Nursing 204 Pharmacology Review

Interleukin-11

..., Megakaryocyte growth factor, used in thrombocytopenia after cancer chemotherapy.

Lithium

..., Mood Stabilizer. This is a salt that is chemically similar to sodium chloride (table salt). It competes with sodium for absorption at receptor sites. Adequate fluid intake is very important. 2,000 - 3,000 mL of water a day. Should avoid caffeine. Serum levels must be checked throughout therapy.

Phenazopyridine HCL (Pyridium)

..., Prototype for Urinary analgesics; relieves burning, pain, frequency, urgency of lower UTI, sidefx: gi disturbances, hemolytic anemia, urine turns reddish orange

Ferrous Sulfate

..., This drug is given for Iron Deficiency Anemia. Do not give with food or milk because they interfere with iron absorption. Giving it with orange juice or vitamin C-rich drinks increases iron absorption.

Synthroid

..., This drug is used for thyroid supplementation in hyperthyroidism. Treatment or suppression of goiters & thyroid cancer. Replaces or supplements thyroid hormones. Increases metabolic rate of body tissues. Promotes gluconeogenesis. Increases utilization and mobilization of glycogen stores. Stimulates protein syntheses. Promotes cell growth & differentiation. Aids in development of brain and CNS.

Magnesium sulfate

..., This med is 1)an anticonvulsant 2)Decreases BP 3) Stops preterm labor contractions, Signs of toxicity of this drug is Lose reflexes, < urinary output (<30 ml hr), Respirations <12 & decreased LOC.

Albuterol

..., a bronchodilator (trade names Ventolin or Proventil) used for asthma and emphysema and other lung conditions

Captopril

..., a drug (trade name Capoten) that blocks the formation of angiotensin in the kidneys resulting in vasodilation

Verapamil

..., a drug (trade names Calan and Isoptin) used as an oral or parenteral calcium blocker in cases of hypertension or congestive heart failure or angina or migraine

Bile Acid Sequestrants

..., bind bile acid and the gi tract resulting in decreased absorption of cholesterol

Bisphosphonates

..., fosamax, boneva, actonel, promotes calcium reabsorption, decreases calcium destruction, used to reverse osteoporosis

Prilosec

..., omeprazole/proton pump inhibitor/ GERD duodenal ulcers

Hydrochlorothiazide

"Hydrodiuril"- expected pharmacological action: thiazide diuretics work in the early distal convoluted tubule (DCT) to: 1) block the reabsorption of sodium and chloride, thus preventing the reabsorption of water at this site. 2) Promote diuresis when renal function is not impaired. Therapeutic Uses: Thiazide diuretics are often the medication of first choice for essential hypertension. They may be used for edema of mild to moderate heart failure and liver and kidney disease. Adverse effects & nursing interventions: 1) Dehydration= assess/monitor for signs of dehydration (dry mouth, increased thirst, minimal urine output, weight loss), monitor serum electrolytes and weight, report urine output less than 30 ml/h. stop medication and notify the provider. 2) Hypokalemia=monitor cardiac status and serum K levels, report a decrease in serum K (less than 3.5 mEq/L), teach client to consume foods high in K such as spinach and tomatoes, teach client to recognize signs of hypokalemia (nausea, vomiting, general weakness.) 3) hyperglycemia-monitor for an increase in blood glucose levels. Contraindications: Pregnancy risk Category B so avoid use during pregnancy and lactation. Digoxin toxicity can occur in the presence of hypokalemia so monitor cardiac status and K and Dig levels, and note that a potassium sparing diuretic can be used in conjunction with a thiazide diuretic to reduce the risk of hypokalemia. Antihypertensives have added hypotensive effects so closely monitor BP. Hyponatremia can lead to decrease in lithium carbonate excretion which may lead to toxicity so closely monitor lithium levels and dosage may need to be adjusted. NSAIDs reduce the diuretic effect so watch for reduced urine output and other signs of decreased effectiveness. Nursing administration: Can only be given orally, obtain baseline data to include orthostatic BP, weight, electrolytes, and location and extent of edema. Monitor K levels. Instruct client to take the medication first thing in the morning and if ordered twice a day be sure the second dose is taken by 2pm to prevent nocturia. Encourage consumption of foods high in K and maintain adequate fluid intake (1500 ml/day unless contraindicated), if GI upset occurs clients may take medication with or after meals, and note that alternate day dosing can decrease electrolyte imbalances. Evaluation: Decrease in BP, Decrease in edema, Increase in urine output.

Aminoglycosides

(amikacin, gentamicin, kanamycin, neomycin, streptomycin, tobramycin,) Classification- Anti-infective Side Effects- ataxia, vertigo, ototoxicity, nephrotoxicity, diarrhea, n&v, hypomagnesemia, apnea, hypersensitivity reactions. Caution in- renal impairment, hearing impairment, neuromuscular diseases, obesity, pregnancy Advise pt to drink plenty of fluids w/these meds.

DTaP

*Pediatric Immunization given IM at 2,4,6 and 15-18 months. Booster at 4-6 yrs. *Contradictions: acute infection, immunosuppressive therapy,previous CNS damage or convulsions. *adverse reactions: redness, tenderness, induration at site, fever, excessive crying, malaise, myalgia, uticaria, hypotension, neurologic and allergic reactions.

Erythromycin

*anti-infectant *ototoxicity, N/V, phlebitis *assess signs of infection, administer as directed around the clock, better absorbed on empty stomach, but may be taken with food to prevent stomach upset, report signs of super infection, eat yogurt daily.

