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A Pharmacology1. Class: antianginal agents
a. type: nitratesi. action
arterial, venous, and capillary vasodilation by relaxing vascular smoothmuscle
o decreases myocardial oxygen consumption
o decreases preload with venous pooling
o decreases afterload by decreasing peripheral vascular
resistance
ii. example nitroglycerin (Nitro-bid IV 10-20 mcg/min, titrate according to blood
pressure) (Nitro-dur 1 transdermal patch daily, remove for 6-8 hoursdaily) (Nitro-stat 0.4 mg sublingual (SL) tablet under the tongue, mayrepeat every 5 minutes up to 3 tablets)
iii. uses: prophylaxis, treatment, and management ofangina, acute myocardialinfarction (MI)
iv. adverse effects
sudden, severe refractory hypotension when taken withsildenafil citrate (Viagra) or tadanafil (Cialis), methoglobinemia,contact dermatitis
headache, nausea, vomiting, dizziness
reflex tachycardia,postural hypotensionv. contraindications
severe anemia, cardiac tamponade
cerebral hemorrhage or trauma
hypovolemia, hypotension, shockvi. nursing care
establish baseline data and monitor during acute angina or IVadministration: blood pressure, heart rate, EKG, chest pain
may decrease effectiveness of heparin
withdraw treatment gradually to avoid angina
toxicity: CNS changes, hypotension, flushing, nausea
buccal area must be moist for SL absorption
may induce alcohol intoxication (without alcohol intake)
maintain a 6-8 hour nitrate-free period every 24 hours after acute
episode to avoid tolerance client teaching
o apply spray under tongue; do not chew tablets
o sit down when taking, change positions slowly
o report blurred vision or dry mouth, avoid alcohol
o keep tablets away from light, moisture, and body heat; change
tablets every 6 monthso use spray or sublingual tablets for immediate relief; combine
drug with rest for acute attacko rotate site of ointment or patch; remove ointment or patch and
clean skin for daily nitrate-free periodo for acute angina: take 1 tablet (or 1 spray under the tongue)
SL every 5 minutes up to three tablets, if not relieved seekemergency
b. type: isosorbide dinitrate, mononitratei. action
vasodilation by relaxing arterial and venous smooth muscleo decreases preload with venous pooling, peripheral vascular
resistance, and myocardial oxygen consumptionii. examples
isosorbide dinitrate (Isordil 5-40 mg by mouth daily in 4 doses)
isosorbide mononitrate (Imdur 10-20 mg by mouth daily in 2 does)iii. uses: maintenance therapy for angina, coronary artery disease (See also:
II.A.1.a nitrates: adverse effects, contraindications, nursing care)c. type: beta-adrenergic blocking agents (See also: II.A.4.e beta-adrenergic blocking
agents)d. type: calcium channel blocking agents (See also: II.A.4.d calcium channel blocking
agents)2. Class: Anticoagulants
1. Type: oral
i. action: interferes with vitamin Kdependent clotting factors in the liverresulting in prolonged bleeding time
ii. example: warfarin (Coumadin 2.5-10 mg by mouth daily for 2-5 days; then,titrate according to INR)
iii. uses: maintenance therapy and prophylaxis to suppress formation ofdangerous clots after MI, mechanical heart valve surgery, atrial fibrillation (afib) and atrial flutter (a flutter), heart failure, DVT, and pulmonary embolism(PE)
iv. adverse effects
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1. hemorrhage, peripheral skin necrosis2. bone marrow depression, liver dysfunction3. anorexia, many drug-drug interactions4. high-risk drug with older or incompetent clients
v. contraindications
1. clients at risk for falls, malabsorption syndrome2. severe hepatic or renal disease3. bleeding disorders and active bleeding4. recent invasive procedure to spinal cord
vi. nursing care
1. establish baseline data and monitor prothrombin time (PT) andinternational normalized ratio (INR), bleeding, bruising, liver functiontests (LFTs), headache, decreased level of consciousness, and risk offalls
2. high risk therapy for older clients in the community3. apply prolonged pressure to any puncture wounds to stop bleeding4. administration of vitamin K suppresses warfarin activity for 1-3 weeks:
may need to provide alternate anticoagulation5. client teaching
1. avoid alcohol, NSAIDs2. use electric razor for shaving3. seek emergency treatment for falls4. wear MedicAlert jewelry, monitor for bleeding5. take at same time daily, need for follow-up care and testing
6. avoid herbal remedies including Echinacea, licorice, andginseng7. avoid foods containing vitamin K (decreases effect of warfarin)
especially green leafy vegetables, broccoli, and liver2. type: low-molecular weight (LMW) heparin
i. action: blocks action of Factors Xa and Iia without appreciably affectingthrombin or prothrombin
ii. examples1. dalteparin (Fragmin 2500 international units by subcutaneous injection
daily)2. enoxaparin (Lovenox 1-1.5 mg/kg by subcutaneous injection daily)
iii. uses: prophylaxis against thromboembolic disorders associated with surgeryand bedrest
iv. adverse effects
1. hemorrhage, thrombocytopenia, angioedema2. increased bleeding times and bruising3. inflammation at injection site, dyspnea, rash
v. contraindications1. recent GI bleed or invasive spinal cord procedure
2. active bleeding, thrombocytopenia, uncontrolled HTNvi. nursing care (See also: II.A.2.a.vi anticoagulants: oral, nursing care)
1. establish baseline data and monitor CBC and platelets
2. does not effect PT, INR, or activated partial thromboplastin time (aPTT)
with therapeutic doses
3. lower risk ofheparin-induced thrombocytopenia (HIT) thanunfractionated heparin
4. give subcutaneously according to manufacturer's direction
5. client teaching: subcutaneous injection technique3. type: unfractionated heparin
i. action: inhibits conversion of prothrombin to thrombin thus preventing fibrinformation
ii. example: heparin sodium (Heparin Sodium Lock Flush Solution)
iii. uses: acute illness to suppress dangerous clot formation; unstable angina(USA), MI, CVA, DVT, PE, afib and flutter, disseminated intravascularcoagulation (DIC)
iv. adverse effects
1. HIT, bronchospasm, increased bleeding time2. rebound hyperlipidemia, fever, chills, rash
3. impairment ofendocrine systemv. contraindications
1. extensive burns, trauma; severe HTN
2. recent surgery or invasive spinal cord procedure3. thrombocytopenia, active bleeding, bleeding disorders
vi. nursing care (See also: II.A.2.a.vi anticoagulants: oral, nursing care)1. establish baseline data and monitor aPTT, CBC, and platelets2. highest risk of HIT
3. adjust dosage when given with nitroglycerin (NTG)
4. high-risk therapy for women, older clients, and with renal or hepaticinsufficiency
