty stomach/separate increases absorption, take with full glass water, Ok Crush pill, LIFELONG treatment , Take weeks to feel full effects. Teach client s/s hyperthyroidism (too much medication) &s/s hypothyroidism (medication not effective), safe during pregnancy, Don't change brands
Antacids, Digoxin, Propranolol, Iron, phenytoin, rifampin, Insulin. OCP decrease levothyroxine
Black Box Warning- not for weight loss, serious side effects when used in euthyroid patients Class: inhibit osteoclasts
Use: post menopausal osteoporosis, Paget's
SE: esophageal ulcer, n/v. Serious adverse effects may include anemia, jaw osteonecrosis, neutropenia, infections, and renal damage
NI: RISK of esophageal ulcers/erosions, dysphagia, esophagitis :Take in AM, Take with 6-8oz H20, before first food, drink Do not chew, REMAIN UPRIGHT for 30- mins p dose, dental exam before start, Abnormal femur fracture.
Contradicted in renal impairment.
Photosensitive Class: antirejection
Use: to prevent transplant rejection and reaction
SE: Gingival hypertrophy Nephrotoxicity, hypertension, and hyperlipidemia
BBW: increased risk of developing malignant cancer
NI: PO (liquid/tablets) Cyclosporine dosing is weight based in both adults and children, with higher doses given immediately before and after the transplant and then tapered over several months to minimize adverse effects and avoid excessive immunosuppression ***Teach Life-long medication, Teach Use soft toothbrush, Teach-notify HCP any signs of infection (avoid crowds, avoid live vaccines/Herpes Zoster & shingles). Contraception Assess Bun, AST,ALT, bilirubin, lipid levels. Dilute liquid med with milk, chocolate milk, or orange juice and drink immediately. Tablets /whole. Check with HCP about changing generic brands.
Take medication same time/day, NO grapefruit juice, NO pregnancy Class: Antihypertensive ACE INHIBITOR
Use: Tx hypertension, first-line agents for treating hypertension and heart failure. Suppresses the renin-angiotensin-aldosterone system and prevents conversion of angiotensin 1 to angiotensin 2 (vasoconstrictor).
SE: Orthostatic BP, Dizziness, fatigue, headache, weakness. GI distress (n/v), Angioedema, -Persistent nonproductive cough (Bradykinin), Hyperkalemia, Erectile dysfunction
NI: Hypotension, Asses BUN, creatinine,(especially in renal patient). Assess for hyperkalemia- No salt substitutes (KCL). Assess for angioedema (swelling in face/neck, difficulty breathing.)Therapeutic effect -within an hour, monitor BP. Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention
Can be taken with diuretics Use caution with African American population as drugs may not be effective. No pregnancy
Black Box warning/fetal toxicity-use birth control
Captopril Interactions: NSAIDS (decrease action of ACE) Digoxin, lithium levels Class: ARB. Blocks effects of the renin-angiotensin-aldosterone system thus causing a decrease in blood pressure.
Use: HTN, CHF, MI, stroke prevention, Can be combined with thiazide diuretics, calcium channel blockers (CCBs), or beta blockers (BBs) to lower blood pressure
SE: dizziness, muscle cramps or weakness, heartburn, diarrhea, and decreased sensitivity to touch.. Angioedema, Hyperkalemia (less compared to ACE inhibitors),
NI: Monitor BP/pulse. Assess BP (more hypotension with ARBs compared to ACE ). Monitor weight. Assess angioedema. Assess for hyperkalemia.Assess BUN . Avoid salt substitute (KCL). Teach do not discontinue medication without informing their health care providers, TEACH safety related to orthostatic BP, AVOID GRAPEFRUIT JUICE Maximal effects on BP usually occur within 3 to 6 weeks.
Contraindicated/Black Box warning No pregnancy. Class: loop diuretic
Use: Inhibits reabsorption of Na and Cl in tubules, Hypertension, Edema -HF, acute pulmonary edema, Glaucoma, Renal disease
SE: N/V, Dizziness, Dehydration., loss potassium, low sodium, low calcium, hyperglycemia, ortho BP, rash, photosensitivity, pancreatitis, hepatic dysfunction
NI: PO, IM, IV Caution cross-sensitivity to sulfonamide. .Ortho BP precautions, Assess K. Ca, Na-/low K supplements. Assess BP, pulse, daily weights- notify HCP > 2lbs/day. Take med in AM. Avoid ETOH, Food/milk lessens GI Upset-slightly less absorption, Assess for Dig toxicity/LOW K . Digoxin/corticosteroids increases risk of low K . Use sunscreen/photosensitivity May increase glucose level/ caution diabetics. Effectiveness persists in impaired renal function. Contraindicated Anuria
BBW: F&E loss and hyperglycemia Class: Thiazide diuretic /sulfonamide
Use: Hypertension, edema,
SE: Dehydration, Hypotension/ortho BP, hypokalemia, hypocalcemia, hypomagnesemia, hyperglycemia, nausea/vomit, anorexia, Thiazide induced photo sensitivity, hearing loss/tinnitus, dizziness, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, or spasms.
