|
Drug |
Action |
Side Effects |
Nursing Implications |
Why Patient is on It |
|
Digoxin (Digitalis) Class:cardiac glycoside, inotropic,
anti-dysrhythmic Dose: 0.125mg (1tab) PO OD [08] |
-Anticipated effect is
control and decrease of rapid atrial rhythms by increasing cardiac output
(positive inotropic)
|
Dysrhythmias, AV block,
hypotension, headache |
-Apical pulse for 1 min
before giving, if pulse <60 in adult take again in 1 hr, if <60 in
adult call prescriber; note rate rhythm character, -Monitor electrolytes K,
Na, Cl, Mg, Ca, BUN, creatininie,
ALT, AST, Hb, Hct, Hypomagnesia and
Hypokalemia should be avoid while on digoxin as it
increases the risk of Digoxin Toxicity (Mcdonald
& Struthers, 2004) |
Atrial fibrillation &
Heart failure |
|
Metroprolol Class:
anti-hypertensive, anti-anginal Beta-Blocker Dose: 12.5mg PO BID [10][22] Hold if SBP <100 or Hr <
50 |
-Anticipated effect is
lowered blood pressure and reduced pulse rate -Blocks sympathetic nervous
system (Beta-adrengergic receptors) producing
slower HR and lowered BP. -Lowers BP by beta-blocking
effects -Blocks B2-andrenergic
receptors in bronchial, vascular smooth muscle only at high doses |
Hypotension, dizziness,
bradycardia, pulmonary edema, chest pain, AV block, broncospasm |
**Hold if HR < 50 **Do BP also Apical/radial pulse before
administration, notify prescriber of any significant changes or pulse
<50bpm. Edema in feet, legs daily Skin turgor I&O |
For control of hypertension |
|
Acetylsalicylic Acid EC tab ASA, aspirin Class:
anti-platelet Dose: 81mg (1tab) PO OD [08] |
-Anticipated effect is
decreased platelet aggregation to prevent MI, ischemic stroke and angina. -Blocks pain impulses in
CNS -Reduces inflammation by
inhibition of prostaglandin synthesis; |
Increased clotting time
(takes longer for blood to clot) Seizures, GI bleeding,
laryngeal edema, agranulocytosis, neutropenia, hepatitis |
Assess Pain Assess hepatic studies Monitor Hepatotoxicity
(dark urine, clay stools, yellow skin, abd pain,
diarrhea) Assess for bleeding |
Prevent MI, ischemic stroke
and angina as patient with atrial fibrillation, CAD
and HF are at increased risk. |
|
Perindopril Class: anti-hypertensive ACE-inhibitor Dose: 4mg (1 tab) PO OD [08] |
-Anticipated effects
include vasodilation and diuresis by decreasing
afterload and preload, thus decreasing workload of heart and lowering blood
pressure. -inhibits ACE; prevents
conversion of angiotension 1 to 2 causing dilation
of arterial venous vessels |
Proteinuira, renal failure, angioedema,
neutropenia, agranulocytosis |
BP, Pulse q4h Electrolytes: K, Na, Cl Edema in legs/feet daily Symptoms of CHF: edema,
dyspnea, wet crackles Monitor dehydration |
To control hypertension |
|
Paroxetine Class:
Anti-depressant, SSRI (selective serotonin reuptake inhibitor) Dose: 30mg (1tab) PO OD) [08] |
-Anticipated effect is
decreased level of anxiety and depression -Inhibits CNS neuron uptake
of serotonin but not of norepinephrine or dopamine |
Nausea, diarrhea, anxiety,
tremor, dizziness **May decrease digoxin levels |
*Assess mental status *Assess BP lying/standing,
if drop >20mmHg notify prescriber, hold drug *ECG flattening T wave |
Treatment of depression |
|
Levothyroxine (T4) Class:
thyroid hormone Dose: 0.125mg (1tab) PO OD [08] |
-Anticipated effect is
maintenance of cardiac output, metabolic rate & protein synthesis, as
well as, an increase in O2 consumption, growth development at cellular level
and temperature. -Exact mechanism is unknown - |
Thyroid storm, cardiac
arrest, palpitations, tremors, insomnia, anxiety, tachycardia, angina,
