Meds for Med surg-wendy
Transcript of Meds for Med surg-wendy
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Medication
Trade/Generic Classification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to
be given Pre/post
admin Labs/VS to
consider
Colace/
docusate sodium OTC
Adult: PO 50-
300 mg/day(docusate
sodium) or 240mg (docusate
calcium or docusate
potassium) prnEnema 4 ml
(docusatesodium)
Available forms:
Docusatecalcium: caps
240 mg;docusate
sodium: caps 50,100, 250 mg;
tabs 100 mg; syr 20 mg/5 ml, 50
mg/15 ml, 100mg/30 ml, 150
mg/15 ml; oralsol 10, 50
mg/ml; enema283 mg/3.9 g
cap
Uses: To soften
stools, preventconstipation,
soften fecalimpaction (rectal
route)
Action: Increaseswater, fat
penetration inintestine; allows
for easier passageof stool; increases
electrolyte, water secretion in colon
Therapeutic
outcome:Passage of
softened stool,absence of
constipation
EENT: Bitter taste, throat
irritation
GI: Nausea, anorexia,cramps, diarrhea
INTEG: Rash
Contraindications:
Hypersensitivity,obstruction, fecal
impaction,nausea/vomiting
Precautions:
Pregnancy C, breastfeeding
Nursing:
Assess cramping,rectal bleeding,
nausea, vomiting; if these symptoms
occur, product should be discontinued;
identify cause of constipation; identify
whether fluids, bulk,or exercise is missing
from lifestyle
Dilute oral
sol in juice or
other fluidto disguise
taste
Give tabsor caps
with 8 ozof liquid;
give onempty
stomachfor
increasedabsorption
, results
N/A
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Medication
Trade/GenericClassification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to
be given
Pre/post
adminLabs/VS to
consider
Senakot S Adult:
PO 1-8 tabs/day ½ to 4 tsp of
granules added towater or juice
RECT SUPP
1-2 at bedtime
SYRUP 1-4 tsp at bedtime
(1 tsp = 4 ml), 7.5-15 ml; (Black
Draught) ¾ oz
dissolved in 2.5 ozof liquid given
between 2-
4 PM the day before procedure(X-Prep)
Availableforms: Tabs 6,
8.6, 15, 25 mg;granules 15, 20mg/5 ml; syr 8.8
mg/5 ml; liquid
33.3 mg/ml
Uses: Acute
constipation; bowel preparation for
surgery or exam,
prevention of constipation in those
taking opiates longterm
Action: Stimulates
peristalsis by actionon Auerbach's
plexus; softens feces
by increasing water and electrolytes in
large intestine
GI: Nausea, vomiting,
anorexia, abdominal cramps, diarrhea, flatulence
GU: Pink-red or brown-black
discoloration of urine
META: Hypocalcemia,
enteropathy, alkalosis,
hypokalemia, tetany
Contraindications:
Breastfeeding,hypersensitivity, GI
bleeding, intestinal
obstruction, CHF,abdominal pain,
nausea/vomiting,appendicitis, acutesurgical abdomen
Nursing: Assess cramping, rectal
bleeding, nausea,
vomiting; if these
symptoms occur, product
should be discontinued;
identify cause of
constipation; identify
whether fluids, bulk, or
exercise is missing fromlifestyle Assess for magnesium
toxicity: thirst, confusion,decrease in reflexes
Monitor blood ammonia
level (30-70 mg/100 ml);
monitor for clearing of
confusion, lethargy,
restlessness, irritability
(hepatic encephalopathy)
Once per
day
Monitor:
-Blood-Urine
-Electrolytes
if used often by patient -Check I&Oratio toidentify fluid
loss
-Monitor bloodammonia
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Medication
Trade/Generic
Classification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to
be given
Pre/post admin
Labs/VS to
consider
Lisinopril/Prinivil, Zestril
F unc. class.:
Antihypertensive,angiotensin converting
enzyme (ACE) inhibitor
Hypertension Adult: PO 10-40
mg/day; may
increase to 80mg/day if required
Geriatric: PO 2.5-5
mg/day, increaseq7day
CHF Adult: PO 5 mg
initially withdiuretics/digoxin,
range 5-20 mg
Available forms: Tabs 2.5, 5, 10, 20,
30 40 mg
Action: Selectively
suppresses renin-
angiotensin-
aldosterone system;inhibits ACE; prevents
conversion of
angiotensin I to
angiotensin II; resultsin dilatation of arterial,
venous vessels
Therapeutic
outcome: DecreasedB/P in hypertension,
decreased preload,
afterload in CHF
Uses: Mild to
moderatehypertension,
