meds for med surg-wendy

8/7/2019 Meds for Med surg-wendy

http://slidepdf.com/reader/full/meds-for-med-surg-wendy 1/17



Medication

Trade/Generic Classification

Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications

Nursing Implications

Time(s) to

be given Pre/post

admin Labs/VS to

consider

Colace/

docusate sodium OTC

Adult: PO 50-

300 mg/day(docusate

sodium) or 240mg (docusate

calcium or docusate

potassium) prnEnema 4 ml

(docusatesodium)

Available forms:

Docusatecalcium: caps

240 mg;docusate

sodium: caps 50,100, 250 mg;

tabs 100 mg; syr 20 mg/5 ml, 50

mg/15 ml, 100mg/30 ml, 150

mg/15 ml; oralsol 10, 50

mg/ml; enema283 mg/3.9 g

cap

Uses: To soften

stools, preventconstipation,

soften fecalimpaction (rectal

route)

Action: Increaseswater, fat

penetration inintestine; allows

for easier passageof stool; increases

electrolyte, water secretion in colon

Therapeutic

outcome:Passage of

softened stool,absence of

constipation

EENT: Bitter taste, throat

irritation

GI: Nausea, anorexia,cramps, diarrhea

INTEG: Rash

Contraindications:

Hypersensitivity,obstruction, fecal

impaction,nausea/vomiting

Precautions:

Pregnancy C, breastfeeding

Nursing:

Assess cramping,rectal bleeding,

nausea, vomiting; if these symptoms

occur, product should be discontinued;

identify cause of constipation; identify

whether fluids, bulk,or exercise is missing

from lifestyle

Dilute oral

sol in juice or

other fluidto disguise

taste

Give tabsor caps

with 8 ozof liquid;

give onempty

stomachfor

increasedabsorption

, results

N/A



Medication

Trade/GenericClassification

Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to

be given

Pre/post

adminLabs/VS to

consider

Senakot S Adult:

PO 1-8 tabs/day ½ to 4 tsp of

granules added towater or juice

RECT SUPP

1-2 at bedtime

SYRUP 1-4 tsp at bedtime

(1 tsp = 4 ml), 7.5-15 ml; (Black

Draught) ¾ oz

dissolved in 2.5 ozof liquid given

between 2-

4 PM the day before procedure(X-Prep)

Availableforms: Tabs 6,

8.6, 15, 25 mg;granules 15, 20mg/5 ml; syr 8.8

mg/5 ml; liquid

33.3 mg/ml

Uses: Acute

constipation; bowel preparation for

surgery or exam,

prevention of constipation in those

taking opiates longterm

Action: Stimulates

peristalsis by actionon Auerbach's

plexus; softens feces

by increasing water and electrolytes in

large intestine

GI: Nausea, vomiting,

anorexia, abdominal cramps, diarrhea, flatulence

GU: Pink-red or brown-black

discoloration of urine

META: Hypocalcemia,

enteropathy, alkalosis,

hypokalemia, tetany

Contraindications:

Breastfeeding,hypersensitivity, GI

bleeding, intestinal

obstruction, CHF,abdominal pain,

nausea/vomiting,appendicitis, acutesurgical abdomen

Nursing: Assess cramping, rectal

bleeding, nausea,

vomiting; if these

symptoms occur, product

should be discontinued;

identify cause of

constipation; identify

whether fluids, bulk, or

exercise is missing fromlifestyle Assess for magnesium

toxicity: thirst, confusion,decrease in reflexes

Monitor blood ammonia

level (30-70 mg/100 ml);

monitor for clearing of

confusion, lethargy,

restlessness, irritability

(hepatic encephalopathy)

Once per

day

Monitor:

-Blood-Urine

-Electrolytes

if used often by patient -Check I&Oratio toidentify fluid

loss

-Monitor bloodammonia



Medication

Trade/Generic

Classification

Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to

be given

Pre/post admin

Labs/VS to

consider

Lisinopril/Prinivil, Zestril

F unc. class.:

Antihypertensive,angiotensin converting

enzyme (ACE) inhibitor

Hypertension Adult: PO 10-40

mg/day; may

increase to 80mg/day if required

Geriatric: PO 2.5-5

mg/day, increaseq7day

CHF Adult: PO 5 mg

initially withdiuretics/digoxin,

range 5-20 mg

Available forms: Tabs 2.5, 5, 10, 20,

30 40 mg

Action: Selectively

suppresses renin-

angiotensin-

aldosterone system;inhibits ACE; prevents

conversion of

angiotensin I to

angiotensin II; resultsin dilatation of arterial,

venous vessels

Therapeutic

outcome: DecreasedB/P in hypertension,

decreased preload,

afterload in CHF

Uses: Mild to

moderatehypertension,

adjunctive therapy of

systolic CHF, acuteMI

CNS : V ertigo, depression, stroke,

insomnia, paresthesias, headache,

fatigue, asthenia, dizziness

CV : Chest pain, hypotension

EE NT : Blurred vision, nasal

congestion

GI: Nausea, vomiting, anorexia,

constipation, flatulence, GIirritation, diarrhea

GU: Proteinuria, renalinsufficiency, sexual dysfunction,

impotence

I NT EG: Rash, pruritus

MI SC : Muscle cramps,

hyperkalemia

RE SP : Dry cough, dyspnea

SYST : Angioedema

Contraindications: Hypersensitivity,

angioedema

Assessment -Assess blood studies:

platelets, WBC with

differential, baseline,

periodically q3mo; if neutrophils <1000/mm3,

discontinue treatment

-Monitor B/P, check for orthostatic hypotension,

syncope; if changesoccur, dosage change may

be required

-baselines in renal, liver

function tests before

therapy begins

-Monitor renal, liver function tests: protein,

BUN, creatinine; watch

for increased levels thatmay indicate nephrotic

syndrome and renal

failure; monitor renal

symptoms: polyuria,

oliguria, frequency,

dysuria

-Check potassium levels

throughout treatment,

-Check for edema

-Assess for allergicreactions: rash, fever,

pruritus, urticaria; product

Onset 1 hr

Peak 6-8 hr

Duration 24 hr

Interference:

glucose/insulin

tolerance tests,

ANA titer



fibrillation, atrial

flutter, atrialtachycardia;

cardiogenic shock, paroxysmal atrial

tachycardia

-Monitor ECG continuouslyduring parenteral loadingdoses and for patients withsuspected toxicity; provide

hemodynamic monitoringfor patients with heart failureor administer multiplecardiac products

closemonitoring isnecessaryStore

protectedfrom light

MedicationTrade/Generic

Classification

Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to be given

Pre/postadmin

Labs/VS toconsider

Zocor/Simvastatin

F unc.class.: Antilipide

mic

C hem. class.: HMG-CoA reductase

inhibitor

Adult: PO 20

mg/dayin PM initially,

usual range 5-40mg/day daily in PM,

max 80 mg/day;

dosage adjustments

may be made at 4-

wk intervals or

more; those taking

verapamil, max 20mg/day

Renal dose/those

taking gemfibrozil,

danazol Adult: PO 5 mg

day, initially; CCr

<20 ml/min 5 mg qd

in the evening

Cardiac/renal

transplantation Adult: PO 5

mg/day, max 10mg/day

With amiodarone

or verapamil

Adult: PO max 20mg/day

Action: Inhibits

HMG-CoAreductase enzyme,

which reducescholesterol

synthesis; thisenzyme is needed

for cholesterol

production

Therapeutic

outcome:Decreasing

cholesterol levelsand LDLs,

increased HDLs

Uses: As anadjunct in primary

hypercholesterolemia (types IIa,

IIb), isolatedhypertriglyceridem

ia (Frederickson

type IV) and typeIII

CNS: Headache, ALS (Lou

Gehrig's disease)

EENT: Lens opacities

GI: Nausea, constipation,diarrhea, dyspepsia, flatus,

abdominal pain, liver

dysfunction, pancreatitis

INTEG: Rash, pruritus,

photosensitivity

MS: Muscle cramps,myalgia, myositis,

rhabdomyolysis

RESP: Upper respiratorytract infection

Contraindications:

Pregnancy X, breastfeeding,

hypersensitivity,active liver disease

Nursing Implications-Assess nutrition: fat,

protein, carbohydrates;

nutritional analysis should be completed by dietitian

before treatment is

initiated

Assess for

rhabdomyolysis: muscle

tenderness, increased

CPK levels; therapy

should be discontinued

- Monitor bowel patterndaily; diarrhea may be a

problem

- Monitor triglycerides,

cholesterol baseline,throughout treatment;

LDL, HDL, triglycerides

and cholesterol should be

watched closely at 6-8 wk

and q6mo; if increased,

Give 30 min

before AM and PM meals

Increased:

CPK, liver function tests



DVT/PE Adult: SUBCUT

5000 units q8-12hr

Heparin flush

Adult and child: IV 10-100

units/ml

coagulation (DIC) immediately; HIT may occur after product discontinuation

- Monitor for

hypersensitivity: fever, skinrash, urticaria; notify prescriber immediately

Medication


Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to

be given

Pre/post

adminLabs/VS to

consider

Fragmin/ Dalteparin

F unc.

class.: Anticoagulant

C hem. class.: Low-molecular-weight

heparin

Hip replacement

surgery/DVT

prophylaxis

Adult: SUBCUT2500 international

units 2 hr before

surgery and 2nd

dose in the evening

the day of surgery

(4-8 hr postop), then

5000 internationalunits SUBCUT 1st

postop day anddaily 5-10 days

Unstable

angina/non-Q-

wave MI Adult: SUBCUT

120 international

units/kg q12hr × 5-8

days; max 10,000

international unitsq12hr × 5-8 dayswith concurrentaspirin, continue

until stable

Deep vein

thrombosis,

prophylaxis for

abdominal surgery Adult: SUBCUT

2500 international

Action: Inhibits

factor Xa/IIa(thrombin),

resulting inanticoagulation

Therapeutic

outcome: Absenceof deep vein

thrombosis

Uses: Unstableangina/non-Q-wave MI;

prevention of deepvein thrombosis in

abdominal surgery,

hip replacement patients or thosewith restricted

mobility duringacute illness;

pulmonaryembolism

CNS : Intracranial bleeding

HEMA:

Thrombocytopenia

INTEG: Pruritus, superficialwound infection

SYST: Hypersensitivity, he

morrhage,anaphylaxis possible

Contraindications: Hypersensitivity to this

product, heparin, pork

products, benzyl alcohol;active major bleeding,

hemophilia, leukemia

with bleeding,

thrombocytopenic

purpura, cerebrovascular

hemorrhage, cerebral

aneurysm, thoseundergoing regional

anesthesia for unstableangina, non-Q-wave MI,dalteparin-induced

thrombocytopenia

Nursing Implications-Assess for bleeding (Hct,

occult blood in stools)

during treatment since

bleeding can occur

- Assess for bleedinggums, petechiae,ecchymosis, black tarrystools, hematuria,

epistaxis, decrease in Hct,

B/P; may indicate

bleeding, possible

hemorrhage; notify

prescriber immediately;

product should bediscontinued

-Assess for

Drug

peaks 4hours after

administration

Hct, Occult

Blood



units daily, evening

prior to abdominal

surgery and repeat

daily × 5-10 days; in

high-risk patients

5000 international

units should be used

hypersensitivity: fever,

skin rash, urticaria; notify

prescriber immediately

- Assess for needed

dosage change q1-2wk;

dose may need to be

decreased if bleedingoccurs

Medication


Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to

be given

Pre/post

adminLabs/VS to

consider

Morphine/

morphine sulfate,Morphitec

F unc. class.: Opioid

analgesic

C hem. class.: Alkaloid

Adult:

SUBCUT/IM 5-20 mg q4hr prn;

PO 10-30 mgq4hr prn;

EXT REL 15-30mg q8-12hr;

RECT 10-20 mgq4hr prn; IV 2.5-15 mg diluted in

4-5 ml of water for inj, over 5

min;

SUS REL cap(Kadian), EXT

REL cap(Avinza) give

total daily doseq24hr; for those

with notolerance to

opioids, 30mg/day, may

adjust by no

Action: Depresses

pain impulsetransmission at the

spinal cord level by interacting with

opioid receptors

Therapeutic

outcome: Decreas

ed pain

Uses: Moderate to

severe pain

CNS: Drowsiness,

dizziness, confusion, headache, sedation, euphoria,

insomnia, seizures

CV: Palpitations, bradycard

ia, change in B/P, shock,

cardiac arrest, chest pain,

hyper/hypotension,

edema, tachycardia

EENT: Tinnitus, blurred

vision, miosis, diplopia

GI: Nausea, vomiting,anorexia, constipation, cram

ps, biliary tract pressure

GU: Urinary retention

HEMA:

Thrombocytopenia

INTEG: Rash, urticaria,

bruising, flushing,diaphoresis, pruritus

Contraindications:

Hypersensitivity,addiction (opioid),

hemorrhage, bronchialasthma, increased ICP

Nursing

Implications

- Assess pain: location,type, character, intensity;give dose before pain

becomes extreme

- Monitor I&O ratio;

check for decreasing

output; may indicate

urinary retention; check

for constipation; increase

fluids, bulk in diet if needed, or stimulantlaxatives may be

prescribed

- Monitor CNS changes:

dizziness, drowsiness,

hallucinations, euphoria,

LOC, pupil reactions

- Monitor allergic

reactions: rash, urticaria

Administ

er when pain is

beginningto return;

determinedosageinterval by

patient

response;continuous dosing

of medicatio

n is moreeffective

thangiving prn

Increased:

amylase



more than 30 mg

q4day Resp: Respiratory

depression, respiratory

arrest, apnea

- Assess respiratory

dysfunction: depression,

character, rate, rhythm;

notify prescriber if

respirations are <10/min

MedicationTrade/Generic

Classification

Patient Dose

Dose Limits

Uses/Purpose

Mode of Action

Side Effects

Adverse Reactions

Contraindications


Time(s) to be given

Pre/postadmin

Labs/VS toconsider

Hydromorphone/

Dilaudid

F unc.class.: Antitussive,

opioid analgesicagonist

C hem.class.: Phenanthrenederivative, guaifenesin

Antitussive Adult: PO 1 mgq3-4hr prn

Child 6-12

yr: PO 0.5 mgq3-4hr

Geriatric: PO 1-2 mg q4-6hr

Availableforms: Inj 1, 2,

4, 10 mg/ml;tabs 2, 4, 8 mg;

oral sol 5 mg/5

ml; supp 3 mg

Action: Inhibits

ascending pain pathways in CNS,

increases painthreshold, alters

pain perception

Therapeutic

outcome: Decreased cough,decreased pain

Uses: As an

antitussive tosuppress cough;

moderate to severe

pain

CNS: Dizziness,

drowsiness, sedation,confusion, headache,

euphoria, moodchanges, seizures

CV: Hy potension,

brad ycardia, palpitations,

change in B/P, tachycardia, peripheral vasodilatation

EENT: Miosis, diplopia, blurred vision, tinnitus

GI: Nausea, constipation,

vomiting, anorexia, dry

mouth, cramps, paralyticileus

GU: Increased urinaryoutput, dysuria, urinary

retention

INTEG: Urticaria, rash,

flushing, bruising,diaphoresis, pruritus

Contraindications:

Hypersensitivity

Nursing

Implications

- Assess pain control,

sedation by scoring on

0-10 scale; around-the-clock dosing is best for

pain control

- Monitor VS after

parenteral route; notemuscle rigidity;

product history, renal,liver function tests;

respiratory dysfunction:

respiratory depression,character, rate, rhythm;notify prescriber if

respirations are

<10/min

- Monitor CNSchanges: dizziness,

drowsiness,hallucinations,euphoria, LOC, pupil

Give when

pain is beginning

to return;determine

dosageinterval by

patient

response;continuous dosing

of medicatio

n is moreeffective

given prn;

explainanalgesiceffect

Increased:

amylase



Human regular Adult: SUBCUT ½-1hr before meals

Insulin, isophane

suspension Adult: SUBCUTdosage individualized

by blood, urineglucose; usual dose 7-26 units; may increase by 2-10 units/day if needed

Insulin detemir Adult: SUBCUT 1 or 2 times/day; if 1 time,give with eveningmeal

Insulin glargine Adult and child 6yr: SUBCUT 10

internationalunits/day, range 2-100international units/day

sulfonylureas in

children >3 yr acetone breath, polyuria,

fatigue, polydipsia,

flushed, dry skin, lethargy

INSULIN Table:

Type Onset Peak Duration

Rapidand Short-Acting

Insulin glulisine (Apidra) 15 min 1 hour 2-3 hours

Insulin lispro (Humalog) 15 min 1 hour 4 hours

Insulin aspart (NovoLog) 30 min 1-3 hours 3-5 hours

Regular insulin*

30 min-1 hour 2-4 hours 5-7 hours

Intermediate-Acting

Isophane insulin suspension (NPH insulin, Humulin N) 3-4 hours 6-12 hours 18-28 hours

Insulin zinc suspension (Lente insulin) 1-3 hours 8-12 hours 36 hoursLong-Acting



Type Onset Peak Duration

Extended insulin zinc suspension (Ultralente) 4-6 hours 18-24 hours 36 hours

Insulin glargine (Lantus)

1-5 hours Plateau 24 hours

Insulin detemir (Levemir) 3-4 hours ³Peakless´ 24 hours

meds for med surg-wendy

Documents