NUR 434V - Med list For CoA- common medications drug list

Med list For CoA- common medications drug list

Acetaminophen (Tylenol)

Adult dose: The FDA limits total daily doses to 4000 mg; however the manufacturer of Tylenol suggests a limit of 3000mg per day pts with liver disease or chronic alcohol consumption are advised not to exceed 2000mg per day.
Class: Nonopioid analgesics
MOA: It blocks peripheral pain impulses by inhibition of prostaglandin synthesis Also lowers febrile body temperatures by acting on the hypothalamus, the structure in the brain that regulates body temperature.
Major side effects: blood disorders or dyscrasias (anemia’s), and nephrotoxicity’s, and hepatotoxicity’s (most serious), more common: skin disorders, N/V
Nursing considerations: allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, and lactation. Skin color, lesions.
Therapeutic monitoring: CBC, renal function and trough levels

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Acetaminophen/Hydrocodone (Vicodin)

Adult dose: 325mg/2.5mg, 300mg/5mg
Class: Analgesics, Opioid combo
MOA: Acetaminophen- Acts on the hypothalamus to produce antipyresis; inhibits prostaglandin synthesis
Hydrocodone- Opioid analgesic agonist; blocks pain perception in the cerebral cortex; decreases synaptic chemical transmission throughout the CNS, which in turn inhibits pain sensation into higher centers
Major side effects: Hallucinations, bradycardia, confusion, dizziness, drowsiness, fatigue
Nursing considerations: Black box warning for addiction, abuse, and misuse. Long acting hydrocodone exposes pts and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death
Therapeutic effect: HR, CBC, renal and kidney function

Amlodipine (370)

Adult dose: 5-10mg a day
Class: Calcium Channel Blocker
MOA: Calcium plays a major role in excitation-contraction of the heart/smooth/skeletal muscles. When blocked this causes relaxation of the muscles and therefore causes coronary arteries to dilate this increases blood flow to the ischemic heart, which in turn increases oxygen supply an helps shift demand ratio back to normal.
Major side effects: Hypotension, palpitations, tachycardia/bradycardia, constipation, nausea, dyspnea, rash, flushing, peripheral edema
Nursing considerations: contraindicated with grapefruit juice also a Look like sound alike drug
Therapeutic monitoring: moniter bp at baseline and then periodically

Ampicillin (608)

Adult dose: 1-12g/day divided every 4-6 hours
Class: Aminopenicillin (antibiotic)
MOA: Involves the inhibition of bacterial cell wall synthesis. Once distributed by the pts bloodstream to infected areas, penicillin molecules slide through bacterial cell walls to get to their site of action. Some are too large to pass through openings. Some bacteria make the openings to their cell walls small so penicillin can’t get through to kill them. Once they do get through they bind to appropriate sites (penicillin-binding proteins). The molecules then interfere with normal cell wall synthesis, causing formation if defective cell walls that are unstable and easily broken down.
Major side effects: Anaphylaxis, C. difficile colitis, erythema multiform (Steven Johnson syndrome- life threatening skin reaction), N/V, thrush, yeast infection, rash, eosinophilia
Nursing considerations: Many pts have a drug allergy to this medication and it is important to figure out the type of reaction the pts experience to this medication
Therapeutic monitoring: CBC and renal function

Aspirin (420)

Adult dose: 81-325mg once daily
Class: antiplatelet
MOA: Aspirin inhibits cyclooxygenase in the platelet irreversibly so that the platelet cannot regenerate this enzyme. Therefore, the effects of aspirin last the lifespan of a platelet (7 days). This irreversible inhibition of cyclooxygenase in the platelet prevents the formation of TXA2, a substance that causes blood vessels to constrict and platelets to aggregate. Thus, by preventing TXA2 formation, aspirin prevents these actions, which results in the dilation of the blood vessels and prevention of platelets from aggregating or forming a clot.
Major side effects: Drowsiness, dizziness, confusion, flushing, N/V, gastrointestinal bleeding, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, bleeding
Nursing considerations: Do not give to pts with thrombocytopenia, leukemia, active bleeding, traumatic injury GI ulcer, vitamin K deficiency or any pt who has had a recent stroke.
Therapeutic monitoring: CBC, renal and liver function as well as ototoxicity

Atorvastatin (442) statin

Adult dose: 10-80mg/day
Class: Antilipemic- HMG-COA reductase inhibitors
MOA: Lower the blood cholesterol level by decreasing the rate of cholesterol production. The liver requires HMG-CoA reductase to produce cholesterol. The statins inhibit this enzyme, thereby decreasing cholesterol. The statins inhibit this enzyme thereby decreasing cholesterol production. When less cholesterol is produced, the liver increases the number of LDL receptors to recycle LDL from the circulation back into the liver where it is needed for the synthesis of other required substances such as steroids, bile acids, and cell membranes.
Major Side Effects: mumyopathy (muscle pain), rhabdomyolysis (breakdown of muscle protein), myoglobinuria (urinary elimination of the muscle protein myoglobin), renal failure, death, headache, dizziness, blurred vision, fatigue, constipation, diarrhea, skin rashes.
Nursing considerations: pregnancy category X drug. Once a day doses usually with the evening meal or at bedtime.
Therapeutic monitoring: cholesterol and triglyceride levels as well as liver function