NI: Cross sensitivity to sulfonamides. Monitor BP, pulse, daily weights>2lbs/day notify MD, Assess for Hypokalemia (weakness, muscle cramps, and arrhythmias. Hyperglycemia. Teach/Increase Diet K+ supplements. Safety -Risk orthostatic BP, Avoid ETOH. Assess for Digoxin Toxicity (low K). Diuresis begins 2 hrs, peak 4 duration 6-12 hrs., Do not reduce fluid intake. Assess renal failure/anuria. Class: Potassium Sparing Diuretic, Aldosterone antagonist
Use: Hypertension, reduce edema, glaucoma, seizures
SE: hyperkalemia, Ortho BP, Hearing loss, tinnitus, Hyperglycemia, hypomagnesemia, hyponatremia, Dehydration, hypocalcemia, dizziness, headache, anorexia, nausea, vomiting, photosensitivity
NI: PO/daily, Monitor BP/pulse frequently, Monitor I & O, daily weight> 2 lbs call HCP, Do not stop abruptly. GI upset with food/milk. Take in AM Do not reduce fluid intake, Avoid ETOH, Notify HCP if muscle cramps, weakness, increased pulse, Drugs may cause hyperkalemia, monitor serum potassium levels. Avoid foods high in potassium (Avocado, Acorn squash, Spinach, Sweet potato, Wild-caught salmon, Dried apricots, Pomegranate, Coconut water, White beans, Banana)
Contradicted in renal failure Classification: Nitrates, Antianginal, Vasodilator
Use: Dilates coronary arteries , systemic vascular beds. Increase flow of oxygenated blood to myocardium, dilates coronary arteries. Decreases Preload
Route - SL, buccal powder, spray(tongue), transdermal, topical/rectal (ointment) , IV
SE: HA, (50%), dizziness, vertigo, hypotension, ortho BP, tachycardia, flushing, blurred vision, dry mouth , N/V, abd pain
NI: Assess VS, BP SL. Stand slowly! Dosing- 1 Tab (whole) under tongue 5 mins apart X 3 No relief- call HCP, Sit down before NTG dose to prevent dizziness, HA- tolerance will develop (treat acetaminophen).
Transdermal- Remove patch(paste) at designated time, Minimize drug tolerance-remove patch for 12 hr nitrate free period. Caution microwave-heats patch, Remove before defibrillation
SL Tablets-Store tabs cool/dark dry, original container (6 months expire)
Shake spray-spray tongue (do not inhale)
Long term use may decrease efficacy. Sudden stop-may cause coronary vasospasm. Avoid ETOH
Contraindicated -Phosphodiesterase 5 (sildenafil), ↑Inc ICP, cerebral hemorrhage angle close glaucoma
Vit E increases effectiveness of nitro Class: Selective Beta Adrenergic Blockers
Decrease HR and cardiac workload via dilation
Use: HTN, angina, MI, headache
SE: •bradycardia, hypotension, confusion, drowsiness, fatigue, hypoglycemia, wheezing, erectile dysfunction, decreased libido, and urinary frequency
NI: Assess/ teach apical pulse before administering- Withhold if apical pulse falls > 50 bpm or arrhythmias, Safety-Ortho BP, Assess I &O, weight daily, Assess for shortness of breath, Teach lifestyle modification. Taper gradually over 2 weeks-Abrupt DC may cause rebound HTN and lead to angina, arrhythmia, MI , Take with meals. Class: Calcium Channel Blocker, Antihypertensives, antianginal
Use: TX unstable angina, mild-to-severe hypertension, decreases contractility and oxygen demand. Drug may also dilate coronary arteries and arterioles.
SE: transient hypotension, No change in Heart rate flushing, headache, dizziness, peripheral/lower limb edema and reflex weakness, pulmonary edema. Constipation, nausea, and gingival hyperplasia,
NI: Assess for angina pain, Do not crush/break sustained-release formulations. Assess BP prior- withhold systolic <90 mm Hg. Assess for excessive vasodilation. (flushing, peripheral edema, and frequent HA). Don't give drug with grapefruit juice. Increase fluid/fiber for constipation.
