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desmopressin (antidiuretic hormone)

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desmopressin (antidiuretic hormone)

ADRs - hyponatremia, fluid retention, seizures, drowsiness, headache interventions - monitor fluid intake+output, sodium serum levels, and for diabetes insipidus client education - increases in weight or edema, report dyspnea, uncontrolled bleeding and ab discomfort

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heparin (factor Xa and thrombin inhibitor)

ADRs - hemorrhage, thrombocytopenia, hypersensitivity reactions Interventions - monitor for signs of hemorrhage (tachycardia and hypotension), platelet count client education - report petechiae, bruising, hematomas, or black tarry stools, calf pain, or swelling

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3

warfarin (vitamin K antagonist)

ADRs - hemorrhage, and toxicity (overdose) Interventions - monitor vitals + hematocrit, blood count, administer vitamin K for overdose client education - stop taking at first sign of hemorrhage, report petechiae, black tarry stools, or hematomas, wear med bracelet

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4

clopidogrel (antiplatelet ADP inhibitor)

ADRs - GI upset/pain, thrombotic thrombocytopenia pupura (TTP) Intervention - monitor for signs of GI bleeding, or hemorrhagic CVA client education - increase fluid intake, report gastric irritation, unusual bleeding, weakness, numbness, or easy bruising

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5

alteplase (thrombolytic)

ADRs - hemorrhage (intracranial, GI, sustained) Interventions - monitor for bleeding, neuro status, GI pain, limit needle sticks, and monitor vitals client education - report unusual or prolonged bleeding, headache, or unilateral weakness

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epoetin alfa (erythropoietic growth factor)

ADRs - HTN, seizures, cardio or cerebro accidents Interventions - monitor HgB, BP, tumor progression, start with low doses client education - frequent BP checks, report sudden chest pain, weakness, numbness, or worsening malignancy

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7

filgrastim (leukopoietic growth factor)

ADRs - leukocytosis, bone pain, fever Interventions - monitor CBC, give lower dose if WBC above 10,000, monitor temp, and for spleen enlargement client education - report bone pain, fever, ab pain/fullness

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8

oprelvekin (thrombopoietic growth factor)

ADRs - cardiac dysrhythmias, fluid retention, allergic reaction Interventions - monitor vitals, EKG, fluid intake+outtake, peripheral edema client education - report heart palpitations, rapid pulse, swelling in lower extremities

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9

captopril (ace inhibitor)

ADRs - severe HTN, dry cough, angioedema, hyperkalemia Interventions - begin w/ low dose, monitor BP, K levels, and cough client education - report cough, rash, sore throat, muscle twitching

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10

losartan (ARB)

ADRs - angioedema, dizziness, hypotension, insomnia Interventions - treat angioedema w/ epi, monitor BP and CNS side effects client education - report minor swelling of mouth, headaches, or dizziness

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11

eplerenone (aldosterone antagonist)

ADRs - hyperkalemia Intervention - monitor K levels, BUN, creatinine, and signs of hyperkalemia client education - No K+ supplements, report palpitations, and muscle twitching

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12

aliskiren (direct renin inhibitor)

ADRs - hyperkalemia, angioedema diarrhea, abdominal pain Interventions - monitor K levels, BUN, and creatinine + signs for hyperkalemia client education - No K+ supplements, report palpitations, and muscle twitching

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13

nifedipine (calcium channel blocker)

ADRs - reflex tachycardia, headache, facial flushing, arrhythmias Interventions - monitor HR, BP, and assist with ambulation client education - report rapid heart beat, swelling, dizziness, or HR less than 50

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14

doxazosin (alpha-1 blocker)

ADRs - ortho hypo, reflex tachycardia, headache Intervention - monitor for ortho HTN and report sig block of 20 or more mmHg and pulse 2-6 hrs after 1st dose client education - report dizziness, rapid HR, no hazardous activities for at least 12 hrs after

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15

atenolol and metroprolol (beta-blockers)

