Clayton's Basic Pharmacology for Nurses

Front Cover
IFC
Title Page
Basic Pharmacology for Nurses
Copyright
Dedication
Reviewers and Ancillary Contributors
LPN/LVN Advisory Board
Preface
CONTENT THREADS
CONTENTS
CHAPTER ORGANIZATION
SPECIAL FEATURES
NEW TO THIS EDITION
TEACHING AND LEARNING PACKAGE
FOR STUDENTS
FOR INSTRUCTORS
I - Applying Pharmacology to Nursing Practice
1 - Drug Names, Standards, Legislation, and Development in the United States
Drug Names
Drug Classifications
Sources of Drug Standards and Drug Information
Package Inserts
Nursing Journals
Electronic Databases
United States Drug Legislation
Controlled Substances Act
Drug Enforcement Administration
Possession of Controlled Substances by Individuals
Effectiveness of Drug Legislation
New Drug Development
Preclinical Research and Development Stage
Clinical Research and Development Stage
Fast Tracking
Parallel Tracking
New Drug Application Review
Postmarketing Surveillance Stage
Black Box Warning
Rare Diseases and the Development of Orphan Drugs
Official Drug
Chemical Name
Proper Name or Generic Name
Brand Name
Sources of Canadian Drug Standards
Canadian Drug Legislation
Food and Drugs Act And Regulations
Controlled Drugs and Substances Act
Nonprescription Drugs
2 - Basic Principles of Drug Action and Drug Interactions
Basic Principles Related to Drug Therapy
Drug Responses in the Body
Routes of Drug Administration
Liberation, Absorption, Distribution, Metabolism, and Excretion
Liberation
Absorption
Distribution
Metabolism
Excretion
Half-Life
Drug Actions
Drug Blood Level
Adverse Effects of Drugs
Idiosyncratic Reaction
Allergic Reaction
Drug Interactions
Changes in Absorption
Changes in Distribution
Changes in Metabolism
Changes in Excretion
Drugs That Enhance the Pharmacologic Effects of Other Drugs
3 - Drug Action Across the Life Span
Age
Body Weight
Gender
Metabolic Rate
Illness
Psychology
Tolerance
Dependence
Cumulative Effect
Factors That Influence Drug Actions
Absorption
Age
Gender
Distribution
Age and Gender
Metabolism
Age
Gender
Excretion
Age
Therapeutic Drug Monitoring
Nursing Implications When Monitoring Drug Therapy
Monitoring Parameters
Pediatric Patients
Geriatric Patients
Pregnant Patients
Breastfeeding Infants
Genetics and Drug Metabolism
4 - The Nursing Process and Pharmacology
ASSESSMENT
NURSING DIAGNOSIS
Focused Assessment
PLANNING
Evidence-Based Practice
Priority Setting
Measurable Outcome Goal Statements
Example of a Therapeutic Outcome
IMPLEMENTATION
Nursing Action or Intervention Statements
Evaluation
ASSESSMENT
NURSING DIAGNOSES
PLANNING
IMPLEMENTATION
Dependent Nursing Actions
Interdependent Nursing Actions
Independent Nursing Actions
EVALUATION
5 - Patient Education to Promote Health
Three Domains of Learning
Affective Domain
PRINCIPLES OF TEACHING AND LEARNING
FOCUS THE LEARNING
CONSIDER LEARNING STYLES
ORGANIZE TEACHING SESSIONS AND MATERIALS
MOTIVATE THE PATIENT TO LEARN
DETERMINE READINESS TO LEARN
SPACE THE CONTENT
USE REPETITION TO ENHANCE LEARNING
CONSIDER EDUCATION LEVEL
INCORPORATE CULTURAL AND ETHNIC DIVERSITY
STRATEGIES FOR HEALTHCARE TEACHING
TEACH APPROPRIATE USE OF THE INTERNET
ENCOURAGE ADHERENCE
Strategies for Increasing Adherence
USE RELEVANT CONTENT
COMMUNICATE GOALS AND EXPECTATIONS OF THERAPY
Changes in Expectations
Cooperative Goal Setting
Discharge Planning and Teaching
II - Illustrated Atlas of Medication Administration
6 - Principles of Medication Administration and Medication Safety
Patient Charts
Contents of Patient Charts
Summary Section
Consent Section
Order Section
History and Physical Examination Section
Progress Notes
Nurses’ Notes
Laboratory Tests Record
Graphic Record
Flow Sheets
Consultation Reports
Other Diagnostic Reports
Medication Profile and Medication Administration Record
PRN or Unscheduled Medication Record
Patient Education Record
Additional Patient Chart Records
Nursing Care Plans
Kardex Records
Charting Methodologies
Drug Distribution Systems
Floor or Ward Stock System
Individual Prescription Order System
Unit-Dose System
Computer-Controlled Dispensing System
Long-Term Care Unit-Dose System
Narcotic Control Systems
Disposal of Unused Medicines
Medication Orders
Types of Medication Orders
Verbal Orders
Electronic Transmission of Patient Orders
Medication Safety
Technology and Prevention of Adverse Drug Events
High-Alert Medications
Medication Reconciliation
Sound-Alike Medications
Nurse’s Responsibilities
Verification
Transcription
Reporting Variance
Seven Rights of Drug Administration
Right Drug
Right Indication
Right Time
Standard Timing Abbreviations
Standardized Administration Times
Maintenance of Consistent Blood Levels
Maximum Drug Absorption
Diagnostic Testing
PRN Medications
Right Dose
Abnormal Hepatic or Renal Function
Pediatric and Older Patients
Nausea and Vomiting
Accurate Dose Forms
Accurate Calculations
Correct Measuring Devices
Right Patient
Pediatric Patients
Older Patients
Right Route
Right Documentation
Discharge Medication Teaching
7 - Percutaneous Administration
DOSE FORMS
Creams
Lotions
Ointments
Powders
DRESSINGS
PROCEDURE PROTOCOL
ADMINISTRATION OF CREAMS, LOTIONS, POWDERS, AND OINTMENTS
EQUIPMENT
SITES
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
PATCH TESTING FOR ALLERGENS
EQUIPMENT
SITES
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF NITROGLYCERIN OINTMENT
DOSE FORM
EQUIPMENT
SITES
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
DOSE FORM
EQUIPMENT
SITES
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
DOSE FORMS
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF EYEDROPS AND OINTMENT
DOSE FORM
EQUIPMENT
SITE
TECHNIQUE
Instilling Drops
Applying Ointment
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF EARDROPS
DOSE FORM
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF NOSE DROPS
EQUIPMENT
SITE
TECHNIQUE
For Adults and Older Children
For Infants and Young Children
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF NASAL SPRAY
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF MEDICATIONS BY INHALATION
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
DOSE FORMS
EQUIPMENT
SITE
TECHNIQUE
Aerosolized Metered-Dose Inhaler
Dry Powder Inhaler
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF VAGINAL MEDICATIONS
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF A VAGINAL DOUCHE
EQUIPMENT
SITE
TECHNIQUE
PATIENT TEACHING
DOCUMENTATION
8 - Enteral Administration
Dose Forms
Capsules
Timed-release capsules and tablets.Timed-release or sustained-release capsules and tablets provide a gradual but continuous rele...
Lozenges
Pills
Tablets
Elixirs
Emulsions
Suspensions
Syrups
Equipment
Unit Dose or Single Dose
Soufflé Cup
Medicine Cup
Medicine Dropper
Teaspoon
Oral Syringe
Nipple
Procedure Protocol
Unit-Dose System
Equipment
Technique
Computer-Controlled Dispensing System
Equipment
Technique
General Principles of Solid-Form Medication Administration
Documentation
Unit-Dose System
Equipment
Technique
Liquid-Form Oral Medications In Multidose Containers
Measuring With a Medicine Cup
Measuring With an Oral Syringe
For An Adult or Child
For An Infant
Documentation
Equipment
Technique
pH and Color Testing of Gastrointestinal Contents to Check for Tube Placement
Two-Syringe Technique for Medication Administration
Documentation
Administration Of Enteral Feedings Via Gastrostomy Or Jejunostomy Tube
Dose Form
Equipment
Technique
Intermittent Tube Feeding
Continuous Tube Feeding
Documentation
Dose Form
Equipment
Technique
Documentation
Dose Form
Equipment
Technique
Documentation
9 - Parenteral Administration: Safe Preparation of Parenteral Medications
SAFE PREPARATION, ADMINISTRATION, AND DISPOSAL OF PARENTERAL MEDICATIONS AND SUPPLIES
SYRINGES
Syringe Calibration
Reading the calibration of the syringe
Milliliter scale. The milliliter scale represents the units whereby medications are routinely ordered. For volumes of 1 mL or le...
Tuberculin syringe. The tuberculin syringe, or 1-mL syringe, was originally designed to administer tuberculin inoculations (see ...
Insulin syringe. The insulin syringe has a scale that has been specifically calibrated for the measurement of insulin. Insulin i...
Prefilled Cartridges and Syringes
THE NEEDLE
Parts of the Needle
Needle Gauge
SELECTION OF THE SYRINGE AND NEEDLE
Selection of Needle Length
PACKAGING OF SYRINGES AND NEEDLES
SAFETY SYSTEMS FOR PARENTERAL PREPARATION, ADMINISTRATION, AND DISPOSAL
BLUNT ACCESS DEVICES
SAFETY DEVICES
APPROPRIATE DISPOSAL
PARENTERAL DOSE FORMS
AMPULES
VIALS
MIX-O-VIALS
PREPARATION OF PARENTERAL MEDICATION
EQUIPMENT
PROCEDURE PROTOCOL
TECHNIQUES
Preparing a Medication From an Ampule
Preparing a Medication From a Vial
Reconstitution of a sterile powder
Removal of a volume of liquid from a vial (see Fig. 9.24A–E)
Preparing a Drug From a Mix-O-Vial
Preparing Two Medications in One Syringe
Drugs Used in the Operating Room
Drugs Used in the Sterile Surgical Field
Method 1
Method 2
10 - Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular Routes
Administration Of Medication By The Intradermal Route
Equipment
Sites
Technique
Intradermal Injection Method
Skin Prick Test Method
Patient Teaching
Documentation
Administration of Medication by the Subcutaneous Route
Equipment
Syringe Size
Needle Length
Needle Gauge
Sites
Technique
Patient Teaching
Documentation
Administration of Medication By The Intramuscular Route
Equipment
Syringe Size
Needle Length
Needle Gauge
Sites
Vastus Lateralis Muscle
Rectus Femoris Muscle
Gluteal Area
Ventrogluteal area.The ventrogluteal area is easily accessible when the patient is in a prone, supine, or side-lying position. I...
Dorsogluteal area.The use of this site is discouraged and not practiced to any great extent because of the possible damage to th...
Deltoid Muscle
Site Rotation
Technique
Standard Method
Z-Track Method
Patient Teaching
Documentation
11 - Parenteral Administration: Intravenous Route
INTRAVENOUS ADMINISTRATION SETS
Equipment Used in Conjunction With Intravenous Therapy
TYPES OF INFUSION-CONTROL PUMPS
Pumps
Syringe Pumps
INTRAVENOUS ACCESS DEVICES
Peripheral Access Devices
Central Access Devices
INTRAVENOUS DOSE FORMS
TYPES OF INTRAVENOUS SOLUTIONS
LARGE-VOLUME SOLUTION CONTAINERS
SMALL-VOLUME SOLUTION CONTAINERS
DOSE FORMS
EQUIPMENT
SITES
Peripheral Intravenous Access
Central Intravenous Access
GENERAL PRINCIPLES OF INTRAVENOUS MEDICATION ADMINISTRATION
DOSE FORM
EQUIPMENT
TECHNIQUE
INTRAVENOUS FLUID MONITORING
BASIC GUIDELINES FOR THE INTRAVENOUS ADMINISTRATION OF MEDICATIONS
EQUIPMENT
PREMEDICATION ASSESSMENT
PROCEDURE PROTOCOL
VENIPUNCTURE
EQUIPMENT
Selection of the Catheter or Butterfly Needle
TECHNIQUE FOR ESTABLISHING AN INTRAVENOUS LINE
Peripheral Over-the-Needle Catheter Insertion (See Fig. 11.6A)
Butterfly Needle Insertion
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF MEDICATION BY A SALINE LOCK OR A MEDLOCK
EQUIPMENT
TECHNIQUE FOR INTRAVENOUS BOLUS MEDICATIONS WITH CAPPED INTRAVENOUS LINE
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF MEDICATIONS INTO AN ESTABLISHED INTRAVENOUS LINE
EQUIPMENT
TECHNIQUE FOR INTRAVENOUS BOLUS MEDICATIONS WITH INTRAVENOUS SOLUTION RUNNING
PATIENT TEACHING
DOCUMENTATION
ADMINISTRATION OF MEDICATION THROUGH AN IMPLANTED VENOUS ACCESS DEVICE
EQUIPMENT
TECHNIQUE FOR INTRAVENOUS MEDICATIONS VIA IMPLANTED VENOUS ACCESS DEVICE
PATIENT TEACHING
DOCUMENTATION
ADDING A MEDICATION TO AN INTRAVENOUS BAG, BOTTLE, OR VOLUME-CONTROL DEVICE
EQUIPMENT
TECHNIQUE FOR ADDING MEDICATIONS TO INTRAVENOUS SOLUTIONS
PATIENT TEACHING
DOCUMENTATION
ADDING A MEDICATION WITH A PIGGYBACK SET
EQUIPMENT
TECHNIQUE FOR INTRAVENOUS PIGGYBACK MEDICATIONS
PATIENT TEACHING
DOCUMENTATION
CHANGING TO THE NEXT CONTAINER OF INTRAVENOUS SOLUTION
EQUIPMENT
TECHNIQUE FOR CHANGING INTRAVENOUS SOLUTIONS
PATIENT TEACHING
DOCUMENTATION
DISCONTINUING AN INTRAVENOUS INFUSION
EQUIPMENT
TECHNIQUE FOR REMOVING AN IV
DOCUMENTATION
MONITORING INTRAVENOUS THERAPY
COMPLICATIONS ASSOCIATED WITH INTRAVENOUS THERAPY
Phlebitis, Thrombophlebitis, and Localized Infection
Septicemia
Infiltration and Extravasation
Air in the Tubing or Air Embolus
Circulatory Overload and Pulmonary Edema
Pulmonary Embolism
“Speed Shock”
PATIENT TEACHING
DOCUMENTATION
III - Drugs Affecting the Autonomic and Central Nervous Systems
12 - THE AUTONOMIC NERVOUS SYSTEM
DRUG CLASS: ADRENERGIC AGENTS
Uses
Nursing Implications for Adrenergic Agents
Premedication assessment
Availability
Common adverse effects. Adverse effects associated with adrenergic agents are usually dose related and resolve when the dosage i...
Serious adverse effects
Drug interactions
Agents that may increase therapeutic and toxic effects. Monoamine oxidase inhibitors (e.g., phenelzine, tranylcypromine), tricyc...
Agents that inhibit therapeutic activity. The concurrent use of beta-adrenergic blocking agents (e.g., propranolol, nadolol, tim...
Uses
Nursing Implications for Beta-Adrenergic Blocking Agents
Premedication assessment
Availability, dosage, and administration
Individualization of dosage. Although the onset of activity is fairly rapid, it may take several days to weeks for a patient to ...
Sudden discontinuation. Patients must be counseled against poor adherence or the sudden discontinuation of therapy without a hea...
Common adverse effects. Most of the adverse effects associated with beta-adrenergic blocking agents are dose related. Response b...
Serious adverse effects
Drug interactions
Antihypertensive agents. All beta-blocking agents have hypotensive properties that are additive with anti
Beta-adrenergic agents. Depending on the dosage, the beta stimulants (e.g., isoproterenol, terbutaline, albuterol) may inhibit t...
Lidocaine, phenytoin, disopyramide, digoxin. When these drugs are occasionally used concurrently with beta-blocking agents, the ...
Enzyme-inducing agents. Enzyme-inducing agents (e.g., phenobarbital, pentobarbital, rifampin, phenytoin) enhance the metabolism ...
Nonsteroidal antiinflammatory agents. Indomethacin, salicylates, and possibly other prostaglandin inhibitors reduce the antihype...
DRUG CLASS: CHOLINERGIC AGENTS
Uses
Nursing Implications for Cholinergic Agents
Premedication assessment
Availability, dosage, and administration
Common adverse effects. Because cholinergic fibers innervate the entire body, effects in most body systems can be expected. Fort...
Serious adverse effects
DRUG CLASS: ANTICHOLINERGIC AGENTS
Uses
Nursing Implications for Anticholinergic Agents
Premedication assessment
Availability dosage and administration
Common adverse effects. Because cholinergic fibers innervate the entire body, effects from blocking this system occur throughout...
Serious adverse effects
Drug interactions
Amantadine, tricyclic antidepressants, phenothiazines. These agents may potentiate anticholinergic adverse effects. Confusion an...
13 - Drugs Used for Sedation and Sleep
SLEEP AND SLEEP PATTERN DISTURBANCE
Sedative-Hypnotic Therapy
Actions
Uses
Central nervous system function.Because sedative-hypnotic drugs depress overall central nervous system (CNS) function, identify ...
Vital signs. Obtain the patient’s current blood pressure, pulse, and respiration rates before initiating drug therapy
Sleep pattern.Assess the patient’s usual pattern of sleep, and obtain information about the pattern of sleep disruption (e.g., d...
Anxiety level.Assess the patient’s exhibited degree of anxiety. Is it really a sedative-hypnotic medication that the patient nee...
Environmental control.Obtain data related to possible disturbances present in the individual’s sleeping environment that may int...
Nutritional needs. Obtain a dietary history to identify sources of caffeinated products that may act as stimulants
Alcohol intake. Although alcohol causes sedation, it disrupts sleep patterns and may cause early-morning awakening
Exercise.Obtain data related to the patient’s usual degree of physical activity and at what times during the day that they are m...
Respiratory status.Patients with respiratory disorders and those who snore heavily may have low respiratory reserves and should ...
Implementation
Vital signs. Obtain the patient’s vital signs periodically as the situation indicates
Preoperative medication. Give the patient pre
Monitoring effects.When a medication is administered, carefully assess the patient at regular intervals for the drug’s therapeut...
As-needed medications.If giving the patient as-needed (PRN) medications, ask the patient about the effectiveness of previously a...
Patient Education: Promote Good Sleep Hygiene
Bedtime. Encourage the patient to choose a standard time to go to bed to help the body establish a rhythm and routine
Nutrition.Teach the patient appropriate nutrition information concerning the US Food and Drug Administration (FDA)’s recommendat...
Avoiding heavy meals during the evening.Alcohol and caffeine consumption should be reduced or discontinued, especially within se...
Personal comfort.Position the patient for maximum comfort, provide a back rub, encourage the patient to empty the bladder, and b...
Environmental control.Tell the patient to sleep in an environment that promotes sleep, such as a quiet, darkened room free from ...
Activity and exercise.Suggest the inclusion of exercise in the patient’s daily activities so that the patient obtains sufficient...
Stress management
Fostering health maintenance.Throughout the course of treatment, discuss medication information and how it will benefit the pati...
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e.g...
Drug Class: Benzodiazepines
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Benzodiazepines
Premedication assessment
Availability, dosage, and administration.See Table 13.1. Use of benzodiazepines may result in physical and psychological depende...
Pregnancy and lactation.It is generally recommended that benzodiazepines not be administered during at least the first trimester...
Common adverse effects
Excessive use or abuse.The habitual use of benzodiazepines may result in physical dependence. Discuss the case with the healthca...
Blood dyscrasias.Blood dyscrasias are rare but have been reported. Routine laboratory studies (e.g., red blood cell count, white...
Hepatotoxicity.The symptoms of hepatotoxicity are anorexia, nausea, vomiting, jaundice, hepatomegaly, splenomegaly, and abnormal...
Drug interactions
Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, narcotics, cimetidine, disulfiram, isoniazid, erythromycin, and...
Smoking and rifampin.Smoking and rifampin enhance the metabolism of benzodiazepines. Larger doses may be necessary to maintain s...
Uses
Therapeutic Outcomes
Nursing Implications of Nonbenzodiazepine Sedative-Hypnotic Agents
Premedication assessment
Availability, dosage, and administration.See Table 13.2. The habitual use of sedative-hypnotic agents may result in physical dep...
Common adverse effects
Drug interactions
Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, narcotics, cimetidine, disulfiram, isoniazid, erythromycin, ket...
Fluvoxamine.Fluvoxamine specifically inhibits the metabolism of ramelteon and tasimelteon, thus causing excessive sedation. Pati...
Rifampin.Rifampin significantly enhances the metabolism of zolpidem, eszopiclone, ramelteon, and tasimelteon, thereby reducing t...
Food.The presence of food—particularly food with a high fat content—slows the absorption of zolpidem, zaleplon, eszopiclone, and...
14 - Drugs Used to Treat Neurodegenerative Disorders
ACTIONS
USES
Unified Parkinson’s Disease Rating Scale. The Unified Parkinson’s Disease Rating Scale (UPDRS) is often used to identify the bas...
History of parkinsonism. Obtain a history of the patient’s exposure to known conditions associated with the development of parki...
Motor function. Patients with Parkinson disease progress through the following symptoms
Tremor. Tremors (uncontrolled shaking) are initially so minor that they are observed only by the patient. They occur primarily w...
Dyskinesia. Dyskinesia is the impairment of the individual’s ability to perform voluntary movements. This symptom commonly start...
Bradykinesia. Bradykinesia is the extremely slow body movement that may eventually progress to akinesia (i.e., a lack of movemen...
Implementation
Patient Education
Nutrition. Teach the patient to drink at least six to eight glasses of water or fluid per day to maintain adequate hydration. Be...
Stress management. Explain to the patient and caregivers about the importance of maintaining an environment that is as free from...
Self-reliance. Encourage patients to perform as many ADLs as they can. Parkinson disease is a progressive disorder; explain to c...
Exercise. Instruct the patient and caregiver about the importance of maintaining correct body alignment, walking as erect as pos...
Mood alterations. Explain to the patient and the
Fostering health maintenance. Provide the patient and their significant others with important information contained in the speci...
Patient self-assessment. Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e....
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Monoamine Oxidase Type B Inhibitor Therapy
Premedication assessment
Availability, dosage, and administration. The dosage must be adjusted according to the patient’s response and tolerance
Common adverse effects. Selegiline, safinamide, and rasagiline cause relatively few adverse effects. They may increase the adver...
Serious adverse effects
Drug interactions
Levodopa. MAO-B inhibitors and levodopa have additive neurologic effects. These interactions may be beneficial because they ofte...
Meperidine, tramadol, methadone. Fatal drug interactions have been reported between monoamine oxidase inhibitors (MAOIs) and the...
Dextromethorphan. Episodes of psychosis and bizarre behavior have been reported with selegiline and dextromethorphan. Do not adm...
Food. Patients should avoid foods and beverages with high tyramine content (e.g., Chianti wine, fava beans, cheeses), particular...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is often necessary in response to excessive orthostat...
Ciprofloxacin. This antibiotic inhibits the metabolism of rasagiline, thus significantly raising rasagiline serum levels and pot...
Antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitor...
Sympathomimetic amines (ephedrine, pseudoephedrine, phenylephrine). Cases of hypertensive crisis have rarely been reported among...
DRUG CLASS: DOPAMINE AGONISTS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Carbidopa-Levodopa Therapy
Premedication assessment
Availability. PO: Sinemet is a combination product that contains both carbidopa and levodopa. The combination product is availab...
Dosage and administration. Adult: PO: For patients who are not receiving levodopa initially, give Sinemet 10/100 or 25/100 mg th...
Common adverse effects. Levodopa causes many adverse effects, but most are dose related and reversible. Adverse effects vary gre...
Serious adverse effects
Drug interactions. Sinemet and Rytary may be used to treat parkinsonism in conjunction with dopamine agonists, COMT inhibitors, ...
Monoamine oxidase inhibitors (phenelzine, tranylcypromine, isocarboxazid, selegiline). These MAOIs unpredictably exaggerate the ...
Isoniazid. Use this drug with caution in conjunction with levodopa. Discontinue isoniazid if patients who are taking levodopa de...
Pyridoxine. Pyridoxine (vitamin B6) in oral doses of 5 to 10 mg may reduce the therapeutic and toxic effects of levodopa. Normal...
Diazepam, chlordiazepoxide, clonidine, phenytoin. These agents appear to cause a deterioration of the therapeutic effects of lev...
Phenothiazines, haloperidol, risperidone, metoclopramide. An adverse effect associated with these agents is a Parkinson-like syn...
Epinephrine, amphetamines. Levodopa may increase the therapeutic and toxic effects of these agents. Monitor the patient for tach...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is frequently necessary in response to excessive orth...
Anticholinergic agonists (benztropine, diphenhydramine, trihexyphenidyl). Although these agents are used to treat parkinsonism, ...
Toilet bowl cleaners. The metabolites of levodopa react with toilet bowl cleaners to turn the urine to shades of red to black. T...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Amantadine Therapy
Premedication assessment
Availability. PO: 100-mg tablets; 100-mg capsules; 50 mg/5 mL syrup; 68.5, 137 mg extended-release (24 hours) capsules (Gocovri)...
Dosage and administration. Adult: PO: Amantadine tablets, capsules, syrup: Initially 100 mg two times daily; maximum daily dose ...
Common adverse effects. Most of the adverse effects of amantadine therapy are dose related and reversible
Dizziness, lightheadedness. Provide patient safety during periods of dizziness or lightheadedness
Serious adverse effects
Drug interactions
Anticholinergic agents (trihexyphenidyl, benztropine, procyclidine, diphenhydramine). Amantadine may exacerbate the side effects...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Apomorphine Therapy
Premedication assessment
Availability. Subcutaneous: 10 mg/mL in 3-mL cartridges. Sublingual film: 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Dosage and administration. Apomorphine is administered by a sublingual film or with the use of a manual, reusable, multidose inj...
Common adverse effects. Most adverse effects observed with apomorphine are direct extensions of its pharmacologic properties
Serious adverse effects
Sudden sleep events. Sleep episodes have been reported with the dopamine agonists (e.g., apomorphine, pergolide, pramipexole, ro...
Drug interactions
Serotonin antagonists (ondansetron, dolasetron, granisetron, palonosetron, alosetron). The use of serotonin antagonists with apo...
Phenothiazines, including prochlorperazine, butyrophenones (e.g., haloperidol), thioxanthenes, metoclopramide. These medicines a...
Ethanol, antihypertensive agents, vasodilators (e.g., nitrates). The use of these agents concurrently with apomorphine significa...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Pramipexole Therapy
Premedication assessment
Availability. PO: tablets: 0.125, 0.25, 0.5, 0.75, 1, and 1.5 mg; tablets, extended release (24 hours): 0.375, 0.75, 1.5, 2.25, ...
Dosage and administration. Adult: PO
Common adverse effects. Pramipexole causes many adverse effects, but most are dose related and are reversible. Adverse effects v...
Serious adverse effects
Sudden sleep events. Sleep episodes have been reported with the dopamine agonists (e.g., pramipexole, ropinirole). These episode...
Impulse control/compulsive behaviors. While taking pramipexole and other dopamine agonists, patients can experience an intense u...
Drug interactions
Cimetidine, diltiazem, verapamil, quinidine, triamterene. These agents inhibit the urinary excretion of pramipexole. A dose redu...
Dopamine antagonists. Dopamine antagonists include phenothiazines, butyrophenones, thioxanthenes, and metoclopramide. As dopamin...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is often necessary in response to excessive orthostat...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Ropinirole Therapy
Premedication assessment
Availability. PO: tablets: 0.25, 0.5, 1, 2, 3, 4, and 5 mg; tablets, extended release (24 hours): 2, 4, 6, 8, and 12 mg
Dosage and administration. Adult: PO: Initially, give 0.25 mg three times daily for 1 week. If tolerated, increase to 0.5 mg thr...
Common adverse effects. Ropinirole causes many adverse effects, but most are dose related and are reversible. Adverse effects va...
Serious adverse effects
Sudden sleep events. Sleep episodes have been reported with the dopamine agonists (e.g., pramipexole, ropinirole). These episode...
Impulse control/compulsive behaviors. Patients can experience an intense urge to gamble, increased sexual urge, an intense urge ...
Drug interactions
Ciprofloxacin. This antibiotic inhibits the metabolism of ropinirole. A dosage reduction of ropinirole is often required to prev...
Estrogens (primarily ethinyl estradiol). Estrogen inhibits ropinirole excretion. If estrogen therapy is started or stopped durin...
Dopamine antagonists. Dopamine antagonists include phenothiazines, butyrophenones, thioxanthenes, and metoclopramide. As dopamin...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is often necessary in response to excessive orthostat...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Rotigotine Therapy
Premedication assessment
Availability. Transdermal: 1, 2, 3, 4, 6, and 8 mg/24 hr patch
Dosage and administration. Adult, early-stage: Transdermal: Initial: Apply 2 mg/24 hr patch once daily; may increase by 2 mg/24 ...
Common adverse effects. Rotigotine causes many adverse effects, but most are dose related and are reversible. Adverse effects va...
Skin. Application site reactions may be seen with rotigotine transdermal patches. The signs and symptoms of these reactions gene...
Serious adverse effects
Sudden sleep events. Sleep episodes have been reported with the dopamine agonists. These episodes are described as “sleep attack...
Impulse control/compulsive behaviors. Patients can experience an intense urge to gamble, increased sexual urge, an intense urge ...
Drug interactions
Dopamine antagonists. Dopamine antagonists include phenothiazines, butyrophenones, thioxanthenes, and metoclopramide. As dopamin...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is often necessary in response to excessive orthostat...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for COMT Inhibitor Therapy
Premedication assessment
Availability. PO: Entacapone (Comtan): 200-mg tablets (do not administer entacapone without levodopa/carbidopa; it has no pharma...
Dosage and administration. Dosage must be adjusted in accordance with the patient’s response and tolerance
Entacapone. Adult: PO: Initially, start therapy by adding entacapone to already existing levodopa/carbidopa therapy: give one 20...
Opicapone. For patients receiving levodopa/carbidopa experiencing “off” episodes
Common adverse effects. Entacapone and opicapone may increase the adverse dopaminergic effects of levodopa (e.g., chorea, confus...
Gastrointestinal. Entacapone may cause the develop of diarrhea 1 to 12 weeks after the initiation of therapy, especially when hi...
Genitourinary. Urine discoloration
Serious adverse effects
Drug interactions
Levodopa. Entacapone and opicapone and levodopa have additive neurologic effects. This interaction may be beneficial because it ...
Antihypertensive agents. A dosage adjustment of the antihypertensive agent is often necessary in response to excessive orthostat...
Apomorphine, isoproterenol, epinephrine, norepinephrine (levarterenol), dopamine, dobutamine. These agents are metabolized by CO...
DRUG CLASS: ANTICHOLINERGIC AGENTS
Uses
Therapeutic Outcome
Nursing Implications for Anticholinergic Agent Therapy
Premedication assessment
Availability, dosage, and administration. Adult: PO (Table 14.3). Administer medication with food or milk to reduce gastric irri...
Common adverse effects
Serious adverse effects
Palpitations, dysrhythmias. Report any changes for further evaluation
Drug interactions
Amantadine, tricyclic antidepressants, phenothiazines. These agents may enhance the anticholinergic adverse effects. Confusion a...
Levodopa. Large doses of anticholinergic agents may slow gastric emptying and inhibit the absorption of levodopa. An increase in...
