pharm

Short acting onset, peak and duration

Regular insulin (Humulin R) Onset- 0.5-1 hr Peak- 2-3 hr Duration- 5-7hr

Dobutamine HCL (Dobutrex)

Short term mgmt of heart failure due to decrease contractility. Stimulates beta 1 receptors to increase contractility but with relatively minor effects on HR. Falling BP (SE) Angina, arrhythmia (SE) Increase contractility and BP Look for increase in cardiac and urine output Monitor- BP, pulse, resp, ECG

Insulin

Reduces blood sugar levels by increasing glucose transport. Promotes conversion of glucose to glycogen. Moves potassium into cells.

What drug stimulates the production of red blood cells in the bone marrow?

epoetin alfa (Procrit) Stimulates the production of erythrocytes (RBC)

Which drug excretes sodium and water and retains potassium?

spironolactone (Aldactone)

Which drug is a leukopoetic growth factor that stimulates the bone marrow to increase production of mature neutrophils?

filgrastim (Neupogen)

A sulfonylureas that stimulates the release of insulin from the pancreas.

glyburide (Diabeta, Euglucon, Glynase, Micronase) Must have a functioning pancreas

Teach pt to monitor for these while on epoetin alfa

headaches chest pain weakness numbness changes in vision check bp often

What are some adverse reactions of insulin?

hypokalemia hypoglycemia lipohypertrophy (accumulation of extra fat at the site of injection)

A potassium channel blocker that widens the QRS complex and decreases contractility

amiodarone HCL

Causes blue discoloration of skin

amiodarone HCL

Causes pulmonary toxicity

amiodarone HCL

Used to treat a fib and ventricular tachycardia that is resistant to other drugs.

amiodarone HCL

Increases HDL and decreases LDL cholesterol by inhibiting HMG CoA- reductase an enzyme which synthesizes cholesterol in the liver.

atorvastin (Lipitor)

Which drug is an osmotic laxative?

lactulose (Cephulac, Chronulac)

Name some adverse effects of glyburide

Hypoglycemia (can occur if pt has liver of kidney impairment) Nausea Diarrhea

A client's blood glucose is 54 mg/dL. The client is lethargic, but arousable. In what order should the nurse perform the following interventions? Recheck blood glucose in 15 min. Give 7 g of protein. Give 15 to 20 g of carbohydrates. Report episode to the provider.

2 Recheck blood glucose in 15 min. 3 Give 7 g of protein. 1 Give 15 to 20 g of carbohydrates. 4 Report episode to the provider. The greatest risk to the client is a lack of glucose for cell metabolism. Therefore, the priority action is to give 15 to 20 g of carbohydrates (4 oz orange juice, 2 oz grape juice, 8 oz milk) to raise the client's serum blood glucose level. Next, the client's blood glucose should be checked in 15 min. If the blood glucose remains below 70 mg/dL, give 15 g more of carbohydrates. Recheck the client's blood glucose in 15 min. Repeat until the client's blood glucose is above 70 mg/dL. Follow with 7 g of protein. Report findings to the client's provider and document actions.

When given IV this drug controls ventricular dysrhythmias caused by myocardial infarction, cardiac surgery or digoxin toxicity.

Lidocain

Blocks entry of sodium into the cells of the myocardium

Lidocaine

Rapid acting onset, peak and duration

Lispro (humalog) Onset- less than 15 min Peak- 0.5-1 hr Duration- 3-4 hr

Lantus Insulin

Long acting pancreatic hormone Lipodystrophy Absent peak Never mix Take once a day Urtiaria (SE=chronic hives) Somogyi effect

Spironolactone (Aldactone)

Low Na Elevated T waves from increase K Avoid citrus juices K level must be monitored Agranulocytosis with triameterene (K sparing diuretic) Uses: Hypertension (K sparing diuretic). Acts on the distal portion of nephron, blocks aldosterone by decreasing excretion of Na and K and increase excretion of water. Teach: Avoid citrus juice, salt substitutes. SE: Hyperkalemia, nausea, diarrhea, dizzy, headache, photosensitivity, increase K=increased T wave.

