|
Pharmacological and Parenteral Therapies 5
- Antacids
-
-
action
-
neutralizes gastric acid
-
coats stomach lining
-
examples
-
aluminum hydroxide gel (Amphojel)
-
aluminum and magnesium hydroxides (Maalox)
-
magaldrate (Riopan)
-
use: peptic ulcers, reflux esophagitis, hiatal hernia
-
adverse reactions
-
aluminum compounds - constipation, intestinal obstruction
-
magnesium compounds - diarrhea
-
reduced absorption of calcium and iron
-
nursing interventions
-
shake oral suspension well
-
monitor client's response to treatment
-
administer with 8 oz glass of water
-
teach client
-
avoid overuse of antacids
-
dietary restrictions for ulcers
-
need for diet high in calcium and iron
-
for clients on low sodium diets: antacids contain sodium
-
may color stools whitish
-
Antiulcers
-
actions
-
decrease acetylcholine release
-
block release of histamines
-
inhibit secretion of pepsin
-
inhibit proton pump
-
examples
-
anticholinergics; belladonna tincture, chlorodiazepoxide (Librax)
-
h2 blockers - cimetidine (Tagamat), ranitidine (Zantac)
-
pepsin inhibitor - sucralfate (Carafate)
-
proton pump inhibitor - lansoprazole (Prevacid), omeprazole (Prilosec)
-
uses: management of peptic ulcer disease, gastroesophageal reflux disease(GERD), protects gastric mucosa from hydrochloric acid production
-
adverse reactions
-
dry mouth, decreased secretions, constipation, tachycardia, & urinary retention
-
headaches, dizziness, constipation, skin reash, pruritis, impotence
-
sucralfate is nonasborable, occasional constipatoin
-
contraindications
-
anticholinergics - narrow- angle glaucoma
-
renal failure
-
liver disease
-
nursing interventions
-
administer on empty stomach
-
avoid antacids within 30 minutes of sucralfate
-
avoid antacids within one to two hours of other antiulcer drugs
-
administer other drugs one to two hours after sucralfate
-
teach clients
-
avoid alcohol, spicy food, and caffeinated beverages
-
eliminate smoking
-
increase fluid intake
-
medication can take up to two weeks for full effect
-
report increasing abdominal pain, vomiting of blood, or passage of bloody stools
-
Anti-diarrheal
-
action: forms the stool; mechanism depends on type of medication
-
examples
-
fluid absorbents - decrease fluid content; kaolin and pectin (Kaopectate)
-
motility suppressants - decrease motility of GI tract; diphenoxylate HCL (Lomotil), loperamide HCL (Imodium)
-
enteric bacterium - replacements help intestine turn carbohydrates into lactic acid; lactobacillus acidophilus (Bacid)
-
use: treat diarrhea
-
adverse reactions
-
fluid absorbents: gastric disturbances, CNS toxicity
-
enteric bacterium replacements: excessive flatulence, abdominal cramps
-
motility suppressants: urinary retention, tachycardia, sedation, paralytic ileus, respiratory depression
-
contraindications:
-
ulcerative colitis
-
nursing interventions
-
monitor effect of medication
-
assess for fluid and electrolyte imbalance
-
assess for cause of diarrhea
-
motility suppressants may cause physical dependence, may impair ability to perform hazardous activities
-
Laxatives
-
action: moves stool; mechanism dependent on type of laxative
-
examples
-
lubricants moisten stool; mineral oil
-
stool softeners allow water to penetrate stool; dioctyl sodium sulfosuccinate (Colace)
-
bulk forming: increase bulk in intestine; psyllium hydrophilic mucilloid (Metamucil)
-
colon irritant stimulates peristalsis; bisacodyl (Dulcolax)
-
saline cathartics increase osmotic pressure thereby absorbing fluid from bowel wall; milk of magnesia
-
use: to treat constipation
-
adverse reactions
-
gastric effects: nausea, cramping, diarrhea
-
