references: pearson nurses’s drug guide saunders ... file03.06.2013 · wsu – conh study guide...

WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013) 1

NLN Pharmacology Study Guide

There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the information

you will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to

prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line.

The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All are

multiple choice questions, including calculations.

Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. They

are pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX test-

taking tips to prepare for this exam also.

References:

Pearson nurses’s drug guide. (2013). Upper Saddle River, NJ: Pearson.

Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN® examination. St. Louis, MO: Mosby.

Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice (2nd ed.). Upper Saddle River, NJ: Pearson.

Calculations

Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or review

a nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one or

more type of calculation.

Tips:

1. READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you select

the correct formula and eliminate unnecessary information.

2. Double (and triple) check actual math. Did you clear the calculator correctly?

3. Does the answer make sense?

4. There are both adult and pediatric calculations.

5. Watch ‘per dose’, ‘per day’. 6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.


2Common calculations include (but are not limited to):

1. Kg to mg to mcg conversion (any which way)

L

K H D M D C M - - mcg

G

liter

(kilo – hecto – deca – meter – deci – centi – milli – skip – skip – micro)

gram

2. Dosage calculations

a. Tablets

b. mg. to tablets

c. mg. to ml

d. units to ml

e. kg to ml

f. Half-life calculation

g. IV rate calculation (hourly infusion rate) AND adjustment

h. IV rate dosage calculation (based on units per ml, etc.)

i. Macro- vs. micro-drop tubing

j. Calculating drops/minute (gtts/min)

Examples: (abbreviated to type of question; exam will add extra information)

1. Have 5 mg tablets; ordered dose 2.5 mg. How many tablets will the nurse administer?

2. Have 2 mg/2 ml; order is 1 mg. How many milliliters will the nurse administer?

3. Prepare a 20 mEq dose of a medication. Available solution is 40 mEq/10 ml. How many ml will be administered?

Note: calculation method is not different in examples 1 - 3, just the unit of measure (mg, units, mEq, etc.). BE SURE AVAILABLE

AND HAVE ARE THE SAME UNIT OF MEASURE.

4. Half-life conversion: Half-life is known to be 2 hours. What percentage will be left in the body after six hours?

5. A person weighs 165 lbs. How many kg does the person weigh?


6. The available medication has been reconstituted to 250 mg/5 ml. The order is 5 mg/kg/daily in two evenly divided doses.

Child weight 44 pounds. How many milliliters will be administered per dose? NOTE: More than one calculation method

must be used to answer this question.

7. IV was ordered at 1000 ml over 8 hour period. After two hours, only 900 ml has infused. Calculate the new infusion rate

for the medication to be administered within the original 8 hour period.

8. Order is for 3000 cc over a 24-hour period. What is the hourly flow rate? OR: What will the pump be set at per hour?

9. Order is for antibiotic to be mixed in 50 ml NS and administered over 45 minutes. What is the hourly flow rate? OR:

What will the pump be set at per hour?

10. Volume is 1000 ml. Ordered infusion time is 8 hours. Have tubing of 15 drops/ml. How many drops need to be counted to

deliver the identified milliliters per minute?

11. Available solution = 25,000 units in 250 ml NS. Order is to administer at 22 ml/hour. How many units will be given per

hour?

12. Available solution = 25,000 units in 250 ml NS. Administer at 2000 units/hour. How many ml will be given be hour? OR:

What will the pump be set at per hour?

Principles of Pharmacology

These include the basics! Review:

1. Routes of administration – benefits and problems

2. Sizes of needles and syringes for injections

3. Six Rights of Medication Administration; Three Checks

4. Side effects; adverse effects; paradoxical reactions; toxicity; antagonists

5. Half-life calculation

6. Allergic or hypersensitivity reactions

7. Absorption, metabolism, distribution and excretion

8. There may be questions on lab values as relevant.

9. There are pediatric and adult questions.

10. Immunosuppression precautions (due to meds for cancer, HIV/AIDS, etc.)


Administration routes: some key points

Sublingual administration

□ absorbed in mucosa of oral cavities

□ rapid onset of action

□ Place tablet on floor of mouth, close mouth. Do not swallow, hold under tongue until dissolve.

□ Use spray on floor of mouth under tongue and close mouth.

Buccal

□ place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve

□ slower to dissolve and absorb than sublingual

Intramuscular injections

□ Given in the vastus lateralis in children up to 3

□ Spread skin taught to bring muscle near surface of skin, with dart-like motion insert needle at 90 degrees

□ Aspirate to determine if needle enter a blood vessel. If there is blood return discard the needle and meds and start

procedure over.

NGtube / Gtube

□ NG usually temporary; G-tube for longer term

□ Follow instructions re crushing, dissolving medication – no sustained release meds

Eye drop administration

□ Clean exudates from eye; (2) tilt head toward side of affected eye; (3) pull lower eyelid down; (4) have pt. look up; (5)

instill drops in conjunctival sac formed by lower lid (not onto the eye); (6) Apply gentle pressure for 30 sec to 1 min over

inner cantus next to nose (this prevents absorption through the tear duct and drainage of the medication). Close eyes

gently massage the eyes to distribute the meds.

□ Slow absorption except in infants where they readily absorb

EYE OINTMENT

□ Same as eye drop except it is expressed directly into the conjunctival sac from the inner canthus to the outer canthus. Close

eyes and gently massage to distribute the medication


Definitions:

Agranulocytosis / Neutropenia / agranulocytopenia

□ Definition: Acute decrease in the number of granulocytes/leukopenia (WBC) in peripheral blood

□ Causes include: treatment with broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime,

ticarcillin, gentamycin), bone marrow transplant, chemotherapy, radiation.

□ Generally is impaired resulting from bone marrow depression by drugs and chemicals or replacement by a neoplasm(oral

lesion, ulcer necrotic, gingivitis, buccal mucosa

□ Lymphadenopathy, lymphadenitis may be prevalent.

□ Could lead to respiratory infection, ulceration of mouth colon, high fever, UTI. But may be asymptomatic

Chelating agents

□ A form of detoxification

□ Chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide (a synthetic amino acid

which attaches to toxic substance such as lead, cadmium, aluminum and other metal in the blood to facilitate their removal

from the body.)

□ May be used to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove

excess calcium from the body.

EDTA: Ethylenediaminetetraacetic acid

□ Use in children with lead level between 45&70 micron/dl.

□ EDTA binds to lead in blood and excreted by the bowel and kidney. EDTA may be toxic to kidney. Monitor urine output.

□ Give this by IV. Dose depends on weight of child, severity of the poison. Agent is given every 4 hours for 5 days. A second

course may be needed if there is a rebound in the blood level. Give oral and IV fluid to enhance excretion

□ Do not use EDTA with hypocalcemia or hypokalemia.

OTHER AGENTS

□ British antiLewisite (BAL) does not give with iron supplement and avoid in pt. with plant allergy. Give this by IM

□ Succimer (Chemer)

□ Chemet – oral medication - Do not give in pt. with encephalopathy

Epistaxis

□ Nose bleed. Can be anterior or posterior. Posterior is more serious.

□ due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma

□ blood can come up through the eye, can also flow down the stomach causing nausea, vomiting


Treat epistaxis

□ cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent

dressing or saline sprayed into the nose

□ Ice pack to forehead or back of the neck

□ pinch septum of nose for 5 minutes

□ Do not pack nose with tissue or gauze

Half-life

□ The time it takes for a medication to lose half of its pharmacologic or physiologic effect

□ To calculate half-life: There is a formula but the easiest way to decrease count.

□ Example: half- life is 1 hour.

Start 100%

1 hr. 50%

2 hrs. 25%

3 hrs. 12.5%

4 hrs. 6.25%

Question – Half-life of ‘xyz’ medication is 1 hour. After 3 hours, what percentage of the medication will be left? A = 12.5%

Osmotic agent - see entry under Mannitol

Paradoxical reaction

□ A response to a drug (or medical treatment) that is the opposite to the usual response, such as agitation produced in an

individual patient by a drug which is ordered to sedate or calm a person.

Sustained release / time released / extended release / controlled release

□ Pills or capsule formulated to dissolve slowly and release drug over time.

□ They can often be taken less frequently, keep steadier levels of the drug in the bloodstream

□ Contain in a matrix of insoluble substance (e.g. Acrylics) the drug swells up to form a gel so that the drug has first to dissolve

in matrix then exit through the outer surface.

□ Cannot be crushed, dissolved or opened


Medication Effects

There is a bit of an overlap here with Principles of Pharmacology. These questions tend to be medication (or classification)

specific. There are many medications on the test and many could be. As applicable, both brand and generic names are used.

We recognize the attached grid is very lengthy, but have included some of the key components as identified below. Most

medications addressed are either high usage or high risk. Please note that auto-corrections will change generic names to

starting with caps. In the grid, we have tried to list generic first, then brand names.

Areas to know:

1. Use, dose, side effects, contraindications

2. Since there are a limited number of questions, not all medications are addressed. You may be asked to select which

medication would be given for a particular diagnosis. When studying, focus on the classifications – this may enable you

to answer without knowing the actual medication.

3. Focus on what are the major side effects of a medication or class? What makes it high risk? Why might one particular

med be used other than another?

4. Patient teaching is a major focus. What would you tell the patient about the medication? What would indicate

understanding? What would indicate need for further teaching?

Common classification of medications

Note letters in medication name and look for those letters that identify a particular classification:

◊ Androgens: end with –terone: testosterone (Testoderm)

◊ ACE Inhibitors: end with –pril: enalapril (Vasotec)

◊ Antidiuretic hormones: end with –pressin: desmopressin (DDAVP)

◊ Antilipidemic: end with –statin: atorvastatin (Lipitor)

◊ Antiviral: contain -vir: ritonavir (Norvir)


◊ Benzodiazepines: include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),

estazolam (ProSom), and triazolam (Halcion). Most others end with –pam: diazepam (Valium)

◊ Beta Blockers: end with –lol: atenolol (Tenormin)

◊ CCB: end with –pine: amlodipine (Norvasc); some exceptions include diltiazem (Cardizem), verapamil

(Isoptin)

◊ Carbonic anhydrase inhibitors: end with –mide: acetazolamide (Diamox)

◊ Estrogens: contain est: conjugated estrogen (Premarin)

◊ Glucocorticoids and corticosteroids: end with –sone: prednisone (Deltasone)

◊ Histamine H2 receptor antagonists: end with –dine: cimetidine (Tagamet)

◊ Nitrates: contain nitr: nitroglycerin (Nitrostat)

◊ Pancreatic enzyme replacements: contain pancre: pancrelipase (Pancrease)

◊ Phenothiazines: end with –zine: chlorpromazine (Thorazine)

◊ Proton Pump Inhibitors: end with –zole: lansoprazole (Prevacid)

◊ Sulfonamides: include –sulf: sulfasalazine (Azulfidine)

◊ Thiazide diuretics: end with –zide: hydrochlorothiazide (HydroDIURIL)

◊ Thrombolytics: end with -ase: alteplase (Activase)

◊ Thyroid hormones: contain –thy: levothyroxine (Synthroid)

◊ Xanthine bronchodialators: end with –line: theophylline


Specific Diseases or treatments:

Aminoglycoside

□ antibiotics - Treats serious life threatening gram negative (and some positive) infections

All aminoglycoside ends Mycin but not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin and

azithromycin)

Examples:

□ Gentamycin

□ Tobramycin

□ Vancomycin

□ Neomycin

□ Generally IM or IV.

□ Oral route is not recommended. It is only use for bowel prep prior to surgery (see Neomycin)

Adverse effects/toxicity:

Two most common MAJOR adverse effects: Nephrotoxicity and ototoxicity.

Also:

□ Photosensitivity

□ risk for superinfections

□ Pseudomembranous colitis (c-diff): stop med and treat with PO Flagyl

Peak level:

□ Drawn 15-30 min after the infusion is completed.

□ Peak concentration determines that toxic level does not occur.

□ If peak is too high, may reduce dose.

Trough level:

□ Drawn immediately (within 30 minutes) before next IV dose

□ Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.

□ Dose will be adjusted if level is not sustained

□


Blood administration

□ Start blood transfusion slow 2 ml/min. Remain with pt. for the first 15-30 min. if there is no sign of side effect, increase rate

to the desired rate

□ Administer using largest gauge IV access as possible.

□ Observe for acute reaction such as: allergic s/s – rash, itching, localized edema; febrile (even low grade); septic; air embolism;

circulatory overload.

□ Observe for delayed reaction: Graft vs. host; hepatitis; hemolysis

Crack abuse effect on newborns

□ Crack crosses the placenta and enters the fetus.

□ Common presentation: Infant may appear normal or develop neurological problem. Child may develop depression or

excitability, they may be lethargy, have poor suck; weak cry and difficulty in arousing, hypotonicity, rigidity, irritability,

inability to console and intolerance to change, small head, decreased birth length

□ Late symptoms: Some infant showed late symptoms 2-8 wks. There may be growth retardation - head growth is one of the

best indication

Diabetes treatment in children

□ Hypoglycemic reaction takes place most time before meals or when insulin effect is peaking.

□ First teaching: (1) let child wear bracelet or tag; (2) Teach how to give injection. Inject at 90 degree angle.

□ Teach only the essentials on the first few visits and intense later. Keep session for children to 14-20 min and adult may go up

to 45-60

□ Have same meal as normal child time intake of food. Eat at the same time each day.

□ Children can start learn to assume responsibility for self-management as soon as age 4-5. At age 9, they can start giving

their own insulin with supervision.

