Mosby's 2014 Nursing Drug Reference (4 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Rho(D) immune globulin microdose IM
Rho(D) immune globulin standard dose IM
Individual Drug Monographs
tissue plasminogen activator (t-PA)
Individual Drug Monographs
Individual Drug Monographs
Individual Drug Monographs
Individual Drug Monographs
α-Adrenergic blockers act by binding to α-adrenergic receptors, causing dilation of peripheral blood vessels. Lowers peripheral resistance, resulting in decreased B/P.
α-adrenergic blockers are used for benign prostatic hyperplasia, pheochromocytoma, prevention of tissue necrosis and sloughing associated with extravasation of IV vasopressors.
Hypersensitive reactions may occur, and allergies should be identified before these products are given. Patients with MI, coronary insufficiency, angina, or other evidence of CAD should not use these products.
•
Starting with low dose, gradually increasing to prevent side effects
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With food or milk for GI symptoms
The most common side effects are hypotension, tachycardia, nasal stuffiness, nausea, vomiting, and diarrhea.
Onset, peak, and duration vary among products.
Vasoconstrictive and hypertensive effects of EPINEPHrine are antagonized by α-adrenergic blockers.
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Risk for injury
[adverse reactions]
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Insomnia
[adverse reactions]
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Impaired urinary elimination
[uses]
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Electrolytes: K, Na, Cl, CO
2
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Weight daily, I&O
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B/P lying, standing before starting treatment, q4hr thereafter
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Nausea, vomiting, diarrhea
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Skin turgor, dryness of mucous membranes for hydration status
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Therapeutic response: decreased B/P, increased peripheral pulses
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To avoid alcoholic beverages
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To report dizziness, palpitations, fainting
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To change position slowly or fainting may occur
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To take product exactly as prescribed
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To avoid all OTC products (cough, cold, allergy) unless directed by prescriber
Anesthetics (general) act on the CNS to produce tranquilization and sleep before invasive procedures. Anesthetics (local) inhibit conduction of nerve impulses from sensory nerves.
General anesthetics are used to premedicate for surgery, induction and maintenance in general anesthesia. For local anesthetics, refer to individual product listing for indications.
Persons with cerebrovascular accident, increased intracranial pressure, severe hypertension, cardiac decompensation should not use these products since severe adverse reactions can occur.
Precautions:
Anesthetics (general) should be used with caution in the geriatric, CVD (hypotension, bradydysrhythmias), renal/hepatic disease, Parkinson’s
disease, children <2 yr. The precaution for anesthetics (local) is pregnancy.
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Anticholinergic preoperatively to decrease secretions
•
Only with crash cart, resuscitative equipment nearby
The most common side effects are dystonia, akathisia, flexion of arms, fine tremors, drowsiness, restlessness, and hypotension. Also common are chills, respiratory depression, and laryngospasm.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
MAOIs, tricyclics, phenothiazines may cause severe hypotension or hypertension when used with local anesthetics. CNS depressants will potentiate general and local anesthetics.
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Risk for injury
[adverse reactions]
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Deficient knowledge
[teaching]
•
Deficient knowledge
[teaching]
•
Acute pain
[uses]
• VS q10min during IV administration, q30min after IM dose
•
Quiet environment for recovery to decrease psychotic symptoms
•
Therapeutic response: maintenance of anesthesia, decreased pain
thiopental
Antacids are basic compounds that neutralize gastric acidity and decrease the rate of gastric emptying. Products are divided into those containing aluminum, magnesium, calcium, or a combination of these.
Antacids decrease hyperacidity in conditions such as peptic ulcer disease, reflux esophagitis, gastritis, and hiatal hernia.
Sensitivity to aluminum or magnesium products may cause hypersensitive reactions. Aluminum products should not be used by persons sensitive to aluminum; magnesium products should not be used by persons sensitive to magnesium. Check for sensitivity before administering.
Precautions:
Magnesium products should be given cautiously to patients with renal insufficiency and during pregnancy and breastfeeding. Sodium content of antacids may be significant; use with caution for patients with hypertension, congestive heart failure or for those on a low-sodium diet.
•
Not to take other products within 1-2 hr of antacid administration because antacids may impair absorption of other products
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All products with an 8-oz glass of water to ensure absorption in the stomach
•
Another antacid if constipation occurs with aluminum products
The most common side effect caused by aluminum-containing antacids is constipation, which may lead to fecal impaction and bowel obstruction. Diarrhea occurs often when magnesium products are given. Alkalosis may occur when systemic products are used. Constipation occurs more frequently than laxation with calcium carbonate. The release of CO
2
from carbonate-containing antacids causes belching, abdominal distention, and flatulence. Sodium bicarbonate may act as a systemic antacid and produce systemic electrolyte disturbances and alkalosis. Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity and milk-alkali syndrome. Alkaluria may occur when products are used on a long-term basis, particularly in persons with abnormal renal function.