ALZHEIMER DISEASE
NURSING IMPLICATIONS FOR ALZHEIMER DISEASE THERAPY
Assessment
Safety and self-care. Caregivers are taught to repeat, reassure, and redirect the patient with Alzheimer disease as the cognitiv...
Stress. The patient with Alzheimer disease can become agitated, anxious, and aggressive as the disease progresses. Recognize the...
Family resources. Help families connect with programs designed to teach them about the various stages of Alzheimer disease and a...
Implementation
Patient Education
Fostering health maintenance
Patient self-assessment. Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g.,...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Donepezil, Galantamine, and Rivastigmine Therapy
Premedication assessment
Availability
Donepezil. PO: 5-, 10-, and 23-mg tablets; 5- and 10-mg orally disintegrating tablets
Galantamine. PO: 4-, 8-, 12-mg tablets; 4-mg/mL oral solution; 8-, 16-, 24-mg extended-release 24-hour capsules
Rivastigmine. Transdermal: 4.6, 9.5, and 13.3 mg/24 hr patch
Dosage and administration
Donepezil. PO: Initial dosage is 5 mg daily at bedtime. After 4 to 6 weeks of therapy, dosage may be increased to 10 mg daily to...
Galantamine. Adult: PO: Immediate release initial dosage 4 mg twice a day. After a minimum of 4 weeks, dosage may be increased t...
Rivastigmine. Transdermal: Initial: Apply 4.6 mg/24 hr patch once daily; if well tolerated, dose may be titrated (no sooner than...
Common adverse effects
Serious adverse effects
Drug interactions
Anticholinergic agents. As a cholinergic agent, donepezil has the potential to reduce the activity of anti
Succinylcholine-type muscle relaxants, cholinergic agents. As a cholinesterase inhibitor, donepezil is likely to exaggerate the ...
DRUG CLASS: NMDA RECEPTOR INHIBITOR
Actions
Uses
Therapeutic Outcome
Nursing Implications for Memantine Therapy
Premedication assessment
Availability. PO: 5- and 10-mg tablets; 7-, 14-, 21-, and 28-mg capsules, extended release (24 hours); 2 mg/mL in 240 and 360-mL...
Dosage and administration. Adult: PO: 5 mg once daily. The dose should be increased in 5-mg increments to 10, 15, and 20 mg dail...
Common and serious adverse effects
Drug interactions
Acetazolamide, sodium bicarbonate. Medicines that alkalinize the pH of the urine will reduce excretion of memantine. Severe medi...
15 - Drugs Used for Anxiety Disorders
Uses
Assessment
History of behaviorObtain a history of the precipitating factors that may have triggered or contributed to the individual’s curr...
Basic mental status Note the patient’s general appearance and appropriateness of attire. Is the individual clean and neat Is the...
Mood and affect Is the individual tearful, excessively excited, angry, hostile, or apathetic Is the facial expression tense, fea...
Clarity of thought Evaluate the coherency, relevancy, and organization of the patient’s thoughts. Ask specific questions about t...
Psychomotor functions Ask specific questions regarding the activity level that the patient has maintained. Is the patient able t...
Obsessions or compulsions Does the individual experience persistent thoughts, images, or ideas that are inappropriate and cause ...
Sleep pattern What is the patient’s normal sleep pattern, and how has it varied since the onset of the symptoms Ask specifically...
Dietary history Ask questions about the individual’s appetite and note weight gains or losses not associated with intentional di...
Implementation
Patient Education
Fostering health maintenance Throughout the course of treatment, discuss medication information and how the medication will bene...
Patient self-assessment Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (see...
Drug Class: Benzodiazepines
Actions
Uses
Therapeutic Outcome
Nursing Implications for Benzodiazepines
Premedication assessment
Availability, dosage, and administration.See Table 15.1. Use of benzodiazepines may result in physical and psychological depende...
Pregnancy and lactation.It is recommended that benzodiazepines not be administered during at least the first trimester of pregna...
Common adverse effects
Serious adverse effects
Drug interactions
Antihistamines, alcohol, analgesics, anesthetics, probenecid, tranquilizers, opioids, cimetidine, other sedative-
Oral contraceptives, cimetidine, fluoxetine, metoprolol, propranolol, isoniazid, ketoconazole, valproic acid.These agents inhibi...
Smoking, rifampin.Smoking and rifampin enhance the metabolism of benzodiazepines. Larger doses may be necessary to maintain anxi...
Drug Class: Azaspirones
Actions
Uses
Therapeutic Outcome
Nursing Implications for Buspirone Therapy
Premedication assessment. Record baseline data regarding the level of anxiety present
Availability.PO: Tablets: 5, 7.5, 10, 15, and 30 mg. Schedule assessments periodically throughout therapy for the development of...
Dosage and administration.Adult: PO: Initially, 5 mg two to three times daily. Doses may be increased by 5 mg every 2 to 3 days....
Common adverse effects
Drug interactions
Itraconazole, erythromycin, clarithromycin, diltiazem, verapamil, fluvoxamine, grapefruit juice.These substances potentiate the ...
Rifampin, phenytoin, phenobarbital, carbamazepine.These drugs enhance the metabolism of buspirone. An increase in the dose of bu...
Alcohol.Buspirone and alcohol generally do not have additive CNS depressant effects, but individual patients may be susceptible ...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Fluvoxamine Therapy
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Hydroxyzine Therapy
Premedication assessment
Availability. PO: 10-, 25-, and 50-mg tablets; 25-, 50-, and 100-mg capsules; 10 mg/5 mL syrup
Dosage and administration. Adult
Common adverse effects.These symptoms are the anti
Drug interactions
Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, opioids, other sedative-hypnotics.These all are agents that can...
16 - Drugs Used for Depressive and Bipolar Disorders
Depressive Disorder
Actions
Uses
Nursing Implications for Mood Disorder Therapy
Assessment
History of mood disorder
Basic mental status
Interpersonal relationships
Mood and affect
Clarity of thought. Evaluate the coherency, relevancy, and organization of the patient’s thoughts; observe for flight of ideas, ...
Suicidal ideation. If the individual is suspected of being suicidal, ask the patient whether they have ever had thoughts about s...
Psychomotor function. Ask specific questions about the activity level the patient has maintained. Is the person able to work or ...
Sleep pattern. What is the patient’s normal sleep pattern, and how does it vary with mood swings Ask specifically whether insomn...
Dietary history. Ask questions about the patient’s appetite, and note weight gains or losses not associated with intentional die...
Nonadherence. Nonadherence is usually expressed by the denial of the severity of the disease. In addition, listen for excuses th...
Implementation
Patient Education
Fostering health maintenance
Patient self-assessment. Enlist the patient’s help with developing and maintaining a written record of monitoring parameters. Se...
Uses
Therapeutic Outcomes
Nursing Implications for Monoamine Oxidase Inhibitors
Premedication assessment
Availability.See Table 16. 1
Dosage and administration
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that increase toxic effects. See the Medication Safety Alert: Monoamine Oxidase Inhibitors and Hypertension
Tricyclic antidepressants.MAOIs and TCAs, especially imipramine and desipramine, should not be administered concurrently. It is ...
Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors.Severe reactions—such as convulsions, hype...
General anesthesia, diuretics, antihypertensive agents.MAOIs may potentiate the hypotensive effects of general anesthesia, diure...
Insulin, oral hypoglycemic agents.MAOIs have an additive hypoglycemic effect when combined with insulin and oral sulfonylureas. ...
Meperidine, tramadol.When MAOIs are used concurrently with meperidine or tramadol, patients may suffer from hyperpyrexia, restle...
Uses
Therapeutic Outcomes
Nursing Implications for Selective Serotonin Reuptake Inhibitor Therapy
Premedication assessment
Availability, dosage, and administration.See Table 16. 1
Observation.Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. Ho...
Discontinuation syndrome.Abrupt discontinuation or interruption of antidepressant therapy may result in a discontinuation syndro...
Common adverse effects
Serious adverse effects
Drug interactions
Tricyclic antidepressants.The interaction between SSRIs and TCAs is very complex. An increased toxicity results from TCAs. Obser...
Lithium.Lithium may enhance the serotonergic effect of SSRIs, thereby increasing the risk of serotonin toxicity (serotonin syndr...
Monoamine oxidase inhibitors.Severe reactions—including excitement, diaphoresis, rigidity, convulsions, hyperpyrexia, and death—...
Haloperidol.Fluoxetine and fluvoxamine increase haloperidol levels and the frequency of extrapyramidal symptoms (EPSs). If used ...
Phenytoin, phenobarbital.Complex interactions occur when phenobarbital and phenytoin enhance the metabolism of paroxetine, there...
Carbamazepine.Fluoxetine and fluvoxamine can increase carbamazepine concentrations, which can result in signs of toxicity such a...
Alprazolam.Fluoxetine, fluvoxamine, and sertraline prolong the activity of alprazolam, which results in excessive sedation and i...
Propranolol, metoprolol.Fluvoxamine and citalopram significantly inhibit the metabolism of these beta-adrenergic blocking agents...
Cimetidine.Cimetidine inhibits the metabolism of paroxetine and sertraline. Patients should be closely monitored when cimetidine...
Warfarin.Fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine may enhance the anticoagulant effects of warfarin. Obse...
Smoking.Cigarette smoking enhances the metabolism of fluvoxamine. Dosages of fluvoxamine may need to be increased to achieve ful...
Amphetamines, tryptophan, dextromethorphan, linezolid, ephedrine, pseudoephedrine, epinephrine.All of these agents increase sero...
Uses
Therapeutic Outcomes
Nursing Implications for Serotonin-Norepinephrine Reuptake Inhibitor Therapy
Premedication assessment
Availability, dosage, and administration.See Table 16. 1
Discontinuation of therapy.If the patient has taken the medicine for more than 1 week before discontinuation, the dosage should ...
Observation.Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. Ho...
Common adverse effects
Serious adverse effects
Drug interactions
Monoamine oxidase inhibitors.Severe reactions—including excitement, diaphoresis, rigidity, convulsions, hyperpyrexia, and death—...
Cimetidine.Cimetidine inhibits the metabolism of venlafaxine and duloxetine. Patients should be closely monitored for excessive ...
Trazodone.Serotonin syndrome may develop when trazodone is used in conjunction with venlafaxine. Use trazodone cautiously; initi...
Haloperidol.Venlafaxine increases haloperidol levels and increases the frequency of EPSs, such as akathisia, dystonia, pseudopar...
Drug Class: Tricyclic Antidepressants
Uses
Therapeutic Outcomes
Nursing Implications for Tricyclic Antidepressants
Premedication assessment
Availability, dosage, and administration.Adult: PO: See Table 16.1. The medication should be initiated at a low dosage level and...
Observation.Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. Ho...
Common adverse effects
Serious adverse effects
Numbness, tingling. Report these symptoms to the healthcare provider for further evaluation
Parkinsonian symptoms.If these symptoms develop, the TCA dosage must be reduced or discontinued. Antiparkinsonian medications wi...
Seizure activity.High doses of antidepressants lower the seizure threshold. Adjustment of anticonvulsant therapy may be required...
Drug interactions
Enhanced anticholinergic activity.Antihistamines, phenothiazines, trihexyphenidyl, and benztropine enhance the anticholinergic a...
Enhanced sedative activity.Ethanol, barbiturates, narcotics, tranquilizers, antihistamines, anesthetics, and sedative-hypnotics ...
Phenobarbital.Phenobarbital may stimulate the metabolism of TCAs. Dosage adjustments of the anti
Bupropion.Bupropion may increase serum levels of TCAs. Dosages may need to be reduced
Carbamazepine.TCAs can increase carbamazepine concentrations, resulting in signs of toxicity such as vertigo, tremor, headache, ...
Valproic acid, methylphenidate.These medications may increase the serum levels of the TCAs. This reaction has been advantageous ...
Clonidine.TCAs inhibit the antihypertensive effects of clonidine and may enhance the hypertension seen with the abrupt discontin...
Monoamine oxidase inhibitors.Severe reactions—including convulsions, hyperpyrexia, and death—have been reported with concurrent ...
Selective serotonin reuptake inhibitors.The interaction between SSRIs and TCAs is complex. The net result is that there is an in...
Amphetamines, tryptophan, dextromethorphan, linezolid, ephedrine, pseudoephedrine, epinephrine.All of these agents increase sero...
Cimetidine.Cimetidine inhibits the metabolism of TCAs. Patients should be closely monitored for additional anticholinergic sympt...
Smoking.Cigarette smoking enhances the metabolism of TCAs. Dosages of the TCA may need to be increased to achieve a full therape...
Drug Class: Miscellaneous Agents
Bupropion Hydrochloride
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Bupropion Therapy
Premedication assessment
Availability.PO: 75- and 100-mg tablets; 100-, 150-, and 200-mg 12-hour extended-release tablets; 150, 174, 300, 348, 450, 522-m...
Dosage and administration for depression.Adult: PO: Immediate release; initially, 100 mg twice daily. This may be increased to 1...
Dosage and administration for smoking cessation.Adult: PO: Dosing should begin at 150 mg/day given every day for the first 3 day...
Individualization of therapy.The smoking cessation patient is more likely to quit smoking and remain abstinent if seen frequentl...
Observation.In the patient with depression, symptoms of depression may improve within a few days (e.g., improved appetite, sleep...
Common adverse effects
Serious adverse effects
Drug interactions
Cimetidine.Cimetidine inhibits the metabolism of bupropion and increases bupropion blood levels. A decrease in the bupropion dos...
Carbamazepine, phenobarbital, phenytoin.Carbama
Nicotine replacement.Although bupropion is used in combination with nicotine replacement products to help with smoking cessation...
Ritonavir.Ritonavir may stimulate the metabolism of bupropion, causing a reduction in serum concentrations of bupropion. An incr...
Levodopa.Bupropion has some mild dopaminergic activity and may result in an increase in the adverse effects caused by levodopa. ...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Mirtazapine Therapy
Premedication assessment
Availability.PO: 7. 5-, 15-, 30-, and 45-mg tablets; 15-, 30-, and 45-mg orally disintegrating tablets (Remeron SolTab)
Dosage and administration.Adult: PO: Initially, 15 mg daily. Every 1 to 2 weeks the dosage may be increased up to a maximum of 4...
Observation.See Tricyclic Antidepressants section. Symptoms of depression may improve (e.g., increased appetite, sleep, and psyc...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Trazodone Therapy
Premedication assessment
Availability. PO: 50-, 100-, 150-, and 300-mg tablets
Dosage and administration.Adult: PO: Initially, 150 mg in three divided doses. Increase the dosage in increments of 50 mg daily ...
Observation.Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. Ho...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedative activity.Ethanol, narcotics, tranquilizers, antihistamines, anesthetics, phenothiazines, and sedative-hypnotic...
MAOIs, SSRIs, SNRIs.Serotonin syndrome may develop when trazodone is used in conjunction with any of these agents. Use trazodone...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Vilazodone Therapy
Premedication assessment
Availability. PO: 10-, 20-, and 40-mg tablets
Dosage and administration.Adult: PO: Initially, 10 mg once daily with food for 7 days, followed by 20 mg once daily with food fo...
Observation.Symptoms of depression may improve (e.g., increased appetite, sleep, and psychomotor activity) within a few days. Ho...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedative activity.Ethanol, narcotics, tranquilizers, antihistamines, anesthetics, phenothiazines, and sedative-hypnotic...
Trazodone, MAOIs, SSRIs, SNRIs, tramadol, triptans.Serotonin syndrome may develop when vilazodone is used in conjunction with an...
Aspirin, nonsteroidal antiinflammatory drugs, warfarin.Serotonin release by platelets plays an important role in hemostasis. SRR...
Phenytoin, phenobarbital, carbamazepine.These agents may enhance the metabolism of vilazodone, reducing serum levels and leading...
Erythromycin, clarithromycin, fluoxetine, grapefruit juice.These drugs inhibit the metabolism of vilazodone, causing an increase...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Vortioxetine Therapy
Premedication assessment
Availability. PO: 5-, 10-, and 20-mg tablets
Dosage and administration.Adult: PO: Initially, 10 mg once daily, followed by 20 mg once daily as tolerated. For those not toler...
Common adverse effects
Serious adverse effects
Drug interactions
Trazodone, MAOIs, SSRIs, SNRIs, tramadol, triptans, buspirone, St. John’s wort, linezolid, fentanyl.Serotonin syndrome may devel...
Aspirin, nonsteroidal antiinflammatory drugs, warfarin.Serotonin release by platelets plays an important role in hemostasis. Sel...
Buspirone.Buspirone inhibits the metabolism of vortioxetine, causing an increase in serum levels and the potential for toxicity....
Drug Class: Antimanic Agent
Lithium Carbonate
Actions
Uses
Therapeutic Outcome
Nursing Implications for Lithium Therapy
Premedication assessment
Availability.PO: Lithium carbonate: 150-, 300-, and 600-mg capsules; 300-mg tablets; 300- and 450-mg slow-release tablets. Lithi...
Dosage and administration.Adult: PO: 300 to 600 mg three or four times daily. Administer with food or milk. An adequate diet is ...
Serum lithium levels.Lithium levels are monitored once or twice weekly during the initiation of therapy and monthly while the pa...
Good nutrition.Lithium may enhance sodium depletion, which increases lithium toxicity. The patient should maintain a normal diet...
Common adverse effects
Serious adverse effects
Rare adverse effects from lithium therapy
Pruritus, ankle edema, metallic taste. Report these symptoms for further evaluation by the healthcare provider
Drug interactions
Reduced serum sodium levels.The therapeutic activity and toxicity of lithium are highly dependent on sodium concentrations. Decr...
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor blockers.Angiotensin-converting enzyme inhibitors (ACEIs) and ...
Diuretics.Diuretics may reduce the elimination of lithium, resulting in lithium toxicity. Monitor the patient’s lithium serum le...
Methyldopa.Monitor patients receiving concurrent long-term therapy for signs of the development of lithium toxicity (e.g., nause...
Nonsteroidal Antiinflammatory Drugs.NSAIDs (e.g., ibuprofen, naproxen; see Chapter 19) may increase the serum concentration of l...
Selective Serotonin Reuptake Inhibitors.Lithium may enhance the serotonergic effect of SSRIs, thereby increasing the risk of ser...
17 - Drugs Used for Psychoses
Treatment of Psychosis
Drug Therapy for Psychosis
Actions
Uses
Extrapyramidal Symptoms
Seizures
Weight Gain
Hyperglycemia
Dyslipidemia
Dysrhythmias
Other Adverse Effects
History of behavior
Basic mental status
Interpersonal relationships.Assess the quality of the relationships in which the patient is involved. Identify people in the pat...
Mood and affect.Patients experiencing altered thinking, behavior, or feelings require careful evaluation of their verbal and non...
Clarity of thoughts and perception
Suicidal ideation.Ask the patient whether they have ever had thoughts about suicide. If the response is “yes,” get more details....
Psychomotor function.What is the patient’s activity level Is the individual unable to sit still and instead paces continually Is...
Sleep pattern.What is the patient’s normal sleep pattern, and how has it varied since the onset of the psychotic symptoms Ask sp...
Dietary history.Ask questions about the patient’s appetite and note weight gains or losses not associated with intentional dieti...
Implementation
Patient Education
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record of monitoring parameters. See...
Drug Class: Antipsychotic Agents
Uses
Therapeutic Outcome
Nursing Implications for Antipsychotic Agent Therapy
Premedication assessment
Availability, dosage, and administration.See Table 17.1. The dosage must be individualized according to the patient’s degree of ...
Common adverse effects
Serious adverse effects
Pseudoparkinsonian symptoms.Report the development of drooling, cogwheel rigidity, shuffling gait, mask-like expression, or trem...
Tardive dyskinesia.Tardive dyskinesia occurs much more commonly with the first-generation anti
Drug interactions
Drugs that increase adverse effects.Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, opiates, St. John’s wort, a...
Carbamazepine, phenytoin, rifampin, St. John’s wort.Carbamazepine, phenytoin, rifampin, and St. John’s wort stimulates the metab...
Divalproex sodium.Divalproex sodium increases the serum level of paliperidone. Dosage adjustments may be needed to avoid toxicit...
Erythromycin, cimetidine, clarithromycin, fluoxetine, grapefruit juice, ketoconazole.All of these agents inhibit the metabolism ...
Fluvoxamine, ciprofloxacin.Fluvoxamine and ciprofloxacin inhibit the metabolism of asenapine, clozapine, and olanzapine. Dosage ...
Paroxetine.Paroxetine inhibits the metabolism of brexpiprazole, haloperidol, iloperidone, risperidone, and thioridazine. Dosage ...
Smoking.Cigarette smoking enhances the metabolism of clozapine and olanzapine. Increased dosages may be necessary to maintain ef...
Antihypertensive agents.Antihypertensive agents (see Chapter 22) (e.g., beta blockers, angiotensin-converting enzyme inhibitors,...
Insulin, oral hypoglycemic agents.Patients with prediabetes or diabetes must be monitored for the development of hyperglycemia, ...
18 - Drugs Used for Seizure Disorders
Descriptions of Seizures
Generalized Convulsive Seizures
Tonic-Clonic Seizures
Atonic or Akinetic Seizures
Myoclonic Seizures
Generalized Nonconvulsive Seizures
Focal (Localized) Seizures
Antiepileptic Therapy
Actions
Uses
Nursing Implications for Antiepileptic Therapy
Assessment
History of seizure activity
Seizure description
Postictal behavior
Implementation
Management of seizure activity. Assist the patient during a seizure by doing the following
Psychological implications
Lifestyle.Encourage the patient to maintain a normal lifestyle. Provide for appropriate limitations (e.g., limits on operating p...
Expressing feelings.Allow the patient to ventilate their feelings. Seizures may occur in public, and they may be accompanied by ...
School-age children.Acceptance by peers can present a problem to a patient in this age group. The school nurse can help teachers...
Denial.Be alert for signs of denial of the disease, which are indicated by increased seizure activity in a previously well-contr...
Adherence.Determine the patient’s current medication schedule, including the name of the medication, the dosage, and the time of...
Status epilepticus
Patient Education
Exercise and activity.Discuss what activities or actions trigger seizures and how to avoid them. Encourage the patient to mainta...
Nutrition.Avoid excessive use of stimulants (e.g., caffeine-containing products). Seizures are also known to follow the signific...
Safety.Teach the patient to avoid operating power equipment or machinery. Driving may be minimized or prohibited. Check state la...
Stress. The reduction of tension and stress within the individual’s environment may reduce seizure activity in some patients
Oral hygiene.Encourage daily oral hygiene practices and scheduling of regular dental examinations. Gingival hyperplasia, which i...
Medication considerations in pregnancy
Fostering health maintenance.Throughout the course of treatment, discuss medication information and how it will benefit the pati...
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record or seizure diary of monitorin...
Uses
Therapeutic Outcomes
Nursing Implications for Benzodiazepines
Premedication assessment
Availability, dosage, and administration.See Table 18.2. Use of benzodiazepines may result in physical and psychological depende...
Intravenous administration.Do not mix parenteral diazepam or lorazepam in the same syringe with other medications; do not add th...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that increase toxic effects.Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, narcotics, cimetidine, sedati...
Smoking.Cigarette smoking enhances the metabolism of benzodiazepines. Increased dosages may be necessary to maintain effects in ...
Drug Class: Hydantoins
Uses
Therapeutic Outcomes
Nursing Implications for Phenytoin
Premedication assessment
Availability, dosage, and administration.See Table 18.2. Administer medication with food or milk to reduce gastric irritation. I...
Common adverse effects
Confusion.Perform a baseline assessment of the patient’s degree of alertness and orientation to name, place, and time before ini...
Nystagmus.Nystagmus is a back-and-forth movement of the eyeballs on the horizontal plain, particularly when looking laterally (o...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Warfarin, carbamazepine, oxcarbazepine (>1200 mg/day), topiramate, metronidazol...
Drugs that decrease therapeutic effects.Loxapine, phenobarbital, nitrofurantoin, theophylline, ethanol (chronic ingestion), rifa...
Disopyramide, quinidine, mexiletine.Phenytoin decreases the serum levels of these agents. Monitor patients for the redevelopment...
Prednisolone, dexamethasone.Phenytoin decreases the serum levels of these agents. Monitor patients for reduced antiinflammatory ...
Estrogen-containing contraceptives.Phenytoin enhances the metabolism of estrogens. Spotting or bleeding may be an indication of ...
Theophylline.Phenytoin decreases the serum levels of theophylline derivatives. Monitor patients for a higher frequency of respir...
Valproic acid.This agent may increase or decrease the activity of phenytoin. Monitor the patient for an increased frequency of s...
Ketoconazole.The concurrent administration with ketoconazole may alter the metabolism of one or both drugs. Monitoring the level...
Drug Class: Succinimides
Uses
Therapeutic Outcomes
Nursing Implications for Succinimides
Premedication assessment
Availability, dosage, and administration.See Table 18. 2
Common adverse effects
Drug interactions
Drugs that enhance toxic effects.Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, other anti
Anchor 480
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Carbamazepine
Premedication assessment
Availability.PO: 200-mg tablets; 100-mg chewable tablets; 100-, 200-, and 400-mg tablets, extended release (12 hours); 100-, 200...
Dosage and administration.Adult: PO: Initial dosage is 200 mg twice daily on the first day. Dosage may be increased by 200 mg/da...
Common adverse effects.These effects can be reduced by slowly increasing the dosage. They are usually mild and tend to resolve w...
Gastrointestinal. Gastrointestinal effects include nausea and vomiting
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Isoniazid, cimetidine, fluoxetine, fluvoxamine, ketoconazole, and macrolide ant...
Verapamil, diltiazem, lamotrigine.These drugs increase serum levels of carbamazepine. Monitor the patient for signs of toxicity ...
Warfarin.Carbamazepine may diminish the anti
Phenobarbital, phenytoin, valproic acid.Carbamazepine enhances the metabolism of these agents. Monitor the patient for an increa...
Doxycycline.Carbamazepine enhances the metabolism of this antibiotic. Monitor the patient for signs of continued infection
Estrogen-containing contraceptives.Carbamazepine enhances the metabolism of estrogens. Spotting or bleeding may be an indication...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Gabapentin
Premedication assessment
Availability. PO: 100-, 300-, and 400-mg capsules; 300-, 600-, and 800-mg tablets; 250 mg/5 mL oral solution
Dosage and administration.Adult: PO: 900 to 1800 mg daily. Initially administer 300 mg at bedtime on day 1, 300 mg two times on ...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
Urine protein.False-positive readings for protein in the urine have been reported by patients who are taking gabapentin who use ...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Lamotrigine
Premedication assessment
Availability.PO: tablets: 25, 100, 150 and 200 mg; chewable tablets: 5 and 25 mg; orally disintegrating tablets: 25, 50, 100, an...
Dosage and administration
Seizure disorder.Adult: PO: If the patient is already taking valproic acid for seizure control, initiate lamotrigine therapy at ...
Bipolar disorder.Adult: PO: Initial dosage depends on other medications that are being taken. Target dosage is 200 mg/daily of i...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Valproic acid reduces the metabolism of lamotrigine by as much as 50%. Signific...
Drugs that decrease therapeutic effects.Phenobarbital, phenytoin, primidone, carbamazepine, oxcarbazepine, ethosuximide, rifampi...
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Levetiracetam
Premedication assessment
Availability.PO: 250-, 500-, 750-, and 1000-mg tablets; 250-, 500-, 750-, 1000-mg disintegrating tablets; 500- and 750-, 1000-, ...
Dosage and administration.Adult: PO: Initial dose is 500 mg twice daily. Dosage may be increased every 2 weeks by 500 mg twice d...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Oxcarbazepine
Premedication assessment
Availability.PO: 150-, 300-, and 600-mg tablets; 150-, 300-, 600-mg tablets, extended release (24 hours); 300 mg/5 mL suspension...
Dosage and administration.Adult: PO: Initial dosage is 300 mg twice daily for the first 3 days. The dosage may be increased by 3...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that decrease therapeutic effects.Phenobarbital, primidone, phenytoin, valproic acid, carbamazepine, and verapamil may enh...
Estrogen- and progestin-containing contraceptives.Oxcarbazepine enhances the metabolism of estrogens and progestins. Spotting or...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Phenobarbital
Premedication assessment
Availability.PO: tablets: 15, 16.2, 30, 32.4, 60, 64.8, 97. 2, and 100 mg; elixir and solution: 20 mg/5 mL
Dosage and administration
Seizure control. Adult: PO: 60 to 200 mg/day or 50 to 100 mg two to three times daily
Status epilepticus. IV: 15 mg/kg as a single dose
Common adverse effects.General adverse effects of phenobarbital include drowsiness, lethargy,
Serious adverse effects
Drug interactions
Drugs that increase toxic effects.Antihistamines, alcohol, analgesics, anesthetics, tranquilizers, valproic acid, monoamine oxid...
Phenytoin.The effects of phenobarbital on phenytoin are variable. Serum levels may be ordered, and a change in phenytoin dosage ...
Reduced therapeutic effects. Phenobarbital reduces the effects of the following medicines
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Pregabalin
Premedication assessment
Availability.PO: capsules: 25, 50, 75, 100, 150, 200, 225, and 300 mg; tablets, 24-hour extended release: 82.5, 165, 330 mg; ora...
Dosage and administration. Dosages should be adjusted for patients with a creatinine clearance below 60 mL/min
Seizure control.Adult: PO: 150 to 600 mg daily. Initially administer 50 mg three times daily or 75 mg twice daily. The daily dos...
Fibromyalgia.Adult: PO: 300 to 450 mg daily. Initially administer 75 mg twice daily and increase to 150 mg twice daily within 1 ...
Neuropathic pain associated with diabetic peripheral neuropathy.Adult: PO: Up to 300 mg daily. Initially administer 50 mg three ...
Spinal cord injury-associated neuropathic pain.Adult: PO: Up to 600 mg daily. Initially administer 75 mg twice daily and increas...
Postherpetic neuralgia.Adult: PO: 150 to 600 mg daily. Initially administer 50 mg three times daily or 75 mg twice daily. For pa...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, benzodiazepines, oxycodone...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Topiramate
Premedication assessment
Availability.PO: 25-, 50-, 100-, and 200-mg tablets; 25-, 50-, 100-, 200-mg capsules, extended release (24 hours); 15- and 25-mg...
Dosage and administration
Antiepileptic.Adult: PO: Initially 25 mg twice daily. Increase the daily dosage by 50 mg at weekly intervals until a clinical re...
Migraine prevention.Adult: PO: Use the tablets or sprinkle capsules. Dosage increase is as follows: week 1, 25 mg daily in the e...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that decrease therapeutic effects.Phenobarbital, primidone, phenytoin, valproic acid, and carbamazepine may enhance the me...
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
Estrogen-containing contraceptives.Topiramate enhances the metabolism of estrogens. Spotting or bleeding may be an indication of...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Valproic Acid
Premedication assessment
Availability.PO: 250-mg capsules; 125-mg capsules containing coated particles (sprinkles); 250-, and 500-mg tablets, sustained r...
Dosage and administration.Adult: PO: 10 to 15 mg/kg daily, divided in two to three doses. Administer medication with food or mil...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that decrease therapeutic effects.Phenobarbital, primidone, phenytoin, topiramate, and carbamazepine may enhance the metab...
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Zonisamide
Premedication assessment
Availability. PO: 25-, 50-, and 100-mg capsules
Dosage and administration.Adult: PO: Initial dosage is 100 mg daily, taken with or without food. Because of sedative effects, th...
Common adverse effects
Serious adverse effects
Drug interactions
Enhanced sedation.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—enhance the se...
