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class: thrombolytics Indication: MI, acute ischemic stroke, occluded central lines Action: converts plasminogen to plasmin which degrades the fibrin found Nursing Considerations:
contraindicated in active bleeding -monitor for anaphylaxis
use caution with uncontrolled hypertension
class: lipid-lowering agent Indication: management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease Action: lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation Nursing Considerations
contraindicated in active liver disease
may cause rhabdomyolysis
monitor serum cholesterol
monitor liver function tests, renal function
class: antipyretic, non-opioid analgesic Indication: pain, fever Action: inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response Nursing Considerations:
do not exceed 4g of acetaminophen per day
overdose will lead to hepatotoxicity
Acetadoteis the antidote for overdose
may increase risk for bleed with warfarin therapy
class: antiviral, purine analogues Indication:genital herpes, herpes zoster, chicken pox Action: interferes with viral DNA synthesis Nursing Considerations:
may cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea
monitor renal function
assess lesions
instruct patient to use proper protection during sexual intercourse
class: bronchodilator ,adrenergic Indication:bronchodilator used to prevent airway obstruction in asthma and COPD Action: binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways Nursing Considerations:
may decrease the effectiveness of Beta Blockers -use caution with: heart disease, diabetes, glaucoma, seizure disorder
overuse of inhalers can lead to bronchospasm
monitor for chest pain and palpitations
can decrease digoxin levels
class: bone resorption inhibitor, biphosphnates Indication: osteoporosis (aging, menopause, corticosteroid induced) Action: inhibits osteoclast activity leading to inhibition of resorption of bone Nursing Considerations:
take first thing in the morning with full glass of water 30 min prior to eating
assess serum calcium and vitamin D
may lead to muscle pain
class: benzodiazepine, anti-anxiety agent Indication:anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis Action: works in CNS to produce anxiolytic effect causing CNS depression. Nursing Considerations:
may cause CNS depression, drowsiness, lethargy
may lead to physical dependence
assess anxiety and mental status
Flumazenil is the antidote for overdose
Grapefruit juice may increase blood levels
class: Antiarrhythmic class III, Potassium channel blocker Indication: ventricular arrhythmias, SVT, ACLS protocol for v-fib and vTACH Action: prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation Nursing Considerations:
may lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension
increases risk for QT prolongation
increases digoxin levels
increases activity of warfarin
monitor EKG
assess for signs and symptoms of ARDS
monitor liver function test
check dosage with another RN
avoid drinking grapefruit juice
class: tricyclic antidepressant Indication: depression, anxiety, insomnia Action: increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects Nursing Considerations:
contraindicated in MI, heart failure, QT prolongation, glaucoma
may increase risk for suicidal ideation
may cause arrhythmias, hypotension, EKG changes
may cause alterations in blood glucose levels
may lead to general sedation and lethargy
do not use within 2 weeks of MAOIs
monitor for orthostatic hypotension
may lead to photosensitivity, instruct patient to use sunscreen
may turn urine blue/green color
class: Ca channel blocker, antihypertensive Indication: hypertension, angina Action: blocks transport of calcium into muscle cells inhibiting excitation and contraction Nursing Considerations:
may cause gingival hyperplasia
grapefruit juice may increase drug level
monitor blood pressure and pulse
monitor intake and output
assess for signs of CHF
assess characteristics of angina
instruct patient of interventions for hypertension and how to take BP
class: anti-infectives, antiulcer agent, aminopenicillins Indication: skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lime disease Action: Inhibits synthesis of bacterial cell wall leading to cell death. Nursing Considerations:
Contraindicated with penicillin allergy
may cause seizures
assess for rash, anaphylaxis
excreted by kidneys - monitor renal labs
monitor patient for diarrhea - bloody stool should be reported immediately
class: aminopenicillin, anti-infective Indication: skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia Action: bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death Nursing Considerations:
contraindicated in penicillin allergy, use caution in renal insufficiency
may lead to seizures, diarrhea, anaphylaxes, super infection
monitor liver function tests
instruct patient on signs of super infection: fury over growth on tongue, vaginal itching, loose and foul smelling stool
pt should not use with oral contraceptive use.
