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ENOXAPRIN (e-nox-a-pa-rin) (low molecular weight heparin [LMWH]) Lovenox
- Drug Classification: anticoagulant and antithrombotic
- INDICATIONS:Prevention of deep vein thrombosis, pulmonary emboli, ischemic complications in patients with unstable angina/non–Q-wave MI. LMWH has a more predictable anticoagulantresponse than unfractionated heparin—special monitoring of clotting times is not necessary.
- Therapeutic Effects: Prevention of thrombus formation.
- DOSAGE: SC: Adults: Knee/hip surgery: 40 mg once dailystarting 9–15 h before hip surgery; abdominal surgery: 40 mg once daily starting within 24 h postop; treatment of DVT/PE:1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/non–Q-wave MI:1 mg/kg q 12 h.
- ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently.
- NURSING IMPLICATIONS: Lab tests:
- Baseline coagulation studies; periodic CBC, platelet count, urine and stool for
- occult blood. *Monitor platelet count closely. Monitor closely patients with
- renal insufficiency and older adults how are at risk for thrombocytopenia. Monitor and report immediately any sign or symptom of unexplained bleeding.
- ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia,hematoma.
- CONTRAINDICATIONS: Hypersensitivity to pork products,uncontrolled bleeding, thrombocytopenia, patients with prosthetic heart valves.
- CAUTIONS: HIGH ALERT MED: Assess patient for signs of bleeding and hemorrhage (bleeding gums, nosebleed; unusual bruising; black, tarry stools, hematuria; fall in hematocritor blood pressure; guaiac-positive stools), bleeding from surgical site. Notify physician if these occur. • Risk of bleedingmay be increased by warfarin, aspirin, NSAIDs, dipyridamole,some penicillins,penicillins, clopidogrel, ticlopidine, abciximab,eptifibatide, tirofiban, and dextran. Increased bleeding risk with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panaxginseng, and others.
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WARFARIN (war-fa-rin) Coumadin, Warfilone
- DRUG CLASSIFICATION:anticoagulant
- INDICATIONS: Venous thrombosis, pulmonary embolism, atrial fibrillation with embolization, MI, prevention of thrombus formation post–prosthetic valve placement.
- Therapeutic Effects: Prevention of thromboembolic events.
- DOSAGE: PO: Adults: 2.5–10 mg/d for 2–4 days; then adjust daily dose by results of prothrombin time or international normalized ratio (INR).
- ADMINISTRATION: PO: Administer at same time daily.
- NURSING IMPLICATIONS: *Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage is established. *Obtain a COMPLETE medication history prior to start of therapy and whenever altered responses to therapy require interpretation; extremely IMPORTANT since many drugs interfere with the activity of anticoagulant drugs. *Lab tests: For maintenance dosage, PT/INR determinations at 1-4 week intervals depending on patient response, periodic urinalysis, stool guaiac and LFTs.
- ADVERSE REACTIONS AND SIDE EFFECTS: Cramps, nausea, dermal necrosis,BLEEDING, fever.
- CONTRAINDICATIONS: Uncontrolled bleeding, open wounds, active ulcer disease, recent brain, eye, or spinal cord injury or surgery, severe liver disease, uncontrolled hypertension, pregnancy.
- CAUTIONS: HIGH ALERT MED: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; bruising; tarry, black stools). • Monitor PT or INR and other clotting factors frequently during therapy. • Androgens, cefotetan, chloral hydrate,
- chloramphenicol, fluconazole, fluoroquinolones, itraconazole, metronidazole, thrombolytic agents, sulfonamides, quinidine, quinine, NSAIDs,
- valproates, and aspirin may increase response and risk of bleeding. • Chronic acetaminophen use may increase the risk of bleeding. • Alcohol,barbiturates,and hormonal contraceptives containing estrogen
- decrease response. • Large quantities of foods high in vitamin K may antagonize
- the anticoagulant effect. • Antidote is vitamin K (phytonadione, AquaMEPHYTON).
- • Avoid IM injections and activities leading to injury. Inform all health care personnel about anticoagulant therapy before lab tests, treatment, or surgery. • Increased bleeding risk with arnica,chamomile, clove, dong quai, feverfew, garlic,ginger, ginkgo, Panax ginseng, and other natural products.
