7115226-Pharmacology

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1.
Cardiac glycosides
a.
action: makes heart beat slower but stronger
i.
improves pumping ability of heart
ii.
increases force of heart's contraction
iii.
decreases rate of contraction
iv.
increases cardiac output
b.
examples
i.
digitoxin (Crystodigin)
ii.
digoxin (Lanoxin)
c.
use
i.
congestive heart failure
ii.
atrial flutter
iii.
atrial fibrillation
d.
contraindications
i.
ventricular tachycardia
ii.
ventricular fibrillation
iii.
second and third degree heart block
e.
adverse side effects
i.
gastrointestinal effects such as nausea and vomiting, diarrhea, and
anorexia
ii.
bradycardia
iii.
xanthopsia
iv.
muscle weakness
v.
dysrhythmia
f.
nursing interventions
i.
before giving glycoside, check apical pulse and heart rhythm. Report
if < 60 bpm
ii.
establish baseline data such as vital signs, electrolytes, clinical
symptoms, creatinine clearance test
iii.
monitor for drug toxicity

in children - cardiac arrhythmias

in adults - visual disturbances, nausea and vomiting,
anorexia

older clients more prone to toxicity
iv.
monitor drug levels

therapeutic range 0.8 to 2.0 ng/ml

toxic range > two ng/ml

diuretics may increase chance of toxicity
g.
monitor intake and output
h.
client teaching
i.
take medication as prescribed
ii.
teach client how to take and record pulse daily
iii.
identify and report signs of toxicity

for atrial fibrillation: take pulse and report if below 60 or
above 100 or changes in rhythm

daily weights: report two pound increase
2.
Antihypertensives
a.
action: dilates peripheral blood vessels
b.
examples
i.
hydralazine HCL (Apresoline)
ii.
enalapril maleate (Vasotec)
iii.
reserpine (Serpasil)
iv.
prazosin HCL (Minipress)
v.
methyldopa (Aldomet)
vi.
clonidine (Catapres)
c.
use: hypertension
d.
contraindications
i.
heart block
ii.
children
e.
adverse side effects
f.
3.
i.
orthostatic hypotension
ii.
dizziness
iii.
bradycardia
iv.
tachycardia
v.
sexual dysfunction
vi.
deterioration in renal function
vii.
agranulosis
nursing interventions
i.
monitor vital signs and blood pressure, sitting and standing
ii.
monitor for hearing changes, renal functioning
iii.
if hypotension, closely monitor client
iv.
encourage intake of foods high in vitamin B
v.
teach client

low sodium diet

change positions slowly

take medication as instructed

avoid hazardous activities

protect medication from heat and light
Thrombolytics
a.
action: binds with plasminogen to dissolve thrombi (clots) in coronary arteries
within four to six hours of myocardial infarction. Activates conversion of
plasminogen to plasmin. Plasmin is able to break down clots (fibrin).
b.
examples
i.
streptokinase (Streptase)
ii.
urokinase (Abbokinase)
c.
uses
i.
myocardial infarction
ii.
deep venous thrombosis
iii.
pulmonary emboli
d.
contraindications
i.
active bleeding
ii.
cerebral embolism/thrombosis/hemorrhage
iii.
recent intraarterial diagnostic procedure or surgery
iv.
recent major surgery
v.
neoplasms of the CNS
vi.
severe hypertension
e.
adverse side effects
i.
bleeding
ii.
allergic reactions:urticaria, itching, flushing, headache (illustration
)
a.
4.
nursing interventions
iii.
monitor for bleeding
iv.
monitor coagulation studies
v.
monitor for allergic reactions
vi.
keep available: aminocaproic acid (fibrinolysis inhibitor)
Lipid-lowering agents (antilipemic)
a.
action and use: lower LDL levels by reducing the synthesis of cholesterol
and/or triglycerides. Use: primary hypercholesterolemia
b.
examples
iii.
cholestyramine (Questran)
iv.
atorvastatin (Lipitor)
v.
colestipol (Colestid)
vi.
nicotinic acid (Niacin)
c.
contraindications:
iii.
hypersensitivity
iv.
pregnancy/lactation
v.
active liver disease
d.
adverse side effects
5.
iii.
skin flushing
iv.
gastric upset
v.
niacin: temporary, intense flushing of face, neck and ears
vi.
reduced absorption of fat-soluble vitamins
vii.
disruption of liver function
viii.
muscle tenderness or weakness (rhabdomyolysis)
e.
nursing interventions
iii.
monitor cholesterol levels
iv.
monitor liver function tests
v.
teach client
I.
blood work and eye exams will be necessary during
treatment
II.
to report blurred vision, severe GI symptoms, or headache
III.
about low-cholesterol high-fiber diet
IV.
to report muscle weakness or tenderness
vi.
with cholestyramine, colestipol: Give other medications (e.g., such as
thiazide diuretics, digoxin, warfarin, and certain antibiotics) one hour
before or four hours after administration of cholestryramine and
colestipol, so that they will not react with bile-acid-binding resins
Antianginals
a.
nitrates
iii.
examples: nitroglycerin, isosorbide dinitrate (Isordil)
iv.
action: dilate arterioles which lowers peripheral vascular resistance
(afterload)
v.
uses: treatment and prevention of acute chest pain caused by
myocardial ischemia
vi.
adverse effects: postural hypotension, headache, flushing, dizziness
vii.
contraindications
I.
hypersensitivity
II.
severe anemia
III.
hypotension
IV.
hypovolemia
viii.
nursing Interventions
I.
monitor for orthostatic hypotension
II.
monitor for tolerance with long term use
III.
administer every five minutes but not more than three
tablets in 15 minutes
IV.
if pain not relieved after 15 minutes and three tablets,
notify physician immediately
V.
instruct client
I.
take pulse before taking medication
II.
take oral preparations without food
III.
when to seek medical attention
IV.
not to chew or swallow sublingual tabs
V.
make position changes slowly
VI.
carry drug so that it is always within reach but
avoid exposure to body heat and light
VII.
replace drug approximately every six months
VIII.
avoid alcohol ingestion
b.
beta-adrenergic blocking agents
iii.
examples: propranolol (Inderal), metoprolol (Lopressor)
iv.
action: inhibit sympathetic stimulation of beta receptors in the heart
decreases heart rate and force of myocardial contraction thus
decreasing myocardial oxygen consumption
v.
uses: reduces frequency and severity of acute anginal attacks,
dysrhythmias
vi.
side effects: blood dyscrasias, hypotension, GI disturbances, flushing
of the skin
vii.
contraindications
I.
hypersensitivity
II.
cardiogenic shock
III.
cardiac failure
viii.
nursing interventions
I.
II.
III.
IV.
V.
6.
8.
weigh daily. Report weight gain of five pounds or greater
monitor ECG if using for dysrhythmia
administer on an empty stomach
protect injectable solution from light
instruct client
I.
take pulse before taking drug
II.
not to discontinue medication abruptly
III.
avoid hazardous activities if drowsiness occurs
IV.
make position changes slowly
V.
take drug at same time each day
c.
calcium channel blockers
iii.
examples: verapamil (Isoptin), nifedipine (Adalat), diltiazem
(Cardizem)
iv.
action: prevent the movement of extracellular calcium into the cell
resulting in coronary and peripheral artery dilation
v.
uses: stable angina, dysrhythmias, hypertension
vi.
side effects: headache, drowsiness, dizziness, GI disturbances,
flushing of the skin
vii.
contraindications: hypersensitivity
viii.
nursing interventions
I.
monitor chest pain
II.
monitor ECG if used for dysrhythmia
III.
administer with food
IV.
instruct client
I.
increase fluids to counteract constipation
II.
take pulse before taking drug
III.
avoid hazardous activities until stabilized on drug
IV.
limit caffeine consumption
V.
avoid alcohol
VI.
change position slowly
Hypotension and shock
a.
natural and synthetic catecholamines
b.
examples: epinephrine, dopamine (Intropin), dobutamine (Dobutrex)
c.
actions: increase cardiac output, (+) inotrope, (+) chronotrope
d.
uses: dopamine and dobutamine: hypovolemic and cardiogenic shock,
epinephrine: anaphylactic shock
e.
adverse effects: dysrhythmias, hypotension, tissue necrosis if extravasation
occurs. Tremors, anxiety, dizziness with epinephrine
f.
contraindications
iii.
hypersensitivity
iv.
ventricular fibrillation
v.
tachydysrhythmias
vi.
safety in children not known
g.
nursing interventions
iii.
correct hypokalemia before administering
iv.
monitor vital signs frequently
v.
monitor ECG continuously during administration
vi.
administer with infusion pump
vii.
start drug slowly and increase according to health care provider's
orders
viii.
monitor injection site for extravasation
ix.
protect solution from light
x.
do not use discolored solution
xi.
stop the drug gradually
Anticoagulants
a.
action: disrupt the blood coagulation process, thereby suppressing the
production of fibrin
b.
examples
i.
heparin: parenteral administration
ii.
coumadin (Warfarin): oral administration
c.
use
i.
pulmonary embolism
d.
e.
f.
ii.
deep vein thrombosis
iii.
myocardial infarction
iv.
atrial fibrillation
adverse side effects
i.
allergic responses such as chills, fever and urticaria
ii.
use cautiously if client tends to bleed (hemophilia, peptic ulcer)
iii.
GI disturbances- nausea and vomiting, diarrhea, abdominal cramps
contraindications
i.
hemophilia
ii.
leukemia
iii.
peptic ulcer
iv.
blood dyscrasias
nursing interventions
i.
heparin: monitor APTT (activated partial thromboplastin time)

