Common Drugs & Nursing Responsibilities

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Activated Charcoal- antiflatulent/ antidote- inactivates toxins and binds until excreted- adverse Effects:

- N/V, black stool, constipation & diarrhea- contraindicated to semiconsciousness, cyanide poisoning, gag reflex depression, & ethanol intoxication- Nursing Considerations:

- assess LOC- give after inducing vomiting unless vomiting is

contraindicated- use laxative to promote elimination- give through NGT if pt is unable to swallow

Albuterol bronchodilator, used in a nebulizer for asthma

patientsTypically a drop (0.5 mg) of albuterol is

suspended in saline and nebulized with oxygen.

AspirinNSAIDCommon AE: tinnitus, hearing loss, Nausea, GI bleeding,

leukopenia, thrombocytopenia, rashes & Reye’s syndromeEffect: may increase liver function test, decrease WBC &

platelet countNursing considerations:

don’t give w/ chicken pox or flu-like symptoms – increases the risk of Reye’s syndrome

If unable to swallow – give it by rectum (watch out for rectal mucosal irritation or bleeding

Stop aspirin 5-7 days prior to surgery Don’t give to patient who is allergic to tartazine dye Take w/ meals to reduce GI unpleasant reaction (best time 1 hr

after lunch or 1 hr pc) Don’t crush or chew

Atenololbeta-blocker similar to metoprolol

AtropineIt is used for several purposes, including inducing the

heart to beat faster as well as an antidote anticholinesterase insecticide poisoning like organophosphate .

It is sometimes used as a drug for patients with severe asthma.

It can also be dripped into the eyes to produce dilation of the pupil (although this is a different formulation).

Can also be used to dry up respiratory secretions during procedures.

Nursing considerations:Watch for tachycardia – may lead to ventricular

fibrillationUse sunglasses – potential sensitivity to the sun

BudesonideAnti-asthmaStock: respuleAE: oral candidiasis, stomatitis, pharyngitis,

rhinnitis, repiratory tract infectionNursing considerations:

○ If bronchospasm results after using shift to bronchodilator

○ Use inhaler for those who have no effect on acute asthma

○ Rinse mouth after using inhaler & spit out the water to prevent developing oral candidiasis

CaptoprilAntihypertensiveAdverse Effect: Leukopenia, agranulocytosis,

pancytopenia, anemia & thrombocytopeniaNursing Considerations:

○ Check WBC & differental count before treatment every 2 wks for 3 months of therapy

○ Check BP at least ≥ 90/60 mmHg○ Take 1 hr a.c. – GI tract may reduce absorption○ Rise slowly – to prevent orthostatic hypotension○ Report swelling of face – sign of Angioedema

Clopidogrel (Plavix)Thrombolytic agentAE: GI hemorrhageEffect: decreases platelet countNursing consideration

○ Avoid activities that can cause trauma or bleeding○ Taken with or without meals

Diazepam (Valium)is a benzodiazepine that is used both as a

powerful sedative and as an anticonvulsant for patients with seizures

use for alcohol withdrawal, cocaine toxicity, and status epilepticus (i.e. uncontrolled seizures)

may produce respiratory depression.Nursing consideration:

○ Do not drink alcohol or take other medications that can make you tired or drowsy while you are taking Valium.

○ Avoid taking Valium with meals, because food may decrease the effect of Valium and delay the time it takes to work in your body.

Digoxin(a derivative of the Foxglove plant) is a cardiac drug –

Cardiac Glycoside use to slow conduction through the heart, especially in

cases of atrial-fibrillationAs a side effect it can produce various dysrhythmias

including ventricular fibrillation and aystole, nausea & vomiting, visual disturbances (yellow green halos around light, blurred vision, light flashes, photophobia & diplopia)

Need normal K+ serum levels to prevent toxicity (K+ binds to the same receptor of Digoxin)

Therapeutic level: 1-0.8 to 2ng/ml – should be obtained at least 6-8 hrs after use

Antidote: Digibind

Nursing Checks:○ Apical rate prior to administration○ Hold for <60 beats/minute○ Hold for change in rhythm