□ Exercise: do not restrict exercise. Have extra snack before and after exercise. Exercise very regularly as it decreases the

need for insulin

□ Carry a source of glucose at all times (hard candy, sugar cubes glucose tablets, insta glucose). The rapid releasing sugar is

followed by complex CHO and protein such as slice of bread or cracker spread with peanut butter

□ After glucagon injection, vomiting may occur. Place child on the side to prevent aspiration.

□ Preferred way of treating ketoacidosis is by insulin IV of low dosing. Note. Run a mixture of insulin through the tubing

before starting the drip because the insulin can chemically bind to plastic. Replace fluid over 24-48 hrs.


Diabetes – Intravenous insulin administration

□ Can only be done with regular insulin in management of DKA, HHNK.

□ Premature discontinuation can cause prolongation of DKA.

□ Begin SQ insulin therapy before stopping the infusion. If not, there might be prolonged hyperglycemia.

Hepatitis – see below

HIV treatment – antiretinoviral therapy

Common meds:

□ abacavir (ziagen)

□ stavudine (Zerit)

□ zidovudine (AZT)

Antiviral protease inhibitor. End in AVIR

□ Use prophylactically.

□ Use in combination to decrease viral

load and increase CD4.

Reverse transcriptase inhibitors: Ends in

INE

□ Stop replication/growth. Reduces

viral load.

□ One major advantage is that they do

not affect adversely affect

development of blood cells.

□ Use in combination with other meds

because resistant strains may rapidly

evolve if used as single agent

therapy.

□ Inhibit cell protein synthesis that

interfere with viral replication; block

protease activity in HIV.

□ Treat AIDS and AIDS-related complex

to decrease viral load

Side effects:

□ Assess for opportunistic infection

(cancer, neurological disease); HA,

fatigue, nausea, vomiting, diarrhea,

abdominal discomfort, anemia, taste

perversion, asthenia, circumoral

paresthesia with ritonivair,

Adverse/toxicity

□ Hepatoxicity, Hepatotoxicity: AST,

ALT, bilirubin; observe for nausea,

vomiting jaundice upper right

abdominal quad enlargement and

tenderness. Reduce dose in liver

dysfunction.

□ Nephrotoxicity; creatinine, BUN,

creatinine clearance, urinalysis, keep

accurate I& O, monitor for SE of

neutropenic, observe occult signs of

infection. (lower back, flank or

suprapubic pain, normal temp or low

grade fever related to UTI

START therapy:

(1) all symptomatic HIV people

(presenting with a AIDS-defining illness)

or

(2) with a CD4 count less than 350 mm3.

(3) also start pregnant women (AZT is

used to prevent maternal transmission

of HIV)

STOP if severe rash or other

hypersensitivity reaction occurs.

Excluding reaction to medications

and/or ineffectiveness of medication,

treatment will be long-term.

TEACH

□ Use neutropenic precautions

□ Eat small frequent meals with

complete or complementary proteins


Inotropic medications:

Positive inotropic meds increase cardiac contractility – examples: epinephrine, norepinephrine, dopamine

Negative inotropic meds decrease cardiac contractility, lower BP: examples – quinidine; betablockers (most end in ‘olol”)

Sulfonamides

□ Anti-infective.

□ Bacteriostatic which action on

bacteria results from interference

with the functioning of enzyme

systems necessary for normal

metabolism, growth and

multiplication

□ Treat: UTI, Chlamydia causing

blindness, pneumonia, brain abscess,

ulcerative colitis, active Crohn’s

disease, rheumatoid arthritis

Examples:

□ Bactrim

Side effects:

□ Rash common; most are urticaria and

maculopapular.

□ GI symptoms

□ Bone marrow depression

□ Headache, dizziness, vertigo, ataxia,

convulsion, depression


□ Hepatotoxicity

□ Nephrotoxicity

□ Stevens Johnson syndrome (an

adverse reaction of skin that

resembles appearance of partial

thickness burns)

CAUTION: do not use:

□ known allergies to sulfa drugs

□ In polyuria, advanced renal or hepatic

dysfunction

□ with intestinal and urinary blockage,

□ asthma

□ Take adequate amount to fluid 3000-

4000ml/day to promote urinary

output, at least 1500ml/d to prevent

crystalluria/stone formation

□ May be taken after meals to prolong

time in intestine.

□ Collect C&S prior to beginning

therapy

Thiazide diuretics:

Examples:

chlorothiazide (Hydrodiuril),

hydrochlorothiazide (HCTZ, Diuril)

Name ends in ZIDE

□ non-potassium sparing diuretic.

□ Acts on distal tubes, blocks

reabsorption of sodium, chloride and

water. Leads to increased loss of

Potassium.

□ Use for edema and mild to moderate

hypertension

□ will see effect of within 1-4 wks.

Side effects:

□ Dizziness, vertigo, HA, weakness,

dehydration, orthostatic hypotension

□ N/V, abdominal pain, diarrhea,

constipation, frequent urination

□ dermatitis and rash

□ Electrolyte imbalance

□ impaired glucose tolerance


□ Renal failure,

□ aplastic anemia, agranulocytosis,

thrombocytopenia

□ anaphylactic reaction

□ Take early in the day to avoid

nocturia

□ Take with food to avoid GI upset.

□ Thiazide is ineffective if creatinine

clearance is < 30ml/min

□ Eat foods high in potassium, restrict

sodium, do not use salt substitute if

taking potassium supplement

□ weigh self daily, report sudden

weight gains or losses

Avoid use with:

□ Children

□ anuria


Tricyclic Antidepressants

□ Initial mechanism of TCA takes 1-3

weeks to develop.

□ Maximum response is achieved in 6-8

wks.

□ Has long half-life.

Most Tricyclics ends in INE

□ nortriptyline (Pamelor)

□ amitriptyline (Elavil)

□ doxepin (sinequan)

□ imipramine (tofranil)

□ Block the reuptake of norepinephrine

or serotonins or both, leaving more

available in the CNS. It intensifies

the effect of norepinephrine and

serotonin which can elevate mood,

increase activity and alertness,

decrease preoccupation with

morbidity, improve appetite and

regulate sleep pattern.

□ It is used to treat insomnia, attention

deficit/hyperactivity and panic

disorder.

Side effects:

□ orthostatic hypotension,

□ sedation and anticholinergic effects.


□ Most serious adverse effect is cardiac

toxicity; in the absence of overdose

or preexisting cardiac impairment,

serious cardiotoxicity is rare.

□ URINARY RETENTION IS URGENT

□ Overdose may cause convulsions

□ Take at nights, it causes sedation.

□ Do not take with MAO it will cause

hypertensive crisis from excessive

adrenergic stimulation of the heart

and blood vessels,

□ monitor orthostatic BP of pt. in

hospital

Use with caution:

□ Glaucoma

□ Elderly

□ constipation, prostatic hyperplasia,

as they are more sensitive to

anticholinergic effect

Avoid use with:

□ hypersensitivity,

□ MI, Cardiovascular disease

Vesicant – Chemotherapy

□ See precautions under “Vincristine”

Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins

Stages of viral hepatitis:

(1) Pre-icteric – precedes appearance of jaundice, may have flulike symptoms

(2) Icteric – appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools

(3) Post-icteric – convalescent stage; jaundice improves; color of urine and stool returns to normal


Hepatitis A (formerly

“infectious hepatitis”)

Cause: enterovirus

At risk:

□ Young children

□ Institutionalized

people

□ Health care

personnel

Transmission:

□ fecal-oral

□ ingestion of food or

liquids

contaminated with

the virus.

□ person by person

contact

Incubation: 3-5 wks.

Infectious: usually 2

wks. before the onset

of jaundice and 1 wk.

after onset of jaundice.

s/s: May have no

symptoms initially.

Complications:

□ Fulminant hepatitis

Hepatitis B.

At risk:

□ IV drug users

□ People on

Hemodialysis

□ Health care

personnel

Transmission:

□ blood and body

fluids

□ contaminated

needles, parenteral

□ sexual activity

Incubation: 6-24 weeks

s/s:

□ progression of

symptoms is more

insidious and

prolonged than

Hep A virus.

□ Initially may be

asymptomatic.

□ 1 week -2 months of

Prodromal

symptoms: fatigue,

anorexia, transient

fever, abdominal

Hepatitis C

At risk:

□ IV drug users

□ People receiving

frequent

transfusions

□ Healthcare

personnel

Transmission:

□ Same as Hep B

□ Blood and body

fluids

Incubation period: 5-10

weeks

s/s: similar to HBV but

often less severe.

Complications:

□ chronic liver disease

□ Cirrhosis.

Hepatitis D

Cause: Occurs only with

Hepatitis B and only

causes problems with

an acute HepB

infection.

At risk:

□ common in Middle

east, south Africa

and Mediterranean

□ same as HepB

Transmission:

□ same as Hepatitis B.

Incubation period: 7-8

weeks

HepD along with HepB

causes superinfection

and worsening of

condition and rapid

progression of cirrhosis

Complications:

As per Hep B

Hepatitis E

Cause: waterborne

virus

At risk:

□ Travel to areas

where sewage

disposal is

inadequate and/or

people bathe in

contaminated rivers

□ At higher risk with

higher mortality:

women in third

trimester of

pregnancy

Transmission:

□ Same as HepA

Incubation: 2-9 weeks

Complications:

□ Maternal and fetal

demise


□ death

discomfort N/V, HA.

□ Then expanding to:

Hepatic S/S,

photophobia,

angioedema, rash,

vasculitis, jaundice

in Icteric phase

Complication:

□ Cirrhosis

□ Fulminant hepatitis

A grid follows with a listing of medications that may be on the exam.


Drug Use and dosage Side effect Teaching and labs contraindication

Acetylsalicylic acid

(Aspirin)

□ Non-narcotic

analgesic

□ Antipyretic

□ Antiplatelets

□ Blocks pain impulse

in peripheral and

some CNS;

□ antipyretic result;

□ inhibit platelets

aggregation

□ Treat TIA, Post MI,

Stroke, angina

□ Increases

coagulation times

□ Reye’s syndrome (encephalopathy

and fatty liver),

□ GI bleed,

□ tinnitus,

□ liver toxicity (dark

urine, clay stool,

itching, yellowing

sclera and skin),

□ visual changes

□ Monitor coagulation

studies

□ Take with full glass

of water, milk for

food to prevent

stomach upset

□ Do not crush enteric

coated

□ given daily (81-325

mg) for cardiac

prophylaxis post MI,

stents, strokes, etc.

Do not use with:

□ children under 12

and/or children or

teenagers with

chicken pox or flu

like symptoms

(because of risk of

Reye’s syndrome); □ pregnancy in 3rd

trimester; and

□ vitamin K deficiency

Activated charcoal

(Actidose)

□ Antidote

□ Adsorbent

□ Treat poison and

overdose following

oral ingestion.

□ Binds to poison and

prevent its

absorption by the

GI tract and then

eliminates in the

feces.

□ Administer within

60 minutes of

ingestion.

□ Give once or twice

depending on the

level of toxin.

□ May come pre-

mixed with water

12.5-25 grams

□ Vomiting with rapid

administration

□ pulmonary

aspiration

□ Binding is

irreversible so

cathartic such as

sorbitol may be

added as well.

□ It allows certain

drugs/toxins to be

drawn out of the

blood and bind to

charcoal in the

intestine a kind of

“gut dialysis”

□ Stools will be black

□ Charcoal does not

change the stomach

PH.

Do not administer with

Ingestion of:

□ caustic alkali agent,

□ high viscosity

petroleum products

OR when:

□ convulsions are

occurring,

□ cardiac

dysrhythmias are

present, or

□ there is emesis of

blood

Implement antidote

supportive care and

prevent aspiration are

if gastric lavage is not

to be performed.



Acyclovir

(Zovirax)

□ Antiviral

- Herpes simplex

virus – HSV

- Herpes zoster

- varicella

□ Used for herpes

simplex. Does not

eradicate latent

herpes. It reduces

viral shedding and

formation of new

lesions and speeds

healing time.

(oral, IV and topical)

□ To decrease

symptoms with

varicella zoster

(chicken pox/

shingles).

Side effects:

□ Headache, dizziness

□ seizure

□ nausea, vomiting,

diarrhea

□ acute renal failure

□ thrombocytopenia

□ purpura hemolytic

□ uremia syndrome


□ nephrotoxicity

□ Even after HSV

infection is

controlled, latent

virus can be

activated by stress,

trauma, fever

exposure to

sunlight, sexual

intercourse.

□ Refrain from sex if

S/S of herpes.

Alteplase recombinant

(Activase)

Streptokinase is similar.

Urokinase is given

mostly in emergency

situation.

□ Thrombolytic agent

Cath-flo Activase – is

for occluded catheters

□ Dissolves or break

down clots to

reestablish

perfusion.

□ Indicated for clients

at risk for

developing

thrombus with

resultant ischemia

such as MI,

ischemic stroke,

arterial thrombosis,

DVT, PE

□ occlusion of IV

catheters.

□ Hemorrhage,

□ N/V,

□ hypotension

□ cardiac

dysrhythmias.

□ Dose related is the

highest problem

□ Watch for s/s

bleeding; VS

changes, s/s of

impending shock

□ If bleeding is

occurring stop

treatment and

notify doctor. May

start on FFP and

PRBC.

□ Aminocaprionic acid

(Amicar) may be

ordered for

overdose or

excessive bleeding.

Do not give with:

□ pregnancy,

□ active bleeding,

□ recent Hx of CVA,

□ Uncontrolled HTN,

IM medication route is

contraindicated when

using thrombolytics.

□ Do not take NSAIDs

or Aspirin because

of enhanced

bleeding.