Carvedilol (315)

Adult dose: 6.25- 100mg/day
Class: Adrenergic blocking- Beta Blocker
MOA: Block SNS stimulation of the beta-adrenergic receptors by competing with norepi and epi. It has many effects including acting as a non selective beta blocker, an alpha1 blocker, a calcium channel blocker and even an antioxidant. Used primarily in the treatment of heart failure but also beneficial for hypertension and angina.
Major side effects: MI, rebound hypertension, chest pain, irregular heart beat, difficulty breathing/swallowing, and fainting.
Nursing considerations: do not suddenly discontinue medication. Stand up slowly from sitting or lying
Therapeutic monitoring: BP, HR, kidney function

Chlordiazepoxide (253)

Adult dose: 5-10mg (mild-moderate pain) 20-25 for severe anxiety
Class: Benzodiazepine- Anxiolytic
MOA: Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through the GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane
Major side Effects: Memory impairment, muscle weakness, drowsiness, ataxia, sedation, confusion, dizziness
Nursing considerations: Black box warning- concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation
Therapeutic Effects: BP, HR

Ciprofloxacin (628)

Adult dose: PO-250-750mg every 12 hr. IV- 200-400mg every 8-12 hr. IV/PO- 250-750 mg once daily
Class: Antibiotic- Fluoroquinolone
MOA: Destroy bacteria by altering their DNA. First broad coverage, potent quinolones to become available. Capable of killing a wide range of gram-negative bacteria. Can kill some anaerobic bacteria as well as atypical organisms such as chlamydia, mycoplasma, and mycobacterium. Also drug of choice for the tx of anthrax.
Major side effects: bacteria overgrowth, prolongation of QT intervals, pins and needles
Nursing considerations: Black box warning for increased tendinitis and tendon rupture with use. Can cause peripheral neuropathy, avoid milk produces and antiacids
Therapeutic monitoring: Liver function, CBC, and renal function

Clopidogrel (420) Plavix

Adult dose: 75mg once daily
Class: coagulation modifier (ADP Inhibitor)- Antiplatelet
MOA: It works by altering the platelet membrane so that it can no longer receive the signal to aggravate to form a clot. This signal is in the form of fibrinogen molecules, which attach to glycoprotein receptors on the surface of the platelet. Clopidogrel inhibits the activation of this receptor.
Major side effects: chest pain, edema, flu like symptoms, abdominal pain, headache, dizziness, serious bleeding episode.
Nursing considerations: It must be avoided in patients taking more than 100mg of aspirin daily, It is indicated in pts with acute coronary syndrome. Do not suddenly discontinue. Bruising or bleeding is more common.
Therapeutic monitoring: CBC, liver and kidney function,

Dextrose 5% (500/877)

Adult dose: IV- 10-25 g. PO- 4-20g as a single dose
Class:
MOA: Parenteral dextrose is oxidized to carbon dioxide and water, and provides 3.4 cal/g of d-glucose
Major side effects: Hyperosmolality, edema, venous thrombosis, and fever
Nursing considerations: Use with caution in pts with DM
Therapeutic monitoring: glucose levels, monitor electrolytes

Docusate Sodium (Colace) (821)

Adult dose: 50-300mg/day
Class: Laxitives- Fecal softner, emollient laxative
MOA: Lower the surface tension of GI fluids, so that more water and fat are absorbed into the stool and the intestines. The lubricant type works by lubricating the fecal material and the intestinal wall and preventing absorption of water from the intestines. Instead of being absorbed, this water in the bowel softens and expands the stool. This promotes bowel distention and reflex peristaltic actions, which ultimately lead to defecation.
Major side effects: Electrolyte imbalances, skin rashes, lipid pneumonia, difficulty breathing, and swelling of mouth/face/lips, rash or hives.
Nursing Considerations: caution use in the following: acute surgical abdomen, appendicitis, symptoms such as abdominal pain, nausea and vomiting; fecal impaction, intestinal obstruction and undiagnosed abdominal pain.
Therapeutic Effect: monitor intake and output closely. Type of stool.

Enalapril (350)

Adult dose: 2.5-5 mg/day and increase to target dose of 10-40 mg/day as a single does or in two equal doses
Class: Antihypertensive- ACE inhibitor
MOA: Inhibit the angiotensin converting enzyme which converts angio1 to angio2. A2 is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone stimulates sodium and water reabsorption which can raise blood pressure by inhibiting this process, blood pressure is lowered.
Major side effects: fatigue, dizziness, mood changes, headaches, angioedema, and fainting, dry cough
Nursing considerations: Report any signs of fever or a sore throat to your doctor who may carry out further tests to ensure it is not neutropenia (a decrease in white blood cells). Look alike sound alike drug.
Therapeutic effect: Kidney and renal function, CBC, BP, blood sugar if diabetic

