NLN Medication Exam

Study online at quizlet.com/_2cmd9g

1. Routes - Slowest to Fastest Transdermal --> sub-q --> IM --> buccal --> inhalation --> IV
2. 6 Rights of Medication Administration 1. Right Person
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Right medication
3. 3 Medication Checks 1. When removing medication from drawer/cart/pixis
2. Before dispensing medication
3. After dispensing medication but before giving it
4. Allergic/Hypersensitivity Reactions Immune response - not a side effect
Determined by degree of sensitization of the immune system
Sensitivity can change over time
mild itching to severe rash to anaphylaxsis
5. Absorption Process of incorporating drug into blood
6. Distribution Movement of drugs through the body
Transport via blood to site of action
7. Metabolism Ability to change a drug biologically from its original form into a water-soluble
form so it can be excreted by the kidneys
8. Excretion Removal of drugs from the body
9. Agranulocytosis/Neutropenia/Agranulocytopenia Acute decrease int eh number of granulocytes/leukopenia (WBCs) in peripheral
blood
Causes: treatment with broad spectrum penicillin, sulfonamides, or
cephalosporin; bone marrow transplant; chemotherapy; radiation
Generally impaired resulting from bone marrow depression by drugs and
chemicals or replacement by a neoplasm
Lymphadenopathy or lypmphadenitis may be prevalent
Could --> respiratory infection, ulceration of mouth, colon, high fever, or UTI
May be asymptomatic
10. Chelating Agents A substance whose molecules can form several bonds to a single metal ion
Involves oral administration or injection of Ethylene Diamine tetra Acetic Avide
may be used to treat hardening of the arteries, heart attack, stroke, arthritis, and
gangrene - removes excess calcium from body
Used for lead poisoning and hypercalcemia
11. Ethylenediaminetetraacetic Acid (EDTA) Use in children with a lead level between 45-70 micron/dL
Binds to lead in blood and excreted by bowel and kidney
May be toxic to the kidney - monitor urine output
Give IV - dose depends on weight of child, severity of poison
- Give q4h 5 days
- Second course may be needed if there is a rebound in blood level
Give oral and IV fluid to enhance excretion
Do not use with hypocalcemia or hypokalemia
Used to treat lead poisoning and hyperkalmeia
12. British AntiLeistie (BAL) Do not give with iron supplement
Avoid in patients with plant allergy
Give IM
Treats poisoning with heavy metals (arsenic, gold, mercury)
13. Succimer (Chemer/Chemet) Chemet = oral
Used to treat lead poisoning
Do not give in patient with encephalopathy
14. Epistaxis Nose bleed
Posterior is more serious
D/t rupture of blood vessels within richly perfused nasal mucosa
Blood can come up through eye, or flow down into stomach --> n/v
Treatment: cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon
gauze, absorbent dressing or saline sprayed into the nose
Ice pack to forehead or back of neck
pinch septum for 5 minutes
Do not pack nose with tissue or gauze
15. Half-life Time it takes for a medication to lose 1/2 its pharmacological or physiologic effect
16. Paradoxical Response to drug that is the opposite of the usual response
Reaction
17. -teron Androgens
18. -pril ACE inhibitors
19. -pressin Antidiuretic hormoens
20. -statin Antilipidemic
21. -vir Antiviral
22. -pam Benzodiazepines (mostly)
23. -lol eta Blockers
24. -pine Calcium Channel Blockers
25. Diltiazem Calcium Channel Blocker - exception
(Caridzem)
26. Verapamil Calcium Channel Blocker - exception
(Isoptin)
27. -mide Carbonic anhydrase inhibitors
28. "est" Estrogens
29. -sone Glucocorticoids and corticosteroids
30. -dine Histamine H2 Receptor Antagonists
31. "nitr" Nitrates
32. "Pancre" Pancreatic enzyme replacements
33. -zien Phenothizines
34. -zole Proton Pump Inhibitors
35. "sulf" Sulfonamides
36. -zide Thiazide Diuretics
37. -ase Thrombolytics
38. "thy" Thyroid hormones
39. -line Xanthine brnchodilators
40. Aminoglycoside Antibiotic
Treats serious life-threatening gram negative (and some positive) infections
All end in -mycin (but not all drugs ending in -mycin are aminoglycosides)
Generally IM or IV (PO not recommended - only for bowel prep or prior to surgery)

Adverse Effects: nephrotoxicity and ototoxicity

- photosensitivity
- Risk for superinfections
- Pseudomembranous colitis (c-diff)

Peak: drawn 15-30 min after infusion is complete

Trough: drawn 30 minutes before next IV dose (1-2 g/mL)
41. What to do if c-diff occurs? Stop the med and treat with PO Flagyl
42. Blood Administration Start blood transfusion slow (2 mL/min) and stay with patient for first 15-30 minutes. If no
signs of side effects increase to desired rate
Administer using largest gauge of IV access possible
Observe for acute reactions:
- Allergic s/s: rash itching, localized edema
- Febrile (even low grade)
- Septic
- Air embolism
- Circulatory Overload
Observe for delayed reaction (Graft vs. Host, Hepatitis, Hemolysis)
43. What is the best indication of crack Head Growth (late symptom is growth retardation)
abuse effect in newborns?
44. Treating Diabetes in Children Hypoglycemic reaction often occurs before meals or when insulin peaks
Teach child to wear a bracelet or tag and how to give injection - 90 degree angle
Teach only essentials first (14-20 minute sessions)
have the same meal as a normal child - time intake of food; eat at same time of day
Can assume responsibility for self-management at age 4-5
Age 9 - give own insulin injection with supervision
No exercise restrictions! Have extra snacks before and after exercise! Exercise
decreases need for insulin
Carry source of glucose at all times
after glucagon injection vomiting may occur - place on side to prevent aspiration
45. Preferred way to treat Ketoacidosis Insulin IV low-dosing
run a mixture of insulin through tubing before starting the drip - can chemically bind to
plastic
Replace fluid over 24-48 hours
46. IV Insulin Administration Can only be done with regular insulin in management of DKA and HHNK
Premature discontinuation can cause prolongation of DKA
Begin sub-q therapy before stopping infusion - if not may have prolonged
hyperglycemia
47. Common meds for HIV Treatment - Abacavir (Ziagen)
antiretroviral Stavudine (Zerit)
Zidoudine (AZT)
48. Antiviral Protease Inhibitor Ends in AVIR
Use prophylactically
Use in combination to decrease viral load and increase CD4
49. Reverse Transcriptase Ends in INE
Inhibitors Stops replication/growth
Reduces viral load
Advantage: do not adversely affect development of blood vessels
Use in combination with other meds because resistant strains may rapidly evolve
Inhibits cell protein synthesis hat interferes with viral replication
Blocks protease activity in HIV
50. Side Effects of HIV Treatment Assess for opportunistic infection (cancer, neurological disease)
Headache
Fatigue
Nausea
Vomiting
Diarrhea
Abdominal discomfort
Anemia
Taste Perversion
Asthenia
Circumoral Parestehsia with ritonivair
51. Adverse Reactions/Toxicity Hepatotoxicity: AST, ALT, bilirubin
with HIV Therapy - N/V, jaunidce, upper right quadrant enlargement and tenderness
- Reduce dose with liver dysfunction

Nephrotoxicity: creatine, BUN, creatinine clearance, urinalysis

- Keep accurate I/O
- Monitor for SE off neutropenia
- Observe signs of occult infection - lower back, flank, suprapubic pain; normal temp or low-grade
fever r/t UTI
52. When to Start HIV Therapy 1. All symptomatic HIV people (presenting with a AIDS-defining illness)
2. CD4 count <350 mm^3
3. Pregnant women (AZT is used to prevent maternal transmission of HIV)

STOP if severe rash or other HS reaction occurs

Treatment will be long-term
53. Teaching for HIV Therapy Use neutropenic precautions
Eat small frequent meals with complete or complementary proteins
54. Positive Inotropic Meds Increase cardiac contractility
Ex: epinephrine, norepinephrine, dopamine
55. Negative Inotropic Meds Decrease cardiac contractility, lower BP
Ex: quinidine, beta blockers
56. Sulfonamides Anti-infective
Bacteriostatic
Action on bacteria results from interference with the functioning of enzyme systems necessary for
normal metabolism, growth, and multiplication
Treats: UTI, Chlamydia causing blindness, pneumonia, brain abscess, ulcerative colitis, active Crohn's
Disease, Rheumatoid Arthritis

Ex: Bactrim
57. Side Effects of Sulfonamides Rash common - most are utricaria and maculopapular
GI symptoms
Bone marrow depression
HA
Dizziness/vertigo
Ataxia
Convulsion
Depression
58. Adverse Effects/Toxicity of Hepatotoxicity
Sulfonamides Nephrotoxicity
Stevens Johnson Syndrome
59. Cautions with Sulfonamides Do not use if:
- Known allergies to sulfa drugs
- In polyuria, advanced renal or hepatic dysfunction
- With intestinal and urinary blockage
- Asthma
Adequate fluid intake (3,00-4,000 mL/day) to promote urinary output, at least 1,500 mL/d to
prevent crystalluria/stone formation
May be taken after meals to prolong time in intestine
Collect C/S prior to beginning therapy
60. Thiazdie Diuretics Ex: Chlorothiazide (Hydrodiruil), Hydrochlorothiazide (HCTZ, Diuril)
Ends in -ZIDE
Non-potassium sparing diuretic
Acts on distal tubes, blocks reabsorption of sodium, chloride, and water. Leads to increased loss
of potassium
Use for edema and mild to moderate HTN
Will see effect within 1-4 weeks
61. Side Effects with Thiazide Dizziness, vertigo, HA, weakness, dehydration, orhtostatic hypotension
Diuretics N//V, abdominal pain, diarrhea, constipation, frequent urination
Dermatitis and rash
Electrolyte imbalance
Impaired glucose tolerance
62. Adverse Effects/Toxicity of Renal Failure
Thiazide Diuretics Aplastic anemia
Agranulocytosis
Thrombocytopenia
Anaphylactic reaction
63. Cautions with Thiazdie Diuretics Take early in the day to avoid nocturia
Take with food to avoid GI upset
Thiazide is ineffective if creatinine clearance is <30 mL/min
Eat foods high in K+
Restrict sodium - do not use salt substitute if taking K+-supplement
Weigh self daily and report sudden weight gains or losses
Avoid use with children and anuria
64. Tricyclic initial mechanism takes 1-3 weeks to develop
Antidepressants Maximum response is achieved in 6-8 weeks
Long half-life

Most end in -INE

- Nortyrptyine (Pamelor)
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Impipramine (Tofranil)

Blocks the reuptake of NE or 5HTs or both, leaving more available in the CNS. It intensifies the effect of NE
and 5HT which can elevate mood, increase activity and alertness, decrease preoccupation with morbidity,
improve appetite and regulate sleep pattern
It is used to treat insomnia, attention deficit/hyperactivity and panic disorder

Take it at night - causes sedation

Do not take with MAO - causes hypertensive crisis from excessive adrenergic stimulation of heart and blood
vessels
Monitor orthostatic BP of patient in hospital
65. Side Effects of Orthostatic Hypotension
Tricyclic Sedation and anticholinergic effects
Antidepressants
66. Adverse Most serious = cardiac toxicity
Effects/Toxicity of in absence of overdose or preexisting cardiac impairment, serious cardiac impairment is rare
Tricyclic Urinary retention is urgent
Antidepressants OD can cause convulsions
67. Cautions with Use with caution...Glaucoma, elderly, constipation, prostatic hyperplasia (more sensitive to anticholinergic
Tricyclic effect)
Antidepressants
Avoid use with: hypersensitivity, MI, CV disease
68. Hepatitis Inflammation of the liver caused by virus, bacteria or exposure to meds or hepatotoxins
69. Stages of Viral 1. Preicteric
Hepatitis 2. Icteric
3. Posticteric
70. Preicteric Stage of Precedes appearance of jaundice, may have flulike symptoms
Hepatitis
71. Icteric Stage of Appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools
Hepatitis
72. Post-icteric Stage of Convalescent stage; jaundice improves; color of urine and stool returns to normal
Hepatitis
73. Hepatitis A Cause: enterovirus
At risk: young children, institutionalized people, healthcare personnel
Transmission: fecal-oral, ingestion of food or liquids contaminated, person-to-person contact
Incubation: 3-5 weeks
Infectious: usually 2 weeks before the onset of jaundice and 1 week after onset of jaundice
S/S: may have no symptoms initially
Complications: fulminant hepatitis
74. Hepatitis At risk: IV drug users, people on hemodialysis, healthcare personnel
B Transmission: blood and bodily fluids; contaminated needles, parenteral; sexual activity
Incubation: 6-24 weeks
S/S: progression of symptoms is more insidious and prolonged than Hepatitis A virus; initially asymptomatic
1 week to 2 months of prodromal symptoms - fatigue, anorexia, transient fever, abdominal discomfort, N/V, HA and then
expanding to hepatic S/S, photophobia, angioedema, rash, vasculitis, jaundice in icteric phase
Complications: cirrhosis, fulminant hepatitis
75. Hepatitis At Risk: IV drug users; people receiving frequent transfusions, healthcare personnel
C Transmission: blood and bodily fluids; contaminated needles, parenteral; sexual activity
Incubation: 5-10 weeks
S/S: like Hep B but less severe (fatigue, anorexia, transient fever, abdominal discomfort, N/V, HA and then expanding to
hepatic S/S, photophobia, angioedema, rash, vasculitis, jaundice in icteric phase)
Complications: chronic liver disease, cirrhosis
76. Hepatitis Causes: occurs only with hepatitis B and only causes problems with an acute Hep B infection
D At risk: common in Middle East, South Africa, and Mediterranean; IV drug users; people on hemodialysis, healthcare
personnel
Transmission: blood and bodily fluids; contaminated needles, parenteral; sexual activity
Incubation: 7-8 weeks
Hep D along with Hep B causes superinfection and worsening of condition and rapid progression of cirrhosis
Complications: cirrhosis, fulminant hepatitis
77. Hepatitis Cause: waterborne virus
E At risk: travel to areas where sewage disposal is inadequate and/or people bathe in contmainated rivers; higher risk with
higher mortality - women in 3rd trimester of pregnancy
Transmission: fecal-oral, ingestion of food or liquids contaminated, person-to-person contact
Incubation: 3-5 weeks
Incubation: 2-9 weeks
Complications: maternal and fetal demise
78. Acyclovir Antiviral (used for HSV,Herpes Zoster, and Varicella)
(Zovirax) Oral, IV, Topical

HSV - does not eradicate latent herpes. Reduces shedding and formation of new lesions and speeds healing over time
Decreases symptoms with varicella zoster

Side Effects: HA, dizziness, seizure, N/V, diarrhea, acute renal failure, thrombocytopenia purpura, hemolytic uremia
syndrome

Adverse Effects/Toxicity: nephrotoxicity

Even after HSV is controlled, latent virus can be activated by stress, trauma,fever, exposure to sunlight, and sexual
intercourse
Refrain from sex if s/s of herpes
79. Alteplase Thrombolytic agent
Recombinant Dissovles or breaks down clots to reestablish perfusion
(Activase) Indicated for those at risk of developing thrombus w/ resultant ischemia like MI, ischemic stroke, arterial
thrombosis, DVT, and PE
Also for occlusion of catheters

Side Effects: Hemorrhage, N/V, hypotension, cardiac dysrhythmias

- Mostly dose-related

Watch for s/s of bleeding, VS changes, & s/s of impending shock

If bleeding is occurring stop treatment and notify doctor - may start on FFP and PRBC
Aminocarponic acid (Amicar) may be ordered for OD or excess bleeding

Do not give with pregnancy, active bleeding, recent hx of CVA, and uncontrolled HTN

IM medication route is contraindicated

Do not take NSAIDs or Aspirin because of enhanced bleeding
80. Cath-flo Activase for occluded catheters
81. Aminocarponic Acid Used for overdose of alteplase recombinant or excessive bleeding
(Amicar)
82. Aluminum Antacid - neutralizes gastric acid
Hydroxide Antiflatulent to alleviate symptoms of gas and bloating
(Amphogel)
Side Effects: increases gastric pH, decreases absorption of other drugs like dig, antibiotics, and iron
supplements
Toxicity: dementia, hypercalcemia, metabolic alkalosis, worsening of HTN, HF from increased intake

Given 2 hours apart from other drugs where interaction may occur.
Observe for s/s altered PO4 levels, anorexia, muscle weakness, malaise
Increase fluid, exercise, and fiber to prevent constipation

Contraindications: abdominal pain, N/V, diarrhea, severe renal dysfunction, fecal impaction, rectal bleeding,
colostomy, ileostomy, dehydration, hpercalcemia, and hypercalciuria
83. Ampicillin (Ampicin) IV, PO, IM antibiotic (aminopenicillin)
Treats bacterial infections
- Commonly used with shigella, salmonella, E. coli, H. influenza, N. gonorrhea, N. meningitis, and gram positive
organisms

Allergic Rxn: skin rash, utricaria, swelling, pruritus, angioedema

Severe Allergy: hives, wheezing, anaphylaxsis

Side Effects: GI, N/V, abdominal pain , pruritus rash like measles

Do not give with fruit juice, milk, or caronated beverages (poor absorption)
Watch for hypokalemia
Take on empty stomach
May not be necessary to stop tx if mild diarrhea develops
Give yogurt or buttermilk to restore normal flora

Contraindications:
- HS to any penicillin's (use cautiously if hx of HS to cephalosporins)
- Exfoliated dermatitis
- Loop diuretics - exacerbate hypokalemia and rash
- K-sparing Diuretics - may contribute to hyperkalemia
84. Atropine Sulfate Anticholinergic (Parkinson's) and for ophthalmic use
Systemic effect is more pronounced in infants and children w/ blue eyes/blonde hair
Increased risk of toxicity w/ Down Syndrome

Used to increase HR, decreases involuntary movement/rigidity in PD

Given pre-op to decrease secretions and prevent aspiration of secretions while under anesthesia
Used for inflammation of the iris and uveal tract

Side Effects: dry mouth, constipation, urinary retention/hesitancy, HA, dizziness

Adverse Effects/Toxicity: paralytic ileus
- Tx overdose (resp. depression and circulatory collapse) symptomatically
Adverse Effects w/ eye use: transient stinging, increases IOP, photophobia

Monitor dosage of meds carefully - overdoses easily

Assess constipation and urinary retention - increase fluids & bulk, exercise; assess bowel sounds to r/o
paralytic ileus
Avoid driving or other hazardous activities - drowsiness can occur
Acute glaucoma can be precipitated by papillary dilation - if not recognized and treated acute
glaucoma can --> blindness
Wear dark sunglasses and avoid bright light for photophobia
Monitor intraocular pressure and vision
85. Beclomethasone Inhaled corticosteriod medication (also nasal inhalant - Beconase)
Diproprionate Used in bronchial asthma and allergic rhinitis
(Beclovent)
Side Effects: pharyngeal irritation and sore throat, coughing, dry mouth, oral fungal infections and
sinusitis
- Increased susceptibility to infection, dermatological effects and osteoporosis, diarrhea, N/V, HA, fever,
dizziness, angioedema, rash, utricaria, and paradoxical bronchospasm

Adverse Effects/Toxicity: adrenocortical insufficiency, f/e disturbances, nervous system effects and
endocrine effects if absorbed systemically

Decrease dose if pt. is on systemic corticosteroid

Assess for impaired bone growth in children receiving inhaled corticsteroid
Monitor for hyperglycemia
Rinse mouth after use for med - oropharyngeal candidiasis and/or hoarseness can occur
Use bronchodilator inhalant b/f corticosteroid when both are ordered
Do not abruptly stop meds - taper over 2 weeks
Be aware of steroid symptoms - moon face, acne, edema, increased fat pads
Report weight gain

Contraindications: children, clients with known allergy; bronchospasm, status asthmaticus

May require adjustment of antidaibetic agent - potential for elevated blood glucose
86. Benztropine Mesylate Anticholinergic and Anti-parkinson
(Congentin) Tx PD symptoms: suppresses tremors & rigidity, not tardive dyskinesia; decreases hypersalivation and
irregular movement; reduces EPS effects

Side Effects: dry mouth, urinary retention/hesitancy, HA, dizziness

Adverse Effects/Toxicity: paralytic ileus

Monitor dose carefully - overdoses easily

Monitor I/O
Avoid driving/hazardous activities - drowsiness
Avoid cough OTC meds unless prescribed

Contraindications: narrow-angle glaucoma, MG, GI obstruction

87. Buspirone (Buspar) Anxiolytic - for anxiety
Desired response may take 7-10 days and full effect takes 3-4 weeks

Side Effects: dizziness, HA, drowsiness

When switching to Buspar, taper of benzos

Less likely to have cognitive impairment than other CNS meds
Does not cause withdrawal s/s and thus does not need to be tapered off when stopping

Contraindications: MAOI's, lactation

Caution with moderate to severe renal impairment
88. Chlordiazepoxide Anxiolytic; sedative-hypnotic benzodiazepine
Hydrochloride (Librium) IM and tablet form
Peak: 1-4 hrs PO and 15-30 min IM
Half-life = 5-30 hours
Relieves tension and/or anxiety; manages alcohol withdrawal

Do not abruptly stop taking drug - will have withdrawal symptoms (5-7 days)

Adverse Effects: respiratory distress, drowsy, dizziness, lethargy, orthostatic hypotension,

photosensitivity
Suicidal tendencies may occur
Monitor closely for paradoxical reactions - excitement, stimulation, and acute rage - withhold drug
and notify HCP

Give w/ milk or food to prevent GI upset

Check BP and pulse early in tx
Monitor CBC, renal and hepatic enzymes
Watch for dependency
Avoid EtOH
No OTC meds unless prescribed
Avoid driving/hazardous activities until effects known

Contraindications: narrow-angle glaucoma, under 12 years old, and lactation

Caution with impending depression, impaired hepatic or renal function, COPD
89. Chloramphenicol Anti-bacterial
(Chloromycetin) Oral, Injection, Ophthalmic drops/ointment
Severe infection - for susceptible organisms when other anti-infectives are ineffective
Used for: sty, conjunctivitis, uveitis

Side Effects: dermatitis, itching, stinging, swelling

Adverse Effects/Toxicity: edema, super infection, aplastic anemia, & Stevens-Johnson Syndrome

Obtain culture specimen from eye b/f initiation of treatment

Remove exudates
Monitor for pain, drainage, redness, swelling
Monitor for bleeding and bruising

Contraindications: hypersensitivity
90. Chlorothiazide Thiazide Diuretic (non-potassium sparing)
(Diuril) Antihypertensive
Increases urinary excretion Na+ & water by inhibiting Na+ reabsorptioin
Use for edema & HTN, HF, cirrhosis, corticosteroid & estrogen therapy, diabetes insipidus

Side Effects: dizziness, vertigo, frequent urination, electrolyte imbalance, impaired glucose tolerance,
hyperuricemia, photosensitivity
Adverse Effects/Toxicity: renal failure, aplastic anemia, and anaphylaxsis

Take early in the morning to avoid nocturia

Give w/ food
Allow 3-4 weeks for max effect
Will not be effective if creatinine clearance is <30 mL/min

Contraindications: anuria and pregnancy

Use cautiously w/ impaired renal or hepatic function
Will increase lithium level
91. Chlorpromazine Antipsychotic med and anti-emetic
Hydrochloride Block DA receptor in CNS
(Thorazine) Uses: tx psychotic disorder (schizophrenia, bipolar, and other metnal illnesses); prevents acute exacerbation
and maintains highest level of function; Controls manic phase; intractable hiccups, N/V
Low potency antipscyhotic which can reduce the risk of EPS effects

Side Effects: sedation, orthostatic hypotension, anticholinergic effect (dry mouth, blurred vision, urinary
retention, photophobia, constipation, tachycardia), liver damage, tremor are 2 major side effects,
photosensitivity
Adverse Effects/Toxicity: neuroleptic malignant syndrome (NMS), catatonia, rigidity, stupor, unstable BP,
profuse sweating, dyspnea

Get baseline ECG, thorough baseline elevation lab tests before treatment
Withdrawal of drug is necessary
Take measures to protect eyes exposed to sunlight

Contraindications: monitor diabetics closely for glucose intolerance

92. Cimetidine (Tagamet) H2 Receptor Antagonist
Works against histmaine receptors, decreases gastric secretion, and used short term for
duodenal ulcers, benign gastric ulcers, & acute upper GI bleeds

Side Effects: cardiac dysrhythmias, diarrhea, dry mouth, constipation

Adverse Effects/Toxicity: rare but may include agranulocytosis, neutropenia,
thrombocytopenia, aplastic anemia, and anaphylaxsis

May be given w/ meals & at bedtime

Avoid smoking which causes gastric simulation
Avoid use w/n 1 hour of dose

Contraindications: hypersensitivity
Use cautiously w/ impaired renal or hepatic function
93. Cisplatin (Platinol) Antineoplastic mediation; Alkylating agent
Major allergic rxn can occur w/n 15 min of amdin (anaphylaxsis w/n minutes)
Half-life 20-30 minutes
Treats ovaraina nd testicula rcancer by interfering with DNA replication

Side Effects: anorexia, uncontrolled N/V, fluid retention, weight gain

Adverse Effects/Toxicity:
- Major toxicities occur int he blood, GI, and reproductive system
- Watch urine output and specific gravity - nephrotoxcitiy w/n 2 weeks
- Ototoxicity

Maintain fluid at least 3,000 mL/24 hours - report reduced urine output
Aovid food high in thiamine --> HTN & intracranial hemorrhage

Contraindications: hx of sensitivity to platinum-containing compounds, impaired renal function

and hearing, history of gout and renal stones
Incompatible w/: dextrose & Reglan or Vanco, Lasix may increase ototoxicity, other
nephrotoxic drugs
94. What to give for neuroleptic Bromocriptine (Parlodel) and Dantorlene (Dantirum)
malignant syndrome (NMS)
95. Codeine Sulfate Opioid Analgesic (agonist) and Antitussive
Rapid onset if IM or IV (peak 1-2 hours)
Duration: up to 7 hours
Treats mild to severe pain and hyperactive cough
Most oral preps combined with ASA or acetaminophen

Side Effects: constipation, urinary retention, dizziness, lightheadedness

Adverse Effects/Toxicity: resp. depression, resp. arrest, circulatory depression, ICP
Long-term use may cause withdrawal symptoms when stopped

Assess for: respirations (hold if <12), CNS changes, allergic rxn

Teach: no EtOH, no OTC pain meds unless ordered, and avoid driving until response is known

Contraindicated: hypersensitivity, increased ICP, head injury, acute alcoholism, labor

96. Cyanocobalamin Half-life = 6 days
(Vitmain B12) Helps in formation of RBCs - essential for proper production of platelets, RBCs, WBCs, and nervous
system
Used w/: malabsorption syndrome and pernicious anemia
Water-soluble vitamin stored in liver

Adverse Effects/Toxicity: anaphylactic shock, sudden death, severe optic nerve atrophy (after years of
use or w/ Leber's disease)

Injection is 1x/month for life w/ pernicious anemia

Oral preps may be mixed w/ fruit juice but give immediately since vitamin C affects its stability
Dietary B12: organ meats, egg yolk, clams, oysters, crabs, sardines, salmon

Contraindications: HS, lactation

97. Cyclosporine Immunosupressant
(Sandimmune) Metabolized in liver
Peak = 4-5 hours
Duration = 20-54 hours
Half-life = 19-27 hours
Inhibits Helper T's and T suppressor cells
Prevents rejection of kidney, liver, and heart transplants
Treats chronic rejection in people who have received immunosuppressive agents, RA, recalcitrant plaque
psoriasis

Side Effects: HTN, increased risk of infection, tremor (expected)

Adverse Effects/Toxicity: renal toxicity, hepatotoxicity

Monitor AST, ALT, BUN, Cr., Platelets, and K

Take w/ food to reduce GI upset - mix w/ chocolate mil or OJ but not grapefruit juice
Mix in glass not plastic
Avoid use of live vaccines
Prevent infection and report s/s
Immunosupressant precautions

Contraindications: pregnant/lactating, antieplieptic meds (decrease levels), oral contraceptives (increase

levels)
Use cautiously w/ renal/hepatic impairment
98. Debrox Drops Ear drops to dewax
Used to soften & loosen ear wax

Side Effects: temporarily decreases hearing after, mild feeling of fullness sin ear, mild itching in ear
Adverse Effects/Toxicity: emergency help w/ allergic rxn - hives, difficulty breathing, swelling of face, lips,
tongue, throat

Tilt head w/ ear facing up - pull back on ear and drop into canal
After using stay lying down w/ head tilted for 5 minutes - may use small piece of cotton to plug ear
Bubbling sound may be heard
May come w/ bulb syringe

Contraindications: ruptured ear drum, s/s of ear infection/injury, children <12 yrs w/o HCP consent, longer
than 4 days in a row
99. Diazepam Benzodiazpeine; mild tranquilizer, anticonvulsant, anxiolytic
(Valium) Absorbed form GI
Metabolized by liver
Onset: 30 min IM, 0 min PO, 15 min IV
Peak: 1-2 hour PO
Duration: 15 min-1 hour IV, up to 3 hrs. PO
Half-life = 20-50 minutes

Relieves pain from discomfort w/ musculoskeletal disorders, manages anxiety, manages acute alcohol withdrawal
Max effect w/n 1-2 weeks (2-4 wks for addictive effect)

Side Effects: Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness, cardiovascular collapse,
laryngospasm, dizzy, weakness, nausea
Adverse Effects/Toxicity: erythema multiforme, angioedema, anaphylaxis, dysrhythmia, seizure

Watch for CNS effect

Monitor CBC w/ differential and WBC
Notify HCP if BP drops 20 mm Hg
Assess for allergic rxn - idiosyncratic rxn, anaphylaxsis, rash, fever, resp. distress
Do not stop abruptly - withdrawal occurs (insomnia, nausea, HA, spasticity, tachycardia)
No EtOH
Suicide prevention precautions

Contraindications: compromised pulmonary function, hepatic disease, impaired myocardial function, acute EtOH
intoxication, infant <6 months, narrow angle/open angle glaucoma
100. Digoxin Cardiac glycoside, antiarrhythmic drug
(Lanoxin) Therapeutic Range = 0.5-2.0 ng/mL
Toxic Level > 2ng/mL
Antidote = digibind
Positive inotropic effect
In HF it increases contraction of heart muscle
In a-fib it slows HR

Side Effects: nausea, HA, loss of usual appetite

Adverse Effects/Toxicity: same sx of flu (n/v, anorexia, diarrhea, visual disturbances); blurred green/yellow vision or
halo effect; dysrhythmias (early sx w/ HF)
- Children rarely show signs of N/V, diarrhea, visual problems or anorexia

May give w/o regard to food

IVP over 5 minutes - do not ive IM - causes tissue irritation
Monitor apical pulse (if <60/min - hold and notify HCP)
Monitor K, Ca, Mg, Cr clearance
Monitor digoxin level q6months
Daily weights - report >2 lbs./day

Contraindications: HS
Caution w/ kidney failure
IV calcium increases risk of cardiac dysrhythmia
Erythromyocin increases dig level
Quinidine, verapamil, and amiodarone increases dig levels (decrease dig dose by 50%)
Cyclophosphamide combineed with dig causes toxicity
101. Disulfiram Only EtOH antagonist in use
(Antabuse) Enzyme inhibitor and anti-EtOH agent
Half-life = 24-36 hours
Onset up to 12 hours
Duration up to 2 weeks
Absorbed from GI tract
Excreted via feces or in breath as carbon disulfide
Adjacent treatemnt of pt. w/ chronic alcoholism who sincerely wants to maintain sobriety
At least 12 hours should elapse from last EtOH intakke and initial dose
Use only in those w/ high physical health
Use 1-2 weeks

Intended Rxn w/ EtOH: flushing face, arms, chest; pulsating HA, nausea, violent vomiting, thirst, sweating, marked
uneasiness

Adverse Effects/Toxicity: acetaldehyde syndrome (hypotension to shock levels, arrhythmias, acute congestive
failure, marked resp. depression, unconsciousness, convulsions, sudden death)

The effects may persist 2 weeks after last dose taken

Give in AM when resolve to drink is strongest and at bedtime to minimize effect of drug
Avoid EtOH in all forms (sauces, cough mixture, after shave, colognes, and liniments)

Contraindications: people who don't want to stop drinking, severe cardiac disease, psychoses, pregnancy, multiple
drug dependence
102. Epinephrine Alpha & beta Adrenergic Agonist; Vasopressor; Bronchodilator
(Adrenaline) IM/sub-q results in 5 minutes and lasts up to 4 hours
Also available in eye drops and intranasal

Reverses anaphylactic reaction

Restores cardiac rhythm in cardiac arrest
Acute asthmatic attacks
Ophthalmic decongestant - manages open angle glaucoma

Side Effects: nervousness, tremors, increased HR/BP, insomnia, anorexia, cardiac stimulation, vascular HA
Adverse Effects/Toxicity: tachyarrhythmias, chest pain, restlessness, agitation, nervousness, insomnia, nasal burning
& stinging, eye burning
Hypersensitivity of eyes: lid itching, discharge, crusting eyelid (notify HCP and d/c)

Report nervousness and sleepiness - dose should be reduced

Administer eye drops at bedtime - may experience HA and stinging but subsides with continued use (report if
continuous)
Monitor VS (HR and BP) d/t cardio effect

Contraindications: MAOI's (hypertensive crisis), narrow angle glaucoma, hemorrhagic/traumatic/cardiogenic shock,

arrhythmias, organic heart or brain disease
Caution with: older adults, HTN, TB, long-standing bronchial asthma, emphysema, children <6
NO BREASTFEEDING!
103. Famotidine Histamine H2 antagonist
(Pepcid) Onset = 1 hour
Pea = 1-3 hours
Duration = 10-12 hours
Half-life = 2.5-4 hours
Decreases output of gastric acid; short-term tx in duodenal ulcers or benign gastric ulcers
Metabolized by liver and excreted in urine

Side Effects: diarrhea, constipation, dry mouth

Adverse Effects/Toxicity: thrombocytopenia

May be taken w/ food. Pain relief may not be experienced for several days.

Use cautiously w/ impaired renal or hepatic function.

DO NOT BREASTFEED!
Avoid antacid use within 1 hour of dose
104. Fluoxetine Tricyclic Antidepressant, SSRI
Hydrochloride Half-life = 1-6 days
(Prozac) Onset = 2-3 weeks for effectiveness
Peak = 4-8 hours
Metabolized in liver, absorbed from GI tract, and excreted in urine and feces.
Uses: major depressive disorder, OCD, bulimia, panic disorder, obesity, alcoholism, chronic pain

Wait 4-6 weeks to switch to MAOI

Side Effects: orthostatic hypotension, sedation, anticholinergic, hypomania, sexual dysfunction

Adverse Effects/Toxicity: cardiac toxicity; selective 5HT syndrome (diaphoresis, agitation, low grade temp -->
increased BP, muscle rigidity, temp, pulse; mental status changes, tremors, hyperthermia, sweating, hypersalivation
(notify HCP ASAP)

Do not stop abruptly

Give meds once a day (noon) - causes insomnia [if Rx BID - once early in AM and once at noon]
Teach side effects
Therapeutic response takes weeks

Contraindication: MI, CVD, pregnancy

- If suicide risk, should not have large supply

TCA and MAOI combination can --> hypertensive crisis from excessive adrenergic stimulation of the heart and
blood vessels
105. Fluphenazine (Proloxin) Phenothaizine; antipsychotic
Half-life = >24 hours
Onset = 1 hour
Peak 0.5 hour
Effect seen in 1-2 days, but full effect takes weeks

Potent medication fro tx of antipsychotic symptoms (schizophrenia)

Tx is not curative - adjust dose for symtpoms
Injectable form for long-term maintenance

Side Effects: EPS (reversible), Anticholienrgic (dry mouth), blurred vision, constipation, drowsiness;
photosensitivity, increased risk of agrnaulocytosis, gynecomastia, amenorrhea, wight gain
Adverse Effects/Toxicity: neurolpetic malignant syndrome (NMS

Monitor LFT's
Avoid alcohol use and other CNS depressants
Do not abruptly stop
Avoid sun exposure
With oral concentrate avoid spills - rinse skin w/ warm water immediately w/ contact
Dilute liquid drug w/ fruit juice, water, carbonated beverage, milk, or soup - avoid mixing with
caffeine, tea, apple juice

Caution with narrow angle glaucoma, hepatic/renal dysfunction, and seizure disorders
DO NOT BREASTFEED!
Reduced doses in elderly
106. What to treat Cogentin, Artane, Benadryl, Symmeteral
Extrapryamidal Side Effects
(EPS) with?
107. Neuroleptic Malignant Presents with cataonia, rigidity, stupor, unstable BP, hyperthermia, profuse sweating, dyspnea,
Syndrome (NMS) incontinence
Stop the drug and treat with Dantrium and Parlodel
Lasts 5-10 days after stopping the med
Fatal side effect of meds
108. Furosemide Loop Diuretic; antihypertensive
(Lasix) Peak = 60-70 minutes PO, 20-60 minutes IV
Onset = 30-60 minutes PO, 5 minutes IV
Duration = 2 hours
Half-life = 30 minutes

Rapid-acting loop diuretic; inhibits reabsorption of sodium and water (in Loop of Henle); lowers BP by
decreasing edema and intravascular fluid
Treats: acute pulmonary edema, edema, heart failure, chronic renal impairment, HTN, hypercalcemia

Side Effects: ototoxicity, HA, dizziness, orthostatic hypotension, weakness

Adverse Effects/Toxicity: s/s of hypokalemia, hyponatremia, hypochloremia, hypomagnesmia, hypocalcemia

IV: administer slowly - hearing loss can occur

Give over 1-2 minutes to prevent hypotension
Teach: orthostatic hypootension precautions, take with food or milk; give early in day to avoid nocturia; replace
K (diet or meds)
Report ringing of ears
Monitor labs (electrolytes, H&H, platelets - all decrease d/t hemoconcentration)
Monitor body weight and I/O

Contraindications: anuria, electrolyte depletion, increasing oliguria, hepatic coma, pregnancy, lactation
Interactions with digitalis - can increase arrhythmias
Interaction w/ aminoglycoside - risk of ototoxicity
109. Gentamicin Aminoglycoside antibiotic
(Garamycin) Peak drawn 15-30 minutes after infusion completed
Trough drawn 30 minutes before next dose (1-2 g/mL)
Peak = 30-90 min
Half-life = 2-4 hours

Broad-spectrum antibiotic; parenteral use limited to severe infections unreponsive to other ab's
Ophthalmic use: treats superficial infection of the eye; have patient keep eyes closed 1-2 minutes after
instillaiton; vision blurred immediately

Side Effects = HA, paresthesia, skin rash, fever

Adverse Effects/Toxicity: nephrotoxicity, ototoxicity (may be irreversible damage); hypersensitivity reactiosn;
superinfection

Maintain hydration to protect kidney damage (2,500-3,000 mL/day); Give high protein foods
Monitor WBC, kideny function tests (BUN, Cr.) closely
Report sore throat, watery stools >4-6/day, severe n/v - indicates possible superinfection

Contraindications = preexisting renal disease; preexisting hearing loss; pregnancy, lactation

Increased risk w/ nephrotoxic drugs
Prolonged tx w/ aminoglycosides
Impaired renal function and other ototoxic drugs like Lasix and Vanco
110. Signs of HA
Ototoxicity N/V
Unsteady gait
Tinnitus
Vertigo
High frequency hearing loss
Dizziness
111. Glipizide Oral antidiabetic; sulfonylurea
(Glucotrol) Duration: 12-24 hours
Onset = 15-30 minutes
Peak = 1-2 hours
Metabolized by liver
Stimulates pancreatic beta cells to secrete insulin
Used for T2D
Given 1-3x/day
May use alone or w/ insulin

Side Effects: GI distress, dizziness, drowsiness, HA

Adverse Effects/Toxicity: severe skin rash, pruritus, hypoglycemia

Monitor labs - glucose, A1c

Take w/ first daily meal; take missed dose as soon as remembered; report s/s of hypoglcyemia if they occur;
avoid alcohol

Contraindications: pregnancy, lactaiton, allergy to sulfa or urea, diabetic ketoacidosis

Caution w/: impaired renal/hepatic fx; adrenal or pituitary insufficiency
112. Glucagon Anti-hypoglycemic
Onset = 5-20 min
Peak = 30 min
Duration = 1-1.5 hour
Half-life = 3-10 minutes
Metabolized in liver, plasma, kidneys
Emergency tx of severe hypoglycemia in unconscious or those unable to swallow
Comes in powder form - reconstitute w/ provided dilutent
Given IV, IM, or SQ immediately (IV through D5W ONLY)

Side Effects = n/v

Adverse Effects/Toxicity: HS rxn; hyperglycemia; hypokalemia

Should awaken w/n 5-20 minutes of giving; givee 50% glucose if no repsonse
Teach: test blood sugar; teach family how to administer

Incompatible w/ NaCl
113. Glyburide (Micronase, Oral antidiabetic; Sulfonylurea
DiaBeta) More potent drug
Onset = 15-60 minutes
Peak = 1-2 hours
Duration up to 24 hours
Half Life = 10 hours
Metabolized in the liver, excreted in urine and feces
Lowers blood sugar concentration in diabetics and nondiabetics by sensitizing pancreatic beta cells to
release insulin in the presence of serum glucose
Use: T2D
Adjunct to diet and exercise to lower blood sugar

Side Effects = hypoglycemia, epigastric fullness, heartburn, pruritus

Adverse Effects/Toxicity: hypoglycemia

Give once in the AM w/ breakfast or first main meal

Monitor labs - glucose, A1c
Report reaction; loss of control of blood glucose may be d/t fever, surgery, trauma, stress, infection

Contraindications: diabetic ketoacidosis; T1D

Caution w/: renal/hepatic insufficiency; older adults; malnourished pts., adrenal or pitutiary insufficiency
114. Haloperidol (Haldol) High potency drug
Antipsychotic; Butyrophenone; Antiemetic
Onset = 30-45 minutes IM
Effects can be seen in 1-2 days w/ substantial improvement in 2-4 weeks; full effect takes several months
Uses: psychotic disorders; long-acting drug for maintenance to control symptoms; Tourette's Syndrome

Side Effects: anticholinergic (dry mouth), blurred vision, constipation, drowsiness, EPS (Parkinson's S/S);
photosensitivity
Adverse Effects/Toxicity: elderly may develop neuroleptic malignant syndrome (NMS)

EPS: usually first few days of treatment; dose-related and controlled by dose or anti-Parkinson's drugs
Oral: give w/ milk or food
Taper dose slowly when stopping
Injection: deep IM - risk for orhtostatic hypotension
No EtOH or driving until repsonse is known

Contraindications: Parkinson's disease; seizure disorder, severe mental depression

Caution w/: older adults, lithium therapy, HTN, lactation
115. Heparin Anticoagulant
Antidote = Protamine Sulfate
Given IV or SQ for anticoagulation
IV infusion for DVT, pulmonary emoblism, angina, acute MI
SQ for prevention
Hep-lock flush is used to maintain patency of IV catheters - not anticoagulation therapy

Side Effects: bleeding, HIT (several weeks later)

Does not dissolve clots - prevents enlargement and development of new clots
Use bleeding precautions
Monitor labs - aPTT (normal = 25-40; coagulated = 1.5-2x normal = 60-80)
Adjust IV dose based on labs

Contraindications = hemorrhage, active bleeding

NEVER GIVE IM
116. Hydrochlorothiazide Electrolyte/water balance - thiazide diuretic
Hydrochloride (Hydrodiuril, Effects noted 3-4 days; max effect takes 3-4 weeks
HCTZ) Most widely prescribed diuretic for HTN
Acts on distal tubules of nephrons and increases urinary excretion of Na, Cl, K, H2O, HCO3
Decreases edema and lowers BP

Side Effects: glucose intolerance, hyperglycemia, hypokalemia

Give w/ food or milk to reduce GI upset; give doses early in the day to avoid nocturia
Limit Na+ intake and eat foods high in K+ - replacement med is not usually needed
Photosensitivity rxn can occur in 10-14 days after initial sun exposure

Contraindications: anuria, HS to thiazides

Caution w/: bronchial asthma, hepatic cirrhosis, renal dysfunction, history of gout, diabetes, SLE,
lactation
117. Hydroxyzine HCl (Atarax, Anti-emetic, Anti-histamine (H1-receptor antagonist), Antipruritic
Vistaril) Onset = 15-30 minutes PO
Peak = 4-6 hours
Absorbed from GI; Metabolized in liver
Treats N/V (use anticipatory); relieves anxiety, reduces narcotic requirement before and after
surgery; treats acute or chronic alcoholism w/ withdrawal symptoms or DT's; pruritus

Side Effects: CNS depression; drowsiness, dizziness, dry mouth, anticholinergic effect, constipation,
visual changes, photosensitivity

Administer deep IM - z-track - gluetus maximus or vastus lateralis in adults; vastus lateralis in kids
Monitor mouth daily; no EtOH, hard candy, ice chips, or rinse mouth w/ warm water frequently to
relieve dry mouth

Contraindications: CNS depression and coma; other CNS meds

Caution w/: glaucoma, seizure, intestinal obstruction, prostatic hyperplasia, asthma,
cardiac/pulmonary/hepatic disease
118. Ibuprofen (Advil, Motrin0 Analgesic, NSAID
High-dose therapy: therapeutic effect may take up to one month
Treats mild to moderate pain
Absorbed in GI tract; metabolized in liver

Side Effects: CNS, renal system, eyes, nephrotoxicity, dysuria, hematuria, oliguria, azotemia, blurred
vision, ototoxicity
Child toxicity = Rash, Stevens Johnson Syndrome

Increases toxicity of anticoagulants, lithium

Avoid EtOH, ASA, and other NSAIDs

Contraindications: GI bleed, Rxn to other NSAIDs, and children under 6 months

119. Insulin Quick-acting, short-acting, intermediate-acting, and long-acting; also available in a premixed form of
regular and NPH (70/30 = 30% regular, 70% NPH)
Uses: Diabetes Mellitus (T1D, T2D)
Could be made of pork/beef, pork, or human insulin type
Short acting and and intermediate acting insulin may be given more than once/day

Side Effects: hypoglycemia (anxiety, confusion, nervousness, hunger, diaphoressis, cool, clammy skin);
lipodysrophy, local allergic rxn
Adverse Effects/Toxicity: Somogyi phenomenon; coma, hyperosmolar hypeglycemic state (HHS), diabetic
ketoacidosis (DKA)

Obtain med alert bracelet; open vial can be stored at room temp for up to 1 month; rotate sites; alcohol
will increase sugar
Requires long-term monitoring of blood sugar control and potential complications

Contraindications: do not use beef/pork insulin if sensitivity

120. Somogyi Phenomenon Rebound response w/ high blood sugar in response to low level at night
121. Regular Insulin Only one that can be given IV!
(Humulin R) Short-acting insulin
IV or SQ
T1D/T2D/Ketoacidosis
Given before meals according to blood sugars
Side effects: hypoglycemia
Clear and colorless
122. Isophane (NPH) Insulin Intermediate acting
(Humulin N) Give 30 minutes before first meal of the day - if necessary another smaller dose may be given 30 minutes
before bedtime
If given before breakfast, hypoglyemic episode is most likely to occur mid-afternoon/dinner time when it
peaks (eat snack in midafternoon)
Carry sugar and candy
Cloudy suspension - roll bottle (DO NOT SHAKE!)
May be mixed with regular insulin w/o altering either solution
123. Insulin Glargine (Lantus) Cannot be mixed in the same syringe w/ any other insulin
Long-acting isulin
T1D children and adults + T2D adults
SQ injection
Usually given at bedtime (may be given BID)
W/ T2D may or may not be given concurrently w/ oral agents
124. Iron Mineral Replacement
Side Effects: N/V, staining of teeth, constipation, black stools (normal)

Taking on empty stomach is preferred w/ full glass of H2O or citrus juice

Calcium inhibits iron absorption - do not take w/ milk
Vitamin C increases its absorption
Liquid can stain teeth
125. Ipecac Syrup Emetic; Antidote
Alternate = Activated Charcoal
For OD of certain drugs or poisoning
Stimulates vomiting w/n 20-30 minutes

Adverse Effects/Toxicity: cardiotoxicity is most serious if vomiting does not occur and the substance is retained

use of this med is not automatic - verify appropriateness w/ poison control center

Contraindications: reduced LOC or convulsions; poison by petroleum, distillates, strong alkaline/acid/stychnine

126. Lidocaine HCl Antiarrhythmic; Topical Anesthetic
(Xylocaine) Bolus dose - may repeat and then start continuous infusion - stop when stable

Therapeutic Level = 1.5-6 mcg/mL

Treats ventricular arrhythmias, PVC's, and V-Tach
Use for rapid control of ventricular dysrhythmias during acute MI or cardiac cath
Use microdrip tubing and infusion pump

Side Effects: drowsiness, HA, dizziness, mild hypotension

Adverse Effects/Toxicity: convulsions, respiratory depression; hypotension, bradycardia, heart block, CV collapse
and arrest
Stop infusion w/ EKG changes (prolonged PR, widened QRS, heart block)

Monitor lidocaine levels and assess if in therapeutic range

Assess electrolytes- check baseline liver and renal blood studies
Report: lightheadedenss, dizziness, confusion, n/t lips/tongue/fingers, visual changes, or ringing in ears
Correct hypokalemia before giving lidocaine

Contraindications = sinus bradycardia, severe degrees of SA, AV, intraventricular heart block
Caution w/: hepatic or renal disease, CHF, hypovolemia, shock, hyperthermia, elderly

Beta Blockers increase its effects

127. Lithium Mood stabilizer; antipsychotic
Carbonate Therapeutic Level = 0.8-1.5 mEq/L
(Eskalith) Toxic Level > 2
Short half life (about 1 day) and high toxicity
Drug of choice to control manic episodes in bipolar disorder
Anti-manic effects usually seen in 5-7 days after initial doses, but full effect does not occur for 2-3 weeks
Salt - exact action is unknown

Does not cause sedation

Mild Side Effects: fine tremor, nausea, thirst, polyuria
Adverse Effects/Toxicity: vomiting, diarrhea, slurred speech, lack of coordination, drowsiness, muscle weakness,
twitching - withhold dose and notify provider but do not stop abruptly

Give w/ meals. Hydration is essential - dehdyration increases levels of med.

Watch for weight gain (fluid retention)
Avoid NSAIDs and diuretics
Essential to monitor mood and behaviors
Li level q3months initially then q6months

Contraindications: dehydration, severe debilitating, severe cardiovascular issues

Caution w/: elderly, cardiac/renal/thyroid issues, diabetes, pregnancy
128. Lorazepam Anxiolytic; sedative-hypnotic; benzodiazepmine
(ativan) Onset = 1-5 minutes IV, 15-30 minutes IM
Peak = 60-90 minutes IM, 2 hours PO
Duration = 12-24 hours
Anxiety disorders, short-term relief for s/s of anxiety; preanesthetic med to produce sedation and reduce anxiety;
status epilepticus

Side Effects: drowsiness, sedation, mild medication w/ limited toxic potential; resp. depression is rare

Paradoxical rxns: nightmares, mania, etc may occur in children, psych pts., and the elderly

Avoid EtOH. Taper dose when stopping to avoid withdrawal symptoms

Watch for suicide risk

Contraindications: acute narrow-angle glaucoma, primary depression, acute EtOH intoxication, pregnancy and
lactation
Caution w/: renal/hepatic impairment; myasthenia gravis, suicidal tendencies
129. Magnesium Iron (Epsom Salt - oral form)
Sulfate Onset = 1-2 hours PO, 1 hour IM
Duration = 30 minutes IV, 3-4 hours PO
Eliminated by kidneys
Normal Mg = 1.8-3 mEq/L

Oral: laxative (by osmotic retention of fluid whyponatremai, hich distends the colon, increases the content of
feces, and causes bowel stimulation)
Parenteral: CNS depressant; used in seizures of toxemia; for hypomagnesmia

4 gm. loading dose over 20-20 minutes via pump

Side Effects: flushed warm feeling, f/e imbalance, hyponatremia, N/V

Adverse Effects/Toxicity: respiratory depression, cathartic effect, profound thirst, feeling of warmth, sedation,
confusion, decreased DTR, muscle weakness, can lead to cardiac arrest

Teach: s/s hypomagnesmia

Monitor U.O and hydrate adequately w/ parenteral administration

Contraindications: MI, heart block, cardiac arrest (except certain arrhythmias)

Caution w/: impaired kidney fx, other cardiac glycosides, lactating moms, children
130. S/S of Irritability
Hypomagnesmia Tremors
Tetany
Tachycardia
HTN
Psychotic behavior
131. Mannitol Electrolyte/Water Balance Agent; Osmotic Diuretic
(Osmitrol) Onset: 1-3 hour diuresis; 30-60 minutes IOP, and 15 minutes for ICP
Duration: 4-6 hours IOP, 3-8 hours ICP
Serum Osmolality = 275-300 mmol/kg
Give IV - usually test dose should give output of 30-50 mL/hour and produced 2-3 hours after administration

Use in oliguria and ARF (helps to prevent RF and reduce increased intracranial or intraoccular pressure); increases
osmolality of plasma, glomerular filtrate, and tubular fluid. Decreases the reabsorption off f/e which increases the
excretion of H2O, CL, and Na and slightly increases the excretion of K

Side Effects: HA, confusion, syncope, f/e imbalance (esp. hyponatremia), pulmonary congestion, rhinitis, water
intoxication
Adverse Effects/Toxicity: seizure, thrombophelbitis, CHF, CV collapse, hponatremia

May be a rebound increase in ICP 12 hours after administration of med - complains of HA and confusion

Use filter needle and/or filter in infusion tubing because crystals may form in he sol'n
Held if serum osmolality exceeds 310-320
Daily weights
Non-narcotics like tylenol if HA
Therapy based on urine flow rate
Reassure pt that excessive thirst, blurred vision, rhinitis should subside when Mannitol is d/c'd

Contraindications: severely impaired renal fx; marked dehydration, breast feeding, hepatic failure, active ICP, anuria,
intracranial bleed/shock

Question admin if pt. has cor pulmonale - needs loop diuretic

132. Meperidiine Narcotic Analgesic (Opioid Agonist)
HCl Gie Narcan for toxicity
(Demerol) Onset = 15 minutes PO, 10 minutes IV
Duration = 2-4 hours
Given for moderate to severe pain; potent and long-acting

Side Effects: N/V, anorexia, sedation, dizziness, elevated BP, rash, urticaria, tremors, hyperventilation
Adverse Effects/Toxicity: respiratory depression, respiratory arrest, circulatory depression, increased ICP

Assess LOC, rash, utricaria, respiratory

If resp. <12/min - withhold

Contraindications: acute bronchial asthma, upper airway obstruction, increased ICP, convulsive disorder, pancreatitis,
acute UC, severe liver/kidney insufficiency
Caution w/: children and elderly
133. Metoprolol Tartate Beta Blocker; Antihypertensive, Antiangial
(Lopressor, Toprol) Decreases HR and CO - lowers BP
Mild-to-severe HTN, angina pectoris, post-acute MI
Max effect takes 1 week

Side Effects: usually well tolerated; n/v; weight gain; worsening CHF; insomnia
Adverse Effects/Toxicity: profound bradycardia, heart block, acute CHF, bronchospasm, laryngospasm

Give w/ or w/o food - but consistent

Do not stop abruptly - may cause a rebound effect
Gradually decrease over 1-2 weeks
Hold if BP <90 or pulse <60
Watch for s/s HF
Can --> elevated BUN/Creatinine
May mask hypoglycemia

Contraindications: heart block >1st degree, sinus bradycardia, cardiogenic shock

Caution w/: hyperactive airway syndrome (asthma or bronchospasm)
Increases chance of digoxin and lithium toxicity
134. Morphine Sulfate MS Contin = sustained release form
Narcotic/opioid analgesic
Give Narcan for toxicity
Onset/Peak/Duration depend on route
Produces effect by binding to opioid receptors throughout the CNS
Schedule II drug - major abuse
For severe, chronic, or acute pain - most commonly in the postop setting
Mild bronchodilator to improve breathing

Side Effects: N/V, anorexia, GI, pruritus, light-headedness, constipation

Adverse Effects/Toxicity:
- Classic Triad: resp. depression, coma, pinpoint pupils
-Withdrawal begins 6-8 hours after last dose - reaches peak intensity within 48-72 hours

Avoid EtOH use

Hold if resp. <1/min
Hydrate adequately to prevent constipation

Contraindications: HS to opiates; acute bronchial asthma or upper airway obstruction; ICP, convulsive
disorders, pancreatitis, acute UC, severe liver/kidney disease
Do not give to children
135. S/S of Morphine Craving
Withdrawal Chills
Sweating
Piloerection
Abdominal pain/cramps
Diarrhea
Runny nose
Irritability
136. Naloxone HCl (Narcan) Opioid Antagonist
Onset = 1-2 min IV, 2-5 min SQ/IM
Duration = 1 hr. IV, up to 4 hrs. IM but starts to diminish after 20 minutes
Competes w/ opioids at the opiate receptor sites, blocking effects of the opioids
Reverses effects of opiates (resp. depression, sedation, hypotension)
May need every few hours

Side Effects: increased BP, HR, hyperapena, tremors, hyperventilation, drowsiness, nervousness, N/V
Adverse Effects/Toxicity: hypotension, V-tach/v-fib; convulsion, hepatitis, pulmonary edema

Watch S and resp. function closely w/ admin

Titrate dose slowly - if too much is given, client will swing from state of intoxication to one of
withdrawal

Contraindications: known allergy, resp. depression d/t non-opioids, substance abuse (--> withdrawal
s/s)
137. Nedocroil (Tilade) Inhaled NSAID - anti-inflammatory/antiasthmatic
Also in opitic form
Asthma prophylaxsis - not acute attacks
Up to one week for full effectiveness
Must be taken regularly to be effective

Adverse Effects: abnormal bitter taste; N/V; dizziness; sore throat

Rinse mouth after taking med to avoid dry mouth; do not use for an attack
Non-compliance is concern d/t bitter taste

Contraindications: acute bronchospasm, status asthmaticus; HS

Cuation w/: hepatic/renal function
138. Neomycin Sulfate Oral aminoglycoside (antibiotic)
(Mycifradin) Antibacterial - GI tract; hepatic coma
Main form is topical for eye, ear, and skin infection
NOT GIVEN IV!

Side Effects: skin rash (esp. topical)

Adverse Effects/Toxicity: nephrotoxicity, ototoxicity

Poorly tolerated GI so it is usually for bowel cleaning

139. Nifedipine (Procardia) CCB; antianginal and antihypertensive
Negative inotropic
Uses: angina, mild to moderate HTN (sustained release)
Dilates coronary arteries and relaxes coronary spasm
Increases CO and decreases PVR
blocks Ca ion flow into cells of myocardium and arterial smooth muscle (cardiac/peripheral blood vessels)
Slows HR and decreases O2 need

Side Effects: usually well tolerated; HA, fatigue, dizziness, postural hypotension, peripheral edema
Adverse Effects/Toxicity: gingival hyperplasia

Do not give 1-2 weeks after an acute MI.

Do not give w/ grapefruit juice (-->toxicity)
Report gradul wt. gain and evidence of edema; may indicate onset of CHF
Do not stop suddenly - rebound symptoms
Smoking decreases efficacy of med
Monitor pulse rate - report irregular or slower than normal. HOLD if BP <90/60
140. Oxytocin (Pitocin) Oxytoic; L&D
Onset = immediate
After stopping med, contractions should stop in 2-3 minutes
Half-life = 3-5 minutes
To initiate or improve uterine contractions at term; induce labor; management of incomplete or missed
abortion; reduces postpartum bleeding

Side Effects: subarachnoid bleed, feta trauma, seizure, coma

Adverse Effects/Toxicity = Hyertensive crisis

For fetal anoxia: stop infusion, turn mom on left side and O2 PRN
Stop infusion for: contraction occurring >q2 minutes or lasting >90 seconds

Careful monitoring of uterine contraction pattern, FHR, & maternal BP

Postpartum: monitor lochia and BP
Do not increase dose after desired contraction pattern is achieved

Contraindications: HS, cephatlopelvic disproprotion; obstetric emergencies

141. Pancrelipase (Creon, Pancreatic enzyme replacement therapy
Pancrease) Helps to breakdown fat, proteins, and carbs for better absorption
Uses: Cystic Fibrosis, chronic pancreatitis, post pancreatectomy, steatorrhea, malabsorption syndrome

Side Effects: nausea, diarrhea, cramps

Adverse Effects/Toxicity: hyperuricemia ( joint pain/swelling w/ high uric acid level

Take w/ or just prior to eating

Do not mix brand names - variance in concentration of enzymes
Swallow whole - don't crush or chew
Can mix powder or open capsule w/ food

Contraindications: allergy to med/pork

Do not give w/ magnesium containing antacid - may be ordered w/ H2 Blockers or PPI's
Iron decreases its effectiveness
142. Phenobarbital (Phenobarbital Sodium =
Luminal - short-acting form)
143. Pilocarpine Hydrochloride (Pilocar)
For status epilepticus - administer slowly IV
Antionvulsant; sedative-hypnotic
Long-term management of grand mal, partial seizure, and status epilepticus.
Sedative effect to decrease anxiety and tension.
No analgesic effect
Side Effect: somnolence, hangover effect
Adverse Effects/Toxicity: CNS depression, Stevens-Johnson; blood dyscrasias,
paradoxical rxn in children, older adults and debilitaed pts.
Ok to crush and mix w/ food or fluids.
Monitor IV infusion closely
Do not stop abruptly
Avoid EtOH and other CNS depressants
Contraindications: HS, resp./kidney failure; pregnancy and lactation
Eye preparation
Miotic (anti-glaucoma agent)
Direct acting cholinergic agent for opthalmic use
Antidote to atropine
For acute/chronic glaucoma - decreases introcular pressure
Will reverse effects of atropine (and atropine reverses its effects)
Side Effects: visual blurring, myopia, irritation, brow pain, and HA (w/ ophthalmic);
increased pigmentation of iris and eyelids, long eye lashes
Adverse Effects/Toxicity: Retinal detachment, ataxia, confusion, and seizure
Apply gentle pressure for 1-2 minutes to nasolacrimal drainage area after administering
eye drops
Eye therapy will continue long-term
Contraindications: asthma, COPD, HTN, acute eye infections, retinal detachment,
contact lens use
144. Prazosin Hydrochloride Antihypertensive
(Minipress) Alpha-adrenergic receptor antagonist
Vasodilator
Treats BPH
Optimal effect takes 4-6 weeks
Uses: Mild to moderate HTN (mainly diastolic) and BPH (d/t vasodilator effects); little effect on CO and
HR

Side Effects: dizziness, drowsiness, fatigue, weakness, priapism, impotence, orthostatic hypotension
Adverse Effects/Toxicity: first dose phenomenon - syncope w/n 30 minutes to 1 hour - effect is transient
and may diminish by giving at bedtime

Monitor for decreased BP, especially w/ initial administration

Monitor urine volume
Change position slowly to prevent orthostatic hypotension
Stop smoking and avoid EtOH intake
Avoid driving and hazardous tasks until effect of med is known

Contraindications: prior sensitivity, hypotension

Caution w/: impaired hepatic function; older adults
145. Prochlorperazine Antiemetic; antipsyhotic, phenothiazine
(Companzine) Severe n/v, management of psychotic disorders, excessive anxiety and agitation
Takes 30-60 minutes before any activity that causes nausea for best effect
Start doses low and increase slowly

Side Effects: drowsiness, dizziness, EPSE

Adverse Effects/Toxicity: persistent tardive dysinesia, tremor, twitching, agranulocytosis,
thrombocytopenia
- After 1-2 months = akathisia (inner restless, inability to sit still) - tx w/ propanolol

Avoid excessive sunlight - may turn skin gray-blue

Urine may turn reddish-brown
use sugarless hard candy or ice chips to avoid dry mouth
Avoid skin contact w/ concentrate
Do not crush/chew - swallow whole
Deep IM, not SQ injection

Contraindications: HS, blood dyscrasias, dementia related psychosis in elderly, young children, seizures,
lactation
146. Promethazine Antiemetic, antihistamine, anti-vertigo
(Phenergan) Long-acting med; motion sickness; nausea
IM route: give deep; not SQ (can cause necrosis)
Avoid intra-arterial injection - can cause necrosis

Side Effects: resp. depression, drowsiness, confusion, agranulocytosis, blurred vision, dry mouth, EPSE

Decrease GI distress by giving PO dose w/ milk or food. May crush and mix w/ food.
Avoid sunlight exposure
Avoid EtOH and other CNS depressants

Contraindications: acute MI, angina, a-fib

Caution w/: narrow angle glaucoma, peptic ulcer, duodenal obstruction
147. Protamine Antidote for heparin toxicity
Sulfate Heparin antagonist
Onset = 5 minutes
Duration = 2 hours
Longer half-life than heparin

Antidote for Heparin overdose

Given IV - max dose of 50 mg in 10 min. time period - should be titrated according to the time and length of time
the heparin was administered

Side Effects: abrupt drop in BP if given too rapidly

Monitor VS and labs closely (aPTT)

Contraindications: hemorrhage not induced by heparin OD

148. Ranitidine H2-Receptor Antagonist
Hydrochloride Higher potency than cimetidine (Tagament)
(Zantac) Uses: Reduces gastric secretion; active duodenal ulcer maintenance after healing; GERD, benign gastric ulcers
short-term

Side Effects: HA, taste disorder, diarrhea, constipation, dry mouth

Adverse Effects/Toxicity: hepatotoxicity; thrombocytopenia

Give w/o regard to meals

Usually given 1x/day
Reduce dose in renal patient
Avoid smoking and avoid antacid wihtin 1 hour of dose

Contraindications: HS
Caution w/: impaired renal/hepatic function
May in crease effects of EtOH, aspirin, Coumadin, and sulfonylureas
149. Rho(D) Biological response modifier; Immunoglobulin
Immune Peak = 2 hours
Globulin Half-life = 25 days
(RhoGAM) Given to Rh-negative moms with Rh positive babies
Provides passive immunity by suppressing active antibody response and formation of anti-RHo when positive fetal
RBCs enter maternal circulation in 3rd stage of labor, there is fetal maternal hemorrhage or trauma during
pregnancy, termination of pregnancy or miscarriage, or following an Rh+ infusion

Side Effects: injection site irritation, slight fever, myalgia, lethargy

Send sample of newborn cord blood to lab for cross match and typing immediately after delivery before
administering RHo (D)
Give to mom IM via deltoid - only a few forms IV
Give immediately after reconstitution
Recommended at 28 weeks gestation and then w/n 72 hours after delivery or 3 hours of termination/miscarriage
Keep epinephrine available - systemic allergic rxns sometimes occur
Teach it will prevent hemolytic disease in a subsequent pregnancy

Contraindications: known sensitivity to human IgG's

150. Setraline Hydrochloride Antidepressant; SSRI
(Zoloft) Uses: panic/anxiety disorders, OCD, PTSD
2-3 weeks to be effective

Side Effect: causes fewer disorders than other antidepresants; fewer SE on HR and HTN, sexual
dysfunction; weight gain
Major Complication: selective serotonin syndrome - pt. can die; elevated temp up to 105 (increased
BP/HR/Temp); may progress to coma

Give w/ food in the AM to prevent insomnia

Watch for suicide risk
Increases effect of coumadin
Avoid grapefruit juice

Contraindications: w/n 14 days of MAOI, seizure disorders

151. Spironolactone F/E balance; antihypertensive; K-sparing diuretic
(Aldactone) Increases Na excretion - does not decrease K
Treats primary aldosteronism
Use: edema & HTN r/t HF

Side Effects: HA, dizziness, weakness, orthostatic hyypotension

Adverse Effects/Toxicity: hyperkalemia (n/v, diarrhea, cramps, tachycardia then bradycardia); aplastic
anemia; thrombocytopenia

Take w/ food; avoid salt substitute high in K

Avoid excessive ingestion of foods high in K - no K supplement is needed
Monitor VS and U.O.
Avoid direct sunlight

Contraindications: serum K >5.5; anuria; acute/chronic renal insufficiency; diabetic nephropathy; HS;
impaired hepatic function
Decreases effect of digoxin
Increases chance of lithium toxicity
152. Tobramycin Sulfate Aminoglycoside antibiotic
IV/IM; inhalation (TOBI), and ophthalmic (Tobrex)
Broad-spectrum antibiotic that kills bacteria cell by affecting protein synthesis; kills gram-negative
infection
Inhalation: preventative w/ CF (28 days on and 28 off)
Eye - external eye infections

Side Effects: HA, paresthesia, skin rash, fevers

Adverse Effects/Toxicity: nephrotoxicity, ototoxicity
- Eye -itching and welling

Doses are based on weight. Do not give other meds in the same IV!
Labs: peak/trough, serum cr., BUN

Contraindications: known sensitivity to other aminoglycosides; preexisiting renal disease

153. Tolbutamide Antidiabetic; sulfonylurea
(Orinase) Peak = 3-5 hours
Duration = 6-12 hours

Mild to moderately severe stable T2D

May be used as adjunct therapy for T1D but not sole medication
Give 1-2x/day after meals
1-2 weeks of medication may be required for full therapeutic effect

Side Effects: GI distress, pruritus, rash (may stop on own), photosensitivity

Adverse Effects/Toxicity: EtOH may cause disulfiram like rxn (flushing, palpation, and nausea/flushing of skin);
hypoglycemia d/t too much med, drug interactions; N/V, inadequate food intake

Monitor blood sugars including fasting and A1c

Teach s/s hypoglycemia and notify HCP if they occur
Wear medic alert bracelet or tag
Avoid EtOH

Contraindications: allergy to sulfa or urea

Beta Blockers can suppress insulin release and delay response to hypoglycemia
Consult HCP when pregnant
154. Triazolam Sedative Hypnotic; Anxiolytic; Benzodiazepine
(Halcioin) Rapid Onset = 15-30 minutes
Peak = 1-2 hours
Duration = 6-8 hours
Short-term management of insomnia (4 weeks) characterized by difficulty falling asleep, frequent wakeful periods

Side Effects: drowsiness, lethargy, confusion, sleepwalking

Adverse Effects/Toxicity: physical dependence; seizures (w/ rapid withdrawal)
- With OD = coma, respiratory depression, paradoxical anxiety

Do not use in addictive prone pt.

Monitor s/s of OD (slurred speech, confusion, somnolence, impaired coordination, coma)
Following long-term use tolerance may develop - don't stop abruptly

Contraindications: known sensitivity; EtOH intoxication, suicidal ideas, pregnancy, lactation

155. Trihexyphenidyl Anticholinergic, Antispasmodic
HCl (Artane) Treats Parkinson's Disease; diminishes hypersalivation; rigidity and irregular movements in PD
Use to control drug-induced EPS

Side Effects: drowsiness, decreased U.O (retention and hesitancy), dry mouth, constipation
Adverse Effects/Toxicity: paralytic ileus

Monitor I/O; increase fluids, bulk, and exercise

Void before taking to reduce urinary retention
Avoid driving or other hazardness activities - drowsiness
Avoid OTC like cough meds w/ EtOH
Very dose sensitive

Contraindications: narrow angle glaucoma, myasthenia gravis, GI obstruction

156. Vincristine Antineoplastic; Vinca Alkaloids (from pain); mitotic inhibitor
Sulfate Vesicant - administer into side arm portal of a free flowing IV
(Oncovin) Hyaluronidase is given if this vesicant should infiltrate - apply heat to site an disperse drug and minimize sloughing

Uses: acute lymphoblastic and other leukemias, lymphosacroma, Hodgkin's disease, breast/lung disease

Side Effects: major toxicities occur in hematopoietic, integumentary, neurologic, and reproductive system;
peripheral neuropathy; paralytic ileus (more common in young children); alopecia
Adverse Effect/Toxicity: neurotoxicity - loss of sensation of the soles of feet and fingertips; depression of the
Achilles reflex is the earliest sign of neuropathy; children are especially likely to develop neuro changes

Neutropenic precautions PRN; Asses hand grip and DTR

Maintain a regimen against constipation and paralytic ileus; report a change in bowel habits

Contraindications: obstructive jaundice, preexisting neuromuscular disease, active infection, pregnancy, lactaiton
Bronchospasm may occur in pt. previously treated wwith mitomycin
157. Hyaluronidase Given if vesicant infiltrates (Vincristine Sulfate - Oncovin)
158. Vesicant Good vein - prefer central access or fresh butterfly stick
Safety Chemo-trained nurse
Precautions Remain during infusion
Have antidote handy
159. Vitamin B6 Water-soluble vitamin absorbed by GI tract
(Pyridoxine Prevention and treatment of pyridoxine deficiency
HCl) Co-enzyme in AA metabolism and RBC production
Treats acute toxicity of INH, hydralazine

Side Effects: pain at injection site

Adverse Effects/Toxicity: neuropathy, ataxia, seizures

Causes of Deficiency: alcoholism, malabsorption disorders, oral contraceptives

Dietary Sources: green leafy veggies, organ meats/fish/poultry; legumes, chickpeas, bananas, whole grains,
potatoes

Caution w/:renal disease, cardiac disease

Common drug interactions: INH, hydralazine, oral contraceptives; reverses or antagonizes effects of levodopa
160. S/S of Vitamin Lack of energy
B6 Deficiency Decreased brain functioning
Skin Lesions
Conjunctivitis
161. Vitamin C (Absorbic Acid) Water soluble vitamin
Protects connective tissue, strengthens blood vessel walls, forms scar tissue, provides matrix w/ bone
growth
Supports immune system
Helps in absorption of iron and to metabolize AA's
Acidifies urine

Side Effects: rare at normal doses

Adverse Effects/Toxicity: crystalluria
Increases absorption of Fe

Mix oral solutions w/ food

Causes of Deficiency: normal aging, EtOH, other meds
Dietary Sources: citrus fruits, canteloupe, strawberries, broccoli, cabbage, tomatoes

Contraindications: prone to kidney stones

Megadoses of vitamin C can interfere w/ the absorption of B12
162. S/S of Vitamin C Malaise
Deficiency (Scurvy) Lethargy
Pinpoint hemorrhages
Bleeding gums
Rough skin
Blotchy spots - especially legs
163. Vitamin D2 Fat-soluble vitamin
(Ergocalciferol) Calcium and phosphate metabolism
Remember Ca & PO4 are inverse
Necessary to develop and maintain strong bones
Uses: osteomalacia, osteoporosis, hypo-parathyroidism, treat and prevent Rickets

Side Effects: uncommon at normal doses; metallic taste

Adverse Effects/Toxicity: N/V; fatigue, HA, hallucinations, dysrhythmias, hypercalcemia, stones

Causes of Deficiency: inadequate sunlight, dietary intake, hypoparathyroid

Dietary Sources: egg yolks, fortified cereals & milk, cod liver oil, some fish
Also obtained from sunlight

Contraindications: HS to vitamin D, hypercalcemia, hyperphosphatemia

164. S/S of Vitamin D2 Bones fail to calcify
Deficiency (Rickets) Bowed legs
Osteomalacia
Muscle Spasm
165. Vitamin E (alpha- Fat-soluble vitamin
tocopherol) S/S of deficiency = hemolytic anemia
Dietary supplement, hemolytic anemia in neonates, topical to chapped skin, prevents cell membrane
damage protects against blood clot development

Side Effects: uncommon at normal doses

Adverse Effects/Toxicity: N/V, fatigue, HA, blurred vision
Toxic: jaundice, brain damage

Causes of Deficiency: normal aging, prematurity, malabsorption diseases

Dietary Sources: wheat germ, vegetable oils, green leafy veggies, nuts, dairy, eggs

Contraindications: bleeding disorders, pregnancy

Avoid mineral oil
166. Vitamin K1 (Aquamephyton, Fat-soluble vitamin
Phytonadione) Given as antidote for Coumadin OD
Onset IV = 6 hours

Promotes liver synthesis of clotting factors

Given to NB's to prevent bleeding
Given as antidote for coumadin toxicity
Also reverses hypo-prothrombinemia from various causes

Side Effects: Swelling and pain at injection site

Adverse Effects/Toxicity: HS/anaphylaxsis-like reaction; bronchospasm, cardiac arrest

SQ administration preferred over IM

Labs: PT/INR
Causes of Deficiency: fat malabsorption, medications
Dietary Sources: asparagus, broccoli, cabbage, green leafy veggies, green tea, tomatoes

Contraindications: known HS to med

167. S/S of Vitamin K Deficiency Causes hemorrhage
168. Warfarin Sodium (Coumadin) Oral anticoagulant
To reserve hyperanticoagulation - hold and/or skip doses of Coumadin, antidote which is
vitamin K1

Coumadin interferes w/ syntehsis of clotting factor(s) that require vitamin K

Given PO
Has narrow therapeutic range - can take 1 week for therapeutic effect
PT level will be maintained at 1.5-2.5x the control value (which is 12-15 seconds)
INR range from 2.0-3.0 (control 1.0)
Labs need monitored often (sometimes 2-3x/week) initially, and then decreased over time

Side Effects: ecchymotic skin; GI & skin problem, hypotension, thrombocytopenia

Adverse Effects/Toxicity: bleeding

May bestarted while pt. is on continuous Ivheparin therpay - bridging

Often given in the evening w/ lab draws int he AM - must be taken at same time each day
Avoid or use consistently foods high in vitamin K
May be long-term med depending on reason for medication
Teach bleeding precautions
Observe closely and report s/s of bleeding

Contraindications: hemorrhaging or bleeding tendencies, malignant HTN, PMH of allergic

rxn of Coumadin

Many meds interact with coumadin