Aluminum hydroxide

(Amphogel)

□ Antacid

□ Neutralizes gastric

acid,

□ antflatulent to

alleviate symptoms

of gas and bloating

□ Increases gastric pH,

□ Decreases

absorption of other

drugs such as dig,

antibiotic, iron

supplement.

□ Toxicity causes

dementia,

Hypercalcemia,

metabolic alkalosis,

worsening of HTN,

heart failure from

increased intake.

□ Given 2 hrs. apart from

other drugs where

interaction may occur.

□ Observe for signs and

symptoms of altered

phosphate levels;

anorexia, muscle

weakness and malaise.

□ Increase fluid, exercise

and fiber to prevent

constipation.

Do not use:

□ abdominal pain,

N/V, diarrhea,

□ severe renal

dysfunction,

□ fecal impaction,

rectal bleeding,

□ colostomy,

ileostomy

□ dehydration

□ hypercalcemia and

hypercalciuria

Ampicillin (Ampicin)

IV, PO, IM.

□ Antibiotic

□ Aminopenicillin

Similar side effects,

allergic reaction, etc.

for all Penicillins (PCN)

Treat bacterial

infection

Commonly used with:

□ Shigella,

□ salmonella,

Escherichia coli,

□ haemophilus

influenza,

□ Neisseria

gonorrhea,

□ Neisseria

meningitis,

□ gram positive

organism

□ allergic reaction:

Skin rash, urticaria,

swelling, pruritus,

angioedema.

□ Severe allergy:

hives, wheezing,

anaphylactic

reaction. Medical

emergency requires

immediate tx or can

lead to death.

□ side effects: GI, N/V,

diarrhea, abdominal

pain.

□ Pruritic rash like

measles is not a true

allergic reaction

□ Do not give with

fruit juice, milk or

carbonated

beverages because

of poor absorption.

□ Watch for

hypokalemia

□ Take on empty

stomach.

□ May not be

necessary to stop

treatment if mild

diarrhea develops.

□ Give yogurt or

buttermilk to

restore normal flora

(or probiotics)

Avoid with:

□ Hypersensitivity to

any penicillins; use

cautiously if history

of hypersensitivity

to cephalosporins;

□ Exfoliated

dermatitis

□ Loop diuretic may

exacerbate

hypokalemia and

rash.

□ Potassium-sparing

diuretic may

contribute to

hyperkalemia



Atropine Sulfate.

Two different uses:

□ Anticholinergic

(such as for

Parkinson’s disease) □ For ophthalmic use

Systemic effect is more

pronounced in infant

and children with blue

eyes and blond hair.

Also increased risk of

toxicity with Down

syndrome

□ Use to increase

heart rate (not

necessarily first

drug of choice).

□ Decreases

involuntary

movement and

rigidity in

Parkinson’s disease □ Pre-op to decrease

secretions and

prevent aspiration

of secretions while

under anesthesia

□ Use for

inflammation of the

iris and uveal tract.

□ Dry mouth,

constipation, urinary

retention or

hesitancy headache,

dizziness


□ Paralytic ileus.

□ Treat overdose

(resp. depression

and circulatory

collapse)

symptomatically.

Adverse effect when

used for the eye

□ Transient stinging,

□ increase IOP,

photophobia,

□ Monitor dosage of

meds carefully, even

slight overdose can

lead to toxicity.

□ Assess for

constipation and

urinary retention;

increase fluids, bulk

and exercise, assess

bowel sound to rule

out paralytic ileus,

□ Avoid driving or

other hazardous

activities,

drowsiness may

occur.

For the Eye

□ Acute glaucoma can

be precipitated by

papillary dilation; if

not recognized and

treat, acute

glaucoma can result

in blindness.

□ Wear dark sunglass

and avoid bright

light for

photophobia,

□ Monitor intraocular

pressure and vision

□ Increased

anticholinergic

effect with

phenothiazine,

antidepressant,

MAO’s amantadine.

□ Contraindicated in

pt. with narrow

angle glaucoma,

myasthenia gravis,

or GI obstruction.



Beclomethasone

diproprionate

(Beclovent)

□ inhaled

corticosteroid

medication

note: also nasal

inhalant as Beconase

□ Used in bronchial

asthma, allergic

rhinitis

Side Effects:

□ Pharyngeal irritation

and sore throat,

coughing, dry mouth,

oral fungal infections,

and sinusitis.

□ Increased

susceptibility to

infection,

dermatologic effects

and osteoporosis,

diarrhea, N/V, HA,

fever, dizziness

angioedema rash

urticaria and

paradoxical

bronchospasm

Adverse effects/toxicity

□ Adrenocortical

insufficiency

□ fluid and electrolyte

disturbances,

□ nervous system

effects and

endocrine effects if

absorbed

systemically.

□ Decrease dose if pt.

is on systematic

corticosteroid.

□ Assess for impaired

bone growth in

children receiving

inhaled

corticosteroid

Considerations:

□ Monitor for

hyperglycemia

□ Rinse mouth after

use for medication;

oropharyngeal

candidiasis and/or

hoarseness can

occur.

□ Use bronchodilator

inhalant before

corticosteroid when

both are ordered.

□ Do not abruptly

stop meds taper

over 2 weeks.

□ Be aware of steroids

symptoms - Moon

face, acne, edema,

increased fat pads

- notify doctor.

□ Report weight gain

Do not use with:

□ children under

□ Clients with known

allergy

□ May require

adjustment of

antidiabetic agent

as there is a

potential for

elevated blood

glucose levels with

corticosteroids are

administered orally.

□ Not use in

bronchospasm or

status asthmaticus.



Benztropine mesylate

(Cogentin)

□ Anticholinergic

(cholinergic

receptor

antagonist)

□ Anti-Parkinson

□ Treat Parkinson

symptoms:

Suppresses

tremors and

rigidity, not tardive

dyskinesia

□ Decreases

hypersalivation and

irregular

movement related

to Parkinson

disease.

□ Reduces extra-

pyramidal side

effects

Side effects:

□ dry mouth,

□ urinary

retention/hesitancy,

□ HA,

□ dizziness.


□ paralytic ileus

□ Monitor dose

carefully; even slight

overdose can lead

to toxicity.

Nursing considerations:

□ Monitor I&O’s,

Education:

□ Avoid driving, or

other hazardous

activities;

drowsiness may

occur.

□ Avoid cough

OTC medication

unless

prescribed.

Avoid use with:

□ narrow-angle

glaucoma,

□ myasthenia gravis,

□ GI obstruction

Buspirone (Buspar)

□ anxiolytic

□ Anxiety

□ Desired response 7-

10 days; Make take

3-4 weeks for full

effect

Side effects:

□ Dizziness

□ headache

□ drowsiness

□ When switching to

Buspar, taper off

benzodiazepines

□ Less likely to have

cognitive

impairment than

other CNS meds

□ Does not cause

withdrawal s/s and

thus does not need

to be tapered off

when stopping

Avoid use with:

□ MAO Inhibitors

□ Lactation

□ Caution with:

moderate to severe

renal impairment



Chlordiazepoxide

hydrochloride

(Librium)

□ Anxiolytic

□ Sedative-hypnotic

benzodiazepine

IM & tablet form

Peak:

□ 1-4 hours PO,

□ 15-30 min IM.

Half-life 5-30hr

□ To relieve tension

and/or anxiety

□ To manage alcohol

withdrawal

□ do not to stop

taking drug

abruptly – will have

withdrawal

symptoms (usually

in 5-7 days)

Adverse effect:

□ respiratory distress,

drowsy, dizziness,

lethargy, orthostatic

hypotension

□ photosensitivity

Suicidal tendencies may

be present and

protective measures

may be necessary.

□ Monitor closely for

paradoxical

reactions –

excitement,

stimulation, acute

rage – usually early

in tx – withhold

drug and notify dr.

□ Give with milk or

food to prevent GI

upset.

□ Check BP and pulse

early in tx. If BP falls

delay medication

and notify dr.

□ Labs: Monitor CBC,

renal and hepatic

enzyme levels

□ watch for

dependency

Education:

□ Avoid alcohol

□ no OTC meds unless

prescribed

□ Avoid driving and

other hazardous

activities until

effects known.

Avoid use with:

□ Narrow angle

glaucoma,

□ under 12 year old

□ lactation

Use cautiously with:

□ impending

depression,

□ impaired hepatic or

renal function,

□ COPD



Chloramphenicol

(Chloromycetin)

Oral, injection,

ophthalmic drops and

ointment

□ Anti-bacterial

□ severe infection for

susceptible

organisms when

other anti-infective

are ineffective.

□ Sty, conjunctivitis,

uveitis

Side effects:

dermatitis, itching,

stinging, swelling

Adverse effects/toxicity

(oral and injection)

□ edema

□ super infection,

□ aplastic anemia.

□ Stevens-Johnson

syndrome

□ obtain culture

specimen from eye

before initiation of

treatment

□ remove exudates.

□ Monitor for pain,

drainage, redness,

swelling.

□ Monitor for

bleeding or bruising

Avoid use with:

□ hypersensitivity

Chlorothiazide (Diuril)

□ Thiazide diuretic,

non-Potassium

sparing

□ Anti-hypertensive

□ Increases urinary

excretion sodium

and water by

inhibiting sodium

reabsorption.

□ Use for edema and

HTN, HF, cirrhosis,

corticosteroid and

estrogen therapy,

diabetes insipidus,

Side effects:

□ Dizziness, vertigo,

frequent urination,

electrolyte

imbalance, impaired

glucose tolerance,

hyperuricemia,

photosensitivity


□ Renal failure,

aplastic anemia, and

anaphylaxis

□ Take early in the

morning to avoid

nocturia.

□ Give with food,

□ allow for 3-4 weeks

for maximum effect,

□ Will not be effective

if creatinine

clearance Is less

than 30ml/min

Avoid use:

□ Client with anuria.

□ Use cautiously with

impaired renal or

hepatic function.

□ If pregnant.

□ Will increase serum

lithium level



Chlorpromazine

hydrochloride

(Thorazine)

□ phenothiazine

□ Antipsychotic

medication

□ Anti-emetic

□ Give bromocripitine

(Parlodel) and

dantrolene

(Dantrium) for

NMS.

□ Block dopamine

receptor in CNS to

□ Use: treat

psychotic disorder

(schizophrenia,

bipolar, and other

mental illnesses);

prevent acute

exacerbation and

maintain highest

possible level of

function

□ Use to control

manic phase

(bipolar)

□ intractable hiccups

□ nausea/vomiting

□ Low potency anti-

psychotic which

can reduce the risk

of EPSE (extra-

pyramidal side

effects)

Side effects:

□ Sedation,

orthostatic

hypotension,

□ anticholinergic

effect (dry mouth,

blurred vision,

urinary retention,

photophobia,

constipation,

tachycardia)

□ liver damage,

tremor are two

major side effects.



□ Neuroleptic

malignant

syndrome (NMS),

catatonia, rigidity,

stupor, unstable

blood pressure

profuse sweating,

dyspnea. Can be

toxic effect and

MAY last for 5-10

days after

discontinuation of

the med.

□ get baseline ECG,

thorough baseline

evaluation lab tests

before treatment.

□ Give bromocripitine

(Parlodel) and

dantrolene

(Dantrium) for

NMS.

□ Withdrawal of drug

is necessary

□ Take measures to

protect eyes

exposed to sunlight

□ Monitor diabetics

closely for glucose

intolerance



Cimetidine (Tagamet)

□ GI meds,

□ H2 receptor

antagonist

□ Works against

histamine

receptors,

decreases gastric

secretion.

□ Use short term for

duodenal ulcer,

benign gastric

ulcer, acute upper

GI bleed

Side effects:

□ Cardiac dysrhythmia,

diarrhea, dry mouth,

constipation


□ Rare but may

include

agranulocytosis

neutropenia ,

thrombocytopenia

aplastic anemia,

anaphylaxis

□ May be given with

meals and at

bedtime

□ Avoid smoking

which cause gastric

stimulation

□ Avoid antacid use

within one hour of

dose

Avoid use:


Use caution:

□ impaired renal or

hepatic function

Cisplatin (Platinol)

Half-life 20-30 minutes

□ Antineoplastic

medication

□ Alkylating agent

** Major allergic

reaction can occur

within first 15 mins. of

administration.

Anaphylaxis may occur

within minutes of drug

initiation.

□ Treat ovarian and

testicular cancer by

interfering with

DNA replication

Side effects:

□ anorexia,

uncontrolled N/V,

fluid retention,

weight gain


□ Major toxicities

occur in the blood,

GI, and reproductive

system.

□ Watch urine output

and specific gravity-

nephrotoxicity may

occur within 2 wks.

□ ototoxicity (tinnitus

or difficulty hearing

in the high

frequency range)

□ maintain fluid at

least 3000 ml in 24

hr. ; report reduced

urine output

□ Avoid food high in

thiamine (beer,

wine cheese,

brewer’s yeast, chicken liver &

banana) - may lead

to hypertension &

intracranial

hemorrhage

Avoid use:

□ Hx of sensitivity to

platinum-containing

compounds,

□ impaired renal

function and

hearing,

□ Hx of gout, renal

stones.

Incompatible with

□ dextrose and

Reglan, Vanco

□ Lasix may increase

otoxicity

□ other nephrotoxic

drugs may increase

nephrotoxicity and

renal failure.



Codeine sulfate

□ Opioid analgesic

(agonist)

□ Antitussive (cough

suppressant)

Rapid onset if IM or IV.

Peak 1-2 hrs.,

Duration up to 7 hours.

□ To treat mild to

severe pain

□ most oral

preparations

combined with ASA

or acetaminophen

□ hyperactive cough

Side effects:

□ Constipation, urinary

retention, dizziness,

lightheadedness.


