Nursing 204 Pharmacology Review

Proventil (albuterol)
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.
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.
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.
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.
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.
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
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.
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.
May turn urine pink or red.
Assess location, duration, frequency, and characteristics of seizures.
Monitor CBC, serum calcium, albumin, and hepatic function.
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.
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.
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
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
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
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
. 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#
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

Insulin promotes cellular uptake of glucose
Insulin moves potassium into cells

SIDE EFFECTS Risk for hypoglycemia
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


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
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
..., Mood Stabilizer. This is a salt that is chemically similar to sodium chloride (table salt). It competes with sodium for absorption at receptor sites. Adequate fluid intake is very important. 2,000 - 3,000 mL of water a day. Should avoid caffeine. Serum levels must be checked throughout therapy.
Magnesium sulfate
..., This med is 1)an anticonvulsant 2)Decreases BP 3) Stops preterm labor contractions, Signs of toxicity of this drug is Lose reflexes, < urinary output (<30 ml hr), Respirations <12 & decreased LOC.
inhaled, long-acting, long-term control of asthma, beta2-adrenergic agonists
Has minimal side effects, tremors caused by activation of beta2 receptors in skeletal muscle, usually resolve with continued medication use, or dosage may need to be reduced
Use cautiously in clients with diabetes, hyperthyroidism, heart disease, hypertension, and angina
Use of beta-adrenergic blockers can negate effects of both medications
MAOIs and TCAs can increase risk of tachycardia and angina
Beta-adrenergic blockers should not be used concurrently
Instruct clients to report changes in heart rate or chest pain
Instruct clients to follow manufacturer's instructions for use of device
Inhale beta2-agonist before inhaling the glucocoticoid if the client is prescribed both
Advise clients not to exceed prescribed dosages
Ensure the client knows appropriate dosage schedule
Serevent is used every 12hr for long-term control and are not to be used to abort an asthma attack
Advise clients to observe for signs of an impending asthma attack and to keep a log of frequency and intensity of attacks
Instruct clients to notify provider if there is an increase in frequency and intensity of attacks
Smoking Cessation
Bupropion (Zyban) - decreases nicotine craving and symptoms of withdrawal.
1. To treat dry mouth, encourage clients to chew gum or suck on hard candy and to sip small amounts of water or suck on ice chips
2. Advise clients to avoid caffeine and other CNS stimulants to control insomnia
Nicotine replacement therapy (nicotine gum [Nicorette] and nicotine patch [Nicotrol] - these nicotine replacements are pharmaceutical product substitutes for the nicotine in cigarettes or chewing tobacco.
1. Clients should avoid using nicotine products while pregnant or breastfeeding

2. Nicotine gum:
Use of chewing gum is not recommended for longer than 6 months
Advise clients to chew gum slowly and intermittently over 30mins
Advise clients to avoid eating or drinking 15min prior to and while chewing the gum

3. Nicotine patch
Clients should apply a nicotine patch to an area of clean, dry skin each day
Advise clients to avoid using any nicotine products while patch is on
Follow product directions for dosage times
Advise clients to stop using patches and to notify provider if local skin reactions occur
Remove the patch prior to MRI scan and replace when scan is completed
..., Broad-spectrum bacteriostatic antibiotics . Inhibit protein synthesis
Use: mycoplasma, chlamydia, rickettsia, borrelia, chronic bronchitis, acne, cholera, syphilis, H. pylori
Tox: GI upset and superinfections, Fanconi's syndrome, photosensitivity, dental enamel dysplasia. Do not take with milk, antacids or iron
Potassium Sparing Diuretics
Retains potassium and secretes sodium and water.
- Used for heart failure, edema.
- SE: Hyperkalemia K+ greater than 5.0 Monitor potassium level, initiate cardiac monitoring for K+ greater than 5.0. Treat hyperkalemia by discontinuing medication, restrict potassium in diet, and insulin injections to drive potassium back into the cell.
Impotence, irregularities of menstrual cycle. Advise clients to observe for SE. Client should notify provider if these SE occur.
- Contraindicated in pt's who have severe renal failure and anuria,
- Monitor potassium regularly
- Can only be given orally.
- Teach pt's to avoid salt substitutes that contain potassium.
- Teach clients to monitor BP and weight.
- Warn clients that triamterene may turn urine a bluish color.
A Meglitinide, results in insulin release from the pancreas.
- Used for Diabetes Mellitus.
- SE: Hypoglycemia
- Monitor clients for signs of hypoglycemia. If abrupt client will experience, tachycardia, palpitations, sweating, and shakiness. If gradual onset client will experience headache, tremors, and weakness.
- Instruct client to self-administer a snack of 15g of carbs ( 4oz orange juice, 2 oz grape juice, 8oz milk).
- Instruct client to notify provider if the is recurrent low blood sugars.
- If severe hypoglycemia occurs, IV glucose may be needed,
- Encourage clients to wear a medical alert bracelet.
- Instruct client to eat within 30 min of taking a dose of medication.
A glucocorticoid, provide symptomatic relief of inflammation and pain.
- SE: Risk for infection, osteoporosis, Adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia.
- Advise client to notify MD if fever or sore throat occur.
- Advise client to take calcium supplements and Vit D.
- Monitor for signs of fluid excess.
- Advise client to report symptoms of GI bleed.
- Monitor glucose levels.
- Monitor potassium levels. Advise client to eat potassium rich foods.
- If client is on a hypoglycemic the dose may need to be increased.
- Risk for GI bleed if taking NSAID's Tell client to avoid them.
Amphotericin B (Fungizone)
-used to treat progressive and life threatening fungal infections;noninvasive forms of fungal disease
-Anxiety,convulsions ,coma,hallucinations,peripheral neuropathy,tremor,vertigo,cardiac failure/arrest/myopathy,hypertension,local Venous pain,nausea,vomiting,diarrhea,epigastric pain,gastroenteritis,azotemia, tubular acidosis, agranulocytosis,thrombocytopenia,acute liver failure,hypokalemia,bone and joint pain, pruritis, erythema,inflammation,pain.
-hx of hypersensitivity,c&s before therapy, renal and hepatic function may require decreased dose if impaired, reconstitute iv,protect from light,monitor i&o,d/c if bun greater than 40mg/100ml,serum cr greater than 3mg/100ml,vs,temp,s/s hypokalemia,maintain hydration ,teach patient any discomfort at infusion site immediately
Antacid Therapy
Medicines that neutralize stomach acid and raise the gastric ph
Used to relieve indigestion, upset stomach, and heartburn
Also used as symptomatic relief for a peptic ulcer
Should be avoided if signs of appendicitis and inflamed bowel are present (cramping, pain, and soreness of the lower abdomen, bloating, and nausea/vomiting)
Side Effects: mild constipation or diarrhea, mild chalky taste, thirst, stomach cramps, nausea, HA, and whitish or speckled stools (these symptoms should go away but if they persist call MD)
Precautions: frequent alcohol use, dehydration/fluid restriction, kidney problems (consult doctor before using)
Seek Immediate Medical Attention if: black/tarry stools, slow/shallow breathing, mental changes, stomach/abdominal pain, vomit that looks like coffee grounds
Examples: Alka-Seltzer, Tums, Milk of Mag, Mylanta, Pepto
Antilipemic Agents:
Lower lipid levels, used as an adjunct to diet therapy
Non drug means should be tried for 6 months before beginning drug therapy (diet, exercise, no smoking)
5 types: HMG-CoA reductase inhibitors (Statins), bile acid sequestrants, niacin (Vit B3), fibric acid derivatives, cholesterol absorption inhibitors
Statins are first line therapy
What should the nurse assess before starting drug therapy?
Dietary patterns, exercise levels, weight, height, VS, tobacco and alcohol use, family history
Biliary obstruction, liver dysfunction, active liver disease
Labs obtained before therapy
Baseline liver function studies
Should be taken with meals to decrease GI upset
Other meds should be taken 1 hour before or 4-6 hours after meals to avoid interference with anti-lipid absorption
May take several weeks to show effectiveness
Nurse should instruct patient to report what 4 things
Persistent GI upset, abnormal or unusual bleeding and yellow discoloration of skin
Eye exam should be done before and during therapy because increased risk of cataract formation
Treatment of Cancer Pain
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
o aspirin
o ibuprofen (Motrin, Advil)
o naproxen (Naprosyn)
o indomethacin (Indocin)
o diclofenc (Voltaren)
o ketorolac (Toradol)
o meloxicam (Mobic)
o celecoxib (Celebrex)
Side Effects: Take with food, milk, or full glasses of water
o GI discomfort
o Damage to GI mucosa
o Renal dysfunction
o Increased risk for MI and stroke
o Salicylism
o Reye Syndrome
o Aspirin Toxicity

