HESI MEDS

Cardiac Glycosides- Used for Description

They are used in heart failure, atrial tachycardia, atrial fibrillation, and atrial flutter.

Direct-Acting Arteriolar Vasodilators- Used for Description

They are used in the client with moderate to severe hypertension and during acute hypertensive emergencies.

Direct-Acting Arteriolar and Peripheral Vasodilators Sodium Nitroprusside Toxicity Nursing Considerations

With sodium nitroprusside, cyanide toxicity and thiocyanate toxicity are possible; monitor cyanide and thiocyanate levels.

Spironolactone, a potassium-retaining diuretic, is prescribed for a client with heart failure, and the nurse provides medication instructions to the client. Which statement by the client indicates an understanding of the instructions? 1. "I need to avoid foods that contain potassium." 2. "I should take the medication on an empty stomach." 3. "I need to eat a banana or drink a glass of orange juice every day." 4. "I need to drink at least 10 to 12 glasses of water per day while I'm taking this medication.

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A client has been prescribed levothyroxine. The nurse should instruct the client to take the medication by which procedure? 1. With food 2. At bedtime 3. With a snack at 3 p.m. 4. In the morning, on an empty stomach

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Macular Degeneration Treatment Description

Age-related macular degeneration (ARMD) may be of the "dry" or "wet" (neovascular) type.

Antiparkinsonian Medications-Include Description

Antiparkinsonian medications include the dopaminergics, which stimulate the dopamine receptors; and the anticholinergics, which block the cholinergic receptors.

Diuretics- Loop Nursing Considerations

Monitor the client taking a loop diuretic for ototoxicity.

Insulin Description

Insulin is prescribed for clients with type 1 diabetes mellitus.

Antiplatelet Medications Nursing Considerations

Monitor the client for bleeding complications and initiate bleeding precautions as needed.

Treatments for Diabetes Mellitus- Glucagon Blood Glucose Regulators Description

which increases blood glucose by stimulating glycogenolysis in the liver, is used to treat insulin-induced hypoglycemia in the client who is semiconscious or unconscious and unable to ingest liquids; the blood glucose level begins to increase within 5 to 20 minutes of administration.

Antiviral medications: (ending)

Most contain vir (e.g., acyclovir).

Tuberculosis Treatment Administration

Most medications should be taken on an empty stomach, with 8 oz (235 ml) of water, 1 hour before or 2 hours after meals to enhance absorption.

Estrogens: (ending)

Most names contain -est (e.g., estradiol or conjugated estrogen).

Nitrates: (ending)

Most names contain nitr (e.g., nitroglycerin).

Pancreatic enzyme replacements: (ending)

Most names contain pancre (e.g., pancrealipase).

Thyroid hormones: (ending)

Most names contain thy (e.g., levothyroxine).

Histamine H2 receptor antagonists: (ending)

Most names end in -dine (e.g., cimetidine).

Sulfonylureas: (ending)

Most names end in -ide (e.g., glipizide). These medications are used to treat diabetes mellitus.

Xanthine bronchodilators: (ending)

Most names end in -line (e.g., theophylline).

Carbonic anhydrase inhibitors: (ending)

Most names end in -mide (e.g., dorzolamide). These medications are used to treat glaucoma.

Calcium channel blockers: (ending)

Most names end in -pine (e.g., amiodipine); exceptions include diltiazem and verapamil.

Antidiuretic hormones: (ending)

Most names end in -pressin (e.g., desmopressin).

Glucocorticoids and corticosteroids: (ending)

Most names end in -sone (e.g., prednisone).

Thiazide diuretics: (ending)

Most names end in -zide (e.g., hydrochlorothiazide).

Proton pump inhibitors: (ending)

Most names end in -zole (e.g., lansoprazole).

Beta-adrenergic blockers: (ending)

Most names end with -lol (e.g., atenolol).

Angiotensin-converting enzyme (ACE) inhibitors: (ending)

Most names end with -pril (e.g., enalapril).

Androgens: (ending)

Most names end with -terone (e.g., testosterone).

Thrombolytics: (ending)

Most names include -ase (e.g., alteplase).

Sulfonamides: (ending)

Most names include sulf (e.g., sulfasalazine).

Expectorants and Mucolytic Agents Nursing Considerations

Mucolytic agents with dextromethorphan, which suppress the cough, should not be used by clients with COPD. Acetylcysteine can increase airway resistance and should not be used in clients with asthma. Instruct the client to take the medication with a full glass of water to loosen mucus and increase fluid intake. Encourage the client to cough and deep-breathe.

Medications That Affect Hearing

*Antibiotics Amikacin Chloramphenicol Erythromycin Gentamicin Streptomycin sulfate Tobramycin sulfate Vancomycin **Diuretics Ethacrynic acid Furosemide **Others Cisplatin Nitrogen mustard Quinine Quinidine

Integumentary Medications- Topical Medications (nursing considerations)

-Topical medications should be applied in a thin layer and gently rubbed into the skin unless otherwise specified by the health care provider. Medications should not be applied to denuded areas unless prescribed, because undesired absorption may occur.

A client with tuberculosis has been taking isoniazid, and now the health care provider has added rifampin to the medication regimen. The client calls the nurse and reports that her urine has been red-orange since she started taking the rifampin. Which response should the nurse give to the client? 1. "This is an expected side effect of the rifampin." 2. "Bring a urine specimen to the health care provider's office for analysis." 3. "The change in urine color is a result of the combination of medications." 4. "Increase your fluid intake. The medication may be causing hemorrhagic cystitis."

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A nurse reviewing laboratory results sees that the serum phenytoin level of a client who is taking oral phenytoin, 300 mg/day, is 22 mcg/mL. Which action should the nurse take first on the basis of this finding? 1. Call the client's health care provider 2. Administer the next scheduled dose 3. Place the laboratory result form in the client's record 4. Inform the client that the result is within the therapeutic range

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Cyclosporine is prescribed for a client who has undergone a kidney transplant. Which should the nurse plan to monitor most closely? 1. Temperature 2. Platelet count 3. Apical heart rate 4. Peripheral pulses

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The nurse discusses Carmela's current home medications with the health care provider. Which medication interactions does the nurse recognize as being of most concern? Select all that apply. 1. Potential systemic side effects of the betaxolol hydrochloride include heart failure. 2. The interaction of the glipizide and metoprolol may mask symptoms of hypoglycemia. 3. The dihydroxyaluminum sodium carbonate could affect the absorption of digoxin. 4. The dihydroxyaluminum sodium carbonate must be used with caution in clients with glaucoma. 5. Betaxolol hydrochloride may contribute to hypertension when taken with the newly prescribed medications.

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The nurse is preparing to administer Carmela's hospital prescribed medications: captopril, furosemide, metoprolol, and digoxin. Which nursing actions are essential before the medications are administered? Select all that apply. 1. Checking fluid balance 2. Counting the apical heart rate 3. Measuring the blood pressure 4. Assessing the client for hypokalemia 5. Performing a complete physical assessment

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Carmela has been receiving furosemide 40 mg/day. For which side/adverse effects does the nurse monitor the client's laboratory results? Select all that apply. 1. Hypokalemia 2. Hypouricemia 3. Hypoglycemia 4. Hypernatremia 5. Hypermagnesemia 6. Increased blood urea nitrogen (BUN)

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Osmotic Medications Description

Osmotics are used to lower intraocular pressure in the emergency treatment of glaucoma. They are also used before and after surgery to decrease the volume of vitreous humor. Such medications include glycerin and mannitol.

A client with Hodgkin's disease will be receiving chemotherapy with doxorubicin. Which action should the nurse plan to take as a means of monitoring the client for toxicity specific to this medication? 1. Checking the client's temperature 2. Attaching a cardiac monitor to the client 3. Assessing the client for peripheral edema 4. Drawing a blood specimen to check the client's platelet count

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A client with terminal cancer is receiving morphine sulfate by way of continuous IV infusion. The nurse checks the client's vital signs and notes a pulse rate of 68 beats/min, a blood pressure of 100/58 mm Hg, and a respiratory rate of 10 breaths/min. Which action should the nurse take? 1. Decrease the rate of infusion 2. Contact the health care provider 3. Ask the client to rate the pain level 4. Continue to monitor the client's vital signs

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A nurse monitoring a client who is receiving intravenous theophylline checks the client's most recent blood theophylline level. The nurse documents that the level is in the therapeutic range if which value is reported? 1. 8 mcg/mL 2. 14 mcg/mL 3. 24 mcg/mL 4. 32 mcg/mL

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Buspirone, a nonbenzodiazepine anxiolytic, is prescribed for a client to treat anxiety, and the nurse provides information to the client about the medication. The nurse should provide which information to the client? 1. The medication is addictive. 2. The medication does not usually cause sedation. 3. The medication relieves anxiety immediately, with the first dose. 4. The medication can intensify the effects of other CNS depressants

2

Carmela is preparing for discharge from the hospital. She has been receiving oral digoxin 0.125 mg/day and will be taking this medication after discharge. The nurse provides medication instructions to Carmela and her daughter. Which statement by Carmela's daughter indicates to the nurse that further instruction is needed? 1. "It's important for her to eat foods that contain potassium." 2. "We should expect visual disturbances with the medication." 3. "We need to check her pulse rate before giving the medication." 4. "She'll have to have blood tests from time to time to check the medication level."

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Oral prednisone, 10 mg/day, has been prescribed for a hospitalized client with a history of type 1 diabetes mellitus for the treatment of an acute exacerbation of asthma. The nurse should monitor the client closely for which occurrence? 1. Signs of hypoglycemia 2. Signs of hyperglycemia 3. The need to decrease the prescribed daily insulin dose 4. The need to change the prescribed daily insulin to an oral hypoglycemic medication

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Rectally administered lactulose is prescribed for a client with hepatic encephalopathy. Which parameter should the nurse monitor to evaluate the effectiveness of the medication? 1. Blood pressure 2. Ammonia level 3. Electrolyte levels 4. Looseness of stools

2

A nurse is preparing to administer digoxin, 0.125 mg orally, to a client with heart failure. Which findings indicate the need to withhold the medication and contact the health care provider? Select all that apply. 1. The client complains of being hungry. 2. The client complains of double vision. 3. The client's digoxin level is 1.8 ng/mL. 4. The client's potassium level is 3.0 mEq/L (3.0 mmol/L). 5. The client's apical heart rate is 62 beats/min

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Which side/adverse effect of captopril will the nurse monitor for in Carmela? 1. Weight gain 2. Bradycardia 3. Hypotension 4. Hypokalemia

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A client is taking capreomycin sulfate, a second-line tuberculosis medication, as a component of pharmacological treatment for the disease. The client calls the nurse at the health care provider's office and reports that he is experiencing ringing in the ears. How should the nurse respond? 1. "You should stop taking the medication immediately." 2. "Ringing in the ears is a harmless effect of the medication." 3. "Ringing in the ears is an expected effect of the medication." 4. "You need to speak to the health care provider about the problem."

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A client with breast cancer who has undergone a mastectomy will be receiving chemotherapy. The oncologist prescribes allopurinol, 100 mg orally daily, to be started before the initiation of chemotherapy. The nurse should tell the client that this medication is used for which purpose? 1. To prevent nausea 2. To prevent diarrhea 3. To reduce postoperative incision pain 4. To minimize an increase in the plasma uric acid level

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A nurse has taught a client with type 1 diabetes mellitus how to draw up and mix the prescribed dose of NPH insulin 20 units and regular insulin 6 units. Which action should the client take first to perform this procedure correctly? 1. Drawing up the NPH insulin 2. Drawing up the regular insulin 3. Putting 20 units of air into the NPH insulin bottle 4. Putting 6 units of air into the regular insulin bottle

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A pregnant client is receiving an IV infusion of oxytocin. Monitoring the client closely, the nurse suddenly notes the presence of uterine hypertonicity. Which action should the nurse take immediately? 1. Document the finding 2. Turn the client on her side 3. Stop the oxytocin infusion 4. Increase the rate of infusion of the nonadditive IV solution

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Allopurinol has been prescribed to treat hyperuricemia in a client with gout, and the nurse provides instructions to the client for the medication. Which statement by the client indicates the need for additional instruction? 1. "I should take the medication with food." 2. "I need to stop putting gravy on my food." 3. "I'll need to limit my fluid intake while I'm taking this medication." 4. "I'll need to have my blood level of the medicine checked while I'm taking it.

