Pharmacological and Parenteral Therapies

1-1/2"
1/2" for child
2-3" for obese clients

20-25 gauge

90 degrees

Deltoid, ventrogluteal, vastus lateralis, recuts femoris, (pediatrics), dorsogluteal.

cont.

1-3 mL

30 mL

5 mL

15 mL

2.2 lbs

240 mL

1,000 mL

Volume (ml)
__________

Time (min) X Drop factor =
IV flow rate (gtt/min)

C = F
__

32

The desired physiologic response to the drug, the expected response

A sometimes predictable, but unavoidable secondary effect

Mild analgesia and reduced fever

GI upset, bleeding, tinnitus

Allergic reaction

Raised irregularly shaped skin eruptions, reddened margins w/ pale center

Allergic reaction

Clear watery nasal drainage from inflammation of mucous membranes

Allergic reaction

Itching of the skin

Allergic reaction

Small, reddened, raised vesicles

Wheezing, angioedema, SOB

Drug effect is enhanced by another drug

Digoxin, dilantin, theophylline, vancomycin, lithium...

Narcan

Romazicon

Parenteral meds

Topical meds

Severe burning or stinging of the nose, nosebleed, or sever burning or watering of the eyes.

Supine

rapidly

Supine w/ neck hyperextended

Monitoring HR, BP, and report an increase of intraocular pressure

Extreme measures of otic meds can result in dizziness, nausea and/or pain

Hyper/hypoglycemia, infection

antituberculosis

Used to inhibit the growth of mycobacteria by preventing synthesis of mycolic acid in cell wall.

S/E: peripheral neuropathy, hepatoxicity

Prevents the reproduction of viral DNA for the use of herpes simplex, varicella, cytomegalovirus.

S/E: nephrotoxicity, thrombocytopenia, reproductive toxicity.

GI discomfort, N/V

Ototoxicity, neurotoxicity, nephrotoxicity

No

Monitor hypersensitivity, renal and hepatic functions

Antituberculars, antivirals, antiprotozoals, macrolides, aminoglycosides, tetracyclines, penicillin, sulfonamides, fluoroquinolone, urinary tract antiseptics, and vancomycin

These type of antibiotics are used as an effective measure against a WIDE variety of microorganisms

These type of antibiotics are effective against a FEW species of microorganisms including gram neg and positive organisms

Hypersensitivity, N/V, rash, diarrhea, GI disturbances, renal impairment, hyperkalemia w/ penicillin G

Take drug 1hr prior a meal or 2 hrs after w/ a full glass of water, EXCEPT for amoxicillins and bacampicillin, Penicillin V and Augmentin which may be taken w/ food. Monitor WBC and temp, signs of superinfections, (mouth ulcers, vaginitis), bleeding

Take drug on time and complete full course of med, increase fluids, and report any allergic reactions such as skin rash, hives, itching, and wheezing

UTI, bronchitis, and E-coli infections

Hypersensitivity, photosensitivity, bld disorders, (anemia), from high doses, anorexia, N/V/D, dizziness, HA, crystalluria

Assessment of allergies, clients w/ renal or hepatic dysfunction, and bld dyscrasias, monitor CBC, force fluids to prevent crystalluria

antacids, dilantin, coumadin, and oral contraceptives

watch for allergic reactions, (skin rashes, itching), drink w/ full glass of water, increase fluids to 8-10 glasses/day, and avoid prolonged exposure to sun and wear sunscreen

cipro, penetrex, maxaquin, noroxin, floxin

Infections of the joints/bones, bronchitis, gastroenteritis, gonorrhea, pneumonia, UTI, antrax

N/V/D, photosensitivity, dizziness, drowsiness, restlessness, suprainfection, (thrush, yeast infections).

Monitor WBC, fever, signs of supainf.

Interacts w/ dairy products, iron salts, aluminum, mag, antacids, theodur, coumadin.

Teach S/S of suprainf and report

Thrush and yeast infections

macrodantin, furadantin, mandelamine, proloprim, timpex, hiprex, urex, hip-rex

UTIs

N/V, GI discomfort, hypersensitivity, bld dyscrasias, peripheral neuropathy, HA, rash

Measure renal function

Antacids, sodium bicarb, methenamine, sulfonamides can increase risk of crystalluria, nalidixic acid enhances coumadin, false positive urine glucose test

May be given w/ food, encourage to drink fluids that increases acidity, (cranberry juice, prune juice), and teach that appearance of urine will have a brownish color

Change in color of urine to brown

It is used for the tx of antibiotic induced pseudomembranous colitis and staph enterocolitis.

