Chapter 62 Classification of drugs

Describe Hydrocodone

Acetaminophen (Lortab, Norco, Vicodin) When hydrocodone is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependance (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely

Blood Products Platelets

Administered to clients who have inadequate platelet production, are undergoing intensive cancer chemotherapy, or are receiving large amounts of stored bank blood. Platelets may also be administered to clients with aplastic anemia and leukemia.

Meds to review

Amoxicillin Penicillin Cefdinir Cephelexin Doxycycline Tetracycline Ciprofloxacin Levaquin Amikacin Azithromycin Erythromycin Septra/Bactrim Nitrofurantoin Fluconazole Ketoconazole Nystatin Miconazole Acyclovir Clinadamycin Metonidazole Vancomycin

Medications That Affect the GI Tract Stomach

Antacids- reduce and control stomach acidity, giving peptic ulcers a chance to heal - calcium carbonate(tums, Maalox) Histamine (H2) antagonists- inhibit gastric secretions that are mediated by histamine. They are used in the treatment of ulcers, gastric reflux, and hypersecretory conditions- Cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac) Proton pump inhibitors Antiflatulents Antispasmodics

Antibodies and Anti-infective Agents, used to treat infection

Antibiotic (one type of anti-infective agent that treats bacterial infections. Chemical compound made from living cells from bacteria, yeast, molds) Broad spectrum or narrow spectrum Bacteriostatic agents or bactericidal agents Reduce the virulence of a pathogenic organism Instruct the client to take the full prescribed dose of antibiotic, even though the symptoms subside

MEDICATIONS THAT AFFECT THE IMMUNE SYSTEM

Antihistamines are most effective in relieving the uncomfortable symptoms of allergic rhinitis and chronic urticaria (itchy rash).

Explain insulin

Best known replacement hormone Oral hypoglycemics are also available for DMII Exubera is the first non injectable insulin

Blood Products Blood Components

Blood components include plasma, plasma proteins, and fractions such as albumin, plasma protein fraction (PPF), immune globulin, and antihemophilic factor preparations

Explain Antihypertensives (reduce BP) Beta (B) Blockers (do not D?C abruptly

Blood vessels contain adrenegic-blocking receptors called alpha (a) and beta (B) receptors. Stimulation of alpha receptors causes vasoconstriction and rising blood pressure. Commonly used as firs-line therapy for HTN . They act directly to decrease heart rate and blood pressure by depressing AV node conduction and decreasing the strength of myocardial contraction. beta blockers are type 2 blockers, act primarily on the bronchial tree to relieve asthma and conditions such a COPD Examples: Inderal (HTN, arrhythmias, migraines) Cogard (angina and arrhthmias) Timolo (glaucoma) Atenolol and Metoprolol-cardioselective beta blockers

Respiratory stimulants doxapram(Dopram)

CNS stimulant often used to reverse respiratory depression immediately after surgery or to treat acute respiratory failure in COPD.

Cephalosporins

Cephalosporins, like PCN, were originally derived from a mold. Because cephalosporins are structurally similar to PCN, clients receiving cephalosporin therapy should be asked about previous sensitivity to PCN. The cephalosporins are divided into three groups: first, second, and third generations. Most cephalosporins are bactericidal. They are produced semisynthetically and are active against gram-positive cocci, including PCN-resistant staphylococci and gram-negative bacteria, including Escherichia coli, Proteus mirabilis, and Klebsiella species. The cephalosporins are used frequently for mixed infections (those caused by more than one pathogen). If the client drinks alcohol while taking a cephalosporin, severe nausea and vomiting are likely. Cephalosporins are available in oral and injectable forms and have become the most widely used antibiotics in the hospital setting. A

Herbal supplements

Certain supplements may cause increased bleeding if combined with oral anticoagulants Know your G herbal/dietary supplements