adjunctive therapy of
systolic CHF, acuteMI
CNS : V ertigo, depression, stroke,
insomnia, paresthesias, headache,
fatigue, asthenia, dizziness
CV : Chest pain, hypotension
EE NT : Blurred vision, nasal
congestion
GI: Nausea, vomiting, anorexia,
constipation, flatulence, GIirritation, diarrhea
GU: Proteinuria, renalinsufficiency, sexual dysfunction,
impotence
I NT EG: Rash, pruritus
MI SC : Muscle cramps,
hyperkalemia
RE SP : Dry cough, dyspnea
SYST : Angioedema
Contraindications: Hypersensitivity,
angioedema
Assessment -Assess blood studies:
platelets, WBC with
differential, baseline,
periodically q3mo; if neutrophils <1000/mm3,
discontinue treatment
-Monitor B/P, check for orthostatic hypotension,
syncope; if changesoccur, dosage change may
be required
-baselines in renal, liver
function tests before
therapy begins
-Monitor renal, liver function tests: protein,
BUN, creatinine; watch
for increased levels thatmay indicate nephrotic
syndrome and renal
failure; monitor renal
symptoms: polyuria,
oliguria, frequency,
dysuria
-Check potassium levels
throughout treatment,
-Check for edema
-Assess for allergicreactions: rash, fever,
pruritus, urticaria; product
Onset 1 hr
Peak 6-8 hr
Duration 24 hr
Interference:
glucose/insulin
tolerance tests,
ANA titer
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fibrillation, atrial
flutter, atrialtachycardia;
cardiogenic shock, paroxysmal atrial
tachycardia
-Monitor ECG continuouslyduring parenteral loadingdoses and for patients withsuspected toxicity; provide
hemodynamic monitoringfor patients with heart failureor administer multiplecardiac products
closemonitoring isnecessaryStore
protectedfrom light
MedicationTrade/Generic
Classification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to be given
Pre/postadmin
Labs/VS toconsider
Zocor/Simvastatin
F unc.class.: Antilipide
mic
C hem. class.: HMG-CoA reductase
inhibitor
Adult: PO 20
mg/dayin PM initially,
usual range 5-40mg/day daily in PM,
max 80 mg/day;
dosage adjustments
may be made at 4-
wk intervals or
more; those taking
verapamil, max 20mg/day
Renal dose/those
taking gemfibrozil,
danazol Adult: PO 5 mg
day, initially; CCr
<20 ml/min 5 mg qd
in the evening
Cardiac/renal
transplantation Adult: PO 5
mg/day, max 10mg/day
With amiodarone
or verapamil
Adult: PO max 20mg/day
Action: Inhibits
HMG-CoAreductase enzyme,
which reducescholesterol
synthesis; thisenzyme is needed
for cholesterol
production
Therapeutic
outcome:Decreasing
cholesterol levelsand LDLs,
increased HDLs
Uses: As anadjunct in primary
hypercholesterolemia (types IIa,
IIb), isolatedhypertriglyceridem
ia (Frederickson
type IV) and typeIII
CNS: Headache, ALS (Lou
Gehrig's disease)
EENT: Lens opacities
GI: Nausea, constipation,diarrhea, dyspepsia, flatus,
abdominal pain, liver
dysfunction, pancreatitis
INTEG: Rash, pruritus,
photosensitivity
MS: Muscle cramps,myalgia, myositis,
rhabdomyolysis
RESP: Upper respiratorytract infection
Contraindications:
Pregnancy X, breastfeeding,
hypersensitivity,active liver disease
Nursing Implications-Assess nutrition: fat,
protein, carbohydrates;
nutritional analysis should be completed by dietitian
before treatment is
initiated
Assess for
rhabdomyolysis: muscle
tenderness, increased
CPK levels; therapy
should be discontinued
- Monitor bowel patterndaily; diarrhea may be a
problem
- Monitor triglycerides,
cholesterol baseline,throughout treatment;
LDL, HDL, triglycerides
and cholesterol should be
watched closely at 6-8 wk
and q6mo; if increased,
Give 30 min
before AM and PM meals
Increased:
CPK, liver function tests
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DVT/PE Adult: SUBCUT
5000 units q8-12hr
Heparin flush
Adult and child: IV 10-100
units/ml
coagulation (DIC) immediately; HIT may occur after product discontinuation
- Monitor for
hypersensitivity: fever, skinrash, urticaria; notify prescriber immediately
Medication
Trade/GenericClassification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to
be given
Pre/post
adminLabs/VS to
consider
Fragmin/ Dalteparin
F unc.
