Drug Cards Name 1 Brittany Ducote Drug Name Therapeutic/ Pharmacologic Class Indication/ Use Adverse/ Side Effects Nursing Considerations Albumin Trade name: Albuminex, Kedbumin, Albuminar-5, Albuminar-25, AlbuRx, Albutein, Buminate, Flexbumin, Plasbumin Pharmacotherapeutic: Plasma protein fraction Action: Blood volume expander Occasional S/E: Hypotension Clinical: Blood derivative Uses: Used for plasma volume expansion, maintenance of cardiac output in treatment of shock or impending shock. May be useful in treatment of severe burns, adult respiratory distress syndrome (ARDS), cardiopulmonary bypass, hemodialysis. Obtain BP, pulse, respirations immediately before administration. Adequate hydration is required before administration. Generic: Albumin, human Usual dosage: IV Adult: Initially 25g; may repeat in 15-30 min. Hypovolemia: IV Adults: 5% albumin: 0.5-1g/kg/dose, repeat as needed. Children: 0.5-1g/kg/dose (1020mL/kg/dose of 5% albumin) Hypoproteinemia: IV Adult, Children: 0.5-1g/kg/dose, repeat every 1-2 days as needed. Hemodialysis: IV Adults: 50100mL (12.5-25g) of 25% albumin as needed. Therapeutic effect: Provides temporary increase in blood volume, reduces hemoconcentration and blood viscosity Off-label: Large-volume paracentesis. In cirrhotic patients, with diuretics to help facilitate diuresis; volume expansion in dehydrated, mildly hypotensive cirrhotic patients. Used for prevention of renal impairment; reduced mortality associated with spontaneous bacterial peritonitis Rare S/E: High dose in repeated therapy: altered vital signs, chills, fever, increased salivation, nausea, vomiting, urticaria, tachycardia. Adverse effects: Fluid overload may occur marked by increased BP, distended neck veins. Pulmonary edema may occur, evidenced by labored respirations, dyspnea, rales, wheezing, coughing. Neurologic changes that may occur include headache, weakness, blurred vision, behavioral changes, incoordination, isolated muscle twitching Monitor BP for hypotension/hypertension. Monitor Hgb, Hct, urine specific gravity. Monitor I&O. Assess for fluid overload, pulmonary edema. Assess skin for flushing, urticaria. Assess for therapeutic response: decreased edema, increased BP. Teach: Report chills, nausea, headache, or back pain to physician immediately. Drug Name 2 Sodium polystyrene sulfonate Trade name: Kayexalate, Kionex, PMS-Sodium Polystyrene Sulfonate, SPS Hyperkalemia: PO: Adults: 60mL (15g) 1-4 times a day. Children: 1g/kg/dose q6h. Therapeutic/ Pharmacologic Class Indication/ Use Adverse/ Side Effects Nursing Considerations Pharmacotherapeutic: Cation exchange resin. Action: Releases sodium ions in exchange primarily for potassium ions. Frequent S/E: High dosage: Anorexia, nausea, vomiting, constipation. High dosage in Elderly: Fecal impaction (severe stomach pain with nausea/vomiting) Baseline serum potassium. Consider other measures because it does not rapidly correct severe hyperkalemia. (Consider IV calcium, IV sodium bicarbonate/glucose/insulin, dialysis in medical emergency) Occasional S/E: Diarrhea, sodium retention (decreased urination, peripheral edema, increased weight) Monitor serum potassium levels frequently. Clinical: Antihyperkalemic Therapeutic effect: Moves potassium from blood into intestine to be expelled from the body. Uses: Treatment of hyperkalemia Rectal: Adults: 30-50g as needed q6h. Children: 1g/kg/dose q2-6h. Drug Name Adverse Effects: Potassium deficiency may occur. Early signs of hypokalemia: confusion, delayed thought processes, extreme weakness, irritability, EKG changes (often associated with prolonged QT interval; widening, flattening, or inversion of T wave; prominent U waves). Hypocalcemia, manifested by abdominal/muscle cramps, occurs occasionally. Arrhythmias, severe muscle weakness may be noted. Therapeutic/ Pharmacologic Class Indication/ Use Adverse/ Side Effects Monitor EKG to determine when treatment should be discontinued. Monitor serum magnesium, calcium levels. Monitor I&O for decreased urinary output and daily weights for any increased weight Monitor daily pattern of stool, consistency in case of fecal impaction, especially with high doses and in elderly. Teach: Report signs of weakness, confusion, changes in stool patterns. If PO, do not mix with orange juice. Nursing Considerations 3 Mannitol Trade name: Aridol, Osmitrol Usual dosage Elevated ICP: IV: Adults, Elderly: 0.251g/kg/dose. May repeat q68h as needed. Children: 0.25-1g/kg/dose; repeat