5. antidote: protamine sulfate (Protamine Sulfate 1.0% 0.5-1 mg IV/100units of heparin given)
6. client teaching: subcutaneous injection technique
2. Antidysrhythmia agents (aka antiarrhythmia)
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1. information common to antidysrhythmia agentsi. use
1. eradication of frequent premature ventricular contractions that causehemodynamic instability or loss of consciousness
2. emergency eradication of ventricular dysrhythmias3. cardiopulmonary resuscitation4. chemical cardioversion of atrial and ventricular dysrhythmias
ii. adverse effects1. heart block2. most are have dysrhythmogenic potential (capable of causing
dysrhythmias)3. prolongation of QTc interval or QRS complex
1. increased risk of torsades des pointesiii. assist HCT to implement client teaching plan
1. count heart rate and pattern of rhythm, i.e., regularity2. provide acceptable range for heart rate3. report
1. new onset of irregular rhythm2. findings outside of acceptable parameters3. worsening heart rate, dizziness, lightheadedness, loss of
consciousness, and edema2. type: sodium channel blocking agents (Class I antidysrhythmia agents)
i. action: suppresses various phases in myocardial cell action potential byblocking sodium channels; stabilizes myocardial cell membrane
ii. example
1. lidocaine (Xylocaine 2 mg/min IV infusion: titrate according tofrequency of ventricular ectopy)
2. quinidine gluconate (Quinalan 325-650 mg by mouth every 6 hours,324-660 mg by mouth every 6-12 hours as extended-release tabs)
3. procainamide (Pronestyl 500-1000 mg by mouth every 4-6 hours, 1gram every 12 hours as sustained-release form)
iii. uses: ventricular dysrhythmias, chemical cardioversion with a fib and a flutter(except lidocaine)
iv. adverse effects1. dysrhythmias, heart block, torsades de pointes
Torsades de Pointe
2. respiratory depression, bone marrow depression3. nausea, vomiting, rash4. increases risk of digoxin toxicity and risk of bleeding with
anticoagulants
5. CNS effects including sedation, confusion, and seizures (especiallylidocaine)
v. contraindications
prolonged QTc interval
hypotension and shock
heart block without pacemaker
prolonged therapy, use with cimetidinevi. nursing care
establish baseline data and monitor vital signs, EKG, QTc interval,neurological status, drug levels
prevent client injury: associated with many adverse effects
quinidine and procainamide reserved for use after many othertherapies have failed
client teachingo avoid citrus juices, antacids, and milk products
o take heart rate daily: report change in rhythm
e. beta-adrenergic blocking agents (Class II antidysrhythmia agents) (See also: II.A.4.3beta-adrenergic antagonists)
f. type: potassium channel blocking agents (Class III antidysrhythmia agents)1. action: slows the outward movement of potassium through myocardial cell
membranes and prolongs the action potential2. examples
i. amiodarone (Cordarone 400 mg by mouth daily)ii. sotalol (Betapace 160-320 mg by mouth daily in 2-3 doses)
3. uses: ventricular and supraventricular dysrhythmias, chemical cardioversionwith a fib and a flutter
4. adverse effects
i. pulmonary fibrosis, hypotension
ii. heart failure, heart block, sinus arrest, liver damage
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iii. nausea, vomiting, dizziness, weakness, photosensitivity5. contraindications
i. prolonged QTc intervalii. concomitant use with quinidine or procainamideiii. severe liver disease, heart block, cardiogenic shock
6. nursing care
i. establish baseline data and monitor vital signs, EKG, hepatic,pulmonary, endocrine, neurological, and GI function
ii. follow oral and IV administration guidelines: timing and rates ofinfusion are very important
iii. client teaching1. avoid taking with echinacea2. need for follow-up care and testing3. protect skin and eyes from UV rays4. monitor pulse and report changes in rhythm5. may take with meals but must be consistent
2. type: anticholinergic agent (See also: II.C.2.iii anticholinergics)1. action: competes with acetylcholine for muscarinic receptor sites to produce
mild vagal excitation
2. example: atropine (!high alert drug) (Atropine 0.51 mg up to 2 mg)3. use: bradycardia associated with increased vagal tone4. adverse effects
i. paradoxical bradycardia with sub-therapeutic dosing; angina,
tachycardiaii. anticholinergic effects
iii. atropine flush 15-20 minutes after injection3. type: acetylcholine-sensitive K+ current activator
1. action: shortens duration of action potential, causes hyperpolarization, andslows normal automaticity
2. example: adenosine (Adenocard 6 mg rapid IV bolus, may administer 12 mgrapid IV bolus in 1-2 minutes)
3. use: chemical conversion of supraventricular tachycardia after failure of vagalmaneuver
4. adverse effects
i. transient asystole, dysrhythmiasii. dyspnea, chest tightness, hypotension, flushing, nausea
5. contraindications: 2nd or 3rd degree AV block, sick sinus syndrome, cardiac
transplant6. nursing care
i. establish baseline data and monitor continuously during therapy: EKG,heart rate, blood pressure, respiratory rate
ii. monitor serum electrolytes
Therapeutic class: antihypertensive agent types:
4. Antihypertensive agentsa. information common to antihypertensive agents
i. uses: heart failure, primary and secondary HTNii. adverse effects
orthostatic hypotension,reflex tachycardia, bradycardia
dizziness, weakness, sexual dysfunction
nausea, vomiting, diarrhea, anorexia, and constipation
iii. contraindications
severe deficiencies in serum electrolytes
heart block, pediatrics, hypovolemiaiv. nursing care
establish baseline data and monitor blood pressure, K+, fluid andelectrolyte balance, renal function
older clients more susceptible to toxicity, labile hypotension, andorthostatic hypotension
client teachingo avoid OTC drugs, change positions slowly
o finding recognition
o take medication only as directed, when feeling well, and if
blood pressure is controlled (indicates that the therapy is
effective)o therapy most effective when combined with weight loss,
smoking cessation, and an active lifestyleb. type: ace inhibitor (ACEI)
i. action: inhibits conversion ofangiotensin I to angiotensin II in the lungspreventing vasoconstriction from angiotensin II and the release ofaldosterone
ii. examples
enalapril (Vasotec 10-40 mg twice daily by mouth, initiate therapy at2.5-5 mg)
lisinopril (Zestril 20-40 mg daily by mouth, initiate therapy at 2.5-5 mg)iii. uses: HTN and heart failureiv. adverse effects
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refractory cough, hyperkalemia
rash, renal and hepatic injury
v. contraindications: hyperkalemia and renal insufficiencyvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents)
