I FACTORS AFFECTING DRUG ABSORPTION DISTRIBUTION plasmaprotein binding volume of distribution barriers blood brain and placental obesity and receptor combination METABOLISM oral medicines age nutrition and hormones ID: 774983
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Slide1
EXCRETIONrenal excretion, drugs affecting elimination of other drugs, blood concentration levels
I. FACTORS AFFECTING DRUG ABSORPTION
DISTRIBUTION plasma-protein binding, volume of distribution, barriers (blood- brain and placental), obesity and receptor combination
METABOLISM
oral medicines, age, nutrition and hormones
Slide2II
. GENERAL PRINCIPLES OF DRUG ADMINISTRATION
&
SAFETY GUIDELINES GIVING MEDICATIONS
Slide3General Principles of Drug Administration and Safety Guidelines Giving Medications
Confirm client diagnosis and appropriateness of medicines
Identify all concurrent medicines and any potential C/I and allergies
Research drug compatibilities, action, purpose, route, C/I, S/E
Calculate dosage accurately especially for pediatric clients
Check for expiration date of medicines
Slide4Confirm client’s identity Provide client teachingsStay with client until medicines is gone; do not leave at bedsideAfter giving medicines, leave client in position of comfortGive medicines within 30 minutes of prescribed time
General Principles of Drug Administration and Safety Guidelines Giving Medications
Slide5General Principles of Drug Administration and Safety Guidelines Giving Medications
11. To ensure safety do not give a medication that someone else prepared
12. Know the policies of your office regarding the administration of medication.
13. Give only the medication(s) that the physician has order in writing. Do not accept verbal order.
14. Check with the physician if you have any doubt about a medication or an order.
15. Avoid conversations or other distractions while drawing up and administering medication. It is important to remain attentive during this task.
Slide6General Principles of Drug Administration and Safety Guidelines Giving Medications
16. Work in quiet, well lighted area.
17.
Check the label when taking the medication from the shelf, when pouring it, and when replacing it on the shelf. This is known as the “three checks” for safe medication administration.
18. Place the order and the medication side by side to compare its accuracy.
19. Check strengths of the medication (eg. 250 mg versus 500 mg) and the routes (eg. ophthalmic, otic, topical).
20. Read labels carefully. Do not scan labels or orders.
Slide7General Principles of Drug Administration and Safety Guidelines Giving Medications
21. Check the patient’s chart for allergies to components of the medication.
22.
Check the medication’s expiration date.
23.
Be alert for color changes, precipitation, odor, or any indication that the medication’s properties have changed (especially insulin, nitroglycerin & phenytoin)
.
24. Measure exactly; there should be no bubbles.
25.
Have sharps containers as close to the area of use as possible.
Slide8General Principles of Drug Administration and Safety Guidelines Giving Medications
26. Put on gloves for all procedures that might result in contact with blood or body fluids.
27. Stay with the patient while oral medication is being taken. Watch for any reaction and record the patient’s response.
28. Never return a medication to the container
.
29.
Never recap, bend, or break a used needle.
30. Never give a medication poured or drawn up by someone else.
31. Never leave the medication cabinet unlocked when not in use.
32. Never give the keys of the medication cabinet to an unauthorized person. Limit access to the medication cabinet by limiting access to the cabinet keys.
Slide9MEDICATION ERRORS
Slide10MEDICATION ERRORS
Even if you are extremely careful, you may make an error when administering a medication. It is imperative that you report the error to the physician and that intervention measures start immediately. The error and all corrective actions must be documented thoroughly on the patient’s chart. An incident report must be completed for the error and filed in the patient’s chart as verification that all possible precautions were taken for the patient. Errors made in charting medications must be corrected using a standard procedure. If you discover a charting error, mark it with one line. Then mark the correction above the error and sign it.
Slide11THERAPEUTIC SERUM MEDICATION LEVEL
Acetaminophen 10 – 20 ug/ml
Carbamazepine 5 – 12 ug/ml
Digoxin 5 – 2 ng/ml
Gentamycin 5 – 10 ug/ml
Lithium 5 – 1.3 mEq/L
Magnesium SO4 4 – 7 mg/dl
Phenytoin 10 – 20 ug/ml
Theophylline 10 – 20 ug/ml
Slide12Right ClientRight DrugRight DoseRight RouteRight TimeRight DocumentationRight Drug Preparation and Administration
III. SEVEN RIGHTS
Slide13Assess oral cavity and ability to swallow medicinesEnteric-coated medicines must not be crushed. Only scored tablets can be brokenDo not administer alcohol-based products like elixirs to alcohol dependent personsHave patients swallow medicines except for sublingual and buccal route. Do not allow fluids 30 minutes after giving medicines. Give iron preparation using straw to prevent teeth staining.When giving medicines via NGT, do not mix with food. Give before or after meals and flush tubing with 30 ml of H2O. Check for tube patency before giving medications.
IV. GENERAL CONSIDERATIONS FOR
ORAL MEDICINES
Slide14Select appropriate needle size and syringe for ID, SQ, IM ROUTESUse tuberculin syringe for medicines less than 1 mlDraw up air equal to amount of medicines neededInject air to vial to prevent negative pressure and aid in aspirating medicinesAmpule: place needle into ampule to draw medicines and use filter needle to avoid glass shardsSelect and rotate sites avoiding bruised or tender areasInsert needle quickly with bevel side up. Aspirate to check for blood except heparin. If blood is present, remove needle and start again. For giving IV medicines, blood return is desiredApply gentle pressure after giving injections except for heparin and Z-track.
V. GENERAL CONSIDERATIONS FOR
PARENTERAL MEDICINES
Slide15a. Use 25g to 27g, ½ to 1 inch needleb. Maximum volume of 1.5 mlc. Pinch skin to form SC fold and insert at 45 degrees in thigh or arm and 90 degrees in abdomenPossible sites: lateral aspect of upper arm, anterior thigh, abdomen…1 inch from umbilicus and scapular areaEXAMPLES: Heparin, Insulin, MMR, Enoxaparin (Lovenox)
1. SQ ADMINISTRATION
Slide16Use 26g to 27g, 1" needle on a 1 ml or tuberculin syringe (vol. approximately 0.1 ml) Insert needle at 10-15 angle with 1-2 mm depth with needle bevel upward When wheal appears, do not massage, mark Possible sites: ventral forearm, scapula, upper chestEXAMPLES: BCG, PPD (Purified Protein Derivative)/ Mantoux test
2. ID ADMINISTRATION
Slide17a. Use 18 g to 23 g, 1-2 inch needle, maximum volume is 5mlb. Stretch skin tautc. Insert at 90 degrees angle. 45 degrees for infants and childrend. Possible sites: gluteus medius (ventrogluteal and dorsogluteal, vastus lateralis (anterior thigh), rectus femoris (medial thigh) and deltoide. For Z-track: 20-22 g, 2-3 inches long with a different needle to draw medicines; draw skin laterally with non-dominant hand to ensure that medicines enter muscle; wait 10 sections before removing injection; do not massage to lock irritating substances in placeEXAMPLES: Vit.K, Hep. B, DPT, Iron dextran (Z-track)
3. IM ADMINISTRATION
Slide18a. Check site for complications (redness, swelling, tenderness)b. Check blood returnc. Prepare medicines according to manufacturer’s specificationsd. Prepare tubing according to requirement: micro or macro tubinge. Change tubing and dress site every 24-72 days depending on hospital policy and label appropriatelyf. Never hang solutions more than 24 hours g. Use syringe infusers and infusion pumps EXAMPLES: vancomycin (Vancocin), amphoterecin B, cisplatin (Platinol), fluorouracil (5-FU), Oxytocin, Mannitol
4. IV ADMINISTRATION
Slide195. IV PRECAUTIONS
a. Monitor the risk for fluid overload especially in patients with respiratory, cardiac, renal and liver diseases. Elderly clients and very young clients cannot tolerate excessive fluid volume
b. Clients with CHF cannot tolerate solutions containing sodium
c. Clients with diabetes mellitus does not typically receive dextrose (glucose) solutions
d. Lactated Ringer’s Solution contain potassium and should not be given to clients with renal failure
Slide20A. INFECTION LOCAL: redness, swelling and drainage at site SYSTEMIC: fever, chills, HA, tachycardia, malaise The longer the site, the higher the risk At risk are HIV/Aids patients and those receiving chemotherapy Assess for the S/Sx of infection, maintain strict asepsis in IV site care, monitor WBC, check the integrity of solutions, change tubings and dressings q 24-72 hrs, prepare to obtain blood culture from venipuncture device
6. COMPLICATIONS OF IV THERAPY
Slide21B. PHLEBITIS/THROMBOPHLEBITIS
PHLEBITIS: Redness, heat and tenderness at site, sluggish IV THROMBOPHLEBITIS: Hard and cordlike vein Use IV cannula smaller than vein Avoid lower extremities and areas of flexion as the site
6. COMPLICATIONS OF IV THERAPY
Slide226. COMPLICATIONS OF IV THERAPY
C. INFILTRATION Edema, pain and coolness at the site d/t seepage of IV fluid outside vein and into the interstitial space; May or may not have blood return Caused when devise dislodged or perforates vein or when vein backs up pressure d/t venospasm Infiltrated if no backflow of blood upon lowering fluid container or after occluding the vein proximal to site and IV continues to flow Remove infiltrated IV, elevate extremity and apply cold or warm compress based on MD’s order
Slide236. COMPLICATIONS OF IV THERAPY
D. CIRCULATORY OVERLOAD Increased BP, distended jugular veins, rapid breathing dyspnea, moist cough and crackles Use infusion pump esp. for clients at risk of overload and time tapeIf it occurs, KVO rate, elevate head of bed, assess for edema and inform MDIf these occurs, remove and restart in opposite extremity apply warm and moist compress; inform doctor
Slide246. COMPLICATIONS OF IV THERAPY
E. AIR EMBOLISM Increased BP, distended jugular veins, rapid breathing dyspnea, moist cough and crackles Occurs when air bolus enters vein through inadequately primed IV line, from loose connection, tubing change and IV removal If S/Sx occur, clamp the tubing, turn the patient on the left side with the head lowered (Trendelenburg position) to trap area in the right atrium, call MD right away
Slide25VI. CONSIDERATIONS IN GIVING OPTHALMIC MEDICINES
1. Have patient lie on back or sit with head turned to the
affected side
to facilitate gravitational flow.
