Generic Name: misoprostol
Brand name: Classification: prostaglandin analog;
analog antisecretory agent
Why is patient/client receiving this?
Prevention of gastric mucosal injury from NSAIDS in high risk pts (geriatric, debilitated, those with a history of ulcers); acts as
prostaglandin and decreases gastric acid secretion; can cause uterine contractions
Dosage/Route:
PO: antiulcer 200 mcg 4 times daily with or after meals and at bedtime, or 400 mcg twice daily (last dose at bedtime)
Termination of pregnancy: 400 mcg single dose 2 days after mifepristone if abortion not achieved
Major Side effects:
- CNS: headache, -GI: abd pain, diharrhea, constipation, dyspepsia, flatulence, n/v –GU: miscarriage, menstrual disorders
Data used to indicate medication is effective: Assess for epigastric or abd pain and for frank or occult blood in stool; begun on 2nd or
3rd of menstrual period following negative pregnancy test; goal: prevention of gastric ulcer
Medication administration concerns: Category X, should not be used with NSAIDS or with pregnant women
Patient/client teaching points:
Don’t share medications, follow medication as prescribed and complete regiment
Diharrhea may occur
cimetidine -TIDINE (Tagamet); histamine H2 antatgonists; antiulcer agents
Why is patient/client receiving this?
Short term treatment of active duodenal ulcers and benign gastric ulcers; maintenance therapy for duodenal and gastric ulcers after
healing of active ulcers, management of GERD, treatment of heartburn ; acts at H2 receptor site in gastric parietal cells, resulting in
inhibition of gastric acid secretion
Dosage/Route:
PO: short term treatment of active ulcers: 300 mg 4 times daily or 800 mg at bedtime or 400-600 mg twice daily (not to exceed
2.4g/day) for up to 8 weeks,
Prophylaxis: 300 mg twice daily or 400 mg at bedtime
GERD: 400 mg q 6hrs or 800 mg twice daily for 12 wks
Major Side effects:
- CNS: confusion, dizziness, drowsiness, hallucinations; CV: arrhythmias, GI: constipation, diharrhea, drug induced hepatitis, nausea
GU: decreased sperm count, erectile dysfunction, Endo: gynecomastia, Hemat: agranulocytosis, aplastic anemia, anemia, neutropenia,
thrombocytopenia HYPERSENSITIVITY RXNS
Data used to indicate medication is effective: Assess for epigastric or abd pain and for frank or occult blood in stool; goal: decrease in
abd pain, treatment/prevention of gastric or duodenal irriation and bleeding, treatment of heartburn, acid indigestion and sour stomach
Medication administration concerns: Hypersensitivity; assess geriatric and debilitated pts routinely for confusion
administer with meals or immediately after to prolong effect
Patient/client teaching points: take full course of therapy, even if feeling better, pts taking OTC should avoid taking max dose
continuously for more than 2 weeks, smoking interferes with action of histamine antagonists, may cause drowsiness or dizziness
omeprazole –prazole (Prilosec) proton pump inhibitor (PPI); anti-ulcer agent
Why is pt receiving this? GERD/maintenance of healing in erosive esophagitis, duodenal ulcers, short term treatment of benign gastric ulcer;
binds to enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into gastric lumen
Dosage PO: GERD/erosive esophagitis 20 mg once daily
H. pylori: 40 mg once daily in the morning with clarithromycin for 2 wk, then 20 mg once daily for 2 wk or 20 mg twice daily with clarithromycin
500 mg twice daily and amoxicillin 1000 mg twice daily for 10 days (if ulcer is present at beginning of therapy, continue omeprazole 20 mg daily
for 18 more days)
Reduction of risk of GI bleeding: 40 mg initially, then another 40 mg 6-8 hrs later
Major side effects CNS: dizziness, drowsiness, fatigue, HA, weakness; -CV: chest pain; -GI: pseudomembranous colitis, abd pain, acid regurg,
constipation, diharrhea, flatulence, n/v, -F/E: hypomagnamesia HYPERSENSITIVITY
Data used to indicate medication is effective Assess pt for epigastric or abd pain and fank/occult blood in the stool, emesis, or gastric aspirate;
monitor bowel function for pseudomembranous colitis, GOAL: decrease in abd pain or prevention of gastric irritation and bleeding
Medication administration concerns Hypersensitivity, administer before meals, DO NOT CRUSH
Pt client teaching points Take for full course of therapy, may cause drowsiness or dizziness, avoid alcohol, products with aspirin or other
NSAIDS, foods that cause an incresase in GI irritation