□ Respiratory

depression,

respiratory arrest,

circulatory

depression, ICP.

□ Long term use may

cause withdrawal

symptoms when

stopped

Assess for:

□ respiration and

usually hold <12

breaths per minute,

□ CNS changes (LOC),

□ allergic reaction

TEACH:

□ no alcohol

□ no OTC pain meds

unless ordered

□ Avoid driving until

drug response is

known.

Do not use:

□ Hypersensitivity

□ Increased ICP, head

injury

□ Acute alcoholism

□ labor

Cyanocobalamin

(Vitamin B12)

Half- life: 6 days

□ Vitamin B12 helps in

the formation of

red blood cells

essential for the

proper production

of blood platelets

and red and white

blood cells and the

nervous system

□ Malabsorption

syndrome

□ Pernicious anemia

□ water-soluble

vitamin that is

stored in the liver.


□ Anaphylactic shock,

sudden death,

□ severe optic nerve

atrophy (may

develop after years

of use or with

Leber’s disease)

Teach:

□ Injection is once per

month for life with

pernicious anemia .

□ Oral preps may be

mixed with fruit

juice but give

immediately since

ascorbic acid (Vit. C)

affects stability of

B12.

□ Dietary B12: best are

organ meats, egg

yolk, clams, oysters,

crabs, sardines,

salmon

Do not use:


□ Lactation

http://www.vitamins-supplements.org/



Cyclosporine

(Sandimmune)

□ Immuno-

suppressant

medication

Metabolized in the

liver.

Peak 4-5hr,

Duration 20-54 hrs.

Half-life 19-27 hrs.

□ Inhibit T helper and

T suppressor cells.

□ Prevent rejection of

kidney, liver and

heart transplants.

□ Treat chronic

rejection in people

who have received

immuno-

suppressive agent,

rheumatoid

arthritis,

recalcitrant plaque

psoriasis

Side effects:

□ Hypertension,

□ increased risk of

infection

□ Tremor is an

expected side effect


□ Renal toxicity,

□ hepatotoxicity

□ Monitor labs: AST,

ALT, BUN, creat,

platelet count, K,

TEACH:

□ Take with food to

reduce GI upset

□ mix with milk,

chocolate milk or

orange juice but not

with Grapefruit juice

□ Mix in glass, not

plastic

□ Avoid use of live

vaccine

□ Prevention of

infection and report

signs of infections

□ Immunosuppressed

precautions

□ Do not use:

Pregnant/lactating

mom,

□ Use cautiously in

renal and hepatic

impairment

□ Antiepileptic

medications

decrease

cyclosporine levels

□ oral contraceptive

increase levels



Debrox drops

□ Ear drops to dewax

□ used to soften and

loosen ear wax,

making it easier to

remove.

Side effects:

□ temporary decrease

in hearing after

using the ear drops

□ mild feeling of

fullness in the ear

□ mild itching inside

the ear.


□ Get emergency

medical help if you

have any of these

signs of an allergic

reaction: hives;

difficulty breathing;

swelling of your

face, lips, tongue, or

throat

Use:

□ Tilt head with ear

facing upward. Pull

back on ear to open

up the ear canal.

Drop the correct

number of ear drops

into the ear.

□ After using the ear

drops, stay lying

down or with your

head tilted for at

least 5 minutes. You

may use a small

piece of cotton ball

to plug the ear and

keep the medicine

from draining out.

□ A bubbling sound

inside may be heard

after putting in the

drops. This is caused

by the foaming

action of carbamide

peroxide, which

helps break up the

wax

□ May come with bulb

syringe.

Do not use:

□ With a ruptured ear

drum.

□ any signs of ear

infection or injury

□ Do not use this

medication in a

child younger than

12 years old without

the advice of a

doctor.

□ Do not use for

longer than 4 days

in a row.



Diazepam (Valium)

□ Benzodiazepine

(have zep and zap

in them)

□ minor tranquilizers,

□ anticonvulsant,

□ anxiolytic

□ Absorbed from GI,

metabolize in liver

Onset 30 min IM, 60

PO, 15 IV. Works

quickly.

Peak 1-2hr PO,

Duration 15 min to 1hr

IV; up to 3 hrs. PO.

Half-life 20-50 min

□ Relieve pain and

discomfort from

musculoskeletal

disorders,

□ manage anxiety,

□ Manage acute

alcohol withdrawal

Maximum effect will

be seen in 1-2 weeks.

Can take 2-4 wks. It has

addictive effect.

Side effects: ABCD.

□ Anticholinergic (dry

mouth),

□ Blurred vision,

□ Constipation, &

□ Drowsiness,

□ cardiovascular

collapse,

laryngospasm,

dizzy, weakness,

nausea


□ Erythema

multiforme,

□ angioedema,

□ anaphylaxis,

□ dysrhythmia

□ seizure

□ Watch for CNS

effect.

□ Monitor CBC WBC

with diff.

□ notify dr. if drop in

BP of 20 mm Hg

□ Assess for allergic

reaction including

idiosyncratic

reaction,

anaphylaxis, rash

fever resp distress

Teach

□ Do not stop

abruptly –

withdrawal

symptoms will

occur (insomnia,

nausea HA,

spasticity,

tachycardia).

□ No alcohol (will

increase CNS

depression)

□ Suicide prevention

precautions

Do not use:

□ compromised

pulmonary

function,

□ hepatic disease,

□ impaired

myocardial

function,

□ acute alcohol

intoxication

□ infant < 6 months

□ narrow angle

glaucoma, open

angle glaucoma



Digoxin (Lanoxin)

□ Cardiac glycoside,

antiarrhythmic

drug.

□ Therapeutic range:

0.5-2.0ng/ml

□ Toxic level > 2

Antidote: digibind

(digoxin immune fab)

□ Positive inotropic

effect

□ In heart failure it

Increase

contraction of the

heart muscle.

□ In atrial fib, it slows

the heart rate

Side effects:

□ Nausea, HA, loss of

usual appetite.


□ Toxicity may go

unrecognized since

it presents with

same symptoms as

flu (N/V, anorexia,

diarrhea, vomiting

visual disturbance).

□ Blurred green or

yellow vision or halo

effect**

□ In HF, early sign of

toxicity includes

dysrhythmias.

□ Children rarely show

signs of N/V,

diarrhea, visual

problem, anorexia

(could become dig toxic

without showing usual

s/s)

□ may give without

regard for food

□ IVP over 5 min, do

not give IM, it will

cause tissue

irritation.

□ Monitor apical

pulse, if <60/min.,

usually hold meds

and notify doctor.

□ Monitor labs (K,

calcium,

magnesium,

creatinine

clearance),

□ Monitor Dig level

every 6 months.

□ weigh daily and

report weight

greater than 2 lbs.

per day

Avoid use with:

□ hypersensitivity to

dig

□ Caution with kidney

failure

Interaction:

□ IV calcium with dig

may increase risk of

cardiac

dysrhythmias,

□ erythromycin will

increase dig level,

□ quinidine,

verapamil and

amiodarone will

increase dig levels

and dig dose should

be decreased by

50%

□ Cyclophosphamide

combined with dig

cause dig toxicity



Disulfiram (Antabuse)

The only alcohol

antagonist in use.

□ Enzyme inhibitor

□ Anti-alcohol agent.

Half-life 24-36 hour

Onset up to 12 hrs.

Duration up to 2 wks.

Absorbed from the GI

excreted in feces or in

the breath as carbon

disulfide

□ Adjunct treatment

of patient with

chronic alcoholism

who sincerely

wants to maintain

sobriety.

□ At least 12 hours

should elapse from

the time of last

alcohol intake and

the initial dose

□ Use only in people

with high physical

health.

□ Use for 1-2 wks.

INTENDED Reaction

with alcohol ingestion:

□ flushing face, chest,

arms

□ pulsating HA

□ Nausea

□ violent vomiting

□ thirst

□ sweating

□ marked uneasiness

Side effects:

□ Rare in the absence

of alcohol

Adverse

effects/toxicity:

** Acetaldehyde

syndrome

□ hypotension to

shock level

arrhythmias,

□ acute congestive

failure,

□ marked respiratory

depression,

□ unconsciousness,

□ convulsions

□ sudden death

□ The effects of

disulfiram may

persist for 2 weeks

after last dose is

taken; alcohol must

not be consumed

until this interval is

over.

□ Give in the morning

when the resolve

not to drink is the

strongest. Give at

bedtime to

minimize the effect

of drug

□ avoid alcohol of all

forms include those

found in sauces,

cough mixture and

after shave lotions,

colognes and

liniments

Do not use:

□ In people who do

not want to stop

drinking.

□ Severe cardiac

disease,

□ psychoses,

□ pregnancy,

□ multiple drug

dependence.



Epinephrine

(Adrenalin)

□ alpha and beta

adrenergic agonist

□ vasopressor

□ bronchodilator

□ If given IM, SQ -

result seen in 5 min

& lasts up to 4 hrs.,

□ Also available eye

drops and

intranasal

□ Reverses

anaphylactic

reaction

□ Restores cardiac

rhythm in cardiac

arrest

□ Acute asthmatic

attack

□ Also use in

ophthalmic

decongestant,

manage open angle

glaucoma

Side effects:

□ nervousness,

□ tremors,

□ increased HR, BP,

□ insomnia,

□ anorexia

□ cardiac stimulation

□ vascular HA.


□ Tachyarrhythmias,

□ chest pain,

□ restlessness,

□ agitation,

□ nervousness and

□ insomnia.

□ Nasal burning

stinging,

□ eye burning

D/C if hypersensitivity

develops (develops of

lids, itching, discharge,

crusting eyelid). Notify

doctor

Teach

□ Report nervousness

and sleeplessness -

dose should be

reduced.

□ Administer eye

drops at bedtime.

May experience

headache and

stinging but subside

with continued use.

Report if continues.

□ Monitor VS

especially HR and

BP because of

cardio effect.

If use with MOA

inhibitors may lead to

hypertensive crisis.

□ Narrow angle

glaucoma,

□ hemorrhagic

traumatic or

cardiogenic shock,

□ arrhythmias,

□ organic heart or

brain disease.

CAUTION in:

□ older adults,

□ HTN

□ TB, long standing

bronchial asthma

and emphysema

□ children < 6

□ No breastfeeding



Famotidine (Pepcid)

□ Histamine

□ H2 antagonist.

Onset 1 hr. Peak 1-3hr

Duration 10-12 hrs.

Half-life 2.5-4hr

□ Decreases output

of gastric acid

□ Short term

treatment in

duodenal ulcer or

benign gastric

ulcer.

□ Metabolized in

liver, excreted in

urine

Side effects:

□ diarrhea,

constipation, dry

mouth



□ May be taken with

food.

□ pain relief may not

be experienced for

several days

□ Use cautiously with

impaired renal or

hepatic function.

□ Do not breastfeed

□ avoid antacid use

within 1 hour of

dose

Fluoxetine

hydrochloride (Prozac)

□ psych med.

□ Tricyclic

antidepressant.

□ Selective Serotonin

Reuptake inhibitors

(SSRI)

□

Half-life 1-6 days.

Onset 2-3 weeks to be

effective.

Peak 4-8hrs.

Metabolized in liver,

absorbed from GI tract,

excreted in urine and

face.

□ Major depressive

disorder

□ Obsessive

compulsive

disorder,

□ bulimia,

□ panic disorder

□ obesity

□ alcoholism

□ chronic pain.

Such as rash. Wait 4-6

weeks before switch to

MAO Inhibitor

Common side effects:

□ Orthostatic

hypotension

□ sedation

□ Anticholinergic

□ Hypomania

□ Sexual dysfunction


□ Cardiac toxicity

Selective Serotonin

syndrome (early s/s:

diaphoresis, agitation,

low grade temp.) Then

increase in BP, muscle

rigidity, temp, resp,

pulse. Mental status

changes, tremors,

hyperthermia, sweating

hypersalivation.

Notify dr ASAP.

□ DO NOT stop

abruptly.

□ Give meds once a

day at about noon

because it causes

insomnia. If

prescribed 2 times

daily give dose in

the morning early

and 12 noon to

prevent insomnia

□ Teach side effects

of drugs

□ Therapeutic

response takes

some weeks to be

established.

□ MI, cerebrovascular

disease.

□ If suicide risk,

should not have

access to a large

quantity.

□ Do not take while

pregnant

□ ** The combination

of TCA and MAOI

can lead to

hypertensive crisis

from excessive

adrenergic

stimulation of the

heart and blood

vessels.



Fluphenazine (Prolixin)

□ phenothiazine; Ends

with azine

□ antipsychotic

Half-life > 24 hours

Onset: 1 hr.,

peak 0. 5 hr. meds

effect can be seen 1-2

days but full effect

several weeks

□ Potent medication

for treatment of

antipsychotic

symptoms,

including

schizophrenia.

□ Treatment is not

curative.

□ Adjust dose to

symptoms.

□ Use injectable form

for long term

maintenance

- the rate of relapse is

usually reduced and is

more favorable

□ Produces EPS which

are reversible.

** Treat EPS with

Cogentin, Artane,

Benadryl, Symmetrel

Side effects: ABCDE

□ Anticholingergic

(dry mouth), Blurred

vision, Constipation,

Drowsiness, EPS


□ may increase risk of

agranulocytosis

□ gynecomastia,

□ amenorrhea

□ weight gain


Neuroleptic malignant

syndrome (NMS) a fatal

side effect. Presents

with catatonia, rigidity,

stupor, unstable blood

pressure, hyperthermia

profuse sweating,

dyspnea, incontinence.