What are some adverse effects of atorvastin (Lipitor)?

Myopathy (muscle pain) rhabdomylysis (breakdown of muscle protein causing kidney damage) liver toxicity

Intermediate acting onset, peak and duration

NPH (Humulin N) Onset- 1-2 hr Peak- 4-12hr Duration- 18-24 hr

A calcium supplement is prescribed to a post menopausal woman to prevent osteoporosis. What should the pt report as a sign of hypercalcemia? Eye twitching Bleeding gums Tinnitus Nausea

Nausea Hypercalcemia includes anorexia, nausea, vomiting and constipation. Hypocalcemia can cause twitching, tetany and muscle spasms, vitamin C deficiency can cause bleeding gums.

A client who has osteoporosis is started on alendronate (Fosamax). The nurse should instruct the client to do which of the following? (Select all that apply.) Take the medication in the morning after arising and before eating. Chew tablets to increase bioavailability. Drink 8 oz of water with each tablet. Take the medication with an antacid if heartburn occurs. Avoid lying down after taking the medication.

Take the medication in the morning after arising and before eating. Drink 8 oz of water with each tablet. Avoid lying down after taking the medication. To prevent esophagitis, the client should take the medication first thing in the morning before eating, swallow the tablet with at least a full 8 oz of water, and avoid lying down after taking the medication. The client should not chew as this can cause esophagitis. To optimize absorption, the client should not ingest anything for 30 min after taking the medication.

A nurse is reinforcing teaching to a client who has been prescribed daily calcium supplements. What foods should the nurse teach the client to avoid at the time she takes her calcium tablets?

The client should avoid taking calcium at the same time as eating spinach, bran, wholegrain breads and cereals, Swiss chard, rhubarb, and beets. These foods decrease the absorption of calcium.

What are some adverse effects of filgrastim (Neupogen)?

leukocytosis (increased white cell count) bone pain fever splenomegaly (enlarged spleen)

filgrastim (Neupogen) is contraindicated in pts with?

Bone marrow cancer respiratory depression Sickle cell disease sensitivity to E Colu derived proteins

Teach pt to report these symptoms if on filgrastim (Neupogen)

Bone pain abdominal pain and fullness

atorvastin (Lipitor)

Decrease manufacture of LDL cholesterol increase manufacture of HDL (good) cholesterol See LFT (hepatotoxcitity) Take with food Avoid grapefruit Take at bed Increase fluid Notice muscle pain (Rhabdomyosis) Myopthy ->muscle aches ->myostitis ->rhabdomyolysis

List some pt teaching for ARBs irebesartan (Avapro).

Monitor and report CNS effects Take with or without food Do not take if pregnant or breastfeeding

What should be monitored while on epoetin alfa (Procrit)?

Monitor blood pressure administer lowest dose possible Give to cancer pts with hemoglobin levels below 10gm/dm

What should be monitored with taking amiodarone HCL

Monitor changes in vision and light sensitivity Monitor skin color changes Monitor breath sounds

What should you monitor for with a pt on lidocaine?

Monitor for CNS effects (toxicity) and cardiac rhythm

Neutralizes gastric acid

Calcium acetate (Phoslo, Renagel)

Provides a non dietary source of calcium

Calcium acetate (Phoslo, Renagel)

Nitroprusside (Nipride, Nitropress)

Centrally acting vasodilator, direct vasodilation of arteries and veins= decrease in BP Dilate vessels = decrease in BP dIzzy Light sensitive solution Administer slowly The ECG and vitals monitored Evaluate cyanide poisoning (Drowsy and headache) Should not be admin with any other meds Cyanide poisoning (drowsy and headache) may lead to cardiac arrest.

What to monitor for with atorvastin (Lipitor)?

Monitor myopathy Measure CPK if muscle pain occurs Monitor liver function tests

Insulin Onset, peak, duration

Onset Peak Duration Rapid acting <15 min 0.5-1.5 3-4hr Humalog short acting 30-60 min 2-3 hr 5-7 hr Humulin R Intermediate 1-2 hr 4-12 hr 18-24hr acting NPH Humulin N Long acting 1-1.5 none 20-24hr Lantun Insulin Glargine

When should calcium supplements be given?

1 hr before or 1 hr after... glucocorticoids (decreases absorption of ca) thyroid supplements (ca decreases absorption of these) Tetracycline and Quinolone antibiotics (ca decreases absorption of these) Thiazide diuretics decrease excretion of ca Give 1 hr after meals

Never give epoetin alfa to this pt

A pt with cancer that is NOT on chemotherapy or radiation

For which of the following clients is a laxative indicated? (Select all that apply.) A. A young adult female who is postpartum following a vaginal delivery with an episiotomy B. A young adult male who has constipation and periumbilical pain C. A young adult client affected by IBS D. An older adult client who has limited mobility and minor bowel incontinence E. An older adult client preparing for a colonoscopy

A, C, E Laxatives will prevent straining until the episiotomy heals. Bulk-forming laxatives can provide relief of diarrhea for clients who have IBS. Use laxatives for bowel cleansing prior to diagnostic procedures of the gastrointestinal tract. Appendicitis can begin in the periumbilical area before progressing to the right lower quadrant. The older adult may be experiencing fecal impaction and a laxative could cause perforation.

A medication record reads: lispro (Humalog) insulin 15 units subcutaneously at 0800. Which of the following actions should the nurse take when administering this medication? A. Administer the medication when the breakfast tray arrives. B. Administer the medication within 30 min of the scheduled time. C. Check the client's blood glucose immediately after administration. D. Clarify the prescription because the medication is usually given at bedtime.

A. Administer the medication when the breakfast tray arrives. This is a rapid-acting insulin with an onset of less than 15 min. Administering the insulin at the time the breakfast tray arrives will ensure adequate blood glucose at time of peak action. The client's blood glucose level should be checked prior to insulin administration to prevent an episode of hypoglycemia. This medication is given prior to meals, and may be given 2 to 3 times/day.

A client's blood glucose level is 232 mg/dL at 1700, and the provider's prescription states to give 8 units Regular insulin (Humulin R) subcutaneously. This client also receives 14 units of insulin glargine (Lantus) subcutaneously at this time. Which of the following methods should the nurse use to draw up and administer the insulin? A. Give two injections by drawing up 8 units of Regular insulin in one syringe and drawing up 14 units of insulin glargine in another syringe. B. Give one injection by drawing up the Regular insulin first, and then drawing up the insulin glargine in the same syringe. C. Give one injection by drawing up the insulin glargine first, and then drawing up the Regular insulin in the same syringe. D. Give only the 8 units of Regular insulin as indicated based on the client's blood glucose.

A. Give two injections by drawing up 8 units of Regular insulin in one syringe and drawing up 14 units of insulin glargine in another syringe. In one insulin syringe, draw up 8 units of Regular insulin. In a separate insulin syringe, draw up 14 units of insulin glargine, and give two separate SC injections. Insulin glargine and Regular insulin are not compatible and cannot be given in the same syringe. The client should receive both the Regular insulin and the routine dose of insulin glargine.

A nurse is reinforcing teaching to a client who is prescribed lovastatin (Mevacor). Which of the following should be included in the teaching? A. Take the medication with the evening meal. B. Change position slowly when rising from a chair. C. Maintain a steady intake of green leafy vegetables. D. Consume no more than 1 L of fluid/day.

A. Take the medication with the evening meal. Instruct the client to take lovastatin with the evening meal to increase absorption. Changing positions slowly may be necessary when taking an antihypertensive. Maintaining a steady intake of green leafy vegetables would be important if taking warfarin. There is no indication for fluid restriction with statins.