Digoxin

- Treatment of heart failure, dysrhythmias - Dysrhythmias, cardiotoxicity leading to bradycardia, GI affects (N/V, abdominal pain) CNS effects (fatigue, vision changes, yellow-green or white halos around objects) - If missed dose do not double up on dose - Monitor Dig levels therapeutic levels (0.5 to 2.0) - Avoid taking OTC medications - Monitor for dig toxicity (anorexia, fatigue, weakness) - Monitor K+ levels for less the 3.5 administer potassium - Treat bradycardia with atropine

Uterine Stimulants-Oxytocics

-Ex. oxytocin (Pitocin, Syntocinon), methylergonovine (Methergine) -Therapeutic use: induce labor (post-term, premature rupture, pre-eclampsia), deliver placenta, control postpartum bleeding, intranasal promotes milk letdown. Methergine is used for postpartum hemorrhage. -Complications-uterine rupture (have mag. sulfate if needed), hypertensive crisis (monitor for sx, headache, n/v, increased BP) -Avoid vasopressors can cause hypertension -Nursing administration *use an infusion pump, gradually increase flow rate, monitor uterine contractions, monitor v.s., monitor for uterine hyperstimulation, monitor fetal heart rate and rhythm

Naloxone

-opioid antagonist -treat opioid overdose, reversal of effects such as resp. depression -S.E. and interventions *tachycardia and tachyapnea- monitor heart rate and resp. function, have resuscitative equipment and O2 *abstinence syndrome- cramping, vomiting, HTN *pulmonary edema- rales, use cautiosly in ct with hx of -Contraindications *ct who are opioid dependent -Nursing administration *do not give orally

Amphotericin B (Fungizone)

-used to treat progressive and life threatening fungal infections;noninvasive forms of fungal disease -Anxiety,convulsions ,coma,hallucinations,peripheral neuropathy,tremor,vertigo,cardiac failure/arrest/myopathy,hypertension,local Venous pain,nausea,vomiting,diarrhea,epigastric pain,gastroenteritis,azotemia, tubular acidosis, agranulocytosis,thrombocytopenia,acute liver failure,hypokalemia,bone and joint pain, pruritis, erythema,inflammation,pain. -hx of hypersensitivity,c&s before therapy, renal and hepatic function may require decreased dose if impaired, reconstitute iv,protect from light,monitor i&o,d/c if bun greater than 40mg/100ml,serum cr greater than 3mg/100ml,vs,temp,s/s hypokalemia,maintain hydration ,teach patient to.report any discomfort at infusion site immediately

Isoniazid

-used to treat tuberculosis (TB) -prevention in people who have had contact with TB (taken usually 6-12 months,PO). SE: Hepatotoxic Peripheral neuritis Optic neuritis

Folic Acid

..., A B-complex vitamin found in many vegetables, beans, fruits, whole grains, and some fortified breakfast cereals and it helps prevent birth defects

Tetracycline

..., Broad-spectrum bacteriostatic antibiotics . Inhibit protein synthesis Use: mycoplasma, chlamydia, rickettsia, borrelia, chronic bronchitis, acne, cholera, syphilis, H. pylori Tox: GI upset and superinfections, Fanconi's syndrome, photosensitivity, dental enamel dysplasia. Do not take with milk, antacids or iron

Flagyl

..., It is used for intra-abdominal and Gynecological infections. It is administered by orally and IV. It works by interfering with DNA synthesis within the cell. Anti-convulsive (Dilantin and Phenobarbital) medication can reduce this drugs effect. It has to be given at certain times to have this effect,

Pancrelipase (Pancrease)

..., pancreatic enzyme replacement therapy of lipase, protease, and amylase. dissolves in the alkaline duodenum and releases enzymes, which act locally and are not absorbed. Powdered formulation s may be sprinkled on food. Adverse effects: uncommon as enzymes are not absorbed. nausea, vomiting, and diarrhea. do not give with allergies to drug or pork products. do not give delayed release with acute pancreatitis. Overdose- treat symptoms of hyperuricemia

Predinisone

A glucocorticoid, provide symptomatic relief of inflammation and pain. - SE: Risk for infection, osteoporosis, Adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia. - Advise client to notify MD if fever or sore throat occur. - Advise client to take calcium supplements and Vit D. - Monitor for signs of fluid excess. - Advise client to report symptoms of GI bleed. - Monitor glucose levels. - Monitor potassium levels. Advise client to eat potassium rich foods. - If client is on a hypoglycemic the dose may need to be increased. - Risk for GI bleed if taking NSAID's Tell client to avoid them.

Nitroglycerin

Action: In stable angina, nitroglycerin decreases cardiac oxygen demand by dilating veins and decreasing venous return (preload). In variant angina, nitroglycerin relaxes and prevents spasms in coronary arteries, thus increasing oxygen supply. Therapeutic Uses: Acute attacks and prophylaxis of stable angina, variant angina. Side/Adverse Effects: HEADACHES - advise the client of symptoms and instruct the client to use aspirin or acetaminophen to relieve pain. ORTHOSTATIC HYPOTENSION - Advise the client to sit or lie down if experiencing dizziness or faintness. REFLEX TACHYCARDIA - Monitor the client's vital signs. TOLERANCE - All long-acting forms of nitroglycerin should be taken with a medication free period each day. Contraindications/Precautions: Pregnancy Risk Category C. Contraindicated with clients with hypersensitivity to nitrates. Contraindicated in clients with traumatic head injury because medication can increase intracranial pressure. Therapeutic Nursing Interventions: Treatment of angina attack - instruct the client to stop activity. The client should take dose of rapid-acting nitroglycerin immediately. If pain is unrelieved in 5 min. then the client should call 911. Client can take up to two more doses at 5 min intervals.

Pitocin

Action: Uterine stimulants increase the strength, frequency, and length of uterine contractions. Therapeutic uses: ■ Induction of labor (postterm pregnancy, premature rupture of membranes, preeclampsia). ■ Enhancement of labor, such as with dysfunctional labor ■ Delivery of placenta (postpartum, miscarriage) ■ Control of postpartum bleeding ■ Fetal stress testing ■ Intranasal: Promotion of milk letdown. Side effects: uterine rupture Nursing intervention/client teaching: • Preassess client risk factors such as multiple deliveries. • Monitor the length, strength, and duration of contractions. • Have magnesium sulfate on standby if needed for relaxation of Myometrium. Contraindications of Oxytocin: - Maternal factors include sepsis, labor induction, a cervix that has not ripened, genital herpes, history of multiple births, and/or uterine surgery). - Fetal factors include immature lungs, cephalopelvic disproportion, fetal malpresentation, prolapsed umbilical cord, fetal distress, and threatened spontaneous abortion. Medication/drug interactions: nursing interventions/client teaching: Vasopressors can lead to hypertension. • Avoid concurrent use of oxytocin and vasopressors. • Monitor maternal blood pressure and report hypertension to the primary care provider. - Prior to administering analgesic or anesthetic pain relief, the nurse should verify that laboris well established by performing a vaginal exam showing cervical dilation to be at least4 cm with the fetus engaged. - Have naloxone (Narcan) available to counteract the effects of respiratory depression in the newborn. - Administer antiemetics as prescribed. - Monitor maternal vital signs, uterine contraction pattern, and continuous FHR monitoring. - Explain to the client that the medication will cause drowsiness. - Instruct the client to request assistance with ambulation.

