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Pharmacological and Parenteral Therapies 5

      1. Antacids
        1. action

          1. neutralizes gastric acid

          2. coats stomach lining

        2. examples

          1. aluminum hydroxide gel (Amphojel)

          2. aluminum and magnesium hydroxides (Maalox)

          3. magaldrate (Riopan)

        3. use: peptic ulcers, reflux esophagitis, hiatal hernia

        4. adverse reactions

          1. aluminum compounds - constipation, intestinal obstruction

          2. magnesium compounds - diarrhea

          3. reduced absorption of calcium and iron

        5. nursing interventions

          1. shake oral suspension well

          2. monitor client's response to treatment

          3. administer with 8 oz glass of water

          4. 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

      1. Antiulcers

        1. actions

          1. decrease acetylcholine release

          2. block release of histamines

          3. inhibit secretion of pepsin

          4. inhibit proton pump

        2. examples

          1. anticholinergics; belladonna tincture, chlorodiazepoxide (Librax)

          2. h2 blockers - cimetidine (Tagamat), ranitidine (Zantac)

          3. pepsin inhibitor - sucralfate (Carafate)

          4. proton pump inhibitor - lansoprazole (Prevacid), omeprazole (Prilosec)

        3. uses: management of peptic ulcer disease, gastroesophageal reflux disease(GERD), protects gastric mucosa from hydrochloric acid production

        4. adverse reactions

          1. dry mouth, decreased secretions, constipation, tachycardia, & urinary retention

          2. headaches, dizziness, constipation, skin reash, pruritis, impotence

          3. sucralfate is nonasborable, occasional constipatoin

        5. contraindications

          1. anticholinergics - narrow- angle glaucoma

          2. renal failure

          3. liver disease

        6. nursing interventions

          1. administer on empty stomach

          2. avoid antacids within 30 minutes of sucralfate

          3. avoid antacids within one to two hours of other antiulcer drugs

          4. administer other drugs one to two hours after sucralfate

          5. 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

      1. Anti-diarrheal

        1. action: forms the stool; mechanism depends on type of medication

        2. examples

          1. fluid absorbents - decrease fluid content; kaolin and pectin (Kaopectate)

          2. motility suppressants - decrease motility of GI tract; diphenoxylate HCL (Lomotil), loperamide HCL (Imodium)

          3. enteric bacterium - replacements help intestine turn carbohydrates into lactic acid; lactobacillus acidophilus (Bacid)

        3. use: treat diarrhea

        4. adverse reactions

          1. fluid absorbents: gastric disturbances, CNS toxicity

          2. enteric bacterium replacements: excessive flatulence, abdominal cramps

          3. motility suppressants: urinary retention, tachycardia, sedation, paralytic ileus, respiratory depression

        5. contraindications:

          1. ulcerative colitis

        6. nursing interventions

          1. monitor effect of medication

          2. assess for fluid and electrolyte imbalance

          3. assess for cause of diarrhea

          4. motility suppressants may cause physical dependence, may impair ability to perform hazardous activities

      1. Laxatives

        1. action: moves stool; mechanism dependent on type of laxative

        2. examples

          1. lubricants moisten stool; mineral oil

          2. stool softeners allow water to penetrate stool; dioctyl sodium sulfosuccinate (Colace)

          3. bulk forming: increase bulk in intestine; psyllium hydrophilic mucilloid (Metamucil)

          4. colon irritant stimulates peristalsis; bisacodyl (Dulcolax)

          5. saline cathartics increase osmotic pressure thereby absorbing fluid from bowel wall; milk of magnesia

        3. use: to treat constipation

        4. adverse reactions

          1. gastric effects: nausea, cramping, diarrhea

          2. dependence with long-term use

          3. intestinal lubricants inhibit absorption of fat-soluble vitamins

          4. saline cathartics: dehydration, hypernatremia

        5. contraindications:

          1. GI obstruction

          2. suspected appendicitis

          3. megacolon

          4. abdominal pain

          5. nausea

        6. nursing interventions

          1. monitor effects of medication

          2. 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

      1. Pancreatic enzymes

        1. action: replacement for natural pancreatic enzymes

        2. examples

          1. pancreatin (Dizymes)

