Mosby's 2014 Nursing Drug Reference (9 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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ANTIPARKINSON AGENTS
ACTION:

Antiparkinson agents are divided into cholinergics, DOPamine, and monoamine oxidase type B agonists. Cholinergics work by blocking or competing at central acetylcholine receptors. DOPamine agonists work by decarboxylation to DOPamine or by activation of dopamine receptors. Monoamine oxidase type B inhibitors work by increasing dopamine activity by inhibiting MAO type B activity.

USES:

Antiparkinson agents are used alone or in combination for patients with Parkinson’s disease.

CONTRAINDICATIONS:

Persons with hypersensitivity, closed-angle glaucoma, and undiagnosed skin lesions should not use these products.

Precautions:
Antiparkinson agents should be used with caution in pregnancy, breastfeeding, children, renal/cardiac/hepatic disease, and affective disorder.

Administer:

• 
Product up until NPO before surgery

• 
Dosage adjustment depending on patient response

• 
With meals; limit protein taken with drug

• 
Only after MAOIs have been discontinued for 2 wk

SIDE EFFECTS:

Side effects and adverse reactions vary widely among products. The most common side effects include involuntary movements, headache, numbness, insomnia, nightmares, nausea, vomiting, dry mouth, and orthostatic hypotension.

PHARMACOKINETICS:

Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.

INTERACTIONS:

Interactions vary widely among products. Check individual monographs for specific information.

POSSIBLE NURSING DIAGNOSES:

• 
Risk for injury
[uses]

• 
Deficient knowledge
[teaching]

• 
Impaired physical mobility
[uses]

NURSING CONSIDERATIONS
Assess:

• 
B/P, respiration

• 
Mental status: affect, mood, behavioral
changes, depression, complete suicide assessment

Perform/provide:

• 
Assistance with ambulation, during beginning therapy

• 
Testing for diabetes mellitus, acromegaly if on long-term therapy

Evaluate:

• 
Therapeutic response: decrease in akathisia, increased mood

Teach patient/family:

• 
To change positions slowly to prevent orthostatic hypotension

• 
To report side effects: twitching, eye spasm; indicate overdose

• 
To use product exactly as prescribed; if product is discontinued abruptly, parkinsonian crisis may occur

 

ANTIPLATELETS
ACTION:

The antiplatelets are divided into the platelet aggregation inhibitors, platelet adhesion inhibitors, and the glycoprotein IIb, IIIa inhibitors. The platelet aggregation inhibitors work by action on thrombin; the platelet adhesion inhibitors work by inhibition of phosphodiesterase; and the glycoprotein IIb, IIIa inhibitors work by preventing fibrin from binding to glycoprotein IIb, IIIa receptors.

USES:

Antiplatelets are used to prevent MI and stroke; other products are used for coronary syndromes.

CONTRAINDICATIONS:

Persons developing hypersensitive reactions should not use these products.

Precautions:
Antiplatelets should be used cautiously in pregnancy, breastfeeding, and bleeding disorders.

Administer:

• 
With heparin or other aspirin (some products)

SIDE EFFECTS:

The most common side effects are headache, dizziness, bleeding, and diarrhea.

PHARMACOKINETICS:

Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.

INTERACTIONS:

Interactions vary widely among products. Check individual monographs for specific information.

POSSIBLE NURSING DIAGNOSES:

• 
Risk for injury
[uses, adverse reactions]

• 
Deficient knowledge
[teaching]

NURSING CONSIDERATIONS
Assess:

• 
Reason for use of these products

• 
For hypersensitivity reactions with some products

• 
For bleeding from orifices, in stool, urine

• 
Blood studies: platelets, Hgb, Hct, PT/APTT, and INR

Perform/provide:

• 
Storage at room temperature vial/ampules, oral products

Evaluate:

• 
Therapeutic response: absence of MI, stroke or other coronary syndromes

Teach patient/family:

• 
To avoid hazardous activities if drowsiness, dizziness occurs; to ask for assistance if hospitalized