dysrhythmias |
*BP pulse q 4 h *Check for bleeding
bruising *Assess for increased
nervousness, excitability, irritablility Assess cardiac status |
Treatment of hypothyroidism |
|
Calcium Carbonate Class:
Antacid, calcium supplement Dose: 1 tab PO OD [08] |
-Anticipated effect is
relief of heart burn by neutralization of gastric activity |
Constipation, diarrhea,
rebound hyperacidity, N&V |
Monitor for side effects |
To decrease gastric acidity
and prevention/ treatment of hypocalcaemia |
|
Pantoprazole Class:
Proton pump inhibitor Dose: 40mg
(1tab) PO OD [07] |
-Anticipated effect is
reduction of gastric secretions thus preventing gastric ulcers and reflux -Suppresses gastric
secretions by inhibiting hydrogen/potassium ATPase
enzyme system in gastric parietal cell; characterized as gastric acid pump
inhibitor, since it blocks final step of acid production |
Headache, diarrhea,
abdominal pain, rash, flatulence, insomnia, hyperglycemia |
Assess GI system q8h Assess hepatic studies AST,
ALT alk phos during tx Diabetic patient may cause
hypo-glycemia |
To prevent gastric acid
production |
|
Diltiazem (tiazac) Class: calcium channel blocker,
anti-arrhythmic class IV Dose:
180mg (1tab) PO OD [08] Hold if SBP<100 or
HR<60 |
-Anticipated effect is
decreased blood pressure & decreased (control
of) ventricular rate -reduces cardiac afterload -causes vasodilation &
systemic vascular resistance -Inhibits action of calcium
ion influx across cell membrane during cardiac depolarization; produces
relaxation of coronary vascular smooth muscle, dilates coronary arteries,
slows SA/AV node conduction times, dilates peripheral arteries |
Sick Sinus Syndrome,
Hypotension, AV block, Dysrhythmias, CHF, heart block, acute renal failure
(decreased amount of urine-oliguria, nocturia, edema in ankles/feet/legs, metallic taste in
mouth, changes in mental status) **increases effect of Beta
Blockers and Digoxin **Sick sinus syndrome ECG will show inappropriate
sinus bradycardia, sinus arrest, sinoatrial block, Afib with slow ventricular response, a prolonged asystolic period after a period of tachycardias |
Assess cardiac status: BP,
pulse, resp, if systolic BP <90mmHg or HR
<60bpm, hold dose, notify prescriber *assess signs of CHF (SOB,
palpitations, weakness, edema ankles/feet) |
To control A-fib and
hypertension |
|
Tolterodine Class:overative bladder product (muscarinic receptor anatagonist) Dose: 4mg (1tab) PO OD [08] |
-Anticipated effect is
decreased urinary frequency and urgency -inhibits bladder
contraction -Relaxes smooth muscles in
urinary tract by inhibiting acetylcholine at postganglionic sites |
Dizziness, vomiting,
nausea, anorexia, dysuria |
*assess urinary patterns *assess for allergic
reaction |
Treatment of urinary
frequency and urgency |
|
Atorvastatin Class:
Anti-lipidemic Dose: 10mg (1tab) PO HS [22] |
-Anticipated effect is a
decrease in blood lipid levels and settle endothelium Lower blood cholesterol
level by decreasing the rate of cholesterol production. In Liver, inhibits
HMG-CoA reductase (enzyme
needed to make cholesterol) |
Myopathy, increased liver enzyme levels, Liver Dysfunction, Rhabdomyolysis, abd cramps,
heartburn *may increase serum levels
of digoxin |
*assess for signs of liver
dysfunction (abd pain, jaundice, loss of appetite) * |
-To settle endothelium -To lower blood lipids in
order to increase cardioprotection *Studies show may reduce
risk of CV events by promiting plaque stability,
reducing imflammation around plaque, reducing
coronary artery calcification, and suppressing the production of thrombin.
