NURS 3404 Chapter Notes - Chapter Drug Guide : Rhinorrhea, Radiation Therapy, Duodenum

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15 Jan 2018
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NURS 3404 Individuals I PRN MEDICATION WORKSHEET Fall 2017
Complete before first clinical day, show to your faculty at 6:30 am and then bring it with you each week for clinical.
Date: 10/3/2017
Drug Name
Class
Action/Therapeutic effects
Side Effects SEVERE
Recommended
Dose/ Route/
Frequency
Rationale
Lab values/ Nursing implications
acetaminophen
(Tylenol)
Class:
Therapeutic:
Antipyretics, nonopioid
analgesics
Pharmacologic:
N/A
Action:
Inhibits synthesis of prostaglandins
that may serve as mediators of pain
and fever, primarily in the CNS. Has
no significant anti-inflammatory
properties or GI toxicity.
Therapeutic Effects:
Analgesia. Antipyresis
Side Effects:
HEPATOTOXICITY, renal failure,
neutropenia, pancytopenia, ACUTE
GENERALIZED
EXANTHEMATOUS PUSTULOSIS,
STEVENS-JOHNSON SYNDROME,
TOXIC EPIDERMAL NECROLYSIS,
rash, urticaria, agitation, anxiety,
headache, fatigue, insomnia,
atelectasis, dyspnea, hypertension,
hypotension, constipation, increased
liver enzymes, nausea, vomiting,
muscle spasms, trismus
*ADULTS & CHILDREN >
12 yr*
Route: PO
Dose: 325-650mg
Freq: q6h
Safe dose: Not to
exceed 3g in 24 hr
*ADULTS & CHILDREN >
13 yr and > 50kg*
Route: IV
Dose: 1000mg \
650mg
Freq: q6h \ q4h
Safe dose: Not to
exceed 1000mg/dose,
4g/day, and less than
4hr dosing interval
*ADULTS & CHILDREN >
13 yr and > 50kg*
Route: IV
Dose: 15mg/kg \
12.5mg/kg
Freq: q6h \ q4h
Safe dose: Not to
exceed 15mg/kg/dose,
75mg/kg/day, and less
than 4hr dosing
interval
*ADULTS & CHILDREN >
12 yr*
Route: Rect
Dose: 325-650mg \ 1g
Freq: q4-6h \ 3-4
times daily
Safe dose: Not to
exceed 4g in 24 hr
Treatment of mild to moderate
pain or fever. IV can treat
moderate to severe pain with
opioid analgesics.
Lab Values:
Evaluate hepatic, hematologic and renal function
periodically during prolonged, high-dose therapy. May
alter results of blood glucose monitoring. May cause
falsely low values when measured with glucose
oxidase/peroxidase method, but probably not with
hexokinase/G6PD method. May also cause falsely high
values with certain instruments; see manufacturer’s
instruction manual. Increased serum bilirubin, LDH,
AST, ALT, and prothrombin time may indicate
hepatotoxicity.
Nursing Implications:
Patients who are malnourished or chronically abuse
alcohol are at higher risk of developing hepatotoxicity
with chronic use of usual doses of this drug. Assess for
rash periodically during therapy. May cause Stevens-
Johnson Syndrome. Discontinue therapy if rash or if
accompanied with fever, general malaise, fatigue,
muscle or joint aches, blisters, oral lesions,
conjunctivitis, hepatitis and/or eosinophilia. Increased
serum bilirubin, LDH, AST, ALT, and prothrombin time
may indicate hepatoxicity. Toxicity and Overdose: if
overdose occurs, acetylcysteine is the antidote. PO:
administer with a full glass of water. May be taken with
food or on an empty stomach. Advise patent to
discontinue med and notify HCP if rash occurs.
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bisacodyl
(Ducolax)
Class:
Therapeutic:
Laxatives
Pharmacologic:
Stimulant laxatives
Action:
Stimulates peristalsis. Alters fluid and
electrolyte transport, producing fluid
accumulation in the colon.
Therapeutic Effects:
Evacuation of the colon.
Side Effects:
Abdominal cramps, nausea, diarrhea,
rectal burning, hypokalemia (with
chronic use), protein losing
enteropathy, tetany (with chronic use)
*ADULTS & CHILDREN >
12 yr*
Route: PO
Dose: 5-15mg
Freq: Daily single
dose
Safe dose: Up to 30
mg/day
*ADULTS & CHILDREN >
12 yr*
Route: Rect
Dose: 10mg
Freq: Daily
Safe dose: Single dose
Treatment of constipation.
Evacuation of the bowel before
radiologic studies or surgery.
Part of a bowel regimen in
spinal cord injury patients.