19 - Drugs Used for Pain Management
Pain Management
Actions
Uses
A Note About Opioid Abuse
Nursing Implications for Pain Management
Assessment
History of pain experience
Nonverbal observations. Note the patient’s general body position during an episode of pain. Look for subtle clues such as facial...
Pain relief. What specific measures relieve the pain What has already been tried for pain relief, and what, if anything, has bee...
Physical data. In the presence of pain, always examine the affected part for any alterations in appearance, change in sensation,...
Behavioral responses. What coping mechanisms does the patient use to manage the pain experience: crying, anger, withdrawal, depr...
Implementation
Comfort measures
Exercise and activity. Unless contraindicated, moderate exercise should be encouraged. Often, pain causes the individual not to ...
Nonpharmacologic approaches. To enhance the effects of the medication therapy, use nonpharmacologic strategies such as relaxatio...
Medication. Even though pain medicine administration may be scheduled, encourage the patient to request pain medication before t...
Pain control. Some patients will not ask for pain medication, so it is important to intervene and anticipate their needs. Ask th...
Nutritional aspects. The patient should eat a well-balanced diet high in B-complex vitamins and limit or eliminate sugar, nicoti...
Patient Education
Fostering health maintenance. Throughout the course of treatment, discuss medication information and how it will benefit the pat...
Patient self-assessment. Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Class: Opiate Agonists
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Opiate Agonists
Premedication assessment
Availability, dosage, and administration.See Table 19. 1
Antidotes. Naloxone will reverse the effects of opiate agonists
Common adverse effects
Confusion, disorientation.Perform a baseline assessment of the patient’s degree of alertness and orientation to name, place, and...
Constipation.Continued use may cause constipation. Maintain the patient’s state of hydration, and obtain an order for stool soft...
Serious adverse effects
Drug interactions
Central nervous system depressants.General anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepress...
Drugs that increase adverse effects.Clarithromycin, diltiazem, erythromycin, isoniazid, itraconazole, and verapamil can inhibit ...
Drugs that decrease the therapeutic effect.Carbamazepine, St. John’s wort, phenytoin, and rifampin are enzyme-inducing agents th...
Selective serotonin reuptake inhibitors, tricyclic anti
Warfarin.The oral anticoagulant effect of warfarin may be increased by tramadol. Carefully monitor the prothrombin time and inte...
Drug Class: Opiate Partial Agonists
Uses
Therapeutic Outcomes
Nursing Implications for Opiate Partial Agonists
Premedication assessment
Availability, dosage, and administration.See Table 19. 2
Antidotes. Naloxone will reverse the effects of opiate partial agonists
Common adverse effects
Serious adverse effects
Endocrine. Long-term use of buprenorphine may cause secondary hypogonadism and hypocortisolism
Drug interactions
Central nervous system depressants.General anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepress...
Opiate agonists.Opiate partial agonists have weak antagonist activity. When administered to patients who have been receiving opi...
Drug Class: Opiate Antagonists
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Naloxone
Premedication assessment
Availability.Injection: 0.4 mg/mL in 1-mL vials, cartridges and prefilled syringes; 1 mg/mL in 2-mL prefilled syringes; 4 mg/10 ...
Dosage and administration.Adult: IV: Postoperative opiate depression: 0.1 to 0.2 mg every 2 to 3 minutes until the desired respo...
Common adverse effects.Naloxone rarely manifests any adverse effects. In rare cases when extremely high doses have been used, me...
Cardiovascular.Use with caution in patients with cardiovascular disease or in patients taking cardiovascular medicines (e.g., an...
Drug interactions.There are no drug interactions other than that of the antagonist activity toward opiate agonists and opiate pa...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Naltrexone
Premedication assessment
Availability. PO: 50-mg tablets
Dosage and administration
Behavior modification.Naltrexone therapy in combination with behavior therapy is more effective than naltrexone or behavior ther...
Treatment of opiate agonist dependence.PO: Induction dose of 25 mg. Observe for development of withdrawal symptoms. If none occu...
Withdrawal symptoms.Naltrexone may precipitate acute and severe withdrawal symptoms in patients who are physically dependent on ...
Treatment of alcoholism. PO: 50 mg once daily (see also Chapter 48)
Common adverse effects.Many adverse effects have been associated with naltrexone therapy, but it is difficult to know exactly wh...
Serious adverse effects
Drug interactions
Opioid-containing products.Patients taking naltrexone will probably not benefit from opioid-containing medicines such as analges...
Clonidine.Clonidine may be administered in patients to reduce the severity of withdrawal symptoms precipitated or exacerbated by...
Drug Class: Prostaglandin Inhibitors
Anchor 403
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Acetaminophen
Premedication assessment
Availability.PO: 325- and 500-mg caplets; 325- and 500-mg capsules and tablets; 80- and 160-mg chewable tablets; 650-mg extended...
Dosage and administration.Adult: PO: 325 to 650 mg every 4 to 6 hours. Doses up to 1000 mg may be given four times daily for sho...
Antidote. The antidote is acetylcysteine
Common adverse effects. When used as directed, acetaminophen is extremely well tolerated
Serious adverse effects
Drug interactions
Phenobarbital, carbamazepine, phenytoin.If acetaminophen is taken in large doses or over the long term, these agents may enhance...
Alcohol.Chronic excessive ingestion of alcohol may increase the potential for hepatotoxicity with therapeutic doses or overdoses...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Salicylates
Premedication assessment
Availability.See Tables 19.3 and 19. 4
Dosage and administration
Treatment of pain, arthritis, acute rheumatic fever, and myocardial infarction prophylaxis.See Table 19. 3
Stroke prevention.See Table 19. 3
Common adverse effects.As beneficial as salicylates are, they are not without adverse effects. In normal therapeutic dosages, th...
Serious adverse effects
Drug interactions
Nonsteroidal antiinflammatory drugs.It is possible that cyclooxygenase-1 (COX-1) inhibitors reduce the platelet-inhibiting effec...
Probenecid.Salicylates inhibit the excretion of uric acid by these agents. Although an occasional aspirin will not interfere wit...
Warfarin.Salicylates may enhance the anticoagulant effects of warfarin. Observe for petechiae; ecchymoses; nosebleeds; bleeding ...
Valproic acid.Monitor the patient with concurrent therapy for signs of valproic acid toxicity, such as sedation or lethargy. Ser...
Oral hypoglycemic agents.Salicylates may enhance the hypoglycemic effects of these agents. Monitor for hypoglycemia, headache, w...
Methotrexate.Monitor for signs of methotrexate toxicity: bone marrow suppression, decreased white blood cell (WBC) count, decrea...
Corticosteroids.Although often used together, salicylates and corticosteroids may produce GI ulceration. Monitor for signs of GI...
Ethanol.The patient should avoid aspirin within 8 to 10 hours of heavy alcohol use. Small amounts of GI bleeding often occur. If...
Uses
Therapeutic Outcomes
Nursing Implications for NSAIDs
Premedication assessment
Availability, dosage, and administration.See Table 19. 3
Common adverse effects
Serious adverse effects
Drug interactions
Warfarin.Nonsteroidal antiinflammatory drugs increase bleeding risk through platelet inhibition. When used concurrently with war...
Phenytoin.Monitor the patient with concurrent therapy for signs of phenytoin toxicity, such as nystagmus, sedation, or lethargy....
Valproic acid.Aspirin inhibits valproic acid metabolism, increasing valproic acid blood levels. Monitor for valproic acid toxici...
Oral hypoglycemic agents.Monitor for hypoglycemia: headache, weakness, decreased coordination, general apprehension, diaphoresis...
Furosemide, thiazide diuretics.Nonsteroidal anti
Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.Nonsteroidal antiinflammatory drugs may diminish t...
Probenecid.Probenecid inhibits the excretion of NSAIDs. Monitor for signs of toxicity: headache, drowsiness, and mental confusio...
Lithium.Nonsteroidal antiinflammatory drugs (except possibly sulindac and aspirin) may induce lithium toxicity. Monitor for lith...
Aspirin.COX-1 inhibitors may reduce the platelet-inhibiting effects of aspirin when administered at about the same time. An NSAI...
Cholestyramine.Cholestyramine resins bind to NSAIDs in the gut, inhibiting absorption. Separate dosage administration by 2 hours...
IV - Drugs Affecting the Cardiovascular System
20 - Introduction to Cardiovascular Disease and Metabolic Syndrome
CARDIOVASCULAR DISEASES
Metabolic Syndrome
Introduction to Cardiovascular Disease and Metabolic Syndrome
Resulting Conditions
Risk Factors
Obesity and Sedentary Lifestyle
Alcohol, Smoking, and Stress
Genetic Factors
Treatment
Drug Therapy to Treat Underlying Conditions for Metabolic Syndrome and Cardiovascular Disease
Hypertension. A combination of a thiazide diuretic plus an angiotensin-converting enzyme inhibitor, calcium channel blocker, or ...
Dyslipidemia. The treatment of dyslipidemia is generally to lower triglyceride and LDL cholesterol levels and to raise the HDL c...
Type 2 diabetes mellitus. Several different classes of medicines may be used to treat insulin resistance and type 2 diabetes. Th...
21 - Drugs Used to Treat Dyslipidemias
Treatment of Hyperlipidemias
Drug Therapy for Hyperlipidemias
Actions
Uses
History of risk factors.Obtain the patient’s age, note gender and race, and take a family history of the incidence of elevated c...
Hypertension.Ask whether the patient has ever been told that they have elevated blood pressure. If yes, obtain details. Ask abou...
Smoking.Obtain a history of the number of cigarettes or cigars smoked daily. How long has the patient smoked Has the patient eve...
Dietary habits
Glucose intolerance.Ask specific questions regarding whether the individual has now or has ever had an elevated serum glucose (b...
Elevated serum lipid levels.Find out whether the patient is aware of having elevated lipid, triglyceride, or cholesterol levels....
Obesity.Weigh the patient. Ask about any recent weight gain or loss and whether it was intentional or unintentional. Using the p...
Psychomotor functions
Patient Education
Nutrition.Patients who take bile acid–sequestering resins may require supplemental vitamins. (The fat-soluble vitamins—D, E, A, ...
Vitamin K deficiency.If the patient is receiving a prescription for a bile acid–sequestering resin, teach the patient about the ...
Follow-up care.Stress the need for long-term regular assessment of the required serum levels (e.g., lipid profile values, liver ...
Relating to medication regimen.Examine the individual drug monographs for details about mixing drugs, scheduling medication admi...
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e.g...
Uses
Therapeutic Outcomes
Nursing Implications for HMG-CoA Reductase Inhibitors
Premedication assessment
Availability, dosage, and administration.See Tables 21.3 and 21.4. Lovastatin should be administered with food at the evening me...
Common adverse effects
Serious adverse effects
Drug interactions
Cyclosporine, itraconazole, ketoconazole, diltiazem, fluconazole, fibrates, niacin, verapamil, erythromycin, clarithromycin, ran...
Bempedoic acid.Concomitant use with simvastatin and pravastatin results in increased levels of simvastatin and pravastatin. Do n...
Fluconazole.Coadministration of these drugs with fluvastatin results in significantly increased fluvastatin levels. Dosage reduc...
Phenytoin, rifampin.Concurrent administration of rifampin and phenytoin, with atorvastatin, lovastatin, or simvastatin results i...
Warfarin.The statins except atorvastatin may increase the anticoagulant effect of warfarin. The prothrombin time (international ...
Grapefruit juice.Grapefruit juice inhibits the metabolism of atorvastatin, lovastatin, and simvastatin, thus increasing their pl...
Drug Class: Bile Acid–Binding Resins
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Bile Acid–Binding Resins
Premedication assessment
Availability
Cholestyramine. PO: 4-g powder packets
Colestipol. PO: 1-g tablets; granules in 5-g packets
Colesevelam.PO: 3. 75-mg packets; 625-mg tablets
Dosage and administration
Cholestyramine.PO: 4 g one to six times daily. Initial dosage is 4 g daily. Maintenance dosage is 8 to 16 g/day. Maximum daily d...
Colestipol.PO: Granules: 5 to 30 g/day in divided doses. Initial dosage is 5 g once or twice daily. Tablets: 2 to 16 g/day. Init...
Colesevelam. PO: 6 tablets once daily or in two divided doses with liquid at meals
Common adverse effects
Drug interactions
Digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, nonsteroidal antiinflammatory agents, tetracycline, beta...
Amiodarone.The resins significantly decrease the absorption of amiodarone. The resins also block the enterohepatic recirculation...
Fat-soluble vitamins (D, E, A, and K), folic acid.High doses of resins may reduce the absorption of these agents, but this inter...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Ezetimibe
Premedication assessment
Availability. PO: 10-mg tablets
Dosage and administration. Adult: PO: 10 mg once daily; may be taken with or without meals
Common adverse effects
Drug interactions
Bile acid–binding resins.These resins may bind to ezetimibe, reducing absorption. The interaction can usually be minimized by ad...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Bempedoic Acid
Premedication assessment
Availability. PO: 180-mg tablets
Dosage and administration. Adult: PO: 180 mg once daily
Common adverse effects
Endocrine and metabolic.Bempedoic acid may increase blood uric acid levels (hyperuricemia), which may lead to gout. Monitor pati...
Serious adverse effects
Tendon rupture.Bempedoic acid is associated with an increased risk of tendon rupture or injury. Tendon rupture occurs within wee...
Drug interactions
Simvastatin.Do not administer bempedoic acid with doses of simvastatin greater than 20 mg daily. Bempedoic acid substantially in...
Pravastatin.Do not administer bempedoic acid with doses of pravastatin greater than 40 mg daily. Bempedoic acid substantially in...
Drug Class: PCSK9 Inhibitors
Actions
Uses
Therapeutic Outcomes
Nursing Implications for PCSK9 Inhibitors
Premedication assessment
Availability. Alirocumab (Praluent): Available in two types of injection devices depending on patient preference
Dosage and administration. Adult: Subcutaneous
Dosage ranges
Alirocumab.Adult: Primary hyperlipidemia. Subcutaneous: 75 mg once every 2 weeks or 300 mg once every 4 weeks; for both regimens...
Evolocumab.Adult: Primary hyperlipidemia. Subcutaneous: 140 mg every 2 weeks or 420 mg once monthly
Common adverse effects
Local.Mild injection-site reactions have been reported, including bruising, redness, warmth, burning, stinging, pain, and inflam...
Musculoskeletal.Symptoms of muscle aches, soreness, spasms, and weakness have been reported with the PCSK9 inhibitors and most c...
Infections.In clinical trials with alirocumab and evolocumab, there was a higher rate of upper respiratory infections (sinusitis...
Hepatic.Fatigue, anorexia, nausea, jaundice. Monitor for signs and symptoms of liver toxicity. Assessment of liver function may ...
Serious adverse effects
Hypersensitivity reactions.Hypersensitivity
Drug interactions. There are no known significant drug interactions
Drug Class: Niacin
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Niacin
Premedication assessment
Availability.PO: 50-, 100-, 250-, or 500-mg tablets; 250- or 500-mg timed-release capsules; 250-, 500-, 750-, or 1000-mg timed-r...
Dosage and administration.PO: Weeks 1 to 4: 500 mg PO at bedtime. Weeks 5 to 8: 1000 mg PO at bedtime. After week 8, titrate to ...
Common adverse effects
Integumentary.Flushing, itching, and rash are common. Patients can reduce their symptoms by taking aspirin (325 mg) or ibuprofen...
Neurologic. Tingling and headache are frequently seen with these drugs
Serious adverse effects
Drug interactions
HMG-CoA reductase inhibitors.The potential of developing myopathy is increased when niacin is added to the treatment regimen. Th...
Drug Class: Fibric Acids
Uses
Therapeutic Outcomes
Nursing Implications for Fibric Acids
Premedication assessment
Availability
Gemfibrozil (Lopid). PO: 600-mg tablets
Fenofibrate.PO: Tablets: 35, 40, 48, 54, 105, 120, 145, and 160 mg; capsules: 30, 43, 50, 67, 90, 130, 134, 150, and 200 mg; del...
Dosage and administration
Gemfibrozil. PO: 1200 mg/day in two divided doses, 30 minutes before the morning and evening meals
Fenofibrate.PO: Initially, 45 to 160 mg/day, given with meals. Increase dosage every 4 to 8 weeks up to 160 mg daily with a meal...
Common adverse effects
Serious adverse effects
Drug interactions
Warfarin.The fibric acids may enhance the pharmacologic effects of warfarin. Reduce the dosage of warfarin using the prothrombin...
Sulfonylureas, insulin.Gemfibrozil may increase the pharmacologic effects of these agents. Monitor the patient for signs of hypo...
Bile acid–binding resins.These resins may bind to fenofibrate, reducing absorption. The interaction can usually be minimized by ...
HMG-CoA reductase inhibitors.The potential for developing myopathy is increased when fibric acids are added to the statin treatm...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Omega-3 Fatty Acids
Premedication assessment
Availability. Omega-3-acid ethyl esters (Lovaza): PO: 1-g capsules
Icosapent ethyl (Vascepa): PO: 0.5 and 1 g capsules
Dosage and Administration:Lovaza: Adult: PO: 4 g once daily or 2 g twice daily for hypertriglyceridemia
Common and serious adverse effects.If any of the following adverse effects occur, report them to the healthcare provider immedia...
Drug interactions
Anticoagulants and antiplatelet agents.Omega-3-acid ethyl esters and icosapent ethyl may increase the risk of bleeding in patien...
22 - Drugs Used to Treat Hypertension
Hypertension
Treatment of Hypertension
Drug Therapy for Hypertension
Actions
Uses
Assessment
History of risk factors
Smoking. Obtain a history of the number of cigarettes or cigars smoked daily. How long has the person smoked Has the person ever...
Dietary habits. Obtain a dietary history. Ask specific questions to obtain data relating to the amount of salt used in cooking a...
Elevated serum lipids. Ask whether the patient is aware of having elevated lipid, triglyceride, or cholesterol levels. If elevat...
Renal function. Has the patient had any laboratory tests to evaluate renal function (e.g., urinalysis—micro
Obesity. Ask about any recent weight gains or losses and whether intentional or unintentional. Note abnormal waist-to-hip ratio....
Psychomotor functions
Medication history
Physical assessments
Blood pressure. Obtain two or more blood pressure measurements
Height and weight.Weigh and measure the patient. Measure the waste circumference 2 inches above the navel. What has the person’s...
Bruits. Check neck, abdomen, and extremities for the presence of bruits
Peripheral pulses. Palpate and record femoral, popliteal, and pedal pulses bilaterally
Eyes.As appropriate to the level of education, perform a funduscopic examination of the interior eye, noting arteriovenous nicki...
Implementation
Patient Education
Baseline and diagnostic studies Review the patient’s chart and all reports available that are used to build baseline information...
Smoking
Nutritional status
Stress management
Exercise and activity. Develop a plan for moderate exercise to improve the patient’s general condition. Consult a healthcare pro...
Blood pressure monitoring. Demonstrate the correct procedure for taking blood pressure. It is best to have the patient or family...
Medication regimen
Fostering health maintenance
Patient self-assessment. Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Class: Diuretics
Uses
Nursing Implications for Diuretic Agents
Premedication assessment
Availability, dosage, and administration. See Chapter 28
Uses
Nursing Implications for Beta-Adrenergic Blocking Agents
Premedication assessment
Availability, dosage, and administration.See Table 12. 3
Individualization of dosage.Although the onset of activity of beta blockers is rapid, it may often take several days to weeks fo...
Sudden discontinuation.Patients must be counseled against poor compliance or sudden discontinuation of therapy without a healthc...
Serious adverse effects
Drug interactions
Antihypertensive agents.All beta blockers have hypo
Beta-adrenergic agents.Depending on the dosages used, the beta stimulants (e.g., isoproterenol, meta
Amiodarone, verapamil, diltiazem, disopyramide, digoxin, propafenone.Although these drugs are occasionally used concurrently, mo...
Enzyme-inducing agents.Enzyme-inducing agents such as phenobarbital, and rifampin enhance the metabolism of propranolol, metopro...
Nonsteroidal antiinflammatory drugs.Indomethacin, and possibly other prostaglandin inhibitors, may inhibit the antihypertensive ...
Uses
Therapeutic Outcome
Nursing Implications for Angiotensin-Converting Enzyme Inhibitors
Premedication assessment
Availability, dosage, and administration.See Table 22.5. Captopril should be administered without food and requires two- to thre...
Common adverse effects
Serious adverse effects
Pregnancy.Medications that act directly on the RAAS can cause fetal and neonatal harm. There is concern about the potential for ...
Nephrotoxicity.A small number of hypertensive patients who are receiving ACE inhibitors, particularly those with preexisting ren...
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, phenothiazines, alcohol, beta-
Drugs that reduce therapeutic effects.Antacids may diminish absorption of ACE inhibitors. Separate the administration times by 2...
Digoxin.ACE inhibitors may increase or decrease the serum levels of digoxin. Monitor for symptoms of anorexia, nausea, vomiting,...
Lithium.ACE inhibitors may induce lithium toxicity. Monitor for lithium toxicity manifested by nausea, anorexia, fine tremors, p...
Hyperkalemia.ACE inhibitors may cause small increases in potassium levels by inhibiting aldosterone secretion. Patients should n...
Capsaicin.Capsaicin may cause or aggravate coughing associated with ACE inhibitor therapy. Monitor for increased frequency of dr...
Uses
Therapeutic Outcome
Nursing Implications for Angiotensin II Receptor Blockers
Premedication assessment
Availability, dosage, and administration.See Table 22. 6
Common adverse effects
Serious adverse effects
Pregnancy.Medications that act directly on the RAAS can cause fetal and neonatal harm. There is potential for birth defects in n...
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, phenothiazines, alcohol, beta-adrenergic blocking agen...
Drugs that reduce therapeutic effects.NSAIDs may diminish the therapeutic effect of ARBs. Monitor blood pressure. Rifampin incre...
Hyperkalemia.ARBs may cause small increases in potassium levels by reducing aldosterone secretion. Patients should not take diet...
Drug Class: Direct Renin Inhibitor
Actions
Uses
Therapeutic Outcome
Nursing Implications for Aliskiren
Premedication assessment
Availability. PO: 150- and 300-mg tablets
Dosage and administration.PO: Initially, 150 mg once daily. After a few weeks, if the blood pressure is not adequately controlle...
Common adverse effects
Serious adverse effects
Pregnancy.Medications that act directly on the RAAS can cause fetal and neonatal harm. There is potential for birth defects in n...
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, antipsychotics, alcohol, beta blockers (e.g., metoprol...
Drugs that reduce therapeutic effects.NSAIDs may diminish the antihypertensive effect of aliskiren. Monitor blood pressure
Hyperkalemia.Renin inhibitors may cause small increases in potassium levels by reducing aldosterone secretion. Patients should n...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Eplerenone
Premedication assessment
Availability. PO: 25- and 50-mg tablets
Dosage and administration.PO: Initially, 50 mg once daily, with or without food. The full therapeutic effect should be apparent ...
Common adverse effects
Serious adverse effects
Gynecomastia, vaginal bleeding.A small number of men have developed gynecomastia and a small number of women have developed vagi...
Hyperkalemia.Because eplerenone inhibits aldosterone, patients may develop slight increases in serum potassium levels. Patients ...
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, antipsychotics, ketoconazole, alcohol, beta blockers (...
Drugs that may induce hyperkalemia.Concurrent use of eplerenone and the following agents may induce hyperkalemia: ACE inhibitors...
Lithium.Eplerenone may induce lithium toxicity. Monitor for lithium toxicity manifested by nausea, anorexia, fine tremors, persi...
Grapefruit juice.Grapefruit juice slows the metabolism of eplerenone in a minor way. If the patient develops orthostatic hypoten...
Phenobarbital, rifampin, St. John’s wort.Phenobarbital, rifampin, and St. John’s wort stimulates the metabolism of eplerenone. A...
Drug Class: Calcium Channel Blockers
Uses
Therapeutic Outcome
Nursing Implications for Calcium Channel Blockers
Premedication assessment
Availability, dosage, and administration.See Table 22. 7
Dosage adjustments.See individual drug monographs for dosage parameters. Adjustments are made based on the individual patient’s ...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, antipsychotics , alcohol, beta blockers (e.g., metopro...
Grapefruit juice.Grapefruit juice (approximately 200 mL) may elevate serum concentrations of diltiazem, felodipine, verapamil, n...
Digoxin.Calcium channel blockers may increase serum levels of digoxin. Monitor the patient for symptoms of anorexia, nausea, vom...
Lovastatin and simvastatin.Amlodipine, diltiazem, and verapamil may increase the serum concentration of lovastatin and simvastat...
Uses
Therapeutic Outcomes
Nursing Implications for Alpha-1 Adrenergic Blocking Agents
Premedication assessment
Availability, dosage, and administration.See Table 22. 8
Common adverse effects
Neurologic. Drowsiness, headache, dizziness, weakness, lethargy
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, antipsychotics, alcohol, beta blockers (e.g., metoprol...
Uses
Therapeutic Outcome
Nursing Implications for Central-Acting Alpha-2 Agonists
Premedication assessment
Availability, dosage, and administration.See Table 22. 9
Sudden discontinuation.Never suddenly discontinue clonidine because it could cause a rebound effect with a rapid increase in blo...
Common adverse effects
Altered test reactions.Methyldopa may cause up to 20% of patients to develop a positive reaction to the direct Coombs test. Howe...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include digoxin, antipsychotics, alcohol, beta blockers (e.g., metoprolol...
Drugs that reduce therapeutic effects.Tricyclic antidepressants (e.g., amitriptyline, imipramine, desipramine), trazodone, and m...
Sedative effects.Alcohol, phenobarbital, antipsychotics, benzodiazepines, tricyclic antidepressants, antihistamines, and any oth...
Drug Class: Direct Vasodilators
Actions
Uses
Therapeutic Outcome
Nursing Implications for Hydralazine
Premedication assessment
Availability. PO: 10-, 25-, 50-, and 100-mg tablets
Dosage and administration.Adult: PO: Initially, 10 mg four times daily for the first 2 to 4 days, then 25 mg four times daily. T...
Common adverse effects
Nausea.This symptom may be anticipated; monitoring is required. If severe, report to a healthcare provider so that the dosage ca...
Palpitations, tachycardia.Although these symptoms may be anticipated, they require monitoring. If severe, they should be reporte...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, alcohol, beta blockers (e.g., propranolol, atenolol, p...
Actions
Uses
Therapeutic Outcomes
Availability. IV: 25 mg/mL in 2-mL vials
23 - Drugs Used to Treat Dysrhythmias
Treatment for Dysrhythmias
Drug Therapy for Dysrhythmias
Actions
Uses
Nursing Implications for Antidysrhythmic Agents
Assessment
Medication history.Obtain details of all medications prescribed and being taken. Tactfully find out if the prescribed medication...
History of six cardinal signs of cardiovascular disease
Basic mental status.Identify the person’s level of consciousness and clarity of thought. Both of these factors are indicators of...
Vital signs. Vital signs should be taken as often as
Auscultation.Nurses with advanced skills can perform auscultation to note changes in heart size and heart and lung sounds. (See ...
Laboratory and diagnostic tests.Review laboratory tests and report abnormal results to the healthcare provider promptly. Such te...
Implementation
Patient Education
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g., ...
Actions
Uses
Actions
Uses
Therapeutic Outcome
Nursing Implications for Procainamide
Premedication assessment
Availability.Procainamide hydrochloride. IV: Injection solution: 100 mg/mL in 10-mL vials and 500 mg/mL in 2-mL vials
Dosage and administration
Procainamide.Adult: IV: 10 to 17 mg/kg IV at a rate of 20 to 50 mg/min or 100 mg IV every 5 minutes; administer until arrhythmia...
Common Adverse Effects
Serious Adverse Effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include other dysrhythmic agents, antipsychotics, cimetidine, diltiazem, ...
Neuromuscular blockade, respiratory depression.Procaina
Actions
Uses
Therapeutic Outcome
Actions
Uses
Therapeutic Outcome
Nursing Implications for Flecainide
Premedication assessment
Availability. PO: 50-, 100-, and 150-mg tablets
Dosage and administration
PSVT, PAF.Adult: PO: Initially, 50 mg every 12 hours, increasing 50 mg twice daily every 4 days. Maximum daily dosage is 300 mg
Sustained VT.Adult: PO: Initially, 100 mg every 12 hours; increase in 50-mg increments twice daily every 4 days. Most patients r...
Common adverse effects.The more frequent adverse effects that occur with flecainide therapy are dizziness, lightheadedness, fain...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include amiodarone, ziprasidone, fluoroquinolones (e.g., ciprofloxacin), ...
Digoxin.When multiple doses of flecainide are administered to patients stabilized on a dose of digoxin, there is a 10% to 20% in...
Urinary acidifiers.These agents (e.g., ascorbic acid, ammonium chloride) may lower the urine pH, causing an increase in the urin...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Propafenone
Premedication assessment
Availability. PO: 150-, 225-, and 300-mg tablets; 225-, 325-, and 425-mg capsules, extended release (12 hr)
Dosage and administration.PO: Initially, 150 mg every 8 hours. At 3- or 4-day intervals, the dosage may be increased to 225 mg e...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include amiodarone, cimetidine, paroxetine, protease inhibitors (e.g., ri...
Digoxin.Propafenone produces dose-related increases in serum digoxin levels. Measure plasma digoxin levels and reduce digoxin do...
Propranolol, metoprolol.Propafenone appears to inhibit the metabolism of these beta blockers. A reduction in beta-blocker dosage...
Warfarin.Propafenone increases plasma warfarin concentrations by inhibiting warfarin metabolism, thus prolonging prothrombin tim...
Uses
Therapeutic Outcome
Nursing Implications for Beta-Adrenergic Blocking Agents
Actions
Uses
Adverse Effects
Therapeutic Outcome
Nursing Implications for Amiodarone
Availability. PO: 100-, 200-, and 400-mg tablets
Dosage and administration.The difficulty of using amiodarone effectively and safely is that it poses a significant risk to patie...
Baseline tests.Before the start of therapy, baseline pulmonary, ophthalmic, thyroid, and liver function tests should be complete...
Gastric irritation.If gastric irritation occurs, administer with food or milk. If symptoms persist or increase in severity, repo...
Serious adverse effects
Drug interactions
Cimetidine, fluoroquinolones, azole-type antifungal agents, protease inhibitors, macrolide antibiotics.Administration of these d...
Rifampin.Rifampin significantly reduces the serum levels of amiodarone. The dose of amiodarone may need to be increased for ther...
Cholestyramine.Cholestyramine significantly reduces the serum levels of amiodarone. The dose of amiodarone may need to be increa...
Fentanyl.When used concurrently, fentanyl and amiodarone may cause hypotension, bradycardia, decreased cardiac output, and sinus...
Digoxin.Administration of amiodarone to patients receiving digoxin therapy regularly results in an increase in the serum digoxin...
Warfarin.Potentiation of warfarin is almost always seen within 3 to 4 days in patients receiving concomitant therapy. The dose o...
Phenytoin.Elevation of phenytoin serum levels by 200% to 300% is observed over several weeks. The dosage of phenytoin must be gr...
Beta blockers, calcium channel blockers.Amiodarone should be used with caution in patients receiving beta-adrenergic blocking ag...
Theophylline.Amiodarone may increase theophylline serum levels, resulting in toxicity. Effects may not be observed until after a...