Dopamine (Intropin)

Adrenergic agonists, catecholamines Causes increase cardiac output Uses: Shock, increased perfusion, hypotension Dilation of pupils HR will increase Aches in head GI (N,V,D) Palpitations Angina May cause gangrene with prolonged use

Erythropoetin (Procrit, Neupogen)

Anemia, replacement of neutrophils and platelets after chemo. Hastening of bone marrow function after transplant. Increase RBC production for chronic renal failure. Hematopoietic growth factors act on bone marrow to increase production of RBC. Produces erythropoietin RBC increased mOnitor BP (Increased HCT=increased BP) Can give with antihypertensives Renal study assessments IV/Sub Q injection Take Iron supplements

What are some adverse effects of irebesartan (Avapro)

Angioedema Headache Insomnia Hypotension

Ondansetron (Zofran)

Anti-emetic blocks effects of seratonin. Prevents nausea and vomiting associated with chemo and radiation. diArrhea No pooping (c0nstipation) Take before chemo Interacts with drugs that affect AST/ALT Eye, face, limb involuntary movement notify dr. Monitor AST/ALT

Vancomycin (Vancocin)

Antibiotic-inhibits bacterial wall synthesis Good to give if allergic to penicillin Monitor for red neck syndrome Caution with renal failure Hearing loss and allergies Temperature and blood cultures (CBC) Vitals Allergic to penicillin (give VANCO) Nephrotoxicity Check CBC Ototoxicity

Metformin (Glucophage)

Antidiabetic: Biguanide Type 2 diabetes Decreases hepatic glucose production, increase peripheral insulin uptake and utilization HBa1c 6%-12% Monitor CBC, blood,urine for keytones Elderly caution Take with food Feel like metal in mouth hypOxemia DC (low O2 in blood) Renal function monitor Monitor lactic acidosis Improve insulin sensitivity Not eating (anorexia)

Lidocaine

Antidysrhythmic- decreases cardiac excitability Sodium channel blockers, stabalize cardiac membranes. decrease electrical conduction, decrease automaticity CNS effects Administer dilantin for seizures toxIcity =drowsy No more than 24 hrs Seizure = severe toxicity

promethazine IV (Phenergan)

Antihistamine, anaphylactic reactions, motion sickness Pee, spit, shit (can't do it, anticholinergic) depRession of CNS with alcohol and opioids Observe for hypotension Motion sickness Watch for: Sedation, hypotension, constipation, urinary retention, Dry mouth

A nurse is caring for a client who has been prescribed calcitonin-salmon to treat osteoporosis. When evaluating the client's therapy, the nurse should recognize that which of the following serum calcium levels is within the expected range? A. 8.6 mg/dL B. 9.6 mg/dL C. 10.6 mg/dL D. 11.6 mg/dL

B. 9.6 mg/dL The expected reference range for serum calcium is 9.0 to 10.5 mg/dL. The other values represent either hypocalcemia or hypercalcemia.

A nurse is caring for a client who is prescribed daily doses of both digoxin (Lanoxin) and furosemide (Lasix). The client's potassium level is 3.2 mEq/L. For which of the following medication interactions is the client at risk? A. Toxic levels of furosemide B. Toxic levels of digoxin C. Sub-therapeutic levels of furosemide D. Sub-therapeutic levels of digoxin

B. Toxic levels of digoxin If potassium levels are decreased in the client who takes both a loop diuretic and digoxin, there is an increased risk for digoxin toxicity. The other choices are not potential interactions between the two medications when potassium levels are low.

carvedilol (Coreg)

Beta blocker, hypertension (B1 and B2 blocker) Decrease release of renin, blocks contractility of heart and sympathetic output. SE: Dizzy, hypotension, bradycardia, decrease cardiac output. Monitor: BP and hypotension, HR below 60 BPM hold drug, take pulse before and after drug