• 
About all aspects of product usage

SELECTED GENERIC NAMES
Platelet aggregation inhibitors

cilostazol

clopidogrel

ticlopidine

Platelet adhesion inhibitors

dipyridamole

Glycoprotein IIb, IIIa inhibitors

eptifibatide

tirofiban

 

ANTIPSYCHOTICS
ACTION:

Antipsychotics/neuroleptics are divided into several subgroups: phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and indolones and other heterocyclic compounds. Although chemically different, these subgroups share many pharmacologic and clinical properties. All antipsychotics work to block postsynaptic dopamine receptors in the brain that are responsible for psychotic behavior, including hallucinations, delusions, and paranoia.

USES:

Antipsychotic behavior is decreased in conditions such as schizophrenia, paranoia, and mania. These agents are also effective for severe anxiety, intractable hiccups, nausea, vomiting, behavioral problems in children, and relaxation before surgery.

CONTRAINDICATIONS:

Persons with hepatic damage, severe hypertension or coronary disease, cerebral arteriosclerosis, blood dyscrasias, bone marrow depression, parkinsonism, severe depression, closed-angle glaucoma, children <12 yr, or persons withdrawing from alcohol or barbiturates should not use antipsychotics until these conditions are corrected.

Precautions:
Caution must be used when antipsychotics are given to geriatric patients because metabolism is slowed, and adverse reactions can occur rapidly. Hepatic/renal disease may cause poor metabolism and excretion of the product. Seizure threshold is decreased with these products; increases in the dose of anticonvulsants may be required. Persons with diabetes mellitus, prostatic hypertrophy, chronic respiratory disease, and peptic ulcer disease should be monitored closely.

Administer:

• 
Antiparkinson agent if EPS occur

• 
Liquid concentrates mixed in glass of juice or cola because taste is unpleasant; avoid contact with skin when preparing liquid concentrate or parenteral medications

• 
Patient should remain lying down for at least 30 min after IM inj

SIDE EFFECTS:

The most common side effects include EPS such as pseudoparkinsonism, akathisia, dystonia, and tardive dyskinesia, which may be controlled by use of antiparkinson agents. Serious adverse reactions such as hypotension, agranulocytosis, cardiac arrest, and laryngospasm have occurred. Other common side effects include dry mouth and photosensitivity.

PHARMACOKINETICS:

Onset, peak, and duration vary widely with different products and routes. Products are metabolized by the liver, are excreted in urine as metabolites, are highly bound to plasma proteins, cross the placenta, and enter breast milk. Half-life can be extended over 3 days.

INTERACTIONS:

Because other CNS depressants can cause oversedation, these combinations should be used carefully. Anticholinergics may decrease the therapeutic actions of phenothiazines and also cause increased anticholinergic effects.

POSSIBLE NURSING DIAGNOSES:

• 
Chronic confusion
[uses]

NURSING CONSIDERATIONS
Assess:

• 
Bilirubin, CBC, hepatic studies monthly because these products are metabolized in the liver and excreted in urine

• 
I&O ratio: palpate bladder if low urinary output occurs; urinary retention occurs with many of these products

• 
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances

• 
Dizziness, faintness, palpitations, tachycardia on rising

• 
B/P (lying and standing); wide fluctuations between lying and standing B/P may require dosage or product change because orthostatic hypotension is occurring

• 
EPS, including akathisia, tardive dyskinesia, pseudoparkinsonism

Perform/provide:

• 
Supervised ambulation until stabilized on medication; do not involve in strenuous exercise program because fainting is possible; patient should not stand still for long periods

• 
Increased fluids to prevent constipation

• 
Sips of water, candy, gum for dry mouth

Evaluate:

• 
Therapeutic response: decrease in excitement, hallucinations, delusions, paranoia; reorganization of thought patterns, speech

Teach patient/family:

• 
To rise from sitting or lying position gradually; fainting may occur

• 
To avoid hot tubs, hot showers, or tub baths; hypotension may occur

• 
To wear a sunscreen or protective clothing to prevent burns

• 
To take extra precautions during hot weather to stay cool; heat stroke can occur

• 
To avoid driving, other activities requiring alertness until response to medication is known

• 
That drowsiness or impaired mental/motor activity is evident the first 2 wk, but tends to decrease over time

 

ANTIPYRETICS
ACTION:

Antipyretics act on the CNS to control fever and also inhibit prostaglandin production.