Actions
Uses
Adverse Effects
Therapeutic Outcome
Nursing Implications for Dofetilide
Availability. PO: 125-, 250-, and 500-mcg capsules
Dosage and administration. Before dofetilide is initiated
Common adverse effects
Drug interactions
Drugs that enhance toxic effects.Cimetidine, trimethoprim, and ketoconazole inhibit urinary excretion of dofetilide, potentially...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Sotalol
Premedication assessment
Availability.Sotalol hydrochloride. PO: Oral solution: 5 mg/mL, 250- and 480-mL bottles
Dosage and administration. Atrial fibrillation/atrial flutter (symptomatic)
Common Adverse Effects
Cardiovascular.Sotalol blocks beta receptors and may cause bradycardia. Monitor heart rate
Central nervous system.Sotalol may cause fatigue, dizziness, and headache. These effects usually subside within a few days. Inst...
Musculoskeletal.Sotalol may cause weakness. Provide for safety and prevent falls
Respiratory.Sotalol blocks beta receptors and may cause dyspnea in patients with asthma or other respiratory disorders. Assess r...
Serious Adverse Effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include other dysrhythmic agents, antipsychotics, diltiazem, digoxin, ver...
Uses
Therapeutic Outcome
Nursing Implications for Calcium Channel Blocking Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Adenosine
Premedication assessment
Availability. IV: 3 mg/mL in 2-, 4-, 20-, and 30-mL vials
Dosage and administration.IV: 6 mg administered by rapid IV bolus injection (over 1 to 2 seconds) followed by a saline flush. A ...
Common adverse effects.The most commonly reported adverse reactions with adenosine include flushing of the face (18%), shortness...
Drug interactions
Drugs that enhance therapeutic and toxic effects.Dipyri
Drugs that reduce therapeutic effects.Theophylline, aminophylline, and caffeine competitively antagonize adenosine; thus larger ...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Digoxin
24 - Drugs Used to Treat Angina Pectoris
Angina Pectoris
Treatment of Angina Pectoris
Drug Therapy for Angina Pectoris
Actions
Uses
Nursing Implications for Anginal Therapy
Assessment
History of anginal attacks. Ask the patient specific questions to identify the onset, duration, and intensity of the pain. Ask t...
Medication history
Central nervous system
Cardiovascular system
Nutritional history
Implementation. Obtain the patient’s vital signs, and include an assessment of the individual’s pain rating
Patient Education
Medications
Lifestyle modifications. Lifestyle modifications are essential for many individuals with angina. Teach the patient about appropr...
Fostering health maintenance
Patient self-assessment. Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e....
Drug Class: Nitrates
Uses
Therapeutic Outcomes
Nursing Implications for Nitrates
Premedication assessment
Availability, dosage, and administration.See Table 24. 1
Sublingual administration
Medication deterioration.Every 6 months, the nitro
Medication storage. Store nitroglycerin in its original dark-colored glass container with a tight lid
Medication accessibility.Nonhospitalized patients should carry nitroglycerin at all times, but not in a pocket directly next to ...
Sustained-release tablet administration.Sustained-release nitroglycerin is usually taken on an empty stomach every 8 to 12 hours...
Translingual spray administration.Patients should familiarize themselves with the position of the spray orifice, which can be id...
Topical ointment administration.See Chapter 7, Fig. 7.4. Nitroglycerin ointment is usually applied on arising in the morning; 6 ...
Transdermal patch administration.See Chapter 7, Fig. 7.5. The transdermal patch provides a controlled release of nitroglycerin t...
Intravenous nitroglycerin administration.Intravenous nitroglycerin is used in an acute inpatient setting (e.g., intensive care u...
Common adverse effects
Tolerance (increasing dosage to attain relief).Tolerance to the nitrate dosages can develop rapidly, particularly if large doses...
Drug interactions
Alcohol.Alcohol accentuates the vasodilation and postural hypotension caused by the nitrates. Patients should be warned that dri...
Calcium channel blockers and beta-adrenergic blockers.Calcium channel blockers and beta-adrenergic blockers may significantly lo...
Avanafil, sildenafil, tadalafil, and vardenafil.The concurrent use of nitrates and these agents used for erectile dysfunction is...
Drug Class: Beta-Adrenergic Blockers
Uses
Therapeutic Outcomes
Nursing Implications for Beta-Adrenergic Blockers
Premedication assessment
Drug Class: Calcium Channel Blockers
Uses
Therapeutic Outcomes
Nursing Implications for Calcium Channel Blockers
Premedication assessment
Availability, dosage, and administration.See Table 24.2. See Chapter 22 for a further discussion of patient education and the nu...
Uses
Therapeutic Outcome
Nursing Implications for Angiotensin-Converting Enzyme Inhibitors
Premedication assessment
Availability, dosage, and administration.See Table 22.5 and Chapter 22 for further discussion of patient education and the nursi...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Ranolazine
Premedication assessment.Initiate laboratory studies as requested by the healthcare provider (e.g., electrocardiography; renal f...
Availability. PO: 500- and 1000-mg tablets, extended release (12 hours)
Dosage and administration.PO: 500 mg twice daily; dosage may be increased to 1000 mg twice daily. Ranolazine may be taken with o...
Common adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Azole-type antifungals (e.g., ketoconazole, fluconazole), macrolide antibiotics...
Statins, tacrolimus, sirolimus.Ranolazine inhibits the metabolism of HMG-CoA inhibitors (statins), tacrolimus, and sirolimus. Re...
25 - Drugs Used to Treat Peripheral Vascular Disease
Peripheral Vascular Disease
Actions
Uses
Assessment
History of risk factors.Determine the patient’s age, gender, and race and obtain a family history of the incidence of symptoms o...
Impotence. If the patient is male, has he experienced impotence
Hypertension.Take the patient’s blood pressure in sitting and supine positions daily. Ask about medications that have been presc...
Smoking.Obtain a history of the number of cigarettes or cigars that the patient smokes daily; include other sources of nicotine,...
Dietary habits
Glucose intolerance.Ask specific questions about whether the individual currently has or has ever had an elevated serum glucose ...
Elevated serum lipid levels.Find out whether the patient is aware of having elevated lipid, triglyceride, or cholesterol levels....
Leg ulcers. Has the individual developed any slow-to-heal or nonhealing sores This would indicate poor circulation
Obesity.Weigh the patient. Ask about any recent weight gains or losses and whether it was intentional or unintentional
Psychomotor functions
Type of lifestyle.Ask the patient to describe their exercise level in terms of amount (e.g., walking three blocks), intensity (e...
Psychological stress.How much stress does the individual estimate having in their life How does the individual cope with stressf...
Assessment of tissue
Oxygenation.Observe the color of each hand, finger, leg, and foot; report cyanosis or reddish-blue areas. Does the patient have ...
Temperature.Feel the temperature in each hand, finger, leg, and foot. Report any paleness or coldness. (Note: These symptoms of ...
Edema.Assess, record, and report edema and its extent, and determine whether it is relieved or unchanged when the limb is depend...
Peripheral pulses.Palpate and record the femoral, popliteal, dorsal and tibial pedal pulses (Fig. 25.2) at least every 4 hours i...
Limb pain.Assess pain in the patient carefully. Pain during exercise that is relieved by rest may be caused by claudication. Con...
Implementation
Patient Education
Psychomotor functions
Nutritional aspects
Medication regimen
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e.g...
Drug Class: Platelet Aggregation Inhibitor
Actions
Uses
Therapeutic Outcome
Nursing Implications for Cilostazol
Premedication assessment
Availability. PO: 50- and 100-mg tablets
Dosage and administration.PO: 100 mg twice daily taken 30 minutes before or 2 hours after breakfast and dinner. Symptomatic reli...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that enhance toxic effects: diltiazem, erythromycin, omeprazole, fluconazole, fluvoxamine, verapamil, ketoconazole, grapef...
26 - Drugs Used to Treat Thromboembolic Disorders
Thromboembolic Disorders
Actions
Uses
Laboratory Tests for Monitoring Anticoagulant Therapy
History.Ask specific questions to determine whether the patient or family members have a history of any type of vascular difficu...
Current symptoms
Medications
Basic assessment
Diagnostic studies.Review completed diagnostic studies and laboratory data (e.g., PT, aPTT, INR), hematocrit, platelet count, Do...
Implementation
Techniques for preventing clot formation
Patient assessment.Monitor vital signs and mental status every 4 to 8 hours or more frequently, depending on the patient’s statu...
Nutritional status
Laboratory and diagnostic data.Monitoring and reporting laboratory results to the prescriber are essential during anticoagulant ...
Medication administration
Patient Education
Nutritional status
Exercise and activity
Medication regimen
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters. See th...
Drug Class: Platelet Inhibitors
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Aspirin Therapy
Premedication assessment
Availability, dosage, and administration.See Chapter 19, specifically Tables 19.3 and 19. 4
Prevention of transient ischemic attacks and stroke. Adult: PO: 50 to 325 mg daily
Treatment of suspected myocardial infarction.Adult: PO: 160 to 325 mg as soon as possible. Continue 160 to 325 mg daily for at l...
Prevention of myocardial infarction.Adult: PO: 75 to 162 mg daily. Current literature mostly supports the use of 81 mg daily for...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Clopidogrel
Premedication assessment
Availability. PO: 75- and 300-mg tablets
Dosage and administration.Adult: PO: Initial: 300 or 600 mg for acute MI and PCI; otherwise, 75 mg. Maintenance: 75 mg once dail...
Common adverse effects
Serious adverse effects
Neutropenia, agranulocytosis.Neutropenia (absolute neutrophil count less than 1200 neutrophils/mm3) was discovered in 0.4% of pa...
Bleeding.A normal physiologic effect of clopidogrel is prolongation of bleeding time. Patients should report any incidents of bl...
Drug interactions
Drugs that increase therapeutic and toxic effects.Heparin, LMWHs, warfarin, aspirin, NSAIDs, fondaparinux, and direct thrombin i...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Prasugrel
Premedication assessment
Availability. PO: 5- and 10-mg tablets
Dosage and administration.Adult: PO: Initially, 60-mg loading dose followed by a daily maintenance dose of 10 mg. If the patient...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that increase therapeutic and toxic effects.Heparin, LMWHs, warfarin, aspirin, NSAIDs, fondaparinux, and direct thrombin i...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Ticagrelor
Premedication assessment
Availability. PO: 60- and 90-mg tablets
Dosage and administration
Acute coronary syndrome or history of MI.PO: Loading dose, 180 mg of ticagrelor with 325 mg of aspirin, followed by 90 mg ticagr...
Patients with coronary arterial disease and no history of stroke or MI.PO: For patients with coronary artery disease but no hist...
Reduced metabolism.Drugs that inhibit the metabolism of ticagrelor, increasing the likelihood of bleeding, include itraconazole,...
Drugs that decrease therapeutic effects.Drugs that may decrease the therapeutic activity of ticagrelor by increasing its rate of...
Glycoprotein Iib/Iiia Inhibitors
Actions
Uses
Therapeutic Outcome
Drug Class: Anticoagulants
Factor Xa Inhibitors
Actions
Uses
Therapeutic Outcome
Nursing Implications for Factor Xa Inhibitors
Premedication assessment
Availability, dosage, and administration.See Table 26. 1
Antidote.Andexanet Alfa (Andexxa) is an antidote that can reverse anticoagulation in patients treated with apixaban or rivaroxab...
Reduced metabolism or increased blood levels.Itraconazole, voriconazole, and clarithromycin, inhibit the metabolism of apixaban,...
Drugs that decrease therapeutic effects.When used concurrently with factor Xa inhibitors, carbamazepine, dexamethasone, phenobar...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Fondaparinux
Premedication assessment
Availability.Subcutaneous: 2.5 mg in 0.5 mL, 5 mg in 0.4 mL, 7.5 mg in 0.6 mL, and 10 mg in 0.8 mL single-
Dosage and administration.Adult: Subcutaneous: Do not expel the air bubble from the prefilled syringe before administration. Adm...
Common adverse effects
Serious adverse effects
Drug interactions.No clinically significant drug interactions have been reported, but fondaparinux should be used cautiously in ...
HEPARINS
Anchor 374
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Heparin
Premedication assessment
Availability.Subcutaneous, Intravenous (IV): 1000, 2000, 5000, 10,000, and 20,000 units/mL in various concentrations and sizes o...
Dosage and administration
Accuracy of dose.Always confirm the dosage calculations with two nurses before IV administration. Be certain the strength is cor...
Dosage adjustment.Blood samples for laboratory studies (aPTT, anti–factor Xa) are usually drawn 4 to 6 hours after the initiatio...
Antidote.Protamine sulfate, 1 mg, will neutralize approximately 100 units of heparin, dalteparin, and 1 mg of enoxaparin. If pro...
Common adverse effects.Patients receiving full-dose heparin therapy should be monitored for hematocrit, platelet counts, aPTT, a...
Serious adverse effects
Drug interactions
Drugs that increase therapeutic and toxic effects.Concurrent use of NSAIDs, aspirin, danshen, ginkgo biloba, dipyridamole, clopi...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Dalteparin
Premedication assessment
Availability.Subcutaneous: anti–factor Xa: 2500, 5000, 7500, 10,000, 12,500, 15,000, and 18,000 units in prefilled syringes with...
Dosage and administration.Adult: Subcutaneous: Administer by deep subcutaneous injection into a U-shaped area around the navel, ...
Hip replacement surgery: DVT prophylaxis.Subcutaneous: 2500 to 5000 units before surgery. At 4 to 8 hours after surgery, 2500 un...
Abdominal surgery: DVT prophylaxis.Subcutaneous: 2500 units once daily, starting 1 to 2 hours before surgery and repeating for 5...
Treatment of symptomatic venous thromboembolism.Subcutaneous: In patients with cancer and symptomatic venous thromboembolism, th...
Thrombocytopenia.Dalteparin may cause type I or II heparin-induced thrombocytopenia (HIT) (see monograph on heparin later in thi...
Thrombotic thrombocytopenic purpura.Thrombotic thrombocytopenic purpura is a very rare but potentially life-threatening conditio...
Drug interactions.No clinically significant drug interactions have been reported, but dalteparin should be used cautiously in pa...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Enoxaparin
Premedication assessment
Availability.Subcutaneous: 30 mg in 0.3 mL, 40 mg in 0.4 mL, 60 mg in 0.6 mL, 80 mg in 0.8 mL, 100 mg in 1 mL, 120 mg in 0.8 mL,...
Dosage and administration.Adult: Subcutaneous: Do not expel the air bubble from the prefilled syringe before administration. Adm...
Dosage range. Subcutaneous: Prophylaxis: 30 mg twice daily or 40 mg once daily, depending on the medical and surgical condition
Common adverse effects
Serious adverse effects
Thrombocytopenia.Enoxaparin may induce type I or type II HIT (see monograph on heparin later in this chapter). Monitor platelet ...
Thrombotic thrombocytopenic purpura.Thrombotic thrombocytopenic purpura is a very rare but potentially life-threatening conditio...
Drug interactions.No clinically significant drug interactions have been reported, but enoxaparin should be used cautiously in pa...
VITAMIN K INHIBITOR
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Warfarin
Premedication assessment
Availability.PO: Tablets: 1, 2, 2.5, 3, 4, 5, 6, 7. 5, and 10 mg
Dosage and administration.Adult: Dosage adjustment: Dosage during therapy is based on the PT. The PT is expressed as the INR, an...
Antidote.Vitamin K is a specific antidote for warf
Common adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.The following drugs, foods, and herbal supplements, when used concurrently with...
Drugs that decrease therapeutic effects.The following drugs, foods, and herbal supplements, when used concurrently with warfarin...
All prescription and nonprescription medications.Caution the patient not to take any over-the-counter (including herbal suppleme...
Thrombin Inhibitors
Actions
Uses
Therapeutic Outcome
Nursing Implications for Dabigatran
Premedication assessment
Availability. PO: 75-, 110-, and 150-mg capsules
Dosage and administration
Nonvalvular atrial fibrillation.To reduce the risk of stroke and systemic embolism: PO: 150 mg twice a day. If creatinine cleara...
DVT and PE. Treatment and prevention: PO: 150 mg twice daily, after 5 to 10 days of parenteral anticoagulation
Antidote. Idarucizumab (Praxbind) is used as an antidote to reverse bleeding caused by dabigatran
Common adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Heparin, LMWHs, warfarin, aspirin, NSAIDs, fondaparinux, and direct thrombin in...
Drug Class: Fibrinolytic Agents
Actions
Uses
Therapeutic Outcome
27 - Drugs Used to Treat Heart Failure
Treatment of Heart Failure
Drug Therapy For Heart Failure
Actions
Uses
History of heart disease.Obtain the patient’s history of treatment for heart disease, related cardiovascular disease (e.g., hype...
Medication history.Obtain details of all medications that have been prescribed to the patient. Tactfully determine whether the p...
History of six cardinal signs of heart disease
Indications of altered cardiac function
Implementation
Patient Education
Medication regimen
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help with developing and maintaining a written record of monitoring parameters (e.g...
Uses
Therapeutic Outcomes
Nursing Implications for Angiotensin-Converting Enzyme Inhibitors
Anchor 181
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Valsartan-Sacubitril
Premedication assessment
Availability. PO: tablets: sacubitril/valsartan 24 mg/26 mg, 49 mg/51 mg, and 97 mg/103 mg
Dosage and administration.Patients not currently taking an ACE inhibitor or an ARB: PO: Initial: sacubitril/valsartan 24 mg/26 m...
Common adverse effects
Serious adverse effects
Pregnancy.Medications that act directly on the renin-angiotensin-aldosterone system can cause fetal and neonatal harm. There is ...
Swelling of the face, eyes, lips, and tongue; difficulty breathing.Angioedema has been reported to occur in a small number of pa...
Nephrotoxicity.Patients who are receiving valsartan-sacubitril, particularly those with preexisting renal impairment and those a...
Drug interactions
Drugs that enhance therapeutic and toxic effects.These include diuretics, antipsychotics, alcohol, beta-adrenergic blocking agen...
Drugs that reduce therapeutic effects.Nonsteroidal antiinflammatory drugs may reduce the effects of valsartan-sacubitril and may...
Lithium.Angiotensin II receptor blockers may induce lithium toxicity. Monitor for lithium toxicity manifested by nausea, anorexi...
Hyperkalemia.Valsartan-sacubitril may cause small increases in potassium levels by inhibiting aldosterone secretion. Patients sh...
Uses
Therapeutic Outcomes
Nursing Implications for Beta-Adrenergic Blocking Agents
Drug Class: Digitalis Glycosides
Anchor 203
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Digoxin
Premedication assessment
Availability.PO: 0.0625-, 0.125-, 0.187.5- and 0.25-mg tablets; pediatric elixir, 0. 05 mg/mL
Implementation
Pulse variations.Always take the apical pulse for 1 full minute before administering any digoxin preparation. Do not administer ...
Accurate identification.Digoxin is often given in very small increments. Always have the mathematical computations checked by an...
Dosage and administration.Give digoxin after meals to minimize gastric irritation. Note: It is recommended that a baseline elect...
Serum levels.Serum levels of digoxin are measured to determine the amount of digoxin in the bloodstream. Blood should be drawn b...
Treatment of digoxin toxicity.The basic treatment of digoxin-induced dysrhythmias consists of stopping the digoxin and any potas...
Antidote for severe digoxin intoxication. Digoxin immune fab (ovine) (Digibind)
Serious adverse effects
Noncardiac effects.Noncardiac symptoms of digoxin toxicity are often vague and difficult to separate from symptoms of heart dise...
Electrolyte balance.Adverse effects of digoxin may also be induced by electrolyte imbalance (see Drug Interactions section later...
Other diseases.The patient’s other clinical conditions may also induce digoxin toxicity. Patients who suffer from hypothyroidism...
Drug interactions
Drugs that enhance therapeutic and toxic effects.Quinidine, diltiazem, verapamil, ranolazine, macrolide antibiotics (e.g., clari...
Drugs that reduce therapeutic effects.St. John’s wort, aminoglycoside antibiotics (e.g., gentamicin, tobramycin, neomycin), chol...
Drugs that may alter electrolyte balance, thus altering digoxin response.Drugs that may alter digoxin response, and thus the inc...
Drug Class: Phosphodiesterase Inhibitor
Anchor 226
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Milrinone
Premedication assessment
Availability.IV: 1 mg/mL in 10-, 20-, and 50-mL vials. Premixed infusion: 200 mcg/mL in 100 and 200 mL of dextrose 5% for inject...
Dosage and administration.Diluents: 0.45% or 0.9% sodium chloride or dextrose 5% for injection may be used to prepare dilutions ...
Serious adverse effects
Drug interactions
Furosemide.Milrinone and furosemide are chemically incompatible. When furosemide is mixed with milrinone, a precipitate forms im...
Drug Class: Miscellaneous Agent
Anchor 238
Actions
Uses
Therapeutic Outcome
Nursing Implications for Ivabradine
Premedication assessment
Availability.PO: 5- and 7. 5-mg tablets; 1 mg/mL in 5 mL ampules for oral use
Dosage and administration.Adult: PO: Initial: 5 mg twice daily or 2.5 mg twice daily in patients who may experience hemodynamic ...
Common adverse effects
Visual.Ivabradine has been associated with visual impairment presenting as transiently enhanced brightness, halos, or colored br...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Diltiazem, verapamil, digoxin, beta blockers, grapefruit juice, amiodarone, mac...
Drugs that reduce therapeutic effects.St. John’s wort, rifampin, phenobarbital, and carbamazepine reduce the therapeutic effects...
Drugs that may alter electrolyte balance, thus altering ivabradine response.Drugs that may alter ivabradine response, and thus t...
28 - Drugs Used for Diuresis
Actions
Uses
Nursing Implications for Diuretic Therapy
Assessment
History of related causative disorders and factors.Ask the patient questions relating to any history of disorders that contribut...
History of current symptoms.Ask the patient questions to ascertain information relating to the onset, duration, and progression ...
Pattern of urination.Ask the patient to describe their current urination pattern and to cite any changes. Details such as freque...
Medication history.Obtain information from the patient about all prescribed and over-the-counter medications being taken. Tactfu...
Hydration status.Obtain the patient’s baseline vital signs. Note a pulse that is bounding and full or irregular (i.e., indicatin...
Dehydration.Assess, report, and record significant signs of dehydration in the patient. Observe for inelastic skin turgor, stick...
Skin turgor.Check the patient’s skin turgor by gently pinching the skin together over the sternum, on the forehead, or on the fo...
Oral mucous membranes.With adequate hydration, the membranes of the mouth feel smooth and glisten. With dehydration, they appear...
Laboratory changes.The patient’s hematocrit, hemoglobin, blood urea nitrogen (BUN), creatinine, osmolality, and electrolytes wil...
Overhydration.Increases in abdominal girth, weight gain, neck vein distention, and circumference of the medial malleolus indicat...
Edema.Edema is a term used to describe excess fluid accumulation in the extracellular spaces, particularly in the lower limbs. E...
Electrolyte imbalance.Because the symptoms of most electrolyte imbalances are similar, the nurse should obtain information relat...
Susceptible people.Those who are particularly susceptible to the development of electrolyte disturbances often have a history of...
Hypokalemia.Hypokalemia is indicated by a serum potassium (K+) level of less than 3.5 mEq/L. Hypokalemia is especially likely to...
Hyperkalemia.Hyperkaliemia is indicated by a serum potassium level of more than 5.5 mEq/L. Hyperkalemia occurs most commonly whe...
Hyponatremia.Hyponatremia is indicated by a serum sodium (Na+) level of less than 135 mEq/L. Remember the following phrase: “Whe...
Hypernatremia.This is indicated by a serum sodium level of more than 145 mEq/L. Hypernatremia occurs most commonly when a patien...
Implementation
Intake.Measure and record accurately all fluids taken (e.g., oral, parenteral, rectal, via tubes). Ice chips and foods such as g...
Nutrition.Patients with edema are routinely placed on a restricted sodium diet to help control edema associated with heart failu...
Output.Record all output from the mouth, urethra, rectum, wounds, and tubes (e.g., surgical drains, nasogastric tubes, indwellin...
Renal diagnostics.Many laboratory tests are ordered throughout the treatment of renal dysfunction (e.g., BUN, serum creatinine, ...
Serum electrolytes.Monitor serum electrolyte reports especially potassium and sodium levels; notify the healthcare provider of d...
Nutrition.Order a prescribed special diet, depending on the underlying pathologic condition. If fluid restrictions are prescribe...
Patient Education
Purposes of diuresis
Medication considerations
Nutrition
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters. See Pa...
Drug Class: Carbonic Anhydrase Inhibitor
Actions
Uses
Uses
Therapeutic Outcome
Nursing Implications for Sulfonamide-Type Loop Diuretics
Premedication assessment
AvailabilitySee Table 28. 1
Dosage and administration.Adult: PO: Do not exceed the maximum dosages identified in Table 28.1. Administer with food or milk to...
Common adverse effects
Serious adverse effects
Hypomagnesemia.Magnesium depletion caused by increased excretion of magnesium is a predictable consequence of the chronic use of...
Hyperuricemia.Furosemide may inhibit the excretion of uric acid, resulting in hyperuricemia. Patients who have had previous atta...
Hyperglycemia.Patients with diabetes or prediabetes must be monitored for the development of hyper
Drug interactions
Alcohol, sedative-hypnotics, opioids.Orthostatic hypotension associated with sulfonamide-type loop diuretic therapy may be aggra...
Digoxin.Sulfonamide-type loop diuretics may cause excessive potassium excretion, leading to hypo
Aminoglycosides.The potential for ototoxicity from the aminoglycosides (e.g., gentamicin, tobramycin, amikacin) is increased. As...
Cisplatin.The potential for ototoxicity from the combination of cisplatin and the sulfonamide-type loop diuretics is increased. ...
Nonsteroidal antiinflammatory drugs.Nonsteroidal anti
Corticosteroids.Corticosteroids (e.g., prednisone) may enhance the loss of potassium. Check potassium levels and monitor more cl...
Metolazone.When used concurrently, there is a considerably greater diuresis than when either agent is used alone. Monitor closel...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Ethacrynic Acid
Premedication assessment
Availability. PO: 25-mg tablets
Dosage and administration.Adult: PO: 50 to 100 mg initially, followed by 50 to 200 mg daily. Do not exceed 400 mg/day. Administe...
Common adverse effects
Serious adverse effects
Dizziness, deafness, tinnitus.People with impaired renal function may experience these symptoms. Assess the patient for gradual,...
Diarrhea.Diarrhea may become severe. Report to the healthcare provider and monitor the patient for dehydration and fluid and ele...
Drug interactions
Aminoglycosides.The potential for ototoxicity from the aminoglycosides (e.g., gentamicin, tobramycin, amikacin) is increased. As...
Nonsteroidal antiinflammatory drugs.NSAIDs (e.g., indomethacin, ibuprofen, naproxen) inhibit the diuretic activity of ethacrynic...
Digoxin.Ethacrynic acid may cause excess potassium excretion, leading to hypokalemia. If the patient is also receiving digoxin, ...
Corticosteroids.Corticosteroids (e.g., prednisone) may enhance the loss of potassium. Check potassium levels and monitor more cl...
Drug Class: Thiazide Diuretics
Uses
Therapeutic Outcomes
Nursing Implications for Thiazide Diuretics
Premedication assessment
Availability.Tables 28.2 and 28.3 list thiazide diuretics and diuretics chemically related to the thiazides. Most of the diureti...
Dosage and administration.See Tables 28.2 and 28.3. Administer with food or milk to reduce gastric irritation. Do not administer...
Common adverse effects
Serious adverse effects
Dermatologic.Skin photosensitivity is associated with thiazide diuretics. Advise patients to limit the amount of time spent in t...
Hypomagnesemia.Thiazide diuretics may increase renal excretion of magnesium. There is the relationship between magnesium and pot...
Hypercalcemia. Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia
Hyperuricemia.The plasma uric acid level is often elevated by the thiazides, which inhibit the excretion of uric acid. Patients ...
Drug interactions
Digoxin.Thiazide diuretics may cause excessive excretion of potassium, resulting in hypokalemia. If the patient is also receivin...
Corticosteroids.Corticosteroids (e.g., prednisone) may enhance the loss of potassium. Check potassium levels and monitor more cl...
Lithium.Thiazide diuretics may induce lithium toxicity. Monitor patients for lithium toxicity manifested by nausea, anorexia, fi...
Nonsteroidal antiinflammatory drugs.NSAIDs (e.g., indomethacin, ibuprofen, naproxen) inhibit the diuretic activity of this agent...
Oral hypoglycemic agents, insulin.Because of the hyper
Drug Class: Potassium-Sparing Diuretics
Actions
Uses
Therapeutic Outcome
Nursing Implications for Amiloride
Premedication assessment
Availability. PO: 5-mg tablets
Dosage and administration.Adult: PO: Initially, 5 mg daily. Dosage may be increased in 5-mg increments up to 20 mg daily with cl...
Common adverse effects
Serious adverse effects
Electrolyte imbalance, dehydration.The electrolytes most commonly altered are potassium, sodium, and chloride. Hyperkalemia is m...
Drug interactions
Lithium.Amiloride may induce lithium toxicity. Monitor patients who take lithium for lithium toxicity as manifested by nausea, a...
Potassium supplements, salt substitutes.Amiloride inhibits potassium excretion. Do not administer with potassium supplements or ...
Hyperkalemia.Angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril, lisinopril, ramipril), angiotensin II receptor blo...
Nonsteroidal antiinflammatory drugs.NSAIDs (e.g., indomethacin, ibuprofen, naproxen) inhibit the diuretic activity of amiloride....
Actions
Uses
Therapeutic Outcome
Nursing Implications for Spironolactone
Premedication assessment
Availability. PO: 25-, 50-, and 100-mg tablets; oral suspension: 25 mg/5 mL in 118- and 473-mL bottles
Dosage and administration.Adult: PO: Initially, 100 mg daily. Maintenance dosage is usually 25 to 200 mg daily, but doses up to ...
Common and serious adverse effects
Drug interactions
Potassium supplements, salt substitutes.Spironolactone inhibits potassium excretion. Do not administer with potassium supplement...
Hyperkalemia.ACE inhibitors (e.g., captopril, lisinopril, ramipril), ARBs (e.g., losartan, candesartan), and aldosterone recepto...
Nonsteroidal antiinflammatory drugs.NSAIDs (e.g., indomethacin, ibuprofen, naproxen) inhibit the diuretic activity of spironolac...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Triamterene
Premedication assessment
Availability. PO: 50- and 100-mg capsules
Dosage and administration. Adult: PO: 100 to 300 mg/day given once or twice daily; maximum dose: 300 mg daily
Common and serious adverse effects
Drug interactions
Salt substitutes, potassium supplements.Triamterene inhibits potassium excretion. Do not administer with potassium supplements o...
Hyperkalemia.ACE inhibitors (e.g., captopril, lisinopril, ramipril), ARBs (e.g., losartan, candesartan), and aldosterone recepto...
Nonsteroidal antiinflammatory drugs.NSAIDs (e.g., indomethacin, ibuprofen, naproxen) inhibit the diuretic activity of triamteren...
Drug Class: Combination Diuretic Products
V - Drugs Affecting the Respiratory System
29 - Drugs Used to Treat Upper Respiratory Disease
Common Cold
Allergic Rhinitis
Rhinitis Medicamentosa
Actions and Uses
Nursing Implications for Upper Respiratory Diseases
Assessment
Description of symptoms
History of treatment
History of concurrent medical problems.Ask specific questions to determine whether the patient has concurrent medical problems (...
Patient Education
Fostering health maintenance
Uses
Therapeutic Outcome
Nursing Implications for Sympathomimetic Decongestants
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that enhance toxic effects.Monoamine oxidase (MAO) inhibitors (e.g., tranylcypromine, phenelzine, isocarboxazid) may enhan...