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FONDAPARINUX (fon-da-par-i-nux) Arixtra
- DRUG CLASSIFICATION: anticoagulant, antithrombolitic
- INDICATIONS: Prevention of deep vein thrombosis or pulmonary embolism in patients undergoing hip or knee replacement surgery or abdominal surgery.
- Therapeutic Effects: Interruption
- of the coagulation cascade resulting in inhibition of thrombus formation.
- DOSAGE: SC: Adults: 2.5 mg once daily, starting 6–8 h after surgery and continuing for 5–9 days (up to 11 days).
- ADMINISTRATION: Administer SC only into fatty tissue, alternating sites between right and left anterolateral or posterolateral abdominal wall.
- NURSING IMPLICATIONS:*Monitor for S&S of bleeding or hemorrhage.
- If noted, withhold and notify the prescriber immediately. *Withhold and notify
- prescriber if platelet count falls belom 100.000/mm3 *Lab tests: Monitor baseline and periodic renal function tests;
- periodic cbc including platelet count, serum creatinine level, and stool occult blood tests . **Patient
- and family education: Report signs of unexplained bleeding such as pink, red or
- dark brown urine, red or dark brown vomitus, bleeding gums or bloody sputum;
- dark, tarry stools. Learn proper injection technique if you are to self administer.
- Do not take any OTC drugs without first consulting prescriber.
- ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness,headache, insomnia, edema, hypotension, constipation,diarrhea, dyspepsia, increased serum aminotransferases,nausea,
- vomiting, urinary retention, bullous eruption,hematoma, purpura, rash,
- BLEEDING, thrombocytopenia,hypokalemia, fever, increased wound drainage.
- CONTRAINDICATIONS: Hypersensitivity, severe renal impairment,body
- weight less than 50 kg, active major bleeding, bacterial endocarditis, and
- thrombocytopenia due to fondaparinux antibodies.
- CAUTIONS: HIGH ALERT MED: Deaths have occurred when two anticoagulant medications inadvertently are given concurrently. Double check medications to ensure that two anticoagulant products are not given simultaneously. • Use with caution in patients with severe uncontrolled hypertension,bleeding disorders, GI pathology, hemorrhagic stroke, recent CNS or ophthalmologic surgery, spinal/epidural anesthesia (increased risk of spinal/epidural hematomas). • Risk of bleeding may be increased by concurrent use of warfarin, aspirin,NSAIDs, dipyridamole,some cephalosporins, valproates,clopidogrel,ticlopidine,abciximab,eptifibatide, tirofiban, and dextran.Increased risk of bleeding with arnica, chamomile,dong quai,feverfew, garlic, ginger, gingko, Panax ginseng,licorice, and others.
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INSULIN, ISOPHANE (NPH) (in-su-lin)
- DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
- INDICATIONS:Intermediate-acting insulin (onset: 1–2 h; peak 8–12 h; duration: 18–24 h) used to treat elevated glucose levels in patients with type 1 and type 2
- diabetes.
- Therapeutic Effects: Control of blood glucose levels.
- DOSAGE: Adults: 7–26 units as a single dose 30-60 minutes before
- breakfast. A second smaller dose may be given before dinner or at bedtime. Dose
- may be increased 2-10 units daily or weekly until desired control is achieved.
- ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do
- not administer cold insulin: can lead to lipodystrophy. Rotate vial between
- palms and invert gently to mix; do not shake. Rotate injection sites. May be
- mixed with regular insulin.
- NURSING IMPLICATIONS: Lab tests: Periodic fasting and postprandial
- blood glucose. *Notify prescriber promptly for marked elevated blood sugar or
- presence of acetone with sugar in urine.*Monitor for hypoglycemia at time of
- peak action of insulin. Onset of hypoglycemia (blood sugar:50-40 mg/dl) may be rapid and sudden.
- ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA,rebound
- hyperglycemia (Somogyi effect), lipodystrophy,itching, lipohypertrophy,
- redness, swelling, allergic reactions including ANAPHYLAXIS.