Enoxaparin Sodium (414/415) levonix-low molecular weight heprin

Adult dose: Subcut: 30 mg/ 12 hr or 40 mg/day
Class: Coagulation modifier- Anticoagulant
MOA: An antithrombotic that inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III
Major side effects: Elevation of serum aminotransferases, Fever, hemorrhage, thrombocytopenia
Nursing considerations: Black box warning for pts receiving epidural or spinal hematoma, Pts should be frequently monitored for signs and symptoms of neurologic impairment (tingling, numbness, muscular weakness)
Therapeutic Effect: Serum aminotransferases, CBC

Ferrous Sulfate (864-866)

Adult dose: 3-4 tablets daily
Class: Anemia- Iron
MOA: oxygen carrier in both hemoglobin and myoglobin and is critical for tissue respiration. Corrects iron deficiency symptoms.
Major side effects: N/V, diarrhea, constipation, cramps, stomach pain, temporary discoloration of teeth and eyes.
Nursing considerations: Educate the pt on keeping the medication out of the reach from children considering they look like candy. Take w ascorbic acid (orange juice) aniacids or calcium might cause black, tarey stool
Therapeutic Effect: iron levels

Furosemide (455) lasix

Adult dose: IM/IV- 20-40 mg/dose. PO-20-120 mg/day
Class: Loop diuretic
MOA: have renal cardiovascular and metabolic effects. Theses drugs act primarily along the thick ascending limb of the loop of Henle blocking chloride and secondarily sodium resorption. Activate renal prostaglandins, which results in dilation of the blood vessels of the kidneys lugs and rest of the body. Useful in the treatment of edema associated with heart failure hepatic cirrhosis and renal disease.
Major side effects: Hypokalemia, thrombocytopenia, agranulocytosis, leukopenia, and neutropenia, and steven-johnsons syndrome (severe skin disorder)
Nursing considerations: If pt has diabetes this medication may increase serum glucose levels. Stand up slowly.
Therapeutic Effect: CBC, potassium levels, all electrolyte levels, uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase.

Gabapentin

PO: 900-3600 mg/day
Antiepileptic drugs: Miscellaneous
Mechanism of Action: A chemical analogue of GABA, a neurotransmitter that inhibits brain activity. Exact MOA is not known with certainty, but is believed to work by increasing the synthesis and synaptic accumulation of GABA between neurons.
Major side effects: Dizziness, drowsiness, nausea, visual and speech changes, edema.
Nursing Considerations: Airway maintenance is critical because the tongue relaxes during seizure activity, falling backward and blocking the airway. Intake of alcohol and caffeine are to be avoided, as is smoking.
Close monitoring of dosing is important to attain therapeutic blood levels. For example, if an antiepileptic drug is ordered to be administered every 6 hours, it is crucial to dose the drug so that it is given around the clock to maintain blood levels

Glucophage

PO: IR: 500-1000 mg bid (max dose 2550 mg/day)
Oral Antidiabetic drug: Biguanide
Mechanism of Action: Decreasing glucose production by the liver. It may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity
Major Side Effects: Abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea-especially at the start of therapy.
Nursing Considerations: Metformin with iodinated radiologic contrast media has been associated with both acute renal failure and lactic acidosis. For these reasons, metformin therapy is to be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.
Therapeutic Monitoring: Monitor blood glucose levels.

Heparin

Prophylaxis: Subcut: 5000 units every 8-12 hour. Treatment: IV infusion: 80 unit/kg bolus, then 18 units/kg/hr (depending on indication)
Anticoagulant Drug
Mechanism of Action: Heparin works by binding to a substance called anti-thrombin III, which turns off three main activating factors: activated factor II (also called thrombin), activated factor X, and activated factor IX. Of these, thrombin is the most sensitive to the actions of heparin. Anti-thrombin III is the major natural inhibitor of thrombin in the blood. The overall effect of heparin is that it turns off the coagulation pathway and prevents clots from forming.
Major Side Effects: Bleeding is a main complication of anticoagulation therapy. Hematoma, anemia, thrombocytopenia. Heparin induced thrombocytopenia (HIT). There are two types of HIT. Type I is characterized by a more gradual reduction in platelets. In this type, heparin therapy can generally be continued. In contrast, in type II HIT there is an acute fall in the number of platelets. Heparin therapy must be discontinued in patients with type II HIT.
Nursing Considerations: Avoid any area within 2 inches of the umbilicus, open wounds, scars, open or abraded areas, incisions, drainage tubes, stomas, or areas of bruising or oozing. These sites would be at higher risk for further tissue damage with injection of the anticoagulant.
Therapeutic Monitoring: Protamine sulfate for toxicity of heparin. aPTT, PT, and INR. *** aPTT levels are measured with heparin, and PT and INR are measured with warfarin.

