ATI NCLEX Medication List

ATI/NCLEX Medication List Generic (Brand) Hydromorphone (Dilaudid) Insulin detemir (Levemir) Metformin (Glucophage) Clue 1. This analgesic is used for a client with moderate to severe pain. 2. This medication replaces a missing pancreatic hormone. 3. This medication may cause a buildup of lactic acid in the body. Speaker Notes C Class: Opioid agonist Indications: Moderate to severe pain. SE: Respiratory depression, nausea Ask: What should the nurse do if the client has a respiratory rate of 10 while on IV Hydromorphone? Answer: Stop hydromorphone ; contact the provider [have naloxone on hand if needed, oxygen 2L/BNC] Class: Long acting insulin [ Onset 1-2 hours, duration up to 24 hours] Indication: Type 1 & 2 diabetes mellitus. SE: Nausea, vomiting, hypoglycemia, Ask: Is detemir given prior to meals to control postprandial blood glucose? Answer: No, peak time is 6-8 hours. [May be taken in evenings] Class: Oral anti-diabetic; [biguanide] Indication: Type 2 diabetes SE: Anorexia, nausea, and diarrhea. [Toxicity results in lactic acidosis. Glucophage is held 48 hours before and after iodinated contrast dye because the dye may cause renal failure, which would increase the harm from lactic acidosis.] Ask: Is hypoglycemia an expected effect? Answer: It is a rare occurrence unless combined with other medications that lower glucose. Methylergonovine (Methergine) 4. This medication might be used postpartum for a woman who delivered twins. Class: Ergot Alkaloid Indication: Postpartum bleeding. SE: Nausea, headache; [life-threatening] hypertension Ask: What places a woman at risk for postpartum hemorrhage? Answer: Uterine atony, laceration, impaired maternal clotting, retained placenta fragments Common causes of uterine atony include:  Multiple gestation pregnancy (twins, large baby over-stretched uterus)  Long labor, grand multipara (overworked uterus) Methotrexate (Mexate) 5. This is a DMARD: disease modifying antirheumatic drug. Class: Antineoplastic; Immunosuppressant Indication: Some types of cancer; rheumatoid arthritis (RA); psoriasis, Crohn’s Disease SE: Nausea, vomiting, diarrhea, elevated LFTs, fatigue, renal failure, pulmonary fibrosis Ask: How does methotrexate improve symptoms of RA? Answer: Immunosuppression [reduces inflammatory processes] Gabapentin (Neurontin) 6. This medication is approved for epilepsy but is often used for neuralgia. Class: Anticonvulsant Indication: Partial seizures, neuropathic pain SE: Drowsiness, dizziness, fatigue Ask: Why is gabapentin most effective 3 x/day? Answer: Doses peak in 2-3 hrs [Gabapentin is rapidly absorbed following oral dosing and reaches peak plasma levels in 2 to 3 hours] RA is an autoimmune condition. Methotrexate causes immunosuppression which will help decrease inflammation caused by RA. Nitroglycerin 7. Don’t take this medication with tadalafil! (Cialis) Class: Organic Nitrate Indication: Angina SE: Headache, hypotension, tachycardia Ask: What safety precautions should the nurse implement? Answer: Fall Risk ( vasodilation causes dizziness) Oxytocin (Pitocin) 8. This medication might be used to induce or augment labor. Class: Uterine stimulant Indication: Induce or augment labor; post-partum hemorrhage SE: Tachysystole, Uterine rupture, elevated BP, fetal hypoxia Ask: What is a tocolytic? Answer: The opposite of oxytocin: Relaxes myometrium Examples of tocolytics: terbutaline, indomethacin, nifedipine, nitroglycerin, atosiban Maternal hypertension, uterine tachysystole, and late FHR decelerations or other signs of fetal distress may be indications to stop the oxytocin perfusion. Pantoprazole (Protonix) 9. This medication is often used to prevent GERD in hospitalized clients. Uterine tachysystole is defined as more than 5 contractions within a 10 minute period, a series of contractions lasting more than 2 minutes each, or contractions of normal duration that occur within 1 minute of each other. Class: Proton pump inhibitor (suffix: prazole) Indication: GERD SE: Diarrhea, osteoporosis, pneumonia Long-term therapy can cause: Osteoporosis and fractures (may inhibit calcium absorption) C-diff, hospital-acquired infections Hypomagnesemia Rebound reflux after discontinuing Gastric cancer, with