Sindhu's Medical News

Pavan Grover is THE HOTTEST MAN...No Doubt

2004-03-23T23:07:00.000-06:00

Pavan Grover is THE HOTTEST MAN...No Doubt

2004-03-23T23:01:00.000-06:00

Pavan Grover is THE HOTTEST MAN...No Doubt

ladies: dr. sanjay gupta has been featured in cosmo magazine since 1999 and has twice been named as one of people magazine's sexiest guys while being a medical correspondent for CNN, i do think that dr. grover will eventually become world famous just like sanjay should his career as an actor take off as well as his career as a writer.

dr sanjay gupta

2003-11-14T20:40:00.000-06:00

dr sanjay gupta

2003-11-14T20:27:00.000-06:00

="http://i.cnn.net/cnn/2002/HEALTH/parenting/08/19/school.anxiety.otsc/story.gupta3.jpg"

dr sanjay gupta

2003-11-14T20:05:00.000-06:00

http://i.cnn.net/cnn/2002/HEALTH/diet.fitness/10/30/gupta.fat.gene.otsc/story.gupta.gif

Renal Medications continued

2003-09-27T14:31:00.000-05:00

preventing organ rejection continued

mycophenolate motefil (cellcept) http://www.rocheusa.com/products/cellcept/pi.pdf

used in combination with cyclosporine and glucocorticoids.

major adverse effects include diarrhea, severe neutropenia, vomiting and sepsis.

associated with an increased risk of infection and malignancies.
absorption is decreased by the use of magnesium and aluminum antacids and by cholestyramine (questran, prevalite)
contraindicated in pregnancy.

muromonab-CD3 (orthoclone OKT3) http://www.orthobiotech.com/pdfs/okt3.pdf

used to prevent acute allograft rejection of kidney transplants
adverse reactions include fever, chills, dyspnea, chest pain and nausea and
vomiting.

antithymocyte globulin (atgam) http://www.pfizer.com/download/uspi_atgam.pdf

used to prevent rejection of renal transplants
usually administered with glucocorticoidss and azathioprine
adverse reactions include chills, fever, leukopenia, and skin reactions.

Renal Medications continued

2003-09-26T18:56:00.000-05:00

preventing organ rejection continued

dacliximab (zenapax) http://www.rocheusa.com/products/zenapax/pi.pdf

basiliximab (simulect) http://www.pharma.us.novartis.com/product/pi/pdf/simulect.pdf

used to prevent acute rejection of transplanted kidneys
used in combination iwth other immunosuppressants such as cyclosporine and glucocorticoids
administered by the IV route
contraindicated in the client with an allergy to protein

dacliximab (zenapax)

initial dose administered within 24 hours before transplanation

side effects include chest pain, GI distress, edema, shortness of breath, pain in the joints, and slow wound healing.

basiliximab (simulect)

initial dose administered within 2 hours before transplantation

side effects are similar to those of zenapax; additionally, headache, insomnia, dizziness can occur.

Cardiovascular medications

2003-09-26T18:16:00.000-05:00

anticoagulants

oral anticoagulants

anisinidione (miradon) http://www.rxlist.com/cgi/generic/miradon.htm

warfarin sodium (coumadin) http://www.rxlist.com/cgi/generic/warfarin.htm

parenteral anticoagulants

ardeparin (normiflo) http://www.drugdigest.org/DD/DVH/Uses/0,3915,46%7CNormiflo+%252D+No+longer+available,00.html

dalteparin (fragmin) http://www.rxlist.com/cgi/generic2/daltep_cp.htm

danaproid (orgaran) http://www.orgaran.com/

enoxaparin (lovenox) http://www.lovenox.com/

description

prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coaguability

used for thrombosis, pulmonary embolism, and myocardial infarction (MI)

contraindicated with active bleeding, except for disseminated intravascular coagulation (DIC), bleeding disorders or blood dsycrasias, ulcers, liver, and kidney disease and spinal cord or brain injuries

side effects

hemorrhage
hematuria
epitaxis
ecchymosis
bleeding gums
thrombocytopenia
hypotension

Cardiovascular medications continued

2003-09-26T17:58:00.000-05:00

heparin sodium (liquaemin sodium)

description

prevents thrombin from converting fibrinogen to fibrin
prevents thromboembolism
the therapeutic dose does not dissolve clots, but prevents new thrombus formation

blood levels

normal activated partial thromboplastin time (APTT) is 20 to 36 seconds
maintain APTT at 1.5 to 2.5 times normal
at therapeutic levels, heparin will increase the APTT by a factor of 1.5 to 2
APTT therapy shuld be measured every 4 to 6 hours during initial therapy, then on a daily basis
if the APTT is too long -- more than 80 seconds--the dosage should be lowered
if aPTT is too short-- less than 60 seconds-- the dosage should be increased
normal clotting time is 8 to 15 minutes; maintain the clotting time at 15 to 20 minutes

implementation

monitor clotting time and APTT
monitor platelet count
observe for bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool and petechiea
when administering heparin subcutaneously, inject into the abdomen using a small needle (25 to 28 gauage) at a 90 degree angle and do not aspirate or rub the injection site
instruct the client regarding measures to prevent bleeding
antidote:protamine sulfate

Cardiovascular medications continued

2003-09-26T17:46:00.000-05:00

anticoagulants

decreases prothrombin activity and prevents the use of vitamin K by the liver
used for long term anticoagulation
prolongs clotting time and is monitored by prothrombin time
used mainly to prevent thromboembolytic conditions such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation, thrombosis, myocardial infarction, or heart valve damage.
usually given for 2 to 3 months after an MI to decrease the incidence of deep vein thrombosisi and thromboembolism.

blood levels

average PT is 9.6 to 11.8 seconds
warfarin sodium prolongs the PT

international normalized ratio (INR)

the normal INR is 1.3 to 2.0
the INR is determined by multiplying the observed PT ratio (the ratio of the client's PT to a control PT) by a correction factor specific to a particular thromboplstin preparation used in the testing.
the treatment goal is to raise the INR to an appropriate value
an INR of 2 to 3 is appropriate fo rmost clients, although for some clients, the target INR is 3.0 to 4.5
if the INR is below the recommended level, warfarin sodium dose should be increased.
if the INR is above the recommended range, warfarin sodium dose should be reduced.

implementation

monitor PT and INR
observe for a bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool in the petechiae
instruct the client regarding measures to prevent bleeding
antidote: vitamin K phytonadione (aquamephyton)

Cardiovascular medications continued

2003-09-26T02:00:00.000-05:00

thromboembolytic medications

alteplase (activase, TPA, tissue plasminogen activator) http://www.gene.com/gene/products/information/cardiovascular/activase/index.jsp

anistrepteplase (eminase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6027%7CEminase,00.html

reteplase (retavase) http://www.retavase.com/retavase_pi.pdf

streptokinase (kabikinase, streptase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6238%7CKABIKINASE,00.html

urokinase (abbokinase) http://www.abbotthosp.com/prod/pdf/abbo.pdf

description

activate plasminogen; plasminogen generates plasmin (the enzyme that dissolves clots)
used early in the course of myocardial infarct (within 4 to 6 hours of the onset of the infarct) to restore blood flow, limit myocardial damage, preserve left ventricular function and prevent death.

contraindications

active internal bleeding
history of cerebrovascular accidents
intracranial problesm
intracranial surgery or trauma within the two previous months
history of thoracic, pelvic or abdominal surgery in the previous ten days.
history of hepatic or renal disease.
uncontrolled hypertension
recently required, prolonged cardiopulmonary resuscitation.

side effects

bleeding
dysrhythmias
fever
allergic reactions

implementation

obtain APTT, PT, fibrinogen level, hematocrit, and platelet count.
monitor vital signs
assess pulses
monitor for bleeding
monitor all excretions for occult blood.
monitor for neurological changes usch as slurred speech, lethargy, confusion and hemiparesis.
monitor for hypotension and tachycardia
avoid injections if possible
apply direct pressure over a puncture site for 20 to 30 minutes
handle teh client as little as possible when moving
instruct teh client to use an electric razor for shaving and to brush teeth gently.

Cardiovascular medications continued

2003-09-22T18:17:00.000-05:00

antiplatelet medications

abciximab (ReoPro) http://pi.lilly.com/reopro.pdf

aspirin (acetylsalicylic acid, ASA) http://www.nursespdr.com/members/database/ndrhtml/acetylsalicylicacid.html

clopidrogel bisulfate (plavix) http://www.sanofi-synthelabous.com/products/pi_plavix/pi_plavix.html

eptifibatide (integrilin) http://www.millennium.com/images/INTEGRILIN(r)insert.pdf

ticlopidine Hydrochloride (ticlid) http://www.rocheusa.com/products/ticlid/pi.pdf

description

inhibits the aggregation of platelets in teh clotting process, thereby prolonging the bleeding time.
may be used in conjunction with anticoagulants
used in the prophylaxis of long term complications after MI, coronary revascularization and CVAs.
contraindicated in bleeding disorders and known sensitivity.

side effects

gastrointestinal bleeding
bruising
hematuria
tarry stools

implementation

determine sensitivity before administration
monitor vital signs
instruct teh client to take medication with food if GI upset occurs
monitor bleeding time
monitor for side effects related to bleeding
instruct the client in the use of the medication
instruct the client to monitor for side effects related to bleeding and in the measures to prevent bleeding.

Cardiovascular medications continued

2003-09-22T16:54:00.000-05:00

positive inotropic/cardiotonic medications

amrinone (inocor):- used for short term managment of congestive heart failure in those who have not responded adequately to cardiac glycosides, diuretics, and vasodilators

http://www.drugs.com/xq/cfm/pageID_0/htm_001901/type_pros/bn_Inocor/micrpro_medex/qx/index.htm

milrinone (primacor):- used for short term management of congestive heart failure or may be given before heart transplantation.

http://www.primacor.com/

description

stimulates myocardial contractility and produces a positive inotropic effect

the increase in myocardial contractility increases cardiac, peripheral and kidney functions by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion; as a result, fluid retention in the lungs and extremities is decreased.

side effects

dysrhythmias
hypotension
thrombocytopenia

adverse reactions

hepatoxicity manifested by elavated liver enzyme levels
hypersensitivity manifested by wheezing, shortness of breath, pruritis, urticaria, clammy skin, and flushing.

implementation

monitor apical pulse and blood pressure
monitor for hypersensitivity
check lung sounds for wheezing and rales
monitor for edema
monitor for relief of congestive heart failure as noted by reduction in edema, lessening of dyspnea, orthopnea and fatigue
monitor electrolytes, liver enzymes, platelet count, and renal function studies, may decrease potassium and increase liver enzymes.

Cardiovascular medications continued

2003-09-22T16:13:00.000-05:00

cardiac glycosides

digoxin (lanoxin, lanoxicaps) http://www.rxlist.com/cgi/generic/dig.htm
digitoxin (crystodigin) http://www.usadrug.com/IMCAccess/ConsDrugs/Digitoxincd.shtml

description

inhibit sodium potassium pump, thereby increasing intracellular calcium, which causes the heart muscle fibers to contract more efficiently.

produces a positive inotropic action, which increases teh force of myocardial contractions

produces a negative chronotropic action which depresses the sinoatrial node (SA), reduces conduction of the impulse through the atrioventricular (AV) node, and slows the heart rate.

produces a negative dromotropic action that decreases the condution of the heart cells.

the increase in myocardial contractility increases cardiac, peripheral, and kidney functions by increasing cardiac output, decreasing preload, and improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion, as a result; fluid retention in the lungs and extremities is decreased.

used for CHF, atrial tachycardia, atrial fibrillation, and atrial flutter

contraindicated in ventricular dysrhythmias and second or third degree heart block

used with caution in clients with renal disease, hypothyroidism, and hypokalemia

side effects

anorexia, nausea vomiting,
headache
visual disturbances:-diplopia, blurred vision, yellow-green halos
photophobia
drowsiness
bradycardia
fatigue, and weakness

implementation

monitor for toxicity as evidenced by anorexia, nausea, vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions (PVCs), and tachydysrhythmias

monitor serum digoxin level, electrolyte balances and renal function tests
therapeutic digoxin range is 0.5 to 2.0 mg/ml and levels above 2.0 are toxic.

Cardiovascular medications continued

2003-09-17T20:07:00.000-05:00

thiazide diuretics

bendroflumethiazide (naturetin) htttp://www.drugdigest.org/DD/DVH/Uses/0,3915,6343%7CNadolol+and+Bendroflumethiazide,00.html

benzthiazide (exna) http://www.usadrug.com/IMCAccess/ConsDrugs/Benzthiazidecd.shtml

chlorothiazide (diuril) http://www.merck.com/product/usa/pi_circulars/d/diuril/diuril_orlsus_pi.pdf

hydrochlorothiazide (hydrodiuril) http://www.drugdigest.org/DD/DVH/Uses/0,3915,325%7CHydroDIURIL,00.html

hydroflumethiazide (saluron, diucardin) http://www.pharmacynetworkgroup.com/d/diucardin-description.htm

methyclothiazide (aquatensen, enduron) http://www.drugdigest.org/DD/DVH/Uses/0,3915,435%7CAquatensen,00.html

polythiazide (renese) http://www.pharmacynetworkgroup.com/d/renese-description.htm

thiazide like diuretics

chlorthalidone (hygroton, thalitone) http://www.pharmacynetworkgroup.com/i/hygroton-indications-dosage.htm

indapamide (lozol) http://www.pharmacynetworkgroup.com/d/lozol-description.htm

metolazone (zaroxolyn) http://www.drugdigest.org/DD/DVH/Uses/0,3915,445%7CZaroxolyn,00.html

quinethazone (mykrox, hydromox) http://www.usadrug.com/IMCAccess/ConsDrugs/Quinethazonecd.shtml

description

increased sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.

used for hypertension and peripheral edema.
used in clients with normal renal function
not effective for immediate diuresis
contraindicated in renal failure
used with caution in the client taking lithium because lithium toxicity can occur
used in caution in the client taking digoxin, corticosteroids, and hypoglycemic medications

side effects

hypercalcemia, hyperglycemia, hyperuricemia
hypokalemia, hyponatremia
hypovolemia
hypotension
headaches
nausea, vomiting
constipation
rashes
photosensitivity
blood dyscrasias

implementation

monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, glucose, calcium and uric acid levels
check peripheral extremities for edema
instruct the client to take medication in the morning to avoid nocturia and sleep interruption
instruct the client how to record the BP
instruct the client to eat foods rich in potassium
instruc the client on how to take potassium supplements if prescribed
instruct the client to take medication with food to avoid GI upset
instruct the client to change positions slowly to prevent orthostatic hypotension
instruct the client to use sunscreen when in direct sunlight
instruct the client with diabetes mellitus to have the blood glucose checked periodically.