Hydromorphone

IV/IM: 0.25-1mg IV every 4-6hr prn. Oral: 2-4 mg PO every 6 hr prn.
Opioid analgesic
Mechanism of Action: The mechanism of action of hydromorphone is as a Full Opioid Agonist. Hydromorphone is the hydrogenated ketone of morphine, a semi-synthetic opioid with analgesic effects. Hydromorphone selectively binds the mu-opioid receptor which is linked through G-proteins.
Major Side Effects: Hypotension, flushing, bradycardia, sedation, disorientation, euphoria, lightheadedness, nausea, vomiting, constipation, itching, rash, resp. depression, and possible aggravation of asthma. ****MOST serious effect of opioid use is CNS depression, which may lead to respiratory depression.
Nursing Considerations: 7 times more potent than morphine. 1 mg hydromorphone= 7 mg morphine. ABCs. Not to be used with alcohol or other CNS depressants.
Therapeutic Monitoring: Naloxone, naltrexone-reverses analgesia as well as CNS depressant effects, such as respiratory depression.

Ibuprofen

1200-3200mg/day divided 3-4 times daily
One of the most commonly used NSAID: Propionic acid derivative
Mechanism of Action: Work through inhibition of the leukotriene pathway, or both. More specifically, NSAIDs relieve pain, headache, and inflammation by blocking the chemical activity of the enzyme called cyclooxygenase (COX)
Major Side Effects: GI intolerance, bleeding (often GI bleeding) and renal impairment. May cause anaphylaxis. Therapy should be discontinued after first sign of rash
Therapeutic Monitoring: Monitor renal and liver labs. Patient should avoid using alcohol instruct the patient that these drugs, if in sustained release or enteric coated dosage forms- are NOT to be crushed or chewed

Insulin-rapid action (Insulin lispro)

Subcut: 0.5-1 unit/kg/day; doses are individualized to desired glycemic control; rapid acting insulins are best given at least 15 min before a meal. May be given per sliding scale or as a basal/bolus; may also be given via continuous subcutaneous infusion pump.
Human recombinant. Rapid-acting insulin analogue
Mechanism of Action: Restores the patients’ ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores.
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Give at least 15 minutes before meals & only after monitoring the patients fasting serum glucose level. Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-short action (Regular Insulin)

Subcut: Same dosage as insulin lispro; subcut doses of regular insulin are best given 30 mins before a meal. Regular insulin may also be given per sliding scale or basal/bolus and is the insulin usually given IV as continuous infusion
Human recombinant. Short-acting insulin
Mechanism of Action: Restores the patient’s ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major side effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-intermediate action (Insulin isophane suspension (NPH))

Mechanism of Action: Restores the patients ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: ***Do not shake NPH (cloudy) and premixed insulin mixtures, but roll them between the hands before administering the prescribed dose. Onset of action of 1-2 hours, so serve meals at least 30-45 mins prior to its administration. Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration. Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-long action. Insulin glargine

Subcut only: 0.2 units/kg/day given once or twice daily. (basal dosing)
Human Recombinant long acting insulin analogue
Mechanism of Action: Restores the patients ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Lactated Ringer’s

This solution is for intravenous use only. Dosage is to be directed by a physician and is dependent upon age, weight, clinical condition of the patient and laboratory determinations. Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy.
Mechanism of Action: Lactated Ringer’s is a sterile solution for fluid and electrolyte replenishment. It restores fluid and electrolyte balances, produces diuresis, and acts as alkalizing agent (reduces acidity)
Major side effects: chest pain, abnormal heart rate, decreased blood pressure, troubled breathing, cough, sneezing, rash, itching, and headache.
Nursing Considerations: Solutions containing lactate are not for use in the treatment of lactic acidosis. Solutions containing lactate should be used with great care in patients with metabolic
or respiratory alkalosis, and in those conditions in which there is an increased level or an impaired utilization of lactate, such as severe hepatic insufficiency.
Therapeutic Monitoring: Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation. Significant deviations from normal concentrations may require tailoring of the electrolyte pattern, in this or an alternative solution.

Lactulose

PO: 15-30 ml daily or twice daily
Hyperosmotic laxative
Mechanism of Action: Work by increasing fecal water content, which results in distention, increased peristalsis, and evacuation. Their site of action is limited to the large intestine
Major side effects: Abdominal bloating, rectal irritation, electrolyte imbalances
Nursing Considerations: Contraindicated in patients on a low-lactose diet. May be taken with juice, milk, or water to increase palatability
Therapeutic Monitoring: Assess baseline fluid and electrolyte levels to identify any deficits prior to use.

Lanoxin (Digoxin)

PO/IV: Loading dose: PO 10-15mcg/kg or IV 8-12 mcg/kg divided into 3 doses; usual oral maintenance dose: 0.125-0.25 mg/day
Digitalis Cardiac Glycoside
Mechanism of Action: The beneficial effect of Dig is thought to be an increase in myocardial contractility-known as positive inotropic effect. This occurs secondarily to the inhibition of the sodium potassium adenosine triphosphate pump. When the action of this enzyme complex is inhibited, the cellular sodium and calcium concentrations increase. The overall result is enhanced myocardial contractility. Enhance cardiac efficiency and output.
Major Side Effects: Bradycardia or tachycardia
Nursing Considerations: Indicated for the treatment of heart failure and atrial fib and flutter. Before administering any dose of Dig, check the serum potassium and mag levels to be sure they are within normal limits to help prevent toxicity. May be administered with meals, but not meals high in fiber because the fiber will bind to the digitalis and lead to altered absorption/bioavailability of the drug.
Therapeutic Monitoring: Low therapeutic index. Dig levels are monitored when the patient first starts taking the drug. 0.5-2 ng/mL (normal therapeutic levels) Frequent monitoring of electrolytes. Toxicity- therapy is digoxin immune Fab.