very long-term use Ask: When and why is a client at risk for pneumonia when using pantoprazole? Answer: Initially there is an alteration in GI flora/impairment of WBCs Risperidone (Risperdal) 10. A decrease in hallucinations and delusions should be seen with this medication. Medication: Risperidone Class: Atypical antipsychotic Indication: Schizophrenia, acute bipolar mania, autism SE: Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and sedation]. EPS risk increases with dose. EPS risk is substantial with depot form Ask: Why does the client using risperidone need routine blood tests? Answer: To monitor for elevated cholesterol and hyperglycemia Follow-up by asking students about normal cholesterol level: Less than 200 mg/dL Methylprednisolone (Solu-Medrol) Budesonide/ formoterol (Symbicort) 11. Prolonged use of this injection may cause Cushing’s Syndrome. (Note: IM or IV routes) 12. This inhaled medication is used to prevent asthma attacks. Class: Glucocorticoid (suffix: solone) Indication: Inflammation SE: Euphoria, Infection, Cushing’s syndrome Ask: What are symptoms of Cushing’s syndrome? Answer: Buffalo hump, moon face, general weakness, hypokalemia, hyperglycemia, hypernatremia Class: Glucocorticoid/bronchodilator. (suffix: terol) Indication: Prophylaxis in chronic restrictive airway diseases (asthma, COPD) SE: GI upset, infection Ask: Why does this medication place the client at risk for infection? Answer: Immunosuppression [Steroids suppress the immune system.] This medication is administered by inhalation Discontinuing abruptly may cause adrenal insufficiency Levothyroxine (Synthroid) 13. This hormone should be taken after rising in the morning and before eating. Class: Hormone Indication: Hypothyroidism SE: Tachycardia, nervousness, insomnia Ask: Why is levothyroxine prior to eating breakfast ? Answer: Absorbed best when taken on an empty stomach; ↑ metabolic rate may cause interference with sleep Many drug interactions Many GI drugs reduce the effect of thyroid hormone Some antiepileptics, rifampin, sertraline increase effect Thyroid hormone accelerates breakdown of warfarin and increases cardiac response to catecholamine's (epinephrine, dopamine, dobutamine) Can ↑ requirements for digoxin and insulin Vancomycin (Vancocin) 14. A client with an intestinal infection caused by clostridium difficile is likely to receive this medication. Class: Antibacterial – glycopeptide. (Vancomycin is NOT an aminoglycoside, despite the common suffix, “mycin”. Indication: Clostridium difficile, MRSA [drug of choice for client who has penicillin allergies.] SE: Nephrotoxicity, “red man syndrome” Many side effects: Major toxicity: nephrotoxicity → renal failure Ototoxicity is rare and usually reversible Thrombophlebitis Immune mediated thrombocytopenia Rapid IV infusion can cause ‘Red man syndrome’ characterized by flushing, rash, chills, pruritus, urticarial, tachycardia, and hypotension (collectively known as “red man syndrome”) Infuses over 1 hr Ask: What labs would the nurse monitor for signs of nephrotoxicity? Answer: Blood urea nitrogen (BUN): 10-20 mg/dL, serum creatinine: 0.6-1.2 mg/dL NOTE: Peak and trough levels drawn to monitor therapeutic levels Draw trough level 15 minutes prior to administration, Draw peak level 30 minutes after IV administration Piperacillin/ tazobactam (Zosyn) 15. Clients allergic to penicillin should not take this medication. Class: Antibiotic (an extended-spectrum penicillin)/beta-lactamase inhibitor (suffix: cillin) Indication: Bacterial infection SE: GI upset, leukopenia. Ask: What client allergy should alert the nurse? Answer: Allergy to penicillin. [Zosyn is a combination drug and classified as an extended release penicillin. ] Crossword A completed crossword follows the Speaker Notes. Down numbers, in the left column, are shaded in grey. Crossword slides open with the location on the crossword. Next to animate is: Class, Indications, and Use. These are also on the HO. Please ask the group for their answer/s. Fly in the answer. Fly in, ask, and discuss the application question. Across 2 Generic /Brand Clue Clopidogrel / Plavix Anti-platelet. Uses: prevent MI & CVA. SE: bleeding, hemorrhage. Speaker Notes: Ask the group for answers. Focus on application of information as it might occur in an NCLEX question for an entry level nurse. Class: Platelet Aggregation Inhibitor Indication: Prevent stenosis after cardiac stent placement, MI & CVA prevention SE: Abdominal pain, dyspepsia, diarrhea, rash bleeding, hemorrhage Ask: What would you assess in a client taking clopiogrel? Answer: H&H, epistaxis, bruising and bleeding Clopidogrel is a platelet aggregation inhibitor; platelets can’t aggregate, or ‘stick together’. This reduces the risk of clot formation. Must stop 5 days prior to elective surgery. 