Opioid Agonists (Opioid Analgesics)
• Morphine sulfate (Morphine)
• fentanyl (Sublimaze, Duragesic)
• meperidine (Demerol)
• methadone (Dolophine)
• codeine, oxycodone (OxyContin)
Side Effects:
o *Respiratory depression
o Constipation
o Orthostatic hypotension
o Urinary Retention
o Cough suppression
o Sedation
o Biliary colic
o Emesis
o Opioid overdose
o Administer opioid antagonists: naloxone (Narcan) or nalmefene (Revex)
parenteral anticoagulant

Pharmacological action: prevent bleeding by inactivation of thrombin
formation and factor Xa resulting in inhibition of the formation of

Therapeutic uses: In conditions necessitating prompt anticoagulant
activity (evolving stroke, pulmonary embolism, massive deep venous
thrombosis), as an adjunct for clients having open heart surgery or
renal dialysis, as low-dose therapy for prophylaxis against
postoperative venous thrombosis, in conjunction with thrombolytic
therapy when treating an acute myocardial infarction, or treatment of
disseminated intravascular coagulation.

Administration: heparin cannot be absorbed by the intestinal tract so
it must be given by subcutaneous injection or IV infusion. It can be
given every 12 hours subQ or continuous or intermittent IV infusion.

Adverse Effects/Nursing Interventions: 1)Hemorrhage secondary to
heparin overdose= monitor VS, observe for signs of bleeding (increased
heart rate, decreased BP, bruising, petechiae, hematomas, black tarry
stool,) in the case of heparin overdose stop the heparin and
administer protamine sulfate and avoid aspirin. Monitor activated
partial thromboplastin time (aPTT) and keep this value at 1.5 to 2
times the baseline. 2) HIT (Heparin Induced Thrombocytopenia) as
evidenced by a low platelet count and increased development of
thrombi- mediated by antibody development (white clot syndrome)=
monitor client's platelet count periodically throughout treatment
especially in the first month, stop heparin if platelet count drops to
less than 100,000/mm3. Nonheparin anticoagulants, such as
lepirudin(Refludan) or argotroban(Acova), can be used as a substitute
if anticoagulation is still needed. 3) Hypersensitivity reactions
(chills, fever, urticarial)= administer a small test dose prior to the
administration of heparin. 4) Toxicity/Overdose= administer protamine
sulfate, which binds with heparin and forms a heparin-protamine
complex that has no anticoagulant properties. Protamine sulfate should
be administered slowly IV no faster than 20 mg/min or 50 m in 10

Contraindications: do not use in patients with low platelet count or
uncontrolled bleeding, use cautiously with clients with hemophilia,
increased capillary permeability, dissecting aneurysm, peptic ulcer
disease, severe hypertension, hepatic or renal disease, or threatened
abortion (miscarriage.) Heparin should not be used during or following
surgeries of the eyes, brain, or spinal cord, lumbar puncture, or
regional anesthesia.

Administration: obtain baseline VS, CBC, platelet count, and
hematocrit levels. Read label carefully since it is dispensed in units
and in different concentrations. Check dosages with another nurse
before administration. Use an infusion pump for continuous IV
administration and monitor the rate of infusion every 30 to 60
minutes. Monitor aPTT every 4 or 6 hours until appropriate dose is
determined, then monitor daily. For subQ injection use a 20-22 gauge
needle to withdraw medication from the vial the change the needle to a
smaller needle (25 or 26, ½ to 5/8 in length), administer deep subQ
injections in the abdomen ensuring 2 inches from the umbilicus and do
not aspirate and apply pressure for 1-2 minutes after injection and
rotate and record injection sites. Monitor for signs of bleeding
(bruising, bleeding gums, abdominal pain, nose bleeds, coffee ground
emesis, tarry stools,) advise clients do not take NSAIDs, aspirin, or
medications containing salicylates, and advise client to use electric
razor for saving and a soft toothbrush.

Evaluation: Client aPTT of 60-80 seconds and no development or no
further development of venous thrombi or emboli.
"Hydrodiuril"- expected pharmacological action:
thiazide diuretics work in the early distal convoluted tubule (DCT)
to: 1) block the reabsorption of sodium and chloride, thus preventing
the reabsorption of water at this site. 2) Promote diuresis when renal
function is not impaired.

Therapeutic Uses: Thiazide diuretics are often the medication of first
choice for essential hypertension. They may be used for edema of mild
to moderate heart failure and liver and kidney disease.

Adverse effects & nursing interventions: 1) Dehydration=
assess/monitor for signs of dehydration (dry mouth, increased thirst,
minimal urine output, weight loss), monitor serum electrolytes and
weight, report urine output less than 30 ml/h. stop medication and
notify the provider. 2) Hypokalemia=monitor cardiac status and serum K
levels, report a decrease in serum K (less than 3.5 mEq/L), teach
client to consume foods high in K such as spinach and tomatoes, teach
client to recognize signs of hypokalemia (nausea, vomiting, general
weakness.) 3) hyperglycemia-monitor for an increase in blood glucose
Contraindications: Pregnancy risk Category B so avoid use during
pregnancy and lactation. Digoxin toxicity can occur in the presence of
hypokalemia so monitor cardiac status and K and Dig levels, and note
that a potassium sparing diuretic can be used in conjunction with a
thiazide diuretic to reduce the risk of hypokalemia. Antihypertensives
have added hypotensive effects so closely monitor BP. Hyponatremia can
lead to decrease in lithium carbonate excretion which may lead to
toxicity so closely monitor lithium levels and dosage may need to be
adjusted. NSAIDs reduce the diuretic effect so watch for reduced urine
output and other signs of decreased effectiveness.

Nursing administration: Can only be given orally, obtain baseline data
to include orthostatic BP, weight, electrolytes, and location and
extent of edema. Monitor K levels. Instruct client to take the
medication first thing in the morning and if ordered twice a day be
sure the second dose is taken by 2pm to prevent nocturia. Encourage
consumption of foods high in K and maintain adequate fluid intake
(1500 ml/day unless contraindicated), if GI upset occurs clients may
take medication with or after meals, and note that alternate day
dosing can decrease electrolyte imbalances.

Evaluation: Decrease in BP, Decrease in edema, Increase in urine output.
..., a triptan=sumatriptan;seperate category than other pain meds; to be used only when a clear diagnosis of migraine has been made workds directly on the blood vessels responsible for the migraine;taken at the onset of a migraine, should be administered as soon as symptoms of a migraine attack appear. A 2nd dose of this medication in tablet form may be taken 2 hours after the 1st dose.
Centrally Acting Alpha 2 Agonists
indomethacin (Indocin), allopurinol (Zyloprim), probenecid

Used To Treat:
Severe cancer pain
Investigational use for: migraine headaches, flushing from menopause, and management of withdrawal symptoms from alcohol, tobacco, and opiods

Side Effects:
Drowsiness abd sedation
Dry mouth
Round hypertension

Nursing Interventions/Client Education:
Avoid activities that require mental alertness until symptoms subside
Chew gum or hard candy, take small sips of water
Don't discontinue treatment without consulting PCP
Should be discontinued over 2 to 4 days
Observe for signs of hypotension (dizziness, lightheadedness, faintness)
Change positions slowly and sit down if feeling dizzy
Advise child bearing women to rule out pregnancy prior to beginning treatment
Additive CNS depression w/ alcohol, don't use with alcohol
Divided doses; take larger dose at bedtime to reduce daytime sleepiness
Decrease in BP
Maintenance of normotensive state
No pain
Antigout medication
indomethacin (Indocin), allopurinol (Zyloprim), probenecid

Used to Treat:
Acute gout attacks
Prolongs the effects of penicillins and cephalosporins be delaying their elimination

Side Effects:
GI toxicity (abdominal pain, diarrhea, nausea and vomiting)
Renal injury

Nursing Interventions/Client Education:
Take with food
Provide antidiarrheal medications as prescribed
If severe symptoms occurs, stop colchicines
Encourage intake of 2 to 3 L of fluids/day
Avoid use during pregnancy ( Category C, if used orally, Category D, if used intravenously)
Use cautiously with the elderly, debilitated clients, and clients with renal, cardiac and GI dysfunction
Allopurinol slows metabolism of Coumadin; watch s/s of bleeding
Salicylates lessen the effect of probenecid
Monitor for improvement of pain caused by gout
Decrease number of gout attacks
Management of nausea and vomiting Treatment of psychoses.
Side Effects:
Neuroleptic Malignant Syndrome (NMS)
Extrapyramidal reactions
May cause drowsiness
Do not take within 2hrs of antacids or antidiarrheals
Radioactive Iodine
Use: Hyperthyroidism, Thyroid Cancer

S/E: Radiation sickness, Bone marrow depression, Hypothyroidism.

Nursing Considerations:
Monitor clients for symptoms of radiation sickness (hematemesis,
epistaxis, intense nausea, vomiting). Stop treatment and notify

Monitor client for anemia, leukopenia, and thrombocytopenia.

Instruct clients to report signs of hypothyroidism to the provider.

Contraindication: Because of irradiating effects, use is
contraindicated in pregnancy, clients of childbearing age/intent, and
during lactation.
Use: ADHD, Conduct disorder

S/E: CNS stimulation (insomnia, restlessness), Weight loss,
Cardiovascular effects (dysrythmias, chest pain, high blood pressure)
May increase the risk of sudden death in clients with heart
abnormalities. Development of psychotic symptoms such as
hallucinations, paranoia. Withdrawal reaction. Hypersensitivity skin
reaction to transdermal methylphenidate (hives, papules)

Nursing Considerations:
Advise clients to observe for symptoms and notify the provider if they
occur. Administer the last dose before 4p.m.

Monitor the clients weight and compare to baseline height and weight.
Administer medication immediately before or after meals. Promote good
nutrition in children. Encourage children to eat at regular meal times
and avoid unhealthy foods for snacks.

Monitor the clients vital signs and ECG. Advise clients to observe for
symptoms and to notify the primary care provider if they occur.

Instruct clients to report symptoms immediately and to discontinue the
medication if they occur.
Advise client to not stop taking medication suddenly. Doing so may
lead to depression and severe fatigue.
Remove patch and notify the provider.

Cntraindications: These medications are contraindicated in clients
who have a history of drug abuse, cardiovascular disorders, severe
anxiety, and psychosis.
..., an alkaloid with anticholinergic effects that is used as a sedative and to treat nausea and to dilate the pupils in ophthalmic procedures
..., a drug (trade names Calan and Isoptin) used as an oral or parenteral calcium blocker in cases of hypertension or congestive heart failure or angina or migraine
aka Neuroleptics. Drugs used in the treatment of psychotic disorders that help alleviate hallucinations and delusional thinking Dopeamine antagonists. Major tranquilizers. Side effects: Wormlike tongue movement. Parkinsonian side effects....,
CHLORPROMAZINE (Thorazine), TRIFLUOPERZINE (Stelazine), THOIRIDAZINE (mellaril) and PERPHENAZINE (trilafon). These drugs are "Phenothiazines" ,
CLOZAPINE (clozarl), OLANZAPINE (Zyprexa), RISPERIDONE (Risperdal), QUETIAPINE (Seroguel), ZIPRASIDONE (Geodon) and ARIPIPRAZOLE (Abilify). These drugs are ATYPICAL of this classification,
EPS - akathesia (motor restlessness) dystonia (muscle tone impairments, tremors), akinesia (muscular paralysis) , pseudoparkkinson like symptoms, and Tardive dyskenesia (involuntary muscle movements)
..., pulmonary anti-inflammatory; corticosteroid
Hemostatic agent
Uses- Management of acute, life-threatening hemorrhage;Used to control bleeding that occurs when blood clots are broken down too quickly.
Side Effects- dizziness, malaise, arrhythmias, bloating, cramping, diarrhea, nausea, diuresis, renal failure, myopathy.
Nursing considerations- Monitor BP, pulse, and respiratory status. Monitor neuro status, I & O, signs of thrombus complications, platelet count and clotting factors; may increase serum K.
(amikacin, gentamicin, kanamycin, neomycin, streptomycin, tobramycin,)
Classification- Anti-infective
Side Effects- ataxia, vertigo, ototoxicity, nephrotoxicity, diarrhea, n&v, hypomagnesemia, apnea, hypersensitivity reactions.
Caution in- renal impairment, hearing impairment, neuromuscular diseases, obesity, pregnancy
Advise pt to drink plenty of fluids w/these meds.
Use: Antidysrhythmic used in conversion of Atrial Fibrillation, recurrent Ventricular Fibrillation, recurrent Ventricular Tachycardia

Side Effects: Pulmonary toxicity (s/s dyspnea, cough, chest pain)

Bradycardia and AV block may lead to heart failure (s/s dyspnea, cough, chest pain, neck vein dystention, crackles in lungs)

Visual disturbances (photophobia, blurred vision, may lead to blindness)

Contraindicated in: Pregnancy (risk category D), newborns, infants, AV block and bradycardia.

Caution in liver, thyroid, respiratory dysfunction, heart failure, fluid and electrolyte imbalances.

Hypotension, bradycardia, AV block

Nursing Considerations: monitor cardiac functions (BP, Pulse, EKG)

monitor respiratory function (respirations, lung sounds, pulse ox)

Advise client to report any visual changes or disturbances

may increase plasma digoxin and warfarin levels

Grapefruit juice may lead to toxicity
Use: Beta-blocker(non-selective) used in hypertension, prevention of MI, Glaucoma

Side effects: Stinging discomfort in eye (drops for glaucoma)

Arhythmia, bradycardia. CHF, Pulmonary edema, fatigue

Caution in patients with Diabetes (may mask s/s of hypoglycemia)

May cause dry eyes

Nursing considerations: Monitor BP, HR, ECG and check apical pulse prior to admin

Advise client to report any visual changes

Monitor blood glucose

Monitor I/O and assess for fluid overload

Withhold if apical pulse < 50 bpm
..., a bronchodilator (trade names Ventolin or Proventil) used for asthma and emphysema and other lung conditions
..., a selective-serotonin reuptake inhibitor commonly prescribed as an antidepressant (trade name Prozac)
Hematopoietic Growth Factor

Action: This medication stimulates the bone marrow to increase production of neutrophils.
Therapeutic Uses: Decreases the risk of infection in clients with neutropenia, such as cancer.
Side/Adverse effects: BONE PAIN - Monitor the client for symptoms and notify the primary care provider. Administer acetaminophen. LEUKOCYTOSIS - Monitor CBC two times per week during treatment.
Contraindications/Precautions: This medication is contraindicated in clients who are sensitive to E. Coli protein. Use cautiously in clients with cancer of the bone marrow.
Therapeutic Nursing interventions: Neupogen should not be agitated and should not be combined with other medications. Monitor CBC two times per week.
Action: In stable angina, nitroglycerin decreases cardiac oxygen demand by dilating veins and decreasing venous return (preload). In variant angina, nitroglycerin relaxes and prevents spasms in coronary arteries, thus increasing oxygen supply.
Therapeutic Uses: Acute attacks and prophylaxis of stable angina, variant angina.
Side/Adverse Effects: HEADACHES - advise the client of symptoms and instruct the client to use aspirin or acetaminophen to relieve pain. ORTHOSTATIC HYPOTENSION - Advise the client to sit or lie down if experiencing dizziness or faintness. REFLEX TACHYCARDIA - Monitor the client's vital signs. TOLERANCE - All long-acting forms of nitroglycerin should be taken with a medication free period each day.
Contraindications/Precautions: Pregnancy Risk Category C. Contraindicated with clients with hypersensitivity to nitrates. Contraindicated in clients with traumatic head injury because medication can increase intracranial pressure.
Therapeutic Nursing Interventions: Treatment of angina attack - instruct the client to stop activity. The client should take dose of rapid-acting nitroglycerin immediately. If pain is unrelieved in 5 min. then the client should call 911. Client can take up to two more doses at 5 min intervals.
Theophylline causes CNS stimulation,tremors,tachycardia,hypotension,
palpitations, GI distress (nausea, vomiting)
Monitor ABG's, acid base values and fluid and electrolyte balance.
Monitor liver and kidney function.
Monitor for signs of toxicity: restlessness, insomnia, irritability,
nausea, tremors and vomiting.

Teach patient to avoid xanthine containing foods: caffeine, chocolate
and colas

Advise client not to smoke.
Fluids to help loosen secretions

Notify phycisian if palpitations, nausea,weakness, dizziness,chest
pain or seizures occur.
All classifications of oral hypoglycemic agents control blood glucose
levels in clients with type 2 diabetes mellitus and are used in
conjunction with diet and exercise lifestyle changes.
Hypoglycemia-monitor clients for signs of hypoglycemia. If abrupt
onset, the client will experience SNS symptoms such as tachycardia,
palpitations, diaphoresis, and shakiness. If gradual onset, the
client will experience PNS symptoms such as headache, tremors, and
weakness.-Instruct client to self-administer a snack of 15g of
carbohydrate (4 oz orange juice, 2 oz grape juice, 8 oz mild, glucose
tablets per manufacturer's suggestion to equal 15g)-Instruct clients
to notify the provider if there is a recurrent problem.-If severe
hypoglycemia occurs, IV glucose may be needed.-Encourage clients to
wear a medical alert bracelet.
Growth Factors
Replacement of neutrophils and platelets after chemotherapy
hastening of bone marrow function after bone marrow transplant
increase in RBC production for clients with chronic renal failure

Erythopoietic growth factors
HTN secondary to elevations in hct level - monitor hgb levels and
blood pressure if elevated administer anti-hypertensives

Increased risk for cardiovascular event with increase of hgb above
12g/dl or more than 1g in 2 wks - Decrease dosage. Therapy may be
resumed when hgb drops to acceptable level, but dosage should be

Leukopoietic Growth Factors
Bone Pain - Monitor for symptoms administer tylenol or opiod analgesic
leukocytosis- Monitor CBC two times per week- decrease dose or
interupt treatment if WBC is greater than 100,000/mm

Granulocyte Growth Factor
Diarrhea, weakness, rash, malaise, bone pain- Monitor and Notify Md if
symptoms occur - Administer tylenol
Leukocytosis, Thrombocytosis - Monitor CBC two times per week during treatment
Reduce dose or interrupt treatment for absolute neutrophil count
>20,000/mm, WBC > 50,000/mm or platelets >500,000/mm
H2 Receptor Antagonists
Suppresses gastric acids; used in gastric and peptic ulcers, GERD,
hypersecretory conditions such as Zollinger-Ellison syndrome
Used with conjunction with antibiotics to treat ulcers caused by H.pylori
Decreased libido- inform clients of the possible effects CNS effects
lethargy, depression, confusion. These effects are seen ore often in
and older adult with kidney or liver dysfunction, H2 receptors should
be avoided in older adults.
Beta Blocker

Used to treat: Atrial and Ventricular arrhythmias; HTN

Side Effects:
Bradycardia: Monitor pulse, hold under 60 BPM,
Use cautiously with clients who have DM. It can mask tachycardia (early sign of blood glucose)

Decreased Cardiac Output: Use cautiously with clients with heart failure. Educate and observe for signs of worsening heart failure (SOB, edema, fatigue)

Orthostatic HTN: Instruct clients to sit or lie down if experiencing dizziness. Instruct avoid sudden changes in position and get up slowly.

Unusual Sweating, Increased thirst

Chest Pain, SOB

Nursing Considerations:
Creatinine clearance should be obtained before dosing

First few doses given in the hospital to monitor reactions

Do not administer to patient with asthma or AV block

Digoxin and diuretics interact with this drug
Bile Acid Sequestrants
..., bind bile acid and the gi tract resulting in decreased absorption of cholesterol
..., fosamax, boneva, actonel, promotes calcium reabsorption, decreases calcium destruction, used to reverse osteoporosis
Treatment of Parkinson's disease.
Side effects: involuntary muscle movements, dizziness, N/V, anorexia, dry mouth, hepatotoxicity, darkening of urine or sweat
Monitor hepatic and renal function tests and CBC with differential.
Assess for signs of toxicity
Adjunctive management of primary hypercholesterolemia and mixed dyslipidemia.
Primary prevention of coronary heart disease.

angioneurotic edema
Avoid drinking more than 1 quart of grapefruit juice per day during therapy.
Notify health care provider if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
Avoid pregnancy or breast-feeding.
Control of hyperglycemia in diabetic patients
SE: hypoglycemia, anaphylaxis, erythema, pruritus, swelling

Assess for s/s of hypoglycemia (anxiety, restlessness, tingling in hands/feet/lips/tongue, chills, cold sweats, confusion, difficulty
concentrating, drowsiness)

Assess for s/s of hyperglycemia (confusion, drowsiness, flushed dry
skin, fruit-like breath odor, rapid deep breathing, polyuria, n/v

Lispro can be mixed w/ NPH insulin
-opioid antagonist
-treat opioid overdose, reversal of effects such as resp. depression
-S.E. and interventions
*tachycardia and tachyapnea- monitor heart rate and resp. function, have resuscitative equipment and O2
*abstinence syndrome- cramping, vomiting, HTN
*pulmonary edema- rales, use cautiosly in ct with hx of
*ct who are opioid dependent
-Nursing administration
*do not give orally
-Blocks MAO-A in brain, increase norepinephrine, serotonin, and dopamine, which intensifies response and relieves depression.
-Therapeutic use: atypical depression, bulimia nervosa, OCD
-S.E. and interventions
*CNS stimulant- advise pt. to observe for sx and notify PCP
*Ortho. hypotension- monitor BP and HR, hold med. for significant changes, change position slowly.
*Hypertensive crisis from intake of tyramine- administer phentolamine (Regitine) IV or nifedipine (Procardia) SL, provide cardiac monitoring and resp. support.
*avoid OTC decongestants and cold remedies
*avoid tyramine rich foods like:aged cheese, pepperoni, salami, bananas, smoked foos, beer, wine
*avoid caffiene
Uterine Stimulants-Oxytocics
-Ex. oxytocin (Pitocin, Syntocinon), methylergonovine (Methergine)
-Therapeutic use: induce labor (post-term, premature rupture, pre-eclampsia), deliver placenta, control postpartum bleeding, intranasal promotes milk letdown. Methergine is used for postpartum hemorrhage.
-Complications-uterine rupture (have mag. sulfate if needed), hypertensive crisis (monitor for sx, headache, n/v, increased BP)
-Avoid vasopressors can cause hypertension
-Nursing administration
*use an infusion pump, gradually increase flow rate, monitor uterine contractions, monitor v.s., monitor for uterine hyperstimulation, monitor fetal heart rate and rhythm
*Pediatric Immunization given IM at 2,4,6 and 15-18 months. Booster at
4-6 yrs.