sucralfate (Carafate, Sulcrate) cytoprotective agents; antiulcer agents
Why is pt receiving this? Short term mgmt. of duodenal ulcers; preventative maintanence of duodenal ulcers; unlabeled use of gastric ulcer or
esopheal reflux, prevention of gastric mucosal injury caused by high dose aspirin or other NSAIDS in pats w/ rheumatoid arthritis or high stress;
aluminum salt of sulfated sucrose reacts w/ gastric acid to form thich paste which adheres to ulcer surface
Dosage PO: Treatment of uclers 1g 4times daily, given 1 hr before meals and at bedtime or 2g twice daily at waking and bedtime;
Prevention of ulcers: 1g twice daily, given 1hr before a meal
GERD: 1 g 4 times daily, given 1 hr before meals and at bedtime
Major side effects CNS: dizziness, drowsiness; GI: constipation, diarrhea, dry mouth, gastric discomfort, indigestion, nausea, DERM: pruritus,
rashes, ENDO: hyperglycemia HYPERSENSTIVITY: ANAPHYLAXIS
Data used to indicate medication is effective Assess pt for epigastric or abd pain and fank/occult blood in the stool GOALS:
Medication administration concerns Consult pharmacy for nasogastric feedings; Hypersenstitivty
Pt client teaching points Take for full course of therapy, increased fluid intake, dietary bulk and exercise may brevent drug induced constipation
aluminum hydroxide; antacids, phosphate binders, antiulcer agents
Why is pt receiving this? Lowering of phosphate levels in pts w/ chronic renal failure; adjunctive therapy in treatment of peptic, duodenal, and
gastric ulcers, hyperacidity indigestion, reflux esophagitis; neutralizes gastric acid and inactivates pepsin
Dosage Antacid: PO 500-1500 mg (5-30 mL) 3-6 times daily
Major side effects GI: Constipation –FandE: hypophosphatemia (bone demineralization)
Data used to indicate medication is effective Assess location duration character and precipitating factors of gastric pain, monitor pH of gastric
secretions
Medication administration concerns DO NOT USE IN CASE OF ABD PAIN WITH NO KNOWN CAUSE ; separate administration of this and
other medications by at least 1-2 hr to prevent interference with absorption of other oral meds, MUST be chewed thoroughly before swallowing,
follow with water, liquid dosages more effective than tablets
Pt client teaching points Take exactly as directed, do not take within 1-2 hrs of other medications, advise pts to check label for sodium content,
ppl with HF or hypertension or on sodium restrictions should use low sodium preparation
calcium carbonate, antacid
Why is pt receiving this? Antacid (mainly: treatment and prevention of hypocalcemia, adjunct in prevention of postmenopausal osteoporosis,
emergency treatment of hyperkalemia and hypermagnesemia and adjuct in cardiac arrest or calcium channel blocking agent toxicity);
Dosage Antacid: PO .5-1.5g PRN
Major side effects CNS: tingling, CV: cardiac arrest, arrhythmias, bradycardia, FandE: hypercalcemia, GI: constipation, diharrhea, n/v, gastric
acid hypersecretion GU: calculi, hyperacliuuria
Data used to indicate medication is effective Assess for heartburn, indigestion, and abd pain; inspect abd auscultate bowel sounds
Medication administration concerns Contraindicated in pts with hypercalcemia, renal calculi, ventricular fibrillation, concurrent use of calcium
supplements, hypercalcemia can increase risk of digoxin toxicity, can increase risk of hypercalcemia, risk of milk-alkali syndrome, may decrease
effects of CCB’s
Pt client teaching points DON’T take enteric coated tablets within 1 hr of calcium carbonate, this results in premature dissolution of tablets; do
not administer w/ foods containing oxalic acid (spinach/rhubarb), phytic acids (brans, cereals), or phosphorus (milk/dairy products); may cause
constipation, avoid excessive use of tobacco or beverages containing alcohol or caffeine, maintain diet adequate in vitamin D
magnesium hydroxide (MILK OF MAGNESIA), antacid, laxative
Why is pt receiving this? Useful in vairiety of GI complaints including hyperacidity, indigestion, GERD, heartburn and constipation; neutralizes
gastric acid following dissolution in gastric contents, inactivates pepsin if pH raised to greater than or equal to 4, draws water to gastric tract to
induce peristalsis
Dosage Antacid: PO: 5-30 mL or 1-2 tablets 1-3 hr after meals and at bedtime ; Laxative: 5-15 mL/dose up to 4 times/day as liquid or 2.5-7.5 mL/dose
up to 4 times/day as liquid concentrate mg/dose or 622-1244 mg/dose (2-4 tabs) up to 4 times/day.
