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Pharmacological and Parenteral Therapies 3

  1. Antituberculosis agents

        1. action: appears to inhibit RNA synthesis, so stops tubercle bacilli from multiplying (first line) or functioning (second line)

        2. examples

          1. first line

            • ethambutol (Myambutol) decreases mycobacterial RNA synthesis

            • isoniazid (INH) - suppresses mycobacterial cell-wall synthesis

          2. second line

            • capreomycin (Capastat)

            • pyrazinamide (PZA)

        3. adverse effects

          1. gastric irritation

          2. CNS disturbances

          3. liver disturbances

          4. blood dyscrasias

          5. streptomycin - ototoxicity

          6. ethambutol - visual disturbances

          7. isoniazid - suppressed absorption of fat and vitamin B complex

        4. contraindications

          1. severe renal disease

          2. hypersensitivity

        5. nursing interventions

          1. monitor client response to therapy

          2. monitor blood work during therapy

          3. if CNS disturbances are evident, take safety precautions

          4. teach client

            • to take medication as ordered

            • to eat foods rich in B-complex vitamins

            • avoid use of alcohol

            • report if become pregnant

            • ethambutol: report eye problems, have regular eye exams

      1. Antihistamines

        1. action: blocks histamine at receptor sites

        2. examples

          1. promethazine HCL (Phenergan)

          2. chlorpheniramine maleate (Chlor-Trimeton)

          3. diphenhydramine (Benedryl)

        3. uses

          1. relieves symptoms of allergies, colds, pruritus

          2. prevents problems in blood transfusion and drug reactions

        4. adverse effects

          1. drowsiness

          2. gastric effects

          3. dry mouth

          4. headache

          5. thickening of bronchial secretions

        5. contraindications

          1. acute asthma

          2. lower respiratory heart disease

          3. narrow angle glaucoma

        6. nursing interventions

          1. discontinue four days before skin testing for allergies

          2. avoid interaction with CNS depressants

          3. teach client

            • avoid driving and hazardous activities

            • take antihistamines with food

            • additive effect with alcohol, other CNS depressants

      1. Anti-inflammatories

        1. action: stabilizes mast cells so chemical mediators are not released as easily; decreases bronchial hyperreactivity; decreases airway inflammation

        2. example:

          1. cromolyn sodium (Intal)

          2. leukotriene receptor antagonists-zafirlukast (Accolate), montelukast (Singular)

          3. glucocorticoids- beclamethasone (Vanceril), triamcinolone (Azmacort)

        3. use: to prevent asthma attacks, exercise-induced bronchospasms

        4. adverse effects

          1. cough

          2. CNS disturbances

          3. burning, stinging eyes

          4. throat irritation

          5. headache

        5. contraindications

          1. status asthmaticus

          2. hypersensitivity

        6. nursing interventions

          1. monitor eosinophil count

          2. monitor respiratory status

          3. store in tightly closed light-resistant container; keep cool

          4. teach client

            • how to use the inhaler

            • rinse mouth after using steroid inhaler

            • when to call health care provider if medications are not effective

            • that therapeutic effect may take up to four weeks

    1. Neurological (including anesthetics)


 

 

  1. Anticonvulsives

  1. Antiparkinson Agents

  1. Cholinesterase Inhibitors

  1. Antidepressants

  1. Antimanic Agents

  1. Antipsychotic

  1. Hypnotics

  1. Antianxiety (Anxiolytic)

  1. General Anesthetics

  1. Local Anesthetics

      1. Anticonvulsants

        1. action - modifies bioelectric activity at subcortical and cortical areas

        2. examples

          1. diazepam (Valium)

          2. magnesium sulfate

          3. phenytoin (Dilantin)

          4. phenobarbital (Luminal)

        3. use: prevents seizures

        4. adverse effects

          1. blood dyscrasias

          2. gastric effects - nausea, vomiting

          3. CNS depression - dizziness, drowsiness

          4. phenytoin: ataxia, hirsutism, hypotension

        5. contraindications

          1. hypersensitivity

        6. nursing interventions

          1. give medication with food

          2. wiith phenytoin: monitor condition of oral mucosa, don't mix with other IV fluids, monitor blood lab results, monitor urine

          3. renal, liver, and blood studies

          4. teach clients

            • avoid alcohol

            • notify physician of unusual symptoms

            • carry medical alert information

            • take medication on schedule; do not discontinue

            • avoid driving and other potentially hazardous activities

            • phenytoin: good oral hygiene, frequent dental visits

    1. Antiparkinson agents

      1. action

        1. anticholinergics: block or compete at central acetylcholine receptors

        2. dopamine agonists: activation of dopamine receptors

 

          1. reinforce client education

            • do not stop taking antiparkinsonian meds suddenly: may precipitate parkinsonian crisis

            • continue medical supervision

            • avoid alcohol while on therapy

            • take with meals

            • caution with hazardous activities

            • to change position slowly to prevent orthostatic hypotension

            • levodopa

              • minimize Vitamin B6 in diet, because it hinders drug's effectiveness

              • do not take OTC medications without health care provider's approval

              • sweat and urine may be dark colored

              • toxicity: personality changes, increased twitching, grimacing, tongue protrusion