class.: Anticoagulant
C hem. class.: Low-molecular-weight
heparin
Hip replacement
surgery/DVT
prophylaxis
Adult: SUBCUT2500 international
units 2 hr before
surgery and 2nd
dose in the evening
the day of surgery
(4-8 hr postop), then
5000 internationalunits SUBCUT 1st
postop day anddaily 5-10 days
Unstable
angina/non-Q-
wave MI Adult: SUBCUT
120 international
units/kg q12hr × 5-8
days; max 10,000
international unitsq12hr × 5-8 dayswith concurrentaspirin, continue
until stable
Deep vein
thrombosis,
prophylaxis for
abdominal surgery Adult: SUBCUT
2500 international
Action: Inhibits
factor Xa/IIa(thrombin),
resulting inanticoagulation
Therapeutic
outcome: Absenceof deep vein
thrombosis
Uses: Unstableangina/non-Q-wave MI;
prevention of deepvein thrombosis in
abdominal surgery,
hip replacement patients or thosewith restricted
mobility duringacute illness;
pulmonaryembolism
CNS : Intracranial bleeding
HEMA:
Thrombocytopenia
INTEG: Pruritus, superficialwound infection
SYST: Hypersensitivity, he
morrhage,anaphylaxis possible
Contraindications: Hypersensitivity to this
product, heparin, pork
products, benzyl alcohol;active major bleeding,
hemophilia, leukemia
with bleeding,
thrombocytopenic
purpura, cerebrovascular
hemorrhage, cerebral
aneurysm, thoseundergoing regional
anesthesia for unstableangina, non-Q-wave MI,dalteparin-induced
thrombocytopenia
Nursing Implications-Assess for bleeding (Hct,
occult blood in stools)
during treatment since
bleeding can occur
- Assess for bleedinggums, petechiae,ecchymosis, black tarrystools, hematuria,
epistaxis, decrease in Hct,
B/P; may indicate
bleeding, possible
hemorrhage; notify
prescriber immediately;
product should bediscontinued
-Assess for
Drug
peaks 4hours after
administration
Hct, Occult
Blood
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units daily, evening
prior to abdominal
surgery and repeat
daily × 5-10 days; in
high-risk patients
5000 international
units should be used
hypersensitivity: fever,
skin rash, urticaria; notify
prescriber immediately
- Assess for needed
dosage change q1-2wk;
dose may need to be
decreased if bleedingoccurs
Medication
Trade/GenericClassification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to
be given
Pre/post
adminLabs/VS to
consider
Morphine/
morphine sulfate,Morphitec
F unc. class.: Opioid
analgesic
C hem. class.: Alkaloid
Adult:
SUBCUT/IM 5-20 mg q4hr prn;
PO 10-30 mgq4hr prn;
EXT REL 15-30mg q8-12hr;
RECT 10-20 mgq4hr prn; IV 2.5-15 mg diluted in
4-5 ml of water for inj, over 5
min;
SUS REL cap(Kadian), EXT
REL cap(Avinza) give
total daily doseq24hr; for those
with notolerance to
opioids, 30mg/day, may
adjust by no
Action: Depresses
pain impulsetransmission at the
spinal cord level by interacting with
opioid receptors
Therapeutic
outcome: Decreas
ed pain
Uses: Moderate to
severe pain
CNS: Drowsiness,
dizziness, confusion, headache, sedation, euphoria,
insomnia, seizures
CV: Palpitations, bradycard
ia, change in B/P, shock,
cardiac arrest, chest pain,
hyper/hypotension,
edema, tachycardia
EENT: Tinnitus, blurred
vision, miosis, diplopia
GI: Nausea, vomiting,anorexia, constipation, cram
ps, biliary tract pressure
GU: Urinary retention
HEMA:
Thrombocytopenia
INTEG: Rash, urticaria,
bruising, flushing,diaphoresis, pruritus
Contraindications:
Hypersensitivity,addiction (opioid),
hemorrhage, bronchialasthma, increased ICP
Nursing
Implications
- Assess pain: location,type, character, intensity;give dose before pain
becomes extreme
- Monitor I&O ratio;
check for decreasing
output; may indicate
urinary retention; check
for constipation; increase
fluids, bulk in diet if needed, or stimulantlaxatives may be