administer on empty stomach
client teachingo take 1 hour before and 2 hours after eating
o avoid salt substitutes containing potassium
o
increased risk of hypersensitivity if given with allopurinolc. type: angiotensin II-receptor blocker (ARB)i. action: binds to angiotensin II receptors to block vasoconstriction and release
of aldosteroneii. examples
losartan (Cozaar 50-100 mg by mouth daily in 1-2 doses)
valsartan (Diovan 160-320 mg by mouth twice daily)iii. uses: HTN and heart failureiv. adverse effects: hyperkalemiav. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents)
relatively few drug-drug interactions
client teaching: may take with food, avoid salt substitutes containingpotassium
d. type: calcium channel blocker (CCB)i. action: block movement of calcium into muscle cellii. examples
amlodipine (Norvasc 5-10 mg by mouth daily)
diltiazem (Cardizem 30-120 mg by mouth 3-4 times daily, Cardizem SR180-240 mg by mouth daily)
verapamil (Calan XR 120-240 mg by mouth daily; IV 5-10 mg/kg, mayrepeat with 10 mg in 15-30 minutes)
iii. uses: HTN, angina, and dysrhythmiasiv. adverse effects
precipitous hypotension
heart block and heart failure
venous pooling, peripheral edema
hypotensive effect of diltiazem potentiated with cycloSPORINEv. contraindications: heart block and sick sinus syndromevi. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents)
client teaching: do not take with grapefruit juice
e. type: beta-adrenergic blocking agents (antagonists)
i. action: selective (beta1-adrenergic receptors) and non-selective (beta1- andbeta2-adrenergic) blockers of the sympathetic nervous system (SNS) resultingin
slower heart rate
decreased vasoconstriction
decreased myocardial oxygen consumptionii. examples
selective blockerso atenolol (Tenormin 50-100 mg by mouth daily; IV 5 mg, may
repeat 2 times)o metoprolol (Toprol 100-450 mg by mouth 1-2 times daily; IV 5
mg every 2 minutes for 3 doses)
non-selective blockero propranolol (Inderal 80-240 mg by mouth in 2-4 divided doses
daily; IV 1-3 mg, may repeat in 2 minutes)
iii. uses: heart failure, hypertension, heart rate control, angina, and migraineheadache prophylaxis
iv. adverse effects
bradycardia, heart block, heart failure, hypotension
depression, decreased exercise tolerance
suppresses clinical indicators ofhypoglycemia bronchospasm (not as common with cardioselective forms)
v. contraindications
thyrotoxicosis , diabetes mellitus (DM)
peripheral vascular disease (PVD)
chronic obstructive pulmonary disease (COPD)vi. nursing care (See also: II.A.4.iv information common to antihypertensive
agents)
establish baseline data and monitor breath sounds and peripheralperfusion
avoid concomitant use ofclonidine and nonsteroidal anti-inflammatorydrug (NSAID)
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taper dose before discontinuing, do not discontinue before surgery
check with provider for administration limits for heart rate and bloodpressure
client teaching: take pulse or blood pressure before administrationf. type: combined alpha and beta-adrenergic blocking agents
i. action: blocks all SNS receptors and inhibits release ofepinephrine (Epi) andnorepinephrine (NE) resulting in decreased vasoconstriction, slower heart rate,and increased renal perfusion
ii. examples
carvedilol (Coreg 6.25-25 mg twice daily by mouth, increase dose in 2weeks intervals)
labetalol (Normodyne 400-800 mg 2-3 times daily by mouth)
guanethidine (Ismelin 25-50 mg daily by mouth)iii. uses: heart failure, HTN secondary to renal failure, refractory HTNiv. adverse effects
cerebrovascular accident (CVA), bronchospasm,pulmonary edema
serious dysrhythmias when combined with CCBs
masks signs of hypoglycemia
impaired peristalsis, decreased exercise tolerance
v. contraindications: heart block, acute asthma, DM, and shockvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents)
establish baseline data and monitor for heart block, bronchospasm,pulmonary edema, and liver failure
taper dose before discontinuingg. type: alpha-adrenergic blocking agents
i. action: non-selective blocker of alpha-adrenergic receptors (of SNS)ii. examples: phentolamine (Regitine 5 mg IV bolus, then 0.5-1 mg/min;
subcutaneously 5-10 mg)
iii. uses: HTN associated with pheochromocytoma, extravasation of epinephrineand dopamine
iv. adverse effects
angina and myocardial infarction (MI), CVA, profoundhypoglycemia
nausea, vomiting, and diarrhea
v. contraindications: coronary artery disease (CAD) and MI
vi. nursing care potentiated by alcohol; suppressed with epinephrine and ephedrine
h. type: alpha1-blocking agentsi. action: blocks alpha1-receptors of SNSii. examples
prazosin (Minipress 6-15 mg by mouth daily in divided doses, not toexceed 40 mg in divided doses)
terazosin (Hytrin 1-5 mg by mouth daily in 2 doses, not to exceed 20mg daily in 2 doses)
tamsulosin (Flomax 0.4-0.8 mg by mouth daily after meals)
iii. uses: hypertension, benign prostatic hypertrophy (BPH)
iv. adverse effects: angina, priapism, headache, peripheral edemav. contraindications: hepatic and renal failure; do not take with sildenafil (Viagra)
or tadalafil (Cialis)vi. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents): provide small frequent meals to manage GI discomfort
i. type: alpha2- agonistsi. action: displaces NE and stimulates alpha2-receptors of SNS resulting in
decreased release of norepinephrine in the peripheryii. example: clonidine (Catapres 0.1-0.6 mg by mouth (twice daily), transdermal
daily over 1 week)iii. uses: HTN, chronic pain related to canceriv. adverse effects
bradycardia
dry mouth, sedation
nausea, vomiting, anorexia, headache, urinary retention
v. contraindications narrow-angle glaucoma
vasospastic disease
thyrotoxicosis or DMvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive
agents)
taper dose before discontinuing
do not discontinue before surgery
do not administer with tricyclic antidepressants or propranololj. type: centrally acting vasodilators
i. action: directly relaxes arteriolar vascular smooth muscle resulting in loweredperipheral vascular resistance and reflex tachycardia
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ii. example: hyrALAZINE (Apresoline 200-300 mg by mouth daily divided in 4doses) (do not confuse with hydrOXYzine)
iii. uses: acute hypertension associated with pregnancy, essential hypertensioniv. adverse effects
shock, myelosuppression, reflex tachycardia, angina
headache, tremors, dizziness, peripheral neuritis
anorexia, paralytic ileus, rash, nasal congestion, flushingv. contraindications: maternal bleeding, CAD, mitral valve diseasevi. nursing care
establish baseline data and monitor FHTs, maternal blood pressure,
