Nursing Drug Reference Weeks 8 and 9

buPROPion (Rx)

• Wellbutrin (depression)
• Zyban (smoking cessation)

• Antidepressant
• Miscellanious smoking deterrent

• Inhibits reuptake of DOPamine
• (PROP DOPE)

• Depression (Wellbutrin)
• Smoking cessation (Zyban) 
• Seasonal affective disorder

• Hypersensitivity
• Eating disorders
• Seizure disorders

• Pregnancy (C)
• Breastfeeding
• Geriatric patients
• Renal/hepatic disease
• Recent MI
• Cranial trauma
• Seizure disorder

Children < 18 years, suicidal thinking/behavior (young adults)

• Common: Headache, agitation, dizziness, akinesia, bradykinesia, confusion, insomnia, sedation, tremors
• Life threatening: Seizures and suicidal ideation

• Common: Dysrhythmias, hypertension, tachycardia
• Life threatening: Complete AV block, QRS prolongation (overdose)

• Common: Blurred vision and auditory disturbance
• Life threatening: NONE

• Common: Nausea, Vomiting, dry mouth, and constipation
• Life threatening: NONE

• A catecholamine neurotransmitter in the central nervous system, retina, and sympathetic ganglia,acting within the brain to help regulate movement and emotion
• NOTE: its depletion may cause Parkinson's disease.
• Pharmacology:  A dopamine preparation may be used to increase the force of contraction of the heart in the treatment of shock

• Common: Menstrual irregularities
• Life threatening: NONE

• Common: Rash and sweating
• Life threatening: Stevens-Johnson syndrome

• Common: Weight loss or gain
• Life threatening: NONE

• Onset: 2-4 weeks
• Half-life: 14 hr
• Extensively metabolized by the liver, some conversion to active metabolites
• Steady state: 5-8 days
• Protein binding: 84%
• Excreted in urine and feces

Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms

• Hepatic/renal function in patients with hepatic, kidney impairment
• For increased risk of seizures; if patient has excessively used CNS depressants and OTC stimulants, dosage of buPROPion should not be exceeded
• For smoking cessation after 7-12 wk; if progress has not been made, product shold be discontinued
• BLACK BOX WARNING: Mental status: mood, sensorium, affect, suicidal tendencies, increasein psychiatric symptoms

• Assistance with ambulation during beginning therapy because sedation occurs
• Safety measures, primarily for geriatric patients

Therapeutic response: decreased depression, ability to perform daily activities, ability to sleep throughout the night, smoking cessation

• That therapeutic effects may take 2-4 wk; not to increase dose without prescriber's approval; that treatment for smoking cessation lasts 7-12 wk
• To use caution when driving, performing other activities that require alertness; sedation, blurred vision may occur
• To avoid alcohol, other CNS depressants; alcohol may increase risk of seizures
• Not to use with nicotine patches unless directed by prescriber; may increase B/P
• To notify prescriber immediately if urinary retention occurs
• That risk of seizures increased when dose exceeded, if patient has siezure disorder
• That suicidal ideas, behaviors, hostility, depression may occur in children or young adults
• To notify prescriber if pregnancy is suspected, planned: pregnancy (C)

ECG monitoring; lavage, activated charcoal; administer anticonvulsant

• Neuropathic pain
• Enhancement of weight loss
• ADHA (attention-deficit/hyperactivity disorder)

Prozac

FLUoxeine (Rx)

Antidepressant, SSRI (selective serotonin reuptake inhibitor)

Inhibits CNS neuron uptake of serotonin but not of norepinephrine

• Major depressive disorder
• Obsessive-compulsive disorder (OCD)
• Bulimia nervosa
• Sarafem: premenstrual dysphoric disorder (PMDD) and panic disorder

• Alcoholism
• Anorexia nervosa
• Borderline personality disorder
• Obesity
• Posttramatic stress disorder
• Autism
• Fibromyalgia
• Orthostatic hypotension
• Premature ejaculation

Hypersensitivity

• Pregnancy (C), breastfeeding, geriatric patients, diabetes mellitus, narrow-angle glaucoma, cardiac malformations in infants (exposed to FLUoxetine in utero)
• BLACK BOX WARNING: Children, suicidal ideation

Children, suicidal ideation

• Common: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziess, fatigue, sedation, poor concertration, abnormal dreams, agitation
• Life threatening: Seizures, suicidal ideation, neuroleptic malignant syndrome-like reactions

• Common: Hot flashes and palpitations
• Life threatening: Tachycardia, 1st degree AV block, bradycardia, MI, and thrombophlebitis

• Common: Nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, tast changes, flatulence, decreased appetite
• Life threatening: NONE

• Common: Dysmenorrhea, decreased libido, urinary frequency and UTI
• Life threatening: NONE

• Common: NONE
• Life threatening: Hemorrhage

• Common: Sweating, rash, and pruritus
• Life threatening: Angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis

• Common: Pain
• Life threatening: NONE

• Common: Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, and bronchitis
• Life threatening: NONE

• Common: Asthenia, viral infection, fever, allergy, and chills
• Life threatening: NONE

• PO: Peak 6-8 hr
• Metabolized: in liver
• Excreated: in urine
• Terminal half-life: 2-3 days
• Norfluoxetine active metabolite (transforms to this drug)
• Half-life: 4-16 days
• Steady state: 28-35 days
• Protein binding: 94% (need albumin labs)

• BLACK BOX WARNING: Mental status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic; monitor for seizures, seisure potential increased
• Bulimia nervosa: appetite, weight daily, increase nutritious foods in diet, watch for bingeing and vomiting
• Alleric reactions/serious skin reactions: angloedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, rash, uticaria; product should be discontinued, may need to give antihistamine
• B/P (lying/standing), pulse q4hr, if systolic B/P drops 20 mm Hg, hold product, notify prescriber; ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
• Blood studies: CBC, leukocytes, differential, cardic enzymes if patient is receiving long-term therapy; check platelets; bleeding can occur, thyroid function, growth rate, and weight
• Hepatic studies: AST, ALT, bilirubin, creatinine, weight weekly; appetite may decrease with product
• Alcohol consumption
• NOTE: If alcohol is consumed, hold dose until the AM

• Storage at room temp; do not freeze
• Safety measures, primarily for geriatric patients

Therapeutic response: decreased depression, symptoms of OCD

• That therapeutic effect may take 1-4 weeks
• To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
• To avoid alcohol and other CNS depressants
• To notify prescriber if pregnant, planning to become pregnant, or breastfeeding
• To change positions slowly because orthostatic hypotension may occur
• To avoid all OTC products unless approved by prescriber
• BLACK BOX WARNING: That suicidal thoughts/behaviors may occur in young adults and children

DULoxetine (Rx)

Cymbalta

Antidepressant

May potentiate serotonergic noradrenergic activity in the CNS; in studies, DULoxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake

• Major depressive disorder (MDD)
• Neuropathic pain associated with diabetic neuropathy
• Generalized anxiety disorder
• Fibromyalgia
• Chronic low back pain
• Oseoarthritis pain

• Stress
• Urinary incontinence

Alcohol intoxication, alcoholism, closed-angle glaucoma, hepatic disease, hepatitis, jaundice, hypersensitivity

• Pregnancy (C), breastfeeding, geriatric patients, mania, hypertension, renal/cardiac disease, seizures, increased intraocular pressure, anorexia nervosa, bleeding, dehydration, diabetes, hyponatremia, hypotension, hypovolemia, orthostatic hypotension, abrupt product withdrawal
• BLACK BOX WARNING: Children, suicidal ideation

• Common: headache
• Life threatening: Neuroleptic malignant-like syndrome reaction, and seizures

• Common: NONE
• Life threatening: Thrombophlebitis and supraventricular dysrhythmia

• Common: Abnormal vision
• Life threatening: NONE

• Common: Nausea
• Life threatening: Hepatic failure

• Common: NONE
• Life threatening: Stevens-Johnson syndrome

• Common: NONE
• Life threatening: Anaphylaxis, angeioedema, serotonin syndrome

• Well absorbed
• Extensively metabolized: in the liver to an active metabolite (ALT/AST)
• Product recovered in the urine: 70%
• Product recovered in the feces: 20%
• Protein binding: 90% (need albumin labs)
• Elimination half-life: 9.2-19.1 hr

• BLACK BOX WARNING: Depression: Mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms; depression, and panic
• B/P lying, standing: If systolic B/P drops 20 mm Hg, hold product, notify prescriber
• Pulse q4hr
• Take VS q4hr in patients with CV disease
• Hepatic studies: AST, ALT, bilirubin
• Weight weekly; weight loss or gain; appetite may increase; peripheral edema may occur
• Sugarless gum, hard candy, frequent sips of water for dry mouth
• Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness; not common unless product is discontinued abruptly
• Malignant neuroleptic-like syndrome reaction
• Serotonin syndrome: nausea/vomiting, dizziness, facial flush, shivering, and sweating
• Sexual dysfunction: ejaculation dysfunction, erectile dysfunction, decreased libido, orgasm dysfunction

• Storge in tight container at room temp; do not freeze
• Assistance with ambulation during beginning therapy, since drowsiness, and dizziness occur
• Confirmation that PO medication swallowed

Therapeutic response: decreased depression

• To report urinary retention; about signs and symptoms of bleeding (GI bleeding, nose bleed, ecchymoses, bruising)
• To use with caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
• To avoid alcohol ingestion, MAOIs, or other CNS depressants
• Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise, taper
• BLACK BOX WARNING: That clinical worsening and suicide risk may occur
• To wear sunscreen or large hat, since photosensitivity may occur
• To notify prescriber if pregnancy planned or suspected, or if breastfeeding
• Improvement may occur in 4-8 wk or in up to 12 wk (geriatric patients)

• bupropion (Rx): Wellbutrin
• fluoxetine (Rx): Prozac
• duloxetine (Rx): Cymbalta

• donepezil (Rx): Aricept
• rivastigmine (Rx): Exelon

donepezil (Rx)

• Aricept
• Aricept (ODT)

Anti-Alzheimer's agent

Reversible cholinesterase inhibiter

• Elevates acetylcholine concentrations (cerebral cortex) by slowing degradation of acetylcholine released in cholinergic neurons
• Does not alter underlying dementia (slows, does not cure)

Hypersensitivity to this poduct or piperidine derivatives

Pregnancy (C), breastfeeding, children, sick sinum syndrome, hiistory of ulcers, GI bleeding, hepatic disease, bladder obstruction, asthma, seizures, COPD, abrupt discontinuation, AV block, GI obstruction, Parkinsson's  disease, and surgery

• Common: Dizziness, insomnia, headache
• Life threatening: Seizures

• Common: NONE
• Life threatening: Atrial fibrillation, sinus bradycardia, and AV block

• Common: Nausea, vomitng, diarrhea
• Life threatening: GI bleeding (black tarry feces)

• Well absorbed PO
• Metabolized by: CYP2D6, CYP3A4
• Elimination half-life: 10 hr single dose
• 70 hr: multiple doses
• Protein binding: 96% (need albumin labs)

• B/P: hypo/hypertension and heart rate
• Mental status: affect, mood, behavioral changes, depression, complete suicide assessment; neurologic status
• GI status: nausea, vomiting, anorexia, diarrhea; monitor weight
• GU status: urinary frequency, incontinence, and I&O

Assistance with ambulation during beginning therapy; dizziness and ataxia may occur

Therapeutic response: decrease in confusion and improved mood

• To report side effects: twitching, nausea, vomiting, sweating, dizziness; indicates cholinergic crisis or overdose
• To use product exactly as prescribed
• To notify prescriber of nausea, vomiting, diarrhea (dose increase or beginning treatment), or rash
• Not to increase or abruptly decrease dose; serious consequences may result
• That product is not  cure and relieves symptoms

rivastigmine (Rx)

• Exelon
• Exelon Patch

Anti-Alzheimer Agent

Cholinesterase inhibitor

• Potent
• Selective inhibitor of brain acetylcholinesterase (AChE) and butyrylcholinesterase (BChE)

• Mild to moderate Alzheimer's dementia
• Mild to moderate parkinson's disease dementia (PDD)

• Vascular dementia: Changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage.
• Demetia with Lewy bodies: Abnormal structures that build up in the brain
• Pick's disease: Frontotemporal dementia (FTD) describes a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain.

Hypersensitivity to this product and other carbamates (Effective insecticides which exert their effect by temporarily inhibiting cholinesterase activity. They are also capable of poisoning. Clinical signs are pupillary constriction, muscle tremor, salivation, ataxia and dyspnea)

Pregnancy (B), breastfeeding, children, respiratory/cardiac/renal/hepatic disease, seizure disorder, peptic ulcer, urinary obstruction, asthma, increased intracranial pressure, surgery, GI bleeding, and jaundice

• Common: NONE
• Life threatening: QT prolongation, AV block, cardiac arrest, and MI

• Common: Tremors, confusion, and insomnia
• Life threatening: NONE

• Common: Nausea, vomiting, anorexia, abdominal distress, and flatulence
• Life threatening: GI bleeding/obstruction and pancreatitis

• Rapidly and completely absorbed
• Metabolized to: decarbamylated metabolite
• Half-life: 1.5 hr
• Excreted via: kidneys (metabolites)
• Clearance: lowered in geriatric patients, hepatic disease and increased with nicotine use
• Protein binding: 40% (need albumin labs)

• Hepatic studies: AST, ALT, alk phos, LDH, bilirubin, CBS
• Sever GI effects: nausea, vomiting, anorexia, weight loss, and diarrhea
• Vitals: B/P, heart rate, respiration during initial treatment;  hypo/hypertension should be reported
• Cognitive/mental status: Affect, mood, behavioral changes, depression, insomnia; complete suicide assessment

Assistance with ambulation during beginning therapy; dizziness may occur

Therapeutic response: Improved mood/cognition

• About the procedure for giving oral sol; use instruction sheet provided; how to apply transdermal product, to fold in half and throw away, not to get in eyes, to wash hands after application; not to use heating pad, sauna, or tanning bed
• To notify prescriber of sever GI effects
• That product may cause dizziness, anorexia, and weight loss
• That effect may take weeks or month
• To notify prescriber if pregnancy is planned or suspected

LORazepam (Rx)

Ativan

Sedative, hypnotic; antianxiety

Bensodiazepiine, short acting

Potentiates the actions of GABA, especially in the limbic system and the reticular formation

• Yes
• Controlled substance schedule IV

• Anxiety
• Irritability with psychiatric or organic disorders
• Preoperatively
• Insomnia
• Adjunct for endoscopic procedures
• Status epilepticus (A common, life-threatening neurologic disorder. It is essentially an acute, prolonged epileptic crisis)

• Antiemetic prior to chemotherapy
• Rectal use
• Alcohol withdrawal
• Seizure prophylaxis
• Agitation
• Insomnia
• Sedation maintenance

Pregnancy (D), breastfeeding, hypersensitivity to bensodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea

Children < 12 yr, geriatric patients, debilitated, renal/hepatic disease, addition, suicidal ediation, abrupt discontinuation

• Common: Dizziness and drowsiness
• Life threatening: NONE

• Common: Orthosttic hypotension
• Life threatening: ECG changes, tachycardia, apnea, and cardiac arrest (IV, rapid - NEVER dump, push slowly)

• Common: Blurred vision
• Life threatening: NONE

• Metabolized by liver
• Excreted: by the kidneys
• Crosses: placenta
• Excreted: in breastmilk
• Half-life: 14 hr
• PO: Onset 1/2 hr, peak 1-6 hr, duration 12-24 hr
• IM: Onset 15-30 min, peak 1-1 1/2 hr, duration 6-8 hr
• IV: Onset 5-15 min, peak unknown, duration 6-8 hr

• ANXIETY: decrease in anxiety; mental status: mood, sensorium, affect, sleeping patter, drowsiness, dizzines, suicidal tendencies
• Renal/hepatic/blood status: if receiving high-dose therapy
• Physical dependency, withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness, tremors, seizures, after long-term, excessive use

• Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
• Check to confirm that PO medication has been swallowed
• Refrigerate parenteral form

Therapeutic response: decreased anxiety, restlessness, and insomnia

• That product may be taken with food
• Not to use product for everyday stress or for >4 mo unless directedby prescriber
• Not to take more than prescribed amount; may be habit forming
• To avoid OTC preparations (cough, cold, hay fever) unless approved by prescriber
• To avoid driving, activities that requie alertness, since drowsiness may occur
• To avoid alcohol, other psychotropic medications unless directed by prescriber
• Not to discontinue medication abruptly after long-term use
• To rise slowly brcause fainting may occur, especially among geriatric patients
• That drowsiness may worsen at beginning of treatment
• To use birth control if of child-bearing age (pregnancy [D])

digoxin

Lanoxin

HIGH ALERT!

Cardiac glycoside, inontropic, antidysrhythmic

• Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect)
• Increases force of contractions
• Decreases heart rate (negative chronotropic effect)
• Decreases AV conduction speed

• Heart failure
• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• Cardiogenic shock,
• Paroxysmal atrial tachycardia
• Rapid digitalization in these disorders
• NOTE: Power to control cardiac output and ventricular response in atrial fibrillation

• Atrial flutter
• Paroxysmal suprabentricular tachycardia (PSVT) treatment/prophylaxis

Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd or 3rd-degree heart block

Pregnancy (C), breastfeeding, geriatric patients, renal disease, acute MI, AV block, severe respiratory disease, hypothyroidism, sinus nodal disease, and hypokalemia

• Common: Headache
• Life threatening: NONE

• Common: Hypotension
• Life threatening: Dysrhythmias and AV block

• Half-life: 1.5 days
• Excreted: in urine
• Protein binding: 20-30%
• PO: Onset 1/2 - 2 hr, peak 6-8 hr, duration 3-4 days
• IV: Onset 5-30 mn, peak 1-5 hr, duration variable

• Apical pulse for 1 min before giving product; if pulse <60 in adult or <90 in infant, take again in 1 hour; if <50 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose
• Electrolytes: K, Na, Cl, Mg, Ca
• Renal function studies: BUN, creatinine
• Blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically thereafter
• I&O ratio, daily weights; monitor turgor, lung sounds, edema
• Monitor product levels; therapeutic level 0.5-2 ng/ml
• Cardiac status: apical pulse, character, rate, rhythm
• NOTE: Get baseline vital signs; get a full one minute apical pulse (must have a minimum of >60 bpm); check labs for digitalis and potassium levels
• Watch for hypokalemia, visual disturbances, fatigue, arrhythmias, anorexia

Storage protected from light

Therapeutic response: decreased weight, edema, pulse, respiration, crackles; increased urine output; serum digoxin level (0.5-2 ng/ml)

• Not to stop product abruptly; about all aspects of product; to take exactly as ordered; how to monitor heart rate
• To avoid OTC medications, herbal remedies because many advers product interactions may occur; not to take antacid at same time
• To notify prescriber of loss of appetite, lowe stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity
• About the toxic symptoms of this product; when to notify prescriber
• To maintain a sodium-restricted diet as ordered
• To report shortness of breath, difficulty breathing, weight gain, edema, persistent cough

Discontinue product; give potassium; monitor ECG; give adrenergic-blocking agent, digoxin immune FAB

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

• Inhibits Na+ & H₂0 reabsorption in renal tubules
• Decreased reabsorption of other electrolytes is also common with use of diuretics (k+)

• Decreased Na+ reabsorption
• Increased Na+ exretion through the kidneys
• Increased H₂0 excretion through the kidneys (H₂0 usually follows Na+)

• Decrease edema
• Decrease HTN (indirectly)

• A potassium wasting diuretic allows the potassium to be elliminated through urine (possible hypokalemia can occur)
• A potassium sparing diuretic allows the  potassium to be recirculated through the system to be utilized.

furosemide (Rx)

Lasix

Loop diuretic

Sulfonamide derivative

Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle

Pulmonary edema; edema with CHF, hepatic disese, nephrotic syndrome, ascites, hypertension

Hypercalcemia with malignancy, hypertensive emergency/urgency, pulmonary edema or prevention of hemodynamic effects associated with blood product transfusion, ascites

Breastfeeding, infants, anuria, hypovolemia, electrolyte depletion

Pregnancy (C), diabetes mellitus, dehydration, severe renal disease, cirrhosis, ascites, hypersensitivity to sulfonamides/thiazides

• Common: NONE
• Life threatening: Circulatory collapse

• Common: Hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, and hyponatremia
• Life threatening: NONE

• Common: Hyperglycemia
• Life threatening: NONE

• Common: Nausea
• Life threatening: NONE

• Common: Polyuria
• Life threatening: Renal failure

• Common: NONE
• Life threatening: Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia

• Common: Rash and pruritus
• Life threatening: Stevens-Johnson syndrome

• PO: Onset 1 hr, pek 1-2 hr, duration 6-8 hr, absorbed 70%
• IV: Onset 5 min; peak 1/2 hr; duration 2 hr (metabolized by the liver 30%); excreated inurine, some as unchanged roduct, and feces; crosses placenta; excreted in breast milk; half-life 1/2-1 hr

• CHF: weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
• Hypertension: B/P lying, standing, postural hypotension may occur
• Metabolic alkalosis: drowsiness, restlessness
• Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness
• Rashes, temp elevation daily
• Confusion, especially in geriatric patients; take safety precautions if needed
• Hearing: including tinnitus and hearing loss, when giving high doses for extended periods
• Rate, depth, rhythm of respiration, effect of exertion, lung sounds
• Electrolytes (potassium, sodium, chloride); include BU, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid
• Glucose in urine if patient diabetic
• Allergies to sulfonamides, thiazides

Increased fluid intake 2-3 L/day unless contraindicated

Therapeutic response: improvement in edema of feet, legs, sacral are (CHF); increase urine output, decreased B/P, decreased calcium levels (hypercalcemia). 

• To discuss the need for a high-potassium diet or potassium replacement with prescriber
• To rise slowly from lying or sitting position because orthostatic hypotension may occur
• To recognize adverse reactions that may occur; muscle cramps, weakness, nausea, dizziness
• About the entire treatment regimen, including exercise, diet, stress relief for hypertension
• To take with food or milk for GI symptoms
• To use sunscreen or protective clothing to prevent photosensitivity
• To take early in the day to prevent sleeplessness
• To avoid OTC medications unless directed by prescriber

Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status

• ACE Inhibitors (medications have the PRIL ending - APRIL)
• Beta Blockers (medications have the OLOL ending)
• Calcium Channel Blockers

• Decreased sympathetic nervous system response
• Decreased Vascular resistance
• Decreased BP

• Inhibits formation of angiotensin II (vasoconstrictor)
• Blocks the release of Aldosterone(promotes Na+ retention)
• Lose Na+ and H₂0

• Decreased calcium levels and thus . . . 
• Decreased cardiac contractility
• Promotes vasodialation

ACE inhibitors: act by selectively suppressing renin-angiotensin I to angiotensin II; dilation of arterial and venous vesels occurs.

Produce a fall in blood pressure without reflex tachycardia or reduction in heart rate through mixture of B-blocking effects; elecated plasma renins are reduced

Act by inhibiting calcium ion influx across the cell membrane in cardiac and vascular smooth muscle. This action produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction, and dilates peripheral arteries

• Used for hypertension.
• Some products are used for heart failure not responsive to conventional therapy. 
• Some products are used in hypertensive crisis, angina, and for some cardiac dysrhythmias

Hypertension, ventricular dysrhythmias, and prophylaxis of angina pectoris

Used for chronic stable angina pectoris, vasospastic angina, dysrhythmias, hypertension, and unstable angina

• Hypersensitive reactions may occur, and allergies should be identified before these products are given.
• Antihypertensives should not be used in children or in patients with heart block

• Hypersensitive reactions may occur, and allergies should be identified before these products are given.
• B-Adrenergic Blockers should not be used heart block, congestive heart failure, or cardiogenic shock

Persons with 2nd-/3rd-degree heart block, sick sinus sundrome, hypotension of <90 mm Hg systolic, Wolff-Parkinson-White syndrome, or cardiogenic shock shoudl not use these products since worsening of those conditions may occur.

Antihypertensives should be used with cautin in geriatric and dialysis patients and in the presence of hypovolemia, leukemia, and electrolyte imbalances.

• Beta Blockers shoudl be used with caution in geriatric patients, or in renal/thyroid disease, COPD, coronary artery disease, diabetes mellitus, prenancy, and asthma
• Administer: PO before meals and at bedtime; tabs may be crushed or swallowed whole; reduced dosage in renal dysfunction

• Congestive heart failure since edema may be increased. hypotension may worsen since B/P is decreased. patients with renal/hepatic disease should use these products cautiously since they are metabolized in the liver and excreted by the kidneys.
• Administer: PO before meals and at bedtime

The most common side effects are hypotension, bradycardia, tachycardia, headache, nausea, and vomiting. Side effects and adverse reactions may vary widely between classes and specific products

The most common side effects re orthostatic hypotension, bradycardia, diarrhea, nausea, and vomiting. Serious adverse reactions include blood dyscrasias, bronchospasm, and congestive heart failure

The most common side effects are dysrhythmias and edema. Also common are headache, fatigue, drowsiness, and flushing.

• Blood studies: neutrpphil; decreased platelets occur with many of the products
• Renal studies: protein, BUN, creatinine; watch for increased level that may indicate nephrotic syndrome; obtain baselines in renal and hepatic function studies before beginning treatment
• Edema in feet and legs daily
• Allergic reaction, including rash, fever, pruritus, urticaria: product should be discontinued if antihistamines fail to help 
• Symptoms of congestive heart failure: edema, dyspnea, wet crackles, B/P
• Renal symptoms: polyuria, oliguria, frequency

• Renal studies: protein, BUN creatinine; watch for increased levels that may indicate nephrotic syndrome; obtain baselines in renal/hepatic function studies before beginning treatment
• I&O, weight daily
• B/P during beginning treatment and periodically thereafter; pulse q4hr, note rate, rhythm, quality
• Apical/radial pulse before administration; notify prescriber of significant changes
• Edema in feet and legs daily

Cardiac system: B/P, pulse, respirations, ECG intervals (PR, QRS, QT)

Supine or Trendelenburg position for severe hypotension

Therapeutic response: decrease in B/P in hypotension; decreased B/P, edema, moist crackles in congestive heart failure

Therapeutic response: decrease in B/P in hypotension; decreased B/P, edema, moist crackles in congestive heart failure

Therapeutic response: decreased anginal pain; decreased B/P, dysrhythmias

• To comply with dosge schedule, even if feeling better
• To rise slowly to sitting or standing position ot miniize orthostatic hypotension

• To comply with dosage schedule even if feeling better
• To rise slowly to sitting or standing position to minimize orthostatic hypotension
• To report bradycardia, dizziness, confusion, depression, and fever
• To take pulse at home; advise when to notify prescriber
• To comply with weight control, dietary adjustment, modified exercise program
• To wear support hose to minimize effects of orthostatic hypotension
• Not to discontinue product abruptly; taper over 2 wk; may precipitate angina

• How to take pulse before taking product; ptient should record or graph pulse to identify changes
• To avoid hazardous activities until stabilized on this product since dizziness commonly occurs
• The need for compliance in all areas of medical regimen, including diet, exercise, stress reduction, and product therapy

An Anti-diabetic

Type 2 diabetes mellitus (stable non-insulin dependent diabetes)

• Stimulates functioning B cells in the pancreas to release insulin
• May improve insulin to bind with it's receptors
• May increase number of insulin receptors

A patient must have functioning B cells in order for this medication to be effective

• In the pancreas
• Beta cells in the islets of Langerhans

• Metabolism of carbs, fats, proteins
• It is the key that opens the cell door, so glucose can move in 

It stimulates the conversion of glycogen into glucose, in the liver

70 to 110 mg/dL

• "Without insulin you will SLIR your words!"
• Short Acting
• Long Acting
• Intermediate Acting
• Rapid Acting

• Names: Regular, Humulin R, Novolin R
• Given: 1/2 - 1 hour before a meal
• Onset: 30 min
• Peak: 2 and 1/2 - 5 hours
• Duration: up to 6 hours

• Name: Lantus
• Given: Usually once at bedtime
• Onset: 1 and 1/2 hours
• Peak: No peak identified (sustained release)
• Duration: ~ 24 hours
• NOTE: NEVER mixed with another insulin!!

• Names: Humulin N, Novolin, Lente
• Onset: 1 and 1/2 - 4 hours
• Peak: 6 - 12 hours
• Duration: 12 - 18 hours
• NOTE: Cloudy

• Names: Novolog and Humalog
• Given: Right before a meal
• Onset: 15 - 30 minutes
• Peak: 1/2 to 1 and 1/2 hours
• Duration: 3 - 4 hours
• NOTE: Clear

Have food ready to be ingested

• All other insulins
• (except Lantus - which is never mixed with another insulin)

• insophane insulin suspension (NPH)
• Lente
• ultralente

• regular (OTC) Humulin R
• insulin lispro (Rx) Humalog

• regular (OTC) Humulin R
• No other insulins can be give via IV!

• Draw back the total amount needed in air
• Insert the amount of air needed in the cloudy insulin (NPH)
• Insert the amount of air needed in the clear insulin (Reg)
• Draw up the amount of insulin needed from the clear (Reg)
• Draw up the amount of insulin needed from the cloudy (NPH)

• I'm TIRED₂!
• Tachycardia
• Irritability
• Restless
• Excessive hunger
• Diaphoresis
• Depression

• Hot and Dry = Sugar high -->Hyperglycemic
• Cold and Clammy = Need some candy -->Hypoglycemic

• Poke the Back LAST!
• Back (just below the shoulder blades)
• Love handles (just above the bottom, at the hips)
• Arms (back side)
• Stomach (each side of the umbilicus)
• Thighs

HIGH ALERT!

Lovenox

enoxaparin (Rx)

• Low molecular weight Heparin
• Anticoagulants
• Used to prevent deep venous thrombosis after hip, knee, or abdominal surgery
• Also used for clients at risk for thromboembolus secondary to prolonged bed rest due to acute illness

• Subcutaniously: once a day or q12hr (do NOT give via IM)
• Position: Client should be lying down for administration
• Do NOT: Expel the air bubble in the prefilled syringe
• Manufacturer recommends: Injection into the right or left anterior lateral or posterior lateral aspect of the abdominal wall for best absorption (alternate sides)
• Do NOT: Massage the injection site to minimize bruising
• Do NOT: Mix with other injections
• Lovenox and Regular heparin: CANNOT be used interchangeably
• Assess baseline lab data: (CBC, liver function, and coagulation)
• Observe: Early signs/symptoms of bleeding
• Administer: Same time every day
• AVOID: Aspirin or NSAIDS