excretion renal excretion, drugs affecting elimination of other drugs, blood concentration levels...

EXCRETIONrenal excretion, drugs affecting elimination of other

drugs, blood concentration levels

DISTRIBUTION plasma-protein binding, volume of distribution,

barriers (blood- brain and placental), obesity and receptor combination

METABOLISMoral medicines, age, nutrition

and hormones

II. GENERAL PRINCIPLES OF

DRUG ADMINISTRATION

& SAFETY GUIDELINES

GIVING MEDICATIONS

General Principles of Drug Administration and Safety Guidelines Giving Medications

1.Confirm client diagnosis and appropriateness of medicines

2.Identify all concurrent medicines and any potential C/I and allergies

3.Research drug compatibilities, action, purpose, route, C/I, S/E

4.Calculate dosage accurately especially for pediatric clients

5.Check for expiration date of medicines

6.Confirm client’s identity 7.Provide client teachings8.Stay with client until medicines is gone; do not

leave at bedside9.After giving medicines, leave client in position

of comfort10.Give medicines within 30 minutes of

prescribed time

General Principles of Drug Administration and Safety Guidelines Giving Medications

General Principles of Drug Administration and Safety Guidelines Giving Medications 11. To ensure safety do not give a medication

that someone else prepared12. Know the policies of your office regarding

the administration of medication.13. Give only the medication(s) that the

physician has order in writing. Do not accept verbal order.

14. Check with the physician if you have any doubt about a medication or an order.

15. Avoid conversations or other distractions while drawing up and administering medication. It is important to remain attentive during this task.

General Principles of Drug Administration and Safety Guidelines Giving Medications 16. Work in quiet, well lighted area.17. Check the label when taking the

medication from the shelf, when pouring it, and when replacing it on the shelf. This is known as the “three checks” for safe medication administration.

18. Place the order and the medication side by side to compare its accuracy.

19. Check strengths of the medication (eg. 250 mg versus 500 mg) and the routes (eg. ophthalmic, otic, topical).

20. Read labels carefully. Do not scan labels or orders.

General Principles of Drug Administration and Safety Guidelines Giving Medications 21. Check the patient’s chart for allergies to components of the medication.22. Check the medication’s expiration date.23. Be alert for color changes, precipitation, odor, or any indication that the medication’s properties have changed (especially insulin, nitroglycerin & phenytoin). 24. Measure exactly; there should be no bubbles.25. Have sharps containers as close to the area of use as possible.

General Principles of Drug Administration and Safety Guidelines Giving Medications 26. Put on gloves for all procedures that might

result in contact with blood or body fluids.27. Stay with the patient while oral medication is

being taken. Watch for any reaction and record the patient’s response.

28. Never return a medication to the container.29. Never recap, bend, or break a used

needle.30. Never give a medication poured or drawn up by

someone else.31. Never leave the medication cabinet unlocked

when not in use.32. Never give the keys of the medication cabinet

to an unauthorized person. Limit access to the medication cabinet by limiting access to the cabinet keys.

Even if you are extremely careful, you may make an error when administering a medication. It is imperative that you report the error to the physician and that intervention measures start immediately. The error and all corrective actions must be documented thoroughly on the patient’s chart. An incident report must be completed for the error and filed in the patient’s chart as verification that all possible precautions were taken for the patient.

Errors made in charting medications must be corrected using a standard procedure. If you discover a charting error, mark it with one line. Then mark the correction above the error and sign it.

THERAPEUTIC SERUM MEDICATION LEVEL

Acetaminophen 10 – 20 ug/mlCarbamazepine 5 – 12 ug/mlDigoxin 5 – 2 ng/mlGentamycin 5 – 10 ug/mlLithium 5 – 1.3 mEq/LMagnesium SO4 4 – 7 mg/dlPhenytoin 10 – 20 ug/mlTheophylline 10 – 20 ug/ml

Right ClientRight DrugRight DoseRight RouteRight Time

Right DocumentationRight Drug Preparation and Administration

1. Assess oral cavity and ability to swallow medicines2. Enteric-coated medicines must not be crushed. Only scored

tablets can be broken3. Do not administer alcohol-based products like elixirs to alcohol

dependent persons4. Have patients swallow medicines except for sublingual and

buccal route. Do not allow fluids 30 minutes after giving medicines. Give iron preparation using straw to prevent teeth staining.

5. When giving medicines via NGT, do not mix with food. Give before or after meals and flush tubing with 30 ml of H2O. Check for tube patency before giving medications.

IV. GENERAL CONSIDERATIONS FOR ORAL MEDICINES

• Select appropriate needle size and syringe for ID, SQ, IM ROUTES• Use tuberculin syringe for medicines less than 1 ml• Draw up air equal to amount of medicines needed• Inject air to vial to prevent negative pressure and aid in aspirating

medicines• Ampule: place needle into ampule to draw medicines and use filter

needle to avoid glass shards• Select and rotate sites avoiding bruised or tender areas• Insert needle quickly with bevel side up. Aspirate to check for blood

except heparin. If blood is present, remove needle and start again. For giving IV medicines, blood return is desired

• Apply gentle pressure after giving injections except for heparin and Z-track.

V. GENERAL CONSIDERATIONS FOR PARENTERAL MEDICINES

a. Use 25g to 27g, ½ to 1 inch needleb. Maximum volume of 1.5 mlc. Pinch skin to form SC fold and insert at 45 degrees in thigh or arm and 90 degrees in

abdomend. Possible sites: lateral aspect of upper arm,

anterior thigh, abdomen…1 inch from umbilicus and scapular area

EXAMPLES: Heparin,

Insulin, MMR,

Enoxaparin (Lovenox)

a. Use 26g to 27g, 1" needle on a 1 ml or tuberculin syringe (vol. approximately 0.1 ml)

b. Insert needle at 10-15 angle with 1-2 mm depth with needle bevel upward

c. When wheal appears, do not massage, mark

d. Possible sites: ventral forearm, scapula, upper chest

EXAMPLES: BCG,

PPD (Purified Protein Derivative)/ Mantoux test

a. Use 18 g to 23 g, 1-2 inch needle, maximum volume is 5mlb. Stretch skin tautc. Insert at 90 degrees angle. 45 degrees for infants and childrend. Possible sites: gluteus medius (ventrogluteal and dorsogluteal, vastus lateralis (anterior thigh), rectus femoris (medial thigh) and deltoide. For Z-track: 20-22 g, 2-3 inches long with a different needle to draw medicines; draw skin laterally with non-dominant hand to ensure that medicines enter muscle; wait 10 sections before removing injection; do not massage to lock irritating substances in placeEXAMPLES: Vit.K, Hep. B, DPT, Iron dextran (Z-track)

a. Check site for complications (redness, swelling, tenderness)b. Check blood returnc. Prepare medicines according to manufacturer’s specificationsd. Prepare tubing according to requirement: micro or macro tubinge. Change tubing and dress site every 24-72 days depending on hospital policy and label appropriatelyf. Never hang solutions more than 24 hours g. Use syringe infusers and infusion pumps EXAMPLES: vancomycin (Vancocin), amphoterecin B, cisplatin (Platinol), fluorouracil (5-FU), Oxytocin, Mannitol

a. Monitor the risk for fluid overload especially in patients with respiratory, cardiac, renal and liver diseases. Elderly clients and very young clients cannot tolerate excessive fluid volumeb. Clients with CHF cannot tolerate solutions containing sodiumc. Clients with diabetes mellitus does not typically receive dextrose (glucose) solutionsd. Lactated Ringer’s Solution contain potassium and should not be given to clients with renal failure

A. INFECTION

• LOCAL: redness, swelling and drainage at site• SYSTEMIC: fever, chills, HA, tachycardia, malaise

