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- High Alert! Lanoxin, LanoxicapsRoute/Dosage (Adult): Initial Dose-several divided doses over a 12-24 hr period- IV 0.5-1 mg, PO 0.75-1.5 mg, Maintenance Dose Tablets-0.125-0.5/day, Gelatin Capsules-0.35-0.5 mg/day
- Classification: Therapeutic (antiarrhythmics, inotropics) Pharmacologic (digitalis glycosides)
- Indication: Heart Failure. Atrial fibrillation & atrial flutter (slows ventricular rate)
- Action: Increases the force of myocardial contraction. Increases cardiac output and slows heart-rate.
- Side Effects: fatigue, blurred/green/yellow vision, ARRHYTHMIAS, bradycardia, increased risk of falls (geriatric)
- Nursing Implication: Monitor apical pulse for 1 full minute prior to administering. Withhold dose and notify physician if pulse is <60 (adult). Immediately report any significant changes in HR, rhythm, or quality of pulse. Evaluate serum electrolyte lvls (potassium, magnesium, calcium). Observe serum lvl is < 0.5-2 ng/mL, evaluate s/s of toxicity (abdominal pain, anorexia, vomiting, visual disturbances, bradycardia)
- Patient/Family Teaching: Instruct pt. to take medications as directed at the same time each day. Do not d/c medication w/o consulting with a healthcare professional. Teach pt. to take pulse and contact healthcare professional prior to taking medication if pulse is <60>100. Review s/s of toxicity and emphasize the importance of follow-up exams to determine effectiveness and monitor toxicity.
- Route/Dosage (Adult): PO, IV 2-5 mg/day for 2-4 days; then adjust daily dose by results of INR (International Normalized Ratio- ability for blood
- to clot).
- Classification: anticoagulant; coumarins
- Action: Prevention of thromboembolic events
- Contraindications: Uncontrolled bleeding, open wounds, active ulcer disease, recent injury/surgery, liver/kidney disease, uncontrolled hypertension.
- Side Effects: Bleeding, dermal necrosis, cramps, nausea
- Nursing Implication: Assess for signs of bleeding and hemorrhage (gums, nose, unusual bruising, black stools, fall in hematocrit or BP, nasogastric aspirate. Monitor PT, INR and other clotting factors frequently. Monitor hepatic function and CBC before and periodically during treatment.
- Patient/Family Teaching: Inform Pt. anticoagulant effect may persist 2-5 days after d/c of Warfarin. Avoid foods rich in Vitamin K (brussel sprouts, leafy greens, spinach). Instruct pt.to avoid injury, use soft toothbrush, do not floss, or use razors to shave.Advise pt. to report any symptoms of unusual bleeding, bruising, or pain.Instruct pt. not to consume alcohol, take other Rx, OTC, or herbal products especially those containing aspirin or NSAIDs. Emphasize the importance of frequent lab tests to monitor coagulation factors.
- Route/Dosage (Adult): PO 20-80 mg/day (single dose initial), Hypertension 40 mg bid (decrease dose of other hypertensive 50%), congestive heart failure-2.5 g/day, Hypercalcemia-120 mg/day (in 3 doses). IM/IV 20-40 mg, may repeat in 1-2 hr and increase 20 mg/ 1-2 hr until desired response is obtained. Continuous infusion-Bolus 0.1 mg/kg followed by 0.1 mg/kg/hr, double q 2 hr up to max 0.4 mg/kg/hr
- Classification: diuretics; loop diuretics
- Action: Decrease BP, reduce edema, Inhibits the reabsorbtion of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, & calcium.
- Contraindications/Precautions: Hepatic coma or anuria, severe liver disease, Electrolyte depletion, Diabetes mellitus, pt. currently taking Digoxin (increased risk of toxicity of digoxin).
- Side Effects: Blurred vision, dizziness, tinnitus, hypotension, polyurea, dehydration, Electrolyte imbalance, APLASTIC ANEMIA, AGRANULOCYTOSIS, Nursing Implication: Assess fluids, monitor daily weight, intake/output ratio, amount/location of edema, lung sounds, skin turgor, and mucus membranes. Notify physician if thirst, dry mouth, weakness, or hypo-tension occur. Monitor BP & pulse before and during medication. Assess pt. for tinnitus or hearing loss. Monitor electrolytes, renal/heptic function, serum glucose, and uric acid lvls. May be taken with food/milk to minimize gastric irritation. Tablets my be crushed if pt. has trouble swallowing.
