Drug cards for clinicals

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Tish430
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Drug cards for clinicals
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2013-03-10 20:53:23
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For Mrs. Fogle's clinicals
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  1. ENOXAPRIN (e-nox-a-pa-rin) (low molecular weight heparin [LMWH]) Lovenox
    • Drug Classification: anticoagulant and antithrombotic
    • INDICATIONS:Prevention of deep vein thrombosis, pulmonary emboli, ischemic complications in patients with unstable angina/non–Q-wave MI. LMWH has a more predictable anticoagulantresponse than unfractionated heparin—special monitoring of clotting times is not necessary.
    • Therapeutic Effects: Prevention of thrombus formation.
    • DOSAGE: SC: Adults: Knee/hip surgery: 40 mg once dailystarting 9–15 h before hip surgery; abdominal surgery: 40 mg once daily starting within 24 h postop; treatment of DVT/PE:1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/non–Q-wave MI:1 mg/kg q 12 h.
    • ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently.
    • NURSING IMPLICATIONS: Lab tests:
    • Baseline coagulation studies; periodic CBC, platelet count, urine and stool for
    • occult blood. *Monitor platelet count closely. Monitor closely patients with
    • renal insufficiency and older adults how are at risk for thrombocytopenia. Monitor and report immediately any sign or symptom of unexplained bleeding.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia,hematoma.
    • CONTRAINDICATIONS: Hypersensitivity to pork products,uncontrolled bleeding, thrombocytopenia, patients with prosthetic heart valves.
    • CAUTIONS: HIGH ALERT MED: Assess patient for signs of bleeding and hemorrhage (bleeding gums, nosebleed; unusual bruising; black, tarry stools, hematuria; fall in hematocritor blood pressure; guaiac-positive stools), bleeding from surgical site. Notify physician if these occur. • Risk of bleedingmay be increased by warfarin, aspirin, NSAIDs, dipyridamole,some penicillins,penicillins, clopidogrel, ticlopidine, abciximab,eptifibatide, tirofiban, and dextran. Increased bleeding risk with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panaxginseng, and others.
  2. WARFARIN (war-fa-rin) Coumadin, Warfilone
    • DRUG CLASSIFICATION:anticoagulant
    • INDICATIONS: Venous thrombosis, pulmonary embolism, atrial fibrillation with embolization, MI, prevention of thrombus formation post–prosthetic valve placement.
    • Therapeutic Effects:  Prevention of thromboembolic events.
    • DOSAGE: PO: Adults: 2.5–10 mg/d for 2–4 days; then adjust daily dose by results of prothrombin time or international normalized ratio (INR).
    • ADMINISTRATION: PO: Administer at same time daily.
    • NURSING IMPLICATIONS: *Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage is established.  *Obtain a COMPLETE medication history prior to start of therapy and whenever altered responses to therapy require interpretation; extremely IMPORTANT since many drugs interfere with the activity of anticoagulant drugs. *Lab tests: For maintenance dosage, PT/INR determinations at 1-4 week intervals depending on patient response, periodic urinalysis, stool guaiac and LFTs.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Cramps, nausea, dermal necrosis,BLEEDING, fever.
    • CONTRAINDICATIONS: Uncontrolled bleeding, open wounds, active ulcer disease, recent brain, eye, or spinal cord injury or surgery, severe liver disease, uncontrolled hypertension, pregnancy.
    • CAUTIONS: HIGH ALERT MED: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; bruising; tarry, black stools). • Monitor PT or INR and other clotting factors frequently during therapy. • Androgens, cefotetan, chloral hydrate,
    • chloramphenicol, fluconazole, fluoroquinolones, itraconazole, metronidazole, thrombolytic agents, sulfonamides, quinidine, quinine, NSAIDs,
    • valproates, and aspirin may increase response and risk of bleeding. • Chronic acetaminophen use may increase the risk of bleeding. • Alcohol,barbiturates,and hormonal contraceptives containing estrogen
    • decrease response. • Large quantities of foods high in vitamin K may antagonize
    • the anticoagulant effect. • Antidote is vitamin K (phytonadione, AquaMEPHYTON).