Zantac

Active duodenal ulcers and benign gastric ulcers and management of GERD Side effects that could cause significant harm that are specific to that medication and prevention measures: Headaches, constipation, diarrhea, nausea, agranulocytosis and anemia Nursing consideration to include monitoring, teaching and administration if significant for that medication: Assess for abdominal pain and occult blood in the stools. Monitor CBC with Diff Instruct the patient to take medication exactly as directed. Smoking interferes with action of histamine antagonists. Avoid alcohol and increase fluid and fiber intake. Report black/tarry stools to doctor immediately.

Lipitor

Adjunctive management of primary hypercholesterolemia and mixed dyslipidemia. Primary prevention of coronary heart disease. rhabdomyolysis angioneurotic edema Avoid drinking more than 1 quart of grapefruit juice per day during therapy. Notify health care provider if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise. Avoid pregnancy or breast-feeding.

Midazolam

Anesthetics, Antianxiety, sedative, hypnotic -Benzodiazepine S/E Respiratory Depression Drowsiness or dizziness may be experienced for 24 hrs after administration Monitor: BP, pulse, respiration continuously during IV administration Oxygen should be given by nasal cannula Resuscitative equipment should be immediately available 2 practitioners should check dose Antidote: Flumazenil (Romazicon)

Procainamide (Pronestyl)

Antiarrhythmic Procainamide is used to treat many different ventricular and atrial heart issues to help keep the heart in a normal rhythm. Major Side Effects: Seizures, Asystole (Lack of cardiac activity), Ventricular Arrhythmias. Nursing Care: Monitor ECG, pulse, and blood pressure continuously throughout IV therapy. Monitor CBC during the first three months of therapy. Monitor Liver function during therapy.

Colchicine

Antigout medication indomethacin (Indocin), allopurinol (Zyloprim), probenecid Used to Treat: Acute gout attacks Hyperuricemia Prolongs the effects of penicillins and cephalosporins be delaying their elimination Side Effects: GI toxicity (abdominal pain, diarrhea, nausea and vomiting) Renal injury Nursing Interventions/Client Education: Take with food Provide antidiarrheal medications as prescribed If severe symptoms occurs, stop colchicines Encourage intake of 2 to 3 L of fluids/day Avoid use during pregnancy ( Category C, if used orally, Category D, if used intravenously) Use cautiously with the elderly, debilitated clients, and clients with renal, cardiac and GI dysfunction Allopurinol slows metabolism of Coumadin; watch s/s of bleeding Salicylates lessen the effect of probenecid Monitor for improvement of pain caused by gout Decrease number of gout attacks

Pepcid

Antiulcer agent(H2 Agonist) Pepcid is used to coat the stomach and protect it from any duodenal ulcers or benign gastric ulcers. Major Side Effects: Arrhythmias, Anemia, nausea, confusion, and constipation. Nursing Care: Monitor for epigasric and abdominal pain, occult blood in the stool, emesis, and gastric aspirate. Monitor CBC during drug therapy.

Statins

Atorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin sodium (Pravachol) Rosuvastatin (Crestor) Fluvastatin (Lescol, Lescol XL) Decrease manufacture of LDL cholesterol. Decrease manufacture of very low-density lipoproteins (VLDL) Increase manufacture of high-density lipoproteins (HDL). Side Effects: Hepatotoxicity, Myopathy, Peripheral neuropathy Advise clients to limit the amount of grapefruit juice consumed each day

Smoking Cessation

Bupropion (Zyban) - decreases nicotine craving and symptoms of withdrawal. 1. To treat dry mouth, encourage clients to chew gum or suck on hard candy and to sip small amounts of water or suck on ice chips 2. Advise clients to avoid caffeine and other CNS stimulants to control insomnia Nicotine replacement therapy (nicotine gum [Nicorette] and nicotine patch [Nicotrol] - these nicotine replacements are pharmaceutical product substitutes for the nicotine in cigarettes or chewing tobacco. 1. Clients should avoid using nicotine products while pregnant or breastfeeding 2. Nicotine gum: Use of chewing gum is not recommended for longer than 6 months Advise clients to chew gum slowly and intermittently over 30mins Advise clients to avoid eating or drinking 15min prior to and while chewing the gum 3. Nicotine patch Clients should apply a nicotine patch to an area of clean, dry skin each day Advise clients to avoid using any nicotine products while patch is on Follow product directions for dosage times Advise clients to stop using patches and to notify provider if local skin reactions occur Remove the patch prior to MRI scan and replace when scan is completed

Clonidine

Centrally Acting Alpha 2 Agonists indomethacin (Indocin), allopurinol (Zyloprim), probenecid Used To Treat: Hypertension Severe cancer pain Investigational use for: migraine headaches, flushing from menopause, and management of withdrawal symptoms from alcohol, tobacco, and opiods Side Effects: Drowsiness abd sedation Dry mouth Round hypertension Nursing Interventions/Client Education: Avoid activities that require mental alertness until symptoms subside Chew gum or hard candy, take small sips of water Don't discontinue treatment without consulting PCP Should be discontinued over 2 to 4 days Observe for signs of hypotension (dizziness, lightheadedness, faintness) Change positions slowly and sit down if feeling dizzy Advise child bearing women to rule out pregnancy prior to beginning treatment Additive CNS depression w/ alcohol, don't use with alcohol Divided doses; take larger dose at bedtime to reduce daytime sleepiness Decrease in BP Maintenance of normotensive state No pain

Lispro

Control of hyperglycemia in diabetic patients SE: hypoglycemia, anaphylaxis, erythema, pruritus, swelling Assess for s/s of hypoglycemia (anxiety, restlessness, tingling in hands/feet/lips/tongue, chills, cold sweats, confusion, difficulty concentrating, drowsiness) Assess for s/s of hyperglycemia (confusion, drowsiness, flushed dry skin, fruit-like breath odor, rapid deep breathing, polyuria, n/v Lispro can be mixed w/ NPH insulin