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Levodopa is prescribed for a client with Parkinson disease. Which vitamin does the nurse instruct the client to avoid while taking the levodopa? 1. Thiamine 2. Riboflavin 3. Pyridoxine 4. Ascorbic acid

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A nurse is instructing a client about the use of sulfisoxazole, which has been prescribed to treat the client's urinary tract infection. Which instructions should the nurse provide to the client? Select all that apply. 1. Expect itching to develop. 2. Limit fluid intake to prevent edema. 3. Apply sunscreen if exposure to sunlight is expected. 4. Use over-the-counter corticosteroid cream for itchy rash. 5. Take the medication on an empty stomach with a full glass of water.

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A nurse provides medication instructions to a client with angina who will be taking nitroglycerin sublingually as needed for chest pain. Which statement by the client indicates the need for further teaching? 1. "I should store the medication in a dark, tightly closed bottle." 2. "I need to check the expiration date on the medication bottle." 3. "If I get a headache from the medication, I can take acetaminophen." 4. "If the first tablet doesn't relieve my chest pain, I should put 2 tablets under my tongue 5 minutes after taking the first."

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A pregnant client with preeclampsia is receiving an IV infusion of magnesium sulfate. Which medication, the antidote to magnesium sulfate, does the nurse ensure is readily available? 1. Vitamin K 2. Acetylcysteine 3. Protamine sulfate 4. Calcium gluconate

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Tranylcypromine sulfate is prescribed for a client with depression, and the nurse provides medication instructions to the client. Which statement by the client indicates a need for further instruction? 1. "I shouldn't eat bananas." 2. "I should get out of bed slowly in the morning." 3. "I need to carry a Medic-Alert card in my wallet." 4. "If I get a headache or any neck soreness, I can take some pain medication."

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Antimyasthenic Agents-Edrophonium Chloride Description

Edrophonium chloride is used to diagnose myasthenia gravis and to distinguish cholinergic crisis from myasthenic crisis (may be called the Tensilon test).

Oral Hypoglycemic Medications nursing considerations

Educate the client about the signs of hypoglycemia and hyperglycemia. Inform the client taking an oral hypoglycemic agent that insulin may be needed during times of stress, surgery, or infection.

Antihypertensives- Ace Inhibitors Nursing Considerations

A persistent dry cough is a common complaint amongst clients taking ACE inhibitors; instruct the client to contact the health care provider if this side effect occurs and persists.

Gastrointestinal Medications- Prokinetic Agent Description

A prokinetic agent such as metoclopramide stimulates motility of the upper GI tract and increases the rate of gastric emptying and is used to treat gastroesophageal reflux and paralytic ileus.

Anticoagulants- Heparin Description

A therapeutic dosage of heparin does not dissolve clots; instead, it prevents formation of new thrombi, and normal activated partial thromboplastin time (APTT) is maintained at 1.5 to 2.5 times normal.

Ocusert System Description

A thin eye wafer (disk) impregnated with time-release pilocarpine is placed in the upper or lower cul-de-sac of the eye; pilocarpine is released over the course of 1 week. (The disk is replaced every 7 days.) Ocusert was devised to overcome the need to apply pilocarpine frequently. Disadvantages include sudden leakage of pilocarpine, migration of the system over the cornea, and unnoticed loss of the disk.

Macular Degeneration Treatment-ARMD Description

ARMD is characterized by the presence of drusen, yellow deposits under the retina. Medications include pegaptanib, ranibizumab, and bevacizumab.

Nonopioid Analgesics Acetaminophen Description

Acetaminophen inhibits prostaglandin synthesis. It is used to ease pain and fever.

Nonopioid Analgesics Acetaminophen Nursing Considerations

Acetaminophen is contraindicated in clients with hepatic or renal disease, alcoholism, or hypersensitivity. The major concern is hepatotoxicity. Assess the client for a history of liver dysfunction. Monitor the client for signs of hepatic damage (e.g., nausea and vomiting, diarrhea, abdominal pain). Monitor liver function parameters. Tell the client that self-medication should not continue longer than 10 days in an adult or 5 days in a child because of the risk of hepatotoxicity. The antidote to acetaminophen is acetylcysteine.

Bronchodilators - GI Irritation Nursing Considerations

Administer oral medications with or after meals to decrease GI irritation.

Cardiac Glycosides- Diet Nursing considerations

Advise the client to eat foods high in potassium (e.g., fresh and dried fruits, fruit juices, vegetables, potatoes) unless he or she is taking a potassium-retaining diuretic (discussed later in this lesson).

Gastrointestinal Medications- Antacids Nursing Considerations

Allow 1 hour between antacid administration and the administration of other medications to minimize interactions with other medications.

Benzodiazepines: (ending)

Although this class includes medications such as alprazolam and chlordiazepoxide, most names such as diazepam end in -pam. (Another tip for identifying a benzodiazepine: The name includes a vowel-z-vowel combination.)

Gastrointestinal Medications- Aluminum Nursing Considerations

Aluminum preparations and sodium bicarbonate are used with caution in clients with hypertension and heart failure because they contain a significant amount of sodium.

Central Nervous System Stimulants Description

Amphetamines, which have a high potential for abuse, and caffeine stimulate the cerebral cortex of the brain. Analeptics and caffeine act on the brainstem and medulla and stimulate respiration. Anorexiants act on the cerebral cortex and hypothalamus to suppress appetite. CNS stimulants may be used to treat narcolepsy, attention deficit-hyperactivity disorder (ADHD), or obesity.

Cardiac Glycosides- increase risk of toxicity Nursing considerations

An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, or hypothyroidism; monitor laboratory values and notify the health care provider if abnormalities are noted. Monitor the client taking a potassium-losing diuretic or corticosteroids for hypokalemia. Note that the older client is more likely to experience toxicity.

Endocrine Medications: Androgens Nursing Considerations

Androgens can cause bleeding (if the client is taking an oral anticoagulant), hepatotoxicity, and a reduced serum glucose level, thereby reducing insulin requirements in the client with diabetes mellitus. Educate the client on the formulation and use of hormonal contraceptives. The nurse should provide the client taking fertility medication with information about the increased potential for multiple births and tell her to notify the health care provider if she experiences signs of ovarian stimulation (e.g., abdominal pain, distention).

Gastrointestinal Medications- Antacids Description

Antacids are used to treat peptic ulcer disease and gastroesophageal reflux disease.

Antibiotics Description

Antibiotics inhibit the growth of bacteria. They are subclassed as aminoglycosides, cephalosporins, fluoroquinolones, macrolides, lincosamides, monobactams, penicillins and penicillinase-resistant penicillins, sulfonamides, tetracyclines, antimycobacterials, antifungals, and antivirals.

Anticholinergic Eye Drugs Description

Anticholinergic agents block responses of the sphincter muscle in the ciliary body, producing mydriasis and cycloplegia.

Antiparkinsonian Medications-Anticholinergic Description

Anticholinergic medications block cholinergic receptors in the CNS, thereby suppressing acetylcholine activity; they reduce rigidity and some tremors but have minimal effect on bradykinesia.

Antiparkinsonian Medications-Anticholinergic Nursing considerations

Anticholinergic medications can cause thick, dry mucus in the client with chronic obstructive pulmonary disease.

Anticoagulants Description

Anticoagulant medications prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.

Anticonvulsant Agents Description

Anticonvulsant agents are used to depress abnormal neuronal discharge and prevent seizures. Anticonvulsant medication classifications include hydantoins, barbiturates, benzodiazepines, succinimides, oxazolidinediones, valproates, and iminostilbenes. One commonly prescribed anticonvulsant is phenytoin, a hydantoin.

Anticonvulsant Agents Nursing Considerations

Anticonvulsants are used with caution in clients taking anticoagulants, aspirin, sulfonamides, cimetidine, or antipsychotics. Absorption is decreased with the use of milk products, antacids, calcium preparations, and antineoplastic medications. Be aware of side and adverse effects and monitor liver and renal function parameters and the blood serum level of the medication. (The therapeutic phenytoin level is 10 to 20 mcg/dL.) Monitor the client for signs of medication toxicity (e.g., CNS depression, ataxia, nausea, vomiting, drowsiness, dizziness, restlessness, visual disturbances). Provide client education about the medication. Oral tube feeding may interfere with the absorption of oral phenytoin and diminish the medication's effectiveness; therefore tube feedings should be scheduled as far as possible from times of phenytoin administration. When administering intravenous phenytoin, dilute in normal saline solution and infuse no faster than 25 to 50 mg/min (as prescribed) to prevent hypotension and dysrhythmias; dextrose causes the medication to precipitate.

Gastrointestinal Medications- Antiemetics/Laxatives Description

Antiemetics are used to control vomiting and motion sickness; the choice of antiemetic is based on the cause of the nausea and vomiting. Laxatives are used to promote the elimination of stool; dependency can occur with long-term use. The goals of treatment for the client with diarrhea are to identify and treat the underlying cause, treat dehydration, replace fluids and electrolytes, relieve abdominal discomfort and cramping, and reduce the passage of stool.

Gastrointestinal Medications- Antiemetics Nursing Considerations

Antiemetics may cause drowsiness, so a priority intervention is protecting the client taking such a medication from injury.

Antihistamines- COPD Nursing Considerations

Antihistamines must be used with caution in clients with COPD because of their drying effect.

Antihypertensives- Nursing Considerations

Antihypertensives can cause orthostatic hypotension, and the client must be instructed in safety measures, such as changing positions slowly. Instruct the client not to discontinue the medication, because abrupt withdrawal can cause severe rebound hypertension.

Antiplatelet Medications Description

Antiplatelet medications inhibit the aggregation of platelets in the clotting process, thereby prolonging bleeding time. They are used in the prophylaxis of long-term complications following myocardial infarction, coronary revascularization, and stroke.

Endocrine Medications: Growth Hormone Nursing Considerations

Assess growth in the child who has been prescribed growth hormones; annual bone-age determinations may be required as well. Growth hormones may increase the blood glucose level. Antidiuretic hormones, used to treat diabetes insipidus, can cause water intoxication (signs include drowsiness, listlessness, headache, and shortness of breath) and nasal congestion with nasal administration.

Priority Points to Remember!

Assess the client for allergies and hypersensitivity to the prescribed medication. Assess the client for existing medical disorders that contraindicate the administration of a prescribed medication. The older client and the neonate and infant are at greater risk for medication toxicity than are the adult client. Nursing interventions always include checking the client's vital signs, monitoring significant laboratory results, watching for side and adverse effects of the medication, and client education. Many medications are contraindicated in pregnancy, during breastfeeding, and in infants and children. The client should avoid taking over-the-counter medications or any other medications (e.g., herbal preparations) unless they are approved for use by the health care provider. The client should wear a Medic-Alert bracelet if he or she is taking certain medications such as anticoagulants, oral hypoglycemics or insulin, certain cardiac medications, corticosteroids and glucocorticoids, antimyasthenic medications, anticonvulsants, and monoamine oxidase inhibitors. The client should follow up with the health care provider as prescribed.