What to teach:○ signs of toxicity○ monitor for rate and rhythm○ monitor for signs of hypokalemia – increase K

intake○ Avoid using herbal meds:

plantain & st. john’s wort – may decrease effectiveness of digoxinsiberian ginseng - may increase toxicity

Diltiazem(Cardizem)calcium channel blocker , antianginaluse to slow the heart down in patients with certain

types of tachycardias such as atrial fibrillationAdverse Effect:

Headache, fatigue, drwosiness, edema, N/V, photosensitivity, rhinitis, dyspnea

Treatment for overdose: atropine for AV block & vasopressor for hypoBP

Nursing Considerations:Assess fluid volume statusAssess BP. PR, RR, ECGMonitor liver function tests; AST, ALT, bilirubingive with meals

Dopamineis a mild vasopressor agent, Symphatomimetic drugis administered IV to produce vasoconstriction

and raise a patient’s blood pressure, renal & mesenteric vasodilation

Indication: treatment for heart failure & Increase renal perfusion

Adverse Effects:○ Headache, tachycardia, hypertension, angina, N/V,

diarrhea, extravasation, dyspnea

Nursing Considerations:○ Monitor ECG for dyspnea, ischemia during treatment○ Monitor BP & PR ○ Check extravasation - change site q48hrs○ Treatment for overdose: short acting A-blockers like

Phentolamine (dilates peripheral blood vessels & lowering peripheral resistance)

• Epinephrine– is a natural substance produced by the adrenal gland

(a.k.a. adrenaline)– is used in emergencies to stimulate the heart or to

dilate the bronchial tree– Other indication: Mydriatic during eye surgery to

control bleeding; and relief of Nasal & nasophrayngeal decongestion

– It is also mixed with lidocaine to prolong lidocaine’s effect and to control bleeding.

– Nursing considerations: • Don’t exceed 5 days for topical nasal solution – rebound

congestion may occur after vasoconstriction subsides• May administer through ET route

Furosemide (Lasix)– is a loop diuretic, which is given IV or PO– produce more urine, thus decreasing the BP. – given to reduce the fluid overload in patients with

congestive heart failure (a.k.a. CHF) or hypertension.– Common AE: increase urination, drowsiness,

sensitivity to sunlight, & increase thirst– Nursing checks:

• BP ≥90/60 mmHG• Urine output at least 30cc/hr

– Nursing considerations:• Administer with foods to prevent GI upset• Give in early day so that increased urinary will not disturb

sleep.• measure fluid and weight to monitor fluid changes• Increase K intake

• Heparin– anticoagulant used to prevent blood from clotting – It is used in patients suspected of having a myocardial

infarction and to prep the syringe for an arterial-blood-gas for the same reason.

– Antidote: Protamine SO4– Nursing Checks:

• Signs of bleeding– Nursing Considerations:

• Use heparin lock needles to avoid repeated injections• Give SC injection, avoid IM & massaging the site– may

cause hematoma formation• Apply pressure• Avoid contact sports or other activities that can cause

injury

Ketorolac (Toradol)– a powerful NSAID, nonopioid analgesic– Uses: severe headaches, musculo-skeletal pain,

kidney stones and inflammation– Adverse Effects:

– Drowsiness, tinnitus, hearing loss, N/V, GI bleeding, taste change, blood dyscrasia, Hematoria, cramps, dry mouth & constipation

– Nursing Considerations:– Monitor blood count during therapy– Assess for GI bleeeding: sputum, emesis, stool– Give 30 mins AC or 2 hrs PC– Caution when driving– Caution pt when using soft contact lenses, the drug may

cause eye burning sensation

LactuloseLaxative, use for chronic constipation & portal-

systemic encephalopathy with heaptic disease Disaccharides that are not absorbed from the digestive tract. They are

thought to improve the generation of ammonia by bacteria, render the ammonia inabsorbable by converting it to ammonium (NH4), and increase transit of bowel content through the gut.

