Medications

Medication Generic/Brand name Dosage Frequency Route Purpose/Action Dosage range How it works Reason ordered Side Effects/Nursing Implications What does the nurse assess prior to/and or after giving medication.

Contraindications

Alprazolam/Zanax
1 x 0.25 mg tablet 2 bid Oral

used to treat anxiety disorders, panic disorders, and anxiety caused by depression dosage range 0.5 to 3mg works by decreasing abnormal excitement in the brain Ordered for pt anxiety caused by depression

Side Effects/Adverse Reactions CNS: dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting, weight gain. Derm: rashes. Misc: physical dependence, psychological dependence, tolerance. Severe Shortness of breath, seizures, hallucinating, severe skin rash, depression, yellowing of eyes or skin, memory problems, problems with speech, unusual changes in mood or behavior, suicide thoughts, problems with coordination or balance Nursing Implications Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically during therapy. Assess patient for drowsiness, light-headedness, and dizziness. These symptoms usually

Hypersensitivity Cross-sensitivity with other benzodiazepines may exist Pre-existing CNS depression Severe uncontrolled pain Angle-closure glaucoma, obstructive sleep apnea, pulmonary disease Pregnancy and lactation Concurrent itraconazole or ketoconazole

Specify the Predicted Outcomes and Evaluate Based on the Actual Outcomes Specify parameters before giving if indicated and if drug was effective Evaluation/Desired Outcomes Decreased sense of anxiety wthout CNS side effects. Decreased frequency and severity of panic attacks.

disappear as therapy progresses. Dose should be reduced if these symptoms persist. Geri: Assess CNS effects and risk of falls. Institute falls prevention strategies. Prolonged high-dose therapy may lead to psychological or physical dependence. Risk is greater in patients taking >4 mg/day. Restrict the amount of drug available to patient. Assess regularly for continued need for treatment. Lab Test Considerations: Monitor CBC and liver and renal function periodically during longterm therapy. May cause hematocrit and neutropenia. Toxicity and Overdose: Flumazenil is the antidote for alprazolam toxicity or overdose. (Flumazenil may induce seizures in patients with a history of seizures disorder or who are on tricyclic antidepressants.). Implementation Do not confuse Xanax (alprazolam) with Zantac (ranitidine). If early morning anxiety or anxiety between doses occurs, the same total daily dose should be divided into more frequent intervals.

PO: May be administered with food if GI upset occurs. Administer greatest dose at bedtime to avoid daytime sedation. Tablets may be crushed and taken with food or fluids if patient has difficulty swallowing. Do not crush, break, or chew extendedrelease tablets. Taper by 0.5 mg q 3 days to prevent withdrawal. Some patients may require longer tapering period (months). For orally disintegrating tablets: Remove tablet from bottle with dry hands just prior to taking medication. Place tablet on tongue. Tablet will dissolve with saliva; may also be taken with water. Remove cotton from bottle and reseal tightly to prevent moisture from entering bottle. If only tablet taken, discard unused portion immediately; may not remain stable. Patient/Family Teaching Instruct patient to take medication exactly as directed; do not skip or double up on missed doses. If a dose is missed, take within 1 hr; otherwise, skip the dose and return to regular schedule. If medication is less effective after a few weeks, check with health care professional; do not increase dose. Abrupt withdrawal may cause sweating, vomiting, muscle cramps, tremors, and