Major side effects GI: diharrhea, FandE: hypermagnemesia hyperkalemia
Data used to indicate medication is effective Assess for heartburn, indigestion, and location, duration, character, and precipitating factors of
gastric pain GOAL: relief of gastric pain and irritation, relief of constipation
Medication administration concerns Contraindicated in ABD PAIN W/NO KNOWN CAUSE, esp. if ACCOMPANIED BY FEVER, RENAL
FAILURE ; chew thoroughly before swallowing
Pt client teaching points alert if no relief, problem is recurring, or if symptoms of gastric bleeding occur,
sodium bicarbonate, alkalinizing agent
Why is pt receiving this? Antacid, used to alkalinize urine and promote excretion of certain drugs in overdasge situations, mgmt. of metabolic
acidosis, acts as alkalinizing agent by releasing bicarb ions
Dosage Antacid: PO: tablets/powder, 325 mg-2g 1-4 times daily OR ½ tsp q 2 hours as needed
Major side effects CV: edema GI: flatulence, gastric distension, gastric acid hypersecretion, FandE: metabolic alkalosis, hypernatremia,
hypocalcemia, hypokalemia,
Data used to indicate medication is effective assess pt for epigastric or abd pain and frank or occult blood in stool, emesis, or gastric aspirate
GOAL: decreased gastric discomfort
Medication administration concerns Contraindicated in alkalosis, hypocalcemia, hypernatremia, patients on sodium restraining diets, severe abd
pain of unknown cause
Pt client teaching points take as directed, review electrolyte imbalances (notify provider), advice pt no to take mikl products with this medication,
avoid routine use of sodium bicarb for indigestion, dyspepsia longer than two weeks should be evaluated, avoid if on sodium restricted diet, notify
if indigestion is accompanied by chest pain, difficulty breathing, or diaphoresis or if stools become dark and tarry
psyllium, (Metamucil) bulk forming laxative
Why is pt receiving this? Mgmt of simple or chronic constipation, particularly if assoc w/ low fiber diet. Useful in situations in which straining
should be avoided. Used in management of chronic watery diarrhea. Combines with water in intestingal contents to form an emollient gel or
viscous solution that promotes peristalsis.
Dosage PO: 1-2 tsp/packet/wafer (3-6 g) in or with A FULL GLASS OF WATER (to prevent obstruction) 2-3 times daily
Major side effects RESP: bronchospasm, GI: cramps, intestinal or esophageal obstruction, n/v
Data used to indicate medication is effective assess pt for abd distension, presence of bowel sounds, usual bowel patterns; assess color,
consistency, and amount of stool produced
Medication administration concerns Contraindicated in hypersensitivity, abd pain, n/v, serious adhesions; may decrease absorption of warfarin,
digoxin
Pt client teaching points encourage pt to use other forms of bowel regulation (increase bulk in the diet, increase fluid intake, increase mobility);
normal bowel haits are individual and may vary; can be used for long term management of chronic constipation, instruct pts with cardiac disease
to avoid straining (valsalva), don’t use w/ abd pain, n/v or fever
docusate sodium, (Colace, Surfak, Doss) stool softener
Why is pt receiving this? PO: prevention of constipation (in pts who should avoid straining such as MI or rectal surgery); rect: enema to soften
impaction, Promotes incorporation of water into stool, resulting in softer fecal mass. May also promote electrolyte and water secretion into colon.
