Heparin monitoring
PTT 60-80have protamine sulfate ready
Warfarin monitoring
INR of 2 or 3vitamin K antidote
eye drop administration
depress the lower lid and place the medication in the lower conjunctival sac.
MDI inhaler use
after using inhaler, rinse mouth thoroughly with water and split out. do not swallow1. observe for side effects:-tachycardia, dysrhythmia, cns excitation, n/v2. evaluate effectiveness-monitor for decreased SOB, wheezing, crackles, loosened secretions and anxiety3. give treatment before meals to avoid n/v and reduce fatigue that accompanies eating
decreased cardiac output
slows distribution
Decreased GI motility
slows absorption
hepatotoxicity s/s
n/v, jaundice, dark urine, abdominal discomfort, anorexia
nephrotoxicity s/s
Oliguria, elevated creatinine, elevated BUN, and acid-base imbalances
allergic reaction/hypersensitivity often occurs
in the first 15 minutesABC priorities
medication interactions
St johns worthGinesengGrape fruit juicetyramine high foodsleafy greens
what increases your likelihood of allergic reaction?
pt has had a previous exposure to the medication
allergic reaction
ABCEPIdiphenhydraminemethylprednisolone
Anticholinergic drugs
A/Edry mouthconstipationurinary retentiondrugs that interrupt or reduce the function of the parasympathetic system
ABX and cultures
take cultures before ABX administration
atropine
Bradycardia, Anesthesia adjunct
benztropine
Parkinson's disease, Prevent EPS and dystonic rxn (mental health meds)
ipratropium
bronchodilator for COPD
oxybutynin
over active bladder
OAB
...
scopolamine
Motion sickness, N/V
vancomycin
Nephrotoxic; ototoxic; red man syndromePeak & trough levels
tetracycline
DO NOT give to pregnant women or children <8; NO dairyCauses tooth discoloration
penicillin & amoxicillin
Allergic rxn
azithromycin
Dysrhythmias, ototoxicity
ciprofloxacin
Achilles tendon rupture
cephalexin
Allergic rxn; do not give w/PCN allergy
gentamicin
Nephrotoxic; ototoxicPeak & trough levels
ketoconazole
Hepatotoxic; GI upsetMonitor LFTs
Amphotericin B
Hepatotoxicity; nephrotoxicity; bone marrow depressionPatient is hydrated with 0.9NSpre-medicated with acetaminophen and diphenhydramineInfuse med slowly over 2-4hrs
metronidazole
Hepatotoxic; dark urine; metallic taste
Antiretrovirals / HAARTfor HIV/AIDSEnd in -vir or -dine
Monitor CBC, electrolytes and liver function tests
Albuterolbeclomethasonemontelukasttheophylline
AsthmaTransient tachycardia, palpitations, tremorsICS: rinse mouth; use SABA 1stLiver dysfunction; depressionCardiac toxicity
albuterolipratropiumbeclomethasone
COPDAs aboveDry mouth, constipation, urinary retentionICS: rinse mouth; use SABA 1st
isoniazidrifampinethambutol
TBPeripheral neuropathyTurns urine & body fluids orangeBlindness
rescue inhaler usage
shakehold for 10 secswait 1-2 minsdo again
Albuterol Precautions:
Paradoxical bronchospasm, use cautiously in patients with CHD, dysrhythmias, DM; patient taking beta-blockers
rifampin
Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine
-prils captopril
Angioedema; ACEI cough; hyperkalemia
-sartan losartan
hyperkalemia
-pine nifedipine
Bradycardia; peripheral edema; dizziness
digoxin
Dig toxicity: Bradycardia, GI upset, vision changes, yellow halosAssess Apical for full minute**digibind reversal
nitroglycerin
HA; dizziness
All CV medications cause
hypotension and orthostatic hypotensionMonitor: HR, BP; teach patient to change positions slowly
furosemide
Dehydration; HYPOKALEMIA; Ototoxicity
hydrochlorothiazide
Dehydration; HYPOKALEMIA
spironolactone
Hyperkalemia; amenorrhea, gynecomastia,
mannitol
F/E imbalance
diuretic patient teaching
take in AMmonitor potassium if loop
Potassium rich foods
Potato, cantaloupe, spinach, broccoli, orange, banana, avocados, tuna, beets
aspirinclopidogrel
Anti-platelet drugs; used in myocardial infarctionDo not give asa to childrenBLEEDING
heparin
BLEEDING; HIT; monitor PTTAntidote: protamine
enoxaparinfondaparinux
Low molecular weight heparinBLEEDING; HITbubble in
warfarin
vitamin K antagonistBLEEDING. Monitor INRAntidote: Vitamin K
apixabandabigatranrivaroxaban
Direct oralanticoagulantsBLEEDINGGI upset; take with food
Bleeding precautions
no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods
Ferrous Sulfate
Iron supplimentMonitor CBC; Fe levelsConstipation; turns stools black; Liquid prep stains teeth; use straw
epoetin alfaerythropoietin
Hematopoietic Growth FactorsMonitor BP and CBCA/E: HTN, DVT, HA, seizures