4 Lithium / Eskalith Mood Stabilizer Use: BPD. SE: tremors, polyuria. Toxicity: GI upset, CNS changes, convulsions, coma, death. Class: Mood stabilizer Indication: Bipolar disorder: control of manic episodes and prophylaxis SE: Tremors, polyuria Toxicity: GI upset, CNS changes, convulsions, coma, death Ask: What are the signs of toxicity? Answer: Vomiting, diarrhea, drowsiness, slurred speech Reinforce the following information with students: Therapeutic level is 0.4-1.4 mEq/L. A level > 2mEq/L is considered toxic; >2.5 mEq/L death can occur S/S of toxicity include: tremor, ataxia, dysarthria, nystagmus, renal impairment To avoid toxicity sodium intake should be consistent (lithium is a salt); hyponatremia precipitates toxicity. NSAIDS also can cause toxicity. Dehydration can put the client at risk for toxicity For that reason caffeine should be avoided because of the diuretic effect. Lithium is pregnancy Category D – should only be used when there are no alternatives and the benefits clearly outweigh the risks. 5 Haloperidol / Haldol Antipsychotic. Uses: schizophrenia; acute psychosis; Tourette’s. SE: neutropenia; high risk of EPS. 1 1 Zolpidem / Ambien Sedative-hypnotic. Use: insomnia. SE: changes in behavior and mental health; sleep walking. Class: Antipsychotic Indication: Schizophrenia; Acute psychosis; Tourette’s SE: Mild leukopenia, EPS (high risk), TD, laryngospasm, respiratory depression, NMS Ask: What are the symptoms of neuroleptic malignant syndrome? Answer: Rigidity, sudden high fever, blood pressure instability Follow-up: What are signs of EPS? Dystonia; akathisia (can’t sit still); tardive dyskinesia. What is Tourette’s syndrome? Involuntary movements and vocalizations called ‘tics’. Class: Sedative-hypnotic (most widely-used) Indication: Short-term treatment of insomnia SE: Dizziness, daytime drowsiness, sleep complex behaviors (like sleepdriving), depression Ask: What changes in behavior and mental health may occur? Answer: Sleep complex behaviors: sleep walking, sleep driving, sleep eating, etc.); depression Drugs affecting the CNS should be avoided: alcohol, antidepressants, anti-seizure, and tranquilizers. Zolpidem is absorbed very quickly; it should be taken right at bedtime. 1 2 Esomeprazole / Nexium PPI. Uses: GERD; gastric ulcer. SE: headache; diarrhea; osteoporosis. Class: Proton Pump Inhibitor (Almost chemically identical to omeprazole) (suffix: prazole) Indication: GERD, gastric ulcers SE: Same as omeprazole: pneumonia, osteoporosis/fractures, rebound heartburn when d/ced, vertigo, agitation, depression, N&V, diarrhea, constipation, abd. pain, dry mouth Ask: When is esomeprazole taken? Answer: 1 hour prior to eating (allows medication to reach effective level prior to eating and stimulation of gastric acid). Change in gastric acid affects absorption of nutrients and medications; Examples: calcium and B12 absorption are impaired. Use of PPI for >1 year may increase hip fracture by 44%. 1 4 1 6 2 0 Amiodarone / Cordarone Antidysrhythmic. Uses: a-fib; v-fib; vtach. SE: lung damage; heart failure; liver & thyroid toxicity. Aripiprazole / Abilify Atypical antipsychotic. Uses: schizophrenia; BPD, major depression; autism. SE: headache; agitation; EPS (low risk). Epoetin / Epogen, Procrit Colony stimulating factor. Use: anemia from chronic kidney disease; perioperative. SE: blood clots. Class: Antidysrhythmic Indication: Approved only for recurrent V-fib and recurrent unstable V-tach; not approved for A-fib but used widely to treat SE: Lung damage, heart failure; liver and thyroid damage; toxicity can continue for weeks or months after drug is d/c’d due to very long half-life Ask: What