Methyldopa.Frequent decongestant use inhibits the antihypertensive activity of methyldopa. Concurrent therapy is not recommended...
Drug Class: ANTIHISTAMINES
Uses
Therapeutic Outcome
Nursing Implications for Antihistamines
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects
Drug interactions
Central nervous system depressants.Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcoh...
Anchor 160
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Intranasal Corticosteroid Therapy
Premedication assessment
Availability, dosage, and administration
Counseling.The therapeutic effects—unlike those of sympathomimetic decongestants—are not immediate. This should be explained to ...
Preparation before administration.Patients with blocked nasal passages should be encouraged to use a nasal decongestant 15 to 30...
Maintenance therapy.After the desired clinical effect is obtained, the maintenance dosage should be reduced to the smallest amou...
Common adverse effects
Drug interactions. No significant drug interactions have been reported
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Cromolyn Sodium
Premedication assessment
Availability.Nasal spray: 5. 2 mg/actuation in 13-mL (100 sprays) and 26-mL (200 sprays) metered-spray devices
Dosage and administration. See Chapter 7 for techniques to use to administer nasal spray
Counseling.The therapeutic effects of these drugs, unlike those of sympathomimetic amines, are not immediate. This should be exp...
Nasal spray.Adult patients with blocked nasal passages should be encouraged to use a decongestant just before intranasal cromoly...
Common adverse effects
Serious adverse effects
Drug interactions. No significant drug interactions have been reported
30 - Drugs Used to Treat Lower Respiratory Disease
Cough
Asthma
Chronic Obstructive Pulmonary Disease
Actions and Uses
Nursing Implications for Lower Respiratory Diseases
Assessment
History of respiratory symptoms
History of respiratory medication
Description of current symptoms
Respiratory assessment.Note: The extent of the pulmonary examination (inspection, palpation, percussion, auscultation) must be a...
Inspection
Palpation.Perform palpation of the chest, noting any tender or painful areas, masses, and increased or decreased tactile fremitu...
Auscultation.Perform auscultation of the chest; note the intensity, pitch, and relative duration of inspiratory and expiratory p...
Cardiovascular assessment.As appropriate to the symptoms and the diagnosis, perform a cardiovascular assessment (see Chapters 22...
Sleep pattern.Ask whether the individual has had difficulty sleeping; determine the number of pillows they require. Obtain detai...
Psychosocial assessment.Ask specifically about the presence and degree of depression, anxiety, and social isolation experienced ...
Laboratory and diagnostic data.Review pulmonary function tests, ABGs, hematology, sputum tests, and x-ray reports as available a...
Implementation
Patient Education
Peak flowmeter.People with asthma are routinely taught how to use a peak flowmeter to measure the peak expiratory flow (PEF) to ...
Avoiding irritants.Smoking, pollen, and environmental pollutants commonly aggravate respiratory disorders. Check the home and wo...
Activity and exercise
Nutritional status
Preventing infections
Increased fluid intake.Unless contraindicated, encourage patients to increase fluid intake. This will aid in decreasing secretio...
Environmental elements.People experiencing difficulty in breathing can benefit from proper temperature, humidification of the ai...
Breathing techniques.If ordered by the healthcare provider, teach postural drainage and pursed-lip breathing or abdominal breath...
Sleep patterns.Discuss adaptations that the individual can make in daily routines to ensure adequate rest. As the disease progre...
Psychosocial behavior
Medications
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g., ...
Drug Class: Expectorant
Actions
Uses
Therapeutic Outcome
Nursing Implications for Guaifenesin
Premedication assessment. Record characteristics of the cough before initiating therapy
Availability.PO: tablets: 200 and 400 mg; extended-release tablets: 600, 1200 mg; oral granules: 100 mg/packet; liquid: 100 mg/5...
Dosage and administration. Adult: PO: 200-400 mg every 4 hours as needed; do not exceed 2400 mg/day
Fluid intake. Maintain fluid intake of 8 to 12 eight-ounce glasses of water daily
Humidification. Suggest the concurrent use of a humidifier
Common adverse effects
Drug interactions. No significant drug interactions have been reported
Drug Class: Saline Solutions
Uses
Therapeutic Outcomes
Nursing Implications for Saline Therapy
Premedication assessment. Record characteristics of cough and mucus production before initiating therapy
Drug Class: Antitussive Agents
Uses
Therapeutic Outcome
Nursing Implications for Antitussive Therapy
Premedication assessment. Record characteristics of cough and mucus before initiating therapy
Availability, dosage, and administration.See Table 30. 5
Common adverse effects
Drug interactions
Central nervous system depressants.The following agents may enhance the depressant effects of anti
Drug Class: Mucolytic Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Acetylcysteine Therapy
Premedication assessment
Availability. Inhalation: 10% and 20% solutions in 4-, 10-, and 30-mL vials
Dosage and administration.Adult: Nebulization: The recommended dosage for most patients is 3 to 5 mL of the 20% solution three o...
Nebulizer.This solution tends to concentrate as it is used. When three-fourths of the original amount in the nebulizer is used, ...
Storage.Store the opened solution of the drug in a refrigerator for up to 96 hours. Discard the unused portion
Discoloration.Use medication stored only in plastic or glass containers. Contact with metals other than stainless steel can caus...
Common adverse effects
Serious adverse effects
Drug interactions
Antibiotics.Acetylcysteine inactivates most anti
Uses
Therapeutic Outcome
Nursing Implications for Beta-Adrenergic Bronchodilators
Premedication assessment
Availability, dosage, and administration
Serious adverse effects
Nervousness, anxiety, restlessness, headache.Perform a baseline assessment of the patient’s mental status (e.g., degree of anxie...
Dizziness.Provide for patient safety during episodes of dizziness. Report episodes of dizziness to the healthcare provider for f...
Drug interactions
Drugs that enhance toxic effects.Tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline, doxepin), monoamine ...
Drugs that reduce therapeutic effects.Beta-adrenergic blocking agents (e.g., propranolol, nadolol, pindolol) reduce the therapeu...
Antihypertensive agents.Sympathomimetic agents may reduce the therapeutic effects of antihypertensive agents. Monitor blood pres...
Drug Class: Anticholinergic Bronchodilating Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Anticholinergic Bronchodilators
Premedication assessment
Availability and dosage
Administration.Ensure that the patient understands how to use the inhaler that accompanies the medication. Read the manufacturer...
Common adverse effects
Serious adverse effects
Drug interactions. No significant interactions have been reported
Uses
Therapeutic Outcome
Nursing Implications for Corticosteroid Therapy
Premedication assessment. Inspect the oral cavity for the presence of any type of infection
Availability and dosage
Administration
Counseling, adherence.The therapeutic effects, unlike those of sympathomimetic bronchodilators, are not immediate. This should b...
Preparation before administration.Patients receiving bronchodilators by inhalation should be advised to use the bronchodilator b...
Maintenance therapy.After the desired clinical effect has been obtained, the maintenance dose should be reduced to the smallest ...
Severe stress or asthma attack.During periods of stress or a severe asthma attack, patients may require treatment with systemic ...
Common adverse effects
Serious adverse effects
Drug interactions. No significant drug interactions have been reported
Drug Class: Antileukotriene Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Montelukast
Premedication assessment.Obtain and record baseline vital signs, perform a respiratory assessment and pulse oximetry, and review...
Availability. PO: 10-mg tablets; 4- and 5-mg chewable tablets; 4-mg granules
Dosage and administration.Adult: PO: 10 mg taken once daily in the evening. Doses greater than 10 mg appear to be of no value. C...
Common adverse effects
Drug interactions. No clinically significant drug interactions have been reported
Drug Class: Phosphodiesterase-4 Inhibitor
Actions
Uses
Therapeutic Outcome
Nursing Implications for Roflumilast
Premedication assessment
Availability. PO: 250-, 500-mcg tablets
Dosage and administration.PO: Initially, 250 mcg once daily for 4 weeks to improve tolerability. The actual therapeutic maintena...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Ciprofloxacin, ketoconazole, fluvoxamine, and cimetidine increase serum concent...
Drugs that reduce therapeutic effects.Rifampin, phenobarbital, carbamazepine, and phenytoin enhance the metabolism of roflumilas...
Drug Class: Immunomodulator Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Immunomodulator Agents
Premedication assessment
Availability and dosage.See Table 30. 12
Preparation and administration.Each of the immunomodulators has very specific instructions on how the product should be stored (...
Common and serious adverse effects
Musculoskeletal.Infusion of reslizumab was associated with oropharyngeal pain, chest pain, neck pain, muscle spasms, extremity p...
Drug interactions. No drug interactions have been reported with benralizumab, mepolizumab, omalizumab, and reslizumab
VI - Drugs Affecting the Digestive System
31 - Drugs Used to Treat Oral Disorders
Oral Anatomy
Mouth Disorders
Cold Sores
Canker Sores
Mucositis
Plaque
Halitosis
Xerostomia
Drug history.Obtain a history of recent drug therapy. Some drugs, such as phenytoin (Dilantin), may cause alterations in the gum...
Dental history
Oral cavity
Implementation
Cold sores
Canker sores
Mucositis.Oral hygiene regimens should be started at the time of chemotherapy or radiation therapy. Oral hygiene should include ...
Plaque. Perform toothbrushing and dental flossing and use mouthwashes on a scheduled basis daily to prevent plaque
Halitosis.Brushing dentures and teeth regularly and using dental floss can remove particles of decaying food. Mouthwashes and br...
Xerostomia.Monitor the medication routine, report xerostomia to the healthcare provider, and use artificial saliva if prescribed...
Dentures.Dentures should be cleaned each time oral hygiene is performed. For neutropenic patients, dentures should be worn only ...
Patient Education
Fostering health maintenance
Drug Class: Dentifrices
Uses
Therapeutic Outcomes
Drug Class: Mouthwashes
Actions
Uses
Therapeutic Outcomes
32 - Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Disease
Common Stomach Disorders
Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Disease
Goals of Treatment
Drug Therapy
Actions
Uses
Nutritional assessment.Obtain patient data about current height, weight, and any recent weight gain or loss. Identify the normal...
Esophagus, stomach.Ask patients to describe symptoms. Question in detail what is meant by the terms indigestion, heartburn, upse...
Pain, discomfort
Activity, exercise.Ask specifically what type of work or activities the individual performs that may increase intraabdominal pre...
History of diseases or disorders
Medication history
Smoking. What is the frequency of smoking Has the patient ever tried to stop smoking
Implementation
Patient Education
Nutrition
Pain, discomfort.Keep a written record (see Patient Self-Assessment later) of the onset, duration, location, and precipitating f...
Medications
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g., ...
Drug Class: Antacids
Uses
Therapeutic Outcomes
Nursing Implications for Antacids
Premedication assessment
Availability.See Table 32. 1
Common adverse effects
Chalky taste.A chalky taste is a common problem with antacids. Suggest a change in brands or flavors. Suggest using a liquid ins...
Serious adverse effects
Drug interactions
Tetracycline antibiotics, fluoroquinolone antibiotics, phenytoin, phenothiazines, ketoconazole, corticosteroids, digoxin, gabape...
Levodopa, valproic acid.The absorption of levodopa is increased by magnesium-aluminum antacids. When antacid therapy is added, t...
Amphetamines.Frequent use of sodium bicarbonate–containing antacid therapy may result in increased urinary pH. Renal excretion o...
Uses
Therapeutic Outcomes
Nursing Implications for H2 Antagonists
Premedication assessment.Perform a baseline assessment of the patient’s mental status for comparison with subsequent mental stat...
Availability, dosage, and administration.See Table 32. 2
Common adverse effects.Approximately 1% to 3% of patients develop these adverse effects. They are usually mild and resolve with ...
Serious adverse effects
Drug interactions
Benzodiazepines.Cimetidine inhibits the metabolism or excretion of the following benzodiazepines: alprazolam, chlordiazepoxide, ...
Beta-adrenergic blocking agents.Cimetidine may inhibit the metabolism of beta-adrenergic blocking agents (e.g., propranolol, lab...
Phenytoin.Cimetidine inhibits the metabolism of phenytoin. Monitor patients with concurrent therapy for signs of phenytoin toxic...
Antacids. Administer 1 hour before or 2 hours after administration of cimetidine
Warfarin.Cimetidine may enhance the anticoagulant effects of warfarin. Observe for the development of petechiae; ecchymoses; nos...
Calcium antagonists.Cimetidine may inhibit the metabolism of diltiazem, nifedipine, and verapamil. Patients should be monitored ...
Tricyclic antidepressants.Cimetidine may inhibit the excretion of imipramine, desipramine, and nortriptyline, usually within 3 t...
Famotidine, nizatidine. In general, there appear to be only minor interactions with these H2 antagonists
Anchor 247
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Misoprostol Therapy
Premedication assessment
Availability. PO: 100- and 200-mcg tablets
Dosage and administration. Adult: PO: 100- to 200-mcg tablets four times daily with food during NSAID therapy
Common adverse effects
Drug interactions. No significant drug interactions have been reported
Drug Class: Proton Pump Inhibitors
Uses
Therapeutic Outcomes
Nursing Implications for Proton Pump Inhibitor Therapy
Premedication assessment. Check pattern of bowel elimination; the PPIs may induce diarrhea
Availability, dosage, and administration.See Table 32.3. Omeprazole, lansoprazole, and esomeprazole need to be taken before a me...
Common adverse effects.The following symptoms are relatively mild and rarely result in the discontinuation of therapy. Encourage...
Neurologic. Headache, fatigue
Musculoskeletal. Muscle pain
Serious adverse effects
GI infection (e.g., Salmonella, Campylobacter).Use of PPIs may increase risk of bacterial infections. Report diarrhea, abdominal...
Drug interactions
Diazepam, triazolam, flurazepam.Omeprazole and esomeprazole significantly increase the half-life of diazepam, triazolam, and flu...
Phenytoin.Omeprazole slows the metabolism of phenytoin. Observe for nystagmus, sedation, and lethargy. The dosage of phenytoin m...
Clopidogrel.There has been a controversy in the literature as to whether PPIs, especially omeprazole and esomeprazole, prevent c...
Warfarin.Omeprazole and esomeprazole may reduce the rate of metabolism of warfarin. Monitor the patient closely for signs of ble...
Sucralfate.Sucralfate inhibits the absorption of PPIs. Administer PPIs at least 30 minutes before sucralfate
Altered absorption. The reduction in gastric acid secretion may alter absorption of food and drugs as follows
Drug Class: Coating Agent
Anchor 277
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Sucralfate Therapy
Premedication assessment. Check pattern of bowel elimination; sucralfate may induce constipation
Availability. PO: 1-g tablets; 1-g/10-mL suspension
Dosage and administration.Adult: PO: 1 tablet four times a day 1 hour before each meal and at bedtime, all on an empty stomach. ...
Common adverse effects.The following adverse effects are usually mild and tend to resolve with continued therapy. Encourage the ...
Drug interactions
Digoxin.Sucralfate may interfere with the absorption of digoxin. Administer digoxin at least 2 hours before sucralfate. Monitor ...
Tetracyclines.Sucralfate may interfere with the absorption of tetracycline. Administer tetracyclines 1 hour before or 2 hours af...
Drug Class: Prokinetic Agent
Anchor 290
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Metoclopramide Therapy
Premedication assessment
Availability. PO: 5- and 10-mg tablets; 5-, 10-mg dis
Caution.Approximately 1 in 500 patients may develop extrapyramidal symptoms manifested by restlessness, involuntary movements, f...
Dosage and administration.Adult: PO: Diabetic gastroparesis: 10 mg four times a day 30 minutes before each meal and at bedtime. ...
Common adverse effects.The following adverse effects are usually mild and tend to resolve with continued therapy. Encourage the ...
Gastrointestinal. Nausea
Serious adverse effects
Extrapyramidal symptoms.Provide for patient safety and then report extrapyramidal symptoms to the healthcare provider immediatel...
Drug interactions
Drugs that increase sedative effects.Antihistamine, alcohol, analgesics, phenothiazines, and sedative-hypnotics increase the sed...
Drugs that decrease therapeutic effects.Anticholinergic agents (e.g., atropine, benztropine, antihistamines, dicyclomine) and op...
Altered absorption. The GI stimulatory effects of metoclopramide may alter absorption of food and drugs as follows
33 - Drugs Used to Treat Nausea and Vomiting
Postoperative Nausea and Vomiting
Motion Sickness
Nausea and Vomiting in Pregnancy
Psychogenic Vomiting
Chemotherapy-Induced Nausea and Vomiting
Radiation-Induced Nausea and Vomiting
Postoperative Nausea and Vomiting
Motion Sickness
Nausea and Vomiting in Pregnancy
Psychogenic Vomiting
Anticipatory Nausea and Vomiting
Chemotherapy-Induced Nausea and Vomiting
Delayed Emesis
Radiation-Induced Nausea and Vomiting
Nursing Implications for Nausea and Vomiting
Assessment
History
Medications
Basic assessment. Individualize the assessment procedure to the underlying cause of the symptoms if known
Laboratory studies.Review laboratory reports for indications that include malabsorption, protein depletion, or dehydration (flui...
Nursing considerations
Implementation
Nutrition
Patient Education
Nutritional status
Medications.Verify the patient’s and significant others’ understanding of all prescribed medications to be given on a scheduled ...
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record of monitoring parameters (e.g., ...
Drug Class: Dopamine Antagonists
Uses
Therapeutic Outcomes
Nursing Implications for Dopamine Antagonists
Premedication assessment
Availability, dosage, administration, and adverse effects.See Table 33.3. For additional information on phenothiazines, olanzapi...
Common adverse effects
Cardiovascular.Amisulpride is associated with procedural hypotension. Blood pressure should be monitored
Endocrine and metabolic.Hypokalemia and increased serum prolactin have been reported with amisulpride. Potassium should be monit...
Gastrointestinal. Amisulpride may cause abdominal distention
Local. Infusion-site pain has been reported with amisulpride
Serious adverse effects
Cardiovascular.QT prolongation has been associated with the IV administration of amisulpride. Electrocardiogram (ECG) monitoring...
Drug interactions
Dopamine agonists.Dopamine agonists may diminish the effect of amisulpride. Avoid using levodopa or other dopamine agonists conc...
Drugs prolonging QT interval.Avoid medications that are known to prolong QT interval (e.g., ondansetron). ECG monitoring is reco...
Drug Class: Serotonin Antagonists
Uses
Therapeutic Outcomes
Nursing Implications for Serotonin Antagonists
Premedication assessment
Availability, dosage, and administration.See Table 33. 3
Common adverse effects.Common adverse effects are fairly mild, especially in relation to the prevention of nausea and vomiting. ...
Neurologic. Headache, sedation
Gastrointestinal. Diarrhea, constipation
Serious adverse effects
Cardiovascular.Prolongation of the QTc interval, inducing potentially fatal dysrhythmias, has been reported for all drugs in the...
Drug interactions
Apomorphine.The use of serotonin antagonists with apomorphine is contraindicated. Profound hypotension and loss of consciousness...
Drug Class: Anticholinergic Agents
Uses
Therapeutic Outcome
Nursing Implications for Anticholinergic Agents
Premedication assessment
Availability, dosage, and administration.See Table 33. 3
Common adverse effects
Drug interactions
Enhanced sedation.Central nervous system depressants, including sleeping aids, analgesics, benzodiazepines, phenothiazines, and ...
Drug Class: Corticosteroids
Uses
Therapeutic Outcome
Nursing Implications for Corticosteroids
Premedication assessment
Availability, dosage, and administration.See Table 33. 3
Common and serious adverse effects.Adverse effects are infrequent because few doses are administered for nausea and vomiting. Se...
Drug interactions. See Chapter 37
Drug Class: Benzodiazepines
Uses
Therapeutic Outcome
Nursing Implications for Benzodiazepines
Premedication assessment
Availability, dosage, and administration.See Table 33. 3
Common adverse effects, serious adverse effects, and drug interactions. See Chapter 15
Drug Class: Cannabinoids
Uses
Therapeutic Outcome
Nursing Implications for Cannabinoids
Premedication assessment
Availability, dosage, and administration.See Table 33. 3
Common and serious adverse effects
Drug interactions
Drugs that increase toxic effects.Antihistamines, alcohol, analgesics, benzodiazepines, phenobarbital, antidepressants, muscle r...
Uses
Therapeutic Outcome
Nursing Implications for NK1 Receptor Antagonists
Premedication assessment
Availability.See Table 33. 3
Dosage and administration
Postoperative nausea and vomiting.See Table 33. 3
Common and serious adverse effects.The most common adverse effects with NK1 antagonists are tiredness, nausea, hiccups, constipa...
Drug interactions
Drugs that increase toxic effects of NK1 antagonists.Ketoconazole, itraconazole, clarithromycin, ritonavir, nelfinavir, and dilt...
Drugs that reduce therapeutic effects of NK1 antagonists.Rifampin, carbamazepine, paroxetine, and phenytoin induce the metabolis...
Oral contraceptives.Female patients receiving aprepitant who take oral contraceptives should be advised to use an alternative or...
Dexamethasone and methylprednisolone.Aprepitant inhibits the metabolism of these corticosteroids. Oral doses of dexamethasone an...
Warfarin.Patients receiving warfarin therapy should be instructed to have an international normalized ratio (INR) checked approx...
Thioridazine. Concurrent use with rolapitant is contraindicated
34 - Drugs Used to Treat Constipation and Diarrhea
Diarrhea
Drugs Used to Treat Constipation and Diarrhea
Causes of Diarrhea
Intestinal Infections
Spicy or Fatty Foods
Enzyme Deficiencies
Excessive Use of Laxatives
Drug Therapy
Emotional Stress
Hyperthyroidism
Inflammatory Bowel Disease
Surgical Bypass
Treatment of Altered Elimination
Constipation
Diarrhea
History
Medications, treatments, and diagnostics
Activity and exercise
Elimination pattern.What is the individual’s usual pattern of stool elimination (i.e., frequency of the urge to defecate, usual ...
Nutrition
Basic assessment
Laboratory studies
Implementation
Patient Education
Nutritional status
Activity and exercise
Medications
Fostering health maintenance
Drug Class: Laxatives
Stimulant laxatives.Stimulant laxatives (e.g., bisacodyl, sennosides A and B) act directly on the intestine, causing an irritati...
Osmotic laxatives.Osmotic laxatives (e.g., lactulose, PEG, glycerin, lactitol) are hypertonic compounds that draw water into the...
Saline laxatives.Saline laxatives (e.g., magnesium hydroxide, magnesium citrate, sodium phosphates) are hypertonic compounds tha...
Chloride channel activator.Lubiprostone (Amitiza) induces secretion of chloride-rich intestinal fluid without altering sodium or...
Guanylate cyclase-C agonists.Linaclotide (Linzess) and plecanatide (Trulance) are guanylate cyclase-C agonists, drugs approved f...
Lubricant laxatives.Lubricant laxatives (e.g., mineral oil) lubricate the intestinal wall and soften the stool, allowing a smoot...
Bulk-forming laxatives.Psyllium, calcium polycarbophil, and methylcellulose are approved bulk-forming laxatives. Psyllium increa...
Stool softeners.Stool softeners, also known as wetting agents, draw water into the stool, causing it to soften. Docusate calcium...
Peripheral opioid antagonists.Methylnaltrexone (Relistor), naloxegol (Movantik), and naldemedine (Symproic) are mu-opioid recept...
Uses
Stimulant, osmotic, chloride channel activator, guanylate cyclase-C agonist, and saline laxatives.Stimulant, osmotic, and saline...
Lubricant laxatives.Lubricant laxatives are helpful for producing a soft stool without causing significant bowel spasm. Lubrican...
Bulk-forming laxatives.Bulk-forming laxatives are generally considered the drug of choice for someone who is incapacitated and n...
Stool softeners.Stool softeners are routinely used for prophylactic purposes to prevent constipation or straining at stool (e.g....
Peripheral opioid antagonists.Methylnaltrexone, naloxegol, and naldemedine are used for the treatment of opioid-induced constipa...
Therapeutic Outcomes
Nursing Implications for Laxative Therapy
Premedication assessment
Availability. For drugs not listed here, see drug mono
Dosage and administration.For drugs not listed here, see drug monographs for individual products for information on dosage and a...
Lactitol.Chronic idiopathic constipation: PO: 20 g orally daily, preferably with meals. The dose should be reduced to 10 g once ...
Lubiprostone.Chronic idiopathic constipation and
Methylnaltrexone.Opioid-induced constipation with chronic noncancer pain: Subcut: 12 mg once daily. PO: 450 mg once daily with w...
Naldemedine.Opioid-induced constipation with chronic noncancer pain: PO: 0. 2 mg daily
Naloxegol.Opioid-induced constipation with noncancer pain: PO: 25 mg once daily in the morning on an empty stomach. If not toler...
Common adverse effects
Cardiovascular.Lactitol may cause an increased blood pressure. Monitor blood pressure
Serious adverse effects
Drug interactions
Bisacodyl.Do not administer with milk, antacids, cimetidine, famotidine, or nizatidine. These products may allow the enteric coa...
Psyllium.Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or di...
Mineral oil. Daily administration of mineral oil for more than 1 to 2 weeks may cause a deficiency of the fat-soluble vitamins
Docusate.Docusate enhances the absorption of mineral oil. Concurrent use is not recommended
Lactitol.May reduce the absorption of medications that are administered at the same time. Administer medications 2 hours before ...
Methylnaltrexone, lubiprostone, linaclotide, and plecanatide. There are no reported drug interactions for these medications
Drugs that reduce therapeutic effects of naldemedine and naloxegol.Rifampin, carbamazepine, phenytoin, and St. John’s wort can i...
Drug Class: Antidiarrheal Agents
Uses
Therapeutic Outcome
Nursing Implications for Antidiarrheal Agents
Premedication assessment
Availability, dosage, and administration.See Table 34. 2
Common adverse effects
Serious adverse effects
Drug interactions
Diphenoxylate, difenoxin.The chemical structure of these two antidiarrheal agents is similar to meperidine. These agents should ...
Sedatives, alcohol, phenothiazines.Sedation caused by diphenoxylate and difenoxin is potentiated by other medications with centr...
VII - Drugs That Affect the Endocrine System
35 - Drugs Used to Treat Diabetes Mellitus
Diabetes Mellitus
Treatment of Diabetes Mellitus
Nursing Implications for Patients With Diabetes Mellitus
Assessment and Implementation
Description of current symptoms
Patient’s understanding of diabetes mellitus
Psychosocial assessment
Nutrition
Activity and exercise
Medications
Monitoring. Ask the patient to bring a record of self-monitoring of insulin or antidiabetic agents taken, as well as any blood g...
Physical Assessment
Patient Education
Psychological adjustment
Smoking. Healthcare providers should emphasize the need for smoking (including e-cigarettes) cessation as a priority of care for...
Nutrition
Activity and exercise
Medication
Hypoglycemia. Hypoglycemia, or low blood sugar, can occur from too much insulin, a sulfonylurea, insufficient food intake to cov...
Symptoms. Recognize and assess early symptoms of hypoglycemia; these include
Treatment.If the patient is conscious and able to swallow, give 2 to 4 ounces of fruit juice, 1 cup of skim milk, or 4 ounces of...
Hyperglycemia. Hyperglycemia (elevated blood sugar) occurs when the glucose available in the body cannot be transported into the...
Symptoms.Symptoms of hyperglycemia associated with diabetic ketoacidosis (DKA) are headache, nausea and vomiting, abdominal pain...
Treatment.Treatment of hyperglycemia often requires hospitalization with close monitoring of hydration status; administration of...
Prevention.The risk of hyperglycemia can be minimized by taking the prescribed dose of insulin or oral antidiabetic agent; adher...
Self-monitoring of blood glucose
Urine testing for ketones
Other laboratory glucose testing
Complications associated with diabetes mellitus
Cardiovascular disease.Men and women with diabetes are at an increased risk of dying from complications of cardiovascular diseas...
Peripheral vascular disease.The patient with diabetes mellitus is more likely to suffer from peripheral vascular disease than th...
Visual alterations.Visual changes are common in the patient with diabetes mellitus. These patients often suffer from blurred vis...
Blindness.In advanced stages of diabetes mellitus, the patient may suffer from changes (microangiopathies) in the small blood ve...
Renal disease.People with diabetes mellitus are more susceptible to urinary tract infections; therefore symptoms such as burning...
Infection.Any type of infection can cause a significant loss of control of diabetes mellitus. Patients should check themselves c...
Neuropathies.Explain to appropriate individuals the complication of degeneration of nerves when it exists. Ask the patient to de...
Impotence.Impotence may occur from a number of causes and should be discussed on an individual basis with the healthcare provide...
Hypertension.All patients with diabetes should have a blood pressure measurement, including orthostatic measurements, completed ...
Fostering health maintenance
At discharge. Develop a list of specific equipment and supplies that the patient will need when discharged. Keep in mind the cos...
Drug Class: Insulins
Uses
Storage of Insulin
Therapeutic Outcomes
Nursing Implications for Insulin
Premedication assessment
Availability, dosage, and administration.See Table 35.5, Fig. 9.26, and Chapter 10 for information regarding availability and ad...
Mixing insulins.Many patients with diabetes mix rapid-acting insulin with intermediate-acting or long-acting insulin to manage t...
Common and serious adverse effects
Hypoglycemia.Insulin overdose or decreased carbohydrate intake may result in hypoglycemia. If untreated, irreversible brain dama...
Lipodystrophies.Rotation of injection sites is important to avoid atrophy or hypertrophy of subcutaneous fat tissue. This dermat...
Drug interactions
Hyperglycemia.The following medications may produce hyperglycemia, especially in patients with diabetes and prediabetes (insulin...
Hypoglycemia.The following drugs may cause hypoglycemia, thereby decreasing insulin requirements, in patients with diabetes: ana...
Beta-adrenergic blocking agents.Beta blockers (e.g., propranolol, nadolol, metoprolol) may mask many of the symptoms of hypoglyc...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Metformin
Premedication assessment
Availability.PO: 500-, 850-, and 1000-mg tablets; 500-, 750-, and 1000-mg tablets, extended release (24 hr); 500 mg/5 mL oral so...
Dosage and administration.Adult: PO: Immediate-release tablet or solution: Initial: 500 mg twice daily or 850 mg once daily; tit...
Common adverse effects
Vitamin B12 deficiency.Long-term administration of metformin may cause vitamin B12 deficiency; monitor vitamin B12 serum concent...
Serious adverse effects
Drug interactions
Drugs that may enhance toxic effects.Amiloride, cimetidine, digoxin, furosemide, morphine, quinidine, ranitidine, triamterene, t...
Ethanol.Patients should be cautioned against excessive alcohol intake, acute or chronic, when taking metformin, because alcohol ...
Hyperglycemia.The following drugs, when used concurrently with metformin, may decrease its therapeutic effects: corticosteroids,...
Nifedipine.Nifedipine appears to increase the absorption of metformin. Reducing the dosage of metformin may minimize adverse eff...
Fluoroquinolones.Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) may cause hyperglycemia or hypoglycemia. Cases of severe h...
Uses
Therapeutic Outcomes
Nursing Implications for Sulfonylurea Oral Hypoglycemic Agents
Premedication assessment
Availability, dosage, and administration.See Table 35.7. Individual dosage adjustment is essential for the successful use of ora...
Common adverse effects
Serious adverse effects
Immune system.Monitor for the development of a sore throat, fever, purpura, jaundice, or excessive and progressively increasing ...