The longer the site, the higher the riskAt risk are HIV/Aids patients and those

receiving chemotherapyAssess for the S/Sx of infection, maintain strict

asepsis in IV site care, monitor WBC, check the integrity of solutions, change tubings and dressings q 24-72 hrs, prepare to obtain blood culture from venipuncture device

B. PHLEBITIS/THROMBOPHLEBITIS

• PHLEBITIS: Redness, heat and tenderness at site, sluggish IV

• THROMBOPHLEBITIS: Hard and cordlike vein Use IV cannula smaller than vein

Avoid lower extremities and areas of flexion as the site

C. INFILTRATION

• Edema, pain and coolness at the site d/t seepage of IV fluid outside vein and into the interstitial space;

• May or may not have blood return

Caused when devise dislodged or perforates vein or when vein backs up pressure d/t venospasm

Infiltrated if no backflow of blood upon lowering fluid container or after occluding the vein proximal to site and IV continues to flow

Remove infiltrated IV, elevate extremity and apply cold or warm compress based on MD’s order

D. CIRCULATORY OVERLOAD

• Increased BP, distended jugular veins, rapid breathing dyspnea, moist cough and crackles

Use infusion pump esp. for clients at risk of overload and time tape

If it occurs, KVO rate, elevate head of bed, assess for edema and inform MDIf these occurs, remove and restart in opposite extremity apply warm and moist compress; inform doctor

E. AIR EMBOLISM

• Increased BP, distended jugular veins, rapid breathing dyspnea, moist cough and crackles

Occurs when air bolus enters vein through inadequately primed IV line, from loose connection, tubing change and IV removal

If S/Sx occur, clamp the tubing, turn the patient on the left side with the head lowered (Trendelenburg position) to trap area in the right atrium, call MD right away

VI. CONSIDERATIONS IN GIVING

OPTHALMIC MEDICINES1. Have patient lie on back or sit with head turned to the affected side to facilitate gravitational flow.2. Cleanse eyelids and eyelashes with sterile gauze pads soaked with physiologic saline.3. Keep eye open by pulling down on cheekbone with thumb and pointer finger to expose lower conjunctiva.4. Place the necessary drops near the outer canthus and away from cornea.5. If using ointment, squeeze into lower conjunctiva and move from inner to outer canthus. Do not touch tip to the eye and twist tube to break medication stream.

VI. CONSIDERATIONS IN GIVING

OPTHALMIC MEDICINES

6. Let patient blink 2-3 times7. Press on nasolacrimal glands (to prevent systemic

absortion, a perfect example is atropinr sulfate)8. Wipe excess medicines starting from inner canthus9. Droppers and ointments are for individual clients and

never shared.

VII. CONSIDERATIONS IN GIVING

OTIC MEDICINES1. Clean outer ear using wet gauze pad.2. Straighten ear canal:

Pull pinna up and back for adults

Pull pinna down and back for children under 33. Instill necessary number of drops along side of canal

without touching ear with dropper. Maintain ear position until medicines has totally entered canal

4. Have client remain on side for 5-10 minutes to allow medicines to reach to reach inner ear.

VIII. CONSIDERATIONS IN GIVING

TOPICAL MEDICINES1. Cleanse area to remove old medicines using gauze with

soap and warm water2. Spread medication evenly and thinly wearing gloves if the

skin is broken3. When applying nitroglycerin ointment, take the client’s BP

5 minutes before and after application4. Wash hands after applying to prevent self-absorption5. For transderm patches, wear gloves to prevent self

absorption and place in an area with little hair. Press down edges to secure patch

IX. CONSIDERATIONS IN GIVING

VAGINAL MEDICINES

1. Let client void2. Drape to provide privacy and wear gloves3. Place client on bedpan in a dorsal recumbent position with

hips and knees flexed4. Cleanse perineum with warm, soapy water working from

inner to outer

IX. CONSIDERATIONS IN GIVING

VAGINAL MEDICINES

5. Moisten suppository with water-soluble lubricant6. Separate labia and insert 2 inches…angled downward and

backward7. Provide pillow under buttocks and let patient remain in that

position for 15-20 minutes (no sphincter to hold suppository in place)

8. Provide with pads

X. CONSIDERATIONS IN GIVING

RECTAL MEDICINES1. Check patient’s bowel function/ability to retain the enema

or suppository2. Store suppositories in the refrigerator3. Provide privacy and position client left laterally4. Don gloves and moisten suppository with water-soluble

lubricant5. Insert suppository tapered end 1st and insert 2 inches to

pass the internal sphincter6. Hold buttocks together.7. Encourage patient to retain:

Suppositories for 10-20 minutesEnema for 20-30 minutes

XI. NEUROLOGIC MEDICINES

Nervous System

CNS PNS

Brain Spinal Cord Somatic Automatic

Adrenergic1. Alpha2. Beta

Cholinergic


1. ANALGESICSA. Narcotic Analgesics

Actions: Combines with opiate receptors in CNS. Reduces stimuli from sensory nerve endings; pain threshold is increased.

DON’T GIVE TO PATIENT’S WITH: Alcoholism, respiratory, renal or hepatic disease, increased intracranial pressure, severe heart disease.

AVOID MIXING WITH THIS DRUGS: Alcohol and/ or CNS depressants, barbiturates, anxiolytics, any products with alcohol. MAOIs may result in a fatal reaction.


1. ANALGESICSA. Narcotic Analgesics

Interventions: Monitor RR, bowel sounds, VS, and pain for type location, intensity, and duration. Dilute and administer IV solution slowly to prevent CNS depression and possible cardiac arrest. Hold medication if respirations <12/min. with the adult or <20/min. with the child. Have Narcan available.

Education: No ambulating without assistance; no driving. Instruct to take before pain is too severe. Dependence on drug is not likely for short –term medical needs. Do not abruptly withdraw medication.

#1. Respiratory Depression (check the respiratory rate first!)

#2. Orthostatic Hypotension (check the blood pressure before

and after taking the drug)

#3. Constipation decreases peristalsis)

MAJOR SIDE EFFECTS OF NARCOTICS (this is according to prioritization):

MORPHINE-LIKE DERIVATIVES

Morphine (roxanol)- the best drug for MINEVER GIVE TO PANCREATITIS AND

CHOLELITHIASIS because it will contract the SPHINCTER of ODDI.

= Codeine (Codeine SO4) & Hydrocodone (hycodan) COMMONLY USED AS AN ANTI-TUSSIVE (cough suppressant)

= Levorphanol (Levodromoran)

MEPERIDINE-LIKE DERIVATIVES

• Meperidine (Demerol) never give to patients with increase ICP. It masks the symptoms of respiratory depression!

• Fentanyl (Sublimaze)

METHADONE-LIKE DERIVATIVES

• Methadone( Dolophine) the #1 preferred drug of choice for heroin withdrawal. Propoxyphene (Darvon) contains aspirin NEVER give to hemorrhagic shock.

a. Others Narcotics:Code: morphone/ codone

hydrocodone (Hycodan); hydromorphone (Dilaudid);oxycodone (Roxicodone); oxymorphone (Numorphan);

Others: Dezocine (Dalgan); fentanyl (Sublimaze), levomethadyl (ORLAAM); levorphanol (Levo-Dromoran); remifentanil (Ultiva); sufentanil (Sufenta). Butorphanol Tartrate (Stadol), Nalbuphine, Pentazocine

b. Narcotic Antagonists (Antidote for Narcotic poisoning)

• Naloxone (Narcan)• Naltrexone (Trexan, Revia)• Nalmefene (Revex)

c. Non-Steroidal Anti-Inflammatory

A. NSAIDS1. ASA (Aspirin) – anti-platelet aggregator,

anti-inflammatory and analgesic

* the best drug for rheumatoid arthritis *always with meals (causes Peptic ulcer)*used in strokes and MI*ototoxic (early side effect: tinnitus and

vertigo)*be careful in giving to individuals with

Viral illness such as chicken pox because there is a risk for REYES SYNDROME (liver damage is evident)

* avoid giving to individuals with bleeding tendencies and potential for blood

dyscrasia such as thrombolytics , anticoagulants, ginko biloba, and phenytoin.