methimazolepropylthiouracil
HyperthyoroidismA/EHypothyroidism; agranulocytosis; hepatotoxicity
Radiation
HyperthyroidismA/EHypothyroidism; bone marrow suppressionRadiation precautions
levothyroxine
HypothyroidismA/EHyperthyroidism; CP; palpitations; dysrhythmias
ketoconazole (cushings)
cushings diseaseA/EHepatotoxicity
hydrocortisone fludrocortisone
Addisons disease
SIADH
furosemide
DI
vasopressindesmopressinMonitor vs, I/O, daily wts, F/E. Complication: water intoxicationEffective: U/O
Opioids
Resp: Respiratory depressionCV: Orthostatic hypotensionNeuro: Sedation & dizzinessGI: CONSTIPATION; N/VGU: Urinary retentionNaloxone antidote
Opioid Nursing care
Pain assessment Baseline vs and monitoring after Follow controlled substances procedures Waste medication not used with another RN as witness Hold med if RR <12 Have reversing agent and emergency equipment available
donepezilmemantine
Alzheimer's diseaseInsomnia; HA; seizures; dysrhythmias; GI upsetSedation; dizziness; HTN; HA
interferon
Multiple sclerosisBone marrow suppression; hepatotoxicity
pyridostigmine
Myasthenia gravis secretions; dysphagia; bronchoconstriction; bradycardia; hypotension
carbidopa-levodopabenztropine
Parkinson's diseaseCV a/e; dyskinesia; hallucinationsdry mouth, constipation, urinary retention
diazepamlorazepam
Abortive meds - seizureRespiratory depression; sedation
seizure maintenance meds
carbamazepine Blood dyscrasiaphenobarbital CNS depression and sedationphenytoin Gingival hyperplasia; bradycardiavalproic acid Hepatotoxicity, pancreatitis
seizure meds monitor
Neurological and cardiopulmonary status Therapeutic serum levels of medications LFTs
oxytocin
Uterine stimulantUsed to induce labor; strengthen contractions; control PP hemorrhage
misoprostol
Uterine stimulant"ripen" cervix; chemical 1st trimester AB
terbutaline
Used to stop premature labor
magnesium sulfate
pre-clampsiaUsed to prevent seizures Monitor DTR; Mg level
betamethasone dexamethasone
labor steroidsStimulates lung maturity in pre-term fetus resp distress syndrome
OB meds monitoring
Uterine contractions Fetus (baby): FHT w/ fetal monitor Maternal VS: BP and HR; I/O
migrane first line treatments
acetaminophen asa & NSAIDsAsa & NSAIDs: GI upset. Take with foodTriptans:sumatriptanCP; coronary artery spasm, dizzinessContraindicated: CHD, HTN
migrane second line treatments
ergotamine GI upset: N/V; muscle pain , paresthesia; Dependency (can cause withdrawal s/s)caffeine
migrane prophylactic
propranolol Bradycardiadivalproex GI upset; pancreatitisamitriptyline. Anticholinergic; drowsiness, dizziness
DTR grading
4+: very brisk, hyperactive with clonus (beating muscle; abnormal)3+: brisker than average (could be normal)2+: average, normal1+: somewhat diminished, low normal0: no response
alprazolamclonazepam
AnxietyA/ESedation, drowsiness; dizziness
buspironezolpidem
AnxietyA/EDrowsiness; dizziness; daytime sleepiness; SI
lithium< 1.5
Bipolar DisorderBradycardia, hypotension, edema; wt. gain; GI upsetpolydipsia; polyuria; HYPONATREMIALITHIUM toxicity = cardiac toxicity
chlorpromazinehaloperidolrisperidone
psychosis/schitzophreniaAgranulocytosisEPS; TD; neuroleptic malignant syndrome Orthostatic hypotension, dysrhythmias; agitation; endocrine a/e
mental health drugs monitor
CBC & LFT
epidural block adverse effects
maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex
fluoxetine (Prozac)paroxetine (Paxil)sertraline (Zoloft)
SSRIA/E libido; wt. loss; serotonin syndrome. SI. bruxismInsomnia vs sleepiness
venlafaxine (Effexor)duloxetine (Cymbalta)
SNRIA/E libido; wt. loss; serotonin syndrome. SI
amitriptyline (Elavil)doxepin (Sinequan)
TCAFor agitation and restlessnessToxicity: dysrhythmias, seizures confusion, coma Anticholinergic a/e. Do not stop abruptly
phenelzine (Nardil)
MAOIOrthostatic hypotension, tachycardia; dysrhythmias, delirium; hypertensive crisis (phentolamine)Avoid tyramine-rich foods
bupropin
AtypicalA/EHTN, tachycardia; dysrhythmias, hypertensive crisis, wt. loss; insomnia
alcoholism
Benzodiazepines• diazepam• Lorazepam• Antidote: flumazenilMaintenance• disulfiram• naltrexone
opioid addiction
• methadone• clonidine• buprenorphineNaloxone is used to treat opioid OD
nicotine dependence
• Nicotine replacement• bupropion• varenicline
medication rights
PatientMedicationDoseRouteTimeDocumentationRationaleResponeseRefusal
missed dose
do no doubletake missed asapdo not leave meds aroundassess for A/Eif error complete incident(not in chart)