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Atropine Overdose
- Temperature rises (Hot as a hare)
- Confusion, delitium (Mad as a hatter)
- Flusher face (Red as a beet)
- decreased secretions, thirsty (Dry as a bone)
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Trihexyphenidyl (Atropine)
- Classification:
- anticholinergic
- antispasmodic
- antidysrhythmic
- Action: inhibits action of acetylcholine. Primary effects are on the heart, exocrine glands, smooth muscles, and eye
- Uses:
- antidysrhythmic-increases the heart rate
- preoperative-decreases secretions, prevents bradycardia
- relaxes smooth muscle-bronchi, bladder, gastrointestinal tract
- Contraindications:
- glaucoma
- tachycardia
- Precautions:
- hyperthyroid
- liver or renal disease
- congestive heart failure
- gastric ulcer
- asthma
- Side effects:
- decreased sweating, which can lead to hyperthermia and flushing
- central nervous system-toxic doses may cause delirium and hallucinations
- dry mouth, tachycardia
- blurred vision, urinary retention, urinary hesitancy, constipation
- Nursing indications:
- Evaluate hydration status
- evaluate frequently for urinary retention, especially in elderly men with prostate problems
- do not administer if client has tachycardia
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Phenazopyridine (Pyridium)
- Classification: urinary tract analgesic
- Action: exerts topical analesic effect on urinary tract mucosa (coats the walls with an orange to red medication, the flakes will stop the burning)
- Uses:
- relief of pain, burning, utgency, frequency resulting from lower urinary tract mucosa irritation
- Contraindications:
- renal and liver insufficiency
- Side effects:
- headache, bright orange-colored urine
- gastrointestional disturbance
- rash and pruritus
- Nursing implications:
- teach client how to avoid upper urinary tract infections
- take with meals
- explain discoloration of urine (reddish orange)
- the drug may discolor contace lenses and stain underwear
- do not crush, break or chew tablet
- medication is available over the counter (OTC)
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Potassium Chloride (IV, PO)
- Classification: Electrolyte replacement
- Action: necessary for nerve impulse conduction; maintians electrical excitability of the heart and assists to regulate acid base balance
- Uses: potassium deficiency
- Contraindications:
- Hyperkalemia
- renal impairment
- untreated addison's disease
- Percautions:
- acute acidosis resulting in potassium shifts
- Side effects:
- gastrointestinal discomfort-nausea and vomiting
- diarrhea and abdominal discomfort
- hyperkalemia-ventricular tachycardia, confusion, anxiety, dyspnia, weakness and tingling
- dysrhythmias, fatigue, muscle weakness, cramps, and decreased reflexes
- Nursing implications:
- Give with a full glass of water with or after meals
- monitor serum potassium (3.5 to 5.5 normal)
- watch for signs of renal insufficiency (increased creatinine, increased blood urea nitrogen (BUN)
- intravenous (IV) potassium must always be diluted before administering
- Never administer potassium via IV push
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Salicylate Poisoning
- initally respiratory excitation occurs (hyperventilation) resulting in respiratory alkalosis
- As toxicity occurs, a decrease in ventilation develops (hypoxemia) resulting in an increase in carbon dioxide levels, resulting in respiratory acidosis
- the respiratory acidosis is umcompensated because the bicarbonate stores are depleted during the early stages of poisoning
- metabolic acidosis results from the acidity of aspirin, along with an increased production of lactic and pyruvic acids
- Signs and Symptoms
- initial symptoms: tinnitus, sweating, headache, and dizziness, hyperventilation
- toxicity: hyperthermia, sweating, and dehydration; respiratory depression, resulting in respiratory acidosis, stupor and coma
- Treatment:
- gastric lavage with activated charcoal
- oxygen or ventilation assistance as necessary
- treat for hyperthermia (external cool down, tepid water sponge bath), dehydration (intravenous, balance pH and electrolytes), and reverse acidosis (slow infusion of bicarbonate)
- dialysis if necessary
- Nursing implications:
- teach parents safe medication storage
- teach parents not to administer aspirin to children who are suspected of having a viral infection, especially chicken pox or influenza
- monitor respiratory status, blood gasses, and for progression of symptoms
- if child complains of any tinnitus, aspirin should be discontinued; parents should have child evaluated
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Lithium Toxicity
- therapeutic levels:
- 0.8 to 1.4 mEqL
- toxic level: <2.0 mEq/L (levels should be kept below 1.5 mEq/L)
- levels should be drawn in the morning, 12 hours after the evening dose
- most common cause of lithium accumulation is sodium depletion
- Signs and symptoms:
- side effects (with therapeutic levels):
- fine hand tremors
- gastrointestinal (GI) effects: nausea, diarrhea, anorexia; fatigue, weakness, headache, polyuria, thirst
- Toxic effects (1.5 to 2.0 mEq/L):
- persistent GI problems (vomiting, diarrhea)
- course hand tremors
- hyperirritability
- poor coordination
- Acute (above 2 mEq/L) Toxicity:
- ataxia
- high output of diluted urine
- electrocardiographic (ECG) changes
- tinnitus
- blurred vision
- severe hypotension
- symptoms may progress to coma and death
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Digoxin Toxicity
- Optimal level: 0.5 to 0.8 ng/ml
- Toxic level: >2.0 ng/ml
- Hypokalemia is the most common predisposing factor to toxicity
- Signs and Symptoms:
- GI signs: anorexia and nausea and vomiting
- CNS signs: fatigue and visual disturbances
- dysrhythmias-atrioventricular (AV) block resulting in bradycardia, ventricular ectopic beats, which may lead to ventricular fibrillation
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Theophylline Toxicity
- Optimal level: 5 to 15 mcg/ml
- Toxic level: >20 mcg/ml
- Signs and Symptoms:
- too rapid intravenous (IV) infusion may cause hypotension, tachycardia, hyperventilation
- GI symptoms initially include severe dysrhythmias and seizures
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Effects of Grapefruit Juice on metabolism
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