Docusate Sodium/ Colace

1 x 100 mg capsule bid Oral

Indications PO: Prevention of constipation (in patients who should avoid straining, such as after MI or rectal surgery). Rect: Used as enema to soften fecal impaction. Action Promotes incorporation of water into stool, resulting in softer fecal mass. May also

seizures. May cause drowsiness or dizziness. Caution patient to avoid driving and other activities requiring alertness until response to the medication is known. Geri: Instruct patient and family how to reduce falls risk at home. Advise patient to avoid drinking grapefruit juice during therapy. Advise patient to avoid the use of alcohol or other CNS depressants concurrently with alprazolam. Instruct patient to consult health care professional before taking Rx, OTC, or herbal products concurrently with this medication. Inform patient that benzodiazepines are usually prescribed for short-term use and do not cure underlying problems. Teach other methods to decrease anxiety (exercise, support group, relaxation techniques). Advise patient to not share medication with anyone. Adverse Reactions/Side Effects EENT: throat irritation . GI: mild cramps. Derm: rashes. NURSING IMPLICATIONS Assessment Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Contraindicated in: Hypersensitivity; Abdominal pain, nausea, or vomiting, especially when associated with fever or other signs of an acute abdomen . Use Cautiously in: Excessive or prolonged use may lead to dependence ; Should not be used if prompt results are desired; OB/Lactation: Has been

Evaluation/Desired Outcomes A soft, formed bowel movement, usually within 2448 hr. Therapy may take 35 days for results. Rectal dose forms produce results within 215 min .

promote electrolyte and water secretion into the colon. Therapeutic Effects: Softening and passage of stool. Dosage Range PO (Adults and Children >12 yr): 50400 mg in 14 divided doses. PO (Children 612 yr): 40150 mg in 14 divided doses. PO (Children 36 yr): 2060 mg in 14 divided doses. PO (Children <3 yr): 1040 mg in 14 divided doses. Rect (Adults): 50100 mg or 1 unit containing 283 mg docusate sodium, soft soap, and glycerin. Reason ordered to soften pt stool to prevent constipation

Donepezil / Aricept
1 x 5 mg tablet Nightly Oral

Indications Mild to moderate dementia associated with Alzheimers disease

Implementation This medication does not stimulate intestinal peristalsis. PO: Administer with a full glass of water or juice. May be administered on an empty stomach for more rapid results. Oral solution may be diluted in milk or fruit juice to decrease bitter taste. Do not administer within 2 hr of other laxatives, especially mineral oil. May cause increased absorption Patient/Family Teaching Advise patients that laxatives should be used only for shortterm therapy. Long-term therapy may cause electrolyte imbalance and dependence. Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake (68 full glasses/day), and increasing mobility. Normal bowel habits are variable and may vary from 3 times/day to 3 times/wk. Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver). Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present. Advise patient not to take docusate within 2 hr of other laxatives Adverse Reactions/Side Effects* CNS: headache, abnormal dreams, depression, dizziness, drowsiness, fatigue, insomnia, syncope,

used safely .

Contraindicated in: Hypersensitivity to donepezil or piperidine derivatives Use Cautiously in: Patients

Evaluation/Desired Outcomes Improvement in cognitive function (memory, attention, reasoning, language, ability to

Action Inhibits acetylcholinesterase thus improving cholinergic function by making more acetylcholine available Therapeutic Effects: May temporarily lessen some of the dementia associated with Alzheimers disease Enhances cognition Does not cure the disease Dosage Range Mild to Moderate Alzheiner's Disease PO (Adults): 5 mg once daily; after 46 wk may increase to 10 mg once daily (dose should not exceed 5 mg/day in frail, elderly females) Severe Alzheimer's Disease PO (Adults): 10 mg once daily (dose should not exceed 10 mg/day) Reason ordered: To help with pt dementia

sedation (unusual). CV: atrial fibrillation, hypertension, hypotension, vasodilation. GI: diarrhea, nausea, anorexia, vomiting, weight gain (unusual). GU: frequent urination. Derm: ecchymoses. Metab: hot flashes, weight loss. MS: arthritis, muscle cramps. Assessment Assess cognitive function (memory, attention, reasoning, language, ability to perform simple tasks) periodically during therapy Administer Mini-Mental Status Exam (MMSE) initially and periodically as a screening tool to rate cognitive functioning Administer Clock Drawing Test initially and periodically as a screening tool to measure severity of dementia Monitor heart rate periodically during therapy. May cause bradycardia PO: Administer in the evening just before going to bed. May be taken without regard to food. Oral disintegrating tablets should be allowed to dissolve on tongue; follow with water.before going to bed. May be taken without regard to food. Oral disintegrating tablets should be allowed to dissolve on tongue; follow with water. Patient/Family Teaching Emphasize the importance of taking donepezil daily, as directed. Missed doses should be skipped and