ADRs - bradycardia, reduced cardiac output + heart failure, rebound excitation interventions - monitor HR, vitals, and signs for heart failure client education - check pulse daily before meds, report SOB, night cough, or extremity edema

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16

reserpine (adrenergic neuron blocker)

ADRs - severe depression, bradycardia, ortho hypo, GI symptoms Interventions - monitor for signs of depression and give lowest dose possible (possible discontinuation) client education - report depression, no driving, move slowly to prevent worth hypo

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17

clonidine (centrally acting alpha-2 agonist)

ADRs- drowsiness, dry mouth, rebound HTN crisis Interventions - monitor for CNS effects client education -hard candies and gum minimize dry mouth effects

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18

carvedilol (alpha-beta blocker)

ADRs- dizziness, hypotension, bradycardia, and postural hypotension interventions - monitor BP and HR (report if less than 60) client education - report dizziness, check HR daily, report if HR is less than 60 bpm

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19

hydralazine (direct acting vasodilator)

ADRs - headache, reflex tachycardia, SLE like symptoms, fluid retention, heart failure Interventions - monitor HR and report tach, monitor joint pain, edema, and crackles in the lungs client education - report rapid HR, facial rash, joint pain, fatigue, edema

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20

hydrochlorothiazide (thiazide diuretic)

ADRs - electrolyte imbalance, hyperglycemia, and increased uric acid levels interventions - monitor serum electrolyte levels, blood glucose and uric acid client education - eat foods high in vitamin K+, report electrolyte imbalances, monitor blood glucose if diabetic

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21

furosemide (loop diuretic)

ADRs - electrolyte imbalance, hypotension, hyperglycemia interventions - monitor electrolyte, BP, blood glucose, and uric acid levels client education - eat foods high in K+, report weakness, dizziness, and monitor BP

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22

spironolactone (potassium sparing diuretic)

ADRs - hyperkalemia, menstrual irregularities, and impotence Intervention - monitor serum K levels and endocrine effects client education - report palpitations, irregular pulse, and avoid K+ supplements

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23

digoxin (cardiac glycoside)

ADRs- cardiac dysrhythmias, GI upset, CNS (fatigue, blurred vision) Interventions - monitor and report CNS effects and Gi symptoms, digoxin and serum K levels client education - report nausea, loss of appetite, heart palpitations, hyperkalemia

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24

dobutamine (sympathomimetics)

ADRs - tachycardia, dysrhythmias, and angina Intervention - monitor EKG and vitals client education - continuous monitoring and report chest pain asap

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25

milrinone (phosphodiesterase inhibitor)

ADRs - hypokalemia, cardiac dysrhythmias, hypotension, angina chest pain Interventions - monitor K levels, vitals, EKG, and chest pain client education - continued ECG rhythm monitoring and VS

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26

atorvastatin (HMG-CoA reductase inhibitor)

ADRs - myopathy, and hepatotoxicity Intervention - monitor for myopathy and liver tests client education - report muscle pain, ab pain, and jaundice

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27

gemfibrozil (fibrate)

ADRs - GI upset, gallstones, myopathy, liver toxicity intervention - monitor Gi symptoms, myopathy, gallstones, and liver function client education - report GI upset, inability to tolerate fried foods, muscle/joint pain

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28

nitroglycerin (nitrate)

ADRs - headache, ortho HTN, tachycardia, and decreased effectiveness over time Interventions - monitor BP and HR and for drug tolerance client education - report dizziness, move slowly, check pulse regularly

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29

albuterol (beta-2 agonist)

ADRs - chest pain, palpation, nervousness, restlessness Interventions - monitor and report dizziness, palpations, chest pain, and SOB client education - takes as prescribed, avoid caffeine, report tremors

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30

ipratropium (anticholinergic)

ADRs - dry mouth, increased intraocular pressure, and urinary retention Intervention - provide water, hard candy, and routine tests for glaucoma client education - suck on hard candy, sip water, report changes in urinary elimination

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31

theophylline (methylxanthine)