Levothyroxine sodium

PO: 25-200 mcg/day. IM/IV: 50% of oral dose. IV: 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary; continue 75-100 mcg/day until changed to oral dosing.
Synthetic thyroid hormone (T4)
Mechanism of Action: At the cellular level, they work to induce changes in the metabolic rate, including the rate of protein, carbohydrate, and lipid metabolism, and to increase oxygen consumption, body temp, blood volume, and overall cellular growth and differentiation. They also stimulate the CV system by increasing the number of myocardial beta-adrenergic receptors. This in turn increases the sensitivity of the heart to catecholamine’s and ultimately increased cardiac output. In addition, thyroid hormones increase renal blood flow and the glomerular filtration rate, which results in diuretic effect.
Major Side Effects: The most significant adverse effect is cardiac dysrhythmia with the risk for life threatening or fatal irregularities. Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, cramps, etc.
Nursing Considerations: Assess levels of T3, T4 and TSH before and during therapy as ordered. When administered, it is important that the drug be given at the same time every day to help maintain consistent blood levels of the drug. ***Extremely important to take in the morning and on an empty stomach, preferably at least 30 mins before breakfast. Avoid taking these drugs with vitamins or supplements containing iron and or calcium within a 4 hour time frame. Antacids and OTC preparations with iodine must also be avoided.
Therapeutic Monitoring: monitoring of serum TSH and free thyroid hormone levels are required to determine the appropriate dose of thyroid replacement drugs Patients need to report the occurrence of excitability, irritability, or palpitations to the prescriber because these symptoms may indicate toxicity.

Lorazepam

The usual range is 2 to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 to 10 mg/day.
For anxiety, most patients require an initial dose of 2 to 3 mg/day given b.i.d. or t.i.d.
Antianxiety Agents, Benzos, Anxiolytics, Anticonvulsants.
Mechanism of Action: Lorazepam is a benzodiazepine with anxiolytic, anti-anxiety, anticonvulsant, anti-emetic and sedative properties. Lorazepam enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid on the GABA receptors by binding to a site that is distinct from the GABA binding site in the central nervous system. This leads to an increase in chloride channel opening events, a facilitation of chloride ion conductance, membrane hyperpolarization, and eventually inhibition of the transmission of nerve signals, thereby decreasing nervous excitation. Major Side Effects: Drowsiness, Dizziness, Tiredness, Muscle weakness, Headache, Blurred vision, Sleep problems (insomnia), Loss of balance or coordination, Forgetfulness or amnesia, Difficulty concentrating, Nausea, Vomiting, Constipation, Changes in appetite, Skin rash.
Nursing Considerations: In general, benzodiazepines should be prescribed for short periods only (e.g., 2 to 4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continuous long-term use of product is not recommended. Withdrawal symptoms (e.g., rebound insomnia) can appear following cessation of recommended doses after as little as one week of
Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy. Ativan (lorazepam) is not recommended for use in patients with a primary depressive disorder or psychosis.
Therapeutic Monitoring: Lorazepam should be used with caution in patients with compromised respiratory function (e.g. COPD, sleep apnea syndrome). Elderly or debilitated patients may be more susceptible to the sedative effects of lorazepam. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg. Some patients on Ativan (lorazepam) have developed leukopenia, and some have had elevations of LDH. As with other benzodiazepines, periodic blood counts and liver function tests are recommended for patients on long-term therapy.

Losartan

PO: 25-100 mg as a single dose or divided bid
Angiotensin II receptor blocker (ARBs)
Mechanism of Action: The ARBs block the binding of AII to type 1 AII receptors. ARBs affect primarily vascular smooth muscle and the adrenal gland. By selectively blocking the binding of AII to the type 1 AII receptors in these tissues, ARBs block vasoconstriction and the secretion of aldosterone. ***The therapeutic effects of ARBs are related to their potent vasodilating properties.
Major side effects: Chest pain, fatigue, hypoglycemia, diarrhea, UTI, anemia, and weakness. Hyperkalemia and cough are less likely to occur than with the ACE inhibitors.
Nursing Considerations: Used in caution in patients with renal artery stenosis and with renal or hepatic dysfunction. Breastfeeding women must NOT take this drug. Must be taken exactly as prescribed. Often tolerated best with meals. Losartan is also an option for patients at risk for stroke and for those who are hypertensive and have left ventricular hypertrophy.
Therapeutic Monitoring: Monitoring the serum potassium levels