with underlying cardiac disease, especially sick sinus syndrome or supraventricular conduction defects Patients with a history of ulcer disease or those currently taking NSAIDs Patients with a history of seizures Patients with a history of asthma or obstructive pulmonary disease OB, Lactation: Pedi: Safety not established; assumed to be secreted in breast milk. Discontinue drug or bottlefeed .

perform simple tasks) in patients with Alzheimers disease.

regular schedule returned to the following day. Do not take more than prescribed; higher doses do not increase effects but may increase side effects Inform patient/family that it may take weeks before improvement in baseline behavior is observed Caution patient and caregiver that donepezil may cause dizziness Advise patient and caregiver to notify health care professional if nausea, vomiting, diarrhea, or changes in color of stool occur or if new symptoms occur or previously noted symptoms increase in severity Advise patient and caregiver to notify health care professional of medication regimen before treatment or surgery Emphasize the importance of follow-up exams to monitor progress; atypical antipsychotics may be used as an adjunct to improve behavior.

Sodium Chloride/ 0.9 %

10mL bid Intravenously

Action designed solely for parenteral use only after addition of drugs that require dilution or must be dissolved in an aqueous vehicle prior to injection Indications extracellular fluid replacement, treatment of metabolic alkalosis in the presence of fluid loss and mild sodium depletion

Side Effects/Adverse Reactions febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection and extravasation. Use with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there

the administration of sodium or chloride could be clinically detrimental.

Evaluation/Desired Outcomes Water balance and distribution extracellular fluid replacement

diluting or dissolving drugs for intravenous, intramuscular or subcutaneous injection, according to instructions of the manufacturer of the drug to be administered. Priming solution in hemodialysis procedures Dosage range dependent upon the age, weight and clinical condition of the patient as well as laboratory determinations. The volume of the preparation to be used for diluting or dissolving any drug for injection, is dependent on the vehicle concentration, dose and route of administration as recommended by the manufacturer. Reason ordered source of electrolytes and water for hydration

exists edema with sodium retention. Assessment Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy. Fluid administration should be based on calculated maintenance or replacement fluid requirements for each patient. monitor changes in fluid balance, electrolyte concentrations, and acidbase balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation

0.9% NaCl Infusion 100 mL/HR Intravenously Contiuously

Action designed solely for parenteral use only after addition of drugs that require dilution or must be dissolved in an aqueous vehicle prior to injection Indications extracellular fluid replacement, treatment of metabolic alkalosis in the presence of fluid loss and mild sodium depletion diluting or dissolving drugs for intravenous, intramuscular or subcutaneous injection, according to instructions of the manufacturer of the drug to be administered. Priming solution in hemodialysis procedures Dosage range dependent upon the age, weight and clinical condition of the patient as well as laboratory determinations. The volume of the preparation to be used for diluting or dissolving any drug for injection, is dependent on the vehicle concentration,

Side Effects/Adverse Reactions febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection and extravasation. Use with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention. Assessment Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy. Fluid administration should be based on calculated maintenance or replacement fluid requirements for each patient. monitor changes in fluid balance, electrolyte concentrations, and acidbase balance during prolonged parenteral therapy or whenever the condition of the patient warrants

the administration of sodium or chloride could be clinically detrimental.

Evaluation/Desired Outcomes Water balance and distribution extracellular fluid replacement

dose and route of administration as recommended by the manufacturer. Reason ordered source of electrolytes and water for hydration

such evaluation