USES:

Antipyretics are used to decrease fever.

CONTRAINDICATIONS:

Persons developing hypersensitive reactions should not use these products.

Precautions:
Antipyretics should be used cautiously in pregnancy, breastfeeding, hepatic disease, geriatric patients, and those with certain GI disorders.

Administer:

• 
Around the clock to keep fever reduced

SIDE EFFECTS:

The most common side effects are nausea, vomiting, and rash.

PHARMACOKINETICS:

Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.

INTERACTIONS:

Interactions vary widely among products. Check individual monographs for specific information.

POSSIBLE NURSING DIAGNOSES:

• 
Risk for injury
[uses, adverse reactions]

• 
Deficient knowledge
[teaching]

NURSING CONSIDERATIONS
Assess:

• 
Temperature frequently

• 
For reason for use and expected outcome

• 
For hypersensitivity reactions: rash, bronchospasm with some products

Perform/provide:

• 
Storage at room temperature

Evaluate:

• 
Therapeutic response: absence or decreasing fever after use

Teach patient/family:

• 
All aspects of product usage

SELECTED GENERIC NAMES

acetaminophen

aspirin

choline/magnesium salicylates

choline salicylate

ibuprofen

ketoprofen

magnesium salicylate

naproxen

salsalate

 

ANTIRETROVIRALS
ACTION:

Antiretrovirals act by blocking DNA synthesis.

USES:

Antiretrovirals are used for HIV infections and chronic hepatitis C to slow the progression of the disease.

CONTRAINDICATIONS:

Persons with hypersensitivity should not use these products.

Precautions:
Antiretrovirals should be used cautiously in renal/hepatic disease, pregnancy, and breastfeeding. Protease inhibitors should be used cautiously in diabetes.

Administer:

• 
In equal intervals around the clock

SIDE EFFECTS:

The most common side effects are nausea, vomiting, anorexia, headache, and diarrhea. The most serious adverse reactions are nephrotoxicity and blood dyscrasias.

PHARMACOKINETICS:

Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.

INTERACTIONS:

Interactions vary widely among products. Check individual monographs for specific information.

POSSIBLE NURSING DIAGNOSES:

• 
Risk for infection
[uses]

• 
Risk for injury
[adverse reactions]

• 
Deficient knowledge
[teaching]

• 
Noncompliance
[teaching]

NURSING CONSIDERATIONS
Assess:

• 
For signs of HIV infection; increased CD4 counts, decreased viral load; signs of chronic hepatitis C

• 
Patients with compromised renal system; because product is excreted slowly in poor renal system function, toxicity may occur rapidly

Perform/provide:

• 
Storage at room temperature

Evaluate:

• 
Therapeutic response: decreased viral load, increased CD4 count, improvement in the symptoms of HIV/AIDS

Teach patient/family:

• 
To report sore throat, fever, fatigue; may indicate superinfection

• 
That medication does not cure condition or prevent infecting others but controls symptoms

• 
That product must be taken around the clock, in equal intervals, to maintain blood levels for duration of therapy

• 
To notify prescriber of side effects such as bruising, bleeding, fatigue, malaise; may indicate blood dyscrasias

SELECTED GENERIC NAMES
Nonnucleoside reverse transcriptase inhibitors

delavirdine

efavirenz

etravirine

nevirapine

Fusion inhibitors

enfuvirtide

Miscellaneous

raltegravir

BOOK: Mosby's 2014 Nursing Drug Reference
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