Safe Medication Administration and Error Reduction: Administering Phenytoin Pharm Chapter 2 Accident/Error/Injury Prevention No information about administering phenytoin in this chapter. 1. Right client- verify client's identification each time a medication is given. 2. Right dose- calculate the correct medication dose. 3. Right time- administer medication on time to maintain a consistent therapeutic blood level. 4. Right route- most common routes are oral, topical, subQ, IM, and IV. 5. Right documentation- immediately record medication dose, route, time, and any pertinent information, including client's response. 2 Safe Medication Administration and Error Reduction: Priority Action for Medication Error Pharm Chapter 2 Reporting of Incident/Event/Irregular Occurrence/Variance 1. Evaluate client response to the medication, and document and report appropriately. 2. Recognize side/adverse effects, and document and report appropriately. 3. Complete an unusual occurrence report within the specified time frame, usually 24 hours. 4. This report should include: client identification, name and dose of meds, time and place of incident, an accurate and objective account of the event, who was notified, what actions were taken, and the signature of the person completing the report. 5. This report does not become a part of the client's permanent record, and the report should not be referenced in another part of the record. 3 Anxiety Disorders: Managing an Overdose of a Benzodiazepine Pharm Chapter 7 Chemical and Other Dependencies/Substance Use Disorder 1. For oral toxicity, gastric lavage can be used, followed by the administration of activated charcoal or saline cathartics. 2. For IV toxicity, administer flumazenil to counteract sedation and reverse adverse effects. 3. Monitor clients vital signs, maintain patent airway, and provide fluids to maintain blood pressure. 4. Have resuscitation equipment available. 5. IV toxicity may lead to respiratory depression, severe hypotension, and or cardiac/respiratory arrest. 6. Oral toxicity results in drowsiness, lethargy, and confusion. 4 Antilipemic Agents: Adverse Effects of Statins Pharm Chapter 24 Adverse Effects/Contraindications/Side Effects/Interactions 1. Hepatoxicity, as evidenced by an increase in AST. 2. Myopathy, as evidenced by muscle aches, pains, and tenderness. 3. May progress to myositis or rhabdomyolysis. 4. Monitor liver function tests after 12 weeks and then every 6 months. 5. Advise clients to observe for indications of liver dysfunction (anorexia, vomiting, nausea, jaundice). 5 Antilipemic Agents: Client Teaching Pharm Chapter 24 Adverse Effects/Contraindications/Side Effects/Interactions 1. Prior to starting antilipemics, obtain baseline levels of total cholesterol, LDL level, HDL lever, and triglycerides. 2. Baseline kidney and liver function tests should be obtained and monitored periodically throughout the course of therapy. 3. Statins are contraindicated in patients who have hepatitis induced by alcohol or viral infections. 4. Rosuvastatin should be avoided for clients of Asian descent or prescribed in a smaller dose than for other clients. 5. Use statins cautiously in older adult clients, clients in debilitated condition, and those who have chronic renal disease. 6 Cardiac Glycosides and Heart Failure: Increased Risk for Toxicity Pharm Chapter 21 Adverse Effects/Contraindications/Side Effects/Interactions 1. Therapeutic serum levels of Digoxin may vary, but usually range from 0.5 to 2. 2. Signs of toxicity may appear at levels less than 1.75. 3. Clients who have heart failure respond best with serum medication levels between 0.5 and 0.8. 4. Dosages should be based on serum levels and client response to medication. 5. Digoxin cardiotoxicity may lead to bradycardia. 7 Chronic Neurologic Disorders: Adverse Effects of Phenytoin Pharm Chapter 13 Adverse Effects/Contraindications/Side Effects/Interactions 1. CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairement) 2. Gingival hyperplasia (softening and overgrowth of gum tissue, tenderness, and bleeding gums) 3. Skin rash. 4. Teratogenic (cleft palate, heart defects). 