to maintain serum osmolality <300320mOsm/kg. Injection Solution (Osmitrol): 20%, 25% Pharmacotherapeutic: Polyol (sugar alcohol). Clinical: Osmotic diuretic, antiglaucoma, antihemolytic Therapeutic effect: Produces diuresis; reduces intraocular pressure (IOP), intracranial pressure (ICP), cerebral edema. Action: Elevates osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes, resulting in increased flow of water into interstitial fluid/plasma. Uses: Prevention, treatment of oliguric phase of acute renal failure (before evidence of permanent renal failure). Reduces increased ICP due to cerebral edema, IOP due to acute glaucoma. Promotes urinary excretion of toxic substances. Off-label: Improve renal transplant function. Frequent S/E: Dry mouth, thirst. Occasional S/E: Blurred vision, increased urinary frequency/volume, headache, arm pain, backache, nausea, vomiting, urticaria, dizziness, hypotension, hypertension, tachycardia, fever, angina-like chest pain. Adverse Effects: Fluid, electrolyte imbalance may occur due to rapid administration of large doses or inadequate urine output resulting in overexpansion of extracellular fluid. Circulatory overload may produce pulmonary edema, HF. Excessive diuresis may produce hypokalemia, hyponatremia. Fluid loss in excess of electrolyte excretion may produce hypernatremia, hyperkalemia. Black box alert: May result in severe bronchospasm. Not recommended in pts with asthma. Obtain baseline BP, pulse. Assess skin turgor, mucous membranes, mental status, muscle strength. Obtain baseline weight, chemistry studies. Assess I&O. Monitor serum electrolytes, serum osmolarity ICP, renal/hepatic function tests. Assess V/S, skin turgor, mucous membranes. Daily weights. Monitor urinary output. Assess for signs of hyponatremia: confusion, drowsiness, thirst, dry mouth, old/clammy skin. Signs of hypokalemia: changes in muscle strength, tremors, muscle cramps, altered mental status, cardiac arrhythmias. Signs of hyperkalemia: colic, diarrhea, muscle twitching followed by weakness, paralysis, arrhythmias. Teach: Expect increased urinary frequency/volume. May cause dry mouth. Report drowsiness, weakness, confusion. Drug Name 4 Potassium chloride Trade name: Apo K, Kaon-Cl, Klor-Con, Klor-Con M10, KlorCon M20, Micro-K Prevention of Hypokalemia with Diuretic Therapy: PO: Adults: 20-40mEq/day in 1-2 divided doses. Children: 1-2 mEq/kg/day in 1-2 divided doses. Treatment of Hypokalemia: PO: Adults: 40-100 mEq/day in divided doses (generally limit amt per dose to 40 mEq); further doses based on lab values. Children: Initially, 1-2 mEq/kg per dose; further doses based on lab values. IV: Adults: 5-10mEq/hr. Children: 0.5-1mEq/kg per dose. Therapeutic/ Pharmacologic Class Indication/ Use Adverse/ Side Effects Nursing Considerations Pharmacotherapeutic: Electrolyte. Action: Necessary for multiple cellular metabolic processes. Primary action is intracellular. Occasional S/E: Nausea, vomiting, diarrhea, flatulence, abdominal discomfort with distention, phlebitis with IV administration (particularly when potassium concentration of greater than 40 mEq/L is infused). Rare S/E: Rash. Assess for hypokalemia: weakness, fatigue, polyuria, polydipsia for baseline. PO should be given with food or after meals with full glass of water or fruit juice to minimize GI irritation. Adverse Effects: Hyperkalemia (more common in elderly, pts with renal impairment) manifested as paresthesia, feeling of heaviness in lower extremities, cold skin, grayish pallor, hypotension, confusion, irritability, flaccid paralysis, cardiac arrhythmias. Monitor I&O for decreased urinary output (may indicate renal insufficiency) Monitor daily stool pattern, consistency Clinical: Potassium replenisher Therapeutic effect: Required for nerve impulse conduction, contraction of cardiac, skeletal, smooth muscle; maintains normal renal function, acidbase balance. Uses: Treatment, prevention of hypokalemia. Monitor serum potassium. If GI disturbance, dilute preparation further or give with meals Assess IV site for extravasation, phlebitis. Assess for signs of hyperkalemia: skin pallor/coldness, paresthesia, feeling of heaviness of lower extremities. Teach: Potassium rich diet: beef, ham, chicken, turkey, fish, milk, bananas, dates, prunes, raisins, avocados, watermelon, beans, broccoli, Brussel sprouts, lentils, potatoes, spinach. Report paresthesia, feeling of heaviness in LE, tarry or bloody stools, weakness, fatigue.