2. Cleanse eyelids and eyelashes
with sterile gauze pads
soaked with physiologic saline.
3.
Keep eye open by pulling down on cheekbone with thumb and pointer finger to expose lower conjunctiva.
4. Place the necessary drops near the
outer canthus and away from cornea.
5. If using ointment, squeeze
into lower conjunctiva and move from inner to outer canthus. Do not touch tip to the eye and twist tube to break medication stream.
Slide26VI. CONSIDERATIONS IN GIVING OPTHALMIC MEDICINES
6. Let patient blink 2-3 times
7.
Press on nasolacrimal glands (to prevent systemic absortion, a perfect example is atropinr sulfate)
8. Wipe excess medicines starting from inner canthus
9. Droppers and ointments are for individual clients
and never shared.
Slide27VII. CONSIDERATIONS IN GIVING OTIC MEDICINES
1. Clean outer ear using wet gauze pad.
2. Straighten ear canal: Pull pinna up and back for adults Pull pinna down and back for children under 33. Instill necessary number of drops along side of canal without touching ear with dropper. Maintain ear position until medicines has totally entered canal4. Have client remain on side for 5-10 minutes to allow medicines to reach to reach inner ear.
Slide28VIII. CONSIDERATIONS IN GIVING TOPICAL MEDICINES
1. Cleanse area to remove old medicines using gauze with soap and warm water
2. Spread medication evenly and
thinly wearing gloves if the skin is broken
3. When applying nitroglycerin ointment, take the client’s BP 5 minutes before and after application
4. Wash hands after applying to prevent self-absorption
5.
For transderm patches, wear gloves to prevent self absorption
and place in an area with little hair. Press down edges to secure
patch
Slide29IX. CONSIDERATIONS IN GIVING VAGINAL MEDICINES
1. Let client void
2. Drape to provide privacy and wear gloves
3. Place client on bedpan in a
dorsal recumbent position with hips and knees flexed
4. Cleanse perineum with warm, soapy water working from inner to outer
Slide30IX. CONSIDERATIONS IN GIVING VAGINAL MEDICINES
5. Moisten suppository with water-soluble lubricant
6. Separate labia
and insert 2 inches…angled downward and backward
7. Provide pillow under buttocks and let patient remain in that position for 15-20 minutes (no sphincter to hold suppository in place)
8. Provide with pads
Slide31X. CONSIDERATIONS IN GIVING RECTAL MEDICINES
1. Check patient’s bowel function/ability to retain the enema or suppository
2. Store suppositories in the refrigerator3. Provide privacy and position client left laterally4. Don gloves and moisten suppository with water-soluble lubricant5. Insert suppository tapered end 1st and insert 2 inches to pass the internal sphincter6. Hold buttocks together.7. Encourage patient to retain: Suppositories for 10-20 minutes Enema for 20-30 minutes
Slide32XI. NEUROLOGIC MEDICINES
Nervous System
CNS
PNS
Brain
Spinal Cord
Somatic
Automatic
Adrenergic
AlphaBeta
Cholinergic
Slide33XI. NEUROLOGIC MEDICINES
1. ANALGESICS
A. Narcotic Analgesics
Actions:
Combines with opiate receptors in CNS. Reduces stimuli from sensory nerve endings; pain threshold is increased.
DON’T GIVE TO PATIENT’S WITH:
Alcoholism, respiratory, renal or hepatic disease,
increased intracranial pressure
, severe heart disease.
AVOID MIXING WITH THIS DRUGS
:
Alcohol and/ or CNS depressants, barbiturates, anxiolytics
, any products with alcohol. MAOIs may result in a fatal reaction.
Slide34XI. NEUROLOGIC MEDICINES
1. ANALGESICS
A. Narcotic Analgesics
Interventions:
Monitor RR
, bowel sounds, VS, and pain for type location, intensity, and duration. Dilute and administer IV solution slowly to prevent CNS depression and possible cardiac arrest. Hold medication if respirations <12/min. with the adult or <20/min. with the child.
Have Narcan available.
Education:
No ambulating without assistance; no driving. Instruct to take before pain is too severe. Dependence on drug is not likely for short –term medical needs. Do not abruptly withdraw medication.
Slide35#1. Respiratory Depression (check the respiratory rate first!)#2. Orthostatic Hypotension (check the blood pressure before and after taking the drug)#3. Constipation decreases peristalsis)
MAJOR SIDE EFFECTS OF NARCOTICS (this is according to prioritization):
Slide36MORPHINE-LIKE DERIVATIVES
M
orphine (roxanol)- the best drug for
M
I
NEVER GIVE TO PANCREATITIS AND CHOLELITHIASIS because it will contract the SPHINCTER of ODDI.
= Codeine (Codeine SO4) & Hydrocodone (hycodan) COMMONLY USED AS AN ANTI- TUSSIVE (cough suppressant)
= Levorphanol (Levodromoran)
Slide37MEPERIDINE-LIKE DERIVATIVES
Meperidine (Demerol) never give to patients with increase ICP. It masks the symptoms of respiratory depression!
Fentanyl (Sublimaze)
Slide38METHADONE-LIKE DERIVATIVES
Methadone( Dolophine) the #1 preferred drug of choice for heroin withdrawal. Propoxyphene (Darvon) contains aspirin NEVER give to hemorrhagic shock.
Slide39a. Others Narcotics:
Code: morphone/ codone
hydro
codone
(Hycodan); hydro
morphone
(Dilaudid);
oxy
codone
(Roxicodone); oxy
morphone
(Numorphan);
Others:
Dezocine (Dalgan);
fentanyl (Sublimaze),
levomethadyl (ORLAAM); levorphanol (Levo-Dromoran); remifentanil (Ultiva);
sufentanil (Sufenta).
Butorphanol Tartrate (Stadol), Nalbuphine, Pentazocine
Slide40b. Narcotic Antagonists (Antidote for Narcotic poisoning) Naloxone (Narcan) Naltrexone (Trexan, Revia) Nalmefene (Revex)
c. Non-Steroidal Anti-Inflammatory
Slide41A. NSAIDS
1. ASA (Aspirin) – anti-platelet aggregator, anti-inflammatory and analgesic
* the best drug for rheumatoid arthritis
*always with meals (causes Peptic ulcer)
*used in strokes and MI
*ototoxic (early side effect: tinnitus and vertigo)
*be careful in giving to individuals with Viral illness such as chicken pox because there is a risk for REYES SYNDROME (liver damage is evident)
* avoid giving to individuals with bleeding tendencies and potential for blood dyscrasia such as thrombolytics , anticoagulants, ginko biloba, and phenytoin.