Match each of the following types of insulin with the time of its onset: NPH insulin (Humulin N) A. Less than 15 min Insulin glargine (Lantus) B. 0.5 to 1 hr Regular insulin (Humulin R) C. 1 to 2 hr Lispro insulin (Humalog) D. 1 hr

C NPH insulin (Humulin N) A. Less than 15 min D Insulin glargine (Lantus) B. 0.5 to 1 hr B Regular insulin (Humulin R) C. 1 to 2 hr A Lispro insulin (Humalog) D. 1 hr

A nurse is providing teaching to the mother of an infant who is to start taking digoxin (Lanoxin). Which of the following instructions should the nurse include? A. "Do not allow your baby to drink anything after the digoxin is administered." B. "Digoxin speeds the heart rate up to allow the heart to pump out more fluid." C. "It is important to administer the correct amount at regularly scheduled times." D. "If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."

C. "It is important to administer the correct amount at regularly scheduled times." The correct amount of digoxin should be administered at regularly scheduled times to maintain therapeutic blood levels. If the infant has teeth, the dose should be followed by water to prevent tooth decay. Digoxin slows the heart rate. If the infant vomits after the dose, it should not be re-administered because there is no way to know if the infant received any of the medication.

Digoxin (Lanoxin) A. Rids body of excess fluid and sodium B. Increases tissue oxygenation C. Improves myocardial contractility D. Reduces afterload

C. Improves myocardial contractility

Which of the following is correct regarding toxicity associated with amiodarone (Cordarone)? A. Visual impairment resolves when the medication is withdrawn. B. Ototoxicity is irreversible. C. Lung damage can persist for months after the medication is discontinued. D. Myopathy is a common manifestation of toxicity.

C. Lung damage can persist for months after the medication is discontinued. impairment can be permanent. Ototoxicity is not a sign of amiodarone toxicity, and myopathy is seen in clients who are receiving statins and fibrates.

A nurse is reinforcing teaching for a client who has a new prescription for digoxin (Lanoxin). Which of the following medications, which the client reports taking, should the nurse report to the provider because it is contraindicated when taken with digoxin? A. Potassium chloride B. Furosemide (Lasix) C. Quinidine sulfate D. Atorvastatin (Lipitor)

C. Quinidine sulfate Quinidine sulfate and digoxin should not be taken concurrently as the result could be greatly increased digoxin levels and digoxin toxicity. The nurse should notify the provider about the client's report. Potassium chloride and furosemide are frequently taken concurrently with digoxin without adverse interactions. Taking atorvastatin does not cause an interaction with digoxin.

While infusing lidocaine what is important to monitor?

Cardiac rhythm while infusing and report numbness of the lips

A nurse is reinforcing teaching for a client newly diagnosed who has type 2 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) Check blood glucose levels less frequently when feeling ill. Take an extra dose of the oral hypoglycemic agent the next day if a dose is missed. Carry a fast-acting glucose source at all times. Eat a snack prior to planned exercise. Inspect feet surfaces daily.

Carry a fast-acting glucose source at all times. Eat a snack prior to planned exercise. Inspect feet surfaces daily. A client who has diabetes should always carry a fast-acting glucose source to treat unexpected hypoglycemia. Active muscle cells can take in glucose without insulin, and therefore prior to exercising the client should eat a snack to ensure enough glucose is available to prevent hypoglycemia. A client who has diabetes should inspect his feet daily to monitor for skin breakdown and signs of infection. A client who has newly diagnosed diabetes should check blood glucose levels at least before meals and at bedtime, and more frequently when ill as acute illness can lead to hyperglycemia. The client should not take an extra dose of medication if a dose is missed.

What is the mechanism of action for irebesartan (Avapro)

Causes vasodilation Urinary excretion of sodium and water Urinary retention of potassium

What are some adverse effects of lidocaine (toxicity)?

