TEST OUT #2 MEDICATIONS

PO/GT Medications

• Metoprolol (Lopressor)

• Digoxin (Lanozin)

• Theraflu

• Senna

• Acetaminophen

• Furosemide (Lasix)

• Senna (Senokot)

• Tussin (Robitussin)

• Percocet (Oxycodone)

Metoprolol

• Betablocker (reduces HR and BP by blocking certain stress hormones) & Antihypertensive

• Indications:

  • Hypertension, HF, angina pectoris (chest pain).

• CHECK FOR:

  • VS: BP & HR.

• WITHHOLD:

  • SBP <110, HR <60 (bradycardia)

Digoxin

• Antiarrhythmic (slows down heart, forcing more contractions)

• Indications:

  • HF, Atrial fib, Atrial Flutter

• CHECK FOR:

  • Apical Pulse (L midclavicular, 5th ICS → for a full min to hear for any irregularities).

  • Potassium levels: 3.5 - 5. (Because potassium is in charge for the contractions of the heart).

• WITHOLD:

  • Apical pulse <60

  • Potassium level < 3.5

Theraflu

• Acetaminophen 650 mg, Dextromethorphan HBr 20mg, Phenylephrine HCl 10mg.

• Indications:

  • Common cold, flu, fever

• CHECK FOR:

  • VS (Temperature)

  • Cough → is it hard to breathe?

  • Check the meds that may contain APAP (acetaminophen)

• WITHOLD:

  • 3g // 3000 mg of APAP

Acetaminophen

• Antipyretic (reduces fever), Nonopioid Analgesic (reduces pain & inflammation).

• Indications:

  • Mild pain & fever

• CHECK FOR:

  • Nonpharmacological Approaches FIRST (FOR ALL PAIN)

  • Pain Levels

  • Temperature (elevated or above 100.5F)

  • Check the meds that may contain APAP (acetaminophen)

  • Assess for liver damage

• WITHOLD:

  • 3g // 3000mg of APAP

Furosemide

• Diuretic (makes you pee more)

• Indications:

  • Hypertension, edema due to HF, fluid retention liver disease, kidney disease

• CHECK FOR:

  • Electrolyte levels (Na <135 mEq/L and K < 3.5 mEq/L)

  • Edema + crackles in lungs (pulmonary edema)

  • BP

  • Turgor (tenting = dehydration)

  • Fluid retention

• WITHOLD:

  • BP < 90/60

  • Tenting

Senna

• Laxative

• Indications:

  • Constipation (caused by usage of a lot of narcotics or pt is in bed a lot).

• CHECK FOR:

  • BM, the consistency, what it looks like, what is considered normal for them.

  • Urine?

  • Electrolyte levels

• WITHOLD

  • Has diarrhea

Tussin

• Dextromethorphan Hbr 20mg / Guaifenesin 200mg (20/200)

• Indications:

  • Cough, chest congestion, mucus

• CHECK FOR:

  • Cough characteristics: productive or not?

  • When was it last administered? (cannot be < 4 hrs).

• WITHOLD:

  • Do not take more than 6 doses in 24 hour period.

Oxycodone 5/325 Tab (Percocet)

• HIGH ALERT MED, NARCOTIC!

• Opioid Analgesic

• CONTAINS APAP!!!

• Indications:

  • Moderate - severe pain.

• CHECK FOR:

  • NONPHARM FIRST

  • RR, LOC, BP, HR

    - can cause respiratory depression

  • Check the meds that may contain APAP (acetaminophen)

• WITHOLD:

  • RR <12

  • BP <90/60

  • HR <60

  • LOC not AOx4

  • 3g / 3000mg

Injections

• Tdap Vaccine

• Ceftriaxone

• Heparin

• Ondansetron (Zofran)

• Hydromorphone (Diluadid)

• Penicillin G Benzathine

• Insulin Regular

• Narcan (Naloxone)

Tdap

• Vaccine

• Indications:

  • Prevention of tetanus (lockjaw), diptheria, acellular pertussis (whooping cough).

• CHECK FOR:

  • Site of injection

• Injection Sites:

  • IM (Deltoid)

    - Use Z track method!

  • 25 G, 5/8”

Ceftriaxone

• Antibiotic

• Indications:

  • Infections (skin, UTI, STD, gonorrhea etc)

• CHECK FOR:

  • Penicillin allergy (same family class)

  • WBC (4500 - 11000)

  • Temperature

• Injection Sites:

  • IM

    - Use Z track method

    - Ventrogluteal (inject DEEP into a well developed muscle) BECAUSE ITS PAINFUL

    - 22G, 1 ½ “

  • IVPB

Heparin 5000 units

• HIGH ALERT MED!