Cardiovascular medications continued

2003-09-16T18:43:00.000-05:00

loop diuretics

furosemide (lasix) http://www.aventis-us.com/PIs/lasix_TXT.html#

bumetanide (bumex) http://www.rocheusa.com/products/bumex/pi.pdf

torsemide (demadex) http://www.rocheusa.com/products/demadex/pi.pdf

ethacrynic acid (edecrin) http://www.merck.com/product/usa/pi_circulars/e/edecrin/edecrin_pi.pdf

description

inhibit sodium and chloride reabsorption from the loop of henle and the distal tubule
they have little effect on the blood glucose; however, they cause marked depletion of water and electrolytes, increased uric acid levels, and cause the excretion of calcium
are more potent than the thiazide diuretics causing rapid diuresis thus decreasing vascular fluid volume, decreasing cardiac output and blood pressure.
used for hypertension, edema associated with CHF, hypercalcemia, and renal disease,
used with caution in the client taking digoxin and lithium
used with caution in the client taking aminoglycosides, anticoagulants, corticosteroids, and amphoterecin B

side effects

hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia
hypochloremia
thrombocytopenia
hyperuricemia
orthostatic hypotension
skin disturbances
ototoxicity and deafness
thiamine deficiency
dehydration

implementation

monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, calcium, magnesium, and uric acid levels
check the peripheral extremities for edema
monitor for signs of digoxin and lithium toxicity if the client is on these medications
instruct the client to take the medicaiton in the morning to prevent nocturia and sleep disruption
instruct the client on how to record the BP
instruct the client to eat foods rich in potassium
instruct the client to take potassium supplements as prescribed
instruct the client to take medication with food to prevent GI upset
instruct the client to change positions slowly to prevent orthostatic hypotension

Cardiovascular medications continued

2003-09-16T16:46:00.000-05:00

osmotic diuretics

mannitol (osmitrol) http://www.drugs.com/xq/cfm/pageID_0/brand_Mannitol/qx/index.htm

urea (ureaphil) http://www.drugs.com/xq/cfm/pageID_0/htm_001673/type_pros/bn_Ureaphil/micrpro_medex/qx/index.htm

description

increase osmotic pressure of the glomerular filterate, inhibiting reabsorption of water and electrolytes.
used for oliguria and to prevent renal failure
used to decrease intracranial pressure
used to decrease intraocular pressure in narrow angle glaucoma.
mannitol is used with chemotherapy to induce diuresis

side effects

fluid and electrolyte imbalances
pulmonary edema from the rapid shifts of fluid
nausea and vomiting
tachycardia from rapid fluid loss
hyponatremia and dehdyration

implementation

monitor vital signs
monitor weight
monitor urine output
monitor electrolyte levels
monitor lung and heart sounds for pulmonary edema
monitor for signs of dehydration
monitor neurological status
assess for signs of decreasing intracranial pressure if appropriate
change the client's position slowly to prevent orthostatic hypotension

Cardiovascular medications continued

2003-09-16T15:41:00.000-05:00

carbonic anyhydrase inhibitors

acetazolamide (diamox) http://www.wyeth.com/content/ShowLabeling.asp?id=96

dichlorphenamide (daranide) http://www.drugdigest.org/DD/DVH/Interactions/0,10923,550569%7CDaranide,00.html

methazolamide (neptazane) http://www.wyeth.com/content/ShowLabeling.asp?id=120

description

block the action of the carbonic enzyme anyhydrase needed to maintain acid-base balance.
inhibition of this enzyme, carbonic anyhydrase, cause increased sodium, potassium, and bicarbonate excretion
metabolic acidosis can occur with prolonged use
used to decrease intraocular pressure in open angle (chronic) glaucoma, to produce diuresis, and produce epilepsy
used to treat metabolic alkalosis
contraindicated in narrow angle or acute glaucoma.

side effects

hyperglycemia, hyperuricemia, hypercalcemia
hypokalemia
anorexia, nausea, vomiting
orthostatic hypotension
renal calculi
hemolytic anemia.

implementation

monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, glucose, calcium and uric acid levels
monitor mental status
instruct the client to monitor for signs of renal calculi

Cardiovascular medications continued

2003-09-16T10:19:00.000-05:00

potassium sparing diuretics

spironolactone (aldactone) http://www.pfizer.com/download/uspi_aldactone.pdf

amiloride (midamor) http://www.merck.com/product/usa/pi_circulars/m/midamor/midamor_pi.pdf

triamterene (dyrenium) http://www.pharmacynetworkgroup.com/d/dyrenium-description.htm

amiloride hydrochloride and hydrochlorothiazide (moduretic) http://www.merck.com/product/usa/pi_circulars/m/moduretic/moduretic_pi.pdf

spironolactone and hydrochlorothiazide (aldactazide) http://www.pharmacynetworkgroup.com/d/aldactazide-description.htm

description

act on the distal tubule to promote sodium and water excretion and potassium retention
used for edema and hypertension; to increase urine output; to treat fluid retention and overload associated with CHF, hepatic cirrhosis, or nephrotic syndrome; and for diuretic induced hypokalemia.
contraindicated in severe kidney or hepatic disease or in severe hyperkalemia
used with caution in the client with diabetes mellitus
used with caution in the client taking antihypertensives and lithium.
used with caution in the client taking angiotensin converting enzyme inhibitors, because hyperkalemia can result
used with caution in the client taking potassium supplements

side effects

hyperkalemia
nausea, vomiting, diarrhea
rash
dizziness
headache
dry mouth
photosensitivity
anemia
thrombocytopenia

implementation

monitor vital signs
monitor urine output
monitor for signs and symptoms of hyperkalemia such as nausea, diarrhea, abdominal cramps, tachycardia followed by bradycardia, peaked narrow T wave on the electrocardiogram (ECG) or oliguria
monitor for a potassium level greater than 5.1 mEq/L which indicates hyperkalemia
instruct the client to avoid foods high in potassium
instruct teh client to avoid exposure to direct sun-light
instruct the client to monitor for signs of hyperkalemia
instruct the client to avoid salt substitutes because they contain potassium
instruct the client to take with or after meals to decrease GI irritation

Cardiovascular medications continued

2003-09-16T09:50:00.000-05:00

peripherally acting alpha-adrenergic blockers

doxazosin mesylate (cardura) http://www.pfizer.com/download/uspi_cardura.pdf

prazosin (minipress) http://www.pharmacynetworkgroup.com/i/minipress-indications-dosage.htm

terazosin (hytrin) http://www.rxabbott.com/pdf/hytrin.PDF

guanadrel (hylorel) http://www.drugdigest.org/DD/DVH/Uses/0,3915,551674%7CHylorel,00.html

guanethidine (ismelin) http://www.pharmacynetworkgroup.com/i/ismelin-indications-dosage.htm

reserpin (serpasil) http://www.drugdigest.org/DD/DVH/HowToTake/0,3919,591%7CSerpasil,00.html

phenoxybenzamine (dibenzyline) http://www.drugdigest.org/DD/DVH/Uses/0,3915,538%7CDibenzyline,00.html

phentolamine mesylate (regitine) http://www.pharmacynetworkgroup.com/d/regitine-description.htm

tolazoline (priscoline) http://www.drugs.com/xq/cfm/pageID_0/htm_001658/type_pros/bn_Priscoline/micrpro_medex/qx/index.htm#citec00165809

description

decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased BP.
used to maintain renal blood flow
used to treat hypertension.

side effects

orthostatic hypotension
reflex tachycardia
sodium and water retention
GI disturbances
nasuea
vomiting
edema
weight gain
serpasil can cause depression, GI irritation, and impotence.

implementation

monitor vital signs
monitor for fluid retention and edema
instruct the client to change positions slowly to prevent orthostatic hypotension
instruct teh client how to monitor the BP
instruct the client to monitor for edema
instruct the client to decrease salt intake
instruct the client to avoid over the counter medications

Cardiovascular medications continued

2003-09-15T18:10:00.000-05:00

peripherally acting sympatholytics (adrenergic blockers)

clonidine (catapres) http://www.rxlist.com/cgi/generic/clonidin.htm

methyldopa (aldomet) http://www.pharmacynetworkgroup.com/i/aldomet-indications-dosage-1.htm

guanabenz (wytensin) http://www.drugdigest.org/DD/DVH/Uses/0,3915,307%7CWytensin,00.html

side effects

sodium and water retention
drowsiness, dizziness
dry mouth
bradycardia
edema
impotence
hypotension
depression

implementation

monitor vital signs
instruct the client not to discontinue medications, because abrupt withdrawal can cause severe rebound hypertension
monitor liver function tests.

Cardiovascular medications continued

2003-09-15T17:51:00.000-05:00

angiotensin converting enzyme inhibitors

benazepril (lotensin) http://www.benazepril.com

captopril (capoten) http://www.pharmacynetworkgroup.com/d/capoten-description.htm

enalapril (vasotec) http://www.rxlist.com/cgi/generic/enalap.htm

fosinopril (monopril) http://www.pharmacynetworkgroup.com/d/monopril-description.htm

lisinopril (prinivil, zestril) http://www.lisinopril.com/

moexipril (univasc) http://www.healthsquare.com/newrx/uni1469.htm

quinapril (accupril) http://www.accupril.com/

ramipirl (altace) http://www.altace.com/index_flash.asp

trandolapril (mavik) http://www.drugdigest.org/DD/DVH/Uses/0,3915,676%7CMavik,00.html

description

prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II
used to treat hypertension
avoid use with potassium supplements and potassium-sparing diuretics.

side effects

nausea, vomiting, diarrhea
persistent cough
hypotension
hyperkalemia
tachycardia
headache
dizziness, fatigue
insomnia
hypoglycemic reaction in the client to with diabetes mellitus
bruising, petechiae, bleeding
diminished taste

implementation

monitor vital signs
monitor protein, albumin, blood urea nitrogen, creatinine, blood cells, and potassium levels
monitor for hypoglycemic reactions in the client with diabetes mellitus
instruct the client to take captopril 20 minutes to 1 hour before a meal
monitor for bruising, petechiae, or bleeding with captopril
instruct the client not to discontinue medications becaues rebound hypertension can occur.
instruct the client not to take over the counter medications
instruct the client how to take the BP
instruct the client that if dizziness occurs and persists, to notify the physician
inform the client that the taste of food may be diminished during the first month of therapy.

Cardiovascular medications continued

2003-09-15T17:02:00.000-05:00

antianginal medications

isosorbide mononitrate (imdur, monoket) http://www.rxlist.com/cgi/generic/isomono.htm

isosorbide dinitrate ( iso-bid, isordil, isotrate, sorbitrate) http://www.drugdigest.org/DD/DVH/Uses/0,3915,550140%7CIsosorbide+Dinitrate,00.html

nitroglycerin (nitrostat, nitrogard, nitrong) http://www.nitroglycerin.com

nitroglycerin ointment (nitro-bid, nitrong, nitrodisc, nitro-dur) http://www.drugdigest.org/DD/DVH/Uses/0,3915,492%7CNitroglycerin+Ointment,00.html

pentaerythritol tetranitrate (pentylan duotrate, peritrate) http://www.clevelandclinic.org/heartcenter/pub/medications/search/default.asp?med_id=128&

description

produces vasodilation
decrease preload and afterload, and reduce mycardial oxygen consumption
contraindicated in the client with marked hypotension, increased intracranial pressure,or severe anemia.
used in caution with severe renal or hepatic disease.
avoid abrupt withdrawal of long acting preparations to prevent the rebound effect of severe pain from myocardial ischemia.

side effects

headache
orthostatic hypotension
dizziness, weakness
faintness
nausea, vomiting
flushing or pallor
confusion
rash
dry mouth
reflex tachycardia
paradoxical bradycardia

sublingual medications

monitor for vital signs
offer sips of water before giving, because dryness may inhibit medication absorption
instruct the client to place under the tongue and leave until fully dissolved
instruct the client not to swallow the medication
instruct the client to take one tablet for pain, and repeat every 5 minutes for a total of three doses.
instruct the client to seek medical help immediately if pain is not relieved in 15 minutes fter the three doses
inform the client that a stinging or biting sensation may indicate that the tablet is fresh
instruct the cleint to store the medication in a dark, tightly closed bottle.
instruct the client to check the expiration date on the medication bottle, because expiration can occur within 6 months of obtaining the medication.
instruct the client to take acetaminophen for a headache.

translingual medications

instruct the client to direct spray above oral mucosa
instruct the client to avoid inhaling the spray

sustained release medicatoins

instruct teh client to swallow and not to chew or crush the medication.

transmucosal-buccal medications

instruct the client to place between the upper lip and gum or in the buccal area between the cheek and gum.
inform the client that the medication will adhere to the oral mucosa and slowly dissolve

transdermal patch

instruct teh client to apply the patch to a hairless area, using a new patch and a differnt site each day.
as prescribed, instruct the client to remove the patch after 12 to 14 hours, allowing for 10 to 12 "patch free hours" each day to prevent tolerance
do not apply the patch on the chest in the area of defibrillator-cardioverter paddle placemtn, because skin burns can result.

topical ointments

instruct the client to remove the ointment on the skin from the previous dose.
instruct the client to squeeze a ribbon of ointment of teh prescribed lenght onto the applicator paper.
instruct the client to spread the ointment over a 6 x 6 inch area, using the chest, back, abdomen, upper arm, or anterior thigh (avoiding hairy areas), and cover with a plastic wrap.
instruct the client to rotate sites and to avoid touching the ointment when applying
do not apply teh ointment on the chest in the area of defibrillator-cardioverter paddle placement, because skin burns can result.