Dosage PO: 50-400 mg in 1-4 individual doses
Major side effects EENT: throat irritation, GI: mild cramps, diarrhea, DERM: rashes
Data used to indicate medication is effective assess pt for abd distension, presence of bowel sounds, usual bowel patterns; assess color,
consistency, and amount of stool produced GOAL: soft, formed bowel movement, usually w/in 48 hrs. Therapy may take 3-5 days for results
Medication administration concerns No significant drug interactions; administer w/ full glass of liquids, can be given on empty stomach for faster
results
Pt client teaching points advise pts laxatives should be used only for short term therapy, long term therapy can result in electrolyte imbalance and
dependence, encourage pt to use other forms of bowel regulation (increase bulk in the diet, increase fluid intake, increase mobility); normal bowel
haits are individual and may vary, instruct pts with cardiac disease to avoid straining (valsalva), don’t use w/ abd pain, n/v or fever do not use
docusate w/ other laxatives w/in 2 hrs
bisacodyl (Dulcolax, ExLax, Senokot, castor oil) stimulant laxatives
Why is pt receiving this? Treatment of constipation, evacuation of the bowel before radiologic studies OR surgery, part of bowel regimen in spinal
cord injuries; stimulates peristalsis, alters fluid and electrolyte transport producing fluid accumulation in colon
Dosage 5-15mg/day PO as single dose; Rect: 10 mg/day single dose
Major side effects GI: abd cramps, nausea, diarrhea, recal burning, F/E: hypokalemia (w/ chronic use) MS: muscle weakness (w/ chronic use),
Misc: tetany, protein losing enteropathy
Data used to indicate medication is effective assess pt for abd distension, presence of bowel sounds, usual bowel patterns; assess color,
consistency, and amount of stool produced GOAL: soft, formed bowel movement
Medication administration concerns SHOULD NOT BE USED w/ anti acid agents (H2 receptor antagonists, ppi’s, antacids) can dissolve enteric
coating early, may be administered at bedtime for morning results; taking on empty stomach will produce more rapid results; take with full glass
of water DO NOT CRUSH
Pt client teaching points advise pts laxatives should be used only for short term therapy, long term therapy can result in electrolyte imbalance and
dependence, encourage pt to use other forms of bowel regulation (increase bulk in the diet, increase fluid intake, increase mobility); normal bowel
haits are individual and may vary, instruct pts with cardiac disease to avoid straining (valsalva), don’t use w/ abd pain, n/v or fever
polyethylene glycol (GoLYTELY) osmotic laxative
Why is pt receiving this? Bowel cleansing in prep for GI examination, unlabeled treatment of acute iron overdose in children; drawes water into
GI lumen
Dosage 240 mL q 10 hrs until fecal discharge appears clear and has no solid material; can be given through NG tube at 20-30 mL/min up to 4 L
Major side effects GI: abd. Fullness, diarrhea, bloating, cramps, ischemic colitis, nv/ -FE fluid/electrolyte imbalances –Misc: RARE allergic rxns
Data used to indicate medication is effective assess color, consistency, and amount of stool produced; assess semiconscious or unconscious
patients closely for regurgitation when administering via NG tube GOAL: Diarrhea which cleanses the bowel w/in 4 hrs
Medication administration concerns can be safely (?) used in clients who are dehydrated or have renal/cardiac disease ; 1st bm happens generally
w/in 1 hour of administration; interferes w/ absorption of orally administered medications; avoid solid food and milk w/in 1-2 hrs of beginning
therapy but can and should keep hydrated w/ clear fluid
Pt client teaching points Drink 240 mL q 10 minutes until 4 L have been consumed or fecal discharge is clear and free of solid matter. Rapidly
conscuming each 240 mL is preferred over drinking small amounts continuously. Advise pt to avoid alcohol
metoclopramide (Reglan) , antiemetic
Why is pt receiving this? Prevention of chemotherapy-induced emesis. Treamtne of postsurgical and diabetic gastric statis. Facilitation of small
bowel intubation in radiographic procedures. Managementof GERD. Treatment and prevention of postoperative n/v when nasogastric suctioning is
undesirable. Blocks dopamine receptors in chemoreceptor trigger zone of CNS. Stimulates motility of upper GI tracts and accelerates gastric
emptying.