normal 40 seconds

at therapeutic levels, APTT increases by a factor of 1.5 to 2
ii.
coumadin - monitor PT (prothrombin time)

normal 12 seconds

INR (International normalized ratio) two to three
iii.
do baseline blood studies before therapy
iv.
have antidote ready

heparin: protamine sulfate

coumadin: vitamin K
v.
monitor client for symptoms of hemorrhage such as increased pulse,
decreased BP
vi.
avoid salicylates (such as aspirin)
vii.
avoid IM injections
viii.
teach client

take medication at same time every day

wear medical alert jewelry: wearer takes anticoagulants
(illustration







9.
)
use a soft toothbrush
do not use a straight razor; use an electric razor
avoid alcohol and smoking
report any signs of bleeding, red or black bowel
movements, headaches, rashes, red or pink-tinged urine,
sputum
avoid trauma
blood levels of the anticoagulant may be monitored
do not take over-the-counter (OTC) medications without
health care provider's approval
Antidysrhythmics
a.
action
i.
prevent abnormal heart rhythms
ii.
action depends on type of antidysrhythmics drug
b.
examples
i.
class I: sodium channel blockers - quinidine (Quinidex), lidocaine;
decreases myocardial excitability and contractility
ii.
class II: beta blockers -propranolol (Inderal); stabilizes cell
membrane
iii.
class III: conduction delayers- bretylium (Bretylol); decreases
conduction and excitability of myocardial cells
iv.
class IV: calcium channel blockers - verapamil (Isoptin);inhibits
influx of calcium ions across cell membrane during cardiac
contraction; reduces cardiac excitability and dilates main coronary
arteries
v.
c.
d.
e.
others - digoxin (Lanoxin), adenosine (Adenocard); slows heart rate,
improves pumping ability of the heart
use: to treat abnormalities in cardiac rate and rhythm
adverse effects
i.
hypotension
ii.
nausea and vomiting
iii.
blood dyscrasias
iv.
toxicity such as CNS disturbances due to neurotoxicity, and diarrhea
due to GI irritation
nursing interventions
i.
monitor cardiac rhythm
ii.
monitor blood levels
iii.
monitor for blood dyscrasias
iv.
administer oral preparations with meals
v.
monitor EKGs
vi.
use infusion-control devices for IV administration
vii.
teach client
I.
report changes in heart rate and/or rhythm
II.
report any side effects
Managing respiratory disease
1.
Bronchodilators
a.
action:
i.
b.
c.
d.
e.
f.
dilate air passages in the lungs, specific action dependent on type of
drug.
increase heart rate
act on the autonomic nervous system
ii.
iii.
examples
i.
beta-adrenergic: abuterol (Proventil, Ventolin), metaproterenol
(Alupent)
ii.
xanthines: aminophylline, theophylline (Theo-Dur) acts on bronchial
smooth muscle
iii.
epinephrine HCL (Adrenalin) - increases the rate and strength of
cardiac contraction through the sympathetic nervous system
iv.
isoproterenol HCL (Isuprel) - increases the heart rate by stimulating
the beta-adrenergic blocking agent of the sympathetic nervous system
use
i.
bronchospasms
ii.
asthma
adverse effects
i.
dizziness
ii.
tremors
iii.
anxiety
iv.
palpitations
v.
gastric disturbances
vi.
headache
vii.
tachycardia
viii.
dysrhythmias
contraindications
i.
hypersensitivity
ii.
narrow angle glaucoma
iii.
tachydysrhythmias
iv.
severe cardiac disease
nursing interventions
i.
monitor theophylline levels (normal ten to 20 mcg/dl)
ii.
monitor intake and output, and vital signs
iii.
monitor EKG, vital signs during therapy
iv.
teach clients

take medication as prescribed only

report adverse effects

stop smoking during therapy


take with meals
avoid OTC drugs
2.
Mucolytics/expectorants
a.
action
i.
mucolytics: disrupt molecular bonds and thins mucus
ii.
expectorants: stimulate a gastric mucosal reflex to increase
production of lung mucous
b.
examples
i.
mucolytic: acetylcysteine (Mucomyst)
ii.
expectorant: guaifenesin (Robitussin)
c.
uses
i.
asthma
ii.
acute or chronic bronchopulmonary disease
iii.
cystic fibrosis
iv.
mucomyst: acetaminophen toxicity
d.
adverse side effects
i.
oropharyngeal irritation
ii.
bronchospasm
iii.
gastric effects
e.
contraindications
i.
increased intracranial pressure
ii.
status asthmaticus
f.
nursing interventions
i.
monitor respiratory status
ii.
teach client

take no fluids directly after oral administration

do take plenty of fluids

encourage coughing and deep breathing, especially before
treatment
3.
Antitussives
a.
action: to supress coughs through medullary cough center or indirect action on
sensory nerves
b.
examples
i.
narcotic: codeine, hydrocodone bitartrate (Hycoda)
ii.
nonnarcotic - dextromethorphan (Robitussin)
c.
use: colds, respiratory congestion, pneumonia, bronchitis, TB, cystic fibrosis,
emphysema
d.
adverse effects
i.
drowsiness
ii.
nausea
iii.
dry mouth
iv.
dizziness
e.
contraindications
i.
hypothyroidism
ii.
iodine sensitivity
f.
nursing interventions
i.
monitor blood counts with long term therapy
ii.
increase fluid intake
iii.
humidify client's room
iv.
teach client

increase fluid intake if not contraindicated

do not to take fluids immediately after medication

avoid driving and other hazardous activity especially if
taking narcotic type

antitussives add to the effects of alcohol
Antituberculosis agents
a.
action: appears to inhibit RNA synthesis, so stops tubercle bacilli from
multiplying (first line) or functioning (second line)
b.
examples
4.
i.
first line

