drugs fall 2014_ppt

8/10/2019 Drugs Fall 2014_ppt

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DRUGS FALL 2014

Pharm List


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ACETAMINOPHEN (TYLENOL)-NON-NS

Drug class: non-opiod analgesic, antipyretic

Mechanism of action: blocks peripheral pain stimuli by inhibiting prostagdirect action on hypothalmus to reduce body temperature

Adult dose: 650-1000 mg by mouth or PR every 6 hours as needed for pa

Infants: dose dependent on age/ weight; given by mouth

Antipyretic of choice in infants and children


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Indications: mild to moderate pain, fever

Contraindications: allergy, severe liver disease, genetic G6PD deficiency

Pregnancy and breast feeding: Category B

Crosses placenta and breast milk; no adequate, well controlled studies

Adverse effects (rare): rash, nausea, vomiting

Drug interactions: other hepatotoxic drugs, alcohol


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Toxicity and overdose: Adults should NOT take more than 3000 mg daily

Liver necrosis, kidney problems

Blood test for acetaminophen level

Half life: 1-4 hours

Onset of action: 10-30 minutes Peak: 30 min -2 hours

Duration: 3-4 hours


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Antidote for OD: acetylcysteine (Mucomyst) Prevents hepatic metabolites from forming

Loading dose of 140 mg/kg by mouth

70mg/ kg every four hours for a total of 17 doses

If the patient vomits within an hour of a dose, then the dose should be re


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ACETYLSALICYLIC ACID (ASPIRIN)-NSA

Drug class: salicylate (acetylated NSAID), antipyretic, prophylaxis againsdisease and stroke

Mechanism of action: block prostaglandins that contribute to inflammatand fever

Adult dose: 81- 325 mg daily to prevent heart disease, 650 mg every fourpain or fever

Infants and Children: associated with progressive neurological deficits lecoma- Reyes syndrome. Only recommended for adults


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Indications: mild to moderate pain, inflammation, fever

Contraindications: drug allergy, bleeding problems, pregnancy, renal or hdisease

Adverse effects: heartburn, stomach upset, gastrointestinal bleeding

Drug interactions: Alcohol and anticoagulants increase risk of bleeding, d

bind protein (dilantin) amy increase therapeutic response, NSAIDS may effectiveness of diuretics (water pills)


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Nursing implications: take with food, monitor for bleeding

Half life: 5-9 hours

Onset of action: 15-30 minutes

Peak: 45 minutes to 3 hours

Duration: 3-4 hours


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Pregnancy Category C (first and 2ndtrimester: adverse effect on animal fevaluate risks/benefits), D (3rdtrimester): dont use Salicylate (aspirin) to

Chronic salicylate intoxication

Symptoms: increased pulse, tinnitus, hearing loss, poor vision, dizziness, menconfusion, weakness (lassitude), drowsiness, sweating, thirst, breathing fast (normalize blood pH), high or low blood sugar, low blood pressure

Metabolic acidosis Acute salicylate toxicity

From a single large dose

Same as above, but happens acutely


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Salicylate level Treatment of Salicylate (aspirin) toxicity

Treatment goals: reduce absorbtion (charcoal, lavage)

Treat fluid and electrolyte imbalance

Metabolic acidosis

Support blood pressure with IV fluids

Support breathing (may need ventilator)

Hemodialysis


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IBUPROFEN (MOTRIN, ADVIL)-NSAID

Drug class: nonsalicylate NSAID, antipyretic

Mechanism of action: same as aspirin

Indications: mild to moderate pain, inflammation, fever

Pregnancy Category B (D in third trimester)

Contraindications: drug allergy, bleeding problems, pregnancy, renal or hdisease

Adverse effects: heartburn, stomach upset, gastrointestinal bleeding, inccardiovascular risk, renal failure


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Drug interactions: Alcohol and anticoagulants increase risk of bleeding, dbind protein (dilantin) may increase therapeutic response, NSAIDS may effectiveness of diuretics (water pills)

Pregnancy category: B (1st2 trimesters), D (3rdtrimester)

Nursing implications: take with food, monitor kidney function, monitor fbleeding

Half life: less than 30 minutes

Onset: 30 minutes to 2 hours

Peak: 1-2 hours

Duration: 4-6 hours


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The dose range is: Adult dose: 1200-3200 mg daily in 3 or 4 divided doses

Infants and Children: 20-40 mg/kg/day in 3 or 4 divided doses

Acute overdose nonsalicylate NSAID

Symptoms: headache, tinnitis, lethargy, confusion, paresthesias, numbnseizures, nausea, vomiting, gastrointestinal bleeding, cardiac arrest

Treatment: removal of the drug by inducing emesis with gastric lavage, gactivated charcoal, support symptoms

Unlike aspirin, hemodialysis will not remove the drug from the body com


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FUROSEMIDE (LASIX)

Distribution: Crosses placenta; enters breast milk

Dose Depends On:

Condition being treated

Size and age of the patient

Route of administration

Dose: Average Adult Dose po 20-80 mg/day Average Adult Dose IV 20-40 mg

Average Pediatric Dose po, IM, IV 2mg/kg*


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FUROSEMIDE (LASIX)

Reactions: Rash, Pruritus

Orthostatic hypotension-Hearing loss

Electrolyte imbalances-Hyperglycemia

Nausea, vomiting, Anorexia

Diarrhea (NVD)

Circulatory collapse , Neutropenia

(Many others are listed in the drug references books.)