Antibiotics Nursing Considerations

Assess the client for allergies. Check the appropriate laboratory values before therapy as appropriate and monitor these values during therapy for indications of adverse effects. Monitor the client for adverse effects and report them to the health care provider if any occur. Encourage fluid intake unless it is contraindicated. Teach the client about the medication and how to take it; emphasize the importance of completing the full prescribed course

Ocusert System Nursing Considerations

Assess the client's ability to insert the medication disk. Instruct the client to store the medication in the refrigerator. Instruct the client to discard damaged or contaminated disks. Inform the client that temporary stinging is to be expected but to notify the health care provider if blurred vision or brow pain occurs. Instruct the client to check for the presence of the disk in the conjunctival sac daily at bedtime and on arising. Because vision may change in the first few hours after the disk is inserted, instruct the client not to perform any activities such as driving. It is best to replace the disk at bedtime.

Opioid Antagonists Nursing Considerations

Assess the client's vital signs, especially respirations. Have oxygen and resuscitative equipment available during administration.

Osmotic Medications- Assess/ Monitor Nursing Considerations

Assess vital signs. Assess visual acuity. Assess the client's risk of injury. Monitor intake and output. Monitor weight. Monitor the client for electrolyte imbalances. Increase fluid intake, unless this is contraindicated. Monitor the client for changes in the level of orientation.

Nitrates- Adverse Effects Nursing Considerations

Avoid abrupt withdrawal of long-acting preparations to prevent the rebound effect of severe pain from myocardial ischemia. Headache, postural (orthostatic) hypotension, dizziness, weakness, flushing or pallor, reflex tachycardia, and paradoxical bradycardia are possible.

Antitussives- patients to avoid Nursing Considerations

Avoid administering antitussives to the client with a head injury or one who has just undergone cranial surgery. Avoid administering antitussives to the client using opioids, sedative hypnotics, barbiturates, or antidepressants, because depression of the CNS may result.

Bronchodilators Description

Bronchodilators dilate the airways of the respiratory tree, making air exchange and respiration easier for the client, and relax the smooth muscle of the bronchi. These medications are used to treat acute bronchospasm, acute and chronic asthma, bronchitis, chronic obstructive pulmonary disease, and emphysema.

Adrenergic Agonists Nursing Considerations

Be alert for side effects (e.g., dysrhythmias, angina, restlessness, urinary urgency or incontinence). Monitor the ECG. Monitor vital signs and urine output.

Central Nervous System Stimulants Nursing Considerations

Be aware of and alert to side and adverse effects.. Instruct the client to take the medication before meals and to avoid foods and beverages containing caffeine to prevent additional stimulation. Instruct the client to read labels of over-the-counter products (many contain caffeine) and to consult with the health care provider before taking OTC medications. Instruct the client to take the last daily dose of the CNS stimulant at least 6 hours before bedtime to help prevent insomnia. Monitor the client for drug dependence and tolerance. If a child is taking a CNS stimulant, instruct the parents to notify the school nurse. Monitor the child with ADHD for calming effects of CNS stimulants within 3 to 4 weeks of the start of therapy. Monitor growth in the child undergoing long-term therapy. Page 90 of 137

Opioid Analgesics Nursing Considerations

Be aware of cautions for specific medications. Initiate nonpharmacological measures before administering an opioid analgesic. Administer the medication 30 to 60 minutes before painful activities. An electronic infusion device is always used for IV infusion. Monitor the respiratory rate; if it is slower than 12 breaths/min in an adult, withhold the medication and notify the health care provider. Monitor the pulse; if bradycardia develops, withhold the medication and notify the health care provider. Monitor the blood pressure for hypotension. Auscultate the lungs for breath sounds. Encourage activities such as turning, deep breathing, and incentive spirometry to help prevent atelectasis and pneumonia. Monitor the client's level of consciousness. Initiate safety precautions. Monitor intake and output and assess the client for urine retention. Instruct the client to take oral doses with milk or a snack to reduce gastric irritation. Instruct the client to avoid activities that require alertness. Assess the effectiveness of the medication. Have an opioid antagonist (e.g., naloxone), oxygen, and resuscitation equipment available.

Antilipemic Medications- Side Effects Nursing Considerations

Be aware of the possibility of side effects, including GI disturbances (e.g., nausea, abdominal discomfort or cramps, flatulence, diarrhea, constipation), muscle aches, headache, blurred vision, and pruritus or rash.

Urinary Analgesics Renal Medications- Side Effects Nursing Considerations

Be aware of the possible side effects of nausea, headache, and vertigo. Inform the client that the urine will turn red or orange.

Osteoporosis Prevention and Treatment Nursing Considerations

Because of the risk of esophagitis, bisphosphonates must be administered in the morning, before the client eats or drinks, with a full glass of water; the client must then remain sitting or standing for at least 30 to 60 minutes, depending on the medication. Antiresorptive medications (nonbisphosphonate) are contraindicated in clients with a history of venous thrombotic events. Antiresorptive medications must be discontinued 72 hours before any period of prolonged immobilization (e.g., extended bed rest). Instruct the client taking antiresorptive medications to avoid extended periods of restricted activity (e.g., while traveling).

Antidysrhythmic Medications- Lidocaine Nursing Considerations

Before administering lidocaine, always check the vial label to prevent administering a form that contains epinephrine or preservatives; such solutions are used for local anesthesia only.

Glaucoma Treatment Beta-Adrenergic Blockers Contraindicated

Beta-adrenergic blockers are contraindicated in the client with asthma because systemic absorption can cause increased airway resistance. Use with caution in the client receiving oral beta-blockers.

Glaucoma Treatment Beta-Adrenergic Blockers Contraindicated/Caution

Beta-adrenergic blockers are contraindicated in the client with asthma because systemic absorption can cause increased airway resistance. Use with caution in the client receiving oral beta-blockers.

Antihypertensives- Beta Adrenergic Blockers Nursing Considerations

Beta-adrenergic blockers can mask the early signs of hypoglycemia (e.g., nervousness, tachycardia).

Cholinergics Description

Bethanechol chloride is used to increase bladder tone and function and to treat nonobstructive urine retention and neurogenic bladder.

Gastrointestinal Medications- Bile Acid Sewuestrants Description

Bile acid sequestrants are used to treat hyperlipidemia in adults, bilary obstruction, and pruritus associated with bilary disease.

Gastrointestinal Medications- Bile Acid Sequestrants Nursing Considerations

Bile acid sequestrants should be used cautiously in clients with suspected bowel obstruction or severe constipation because they can worsen these conditions.

Anticholinergic Medications Side effects

Blurred vision Dry mouth and dry secretions Increased pulse rate Constipation Urine retention Restlessness and confusion Photophobia

Bronchodilators - Contraindicated in Nursing Considerations

Bronchodilators are contraindicated in individuals with peptic ulcer disease, severe cardiac disease or cardiac dysrhythmias, hyperthyroidism, and uncontrolled seizure disorders.

Glaucoma Treatment Carbonic Anhydrase Inhibitors Contraindicated

Carbonic anhydrase inhibitors should not be used in clients who are allergic to sulfonamides.

Cardiac Glycosides Description

Cardiac glycosides increase the force of myocardial contractions and slow the heart rate.

Ceruminolytic Preparations Nursing Considerations

Ceruminolytic medications may cause irritation and redness or swelling of the ear canal. Instruct the client not to use the drops more often than prescribed. Moisten a cotton plug with medication before insertion. Avoid touching the ear with the medication dropper. Keep the container tightly closed and away from moisture. Thirty minutes after instillation, gently irrigate the ear as prescribed. Instruct the client to notify the health care provider if redness, pain, or swelling occurs and persists.

Glaucoma Treatment Beta-Adrenergic Blockers Check before administration

Check vital signs, especially blood pressure and pulse, before administering the medication; if the pulse is 60 beats/min or slower or if the systolic blood pressure is 90 mm Hg or lower, withhold the medication and contact the health care provider.

Cholinergics-When not to administer Nursing Considerations

Cholinergics are not administered if the client has a urinary tract obstruction. Never administer a cholinergic by way of the intramuscular or IV route.

Diuretics- Side Effects Nursing Considerations

Common side effects include hypokalemia, hyponatremia, hyperglycemia, hyperuricemia, hypovolemia with signs of dehydration, hypotension, and photosensitivity.

Alzheimer Disease Treatment

Description Acetylcholinesterase inhibitors may be used to treat Alzheimer disease to improve cognitive function in the early stages. Nursing Considerations Donepezil: Side effects include nausea and diarrhea, and the medication may slow the heart rate by means of its vagotonic effect. Tacrine: Side effects include ataxia, loss of appetite, nausea and vomiting, and diarrhea; hepatotoxicity is an adverse effect, and liver function parameters must be monitored. Galantamine: Side effects include nausea and vomiting, diarrhea, anorexia, and weight loss; it can also cause bronchoconstriction and is used with caution in clients with asthma and COPD. Memantine: Side effects include dizziness, headache, confusion, and constipation; sodium bicarbonate and other medications that alkalinize the urine can decrease renal excretion of memantine, resulting in accumulation to toxic levels. Rivastigmine: Side effects include nausea and vomiting, diarrhea, abdominal pain, and anorexia; it is used with caution in clients with peptic ulcer disease, bradycardia, sick sinus syndrome, urinary obstruction, and lung disease, because it enhances cholinergic transmission, thereby intensifying symptoms of these disorders.

Antianxiety (Anxiolytic) Medications

Description Antianxiety medications include barbiturates, sedative-hypnotics, benzodiazepines, and nonbenzodiazepines. They are used to promote sleep and relieve anxiety and to suppress seizure disorders, relax muscles, ease alcohol withdrawal, and induce anesthesia. Nursing Considerations Antianxiety medications can cause profound respiratory depression when used with other CNS depressants. Physical dependence is possible; to minimize withdrawal symptoms, medication should be withdrawn gradually over a period of weeks or months. Abrupt withdrawal can be life-threatening, and withdrawal should only occur under medical supervision. Most medications cause daytime sedation, so safety is a priority. (Buspirone, a nonbenzodiazepine anxiolytic, does not usually cause sedation.) Anterograde amnesia (impaired recall of events that take place after dosing) may occur. Paradoxical effects (e.g., insomnia, excitation, euphoria, heightened anxiety, rage) are possible; the medication should be withdrawn if these occur. Signs of toxicity of oral benzodiazepines include drowsiness, lethargy, confusion; profound hypotension, respiratory arrest, and cardiac arrest. IV flumazenil, a benzodiazepine antagonist, is used to treat benzodiazepine toxicity.

Antipsychotic Medications

Description Conventional antipsychotics block receptors for dopamine in the CNS. They may cause extrapyramidal syndrome. Atypical antipsychotics produce moderate blockade of receptors for dopamine. The risk of extrapyramidal syndrome is low. Schizophrenia is the primary indication for antipsychotic medications; other uses include mood disorders, Tourette syndrome, dementia and other organic mental syndromes, delusional disorders, and schizoaffective disorder. Nursing Considerations Side/adverse effects include drowsiness, blood dyscrasias, pruritus, photosensitivity, elevated blood glucose level, weight gain, and gynecomastia; anticholinergic and extrapyramidal effects may also occur. Monitor the client for side and adverse effects and signs of extrapyramidal syndrome and neuroleptic malignant syndrome; inform the client of these signs and stress the need to report them to the health care provider immediately if they occur. Obtain a baseline ECG, CBC, and determinations of electrolytes and liver and renal function parameters as prescribed. Instruct the client to use sunscreen, hats, and protective clothing outdoors. Instruct the client to report signs of agranulocytosis, including sore throat, fever, and malaise. Instruct the client to report signs of liver dysfunction, including jaundice, malaise, fever, and right-side upper abdominal pain. Inform the client of the possibility of sexual dysfunction and stress the need to report it to the health care provider.