Adverse effects: N/V, anorexia, diarrhea, flatulence, distention belching, abdominal cramps

Nursing Considerations: Assess abdominal cramping , rectal bleeding, N/V – if these will

occur the drug may be discontinued by the prescriber Monitor blood ammonia level: 30-70 mg/100ml, monitor LOC

(increased LOC is the expected outcome for pt with hepatic disease)

Avoid for long-term use bowel tone may be lost If diarrhea occurs it indicates overdosage

Lidocaine2 uses:

- local anesthetic when injected subcutaneously (and it can be used for a nerve block)

- antidysrhythmic drug when injected IV (used to treat cardiac dysrhythmias).

Anesthetic preparations come in 2 forms: with and without epinephrine.

The epinephrine is added to reduce absorption and prolong the effect.

toxic dose when used as a local anesthetic:- 5mg/kg for lidocaine without epi, and 7mg/kg with epi.

LorazepamSedativeAE: drowsiness, sedation & decreases BPEffect: Increases Liver function testNursing considerations:

○ Avoid alcohol & hazardous activities that requires alertness

○ Instruct patient to avoid standing after taking the drug

• Magnesium Sulfate– Antiepiliptic, electrolyte, laxative– Laxative – attract water and retains water in

the intestinal lumen and distend the bowel to promote mass movement & relieve constipation

– Usually given for eclamptic pt.– Antidote: Ca Gluconate– Nursing checks:

• Knee jerk reflex• BP≥ 90/60mmHG• RR≥ 16CPM• Take ECG• Serum K determination

Mannitol– Osmotic diuretic– Decreases intracranial pressure, thus

decreasing the pt’s BP– Common AE: increased urination, GI upset, dry

mouth, headache, blurred vision– Nursing considerations:

• Don’t’ expose solution to low temperature – crystallization may occur– If crystals are seen – arm the bottle in a hot water bath, then cool the

body temperature before adminstration

• Take BP before adminstration, withhold if BP ˂90/60mmhg• Check urine output at least 30cc/hr• Assess for difficulty of breathing, chest pain, and pain in the IV

site

Metoprolol Antihypertensive & antianginal beta-blocker use to slow down the heart and lower blood-pressure

Common AE:Fluid retention and worsening heart failure, Fatigue, Hypotension,

Bradycardia or heart block , drowsiness

Nursing Alert: are not typically used in asthmatics, as they can induce bronchoconstriction

Treatment for overdose: atropine – bradycardia, theophylline – bronchospasm, glucose for hyperglycemia

Nursing Considerations:Give with food to prevent GI upsetTeach signs & symptoms of CHFCheck BP & PRHold if PR ˂ 60bpm, BP ˂90/60 mmHg

Metronidazole (Flagyl)is an antibiotic used against anaerobic bacteria and

certain parasite ( Amebecide & Antiinfective)Given to patient with hepoencephalopathy: the

rationale of their use was the fact that ammonia and other waste products are generated and converted by intestinal bacteria, and killing of these bacteria would reduce the generation of these waste products.

Adverse Effects: Sore throat, metallic taste, stomatitis, N/V, anorexia,

pseudomembranous colitis, darkened urine, nephrotoxicity, decreased libido, bone marrow depression, leukopenia, vaginal drynes

Nursing considerations:

Assess signs of infections Asses urine output – check for increased BUN & creatinine Instruct pt of metallic taste andt urine may turn dark Avoid alcohol when taking this drug because it makes their

stommach violently ill, may experience disulfiran (antabuse) reactions

Midazolam (Versed)a very powerful short acting benzodiazepine type

of sedative is used to sedate patients for painful procedures

(preoperative, endoscopic, intubation)Adverse effect:

Retrograde amnesia, hypotension, cardiac arrest, N/V, respiratory depression, blurrred vision & loss of balance

Nursing Considerations: Excessive dosing may produce respiration depression (when given i.v.)

or coma. Grapefruit foods can increase midazolam effect Monitor BP, PR, RR during IV – medical equipment should be nearby Don’t give rapid bolus for IV route