Cytotoxic Medications

Cytoxic medications are chemotherapy agents used to kill fast growing cancer cells, as well as healthy cells including skin, hair, intestinal mucosa, and hematopoietic cells. Classifications: Antimetabolites : kills cancer cells by interrupting the specific cell phase of cell production (Methotrexate, Cytarabine, Mercaptopurine) Alkylating agents: Kills cancer cells by altering DNA structure and preventing reproduction (Cyclophosphamide, Carmustine, Cisplan) Antitoumor antibiotics : Kills cancer cells by stopping the synthesis of RNA, DNA or proteins (Doxorubicin, Danctinomycin) Topoisomerase inhibitors: Kills cancer cells by interrupting DNA synthesis Antimitotics: Kills cancer cells by inhibiting mitosis and preventing cell division (Vincristine, Vinblastine, Paclitaxel) Other: kills cells by various mechanisms including interrupting DNA and RN synthesis in leukemia cells ** Remember these meds have chemo side effects. (hair loss, nausea, fatigue.. etc.) Nursing Considerations: Reduce dosage in patients who have renal disease Advise clients to avoid alcohol Monitor CBC and liver enzymes Monitor for jaundice, dark urine or clay colored stools ** I would suggest reading through ATI chapter 42, page 529 and also reviewing notes from our cancer 202 lecture..this is a very extensive class of medications, each has their own side effects and teachings.

Thrombolytics

Decrease risk of CHF or death Decrease risk of neurological sequelae Increase ventricular function S.E. Intracranial hemorrhage, GI bleeding, anaphylaxis and hypotension Monitor VS including temperature Assess for bleeding Assess neuro status monitor EKG Explain purpose of medication to family. Advise patient to report any hypersensitivity reactions ( redness or rash) Explain importance of bedrest to avoid injury.

Medications for Acute Alcohol Withdrawal

Effects of alcohol withdrawal usually start within 4 to 12 hrs, and peak at 24-48 hrs. BENZODIAZEPINES: chlordiazepoxide (Librium#, diazepam #Valium# (anticonvulsant# and lorazepam # Ativan#. . maintain vitals WNL, obtaining baselines. . Neuro status . Seizure precautions . CNS depression . Can lead to dependency . Decreases effects of oral contraceptives . Assess for tremors, agitation, delirum and hallucinations . Protect patient from injury, increased risk of falls in elderly. ADJUNCT MEDICATIONS; carbamazepine #Tegretol#, clonidine #Catapres#, propranolol #Inderal#. . Tegretol decreases seizures . Inderal & Catapres decrease BP, HR, and diaphoresis . Inderal decreases cravings ANTABUSE #disulfiram#, ReVia #naltrexone), and acamprosate #Campral) are all for maintenance following detoxification.

ACE Inhibitors

Enalapril (Vasotec), Enalarilat (Vasotec IV), captopril (capoten), Fosinopril (Monopril), Lisinopril (Prinivil), Ramipril (Altace) Used to treat: Hypertension, Heart Failure, Myocardial infarction, nephropathy, and patients at risk for a cardiovascular event. Side Effects: Orthostatic hypotension Cough Hyperkalemia Rash and dysgeusia (alt. taste) Angioedema Neutrpenia Take with or without food except catopril taken at least 1 hour before meals

Erythropoietin

For: anemia r/t chronic renal failure anemia secondary to AZT therapy in clients with HIV, chemotherapy, and elective surgery S/E: HTN secondary to elevated hematocrit increased risk for cardiovascular event (MI, stroke, cardiac arrest) if Hgb above 12g/dl or more than 1g in 2 weeks Interventions: H&H and BP, and if elevated, administer antihypertensives decrease dosage when limits are reached Considerations: obtain baseline BP SubQ or IV bolus - do not agitate or mix with other meds monitor iron levels dosing is usually 3x's weekly (but can be weekly or monthly)

Medications for Diabetes Mellitus

Humalog-short acting NPH (Humulin-N)-intermediate acting Lantus-long Insulin promotes cellular uptake of glucose Insulin moves potassium into cells SIDE EFFECTS Risk for hypoglycemia THERAPEUTIC INTERVENTIONS Draw the short-acting insulin up into the syringe first then the long acting insulin. Teach the client the importance of proper diet and consistant exercise ORAL HYPO GLYCEMICS SULFONYLUREAS-tolbutamide, glipizide Controls blood glucose levels in DMII SIDE EFFECTS Hypoglycemia TEACHING Consistent exercise and diet guidelines MEGLITINIDES - repaglinide Promotes insulin release from the pancreas SIDE EFFECTS Hypoglycemia TEACHING Instuct client to eat within 30 min. of taking a dose Consistent exercise and diet guidelines BIGUANIDES-metformin HCI Reduces the production of glucose within the liver SIDE EFFECTS Gastric effects (Anorexia N/V) Vitamin b deficiency Lactic acidosis (hyperventilation, myalgia, sluggishness)50%mortality

Dopamine

Inotropic, vasopressor Increases cardiac output, increase BP, improve renal blood flow s.e. Arrhythmias, hypotension, headache Monitor BP, HR, pulse, pulse pressure Monitor urine output Palpate peripheral pulses Advise doctor if chest pain, dyspnea, numbness, tingling or burning of extremities occur Advise doctor of any pain or discomfort.

Lasix

Loop Diuretic-Edema due to HF, Hepatic impairment, Renal disease or HTN Side Effects: Dehydration, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis Assess fluid status: daily weight, Intake & output Monitor signs of dehydration: dry mouth, increase thirst, minimal urine output & weight loss Monitor Electrolytes-cardiac status & potassium levels. Report to M.D potassium <3.5. Teach consume high potassium foods s/a bananas or potatoes. S/S hypokalemia N/V & generalized weakness. Monitor BP (teach pt to sit or lie down if lightheadness or dizziness occur) Avoid sudden changes of position.

