Nursing Drug Reference Weeks 6 and 7

Ondansetron (Rx)

Zofran, Zofran ODT, and Zuplenz

• Patient cannot swallow
• Decreased LOC
• Drug inactivated by gastric juices
• Desire to increase drug effectiveness 
• Does not go through first pass

• Vials, ampules
• Pre-filled syringes
• Powder form
• *These drugs are prepared, packaged, administered in ways to maitain sterility.

• Check dates for possible expiration
• Assess fluid for clarity and color
• Wear gloves to administer

• Glass or plastic with needle-accessible rubber stopper
• Single use vial
• Multiple dose vial

• Plunger
• Barrel
• Needle hit or hub
• Needle

• Shaft
• Lumen
• Bevel

Ready solution or powder for reconstitution

No preservatives - discard after one use

• May contain a preservative, used for several doses IF asepsis maintained
• Must be laveled with date/time opened & initials of person who opened
• If drug expires, this date & time must be labeled also

• The larger the gauge number, the smaller the diameter of the lumen
• The smaller the gauge number, the larger the diameter of the lumen

• Needle gauge 25, 26, 27
• Needle length 3/8, 1/2, 5/8

• Needle gauge 25, 26, 28
• Needle length 3/8, 1/2, 5/8

• Needle gauge 19, 20, 21, 22
• Needle length 1, 1 1/2, 2

5 - 15 degrees, just under the epidermis, and create a bleb

90 degree angle

45 and 90 degree angles

Do not recap the needle and place in sharps container

• 1. Use appropriate sized syringe
• 2. Use appropriate needle size
• 3. Consider depth of site and type of solution
• 4. Choose muscular sites
•      a. Ventrogluteal, dorsogluteal, deltoid, and vastus lateralis
•      b. Select by identifying anatomic landmarks
•      c. Avoid use of same site repeatedly

• Used for IM injections ONLY
• Move skin to one side
• Administer medication
• Withdraw needle
• Once the needle is withdrawn, displaced tissue is allowed to return to its normal position, preventing the solutuion from escaping from the musle tissue

• Greater trochanter of femur
• Anterior/Superior of iliac spine
• Iliac crest

• Ventrogluteal 
• Vastus Lateralis
• Deltoid
• Dorsogluteal

• Posterior/Superior Iliac Spine
• Greater trochanter of femur
• Gluteous medias
• OR BLESS THE BOOTY (horizontal line across anus - verticle line down from iliac crest)
• Upper/Lateral quadrant

• Used for administration of diagnostic agents:
• 1. Preferred site is the inner aspect of forearm
•      a. Hairless, thinly keratinized
•      b. Upper chest or back also used
• 2. 1 mL tuberculin syringe, 26 gauge needle
• 3. Position needle with bevel up
• 4. Insert through epidermis so point of needle is almost visible under skin - advance needle 1/8 inch under skin
• 5. Inject (0.1 mL) until wheal appears - withdraw needle

Crackers and Peanut Butter

• 1. Review Order
• 2. Gather all supplies
• 3. Wash hands, Explain procedure, don gloves
• 4. Select a site (lateral aspect or side of finger)
• 5. Cleanse with alcohol, let dry
• 6. Activate monitor and insert regent strip
• 7. Place the injector (lance) against the site & release needle
• 8. Squeeze till "hanging drop" is obtained
• 9. Hold the regent strip under the puncture site until adequate blood is applied
• 10. Give patient tissue or gauze for puncture site
• 11. Follow the monitor countdown and read the outcome
• 12. Discard the regent strip & lancet into sharps container (cleanse glucometer with cleansing wipes if contaminated)
• 13. Discard gloves, wash hands
• 14. Record the outcome and report to nurse

• 1. Explain the purpose of the specimen collection and the procedure
• 2. Provide client comfort, privacy, and safety
• 3. Use the correct procedure or ensure that client or staff follows the correct procedure
• 4. Follow up on any need for insulin coverage for the patient