`Lithium Carbonate

Description Lithium is a mood stabilizer. It affects cellular transport mechanism and alters both presynaptic and postsynaptic events affecting serotonin, thereby enhancing serotonin function. Lithium is used to control acute manic episodes and as prophylaxis against recurrent mania and depression. Nursing Considerations Lithium is contraindicated during the first trimester of pregnancy and should be avoided in the second and third trimesters. (It must be avoided during breastfeeding; lithium is excreted in breast milk.) Use lithium with caution in the presence of renal disease, cardiovascular disease, dehydration, or sodium depletion and in the client taking a diuretic. The therapeutic serum level is 0.6 to 1.2 mEq/L, only slightly lower than the toxic concentration. The serum lithium level should be checked every 2 to 3 days during initial therapy and every 1 to 3 months during maintenance or whenever a behavioral change suggests an altered serum level; blood samples should be drawn in the morning, 12 hours after the last dose was taken. An increased lithium level may result from decreased sodium intake; fluid and electrolyte loss associated with severe sweating, dehydration, diarrhea, or diuretic therapy; illness; or overdose. The client is educated about the signs of toxicity; if any occur, the medication is withheld and the health care provider is notified immediately. The medication is administered with food to minimize GI irritation. To help prevent toxicity, instruct the client to maintain adequate sodium intake, to drink eight to 12 glasses of water a day, and to avoid excessive amounts of caffeine, which has a diuretic effect. Monitor the client for suicidal tendencies and institute suicide precautions.

Magnesium Sulfate

Description Magnesium sulfate is a CNS depressant and anticonvulsant that causes smooth muscle relaxation. It is used to stop preterm labor to prevent preterm birth and prevent and control seizures in preeclamptic and eclamptic clients. Nursing Considerations Magnesium sulfate is administered by way of IV infusion with the use of an infusion monitoring device; carefully monitor the dose being administered. It may slow the respiratory and heart rates, dull reflexes, and cause flushing or hypotension. A continuous infusion increases the risk of magnesium toxicity in the neonate and should not be used in the 2 hours preceding delivery. The medication may be prescribed for the first 12 to 24 hours after delivery if it is being used for preeclampsia. High doses may cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest, so the medication is contraindicated in the client with heart block, myocardial damage, or renal failure and used with caution in the client with renal impairment. Careful monitoring of the client is essential. Keep calcium gluconate, which antagonizes the effect of magnesium sulfate, on hand in case of overdose. Test the patellar (knee-jerk) reflex (see image) before administering repeat parenteral doses. (Suppression of this reflex, which is used as an indicator of CNS depression, may be a sign of impending respiratory arrest.) The patellar reflex must be present and the respiratory rate faster than 16 breaths/min before each parenteral dose.

Management of Postpartum Hemorrhage

Description Medications used to treat postpartum hemorrhage include ergot alkaloids, prostaglandin F2a (carboprost tromethamine), and oxytocin. These medications stimulate uterine muscle and increase the force and frequency of contractions. Nursing Considerations Ergot alkaloids can produce arterial vasoconstriction and vasospasm of the coronary arteries; severe hypertension is a concern. The nurse should always check the client's blood pressure before administration and withhold the medication and contact the health care provider if it is increased. Ergot alkaloids are not administered before the delivery of the placenta.

Oxytocin

Description Oxytocin stimulates the smooth muscle of the uterus and induces contraction of the myocardium. It is used to induce or augment labor or control postpartum bleeding. Nursing Considerations Oxytocin may produce uterine hypertonicity resulting in fetal or maternal injury. Postpartum hemorrhage may result if the uterus becomes atonic when the medication wears off. Oxytocin should not be used in a client who cannot deliver vaginally or in a client with hypertonic uterine contractions. Check maternal vital signs every 15 minutes, especially blood pressure and heart rate; monitor daily weight, intake and output, level of consciousness, and lung sounds. Assess the frequency, duration, and force of contractions and resting uterine tone every 15 minutes. Check the fetal heart rate (FHR) every 15 minutes and notify the health care provider if significant changes occur; an internal fetal scalp electrode may be placed if not contraindicated. An IV infusion monitoring device is always used; the prescribed additive solution (e.g., normal saline) is piggybacked at the port nearest the point of venous insertion. Do not leave the client unattended while the oxytocin is infusing. Administer oxygen, if prescribed. If uterine hyperstimulation (hypertonicity) or a nonreassuring FHR occurs, stop the oxytocin infusion, turn the client on her side, increase the IV rate of the additive solution, administer oxygen by way of face mask, and notify the provider. Monitor the client for signs of water intoxication. Have emergency equipment available. Document the dosage of the medication and the times at which administration was started, increased, maintained, and discontinued. Keep the family informed of the client's progress.

Rho(D) Immune Globulin

Description Prevention of anti-Rh(D) antibody formation is most successful if Rho(D) immune globulin (RhoGAM) is administered twice: at 28 weeks of gestation and within 72 hours of delivery. RhoGAM prevents isoimmunization in Rh-negative clients who are exposed or may have been exposed to Rh-positive RBCs through transfusion, termination of pregnancy, amniocentesis, chorionic villus sampling, abdominal trauma, or bleeding during pregnancy or the birth process. Nursing Considerations RhoGAM should be administered in the 72 hours after potential or actual exposure to Rh-positive blood; it must be given with each subsequent exposure or potential exposure to Rh-positive blood. It is of no benefit once the client has developed a positive antibody titer to the Rh antigen. RhoGAM is contraindicated in Rh-positive women and in clients with a history of systemic allergic reactions to preparations containing human immunoglobulins. It is not administered to the newborn.

Neonatal Eye Prophylaxis

Description Preventive eye treatment against ophthalmia neonatorum in the newborn is required by law in the United States. Erythromycin (0.5%) is bacteriostatic and bactericidal and provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis. Nursing Considerations Cleanse the neonate's eyes before instilling drops or ointment. Instill medication into each of the neonate's conjunctival sacs within 1 hour of delivery; eye prophylaxis may be delayed until an hour or so after birth as a means of facilitating eye contact and parent-infant bonding. Do not flush the eyes after instillation.

Prostaglandins

Description Prostaglandins are used to soften and promote dilation of the cervix to facilitate vaginal delivery. Nursing Considerations GI side effects include nausea and vomiting, stomach cramps, and diarrhea. Fever, chills, flushing, headache, and hypotension may occur. Monitor maternal vital signs, FHR patterns, and the status of pregnancy, including signs of labor or impending labor. Also monitor the Bishop score. Have the client void before administration and maintain the client in a supine position for 30 to 60 minutes after administration of the medication. Remain with the client for 30 minutes after administration to monitor her for anaphylaxis; signs include shortness of breath or difficulty breathing, tachycardia, hives, tightness in the chest, and swelling of the face. Monitor the client for hyperstimulation of the uterus and vaginal bleeding.

Recombivax HB Pediatric (Hepatitis B Virus [HBV])Vaccine

Description Recommended for all newborns to prevent hepatitis B Given intramuscularly to the newborn before discharge home Adverse effects include rash, fever, erythema, and pain at the injection site Nursing Considerations Parenteral consent must be obtained Administer in the lateral aspect of the middle third of the vastus lateralis muscle of the thigh If the infant was born to a mother positive for hepatitis B surface antigen, hepatitis B immune globulin should be given within 12 hours of birth in addition to the HBV vaccine. Then, the regularly scheduled HBV vaccination schedule is followed. Document immunization administration on a vaccination card for parents to have a record that it was administered.

Attention Deficit-Hyperactivity Disorder Treatment

Description Some children with ADHD require medication to reduce hyperactive behavior and lengthen attention span. The medications that are most effective in controlling this disorder are CNS stimulants, which increase agitation and activity in adults but have a calming effect on children with ADHD, increasing alertness and sensitivity to stimuli. Nursing Considerations Abrupt withdrawal may produce extreme fatigue and depression; the medication must be withdrawn gradually. Monitor the client for side/adverse effects (e.g., tachycardia, anorexia and weight loss, increased blood pressure, dizziness, agitation). Inform the client and parents that the client should avoid food and drink containing caffeine. Explain to the client and parents that the morning dose should be taken after breakfast and the last dose of the day at least 6 hours before bedtime (14 hours for extended-released forms) to help prevent insomnia. Monitor height and weight, particularly in children. Reiterate to the client and parents that several weeks of therapy may be necessary before the therapeutic effect can be evaluated. Tell the client and the parents that a drug-free period may be prescribed to permit growth if the medication has caused growth retardation.

Antidepressants Tricyclic Antidepressants (TCAs)

Description TCAs block reuptake of norepinephrine and serotonin at the presynaptic neuron. Nursing Considerations TCAs should not be administered with MAOIs; this could result in hypertensive crisis. These medications are used with caution in clients with cardiac disorders, increased intraocular pressure (i.e., glaucoma), urine retention, hyperthyroidism, seizure disorders (TCAs lower the seizure threshold), and liver or kidney disorders. The concurrent use of anticholinergic medications (e.g., antihistamines) should be avoided. Monitor the client for anticholinergic effects (e.g., dry mouth, diminished GI motility and constipation, tachycardia, difficulty voiding, dilated pupils, blurred vision, photophobia, restlessness and confusion). Instruct the client to contact the health care provider if anticholinergic effects persist. Cardiotoxicity, which may be life-threatening if an overdose is taken, is possible. Monitor the client's cardiac status and obtain an ECG before treatment and periodically during therapy.

Rubella Vaccine

Description The rubella vaccine is given subcutaneously before hospital discharge to the nonimmune postpartum client (rubella titer less than 1:8). Nursing Considerations The rubella vaccine is not administered if the client or other family members are immunocompromised. The client must be informed that pregnancy should be avoided for 1 to 3 months (or as prescribed) after receiving the rubella vaccine and about the need to use a contraceptive method at this time. Assess for an allergy to duck eggs and notify the health care provider before administration if an allergy exists.

Opioid Analgesics

Description These medications are used to relieve moderate to severe pain associated with labor. Nursing Considerations The regular use of opioids during pregnancy may produce withdrawal symptoms in the newborn (e.g., irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures). Obtain a drug history before administration of an opioid analgesic; some medications may be contraindicated if the client has a history of opioid dependency, because these medications can precipitate withdrawal symptoms in the client and newborn. Monitor vital signs (if the respiratory rate is less than 12 breaths/min withhold the medication and contact the health care provider). Monitor the fetal heart rate. Have the antidote naloxone available.

Monoamine Oxidase Inhibitors (MAOIs)

Description These medications inhibit monoamine oxidase (MAO), an enzyme present in the brain, platelets, liver, spleen, and kidneys. Inhibition of MAO results in metabolism of amines, norepinephrine, and serotonin, increasing the concentrations of these amines. They are used for clients who have depression and have not responded to other antidepressant therapies. Nursing Considerations Concurrent use with substances such as amphetamines, antidepressants, dopamine, vasoconstrictors, nasal decongestants, and tyramine-containing foods can cause hypertensive crisis. MAOIs cannot be administered in conjunction with selective serotonin reuptake inhibitors, an antidepressant, because serotonin syndrome could result. Concurrent use of opioids may cause hypertension or hypotension, seizures, or coma. Antihypertensive medications can potentiate the hypotensive effect of MAOIs. MAOIs are used with caution in clients taking tricyclic antidepressants. Instruct the client to avoid tyramine-rich foods and products to help prevent hypertensive crisis. Monitor the client's blood pressure and watch for signs of hypertensive crisis; withhold the medication and contact the health care provider if signs develop. Instruct the client to wear a Medic-Alert bracelet or carry a card indicating that an MAOI is being taken. Intravenous phentolamine is used to treat hypertensive crisis. Page 106 of 137

Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs)

Description These medications inhibit serotonin uptake and elicit an antidepressant response. Nursing Considerations Serotonin syndrome (agitation, confusion, anxiety, hallucinations, hyperreflexia, excessive sweating, tremor, fever) may occur, especially when an SSRI is combined with a monoamine oxidase inhibitor. An MAOI must be discontinued at least 14 days before an SSRI is started.