Compazine

Management of nausea and vomiting Treatment of psychoses. Side Effects: Neuroleptic Malignant Syndrome (NMS) Agranulocytosis Extrapyramidal reactions May cause drowsiness Do not take within 2hrs of antacids or antidiarrheals

Cytotec

Medication Use: Cytotec is an antiulcer agent used to treat duodenal ulcers. Side Effects: abdominal pain, diarrhea, miscarriage. Nursing Considerations: Assess women of childbearing age of pregnancy (can be started on 2nd or 3rd day of menstrual period following a negative pregnancy test) Assess pt.'s routinely for epigastric or abdominal pain and for frank or occult blood in the stool, emesis or gastric aspirate. Be sure to teach women of childbearing age the risk for miscarriage. Do not confuse Cytotec with Cytoxin.

Antacid Therapy

Medicines that neutralize stomach acid and raise the gastric ph Used to relieve indigestion, upset stomach, and heartburn Also used as symptomatic relief for a peptic ulcer Should be avoided if signs of appendicitis and inflamed bowel are present (cramping, pain, and soreness of the lower abdomen, bloating, and nausea/vomiting) Side Effects: mild constipation or diarrhea, mild chalky taste, thirst, stomach cramps, nausea, HA, and whitish or speckled stools (these symptoms should go away but if they persist call MD) Precautions: frequent alcohol use, dehydration/fluid restriction, kidney problems (consult doctor before using) Seek Immediate Medical Attention if: black/tarry stools, slow/shallow breathing, mental changes, stomach/abdominal pain, vomit that looks like coffee grounds Examples: Alka-Seltzer, Tums, Milk of Mag, Mylanta, Pepto

Beta Blockers

Metoprolol (Lopressor), Atenolol (Tenormin), Metoprolol succinate (Toprol XL), Esmolol HCL (Brevibloc), propranolol (Inderal), Nadolo (Corgard), Labetalol (Normodyne) Used to treat: Primary hypertension Angina/heart failure, myocardial infarction, tachydysrhythmias Hyperthyroidism, migraines, stage fright glaucoma, and pheochromocytoma Side effects Bradycardia Decreased CO AV block Orthostatic hypotension Rebound myocardium excitation

Cyclosporine

Used to treat--is a DMARD, rheumatoid arthritis, prevent rejection reactions SE--infection,hepatotoxicity, nephrotoxicity,seizure Nursing considerations--monitor for signs of infection, monitor liver function, monitor bun and creatinine, I&O

Chemotherapy Agents: Side Effects

Pain-take pain medications as prescribe, meditation, relaxation strategies, rest diarrhea - eat low fiber foods, avoid greasy foods and strong spices constipation - increase fiber in diet, stool softeners and laxatives mouth sores - prescribed mouth rinses, pain medications, avoid infections hair loss - purchase wig and start wearing before hair loss occurs to get used to wearing it nausea and vomiting - take antiemetic medications neutropenia - have WBC levels monitored, avoid crowds and those with infections or illness, MD may prescribe prophylactic antibiotics or neupogen to stimulate WBC production anemia - increase iron and folic acid in diet, eat iron rich foods such as red meats, dark, leafy, vegetables, egg yolks, dried fruit, beans; patient may need blood transfusion or MD may prescribe erythropoietin thrombocytopenia - patient may need transfusion of platelets, use soft bristle toothbrush, use electric razor, blow nose gently

SSRI

Paroxetine (Paxil ) Sertraline (Zoloft) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons. Adverse effects: nausea, diaphoresis, tremor, fatigue, drowsiness, sexual dysfunction, weight gain, GI bleeding, serotonin syndrome, bruxism, withdrawal syndrome Inform the patient that it may take up 1-3 weeks to feel the therapeutic effects of the medication.

Warfarin

Prophylaxis and treatment of venous thrombosis, pulmonary embolism, A-fib Side effects that could cause significant harm that are specific to that medication and prevention measures: Bleeding Nursing considerations to include monitoring, teaching and administration if significant for that medication: Assess for signs of bleeding and hemorrhage Lab test: PT, INR. Therapeutic INR ranges 1.3-1.5 times greater than control. Monitor CBC with Diff and urine and stool for blood. Instruct the patient to take medication exactly as directed. Review foods high in vitamin K (limit intake of these foods) avoid anything that may cause patient to bleed (such as shaving with a razor). Report symptoms of unusual bruising or bleeding to doctor immediately

Phenytoin

Therapeutic uses: • Phenytoin is effective against all major forms of epilepsy except absence seizures. • Use IV route for status epilepticus. • Phenytoin is an antidysrhythmic. Side effects: Nursing considerations/actions: pg:163 ATI CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment) • Monitor for symptoms and notify the provider if symptoms occur. Gingival hyperplasia (softening and overgrowth of gum tissue, tenderness, and bleeding gums) • Advise clients to maintain good oral hygiene (dental flossing, massaging gums). Skin rash • Stop medication if rash develops. Teratogenic (cleft palate, heart defects) • Avoid use in pregnancy. Cardiovascular effects (dysrhythmias, hypotension) • Administer at slow IV rate and in dilute solution to prevent adverse CV effects. Endocrine and other effects (coarsening of facial features, hirsutism, and interference with vitamin D metabolism) • Instruct clients to report changes. • Encourage clients to consume adequate amounts of calcium and vitamin D. - Phenytoin are contraindicated in clients with sinus bradycardia, sinoatrial blocks, second- and third-degree AV block, or Stokes-Adams syndrome. Medication/food interactions: Nursing interventions/client teaching: pg :165 ATI Phenytoin causes a decrease in the effects of oral contraceptives, warfarin (Coumadin), and glucocorticoids because of the stimulation of hepatic drug-metabolizing enzymes. • Dose of oral contraceptives may need to be adjusted or an alternative form of birth control used. • Monitor for therapeutic effects of warfarin and glucocorticoids. Dosages may need to be adjusted. Alcohol, diazepam (Valium), cimetidine (Tagamet), and valproic acid increase phenytoin levels. • Advise clients to avoid alcohol use. • Monitor serum levels. Carbamazepine (Tegretol), phenobarbital, and chronic alcohol use decrease phenytoin levels. • Encourage the client to avoid use of alcohol. Additive CNS depressant effects can occur with concurrent use of CNS depressants (barbiturates, alcohol). • Advise clients to avoid concurrent use of alcohol and other CNS depressants. ● Monitor therapeutic plasma levels. Be aware of therapeutic levels for medications prescribed. Notify the provider of results. ● Advise clients taking antiepileptic medications that treatment provides for control of seizures, not cure of disorder. ● Encourage clients to keep a seizure frequency diary to monitor effectiveness of therapy. ● Advise clients to take medications as prescribed and not to stop medications without consulting the provider. Sudden cessation of medication may trigger seizures. ● Advise clients to avoid hazardous activities (driving, operating heavy machinery) until seizures are fully controlled. ● Advise clients who are traveling to carry extra medication to avoid interruption of treatment in locations where their medication is not available. ● Advise clients of childbearing age to avoid pregnancy, because medications may cause birth defects and congenital abnormalities. ● Advise the client that phenytoin doses must be individualized. Dosing usually starts twice a day and can be switched to once a day dosing with an extended-release form when maintenance dose has been established. ● Advise clients that phenytoin has a narrow therapeutic range, and strict adherence to the medication regimen is imperative to prevent toxicity or therapeutic failure.