    • • Avoid IM injections and activities leading to injury. Inform all health care personnel about anticoagulant therapy before lab tests, treatment, or surgery. • Increased bleeding risk with arnica,chamomile, clove, dong quai, feverfew, garlic,ginger, ginkgo, Panax ginseng, and other natural products.
  3. FONDAPARINUX (fon-da-par-i-nux) Arixtra
    • DRUG CLASSIFICATION: anticoagulant, antithrombolitic
    • INDICATIONS: Prevention of deep vein thrombosis or pulmonary embolism in patients undergoing hip or knee replacement surgery or abdominal surgery.
    • Therapeutic Effects: Interruption
    • of the coagulation cascade resulting in inhibition of thrombus formation.
    • DOSAGE: SC: Adults: 2.5 mg once daily, starting 6–8 h after surgery and continuing for 5–9 days (up to 11 days).
    • ADMINISTRATION: Administer SC only into fatty tissue, alternating sites between right and left anterolateral or posterolateral abdominal wall.
    • NURSING IMPLICATIONS:*Monitor for S&S of bleeding or hemorrhage.
    • If noted, withhold and notify the prescriber immediately. *Withhold and notify
    • prescriber if platelet count falls belom 100.000/mm3  *Lab tests: Monitor baseline and periodic renal function tests;
    • periodic cbc including platelet count, serum creatinine  level, and stool occult blood tests . **Patient
    • and family education: Report signs of unexplained bleeding such as pink, red or
    • dark brown urine, red or dark brown vomitus, bleeding gums or bloody sputum;
    • dark, tarry stools. Learn proper injection technique if you are to self administer.
    • Do not take any OTC drugs without first consulting prescriber.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness,headache, insomnia, edema, hypotension, constipation,diarrhea, dyspepsia, increased serum aminotransferases,nausea,
    • vomiting, urinary retention, bullous eruption,hematoma, purpura, rash,
    • BLEEDING, thrombocytopenia,hypokalemia, fever, increased wound drainage.
    • CONTRAINDICATIONS: Hypersensitivity, severe renal impairment,body
    • weight less than 50 kg, active major bleeding, bacterial endocarditis, and
    • thrombocytopenia due to fondaparinux antibodies.
    • CAUTIONS: HIGH ALERT MED: Deaths have occurred when two anticoagulant medications inadvertently are given concurrently. Double check medications to ensure that two anticoagulant products are not given simultaneously. • Use with caution in patients with severe uncontrolled hypertension,bleeding disorders, GI pathology, hemorrhagic stroke, recent CNS or ophthalmologic surgery, spinal/epidural anesthesia (increased risk of spinal/epidural hematomas). • Risk of bleeding may be increased by concurrent use of warfarin, aspirin,NSAIDs, dipyridamole,some cephalosporins, valproates,clopidogrel,ticlopidine,abciximab,eptifibatide, tirofiban, and dextran.Increased risk of bleeding with arnica, chamomile,dong quai,feverfew, garlic, ginger, gingko, Panax ginseng,licorice, and others.
  4. INSULIN, ISOPHANE (NPH) (in-su-lin)
    • DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
    • INDICATIONS:Intermediate-acting insulin (onset: 1–2 h; peak 8–12 h; duration: 18–24 h) used to treat elevated glucose levels in patients with type 1 and type 2
    • diabetes.
    • Therapeutic Effects: Control of blood glucose levels.
    • DOSAGE: Adults: 7–26 units as a single dose 30-60 minutes before
    • breakfast. A second smaller dose may be given before dinner or at bedtime. Dose
    • may be increased 2-10 units daily or weekly until desired control is achieved.
    • ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do
    • not administer cold insulin: can lead to lipodystrophy. Rotate vial between
    • palms and invert gently to mix; do not shake. Rotate injection sites. May be
    • mixed with regular insulin.
    • NURSING IMPLICATIONS: Lab tests: Periodic fasting and postprandial
    • blood glucose. *Notify prescriber promptly for marked elevated blood sugar or
    • presence of acetone with sugar in urine.*Monitor for hypoglycemia at time of
    • peak action of insulin. Onset of hypoglycemia (blood sugar:50-40 mg/dl) may be rapid and sudden.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA,rebound
    • hyperglycemia (Somogyi effect), lipodystrophy,itching, lipohypertrophy,
    • redness, swelling, allergic reactions including ANAPHYLAXIS.