2. Para – chlorobenzoic Acid (Indoles)Indomethacin (Indocin)Sulindac (Clinoril)Tolmetin (Tolectin)

3. Pyrazolone derivatives: Phenylbutazone (Butazolidin)

A. NSAIDS

Proprionic Acid Derivatives

Ibuprofen (Motrin, Advil, Nuprin)Fenoprofen Calcium (Nalfon)Naproxen (Naprosyn)

Flurbiprofen Sodium (Ansaid, Ocufen)Ketoprofen (Orudis)Oxaprozin (Daypro)

A. NSAIDS

7. Phenylacetic Acid DerivativesEthodolac (Lodine)Diclofenac Sodium (Voltaren)Ketorolac tromethamine (Toradol)

8. COX-2 INHIBIOTORSCelecoxib (Celebrex)Meloxicaqm (Mobic)Rofecoxib (Vioxx)

9. Miscellaneous Analgesic AgentsAcetaminophen (Tylenol)

1. Acetaminophen (Tylenol)*hepatotoxic ( monitor SGPT/ALT)*with food

A. NSAIDS

ANXIOLYTICS/ANTI-ANXIETYAnother word: Sedatives/Hypnotics/Minor Tranquilizer

For: Delirium, anti-anxiety, insomnia ACTION: Increases GABA (gamma amino butyric acid)

USES: Major Use

to reduce anxiety; also induce sedation, relax muscles, inhibit convulsion; Used in neuroses, psychosomatic

disorders, functional psychiatric disorders. DO NOT modify psychotic behavior.

Most commonly prescribed drugs in medicine

Greatest harm: When combined with ALCOHOL

I. BENZODIAZEPINECode: ZEPAM / ZOLAM

Action: Anticonvulsant, muscle relaxant & anxiolytic

Diazepam (Valium)* best for: Status epilepticus , the best for delirium tremens (alcohol &

cocaine withdrawal

ANXIOLYTICS/ANTI-ANXIETY

Estazolam (Prosom)Alprazolam (Xanax) Chlorazepate (Tranxene)Oxazepam (Serax)*

The best in sundown syndrome (seen in Alzheimers)

Advantage: Not hepatotoxic

ANXIOLYTICS/ANTI-ANXIETYI. BENZODIAZEPINE

Lorazepam (Ativan)* 2nd drug for sundown syndrome

Triazolam (Halcion)* Anti-insomnia

Temazepam (Restoril)* Anti-insomnia

Flurazepam (Dalmane)* Anti-insomnia; do not stop abruptly because of rebound grand mal seizure

Midazolam (Dormicum)

Prazepam (Centrax)


Chlordiazepoxide (Librium)* 2nd drug of choice for delirium tremens

Chlordiazepoxide (Librium), multivitamins, thiamine and folic acid help decrease withdrawal symptoms of alcohol withdrawal. Positive outcome of Librium in alcoholic depressed woman includes an observation that client can pick an object on floor w/ smooth coordination

Clonazepam (Klonopin)Halazepam (Paxipam)


Side Effects #1: Vital sign to be monitored: Respiratory Rate due to its Lethal Side Effect; Respiratory Depression

1. Early Side effects decrease LOC Lethargic Late/Fatal side effects decrease RR Respiratory Depression RR below 12

Avoid strenuous activities

Antidote for Benzodiazepine intoxication: FLUMAZENIL (ROMAZICON); an anxiolytic antagonist


II. BARBITURATES Action:

Used as an anticonvulsant besides being a sedative

Code: TAL / AL

Secobarbital (seconal)Phenobarbital (luminal)* commonly used anticonvulsant barbiturateMethohexital (Brevital)Amobarbital (Amital)Methobarbital (Methalba)


III. A TYPICAL ANXIOLYTICSMeprobamate (Equanil, Milltown)

Chloral Hydrate (Noctec)Hydroxyzine (Atarax, Iterax, Vistaril)*

anti emetic & antihistamineDiphenhydramine (Benadryl)*

Antiparkinsons, Antihistamine,and an Anxiolytic (addictive)

Zolpidem (Ambien, Stillnox) sleeping aidDoxylamine (Unisom) sleeping aid

Buspirone (Buspar)* will take 1 week before the effect could be seen


a. Barbiturates (given above)b. Benzodiazepines (given above)c. Hydantoins (code: toin)

Phenytoin (Dilantin) best anticonvulsant petit mal seizures for children

SE: Gingival hyperplasia & pinkish urine, alopecia, hyperglycemia, Intervention: Massage the gums & use soft bristle toothbrush

Adverse Effect: Blood dyscrasia- thrombocytopenia S/SX: Bleeding of the gumsLab test: Platelet count = 150,000-400,000; if ↓100,000-active bleeding

Special Considerations: The only COMPATIBLE I.V. Solution for Phenytoin (dilantin) is NSS (Normal Saline Solution)

• Ethotoin (Peganone)• Mephenetoin (Mesantoin)

Hydantoins

d. Miscellaneouse. Carbamazepine (Tegretol) trigeminal neuralgia

(tic douloureux) A/E: Agranulocytosis – S/Sx: Sore throat

MgSO4The best tocolytic for premature labor, also efficient as an anti-convulsant for Eclampsia or PIH.Early side effects: decrease deep tendon reflex and oliguria (renal failure).Fatal/Late Side Effect: Respiratory Depression

(assess the RR if it is below 12 /min).Valproic Acid (Depakene) therapeutic serum level:

40-100 mcgAdverse Reaction: Hepatotoxic (assess SGPT or ALT)

e.Succinimides (code: suximide)

Ethosuximide (Zarantoin)

Methoximide (Celontin)

Phensuximide (Milontin)

Another word: Neuroleptic / Major Tranquilizers

USES: Schizophrenia, acute mania, depression and organic conditions; Non-psychiatric cases: Nausea and vomiting, pre-anesthesia, intractable hiccups.

Antipsychotics can only decrease the positive symptoms of schizophrenia, but not the negative symptom such as ambivalence.

Action:↓ delusion, hallucinations, looseness of association to decrease levels of dopamine in the substantia nigra

ANTIPSYCHOTICS

I. PHENOTHIAZINE Code: AZINEFluphenazine (Prolixin)*Acetophenazine (Tindal)Pherphenazine (Trilafon)Promazine (Sparine)

Chlorpromazine (Thorazine)*#1 that causes photosensitivity/photophobia;

Side effects: Causes also red orange urine. In liquid form is usually put in a chaser Chaser: 60-100ml juice (prone or tomato); to prevent constipation & contact dermatitis; taken with straw (bite straw & sip)

ANTIPSYCHOTICS

MESORIDAZINE (SERENTIL)Thioridazine (Mellaril)*

ceiling dose/day: 800 mg

Adverse Effect: Retinitis pigmentosa

Prochlorperazine (Compazine)*#1 commonly used anti emetic

Trifluoperazine (Stelazine)

ANTIPSYCHOTICS

II. BUTYROPHENONESCode: PERIDOL

Haloperidol (Haldol, Serenase)* #1 drug used for extreme violent behavior

Instruct patient taking Haldol to wear sunscreenDroperidol (Inapsine)