Dosage Prevention: PO 1-2mg/kg 30 min before chemo, facilitation of small bowel intubation: 10 mg over 1-2 min (IV)
IV: administer dose 30 min before chemo, doses give slowly over 1-3 min; Intermittent: may be diluted in 50 ml D5W, NS, D51/2NS, Ringers or
Lactated Ringers, may dilute to .2mg/mL or give undiluted at 5mg/mL infuse slowly over at least 15-30 min (rate of 5mg/min)
Major side effects CNS: drowsiness, extrapyramidal rxns, tartdive dyskinesia, anxiety, depression, irritability, neuroleptic malignant
syndrome CV: arrhythmias (supraventricular tachycardia, bradcardia) hyper/hypotension, GI: constipation, diarrhea, dry mouth, nausea ENDO:
gyencomastia HEMAT: methemoglobinemia, neutropenia leukopenia, agranulocytosis
Data used to indicate medication is effective assess n/v, abd distension and bowel sounds. aassess color, consistency, and amount of stool
produced Assess for extrapyramidal side effects periodically throughout course of therapy, monitor for tardive diskynesia, monitor for neuroleptic
malignant syndrome (hyperthermia, muscle rigidty, altered consciousness, irregular pulse/BP, tachycardia and diaphoresis) assess for signs of
depression GOAL: prevention or relief of nausea/vomiting, decreased syptoms of gastric stasis, facilitation of small bowel intubation
Medication administration concerns contraindicated in pts w/ hypersensitivity, possible gi obstruction or hemorrhage, history of seizure
disorders, phenochromocytoma, prakionson’s; administer PO dose 30 min before meals and at bedtime
Pt client teaching points Take as directed, may cause drowsiness, avoid concurrent use of alcohol and other CNS depressants, inform risk of
extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome
lactulose (Chronulac, Duphalac) osmotic laxative (prescription laxative)
Why is pt receiving this? Treatment of chornic constipation, adjunct in management of portal systemic encephalopathy; Increases water content
and softens stool, lowers pH of colon which inhibits diffusion of ammonia from colon into blood thereby reducing blood ammonia levels
Dosage Constipation PO: 15-30 mL/day up to 60 ml/day as liquid or 10-20 g as powder for oral solution (up to 40g/day) PSE: 30-45 mL 3-4
times/day may be given q 1-2 hr initially to induce laxation RECT enema: to administer use rectal balloon catheter, mix 200 mL with 700 mL
water or NS Ensema should be retained 30-60 min
Major side effects GI: belching, cramps, distension, flatulence, diarrhea ENDO: hyperglycemia (diabetics)
Data used to indicate medication is effective assess pt for abd distension, presence of bowel sounds and normal pattern of bowel function, color
consistency and amount of stool produced, asses mental status (for use with PSE) GOAL : passage of soft, small bm w/in 24-48 hrs
Medication administration concerns contraindicated in pts w/galactose restrictions, use cautiously in diabetes and excessive use, should not be
used w/ other laxatives in treatment of hepatic encephalopathy, MIX w/ juice, water milk or carbonated citrus beverage to improve flavor,
administer w/ full glass of water or juice, can be administered on empty stomach for rapid results
Pt client teaching points Encourage other forms of bowel regulation (increasing bulk in diet, increasing luid intake, increasing mobility), may
cause belching flatulence or abd cramping
paregoric, opioid antidiarrheal (schedule III) CONTAINS 2 mg ANHYDROUS MORPHINE/5mL
Why is pt receiving this? Symptomatic treatment of diarrhea, inhbits GI peristalsis by morphine
Dosage PO: 5-10 mL 1-4 times daily
Major side effects CNS: dizziness, drowsiness, EENT: miosis, RESP: resp depression CV: orthostatic hypotension, bradycardia, vasodilation GI:
biliary tract spasm, constipation GU: urinary retention MISC: histamine release (rash/pruritis)
Data used to indicate medication is effective assess pt for abd distension, presence of bowel sounds and normal pattern of bowel function, color
consistency and amount of stool produced, monitor fluid electrolyte balance and skin turgor for dehydration, monitor RR (esp in infants and