Stop drug. Tx with

Dantrium and Parlodel.

Condition lasts for 5-10

days after stopping

med.

Monitor LFTs

TEACH

□ Avoid alcohol use

and other CNS

depressants

□ Do not alter dose or

stop abruptly

□ Avoid sun exposure

□ With oral

concentrate, avoid

spills. Rinse skin

with warm water

immediately if there

is contact

□ Dilute liquid drug

with fruit juice

water, carbonated

beverage, milk,

soup – avoid mixing

with caffeine, tea,

apple juice.

Avoid with:

□ Caution with

narrow angle

glaucoma, hepatic

or renal dysfunction

and seizure

disorder.

□ Do not breastfeed

□ Dose should be

reduced in the

elderly.



Furosemide (Lasix)

□ Loop diuretics,

□ Anti-hypertensive

Peak 60-70 min PO, 20-

60 min IV.

Onset 30-60 min PO, 5

min IV,

Duration 2 hrs.,

Half-life 30 min

□ Rapid acting loop

diuretic

□ Inhibits

reabsorption of

sodium and water

(in Loop of Henle)

□ Lowers BP by

decreasing edema

and intravascular

fluid

Treat

□ acute pulmonary

edema, edema,

□ heart failure,

□ chronic renal

impairment,

□ hypertension,

□ hypercalcemia

Side effects:

□ Ototoxicity

□ headache

□ Dizziness

□ Orthostatic

hypotension

□ weakness


□ s/s hypokalemia –

□ Hyponatremia,

□ hypochloremia,

□ hypomagnesaemia

□ hypocalcemia

IV form:

□ Administer slowly;

hearing loss can

occur if injected

rapidly (ototoxicity).

□ Give over 1-2

minutes to prevent

hypotension.

TEACH

□ change position

slowly to avoid

dizziness and

orthostatic

hypotension

□ report ringing in the

ear immediately

□ Take with food or

milk

□ Give early in day to

avoid nocturia

□ Replace potassium

(dietary or meds)

□ Monitor labs,

especially

electrolytes. Also

hgb, hct, platelet as

these increase d/t

hemoconcentration

□ Monitor body

weight and I&O.

Avoid with:

□ anuria, electrolyte

depletion,

increasing oliguria,

anuria

□ hepatic coma,

□ pregnancy,

lactation

□ Interaction with

digitalis can

increase

arrhythmias.

□ Interaction with

aminoglycosides

increases risk of

ototoxicity.



Gentamicin

(Garamycin)

□ Aminoglycosides.

□ Antibiotic

Peak level:

□ Drawn 15-30 min

after the infusion is

completed.

□ Peak concentration

determines that

toxic level does not

occur.

□ If peak is too high,

may reduce dose.

Trough level:

□ Drawn immediately

(within 30 minutes)

before next IV dose

□ Assures that

therapeutic level of

drug is maintained.

Trough level is 1-2

g/ml between

doses.

□ Dose will be

adjusted if level is

not sustained

Peak 30-90 min

Half-life 2-4 hr.

□ Broad-spectrum

antibiotic

□ Parenteral use

limited to severe

infections,

unresponsive to

other antibiotics.

Ophthalmic:

□ treat superficial

infection of the

eye.

□ Have pt. keep eyes

closed for 1-2 min

after instillation.

□ Vision will be

blurred initially

Side effects:

□ HA, parenthesia,

skin rash fever


□ Nephrotoxicity

□ Ototoxicity.

This may cause

irreversible auditory

impairment and

vestibular damage

Signs of ototoxicity

include HA, NV unsteady

gait, tinnitus, vertigo,

high frequency, hearing

loss and dizziness


reactions

□ Superinfection: a

secondary infection

caused by

eradication of

normal flora:

Candidiasis, skin and

mucous membrane

□ Maintain hydration

to protect kidney

damage. Fluid

intake should be

2,500-3000 ml/day

□ give high protein

foods

LABS

□ WBC to monitor the

effectiveness of

therapy

□ Watch kidney

function tests (BUN,

Creat) closely due to

toxicity risk

□ Report sore throat,

watery stools

greater than 4-6 per

day, severe nausea

or vomiting,

indicating possible

super infection

Avoid with:

□ Pre-existing renal

disease

□ Use caution with

pre-existing hearing

loss

□ Pregnancy,

lactation

□ Increased risk with

nephrotoxic drugs,

prolonged

treatment with

aminoglycosides,

impaired renal

function and other

ototoxic drug such

as Lasix, Vanco.



Glipizide (Glucotrol)

□ oral antidiabetic

□ Sulfonylurea

duration: 12-24 hours

Onset: 15-30 min

Peak: 1-2hr

Metabolized by the

liver

□ Stimulates

pancreatic beta

cells to secrete

insulin.

□ Type 2 diabetes

mellitus

□ Give dose 1-3 time

daily

□ may use alone or in

combination with

insulin

Side effects:

□ GI distress

□ dizziness

□ drowsiness

□ headache


□ Severe skin rash,

pruritus

□ Hypoglycemia

□ Monitor labs

including glucose,

Hgb A1C

TEACH

□ Take with first daily

meal.

□ Take any missed

dose as soon as

remembered.

□ Report s/s of

hypoglycemia if

they occur

□ Avoid alcohol

Avoid with:

□ Pregnancy,

lactation

□ Allergy to sulfa or

urea

□ Diabetic

ketoacidosis

Caution with:

□ impaired renal and

hepatic function

□ Adrenal or pituitary

insufficiency.

Glucagon

□ Anti-hypoglycemic

Onset 5-20 min,

Peak 30 min

Duration 1-1.5 hr.,

Half-Life; 3-10 minutes

Metabolizes in liver,

plasma and kidneys

□ Emergency

treatment of

severe

hypoglycemia in

unconscious client

or those unable to

swallow

□ Comes in powder

form. Reconstitute

with provided

diluent.

□ Give IV, IM or SQ

immediately

□ Give IV through

D5W only, not NS

Side effects:

□ Nausea/ vomiting



reaction,

□ hyperglycemia

□ Hypokalemia

□ Should awaken

within 5-20 min

after giving.

□ Give 50% glucose if

no response to

glucagon

Teach

□ test blood sugar,

□ teach family how to

administer SQ or IM

□ Incompatible with

sodium chloride

solution.



Glyburide

(Micronase, DiaBeta)

□ Oral antidiabetic,

□ more potent drug

□ Sulfonylurea

Onset 15-60 min

Peak 1-2 hrs.

Duration up to 24 hrs.

Half-life 10 hours

Metabolized in the

liver, excreted in urine

and feces.

□ Lowers blood sugar

concentration in

diabetics and

nondiabetics by

sensitizing

pancreatic beta

cells to release

insulin in the

presence of serum

glucose.

□ Type 2 diabetes

□ Use as adjunct to

diet and exercise to

lower blood sugar

Side effects:

□ Hypoglycemia,

□ epigastric fullness

□ heartburn

□ pruritus


□ hypoglycemia

□ Give once in the

morning with

breakfast or with

first main meal

□ Monitor labs

including glucose,

HgbA1c

Teach

□ Report reaction

□ Loss of control of

blood glucose level

may be due to

fever, surgery,

trauma, stress,

infection.

Avoid use with:

□ diabetic

ketoacidosis

□ Type I diabetes

Caution with:

□ renal or hepatic

insufficiency

□ older adult

□ malnourished pt.

□ adrenal or pituitary

insufficiency

Haloperidol (Haldol)

High potency drug

□ Antipsychotic

□ Butyrophenone

□ Antiemetic

Onset: 30-45 min IM

Effects can be seen in 1-

2 days. Substantial

improvement 2-4 wks.

Full effect several

months.

□ Psychotic disorders

□ Long acting drug

for maintenance –

to control

symptoms

□ Tourette’s syndrome

Side effects: ABCDE:

□ Anticholinergic (dry

mouth)

□ Blurred vision

□ Constipation

□ Drowsiness

□ Extrapyramidal

syndrome (such as

Parkinson’s s/s)



□ Elderly patient may

develop Neuroleptic

Malignant

Syndrome (NLMS)

□ EPSE: usually first

few days of tx, dose

related, controlled

by dose or anti-

Parkinson’s drugs

□ Oral: Give with milk

or food.

□ Taper dose slowly

when stopping.

□ Injection: deep IM –

risk for orthostatic

hypotension

□ no alcohol or driving

until response

known

Avoid with:

□ Parkinson’s disease

□ seizure disorder

□ severe mental

depression

Use caution:

□ older adults,

□ lithium therapy

□ HTN

□ Lactation



Heparin

□ Anticoagulant

Antidote = Protamine

sulfate (see separate

listing)

□ As anticoagulant –

given IV or SQ

□ Use as continuous

IV infusion for DVT,

Pulmonary

embolus, angina,

acute MI

□ SQ for prevention

□ Hep-lock (flush) is

to maintain

patency of IV

catheters; not for

anticoagulant

therapy

Side effects:

□ Bleeding

□ Heparin-induced

Thrombocytopenia

(HIT) – may appear

up to several weeks

later.

□ Does not dissolve

clots – prevents

enlargement and

development of

new clots.

□ Use bleeding

precautions

□ Monitor labs: aPTT

Normal = 25-40

Coagulated = 1.5-2

times normal = 60-80

□ Adjust IV dose

based on labs.

Avoid use with:

□ Hemorrhage, active

bleeding

□ Do not give IM.

Hydrochlorothiazide

hydrochloride

(Hydrodiuril, HCTZ)

□ Electrolyte and

water balance

□ Thiazide diuretic

□ Effects noted 3-4

days; max effect

takes 3-4 weeks

□ Most widely

prescribed diuretic

for HTN

□ Act on distal

tubules of nephron

and increases

urinary excretion of

sodium, chloride,

potassium, water,

bicarbonate

□ Decreases edema

and lowers blood

pressure

Side effects:

□ Glucose intolerance,

hyperglycemia

□ Hypokalemia (low

K+)

□ Give with food or

mild to reduce GI

upset.

□ Give dose(s) early in

the day to avoid

nocturia

□ Limit Sodium intake

□ Eat foods high in K+.

– replacement med

usually not needed


reaction occur 10-14

days after initial sun

exposure

Avoid with:

□ Anuria


thiazide

Use caution:

□ Bronchial asthma

□ hepatic cirrhosis

□ renal dysfunction

□ history of gout

□ diabetes

□ SLE

□ Lactation



Hydroxyzine HCl

(Atarax, Vistaril)

□ Anti-emetics

□ Anti-histamine (H1

receptor

antagonist)

□ antipruritic

Onset 15-30 min PO

Peak 4-6 hrs.

Duration

Absorbed form GI.

Metabolized in the liver

□ Treat N/V (use

anticipatorily)

□ Relieve anxiety

□ Reduce narcotic

requirement before

and after surgery.

□ Treat acute or

chronic alcoholism

with withdrawal

symptom or DTs

□ Pruritus

Usually PO for

maintenance

Side effects:

□ CNS depression,

□ Drowsiness

□ Dizziness

□ dry mouth,

anticholinergic

effect

□ constipation

□ visual changes


IM:

□ Administer deep IM,

Z-track – gluteus

maximum or vastus

lateralis in adults;

vastus lateralis in

children

□ monitor mouth daily

□ no alcohol

□ hard candy, ice

chips or rinse mouth

with warm water

frequently to relieve

dry mouth

Avoid with:

□ CNS depression and

coma.

□ Other CNS meds

Use caution with:

□ glaucoma

□ seizure

□ intestinal

obstruction

□ prostatic

hyperplasia

□ asthma

□ cardiac, pulmonary

or hepatic disease

Ibuprofen

(Advil, Motrin)

□ Analgesic

□ Non-steroidal anti-

inflammatory

(NSAID)

□ For high dose

therapy:

therapeutic effect

may take up to one

month

□ Treat mild to

moderate pain

□ absorbed in GI;

metabolized in liver

Side effects:

□ CNS, renal system,

eyes

□ Nephrotoxicity

□ dysuria, hematuria,

oliguria, azotemia,

□ Blurred vision.

□ Ototoxicity

Children toxicity:

□ Rash, Stevens-

Johnson syndrome

□ Increases toxicity of

anticoagulant,

lithium

□ Avoid alcohol, ASA,

other NSAIDs

Avoid with:

□ GI bleed

□ Reaction to other

NSAIDs

□ Children under 6

months



INSULINS

- quick acting:

- short acting

- intermediate acting

- long acting

Insulin is also available

in a premixed form of

Regular and NPH

(example: 70/30 = 30%

regular, 70% NPH).

□ Diabetes mellitus,

type 1 or type 2

□ Could be made of:

pork/beef, pork or

human insulin type.

□ Short acting and

intermediate acting

insulin may be

given more than

once per day.

Side effects:

□ Hypoglycemia

(anxiety, confusion,

nervousness,

hunger, diaphoresis,

cool, clammy skin)

□ Lipodystrophy

(abnormal deposits

of subcutaneous fat

at injection sites),

□ local allergic

reaction


□ Somogyi

phenomenon: a

rebound response

with high blood

sugar in response to

low level at night.

□ Coma

□ Hyperosmolar

hyperglycemic state

(HHS)

□ Diabetic

ketoacidosis (DKA)

□ obtain med alert

bracelets

□ Open vial can be

stored at room

temp for up to one

month.

□ Rotate sites

□ Alcohol will increase

blood sugar

□ Requires long-term

monitoring of blood

sugar control and

potential

complications.