Parenteral Vanco is indicated for bacterial endocarditis caused by staph including MRSA

Taste alterations.

Rare S/E:
Ototoxicity, nephrotoxicity, red neck syndrome, (flushed, chills, itching).

Peak & trough to measure serum drug levels, (toxicity), monitor renal function and ototoxicity

Bacterial endocarditis caused by staph including MRSA

ACE inhibitors, antithrombotic meds, antilipid meds, beta blockers, calcium channel blockers, positive inotropic agents, sympathomimetics, and nitrates

Angiotensin-Converting Enzyme Inhibitors

Used for mild-severe HTN, heart failure and help diabetics prevent kidney problems

It inhibits the angiotensin-converting enzyme responsible for converting angiotensin I to angiotensin II

after-load and acts as a vasodilator

Within 48 hrs

ACE inhibitors

enalapril, (Vasotec), lisinopril, (Zestril), captopril, (Capoten)

Administer at same time of day

Monitor for hypotension, cough, hypokalemia, increased creatinine and BUN levels.

w/out regard

coaguability, (fibrin system)

clots, larger

No

active bleeding

clots

growth

No

Can be given in sm doses

Protamine sulfate

Via sub-q inj or IV infusion

12

continous or intermittent

2, 8

5, 9

aPTT q 4-6 hrs until appropriate dose is determined, then monitor daily

Vit. K

PT/INR

same

2-3

Vit. K

Those w/ active bleeding

No

Monitor for bleeding

Aspirin; plavis, (Clopidogrel); ticlid, (Ticlodipine); ReoPro, (Abciximab), aggrastat, (Tirofiban)

To dissolve thrombi in the coronary arteries and restore myocardial bld flow during the 1st 6 hrs of an MI

active bleeding, recent stroke, surgery, trauma, severe HTN, pregnancy

retavase, TNKase, (tenecteplase), t-PA, (tissue plasminogenactivator), streptokinase

abnormal electrical activity of the heart, (atrial and ventricular dysrhythmias)

Monitor rate, rhythm and hypotension

amiodarone, (Cordarone), lidocaine, (Xylocaine), quinidine, (Quinidine Gluconate, Quinidine Sulfate), procainamide, (Pronestyl, Procan-SR, Procanbid)

lower circulating lipid and LDL cholesterol levels

Baseline levels of total cholesterol, LDL, HDL, and triglycerides, (TGs).

LDL, HDL, total cholesterol levels, and TGs.

Also baseline function tests of the liver and kidneys, periodically

When diet adjustment and other non-pharmacological therapies have been ineffective

lower cholesterol by blocking enzymes that are essential to the production of cholesterol in the body

myositis, myopathy w/ the potential for rhabdomyolysis, leading to renal failure

lovastatin, (Mevachor), simvastatin, (Zocor), atorvastatin, (Lipitor), Niacin, Questran, gemfibrozil, (Lopid)

They are used for mild to moderate HTN, moderate to severe angina, post-myocardial infarction

decrease

apical

less, 60

Notify provider

Fatigue, lethargy, impotence, wheezing, dyspnea, heart failure, contraindicated in bronchial asthma

metoprolol, (Lopressor), atenolol, (Tenormin), carvedilol, (Coreg)

dilate

decreases

angina, mild-mod HTN, dysrhythmias

No

Monitor HR and rhythm, BP

diltiazem, (Cardizem), verapamil, (Calan)

increase

Digoxin

slower, relax

Increased cardiac output and increased blood flow to the kidneys

Anorexia, N&V, visual disturbances, lethargy, bradycardia, heart block, tachydysrhythmias

apical, rhythm

Monitor digoxin levels for toxicity and potassium

0.8 - 2.0

increase, high

toxicity

Sympathomimetics

Sympathomimetics

increase, AV

Dopamine

low, kidney

Epinephrine

Digiband

7

Nitrates

SL, IV, PO, TD

Angina, HTN, MI, CHF

nitro, acute

Instruct to lie down, repeat dose at a 5 min interval, and if pain does not relieve, take up to 3 tabs

Call provider and/or go to the nearest ER

HA and hypotension

Decrease BP by decreasing CO

Decrease HR, contractility, so decreases O2 demand of the myocardium

Blocking beta receptors allow the myocardium to remodel and limits stress by preventing myotoxicity caused by chronic high doses of catecholamines