5.
6.
ethambutol (Myambutol) decreases mycobacterial RNA
synthesis

isoniazid (INH) - suppresses mycobacterial cell-wall
synthesis
ii.
second line

capreomycin (Capastat)

pyrazinamide (PZA)
c.
adverse effects
i.
gastric irritation
ii.
CNS disturbances
iii.
liver disturbances
iv.
blood dyscrasias
v.
streptomycin - ototoxicity
vi.
ethambutol - visual disturbances
vii.
isoniazid - suppressed absorption of fat and vitamin B complex
d.
contraindications
i.
severe renal disease
ii.
hypersensitivity
e.
nursing interventions
i.
monitor client response to therapy
ii.
monitor blood work during therapy
iii.
if CNS disturbances are evident, take safety precautions
iv.
teach client

to take medication as ordered

to eat foods rich in B-complex vitamins

avoid use of alcohol

report if become pregnant

ethambutol: report eye problems, have regular eye exams
Antihistamines
a.
action: blocks histamine at receptor sites
b.
examples
i.
promethazine HCL (Phenergan)
ii.
chlorpheniramine maleate (Chlor-Trimeton)
iii.
diphenhydramine (Benedryl)
c.
uses
i.
relieves symptoms of allergies, colds, pruritus
ii.
prevents problems in blood transfusion and drug reactions
d.
adverse effects
i.
drowsiness
ii.
gastric effects
iii.
dry mouth
iv.
headache
v.
thickening of bronchial secretions
e.
contraindications
i.
acute asthma
ii.
lower respiratory heart disease
iii.
narrow angle glaucoma
f.
nursing interventions
i.
discontinue four days before skin testing for allergies
ii.
avoid interaction with CNS depressants
iii.
teach client

avoid driving and hazardous activities

take antihistamines with food

additive effect with alcohol, other CNS depressants
Anti-inflammatories
a.
action: stabilizes mast cells so chemical mediators are not released as easily;
decreases bronchial hyperreactivity; decreases airway inflammation
b.
example:
i.
cromolyn sodium (Intal)
ii.
c.
d.
e.
f.
leukotriene receptor antagonists-zafirlukast (Accolate), montelukast
(Singular)
iii.
glucocorticoids- beclamethasone (Vanceril), triamcinolone
(Azmacort)
use: to prevent asthma attacks, exercise-induced bronchospasms
adverse effects
i.
cough
ii.
CNS disturbances
iii.
burning, stinging eyes
iv.
throat irritation
v.
headache
contraindications
i.
status asthmaticus
ii.
hypersensitivity
nursing interventions
i.
monitor eosinophil count
ii.
monitor respiratory status
iii.
store in tightly closed light-resistant container; keep cool
iv.
teach client

how to use the inhaler



rinse mouth after using steroid inhaler
when to call health care provider if medications are not
effective
that therapeutic effect may take up to four weeks
Neurological (including anesthetics)
1.
2.
Anticonvulsants
a.
action - modifies bioelectric activity at subcortical and cortical areas
b.
examples
i.
diazepam (Valium)
ii.
magnesium sulfate
iii.
phenytoin (Dilantin)
iv.
phenobarbital (Luminal)
c.
use: prevents seizures
d.
adverse effects
i.
blood dyscrasias
ii.
gastric effects - nausea, vomiting
iii.
CNS depression - dizziness, drowsiness
iv.
phenytoin: ataxia, hirsutism, hypotension
e.
contraindications
i.
hypersensitivity
f.
nursing interventions
i.
give medication with food
ii.
wiith phenytoin: monitor condition of oral mucosa, don't mix with
other IV fluids, monitor blood lab results, monitor urine
iii.
renal, liver, and blood studies
iv.
teach clients

avoid alcohol

notify physician of unusual symptoms

carry medical alert information

take medication on schedule; do not discontinue

avoid driving and other potentially hazardous activities

phenytoin: good oral hygiene, frequent dental visits
Antiparkinson agents
a. action
i.
anticholinergics: block or compete at central acetylcholine receptors
ii.
dopamine agonists: activation of dopamine receptors
iii.
3.
reinforce client education
 do not stop taking antiparkinsonian meds suddenly: may
precipitate parkinsonian crisis
 continue medical supervision
 avoid alcohol while on therapy
 take with meals
 caution with hazardous activities
 to change position slowly to prevent orthostatic
hypotension
 levodopa
o minimize Vitamin B6 in diet, because it hinders
drug's effectiveness
o do not take OTC medications without health care
provider's approval
o sweat and urine may be dark colored
o toxicity: personality changes, increased
twitching, grimacing, tongue protrusion
Cholinesterase inhibitors
a.
action
i.
prevents breakdown of acetylcholine at nerve endings
ii.
facilitates transmission of impulses across myoneural junction
iii.
strengthens muscle contractions including respiratory muscles
b.
c.
d.
e.
f.
4.
examples
i.
edrophonium chloride (Tensilon) for diagnostic purposes
ii.
neostigmine bromide (Prostigmin)
iii.
ambenonium chloride (Mytelase)
use: treat myasthenia gravis
adverse effects
i.
gastric irritation: nausea, vomiting, diarrhea
ii.
hypersalivation
iii.
CNS disturbances
iv.
orthostatic hypotension
v.
toxicity: pulmonary edema, respiratory failure, bronchospasm
contraindications
i.
intestinal obstruction, renal obstruction
ii.
peritonitis
nursing interventions
i.
monitor client response to medication; may need to adjust dosage
ii.
monitor vital signs during period of dosage adjustment
iii.
keep atropine sulfate available for overdosage
iv.
administer medication with food
v.
administer medication as per schedule
vi.
teach client

wear medic alert jewelry and ID

change position cautiously; sit at first feeling of faintness.
Antidepressants
a.
action: increase norephinephrine at subcortical neuroeffector sites
b.
examples
i.
norepinephrine blockers (tricyclic, TCAs): amitriptyline (Elavil),
imipramine (Tofranil)
ii.
monoamine oxidase inhibitors (MAOIs): isocarboxazid (Marplan),
phenelzine sulfate (Nardil)
iii.
selective serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline
(Zoloft)
c.
use: treat melancholia, depression
d.
adverse effects
i.
norepinephrine blockers

potentiate anticholinergics and CNS depressants

orthostatic hypotension

drowsiness, dizziness, confusion

CNS stimulation
ii.
MAOIs

potentiate alcohol, barbiturates, antihistamines

hypertensive crisis with ingestion of foods high in tyramine
(pickled herring, beer, wine, cheese, chocolate)

orthostatic hypotension
iii.
selective serotonin reuptake inhibitors

may interact with tryptophan

insomnia

headache

sexual dysfunction

gastric irritation
e.
contraindications
i.
acute schizophrenia
ii.
mixed mania and depression
iii.
suicidal tendencies
iv.
narrow angle glaucoma
f.
nursing interventions
i.
monitor effect of medication
ii.
maintain suicide precautions especially as depression lifts
iii.
give SSRIs in morning; TCAs at bedtime
iv.
5.
6.
teach client

do not take OTC medication without physician approval

avoid hazardous activities

effect of medication may take up to four weeks

MAOIs: teach client to avoid food containing tyramine;
monitor client for hypertensive crisis

SSRIs and MAOIs should not be given concurrently or
close together
Antimanic agents
a.
action: reduces adrenergic neurotransmitter levels in cerebral tissue
b.
examples
i.
antimanic agents: lithium carbonate (Lithane)
ii.
alternative antimanic agents: carbamazepine (Tegretol), clonazepam
(Klonopin)
c.
use: control of manic phase of mood disorders; bipolar disorder
d.
adverse effects
i.
metallic taste
ii.
hand tremors
iii.
excess voiding and extreme thirst
iv.
slurred speech
v.
disorientation
vi.
cogwheel rigidity
vii.
renal failure
viii.
respiratory depression
e.
nursing interventions
i.
monitor blood levels
ii.
avoid concurrent administration of adrenergic drugs
iii.
evaluate client's response to medication
iv.
teach client

effect of medication may take several weeks

high intake of fluids and normal sodium

toxicity signs: diarrhea, vomiting, weak muscles, confusion
etc.