class: antipyretics, non-opioid, analgesics Indication: rheumatoid arthritis, osteoarthritis, ischemic stroke and MI prophylaxis Action: inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases Nursing Considerations:
use caution in bleeding disorders, chronic alcohol use
may lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis
increases risk for bleeding with warfarin, heparin, and clopidogrel
increased risk for GI bleeding with NSAID use
monitor liver function tests
concurrent use with alcohol may increase risk for GI bleeding
class: beta blocker, antianginal, antihypertensive Indication: hypertension, angina, prevention of MI Action: blocks the stimulation of beta1 receptors in the SNS with minimal effect on beta2 receptors Nursing Considerations:
Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block
monitor hemodynamic parameters (HR, BP)
May cause bradycardia, CHF, pulmonary edema
Masks symptoms associated with diabetes mellitus
advise to change positions slowly to prevent orthostatic hypotension
instruct patient on how to take blood pressure
class: antiarrhythmic, anticholinergic, antimuscarinic Indication: decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm Action: Atropine is an anticholinergic which means that it inhibits the effects of the parasympathetic nervous system, specifically acetylcholine. This inhibition causes increase in HR, bronchodilation, decreased GI and respiratory secretions. Nursing Considerations:
Avoid in acute hemorrhage, tachycardia, and angle closure glaucoma
monitor patient for tachycardia and palpitations
may cause urinary retention in elderly patients
patients may experience constipation due to slowed GI motility
class: agents for atypical mycobacterium, anti-infectives Indication: URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis Action: inhibits bacterial protein synthesis Nursing Considerations: -may lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema
may increase risks for warfarin toxicity
monitor patient for signs of anaphylaxis
instruct patient to notify physician for diarrhea, or blood or pus in stool
instruct patient to take medication exactly as prescribed
class: Anticholinergic, Antiparkinson agent Indication: anticholinergic properties in the CNS to reduce rigidity and tremors Action: treatment for Parkinson's disease, Nursing Considerations:
may lead to arrhythmias, hypotension, palpitations, and tachycardia
anticholinergic effects like constipation, dry mouth
assess for extrapyramidal symptoms
instruct patient to take as directed
instruct patient to maintain good oral hygiene
class: stimulant laxatives Indication: treatment of constipation, bowel regimen Action: stimulates peristalsis leads to fluid accumulation in the colon Nursing Considerations: -may lead to hypokalemia
may cause abdominal pain and cramps
use caution with milk
assess for abdominal distention and bowel function
instruct patient to drink 1500-2000 mL/day during therapy
monitor fluid and electrolyte levels
instruct patient to take as ordered
class: antidiarrheal, antiulcer Indication: diarrhea, heartburn, indigestion, H. pylori associated ulcer Action: Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins Nursing Considerations: -contraindicated in aspirin hypersensitivity
increase risk for impaction with geriatric and pediatric patients
monitor liver profile
bismuth may interfere with radiologic exams
class: Antidepressants, smoking deterrents Indication: depression, smoking cessation, treat ADHD in adults Action: Nursing Considerations:
may lead to seizures, suicidal thoughts
do not administer if patient is taking MAOI
use caution with renal and liver impairment
assess mental status
instruct patient to avoid alcohol while taking bupropion
class: Antidepressants, smoking deterrents Indication:management of anxiety Action: relieves anxiety by binding to dopamine and serotonin receptors Nursing Considerations:
do not administer concurrently with MOAI or grapefruit juice
may lead to dizziness, drowsiness, fatigue, and weakness
patient may experience chest pain, palpitations, tachycardia
instruct patient to take as directed
instruct patient to avoid alcohol and other CNS depressants
class: Opioid Analgesic Indication: moderate to severe pain, labor pain, sedation Action: alters perception and response to pain by biding to opiate receptors in CNS Nursing Considerations: -use caution with concurrent use of MAOIs
may cause confusion, hallucinations, sedation
monitor for CNS depression
assess blood pressure pulse and respirations during administration
administer slowly through IV line
class: antacids Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation Nursing Considerations:
may cause cardiac arrest and arrhythmias
phlebitis at site of insertion
monitor hemodynamics
may causes hypotension, bradycardia, and arrhythmias
hypercalcemia can increase risk for digoxin toxicity
administer slowly
instruct pt on foods that contain Vitamin D and encourage adequate intake.
monitor parathyroid hormone
class: antacids Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, used as antacid Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation Nursing Considerations:
may cause cardiac arrest and arrhythmias
monitor hemodynamics
may causes hypotension, bradycardia, and arrhythmias
hypercalcemia can increase risk for digoxin toxicity
instruct pt on foods that contain Vitamin D and encourage adequate intake.
monitor parathyroid hormone
class: ACE Inhibitor, antihypertensives Indication: hypertension, management of CHF, decrease progression of DM neuropathy Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation Nursing Considerations:
can cause neutropenia - check WBCs regularly
use cautiously with potassium supplements and potassium sparing diuretics.