      1. Cholinesterase inhibitors

        1. action

          1. prevents breakdown of acetylcholine at nerve endings

          2. facilitates transmission of impulses across myoneural junction

          3. strengthens muscle contractions including respiratory muscles

        2. examples

          1. edrophonium chloride (Tensilon) for diagnostic purposes

          2. neostigmine bromide (Prostigmin)

          3. ambenonium chloride (Mytelase)

        3. use: treat myasthenia gravis

        4. adverse effects

          1. gastric irritation: nausea, vomiting, diarrhea

          2. hypersalivation

          3. CNS disturbances

          4. orthostatic hypotension

          5. toxicity: pulmonary edema, respiratory failure, bronchospasm

        5. contraindications

          1. intestinal obstruction, renal obstruction

          2. peritonitis

        6. nursing interventions

          1. monitor client response to medication; may need to adjust dosage

          2. monitor vital signs during period of dosage adjustment

          3. keep atropine sulfate available for overdosage

          4. administer medication with food

          5. administer medication as per schedule

          6. teach client

            • wear medic alert jewelry and ID

            • change position cautiously; sit at first feeling of faintness.

      1. Antidepressants

        1. action: increase norephinephrine at subcortical neuroeffector sites

        2. examples

          1. norepinephrine blockers (tricyclic, TCAs): amitriptyline (Elavil), imipramine (Tofranil)

          2. monoamine oxidase inhibitors (MAOIs): isocarboxazid (Marplan), phenelzine sulfate (Nardil)

          3. selective serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft)

        3. use: treat melancholia, depression

        4. adverse effects

          1. norepinephrine blockers

            • potentiate anticholinergics and CNS depressants

            • orthostatic hypotension

            • drowsiness, dizziness, confusion

            • CNS stimulation

          2. MAOIs

            • potentiate alcohol, barbiturates, antihistamines

            • hypertensive crisis with ingestion of foods high in tyramine (pickled herring, beer, wine, cheese, chocolate)

            • orthostatic hypotension

          3. selective serotonin reuptake inhibitors

            • may interact with tryptophan

            • insomnia

            • headache

            • sexual dysfunction

            • gastric irritation

        5. contraindications

          1. acute schizophrenia

          2. mixed mania and depression

          3. suicidal tendencies

          4. narrow angle glaucoma

        6. nursing interventions

          1. monitor effect of medication

          2. maintain suicide precautions especially as depression lifts

          3. give SSRIs in morning; TCAs at bedtime

          4. teach client

            • do not take OTC medication without physician approval

            • avoid hazardous activities

            • effect of medication may take up to four weeks

            • MAOIs: teach client to avoid food containing tyramine; monitor client for hypertensive crisis

            • SSRIs and MAOIs should not be given concurrently or close together

      1. Antimanic agents

        1. action: reduces adrenergic neurotransmitter levels in cerebral tissue

        2. examples

          1. antimanic agents: lithium carbonate (Lithane)

          2. alternative antimanic agents: carbamazepine (Tegretol), clonazepam (Klonopin)

        3. use: control of manic phase of mood disorders; bipolar disorder

        4. adverse effects

          1. metallic taste

          2. hand tremors

          3. excess voiding and extreme thirst

          4. slurred speech

          5. disorientation

          6. cogwheel rigidity

          7. renal failure

          8. respiratory depression

        5. nursing interventions

          1. monitor blood levels

          2. avoid concurrent administration of adrenergic drugs

          3. evaluate client's response to medication

          4. teach client

            • effect of medication may take several weeks

            • high intake of fluids and normal sodium

            • toxicity signs: diarrhea, vomiting, weak muscles, confusion etc.

            • take medication with meals

      1. Antipsychotics

        1. action blocks dopamine hydrochloride receptors in the CNS and sympathetic nervous system

        2. examples

          1. phenothiazines: chlorpromazine (Thorazine), thioridazine (Mellaril)

          2. benzisoxazole: risperidone (Risperdal)

          3. thioxanthenes: chlorprothixene (Taractan)

          4. butyrophenones: haloperidol (Haldol)

        3. use: treatment of psychotic symptoms in schizophrenia, psychosis, Tourette's syndrome, bipolar disorder

        4. adverse effects

          1. excessive sedation

          2. jaundice

          3. orthostatic hypotension

          4. urinary retention

          5. anorexia

          6. dry mouth

          7. hypersensitivity reactions (such as photoallergic reaction, impotence, cardiac toxicity)

          8. blood dyscrasias - agranulocytosis

          9. extrapyramidal side effects: dystonia, pseudoparkinsonism, akathisia, akinesia, tardive dyskinesia

          10. neuroleptic malignant syndrome: fever, muscle rigidity, agitation, confusion, deliruim, respiratory failure

        5. nursing interventions

          1. assess client's response to therapy

          2. monitor for signs of infection, liver toxicity, extrapyramidal symptoms

          3. monitor blood work if long-term therapy

          4. monitor vital signs

          5. give medication at bedtime

          6. teach client

            • avoid alcohol use

            • avoid driving or other hazardous activities

            • avoid exposure to direct sunlight

            • good oral hygiene

            • report extrapyramidal symptoms or signs of infection to physician

            • drink plenty of water
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