III. THIOXANTHENES Code: THIXENEChlorprothixene (Taractan)Thiothixene (Navane)

ANTIPSYCHOTICS

ANTIPSYCHOTICS

IV. ATYPICAL ANTIPSYCHOTICS Code: DONE / ZAPINE or APINE

Olanzapine (Zyprexia)Clozapine (Clozaril) #1 that causes Agranulocytosis &

Blood Dyscrasia“I will need to monitor my blood level to continue my medication.” shows a correct understanding of a patient while taking Clozaril.Loxapine (Loxitane)Risperidone (Risperidone) #1 drug for

Korsakoff’s psychosis Molindone (Moban)Aripiprazole (Abilify) newest antipsychotic drug

SIX COMMON ANTICHOLINERGIC SIDE EFFECTS OF ANTIPSYCHOTICS

(Anticholinergic effects are drug actions of antipsychotic drugs because they BLOCK

MUSCARINIC CHOLINERGIC RECEPTORS)

CODE: BUCO PanDan – anticholinergic S/Es


1. Blurring of Vision - ↑ sympathetic reaction (don’t operate machinery);Mydriatic – pupil dilate sympa ↑ IOP don’t use in glaucoma

2. Urinary Retention – Nursing Interventions:1. Provide Privacy – give bed pan2. Sounds of dripping water – faucet3. Intermittent cold & warm compress


3. ConstipationNursing Interventions:

1. Prevent constipation ↑ fiber (residue) roughage, prune/pineapple/papaya juice/ fruits.

2. ↑ OFI3. ↑exercise

4. Orthostatic Hypotension/Postural Hypotension

Difference of BP 15-20 mm Hg above the diastole after sudden changing of positionS/Sx: Pallor, dizzinessNursing consideration:

Slowly change positionTold patient to dangle feet first before

standing


5. Pan Photosensitivity (photophobia)Nursing Intervention:1. Use sun glasses, sun block, long

sleeves or/and umbrella. Patients taking antipsychotic should be instructed to wear wide brimmed hat when going outside

6. Dan Dry mouth/ XerostomiaPrioritized Nursing Intervention:Give (1) ice chips, (2) chewing gum, (3) sips of water


ANTIDEPRESSANTS or

THYMOLEPTICS

I. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

Usually the FIRST LINE of drug. RATIONALE: FEWER SIDE EFFECTS

Action: Balance Serotonin – gradual effect (usually 2 weeks)

Effect: 2 wks.

ANTIDEPRESSANTS or THYMOLEPTICS

Code: XETINE/ODONEFluoxetine HCl (Prozac) – causes too much

dry mouth (xerostomia)Paroxetine HCl (Paxil)Trazodone (Desyrel)) – adverse effect:

Priapism (prolonged use)Nefazodone (Serzone)Fluvoxamine (Luvox)Sertraline (Zoloft) – causes GI upset

(diarrhea, insomnia): always with mealsVenlafaxine (Effexor)Citalopram (Celexia)

ANTIDEPRESSANTS or THYMOLEPTICS I. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

COMMON SIDE EFFECTS:

1. Weight Loss2. Insomnia (single am dose)

Nursing Considerations:1. For insomnia:

a. Induce sleep thru:1. Warm bath (systemic effect) 2. Warm milk/banana (active

substance: tryptophan)3. Massage

b. Give meds in single AM dose Antidepressants are best taken after meals

ANTIDEPRESSANTS or THYMOLEPTICS II. SECOND GENERATION TRICYCLIC ANTI DEPRESSANT

Action: Increases norepinephrine and/or serotonin levels in CNS by blocking their uptake by presynaptic neurons or it balances

Serotonin & Epinephrine levels.

Effect: 2-4 wks.

Code: PRAMINE/TRYPTILLINE

Clomipramine HCl (Anaframil) #1 for OCD*Imipramine (Tofranil)* the best drug for

enuresis Amitryptilline (Elavil)Protryphilline (Vivactil)Maprotilline (Ludiomil)Norpramine (Desipramine) #1

antidepressant for elderly depression. RATIONALE: Fewer anticholinergic S/E


Code: PRAMINE/TRYPTILLINE

Nortryptilline (Pamelor, Aventyl)Trimipramine ( Surmontil)Buproprion (Wellbutrin) 400 mg/day*(ceiling dose)

EXCESS INTAKE:Grand mal seizure

Doxepine (Sinequan) Amoxapine (Asendin)


COMMON SIDE EFFECTS:1. Sedation (best given at night)2. Weight gain

Nursing Consideration:1. Give meds at night#1 adverse effect – cardiac dysrhythmias#1 screening test before taking TCA – ECGWhen a depressed client taking TCA shows no

improvement in the symptoms, the nurse must anticipate the physician to discontinue TCA after two weeks and start on Parnate.

Nursing intervention before giving the drug includes checking the BP to assess for orthostatic hypotension.

ACTION: Psychomotor stimulator or psychic energizers; block oxidative deamination of naturally occurring monoamines (epinephrine, NOREPINEPHRINE, serotonin) → CNS stimulation Effect: 2 weeks

CODE: PAMMANAParnate (tranylcypromine)Marplan (Isocarboxacid)Mannerix (Moclobemide) *the newest MAOINardil (Phenelzine SO4)

ANTIDEPRESSANTS or THYMOLEPTICS III. MAOI – MONO AMINE OXIDESE INHIBITOR


CONTAINDICATIONS: TYRAMINE + MAOI = HYPERTENSIVE CRISIS 1. Tyramine rich-food, high in Na & cholesterol Hypertensive Crisis1. Aged cheese (except cottage cheese, cream cheese), Cheddar cheese and Swiss cheese are high in tyramine and should be avoided. 2. Canned foods such as sardines, soy sauce & catsup 3. Organ meats (chicken gizzard & liver) & Process foods (salami/bacon) ↑ Na4. Red wine (alcohol)


5. Soy sauce6. Cheese burger7. Banana, papaya, avocado, raisins (all over ripe fruits except apricot)8. Yogurt, sour cream, margarine; 9. Mayonnaise 10. OTC decongestants 11. Pickled foods, Pickled herring12. Other Foods contraindicated in MAOI therapy includes figs, bologna, chicken liver, meat tenderizer, , sausage, chocolate, licorice, yeast, sauerkrauts.

Antidote for Hypertensive Crisis: CALCIUM CHANNEL BLOCKERS (-DIPINE)

1. Verapamil (Calan)2. Phentolamine (Regitine)

also the #1drug for Pheochromocytoma (tumor in the medulla)


ANTICOAGULANTS

CODE: PARIN, RIN

Indication: to prevent clot formation. Used in MI, cardiac catheterization, pulmonary embolism.

Warfarin (Coumadin)Heparin , Enoxaparin (Lovenox),

Ardeparin, Dalteparin

ANTICOAGULANTS

Heparin Coumadin

Onset of Action: Immediate Slow (24-48hrs)

Route of Administration:

Parenteral Oral

Duration of Action: Short (<4hrs)

Long (approximately 2-5 days)

Lab Test: PTT or APTT PT

Antidote: Protamine SO4

Vitamin K or aquamephyton

Cost Expensive Inexpensive

COMPARISON OF CHARACTERISTICS OF ANTICOAGULANT DRUGS

Action: Interferes with the hepatic synthesis of vitamin K-clotting factors (II, VII, IX, and X)

Indication: Prevents or slow extension of a blood clot

Undesirable Effects:

Anorexia, nausea, diarrhea; rash; bleeding, hematuria, thrombocytopenia, hemorrhage

Warnings: Pregnancy; hemorrhagic tendencies such as hemophilia, thromb-ocytopenia purpura, leukemia; peptic ulcer; cerebral vascular accident (CVA); severe renal.

DIC, Blood dyscrasia, liver & kidney diseases

1. WARFARIN

Other Specific Information:

AVOID THE FOLLOWING !!!!H2 blockers , Aspirin, Phenytoin, Oral

Hypoglycemics & NSAIDS ( avoid HAPON!)

