Mosby's 2011 nursing drug reference 24e samplechapter
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Mosby's 2011 nursing drug reference 24e samplechapter



If you are going to buy one drug handbook -- this should be the one. No other drug handbook enables you to access reliable drug information quicker. With an A-Z organization, each drug is easy to ...

If you are going to buy one drug handbook -- this should be the one. No other drug handbook enables you to access reliable drug information quicker. With an A-Z organization, each drug is easy to find. But what's even better is the fact that Mosby's Nursing Drug Reference gives you the most complete drug information for each drug, including uses, side effects, and interactions. Key nursing considerations are identified to help you assess, administer, evaluate, and teach your patients. Instructions for giving drugs by various routes (e.g., PO, IM, IV) are also included. You will ALWAYS find the latest and most trustworthy drug information in Mosby's Nursing Drug Reference by Linda Skidmore-Roth, a well-known expert in nursing pharmacology. There is a difference in drug handbooks -- put your trust in Mosby, the leading name in nursing publishing.



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Mosby's 2011 nursing drug reference 24e samplechapter Mosby's 2011 nursing drug reference 24e samplechapter Document Transcript

  • #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 1/12 Pg: i BLACK COLOR Team:
  • Be in the know on the go! Mosby’s 2011 Nursing Drug Reference Linda Skidmore-Roth, RN, MSN, NPTake drug information Available via Skyscape:with you on the job! www.skyscape.comPowered by Skyscape,this PDA software offers Bonus material includes:instant access to all • Nursing drug dosageof the content found in calculationsMosby’s 2011 Nursing • A database of similar drugDrug Reference – with key names – combining moreinformation on more than than 1,200 pairs of easily1,300 generic and 4,500 confused drug namestrade-name drugs, • Extensive cross-linking andthousands of new drug search capabilitiesfacts, and approximately • And more!25 drugs recentlyapproved by the FDA. Order your copy today! Available formats: • iPhone®/iPod Touch® • Blackberry®/SmartPhone® Download it directly to • Palm® your device! • Pocket PC® Visit • AndroidTM SL100191 #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 2/12 Pg: ii BLACK COLOR Team:
  • Linda Skidmore-Roth, RN, MSN, NP Consultant Littleton, Colorado Formerly, Nursing Faculty New Mexico State University Las Cruces, New Mexico; El Paso Community College El Paso, Texas#10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 3/12 Pg: iii BLACK COLOR Team:
  • Mosby’s 2011 Nursing Drug Reference, 24e Skidmore Roth  MOSBY An imprint of Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103‐2899  Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.  All rights reserved. No part of this publication may by reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information retrieval system, without written permission from the publisher.  Original ISBN: 978‐0‐323‐06918‐2  This edition of Mosby’s 2011 Nursing Drug Reference, 24e by Linda Skidmore‐Roth, RN, MSN, NP is published by an arrangement with Elsevier Inc.  Indian Reprint ISBN: 978‐81‐312‐2844‐9 First Reprinted in India 2011     Restricted South Asia Edition     This edition is for sale in Bangladesh, Bhutan, India, Maldives, Nepal,  Pakistan and Sri Lanka only.   This edition is not authorized for export outside these territories.   Circulation of this edition outside these territories is unauthorized and illegal.     Notice   Medical  Knowledge  is  constantly  changing.  Standard  safety  precautions  must  be  followed,   but  as  new  research  and  clinical  experience  broaden  our  knowledge,  changes  in  treatment   and  drug  therapy  may  become  necessary  or  appropriate.  Readers  are  advised  to  check  the   most  current  product  information  provided  by  the  manufacturer  of  each  drug  to  be   administered,  to  verify  the  recommended  dose,  the  method  and  the  duration  of   administration,  and  the  contraindications.  It  is  the  responsibility  of  the  practitioner,  relying   on  their  own  experience  and  knowledge  of  the  patient,  to  determine  dosages  and  the  best   treatment  for  each  individual  patient.  Neither  the  Publisher  nor  the  Authors  assume  any   liability for any injury and/or damage to persons or property arising from this publication.      The Publisher    Published by Elsevier, a division of Reed Elsevier India Private Limited.  Registered Office: 622, Indraprakash Building, 21 Barakhamba Road, New Delhi‐110001. Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase‐II, Gurgaon‐122 002, Haryana, India.  Printed and bound in India at Sanat Printers, (Kundli). 
  • ConsultantsTimothy L. Brenner, PharmD, Michael J. Koronkowski, BCOP PharmD, CGPClinical Pharmacy Specialist Clinical Assistant Professor, GeriatricsUPMC Cancer Centers University of Illinois, College ofPittsburgh, Pennsylvania Pharmacy Chicago, IllinoisClaudia Chiesa, PhDMarana, Arizona Shalini S. Lynch, PharmD Assistant Clinical Professor of PharmacyDavid S. Chun, PharmD, BCPS University of California, San FranciscoRichmond Heights, Missouri School of Pharmacy San Francisco, CaliforniaJeffrey J. Fong, PharmD, BCPSAssistant Professor of Pharmacy Practice Michele Matthews, PharmDMassachusetts College of Pharmacy and Assistant Professor Health Sciences Massachusetts College of PharmacyWorcester, Massachusetts Clinical Pharmacist Brigham and Women’s HospitalAmanda Gross, RPh Boston, MassachusettsClinical PharmacistUniversity of Colorado Hospital Sandra Meeker, MSN, RNAurora, Colorado Assistant Professor University of Mary Hardin BaylorDana H. Hamamura, Belton, Texas PharmDClinical Pharmacist, Emergency Joshua J. Neumiller, Department PharmD, CDE, CGP FASCP ,University of Colorado Hospital Assistant ProfessorAurora, Colorado Washington State University Spokane, WashingtonRose Knapp, DNP, RN, APRN-CAssistant Professor of Nursing/ Christopher T. Owens, Pharmacology PharmD, BCPSNew York University Associate Professor and ChairNew York, New York Idaho State University College of Pharmacy Pocatello, Idaho v #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 5/12 Pg: v BLACK COLOR Team:
  • vi ConsultantsBrenda Pavill, PhD, RN, FNP, Sheila M. Seed, PharmD, RPh, IBCLC MPHAssociate Professor Assistant Professor of Pharmacy PracticeUniversity of North Carolina at Massachusetts College of Pharmacy and Wilmington Health SciencesWilmington, North Carolina Worcester, MassachusettsAdam B. Pesaturo, PharmD, Stephen M. Setter, PharmD, BCPS DVM, CDE, CGP FASCP ,Critical Care Pharmacist Associate Professor of PharmacotherapyBaystate Medical Center Elder Services/Visiting NursesSpringfield, Massachusetts Association Washington State UniversityKimberly A. Pesaturo, Spokane, Washington PharmD, BCPSAssistant Professor of Pharmacy Practice Travis E. Sonnett, PharmDMassachusetts College of Pharmacy and Clinical Assistant Professor Health Sciences Washington State UniversityWorcester, Massachusetts Pullman, WashingtonSarah Reidunn Pool, MS, RN Patricia R. Teasley, MSN, RNNurse Manager Nursing Programs CoordinatorMayo Clinic ProfessorRochester, Minnesota Central Texas College Killeen, TexasRandolph Eldon Regal, BS, PharmD, RPh Juanita C. Widener, MAEd,Clinical Associate Professor BSN, RNAdult Internal Medicine Instructor of NursingUniversity of Michigan Bainbridge CollegeAnn Arbor, Michigan Bainbridge, Georgia #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 6/12 Pg: vi BLACK COLOR Team:
  • PrefaceSince the first publication of Mosby’s Nursing Drug Reference in 1988, more than100 U.S. and Canadian pharmacists and consultants have reviewed the book’s contentclosely. Today, Mosby’s 2011 Nursing Drug Reference is more up to date than ever—with features that make it easy to find critical information fast!New Features• Twenty-five recent FDA-approved drugs located throughout the book and in Appen- dix A (see Table of Contents for a complete list). Included are monographs for: • asenapine (Saphris)—used for schizophrenia • dronedarone (Multaq)—used for atrial fibrillation or atrial flutter • everolimus (Affinitor)—used for advanced renal cell carcinoma • pitavastatin (Livalo)—used for hypercholesterolemia • telavancin (Vibatin)—used for complicated gram-positive infections• A companion CD-ROM that offers complete and printable monographs for 100 of the most commonly prescribed drugs in the United States, numerous patient teach- ing guides in English and Spanish for these same drugs, hundreds of normal labo- ratory values, an English-to-Spanish guide for drug phrases and terms, 30 calcula- tors, and Canadian resourcesNew FactsThis edition features more than 2000 new drug facts, including:• New drugs and new dosage information• Newly researched side effects and adverse reactions• New Black Box Warnings• The latest precautions, interactions, and contraindications• IV therapy updates• Revised nursing considerations• Updated patient/family teaching guidelinesOrganizationThis reference is organized into four main sections:• Drug categories• Full-color insert• Individual drug monographs (in alphabetical order by generic name)• Appendixes (identified by the wide, dark blue thumb tabs on the edge)The guiding principle behind this book is to provide fast, easy access to drug informa-tion and nursing considerations. Every detail—from the paper, typeface, cover, bind-ing, use of color, and appendixes—has been carefully chosen with the user in mind. vii #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 7/12 Pg: vii BLACK COLOR Team:
  • viii PrefaceColor InsertThis insert features 14 detailed, four-color illustrations to help enhance the understand-ing of the mechanism or site of action for the following select drugs and drug classes:• ACE inhibitors• Adrenocortical steroids• Antidepressants• Antidiabetic agents• Antifungal agents• Antiinfective agents• Antiplatelet agents• Antiretroviral agents• Benzodiazepines• Diuretics• Drugs used to treat GERD• Narcotic agonist-antagonist analgesics• Narcotic analgesics• SympatholyticsAlso included in the color insert are the 2010 recommended childhood and adoles-cent immunization schedules for the United States.Individual Drug MonographsThis book contains monographs for more than 1300 generic and 4500 trade medica-tions. Common trade names are given for all drugs regularly used in the United Statesand Canada, with drugs available only in Canada identified by a maple leaf . The following information is provided, whenever possible, for safe, effective ad-ministration of each drug: High-alert status: Identifies high-alert drugs with a label and icon. Visit theInstitute for Safe Medication Practices (ISMP) at for a list of medications and drug classes with the greatestpotential for patient harm if they are used in error. ‘‘Tall Man’’ lettering: Uses the capitalization of distinguishing letters to avoidmedication errors and is required by the FDA for drug manufacturers. Pronunciation: Helps the nurse master complex generic names. ]/OTC: Identifies prescription or over-the-counter drugs. Functional and chemical classifications: Allows the nurse to see similaritiesand dissimilarities among drugs in the same functional but different chemical classes. Controlled-substance schedule: Includes schedules for the United States andCanada. Do not confuse: Presents drug names that might easily be confused, within eachappropriate monograph. Action: Describes pharmacologic properties concisely. Uses: Lists the conditions the drug is used to treat. Unlabeled uses: Describes drug uses that may be encountered in practice butare not yet FDA-approved. Dosages and routes: Lists all available and approved dosages and routes foradult, pediatric, and geriatric patients. Available forms: Includes tablets, capsules, extended-release, injectables (IV,IM, SUBCUT), solutions, creams, ointments, lotions, gels, shampoos, elixirs, suspen-sions, suppositories, sprays, aerosols, and lozenges. #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 8/12 Pg: viii BLACK COLOR Team:
  • Preface ix Side effects: Groups these reactions by alphabetical body system, with commonside effects italicized and life-threatening reactions (those that are potentially fataland/or permanently disabling) in bold type for emphasis. Contraindications: Lists conditions under which the drug absolutely should notbe given, including FDA pregnancy safety categories D or X. Precautions: Lists conditions that require special consideration when the drugis prescribed, including FDA pregnancy safety categories A, B, or C. Black box warnings: Identifies FDA warnings that highlight serious and life-threatening adverse effects. Pharmacokinetics: Outlines metabolism, distribution, and elimination. Interactions: Includes confirmed drug interactions, followed by the drug ornutrient causing that interaction, when applicable. Drug/herb: Highlights more than 400 potential interactions between herbal prod-ucts and prescription or OTC drugs. Drug/food: Identifies many common drug interactions with foods. Drug/lab test: Identifies how the drug may affect lab test results. Nursing considerations: Identifies key nursing considerations for each step ofthe nursing process: Assess, Administer, Perform/Provide, Evaluate, and Teach Patient/Family. Instructions for giving drugs by various routes (e.g., PO, IM, IV) are included,with route subheadings in bold. Compatibilities: Lists syringe, Y-site, and additive compatibilities and incompat-ibilities. If no compatibilities are listed for a drug, the necessary compatibility