Pharm Study Guide

interactions with digoxin

-amiodarone, quinidine, verapamil, diltiazem, propafenone, and flecainide are antidysrhythmics, which increase digoxin levels. -corticosteriods, duiretics, thiazides, and amphotericin B may cause decreased potassium level. -antacids and metoclopramide may decrease digoxin absorption.

Cardiovascular adverse effects

-antihypertensives cause orthostatic hypotension -teach pt about signs/symptoms^^^ light headedness -orthostatic hypotension can be minimized by changing positions slowly

med-food interactions: tetracycline

-chelating agents, such as milk -do not take tetracycline within 2 hr of consuming dairy

immunosuppression

-glucocorticoids can mask the usual manifestations of infection, such as fever -monitor for delayed wound healing and sore throat -advise these patients to avoid people with communicable diseases

Over the counter medication interactions

-ingredients in OTC meds may interact with prescription meds, can also interfere with therapeutic effects -inactive ingredients such as dyes, alcohol, or preservatives can cause adverse reactions

med-food interactions: grapefruit juice

-inhibits meds metabolism in the small bowel -this increases therapeutic effect or adverse reaction -*no specific meds listed

hepatotoxicity

-many meds are metabolized in the liver, so its vulnerable -many meds can alter normal values of liver function with no clinical signs of liver dysfunction -signs of hepatotoxicity = nausea, vomiting, jaundice, anorexia

Toxicity

-may be caused by excessive dose, can also occur at therapeutic levels -acetaminophen OD = live damage (greater risk with chronic alcohol use) -antidote is acetylcysteine, may reduce liver damage

Drug-Drug interaction: increase therapeutic effect

-meds given together to increase therapeutic effect

interactions with adenosine

-methylxanthines, such as theophylline and caffeine, block receptors for adenosine and therefore prevent therapeutic effect. -cellular uptake of dipyridamole (presantine) is blocked, leading to intensification of effects.

allergic reaction

-mild rashes and hives = diphenhydramine (Benadryl) -before administering any meds, get complete medication Hx

Anticholinergic adverse effects

-most seen in the eyes, smooth muscle, exocrine glands, and heart -can't see, can't pee, can't shit, can't spit -teach pt how to manage symptoms: sip on liquids, sunglasses, urinating before taking med

Category B

-no evidence of risk to animal fetuses, but no studies in humans have been done

Category A

-no evidence of risk to fetus

Side effects

-occur when the med is given at therapeutic dose, discontinuation is not usually warranted

Drug-Drug interaction:decrease side/adverse effects

-one med can be given to counteract the side/adverse effects of another med -common one is odansetron chloride (Zofran) to counteract the side effects of chemotherapy

Drug-Drug interaction: increase serum levels leading to toxicity

-one med can decrease the metabolism of a second medication and therefore increase the serum level of the second med... which may lead to toxicity -common one is fluconazole (Diflucan) increases aripiprazole (Abilify) levels

Drug-Drug interaction: decrease therapeutic effects

-one med can increase the metabolism of a second med and therefore decrease the serum level and effectiveness of the second med -common one is phenytoin decreases warfarin serum levels

contraindications of digoxin

-pregnancy risk cat C -contraindicated in clients who have ventricular tachycardia or ventricular fibrillation not caused by heart failure. -use cautiously in clients who have AV block, bradycardia, renal disease, hypothyroididm and cardiomyopathy

contraindications of adenosine

-pregnancy risk cat C. -contraindicated in clients who have second and third degree heart block, AV block, atrial flutter, and atrial fibrillation -use cautiously in older adults and clients who have asthma

nephrotoxicity

-primarily the result of antimicrobial agents and NSAIDS -monitor serum creatinine and BUN as well as peak and trough med levels for clients taken meds that are nephrotoxic

A nurse is preparing to administer erythromycin estolate 0.25g PO Q 6 hr. The amount available is erythromycin estolate oral suspension 250 mg/ml. How many ml should the nurse administer per dose?

1 ml PO Q 6 hrs

What are the three methods of antimicrobial actions?

1) Destroy the cell wall of the bacteria 2) Inhibit the conversion of an enzyme 3) Impair protein synthesis in the ribosomes of the bacteria

In what two conditions should we recommend individuals use antimicrobials more frequent?

1) Patients with prosthetic heart valves prior to dental or other procedures 2) patients with recurring UTI's

What are the two main uses for prophylactic antimicrobials?

1) Prior to BIG surgeries (cardiac, GI, Ortho, Gyn, Vasculature) 2) STI following exposure

1 Tbsp equals how many ml?

15 ml

Hepatitis B

Administer within 12 hr after birth with additional doses at age 1-2 months and 6-18 months. Adult: Administer 3 doses for high risk clients. Must be at least 4 weeks between doses 1 & 2, and at least 8 weeks between doses 2 & 3. Adverse effects: same as hep A Contraindications/Precautions: allergy to baker's yeast

Later complications of SSRIs

After 5 to 6 weeks of therapy: sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest) CLIENT EDUCATION: Instruct clients to report problems with sexual function (managed with dose reduction, medication holiday, changing medication

Quetiapine (Seroquel): tablet, extended release injectable

COMPLICATIONS ● Low risk of EPS ● Moderate risk for diabetes mellitus, weight gain, and dyslipidemia ● Other effects: cataracts, sedation, orthostatic hypotension, anticholinergic effects ● Clients should have screening eye exam and then every 6 months. INTERACTIONS: Barbiturates and phenytoin Fluconazole

Olanzapine (Zyprexa): tablet, short-acting and extended-release injection

COMPLICATIONS ● Low risk of EPS ● high risk for diabetes mellitus, weight gain, and dyslipidemia ● Other adverse effects: sedation, orthostatic hypotension, anticholinergic effects

Aripiprazole (Abilify): tablets, sustained-release injectable

COMPLICATIONS: ● Bleeding and cardiovascular effects INTERACTIONS: Barbiturates and phenytoin Fluconazole

Angiotensin II receptor Blockers (ARBs)-

Iosartan (Cozaar)*, Valsartan (Divan), Irbesartan (Avapro), Candesartan (Atacand), Olmestartan (Benicar) Purpose: vasodilation (mostly arteriole), excreation of sodium and water and retention of potassium Therapeutic use: hypertension, heart failure and prevention of mortality following MI, stroke prevention, delay progression of diabetic nephropathy Adverse Effects: angioedema, fetal injury (2nd and 3rd trimester) Contraindications: fetal damage, renal stenosis, use cautiously in pt who experienced angioedema with ACE inhibitor Med/ food interaction: antihypertensive meds have additive effect -oral, may be taken alone or with hydrochlorothiazide, take with or without food

What is alcohol withdrawal delirium?

It occurs 2 to 3 days after cessation of alcohol, may last 2 to 3 days and is considered a medical emergency.

BAS Interactions

Levothyrozine, phenytoin (Dilantin), fat soluble vitamins (A, D, E, K), and oral contraceptives

Neuroleptic malignant syndrome: sudden high‐grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, diaphoresis, drooling, and change in level of consciousness developing into coma

Life‐threatening medical emergency! Treatment: -Stop medication -Monitor vitals signs -Apply cool blankets -Administer antipyretics (aspirin, acetaminophen) -Increase fluid intake. -Administer diazepam to control anxiety. -Administer dantrolene and bromocriptine to induce muscle relaxation. -Wait 2 weeks before resuming therapy. Consider switching to an atypical agent.

Insulin: Rapid-acting

Lispro insulin (Humalog) & Insulin aspart (NovoLog) & Insulin glulisine (Apidra) Onset: 15-30min Peak: 0.5-2.5 hr Duration: 3-6 hr

Oral antidiabetics: Thiazolidinediones (Glitazones)

Med: pioglitazone (Actos) Action: increases cellular response to insulin by decreasing insulin resistance Action: Increased glucose uptake and decreased glucose production Adverse Effects: fluid retention, elevations in LDL cholesterol, hepatotoxicity

Amylin Mimetics

Med: pramlintide (Symlin) *Supplemental glucose control for type 1 & 2. Used in conjunction with insulin or oral antidiabetic Action: reduces postprandial glucose levels from decreased gastric emptying time and inhibition of secretion of glucagon Action: increase in the sensation of satiety, which helps decrease caloric intake Adverse effects: nausea, reaction at injection site

Antithyroid Medication

Med: radioactive iodine (RAI) Action: is absorbed by thyroid and destroys some of the thyroid producing cells. At high doses, it destroys thyroid cells. Use: hyperthyroidism, thyroid cancer and at a low dose- thyroid function studies Adverse effects: radiation sickness (hematemesis, epistaxis, intense nausea, vomiting); Bone marrow depression; Hypothyroidism *contraindicated in pregnancy

Oral antidiabetics: Gliptins

Med: sitagliptin (Januvia) Action: augments naturally occurring incretin hormones, which promote release of insulin and decrease secretion of glucagon Acton: lowers fasting and postprandial blood glucose levels *Generally well tolerated*

Anterior Pituitary Hormone/Growth Hormones

Med: somatropin (Genotropin, Nutropin) Action: stimulate overall growth and the production of protein, and decrease the use of glucose Use: treat growth hormone deficiencies (child and adult, Turner's syndrome, Prader-Willi syndrome) Adverse effects: hyperglycemia, hypercalciuria and renal calculi

Toxic effects

Medication can have specific risks and manifestations of toxicity.

Medication interactions

Medications can interact with each other resulting in desired or undesired effects. Obtain a complete medication history, and be knowledgeable of clinically significant interactions.

Precautions/contraindications

Medications may be for a client who has a specific disease or condition.

Medication category/class

Medications may be organized according to pharmacological action, therapeutic use, body system, chemical makeup, and safe use during pregnancy.

Classifcation: Estrogens

Medications: *conjugated equine estrogens (Premarin); estradiol (Estrace, Vagifem), estradiol hemihydrate (Estrasorb). Purpose: Estrogens suppress the release of follicle stimulation hormone (FSH) needed for conception. Therapeutic Use: Contraception, relief of post-menopausal symptoms (hot flashes, mood changes, osteoporosis), treatment of prostate cancer, Adverse Effects: Endometrial and ovarian cancers when prolonged estrogen is the only therapy, breast cancer, embolic events (embolism, DVT, PE, MI) Misc: Estrogens reduce the effectiveness of warfarin, smoking increases risk of embolic events, pregnancy category X

Classification: Progesterones

Medications: *medroxyprogesterone (Provera), norethindrone (Micronor), megestrol acetate (Megace) Purpose: Induce favorable conditions for fetal growth and development and maintain pregnancy. Prevents preterm birth. Therapeutic Use: Counters adverse effects of estrogen hormone therapy for treatment of dysfunctional uterine bleeding, amenorrhea, endometriosis, advanced cancer of the endometrium, breast and kidney. Adverse Effects: Breast cancer, thromboembolic events, breakthrough bleeding, edema, jaundice, migraines. Misc: Pregnancy category X

Classification: Hormonal Contraceptives

Medications: Estrogen-progestin combinations are called "oral contraceptives" (OC's); ethinyl estradiol and norethindrone (Ovcon 35, Necon 1/35), ethinyl estradiol and drospirenone (Yasmin), norethindrone (Micronor), Ortho Evra, NuvaRing, Depo-Provera. Purpose: Stop contraception bu preventing ovulation, thicken cervical mucus and alter endometrial lining to reduce chance of fertilization. Adverse Effects: Thromboembolic events, HTN, breakthrough or abnormal bleeding, breast cancer Misc: Pregnancy category X, OC's effectiveness decreases with use of antibiotics, carbamazepine, and Dilantin.

Classifications: 5-Alpha Reductase Inhibitors

Medications: finasteride (Proscar, Propecia); dutasteride (Avodart) Purpose: Causes a reduction in prostate size and increases hair growth. Therapeutic Use: Treatment of BPH and male pattern baldness Adverse Effects: Decreased libido, ejaculate volume, gynecomastia, orthostatic hypotension Misc: Pregnancy category X, may take 6 months or longer, pregnant women should not handle pills, do not donate blood unless medication has been stopped for 1 month.

Classification: Opioid Analgesics

Medications: meperidine hydrochloride (Demerol), butorphanol (Stadol), nalbuphine (Nubain) Purpose: Act on the CNS to decrease the perception of pain without loss of consciousness. Therapeutic: Stadol and Nubain provide pain relief without causing significant respiratory depression. Adverse Effects: Dry mouth, nausea/vomiting, neonatal depression, tachycardia, hypotension, decreased fetal HR variability, sedation. Misc: Do not give if delivery is expected within 4 hours of administration. Dilation should be a 4 cm and fetus engaged (can delay progression of labor).

Classification: Uterine Stimulants - Oxytocics

Medications: oxytocin (Pitocin), dinoprostone (Cervidil), methylergonovine (Methergine) Purpose: Uterine stimulants increase the strength, frequency and length of uterine contractions. Therapeutic: Induction of labor, delivery of placenta, management of postpartum hemorrhage, stress testing. Cervidil promotes cervical ripening, Methergine is used for emergenct intervention and postpartum hemorrhage. Adverse Effects: Uterine rupture, hypertensive crisis, Misc: Monitor fetal HR and rhythm, continuous BP and HR monitoring, monitor contraction frequency and duration.

Classification: Phosphodiesterase Type 5 (PDE5) Inhibitors

Medications: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) Purpose: Results in enhanced blood flow to the corpus cavernosum and penile erection Therapeutic Use: Treats erectile dysfunction Adverse Effects: MI, sudden death, priapism (prolonged erection lasting longer than 4 hours) Misc: Do not take with nitroglycerin, grapefruit juice may increase plasma concentrations.

Classification: Alpha 1 Andrenergic Antagonists

Medications: tamsulosin (Flomax), silodosin (Rapaflo), alfuzosin (Uroxatral), Terazosin, doxazosin (Cardura) Purpose: Decrease mechanical obstruction of the urethra by relaxing smooth muscles of the bladder neck and prostate. Therapeutic Use: Treats BPH, increases urinary flow Adverse Effects: Hypotension, dizziness, nasal congestion, sleepiness, faintness, problems with ejaculation (failure, decreased volume) Misc: Use with antihypertensives and nitroglycerin may cause severe hypotension.

Classification: Tocolytic Medications

Medications: terbutaline sulfate (Brethine), nifedipine (Procardia, Adalat), indomethacin (Indocin) Purpose: Results in smooth muscle relaxation Therapeutic: Can be used for up to 48 hours to delay but not prevent preterm labor Adverse Effects: Tachycardia, palpitations, chest pain, tremors, anxiety, and headache Misc: Monitor fetal HR, uterine contractions, pulse, BP, and respiratory rate. Limit fluid intake while on this medication.

Classification: Androgens

Medications: testosterone (Androderm-50, Testopel), methyltestosterone (Android, Testred) Purpose: Development of sex traits in men, and production and maturation of sperm, increase skeletal muscle, increase in synthesis of erythropoietin. Therapeutic Use: Treats hypogonadism, delayed puberty in boys, anemia not responsive to traditional therapy, post menopausal breast cancer, muscle wasting in AIDS pt's. Adverse Effects: Acne, priapism, increased facial and body hair, penile enlargement, premature epiphyseal closure, jaundice, hypercholesterolemia, increase chance of prostate cancer, polycythemia, edema, high abuse potential Misc: Pregnancy category X, may alter effects of anticoagulants, insulin and anti-diabetic medications.

Oral antidiabetics: Alpha glucosidase inhibitors

Meds: acarbose (Precose); miglitol (Glyset) Action: slows carbohydrate absorption and digestion Adverse Effects: intestinal effects (abdominal distention, cramping, hyperactive bowel sounds, diarrhea, excessive gas); anemia due to decrease of iron absorption; hepatotoxicity with long-term use

Incretin Mimetics

Meds: exenatide (Byetta); liraglutide (Victoza) *Supplemental glucose control for type 2. Used in conjunction with oral antidiabetic med (metformin or a sulfonyurea) Action: Fasting and postprandial blood glucose levels are lowered Adverse effects: GI (nausea, vomiting, diarrhea), pancreatitis

Thyroid Hormone

Meds: levothyroxine (Synthroid, Levothroid) Other meds: Liothyronine (Cytomel), Liotrix (Thyrolar), Thyroid (Thyroid USP) Action: synthetic forms of T4, T3, or a cmbo of T3 and T4 that increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temp, blood volume, and growth process Use: replacement for hypothyroidism (all ages and forms) Use: emergency treatment of myxedema coma Adverse effects: overmedication can result in hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite, fever, cramping, heat intolerance, weight loss, etc)

Oral antidiabetics: Biguanides

Meds: metformin HCl (Glucophage) Action: reduces the production of glucose withing the liver through suppression of gluconeogenesis Action: increases muscles' glucose uptake and use Adverse Effects: GI effects (anorexia, nausea, vomiting); Vitamin B12 and folic acid deficiency; lactic acidosis

Oral antidiabetics: Meglitinides

Meds: repaglinidine (Prandin); nateglinide (Starlix) Action: insulin release from the pancreas Adverse effect: hypolycemia

Tardive dyskinesia (TD): involuntary movements of the tongue and face, such as lip‐smacking, which cause speech and/or eating disturbances, also involuntary movements of arms, legs, or trunk.