Dermatologic.Report a rash or pruritus immediately. Withhold additional doses pending approval by the healthcare provider
Drug interactions
Hypoglycemia.The following drugs may enhance the hypoglycemic effects of the sulfonylureas: azole antifungal agents (e.g., fluco...
Hyperglycemia.The following drugs, when used concurrently with the sulfonylureas, may decrease the therapeutic effects of the su...
Beta-adrenergic blocking agents.Beta blockers (e.g., propranolol, nadolol, metoprolol, carvedilol) may induce hypoglycemia but m...
Alcohol.Ingestion of alcoholic beverages during sulfonylurea therapy may infrequently result in an Antabuse-like reaction, manif...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Meglitinide Therapy
Premedication assessment
Availability, dosage, and administration.See Table 35.8. Doses may be administered within 1 to 30 minutes of the meal
Common and serious adverse effects
Drug interactions
Hypoglycemia.The following drugs may enhance the hypoglycemic effects of repaglinide and nateglinide: ethanol, erythromycin, cla...
Hyperglycemia.The following drugs, when used concurrently with the meglitinides, may decrease the therapeutic effects of the meg...
Beta-adrenergic blocking agents.Beta blockers (e.g., propranolol, nadolol, metoprolol, carvedilol) may induce hypoglycemia but m...
Carbamazepine, barbiturates, rifampin.These agents may increase repaglinide metabolism. Monitor blood glucose levels closely whe...
Erythromycin, clarithromycin, ketoconazole.These agents may inhibit repaglinide metabolism. Monitor closely for hypoglycemia if ...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Thiazolidinedione Therapy
Premedication assessment
Availability, dosage, and administration.See Table 35.9. Individual dosage adjustment is essential for the successful use of hyp...
Common adverse effects
Serious adverse effects
Drug interactions
Hypoglycemia.The following drugs may enhance the hypoglycemic effects of TZDs: sulfonylureas, ethanol, androgens (e.g., methandr...
Hyperglycemia.The following drugs, when used concurrently with TZDs, may decrease the therapeutic effects of TZDs: corticosteroi...
Beta-adrenergic blocking agents.Beta blockers (e.g., propranolol, nadolol, metoprolol, carvedilol) may induce hypoglycemia but m...
Oral contraceptives.Pioglitazone may enhance the metabolism of ethinyl estradiol and norethindrone, which may cause a resumption...
Drugs that inhibit metabolism.Erythromycin, ketoconazole, itraconazole, calcium channel blockers, corticosteroids, cyclosporine,...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Acarbose and Miglitol
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects
Drug interactions
Hyperglycemia.The following drugs, when used concurrently with acarbose and miglitol, may decrease the therapeutic effects of ac...
Digestive enzymes, intestinal adsorbents.Digestive enzymes (e.g., amylase, pancreatin) and intestinal adsorbents (e.g., charcoal...
Digoxin.Acarbose may inhibit the absorption of digoxin. Monitor serum digoxin levels and therapeutic effects to assess whether t...
Uses
Therapeutic Outcomes
Nursing Implications for SGLT2 Inhibitors
Premedication assessment
Availability, dosage, and administration
Common and serious adverse effects
Increases in low-density lipoprotein cholesterol.It was noted in clinical trials that LDL cholesterol increased 5% to 7% in pati...
Glycosuria.Based on the mechanism of action of SGLT2 inhibitors, patients will commonly spill glucose in the urine. Patients who...
Increased urination. Excretion of additional urine glucose may result in polyuria and nocturia in 2% to 5% of patients
Drug interactions
Antihypertensive agents.Patients taking antihypertensive agents (ACE inhibitors, beta blockers, alpha blockers, calcium channel ...
Uses
Therapeutic Outcomes
Nursing Implications for GLP-1 Agonists
Premedication assessment
Availability, dosage, and administration.See Table 35.12. Administer GLP-1 agonists as a subcutaneous injection in the thigh, ab...
Common adverse effects
Serious adverse effects
Drug interactions
Hypoglycemia.The following drugs may enhance the hypoglycemic effects of the sulfonylureas and GLP-1 agonists: ethanol, androgen...
Hyperglycemia.The following medications, when used concurrently with GLP-1 agonists, may decrease the therapeutic effects of GLP...
Uses
Therapeutic Outcomes
Nursing Implications for DPP-4 Inhibitors
Premedication assessment.Ensure that the dosages of concurrent oral antidiabetic therapy are well adjusted before starting DPP-4...
Availability, dosage, and administration.See Table 35.13. Adult: Administer with or without food. Adjust DPP-4 inhibitor dosage ...
Common adverse effects
Serious adverse effects
Pancreatitis.DPP-4 inhibitors infrequently cause pancreatitis, particularly when treatment is started and following increases in...
Arthralgia.Severe and disabling arthralgia has been reported with DPP-IV inhibitor use; onset may occur within 1 day to years af...
Bullous pemphigoid.DPP-4 inhibitors may cause bullous pemphigoid characterized by skin eruptions. Advise patients to report deve...
Drug interactions
Digoxin.Patients taking sitagliptin and digoxin concurrently may experience a 20% increase in digoxin serum levels. In most pati...
Hypoglycemia.The following drugs may enhance the hypoglycemic effects of DPP-4 inhibitors: ethanol, androgens (e.g., methandrost...
Hyperglycemia.The following drugs, when used concurrently with DPP-4 inhibitors, may decrease the therapeutic effects of sitagli...
Drug Class: Antihypoglycemic Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Glucagon
Premedication assessment
Availability.Subcutaneous, IM, IV: 1-mg vial. Prefilled syringe: 0.5 mg/0.1 mL, 1 mg/0. 2 mL
Dosage and administration.Adult: Subcutaneous, IM, IV: Administer 1 mg. Repeat in 15 minutes as needed. Administer fast-acting a...
Common and serious adverse effects
Respiratory.For the intranasal glucagon, upper respiratory system symptoms (e.g., rhinorrhea, nasal congestion, cough, and epist...
Drug interactions
Warfarin.Glucagon may potentiate the anticoagulant effects of warfarin if used for several days. Monitor the patient’s internati...
36 - Drugs Used to Treat Thyroid Disease
Thyroid Diseases
Treatment of Thyroid Diseases
Nursing Implications for Patients With Thyroid Disorders
Assessment
Medications.Request a list of all prescribed and over-the-counter medications being taken. Ask if any of the prescribed medicati...
Description of current symptoms.Ask the patient to explain symptoms experienced and what changes in functioning have occurred ov...
Focused assessment. Perform a focused assessment of the body systems generally affected by hypothyroid or hyperthyroid states
Laboratory and diagnostic studies and surgery.Review laboratory and diagnostic studies available on the patient’s record associa...
Implementation
Environment
Nutrition
Psychosocial care
Activity and exercise.Note the prescribed level of activity ordered by the healthcare provider. Institute safety precautions for...
Medications.Give prescribed medications and monitor for response to therapy. Thyroid medications usually are scheduled early in ...
Patient Education
Medications
Environment.Explain the need for a cool environment for a patient with hyperthyroidism or a warm environment for the person with...
Nutrition
Psychosocial.The patient may have had a major personality change, may be depressed, or (at the other end of the spectrum) may be...
Activity and exercise
Fostering health maintenance
Patient self-assessment.Enlist the patient’s aid in developing and maintaining a written record; see Patient Self-Assessment For...
Drug Class: Thyroid Replacement Hormones
Uses
Therapeutic Outcome
Nursing Implications for Thyroid Hormone Replacement Therapy
Premedication assessment
Availability and dosage
Administration.Adult: PO: Therapy may be initiated with low dosages of levothyroxine, such as 50 to 100 mcg daily. Dosages are g...
Common and serious adverse effects
Drug interactions
Warfarin.Patients with hypothyroidism require increased dosage of anticoagulants. If thyroid replacement therapy is initiated wh...
Digoxin.Patients with hypothyroidism require a decreased dosage of digoxin. If thyroid replacement therapy is started while the ...
Estrogens.Patients who have no thyroid function and who start estrogen therapy may require an increase in dosage of the thyroid ...
Cholestyramine and calcium- or iron-containing products.To prevent binding of thyroid hormones by cholestyramine and calcium- or...
Hyperglycemia.Patients with diabetes should be monitored for the development of hyperglycemia, particularly during the early wee...
Drug Class: Antithyroid Medications
Actions
Uses
Therapeutic Outcome
Nursing Implications for Radioactive Iodine
Premedication assessment
Availability. Each dose is prepared for an individual patient by a nuclear pharmacy
Administration.Administration of a radioactive iodine preparation seems simple—it is given orally by capsule or added to water a...
Common and serious adverse effects
Gastrointestinal.Radioactive iodine may cause a metallic taste in the mouth that can last a few days. If nausea develops it usua...
Hyperthyroidism.A return of symptoms of hyperthyroidism occurs in about 40% of patients who have received one dose of radioactiv...
Hypothyroidism.Some patients who receive radio
Drug interactions
Lithium carbonate.Lithium and iodine may cause synergistic hypothyroid activity. Concurrent use may result in hypothyroidism. Mo...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Propylthiouracil and Methimazole
Premedication assessment
Availability
Propylthiouracil. PO: 50-mg tablets
Methimazole. PO: 5- and 10-mg tablets
Dosage and administration
Propylthiouracil.Adult: PO: Initially, 100 to 150 mg every 8 hours. Dosage ranges up to 900 mg daily. The maintenance dosage is ...
Methimazole.Adult: PO: Initially, 5 to 20 mg every 8 hours. Daily maintenance dosage is 5 to 15 mg
Common and serious adverse effects
Drug interactions
Warfarin.Patients with hyperthyroidism require reduced dosage of anticoagulants. If antithyroid therapy is initiated while the p...
Digoxin.Patients with hyperthyroidism require an increased dosage of digoxin. If antithyroid replacement therapy is started whil...
37 - Corticosteroids
Assessment
History of pain experience.See equivalent subsection under Assessment in the Nursing Implications for Pain Management section of...
Medication use.Obtain a detailed history of all prescribed and over-the-counter medications (including herbal medicines). Ask if...
Physical assessment
Neurologic
Status of hydration
Presence of ulcer disease.Patients receiving cortico
Laboratory tests
Nutrition.Obtain a history of the patient’s diet. Ask questions regarding appetite and the presence of nausea and vomiting. Anor...
Hyperglycemia.Corticosteroid therapy may induce hyperglycemia, particularly in patients with prediabetes or diabetes. All patien...
Activity and exercise. Ask questions to obtain information about the effect of exercise on the patient’s functioning
Implementation
Presence of illness.If an infectious disease process is suspected and tuberculosis testing is planned, it should be performed be...
Medication use.Review prescription medications and over-the-counter medications (including herbal medicines) being taken and est...
Medication administration
Neurologic.Plan for stress reduction education and discussion of effective means of coping with stressful events. Note the patie...
Fluid volume status.Plan to monitor intake and output at intervals appropriate to the patient’s condition. Report intake that ex...
Nutrition.Examine the dietary history to determine whether referral to a nutritionist would help the patient understand the diet...
Pain management.When pain is present, comfort measures must be implemented to allow the patient to decrease the pain. Fatigue ma...
Vital signs and status of hydration
Laboratory tests.Check for and report abnormal laboratory values (e.g., hypokalemia, hyperkalemia, hypoglycemia, hyperglycemia, ...
Patient Education
Contact with healthcare provider
Skin care.Teach appropriate skin care and the need to change position at least every 2 hours, especially when edema is present. ...
Coping with stress
Avoidance of infections.Advise the patient to avoid crowds or people known to have infections. Report even minor signs of an inf...
Nutritional status
Activity and exercise
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Class: Mineralocorticoid
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Fludrocortisone
Premedication assessment
Availability.PO: 0. 1-mg tablets
Dosage and administration.Adult: PO: 0.1 mg daily. Dosage may be adjusted as needed. Cortisone or hydrocortisone are also usuall...
Common and serious adverse effects and drug interactions. See equivalent sections under Drug Class: Glucocorticoids
Drug Class: Glucocorticoids
Uses
Therapeutic Outcomes
Nursing Implications for Glucocorticoids
Premedication assessment
Availability, dosage, and administration
Common and serious adverse effects
Drug interactions
Diuretics (e.g., furosemide, bumetanide, thiazides).Corticosteroids may enhance the loss of potassium. Check potassium levels an...
Warfarin.Steroids may enhance or decrease the anticoagulant effects of warfarin. Observe for the development of petechiae; ecchy...
Hyperglycemia.Patients with prediabetes or diabetes must be monitored for the development of hyperglycemia, particularly during ...
Rifampin.Rifampin may enhance the metabolism of corticosteroids, thus reducing therapeutic effect. Monitor for diminished therap...
38 - Gonadal Hormones
Table 38.1 - Gonadal Hormones
History.Ask the patient to describe the current problem that initiated this visit. How long have the symptoms been present Is th...
Reproductive.Ask female patients to describe the following, as appropriate: age of menarche; usual pattern of menses (i.e., dura...
Prior illnesses.Any indication of hypertension, heart or liver disease, thromboembolic disorders, or cancer of the reproductive ...
Medication.Obtain a detailed history of all prescribed medications, including oral contraceptives; over-the-counter medications,...
Smoking. Does the person smoke
Physical examination
Psychosocial.Patients requiring androgen therapy may need to be encouraged to discuss feelings relating to sexuality, sterility,...
Implementation
Patient Education
Expectations of therapy.Discuss the expectations of therapy with the patient (e.g., degree of pain relief, frequency of use of t...
Smoking.Explain the risks of continuing to smoke, especially when the patient is receiving estrogen or progestin therapy. The in...
Physical examination. Stress the need for regular periodic medical examinations and laboratory studies
Fostering health maintenance.Discuss medication information and how it will benefit the course of treatment to produce an optima...
Patient self-assessment.Plan to teach the individual to monitor vital signs and weight daily. Enlist the patient’s help in devel...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Estrogen Therapy
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects.The following are all complications associated with estrogen therapy. It is extremely important that the...
Cardiovascular. Hypertension, thrombophlebitis, and thromboembolism
Metabolic. Hyperglycemia
Gynecologic.Breakthrough bleeding may occur. Long-term exposure to estrogens can increase the risks of breast, endometrial, and ...
Drug interactions
Warfarin.This medication may diminish the anti
Lamotrigine.Estrogens contained in contraceptives may decrease the serum concentration of lamotrigine. This may increase the ris...
Phenytoin.Phenytoin enhances the metabolism of estrogens. Spotting or bleeding may be an indication of reduced estrogen levels a...
Thyroid hormones.Patients who have no thyroid function (and therefore prescribed thyroid replacement therapy) and who start estr...
Drug Class: Progestins
Uses
Therapeutic Outcomes
Nursing Implications for Progestins
Premedication assessment
Availability, dosage, and administration
Common adverse effects.These symptoms tend to be mild and resolve with continued therapy. If they do not resolve or become parti...
Endocrine. Weight gain, edema, tiredness, oily scalp, acne
Gastrointestinal. Nausea, vomiting, diarrhea
Serious adverse effects.The following are complications associated with progestin therapy. If these complications occur, it is e...
Neurologic. Continuing headache, depression
Gastrointestinal. Cholestatic jaundice
Drug interactions
Rifampin.Rifampin may enhance the metabolism of norethindrone. The dosage of norethindrone may need to be increased to provide t...
Drug Class: Androgens
Uses
Therapeutic Outcomes
Nursing Implications for Androgens
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Genitourinary.Androgen therapy may increase prostate specific antigen (PSA) levels and increase the risk of benign prostatic hyp...
Serious adverse effects
Venous thromboembolism.Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), have been...
Hypercalcemia.In immobilized patients and patients with breast cancer, androgen therapy may cause hypercalcemia. Monitor patient...
Drug interactions
Warfarin.Androgens may enhance the anticoagulant effects of warfarin. Observe for the development of petechiae; ecchymoses; nose...
Oral antidiabetic agents, insulin.Monitor for hypoglycemia; symptoms include headache, weakness, decreased coordination, general...
Corticosteroids. Concurrent use may increase the possibility of electrolyte imbalance and fluid retention
VIII -Drugs Affecting the Reproductive System
39 - Drugs Used in Obstetrics
Nursing Implications For Obstetrics
Prenatal assessment.Obtain basic historical information about the woman and family concerning acute or chronic conditions, surge...
Nutritional history
Elimination pattern
Psychosocial cultural history
Medication history.Ask the woman if she takes any prescribed medications, over-the-counter medications, or herbal remedies. If s...
Alcohol and tobacco history.The pregnant woman should be encouraged to abstain from smoking, chewing, or vaping tobacco products...
Physical examination. Assist the woman to undress and prepare for examination, including a pelvic examination and Pap test
Assessment during first, second, and third trimesters.Assessment done at routine visits during the pregnancy includes weight; me...
Assessment of the pregnant patient at risk.Assess for signs and symptoms of potential obstetric complications (see an obstetrics...
Assessment during normal labor and delivery
History of pregnancy. On admission of the pregnant woman to the hospital, obtain the following information
Physical examination. The physical examination should include the following
Assessment after delivery and during postpartum care
Assessment of the neonate
Implementation
Prenatal
Complications of pregnancy
Preterm labor
Premature rupture of membranes
Gestational diabetes mellitus
Pregnancy hypertension disorders (preeclampsia, eclampsia)
Termination of pregnancy
Normal labor and delivery
Immediate neonatal care.Before delivery, the maternal history through the current stage of labor should be reviewed to identify ...
Airway.Ensure that the airway remains open. As soon as the head is delivered, suction the oropharynx and nasal passages with a s...
Clamping the umbilical cord.Consult with the mother before delivery if she is participating in cord blood banking. If so, specia...
Health status.The health status of the neonate is estimated at 1 minute and 5 minutes after delivery using the Apgar scoring sys...
Temperature maintenance.The neonate should be dried immediately and body temperature maintained with the use of prewarmed blanke...
Eye prophylaxis.It is a legal requirement that every newborn baby’s eyes be treated prophylactically for Neisseria gonorrhoeae. ...
Other procedures.While the parents are bonding with the newborn infant, the nurse should prepare an infant identification bracel...
Postpartum care. Postpartum is defined as the time between delivery and return of the reproductive organs to prepregnancy status
Patient Education
Adequate rest and relaxation.Assist the individual to plan for adequate rest periods throughout the day to prevent fatigue, irri...
Activity and exercise.Usually the woman can continue to perform common activities of daily living and her usual exercise regimen...
Employment.Advice about continued employment should be based on the type of job; working conditions; amount of lifting, standing...
General personal hygiene.Encourage maintenance of general hygiene through daily tub baths or showers. The pregnant woman should ...
Clothing.Encourage the mother to dress in nonconstricting clothing. As the pregnancy progresses, the mother may be more comforta...
Oral hygiene.Encourage the pregnant patient to have a thorough dental examination at the beginning of the pregnancy. She should ...
Sexual activity.Refer to an obstetrics textbook for discussion of alterations in sexuality during pregnancy. The wide range of f...
Smoking and alcohol.The pregnant woman should be encouraged to abstain from smoking, chewing, or vaping tobacco products; using ...
Nutritional needs.Balanced nutrition is always to be encouraged, but it is especially important throughout the course of the pre...
Bowel habits.Assess the individual’s usual pattern of elimination and anticipate its continuance until later in pregnancy. Press...
Douching. Discourage any type of douching because it is contraindicated during pregnancy
Discomforts of pregnancy.Use assessment data as pregnancy progresses to determine individualized teaching needed to deal with di...
Complications of pregnancy.Individualize health teaching to deal with complications as they arise. The woman should always immed...
At discharge
Fostering health maintenance
Patient self-assessment.Enlist the mother’s help in developing and maintaining a written record of monitoring parameters (e.g., ...
Drug Therapy In Pregnancy
Induction of labor.Uterine stimulants, primarily oxytocin, may be prescribed in cases in which, in the healthcare provider’s jud...
Augmentation of labor.With regard to augmentation of labor, in general, oxytocin should not be used to hasten labor. The type an...
Postpartum atony and hemorrhage.After delivery of the fetus and the placenta, the uterus sometimes remains flaccid and “boggy.” ...
Therapeutic (induced) abortion.Pharmacologic agents are usually not effective in evacuating uterine contents until several weeks...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Oxytocin
Premedication assessment.Never leave a patient receiving an oxytocin infusion unattended. Ensure that the IV site is functional ...
Availability. IV: 10 units/mL in 1-mL, 10-mL, 30-mL, and 50-mL vials
Dosage and administration
Common adverse effects
Serious adverse effects
Drug interactions
Anesthetics.Monitor the blood pressure and heart rate and rhythm closely. Report significant changes. For those patients receivi...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Methylergonovine
Premedication assessment
Availability.PO: 0. 2-mg tablets
Dosage and administration.Adult: PO: 0. 2 mg three or four times daily for up to 1 week
Common adverse effects
Serious adverse effects
Drug interactions.Drugs that may enhance therapeutic and toxic effects of methylergonovine include macrolide antibiotics (e.g., ...
Drug Class: Uterine Relaxants
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Magnesium Sulfate
Premedication assessment
Availability.Injection: solutions: 1% (0.081 mEq/mL), 2% (0.162 mEq/mL), 4% (0.325 mEq/mL), 8% (0.65 mEq/mL), and 50% (4 mEq/mL)...
Dosage and administration.IM: Intramuscular injection is extremely painful. Avoid, if possible, or administer in conjunction wit...
Seizures in preeclampsia/eclampsia.IV: Loading dose: 4 g of magnesium sulfate is added to 250 mL of 5% dextrose in water (D5W) a...
Preterm labor.IV: Loading dose: 4 g of magnesium sulfate is added to 250 mL of D5W or 0.9% sodium chloride solution and infused ...
Serious adverse effects
Confusion.Perform a baseline assessment of the patient’s degree of alertness and orientation to name, place, and time before ini...
Overdose.The antidote for magnesium intoxication (shown by respiratory depression and heart block) is calcium gluconate. A 10% s...
Neonatal effects.Infants born of mothers who receive magnesium sulfate must be monitored for hypotension, hyporeflexia, and resp...
Drug interactions
Central nervous system depressants.Central nervous system depressants, including analgesics, general anesthetics, and alcohol, w...
Neuromuscular blockade.Concurrent use of neuromuscular blocking agents and magnesium sulfate will further depress muscular activ...
Drug Therapy for Neonatal Care
Actions and Uses
Therapeutic Outcome
Nursing Implications for erythromycin Ophthalmic Ointment
Premedication assessment. Describe any drainage present in the eye or on the lids; cleanse thoroughly
Availability. Ophthalmic ointment: 5 mg/g in 1-g tube
Dosage and administration
Common adverse effects
Drug interactions. No significant drug interactions have been reported
Actions
Uses
Therapeutic Outcome
Nursing Implications for Phytonadione
Premedication assessment. No assessment is required
Availability.Injection: 1 mg in 0. 5-mL ampule and prefilled syringe
Dosage and administration.IM: 0. 5 to 1 mg in the lateral aspect of the thigh within 1 hour of birth
Serious adverse effects
Drug interactions. No significant drug interactions have been reported
40 - Drugs Used in Men’s and Women’s Health
Assessment
Female reproductive history. Assess for the following
Male reproductive history. Assess for the following
History of current symptoms.Ask the patient to describe the current problem or problems that initiated this visit. How long have...
Medication history
Psychosocial.STIs cause a high degree of anxiety. The intimate nature of the questioning required to obtain a sexual history may...
Laboratory and diagnostic studies
Physical examination
Implementation
Patient Education
Instructions for adolescents.The rate of STIs is high in this age group, so it is important to do a thorough assessment of sexua...
Instructions for women
Instructions for men
Instructions for women and men
Medications
For women.Teach the patient the proper way to apply medications topically or intravaginally using ointments or suppositories. It...
For men and women. Teach the medication regimen and who must take the medications—both partners in a sexual relationship
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Therapy For Contraception
Drug Class: Oral Contraceptives
Uses
Therapeutic Outcome. The primary therapeutic outcome associated with oral contraceptive therapy is prevention of pregnancy
Nursing Implications for Oral Contraceptives
Premedication assessment
Availability
Dosage and administration.The estrogenic component of the combination-type pills is responsible for most of the adverse effects ...
Before initiating therapy.The patient should have a complete physical examination that includes blood pressure, body weight, pel...
Instructions for using combination oral contraceptives.Start the first pill on the first Sunday after the menstrual period begin...
Instructions for using the minipill.Start using the mini
Common adverse effects.These are the most common adverse effects of hormonal contraceptive therapy. If these symptoms are not re...
Gastrointestinal. Nausea
Gynecologic, hormonal. Weight gain, spotting, changed menstrual flow, missed periods, chloasma (facial pigmentation)
Psychological, neurologic. Depression, mood changes, headaches
Serious adverse effects.The following symptoms represent the development of secondary disorders. Examination, a change in oral c...
Gynecologic. Vaginal discharge, breakthrough bleeding, yeast infection
Drug interactions
Drugs that reduce therapeutic effects
Reduced therapeutic effects of drugs by oral contraceptives
Drugs that enhance therapeutic and toxic effects.Itraconazole and ketoconazole may inhibit the metabolism of oral contraceptives...
Warfarin.Oral contraceptives may diminish or enhance the anticoagulant effects of warfarin. Monitor the prothrombin time and the...
Phenytoin.Monitor patients with concurrent therapy for signs of breakthrough seizures or phenytoin toxicity—nystagmus, sedation,...
Thyroid hormones.Patients who have no thyroid function and who start estrogen therapy may require an increase in thyroid hormone...
Benzodiazepines.Oral contraceptives appear to have a variable effect on the metabolism of benzodiazepines. Those that have reduc...
Drug Class: Transdermal Contraceptive
Actions
Uses
Therapeutic Outcome
Nursing Implications for Transdermal Contraceptives
Premedication assessment
Availability.Transdermal patch: 4.86 mg norelgestromin and 0.53 mg ethinyl estradiol per patch. The patch release 150 mcg of nor...
Implementation
Before initiating therapy.The patient should have a complete physical examination that includes blood pressure, pelvic and breas...
Instructions for using transdermal contraceptives.A new patch should be applied on the same day of the week. This day is known a...
Common and serious adverse effects.See Common Adverse Effects and Serious Adverse Effects for Oral Contraceptives earlier in thi...
Drug interactions. See Drug Interactions for Oral Contraceptives earlier in this section
Actions
Uses
Therapeutic Outcome
Nursing Implications for Intravaginal Hormonal Contraceptive
Premedication assessment
Availability.NuvaRing and EluRyng each release 0.12 mg etonogestrel and 0. 015 mg ethinyl estradiol per day (3-week duration)
Implementation
Before initiating therapy.The patient should have a complete physical examination that includes blood pressure, pelvic and breas...
Instructions for using the intravaginal hormonal contraceptive
Common and serious adverse effects.See Common Adverse Effects and Serious Adverse Effects for Oral Contraceptives earlier in thi...
Drug Interactions. See Drug Interactions for Oral Contraceptives earlier in this section
Drug Class: Intravaginal Nonhormonal Contraceptive
Osteoporosis
Drug Therapy For Osteoporosis
Nursing Implications For Osteoporosis
Smoking.Obtain a history of the number of cigarettes or cigars that the patient smokes daily; include other sources of nicotine,...
Dietary habits.Obtain a dietary history. Ask specific questions to obtain data relating to the amount of calcium- and vitamin D–...
Psychomotor functions
Alcohol.Determine whether the patient consumes alcohol greater than three drinks daily, and counsel the need to decrease consump...
Dentition.Nurses should provide education regarding the need for dental examination prior to initiation of medication. Complicat...
Pain. Assess for and report increased pain in hips, groin, or thighs with long-term use of medication
Implementation
Patient Education
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Class: Bisphosphonates
Uses
Therapeutic Outcome
Nursing Implications for Bisphosphonates
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Musculoskeletal pain.This is a common adverse effect. It is usually mild and tends to resolve with continued therapy. If adverse...
Serious adverse effects
Dysphagia, gastritis, gastric ulcers.Bisphosphonates given orally may cause local irritation of the upper gastrointestinal mucos...
Musculoskeletal pain.Incapacitating bone, joint, and or muscle pain has been reported. The onset of symptoms varies from 1 day t...
Nephrotoxicity. Bisphosphonates are contraindicated in patients with a creatinine clearance of less than 35 mL/min
Osteonecrosis of the jaw.Osteonecrosis of the jaw is generally associated with tooth extraction. Risk factors include tooth extr...
Atypical femoral fractures.Atypical femoral fractures may occur with minimal or no trauma to the affected area. Patients should ...
Drug interactions
Calcium supplements/antacids.Coadministration with calcium and antacids will interfere with the absorption of oral bisphosphonat...
Aspirin and nonsteroidal antiinflammatory drugs.The incidence of upper gastrointestinal adverse effects is increased with daily ...
Nephrotoxic drugs.Use caution when taking zoledronic acid with other potentially nephrotoxic drugs such as nonsteroidal antiinfl...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Denosumab
Premedication assessment
Availability. Subcutaneous solution: Prolia: 60 mg/mL in 1-mL prefilled syringe
Dosage and administration.Denosumab should be administered subcutaneously in the upper arm, upper thigh, or abdomen by a healthc...
Common adverse effects
Dermatologic. Dermatitis (4% to 11%), eczema (4% to 11%), skin rash (3% to 11%)
Cardiovascular. Hypertension, hypercholesterolemia in women
Musculoskeletal. Arthralgia (7% to 14%), limb pain (10% to 12%), back pain (8% to 12%)
Urinary.Cystitis may occur in women. Instruct the patient to contact the healthcare provider
Serious adverse effects. Instruct the patient to contact the healthcare provider regarding the following symptoms or conditions
Hypersensitivity.Anaphylactic reactions may occur. Denosumab may be discontinued permanently if a significant reaction occurs
Hypocalcemia.Obtain calcium level before initiating therapy; a deficient level must be corrected before initiating denosumab the...
Osteonecrosis of the jaw. Monitor for symptoms of jaw pain, difficulty in chewing
Atypical femoral fractures. Evaluate patients with thigh or groin pain to rule out a femoral fracture
Infections.The patient may develop signs or symptoms of infection such as fever, tenderness and inflammation, or muscle or joint...
Dermatologic reactions. Severe symptoms of dermatitis, rashes, and eczema may develop
Drug interactions. No drug interactions have been reported
Benign Prostatic Hyperplasia
Uses
Therapeutic Outcomes
Nursing Implications for Alpha-1 Adrenergic Blocking Agents
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.Diuretics, cimetidine, tranquilizers, alcohol, antihistamines, beta-adrenergic ...
Avanafil, sildenafil, tadalafil, vardenafil.These drugs are used to treat ED. They may aggravate hypotensive effects of doxazosi...
Drug Class: Antiandrogen Agents
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Dutasteride
Premedication assessment.Obtain a baseline PSA blood level. Dutasteride causes a decrease in serum PSA levels by about 50% in pa...
Availability.PO: 0. 5-mg capsules
Dosage and administration.PO: 0. 5 mg once daily, with or without food
Common adverse effects
Drug interactions
Drugs that enhance toxic effects.Ketoconazole, itraconazole, ritonavir, diltiazem, verapamil, cimetidine, and ciprofloxacin inhi...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Finasteride
Premedication assessment.Obtain a baseline PSA blood level. Finasteride causes a decrease in serum PSA levels by about 50% in pa...