Slows AVE nodal conduction velocity

Blocks catecholamine induced vasodilation in cerebral vasculature

1) Hypokalemia, 2) hyperglycemia, 3) hyperlipidemia, 4) hyperuricemia, 5) hypercalcemia

K+ wasting, metabolic alkalosis, hypotension, ototoxicity

Impotence, asthma, bradycardia, CHF, AV block, and on CNS: sedation, sleep alterations

Hyperkalemia, cough, angioedema, proteinuria, taste changes, hypotension, pregnancy problems, rash, increased renin, lower angiotensin II

Blocks voltage dependent calcium channels of cardiac and smooth muscle and so reduces muscle contractility

HTN, angina, arrythmias, (verapamil).

Dizziness, flusing, constipation, (verapamil); and nausea

Decreasesd EDV, (dilate veins); decreases BP, (dilate arteries); increases contractility, (reflex response); increases HR, (reflex response); decrease ejection time; decreases O2 consumption

Increases EDV; decreases BP; decreases contractility; decreases HR, increases ejection time, decreases O2 consumption

Beta blockers decreases afterload, nitrates decreases preload

It blocks the H1 receptors on the surface of basophils and mast cells.

Antihistamines most often prescribed for allergic rhinitis, may also be used to treat nausea, motion sickness, allergic reactions and insomnia

Drowsiness, dry mouth, change in vision, difficulty urinating, and constipation

It acts by selectiveely activating the beta2 receptors in the bronchial smooth muscle, resulting in bronchodilation causing the bronchospasm to become relieved

To treat wheezing and SOB, caused by breathing problems, (asthma, COPD)

Bronchodilators

It works in the airways by opening breathing passages and relaxing muscles.

minimal

tachycardia, angina

tremors

Remove cap and hold upright, shake inhaler, tilt head back slightly and breathe out, open mouth, hold inhaler 1-2 in away, use spacer attached to inhaler, hold inhaler in your mouth, press down on the inhaler to release the medicine and breathe in slowly for 3-5 sec, hold breath for 10 sec. Repeat as directed. Wait 1 min between puffs

Theophylline causes relaxation of bronchial smooth muscle, resulting in bronchodilation

long-term

Oral/IV, (emergency use only)

Mild toxicity which may include GI distress, nervousness, and restlessness; severe arrhythmias, tachycardia, & tremors

Teach client to stop med if A/E occur and notify provider

10-20

Montelukast blocks leudotrienes in the body which decreases symptoms caused by asthma/allergies.

Montelukast, (Singulair)

14

Allergic rhinitis, allergies, hay fever

Fluids assist in decreasing the viscosity of the resp secretions facilitating removal

glucocorticoid, bronchodilator, steroid, bronchodilator

Corticosteroid inhalers

Apidra, Humalog, Novolog

Humulin R, Novolin R

Humulin N, Novolin N

Levemir, Lantus

Insulin Glulisine

Insulin Lispro

Insulin Aspart

Regular

Regular

NPH

NPH

Insulin Detemir

Insulin Glargine

<15 min

1/2 - 1 hr

2-4 hrs

3/4 -2 hrs

2-4 hrs

1-2 hrs

2-3 hrs

4-10 hrs

Minimal peak action

There is no peak

3-4 hrs

3-6 hrs

10-16 hrs

Up to 24 hrs

20-24 hrs

8:48-10:48

A. Take another dose using a sliding scale

B. Repeat CBS in an hr

C. Notify provider as this is not an expected event

D. Do not consume any carbs for the next 12 hrs

Regular or rapid

Only reg insulin

3-4 hrs

Lantus, Levemir, (long acting insulin)

levothyroxine, (Synthroid, Levothroid).

Overmedication resulting in hyperthyroidism

Increase metabolic rate, cardiac output, renal perfusion, oxygen use, body temp, bld vol, and growth processes

Can increase the anticoagulant effect of warfarin by breaking down Vit. K. Some seizure meds can increase the levels of thyroid hormones

Anxiety, tachycardia, palpitations, altered appetite, abdominal cramping, heat intolerance, fever, diaphoresis, wt loss, and menstrual irregularities

antithyroid

To treat Graves' disease. It produces a euthyroid state prior to thyroid removal surgery as an adjunct to irradiation of the thyroid gland. In the emergency tx of thyrotoxicosis

Overmedication results in hypothyroidism

Drowsiness, depression, wt gain, edema, bradycardia, anorexia, cold intolerance, dry skin, and menorrhea, agranulocytosis

Used to treat growth hormone deficiencies, (pediatric and adult, Turner's syndrome, Prader-Willi syndrome).

