prototype medications

acetylsalic acid

Aspirin

ibuprofen

• Motrin

• Advil

• Indomethacin

presdnisolone

Prednisone

acetaminophen

Tylenol

pantoprazole

Protonix

famotidine

Pepcid

psyllium powder

Metamucil

docusate sodium

Colace

ondansetron

Zofran

metoclopramide

Reglan

insulin lispro

• Humalog

• rapid acting

insulin regular

• Humulin R

• short acting

insulin isophane

• NPH

• intermediate acting

insulin glargine

• Lantus

• long acting

metformin

• Glucophage

• 500mg PO BID

potassium chloride uses

• preventing/treating hypokalemia

• treat mild forms of alkalosis

• tablets, powders, liquids usually heavily flavored due to unpleasant taste

• can cause peptic ulcers » dilute with plenty of water

• IV » administer slowly since bolus injections can overload heart » cardiac arrest

• other drugs: acetate, bicarbonate, citrate, gluconate salts

potassium chloride administration considerations

• always give oral meds when pt is upright » prevent esophagitis

• advise pt to not crush/chew tabs

• dilute liquid form before giving PO/NGT

• never administer IV push or in concentration amounts

• do not exceed IV rate of 10 mEq/h

• use caution to avoid extravasation and infiltration

• no definitive data on use of drug during pregnancy/lactation

potassium chloride contraindications

• HYPERkalemia

• CKD

• systemic acidosis

• severe dehydration

• extensive tissue breakdown (ex. severe burns)

• adrenal insufficiency

• administration of potassium sparing diuretic or angiotensin converting enzyme inhibitors » increase risk for hyperkalemia

• overdose » potassium sparing diuretics and meds with significant amount of potassium withheld

  • IV administration of 10% dextrose solution with 10-20 units of regular insulin

  • sodium bicarbonate may be infused to correct acidosis

  • potassium binding agent may be administered to enhance potassium elimination

aspirin action

• antipyretic

• anti inflammatory

• anti platelet » reduce stickyness of platelets » platelets are smoother » do not clump and form thrombosis/blood clots » treat cardiovascular disease » prevent MI and strokes

• analgesic

aspirin dose

• 81mg, chewable » antiplatelet dose

• 325mg - 650mg PO » antipyretic/analgesic

• watch for enteric coated considerations vs chewable

aspirin side effects

• GI bleed » pulse rises, BP decreases, signs of anemia (pale, cool to touch, SOB), stool tarry and black » RBC/H/H reduced

• thrombocytopenia » drop in platelet count (want to be >100,000) » acute spontaneous hemorrhage

• GI distress

• ringing ears (tinnitus)

• renal impairment

• headache

• dizziness

• blurry vision

• mental confusion

aspirin caution

• bleeding precautions » stop one week prior to surgery

• take with food » extremely harsh on stomach lining » alter stomach pH » dyspepsia, heartburn, epigastric discomfort. nausea » PUD, gastric ulcers

ibuprofen action

• antipyretic

• anti inflammatory

• analgesic

• rapidly absorbed in GI tract

• peak levels 1-2 hours

• metabolized in liver » excreted by kidneys

ibuprofen dose

200-400mg PO every 6 hours

ibuprofen precautions/side effects

• screen for risk of PUD, GI bleed » increase GI distress/bleeding

• renal impairment » monitor kidney function » chem panel, BUN, serum creatinine levels » stay hydrated, control HTN and diabetes

• tinnitus

• MI/stroke following MI

• not good with asthma pt

• crosses placenta and into breastmilk » not recommended during pregnancy or lactation

• toxicity » drowsy, mental confusion, N/V, GI bleed, cardiac arrest

tylenol action

• blocks peripheral pain impulses by inhibition of prostaglandin synthesis

• exert effects directly within brain and spinal cord

• reduces fever by direct action at level of hypothalamus

• alternative to NSAIDs when pt cannot take aspirin or ibuprofen (children)

• rapidly absorbed in GI tract

• antipyretic

• analgesic

• less anti inflammatory outcomes

• rapidly absorbed in GI tract

• metabolized in liver » excreted in urine

• onset 10-20 min

• peak levels 0.5-2 hours

• half life 1-4 hours

• duration 3-4 hours

tylenol dose

• 300-650mg PO every 4-6 hours

• PO, rectal, IV

• do not exceed 3g daily per FDA

tylenol caution

• careful using in someone with hepatic disease or ETOH abuse

• care using in someone taking other meds harsh on liver

• overdose » hepatic necrosis

  • antidote » mucomyst (acetylcysteine) » prevents hepatotoxic metabolites of acetaminophen from forming » most effective within 10 hours of overdose

s/s of tylenol overdose

• cramping/tenderness in RUQ

• N/V

• indigestion

• intolerance to fatty foods

• increase in bilirubin » itchy yellow skin, yellow sclera of eyes

presdnisolone action

• suppress immune immune response and chemical mediators » reduce overall inflammation » reduce swelling and pain

• reduction in immune response » increase likelihood of developing infection

presdnisolone route

• PO

• topical » cortisone, anti itch cream

• injection » juvenile/rheumatoid arthritis

• inhaled » asthma

presdnisolone adverse effects

• alter aldosterone mechanism in kidneys and metabolism of cortisol » water retention and weight gain » increase BP and blood sugar » cushings syndrome

• increased risk of infection

• tendon ruptures

• thrush

metformin action

reduces amount of glucose produced by liver and released in blood stream

special considerations for metformin

• take with meals » reduce GI upset

• does not increase production of insulin

• renal dysfunction » can accumulate in body » watch for creatine >1.2

• contraindicated in pt with GFR <30mL/min

• long term use » B12 deficiency » monitor symptoms of peripheral neuropathy, anemia

• caution in pt with liver disease, ETOH, lactic acidosis

• black box warning » avoid IV contrast dye within 48 hours » MRI, CT, angiograms with contrast