• Anticoagulant (slows down/interrupts/prevents blood clotting)

• Indications:

  • DVT, Pulmonary embolism, MI, clot prevention

• CHECK FOR:

  • Coagulation levels (PT, PTT, INR Platelets)

    - PTT (25-35 secs)

  • Bruising on skin, bleeding (stool, urine, nosebleed, gums)

    - Bright red blood = hematochezia = lower GI bleeding.

    - Dark brown/tarry blood = melena = upper GI bleeding.

• WITHOLD:

  - Bleeding

• Injection Sites:

  • SQ

  • Use tuberculin syringe

Ondansetron (Zofran)

• Antiemetic (prevent/relieve nausea and vomiting)

• Indications:

  • Prevention for N/V

• CHECK FOR:

  • Risk for aspiration = don’t give PO

• Injection Sites:

  • IM

  • IVP

  • Others: PO, sublingual, suppository

Hydromorphone (Diluadid)

• HIGH ALERT MED! Narcotic Analgesic

• 2-8x stronger than morphine

• Indications:

  • Severe pain

• CHECK FOR:

  • RR, LOC, HR

    • if RR <10/min, assess level of sedation.

    • can cause respiratory depression

  • Pain scale

  • Can make you nauseous

  • NEED ANOTHER RN TO WATCH WASTING

• WITHOLD:

  • RR <12

  • BP <90/60

  • HR <60

  • LOC not AOx4

  • Use Narcan for opioid OD.

• Injection Sites:

  • IVP

  • IM

    - Use Z track method!

    - smaller muscles preferred such as deltoid

    - Rationale: rather use a smaller needle than a larger one (least invasive → most invasive).

    - VL 23G, 1”

    - Deltoid 25G, 5/8”

Penicillin G Benzathine

• Antibiotic

• Indications:

  • Bacterial infection (strep, syphilis, etc).

• CHECK FOR:

  • Penicillin Allergy

  • WBCs (4000 - 11000)

  • Temp

    • If fever lasts a week and still giving this, then it isn’t working.

• Injection Sites:

  • IM

    - PAINFUL MED DUE TO THICK CONSISTENCY!

    - Use Z-track method

    - Inject in VG

    - 20G or lower, 1 ½ “

Insulin Regular

• HIGH ALERT MED!

• Indications:

  • DM 1 or 2

• CHECK FOR:

  • BS levels, use sliding scale!

  • Check for food tray/if they have eaten

• Injection Sites:

  • SQ (abdomen, posterior arm, mid upper thighs).

  • Onset: 30-60 min → make sure food tray is within unit

  • Peak: 2-3 hr

  • Duration: 5-7hr

  • Double check with another nurse after aspirating.

Narcan (naloxone)

• Opioid Antidote

• Indications:

  • Opioid Overdose

• CHECK FOR:

  • Assess RR, LOC, BP, HR

• Injection Sites:

  • IVP (best route), but can be given IM, SQ,

  • Onset: 2-5 min.

  • Duration: > 45 min

IV

• Sodium Chloride (Normal Saline)

• Ceftriaxone

• Morphine Sulfate

• Hydromorphone (Dilaudid)

• Narcan (Naloxone)

Sodium Chloride (Normal Saline)

• Indications:

  • Maintain fluid and electrolyte imbalances.

  • Used to reconstitute or irrigate meds.

• CHECK FOR:

  • Electrolyte (Na+ and Cl-) and fluid balance

    • Na+: 135 - 145

  • Input and Output

  • Fluid retention/edema/pulmonary edema

  • Skin Turgor

  • IV site (redness, warmth, leaking)

  • Particles in IV bag

• WITHOLD:

  • Fluid retention//overhydration

• Interactions:

  • Excessive amount of NaCl may antagonize effects of anithypertensives.

  • Use with corticosteroids may result in excess sodium retention.

Morphine Sulfate

• HIGH ALERT MED! Narcotic

• Indications:

  • Moderate - severe pain

• CHECK FOR:

  • NONPHARM INTERVENTIONS FIRST

  • RR, LOC, BP, HR

    - can cause respiratory depression

  • Pain level

  • Is the med really necessary?

• WITHOLD:

  • RR <12,

  • LOC not AxO x4

  • Low HR and BP