Chapter 18 and 19 Pharmacology

Potassium needs to stay within its healthy (normal) limits

3.5 - 5.0

Consuming too much sodium works against potassium's relaxation effect.

It pulls water back into blood vessels & will raise blood pressure (it's counter-intuitive if the diuretic is used to lower blood pressure

High-ceiling loop diuretics (Furosemide

Works in the loop of Henle & blocks reabsorption of sodium, chloride, and water.

Foods high in potassium

bananas, potatoes, dried fruits, nuts, and spinach

Upper respiratory includes

sinus, nose, nasal cavity, pharynx, and larynx).

Because diuretics increase the amount of fluid excretion in renal system

take them in the morning to avoid nocturia

Upper respiratory tract conditions/infections include

the common cold, seasonal rhinitis, and pharyngitis.

Mucolytics (Acetylcysteine) Client Education

· Administration can be inhalation. Be prepared to suction client if aspiration occurs.

Mucolytics (Acetylcysteine) Complications

· Aspiration · Bronchospasm when given orally. · Drowsiness

Antitussives: Non-opioids (Dextromethorphan) Client education

· Avoid activities that require alertness. Be careful because some of the meds have alcohol in it.

Antihistamines (Diphenhydramine) Client Education

· Avoid activities that require alertness. DO NOT administer Promethazine in a peripheral IV.

Antitussives with Opioid (Dextromethorphan) (with Codeine) Client education

· Avoid activities that require alertness. · Take with food to reduce N/V · Eat foods high in fiber to treat constipation. Don't take if cough is productive.

Antitussives with Opioid (Dextromethorphan) (with Codeine) Complications

· CNS depressant effects · GI distress (N/V & constipation) Codeine is addictive

Nasal glucocorticoids (Mometasone) Client Education

· Clear blocked nasal passages before administering (it needs to attach to the mucus membrane).

Antitussives with Opioid (Dextromethorphan) (with Codeine)

· Cough suppressant. · Dextromethorphan with codeine (opioid) Codeine increases the cough threshold in the CNS. (It takes stronger CNS stimulation to make a person cough.)

Antitussives: Non-opioids (Dextromethorphan)

· Cough suppressant. · Found in many OTC (over the counter) products to reduce cough.

Thiazide diuretic (Hydrochlorothiazide) Complications

· Dehydration · Hyponatremia & hypochloremia · Hypokalemia · Hyperuricemia (too much uric acid in the blood stream) Hyperglycemia

High-ceiling loop diuretics (Furosemide Complications

· Dehydration & hypotension · Hyponatremia & hypochloremia · Hypokalemia · Ototoxicity (hearing loss) · Lithium toxicity can occur from hyponatremia. · Digoxin toxicity can occur from hypokalemia. NSAIDS reduce urine output.

Potassium-sparing diuretics Aldosterone antagonists (Spironolactone) Client Education

· Encourage foods low in potassium. (Avoid food high in potassium!) · Monitor potassium levels · Avoid concurrent use of ACE inhibitors, renin inhibitors, & angiotensin receptor blockers because they increase the risk of hyperkalemia. Salt substitutes ↑ potassium levels because they're high in potassium.

Expectorants (Guaifenesin) Complications

· GI upset Drowsiness

Osmotic diuretics (Mannitol) Complications

· Heart failure & pulmonary edema. · Rebound intracranial pressure (ICP). · Metabolic acidosis Contraindications: · Heart failure (dyspnea related to fluid backing up from the heart into the lungs).

Potassium-sparing diuretics Aldosterone antagonists (Spironolactone) Complications

· Hyperkalemia · Endocrine effects · M: low voice & impotence · F: irregular menstrual cycle · Drowsiness Metabolic acidosis

Nasal glucocorticoids (Mometasone)

· It's a mild steroid that reduces inflammation. · For seasonal allergies, it can take 7 days before the medication reaches its maximum effect. · Common brand name: Flonase

Mucolytics (Acetylcysteine)

· Medication for cystic fibrosis · It breaks down mucus and enhances flow of secretions when there is a large amount. · Acetylcysteine smells like rotten eggs. · Acetylcysteine is the antidote for Tylenol overdose.

When the concentration of either sodium or potassium is off, dysrhythmias can happen.

· Potassium also helps relaxes blood vessels & lowers blood pressure.

Decongestants (Phenylephrine) Complications

· Rebound nasal congestion if used as a nasal spray or nasal drops. Vasoconstriction in nasal area.

Decongestants (Phenylephrine)

· Reduces nasal congestion for allergic & non-allergic rhinitis. · Reduces chest congestion. · Sympathomimetic · Reduces inflammation in the nasal mucus membrane. Common brand name: Afrin

Expectorants (Guaifenesin) Client Education

· Report a cough lasting longer than 1 week to provider. Take this medication with a full glass of water to thin mucous secretions to increase cough production

Antihistamines (Diphenhydramine) Complications

· Sedation · Anticholinergic effects (can BP) Promethazine can cause peripheral intravenous extravasation.

Antitussives: Non-opioids (Dextromethorphan) Complications

· Sedation (Some people use this to help them fall asleep). · This med has few adverse effects.

Nasal glucocorticoids (Mometasone) Complications

· Sore throat · Nosebleed · Headache Hyperglycemia

High-ceiling loop diuretics (Furosemide Client education

· Stop med & report urine output < 30mL/hr. · Monitor potassium levels. · Encourage food that are high in potassium. · Avoid other ototoxic drugs (Gent) & notify physician if tinnitus occurs Record daily weight

Thiazide diuretic (Hydrochlorothiazide) Client Education

· Stop med & report urine output < 30mL/hr. · Monitor potassium levels. · Encourage food that are high in potassium. · Monitor uric acid & blood glucose levels. Record daily weight.

Osmotic diuretics (Mannitol) Client Education

· Stop medication immediately and notify physician if signs & symptoms of dyspnea, neck vain distention, & weakness (signs of fluid overload). Monitor for S/S of ICP returning (change in consciousness & pupils, headache, N/V).

Antihistamines (Diphenhydramine)

· There are short-acting & long-acting meds. · Benadryl is short-acting. · Long-acting meds are Claritin, Zyrtec, & Allegra · Blocks histamine release on H1 receptors. · Given during anaphylaxis.

Expectorants (Guaifenesin)

· Thins mucus so coughs can be more productive. · It is often combined with antitussives. · Take with a full glass of water (also helps thin mucus).

Decongestants (Phenylephrine) Client Education

· Topicals and orals work differently. · Topicals are more effective and work faster (and don't last as long). Topicals don't cause sympatho-mimetic effect.

Potassium-sparing diuretics Aldosterone antagonists (Spironolactone)

· Works by blocking aldosterone, which spares potassium and excretes sodium & water. · Client will switch to this med if they become hypokalemic.

Thiazide diuretic (Hydrochlorothiazide)

· Works in the early distal convoluted tubule & blocks reabsorption of sodium, chloride, and water. It is often the medication of 1st choice to treat essential hypertension.

Osmotic diuretics (Mannitol)

· Works to decrease intracranial & intraocular pressure by raising osmolality and drawing fluid back into vascular/extravascular space (where it can be excreted). Prevents renal failure related to hypovolemia. (Mannitol increases blood volume, which also increases renal perfusion).

Diuretics are medications that treat

· hypertension, heart failure, kidney disease, and liver disease.