Explain ANTINEOPLASTIC MEDICATIONS

Chemotherapy is the administration of antineoplastic medications (see Chapter 83). In some cases, antineoplastic ("against cancer") medications are used as a palliative measure for tumors that are no longer curable by surgery or for cancers such as leukemia that spread throughout the body. Antineoplastic medications can be divided into several large groups based on their probable mode of action. These include: • Alkylating agents (e.g., cisplatin—interferes with DNA synthesis) • Antineoplastic antibiotics (e.g., doxorubicin [Adriamycin]—inhibits DNA synthesis) • Antimetabolites (e.g., 5-fluorouracil—inhibits vital metabolic functions for DNA growth) • Antimitotics (e.g., vincristine [Oncovin]—interferes with cell mitosis) • Hormonal agents (e.g., tamoxifen—antiestrogenic effects; produces temporary regression of metastasis) • Corticosteroids (e.g., prednisone—anti-inflammatory and immunosuppressive actions) • Antiangiogenics (e.g., endostatin—interferes with formation of tumor-feeding blood vessels) • Biologicals

Explain steroids, Cortisone

Cortisone, The most common adrenocortical hormone is cortisone, a very effective anti-inflammatory agent. Steroids have immunosuppressive and salt-retaining effects Prolonged cortisone therapy has many serious side effects, including changes in physical appearance. Possible side effect of long term use may result in weight gain, more serious side effect is thrmbophlitis

How is the correct antibiotic chosen

Culture and sensitivity

Selection of the appropriate antibiotic

Culture and sensitivity (C & S) test Penicillins Cephalosporins Tetacyclines Aminogycosides Macrolide antibiotics Sulfonamides and other urinary antiseptics Other anti-infectives

Celecoxib, Describe

(Celebrex) is a newer type of NSAID. It inhibits (blocks) the cyclo-oxygenase-2 (COX-2) enzyme, which is activated in inflammation. However, the drug does not inhibit cyclo-oxygenase-1 (COX-1), an enzyme that protects the lining of the GI tract and plays a role in blood clotting and kidney function. COX-2 inhibitors have excellent anti-inflammatory and analgesic properties, with fewer GI side effects. Celebrex, a pregnancy category C agent, is often the drug of choice for clients with arthritis or peptic ulcer disease. It should not be given to clients who are allergic to sulfonamides, NSAIDs, or aspirin. Side effects include headache, dyspepsia, and diarrhea. This medication is the only anti-inflammatory drug that can be safely taken by clients who are taking warfarin for anticoagulation.

Indomethacin, explain

(Indocin) belongs to the NSAID group, but is chemically unrelated to other medications in this class. It is a pregnancy category B agent during the first two trimesters and a category D agent during the third trimester. Indomethacin is effective in treating arthritis, bursitis, and other joint diseases. Clients should always take it with meals or milk because it may cause severe gastric distress.

Explain Ibuprofen

(Motrin, Advil, Midol Liqui-gel, Genpril) is a potent NSAID used to relieve mild to moderate pain. Ibuprofen is available OTC and is indicated for minor aches and pains, fever reduction, and dysmenorrhea (painful menstruation). Monitoring liver and kidney function is necessary for the client receiving ibuprofen.

Propranolol

(inderal) beta blocker-decreases heart rate, increases cardiac output, lowers BP

Medications that affect the sensory system Agents that reduce intraocular pressure

(leads to gaucoma or ocular hypertension.) Most common type of adult primary glaucoma is open-angle glaucoma , which can be acute or chronic. Ocular hypetension is a situation in which intraocular pressure is elevated without any other signs of glaucoma Meications: brimonidine tartrate (alphagan,), brinzolamide (Azopt), dorozalmide (Trusopt), Latanoprst (Xalatan), Levobetaxolol (Betaxon), levobunolol (AK Beta, Betagan), and metipranolol ( Opipranolol), Epinephrine (Adrenaline), also may be used to decrease production of aqueous humor.