    • CONTRAINDICATIONS: Allergy or hypersensitivity.
    • CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the
    • abbreviation “U” for “units.” It can be misread as a zero and has resulted in
    • serious, tenfold overdoses. Clarify any order that contains this abbreviation.
    • • Do not confuse Humulin N with Humulin R, Humulin U, or Humalog. •Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin,difficulty concentrating, drowsiness;excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy.• Advise patient to eat a snack mid-afternoon and bedtimeto prevent hypoglycemia during
    • peak hours.
  5. INSULIN GLARGINE (in-su-lin glar-geen) Lantus
    • DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
    • INDICATIONS:Type 1 and type 2 diabetes. Long-acting insulin with a constant concentration over 24 hours with no pronounced peak. Provides a continuous level of insulin, similar to the steady
    • secretion of insulin provided by the normal pancreas. Therapeutic
    • Effects: Control of blood glucose levels.
    • DOSAGE: SC: Adults and children: Begin with 10 units at bedtime and titrate
    • according to glucose levels.
    • ADMINISTRATION: SC: Use only insulin syringes to draw up dose. Rotate injection sites.
    • NURSING IMPLICATIONS: Monitor
    • for S&S of hypoglycemia especially after changes in insulin dose or type.*Lab tests: Measure fasting blood glucose and HbA1C periodically. *Withhold drug and notify prescriber if patient is hypokalemic.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria,HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy,itching,lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS.
    • CONTRAINDICATIONS: Allergy or hypersensitivity.
    • CAUTIONS: HIGH ALERT MED: Lantus insulin cannot be mixed with other insulins; action may be affected in an unpredictable manner. • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Lantus insulin with Lente
    • insulin. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) throughout therapy
  6. INSULIN,PREMIXED COMBINATIONS (NPH/regular insulin mixtures)Humulin 70/30, Novolin 70/30
    • DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
    • INDICATIONS: Combination of
    • short-acting and intermediateacting insulins with short-acting insulin
    • comprising 30% to 50% of the solution and intermediate acting insulin
    • comprising 50% to 70% (onset: 30 min; peak 2–8 h; duration: 24 h). Used to treat elevated glucose levels in patients with type 1 and type 2 diabetes.
    • Therapeutic Effects:Control of blood glucose levels.
    • DOSAGE: SC: Adults:Titrated individually based on multiple factors. Maintenance therapy is usually 0.5–1 unit/kg/d.
    • ADMINISTRATION: Use only insulin
    • syringes to draw up dose. SC: Do not administer cold insulin: can lead to
    • lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake.
    • Rotate injection sites. May be mixed with regular insulin.
    • NURSING IMPLICATIONS: Monitor for S&S of hypoglycemia. Initial hypoglycemic
    • response begins within 15 min and peaks 45-90 min after injection. Lab tests:
    • Periodic postprandial blood glucose and HbA1C. *Withhold drug and notify prescriber if patient is hypokalemic.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria,HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching,lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS.
    • CONTRAINDICATIONS: Allergy or
    • hypersensitivity.
    • CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order
    • that contains this abbreviation.• Assess patient for signs and symptoms of
    • hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive
    • hunger; headache; irritability; nausea; rapid pulse;shakiness) and hyperglycemia throughout therapy. • Advise patient to
    • eat a snack mid afternoon and bedtime to prevent hypoglycemia during peak hours
  7. INSULIN INJECTION (REGULAR) (in-su-lin) Humulin R, Novolin R
    • DRUG CLASSIFICATION:  antidiabetic
    • (pancreatic hormone)
    • INDICATIONS: Short-acting insulin (onset: 1/2–1 h;peak 2–3 h; duration: 5–7 h) used to treat elevated glucose levels in type 1 and type 2 diabetes (usually in addition to intermediate and long-acting insulins);
    • diabetic ketoacidosis/coma, hyperkalemia.
    • Therapeutic Effects:  Reduction of
    • blood glucose levels; intracellular shift of potassium.
    • DOSAGE: SC: Adult: 2–10 units 15–30
    • minutes before meals or in response to blood glucose elevations. Child: 2–4
    • units 15–30 minutes before meals or in response to blood glucose elevations. IV:
    • Adult: 2–7 units per hour as a continuous infusion. Child: 0.1 unit/kg per hour as a continuous infusion.