use cautiously with diuretic therapy
administer 1 hour before meals
monitor blood pressure often
monitor weight and fluid status
monitor renal profile
monitor CBC frequently
May lead to Rhabdomyolysis
Dry cough
class: Anticonvulsant Indication: seizures, DM neuropathy, pain associated with trigeminal neuralgia Action: affects Na channels in neurons leading to decreased synaptic transmission Nursing Considerations:
interferes with oral contraceptives
do not use with MAOIs
may cause suicidal thoughts
may cause Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, thrombocytopenia
do not consume grapefruit juice while taking this medication
monitor CBC and platelet count
monitor serum blood levels of medication often
class: Antiparkinson agent, Dopamine Agonist Indication: Parkinson's disease Action: levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa Nursing Considerations:
may cause orthostatic hypotension
may cause dark urine
weeks to months to take effect
do not use with MAOIs
don't use with glaucoma, melanoma
assess for parkinsonian symptoms
instruct patient to take as directed
class: Cephalosporin 2nd generations Indication: treatment of respiratory tract infections, skin infections, otitis media Action: bacteriacidal, binds to bacterial cell wall causing cell death Nursing Considerations: contraindicated in cephalosporin and possibly penicillin allergies
may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
Assess infection and allergies
obtain cultures prior to therapy
monitor bowel function
may lead to super infection
class: Cephalosporin 2nd generations Indication: treatment of skin infections, otitis media Action: bactericidal, binds to bacterial cell wall causing cell death Nursing Considerations:
contraindicated in cephalosporin and possibly penicillin allergies
may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
Assess infection and allergies
obtain cultures prior to therapy
monitor bowel function
monitor for bleeding
may lead to super infection
class: antirrheumatics/NSAID Indication: osteoarthritis, rheumatoid arthritis, acute pain Action: decreases pain and inflammation by inhibiting synthesis of prostaglandins Nursing Considerations:
use caution with cardiovascular disease
increases risk for MI, CVA, thrombosis
may cause GI bleeding, Stevens-Johnson syndrome, dermatitis
notify provider for new-onset abdominal pain or black stool
class: Cephalosporin 1st generations Indication: skin infections, pneumonia, UTI, otitis media Action: bactericidal: binds to bacterial cell wall leading to cell death Nursing Considerations:
contraindicated with cephalosporin and serious penicillin allergies.
may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis
Assess infection and allergies
obtain cultures prior to therapy
monitor bowel function
may lead to super infection
may cause elevated liver enzymes
class: Antipsychotic, antiemetic Indication:second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op sedation, acute intermittent porphyria, headache, bipolar Action: exhibits anticholinergic activity, alters effects of dopamine in CNS Nursing Considerations:
may cause neuroliptic malignant syndrome, sedation, tardive dyskineisa, hypotenstion, agranulocytosis
assess mental status prior to and during treatment
monitor blood pressure
ensure patient is taking medication
monitor CBC and liver function tests
instruct patient not to skip doses or double dose
class: Histamine H2 antagonist, antiulcer agent Indication: treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome, prevention of GI bleeding in critical patients. Action: inhibits action of histamine leading to inhibition of gastric acid secretion Nursing Considerations:
increases serum level of warfarin
can lead to respiratory infection (green sputum)
monitor for arryhtmias
may cause agranulocytosis, aplastic anemia
monitor CBC during therapy
take medication as directed
instruct patient to increase fluid and fiber intake to decrease constipation
class: Fluoroquinolone, anti-infectives Indication: urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections Action: inhibits bacterial DNA synthesis Nursing Considerations:
contraindicated in allergies
may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
can cause seizures, arrythmias, pseudomembranous colitis, anaphalaxis, Stevens Johnson syndrome
may decreased of phenytoin
monitor renal panel
assess for infection, obtain cultures prior to therapy
monitor liver function tests
class: Anti-infectives Indication: skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis Action: inhibits protein synthesis Nursing Considerations:
arrythmias, pseudomembranous colitis, diarrhea, phlebitis
monitor bowel function
assess for infection, obtain cultures prior to therapy
monitor liver function tests.