ADRs - rare but nausea, vomiting, diarrhea, seizures intervention - monitor plasma levels, HR, rhythm, and give activated charcoal for overdose client education - reduce or eliminate caffeine intake, periodic testing of drug levels

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32

beclomethasone dipropionate (glucocorticoid)

ADRs - hyperglycemia, PUD, infection, headache Intervention - monitor plasma drug levels, blood glucose, and give with food client education - use a spacer, take drug on alternate days, avoid NSAIDs, increase fluid intake

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33

prednisone (glucocorticoid)

ADRs - hyperglycemia, PUD, infection, headache Intervention - monitor plasma drug levels, blood glucose, and give with food client education - report weakness, weight gain, polyphagia, signs of infection

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34

fluticasone

class - glucocorticoids (flonase+flovent) mechanism - suppresses inflammation -> decreases edema in airways ADRs - hyperglycemia, PUD, infection, headache Intervention - monitor plasma drug levels, blood glucose, and give with food

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35

cromolyn (mast cell stabilizer)

ADRs - allergic reaction Intervention - administer epinephrine for allergic reactions client education - seek medical care for sudden rash, swelling of mouth

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36

montelukast (leukotriene modifier)

ADRs - zyflo can cause liver damage and suicidal ideation Interventions - monitor liver function and observe behavioral changes client education - report ab tenderness, nausea, and behavioral changes

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37

diphenhydramine (first gen antihistamine)

ADRs - drowsiness, dizziness, dry mouth, and constipation Interventions - monitor client while ambulating, give w/ food, high intake of fluids client education - take at bedtime, take w/ food, increase fluids and fiber, take laxative as needed

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38

cetirizine (second gen antihistamine)

ADRs - drowsiness, fatigue, dry mouth, nose, and throat Interventions - monitor client when ambulating and provide water client education - once daily, take frequent sips of water

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39

Phenylephrine (sympathomimetics)

ADRs - CNS effects, increased BP, tachycardia, palpations, rebound congestion Interventions - monitor for anxiety, BP, HR, administer only when needed client education - report prolonged tachycardia and have BP checked regularly

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40

codeine (opioid antitussives)

ADRs - drowsiness, sedation, GI distress, respiratory depression Interventions - drug w/ food or drink, diet w/ high fiber and fluids client education - avoid alcohol, take drug w/ food or milk, increase fiber and fluids

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41

dextromethorphan (nonopioid antitussive)

ADRs- drowsiness, sedation, GI distress, respiratory depression Interventions - drug w/ food or drink, diet w/ high fiber and fluids client education - take drug PRN for a short time, increase fluids and fiber intake

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42

guaifenesin (expectorant)

ADRs - dizziness, drowsiness, GI distress, and allergic reaction Intervention - give drug w/ food or 8oz water client education - change positions gradually, take w/food

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43

acetylcyseine (mucolytic)

ADRs - GI distress and bronchospasms interventions - monitor respiratory status and keep suction available client education - report difficulty breathing, worsening cough, drink 2,000+ mL water daily

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44

amoxicillin (penicillin)

ADRs - GI upset, allergic reaction, superinfection (candida) interventions - monitor GI, bloody/watery stools, monitor for allergic reactions or candida infections client education - report bloody, watery stool, mouth pain, vaginal burning, take w/ meals

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45

cephalexin (cephalosporin)

ADRs - Gi upset, cross allergy with PCN, thrombophlebitis, hemorrhage interventions - monitor for bloody/watery stools, diarrhea, assess for allergy, prothrombin, thrombophlebitis, BUN/ creatinine client education - take w/ food, report watery/bloody stools, unusual bleeding, burning, pain, or swelling at IV site

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46

Aztreonam (monobactam)

ADRs - thrombophlebitis, abdominal distress, rash and chest pain interventions - monitor site for redness, swelling, pain, assess bowel function, and anaphylaxis client education - report pain, swelling, and redness at the IV

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imipenem (carbapenem)

ADRs - GI upset, thrombophlebitis, superinfx, possible cross allergy interventions - monitor for nausea, redness/swelling at IV, assess for allergy, test BUN, AST, creatinine client education - report nausea, pain, swelling at IV, report all drugs to provider, mouth pain, vaginal irritation