Onset: late EPS can occur months or years after start of therapy, can improve or be permanent. Treatment: Administer the lowest dosage possible to control manifestations. Evaluate the client after 12 months of therapy and then every 3 months. If indications of TD appear, dosage should be lowered or the client should be switched to an atypical agent.

Parkinsonism: bradykinesia, rigidity, shuffling gait, drooling, and tremors.

Onset: within 1 month of initiation Treatment: benztropine, diphenhydramine, or amantadine

Akathisia: unable to stand still or sit, and is continually pacing and agitated.

Onset: within 2 months of initiation Treatment: manage effects with beta-blocker, benzodiazepine, or anticholinergic medication.

Rotavirus (RV)

Oral Vaccine Two formulations are available, the infant may be administered either. The 1st dose of either form should not be initiated for infants 15 weeks or older. Max age for any vaccination with an RV vaccine is 8 months. RV-5 (RotaTeq): 3 dose series - ages 2, 4, & 6 months RV-1 (Rotarix): 2 dose series - 2 & 4 months. Adverse effects: irritability, mild-temporary N/V Contraindications/Precautions: infants who have severe combined immunodeficiency; use caution in infants who are immunocompromised from HIV infection or med administration, or who have chronic GI disorders.

Statin Administration

Oral route Administer lovastatin with evening mean. Other statins can be taken without food, but evening dosing is best because most cholesterol is synthesized during the night Obtain baseline cholesterol and liver and kidney function tests

Pharmacological action of Digoxin

Positive inotropic effect: increased force of myocardial contraction (Improves the hearts effectiveness as a pump, improving stroke volume and cardiac output) Negative chronotropic effect: decreased heart rate (Dig slows the rate of the SA node depolarization and the rate of the impulses through the conduction system of the heart & decreased heart rate gives the ventricles more time to fill with blood coming from the atria, which leads to increased SV and increases CO)

Antidiuretic Hormone (ADH)

Prototype med: vasopressin Other med: desmopressin (DDAVP, Stimate) Action: ADH, produced by the posterior pituitary, promotes reabsorption of water within the kidney Action: Natural ADH causes vasoconstriction because of the contraction of the vascular smooth muscle. Use: treat diabetes insipidus Use: sometimes used during CPR to temporarily decrease blood flow to periphery and increase blood flow to heart and brain Adverse effects: reabsorption of too much water; myocardial ischemia from excessive vasoconstriction

Statin Medications

Prototype: atorvastatin (Lipitor) Others: Simvastatin Lovastatin Pravastatin Rosuvastatin Fluvastatin

Anti-Parkinson's medications: Dopamine agonists pramipexole(Mirapex)*, bromocriptine(parlodel), Ropinirole(Requip)

Purpose: Activate dopamine receptors Therapeutic use: Early therapy of PD Adverse effects: Sudden inability to stay awake, daytime sleepiness, orthostatic hypotension, psychosis, impulse control disorder, dyskinesias( head bobbing, tics, grimacing, tremors), Nausea

Fluoroquinolone Antibiotic plus Steroid Med FOR EAR DISORDERS: Ciprofloxacin plus Hydrocortisone (CIPRO HC)*, acetic acid (Vasolate), Ofloxacin (floxin)

Purpose: Bacterialcidal effect plus steroid to decrease pain, edema, and erythema in ear canal TU: Otitis externa AE: CNS Effects (Dizziness, lightheadedness, tremors, restlessness, convulsions), rash

Beta adrenergic blockers for EYE DISORDERS: Timolol (Timoptic, betimol0*, Carteolol(Ocupress), Metipranolol(Optipranolol), LEvobunolol (betagan liquifilm), Betaxolol (Betoptic), Levobetaxolol(Betaxon)

Purpose: Decrease IOP by decreasing the amount of aqueous humor produced TU: To Treat Primary open-angle glaucome (POAG) AE: Stinging, blurred vision, photophobia, dry eyes, bradycardia Misc: Effects insulin

Carbonic anhydrase inhibitor: Dorzolamide(Trusopt)*

Purpose: Decrease aqueous humor production TU: Second line tx for POAG AE: Allergic reaction in up to 15% of users, blurred vision, dryness, photophobia

Alpha 2- adrenergic agonists FOR EYE DISORDERS: brimonidine (alphagan)*, Apraclonidine (Iopidine)

Purpose: Decreases production and increase outflow of aqueous humor to lower IOP TU: First line med for POAG AE: Stinging, blurred vision, reddened sclera, hypotension, drowsiness

Second line TOPICALS for GLAUCOMA: Pilocarpine(Isopto Carpine, Pilocar)*

Purpose: Lowers IOP through ciliary muscle contraction TU: POAG and Closed-angle glaucoma AE: Retinal detachment, bradycardia, decreased visual acuity

Anti-parkinson's medications: MAO-B inhibitors selegiline(Carbex, Zelapar)*, rasagiline(Azilect)

Purpose: Prevent dopamine breakdown TU: combined with levodopa/carbidopa to decrease the "wear-off" effect AE: insomnia, hypertensive crisis triggered from foods containing tyramine(Avocado, soybean, figs, smoked meats, cured fish, cheese, yeast products, beer, chocolate, caffeinated bevs)

Cholinesterase inhibitors: neostigmine(prostigmin)*, Ambenonium(mytelase), Pyridostigmine(Mestinon), Edrophonium(Tensilon)

Purpose: Prevent the enzyme cholinesterase from inactivating acetylcholine. Therapeutic use: Myasthenia gravis, reversal of non depolarizing neuromuscular blocking agents. Adverse effects: increased GI motility, increased GI secretions, bradycardia, urinary urgency

Anti-parkinson's medications: Dopaminergic carbidopa(Lodosyn)*, Levodopa( Sinemet, Parcopa)

Purpose: Promote dopamine synthesis, active dopamine receptors, prevent dopamine breakdown, promote dopamine release Therapeutic use: most effective for parkinson's Tx, later Tx Adverse effects: N/V, Dyskinesias (head bobbing, tics, grimacing, tremors), Orthostatic hypotension, Tachycardia, palpitations, psychosis, discoloration of sweat and urine, activation of malignant melanoma

Anti-epileptics (AEDs): New meds Lamotrigine(Lamictal)*, Levetiracetam(Keppra), Topiramate(Topamax), Oxcarbazepine(trileptal), Gabapentin(Neurontin), Pregabalin(Lyrica), Tiagabine( Gabitril Filmtabs), Zonisamine(Zonegran), Lacosamine(Vimpat), Vigabatrin(Sabril), Ezogabine(Potiga)

Purpose: control seizure disorder TU: simple partial, complex partial seizures

Anti-epileptics (AEDs): traditional Phenobarbital (Luminal)*, Primidone(Mysoline), Phenytoin(Dilantin), Carbamazepine(Tegretol), Valproic Acid (depakote), ethosuximide(Zarontin)

Purpose: control seizure disorders TU: Simple partial, complex partial, tonic-clonic, absence, myoclonic seizures AE: drowsiness, sedation, depression, Toxicity(nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension, death), decrease effectivness of warfarin

Anti-Parkinson's medicatons: Centrally acting anticholinergic antagonists benztropine(Cogentin)*, trihexyphenidyl(Artane)

Purpose: diminish neuron excitability due to decreased dopamine TU:maintains balance between dopamine and acetylcholine receptors in brain AE: N/V, dry mouth, blurred vision, urinary retention, constipation, sedation, drowsiness

Anti-parkinson's medications: COMT inhibitors entacapone(Comtan)*, tolcapone (Tasmar)

Purpose: enhances effect of levodopa by blocking its breakdown Therapeutic uses: taken with levodopa to inhibit metabolism of leveodopa in intestines and peripheral tissues Adverse effects: N/V, diarrhea, constipation, discoloration of urine (yellow-orange)

Antimicrobials FOR EAR DISORDERS: Amoxicillin (Amoxil)*, Azithromycin (zithromax),Clavulanate (Augmentin), Ceftriaxone (rocephin), Cefdinir(Omnicef), Cefpodoxime (Ceftin), Clindamycin (Cleocin)

Purpose: eradication of infection TU: Otitis media AE: Allergic reaction if allergic to penicillin, GI upset, Suprainfection (oral candidiasis)

Prostaglandin analogs FOR EYE DISORDERS: latanoprost (Xalatan)*, Travoprost (travatan), bimatoprost(Lumigan)

Purpose: increase aqueous humor outflow through relaxation of ciliary muscle TU: TOPICAL first line med for POAG and ocular hypertension AE: Permanent brown pigmentation of eyes, lids and lashes, Stinging, reddened sclera, blurred vision, migraine

select antidepressants

SSRIs: --parozetine, sertraline, fluoxetine, citalopram, escitalopram, fluvoxamine SNRIs: --vanlafaxine, duloxetine

What are the nursing interventions for the adjunct medications?

Seizure precautions Obtain baseline vitals and monitor continuously

Which three antimicrobial's are not appropriate for pregnant patients, why?

Sulfonamides- cause kernicterus of infants Gentamicin- hearing loss of infants Tetracyclines- discoloration of teeth in infants

Mechanism of action

This is how the medication produces the desired therapeutic effect.

Therapeutic effect

This is the preferred and expected effect for which the medication is administered to a specific client. One medication may have more than one therapeutic effect.

contraindications of Propranolol

beta-adrenergic blocker (class 2 med) -pregnancy risk cat C. -contraindicated in clients who have greater than first degree AV block, heart failure, and bradycardia -use cautiously in clients who have Wolff-Parkinson-White syndrome, diabetes mellitus, or liver, thyroid and respiratory dysfunction.

interactions with propranolol

beta-adrenergic blocker (class 2 med) -verapamil (calan) and diltiazem (cardizem) have additive cardiosuppression effects -Propranolol use can mask the hypoglycemic effect of insulin and prevent the breakdown of fat in repsonse to hypoglycemia.

Osmotic diuretics:

mannitol (Osmitrol)* Purpose: reduce ICP and intraocular pressure by raising serum osmolality and drawing fluid back into the vascular and extravascular space Therapeutic uses: prevent kidney failure in hypovolemic shock and sever hypotension, decreases ICP, Decreased IOP, promote sodium retention and water excretion, olguria for AKI Adverse Effects: heart failure, pulmonary edema, kidney failure, fluid and electrolyte imbalances Contraindications: extreme caution in pt heart failure Med/ food interaction: monitor lithium levels ** continuous IV infusion, monitor dehydration, AKI, edema, weight, I&O, electorlytes BMEDICATION EFFECTIVENESS: normal kidney function- output, creatinine, and BUN; decrease ICP/IOP

Which medications are used to support withdrawal/abstinence from opiods?

methadone (Dolophine) clonidine (Catapress) buprenorphine (Subutex)

SSRIs and Suicidal ideation

monitor and report manifestations of depression and thoughts of suicide

SSRIs and postural hypotension

monitor for hypotension and advise client to change positions slowly

antifungal uses

candidiasis, aspergillosis, cryptoccocis, mucormycosis, histoplasmosis; some treat tinea pedis

complications of buspirone *nonbarbiturate anxiolytic

dizziness, nausea, headache, lightheadedness, agitation CLIENT EDUCATION ●Advise the client to take with food to decrease nausea. ●Avoid activities that require alertness until effects are known. ●Instruct client that most adverse effects are self‑limiting. Constipation: CLIENT EDUCATION: Advise client to increase fiber and fluid. Suicidal ideation: NURSING CONSIDERATIONS: Monitor and report manifestations of depression and thoughts of suicide

Side effects: Dopamine

dysrhythmias, increase the workload of the heart, increased o2 demand, necrosis

Therapeutic uses of Paroxetine (SSRI)

geralized anxiety disorder (GAD) ●Panic disorder: Decreases both the frequency and intensity of panic attacks and also prevents anticipatory anxiety about attacks ●Obsessive-compulsive disorder (OCD): Reduces manifestations by increasing serotonin ●Social anxiety disorder ●Trauma‑ and stressor‑related disorders ●Dissociative disorders ●Depressive disorders ●Adjustment disorder

SSRIs and Bruxism

grinding and clenching of teeth, usually during sleep NURSING CONSIDERATIONS ●Report bruxism to the provider, who might switch the client to another class of medication. ●Treat bruxism with low‑dose buspirone. ●Advise the client to use a mouth guard during sleep.

Antimycobacterial action

highly specific to mycobacteria. Isonizid inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall

paradoxical response

include anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, hypertension, muscle twitching, and seizures CLIENT EDUCATION ●Advise clients that withdrawal effects are not common with short‑term use. ●Advise clients who have been taking benzodiazepines regularly and in high doses to taper the dose over several weeks

therapeutic uses of escitalopram (SSRI)

indicated for GAD and OCD

therapeutic uses of sertaline (SSRI)

indicated for panic disorder, OCD, social anxiety disorder, and PTSD

SSRIs and hyponatremia

more likely in older adult clients taking diuretics NURSING CONSIDERATIONS: Obtain baseline serum sodium, and monitor level periodically throughouttreatment

SSRIs and withdrawal syndrome

nausea, sensory disturbances, anxiety, tremor, malaise,unease NURSING CONSIDERATIONS ●Minimized by tapering the medication slowly ●Advise clients that, after a long period of use, the medication is tapered slowly to avoid withdrawalsyndrome. ●Advise clients not to discontinue use abruptly

Potassium-sparing diuretics:

spironolactone (Aldactone)*, triamterene (Dyreium), amiloride (Midamor) Purpose: block action of aldosterone (sodium and water retention) which result in potassium retention and secretion of sodium and water Therapeutic uses: combined with loop diurtetics for potassium sparing, heart failure, hyperaldosteronism, may take 12-24 hours Adverse Effects: hyperkalemia, endocrine effects, triamterene may turn urine blue Contraindications: do not give if potassium is high, or have sever kidney failure/ anuria Med/ food interaction: use with ACE/potassium increase hyperkalemia **avoid slat substitutes, monitor potassium levels

what is the purpose of benzodiazepines?

they enhance the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS. Relief from anxiety occurs rapidly following administration.

what is the major concern for antidysrhyrhmic meds?

toxicity, which may lead to increased cardiac dysrhythmias

Vitamin B12_ Cyanocobalamin

● Select Prototype Medication: ◯vitamin B12 ●Other Medications: intranasal cyanocobalamin (Nascobal) ●Purpose ◯Vitamin B12 is necessary to convert folic acid from its inactive form to its active form. All cells rely on folic acid for DNA production. ◯Vitamin B12 may be administered to prevent or correct deficiency, which results in megaloblastic anemia (macrocytic) and can cause fatal heart failure if not corrected. ◯Damage to rapidly multiplying cells can affect the skin and mucous membranes, causing GI disturbances. Neurologic damage, which includes numbness and tingling of extremities and CNS damage caused by demyelination of neurons, may result from deficiency of this vitamin. ◯In addition, a deficiency affects all blood cells produced in the bone marrow. ■Loss of erythrocytes leads to heart failure, cerebral vascular insufficiency, and hypoxia. ■Loss of leukocytes leads to infections. ■Loss of thrombocytes leads to bleeding and hemorrhage. ◯Loss of intrinsic factor within the cells of the stomach causes inability to absorb vitamin B12 making it necessary to administer parenteral or intranasal vitamin B12 or high doses of oral B12 for the rest of the client's life. ●Therapeutic uses ◯Treatment of vitamin B12 deficiency ◯Megaloblastic (macrocytic) anemia related to vitamin B12 deficiency ●Adverse Effects ◯Hypokalemia secondary to the increased RBC production effects of vitamin B12 ●Contraindications/Precautions ◯Vitamin B12 deficiency should never be treated only with folic acid, which can result in neurological damage. If folic acid is used for a client with vitamin B12 deficiency, ensure that dosage is adequate. ◯Oral and intranasal cyanocobalamin are Pregnancy Risk Category A. ◯Parenteral formulation is Pregnancy Risk Category C. ●Interactions ◯Masking of signs of vitamin B12 deficiency with concurrent administration of folic acid.