monitor CBC
class: Antiplatelet agent Indication: atherosclerotic events, MI, CVA, PVD, acute coronary syndrome Action: Nursing Considerations:
may cause GI bleeding, neutropenia, hypercholesterolemia
may increase risk for bleeding in warfarin, aspirin, heparin
can increase risk for bleeding with garlic, ginkgo, ginger
monitor for signs of bleeding
monitor bleeding times
monitor CBS and platelet count
discontinue use 5-7 days before surgery
class: opioid agonist Indication: management of pain, diarrhea, cough suppressant Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility. Nursing Considerations:
may cause alterations in mentation, hypotension, constipation, nausea, vomiting
assess BP, pulse, and respiratory rate prior to administration and frequently during administration
use caution if patient is receiving MAO Inhibitors
Narcan (naloxone) is the antidote for opioid agonists
class: antiasthmatics, corticosteroids Indication: management of adrenocortical insufficiency (Addison's Disease). Action: Replace cortisol in states of deficiency, suppress inflammation and normal immune response. Nursing Considerations:
Excreted by the liver - monitor liver profile
Avoid in active untreated infections
may cause CNS alterations
may cause peptic ulcers
may cause Cushingoid appearance (buffalo hump, moon face)
Weight gain
Osteoporosis
Decrease wound healing
May elevate blood sugars
May increase cholesterol and lipid values
class: immunosuppresants, antirheumatics (DMARD) Indication: prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis Action: inhibits normal immune response Nursing Considerations: -may cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia
increases immune suppression with corticosteroids
avoid grapefruit juice while taking this medications
assess for signs of organ rejection
monitor renal panel, liver enzymes
take medication as directed
lifelong therapy required for transplant patients
instruct pt on how to take blood pressure
class: antiasthmatics, corticosteroids Indication:Manage cerebral edema, assess for Cushing's Disease Action: Suppress inflammation and normal immune response. Used in inflammatory states to decrease inflammation. Nursing Considerations: -Excreted by the liver
monitor liver profile
Avoid in active untreated infections
may cause CNS alterations
may cause peptic ulcers
may cause Cushingoid appearance (buffalo hump, moon face)
Weight gain
Osteoporosis
Decrease wound healing
May elevate blood sugars
May increase cholesterol and lipid values
class: Benzodiazepine Indication: anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal Action: depresses the CNS Nursing Considerations:
contraindicated in hepatic dysfunction
use caution with renal impairment
can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance
instruct patient to take as directed
caution to avoid alcohol use
Romazicon is the reversal agent
class: antiarrhythmic, inotropics Indication: CHF, A-fib, A-flutter Action: Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate. Nursing Considerations:
Excreted by kidneys
Assess patient for hypersensitivity
Contraindicated with uncontrolled ventricular arryhtmias
Hypokalemia increase risk for toxcicity
Hypercalcemia ↑ risk for toxicity
Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to toxicity
Assess patient for cardiac arrythmias including bradycardia
Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances)
Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)
class: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive Indication: hypertension, angina, SVT, a-fib, aflutter Action: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure. Nursing Considerations:
contraindicated in 2nd and 3rd AV block
may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia
increases digoxin levels
don't drink grapefruit juice
assess for signs of CHF
monitor EKG continuously
tell patient to change positions slowly
monitor serum potassium
instruct pt on how to take blood pressure
class: antihistamine, antitussive Indication: allergy, anaphylaxis, sedation, motion sickness, antitussive Action: antagonizes effects of histamine, CNS depression Nursing Considerations: -may cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache
anticholinergic effects
assess purpose of medication prior to giving it
assess allergies, sleep patterns, cough and lung sounds
patient should avoid other over-the-counter cough and cold remedies
class: anticholinergic, antidiarrheal Indication: Treatment for diarrhea Action: Inhibits GI motility via anticholinergic effects Nursing Considerations:
Contraindicated with angle-closure glaucoma, dehydration
Structurally related to opioids so use caution with patients that have allergies to opioids
Side effects: constipation, tachycardia, dizziness, ileus
Monitor liver function as medication is excreted by the liver
Insure that client is taking medication as prescribed and not double dosing
class: Anticonvulsant, vascular headache suppressants Indication: seizures, manic episodes, prevention of headache Action: increases the level of GABA in CNS Nursing Considerations:
may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis
increases risk for bleeding with Warfarin
use caution with MAOIs
monitor liver function tests
class: beta-adrenergic agonist, inotropic Indication: short term management of heart failure Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Nursing Considerations:
Monitor hemodynamics: hypertension, ↑HR, PVCs
Skin reactions may occur with hypersensitivity
Beta blockers may negate therapeutic effects of dobutamine
Monitor cardiac output
Monitor peripheral pulses before, during, and after therapy
DO NOT confuse dobutamine with dopamine
class: inotropic, vasopressor, adrenergic Indication: used to improve blood pressure, cardiac output, and urine output Action: -Smaller doses result in renal vasodilation -Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors -Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR) Nursing Considerations: -Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available
Obtain parameters for hemodynamic values
Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)
Irritation may occur at IV site
Beta blockers may counteract therapeutic effects
class: ACE Inhibitor, antihypertensives Indication: hypertension, management of CHF Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation Nursing Considerations:
can cause neutropenia - check WBCs regularly
use cautiously with potassium supplements and potassium sparing diuretics.
