Drug Manuscript PDF
PAIN MED. MED Name/class Mild Pain Tylenol (Acetaminophen) NSAIDS: Safe dose/Route/ Freq Motrin (Ibuprofen) Toridol (Ketorolac) Moderate Pain OPIOID ANALGESICS Norco (Hydrocodone) Children (general): 10 to 15 mg per kg of body weight, every 4 to 6 hours, to a maximum of 65 mg/kg in 24 hours. Adults: 325 mg to 650 mg every 4 to 6 hours to a maximum of 4,000 mg in 24 hours. 10-40 mg every 4-6 hours 7.5-10mg (oral) every 4-6 hours Vicodine (Hydrocodone) SE 4-6 pain Analgesia for moderate to severe acute pain Alternative to Narcotic Analgesic Intramuscular Dose Regular 30-120mg Low 15-60mg Intravenous Dose Regular 30mg Low 15mg Oral Dose Maximum 40mg Regular 10-20mg Low 10mg 10-80mg (oral) Oxycontin (Oxycodone HCl) Percocet (Oxycodone) Severe Pain OPIOID ANALGESICS Dilaudid (Hydromorphone) Adults: Oral 325-650 mg every 4-6 hours. (maximum daily dose is 4 grams)Suppository 650mg every 4-6 hours. Children: Oral 40-650 mg every 4 hoursSuppository 80325 mg every 4-6 hours depending on age. Uses (Goals) Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis Relief of mild to moderate pain Treatment of primary dysmenorrhea Fever reduction Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine Headache Chest pain, Hepatic toxicity and failure, jaundice Acute kidney failure, renal tubular necrosis Rash fever Lightheadedness Dizziness Drowsiness Nausea Vomiting Constipation RN Consider Assess pain Assessmusculoskeletal status: ROMbefore dose and 1 hr. after Monitor liver function studies Monitor renal function studies Monitor bloodstudies: CBC,Hgb, Hct,proteome if patient is on longterm therapy Check I&O ratio Assesshepatotoxicity Assess forallergicreactions, visualchanges andototoxicity Identify prior drug history Identify fever:length of time inevidence andrelatedsymptoms BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST) Pt. Teaching Administer in the morning with a full glass of water at least 60 min before the first beverage, food, and medication of the day. Patient must stay up right for 60min after taking the tablet to avoid potentially serious esophageal erosion Do not exceed recommended dose; do not take for longer than 10 days. Take the drug only for complaints indicated; it is not an antiinflammatory agent. Action Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation prostaglandin precursors. Drug 2 Drug Interaction Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen [for example, carbamazepine (Tegretol), isoniazid (INH, Nydrazid, and Laniazid), rifampin (Rifamate, Rifadin, and Rimactane)] reduce the levels of acetaminophen and may decrease the action of acetaminophen. Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver. Dizzy >no standing N/V > call nurse Inform patient that hydrocodone and acetaminophen may cause dizziness and drowsiness. Advise patient to avoid hazardous activities until drugs CN effects are known. Advise patient to change position slowly to minimize effects of orthostatic hypotension Management of moderate to severe pain. Binds to opiate receptors in the CNS Alters the perception of ad response to painful stimuli, while producing generalized CNS depression Avoid alcohol and other CNS depressants while receiving morphine. Do not use OTC drug unless approved by physician Do not smoke or Binds to opiate receptors in the CNS Alters the perception of and response to painful stimuli while producing generalized CNS depression High risk of CNS depression with alcohol, antidepressant, antihistamines, and sedative/hypnotics including benzodiazepines and Anticholinergic: Increased risk of ileus, sever constipation and urine retention. Antidiarrheal: Increased risk of CNS depression and severe constipation. Barbiturate anesthetics: Possibly increased respiratory and CNS depression. 2.5-10mg (oral) 1mg IV Q 4-6 hours prn Peak 15-30min Onset 10-15min Duration 2-3 hour 7-10 pain PCA pump Symptomatic relief of sever, acute and chronic pain after non-narcotic analgesics have failed and preanasthetic Constipation Dizziness Hypotension Blurred vision Nausea and vomiting Urine Retention BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST) Morphine Allergy to Sulfa Drugs Page 2 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed PAIN MED. MED Name/Class Safedose/Rout (Morphine) Adult: (PO) 10-30mg q4h (IV) 2.5-15mg q4h (IM/SC) 5-20mg (PR) 1020mg (Fentanyl) 0.5-1mcg/kg/dose, may repeat after 30-60min. (Demerol) 100 mg/ 2mL Uses/Goals SE RN Consider medication Used to relieve dyspnea of acute left ventricular failure and pulmonary edema and pain of MI. Pt Teaching Anti-Anxiety >Benzodiazepines< Ativan (Lorazopam) adult: PO 2–6 mg/d in divided doses (max: 10 mg/d) geriatric: PO 0.5–1 mg/d (max: 2 mg/d) child: PO/IV 0.05 mg/kg q4–8h (max: 2 mg/dose) Management of anxiety disorders and for shortterm relief of symptoms of anxiety. Also used for preanesthetic medication to produce sedation and to reduce anxiety and recall of events related to day of surgery; for management of status epilepticus. Drowsiness Headache Hyper/hypotension Nausea and vomiting > Barbiturates< Phenobarbitol 15-120 mg/day PO divided BID/TID Sedative (oral or parenteral) Hypnotic, short-term (up to 2 wk.) treatment of insomnia (oral or parenteral) Long-term treatment of generalized tonic-conic and cortical focal seizures (oral) Vertigo CNS Depression Nausea and vomiting Constipation / diarrhea ambulate without assistance after receiving drug. Bedside rails are advised Use caution or avoid tasks requiring alertness (e.g. Driving a car) until response to drug is known since drug may cause drowsiness, dizziness, or blurred vision Do not breast feed while taking this drug Do not drive or engage in other hazardous activities for a least 24– 48 h after receiving IM injection of lorazepam. Do not drink largevolumes of coffee. Anxiolytic effects of lorazepam can significantly be altered by caffeine. Do not consume alcoholic beverages for at least 24–48 h after an injection and avoid when taking an oral regimen. Notify physician if daytime psychomotor function is impaired; a change in regimen or drug may be needed. Terminate regimen gradually over a period of several days. Do not stop long-term therapy abruptly; withdrawal may be induced with feelings of panic, tonic– clonic seizures, tremors, abdominal and muscle cramps, sweating, vomiting. Be aware that SL administration has more rapid absorption than PO, and bioavailability compares to IM use. Do not administer intraarterially; arteriospasm, gangrene may result. Give IM injections of undiluted drug deep into muscle mass, monitor injection sites. Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution. Keep equipment to maintain a patent airway on standby when drug is given IV. Monitor patient responses, blood levels (as appropriate) if any of the above interacting drugs are given with phenobarbital; suggest alternative means of contraception to women using hormonal contraceptives. Do not administer intraarterially; may produce arteriospasm, thrombosis, gangrene. Administer IV doses This drug will make you drowsy and less anxious; do not try to get up after youhave received this drug (request assistance to sit up or move around). Take this drug exactly as prescribed; this drug is habit forming; its effectiveness infacilitating sleep disappears after a short time. Do not take this drug Action Suppresses the cough reflex via a direct central action. Pain Control Drug 2 Drug Interaction phenothiazines. Most potent of the available benzodiazepines. Effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are mediated by the inhibitory neurotransmitter GABA. Action sites: thalamic, hypothalamic, and limbic levels of CNS. Increased CNS depression with alcohol and other sedating medications, such as barbiturates and opioids Decreased effectiveness with theophylline’s General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at sub hypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an Increased serum levels and therapeutic and toxic effects with valproic acid Increased CNS depression with alcohol Increased risk of nephrotoxicity with methoxyflurane Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics Page 3 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed PAIN MED. MED Name/Class Safedose/Rout Uses/Goals SE RN Consider slowly. Administer IM doses deep in a large muscle mass (gluteus maximus, vastus laterals) or other areas where there is little risk of encountering a nerve trunk or major artery. Pt Teaching Action longer than 2 wk. (for insomnia), and do not increase thedosage without consulting the prescriber. Drug 2 Drug Interaction antiepileptic. GI : SBO, GERD, Ulcers, Gastritis MED Name/class PPI (proton pump inhibitor) “Prazole” Protonix (pantoprazole) Prilosec (omeprazole) Safe dose/Route/ Freq Adult 20-80mg 20mg PO Q12 H2 Blockers“tidine” Uses (Goals) Stress Ulcers GERD Gastritis Absence of epigastric pain Fullness Pain SE Headache Diarrhea Abdominal pain Nausea Vomiting Insomnia Hyperglycemia RN Consider Assess for epigastric or abdominal pain and occult blood in stool emesis or gastric aspirate Known hypersensitivity, hypocalcaemia or if taking any meds that interact with this drug. Treatment and prevention of heartburn, acid indigestion, and sour stomach. Dizziness Arrhythmias Drowsiness Headache Nausea Anti-Acids (Tums) 2-4 teaspoons (10-20 mL) 4 times a day taken 20min to 1 hr. after meals and at bedtime or as directed by the physician. Relieve heartburn Major symptom of gastro esophageal reflux disease or acids indigestion. Treatment of ulcers Upset stomach Vomiting Stomach pain Belching constipation Pt Teaching Report severe diarrhea If patientsdiabetic may cause hyperglycemia Avoid hazardous activities as dizziness may occur Avoid salicylates, ibuprofen ETOH- may cause GI irritation Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause falsepositive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly. Observe ’10 rights’ in drug administration to avoid medication errors. Monitor and record pain scales to serve as Instruct patient to avoid caffeine, alcohol, harsh spices, and black pepper because it may aggravate the underlying Action Blocks final step of acid production Inhibits H+/K+ ATPas in gastric parietal cell suppressing gastric secretion. Binds to an enzyme on gastric parietal cells in the presence of acidic gastric PH. Preventing the final transportation of hydrogen ions into the gastric lumen. Drug 2 Drug Interaction Contraindicated in hypersensitivity, metabolic alkalosis and hypocalcaemia. ↑ Pantoprazole serum levels w/ meds: diazepam, flurezepam, triazolam, clarithromycin, phenytoin ↓ Absorption w/meds: calcium carbonate, vit B12, sucralfate. ↑ Blding w/ warfarin Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Aluminum hydroxide may form complexes withcertain drugs e.g., tetracycline’s,digoxin andvitamins, resulting in decreased absorption. Thisshould Blocks HCl production Turns down Volume of Stomach Acid production Neutralizes Stomach Acids 20-30min. Page 4 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed GI : SBO, GERD, Ulcers, Gastritis MED Name/Class Safedose/Rout Uses/Goals (Suspension) SE RN Consider resulting from excessive acidity. Stool Softeners Colace (docusate sodium) Bisacodyl (Dulcolax) 100mg PO BID 5-15 mg tablets 10 mg suppository Prevention of constipation. Used as enema to soften fecal impaction Promotes incorporation of water into stool, resulting in softer fecal mass. May also promote electrolyte and water secretion. Abdominal Pain Nausea Vomiting baseline data and to determinethe effectiveness of the drug. Give drug 20 min- 1 hour after meal to counteract the hydrochloric acid production by neutralizing the acidity. Administer with at least 8 ounces of water to enhance absorption Monitor stool consistency to prevent diarrhea and constipation. ` Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Asses color, consistency and amount of stool produced. Pt Teaching Anti-Emetic Zofran (Ondansetron) 0.12 mg/kg or 32mg single dose Treatment for nausea and vomiting Prevent symptoms of gastric static and esophageal reflux. Headache Dizziness Diarrhea Constipation Abdominal Pain Compazine (Prochlorperazine) Reglan (metoclopramide) Assess for nausea, vomiting, abdominal distention and bowel sounds prior to and following administration. Assess patient for extrapyramidal effect periodically Assess patient BP Drug 2 Drug Interaction be borne in mind when concomitantadministration is considered. Advice patients that laxatives should be used only for short-term therapy. Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake and increasing mobility. Advice patient not to use laxative when abdominal pain, nausea, vomiting or fever is present. Advice patient not to take docusate within 2 hour of other laxatives. Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. Electrolyte imbalance Advice patient to notify health care professional immediately if involuntary movement of eyes, face or limbs occur. Blocks the effects of serotonin at 5ht receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS. Decreases incidence and severity of nausea and vomiting. May be affected by drugs altteringthe activity of liver enzymes. May cause transient increase in serum bilirubin, AST and ALT levels. PO: 2.5mg-10mg max 40mg/day IM: 0.1-10mg max 40mg/day IV: 2.5-10mg max 40mg/day Rectal: 25mg bid IV not recommended for children 10mg q6-8hour Action GIcondition. Instruct patient to increase fiber and fluid intake and regular physical activity to help ease constipation. Instruct patient to eat banana if diarrhea occurred. Canbeusedastranquilizerfornonpsychoticanxiety,butotherdrugsma y have more favorable side effect profile (e.g., benzodiazepines) Restlessness Anxiety Depression Irritability Hyper/hypotension Page 5 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/class ACE Inhibitor “PRIL” Prinivil, Zestril (Lisinopril) Capoten (Captopril) dose/Route/Freq MAX Daily Uses (Goals) SE 2.5-40mg 40mg/day 0.3-25mg PO Hypertension Management of congestive heart failure (CHF) Reduces the risk of death or development of CHF after myocardial infarction (MI) Slows the progression of left ventricular dysfunction into overt heart failure Used to decreased the progression of diabetic neuropathy Insomnia Vertigo Weakness Cough Hypotension Chest pain Tachycardia RN Consider Pt. Teaching Action Drug 2 Drug Interaction Advice patient take the med same time daily. Change position slowly Decreased antihypertensive effects if taken with indomethacin Exacerbation of cough if combined with capsaicin Take drug without regard to means Report fever chills, dizziness and pregnancy. Selectively blocks the binding of angiotensin II to specific tissue receptors found in thevascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin\u2013angiotensin system as well as the release of aldosterone, leading to decreasedBP; may prevent the vessel remodeling associated with the development of Atherosclerosis. Block Altosterone in R.A.A.S decrease total body fluid BP Mild diuretic that acts on the distal tubule to inhibit sodium exchange for potassium, resulting inincreased secretion of sodium andwater conservation of potassium. Analdosterone antagonist Manifests a slightantihypertensiveef ARB angiotensin block Valsartan Candesartan Losartan 1 tab daily; 25100mg/d 16mg once daily Aldactone(Spironolactone) 2-32 mg/day as a single dose or divided into 2 daily doses Treatment of hypertension, alone or in combination with other antihypertensive. Treatment of heart failure in patients who are intolerant of angiotensin-converting enzyme (ACE_ inhibitors. Decrease BP Take Pressure Off L Ventricle of heart Treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat swelling (edema) Headache Dizziness Hypotension Diarrhea URI Symptoms BP_____ HR_____ Administer without regard to meals. Ensure that patients is not pregnant before beginning therapy Check blood pressure before initiation of therapy and at regular intervals throughout therapy. Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin level when used 100-200 mg/dayPO for edema;100400mg/day PO for hyperaldostero nism; 50-100 mg/day PO for hypertension Pediatric :3.3 mg/kg/day PO 100mg/day PO BID Inspra (Eplerenone) 25-50mg/day Headache diarrhea, cramps, drowsiness, rash, nausea, vomiting, impotence, irregular menstrual periods, irregular hair growth Stops Angiotensin 1 to converting to Angiotensin 2 in the R.A.A.S Decrease B/P Excretion of sodium and water and retention of potassium Assess Vital Signs before giving Rx. Monitor BP and pulse frequently during initial dose adjustment Monitor weight and assess lungs for rales/crackles Assess for peripheral edema, jugular venous distention 50mg OD Aldosterone Antagonist 360mg/day H/O AngioEdema Mod-severe aortic stenosis Systolic BP <90, Cr>3.0 K+ >5.5 BP_____ HR_____ Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 2–3 d after drug is withdrawn. Report signs of hypernatremia or hyperkalemia (see Appendix F), most likely to occur in patients with severe cirrhosis. Contraindicated with hypersensitivity to valsartan, pregnancy (use during second Or third trimester can cause injury or even death to fetus), lactation. Use cautiously with hepatic or renal dysfunction, hypovolemic Increased hyperkalemia with potassium supplements, ACE inhibitors, diets rich in potassium. Decreased diuretic effect with salicylates Decreased hypoprothrombinemic effect of anticoagulants Page 6 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Loop Diuretics Lasix (Furosemide) Safedose/Rout for 4 weeks 20mg/tab Bumex(Bumetanide) 0.5-1mg/day Demadex (Torsemide) 5-20mg/day 5-20mg/day Thiazide Diuretics Hydrochlorothiazide (Metolazone) MAX daily 10mg/day 80mg/day Uses/Goals SE RN Consider Pt Teaching concurrently. Assess for signs of fluid and electrolyte imbalance, and signs of digoxin toxicity. Monitor daily I&O and check for edema. Report lack of diuretic response or development of edema; both may indicate tolerance to drug. Weigh patient under standard conditions before therapy begins and daily throughout therapy. Weight is a useful index of need for dosage adjustment. For patients with ascites, physician may want measurements of abdominal girth. Avoid replacing fluid losses with large amounts of free water Action fect. Interferes with synthesis of testosterone and mayincrease formation of estradiol from estrogenthus leading to endocrine abnormalities Treatment of edema associated with CHF, hepatic cirrhosis, and renal disease. Hypertension. orthostatic hypertension thrombophlebitis chronic aortitis vertigo headache BP_____ HR_____ Weights (trending) 1___2 ___3 ___4 ___ K+ ____ Assess patient's underlying condition. Monitor for renal, cardiac, neurologic, GI, pulmonary manifestation of hypokalemia. Assess fluid volume. s/s Hypo K+ Posteral Syncope advise patient totake drug with food toprevent GI upsetinform patient of possibleneed for potassium ormagnesium supplements For pain on integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout. BP_____ HR_____ Assess for pain: type, location and pattern Note for asthma Record intermittent therapy on a calendar, or use prepared dated envelopes. Take drug heartburn Thirst fever dimness of vision Drug 2 Drug Interaction Inhabits sodium and chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water together with sodium, chloride and potassium. Diuretic antihypertensive. Inhibits reabsorption of sodium and chloride in distal renal tubule, increasing the Excretion of sodium, Cross-sensitivity with thiazides and sulfonamides may occur Taking insulin with Hydrochlorothiazide may cause high blood sugar (hyperglycemia. Page 7 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals Arthritis, SLE, acute rheumatic fever SE RN Consider asthma like symptoms Monitor renal,LFTs and CBC Determine history of peptic ulcers or bleeding tendencies. early so increased urination will not disturb sleep. Drug may be taken with food or meals if GI upset occurs. Weigh yourself on a regular basis, at the same time and in the same clothing; Record weight on your calendar. chloride, and water by the kidney. Take with meals if upset stomach occurs. Block Ca+ channels of cell inhabits the movement of calcium ions across the membranes of cardiac and arterial muscle cells inhabits trans membranecalcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells osteoporosis Ca+ Channel Block “PINES” Norvasc (Amlodipine) Beta Block Zabeta (Bisoprolol) Coreg (Carvedilol) Lopressor Metroprolol CHR Angina hypertension 5mg/tab OD 1.25mg 3.125mg x 2 12.5 – 25mg 10mg 25 50mg x 2 If >85kg 200mg x 1 CHF Tachycardia Management of hypertension, used alone or with other antihypertensive agents Dizziness headache Peripheral edema Flushing rush Nausea Abdominal discomfort Pharyngitis Dizziness Vertigo Bardycardia CHF Cardiac Arrhythmias Rush Monitor patients BP, cardiac rhythm, and output. Pt Teaching Action Baseline weight, skin condition, neurologic status, P, BP, ECG, R,kidney and liver function tests, blood and urine glucose Do not stop taking this drug unless instructed to do so by a health care provider. Avoid over-thecounter medications. Avoid driving or dangerous activities if dizziness, weakness occur. These side effects may occur: Dizziness, lightheadedness, loss of appetite, nightmares, depression, and sexual impotence. Report difficulty breathing, night cough, swelling of extremities, slow pulse, Confusion, depression, rash, fever, sore throat. Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of renin fromthe kidney, and lowering blood pressure. Drug 2 Drug Interaction The body breaks down (metabolizes) amlodipine using liver enzymes known as CYP 3A4 enzymes. Drugs known as CYP 3A4 inducers speed up the activity of these enzymes, causing the body to metabolize amlodipine too quickly. This may make amlodipine less effective. Increased effects with verapamil, anticholinergic Increased risk of orthostatic hypotension with prazosin Possible increased BPlowering effects with aspirin, bismuth subsalicylate, magnesium salicylate, sulfinpyrazone, hormonal contraceptives Decreased antihypertensive effects with NSAIDs Possible increased hypoglycemic effect of insulin Page 8 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Inotropic Cardiac Glycosides Lanoxin (Digoxin) 0.125mg x 1 0.125 mg – 0.25mg x1 Nitrates VASODILATOR Nitro (Nitroglycerin) 0.2-0.6 mg SL q 5 minutes 3doses in 15 minutes Blood Thinners (anti-coagulants) Uses/Goals Heart failureSupraventricular arrhythmiasEmergency heart failure MI, /CAD Treatment of angina pectoris SE RN Consider Headache Weakness Drowsiness visual disturbances mental status change Arrhythmias GI upset, anorexia Dig Toxic0.82.0ng/ml Low K+ levels (^dig toxic) BP_____ HR_____ EKG Monitor apical pulse for 1 minute before administering. Administer as indicated. Check dosage and preparation carefully.- Avoid giving with meals; this will delay absorption Headache Restlessness Nausea Vomiting Hypotension Tachycardia Viagra BP_____ HR_____ Monitor blood pressure and heart rate on a regular basis Dizziness Headache Observe patients receiving Pt Teaching Instruct patient not to stop taking drug without notifying physician. Instruct to report slow or irregular pulse, rapid weight gain, loss of appetite, nausea, diarrhea, vomiting, blurred or yellow vision, unusual tiredness or weakness, swelling of the ankles, legs or fingers, difficulty breathing. Weigh patient every other day. Instruct to have regular medical check-ups, which may include blood tests, to evaluate effects of drug. Do proper documentation. NO Viagra (Vascular Collapse) Instruct patient to take medication while sitting down and to change positionsslowly. Instruct patient to allow tablets to dissolve under tongue, and not to chewer swallow sublingual tablets. Instruct patient to seek emergency help promptly if chest pain is unresolved after 15 minutes. Instruct patient not to change brands without consultingprescriber . Instruct patient to keep tablets in original, air-tight container Protect from injury and notify Dr of Action Drug 2 Drug Interaction Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity effectiveness reduced by phenytoin, neomycin,sulphasalazin e, kaolin, pectin, antacids and inpatients receiving radiotherapyMetoclopramide may alter the absorption of solid dosage forms of digoxin- Blood levels increased by calcium channel blockers, spironolactone, quinidine and calcium salts.- Electrolyte imbalances such as hypokalemiaand hypomagnesaemia(e.g. admin of potassiumlosing diuretics, corticosteroids) can increase the risk of cardiac toxicity Reduces cardiac oxygen demand by decreasing leftventricularpressure and systemicvascular resistance; dilates coronaryarteries andimproves collateral flow to ischemic regions Viagra ASA: Prevent bleeding by Use of heparin, ASA, Tylenol, Page 9 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class ASPRIN (anti-platelet) Heparin (Heparin Sodium) Lovenox (enoxaparin) Safedose/Rout MAX daily 81mg Q Day 325mg CP 150=10,000 U/kg IV 40mg SQ daily Uses/Goals Coumadin (Warfarin) 2.5 mg/1 tab OD Anticoagulation for purposes of stroke, PE, deep venous thrombosis, prophylaxis for venous thrombosis, acute MI Prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculat ion, and dialysis procedures Prevention o thrombus formation Systemic anticoagulation for prevention of ischemic or thrombotic events Prevents further extension of formed existing clot, prevention of new clot formation, and secondary thromboembolic complications. And for treatment of hyperkalemia. SE RN Consider Insomnia Constipation N/V Urinary Retention Bleeding Anemia Thrombocytopenia parenteral drug carefully; closely monitor BP and vital signs. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Monitor for S&S of hypokalemia. Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Pt Teaching pink, red, dark brown or cloudy urine, red or dark brown vomitus; red or black stools, bleeding gums or oral mucosa; ecchymosis, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness Menstruation may be somewhat increased and prolonged; Learn correct technique for SC admin if discharged from hospital on heparin Engage in normal activities such as shaving with a safety razor in the absence of a low platelet count. Alcohol and smoking may alter the response to heparin and are not advised Do not take aspirin or any other OTC meds without the Dr approval Action inactivation of thrombin formation, inhibition of formation of fibrin Heparin: exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin tothrombin and fibrinogen to fibrin. Drug 2 Drug Interaction glucocorticoids, sulfonamides, cephalosporin’sincrea se effects of warfarin. Phenobarbital, tegrtol, Dilantin, oral contraceptives decreases anticoagulation effects. Coumadin: Warfarin is used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolusPE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack Page 10 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed MED Name/class Insulin Rapid Acting “LOG” Apidra (Glusine) Aspart (Novolog) Lispro (Humalog) Short Acting “LIN” Humalin/Novolin R ONSET/ Peak/ Duration Intermediate (cloudy) NPH 1-2HR ONSET 6-10 hr. PEAK DURATION 4 Hr. ONSET NO PEAK 18 – 24 Hr. DURATION Safe dose/Route/ Freq Long Act Glargine (Lantus) Detremir (Levemir) MED Name/class Anti-Diabetic (Metformin) Glucophage 15min ONSET 30 - 90 min PEAK 4-6 hour DURATION Uses (Goals) Diabetes Mellitus Regulate sugar in your bloodstream 30 – 60 min ONSET 2-4 hr. PEAK DURATION 500-1000mg Max. 2000mg/day (child) 2500mg/day (adult) Insulin & Diabetic RN Consider Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips or tongue; chills; cold sweats; confusion; cool pale skin; difficulty in concentration; drowsiness; excessive hunger; headache Monitor body weight Roll NPH to mix Uses (Goals) SE improve glycemiccontrolling clients with type 2diabetes Diarrhea Nausea Unpleasant metallic taste. Extended-Release form used to treat type2 diabetes as initial therapy Asses for symptoms of hypoglycemia. Monitor body weight. RN Consider Assess for patients history of diabetes Monitor patients’ blood glucose before and after giving medications. Assess for hypersensitivity to Metformin Assess Patients renal function Monitor sign and symptoms of hypoglycemic reaction. Pt. Teaching Hypoglycemia H.A.N.D.W.A.S.H Headache Altered Nervousness Disoriented W Anxiety Shaky Action Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat and inhibiting hepatic glucose production. Insulin also inhabits lipolysis and proteolysis and enhances protein synthesis. A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with intermediate or long acting insulin. Drug 2 Drug Interaction Lantus/Lefemir NO MIXING!!!! With other insulin’s Beta blockers may block some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Lopressor) Alcohol may decrease insulin requirements. Pt. Teaching Action Drug 2 Drug Interaction Inform the patient of potential risks/advantages of therapy and of alternative modes of therapy Do not discontinue this medication without consulting your health care provider. Monitor urine or blood for glucose and ketones as prescribed. Do not use this drug during pregnancy; if you become pregnant, consult with your Health care provider for appropriate therapy. Decreases heptic glucose production Decreases intestinal glucose absorption. Increases sensitivity to insulin. decongestants can make metformin less effective, increasing your chance of high blood sugar (hyperglycemia) Page 11 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed MED Name/class Bronchodilators Beta 2 Agonist Proventil (Albuterol) Methylaxthine Theophylline (Elixophyllin) Safe dose/Route/ Freq PO (Adults and Children more than 12 years): 24 mg 3-4 times a day or 4-8 mgof extended dose tablets twice a day. 1.4 mg poq12h Maintenance 3mg/kg q 8hr. RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease Uses (Goals) SE RN Consider Pt. Teaching To control and prevent Restlessness Relief and prevention of Do not exceed reversible airway bronchospasm in recommended dosage; cardiac arrhythmias obstruction caused by patients with reversible adverse effects or loss palpitation asthma or chronic obstructive of effectiveness may sweating obstructive pulmonary airway disease Result. Read the nausea & vomiting disorder (COPD) instructions that come Inhalation: Treatment Quick relief for with respiratory of acute attacks of bronchospasm inhalant. bronchospasm For the prevention of These side effects may Prevention of exerciseexercise-induced occur: Dizziness, induced bronchospasm bronchospasm4. Longdrowsiness, fatigue, Unlabeled use: Adjunct term control agent for headache (use in treating serious patients with chronic or caution if driving or hyperkalemia in dialysis persistent performing tasks that patients; bronchospasm require alertness); seems to lower nausea, vomiting, potassium change in taste (eat concentrations when small, frequent meals); inhaled by patients on rapid heart rate, hemodialysis anxiety, sweating, Flushing, insomnia. Report chest pain, dizziness, insomnia, weakness, tremors or irregular heartbeat, difficulty breathing, productive cough, failure to respond to usual dosage Bronchospasm of COPD Nausea Vomiting Monitor theophylline Take this drug exactly blood levels as prescribed Bronchial asthma Palpitation Monitor I&O Avoid excessive intake Chronic bronchitis Hyperglycemia of coffee, tea, cocoa, Assess for signs of Anxiety cola, and chocolates. toxicity: irritability, Insomnia Have frequent blood insomnia, restlessness, tremors test to monitor drug effects and ensure safe Monitor respiratory and effective dosage. rate, rhythm and dept. Assess for allergic reaction. Action in low doses, acts relatively selectively at beta2-adrenergic receptors to cause bronchodilator and vasodilation; at higher doses, beta2 selectivity is lost, and the drug Acts at beta2 receptors to cause typical sympathomimetic cardiac effects. Drug 2 Drug Interaction Increased sympathomimetic effects with other sympathomimetic drugs Increased risk of toxicity, especially cardiac, when used