□ Do not use

beef/pork insulin if

sensitivity



Insulin – Regular

(Humulin R)

**THIS IS THE ONLY TYPE

OF INSULIN WHICH CAN BE

GIVEN IV. **

□ Short acting insulin

□ Given IV or SQ

□ type 1 and type 2

diabetes mellitus

and ketoacidosis.

□ given before meals

according to blood

levels

□ hypoglycemia □ Regular insulin is

clear and colorless.

Isophane (NPH) insulin

(Humulin N)

□ Intermediate

acting insulin

□ Give 30 min before

first meal of the

day. If necessary, a

second smaller

dose may be

prescribed 30 min

before bedtime.

□ If given before

breakfast,

hypoglycemic

episode is most

likely to occur

between mid-

afternoon and

dinner, when it

peaks. Eat snack in

midafternoon and

carry sugar candy.

□ NPH Insulin is a

cloudy suspension.

□ Roll the bottle to

mix; do not shake.

□ NOTE: NPH may be

mixed with Regular

insulin injection

without altering

either solution.

Insulin – Glargine

(Lantus)

** LANTUS CANNOT BE

MIXED IN SAME SYRINGE

WITH ANY OTHER

INSULIN.**

□ Long acting insulin

□ Type 1 children &

adults; Type 2

adults

□ SQ injection

□ Usually given one

per day at bedtime.

May be given two

times per day.

□ With Type 2

diabetes, may or

may not be given

concurrently with

oral agents.



Iron □ Mineral

replacement

Side effects:

□ Nausea/vomiting

□ Staining of teeth

□ Constipation

□ Black stools

(normal)

□ Taking on empty

stomach preferred

with full glass of

water or citrus juice

□ Calcium inhibits iron

absorption – do not

take with milk.

□ Vitamin C increases

iron absorption

□ Liquid form can

stain teeth

Ipecac Syrup

□ Emetic

□ Antidote

Alternate: Activated

Charcoal (see separate

listing)

□ For overdose on

certain drug or

poison

□ stimulates vomiting

within 20-30 min


□ Cardiotoxicity is

most serious if

vomiting does not

occur and the

substance is

retained.

□ Use of this

medication is not

automatic – verify

appropriateness

with Poison control

center

Do not use:

□ With reduced level

of consciousness or

convulsions

□ poison by

Petroleum

distillates, strong

alkaline, acid or

strychnine



Lidocaine HCl

(Xylocaine)

□ Antiarrhythmic

□ Topical Anesthetic

Bolus dose – may

repeat – then start

continuous infusion –

stop when stable.

Therapeutic level: 1.5-

6mcg/ml

□ Treat VENTRICULAR

arrhythmias, PVC’s, V-Tach.

□ Use for rapid

control of

ventricular

dysrhythmias

during acute MI or

Cardiac cath

□ Use microdrip

tubing and infusion

pump.

Side effects:

□ Drowsiness,

headache, dizziness,

mild hypotension.


□ convulsions,

respiratory

depression

□ CV: hypotension,

bradycardia, heart

block CV collapse,

and arrest

□ Stop infusion with

EKG changes such as

prolonged PR,

widened QRS, heart

block.

LAB

□ Monitor Lidocaine

levels assess,

therapeutic level is

1.5 -6mcg/ml

□ Assess electrolyte,

check baseline liver

and renal blood

studies.

Report:

□ lightheadedness,

□ dizziness, confusion,

□ numbness or

tingling of lips,

tongue or fingers

□ visual changes or

□ ringing in ears

□ Correct

hypokalemia before

giving Lidocaine

Avoid with:

□ Sinus bradycardia

□ Severe degrees of

SA, AV and

intraventricular

heart block.

Use caution:

□ hepatic or renal

disease

□ CHF

□ Hypovolemia

□ shock

□ hyperthermia

□ elderly

□ BETA BLOCKERS

increase the effect

of lidocaine



Lithium carbonate

(Eskalith)

□ Mood stabilizer

□ Antipsychotic

□ Therapeutic level

0.8-1.5meq/L.

□ Toxic level >2.

□ Lithium has short

half-life (about 1

day) and high

toxicity.

□ Drug of choice to

control manic

episodes in bipolar

disorder

□ Anti manic effects

are usually seen in

5-7 days after initial

doses, but full

effect does not

occur for 2-3 wks.

□ Lithium is a salt;

exact action

uncertain

□ This med does not

cause sedation.

Mild Side effects:

□ fine tremor, nausea,

thirst, polyuria,


□ Vomiting, diarrhea,

slurred speech, lack

of coordination,

drowsiness, muscle

weakness, or

twitching) –

withhold dose and

notify provider but

DO NOT stop

abruptly.

□ Give with meals

□ Hydration is

essential –

dehydration will

increase levels

□ Watch for weight

gain (fluid

retention)

□ Avoid NSAIDs and

diuretics.

□ Essential to monitor

mood and behaviors

□ Labs: Lithium level

every 3 months

initially, then every

6 months.

Do not use with:

□ Dehydration,

severe debilitating,

severe

cardiovascular.

Use caution:

□ elderly,

□ pt. with cardiac,

renal, thyroid or

diabetes

□ pregnancy

Lorazepam (Ativan)

□ Anxiolytic


□ Benzodiazepines.

Onset

1-5 min IV, 15-30 IM,

Peak

60-90 min IM, 2 hrs. PO

Duration 12-24 hrs.

□ anxiety disorder

□ short term for relief

of symptoms of

anxiety

□ Pre-anesthetic

medication to

produce sedation

and reduce anxiety.

□ Status epilepticus

Side effects:

□ Drowsiness

□ sedation

□ Mild medication

with limited toxic

potential

□ respiratory

depression is rate

Paradoxical reactions

(nightmares, mania,

etc.) may occur in

children, psych patients

and the elderly.

□ Avoid alcohol □ Taper dose when

stopping to avoid

withdrawal

symptoms □ Watch for suicidal

risk

Do not use with:

□ Acute narrow-angle

glaucoma,

□ Primary depression

□ acute alcohol

intoxication.

□ Pregnancy and

Lactation

Use caution:

□ renal or hepatic

impairment

□ myasthenia gravis

□ suicidal tendencies



Magnesium Sulfate

iron(Epsom salt – oral

form)

Onset 1-2 hrs. PO; 1 hr.

IM.

Duration 30 min IV, 3-4

hr. PO

Eliminated by kidneys

Normal Magnesium

level: 1.8-3 mEq/L

□ Oral: laxative (by

osmotic retention

of fluid which

distend the colon,

increase content of

feces and cause

bowel stimulation)

□ Parenteral: CNS

depressant; used in

seizures of

toxemia; for

hypomagnesemia

□ 4 gm. loading dose

is give over 20-20

min via pump.

Side effects:

□ Flushed warm

feeling


imbalance

□ hyponatremia

□ N/V


Early indication of

magnesium toxicity

□ Respiratory

depression

□ Cathartic effect

□ profound thirst

□ feeling of warmth

□ sedation

□ confusion

□ depressed deep

tendon reflexes

□ muscle weakness

□ can lead to cardiac

arrest

s/s hypomagnesemia:

□ irritability

□ tremors, tetany

□ tachycardia

□ hypertension

□ psychotic behavior

□ Monitor urinary

output and hydrate

adequately with

parenteral

administration.

Avoid with:

□ MI, heart block,

cardiac arrest

except for certain

arrhythmias.

Use caution:

□ impaired kidney

function

□ other cardiac

glycosides

□ Lactating moms

and children



Mannitol (Osmitrol)

□ Electrolyte and

water balance

agent

□ osmotic diuretic

Onset

1-3 hr. diuresis; 30 to 60

min IOP, 15 min. for ICP

Duration

4-6 hr. IOP,

3-8 hr. ICP

Serum osmolality is 275-

300 mmol/kg.

Give IV.

Usually give test dose

which should result in

Output of 30 to 50

ml/hr. and is produced

2-3 hrs. after

administration.

□ Use in oliguria and

acute renal failure.

Help to prevent

renal failure and

reduce increased

intracranial or

intraocular

pressure

□ It acts by increasing

the osmolality of

plasma, glomerular

filtrate, and tubular

fluid. This

decreases the

reabsorption of

fluid and

electrolytes, which

increases excretion

of water, chloride

and sodium and

slightly increase the

excretion of

Potassium.

□ In intraocular (IOP)

and CSF (ICP), it

pulls the fluid and

sends it to the

plasma and

extravascular

systems

Side effects:

□ HA, confusion,

syncope


imbalance, esp.

hyponatremia

□ pulmonary

congestion, rhinitis

□ Water intoxication


□ Seizure,

□ thrombophlebitis,

□ CHF, Cardiovascular

collapse

□ Hyponatremia

Warning: There may be

a rebound increase in

ICP about 12 hours after

administration of med.

Pt may complain of HA,

or confusion.

□ Use filter needle

and/or filter in

infusion tubing

because crystals

may form in the

solution.

□ Mannitol is held if

serum osmolality

exceeds 310 -320.

□ Daily weights

Teach

□ Non-narcotics such

as Tylenol if there is

headache

□ Therapy is based on

urine flow rate.

□ Reassure pt. that

excessive thirst,

blurred vision,

rhinitis should

subside when

Mannitol is

discontinued

Do not use:

□ severely impaired

renal function

□ marked

dehydration

□ breast feeding

□ hepatic failure,

□ active ICP

□ anuria

□ Intracranial bleed

shock

□ Question the

administration of

mannitol if the

patient has cor

pulmonae (right

sided heart failure)

because Mannitol

pulls fluid and it

may lead to

circulatory overload

which the heart

could not handle.

This client would

need loop diuretic

to prevent serious

complications



Meperidine HCl

(Demerol)

□ Narcotic analgesic

(opioid agonist)

Give Narcan for

toxicity - It is use to

reverse respiratory

depression induced by

overdose

Onset: 15 mins. PO, 10

mins. IM, 5 mins IV

duration 2-4 hours

□ Given for moderate

to severe pain.

□ Potent, long acting

Side effects:

□ N/V, Anorexia

□ Sedation, dizziness

□ elevated BP

□ rash, urticaria

□ tremors

□ hyperventilation


□ Resp depression,

□ respiratory arrest,

□ circulatory

depression,

□ increased

intracranial pressure

Assess:

□ LOC

□ rash, urticaria

□ respiratory rate.

If respirations < 12 per

minute – withhold

meds.

Avoid use with:

□ acute bronchial

asthma, upper

airway obstruction

□ increased

intracranial

pressure

□ convulsive disorder

□ pancreatitis, acute

ulcerative colitis

□ severe liver or

kidney insufficiency

Caution with:

□ children and elderly

Metoprolol tartrate

(Lopressor, Toprol)

□ Beta adrenergic

antagonist

(beta blocker)

□ Antihypertensive

□ Antianginal = same

action as with

propanolol

□ Decreases heart

rate and cardiac

output

□ Lowers BP

□ Mild to severe HTN

□ angina pectoris

□ **Post - acute MI**

□ Max effect may

take 1 week

Side effects:

□ Usually well

tolerated

□ Nausea, vomiting

□ Weight gain

□ worsening CHF

□ insomnia


□ profound

bradycardia

□ heart block

□ acute CHF,

□ bronchospasm

□ laryngospasm

□ Give with or w/o

food, but consistent

□ Do not stop

abruptly; may cause

rebound effect.

Gradually decrease

over 1-2 wks.

□ Hold meds if BP < 90

or pulse < 60

□ Watch for s/s heart

failure

□ Can lead to elevated

BUN, creat.

□ May mask

hypoglycemia

Avoid use with:

□ Heart block greater

than 1st degree

□ Sinus brady,

□ cardiogenic shock

Use caution:

□ hyperactive airway

syndrome ( asthma

or bronchospasm)

□ Increases chance of

both Dig and

Lithium toxicity



Morphine Sulfate

(MS Contin = sustained

release form)

□ Narcotic analgesic

(Opioid agonist)

Give Narcan for

toxicity.

Onset, Peak, Duration

depend on route of

medication.

Onset: Immediate IV,

rapid if given IM or oral,

except MS Contin

□ Produces effect by

binding to opioid

receptors

throughout the

CNS.

□ Schedule II drug,

major drug abuse.

□ For severe, chronic

or acute pain.

□ Most commonly

use in post-

operative setting.

□ mild bronchodilator

to improve

breathing

□ MS Contin is

sustained release;

it will not control

break-through pain

because it is time

release.

Side effects:

□ Nausea vomiting

anorexia, GI,

□ pruritus,

□ light headedness

□ constipation


□ Classic triad of

symptoms:

respiratory

depression, coma,

pinpoint pupils.

□ Withdrawal begins

6-8 hrs. After the

last dose, reach

peak intensity within

48-72 hrs. S/S

include craving,

chills, sweating

piloerection (goose

flesh), abdominal

pain and cramps,

diarrhea, runny

nose, irritability.

□ Morphine induced

CNS stimulation –

paradoxical reaction

common in women

and older adults.

□ Avoid alcohol use

□ Hold medication if

respirations < 12/min

□ Hydrate adequately

to prevent

constipation

Avoid use with:


opiates)

□ acute bronchial

asthma or upper

airway obstruction,

□ ICP

□ convulsive

disorders

□ pancreatitis, acute

ulcerative colitis

□ severe liver or

kidney disease

□ Do not give

morphine to

children



Naloxone HCl (Narcan)

□ Opioid antagonist.

Onset

1-2 min IV;

2-5 mins. SQ or IM

Duration

1 hr. IV; up to 4 hrs. IM

but start to diminish

after 20 mins.

□ Competes with

opioids at the

opiate receptor

sites, blocking the

effects of the

opioids

□ Reverses effects of

opiates, including

respiratory

depression,

sedation and

hypotension.