heart rate, EKG, breath sounds, CBC, weight, edema administration
o give orally with food
o hypertension in pregnancy: given IV bolus, monitor vital signs
every 15 minutes
client teachingo report chest pain, severe fatigue, muscle or joint pain
o avoid OTC drugs
o change positions slowly
vii. type: diuretics (See also: II.H.1 diuretics)5. Antilipid agents
i. type: bile acid sequestrants
ii. action: bind with bile acid in small intestine leading to decreased absorption
and increased excretion of fat in stooliii. example: cholestyramine (Questran 4-20 grams by mouth once or twice daily)
iv. uses: in combination with low fat diet to lower serum lipids, primaryhypercholesterolemia, and elevated low-density lipoprotein (LDL)
v. adverse effects
increased bleeding time
headache, nausea, constipation
decreased absorption of fat-soluble vitaminsvi. contraindications
bleeding disorders, biliary obstruction
post-cholecystectomy, abnormal bowel functionvii. nursing care
bowel sounds administering, serum lipids, bowel pattern, bleeding
prevent constipation, monitor: vitamin deficiency and increasedbleeding times
administrationo do not crush or chew tablets
o give with food; do not administer in dry form
o administer 1 hour before or 4-6 hours after thiazide, diuretics,
digoxin, warfarin, thyroid hormone, or glucocorticoids
client teachingo must take with food
o report bleeding, muscle pain
o prevent constipation with increased fluids, fiber, and physical
activityc. type: HMG-COA reductase inhibitors (statins)
1. action: controls final step in cholesterol formation by blocking formation of cellular
cholesterol leading to decreased serum cholesterol and slightly increased high-densitylipoproteins (HDL)
2. examples
atorvastatin (Lipitor 20-40 mg by mouth daily)
simvastatin (Zocor 5-10 mg by mouth daily at bedtime)
rosuvastatin (Crestor 5-10 mg by mouth daily)
2. uses: hypercholesterolemia, arteriosclerosis , and DM in combination with low-fat diet and exercise3. adverse effects
increased risk of rhabdomyolysis when given witherythromycin, cyclosporine, antifungal agents, and otherantilipid drugs, and with higher doses
cataracts, liver and renal dysfunction
flatulence, abdominal cramping, nausea, and vomiting increases estrogen level when taking oral contraceptives
increased risk of toxicity when given with digoxin or warfarin4. contraindications
alcoholism, allergy to fungus
active liver disease, impaired endocrine function5. nursing care
establish baseline data and monitor liver and renal function tests,LDLs, HDLs, muscle pain, vision
administer at bedtime, may take with food
client teachingo promptly report vision changes, muscle pain
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o monitor for bleeding, dark urine, and dark stool
o maintain regular follow-up care and testing
o most effective when combined with lifestyle changes including
low-fat diet, weight loss, high-fiber diet, and exercise
c. type: fibrates
action: decreases synthesis of hepatic LDLs and cholesterol
exampleso clofibrate (Atromid-S)
o gemfibrozil (Lopid 600 mg by mouth twice daily)
uses: familial hypercholesterolemia not responding to diet and othertherapy
adverse effects: rhabdomyolysis
contraindications: concomitant use with statins
nursing careo establish baseline data and monitor serum lipids, muscle pain,
LFTs, RFTsd. type: niacin
action: inhibits release offatty acid from adipose tissue, improvesremoval oftriglycerides from plasma
example: niacin (Niaspan 1-2 grams three times daily)
uses: hyperlipidemia not responding to diet and weight loss
adverse effectso increases serum uric acid levelo intense cutaneous flushing, nausea, and abdominal pain
nursing careo establish baseline data and monitor serum lipids, uric acid,
joint paino give at bedtime
o often combined with bile acid sequestrants, but administer 4-6
hours after the bile acid sequestrantse. type: LDL absorption inhibitors
i. action: inhibits absorption of lipids from small intestinesii. example: ezetimibe (Zetia 10 mg by mouth daily)iii. uses: to decrease serum levels of cholesterol, LDLs, and triglycerides, and to
increase HDLs in hypercholesterolemiaiv. adverse effects
sinusitis, muscle and back pain
abdominal pain, diarrhea
effect greatly increased when given with cyclosporinev. contraindications: liver disease or unexplained increase in LFTsvi. nursing care
establish baseline data before initiating therapy and monitor duringtreatment: LFTs, lipid levels, muscle pain, bowel pattern
do not give with HMG-COA reductase inhibitors (statins)
client teachingo take with or without food
o most effective when combined with low-fat diet and weight
loss6. Antiplatelet agents
a. type: aspirinvii. action: inhibits prostaglandin formationviii. examples: acetylsalicylic acid (Bayer 81325 mg by mouth daily)
ix. uses: prophylaxis against ischemic attacks in brain and heart, to decrease riskof death or MI in clients with angina; also classified as antipyretic, non-steroidal anti-inflammatory drug (NSAID), and analgesic
x. adverse effects
bleeding and bruising, tinnitus, GI upset and erosion
hemolytic anemiaxi. contraindications
asthma, sensitivity to other NSAIDs
history of GI bleeding, bleeding disorders
within 10 days of invasive procedure or surgery
children
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o take with plenty of fluids
b. type: adenosine diphosphate inhibitor
i. action: inhibits platelet aggregation by preventing adenosine diphosphatebinding to platelet receptor
ii. example
clopidogrel (Plavix 75 mg by mouth daily)
ticlopidine (Ticlid 250 mg by mouth twice daily with food)iii. uses: secondary prevention of MI, CVA, and unstable angina; established PVDiv. adverse and side effects
myelotoxicity, thrombotic thrombocytopenic purpura chest pain,edema, HTN
flu-like findings, headache, dizziness, rash
epistaxisv. contraindications
closed head bleeding or injury
history of bleeding or bleeding disordervi. nursing care
establish baseline data and monitor platelet count, lipids
discontinue 7-10 days before surgery
protect medication from light
client teachingo increased bleeding effect with anticoagulants, NSAIDs,
feverfew, garlic, ginger, and ginkgoc. type: non-nitrate vasodilator (See also: II.A.10 vasodilators)
7. Diruetics (Additional Information diuretics II.H.1)8. Positive inotropes: improve myocardial contractility and cardiac output
a. type: cardiac glycoside
i. action: slows A-V conduction, improves cardiac output, and improvesmyocardial contractility
ii. example: digoxin (Lanoxin 0.125-0.25 mg by mouth daily)
iii. uses: heart failure, ventricular rate control in atrial fibrillation (a fib) and atrialflutter (a flutter)
iv. adverse effects