(Lilley, Harrington, Synder, 2007, p.482) |
|
Docusate Sodium Class:
Laxative, emollient; stool Dose:100mg
(1tab) PO BID [08][ 17] |
-Anticipated effect is
softening of the stool to allow easier passage in defecation. - works by increasing the
amount of water in the stool, making stools softer and easier to pass -Increases water, fat
penetration in intestine, allows for easier passage of stool |
Nausea, cramps, diarrhea,
rash, bitter taste, throat irritation |
*Monitor effectiveness *Assess for side effects *Assess cause of
constipation (exercise, dehydration, constipating drugs) *Assess for cramping ,
rectal bleeding, N&V |
To prevent of dry, hard
stools, & treat constipation while avoiding straining |
|
Nystatin Class:
Anti-fungal Dose:5000U
in 5ml swish and swallow qid [09][13][18[22] |
Acts by binding to sterols
in fungal cell membrane, allowing cell permeability and allowing leakage of
intracellular components. Kills susceptible yeast and fungi |
Diarrhea, N&V, rash |
Assess for infection: WBC,
temp periodically, neutrophils Monitor hydration status |
Tx of candida albicans (thrush) in mouth |
|
Telebrix Class: contrast
agent for abdominal CT Dose: 8mL
in 500mL in H20 [09] |
Water soluble, monomeric, ionic x-ray contrast medium based on
tri-iodinated benzoic acid |
Proteinuria |
Assess for allergic
reaction Do not give until CT
confirmed by radiology Must be NPO 4 hours prior
to CT |
Contrast agent for
abdominal CT as patient is allergic to angiodye |
|
Insulin – Humilin R Class:anti-diabetic, pancreatic hormone Short acting, Regular
Insulin Onset: 30 min Peak: 3-4hr Duration: 6-8hr Dose: SC sliding scale [0730][1130][1630] [2130] |
-Anticipated effect is
short acting decrease in blood glucose. Taken 30 minutes before eating to aid
the body in the breakdown of glucose from the food you eat Decreases blood glucose by
transport of glucose into cells and the conversion of glucose to glycogen,
indirectly increase blood pyruvate and lactate, decreases phosphate and
potassium; |
Hypoglycaemia, rebound
hyperglycemia, lipodystrophy, blurred vision, dry
mouth |
*GST prior to giving *monitor for signs of
hypoglycaemia during peak time (2.5-5hr)à sweating, weakness, dizziness, chills, confusion,
nausea, rapid weak pulse, fatigue, tachycardia, tremors, hunger -GST 30 min prior to meal *For hyperglycemia: acetone
breath, polyuria, fatigue, polydipsia,
flushed, lethargy |
To lower blood glucose |
|
Pancrelipase Class: digestant Dose: 2 caps PO TID with meals [08][12][17] |
-Anticipated effect is the
breakdown of substances released from the pancreas to aid in digestion Pancreatic enzyme needed
for breakdown of substances released from the pancreas |
N&V, diarrhea, hyperuricuria |
*assess I&O watch for
increasing urinary output *for polyuria,
polydipsia, polyphagia |
For prophylactic pancreatic
enzyme deficiency |
|
Furosemide Class:
Loop diuretic Dose:40mg
(1tab) PO BID [08][ 14] |
-Anticipated effect is a
decrease in fluid volume that leads to a decrease return of blood to the
heart, or decreased filling pressures. -Lowers BP, Reduces
pulmonary vascular resistance, reduces systemic vascular resistance, reduces
central venous pressure, reduces left ventricular end-diastolic pressure and
reduction in pre-load -Inhibits reabsorption of sodium and chloride in the loop of Henle |
Circulatory collapse, loss
of hearing, fatigue, weakness, orthostatic hypotension, chest pain,
hypokalemia, hypochloremic alkalosis, hypocalcemia, hyponatremia,
metabolic alkalosis, hyperglycemia, renal failure, *Diuretics increase urinary
frequency, which Tolterodine is attempting to
decrease |
Assess for signs of