take medication with meals
Antipsychotics
a.
action blocks dopamine hydrochloride receptors in the CNS and sympathetic
nervous system
b.
examples
i.
phenothiazines: chlorpromazine (Thorazine), thioridazine (Mellaril)
ii.
benzisoxazole: risperidone (Risperdal)
iii.
thioxanthenes: chlorprothixene (Taractan)
iv.
butyrophenones: haloperidol (Haldol)
c.
use: treatment of psychotic symptoms in schizophrenia, psychosis, Tourette's
syndrome, bipolar disorder
d.
adverse effects
i.
excessive sedation
ii.
jaundice
iii.
orthostatic hypotension
iv.
urinary retention
v.
anorexia
vi.
dry mouth
vii.
hypersensitivity reactions (such as photoallergic reaction, impotence,
cardiac toxicity)
viii.
blood dyscrasias - agranulocytosis
ix.
extrapyramidal side effects: dystonia, pseudoparkinsonism, akathisia,
akinesia, tardive dyskinesia
x.
neuroleptic malignant syndrome: fever, muscle rigidity, agitation,
confusion, deliruim, respiratory failure
e.
nursing interventions
i.
assess client's response to therapy
ii.
iii.
iv.
v.
vi.
7.
8.
monitor for signs of infection, liver toxicity, extrapyramidal
symptoms
monitor blood work if long-term therapy
monitor vital signs
give medication at bedtime
teach client

avoid alcohol use

avoid driving or other hazardous activities

avoid exposure to direct sunlight

good oral hygiene

report extrapyramidal symptoms or signs of infection to
physician

drink plenty of water
Hypnotics
a.
action: depress CNS
b.
examples
i.
barbiturates: pentobarbital (Nembutal), secobarbital (Seconal):
physical dependency may result with long term use
ii.
acetylinic alcohol: ethchlorvynol (Placidyl)
iii.
chloral derivatives: chloral hydrate (Noctec)
c.
uses: insomnia, sedation
d.
adverse reaftions
i.
respiratory depression
ii.
hypotension
iii.
barbiturate toxicity: hypotension, pulmonary constriction, cold and
clammy skin, cyanosis of lips, insomnia, hallucinations, delirium
e.
contraindications
i.
hypersensitivity
ii.
pregnancy
f.
nursing interventions
i.
monitor client response to medication
ii.
teach client

take medication exactly as prescribed

avoid alcohol and other depressant use

avoid driving and other hazardous activities while under the
influence
Antianxiety (Anxiolytic)
a.
action: depress CNS
b.
examples
i.
benzodiazepines: alprazolam (Xanax), chlordiazepoxide
(Librium):physical dependency and withdrawl finsings after long
term use
ii.
azapirones: buspirone (Buspar)
c.
uses: anxiety, sleep disorders, alcohol withdrawl
d.
adverse reactions
i.
CNS disturbances: dizziness drowsiness, lethargy, orthostatic
hypotension
ii.
skin rash
iii.
blood dyscrasias
e.
contraindications
i.
hypersensitivity
ii.
acute narrow angle glaucoma
iii.
liver disease
f.
nursing interventions
i.
notify health care provider if systolic BP drops 20mm Hg
ii.
administer with food or milk
iii.
teach client

take medication as prescribed

do not take OTC medication without health care provider's
approval

use caution when driving or hazardous activities



9.
General anesthetics
a.
b.
c.
d.
e.
f.
10.
action potentiated with alcohol or sedatives
never abruptly stop taking benodiazepine
with chlordiazepoxide- avoid excessive sunlight
action: depresses the CNS through a progressive sequence
examples
i.
inhalation anesthetics: cyclopropane, enflurane (Ethrane), ether,
nitrous oxide
ii.
IV barbiturates: thiopental sodium (Pentothal), methohexital sodium
(Brevital)
iii.
IV and IM nonbarbiturates: midazolam HCL (Versed), ketamine
HCL (Ketaject)
use: used in combination for surgical anesthesia
adverse effects
i.
inhalation anesthetics: excitement and restlessness, nausea and
vomiting, respiratory distress
ii.
IV barbiturates: respiratory depression, hypotension, tachycardia,
laryngospasm
iii.
IV and IM nonbarbiturates: respiratory failure, hyper/hypotension,
rigidity, psychiatric disturbances
contraindications
i.
CVA
ii.
increased intracranial pressure
iii.
severe hypertension
iv.
cardiac decompensation
nursing interventions
i.
have oxygen and emergency treatment available
ii.
monitor vital signs
iii.
use precautions if agent flammable
iv.
use safety precautions when client induced
Local anesthetics
a.
action: decreases nerve membrane permeability to sodium ion influx
b.
examples
i.
topical: benzocaine, cocaine, lidocaine HCL (Xylocaine)
ii.
spinal: dibucaine (Nupercaine), procaine HCL (Novocaine)
iii.
nerve block: bupivacaine HCL (Marcaine), mepivacaine HCL
(Carbocaine)
c.
use: pain control while client is conscious
d.
adverse effects
i.
allergic reactions
ii.
respiratory arrest
iii.
arrhythmias, cardiac arrest
iv.
convulsions
v.
hypotension
e.
nursing interventions
i.
have oxygen and emergency equipment available
ii.
monitor vital signs during local anesthesia
iii.
if spinal anesthesia, keep client flat for 6-12 hours to prevent
headaches
Managing musculoskeletal conditions
1.
Skeletal muscle relaxants
a.
use: relax muscles, treat spasm disorders
2.
Nonsteroidal antinflammatory drugs (NSAIDS)
a.
action: interferes with prostaglandin synthesis
b.
examples: ibuprofen (Motrin), indomethacin (Indocin)
i.
first generation (COX-1 inhibitor) - salicylates (aspirin - Bayer,
Ecotrin), ibuprofen(Motrin, Advil), naproxen (Naprosyn)
ii.
second generation (COX-2 inhibitor)- celecoxib (Celebrex)
c.
use: rheumatoid arthritis, osteoarthritis, dysmenorrhea
d.
adverse effects
i.
gastric disturbances- lessened with administration of COX-2
inhibitors
ii.
skin rash
iii.
blood dyscrasias/bleeding
iv.
CNS disturbances
v.
nephrotoxicity
e.
contraindications
i.
hypersensitivity
ii.
asthma
iii.
renal disease
iv.
liver disease
f.
nursing interventions
i.
administer one hour before or two hours after meals
ii.
monitor blood work, vital signs
iii.
monitor response to medication
3.
Antigout agents
a.
action: increases excretion of uric acid and decreases uric acid formation
b.
c.
d.
e.
f.
examples
i.
allopurinol (Zyloprim)
ii.
colchicine (Novocolchine)
iii.
probenecid (Benemid)
use: prevent gout attacks
adverse effects
i.
gastric effects: nausea and vomiting, indigestion
ii.
blood dyscrasias
iii.
liver damage
iv.
skin rash
v.
gi disturbances
contraindications: hypersensitivity
nursing interventions
i.
increase fluid intake to prevent renal calculi
ii.
monitor fluid intake and output
iii.
administer with meals
iv.
monitor blood work, including serum uric levels, and electrolyte
levels
v.
instruct client
I.
lose weight if needed
II.
avoid high purine foods (organ meats, sardines, shellfish,
etc.)
III.
avoid fermented beverages such as beer, ale, wine
Managing integumentary conditions
1.
2.
Scabicides/pediculicides (illustration 1
illustration 2
)
a.
action: targets the parasite's nerve-cell membrane
b.
examples
i.
permethrin (Nix, Elimite)
ii.
lindane (Kwell)
c.
use: treat parasitic arthropods: itch mites (scabies) and lice
d.
adverse reaction: skin irritation
e.
contraindications: hypersensitivity
f.
nursing interventions
i.
use precautions to prevent spread of parasites (for example,
use gown and gloves, keep infected linen separate, etc.)
ii.
keep medication away from eyes and mucous membranes
iii.
monitor for skin irritation
iv.
determine source of contamination
v.
evaluate effectiveness of treatment
3.
Antipruritics
a.
action: inhibits conduction of nerve impulses to sensory endings
b.
examples i.
benzocaine (Solarcaine)
ii.
lidocaine HCL (Xylocaine)
c.
use: temporary relief of skin problems such as minor burns, insect
bites, sunburn
d.
adverse reactions - skin irritation
e.
nursing interventions
i.
monitor effect of treatment
ii.
avoid contact with eyes
Anti-infectives
2.
action: interfere with essential metabolic actions of microbial cells
3.
examples
a.
silver sulfadiazine (Silvadene)
b.
silver nitrate 0.1%-0.5% solution
4.
uses
a.
ophthalmic solutions: treat ophthalmic infections
b.
bladder and urethra irrigations
5.
adverse effects
a.
silver sulfadiazine: skin irritation
b.
3.
silver nitrate
i.
electrolyte imbalance
ii.
brownish black discoloration produced on contact
6.
nursing interventions
a.
monitor client's condition during treatment
b.
for eyes, use only silver nitrate in ophthalmic solution
c.
handle silver nitrate with care: solutions stain skin and clothing
d.
silver sulfadiazine: use aseptic technique when applying
Antiinflammatory (steroids, glucocorticoids)
2.
action: stabilize leukocyte lysosomal membranes, inhibit phagocytosis and
release of allergic substances
3.
examples
a.
hydrocortisone sodium succinate (Solu-Cortef)
b.
hydrocortisone sodium phosphate (Hydrocortone)
4.
use: to suppress inflammatory or immune responses
5.
adverse reactions
a.
sodium and fluid retention
b.
nausea, acne, impaired wound healing
c.
anaphylactic reaction
d.
masking of infection
e.
behavior changes
6.
contraindications
a.
hypersensitivity
b.
systemic fungal infections
7.
nursing interventions
a.
establish baseline of vital signs, I/O ratio, weight
b.
monitor blood pressure during stabilization period
c.
assess client's response to treatment
d.
teach client
i.
take oral steroid with food
ii.
take anti-inflammatories on schedule and don't stop
abruptly
iii.
expect a slight weight gain
iv.
avoid alcohol and caffeine
v.
do not use OTC medications unless approved by health
care provider
vi.
report slow healing, vague feeling of being sick, or relapse
vii.
use medic alert jewelry or ID
Managing gastrointestinal conditions
1.
Antiemetics
a.
action - prevent expulsion of stomach contents by decreasing stimulation of
either the chemoreceptor trigger zone (CTZ), near the medulla, or the vomiting
center in the medulla
b.
examples
i.
antihistamines: dimenhydrinate (Dramamine), promethazine
(Phenergan)
ii.
anticholinergic: scopolamine (Transderm- Scop)
iii.
phenothiazines;chlorprimazine (Thorazine), prochlorperazine
(Compazine)
iv.
seratonin (5-HT3) receptor antagonist; granisetron (Kytril),
odansetron (Zofran)
c.
use: prevent nausea and vomiting; cause must be identified to prevent masking
a serious problem
d.
adverse reactions
i.
tachycardia, hypotension
ii.
dry mouth and eyes, blurred vision, constipation
iii.
sedation, drowsiness
e.
contraindications
i.
narrow-angle glaucoma
ii.
liver disease
f.
2.
3.
iii.
intestinal obstrucion
iv.
depression
nursing interventions
i.
use nonpharmacologic measures first (tea, crackers, dry toast)
ii.
monitor vital signs
iii.
monitor for signs and symptoms of shock if vomiting severe
iv.
monitor bowel sounds
v.
provide mouth care after vomiting
vi.
teach client