Medications that affect the Nervous system Stimulants

(speed mental and physical process Abuse and adverse effects

Beta blockers like most cardiac medications, can be discontinued abruptly T or F

False Most cardiac medications, particularly beta blockers, cannot be discontinued abruptly. This creates a high risk of rebound angina

Medications that affect the blood Vitamins

Folic Acid ( stimulates the production of RBC"S Folic acid is commonly prescribed in combination with vitamins and minerals before conception and during early pregnancy to reduce the incidence of birth defects in infants) B12 (cyanocobalamin) is necessary for the manufacture of erythrocytes and healthy nervous system functioning

Nursing considerations

For administration of single maintenance doses of antidysrhythmic medications, CHECK APICAL HEART RATE (HR) FOR 1 FULL MINUTE. Hold the medications if HR is <60/minor>120 min CHECK THE PATIENT'S BLOOD PRESSURE PRIOR TO ADMINISTERING AN ANTIDYSRHYTHMIC MEDICATION OR HEMODYNAMIC MEDICATION (like vasodilators). If systolic blood pressure is <100 mm Hg or 30mm Hg below baseline then hold medication

Medications that affect the blood Iron replacement preparations

Give liquid form through straw to prevent staining of teeth take oral forms with food

Classification of Medication Classifications of medications

Helps to implement appropriate nursing actions before administering medication to a client

Classification of Medication Proper data gathering and follow up

Helps to prevent possible overdose or other adverse reactions that could be life threatening Becoming familiar with medication classifications helps the student to recognize possible adverse client effects, providing a basis for implementing appropriate nursing actions, should undesirable effects occur

Obtain apical pulse for 1 full minute!!!

If the client's heart rate is below 60 bpm or if irregularities in heart rhythm are present, withhold the medication and report the information toxicity or overdose include nausea, vomiting, headache, premature ventricular contractions, diarrhea, confusion, drowsiness, blurred vision, or visual disturbances in which lights appear much brighter that they really are to appear to have halos around them.

Explain Antihypertensives (reduce BP) Diuretics

Increase the amount of urine excreted by the kidneys. Thus, they decrease the body's circulating fluid volume, thereby lowering blood pressure. Indications for use include edema ( by increasing sodium execration, HTN, heart failure, and PIH Potassium wasting (HCTZ,Lasix) vs potassium sparing (Dyrazide, spironolactone, triamterene

Medications that affect the blood Anticoagulants

Increase the time it takes blood to coagulate. They are used to treat thrombophlebitis (blood clots), to prevent thrombus formation after surgery, and to treat blood disorders in which blood viscosity is abnormally high. Observe any client receiving anticoagulant therapy for evidence of bleeding, including bleeding gums or unexplained bruising. Check the stool for occult (hidden) blood

Antibiotic-resistant organisms

Indiscriminate use of antibiotics

Describe Calcium channel blockers

Inhibit or block movement of calcium ions across cell membranes, reducing peripheral vascular resistance and resulting in lowered blood pressure Eg: diltiazxam (Carizem, nifedipine (Procardia), veramamil (Calan), amlodipine ( Norvasc)

Effectiveness of antibiotic

Is soluble in water, diffuses readily into body tissue Does not cause an adverse or allergic reaction, or affect the normal flora ( normal useful bacteria in the body Is well absorbed by the GI tract Is not an antagonistic to other antibiotics

Diphenhydramine (Benadryl)

It is more sedating than other antihistamines and is sometimes prescribed as a sleep enhancer

Explain vasoconstrictors

Medications that primarily act on the blood vessels Vasoconstrictors (vasopressors)-used to control bleeding, increase heart's pumping action, increase BP, relieve nasal congestion Examples- norepinephrine, metaraminol, phenylephrine

Explain Antiarrhythmics

Medications that regulate heart rhythm (regulate and slow the heart rate, Quinidine, Procainamide Verapamil (calcium channel blocker; can also have antianginal and antihypertensive effects