with theophylline, aminophylline, oxtriphylline Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol) Decreased effectiveness of insulin, oral hypoglycemic drugs Decreased serum levels and therapeutic effects of digoxin Anti - Cholinergic Ipratropium Inhaler (Atrovent,Apovent,Aerov ent) 2 inhalations (36 mcg) qid. Bronchodilator for maintenance treatment of bronchospasm associated with COPD (solution, aerosol), chronic bronchitis, and emphysema Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis, Nausea GI distress Dry mouth Dyspnea bronchitis Back pain Chest pain. Asses History of hypersensitivity to atropine Asses skin color lesion texture BP, P, R adventitious sounds Bowel sounds Use as an inhalation product Side effect may occur Report rash, eye pain, difficulty voiding, palpitation, vision changes Relaxes bronchial smooth muscle, causing bronchodilator and increasing vital capacity that has been impaired by bronchospasm and air trapping; actions may be mediated by inhibition of phosphodiesterase, which increases the concentration of cyclic adenosine monophosphate; in concentrations that may be higher than those reached clinically, it also Inhibits the release of slow-reacting substance of anaphylaxis and histamine. STOPS(inhibits) secretion from serous and seromucous glands lining the nasal mucosa. Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes By antagonizing the action of acetylcholine. Drinking alcohol can increase the level of theophylline in your blood, which can cause dangerous side effects. It is best to avoid alcohol while taking theophylline. Page 12 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed MED Name/Class Anti-Inflam Agents Corticosteroids Prednisone (Deltasone/Flovent) Mast Cell Stabilizer CromolynSodium (Intal Rynacrom) RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease SE RN Consider Pt Teaching Uses/Goals common cold Replacement therapy in ^Blood sugar & Infection Assess physical weight, Do not immediately adrenal cortical T, reflexes and grip stop taking the ^ Edema (retain Na+) insufficiency strength, affect and corticosteroid, need to Wt gain orientation, P, BP, be tapered OFF, Hyperkalemia associated bloating peripheral perfusion, ADRENAL crisis may with cancer moon face prominence of occur Short-term management superficial veins, R, Avoid exposure to of various inflammatory Adventitious sounds, infections. and allergic disorders, serum electrolytes, Report unusual weight such as blood glucose. gain, swelling of the rheumatoid arthritis, extremities, muscle collagen diseases (e.g., weakness, black or tarry SLE), dermatologic stools, fever, prolonged diseases (e.g., sore throat, colds or pemphigus), status other infections, asthmatics, and worsening of the autoimmune disorders disorder for which the Hematologic disorders: drug is being taken thrombocytopenia purpura, erythroblastopenia Ulcerative colitis, acute exacerbations of multiple sclerosis and palliation in some leukemia’s and lymphomas Trichinosis with neurologic or myocardial involvement Safedose/Rout 10mg/5ml OD on full stomach involvement Treats asthma, COPD, Hay Fever or Chronic inflammation of the major pathways of the respiratory tract (bronchioles/’ bronchi) Inhalers or Nasal spray H/A Trouble Swollowing Skin itchy Muscle pain Ensure proper use of inhailer (exhale completely before inhailing drug with admin of inhailor) Respiratory assessment Lung Sounds Educate MEDS WORK SLOWLY 2-6 weeks to become effective Causes bronchodilator Action Inhabitations of leukocyte infiltration at the site of inflammation Interference in the faction of mediators of inflammatory response, and suppression of humeral immune responses. Drug 2 Drug Interaction Increased therapeutic and toxic effects with troleandomycin, ketoconazole Increased therapeutic and toxic effects of estrogens, including hormonal contraceptives Risk of severe deterioration of muscle strength in myasthenia gravis patients who also are receiving ambenonium, edrophonium, neostigmine, pyridostigmine Decreased steroid blood levels with barbiturates, phenytoin, rifampin Decreased effectiveness of salicylates Prevents allergy and inflammation Reaction from releasing histamines that cause allergic inflammation DO NOT USE for immediate allergy relief or acute asthma attack SE: Runny Nose, Throat irritation, HA CALL DR. if white sores in throat OR swelling tough Leukotrine Rec. Antagonist zafirlukast (Astra, Accolate) (Singulair) ADULTS AND CHILDREN > 12 YR 20 mg PO bid on an empty stomach. PEDIATRIC PATIENTS 5\u201311 YR 10 mg PO bid on an empty stomach Leukotriene modifiers reduce inflammation in the lung tissue treatment of bronchial asthma Headache Dizziness Nausea diarrhea abdominal pain Vomiting Ensure that drug is taken continually for optimal effect. Do not administer for acute asthma attack or acute bronchospasm. Take this drug on an empty stomach, 1 hr. before or 2 hr. after meals. Take this drug regularly as prescribed; do not stop taking it during symptom-free periods; do not stop taking it without consulting your health care provider. Do not take this drug for acute asthma attack or Selectively and competitively blocks receptor for leukotriene D4 and E4, components of SRS-A, thus blocking airway edema, smooth muscle constriction, and cellular activity associated with inflammatory process that contribute to signs and symptoms of asthma. Increased risk of bleeding with warfarin Potentially for increased effects and toxicity of calcium channelblockers, cyclosporine. Decreased effective with erythromycin, theophylline. Page 13 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease MED Name/Class Safedose/Rout Uses/Goals 150 to 375 mg is administered SC every 2 or 4 weeks Anti-Allergic Xolair (Omalizumab) SE moderate to sever persistent asthma who have a positive skin test otinvitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids. RN Consider POST OP (Blood & Bones) RN Consider MED Name/class Safe dose/Route/ Freq Uses (Goals) SE Blood 1-2 units over 2-4 hours (faster admin will neg. affect kidneys) Anemia Blood loss S/P Sx Allergic Rx Lysed cells Death Fe+ (iron) PO: ADULTS, ELDERLY: 2-3 mg/kg/day or 50-100mg elemental iron 2 time/day up to 100mg 4time/day. CHILDREN: 3 mg/kg/day elemental iron in 1-3 divided doses prevention or treatment of iron deficiency anemia due to inadequate diet, malabsorption pregnancy, and blood loss Mild, transient nausea Heartburn Anorexia