Metoprolol

PO: 50-400 mg/day depending of form used. IV/PO: 3 bolus injections of 5mg at 2 min intervals followed in 15 min by 50 mg PO every 6 hr for 48 hrs; thereafter 50-100 mg PO bid
Beta1 Blocker
Mechanism of Action: The beta adrenergic blocking drugs (beta blockers) block SNS stimulation of the beta adrenergic receptors by competing with epi and norepi. The beta blockers can be selective or nonselective. Beta1 adrenergic receptors are located in the heart. Beta blockers that are selective for these receptors are called cardioselective beta blockers, or beta1 blocking drugs.
Other beta blockers block both beta1 and beta2 adrenergic receptors and are referred to as nonselective beta blockers. Beta2 receptors are located on the smooth muscles of the bronchioles and blood vessels. Cardioselective beta1 blockers block the beta1 receptors on the surface of the heart. This reduces myocardial stimulation which in turn reduces heart rate, slows conduction through the AV node, prolongs SA node recovery, and decreases myocardial oxygen demand by decreasing contractility. Nonselective beta blockers not only have these cardiac effects, but they block beta2 receptors on the smooth muscle of the bronchioles and blood vessels as well.
Major side effects: bradycardia, depression, impotence, constipation and fatigue. Some of the most serious undesirable effects can be caused by acute withdrawl of the drug. For example: underlying angina, precipitate an MI or cause rebound hypertension.
Nursing Considerations: When given IV, it is considered a high alert drug and patient should be monitored. To help minimize dry mouth, encourage intake of water within any restrictions and frequent rinsing/spraying of mouth with over the counter dental products indicated for dry mouth. Sugarless gum/candy may also be helpful with dry mouth. ****Nursing considerations for patients taking alpha and beta blockers include teaching patients that they must weigh themselves daily, avoid sudden changes in position and increase intake of fluids and fiber. ****Weight gain, dizziness, fainting and/or decrease in HR below 60 beats/min or a BP of less than 100mm Hg systolic or less than 80mm Hg diastolic need to be reported immediately! Caffeine and other central nervous system stimulants must be avoided while taking adrenergic blocking drugs to prevent
Therapeutic Monitoring: When metoprolol is given IV, it is considered a high alert drug and the patient should be monitored.
Metoclopramide
IV: 1-2mg /kg (30 min before chemotherapy; repeat every 2 hr x 2 doses, then every 3 hr x doses) IM: 10-20 mg x 1 dose near end of surgery; repeat every 4-6 as needed
Dopamine antagonist- Prokinetic Drugs.
Mechanism of Action: Act as antiemetics by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ), which desensitizes the CTZ to impulses it receives from the GI tract. Their primary action is to stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum, as well as the intestinal movements.
Major Side Effects: Hypotension, supraventricular, tachycardia, sedation, fatigue, restlessness, headache, dystonia, dry mouth, nausea and vomiting, diarrhea
Nursing Considerations: FDA posted a public health advisory regarding the potential for developing tardive dyskinesia with long term use of metoclopramide. Given orally is best taken 30 mins before meals and at bedtime.
Therapeutic Monitoring: Action of this drug is decreased when it is taken with anticholinergics or opiates, therefore assess for this interaction as well as for interactions with alcohol.

Metronidazole (Flagyl)- COMEBACK

Adult dosing- IV/PO: 250-500 mg every 6-12 hrs
Pharmacologic classification and mechanisms- Class: Nitromidazole(antibiotics)

MOA: works by interfering with microbial DNA synthesis, and in this regard is similar to quinolones

Major side effects-reversible neutropenia and thrombocytopenia
Nursing considerations- Pregnancy category B, although not recommended for using during first trimester of pregnancy
Therapeutic monitoring- cytochrome P-450 liver enzyme that results in altered drug metabolism when drugs are taken concurrently with metronidazole.

Morphine Sulfate

Adult dosing- PO: 10-30 mg every 4 hr prn, IV/IM/ subcut: 2.5-10 mg every 2-6 hr prn, continuous release PO: 15 mg every 8 hrs 2- 200 mg every 8-12 hr
Pharmacologic classification and mechanisms-Class: Opioid Agonists/analgesic MOA: agonists binds to an opioid pain receptor in the brain and causes an analgesic response- the reduction of pain sensation
Major side effects- most serious adverse effects of opioid use is CNS depression, which may lead to respiratory depression. Bradycardia may also be seen. GI adverse affects are common in pts receiving opioids due to stimulation of GI receptors (constipation). Urinary retention
Nursing considerations- When opioids are given, care must be taken to titrate the dose so that the patients pain is controlled without affecting respitory function.
Therapeutic monitoring- Narcan (naloxone) is reversal drug for opioids. Monitor urinary output (should be at least 600mL/ 24 hr) and monitor bowel sounds as well.