Confusion, drowsy, paresthesia, restlessness, seizures and respiratory arrest

You have a pt taking oral amiodarone (Cordarone) to treat atrial fibrillation. You should advise the pt to watch and report the following. Select all that apply Cough Blurred vision Dizziness Sore throat Fever

Cough Blurred vision Dizziness Fever

Which of the following interventions should the nurse implement when preparing to administer filgrastim (Neupogen) for the first time to a client who has just undergone a bone marrow transplant? A. Administer intramuscularly in a large muscle mass to prevent injury. B. Give orally with a meal or snack to prevent severe GI upset. C. Shake vial gently to mix well before withdrawing dose. D. Discard vial after removing one dose of the medication.

D. Discard vial after removing one dose of the medication. Filgrastim is dispensed in a vial meant for single-dose use and any unused portion should be discarded. The medication is administered by subcutaneous and IV routes only, so neither oral nor IM administration is appropriate. The vial should not be shaken before withdrawal because this may damage the medication.

How do you mix insulin?

Draw up regular insulin then draw up NPH

A nurse is reinforcing teaching to a client who has heart failure and takes digoxin (Lanoxin). The client tells the nurse that he sometimes forgets to take his medication and asks if he can just take a double dose of digoxin the next morning to make up for the missed dose. What is an appropriate response by the nurse?

Due to the narrow therapeutic range of digoxin and the high risk for toxicity, the client should not take a double dose of the medication the next day to attempt to make up for a missed dose.

Furosemide (IV) (Lasix)

Edema from CHF, hypertension, loop diuretic Monitor electrolytes, decrease in Na, K, Ca, and Mg. Monitor glucose, report change in hearing, vomiting, twitching, tetany (decrease Ca) (Everything is decrease except glucose and uric acid) Dizzy Lizzy Dizzy Ringing ears Decrease K Ototoxicity hypocalcemia

A nurse is reinforcing teaching to a client who is prescribed digoxin (Lanoxin). Which of the following should the nurse instruct the client to report to the provider? (Select all that apply.) Fatigue Constipation Anorexia Rash Diplopia

Fatigue Anorexia Diplopia Fatigue, anorexia, and diplopia are side effects indicating a possible digoxin toxicity. Constipation and rash are not side effects of digoxin toxicity.

What are some side effects of lactulose (Cephulac, Chronulac)?

GI irritation, laxatives with magnesium salts, such as magnesium hydroxide, can lead to accumulation of toxic levels of magnesium, dehydration

When should glyburide be given?

Give 30 minutes before a meal

Methylprednisolone Sodium (Solu-medrol) IV

Glucocorticoids Prevent inflammation, suppress sirway mucus production and promote responsiveness of B2 receptors in bronchial tree. Cushing bUffalo hump Sodium sweats Headache, hyperglycemia Increase in BP, HR, and appetite Not healing GI upset Sodium increase Potassium decrease Glucose increase Calcium decrease Cautious in people with fungal infections, peptic ulcer disease, and kidney dysfunction

Pts taking statins should avoid what food

Grapefruit

Why would a high dose of lactulose (Cephulac, Chronulac) be given?

High dose - Client preparation prior to surgery or diagnostic tests (colonoscopy)

What are some adverse effects of calcium acetate?

Hypercalcemia Nausea and vomiting constipation kidney stones polyuria

Some side effects of epoetin alfa (Procrit)

Hypertension Malignancy progression

Irebesartan (Avapro)

Hypertension, heart failure, stroke prevention ARBS (angiotensin Receptor blocker) Blocks the action of angiotensin 11 in the body. Results in vasodilation -Excretes Na and water and retention of K -Use of ARBS and NSAIDS increase risk of renal failure Admin with regard to food Renal function tests Blocks vasoconstriction Salt substitute and supplements (AVOID!)

Glyburide is contraindicated in?

Impaired renal or hepatic functioning Diabetic keotacidosis Pregnancy, lactation

list some pt teaching with lactulose (Cephulac, Chronulac)

Increase fluid to 2-3 L a day. over use can lead to electrolyte imbalances, maintain regular exercise.

