MEDICATION AIDE CHAPTERS 24-27

RESPIRATORY SYSTEM

• Upper respiratory tract• Nose• Sinuses• Naso-pharynx• Pharynx• Tonsils• Eustachian tubes• larynx

• Lower respiratory tract• Larynx• Trachea• Bronchi• Bronchioles• Alveoli

COMMON CONDITIONS AFFECTING THE RESPIRATORY SYSTEM

• URI• Rhinitis• COPD (asthma, bronchitis, emphysema, reactive

airway disease)• Sinusitis, tonsilitis

DECONGESTANTS

• Used to shrink nasal mucous membranes, help reduce fluid secretions

• Common side affects• Nervousness• Rebound engorgement• Elevated blood pressure• Elevated glucose levels

• Nursing precautions• Monitor BP• Limit use of nasal sprays, drops to 5 days

• Examples • Allerest• Beconase• Sudafed• Flonase• Nasocort• Sinex, Neo-Synephrine• Afrin

ANTIHISTAMINES • Common side affects

• Drowsiness & sedation• Dry mouth• Lower blood pressure• Urinary retention

• Nursing precautions • Avoid alcohol

• Examples • Benylin• Zyrtec vestaril• Seldene• Hismanal• Chor-trimeton• Tavist• Allegra• Atrovent• Claritin• Phenergan

• Used to decrease nasopharyngeal secretions, relieve symptoms of allergies, common cold

ANTI-INFLAMMATORY AGENTS

• Anti-inflammatory agent• Used with a decongestant or a anti-histamine• Nasalcrom

• Intra-nasal cortico-steroids• Reduce nasal symptoms of allergic rhinitis• Used with decongestants• Flonase• Nasacort AG• Beconase

DRUG THERAPY FOR LOWER RESPIRATORY DISEASES

• Signs and symptoms• Lung congestion• Cough

Expectorants, antitussives, broncho-dilators, mucolytic agents

DRUG THERAPY FOR UPPER RESPIRATORY DISEASES

• Signs and symptoms of URI• Nasal itching• Sneezing• Rhinorrhea• Tearing• Itchy eyes

Antihistamines and decongestants Anti-inflammatory agents and steroids

EXPECTORANTS

• Used to loosen bronchial secretions to be eliminated with coughing

• Common side affects• Nausea• Vertigo• Drowsiness• Sedation

• Nursing precautions• Avoid alcohol, hypnotics, narcotics• Encourage additional fluids• Monitor BP as directed

• Examples • Robitussin (guaifenesin)• SSKI (potassium iodine)

ANTITUSSIVES

• Used to suppress cough• Common side affects• Nausea, vomiting• Headache• Drowsiness & sedation

• Nursing precautions• Hydration is best expectorant• Observe color of bronchial secretions• Do not give fluid or food for 20 minutes after administration• Codeine is the most constipating

• Examples • Guaifenesin (Robitussin)• SSKI• Tusstat (diphenhydramine)Benadryl• Hycodan• Tessalon Perles

BRONCHO-DILATORS

• Relaxes the smooth muscle of the trachea-bronchial tree• Used with anti-inflammatory agents• Singulair• Accolate

• Cortico-steroids are most effective as used by inhalation• Azmacort• Advair(a powder given by diskus)

• Nsg. Precaution• S/E are usually dose related• Give with food & a full glass of water• Provide for safety & prevention of falls• Give according to manufacturing directions

CONT.

• Side effects• Tachycardia/palpitations• Tremors• Nervousness• Nausea/vomiting• Dizziness• Proventil• Alupent• Maxair• Brethine• Atrovent• Spiriva(dry powder given by inhalation)

XANTHINE DERIVATIVE-BRONCHODILATOR

• Act on smooth muscle to dilate the bronchi• Goal is easier breathing with less effort• Theolair• Bronkodyl

MUCOLYTIC AGENTS

• Used to reduce the stickiness and thickness of pulmonary secretions

• Common side affects• Dry mouth• Restlessness• Elevated blood pressure

• Nursing precautions• Note the person’s cough- productive/nonproductive• Sputum• Monitor vitals

• Examples • Mucomyst (acetylcysteine)

ANTIBIOTICS

• Used to treat infections in respiratory tract• Common side affects• Diarrhea• Rash• nausea