findings indicate respiratory failure? Answer: Dyspnea, diminished breath sounds, rales, friction rub Bradydysrhythmias can occur which could lead to hypotension. The client should not consume any grapefruit (can ↑ levels of medication). NCLEX tip: when administering antipsychotics – think safety. What would you look for? Fall risk, dizziness, impaired thinking/cognition, driving a motor vehicle. Class: Atypical antipsychotic (note that even though it has a “prazole” suffix, this is not a PPI) Indications: Schizophrenia; major depressive disorder; bipolar mania, autism. SE: Anxiety, insomnia, agitation, EPS (low risk) Low risk for EPS and neuroleptic malignant syndrome Ask: What mental health safety concerns are associated with this medication? Answer: Increased depression, suicidal ideation Class: Growth factor Indication: Anemia of chronic kidney disease; chemotherapy-induced anemia (carefully – hgb ↑ 12 gm/dL due to epoetin is associated with accelerated tumor grow), HIV clients taking zidovudine, anemia in preoperative clients SE: HTN, thrombotic stroke, clotting of AV fistula Risk for cardiovascular events are greatest when hgb exceeds 11gm/dL or the rise in hgb, within two weeks of receiving therapy, exceeds 1gm/dL; medication is held if either of these occur Ask : What labs should the nurse monitor? Answer: H&H, CBC, BUN, potassium, iron What is erythropoietin? Hormone released by kidneys when O2 levels are low. Stimulates production of RBCs. Routes: SQ or IV. 2 1 Risedronate / Actonel Bisphosphonate. Use: osteoporosis. SE: jaw problems; pain in bones, muscles, and joints. Class: Biophosphonate Indication: Osteoporosis SE: Bone pain, leg cramps, colitis Ask: How is risedronate taken? Answer: With a full glass of water; after taking: must sit or stand and remain NPO for 30 minutes to one hour Note: The delayed release tablets must be taken immediately after breakfast. Follow-up: Ask students what increases risk for osteoporosis: Heredity, immobility, menopause, Paget’s disease, Cushing’s What diet is important? One high in calcium and vitamin D. 2 2 Pregabalin / Lyrica Anticonvulsant. Use: neuralgia, partial seizures, fibromyalgia. SE: changes in behavior or mood; muscle twitching; confusion. Class: Anticonvulsant Indication: Post-herpatic and diabetic neuralgia, partial seizures, fibromyalgia SE: Dizziness (most frequent SE), somnolence, weight gain, blurred vision, difficulty thinking, H/A, peripheral edema, dry mouth, ataxia Ask: How would the nurse assess pain in a nonverbal patient Answer: Observe for grimacing, guarding, restlessness; Determine if client can communicate by pointing, nodding, blinking. Consider if pain is expected with client’s condition. Remind students that non-verbal patients are more likely to have their pain needs neglected. (Students may come up with additional answers.) NCLEX tip: effectiveness is assessed based upon the ‘use’ of a medication. For example, what would the nurse assess if pregabalin is used for: Fibromyalgia? Reduction in the S&S of pain, headache, fatigue, depression, etc. Partial seizures? Reduction in seizure activity. Diabetic neuralgia? Reduction in pain (not blood glucose levels). 2 3 Aspart / Novolog Insulin. Rapid – acting. Use: Type 1 & 2 diabetes mellitus. SE: Hypoglycemia Class: Insulin (Rapid-acting) Indication: Type 1 and type 2 Diabetes Mellitus SE: Hypoglycemia Ask: When is insulin aspart given in relationship to food? Answer: 5-10 minutes before eating a meal. Follow-up: What is the onset/peak/duration of action? Onset 10-20 minutes; Peak 40-50 minutes; Duration 3-5 hours Note: NovoLog Mix 70/30 (aspart/aspart protamine) is given 15 minutes prior to a meal. 2 4 2 5 Diltiazem / Cardizem Ca++ Channel Blocker. Uses: HTN; angina; a-fib; aflutter; SVT. SE: heart failure; peripheral edema. Varenicline / Chantix Smoking cessation aid. Use: Aid efforts to stop smoking. SE: change in appetite; unusual dreams. Down: 1 Furosemide / Lasix Loop diuretic. Uses: renal failure; heart failure. SE: hypokalemia; ototoxicity. Class: Calcium Channel Blocker Indication: HTN; Angina; A-fib; A-flutter; SVT SE: Heart failure; peripheral edema Ask: What are the signs and symptoms of heart failure? Answer: Weight gain, dyspnea, edema