Foods: Green leafy vegetables (Vitamin K) decrease Effectiveness (i.e. asparagus,

cabbage, cauliflower, turnip greens, and other green leafy vegetables)

Drugs: decrease Effectiveness - Phenytoin Oral contraceptives, Rifampin,Estrogen (PORE). Increase Risk of bleeding with chamomile, garlic, ginger, ginkgo, and ginseng therapy. There are numerous interactions.

Interventions: A Warfarin’s antidote is Vitamin K (Aquamephytoin). Laboratory test is PT

Check all drugs for potential drug-drug interactions.

Education: Evaluation of PT/INR will be required to regulate dosage. Report any unusual bleeding. Review a diet low in vitamin K. Wear a medical identification card or jewelry. No strenuous activities (skydiving, long distance running, football). Review bleeding protocol (i.e., electronic razors, soft toothbrushes, etc.)

Evaluation:

PT will have a value of 1.5 to 2.5 times the control value in seconds; the INR will be 2-3. Normal PT is 9-11 seconds times 1.5 to 2.5 times the normal value.The client will have no signs or symptoms of bleeding.

Medical Alert: · Always advise other providers (i.e., dentists,

surgeon, etc.) of medication. · No OTC medication without provider approval.

Action: Combines with antithrombin III to retard thrombin activity.

Low molecular-weight heparin blocks factor Xa, factor IIa.

Indications: Thrombosis Reduces risk of myocardial infraction (MI) CVA Clots associated with atrial fibrillation:

pulmonary embolism


Hemorrhagic tendencies: hematuria, bleeding gums, frank hemorrhage

Other Specific Informatio:

Risk of bleeding with chamomile, garlic, ginger, ginkgo, and ginseng therapy.

2. HEPARIN SODIUM

Interventions:

Monitor PTT (usually 1.5- 2.5 times control values) and platelet count. Monitor for signs of unusual bleeding (petechiae, hematuria. GI bleeding, gum bleeding). Initiate bleeding protocol measures (use electric razors, hold pressure for 5 minutes with venipunctures, soft toothbrushes). Monitor IV site carefully. Heparin has short half life, therefore, with discontinuation, PTT will usually return to baseline within 1-2 hours. Have protamine sulfate available as an antidote.*Monitor clotting time; normal is 8-15 minutes; maintain clotting time 15-20 minutes

Education: Inject SQ into the abdomen with 25-28g at 90 degrees

angle; don’t aspirate or rub injection site Explain bleeding protocol

precautions. Explain the need of several PTT

evaluation. Teach signs of unusual bleeding. Avoid activities with risk of injury. Caution with sharp utensils while

cooking or eating. Avoid salicylates or any OTC

medication without approval from provider.

Wear identification that notes anticoagulant therapy.

Inform provider of therapy prior to surgical procedure.

Evaluation: Heparin’s antidote is Protamine Sulfate. Laboratory test is aPTT. Normal PTT is 60-70 seconds

Normal aPTT is 20-36 seconds times 1.5 to 2.5 times the normal value.

Drugs: Heparin Sodium (Hyperlin) Low Molecular Weight Heparins:

Ardeparin (Normiflo); Dalteparin (Frafmin); Danaparoid (Organ); Enoxaparin (Lovenox)

THROMBOLYTIC MEDICINES

CODE: ASE / KINASE

Example: Alteplase / Urokinase/ Streptokinase/ Reteplase/ RetavaseSalteplase (Activase, t-PA tissue plasminogen activator); Abbokinase, Streptase, Kabikinase)

Action: Binds with plasminogen causing conversion to plasmin which dissolves blood clots. Activates plasminogen which generates plasmin .

The best drug to DISSOLVE clot , such as pulmonary embolism & myocardial infarction

Indications:

Dissolves blood clots due to coronary artery thrombi, deep vein thrombosis, and pulmonary embolism.

. Used 4-6 hrs after MI to restore blood flow, limit myocardial damage, and preserve left ventricular function.



Warnings: Active internal bleeding; recent CVA; aneurysm, hypertension; anticoagulant therapy; ulcerative colitis.

Severe allergic reactions to either anistreplase or streptokinase.

Other Specific Information

:

Monitor for bleeding, hypotension & tachycardia .Handle clients minimally & let clients use electric razors & brush teeth gently.

Effects of drug disappear within a few hours after discontinuing but the systemic effect of coagulation and the risk of bleeding may persist for 24 hours.

Increase in risk for bleeding with heparin, oral anticoagulants, antiplatelet drugs and NSAIDs.

Interventions:

Apply direct pressure over a puncture site for 20 – 30 minutes

Monitor CBC especially hgb/hct, coagulation tests.

Evaluate bleeding at a sutured wound, arterial site, central line.

Monitor vital signs during and after infusion.

Monitor EKG for re-perfusion dysrhythmias.

Watch for unusual bleeding disturbance (GI, GU)

Initiate bleeding protocol measures for several hours (e.g., no venipunctures, repetitive manual blood pressure, or removal of IV lines or catheters).

Antidote: Aminocaproic Acid (Amicar)


Action: Platelet aggregation inhibitor; inhibitis platelet synthesis of thromboxane A2, a vasoconstrictor and inducer of platelet aggregation. This occurs at low doses and lasts for 8 days (life of the platelet).

Indications: TIAs, CVAs with a history of TIA due to fibrin platelet emboli.

Reduces risk of death from MI in clients with a history of infarction or unstable angina.

Warnings: Allergy to salicylates or NSAIDs. Bleeding disorders, renal or

hepatic disorders, chickenpox, influenza (risk of Reye’s in syndrome in children), pregnancy, lactation.

ANTIPLATELET: ASPIRIN

Warnings: Allergy to salicylates or NSAIDs. Bleeding disorders, renal or

hepatic disorders, chickenpox, influenza (risk of Reye’s in syndrome in children), pregnancy, lactation.


GI discomfort, bleeding, dizziness, tinnitus

Other Specific Information

:

Risk of bleeding with anticoagulants, thrombolytics

Risk of GI ulceration with alcohol, NSAIDs, phenylbutazone, steroids.


Interventions:

Monitor liver and renal function tests, CBC, clotting times, stool guaiac, blood drug levels, and vital signs.

Education: Instruct to take drug with food and a full glass of water.

Do not crush and do not chew sustained-release preparations.

Drugs: COMMON DRUGS: Code: D CATDipyridamole(persantine)Clopidogrel(plavix)Aspirin(ASA) Ticlopidine(Ticlid) Aspirin (Bayer, Bufferin, Ecotrin) Other antiplatelet drugs are listed below,

however, there are numerous differences between each drug : Abciximab (Reopro); Cilostazol (Pletal); Eptifibatide (Integrilin); Sulinpyrazone (Anturane); Tirofiban (Aggrastat)


CARDIOVASCULAR DRUGS

CARDIOVASCULAR DRUGSANTIHYPERTENSIVESCODE NAME: AAABCCD (short cut for anti-

hypertensive) Angiotensin Converting Enzyme Inhibitor or Antagonist (ACE Inhibitor)Angiotensin II Receptor Blocker (ARBS)Alpha Adrenergic Blockers Beta Adrenergic BlockersCalcium Channel BlockersCentral Acting Sympatholytics /Adrenergic BlockersDirect Acting VasodilatorsAngiotensin Converting Enzyme Inhibitor or Antagonist (ACE Inhibitor)

Angiotensin Converting Enzyme Inhibitor or Antagonist (ACE Inhibitor)

ACTION: prevent vasoconstriction by blocking angiotensin 1 to angiotensin 2

USE: hypertension, adjunctive therapy in CHF, PREVENTS SEVERE HEART FAILURE following

M.I. in clients with IMPAIRED LEFT VENTRICULAR FUNCTION and prevents kidney failure in Type 2 Diabetes.