- CONTRAINDICATIONS: Allergy or hypersensitivity.
- CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the
- abbreviation “U” for “units.” It can be misread as a zero and has resulted in
- serious, tenfold overdoses. Clarify any order that contains this abbreviation.
- • Do not confuse Humulin N with Humulin R, Humulin U, or Humalog. •Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin,difficulty concentrating, drowsiness;excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy.• Advise patient to eat a snack mid-afternoon and bedtimeto prevent hypoglycemia during
- peak hours.
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INSULIN GLARGINE (in-su-lin glar-geen) Lantus
- DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
- INDICATIONS:Type 1 and type 2 diabetes. Long-acting insulin with a constant concentration over 24 hours with no pronounced peak. Provides a continuous level of insulin, similar to the steady
- secretion of insulin provided by the normal pancreas. Therapeutic
- Effects: Control of blood glucose levels.
- DOSAGE: SC: Adults and children: Begin with 10 units at bedtime and titrate
- according to glucose levels.
- ADMINISTRATION: SC: Use only insulin syringes to draw up dose. Rotate injection sites.
- NURSING IMPLICATIONS: Monitor
- for S&S of hypoglycemia especially after changes in insulin dose or type.*Lab tests: Measure fasting blood glucose and HbA1C periodically. *Withhold drug and notify prescriber if patient is hypokalemic.
- ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria,HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy,itching,lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS.
- CONTRAINDICATIONS: Allergy or hypersensitivity.
- CAUTIONS: HIGH ALERT MED: Lantus insulin cannot be mixed with other insulins; action may be affected in an unpredictable manner. • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Lantus insulin with Lente
- insulin. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) throughout therapy
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INSULIN,PREMIXED COMBINATIONS (NPH/regular insulin mixtures)Humulin 70/30, Novolin 70/30
- DRUG CLASSIFICATION: antidiabetic (pancreatic hormone)
- INDICATIONS: Combination of
- short-acting and intermediateacting insulins with short-acting insulin
- comprising 30% to 50% of the solution and intermediate acting insulin
- comprising 50% to 70% (onset: 30 min; peak 2–8 h; duration: 24 h). Used to treat elevated glucose levels in patients with type 1 and type 2 diabetes.
- Therapeutic Effects:Control of blood glucose levels.
- DOSAGE: SC: Adults:Titrated individually based on multiple factors. Maintenance therapy is usually 0.5–1 unit/kg/d.
- ADMINISTRATION: Use only insulin
- syringes to draw up dose. SC: Do not administer cold insulin: can lead to
- lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake.
- Rotate injection sites. May be mixed with regular insulin.
- NURSING IMPLICATIONS: Monitor for S&S of hypoglycemia. Initial hypoglycemic
- response begins within 15 min and peaks 45-90 min after injection. Lab tests:
- Periodic postprandial blood glucose and HbA1C. *Withhold drug and notify prescriber if patient is hypokalemic.
- ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria,HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching,lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS.
- CONTRAINDICATIONS: Allergy or
- hypersensitivity.
- CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order
- that contains this abbreviation.• Assess patient for signs and symptoms of
- hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive
- hunger; headache; irritability; nausea; rapid pulse;shakiness) and hyperglycemia throughout therapy. • Advise patient to
- eat a snack mid afternoon and bedtime to prevent hypoglycemia during peak hours
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INSULIN INJECTION (REGULAR) (in-su-lin) Humulin R, Novolin R
- DRUG CLASSIFICATION: antidiabetic
- (pancreatic hormone)
- INDICATIONS: Short-acting insulin (onset: 1/2–1 h;peak 2–3 h; duration: 5–7 h) used to treat elevated glucose levels in type 1 and type 2 diabetes (usually in addition to intermediate and long-acting insulins);
- diabetic ketoacidosis/coma, hyperkalemia.
- Therapeutic Effects: Reduction of
- blood glucose levels; intracellular shift of potassium.
- DOSAGE: SC: Adult: 2–10 units 15–30
- minutes before meals or in response to blood glucose elevations. Child: 2–4
- units 15–30 minutes before meals or in response to blood glucose elevations. IV:
- Adult: 2–7 units per hour as a continuous infusion. Child: 0.1 unit/kg per hour as a continuous infusion.