Herbal Supplements- Echinacea

●Purpose ◯Stimulates the immune system ◯Decreases inflammation ◯Topically heals skin disorders, wounds, and burns ◯Possibly treats viruses (common cold, herpes simplex) ◯Used to increase T-lymphocyte, tumor necrosis factor, and interferon production ●Adverse Effects and Precautions ◯Bitter taste ◯Mild GI symptoms or fever may occur ◯Allergic reactions, especially in clients who are allergic to plants such as ragweed or others in the daisy family ●Interactions ◯With chronic use (more than 6 months), echinacea can decrease positive effects of medications for tuberculosis, HIV, or cancer.

Herbal Supplements- Garlic

●Purpose ◯When crushed forms the enzyme allicin ◯Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides ◯Suppresses platelet aggregation and disrupts coagulation ◯Acts as a vasodilator (may lower BP) ●Adverse Effects and Precautions ◯GI symptoms ●Interactions ◯Due to antiplatelet qualities, can increase risk of bleeding in clients taking NSAIDs, warfarin, and heparin ◯Can increase hypoglycemic effects of diabetes medications ◯Decreases levels of saquinavir, a medication for HIV treatment

Magnesium Sulfate

●Select Prototype Medication: ◯Parenteral: Magnesium sulfate ◯Oral: Magnesium hydroxide (Milk of Magnesia [MOM]) and magnesium oxide (Uro-Mag, Maox), magnesium citrate (Citrate of Magnesia, Citroma, Citro-Nesia) ■Magnesium hydroxide and magnesium oxide act as antacids when administered in a low dose, and all three act as laxatives. ●Purpose ◯Magnesium activates many intracellular enzymes and plays a role in regulating skeletal muscle contractility and blood coagulation. ●Therapeutic Uses ◯Magnesium supplements are used for clients with hypomagnesemia (magnesium level less than 1.3 mEq/L). ◯Oral preparations of magnesium sulfate are used to prevent or treat low magnesium levels and as laxatives. ◯Parenteral magnesium is used for clients with severe hypomagnesemia. ◯IV magnesium sulfate is used to stop preterm labor and as an anticonvulsant during labor and delivery ●Adverse Effects ◯Muscle weakness, flaccid paralysis,painful muscle contractions, cardiac disorders, and respiratory depression ◯Diarrhea ●Contraindications/Precautions ◯Magnesium is Pregnancy Risk Category A. ◯Use cautiously with clients who have AV block, rectal bleeding, nausea/vomiting, and abdominal pain. ◯Use cautiously with clients who have renal and/or cardiac disease. ●Interactions ◯Magnesium sulfate may decrease the absorption of tetracyclines. ◯Monitor the therapeutic effect to determine if absorption has been affected

Folic Acid

●Select Prototype Medication: ◯folic acid ●Purpose ◯Folic acid is essential in the production of DNA and erythropoiesis (RBC, WBC, and platelets). ●Therapeutic Uses ◯Treatment of megaloblastic (macrocytic) anemia secondary to folic acid deficiency ◯Prevention of neural tube defects during pregnancy (thus needed for all women of child-bearing age who may become pregnant) ◯Treatment of malabsorption syndrome, such as sprue ◯Alcohol use disorder (supplementation required due to poor dietary intake of folic acid and injury to the liver) ●Contraindications/Precautions ◯Indiscriminate use of folic acid is inappropriate because of the risk of masking signs of vitamin B12 deficiency. ●Interactions ◯Folate effect is antagonized by chloramphenicol (chloromycetin sodium succinate). ◯Folate may decrease phenytoin serum levels because of increased metabolism.

Potassium Supplements

●Select Prototype Medication: ◯potassium chloride (K-Dur, Klor-Con, Slow-K, KCl 5%) ●Other Medications: ◯Potassium gluconate ◯Potassium phosphate ◯Potassium bicarbonate ●Purpose ◯Potassium is essential for conducting nerve impulses, maintaining electrical excitability of muscle, and regulation of acid/base balance. ●Therapeutic uses ◯Potassium supplements are used to treat hypokalemia (potassium less than 3.5 mEq/L). ◯Potassium supplements are used: ■For clients receiving diuretics resulting in potassium loss, such as furosemide (Lasix) ■For clients with potassium loss due to excessive or prolonged vomiting,diarrhea, abuse of laxatives, intestinal drainage, and GI fistulas ●Adverse Effects ◯Local GI ulceration and GI distress, such as nausea, vomiting, diarrhea, abdominal discomfort, and esophagitis with oral administration ◯Hyperkalemia (potassium > 5.0 mEq/L) ●Contraindications/Precautions ◯Contraindicated for clients with severe kidney disease, hypoaldosteronism. ◯Contraindicated for clients who have digitalis toxicity with AV block. ●Interactions ◯Concurrent use of potassium-sparing diuretics, such as spironolactone or ACE inhibitors (lisinopril), increases the risk of hyperkalemia.

What are some good examples of client education?

●advise clients to observe for CNS depression. Instruct the client to notify the provider if effects occur. ●Advise clients to avoid activities that require alertness (driving, operating heavy equipment/machinery). ●Advise clients to avoid alcohol and other antianxiety medications due to potentiated depressant effects such as severe respiratory depression.

nursing administration

●advise clients to take the medication as prescribed and to avoid abrupt discontinuation of treatment to prevent withdrawal manifestations. Do not change the dosage or frequency without prior approval of prescriber. ●When discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks. ●Administer the medication with meals or snacks if gastrointestinal upset occurs. ●Administer the medication at bedtime if possible due to sedation. ●Advise clients to swallow sustained‑release tablets and to avoid chewing or crushing the tablets. ●Inform clients about the possible development of dependency during and after treatment and to notify the provider if indications of withdrawal occur. ●Advise clients to keep benzodiazepines in a secure place due to their abuse potential

Nursing administration of buspirone *nonbarbiturate anxiolytic

●advise clients to take the medication with meals to prevent gastric irritation. ●Advise clients that effects do not occur immediately. It can take a week to notice the first therapeutic effects and 2 to 6 weeks for the full benefit. Take on a regular basis and not PRN. ●Instruct clients that tolerance, dependence, or withdrawal effects are not an issue with this medication. ●Labeled for short‑term treatment of anxiety, but has shown therapeutic benefit for as long as a year.

contraindications

●benzodiazepines area Pregnancy Risk Category D medications and are avoided in women who are pregnant or breastfeeding. ●Benzodiazepines are classified under Schedule IV of the Controlled Substances Act. ●Benzodiazepines are contraindicated in clients who have sleep apnea, respiratory depression, or glaucoma. ●Use benzodiazepines cautiously in older adult clients and those who have liver disease or a history of mental illness or a substance use disorder. ●Benzodiazepines are generally used short‑term due to the risk for dependence

Therapeutic uses of benzos

●generalized anxiety disorder (GAD) and panic disorder --other uses include: ●Trauma‑ and stressor‑related disorders: Acute stress disorder (ASD) and post-traumatic stress disorder(PTSD) ●Hyperarousal manifestations of dissociative disorders ●Seizure disorders ●Insomnia ●Muscle spasm ●Alcohol withdrawal (for prevention and treatment of acute manifestations) ●Induction of anesthesia ●Amnesic prior to surgery or procedures

therapeutic uses of buspirone *nonbarbiturate anxiolytic

●panic disorder ●Social anxiety disorder ●Obsessive‑compulsive and related disorders ●Trauma‑ and stressor‑related disorders ●PTSD

paroxetine contraindications

●paroxetine is a Pregnancy Risk Category D medication. ●Paroxetine is contraindicated in clients taking MAOIs or a TCA. ●Clients taking paroxetine should avoid alcohol. ●Use paroxetine cautiously in clients who have liver and renal dysfunction, seizure disorders, or a history of GI bleeding

DTaP

(diptheria and tetanus toxoids and acellular pertussis) Administer doses at 2, 4, 6, 15-18 months, and at 4-6 years. (Td) booster- one dose every 10 years following DTaP. Adverse effects: local reaction at injection site, fever & irritability, crying that cannot be consoled, lasting up to 3 hrs, seizures, acute encephalopathy (rare). Contraindications/Precautions: an occurrence of encephalopathy 7 days after admin; seizures within 3 days of vaccination; hx of uncontrollable crying or temp of 105 degrees or higher that occurs within 48 hr of vaccination.

First-generation: Therapeutic Uses

*Acute and chronic psychotic disorders *Schizophrenia spectrum disorders *Bipolar disorders (primarily the manic phase) *Tourette syndrome *Agitation *Prevention of nausea/vomiting through blocking of dopamine in the chemoreceptor trigger zone of the medulla *Indications *These medications are reserved for clients who are: Using them successfully and can tolerate the adverse effects. *Violent or particularly aggressive.

First-generation: interactions

*Anticholinergic agents *CNS depressants (alcohol, opioids, antihistamines) *Levodopa

First-generation: Medication

*Chlorpromazine: low potency (select prototype) *Haloperidol (Haldol): high potency *Fluphenazine: high potency *Thiothixene (Navane): high potency *Perphenazine: medium potency *Thioridazine: low potency

Second‐and third‐generation (atypical): interactions

*Immunosuppressive medications *Alcohol, opioids, and antihistamines *Antipsychotic agents *Tricyclic antidepressants, amiodarone, and clarithromycin *Barbiturates and phenytoin *Fluconazole

First-generation: Adverse Effects

*Neuroleptic malignant syndrome *Anticholinergic effects *Neuroendocrine effects *Seizures *Skin effects (severe sunburns and contact dermatitis) *Orthostatic hypotension *Sedation *Sexual dysfunction *Arganulocytosis *Severe Dysrhythmias *Liver Impairment

Antipsychotics: Second‐and third‐generation (atypical)

*Often chosen as first-line treatment for schizophrenia. *Choice for clients receiving initial treatment and for treating breakthrough episodes * Are more effective with fewer adverse effects

Evaluation of Medication Effectiveness

*Positive and negative manifestations (prevention of acute psychotic manifestations, absence of hallucinations, delusions, anxiety, and hostility) *Ability to perform ADLs *Ability to interact socially with peers *Sleeping and eating habits

Second‐and third‐generation (atypical): Advantages

*Relief of both the positive and negative symptoms of the disease *Decrease in affective manifestations (depression, anxiety) and suicidal behaviors *Improvement of neurocognitive deficits, such as poor memory *Fewer or no EPSs, including TD, because of less dopamine blockade *Fewer anticholinergic adverse effects because most atypical antipsychotics, with the exception of clozapine, cause little or no blockade of cholinergic receptors *Less relapse

Second‐and third‐generation (atypical): Contraindications/Precautions

*Risperidone and most other atypical antipsychotics are Pregnancy Risk Category C. *Lurasidone and clozapine are Category B. *Clients who have dementia. All atypical antipsychotic medications can cause death related to cerebrovascular accident or infection. *Clients should avoid use of alcohol. *Use cautiously in clients who have cardiovascular or cerebrovascular disease, seizures, or diabetes mellitus. Obtain a fasting blood glucose for clients who have diabetes mellitus, and monitor blood glucose carefully.

anaphylactic reaction

- life threatening, immediate -causes respiratory distress, bronchospasm, cardiovascular collapse -Tx with epinephrine, bronchodialators, antihistamines, respiratory support

Antiplatelets

-Antiplatelet/salicylic-Aspirin -Antiplatelet/glycoprotein inhibitor-Abciximab*, eptifibatide, tirofiban Antiplatelet/ADP inhibitor-Clopidogrel*, ticlopidine Antiplatelet/Arterial vasodilator-Pentoxifylline*, dipyridamole, cilostazol

Complications of Rivaroxaban

-Bleeding -Elevated liver enzymes and bilirubin

Complications of Direct thrombin inhibitors

-Bleeding -GI discomfort, N/V, esophageal reflux, ulcer formation -Bivalirudin may also cause hypotension and headache

Medication/food interactions for Rivaroxaban

-Bleeding risk is increased when taking erythromycin, diltiazem, verapamil, quinidine, amiodarone -Rifampin, carbamazepaine, phenytoin, and St johns wort may decrease Rivaroxaban levels

Medication/food interactions for pentoxifylline

-Concurrent use of anticoagulants increase risk for bleeding -May increase levels of theophylline

Medication/food interactions with warfarin

-Concurrent use of heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins, increases effects of warfarin, which increases the risk for bleeding -Concurrent use of phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decreases anticoagulant effects -Foods high in vitamin K, such as dark leafy vegetables, cabbage, broccoli, brussesls sprouts, mayonnaise, canola, and soybean oil may decrease anticoagulant effects with excessive intake

Purpose of Thrombolytic medications

-Dissolve clots that have already formed. Clots are dissolved by conversion of plasminogen to plasmin, which destroys fibrinogen and other clotting factors

Complications of pentoxifylline

-Dyspepsia, N/V

Complications of aspirin

-GI effects, N/V, dyspepsia -Hemorrhagic stroke -Prolonged bleeding time, gastric bleed, thrombocytopenia -Tinnitus, hearing loss

Complications of warfarin

-Hemorrhage -Hepatitis -Toxicity/overdose

Complications of Fondaparinux

-Hemorrhage -Neurologic damage from hematoma formed during spinal or epidural anesthesia -Thrombocytopenia

Complications of Enoxaparin

-Hemorrhage -Neurologic damage from hematoma formed during spinal or epidural anesthesia -Thrombocytopenia -Toxicity/overdose

Complications of Heparin

-Hemorrhage secondary to heparin overdose -Heparin-induced thrombocytopenia -Hypersensitivity reactions -Toxicity/overdose

Complications of Abciximab

-Hypotension and bradycardia -Prolonged bleeding time, gastric bleed, thrombocytopenia, bleed from cardiac catheterization site

Contraindications/Precautions for Anticoagulants Parenteral

-In clients who have low platelet counts or uncontrollable bleeding -Should not be used during or following surgeries of the eyes, brain, or spinal cord; lumbar puncture; or regional anesthesia -Use cautiously in clients who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe HTN, hepatic or renal disease, or threatened abortion

Therapeutic uses for Heparin

-In conditions necessitating prompt anticoagulant activity -As an adjunct for clients having open heart surgery or renal dialysis -A low-dose therapy for prophylaxis against postoperative venous thrombosis -For treatment of DIC

Contraindications for clopidogrel

-Pregnancy risk category B -Clients who have bleeding disorders, thrombocytopenia, peptic ulcer disease, and intracranial bleeding -Use cautiously in clients who have peptic ulcer disease, and severe renal or hepatic disorder. Clients who are breast feeding should not take this med.

Contraindications for Thrombolytic medications

-Pregnancy risk category C -Any prior intracranial hemorrhage -Known structural cerebral vascular lesion -Active internal bleeding -History of significant closed head or spinal trauma within past 2 months -Acute pericarditis or bacterial endocarditis -Brain tumors -Severe hepatic or renal disorders -Use cautiously in patients who have severe HTN, cerebral vascular disorders, recent GU or GI bleeding, major surgery within past 10 days or in older adults

Contraindications for pentoxifylline

-Pregnancy risk category C -Clients who have bleeding disorders or retinal or cerebral bleeds

Contraindications for abciximab

-Pregnancy risk category C -Clients who have bleeding disorders, thrombocytopenia, recent stroke, AV malformations, aneurysm, uncontrolled HTN, and recent major surgery -Use cautiously in clients who have peptic ulcer disease and severe renal or hepatic disordres

Complications of alteplase

-Serious risk of bleeding from different sites, internal bleeding, as well as superficial bleeding

4 main classification groups of antidysrhythmics:

-Sodium channel blockers -beta-adrenergic blockers -potassium channel blockers -calcium channel blockers

Therapeutic uses for Thrombolytic medications

-Treat acute MI -Treat massive PE with alteplase -Treat acute ischemic stroke with alteplase -Restore patency of central IV catheters with cathflo activase

Therapeutic uses for warfarin

-Treatment of venous thrombosis -Treatment of thrombus formation in clients who have a fib or prosthetic heart valves -Prevention of recurrent MI, TIA, PE, and DVT

Nursing care for Thrombolytic medications

-Use of thrombolytic agents should take place as soon as possible after onset of manifestations, within 3 hours is best -Monitor platelet counts, Hct, Hgb, aPTT, PT, INR and fibrinogen levels -Treat severe bleeding with whole blood, packed red blood cells or fresh frozen plasma -Ensure that IV aminocaproic acid is available in the event of excessive fibrinolysis

EPS adverse effects

-abnormal body movements, may occur within a few hours or months -associated with meds that affect CNS, usually used to treat mental health disorders

Category C

-adverse effects in animal fetuses, but no studies in humans -med may be warranted based on potential benefits

Category X

-adverse effects on human and animal fetuses -totally contraindicated because risk outweighs benefits

Category D

-adverse effects on human fetuses -may be warranted based on potential benefits

Hematologic adverse effects

-anticancer meds = bone marrow suppression -anticoagulants/thrombolytics = hemorrhagic disorders -educate about S/S of bleeding = bruising, discolored urine or stool, petechiae, bleeding gums... notify provider!!