          2. pancrelipase (Cotazym)

        3. use: aid in digestion; cystic fibrosis

        4. adverse reactions, with large doses

          1. diarrhea

          2. nausea

          3. hypersensitivity reaction: sneezing, skin rashes

        5. contraindications

          1. hypersensitivity to pork

          2. chronic pancreatic disease

        6. nursing interventions

          1. monitor for symptoms of diabetes mellitus (such as polyuria, thirst, hunger)

          2. monitor weight, intake and output

          3. administer with meals

          4. do not crush enteric coated medications

          5. determine client's response to therapy

    1. Managing endocrine conditions

 

 

  1. Antidiabetic agents

  1. Hypothyroid agents

  1. Hyperthyroid agents

  1. Anterior pituitary growth hormone

  1. Antidiuretic hormone

      1. Antidiabetic agents

        1. action: provides insulin to promote transport of glucose; exact mechanism dependent on type of antidiabetic agent

        2. examples

          1. oral hypoglycemics stimulate pancreatic beta cells to produce insulin tolazamide (Tolinase), glipizide (Glucotrol), metformin (Glucophage), rosiglitazone (Avandia)

          2. parenteral agents provide exogenous insulin 

        3. use: treat diabetes mellitus

        4. adverse effects

          1. hypoglycemia, irritability, confusion

          2. convulsions, tachycardia, tremor

          3. moist skin, headache, hunger

          4. nausea, bloating, diarrhea

        5. contraindications:

          1. hypersensitivity

        6. nursing interventions

          1. assess client for effect of medication

          2. monitor blood/urine glucose levels

          3. 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

          4. 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

      1. Hypothyroid agents

        1. action: help regulate the metabolic rate of cells

        2. examples

          1. levothyroxine sodium (Synthroid)

          2. thyroglobulin (Proloid)

          3. thyroid (Thyrar)

        3. use: replace thyroid hormones

        4. adverse reactions

          1. hyperactivity

          2. cardiac stimulation

          3. thyroid storm

        5. contraindications

          1. adrenal insufficiency

          2. myocardial infarction

          3. thyrotoxicosis

          4. hypersensitivity to beef

        6. nursing interventions

          1. monitor client's response to medication

          2. 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

      1. Hyperthyroid agents

        1. action: blocks synthesis of thyroid hormone

        2. examples

          1. iodine (Lugol's solution)

          2. methimazole (Tapazole)

          3. propylthiouracil (PTL)

        3. use: treat hyperthyroidism

        4. adverse effects

          1. agranulocytosis

          2. skin disturbances

          3. decreased metabolism

          4. gastric disturbances

          5. iodine: stains teeth, bitter taste

        5. contraindications:

          1. hypersensitivity

        6. nursing interventions

          1. administer iodine preparations through a straw

          2. monitor effects of medication

          3. instruct client

            • report side effects

            • avoid OTC drugs containing iodine

            • do not discontinue medication abruptly

            • carry medic alert jewelry

      1. Anterior pituitary: growth hormone

        1. action: stimulates the growth of practically all organs and tissues

        2. examples

          1. somatrem (Protropin)

          2. somatropin (Humatrope)

        3. use: treat dwarfism

        4. adverse effects

          1. hyperglycemia

          2. hypothyroidism

          3. antibodies to growth hormone

          4. interaction with glucocorticoids

        5. contraindications:

          1. hypersensitivity to benzyl alcohol

          2. closed epiphyses

          3. intracranial lesions

        6. nursing interventions

          1. monitor diabetic client closely

          2. instruct client

            • record height measurements at regular intervals

            • report to physician if growth is less than expected

      1. Antidiuretic hormone

        1. action: helps distal renal tubules reabsorb water

        2. examples

          1. lypressin (Diapid)

          2. vasopressin (Pitressin)

        3. use: treatment of diabetes insipidus

        4. adverse effects

          1. gastric disturbances

          2. hyponatremia

          3. water intoxication

          4. cardiac disturbances

        5. nursing interventions

          1. monitor response to therapy: intake and output, blood pressure

          2. assess for dehydration

    1. Managing genitourinary diseases

 