Classification of Medication Cross Sensitivity

Medications that share common actions may also share common adverse effects

Medications that affect the Cardiovascular system Cardiotonics

Medications that stimulate or strengthen the heart's pumping action (common med digoxin) Digitalizing dose-to reduce heart rate to 60-80 bpm, maintenance dos-maintains (administered daily)

Other Narcotic analgesics

Methadone hydrochloride (Dolophine), a pregnancy category C agent, is much like morphine in that it is an effective pain reliever and has similarly lasting effects. However, it does not cause euphoria, so it is used to manage heroin addiction. Methadone is slightly more effective than morphine in relieving chronic pain and is effective in depressing the cough reflex.

Medications affecting the ear Ant-infectives, analgesics, and cerumenolytics

Most medications that affect the ears are applied directly into the ears to treat localized conditions Commonly used medications Anti-infectives (to treat ear infections analgesics (to treat the pain of otitis media, especially for children, and cerumenolytics (to loosen and remove impacted earwax)

Medications That Affect the GI Tract Mouth and Teeth

Mouthwashes- help kill microorganisms, relieve pain (swish and swallow, swish and spit, magic mouthwash) - stannous fluoride prevents tooth decay

Medications that affect the sensory system Other ophthalmic medications:

Nepafenac (Nevanac) and Ketorolac (Acular) are anti-inflammatory agents used in incisional refractive surgery (LASIK), and other laser surgeries to offset pain and photophobia. Azelastine (Optivar), emedastine (Emadine), levocabastine (Livostin), and olopatadine (Patanol) are used to treat allergic conjunctivitis

Explain Oxycodone

Oxycodone, typically combined with aspirin (Percodan) or acetaminophen (Percocet), is effective for the treatment of moderate pain. Side effects are similar to those found with other narcotics. Onset of action is approximately 15 minutes and the duration of action is 4 to 5 hours. OxyContin is the extended-release (ER) version of oxycodone.

Penicillin

Penicillin (PCN), derived from a specific mold, inhibits the growth of susceptible bacteria. It is also bactericidal (kills bacteria) in sufficiently high concentrations or blood levels. It is most effective against gram-positive organisms, such as streptococci, staphylococci, and pneumococci. It is also active against some gram-negative organisms, such as gonococci and meningococci, and against the organism that causes syphilis. PCN has also proven effective in treating early Lyme disease in some cases. It is excreted rapidly in the urine and is remarkably free of toxic effects. PCN is ineffective against the tubercle bacillus, all viruses, and the organisms causing typhoid fever. Therefore, is a fairly narrow-spectrum antibiotic. Has few side effects

Medications that affect the blood Heparin

Prevents platelets from attaching to blood vessel walls, the first step in thrombus formation. Heparin is useful in preventing postoperative thrombosis and embolism. Heparin is administered SQ. most often in the abdominal area, or IV LMWH-Lovenox

Describe Angiotensin-converting enzyme (ACE) inhibitors

Reduce peripheral vascular resistance in the hypertensive client by blocking the activation of angiotensin. They are the most widely prescribed antihypertensive agents Ex: captropril, enalapril, and lisinopril (prinivil, Zestril) Disbetic clients are often prescribed an ACE inhibitor to prevent kidney damage and diabetic neuropathy. Side effect of cough, may require d/c of medication

Medications That Affect the GI Tract Metoclopramide

Reglan functions as an antiemetic because it increases gastric motility, thus increasing gastric emptying time, which can lead to a decrease in nausea. Metoclopramide has the possibility of adverse side effects, including Parkinson-like dyskinesias and akathisia.