Naloxone

Adult dosing- IV: 0.4-2 mg, repeat in 2-8 mins if needed. IV: 0.1-0.2 mg, repeat at 2-3 min intervals. PO: 50 mg every 24 hrs or 100 mg every other day
Pharmacologic classification and mechanisms- Class: opioid antagonist MOA: binds to a pain receptor but does not reduce the pain signals. It functions as a competitive antagonist bc it compete with and reverses the effects of agonist and agonist-antagonist drugs at the receptor site.
Major side effects- opioid withdrawal syndrome, which can occur with abrupt over- reversal in opioid- tolerant patients. Also raised or lowered BP, dysrhythmias, and pulmonary edema.
Nursing considerations- remembered that the antagonist drug may not work with just one dosing and that repeated doses are generally needed to reverse the effects of the opioid.
Therapeutic monitoring- Assess and document vital signs before, during, and after the use of antagonist so that the therapeutic can be further assessed and documented and the need for further doses determined

Nifedipine

Adult dosing- 10 mg PO q8hr or 30-60 mg (extended relsease PO once a day may be increased every 14 days PRN
Pharmacologic classification and mechanisms- Class: Calcium channel blocker MOA: calcium channel blocker; inhibits transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell membranes without changing serum calcium concentrations; this results in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries which increases clood flow to the ischemic heart which in turn increases o2 supply helps shift the supply/demand ratio back to normal
Major side effects- adverse affects are limited and primarily relate to over expesrrion of their therapeutic effects. Used to be used to lower bp in acute hypertensive emergencies however, negative outcomes came out of dramatic reduction of bp
Nursing considerations- bc of safety and acceptable adverse affects they are considered first line drugs for tx of conditions like angina, htn, svt, and coronary spasms. GRAPEFRUIT REDUCES THE MEABLOISM OF NIFEDIPINE, leading to possible toxicity
Therapeutic monitoring-dosage form. Carefully administer and closely monitor the pt, weight, monitor pt for edema

Normal Saline

Adult dosing-
Pharmacologic classification and mechanisms-Class: Crystalloid MOA: Crystalloid solutions contain fluids and electrolytes that are normally found in the body. Crystalloids are also substances in a solution that diffuse though a semipermeable membrane.
Major side effects-Crystalloid are very safe and effective means of replacing needed fluids. However one unwanted side effect is edema bc since they contain no large particles, such as protein, they do not stay within blood vessels and can leak out of the plasma into the tissue and cells, resulting in edema.
Nursing considerations- hypertonic saline is considered high-risk drug bc deaths have occurred when infused properly.
Therapeutic monitoring- intravascular volume, plasma volume, fluid volume and electrolyte status, vital signs, urinary specific gravity and intake and output

Ondansetron (Zofran)

Adult dosing- PO: 8 mg tid IV: 0.15 mg/kg every 4 hr usually given over 2 to 5 min push
Pharmacologic classification and mechanisms- Class: Antiserotonergic MOA: serotonin blockers work by blocking serotonin receptors in the GI tract, the CTZ, and the vomiting Also called 5-HT3 receptor blockers bc they block the 5-HT3 receptor subtype
Major side effects- Ondansetron has the warning of its use and the risk of cardiac dysrhythmias. HA, diarrhea, rash, broncospam
Nursing considerations- oral forms are well tolerated regardless of the relation of dosing to meals. Encourage pts to avoid alcohol and other CNS depressants during this therapy and to avoid activates requiring mental alertness or motor skill.
Therapeutic monitoring- requires assessment of signs and symptoms of dehydration and electrolye disturbance.

Pantoprazole (Protonix)

Adult dosing- PO/IV: 20-80 mg/day
Pharmacologic classification and mechanisms- Class: Proton Pump Inhibitor MOA: PPI’s bind irreversibly to the proton pump. This inhibition prevents movement of hydrogen ions out of the parietal cell into the stomach and thereby blocks all gastric acid secretion.
Major side effects- PPI’s are generally well tolerated The frequency of adverse effects has been similar to that for placebo or H2 receptor antagonist. There are concerns that these drugs may be over prescribed and may redispose pts to GI tract infections bc reduction or normal acid.
Nursing considerations- New concerns have risen over the potential for long- term users of PPI’s to develop osteoporosis
Therapeutic monitoring- Since concerns about thoroughly asses bones for this disorder and monitor GI tract infections due to decreased acid-mediated antimicrobial` protection.

Phenytoin (Dilantin)

Adult dosing- PO: 300-400 mg/kg
Pharmacologic classification and mechanisms- Class: anticonvulsants- hydantoins MOA:
Major side effects- analeptic drugs are plagued by many adverse effects which often limit their usefulness. Adverse effects include nystagmus, ataxia, gingival hyperplasia, dysarthria and encephalopathy thrombocytopenia, hypertrophy of subcutaneous facial tissue hepatitis, GI upset
Nursing considerations- Phenytoin has may advantages for long term therapy. It is usually well tolerate, highly effective can be given IV but, it is very irritating to veins when injected and must be given by slow IV push
Therapeutic monitoring- phenytoin levels, serum albumin, liver enzyme P-450 enzyme, neurologic function with any CNS altering medication, CBC

Potassium

Adult dosing- Fluid and electrolyte therapy involves replacing any deficits or losses and/or providing maintenance levels for specific pt requirements. Suggested dosage guide lines
Pharmacologic classification and mechanisms- Class: Electrolytes MOA: Potassium supplements are administered Potassium is also essential for the maintenance of acid-case balance, isotonicity, and the electrodynamics characteristics of the cell and is the primary intracellular electrolyte
Major side effects- GI bleeding and ulceration. Cases of phlebitis have been associated
Nursing considerations- if given with potassium supplements can cause adverse hyperkalemia and possible cardiac dysrhythmias
Therapeutic monitoring- Serum Potassium 3.5-5 mEq/L