Cardiovascular medications continued

2003-09-14T16:49:00.000-05:00

beta-adrenergic blockers

acebutolol (sectral) http://www.medicinenet.com/acebutolol/article.htm

atenolol (tenormin) http://drs.yahoo.com/S=2766679/K=tenormin/v=2/SID=w/l=WS1/R=1/H=0/*-http://www.astrazeneca-us.com/cgi-bin/az_pi.cgi?product=tenormin&country=us

betaxolol (betoptic) http://www.medicinenet.com/betaxolol/article.htm

bisoprolol fumarate (zebeta) http://www.drugdigest.org/DD/DVH/Uses/0,3915,80%7CZebeta,00.html

carteolol (cartrol) http://www.drugdigest.org/DD/DVH/Uses/0,3915,105%7CCartrol,00.html

carvedilol (coreg) http://www.coreg.com/?a=86

esmolol (brevibloc) http://www.pharmacynetworkgroup.com/i/brevibloc-indications-dosage.htm

labetalol (normodyne, trandate, vescal) http://www.drugdigest.org/DD/DVH/Uses/0,3915,366%7CNormodyne,00.html

levobunolol (betagan) http://www.pharmacynetworkgroup.com/i/betagan-indications-dosage.htm

metipranolol (optipranolol) http://www.pharmacynetworkgroup.com/i/optipranolol-indications-dosage.htm

metoprolol (lopressor, toprol XL) http://www.metoprolol.com/

nadolol (corgard) http://www.pharmacynetworkgroup.com/d/corgard-description.htm

penbutolol (levotol) http://www.drugdigest.org/DD/DVH/SideEffects/0,3917,726%7CPenbutolol,00.html

pindolol (visken) http://www.drugdigest.org/DD/DVH/Uses/0,3915,546%7CVisken,00.html

propranolol (inderal) http://www.wyeth.com/content/ShowLabeling.asp?id=106

sotalol (betapace) http://www.betapaceaf.com/hcp/prod_info/betapacepi.htm

timolol (blocadren, timoptic) http://www.timolol.com/

description

inhibit response to beta-adrenergic stimulation, thus decreasing cardiac output
block the release of the catecholamines epinephrine and norepinephrine, thus decreasing the heart rate and blood pressure.
decrease the workload of the heart and decrease oxygen demands
used for angina, dysrhythmias, hypertension, migraine headaches, prevention of MI and glaucoma.
contraindicated in the client with asthma, bradycardia, CHF, severe renal or hepatic disease, hyperthyroidism, and CVA.
used in caution in the client with diabetes mellitus, because it may mask symptoms of hypoglycemia
used in caution in the client on antihypertensives.

side effects

bradycardia
bronchospasm
hypotension
fatigue
weakness
nausea, vomiting
dizziness
hyperglycemia
agranulocytosis
behavioral or psychotic response
depression
nightmares

implementation

monitor vital signs
hold the medication if the pulse or BP is not within the prescribed parameters
monitor for signs of CHF
assess for respiratory distress and for signs of wheezing and dyspnea
instruct the cleint to report dizziness, lightheadedness, or nasal congestion
insturct the client not to stop taking the medication because rebound hypertension, rebound tachycardia or an anginal attack can occur.
advise teh client on insulin that early signs of hypoglycemia, such as tachycardia, and nervousness can be masked by the beta blocker
instruct the client on insulin to monitor the blood glucose level
instruct the client to take a pulse and BP
instruct the client to change positions slowly to prevent orthostatic hypotension
instruct teh client to avoid over the counter cold medications and decongestants

Cardiovascular medications continued

2003-09-14T15:54:00.000-05:00

calcium channel blockers

amlodipine (norvasc) http://www.norvasc.com

bepridil (bepadin, vascor) http://www.ortho-mcneil.com/products/pi/pdfs/vascor.pdf

diltiazem (cardizem, cardizem SR) http://www.cardizem.com/

felodipine (plendil) http://www.astrazeneca-us.com/pi/plendil.pdf

isradipine (dynaCircc) http://www.pharmacynetworkgroup.com/d/dynacirc-description.htm

nicardipine (cardene) http://www.rocheusa.com/products/cardene/pi.pdf

nifedipine (procardia, procardia XL, Adalat CC) http://www.pfizer.com/download/uspi_procardia.pdf

nisoldipine (sular) http://www.pharmacynetworkgroup.com/sular-side-effects.htm

verapamil (calan, isoptin) http://www.rxlist.com/cgi/generic/verapsr.htm

description

decrease cardiac contractility (negative inotropic effect by releasing smooth muscle) and the workload of the heart, thus decreasing the need for oxygen
promote vasodilation of the coronary and peripheral vessels
used for angina, dysrhythmias or hypertension
used in caution in the client with CHF, bradycardia or AV block

side effects

bradycardia
hypotension
reflex tachycardia as a result of hypotension
dizziness
fatigue
peripheral edema
constipation
flushig of the skin
changes in liver and kidney function

implementation

monitor vital signs
monitor for signs of CHF
monitor liver enzyme levels
monitor kidney funciton tests
instruct the client not to discontinue the medication
instruct the client how to take a pulse
instruct teh client to notify the physician if a dizziness or fainting occurs
instruct the client not to crush or chew sustained release tablets

cardiovascular medications continued

2003-09-09T20:28:00.000-05:00

peripheral vasodilators

alpha adrenergic blocker

tolazoline (priscoline) http://www.drugs.com/xq/cfm/pageid_0/htm_001658/tgid_41/type_pros/bn_Priscoline/micrpro_medex/qx/index.htm

beta-adrenergic agonist

isoxsuprine (vasodilan) http://www.drugs.com/xq/cfm/pageID_0/htm_001359/type_pros/bn_Vasodilan/micrpro_medex/qx/index.htm

direct acting peripheral vasodilator

ergoloid mesylate (hydergine) http://www.healthsquare.com/newrx/hyd1198.htm

alpha blocker

doxazosin mesylate (cardura) http://www.pfizer.com/download/uspi_cardura.pdf
prazosin hydrochloride (minipress) http://www.pharmacynetworkgroup.com/i/minipress-indications-dosage.htm
terazosin hydrochloride (hytrin) http://www.rxabbott.com/pdf/hytrin.PDF

calcium channel blocker

nifedipine (procardia) http://www.pfizer.com/download/uspi_procardia.pdf
nimodipine (nimotop) http://www.univgraph.com/bayer/inserts/nimotop.pdf

hemorrheologic

pentoxifylline (trental) http://www.aventis-us.com/PIs/trental_TXT.html#
increases tissue perfusion and microcirculation

description

decrease peripheral resistance by exerting a direct action on the arteries or on both the arteries and veins
increase blood flow to the extremities.
used in peripheral vascular disorders of venous and arterial vessels
most effective for disorders resulting from raynaud's disease.
these medications may decrease some of the symptoms of cerebral vascular insuffiency.

side effects

light headedness, dizziness
postural hypotension
tachycardia
palpitations
flushing
GI distress

implementation

monitor vital signs, especially the BP and heart rate
monitor for orthostatic hypotension and tachycardia
monitor for signs of inadequate blood flow to the extremities such as pallor, coldness of the extremities and pain.
instruct the client that it may take longer up to 3 months for a desired therapuetic response.
advise the client not to smoke because smoking increases vasospasm.
instruct teh client to avoid aspirin or aspirin like compounds unless approved by the physician.
instruct the client to take the medication with meals if GI disturbances occur.
instruct teh client to avoid alcohol because alcohol may cause a hypotensive reaction.
encourage teh client to change positions slowly to avoid orthostatic hypotension.

cardiovascular medications continued

2003-09-09T16:00:00.000-05:00

antilipemic medications

description

reduce serum levels of cholesterol , triglycerides, or low density lipoproteins (LDL)
when cholesterol, triglycerides and LDL are elevated, the client is at increased risk for coronary artery disease.
in many cases, diet alone will not lower blood lipid levels; therefore antilipemic medications will be prescribed.

bile sequestrants

bile acid sequestrants

cholestyramine (questran) http://www.rxlist.com/cgi/generic3/cholestyramine.htm
colestipol (colestid) http://www.rxlist.com/cgi/generic/colestipol.htm

description

binds with acids in the intestines
bile acid sequestrants should not be used as the only therapy in clients with elevated triglycerides, because they raise triglyceride levels.

side effects

constipation and peptic ulcer

implementation

cholestyramine (questran) comes in a gritty powder that must be mixed thoroughly in juice or water before administration
monitor the client for early signs of peptic ulcer such as nausea and abdominal pain and distention
instruct the client that medication must be taken with and followed by sufficient fluids.

HMG-CoA reductase inhibitors

atorvastatin (lipitor) http://www.lipitor.com
cerivastin (baycol) http://www.fda.gov/cder/drug/infopage/baycol/default.htm
fluvastatin (lescol) http://www.pharma.us.novartis.com/product/pi/pdf/Lescol.pdf">
lovastatin (mevacor)http://www.merck.com/product/usa/pi_circulars/m/mevacor/mevacor_pi.pdf
rosuvastatin (crestor) http://www.crestor.com/strong>
simvastatin (zocor) http://www.zocor.com
pravastatin (pravachol) http://www.rxlist.com/cgi/generic/pravast.htm

description

lovastatin (mevacor) is highly protein bound and should not be administered with anticoagulants
lovastatin should not be administered with lopid
lovastatin should be used in caution to clients who take immunosuppresant medications

side effects

nausea
vomiting
abdominal pian or cramps
flatulence
dizziness
headaches
blurred vision
rash
pruritis
elevated liver enzymes
causes GI disturbances, headaches, muscle cramps, and fatigue

implementation

monitor serum liver enzymes
instruct the client to receive an annual examination because the medication causes cataract formation
if lovastatin is not effective in lowering the lipid level after 3 months, it should be discontinued

other antilipemic medications

clofibrate (atromid-s) fenofibrate (tricor) http://www.rxlist.com/cgi/generic3/fenofibrate.htm
gemfibrozil (lopid) http://www.pharmacynetworkgroup.com/d/lopid-description.htm
nicotinic acid (niacor, niacin)

respiratory medications

2003-09-09T00:30:00.000-05:00
bronchodilators

bronchodilators:sympathomimetics

beta-receptor agonists

albuterol (proventil, ventolin)
bitoletrol mesylate (tornalate)
ephedrine sulfate
epinephrine (base) suspension (sus-phrine)
epinephrine (asthmahaler mist)
epinephrine bitratrate (bronkaid suspension mist)
epinephrine (racemic) (vaponefrin)
epinephrine hydrochloride (adrenalin chloride)
ethylnorepinephrine (bronkopherin)
isoetharine hydrochloride (bronkosol)
isoetharine mesylate (bronkometer)
isoproterenol hydrochloride (isuprel glossets, isuprel mistometer)
isoproterenol sulfate (medihaler-iso)
metaproterenol sulfate (alupent, metaprel)
pirbuterol acetate (maxair, autoinahler)
salmeterol (serevent)
terbutaline sulfate (brethine, bricanyl, brethaire)

anticholinergic

ipratropium bromide (atrovent)

bronchodilator:xanthines

aminophylline (generic, truphylline, phyllocontin)
theophylline
theophylline (aerolate, slo-phyllin, theolair)
theophylline (theo-dur, slo-bid, theo-24, uni-dur, uniphyl)
oxitriphylline (choledyl, choledyl SA)

description

sympathomimetic bronchodilators dilate teh airways of the respiratory tree, making air exchange and respiration easier for the client, and relax the smooth muscle of the bronchi.
xanthine bronchodilators stimulate the central nervous system and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscles.
used to treat allergic rhinitis and sinusitis, acute bronchospasm, acute and chronic asthma, bronchitis, chronic obstructive pulmonary disease, and emphysema.
contraindicated in individuals with hypersensitivity, peptic ulcer disease, severe cardiac disease and cardiac dysrhthmias, hyperthyroidism, and uncontrolled seizure disorders
used in caution in clients with hypertension, diabetes mellitus, and narrow angle glaucoma
theophylline increases the risk of digitalis toxicity and decreases the effects of lithium and phenytoin (dilantin)
if theophylline and a beta adrenergic agonist are administered together, cardiac dysrhythmias may result
beta blockers cimetidine (tagamet) and erythromycin increase the effects of theophylline
barbituates and carbamazepine (tegretol) decrease teh effects of theophylline

side effects

palpitations
tachycardia
dysrhythmias
restlessness, nervousness, tremors
anorexia, nausea and vomiting
headaches, and dizziness
hyperglycemia
decreased clotting time
mouth dryness and throat irritation with inhalers
tolerance and paradoxical bronchoconstriction with inhalers

implementation

assess vital signs
monitor for cardiac dysrhythmias
assess for cough, wheezing, decreased breath sounds, and sputum production
monitor for restless and confusion
provide adequate hydration
administer the medication at regular intervals around the clock to maintain a sustained therapeutic level
administer oral medications with or after meals to decrease GI irritation
instruct the client not to crush enteric coated or sustained release tablets or capsules
instruct the client to avoid caffeine products such as coffee, tea, cola and chocolate
instruct the client in the side effects of bronchodilators
instruct the client to monitor the pulse and to report any abnormalities to the physician
instruct the client how to use an inhaler or nebulizer and how to monitor the amount of medication remaining in an inhaler canister
instruct the client to avoid over the counter medications
instruct the client to stop smoking and provide information regarding support services
instruct the client with diabetes mellitus to monitor blood glucose levels
instruct the client with asthma to wear a medic-alert bracelet
monitor for a therapeutic serum theophylline level of 10 to 20 mg/ml
note that toxicity is likely to occur when the serum level is greater than 20 mg/ml
Iv aminophylline or theophylline preparations should be administered slowly and always via an infusion pump.