    • ADMINISTRATION: Use only insulin
    • syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites. IV: Regular insulin is the only insulin that can be administered IV.
    • NURSING IMPLICATIONS: Lab tests:
    • Periodic fasting and postprandial blood glucose. *Notify prescriber promptly
    • for marked elevated blood sugar or presence of acetone with sugar in urine.*Monitor for hypoglycemia at time of peak action of insulin. Onset of hypoglycemia (blood sugar:50-40 mg/dl) may be rapid and sudden.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy,
    • redness, swelling, allergic reactions including ANAPHYLAXIS.
    • CONTRAINDICATIONS: Allergy or
    • hypersensitivity.
    • CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” Itcan be misread as a zero and has resulted in serious, tenfold overdoses.Clarify any order that contains this abbreviation. Do not confuse Humulin R with Humulin N,Humulin U, or Humalog. • Assess patient for signs and symptoms of hypoglycemia(cool, clammy skin, difficulty concentrating, drowsiness;excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy.
  8. Docusate Sodium (dok’yoo-sate) Colace, Colace Enema, Lax-gel,Regutol, Therevac-Plus, Therevac-SB
    • DRUG CLASSIFICATION: Stool softener
    • INDICATIONS: Prophylactically in patients who should avoid straining
    • during defecation and for treatment of constipation associated with hard dry stools
    • (e.g.; following anorectal surgery, MI).
    • THERAPUTIC USE: Detergent action lowers surface tension, permitting water and facts to penetrate and soften stools for easier passage.
    • DOSAGE: PO 50-500 m/day PR 50-100 added to enema fluid
    • ADMINISTRATION: oral: give with a full glass of water if allowed.
    • Rectal: Microenema:Insert full lengh of nozzle into rectum. Squeeze entire
    • contents of tube and remove completely before releasing grip on tube.
    • NURSING IMPLICATIONS: *Withhold drug if diarrhea develops and notify prescriber. Therapeutic effectiveness: Usually apparent 1-3 days after first dose.  Patient and Family Education: Take sufficient liquid with each dose and increase fluid intake if allowed. Do not take with mineral oil. Do not take for prolonged periods of time.
    • ADVERSE REACTIONS AND SIDE EFFECTS: GI: Occasional mild abdominal cramps,diarrhea, nausea, bitter taste. Other: Throat irritation (liquid preparation),
    • rash.
    • CONTRAINDICATIONS: Hypersensitivity
    • to dofetilide, QT prolongation, ventricular arrhythmias, electrolyte imbalances, renal failure, lactation.
  9. Baza Antifungal 2 % Topical Cream Generic name: Miconazole
    • DRUG CLASSIFICATION: antifungal
    • INDICATIONS:Vulvovaginal candidiasis, tinea pedis, tenea cruris, tinea corporis, and tinea versicolor
    • caused by dermatophytes.
    • THERAPUTIC  USE: Broad spectrum agent with fungicidal activity
    • DOSAGE: Topical-Apply cream sparingly to affected area twice a day and once daily for tinea versicolor, for 2wk, tinea pedis is
    • treated for one month. Intervainal-insert suppository or vaginal cream each
    • night x 7 days(100 mg) or 3 days (200 mg)
    • NURSING IMPLICATIONS: Expect clinical
    • improvement from topical application in one or two wk. If no improvement in 4 wk, diagnosis is reevaluated. Patient and Family education: Complete full course of treatment to ensure recovery. Do not interrupt vaginal application during menstrual period. Avoid contact of drug with eyes.
    • ADVERSE REACTIONS AND SIDE EFFECTS: Vulvovaginal burning, itching, or irritation; maceration, allergic contact dermatitis
    • CONTRAINDICATIONS: Hypersensitivity to miconazole
  10. CarraKlenzDermal Wound Cleanser
    • DRUG CLASSIFICATION: emollient
    • THERAPUTIC USE: removes organic material, debris, and dead
    • tissue from high, medium and low exuding wounds.
    • ADMINISTRATION/DOSAGE: spray
    • NURSING IMPLICATIONS:

    ADVERSE REACTIONS AND SIDE EFFECTS:

     

    CONTRAINDICATIONS:

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