5. Cardiovascular effects (dysrhythmias, hypotension). 6. Endocrine and other effects (coarsening of facial features, hirsutism, and interference with vitamin D metabolism). 7. Interference with vitamin K- dependent clotting factors causing bleeding in newborns. 8 GI Disorders: Medications for Inflammatory Bowel Disease Pharm Chapter 29 Adverse Effects/Contraindications/Side Effects/Interactions 1. Aloestron is approved only for female clients who have severe IBS-D that has lasted more than 6 months and has been resistant to conventional management. 2. Advserse effects include constipation, which may result in GI toxicity. 3. Medications such as phenobarbital may decrease levels of aloestron. 4. Iubiprostone is used to treat ISB-C and chronic constipation. 5. Diarrhea and nausea are adverse effects of lubiprostone. 9 Medications Affecting Coagulation: Contraindications for Antiplatelet Medications Pharm Chapter 25 Adverse Effects/Contraindications/Side Effects/Interactions 1. Aspirin is contraindicated with clients who have bleeding disorders and thrombocytopenia. 2. Abciximab is contraindicated in clients who have bleeding disorders, thrombocytopenia, recent stroke, AV malformation, aneurysm, uncontrolled hypertension, and recent major surgery. 3. Clopidogrel is contraindicated in clients who have bleeding disorders, thrombocytopenia, peptic ulcer disease, and intracranial bleed. 4. Pentoxifylline is contraindicated in clients who have bleeding disorders or retinal or cerebral bleeds. 5. Clopidogrel is a pregnancy risk B, Abciximab and Pentoxifylline are pregnancy risk C's, and Aspirin is a pregnancy risk D. 10 Medications Affecting Urinary Output: Client Teaching Regarding Potassium-Sparing Diuretics Pharm Chapter 19 Adverse Effects/Contraindications/Side Effects/Interactions 1. Monitor potassium level regularly. 2. Teach clients to avoid salt substitutes that contain potassium. 3. Teach clients to self-monitor blood pressure. 4. Instruct clients to keep a log of blood pressure and weight. 5. Warn clients that triamterene may turn urine a blueish color. 11 Medications Affecting Urinary Output: Effects of Diuretics Pharm Chapter 19 Adverse Effects/Contraindications/Side Effects/Interactions 1. Treat hyperkalemia by discontinuing medication, restricting potassium in the diet, and administering insulin injections to drive potassium back into the cell. 2. Potassium supplements or other potassium-sparing diuretics should never be administered in conjunction with spironolactone. 3. Caution is recommended when administered with ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors because these may cause elevated potassium levels. 4. Advise clients to observe for endocrine effects (impotence in male clients, irregularities of menstrual cycle in female client). 5. Monitor cardiac activity of patients with hyperkalemia. 12 Nonopiod Analgesics: Manifestations of Salicylism Pharm Chapter 35 Adverse Effects/Contraindications/Side Effects/Interactions 1. Nausea 2. Vomiting 3. Diaphoresis 4. Tinnitus 5. As toxicity progresses, agitation, delirium, hallucinations, convulsions, lethargy, and stupor may occur. 13 Dosage Calculation: Potassium Supplement Pharm Chapter 3 Dosage Calculation Specific calculations not in ATI book. 14 Anxiety Disorders: Evaluating the Therapeutic Effects of an SSRI Pharm Chapter 7 Expected Actions/Outcomes 1. Paroxetine is used to treat GAD, panic disorders, OCD, social anxiety disorder, trauma and stress related disorders, and depressive disorders. 2. Sertraline is indicated for panic disorder, OCD, social anxiety disorder, and PTSD. 3. Escitalopram is indicated for GAD and OCD. 4. Fluoxetine is used for panic disorders and OCD. 5. Fluvoxamine is used for OCD and social anxiety disorder. 15 Mycobacterial, Fungal, and Parasitic Infections: Evaluating Use of Anti-infective Medications Pharm Chapter 47 Expected Actions/Outcomes 1. Isoniazid is highly specific for mycobacteria. 2. Isoniazid inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall. 3. Isoniazid is used for active and latent TB. 4. Rifampin is bactericidal as a result of the inhibition of protein synthesis. 