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Diuretics 6
Compare the action and uses of thiazide, loop, and potassium-sparing
diuretics
Apply the nursing process for the patient taking thiazide, loop, and
potassium-sparing diuretics
Antihypertensives 8
Anticoagulants, Antiplatelets, 6
Thrombolytics
Antihyperlipidemics 5
Describe the action of the two main drug groups: antihyperlipidemics
and drugs that improve peripheral blood flow
Dosage Calculations 5
TOTAL 50
Ch 37-Cardiac Glycosides, Antianginals, & Antidysrhythmics: 8
Differentiate the actions of cardiac glycosides, antianginal drugs, and antidysrhythmic drugs.
Cardiac Glycosides
Digoxin/Digitalis
● Inhibits Na+/K+ pump → increase in intracellular Na+ → influx of Ca+ causes cardiac
muscle to contract more efficiently
● Positive inotropic: increases myocardial contraction (SV)
Negative chronotropic: decreases HR
Negative dromotropic: decreases conduction of heart cells
● Overall increases force/velocity of myocardial systolic contraction
● Corrects atrial fibrillation and atrial flutter; secondary drug for heart failure
● Therapeutic serum level (NARROW)
○ Dysrhythmias: 0.8-2.0 ng/mL
○ Heart failure: 0.5-1.0 ng/mL
● Potent diuretics (furosemide/hydrochlorothiazide) promote K+ loss → hypokalemia
increases effect of digoxin → digitalis toxicity
● Cortisones and antacids also can lead to hypokalemia
● Antidote for digitalis toxicity: Digoxin-immune Fab--only give if severe/life threatening
(may cause anaphylaxis)
Phosphodiesterase Inhibitors
● Positive inotropic response/vasodilation
● Milrinone Lactate: increase SV and CO/promotes vasodilation. HIGH ALERT
medication-causes harm when given inappropriately. Given IV over 48-72 hrs
Other drugs for HF
● Vasodilators, ACE Inhibitors, angiotensin II-receptor antagonists, diuretics (thiazides,
furosemide), spironolactone, some beta blockers
-Nonpharmacological measures to treat HF: limit salt intake, avoid alcohol/smoking, decrease
saturated fat intake, fluid intake may be restricted. Mild exercise recommended.
-ANH: 20-77 ng/L
-BNP: <100 pg/mL
Antianginals
● Treat anginal pain: tightness, pressure in center of chest, pain radiating down left arm
● Increase blood flow: increase oxygen supply or decrease oxygen demand by
myocardium
● Classic (stable) angina: predictable stress/exertion
Unstable (preinfarction) angina: occurs frequently with progressive severity unrelated to
activity. Unpredictable. Emergency situation
Variant angina: occurs during rest. Caused by vasospasm
● Classic & unstable: caused by narrowing/partial occlusion of coronary arteries
● Common for patient to have both classic and variant
● Nonpharm measures to decrease anginal attacks: Avoid-- heavy meals and smoking,
extreme weather changes, emotional upset. Moderate exercise may help.
Nitrates
● Vascular/coronary vasodilation
● Reduces myocardial ischemia
● Sublingual nitroglycerin: most commonly used nitrate-effects last 30 to 60 minutes.
● Others (long-acting): isosorbide dintrate, isosorbide mononitrate
● Ointment—only effective for 4-8 hrs. Patch—once daily
● Use for unstable and variant
Beta Blockers
● Block action of epinephrine/norepinephrine → decrease HR/BP. Most useful for stable
angina
● The -olol group
Calcium Channel Blockers
● Treat variant and stable angina
● Diltiazem, verapamil and the -pines
● Frequently given w/ nitrates
Antidysrhythmics
● Restore cardiac rhythym to normal
● Sodium Channel blockers-ventricular
○ Procainamide (used for CPR), lidocaine, mexiletine
● Beta Blockers-atrial and ventricular
○ -olols
○ Decrease HR/BP
○ More frequently prescribed than Na+ blockers
● Drugs that prolong repolarization-ventricular
○ Adenosine, amiodarone (stops your heart), dofetilide, ibutilide
○ Emergency treatment of ventricular dysrhythmias other antidysrhythmics are
ineffective
● Calcium Channel Blockers-atrial
○ Verapamil (CI for pt w/ AV block or HF)
○ Diltiazem
○ Negative inotropic action
○ For dysrhythmias and hypertension
○ Relax arteries
Apply the nursing process, including patient teaching, related to cardiac glycosides, antianginal
drugs, and antidysrhythmic drugs.
● Glycosides:
○ Check pulse rate with apical pulse for a full min-should be greater than 60
beats/min--DO NOT administer Digoxin if pulse is below 60
○ Monitor serum digoxin level 0.8-2 ng/ml and K+ levels 3.5-5 (report hypokalemia)
○ Eat foods high in K+
● Antianginals:
○ Nitro:
■ Give water before SL nitrates—dryness prevents correct absorption
■ Patient lying/sitting down when administering.
■ Use gloves when using ointment form.
■ Apply patches/rotate skins sites. Avoid hairy areas.
■ Store drug away from light, heat, and needs to be airtight--not childproof
■ If hypotension occurs, put pt in supine position w/ legs elevated
■ If pain does not get better in 5 min call 911
■ Avoid alcohol
■ Report if chest pain not alleviated (possible tolerance)
● Antidysrhythmics:
○ Monitor vital sign and get a baseline
○ Administer drug by IV push or bolus over a period of 2-3 min
○ Avoid, Caffeine, Alcohol, and tobacco
○ Usually only used during continuous cardiac monitoring in hospital setting
Ch 38-Diuretics: 6
● Two main purposes: to decrease hypertension and decrease edema in HF, renal or liver
disorders.
● Antihypertensive effect through Na+ and water loss
● 5 categories: Thiazide/thiazide-like, loop/high-ceiling, osmotic, carbonic anhydrase
inhibitors, potassium-sparing
● All diuretics are K+ wasting (except K+ sparing)
● Hypertension: BP greater than 140/90 mmHg
Compare the action and uses of thiazide, loop and potassium-sparing diuretics.
Thiazides
● Chlorothiazide--first thiazide
● Hydrochlorothiazide--prototype drug.
● Mild diuretics—treat hypertension/peripheral edema
● Thiazides act on the distal convoluted renal tubule → promote Sodium, Chloride, and
water excretion.
● Not effective for immediate diuresis/don’t use in patients with severe renal dysfunction.
● Used primarily for patients with normal renal function.
● Promotes Ca+ reabsorption
● Hypercalcemia, hypokalemia, and hyperglycemia (caution w/ diabetes) can occur
● Hypercalcemia and hypokalemia → digitalis toxicity.
● Often combined with other drugs.
● Administer in the morning to prevent nocturia
● Divided into three categories: short-acting (less than 12 hours), intermediate acting
(12-24), and long-acting (greater than 24 hours)
Loop:
● Inhibit sodium reabsorption
● Can cause hypokalemia
● Can affect blood sugar and increase uric acid levels
● Extremely potent and may cause depletion of water and electrolytes
● Less effective as antihypertensive agents. Should not be prescribed if a thiazide can
alleviate body fluid excess.
● Furosemide is usually administered orally in the morning or IV when immediate removal
of body fluid needs to happen in case of acute heart failure or pulmonary edema.
● Used with end stage renal failure or if creatinine clearance is less than 30/min.
● Furosemide and bumetanide are derivatives of sulfonamides.
● Ethacrynic acid is a phenoxyacetic acid and is reserved for patients allergic to sulfa
drugs.
● Highly protein bound
● Used when other conservative measures, such as sodium restriction and use of less
potent diuretics, fail.
Potassium-sparing diuretics:
● Weaker than thiazides and loop diuretics. Used as mild diuretics or in combination with
other diuretics.
● Watch for hyperkalemia >5.3 mEq/L
● Act on the distal tubule and sodium-potassium pumps.
● Spironolactone- blocks aldosterone and inhibits the sodium-potassium pump, effects
may take 48 hours, heart rate is more regular and the possibility of myocardial fibrosis is
decreased.
● Amiloride, triamterene-effective antihypertensive agents.
● Triamterene is useful in the treatment of edema caused by HF or cirrhosis of the liver.
● Spironolactone and eplerenone are effective for chronic HF.
● Don’t take with ACE inhibitors, angiotensin II blockers (ARBs) because they can
increase potassium levels.
● Common diuretics contain a potassium-sparing diuretic with hydrochlorothiazide.
Differentiate side effects and adverse reactions related to thiazide, loop and potassium-sparing
diuretics.
Thiazide SE:
● Hypokalemia, hypercalcemia, hypomagnesemia, and bicarbonate loss (watch for digitalis
toxicity)
● Hyperglycemia, hyperuricemia, hyperlipidemia
● Other side effects include GI, hives (urticaria), blood dyscrasias, dizziness, headaches
Loop SE:
● Fluid and electrolyte imbalances result (hypo everything)
● Hypochloremic metabolic alkalosis may result, which can worsen hypokalemia
● Orthostatic hypotension
Potassium-sparing SE:
● Hyperkalemia, GI disturbances, and tingling of hands and feet can occur
● Watch for kidney function, urine output should be at least 600 mL/day
● If given with ACE inhibitors the likelihood of hyperkalemia is increased.
Explain the nursing interventions, including patient teaching, related to thiazide, loop, and
potassium-sparing diuretics.
Thiazide:
Assessment-
● Electrolytes (hypokalemia), glucose, and uric acid
● Check for pitting edema
Interventions-
● Monitor weight
● Digoxin toxicity with hypokalemia
● Signs of hypokalemia
● Note urine output
Teaching-
● Take hydrochlorothiazide in the morning to avoid sleep disturbance from nocturia
● Change positions slowly (orthostatic hypotension)
● Large doses can cause hyperglycemia
● Eat foods rich in potassium
● Take drugs with food to avoid GI upset.
Loop:
Assessment-
● Obtain drug history, furosemide is highly protein-bound and can displace other
protein-bound drugs such as warfarin.
● Note if patient is hypersensitive to sulfonamides.
Interventions-
● Urinary output should be at least 30 mL/h or 600 mL/24h
● Notify health care provider if urine output does not increase. Renal disorder may be
present
● Watch for drop in BP
● Administer IV furosemide slowly; hearing loss may occur if rapidly injected
● Watch for hypokalemia
Teaching-
● Take furosemide in the morning to avoid nocturia
● Arise slowly to avoid orthostatic hypotension
● Take with food to avoid nausea
Potassium-sparing:
Assessment-
● Note whether patient is taking potassium supplement or using a salt substitute
● Get vital signs, etc
Interventions-
● Because of long half-life spironolactone is usually administered once a day
● Monitor urine output, report if urine is < 30mL/h or <600 mL/h
● Watch for hypokalemia
● Administer spironolactone in the morning to avoid nocturia
Teaching-
● Take with meals
● Avoid exposure to direct sunlight, because drug can cause photosensitivity
● Avoid foods rich in potassium
Ch 39-Antihypertensives: 8
Differentiate the pharmacologic action of the various categories of antihypertensive drugs.
-Biggest SE is orthostatic hypotension
-Nonpharmacologic control of hypertension:
-stress-reduction techniques, exercise, salt restriction, decreased alcohol & smoking
-Often more than one AH is used → fewer adverse effects
Diuretics
● They promote sodium depletion
● First line drugs to treat mild hypertension--hydrochlorothiazide=most frequently
prescribed
● Diuretics are usually prescribed together with antihypertensive agents because many of
them cause fluid retention
● Loop diuretics: usually recommended--does not depress renal blood flow
○ However don’t use if hypertension has RAAS involvement- they tend to elevate
the serum renin level immediately
● A combination of potassium wasting and potassium sparing diuretics should be useful
instead of a single thiazide drug--combination intensifies diuretic effect and prevents
potassium loss
● Thiazides can be combined with other AH drugs to increase effect
Sympatholytics (Sympathetic Depressants)
-halts fight or flight
● Beta adrenergic blockers:
○ May be used in combo w/ diuretic
○ Lowers BP/HR
○ Higher renin levels=greater hypotensive response
○ African Americans--must combine BB w/ diuretics
○ Cardio-selective BB preferred: act on B1 and lessen chance of
bronchoconstriction
○ Use w/ caution for pulmonary disease and preexisting bronchospasm
○ Lowers BP in pt with elevated renin level
● Centrally acting Alpha 2 Agonists
○ Decrease sympathetic activity
○ Vasodilation
○ Methyldopa, clonidine (avoid if pregnant)--given w/ diuretics
○ Guanfacine-- rebound hypertension less likely
● Alpha-Adrenergic Blockers
○ -zosin
○ Vasodilation, decreased BP
○ Useful for lipid abnormalities
○ Decrease VLDL and LDL
○ Safe for diabetes and don’t affect respiratory function
○ Can treat BPH
○ Prazosin= commonly prescribed
○ Terazosin, doxazosin normally given once at bedtime
○ Can cause edema
● Adrenergic Neuron Blockers (peripherally acting)
○ POTENT
○ Decrease in norepi
○ Reserpine=most potent, used for severe hypertension.
○ Last choice for chronic hypertension bc of ortho hypo
● Alpha1 and Beta1 Blockers
○ Labetolol
○ Alpha effect is stronger than beta- BP lowered and pulse rate is moderately
decreased
Direct-Acting Arteriolar Vasodilators
● POTENT
● BP decrease
● BB frequently prescribed with these
● Hydralazine, minoxidil
● Nitroprusside: acute hypertensive emergency--very potent and rapid BP decrease
Angiotensin-Converting Enzyme Inhibitors (ACE)
● Inhibits angiotensin II (vasoconstrictor) and blocks aldosterone
● -pril
● African Americans and older adults don’t respond to these unless taken w/ diuretic
Angiotensin II Receptor Blockers (ARBs)
● Prevent release of aldosterone
● Vasodilation
● -sartan
● Valsartan: prototype--watch for hyperkalemia & rhabdomyolysis
Direct Renin Inhibitors
● Aliskiren
● Mild and moderate hypertension
● Not given to blacks
Calcium Channel Blockers
● Vasodilation
● Can use for blacks
● Verapamil, diltiazem, and -pines
● Reflex tachycardia prevalent with nifedipine--only use in hospital
Miscellaneous:
-Beta blockers & ACE inhibitors--less effective for African Americans--use Alpha 1 blockers &
Calcium blockers
-African Americans don’t respond well to diuretics
-Asians twice as sensitive as white to beta blockers
Compare the side effects and adverse reactions to sympatholytics, direct-acting vasodilators,
and angiotensin antagonists.
Sympatholytics SE:
● Beta blockers:
○ Decreased pulse rate, decreased BP, bronchospasm.
○ Can also cause bradycardia, dizzy, insomnia, depression, fatigue, nightmares,
sexual dysfunction
○ Don’t abruptly stop → rebound hypertension, angina, dysrhythmias, MI
○ Use caution w/ diabetes mellitus → possible hypoglycemic symptoms
● Centrally acting Alpha 2 Agonists:
○ Don’t give with BB → bradycardia, rebound hypertension upon discontinuation
○ Drowsiness, dry mouth, dizzy, bradycardia
○ Methyldopa CI for impaired liver function, but used during pregnancy
○ Sodium/water retention=peripheral edema
● Alpha-Adrenergic Blockers:
○ Ortho hypo, nausea, headache, drowsy, nasal congestion from vasodilation,
edema, weight gain
● Adrenergic Neuron Blockers (peripherally acting):
○ Reserpine: Causes ortho hypo, vivid dreams, nightmares, suicidal ideation
● Alpha1 and Beta1 Blockers
○ Large doses increase airway resistance
○ Large doses CI for severe asthma
○ Ortho hypo, GI upset, nervousness, dry mouth, fatigue
○ Large doses of labetolol may cause AV heart block
Direct-Acting Arteriolar Vasodilators SE:
● Reflex tachycardia
● Hydralizine: reflex tachycardia, palpitations, edema, nasal congestion, lupus-like
symptoms, neurologic symptoms
● Minoxidil: similar, plus excess hair growth
Angiotensin-Converting Enzyme Inhibitors (ACE) SE:
● Constant, unproductive, irritated cough
● Hyperkalemia, tachycardia, first-dose hypotension
● Angioedema (higher incidence in blacks)
● Laryngeal edema--rescue epi
Calcium Channel Blockers
● Flushing, headache, dizzy, ankle edema, bradycardia, AV block
Apply the nursing process related to antihypertensives including nursing interventions and
teaching.
Diuretics
● Loop: most common SE- fluid/elec imbalances (hypokalemia, hyponatremia,
hypocalcemia, hypomagnesemia, hypochloremia). Pulls all electrolytes out.
○ Hypochloremic metabolic alkalosis may result which worsens hypokalemia
○ Orthostatic hypotension
○ Transient deafness if pushed too fast (Furosemide)
○ Thrombocytopenia & skin disturbances also rare
○ Digitalis toxicity if taken with digoxin
○ Need potassium replacement (food/supplements)--monitor levels
○ Observe for hypokalemia
Sympatholytics
● Centrally acting Alpha 2 Agonists:
○ Don’t abruptly stop=rebound hypertensive crisis
● Alpha-Adrenergic Blockers:
○ Do not take with antiinflammatories or nitrates → peripheral edema and faintness
can occur
○ Water retention--monitor weight gain
Direct-Acting Arteriolar Vasodilators
● Edema
Angiotensin-Converting Enzyme Inhibitors (ACE)
● Don’t give during pregnancy
● Give with food except for moexipril
● Don’t take with potassium sparing diuretics or w/ salt substitutes that contain potassium
(hyperkalemia)
● Monitor for renal impairment
● Warn of dizziness/lightheadedness in first week of captopril therapy
Calcium blockers:
● Amlodipine-don’t take if you have edema
Describe the blood pressure guidelines for determining hypertension.
Normal <120 / <80
Prehypertension 120-139/ 80-89
Stage 1 140-159/90-99
Stage 2 >160/ >100
Discuss the laboratory tests used to determine the therapeutic range of anticoagulants
differentiating between heparin and warfarin.
● Heparin is PTT & APTT (Partial Thromboplastin Time/Activated Partial Thromboplastin
time)
● Warfarin is PT (Prothrombin time) and INR
● PT is the time it takes for blood to clot w/ certain clotting factors which warfarin affects
○ PT performed immediately before admin the next drug dose until therapeutic
level is reached
● International Normalized Ratio (INR) normal INR is 1.3 -2, patients on warfarin need to
be at 2-3. (If patients have mechanical heart valve or systemic embolism the levels
should be 2.5-3.5 possibly to 4.5)
Differentiate the side effects and adverse reactions of anticoagulants, antiplatelets, and
thrombolytics.
● BLEEDING for everything!!!!
Anticoagulants
-Avoid these until thrombolytic effect has passed
● Heparin
○ Decrease platelet count → thrombocytopenia
○ Do not take antiplatelet drugs with anticoagulants
○ LMWH: CI for stroke, peptic ulcer, blood anomalies, eye, brain or spinal injury
● Warfarin
○ BLEEDING
○ Use acetaminophen instead of NSAIDS--don’t use oral hypoglycemic drugs
Thrombolytics
● Allergic reactions/anaphylaxis, facial/throat edema, rhabdomyolysis
● Hemorrhage: use aminocaproic acid to stop bleeding
● Watch for 24 hrs after therapy stops for bleeding
Apply the nursing process, including patient teaching, for anticoagulants and thrombolytics.
Ch 41-Antihyperlipidemics: 5
Describe the action of the two main drug groups: antihyperlipidemics and drugs that improve
peripheral blood flow.
Antihyperlipidemics
● (Bile-acid sequestrants, fibrates, nicotinic acid, cholesterol absorption inhibitors)-don’t
need to know, hepatic 3-hydroxy-3-methylglutary-coenzyme A reductase inhibitors
(STATINS)
● Cholestyramine-a bile-acid sequestrant that reduces LDL. Effective against
hyperlipidemia type II
● Fibric Acid Agents- gemfribrozil
● COLESEVELAM-has less side effects and less effect on the absorption of fat soluble
vitamins making it good.
● Nicotinic Acid/niacin-many side effects, but used properly it is very effective
● Ezetimibe-cholesterol inhibitor and usually combined with a statin.
● hs-CrP lab values are used to monitor cardiovascular disease risk.
Statins (HMG-CoA Reductase Inhibitors)-decrease cholesterol, LDL, and slightly increases
HDL (good cholesterol).
● Statins all end in -statin
● Serum liver enzymes monitored
● Annual eye examinations because cataract formation can occur
● Patient should report any muscle aches or weakness because rhabdomyolysis can occur
● GI, muscle cramps, fatigue, headache
● Patients will be on drugs for the rest of their lives
● Abruptly stopping can cause a threefold rebound effect that may cause death from an
acute MI
● You want your cholesterol levels less than 200.
● Use continuously
Peripheral Blood Flow drugs:
Peripheral Vasodilators
● Used to treat peripheral vascular disease
● More effective in conditions resulting from vasospasm (Raynaud’s) instead of vessel
occlusion
● Cilostazol: antiplatelet and vasodilation properties-used to treat intermittent claudication.
It’s a direct acting vasodilator.
● Pentoxifylline-this is a blood thinner
○ Decrease blood viscosity and improves flexibility of erythrocytes
○ Used to improve microcirculation in the capillaries
○ Used in patients with intermittent claudication and has been prescribe for those
with Buerger’s disease resulting from arterial occlusions
○ Avoid smoking- it causes vasoconstriction
Differentiate the side effects and adverse reactions of peripheral vasodilators and blood
viscosity reducer agents.
● Peripheral Vasodilators/Cilostazol-lightheadedness, dizziness, tachycardia, palpitation,
and GI distress
● Pentoxifylline-flushing of the skin, faintness, sedation, and GI disturbances. Take with
food
Apply the nursing process, including patient teaching, for antihyperlipidemics and blood
viscosity reducer agents.
Antihyperlipidemics-Statins:
Assessment
● Assess vital signs and lab values
● CI in patients with liver disease or are pregnant
Interventions
● Monitor lipid levels
● Monitor liver function and GI upset
Teaching
● It may take several weeks to see lipid levels decline
● Have serum liver enzymes monitored
● Have annual eye examination
● Watch for bleeding if taking oral anticoagulant
● Watch blood sugar
● Large doses of nicotinic acid can cause vasodilation, producing dizziness and faintness
● Statins-watch for muscle weakness or pain, rhabdomyolysis can occur
● Do not abruptly stop taking statins as rebound effect might occur
Vasodilators: Cilostazol
Assessment
● Look for signs of inadequate blood flow to extremities: pallor, coldness, and pain
Interventions
● Vitals, tachycardia and orthostatic hypotension can be a problem
Teaching
● Therapeutic effect may take 1.5-3 months
● Don’t smoke
● Avoid aspirin
● Change position slowly because of orthostatic hypotension
● Avoid alcohol- hypotensive reaction can occur
Contrast that action, uses, side effects, and adverse effects of traditional typical and atypical
antipsychotics.
EPS:
● Parkinson like symptoms
Acute dystonia:
● Facial grimacing, involuntary upward eye movement, muscle spasms, laryngeal spasm
Akathisia:
● Restless, trouble standing still, paces the floor, feet in constant motion
Tardive dyskinesia: (does not always resolve with discontinuation of drug)
● Protrusion and rolling of the tongue
● Sucking and smacking lips
● Chewing motion, facial dyskinesia
● Involuntary movements of the body
-If patient has neuroleptic malignant syndrome the medication needs to be discontinued
immediately. It’s a life threatening condition
Traditional Typical:
● The most common is drowsiness
● Some have anticholinergic effects: dry mouth, increased HR, urinary retention, and
constipation
● BP decreases
● EPS can occur
● High dosing or long term use can cause blood dyscrasias or agranulocytosis
● Monitor WBC and watch for leukocytopenia
● Dermatologic side effects: pruritus and photosensitivity
● Interact with anticonvulsants
● Atropine counteracts EPS and potentiates antipsychotic effects
● Do not give multiple antipsychotics at once...if one doesn’t work replace it with another
one
● Do not abruptly stop
● STANCE-Sedation and photosensitivity, Tardive dyskinesia, Anticholinergic and
agranulocytosis, neuroleptic malignant syndrome, cardiac arrhythmia, EPS
Atypical Antipsychotics:
Benzodiazepines
● Sedation, dizziness, headaches, dry mouth, blurred vision, rare urinary incontinence and
constipation
● Leukopenia
● Do not abruptly stop, withdrawal can occur
Plan nursing interventions, including patient teaching, for the patient taking antipsychotics and
anxiolytics.
Phenothiazines/Nonphenothiazines
● Assessment:
○ Mental status, cardiac, eye, and respiratory disorders, continue daily assessment
● Interventions:
○ Orthostatic hypotension is likely
○ Stay with patient when taking medication, many patients will hide their drugs to
avoid taking them
○ Avoid skin contact with liquid concentrates to prevent contact dermatitis. Liquid
must be protected from light and should be diluted with fruit juice.
○ Check BP 30 minutes after giving the drug
○ Observe for EPS
○ Assess for symptoms of NMS: increased fever, pulse, and bp, muscle rigidity,
WBC
● Teaching:
○ Medication might take 6 weeks to achieve full effect
○ Do not consume alcohol or other CNS depressants
○ Stop smoking, maintain good hygiene
○ Talk with doctor if planning on starting a family
○ Phenothiazine pass into the breast milk thus affecting the infant
○ Monitor WBC every 3 months
○ Side effects: drowsiness, orthostatic hypotension
Benzodiazepines:
● Assessment
○ Assess for suicidal ideation, patient’s support system, and anxiety reactions
● Interventions:
○ Monitor vital signs, bp and pulse as hypotension may occur
○ Drug tolerance can occur
● Teaching:
○ Sedation is a common side effect so avoid driving motor vehicles
○ Don’t consume alcohol or CNS depressants
○ Teach how to control excess stress
○ Rise slowly because of orthostatic hypotension
Explain the uses of lithium and its serum/plasma therapeutic ranges, side effects and adverse
reactions, and nursing interventions.
Lithium:
● Used to treat bipolar affective disorder
● Has a calming effect, but may cause some memory loss and confusion
● Expect to be on it for a long time
● Therapeutic serum range 0.5-1.5 mEq/L
● Levels greater than 1.5-2 mEq/L are toxic
● Monitor levels bi-weekly until therapeutic level has been met and then monthly
afterwards
● Watch for hyponatremia as lithium causes excess sodium excretion.
● Adequate fluid intake needs to occur
● Be careful if taking a diuretic (might be best to stop lithium)
Side Effects:
● Dry mouth, thirst, increased urination (loss of water and sodium)
● Weight gain, bloated feeling, metallic taste, and edema (ankle and hands)
● May have teratogenic effects, can’t be on if patient is pregnant
● Avoid NSAIDs and lithium usage together
● Watch for thyroid issues
● Do not take if patient has cardiac “sick sinus syndrome”
Apply the nursing process to the patient taking lithium, carbamazepine, and valproic acid.
Assessment:
● Watch for suicidal ideation
● Neurological status
● Watch for signs of toxicity...1.5-2 can cause nausea, vomiting, diarrhea, tinnitus, and
blurred vision
● Toxicity of 2-3.5 causes dilute urine, tremors, muscular irritability, mental confusion,
giddiness
● Toxicity about 3.5 is life threatening and may result in impaired consciousness, seizures,
nystagmus, MI
Interventions:
● Watch for orthostatic hypotension
● Draw blood and monitor lithium levels
● Watch for suicidal tendencies
● Watch urine output and weight
● Check patient’s cardiac status
Teaching:
● Check with provider before using OTC drugs
Dosage Calculations: 5