EXAMPLES: Captopril (Capoten)

ONE HOUR BEFORE MEALSEnalapril (Vasotec)

Ramipril (Altace)

Side Effects: CHIT – BC: cough persistentH: Hyperkalemia and

Hypoglycemia I: Impotence and InsomniaT: Taste decreasesB: Bleeding

Angiotensin II Receptor Blocker (ARBS)

ACTION: blocks the binding of angiotensin II to the Angiotensin 1 , and also blocks the release of aldosterone resulting in a decrease BP.

USE: HypertensionCode: SARTANExamples: Losartan (Cozaar)

Eprosartan (Teveten) Candesartan (Atacand)

Side Effects: Upper Respiratory Infection (cough); Diarrhea

Adverse Effect: Nephrotoxic / Hepatotoxic

ALPHA ADRENERGIC BLOCKERS

ACTION: blocks the alpha 1 adrenergic receptors resulting in vasodilation of arteries and veins, decreases peripheral resistance and relaxes smooth muscle of bladder and prostate.USE: Hypertension, Prazocin used in CHF and Doxazocin used in BPH.

Code: ZOCIN Examples:

Doxazocin (Cardura)Prazocin (Minipress)Terazocin (Hytrin)

ALPHA ADRENERGIC BLOCKERS

SIDE EFFECTS: SI – DUD Syncope Impotence Depression Urination Dry mouth

ADVERSE EFFECTS:Nephrotoxicity

ACTION: binds to beta 1 (cardiac) and beta 2 (lungs) adrenergic receptors sites that prevents the release of catecholamine.

USE: Angina, Hypertension, anxiety disorders, as a Group II anti dysrhythmias

CODE: OLOL

BETA ADRENERGIC BLOCKERS

BETA ADRENERGIC BLOCKERS

SIDE EFFECTS: P - BBNDAH Psychotic Features Bradycardia Bronchoconstriction Nightmares Depression Agranulocytosis Hypoglycemia

NEVER USED IN PATIENTS WITH COPD, CVA, CHF, HEPATIC DISEASE, GRAVES, and

BRADYCARDIA

ACTION: Decrease contractility (negative inotropic effect by relaxing the smooth muscle) and the workload of the heart thus decreasing the need for oxygen. It also causes coronary and peripheral vasodilation.

USE: Group IV antidysrythmia, vasodilator and anti hypertensive drug.

CALCIUM CHANNEL BLOCKERS

CODE: DIPINE except Verapamil (Calan) and Diltiazem (Cardizem)

SIDE EFFECTS: CAP Constipation AV block

(therefore never give it to patients with CHF) Peripheral Edema

ADVERSE EFFECTS:Hepatotoxic and Nephrotoxic

CALCIUM CHANNEL BLOCKERS

CENTRAL ACTING SYMPTHOLYTICS / ADNEGERNIC BLOCKERS

ACTION: Decreases the release of adrenergic hormones from the brain resulting in decrease peripheral vascular resistance and blood pressure.

MC G Methyldopa (Aldomet)Clonidine (Catapress)Guanabenz (Wytensin)

SIDE EFFECTS: DIES Depression Impotence Edema (if more than 4 lbs/week) Sodium & Water retention

ADVERSE EFFECT:Hepatotoxic

CENTRAL ACTING SYMPTHOLYTICS / ADNEGERNIC BLOCKERS

ACTION: uses arterial vasodilatation

Nitroglycerin causes DECREASE LAV M

DECREASE Left Ventricular Workload

DECREASE Arterial BPDECREASE Venous returnDECREASE Myocardial O2

Consumption

DIRECT ACTING VASODILATORS

DIRECT ACTING VASODILATORS

SIDE EFFECTS: HEN GHeadaches (orthostatic Hypotension)EdemaNasal CongestionGI Bleeding

Examples: D MANNDiazoxide (Hyperstat)Minoxidil (Lomiten)Apresoline (Hydralazine)Nitropruside (Nipride)

NITROGLYCERIN (Nitrobid, Nitrostat)

Action: Relaxes the vascular smooth system.

↓ Myocardial demand for oxygen. ↓ Left ventricular preload by

dilating veins thus indirectly ↓ afterload.


Headache (most common), hypotension, postural hypotension, syncope, dizziness, weakness, reflex tachycardia, paradoxical bradycardia.

Sublingual: burning, tingling sensation in mouth.

Ointment erythematous, vesicular and pruritic lesions.


Interventions:

Record characteristics and precipitating factors of anginal pain.

Monitor BP and apical pulse before administration and periodically after dose.

Have client sit or lie down if taking drug for the first time.

Client must have continuing EKG monitoring for IV administration.

Cardioverter / defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the Transderm-Nitro patch (may cause burns on client).

Assist with ambulating if dizzy.

Education: Avoid alcohol. Teach to recognize symptoms of

hypotension. Advise to make position changes slowly

and to avoid prolonged standing. Teach about the form of nitroglycerin

prescribed. Oral: Instruct to take on an empty stomach

with a full glass of water. Do not chew tablet

Sublingual: Instruct to take at first sign of anginal pain. May be repeated every 5 minutes to a maximum of 3 doses. If the client doesn’t experience relief, advise to seek medical assistance immediately.

A stinging or biting sensation may indicate the tablet is fresh. With newer SL nitroglycerin, the biting sensation may not be present.

Protect drug from light moisture, and heat. Instruct to apply Transderm-Nitro patch

once a day, usually in the morning. Rotation of sites is necessary.


Drugs: Nitroglycerin intravenous (Nitro-Bid IV, Tridil) Sublingual (Nitrostat) Sustained-release (Nitroglyn, Nitrong, Nitro-Time) Topical (Nitro-Bid, Nitrol, Nitrong,

Nitrostat) Transdermal (Deponit, Minitran,

Nitro-Dur, Nitrodisc, Transderm-Nitro, Nitro-Derm)

Translingual (Nitrolingual) Transmucosal (Nitrogard)


CARDIAC GLYCOSIDES

Code:Dig

Example: Digoxin (lanoxin)

Digitoxin (Crystodigin)

Action: Inhibits the sodium-potassium ATPase, resulting in cardiac construction.

Effect: Positive Inotropic (increase Contraction of the heart)

Negative Chronotropic (slows Cardiac rate- depresses SA node- bradycardia)

Negative Dromotropic (slows conduction velocity)

Indication: THE BEST DRUG OF CHOICE FOR CHF for CHF, atrial tachycardia, atrial fibrillation &

atrial flutter.

CARDIAC GLYCOSIDES

Side Effects: 1st / Initial: Nausea & Vomiting(adult) Confusion(elderly)

2nd: Bradycardia3rd: Hypokalemia (highest in K rich food is

apricot and avocado, next is potato and raisins)

Adverse Rxn/ Late: Yellow & Green VisionSpecial Consideration: Never give with

FOOD. Check the pulse before & after giving. Compare the apical and the radial pulse in a FULL minute. Check the therapeutic serum level which is .5- 2 ng/ml

Contraindicated: MI, heart blocks & PVC

CARDIAC GLYCOSIDES

OtherSignificantInformation:

↓ K; ↓ Mg”, and ↑ Ca “may be associated with digitalis toxicity.

Administer separately from antacids (1 to 2 hours apart).

Use cautiously with calcium channel blockers or beta blockers.

Interventions: Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 ng/ml. toxity is > 2.0 ng/mL).

Before each dose, assess apical pulse for full minute; record and report changes in rate or rhythm.

Withhold drug and contact provider if pulse is < 60/minute or > 100 (adults) or <1 10 minute (children) unless provider has outlined specific parameters.

Weigh daily, monitor I O, and signs has CHF.

CARDIAC GLYCOSIDES

Education: Teach to take pulse correctly and report if pulse is out of parameter.