Availability. PO: Proscar: 5-mg tablets; Propecia: 1-mg tablets
Dosage and administration. BPH: PO: 5 mg once daily, with or without food
Common adverse effects
Drug interactions. No clinically significant drug interactions have been reported to date
Erectile Dysfunction
Drug Therapy For Erectile Dysfunction
Drug Class: Phosphodiesterase Inhibitors
Actions
Uses
Therapeutic Outcome
Nursing Implications for Phosphodiesterase Inhibitors
Premedication assessment.Obtain baseline vital signs and a history of recent use of medicines, including recreational drugs. Pat...
Availability, dosage, and administration.See Table 40.9. Phosphodiesterase inhibitors do not protect against STIs, HIV, or pregn...
Common adverse effects
Serious adverse effects
Drug interactions
Nitroglycerin patches, nitroglycerin ointment, amyl nitrate.Nitrates increase the production of nitric oxide, potentially causin...
Cimetidine, erythromycin, ketoconazole, itraconazole, ritonavir, indinavir, saquinavir.These agents inhibit the metabolism of ph...
Alcohol.Alcohol and phosphodiesterase inhibitors are both mild vasodilators. Excessive consumption of alcohol in combination wit...
Alpha-adrenergic blocking agents.Use of phosphodiesterase inhibitors in conjunction with alpha-adrenergic blocking agents (e.g.,...
Rifampin.This drug may enhance the metabolism of sildenafil and tadalafil, reducing their duration of action. An increase in dos...
IX - Drugs Affecting Other Body Systems
41 - Drugs Used to Treat Disorders of the Urinary System
Nursing Implications For Urinary System Disease
Assessment
History of urinary tract symptoms
History of current symptoms
Medication history.Ask for a list of all prescribed over-the-counter medicines and herbal supplements being taken. Many pharmaco...
Nutritional history
Laboratory and diagnostic studies.Review diagnostic and laboratory reports, such as urinalysis, renal function tests, voiding ev...
Implementation
Patient Education
For incontinence
For urinary tract infections
For urinary retention.Teach self-examination to assess for bladder distention, Credé maneuver (manual compression of the bladder...
Medications
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters for ur...
Uses
Drug Class: Fosfomycin Antibiotic
Actions
Uses
Therapeutic Outcome
Nursing Implications for Fosfomycin
Premedication assessment
Availability. PO: Single-dose 3-g packets of fosfomycin granules
Dosage and administration.Adult: PO: Pour the entire contents of a single-dose packet of fosfomycin into 90 to 120 mL (3 to 4 ou...
Common adverse effects
Serious adverse effects
Drug interactions
Metoclopramide.Metoclopramide has been reported to lower the serum concentration and urinary excretion of fosfomycin by enhancin...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Nitrofurantoin
Premedication assessment
Availability. PO: 25-, 50-, and 100-mg capsules; 25-mg/5-mL suspension
Dosage and administration.Adult: PO: Macrodantin 50 to 100 mg four times daily or Macrobid 100 mg two times a day for 7 days or ...
Common adverse effects
Serious adverse effects
Pulmonary.Nitrofurantoin used for more than 6 months may cause interstitial pneumonitis or fibrosis. Monitor for malaise, dyspne...
Drug interactions
Probenecid.Probenecid may inhibit the excretion of nitrofurantoin from the renal tubules. Monitor patients for the development o...
Eplerenone, spironolactone.Nitrofurantoin may enhance the hyperkalemic effects of these two agents. Monitor serum potassium leve...
Antacids.Discourage the patient from taking products containing magnesium trisilicate (e.g., Gaviscon-2) concurrently with nitro...
Uses
Therapeutic Outcome
Nursing Implications for Urinary Anticholinergic Agents
Premedication assessment
Availability, dosage, and administration.See Table 41. 2
Common adverse effects
Serious adverse effects.If any of the aforementioned adverse effects intensifies, it should be reported to the prescribing healt...
Drug interactions
Anticholinergic agents.The concurrent use of the urinary anticholinergic agents with other anticholinergic agents may increase t...
Fluoxetine, erythromycin, clarithromycin, itraconazole, ritonavir.These agents inhibit the metabolism of tolterodine, darifenaci...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Mirabegron
Premedication assessment
Availability.PO: 25- and 50-mg tablets, extended release (24 hours). lso available as 8 mg/mL Extended-Release Granules for susp...
Liquid: 8 mg/mL in 100 mL bottle
Dosage and administration.PO: Initial: 25 mg once daily; efficacy is observed within 8 weeks for 25-mg dose. May increase to 50 ...
Common adverse effects
Serious adverse effects
Hypertension.Monitor the patient’s blood pressure periodically. Notify the healthcare provider if this
Drug interactions
Metoprolol, digoxin, nebivolol, fesoterodine.Mirabe
Anticholinergic agents.The concurrent use of mirabegron with anticholinergic agents used for OAB may enhance the risk of urinary...
Miscellaneous Urinary Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for bethanechol
Premedication assessment
Availability. PO: 5-, 10-, 25-, and 50-mg tablets
Dosage and administration. Adult: PO: 10 to 50 mg three to four times a day
Common adverse effects
Serious adverse effects
Drug interactions
Beta-adrenergic blocking agents.Beta blockers may enhance the adverse effects of bethanechol. Especially of concern is the poten...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Phenazopyridine
Premedication assessment
Availability.PO: 95-, 99. 5-, 100-, and 200-mg tablets
Dosage and administration. Adult: PO: 190 to 200 mg three times daily for two days
Common adverse effects
Serious adverse effects
Drug interactions
Urine colorimetric procedures.Phenazopyridine interferes with colorimetric diagnostic tests performed on urine. Consult the hosp...
42 - Drugs Used to Treat Glaucoma and Other Eye Disorders
Glaucoma
Drug Therapy for Glaucoma
Nursing Implications for Glaucoma and Other Eye Disorders
Assessment
Eye examination
History of symptoms
Psychological.What type of response is the patient exhibiting to the disturbance in visual acuity Is the patient withdrawing soc...
Diagnostics.Ask the patient to describe what eye diagnostic procedures have been completed before admission (e.g., visual acuity...
Medications.Ask for a list of all prescribed and over-the-counter medications and herbal products being taken. Ask for details o...
Implementation
Patient Education
After eye surgery
Disease or disorder
Visual acuity
Medications
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Drug Class: Carbonic Anhydrase Inhibitors
Uses
Therapeutic Outcome
Nursing Implications for Carbonic Anhydrase Inhibitors
Premedication assessment
Availability, dosage, and administration
Common adverse effects with ophthalmic eyedrop preparations.Brinzolamide and dorzolamide may cause ocular adverse effects includ...
Serious adverse effects with ophthalmic eyedrop preparations.Brinzolamide and dorzolamide are sulfonamide derivatives; although ...
Common adverse effects with oral administration of tablets (acetazolamide or methazolamide)
Gastric irritation.If gastric irritation occurs, administer the medication with food or milk. If symptoms persist or increase in...
Serious adverse effects
Drowsiness.This adverse effect is usually mild and tends to resolve with continued therapy. Encourage the patient not to discont...
Drug interactions
Digoxin.Patients receiving these orally administered diuretic drugs may excrete excess potassium, which leads to hypokalemia. If...
Corticosteroids (prednisone, others).Corticosteroids may enhance the loss of potassium. Check potassium levels and monitor more ...
Drug Class: Alpha-Adrenergic Agents
Uses
Therapeutic Outcomes
Nursing Implications for Alpha-Adrenergic Agents
Premedication assessment
Availability, dosage, and administration.See Table 42. 2
Common adverse effects
Conjunctival irritation, lacrimation.These adverse effects are usually mild and tend to resolve with continued therapy. Encourag...
Serious adverse effects
Diaphoresis, trembling.Touch the patient and bedding to assess for diaphoresis, particularly when these medications are used in ...
Drug interactions
Tricyclic antidepressants.Tricyclic antidepressants (e.g., amitriptyline, imipramine, doxepin) may cause additive hypertensive e...
Uses
Therapeutic Outcome
Nursing Implications for Beta-Adrenergic Blocking Agents
Premedication assessment
Availability, dosage, and administration.See Table 42. 3
Common adverse effects
Serious adverse effects
Drug interactions
Nonophthalmic beta-adrenergic blocking agents.Non
Drug Class: Prostaglandin Agonists
Uses
Therapeutic Outcome
Nursing Implications for Prostaglandin Agonists
Premedication assessment
Availability, dosage, and administration.See Table 42.4. If more than one drug is to be instilled in the same eye, administer th...
Common and serious adverse effects
Eye pigment changes.The prostaglandin agonists may gradually cause changes to pigmented tissues, including change to eye color, ...
Drug interactions
Thimerosal.A precipitate occurs when eyedrops containing thimerosal (a commonly used preservative in ophthalmic solutions) are m...
Drug Class: Rho Kinase Inhibitor
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Rho Kinase Inhibitors
Premedication assessment
Availability.Ophthalmic: 0.02% solution in 2. 5 mL bottles
Storage.Containers should be stored refrigerated at 36 to 46°F until ready for application. After opening and applying, store at...
Dosage and administration.Elevated IOP: 1 drop into affected eye(s) daily in the evening. If used in conjunction with other opht...
Common adverse effects
Serious adverse effects
Conjunctival hemorrhage, corneal deposits.These adverse effects need to be brought to the attention of the healthcare provider. ...
Drug interactions. There are no clinically significant drug interactions reported
Other Ophthalmic Agents
Uses
Therapeutic Outcomes
Nursing Implications for Anticholinergic Agents
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects
Drug interactions. No clinically significant drug interactions have been reported
Drug Class: Antifungal Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Natamycin
Premedication assessment
Availability. Ophthalmic: 5% suspension in 15 mL bottle
Dosage and administration.Fungal keratitis: One drop in the conjunctival sac at 1- or 2-hour intervals for the first 3 to 4 days...
Common adverse effects
Serious adverse effects
Drug interactions. No significant drug interactions have been reported
Drug Class: Antiviral Agents
Uses
Therapeutic Outcome
Nursing Implications for Antiviral Agents
Premedication assessment. Record baseline data concerning the symptoms and the degree of visual impairment
Availability, dosage, and administration
Storage. Trifluridine should be stored in the refrigerator
Common adverse effects
Serious adverse effects
Drug interactions. No significant drug interactions have been reported
Drug Class: Ophthalmic Antibiotics
Drug Class: Corticosteroids
Drug Class: Ophthalmic Antiinflammatory Agents
Availability and Dosage
Drug Class: Antihistamines
Drug Class: Antiallergenic Agents
Drug Class: Diagnostic Agent
Drug Class: Artificial Tear Solutions
Drug Class: Vascular Endothelial Growth Factor Antagonists
43 - Drug Therapy for Cancer
Alkylating Agents
Antimetabolites
Mitotic Inhibitors
Antineoplastic Antibiotics
Hormones
Topoisomerase Inhibitors
Tyrosine Kinase Inhibitors
Polyadenosine Diphosphate Ribose Polymerase Inhibitors
Cyclin-Dependent Kinases 4/6 Inhibitors
Proteasome Inhibitors
Checkpoint Inhibitors
Biologic Therapies
Other Agents
Safety When Using Chemotherapy
Nursing Implications for Chemotherapy
History of risk factors
Dietary habits
Preexisting health problems.Ask about any pre
Understanding of the diagnosis
Adaptation to the diagnosis
Psychomotor functions
Safety.Assess for weakness, confusion, orthostatic hypotension, or similar symptoms that could signal impending potential for in...
Symptoms of pharmacologic adverse effects.Ask specific questions to determine whether the individual has been or is experiencing...
Physical assessment
Sexual assessment.Discuss birth control and reproductive counseling issues at the time of initiation of therapy. Male patients m...
Smoking.Discuss tobacco product use (smoking, chewing, vaping) with the patient and plan a mutually agreeable way to handle this...
Pain.Ask whether the person is having any pain and what interventions are being used to manage the pain. Obtain a rating of pain...
Implementation
Patient Education
Nutrition
Diagnosis and adaptation to diagnosis
Sexual needs.Patients should discuss methods of birth control to be used during chemotherapy and/or sperm storage and fertilizat...
Vascular access devices.The need for frequent injection of chemotherapeutic agents intravenously necessitates the use of implant...
Skin care
Psychomotor
Nausea and vomiting
Diarrhea or constipation
Neutropenia
Pain
Anemia
Thrombocytopenia
Home care
Anxiety
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
44 - Muscle Relaxants, Neuromuscular Blocking Agents, and Gout Agents
Nursing Implications for Skeletal Muscle Relaxants, Neuromuscular Blocking Agents, and Gout Agents
Assessment for skeletal muscle disorders.Musculo
Current history
History
Medication history
Activity and exercise
Sleep and rest
Elimination
Nutrition
Physical examination
Laboratory and diagnostic studies
Assessment for neuromuscular blocking agents
Detection of respiratory depression
Pain assessment.Assess the degree of pain present because neuromuscular blocking agents paralyze the muscles but do not relieve ...
Implementation
Nursing interventions with musculoskeletal disorders
Nursing interventions with neuromuscular blocking agents
Patient Education
Pain relief
Activities and exercise.The patient should resume activities of daily living within the boundaries set by her or his healthcare ...
Psychosocial.For chronic disorders, encourage the patient to express feelings regarding chronic illness. The adjustment to this ...
Medications.Many of the medications used in the treatment of musculoskeletal disorders produce sedation. Teach the patient about...
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Uses
Therapeutic Outcome
Nursing Implications for Centrally Acting Skeletal Muscle Relaxants
Premedication assessment
Availability, dosage, and administration.See Table 44. 1
Common adverse effects.These adverse effects are usually mild and tend to resolve with continued therapy. Encourage the patient ...
Gastrointestinal. Report any gastrointestinal complaints to the healthcare provider for further evaluation
Serious adverse effects
Drug interactions
Central nervous system depressants.Central nervous system depressants, including alcohol, opioid agonists, antiepileptics, sedat...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Baclofen
Premedication assessment
Availability. PO: 5-, 10-, and 20-mg tablets, oral suspension 1 mg/mL and 5 mg/mL
Dosage and administration.Adult: PO: Initially 5 mg three times daily. Increase the dosage by 5 mg every 3 to 7 days based on re...
Common adverse effects.These adverse effects are usually mild and tend to resolve with continued therapy. Encourage the patient ...
Gastrointestinal. Nausea
Drug interactions
Central nervous system depressants.Central nervous system depressants, including sleep aids, analgesics, benzodiazepines, and al...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Dantrolene
Premedication assessment
Availability.PO: 25-, 50-, and 100-mg capsules. IV: Solution: 20-mg/vial; suspension: 250 mg/vial
Dosage and administration.Adult: PO: Initially, 25 mg daily for 7 days. Increase to 25 mg three times daily for 7 days; then inc...
Response to therapy.Tell the patient that effectiveness of the drug may not be apparent for 1 week or longer. Encourage the pati...
Common adverse effects.These adverse effects are usually mild and tend to resolve with continued therapy. They can often be mini...
Gastrointestinal. Diarrhea
Serious adverse effects
Drug interactions
Central nervous system depressants.Central nervous system depressants, including sleeping aids, analgesics, benzodiazepines, and...
Uses
Therapeutic Outcome
Nursing Implications for Neuromuscular Blocking Agents
Premedication assessment
Availability.See Table 44. 2
Administration.These agents are usually given by the intravenous (IV) route but may also be given by the intra
Treatment of overdose.Treatment of overdose includes artificial respiration with oxygen and antidotes such as neostigmine methyl...
Common adverse effects
Histamine release.Neuromuscular blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary se...
Serious adverse effects
Drug interactions
Drugs that enhance therapeutic and toxic effects.General anesthetics (e.g., ether, enflurane), aminoglycoside antibiotics (e.g.,...
Drugs that reduce therapeutic effects.These include neostigmine methylsulfate and pyridostigmine bromide. These agents are used ...
Carbamazepine.Carbamazepine hastens recovery time from neuromuscular blocking agents. Higher or more frequent doses of the neuro...
Respiratory depressants.Analgesics, sedatives, and benzodiazepines used in combination with muscle relaxants may potentiate resp...
Drug Class: Gout Agents
Actions
Uses
Therapeutic Outcome
Nursing Implications for Colchicine
Premedication assessment
Availability.PO: Tablets and capsules: 0.6 mg. Solution: 0. 6 mg/5 mL
Dosage and administration.Adult: PO: Acute gout: 1.2 mg at first sign of gout flare, followed by 0.6 mg 1 hour later; do not exc...
Fluid intake.Monitor intake and output during therapy. Maintain fluid intake at 8 to 12 eight-ounce glasses daily
Common adverse effects
Serious adverse effects
Neuromuscular toxicity.Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported with chronic treatment in...
Drug interactions
Drugs that enhance the toxic effects.Clarithromycin, diltiazem, itraconazole, ranolazine, and verapamil reduces the metabolism o...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Probenecid
Premedication assessment
Availability. PO: 500-mg tablets
Dosage and administration.Adult: PO: Initially 250 mg twice daily for 1 week, then 500 mg twice daily. The dosage may be increas...
Common adverse effects
Serious adverse effects
Drug interactions
Oral hypoglycemic agents.Monitor for hypoglycemia (e.g., headache, weakness, decreased coordination, general apprehension, diaph...
Acyclovir, famciclovir, valacyclovir, indomethacin, rifampin, sulfonamides, naproxen, penicillins, cephalosporins, methotrexate....
Salicylates.Although occasional use of aspirin will not interfere with the effectiveness of probenecid, regular use of aspirin o...
Antineoplastic agents.Because of the potential development of renal uric acid stones, probenecid is not recommended for increase...
Drug Class: Xanthine Oxidase Inhibitors
Uses
Therapeutic Outcome
Nursing Implications for Xanthine Oxidase Inhibitors
Premedication assessment
Availability, dosage, and administration.See Table 44. 3
Allopurinol.Adult: IV: Chemotherapy-induced tumor lysis syndrome: 200 to 400 mg/kg/day, maximum dose is 600 mg/day. Infuse at a ...
Febuxostat. Dosage must be reduced in patients with a creatinine clearance of 30 mL/min or lower
Fluid intake. Maintain fluid intake at 8 to 12 eight-ounce glasses daily
Common adverse effects
Serious adverse effects
Drug interactions
Theophylline derivatives.Xanthine oxidase inhibitors, when given with theophylline derivatives, may cause theophylline toxicity....
Azathioprine, mercaptopurine.Xanthine oxidase inhibitors inhibit the metabolism of these agents. When initiating therapy with az...
Ampicillin, amoxicillin.There is a high incidence of rash when patients are taking both allopurinol and ampicillin or amoxicilli...
Cyclophosphamide.There is a greater incidence of bone marrow depression in patients receiving allopurinol and cyclophosphamide c...
45 - Drugs Used to Treat Infections
NURSING IMPLICATIONS FOR ANTIMICROBIAL THERAPY
Assessment
History of current infection. What symptoms are described by the patient? Which of the symptoms described potentially relate to ...
Medication history
Physical examination
Psychosocial. For an individual with a serious communicable disease, assess the response and adaptive processes used to cope wit...
Assessments during antimicrobial therapy. Read each drug monograph for specific common and serious adverse effects, and individu...
Nausea, vomiting, and diarrhea. These conditions are the “big three” adverse effects associated with antimicrobial drug therapy....
Secondary infection. Assess for symptoms of secondary infection such as oral infection. Observe for a black, hairy tongue; white...
Allergies and anaphylaxis. The severity of an allergic reaction ranges from a mild rash to fatal anaphylaxis. Allergic reactions...
Nephrotoxicity. Assess nephrotoxicity through an increasing blood urea nitrogen (BUN) and creatinine, decreasing urine output, d...
Hepatotoxicity. Assess for preexisting hepatic disease such as cirrhosis or hepatitis. Review laboratory studies (e.g., bilirubi...
Ototoxicity. Damage to the eighth cranial nerve (ototoxicity) can occur from drug therapy, particularly from aminoglycosides. Th...
Blood dyscrasias
Photosensitivity. Assess for the development of dermatologic symptoms such as exaggerated sunburn, itching, rash, urticaria, pru...
Implementation
Medication history
Patient Education
Medications
Fostering health maintenance
Patient self-assessment. Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g....
Actions
Uses
Therapeutic Outcome
Nursing Implications for Aminoglycosides
Premedication assessment
Availability, dosage, and administration
Admixture compatibilities. Do not mix other drugs in the same syringe with aminoglycoside antibiotics or infuse together with ot...
Rate of infusion. Check with the hospital laboratory regarding timing of aminoglycoside blood level tests. The rate of infusion ...
Serious adverse effects
Drug interactions
Nephrotoxic potential. Cephalosporins, amphotericin-B, vancomycin, and loop diuretics, when combined with aminoglycosides, may i...
Ototoxic potential. Aminoglycosides, when combined with torsemide, bumetanide, and furosemide, may increase ototoxicity. Therefo...
Myasthenia gravis. Aminoglycosides should be avoided in patients with myasthenia gravis if possible. They may interfere with neu...
Neuromuscular blockade. Taking aminoglycoside anti
Heparin. The aminoglycoside gentamicin and heparin are physically incompatible. Do not mix together before infusion
Beta-lactam–type antibiotics (penicillins, cephalosporins). These drugs rapidly inactivate aminoglycoside antibiotics. Do not mi...
DRUG CLASS: CARBAPENEMS
Uses
Therapeutic Outcome
Nursing Implications for Carbapenems
Premedication assessment
Availability, dosage, and administration
Hypersensitivity. Although these antibiotics are carbapenems rather than penicillins or cephalosporins, they also contain a beta...
Admixture compatibilities. Do not mix other drugs in the same syringe with carbapenems or infuse together with other drugs. See ...
Common adverse effects
Drug interactions
Probenecid. Probenecid inhibits the urinary excretion of carbapenems. Do not administer probenecid concurrently
Valproic acid. Carbapenem antibiotics may produce clinically significant reductions in valproic acid levels, which may lead to a...
Ganciclovir. Concurrent administration of ganciclovir and imipenem-cilastatin has resulted in an increased incidence of seizures...
DRUG CLASS: CEPHALOSPORINS
Uses
Therapeutic Outcome
Nursing Implications for Cephalosporins
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Hepatotoxicity. Transient elevations of liver function test results (e.g., AST, ALT, alkaline phosphatase) have been reported. M...
Electrolyte imbalance. If a patient develops hyperkalemia or hypernatremia, consider the electrolyte content of the antibiotics....
Drug interactions
Nephrotoxic potential. Patients receiving cephalosporins, aminoglycosides, vancomycin, and loop diuretics concurrently should be...
Antacids. Antacids inhibit the absorption of cefaclor, cefdinir, and cefpodoxime. If antacids must be taken, the antibiotic shou...
Histamine-2 antagonists. Histamine-2 (H2) antagonists (e.g., cimetidine, famotidine, nizatidine, ranitidine) inhibit the absorpt...
Iron supplements. Iron supplements and food fortified with iron inhibit the absorption of cefdinir. If iron supplements must be ...
Probenecid. Patients receiving probenecid in combination with cephalosporins are more susceptible to toxicity because of the inh...
Alcohol. Instruct the patient to avoid alcohol consumption during cefotetan therapy. Patients ingesting alcohol during, and for ...
Oral contraceptives. Cephalosporins may interfere with the contraceptive activity of oral contraceptives. Oral contraceptives sh...
DRUG CLASS: GLYCOPEPTIDES
Uses
Therapeutic Outcome
Nursing Implications for Glycopeptides
Premedication assessment
Availability, dosage, and administration
Serum levels. Serum trough levels of vancomycin should be routinely ordered to minimize adverse effects. Notify the healthcare p...
Serious adverse effects
Coagulation. Although telavancin and oritavancin do not interfere with coagulation, they can interfere with certain tests used t...
Hepatic effects. ALT elevations have been reported with dalbavancin
Drug interactions
Nephrotoxicity, ototoxicity. Concurrent and sequential use of vancomycin with other ototoxic or nephrotoxic agents such as the a...
Neuromuscular blockade. Vancomycin in combination with skeletal muscle relaxants may produce respiratory depression. Check the a...
Heparin. Avoid the use of IV heparin with telavancin and oritavancin. Both may artificially increase the results of laboratory t...
DRUG CLASS: GLYCYLCYCLINES
Actions
Uses
Therapeutic Outcome
Nursing Implications for Tigecycline
Premedication assessment
Availability. IV: 50-mg vials
Dosage and administration. IV: Initial: 100 mg followed by 50 mg every 12 hours. Administer by IV infusion over 30 to 60 minutes...
Common adverse effects
Drug interactions
Warfarin. Tigecycline may enhance the anti
Oral contraceptives. Tigecycline may interfere with the activity of oral contraceptives. Oral contraceptives should not be disco...
DRUG CLASS: MACROLIDES
Uses
Therapeutic Outcome
Nursing Implications for Macrolides
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Serious adverse effects
Drug interactions
Toxicity caused by macrolides. Macrolide antibiotics may inhibit the metabolism of several drugs, causing accumulation and poten...
Pimozide. Coadministration of a macrolide anti
Rifampin, rifabutin. The coadministration of a macrolide antibiotic with rifampin or rifabutin may cause a reduction in antimicr...
Oral contraceptives. Macrolides may interfere with the activity of oral contraceptives. Oral contraceptives should not be discon...
DRUG CLASS: OXAZOLIDINONES
Actions
Uses
Therapeutic Outcome
Nursing Implications for Linezolid and Tedizolid
Premedication assessment
Availability
Linezolid. PO: 600-mg tablets; 100-mg/5-mL oral suspension in 150 mL. IV: 200- and 600-mg prefilled containers at 2 mg/mL
Tedizolid. PO: 200-mg tablets; IV: 200 mg/vial
Dosage and administration
Linezolid. Adults
Tedizolid. Adults: Acute bacterial skin and skin structure infections: PO, IV: 200 mg once daily for 6 days
Common adverse effects
Serious adverse effects
Drug interactions
Monoamine oxidase inhibitors. Both agents inhibit monoamine oxidase A and should not be used in patients taking other monoamine ...
Adrenergic agents. Both agents are monoamine oxidase inhibitors that will reduce the metabolism of adrenergic agents (e.g., dopa...
Serotonergic agents. As monoamine oxidase A inhibitors, both agents have the potential to interact with serotonergic agents (e.g...
DRUG CLASS: PENICILLINS
Uses
Therapeutic Outcome
Nursing Implications for Penicillins
Premedication assessment
Availability, dosage, and administration
Admixture compatibilities. Do not mix with other drugs in the same syringe with penicillins or infuse with other drugs. See the ...
Common adverse effects
Severe adverse effects
Drug interactions
Probenecid. Patients receiving probenecid in combination with penicillins are more susceptible to toxicity because probenecid in...
Ampicillin, amoxicillin, and allopurinol. When ampicillin or amoxicillin is used concurrently with allopurinol, there is a highe...
Antacids. Excessive use of antacids may diminish the absorption of oral penicillins
Oral contraceptives. Penicillins may interfere with the activity of oral contraceptives. Oral contraceptives should not be disco...
DRUG CLASS: PLEUROMUTILIN
Actions
Uses
Therapeutic Outcome
Nursing Implications for Lefamulin
Premedication assessment
Availability. IV: 150 mg/15 mL. Oral: 600 mg tablets
Dosage and administration. IV: 150 mg every 12 hours over 60 minutes. Therapy is continued for 5 to 7 days. Could switch to the ...
Common adverse effects
Serious adverse effects
Drug interactions
Drugs that increase adverse effects. Clarithromycin, itraconazole, amiodarone, erythromycin, diltiazem, and verapamil may inhibi...
Drugs that decrease therapeutic outcomes. Carbamazepine, phenobarbital, phenytoin, rifampin, and St. John’s wort may increase th...
DRUG CLASS: QUINOLONES
Uses
Therapeutic Outcome
Nursing Implications for Quinolones
Premedication assessment
Availability, dosage, and administration
Children and older adults, patients taking corticosteroids, transplant patients. Fluoroquinolones should not be prescribed for p...
Pregnant women. Quinolone therapy is not recommended during pregnancy unless the benefit of therapy outweighs the risk. No studi...
Common adverse effects
Serious adverse effects
Rash. Report a rash or pruritus immediately and withhold additional doses pending approval by the healthcare provider
Worsening symptoms for those with myasthenia gravis. Quinolones may exacerbate muscle weakness in patients with myasthenia gravi...
Irreversible peripheral neuropathy (serious nerve damage). Fluoroquinolones have been associated with an increased risk of perip...
Drug interactions
Iron, antacids, sucralfate. Iron salts, zinc salts, sucralfate, and antacids containing magnesium hydroxide or aluminum hydroxid...
Nonsteroidal antiinflammatory drugs. The concurrent administration of nonsteroidal antiinflammatory drugs with fluoroquinolones ...
Theophylline. The fluoroquinolones (e.g., ciprofloxacin, moxifloxacin, ofloxacin), when given with theophylline, may produce the...
DRUG CLASS: STREPTOGRAMINS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Streptogramins
Premedication assessment
Availability. IV: 500 mg (150 mg quinupristin and 350 mg dalfopristin) in 10-mL vial. All dosage recommendations are based on to...
Dosage and administration. Adult: IV: 7.5 mg/kg every 8 hours for the treatment of VRE bacteremia or every 12 hours for treatmen...
Admixture compatibility. Reconstitute only with 5% dextrose or sterile water for injection and then dilute with 5% dextrose to a...
Serious adverse effects
Drug interactions
Toxicity induced by quinupristin-dalfopristin. Quinupristin-dalfopristin may decrease the metabolism of HMG-CoA reductase inhibi...
DRUG CLASS: SULFONAMIDES
Uses
Therapeutic Outcome
Nursing Implications for Sulfonamides
Premedication assessment
Availability, dosage, and administration
Common adverse effects
Drug interactions
Oral hypoglycemic agents. Sulfonamides may displace sulfonylurea oral hypoglycemic agents (e.g., glipizide, glimepiride, glyburi...
Warfarin. Sulfonamides may enhance the anti
Methotrexate. Sulfonamides may produce methotrexate toxicity when given simultaneously. Monitor patients on concurrent therapy f...
Phenytoin. Sulfisoxazole may displace phenytoin from protein-binding sites, resulting in phenytoin toxicity. Monitor patients on...
Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, eplerenone, spironolactone. With concurrent use of thes...
DRUG CLASS: TETRACYCLINES
Uses
Therapeutic Outcome
Nursing Implications for Tetracyclines
Premedication assessment
Availability, dosage, and administration. See Table 45.9. PO: Emphasize the importance of taking medication 1 hour before or 2 h...
Common adverse effects
Drug and other interactions
Warfarin. Tetracyclines may enhance the anti
Impaired absorption. Iron, calcium-containing foods (milk and dairy products), and calcium, aluminum, or magnesium preparations ...
Phenytoin, carbamazepine. These agents reduce the half-life of doxycycline. Monitor patients for lack of clinical improvement fr...
Tooth development. Do not administer tetracyclines to pregnant patients or to children younger than 8 years. The infant’s or chi...
Lactation. Nursing mothers must switch their babies to formula while taking tetracyclines because tetracyclines are present in b...
Oral contraceptives. Tetracyclines may interfere with the activity of oral contraceptives. Oral contraceptives should not be dis...
DRUG CLASS: ANTITUBERCULAR AGENTS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Ethambutol
Premedication assessment
Availability. PO: 100- and 400-mg tablets
Dosage and administration. Adult: PO: Initial treatment: 15 mg/kg administered as a single dose every 24 hours. Retreatment: 25 ...