Slide422. Para – chlorobenzoic Acid (Indoles) Indomethacin (Indocin) Sulindac (Clinoril) Tolmetin (Tolectin) Pyrazolone derivatives: Phenylbutazone (Butazolidin)
A. NSAIDS
Slide43Proprionic Acid Derivatives Ibuprofen (Motrin, Advil, Nuprin) Fenoprofen Calcium (Nalfon) Naproxen (Naprosyn) Flurbiprofen Sodium (Ansaid, Ocufen) Ketoprofen (Orudis) Oxaprozin (Daypro)
A. NSAIDS
Slide44Phenylacetic Acid Derivatives Ethodolac (Lodine) Diclofenac Sodium (Voltaren) Ketorolac tromethamine (Toradol) COX-2 INHIBIOTORS Celecoxib (Celebrex) Meloxicaqm (Mobic) Rofecoxib (Vioxx)9. Miscellaneous Analgesic AgentsAcetaminophen (Tylenol) 1. Acetaminophen (Tylenol) *hepatotoxic ( monitor SGPT/ALT) *with food
A. NSAIDS
Slide45ANXIOLYTICS/ANTI-ANXIETY
Another word: Sedatives/Hypnotics/Minor Tranquilizer
For:
Delirium, anti-anxiety, insomnia
ACTION:
Increases GABA (gamma amino butyric acid)
USES:
Major Use
to reduce anxiety; also induce sedation, relax muscles,
inhibit convulsion; Used in neuroses, psychosomatic
disorders, functional psychiatric disorders.
DO NOT modify psychotic behavior.
Most commonly prescribed drugs in medicine
Greatest harm: When combined with ALCOHOL
Slide46I. BENZODIAZEPINE Code: ZEPAM / ZOLAM Action: Anticonvulsant, muscle relaxant & anxiolyticDiazepam (Valium)* best for: Status epilepticus , the best for delirium tremens (alcohol & cocaine withdrawal
ANXIOLYTICS/ANTI-ANXIETY
Slide47Estazolam (Prosom) Alprazolam (Xanax) Chlorazepate (Tranxene)Oxazepam (Serax)* The best in sundown syndrome (seen in Alzheimers) Advantage: Not hepatotoxic
ANXIOLYTICS/ANTI-ANXIETY
I. BENZODIAZEPINE
Slide48Lorazepam (Ativan)* 2nd drug for sundown syndromeTriazolam (Halcion)* Anti-insomniaTemazepam (Restoril)* Anti-insomniaFlurazepam (Dalmane)* Anti-insomnia; do not stop abruptly because of rebound grand mal seizureMidazolam (Dormicum)Prazepam (Centrax)
ANXIOLYTICS/ANTI-ANXIETY
I. BENZODIAZEPINE
Slide49Chlordiazepoxide (Librium)* 2nd drug of choice for delirium tremensChlordiazepoxide (Librium), multivitamins, thiamine and folic acid help decrease withdrawal symptoms of alcohol withdrawal. Positive outcome of Librium in alcoholic depressed woman includes an observation that client can pick an object on floor w/ smooth coordination Clonazepam (Klonopin) Halazepam (Paxipam)
ANXIOLYTICS/ANTI-ANXIETY
I. BENZODIAZEPINE
Slide50Side Effects #1: Vital sign to be monitored: Respiratory Rate due to its Lethal Side Effect; Respiratory Depression1. Early Side effects decrease LOC Lethargic Late/Fatal side effects decrease RR Respiratory Depression RR below 12Avoid strenuous activitiesAntidote for Benzodiazepine intoxication: FLUMAZENIL (ROMAZICON); an anxiolytic antagonist
ANXIOLYTICS/ANTI-ANXIETY
I. BENZODIAZEPINE
Slide51II. BARBITURATES Action: Used as an anticonvulsant besides being a sedative Code: TAL / AL Secobarbital (seconal) Phenobarbital (luminal)* commonly used anticonvulsant barbiturate Methohexital (Brevital) Amobarbital (Amital) Methobarbital (Methalba)
ANXIOLYTICS/ANTI-ANXIETY
Slide52III. A TYPICAL ANXIOLYTICS Meprobamate (Equanil, Milltown) Chloral Hydrate (Noctec) Hydroxyzine (Atarax, Iterax, Vistaril)* anti emetic & antihistamine Diphenhydramine (Benadryl)* Antiparkinsons, Antihistamine,and an Anxiolytic (addictive) Zolpidem (Ambien, Stillnox) sleeping aid Doxylamine (Unisom) sleeping aid Buspirone (Buspar)* will take 1 week before the effect could be seen
ANXIOLYTICS/ANTI-ANXIETY
Slide53ANTICONVULSANTS
Slide54ANTICONVULSANTS
a. Barbiturates (given above)
b. Benzodiazepines (given above)
c. Hydan
toin
s (code: toin)
Pheny
toin
(Dilantin)
best anticonvulsant petit mal seizures for children
SE:
Gingival hyperplasia & pinkish urine, alopecia, hyperglycemia, Intervention: Massage the gums & use soft bristle toothbrush
Slide55Adverse Effect: Blood dyscrasia- thrombocytopenia S/SX: Bleeding of the gumsLab test: Platelet count = 150,000-400,000; if ↓100,000-active bleedingSpecial Considerations: The only COMPATIBLE I.V. Solution for Phenytoin (dilantin) is NSS (Normal Saline Solution) Ethotoin (Peganone) Mephenetoin (Mesantoin)
ANTICONVULSANTS
Hydantoins
Slide56ANTICONVULSANTS
Miscellaneous
Carbamazepine (Tegretol)
trigeminal neuralgia
(tic douloureux) A/E: Agranulocytosis –
S/Sx: Sore throat
MgSO4
The best tocolytic for premature labor, also
efficient as an anti-convulsant for Eclampsia or PIH.
Early side effects: decrease deep tendon reflex
and oliguria (renal failure).
Fatal/Late Side Effect: Respiratory Depression
(assess the RR if it is below 12 /min).
Valproic Acid (Depakene) therapeutic serum level:
40-100 mcg
Adverse Reaction: Hepatotoxic (assess SGPT or ALT)
Slide57Succinimides (code: suximide) Ethosuximide (Zarantoin) Methoximide (Celontin) Phensuximide (Milontin)
ANTICONVULSANTS
Slide58ANTIPSYCHOTICS
Slide59Another word: Neuroleptic / Major TranquilizersUSES: Schizophrenia, acute mania, depression and organic conditions; Non-psychiatric cases: Nausea and vomiting, pre-anesthesia, intractable hiccups.Antipsychotics can only decrease the positive symptoms of schizophrenia, but not the negative symptom such as ambivalence. Action:↓ delusion, hallucinations, looseness of association to decrease levels of dopamine in the substantia nigra
ANTIPSYCHOTICS
Slide60I. PHENOTHIAZINE Code: AZINE Fluphenazine (Prolixin)* Acetophenazine (Tindal) Pherphenazine (Trilafon) Promazine (Sparine)Chlorpromazine (Thorazine)*#1 that causes photosensitivity/photophobia; Side effects: Causes also red orange urine. In liquid form is usually put in a chaser Chaser: 60-100ml juice (prone or tomato); to prevent constipation & contact dermatitis; taken with straw (bite straw & sip)
ANTIPSYCHOTICS
Slide61MESORIDAZINE (SERENTIL) Thioridazine (Mellaril)* ceiling dose/day: 800 mg Adverse Effect: Retinitis pigmentosa Prochlorperazine (Compazine)* #1 commonly used anti emetic Trifluoperazine (Stelazine)
ANTIPSYCHOTICS
Slide62II. BUTYROPHENONES Code: PERIDOLHaloperidol (Haldol, Serenase)* #1 drug used for extreme violent behavior Instruct patient taking Haldol to wear sunscreenDroperidol (Inapsine)III. THIOXANTHENES Code: THIXENE Chlorprothixene (Taractan) Thiothixene (Navane)
ANTIPSYCHOTICS
Slide63ANTIPSYCHOTICS
IV. ATYPICAL ANTIPSYCHOTICS
Code:
DONE / ZAPINE or APINE
Olan
zapine
(Zyprexia)
Clo
zapine
(Clozaril) #1 that causes Agranulocytosis &
Blood Dyscrasia
“I will need to monitor my blood level to continue my medication.” shows a correct understanding of a patient while taking Clozaril.