What are analgesics used for

Relieve pain

Describe Angiotensin II receptor blockers (ARBs)

Selectively block the binding of angiotension II to specific receptors in the smooth muscle of blood vessels and in the adrenal gland. This blocks the vasoconstriction effect of the RAAS. Treats HTN, heart failure, and reduces risk of CVA EX: cilexetil (Atacand), eprosartan mesylate ( Teveten, irbesartan (Avapro), losartan potassium (Cozaar), and Valsartan (Diovan)

Speed of action of medications

Several terms refer to the length of time a medication will be effective. Some are used interchangeably. Controlled release (CR): drug slowly released over a period of time Delayed release (DR): medication will begin to take effect after a period of time Extended release (ER): drug released over a longer period of time Immediate release (IR): drug released immediately after being taken Sustained release (SR): drug released over a period of time Depot, decanoate injections: drug released for 2 to 3 weeks Transdermal patches: drug released for 12 hours to 30 days

Medications that affect the Nervous system Depressants

Slow mental and physical processes Analgesics, hypnotics and sedatives, selective depressants

Interactions between food and medication

Some interact negatively with certain foods. Grapefruit juice A number of medications should not be given with grapefruit juice. Chemicals in the grapefruit juice inhibit the metabolism of these medications, which can lead to increased blood levels and medication toxicity. Do not take the following medications with grapefruit juice: albendazole alfentanil amiodarone (Cordarone) amlodipine (Norvasc) alprazolam (Xanax) atorvastatin (Lipitor) 17 beta-estradiol budesonide (Pulmicort) buspirone (BuSpar) caffeine carbamazepine (Tegretol) carvedilol (Coreg) cilostazol (Pletal) clarithromycin (Biaxin) clomipramine (Clomid) cortisol cyclophosphamide (Cytoxan) cyclosporine-A (Gengraf) dextromethorphan (Delsym, Robitussin) diltiazem (Cardizem) erythromycin estrogens (e.g., Premarin) etoposide (Toposar) felodipine (Plendil) fentanyl (Duragesic, Sublimaze) fexofenadine (Allegra) fluoxetine (Prozac) fluvastatin (Lescol) fluvoxamine (Luvox) indinavir (Crixivan) itraconazole (Sporanox) losartan (Cozaar) lovastatin (Mevacor) methadone (Dolophine) methylprednisolone (Medrol) midazolam (Versed) nelfinavir (Viracept) nicardipine (Cardene) nifedipine (Procardia) nimodipine nisoldipine (Sular) progesterone quinidine ritonavir (Norvir) saquinavir (Invirase) sertraline (Zoloft) sildenafil (Viagra) simvastatin (Zocor) sirolimus (Rapamune) sufentanil (Sufenta) tacrolimus (Prograf) tadalafil (Cialis) tamoxifen temsirolimus (Torisel) testosterone theophylline triazolam (Halcion) troleandomycin vardenafil (Levitra) verapamil (Calan) vinblastine (Velban) vincristine (Oncovin)

High alert medications

Some medications look alike or their names sound alike. Be particularly careful when administering these medications. Examples include: • OxyCONTIN and oxyCODONE • hydrALAZINE and hydrOXYzine • ePINEPHrine and ePHEDrine • hydroMORPHONE (Dilaudid) and MORPHINE • loRAZEPAM (Ativan) and ALPRAZolam (Xanax) • METROnidazole and METformin • CeleBREX (celecoxib), CeLEXA (citalopram), and CereBYX (fosphenytoin) • cloNIDine (Catapres) and KlonoPIN (clonazePAM) • vinBLASTine and vinCRISTine Other medications carry high potential for life-threatening effects, if used incorrectly. These include: • chemotherapy agents • any intravenous (IV) narcotics • heparin • any insulin preparation • digoxin and derivatives • blood products Often, agency protocol requires nurses to double-check any high alert medications before administration.

Explain tetracyclines

Tetracyclines (TCN) are broad-spectrum antibiotics effective against a wide variety of organisms, including Rickettsia, Chlamydia, and Mycoplasma. They are sometimes used in clients who are allergic to penicillin. TCNs are well absorbed orally and are also available for IM or IV use. The presence of food and some dairy products (especially milk) in the stomach decreases oral absorption. To promote GI absorption, clients should receive tetracyclines on an empty stomach at least 1 hour before or 2 to 3 hours after eating. The presence of iron, calcium, magnesium, or aluminum in the stomach influences tetracycline absorption. Therefore, clients taking tetracyclines should not take antacids such as Gelusil, Maalox, Mylanta, Tums, or Milk of Magnesia. Oral calcium supplements will also inhibit absorption and should be taken at least 1 hour before or 3 hours after taking tetracyclines. Photosensitivity (sensitivity to light) may develop.