use cautiously with diuretic therapy
administer 1 hour before meals
monitor blood pressure often
monitor weight and fluid status
monitor renal profile
monitor CBC frequently
dry cough
class: antithrombotic Indication: prevention of VTE, DVT, and PE Action: prevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin Nursing Considerations:
contraindicated in pork hypersensitivity
monitor for signs of bleeding
administer in subcutaneous tissue
DO NOT eject air bubble prior to injection
DO NOT aspirate or massage site
class: adrenergic agonist, antiasthmatic, bronchodilator, vasopressor Indication: Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct Action: Affects both beta1 and beta2 also has alpha agonist properties. Results in bronchodilation, increases in HR and BP Nursing Considerations:
Side effects include: angina, tachycardia, hypertension, restlessness, nervousness, hyperglycemia
Use with MAOI may lead to hypertensive crisis
Patients should not use stimulants (caffeine, guarana, etc)
Excessive use may cause bronchospasm
Assess lung sounds, pulse, BP, and other hemodynamic parameters
Monitor for chest pain
Instruct patient to use as directed
Patient should insure adequate fluid intake to liquefy secretions
Mouth should be rinsed after inhalation
Beta blocker may negate effects
May increase blood glucose levels
class: antianemics, hormones Indication anemia Action: stimulates erythropoesis Nursing Considerations:
contraindicated in albumin hypersensitivity
may cause seizures, CHF, MI, CVA, HTN
monitor blood pressure during therapy
monitor for signs of anemia
assess dialysis shunts
monitor bleeding times
initiate seizure precautions
do not shake vial
class: macrolide, anti-infective Indication useful in place of penicillin when patient cannot take penicillin, upper and lower respiratory tract infections, otitis media, skin infections, pertussis, syphilis, rheumatic fever Action: suppresses bacterial protein synthesis, bacteriostatic Nursing Considerations:
Causes QT prolongation, ventricular arrhythmias
diarrhea
asses infection
monitor liver function tests
instruct patient to finish medication dosage even if they are feeling better
medication should not be shared
class: SSRI, antidepressant Indication major depressive disorder, anxiety disorder, PCD, PTSD, social phobia Action: selectively inhibits reuptake of serotonin Nursing Considerations: -contraindicated with MAOI
may cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea, serotonin syndrome
may cause QT prolongation with certain medications
assess for sexual dysfunction
may take 4-6 weeks for full affect to take place
class: Histamine H2 antagonist Indication short term treatment of active ulcer, GERD, treatment of heartburn, indigestion, management of Zollinger Ellison syndrome, prevention of GI bleeding in critically ill patients, management of symptoms associated with overuse of NSAIDs Action: blocks action of histamine located in gastric parietal cells, inhibits gastric acid secretion Nursing Considerations:
may cause arrythmias, agranulocytosis, aplastic anemias
assess for abdominal pain and occult blood
monitor CBC
instruct pt to increase fluid and fiber intake to prevent constipation
class: Opioid Analgesic Indication supplement to general anesthesia, continuous IV infusion for purpose of analgesia Action: binds to opiate receptors in CNS altering perception of pain, producing CNS depression Nursing Considerations:
use caution with increased ICP, head trauma, adrenal insufficiency
avoid use with MAOIs
may cause apnea, laryngospasm, decreased respirations, bradycardia, hypotension
do not consume grapefruit while taking this medication
monitor hemodynamics during administration
assess patient pain scale frequently
class: iron supplements Indication prevention and treatment of iron-deficiency anemia Action: Iron is essential for hemoglobin, myoglobin and enzymes, it is transported to organs where it becomes part of iron stores Nursing Considerations:
may cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis
assess nutritional status, bowel function
monitor hemoglobin, hematocrit, iron levels
may cause elevated liver enzymes
take on an empty stomach to increase absorption/vitamin c helps with absorption
use z-track for IM injections
class: SSRI, antidepressant Indication depressive disorder, OCD, bulimia, panic disorder, bipolar, anorexia, ADHD, DM neuropathy, obesity Action: inhibits reuptake of serotonin Nursing Considerations:
do not use while taking MAOIs
may cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction, insomnia, palpitations
monitor closely for serotonin syndrome
concurrent use with certain medications may lead to QT prolongation
monitor mood changes and assess for suicidal ideation
monitor nutrition status
may cause elevated liver enzymes
instruct pt to maintain good oral hygiene
class: corticosteroids, anti-asthmatics, anti-inflammatory (steroid) Indication prophylactic asthma treatment Action: locally acting anti-inflammatory Nursing Considerations:
use cautiously with untreated infections and suppressed immune function
may cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression
monitor patient's respiratory status
may lead to decreased bone density
instruct patients using corticosteroids and bronchodilators that they need to use bronchodilators first.
instruct patient to stop smoking
class: loop diuretics Indication edema, hypertension Action: prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium. Nursing Considerations:
use caution with liver disease
may cause hypotension, dry mouth, excessive urination, dehydration, electrolyte abnormalities, metabolic alkalosis
hypokalemia may lead to increase risk of digoxin toxicity
monitor renal panel
use caution with other anithypertensives
causes arthritic symptoms/do not administer with aminoglycosides due to ototoxicity
class: analgesic adjuncts, therapeutic, anticonvulsants, mood stabilizers Indication seizures, peripheral neuropathy, neuropathic pain, prevention of migraines Action: exact method of action unknown Nursing Considerations:
may cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial edema, hypertension
monitor pt closely for changes in behavior and depression
assess seizure activity
assess pain level
patient should take medications exactly as prescribed
class: Aminoglycoside, anti-infectants Indication Treatment of gram negative infections when penicillin is ineffective Action: Inhibits bacterial protein synthesis Nursing Considerations:
causes tinnitus-hearing loss/do not administer with penicillin
use caution in renal impairment
assess for infection
obtain cultures prior to therapy
monitor liver function tests
monitor blood levels of drug
class: sulfonylureas, anti-diabetic Indication type 2 diabetes mellitus Action: stimulates release and sensitivity to insulin to lower blood glucose Nursing Considerations:
may cause aplastic anemias, hypoglycemia, photosensitivity, dizziness, drowsiness, headache, diarrhea
monitor CBC, assess for allergy to sulfonamides
beta blockers may create signs of hypoglycemia
instruct patient on how to check blood sugars and
instruct patient on importance of carrying source of sugar in case of hypoglycemia
class: pancreatics Indication Severe hypoglycemia, antidote for Beta Blockers and calcium channel blockers Action: Stimulates production of glucose, relaxes Gi tract, Nursing Considerations:
may cause anaphylaxis
may cause hypotension
assess for signs of hypoglycemia, neuro status
monitor serum glucose levels
teach patient signs of hypoglycemia
class: allergy, cold and cough remedies, expectorant Indication Cough suppression, expectorant Action: Decreases viscosity of and mobilizes secretions Nursing Considerations:
patient should avoid over the counter cold medications
assess lung sounds
maintain adequate fluid intake
class: Atypical Antipsychotic Indication Schizophrenia, mania, aggressive and agitated patient Action: Alters the effect of dopamine Nursing Considerations:
extrapyramidal symptoms
use caution in QT prolongation
may cause seizures, constipation, dry mouth, agranulosytosis
assess for hallucinations
monitor hemodynamics
monitor for neuroleptic malignant syndrome
monitor CBC with differential
class: antithrombotic Indication Venous thromboembolism prophylaxis and treatment, low dose used to ensure patency of IV catheters Action: increases the inhibitory effect of antithrombin on factor Xa Nursing Considerations:
monitor for signs of bleeding
monitor platelet count
may cause hyperkalemia
have patient report any signs of bleeding
class: vasodilator, anti-hypertensive Indication hypertension Action: arterial vasodilator Nursing Considerations:
may cause tachycardia, sodium retention, arrhythmias, angina
use caution with MAOIs
monitor blood pressure
instruct patient on how to take blood pressure
class: antihypertensives, diuretics Indication Hypertension, CHF, renal dysfunction, cirrhosis, glucocorticoid therapy Action: Increases sodium and water excretion produces arterial dilation Nursing Considerations: -May cause dizziness, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia, dehydration
Hypokalemia can increase risk for digoxin toxicity
Monitor blood pressure and intake and output
Monitor electrolyte levels
Patient should take medication at the same time each day even if feeling better
Instruct patient on how to take blood pressure
class: opioid agonists, nonopioid analgesic combinations Indication management of moderate to severe pain Action: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Nursing Considerations: -use caution with concurrent use of MAOI - avoid use within 14 days of each other
hypotension - monitor hemodynamics and respirations after administering
may increase ICP use caution with head trauma
Narcan is the antidote for overdose
do not exceed 4g of acetaminophen per day
class: opioid agonist Indication moderate to severe pain Action: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Nursing Considerations: -Assess BP, respirations, and pulse before and during administration - medication causes general CNS depression
Narcan is the antidote for overdose
use caution with concurrent use of MAOI - avoid use within 14 days of each other
may be used as an antitussive
advised to dilute with NS prior to administration and to administer slowly to decrease CNS depression
class: antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents (NSAIDS) Indication Mild to moderate pain, inflammatory states Action: Decreases pain and inflammation by inhibiting prostaglandins Nursing Considerations: -may cause GI bleeding, hepatitis, Stevens-Johnson Syndrome
may cause anaphylaxis
monitor for headache, nausea, vomiting, constipation
therapy should be discontinued after first sign of rash