- Patient/Family Teaching: Caution pt. to change positions slowly, avoid standing long periods of time, exercising in hot weather or use of alcohol to minimize
- orthostatic hypotension. Teach pt. to avoid diet high in potassium. Advise pt.to contact healthcare professional if weight gain is > 3lbs in a day, muscle weakness, cramps, dizziness, tingling/numbness in extremities. Caution pt. of increased photosensitivity.
- K-DurRoute/Dosage (Adult):PO, IV 40-80 mEq/day
- Classification: mineral & electrolyte replacements/supplements
- Action: Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.Replacement/prevention of deficiency.
- Side Effects: Confusion,restlessness, ARRHYTHMIAS,abdominal pain, diarrhea, flatulence.
- Nursing Implication: Assess s/s of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia). Monitor pulse, BP, and ECG
- periodically during IV therapy. Monitor labs (serum potassium, renal function, serum bicarbonate, pH). Monitor for s/s of toxicity/overdose (hyperkalemia,
- confusion, abnormal ECG readings).
- Patient/Family Teaching: Do not chew on enteric-coated tablets, reduce excessive K in diet. Avoid salt substitutes or low salt milk/food unless
- approved by physician. Instruct pt. to report dark, tarry, or bloody stools, weakness, unusual fatigue, or tingling in extremities.
- Route/Dosage (Adult): PO Anti-inflammitory-400-800 mg 3-4/day (up to 3200 mg/day). Analgesic/antidysmenorrheal/antipyretic
- -200-400 mg q 4-6 hrs (not to exceed 1200 mg/day). IV Analgesic-400-800 mg q 6hr (not exceed 3200 mg/day), Antipyretic-400 mg q 4-6hr/ 100-200 q 4hr (not exceed 3200 mg/day)
- Classification: antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents;
- Action: treatment of mild-moderate pain/fever. Reduces pain/inflammation/fever
- Side Effects: Headache, GI BLEEDING, HEPATITIS, ANAPHYLAXIS, DERM PROBLEMS, anemia Nursing Implication: Assess for rhinitis, asthma, urticaria, skin rash, pain lvl, ROM. May cause prolonged bleeding. Ensure pt. well hydrated
- Patient/Family Teaching: Advise pt. to take w/ full glass of water and remain in upright position for 15-30 min. May cause drowsiness/dizziness. Avoid concurrent use of alcohol (GI bleeding), ASA, ACE. Do not take > 10 days for pain, >3 days for fever.
- EcotrinRoute/Dosage (Adult): Pain/fever- PO 325-1000mg q 4-6 hr (not exceed 4 g/day). Inflammation-2.4 g/day (initially), 3.6-5.4 g/day (in divided doses) 7.8 g/day for acuterheumatic fever. Prevention of TIA-50-325 mg q.d. Prevention of MI-80-325 mg q.d.
- Classification: antipyretic,nonopioid analgesics; salicylates
- Action: Decreaseincidence of TIA & MI; decrease platelet aggregation, reduceinflammation/fever/pain.
- Side Effects: tinnitus, GI BLEEDING,epigastric distress, anemia,
- Nursing Implication: Assess pain & ROM, may cause prolonged bleeding, Prolong/high dose-monitor hepatic function, serum salicylates lvls, hematocrit. Monitor for onsetof tinnitus, headache, hyperventilation, agitation, mental confusion, Do nottake antacids within 1-2 hr of taking enteric-coated tabs
- Patient/Family Teaching: Take with full glass of water, remain upright 15-30 min. advise pt. toreport tinnitus, unusual bleeding, brushing, black stools, fever lasting > 3days. Caution pt. of GI bleeding from alcohol, and avoid ACE or NSAIDsconcurrently w/ aspirin. Teach pt. reduce Na in diet. Tabs w. vinegar-likesmell should be discarded. Aspirin may need to be withheld prior to surgery.Advise pt. of reduction of TIA/MI not to take > prescribed dose as increasedose not found to provide additional benefit.
- LovenoxRoute/Dosage (Adult): Prophylaxis-30 q 12hr,40 mg/day, 1 mg/kg q 12hr.
- Classification:anticoagulants; antithrombotics
- Action: Preventionof thrombus formation
- Side Effects: dizziness,BLEEDING, anemia, insomnia, urinary retention.