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48

vancomycin

ADRs - nephrotoxicity, red man syndrome, ototoxicity, thrombophlebitis, hypotension interventions - monitor vital signs, trough levels, BUN/creatinine client education - report flushing, feelings of faintness, tinnitus, increase/decrease in urine output

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49

tetracyclines

ADRs - GI upset, hepatotoxicity, photosensitivity, superinfections interventions - monitor and report GI, pregnancy before, liver function tests, skin reaction client education - take w/ non-diary, report pregnancy, jaundice, abdominal pain, watery/bloody stools

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50

erythromycin (macrolide)

ADRs - GI upset, serious ventricular dysrhythmias, ototoxicity, superinfx interventions - monitor and report GI, question prolonged QT interval, monitor liver function, and ototoxicity client education - take w/ food, report palpitations, fainting spells, hearing loss, bloody/watery stool, mouth pain

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51

gentamicin (aminoglycoside)

ADRs - increased trough levels can cause ototoxicity and nephrotoxicity interventions - monitor for tinnitus, peak and trough, BUN/ creatinine, urine for protein casts, and I&O client education - report onset of tinnitus, headache, hearing loss, an increase of output of dilute urine

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52

ciprofloxacin (fluoroquinolone)

ADRs - mild CNS symptoms, GI upset, photosensitivity, Achilles tendon rupture, seizure, suicide, hepatotoxicity interventions - monitor and report GI upset, do not let pt. go out in the sun w/o covering their skin client education - decrease caffeine intake, report CNS and GI s/s, avoid sunlight exposure, increase fluid intake

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53

Trimethoprim/Sulfamethoxazole (sulfonamide)

ADRs - GI upset, allergic skin reaction, superinfx, SJS, blood cell deficiencies interventions - monitor and report rash, diarrhea, encourage fluids, monitor I&O, CBC, and urinalysis client education - take w/ food, report rash, hives, pallor, watery/bloody stool, diarrhea, pain in the mouth, increase fluids

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54

nitrofurantoin (urinary tract antiseptic)

ADRs - GI upset, chills/fever, SOB, permanent neuropathy, blood cell deficiency, brown urine, photosensitivity interventions - monitor and report GI, respiratory, nephropathy symptoms, I&O, and bowel function client education - take w/ milk or food, report dyspnea, fever, cough, numbness, fatigue, rinse mouth after suspension

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55

metronidazole (antiprotozoal)

ADRs - GI upset, darkening of urine, CNS, dry mouth interventions - monitor and report GI and CNS symptoms client education - take b4 or w/ a meal, report GI and CNS symptoms, avoid alcohol, metallic taste

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56

chloroquine (anitmalarial)

ADRs - visual symptoms, GI upset, headaches interventions - monitor and report visual and GI symptoms client education - wear sunglasses, report vision changes, take b4 or w/ meal

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57

amphotericin B (polyene antibiotic)

ADRs - infusion reaction, renal toxicity, hypokalemia, RBC suppression interventions - admin tylenol or benadryl before the drug, monitor vitals, BUN, creatinine, blood potassium, I&O, and weight client education - be aware of infusion rates, comply with lab testing, report increase in fatigue

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58

ketoconazole (azole)

ADRs - liver toxicity, GI upset, topical use (burning, itching, redness, hypersensitivity) Interventions - monitor liver tests, report severe GI symptoms, and CNS client education - report abdominal pain, jaundice, take w/ food, do not take antacids

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59

acyclovir (purine analog)

ADRs - topical (burning, itching) oral (GI, headache, vertigo), IV (renal toxicity/ CNS toxicity) interventions - monitor for severe skin reactions, CNS, BUN, creatinine, infuse IV slowly client education - avoid scratching, at application site, take w/ food, report restlessness, tremors, burning, pain