*Contradictions: acute infection, immunosuppressive therapy,previous
CNS damage or convulsions.

*adverse reactions: redness, tenderness, induration at site, fever,
excessive crying, malaise, myalgia, uticaria, hypotension, neurologic
and allergic reactions.

*contradictions:angle-closure glaucoma, recent MI or heart failure.

*adverse reactions: lethargy, sedation, blurred vision, dry eyes, dry
mouth, arrhythmias, hypotension, constipation, sexual dysfunction.

*monitor mental status, assess for suicidal tendencies, may require
several weeks for effectiveness, may be given at bedtime due to
sedation effect, moisture eye drops, moisture mouth rinses or chew
gum, hard tack candy.

*ototoxicity, N/V, phlebitis

*assess signs of infection, administer as directed around the clock,
better absorbed on empty stomach, but may be taken with food to
prevent stomach upset, report signs of super infection, eat yogurt
..., a bronchodilator (trade names Ventolin or Proventil) used for asthma and emphysema and other lung conditions
Used to treat: edema r/t Congestive Heart failure, Edema r/t Nephrotic syndrome, or ascites r/t cirrhosis of the liver

Side Effects: Stomach upset (diarrhea, nausea, vomiting, cramps), Hyperkalemia, hyponatremia, dermatologic rash.

Nursing measures: check electrolytes (especially K & NA), monitor urine output and blood pressure, educate patient about signs and symptoms of hyperkalemia (parathesia, fatigue, muscle weakness, flaccid extremities, and bradycardia)
Alpha Adrenergic Antagonists
Used to treat: high blood pressure, enlarged prostate (BPH) ,circulatory conditions such as Raynaud's.

Side Effects: headache, pounding heartbeat, nausea, weakness, weight gain, and syncope.

Nursing measures: check blood pressure & pulse before administration, monitor or orthostatic hypotension (advise patient to rise slowly from a sitting or lying position), take medication at night to reduce side effects, do not abruptly discontinue (dose must be tapered to prevent rebound hypertension).
Calcium Channel Blockers
• Treats:
o angina/A Fib/HTN
• Side Effects:
o edema/constipation/dizziness/flu-like symptoms/pulmonary edema/MI
• Monitor:
o BP/reduction in s/s of angina/liver function
• Teaching:
o may cause edema/constipation/nausea/HA/s/s hypotension/don't abruptly d/c medication/avoid alcohol
Calcium gluconate
Treatment and prevention of hypocalcemia
Adjunct in the prevention of postmenopausal osteoporosis
Emergency treatment of hyperkalemia and hypermagnesemia
Adjunct in cardiac arrest or calcium channel blocking agent toxicity
Side Effects:
Cardiac arrest
*If giving IV push, administer medication over 5 minutes or longer. Push SLOWLY to prevent cardiac arrest and other cardiac issues (arrhythmias, bradycardia, etc.)
Monitor blood pressure, pulse, and ECG frequently throughout parenteral therapy.
Toxicity and Overdose: Assess patient for nausea, vomiting, anorexia, thirst, severe constipation, paralytic ileus, and bradycardia.
..., a drug (trade name Capoten) that blocks the formation of angiotensin in the kidneys resulting in vasodilation
Treatment for Heart Failure
• Digoxin:
o Side Effects: dysrhythmias/cardiotoxicity leading to bradycardia/anorexia/n/v/abdominal pain/fatigue/weakness/vision changes (diplopia/blurred vision)
o Prevention measures: monitor/maintain levels btw 3.5-5.0/monitor digoxin levels btw 0.5-2.0 s/s of hyperkalemia/monitor pulse/report changes in CNS/GI
o Monitoring: ECG/BP/HR/K/Mg/Ca/reduction in s/s of cardiac failure
o Teaching: may cause GI disturbances/HA/visual disturbances/cardiac dysrhythmias/report s/s of bradycardia/avoid antacids/don't d/c medication abruptly

• Loop diuretic:
o Side Effects: orthostatic hypotension/pancreatitis/agraulocytosis/loss of appetite/bladder spasms
o Prevention measures: may need to give K supplements/slow getting up
o Monitoring: edema/HTN/electrolytes/liver/kidney damage/hearing loss/ BUN/creatinine/ urinary retention
o Teaching: sun-sensitivity/may cause hyperglycemia/constipation/diarrhea/n/v/ vertigo/blurred vision/avoid alcohol
• Beta-Blockers:
o Side Effects: bradycardia/decreased cardiac output/AV block/orthostatic hypotension
o Monitoring: pulse/BP/observe for s/s of worsening heart failure
o Teaching: avoid sudden changes of position/rise slowly/monitor glucose if diabetic/monitor pulse
Therapeutic uses: • Phenytoin is effective against all major forms of epilepsy except absence seizures.
• Use IV route for status epilepticus.
• Phenytoin is an antidysrhythmic.
Side effects: Nursing considerations/actions: pg:163 ATI
CNS effects (nystagmus, sedation, ataxia, double
vision, cognitive impairment) • Monitor for symptoms and notify the provider
if symptoms occur.
Gingival hyperplasia (softening and overgrowth
of gum tissue, tenderness, and bleeding gums) • Advise clients to maintain good oral hygiene
(dental flossing, massaging gums).
Skin rash • Stop medication if rash develops.
Teratogenic (cleft palate, heart defects) • Avoid use in pregnancy.
Cardiovascular effects (dysrhythmias,
hypotension) • Administer at slow IV rate and in dilute
solution to prevent adverse CV effects.
Endocrine and other effects (coarsening of facial
features, hirsutism, and interference with vitamin
D metabolism) • Instruct clients to report changes.
• Encourage clients to consume adequate
amounts of calcium and vitamin D.

- Phenytoin are contraindicated in clients with sinus bradycardia, sinoatrial blocks, second- and third-degree AV block, or Stokes-Adams syndrome.

Medication/food interactions: Nursing interventions/client teaching: pg :165 ATI
Phenytoin causes a decrease in the effects of
oral contraceptives, warfarin (Coumadin), and
glucocorticoids because of the stimulation of
hepatic drug-metabolizing enzymes. • Dose of oral contraceptives may need to
be adjusted or an alternative form of birth
control used.
• Monitor for therapeutic effects of warfarin
and glucocorticoids. Dosages may need to
be adjusted.
Alcohol, diazepam (Valium), cimetidine (Tagamet),
and valproic acid increase phenytoin levels. • Advise clients to avoid alcohol use.
• Monitor serum levels.
Carbamazepine (Tegretol), phenobarbital, and
chronic alcohol use decrease phenytoin levels. • Encourage the client to avoid use of alcohol.
Additive CNS depressant effects can occur
with concurrent use of CNS depressants
(barbiturates, alcohol). • Advise clients to avoid concurrent use of
alcohol and other CNS depressants.

● Monitor therapeutic plasma levels. Be aware of therapeutic levels for medications prescribed. Notify the provider of results.
● Advise clients taking antiepileptic medications that treatment provides for control of seizures, not cure of disorder.
● Encourage clients to keep a seizure frequency diary to monitor effectiveness of therapy.
● Advise clients to take medications as prescribed and not to stop medications without consulting the provider. Sudden cessation of medication may trigger seizures.
● Advise clients to avoid hazardous activities (driving, operating heavy machinery) until seizures are fully controlled.
● Advise clients who are traveling to carry extra medication to avoid interruption of treatment in locations where their medication is not available.
● Advise clients of childbearing age to avoid pregnancy, because medications may cause birth defects and congenital abnormalities.
● Advise the client that phenytoin doses must be individualized. Dosing usually starts twice a day and can be switched to once a day dosing with an extended-release form when maintenance dose has been established.
● Advise clients that phenytoin has a narrow therapeutic range, and strict adherence to the medication regimen is imperative to prevent toxicity or therapeutic failure.
Action: Uterine stimulants increase the strength, frequency, and length of uterine contractions.
Therapeutic uses:
■ Induction of labor (postterm pregnancy, premature rupture of membranes, preeclampsia).
■ Enhancement of labor, such as with dysfunctional labor
■ Delivery of placenta (postpartum, miscarriage)
■ Control of postpartum bleeding
■ Fetal stress testing
■ Intranasal: Promotion of milk letdown.