FDA pregnancy categories

The U.S. Federal Drug Administration (FDA) has established categories of risk potential during pregnancy, as related to benefits. • Category A: A risk has not been documented during pregnancy. • Category B: Animal studies have not shown a risk, but there is inadequate documentation in humans, OR animal studies have shown adverse effects, but this has not been demonstrated in humans. • Category C: Animal studies have shown adverse effects, but there are no adequate studies in humans, OR the benefits to the pregnant woman may outweigh potential risks, OR there are no adequate studies in humans or animals. • Category D: There is evidence of human fetal risk, but the benefits may outweigh potential risks. • Category X: Abnormalities have been documented. The risk of use in pregnant women precludes the use of the medication. • Category N: FDA has not yet classified the drug. It is important to remember that no drugs should be administered to pregnant women unless absolutely necessary.

Thyroid replacement hormones Name them

Thryroxine (T4) Triiodothyronine (T3)

Antihistamines

Treat allergic reactions. vasoconstrictive effects have the greatest impact on nasal mucous membranes. They are particularly helpful in controlling the symptoms of allergic rhinitis. Contraindicated in clients with glaucoma and DM. Commonly used antihistamines include cetirizine (Zyrtec), chlorpheniramine maleate (Chlor-Trimeton), clemastine fumarate (Tavist), diphenhydramine (Benadryl), fexofenadine (Allegra), loratadine (Claritin), and promethazine (Phenergan)

Anaphylactic reactions may result from the administration of any drugs T or F

True Severe, total-body life-threatening adverse reactions are anaphylactic reactions and may result from the administration of any drug Although these reactions are rare, death can result if proper treatment is not instituted immediately. Medications can react with OTC medications to cause toxicity Medications can react with other medications prescribed for the client.

Clients taking tetracylines should not take antacids such a Gelusil, Tums, or Milk of Magnesia T or F

True The presence of iron, calcium, magnesium, or aluminum in the stomach influences tetracyclines absorption. Therefore, clients taking tetracyclines should not take antacids such as Gelusil, Maalox, Mylanta, Tums, or Milk of Magnesia Oral calcium supplements will also inhibit absorption and should be taken at least 1 hour before or 3 hours after taking tetracyclines

Antibiotic therapy should not start until after the specimen for C&S is forwarded to the laboratory for analysis T or F

True To ensure the accuracy of tests result, antibiotic therapy should not start until after the specimen for C&S is obtained and forwarded to the laboratory for anolysis If antibiotic therapy begins before the specimen is secured, the numbers and types of bacteria present in the specimen could be reduced, which may result in inappropriate, and perhaps ineffective, antibiotc selection

Interactions between drugs (drug-drug interactions

Vary from decreased effectiveness of the drug to overdose of the drug to overdose of the drug This includes the use of prescription drugs, OTC drugs, vitamins, and herbal supplements. The possible interactions vary from decreased drug effectiveness to overdose If you are not familiar with your client's medications, always consult a reliable reference to ensure maximum benefit to your client.

