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Nursing 204 Pharmacology Review

Terms in this set (127)

parenteral anticoagulant

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

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
minutes.

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
levels.
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.
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
Myometrium.

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
abortion.

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


- 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.
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
available.
• 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).

Contraindications/Precautions:
- 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