store drug in tight, light resistant container

avoid OTC drugs

avoid alcohol because of cumulative sedative effects

avoid during first trimester of pregnancy
Antacids
a.
action
i.
neutralizes gastric acid
ii.
coats stomach lining
b.
examples
i.
aluminum hydroxide gel (Amphojel)
ii.
aluminum and magnesium hydroxides (Maalox)
iii.
magaldrate (Riopan)
c.
use: peptic ulcers, reflux esophagitis, hiatal hernia
d.
adverse reactions
i.
aluminum compounds - constipation, intestinal obstruction
ii.
magnesium compounds - diarrhea
iii.
reduced absorption of calcium and iron
e.
nursing interventions
i.
shake oral suspension well
ii.
monitor client's response to treatment
iii.
administer with 8 oz glass of water
iv.
teach client

avoid overuse of antacids

dietary restrictions for ulcers

need for diet high in calcium and iron

for clients on low sodium diets: antacids contain sodium

may color stools whitish
Antiulcers
a.
actions
i.
decrease acetylcholine release
ii.
block release of histamines
iii.
inhibit secretion of pepsin
iv.
inhibit proton pump
b.
examples
i.
anticholinergics; belladonna tincture, chlorodiazepoxide (Librax)
ii.
h2 blockers - cimetidine (Tagamat), ranitidine (Zantac)
iii.
pepsin inhibitor - sucralfate (Carafate)
iv.
proton pump inhibitor - lansoprazole (Prevacid), omeprazole
(Prilosec)
c.
uses: management of peptic ulcer disease, gastroesophageal reflux
disease(GERD), protects gastric mucosa from hydrochloric acid production
d.
adverse reactions
i.
dry mouth, decreased secretions, constipation, tachycardia, & urinary
retention
ii.
headaches, dizziness, constipation, skin reash, pruritis, impotence
iii.
sucralfate is nonasborable, occasional constipatoin
e.
contraindications
i.
anticholinergics - narrow- angle glaucoma
ii.
renal failure
f.
4.
5.
iii.
liver disease
nursing interventions
i.
administer on empty stomach
ii.
avoid antacids within 30 minutes of sucralfate
iii.
avoid antacids within one to two hours of other antiulcer drugs
iv.
administer other drugs one to two hours after sucralfate
v.
teach clients

avoid alcohol, spicy food, and caffeinated beverages

eliminate smoking

increase fluid intake

medication can take up to two weeks for full effect

report increasing abdominal pain, vomiting of blood, or
passage of bloody stools
Anti-diarrheal
a.
action: forms the stool; mechanism depends on type of medication
b.
examples
i.
fluid absorbents - decrease fluid content; kaolin and pectin
(Kaopectate)
ii.
motility suppressants - decrease motility of GI tract; diphenoxylate
HCL (Lomotil), loperamide HCL (Imodium)
iii.
enteric bacterium - replacements help intestine turn carbohydrates
into lactic acid; lactobacillus acidophilus (Bacid)
c.
use: treat diarrhea
d.
adverse reactions
i.
fluid absorbents: gastric disturbances, CNS toxicity
ii.
enteric bacterium replacements: excessive flatulence, abdominal
cramps
iii.
motility suppressants: urinary retention, tachycardia, sedation,
paralytic ileus, respiratory depression
e.
contraindications:
i.
ulcerative colitis
f.
nursing interventions
i.
monitor effect of medication
ii.
assess for fluid and electrolyte imbalance
iii.
assess for cause of diarrhea
iv.
motility suppressants may cause physical dependence, may impair
ability to perform hazardous activities
Laxatives
a.
action: moves stool; mechanism dependent on type of laxative
b.
examples
i.
lubricants moisten stool; mineral oil
ii.
stool softeners allow water to penetrate stool; dioctyl sodium
sulfosuccinate (Colace)
iii.
bulk forming: increase bulk in intestine; psyllium hydrophilic
mucilloid (Metamucil)
iv.
colon irritant stimulates peristalsis; bisacodyl (Dulcolax)
v.
saline cathartics increase osmotic pressure thereby absorbing fluid
from bowel wall; milk of magnesia
c.
use: to treat constipation
d.
adverse reactions
i.
gastric effects: nausea, cramping, diarrhea
ii.
dependence with long-term use
iii.
intestinal lubricants inhibit absorption of fat-soluble vitamins
iv.
saline cathartics: dehydration, hypernatremia
e.
contraindications:
i.
GI obstruction
ii.
suspected appendicitis
iii.
megacolon
f.
6.
iv.
abdominal pain
v.
nausea
nursing interventions
i.
monitor effects of medication
ii.
teach client
I.
dietary considerations (increased fiber and fluid intake)
II.
maintain/increase activity level
III.
caution regarding overuse of laxatives
IV.
water and follow with another glass of water
mix bulk-forming laxatives with a glass of Pancreatic enzymes
a.
action: replacement for natural pancreatic enzymes
b.
examples
i.
pancreatin (Dizymes)
ii.
pancrelipase (Cotazym)
c.
use: aid in digestion; cystic fibrosis
d.
adverse reactions, with large doses
i.
diarrhea
ii.
nausea
iii.
hypersensitivity reaction: sneezing, skin rashes
e.
contraindications
i.
hypersensitivity to pork
ii.
chronic pancreatic disease
f.
nursing interventions
i.
monitor for symptoms of diabetes mellitus (such as polyuria, thirst,
hunger)
ii.
monitor weight, intake and output
iii.
administer with meals
iv.
do not crush enteric coated medications
v.
determine client's response to therapy
Managing endocrine conditions
1.
Antidiabetic agents
a.
action: provides insulin to promote transport of glucose; exact mechanism
dependent on type of antidiabetic agent
b.
examples
i.
oral hypoglycemics stimulate pancreatic beta cells to produce insulin
tolazamide (Tolinase), glipizide (Glucotrol), metformin
(Glucophage), rosiglitazone (Avandia)
c.
d.
e.
f.
ii.
parenteral agents provide exogenous insulin
use: treat diabetes mellitus
adverse effects
i.
hypoglycemia, irritability, confusion
ii.
convulsions, tachycardia, tremor
iii.
moist skin, headache, hunger
iv.
nausea, bloating, diarrhea
contraindications:
i.
hypersensitivity
nursing interventions
i.
assess client for effect of medication
ii.
monitor blood/urine glucose levels
iii.
guidelines for administration of insulin