Electrophysiological changes may include:

-prolonging the AV node -increasing or reducing conduction speed -altering ectopic pacemakers and SA node -reducing myocardial excitability -lengthening effective refractory period -stimulating the autonomic nervous system

Drug-Drug interaction: increase adverse effects

-pt may take two meds that have the same side/adverse effect, this increases the risk of these effects

CNS adverse effects

-results from either CNS stimulation or depression -stimulation= risk for seizure -depression= advise pt not to drive

GI adverse effects

-take NSAIDS with food to avoid GI upset

med-food interactions: MAOI's

-tyramine(cheese and processed meats): can cause hypertensive crisis

Adverse effects

-undesired, inadvertent, and unexpected dangerous effects, can occur at both therapeutic and higher doses

med-food interactions: Vitamin K

-warfarin: risk for developing blood clots -should have consistent amount of Vit K

A nurse is preparing to administer Heparin 8,000 Units SQ every 8 hours. The amount available is Heparin injection 10,000 units/ml. How many ml should the nurse administer per dose?

0.8 ml SQ Q 8hrs

Digoxin Toxicity management

1. Digoxin and potassium-sparing medication should be stopped IMMEDIATELY 2. Monitor Potassium levels. Levels less than 3.5 administer potassium IV or mouth. Do not give any further potassium if level is greater than 5.0 3. Treat dysrhythmias with Phenytoin or lidocaine 4. Treat bradycardia with Atropine 5. Overdose: activated charcoal, cholestyramine, or Digibind can be used to bind digoxin and prevent absorption

Digoxin Nursing Administration

1. Do NOT double missed doses 2. Check pulse rate and rhythm before taking Digoxin (Less than 60 do NOT take) 3. Take at the same time daily 4. Monitor digoxin levels frequently 5. Avoid OTC medications to prevent adverse effects

Medication/Food interactions

1. MAOI - prolong epinephrine effects 2. Tricyclic antidepressants - prolong/intensify epinephrine 3. General anesthesia -hypersensitive to epinephrine leading to dysrhythmias 4. Alpha-adrenergic blocking agents: block alpha receptors 5. Beta adrenergic blockers - block beta receptors 6. Diuretics - promote beneficial effects of dopamine

Med/Food interactions while taking Digoxin

1. Thiazide diuretics - leads to hypokalemia 2. ACE inhibitors/ARBS - increase risk of hyperkalemia & decreased Digoxin effects 3. Dopamine - increase the rate and force of heart muscle contraction 4. Quinidine - increases risk of Digoxin toxicity 5. Verapamil (Calan) - increases plasma levels of digoxin 6. Antacids - decreased absorption of digoxin and can decrease the effectiveness

1 kg equals how many g?

1000 g

1 g equals how many mg?

1000 mg

A nurse is preparing to administer phenytoin (Dilantin) 0.2 g PO every 8 hrs. The amount available is phenytoin 100 mg/capsule. How many capsules should the nurse administer per dose? Round to the nearest whole number.

2 Caps PO Q 8 hrs

A nurse is preparing to administer cefixine (Suprax) 8 mg/kg/day PO divided in equal doses every 12 hr to a toddler who weighs 22 lbs. The amount available is Cefixine 100mg/5ml. How many ml should the nurse administer per dose?

2 ml PO Q 12 hrs

1 Kg equals how many lbs?

2.2 lbs

1 Tbsp equals how many tsp?

3 tsp

1 oz equals how many ml?

30 ml

A nurse is preparing to administer Dextrose 5% in water 500 ml IV to infuse over 4 hrs. The nurse should set the IV infusion pump to deliver how many ml/hr?

500ml IV at 125ml/hr

Adverse effects and nursing interventions of Adenosine

>****Sinus bradycardia (decresed conduction through AV node), hypotension, dyspnea (bronchoconstriction), flushing of face (vasodilation) -interventions: Monitor ECG. Effects usually last 1 min or less. Monitor clients for manifestations, and notify the provider if they occur.

Adverse effects and nursing interventions of Digoxin

>****bradycardia, hypotension, toxicity, nausea and vomiting, dysrhythmias -interventions: Monitor apical HR. Hold dose for HR less than 60/min Monitor dig level. normal is 0.5 to 0.8 ng/mL Hypokalemia increases risk for toxicity; keep potassium level between 3.5 and 5.0 mEq/L

A nurse is teaching a client who has obsessive‑compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include? A."It can take several weeks before you feel like the medication is helping." B."Take the medication just before bedtime to promote sleep." C."You should take the medication when needed for obsessive urges." D."monitor for weight gain while taking this medication."

A CORRECT: Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic benefit

What are the intended effects of varenicline?

A niccotinic receptor agonist that promotes the release of dopamine to stimulate the effects of nicotine Reduces cravings of nicotine and severity of withdrawal symptoms Reduces incidence of relapse by blocking the desired effects

Herpes Zoster

A one time dose is recommended for all adults over age 60 years. Adverse effects: mild local reaction at injection site Contraindications/Precautions: Clients who are immunocompromised

A nurse is providing teaching to a client who is starting simvastatin (Zocor). Which of the followingg should the nurse include in the teaching? A. Take his medication in the evening 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 his medication in the evening The client should take simvastatin in the evening because nighttime is when the most cholesterol is synthesized in the body.

Epinephrine Beta 2

Action: Bronchodilation Use: Asthma

Epinephrine Beta 1

Action: Increased heart rate, increased myocardial contractility, increased rate of conduction through the AV node Use: Treatment of AV block and cardiac arrest

Dopamine: Low dose

Action: Renal blood vessel dilation Use: Shock, heart failure

Dopamine: Moderate dose (beta 1)

Action: Renal blood vessel dilation, increased heart rate, increased myocardial contractility, increased rate of conduction through AV node Use: Shock, Heart failure

Dopamine: High dose (Beta 1, Alpha 1)

Action: Renal blood vessel dilation, increased heart rate, increased myocardial contractility, increased rate of conduction through AV node, vasoconstriction Use: Shock, Heart failure

Epinephrine Alpha 1

Action: Vasoconstriction Use: Slows absorption of local anesthetics, manages superficial bleeding, decreased congestion of nasal mucosa, increased blood pressure

Dobutamine: Beta 1

Action:Increased heart rate, increased myocardial contractility, increased rate of conduction through AV node Use: Heart Failure

Alpha 1

Activation of receptors in arterioles of skin, viscera and mucous membranes leader to vasoconstriction

Beta 2

Activation of receptors in the arterioles of the heart, lungs, and skeletal muscles leads to vasodilation Bronchial stimulation leads to bronchiodilation Activation of receptors in uterine smooth muscle causes relaxation Activation of receptors in the liver causes glycogenolysis Skeletal muscle receptor activation leads to muscle contraction

other meds:

Adenosine (Adenocard)-IV -purpose: decrease electrical conduction through AV node -theraputic uses: paroxysmal SVT, Wolff-parkinson-whte syndrome -adverse effects: sinus bradycardia, hypotension, dyspnea, flushing of face -nursing considerations: very short half-life so adverse effects are mild and last for less than 1 min. Administration should be by IV bolus, flushed with saline following administration. Digoxin (Lanoxin)- Oral, IV -purpose: decrease electrical conduction through AV node, increase myocardial contraction -therapeutic uses: HF, atrial fibrillation and flutter, paroxysmal SVT -adverse effects: bradycardia, hypotension, toxicity: nausea, vomiting, dysrhythmias -nursing considerations: Take apical pulse for 1 min before taking a dose. If the hear rate is less than 60/min, the client should hold the dose and notify provider. Advise client to eat a high-potassium diet.

Hepatitis A

Administer 2 doses after age 12 months. 2nd dose 6-18 months after first dose. Adult: administer 2 doses spaced 6-12 months apart for high risk individuals. Adverse: local reaction at injection site, mild fever, anaphylaxis Contraindications/Precautions: pregnancy

CAI Administration

Advise client to report muscle aches or pain, Medication may be discontinued if CK levels are elevated

Ziprasidone (Geodon): capsules, shot-acting injection

Affects both dopamine and serotonin; can be used for clients who have concurrent depression COMPLICATIONS ● Low risk of EPS, diabetes mellitus, weight gain, dyslipidemia ● Other effects: sedation, orthostatic hypotension, anticholinergic effects, rash ● ECG changes and QT prolongation can lead to torsades de pointes. INTERACTIONS: Tricyclic antidepressants, amiodarone, and clarithromycin. Barbiturates and phenytoin. Fluconazole

What are the major substances associated with abstinence syndrome?

Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics, stimulants and tobacco

Thrombolytic medications

Alteplase*, tenecteplase, reteplase

What are the intended effects of naltrexone?

An opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opioid withdrawal.

Seasonal Influenza vaccine

Annually, beginning at age 6 months, administer trivalent inactivated influenza vaccine (TIV). Starting at age 2, the live, attenuated influenza vaccine (LAIV) (nasal spray) can be used. October through November is the ideal time, and December is acceptable. Adverse effects: inactivated- mild local reaction, and fever. Live attenuated- headache, cough, fever. Rare risk for Guillain-Barre Syndrome manifested by ascending paralysis, beginning with weakness of lower extremities and progressing to difficulty breathing. Contraindications/Precautions: LAIV admin as nasal spray is contraindicated for adults over 50 and children under 2 years. And anyone who is immunocompromised, have a chronic disease, or are receiving certain antiviral meds. Pregnant women should not get live vaccine. Hx of Guillain-Barre Syndrome.

Purpose of Anticoagulant-Oral

Antagonize vitamin K, thereby preventing the synthesis of four coagulation factor VII, IX, X and prothrombin

Medication/Food interactions with Anticoagulatns-Parenteral

Anti-platelet agents such as aspirin, NSAIDs, and other anticoagulants may increase risk for bleeding

Overview

Antilipemic agents work in different ways to help lower low-density lipoprotein (LDL cholesterol) levels, raise high-density lipoprotein (HDL cholesterol) levels, and possibly decrease very low density lipoprotein. These medications should be used along with lifestyle modifications such as regular activity diet, and weight control

What are the nursing interventions for the nicotine pathc?

Apply to clean dry skin each day. Stop using if local skin rash occurs do not use during MRI scans

What are the intended effects of nicotine replacement therapy?

As substitutes for the nicotine Doubles the rate of smoking cessation

What are the intended effects of clonidine?

Assists with withdrawal effects related to autonomic hyperactivity detoxification. Does not reduce the cravings for opioids

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A.Administer flumazenil. B.Identify the client's level of orientation. C.Infuse IV fluids. D.Prepare the client for gastric lavage

B CORRECT: The first action the nurse should take when using the nursing process is to assess the client. Identifying the client's level of orientation is the priority action

A nurse is crying for a client who is starting niacin (Nissan) to reduce cholesterol. The nurse should monitor the client for which of the following adverse effects? (Select all the apply) A. muscle aches B. Hyperglycemia C. Hearing Loss D. Flushing of the skin E. Jaundice

B, D, E

Application Exercise: A nurse is caring for a group of clients who are receiving antimicrobial therapy. Which of the following clients should the nurse plan to monitor for manifestations of antibiotic toxicity? a. an adolescent with a sinus infection b. an older adult who has prostatitis c.postpartum with mastitis d. middle age adult with a UTI

B. Older adult who has prostatitis

Application Exercise: A nurse is implementing a plan of care for a client who has a wound infection. Which of the following actions should the nurse perform first? a. Administer antibiotic b. Obtain a wound specimen for culture c. Review WBC lab d. Apply a dressing

B. obtain the wound specimen for culture

What is the difference between bactericidal and bacteriostatic medications?

Bactericidal- directly lethal to microorganism Bacteriostatic- slows the growth, but the immune system response actually destroys the bacteria

Do we prescribe bacteriostatic or bactericidal to the immuno-suppressed? why?

Bactericidal- they dont have the immune system to kill the bacteria even if the growth is slowed, these antibiotics do both

What medications are used to detoxify the client from dependent substances?

Benzodiazepines such as: Chlordizepoxide (Librium) diazepam (Valium) lorazepam (Ativan) Adjunct medications: Carbamazepine (Tegretol) Clonidine (Catapres) Propranolol (Inderal)

CAI Interactions

Bile acid sequestrants interfere with absorption, statins, such as atorvastatin, can increase risk of liver dysfunction and/or myopathy

Classification

Bile-Acid Sequestrants

Carbamazepine(Tegretol) Adverse effects

Birth defects (spina bifida, neural tube defect), Anemia, thrombocytopenia, Steven-johnson syndrome DO NOT TAKE WITH GRAPEFRUIT JUICE Decreases effects of oral contraceptics and wafarin

Trade name

Brand or proprietary name given by the company that manufactures the medication.

A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A."I should take the medication on an empty stomach." B."I will follow a low‑sodium diet while taking this medication." C."I need to discontinue this medication slowly." D."I should not crush this medication before swallowing"

C CORRECT: When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered

A nurse in completing a nursing history for a client who currently takes simvastatin (Zocor). The provider recommends adding ezetimibe to the clients medications. Which of the following disorders is a contraindication to adding ezetimibe (Zetia) to the clients medications? A. hx of severe constipation B. hx of hypertension C. active Hepatitis C D. Type 2 DM

C. Active Hepatitis C

A nurse is collecting data from a client who is taking gemfibrozil (Lopid). Which of the following assessment findings is in adverse reaction to the medications? A. Mental status changes B. Tremor C. Jaundice D. Pneumonia

C. Jaundice Jaundice, anorexia, and upper abdominal discomfort may be findings inlayer impairment, which may occur in clients taking gemfibrozil

Application Exercise: A nurse is crying for a client who has a UTI and a history of recurrent UTI's. The client asks why the provider has not yet prescribed an antibiotic. The nurse should explain that the provider has to wait for the results of which test? a. Gram Stain b. Culture c. Sensitivity d. Specific Gravity

C. sensitvity

interactions

CNS depressants (alcohol, barbiturates, opioids) can result in respiratory depression. Anticonvulsants and antihistamines can cause increased CNS depression. NURSING CONSIDERATIONS ●Advise clients to avoid alcohol and other substances that cause CNS depression. ●Advise clients to avoid activities that require alertness (driving, operating heavy equipment/machinery). Grapefruit juice can reduce metabolism. NURSING CONSIDERATIONS: Avoid the use of grapefruit juice. High-fat meals can reduce absorption NURSING CONSIDERATIONS: Do not take with fatty foods

Phenytoin(Dilantin) Adverse effects

CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment), Gingival hyperplasia (softening and overgrowth of gum tissue), Skin rash, Hypotension

Lamotrigine(Lamictal)* Adverse effects

CNS effects(dizziness, aphasia, double/blurred vision, headache, N/V, Depression), Skin disorders (Steven-jphnson syndrome), Cleft palate, heart defects

Iloperidone (Fanapt): tablets

COMPLICATIONS ● Common adverse effects: dry mouth, sedation, fatigue, nasal congestion ● Significant risk for weight gain, prolonged QT interval, orthostatic hypotension ● Advise clients to follow titration schedule during initial therapy to minimize hypotension. ● Low risk for diabetes mellitus, dyslipidemia, EPS

Lurasidone (Latuda): tablets

COMPLICATIONS ● Common adverse effects: sedation, akathisia, parkinsonism, agitation, anxiety ● Low risk for diabetes mellitus, weight gain, dyslipidemia ● Does not cause anticholinergic effects ● Pregnancy Risk Category B

Asenapine (Saphris): sublingual tablets

COMPLICATIONS ● Drowsiness, prolonged QT interval, EPS (higher doses) ● Causes temporary numbing of the mouth ● Low risk of diabetes mellitus, weight gain, dyslipidemia, anticholinergic effects

Paliperidone (Invega): extended‐release tablets, extended‐release injections

COMPLICATIONS ● High risk for diabetes mellitus, weight gain, dyslipidemia ● Other adverse effects: sedation, prolonged QT interval, orthostatic hypotension, anticholinergic effects, mild EPS

Clozapine (Clozaril): tablets *Serious adverse effects no longer first-line medication

COMPLICATIONS ● Low risk of EPS ● High risk of weight gain, diabetes mellitus, dyslipidemia ● Agranulocytosis can occur. Obtain baseline WBC and monitor weekly, bi‐weekly, to monthly per protocol. ● Monitor for indications of infection (fever, sore throat, lesions in mouth), and notify the provider if manifestations occur. ● Other adverse effects: sedation, hypersalivation, orthostatic hypotension, and anticholinergic effects ● Pregnancy Risk Category B INTERACTIONS: Immunosuppressive medication

What are the nursing interventions for the benzodiazepines?