geriatric) GOAL :decrease in diarrhea, return to normal bowel habits, resolution of withdrawl symptoms
Medication administration concerns DO NOT CONFUSE w/ opium tincture which is 25x more potent! If GI irritation occurs, can administer w/
food or meals SHOULD NOT USE IF UNDERLYTING CAUSE IS INVADING ORGANISM
Pt client teaching points Fall risk, teach patients to use call light, fall risk interventions and to take several minutes to reposition self. Avoid CNS
depressents including alcohol for additive CNS Depression effects; take medication exactly as directed DO NOT TAKE MORE THAN
PRESCRIBED, may need to be gradually reduced to prevent withdrawl symptoms, May cause drowsiness
loperamide (Immodium) synthetic opioid antidiharrheal
Why is pt receiving this? Adjunctive therapy of acute diarrhea, chronic diarrhea assoc. with inflammatory bowel disease, decreases volume of
ostemy drainage; inhibits peristalsis and prolongs transit time y direct effect on nerves
Dosage PO: 4 mg initially, then 2 mg after each loose stool; maintenance dose usually 4-8 mg/day in divided doses for acute and chornic diharrhea
Major side effects CNS: drowsiness, dizziness; GI: constipation, abd. pain/distension/ discomfort, dry mouth, nausea, vomiting, -allergic reactions
Data used to indicate medication is effective assess color consistency and amount of stool produced, monitor fluid and electrolyte balance and
skin turgor for dehydration GOAL :decrease in diarrhea, return to normal bowel habits, resolution of withdrawl symptoms
Medication administration concerns Contraindicated in abd pain of unkown orign, pts in which constipation must be avoided,
HYPERSENSITIVITY; Increased CNS depression with other depressants including alcohol, antihistamines
Pt client teaching points Take fluids to prevent dehydration w/ diarrhea, advise pt not to exceed max dose, may cause drowsiness, CNS depression
FALL RISK PRECAUTIONS GOAL: decrease in diarrhea, treatment should be discontinued if no improvement is seen in 48 hours
ondansteron (Zofran) atiemetic, 5-HT3 antagonist
Why is pt receiving this? Prevention of N/V assoc. with highly or moderately emetogenic chemotherapy, PO: prevention of N/V associated w/
radiation therapy or postoperative; Bloccks the effects of serotonin at 5HT3 recepotr sites (SELECTIVE ANTAGONIST) located in vagal
nerve terminals and the chemoreceptor trigger zone in CNS
Dosage PO: 24 mg prior to chemotherapy; Prevention of n/v associated with emetogenic chemotherapy 8 mg 30 min prior to chemotherapy
and repeated 8 hr later; 8 mg q 12 hr may be given for 1-2 days following chemotherapy; prevention of radiation induced n/v 8 mg 1-2 hr
prior to radiation may be repeated q 8 hr, depending on type location and extent of radiation; prevention of postoperative n/v 16 mg 1 hr before
induction of anesthesia
IV: prevention of chemotherapy .15 mg/kg 30 min prior, repeated 4 and 8 hr later; IM,IV: 4 mg before induction of anesthesia or
postoperatively
Direct IV: administer undiluted preoperatively or postoperatively if n/v occur shortly after surgery; administer preferably over 2-5 min
Intermittent: dilute in 50 mL D5W, NS, D5NS, D51/2NS at 1mg/mL
Major side effects CNS: HA, dizziness, drowsiness, fatigue, weakness CV: torsade de pointes, qt interval prolongation, GI:
constipation, diharrhea, abd pain, dry mouth increased liver enzymes, NEURO: extrapyramidal rxns
Data used to indicate medication is effective assess patient for n/v abdominal distension, bowelsounds prior to and following administration;
assess pt for extrapyramidal effects periodically during therapy,
Medication administration concerns MONITOR ECG in pts with hypokalemia, hypomagnemesia, HF, bradayarrythmias, or patients taking
meds that prolong QT interval
Pt client teaching points Take as directed, advise pt if symptoms of irregular heart beat or involuntary mvmt of eeys, face, or limbs occur
scopolamine anticholinergic antiemetic
Why is pt receiving this? Transdermal: prevention of motion sickeness, mgmt. of n/v associated w/ opioid analgesia or general anesthesia