Morphine Sulfate– a powerful opiate (derived from opium and similar

to heroin) that is used as a pain killer (i.e. analgesic)

– Adverse Effects:– drowsiness, confusion, euphoria, papitation,

bradycardia, cardiac arrest, hypoBP, blurred vision, miosis, N/V, urinary retention, respiratory depression and constipation

– Antidote: Naloxone (Narcan)

– Nursing Considerations:• Check BP at least not less than 90/60 mmhg• Check RR not > 12 CPM• Check Urine output >30 cc/hr – Monitor I&O• Monitor LOC• Increase bulk & fluids in diet• May be given by PCA pump in terminal illness

Naloxone (Narcan)antidote to opioids such as heroin or morphineIt is very rapidly acting and competes with the

opioid at the opioid receptor. Adverse effect:Drowsiness, nervousness, ventricular

tachycardia, increase sytolic BP (high doses), N/V, hyperpnea

Nursing considerations:○ Assess cardiac status: tachycardia, hyperBP, ECG○ Monitor LOC○ Assess for signs of Opioids withdrawal: cramping,

hypertension, vomiting – these may occur 2 hrs after administration

N-Acetylcysteine (Mucomyst)Mucomyst is given in cases of acetaminophen

toxicity (e.g. Tylenol).Adverse effects:

○ Drowsiness, hypotension, rhinorrhea, hepatotoxicity, bronchospasm, chest tightness, stomatitis

Nursing Considerations:○ Assess cough○ Assess cardiac status○ Frequent rinsing of mouth for dryness of oral cavity

NitroglycerinAntianginal drugTreats Hypertension, acute heart failure, & anginal

painNursing Considerations:

Abrupt stopping may cause sapsm of the artery Administer 1 tab SL q 5 mins. Maximum of 3 tablets

can be taken by the pt having anginal pain Tingling sensation w/ SL drug, hold tablet in cheek 30mins-2hrs p.c. – swallow tablet don’t chew Rise slowly – prevent orthostatic hypotension Place in a Light protected – cool & dark container,

close tightly and remove cotton because it absorbs the drug

If transdermal patch (Deponit) is used:○ Remove the patch before defibrillation

because aluminum backing may damage the puddle and cause burns

○ Apply in rotation & hairless site

Prednisoneis a corticosteroid that is given for asthma and

as an anti-inflammatory A side effect of prolonged use is Cushing’s

syndrome and often you may see tremors.Adverse Effects:

○ Depression, flushing, sweating, hypertension, circulatory collapse, fungal infections, increased IOP, nausea, thrombocytopenia, poor wound healing, hyperglycemia, ecchymosis, osteoporosis

Nursing Considerations:○ Monitor serum K, blood glucose, urine glucose –

may cause hypokalemia & hyperglycemia

○ Monitor weight daily: notify physicain wt gain ˃5 lbs○ Monitor I&O: report for decreasing urinary output &

increasing edema○ Monitor Bp: refer for chest pain○ Monitor plasma cortisol level (138-635 mmol/L

measured at 8am ○ Assess adrenal functions – may suppress

hypothalamic, pituitary & adrenal ○ Assess infection, the drug masks inections

symptoms○ May be given w/ food or milk to reduce GI

symptoms○ Use emergency ID as steroid user○ Don’t discontinue abruptly may cause adrenal crisis

Pilocarpineis dripped into the eyes to produce constriction of

the pupil in patients with glaucoma

Phenobarbital is a barbiturate used either as a sedative and/or anticonvulsant

medication. Adverse Effects:

○ Drowsiness, hangover headache, coma, N/V, stevens-johnson syndrome & thrombophebitis

Nursing Considerations:○ Assess mental status○ Assess respiratory dysfunctions – hold drug if

RR˂10/min or pupils are dilated○ Assess signs of drug toxicity:

Hypotension, pulmonary constriction, cold & clammy skin, cyanosis, coma, CNS depression

○ May crush or mix with food if difficulty of swallong

○ Drug should be tapered before discontinuing○ Bruising & bleeding indicates blood dyscrasias○ Avoid driving & other activities that require

alertness○ Overdose: Activated Charcoal

PentobarbitalSimilar to phenobarbital but much faster

acting and with a duration of effect. It is used as an anticonvulsant medication

and to treat severe alcohol withdrawal.