Can only use chlorizepoxide orally, but diazepam and lorazepam can be oral or IV Obtain baseline vitals and monitor continuously Monitor vitals and neurological status Seizure precautions

Adrenergic agonists

Catecholamines: Epinephrine (adrenaline), Dopamine (intropin), Dobutamine Others: Isoproterenol (catecholamine), Terbutaline (noncatecholamine)

Varicella

Chicken pox vaccination Administer one dose at 12-15 months and 4-6 years; or 2 doses administered 4 weeks apart, if after 13 years of age. Adverse effects: varicella-like rash, local or generalized such as vesicles on the body. Contraindications/Precautions: pregnancy or possibility of within 4 weeks, pregnant women should avoid close contact to children recently vaccinated, cancers of the blood and lymphatic system, allergy to gelatin or neomycin, clients who are immunocompromised, recent blood transfusion.

Classification

Cholesterol Absorption Inhibitor (Zetia)

Class 1B meds

Classification-Sodium channel blockers *prototype: Lidocaine (Xylocaine)- comes in IV -other meds: Mexiletine (Mexitil), Tocainide (Tonocard) Purpose: -Decrease electrical conduction -Decrease automaticity -Increase rate of repolarization Therapeutic uses: short-term use only for ventricular dsyrhythmias Adverse effects: CNS effects (drowsiness, altered mental status, paresthesias, seizures), respiratory arrest -nursing administration: Iv administration is usually started with a loading dose, which is weight-based, followed by a maintenance dose of 1 to 4 mg/min. Adjust the rate according to cardiac response. usually used for no more than 24 hours. Never administer lidocaine preparation that contains epinephrine, severe hypertension or dysrhythmias may occur.

Nitrosoureas

Classification: Alkylating Agents Medication Names: *carmustine (BiCNU, Gliadel) Purpose: kills rapid growing cells by interrupting DNA and RNA synthesis Therapeutic Use: brain tumors, Hodgkin's & non-Hodgkin's lymphomas, and multiple myeloma. Adverse effects: pulmonary fibrosis, liver and kidney toxicity

Platinum compounds

Classification: Alkylating Agents Medication Names: *cisplatin (Platinol) Purpose: kills rapid growing cells by interrupting DNA and RNA synthesis Therapeutic Use: bladder, testicular, and ovarian cancers Adverse effects: renal toxicity, hearing loss

Nitrogen Mustards

Classification: Alkylating Agents Medication Names: *cyclophosphamide (Cytoxan, Neosar) Purpose: kills rapid growing cells by interrupting DNA and RNA synthesis Therapeutic Use: acute lymphomas, solid tumors (head neck and breast, Hodgkins and non-Hodgkins lymphoma) Adverse effects: acute hemorrhagic cystitis, alopecia

Purine analogs

Classification: Antimetabolites Medication Names: *mercaptopurine (Purinethol) Purpose: Interrupts RNA and DNA synthesis of cancer cells Therapeutic Use: acute lymphocytic leukemia, acute nonlymphocytic leukemias Adverse effects: liver toxicity, mucositis (GI tract), gastric ulcers, perforation, reproductive toxicity such as congenital abnormalities.

Procarbazine

Classification: Antineoplastic agent Medication Names: *procarbazine (Matulane) Purpose: kills cancer cells by interrupting DNA and RNA synthesis Therapeutic Use: brain tumors, Hodgkins & non-Hodgkins lymphomas Adverse effects: peripheral neuropathy symptoms-weakness and paresthesia

Nonanthracyclines

Classification: Antitumor antibiotics Medication Names: *dactinomycin (Cosmegen) Purpose: Binds to DNA, altering its structure Therapeutic Use: Includes Wilms tumor. rhabdomyosarcoma, choriocarcinoma, Ewing's sarcoma, and Kaposi's sarcoma. Adverse effects: bone marrow suppression, GI manifestations, severe tissue damage, alopecia.

Anthracyclines

Classification: Antitumor antibiotics Medication Names: *doxorubicin (Adriamycin) Purpose: binds to DNA, altering its structure Therapeutic Use: includes solid tumors, such as lung, bone, stomach, and breast cancers, Hodgkin's and non-hodgkin's lymphomas. Adverse effects: acute cardiac toxicity, dysrhythmias, cardiomyopathy, heart failure, red coloration to urine and sweat.

Angiogenesis Inhibitors

Classification: Targeted Antineoplastic Medication Names: *bevacizumab (Avastin) Purpose: antibody that stops cancer cell growth and increases cell death Therapeutic Use: treat colorectal and lung cancers Adverse effects: thromboembolism, including cerebrovascular accident, MI, TIA, alopecia, hemorrhage-GI, vaginal, nasal, intracranial, or pulmonary, HTN, gastric perforation.

BCR-ABL Tyrosine Kinase Inhibitors

Classification: Targeted Antineoplastic Medication Names: *imatinib (Gleevec) Purpose: stops cancer growth by inhibiting intracellular enzymes Therapeutic Use: treat chronic myeloid leukemia Adverse effects: GI discomfort, flu-like symptoms, edema, hypokalemia, neutropenia, anemia

CD20 Directed Antibodies

Classification: Targeted Antineoplastic Medication Names: *rituximab (Rituxan) Purpose: antibody that stops cancer cell growth and increases cell death Therapeutic Use: treat non-Hodgkin's lymphoma Adverse effects: infusion reaction, rash, hypotension, wheezing, flu-like symptoms, tumor lysis syndrome, hypocalcemia, and hyperuricemia

EGFR-tyrosine Kinase Inhibitors

Classification: Targeted Antineoplastic Medication Names: *cetuximab (Erbitux) Purpose: antibody that stops cancer cell growth and increases cell death Therapeutic Use: treat cancers that are EGFR (+), such as colorectal and solid tumors of the head and neck Adverse effects: infusion reaction, rash, hypotension, wheezing, pulmonary emboli, skin toxicity, rash

Androgen Receptor Blockers

Classification: hormonal agents Medication Names: *flutamide (Eulexin) Purpose: blocks testosterone at receptor site; used in conjunction with gonadotropin-releasing hormone agonist Therapeutic Use: treatment of prostate cancer Adverse effects: hot flushes, decreased libido, and gynecomastia, N/V, diarrhea, hepatitis

Gonadotropin-releasing hormone agonist

Classification: hormonal agents Medication Names: *leuprolide (Eligard, Lupron) Purpose: testes stop producing testosterone Therapeutic Use: palliative treatment for advanced prostate cancer Adverse effects: hot flushes, decreased libido, and gynecomastia, decreased bone density, arrhythmias, pulmonary edema

Estrogen receptor blockers

Classification: hormonal agents Medication Names: *tamoxifen (Nolvadex) Purpose: stops growth of breast cancer cells Therapeutic Use: used to treat/prevent breast cancer Adverse effects: endometrial cancer, hypercalcemia, N/V, PE, hot flushes, vaginal discharge or bleeding.

BAS Adverse Effects

Constipation

A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A."Take this medication on an empty stomach" B."Expect optimal therapeutic effects within 24 hr." C."Take this medication when needed for anxiety" D."This medication has a low risk for dependency"

D CORRECT: Buspirone has a low risk for physical or psychological dependence or tolerance

A nurse is teaching a client who is taking digoxin (Lanolin) and has a new prescription for colesevelam (Welchol). Which of the following should the nurse include in the teaching? A. take digoxin with you morning dose of colesevelam B. Your sodium and potassium levels will be monitored periodically while taking colesevelam C. Watch for bleeding a bruising while taking colesevelam D. Take colesevelam with food and at least one glass of water

D. Take colesevelam with food and at least one glass of water Colesevelam should be taken with food and at least 8oz of water

Direct thrombin inhibitors

Dabigatran*, bivalirudin, lepirudin, argatroban

BAS Action

Decrease LDL cholesterol

Statin Actions

Decrease manufacture of LDL cholesterol, VLDL, and HDL. Promotes vasodilation, decreases plaque site inflammation, and decrease risk of thromboembolism

What are the intended effects of the adjunct medications?

Decrease seizures (carbamazepine) Depression of autonomic response (clonidine and propranolol) Decrease cravings (propranolol)

What are the intended effects of bupropion?

Decreases nicotine cravings and manifestations of withdrawal

What are the intended effects of acamprosate?

Decreases unpleasant effects resulting from abstinence such as anxiety and restlessness.

Cardiac glycosides

Digoxin

Phenobarbital(Luminal)* Adverse effects

Drowsniness, sedation, toxicity(Nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension), Decreases effectiveness of warfarin and oral contraceptives

Side effects of Digoxin

Dysrhymias, cardiotoxicity, anorexia (first sign), nausea, vomiting, CNS effects (fatigue, weakness, vision changes, diplopia, blurred vision, yellow-green or white halos around objects)

First-generation: Complications

EXTRAPYRAmIDAL SIDE EFFECTS (EPSs): *Acute dystonia *Parkinsonism *Akathisia *Tardive dyskinesia (TD)

What are the nursing interventions for bupropion?

Encourage client to chew gum, suck on hard candy or sip small amounts of water to help with dry mouth. Advise client to avoid caffiene or other CNS stimulants to help with insomnia

interactions with buspirone *nonbarbiturate anxiolytic

Erythromycin, ketoconazole, St. John's wort, and grapefruit juice can increase the effects of buspirone. NURSING CONSIDERATIONS ●Advise clients to avoid the use of these antimicrobial agents. ●Advise clients to avoid herbal preparations containing St.John's wort. ●Advise clients to avoid drinking grapefruit juice. Increased risk for serotonin syndrome with SSRIs: NURSING CONSIDERATIONS: Monitor for serotonin syndrome, fever, tremor, diarrhea, and delirium. Avoid concurrent use

CAI Action & Therapeutic Use

Ezetimibe inhibits absorption of cholesterol secreted in the bile and from food Clients who have modified diets can use this medication as an adjunct to help lower LDL Cholesterol. Can be used alone or in combination with a statin.

S/S of Digoxin Toxicity

Fatigue, weakness, vision changes, GI effects - Notify provider if any of these occur

Classification

Fibrates

Statin Interactions

Fibrates- increase the risk of myopathy Medications that suppress CYP3A4, such as erythromycin- can increase levels of statins when taken concurrently Grapefruit juice suppresses CYP3A4 and can increase levels of statins

antiprotozoal adverse effects

GI discomfort, darkening of urine, CNS symptoms such as numbness of extremities, ataxia, and seizures.

Vibrates Adverse Effects

GI distress, Gallstones, Myopathy, Hepatotoxicity

Nicotinic acid, niacin (niacin, niaspan) Adverse Effects

GI distress, facial flushing and feeling of warmth, tingling of hands and feet, hyperglycemia, hepatotoxicity, hyperuricemia

Stat Presciption

Given once and immediately.

Single/one time prescription

Given once at a specific time or as soon as possible.

Classification

HMG COA Reductase Inhibitors (Statins)

Hib

Haemophilus influenza Type B Administer doses at 2 ,4, 6, and at 12-15 months. Adverse effects: mild local reactions, low-grade fever; fever- (temp >101.3), vomiting, or crying. Contraindications/Precautions: children less than 6 weeks of age.

Uses of Digoxin

Heart failure, atrial fibrillation

Beta 1

Heart stimulation leads to increased heart rate, increased myocardial contractility, and increased rate of conduction through AV node Activation of receptors in the kidney lead to the release of renin

What are the intended effects of disulfiram?

Help with behavioral therapy --can cause actetaldehyde syndrome when used with alcohol --> side effects include N/V weakness, sweating, palpitations and hypotension --> can progress to respiratory depression, cardiovascular suppression, seizures and death.

Anticoagulants-Parenteral

Heparin* LMWH-Enoxaparin_, fragmin, innohep Activated factor X (Xa) inhibitor-Fondaparinux

CAI Adverse Effects

Hepatits, Myopathy

Statin Adverse Effects

Hepatotoxicity, Myopathy, and Peripheral Neuropathy

HPV2 or HPV4

Human papillomavirus vaccinations Administer 3 doses over a 6 month period for males and females 9-12 years. Administer males only HPV4 (Gardasil); administer females either HPV4 or HPV2 (Cervarix) 3 doses recommended for females up to 26 who were not vaccinated as children. If not vaccinated as children, HPV4 for males 19-21 years and for males 22-26 who have a high risk for HPV. Adverse effects: mild local reaction and fever, fainting shortly after receiving vaccine; risk for Guillain Barre (rare) Contraindications/Precautions: pregnancy & allergy to baker's yeast.

Signs of effectiveness

Improved perfusion (Urine output greater than or equal to 30mL/hr) improved mental status, and systolic BP maintained at greater than or equal to 90 mm Hg.

IPV

Inactivated poliovirus vaccine Administer doses at 2, 4, and 6-18 months and at 4-6 years Adverse effects: local reaction at injection site, vaccine-assoc. paralytic poliomyelitis (rare) Contraindications/Precautions: pregnancy (unless the woman is at high risk for contracting polio, in which case the immunizations may be prescribed during pregnancy), confirmed allergy to streptomycin, neomycin, or polymyxin B.

Goal of medication

Increase circulation and perfusion, decrease pain, and prevent further tissue damage

Side effects: Dobutamine

Increased heart rate

Which two age groups are at risk for antimicrobial toxicity and why?

Infants- underdeveloped kidneys and liver Older adults- reduction in medication metabolism and secretion

What are the nursing interventions for disulfiram?

Inform clients of dangers of consuming alcohol with medication Avoid all products that contain alcohol Monitor liver function Encourage to wear a medical alert bracelet Refer to a 12-step self-help program Advise clients that medication effects persist for 2 weeks following discontinuation

What are the nursing interventions of acamprosate?

Inform clients that diarrhea may result Advise clients to take in adequate fluids and rest Advise to avoid use during pregnancy.

Preparation, dosage, administration

It is important to know any special considerations for preparations, recommended dosages, and how to administer the medication.

What is abstinence syndrome?

It occurs when clients abruptly withdraw from a substance to which they are physically dependent, usually from a substance that has potential to cause addiction. Manifestations can lead to coma and death.

What manifestations can abstinence syndrome cause?

It varies depending on the substance, but it can produce a variety of manifestations including GI distress, neurological and behavioral changes, cardiovascular changes and seizures.

Nursing Implications

Know how to monitor therapeutic effects, prevent and treat adverse effects, provide for comfort, and instruct client in the safe use of medications

What do minimum inhibitory concentration (MIC) and Minimum bactericidal concentration mean?

MIC- amount of antibiotic that inhibits growth completely but does not kill the bacteria MBC- lowest concentration of antibiotic that kills 99.9% of bacteria- providers use this to dose

What are the intended effects of the benzodiazepines?

Maintenance of vital signs Decrease risk for seizures Decreases intensity of withdrawal manifestations

MMR

Measles, mumps, and rubella vaccine Administer doses at 12-15 months and at 4 to 6 years Adult dose: administer 1-2 doses at ages 19-49. Adverse effects: local reaction at injection site, rash, fever, swollen glands, possibility of joint pain lasting for days-weeks; risk for anaphylaxis and thrombocytopenia. Contraindications/Precautions: pregnancy or the possibility of within 4 weeks; clients who are immunocompromised; recent transfusion with blood products; hx of thrombocytopenia.

Hyperglycemic Agent

Med: glucagon (GlucaGen) *Emergency management of hypoglycemic reaction such as insulin overdose Action: increases BG levels by increasing breakdown of glycogen into glucose, decreasing glycogen synthesis enhances the synthesis of glucose Adverse effects: GI distress (nausea, vomiting)

Oral antidiabetics: Sulfonylureas

Meds: 1st gen.- chlorpromamide (Diabinese); tolzamide 2nd gen.- glipizide (Glucotrol, Glucotrol XL); glyburide (DiaBeta); glimepiride (Amaryl) Action: insulin release from the pancreas Adverse effect: hypoglycemia

MCV4

Meningococcal vaccine Administer one dose at age 11-12 years (earlier if at risk); those entering college and living in dorms (if not previously immunized) Adverse effects: mild local reaction, risk of allergic response (rare) Contraindications/Precautions: Hx of Guillain Barre Syndrome

Valproic Acid( Depakote) Adverse effects

N/V, indigetsiton, Hepatotoxicity, jaundice, thrombocytopenia

Insulin: Intermediate-acting

NPH insulin (Humulin N) & Insulin detemir (Levemir) Onset: 1-2 hr Peak: 6-14 hr Duration: 16-24 hr

Other medications

Nicotinic acid, niacin (niacin, niaspan)

What are the nursing interventions for nicotine replacement therapy (nicotine gum)?

Not for more than 6 months Chew intermittently over 30 minutes avoid eating or drinking for 15 minutes prior to chewing gum

What are the nursing interventions for catapress?