How does this medication work? Diltiazem produces vasodilation and a reduction in heart rate (in part by ‘calming’ SA & AV node). Which VS is important to check? BP. Why? Vasodilation which may decrease BP. Pulse. Why? Diltiazem affects the conductivity in the heart. What assessment findings may indicate heart failure? Weight gain, dyspnea, edema. Class: Smoking cessation aid Indication: Aid efforts to stop smoking SE: Nausea, anorexia, unusual dreams, mood changes, suicidal thoughts Ask: How long will the client expect to take varenicline? Answer: 12 weeks The client should start taking 1 week prior to stop-smoking-date. Blocks pleasant feelings from nicotine. Class: Loop diuretic Indication: Heart failure, renal or hepatic failure, uncontrolled HTN, pulmonary edema SE: Hypokalemia; ototoxicity Ask: How would the nurse assess for ototoxicity? Answer: Observe for s/s of hearing loss: Indifference, turning up volume on TV, irritability when conversing (students may come up with others) Remind students that a baseline hearing test may be indicated prior to medication initiation. A client received IV furosemide. After 15 minutes there is no increase in UO. What should the nurse do? Check for obstruction of the catheter tubing; listen to lung sounds. UO should increase within 5 minutes of IV furosemide. A client received oral furosemide. After 15 minutes there is no increase in UO. What would the nurse do? Continue to assess. UO should increase about 60 minutes after an oral dose of furosemide. Note: furosemide is available in oral, sublingual, IV and IM routes. 3 Levofloxacin / Levaquin Fluoroquinolone. Uses: pneumonia, sinusitis, skin infection. SE: tendonitis, photosensitivity. Class: Antibiotic – Fluroquinolone Note: -floxacin is a common suffix for fluroquinolones Indication: Pneumonia; Sinusitis; Skin infections SE: Tendonitis, photosensitivity Ask: What should the nurse do if a client experiences joint pain while taking levofloxacin? Answer: Hold the next dose, place client on bed rest, and call provider. Levofloxacin, and other fluroquinolones, may cause tendonitis and/or tendon rupture during therapy and up to several months after therapy ends. [Associated with tendonitis/tendon rupture ] 6 Atorvastatin / Lipitor Statin. Uses: lower cholesterol & LDL; raise HDL. SE: rhabdomyolysis; hepatotoxicity. Tip: Suffix: -statin. Class: Statin (suffix: statin) Indication: Lower cholesterol & LDL levels; Raise HDL levels. SE: Rhabdomyolysis; hepatotoxicity Ask: What labs should be assessed for side effects? Answer: LFT: ALT/AST; rhabdomyolysis: myoglobin, CK Follow-up: What labs should be assessed for effectiveness? Cholesterol, LDL/HDL, triglygerides Grapefruit, alcohol are contraindicated. 7 Sildenafil / Viagra Phosphodiesterase inhibitor. Use: ED. SE: flushing, erection lasting >4 hours, MI. Tip: suffix –afil Class: Phosphodiesterase inhibitor (suffix: afil) Indication: Erectile dysfunction SE: Hypotension, priapism, flushing, HA Ask: Why is sildenafil contraindicated with NTG? Answer: Life-threatening hypotension can occur. The client must wait 24 hours after sildenafil to take a nitrate; Sildenafil is absolutely contraindicated in men who are already taking nitrates 8 Sertraline / Zoloft SSRI. Uses: depression, OCD, PTSD, panic attacks. SE: weight changes, drowsiness, loss of libido, hallucinations, insomnia. Class: SSRI Indication: Depression, OCD, PTSD, Panic attacks SE: Insomnia, agitation, weight gain, sexual dysfunction; suicidal thoughts Ask: How many days should the client be instructed to wait when stopping an MAOI and starting Sertraline? Answer: MAOI should be withdrawn at least 14 days prior to starting sertraline (and the reverse – sertraline should be withdrawn at least 14 days prior to starting an MAOI) due to risk of serotonin syndrome Follow-up: Ask students for s/s of serotonin syndrome: Fever, excessive sweating, agitation, diarrhea, heart and blood pressure changes, myoclonus, hyperreflexia, tremors, and loss of coordination Note: SSRI’s should not be stopped suddenly. Use in children and adolescents may cause suicidal ideation. Alcohol should be avoided. 9 Fentanyl / Duragesic transdermal Narcotic Analgesic. Use: chronic pain not responding to other analgesics. SE: addiction, respiratory depression. 