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Transcript
NURSING PROCESS PAPER
13
Medication Information
Drug Name
(generic/trade name)
omeprazole
Losec (CAN), Prilosec,
Zegerid
Drug Action/
Purpose
Omeprazole interferes
with gastric acid
secretion by inhibiting
the hydrogen-potassiumadenosine triphosphatase
(H+K+-ATPase)
enzyme system, or
proton pump, in gastric
parietal cells. Normally,
the proton pump uses
energy from the
hydrolysis of adenosine
triphos-phate to drive
hydrogen (H+) and
chloride (Cl-) out of
parietal cells and into the
stomach lumen in
exchange for potassium
(K+), which leaves the
stomach lumen and
enters the parietal cells.
After this exchange, H+
and Cl-combine in the
stomach to form
hydrochloric acid (HCl),
as shown below left.
Omeprazole irreversibly
blocks the exchange of
intracellu-lar H+ and
Normal Dose
Range
* To treat GERD with
erosive esophagitis
Delayed-release
capsules, delayedrelease tablets, oral
suspension
Adults.
20 mg daily for 4 to 8
wk.
Major side
Effects
CNS:
Agitation, asthenia,
dizziness, drowsiness,
fatigue, headache,
psychic disturbances,
somnolence
CV:
Chest pain,
hypertension, peripheral
ed-dema
EENT:
Anterior ischemic optic
neuropathy, optic
atrophy or neuritis,
stomatitis
ENDO:
Hypoglycemia
GI:
Abdominal pain,
constipation, diarrhea,
dyspepsia, elevated liver
function test results,
flatulence, hepatic
dysfunction or failure,
indigestion, nausea,
pancreatitis, vomiting
GU:
Interstitial nephritis
HEME:
Nursing
Considerations
* Give omeprazole
before meals, preferably
in the morning for oncedaily dosing. If necessary, also give an
antacid, as prescribed.
* If needed, open
capsule and sprinkle
enteric-coated granules
on applesauce or yogurt
or mix with water or
acidic fruit juice, such as
apple or cranberry juice.
Give immediately.
* To give drug via NG
tube, mix granules in
acidic juice because
enteric coating dissolves
in alkaline pH.
* Because drug can
interfere with absorption
of vitamin B12, monitor
for macrocytic anemia.
* Be aware that longterm use of omeprazole
may increase the risk of
gastric carcinoma.
NURSING PROCESS PAPER
14
extracellular K+, as
shown below right. By
preventing H+ from
entering the stomach
lumen, omeprazole
prevents additional HCl
from forming.
prednisone
Apo-Prednisone (CAN),
Deltasone Liquid Pred,
Meticorten, Orasone 1,
Orasone 5, Orasone 10,
Prednicen-M, Prednicot,
Prednisone Intensol,
Sterapred, Sterapred DS,
Winpred (CAN)
Binds to intracellular
glucocorticoid receptors
and suppresses
inflammatory and
immune responses by:
inhibiting neutrophil and
monocyte accumulation
at inflammation site and
suppressing their
phagocytic and
bactericidal
activitystabilizing
* To treat adrenal
insufficiency and acute
and chronic
inflammatory and
immunosuppressive
disorders
Oral solution,
syrup,tablets
Adults and adolescents.
5 to 60 mg daily as a
single dose or in divided
Agranulocytosis,
anemia, hemolytic
anemia, leukopenia,
leukocytosis, neutropenia, pancytopenia,
thrombocytopenia
MS:
Back pain
RESP:
Cough
SKIN:
Erythema multiforme,
photosensitivity,
pruritus, rash, StevensJohnson syndrome, toxic
epidermal necrolysis,
urticaria
Other:
Anaphylaxis,
angioedema, hyponatremia
CNS:
Euphoria, headache,
insomnia, nervousness,
psychosis, restlessness,
seizures, vertigo
CV:
Edema, heart failure,
hypertension
EENT:
Cataracts,
exophthalmos,
glaucoma, increased
* Administer once-daily
doses of prednisone in
the morning to match the
body’s normal cortisol
secretion schedule.
* Because prednisone
can produce many
adverse reactions, assess
regularly for signs and
symptoms of such
reactions as heart failure
and hypertension. Also
NURSING PROCESS PAPER
lysosomal
membranessuppressing
antigen response of
macrophages and helper
T cellsinhibiting
synthesis of
inflammatory response
mediators, such as
cytokines, interleukins,
and prostaglandins.
acetaminophen
Inhibits the enzyme
cyclooxygenase,
15
doses.
ocular pressure
ENDO:
Adrenal insufficiency,
Cushing’s syndrome,
growth suppression in
children, hyperglycemia
GI:
Anorexia, GI bleeding
and ulceration, increased
appetite, indigestion,
intestinal perforation,
nausea, pancreatitis,
vomiting
GU:
Menstrual irregularities
MS:
Avascular necrosis of
joints, bone fractures,
muscle atrophy or
weakness, myalgia,
osteoporosis
SKIN:
Acne; diaphoresis;
ecchymosis; flushing;
petechiae; striae; thin,
fragile skin
Other:
Delayed wound healing,
hypernatremia,
hypokalemia, negative
nitrogen balance
* To relieve mild to
GI:
moderate pain associated Abdominal pain,
monitor fluid intake and
output and daily weight.
* Monitor growth
pattern in children
because prednisone may
retard bone growth.
* Be aware that
prolonged use of
prednisone may cause
hypothalamic-pituitaryadrenal suppression.
* WARNING
Withdraw prednisone
gradually, as ordered, if
therapy lasts longer than
2 weeks. Abrupt
discontinuation may
cause acute adrenal
insufficiency and,
possibly, death.
* Before and during
long-term therapy,
NURSING PROCESS PAPER
Abenol (CAN),
Acephen, Aceta Elixir,
Aceta-minophen
Uniserts, Aceta Tablets,
Apacet Capsules, Apacet
Elixir, Apacet Extra
Strength Tablets, Apacet
Regular Strength
Tablets, Aspirin Free
Pain Relief, Exdol
(CAN), Feverall,
Feverall Sprinkle Caps,
Genapap Infants’ Drops,
Genebs Extra Strength,
Halenol Children's
Junior Strength,
Liquiprin Elixir,
Liquiprin Infants’
Drops, Meda Cap,
Neopap, Oraphen-PD,
Panadol, Panadol
Infants’ Drops,
Pediaphen, Redutemp,
Robigesic (CAN), St.
Joseph Aspirin-Free
Infant Drops, Tapanol
Extra Strength, Tempra,
Tempra Drops, Tylenol,
Tylenol Caplets, Tylenol
Children's Chewable
Tablets, Tylenol Extra
Strength, Tylenol Gelcaps, Tylenol Infants’
blocking prostaglandin
production and
interfering with pain
impulse generation in
the peripheral nervous
system. Acetamin-ophen
also acts directly on
temperature-regulating
center in the
hypothalamus by
inhibiting synthesis of
prostaglandin E2.
16
with headache, muscle
ache, backache, minor
arthritis, common cold,
toothache, and menstrual
cramps; to reduce fever
Caplets, capsules,
chewable tablets, elixir,
e.r. caplets, gelcaps,
liquid, solution,
sprinkles, suspension,
tablets
Adults.
325 to 650 mg every 4 to
6 hr, or 1,000 mg t.i.d.
or q.i.d., or 2 E.R.
caplets every 8 hr.
Maximum: 4,000 mg
daily.
hepatotoxicity, nausea,
vomiting
HEME:
Hemolytic anemia (with
long-term use),
leukopenia, neutropenia,
pancytopenia,
thrombocytopenia
SKIN:
Jaundice, rash, urticaria
Other:
Angioedema,
hypoglycemic coma
monitor liver function
test results, including
AST, ALT, bilirubin,
and creatinine levels, as
ordered.
* Monitor renal
function in patient on
long-term therapy. Keep
in mind that blood or
albumin in urine may
indicate nephritis;
decreased urine output,
renal failure; and dark
brown urine, presence of
the metabolite
phenacetin.
* Expect to reduce
dosage for patients with
renal dysfunction.
* Store suppositories
under 80° F (26.6° C).
* WARNING Be
aware that Pediaphen is
a concentrated form of
acetaminophen
containing 80 mg/0.8 ml
(standard liquid forms
contain 32 mg/ml).
Make sure to use correct
concentration and
correct dosage of liquid
acetaminophen because
serious adverse reactions
NURSING PROCESS PAPER
17
Drops
Levsin
hyoscyamine sulfate,
Anaspaz, A-Spas S/L,
Cystospaz, CystospazM, Donnamar, EDSPAZ, Gastrosed,
Levbid, Levsin/SL,
Levsinex Timecaps,
Symax SL, Symax SR
Competitively inhibits
acetylcholine at
autonomic
postganglionic
cholinergic receptors.
Because the most
sensitive receptors are in
the salivary, bronchial,
and sweat glands,
hyoscyamine acts
mainly to reduce
salivary, bronchial, and
sweat gland secretions.
It also causes GI smooth
muscle to contract and
decreases gastric
secretion and GI
motility. In addition,
hyoscyamine causes the
bladder detrusor muscle
to contract; reduces
nasal and oropharyngeal
secretions; and decreases
airway resistance from
relaxation of smooth
muscle in the bronchi
and bronchioles.
* To treat peptic ulcers
and GI tract disorders
caused by spasm
CNS:
Drowsiness, insomnia
EENT:
Blurred vision; dry
Elixir, oral solution
mouth, nose, and throat;
Adults and adolescents.
photophobia
0.125 to 0.25 mg every 4 ENDO:
to 6 hr.
Decreased lactation
GI:
Constipation
GU:
Impotence, urine
retention
SKIN:
Decreased sweating
Other:
Heatstroke, injection site
redness and urticaria
can result from
confusing concentrated
form with regular liquid
form.
* Use hyoscyamine
cautiously in patients
who have arrhythmias,
autonomic neuropathy,
coronary artery disease,
heart failure, hiatal
hernia with reflux
esophagitis,
hypertension,
hyperthyroidism, renal
failure, or tachycardia.
* Give drug 30 to 60
minutes before meals
and at bedtime. Give
bedtime dose at least 2
hours after the day’s last
meal.
* Anticipate that
tablets may not
disintegrate and may
appear in stool.
* WARNING
Anticipate an increased
risk of drug-induced
heatstroke in hot or
humid weather because
hyoscyamine decreases
sweating.
* WARNING Be
NURSING PROCESS PAPER
Neutralizes or reduces
gastric acidity, resulting
magnesium hydroxide
in increased stomach
(milk of magnesia)/
and duodenal alkalinity.
aluminum hydroxide
Protects stomach and
duodenum lining by
inhibiting pepsin's prote(contains 135 mg
olytic activity. Binds
elemental magnesium
with phosphate ions in
per tablet, 129 to 130 mg the intestine to form
elemental magnesium
insoluble aluminumper chewable tablet, and phosphate compounds,
164 to 328 mg elemental which lower the blood
magnesium per 5 ml
phosphate level.
liquid, liquid
concentrate, or oral
solution)
Maalox
Phillips’ Chewable
Tablets, Phillips’
18
To treat hyperacidity
associated with gastric
hyperacidity, gastritis,
hiatal hernia, peptic
esophagitis, and peptic
ulcers; to prevent
phosphate renal calculus
formation; to reduce
hyperphosphatemia in
chronic renal failure
Aluminum hydroxide
capsules, suspension, or
tablets
Adults.
500 to 1,500 mg as
capsules or tablets in
divided doses 3 to 6
times daily, taken
between meals and at
CNS:
Encephalopathy
GI:
Constipation, intestinal
obstruction, whitespeckled stool
MS:
Osteomalacia,
osteoporosis
Other:
Aluminum accumulation
in serum, bone, and
CNS; aluminum
intoxication; electrolyte
imbalances
aware that lower doses
may paradoxically
decrease heart rate.
Higher doses affect
nicotinic receptors in
autonomic ganglia,
causing delirium,
disorientation,
hallucinations, and
restlessness.
* Monitor urine
output, and be alert for
urine retention.
* Don't administer
aluminum hydroxide
within 1 to 2 hours of
other oral drugs.
* Be aware that two
0.6-g aluminum
hydroxide tablets can
neutralize 16 mEq of
acid.
* Monitor patient's
serum levels of sodium,
phosphate, and other
electrolytes, as
appropriate.
NURSING PROCESS PAPER
Magnesia Tablets
(CAN), Phillips’ Milk of
Magnesia, Phillips’ Milk
of Magnesia Concentrate
19
bedtime; 5 to 30 ml as
suspension p.r.n., taken
between meals and at
bedtime.
AlternaGEL, Alu-Cap,
Alugel (CAN), Alu-Tab,
Amphojel, Dialume
Zoloft
sertraline hydrochloride
Inhibits reuptake of the
neurotransmitter
serotonin by CNS
neurons, thereby
increasing the amount of
serotonin available in
nerve synapses. An
elevated serotonin level
may result in elevated
mood and reduced
depression. This action
may also relieve
symptoms of other
psychiatric conditions
attributed to serotonin
deficiency.
* To treat major
depression
Oral concentrate,tablets
Adults.
Initial: 50 mg daily,
increased after several
wk in increments of 50
mg daily every wk, as
needed. Maximum: 200
mg daily.
* To treat obsessivecompulsive disorder
Oral concentrate,tablets
Adults and adolescents.
Initial: 50 mg daily,
increased after several
wk in increments of 50
mg daily every wk, as
needed. Maximum: 200
mg daily.
CNS:
Aggressiveness,
agitation, anxiety,
dizziness, drowsiness,
fatigue, fever, headache,
hyperkinesia, insomnia,
nervousness, neuroleptic
malignant syndrome–
like reaction,
paresthesia, serotonin
syndrome, suicidal
ideation, tremor,
weakness, yawning
CV:
Palpitations
EENT:
Dry mouth, epistaxis,
sinusitis, vision changes
ENDO:
Syndrome of
inappropriate ADH
secretion
GI:
Abdominal cramps,
* Monitor liver function
test results and BUN and
serum creatinine levels,
as appropriate, in
patients with hepatic or
renal dysfunction.
* WARNING
Monitor patient closely
for evidence of serotonin
syndrome, such as
agitation, hallucinations,
coma, tachycardia, labile
blood pressure,
hyperthermia,
hyperreflexia,
incoordination, nausea,
vomiting, and diarrhea.
Serotonin syndrome in
its most severe form can
resemble neuroleptic
malignant syndrome,
which includes
hyperthermia, muscle
rigidity, autonomic
NURSING PROCESS PAPER
20
anorexia, constipation,
diarrhea, flatulence,
increased appetite,
indigestion, nausea,
vomiting
GU:
Anorgasmia, decreased
libido, ejaculation
disorders, impotence,
urinary incontinence
SKIN:
Diaphoresis, flushing,
purpura, rash
Other:
Weight loss
instability, possibly
rapid changes in vital
signs, and mental status
changes. Notify
prescriber immediately
because serotonin
syndrome reactions that
resemble neuroleptic
malignant syndrome
may be life-threatening.
Be prepared to provide
supportive care.
* Monitor patient for
hypoosmolarity of serum
and urine and for
hyponatremia, which
may indicate sertralineinduced syndrome of
inappropriate ADH
secretion.
* Be aware that
effective antidepressant
therapy can promote
development of mania in
predisposed people. If
mania develops, notify
prescriber immediately
and expect to withhold
sertraline.
* Watch closely for
suicidal tendencies,
especially when therapy
starts and dosage
NURSING PROCESS PAPER
Coumadin
warfarin sodium
Interferes with the
liver’s ability to
synthesize vitamin K–
dependent clotting
factors, depleting
clotting factors II
(prothrombin), VII, IX,
and X. This action, in
turn, interferes with the
clotting cascade. By
depleting vitamin Kdependent clotting
factors and interfering
with the clotting
cascade, warfarin
prevents coagulation.
21
To prevent or treat
pulmonary embolism;
recurrent MI;
thromboembolic
complications from
atrial fibrillation, heart
valve replacement, or
MI; and venous
thrombosis (and its
extension)
Tablets
Adults.
Initial: 2 to 5 mg daily
CNS:
Coma, intracranial
hemorrhage, loss of
consciousness, syncope,
weakness
CV:
Angina, chest pain,
hypotension
EENT:
Epistaxis, intraocular
hemorrhage
GI:
Abdominal cramps and
pain, diarrhea, hepatitis,
nausea, vomiting
GU:
changes and especially
in children and
adolescents.
* Monitor patient
closely for evidence of
GI bleeding, especially
if patient takes a drug
known to cause it, such
as aspirin, an NSAID, a
serotonin or
norepinephrine reup-take
inhibitor, or warfarin.
* When theray stops,
expect to taper dosage to
minimize adverse effects
rather than stopping drug
abruptly.
* Reconstitute parenteral
warfarin just before
administration with 2.7
ml of sterile water for
injection to yield 2
mg/ml. Then administer
slowly over 1 to 2
minutes through
peripheral I.V.
* Expect to administer
another parenteral
anticoagulant, such as
heparin or enoxaparin,
with oral warfarin for at
least 3 days, or until
desired response occurs,
NURSING PROCESS PAPER
22
Hematuria, vaginal
bleeding (abnormal)
HEME:
Anemia, potentially fatal
hemorrhage (from any
tissue or organ)
SKIN:
Alopecia, ecchymosis,
jaundice, petechiae,
pruritus, purple-toe
syndrome, tissue
necrosis
Other:
Anaphylaxis
before giving warfarin
only.
* Avoid I.M.
injections during
warfarin therapy, if
possible, because they
can result in bleeding,
bruising, and hematoma.
* Monitor INR (daily
in acute care setting) and
assess for therapeutic
effects, as prescribed.
Therapeutic INR levels
are 2.0 to 3.0 for
bioprosthetic heart
valve, nonvalvular atrial
fibrillation, and venous
thromboembolism, and
2.5 to 3.5 after MI and
for mechanical heart
valve.
* Expect treatment to
last up to 12 weeks for
bioprosthetic heart
valve, 1 to 3 months for
nonvalvular atrial
fibrillation or venous
thromboembolism, and
for rest of life after MI
and for mechanical heart
valve replacement.
* WARNING Be
aware of the increased
NURSING PROCESS PAPER
ibuprofen
Actiprofen Caplets
(CAN), Advil, ApoIbuprofen (CAN), Bayer
Select Ibuprofen Pain
Relief Formula Caplets,
Children’s Advil,
Children’s Motrin,
Dolgesic, Excedrin IB,
Blocks the activity of
cyclooxygenase, the
enzyme needed to
synthesize
prostaglandins, which
mediate the
inflammatory response
and cause local
vasodilation, swelling,
and pain. By inhibiting
23
* To relieve pain in
rheumatoid arthritis and
osteoarthritis
Capsules, chewable
tablets, oral suspension,
tablets
Adults.
300 mg q.i.d., or 400,
600, or 800 mg t.i.d. or
CNS:
Aseptic meningitis,
dizziness, headache,
nervousness, seizures,
stroke
CV:
Fluid retention, heart
failure, hypertension,
MI, peripheral edema,
tachycardia
risk for intracranial
hemorrhage if patient
has cerebral ischemia
(such as recent transient
ischemic attack or minor
ischemic CVA) and INR
of 3 to 4.5. As
prescribed, withhold
next warfarin dose and
give vitamin K if INR
exceeds 4 because of the
risk of bleeding.
* Assess for occult
bleeding if patient
receives I.V. lipid
emulsion or other
medical product that
contains soybean oil.
Such products can
decrease vitamin K
absorption and increase
warfarin’s anticoagulant
effect.
* Use ibuprofen with
extreme caution in
patients with a history of
ulcer disease or GI
bleeding because
NSAIDs such as
ibuprofen increase the
risk of GI bleeding and
ulceration. Expect to use
ibuprofen for the
NURSING PROCESS PAPER
Genpril, Hal-tran, Ibifon
600 Caplets, Ibuprin,
Ibuprohm Caplets, IbuTab, Medipren, Midol
IB, Motrin, Motrin-IB,
Novo-Profen (CAN),
Nu-Ibuprofen (CAN),
Nuprin, Pamprin-IB, QProfen, Rufen, Trendar
prostaglandins, this
NSAID reduces
inflammatory symptoms
and relieves pain.