Obtain baseline vitals advise client to avoid activities that require mental alertness until drowsiness subsides Encourage patient to chew sugarless gum, hard candy or sip small amounts of water to help with dry mouth.

Generic name

Official or nonproprietary name that is given by the US adopted names council.

PCV

Pneumococcal conjugate vaccine Administer doses at 2, 4, 6, and 12-15 months Adverse effects: mild local reactions, fever Contraindications/Precautions: safety during pregnancy has not been established.

PPV

Pneumococcal polysaccharide vaccine Vaccinate adults who are immunocompromised, have a chronic disease, smoke, or live in long-term care facility. Adverse effects: same as PCV Contraindications/Precautions: same as PCV

CAI Contraindications

Pregnancy, Liver disorders

Nicotinic acid, niacin (niacin, niaspan) Contraindications

Pregnancy, clients who have liver disease and gout

Fibrates Contraindications

Pregnancy, liver disorders, severe renal dysfunction and gallbladder disease

BAS Contraindications

Pregnancy, pancreatitis, clients who havebiliary disorders, DM, and in older adults

Standard prescription/ Routine order

Prescription that identifies medications that are given on a regular schedule.

Purpose of Anticoagulants-Parenteral

Prevent clotting by activating antithrombin, thus indirectly inactivating both thrombin and factor Xa. This inhibits fibrin formation.

Reversal agent for heparin, enoxaparin, fondaparinus

Protamine sulfate

Antithyroid Medications

Prototype Med: propylthiouracil (PTU) Other med: methimazole (Tapazple) Acton: blocks synthesis of thyroid hormones. Prevents the oxidation of iodide. Blocks conversions of T4 and T3 Use: Tx of Graves' disease. Produces a euthyroid state prior to thyroid removal surgery. Adjunct to irradiation of the thyroid gland Emergency tx of thyrotoxicosis Adverse effects: overmedication can result in hypothyroidism (drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia); Agranulocytosis; Liver injury, hepatitis *Contraindicated in pregnancy

Adrenal Hormone Replacement

Prototype med: hydrocortisone (Solu-Cortef) Other meds: prednisone, dexamethasone, fludrocortisone Action: mimic effect of natural hormones Use: acute and chronic replacement therapy for adrenocortical insufficiency (Addison's disease) Use: nonendocrine disorders (cancer, inflammation, allergic reaction) Adverse effects: osteoporosis, adrenal suppression, peptic ulcer, GI discomfort, infection

Antithyroid Medication

Prototype med: strong iodine solution (Lugol's solution)-non radioactive iodine Other med: sodium iodide, potassium iodide Action: creates high levels of iodide that will reduce the iodine uptake by thyroid gland, inhibit thyroid hormone production, and block release of thyroid hormone into blood stream Use: development of euthyroid state and reduction of thyroid gland size prior to thyroid removal surgery. Use: emergency tx of thyrotoxicosis Adverse effects: iodism due to corrosive property (metallic taste, stomatitis, sore teeth and gums, frontal headache, skin rash)

Osmotic Agents: mannitol(Osmitrol)*

Purpose: Decrease IOP by drawing fluid from anterior chamber of eye TU: Rapid progression of Closed-angle glaucoma to prevent blindess

Anti-parkinson's medications: Dopamine Releaser Amantadine

Purpose: release dopamine Therapeutic uses: Tx of PD Adverse effects: CNS effects (confusion, dizziness, restlessness), Dry mouth, blurred vision, urinary hesitancy or retention, constipation, discoloration of skin (called livedo reticularis)

Serum Digoxin levels

Range: 0.5-2.0 ng/mL Signs of Toxicity: less than 1.75 ng/mL

Insulin: Short-acting

Regular insulin (Humalin R) & (Novolin R) Onset: 0.5-1 hr Peak: 1-5 hr Duration: 6-10 hr

What are the intended effects of methadone?

Replaces the opioid to which the client is addicted Prevent abstinence syndrome of occuring Used for withdrawal and long-term maintenance Dependence is transferred from illegal substance to methadone

Six rights of safe medication administration

Right client, med, dose, time, route, and documentation.

Second‐and third‐generation (atypical): Medications

Risperidone (second-generation antipsychotic) Olanzapine (atypical) Quetiapine (atypical) Ziprasidone (atypical) Clozapine (atypical) Asenapine (atypical) Lurasidone (atypical) Paliperidone (atypical) Iloperidone (atypical) Aripiprazole (third-generation)

Direct inhibitor of factor Xa

Rivaroxaban

Benzodiazepines

SELECT PROTOTYPE MEDICATION: Alprazolam OTHER MEDICATIONS ●Diazepam●Lorazepam●Chlordiazepoxide●Clorazepate●Oxazepam●Clonazepam

What are the findings of alcohol withdrawal delirium?

Severe disorientation, psychotic manifestations, severe hypertension and cardiac dysrhythmias that progress to death.

Adverse effects and nursing interventions of Propadenone

Sodium channel blocker >****bradycardia, heart failure, dizziness, weakness -interventions: Monitor HR. Monitor for chest pain or edema

Averse effects and nursing interventions of Procainamide

Sodium channel blocker >****systemic lupus syndrome (fever, painful and swollen joints, butterfly-shaped rash on face) interventions: manifestations resolve with discontinuation of the medication. If no alternative can be used, effects can be controlled with NSAIDS Clients should be monitored for cuclear antibody titers (ANA). If ANA titer is present and increase, med should be discontinued. >****Neutropenia and thrombocytopenia -interventions: monitor the client's weekly CBC for the first 12 weeks and then periodically Monitor the clients for indications of infection and bleeding. Med should be stopped if there is evidence of bone marrow suppression. >****Cardiotoxicity (widening QRS by more than 50%, increasing of the QT interval, and prolonging of the PR interval are indications of procainamide cardiotoxicity) -interventions: Monitor medication levels (normal is 4 to 8 mcg/mL) Monitor the client's vital signs and ECG If dysrhythmias occur, hold medication and contact the provider >****Hypotension -interventions: monitor blood pressure, May need to withhold medication for hypotension

Prn prescription

Stipulates at what dosage, what frequency, and under what conditions a medication may be given.

What are the nursing interventions for naltrexone?

Take an accurate history to determine dependence of opioids (can lead to an opioid overdose) Advise client to take the medication with meals Suggest monthly IM injections for clients who have difficulty adhering to the regimen

What are the nursing interventions for varenicline?

Take medication with meal Monitor BP Monitor for loss of glycemic control is diabetics titrate for minimal adverse effects Notify provider of nausea/vomiting, insomnia, new-onset depression of thoughts of suicide occur.

What is the most important education for antibiotics regarding their continued effectiveness?

Take the whole bottle, don's stop before you are out of the prescribed dose.

Tdap

Tetanus and diptheria toxoids and pertussis vaccine Administer one dose at 11-12 years. Adverse effects: pain & redness near injection site.

What do disk diffusion tests (Kirby-Bauer test) tell us about the organism?

These are performed on disks covered with the bacteria, disks of antibiotics are placed, if there is a clear zone around it this antibiotic is effective.

Adverse effects

These are undesired, inadvertent, and unexpected dangerous effects of the medication. Adverse effects usually are identified according to body system

Side effects

These are usually expected and inevitable when a medication is given at therapeutic dose.

Administration of Anticoagulants-Parenteral

These medications cannot be absorbed by the intestinal tract and must be given by subcutaneous injection of IV infusion

Acute dystonia: Severe spasms of tongue, neck, face, or back.

This is a crisis situation, which requires rapid treatment. Onset: 5 hrs to 5 days of first dose Treatment: anticholinergic agents (benztropine or diphenhydramine)

Use of medication

Used to prevent clot formation or break apart an already formed clot

Side effects: Epinephrine

Vasoconstriction, dysrhythmias, increase workload of the heart, increased o2 demand

Digoxin contraindications

Ventricular rhythms, second/third degree blocks, hypokalemia, partial AV block, advanced heart failure, and renal insufficiency

Reversal agent for warfarin

Vitamin K

Anticoagulant-Oral

Warfarin

What does it mean to be a broad-spectrum antibiotic?

Wide variety of bacteria are sensitive

When do the effects of withdrawal from alcohol start?

Within 4 to 12 hours and peak after 24 to 48 hours, and usually subside within 5 to 7 days.

Purpose of Direct thrombin inhibitors

Work by directly inhibiting thrombin, thus preventing a thrombus from developing

Third-generation: Purpose

Works by stabilizing the dopamine system as both an agonist and antagonist.

Standing prescription

Written for specific circumstances and/or for specific units

Common medication errors

Wrong medication, incorrect dosage or IV, wrong client, route, time, administration of known allergic medication, omission of dose, an incorrect discontinuation of medication of IV fluid.

Application Exercise: A nurse is preparing info for the units nurses about the effectiveness of antimicrobial therapy for clients who have bacterial infections. which of the following host factors should the nurse include as conditions that affect effectiveness? Select all that apply a. Meningitis b. Pacemaker c. Endocarditis d. Pneumonia e. Pyelonephritis

a. Meningitis b. Pacemaker c. Endocarditis

Dopamine

activation of receptors in the kidney cause the renal blood vessels to dilate

antivirals

acyclovir (zovirax), ganciclovir (cytovene), interferon alfa-2b (intron a), oseltamivir (tamiflu), amantadine (symmetrel)

antiviral uses

acyclovir: herpes simplex and varicella; ganciclovir: cytomegalovirus, HIV/AIDS, organ transplants; hepatitis B and C, Influenza A and B, RSV

Nicotinic acid, niacin (niacin, niaspan) Administration

administer PO, TID or with meals

Fibrates Administration

administer PO, advise clients to take 30 mins prior to breakfast and dinner

SSRIs and weight gain

advise clients to follow a well-balanced diet and exercise regularly

Purpose of meds affecting cardiac rhythm

alter cardiac electrophysiologic function in order to treat or prevent dysrhythmias.

TCAs

amitriptyline, imipramine, clomipramine

major meds used to treat anxiety disorders

benzos sedative hypnotic anxiolytics such as: --lorazepam --alprazolam --diazepam atypical anxiolytic/nonbarbituate anxiolytics such as: --buspirone

Adverse effects and nursing interventions of Propranolol

beta-adrenergic blocker >****hypotension, bradycardia, heart failure, fatigue -interventions: Monitor BP and HR. Check apical pulse prior to dosage Notify provider for pulse rate less than 60/min, or other prescribed rate

antiprotozoals action

broad-spectrum antimicrobial with bactericidal activity against anaerobic micro-organisms

Which medications are used to support withdrawal/abstinence from nicotine?

bupropion (Zyban) Nicotine replacement therapy varenicline (Chantix)

Adverse effects and nursing interventions of verapamil

calcium channel blocker >****bradycardia, hypotension, heart failure, constipation -Interventions: monitor ECG and BP. Severe hypotension may be treated with IV fluid therapy, modified Trendelenburg position, or IV calcium gluconate Clients who have a history of heart failure may need a reduced dose

interactions with verapamil

calcium channel blocker (class 4 med) -concurrent use of atenolol, esmolol, or propanol may cause additive effects of both medications -verapamil may potentiate carbamazepine and digoxin -beta blockers may cause heart failure

contraindications of verapamil

calcium channel blocker (class 4 med) -pregnancy risk cat C. -contraindicated in clients who have greater than first-degree AV block (unless they have a working pacemaker), atrial fib/flutter, and severe hypotension. -IV form is contraindicated in ventricular tachycardia and for clients taking beta blockers. -use cautiously in clients who have liver or kidney dysfunction or increased intracranial pressure.

IV toxicity

can lead to respiratory depression, severe hypotension, or cardiac/respiratory arrestBenzodiazepines for IV use include ●Diazepam ●Lorazepam

Class 1A meds

classification-SODIUM CHANNEL BLOCKERS that stabilize cardiac membranes *protoype: Procainamide (Pronestyl, Procanbid)-comes in oral and IV -other meds: Quinaglute gluconate (Quinaglute Dura-tabs), Quinidine sulfate (Quinidex Extentabs), Disopyramide (Norpace) -Purpose: -Decrease electrical conduction -Decrease automaticity -Decrease rate of repolarization -Therapeutic uses: Supraventricular tachycardia (SVT), ventricular tachycardia, atrial flutter, atrial fibrillation -Adverse effects: systemic lupus syndrome, neutopenia and thrombocytopenia, cardiotoxicity, hypotension

Class 2 meds

classification: BETA-ADRENERGIC BLOCKERS that prevent sympathetic nervous system stimulation of the heart *prototype: Propranolol hydrochloride (Inderal)-comes in oral, IV -other meds: Esmolol hydrochloride (Brevibloc), Acebutolol hydrochloride (Sectral) -Purpose: -Decrease heart rate - Slow rate of conduction through the SA node -Decrease atrial ectopic stimulation Therapeutic uses: Atrial fibrillation, atrial flutter, paroxysmal SVT, hypertension, angina adverse effects: hypotension, bradycardia, heart failure, fatigue nursing administration: instruct clients to take apical pulse daily and notify the provider of significant chance. Administer no faster than 1mg/min IV.

Class 4 meds

classification: CALCIUM CHANNEL BLOCKERS that depress depolarization and decrease oxygen demand of the heart *prototype: Verapamil (Calan)- comes in IV and oral -other meds: Diltiazem (Cardizem) -Purpose: -Decrease force of contraction -decrease heart rate -Slow rate of conduction through the SA and AV node therapeutic uses: atrial fibrillation and flutter, SVT, hypertension, angina pectoris adverse effects: bradycardia, hypotension, heart failure, constipation nursing considerations: may cause orthostatic hypotension.. Advise clients to change position slowly. Notify provider for perippheral edema or shortness of breath.

Nicotinic acid, niacin (niacin, niaspan) action

decrease in LDL cholesterol and triglyceride levels

Fibrates Action

decrease triglyceride levels, increase HDL levels by promoting production of precursors to HDL's

what is anterograde amnesia?

difficulty recalling events that occur after dosing CLIENT EDUCATION: Advise clients to observe for manifestations. Instruct clients to notify the provider if effects occur.

Which medications are used for abstinence maintenance (following detoxification)?

disulfiram (Antabuse) Naltrexone (Vivitrol) acamprosate (Camprall)

antiprotozoal interactions

do not take with warfarin!!

Oral toxicity

drowsiness, lethargy, confusion

Early Complications of SSRIs

first few days/weeks: nausea, diaphoresis, tremor, fatigue,drowsiness CLIENT EDUCATION ●Instruct clients to report adverse effects to the provider. ●Instruct clients to take the medication as prescribed. ●Advise clients that these effects should soon subside

antifungal adverse effects

infusion reaction (chills, fever, headache; treat with benadryl), thrombophlebitis, nephrotoxicity, hypokalemia, bone marrow suppression

antimycobactrial contraindications

isoniazid is contraindicated in those with liver disease. use cautiously in older adults and those with diabetes or alcohol dependence

antimycobacterial therapeutic uses

latent and active tuberculosis; latent: isoniazid only 6-9 months, or isoniazid and rifapentine weekly for 3 months.; active: involves multiple medications

What are the nursing interventions for subutex?

medication must be administered by an approved treatment center Administer IM or IV

antiprotozoals:

metronidazole (flagyl)

antimycobacterial adverse effects

peripheral neuropathy (take vit. B6 daily to prevent), hepatotoxicity (anorexia, malaise, fatigue, nausea, jaundice) (avoid alcohol), hyperglycemia; rifampin will turn body fluids orange

antiviral adverse effects

phlebitis and inflammation at insertion site, nephrotoxicity

interactions with amiodarone

potassium channel blocker (class 3 med) -may increase plasma levels of quinidine, procainamide, digozin, diltiazem and warfarin. -Cholestytamine decreases levels of amiodarone -diuretics, other antidysrhythmics, and antibiotics (erythromycin, azithromycin may increase the risk of dysrhythmias) -concurrent use of beta blockers, verapamil, and diltiazem can lead to bradycardia. -propranolol may increase digoxin level -consuming grapefruit juice can lead to toxicity

contraindications of amiodarone

potassium channel blocker (class 3 med) -pregnancy risk cat D. -contraindicated in clients who have AV block and bradycardia, newborns, and infants. -cautiously in clients who have liver, thyroid or respiratory dysfunction, heart failure, and fluid and electrolyte imbalances

Fluid Overload -s/s -tx

s/s- distended neck veins, increased blood pressure, tachycardia, SOB, crackles in lungs, edema tx- slow IV rate, raise HOB, assess vitals, adjust rate as prescribed, administer diuretics if prescribed

Hematoma -s/s -tx

s/s- ecchymosis (bruising) bruising at site tx- do not apply alcohol, apply pressure after IV catheter removal, use *warm compresses and elevation after the bleeding stops

Phlebitis/Thrombophlebitis -s/s -tx

s/s- edema, throbbing, burning, pain at site, increased skin temp, erythema, *red line up arm, slowed infusion tx- dc infusion and remove catheter, elevate extremity, document the size of infiltrated area, apply *cold compresses to stop blood flow then *warm compress to increase circulation

interactions with procainamide

sodium channel blocker (class 1A) -antidysrhythmics have additive effects and may increase the risk for toxicity -anticholinergic meds may increase anticholinergic effects -antihypertensives have an additive hypotensive effects

antiprotozoals therapeutic uses

treatment of intestinal amebiasis, giardiasis, trichomoniasis, and obligate anaerobic bacteria such as clostridium difficile.; treatment of H. pylori in combination with tetracycline and bismuth salicylate.

interactions with SSRIs

use of MAOI antidepressants or TCAs can cause serotoninsyndrome. NURSING CONSIDERATIONS: Educate the client about this combination. Avoid concurrent use. Antiplatelet medications and anticoagulants can increase risk for bleeding: NURSING CONSIDERATIONS: Monitor for bleeding. Avoid concurrent use

therapeutic uses of fluvoxamine (SSRI)

used for OCD and social anxiety disorder

therapeutic uses of Fluoxetine (SSRI)

used for panic disorder, OCD, and PTSD

antimycobacterial administration

usually oral, take 1 hour before meals or 2 hr. after. if upset occurs, take with meals.

antiviral administration

wear gloves, give slowly over 1 hr if IV

Fibrates Interactions

with concurrent use of warfarin (Coumadin)

contraindications of buspirone *nonbarbiturate anxiolytic

●Buspirone is Pregnancy Risk Category B. ●Buspirone is not recommended for use by women who are breastfeeding. ●Use buspirone cautiously in older adult clients and clients who have liver and/or renal dysfunction. ●Buspirone is contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs are discontinued. Hypertensive crisis can result

Herbal Supplements- Saw Palmetto

●Purpose ◯May decrease prostate symptoms of hyperplasia ●Adverse Effects and Precautions ◯Few adverse effects; can cause mild GI effects ◯Precaution: Can decrease prostate specific antigen (PSA), the marker used to detect prostate cancer ●Interactions ◯Possible additive effects with finasteride (Proscar) ◯May interact with antiplatelet and anticoagulant medications ◯FDA Pregnancy Risk Category X

Herbal Supplements- Ginkgo Biloba

●Purpose ◯Promotes vasodilation - Decreases leg pain caused from occlusive arterial disorders ◯Decreases platelet aggregation - May decrease risk of thrombosis ◯Decreases bronchospasm ◯Increases blood flow to the brain - Improves memory (dementia, Alzheimer's disease) ●Adverse Effects and Precautions ◯Mild GI upset, headache, lightheadedness, which may be decreased by reducing dose ◯Should be taken with caution in those at risk for seizure ●Interactions ◯May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics ◯Can interfere with coagulation

Purpose of SSRIs *Paroxetine others: ●sertraline ●Citalopram ●Escitalopram ●Fluoxetine ●Fluvoxami

●paroxetine selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons. ●It does not block uptake of dopamine or norepinephrine. ●Paroxetine produces CNS stimulation, which can cause insomnia .●The medication has a long effective half-life. A time frame of up to 4 weeks is necessary to produce therapeutic medication levels

What are the nursing interventions for nicotine nasal spray?

One spray in each nostril delivers the same amount of nicotine as one cigarette. Not recommended for clients with chronic sinus problems, allergies or asthma.

What does it mean to be a narrow-spectrum antibiotic?

Only a few types of bacteria are sensitive

Therapeutic uses for Direct thrombin inhibitors

-Dabigatran prevents stroke or embolism in clients who have a fib not caused by valvular heart disease -Bivalirudin is given concurrently with aspirin for clients who undergo coronary angioplasty -Argatroban is used to prevent or treat thrombosis in clients who cannot take heparin due to HIT

Therapeutic uses for LMWH

-Prevent DVTs in postoperative clients -Treat DVTs and pulmonary embolism -Prevent complications in certain types of myocardial infarction

Purpose of Antiplatelets

-Prevent platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting -Inhibit platelet aggregation at the onset of the clotting process, alter bleeding time

Therapeutic uses for Antiplatelets

-Primary prevention of acute MI -Prevention of re infarction in clients following and acute MI -Prevention of ischemic stroke -Acute coronary syndromes -Intermittent claudication

Complications of clopidogrel

-Prolonged bleeding time, gastric bleed, thrombocytopenia -Gi effects, diarrhea, dyspepsia, pain

Purpose of Direct inhibitor of factor Xa

-Provides anticoagulation selectively and directly by inhibiting factor Xa

Medication/food interactions for Direct thrombin inhibitors

-Rifampin decreases levels of dabigatran -Other thrombolytics and anticoagulants may increase risk for bleeding with argatroban

First-generation: Contraindications/Precautions

*Clients in a coma, and who have severe depression, Parkinson's disease, prolactin-dependent cancer of the breast, and severe hypotension *Older clients who have dementia *Use cautiously in clients with glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease, and seizure disorders

Second‐and third‐generation (atypical): Therapeutic Uses

*Schizophrenia spectrum disorders (negative and positive symptoms) *Psychotic episodes induced by levodopa therapy Bipolar disorders *Impulse control disorders

Medication/food interactions for Thrombolytic medications

-Concurrent use of other medications that enhance bleeding increases risk for bleeding

Medication/food interactions for Abciximab

-Concurrent use of other meds that enhance bleeding increases risk for bleeding

Medication/food interactions for Clopidgrel

-Concurrent use of other meds that enhance bleeding increases risk for bleeding -Proton pump inhibitors decrease effectiveness

Medication/food interactions for aspirin

-Concurrent use of other meds that enhance bleeding increases risk for bleeind -Urine acidifiers may increase aspirin levels -Concurrent use of aspirin may reduce hypertensive action of beta blockers -Corticosteroids may increase aspirin excretion and decrease effects. These meds may increase risk for GI bleed -Caffeine may increase absorption

Contraindications/Precautions for Direct thrombin inhibitors

-Dabigatran and argatroban are Pregnancy risk category C -Bivalirudin and lepirudin are pregnancy risk category b -Clients who have active bleeding or allergy to med -Use cautiously in clients who have liver impairment or who are at risk for bleeding -Use dabigatran, bivalirudin, and lepirudin cautiously in clients who have renal impairment

Nursing care for warfarin

-Monitor PT levels for level of 18-24 and INR levels for 2-3 -May not take affect for 8-12 hours and full therapeutic dose is not achieved for 3-5 days -Avoid alcohol and OTC medications

Heparin nursing care

-Monitor aPTT every 4-6 hours for levels of 60-80 seconds -Inject in abdomen -Monitor for signs of bleeding

Enoxaparin/fondaparinus nursing care

-Monitoring is not required, meds acceptable for home use -Inject in abdomen -Monitor for signs of bleeding

Contraindications for Rivaroxaban

-Pregnancy risk category C -Previous allergry to Rivaroxaban or in clients who have active bleeding; severe renal impairment or moderate to severe liver impairment -Use cautiously in clients taking anticoagulants, antiplatelet medications, or fibrinolytics, and in mild liver impairment or moderate renal impairment

Contraindications of aspirin

-Pregnancy risk category D in third trimester -Clients who have bleeding disorders and thrombocytopenia -Use cautiously in clients who have peptic ulcer disease and severe renal or hepatic disorders. Do not give to children or adolescents with fever or recent chickenpox -Use with caution in older adults

Contraindications for warfarin

-Pregnancy risk category x, notify doctor if they become pregnant during warfarin therapy -Clients who have a low platelet count or uncontrollable bleeding -During or following surgeries of the eyes, brain, or spinal cord -Clients who have a vitamin K deficiency, liver disorder, alcohol use disorder due to the additive risk of bleeding -Use cautiously in clients who have hemophilia, dissecting aneurysm, peptic ulcer disease, severe HTN, or threatened abortion

Statin Contraindications

-Pregnancy, clients who have hepatitis induced by viral infection or alcohol -Rosuvastatin should be avoided for clients of asian descent or prescribed in a smaller dose than for other clients -Use cautiously in older adults and those who have chronic renal disease.

Therapeutic uses for Direct inhibitor of factor Xa

-Prevent DVT and PE in clients who are undergoing total hip or knee arthroplasty surgery

Therapeutic uses for Activated Factor X inhibitor

-Prevent DVTs and pulmonary embolism in postop clients -Treat acute DVT of pulmonary embolism in conjunction with warfarin

Beta adrenergic blockers (sympatholytics)

1) all prototype: cardioselective beta 1 (effects only the heart) Metoprolol (Lopressor), Atenolol (Tenormin), Metoprolol succinate (Toprol XL), Exmolol HCL (Brevibloc) 2) nonselective: beta 1&2 (effecting both lungs and heart) Propranolol (Inderal), Nadolol (Corgard) 3) alpha and beta blockers: Carvedilol (Coreg), Labetalol (Trandate) Purpose: decrease HR, myocardial contractility, rate of conduction through AV node and alpha blockade adds vasodilation meds (3) Therapeutic uses: hypertension, angina, tachydysrhythamis, heart failure, MI, hypothyroidism, migraine, stage fright, phenchromocytoma, and glaucoma Adverse Effects: 1- bradycardia, decreased CO, AV block, ortho hypotension, rebound myocardium excitation 2- bronchoconstriction, glycogenolysis is inhibited Contraindications: pt AV block and bradycardia, 2 with asthma, bronchospasms, and heart failure, 1 with asthma, pt with myasthenia gravis, DM, depression, and elderly with hx of allergies Med/ food interaction: 1 calcium channel blockers intensify effects of beta blockers, hypotension with concurrent use of antihypertensive meds 2- propranolol can mask hypoglycemic effect of insulin and prevent breakdown of fat in hypoglycemia ** don't crush or chew, pt monitor HR and BP ** evaluation of medication effectiveness (absence of chest pain, absence of cardiac dysrhythmias, normal BP, corntorl of heart failure S&S)

First-generation: Purpose

1. Block dopamine (D2), acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. 2. Inhibition of psychotic manifestations, believed to be a result of D2 blockade in the brain.

Second-generation: Purpose

1. Work mainly by blocking serotonin, and to a lesser degree, dopamine receptors. 2. Also block receptors for norepinephrine, histamine, and acetylcholine.

1 mg equals how many mcg?

1000 mcg

1 L equals how many ml?

1000 ml

1 tsp equals how many ml?

5 ml

A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply.) A.Concurrent administration of buspirone B.Administration of a different SSRI C.Use of a mouth guard D.Changing to a different class of antidepressant medication E.Increasing the dose of paroxetine

A, C, D A. CORRECT: Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine. B. Other SSRIs also will have bruxism as an adverse effect. This is not an effective measure. C. CORRECT: Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism. D. CORRECT: Changing to different class of antidepressant medication that does not have the adverse effect of bruxism is an effective measure. E. Increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen. This is not an effective measu

Folic Acid Analog

Classification: Antimetabolites Medication Names: *methotrexate (Rheumatrex, Trexall) Purpose: Stops cell reproduction by inhibiting folic acid conversion. Therapeutic Use: Choriocarcinoma, solid tumors, such as breast and lung, head and neck sarcomas, acute lymphocytic leukemia, non-Hodgkin's lymphoma. Adverse effects: mucositis (GI tract), gastric ulcers, perforation, reproductive toxicity (congenital abnormalities), renal damage due to hyperuricemia or elevated levels of uric acid.

Pyrimidine analog

Classification: Antimetabolites Medication Names: *cytarabine (Cytosar-U) Purpose: Inhibits RNA and DNA synthesis of cancer cells Therapeutic Use: Acute myelogenous leukemia, solid tumors, such as breast and colon, superficial skin cancers Adverse effects: liver disease, pulmonary edema, arachnoiditis (indications include nausea, headache, and fever)

Vinca Alkaloids

Classification: Antimitotics Medication Names: *vincristine (Oncovin, Vincasar PFS) Purpose: useful in combo with other chemo meds; stops cell division during mitosis. Therapeutic Use: acute lymphocytic leukemia, Wilms tumor, rhabdomyosarcoma, solid tumors (bladder and breast, Hodgkin's and non-Hodgkin's lymphoma) Adverse effects: peripheral neuropathy effects, severe tissue damage, alopecia.

Taxanes

Classification: Antimitotics Medication Names: *paclitaxel (Abraxane) Purpose: stop cell division during mitosis Therapeutic Use: includes ovarian, non-small cell lung tumors, and Kaposi's sarcoma. Adverse effects: bone marrow suppression, bradycardia, heart block, MI, alopecia.

Asparaginase

Classification: Antineoplastic agent Medication Names: *asparaginase (Elspar) Purpose: kills cancer cells by interrupting DNA synthesis in leukemia cells Therapeutic Use: acute lymphocytic leukemia Adverse effects: hypersensitivity reaction, CNS effects, liver and pancreas toxicity, renal toxicity, GI discomfort

Hydroxyurea

Classification: Antineoplastic agent Medication Names: *hydroxyurea (Hydrea, Mylocel) Purpose: kills cancer cells by interrupting DNA synthesis Therapeutic Use: chronic myelogenous leukemia, ovarian and squamous cell cancers Adverse effects: bone marrow suppression, GI discomfort

topotecan

Classification: Topoisomerase inhibitors Medication Names: *topotecan (Hycamtin) Purpose: kills cancer cells by interrupting DNA synthesis Therapeutic Use: treats metastatic ovarian cancer, cervical cancer, and small cell lung cancer Adverse effects: bone marrow suppression, GI discomfort, and alopecia

interferon alfa-2b

Classification: biologic response modifiers Medication Names: *interferon alfa-2b (Intron A) Purpose: increases immune response and decreases production of cancer cells Therapeutic Use: treat or prevent hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma, and AIDS related Kaposi's sarcoma. Adverse effects: flu-like symptoms, bone marrow suppression, depression, anxiety, insomnia, altered mental status.

Monoclonal Antibody

Classification: hormonal agent Medication Names: *trastuzumab (Herceptin) Purpose: targets breast cancer cells, prevents cell growth, and causes cell death Therapeutic Use: metastatic breast cancer, may be used alone or in conjunction with paclitaxel Adverse effects: cardiac toxicity, tachycardia, heart failure, hypersensitivity, N/V

Aromatase inhibitors

Classification: hormonal agents Medication Names: *anastrozole (Arimidex) Purpose: blocks estrogen production Therapeutic Use: treat breast cancer in postmenopausal women Adverse effects: muscle and joint pain, headache, nausea, vaginal bleeding, increased risk for osteoporosis, hot flushes

Adverse effects and nursing interventions of Lidocaine

sodium channel blocker >**** CNS effects (drowsiness, altered mental status, paresthesias, seizures) -interventions: carefully monitor clients and notify the provider if manifestations occur administer phenytoin (Dilantin) to control seizure activity >**** Respiratory arrest -interventions: monitor the client's vital signs and ECG. Ensure resuscitation equipment ready at bedside

Contraindications of Procainamide

sodium channel blocker (Class 1A) -Pregnancy Risk cat C -controindicated in clients who have hypersensitivity to procaine or quinidine, complete heart block, atypical ventricular tachycardia, myasthenia gravis, and systemic lupus erythematosus -use cautiously in clients who have partial AV block, liver or renal disorders, heart failure, and digoxin toxicity

interections with lidocaine

sodium channel blocker (class 1B) -cimetidine, beta-blockers, and phenytoin may decrease metabolism of lidocaine, increasing chance of toxicity.

contraindications of Lidocaine

sodium channel blocker (class 1B) -pregnancy risk cat B -contraindicated in clients who have Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, and severe heart block. -cautiously in clients who have liver and renal dysfunction, second-degree heart clock, sinus bradycardia, and heart failure.

interactions with propafenone

sodium channel blocker (class 1C) -may slow medication metabolism and cause an increase in the levels of digoxin, oral anticoagulants, and propranolol. -Quinidine and amiodarone increase risk off propafenone toxicity.

contraindications of Propafenone

sodium channel blocker (class 1c) -pregnancy risk cat C. -contraindicated in clients who have AV block, severe heart failure, severe hypotension, and cardiogenic shock. -use cautiously in clients who have heart failure, liver or kidney dysfunction, chronic respiratory disorders, and in older adults

What are the nursing interventions for methdone?