Hyperglycemia, hypothyroidism

Concurrent use of glucorticoids can counteract growth-promoting effects

To treat diabetes insipidus and during cardiac arrest, (Vasopressin).

Reabsorption of too much water and myocardial ischemia from vasoconstriction

Carbamazepine and tricyclic antidepressants may increase the antidiuretic action

Acute/chronic replacement therapy for adrenocortical insufficiency, (Addison's disease).

Cancer, inflammation, and allergic reactions

Osteoporosis, adrenal suppression, peptic ulcer, GI discomfort, inf

NSAIDs or alcohol use may cause increased gastric distress/bleed, concurrent use w/ oral anticoagulants may increase or decrease anticoagulation, concurrent use w/ K+ depleting agents may cause increased K+ loss, and concurrent use w/ vaccines and toxoids may reduce the antibody response

They neutralize gastric acid and inactivate pepsin

prostaglandis

peptic ulcer disease by promoting healing and relieving pain

GERD

May cause constipation

May cause diarrhea

fluid retention

hypophospatemia

toxicity

Pregnancy, not given to clients w/ GI perforation or obstruction, and use w/ caution for clients w/ abdominal pain

Warfarin and tetracycline

-Chew tab thoroughly and drink at least 8oz of water/milk.

-Shake liq formulations for proper dispersion.

-Encourage compliance

-Take all other meds at least 1 hr before or after taking an antacid

-Med adminis x7/d, (1hr before and 3 hrs after meals and at bedtime)

serotonin and dopamine antagonists, glucocorticoid, canabinoids, anticholinergics, antihistamines, and prokinetic agents

ondansetron, (Zofran)

Serotonin antagonist

Dopamine antagonist

prochlorperaxine, (Compazine)

N&V

dronabinol, (Marinol)

Anticholinergics

motion sickness

scopolamine, (Transderm Scop)

Antihistamines

Antihistamines

dimenhydrinate, (Dramamine)

Prokinetic agents

Prokinetic agents

post-op, chemo

Prokinetic agents

HA, diarrhea, dizziness, hypotension, sedation, tachycardia.

Extrapyramidal symptoms: restlessness, anxiety, spasms of face and neck.

Anticholinergic effects: Dry mouth, urinary retention, constipation

Use cautiously in children and older adults due to the high risk of extrapyramidal S/E

urinary retention/obstruction, asthma, and narrow angle glaucoma

seizures

CNS depressants, (opioids which can intensify depression of anti-emetics), antihypertensives intensifies hypotensive effects of antiemetics, anticholinergic meds concurrent use can intensify anticholinergic effects of antiemetics

Anti-emetics are more effective when used to prevetn N&V than to treas N&V that has already occured.

Combining more than one anti-emetic allos for lower doses of each thera.py, thereby reducing S/E.

Prevent or treat N&V from various causes. Match the med w/ the cause.

Prescribed for gastric and peptic ulcers, GERD, hypersecretory conditions

Antibiotics

Decrease in libido and impotence. CNS effects, (lethargy, depression, confusion)

warfarin, phenytoin, and antacids

pregnancy, for older adults use w/ caution because of antiadrenergic effects and w/ those who are at a high risk for pneumonia

Good nutrition, (eat 6 sm meals rather than 3 lrg meals); adequate rest and reduction of stress, no smoking, avoid ASA and NSAIDs, and stop drinkin ETOH

gastric, peptic ulcers and hypersecretory conditions

S/E can be insignificant w/ short term tx. Low incidence of HA, diarrhea, and N/V

Ampicillin, digoxin, iron, ketoconazole

Pregnancy, use w/ caution on children and women who are breastfeeding, those w/ hypersensitivity to this med, and due to an increase for the risk of pneumonia, use w/ caution for those who might be prone to disease, (COPD)

not crushing, chewing, or breaking the SR caps, avoid taking ibuprofen/alcohol, and notify any signs of obvious occult GI bleeding

ulcer

6 hrs

No

constipation; and no systemic effects

warfarin, phenytoin, digoxin, ciprofloxacin, and antacids

pregnancy and hypersensitivity

to maintain med regimen, take on empty stomach, take 4x/d 1 hr before meals and at bedtime, med can be broken or dissolved in water, but NOT crushed or chewed, and complete entire course of therapy

NSAIDs

Prostaglandin E analog

diarrhea, abdominal pain, women may experience dysmenorrhea and spotting

No

For women of childbearing age, follow certain guidelines regarding contraception and notification of warnings.