Lung Surfactants

Description These medications replenish surfactant and restore surface activity to the lungs. They are used to prevent or treat respiratory distress syndrome (hyaline membrane disease) in the premature infant. Nursing Considerations Administered with caution in newborns at risk for circulatory overload. The medication is inserted into the infant's endotracheal tube. (Avoid suctioning for at least 2 hours after administration, if possible.) Lung surfactants may cause transient bradycardia and oxygen desaturation. Monitor the infant for bradycardia and decreased oxygen saturation during administration. Assess lung sounds for crackles.

Tocolytics

Description Tocolytics such as magnesium sulfate are used to stop uterine contractions and prevent preterm birth. Nursing Considerations Maternal contraindications include severe preeclampsia and eclampsia, active vaginal bleeding, intrauterine infection, cardiac disease, and a medical or obstetric condition that contraindicates the continuation of pregnancy. Fetal contraindications include estimated gestational age greater than 37 weeks, cervical dilation greater than 4 cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction. The client should be positioned on her side to enhance placental perfusion and reduce pressure on the cervix. Maternal vital signs, fetal status, and labor status are assessed frequently or in accordance with agency protocol. Monitor daily weight and intake and output. Provide comfort measures and psychosocial support to the client and family.

Vitamin K

Description Vitamin K aids production of active prothrombin. The newborn is deficient in vitamin K for the first 5 to 8 days of life because of the lack of intestinal flora. Vitamin K is used for prophylaxis and to treat hemorrhagic disease of the newborn. Nursing Considerations Vitamin K can cause hyperbilirubinemia in the newborn although the incidence is rare. Protect the medication from light. Administer vitamin K to the neonate during the early neonatal period in the lateral aspect of the middle third of the vastus lateralis muscle of the thigh. Monitor the neonate for bruising at the injection site and for bleeding from the cord. Watch for jaundice and monitor the bilirubin level, because the medication can cause hyperbilirubinemia in the neonate.

Gastrointestinal Medications- Diarrhea Nursing Considerations

Diarrhea caused by a poison, infection, or bacterial toxin is worsened by administration of an antidiarrheal because elimination of the toxin is delayed.

Cardiac Glycosides- Antidote Nursing considerations

Digoxin immune Fab, an antidote, is used in cases of extreme toxicity.

Antihistamines- Glaucoma Nursing Considerations

Diphenhydramine has an anticholinergic effect and should be avoided in clients with narrow-angle glaucoma.

Diuretics Description

Diuretics are subclassed as loop, osmotic, thiazide, and potassium-retaining.

Antitussives- Side effects Nursing Considerations

Dizziness, drowsiness, and sedation may occur, so safety is a concern; the client should avoid activities requiring alertness. Instruct the client to notify the health care provider if coughing continues for more than 1 week or a fever develops.

Dopamine Hydrochloride Adrenergic Agonists Description

Dopamine increases blood pressure and cardiac output through positive inotropic action and increases renal blood flow through its action on α- and β-receptors.

Antiparkinsonian Medications-Dopaminergic Nursing considerations

Dopaminergic medications increase the amount of dopamine available in the CNS or enhance neurotransmission of dopamine.

Dopaminergic Medications Side effects

Dyskinesia Involuntary body movements Tachycardia Nausea and vomiting Urine retention Constipation Dizziness and postural hypotension Confusion Mood changes Hallucinations

Endocrine Medications: include what types of medications

Endocrine medications include pituitary medications, antidiuretic hormones, thyroid hormones, antithyroid medications, parathyroid medications, corticosteroids (glucocorticoids), androgens, contraceptives (estrogens and progestins), fertility medications, and medications for diabetes mellitus

Tuberculosis Treatment Failure to take medications

Failure to take medications as prescribed may result in the development of multidrug-resistant tuberculosis.

Tuberculosis Treatment First Line

First-line medications provide the most effective activity against tuberculosis.

Urinary Tract Antiseptics- Fluroquinolones Description

Fluoroquinolones, a classification of antibiotics, are also used to treat urinary tract infections; they suppress bacterial growth by inhibiting an enzyme necessary for DNA synthesis and are active against a broad spectrum of microbes.

Integumentary Medications- Burns (nursing considerations)

For the client with a burn injury, avoid the intramuscular or subcutaneous medication routes because absorption through the soft tissue is unreliable when hypovolemia and large fluid shifts occur.

Gastrointestinal Medications- Gastric Protectants Description

Gastric protectants form a barrier against acid and pepsin. (Most oral preparations should be taken on an empty stomach.)

Endocrine Medications: Glucocorticoids Nursing Considerations

Glucocorticoids and corticosteroids alter the normal immune response and suppress inflammation, promote sodium and water retention and potassium excretion, can mask the signs and symptoms of infection, and are used with caution in clients with diabetes mellitus because they increase blood glucose. Client teaching tips are found here.

Endocrine Medications: Parathyroid Nursing Considerations

Hyperparathyroidism results in a high serum calcium level and bone demineralization; medication is used to decrease serum calcium. Hypoparathyroidism results in a low serum calcium level, which increases neuromuscular excitability; treatment includes calcium and vitamin D supplements.

Sulfonamides- Adverse Effects Nursing Considerations

Hypersensitivity reactions (e.g., rash, fever, photosensitivity) are possible. Assess the client for allergies. Instruct the client to stop the medication and contact the health care provider if a rash occurs. Tell the client to take the medication on an empty stomach with a full glass of water. Recommend that the client avoid prolonged exposure to sunlight, wear protective clothing, and apply sunscreen to exposed skin. Stevens-Johnson syndrome, the most severe hypersensitivity response, produces symptoms that include widespread lesions on the skin and mucous membranes and fever, malaise, and toxemia.

Gastrointestinal Medications- Histamine Nursing Considerations

Histamine H2-receptor antagonists are used with caution in clients with impaired renal or hepatic function. Monitor the older client taking a histamine H2-receptor antagonist for mental status changes such as confusion.

Gastrointestinal Medications- Histamine H2-receptor antagonist Description

Histamine H2-receptor antagonists suppress the secretion of gastric acid, alleviate symptoms of heartburn, help prevent complications of peptic ulcer disease, and promote healing in gastroesophageal reflux disease.

Bronchodilators - IV administration Nursing Considerations

IV preparations should be administered slowly, always by means of an infusion pump.

Renal Medications Immunosuppressants for Transplants Description

Immunosuppressants are the primary class of medications used to prevent rejection. These medications may be used in combination with other medications, such as corticosteroids, to produce different actions on the immune system. Combination therapy also allows the administration of the medications in lower dosages, reducing the likelihood or severity of side effects.

Antihypertensives Description

In addition to diuretics, medications used to treat hypertension include peripherally and centrally acting α-adrenergic blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), beta-adrenergic blockers, and calcium channel blockers; these medications may also be used to treat such cardiac disorders as angina and dysrhythmias.

Anticoagulants- Adverse Effects Description

In addition to heparin and warfarin, other oral and parenteral anticoagulants are available and may be prescribed; however, with all anticoagulants the major adverse effect is bleeding.

Macular Degeneration Treatment-DRY Description

In dry ARMD, the more common of the two conditions, macular photoreceptors undergo gradual breakdown, leading to gradual blurring of central vision.

Gastrointestinal Medications- Inflammatory Bowel Disease Description

Inflammatory bowel disease (Crohn disease and ulcerative colitis) may be treated with a variety of medications: antimicrobials, 5-aminosalicylates, corticosteroids, immunosuppressants, and immunomodulators. Symptomatic relief of irritable bowel syndrome is usually provided with the use of antispasmodics that relax the smooth muscle of the GI tract, bulk-forming medications, antidiarrheals, and antidepressants.

Direct-Acting Arteriolar and Peripheral Vasodilators avoid Nursing Considerations

Instruct the client to avoid aspirin and aspirin-like compounds unless they are approved by the health care provider.

Bronchodilators - Avoid Nursing Considerations

Instruct the client to avoid products, such as coffee, tea, cola, and chocolate, that contain caffeine.

Antilipemic Medications- Patient Teaching Nursing Considerations

Instruct the client to follow an exercise program. Instruct the client to increase fluid intake. Tell the client that it may take several weeks before the lipid level declines. Instruct the client to have an annual eye exam and to report any changes in vision. Instruct the client to report any GI disturbances or muscle aches.

Diuretics- Administration Nursing Considerations

Instruct the client to take the medication in the morning to avoid nocturia and sleep interruption.

Antiparkinsonian Medications- Teaching Nursing considerations

Instruct the client to take the medication with food if nausea and vomiting occur. Have the client increase fluid intake and suck on ice chips or hard candy or use chewing gum to ease dry mouth. Increased fluids and fiber in the diet will help prevent constipation. Instruct the client to use sunglasses in direct sun because of the risk of photophobia. Inform the client taking a dopaminergic medication that urine or perspiration may be harmlessly discolored but may also stain clothing. Instruct the client taking levodopa to avoid excessive intake of pyridoxine, which decreases the amount of levodopa reaching the CNS.

Antihistamines- GI Distress Nursing Considerations

Instruct the client to take the medication with food or milk to avoid GI distress. Instruct the client taking the medication for motion sickness to take it 30 minutes before the event and then before meals and at bedtime during the event. Instruct the client to suck on hard candy or ice chips to alleviate dry mouth.

Treatments for Diabetes Mellitus- Insulin Blood Glucose Regulators Description

Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, lowering the serum glucose level.

Leukotriene Modifiers Nursing Considerations

It is important to monitor lung sounds. Use with caution in clients with impaired hepatic function; assess liver function parameters. Instruct the client to take the medication 1 hour before or 2 hours after meals to enhance absorption. Instruct the client to increase fluid intake. Instruct the client not to discontinue the medication and to take it as prescribed, even during symptom-free periods.

Dobutamine- Uses Adrenergic Agonists Description

It is used in heart failure and for clients undergoing cardiopulmonary bypass surgery.

Dopamine Hydrochloride-Uses Adrenergic Agonists Description

It is used to treat hypotension and mild kidney failure caused by low cardiac output.

Antilipemic Medications- Liver function Nursing Considerations

Liver enzymes may be increased by the medications, so closely monitor liver function parameters. Monitor serum cholesterol and triglyceride levels and instruct the client to restrict intake of fats and cholesterol.

Antilipemic medications: (ending)

Many end with -statin (e.g., atorvastatin).

Tuberculosis Treatment Adverse Effects

Many tuberculosis medications can cause toxic effects such as hepatotoxicity, nephrotoxicity, neurotoxicity, optic neuritis, or ototoxicity. Teach the client about the signs of toxicity and explain that the health care provider needs to be notified if any signs arise. Initiate safety or seizure precautions in the client at risk for seizures, orthostatic hypotension, or suicidal ideation resulting from the use of tuberculosis medication.

Antiarthritis Medications Description

Medication therapy includes NSAIDs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs). Gold salts may be used to reduce the progression of joint damage caused by arthritic processes but are not frequently prescribed. DMARDs are effective antirheumatic medications that are used to slow the degenerative effects of arthritis. DMARDs are usually prescribed secondarily to NSAIDs but are often the first choice in the treatment of severe arthritis.