Inform clients of need to taper dose when stopping medication Encourage client to participate in a 12-step program Medication must be administered by an approved treatment center

Purpose of Buspirone *nonbarbiturate anxiolytic

EXPECTED PHARMACOLOGICAL ACTION ●The exact antianxiety mechanism of this medication is unknown. This medication binds to serotonin and dopamine receptors. Dependency is much less likely than with other anxiolytics, and use of buspirone does not result in sedation or potentiate the effects of other CNS depressants. ●The major disadvantage is that antianxiety effects develop slowly. Initial responses take a week, and at least 2 to 6 weeks for it to reach its full effects. As a result of this pharmacological action, buspirone is taken on a scheduled basis, and is not suitable for PRN usage

Insulin: Long-acting

Insulin glargine (Lantus) Onset: 70min Peak: none Duration: 24 hr

Toxicity nursing considerations

NURSING CONSIDERATIONS ●For oral toxicity, gastric lavage is used, followedby the administration of activated charcoal or saline cathartics .●Administer flumazenil for benzodiazepine overdose/toxicity to counteract sedation and reverse adverse effects. ●Monitor vital signs, maintain patent airway, and provide fluids to maintain blood pressure. ●Have resuscitation equipment available

SSRIs and GI bleeding

NURSING CONSIDERATIONS ●Use caution in clients who have a history of GI bleed or ulcers and in clients taking other medications that affect blood coagulation. ●Advise clients to report indications of bleeding such as dark stool or coffee ground emesis

Chemical name

Name of the medication determined by its chemical composition.

Components of a prescription

Name, date and time, name of med,dosage, route, time and frequency of medication administration, and signature of provider.

What are the manifestations of alcohol withdrawal?

Nausea/vomiting; tremors; restlessness and inability to sleep; depressed mood or irritability; increased heart rate, blood pressure, respiratory rate and temperature; and tonic-clonic seizures. Illusions are also common.

Calcium channel blockers

Nifedipine (Adalta, Procardia)*, Verapramil (Calan)*, Diltiazem (Cardizen)*, Amlodipine (Norvasc), Felodipine (Plendil), Nicardipine (cardene, cleviprex) Purpose &Therapeutic uses: see chart on 256 (sorry to complicated) Adverse Effects: nifedipine (reflex tachycardia, peripheral edema, acute toxicity) verapamil &diltiazem (ortho hypotension, peripheral edema, constipation (vera), bradycardia, heart failure, QRS complex is widened and QT prlonged, acute toxicity hypotension, bradycardia, AV block, ventricular tachydysrthymias Contraindications: use cautiously in eldery and pt with kidney, liver, heart failure, or gerd; nifedipine contraindicated in acute MI, unstable angina, aortic stenosis, shock and intestional obstruction, verapamil is contra in heart block, dig toxicity, sever heart failure, and during lactation. Prego risk C Med/ food interaction: nifedipine: grapefruit juice lead to toxity & verapramil and diltilazen: increase dig levelsdig toxicity, used with beta blockers cause heart failure, AV block and bradycardia, grapefruit juice leads to toxicity

What are the intended effects of buprenorphine?

Used for detoxification and maintenance. Decreases feelings of craving and may be effective in maintaining adherence.

SSRIs and serotonin syndrome

agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, myoclonus (spastic, jerky muscle contractions), hyperreflexia, incoordination, tremors, fever,diaphoresis NURSING CONSIDERATIONS ●Usually begins 2 to 72 hr after initiation oftreatment ●Resolves when the medication isdiscontinued ●Watch for and advise clients to report any of these manifestations, which could indicate a lethal problem

Antifungals

amphotericin B (fungizone), ketoconazole (nizoral), nystatin (mycostatin), fluconazole (diglucan) griseofulvin (grifulvin)

Ace inhibitors

captopril (Capoten)*, Enalapril (Vasotec), Enalaprilat (Vasotec intravenous), Fosinopril (monopril), Lisinopril (Prinivil), Ramipril (Altace), Moexipril (Univasc) Purpose: Vasodilation (mostly arterisole), excretion of sodium and water and retention of potassium by action in the kidneys, reduction in pathological changes in the blood vessels and heart that result from the pressure of angiotensin II and aldosterone Therapeutic Use: hypertension, heart failure, MI, diabetic and nondiabetic nephropathy, pt at high risk for cardiovascular event, Ramipril can be used to prevent MI, stroke, or death Adverse Effects: first dose orthostatic hypotension, cough related to inhibition of kinase II which results in increase in bradykinin, hyperkalemia, rash and dysgeusia (altered taste)- mostly with captopril, angioedema (swelling of tongue and oral pharynx), neutropenia (rare but serious complication of captopril) Contraindications: pt have hx allergy/ angioedema to ACE, bilt renal artery stenosis, pt have one kidney, used causously for pt with reanal impairment lead to neutropenia Med/ food interaction: duirectes confribute to first dose orthostatic hypotension, K supplements and K sparing diuretics increase risk hyperkalemia, Ace increase levels of lithiym carbonate (Eskalith), NSAIDs may decrease antihypertensive effect of ACE -How long to monitor pt for hypotension after first dose 2 hours -captopril and moexipril should be taken 1 hour before mealsorthers can be taken with or without food -notify provider cough, rash, dysgeusia, or signs of infections

Class 1C meds

classification -sodium channel blockers *prototype: Propafenone (Rythmol)- comes in oral -other meds: Flecainide (trambocor) Purpose: -Decrease electrical conduction -Decrease excitability -Increase rate of repolarization Therapeutic uses: SVT adverse effects: bradycardia, heart failure, dizziness, weakness nursing administration: monitor ECG during treatment. Monitor for bradycardia and hypotension Take med with food.

Class 3 meds

classification: POTASSIUM CHANNEL BLOCKERS prolong the action potential and refractory period o the cardiac cycle *prototype: Amiodarone (Cordarone, Pacerone)- comes in oral, IV -other meds: Sotalol (Betapace), Ibutilide (Corvert), Dofetilide (Tikosyn) -Purpose: -Decrease rate of repolarization -Decrease electrical conduction -Decrease contractility -Decrease automaticity Therapeutic uses: conversion of atrial-fibrillation-oral route, recurrent ventricular fibrillation, recurrent ventricular tachycardia adverse effects: pulmonary toxicity, sinus bradycardia and AV block, visual distrubances, liver and thryroid dysfunction, GI disturbances, CNS effects, phlebitis with IV administration, hypotension, bradycardia, AV block nursing considerations: Highly toxic Adverse effects may continue for an extended period of time after the med is D/C.

Centrally acting alpha2 agonists

clonidine (Catapres)*, guanfacine HCL (tenex), methyldopa (Aldomet) Purpose: decreased sympathetic outflow to myocardium result in brady cardia and decreased CO vasodilation decreased BP Therapeutic uses: hypertension, severe cancer pain Adverse Effects: drowsiness/ sedation, dry mouth rebound hypotension (if stopped suddenly) Contraindications: clon: prego C meth: prego B, avoid during lactation, avoid use of transdermal patch on scleroderma and SLE affected areas Med/ food interaction: CNS depression with alcohol

BAS Medications

colesevelam HCL (Welchol) colestipol (Colestid)

BAS Administration

colesnvelam HCL is taken orally in tablet form and should be taken with food and 8ox of water and not concurrently with other medications colestipol is supplied as an oral tablet that should not be crushed or chewed, give 30 mins before a meal

Antipsychotics: First-generation (conventional)

control positive symptoms of psychotic disorders, such as hallucinations, delusions, and bizarre behavior.

Adverse effects and nursing interventions of Amiodarone

potassium channel blocker >****pulmonary toxicity -interventions: Obtain baseline chest X-ray and pulmonary function tests. Continue to monitor pulmonary function through course of therapy advise clients to observe for dyspnea, cough, and chest pain. Notify the provider if effects occur >****Sinus bradycardia and AV block, which may lead to heart failure -interventions: Monitor BP and ECG Monitor for indications of heart failure (dyspnea, cough, chest pain, neck vein distention, crackles) and notify the provider if they occur If AV block occurs, med should be D/C, A pacemaker may be inserted. Med may be D/C >**** Visual disturbance (photophobia, blurred vision, may lead to blindness) -interventions: advise clients to report visual disturbances >****Other effects may include liver and thyroid dysfunction: GI disturbances, CNS effects -Interventions: Obtain baseline liver and thyroid function and monitor periodically. Advise clients to observe for manifestations, and report to the provider if they occur >****Phlebitis with IV administration -Interventions: use of central venous catheter is indicated >****hypotension, bradycardia, AV block -Interventions: monitor cardiac status

antimycobacterial (antituberculosis) names

pyrazinamide (pza), ethambutol (myambutol), and rifapentine (priftin), Isoniazid, rifampin

Catheter Embolus -s/s -tx

s/s- missing tip when dc, severe pain at site with mitigation tx- place tourniquet high on extremity to limit venous flow, prepare for removal under x-ray or surgery, save catheter tip after removal to determine the cause

Extravasation -s/s -tx

s/s- pain, burning, redness, swelling tx- stop infusion and notify provider, follow facility protocol. may need to administer antidote through IV site

Cellulitis -s/s -tx

s/s- pain, warmth, edema, induration, *red streaking, fever, chills, malaise tx- dc infusion and remove catheter, elevate extremity, apply *warm compresses 3-4 x's daily, administer antibiotics-analgesics-antipyretics

what are some complications associated with CNS depression?

sedation, lightheadedness, ataxia, decreased cognitive function

Iron Preparations

● Select Prototype Medications: ◯ Oral: Ferrous sulfate (Feosol, FeroSul, Slow FE) ◯ Parenteral: Iron dextran (INFeD, DexFerrum) ● Other Medications: ◯ Oral: ferrous gluconate (Fergon), ferrous fumarate (Feostat, Femiron) ◯ Parenteral: ferumoxytol (Feraheme), iron sucrose (Venofer), sodium-ferric gluconate complex (SFGC) (Ferrlecit) ● Purpose ◯Iron preparations provide iron needed for RBC development and oxygen transport to cells. During times of increased growth (in growing children or during pregnancy) or when RBCs are in high demand (after blood loss), the need for iron may be greatly increased. Iron is poorly absorbed by the body, so relatively large amounts must be ingested orally to increase Hgb and Hct levels. ●Therapeutic Uses ◯Iron preparations are used to treat iron-deficiency anemia. ■Ferumoxytol is limited to clients who have chronic kidney disease, regardless if on dialysis or administered erythropoietin. ■Ferumoxytol requires only two doses over 3 to 8 days compared with SFGC and iron sucrose, which requires 3 to 10 doses over several weeks. ■Iron sucrose and SFGC are used solely for clients who are undergoing long-term hemodialysis and are deficient in iron ◯Iron preparations are used to prevent iron deficiency anemia for clients who are at an increased risk, such as pregnant women, infants, and children ◯Parenteral forms should only be used in clients who are unable to take oral medications, in which case the IV route is preferred. ●Adverse Effects ◯GI distress (nausea,constipation, heartburn) ◯Teeth staining (liquid form) ◯Staining of skin and other tissues with IM injections ◯Anaphylaxis risk with parenteral administration of iron dextran. ◯Anaphylaxis is triggered by the dextran in iron dextran, not by the iron. ◯Anaphylaxis is minimal with SFGC, iron sucrose, and ferumoxytol. ◯Hypotension, which may progress to circulatory collapse with parenteral administration ◯Fatal iron toxicity in children may occur when an overdose of iron (2 to 10 g) is ingested. ●Contraindications/Precautions ◯Contraindicated for clients with ■Previous hypersensitivity to iron ■Hemolytic anemia, peptic ulcer disease, and severe liver disease ●Interactions ◯Coadministration of antacids or tetracyclines reduces absorption of iron. ◯Vitamin C increases absorption, but also increases incidence of GI complications.

Herbal Supplements- Aloe, Aloe Vera (Aloe Gel, Aloe Latex)

●Purpose ◯Acts as a topical antimicr obial, anti-inflammatory, analgesic, and cathartic ◯Soothes pain, heals burns (aloe gel) ◯Softens skin, laxative (aloe latex) ●Adverse Effects and Precautions ◯Skin preparations: possible hypersensitivity ◯Laxative: Possible fluid and electrolyte imbalances ◯Increases menstrual flow when taken during menses ◯Avoid taking if the client has kidney disorders. ●Interactions ◯Interacts with digoxin, diur etics, corticosteroids and antidysrhythmics

Herbal Supplements- Black Cohosh

●Purpose ◯Acts as an estrogen substitute ◯Mechanism of action is unknown ◯Treats symptoms of menopause ●Adverse Effects and Precautions ◯GI distress, lightheadedness, headache, rash, weight gain ◯Avoid taking during the first two trimesters of pregnancy. ◯Limit use to no longer than 6 months due to lack of information regarding long-term effects. ●Interactions ◯Increases effects of antihypertensive medications ◯May increase effect of estrogen medications ◯Increases hypoglycemia in clients taking insulin or other medications for diabetes ◯Some products contain St. John's wort and should be avoided because of drug interactions related to St. John's wort.

Herbal Supplements- St John's Wort

●Purpose ◯Affects serotonin, producing antidepressant effects - Used for mild depression ◯Used orally as an analgesic to relieve pain and inflammation ◯Applied topically for infection ●Adverse Effects and Precautions ◯Mild adverse effects, including dry mouth, lightheadedness, constipation, GI symptoms ◯Skin rash when exposed to sunlight ●Interactions ◯May cause serotonin syndrome when combined with other antidepressants, amphetamine, and cocaine ◯Decreases effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin, calcium-channel blockers, steroids, HIV protease inhibitors, and some cancer chemotherapy medications

Herbal Supplements-

●Purpose ◯Can block platelet aggregation ◯May block a factor that causes migraines ◯May decrease the number and severity of migraine headaches (does not treat an existing migraine) ●Adverse Effects and Precautions ◯Mild GI symptoms ◯Post-feverfew syndrome may occur, causing agitation, tiredness, inability to sleep, headache, joint discomfort ◯May cause allergic reactions in clients allergic to ragweed or echinacea ●Interactions ◯May cause increased risk of bleeding in clients taking NSAIDs, heparin, and warfarin ◯Discontinue 2 weeks before elective surgery.

Herbal Supplements- Valerian

●Purpose ◯Increases gamma-aminobutyric acid (GABA) to prevent insomnia (similar to benzodiazepines) -Reduces anxiety-related restlessness -Drowsiness effect increases over time ●Adverse Effects and Precautions ◯Can cause drowsiness, lightheadedness, depression ◯Risk of physical dependence ◯Precaution: Clients with mental health disorders should use with caution. ◯Should be avoided by pregnant and lactating women ●Interactions ◯Not known if valerian potentiates effects of CNS depressants

Herbal Supplements- Ginger Root

●Purpose ◯Relieves vertigo and nausea ◯Increases intestinal motility ◯Increases gastric mucous production ◯Decreases GI spasms ◯Produces an anti-inflammatory effect ◯Suppresses platelet aggregation ◯Used to treat morning sickness, motion sickness, nausea from surgery ◯Can decrease pain and stiffness of rheumatoid arthritis ●Adverse Effects and Precautions ◯Use cautiously in pregnancy because high doses may cause uterine spasms. ◯Adverse effects unknown, with potential CNS and cardiac problems with very large overdose ●Interactions ◯Interacts with medications that interfere with coagulation (NSAIDS, warfarin, and heparin)

Herbal Supplements- Kava (Kava Kava)

●Purpose ◯SHOULD BE AVOIDED - causes liver injury ◯Possibly acts on GABA receptors in the CNS ◯Promotes sleep ◯Decreases anxiety ◯Promotes muscle relaxation without affecting concentration ●Adverse Effects and Precautions ◯Chronic use causes dry, flaky skin and jaundice. ◯Chronic use and large doses can cause liver damage, including severe liver failure. ●Interactions ◯Can cause sedation when taken concurrently with CNS depressants.

Herbal Supplements- Glucosamine

●Purpose ◯Stimulates cells to make cartilage and synovial fluid ◯Suppresses inflammation of the joints and cartilage degradation -Treats osteoarthritis of the knee, hip, and wrist ●Adverse Effects and Precautions ◯Mild GI upset (nausea, heartburn) ◯Use with caution with shellfish allergy. ●Interactions ◯Use caution if taking antiplatelet or anticoagulant medication.

Herbal Supplements- Ma Huang (Ephedra Sinica)

●Purpose ◯Stimulates the CNS -Suppresses the appetite -Used for weight loss ◯Constricts arterioles - Increases heart rate and BP ◯Bronchodilates - Treats colds, influenza, and allergies ●Adverse Effects and Precautions ◯Because it contains ephedrine, ma huang can stimulate the cardiovascular system and, at high doses, can cause death from hypertension and dysrhythmias. ◯Stimulation of CNS may cause euphoria and, in high doses, psychosis. ●Interactions ◯Interacts with CNS stimulants to potentiate their effect ◯May cause severe hypertension when taken with MAOI antidepressants ◯Interacts with antihypertensive medications, decreasing effects .