IM/IV/SubQ: preoperatively to produce amnesia and to decrease salivation and excesive resp. secretions PO: symptomatic treatment of
postencephalitis parkinsonism and paralysis agitans. Inhibits ecessive motility and hypertonus of GI tract in irritable colon syndrome, mild
dysentery, diverticulitis, and pylorospasm, prevention of motion sickness; Inhibits muscarinic activity of acetylcholine, Corrects imbalance of
acetylcholine and norepinephrine in CNS which may be responsible for motion sickness
Dosage Transdermal: motion sickness: apply 1 patch hr prior to travel and then every 3 days PRN; apply 1 patch evening before surgery
PO: .4-.8mg, may repeat every 8-12 hrs as needed
IM,IV, SubQ: antiemetic/anticholinergic .3-.6 mg; antisecretor .2-.6, amnestic effect .32-.65, sedation .6 mg 3-4 times daily
DIRECT IV: diluted with sterile water for injection prior to IV administration, inject slowly over 2-3 min
Major side effects CNS: drowsiness, confusion EENT: blurred vision, mydriassis, photophobia CV: tachycardia, palpitations GI: dry mouth,
constipation CU: urinary hesitancy, urinary retention DERM: decreased perspiration
Data used to indicate medication is effective assess patient for n/v abdominal distension, bowelsounds prior to and following administration;
assess pt for extrapyramidal effects periodically during therapy GOAL: decrease in salivation and respiratory secretion preoperatively,
prevention of motion sickness
Medication administration concerns CONTRAINDICATED in pts with HYPERSENSITIVTY, oral contraindicated in prostatic hyperplasia
and obstruction; additive anticholinergic effects with antihistamines, antidepressents, quinidine or disopyramide; increased CNS depression
with alcohol, antidepressents, antihistamines, opioid analgesis or sedatives/hypnotics
Pt client teaching points Take 1 hr before travel to achieve optimum effects, may cause drowsiness or blurred vision, avoid concurrent use
with alchol and other CNS depressents
dronabinol (Mrinol) anitemetics, cannabinoid SCHEDULE III
Why is pt receiving this? Prevention of N/V from cancer chemotherapy when more conventional interventions have failed; to prevent anorexia
associated w/ weight loss in patietns with AIDS
Dosage PO: Antiemetic: 5mg/m^2 1-3 hr prior to chemo, may repeat every 2-4 hr after to a toal of 4-6 doses/day, can be adjusted to max of 15
mg/m^2
PO: appetite: 2.5 mg bid initially, may be increased PRN
Major side effects CNS: anxiety, concentration difficulty, confusion, dizziness, drowsiness, mood change, abnormal thinking, depression,
disorientation, hallucinations, HA, impaired judgment, memory lapse EENT: dry mouth CV: palpitations, syncope, tachycardia GI: abd pain,
N/V, Derm: facial flushing Neuro: ataxia, paresthesia, Misc: dependence (physical/psychological) for high doses
Data used to indicate medication is effective assess patient for n/v , appetite, bowel sounds, abd pain; monitor hydration, nutritional stats and
intake and output, BP and HR GOAL: relief of and decrease in N/V assoc. w/ chemotherapy
Medication administration concerns additive CNS depression w/ alcohol, antihistamines, barbiturates, benzos, atropine, scopolamine, lithium,
opioid analgesics, tricyldes, andtidepressents, sedatives/hypnotics; Increased risk of tachycardia with amphetamine, atropine, scopolamine,
cocaine, antihistamines; CAPSULES Should be refrigerated
Pt client teaching points altered CNS status AND orthostatic hypotension: fall risk; avoid taking other CNS depressents, advise of general
measures to decrease naues (sips of liquid, avoid greasy meals, provide oral hygiene, remove noxious stimuli
promethazine (Phenergan) phenothiazines, antiemetic, antihistamine HIGH ALERT
Why is pt receiving this? Treatment of various allergic conditions and motion sickness; preoperative sedation; treatment/prevention of
nausea/vomiting; adjunct to anesthesia and analgesia; blocks effects of histamine, has inhibitory effect of chemoreceptor trigger zone,
alters effects of dopamine in CNS, posessess significant anticholinergic activity, produces CNS depression by indirectly decreased
stimulation of CNS