Long acting onset, peak, and duration

Indulin Glargine (Lantus) Onset- 1hr Peak- None Duration- 10.4-24hr

When talking with a pt about self administration of regular insulin (Humulin R) you should include which of the following? shake the vial vigorously Expect the solution to appear cloudy Store unopened vial at room temperature inject it subcutaneously

Inject the insulin subcutaneously Make sure the pt understand how to inject the insulin. Do not shake the vial, rotate it gently, vials should be stored in the fridge. The insulin should not appear cloudy

What insulins should never be mixed?

Insulin glargine and detemir

A nurse is caring for a group of clients who need insulin injections. The nurse should recognize that he can mix which of the following insulins in the same syringe with another insulin? (Select all that apply.) Insulin detemir (Levemir) Insulin lispro (Humalog) Insulin glargine (Lantus) Insulin glulisine (Apidra) Insulin aspart (Novolog)

Insulin lispro (Humalog) Insulin glulisine (Apidra) Insulin aspart (Novolog) Only four types of clear insulin may be mixed in the same syringe with another insulin (usually NPH insulin). These include insulin lispro, regular insulin, insulin glulisine, and insulin aspart. Do not mix insulin detemir and insulin glargine in a syringe with another insulin.

Why would a low dose of lactulose (Cephulac, Chronulac) be given?

Low dose - Prevent painful elimination (clients who have episiotomy or hemorrhoids)

Calcium acetate (Phoslo, RenageL)

Maintenance of normal musculoskeletal, neuro and cardio function. Bone tumors (DON'T GIVE) Observe sedation (increased Ca) Normal level (8.5-10.5) ECG Spinach, rhubarb, bran and whole grains decrease ca absorption. Avoid eating these with ca supplements CA=SEDATIVE

What should nurses monitor with lactulose (Cephulac, Chronulac)?

Monitor I and O and for signs of dehydration. Avoid lactulose (Cephulac, Chronulac) with renal dysfunction which can lead to toxic levels of magnesium.

Lactulose (Cephulac,Chronulac)

Osmotic laxative draws water into intestine PSE and constipation are indications Orientation (LOC) monitored Output and electrolytes monitored SE: Dehydration Education: Increase fluids and fiber, don't give with fecal impaction, nausea, cramping and abdominal pain.

Pipercillin, Tazobactam (Zosyn)

Penicillin-destroy bacteria by weakening the cell wall Complications-allergy, anaphylaxis to penicillin or cephalosporin Monitor: I and O, WBC, Renal function. Educate: Take 1-2 he before food or 2-3 hours after meal. Increase fluid. If GI upset occurs take with food. Call if rash, fever, chills, diarrhea or bleeding occur.

Amiodarone HCL (Codarone, Amio-aqeous,Pacerone)

Potassium channel blocker, severe ventricular tachycardia, ventricular fib not controlled by other meds. Coumadin must be decreased Ordered for vent arrhythmia Resp distress Dig must be decreased Ataxia (loss of control of body movement) and dizzy Risk for bradycardia Ordered for GI No SUN!! Eval with ECG for effectiveness SE: Vomiting, headache, dizzy, report bruising and ataxia

Mannitol (Osmitrol)

Promote na retention and water excretion for hyponatremia and fluid excess. Osmotic diuretic decreases intracranial pressure by increasing serum osmolality and drawing fluid back into vascular and extravascular space. Prevent kidney failure in hypovolemic shock and hypotension. Decreased ICP caused by cerebral edema drawing off fluid from brain an into blood stream. Oligura (little pee) Stops reabsorption of water Monitor electrolytes and reanl function Oh so nauseaus Toxicity for dig increases vIsion blurry (SE) Can't think, blink

Insulin Lispro (Humalog)