rotate sites

administered subcutaneously

only regular insulin is administered IV

when mixing insulin, regular insulin is withdrawn into the
syringe first
iv.
instruct client

how to administer the medication

compliance with dietary restrictions





2.
3.
4.
urine and blood testing
wear medic alert jewelry
how to cope with hypoglycemic reactions
signs of ketoacidosis
importance of weight loss if obese
Hypothyroid agents
a.
action: help regulate the metabolic rate of cells
b.
examples
i.
levothyroxine sodium (Synthroid)
ii.
thyroglobulin (Proloid)
iii.
thyroid (Thyrar)
c.
use: replace thyroid hormones
d.
adverse reactions
i.
hyperactivity
ii.
cardiac stimulation
iii.
thyroid storm
e.
contraindications
i.
adrenal insufficiency
ii.
myocardial infarction
iii.
thyrotoxicosis
iv.
hypersensitivity to beef
f.
nursing interventions
i.
monitor client's response to medication
ii.
teach client

usually lifelong therapy

take medication same time each day

monitor pulse rate; report pulse rate over 100

report signs of toxicity (such as chest pain, palpitations,
nervousness)

wear medic alert jewelry / ID

avoid OTC medications unless approved by health care
provider

continue medical supervision
Hyperthyroid agents
a.
action: blocks synthesis of thyroid hormone
b.
examples
i.
iodine (Lugol's solution)
ii.
methimazole (Tapazole)
iii.
propylthiouracil (PTL)
c.
use: treat hyperthyroidism
d.
adverse effects
i.
agranulocytosis
ii.
skin disturbances
iii.
decreased metabolism
iv.
gastric disturbances
v.
iodine: stains teeth, bitter taste
e.
contraindications:
i.
hypersensitivity
f.
nursing interventions
i.
administer iodine preparations through a straw
ii.
monitor effects of medication
iii.
instruct client

report side effects

avoid OTC drugs containing iodine

do not discontinue medication abruptly

carry medic alert jewelry
Anterior pituitary: growth hormone
a.
action: stimulates the growth of practically all organs and tissues
b.
examples
5.
i.
somatrem (Protropin)
ii.
somatropin (Humatrope)
c.
use: treat dwarfism
d.
adverse effects
i.
hyperglycemia
ii.
hypothyroidism
iii.
antibodies to growth hormone
iv.
interaction with glucocorticoids
e.
contraindications:
i.
hypersensitivity to benzyl alcohol
ii.
closed epiphyses
iii.
intracranial lesions
f.
nursing interventions
i.
monitor diabetic client closely
ii.
instruct client

record height measurements at regular intervals

report to physician if growth is less than expected
Antidiuretic hormone
a.
action: helps distal renal tubules reabsorb water
b.
examples
i.
lypressin (Diapid)
ii.
vasopressin (Pitressin)
c.
use: treatment of diabetes insipidus
d.
adverse effects
i.
gastric disturbances
ii.
hyponatremia
iii.
water intoxication
iv.
cardiac disturbances
e.
nursing interventions
i.
monitor response to therapy: intake and output, blood pressure
ii.
assess for dehydration
Managing genitourinary diseases
1.
Diuretics
a.
action: interferes with sodium reabsorption
b.
c.
d.
e.
examples
i.
loop diuretics interrupt the transport of sodium ions in Loop of Henle

bumetanide (Bumex)

furosemide (Lasix)
ii.
potassium sparers act on collecting tubules to promote sodium and
water excretion

spironolactone (Aldactone)

triamterene (Dyrenium)
iii.
thiazides: inhibit reabsorption of Na+ and CL- in early distal tubule

chlorothiazide (Diuril)

hydrochlorothiazide (Hydrodiuril)
iv.
osmotic: increase osmotic pressure of glomerular filtrate

mannitol

urea
use: treat hypertension, edema
adverse side effects
i.
gastrointestinal irritation
ii.
electrolyte imbalance: hyponatremia, hypokalemia
iii.
orthostatic hypotension
iv.
dehydration
contraindications
i.
electrolyte imbalances
ii.
dehydration
iii.
anuria
nursing interventions
i.
monitor weight, intake and output, vital signs
ii.
give medication in morning
iii.
monitor client for fluid and electrolyte imbalance
iv.
teach client

change positions slowly

report changes in hearing

diabetic clients: closely monitor glucose levels
Sulfonamides
b.
action: substitutes a false metabolite for p-aminobenzoic acid, which is
essential for the bacterial synthesis of folic acid
c.
example
i.
succinylsulfathiazole (Sulfasuxidine)
ii.
sulfisoxazole (Gantrisin)
iii.
sulfamethoxazole and trimethoprim (Bactrim, Septra)
d.
use: urinary tract infections
e.
adverse effects
i.
gastric irritation: nausea and vomiting, stomatitis
ii.
rash
iii.
malaise
iv.
blood dyscrasias
v.
crystalluria
vi.
photosensitivity
vii.
allergic response
f.
contraindications
i.
hypersensitivity
ii.
infants < two months-old
iii.
pregnancy at term
g.
nursing interventions
i.
check if client has a history of allergies
ii.
monitor client response to treatment
iii.
monitor vital signs and blood work
iv.
teach client

drink plenty of fluids

take medication as prescribed

avoid OTC medications unless approved by health care
provider

avoid direct sunlight
f.
2.
3.
Immunosuppressants
a.
action: inhibit immune responses
b.
example: cyclosporine (Sandimmune)
c.
use
i.
prevent organ rejection in transplant patient
ii.
treat autoimmune disorders (such as rheumatoid arthritis, systemic
lupus erythematosus)
d.
adverse effects
i.
nephrotoxicity (poisons kidneys)
ii.
infection
iii.
hypertension
iv.
tremor
v.
hirsutism
e.
contraindications
i.
hypersensitivity
ii.
nursing interventions

monitor BUN and creatinine; liver function tests

teach client
o
report early signs of infection (such as fever, sore
throat)
o
medication may be taken with meals
o
o
4.
J.
take medication same time each day
hirsutism is reversible when treatment stops
Antinfective
a.
action: interferes with several bacterial enzyme systems
b.
example
i.
nitrofurantoin (Furadantin)
ii.
methenamine (Hiprex)
c.
use: treat pyelonephritis, pyelitis, cystitis
d.
adverse effects
i.
anorexia
ii.
nausea and vomiting
iii.
methenamine - crystalluria, bladder irritation
iv.
nitrofurantoin: exfoliative dermatitis, interstitial nephritis, necrosis
e.
contraindications
i.
hypersensitivity
ii.
anuria
iii.
severe renal disease
iv.
infants < 1 month-old
f.
nursing interventions
i.
monitor intake and output
ii.
teach client