- ADMINISTRATION: Use only insulin
- syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites. IV: Regular insulin is the only insulin that can be administered IV.
- NURSING IMPLICATIONS: Lab tests:
- Periodic fasting and postprandial blood glucose. *Notify prescriber promptly
- for marked elevated blood sugar or presence of acetone with sugar in urine.*Monitor for hypoglycemia at time of peak action of insulin. Onset of hypoglycemia (blood sugar:50-40 mg/dl) may be rapid and sudden.
- ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy,
- redness, swelling, allergic reactions including ANAPHYLAXIS.
- CONTRAINDICATIONS: Allergy or
- hypersensitivity.
- CAUTIONS:HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” Itcan be misread as a zero and has resulted in serious, tenfold overdoses.Clarify any order that contains this abbreviation. Do not confuse Humulin R with Humulin N,Humulin U, or Humalog. • Assess patient for signs and symptoms of hypoglycemia(cool, clammy skin, difficulty concentrating, drowsiness;excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy.
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Docusate Sodium (dok’yoo-sate) Colace, Colace Enema, Lax-gel,Regutol, Therevac-Plus, Therevac-SB
- DRUG CLASSIFICATION: Stool softener
- INDICATIONS: Prophylactically in patients who should avoid straining
- during defecation and for treatment of constipation associated with hard dry stools
- (e.g.; following anorectal surgery, MI).
- THERAPUTIC USE: Detergent action lowers surface tension, permitting water and facts to penetrate and soften stools for easier passage.
- DOSAGE: PO 50-500 m/day PR 50-100 added to enema fluid
- ADMINISTRATION: oral: give with a full glass of water if allowed.
- Rectal: Microenema:Insert full lengh of nozzle into rectum. Squeeze entire
- contents of tube and remove completely before releasing grip on tube.
- NURSING IMPLICATIONS: *Withhold drug if diarrhea develops and notify prescriber. Therapeutic effectiveness: Usually apparent 1-3 days after first dose. Patient and Family Education: Take sufficient liquid with each dose and increase fluid intake if allowed. Do not take with mineral oil. Do not take for prolonged periods of time.
- ADVERSE REACTIONS AND SIDE EFFECTS: GI: Occasional mild abdominal cramps,diarrhea, nausea, bitter taste. Other: Throat irritation (liquid preparation),
- rash.
- CONTRAINDICATIONS: Hypersensitivity
- to dofetilide, QT prolongation, ventricular arrhythmias, electrolyte imbalances, renal failure, lactation.
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Baza Antifungal 2 % Topical Cream Generic name: Miconazole
- DRUG CLASSIFICATION: antifungal
- INDICATIONS:Vulvovaginal candidiasis, tinea pedis, tenea cruris, tinea corporis, and tinea versicolor
- caused by dermatophytes.
- THERAPUTIC USE: Broad spectrum agent with fungicidal activity
- DOSAGE: Topical-Apply cream sparingly to affected area twice a day and once daily for tinea versicolor, for 2wk, tinea pedis is
- treated for one month. Intervainal-insert suppository or vaginal cream each
- night x 7 days(100 mg) or 3 days (200 mg)
- NURSING IMPLICATIONS: Expect clinical
- improvement from topical application in one or two wk. If no improvement in 4 wk, diagnosis is reevaluated. Patient and Family education: Complete full course of treatment to ensure recovery. Do not interrupt vaginal application during menstrual period. Avoid contact of drug with eyes.
- ADVERSE REACTIONS AND SIDE EFFECTS: Vulvovaginal burning, itching, or irritation; maceration, allergic contact dermatitis
- CONTRAINDICATIONS: Hypersensitivity to miconazole
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CarraKlenzDermal Wound Cleanser
- DRUG CLASSIFICATION: emollient
- THERAPUTIC USE: removes organic material, debris, and dead
- tissue from high, medium and low exuding wounds.
- ADMINISTRATION/DOSAGE: spray
- NURSING IMPLICATIONS:
ADVERSE REACTIONS AND SIDE EFFECTS:
CONTRAINDICATIONS:
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