Prednisone

Adult dosing- 5-60 mg/day
Pharmacologic classification and mechanisms- Class: adrenal Corticosteroids MOA: Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level; in physiologic doses, corticosteroids are administered to replace deficient endogenous hormones; in larger (pharmacologic) doses, they decrease inflammation
Major side effects- The most serious adverse effect of glucocorticoids is adrenal suppression
Nursing considerations- Glucocorticoids should be used with caution on pts with heart failure, due to their ability to cause fluid retention
Therapeutic monitoring- water and salt retention, weight nutritional hydration, intake and output,

Promethazine (Phenergan)

Adult dosing- IV, IM, PO, PR: 12.5-25 mg every 4-6 hrs
Pharmacologic classification and mechanisms- Class: Antidopaminergics MOA: block dopamine receptors in the CTZ and may also have anticholinergic actions and calm the CNS
Major side effects- orthostatic hypertension, tachycardia constipation
Nursing considerations- Encourage pt to avoid alcohol and other CNS depressants during this therapy. Also avoid activates requiring mental alertness or motor skills.
Therapeutic monitoring- monitor vital signs, BP, and pulse rate due to adverse effects of orthostatic hypertension and tachycardia

Sulfamethoxazole/Trimethoprim

Adult dosing- IV/PO: 8-20 mg/kg/day in divided doses
Pharmacologic classification and mechanisms- Class: Sulfonamides MOA: They do not destroy bacteria, rather they inhibit their growth (bacteriostatic antibiotics) by preventing bacterial synthesis of folic acid. Folic acid is required for proper synthesis pf purines a component of nucleic acids (DNA and RNA)
Major side effects- necrosis, photosensitivity which can result in severe sunburn
Nursing considerations- resistant bacterial strains are growing the combination of these two drugs allows for a synergistic antibacterial effect
Therapeutic monitoring- therapeutic efficacy and adverse drug effects, WBC count, sulfa allergy, bun/creatinine

Tramadol

Adult dosing- PO: 50-100 mg every 2-4 hrs not to exceed 400mg/day
Pharmacologic classification and mechanisms- class: nonopioid analgesic MOA: It is centrally acting analgesic with a dual MOA. It creates a weak bond to the mu opioid receptors and inhibits the reuptake of both norepinephrine and serotonin. Although it does have weak opioid receptor activity, tramadol is not currently classified as a controlled substance.
Major side effects-similar to those od opioids: respiratory depression, constipation nausea, dizziness, drowsiness, HA. Seizures have been reports in pts taking tramadol and can occur in pts taking both normal and excessive dosages
Nursing considerations- With tramadol assessment of age is important bc this drug is not recommended for use in individual 75 years of age or older.
Therapeutic monitoring- monitor for respiratory depression, especially during inital or following a does increase, ultra rapid metabolism, cytochrome P-450 liver enzyme

Vancomycin

Adult dosing- IV: 15-20 mg/kg/day PO: 125-500 mg every 6 hrs
Pharmacologic classification and mechanisms- Class: Tricyclic Glycopeptide lass MOA: It destroys bacteria by binding to the bacterial cell wall, producing immediate inhibition of cell wall synthesis and death.
Major side effects- ototoxicity (hearing loss) and nephrotoxicity (kidney damage) red man syndrome seen when administered to rapidly, not harmful just bothersome.
Nursing considerations- assess pt for history of preexisting renal dz. Vanc may be used orally but is poorly absorbed by this route, and is only used to treat GI treat microbes (C-diff). Is drug of choice for MRSA infection and infections cause ny many other gram + bacteria. Is not active against gram – bacteria
Therapeutic monitoring- kidney function, trough levels, possible hearing loss, skin color

Warfarin(Coumadin)

Adult dosing- INR determines maintenance dosage, usually 1-10 mg/day orally
Pharmacologic classification and mechanisms- Class: Anticoagulants MOA: sometimes also called antithrombotic bc they work to prevent the formation of a clot or thrombus a condition known as thrombosis, All anticoagulants work in the clotting cascade but do at different points. Warfarin works by inhibiting vitamin K synthesis in GI tract. This in turn inhibits clotting factors II, VII IX, & X that are normally synthesized in the liver and are vitamin K dependent.
Major side effects- Warfarin can cause necrosis and “purple toes” syndrome.
Nursing considerations- Combining Warfarin and Amiodarone will lead to 50% increase in the INR. When Amiodarone is added to therapy, it is recommended that warfarin be cut in half. Genetic testing for these genes CYP2CP and VKORC1 bc 1/3 of pts taking this drug with these genes metabolize it differently, it is helpful in determining the appropriate initial dosage of warfarin. Caution with Vitamin K rich foods (leafy greens) could cause reversal.
Therapeutic monitoring- careful monitoring of PT/INR