bradycardia, heart block,dysrhythmias
xanthopsia, muscle weakness
nausea, vomiting, diarrhea, and anorexiav. contraindications
ventricular fibrillationVentricular Fibrillation
Ventricular Tachycardia
heart block
hypokalemiavii. nursing interventions
establish baseline data and monitor heart rate, intake and output,serum potassium
check if heart rate is within parameters established by provider,usually >50 bpm
monitor for toxicityo therapeutic range 0.8 to 2.0 ng/ml
o pediatrics: dysrhythmias
o adults: visual disturbances, nausea and vomiting, anorexia
o older clients: higher risk of toxicity
client teachingo take medication as prescribed
o avoid St. Johns Wort, licorice, ginsengo take heart rate daily before administration
o perform daily weight: report > 2 pound increase in 24 hours
o finding recognition: irregular pulse or change in rhythm, heart
rate < 60 bpm2. type: phosphodiesterase inhibitor
vi. action: blocks action of phosphodiesterase leading to increased myocardialcontractility and vasodilation, increased myocardial oxygen consumption, anddysrhythmias
vii. examples: inamrinone (Inocor) and milrinone (Primacor)viii. uses: IV therapy for heart failure unresponsive to digoxin, diuretics, and
vasodilators; bridge to transplantation
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ix. adverse effects
lethal ventricular dysrhythmias
chest pain, hypotension
nausea, vomiting, anorexiax. contraindications
acute MI, hypovolemia, severe heart valve disease
allergy to bisulfitesxi. nursing care
establish baseline data and monitor vital signs and (EKG), platelets,fluid balance, BNP
administration: protect drug from light, administer in large borecatheter
client may be maintained on therapy at home
client teachingo establish reliable emergency response for cardiac arrest,
unstable angina, syncope, or change in level of consciousness(LOC)
o long-term IV therapy
9. Thrombolytics
a. action: binds with plasminogen to dissolve thrombi (clots) in coronary arteries within 4to 6 hours ofmyocardial infarction. Activated conversion of plasminogen to plasmin.Plasmin is able to break down clots (fibrin).
b. examples
i. streptokinase (Streptase)ii. urokinase (Abbokinase)
c. usesi. myocardial infarction
ii. deep venous thrombosis
iii. pulmonary embolismiv. thrombosed intravenous catheters
d. contraindicationsi. CNS neoplasmsii. active bleeding or severe hypertensioniii. cerebral embolism, thrombosis, hemorrhageiv. recent arterial diagnostic procedure or surgeryv. recent major surgery, trauma, invasive spinal procedures
e. adverse side effects
i. bleedingii. reperfusion injury, dysrhythmias
iii. allergic reactions: urticaria, itching, flushing headachef. nursing interventions
i. monitor CBC, coagulation studies, and hypersensitivityii. monitor for bleeding (overt and occult, abdominal girth)
iii. keep available: aminocaproic acid (fibrinolysis inhibitor)iv. avoid IM injections prior to administrationv. monitor neurological status, reperfusion injury, and dysrhythmia
10. Vasodilatorsa. type: non-nitrate
i. action: coronary artery vasodilation with action similar to papaverine;antiplatelet properties and mild positive inotrope
ii. example: dipyridamole (Persantine 225-400 mg by mouth in 3-4 doses daily)iii. uses
reduce need for nitrates
peripheral vascular disease (PVD)
adjunct for thallium stress test
prevention of postoperative thromboembolic complicationsiv. adverse effects: usually dose related; headache, dizziness, peripheral
vasodilation, nausea, and vomitingv. nursing care
establish baseline therapy and monitor blood pressure
therapeutic effect may take 2-3 months to appear
client teaching: change positions slowlyb. type: peptide hormone, synthetic
i. action: inhibits anti-diuretic hormone (ADH) to increase urine output and
relaxes vascular smooth muscleii. example: beta-natriuretic hormone, nesiritide (Natrecor 0.1 mcg/kg/min titrate
to cardiac output)iii. adverse effects
hypotension, dysrhythmias
insomnia, dizziness, confusion
fever, abdominal pain, pruritus, rashiv. contraindications
cardiogenic shock or PAP, PCWP
cardiac tamponade or constrictive pericarditisv. nursing care
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establish baseline data and monitor vital signs, PCWP, cardiac output,fluid and electrolyte balance, and urine output continuously duringtherapy
monitor serum creatinine
extremely expensive, made from recombinant DNA
solution is extremely dilute; very carefully calculate mcg/kg/min;requires loading dose
c. type: nitrate (See also: II.A1.a antianginal agents)d. type: calcium channel blockers (See also: antihypertensives II.A.4.d)
11. Vasopressors
a. type: alpha- & beta-adrenergic agonists, sympathomimetic agents
i. action: increases heart rate, vasoconstricts peripheral vessels to increaseblood pressure, and dilates renal and splanchnic vessels to improve perfusionvia stimulation of sympathetic nervous system; opposite action of alpha- orbeta-blockers>
ii. examples
dopamine hydrochloride, seeAgents used as vasopressors (Intropin0.5-10 mg/kg/min IV titrated to blood pressure)
norepinephrine bitartrate (Levophed 2-30 mcg/min IV titratedaccording to blood pressure and vasoconstriction)
epINEPHrine (Adrenalin 1 mg IV bolus every 3-5 minutes in cardiacarrest) (See also: bronchodilators: epINEPHrine II.B.1)
iv. uses: improve cardiac output and perfusion of vital organs in shock states and
profound hypotensionv. adverse effects
angina, dysrhythmias, vasoconstriction, necrosis
impairs glucose metabolism (epi)
nausea, vomiting, headache
disproportionate increase in diastolic blood pressurevi. contraindications: pheochromocytoma, PVD, hypovolemia, tachydysrhythmiasvii. nursing care
establish baseline data and monitoro blood pressure, heart rate, and rhythm every 15 minutes
o peripheral perfusion, urine output, chest pain
infuse in central venous catheter with infusion pump, protect infusionfrom light
solution is very dilute (epi): carefully calculate dosage, based onmcg/kg of body weight/minute
antidote for extravasationo stop infusion and remove IV tubing
o phentolamine mesylate 10-15 ml subcutaneously into affected
tissuec. type: beta-agonist, sympathomimetic agent
action: selectively stimulates cardiac beta1-adrenergic receptors;primarily increases cardiac output; increases blood pressure withoutconcomitant increase in heart rate
exampleo dobutamine hydrochloride (Dobutrex 2.5-15 mcg/kg IV titrated
to blood pressure, cardiac output)o isoproterenol (Isuprel 2-6 mcg/kg IV titrated to blood pressure
and heart rate) uses: cardiogenic shock, preparation for pediatric cardiac
catheterization
adverse effectso HTN, tachydysrhythmias, vasoconstriction
o angina, nausea, vomiting