• Nursing precautions• Do not give food, mild products, antacids, with tetracycline product• Observe for allergic reaction (rash)• Full course of therapy required

• Examples • Amoxil• Cipro• Vibramycin

COMMON CONDITIONS OF GI SYSTEM

• GERD (Gastro-esophageal reflux disease)• Dysphagia• Stomatitis• Stomach ulcer• Gastritis • Gallstones• Hemorrhoids • Colon cancer• Cirrhosis• Nausea, vomiting• Diarrhea, vomiting• Diarrhea• Bowel incontinence• Constipation• Hypokalemia• Hyponatremia

GERD

• Heartburn is the most common• S/S include chest pain when lying down• Hoarseness in the morning• Dysphagia• Choking sensation• Feeling like food is stuck or the throat is tight• Dry cough, sore throat or bad breath

• Risk factors• Being over- weight• Alcohol use• Pregnancy• Smoking• Hiatal hernia

CONT

• Treatment: Life-style changes, meds to promote emptying of the stomach or reduce stomach acid production• Life style changes• No smoking or alcohol• Losing weight• Eating small meals• Wearing loose belts & loose fitting clothing• Not lying down for 3 hrs. after meals• Raising the HOB 5-8 “

CONT.

• Meds Antacids (give other drugs 1 hr before or 2 hrs, after the antacid• S/E constipation or diarrhea• Edema or S/S of heart failure(meds are high in sodium)• Coffee ground emesis & bloody or black tarry stools• Meds include Gelusil• Maalox • Mylanta• Riopan• Tums• MOM

HISTAMINE RECEPTOR ANTAGONISTS

• Blocks the secretion of gastric juices• Give with food or milk• S/E Dizziness, HA, sleepiness• Diarrhea, constipation• Confusion, slurred speech, hallucinations• Anorexia, N/V jaundice(liver toxicity)• Tagamet• Pepcid• Axid• Zantac

G-I PROSTAGLADIN

• Inhibits gastric acid secretion• Used to treat gastric ulcers from NSAIDS or

aspirin• Cytotec (give with food)• Proton Pump Inhibitors-blocks gastric acid production• Prevacid• Prilosec• Nexium

• Coating agent-protects the duodenal ulcer from gastric juices

• Give on empty stomach• Carafate

• S/E constipation

PROKINETIC AGENTS

• Stimulates stomach movement or motility• Reduces acid reflux• Empties stomach faster• Increases GI peristalsis• Prevents vomiting with CA therapy• S/E Drowsiness, fatigue, dizziness(provide for

safety)• Restlessness, abnormal tongue movements• Reglan give 30 min before meals & @ bedtime

ANTISPASMOTIC AGENTS

• Decreases gastric juices & GI motility• Decreases perspiration & oral & bronchial

secretions• Dilates pupils & causes blurred vision• Constipation & urinary retention• Tachycardia & palpitations• Orthostatic hypotension• Confusion, delusions, nightmares, hallucinations• Nsg. Precautions-Monitor BP & heart rate for 1

min. for irregularity• Atropine, Bentylol, Pro-Banthine & scopolamine

NAUSEA, VOMITING, RETCHING, CONSTIPATION, FECAL IMPACTION, DIARRHEA

• Nausea- sensation of abdominal discomfort • Vomiting- means expelling stomach contents

through the mouth (emesis).• Retching- involuntary, labored, spasmodic

contractions of the abdominal and respiratory muscles without vomitus (dry heaves).• Constipation- passage of a hard, dry stool. • Fecal impaction- prolonged retention and buildup

of feces in the rectum.• Diarrhea- frequent passage of liquid stools.

ANTIEMETICS

• Used to relieve nausea & vomiting• Common side affects

• Drowsiness• Dizziness• Dry mouth• Headache• Diarrhea• Confusion• Tremors• Blurred vision

• Nursing precautions• Safety measures to prevent injury from drowsiness• Orthostatic hypotension precautions • Best if given @ the onset of nausea

• Examples • scopolamine (Transderm scop)• meclizine (Antivert)• prochlorperazine (Compazine)• promethazine (Phenergan)• metoclopramide (Reglan)• ondansetron (Zofran)• ohlorpromazine (Thorazine)• diphenhydramine (Benadryl)• hydroxyline (Atarax, Vistaril)• torazepam (Ativan)