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60

Vaccines (Birth to 6 years)

hepatitis A + B, rotavirus, DTaP, Hib, MMR, polio, varicella

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61

Vaccines (7-18 yrs)

booster TDaP, HPV, meningococcal, flu

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62

Vaccines (Adults/Older adults)

flu, TD, pneumococcal, herpes zoster, varicella, hepatitis A/B, MMR

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63

methotrexate (folic acid analog)

bone marrow suppression which leads to low neutrophils, neutropenic precautions

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64

cytarabine (pyrimidine analog)

Nadir (following chemo when WBC+ platelets are lowest) when to look for s/s

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65

mercaptopurine (purine analog)

admin of antiemetics to prevent severe emesis and nausea

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66

cyclophosphamide (nitrogen mustard)

alopecia -> review mental status and self-esteem of patient

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67

carmustine (nitrosourea)

teratogenic which can cause cancer, malformations, or death to the fetus

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68

cisplatin (platinum compound)

increase hydration to 1/2 L before therapy and monitor I&O

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69

Doxorubicin (anthracycline)

overgrowth of candida/yeast, monitor for s/s of thrush

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70

vincristine (vinca alkaloid)

constipation in children which can lead to paralytic ileus (impaction)

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71

paclitaxel (taxane)

monitor neutrophil count prior to administration

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72

topotecan (topoisomerase inhibitor)

monitor platelet count, avoid needles and excessive pressure when taking BP, monitor LOC which can indicate a cranial bleed

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73

flutamide (androgen receptor antagonist)

give drug with GRH to stop testosterone production

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74

tamoxifen (estrogen receptor antagonist)

increased risk for endometrial cancer

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75

anastrozole (aromatase inhibitor)

check familial history for osteoporosis

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76

trastuzumab (monoclonal antibody)

HF effects on the ventricles of the heart and increased urination at night (nocturia)

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77

alfa 2a + beta - 1b (interferon)

ensure pharmacy sends the RIGHT drug

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78

imantinib (targeted antineoplastic drug)

fluid retention monitoring (pulmonary edema and ascities)

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79

aspirin+ibuprofen(COX-1+COX-2 Inhibitor)

ADRs - Reyes syndrome+salicylism (aspirin), GI upset, renal dysfunction interventions - monitor BUN+creatnine and I&O client education - report persistent gastric irritation, prolonged bleeding, weight gain, buzzing in ears, SOB

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80

celecoxib (selective Cox-2 inhibitor)

ADRs- GI upset, MI, CVA, and thromboembolic events interventions- monitor for gastric upset, I&O, rapid rise in BUN+creatnine, signs of MI client education- avoid alcohol, persistent gastric upset, changes in I&O, chest pain

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81

acetaminophen (nonopioid analgesic)

ADRs- liver toxicity/damage and hypertension interventions- monitor for symptoms of an overdose and prepare to administer acetylcysteine if overdose occurs. client education- limit intake to 4g a day, report any nausea or other GI discomfort, do not take many other OTC drugs while taking ace.

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82

tramadol (centrally acting nonopioid)

ADRs- sedation, GI upset, respiratory depression, urinary retention interventions - give w/food, monitor respirations and urinary retention client education - increase fiber intake, change positions slowly

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83

morphine (opioid agonist)

ADRs- respiratory depression, ortho hypotension, urinary retention interventions- monitor VS, respiratory status, I&O client interaction - PRN, increase fiber+fluid intake, report inability to urinate

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84

butorphanol / pentazocine (opioid agonist-antagonist)

ADRs- sedation, resp. depression, increases cardiac workload interventions- VS + resp. status, DO NOT give to pt. w/ MI client education - PRN, lie down when nausea, do not use for angina or use opioids

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85

naloxone (opioid antagonist)

ADRs- ventricular arrhythmias and abstinence syndrome interventions - monitor VS and EKG, have oxygen and emerg. equipment ready

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86

allopurinol (antihyperuricemic)

ADRs- cataracts, metallic taste, hypersensitivity syndrome, GI upset interventions - monitor CBC, uric acid, ophthalmic exams, give after meals client education - report rash, swelling, take w/ food, blurred vision, 3L/day hydration