dependence with long-term use
-
intestinal lubricants inhibit absorption of fat-soluble vitamins
-
saline cathartics: dehydration, hypernatremia
-
contraindications:
-
GI obstruction
-
suspected appendicitis
-
megacolon
-
abdominal pain
-
nausea
-
nursing interventions
-
monitor effects of medication
-
teach client
-
dietary considerations (increased fiber and fluid intake)
-
maintain/increase activity level
-
caution regarding overuse of laxatives
-
mix bulk-forming laxatives with a glass of water and follow with another glass of water
-
Pancreatic enzymes
-
action: replacement for natural pancreatic enzymes
-
examples
-
pancreatin (Dizymes)
-
pancrelipase (Cotazym)
-
use: aid in digestion; cystic fibrosis
-
adverse reactions, with large doses
-
diarrhea
-
nausea
-
hypersensitivity reaction: sneezing, skin rashes
-
contraindications
-
hypersensitivity to pork
-
chronic pancreatic disease
-
nursing interventions
-
monitor for symptoms of diabetes mellitus (such as polyuria, thirst, hunger)
-
monitor weight, intake and output
-
administer with meals
-
do not crush enteric coated medications
-
determine client's response to therapy
-
Managing endocrine conditions
|
-
Antidiabetic agents |
-
Hypothyroid agents |
-
Hyperthyroid agents |
-
Anterior pituitary growth hormone |
-
Antidiuretic hormone |
-
Antidiabetic agents
-
action: provides insulin to promote transport of glucose; exact mechanism dependent on type of antidiabetic agent
-
examples
-
oral hypoglycemics stimulate pancreatic beta cells to produce insulin tolazamide (Tolinase), glipizide (Glucotrol), metformin (Glucophage), rosiglitazone (Avandia)
-
parenteral agents provide exogenous insulin
-
use: treat diabetes mellitus
-
adverse effects
-
hypoglycemia, irritability, confusion
-
convulsions, tachycardia, tremor
-
moist skin, headache, hunger
-
nausea, bloating, diarrhea
-
contraindications:
-
hypersensitivity
-
nursing interventions
-
assess client for effect of medication
-
monitor blood/urine glucose levels
-
guidelines for administration of insulin
-
rotate sites
-
administered subcutaneously
-
only regular insulin is administered IV
-
when mixing insulin, regular insulin is withdrawn into the syringe first
-
instruct client
-
how to administer the medication
-
compliance with dietary restrictions
-
urine and blood testing
-
wear medic alert jewelry
-
how to cope with hypoglycemic reactions
-
signs of ketoacidosis
-
importance of weight loss if obese
-
Hypothyroid agents
-
action: help regulate the metabolic rate of cells
-
examples
-
levothyroxine sodium (Synthroid)
-
thyroglobulin (Proloid)
-
thyroid (Thyrar)
-
use: replace thyroid hormones
-
adverse reactions
-
hyperactivity
-
cardiac stimulation
-
thyroid storm
-
contraindications
-
adrenal insufficiency
-
myocardial infarction
-
thyrotoxicosis
-
hypersensitivity to beef
-
nursing interventions
-
monitor client's response to medication
-
teach client
-
usually lifelong therapy
-
take medication same time each day
-
monitor pulse rate; report pulse rate over 100
-
report signs of toxicity (such as chest pain, palpitations, nervousness)
-
wear medic alert jewelry / ID
-
avoid OTC medications unless approved by health care provider
-
continue medical supervision
-
Hyperthyroid agents
-
action: blocks synthesis of thyroid hormone
-
examples
-
iodine (Lugol's solution)
-
methimazole (Tapazole)
-
propylthiouracil (PTL)
-
use: treat hyperthyroidism
-
adverse effects
-
agranulocytosis
-
skin disturbances
-
decreased metabolism
-
gastric disturbances
-
iodine: stains teeth, bitter taste
-
contraindications:
-
hypersensitivity
-
nursing interventions
-