Lox
apine
(Loxitane)
Risperi
done
(Risperidone) #1 drug for
Korsakoff’s psychosis
Molin
done
(Moban)
Aripiprazole (Abilify)
newest antipsychotic drug
Slide64SIX COMMON ANTICHOLINERGIC SIDE EFFECTS OF ANTIPSYCHOTICS
(Anticholinergic effects are drug actions of antipsychotic drugs because they
BLOCK MUSCARINIC CHOLINERGIC RECEPTORS
)
CODE
:
BUCO PanDan
–
anticholinergic S/Es
Slide65CODE: BUCO PanDan – anticholinergic S/Es
1.
B
lurring of Vision - ↑ sympathetic reaction (don’t operate machinery);
Mydriatic – pupil dilate
sympa
↑ IOP
don’t use in glaucoma
2.
U
rinary Retention –
Nursing Interventions:
1. Provide Privacy – give bed pan
2. Sounds of dripping water – faucet
3. Intermittent cold & warm compress
Slide66CODE: BUCO PanDan – anticholinergic S/Es
3.
C
onstipation
Nursing Interventions:
1. Prevent constipation ↑ fiber (residue) roughage,
prune
/pineapple/papaya juice/ fruits.
2. ↑ OFI
3. ↑exercise
Slide674. Orthostatic Hypotension/Postural HypotensionDifference of BP 15-20 mm Hg above the diastole after sudden changing of positionS/Sx: Pallor, dizzinessNursing consideration: Slowly change position Told patient to dangle feet first before standing
CODE: BUCO PanDan – anticholinergic S/Es
Slide685. Pan Photosensitivity (photophobia) Nursing Intervention: 1. Use sun glasses, sun block, long sleeves or/and umbrella. Patients taking antipsychotic should be instructed to wear wide brimmed hat when going outside6. Dan Dry mouth/ Xerostomia Prioritized Nursing Intervention: Give (1) ice chips, (2) chewing gum, (3) sips of water
CODE: BUCO PanDan – anticholinergic S/Es
Slide69ANTIDEPRESSANTS or THYMOLEPTICS
Slide70SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Usually the FIRST LINE of drug. RATIONALE: FEWER SIDE EFFECTS Action: Balance Serotonin – gradual effect (usually 2 weeks) Effect: 2 wks.
ANTIDEPRESSANTS or THYMOLEPTICS
Slide71Code: XETINE/ODONE Fluoxetine HCl (Prozac) – causes too much dry mouth (xerostomia) Paroxetine HCl (Paxil) Trazodone (Desyrel)) – adverse effect: Priapism (prolonged use) Nefazodone (Serzone) Fluvoxamine (Luvox) Sertraline (Zoloft) – causes GI upset (diarrhea, insomnia): always with meals Venlafaxine (Effexor) Citalopram (Celexia)
ANTIDEPRESSANTS or THYMOLEPTICS
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Slide72COMMON SIDE EFFECTS:
1. Weight Loss
2. Insomnia (single am dose)
Nursing Considerations:
1. For insomnia:
a. Induce sleep thru:
1. Warm bath (systemic effect)
2. Warm milk/banana (active substance: tryptophan)
3. Massage
b. Give meds in single AM dose
Antidepressants are best taken after meals
Slide73ANTIDEPRESSANTS or THYMOLEPTICS
II. SECOND GENERATION TRICYCLIC ANTI DEPRESSANT
Action:
Increases norepinephrine and/or serotonin levels
in CNS by blocking their uptake by presynaptic neurons or it balances Serotonin & Epinephrine levels.
Effect:
2-4 wks.
Slide74Code: PRAMINE/TRYPTILLINE Clomipramine HCl (Anaframil) #1 for OCD* Imipramine (Tofranil)* the best drug for enuresis Amitryptilline (Elavil) Protryphilline (Vivactil) Maprotilline (Ludiomil) Norpramine (Desipramine) #1 antidepressant for elderly depression. RATIONALE: Fewer anticholinergic S/E
ANTIDEPRESSANTS or THYMOLEPTICS
II. SECOND GENERATION TRICYCLIC ANTI DEPRESSANT
Slide75Code: PRAMINE/TRYPTILLINENortryptilline (Pamelor, Aventyl)Trimipramine ( Surmontil)Buproprion (Wellbutrin) 400 mg/day*(ceiling dose) EXCESS INTAKE:Grand mal seizure Doxepine (Sinequan) Amoxapine (Asendin)
ANTIDEPRESSANTS or THYMOLEPTICS
II. SECOND GENERATION TRICYCLIC ANTI DEPRESSANT
Slide76COMMON SIDE EFFECTS:
1.
Sedation (best given at night)
2. Weight gain
Nursing Consideration:
1.
Give meds at night
#1 adverse effect – cardiac dysrhythmias
#1 screening test before taking TCA – ECG
When a depressed client taking TCA shows no improvement in the symptoms, the nurse must anticipate the physician to discontinue TCA after two weeks and start on Parnate.
Nursing intervention before giving the drug includes checking the BP to assess for orthostatic hypotension.
Slide77ACTION: Psychomotor stimulator or psychic energizers; block oxidative deamination of naturally occurring monoamines (epinephrine, NOREPINEPHRINE, serotonin) → CNS stimulation Effect: 2 weeksCODE: PAMMANA Parnate (tranylcypromine) Marplan (Isocarboxacid) Mannerix (Moclobemide) *the newest MAOI Nardil (Phenelzine SO4)
ANTIDEPRESSANTS or THYMOLEPTICS
III. MAOI – MONO AMINE OXIDESE INHIBITOR
Slide78ANTIDEPRESSANTS or THYMOLEPTICS
III. MAOI – MONO AMINE OXIDESE INHIBITOR
CONTAINDICATIONS: TYRAMINE + MAOI = HYPERTENSIVE CRISIS
1. Tyramine rich-food, high in Na & cholesterol
Hypertensive Crisis
1. Aged cheese (except cottage cheese, cream cheese), Cheddar cheese and Swiss cheese are high in tyramine and should be avoided.
2. Canned foods such as sardines, soy sauce & catsup
3. Organ meats (chicken gizzard & liver) & Process foods (salami/bacon)
↑ Na
4. Red wine (alcohol)
Slide79ANTIDEPRESSANTS or THYMOLEPTICS
III. MAOI – MONO AMINE OXIDESE INHIBITOR
5. Soy sauce
6. Cheese burger
7. Banana, papaya, avocado, raisins (all over ripe fruits except apricot)
8. Yogurt, sour cream, margarine;
9. Mayonnaise
10. OTC decongestants
11. Pickled foods, Pickled herring
12. Other Foods contraindicated in MAOI therapy includes figs, bologna, chicken liver, meat tenderizer, , sausage, chocolate, licorice, yeast, sauerkrauts.
Slide80Antidote for Hypertensive Crisis: CALCIUM CHANNEL BLOCKERS (-DIPINE) 1. Verapamil (Calan) 2. Phentolamine (Regitine) also the #1drug for Pheochromocytoma (tumor in the medulla)
ANTIDEPRESSANTS or THYMOLEPTICS
III. MAOI – MONO AMINE OXIDESE INHIBITOR
Slide81ANTICOAGULANTS
Slide82CODE: PARIN, RIN Indication: to prevent clot formation. Used in MI, cardiac catheterization, pulmonary embolism.Warfarin (Coumadin)Heparin , Enoxaparin (Lovenox), Ardeparin, Dalteparin
ANTICOAGULANTS
Slide83HeparinCoumadinOnset of Action:ImmediateSlow (24-48hrs)Route of Administration:ParenteralOralDuration of Action:Short (<4hrs)Long (approximately 2-5 days)Lab Test:PTT or APTTPTAntidote:Protamine SO4Vitamin K or aquamephytonCostExpensiveInexpensive
COMPARISON OF CHARACTERISTICS OF
ANTICOAGULANT DRUGS
Slide84Action:Interferes with the hepatic synthesis of vitamin K-clotting factors (II, VII, IX, and X)Indication:Prevents or slow extension of a blood clotUndesirable Effects:Anorexia, nausea, diarrhea; rash; bleeding, hematuria, thrombocytopenia, hemorrhageWarnings:Pregnancy; hemorrhagic tendencies such as hemophilia, thromb-ocytopenia purpura, leukemia; peptic ulcer; cerebral vascular accident (CVA); severe renal. DIC, Blood dyscrasia, liver & kidney diseases
1. WARFARIN
Slide85Other Specific Information:
AVOID THE FOLLOWING !!!!