contraindications: tachydysrhythmias, idiopathic subaortic stenosis
nursing careo establish baseline data and monitor cardiac output, peripheral
perfusion, urine output, chest paino monitor blood pressure, heart rate, and rhythm every 15
minuteso control with infusion pump: carefully calculate dosage based
on mcg/kg of body weight/minuteo infuse in central venous catheter
o antidote for extravasation: stop infusion, remove IV tubing
o increased risk of peripheral vasoconstriction when given with
beta-adrenergic blockersc. type: alpha-agonist
action: direct stimulation of SNS resulting in vasoconstriction
example: phenylephrine (Neo-Synephrine 100-180 mcg IV, may repeatinitial dose every 10-15 minutes)
use: profound hypotension
adverse effectso dysrhythmias, tachycardia, gangrene, anaphylaxis
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o headache, dizziness, weakness, anxiety, tremor
o insomnia, nausea, vomiting
contraindicationso narrow-angle glaucoma, pheochromocytoma
o ventricular fibrillation, tachydysrhythmias, HTN, peripheral
vascular disease
nursing careo establish baseline data and monitor blood pressure, heart rate,
EKG, urine output, fluid volume status, ventricular fillingpressures
B. Managing respiratory conditions
1. Bronchodilatorsa. information common to bronchodilators
i. action: most effective agents are short-acting beta adrenergic agonists causingdirect relaxation of bronchial smooth muscle
ii. nursing care
encourage smoking cessation therapy
establish baseline data and monitor throughout therapyo breath sounds, oxygen saturation (SaO2)
o vital signs and EKG
iii. client teaching
report worsening findings
avoid caffeine and OTC drugs
eat small, frequent meals to ameliorate GI upset take medication only as directed; do not take extra doses
client teaching: use of delivery method: oral, meter-dose inhaler (MDI),nebulizer
b. type: adrenergic agonist (sympathomimetic)i. action
stimulates and enhances SNS effects to relax bronchial smooth muscle
may increase rate and depth of respirations
inhibits release of inflammatory mediators (short-term effect)ii. examples:
short-actingo type: alpha1- and beta2-adrenergic agonists, non-selective
adrenomimetic
1. epINEPhrine (Adrenalin, Primatene Mist*) (See also:II.A.11.a vasopressors: alpha- & beta-adrenergicagonists, sympathomimetic)
2. isoproterenol (Isuprel) (See also: II.A.11.bvasopressors: beta-agonist, sympathomimetic agents)
3. terbutaline** (Brethine)4. ritodrine (Yutopar) (See also: III.C.2.b.2 tocolytic
agents)o type: beta2-adrenergic agonists, selective adrenomimetic
1. albuterol **(Proventil 2 inhalations via metered-doseinhaler every 4-6 hours) (See also: I.D.5.a metered-dose inhaler)
2. metaproterenol** (Alupent)3. levalbuterol (Xopenex 0.63-1.25 mg via nebulizer every
6-8 hours) long-acting
o salmeterol (Serevent 50 mcg inhaled as dry powder every 12
hours)iii. uses
acute bronchospasm, anaphylaxis (epi)
asthma, chronic bronchitis, and COPD
prophylaxis for exercise-induced asthmaiv. adverse effects
desired effect lost when dose exceeds therapeutic level leading too angina, dysrhythmia, increased myocardial oxygen
consumptiono hypertension, peripheral vasoconstriction,hypoperfusion to
non-vital organso *associated with tachydysrhythmias, hypertension,
death
impaired glucose metabolism (epi)
tremor, nervousness, insomniav. contraindications
peripheral vascular disease (PVD)
diabetes mellitus,hyperthyroidism
unstable angina, hypertension, cardiac diseasevi. nursing care
establish baseline data and monitor breath sounds, SaO2 and vitalsigns
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** available in oral therapy
small frequent meals to ameliorate nausea, vomiting, anorexia
client teachingo take before other inhaled medications and 30-60 minutes
before exerciseo report chest pain or palpitations
o avoid OTC drugs, stimulants including caffeinated beverages
and dark chocolate, Primatene Mist (may result in death)c. type: xanthines
i. actions
stimulates the SNS: acts directly on bronchial smooth muscle to dilateairways and on medulla in brainstem to increase rate and depth ofrespirations
inhibits release of inflammatory mediators in anaphylaxisii. examples
caffeine
aminophylline (Truphylline up to 13 mg/kg or 900 mg/day given in 3doses)
theophylline (Slo-bid)iii. uses: bronchospasm, asthma, COPD, chronic bronchitis, anaphylaxisiv. adverse effects
respiratory arrest, hypotension and seizures indicative of toxicity
dizziness in older clients
palpitations, dysrhythmias nausea, anorexia, vomiting, insomnia, nervousness, headache
v. contraindications
CAD and heart failure
ischemic cardiomyopathy
severe liver or kidney diseasevi. nursing care
monitor drug levels: has narrow therapeutic range at 10-20 mcg/ml
do not exceed administration rate of 20 mg/min
dilute in 5% dextrose in water
less effective with smoking and St. Johns Wort
client teachingo maintain consistent diet
o avoid charcoal-broiled foodo take at the same time everyday
o drink plenty of caffeine-free beverages
d. type: anticholinergici. action
blocks muscarinic receptors, Ach release, and stimulation ofvagusnerve
results in bronchodilation, diminished secretions, low CNS effect
less inhibitory effect on mucociliary clearance
parasympatholytic, acts like atropine sulfateii. examples
ipratropium bromide (Atrovent, inhaler 1-4 inhalations 3-4 times daily,not to exceed 24 inhalations in 24 hours)
tiotropium bromide, long duration of action (Spiriva, inhaler 18 mcgdaily)
iii. uses
COPD
prophylaxis for bronchospasm; maintenance therapy for chronicbronchitis; allergic rhinitis
not rescue therapy, less effective for asthmaiv. adverse effects
worsening ofnarrow-angle glaucoma
dry mouth, blurred vision, constipation, urinary retention, coughv. contraindications
narrow-angle glaucoma
acute bronchospasm
vi. nursing care establish baseline data and monitor urine output
client teachingo not for use in acute bronchospasm
o wait 5 minutes before administering other inhaled medications
or as directed by providero wait 30-60 seconds between puffs, rinse mouth after each
treatment
2. Mucolytics and expectorantsa. mucolytics
i. action: thins respiratory secretions by splitting disulfite bonds in secretions;mobilizes secretions
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ii. type: acetylcysteine (Mucomyst 70 mg/kg every 4 hours for 18 doses)iii. uses
clients having difficulty with mobilizing and coughing up secretions
COPD, cystic fibrosis, pneumonia
acetaminophen overdoseiv. adverse effects
GI upset
stomatitis, rash, bronchospasmv. contraindications
acute bronchospasm, esophageal varices
peripheral vascular diseasevi. nursing care