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MILK OF MAGNESIA (MAGNESIUM HYDROX

Onset: 0.5-3 hr

peak 3 hr

duration: variable


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SENNA

onset: 6-24 hr Peak 24 hr

Duration: 24-36 hr


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BISMUTH SUBSALICYLATE (KAOPECTATE,PEPTO-BISMAL)

Check with physician before giving to children

Associated with Reyes syndrome

Onset: 0.5-2hr

Peak: 2-5 hr

Duration and half life variable

May cause black stool


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LOPERAMIDE (IMMODIUM A-D)

Drug class: anticholinergic Action: inhibits peristalsis and reduces intestinal secretion

Reduces number of stools and water content

Contraindications: ulcerative colitis, pseudomembranous colitis, infectious diar

Half life:7-15 hrs

Onset: 1-3 hrs

Peak: 4 hrs

Duration: 40-50 hrs

Pregnancy Category B


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DOCUSATE SODIUM (COLACE)

Onset and duration: 1-3 days Peak: unknown Pregnancy category C


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BARBITURATES

First introduced into clinical use in 1903

Prescribed for sedative, hypnotic, and antiseizureffects & was mainstay of treatment for anxiety insomnia

Now rarely prescribed for anxiety and insomnia due to side effects and a

of more effective medications Chemically they are derivatives of barbituric acid

They are habit forming and have a narrow therapeutic index


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BARBITURATES

Drug Effects:

In low doses, acts as sedative.

Increasing the dose produces hypnotic effect decreasingrespiratory rate

Stimulate enzymes in liver responsible for metabolism of drugsdrugs have faster onset of action and shof effect.

Side Effects/Adverse Effects

Main side effects affect CNS Drowsiness

Lethargy

Dizziness

Hangover

Paradoxical restlessness or excitement

Chronic effects on sleep architecture can be detrimental d/t decreased REM sleewithdrawal causes nightmares d/t increased REM with rebound effect


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BARBITURATES

Toxicity: Respiratory depression

Intentional overdoses

Phenobarbital coma

CNS depression ranging from sleep to profound coma and death

Respiratory depressions progresses to hypoventilation and cyanosisSigns of OD

Cold, clammy skin, may be hypothermic

Later can exhibit fever, areflexia, tachycardia, and hypotension

Pupils usually slightly constricted, but may be dilated in the event of severe pois


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BENZODIAZEPINES

Most frequently prescribed sedative-hypnotic agents and one of thcommonly prescribed classes of drugs.

Favorable side effect profiles, efficacy, and safety.

Classified as anxiolytic or sedative-hypnotic, depending on primary

All 15 have same side effects and adverse reactions

Produce considerably less physical dependence and result in less tothan barbiturates

May be abused recreationally


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BENZODIAZEPINES: SEDATIVE-HYPNO


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BENZODIAZEPINES

Action Bind to GABA, a natural inhibitory neurotransmitter in brain

Metabolized in liver to active metabolites and excreted primarily in urine

Do NOT produce life-threatening respiratory depression or coma in excessive amouhowever, will still cause rapid CNS and respiratory depression when given IV- monito

Indications:

Drug of choice for short term treatment of insomnia caused by anx Shorten length of time to fall asleep

Reduce frequency of interrupted sleep

Increase total sleep time, but reduce stage 4 and some REM


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BENZODIAZEPINES

Nursing Considerations:

Monitor condition and provide education

Assess symptoms and need for medication

Use with caution if suicidal or has sleep apnea

Contraindicated in narrow-angle glaucoma & organic brain disease

Use cautiously in presence of

Liver or renal impairment Impaired respiratory function

Pregnancy category D Not recommended for pregnant or nursing moms

Crosses placenta and excreted in breast milk


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BENZODIAZEPINES

Side Effects Drowsiness

Dizziness

Risk for injury

For overdose, Flumazenil (Romazicon) used to acutely reverse effe

competes for binding at receptor sites


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MUSCULOSKELETAL RELAXANTS

Most are central-acting: All central-acting have potential to casedation

Mechanism of action not fully known

Believed to inhibit upper motor neuron activity

Causes sedation

Alters simple reflexes

Most effective in conjunction with rest and physical thera

Enhanced CNS depression results from co-ingestion of ETopioids, or other CNS depressants


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MUSCULOSKELETAL RELAXANTS

Nursing Considerations:

Assess Food and drug allergies

Contraindicated if hypersensitive to protein-based foods

History of uncontrolled hypertension Drug can raise BP to dangerously high levels

Vital signs

Baseline lab tests Especially CBC

Use with caution in pregnant and lactating women (pregnancy category C)

Monitor for early signs of heart attack or stroke Increases risk of thromboembolic disease

May need increased doses of heparin

Monitor for side effects of nausea, vomiting, constipation, medication site reaction, & headac

drugs fall 2014_ppt

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