take medication as prescribed

drink plenty of fluids

take medication with food or milk

with nitrofurantoin:
o
do not crush pill because it stains teeth; dilute
oral suspensions and rinse mouth after taking
o
report changes in urinary pattern
o
report muscle weakness, tingling or numbness
o
urine may look brown or rust yellow
o
avoid alcohol
Managing hematological conditions
4.
Hematopoietic growth agent
a.
action: stimulates production, growth, maturation, and differentiation of bone
marrow stem cells
b.
example
i.
filgrastim (Neupogen)- stimulates production of white blood cells
ii.
epoetin alfa (Epogen)- stimulates production of red blood cells
c.
use: chronic renal failure, HIV-infected clients, reduce bone marrow recovery
after transplantation, stimulate bone marrow production after chemotherapy
d.
adverse effects
i.
filgrastim: bone pain
ii.
epoetin alfa: hypertension, headache, joint pain
e.
contraindications
i.
hypersensitivity to proteins of E. Coli
f.
nursing interventions
i.
take baseline CBC and diff (complete blood count and differential
count) prior to treatment
ii.
monitor lab results until target reached
5.
Iron supplements
a.
action: iron transported as transferrin to bone marrow and incorporated into
hemoglobin
b.
examples
i.
ferrous sulfate (Feosol)
ii.
ferrous fumarte (Feco-T)
iii.
ferrous gluconate (Fergon)
c.
use: correct simple iron deficiency anemia
d.
adverse effects
i.
gastric disturbances
ii.
with massive overdose - lethargy, drowsiness, leading to metabolic
acidosis, shock and cardiovascular collapse
e.
V.
contraindications:
i.
hypersensitivity
ii.
ulcerative colitis
iii.
peptic ulcer disease
iv.
hemolytic anemia
v.
cirrhosis
f.
nursing interventions
i.
monitor hemoglobin level
ii.
teach client