DRUGS FOR N/V

• Dopamine Antagonist(blocks the pathway to the vomiting center)• Pnenothiazides(Thorazine, Compazine)• Butyrophenones(Haldol, Reglan)• Seratonan Antagonist(Zofran)• Anti-Choli nergic for motion sickness(Dramamine,

Benadry,Atarax, Antivert, Transderm scopalamine)• Cortico-steroids-can be used alone or with other meds• (Decadron(usually only given a few times, so few SE)• Neurokinin-1 Receptor Inhibitor(emend-used with a

serotonin antagonist & a cortico-steroid

LAXATIVES

• Used to treat constipation• Common side affects • Nursing precautions• Examples • psyllium (Metamucil)• methylcellulose (Citrucel)• docusate sodium (Colace)• polyethylene (Miralax)• senna (Senokot)• Ducolax• Ex-lax• Peri-colace

ANTIDIARRHEAL

• Used to reduce or stop frequent stools-Local(absorbs excess water, irritants or bacteria causing the diarrhea)-Systemic (reduces peristalsis & GI motility)

• Common side affects• Headaches• Upset stomach• Nausea, vomiting• Constipation• Confusion• Blurred vision

• Nursing precautions• Observe for changes in stools, stomach cramps, vomiting

• Examples • Local-Pepto-bismol & Kaopectate• Systemic-Lomotil, Imodium, & Paregoric

COMMON CONDITIONS OF THE ENDOCRINE SYSTEM

• Thyroid• Hypothyroidism (cretinism- child, myxedema- adult• Hyperthyroidism (Graves disease, thyrotoxicoses)

• Parathyroid- tetany• Adrenal• Hypo-Addison’s disease• Hyper- Cushing’s syndrome

• Pancreases – diabetes (type I and II)• Gonads- reproductive system

DIABETES-INSULIN

• Ma’s are not allowed to give, except for those working in Ass. Living

• Insulin past 30 days from when opened, must be discarded

• Cold insulin is uncomfortable, thus you need to rotate in your hands to warm up prior to giving

• Is used for Type I or Type 2 if diet & exercise do not control the person’s blood sugar as well as surgery, infections, pregnancy or during increased physical or psychological stress

• Always monitor the injection site for redness or irritation

INSULIN

• Common side affects• Refer to signs/symptoms of hypo and hyperglycemia

• Nursing precautions• Monitor blood glucose levels• Monitor vital signs (tachycardia in insulin reactions)

• Examples • Rapid acting insulin(onset 20 min. Duration to 3-5 hrs.)

• Regular• Humalog• Novolog

• Short acting insulin(onset ½ hr. Duration5-10 hrs.)• Humulin R• Novolin R

• Intermediate acting insulin(onset 1/2hr. Duration 24 hrs.)• Lente • Humulin• Novolin• Humalog • Novolog

• Long acting insulin

• Used to provide insulin to regulate blood glucose levels• Lantus (Onset Duration 24 hrs.)

SULFONYLUREA-ORAL HYPO-GLYCEMIC AGENT

• Used when the pancreas can still secrete insulin• Low sugars are primary SE• !st generation drugs were produced over 30 yrs.

Ago• Side effects are • Nausea, vomiting• Jaundice(liver toxicity)• Abdominal cramps• Rash, itching(allergic reaction)• Sore throat & fever(changes in red & white blood cells)

CONT.

• 1st generation agents(Diabinese, Tolinase, Orinase)2nd generation agents(Amaryl, Glucotrol, Micronase)Meglitinide agents-stimulates the release of insulin-used

with metformin, PrandinTZD- Avandia-Makes muscle & fat cells more sensitive to

insulinAlpha-Glucosidase inhibitors-delays glucose absorption(usually used with other meds)

PrecoseGlyset

DRUG THERAPY FOR THYROID DISEASES

• Thyroid Replacement Hormones-treatment for hypothyroid ism(T3 & T4)• Observe for S/S of hyperthyroidism see p. 340• (Synthroid, Levoxyl, Cytomel, Thyrolar)• Monitor weight

• Anti-thyroid Drugs-blocks the formation of t3 & T4• Observe for S/S of hypothyroidism see p.340• (PTU, Propacil, Tapazole)• Monitor anorexia & nausea(liver toxicity)• Decreased urine output-bloody or smoky urine(kidney

toxicity)