Side effects: uterine rupture
Nursing intervention/client teaching: • Preassess client risk factors such as multiple deliveries.
• Monitor the length, strength, and duration of contractions.
• Have magnesium sulfate on standby if needed for relaxation of

Contraindications of Oxytocin:
- Maternal factors include sepsis, labor induction, a cervix that has not ripened, genital
herpes, history of multiple births, and/or uterine surgery).
- Fetal factors include immature lungs, cephalopelvic disproportion, fetal
malpresentation, prolapsed umbilical cord, fetal distress, and threatened spontaneous

Medication/drug interactions: nursing interventions/client teaching:
Vasopressors can lead to hypertension. • Avoid concurrent use of oxytocin and
• Monitor maternal blood pressure and
report hypertension to the primary care

- Prior to administering analgesic or anesthetic pain relief, the nurse should verify that laboris well established by performing a vaginal exam showing cervical dilation to be at least4 cm with the fetus engaged.
- Have naloxone (Narcan) available to counteract the effects of respiratory depression in the newborn.
- Administer antiemetics as prescribed.
- Monitor maternal vital signs, uterine contraction pattern, and continuous FHR monitoring.
- Explain to the client that the medication will cause drowsiness.
- Instruct the client to request assistance with ambulation.
..., 3.5 - 5.0 mEq/L, helps build protein; maintains fluids; helps nerves communicate; helps muscles contract
..., an antiviral drug (trade name Retrovir) used in the treatment of AIDS
..., wide variety of bacterial infections (e.g., middle ear, urine, respiratory and intestinal infections), Sulfamethoxazole + Trimethoprim
Oral contraceptives
..., pills that prevent pregnancy by stopping ovulation or by changing conditions in the uterus,
cholestasis, thrombosis, folate deficiency, hypertension, hepatic adenoma
Pancrelipase (Pancrease)
..., pancreatic enzyme

replacement therapy of lipase, protease, and amylase. dissolves in the alkaline duodenum and releases enzymes, which act locally and are not absorbed.

Powdered formulation s may be sprinkled on food.

Adverse effects: uncommon as enzymes are not absorbed. nausea, vomiting, and diarrhea.

do not give with allergies to drug or pork products. do not give delayed release with acute pancreatitis.

Overdose- treat symptoms of hyperuricemia
Phenazopyridine HCL (Pyridium)
..., Prototype for Urinary analgesics; relieves burning, pain, frequency, urgency of lower UTI, sidefx: gi disturbances, hemolytic anemia, urine turns reddish orange
ACE Inhibitors
Enalapril (Vasotec), Enalarilat (Vasotec IV), captopril (capoten), Fosinopril (Monopril), Lisinopril (Prinivil), Ramipril (Altace)
Used to treat: Hypertension, Heart Failure, Myocardial infarction, nephropathy, and patients at risk for a cardiovascular event.
Side Effects:
Orthostatic hypotension
Rash and dysgeusia (alt. taste)
Take with or without food except catopril taken at least 1 hour before meals
Treat herpes simplex and varicella-zoster viruses
Side effects:
Phlebitis and inflammation at infusion site
Mild discomfort with oral therapy (nausea, headache, diarrhea)
Advise to refrain from sexual contact while lesions are present
Beta Blockers
Metoprolol (Lopressor), Atenolol (Tenormin), Metoprolol succinate (Toprol XL), Esmolol HCL (Brevibloc), propranolol (Inderal), Nadolo (Corgard), Labetalol (Normodyne)

Used to treat:
Primary hypertension
Angina/heart failure, myocardial infarction, tachydysrhythmias
Hyperthyroidism, migraines, stage fright glaucoma, and pheochromocytoma

Side effects
Decreased CO
AV block
Orthostatic hypotension
Rebound myocardium excitation
..., Megakaryocyte growth factor, used in thrombocytopenia after cancer chemotherapy.
-used to treat tuberculosis (TB)
-prevention in people who have had contact with TB (taken usually 6-12 months,PO).
Peripheral neuritis
Optic neuritis
..., Accutane,
Multiple abnormalities involving the CNS, cranium, face cardiovascular system, thymus gland
Retinoid,vit A derivative, acne.
Tetanus booster
..., -Artificial Active Acquired Immuntiy
-Booster is to restimulate the T and B memory cells
Bone resoption inhibitor
treat/prevent osteoporosis
Contra-renal insufficiency, ob lactation
SE- headache
Adim in a.m. w/8oz plain water alone
Used for: Anitbiotic to treat severe or serious bacterial infection.

Side effects: Stop taking if have allergic reaction, little or no urine, decreased hearing or ringing in ears, numbness, skin tingling, muscle twitching, seizures, severe watery diarrhea.

Monitor: Nephrotoxic obtain baseline renal studies & regular during therapy
Neurotoxic- blood levels monitor.
Teaching: Drink 2L fluids a day if not contraindicated, do not take with other OTC drugs incl. vitamins, minerals, & herbals before consulting Dr.
Used for: prevent imflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree. Promote bronchodialtion

Side effects: Dry mouth
precautions: pregnancy risk; contraindicated in clients with peanut allergy, use cautiously with clients who have narrow angle glaucooma and benign prostatic hypertrophy(due to anticholinergic effects).

Teaching: Rinse mouth after inhalation to decrease unpleasant taste.; usual adult dosage two puffs-instruct client to wait the length of time directed between puffs.
Administer useing and MDI device or nebulizer. When prescribed with an inhaled beta 2-agonist advise client to inhale the beta 2 before inhaling the glucocorticoid wait 5 minutes between medications.
..., omeprazole/proton pump inhibitor/ GERD duodenal ulcers
Procainamide (Pronestyl)

Procainamide is used to treat many different ventricular and atrial
heart issues to help keep the heart in a normal rhythm.

Major Side Effects: Seizures, Asystole (Lack of cardiac activity),
Ventricular Arrhythmias.

Nursing Care: Monitor ECG, pulse, and blood pressure continuously
throughout IV therapy. Monitor CBC during the first three months of
therapy. Monitor Liver function during therapy.
..., a cholinergic drug (trade name Prostigmin) used to treat some ophthalmic conditions and to treat myasthenia gravis
Nonopioid Analgesics
What the medication is used to treat: inflammation, fever reduction, mild to moderate pain, dysmenorrhea, low level suppression of platelet aggregation

Side effects that could cause significant harm that are specific to that medication and any prevention measures that the nurse must address: GI upset, renal dysfunction, salicylism, Reye syndrome

Nursing considerations to include monitoring, teaching and administration if significant for that medication: stop 1 week before elective surgery, take with food or milk to reduce gastric discomfort
Nonselective Beta Adrenergic Blockers
What the medication is used to treat: chest pain, htn, cardiac dysrhythmias, MI, heart failure

Side effects that could cause significant harm that are specific to that medication and any prevention measures that the nurse must address: bronchoconstriction, inhibition of glycogenolysis that can mask s/s low blood glucose

Nursing considerations to include monitoring, teaching and administration if significant for that medication: monitor bp, hr
Opioid Agonists and Antagonists
..., Morphine
Morphine congeners: codeine and oxycodone (partial agonists), heroin
Merperidine-like drugs: merperidine, diphenoxylate, fentanyl citrate, remifentanyl
Agonist-antagoinsts: pentazocaine, buprenorphine

Antagonists: naloxone, naltrexone, methylnaltrexone
..., medications that are used in depression and anxiety disorders; they increase the level of serotonin without the side effects of MAOIs; Prozac is an example.
..., agents that lower cholesterol in the blood by inhibiting the effect of HMG-CoA reductase, a liver enzyme responsible for producing cholesterol
..., This drug is used for thyroid supplementation in hyperthyroidism. Treatment or suppression of goiters & thyroid cancer. Replaces or supplements thyroid hormones. Increases metabolic rate of body tissues. Promotes gluconeogenesis. Increases utilization and mobilization of glycogen stores. Stimulates protein syntheses. Promotes cell growth & differentiation. Aids in development of brain and CNS.
Active duodenal ulcers and benign gastric ulcers and management of GERD
Side effects that could cause significant harm that are specific to that medication and prevention measures:
Headaches, constipation, diarrhea, nausea, agranulocytosis and anemia
Nursing consideration to include monitoring, teaching and administration if significant for that medication:
Assess for abdominal pain and occult blood in the stools.
Monitor CBC with Diff
Instruct the patient to take medication exactly as directed. Smoking interferes with action of histamine antagonists. Avoid alcohol and increase fluid and fiber intake. Report black/tarry stools to doctor immediately.
Mild to Moderate Hyperkalemia
Side effects: constipation, fecal impaction, hypokalemia, hypocalcemia, sodium retention
Labs: monitor serum potassium daily
Monitor: Intake, Output & daily weight. Assess for fluid overload (dyspnea, rales/crackles, JVD, peripheral edema)
Loop Diuretic-Edema due to HF, Hepatic impairment, Renal disease or HTN
Side Effects: Dehydration, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis
Assess fluid status: daily weight, Intake & output
Monitor signs of dehydration: dry mouth, increase thirst, minimal urine output & weight loss
Monitor Electrolytes-cardiac status & potassium levels. Report to M.D potassium <3.5.
Teach consume high potassium foods s/a bananas or potatoes. S/S hypokalemia N/V & generalized weakness.
Monitor BP (teach pt to sit or lie down if lightheadness or dizziness occur) Avoid sudden changes of position.
Leukotriene Receptor Inhibitors
..., Lower Respiratory (Anti-inflammatories)
Action: reduce inflammatory process and decrease bronchoconstriction
Use: prophylactic and maintenance for chronic asthma
Side effects: dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis
Prophylaxis and treatment of venous thrombosis, pulmonary embolism, A-fib
Side effects that could cause significant harm that are specific to that medication and prevention measures:
Nursing considerations to include monitoring, teaching and administration if significant for that medication:
Assess for signs of bleeding and hemorrhage
Lab test: PT, INR. Therapeutic INR ranges 1.3-1.5 times greater than control. Monitor CBC with Diff and urine and stool for blood.
Instruct the patient to take medication exactly as directed. Review foods high in vitamin K (limit intake of these foods) avoid anything that may cause patient to bleed (such as shaving with a razor). Report symptoms of unusual bruising or bleeding to doctor immediately
Ferrous Sulfate
..., This drug is given for Iron Deficiency Anemia. Do not give with food or milk because they interfere with iron absorption. Giving it with orange juice or vitamin C-rich drinks increases iron absorption.
..., It is used for intra-abdominal and Gynecological infections. It is administered by orally and IV. It works by interfering with DNA synthesis within the cell. Anti-convulsive (Dilantin and Phenobarbital) medication can reduce this drugs effect. It has to be given at certain times to have this effect,
Folic Acid
..., A B-complex vitamin found in many vegetables, beans, fruits, whole grains, and some fortified breakfast cereals and it helps prevent birth defects
Anti ulcer, GI protectant
Dizziness, drowsiness, constipation
Stand up slowly, don't operate machinery/cars before you know how you
will respond to drug, increase fiber in diet
Assess for occult blood in stool
Administer on empty stomach
If antacids are taken as well, administer 30 minutes before or after meals
Cardiac Glycosides
Treats heart failure, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia
Monitor for:
Arrhythmias, bradycardia, anorexia, nausea, vomiting, digoxin toxicity
Monitor apical pulse before administration
Monitor renal and hepatic function
Monitor potassium because hypokalemia can cause digoxin toxicity
Monitor digoxin levels.
Therapeutic range is 0.5-2ng/mL
Monitor for signs of toxicity: abdominal pain, nausea, vomiting, visual disturbances, bradycardia, other arrhythmias
Chemotherapy Agents: Side Effects
Pain-take pain medications as prescribe, meditation, relaxation strategies, rest

diarrhea - eat low fiber foods, avoid greasy foods and strong spices

constipation - increase fiber in diet, stool softeners and laxatives

mouth sores - prescribed mouth rinses, pain medications, avoid infections

hair loss - purchase wig and start wearing before hair loss occurs to get used to wearing it

nausea and vomiting - take antiemetic medications

neutropenia - have WBC levels monitored, avoid crowds and those with
infections or illness, MD may prescribe prophylactic antibiotics or
neupogen to stimulate WBC production

anemia - increase iron and folic acid in diet, eat iron rich foods such as red meats, dark, leafy, vegetables, egg yolks, dried fruit,
beans; patient may need blood transfusion or MD may prescribe

thrombocytopenia - patient may need transfusion of platelets, use soft
bristle toothbrush, use electric razor, blow nose gently
Antidiabetic - Management of Type 2 Diabetes
S/E: Lactic acidosis
Assess renal function before initiating and at least annually during therapy
Anesthetics, Antianxiety, sedative, hypnotic -Benzodiazepine
Respiratory Depression
Drowsiness or dizziness may be experienced for 24 hrs after administration
Monitor: BP, pulse, respiration continuously during IV administration
Oxygen should be given by nasal cannula
Resuscitative equipment should be immediately available
2 practitioners should check dose
Antidote: Flumazenil (Romazicon)
..., Produces antibodies that provide active immunity, prevents childhood infectious diseases, Childhood series
the process of inducing immunity
by administering an antigen to allow the immune
system to prevent infection or illness when it
subsequently encounters the same pathogen
Hep A and B
IPV (polio)
Geriatric: pneumococcal, influenza, varicella zoster (shingles), Tdap,
..., beta blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors), and other conditions. It is used after a heart attack to improve the chance of survival/nitrate
..., antiasthamatic; allergy, cold and cough remedy; mast cell stabilizer
For: treatment and prevention of osteoporosis
decreased risk of breast cancer
decrease plasma levels of cholesterol

S/E: increased risk for PE and DVT
hot flashes

Interventions: stop medication prior to immobilization, resume when
fully mobile
discourage long periods of inactivity
inform pt. med may exacerbate hot flashes