1 0 Fluticasone / Flonase Corticosteroid. Uses: seasonal and perennial rhinitis. SE: nausea, dizziness, epistaxis. Class: Narcotic (opioid) analgesic Indication: Chronic pain; surgical analgesia, control of breakthrough pain in clients taking other opioids SE: Respiratory depression, sedation, constipation, urinary retention Ask: How long is the patch worn? Answer: 72 hours The transdermal patch (Duragesic) is worn for 3 days; full analgesic effect takes 24 hours; short-term pain med may be required during that time. Follow-up: Ask students about considerations re: patch: Direct heat (heating pads, electric blankets) at the site should be avoided since it accelerates absorption due to vasodilation, as do fever, sunbathing and strenuous exercise. Available in parenteral, transmucosal, transdermal, intranasal forms High abuse potential; client may develop opioid tolerance . Tip: suffix –sone. Class: Glucocorticoid (suffix: sone) Indication: Prophylaxis for asthma, allergic rhinitis SE: Oropharyngeal candidiasis, hoarseness Ask: How often should the client use fluticasone? Answer: Daily, on a regular basis Fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes bronchodilation. Eliminate grapefruit from diet. The client should gargle after using medication to minimize chance of developing candidiasis Note: fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes bronchodilation. 1 3 Propranolol / Inderal Non-selective beta blocker. Uses: HTN; dysrhythmias; migraine, many others. SE: bradycardia, hypotension. Tip: suffix –olol. Class: Beta blocker/Antihypertensive Indication: HTN, angina, dysrhythmias, MI, acute anxiety (“stage fright”) SE: Bradycardia, AV heart block, heart failure, bronchoconstriction, depression Tip: suffix –olol. Contraindicated or used with extreme caution for clients with restrictive airway diseases, diabetes (inhibits glycogenesis), depression, heart failure, heart block, severe allergy (can inhibit the action of epinephrine) Can cause rebound cardiac excitation resulting in tachycardia and ventricular dysrthymias Ask: What is the black box warning for propranolol? Answer: Exacerbation of angina/MI if abruptly discontinued First dose effect may cause fainting due to severe hypotension; the client should be forewarned and advised not to drive or engage in other hazardous activities for 12-24 hours; taking at bedtime can help minimize risk 1 5 1 7 When might the nurse hold this medication? Systolic BP below 100, pulse below 60 or client is showing signs of hypoxia. Donepezil / Aricept Class: Cholinesterase inhibitor Cholinesterase Indication: Mild to severe Alzheimer’s Disease inhibitor. Use: Mild to SE: Nausea, vomiting, diarrhea, GI bleeding, anorexia, dizziness, severe AD. bronchoconstriction, bradycardia SE: may decrease reaction time. Ask: What important teaching is needed? Answer: Take donepezil at bedtime, may cause vivid unusual dreams, implement safety precautions Lisinopril / Zestril ACE inhibitor. Uses: HTN, MI. SE: persistent cough, angioedema. Should be taken daily, at bedtime. Low dose is started initially and slowly increased to minimize side effects of nausea, diarrhea, dizziness, bronchoconstriction, and bradycardia. Should be used cautiously in clients with asthma or COPD. Do not discontinue suddenly as respiratory failure may result. Tip: suffix -pril Class: ACE Inhibitor (suffix -pril) Indication: Hypertension, heart failure, acute MI SE: Persistent dry cough, hyperkalemia, renal failure, fetal injury, angioedema Remind students of first dose effect (fainting due to hypotension) of antihypertensives Ask: Should women use a reliable form of birth control while taking this Lisinopril? Answer: Yes, black box warning of being associated with fetal injury/death Angioedema: swelling in the face, throat, tongue could close airway (could also occur in extremities). Cough is annoying and may require a change in medication but is not life-threatening. 