Rapid acting insulin Lipodystrophy (loss of body fat) I (first) draw up first Somogyi effect (rebound hyperglycemia) Prefilled syringes=1 week Rapid action-have food ready Observe for Tired/tachy Flush/fruit breath Irritable/insomnia Lethargic Restless Urine output increased Excess hunger Skin dry diaphoresis/drowsy Hyperventilate (Hypoglycemia) Extreme N and V Drowsy (hyperglycemia)

Pantaprazole (Protonix)

Proton pump inhibitor Suppresses gastric acid production by inhibiting the enzyme that produces gastric acid. Pass gass UE: GI, headache, dizzy Max 16 weeks for protonix Pooping a lot (diarrhea)

A nurse is preparing to administer sodium phosphate (Fleet Phospho-Soda) liquid osmotic laxative to a client who is undergoing bowel preparation for a colonoscopy. The nurse should understand that sodium phosphate may exacerbate what client condition? (Lactulose)

Sodium laxatives can increase the risk for worsening of heart failure or hypertension. They can create fluid retention caused by increased serum sodium in a client who has an underlying heart condition.

A nurse is preparing to administer sodium phosphate (Fleet Phospho-Soda) liquid osmotic laxative to a client who is undergoing bowel preparation for a colonoscopy. The nurse should understand that sodium phosphate may exacerbate what client condition?

Sodium laxatives can increase the risk for worsening of heart failure or hypertension. They can create fluid retention caused by increased serum sodium in a client who has an underlying heart condition.

Glyburide (Diabeta, Euglucon, Glynase, Micronase)

Stimulates insulin release from pancreas GI (N, V, D) Look for headache hYpolycemia Better for elderly sUlfonylureas Renal function Instruct to take with food Diabetes type 2 Evaluate vitals Teach: Avoid alcohol, pregnancy and increase fluid. Monitor: BP, hpoglycemia, hydration and renal function

A nurse is monitoring serum electrolytes for a client prescribed digoxin (Lanoxin). The serum potassium is reported to be 2.8 mEq/L. What action should the nurse take? Why?

The nurse should report the low level of potassium immediately to the provider as hypokalemia can result in fatal dysrhythmias. Digoxin works by binding to and inhibiting the enzyme Na+K+-ATPase. Potassium and digoxin compete for the same binding sites on this enzyme. With hypokalemia, digoxin has more opportunity to bind to Na+K+-ATPase and can lead to cardiotoxicity.

If angioedema occurs and the pt is taking a irebesartan (Avapro) (ARB) what should the nurse do?

The pt needs to discontinue the ARB ASAP.

Nitroglycerin NTG (Tridil)

Treat, prevent angina pectoris Dilates vascular smooth muscles, requires less force to expel blood and decrease oxygen need of cardiac tissue. -BP and apical pulse before admin -Continuous ECK for IV administration SE: Dizzy, headache, weak, nausea, hypotension

Digoxin IV (Lanoxin, Digitek)

Treats dysrhtymias- increase cardiac output, increase excretion of water and Na. increase blood flow, decrease vasoconstriciton. Dig level >2 = toxic (low k =toxicity as well) Increases myocardial contractility GI and CNS signs = toxicity Monitor: vomiting can cause hypokalemia, hold if apical pulse below 60 bpm, dig and K levels, report visual disturbances, pulse and hypokalemia.

What should be monitored during treatment with filgrastim (Neupogen)?

White cell count (2x a week) bone pain temperature spleen size

When is lactulose (Cephulac, Chronulac) contraindicated?

clients with fecal impaction and bowel obstruction, nausea, cramping, and abdominal pain.

Which drug blocks angiotensin II receptors

irebesartan (Avapro)

What should be monitored while on calcium acetate?

serum calcium signs of decreased gastric and intestinal motility polyuria flank pain blood in urine (stones)

amiodarone can increase the blood levels of?

warfarin phenytoin digoxin statins

Pts taking this drug with statins are at an increased risk for bleeding

warfarin, increases PT levels