respiratory medications continued

2003-09-08T22:13:00.000-05:00
glucocorticoids medication continued

bethamethasone (celestone)
cortisone (cortone)
fludrocortisone (florinef)
hydrocortisone (cortef)
triamcinolone (aristocort, kenacort)
dexamethasone (decadron)
methylprednisolone (depo-medrol, solu-medrol)
prednisolone (delta-cortef, prelone)
prednisone (deltasone, orasone, and meticorten)

description

produce metabolic effects
alter the immune response and suppress inflammation
promote sodium and water retention and potassium excretion
produce antiinflammatory, antiallergic and antistress effects
may be used as replacement for adrenocortical insuffiency

side effects

hyperglycemia
hypokalemia
sodium and water retention
edema
cause muscle wasting, osteoporosis, growth retardation in children, peptic ulcer, increased serum glucose levels, hypertension, convulsions, mood swings, cataracts, glaucoma, fragile skin, hirsutism, altered fat distribution.
masks the signs and symptoms of infection.

contraindications and cautions

contraindicated in hypersensitivity, psychosis, and fungal infections.
use with caution in diabetes mellitus
dexamethasone (decadron) decreases the effects of oral anticoagulants and oral antidiabetic agents
increase the potency of medications taken concurrently, such as aspirin, and nonsteroidal antiinflammatory drugs (NSAIDS), thus increasing the risk of GI bleeding and ulceration
use of potassium wasting diuretics increases potassium loss, resulting in hypokalemia.
barbituates, phenytoin (dilantin) and rifampin (rifadin) decrease the effect of prednisone
the action of dexamethasone (decadron ) is decreased by the use of phenytoin (dilantin), theophylline, rifampin (rifadin), barbituates and antacids
NSAIds, aspirin, and estrogen increase the effect of dexamethasone (decadron)
should be used with extreme caution in clients with infections because they mask the signs and symptoms of an infection
advise the client to wear a medic-alert bracelet.

implementation

monitor vital signs
monitor serum electrolytes and blood glucose level
monitor for hypokalemia and hyperglycemia
monitor I and O, weight and edema'
monitor for hypertension
check the client's medical history for glaucoma, cataracts, peptic ulcer, mental health disorders or diabetes mellitus
monitor the older client for signs and symptoms of increased osteoporosis
monitor for changes in muscle strength
prepare a schedule for the client on short term, tapered doses.
instruct the cleint to take it at mealtime or with food
advise the client to eat foods high in potassium
instruct the client to avoid individuals with respiratory infections
advise the client to inform all health care providers of taking the medication
instruct the client to report signs and symptoms of a medication overdose or cushing's syndrome, including a moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, and menstrual irregularities
note that the client may need additional doses during periods of stress such as surgery
instruct the client not to stop the medication abruptly, as abrupt withdrawal can result in severe adrenal insufficiency
advise the client to consult with the physician before receiving vaccinations
advise the client to wear a medic-alert bracelet

2003-09-07T23:10:00.000-05:00

respiratory medications continued

2003-09-07T22:44:00.000-05:00
glucocorticoids medication continued

mineralocorticoids

fludrocortisone (florinef)

description

steroid hormones that enhance the reabsorption of sodium and chloride and promote teh excretion of potassium and hydrogen from the renal tubules, thereby, helping to maintain fluid and electrolyte balance.
used for replacement therapy in primary and secondary adrenal insufficiency in Addison's disease.

side effects

sodium and water retention
hypokalemia
hypocalcemia
increased susceptibility to infection
delayed wound healing
GI distress
diarrhea or constipation
increased appetite
weight gain
insomnia
mood swings
abdominal distention

implementation

monitor vital signs
monitor weight
monitor electrolytes and calcium levles
instruct the client to take the medication with milk
instruct the client to consume a high potassium diet
instruct the client not to stop taking the medication abruptly
instruct the physician to notify the physician if signs of infection, muscle aches, sudden weight gain or headaches occur
instruct the client to avoid exposure to disease or trauma.

respiratory medications continued

2003-09-07T22:34:00.000-05:00
inhaled non steroidal antiallergy agents

cromolyn sodium ( intal)
nedocromil (tilade)

description

an antiasthmatic, antiallergic, and mast cell stablizer that inhibits mast cell release after exposure to antigens
used for the treatment of allergic rhinitis, bronchial asthma, and exercised-induced bronchospasm.
contraindicated in cilents with known hypersensitivity
oral cromolyn sodium is used with caution in clients with impaired hepatic or renal function

side effects

cough or bronchospasm after inhalation
nasal sting or sneezing after inhalation
unpleasant taste in teh mouth

implementation

monitor vital signs
monitor respirations and assess lung sounds for rhonchi, wheezing and rhales.
instruct the client to drink a few sips of water before and after inhalation to prevent cough and unpleasant taste in the mouth.
administer oral capsules (cromolyn sodium) atleast 30 minutes before meals.
instruct the client not to discontinue the medicatin abruptly because a rebound asthmatic attack can occur.

luekotrine modifiers

montelukast (singulair)
zafirlukast (accolate)
zileuton (zyflo)

description

used in the prophylaxis and treatment of chronic bronchial asthma
not used for acute asthma episodes
inhibits bronchoconstriction caused by specific antigens
reduces airway edema and smooth muscle constriction
contraindicated in hypersensitivity and in breastfeeding mothers
used with caution in clients with impaired hepatic function
coadministration of inhaled glucocorticoids increases the risk of upper respiratory infection

side effects

headache
nausea and vomiting
dyspepsia
diarrhea
generalized pain, myalgia
fever
dizziness

implementation

monitor vital signs
assess lung sounds for rhonchi, wheezing, and rales
assess liver funciton tests
monitor for cyanosis
instruct the client to take the medication 1 hour before or 2 hours after meals.
instruct the client to increase fluid intake
instruct the client not to discontinue medication and to take it as prescribed even during symptom free periods,

respiratory medications continued

2003-09-06T17:35:00.000-05:00
antihistamines

astemizole (hismanal)
azatadine maleate (optimine)
azelastine hydrochloride (astelin)
brompheniramine maleate (dimetane)
cetirizine hydrochloride (zyrtec)
chlorpheniramine maleate (aller-chlor, chlor-trimeton)
clemastine fumarate (tavist)
cyprophetadine hydrochloride (periactin)
dexchlorpheniramine maleate (polaramine)
diphenhydramine (benadryl)
doxylamine succinate (unisom)
fexofenadine (allegra)
loratadine (claritin)
methyldilazine hydrochloride (tacaryl)
phenindamine tartrate (nolahist)
pyrilamine maleate (nisaval)
tripelennamine citrate or hydrochloride (PBZ-SR)
triprolidine hydrochloride (myidil)

description

called histamine antagonists or h1 receptor blockers, these medications compete with histamine for receptor sites, thus preventing a histamine response.
when the h1 receptor is stimulated, the extravascular muscles, including those lining the nasal cavity are constricted.
decrease nasopharyngeal secretions by blocking the h1 receptor and decrease nasal itching that causes sneezing
used for the comon cold, rhinitis, nausea and vomiting, motion sickness, uriticaria and as sleep aid
can cause central nervous system depression if taken with alcohol, narcotics, barbituates, or hypnotics
used with caution in clients with chronic obstructive pulmonary disease because of their drying effect
diphenhydramine (benadryl) has an anticholinergic effect and shuold be avoided in clients with narrow angle glaucoma

side effects

drowsiness and fatigue
dizziness
urinary retention
blurred vision
wheezing
constipation
dry mouth
GI irritation
hypotension
hearing disturbances
photosensitivity
nervousness and irritability
confusion
nightmares

implementation

monitor vital signs
monitor for signs of urinary dysfunction
administer with food or milk
avoid subcutaneous injection and administer intramuscular injection in a large muscle if the IM route is prescribed
insturct the client to avoid hazardous activities, alcohol and other CNS depressants
instruct the client taking medication for motion sickness to take the medication 30 minutes before the event, and then before meals and at bedtime during the event.
instruct the client to suck on hard candy or ice chips for dry mouth.

respiratory medications continued

2003-09-06T17:06:00.000-05:00
nasal decongestants

oxymetazoline hydrochloride (afrin)
phenylephrine HCL (neo-synephrine)
phenylpropranolamine hydrochloride (dimetapp)
pseudoephedrine hydrochloride (sudafed)
xylometazoline hydrochloride (otrivin)

description

stimulate the alpha-adrenergic receptors, thus producing vasoconstriction of the capillaries within the nasal mucosa
shrink nasal mucosaal membranes and reduce fluid secretions
used for allergic rhinitis, hay fever, and acute coryza (profuse nasal discharge)
contraindicated or used in caution with clients with hypertension, cardiac disease, hyperthyroidism, and diabetes mellitus
nasal decongestants can cause tolerance and rebound nasal congestion (vasodilation) caused by irritation of the nasal mucosa and should not be used for more than 48 hours.

side effects

frequent use of decongestants, especially nasal sprays or drops can result in tolerance and irritation of the nasal mucosa
nervousness
restlessness
hypertension
hyperglycemia

implementation

assess teh client for exisiting medical orders
assess the client for cardiac dysrhythmias
monitor blood glucose levels
instruct the clients to avoid caffeine in large amounts because it can increase restlessness and palpitations
instruct the client in the importance of limiting the use of nasal sprays and drops.

respiratory medications continued

2003-09-06T16:48:00.000-05:00
expectorants and mucolytic agents

expectorants

guaifenesin (glycerylguaiacolate)

mucolytic

acetylcysteine (mucomyst)

description

loosen bronchial secretions so that they can be eliminated without coughing
used for dry, unproductive cough and to stimulate bronchial secretions
mucolytic agents with dextromethorphan should not be used with clients with COPD because they suppress the cough
acetylcysteine (mucomyst) can increase airway resistance and should not be used in clients with asthma.

side effects

GI irritation
skin rash
oropharyngeal irritation

implementation

instruct the client to take medication with a full glass of water to loosen mucusinstruct the client to maintain an adequate fluid intake
encourage the clietn to cough and deep breath
acetylcysteine (mucomyst), administered by nebulization, should not be mixed together with another medication
if acetylcysteine is administered with a bronchodilator, the bronchodilator should be administered 5 minutes before the acetylcysteine.
monitor for side effects of acetylcysteine such as nausea and vomiting, stomatitis, and runny nose.

respiratory medications continued

2003-09-06T16:22:00.000-05:00
antitussives

narcotics

codeine, codeine phosphate, codeine sulfate, hydrocodone bitartrate (hycodan)

nonnarcotics

dextromethrophan hydrochloride (benylin, robitussin DM)
diphenhydramine hydrochloride (benadryl, benylin cough syrup)

description

act on the cough control center in the medulla to suppress the cough reflex
used for a cough that is nonproductive and irritating

side effects

dizziness, drowsiness, sedation
GI irritation
nausea
dry mouth
constipation
respiratory depression

implementation

instruct the client that if the cough lasts longer than 1 week and a fever or rash occurs, the physician should be notified.
encourage the clietn to take adequate fluids with the medication
encourage the clietn to sleep with the head of the bed elevated
instruct the clietn to avoid hazardous activities
note that drug dependency can occur
avoid administration to the client with a head injury or post operative cranial surgery
avoid administration to the client using narcotics, sedatives, barbituates, or antidepressants, because CNS depression can occur
instruct the client to avoid the use of alcohol.

respiratory medications continued

2003-09-06T16:05:00.000-05:00
narcotic agonist

naloxone hydrochloride (narcan)

description

reverses respiratory depression in narcotic overdose
avoid use in nonnarcotic respiratory depression

side effects

CNS depression,
nausea, vomiting
tremors
sweating
increased blood pressure
tachycardia

implementation

assess vital signs, especially respirations
have oxygen and resuscitative equipment available during administration

use of an inhaler

client instructions

if two different inhaled medications are prescribed, and one of the medicaton contains a glucocorticoid (corticosteroid), administer the bronchodilator first and the corticosoteroid second.
wait 5 minutes after the bronchodilator before inhaling the corticosteroid.

tuberculosis medications

descripiton

the most effective method for treating the disease and preventing transmission
treatment of identified lesions depends on whehter the individual has active disease or has been exposed to the disease
treatment is difficult because the bacterium has a waxy substance on the capsule, which makes penetration and destruction difficult.
the use of a multiple medication regimen destroys organisms as quickly as possilbe and minimizes teh emergence of medications to which the organism is susceptible.
individuals with active TB are treated for 6 to 9 months; however, clients with human immunodeficiency virus (HIV) infection will be treated for a longer period.
after the infected individual has received the medication for 2 to 3 weeks, the risk of transmission is greatly reduced.
most clients have negative sputum cultures after 3 months with compliance to medication therapy
individuals who have been exposed to active TB are treated with preventive isoniazid for 6 to 9 months upto 1 year.