Dosage ANTIHISTAMINE: PO: 5.25-12.5 mg 3 times/day and 25 mg at bedtime IM, IV, rect: 25 mg may repeat in 2 hrs
ANTIEMETIC: PO RECT IM IV: 12.5-25 mg q 4 hr as needed, initial PO dose should be 25 mg
DIRECT IV: dilute with NS or D5W, doses should not exceed [25 mg/mL], administer through LARGE BORE VEIN Through a running IV
line into most distal port; administer each 25 mg slowly over at least 10-15 min
Major side effects CNS: neuroleptic malignant syndrome, confusion, disorientation, sedation, dizziness, extrapyramidal rxns, fatigue,
insomnia, nervousness; EENT: blurred vision, diplopia, tinnitus; CV: brady/tachycardia, hyper/hypotension GI: constipation, drug induced
hepatitis, dry mouth; DERM: photosensitivity, SEVERE tissue necrosis w/ infiltration at IV site
Data used to indicate medication is effective IV: monitor BP, pulse, RR in pts; assess sedation after administration, monitor extrapyramidal
side effects, notice for signs of neuroleptic malignant syndrome (fever, resp. distress, tachycardia, seizures, diaphoresis, hyper/hypotension,
pallor, tiredness, severe muscle stiffness GOAL :relief from allergies, prevention of motion sickness, sedation, relief from n/v
Medication administration concerns contraindicated in hypersensitivity, comatose pts, additive CNS depression with alcohol, other
antihistamines, opioid analgesics and other sedative/hypnotics; additive anticholinergic effects, may precipitate seizures when used with drugs
that lower seizure threshold
Pt client teaching points Drowsiness, additive CNS effects; frequent mouth rinses, good oral hygine, and sugarless gum/candy can decrease
dry mouth, use sunscreen/protective clothing when outdoors, orthostatic hypotension FALL RISK PROTOCOL, notify HCP if sore throat,
fever, jaundice or uncontrolled movements are noted
cholestryamine (Questran) bile acid sequestrates
Why is pt receiving this? Mgmt. of primary hypercholesterolemia; unlabeled use: diarrhea with excess of bile acids; binds with bile
in GI Tract to form insoluble compound that can be excreted (affinity for acidic materials)
Dosage
PO: 4 g 1-2 times daily initially, may be increased to 24 g/day in 6 divided doses
Major side effects EENT: irritation of tongue, GI: abd discomfort, constipation, nausea, fecal impaction, flatulence, vomiting DERM:
irritation, rashes, FandE: hypercholeremic acidosis, Metab: Vitamin A,E, and K deficiency
Data used to indicate medication is effective obtain diet history esp. regarding fat intake, assess frequency, consistency, color of stools,
GOAL: decrease in severity/frequency of stools
Medication administration concerns may decrease absorption of orally administered medications and fat soluble vitamins, mix with water,
milk, juices, noncarbonated beverages, soups,
Pt client teaching points TAKE EXACTLY AS DIRECTED, take before meals, notify if constipation occurs, can prevent constipation w/
increased bulk in diet, mobility, increased fluid intake
orlistat (xenical) lipase inhibitor
Why is pt receiving this? obesity management when used in conjunction with reduced calorie diet in patients with initial BMI
greater or equal to 30, or 27 with additional risk factors, reduces risk of regain after prior loss, may delay onset of TIIDM;
reversibly inhibits lipases which are needed for absorption of fat
Dosage
PO: 60-120 mg 3 times daily with each meal containing fat
Major side effects GI: Hepatotoxcity, dumping syndrome, fecal urgency, flatus with discharge, oily stools, reduces absorption of fat soluble
vitamins and beta carotene GU: renal impairment
Data used to indicate medication is effective monitor weight loss and concurrent medications GOAL: slow, consistent weight loss when
combined with reduced calorie diet
Medication administration concerns may decrease absorption of orally administered medications and fat soluble vitamins
Pt client teaching points take as directed, if missed meal or meal contains no fat, ok to omit, Taking with meal high in fats can exacerbate GI
symptoms, regular physical activity w/ diet should be encouraged, notify provider for signs of hepatotoxicity