Sodium BicarbonateThe drug is given to correct Hyperkalemia,

metabolic acidosis with bicarbonate loss, hypoxic lactic acidosis, as an antacid (symptomatic relief of GI upset)

Nursing considerations:○ Check serum K levels – risk of metabolic acidosis in

increase state of hypokalemia○ Hook pt to cardiac monitor while administering the

drug○ Chew oral tablet follow with water○ don’t take 1-2 hrs in any drug may decrease the

effect

• Valproic Acid (Depakene)– is used as an anticonvulsant medication – It is not typically used in the emergency treatment

of seizures, but toxicity can often be seen with seizure patients who have taken too much.

– Effect: may cause positive result of ketones– Nursing considerations:

• Avoid withdrawing the drug immediately to prevent worsening of seizure

• Take with foods• Don’t not chew tablet form – may cause irritation of

the throat and mouth• Don’t mix with carbonated beverages

Phenytoin (Dilantin)is an anticonvulsant, antidysrhythmicwhen administered too fast, it can induce

hypotensionAntidote: AcetylceisteineAdverse Effects:

○ Drowsiness, confusion, suicidal tendencies, hypotension, blurred vision, hepatitis, gingival hyperplasia, anemia, stevens-Johnson syndrome

Nursing considerations:○ Assess drug level: wait ≥1wk to determine the level

Therapeutic level 7.5-20mcg/ml Toxic level 30-50 mcg/ml

Assess mental status Assess beginning rash may lead to SJS Assess for blood dyscrasia: fever, sore, throat, bruising, rash,

jaundice, epistaxis Monitor for toxicity: bone marrow depression, N/V, CV collapse,

slurred speech & confusion Monitor liver function test: ALT & AST, Bilirubin Give with meals Tablet: can be crushed or chewed Don’t take antidiarrheal or antacid within 2-3 hrs of taking the

drug Avoid driving or other activities that require mental alertness Taper off dosage over several week Proper oral hygiene or visit dentist toutinly – gingival hyperplasia

RanitidineAntiulcerNursing considerations:

○ Assess abdominal pain, acute presence of blood in emesis, stool or gastric aspirate

○ Take at bedtime for best effect○ May be taken with or without meals○ Avoid smoking – increase gastric acid secretions

SucralfateAntiulcerAE: constipation, nausea, dry mouth and

indegistionNursing considerations:

○ Take 1 hr ac or empty stomach & at bedtime○ Avoid smoking○ Antacid my be used while taking sucralfate by 30

mins apart

Topiramate (Topamax)AnticonvulsantIt is also indicated to prevent migraine headacheEffect: Sleepiness or concentration problemsNursing considerations:

○ Caution in hot weather – may cause oligohydrosis or hyperthermia

○ Increase oral fluid to prevent of forming kidney stones

○ Don’t break or crush – casue bitter taste, swallow immediately without chewing

Vancomycinantibiotic, used for highly resistant bacteriaIt is fairly toxic to the patient, and often is a drug

of choice to a septic, shocky patient.Adverse Effects:

○ Cardiac Arrest, ototoxicity, permanent deafness, tinnitus, nephrotoxicity, increased BUN & creatinine, wheezing & dyspnea, leukopenia, neutropenia, anaphylaxis

Nursing Considerations:○ Report hematuria○ Report compromise renal system – drug is slowly

excreted in the renal system ○ if pt experience ringing or roaring ear, the drug

should be discontued○ Have adrenalin, suction, tracheostomy set,

endotracheal intubation equipment – anaphylaxis may occur

50% Dextrose sol. Alternative: Glucagon Classification: Antihypoglycemic Indication:

To treat hypoglycemia that results either from fasting or insulin use in a patient with diabetes mellitus.

The End!!!

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