Potassium Sparing Diuretics

Retains potassium and secretes sodium and water. - Used for heart failure, edema. - SE: Hyperkalemia K+ greater than 5.0 Monitor potassium level, initiate cardiac monitoring for K+ greater than 5.0. Treat hyperkalemia by discontinuing medication, restrict potassium in diet, and insulin injections to drive potassium back into the cell. Impotence, irregularities of menstrual cycle. Advise clients to observe for SE. Client should notify provider if these SE occur. - Contraindicated in pt's who have severe renal failure and anuria, - Monitor potassium regularly - Can only be given orally. - Teach pt's to avoid salt substitutes that contain potassium. - Teach clients to monitor BP and weight. - Warn clients that triamterene may turn urine a bluish color.

Acyclovir

Treat herpes simplex and varicella-zoster viruses Side effects: Phlebitis and inflammation at infusion site Nephrotoxicity Mild discomfort with oral therapy (nausea, headache, diarrhea) Advise to refrain from sexual contact while lesions are present

Calcium gluconate

Treatment and prevention of hypocalcemia Adjunct in the prevention of postmenopausal osteoporosis Emergency treatment of hyperkalemia and hypermagnesemia Adjunct in cardiac arrest or calcium channel blocking agent toxicity Side Effects: Cardiac arrest Arrhythmias Bradycardia Constipation *If giving IV push, administer medication over 5 minutes or longer. Push SLOWLY to prevent cardiac arrest and other cardiac issues (arrhythmias, bradycardia, etc.) Monitor blood pressure, pulse, and ECG frequently throughout parenteral therapy. Toxicity and Overdose: Assess patient for nausea, vomiting, anorexia, thirst, severe constipation, paralytic ileus, and bradycardia.

Levadopa

Treatment of Parkinson's disease. Side effects: involuntary muscle movements, dizziness, N/V, anorexia, dry mouth, hepatotoxicity, darkening of urine or sweat Monitor hepatic and renal function tests and CBC with differential. Assess for signs of toxicity

Timolol

Use: Beta-blocker(non-selective) used in hypertension, prevention of MI, Glaucoma Side effects: Stinging discomfort in eye (drops for glaucoma) Arhythmia, bradycardia. CHF, Pulmonary edema, fatigue Caution in patients with Diabetes (may mask s/s of hypoglycemia) May cause dry eyes Nursing considerations: Monitor BP, HR, ECG and check apical pulse prior to admin Advise client to report any visual changes Monitor blood glucose Monitor I/O and assess for fluid overload Withhold if apical pulse < 50 bpm

Ritalin

Use: ADHD, Conduct disorder S/E: CNS stimulation (insomnia, restlessness), Weight loss, Cardiovascular effects (dysrythmias, chest pain, high blood pressure) May increase the risk of sudden death in clients with heart abnormalities. Development of psychotic symptoms such as hallucinations, paranoia. Withdrawal reaction. Hypersensitivity skin reaction to transdermal methylphenidate (hives, papules) Nursing Considerations: Advise clients to observe for symptoms and notify the provider if they occur. Administer the last dose before 4p.m. Monitor the clients weight and compare to baseline height and weight. Administer medication immediately before or after meals. Promote good nutrition in children. Encourage children to eat at regular meal times and avoid unhealthy foods for snacks. Monitor the clients vital signs and ECG. Advise clients to observe for symptoms and to notify the primary care provider if they occur. Instruct clients to report symptoms immediately and to discontinue the medication if they occur. Advise client to not stop taking medication suddenly. Doing so may lead to depression and severe fatigue. Remove patch and notify the provider. Cntraindications: These medications are contraindicated in clients who have a history of drug abuse, cardiovascular disorders, severe anxiety, and psychosis.

Amiodarone

Use: Antidysrhythmic used in conversion of Atrial Fibrillation, recurrent Ventricular Fibrillation, recurrent Ventricular Tachycardia Side Effects: Pulmonary toxicity (s/s dyspnea, cough, chest pain) Bradycardia and AV block may lead to heart failure (s/s dyspnea, cough, chest pain, neck vein dystention, crackles in lungs) Visual disturbances (photophobia, blurred vision, may lead to blindness) Contraindicated in: Pregnancy (risk category D), newborns, infants, AV block and bradycardia. Caution in liver, thyroid, respiratory dysfunction, heart failure, fluid and electrolyte imbalances. Hypotension, bradycardia, AV block Nursing Considerations: monitor cardiac functions (BP, Pulse, EKG) monitor respiratory function (respirations, lung sounds, pulse ox) Advise client to report any visual changes or disturbances may increase plasma digoxin and warfarin levels Grapefruit juice may lead to toxicity

Glucocorticoids

Used for: prevent imflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree. Promote bronchodialtion Side effects: Dry mouth precautions: pregnancy risk; contraindicated in clients with peanut allergy, use cautiously with clients who have narrow angle glaucooma and benign prostatic hypertrophy(due to anticholinergic effects). Teaching: Rinse mouth after inhalation to decrease unpleasant taste.; usual adult dosage two puffs-instruct client to wait the length of time directed between puffs. Administer useing and MDI device or nebulizer. When prescribed with an inhaled beta 2-agonist advise client to inhale the beta 2 before inhaling the glucocorticoid wait 5 minutes between medications.