first or second line medications

first line medications provide the most effective antituberculosis activity
second line medications are used in combination with first line medications but are more toxic
current infecting organisms are proving resistant to standard first line medications and the resistant organisms develop becuase the individuals with the disease fail to complete the course of treatment; surviving bacteria adiapt to the medication and becoem resistant
multidrug therapies are instituted because of the persistent organisms.

multidrug resistant tuberculosis (MDR-TB)

occurs when a client receiving two medications (first line and second line medications) discontinues one of teh medications without the physician's knowledge.
the client briefly experiences some response from teh single medication, but then large numbers of resistant organisms begin to grow
the client, infectious again, transmits the drug resistant organism to other individuals
as this event is repeated, an organism develops that is resistant to many of the first line tuberculosis medications.

respiratory medications continued

2003-09-05T23:44:00.000-05:00
first line medications for TB continued

isoniazid

description

bactericidal
inhibitis synthesis of mycolic acids and acts to kill actively growing organisms in the extracellular environment
inhibits growth of dormant organisms in the macrophages and caseating granulomas
active only during cell division
used in combination with other antitubercular medications

contraindications and cautions

contraindicated in clients with hypersensitivity or with acute liver disease
use in caution in cilents with chronic liver disease or renal impairment
used in cuation with clients taking niacin, nicotinic acid
used in caution with clients taking hepatotoxic medications because the risk for hepatotoxicity increases
isoniazid may increase the risk of toxicity for carbamazepine (tegretol) and phenytoin (dilantin)
isoniazid may decrease ketoconazole (nizoral) concentrations

side effects

hypersensitivity reactions
peripheral neuritis
neurotoxicity
hepatotoxicity
pyridoxine (vitaminb6) deficiency
irritation at injection site with IM administration
nausea and vomiting
dry mouth
dizziness
hyperglycemia
increased liver function tests
hepatitis

implementation

assess for hypersensitivity
assess for hepatic dysfunction
assess for sensitivity to niacin, nicotinic acid
monitor for liver function tests
monitor for signs of hepatitis, such as anorexia, nausea, vomiting, weakness, fatigue, dark urine, jaundice, if these symptoms persists, withhold the medication and notify the physician.
monitor for bleeding, tingling, numbness
assess mental status
monitor for visual changes and notify the physician if they occur
assess for dizziness and initiate safety precautions
monitor complete blood count and blood glucose levels
administer 1 hour before and 2 hours after a meal because food may delay absorption
administer atleast one hour before antacids especially those antacids that contain aluminum

client education

instruct the client not to skip doses and to take medication for the full length of the prescribed therapy
instruct teh client not to take any other medication without consulting the physician.
advise the client about the importance of follow up visits, vision testing and laboratory tests.
instruct the client to avoid alcohol
advise the client to take medication on an empty stomach with 8 ounces of water 1 hour before or 2 hours after meals and to avoid taking antacids with the medication
instruct the clietn to avoid tyramine containing foods because they may cause a skin reaction such as red and itching skin, a pounding heart beat, light headedness, a hot or clammy feeling, or a headache, if these reactions occur, notify the physician
instruct the client in the signs of neurotoxicity, hepatitis, and hepatotoxicity
instruct the client to noitify the physician if signs of neurotoxicity, hepatitis, and hepatotoxicity or visual changes occur.

rifampin (rifadin)

description

inhibits bacterial synthesis
binds to DNA dependent RNA polymerase and blocks RNA transciption
used in conjunction with atleast one other antitubercular medication

Contraindications and Cautions

contraindicated in clients with hypersensitivity
use with caution in clients with hepatic dysfunction or alcoholism
use of alcohol or hepatotoxic medications may increase the risk of hepatotoxicity
decrease the effects of several medications including oral anticoagulants, oral hypoglycemics, chloramphenicol, digoxin, disopyramide phosphate (norpace), mexiletine (mexitil), quinidine polygalacturonate (cardioquin), tocainide hydrochloride (tonocard), fluconazole (diflucan), methadone hydrochloride (dolophine), phenytoin (dilantin), and verapamil hydrochloride (calan)

side effects

hypersensitivity reaction including fever, chills, shivering, headache, muscle and bone pain, and dyspnea
heartburn
nausea, vomiting, diarrhea
increased liver function tests
hepatotoxicity and hepatitis
increased uric acid levels
blood dyscrasias
colitis

implementation

assess for hypersensitivity
evaluate CBC, uric acid, and liver function tests
assess for signs of hepatitis, and if they occur, withhold the medication and notify the physician
monitor stools for signs of colitis
monitor mental status
assess for visual changes

client education

instruct teh client not to skip doses and to take medication for the full length of the prescirbed therapy
instruct the client not to take any other medication without consulting the physician
advise teh client of teh importance of follow up phyisician visits and laboratory tests
instruct the client to avoid alcohol
advise the client to take medication on an empty stomach with 8 oz of water 1 hour before or 2 hours after meals and to avoid taking antacids with the medication
instruct the client that urine, feces sweat and tears will be red-orange in color and that soft contact lenses can become permanently discolored.
insturct teh client to notify physician if jaundice develops or if weakness, nausea, fatigue, vomiting, sore throat, fever, or unusal bleeding occurs.

respiratory medications continued

2003-09-05T21:47:00.000-05:00
first line medications for TB

ethambutol (myambutal)

description

bacteriostatic
interferes with cell metabolism and multiplication by inhibiting one or more metabolites in teh susceptible organism
inhibits bacterial RNA synthesis
active only during cell division
is slow acting and must be used in combintation with other bactericidal agents

Contraindications and cautions

contraindicated in clients with hypersensitivity, optic neuritis, and in children under 13 years old.
use in caution in clients with renal dysfunction, gout, ocular defects, diabetic retinopathy, cataracts, and ocular inflammatory conditions
use in caution in clients taking neurotoxic medications as the risk of neurotoxicity increases.

side effects

hypersensitivity reactions
anorexia, nausea, vomiting
dizziness
malaise
mental confusion
joint pain
dermatitis
optic neuritis
peripheral neuritis
thrombocytopenia
increased uric acid levels
anaphylactoid reaction

implementation

assess for hypersensitivity
evaluate results of CBC, uric acid, renal andl iver dysfunction tests
obtain baseline visual acuity and color discrimination, especially to the color green
administer once every 24 hours and administer with food to decrease gastrointestinal upset
monitor input and output and for adequate renal function
assess mental status
monitor for dizziness and initiate safety precautions
assess for peripheral neuritis (numbness, tingling, or burning of teh extremities) and if it occurs, notify the physician.

client education

inform the client that he or she can prevent nausea related to the medication by taking the daily dose at bedtime, or to take prescribed antinausea medications
instruct the client not to skip doses and to take the medication for the full length of the prescribed therapy
instruct the client not to take any other medication without consulting the physician.
advise the client of the importance of follow up visits, vision testing, and laboratory tests.
instruct the client to notify the physician immediately if any visual problems occur; if a rash, swelling or joint pain, or numbness or tingling occurs, or if burning in the hands or feet occurs.

streptomycin

description

an aminoglycoside antibiotic that is used in conjunction with atleast one other antitubercular medication
bactericidal, because of receptor binding action, interfereing with protein synthesis in susceptible organisms.

contraindications and cautions

contraindicated in clients with hypersensitivity, myasthenia gravis, parkinsonism, or eighth cranial nerve damage
use with caution in the elderly, in neonates because of renal sufficiency and immaturity and in young infants because the medication may cause CNS depression.
the risk of toxicity increases when taken with other aminoglycosides or nephrotoxic or ototoxic producing medications.

side effects

hypersensitivity
visual changes
increased liver function and renal function tests
peripheral neuritis such as burning of the face or mouth.>

implementation

assess for hypersensitivity
monitor liver and renal function tests
monitor for ototoxic, neurotoxic, and nephrotoxic reactions
obtain baseline audiometric tests and repeat every 1 to 2 months because the medication impairs the eighth cranial nerve
assess hearing activity
monitor for visual changes
assess hydration status and maintain adequate hydration during therapy
monitor I and O
assess urinalysis
monitor for signs of peripheral neuritis

side effects of streptomycin

nephrotoxicity

changes in urine output
increased thirst
decreased appetite
nausea, vomiting

vestibular ototoxicity

dizziness
clumsiness
unsteadiness

neurotoxicity

muscle numbness
tingling
twitching
seizures

auditory ototoxicity

ringing in the ears
loss of hearing
a full feeling in the ears

client education

instruct teh client not to skip doses and to take medication for the full length of the prescribed therapy.
instruct the client not to take any other medication without consulting the physician
advise the client of the importance of follow up physician visits and laboratory tests
instruct the client to notify physician if hearing loss, changes in vision and urinary problems occur.

pyrazinamide

description

exact mechanism of action is unknown
may be bacteriostatic and bactericidal depending on its concentration at the infection site and susceptibility of infecting organism
used in conjuction with atleast one other antitubercular medication after failure or ineffectiveness of the primary medications occurs

contraindications and cautions

contraindicated in clients with hypersensitivity
use with caution in clients with diabetes mellitus, renal impairment, gout and in children
may decrease the effects of allopurinol (zyloprim), colchicine, sulfinpyrazone (anturane)
cross senstivity is possible with isoniazid (INH), ethionamide (trecator-sc), or niacin, and nicotinic acid (nicobid)

side effects

increases liver function and uric acid levels
arthralgia, myalgia
photosensitivity
hepatotoxicity
thrombocytopenia

implementation

assess for hypersensitivity
evaluate CBC, liver function tests, and uric acid levels
observe for hepatotoxic effects, and if they occur, withhold the medication, and notify the physician
assess for painful or swollen joints
evaluate blood glucose levels because diabetes mellitus may be difficult to control while on medication.

client education

instruct the client to take the medication with food to reduce GI distress
instruct the client to avoid sunlight or ultraviolet light until photosensitivity is determined.
instruct the client to notifiy physician if any side effect occur
instruct the client not to skip doses and to take medication for the full length of the prescribed therapy
instruct the client not to take any other medication without consulting the physician
advise the client of the importance of follow up physician visits and laboratory tests

respiratory medications continued

2003-08-28T02:35:00.000-05:00
second line medications for TB

capreomycin sulfate (capastat sulfate)

description

mechanism of action is unknown
used to treat MDR-TB when significant resistance to other medications is expected
must be given by the IM route

contraindications and cautions

the risk of nephrotoxicity, ototoxicity and neuromuscular blockade is increased with the use of aminoglycosides or loop diuretics.
use with caution in clients with renal insufficiency, acoustic nerve impairment, hepatic disorder, myasthenia gravis, and parkinsonism.
do not administer to client receiving streptomycin

side effects

nephrotoxicity
ototoxicity
neuromuscular blockade

implementation

perform baseline audiometric testing
assess renal, hepatic and electrolyte levels before administration
monitor I&O
reconstituted medication may be stored for 48 hours at room temperature
administer deep IM in large muscle mass
rotate injection sites
observe injection site for redness, excessive bleeding, and inflammation

client education

instruct the client not to perform tasks that require mental alertness
instruct the client to report any hearing loss, balance disturbances, respiratory difficulty, weakness or signs of hypersensitivity reactions

kanamycin (kantrex)

description

an aminoglycoside antibiotic that is used in conjunction with at least one other antitubercular injection
bactericidal, because of receptor binding action, interfering with protein synthesis in susceptible microorganisms.

contraindications and cautions

contraindicated in clients with with hypersensitivity, neuromuscular disorders, or eighth cranial nerve damage
use with caution in the elderly, in neonates because of renal insufficiency and immaturity, and in young infants because it may cause CNS depression.
the risk of toxicity increases when taken with other aminoglycosides, or nephrotoxic or ototoxic-producing medications.

side effects

hypersensitivity
pain and irritation at the injection site
nephrotoxicity as evidenced by increased blood urea nitrogen and serum creatinine
ototoxcity as evidenced by tinnitus, dizziness, ringing/roaring in the ears, and reduced hearing
neurotoxicity as evidenced by headache, dizziness, lethargy, tremors, and visual disturbances
superinfections

implementation

assess for hypersensitivity
monitor for ototoxic, neurotoxic, and nephrotoxic reactions
monitor liver and renal function tests
obtain baseline audiometric test and repeat every one to two months because the medication impairs the eigth cranial nerve
assess hearing acuity
monitor for visual changes
assess hydration status and maintain adequate hydration during therapy.
monitor I &O
assess urinalysis
monitor for superinfection

client education

instruct the client not to skip doses and to take medication for the full length of the prescribed therapy.
instruct the client not to take any other medication without consulting the physician.
advise the client of the importance of follow up physician visits and laboratory tests
instruct the client to notify the physician if hearing loss, changes in vision, or urinary problems occur.

ethionamide (trecator-SC)

description

mechanism of action is unknown
used to treat MDR-TB when signficant resistance to other medications is expected.

contraindications and cautions

contraindications in clients with hypersensitivity
use with caution in clients with diabetes mellitus or renal dysfunction

side effects

anorexia, nausea and vomiting
metallic taste in the mouth
orthostatic hypotension
jaundice
mental changes
peripheral neuritis
rash

implementation

assess liver and renal function tests
monitor glucose levels in teh client with diabetes mellitus
administer pyridoxine as prescribed to reduce the risk of neurotoxcity.

client education

instruct the client to take medication with food or meals to minimize GI irriation.
instruct the client to change positions slowly.
instruct the client to report signs of a rash, which canprogress to exfoliative dermatitis if the medication is not discontinued.
instruct the client to avoid alcohol
instruct the clietn to report any sign of jaundice and other side effects of the medication if they occur.

aminosalicylate sodium (Tubasal)

description

inhibits folic acid metabolism in mycobacteria
used to treat MDR-TB when significant resistance to other medications is expected.

contraindications and cautions

contraindicated with hypersensitivity to aminosalicylates, salicylates or compounds containing para-aminophenyl group.