as mucolytics: give by nebulizer
as antidote for acetaminophen poisoning: direct instillation, dilute withsterile water for injection
most effective when combined with adjunct therapy: encourageambulation plus coughing and deep breathing
b. expectorantsi. action: liquefies respiratory secretions by decreasing the surface tension
ii. type: guaifenesin (Robitussin 200-400 mg by mouth every four hours)iii. uses
clients having difficulty mobilizing and coughing up secretions
dry, nonproductive cough common cold, acute bronchitis, influenza
iv. adverse effects
low side effect profile
GI upset, allergy, headachev. nursing care
identify and resolve etiology of cough
establish baseline data and monitor appearance and amount ofsecretions
most effective when combined with adjunct therapy: encourageambulation, coughing and deep breathing
client teachingo guaifenesin found in many OTC combination products: avoid
using combination products for expectoranto must be given with plenty of water to be effective
o avoid dairy products and caffeinated beverages
3. Antitussive
a. type: narcotic [opioid]
i. action: cough suppression by depression of cough center in medulla ofbrainstem, similar to morphine; moderate histamine releasing action
ii. example
codeine 30-60 mg by mouth every 4-6 hours
hydrocodone bitartrate (Vicodin 5 mg by mouth every 4-6 hours)iii. uses
gold standard for cough suppression
cough due to pharyngitis, sinusitis, and pneumonia
analgesia, analgesia for head injuries, cranial surgeryiv. adverse effects
dizziness, dependence
sedation, over-stimulation
constipation, nausea, rash
increased viscosity of secretions
respiratory depression (weakest of the opioids)v. contraindications
clients who need to cough: asthma, postoperative thoracic surgeriesvi. nursing care
establish baseline data and monitor level of consciousness, respiratoryrate, bowel movements, temperature
provide adjunct therapy to relieve cough: expectorants, fluid,
humidification, lozenges client teaching
o take only as directed
o change positions slowly; ask for help before getting up and
avoid dangerous activities until full effects of treatment arewell established
o take with food to avoid nausea
o drink fluids, increase fiber in diet, ambulate, and establish
personal bowel habits to prevent constipationb. type: non-narcotic
i. benzonatate
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action: cough suppressant without suppression ofrespiratory center attherapeutic doses; acts like tetracaine hydrochloride
example: benzonatate (Tessalon 300-600 mg by mouth three timesdaily)
uses: acute and chronic respiratory condition to decrease frequencyand intensity of cough
adverse effectso low side effect profile
o drowsiness, sedation headache
o nausea, constipation, rash
nursing careo establish baseline data and monitor appearance and amount of
secretionso client teaching
1. swallow soft capsules whole: if dissolves in the mouth,may suppress gag reflex
2. store capsules in air tight container
ii. dextromethorphan
action: cough suppression by depressing the medulla; in therapeuticdoses comparable to codeine but without CNS depression andanalgesia, much less likely to cause constipation, drowsiness, or GIupset
examples: dextromethorphan hydrobromide (Benylin DM, Robitussin
DM up to 120 mg/day in divided doses) uses: temporary relief of cough spasms in nonproductive coughs
adverse effectso GI upset, constipation
o dizziness and drowsiness, especially in older clients
o hyperexcitability, especially in children
contraindications: children < 2 years-old, asthma, productive cough,hepatic dysfunction
nursing careo humidify air
client teachingo report cough lasting > 7-10 days
o do not crush or chew extended release forms
o avoid irritants, should not completely suppress cougho do not overdose dextromethorphan by taking combination
product4. Type: antituberculosis agents
a. general antituberculosis agents
i. actions: bacteriostatic or bactericidal anti-infective agents for treatmentofMycobacterium tuberculosis infection
ii. examples
first-line therapy
second-line therapy
iii. use: used in combination with other antituberculosis agents; none indicated formonotherapy
iv. adverse effects
hepatotoxicity, nephrotoxicity , myelosuppression
nausea, vomiting, anorexia, abdominal pain
many drug-drug interactions with other therapies and antituberculosisagents
v. contraindications
hepatic or renal dysfunction
seizure disorder and neuritisvi. nursing care
establish baseline data and monitoro sputum cultures, liver function tests (LFT)
o CBC, PT
o BUN and creatinine (RFTs)
review drug-drug interactions for incompatibility
M. tuberculosis eradicated after three negative sputum cultures in arow
o client teaching
1. report- worsening symptoms, return of fever- rash, decreased urine output, edema, weight gain- dyspnea, hallucinations,jaundice
o avoid alcohol
o take as directed with plenty of fluids
o change positions slowly when altering dosages
o duration of therapy months to years; need for long-term care
and follow-up testing
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o continue taking antituberculosis therapy until instructed to
stop; continue therapy when feeling good and whennoncontagious
b. first-line therapy
i. isoniazid (INH 15 mg/kg up to 900 mg by mouth, IM 2-3 times weekly)
action: bacteriostatic agent that interferes with DNA ofM. tuberculosis
use: highly specific treatment for tuberculosis infection; usuallyincluded in antituberculosis pharmacotherapy
adverse effectso agranulocytosis
o visual disturbances, connective tissue syndromes
o paresthesias and peripheral neuropathy
o impaired vitamin absorption and glucose metabolism
contraindication: acute liver dysfunction
nursing careo establish baseline data and monitor blood sugar
o administer on empty stomach, 1 hour before or 2 hours after
meals; may give by deep IM injectiono client teaching
1. monitoring blood sugar2. avoid foods with histamine: skip-jack tuna, sauerkraut
juice, yeast extract3. report tingling, numbness, or burning of extremities:
may indicate toxicity4. avoid foods with tyramine: aged cheese, cured meat,
smoked fish
ii. rifampin (Rifadin 10 mg/kg by mouth, IV 2-3 times weekly)
action: inhibits RNA synthesis in M. tuberculosis
adverse effectso hepatorenal syndrome
o pseudomembranous colitis, heartburn
contraindicationso meningococcal disease
o obstructive biliary disease
o intermittent therapy with rifampin: significantly increases risk
of developing drug resistant organisms and hepatorenal
syndrome nursing care
o monitor PT
o use oral form for pediatrics
o client teaching
report bleeding or bruising
do not interrupt prescribed drug regimen