Considerations: medication is a pregnancy risk category
contradicted in pts. with history of venous thrombosis
consume adequate calcium and vit.D
bone density q12-18 months
monitor serum calcium (9.0-10.5 mg/dl)
monitor liver functions
encourage weight-bearing exercises daily (walking)
Moderate to severe pain.
SE- confusion,sedation,weakness, dizziness,restlessness, apnea.
Avoid in pts on maoi within 14 DAYS
Assess bp, pulse,resp,prior and during admin
Used to treat--Venous thrombosis, prevention of MI
Nursing considerations--monitor VS, monitor INR...want to keep between
2 and 3, monitor liver enzymes, monitor for signs of bleeding ,
vitamin k for overdose, takes 3-5 days to have therapeutic effect
Used to treat-- vitamin b deficiency, megoblastic anemia related to
vitamin b12 deficiency
SE-- hypokalemia secondary to the increased rbc production efforts of
vitamin b12
Nursing consider-- monitor clients potassium levels during start of
treatment, observe for findings of potassium deficiency, client may
require potassium supplements.
Used to treat--is a DMARD, rheumatoid arthritis, prevent rejection reactions
SE--infection,hepatotoxicity, nephrotoxicity,seizure
Nursing considerations--monitor for signs of infection, monitor liver
function, monitor bun and creatinine, I&O
Medication Use: Cytotec is an antiulcer agent used to treat duodenal ulcers.
Side Effects: abdominal pain, diarrhea, miscarriage.
Nursing Considerations:
Assess women of childbearing age of pregnancy (can be started on 2nd or 3rd day of menstrual period following a negative pregnancy test)
Assess pt.'s routinely for epigastric or abdominal pain and for frank or occult blood in the stool, emesis or gastric aspirate.
Be sure to teach women of childbearing age the risk for miscarriage. Do not confuse Cytotec with Cytoxin.
Cytotoxic Medications
Cytoxic medications are chemotherapy agents used to kill fast growing cancer cells, as well as healthy cells including skin, hair, intestinal mucosa, and hematopoietic cells.
Antimetabolites : kills cancer cells by interrupting the specific cell phase of cell production
(Methotrexate, Cytarabine, Mercaptopurine)
Alkylating agents: Kills cancer cells by altering DNA structure and preventing reproduction
(Cyclophosphamide, Carmustine, Cisplan)
Antitoumor antibiotics : Kills cancer cells by stopping the synthesis of RNA, DNA or proteins
(Doxorubicin, Danctinomycin)
Topoisomerase inhibitors: Kills cancer cells by interrupting DNA synthesis
Antimitotics: Kills cancer cells by inhibiting mitosis and preventing cell division
(Vincristine, Vinblastine, Paclitaxel)
Other: kills cells by various mechanisms including interrupting DNA and RN synthesis in leukemia cells
** Remember these meds have chemo side effects. (hair loss, nausea, fatigue.. etc.)
Nursing Considerations:
Reduce dosage in patients who have renal disease
Advise clients to avoid alcohol
Monitor CBC and liver enzymes
Monitor for jaundice, dark urine or clay colored stools
** I would suggest reading through ATI chapter 42, page 529 and also reviewing notes from our cancer 202 lecture..this is a very extensive class of medications, each has their own side effects and teachings.
Medication use: this medication is used for correction of hormone deficiency (testosterone deficiency) in male hypogonadism, initiation of male puberty and suppression of tumor growth in some forms of breast cancer.
Side Effects:
Deepening of voice
Women: change in libido, clitorial enlargement, decrease in breast size
Men: acne, facial hair, gynecomastia, erectile dysfunction, oligospermia, priapism
Chronic skin irritation
Nursing considerations:
Advise patients to report immediately:
In Men: Priapism (painful sustained erections) difficulty urinating
In Women: Virilism, hypercalcemia (nausea, vomiting and weakness)
In male and female: weight gain , swelling of hands or feet, yellowing of skin or unusual bruising or bleeding.
- Opioid analgesics are used to treat moderate to severe pain
- SIDE EFFECTS -Respiratory depression - monitor pt vital signs, stop opioid use if respiratory rate is less than 12/min
- Constipation- increase fluids and physical activity, administer laxative
- Orthostatic Hypotension- advise client to sit or lay down slowly, avoid sudden changes in position
- Urinary Retention- advise clients to void every 4 hrs, monitor I and O
- Sedation- advise clients to avoid hazardous activities such as driving
- Contraindicated for clients with renal failure because of the accumulation of noremeperidine which can result in seizures and neurotoxicity
- Assess the clients pain level, double check the dose, always check the pt respiratory rate if less than 12/min do not give and call the Dr.
- Mood stabilizing antiepileptic (AEDs)
- Change in appetite; constipation; diarrhea; dizziness; drowsiness; hair loss; headache; indigestion; nausea; stomach cramps or pain; trouble sleeping; vomiting; weakness; weight changes.
- Don't give to liver disorder patients
- Monitor phenytoin and Phenobarbital levels
- Monitor Thrombolytic count, amylase level and liver function test
- Treatment of heart failure, dysrhythmias
- Dysrhythmias, cardiotoxicity leading to bradycardia, GI affects (N/V, abdominal pain) CNS effects (fatigue, vision changes, yellow-green or white halos around objects)
- If missed dose do not double up on dose
- Monitor Dig levels therapeutic levels (0.5 to 2.0)
- Avoid taking OTC medications
- Monitor for dig toxicity (anorexia, fatigue, weakness)
- Monitor K+ levels for less the 3.5 administer potassium
- Treat bradycardia with atropine
For: anemia r/t chronic renal failure
anemia secondary to AZT therapy in clients with HIV, chemotherapy,
and elective surgery

S/E: HTN secondary to elevated hematocrit
increased risk for cardiovascular event (MI, stroke, cardiac arrest) if
Hgb above 12g/dl or more than 1g in 2 weeks

Interventions: H&H and BP, and if elevated, administer antihypertensives
decrease dosage when limits are reached

Considerations: obtain baseline BP
SubQ or IV bolus - do not agitate or mix with other meds
monitor iron levels
dosing is usually 3x's weekly (but can be weekly or monthly)
Morphine sulfate
Action: (opioid analgesic): act on the mu receptors, and to a lesser degree on kappa receptors. Activation of mu receptors produces analgesia, respiratory depression, euphoria, and sedation, whereas kappa receptor activation produces analgesia, sedation, and decreased GI motility.
Therapeutic uses: - Relief of moderate to severe pain (postoperative, myocardial infarction, cancer)
- Sedation
- Reduction of bowel motility

Side effects: Nursing intervention/client teaching:
Respiratory depression • Monitor the client's vital signs.
• Stop opioids if the client's respiratory rate is less than 12/
min, and then notify the provider.
• Have naloxone (Narcan) and resuscitation equipment
• Avoid the use of opioids with CNS depressant medications
(barbiturates, benzodiazepines, and consumption of alcohol).
Constipation • Increased fluid intake and physical activity.
• Administer a stimulant laxative, such as bisacodyl (Dulcolax),
to counteract decreased bowel motility, or a stool softener,
such as docusate sodium (Colace), to prevent constipation.
Orthostatic hypotension • Advise clients to sit or lie down if symptoms of
lightheadedness or dizziness occur.
• Avoid sudden changes in position by slowly moving clients
from a lying to a sitting or standing position.
• Provide assistance with ambulation as needed.
Urinary retention • Advise clients to void every 4 hr.
• Monitor I&O.
• Assess the client's bladder for distention by palpating the
lower abdomen area every 4 to 6 hr.
Cough suppression • Advise clients to cough at regular intervals to prevent
accumulation of secretions in the airway.
• Auscultate the client's lungs for crackles, and instruct clients
to increase intake of fluid to liquefy secretions.
Sedation • Advise clients to avoid hazardous activities such as driving
or operating heavy machinery.
Biliary colic • Avoid giving morphine to clients who have a history of
biliary colic. Use meperidine as an alternative.
Emesis • Administer an antiemetic such as promethazine (Phenergan).
Opioid overdose triad of
coma, respiratory depression,
and pinpoint pupils • Monitor the client's vital signs.
• Provide mechanical ventilation.
• Administer opioid antagonists, such as naloxone (Narcan) or nalmefene (Revex).

- Morphine is contraindicated after biliary tract surgery.
- Morphine is contraindicated for premature infants during and after delivery because of respiratory depressant effects.
- Meperidine is contraindicated for clients with renal failure because of the accumulation of normeperidine, which can result in seizures and neurotoxicity.
- Use cautiously with:
* Clients who have asthma, emphysema, and/or head injuries; infants, and older adult clients (risk of respiratory depression)
* Clients who are pregnant (risk of physical dependence of the fetus)
* Clients in labor (risk of respiratory depression in the newborn and inhibition of labor by decreasing uterine contractions)
* Clients who are extremely obese (greater risk for prolonged side effects because of the accumulation of medication that is metabolized at a slower rate)
* Clients with inflammatory bowel disease (risk of megacolon or paralytic ileus)
* Clients with an enlarged prostate (risk of acute urinary retention)
* Clients with hepatic or renal disease
-do not use antihypertensives with morphine as it will increase risk of respiratory distress
Antiulcer agent(H2 Agonist)

Pepcid is used to coat the stomach and protect it from any duodenal
ulcers or benign gastric ulcers.

Major Side Effects: Arrhythmias, Anemia, nausea, confusion, and constipation.

Nursing Care: Monitor for epigasric and abdominal pain, occult blood
in the stool, emesis, and gastric aspirate. Monitor CBC during drug