Caution immediate and extended relief tablets ( don't confuse) Class: cardiac digitalis glycoside
Use: TX CHF, dysthymias (tachyarrhythmia, atrial fibril) improves cardiac contractility and pumping ability
Route: PO (same time Q day) IV
SE: Fatigue, HA, bradycardia ,arrhytmias impaired vision (yellow green halos, light flashes, diplopia, photophobia
Digoxin Toxicity- Nausea, vomiting abd pain, anorexia , Nausea, vomiting weakness, visual disturbances (including blurred vision, halo effect-
Therapeutic level: 0.5-2 ng/dl > 2 toxic Antidote-Digoxin immune Fab (Digibind) is used to treat massive digoxin overdose
NI: Take apical pulse (Call HCP<60-70) for full minute. Daily weights (Report >2lb gain/day), Assess pep edema, Auscultate lungs for rales/crackles . Encourage high K diet ( Low K increases risk of dig toxicity), bradycardia, arrhythmias. Give with food, tablet may be crushed/food . Do NOT skip/add/stop abruptly doses. Assess renal function (administer with caution to renal pts) ,
Check for drug interactions-Thyroid hormone , Thiazide, loop diuretics (cause hypokalemia). corticosteroids, and excessive use of laxatives (cause hypokalemia). Licorice*, ginseng, ephedra, hawthorn. Class: antidiabetic
Use: Management of type 2 diabetes mellitus/ Decreases hepatic glucose production. Decreases intestinal glucose absorption. Maintenance of blood glucose. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production. Antihyperglycemic rather then hypoglycemia (can't cause hypoglycemia)
SE: abdominal bloating, diarrhea, nausea, vomiting,
NI: Risk of lactic acidosis Symptoms of lactic acidosis (chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness) should be reported to health care professional immediately.
BBW-DANGER OF LACTIC ACIDOSIS,
Patients over 80 should avoid, DO NOT TAKE WITH ALCOHOL Class: Reversible Indirect Acting Cholinesterase inhibitor
Use: Improvement of cognition and function (Alzheimer), Delays progression of disease for up to 55 weeks
Action: Delays acetylcholine uptake by inhibiting reuptake enzyme (Cholinesterase)
SE: HA, dizziness, depression, N/V (small meals) diarrhea, insomnia, GI bleeding ,insomnia, fatigue, confusion (driving?), Serious (rare) severe vomiting, yellowing, jaundice, changes in stool/urine, dyspnea, seizures
NI: Once daily dosing Route: PO & Dissolving tablets on tongue then H20 , BEDTIME DOSING Watch liver function (jaundice, yellowing) -Continue medication even if no cognitive changes assessed. Stop medication-lose the benefits gained, safety /med alert
Watch Safety—THEOPHYLLINE, ANTICHOLINGERICC & NSAIDS -change rate of metabolism Class: Cognition-enhancing, glutamate inhibitor
Use: slows progression of moderate to severe Alzheimer's . does not cure Alzheimer's disease- may improve memory, awareness, and the ability to perform daily functions.