 

  1. Diuretics

  1. Sulfonamides

  1. Immunosuppressants

  1. Anti-infectives

      1. Diuretics

        1. action: interferes with sodium reabsorption

        1. examples

          1. loop diuretics interrupt the transport of sodium ions in Loop of Henle

            • bumetanide (Bumex)

            • furosemide (Lasix)

          2. potassium sparers act on collecting tubules to promote sodium and water excretion

            • spironolactone (Aldactone)

            • triamterene (Dyrenium)

          3. thiazides: inhibit reabsorption of Na+ and CL- in early distal tubule

            • chlorothiazide (Diuril)

            • hydrochlorothiazide (Hydrodiuril)

          4. osmotic: increase osmotic pressure of glomerular filtrate

            • mannitol

            • urea

        2. use: treat hypertension, edema

        3. adverse side effects

          1. gastrointestinal irritation

          2. electrolyte imbalance: hyponatremia, hypokalemia

          3. orthostatic hypotension

          4. dehydration

        4. contraindications

          1. electrolyte imbalances

          2. dehydration

          3. anuria

        5. nursing interventions

          1. monitor weight, intake and output, vital signs

          2. give medication in morning

          3. monitor client for fluid and electrolyte imbalance

          4. teach client

            • change positions slowly

            • report changes in hearing

            • diabetic clients: closely monitor glucose levels

      1. Sulfonamides

        1. action: substitutes a false metabolite for p-aminobenzoic acid, which is essential for the bacterial synthesis of folic acid

        2. example

          1. succinylsulfathiazole (Sulfasuxidine)

          2. sulfisoxazole (Gantrisin)

          3. sulfamethoxazole and trimethoprim (Bactrim, Septra)

        3. use: urinary tract infections

        4. adverse effects

          1. gastric irritation: nausea and vomiting, stomatitis

          2. rash

          3. malaise

          4. blood dyscrasias

          5. crystalluria

          6. photosensitivity

          7. allergic response

        5. contraindications

          1. hypersensitivity

          2. infants < two months-old

          3. pregnancy at term

        6. nursing interventions

          1. check if client has a history of allergies

          2. monitor client response to treatment

          3. monitor vital signs and blood work

          4. teach client

            • drink plenty of fluids

            • take medication as prescribed

            • avoid OTC medications unless approved by health care provider

            • avoid direct sunlight

      1. Immunosuppressants

        1. action: inhibit immune responses

        2. example: cyclosporine (Sandimmune)

        3. use

          1. prevent organ rejection in transplant patient

          2. treat autoimmune disorders (such as rheumatoid arthritis, systemic lupus erythematosus)

        4. adverse effects

          1. nephrotoxicity (poisons kidneys)

          2. infection

          3. hypertension

          4. tremor

          5. hirsutism

        5. contraindications

          1. hypersensitivity

          2. nursing interventions

            • monitor BUN and creatinine; liver function tests

            • teach client

              • report early signs of infection (such as fever, sore throat)

              • medication may be taken with meals

              • take medication same time each day

              • hirsutism is reversible when treatment stops

      1. Antinfective

        1. action: interferes with several bacterial enzyme systems

        2. example

          1. nitrofurantoin (Furadantin)

          2. methenamine (Hiprex)

        3. use: treat pyelonephritis, pyelitis, cystitis

        4. adverse effects

          1. anorexia

          2. nausea and vomiting

          3. methenamine - crystalluria, bladder irritation

          4. nitrofurantoin: exfoliative dermatitis, interstitial nephritis, necrosis

        5. contraindications

          1. hypersensitivity

          2. anuria

          3. severe renal disease

          4. infants < 1 month-old

        6. nursing interventions

          1. monitor intake and output

          2. teach client

            • take medication as prescribed

            • drink plenty of fluids

            • take medication with food or milk

            • with nitrofurantoin:

              • do not crush pill because it stains teeth; dilute oral suspensions and rinse mouth after taking

              • report changes in urinary pattern

              • report muscle weakness, tingling or numbness

              • urine may look brown or rust yellow

              • avoid alcohol