monitor renal and liver labs
patient should avoid using alcohol
class: antirheumatics, ductus arteriosus patency adjuncts (IV only), nonsteroidal anti-inflammatory agents Indication Inflammatory disorders when patients do not respond to other medications Action: Decreases pain and inflammation by inhibiting prostaglandin synthesis Nursing Considerations: -Monitor for hepatitis and GI bleeding
Monitor for dizziness, drowsiness, and headache
Assess for anaphylactic reaction
Aspirin may decrease effectiveness
Monitor renal labs
Shake suspension before administration
Patient should wear sunscreen and protective clothing to protect against photosensitivity
class: antidiabetics, hormones Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (short acting) Nursing Considerations: -assess for symptoms of hypoglycemia or hyperglycemia
monitor body weight over time
may cause decreased inorganic phosphates, potassium, and magnesium
monitor blood sugars every 6 hours, monitor A1C every 3-6 months
class: antidiabetics, hormones Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (intermediate acting) Nursing Considerations: -assess for symptoms of hypoglycemia or hyperglycemia
monitor body weight over time
may cause decreased inorganic phosphates, potassium, and magnesium
monitor blood sugars every 6 hours, monitor A1C every 3-6 months
class: antidiabetics, hormones Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (long acting) Nursing Considerations: -assess for symptoms of hypoglycemia or hyperglycemia
monitor body weight over time
may cause decreased inorganic phosphates, potassium, and magnesium
monitor blood sugars every 6 hours, monitor A1C every 3-6 months
class: antidiabetics, hormones Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (rapid acting) Nursing Considerations: -assess for symptoms of hypoglycemia or hyperglycemia
monitor body weight over time
may cause decreased inorganic phosphates, potassium, and magnesium
monitor blood sugars every 6 hours, monitor A1C every 3-6 months
class: antidiabetics, hormones Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (insulin mixtures) Nursing Considerations: -assess for symptoms of hypoglycemia or hyperglycemia
monitor body weight over time
may cause decreased inorganic phosphates, potassium, and magnesium
monitor blood sugars every 6 hours, monitor A1C every 3-6 months
class: Antitubercular Indication tuberculosis Action: Inhibits synthesis of mycobacterial cell wall Nursing Considerations: -can cause jaundice
may cause peripheral neuropathy, seizures, hepatitis
patient should avoid high amounts of tyramine (pickled meats, aged/smoked meats, alcohol, exotic/aged cheese)
monitor liver function tests
complete full course of therapy (6-12 months)
often used in combination with Rifampin
class: nonsteroidal anti-inflammatory agents, nonopioid analgesics Indication pain Action: Pain relief due to prostaglandin inhibition Nursing Considerations: -may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness
should not exceed 5 days of therapy
bleeding risk increased with garlic, ginger, and ginkgo
may decrease effectiveness of hypertensive medications and diuretics
class: laxative Indication Constipation, portal-systemic encephalopathy Action: Draws water into the stool and softens stool, inhibits ammonia passing into the colon Nursing Considerations: -use caution with DM
may cause cramps, abdominal distention, hyperglycemia
assess mental status, ammonia levels, abdominal distention
patient should average 2-3 bowel movements per day
class: anticonvulsant Indication Seizures r/t epilepsy, bipolar Action: Inhibits sodium transport in neurons Nursing Considerations:
May cause suicidal thoughts, dizziness, behavior changes, nausea, vomiting, photosensitivity, rash, Stevens-Johnson Syndrome
Use caution with oral contraceptive use
Assess mental status
Assess for seizures
Do not discontinue use abruptly
class: anticonvulsants Indication Seizures Action: Decreases severity and incidence of seizures Nursing Considerations: -May cause suicidal thoughts, dizziness, weakness
May alter RBC, WBC, and liver function
May cause somnolence
Should be infused over 15 minutes
class: fluoroquinolone, Anti-infective Indication urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections Action: Inhibits DNA synthesis in bacteria Nursing Considerations: -contraindicated in allergies
may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
can cause seizures, arrythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome
may decreased of phenytoin
monitor renal panel
assess for infection, obtain cultures prior to therapy
monitor liver function tests
class: hormone Indication thyroid hormone replacement in hypothyroidism Action: replaces thyroid hormone increasing metabolism, promotes gluconeogenesis, stimulates protein synthesis, restores normal hormone balance and suppresses thyroid cancer Nursing Considerations: -assess pulse and monitor for tachyarrythmias and chest pain
monitor TSH levels
overdose is presented as hyperthyroidism
start with low doses and increase as indicated
therapy is lifelong
take directly after breast feeding
increases the effects of warfarin
class: ACE Inhibitor, anti-hypertensive Indication hypertension, management of CHF Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation Nursing Considerations: -Dry cough
1st dose hypotension
use cautiously with potassium supplements and potassium sparing diuretics.
use cautiously with diuretic therapy
administer 1 hour before meals
monitor blood pressure often
monitor weight and fluid status
monitor renal profile
monitor liver function tests
class: Mood Stabilizer Indication: mania Action: alters cation transport and neurotransmitter reuptake Nursing Considerations:
do not administer with NSAIDs
monitor drug blood levels frequently
may cause seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors
Ace Inhibitors may increase serum levels
instruct patient to maintain adequate fluid intake
therapeutic level: 0.5-1.5 mEq/L
class: antidiarrheal Indication acute diarrhea, decrease drainage post ileostomy Action: inhibits peristalsis, reduces the volume of feces while increasing the bulk and viscosity Nursing Considerations: -may lead to constipation - insure proper use
assess bowel function
assess fluid and electrolyte levels
class: Benzodiazepine Indication: anxiety, sedation, seizures Action: general CNS depression Nursing Considerations:
use caution with COPD and sleep apnea
avoid alcohol use
antidote is* Flumazenil (Romazicon)*
may cause apnea, cardiac arrest, bradycardia, hypotension
use caution with other CNS depressants
administer slowly and dilute to decrease complications
class: angiotensin II receptor antagonist, antihypertensives Indication hypertension, DM neuropathy, CHF Action: inhibits vasoconstrictive properties of angiotensin II Nursing Considerations: -may cause hypotension, tacycardia, angiodema, hyperkalemia
may increase digoxin levels
assess blood pressure and heart rate
assess fluid levels
monitor daily weights with CHF
monitor renal and liver
instruct patient on how to take blood pressure
class: minerals/electrolytes Indication: treatment of hypomagnesaemia, hypertension, preterm labor, torsade de pointes, asthma, anticonvulsant with eclampsia Action: magnesium plays a role in muscle excitability Nursing Considerations: -use caution with renal insufficiency
may cause decreased respiratory rate, arrythmias, hypotension, muscle weakness
monitor EKG and respiratory status
monitor Mg levels
ensure dosage with secondary practitioner
Calcium gluconate is the antidote -Magnesium toxicity results in respiratory depress and loss of deep tendon reflexes
class: osmotic diuretic Indication increased ICP, oliguric renal failure, edema, intraocular pressure Action: inhibits reabsorption of water and electrolytes by increasing osmotic pressure, excreted by kidneys Nursing Considerations:
may cause phlebitis at IV site
may cause dehydration, fluid and electrolyte imbalances
monitor neuro status
administer via a filter
class: Opioid Analgesic Indication moderate to severe pain, sedation Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. Nursing Considerations: -may cause alterations in mentation, hypotension, constipation, nausea, vomiting
assess BP, pulse, and respiratory rate prior to administration and frequently during administration
use caution if patient is receiving MAOIs
Narcan (naloxone) is the antidote for opioid agonists
can cause seizure
may increase pancreatic enzyme levels
assess bowel function
class: Anti-diabetic Indication: management of Type II DM, PCOS Action: decreases glucose production in the liver, decreases absorption, increases cellular insulin sensitivity. Nursing Considerations:
do not use with renal dysfunction, metabolic acidosis
may cause diarrhea, nausea, vomiting, lactic acidosis
monitor patient closely for ketoacidosis and lactic acidosis, discontinue medication immediately if acidotic
may cause metallic taste
instruct patient that medication does not cure diabetes
class: opioid analgesic Indication withdrawal symptoms, pain Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. Suppresses withdrawal symptoms. This depression also causes a decrease in the cough reflex and GI motility. Nursing Considerations: -use caution if patient is receiving MAO Inhibitors
may cause QT prolongation, hypotension, respiratory depression, dependence, confusion, sedation
assess pain, vital signs, bowel function
may increase pancreatic enzyme levels
assess withdrawal symptoms
class: oxytocic Indication treatment of post-partum hemorrhage Action: stimulates uterine muscles causing uterine contraction Nursing Considerations: -can cause hypertension, cramps, nausea, vomiting, dyspnea
monitor BP, heart rate, uterine response
assess calcium levels - effectiveness ↓ with hypocalcemia
monitor uterine bleeding and notify physician of any changes
class: central nervous system stimulant Indication: ADHD, narcolepsy Action: improves attention span in ADHD by producing CNS stimulation Nursing Considerations: -can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia
may decrease effects of Warfarin and Phenytoin
do not use with MAOIs
monitor cardiovascular system
monitor for behavioral changes
monitor for dependence
do not consume caffeinated beverages -"Drug Holiday" used to assess dependence and status
class: antiemetic Indication: prevention of nausea, vomiting, hiccups, migraines, gastric stasis Action: accelerates gastric emptying by stimulating motility Nursing Considerations:
don't use with GI obstruction
may cause extrapyramidal reaction, neurolyptic malignant syndrome, tardive dyskinesia, arrhythmias, blood pressure alterations, hematologic alterations, facial movements, sedation
can decrease effects of levodopa
assess nausea/vomiting
monitor liver function tests
Note 
Flashcard (95)