□ May need given

every few hours

until the opioids

has dropped to a

nontoxic level

Side effects:

□ Increased BP, HR,

hyperpnea

□ tremors,

□ hyperventilation,

□ drowsiness,

□ nervousness

□ N/V


□ Hypotension,

□ V-tach and V-fib

□ convulsion,

□ hepatitis

□ pulmonary edema,

□ Watch vital signs

and respiratory

function closely

with administration

of medication

□ Titrate dose slowly -

if too much is given

the client will swing

from a state of

intoxication to one

of withdrawal

Avoid use with:

□ Known allergy

□ Respiratory

depression d/t non-

opioids

□ Substance abuse

(may lead to

withdrawal

symptoms)

Nedocromil (Tilade)

□ Inhaled non-

steroidal

medication

□ anti-inflammatory

and antiasthmatic.

(also available as optic

form – for ocular

allergic conjunctivitis)

□ asthma prophylaxis

NOT for acute

asthma attacks

□ up to a week for

full effectiveness

□ Must be taken

regularly to be

effective

Adverse effect:

□ abnormal bitter

taste

□ N/V, HA, dizziness,

sore throat.

□ Rinse mouth after

taking medication

to avoid dry mouth

□ Do not use for

acute attack

□ Non-compliance is a

concern due to

bitter taste

Avoid use with:

□ acute

bronchospasm or

status asthmaticus.


Use with caution:

□ hepatic or renal

function



Neomycin sulfate

(Mycifradin)

□ ORAL

aminoglycoside

□ antibiotic

Antibacterial – ORAL

□ GI tract

□ Hepatic coma

Main form is topical for

eye, ear and skin

infection.

NEOMYCIN IS NOT GIVEN IV

Side effects: skin rash

(esp. topical)


□ Nephrotoxicity

□ Ototoxicity.

□ Poorly tolerated GI

so it is usually for

bowel cleansing.

Nifedipine (Procardia)

□ Calcium Channel

Blocker

□ Antianginal


□ Negative inotropic

□ angina

□ mild to moderate

HTN (sustained

release form)

□ Dilates coronary

arteries and relaxes

coronary spasm

□ Increases cardiac

output; decreases

peripheral vascular

resistance.

□ Blocks calcium ion

flow into cells of

myocardial and

arterial smooth

muscle (cardiac and

peripheral blood

vessels)

□ Slows HR;

decreases O2 need

Side effects:

□ Usually well

tolerated

□ Headache

□ fatigue

□ Dizziness

□ Postural

hypotension

□ peripheral edema


□ Gingival hyperplasia

□ Do not give 1-2 wks.

after an acute MI.


grapefruit juice

(could lead to

toxicity)

□ Report gradual

weight gain and

evidence of edema;

may indicate onset

of CHF.

□ Do not stop

suddenly (will have

rebound symptoms)

□ Smoking decreases

efficacy of med

□ Monitor pulse rate –

report irregular or

slower than normal

rate. Hold for BP

below 90/60.

Avoid use with:

□ Known

hypersensitivity

□ Unstable angina

□ Lactation



Oxytocin (Pitocin)

□ Oxytocic

Labor and delivery.

Onset is immediate.

After stopping med,

contractions should

stop in 2-3 minutes

Half-life 3-5 min

□ To initiate or

improve uterine

contractions at

term

□ Induce labor

□ Management of

incomplete or

missed abortion

(miscarriage)

□ reduce postpartum

bleeding

Side effects:

□ subarachnoid bleed

□ fetal trauma

□ seizure, coma


Hypertensive crisis.

For fetal anoxia:

□ stop infusion, turn

mom on left side,

oxygen prn

Stop infusion for:

□ Contractions which

occur more often

than every 2 mins.

or last over 90 sec.

□ Careful monitoring

of uterine

contraction pattern,

fetal heart rate and

maternal BP.

□ Postpartum;

monitor lochia and

BP.

□ Do not increase

dose after desired

contraction pattern

is achieved

(contraction

frequency of 2-3 min

lasting 60 sec).

Avoid use with:


□ Cepahalopelvic

disproportion

□ Obstetric

emergencies

Pancrelipase

(Creon, Pancrease)

□ Pancreatic enzyme

replacement

therapy

□ Help to breakdown

fat, proteins and

carbs for better

absorption.

□ cystic fibrosis

□ chronic

pancreatitis, post

pancretectomy

□ steatorrhea

□ malabsorption

syndrome

Side effects:

□ Nausea, diarrhea,

and cramps


Hyperuricemia.

□ Report joint or

swelling pain (high

uric acid level)

□ Take with or just

prior to eating

□ Do not mix brand

names; there is a

variance in

concentration of

enzymes

□ Swallow tablet or

capsule whole; do

not crush or chew.

□ Can mix powder or

open capsule with

food.

Drug interaction:

□ Allergy to med or

pork


magnesium-

containing antacid.

May be ordered

with H2 blockers or

with proton pump

inhibitors.

□ Iron will decrease

effectiveness of

med.



Phenobartial

(Phenobarbital Sodium

= Luminal) – this is the

short-acting form.

For status epilepticus:

Administer slow IV

□ Anticonvulsant


□ Long-term

management of

grand mal, partial

seizure and status

epilepticus.

□ Sedative effect to

decrease anxiety

and tension.

□ No analgesic effect

Side effects:

□ Somnolence,

hangover effect


□ CNS depression,

□ Stevens-Johnson

□ Blood dyscrasias

□ Paradoxical

reactions may occur

in children, older

adults and

debilitated people

□ Okay to crush and

mix with food or

fluids

□ Monitor IV infusion

closely.

□ Do not stop

abruptly

□ Avoid alcohol and

other CNS

depressants

Avoid use with:


□ Resp or kidney

failure

□ Pregnancy and

lactation

Pilocarpine

hydrochloride (Pilocar)

□ Eye preparation.

□ Miotic (Anti-

glaucoma agent).

□ Direct acting

cholinergic agent

for ophthalmic use.

□ It is an antidote to

Atropine

□ For acute or

chronic Glaucoma –

decreases

intraocular

pressure

□ Will reverse the

effects of Atropine

(and Atropine will

reverse the effects

of Pilocarpine).

Side effects:

□ Visual blurring,

myopia, irritation,

brow pain and HA.

(with ophthalmic)

□ Normal: Increased

pigmentation of iris

and eyelids; long

eyelashes.


□ Retinal detachment

□ Ataxia

□ Confusion

□ seizure

□ Apply gentle

pressure for 1-2

mins. to

nasolacrimal

drainage area after

administering eye

gtts

□ Eye therapy will

continue long term

Avoid use with:

□ Asthma, COPD

□ HTN

□ Acute eye

infections, retinal

detachment,

contact lens use



Prazosin hydrochloride

(Minipress)


□ Alpha-adrenergic

receptor antagonist

□ vasodilator

□ Treat benign

prosthetic

hyperplasia (BPH)

Optimal effects may

take 4-6 weeks

□ Mild to moderate

HTN – mainly

diastolic

□ little effect on

cardiac output and

HR

□ BPH (due to

vasodilator effects)

Side effects:

□ Dizziness,

drowsiness

□ Fatigue, weakness.

□ Priapism, impotence

□ Orthostatic

hypotension


□ First-dose

phenomenon:

syncope within 30

min to 1 hr. Effect is

transient, may

diminish by giving

at bedtime.

□ monitor for

decreased BP,

especially with

initial administration

□ Monitor urine vol.

□ change position

slowly to prevent

orthostatic

hypotension

□ stop smoking and

avoid alcohol intake

□ avoid driving and

hazardous tasks

until effect of med

is known

Avoid use with:

□ Prior sensitivity

□ hypotension

Use caution with:

□ impaired hepatic

function

□ older adults

Prochlorperazine

(Compazine)

□ Antiemetic

□ Antipsychotic

□ Phenothiazine

□ Severe nausea and

vomiting

□ Management of

psychotic

disorders,

excessive anxiety

and agitation

□ Take 30-60 min

before any activity

that causes nausea

for best effect.

□ Start doses low and

increase slowly

Side effects:

□ drowsiness,

dizziness,

□ EPSE


□ Persistent tardive

dyskinesia

□ Tremor, twitching

□ Agranulocytosis,


□ After 1-2 months:

Akathisia (inner

restless, inability to

sit still) – may tx

with propranolol.

□ Avoid excessive

sunlight – may turn

skin gray-blue

□ Urine may turn

reddish brown

□ Use sugarless hard

candy or ice chips to

avoid dry mouth.

□ Avoid skin contact

with concentrate

□ Do not crush or

chew – swallow

whole

□ Deep IM, not SQ

injection

Avoid use with:


□ Blood dyscrasias

□ Dementia related

psychosis in elderly

□ Young children

□ Seizures

□ Lactation



Promethazine

(Phenergan)

□ Antiemetic

□ Antihistamine

□ Anti-vertigo

□ Long-acting med

□ motion sickness

□ nausea

□ IM route: Give deep

IM; not SQ (can

cause necrosis)

□ Avoid intra-arterial

injection – can

cause necrosis.

Side effects:

□ Resp depression,

□ drowsiness,

confusion

□ agranulocytosis

□ blurred vision

□ dry mouth

□ EPSE

□ Decrease GI distress

by giving oral dose

with milk or food.

□ May crush and mix

with food.

□ Avoid sunlight

exposure

□ Avoid alcohol and

other CNS

depressants

Avoid use with:

□ Acute MI, angina,

atrial fib

Use caution with:

□ Narrow angle

glaucoma

□ peptic ulcer

□ duodenal

obstruction

Protamine sulfate

□ Antidote for

Heparin toxicity.

□ Heparin antagonist

Onset = 5 minutes

Duration = 2 hours

Longer half-life than

heparin

□ Antidote for

Heparin overdose

□ Given IV; maximum

dose of 50 mg in 10

min time period;

should be titrated

according to the

time and length of

time the heparin

was administered

Side effect:

□ Abrupt drop in BP if

administered too

rapidly.

□ Monitor vital signs

and labs closely

(aPTT)

See listing for HEPARIN

Avoid use with:

□ Hemorrhage not

induced by heparin

overdose.

Ranitidine

hydrochloride (Zantac)

□ H2-receptor

antagonist.

□ Higher potency

than cimetidine

(Tagamet)

□ Reduce gastric

secretion.

□ Active duodenal

ulcer, maintenance

after healing

□ GERD

□ benign gastric ulcer

(short-term)

Side effects:

□ headache

□ taste disorder,

diarrhea,

constipation

□ dry mouth


□ hepatotoxicity


□ Give without regard

to meals

□ Usually give 1 x day

□ reduce dose in renal

patient

□ avoid smoking to

□ avoid antacid within

1 hour of dose

Avoid use with:


Use caution with:

□ Impaired renal of

hepatic function.

□ May increase

effects of alcohol,

aspirin, Coumadin

and sulfonylureas



Rh0(D) immune

globulin (RhoGAM)

□ Biological response

modifier

□ Immunoglobulin

(IgG)

Peak 2 hour

Half-life 25 days

□ Given to Rh-

negative moms

with RH positive

babies.

□ Provides passive

immunity by

suppressing active

antibody response

and formation of

anti-RHo when (1)

positive fetal RBC

enters maternal

circulation during

the third stage of

labor; (2) there is

fetal maternal

hemorrhage or other

trauma during

pregnancy; (3)

termination of

pregnancy or

miscarriage; or (4)

following a Rh+

transfusion.

Side effects:

□ Injection site

irritation

□ slight fever

□ myalgia

□ lethargy

□ Send sample of

newborn cord blood

to lab for cross

match and typing

immediately after

delivery before

administer RHo (D)

□ Give to mom IM via

deltoid. (Only a few

forms can be given

IV).

□ Give immediately

after reconstitution

□ Recommended at

28 weeks gestation

and then within 72

hours after delivery

or 3 hrs. of

termination of

pregnancy or

miscarriage.

□ Keep epinephrine

available; systemic

allergic reactions

sometimes occur.

□ TEACH it will

prevent hemolytic

disease in a

subsequent

pregnancy

Avoid use with:

□ Known sensitivity

to human

immunoglobulins.



Setraline

hydrochloride (Zoloft)

□ Antidepressant

□ SSRI (selective

serotonin reuptake

inhibitor)

□ panic disorders

□ Anxiety disorders

□ OCD

□ PTSD

□ 2-3 wks. to be

effective

Side effects:

□ Cause fewer

disorders than other

antidepressants

□ fewer side effects

on HR and HTN

□ Sexual dysfunction

□ Weight gain

Major complication

□ (Selective Serotonin

Syndrome): Pt. can

die from it. Elevated

temp up to 105.

Every speed up. BP,

HR, Temp. May

progress to coma.

□ Give with food in

the morning to

prevent insomnia

□ Watch for suicide

risk

□ Increases effect of

Coumadin

□ Avoid grapefruit

juice

Avoid use:

□ Within 14 days of

using MAO inhibitor

□ Seizure disorder

Spironolactone

(Aldactone)

□ Fluid & electrolyte

balance

□ antihypertensive

□ Potassium sparing

diuretic

□ Increases sodium

excretion; does not

decrease

potassium

□ treatment of

primary

aldosteronism

□ Use for edema and

HTN associated

with heart failure.

Side effects:

□ Headache

□ dizziness, weakness

□ orthostatic

hypotension


□ Hyperkalemia

(nausea, vomiting,

diarrhea, cramps,

tachycardia then

bradycardia)

□ aplastic anemia


□ Take with food

□ avoid salt substitute

high in K+

□ Avoid excessive

ingestion of foods

high in potassium.