administer iodine preparations through a straw
-
monitor effects of medication
-
instruct client
-
report side effects
-
avoid OTC drugs containing iodine
-
do not discontinue medication abruptly
-
carry medic alert jewelry
-
Anterior pituitary: growth hormone
-
action: stimulates the growth of practically all organs and tissues
-
examples
-
somatrem (Protropin)
-
somatropin (Humatrope)
-
use: treat dwarfism
-
adverse effects
-
hyperglycemia
-
hypothyroidism
-
antibodies to growth hormone
-
interaction with glucocorticoids
-
contraindications:
-
hypersensitivity to benzyl alcohol
-
closed epiphyses
-
intracranial lesions
-
nursing interventions
-
monitor diabetic client closely
-
instruct client
-
Antidiuretic hormone
-
action: helps distal renal tubules reabsorb water
-
examples
-
lypressin (Diapid)
-
vasopressin (Pitressin)
-
use: treatment of diabetes insipidus
-
adverse effects
-
gastric disturbances
-
hyponatremia
-
water intoxication
-
cardiac disturbances
-
nursing interventions
-
monitor response to therapy: intake and output, blood pressure
-
assess for dehydration
-
Managing genitourinary diseases
|
-
Diuretics |
-
Sulfonamides |
-
Immunosuppressants |
-
Anti-infectives |
-
Diuretics
-
action: interferes with sodium reabsorption
-
examples
-
loop diuretics interrupt the transport of sodium ions in Loop of Henle
-
bumetanide (Bumex)
-
furosemide (Lasix)
-
potassium sparers act on collecting tubules to promote sodium and water excretion
-
thiazides: inhibit reabsorption of Na+ and CL- in early distal tubule
-
osmotic: increase osmotic pressure of glomerular filtrate
-
use: treat hypertension, edema
-
adverse side effects
-
gastrointestinal irritation
-
electrolyte imbalance: hyponatremia, hypokalemia
-
orthostatic hypotension
-
dehydration
-
contraindications
-
electrolyte imbalances
-
dehydration
-
anuria
-
nursing interventions
-
monitor weight, intake and output, vital signs
-
give medication in morning
-
monitor client for fluid and electrolyte imbalance
-
teach client
-
Sulfonamides
-
action: substitutes a false metabolite for p-aminobenzoic acid, which is essential for the bacterial synthesis of folic acid
-
example
-
succinylsulfathiazole (Sulfasuxidine)
-
sulfisoxazole (Gantrisin)
-
sulfamethoxazole and trimethoprim (Bactrim, Septra)
-
use: urinary tract infections
-
adverse effects
-
gastric irritation: nausea and vomiting, stomatitis
-
rash
-
malaise
-
blood dyscrasias
-
crystalluria
-
photosensitivity
-
allergic response
-
contraindications
-
hypersensitivity
-
infants < two months-old
-
pregnancy at term
-
nursing interventions
-
check if client has a history of allergies
-
monitor client response to treatment
-
monitor vital signs and blood work
-
teach client
-
Immunosuppressants
-
action: inhibit immune responses
-
example: cyclosporine (Sandimmune)
-
use
-
prevent organ rejection in transplant patient
-
treat autoimmune disorders (such as rheumatoid arthritis, systemic lupus erythematosus)
-
adverse effects
-
nephrotoxicity (poisons kidneys)
-
infection
-
hypertension
-
tremor
-
hirsutism
-
contraindications
-
hypersensitivity
-
nursing interventions
-
Antinfective
-
action: interferes with several bacterial enzyme systems
-
example
-
nitrofurantoin (Furadantin)
-
methenamine (Hiprex)
-
use: treat pyelonephritis, pyelitis, cystitis
-
adverse effects
-
anorexia
-
nausea and vomiting
-
methenamine - crystalluria, bladder irritation
-
nitrofurantoin: exfoliative dermatitis, interstitial nephritis, necrosis
-
contraindications
-
hypersensitivity
-
anuria
-
severe renal disease
-
infants < 1 month-old
-
nursing interventions
-
monitor intake and output
-
teach client
|
|