AHN 448: MEDICATION QUIZ 1

lisinopril (Zestril) fosinopril (Monopril)

ACEI, antihypertensives MOA Management of HF and hypertension CONTRAINDICATIONS angioedema, renal impairment, hypovolemia, hyponatremia, pregnancy S/E dizziness, cough, hypotension, hyperkalemia, angioedema INTERVENTIONS Monitor BP and HR, monitor for angioedema, monitor for fluid overload, monitor BUN/creatinine, monitor K+

Vancomycin (Vancocin)

Anti-infectives MOA Bactericidal action, binds to bacterial cell wall resulting in cell death S/E nephrotoxicity, phlebitis, ototoxicity, hypotension, N/V CONTRAINDICATIONS renal impairment, hearing impairment, intestinal obstruction or inflammation INTERVENTIONS Obtain peak and trough levels (trough should not exceed 10 mcg/mL) Evaluate renal function before administration Obtain culture

Azithromycin (Zithromax)

Anti-infectives, macrolides MOA Bacteriostatic = slow growth rate CONTRAINDICATIONS hypokalemia, hypomagnesemia, or bradycardia S/E Abdominal pain, diarrhea, nausea, headache, Stevens-Johnson Syndrome, hyperkalemia, ototoxicity INTERVENTIONS Assess patient for skin rash, stop the medication at first sign of rash. Monitor LFTs, BUN, creatinine, potassium

Hydralazine (Apresoline)

Antihypertensice; vasodilator MOA Lowering of BP in hypertensive patients and decrease afterload in patients with HF CONTRAINDICATIONS Cardiovascular or cerebrovascular disease; Severe renal and hepatic disease. Has been used safely during pregnancy. S/E Dizziness, headache, drowsiness, tachycardia, angina, arrhythmias, edema, orthostatic hypotension, diarrhea, nausea, vomiting, rash, sodium retention, arthritis, peripheral neuropathy INTERVENTIONS Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. ure. Monitor frequency of prescription refills to determine adherence. Monitor CBC, electrolytes, LE cell prep, and ANA titer prior to and periodically during prolonged therapy. May cause a positive direct Coombs' test result.

insulin: overview of times

RAPID ACTING (lispro, aspart) Onset: 15-30 minutes Peak: 1-3 hours Duration: 3-5 hours SHORT ACTING (regular) Onset: 0.5-1.5 hours Peak: 2-5 hours Duration: 6-10 hours INTERMEDIATE ACTING (NPH) Onset: 0.5-5 hours Peak: 4-14 hours Duration: 16-24 hours LONG ACTING (Levemir, Detemir, Glargine, Lantus) Onset: 1-2 hours Peak: NONE Duration: up to 24 hours

amoxicillin (Amoxil)

anti-infectives, antiulcer agents, aminopenicillins MOA Treatment of infections; binds to bacterial cell wall resulting in cell death CONTRAINDICATIONS allergy to penicillins, renal impairment S/E seizures, C. Diff, diarrhea, N/V, superinfection INTERVENTIONS Observe for anaphylaxis Monitor bowel function

ceftriaxone (Rocephin)

anti-infectives, cephalosporin MOA Binds to the bacterial cell wall membrane, causing cell death; tx of infections CONTRAINDICATIONS premature neonates, hyperbilirubinemia, GI dz S/E seizures, C. Diff, acute renal failure INTERVENTIONS Assess for anaphylaxis Monitor bowel function Monitor liver function especially bilirubin, BUN, Creatinine

metoprolol (Toprol)

antianginals, antihypertensives, beta blockers MOA Decreased BP and heart rate. Decreased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure. CONTRAINDICATIONS Uncompensated HF, pulmonary edema, cardiogenic shock, bradycardia, heart block, or sick sinus syndrome S/E fatigue, weakness, bradycardia, HF, pulmonary edema, erectile dysfunction INTERVENTIONS Monitor BP, HR, ECG Monitor VS Monitor I&O

enoxaparin (Lovenox)

anticoagulants, antithrombotics, low molecular weight heparins MOA prevention of thromboembolic events, Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin CONTRAINDICATIONS hx of H.I.T., active bleeding, retinopathy, liver impairment, uncontrolled hypertension S/E bleeding, anemia, thrombocytopenia, dizziness, insomnia INTERVENTIONS Assess for signs of bleeding Monitor CBC, platelet count, and stools Antidote: Protamine Sulfate

escitalopram (Lexapro)

antidepressants, SSRI MOA Selectively inhibits the re-uptake of serotonin in the CNS. CONTRAINDICATIONS current use of MAOIs, hx of seizures, liver/renal impairment S/E neuroleptic malignant syndrome, suicidal thoughts, insomnia, hyponatremia, diarrhea, nausea, decreased libido, serotonin syndrome INTERVENTIONS Assess for suicidal tendencies Assess for serotonin syndrome

ondansteron (Zofran)

antiemetics MOA Decreased incidence and severity of nausea and vomiting CONTRAINDICATIONS PKU, prolonged QT interval, liver impairment S/E serotonin syndrome, headache, constipation, EPS, torsade de pointes INTERVENTIONS Monitor ECG with hypokalemia, hypomagnesia, HF, bradyarrhythmias Assess for S&S of serotonin syndrome

diphenhydramine (Benadryl)

antihistamine, antitussive MOA Significant CNS depressant and anticholinergic properties CONTRAINDICATIONS asthma attacks, alcohol intolerance, liver disease, seizure disorders, gastric ulcers S/E drowsiness, dry mouth, anorexia, tinnitus, blurred vision, photo-sensitivity

acetaminophen (Tylenol)

antipyretic, nonopioid analgesic MOA Inhibits synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. CONTRAINDICATIONS hepatic/renal disease, alcoholism, malnutrition S/E hypokalemia, renal failure, hepatotoxicity INTERVENTIONS Assess alcohol usage Assess use of OTC drugs Assess liver function and prothombin time

aspirin (ASA)

antipyretics, non-opioid analgesics, salicylates MOA Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins Decreases platelet aggregation CONTRAINDICATIONS other NSAIDs, bleeding disorders, hx of GI ulcers/bleeding, chronic alcohol use S/E tinnitus, GI bleeding, dyspepsia, epigastric distress, nausea, hepatotoxicity, anemia INTERVENTIONS Monitor liver function, prothrombin time, H&H Instruct to drink with full glass of water and remain in upright position 15 to 30 minutes

albuterol (Ventolin)

bronchodilators, adrenergics MOA Relaxation of airway smooth muscle with subsequent bronchodilation CONTRAINDICATIONS Cardiac disease, Hypertension, Hyperthyroidism, Diabetes, Glaucoma, Seizure disorders S/E restlessness, nervousness, tremor, bronchospasm, chest pain, palpitations, hypokalemia INTERVENTIONS Observe for bronchospasm

atorvastatin (Lipitor)

lipid-lowering agents MOA an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol CONTRAINDICATIONS liver disease, alcoholism, renal impairment, pregnancy S/E abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes, rhabdomyolysis INTERVENTIONS Monitor cholesterol Monitor LFTs Monitor CPK with muscle tenderness Teach to avoid grapefuit

morphine (MS Contin)

opioid analgesics, opioid agonists MOA Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Decreases severity of pain CONTRAINDICATIONS respiratory depression, asthma, paralytic ileus S/E confusion, sedation, hypotension, constipation INTERVENTIONS Assess LOC, BP, HR, RR Assess risk for opioid addiction Antidote is Narcan