side effects

hypersensitivity
bitter taste in the mouth
GI tract irritation
exfoliative dermatitis
blood dyscrasias
crystalluria
changes in thyroid function

implementation

assess for hypersensitivity
offer clear water to rinse the mouth, chewing gum, or hard candy to alleviate the bitter taste.
encourage fluid intake to prevent crystalluria
monitor I&O

client education

instruct the client to discard teh medication if a purplish brown discoloration occurs.
instruct the client that urine may turn red on contact with hypochlorite bleach if bleach was used to clean a toilet.
instruct the client not to take aspirin or over the counter medications without the physicians approval.inform the client with diabetes mellitus that a false positive test may occur in glucose monitoring
instruct teh clietn to report signs of blood dyscrasia such as sore throat or mouth, malaise, fatigue, bruising or bleeding.

cycloserine (seromycin)

description

intereferes with cell wall biosynthesis
used to treat MDR-TB when significant resistance to other medications is expected.

contraindications and cautions

use of alcohol or ethionamide increases the risk of seizures
use with caution in clients with epilepsy, depression, severe anxiety, psychosis, renal insufficiency or the client who uses alcohol.

side effects

hypersensitivity
CNS reactions
neurotoxicity
seizures
heart failures
headaches
vertigo
altered level of conscioiusness
irritability, nervousness, anxiety
confusion
mood changes, depression, thoughts of suicide

implementation

monitor LOC
monitor for changes in mental status and thought processes
monitor renal and hepatic function tests
monitor serum drug level to avoid the risk of neurotoxicity; peak concentrations, measured 2 hours after dosing, should be 25 to 35 mcg/ml

client education

instruct the client to take the medication after meals to prevent GI upset
instruct the client to avoid alcohol
instruct the clietn to report signs of a rash or signs of CNS Toxicity
instruct the client to avoid driving or performing tasks that require alertness until the reaction to the medication has been determined.
advise the clietn of the need for serum drug levels weekly; as prescribed.

gastrointestinal medications continued

2003-08-25T23:44:00.000-05:00
laxatives

bulk forming laxativesmethylcellulose (Citrucel)
calcium polycarbophil (fibercon)
psyllium hydrophilic mucilloid (metamucil, fiberall, konsyl, serutan, modane bulk)>

description of bulk forming laxatives

absorb water into the feces and increase bulk to produce large and soft stools.
for short term use.
contraindicated in bowel obstruction

side effects

GI disturbances
dehydration
electrolyte imbalance
dependency with chronic use

stimulant cathartics

bisacodyl (dulcolax)
cascara sagrade
castor oil emulsified (neoloid)
phenolphythalein (ex-lax)
senna concentrate (senexon, senna-gen)

description of stimulant cathartics

stimulate motility of large intestine.

biscodyl (dulcolax): do not administer within 60 minutes of an antacid or millk.

cascara (castor oil): administer with juice, produces results in 2 to 6 hours.saline cathartics

glycerine suppositories (senokot)
lactulose (chronulac)
magnesium citrate (Citroma)
magnesium sulfate (epsom salt)
sodium phosphate (fleet phospho soda)
magnesium hydroxide (milk of magnesia)
potassium bitrate and sodium bicarbonate (coe-two)

description of saline cathartics
attract water into the large intestine to produce bulk.
stimulate peristalsis.
acheive results in 2 to 6 hours.

stool softeners

docusate calcium (surfak)
docusate sodium (colace)
docusate with casanthranol (peri-colace)

description of stool softners

inhibit absorption of water so fecal mass remains large and soft.
used to avoid straining.

lubricant

mineral oil

description of lubricants

act to control the feces
ease the strain of passing stool
lessen irriation with hemorrhoids
mineral oil:- can cause lipid pneumonia if accidently aspirated
interferes with absorption of fat soluble vitamins A, D, E, and K

medications to control diarrhea

opioid and related medications

codeine phosphate; codeine sulfate
difenoxin with atropine (motofen)
diphenoxylate hydrochloride with atropine (lomotil)
loperamide hydrochloride (immodium)
tincture of opium

description of opioids

decrease intestinal motility and peristalsis
when poisons, infections, or bacterial toxins are the cause of the diarrhea, opioids worsen the condition by delaying the elimination of toxins.
tincture of opium has an unpleasant taste and can be diluted with 15 to 30 ml of water for administration

other antidiarrheals

bismuth subsalicylate (pepto-bismol)
kaolin and pectin (kao-spen, kapectolin)
somatostatin analog
octreotide (sandostatin)

antispasmodics

dicyclomine hydrochloride (antispas)
dicyclomine hydrochloride (bentyl)

side effects

constipation
rash
euphoria
dizziness
drowsiness
headache
nausea and weakness

gastrointestinal medications

2003-08-25T02:44:00.000-05:00
medications to treat hepatic encephalopathy

lactulose (cephulac)
neomycin (mycifradin)

lactulose

reduces ammonia levels
improves protein tolerance in clients with advanced hepatic cirrhosis.
lowers the colonic ph from 7 to 5; this acidification pulls ammonia into the bowel to be excreted in the feces, thus lowering the ammonia level.
administered orally in the form of a syrup.

neomycin (mycidradin)

reduces teh number of colonic bacteria that normally convert urea and amino acids into ammonia
adminstered orally or via nasogastric tube
used with caution in clients with kidney impairment.

pancreatic enzyme replacements

pancreatin (creon)
pancrelipase (cotazym, pancreas, viokase)

used to supplement or replace pancreatic enzymes.
taken meals with a snack (food helps to buffer the stomach acid)
a high fiber diet may increase the efficacy of the medication
side effects include abdominal cramps, or pain, nausea and diarrhea.
products that contain calcium carbonate or magnesium hydroxide interfere with the action of the medication

antiemetics

commonly administered antiemetics

diphenidol hydrochloride (Vontrol)
dolasteron mesylate (Anzemet)
dronabinol (marinol)
granisetron (kytril)
hydroxine hydrochloride (atarax)
hydroxine pamoate (vistaril)
meclizine hydrochloride (antivert)
metoclopramide (reglan)
ondansetron (Zofran)
promethazine hydrochloride (phenergan)
thiethylperazine malate (torecon)
trimethobenzamide hydrochloride (Tigan)
prochlorperazine (Compazine)

medications used to control vomiting
the choice of the antiemetic is determined by the cause of the nausea and diarrhea.
monitor for drowsiness and protect the client from injury.
monitor vital signs and input and output
limit odors in the client's room when the client is nauseated and or vomiting
limit oral intake to clear liquids when the client is nauseated or vomiting

gastrointestinal medications continued

2003-08-24T22:55:00.000-05:00
Bile Acid Sequestrants

cholestyramine (questran, prevalite)
colestipol (colestid)

description of bile acid sequestrants

used to treat pruritis associated with biliary disease
acts by absorbing and combining with instestinal bile salts, which are then secreted in the feces, preventing intestinal reabsorption
may be used cautiously in the treatment of hypercholesterolemia in adults.
used cautiously in clients with bowel obstruction or severe constipation because of the adverse GI effects.
taste and palatability are often reasons for noncompliance and can be improved by the use of flavored products or mixing the medication with various juices.
stool softners and other sources of fibers can be used to abate the GI side effects

side effects

constipation
bloating
flatulence
nausea
fecal impaction and intestinal obstruction
exacerbation of hemorroids
hypoprothrombinemia
decreased vitamin absorption

medications for cholelithiaisis

chenodiol (chenix)
monoctanoin (moctanin)
ursodiol ( Actigall)

chenodiol (chenix)

decreases cholesterol production, lowering content of bile, thus facilitates dissolution of gallstones
can cause diarrhea and possible hepatoxicity
baseline liver function studies should be performed
client should be instructed to contact the physician if abdominal pain, sudden right upper quadrant, nausea or vomiting occurs.
administer with food and milk
avoid aluminium containing antacids

Ursodiol (actigall)

a naturally occuring bile salt
suppresses hepatic synthesis and secretion of cholesterol and inhibitis intestinal absorption
requires months of therapy for dissolution of gallstone to occur
ultrasound images are obtained within 6 months to determine effectiveness of therapy.
clients should be instructed to report nausea, vomiting, diarrhea, or rash to the physician
administer with food or milk
avoid aluminum containing antacids

monoctanoin (moctanin)

used when stones made of calcium are resistant to dissolution by oral chenodiol
administered through a T tube, nasal biliary catheter or percutaneous transhepatic catheter.
effective only when in contact witht he stone
major side effects include diarrhea, nausea, and abdominal pain.

gastrointestinal medications continued

2003-08-24T22:30:00.000-05:00

proton pump inhibitors

omeprazole (prilosec)
lansoprazole (prevacid)

description of proton pump inhibitors
supress gastric acid secretion
used with active ulcer diseasem, erosive esophagitis and pathological hypersecretory conditions
<strong>contraindicated in hypersensitivity
common side effects include headache, nausea, vomiting, diarrhea, and abdominal pain.

gastrointestinal stimulants
bethanecol chloride (urecholine, Duvoid)
metoclopramide (reglan)
neostigmine methylsulfate (prostigmin)description of gastrointestinal stimulants

stimulates motility of the upper GI tract and increases the rate of gastric emptying without stimulating gastric, biliary, or pancreatic secretions
used for gastroesophageal reflux
may cause restlessness, drowsiness, extrapyramidal reactions, dizziness, insomnia, headaches
contraindicated in clients with sensitivity.
contraindicated in clients with mechanical obstruction, perforation, or GI hemorrhage
can precipitate hypertensive crisis in clients with phechromocytoma.
safety in pregnancy is not established.
reglan can cause parkinson like reactions and if this occurs this medication is discontinued
anticholingerics and narcotic analgesics antagonize the effects of metoclopramide (reglan)alcohol, sedatives, cyclosporine (sandimmune) and tranquilizers produce an additive effect.

Gastrointestinal medications

2003-08-12T00:38:00.000-05:00
antacids

aluminium hydroxide gel (amphogel, alternaGel)
aluminium carbonate gel (basaljel)
bismuth subsalicylate (pepto-bismol)
calcium carbonate (tums)
magnesium hydroxide (milk of magnesia, MOM)
misoprostol (cytotec)
sulcralfate (carafate)

description
react with gastric acid to produce neutral salts or salts of low acidity
inactivate pepsin and enhance mucosal protection but do not coat the ulcer crater to protect it from teh acid and pepsin.
used for peptic ulcer disease and gastroesophageal reflux disease.
should be taken on a regular schedule
are usually administered severn times a day, 1 and 3 hourws after each meal and at bedtime
to provide maximum benefit, treatement should elevate the gastric pH above 5
antacid tablets should be chewed thoroughly and followed with a glass of water or milk.
liquid preparations should be taken before dispensing.
interactions with other medications can be minimized by allowing one hour between antacid administraiton and administration of other medications.
can interfere with the action of sucralfate (carafate) and to minimize this interaction, the medications should be administered 1 hour apart from each other.

sucralfate (carafate)

creates a protective barrier against acid and pepsin.
administered orally; should be taken on an empty stomach
administer atleast 60 minutes apart from an antacid
may cause constipation
may impede absorption of warfarin sodium (coumadin), phenytoin (dilantin), theophylline, digoxin (lanoxin) and some antibiotics and should be administered atleast 2 hours apart from these medications.

misoprostol (cytotec)

used to prevent gastric ulcers caused by long term therapy with nonsteroidal antiinflammatory drugs (NSAIDS)
suppresses secretion of gastric acid
promotes secretion of bicarbonate and cytoprotective mucous.
maintains submucosal blood flow by promoting vasodilation
administered with meals.
causes diarrhea and abdominal pain
contraindicated for use in pregnancy.

magnesium hydroxide

rapid acting
also referred to as milk of magnesia
most prominent side effect is diarrhea
usually administered in combination with aluminium hydroxide; an antacid that assists in preventing diarrhea.
contraindicated in clients with intestinal obstruction, appendicitis, or clients with undiagnosed abdominal pain.
in clients with renal impariment, magnesium can accumulate to high levels, causing signs of toxicity.

aluminium hydroxide gel (amphogel, alternagel)

slow acting
contains significant amounts of sodium
used with caution in clients with hypertension and heart failure
most common side effect is constipation
can reduce teh effect of tetracyclines, warfarin sodium (coumadin), and digoxin (lanoxin)
can reduce phosphate absorption and thereby cause hypophosphatemia.

calcium carbonate (tums)
rapid acting
common side effect is constipation

sodium bicarbonate

rapid onset
liberates carbon dioxide, increases intraabdominal pressure and flatulence.
used in caution with clients with hypertension and heart failure
can cause systemic alkalosis in clients with renal impairment
in useful for treating acidosis and elevating urinary pH to promote excretion of acidic medications after overdose.

histamine H-2 receptor aganoists

cimetidine (tagamet)
famotidine (pepcid)
nizatidine (axid)
ranitidine (zantac)
ranitidine bismuth citrate (tritec)

description

suppress secretions of gastric acid
alleviate symptoms of heartburn and assist in preventing complications of peptic culcer disease
prevent stress ulcers and reduce the recurrence of all ulcers
promotes healing in GERD
contraindicated in hypersensitivity
used with caution in clients with impaired renal or hepatic function.

cimetidine (tagamet)

can be administered orally (IV); intramuscularly (IM), or intravenously (IV)
food reduces the rate of absorption if taken with meals, absorption will be slowed.
antacids can decrease the absorption of cimetidine
cimetidine and antacids should be administered atleast one hour apart from each other
passes the blood brain barrier, and central nervous system side effects can occur.
may cause mental confusion, agitation, psychosis, depression, anxiety and disorientation.
dosage should be reduced in clients with renal impairment.
IV administration can cause hypotension and dysrhythmias
if administered with warfarin sodium (coumadin), phenytoin (dilantin), theophylline or lidocaine (xylocaine), the dosages of these medications should be reduced.

ranitidine (zantac)

can be administered orally, IM, IV
side effects are uncommon
unlike cimetidine, ranitidine (zantac) does not penetrate the blood-brain barrier.
zantac is not affected by food.

famotidine (pepcid) and nizatidine (axid)

similar to zantac and tagamet
do not need to be administered with food.

ranitidine bismuth citrate (tritec)

used to treat active duodenal ulcers associated with helicobacter pylori
administered with the antibiotic clarithromycin (biaxin)

antineoplastic medications continued.

2003-08-10T23:06:00.000-05:00
hormonal medications and enzymes

androgens

testolactone (teslac)
fluoxymesterone (halotestin)

hormonal antagonists, enzymes

aminoglutethimide (Cytadren)
asparaginase (elspar)
diethylstilbestrol (stilphostrol)
flutamide (Eulexin)
goserelin acetate (zoladex)
megesterol acetate (megace)
mitotane (lysodren)
tamoxifen citrate (nolvadex)

description

suppress the immune system and block normal hormones in hormone sensitive tumors
change teh hormonal balance and slow the growth rate of certain tumors.

side effects

anorexia, nausea and vomiting
leukopenia
impaired pancreatic function with asparaginase (elspar)
gynecomastia
breast swelling
hot flashes
weight gain
hemorrhagic cystitis, hypouricemia, and hypercholesterolemia with mitotane (lysodren)
hypertension
thromboembolytic disorders
edema
sex characteristic alterations
electrolyte imbalances
tamoxifen citrate (nolvadex) may cause edema, and elevated cholesterol and triglyceride levels and decreases the effect of estrogen.
diethylstilbestrol (stilphostrol) may cause impotence and gynecomastia in mena and may alter effects of insulin, oral anticoagulants, and oral hypoglycemic agents.

implementation

monitor vital signs
ask the client about the medications currently taking
monitor serum calcium levels with androgens
monitor for signs of alterations in sexual characteristics
montir pancreatic functionwith asparaginase
encourage an oral intake of 2 to 3 liters of fluids per day
monitor uric acid and cholesterol levels
monitor for signs of hemorrhagic cystitis.

immunotherapy: biological response modifiers

colony stimulating factors (CSF)

granulocyte/macrophage colony stimulating factor(gm-csf)

sargramostim (leukine, prokine)

granulocyte stimulating factors (g-csf)

filgastrim (neupogen)

erythropoietin (EPO)

epotin alfa (epogen)

description

stimulate the immune system to recognize cancer cells and take action to eliminate or destroy them.
interleukins: help different immune system cells to recognize and destroy abnormal body cells.
interferons: slow down tumor cells division; stimulate proliferation and activiation of natural killer cells; and help cancer cells resume a more normal appearance and revert to their previous characteristics.

colony stimulating factors: induce more rapid bone marrow recovery after suppression by chemotherapy

antineoplastic medications continued

2003-08-10T21:47:00.000-05:00
vinca (plant) alkaloids

etoposide (vepesid)
paclitaxel (taxol)
docetaxel (taxotere)
teniposide (Vumon)
vinblastine sulphate (velban)
vincristine sulphate (oncovin)
vindesine (eldisine)
vinorelbine (navelbine)

description

prevent mitosis, causing cell death
mitotic inhibitor that prevents cell division
cell cycle phase specific and act on the M phase

side effects

leukopenia
neurotoxicity with vincristine sulfate (oncovin) manifested as numbness and tingling in the fingers and toes.
ptosis
hoarseness
motor instability
anorexia, nausea, and vomiting
constipation
peripheral neuropathy
alopecia
stomatitis
hyperuricemia
phlebitis at IV site

implementation

monitor vital signs
monitor WBC, CBC, uric acid, and platelet counts
monitor for hoarseness
check the eye for ptosis
monitor motor stability and initate safety precautions as necessary
monitor for neurotoxicity with vincristine sulfate (oncovin) manifested as numbness and tingling in the fingers and toes.

antineoplastic medications continued

2003-08-03T03:26:00.000-05:00
antimetabolite medications

A. Description

1. halt the synthesis of cell protein
2. replace normal proteins required for DNA synthesis
3. cell cycle phase specific and affect the S phase

B. side effects

1. anorexia, nausea and vomiting
2. diarrhea
3. alopecia
4. stomatitis
5. depression of bone marrow
6. cytarabine HCL (cytosar U) may cause alopecia, stomatitis, hyperuricemia, and hepatotoxicity
7. florouracil (adrucil) may cause alopecia, stomatitis, diarrhea, phototoxicity reactions, and cerebellar dysfunction.
8. mercaptopurine (purinethol) may cause hyperuricemia, and hepatotoxicity
9. methotrexate (folex) may cause alopecia, stomatitis, hyperuricemia, photosensitivity, hepatotoxicity, hematological, GI, and skin toxicity.

C. Implementation

1. monitor vital signs and temperature for signs of infection.
2. monitor the CBC, WBC, uric acid, and platelet count
3. the medication is withheld if the WBC count is less than 4,000 cells/ul or the platelet count is less than 75,000 cells/ul and the physician is notified.
4. monitor renal funciton studies.
5. monitor for cerebellar dysfunction
6. monitor for photosensitivity
7. antiemetics are administered 30 to 60 minutes before the antineoplastic medication as prescribed.
8. monitor the IV site for extravasation.
9. encourage fluid intake of 2 to 3 liters per day
10. encourage good oral hygiene
11. instruct the client how to avoid infections and bleeding.
12. when teh client is receiving flororuracil (adrucil), monitor for signs of cerebellar dysfunciton such as dizziness, weakness, and ataxia, and for stomatitis, and diarrhea, which may necessitate medication discontinuation.
13. when the client is receiving folex in large doses, leucovorin (folinic acid or citrovorum factor) may be prescribed to prevent fatal toxicity ( known as leucovorin rescue)
14. when the client is receiving adrucil or folex, instruct the client to use sunscreen and wear protective clothing to prevent photosensitivity reactions.

antineoplastic medications continued

2003-08-03T03:09:00.000-05:00
antimetabolite medications

folic acid antagonist
methotrexate (folex)

pyrimidine analogs
cytarabine HCL (ara-C)
floxuridine (FUDR)
procarbazine (maturane)

purine analogs
mercaptopurine (purinethol)
thioguanine

miscellaneous ribonucleotide reductase inhibitors
hydroxurea (hydrea)
trimetrexate glucoronate (neutrexin)

antimicrotuble
pentostatin (nipent)

2003-08-03T02:58:00.000-05:00
antineoplastic medications continued

Alkalating medications

nitrogen mustards

Chlorambucil (leukeran)
cyclophosphamide (cytoxan)
Estramustine phosphate sodium (emcyt)
ifosfamide (Ifex)
methchlorethamine HCL (mustargen)
melphalan (alkeran)

nitrosoureas

busulfan (myleran)
Carmustine (BCNU)
chlorozotozin (DCNU)
lomustine (CCNU)
semustine (Methyl CCNU)
streptozocin (Zanosar)

alkalalting like medications

altretamine (Hexalen)
carboplatin (paraplatin)
cisplatin (platinol)
thiotepa
dacarbazine (DTIC)

description

affects the synthesis of DNA by causing cross linking of DNA to inhibit cell reproduction
cell cycle phase nonspecific medication.

side effects

1. Anorexia, nausea, and vomiting
2. Stomatitis
3. Skin rash
4. Pain During IV administration
5. busulfan (myleran) may cause hyperuricemia
6. Chlorambucil (leukeran) and mechlorethamine HCL (mustargen) may cause gonadal suppression and hyperuricemia
7. Cisplatin (platinol) may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia and nephrotoxicity.
8. Cyclophosphamide (cytoxan) may cause alopecia, gonadal suppression, hemorrhagic cystitis, and hematuria.

C. implementation

1. monitor vital signs and the temperature for signs of infection.
2. monitor CBC, WBC, platelet, uric acid and electrolyte counts
3. the medication is withheld if the platelet count is less than 75,000 and notify the physician.
4. pulmonary function tests are monitored
5. chest radiographs and renal and liver function studies are monitored.
6. the client is hydrated with IV and/or fluids before teh antineoplastic medication is administered as prescribed.
7. an antiemetic is prescribed 30 to 60 minutes before the antineoplastic medication
8. as prescribed, IV site pain is reduced by altering IV rates, diluting the medication, or warming the injection site to distend vein and increase blood flow.
9. monitor IV site for irritation and phlebitis
10. when the client is receiving cisplatin (platinol), monitor the client for dizziness, tinnitus, hearing loss, incoordination, and numbness and tingling of extremities.
11. monitor for signs of hemorrhagic cystitis, such as hematuria or dysuria, during cyclophosphamide (cytoxan) or ifosfamide (ifex) therapy, and encourage the client to drink atleast 2 to 3 literes per day.
12. instruct the client that cyclophosphamide (cytoxan) when prescribed orally, is administered without food.
13. instruct the client to follow a diet low in purines to alkalize urine and lower uric acid blood levels.
14. instruct the clients how to avoid infection
15. instruct the client to report signs of infection or bleeding.
16. instruct the client about good oral hygiene and the use of a soft toothbrush.

antitumor antibiotic medications

antitumor antibiotic medications

bleomycin sulfate (blenoxane)
dactinomycin (actinomycin D)
Daunorubicin (cerubidine)
doxorubicin (adriamycin)
idarubicin (idamycin)
mitomycin (mutamycin)
plicamycin (mithracin)
mitoxantrone (novantrone)

description

interferes with DNA and Ribonucleic acid synthesis
cell cycle phase non specific medications

side effects

1. nausea and vomiting
2. fever
3. bone marrow depression
4. skin rash
5. alopecia (baldness)
6. stomatitis
7. gonadal suppression
8. hyperuricemia
9. vesication (blistering of tissue at IV site)
10. plicamycin (mithracin) affects bleeding time.
11. Daunorubicin (cerubidine) may cause congestive heart failure and dysrhythmias
12. doxorubicin (adriamycin) and idarubicin (idamycin) may cause cardio toxicity,, cardiomyopathy, electrocardiogram changes (EKG)
13. pulmonary toxciity can occur with bleomycin sulfate (blenoxane)

C. implementation

1. monitor vital signs and temperature for signs of infection.
2. monitor CBC, WBC , platelets, uric acid, bleeding time and electrolyte counts
3. the medications are withheld if the platelets are less than 75, 000 cells or the WBC ccount is less than 4,000 cells/ul and the physician is notified.
4. pulmonary function tests are monitored.
5. The ECG is monitored for changes
6. monitor lung sound for rales.
7. monitor for signs of CHF; including dyspnea, crackles, peripheral edema, and weight gain.
8. chest radiographs and renal and liver function studies are monitored.
9. the cilent is hydrated with IV and or oral fluids before the antineoplastic medication
10. an antiemetic is administered 30 to 60 minutes before the antineoplastic medication
11. as prescribed, IV Site pain is reduced by altering IV rates, diluting the medication, and warming the injection site to distend the vein and increase blood flow.
12. monitor Iv site for irritation, phlebitis, and vesication.
13. monitor for myocardial toxicity, dyspnea, dysrhythmias, hypotension, and weight gain when doxorubicin (adriamycin) or idarubicin (idamycin) is administered.
14. monitor the pulmonary status when bleomycin (blenoxane) is administered.
15. aspirin, anticoagulants, and thrombolytic agents are avoided when plicamycin (mithracin) is administered.

2003-08-02T17:06:00.000-05:00
A. general descritions of antineoplastic medications

1. kill or inhibit the reproduction of neoplastic cells.
2. the effect of antineoplastic medications may not be limited to neoplastic cells, normal cells are also affected by the medication.
3. cell cycle phase specific medications affect cells only during a certain phase of the reproductive cycle.
4. several medications are used in combination to increase the therapeutic response.
5. antineoplastic medications may be combined with other treatments such as surgery and radiation.
6. The routes of antineoplastic medication administration can vary; intravenous route is the most preferred route.
7. side effects result from the effects of teh antineoplastic medication on normal cells.
8. cell cycle nonphase specific affect cells in any phase of the reproductive cycle.

b. side effects

1. Mucositis
2. Alopecia
3. Anorexia, nausea and vomiting
4. diarrhea
5. Anemia
6. Low white blood cell count
7. Thrombocytopenia
8. Infertility

C. Implementation

1. Physiological Integrity

a. monitor complete blood count (CBC), WBC count, platelet count and electrolyte count.
b. initiate bleeding precuations if thrombocytopenia occurs.
c. when the platelet count is less than 50,000 cells/uL, any small trauma can lead to episodes of prolonged bleeding; when loss than 20,000 cells/uL, spontaneous and uncontrollable bleeding can occur.
d. Monitor for petechiae, ecchymosis, bleeding of the gums, and nose bleeds because decreased platelet count can precipitate bleeding tendencies.
e. Avoid intramuscular injections and venipunctures as much as possible to prevent bleeding.
f. Initiate neutropenic precautions if the WBC count decreases.
g. Monitor for fever, sore throat, unsual bleeding, or signs and symptoms of infection.
h. Inform the client that loss of appetite may also be due to a bitter taste in the mouth from medications.
I. Monitor for nausea and vomiting and provide a high calorie diet with protein supplements.
j. Antiemetics are administered several hours before chemotherapy and for 12 to 48 hours afterward, as prescribed , because antineoplastic medications stimulate the vomiting centers.
k. Encourage plenty of hydration; IV fluids will be administered before and during therapy.
l. Promote a fluid intake of atleast 2,000 ml a day to maintain adequate renal function.
m. Administer allopurinol (zyloprim) as prescribed to reduce the serum uric acid that occurs from the rapid destruction of cells by the antineoplastic medication.

2 safe, effective care environment.

a. IV chemotherapy is prepared in an air vented space.
b. antineoplastic medications are administered in short, high dose, intermittent courses as prescribed, to maximize antineoplastic effects while allowing normal cells to recover.
c. gloves, gown, and a mask are worn when handling IV medications.
d. monitor for phlebitis with IV administration, as these medications irritate the veins.
e. monitor for extravasation (leakage of medicine into the surrounding skin and subcutaneou tissue), which causes tissue necrosis, and the physician is notified if this occurs; heat or ice is applied depending upon the medication, and an antidote may be injected into the site.
f. discard Iv equipment in designated containers.

3. psychosocial integrity

a. instruct the client in teh potential for hair loss, and that varying degrees of hair loss may occur after the first or second treatment.
b. discuss the purchase of a wig before treatment starts
c. inform the client that new hair growth will occur several months after the final treatment.
d. instruct the client about the need for contraception, as these medications have teratogenic effects.
e. discuss teh potential effect of infertility which may be irreversible.

4. health promotion and maintenance

a. if diarrhea is a problem, instruct the client to avoid hot foods and high fiber foods, which increase peristalsis.
b. instruct the client to inspect the oral mucosa for erythema and ulcers, to rinse mouth after meals, and to provide good oral hygiene.
c. instruct the client to use saline or sodium bicarbonate mouth rinses for mouth sores.
d. instruct the client in use of antifungal medications for mouth sores, if prescribed for the development of a superinfection.
e. instruct the client to avoid crowds and persosn with infections and to report signs of infection such as fever, chills or sore throat.
f. instruct individuals with colds or infections to wear a mask when visiting or so avoid visiting the client.
g. instruct the client to use a soft tooth brush and an electric razor to minimize the risk of bleeding.
h. instruc the client to avoid alcohol to minimize the risk of toxicity.
j. instruc the client to consult the physician before receiving vaccinations.

C. anaphylactic reactions

1. precautions

a. obtain an allergy history
b. a test dose may be administered when prescribed by the physician.
c. stay with the client during the administration of medication.
d. monitor vital signs
e. have emergency equipment and medications readily available.
f. an IV line is needed for the administration of emergency medications if needed.

2. signs of anaphylactic reaction

a. dyspnea
b. chest tightness or pain
c. pruritis/urticaria
d. tachycardia
e. dizziness
f. anxiety/agitation
g. flushed appearance
h. inability to speak
i. nausea and abdominal pain.
j. hypotension
k. decreased sensorium
l cyanosis.

antineoplastic medications (cancer medications)

2003-08-02T16:20:00.000-05:00

general descriptions of antineoplastic medications

2003-07-27T12:24:00.000-05:00
insulin

insulin primarily acts in the liver, muscle, and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose, potassium and magnesium. it is prescribed for clients with type 1 diabetes mellitus.

storing insulin.

exposures to extremes in temperatures is avoided; insulin should not be frozen or kept in direct sunlight or a hot car.
before injection, insulin should be at room temperature. if a vial of insulin will be used at room temperature, the vial should be refrigerated.

insulin injection sites:-

the main areas for injections are the abdomen, arms (posterior surface), thighs (anterior surface), and hips.l

insulin injected into the abdomen may absorb more evenly and rapidly than at other sites.

systematic rotation within one anatomical area is recommended to prevent lipodystrophy, client should be instructed not to use the same site more than once in a 2 to 3 week period.

injections should be one and a half inches apart within the anatomical area.

heat, massage and exercise of the injected area can increase absorption rates and may result in hypoglycemia

injection into scar tissue may delay absorption of insulin.

administering insulin

to prevent dosage errors, be certain that there is a match of teh insulin concentration noted on the vial with the calibration of units on the insulin syringe. the usual concentration of insulin is U 100 (100 units per milliliter)

most insulin syringes have a 27 to 29 gauge needle that is approximately 0.5 inches long.

before use, roll, not shake (to avoid bubbles) the insulin bottle to ensure that the insulin and ingredients as mixed well; otherwise an inaccurate dose will be drawn.

premixed insulins (NPH to regular insulin) are available as 70/30 (most commonly used), 80/20, 60/40, and 50/50/

a 3 week supply of insuin may be prepared and kept in the refrigerator, prefilled syringes should be kept flat or with the needle in an upright position to avoid clogging of the needle.

inject air into the insulin bottle (a vaccum makes it difficult to draw up the insulin).

It is recommended to draw up the regular (shorter acting) insuin first. Regular insulin may be mixed with any other type of insulin.

insulin zinc suspensions may be mixed only with each other and Regular insulin, not with any other types of insulin.

administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time, the regular insulinbinds with the NPH insulin and its action is reduced.

aspiration is not recommended with self injection of insulin.

administer insulin at a 45 to 90 degree angle and at a 45 to 60 degree angle in thin persons.

regular insulin is teh only type of insulin that can be adminstered intravenously.

Glucagon is a hormone secreted by the alpha cells of the islets of langerhans in the pancreas. it increases blood sugar by stimultating glycogenolysis in the liver. (it destroys glycogen). it can be administered intravenously, intramuscularly, and subcutaneously. it is used to treat insulin induced hypoglycemia when the client is semiconscious or unconscious and is unable to ingest liquids. the blood glucose level begins to increase within 5 to 20 minutes after administration.

Diazoxide (Proglycem)

increases blood glucose by inhibiting insulin release from the beta cells and stimulating the release of epinephrine from the adrenal medulla. it is used to treat chronic hypoglycemia caused by hyperinsulinism resulting from islet cell cancer (a type of pancreatic cancer) or hyperplasia. it is not used for hypoglycemic reactions from insulin.

Common types of insulin

rapid acting:- lispro (humalog) 10-15 minutes (onset), 1 hour (peak), and 3 hours (duration)

short acting:- regular insulin 0.5-1 hour (onset), 2-3 hours (peak), and 4-6 hours (duration)

intermediate acting:- Humulin NPH 3-4 hours (onset), 4-12 hours (peak), and 16-20 hours (duration)
humulin lente same as humulin NPH
long acting:- humulin ultralente 6-8 hous (onset), 12-16 hours (peak), and 20-30 hours (duration)

Premixed:- 70% NPH and 30% Regular 0.5-1 hour (onset), 2-12 hours (peak), 18-24 hours (duration)

2003-07-26T22:45:00.000-05:00
medications for diabetes mellitus

first and second generation sulfonylureas and nonsulfonylureas

first generation sulfonylurea
short acting

tolbutamide (orinase)

intermediate acting

acetohexamide (Dymelor)
tolazamide (Tolinase)

long acting

Chlorpropramide (Diabenese)

second generation sulfonylureas

Glipizide (glucotrol, Glucotrol XL)
glyburide (Diabeta, Micronase, Glynase)
Glimipiride (Amaryl)

nonsulfonylureas

Biguanide

metformin (glucophage)

Alpha Glucosidase Inhibitor

Acarbase (Precose)
Miglitol (Glyset)

Thiozolidinediones

Troglitazone (Rezulin)
pioglitazone (Actos)
Rosiglitazone (Avandia)

meglitinide

Rapaglinide (Prandin)

Insulin and Oral hypoglycemic medications

Descriptions

Insulin increasesss glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels.

oral hypoglycemic agentss stimulate the pancrease to produce more insulin and increase the sensitivity of peripheral receptors to insulin, thereby decreasing serum glucose levels.

Contraindications and concerns

insulin is contraindicated in clients with hypersenstivity
oral hypoglycemic agents are contraindicated in type 1 diabetes mellitus and in those individuals allergic to sulfonylureas.
sulfonylureas can affect cardiac function, oxygen consumption and can lead to cardiac arrhythmias.
use of hypoglycemic medications with beta-adrenergic blocking agents mask signs and symptoms of hypoglycemia.
anticoagulants, chloramphenicol (chloromycetin), clorfibrate (Atromid-s), salicylates, mononamine oxidase inhibitors (MAOIs), pentamidine (pentam 300), and sulfonylureas may cause hypoglycemia.

corticosteriods, sympathomimetics, thiazide diuretics, phenytoin (dilantin), thyroid preparations, oral contraceptives, and estrogen compounds, may cause hyperglycemia.

side effects of the sulfonylureas include gastrointestinal symptoms, and dermatological reactions,; hypoglycemia can occur when an excessive dose is administered or when meals are omitted or delayed. food intake is decreased or activtity is increased.

Chlorpropramide (Diabenese) can cause a disulfiram (Antabuse) type reaction when alcohol is ingested.

oral hypoglycemic medications:-

Are prescribed for clients with type 2 diabetes

sulfonylureas stimulate the beta cells to produce more insulin

nonsulfonylureas affect the hepatic and GI production of glucose and can be used in combination with a sulfonylurea.

implementation:-

assess the client's knowledge of diabetes mellitus and the use of oral antidiabetic agents.

obtain a medication history regarding medications that the client is currently taking
monitor vital signs and blood glucose levels.
instruct the client to recognize signs and symptoms of hypoglycemia and hyperglycemia.
instruct the client to avoid over the counter medications unless prescribed by physician.
instruct the client not to ingest alcohol with sulfonylureas.
instruct the client that insulin may be needed during times of stress, surgery or infection.
instruct the client in the necessity of compliance with prescribed medication.
advise teh client to wear a medic alert bracelet.

tomorrow, i will go over insulin and how to administer it.

2003-07-25T00:09:00.000-05:00
tomorrow i will post the use and side effects of some of the drugs that were mentioned here.

2003-07-25T00:08:00.000-05:00
guide to care for patients with type 2 diabetes

what is type 2 diabetes?

when you eat, your body breaks down food into a fuel called glucose (sugar). your pancreas makes insulin to help sugar enter your body's cells. then the sugar can be used for energy. when you have type 2 diabetes, the sugar in the blood stream cannot get into the body's cells. this can happen because the body is not making enought insulin or your body's cells no longer recognize it. as a result, teh cells don't get the energy they need and sugar builds up to a level that is higher than normal.

how does my health care provider know if i have diabetes?

your health care provider will order tests if he or she suspectws that you have diabetes. two types of test are used to determine the cause of diabetes:- the fasting plasma glucose test (FPG) and the oral glucose tolerance test (OGTT). both test need you to fast overnight.

your health care provider will also draw blood to measure your average blood sugar level over a 3 month period. this test is called a hemoglobin A1c Test.

symptoms of hight blood sugar (diabetes)

weakness, tiredness, fatigue
blurred vision
excessive thirst
frequent urination
sudden weight loss
inability to concentrate
sexual problems
slow healing skin infections, cuts, or sores
loss of coordination
numbness or tingling in the hands or feet
excessive weight.

symptoms of low blood sugar

sudden onset of symptoms
poor coordination
moodiness
pale skin
confusion
inablity to concentrate
sudden hunger
sweating
trembling

normal blood sugar:- 70 - 150 mg/dl
prediabetes:- 140 - 200 mg/dl
diabetes:- 200 mg/dl and over

FPG (fasting plasma glucose)

normal:- < 110 mg/dl
prediabetes:- 111-125 mg/dl
diagnosis of diabetes: FPG > 126 mg/dl

what can i do to keep my blood sugar level within the normal range?

you'll have diabetes for the rest of your life but you should not let it control you.

here are a few things that you can do to control your diabetes:

blood sugar monitoring.

blood sugar monitoring should be made a part of your normal morning daily routine.

your physician may advise you to check your sugar before eating meals. these readings will give your primary care physician an idea of how your treatment plan is working. let your physician about your results. look out for trends to see how your blood sugar works at different times of the day. for example, today morning your blood sugar level was 130 mg/dl before breakfast, compare it to when you take it before lunch and see if it is slightly higher or lower. your physician will need to know how you are progressing and decide if your treatment plan needs to have some modifications.

eating right.

the food that you eat has a direct effect on your blood sugar level. it is imporant to keep a diet plan handy so as to remind you what to eat and when to eat. a dietitian can help you in creating this plan. he or she will also tell you why your diet should include certain types of foods such as fruits and leafy vegetables and why it is best to eat a low fat diet. you will also learn to limit your use of table salt. you need not have to give up the foods you enjoy completely. you can enjoy them in moderation.

staying active.

exercise will help your body burn off excessive sugar more quickly. it may also aid in helping your body respond better to insulin. exercise will help to lower your blood sugar. walking, swimming, jogging are good exercises to do everyday for 30 minutes to a hour. check with your health care provider before starting an exercise program as togther you both can create a program that works out best for you.

coping with stress.

the body responds to stress by raising blood sugar levels and new ways must be found to cope with stress. when feeling stress, take a five minute break, stretch, breathe deeply, listen to music and take a bath. be sure to keep in touch with a network of close friends.

what medications can i take to control my blood sugar?

your physician may put you one or more oral medications to help control your blood sugar level. Amaryl and Glyburide are two drugs that are prescribed by most physicians. these two drugs enable the pancreas to make more insulin.
sulfonylureas can cause the pancreas to make more insulin which then causes hypoglycemia (low blood sugar). there are the newer classes of sulfonylureas which are less likely to cause low blood sugar. Glucophage (metformin) is another drug that is prescirbed by the physician. Avandia and Actos are the other drugs your physician may order for you. Actos and Avandia are also called insulin sensitizers, these drugs make your body recognize insulin. if you have a history of heart disease, these drugs should be avoided as they may cause you to retain water. you will also need to have frequent liver function tests to determine if your liver is working well. Precose and Glyset may be prescribed to prevent your small intestine from taking in glucose. These drugs are taken with food. you may have gas and stomach pain when taking them. you may have gas and bloating when taking them. you should avoid these drugs if inflammatory bowel disease is present.

2003-07-23T01:10:00.000-05:00
Hi Sindhu from Ann Stewart
This blog is for you.
Check the comment box.