Mosby's 2014 Nursing Drug Reference (14 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Thrombolytics act by activating conversion of plasminogen to plasmin (fibrinolysin). Plasmin is able to break down clots (fibrin).
Thrombolytics are used to treat DVT, pulmonary embolism, arterial thrombosis, arterial embolism, arteriovenous cannula occlusion, lysis of coronary artery thrombi after MI, and acute, evolving transmural MI.
Persons with hypersensitivity, active bleeding, intraspinal surgery, neoplasms of the CNS, ulcerative colitis/enteritis, severe hypertension, renal/hepatic disease, hypocoagulation, COPD, subacute bacterial endocarditis, rheumatic valvular disease, cerebral embolism/thrombosis/hemorrhage, recent intraarterial diagnostic procedure or surgery (10 days), and recent major surgery should not use these products.
Precautions:
Caution should be used in arterial emboli from left side of heart and pregnancy.
•
As soon as thrombi identified; not useful for thrombi over 1 wk old
•
Cryoprecipitate or fresh, frozen plasma if bleeding occurs
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Loading dose at beginning of therapy; may require increased loading doses
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Heparin after fibrinogen level is >100 mg/dl; heparin inf to increase PTT to 1.5-2 × baseline for 3-7 days
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About 10% of patients have high streptococcal antibody titers requiring increased loading doses
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IV therapy using 0.8 μm filter
Serious adverse reactions include GI, GU, intracranial retroperitoneal bleeding, and anaphylaxis. The most common side effects are decreased Hct, urticaria, headache, and nausea.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
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Risk for injury
[uses]
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VS, B/P, pulse, resp, neurologic signs, temp at least q4hr; temp >104° F (40° C) indicator of internal bleeding; cardiac rhythm following intracoronary administration; systolic pressure increase of >25 mm Hg should be reported to prescriber
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For neurologic changes that may indicate intracranial bleeding
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Retroperitoneal bleeding: back pain, leg weakness, diminished pulses
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Allergy: fever, rash, itching, chill; mild reaction may be treated with antihistamines
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For bleeding during 1st hr of treatment: hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis
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Blood studies (Hct, platelets, PTT, PT, TT, aPTT) before starting therapy; PT or APTT must be <2× control before starting therapy or PT q3-4hr during treatment
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Storage of reconstituted product in refrigerator; discard after 24 hr
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Bed rest during entire course of treatment
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Therapeutic response: resolution of thrombosis, embolism
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To avoid venous or arterial puncture, inj, rectal temp
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To treat fever with acetaminophen or aspirin
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To apply pressure for 30 sec to minor bleeding sites; to inform prescriber if this does not attain hemostasis; to apply pressure dressing
Thyroid hormones act by increasing metabolic rates resulting in increased cardiac output, O
2
consumption, body temp, blood volume, growth, development at cellular level, respiratory rate, and enzyme system activity.
Thyroid hormones are used for thyroid replacement.
Persons with adrenal insufficiency, MI, or thyrotoxicosis should not use these products.
Precautions:
Geriatric patients and those with angina pectoris, hypertension, ischemia, cardiac disease, diabetes mellitus or insipidus should be watched closely when using these products. Caution should be used in pregnancy (A) and breastfeeding.
•
At same time each day to maintain product level
•
Only for hormone imbalances; not to be used for obesity, male infertility, menstrual conditions, lethargy
The most common side effects include insomnia, tremors, tachycardia, palpitations, angina, dysrhythmias, weight loss, and changes in appetite. Serious adverse reactions include thyroid storm.
Pharmacokinetics vary widely among products. Check individual monographs for specific information.
•
Impaired absorption of thyroid products may occur when administered with cholestyramine, iron products (separate by 4-5 hr)
•
Increased effects of anticoagulants, sympathomimetics, tricyclics, catecholamines may occur
•
Decreased effects of digoxin, glycosides, insulin, hypoglycemics may occur
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Decreased effects of thyroid products may occur with estrogens
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Disturbed body image
[adverse reactions]
•
Deficient knowledge
[teaching]
•
Noncompliance
[teaching]
•
B/P, pulse before each dose
•
I&O ratio
•
Weight daily in same clothing, using same scale, at same time of day
•
PT should be closely monitored, and dosage of anticoagulant therapy may need adjustment
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Height, growth rate if given to a child
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T
3
, T
4
, which are decreased; radioimmunoassay of TSH, which is increased; ratio uptake, which is decreased if patient is on too low a dosage of medication
•
Increased nervousness, excitability, irritability; may indicate overdosage, usually after 1-3 wk of treatment
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Cardiac status: angina, palpitation, chest pain, change in VS
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Removal of medication 4 wk before RAIU test
•
Therapeutic response: absence of depression; increased weight loss; diuresis; pulse; appetite; absence of constipation; peripheral edema; cold intolerance; pale, cool, dry skin; brittle nails; alopecia; coarse hair; menorrhagia; night blindness; paresthesias; syncope; stupor; coma; rosy cheeks
•
That hair loss will occur in children and is temporary
•
To report excitability, irritability, anxiety, chest pain, palpitations, increased pulse, excessive sweating, heat intolerance; indicates overdose
•
Not to switch brands unless directed by prescriber
•
That hypothyroid children will show almost immediate behavior/personality change
•
That treatment product is not to be taken to reduce weight
•
To avoid OTC preparations with iodine; read labels
•
To avoid iodine in food: iodinized salt, soybeans, tofu, turnips, some seafood, some bread
Vasodilators have various modes of action. Check individual monographs for specific action.
Vasodilators are used to treat intermittent claudication, arteriosclerosis obliterans, vasospasm and muscular ischemia, ischemic cerebrovascular disease, hypertension, and angina.
Some products are contraindicated in acute MI, paroxysmal tachycardia, and thyrotoxicosis.
Precautions:
Caution should be used in uncompensated heart disease or peptic ulcer disease.
•
With meals to reduce GI symptoms
The most common side effects are headache, nausea, hypotension, hypertension, and ECG changes.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
•
Decreased cardiac output
[uses]
•
Deficient knowledge
[teaching]
•
Ineffective cardiac tissue perfusion
[uses]
•
Bleeding time in individuals with bleeding disorders
•
Cardiac status: B/P, pulse, rate, rhythm, character; watch for increasing pulse
•
Storage in tight container at room temperature
•
Therapeutic response: ability to walk without pain, increased temp in extremities, increased pulse volume
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That medication is not a cure; may need to be taken continuously
•
That it is necessary to quit smoking to prevent excessive vasoconstriction
•
That improvement may be sudden, but usually occurs gradually over several weeks
•
To report headache, weakness, increased pulse, as product may have to be decreased or discontinued
•
To avoid hazardous activities until stabilized on medication; dizziness may occur
The action of vitamins varies widely among products and classes. Check individual monographs for specific information.
Vitamins are used to correct and prevent vitamin deficiencies.
Hypersensitive reactions may occur, and allergies should be identified before these products are given.
•
PO with food for better absorption
There are no side effects or adverse reactions with the water-soluble vitamins (C, B). However, fat-soluble vitamins (A, D, E, K) may accumulate in the body and cause adverse reactions (see individual monographs).
Onset, peak, and duration vary widely among products. Check individual monographs for specific information.
•
Imbalanced nutrition: less than body requirements
[uses]
•
Storage in tight, light-resistant container
•
Therapeutic response: no vitamin deficiency
•
Not to take more than prescribed amount
multivitamins
Canada only Side effects:
italics
= common;
bold
= life-threatening 
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