1 8 Rifampin / Rifadin Antimycobacterial. Uses: TB, some other infections. SE: hepatotoxicity. Class: Antibiotic Indication: TB, leprosy (Hansen’s disease) and to eliminate meningococcal bacterium (Neisseria meningitidis) from the nasopharynx from asymptomatic carriers, but should not be used for active disease. SE: EPS, angioedema, hepatotoxicity Ask: How would the nurse assess liver toxicity? Answer: ↑ LFT, jaundice, dark urine, light stools, RUQ pain When prescribed for TB, rifampin is often used with other medications such as ethambutol and isoniazid. Can decrease effectiveness of birth control pills. Causes body secretions to turn orange and can permanently stain contact lenses. Monitor blood sugar in diabetic clients. 1 9 Enoxaparin / Lovenox Anticoagulant. Use: DVT prevention. SE: bleeding; neurological impairment. Tip: suffix –parin. Low molecular weight heparin (LMW) heparin. Class: Anticoagulant (low molecular weight heparin --LMW) Indication: DVT prevention, ischemia prevention in unstable angina and MI SE: Bleeding, severe neurological injury if given to patient undergoing any type of spinal injection or puncture. Tip: suffix –arin Levels cannot be monitored with aPTT Fill-in-the-Blank Generic (Brand) 1 (Adenocard) Speaker Notes Class: Antidysrhythmic Indications: Paroxysmal SVT SE: Bradycardia, dyspnea, hypotension, flushing, chest discomfort Ask: What client outcome should the nurse expect? Answer: Conversion to normal sinus rhythm Note: IV administration of adenosine is not within the PN scope of practice. What should the nurse monitor? VS, EKG, lung sounds, UO. 2 Dutasteride (Avodart) Class: 5-alpha-reductase inhibitor Indication: Benign prostatic hypertrophy SE: Decreased ejaculate, decreased libido Ask: Should clients using dutasteride donate blood? Answer: No; Dutasteride is teratogenic. NOTE: It is pregnancy category X. Blood donation should not occur for at least six moths after discontinuing because donated blood might be given to a pregnant woman. Pregnant woman should not handle dutasteride as it is absorbed through the skin. 3 Warfarin (Coumadin) Class: Anticoagulant (Suffix: arin) Indication: Prophylaxis for thrombosis, TIAs and MI SE: Black Box Warning: Serious/fatal bleeding events (Category X) Ask: Should foods containing vitamin K be avoided while taking warfarin? Answer: No. Clients should maintain a consistent intake of Vitamin K. Increasing or decreasing intake will require a change in warfarin dosage. Many medications adversely interact with warfarin (ex. Aspirin, amiodarone, phenytoin, rifampin). Clients should wear a Medic Alert bracelet and inform provider(s) of warfarin use. Note: there are lots of follow-up questions to ask students: Q: What are foods that are high in vitamin K? A: green leafy vegetable, mayonnaise, canola oil, soybean oil. Q: What is the antidote for warfarin overdose? A: Vitamin K Q: What bleeding precautions can be taken by clients? A: Use a soft toothbrush, use an electric razor. Q: What is the therapeutic INR level? A: 2-3 What are foods that are high in vitamin K? green leafy vegetable, mayonnaise, canola oil, soybean oil. Not safe in pregnancy. A client who is pregnant and requires anticoagulant therapy will have a change in therapy to heparin or lovenox. 4 Phenytoin (Dilantin) Class: Antieplileptic Indication: Seizures SE: Gingival hyperplasia, thrombocytopenia Ask: Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome? Answer: Yes, (flu like S&S, skin rash) instruct client to stop taking medication and notify provider Follow-up: Q: Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome? A: Yes, (flu like S&S, skin rash) and they should stop taking medication and notify provider Phenytoin is a teratogen, Pregnancy Category D:only used if seizure control is not possible other medications Phenytoin has many medication interactions (ex. Warfarin, oral contraceptives, glucocorticoids, cimetidine). Patient should be instructed to avoid alcohol – increases the CNS depressant actions of phenytoin and decreases phenytoin levels. 5 Metronidazole (Flagyl) Class: Antiprotozoal, antimicrobial, amebicide Indication: Amoebiasis, trichomoniasis, giardiasis , Drug of choice for C-Difficele SE: Nausea, headache, metallic taste, dark urine. These are unpleasant but do not require discontinuing the medication. Ask: Why is alcohol contraindicated with this drug? Answer: Metronidazole has disulfiram-like reactions with alcohol which may be dangerous. Symptoms include severe nausea, copious vomiting, flushing, HA, sweating, thirst, blurred vision and hypotension; BP can potentially drop to shock levels; lasts 30 minutes to several hours Metronidazole is used to treat trichomoniasis. This is a sexually transmitted protozoal infection, Symptoms in a woman include a green/yellow odiferous vaginal discharge, vaginal itching, and dyspareunia. Men may not have symptoms. Both partners require treatment to prevent reinfection. It is the drug of choice for amebiasis and giardiasis 6 Gentamicin (Gentamicin) Class: Aminoglycoside antibiotic (suffix: micin) Indications: Bacterial infections, topically for skin infections SE: Nephrotoxicity, ototoxicity Ask: What lab work is done to evaluate the therapeutic effects or toxic levels? Answer: Peak/Trough (Ask as f/u, when peak and trough are drawn; peak ~ 30 minutes after IV administration; trough drawn ~ 30 minutes before IV administration). Reserved for serious infections due to toxic risk Monitor: hearing and balance (inner ear functions), and kidney function. Neuromuscular blockade can cause potentially fatal respiratory depression. Clients at highest risk are those with myasthenia gravis and those receiving a muscle relaxant or general anesthetic. 7 Digoxin (Lanoxin) Class: Cardiac Glycoside, Inotrope Indications: Heart failure, cardiac dysrhythmias SE: Dysrhythmias, anorexia, nausea, fatigue, yellow tinge to vision [client may report this as blurred vision, yellow tinge to vision, appearance of halos around dark objects] Ask: What should the nurse monitor? Answer: Digoxin levels, potassium levels, apical pulse rate The apical pulse must be auscultated for one full minute, prior to administering the medication; potassium level must be monitored as hypokalemia as it can cause potentially fatal dysrhythmias, most commonly from diuretics that are commonly used with digoxin. Digoxin works by improving heart contractility and reducing heart rate. Those commonly prescribed in the past, it is now considered a second line drug. Diuretics and either an ACE inhibitor, ARB or beta blocker are first line for treatment of HF (note: Beta blockers used to be contraindicated for HF, but, with carefully controlled dosage, they can improve symptoms and prolong life) The therapeutic range for Digoxin is very narrow – 0.8 – 2.0 ng/mL; toxicity occurs at a level =/> 2.4 ng/mL 8 Memantine (Namenda) NMDA Antagonist Use: Moderate to Severe Alzheimer’s disease (AD) SE: dizziness, headache, confusion, constipation Ask: What medication might be used for mild AD? Answer: Donepezil Unlike cholinesterase inhibitors (such as donepezil), Memantine is approved for moderate to severe AD only. It does not benefit clients with mild AD. It is generally well tolerated with only small percentages of the side effects listed above. Sodium bicarbonate causes urine to become more alkaline and can decrease renal excretion of memantine, leading to toxic levels. 9 Oxycodone (Oxycontin) Memantine should be avoided in clients with renal failure. Opioid Analgesic Use: Moderate to severe pain SE: respiratory depression, constipation, urinary retention, cough suppression, miosis, sedation, euphoria Oxycodone tablets should not be broken, crushed, or chewed Ask: What should the nurse monitor? Answer: Respirations, BP (orthostatic hypotension), urine output Oxycodone has high abuse potential, but concerns shouldn’t interfere with treatment of pain. New formulations are available that discourage abuse (turns into a blob if exposed to fluid making it difficult to inject; burns nasal passages if crushed and snorted) 10 Montelukast (Singulair) Class: Leukotriene Modifier Use: Asthma maintenance and prophylaxis, prevention of exercise induced bronchospasm, relief of allergic rhinitis SE: mood changes, suicidal thoughts/actions Ask: What medication would the nurse expect to give for acute asthma? Answer: Albuterol, levalbuterol, perbuterol [Ipratropium (Atrovent), an anticholinergic, and glucocorticoids may also be used.] Montelukast is not indicated for acute asthma attacks. Used for clients 1 year and older for asthma maintenance and prevention. Used in clients at least 15 years old to prevent exercise-induced bronchospasm.