- Nursing Implication: Assess forsigns of bleeding & hemorrhage. Assess for evidence of additionalthrombosis. Monitor neurological impairment frequently (may require urgentcare). Monitor for hypersensitivity (chills, fever). Observe injection sites for hematomas, ecchymosis, inflammation. Monitor labs (CBC, platelet count, blood in stools).
- Patient/Family Teaching: Advisept. to report any s/s of unusual bleeding, bruising, dizziness, itching, rash,fever, swelling, difficulty breathing. Instruct pt. not to take aspirin orNSAIDs.
- Route/Dosage (Adult): PO 5-10 mg/ day.; 2.5 mg/day (small pt., pt. already receivingantihypertensive.) up to 10 mg/day.
- Classification: antihypertensive; Calcium channel blocker
- Action: Systemicvasodilatation resulting in decreased BP. Coronary vasodilatation resulting indecreasing frequency and severity of angina. Side Effects: headache,peripheral edema, bradycardia, hypotension
- Nursing Implication: Monitor BP& pulse prior before treatment/during dose titration/periodically during therapy. Monitor intake/output ratios, daily weight, signs of CHF (peripheraledema, rails/crackles, dyspnea, weight gain).
- Patient/Family Teaching: Avoid grapefruit juice, instruct pt. how to take pulse and BP contact health care professional if HR < 50 BPM. Caution pt. to move positions slowly, photosensitivity. Instruct pt. importance of good dental hygiene, avoidalcohol use, OTC medications (especially cold preparations).
- MS Contin
- Route/Dosage (Adult): PO >50 kg= 30 mg q 3-4 hr; <50 mg= 0.3mg/kg q 3-4 hr.; IV, IM, Subcut>50 kg=4-10 mg q 3-4 hr <50kg=0.05-0.2 mg/kg q 3-4hr max 15 mg/dose.
- Classification: Opioidanalgesics; opioid agonists
- Action: For severe pain
- Side Effects:Confusion, sedation, RESPIRATORY DEPRESSION, hypotension,
- Nursing Implication: Assess type, location, intensity of pain prior to and following PO,subcut, IM (20 min (peak) following IV). Assess lvls of consciousness, BP,pulse, and respirations before and periodically during administration. If respiratoryrate <10/min, assess lvl of sedation. Assess geriatric pt.s often. Asses bowel function routinely. Explain therapeutic value prior to administration toenhance its analgesic effect.
- Patient/Family Teaching: Instruct pt. how/when to ask for pain med. Instruct family not to administer PCA dosesto sleeping pt. (overmedication, sedation, repiratory depression can result).Encourage bedfast pt. to turn, cough, breathe deeply at least q 2hr. Teach pt./family how/when to administer medication, infusion care, accurate measuringof med. Emphasize importance of aggressive prevention of constipation.
- Route/Dosage (Adult): PO 300-800 mg (bid, hs, q 6hr). IM/IV- 300-600 mg q 6hr. 37.5 mg/hr.Not to exceed 2.4g/day (PO,IM,IV)
- Classification: antiulceragents; histamine H2 antagonists
- Action: Short-term treatment of duodenal ulcers. Management of gastric hypersecretory states,GERD. tx of heartburn, acid indigestion, sour stomach.
- Side Effects:Confusion, ARRHYTHMIAS, AGRANULOCYTOSIS, APLASTIC ANEMIA, decrease sperm count,ED, drug-induce hepatitis.
- Nursing Implication: Assess for epigastric/abdominal pain, blood in stool, emesis, or gastric aspirate. Monitor CBC w/ diff periodically. Administer w/ meals or immediately afterward/atbedtime to prolong effect. Avoid antacids within 1 hr of taking med
- Patient/Family Teaching: Notify healthcare professional if difficulty swallowing or abdominal pain occurs.Inform pt. smoking interferes with action medication. Inform pt. increasedfluid and fiber intake helps min. constipation. Advise pt. to report onset of black, tarry stools, fever sore throat diarrhea, dizziness, confusion, and hallucinations.
- Route/Dosage (Adult): PO-250-500 mgq 6hr
- Classification: anti-infectives;1st gen. cephalosporins
- Action: Treatmentof infections caused by burn wounds, pneumonia, UTI, bone/joint infection,Septicemia. Otitis media
- Side Effects: SEIZURES(high dose), PSEUDOMEMBRANOUS COLITIS, S/J SYNDROME, rash, hemolytic anemia,
- Nursing Implication: assess for infection at beginning and during tx. Obtain hx to determine previoususe/reaction to penicillin/cephalosporins. Obtain specimens forculture/sensitivity before therapy. Observe for s/s of anaphylaxis. Monitor for bowel function, diarrhea, bloody stools.