Weigh every other day and record. Restrict alcohol, sodium and

smoking. Eat food rich in potassium. Wear medical alert tag. Emphasize

importance of regular checkups.Evaluation

: Normal sinus rhythm on ECG.

Clinical improvement as evidenced by no S3, edema, etc.

Cardiomegaly decreased.

Antidote Antidote: Digibind Fab

CARDIAC GLYCOSIDES

ANTIHYPERTENSIVE

STEP 1. Diuretic (1st step for younger clients with tachycardia and marked liability of BP)

STEP 2. Beta-Blocking Agent Beta 1 Adrenergic (Cardioselective) Blocking Agents:

Acetabulol (Sectral); Atenolol (Tenormin); Metoprolol (Betaloc)

Beta 1 and 2 (Nonselective) Blocking Agents: Nadolol (Corgard), Pindolol (Visken), Propranolol (Inderal, Novopranol), Timolol Adrenergic Inhibiting Agent

Clonidine, Methyldopa, Reserpine, Prazoline Usually diuretic added to prevent fluid retention

STEP 3. Vasodilator Agent Hydralazine

Added with adrenergic blocking agent and diuretic decrease workload

STEP 4. Guanethedine, Minoxidil or Angiotensin Inhibitors Captopril or Analapril

ANTIHYPERTENSIVE

ANTIDYSRHYTHMIC

GROUP 1 - Generally inhibit the fast sodium channel in cardiac muscle resulting in an increased refractory period

a.Disopyramide phosphate (Norpace); Procainimide HCl (Procan); Quinidine (Quinidex)

b.Lidocaine (Xylocaine)

c.Flecainide

ANTIDYSRHYTHMIC

GROUP 2-Beta blockers that decrease stimulation of the heart

• Beta 1 Selective AntagonistsCardiogenic Blockers; Block Beta 1 cardiac receptorsAtelonol (Ternonim), Acebutolol Sectral, Metoprolol (Betaloc)

• Beta 2 Selective AntagonistsMucolytics and Bronchodilators

• Nonseletive Beta Adrenergic Blocking Agents; (Beta 1 and Beta 2 Blockers)

Nadolol (Corgard); Oxyprenelol (Trasicor); Pindolol (Visken); Propranolol (Inderal); Timolol

ANTIDYSRHYTHMIC

Group 3 - Generally do not affect depolarization but work by prolonging cardiac repolarization

• Anti adrenergic; Positive inotropic action• Bretylium, Amiodarone HCl (Cordarone)

Group 4• Calcium antagonist action - Depression of heart

and smooth muscle contraction, decreased atomaticity and decreased conduction velocity

• Verapamil

ANTIDYSRHYTHMIC

RESPIRATORY AGENTS

Respiratory Agents1. BRONCHODILATORS

a. Breathing and Coughing Techniques: This will facilitate the removal of respiratory secretions and optimize oxygen exchange.

b. Relation Techniques: Since anxiety may result in respiratory difficulty, review ways to alleviate anxiety such as music and relaxation techniques.

c. Evaluate Heart Rate and BP: Teach client to monitor heart rate and BP since an undesirable effect of these medications may be tachycardia, cardiac arrthymias, and a change in blood pressure. (Beta2, Adrenergic Agonists can cause hypertension; methylxanthines can cause hypotension at theophylline levels > 30-35 mcg/ml.)

d. Arm Identification: Recommend clients having asthmatic attacks to wear an ID bracelet or tag.

e. Tremors: Evaluate client for tremors from these medications.

Have 8 or more glasses of fluids. Fluid will assist in decreasing the viscosity of the respiratory secretions.

f. Emphasize No Smoking: Encourage the client to stop smoking under medical supervision.

Respiratory Agents1. BRONCHODILATORS

Respiratory Agents2. ANTIHISTAMINESCODE: tadine, amine, ramine

Action: Blocks histamine at H, receptors

Indications: Upper respiratory allergic disorders, anaphylactic reactions; blood transfusion reactions; acute urticaria; motion sickness.

Warnings: Allergies, acute asthmatic attack, respiratory disease, hepatic disorder, narrow-angle glaucoma, symptomatic prostatic hypertrophy, pregnancy, lactation.

Side Effects:

CODE: BUCO PDBlurring of Vision, Urinary Retention, Constipation, Orthostatic Hypotension, Photosensitivity & Dry Mouth

Interventions:

Monitor vital signs, intake and output. If secretions are thick, use a humidifier.

Education: Instruct client to take with food; drink minimum of 8 glasses of fluid per day.

Advise to do frequent mouth care; may use sugarless gum, lozenges, or candy.

Notify provider if confusion or other undesirable effects occur.

Instruct client not to drive or operate machinery if drowsiness occurs or until response to drug has been determined.

For prophylaxis of motion sickness, recommend taking 30-60 minutes before traveling. Avoid alcohol and other CNS depressants.

Respiratory Agents2. ANTIHISTAMINES

Drugs: Loratadine, Azatadine, Cyproheptadine, Cyproheptadine (Periactin), Diphenhydramine, Chlorpheniramine, Dexchlorpheniramine (Polaramine), Doxylamine, Phenylpropanolamine, Brompheniramine

Others: Azelastine (Astelin); Buclizine (Bucladin-S); Cetirizine (Zyrtec); Clemastine (Tavist); Cyclizine (Mazerine); Dimenhydrinate (Dramamine); Fexofenadine (Allegra); Hydroxyzine (Atarax, Vistaril); Loratidine (Claritin); Meclizine (Antivert); Promethazine (Phenergan); Tripelen-namine (PBZ)

Respiratory Agents2. ANTIHISTAMINES

Respiratory Agents3. BRONCHODILATORCODE: terol, terenol, phrine, phylline

Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle.

Increases vital capacity, decreases airway resistance.

Indications:

the best drug for COPD or CAL (chronic airflow limitation)

Asthma, bronchitis, emphysema, relief of bronchospasm occurring during anesthesia, exercised-induced bronchospasm.

Warnings: Hypersensitivity, angina, tachycardia, cardiac arrhythmias, hypertension, cardiac disease, narrow-angle glaucoma, hepatic disease.

Side effects:

Sympathetic Side Effects such as palpitation, tachycardia, restlessness, nervousness, Hyperglycemia, hypertension, cardiac dysrhythmias.

Caution with clients with glaucoma & HPN

OtherSpecific Information

:

Special Consideration: Avoid Uppers- caffeine, cola & tea. Be careful in giving bronchodilators with DIABETES (hypoglycemia). Remember that the therapeutic serum level of theophylline is 10-20mcg/ml. Theophylline when given intravenously should be given SLOWLY. If not sympathetic reactions will occur.

Respiratory Agents3. BRONCHODILATOR

Interventions: Check for cardiac dysrhythmias.

Education: Notify provider taking other medicines or if symptoms are not relieved. Watch our for status asthmaticus.

Demonstrate correct use of inhalers or nebulizers. Teach about metered-dose inhalers (MDI). When two puffs are needed, 1-3 minutes should lapse between two puffs. A spacer may be used to increase the delivery of the medication. Always prioritized using FIRST the bronchodilator before using steroids or another drug such as a mucolytic.

* Avoid caffeine products

Drugs: Albuterol, Isoproterenol, Formoterol, Bitolterol, Levalbuterol, Epinephrine, Aminophylline,Theophylline, Oxtriphylline

Respiratory Agents3. BRONCHODILATOR

Respiratory Agents4. STEROIDSCODE: sone, one, solone

Action: Synthesized by adrenal cortex. Exhibits antiinflamatory properties

suppress the normal immune response.

Increases carbohydrate, fat and protein metabolism.