Integumentary Medications (Description)

Medications are available to treat such disparate conditions as poison ivy, dermatitis, actinic keratosis, psoriasis, acne, and burns.

Anticholinergic Antispasmodics Description

Medications in this class are used to treat overactive bladder (urge incontinence).

Antihistamines Description

Medications in this class can cause central nervous system (CNS) depression if taken with alcohol, opioids, hypnotics, or barbiturates; instruct the client to avoid activities that require alertness.

Opioid Antagonists Description

Medications in this class reverse respiratory depression in opioid overdose. The best-known opioid antagonist is naloxone hydrochloride.

HIV Infection and AIDS Treatment Description

Medications include nucleoside-nucleotide reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, chemokine receptor 5 (CCR5) antagonist, and fusion inhibitors. Nucleoside-nucleotide reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors work by inhibiting the activity of reverse transcriptase. Protease inhibitors work by interfering with the activity of the enzyme protease. Integrase inhibitors stop HIV replication. Chemokine receptor 5 (CCR5) antagonist binds with CCR5 and blocks viral entry Fusion inhibitors work by inhibiting the binding of human immunodeficiency virus to cells. Standard treatment consists of using three or four medications in regimens known as highly active antiretroviral therapy (HAART); though not curative, it can delay or reverse loss of immune function, preserve health, and prolong life.

Gastrointestinal Medications- Hepatic Encephalopathy Description

Medications to treat hepatic encephalopathy promote increased peristalsis and bowel evacuation, resulting in the expulsion of ammonia from the colon and a reduced ammonia level.

Glaucoma Treatment Miotic Agents Contraindications

Miotic agents are contraindicated in clients with retinal detachment, adhesions between the iris and lens, or inflammatory diseases. Use with caution in clients with asthma, hypertension, corneal abrasion, hyperthyroidism, coronary vascular disease, urinary tract obstruction, GI obstruction, ulcer disease, parkinsonism, or bradycardia.

Antineoplastic Medications: Nursing Considerations

Monitor complete blood cell count (CBC), white blood cell (WBC) count, platelet count, and electrolyte concentrations; initiate bleeding precautions if thrombocytopenia occurs or neutropenia precautions if the WBC count falls. Antineoplastic medications stimulate the vomiting center; take precautions against nausea and vomiting. Monitor the client for hyperuricemia and take precautions against it. Inform the client of the potential for hair loss and discuss the purchase of a wig or other head covering before the start of treatment. (New hair growth will occur several months after the final treatment.) Discuss the need for contraception (antineoplastic medications have teratogenic effects) and the potential for infertility, which may be irreversible. Instruct the client to inspect the oral mucosa for sores, and contact the health care provider regarding treatment if sores occur. Instruct the client to report signs of infection (e.g., fever, chills, sore throat).

Antidysrhythmic Medications- Monitor Nursing Considerations

Monitor heart rate, respiratory rate, and blood pressure. Provide cardiac monitoring and pay close attention to the electrocardiogram (ECG). Maintain a therapeutic serum drug level as appropriate.

Gastrointestinal Medications- Pancreatic Encephalopathy Nursing Considerations

Monitor the ammonia level in a client receiving medication for hepatic encephalopathy.

Cardiac Glycosides- When to hold medication Nursing considerations

Monitor the apical pulse rate; if it is slower than 60 beats/min, the medication should be withheld and the health care provider notified. Teach the client how to measure the pulse and stress the need to notify the health care provider if the pulse rate is slower than 60 or faster than 100 beats/min or as specified by the health care provider.

Thrombolytic Medications- Monitor for Nursing Considerations

Monitor the client for bleeding and dysrhythmias. Monitor the client for neurological changes (e.g., slurred speech, lethargy, confusion, hemiparesis) that might indicate intracranial bleeding.

Antidysrhythmic Medications- Patient Teaching Nursing Considerations

Monitor the client for side effects of the medication; discuss side effects with the client and explain when it is necessary to contact the health care provider. Advise the client to limit fluid and salt intake to minimize fluid retention. Instruct the client to change position slowly to help prevent postural hypotension.

Mydriatic/Cycloplegic and Anticholinergic Drugs Side Effects Nursing Considerations

Monitor the client for side/adverse effects, including tachycardia, photophobia, conjunctivitis, dermatitis, and atropine toxicity. Inform the client that he or she may experience a burning sensation on instilling the medication. Instruct the client not to drive or operate machinery for 24 hours after instillation of the medication unless otherwise directed by the health care provider. Instruct the client to wear sunglasses until the effects of the medication have worn off. Instruct the client to notify the health care provider if signs of atropine toxicity occur.

Anticholinergic Antispasmodics- Toxicity Nursing Considerations

Monitor the client for signs of toxicity (i.e., CNS stimulation) such as hypotension or hypertension, confusion, tachycardia, flushed or red face, signs of respiratory depression, nervousness, restlessness, hallucinations, and irritability.

Cardiac Glycosides- Toxicity signs Nursing considerations

Monitor the client for signs of toxicity, including anorexia, nausea and vomiting, visual disturbances (e.g., diplopia, blurred vision, yellow-green halos), bradycardia, and photophobia.

Immunosuppressants Nursing Considerations

Monitor the client taking an immunosuppressant closely for signs of infection. Cyclosporine can cause nephrotoxicity, infection, hypertension, and hirsutism. Tacrolimus can cause nephrotoxicity, neurotoxicity, GI effects, hypertension, hyperkalemia, hyperglycemia, hirsutism, and gum hyperplasia. Azathioprine can cause neutropenia and thrombocytopenia. Cyclophosphamide can cause neutropenia and hemorrhagic cystitis. Methotrexate can cause hepatic fibrosis and cirrhosis, bone marrow suppression, ulcerative stomatitis, and renal damage. Mycophenolate mofetil and mycophenlic acid can cause diarrhea, vomiting, neutropenia, sepsis; the risk of infection and malignancies, especially lymphomas, is increased. Basiliximab and daclizumab can cause severe acute hypersensitivity reactions, including anaphylaxis. Lymphocyte immune globulin and antithymocyte globulin can cause fever, chills, leukopenia, and skin reactions, including anaphylactoid reactions. Sirolimus increases the risk of infection, increases cholesterol and triglyceride levels, and can cause renal injury; other effects include rash, acne, anemia, thrombocytopenia, joint pain, diarrhea, and hypokalemia.

Gastrointestinal Medications- Magnesium Nursing Considerations

Monitor the client with renal impairment who is receiving a magnesium preparation for signs of toxicity (e.g., hypotension, depressed respirations, diminished or absent deep tendon reflexes).

Mydriatic/Cycloplegic Drugs Description

Mydriatic and cycloplegic agents dilate the pupils and relax the ciliary muscles, respectively.

Nonsteroidal Antiinflammatory Drugs and Acetylsalicylic Acid Nursing Consideration

NSAIDs are contraindicated in liver or renal disease. Acetylsalicylic acid should not be taken by children because of the risk of Reye syndrome. Acetylsalicylic acid should not be taken if the client is taking an anticoagulant. Acetylsalicylic acid and other NSAIDs should not be taken together. NSAIDs can amplify the effects of warfarin, sulfonamides, cephalosporins, and phenytoin. Hypoglycemia may result if ibuprofen is taken with insulin or an oral hypoglycemic medication. A high risk of toxicity exists if ibuprofen is taken concurrently with calcium-channel blockers. Assess the client for a history of gastric irritation or bleeding or liver disease. Assess the client for GI upset during administration. Monitor the serum salicylate level when the client is taking high doses. Watch for side/adverse effects and signs of bleeding (e.g., tarry stools, bleeding gums, petechiae, ecchymosis, purpura). Instruct the client to take the medication with water, milk, or food; enteric-coated or buffered aspirin may be taken to decrease gastric distress. (Enteric-coated tablets should not be crushed or broken.) Acetylsalicylic acid should be discontinued 3 to 7 days before surgery (or as prescribed) to reduce the risk of bleeding.

Urinary Tract Antiseptics- Nalidixic Nursing Considerations

Nalidixic acid may produce intracranial hypertension in pediatric clients and should not be administered to children younger than 3 months.

Nasal Decongestants Nursing Considerations

Nasal decongestants can cause tolerance and rebound nasal congestion (vasodilation), a result of irritation of the nasal mucosa, and should not be used for more than 48 hours. Side effects include restlessness, nervousness, hypertension, and hyperglycemia. Instruct the client to avoid caffeine, which can increase restlessness and the chance of palpitations.

Nitrates- Contraindicated Nursing Considerations

Nitrates are contraindicated in the client with marked hypotension,increased intracranial pressure, or severe anemia.

Nitrates Description

Nitrates produce vasodilation, decrease preload and afterload, and reduce myocardial oxygen consumption.

Nonsteroidal Antiinflammatory Drugs and Acetylsalicylic Acid Description

Nonsteroidal antiinflammatory drugs (NSAIDs) are acetylsalicylic acid (aspirin and aspirin-like) medications that inhibit the synthesis of prostaglandins. They act as analgesics to relieve inflammation and pain, as antipyretics to reduce body temperature, and as anticoagulants to inhibit platelet aggregation.

Norepinephrine Adrenergic Agonists Description

Norepinephrine stimulates the heart in cardiac arrest. It induces vasoconstriction and increases blood pressure in hypotension and shock.

Heparin-APTT Nursing Considerations

Normal activated partial thromboplastin time (aPTT) is maintained at 1.5 to 2.5 times when the client is on a continuous heparin infusion. The normal aPTT is 30 to 40 seconds. If the APTT is too great (longer than 80 seconds), the dosage should be decreased; if the APTT is too short (shorter than 60 seconds), the dosage should be increased. Normal clotting time is 8 to 15 minutes; clotting time is maintained at 15 to 20 minutes.

Antidepressants General Nursing Considerations

Observe and record the client's behavior; monitor the client for suicide potential. Carefully monitor the suicidal client, especially once mood improves and energy level increases, because this is when the client has the energy to commit suicide. When administering the medication to a hospitalized client, ensure that the client swallows the medication and that it is not held in the cheek. Administer the medication with food if GI distress occurs. Nonhospitalized clients should be provided with no more than 1 week's supply of medication at a time. Emphasize the importance of medication compliance and the need to continue therapy even if symptoms have subsided. Monitor the client for side and adverse effects of the medication. Many antidepressants cause postural hypotension, dizziness, sedation, weight gain, anxiety, restlessness, and irritability. Instruct the client to take medication in the morning, if a single daily dose is prescribed, to prevent insomnia. If the medication causes sedation, it should be taken at bedtime to minimize daytime sedation and promote sleep. Tell the client to discuss sexual dysfunction with the health care provider. Instruct the client to report any rash, a possible sign of hypersensitivity, to the health care provider. Inform the client that it may take 2 to 4 weeks for the desired response to develop. (Maximal response develops in 1 to 2 months.) Instruct the client to change position slowly to avoid a hypotensive effect and to exercise caution when performing tasks that require alertness (e.g., driving). In a hospitalized client, monitor pulse and blood pressure; if the blood pressure is low or the pulse rate high, the medication is withheld and the health care provider is notified. Monitor the client's weight and eating pattern; long-term therapy can result in weight gain, so clients are advised to exercise as appropriate and to restrict calorie intake. Monitor bowel activity. In the client undergoing long-term therapy, monitor liver and renal function parameters. Assess the client for improvement of symptoms.

Treatments for Diabetes Mellitus- Oral Hypoglycemic agents Blood Glucose Regulators Description

Oral hypoglycemic agents stimulate the pancreas to produce more insulin and increase the sensitivity of peripheral receptors to insulin, thereby decreasing the serum glucose level. Use of hypoglycemic medications together with ß-adrenergic blocking agents masks signs and symptoms of hypoglycemia.

Osteoporosis Prevention and Treatment Description

Osteoporosis is characterized by low bone mass and increased bone fragility. Calcium and vitamin D supplementation can reduce the risk of osteoporosis; calcium maximizes bone growth early in life and maintains bone integrity later in life, and vitamin D helps ensure calcium absorption. Medications that decrease bone resorption (antiresorptive) and medications that promote bone formation are used to reduce the occurrence of fractures by maintaining or increasing bone strength. Bisphosphonates inhibit osteoclast-mediated bone resorption, thereby increasing total bone mass.

Gastrointestinal Medications- Pancreatic Enzyme Replacements Description

Pancreatic enzyme replacements are used to supplement or replace pancreatic enzymes and thus improve nutritional status and reduce the amount of fatty stools.

Gastrointestinal Medications- Pancreatic Enzyme Replacements Nursing Considerations

Pancreatic enzyme replacements should be taken with all meals and snacks; side effects include abdominal cramps or pain, nausea, and diarrhea.

Antihypertensives- Potassium Nursing Considerations

Potassium supplements and potassium-retaining diuretics are avoided with the use of ACE inhibitors and ARBs because of the risk of hyperkalemia.

Gastrointestinal Medications- Prokinetic Agents Nursing Considerations

Prokinetic agents such metoclopramide are usually administered 30 minutes before meals and at bedtime; these drugs are contraindicated in clients with mechanical obstruction, perforation, or GI hemorrhage and may cause a parkinsonian reaction.

Direct-Acting Arteriolar and Peripheral Vasodilators Sodium Nitroprusside Administration Nursing Considerations

Protect the medication (sodium nitroprusside) from light to help slow decomposition. During administration of sodium nitroprusside, the solution needs to be protected from light and covered with the supplied opaque sleeve, aluminium foil, or other opaque material; if properly protected from light, a freshly diluted solution will remain stable for 24 hours. Discard the sodium nitroprusside if it is red or blue.

Warfarin Sodium- PTT Nursing Considerations

Prothrombin time (PT) averages 11 to 12.5 seconds; warfarin sodium prolongs the PT.

Gastrointestinal Medications- Proton Pump Inhibitors Description

Proton pump inhibitors, which suppress the secretion of gastric acid, are used to treat active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions.

Endocrine Medications: Thyroid Nursing Considerations

Provide teaching to the client who has been prescribed thyroid hormones for hypothyroidism. Provide teaching, including information on thyroid storm, to the client who has been prescribed medication to treat hyperthyroidism. Instruct the client receiving oral calcium to maintain adequate intake of vitamin D, which enhances the absorption of calcium.

Warfarin Sodium- INR Nursing Considerations

The normal international normalized ratio (INR) is 0.81 to 1.2. A level of 2.0 to 3.0 is maintained in standard warfarin therapy and a level of 3.0 to 4.5 in high-dose warfarin sodium therapy. If the INR is below the recommended range, the dosage should be increased; if it is above the recommended range, the dosage should be reduced.

Insulin- Type that can be delivered IV Nursing Considerations

Regular insulin may be administered intravenously.

Influenza Medications

Seasonal flu vaccination, is recommended for all individuals unless vaccination is contraindicated. Consult the U.S. Centers for Disease Control and Prevention for additional information.

Tuberculosis Treatment Second Line

Second-line medications are used in combination with first-line medications but are more toxic.

Antiarthritis medications Nursing Considerations

Side and adverse effects of DMARDs include injection site inflammation and pain, ecchymosis, and edema, pancytopenia and infection, fatigue, headache, nausea, vomiting, and flu-like symptoms, and allergic response. Instruct the client to monitor for signs of infection and report signs to the health care provider. Instruct the client to consult with the health care provider before receiving vaccines and to avoid exposure to infections. Inform the client about the importance of laboratory tests for neutrophil counts, white blood cell counts, and platelet counts before initiation of treatment and during treatment. If gold toxicity — characterized by pruritis, rash, metallic taste, stomatitis, and diarrhea — occurs, dimercaprol may be prescribed to enhance gold excretion.

Glaucoma Treatment Miotic Agents Side Effects/Teaching

Side effects include local irritation, headache, eye pain, and diminished visual acuity. Instruct the client to avoid activities such as driving while vision is impaired. Instruct the client with glaucoma to carefully read labels of over-the-counter medications and to avoid atropine-like medications; atropine increases intraocular pressure.

Glaucoma Treatment Carbonic Anhydrase Inhibitors Adverse Effects/ Patient Teaching

Side/adverse effects include GI disturbances; paresthesias of the fingers, toes, and face; lethargy and drowsiness; photosensitivity; hypokalemia; renal calculi; and depression. Instruct the client to increase fluid intake, unless contraindicated, to prevent the formation of calculi. Instruct the client in the signs of hypokalemia and foods high in potassium. Advise the client to avoid prolonged exposure to sunlight. Instruct the client to avoid hazardous activities while vision is impaired and, if drowsiness occurs, activities that require alertness.

Anticholinergic Antispasmodics- Side Effects Nursing Considerations

Side/adverse effects include anorexia, nausea and vomiting, and dry mouth; blurred vision and dry eyes; confusion in older clients; constipation; decreased sweating; drowsiness and dizziness; headache; tachycardia, and urine retention.

Macular Degeneration Treatment Nursing Considerations

Side/adverse effects include endophthalmitis (eye inflammation caused by bacterial, viral, or fungal infection), blurred vision or reduced visual acuity, cataracts, corneal edema, eye discomfort and discharge, conjunctival hemorrhage, and increased intraocular pressure. Teach the client about side and adverse effects and when the health care provider should be notified.

Cholinergics-Side Effects Nursing Considerations

Side/adverse effects include headache, hypotension, flushing and sweating, increased salivation, nausea and vomiting, diarrhea, urinary urgency, and bronchoconstriction.

Osmotic Medications- Side Effects Nursing Considerations

Side/adverse effects include headache, nausea and vomiting, diarrhea, disorientation, and electrolyte imbalances.

Antigout Medications Nursing Considerations

Side/adverse effects include headaches, nausea and vomiting, diarrhea, blood dyscrasias related to bone-marrow depression, flushed skin, rash, sore gums, and metallic taste in the mouth. The nurse should monitor the serum uric acid level and the client's intake and output. Instruct the client to maintain a fluid intake of at least 2000 to 3000 mL per day (unless contraindicated) to prevent renal tract stones. Instruct the client to avoid alcohol and caffeine, which can increase uric acid. Instruct the client to avoid foods high in purines (e.g., alcohol, organ meats, sardines, salmon, gravy), which worsen gout. Instruct the client to take the medication with food to minimize GI distress. Advise the client to have a yearly eye examination; prolonged use of allopurinol may cause cataracts. Caution the client to take acetaminophen, not acetylsalicylic acid, with these medications; concurrent use of acetylsalicylic acid increases uric acid.

Direct-Acting Arteriolar and Peripheral Vasodilators Adverse Effects Nursing Considerations

Side/adverse effects include hypotension, reflex tachycardia, edema, dizziness, and headache. Monitor the client for signs of inadequate blood flow to the extremities (e.g., pallor, coldness of extremities, pain). Instruct the client to take the medication with meals if GI disturbances occur. Encourage the client to change position slowly to help prevent postural hypotension.

Glaucoma Treatment Beta-Adrenergic Blockers Side Effects/Teaching

Side/adverse effects include ocular irritation, visual disturbances, bradycardia, hypotension, and bronchospasm. Monitor the client for shortness of breath and instruct the outpatient to notify the health care provider if shortness of breath occurs. To decrease the risk of postural hypotension, instruct the client to change position slowly and to avoid hazardous activities.

Antidysrhythmic Medications- Adverse Effects Nursing Considerations

Side/adverse effects vary, depending on the medication, but include worsening or new dysrhythmias, hypotension, heart failure, nausea and vomiting, diarrhea or constipation, dizziness, and bradycardia or tachycardia.

Skeletal Muscle Relaxants Nursing Considerations

Skeletal muscle relaxants should not be taken with CNS depressants (e.g., barbiturates, opioids, alcohol, sedatives, hypnotics, or tricyclic antidepressants). Side/adverse effects include dizziness and hypotension, drowsiness, dry mouth, GI upset, photosensitivity, and hepatic toxicity. Safety is a priority; assess the client for his or her risk of injury. Assess involved joints and muscles for pain and mobility. Monitor liver function parameters; hepatotoxicity may occur. Instruct the client to take the medication with food to help prevent GI upset. Instruct the client to avoid activities requiring alertness, because drowsiness may occur. Instruct the client to implement measures to alleviate photosensitivity if it occurs (e.g., by wearing sunglasses).

Urinary Tract Antiseptics- Contraindicated Nursing Considerations

Some medications are contraindicated in clients with renal or liver impairment.

Mydriatic/Cycloplegic and Anticholinergic Drugs Contraindications/Cautions Nursing Considerations

Such medications are contraindicated in clients with glaucoma because of the risk of increased intraocular pressure and in clients with cardiac dysrhythmias and cerebral atherosclerosis. They are used with caution in the older client and in clients with prostatic hypertrophy, diabetes mellitus, or parkinsonism.

Bronchodilators - Adverse Effects Nursing Considerations

The nurse must monitor the client closely for adverse effects (e.g., restlessness, tremors, palpitations and tachycardia, dysrhythmias, anorexia, nausea, and vomiting); if such effects occur, the medication is stopped and the health care provider is notified immediately. Mouth dryness and throat irritation may occur with inhaled bronchodilators; tolerance and paradoxical bronchoconstriction are also possible.

Direct-Acting Arteriolar and Peripheral Vasodilators Therapeutic Response Nursing Considerations

Tell the client that it may take as long as 3 months for the desired therapeutic response to occur.

Diuretics- Thiazide Nursing Considerations

Tell the client using a thiazide diuretic to use sunscreen in direct sunlight. Instruct the client with diabetes mellitus who is taking a thiazide diuretic to watch for increases in blood glucose, which may be caused by the diuretic.

Renal Medications Immunosuppressants for Transplants Nursing Considerations

The three main immunosupressants — cyclosporine, tacrolimus, and sirolimus — are subject to a wide range of cautions and can induce many different side and adverse effects.

Thrombolytic Medications- Antidote Nursing Considerations

The antidote to "clot-busting" medications is aminocaproic acid; used only in acute life-threatening conditions.

Heparin- Antidote Nursing Considerations

The antidote to heparin is protamine sulfate.

Urinary Tract Antiseptics- Adverse Effects Nursing Considerations

The antiseptics can cause GI effects (e.g., anorexia, nausea and vomiting, diarrhea); these can be minimized by administration with milk or meals. Visual disturbances and photosensitivity are possible. Hematological effects may occur (e.g., agranulocytosis, leukopenia, thrombocytopenia, megaloblastic anemia). Peripheral neuropathy (e.g., muscle weakness, tingling sensations, numbness) is possible. Neurological effects (e.g., headache, vertigo, drowsiness, nystagmus) may occur. Some medications impart a harmless brown color to the urine.

Glaucoma Treatment Beta-Adrenergic Blockers Description

These agents reduce intraocular pressure by decreasing sympathetic impulses and decreasing production of aqueous humor without affecting accommodation or pupil size.

Insulin Nursing Considerations

The client must be taught how to store insulin (insulin vials and insulin pens). Discuss injection-site protocol with the client. To help prevent dosing errors, be certain that the insulin concentration noted on the vial matches the calibration of units on the insulin syringe; the usual concentration of insulin is Units 100 (100 units/mL). Most insulin syringes have a 27- to 29-gauge needle, approximately 0.5 inch (1.3 cm) long. Roll (never shake, which produces bubbles) the insulin bottle to ensure that the insulin and other ingredients are mixed well; otherwise, an inaccurate dose will be drawn. Administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time the rapid/short-acting insulin binds with the NPH insulin and its action is reduced. Aspiration is generally not recommended with self-injection of insulin. Administer insulin with the needle at a 45- to 90-degree angle (45- to 60-degree angle in thin persons) to the skin.

Gastrointestinal Medications- Laxatives Nursing Considerations

The client receiving a laxative should increase fluid intake to help prevent dehydration.

Gastrointestinal Medications- Irritable Bowel Syndrome Nursing Considerations

The client receiving medications for irritable bowel syndrome must be informed of the side and adverse effects of the medication and told when it is necessary to notify the health care provider.

Antihistamines- Adverse Effects Nursing Considerations

The client taking an antihistamine may experience drowsiness, dizziness, blurred vision, dry mouth, or urine retention.

HIV Infection and AIDS Treatment Nursing Considerations

The client with HIV or AIDS is at high risk for the development of opportunistic infections; other medications to treat complications or opportunistic infections that develop are included in the treatment regimen. Adverse effects of medications depend on the specific medication; however, every client should be monitored closely for signs of infection and laboratory values should be monitored for indications of blood dyscrasias. Some medications used to treat opportunistic infections include anti-inflammatory medications, antiinfectives, antifungals, or antivirals.

Endocrine Medications: Description

The endocrine system consists of a variety of glands: adrenal gland, hypothalamus, pituitary gland, parathyroid gland, thyroid gland, pancreas, and ovaries/testes.

Cardiac Glycosides- Most Common Description

The most commonly used of these medications is digoxin.

Diuretics- Used for Description

They are used in cases of hypertension, peripheral edema (see image), and heart failure or pulmonary edema.

Diuretics- Potassium-retaining diuretic Nursing Considerations

The major adverse effect of potassium-retaining diuretics is hyperkalemia.

Bronchodilators - Monitor Nursing Considerations

The nurse must monitor the serum theophylline level. (The therapeutic range is 10 to 20 mcg/mL; a level greater than 20 mcg/mL indicates toxicity, and the medication is stopped and the health care provider notified immediately.) Instruct the client in how to monitor the pulse and to report any abnormalities to the health care provider. Instruct the client with diabetes mellitus to monitor the blood glucose level, because bronchodilators can increase blood glucose.

Cardiac Glycosides- Therapeutic Range Nursing considerations

The therapeutic range is 0.5 to 2.0 ng/mL (depending on laboratory testing); levels above 2.0 ng/mL are toxic.

Skeletal Muscle Relaxants Description

These medications act directly on the neuromuscular junction or indirectly on the CNS. Centrally acting muscle relaxants depress neuron activity in the spinal cord or brain. Peripherally acting muscle relaxants act directly on skeletal muscle. They are used to prevent or relieve muscle spasms, to treat spasticity associated with spinal cord disease or lesions, for painful musculoskeletal conditions, and for chronic debilitating disorders (e.g., multiple sclerosis, cerebral palsy).

Antitussives Description

These medications act on the cough control center in the medulla to suppress the cough reflex.

Thrombolytic Medications Description

These medications activate plasminogen, which generates plasmin, the enzyme that dissolves clots. Used early in the course of myocardial infarction (within 4 to 6 hours of onset), thrombolytic agents can restore blood flow, limit myocardial damage, preserve left ventricular function, and prevent death.

Cardiac Glycosides- Contraindicated in Nursing considerations

These medications are contraindicated in clients with ventricular dysrhythmias and second- or third-degree heart block and are used with caution in clients with renal disease, hypothyroidism, and hypokalemia.

Oral Hypoglycemic Medications Description

These medications are prescribed for clients with type 2 diabetes mellitus. Hypoglycemia may occur if an excessive dose is administered or if meals are omitted or delayed, food intake is decreased, or activity is increased.

Mydriatic/Cycloplegic and Anticholinergic Drugs Uses

These medications are used before surgery or for eye examinations to produce mydriasis.

Peripheral Vasodilators- Used for Description

These medications are used in peripheral vascular disorders of venous and arterial vessels such as disorders resulting from vasospasm (e.g., Raynaud disease).

Antigout Medications Description

These medications are used to prevent or relieve gout and to manage hyperuricemia.

Immunosuppressants Description

These medications are used to prevent organ or tissue rejection in transplant recipients and to treat autoimmune disorders such as systemic lupus erythematosus.

Anticoagulants- Treatment for Description

These medications are used to treat thrombosis, pulmonary embolism, and myocardial infarction and are also given to clients at risk for thromboembolism.

Ceruminolytic Preparations Description

These medications emulsify and loosen cerumen deposits to ease removal of impacted wax from the ear canal.

Glaucoma Treatment Carbonic Anhydrase Inhibitors Description

These medications interfere with the production of carbonic acid, leading to reduced production of aqueous humor and decreased intraocular pressure.

Expectorants and Mucolytic Agents Description

These medications loosen bronchial secretions so that they can be eliminated with coughing.

Antiviral Medications

These medications must be administered within 2 days of the onset of influenza symptoms and continued for the entire prescription to ensure eradication of the virus.

Glaucoma Treatment Miotic Agents Description

These medications reduce intraocular pressure by constricting the pupil and contracting the ciliary muscle, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. One such commonly prescribed medication is pilocarpine hydrochloride.

Antilipemic Medications Description

These medications reduce serum levels of cholesterol, triglycerides, and low-density lipoprotein. (High levels increase the risk for coronary artery disease.) In many cases diet alone will not reduce blood lipid levels, so antilipemic medications are prescribed.

Direct-Acting Arteriolar Vasodilators Description

These medications relax the smooth muscle of the blood vessels, mainly the arteries, causing vasodilation.

Antimyasthenic Agents Description

These medications relieve muscle weakness associated with myasthenia gravis by blocking acetycholine breakdown at the neuromuscular junction.

Antiparkinsonian Medications Description

These medications restore the balance of neurotransmitters acetylcholine and dopamine in the CNS, easing the signs and symptoms of Parkinson's disease.

Nasal Decongestants Description

These medications shrink nasal mucosal membranes and reduce fluid secretion. They are used to treat allergic rhinitis, hay fever, or acute coryza (profuse nasal drainage).

Sulfonamides Description

These medications suppress bacterial growth by inhibiting the synthesis of folic acid; active against a broad spectrum of microbes.

Antidysrhythmic Medications Description

These medications suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart.

Opioid Analgesics Description

These medications suppress pain impulses but can also suppress respiration and coughing by acting on the respiratory and cough center, located in the medulla of the brainstem. Opioids, which produce euphoria and sedation, can cause physical dependence.

Urinary Tract Antiseptics Description

These medications, which inhibit the growth of bacteria in the urine and act as disinfectants within the urinary tract, are used to treat urinary tract infections.

Antineoplastic Medications: (Description)

These medications, which kill or inhibit the reproduction of neoplastic cells through a variety of actions, are used to treat various types of cancer. Normal cells are also affected by these medications, leading to a wide range of side and adverse effects. Generally several medications are used in combination to increase the therapeutic response. Antineoplastic medications cause the rapid destruction of cells, resulting in the release of uric acid; allopurinol may be prescribed to lower the serum uric acid level.

Antiparkinsonian Medications-Contraindicated Nursing considerations

They are contraindicated in cardiac, renal, and psychiatric disorders; additionally, taking levodopa with a monoamine oxidase inhibitor antidepressant can cause hypertensive crisis.

Leukotriene Modifiers Description

This class includes medications such as montelukast, zafirlukast, and zileuton. Leukotriene modifiers are used in the prophylaxis and treatment of chronic bronchial asthma.

Urinary Analgesics Renal Medications Description

This class of medications is used to treat pain resulting from urinary tract irritation or infection. One commonly used urinary analgesic is phenazopyridine hydrochloride. These medications are usually administered with an antibiotic because they do not treat infection, only pain.

Dobutamine Adrenergic Agonists Description

This medication increases myocardial force and cardiac output through stimulation of beta-receptors.

Epinephrine-Uses Adrenergic Agonists Description

This medication is used for cardiac stimulation in cardiac arrest.

Isoproterenol Hydrochloride-Uses Adrenergic Agonists Description

This medication is used to induce cardiac stimulation and bronchodilation.

Peripheral Vasodilators Description

This type of vasodilator decreases peripheral resistance by exerting direct action on the arteries or on both the arteries and the veins, increasing blood flow to the extremities.

Anticholinergic Antispasmodics- Use Cautiously Nursing Considerations

Tolterodine should be used cautiously in clients with glaucoma. Do not administer oxybutynin to clients with known hypersensitivity, GI or genitourinary obstruction, glaucoma, severe colitis, or myasthenia gravis.

Integumentary Medications- Glucocorticoids (nursing considerations)

Topical glucocorticoids can absorb into the systemic circulation, especially if applied in a thick layer; absorption is more likely to occur in thinner skin areas such as the scalp, axilla, face and neck, eyelids and perineum.

Integumentary Medications- Side Effects (nursing considerations)

Topical medications can cause burning or irritation of the skin, as well as other local adverse effects, including bacterial, fungal, and viral overgrowth. Isotretinoin, which is highly teratogenic and can cause fetal abnormalities, must not be used if the client is pregnant. Clients who have been prescribed isotretinoin must follow the strict rules of the iPLEDGE Program.

Endocrine Medications: 2 types of conditions that may occur

Two types of conditions may occur: hypersecretion or hyposecretion of the hormone from the gland. When hypersecretion occurs, medication is administered to inhibit secretion of the hormone into the body (and, in certain situations, surgery may be performed). When hyposecretion occurs, medication is administered to replace the needed hormone in the body.

Urinary Analgesics Renal Medications- Contraindications Nursing Considerations

Urinary analgesics are contraindicated in clients with renal or hepatic disease.

Diuretics- Use with caution in Nursing Considerations

Use these medications with caution in the client taking digoxin or lithium, because toxicity may occur.

Macular Degeneration Treatment-WET Description

Wet ARMD, which progresses faster, is caused by growth of new subretinal blood vessels leading to fluid leakage that lifts the macula and causes permanent injury.

Warfarin Sodium- Antidote Nursing Considerations

Vitamin K is the antidote to warfarin. Page 44 of 137

Anticoagulants- Warfarin Description

Warfarin, which decreases prothrombin activity and prevents the use of vitamin K by the liver, is used for long-term anticoagulation to prevent thromboembolitic conditions such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation, thrombosis, myocardial infarction, or heart valve damage.

Antimyasthenic Agents Nursing Considerations

Watch for signs and symptoms of medication overdose (cholinergic crisis) and underdose (myasthenic crisis). Assess the client's neuromuscular status, including reflexes, muscle strength, and gait. Instruct the client to take medications on time to prevent weakness, which may impair the client's ability to breathe and swallow. Instruct the client to take the medication before meals for best absorption. Explain that antimyasthenic therapy is lifelong. Evaluate the effectiveness of the medication on the basis of improvement of neuromuscular symptoms or strength without cholinergic signs and symptoms.

Heparin- Watch for Nursing Considerations

Watch for signs of bleeding (e.g., bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult fecal blood, petechiae) and implement bleeding precautions.

Heparin- Sub-Q Nursing Considerations

When administering heparin subcutaneously, inject it into the abdomen with a small needle (25- to 28-gauge) at a 90-degree angle; do not aspirate or rub the injection site.

Treatments for Diabetes Mellitus- Sulfonylureas Blood Glucose Regulators Description

used to treat diabetes mellitus, can affect cardiac function and oxygen consumption and lead to cardiac dysrhythmias; they can also cause the type of reaction triggered by disulfiram when the client ingests alcohol.