metabolic alkalosis (drowsiness, restlessness) Assess for signs of
hypokalemia (postural hypotension, malaise, fatigue, tachycardia, leg cramps,
weakness.) Assess electrolytes K, Na, Cl, BUN, creatinine, blood glucose, blood pH *teach patient to rise
slowly |
Used to decrease edema in
heart disease and lower blood pressure in hypertension |
|
Morphine Class:
opioid analgesic Dose:
1-5mg IV/PO q 1-2h PRN |
Anticipated effect is a
decrease in the
pain level assessed before the morphine was given. -Binds to opiate receptors
in the CNS. Alters the perception of and response to painful stimuli while
producing a generalized depression in the CNS. |
Confusion, hypotension,
bradycardia, constipation, nausea, vomiting, sedation, respiratory depression * Elderly Patients who have
a long history of hypothyroidism may have increased sensitivity to analgesics
because of changes to liver and renal function. Take caution when
administering to these patients. (Day, Paul, Williams, Smeltzer
& Bare, 2007, p.1220) |
*Monitor for respiratory
depression, cardiac status *GI symptoms |
For pain relief |
|
Dimenhydrinate Gravol Class:
Antiemetic, antihistamine, anticholinergic Dose:
25-50mg IV/PO q4h PRN |
-Anticipated effect is a
decrease in nausea/vomiting -Competes with histamine
for H1 receptors in GI tract, blood vessels, respiratory tract, which results
in decreased vestibular stimulation and blockade of chemoreceptor trigger
zone that triggers |
Drowsiness, confusion,
hypertension, hypotension, nausea, vomiting, constipation, fever |
*monitor for Gi symptoms, drowsiness, hypotension |
If nauseated or vomiting
from effects of medications |
|
Haloperdiol Class:
anti-psychotic, neuroleptic Dose: 0.5-1mg
IV q1h PRN |
-Anticipated effect is a
decrease in the level of anxiety assessed before the medication was given. -Depresses cerebral cortex,
hypothalamus, limbic system, which control activity and aggression; blocks
neurotransmission produced by dopamine at synapse. |
Seizures, neuroleptic malignant syndrome, cardiac arrest,
tachycardia |
Assess LOC Assess for EPS Assess for NMS
(hyperthermia, muscle rigidity, altered mental status, increased CPK,
seizures, hyper/hypotension, tachycardia, notify Dr stat |
Relieve anxiety |
|
Vitamin K Class: vit K1 fat soluble vitamin Dose: 5mg
IM/SC once weekly (Saturday) while on TPN |
-Anticipated effect is a
shortened prothrombin time. Vitamin K needed for
adequate blood clotting (factors II, VII, IX, X) |
Hemoglobinuria, hyperbilirubinemia, hemoltyic anemia, headache, decreased LFTs |
*Monitor for bleeding in
emesis, stools, urine, *PT during treatment (2sec
deviation from control time, bleeding time and clotting time) Monitor for bleeding do BP/Pilse |
Supplemental vitamin while
on TPN as Vit K needed for clotting |
|
TPN: #2 Central
Stress 938kcal/L Nitrogen 9.6 Gm/L Dextrose 125Gm/L Lipid 25 Gm/L Sodium 70mEq/day, Potassium 40 mEq/day, Flow
Rate 35ml/hr |
938kcal/L Nitrogen 9.6 Gm/L Dextrose 125Gm/L Lipid 25 Gm/L Sodium 70mEq/day, Potassium 40 mEq/day, Flow
Rate 35ml/hr |
Complications of long term
TPN may include fatty liver |
*Give Vitamin K 5mg IM/SC
once weekly while on TPN *Monitor liver enzymes -Chart current rate |
To provide nutrition to the
patient’s body while NPO. |
|
Nystatin Powder Class: Anti-fungal Dose: nystatin powder 100 000 units/g 15g prn to groin |
Acts by binding to sterols
in fungal cell membrane, allowing cell permeability and allowing leakage of
intracellular components. Kills susceptible yeast and fungi |
rash |
Assess for infection: WBC,
temp periodically, neutrophils Monitor hydration status |
Tx of candida albicans to groin |