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87

prednisone (glucocorticoid)

ADRs - adrenal suppression , hyperglycemia, myopathy, cushing's, osteoporosis interventions - monitor BG, I&O, ophthalmic exams client education - report increased stress, s/s of infection, weight gain, and increase weight bearing exercise

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88

methotrexate (nonbiologic DMARD)

ADRs- bone marrow suppression, pulmonary fibrosis, hepatotoxicity, GI upset interventions - monitor CBC, liver function+tests, s/s of infection client education - report ab bleeding, s/s of infection, avoid alcohol, 2L/day

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89

etanercept (biologic DMARD)

ADRs- psoriasis, pancytopenia, HF, SJS, pharyngitis interventions - assess for infection, s/s of HF, TB test prior to admin client education - report s/s of infection, s/s of HF, SOB

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90

raloxifene (SERM)

ADRs - thromboembolic events, stroke, vasomotor symptoms interventions - monitor bone density and s/s of thromboembolism client education - report calf pain or SOB, NO estrogen replace therapy, increase calcium, vitamin D, and weight bearing activity

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91

alendronate (bisphosphonate)

ADRs - GI upset, esophagitis, muscle+joint pain, eye pain/vision changes interventions - take w/ 8oz water, sit upright 30 min after admin, avoid calcium supplements, monitor for visions changes client education - avoid eating or drinking anything besides water 30 min after, report changes in swallowing or vision

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92

calcitonin-salmon (calcitonin)

ADRs- nasal dryness, hypersensitivity, hypocalcemia intervention - monitor Ca, intradermal allergy test prior to therapy, diet high in calcium client education - report rash, itching, swelling, muscle spasms, monitor for loss of bone density

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93

calcium citrate (calcium supplements)

ADRs- hypercalcemia, GI upset, kidney stones interventions - monitor serum Ca, I&O, decreased gastric mobility client education - teach signs of hypercalcemia, 1 hr b4 or 1-2 after other meds, 1hr after meal w/ 8oz water, do not exceed 600mg, high fiber diet

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94

cimetidine (histamine antagonist)

ADRs - impotence, aplastic anemia, pneumonia, arrhythmias interventions - monitor older clients for confusion client education - take meds as prescribed, avoid smoking, report signs of GI bleeding

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95

omeprazole (proton pump inhibitor)

ADRs- osteoporosis, headache, GI upset, hypomagnesemia, C. Diff interventions- monitor mag level, bone density, lowest dose/shortest duration client education - weight-bearing exercise, increase calcium, vitamin D, clear fluids

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96

sucralfate (mucosal protectant)

ADRS - constipation interventions - monitor bowel function, stool softener if needed - empty stomach admin 1 hr prior, avoid meds 2 hr before/after admin client education - increase fiber, fluids, exercise, report any signs of GI bleeding

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97

aluminum hydroxide (antacid)

ADRs - constipation (Al/Ca) diarrhea (mag), hypophosphatemia interventions - monitor bowel function, take w/ glass of water, monitor mag and phos levels client education - DO NOT take w/in 1-2 hrs of other meds, increase fiber, fluids, exercise, report GI bleed, pain, dirrhea

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98

misoprostol (prostaglandin-E analog)

ADRs - dysmenorrhea, uterine cramping, miscarriage, ab pain interventions - give w/ meals, monitor for severe bleeding, ab pain, diarrhea client education - report worsening diarrhea, plenty of clear fluids, report menstrual changes

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99

ondansetron (serotonin antagonist)

ADRs- serotonin syndrome, SJS, CNS symptoms interventions - by mouth or IV, monitor for persistent headache/dizziness, severe diarrhea, client education - report headache, dizziness, diarrhea, plenty of fluids

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100

dimenhydrinate (antihistamine)

ADRs - sedation, dry mouth, anticholinergic symp intervention - monitor when ambulating, bowel elimin patterns, VS, 30-60 min b4 activity client education - increase fluid, fiber, activity, urinate every 4 hrs

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