take on empty stomach

liquid preparation - take with a straw to prevent tooth
discoloration

protect from moisture and heat

may cause dark or greenish stools
Antibiotics, Antivirals, Antifungals, Antiparasitics
I.
Antibiotics
4.
Action: destroys or inhibits bacteria
5.
Examples
a.
penicillins, broad spectrum
i.
ampicillin (Omnipen)
ii.
penicillin V (V-cillin)
b.
cephalosporins, broad spectrum
i.
cefazolin sodium (Ancef)
ii.
ceftriaxone (Rocephin)
c.
macrolides
i.
erythromycin (E-mycin)
ii.
azithromycin (Zithromax)
d.
tetracyclines, broad spectrum
i.
doxycycline (Vibramycin)
ii.
oxytetracycline (Terramycin)
e.
aminoglycosides, broad spectrum
i.
gentamicin sulfate (Garamycin)
ii.
streptomycin sulfate (Strycin)
f.
fluoroquinalones
i.
ciprofloxacin (Cipro)
ii.
levofloxacin (Levaquin)
g.
polymyxin: polymyxin B sulfate (Aerosporin)
h.
chloramphenicol (Chloromycetin)
6.
Use: treat bacterial infection
7.
Adverse effects
a.
gastric disturbances: nausea / vomiting, poor appetite, diarrhea
b.
allergic reactions
c.
superinfection
d.
loss of water-soluble vitamins and minerals
e.
tetracyclines: hepatotoxicity, phototoxicity, hyperuricemia, tooth enamel
hypoplasia, and bone defects in children under eight years of age
f.
fluoroquinolones- photosensitivity
g.
aminoglycosides: ototoxicity, leukopenia, thrombocytopenia, headache,
confusion, peripheral neuropathy, optic neuritis, nephrotoxicity
h.
chloramphenicol: blood dyscrasias, fever, rash, jaundice
8.
Contraindications:
a.
hypersensitivity
b.
pregnancy- tetracyclines, fluoroquinolones, aminoglycosides
c.
fluoroquinolones- children <18 years of age
9.
Nursing interventions
a.
monitor client for allergies
b.
monitor client's response to treatment
c.
teach client
i.
take all of prescribed medication
ii.
symptoms of allergic response
iii.
if taking a liquid (suspension), shake it first
iv.
take medication before meals
d.
e.
f.
g.
J.
K.
L.
tetracyclines
i.
not for young children or in last half of pregnancy
ii.
possible oral anticoagulant effect
fluoroquinolones: avoid hazardous machinery, avoid sunlight
aminoglycosides and polymyxins: May potentiate neuromuscular blocking
agents, general anesthesia or magnesium effects; monitor for all three
potentiation effects
chloramphenicol
i.
assess blood work during therapy
ii.
assess for potentiation of phenytoin, oral antidiabetic agents or
coumadin anticoagulant effects
Antivirals
4.
Action: interfere with DNA synthesis needed for viral replication
5.
Examples
a.
acyclovir sodium (Zovirax)
b.
amantadine HCL (Symmetrel)
c.
oseltamivir (Tamiflu)
6.
Use: viral infections such as herpes, viral encephalitis
7.
Adverse effects
a.
orthostatic hypotension
b.
dizziness
c.
GI disturbances
d.
nephrotoxicity
e.
blood dyscrasias
8.
Contraindications:
a.
hypersensitivity
b.
immunosuppression
9.
Nursing interventions
a.
monitor vital signs during antiviral therapy
b.
monitor effect of therapy
c.
increased fluid intake
d.
monitor for signs of superinfection: sore throat, fever, fatigue
Antifungals (systemic)
4.
Action: destroys fungal cells or inhibits their reproduction
5.
Examples
a.
amphotericin B (Fungizone)
b.
griseofulvin (Grisactin)
c.
nystatin (Mycostatin)
6.
Use - treat local and systematic fungal infections such as histoplasmosis, candidiasis,
tinea
7.
Adverse effects
a.
gastric irritability: nausea, vomiting
b.
headache
c.
fever, chills
d.
paresthesia
e.
renal impairment
8.
Contraindications
a.
severe bone marrow depression
b.
hypersensitivity
9.
Nursing interventions
a.
monitor vital signs and I and O during therapy
b.
with amphotericin B
i.
protect IV solution from light
ii.
monitor blood work
iii.
use infusion device for IV administration
c.
with griseofulvin: instruct client to avoid sunlight
Antiparasitics
4.
Action: interferes with parasite metabolism and reproduction
5.
Examples
a.
b.
c.
anthelmintics: mebendazole (Vermox), piperazine (Vermizine) (illustration
)
amebicides: chloroquine HCL (Aralen), metronidazole (Flagyl)
antimalarials: chloroquine HCL (Aralen), quinine sulfate (Quinamm)
6.
VI.
VII.
Use: kills parasites, helminths (pinworm and tapeworm), protozoa (amebiasis and
malaria)
7.
Adverse effects
a.
anthelmintics: GI upset, CNS disturbances, skin rash, headache
b.
amebicides: GI upset, blood dyscrasias, skin rash, CNS disturbances
c.
antimalarials: GI upset, blood dyscrasia, visual disturbances
8.
Nursing interventions
a.
administer medication with food
b.
monitor vital signs, blood work during therapy
c.
use safety precautions if CNS disturbances manifested
d.
teach client to prevent further infection
e.
with antimalarials: frequent visual examinations, urine may turn rust colored
Total Parenteral Nutrition (TPN)
I.
A form of specialized nutritional support in which nutrients are provided by the intravenous route
J.
Purpose: to sustain clients nutritionally. Solutions consist of water, amino acids, glucose, minerals,
vitamins and lipid emulsions, and trace elements which are calculated for each client individually.
K.
Used for clients who are unable to digest or absorb sufficient enteral nutrition
L.
Complications
4.
Hypoglycemia
5.
Hyperglycemia
6.
Fluid overload
7.
Catheter - related sepsis
8.
Air embolism
9.
Central venous thrombosis
10.
Catheter occlusion
M.
Administration
4.
Via peripheral administration - up to 10% glucose solutions
5.
Via central administration - up to 35% glucose solutions
N.
Nursing interventions
4.
Before administration of TPN
a.
check label of solution with medical order
b.
check rate of infusion with medical order
c.
inspect TPN bottle for precipitates or turbidity
d.
administer via an infusion pump
5.
During administration
a.
monitor vital signs every four hours
b.
observe for signs of air embolism, pneumothorax, or allergic responses (such as
chills, increased temperature, urticaria etc.)
c.
monitor client's weight daily
d.
monitor laboratory values; if blood glucose levels rise, may need to use slidingscale insulin therapy
e.
monitor client for fluid overload
f.
monitor respiratory rate: tachypnea may indicate excess carbohydrates are
increasing carbon dioxide production
g.
monitor insertion site for infection
h.
monitor infusion rate
i.
if rate too high, hyperosmolar diuresis and dehydration
ii.
if too slow, little benefit
iii.
do not overcorrect flow rate if too slow or fast
iv.
accurately record intake and output
v.
change insertion site dressing as per facility's policy
vi.
encourage exercise as tolerated to promote the development of
muscle instead of fat
vii.
while changing tube, instruct client to use Valsalva maneuver and
clamp tube to prevent an air embolism
Antineoplastics (Cytotoxic, Antiproliferative Agents)
I.
Action
4.
Highly toxic agents that attack all rapidly dividing cells, both normal and malignant
5.
Represents a systemic approach that bases its action on disruption of the cell life cycle
6.
Most agents modify or interfere with DNA synthesis
J.
Examples
4.
K.
L.
M.
N.
O.
Alkalyting agents: mechlorethamine HCl (Nitrogen Mustard), cyclophosphamide
(Cytoxan): produce breaks in DNA molecule and cross-linking of strands thus interfering
with DNA replication; most effective in hematologic malignancies
5.
Antitumor antibiotics: Biomycin; bind directly with DNA changing its configuration and
inhibiting replication
6.
Antimetabolites: methotrexate, 5-fluorouracil, floxuridine, cytosine arabinoside, 6mercaptopurine, 6-thioguanine: inhibit DNA synthesis; most effective against rapidly
growing tumors enzymes necessary for cell function and replication
7.
Plant alkaloids: Vinblastine, Vincristine, Etoposide: Bind to substances needed to form
mitotic spindle, thus preventing cell division
8.
Hormones and hormone inhibitors: Tamoxifen alters the endocrine environment to make
it less conducive to cell growth; used in cancers of the breast, prostate, and other
reproductive organs
Routes of administration
4.
Intravenous (peripheral or central venous access)
5.
Oral
6.
Intraarterial
7.
Intraperitoneal
8.
Intrapleural
9.
Intrathecal
10.
Via ventricular reservoir
Use
4.
To cure, control or palliate results of neoplasm
5.
May be used as an adjunct to surgery and radiation
Adverse effects: result from the damage to normal cells
4.
Nausea/ vomiting, stomatitis, alterations in taste, anorexia
5.
Diarrhea, constipation
6.
Alopecia, dermatitis, pruritus, paresthesia, rash, bruising
7.
Hemorrhagic cystitis
8.
Cardiomyopathy
9.
Fatigue, dyspnea, fever, chills
10.
Sterility, amenorrhea
11.
Depression, anxiety
12.
Myelosuppression
Nursing interventions
4.
Monitor lab studies as ordered
5.
Monitor IV administration site for extravasation
6.
Maintain strict asepsis
7.
Administer antiemetic agents as ordered and prophylactically before chemotherapy.
8.
Give antihistamines as ordered
9.
Withhold food and fluids for four to six hours before treatment
10.
Between treatments, give small, frequent, bland meals
11.
Give antidiarrheals as ordered
12.
Monitor for signs of dehydration and encourage fluids as tolerated
13.
Provide frequent oral hygiene, lubricate lips as indicated
14.
For stomatitis, use topical anesthetics before eating and as indicated
15.
Apply lotion to skin as indicated; avoid harsh, drying soaps
16.
Provide a restful environment, emotional support and anxiolytics as ordered
17.
Teach client
a.
medications and side effects
b.
alopecia is temporary
c.
avoid bruising, aspirin products, and persons with infections
d.
conserve energy
e.
recognize signs of bleeding; anemia, infection
f.
use a soft-bristle toothbrush
g.
avoid use of razors
Special nursing considerations
4.
Exposure to chemotherapeutic agents can lead to adverse reactions
a.
contact dermatitis
b.
nausea and vomiting
c.
diarrhea
5.
Exposure during pregnancy can lead to
a.
increased risk of fetal abnormalities
6.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
XVIII.
XIX.
b.
ectopic pregnancies
c.
spontaneous abortions
Guidlines for reducing risks when handling cytotoxic antineoplastic drugs
a.
wear a mask to avoid inhaling powder when handling a powder form of a drug.
b.
do not prepare drugs in eating places Wear gloves, eye protectors and
protective clothing when in contact with injectable solutions.
c.
dispose of contaminated materials in puncture-proof containers labeled as
hazardous material.
d.
wear gloves when handling linens contaminated with drugs for at least 48 hours
after contamination.
e.
wash hands thoroughly before and after exposure to drugs.
f.
follow organizational procedure to clean-up after chemical spill.
Blood Transfusion
I.
Use: restore blood volume or blood components
J.
Nursing responsibilities and interventions
4.
Verify that blood had been typed and cross matched
5.
Verify five factors:
a.
client number
b.
blood type
c.
Rh factor
d.
blood number
e.
expiration date
6.
Pretransfusion assessment includes baseline vital signs, lung sounds, level of
consciousness, IV site, and prescence of pain
7.
Verify informed consent
8.
Start infusion with blood administration set, filter, and normal saline IV
9.
Watch for signs of hemolytic reaction; usually occurs within the first 15 minutes
(shivering, headache, lower back pain, oliguria, hypotension)
10.
Watch for signs of febrile reaction; usually occurs within first 30 minutes (hematemesis,
confusion, back pain, elevated temperature, headache, shaking)
11.
Watch for allergic reaction (hives, wheezing, pruritus, joint pain)
12.
Monitor vital signs
13.
If reaction occurs
a.
stop blood immediately
b.
maintain IV with saline
c.
notify physician
d.
send blood and urine specimen to lab
e.
monitor client during transfusion
f.
monitor lab results - hemoglobin and hematocrit
The dosage of medication needed for a therapeutic effect can vary with age, weight, gender, health status and
environmental factors.
Most drugs produce a mixture of therapeutic and adverse effects.
Medications require a written order from a physician or a nurse practitioner legally permitted to prescribe
them.
Because most drugs are metabolized in the liver, it is especially susceptible to drug induced injury.
The nurse is responsible to judge independently before giving a prescribed medication.
The route of administration will be chosen to achieve a certain therapeutic action, at a certain speed.
Medications interact with foods, and that interaction can block or slow therapeutic action
People metabolize medications differently, depending on age, gender, body size, health status, drug tolerance,
cumulative effect of medication, and genetics.
Inhalers are most effective when their users know the right technique. Teach the technique and then test how
well the client uses it.
Medications are especially likely to cause hypotension in elderly people.
There are two types of drug dependence: psychic and physical. Psychic dependence implies a craving to use
the drug periodically. Physical dependence implies physical symptoms when the drug is withheld.
ASAPHypersusceptibilityIdiosyncrasy PharmacodynamicsPotentiationTachyphylaxisToxicology


Allergic reactions: urticaria, itching, flushing, headache Anthelmintics: mebendazole (Vermox), piperazine
(Vermizine) Intramuscular (IM) Scabicides/Pediculicides (1) Scabicides/Pediculicides (2)
Venous access devices Wear medical alert jewelry: wearer takes anticoagulants
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