- Patient/Family Teaching: Take medication completely as directed, even if they feel better. Advise pt. to report s/s of superinfection. Instruct pt to report if they experience fever and diarrhea, especially if diarrhea contains blood, mucus, pus. Advise pt. notto treat diarrhea w/o speaking with healthcare professional.
- Route/Dosage (Adult): 50 mcg(initially), increase q 2-3 wk; maintenancedose- 75-125 mcg/day (1.5 mcg/kg/day)
- Classification: hormones;thyroid preparations. Action: Replacementin hypothyroidism to restore normal hormonal balance. Suppression of thyroidcancers.
- Side Effects: Nervousness,hypotension, menstrual irregularities,
- Nursing Implication: assess apical pulse & BP prior and periodically during therapy. Assess for tachyarrhythmias & chest pain. Monitor labs (thyroid function, TSH concentration (w/ brand change). Assess for hyperthyroidism (tachycardia, chestpain, nervousness, insomnia, diaphoresis, tremors, weight loss). Administer in AM to avoid insomnia.
- Patient/Family Teaching: Instruct changing brands may effect bioavailability, explain medication does not cure hypothyroidism. Take with water to avoid rapid tablet swell causing choking/trouble swallowing.
- Route/Dosage (Adult): antihistamine- PO 6.25-12.5mg tid/ 25 mg hs (IV, IM, Rect- 25mg; may repeat q 2hr). antivertigo-PO-25 mg before departure (may repeat in8-12hr). Sedation-PO,Rect,IM,IV-25-50 mg, may repeat q4hr. Antiemetic-PO,Rect,IM,IV- 12.5-25 mg q 4hr PRN (initial PO dose=25 mg).
- Classification: antiemetics, antihistamines, sedative/hypnotics;phenthiazines
- Action: tx of various allergic conditions and motion sickness. Tx/prevention of nausea/vomiting. Adjunct to anesthesia & analgesia
- Side Effects: May cause severe injury to tissue in IV. NEUROLEPTIC MALIGNANT SYNDROME, confusion,disorientation, sedation, dry mouth, photosensitivity.
- Nursing Implication: Monitor BP, pulse, respirations often of pt. receiving IV dose. Monitor pt for extrapyramidal & pseudoparkinsonian side effects. Assess for delirium,confusion, blurred vision. In IV- assess for burning and pain at IV site.(avoid IV administration if possible). May cause false +/- pregnancy results.
- Patient/Family Teaching: Advise frequent mouth rinses, good oral hygiene, and sugarless gum can decrease dry-mouth. Instruct pt to report sore throat, jaundice, fever, uncontrolled movements.When taken for motion sickness, advise pt to take at least 30 min prior (preferably1-2hr prior) to exposure to conditions that may cause motion sickness.
- Route/Dosage (Adult): PO-30-120 mg3-4 qd/ 60-120 mg bid as SR caps/ 180-240 mg qd as CD/XR caps or LA tabs (up to360 mg/day). IV-0.25/kg, may repeatin 15 min w/ dose of 0.35 mg/kg. May follow continuous infusion at 10 mg/hr(range 5-15 mg/hr) up to 24hr.
- Classification:antianginals, antiarrhythmics (class 4), antihypertensives; Calcium Channel Blocker
- Action: Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreased frequency/severity of attacks of angina. Reduction of ventricularrate in atrial fibrillation or flutter.
- Side Effects: Abnormal dreams, anxiety,blurred vision, tinnitus, ARRYTHMIAS, CHE, peripheral edema, S/J SYNDROME,
- Nursing Implication: Monitor BP and pulse prior to therapy, during dose titration, and periodically during therapy. Monitor ECG continuously during administration; periodically during prolonged therapy. Monitor intake/output ratios and daily weight. Assess signs of CHF(peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
- Patient/Family Teaching: Avoid grapefruit juice. Change position slowly. Instruct pt of importance of dental hygiene and seeing dentist frequently for teeth cleaning to prevent tenderness, bleeding, gum enlargement. Advise pt to report irregular HB, dyspnea, swelling of hands/feet, chest pain does not improve. Instruct pt/family in proper technique for monitoring BP weekly and report sig. changes