Cyanocobalamin

Used to treat-- vitamin b deficiency, megoblastic anemia related to vitamin b12 deficiency SE-- hypokalemia secondary to the increased rbc production efforts of vitamin b12 Nursing consider-- monitor clients potassium levels during start of treatment, observe for findings of potassium deficiency, client may require potassium supplements.

Coumadin

Used to treat--Venous thrombosis, prevention of MI SE--hemorrhage,hepatitis,toxicity/overdose Nursing considerations--monitor VS, monitor INR...want to keep between 2 and 3, monitor liver enzymes, monitor for signs of bleeding , vitamin k for overdose, takes 3-5 days to have therapeutic effect

tricyclic antidepressants

Used to treat: depression, depressive episodes in bipolar disorder, chronic pain and enuresis Significant side effects: orthostatic hypotension- change position slowly, monitor BP and heart rate. Dry mouth- chew sugarless gum, suck on mints or other hard candies, sip on water sedation- take at bedtime and avoid hazardous activities decreased seizure threshold- watch in patients with seizure disorder cardiac toxicity- monitor for dysrhythmias, confusion, agitation, followed by coma, seizures and possibly death. Obtain a baseline and monitor vitals frequently Nursing measures: Teach to avoid alcohol, benzodiazepenes, opiods, and antihistamines because of increased risk for CNS depression Avoid use of MAOIs, St. John's Wart

Aldactone

Used to treat: edema r/t Congestive Heart failure, Edema r/t Nephrotic syndrome, or ascites r/t cirrhosis of the liver Side Effects: Stomach upset (diarrhea, nausea, vomiting, cramps), Hyperkalemia, hyponatremia, dermatologic rash. Nursing measures: check electrolytes (especially K & NA), monitor urine output and blood pressure, educate patient about signs and symptoms of hyperkalemia (parathesia, fatigue, muscle weakness, flaccid extremities, and bradycardia)

Alpha Adrenergic Antagonists

Used to treat: high blood pressure, enlarged prostate (BPH) ,circulatory conditions such as Raynaud's. Side Effects: headache, pounding heartbeat, nausea, weakness, weight gain, and syncope. Nursing measures: check blood pressure & pulse before administration, monitor or orthostatic hypotension (advise patient to rise slowly from a sitting or lying position), take medication at night to reduce side effects, do not abruptly discontinue (dose must be tapered to prevent rebound hypertension).

Antipsychotics

aka Neuroleptics. Drugs used in the treatment of psychotic disorders that help alleviate hallucinations and delusional thinking Dopeamine antagonists. Major tranquilizers. Side effects: Wormlike tongue movement. Parkinsonian side effects...., CHLORPROMAZINE (Thorazine), TRIFLUOPERZINE (Stelazine), THOIRIDAZINE (mellaril) and PERPHENAZINE (trilafon). These drugs are "Phenothiazines" , CLOZAPINE (clozarl), OLANZAPINE (Zyprexa), RISPERIDONE (Risperdal), QUETIAPINE (Seroguel), ZIPRASIDONE (Geodon) and ARIPIPRAZOLE (Abilify). These drugs are ATYPICAL of this classification, EPS - akathesia (motor restlessness) dystonia (muscle tone impairments, tremors), akinesia (muscular paralysis) , pseudoparkkinson like symptoms, and Tardive dyskenesia (involuntary muscle movements)

Theophylline

bronchodilator. Theophylline causes CNS stimulation,tremors,tachycardia,hypotension, palpitations, GI distress (nausea, vomiting) Monitor ABG's, acid base values and fluid and electrolyte balance. Monitor liver and kidney function. Monitor for signs of toxicity: restlessness, insomnia, irritability, nausea, tremors and vomiting. Teach patient to avoid xanthine containing foods: caffeine, chocolate and colas Advise client not to smoke. Fluids to help loosen secretions Notify phycisian if palpitations, nausea,weakness, dizziness,chest pain or seizures occur.

Proventil (albuterol)

is a bronchodilator used for prevention and long term treatment of asthma attacks. Inhaled agents have minimal side effects. Oral agents can cause tachycardia and angina. Advise clients to observe for signs and symptoms (chest, jaw, or arm pain or palpitations). Instruct clients on how to check pulse and to report an increase greater than 20 to 30 beats/min. Use cautiously in patients with diabetes, hyperthyroidism, heart disease, hypertension, and angina.

Prozac

is an SSRI used for depression, PTSD, OCD, and ADHD. Side effects: suicidal behavior, CNS stimulation (inability to sleep, agitation, anxiety), weight gain. Watch for serotonin syndrome it may begin 2 to 72hrs after starting treatment, and it can be lethal watch for: mental confusion, difficulty concentration, hallucinations, incoordination, tremors, fever, and diaphoresis. Asses for alcohol use, make sure they are not taking MAOIs or TCAs because that increases the risk of serotonin syndrome. It may take 1-3 weeks to take effect.

MAOIs

isocarboxazid (Marplan), phenelzine (Nardil),and tranylcypromine (Parnate) ANTIDEPRESSANTS when other therapies have failed. For panic disorders, social anxiety, and social phobias. . Not for patients with elective surgery requiring anesthesia, should be discontinued days before surgery. . DONT PLAY WELL WITH OTHER MEDS. Just a few of the long list are: SSRI's, SSNRI's, tricyclic antidepressants, fluoxetine (wait 5 weeks aft d/c#, trazodone,and antihistamines. NO ST. JOHN'S WART, SAMe, or GINSENG. . DO NOT CONSUME TYRAMINE . LIMIT CAFFEINE INTAKE . Don't administer in the evening to help with insomnia . May be crushed, or mixed with a liquid. . Wait at least 2 weeks from stopping these meds #longer for certain meds) before starting another med. . Increased risk of hypoglycemia, seizures, dizziness, hypertensive crisis, arrhythmias, diarrhea, and weight gain. ASSESS mental status, anxiety level, suicidal tendancies, monitor I&O, BP, Pulse, daily weights, and urine retention. Headache is the 1st sign of hypertensive crisis, other S&S palaitations, chest or throat tightness, sweating, dizziness, neck stiffness,and n/v. LABS: Hepatic function, serum glucose advise pt to carry ID describing med regimen at all times.