Explain Vasodialators

Vasodialators-dilate blood vessels, treat peripheral blood vessel disease, CAD HTN (increase lumen size of blood vessels and increase blood flow)

Medications that affect the blood Coagulants

Vitamin K (necessary in formation of prothrombin)

Blood products Whole blood

Whole blood is indicated primarily when ther is a rapid loss of both RBC's and plasma, such as in massive hemorrhage. A transfusion of whole blood quickly increases the number of erythrocytes, restoring blood volume and, thus, raising blood pressure. For most transfusions, packed red cells are preferred because they provide only the blood component needed, without extra fluid. Administration of packed RBC's helps prevent circulatory overload

Fecal softeners

act like a detergent by helping permit water and fatty material to mix with fecal contents. They cause stools to become moist and bulky, thus stimulating the bowel and softening the stool so it can be expelled more easily. DSS- Docusate Sodium, Surfak- Docusate calcium

Explain noncatecholamines

agonist that affects the contractility of heart muscle and increases blood pressure. It is used to treat severe shock and hypotension. Dopamine is available for IV administration. Side effects include restlessness, nervousness, headache, tachycardia (rapid pulse), palpitations, and anginal-type chest pain.

Miscellaneous agents

an antihypertensive that may be used on a continuing basis or in hypertensive emergency is clonidine HCL

Medications that affect the blood Warafarin (coumadin

anticoagulant used to treat venous thrombosis and pulmonary embolism. It prevents thrombophlebitis by inhibiting synthesis of all types of prothrombin. It is available in tablets for oral administration and also in parenteral form for dilution in sterile water Clients receiving any anticoagulant therapy should have regular PT or PTT evaluations to ensure the blood is not becoming "over anticagulated"

Medications That Affect the GI Tract Prochlorperazine HCl (Compazine

antipsychotic drug that is also used to control nausea and intractable hiccoughs

A client is prescribed lisinopril (Prinivil) for the treatment of hypertension. What undesirable side effect does the nurse inform the client may be experienced that requires discontinuation of the medication? a. Nausea b. Dry cough c. Increase in urination d. Constipation

b. Dry cough

A client develops a severe allergic reaction while receiving an IV antibiotic. What medication should be immediately administered by the nurse with a healthcare provider's order? a. Prednisone b. Norepinephrine (Levophed) c. Tylenol d. Epinephrine

d. Epinephrine

A client taking digoxin (Lanoxin) has a heart rate of 50 bpm, vomiting, diarrhea, confusion, and reports seeing a halo around the visual field. What is the appropriate action by the nurse? a. Administer the antiemetic prescribed by the healthcare provider. b. Administer the next dose of digoxin and monitor the client. c. Administer Epinephrine since the client is having an allergic reaction. d. Withhold further doses and report findings to the healthcare provider immediately.

d. Withhold further doses and report findings to the healthcare provider immediately.

Medications that affect the sensory system Mydriatics and miotics

dilate or constrict pupils

Medications That Affect the GI Tract Antispasmodics

educes gastric secretions and slows GI motility. Although there are a number of these medications, they are associated with adverse effects, including blurred vision, dry mouth, and rapid heart rate. Antispasmodics include dicyclomine HCl (Bentyl), and glycopyrrolate (Robinul).

Adrenergics or sympathomimetics

epinephrine or a substance that acts like epinephrine

Medications that affect the sensory system Opthalamic antibiotics

examples-bacitracin (AK-Tracin), tobramycin ( Tobrex), (ofloxacin), and moxifloxacin (Vigamox).

Antidiarrheals

given to slow GI peristalsis and stop diarrhea. Examples are diphenoxylate hydrochloride in combination with atropine (Lomotil) and loperamide (Imodium). Lomotil is a schedule V controlled substance. It reduces intestinal motility and increases intestinal tone. It must not be given to children younger than 2 years.