Lab Values:
May cause decrease in potassium levels and other fluid
and electrolyte imbalances
Nursing Implications:
Assess patient for abdominal distension, presence of
bowel sounds, and usual pattern of bowel function.
Assess color, consistency, and amount of stool
produced. Do not confuse Dulcolax (bisacodyl) with
Dulcolax (docusate sodium). May be administered at
bedtime for morning results. Taking on an empty
stomach will produce more rapid results. Do not crush
or chew enteric-coated tablets. Take with a full glass of
water or juice. Do not administer oral doses within 1 hr
of milk or antacids; this may lead to premature
dissolution of tablet and gastric or duodenal irritation.
Advise patient that med should not be used when
constipation is accompanied by abdominal pain, fever,
nausea, or vomiting.
diphenhydramine
(Benadryl)
Class:
Therapeutic:
Allergy, cold, and cough
remedies, antihistamines,
antitussives
Pharmacologic:
N/A
Action:
Antagonizes the effects of histamine at
H1-receptor sites; does not bind to or
inactive histamine. Significant CNS
depressant and anticholinergic
properties.
Therapeutic Effects:
Decreased symptoms of histamine
excess (sneezing, rhinorrhea, nasal and
ocular pruritus, ocular tearing and
redness, urticarial). Relief of acute
dystonic reactions. Prevention of
motion sickness. Suppression of
cough.
Side Effects:
Drowsiness, dizziness, headache,
paradoxical excitation (increased in
children), blurred vision, tinnitus,
hypotension, palpitations, anorexia,
dry mouth, constipation, nausea,
dysuria, frequency, urinary retention,
photosensitivity, chest tightness,
thickened bronchial secretions,
wheezing, pain at IM site.
*ADULTS & CHILDREN >
12 yr*
Route: PO:
antihistaminic/antieme
tic/antivertiginic \
antitussive \
antidyskinetic \
sedative/hypnotic
Dose: 25-50mg \
25mg \ 25-50mg\
50mg
Freq: q4-6h \ q4h as
needed \ q4h \ 20-
30min before bedtime
Safe dose: Not to
exceed 300mg/day \
not to exceed
150mg/day \ not to
exceed 400mg/day \
single dose
*ADULTS *
Route: IM, IV
Dose: 25-50mg
Freq: q4h as needed
Safe dose: may need
up to 100mg dose, not
to exceed 400mg/day
Relief of allergic symptoms
caused by histamine release
including: Anaphylaxis,
Seasonal and perennial allergic
rhinitis, Allergic dermatoses.
Parkinson’s disease and
dystonic reactions from
medications. Mild nighttime
sedation. Prevention of motion
sickness. Antitussive (syrup
only).
Lab Values:
May decrease skin response to allergy tests. Discontinue
4 days before skin testing.
Nursing Implications:
Med has multiple uses. Determine why the med was
ordered and assess symptoms that apply to the patient.
Geri: appears on the “Beers list”. May cause sedation
and confusion due to increased sensitivity to
antichlinergic effects. Monitor carefully, assess for
confusion, delirium, other anticholinergic side effects
and fall risk.
Prevention and treatment of anaphylaxis: assess for
urticarial and patency of airway. Allergic rhinitis: assess
degree of nasal stuffiness, rhinorrhea, and sneezing.
Parkinsonism and extrapyramidal reactions: assess
movement disorder before and after administration.
Insomnia: assess sleep patterns. Cough suppressant:
assess frequency and nature of cough, lung sounds, and
amount and type of sputum produced. Unless
contraindicated, maintain fluid intake of 1500-2000mL
daily to decrease viscosity of bronchial secretions.
Pruritus: assess degree of itching, skin rash, and
inflammation.
Do not confuse with benazepril. When used for
insomnia administer 20 min before bedtime. PO:
administer with meals or milk to minimize GI irritation.
Capsule may be emptied and contents taken with food or
water. May cause dry mouth, oral rinses can minimize
effect.
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hydrocodone
Class:
Therapeutic:
Allergy, cold, and cough
remedies (antitussive), opioid
analgesics
Pharmacologic:
Opioid agonists/nonopioid
analgesic combinations
Action:
Blind to opiate receptors in the CNS.
Alter the perception of and response to
painful stimuli while producing
generalized CNS depression: suppress
the cough reflex via a direct central
action.
Therapeutic Effects:
Decrease in severity of moderate pain.
Suppression of the cough reflex.
Side Effects:
Confusion, dizziness, sedation,
euphoria, hallucinations, headache,
unusual dreams, blurred vision,
diplopia, miosis, respiratory
depression, hypotension, bradycardia,
constipation, dyspepsia, nausea,
choking, dysphagia, esophageal
obstruction, vomiting, urinary
retention, seating, physical
dependence, psychological
dependence, tolerance.