H
2 blockers ,
A
spirin
,
P
henytoin
, O
ral Hypoglycemics &
N
SAIDS ( avoid
HAPON!)
Foods: Green leafy vegetables (Vitamin K)
decrease Effectiveness (i.e. asparagus, cabbage, cauliflower, turnip greens, and other green leafy vegetables)
Drugs:
decrease Effectiveness - Phenytoin Oral contraceptives, Rifampin,Estrogen (PORE).
Increase Risk of bleeding with chamomile, garlic, ginger, ginkgo, and ginseng therapy. There are numerous interactions.
Interventions:
A Warfarin’s antidote is Vitamin K (Aquamephytoin). Laboratory test is PT
Check all drugs for potential drug-drug interactions.
Slide86Education:
Evaluation of PT/INR will be required to regulate dosage. Report any unusual bleeding. Review a diet low in vitamin K. Wear a medical identification card or jewelry. No strenuous activities (skydiving, long distance running, football). Review bleeding protocol (i.e., electronic razors, soft toothbrushes, etc.) Evaluation:PT will have a value of 1.5 to 2.5 times the control value in seconds; the INR will be 2-3. Normal PT is 9-11 seconds times 1.5 to 2.5 times the normal value.The client will have no signs or symptoms of bleeding.
Medical Alert:
Always advise other providers (i.e., dentists, surgeon, etc.) of medication.
No OTC medication without provider approval.
Slide87Action:Combines with antithrombin III to retard thrombin activity. Low molecular-weight heparin blocks factor Xa, factor IIa.Indications:ThrombosisReduces risk of myocardial infraction (MI)CVAClots associated with atrial fibrillation: pulmonary embolismUndesirable Effects:Hemorrhagic tendencies: hematuria, bleeding gums, frank hemorrhageOther Specific Informatio:Risk of bleeding with chamomile, garlic, ginger, ginkgo, and ginseng therapy.
2. HEPARIN SODIUM
Slide88Interventions
:
Monitor PTT (usually 1.5- 2.5 times control values) and platelet count.
Monitor for signs of unusual bleeding (petechiae, hematuria. GI bleeding, gum bleeding).
Initiate bleeding protocol measures (use electric razors, hold pressure for 5 minutes with venipunctures, soft toothbrushes).
Monitor IV site carefully.
Heparin has short half life, therefore, with discontinuation, PTT will usually return to baseline within 1-2 hours.
Have protamine sulfate available as an antidote.
*Monitor clotting time; normal is 8-15 minutes; maintain
clotting time 15-20 minutes
Slide89Education
:
Inject SQ into the abdomen with 25-28g at 90 degrees
angle; don’t aspirate or rub injection site
Explain bleeding protocol precautions.
Explain the need of several PTT evaluation.
Teach signs of unusual bleeding.
Avoid activities with risk of injury.
Caution with sharp utensils while cooking or eating.
Avoid salicylates or any OTC medication without approval from provider.
Wear identification that notes anticoagulant therapy.
Inform provider of therapy prior to surgical procedure.
Slide90Evaluation
:
Heparin’s antidote is Protamine Sulfate. Laboratory test is aPTT.
Normal PTT is 60-70 seconds
Normal aPTT is 20-36 seconds times 1.5 to 2.5 times the normal value.
Drugs
:
Heparin Sodium (Hyperlin)
Low Molecular Weight Heparins: Ardeparin (Normiflo); Dalteparin (Frafmin); Danaparoid (Organ); Enoxaparin (Lovenox)
Slide91THROMBOLYTIC MEDICINES
CODE:
ASE / KINASE
Example:
Altepl
ase
/ Uro
kinase
/ Strepto
kinase
/ Retepl
ase
/ Retav
ase
Saltepl
ase
(
Acti
v
ase
,
t-PA tissue plasminogen activator);
Abbo
kinase
, Strep
t
ase
, Kabi
kinase
)
Slide92Action:Binds with plasminogen causing conversion to plasmin which dissolves blood clots. Activates plasminogen which generates plasmin .The best drug to DISSOLVE clot , such as pulmonary embolism & myocardial infarctionIndications:Dissolves blood clots due to coronary artery thrombi, deep vein thrombosis, and pulmonary embolism.. Used 4-6 hrs after MI to restore blood flow, limit myocardial damage, and preserve left ventricular function.
THROMBOLYTIC MEDICINES
Slide93THROMBOLYTIC MEDICINES
Warnings:
Active internal bleeding; recent CVA; aneurysm, hypertension; anticoagulant therapy; ulcerative colitis.
Severe allergic reactions to either anistreplase or streptokinase.
Other
Specific
Information:
Monitor for bleeding, hypotension & tachycardia
.Handle clients minimally & let clients use electric razors & brush teeth gently.
Effects of drug disappear within a few hours after discontinuing but the systemic effect of coagulation and the risk of bleeding may persist for 24 hours.
Increase in risk for bleeding with heparin, oral anticoagulants, antiplatelet drugs and NSAIDs.
Slide94Interventions:Apply direct pressure over a puncture site for 20 – 30 minutesMonitor CBC especially hgb/hct, coagulation tests. Evaluate bleeding at a sutured wound, arterial site, central line. Monitor vital signs during and after infusion. Monitor EKG for re-perfusion dysrhythmias. Watch for unusual bleeding disturbance (GI, GU) Initiate bleeding protocol measures for several hours (e.g., no venipunctures, repetitive manual blood pressure, or removal of IV lines or catheters).Antidote:Aminocaproic Acid (Amicar)
THROMBOLYTIC MEDICINES
Slide95Action:Platelet aggregation inhibitor; inhibitis platelet synthesis of thromboxane A2, a vasoconstrictor and inducer of platelet aggregation. This occurs at low doses and lasts for 8 days (life of the platelet).Indications:TIAs, CVAs with a history of TIA due to fibrin platelet emboli. Reduces risk of death from MI in clients with a history of infarction or unstable angina. Warnings:Allergy to salicylates or NSAIDs. Bleeding disorders, renal or hepatic disorders, chickenpox, influenza (risk of Reye’s in syndrome in children), pregnancy, lactation.
ANTIPLATELET: ASPIRIN
Slide96Warnings:Allergy to salicylates or NSAIDs. Bleeding disorders, renal or hepatic disorders, chickenpox, influenza (risk of Reye’s in syndrome in children), pregnancy, lactation.Undesirable Effects:GI discomfort, bleeding, dizziness, tinnitusOther Specific Information: Risk of bleeding with anticoagulants, thrombolytics Risk of GI ulceration with alcohol, NSAIDs, phenylbutazone, steroids.
ANTIPLATELET: ASPIRIN
Slide97Interventions:Monitor liver and renal function tests, CBC, clotting times, stool guaiac, blood drug levels, and vital signs.Education:Instruct to take drug with food and a full glass of water. Do not crush and do not chew sustained-release preparations. Drugs:COMMON DRUGS: Code: D CATDipyridamole(persantine)Clopidogrel(plavix)Aspirin(ASA) Ticlopidine(Ticlid)Aspirin (Bayer, Bufferin, Ecotrin)Other antiplatelet drugs are listed below, however, there are numerous differences between each drug : Abciximab (Reopro); Cilostazol (Pletal); Eptifibatide (Integrilin); Sulinpyrazone (Anturane); Tirofiban (Aggrastat)
ANTIPLATELET: ASPIRIN
Slide98CARDIOVASCULAR DRUGS
Slide99CARDIOVASCULAR DRUGS
ANTIHYPERTENSIVES
CODE NAME: AAABCCD (short cut for anti-hypertensive)
A
ngiotensin Converting Enzyme Inhibitor or Antagonist
(ACE Inhibitor)
A
ngiotensin II Receptor Blocker (ARBS)
A
lpha Adrenergic Blockers
B
eta Adrenergic Blockers
C
alcium Channel Blockers
C
entral Acting Sympatholytics /Adrenergic Blockers
D
irect Acting Vasodilators
Angiotensin Converting Enzyme Inhibitor or Antagonist
(ACE Inhibitor)
Slide100Angiotensin Converting Enzyme Inhibitor or Antagonist (ACE Inhibitor)
ACTION:
prevent vasoconstriction by blocking angiotensin 1 to angiotensin 2
USE:
hypertension, adjunctive therapy in CHF, PREVENTS SEVERE HEART FAILURE following
M.I. in clients with
IMPAIRED LEFT VENTRICULAR FUNCTION
and prevents kidney failure in Type 2 Diabetes.