□ no potassium

supplement needed

□ Monitor VS and

urine output

□ Avoid direct

sunlight

Avoid use with:

□ Serum K+ level > 5.5

□ anuria, acute and

chronic renal

insufficiency

□ diabetic

nephropathy


□ impaired hepatic

function

□ Decreases effect of

Dig;

□ increases chance of

lithium toxicity



Sucralfate (Carafate)

□ Antiulcer

□ Gastro-protective

agent

□ Protects the ulcer

from gastric acid by

forming an

adherent coating; it

absorbs pepsin

decreasing its

activity.

□ Duodenal ulcer

□ Short term with

gastric ulcer

□ esophageal ulcer

related to radiation

or chemotherapy

Side effects:

□ constipation

□ nausea

□ No antacid use

within ½ hour of

this medication

□ Avoid gastric

irritants such as

caffeine, alcohol,

smoking and spicy

foods.

Avoid use with:

□ Chronic kidney

failure

□ Decreases

absorption of Cipro,

Dig, Dilantin,

Tetracycline (so take

these med 2 hours

apart from Sucralfate)

Theophylline

(Theo-dur)

□ Bronchodilator

(resp. smooth

muscle relaxant)

□ xanthines

□ Normal level 10-20.

toxic level (> 20)

may develop

quickly

□ bronchospasms

□ asthma

□ bronchitis

□ emphysema

Side effects:

□ Tachycardia

□ Seizures

□ N/V, anorexia,


□ restlessness,

agitation, HA, and

insomnia

□ note: restlessness

could be due to

toxicity or hypoxia

so close assessment

is required

□ PO: take with water

and after meals.

□ Wait 4-6 hours after

IV to start PO.

□ Take same time

each day

□ Limit caffeine

□ Smoking decreases

effect of med

□ Increases lithium

excretion

Avoid use with:

□ CAD, angina

□ Renal or liver

disease

□ Pregnancy,

lactation

□ children

□ CHF and acute viral

□ can cause seizure

(with high

doses/levels) so

avoid with seizure

disorder unless

bronchospasm is

unresponsive to

other treatments



Tobramycin sulfate

□ Aminoglycoside

□ Antibiotic

IV/IM

Inhalation (TOBI)

Ophthalmic (Tobrex)

□ broad spectrum

antibiotic

□ Kills bacteria cell by

affecting protein

synthesis. Kill Gram

negative infection.

□ Inhalation –

preventative with

cystic fibrosis (28

days on, 28 days

off)

□ Eye – external eye

infections

Side effects:

□ HA, paresthesia, skin

rash, fevers.


□ Nephrotoxicity and

ototoxicity are two

common toxicities

associated with

aminoglycosides.

Eye – itching, swelling

REFER to sections on

aminoglycosides

(Gentamycin)

□ Doses are based on

weight

□ Do not other meds

In the same IV

LAB

□ Peak and Trough

□ serum creatinine,

BUN to monitor

renal function

Do not use with:


to other

aminoglycosides

□ Preexisting renal

disease.

Tolbutamide (Orinase)

□ Antidiabetic

□ Sulfonylureas

Peak: 3-5 hours

Duration: 6-12 hours

□ Mild to moderately

severe, stable Type

2 Diabetes

□ May be used as

adjunct therapy for

Type 1 Diabetes but

not sole medication

□ Give 1-2 x day after

meals

□ 1-2 weeks of

medication may be

required for full

therapeutic effect

Side effects:

□ GI distress

□ Pruritus, rash (may

stop on own)



□ Alcohol may cause

disulfiram like

reaction (flushing,

palpation and

nausea, flushing of

skin).

□ Hypoglycemia due

to too much med,

drug interactions,

N/V, inadequate

food intake.

□ Monitor blood

sugars including

fasting and HgbA1C

Teach

□ Signs and symptoms

of hypoglycemia

and notify

prescriber if they

occur.

□ Wear medic alert

bracelet or tag

□ Avoid alcohol

Avoid use with:

□ Allergy to sulfa or

urea

□ Beta adrenergic

blocking agents

(betablockers) can

suppress insulin

release and delay

response to

hypoglycemia

□ Consult dr. when

pregnant



Triazolam (Halcion)

□ sedative hypnotic

□ Anxiolytic

□ Benzodiazepine

Has rapid onset (15-30

mins.)

Peak 1-2 hours

Duration 6-8 hours

□ short term

management of

insomnia (4 weeks)

characterized by

difficulty falling

asleep, frequent

wakeful periods

□ Drowsiness,

lethargy, confusion

□ sleepwalking


□ Physical

dependence

□ Seizures (with rapid

withdrawal)

□ With overdose:

coma, respiratory

depression,

paradoxical anxiety

□ Do not use in

addictive prone pt.

□ Monitor symptoms

of overdose (slurred

speech, confusion,

somnolence,

impaired

coordination and

coma).

□ following long term

use, tolerance may

develop so do not

stop taking abruptly

Avoid use with:


□ Alcohol intoxication

□ Suicidal ideas

□ Pregnancy,

lactation

Trihexyphenidyl HCl

(Artane)

□ Anticholinergic

□ Antispasmodic

□ Treat Parkinson’s disease.

□ Diminishes hyper-

salivation; rigidity

and irregular

movements in

Parkinson’s. □ Use to control

drug-induced extra-

pyramidal side

effects

Side effects:

□ Drowsiness

□ Decrease urine

output, retention or

hesitancy

□ Dry mouth

□ Constipation


□ Paralytic ileus

□ Monitor I& O

□ increase fluids, bulk

and exercise

□ void before taking

to reduce urinary

retention

□ Avoid driving or

other hazardous

activities as

drowsiness may

occur.

□ Avoid OTC such as

cough medicine

with alcohol.

□ Very dose sensitive

Avoid use with:

□ narrow angle

glaucoma,

□ myasthenia gravis

□ GI obstruction



Vincristine sulfate

(Oncovin)

□ Antineoplastic

□ Vinca alkaloids

(from plant)

□ mitotic inhibitor

□ IS a vesicant;

administer into the

side arm portal of a

freely flowing IV.

□ Hyaluronidase is

given if this

vesicant should

infiltrate. May

apply heat to site to

disperse drug and

minimize sloughing.

□ Acute

lymphoblastic and

other leukemias

□ lymphosarcoma,

□ Hodgkin’s disease

□ breast and lung

cancers

□ Major toxicities

occur in the

hematopoietic,

integumentary,

neurologic and

reproductive,

system.

□ Peripheral

neuropathy

□ Paralytic ileus (more

common in young

children)

□ Alopecia


□ Neurotoxicity - loss

of sensation of the

soles of feet and

fingertips

□ Depression of the

Achilles reflex is the

earliest sign of

neuropathy

□ Children are

especially likely to

develop neuro

changes

□ Neutropenic

precautions prn

□ Assess hand grasp

and deep tendon

reflexes

□ Maintain a regimen

against constipation

and paralytic ileus;

report a change in

bowel habits.

Vesicant safety

precautions:

□ Good vein, prefer

central line access

or fresh butterfly

stick

□ chemo-trained

nurse

□ remain during

infusion

□ have antidote

handy

Avoid use with:

□ Obstructive

jaundice

□ Pre-existing

neuromuscular

disease

□ Active infection

□ Pregnancy,

lactation

□ Bronchospasm may

occur in pt

previously treated

with mitomycin



Vitamin B6

(Pyridoxine HCl)

□ Water-soluble

vitamin

Absorbed by GI tract

s/s of deficiency:

□ Lack of energy

□ Decreased brain

functioning

□ skin lesions,

□ conjunctivitis

□ Prevention and

treatment of

pyridoxine

deficiency (see

causes)

□ Co-enzyme in

amino acid

metabolism and

red blood cell

production

□ Treats acute

toxicity of INH,

hydralazine.

Side effects:

□ Pain at injection site


□ Neuropathy

□ Ataxia

□ seizures

Causes of deficiency:

□ Alcoholism

□ Malabsorption

disorders

□ Oral contraceptives

Dietary sources:

□ green leafy veg.

□ organ meats, fish,

poultry

□ legumes, chickpeas

□ bananas

□ whole grains,

□ potatoes

Use with caution:

□ Renal disease

□ Cardiac disease

Common drug

interactions:

□ INH, hydralazine,

oral contraceptives

□ Reverses or

antagonizes effects

of levodopa.

Vitamin B12

(see entry under

Cyanocobalamin)

Vitamin C

(Ascorbic acid)

□ Water soluble

vitamin

s/s of Deficiency which

is called Scurvy

□ Malaise, lethargy

□ pinpoint

hemorrhages

□ bleeding gums,

rough skin and

blotchy spots

especially legs

□ Protects

connective tissue,

strengthens blood

vessel walls, forms

scar tissue,

provides matrix for

bone growth

□ Supports immune

system

□ helps in absorption

of iron and to

metabolize amino

acid

□ acidifies urine

Side effects:

Rare at normal doses


□ crystalluria

□ Increases

absorption of Iron

□ Mix oral solutions

with food


□ Normal aging

□ Alcohol

□ Other meds

Dietary Sources:

□ citrus fruits,

cantaloupe,

strawberries,

□ broccoli, cabbage,

cauliflower

□ tomatoes

Avoid use with:

□ Prone to kidney

stones

□ Megadoses of Vit. C

can interfere with

absorption of

Vitamin B12.



Vitamin D2

(Ergocalciferol)

□ Fat-soluble vitamin

s/s deficiency which is

called rickets

□ bones fail to calcify

□ bowed legs

□ osteomalacia

□ muscle spasm

□ Calcium and

phosphate

metabolism

Remember calcium

and phosphorus are

inverse (high one,

lower other)

□ Necessary to

develop and

maintain strong

bones

□ osteomalacia and

osteoporosis

□ hypo-

parathyroidism

□ Treat and prevent

rickets

Side effects:

□ Uncommon at

normal doses

□ Metallic taste


□ n/v,

□ fatigue, headache,

□ hallucinations

□ dysrhythmias

□ Hypercalcemia

□ Stones


□ Inadequate sunlight

□ Dietary intake

□ hypoparathyroid

Dietary Sources:

□ Egg yolks

□ fortified cereals and

milk

□ Cod liver oil

□ some fish

□ Also obtained from

sunlight

Avoid use with:


Vit. D

□ Hypercalcemia

□ Hyper-

phosphatemia



Vitamin E

(alpha-tocopherol)

□ Fat-soluble vitamin

s/s deficiency:

□ Hemolytic anemia

□ Dietary supplement

□ Hemolytic anemia

in neonates

□ Topical to chapped

skin

□ Prevents cell

membrane damage

protects against

blood clot

development

Side effects:

□ Uncommon at

normal doses


□ N/V

□ fatigue,

□ headache

□ blurred vision

Toxic:

□ jaundice

□ brain damage


□ normal aging

□ Prematurity

□ Malabsorption

diseases

Dietary Sources:

□ Wheat germ

□ Vegetable oils

□ Green leafy

vegetables

□ Nuts

□ Dairy, eggs

Use with caution:

□ Bleeding disorders

□ Pregnancy

□ Avoid mineral oil

Vitamin K1

(Aquamephyton)

(Phytonadione)

□ Fat soluble vitamin

s/s deficiency:

□ Deficiency causes

hemorrhage.

Given as antidote for

Coumadin (warfarin)

overdose.

Onset IV = 6 hours

See entry under

Warfarin (Coumadin)

□ Promotes liver

synthesis of

clotting factors

□ Given to newborns

to prevent bleeding

□ Given as antidote

for coumadin

toxicity.

□ Also reverses hypo-

prothrombinemia

from various

causes

Side effects:

□ Swelling and pain at

injection site


□ Hypersensitivity or

anaphylaxis – like

reaction

□ Bronchospasm,

Cardiac arrest

□ SQ administration

preferred over IM.

□ Labs: Monitor

PT/INR (see note

under ‘warfarin’)


□ fat malabsorption

□ medication

Dietary Sources:

□ Asparagus, broccoli,

cabbage, Green

leafy vegetables

□ Green tea

□ Tomatoes

Avoid use with:

□ Known

hypersensitivity to

med



Warfarin sodium

(Coumadin)

□ ORAL anticoagulant

To reserve

hyperanticoagulation –

(1) Hold and/or skip

doses of Coumadin

(2) Antidote which is

Vitamin K1

(Aquamephyton)

□ Coumadin

interferes with

synthesis of

clotting factor(s)

that require Vit. K.

□ Given PO.

□ Has narrow

therapeutic range.

Can take 1 week for

Therapeutic effect

□ PT level will be

maintained at 1.5 –

2.5 the times the

control value

(which is 12-15 sec.)

□ INR range from 2.0-

3.0 (control 1.0)

□ Labs need

monitored often

(sometimes 2-3 x

week) initially,

then are decreased

over time

Side effects:

□ Ecchymotic skin

□ GI & skin problem

□ Hypotension



□ Bleeding is the

major adverse

effect.

□ Coumadin may be

started while pt is

still on continuous

IV heparin therapy).

Heparin is tapered

off slowly over 2-3

days. Pt. remains on

oral Coumadin.

□ Often given in the

evening with lab

draws in the

morning – it must

be taken same time

each day

□ Avoid or use

consistently foods

high in Vit. K

□ May be long-term

medication

depending on

reason for

medication

□ Teach bleeding

precautions

□ Observe closely and

report s/s bleeding

Avoid use with:

□ hemorrhaging or

bleeding

tendencies

□ malignant

hypertension

□ past history of

allergic reaction to

Coumadin

□ Many, many meds

have drug

interactions with

Coumadin

references: pearson nurses’s drug guide saunders ... file03.06.2013 · wsu – conh study guide...

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