*ADULTS *
Route: PO: analgesic
\ antitussive \ extended
release (Zohydro ER) \
extended release
(Hiysingla)
Dose: 2.5-10mg \ 5mg
\ 10mg, may increase
as needed in
increments of 10mg \
20mg, may increase as
needed in increments
of 10-20mg
Freq: q3-6h \ q4-6h \
q12h \ daily
Safe dose: if using in
combination products,
acetaminophen dosage
should not exceed
4g/day and should not
exceed 5tablets/day of
ibuprofen containing
products \ N/A \ only
increase every 3-7
days if needed \ only
increase every 3-5
days if needed
Extended release products:
management of pain that is
severe enough to warrant daily,
around-the-clock, long-term
opioid treatment where
alternative treatment options
are inadequate.
Combination products:
management of moderate to
severe pain. Antitussive
(usually in combination with
decongestants).
Lab Values:
May cause increased plasma amylase and lipase
concentrations.
Nursing Implications:
Assess bowel function routinely. Assess BP, pulse and
respirations before and periodically during
administration. If respiratory rate is < 10/min, assess
level of sedation. Physical stimulation may be sufficient
to prevent significant hypoventilation. Initial drowsiness
will decrease with continued use. Assess pain prior to
and 1 hr after administration. A repeat dose can be
safely administered at the time of the peak if previous
dose is ineffective and side effects are minimal. Assess
for risk of addiction, abuse, or misuse prior to
administration. Explain therapeutic value before
administration to enhance analgesic effect. PO: may be
administered with food or milk to minimize GI
irritation. Swallow extended release capsules whole; do
not crush, open, dissolve, or chew. Encourage patient to
turn and cough as well as breath deeply every 2 hours to
prevent atelectasis.
hydromorphone
(Dilaudid)
Class:
Therapeutic:
Allergy, cold, and cough
remedies (antitussives,
opioid analgesics
Pharmacologic:
Opioid agonists
Action:
Binds to opiate receptors in the CNS.
Alters the perception of and the
response to painful stimuli while
producing generalized CNS
depression. Suppresses the cough
reflex via a direct central action.
Therapeutic Effects:
Decrease in moderate to severe pain.
Suppression of cough.
Side Effects:
Confusion, dizziness, sedation,
euphoria, floating feeling,
hallucinations, headache, unusual
dreams, blurred vision, diplopia,
miosis, RESPIRATORY
DEPRESSION, hypotension,
bradycardia, constipation, dry mouth,
nausea, vomiting, urinary retention,
flushing, sweating, physical
dependence, psychological
dependence, tolerance.
*ADULTS > 50 kg*
Route: PO:
immediate-release or
extended-release
Dose: 4-8mg
Freq: q3-4h initially
or once daily
*ADULTS > 50 kg*
Route: IV, IM, Subcut
Dose: 1.5mg, may be
increased
Freq: q3-4h as needed
initially
*ADULTS *
Route: Rect
Dose: 3mg
Freq: q6-8h
Moderate to severe pain (alone
and in combination with
nonopioid analgesics).
Moderate to sever chronic pain
in opioid-tolerant patients
requiring use of daily, around-
the-clock long-term opioid
treatment and for which
alternative treatment options
are inadequate (extended-
release). Antitussive (lower
doses).
Lab Values:
May increase plasma amylase and lipase concentrations.
Nursing Implications:
Assess BP, pulse and respirations before and
periodically during administration. If respiratory rate is
< 10/min, assess level of sedation. Dose may need to be
decreased by 25-50%. Initial drowsiness will diminish
with continued use. Assess bowel function routinely,
and implement constipation prevention. Assess pain
type, location, and intensity. Patients on a continuous
infusion should have additional bolus doses provided
15-30 min, as needed, for breakthrough pain. Assess for
risk of opioid addiction prior to administration. DO
NOT CONFUSE WITH MORPHINE. PO: may be
administered with food or milk to minimize GI
irritation.
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Document Summary

Complete before first clinical day, show to your faculty at 6:30 am and then bring it with you each week for clinical. Treatment of mild to moderate pain or fever. Iv can treat moderate to severe pain with opioid analgesics. Evaluate hepatic, hematologic and renal function periodically during prolonged, high-dose therapy. May cause falsely low values when measured with glucose oxidase/peroxidase method, but probably not with hexokinase/g6pd method. May also cause falsely high values with certain instruments; see manufacturer"s instruction manual. Ast, alt, and prothrombin time may indicate hepatotoxicity. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Discontinue therapy if rash or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia. Increased serum bilirubin, ldh, ast, alt, and prothrombin time may indicate hepatoxicity. Toxicity and overdose: if overdose occurs, acetylcysteine is the antidote.

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