testinghas not been done and that compatibility information is unknown. To ensure safety,assume that the drug may not be mixed with other drugs unless specifically stated. ‘‘Nursing Alert’’ icon : Highlights a critical consideration. Treatment of overdose: Provides drugs and treatment for overdoses whereappropriate.AppendixesSelected new drugs: Includes comprehensive information on 22 key drugs ap-proved by the FDA during the last 12 months. Ophthalmic, otic, nasal, and topical products: Provides essential informa-tion for more than 140 ophthalmic, otic, nasal, and topical products commonly usedtoday, grouped by chemical drug class. Vaccines and toxoids: Features an easy-to-use table with generic and tradenames, uses, dosages and routes, and contraindications for 39 key vaccines andtoxoids. Antitoxins and antivenins: Provides names, uses, dosages, and contraindica-tions. Combination products: Provides details on the forms and uses of more than550 combination products. FDA pregnancy categories: Explains the five FDA pregnancy categories. Abbreviations: Lists abbreviations alphabetically with their meanings. #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 4/6/10 58 Pos: 9/12 Pg: ix BLACK COLOR Team:
  • x PrefaceI am indebted to the nursing and pharmacology consultants who reviewed the manu-script and thank them for their criticism and encouragement. I would also like tothank Nancy O’Brien and Angela Perdue, my editors, whose active encouragementand enthusiasm have made this book better than it might otherwise have been. I amlikewise grateful to Joy Moore and Graphic World Inc. for the coordination of theproduction process and assistance with the development of the new edition. Linda Skidmore-Roth #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 10/12 Pg: x BLACK COLOR Team:
  • ContentsDrug categories, 1 α-Adrenergic blockers, 1 Antiretrovirals, 32 Anesthetics—general/local, 1 Antituberculars, 33 Antacids, 2 Antitussives/expectorants, 34 Anti-Alzheimer agents, 4 Antivirals, 35 Antianginals, 4 β-Adrenergic blockers, 36 Antianxiety agents, 6 Bone resorption inhibitors, 37 Antiasthmatics, 7 Calcium channel blockers, 38 Anticholinergics, 9 Cardiac glycosides, 39 Anticoagulants, 10 Cholinergics, 40 Anticonvulsants, 11 Cholinergic blockers, 41 Antidepressants, 12 Corticosteroids, 42 Antidiabetics, 14 Diuretics, 44 Antidiarrheals, 15 Histamine H2 antagonists, 46 Antidysrhythmics, 16 Immunosuppressants, 46 Antiemetics, 17 Laxatives, 47 Antifungals (systemic), 18 Neuromuscular blocking agents, 48 Antihistamines, 20 Nonsteroidal antiinflammatories, 49 Antihypertensives, 21 Opioid analgesics, 50 Antiinfectives, 23 Salicylates, 52 Antilipidemics, 24 Sedatives/hypnotics, 53 Antineoplastics, 25 Skeletal muscle relaxants, 54 Antiparkinson agents, 28 Thrombolytics, 55 Antiplatelets, 29 Thyroid hormones, 56 Antipsychotics, 29 Vasodilators, 58 Antipyretics, 31 Vitamins, 59Color insert Mechanisms and sites of action illustrations, 60 Recommended 2010 United States immunization schedule for persons aged 0-6 years, 75 Recommended 2010 United States immunization schedule for persons aged 7-18 years, 76Individual drugs, 77 Continued xi #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 3/2/10 57 Pos: 11/12 Pg: xi BLACK COLOR Team:
  • xii ContentsAppendixes, 1194 A. Selected new drugs, 1194 abobotulinumtoxinA hylan G-F 20 asenapine iloperidone canakinumab pitavastatin dexlansoprazole plerixafor dronedarone pralatrexate eltrombopag prasugrel everolimus saxagliptin febuxostat tapentadol fenofibric acid telavancin ferumoxytol tolvaptan fibrinogen, concentrate, human ustekinumab fospropofol vigabatrin golimumab B. Ophthalmic, otic, nasal, and topical products, 1199 C. Vaccines and toxoids, 1213 D. Antitoxins and antivenins, 1219 E. Combination products, 1220 F. FDA pregnancy categories, 1251 G. Abbreviations, 1252Index, 1255Evolve Website • Bibliography • Calculators for Drug Dosages • Canadian Resources (high-alert Canadian medication, Canadian controlled substance chart, Canadian recommended immunization schedule for infants and children) • Color Pill Atlas • Content Updates • Controlled Substance Chart • Drug Monographs • Drug Name Safety • Drugs Metabolized by Known P450s • English-to-Spanish Translations • FDA Alerts • Herbal Products • Medications that May Be Inappropriate for Geriatric Patients • Orphan Drugs and Biologicals • Patient Teaching Guidelines • Recently Approved Drugs • Safety in Handling Chemotherapeutic Agents • Selected Prescription Drugs with Potential for Abuse • Weblinks • Weights and Equivalents #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_01-fm 4/14/10 63 Pos: 12/12 Pg: xii BLACK COLOR Team:
  • anesthetics— general/local 1 -ADRENERGIC BLOCKERS • B/P lying, standing before starting treatment, q4hr thereafterAction: α-Adrenergic blockers act • Nausea, vomiting, diarrheaby binding to α-adrenergic recep- • Skin turgor, dryness of mucoustors, causing dilation of peripheral membranes for hydration statusblood vessels. Lowers peripheral re- Administer:sistance, resulting in decreased B/P. • Starting with low dose, graduallyUses: α-adrenergic blockers are increasing to prevent side effectsused for benign prostatic hyperpla- • With food or milk for GI symp-sia, pheochromocytoma, prevention tomsof tissue necrosis and sloughing asso- Evaluate:ciated with extravasation of IV vaso- • Therapeutic response: decreasedpressors. B/P, increased peripheral pulses Teach patient/family:Side effects: The most common • To avoid alcoholic beveragesside effects are hypotension, tachycar- • To report dizziness, palpitations,dia, nasal stuffiness, nausea, vomit- faintinging, and diarrhea. • To change position slowly or faint-Contraindications: Hypersensi- ing may occurtive reactions may occur, and aller- • To take product exactly as pre-gies should be identified before these scribedproducts are given. Patients with MI, • To avoid all OTC products (cough,coronary insufficiency, angina, or cold, allergy) unless directed by pre-other evidence of CAD should not use scriberthese products. Selected Generic NamesPharmacokinetics: Onset, peak, phentolamineand duration vary among products. 1 blockersInteractions: Vasoconstrictive and silodosinhypertensive effects of epinephrine tamsulosinare antagonized by α-adrenergicblockers.Possible nursing diagnoses:• Risk for injury [adverse reac- ANESTHETICS—tions] GENERAL/LOCAL• Sleep deprivation [adverse reac- Action: Anesthetics (general) act ontions] the CNS to produce tranquilization• Ineffective tissue perfusion [uses] and sleep before invasive procedures.• Impaired urinary elimination Anesthetics (local) inhibit conduc-[uses] tion of nerve impulses from sensory nerves.Nursing Considerations Uses: General anesthetics are usedAssess: to premedicate for surgery, induc-• Electrolytes: K, Na, Cl, CO2 tion and maintenance in general an-• Weight daily, I&O esthesia. For local anesthetics, refer #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 1/60 Pg: 1 BLACK COLOR Team:
  • 2 antacidsto individual product listing for indi- Administer:cations. • Anticholinergic preoperatively toSide effects: The most common decrease secretionsside effects are dystonia, akathisia, • Only with crash cart, resuscitativeflexion of arms, fine tremors, drows- equipment nearbyiness, restlessness, and hypotension. Perform/provide:Also common are chills, respiratory • Quiet environment for recovery todepression, and laryngospasm. decrease psychotic symptomsContraindications: Persons with Evaluate:cerebrovascular accident, increased • Therapeutic response: mainte- nance of anesthesia, decreased painintracranial pressure, severe hyper-tension, cardiac decompensation Selected Generic Namesshould not use these products since (Injectables Only)severe adverse reactions can occur. General anestheticsPrecautions: Anesthetics (general) droperidolshould be used with caution in etomidatethe geriatric, CVD (hypotension, fentanylbradydysrhythmias), renal/hepatic fentanyl/droperidoldisease, Parkinson’s disease, children fentanyl transdermal<2 yr. The precaution for anesthetics fospropofol(local) is pregnancy. midazolamPharmacokinetics: Onset, peak, propofoland duration vary widely among thiopentalproducts. Most products are metabo- Local anestheticslized in the liver and excreted in lidocaineurine. procaineInteractions: MAOIs, tricyclics, ropivacainephenothiazines may cause severe hy- tetracainepotension or hypertension when usedwith local anesthetics. CNS depres-sants will potentiate general and lo-cal anesthetics. ANTACIDSPossible nursing diagnoses: Action: Antacids are basic com-General: pounds that neutralize gastric acidity• Risk for injury [adverse reac- and decrease the rate of gastric emp-tions] tying. Products are divided into those• Deficient knowledge [teaching] containing aluminum, magnesium,Local: calcium, or a combination of these.• Deficient knowledge [teaching] Uses: Antacids decrease hyperacid-• Acute pain [uses] ity in conditions such as peptic ulcer disease, reflux esophagitis, gastritis,Nursing Considerations and hiatal hernia.Assess: Side effects: The most common• VS q10min during IV administra- side effect caused by aluminum-tion, q30min after IM dose containing antacids is constipation, #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 2/60 Pg: 2 BLACK COLOR Team:
  • antacids 3which may lead to fecal impac- fects may be decreased by some ant-tion and bowel obstruction. Diar- acids: cimetidine, corticosteroids,rhea occurs often when magnesium ranitidine, iron salts, phenothi-products are given. Alkalosis may azines, phenytoin, digoxin, tetracy-occur when systemic products are clines, ketoconazole, salicylates, iso-used. Constipation occurs more fre- niazid.quently than laxation with calcium Possible nursing diagnoses:carbonate. The release of CO2 from • Constipation [adverse reactions]carbonate-containing antacids causes • Diarrhea [adverse reactions]belching, abdominal distention, and • Chronic pain [uses]flatulence. Sodium bicarbonate mayact as a systemic antacid and pro- Nursing Considerationsduce systemic electrolyte distur- Assess:bances and alkalosis. Calcium car- • Aggravating and alleviating factorsbonate and sodium bicarbonate may of epigastric pain or hyperacidity;cause rebound hyperacidity and milk- identify the location, duration, andalkali syndrome. Alkaluria may oc- characteristics of epigastric paincur when products are used on a • GI symptoms, including constipa-long-term basis, particularly in per- tion, diarrhea, abdominal pain; if se-sons with abnormal renal function. vere abdominal pain with fever oc-Contraindications: Sensitivity to curs, these products should not bealuminum or magnesium products givenmay cause hypersensitive reactions. • Renal symptoms, including in-Aluminum products should not be creasing urinary pH, electrolytesused by persons sensitive to alumi- Administer:num; magnesium products should • Not to take other products withinnot be used by persons sensitive to 1-2 hr of antacid administration,magnesium. Check for sensitivity be- since antacids may impair absorp-fore administering. tion of other productsPrecautions: Magnesium products • All products with an 8-oz glass ofshould be given cautiously to patients water to ensure absorption in thewith renal insufficiency, and during stomachpregnancy and breastfeeding. Sodium • Another antacid if constipation oc-content of antacids may be signifi- curs with aluminum productscant; use with caution for patients Evaluate:with hypertension, congestive heart • Therapeutic response: absence offailure, or those on a low-sodium epigastric pain, and decreased acid-diet. ityPharmacokinetics: Duration is20-40 min. If ingested 1 hr after meals, Selected Generic Namesacidity is reduced for at least 3 hr. aluminum hydroxideInteractions: Products whose ef- bismuth subsalicylatefects may be increased by some ant- calcium carbonateacids: quinidine, amphetamines, magaldratepseudoephedrine, levodopa, valproic magnesium oxideacid, dicumarol. Products whose ef- sodium bicarbonate #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 3/60 Pg: 3 BLACK COLOR Team:
  • 4 anti-Alzheimer agents Nursing Considerations ANTI-ALZHEIMER AGENTS Assess:Action: Anti-Alzheimer agents im- • B/P, hypotension, hypertensionprove cognitive functioning by in- • Mental status: affect, mood, behav-creasing acetylcholine and inhibiting ioral changes, depression, confusioncholinesterase in the CNS. Do not • GI status: nausea, vomiting, an-cure condition, but improve symp- orexia, diarrheatoms. • GU status: urinary frequency, in-Uses: Anti-Alzheimer agents are used continencefor the treatment of Alzheimer’s Administer:symptoms. • Lowest possible dose for therapeu-Side effects: The most common tic result; adjust dose to responseside effects are nausea, vomiting, di- Perform/provide: • Assistance with ambulation duringarrhea, dry mouth, insomnia, dizzi- beginning therapy if dizziness, ataxianess, as well as urinary frequency, in- occurcontinence, and rash. The most seri- Evaluate:ous side effects are seizures and • Therapeutic response: decrease indysrhythmias. confusion, improved moodContraindications: Persons with Teach patient/family:hypersensitivity reactions should not • To report side effects, adverse re-use these products. actions to health care providerPrecautions: Anti-Alzheimer agents • To use exactly as prescribed, atshould be used cautiously in preg- regular intervalsnancy (C), breastfeeding, sick sinus • Not to increase or abruptly de-syndrome, GI bleeding, bladder ob- crease dose; serious consequences may resultstruction, and seizures. • That product is not a cure, but re-Pharmacokinetics: Onset, peak, lieves symptomsand duration vary widely amongproducts. Most products are metabo- Selected Generic Nameslized in the liver and excreted by the donepezilkidneys. galanthamineInteractions: Increased synergis- memantinetic reactions may occur with succinyl- rivastigminecholine, cholinesterase inhibitors,and cholinergic agonists. There maybe a decrease in the action of anti-cholinergics, and there may be addi- ANTIANGINALStive effects when used with choliner- Action: Antianginals are divided intogic agents. the nitrates, calcium channel block-Possible nursing diagnoses: ers, and β-adrenergic blockers. The• Chronic confusion [uses] nitrates dilate coronary arteries, caus-• Deficient knowledge [teaching] ing decreased preload, and dilate sys-• Noncompliance [teaching] temic arteries, causing decreased af- #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 4/60 Pg: 4 BLACK COLOR Team:
  • antianginals 5terload. Calcium channel blockers di- Nursing Considerationslate coronary arteries and decrease Assess:SA/AV node conduction. β-Adrenergic • Orthostatic B/P, pulseblockers decrease heart rate so that • Pain: duration, time started, activ-myocardial O2 use is decreased. Dipyr- ity being performed, characteridamole selectively dilates coronary ar- • Tolerance if taken over long periodteries to increase coronary blood flow. • Headache, light-headedness, de-Uses: Antianginals are used in creased B/P; may indicate a need forchronic stable angina pectoris, unsta- decreased dosageble angina, vasospastic angina. Some Perform/provide:(i.e., calcium channel blockers and • Storage protected from light, mois-β-blockers) may be used for dys- ture; place in cool environmentrhythmias and in hypertension. Evaluate:Side effects: The most common • Therapeutic response: decrease,side effects are postural hypotension, prevention of anginal painheadache, flushing, dizziness, nausea, Teach patient/family:edema, and drowsiness. Also common • To keep tabs in original containerare rash, dysrhythmias, and fatigue. • Not to use OTC products unless di-Contraindications: Persons with rected by prescriberknown hypersensitivity, increased in- • To report bradycardia, dizziness,tracranial pressure, or cerebral hem- confusion, depression, feverorrhage should not use some of these • To take pulse at home, advise whenproducts. to notify prescriberPrecautions: Antianginals should • To avoid alcohol, smoking, sodiumbe used with caution in postural hy- intakepotension, pregnancy, breastfeeding, • To comply with weight control, di-children, renal disease, and hepatic etary adjustments, modified exerciseinjury. programPharmacokinetics: Onset, peak, • To carry emergency ID to identifyand duration vary widely among cor- product that you are taking, allergiesonary products. Most products are • To make position changes slowlymetabolized in the liver and excreted to prevent faintingin urine.Interactions: Interactions vary Selected Generic Nameswidely among products. Check indi- Nitratesvidual monographs for specific infor- amyl nitritemation. isosorbidePossible nursing diagnoses: nitroglycerin• Decreased cardiac output [adverse -Adrenergic blockersreactions] atenolol• Risk for injury [uses] dipyridamole• Deficient knowledge [teaching] metoprolol• Acute pain [uses] nadolol• Ineffective tissue perfusion [uses] propranolol #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 5/60 Pg: 5 BLACK COLOR Team:
  • 6 antianxiety agentsCalcium channel blockers layed excretion. Clonazepam may in-amlodipine crease the incidence of seizures.bepridil Pharmacokinetics: Most of thesediltiazem agents are metabolized by the liverniCARdipine and excreted via the kidneys.NIFEdipine Interactions: Increased CNS de-verapamil pression may occur when given withMiscellaneous other CNS depressants. These prod-ranolazine ucts should be used together cau- tiously. Alcohol should not be used, as fatal reactions have occurred. The serum concentration and toxicity may ANTIANXIETY AGENTS be increased when used with benzo- diazepines.Action: Benzodiazepines potentiate Possible nursing diagnoses:the action of GABA, including any • Anxiety [uses]other inhibitory transmitters in the • Risk for injury [adverse reac-CNS resulting in decreased anxiety. tions]Most agents cause a decrease in CNS • Deficient knowledge [teaching]excitability.Uses: Anxiety is relieved in condi- Nursing Considerationstions such as generalized anxiety dis- Assess:order and phobic disorders. Benzo- • B/P (lying and standing), pulse; ifdiazepines are also used for acute al- systolic B/P drops 20 mm Hg, holdcohol withdrawal to prevent delirium product and notify prescriber; ortho-tremens, and some products are used static hypotension can be severefor relaxation before surgery. • Hepatic/renal studies: AST, ALT, bil-Side effects: The most common irubin, creatinine, LDH, alk phosside effects are dizziness, drowsiness, • Physical dependency and with-blurred vision, and orthostatic hypo- drawal with some products, includ-tension. Most adverse reactions are ing headache, nausea, vomiting, mus-mediated through the CNS. There is cle pain, and weakness after long-the potential for abuse and physical term usedependence with some products. Administer:Contraindications: These prod- • With food or milk for GI symp-ucts are contraindicated in hypersen- toms; may give crushed if patient issitivity, acute closed-angle glaucoma, unable to swallow whole (tabs only,children <6 mo, hepatic disease no controlled- or sustained-release(clonazepam), and breastfeeding (di- products)azepam). Evaluate:Precautions: Antianxiety agents • Therapeutic response: decreasedshould be used cautiously in geriat- anxiety, increased relaxationric or debilitated patients. Usually Teach patient/family:smaller doses are needed since me- • That product should not be usedtabolism is slowed. Persons with for everyday stress or long-term use;renal/hepatic disease may show de- not to take more than prescribed #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 6/60 Pg: 6 BLACK COLOR Team:
  • antiasthmatics 7amount since product is habit form- Adrenergic agonists act by relaxinging bronchial smooth muscle and in-• To avoid driving and activities that creasing diameter of nasal passages.require alertness since drowsiness β-Adrenergic agonists act by actionand dizziness may occur on β2-receptors, which relaxes bron-• To abstain from alcohol, other psy- chial smooth muscle. Phosphodies-chotropic medications unless di- terase inhibitors act by blockingrected by prescriber phosphodiesterase and increasing• Not to discontinue abruptly; after cAMP, which mediates smooth mus-extended periods, withdrawal symp- cle relaxation in the respiratory sys-toms may occur tem. Corticosteroids act by decreas- ing inflammation in the bronchial sys-Selected Generic Names tem. Leukotriene receptor antagonistsBenzodiazepines decrease leukotrienes, and mast cellalprazolam stabilizers decrease histamine; bothchlordiazepoxide act to decrease bronchospasm.clonazepam Uses: Antiasthmatics are used fordiazepam bronchial asthma; bronchospasm as-lorazepam sociated with bronchitis, emphysema,midazolam or other obstructive pulmonary dis-oxazepine eases; Cheyne-Stokes respirations;temazepine and prevention of exercise-inducedtriazolam asthma. Some products are used forMiscellaneous rhinitis and other allergic reactions.busPIRone Side effects: The most commondoxepin side effects are tremors, anxiety, nau-hydrOXYzine sea, vomiting, and irritation in themeprobamate throat. The most serious adverse re-paroxetine actions are bronchospasm and dys-venlafaxine pnea. Contraindications: Persons with hypersensitivity, closed-angle glau- coma, tachydysrhythmias, and severe ANTIASTHMATICS cardiac disease should not use someAction: Bronchodilators are divided of these products.into anticholinergics, α/β-adrenergic Precautions: Antiasthmatics shouldagonists, β-adrenergic agonists, and be used with caution in breastfeed-phosphodiesterase inhibitors. Also in- ing, pregnancy, hyperthyroidism, hy-cluded in antiasthmatic agents are pertension, prostatic hypertrophy,corticosteroids, leukotriene antago- and seizure disorders.nists, mast cell stabilizers, and mono- Pharmacokinetics: Onset, peak,clonal antibodies. Anticholinergics and duration vary widely amongact by inhibiting interaction of products. Most products are metabo-acetylcholine at receptor sites on lized by the liver and excreted inbronchial smooth muscle. α/β- urine. #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 7/60 Pg: 7 BLACK COLOR Team:
  • 8 antiasthmaticsInteractions: Interactions vary somnia, heart palpitations, light-widely among products. Check indi- headedness; these side effects mayvidual monographs for specific infor- occur with some productsmation.Possible nursing diagnoses: Selected Generic Names• Activity intolerance [uses] Bronchodilators• Ineffective airway clearance [uses]• Risk for injury [adverse reac- albuteroltions] arformoterol• Deficient knowledge [teaching] atropine• Noncompliance [teaching] bitolterol dyphyllineNursing Considerations formoterolAssess: ipratropium• Respiratory function: vital capac- isoproterenolity, forced expiratory volume, ABGs, levalbuterollung sounds, heart rate and rhythm, metaproterenolaggravating and alleviating factors pirbuterolAdminister:• Inhaled product after shaking; ex- terbutalinehale, place mouthpiece in mouth, theophyllineinhale slowly, hold breath, remove, tiotropiumexhale slowly Adrenergics• PO product with meals to decrease epinephrinegastric irritation CorticosteroidsPerform/provide: beclomethasone• Storage of inhaled product in light- betamethasoneresistant container; do not expose to budesonidetemps over 86° F (30° C)• Gum, small sips of water for dry cortisonemouth dexamethasoneEvaluate: flunisolide• Therapeutic response: decrease se- fluticasoneverity and number of asthma attacks; hydrocortisoneabsence of dyspnea, wheezing methylPREDNISoloneTeach patient/family: predniSONE• To avoid hazardous activities; trimicinolonedrowsiness or dizziness may occur Leukotriene antagonistswith some products zafirlukast• To obtain blood work as required;some products require blood levels Mast cell stabilizersto be drawn cromolyn• Avoid all OTC medications unless nedocromilapproved by provider Monoclonal antibodies• To report side effects, including in- omalizumab #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 8/60 Pg: 8 BLACK COLOR Team:
  • anticholinergics 9 ANTICHOLINERGICS with MAOIs and tricyclics and aman- tadine. Anticholinergics may cause aAction: Anticholinergics inhibit the decreased effect of phenothiazinesmuscarinic actions of acetylcholine at and levodopa.receptor sites in the autonomic ner- Possible nursing diagnoses:vous system. Anticholinergics are also • Decreased cardiac output [uses]known as antimuscarinic products. • Constipation [adverse reactions]Uses: Anticholinergics are used for • Deficient knowledge [teaching]a variety of conditions: decreasing in-voluntary movements in parkinson- Nursing Considerationsism (benztropine, trihexyphenidyl); Assess:bradydysrhythmias (atropine); nau- • I&O ratio; retention commonlysea and vomiting (scopolamine); and causes decreased urinary outputas cycloplegic mydriatics (atropine, • Urinary hesitancy, retention; pal-homatropine, scopolamine, cyclo- pate bladder if retention occurspentolate, tropicamide). Gastrointes- • Constipation; increase fluids, bulk,tinal anticholinergics are used to de- exercise if this occurscrease motility (smooth muscle tone) • For tolerance over long-term ther-in the GI, biliary, and urinary tracts apy, dose may need to be increasedand for their ability to decrease gas- or changedtric secretions (propantheline, glyco- • Mental status: affect, mood, CNSpyrrolate). depression, worsening of mentalSide effects: The most common symptoms during early therapyside effects are dry mouth, constipa- Administer:tion, urinary retention, urinary hesi- • Parenteral dose with patienttancy, headache, and dizziness. Also recumbent to prevent postural hypo-common is paralytic ileus. tensionContraindications: Persons with • With or after meals to prevent GIclosed-angle glaucoma, myasthenia upset; may give with fluids other thangravis, or GI/GU obstruction should waternot use some of these products. • Parenteral dose slowly; keep in bedPrecautions: Anticholinergics for at least 1 hr after dose; monitorshould be used with caution in pa- vital signstients who are geriatric, pregnant, or • After checking dose carefully; evenbreastfeeding or in those with pros- slight overdose can lead to toxicitytatic hypertrophy, congestive heart Perform/provide:failure, or hypertension; use with cau- • Storage at room temperaturetion in presence of high environmen- • Hard candy, frequent drinks, sug-tal temperature. arless gum to relieve dry mouthPharmacokinetics: Onset, peak, Evaluate:and duration vary widely among • Therapeutic response: decreasedproducts. Most products are metabo- secretions, absence of nausea andlized in the liver and excreted in vomitingurine. Teach patient/family:Interactions: Increased anticholin- • To avoid driving or other hazard-ergic effects may occur when used ous activities; drowsiness may occur #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 9/60 Pg: 9 BLACK COLOR Team:
  • 10 anticoagulants• To avoid OTC medication: cough, Precautions: Anticoagulants shouldcold preparations with alcohol, anti- be used with caution in alcoholism,histamines unless directed by pre- geriatric patients, and pregnancy.scriber Pharmacokinetics: Onset, peak, and duration vary widely among prod-Selected Generic Names ucts. Most products are metabolizedatropine in the liver and excreted in urine.benztropine Interactions: Salicylates, steroids,biperiden and nonsteroidal antiinflammatoriesdicyclomine will potentiate the action of antico- agulants. Anticoagulants may causeglycopyrrolate serious effects; check individualhyoscyamine monographs.propantheline Possible nursing diagnoses:scopolamine (transdermal) • Risk for injury [side effects]solifenacin • Deficient knowledge [teaching]trihexyphenidyl • Ineffective tissue perfusion [uses] Nursing Considerations ANTICOAGULANTS Assess: • Blood studies (Hct, platelets, oc-Action: Anticoagulants interfere with cult blood in stools) q3moblood clotting by preventing clot for- • Partial PT, which should be 11⁄2-2mation. × control PPT daily, also APTT, ACTUses: Anticoagulants are used for • B/P; watch for increasing signs ofdeep vein thrombosis, PE, MI, open- hypertensionheart surgery, disseminated intravas- • Bleeding gums, petechiae, ecchy-cular clotting syndrome; atrial fibril- mosis; black, tarry stools; hematurialation with embolization, transfusion, • Fever, skin rash, urticariaand dialysis. • Needed dosage change q1-2wkSide effects: The most serious ad- Administer:verse reactions are hemorrhage, • At same time each day to maintainagranulocytosis, leukopenia, eosino- steady blood levelsphilia, and thrombocytopenia, de- • In abdomen between pelvic bone,pending on the specific product. The rotate sites; do not massage area ormost common side effects are diar- aspirate when giving SUBCUT injec-rhea, rash, and fever. tion; do not pull back on plunger,Contraindications: Persons with leave in for 10 sec, apply gentle pres-hemophilia and related disorders, sure for 1 minleukemia with bleeding, peptic ulcer • Without changing needlesdisease, thrombocytopenic purpura, • Avoiding all IM inj that may causeblood dyscrasias, acute nephritis, and bleedingsubacute bacterial endocarditis Perform/provide:should not use these products. • Storage in tight container #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 10/60 Pg: 10 BLACK COLOR Team:
  • anticonvulsants 11Evaluate: and wave formation; they also de-• Therapeutic response: decrease of crease amplitude, frequency, dura-DVT tion, and spread of discharge in sei-Teach patient/family: zures.• To avoid OTC preparations that Uses: Hydantoins are used in gener-may cause serious product interac- alized tonic-clonic seizures, statustions unless directed by prescriber epilepticus, and psychomotor sei-• That product may be held during zures. Succinimides are used foractive bleeding (menstruation), de- absence (petit mal) seizures. Bar-pending on condition biturates are used in generalized• To use soft-bristle toothbrush to tonic-clonic and cortical focal sei-avoid bleeding gums; avoid contact zures.sports, use electric razor Side effects: Bone marrow depres-• To carry emergency ID identifying sion is the most life-threateningproduct taken adverse reaction associated with hy-• To report any signs of bleeding: dantoins or succinimides. The mostgums, under skin, urine, stools common side effects are GI symp- toms. Other common side effects forSelected Generic Names hydantoins are gingival hyperplasiaardeparin and CNS effects such as nystagmus,argatroban ataxia, slurred speech, and mentaldalteparin confusion.danaparoid Contraindications: Hypersensi-desirudin tive reactions may occur, and aller-enoxaparin gies should be identified before thesefondaparinux products are given.heparin Precautions: Persons with renal/lepirudintinzaparin hepatic disease should be watchedwarfarin closely. Pharmacokinetics: Onset, peak, and duration vary widely among products. Most products are metabo- ANTICONVULSANTS lized in the liver and excreted inAction: Anticonvulsants are di- urine, bile, and feces.vided into the barbiturates, benzodi- Interactions: Decreased effects ofazepines, hydantoins, succinimides, estrogens, oral contraceptives (hy-and miscellaneous products. Barbitu- dantoins).rates and benzodiazepines are dis- Possible nursing diagnoses:cussed in separate sections. Hydanto- • Injury, risk for [uses]ins act by inhibiting the spread of sei- • Noncompliance [teaching]zure activity in the motor cortex. • Sleep deprivation [adverse reac-Succinimides act by inhibiting spike tions] #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 11/60 Pg: 11 BLACK COLOR Team:
  • 12 antidepressantsNursing Considerations Selected Generic NamesAssess: Barbiturates• Renal studies, including BUN, cre- phenobarbitalatinine, serum uric acid, urine creat- primidoneinine clearance before and during thiopentaltherapy Hydantoins• Blood studies: RBC, Hct, Hgb, retic- fosphenytoinulocyte counts q wk for 4 wk then q phenytoinmo Succinimides• Hepatic studies: AST, ALT, biliru- ethosuximidebin, creatinine Miscellaneous• Mental status, including mood, sen- acetaZOLAMIDEsorium, affect, behavorial changes; if carbamazepinemental status changes, notify pre- clonazepamscriber diazepam• Eye problems, including need for felbamate gabapentinophthalmic exam before, during, and lacosamideafter treatment (slit lamp, fundus- lamotriginecopy, tonometry) magnesium sulfate• Allergic reactions, including red, paraldehyderaised rash; if this occurs, product paramethadioneshould be discontinued phenacemide• Blood dyscrasia, including fever, rufinamidesore throat, bruising, rash, jaundice tiagabine• Toxicity, including bone marrow topiramatedepression, nausea, vomiting, ataxia, valproate/valproic acid, divalproexdiplopia, CV collapse, Stevens- sodiumJohnson syndrome vigabatrinAdminister: zonisamide• With food, milk to decrease GIsymptomsPerform/provide:• Good oral hygiene as it is impor- ANTIDEPRESSANTStant for hydantoins Action: Antidepressants are dividedEvaluate: into the tricyclics, MAOIs, and miscel-• Therapeutic response: decreased laneous antidepressants (SSRIs). Theseizure activity; document on patient’s tricyclics work by blocking reuptakechart of norepinephrine and serotonin intoTeach patient/family: nerve endings and increasing action• To carry emergency ID stating of norepinephrine and serotonin inproducts taken, condition, prescrib- nerve cells. MAOIs act by increasinger’s name, phone number concentrations of endogenous epi-• To avoid driving, other activities nephrine, norepinephrine, serotonin,that require alertness DOPamine in storage sites in CNS by #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 3/31/10 238 Pos: 12/60 Pg: 12 BLACK COLOR Team:
  • antidepressants 13inhibition of MAO; increased concen- • Blood studies: CBC, leukocytes, dif-tration reduces depression. ferential, cardiac enzymes if patientUses: Antidepressants are used for is receiving long-term therapydepression and, in some cases, en- • Hepatic studies: AST, ALT, biliru-uresis in children. bin, creatinineSide effects: The most serious ad- • Weight q wk; appetite may increaseverse reactions are paralytic ileus, with productacute renal failure, hypertension, and • EPS, primarily in geriatric patients:hypertensive crisis, depending on the rigidity, dystonia, akathisiaspecific product. Common side ef- • Mental status: mood, sensorium,fects are dizziness, drowsiness, diar- affect, suicidal tendencies, increaserhea, dry mouth, urinary retention, in psychiatric symptoms: depression,and orthostatic hypotension. panicContraindications: The contrain- • Urinary retention, constipation;dications to antidepressants are sei- constipation is more likely to occurzure disorders, prostatic hypertro- in children, geriatric patientsphy and severe renal/hepatic/cardiac • Withdrawal symptoms: headache,disease depending on the type of nausea, vomiting, muscle pain, weak-medication. ness; do not usually occur unlessPrecautions: Antidepressants product was discontinued abruptlyshould be used cautiously in suicidal • Alcohol consumption; if alcohol ispatients, severe depression, schizo- consumed, hold dose until morningphrenia, hyperactivity, diabetes melli- Administer:tus, pregnancy, and geriatric patients. • Increased fluids if urinary reten-Pharmacokinetics: Onset, peak, tion occurs, bulk in diet, if constipa-and duration vary widely among tion occursproducts. Most products are metabo- • With food or milk for GI symp-lized in the liver and excreted in tomsurine. Perform/provide:Interactions: Interactions vary • Storage in tight container at roomwidely among products. Check indi- temperature; do not freezevidual monographs for specific infor- • Assistance with ambulation duringmation. beginning therapy since drowsiness,Possible nursing diagnoses: dizziness occur• Ineffective coping [uses] • Safety measures including side rails• Risk for injury [uses/adverse reac- primarily in geriatric patientstions] • Checking to see PO medication• Deficient knowledge [teaching] swallowed • Gum, hard candy, or frequent sipsNursing Considerations of water for dry mouthAssess: Evaluate:• B/P (lying, standing), pulse q4hr; • Therapeutic response: decreasedif systolic B/P drops 20 mm Hg, hold depressionproduct, notify prescriber; take VS Teach patient/family:q4hr in patients with cardiovascular • That therapeutic effects may takedisease 2-3 wk #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 13/60 Pg: 13 BLACK COLOR Team:
  • 14 antidiabetics• To use caution in driving, other ac- glucose, phosphate, and potassiumtivities requiring alertness because of and increase blood pyruvate anddrowsiness, dizziness, blurred vision lactate; and oral antidiabetics that• To avoid alcohol ingestion, other cause functioning β-cells in the pan-CNS depressants creas to release insulin, improve the• Not to discontinue medication effect of endogenous and exogenousquickly after long-term use; may insulin.cause nausea, headache, malaise Uses: Insulins are used for ketoaci-• To wear sunscreen or wide- dosis and diabetes mellitus types 1brimmed hat since photosensitivity and 2; oral antidiabetics are used formay occur stable adult-onset diabetes mellitus type 2.Selected Generic Names Side effects: The most commonTetracyclics side effect of insulin and oral antidia-mirtazapine betics is hypoglycemia. Other adverseTricyclics reactions to oral antidiabetics includeamitriptyline blood dyscrasias, hepatotoxicity, andamoxapine rarely, cholestatic jaundice. AdverseclomiPRAMINE reactions to insulin products includedesipramine allergic responses and, more rarely,doxepin anaphylaxis.imipramine Contraindications: Hypersensi-nortriptyline tive reactions may occur, and aller-trimipramine gies should be identified before theseMiscellaneous products are given. Oral antidiabet-buPROPion ics should not be used in juvenile orduloxetine brittle diabetes, diabetic ketoacido-trazodone sis, or severe renal/hepatic disease.venlafaxine Precautions: Oral antidiabeticsMAOIs should be used with caution in thephenelzine geriatric patient, in cardiac disease,tranylcypromine pregnancy, breastfeeding, and in theSSRIs presence of alcohol.citalopram Pharmacokinetics: Onset, peak,escitalopram and duration vary widely amongfluoxetine products. Oral antidiabetics are me-fluvoxamine tabolized in the liver, with metabo-paroxetine lites excreted in urine, bile, and feces.sertraline Interactions: Interactions vary widely among products. Check indi- vidual monographs for specific infor- mation. ANTIDIABETICS Possible nursing diagnoses:Action: Antidiabetics are divided • Imbalanced nutrition: more thaninto the insulins that decrease blood body requirements [uses] #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 14/60 Pg: 14 BLACK COLOR Team:
  • antidiarrheals 15Nursing Considerations • To continue weight control, di-Assess: etary restrictions, exercise, hygiene • Obtain yearly eye exams• Blood, urine glucose levels duringtreatment to determine diabetes con- Selected Generic Namestrol (oral products) chlorproPAMIDE• Fasting blood glucose, 2 hr PP glipiZIDE(60-100 mg/dl normal fasting level) glyBURIDE(70-130 mg/dl normal 2-hr level) insulin aspart insulin detemir• Hypoglycemic reaction that can oc- insulin glarginecur during peak time insulin glulisineAdminister: insulin lispro• Insulin after warming to room tem- insulin, regularperature by rotating in palms to pre- insulin, regular concentratedvent lipodystrophy from injecting cold insulin, zinc suspension (Lente)insulin insulin, zinc suspension extended• Human insulin to those allergic to (Ultralente)beef or pork metformin• Oral antidiabetic 30 min before miglitolmeals nateglinidePerform/provide: pioglitazone• Rotation of inj sites when giving in- repaglinidesulin; use abdomen, upper back, rosiglitazonethighs, upper arm, buttocks; rotate saxagliptansites within one of these regions; keep sitagliptina record of sitesEvaluate: ANTIDIARRHEALS• Therapeutic response: decrease inpolyuria, polydipsia, polyphagia, Action: Antidiarrheals work by vari-clear sensorium; absence of dizzi- ous actions, including direct action onness; stable gait intestinal muscles to decrease GITeach patient/family: peristalsis; by inhibiting prostaglan-• To avoid alcohol and salicylates ex- din synthesis responsible for GI hy- permotility; by acting on mucosal re-cept on advice of prescriber ceptors responsible for peristalsis; or• Symptoms of ketoacidosis: nausea, by decreasing water content of stools.thirst, polyuria, dry mouth, decreased Uses: Antidiarrheals are used for di-B/P; dry, flushed skin; acetone breath, arrhea of undetermined causes.drowsiness, Kussmaul respiration Side effects: The most serious ad-• Symptoms of hypoglycemia: head- verse reactions of some products areache, tremors, fatigue, weakness; that paralytic ileus, toxic megacolon, andcandy or sugar should be carried to angioneurotic edema. The most com-treat hypoglycemia mon side effects are constipation,• To test urine for glucose/ketones nausea, dry mouth, and abdominaltid if this product is replacing insulin pain. #10782 @sunultra1/raid/CLS_books/GRP_mosby/JOB_skndr_2011/DIV_02-pp1-60 2/24/10 232 Pos: 15/60 Pg: 15 BLACK COLOR Team: