Download File - Lauren Watson

OTC Drugs
Libby Bledsoe
Arron Herring
Anchalem Alemayehu
Vitamins
Vitamins: Two Categories
Fat Soluble Vitamins
Fat soluble vitamins are A, D, E and K . They are
metabolized slowly; can be stored in fatty tissue, and
liver, and muscle in significant amounts and excreted
in the urine, at a slow rate.
Vitamin A
• Contraindications: Hypervitaminosis A, pregnancy
(Massive dose)
• S/Es: HA, fatigue, drowsiness, irritability, anorexia,
vomiting, diarrhea, dry skin, visual change
• ADE: Evident only with toxicity: leukopenia, aplastic
anemia, papilledema, increased intracranial
pressure, hypervitaminosis A, bulging fontanelles
in infants, jaundice
Vitamin D ( Calciferol)
• Vitamin D has a major role in regulating calcium
and phosphorous metabolism and is needed for
calcium absorption from intestines.
• Excess vitamin D ingestion (> 40, 000 international
units) results in hypervitaminosis D and may cause
hypercalcemia( an elevated serum calcium level).
• Anorexia, nausea and vomiting are early symptoms
of vitamin D toxicity.
Vitamin E
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Has antioxidant properties that protect cellular components from being oxidized and
red blood cells from hemolysis.
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It has been reported that taking 400-800 international units of vitamin E per day reduces
the number of nonfatal myocardial infarctions(MIs) and taking 200 unites for several
years can reduces the risk of coronary artery disease(CAD)
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S/Es: large doses of vitamin E may include fatigue, weakness, nausea, GI upset,
headache, and breast tenderness.
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Vitamin E prolongs the prothrombin time (PT) and patient taking Warfarin should have
their PT monitored closely. Iron and Vitamin E shouldn't be taken together because iron
interferes with the body's absorption and use of vitamin E.
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Use Vitamin E: Cautiously in: Anemia due to iron deficiency, vitamin K deficiency (May
increase risk of bleeding)
Vitamin K
• Is used as antidote for oral anticoagulant overdose
and to prevent and treat the hypoprothrombinemia
of vitamin K deficiencies.
Water Soluble Vitamins
• Water soluble Vitamins are the B-complex vitamins
and vitamin C. Theses group of vitamins are not
very toxic unless taken in excessive amount.
Vitamin B complex
• Four of the vitamin B-complex members are
vitamin B1 ( thiamine), vitamin B2( riboflavin),
vitamin B3( Nicotinic acid, or niacin) and vitamin B6
( Pyridoxine)
Vitamin B12 (Cobalamin)
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Functions as a building block of nucleic acids and to
form red blood cells. And also it facilitates functioning
of nervous system.
Vitamin B12 is stored in the liver and it can take 2 to 3
years for stored vitamin B12 to be depleted and a
deficient noticed.
Contraindicated in: hypersensitivity
S/Es: Headache, dizziness, memory impairment,
restlessness, chest pain. Tachycardia, diarrhea,
abdominal discomfort, dusphagia, pain at injection (IM
site)
Use cautiously in: Hereditary optic nerve atrophy
(accelerates nerve damage); uremia, folic acid deficiency
Vitamin C
• Is used to prevent and treat vitamin C deficiency (Scurvy); to
increase wound healing, for burns. Preserves integrity of
blood vessels. It is a water soluble vitamin, thus essential for
collagen formation and tissue repair (bones, skin, blood
vessels). Synthesis of lipids, protein, and carnithine
• Contraindications(caution): Renal calculi, gout, anemia, sickle
cell, sideroblastic and thalassemia
• S/Es: Oral: Nausea, vomiting, diarrhea, heartburn, headache
Parenteral: Flushing, headache, dizziness, soreness at
injection site
• ADE: Kidney stones, crystalluria, hyperuricemia, hemolytic
anemia with clients with G6PD
• Life threatening: Sickle cell crisis, seep vein thrombosis
Nursing Process: Assessment
• Check client for vitamin deficiency before start or
therapy and regularly there after. Explore such
areas as inadequate nutrient intake, debilitating
disease and GI disorders.