Common adverse effects
Serious adverse effects
Drug interactions
Antacids. Aluminum salts may delay and reduce absorption of ethambutol. Separate administration by at least 2 hours
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Isoniazid
Premedication assessment
Availability. PO: 100- and 300-mg tablets; 50-mg/5-mL syrup. IM: 100 mg/mL in 10-mL vials
Dosage and administration. Adult: PO: Treatment of active tuberculosis: 5 mg/kg to a maximum of 300 mg daily, or 15 mg/kg/day (9...
Common and serious adverse effects
Hepatotoxicity. The incidence of hepatotoxicity increases with age and with the consumption of alcohol. This reaction usually oc...
Dizziness, ataxia. Provide for patient safety and assistance in ambulation until either a dosage adjustment or addition of pyrid...
Drug interactions
Disulfiram. Patients receiving concurrent therapy may experience changes in physical coordination and mental affect and behavior...
Carbamazepine. Isoniazid may inhibit the metabolism of carbamazepine. Monitor patients receiving concurrent therapy for signs of...
Theophylline. Isoniazid may inhibit the metabolism of theophylline. Monitor patients receiving concurrent therapy for signs of t...
Phenytoin. Isoniazid may inhibit the metabolism of phenytoin. Monitor patients receiving concurrent therapy for signs of phenyto...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Pyrazinamide
Premedication assessment
Availability. PO: 500-mg tablets
Dosage and administration. Adult: PO: Dosage by weight: 40 to 55 kg: 1000 mg once daily; 56 to 75 kg: 1500 mg once daily; 76 to ...
Common adverse effects
Serious adverse effects
Drug interactions
Cyclosporine. Pyrazinamide may decrease the serum concentration of cyclosporine
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Rifampin
Premedication assessment
Availability. PO: 150- and 300-mg capsules. 25 mg/mL per 120 mL bottle suspension. IV: 600-mg vials
Dosage and administration. Adult: PO: 10 mg/kg (maximum 600 mg) once daily, either 1 hour before or 2 hours after a meal. IV: sa...
Common adverse effects
Serious adverse effects
Drug interactions
Warfarin. Rifampin may diminish the anticoagulant effects of warfarin. Monitor the INR and increase the dosage of warfarin if ne...
Isoniazid. Concurrent therapy may rarely result in hepatotoxicity. Patients on combined therapy should have liver function tests...
Decreased therapeutic effects induced by rifampin. Rifampin stimulates the metabolism of benzodiazepines (e.g., diazepam, midazo...
Ketoconazole. Administration of rifampin and ketoconazole decreases serum levels of both drugs. Avoid concurrent use if possible...
Oral contraceptives. Rifampin interferes with the activity of oral contraceptives. Counseling regarding alternative methods of b...
DRUG CLASS: OTHER ANTIBIOTICS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Aztreonam
Premedication assessment
Availability. IM, IV: 1- and 2-g/vial. Inhalation: 75 mg/vial for reconstitution
Dosage and administration. Adult: IM or IV: Urinary tract infections: 0.5 to 1 g every 8 to 12 hours. Moderately severe systemic...
Common adverse effects
Serious adverse effects
Drug interactions
Beta-lactamase antibiotics. These antibiotics (e.g., cefoxitin, imipenem) induce the production of beta-lactamase in some gram-n...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Clindamycin
Premedication assessment
Availability. PO: 75-, 150-, and 300-mg capsules; 75-mg/5-mL suspension in 100 ML bottles. IV: 150 mg/mL in 2-, 4-, and 6-mL amp...
Dosage and administration. Adult: PO: 150 to 450 mg every 6 hours. Do not refrigerate the suspension. It is stable at room tempe...
Common adverse effects
Serious adverse effects
Drug interactions
Neuromuscular blockade. Label charts of patients scheduled for surgery who are taking clindamycin. When combined with surgical m...
Erythromycin. Therapeutic antagonism has been reported between clindamycin and erythromycin. Do not administer concurrently
Actions
Uses
Therapeutic Outcome
Nursing Implications for Daptomycin
Premedication assessment
Availability. IV: 350-, 500-mg vials
Dosage and administration. IV: Complicated skin and skin structure infections: 4 mg/kg once every 24 hours for 7 to 14 days
Admixture compatibility. Daptomycin is not compatible with dextrose-containing diluents, and additives or other medications shou...
Common adverse effects
Serious adverse effects
Drug interactions
HMG-CoA reductase inhibitors. The statins (e.g., atorvastatin, lovastatin, simvastatin, others) may infrequently cause skeletal ...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Metronidazole
Premedication assessment
Availability. PO: 250- and 500-mg tablets; 375-mg capsules. Suspension: 50 mg/mL in 120 mL bottles. Injection: 500-mg powder/via...
Dosage and administration. Adult: PO
Common adverse effects
Serious adverse effects
Drug interactions
Alcohol. Use of alcohol and alcohol-containing preparations, such as OTC cough medications and mouthwashes (e.g., Listerine, Cēp...
Warfarin. Metronidazole may enhance the anti
Disulfiram. Combined use of disulfiram and metronidazole may result in mental confusion and psychoses. Concurrent therapy is not...
Lithium. Patients receiving higher dosages of lithium are more susceptible to lithium toxicity and potential renal damage. Metro...
Phenytoin, fosphenytoin. Metronidazole inhibits phenytoin metabolism. Monitor patients with concurrent therapy for signs of phen...
Action
Uses
Therapeutic Outcome
Nursing Implications for Tinidazole
Premedication assessment
Availability. PO: 250- and 500-mg tablets
Dosage and administration. PO: Trichomoniasis: Men and women: 2 g once. Sexual partners must be treated concurrently to prevent ...
Common adverse effects
Serious adverse effects
Drug interactions
Alcohol. Use of alcohol and alcohol-containing preparations, such as OTC cough medications and mouthwashes (e.g., Listerine, Cēp...
Warfarin. Tinidazole may enhance the anticoagulant effects of warfarin during and up to 8 days after taking tinidazole. Observe ...
Lithium. Patients receiving higher dosages of lithium are more susceptible to lithium toxicity and potential renal damage. Tinid...
Phenytoin, fosphenytoin. Tinidazole inhibits phenytoin metabolism. Monitor patients with concurrent therapy for signs of phenyto...
DRUG CLASS: TOPICAL ANTIFUNGAL AGENTS
Uses
Therapeutic Outcome
Nursing Implications for Topical Antifungals
Premedication assessment
Availability, dosage, and administration
Topical. Apply clean gloves. Wash hands thoroughly before and immediately after application. Cleanse skin with soap and water an...
Eye contact. Instruct patients to avoid contact with the eyes and to wash their eyes immediately if contact occurs
Intravaginal. Give the patient the following instructions
Common and serious adverse effects
Drug interactions. No clinically significant drug interactions have been reported
DRUG CLASS: SYSTEMIC ANTIFUNGAL AGENTS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Amphotericin B
Premedication assessment
Availability. IV
Dosage and administration. Dosage varies depending on the dosage form and the organism for which the medicine is being used. Con...
Common and serious adverse effects
Drug interactions
Corticosteroids. The concurrent use of amphotericin B and corticosteroids (e.g., prednisone) may enhance the loss of potassium. ...
Nephrotoxic potential. Combining amphotericin B with other nephrotoxic agents such as aminoglycosides, diuretics, or cisplatin s...
Digoxin. Because amphotericin B may induce hypokalemia, use cautiously in patients receiving digoxin. Hypokalemia may induce dig...
Diuretics. Thiazide and loop diuretics may induce hypokalemia. Monitor patients receiving amphotericin B and diuretic therapy ve...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Fluconazole
Premedication assessment
Availability. PO: 50-, 100-, 150-, and 200-mg tablets; 10 and 40 mg/mL suspension in 35-mL bottle. IV: 200- and 400-mg vials
Dosage and administration. PO: 100 to 400 mg daily; dosage must be individualized to type of infection being treated. IV: same a...
Common adverse effects
Serious adverse effects
Drug interactions
Cimetidine. Cimetidine inhibits the absorption of fluconazole. Concurrent use is not recommended
Diuretics. Diuretics inhibit the excretion of fluconazole. Monitor patients for an increase in frequency of adverse effects. The...
Toxicity induced by fluconazole. Fluconazole can increase serum concentrations of alfentanil, benzodiazepines, buspirone, cyclos...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Griseofulvin
Premedication assessment
Availability. PO: Microsize: 500-mg tablets; 125-mg/5-mL oral suspension in 120-mL bottle. Ultramicrosize: 125- and 250-mg table...
Dosage and administration. Adult: PO: Microsize: depending on the specific organism and the location of the infection, 500 mg to...
Common adverse effects
Serious adverse effects
Photosensitivity. The patient should be cautioned to avoid exposure to sunlight and ultraviolet light. Suggest wearing long-slee...
Dizziness. Provide for patient safety during episodes of dizziness; report to the healthcare provider for further evaluation
Hematologic. Routine laboratory studies (e.g., RBC, white blood cell, and differential counts) are scheduled for patients taking...
Drug interactions
Warfarin. Griseofulvin may diminish the anticoagulant effects of warfarin. Monitor the INR and increase the dosage of warfarin i...
Phenobarbital. The absorption of griseofulvin is impaired when combined with phenobarbital. If concurrent therapy cannot be avoi...
Oral contraceptives. Griseofulvin may cause amenorrhea, increased breakthrough bleeding, and possibly decreased contraceptive ef...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Itraconazole
Premedication assessment
Availability. PO: 65, 100-mg capsules; 200-mg tablets; 10 mg/mL oral solution in 150-mL containers
Dosage and administration. Adult: PO: 100 to 400 mg daily. Dosages of more than 200 mg should be given in two divided doses. Ins...
Common adverse effects
Serious adverse effects
Drug interactions
Histamine-2 antagonists, antacids, protease inhibitors. H2 antagonists (e.g., cimetidine, famotidine, ranitidine, nizatidine), a...
Carbamazepine, phenytoin, rifampin. Concurrent administration of itraconazole and these agents has resulted in a significant dec...
Toxicity induced by itraconazole. Itraconazole can increase serum concentrations of alfentanil, benzodiazepines (e.g., triazolam...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Terbinafine
Premedication assessment
Availability. PO: 250-mg tablets
Dosage and administration. Adult: PO: 250 mg daily for 6 weeks to treat fungal infections of the fingernail and 12 weeks for tre...
Serious adverse effects
Drug interactions
Selective serotonin reuptake inhibitors and tricyclic anti
Cyclosporine. Terbinafine can decrease serum concentrations of cyclosporine. Monitor patients for signs of transplant rejection....
Caffeine. Terbinafine can increase serum concentrations of caffeine. Monitor patients for excitability, agitation, irritability,...
Dextromethorphan. Terbinafine can increase serum concentrations of dextromethorphan. Monitor patients for dizziness, drowsiness,...
Rifampin. Rifampin reduces serum levels of terbinafine. Use of another antifungal agent whose metabolism is not induced by rifam...
Cimetidine. Cimetidine may inhibit the metabolism of terbinafine, increasing the potential for toxicity from terbinafine. Switch...
DRUG CLASS: ANTIVIRAL AGENTS
Actions
Uses
Therapeutic Outcome
Nursing Implications for Acyclovir
Premedication assessment
Availability. Topical: 5% ointment and cream. PO: 200-mg capsules; 400- and 800-mg tablets; 200-mg/5-mL suspension. IV: 50 mg/mL...
Dosage and administration. Adult: Topical: Apply to each lesion every 3 hours, six times daily for 7 days. A finger cot or rubbe...
Serious adverse effects
Rash, hives. Assess, describe, and chart the location and extent of these presenting symptoms. Report to the healthcare provider...
Diaphoresis. Diaphoresis can be serious if the patient is not well hydrated. Assess hydration state, monitor electrolytes, and p...
Drug interactions
Probenecid. Probenecid may reduce urinary excretion of acyclovir. Monitor closely for signs of toxicity from acyclovir
Theophylline. Acyclovir may increase theophylline levels. Monitor theophylline serum levels
Phenytoin, fosphenytoin, valproic acid. Acyclovir may decrease phenytoin, fosphenytoin, and valproic acid levels. Monitor serum ...
Zidovudine. Patients may complain of severe drowsiness and lethargy when acyclovir and zidovudine are used concurrently. Observe...
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Baloxavir
Premedication assessment
Availability. PO: 20-, 40-, 80 mg tablets
Dosage and administration. Adult: PO: Dosage by weight: 80 kg or more: 80 mg as a single dose; 40 to less than 80 kg: 40 mg as a...
Common adverse effects
Drug interactions
Drugs that may decrease the therapeutic outcome. Coadministration with antacids, calcium, iron, magnesium, and zinc may decrease...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Famciclovir
Premedication assessment
Availability. PO: 125-, 250-, and 500-mg tablets
Dosage and administration. Adult: PO: Treatment of genital herpes: Recurrent episodes: 1000 mg twice daily for 1 day. Therapy sh...
Common adverse effects
Serious adverse effects
Drug interactions
Probenecid. Probenecid may reduce urinary excretion of famciclovir. Monitor closely for signs of toxicity from famciclovir
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Oseltamivir
Premedication assessment
Availability. PO: 30-, 45-, and 75-mg capsules; 6 mg/mL oral suspension in 60-mL container
Dosage and administration. Adult: PO: 75 mg twice daily for 5 days. Treatment should begin within 2 days after the onset of symp...
Common adverse effects
Serious adverse effects
Neuropsychiatric events. Oseltamivir may cause rare neuropsychiatric events (including confusion, delirium, hallucinations, and ...
Drug interactions. Oseltamivir may diminish the therapeutic effect of live attenuated influenza virus vaccine. Avoid antiinfluen...
Actions
Uses
Therapeutic Outcome
Nursing Implications for Valacyclovir
Premedication assessment
Availability. PO: 500-mg and 1-g tablets
Dosage and administration. Adult: PO: Treatment of herpes zoster (shingles): 1 g three times daily for 7 days. To be effective, ...
Serious adverse effects and drug interactions. See earlier section on acyclovir
Actions
Uses
Therapeutic Outcomes
Nursing Implications for Zanamivir
Premedication assessment
Availability. Inhaler: 5-mg blisters of powder for inhalation through a Diskhaler
Dosage and administration. Adult: Inhalation: Two inhalations (one 5-mg blister per inhalation for a total of 10 mg) twice daily...
Serious adverse effects
Drug interactions. Zanamivir may diminish the therapeutic effect of live attenuated influenza virus vaccine. Avoid antiinfluenza...
X - Drugs Affecting the General Health of the Body
46 - Nutrition
Principles of Nutrition
Methods for Assessing Nutrition
Governmental Guidelines
Alternatives to Governmental Guidelines
Counting Calories
Dietary Reference Intakes
Macronutrients
Vitamins
Minerals
Water
Physical Activity
Malnutrition
Therapy For Malnutrition
Nursing Implications For Nutritional Support
Assessment
History of nutritional deficit.Review the patient’s history to identify the rationale for use of nutritional support (e.g., prot...
Nutritional history
Physical changes related to a malnourished state
Implementation
Monitoring tube feedings
Monitoring peripheral parenteral nutrition
Monitoring central parenteral nutrition
Patient Education
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters. See t...
Enteral Nutrition
Uses
Therapeutic Outcomes
Nursing Implications for Enteral Nutrition
Premedication assessment
Availability.See Table 46. 4
Dosage and administration.Tube feedings, especially those that have an osmolality of 300 mOsm/L water or higher, need to be star...
Administration of medicines to the tube-fed patient
Common adverse effects
Serious adverse effects
Drug interactions.Food can affect medicines by altering absorption, metabolism, and excretion; conversely, medicines can affect ...
Alcohol and disulfiram, metronidazole, and tinidazole.Alcohol interacts with these three medicines, causing nausea, vomiting, ab...
Tetracycline, doxycycline, ciprofloxacin, levofloxacin.The patient should avoid taking these antibiotics within 2 hours before o...
Itraconazole (capsules), ganciclovir, ritonavir.These medicines should be taken with food to increase absorption and therapeutic...
Itraconazole solution.Take at least 1 hour before or 2 hours after meals. Take on an empty stomach to increase absorption and th...
Alendronate, risedronate, ibandronate.Alendronate should be taken at least 30 minutes before the first food, beverage, or medica...
Monoamine oxidase inhibitors (tranylcypromine, phenelzine, isocarboxazid).A major potential complication with monoamine oxidase ...
Warfarin.Patients receiving warfarin should avoid extreme changes in diet and daily consumption of large amounts of dark green v...
Grapefruit juice.Fresh or frozen grapefruit juice inhibits the metabolism of several drugs. The severity of the interaction vari...
Carbamazepine.Monitor for signs of toxicity such as dizziness, drowsiness, sedation, nausea, vomiting, blurred vision, and hepat...
Antidepressant and antianxiety medicines.Serum concentrations of buspirone, diazepam, triazolam, nefazodone, and trazodone may b...
Cyclosporine. Monitor for signs of toxicity such as nephrotoxicity, hepatotoxicity, and increased immunosuppression
Caffeine. Monitor for signs of toxicity such as nervousness and overstimulation
Parenteral Nutrition
Uses
Therapeutic Outcomes
Nursing Implications for Parenteral Nutrition
Premedication assessment
Availability
Dosage and administration.Do not use TPN IV lines or central venous catheters for delivery of any other medications or solutions...
Common adverse effects
Serious adverse effects
Fluid imbalance.Overhydration may be recognized by weight gain, neck vein distention, change in mental status, edema, dyspnea, c...
Electrolyte imbalances.Check for indications of electrolyte imbalance (e.g., mental status [alertness, orientation, confusion], ...
Vitamin deficiencies. Deficiencies of fat-soluble vitamins
Drug interactions.No other drugs should be administered concurrently with TPN. Consult a pharmacist for parenteral nutrition sol...
47 - Herbal and Dietary Supplement Therapy
Independent Product Testing
Assessment
History of symptoms.Examine data to determine the individual’s understanding of the symptoms or the disease process for which th...
Medication history
Cultural beliefs.If cultural issues are involved in the use of the supplement products, research the belief system and ways that...
Implementation
Patient Education
Expectations of therapy.Discuss the expectations of therapy with the patient and why self-treatment needs to be discussed with o...
Fostering health maintenance
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters (e.g.,...
Herbal Therapy
Actions
Uses
Nursing Implications for Aloe
Availability.Aloe gel: Moisturizing lotion, shampoo, hair conditioner, gels, toothpaste, aloe juice for topical application. Cap...
Adverse effects.When applied to the skin, no adverse effects have been reported. When taken orally, aloe products may cause diar...
Drug interactions
Diabetic therapy.Monitor blood glucose levels closely because of claims that, when taken orally, aloe may have hypoglycemic effe...
Actions
Uses
Nursing Implications for Black Cohosh
Availability. PO: Elixirs, tablets, capsules
Adverse effect. Upset stomach is rare
Comments.Do not confuse black cohosh with blue cohosh. Blue cohosh is used as an antispasmodic and uterine stimulant to promote ...
Actions
Uses
Nursing Implications for Chamomile
Availability, dosage, and administration.German chamomile is available as ointment and gel in strengths of 3% to 10%. As a bath ...
Adverse effects.Rare hypersensitivity reactions may occur in patients who are allergic to ragweed, asters, chrysanthemums, or da...
Drug interactions. No clinically significant drug interactions have been reported with chamomile
Actions
Uses
Nursing Implications for Echinacea
Availability. PO: Echinacea is available as dried roots, teas, tinctures, and dry powder extracts
Adverse effects.Rare hypersensitivity reactions may occur in patients who are allergic to ragweed, asters, chrysanthemums, or da...
Comments.Because echinacea appears to be an immuno
Actions
Uses
Nursing Implications for Feverfew
Availability. PO: Leaf powder for making tea; tablets
Adverse effects.Fresh feverfew leaves appear to be most effective in reducing the frequency and pain associated with migraine he...
Comments
Actions
Uses
Nursing Implications for Garlic
Availability. PO: Cloves, oil, enteric-coated tablets, capsules, elixirs
Adverse effects.The most common adverse effect of garlic is its characteristic taste and odor, often resulting in halitosis. Ent...
Comments.Fresh garlic is the most potent from a biologic standpoint, releasing the active ingredients in the mouth when chewed. ...
Actions
Uses
Nursing Implications for Ginger
Availability and dosage.PO: Powdered ginger root; ginger tea made from ginger root; tinctures. The dosages are quite variable, b...
Adverse effects.Generally, ginger is well tolerated. There have been reports of heartburn, diarrhea, and irritation to the mouth...
Comments.Ginger is generally recognized as safe when used in food preparation. The dosages used for nausea, vomiting, and analge...
Actions
Uses
Nursing Implications for Ginkgo
Availability and dosage.PO: 40 mg GBE in liquid, tablets, and capsules. Dosages range from 120 to 240 mg of GBE twice daily
Adverse effects.Large doses of GBE may cause mild restlessness, diarrhea, nausea, vomiting, and dizziness. Adverse effects may b...
Actions
Uses
Nursing Implications for Ginseng
Availability.PO: Teas, powders, capsules, tablets, liquids. There are no standardized methods of purity. Commercial ginseng extr...
Adverse effects.Many adverse effects have been reported with the use of ginseng, but most are single case reports and may be the...
Comments.Even though thousands of articles have been written lauding its praises, ginseng has not undergone much scientific stud...
Actions
Uses
Nursing Implications for Goldenseal
Availability. PO: Powder for tea, tincture, fluid extract, freeze-dried root
Adverse effects.The alkaloids in goldenseal are not absorbed to any extent when swallowed, producing no systemic effects. High d...
Comments.One of the more recent popular uses for goldenseal is to mask the presence of illicit drugs in urine samples. Contrary ...
Actions
Uses
Nursing Implications for Green Tea
Availability and dosage.PO: Green tea is readily available in premade tea bags and in bulk form for brewing. Moderate consumptio...
Adverse effects.Many of the adverse effects of green tea are an extension of the pharmacologic effects of caffeine: anxiety, ner...
Actions
Uses
Nursing Implications for St. John’s Wort
Availability and dosage.St. John’s wort is available as powder, tablets, capsules, and liquid. It is also found in semisolid pre...
Adverse effects.St. John’s wort may cause photo
Comments
Actions
Uses
Nursing Implications for Valerian
Availability.PO: Valerian may be administered in the form of a tea, tincture, extract, tablets, or capsules. Some preparations a...
Adverse effects. Adverse effects are rare; chronic users may experience excitability, uneasiness, and headache
Comments.Because of similarity in names, valerian and Valium have sometimes been confused. Valerian is a mild tranquilizer, wher...
Drug interactions.No clinically significant drug interactions have been reported, but concurrent use of other medicines with sed...
Other Supplements
Description and Actions
Uses
Nursing Implications for CBD
Availability. PO: Drops, capsules, gummies, sublingual spray; inhalation; topical creams and lotions
Dosage and administration.Social anxiety disorder: PO: Single doses of cannabidiol 300 to 600 mg have been used for anxiety rela...
Adverse effects
Gastrointestinal.CBD may cause dry mouth, diarrhea, decreased appetite, and weight loss. Monitor weight and frequency and consis...
Cardiovascular.CBD may cause hypotension and orthostatic hypotension. Monitor blood pressure
CNS.CBD may cause somnolence with a significantly higher incidence when used in conjunction with other CNS depressants (e.g., al...
Severe adverse effects
Hepatotoxicity. CBD may cause elevated liver enzymes
Description and Actions
Uses
Nursing Implications for CoQ10
Availability. PO: Powder-filled capsules, tablets, liquid-filled gel capsules, chewable wafers, intraoral spray
Dosage and administration.Usual dosage is 10 to 300 mg/day in one dose or in divided doses up to three times per day. Up to 3000...
Adverse effects.No serious adverse effects have been reported. Less than 1% of patients describe symptoms of nausea, upset stoma...
Description and Actions
Uses
Nursing Implications for Creatine
Availability.PO: Powder, candy, gum, and liquid. It is often combined with other supplements for energy
Dosage.Dosage regimens in clinical trials vary from 2 to 20 g daily and from 1 week up to 4 years. Skeletal muscle enhancement r...
Adverse effects.No serious adverse effects have been reported, but long-term studies that might document adverse effects have no...
Comments
Description and Actions
Uses
Nursing Implications for GHB
Availability.GHB is available as a prescription product (sodium oxybate [Xyrem]) for treating a small population of patients wit...
Adverse effects.Adverse effects related to GHB ingestion are highly variable among individuals, possibly relating to contaminati...
Description and Actions
Uses
Nursing Implications for Lycopene
Availability.Research indicates that lycopene in tomatoes can be absorbed more efficiently by the body if processed into tomato ...
Dosage.Optimal dosages of lycopene have not been established. Analysis of major studies indicates that 5 to 10 servings per week...
Adverse effects. No serious adverse effects have been reported
Description and Actions
Uses
Nursing Implications for Melatonin
Availability. PO
Dosage. PO: Insomnia: Melatonin 3 to 5 mg given orally 3 to 4 hours before an imposed sleep period over 4 weeks
Comments.The safety of melatonin in children and during pregnancy and lactation has not been established, and its use is not rec...
Adverse effects
Description and Actions
Uses
Nursing Implications for Policosanol
Availability. PO: 10- and 20 mg tablets
Dosage.The dosage is 5 to 10 mg twice daily of a product containing at least 60% octacosanol. Two months of therapy may be requi...
Adverse effects.No serious adverse effects have been reported. Only mild adverse effects such as nervousness, headache, diarrhea...
Drug interactions
Aspirin, warfarin, heparin, clopidogrel.The blood-thinning properties of policosanol may enhance the anti
Garlic, ginkgo, high-dose vitamin E.The blood-thinning properties of policosanol may enhance the blood-thinning effects of these...
Description and Actions
Uses.Omega-3 fatty acids are used for reduction of risk of death from myocardial infarction or heart failure. They are also used...
Nursing Implications for Omega-3 Fatty Acids
Availability.Omega-3 fatty acid content is highly variable in OTC supplements, ranging from 300 to 2700 mg of EPA-DHA per teaspo...
Dosage.The American Heart Association recommends a daily intake of omega-3 fatty acids (Table 47. 1)
Adverse effects.Dyspepsia and eructation (burping or belching) with a fishy aftertaste are the most common problems reported. Th...
Drug interactions
Aspirin, warfarin, heparin, clopidogrel.The blood-thinning properties of omega-3 fatty acids may enhance the anti
Comments.Factors to consider in product selection are purity, strength, calories, cholesterol count, and other ingredients, such...
Description and Actions
Uses
Nursing Implications for S-Adenosylmethionine
Availability.A variety of tablet and capsule dosage forms are available, but the enteric forms that dissolve in the intestines (...
Dosage.PO: 400 mg three or four times daily is recommended. Patients should start with lower dosages and gradually increase to a...
Comments
Adverse effects.No serious adverse effects have been reported. Mild stomach distress has been reported at starting doses of 400 ...
48 - Substance Abuse
Substance Use Disorders
Signs of Impairment
Legal Considerations of Substance Abuse and Dependence
Educating Healthcare Professionals about Substance Abuse
Alcohol
Intoxication
Withdrawal
Treatment
Relapse Prevention
cannabis
Intoxication
Withdrawal
Treatment
Opioids
Intoxication
Withdrawal
Treatment
Relapse Prevention
Amphetamine-Type Stimulants
Intoxication
Withdrawal
Treatment
Cocaine
Intoxication
Withdrawal
Treatment
Assessment
History of the event, accident, or behavior.For the person who appears to be intoxicated, ask simple, direct questions about whe...
Vital signs.Persistent abnormal vital signs during routine testing should raise suspicion of substance abuse. Vital signs should...
Basic mental status.Be alert for fluctuating levels of consciousness; lack of awareness or attention; paranoid thoughts; visual,...
Appearance. Describe the individual’s gait, coordination, and physical appearance
Neurologic assessment.Determine the Glasgow Coma Scale score if appropriate (Table 48. 4)
Heart assessment.Heart palpitations and irregularity may occur during withdrawal. Cocaine is associated with causing cardiotoxic...
Eyes.Check pupil size, equality, light reaction, and accommodation. Note ptosis, nystagmus, or other abnormal eye movements. Abn...
Ears, oral cavity, nose, and throat.The range of symptoms associated with substance abuse is extensive in these tissues. Ringing...
Skin assessment.Check skin color; jaundice may indicate hepatitis, which is common in people who misuse drugs and share needles ...
Musculoskeletal assessment.Alcohol depletes calcium from the bones, making them more susceptible to fractures. Osteoporosis also...
Medication history.Ask specific questions relating to the use of prescription, OTC, and street or illicit drugs. Does the indivi...
Coexisting diseases and disorders.Is the individual currently under treatment for other diseases Is there a history of any cardi...
Sexually transmitted infections.The individual will need examination and testing for the entire scope of sexually transmitted in...
Pregnancy.Ask female patients if they are pregnant. Use of drugs and alcohol while pregnant has a strong likelihood of harming n...
Laboratory tests.Urine and/or blood toxicology screening; complete blood cell count; electrolyte studies; renal and liver functi...
Emergency treatment.The nurse should be aware of the policy for calling codes, location of the emergency cart, and procedures us...
Safety.Provide for patient safety during and following detoxification until the individual is able to assume self-responsibility...
Goal setting for the patient.Establish goals and outcomes for the immediate needs of an individual who has had an injury or has ...
Family and support involvement.Integrate family and others within the patient’s support network into the interdisciplinary team ...
Implementation
Patient Education
Nutritional status
Stress management.Identify stress-producing situations in the patient’s life and seek means to reduce these factors significantl...
Fostering health maintenance.Seek the patient’s co
Patient self-assessment.Enlist the patient’s help in developing and maintaining a written record of monitoring parameters for co...
Drugs Used To Treat Alcoholism
Actions
Uses
Therapeutic Outcome
Nursing Implications for Acamprosate
Premedication assessment
Availability. PO: 333-mg delayed-release tablets
Dosage and administration.Adult: PO: Two 333-mg tablets (666 mg) three times daily. Tablets may be taken without regard to meals...
Behavior modification.Acamprosate therapy in combination with behavior therapy has been shown to be more effective than acampros...
Common adverse effects
Serious adverse effects
Drug interactions. No clinically significant drug interactions have been reported
Actions
Uses
Therapeutic Outcome
Nursing Implications for Disulfiram
Premedication assessment
Availability. PO: 250- and 500-mg tablets
Dosage and administration.Adult: PO: Initially a maximum of 500 mg once daily for 1 to 2 weeks. The maintenance dosage is usuall...
Behavior modification.Disulfiram therapy, in combination with behavior therapy, has been shown to be more effective than disulfi...
Common adverse effects.These adverse effects are usually mild and tend to resolve with continued therapy. Encourage the patient ...
Neurologic. Drowsiness, fatigue, headache
Reproductive. Impotence
Gastrointestinal. Metallic taste
Serious adverse effects
Drug interactions
Warfarin.Disulfiram may enhance the anti
Phenytoin.Disulfiram inhibits the metabolism of phenytoin. Monitor patients with concurrent use for signs of phenytoin toxicity ...
Isoniazid.Disulfiram alters the metabolism of isoniazid. Perform a baseline assessment of the patient’s degree of alertness (e.g...
Metronidazole.Concurrent administration of disulfiram and metronidazole may result in psychotic episodes and confusional states....
Benzodiazepines.Disulfiram inhibits the metabolism of specific benzodiazepines (e.g., chlordiazepoxide, diazepam, clorazepate, f...
Caffeine.The cardiovascular and CNS stimulant effects of caffeine may be increased by disulfiram. If tachycardia or nervousness ...
A - Nomogram for Calculating the Body Surface Area of Adults, Children, and Infants
B - Template for Developing a Written Record for Patients to Monitor Their Own Therapy
Bibliography
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
IBC