Heparin

parenteral anticoagulant Pharmacological action: prevent bleeding by inactivation of thrombin formation and factor Xa resulting in inhibition of the formation of fibrin. Therapeutic uses: In conditions necessitating prompt anticoagulant activity (evolving stroke, pulmonary embolism, massive deep venous thrombosis), as an adjunct for clients having open heart surgery or renal dialysis, as low-dose therapy for prophylaxis against postoperative venous thrombosis, in conjunction with thrombolytic therapy when treating an acute myocardial infarction, or treatment of disseminated intravascular coagulation. Administration: heparin cannot be absorbed by the intestinal tract so it must be given by subcutaneous injection or IV infusion. It can be given every 12 hours subQ or continuous or intermittent IV infusion. Adverse Effects/Nursing Interventions: 1)Hemorrhage secondary to heparin overdose= monitor VS, observe for signs of bleeding (increased heart rate, decreased BP, bruising, petechiae, hematomas, black tarry stool,) in the case of heparin overdose stop the heparin and administer protamine sulfate and avoid aspirin. Monitor activated partial thromboplastin time (aPTT) and keep this value at 1.5 to 2 times the baseline. 2) HIT (Heparin Induced Thrombocytopenia) as evidenced by a low platelet count and increased development of thrombi- mediated by antibody development (white clot syndrome)= monitor client's platelet count periodically throughout treatment especially in the first month, stop heparin if platelet count drops to less than 100,000/mm3. Nonheparin anticoagulants, such as lepirudin(Refludan) or argotroban(Acova), can be used as a substitute if anticoagulation is still needed. 3) Hypersensitivity reactions (chills, fever, urticarial)= administer a small test dose prior to the administration of heparin. 4) Toxicity/Overdose= administer protamine sulfate, which binds with heparin and forms a heparin-protamine complex that has no anticoagulant properties. Protamine sulfate should be administered slowly IV no faster than 20 mg/min or 50 m in 10 minutes. Contraindications: do not use in patients with low platelet count or uncontrolled bleeding, use cautiously with clients with hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion (miscarriage.) Heparin should not be used during or following surgeries of the eyes, brain, or spinal cord, lumbar puncture, or regional anesthesia. Administration: obtain baseline VS, CBC, platelet count, and hematocrit levels. Read label carefully since it is dispensed in units and in different concentrations. Check dosages with another nurse before administration. Use an infusion pump for continuous IV administration and monitor the rate of infusion every 30 to 60 minutes. Monitor aPTT every 4 or 6 hours until appropriate dose is determined, then monitor daily. For subQ injection use a 20-22 gauge needle to withdraw medication from the vial the change the needle to a smaller needle (25 or 26, ½ to 5/8 in length), administer deep subQ injections in the abdomen ensuring 2 inches from the umbilicus and do not aspirate and apply pressure for 1-2 minutes after injection and rotate and record injection sites. Monitor for signs of bleeding (bruising, bleeding gums, abdominal pain, nose bleeds, coffee ground emesis, tarry stools,) advise clients do not take NSAIDs, aspirin, or medications containing salicylates, and advise client to use electric razor for saving and a soft toothbrush. Evaluation: Client aPTT of 60-80 seconds and no development or no further development of venous thrombi or emboli.

Terbutaline

selectively activates beta2-adrenergic receptors resulting in uterine smooth muscle relaxation. SIDE EFFECTS Tachycardia,palpitationschest pains, tremors, anxiety, headache NURSING CONSIDERATIONS Moniter the maternal pujse and blood pressure Moniter the patient for symptoms of fetal distress

Dilantin

used to prevent seizures. abrupt withdrawl after long use may precipitate seizures. Maintain a patent airway. protect head. Turn pt on their side. loosen constrictive clothing. ease to floor. May cause gingival hyperplasia. Provide good dental hygiene, including regular toothbrushing and flossing. Toxicity. Therapeutic level: 10.0-20.0 mcg/mL. Toxic level: 30-50 mcg/mL. Monitor blood levels. Monitor for signs of toxicity: dizziness, slurred speech, lethargy. Nursing: May turn urine pink or red. Assess location, duration, frequency, and characteristics of seizures. Monitor CBC, serum calcium, albumin, and hepatic function.

Treatment for Heart Failure

• Digoxin: o Side Effects: dysrhythmias/cardiotoxicity leading to bradycardia/anorexia/n/v/abdominal pain/fatigue/weakness/vision changes (diplopia/blurred vision) o Prevention measures: monitor/maintain levels btw 3.5-5.0/monitor digoxin levels btw 0.5-2.0 s/s of hyperkalemia/monitor pulse/report changes in CNS/GI o Monitoring: ECG/BP/HR/K/Mg/Ca/reduction in s/s of cardiac failure o Teaching: may cause GI disturbances/HA/visual disturbances/cardiac dysrhythmias/report s/s of bradycardia/avoid antacids/don't d/c medication abruptly • Loop diuretic: o Side Effects: orthostatic hypotension/pancreatitis/agraulocytosis/loss of appetite/bladder spasms o Prevention measures: may need to give K supplements/slow getting up o Monitoring: edema/HTN/electrolytes/liver/kidney damage/hearing loss/ BUN/creatinine/ urinary retention o Teaching: sun-sensitivity/may cause hyperglycemia/constipation/diarrhea/n/v/ vertigo/blurred vision/avoid alcohol • Beta-Blockers: o Side Effects: bradycardia/decreased cardiac output/AV block/orthostatic hypotension o Monitoring: pulse/BP/observe for s/s of worsening heart failure o Teaching: avoid sudden changes of position/rise slowly/monitor glucose if diabetic/monitor pulse

Calcium Channel Blockers

• Treats: o angina/A Fib/HTN • Side Effects: o edema/constipation/dizziness/flu-like symptoms/pulmonary edema/MI • Monitor: o BP/reduction in s/s of angina/liver function • Teaching: o may cause edema/constipation/nausea/HA/s/s hypotension/don't abruptly d/c medication/avoid alcohol