Yes, yes

laxative

Bulk forming laxatives

psyllium, (Metamucil).

Surfacant laxative

docusate sodium, (Colace)

Stimulant laxative

bisacodyl, (Dulcolax)

Osmotic laxatives

magnesium hydroxide, (MOM)

GI irritation, rectal burning sensation, dehydration. Laxatives w/ mag salts can lead to toxic levels of mag. Laxatives w/ Na salts places clients at risk for Na absorption and fluid retention

not to crush/chew enteric-coated tabs, discourage from bisacodyl suppositories on a reg basis, read labels carefully, monitor I&O and signs of dehydration, encourage fluids and ambulation when appropriate

that w/ chronic use, may lead to fluid and electrolyte imbalances, increase fiber, exercise.

full glass of water

laxatives

Milk and antacids destroy enteric coating of bisacodyl.

Anti-diarrheals

typical opioid effects such as euphoria and CNS depression when used in high doses.

an increased risk of megacolon in clients w/ inflammatory bowel disorders which can lead to complications such as perforation of the bowel

alcohol and other CNS depressants which may enhance CNS depression

Drink sm amnts of clear liq of a commercial oral electrolyte sol to maintain electrolyte bal for the 1st 24 hrs, advise to avoid plain water, caffeine, monitor wt, I&O, VS

Should not be taken w/ any of the MAO inhibitor-class of antidepressants, such as isocarboxazid, (Marplan), phenelzine, (Nardil), and procarbazine, (Matulane), because of the increased risk of extrapyramidal symptoms, (EPS)

Tardive dyskinesia

promethazine, (Phenergan)

Signs of bleeding and increased prothrombin time, (PT), INR, and aPTT levels

Cimetidine can increase the levels of warfarin, phenytoin, (Dilantin), theophylline, and lidocaine

Mag++

CNS effects, (lethargy, depression, confusion)

Risk for pneumonia. Use w/ caution w/ those who have COPD

Dig levels may be increased when used concurrently w/ omeprazole. Monitor dig levels when prescribed concurrently

Instruct clients that sucralfate should be taken four times a day, 1 hr before meals, and again at bedtime.

Preventing nausea and vomiting associated with cancer chemotherapy or surgery

Feces

Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in nose or throat.

Bulk-forming laxatives soften fecal mass and increase bulk, which is identical to the action of dietary fiber.

Docusate sodium (Colace) lowers the surface tension at the oil-water interface of the feces, allowing water and lipids to penetrate the stool. This helps hydrate and soften fecal material and facilitates natural defecation.

Important for the provider to know if the client has kidney disease, dehydration, or an electrolyte imbalance (such as high or low levels of potassium, sodium, phosphorous, or magnesium in your blood).

At high doses, clients may experience typical opioid effects, such as euphoria or CNS depression. However, the addition of atropine, which has unpleasant adverse effects (blurred vision, dry mouth, urinary retention, constipation, tachycardia) in diphenoxylate discourages ingestion of doses higher than those prescribed.

The peak action time is 24-72 hours

There will be increased absorption of both medications when taken together

Bisacodyl, a laxative, is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and examinations such as X-ray procedures using barium enemas.

Bisacodyl is a stimulant laxative. It is typically prescribed to treat constipation, for the management of neurogenic bowel disease and as well as well as part of bowel preparation before medical examinations, such as for a colonoscopy.

Lomotil

Senna may interact with drugs called calcium channel blockers, such as Procardia, and the drug Indocin

If used too frequently, it may cause loss of normal bowel function and an inability to have a bowel movement without using the product (laxative dependence).

Presence of nausea, vomiting, fever, abdominal pain or symptoms of an acute abdomen, intestinal obstruction, fecal impaction, undiagnosed rectal bleeding or dysphagia. The Instant Mix preparation is contraindicated in patients who must severely restrict their dietary sodium intake, including patients with congestive heart failure.

16mg

Active naturalimmunity develops when the body produces antibodies in response to exposure to a live pathogen.
Active artificial immunity develops when an immunization is given and the body produces antibodies in response to exposure to a killed or attenuated virus.

Passive natural immunity occurs when antibodies are passed from the mother to the newborn/infant through the placenta and then breast feeding.
Passive artificial immunity is temporary, and occurs after antibodies in the form of immune globulins are administered to an individual who requires immediate protection against a disease after exposure has occurred.