SE: Change in BP, CNS adverse effects such as dizziness, confusion, anxiety, fatigue, and hallucinations, assess for diarrhea/constipation, vomiting, abdominal pain, urinary incontinence, back pain, and cough
NI: po capsule/extended release/liquid. Assess patient's behavior and level of confusion. CNS effects Safety -protect from falls. Assess for changes in memory, mood, dementia. Avoid sodium bicarbonate, which increases the serum level of memantine. Not to be used with renal failure, Class: Dopamine Receptor Agonist
Use: stimulates dopamine receptors-Restores dopamine levels TX- Parkinson
SE: HA, anxiety, Involuntary movements/extrapyramidal movements, N/V, dry mouth, urinary retention, hallucinations, urges (gambling, sexual)
NI: "Wearing off"/Timing/Take med same time with food/reduce N/V Do Not Crush time released, Check Ortho BP change position slowly/safety, Do not take with high protein meal, Do not take with IRON, check liver, kidney function, Avoid Multivitamin (pyridoxine/B6). (hallucinations (elderly), candy/dry mouth. Report fainting, light-headedness, irregular heart rate, uncontrolled facial movements, urinary retention, N/V to HCP. Contraindicated -Narrow angle glaucoma. Class: antiulcer/ Histamine H2 antagonist (blocks gastric acid secretion)
Use: GERD, peptic ulcers, duodenal ulcers, heartburn/indigestion
SE: diarrhea, dizziness, drowsiness, headache, confusion, gynecomastia (man boobs)
NI: PO, onset 30min, peak 45-60mins, duration 4-5h
Once daily at bedtime, take with every meal. Do NOT stop taking, finish the bottle. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. NO smoking, alcohol. Increase fluid and fiber. Report GI bleed and hallucinations. 6-8-week treatment in ulcers. SAFE for renal impair. Increases effects of warfarin and risks toxicity Class: 1st gen antihistamine
Use: antiemetic, motion sickness, antihistamine, sedative
SE: urinary retention (BPH), confusion, disorientation, sedation, photosensitivity, ortho-hypotension
NI: IM/IV, teach ortho/hypo interventions, teach photosensitivity precautions, avoid etoh and sedatives
BBW: contradicted in children, contradicted in SubQ admin. Class: Decongestant Adrenergic (Sympathomimetic)
Use: relief nasal obstruction/discharge, shrinks swollen nasal membrane
SE: hypertension, anxiety, headache, dizziness, drowsiness, vision changes, seizure, arrhythmias, urinary retention, N/V
NI: PO/nasal spray/drops, Spray: use <3 days > PO. Monitor HR, BP, sedation/safety. Do not take with caffeine. Avoid eating/drinking for 30 minutes after spray. Review OTC meds, avoid smoking
BBW: thyroid disease, severe HTN, CAD, narrow angle glaucoma, MOA, antidepressants (topical over PO to decrease cardiac effects), dysrhythmias, DM, prostatic hypertrophy Class: antihistamine 1st generation/Benadryl, anticholinergic
Use: Symptomatic relief of rhinitis, allergic conjunctivitis, urticaria, angioedema, motion sickness and sleep aide, minimizes risk in blood transfusion reaction
SE: drowsiness/sedation, dry mouth, dry skin, decreased saliva and tear formation, thickened bronchial secretions, hypotension, tachycardia, arrhythmias
NI: review OTCs, drowsiness/ sickness teaching, Avoid ETOH and operating machinery, dry mouth: lozenges & ice chips, dry skin: moisturize, encourage increase fluids and humidifier to thin mucus
Take 30-60 mins before travel
Contradiction: narrow-angle glaucoma, bladder obstruction, cardiac complications, OTC meds, young children, pregnancy Class: antitussive
Use: suppress cough reflex, symptomatic relief of DRY, NON-PRODUCTIVE COUGH
SE: dizziness and sedation in high doses, GI/Nausea
NI: Asses resp. status, teach cough, avoid irritants, humidifier, taking increased dose, avoid ETOH, CNS depress. Teach drowsiness/safety. Do not take w food
Contradiction: MOA, cough lasting >1 wk or accompanied by fever, rash, headache (call HCP) Class: cough expectorant
Use: reduce viscosity of tenacious secretions (increases resp. tract fluid)
SE: HA, dizziness, N/V, GI, rash
NI: OTC, teach cough/deep breathing, ambulation, chest PT, increase fluid. NO smoking, maintain humidified air, sugarless gum& hard candy to increase saliva. Do NOT take with fever, rash, headache or cough >1 wk (call HCP) Class: mucolytic (inhalation/nebulizer) & antidote to acetaminophen overdose (PO/IV)
Use: PO/IV: lessens liver damage, decreases buildup of hepatotoxic metabolite in acetaminophen. Inhalation: degrades mucus and liquefies secretions, allowing easier mobilization and expectoration
SE: drowsiness, nervousness, nausea, stomatitis, urticaria, rhinorrhea, bronchospasms, angioedema
NI: Cough & deep breathing before TX, unpleasant odor/taste/smell, rinse mouth/face, assess bronchospasm, no smoking, increase fluid Class: bronchodilator (no longer 1st drug of choice)
Use: bronchodilation, long-term control in COPD
SE: agitation/ irritability/ anxiety, dysrhythmias, tachycardia, palpitation, insomnia, HA, N/V
NI: Assess resp. status, peak flow, PO, assess theophylline levels, increase fluid to minimum 8 glasses, caution w peptic ulcer, Avoid ETOH, caffeine, smoking
THEOPHYLLINE level: Therapeutic range: 10-15 mcg/mL for asthma.