benign staining of excreted body fluids and stooliii. ethambutol (Myambutol 15-25 mg/kg by mouth 2-3 times weekly)
action: inhibits RNA synthesis
adverse effects: anaphylaxis, color blindness, retrobulbar neuritis
contraindication: optic neuritis
nursing care
o encourage regular eye examso establish baseline data and monitor uric acid level
o optic toxicity appears within first 7 months of therapy; usually
disappears after therapy is discontinuedo client teaching
report decreased urine output, edema and weight gainiv. streptomycin (See also: II.K.5.b.1 antibiotics: aminoglycosides)(Streptomycin 1
gram IM 2-3 times weekly)d. second-line therapy
1. ethionamide (Trecator-SC)
action: bacteriostatic and bactericidal
use: in combination with other antituberculosis therapy when first-lineagents have failed
adverse effectso exfoliative dermatitis
o heartburn, stomatitis, diarrhea
o impaired glucose metabolism
contraindicationso hypersensitivity to ethionamide, isoniazid, and niacin
o severe liver dysfunction
client teachingo promptly report skin rash
o take with food to decrease GI upset
o may take as single dose before bedtime
2. pyrazinamide
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3. cycloserine (Seromycin)4. aminoglycoside antibiotics (See also: II.K.5.b.1 antibiotics:aminoglycosides)
2. Anti-inflammatory agents (used in respiratory conditions; available as inhalants)a. glucocorticoid (inhaled)
1. actions
inhibits phagocytosis
reduces capillary permeability
stabilizes leukocyte membrane
decreases release of inflammatory mediators2. examples
flunisolide (Nasalide 2 metered-dose inhalations twice daily)
fluticasone propionate (Flovent 88-440 mcg/spray inhalations twicedaily)
triamcinolone acetomide (Azmacort 55 mcg/spray, 2 inhalations 3-4times daily)
beclomethosone dipropionate (Vanceril 84 mcg/spray, 1-2 inhalations2-4 times daily)
3. uses
long-term prophylactic treatment for asthma
bronchial asthma not responding to conventional therapy
preferred long-term therapy for adults and children with persistentasthma
adverse effects (same side effect profile as oral or IV therapy, muchless likely to occur with inhaled therapy)
hypothalamic-pituitary-adrenal axis suppression, opportunisticinfections, impaired healing, increased skin fragility, impairedglucose metabolism and hypokalemia
nausea, vomiting, PUD
insomnia, confusion, psychosis
muscle wasting, osteoporosis, cataracts, Cushing's disease, fluidretention
4. contraindications
renal dysfunction
prolonged pediatric therapy
immunosuppression, active respiratory infection
5. nursing care establish baseline data and monitor
o weight, blood pressure, infection
o blood sugar, renal function
collaborate with dietitian and provider to manage fluid retention,hyperglycemia, and hypokalemia
client teachingo not rescue therapy: not indicated for acute asthma or allergic
attack
therapeutic effect takes 1-2 weeks
be prepared for acute asthma attacko report infections and fever, worsening findings
o low-sodium diet, blood glucose testing
o avoid sick people, wash hands frequentlyo meal planning for daily calorie restrictions
o rinse mouth after treatment to avoid Candida albicans
overgrowth (thrush)d. type: mast cell stabilizer
action: inhibits release of histamine and slow reacting substance ofanaphylaxis (SRS-A) but without antihistaminic properties
exampleso cromolyn sodium (Nasalcrom 5.2 mg sprays, 1 inhalation each
nostril 3-4 times daily)o nedocromil sodium (Tilade 1.75 mg sprays, 2 sprays each
nostril 2-3 times daily)
uses: prophylactic treatment of asthma, allergic rhinitis, conjunctivitis;not for use with acute asthma
adverse effectso angioedema
o dry mouth, bitter aftertaste
o nasopharyngeal irritation
o nausea, transient ocular stinging
contraindicationso acute asthma
o aerosol administration in clients with CAD or dysrhythmias
nursing careo establish baseline data and monitor breath sounds, SaO2,
secretions
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o stop treatment with angioedema or bronchospasm
o pediatric dose with MDI: usually one-half of adult dose
o asthma findings may increase while tapering hydrocortisone
therapyo client teaching
not rescue therapy: not indicated for acute asthma orallergic attack
1. therapeutic effect takes 1-2 weeks2. be prepared for acute asthma attack
may stain soft contact lenses
use of inhaler or drug delivery device
does not eliminate need for other therapies
minimize throat irritation by following treatment withsips of water, lozenges
e. type: leukotriene-receptor antagonists
action: selectively interferes with leukotrienes to inhibit bronchospasmand airway edema
exampleo zafirlukast (Accolade 20 mg by mouth daily)
o montelukast (Singular 10 mg by mouth daily)
uses: prophylaxis against asthma and exercise induced asthma
adverse effectso fever, headache
o Churg-Strauss syndromeo generalized pain, back pain
contraindication: acute asthma
nursing careo establish baseline data and monitor breath sounds, SaO2,
respiratory rate, liver functiono administer 1 hour before or 2 hours after meals
o client teaching
take on regular basis: missing a dose may result in alapse in therapeutic effect
report flu-like findings, worsening condition, jaundice,dark urine or stool
6. Antihistamines (See also antihistamines II.K.2)
a. type: first generation antihistamines (for respiratory tract)i. action: potent H1 receptor antagonist (histamine blocking agent) to block the
effects ofhistamineii. example: azelastine
Optivar 2 sprays per nostril twice daily
iii. uses: seasonal allergic rhinitis, itching eyes associated with seasonal allergiesiv. adverse effects
drowsiness, fatigue
bitter taste
headache, rhinitis
dry mouth, nausea
v. contraindications: concurrent use ofCNS depressantsvi. nursing care
establish baseline data and monitor upper respiratory systemcongestion; drowsiness; reddened, itchy eyes, other clinical indicatorsof hypersensitivity
prime delivery unit before dispensing
client teachingo avoid
alcohol
getting nasal spray in eyes
driving, dangerous activity until adverse effects arewell-established
o blow nose before instillation: tilt head forward slightly and sniff
gentlyb. type: second generation antihistamines
i. action: blocks effects of histamine by blocking H1 receptor and mast cellrelease of inflammatory mediators
ii. examples
loratadine (Claritin)
fexofenadine (Allegra)
desloratadine (Clarinex)iii. uses: relief from itchy, watery eyes, nasal congestion, and runny nose due to
allergic rhinitis
iv. adverse effects: flu-like findings, drowsiness, dizziness, dry mouth,dysmenorrhea
v. contraindications: renal or hepatic impairmentvi. nursing care
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