Medications That Affect the GI Tract Proton pump inhibitors

inhibit gastric acid secretion in its final stage. They are used in the treatment of ulcers and in gastroesophageal reflux disease (GERD). Omeprazole (Prilosec), esomeprazole (Nexium), rabeprazole (Aciphex), pantoprazole (Protonix), and lansoprazole (Prevacid)

Lidocaine hydrochloride ( Xylocaine)

is used to treat life-threatening ventricular arrhythmias following MI. It is available for this only in IV or IM forms and should be used only in intensive care settings Other antiarrhythmics include acebutolol HCL (Sectral, adenosine (Adenocard), amiodarone (Cordarone), carvedilol (Coreg). flecainide acetate (Tambocor), ibutilide fumarate (Corvert), and tocainide HCL (Tonocard)

Corticosteroid

nasal spray is used when antihistamines are ineffective in controlling the symptoms of allergic rhinitis. They are very effective and the newer forms have few, if any, side effects. They are available OTC (Nasacort) and by prescription (Nasonex). If the inhaled form of corticosteroid is not effective, oral corticosteroids may be needed to bring the situation under control. Oral agents may be used only for a maximum of 10 days. D/C of steroids should be tapered Immune sera and vaccines

Catecholamines, explain

neurotransmitters that play an important part in the body's response to stress. Their release at sympathetic nerve endings increases cardiac output by increasing the strength of cardiac muscle contractions, constriction of peripheral blood vessels, rising blood pressure, and bronchodilation. Epinephrine (adrenaline) and norepinephrine are catecholamines.

Medications That Affect the GI Tract Ondansetron (Zofran)

prevention and treatment of nausea and vomiting associated with chemotherapy, radiotherapy, and that following surgery. It is available for administration IV, or orally in tablets, oral solution, and orally disintegrating tablets.

Decongestants

reducing swelling of nasal membranes and opening nasal passages. Administered orally as tablets or liquids, or topically as nasal sprays or nose drops. Nasal decongestants should not be used for longer than 3 days; after this time they cause rebound congestion (the client becomes congested again). Oral decongestants, such as pseudoephedrine HCl (Sudafed) are contraindicated in clients who have HTN, because they can increase blood pressure. Sudafed is regulated by federal government because it is a component of methamphetamine.

Respiratory stimulants naloxone(Narcan)

specific antidote to opiates, is most often used to reverse respiratory depression resulting from opiate overdose

Medications That Affect the GI Tract Medications that produce or stop vomiting Emetics Antiemetics

symptomatic relief from nausea and vomiting

Chlorpheniramine (Chlor-Trimeton)

than other antihistamines and is sometimes prescribed as a sleep enhancer. Chlorpheniramine (Chlor-Trimeton) is slower acting, but has fewer side effects than diphenhydramine. Loratadine (Claritin), Cetirizine (Zyrtec), and fexofenadine (Allegra) are long acting (24 hours) and have the advantage of once-daily dosing. They cause the least drowsiness of drugs in this class. Combinations of antihistamines and decongestants (Claritin-D, Zyrtec-D, Allegra-D, Dimetapp) are useful in treating sinusitis, rhinitis, nasal congestion, and postnasal drip.

Osmotic agents

total bowel emptying is required. One common agent for this process is polyethylene glycol electrolyte solution (Colyte, GoLYTELY). Osmotic agents are not absorbed and, thus, do not result in electrolyte imbalance. The client must drink the total amount of solution over 3 hours. Because the total prescribed amount is contained in 4 L of solution, monitor intake and encourage the client to drink the total amount. Polyethylene glycol 3350, NF powder (Miralax), is an OTC laxative. It is an osmotic product that draws water into the stool, softening the stool and increasing the frequency of bowel movements. The dose is 17 g of powder, mixed in 8 oz of water.

What do Nitrates do

treat heart pain NTG-treatment of choice for angina pectoris. Symptom relief within 1-2 mins, duration of 30 mins (Nitroglycerin tablets should not be crushed, chewed, or swallowed. Translingual spray should not be inhaled or swallowed. Sustained-release forms should be given with water.) Amyl Nitrate Hydralazine, Prazosin

Medications That Affect the GI Tract Antiflatulents-

treat symptoms associated with excess flatus (gas) in the digestive tract. Simethicone (Mylicon, Gas-X) is the most common antiflatulent. It is safe to use in infants with colic. It is dosed after meals and at bedtime.

Medications That Affect the GI Tract Dimenhydrinate (Dramamine)

used for motion sickness