>20mcg/mL=toxicity S&S: anorexia. N/V, cramps, diarrhea, confusion, HA, restlessness, insomnia, tachycardia, arrhythmias, seizure. Notify HCP Class: Bronchodilator/sympathetic Short acting beta 2 adrenergic
Use: 1st line therapy for acute asthma attack/ relaxation of the bronchial tubes. Inhaler: rescue inhalant (quick relief) PO: maintenance inhalant (long-term prevention)
SE: nervousness, tremors, anxiety, HA, palpitation, tachycardia, hypo/hypertension, bronchospasm
NI: Asses resp. rate, vitals, sputum. Teach use of inhaler, do not exceed recommended dose, assess bronchospasm (w first dose from new canister), bad taste, advise mouth rinses after inhalation to prevent candida. Clean mouthpiece with water once a week. Admin albuterol by MDI= less systemic effects than higher dose PO or nebulizer
Contradicted: tachycardia, severe CAD, use w caution in HTN, DM, seizures. Overdose= cardiac & CNS stimulation Class: anti-inflammatory (steroid)
Use: inhaled, potent, locally broncho- anti-inflammatory and immunomodifier. Decrease frequency and severity of asthma attacks.
SE: HA, bronchospasm, cough, oral pharynx fungal infection
SI: Inhalation/MDI, assess respirator/lung sounds, advise use of corticosteroids and bronchodilator- use bronchodilator 1st, allow 5 min elapse before admin corticosteroid, drug peaks 1-4 wks. NOT for use in emergency. Avoid allergens/irritants, rinse mouth after admin. Call HCP is sore throat or mouth Class: barbiturates, anticonvulsants, sedative/hypnotic
Use: depress CNS
SE: hangover, decrease appetite, lethargy, vertigo, risk of depression, light headiness, hypersensitivity reaction (angioedema and serum sickness*)
NI: Fast absorption, IV works in mins last 4h. Takes 2-3 wks to reach therapeutic level, risk for falls. Advise pt to notify HCP if s&s of angioedema, fever, sore throat/mouth, unusual bleeding/bruising, nosebleeds or petechiae
Older adults- Increased sedation (decreased absorption) - altered renal excretion, risk for injury
Do NOT use in kidney/hepatic impair. Class: skeletal muscle relaxant/ anticonvulsant/ antianxiety
Use: anxiety, muscle relaxant, anticonvulsant; Treatment: status epilepticus, depress CNS
SE: N/V, bradycardia, HTN
NI: Onset: (quick if IV) 1-5min, peak 30min, duration 15-60 min
Asses mental changes, dizziness, drowsiness, level of sedation, muscle spasms, pain, limitation of movement, prolonged use>physical/psychological dependence, kidney excretion, liver. CBC, assess fall risk, avoid ETOH (resp depress.) May take w food/water, crush if necessary. Reduce dose in elderly.
Antidote: Flumazenil Class: anticonvulsant
Use: seizures, neuralgia pain, prevents migraine, pain in shingles
SE: N/V, confusion, insomnia, dizziness, fatigue, somnolence, suicide, ataxia, dry mouth, impaired vision*
NI: peak 1h, metabolized in liver> excreted in kidney, do NOT crush, store away from light, watch personality changes, HCP for seixure, take w food/ w/o food for GI upset, taper over 1 wk, do not operate heavy machinery, assess seizure and neuro pain. Report changes in stool and urine. Ginkgo & antacids decreases effectiveness Class: anticonvulsant
Use: antiseizure, psychomotor seizures
SE: gingival hyperplasia, hirsutism (facial hair), anemia, neutropenia, N/V, constipation, drug-induced hepatitis, hypotension, Stevens-Johnson syndrome, suicidal thoughts, inhibits insulin
NI: PO (chew, oral susp., injectable), monitor for suicidal thoughts, check BP, assess rash (Steven-Johnson) diplopia, nystagmus, liver funx, do NOT stop abruptly (risk seizure), take with food (decrease N/V) use back up contraception
DO NOT SWITCH BRANDS/miss doses, interferes w OCP (Birth control)
Therapeutic range 10-20 mcg/mL, monitor Dilantin level-nystagmus observed at >20µg/m 7th Edition•ISBN: 9780323087896 (1 more)Julie S Snyder, Linda Lilley, Shelly Collins388 solutions
7th Edition•ISBN: 9780323527361Julie S Snyder, Mariann M Harding2,512 solutions
7th Edition•ISBN: 9780323402101Gary A. Thibodeau, Kevin T. Patton1,505 solutions
8th Edition•ISBN: 9781266591631Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh1,355 solutions