• The sealed glass container must be broken to allow insertion of needle and withdrawal of the medication (use safety precautions)
• Use filter needle to prevent glass in solution
• Discard unused portion
• Discard broken ampule in sharps container

• Single dose/Single use
• Some have needle attached
• Several forms of these
• ***Often called "Tubexes"
• ***May require adapter to administer

• Insulin or Heparin
•      a. Small gauge
•      b. Shorter needle
• Never more than 1 mL at a site
• Use angle of needle that insures infusion into SC and not muscle
• Do NOT aspirate
• ***Insulin is ONLY drawn up in Insulin syringes***

• Rotate sites
• Avoid overuse and damage

• Greater Trochanter of femur
• Patella

• Acromial process at the Head of the Humerus
• Three fingers down

Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine

Prevention of nausea, vomiting associated with cancer chemotherapy; radiotherapy; prevention of postoperative nausea, vomiting

Headache, dizziness, drowsiness, fatigue, EPS

Diarrhea, constipation, abdominal pain, dry mouth

Rash, bronchospasm (rare), musculoskeletal pain, wound problems, shivering, fever, hypoxia, urinary retention

• Absence of nausea, vomiting during chemotherapy
• Hypersensitivity reaction: rash, bronchospasm (rare)

Shuffling gait, tremors, grimacing, rigidity periodically

Storage at room temp for 48 hr after dilution

Therapeutic response: absence of nausea, vomiting during cancer chemotherapy

• To report diarrhea, constipation, rash, changes in respirations, or discomfort at insertion site
• Headache requiring analgesic is common

Antacid, hypophosphatemic

Neutralizes gastric acidity; binds phosphates in GI tract, these phosphates are then excreted

• Antacid, hyperphosphatemia in chronic renal failure; adjunct in gastric, peptic, duodenal ulcers; hyperacidity, reflux esophagitis, heartburn, stress ulcer prevention in critically ill, GERD
• NOTE: Unlabeled uses: GI bleeding

Constipation, anorexia, obstruction, fecal impaction

Hypopbosphatemia, hypercalciuria

• Pain: location, intensity, duration, character, aggravating, alleviating factors
• Phosphate, calcium levels: Because product is bound in GI system
• Hypophosphatemia: anorexia, weakness, fatigue, bone pain, hyporeflexia
• Constipation: increase bulk in diet if needed

Therapeutic response: absence of pain, decreased acidity, healed ulcers, decreased phosphate levels

• To increase fluids to 2 L/day unless contraindicated; measures to prevent constipation
• Antacid: not to use for prolonged periods for patients with low serum phosphate or patients on low-sodium diets
• That stools may appear white or speckled
• To check with prescriber after 2 wk of self-prescribed antacid use
• To separate from other medications by 2 hr
• Hyperphosphatemia: To avoid phosphate foods (most dairy products, eggs, fruits, carbonated beverages) during product therapy

No risk demonstrated to the fetus in any trimester

No adverse effects in animals, no human studies available

Only given after risks to the fetus are considered; animal studies have shown adverse reactions; no human studies available

Definate fetal risks, may be given in spite of risks if needed in life threatening conditions

The time it takes for 50% of the drug to get out of your system.

Time when the drug is the strongest.

Absolute fetal abnormalities; not to be used anytime during a  pregnancy

Frequency, urinary retention, dysuria

Benadryl

diphenhydrAMINE (OTC, Rx)

Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site; decreases allergic response by blocking histamine

Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, night-time sedation, infant colic, nonproductive cough, insomnia in children

• Nystagmus 
• A term to describe fast, uncontrollable movements of the eyes that may be:
• Side to side (horizontal nystagmus)
• Up and down (vertical nystagmus)
• Rotary (rotary or torsional nystagmus)
• Depending on the cause, these movements may be in both eyes or in just one eye. The term "dancing eyes" has been used to describe nystagmus.

• CNS: seizures
• HEMA: thrombocytopenia, agranulocytosis, hemolytic anemia
• MISC: anaphylaxis

• CNS: Suicidal ideation
• HEMA: Leukopeia, granulocytopenia (rare)
• SYST: Severe allergic reactions

• BUN
• ALT
• AST

Ambien, Ambien CR, Edluar, Zolpimist

zolpidem (Rx)

Yes, Schedule IV

To pump or leave the stomach

Restoril

temazepam (Rx)

Sedative/hypnotic

Yes, schedule IV

Insomnia

How a drug moves or works through the body.

• Albumin, to check protein levels
• If protein is low, the drug will connect with receptor sites and the individual is at risk for drug toxicity!

It means the drug binds to the protein in the body.

If the protein levels are low, the drug will bind to receptor sites and the individual is at risk for drug toxicity. CHECK ALBUMIN LEVELS (for protein).

Produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter y-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action.

Pregnancy (X), breastfeeding, hypersensitivity to benzodiazepines, intermittent porphyria

SYST: Severe allergic reactions

Antiemetic

Hypersensitivity to H₁-receptor antagonist, acute asthma attack, lower respiratorytrack disease, neonates

Pregnancy (B), breastfeeding, children <2 yr, increased intraocular pressure, cardiac/renal disease, hypertension, bronchial asthma, seizure disorder, stenosed peptic ulcers, hyperthyroidism, prostatic hypertrophy, bladder neck obstruction

• Avoid use in children <2 yr; death has occurred; overdose has occurred with topical gel taken orally (adult/child)
• • With meals for GI symptoms; absorption rate may slightly decrease
• • Deep IM in large muscle; rotate site
• • At bedtime only if using for sleep aid

• Metabolized in liver, excreted by kidneys, crosses placenta, excreted in breast milk, half-life 2-7 hr
• PO: Peak 1-3 hr, duration 4-7 hr
• IM: Onset 1/2 hr, peak 1-4 hr, duration 4-7 hr
• IV: Onset immediate, duration 4-7 hr

• • Urinary retention, frequency, dysuria; product should be discontinued
• • CBC during long-term therapy; blood dyscrasias may occur
• • Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness

• • Hard candy, gum, frequent rinsing of mouth for dryness
• • Storage in tight container at room temp

• Therapeutic response: absence of running or congested nose or rashes, improved sleep

• • About all aspects of product use; to notify prescriber of confusion, sedation, hypotension
• • To avoid driving, other hazardous activity if drowsiness occurs
• • That photosensitivity may occur
• • To avoid concurrent use of alcohol, other CNS depressants
• • To avoid breastfeeding

Children <15 yr, geriatric patients, anemia, renal/hepatic disease, suicidal individuals, drug abuse, psychosis, acute closed-angle glaucoma, seizure disorders, angioedema, sleep-related behaviors (sleepwalking), pulmonary disease

Produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter γ-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action

Onset 30-60 min, duration 6-8 hr, half-life 10-20 hr, metabolized by liver, excreted by kidneys, crosses placenta, excreted in breast milk, 98% protein binding

Lavage, activated charcoal; monitor electrolytes, VS

• • Mental status: mood, sensorium, affect, memory (long, short)
• • Type of sleep problem: falling asleep, staying asleep
• • Dependency: restrict amount given to patient, assess for physical/psychological dependency; high-level risk for abuse

• • Assistance with ambulation after receiving dose
• • Safety measures: night-light, call bell within easy reach
• • Checking to confirm that PO medication has been swallowed
• • Storage in tight container in cool environment

• Therapeutic response: ability to sleep at night, decreased early morning awakening if taking product for insomnia

• • To avoid driving, other activities requiring alertness until stabilized
• • To avoid alcohol ingestion
• • That effects may take 2 nights for benefits to be noticed
• • To limit to 7-10 days of continuous use
• • About alternative measures to improve sleep: reading, exercise several hours before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing
• • Not to discontinue abruptly, withdraw gradually
• • That complex sleep-related behaviors may occur: sleep driving/eating
• • That hangover, memory impairment are common in geriatric patients but less common than with barbiturates
• To notify prescriber if pregnancy is planned or suspected, pregnancy (X); to use contraception while taking this product

Produces CNS depression at limbic, thalamic, hypothalamic levels of CNS; may be mediated by neurotransmitter γ-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action

Insomnia, short-term treatment; insomnia with difficulty of sleep onset/maintenance (ext rel)

Hypersensitivity to benzodiazepines

Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, anemia, renal/hepatic disease, suicidal individuals, drug abuse, psychosis, seizure disorders, angioedema, depression, respiratory disease, sleep apnea, sleep-related behaviors (sleepwalking), myasthenia gravis

• PO route:
• • Do not break, crush, or chew ext rel
• • After trying conservative measures for insomnia, take with full glass of water
• • 1/2-1 hr before bedtime (PO); right before retiring (ext rel)
• • On empty stomach for fast onset; may be taken with food if GI symptoms occur
• • Avoid use with CNS depressants; serious CNS depression may result
• Spray route:
• • Prime before first use or if pump is not used for ≥14 days
• • Do not use spray with or after a meal
• Sublingual route:
• • Separate blister pack at perforation, peel paper and push product through, place product under tongue, allow to dissolve before swallowing; do not take with water

PO: Onset up to 1.5 hr, metabolized by liver, excreted by kidneys (inactive metabolites), crosses placenta, excreted in breast milk, half-life 2-3 hr

• • That dependence is possible after long-term use
• That complex sleep-related behaviors may occur (sleep driving/eating)
• • To avoid driving or other activities requiring alertness until dosage is stabilized
• • To avoid alcohol ingestion
• • That effects may take 2 nights for benefits to be noticed
• • About alternative measures to improve sleep: reading, exercise several hours before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing
• • Not to use during pregnancy, breastfeeding
• • That hangover is common in geriatric patients but less common than with barbiturates; that rebound insomnia may occur for 1-2 nights after discontinuing product; not to discontinue abruptly; to taper

• Mental status -  mood, sensorium, affect, memory (long, short term), excessive sedation, impaired coordination, suicidal thoughts/behaviors
• • Blood dyscrasias: fever, sore throat, bruising, rash, jaundice, epistaxis (rare)
• • Type of sleep problem: falling asleep, staying asleep

• • Assistance with ambulation after receiving dose
• • Storage in tight container in cool environment

• Therapeutic response: ability to sleep at night, decreased amount of early morning awakening if taking product for insomnia

Lavage, activated charcoal; monitor electrolytes, VS

Antiemetic

Antihistamine (1st generation, nonselective)

REM Rebound: May result in vivid dreams and nightmares.

When you are sleep deprived you lose out on two types of sleep, REM and NREM (non-REM).Typically when you have a chance to fall asleep after sleep deprivation you have a tendency to get more REM sleep than you would normally get. This is your body's way of trying to catch up on its REM sleep. (Prolonged period in REM can cause vivid dreams and nightmares).

It suppresses stage 4 of NREM sleep (the deepest sleep) and may result in vivid dreams or nightmares and can delay REM sleep (causing you to be in REM longer than you should be).

• Yes, 98%
• This can be a cause for concern, if the patient's protein level is low, as it will result in more of the drug floating freely in their bodies, as it can result in Drug Toxicity.

• Ensure they have swallowed the pill. 
• The patient is at risk for suicide and if the pills are saved up and taken at once, can cause death.
• XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
• End of Module 6 and 7 medications

• Positive inotropic action
• Negative chronotropic action
• Negative dromotropic action
• Increases stroke volume
• NOTE: Gives your heart a little umph!

• Lanoxin
• NOTE: Do not confuse with Levoxine!!!

digoxin (Rx)

Cardiac glycoside, inotropic, antidysrhythmic