Duration is 20-40 min. If ingested 1 hr after meals, acidity is reduced for at least 3 hr.
Effects of the following products may be increased by some antacids: quiNIDine, amphetamines, pseudoephedrine, levodopa, valproic acid, dicumarol. Effects of the following products may be decreased by some antacids: cimetidine, corticosteroids, ranitidine, iron salts, phenothiazines, phenytoin, digoxin, tetracyclines, ketoconazole, salicylates, isoniazid.
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Constipation
[adverse reactions]
•
Diarrhea
[adverse reactions]
•
Chronic pain
[uses]
•
Aggravating and alleviating factors of epigastric pain or hyperacidity; identify the location, duration, and characteristics of epigastric pain
•
GI symptoms, including constipation, diarrhea, abdominal pain; if severe abdominal pain with fever occurs, these products should not be given
•
Renal symptoms, including increasing urinary pH, electrolytes
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Therapeutic response: absence of epigastric pain, and decreased acidity
Anti-Alzheimer agents improve cognitive functioning by increasing acetylcholine and inhibiting cholinesterase in the CNS. Do not cure condition, but improve symptoms.
Anti-Alzheimer agents are used for the treatment of Alzheimer’s symptoms.
Persons with hypersensitivity reactions should not use these products.
Precautions:
Anti-Alzheimer agents should be used cautiously in pregnancy (C), breastfeeding, sick sinus syndrome,
GI bleeding, bladder obstruction, and seizures.
•
Lowest possible dose for therapeutic result; adjust dose to response
The most common side effects are nausea, vomiting, diarrhea, dry mouth, insomnia, dizziness, as well as urinary frequency, incontinence, and rash. The most serious side effects are seizures and dysrhythmias.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted by the kidneys.
Increased synergistic reactions may occur with succinylcholine, cholinesterase inhibitors, and cholinergic agonists. There may be a decrease in the action of anticholinergics, and there may be additive effects when used with cholinergic agents.
•
Chronic confusion
[uses]
•
Deficient knowledge
[teaching]
•
Noncompliance
[teaching]
•
B/P, hypotension, hypertension
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Mental status: affect, mood, behavioral changes, depression, confusion
•
GI status: nausea, vomiting, anorexia, diarrhea
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GU status: urinary frequency, incontinence
•
Assistance with ambulation during beginning therapy if dizziness, ataxia occur
•
Therapeutic response: decrease in confusion, improved mood
•
To report side effects, adverse reactions to health care provider
•
To use exactly as prescribed, at regular intervals
•
Not to increase or abruptly decrease dose; serious consequences may result
•
That product is not a cure but relieves symptoms
Antianginals are divided into the nitrates, calcium channel blockers, and β-adrenergic blockers. The nitrates dilate coronary arteries, causing decreased preload, and dilate systemic arteries, causing decreased afterload. Calcium channel blockers dilate coronary arteries and decrease SA/AV node conduction. β-Adrenergic blockers decrease heart rate so that myocardial O
2
use is decreased. Dipyridamole selectively dilates coronary arteries to increase coronary blood flow.
Antianginals are used in chronic stable angina pectoris, unstable angina, vasospastic angina. Some (i.e., calcium channel blockers and β-blockers) may be used for dysrhythmias and in hypertension.
Persons with known hypersensitivity, increased intracranial pressure, or cerebral hemorrhage should not use some of these products.
Precautions:
Antianginals should be used with caution in postural hypotension, pregnancy, breastfeeding, children, renal disease, and hepatic injury.
The most common side effects are postural hypotension, headache, flushing, dizziness, nausea,
edema, and drowsiness. Also common are rash, dysrhythmias, and fatigue.
Onset, peak, and duration vary widely among coronary 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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Decreased cardiac output
[adverse reactions]
•
Risk for injury
[uses]
•
Deficient knowledge
[teaching]
•
Acute pain
[uses]
•
Ineffective cardiac tissue perfusion
[uses]
•
Orthostatic B/P, pulse
•
Pain: duration, time started, activity being performed, character
•
Tolerance if taken over long period
•
Headache, light-headedness, decreased B/P; may indicate a need for decreased dosage
•
Storage protected from light, moisture; place in cool environment
•
Therapeutic response: decrease, prevention of anginal pain
•
To keep tabs in original container
•
Not to use OTC products unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever
•
To take pulse at home, advise when to notify prescriber
•
To avoid alcohol, smoking, sodium intake
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product that you are taking, allergies
•
To make position changes slowly to prevent fainting