Indications:

Adrenal replacement therapy, immunosuppressant and increases fat & carbohydrate metabolism

Antiinflammatory, immunosuppressant dermatological disorders

Replacement in adrenal cortical insufficiency.


Code name: GO CHAT!!!G.I. upset, Osteoporosis, Cushing like

symptoms & Calcium is decrease, High glucose & Sodium, Addisonian Crisis (if abruptly withdrawn) , Tachycardia .

Initial Side Effect: Hyperglycemia Late Side Effect:

ImmunocompromisedOther Specific Information:

Always with food may cause Peptic Ulcer, monitor BP for Hypertension, do not abruptly discontinue the drug ,may cause Addisonian Crisis, Moon Face, Cushing like Symptoms

Interventions: Monitor VS, BP, weight, blood glucose, electrolytes, EKG, and TB skin test results.

Respiratory Agents4. STEROIDS

Education: Special Considerations: Always With Food. Gradually Taper. Do not receive vaccination .High Calcium diet & Vitamin D. Steroids mask the symptoms of Infection. Avoid Potassium wasting diuretics – it increases HYPOKALEMIA.

Anticoagulants decrease the effects of Steroids. Instruct to administer oral drugs with food or

milk early in the morning, withdraw medication slowly or taper off gradually under medical supervision.

Follow-up visits and lab tests are essential. Avoid infection. Wounds may heal slowly. Do not receive vaccination. Do not take aspirin or any medication without

consulting provider. Discuss a diet low in sodium, high in vitamin D,

protein and potassium. Avoid sun light on treated area. Recommend wearing a medical alert tag.


Drugs: CODE: SONE, ONE, SOLONE Common Medications: (Baby) Bethamethasone

(Celestone) usually given to premature infants, to increase Lung maturity), Dexamethasone (Decadron), Prednisone(Deltasone), Hydrocortisone (Solu-cortef), Prednisolone (Prelone),

Triamcinolone (Azmacort, Kenalog, Nasacort-O) Topical: Alclometasone (Acolvate); Amcinonide (Cylocort);

Clobetasol (Ternovate); Cortisone (Cortone-O); Desoride (Tridesilone); Desoximetasone (Topicort);

IM, IV, OP, IN, IH); Fluocinolone (Synalar, Synemol); Flurandrenolide (Cordran); Fluocasone (Cutivate, Flonase-IN); Halcmonide (Halog); Halobetasol (Ultravate); Hydrocortisone (Cort-Dome, Cortef, Hydrocortone, Solu-Cortef – mO, IM, IV, SubQ, R); Mometasone (Elocon); ; Prednicarbate (Dermatop);

Inhalation, intranasal: Beclomethasone (Beclovent, Vanceril, Benconase, Vancenase); Budesonide (Rhinocort-IN only); Flunisolide (Aerobid, Nasalide);; Oral; Fludrocortisone (Florinef); Methylprednisolone (Medrol, Solu-Medrol – IM, IV); Prednisolone (Delta-Cortef, Hydeltra, Hydeltrasol – IM, IV, Il, IA); Prednisone (Deltasone, Meticorten, Orasone).

Ophthalmic: Fluorometholone (FML); Nmexolone (Vexol).


GIT MEDICINES

GIT Medicines1. ANTACIDS AND MUCOSAL PROTECTIVES

react with gastric acid to produce neutral salts or salts of low acidity

inactivate pepsin and enhance mucosal protection but do not coat ulcer to protect from acid & pepsin

used for patients with PUD & GRF (gastroesophageal reflex disease)

antacid tablets should be chewed and followed with glass of H2O or milk

administer 1 hour – 2 hours apart from other meds to minimize the chance of drug interactions


Sucralfate (Carafate)CODE:Sucralfate (S for STOMACH EMPTY!)Carafate (CONSTIPATION IS THE SIDE EFFECT!)

creates a protective barrier against acid & pepsingiven po & on an empty stomachA/R: constipation, impede absorption of

warfarin Na,phenytoin, theophylline, digoxin & some antibiotics…

Administer 2 hours apart from these meds


Magnesium Hydroxide (Milk of Magnesia)

rapid acting & A/R is diarrhea

usually combined with aluminum hydroxide to counter diarrhea

slow acting & A/R: constipation

with significant Na content…caution in clients with HPN & Heart failure; reduce effect of tetracyclines, warfarin Na & digoxin

reduce phosphate absorption (USED IN CRF- Chronic Renal Failure)


Alumni Hydroxide (Amphoiel, Alu-Cap)

rapid onset

A/R: liberates CO2 & increases intra-abdominal pressure causing flatulence, caution in clients with HPN & heart failure, systemic alkalosis in clients with renal failure


Sodium Bicarbonate

rapid acting & A/R: constipation

Calcium Carbonate (Tums)

GIT Medicines2. H2 BLOCKERS

• suppress secretion of gastric acid• indicated for PUD & heart burn & for GRF

( gastro esophageal reflux disease)

CODE: TIDINECimetidine (Tagamet)Ranitidine (Zantac)Famotidine (Pepcid)

GIT Medicines

cimetidine (Tagamet)*taken on an empty stomach

*administered 1 hour apart from antacids

*crosses the blood-brain barrier & may cause mental confusion, agitation, anxiety & disorientation

*dosages of these meds are reduced when taken together: warfarin Na, phenytoin, theophyllin & lidocaine

ranitidine (Zantac)*not affected by food*S/E are uncommon & does not cross blood-brain barrier

2. H2 BLOCKERS

*used to supplement pancreatic enzymes

*taken with meals or snacks

*interacts with calcium carbonate & magnesium hydroxide

GIT Medicines3. PANCREATIC ENZYME REPLACEMENTCODE: PREFIX is PANCREA

Pancreatin (Creon)Pancrelipase (Cotazym, Viokase, Pancrease)

GIT Medicines4. MEDICINES FOR HEPATIC ENCEHALOPATHY

LACTULOSE (CEPHULAC)*reduces the ammonia level*given p.o. in the form of a syrup*improves CHON tolerance in clients with advanced liver cirrhosis*lowers colonic pH from 7 to 5; acidification pulls ammonia

into the bowel to be excreted in the feces thus decreasing the ammonia level

NEOMYCIN (MYCIFRADIN)*reduces the number of colonic bacteria that normally convert urea & amino acids into ammonia*given p.o. or via NGT*used with caution in clients with kidney impairment

GIT Medicines5. LAXATIVES

BULK FORMING LAXATIVESpsyllium hydrophillic mucilloid (Metamucil)*absorbs water into the feces & increase bulk to form large and soft stools*C/I bowel obstruction*A/R: dehydration, electrolyte imbalance & dependent

STOOL SOFTENERSdocusate calcium (Surfak), docusate sodium (Colace)*inhibit the absorption of H2O so fecal mass remains large & soft*used to avoid straining*Commonly used in CVA, MI, post op head surgeries, glaucoma and post op eye injuries so as to decrease straining and chances of complications.

LUBRICANTSMineral oil

*soften stools, ease strain of passing stools; lessen the rritation of hemorrhoids

*interferes with absorption of fat-soluble vitamins A, D, E, K

*Never use in pregnant women, may trigger premature labor

GIT Medicines5. LAXATIVES

GIT Medicines6. STIMULANTS CATHARTICS

biscodyl (Dulcolax): give 1 hour before/after antacids & milk cascara (Castor Oil): effect 2-6 hours; give with juice*stimulate motility of large intestine

SALINE CATHARTICSGlycerin suppositories (Senokot); Mg hydroxide*Attract H2O to large intestine to produce bulk, stimulate peristalsis & effect begins in 2-6 hours

excretion renal excretion, drugs affecting elimination of other drugs, blood concentration levels...

Documents

administration of medication

oral medication

safe medication administration

medication cabinet

medications properties

medications expiration

concurrent medicines

appropriateness of medicines