prescribed
- Monitor CNS changes:
dizziness, drowsiness,
hallucinations, euphoria,
LOC, pupil reactions
- Monitor allergic
reactions: rash, urticaria
Administ
er when pain is
beginningto return;
determinedosageinterval by
patient
response;continuous dosing
of medicatio
n is moreeffective
thangiving prn
Increased:
amylase
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more than 30 mg
q4day Resp: Respiratory
depression, respiratory
arrest, apnea
- Assess respiratory
dysfunction: depression,
character, rate, rhythm;
notify prescriber if
respirations are <10/min
MedicationTrade/Generic
Classification
Patient Dose
Dose Limits
Uses/Purpose
Mode of Action
Side Effects
Adverse Reactions
Contraindications
Nursing Implications
Time(s) to be given
Pre/postadmin
Labs/VS toconsider
Hydromorphone/
Dilaudid
F unc.class.: Antitussive,
opioid analgesicagonist
C hem.class.: Phenanthrenederivative, guaifenesin
Antitussive Adult: PO 1 mgq3-4hr prn
Child 6-12
yr: PO 0.5 mgq3-4hr
Geriatric: PO 1-2 mg q4-6hr
Availableforms: Inj 1, 2,
4, 10 mg/ml;tabs 2, 4, 8 mg;
oral sol 5 mg/5
ml; supp 3 mg
Action: Inhibits
ascending pain pathways in CNS,
increases painthreshold, alters
pain perception
Therapeutic
outcome: Decreased cough,decreased pain
Uses: As an
antitussive tosuppress cough;
moderate to severe
pain
CNS: Dizziness,
drowsiness, sedation,confusion, headache,
euphoria, moodchanges, seizures
CV: Hy potension,
brad ycardia, palpitations,
change in B/P, tachycardia, peripheral vasodilatation
EENT: Miosis, diplopia, blurred vision, tinnitus
GI: Nausea, constipation,
vomiting, anorexia, dry
mouth, cramps, paralyticileus
GU: Increased urinaryoutput, dysuria, urinary
retention
INTEG: Urticaria, rash,
flushing, bruising,diaphoresis, pruritus
Contraindications:
Hypersensitivity
Nursing
Implications
- Assess pain control,
sedation by scoring on
0-10 scale; around-the-clock dosing is best for
pain control
- Monitor VS after
parenteral route; notemuscle rigidity;
product history, renal,liver function tests;
respiratory dysfunction:
respiratory depression,character, rate, rhythm;notify prescriber if
respirations are
<10/min
- Monitor CNSchanges: dizziness,
drowsiness,hallucinations,euphoria, LOC, pupil
Give when
pain is beginning
to return;determine
dosageinterval by
patient
response;continuous dosing
of medicatio
n is moreeffective
given prn;
explainanalgesiceffect
Increased:
amylase
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Human regular Adult: SUBCUT ½-1hr before meals
Insulin, isophane
suspension Adult: SUBCUTdosage individualized
by blood, urineglucose; usual dose 7-26 units; may increase by 2-10 units/day if needed
Insulin detemir Adult: SUBCUT 1 or 2 times/day; if 1 time,give with eveningmeal
Insulin glargine Adult and child 6yr: SUBCUT 10
internationalunits/day, range 2-100international units/day
sulfonylureas in
children >3 yr acetone breath, polyuria,
fatigue, polydipsia,
flushed, dry skin, lethargy
INSULIN Table:
Type Onset Peak Duration
Rapidand Short-Acting
Insulin glulisine (Apidra) 15 min 1 hour 2-3 hours
Insulin lispro (Humalog) 15 min 1 hour 4 hours
Insulin aspart (NovoLog) 30 min 1-3 hours 3-5 hours
Regular insulin*
30 min-1 hour 2-4 hours 5-7 hours
Intermediate-Acting
Isophane insulin suspension (NPH insulin, Humulin N) 3-4 hours 6-12 hours 18-28 hours
Insulin zinc suspension (Lente insulin) 1-3 hours 8-12 hours 36 hoursLong-Acting
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Type Onset Peak Duration
Extended insulin zinc suspension (Ultralente) 4-6 hours 18-24 hours 36 hours
Insulin glargine (Lantus)
1-5 hours Plateau 24 hours
Insulin detemir (Levemir) 3-4 hours ³Peakless´ 24 hours