Constipation Diarrhea Easy Bruising Increased r/f bleeding Fever Rhinitis Hyperkalemia Irritation Mild Pain Blood Thinners (anti-coagulants) ASA Heparin (Heparin Sodium) Lovenox (Enoxaparin) 81mg Q Day 325mg CP SQ 5,000 – 10,000 UNITS Adults: Initially, 5,000 units by I.V. bolus; then 20,000 to 40,000 units/day by I.V. infusion with pump. Titrate hourly rate based on PTT results (every 4 to 6 hours in the early stages of treatment). Children: Initially, 50 units/kg I.V.; then 25 units/kg/hour or 20,000 units/m 2 daily by I.V. infusion pump. 40 mg once daily SQ Clot Prevention, ^CMS Boost Circulation prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculation, and dialysis procedures Prevention of DVT/Pulmonary Embolism Assess lung sounds and RR, assess for allergic reactions within 2 hr of first injection, monitor for injection site reactions.Solution is viscous and maytake 510 sec. to administer Wheezing tightness in your cheat skin rash feeling anxious Swelling face, lips, tongue H/H _____ RBC____ BP____ HR____ TEMP____ VS before VS 15 min into VS Q 30 min VS After Assess for clinical improvement, record of relief of symptoms (fatigue, irritability, pallor, paresthesia, and headache). Check: H/H: ___ Plt, ___ INR ___ (2.0-3.0 Therp. Warforin) PTT: ___ NO Give: GI Bleed, Ulcers APTT Pt Teaching acute bronchospasm; Take daily Use flow meter to every AM to track lung copasity from day to day Action Inhibits binding of IgE toreceptors on mast cells andeosinophils, preventing of mediators of theallergic response. Alsodecreases amount of IgEreceptors on basophils. Drug 2 Drug Interaction CI in hypersensitivity and acute bronchospasm Pt. Teaching Action Drug 2 Drug Interaction Benadryl Cortisone Back pain, Diff breathing, Rapid HR s/s RX O (Universal Donor) AB (universal Reciever) Rh + (receives everyone +/Rh – (ONLY receives Neg.) A-A B-B O – O & GIVE TO ALL, AB-Recieves ALL Expect stools to darken in color. If gastrointestinal discomfort occurs, take after meals or with food. Do not take within 2 hours of antacids because it prevents absorption - Black Stool (call PMD) - Easy Bruising & Bleeding - Brush teeth slowly to prevent bleeding gums - NO shaving with Razors - Safety! essential component in the formation of hemoglobin, myoglobin andenzymes. It is necessary for effective erythropoiesis and transport or utilization of oxygen exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombintothrombin and fibrinogen to fibrin Doxycycline, mycophenolate, penicillamine, or thyroid hormones (eg,levothyroxine) Antihistamines Digoxin Tetracycline Page 14 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed POST OP (Blood & Bones) MED Name/Class Coumadin (Warfarin) Safedose/Rout 2.5-10mg per day for 2-4 days then adjust daily dose by results of prothrombin time or INR Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction Management of Myocardial infarction: decreases risk of death, decreases risk of subsequent MI Page 15 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed POST OP (Blood & Bones) ANTI-INFECTIVES `MED Name/class Penicillin Amoxil (Amoxicillin) Safe dose/Route/ Freq Uses (Goals) SE Infections of the resp. tract, skin and skin structures, Para nasal sinuses, genitourinary tract, otitis media, sinusitis Meningitis. UTI Adult: 250-500mg every 8hours Children: 2040/mg/kg/day divided dosage given every 8 hours Polycillin (Ampicillin) 20-500mg Geocillin (Carbenicillin Indanyl Sodium) 382 to 764 mg Zosyn (Piperacillin/Tazobactam) 3.375-4.5g every 6 hours Bicillin (Penicillin G Sodium) 1-4mL Action Drug 2 Drug Interaction Allopurinol: increased risk of rash chlothromycins, sulfonamides tetracycline’s: Reduced bactericidal effect of amoxicillin Methotrexate: Increased risk of methotrexate Obtain pt.’shas of allergy. Assess pt. for any s/s of infection Asses for pt.’s sensitivity to penicillin or other cephalosporin’s Assess for allergic reaction during therapy. Assess for bowel pattern Teach patient to report adverse reactions. Notify prescriber if infection worsens or doesn’t improve after 72 hours Prevents bacterial cell wall synthesis during replication NO AMINOGLYCO IV TUBING Bactocil (Oxacillin Sodium) Keflex (Cefalexin) Duricef, Ultracef (cefadroxil) nd >2 Gen< Mandol(Cefamandole) Cefzil(Cefprozil) Zinacef, Ceftin (Cefuroxime) rd >3 Gen< Cefizox (Ceftizoxime) Rocephin (Ceftriaxone) Claforan (cefotaxime) Tetracycline’s Doryx (Doxycycline) Pt. Teaching Cephalosporin’s st >1 Gen< Ancef (cefazolin) Dizziness Nausea and vomiting Diarrhea Abdominal pain RN Consider Achromycin (Tetracycline) Terramycin (Oxytetracline) `MED Name/class Macrolides Zithromax (Azithromycin) IV/IM 0.5-1 g 6-12 hrly. Max: 6 g/day, up to 12 g/day in severe infections. 500mg 1cap q6hrs 1 g/day P.O. or 500 mg P.O. q 12 hours Staphylococcus Infections -Lower Lungs - Bones Infections - Blood Infections Respiratory tract infections Skin and skin structure infections Bone and joints infections Acne H. Pylori Gonorrhea Certain types of pneumonia Lyme disease Uses (Goals) URI GU Mild moderate nausea, SE Nausea Vomiting abdominal pain Loss of appetite Mild diarrhea Nausea Stomach cramps Vomiting 250 to 500 mg, every 8 hours, PO 125-500mg IM/IV 1-2g max of 3-4g 1-2 g IV/IM qDay or divided BID for 4-14 days depending on type and severity of infection 1 to 2 g IV/IM q8hr 200mg once daily PO Adult: 500mg PO bid Child: 25-50mg/kg PO qid PO: Onset-Rapid, Peak 2-3hours; Duration 6-12 hours Dizziness Vestibular reaction Diarrhea Nausea and vomiting Photosensitivity Be alert of adverse reactions and drug interaction. This drug should be used extremely carefully because of its potent vasoconstrictor action. IV use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give IV slowly over several minutes and monitor blood pressure closely. Tell patient to take entireamount of drug exactly asprescribed, even after he feelsbetter. Advise patient to notify prescriber if rash develops or signs and symptoms of super infection appear. Inform patient not to crush, cut,or chew extendedreleasetablets. Bind to bacterial cell wall membrane,causing cell death. ** ALLERGY: PENICILLIN* NO PENECILLIN IV TUBING Assess patient for infection (vital signs, appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy Sun screen d/t making skin sensitive to sunlight Yellow Teeth NO dairy NO Iron NO antiacids Not with food Inhibits bacterial protein synthesis at the level of the 30s bacterial ribosome. RN Consider Assess skin color, GI output Bowel sounds Pt. Teaching Take the full course prescribed. Do not take with Action Azithromycinblockstranspeptidation by binding to50s ribosomal subunit of susceptible organismsand No DAIRY NO IRON NO Anti-acids 10-50mg/kg Safe dose/Route/ Freq 500mg/daily for 3 days. Drug 2 Drug Interaction Coumadin Theophylline Prednisone Page 16 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed POST OP (Blood & Bones) MED Name/Class Safedose/Rout Uses/Goals 500mg 1tac Bid PO Biaxin (Clarithromycin) (E-Mycin) Erythromycin Aminoglycosides Garamycin (Gentamicin) Kantrex (kanamycin) Mycifradin (Neomycin) Fluroquinolones Cipro (ciprofloxacin) Levaquin (lomefloxacin) (Floxin) vomiting, abdominal pain, dyspepsia, flatulence, diarrhea, cramping; angioedema, cholestasis jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values 250mg every 8 hours PO Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d. Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d. Neonate: IV/IM 2.5 mg/kg q12–24h 500mg BID Per Orem 250-750mg Q 24 hr. Oral Adults 600-1800 mg/day in 2-4 equal doses. Childn>1 mth 8-25 mg/kg/day in 3-4 equal doses IM/IV AdultSeriousinfections 2400-2700 mg in 2-4 equal doses. Less complicated infections 1200-1800 mg/day in 3-4 equal doses. Childn>1mth 20-40 mg/kg in 3-4 equal doses. Neonates <1 mth 15-20 mg/kg in 3-4 equal doses. Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa. Resp: GU Bone Skin Infections SE RN Consider dyspepsia Diahhrea NEPHRO TOXICITY Tennatus (ringing in ears) Skeletal muscle weakness Apnea Nausea Vomiting Diarrhea Difficulty sleeping headache nausea, vomiting stomach upset, gas unusual taste vaginal irritation Pt Teaching antacids. May exp. side effects Report severe or watery diarrhea, nausea/vomiting0 Perform C&S and RENAL function (BUN/ Creat) prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, and patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Assess for level of pain relief and administer prn dose as needed but not to exceed the recommended total daily dose. Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression. Discontinue drug and notify physician if S&S of hypersensitivity occur. Assess bowel and bladder function; report urinary frequency or retention. Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold. Monitor ambulation and take appropriate safety precautions. Weekly Blood Draws To check Peak & trough levels (TOXICITY LEVELS &Theraputic range) Action disrupting RNA-dependent protein synthesis at the chain elongation step Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpose. Action is usually bactericidal. Report: - Tennatus (ringing in ears) may indicate Kidney toxicity Drug 2 Drug Interaction Dopamine Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established NO PENECILLIN IV TUBING Exercise caution with potentially hazardous activities until response to drug is known. Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to physician. Do not breast feed while taking this drug. Inhibition of topoisomerase(DNA gyrase) enzymes, which inhibits relaxation of super coiled DNA and promotes breakage of double stranded DNA Do not take with Cisapride, droperidol, some medicines for irregular heart rhythm. NOT WITH FOOD NO MILK NO IRON NOT WITH FOOD NO MILK NO IRON Page 17 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed POST OP (Blood & Bones) `MED Name/class Sulfanamides Bactrim, Septra (TrimethoprimSulfamethoxazole) The Others: Vancocin (vancomycin) Flagyl(Metronidazole) Safe dose/Route/ Freq Tab 2 tab Forer tab. 1 tab infant & children TM 6 mg &SMZ 30 mg/kg body wt daily. To be given in bid. Gonorrhea 5 tab bid or 2 ½ forte tab bid for 1 day. Uses (Goals) Resp tract, renal GIT, GUT. Osteomyelitis, pneumocystis carinii pneumonia, toxoplasmosis, actinomycetoma, acute brucellosis, nocardiosis SE Treat a severe intestinal condition known as Clostridium difficile-associated diarrhea. Treats only bacterial infections of the intestines. 2 g/day IV divided q612hr; may increase based on body weight or to achieve higher trough values, increase toxicity >4 g/day Zyvox (Linezolid) Capsules: 375 mg Injection: 5mg/mLOral suspension:200mg/5ml Tablets:200mg, 250mg, 400mg, 500mg Topical gel: 0.75 %, 1% Clindamycin(Cleocin) 600mg every 12 hour for 14-28 days Oral 150-300mg q6hr. IV 600mg/day in 2-4equal doses up to 4.8g/day UV ir IM Fatigue Nausea Vomiting diarrhea Crystalluria Toxic epidermal Chills Drug fever Rash Eosinophilia Reversible neutropenia RN Consider Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;WBC) at beginning and during therapy. Obtain specimens for culture and sensitivity before initiating therapy. Inspect IV site frequently. Phlebitis is common. Monitor CBC and urinalysis periodically during therapy Pt. Teaching Instruct patient to notify health care professional if rash, or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional. Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Assess patient for infection Vital signs appearance of wound, sputum, urine, and stool WBC Beginning of and throughout therapy. Allergy to medication monitor I/O Instructed patient on range of Vancomycin toxicity (toxicity is reported at levels sustained above 80 to 100 mcg/ml). Patient verbalized understanding of instructions given. Instructed patient on Vancomycin adverse effects such as: erythroderrma, thrombocytopenia, neutropenia, ototoxicity, and nephrotoxicity. Patient verbalized understanding of instructions given. VANCOMYCIN>>>>>>> RED MANS SYNDROME: (NOT A ALLERGY RX)infusing too rapidly may cause REDDING of skin, NOT a adverse RX, only a Side Effect Action Interferes with bacterial growth by inhibiting bacterial folic acid synthesisthrough competitive antagonism of PABA. Treatment of potentially lifethreatening infections when less toxic anti-infective are contraindicated. Particularly useful in staphylococcal infections, including:endocarditis, meningitis, osteomyelitis, and pneumonia septicemia, soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin. Drug 2 Drug Interaction Oral Anticoag./ Diuretics no work K+ Supplements Anta-Acids & Ca+ Block Ototoxic and nephrotoxic drugs (aspirin, aminoglycosides, cyclosporine cisplatin, loop diuretics): no depolarizing neuromuscular blocking agents: general anesthetics. hypotensive symptoms. Patient verbalized understanding of instructions given. 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