5. Rifampin is a broad spectrum antibiotic effective for gram-positive and gram-negative bacteria. 16 Angina: Evaluating Client Understanding of Nitroglycerin Transdermal Patches Pharm Chapter 22 Medication Administration 1. Use of alcohol can contribute to the hypotensive effect of nitroglycerin. 2. Transdermal patches have a slow onset and long duration. 3. Patches are used for long-term prophylaxis against anginal attacks. 4. Place the patch on a hairless area of the skin and rotate sites to prevent skin irritation. 5. Remove patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication-free between 10 and 12 hours per day. 17 Chronic Neurologic Disorders: Teaching About Phenytoin Pharm Chapter 13 Medication Administration 1. Phenytoin causes a decrease in the effects of oral contraceptives, warfarin, and glucocorticoids because of the stimulation of hepatic drug-metabolizing enzymes. 2. Alcohol, diazepam, cimetidine, and valproic acid increase phenytoin levels. 3. Carbamazepine, phenobarbital, and chronic alcohol use decrease phenytoin levels. 4. Additive CNS depressant effects can occur with concurrent use of CNS depressants. 5. Adverse effects are noted in a note card above. 18 Depression: Adverse Effects of SSRIs Pharm Chapter 8 Medication Administration 1. Sexual dysfunction (no orgasm, impotence, decreased libido). 2. CNS stimulation (inability to sleep, agitation, anxiety). 3. Weight loss early in therapy, may be followed by weight gain with long-term treatment. 4. Serotonin syndrome may begin 2 to 72 hours after starting treatment and may be lethal. Manifestations include mental confusion, fever, agitaion, anxiety, hallucinatinos, incoordination, hyperreflexia, diaphoresis, and tremors. 5. Withdrawal syndrome resulting in headache, nausea, visual disturbances, anxiety, dizziness, and tremors. 19 GI Disorders: Understanding Self-Administration of an Antiemetic Pharm Chapter 29 Medication Administration 1. Antiemetics prevent or treat nausea and vomiting from various causes. 2. Nursing assessment can identify the underlying related factors and verify that the appropriate medication is used. 3. When a client is recieving a chemotherapy agent that causes severe nausea, combining three antiemetics and administering them prior to chemotherapy is more effective than treating nausea that is already occuring. 4. Ondansetron should not be given to clients who have long QT syndrome. 5. Use dopamine antagonists cautiously, if at all with children and older adults due to the increased risk of extrapyramidal side effects. 20 Opiod Agonists and Antagonists: Evaluating Medication Prescriptions Pharm Chapter 36 Medication Administration 1. Opioid analfesics are medications used to treat moderate to severe pain. 2. Most opioid analgesics reduce pain by attaching to a receptor in the central nervous system, altering perception and response to pain. 3. Opioids are classified as agonists, agonist-antagonists, and antagonists. 4. An agonist attaches to a receptor and produces a response. 5. An antagonist attaches to a receptor site and prevents a response. 6. An agonist-antagonist binds to one receptor, causing a response, and binds to another receptor, which prevents a response. 21 Vitamins, Minerals, and Supplements: Instructing Client About Ferrous Sulfate Pharm Chapter 30 Medication Administration 1. Instruct clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorbtion. Stomach acid increases absorbtion. 2. Instruct clients to take with food if GI adverse effects occur. This may increase adherence to therapy even though absorption is also decreased. 3. Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. 4. Teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse the mouth after swallowing. 5. Instruct clients to increase water and fiber intake and to maintain an exercise program to counter the constipation effects. 6. Advise clients that therapy may last 1 to 2 months. 7. Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast, grains, green leafy vegetables).