Slide101EXAMPLES:
Captopril (Capoten)
ONE HOUR BEFORE MEALS
Enalapril (Vasotec)
Ramipril (Altace)
Side Effects:
CHIT – B
C:
cough persistent
H:
Hyperkalemia and Hypoglycemia
I:
Impotence and Insomnia
T:
Taste decreases
B:
Bleeding
Slide102Angiotensin II Receptor Blocker (ARBS)
ACTION:
blocks the
binding
of angiotensin II to the Angiotensin 1 , and also blocks the release of aldosterone resulting in a decrease BP.
USE:
Hypertension
Code:
SARTAN
Examples: Lo
sartan
(Cozaar)
Epro
sartan
(Teveten)
Cande
sartan
(Atacand)
Side Effects:
Upper Respiratory Infection (cough); Diarrhea
Adverse Effect:
Nephrotoxic / Hepatotoxic
Slide103ALPHA ADRENERGIC BLOCKERS
ACTION:
blocks the alpha 1 adrenergic receptors resulting in vasodilation of arteries and veins, decreases peripheral resistance and relaxes smooth muscle of bladder and prostate.
USE:
Hypertension, Prazocin used in CHF and Doxazocin used in BPH.
Code:
ZOCIN
Examples:
Doxa
zocin
(Cardura)
Pra
zocin
(Minipress)
Tera
zocin
(Hytrin)
Slide104ALPHA ADRENERGIC BLOCKERS
SIDE EFFECTS:
SI – DUD
Syncope
Impotence
Depression
Urination
Dry mouth
ADVERSE EFFECTS:
Nephrotoxicity
Slide105ACTION: binds to beta 1 (cardiac) and beta 2 (lungs) adrenergic receptors sites that prevents the release of catecholamine. USE: Angina, Hypertension, anxiety disorders, as a Group II anti dysrhythmias CODE: OLOL
BETA ADRENERGIC BLOCKERS
Slide106BETA ADRENERGIC BLOCKERS
SIDE EFFECTS:
P - BBNDAH
Psychotic Features
Bradycardia
Bronchoconstriction
Nightmares
Depression
Agranulocytosis
Hypoglycemia
NEVER USED IN PATIENTS WITH COPD, CVA, CHF, HEPATIC DISEASE, GRAVES, and BRADYCARDIA
Slide107ACTION: Decrease contractility (negative inotropic effect by relaxing the smooth muscle) and the workload of the heart thus decreasing the need for oxygen. It also causes coronary and peripheral vasodilation. USE: Group IV antidysrythmia, vasodilator and anti hypertensive drug.
CALCIUM CHANNEL BLOCKERS
Slide108CODE: DIPINE except Verapamil (Calan) and Diltiazem (Cardizem)SIDE EFFECTS: CAP Constipation AV block (therefore never give it to patients with CHF) Peripheral EdemaADVERSE EFFECTS: Hepatotoxic and Nephrotoxic
CALCIUM CHANNEL BLOCKERS
Slide109CENTRAL ACTING SYMPTHOLYTICS / ADNEGERNIC BLOCKERS
ACTION:
Decreases the release of adrenergic hormones from the brain resulting in decrease peripheral vascular resistance and blood pressure.
MC G
Methyldopa (Aldomet)
Clonidine (Catapress)
Guanabenz (Wytensin)
Slide110SIDE EFFECTS: DIES Depression Impotence Edema (if more than 4 lbs/week) Sodium & Water retentionADVERSE EFFECT: Hepatotoxic
CENTRAL ACTING SYMPTHOLYTICS / ADNEGERNIC BLOCKERS
Slide111ACTION: uses arterial vasodilatationNitroglycerin causes DECREASE LAV M DECREASE Left Ventricular Workload DECREASE Arterial BP DECREASE Venous return DECREASE Myocardial O2 Consumption
D
IRECT
A
CTING
V
ASODILATORS
Slide112DIRECT ACTING VASODILATORS
SIDE EFFECTS:
HEN G
Headaches (orthostatic Hypotension)
Edema
Nasal Congestion
GI Bleeding
Examples:
D MANN
Diazoxide (Hyperstat)
Minoxidil (Lomiten)
Apresoline (Hydralazine)
Nitropruside (Nipride)
Slide113NITROGLYCERIN (Nitrobid, Nitrostat)
Action:
Relaxes the vascular smooth system.
↓
Myocardial demand for oxygen.
↓
Left ventricular preload by dilating veins thus indirectly
↓
afterload.
Undesirable Effects:
Headache (most common), hypotension, postural hypotension, syncope, dizziness, weakness, reflex tachycardia, paradoxical bradycardia.
Sublingual: burning, tingling sensation in mouth.
Ointment erythematous, vesicular and pruritic lesions.
Slide114NITROGLYCERIN (Nitrobid, Nitrostat)
Interventions
:
Record characteristics and precipitating factors of anginal pain.
Monitor BP and apical pulse before administration and periodically after dose.
Have client sit or lie down if taking drug for the first time.
Client must have continuing EKG monitoring for IV administration.
Cardioverter / defibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the Transderm-Nitro patch (may cause burns on client).
Assist with ambulating if dizzy.
Slide115Education:Avoid alcohol. Teach to recognize symptoms of hypotension. Advise to make position changes slowly and to avoid prolonged standing. Teach about the form of nitroglycerin prescribed. Oral: Instruct to take on an empty stomach with a full glass of water. Do not chew tablet Sublingual: Instruct to take at first sign of anginal pain. May be repeated every 5 minutes to a maximum of 3 doses. If the client doesn’t experience relief, advise to seek medical assistance immediately. A stinging or biting sensation may indicate the tablet is fresh. With newer SL nitroglycerin, the biting sensation may not be present. Protect drug from light moisture, and heat. Instruct to apply Transderm-Nitro patch once a day, usually in the morning. Rotation of sites is necessary.
NITROGLYCERIN (Nitrobid, Nitrostat)
Slide116Drugs:Nitroglycerin intravenous (Nitro-Bid IV, Tridil)Sublingual (Nitrostat)Sustained-release (Nitroglyn, Nitrong, Nitro-Time)Topical (Nitro-Bid, Nitrol, Nitrong, Nitrostat)Transdermal (Deponit, Minitran, Nitro-Dur, Nitrodisc, Transderm-Nitro, Nitro-Derm)Translingual (Nitrolingual)Transmucosal (Nitrogard)
NITROGLYCERIN (Nitrobid, Nitrostat)
Slide117CARDIAC GLYCOSIDES
Code:
Dig
Example:
Digoxin (lanoxin)
Digitoxin (Crystodigin)
Slide118Action:Inhibits the sodium-potassium ATPase, resulting in cardiac construction.Effect: Positive Inotropic (increase Contraction of the heart) Negative Chronotropic (slows Cardiac rate- depresses SA node- bradycardia) Negative Dromotropic (slows conduction velocity)Indication:THE BEST DRUG OF CHOICE FOR CHF for CHF, atrial tachycardia, atrial fibrillation & atrial flutter.
CARDIAC GLYCOSIDES
Slide119Side Effects:1st / Initial: Nausea & Vomiting(adult) Confusion(elderly)2nd: Bradycardia3rd: Hypokalemia (highest in K rich food is apricot and avocado, next is potato and raisins)Adverse Rxn/ Late: Yellow & Green VisionSpecial Consideration: Never give with FOOD. Check the pulse before & after giving. Compare the apical and the radial pulse in a FULL minute. Check the therapeutic serum level which is .5- 2 ng/mlContraindicated: MI, heart blocks & PVC
CARDIAC GLYCOSIDES
Slide120OtherSignificantInformation:↓ K; ↓ Mg”, and ↑ Ca “may be associated with digitalis toxicity. Administer separately from antacids (1 to 2 hours apart). Use cautiously with calcium channel blockers or beta blockers. Interventions:Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 ng/ml. toxity is > 2.0 ng/mL). Before each dose, assess apical pulse for full minute; record and report changes in rate or rhythm. Withhold drug and contact provider if pulse is < 60/minute or > 100 (adults) or <1 10 minute (children) unless provider has outlined specific parameters. Weigh daily, monitor I O, and signs has CHF.
CARDIAC GLYCOSIDES
Slide121Education:Teach to take pulse correctly and report if pulse is out of parameter. Weigh every other day and record. Restrict alcohol, sodium and smoking. Eat food rich in potassium. Wear medical alert tag. Emphasize importance of regular checkups.Evaluation:Normal sinus rhythm on ECG. Clinical improvement as evidenced by no S3, edema, etc. Cardiomegaly decreased.AntidoteAntidote: Digibind Fab
CARDIAC GLYCOSIDES
Slide122ANTIHYPERTENSIVE
Slide123STEP 1. Diuretic (1st step for younger clients with tachycardia and marked liability of BP)STEP 2. Beta-Blocking Agent Beta 1 Adrenergic (Cardioselective) Blocking Agents: Acetabulol (Sectral); Atenolol (Tenormin); Metoprolol (Betaloc) Beta 1 and 2 (Nonselective) Blocking Agents: Nadolol (Corgard), Pindolol (Visken), Propranolol (Inderal, Novopranol), Timolol Adrenergic Inhibiting Agent Clonidine, Methyldopa, Reserpine, Prazoline Usually diuretic added to prevent fluid retentionSTEP 3. Vasodilator Agent Hydralazine Added with adrenergic blocking agent and diuretic decrease workloadSTEP 4. Guanethedine, Minoxidil or Angiotensin Inhibitors Captopril or Analapril
ANTIHYPERTENSIVE
Slide124ANTIDYSRHYTHMIC
Slide125GROUP 1 - Generally inhibit the fast sodium channel in cardiac muscle resulting in an increased refractory periodDisopyramide phosphate (Norpace); Procainimide HCl (Procan); Quinidine (Quinidex)Lidocaine (Xylocaine)Flecainide
ANTIDYSRHYTHMIC
Slide126GROUP 2-Beta blockers that decrease stimulation of the heartBeta 1 Selective AntagonistsCardiogenic Blockers; Block Beta 1 cardiac receptorsAtelonol (Ternonim), Acebutolol Sectral, Metoprolol (Betaloc)Beta 2 Selective AntagonistsMucolytics and BronchodilatorsNonseletive Beta Adrenergic Blocking Agents; (Beta 1 and Beta 2 Blockers) Nadolol (Corgard); Oxyprenelol (Trasicor); Pindolol (Visken); Propranolol (Inderal); Timolol
ANTIDYSRHYTHMIC
Slide127Group 3 - Generally do not affect depolarization but work by prolonging cardiac repolarizationAnti adrenergic; Positive inotropic actionBretylium, Amiodarone HCl (Cordarone)Group 4Calcium antagonist action - Depression of heart and smooth muscle contraction, decreased atomaticity and decreased conduction velocityVerapamil
ANTIDYSRHYTHMIC
Slide128RESPIRATORY AGENTS
Slide129Respiratory Agents
BRONCHODILATORS
a. Breathing and Coughing Techniques:
This will facilitate the removal of respiratory secretions and optimize oxygen exchange.
b. Relation Techniques:
Since anxiety may result in respiratory difficulty, review ways to alleviate anxiety such as music and relaxation techniques.
c. Evaluate Heart Rate and BP:
Teach client to monitor heart rate and BP since an undesirable effect of these medications may be tachycardia, cardiac arrthymias, and a change in blood pressure. (Beta2, Adrenergic Agonists can cause hypertension; methylxanthines can cause hypotension at theophylline levels > 30-35 mcg/ml.)
Slide130d. Arm Identification: Recommend clients having asthmatic attacks to wear an ID bracelet or tag.e. Tremors: Evaluate client for tremors from these medications. Have 8 or more glasses of fluids. Fluid will assist in decreasing the viscosity of the respiratory secretions.f. Emphasize No Smoking: Encourage the client to stop smoking under medical supervision.
Respiratory Agents
BRONCHODILATORS
Slide131Respiratory Agents
2. ANTIHISTAMINES
CODE: tadine, amine, ramine
Action:
Blocks histamine at H, receptors
Indications:
Upper respiratory allergic disorders, anaphylactic reactions; blood transfusion reactions; acute urticaria; motion sickness.
Warnings:
Allergies, acute asthmatic attack, respiratory disease, hepatic disorder, narrow-angle glaucoma, symptomatic prostatic hypertrophy, pregnancy, lactation.
Side Effects:
CODE:
BUCO PD
B
lurring of Vision,
U
rinary Retention,
C
onstipation,
O
rthostatic
H
ypotension,
P
hotosensitivity &
D
ry Mouth
Slide132Interventions:Monitor vital signs, intake and output. If secretions are thick, use a humidifier.Education:Instruct client to take with food; drink minimum of 8 glasses of fluid per day. Advise to do frequent mouth care; may use sugarless gum, lozenges, or candy. Notify provider if confusion or other undesirable effects occur. Instruct client not to drive or operate machinery if drowsiness occurs or until response to drug has been determined. For prophylaxis of motion sickness, recommend taking 30-60 minutes before traveling. Avoid alcohol and other CNS depressants.
Respiratory Agents
2. ANTIHISTAMINES
Slide133Drugs:Loratadine, Azatadine, Cyproheptadine, Cyproheptadine (Periactin), Diphenhydramine, Chlorpheniramine, Dexchlorpheniramine (Polaramine), Doxylamine, Phenylpropanolamine, BrompheniramineOthers: Azelastine (Astelin); Buclizine (Bucladin-S); Cetirizine (Zyrtec); Clemastine (Tavist); Cyclizine (Mazerine); Dimenhydrinate (Dramamine); Fexofenadine (Allegra); Hydroxyzine (Atarax, Vistaril); Loratidine (Claritin); Meclizine (Antivert); Promethazine (Phenergan); Tripelen-namine (PBZ)
Respiratory Agents
2. ANTIHISTAMINES
Slide134Respiratory Agents
3. BRONCHODILATOR
CODE: terol, terenol, phrine, phylline
Action:
Stimulates beta receptors in lung. Relaxes bronchial smooth muscle.
Increases vital capacity, decreases airway resistance.
Indications:
the best drug for COPD or CAL (chronic airflow limitation)
Asthma, bronchitis, emphysema, relief of bronchospasm occurring during anesthesia, exercised-induced bronchospasm.
Warnings:
Hypersensitivity, angina, tachycardia,
cardiac arrhythmias
, hypertension, cardiac disease,
narrow-angle glaucoma,
hepatic disease.
Slide135Side effects:Sympathetic Side Effects such as palpitation, tachycardia, restlessness, nervousness, Hyperglycemia, hypertension, cardiac dysrhythmias.Caution with clients with glaucoma & HPNOtherSpecific Information:Special Consideration: Avoid Uppers- caffeine, cola & tea. Be careful in giving bronchodilators with DIABETES (hypoglycemia). Remember that the therapeutic serum level of theophylline is 10-20mcg/ml. Theophylline when given intravenously should be given SLOWLY. If not sympathetic reactions will occur.
Respiratory Agents
3. BRONCHODILATOR
Slide136Interventions:Check for cardiac dysrhythmias.Education:Notify provider taking other medicines or if symptoms are not relieved. Watch our for status asthmaticus.Demonstrate correct use of inhalers or nebulizers. Teach about metered-dose inhalers (MDI). When two puffs are needed, 1-3 minutes should lapse between two puffs. A spacer may be used to increase the delivery of the medication. Always prioritized using FIRST the bronchodilator before using steroids or another drug such as a mucolytic.* Avoid caffeine products Drugs: Albuterol, Isoproterenol, Formoterol, Bitolterol, Levalbuterol, Epinephrine, Aminophylline,Theophylline, Oxtriphylline
Respiratory Agents
3. BRONCHODILATOR
Slide137Respiratory Agents
4. STEROIDS
CODE: sone, one, solone
Action:
Synthesized by adrenal cortex.
Exhibits antiinflamatory properties suppress the normal immune response.
Increases carbohydrate, fat and protein metabolism.
Indications:
Adrenal replacement therapy, immunosuppressant
and increases fat & carbohydrate metabolism
Antiinflammatory, immunosuppressant dermatological disorders
Replacement in adrenal cortical insufficiency.
Slide138Undesirable Effects:Code name: GO CHAT!!!G.I. upset, Osteoporosis, Cushing like symptoms & Calcium is decrease, High glucose & Sodium, Addisonian Crisis (if abruptly withdrawn) , Tachycardia .Initial Side Effect: HyperglycemiaLate Side Effect: ImmunocompromisedOther Specific Information: Always with food may cause Peptic Ulcer, monitor BP for Hypertension, do not abruptly discontinue the drug ,may cause Addisonian Crisis, Moon Face, Cushing like SymptomsInterventions:Monitor VS, BP, weight, blood glucose, electrolytes, EKG, and TB skin test results.
Respiratory Agents
4. STEROIDS
Slide139Education:Special Considerations: Always With Food. Gradually Taper. Do not receive vaccination .High Calcium diet & Vitamin D. Steroids mask the symptoms of Infection. Avoid Potassium wasting diuretics – it increases HYPOKALEMIA. Anticoagulants decrease the effects of Steroids.Instruct to administer oral drugs with food or milk early in the morning, withdraw medication slowly or taper off gradually under medical supervision. Follow-up visits and lab tests are essential. Avoid infection. Wounds may heal slowly. Do not receive vaccination. Do not take aspirin or any medication without consulting provider. Discuss a diet low in sodium, high in vitamin D, protein and potassium. Avoid sun light on treated area. Recommend wearing a medical alert tag.
Respiratory Agents
4. STEROIDS
Slide140Drugs: CODE: SONE, ONE, SOLONECommon Medications: (Baby) Bethamethasone (Celestone) usually given to premature infants, to increase Lung maturity), Dexamethasone (Decadron), Prednisone(Deltasone), Hydrocortisone (Solu-cortef), Prednisolone (Prelone), Triamcinolone (Azmacort, Kenalog, Nasacort-O)Topical: Alclometasone (Acolvate); Amcinonide (Cylocort); Clobetasol (Ternovate); Cortisone (Cortone-O); Desoride (Tridesilone); Desoximetasone (Topicort); IM, IV, OP, IN, IH); Fluocinolone (Synalar, Synemol); Flurandrenolide (Cordran); Fluocasone (Cutivate, Flonase-IN); Halcmonide (Halog); Halobetasol (Ultravate); Hydrocortisone (Cort-Dome, Cortef, Hydrocortone, Solu-Cortef – mO, IM, IV, SubQ, R); Mometasone (Elocon); ; Prednicarbate (Dermatop); Inhalation, intranasal: Beclomethasone (Beclovent, Vanceril, Benconase, Vancenase); Budesonide (Rhinocort-IN only); Flunisolide (Aerobid, Nasalide);; Oral; Fludrocortisone (Florinef); Methylprednisolone (Medrol, Solu-Medrol – IM, IV); Prednisolone (Delta-Cortef, Hydeltra, Hydeltrasol – IM, IV, Il, IA); Prednisone (Deltasone, Meticorten, Orasone). Ophthalmic: Fluorometholone (FML); Nmexolone (Vexol).
Respiratory Agents
4. STEROIDS
Slide141GIT MEDICINES
Slide142GIT Medicines
1. ANTACIDS AND MUCOSAL PROTECTIVES
react with gastric acid to produce neutral salts or salts of low acidity
inactivate pepsin and enhance mucosal protection but do not coat ulcer to protect from acid & pepsin
used for patients with PUD & GRF (gastroesophageal reflex disease)
antacid tablets should be chewed and followed with glass of H2O or milk
administer 1 hour – 2 hours apart from other meds to minimize the chance of drug interactions
Slide143GIT Medicines
1. ANTACIDS AND MUCOSAL PROTECTIVES
Sucralfate (Carafate)
CODE:
Sucralfate (S for STOMACH EMPTY!)Carafate (CONSTIPATION IS THE SIDE EFFECT!)
creates a protective barrier against acid & pepsin
given po & on an empty stomach
A/R
: constipation
, impede absorption of warfarin Na,phenytoin, theophylline, digoxin & some antibiotics…
Administer 2 hours apart from these meds
Slide144GIT Medicines
1. ANTACIDS AND MUCOSAL PROTECTIVES
Magnesium Hydroxide (Milk of Magnesia)
rapid acting & A/R is
diarrhea
usually combined with aluminum hydroxide to counter diarrhea
Slide145slow acting & A/R: constipationwith significant Na content…caution in clients with HPN & Heart failure; reduce effect of tetracyclines, warfarin Na & digoxinreduce phosphate absorption (USED IN CRF- Chronic Renal Failure)
GIT Medicines
1. ANTACIDS AND MUCOSAL PROTECTIVES
Alumni Hydroxide (Amphoiel, Alu-Cap)
Slide146rapid onsetA/R: liberates CO2 & increases intra-abdominal pressure causing flatulence, caution in clients with HPN & heart failure, systemic alkalosis in clients with renal failure
GIT Medicines
1. ANTACIDS AND MUCOSAL PROTECTIVES
Sodium Bicarbonate
rapid acting & A/R:
constipation
Calcium Carbonate (Tums)
Slide147GIT Medicines
2. H
2 BLOCKERS
suppress secretion of gastric acid
indicated for PUD & heart burn & for GRF ( gastro esophageal reflux disease)
CODE: TIDINE
Cime
tidine
(Tagamet)
Rani
t
idine
(Zantac)
Famo
tidine
(Pepcid)
Slide148GIT Medicines
cimetidine (Tagamet)
*taken on an empty stomach*administered 1 hour apart from antacids*crosses the blood-brain barrier & may cause mental confusion, agitation, anxiety & disorientation*dosages of these meds are reduced when taken together: warfarin Na, phenytoin, theophyllin & lidocaine
ranitidine (Zantac)*not affected by food*S/E are uncommon & does not cross blood-brain barrier
2. H
2
BLOCKERS
Slide149*used to supplement pancreatic enzymes*taken with meals or snacks*interacts with calcium carbonate & magnesium hydroxide
GIT Medicines
3. PANCREATIC ENZYME REPLACEMENT
CODE:
PREFIX is PANCREA
Pancreatin (Creon)
Pancrelipase (Cotazym, Viokase, Pancrease)
Slide150GIT Medicines
4. MEDICINES FOR HEPATIC
ENCEHALOPATHY
LACTULOSE (CEPHULAC)*reduces the ammonia level*given p.o. in the form of a syrup*improves CHON tolerance in clients with advanced liver cirrhosis*lowers colonic pH from 7 to 5; acidification pulls ammonia into the bowel to be excreted in the feces thus decreasing the ammonia level
NEOMYCIN (MYCIFRADIN)
*reduces the number of colonic bacteria that normally convert urea & amino acids into ammonia
*given p.o. or via NGT
*
used with caution in clients with kidney impairment
Slide151GIT Medicines
5. LAXATIVES
BULK FORMING LAXATIVES
psyllium hydrophillic mucilloid (Metamucil)
*absorbs water into the feces & increase bulk to form large and soft stools
*C/I bowel obstruction
*A/R: dehydration, electrolyte imbalance & dependent
STOOL SOFTENERS
docusate calcium (Surfak), docusate sodium (Colace)
*inhibit the absorption of H2O so fecal mass remains large & soft
*
used to avoid straining
*Commonly used in CVA, MI, post op head surgeries, glaucoma and post op eye injuries so as
to decrease straining and chances of complications.
Slide152LUBRICANTSMineral oil*soften stools, ease strain of passing stools; lessen the rritation of hemorrhoids*interferes with absorption of fat-soluble vitamins A, D, E, K*Never use in pregnant women, may trigger premature labor
GIT Medicines
5. LAXATIVES
Slide153GIT Medicines
6. STIMULANTS CATHARTICS
biscodyl (Dulcolax
):
give 1 hour before/after antacids & milk cascara
(Castor Oil):
effect 2-6 hours;
give with juice
*stimulate motility of large intestine
SALINE CATHARTICS
Glycerin suppositories (Senokot); Mg hydroxide
*Attract H2O to large intestine to produce bulk, stimulate peristalsis & effect begins in 2-6 hours