Ibuprofen’s antipyretic
action probably stems
from its effect on the
hypothalamus, which
increases peripheral
blood flow, causing
vasodilation and
encouraging heat
dissipation.
24
q.i.d. Range: 1.2 to 3.2 g
daily.
EENT:
Amblyopia, epistaxis,
stomatitis, tinnitus
GI:
Abdominal cramps,
distention, or pain;
anorexia; constipation;
diarrhea; diverticulitis;
dyspepsia; dysphagia;
elevated liver function
test results; epigastric
discomfort; esophagitis;
flatulence; gastritis;
gastroenteritis;
gastroesophageal reflux
disease; GI bleeding,
hemorrhage, perforation,
or ulceration; heartburn;
hemorrhoids; hepatic
failure; hepatitis; hiatal
hernia; indigestion;
melena; nausea;
stomatitis; vomiting
GU:
Cystitis, hematuria, renal
failure (acute)
HEME:
Agranulocytosis,
anemia, aplastic anemia,
eosinophilia, hemolytic
anemia, leukopenia,
neutropenia,
pancytopenia, prolonged
shortest time possible in
these patients.
* Be aware that
serious GI tract
ulceration, bleeding, and
perforation may occur
without warning
symptoms. Elderly
patients are at greater
risk. To minimize risk,
give drug with food. If
GI distress occurs,
withhold drug and notify
prescriber immediately.
* Use ibuprofen
cautiously in patients
with hypertension, and
monitor blood pressure
closely throughout
therapy. Drug may cause
hypertension or worsen
it.
* WARNING
Monitor patient closely
for thrombotic events,
including MI and stroke,
because NSAIDs
increase the risk.
* Monitor patient—
especially if he’s elderly
or receiving long-term
ibuprofen therapy—for
less common but serious
NURSING PROCESS PAPER
25
bleeding time,
thrombocytopenia
RESP:
Bronchospasm, dyspnea,
wheezing
SKIN:
Blisters, erythema
multiforme,
photosensitivity,
pruritus, rash, StevensJohnson syndrome, toxic
epidermal necrolysis,
urticaria
Other:
Anaphylaxis,
angioedema, flulike
symptoms, weight gain
adverse GI reactions,
including anorexia,
constipation,
diverticulitis, dysphagia,
esophagitis, gastritis,
gastroenteritis,
gastroesophageal reflux
disease, hemorrhoids,
hiatal hernia, melena,
stomatitis, and vomiting.
* Monitor liver
function test results
because, in rare cases,
elevations may progress
to severe hepatic
reactions, including fatal
hepatitis, liver necrosis,
and hepatic failure.
* Monitor BUN and
serum creatinine levels
in elderly patients,
patients taking diuretics
or ACE inhibitors, and
patients with heart
failure, impaired renal
function, or hepatic
dysfunction; drug may
cause renal failure.
* Monitor CBC for
decreased hemoglobin
and hematocrit. Drug
may worsen anemia.
* WARNING If
NURSING PROCESS PAPER
26
patient has bone marrow
suppression or is
receiving an
antineoplastic drug,
monitor laboratory
results (including WBC
count), and watch for
evidence of infection
because
antiinflammatory and
antipyretic actions of
ibuprofen may mask
signs and symptoms,
such as fever and pain.
* Assess patient’s skin
regularly for signs of
rash or other
hypersensitivity reaction
because ibuprofen is an
NSAID and may cause
serious skin reactions
without warning, even in
patients with no history
of NSAID sensivitity. At
first sign of reaction,
stop drug and notify
prescriber.
* Although drug’s
analgesic effect occurs at
low doses, expect to give
at least 400 mg four
times daily for
antiinflammatory effect.
NURSING PROCESS PAPER
27
* Expect higher doses
for rheumatoid arthritis
than for osteoarthritis.
* Be aware that
ibuprofen oral
suspension may contain
sucrose, which may
affect blood glucose
level in patients with
diabetes.
Source: Davis’s Drug Guide for Nurse 2011