• Obtain 24 and 48 hour diet history analysis
Nursing process: Interventions
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Administer vitamins with food to promote absorption
• Store drug in light - resistant container
• Administer IM primarily for clients unable to take by PO
route( eg., GI malabsorption syndrome)
• Recognize need for vitamin E supplements for infants
receiving vitamin A to avoid risk of hemolytic anemia.
• Monitor for vitamin A therapeutic serum levels ( 80 to
300 international unites/ ML)
Nursing process: Teaching
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Instruct client to take prescribed amount of drug
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Inform clients to read vitamin labels to determine which vitamin is most appropriate for
them.
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Instruct client to consult with health care provider/ pharmacist regarding interactions
with prescription and OTC medications
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Discourage client from taking megavitamins over a long period unless these are
prescribed for specific purpose by health care provider.
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Inform client that missing vitamins for 1 or 2 days is not a cause of concern, because
deficiencies do not occur for sometime.
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Advice clients to check expiration dates on vitamins containers before purchasing them.
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Instruct client to avoid taking mineral oil with vitamin A on a regular basis, because it
interferes with vitamin E absorption. If needed take mineral oil at bed time.
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Explain to client that there is no scientific evidence that megadoses of vitamin C (
ascorbic acid) will cure a cold.
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Alert client not to take megadose of vitamin C with aspirin or sulfonamides because
crystals may form in the kidneys and urine.
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Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause
vitamin B – complex deficiencies.
Nursing process: Diet
• Advice client to eat well balanced diet, and inform
client that vitamin supplements are not needed if
the person is healthy and receives the proper
nutrition on a regular basis.
• Instruct client about foods rich in vitamin A,
including whole milk, butter, eggs, leafy green and
yellow vegetables, fruits and liver.
Nursing process: SE/ADE’s
• Instruct client that nausea, vomiting, headache, loss
of hair, and cracked lips (symptoms of
hypervitaminosis A) should be reported to the
health care provider. Early symptoms of
hypervitaminosis D are anorexia, nausea and
vomiting.
Herbs
Herbs
• Herbs are a plant or plant parts used for its
medicinal qualities.
• Herbs were the originals medicines used
throughout the world and are still used today for
therapeutic effects.
• Herbs can help promote health, but when mixed
with some certain medications they can be
contraindicated or even cause toxicity.
Client Responsibility
• Because of the risks of mixing herbal remedies and
medications, It is the responsibility of the client
• To consult with the health care provider
before taking any herbal preparation
• Report any herbal preparations taken to
the health care provider
• Inform health care providers of any allergy
or sensitivity to any herbal products
Dietary Supplement Health And
Education Act of 1994
• This act made regulations for herbal preparations
• Made herbs marketed with dosages
• Physiologic effects can be noted, but cant make
claims about preventing or curing conditions
• Herbs need a disclaimer that indicates it is NOT
approve by the U.S. Food and Drug administration
and not meant to be used as a drug.
Types of Herbal Preparations
• Dried: fresh herbs that have their moisture
removed by the sun
• Extracts: certain isolated components of the herb
• Oils: soaking herb in olive or vegetable oil then
heated
• Salves: crushing herb and mixing it in a petroleum
jelly base
• Teas: steeping fresh or dried herbs in boiling water
• Syrups: adding sweetener to herb then cooking it
Commonly Used Herbs
Aloe Vera
The juice is used for minor sun burns and insect
bites. If ingested, it can be used as a laxative. But can
cause increased menstrual flow.
• Side Effects: arrhythmias, edemas, neuropathies,
and hematuria.
• Contraindicated in: pregnant or lactating women
and children under the age of 12.
• Drug Interactions in cardiac glycosides,
antiarrthymics, corticosteroids, and thiazide
diuretics.
Ginko (Ginkgo Biloba)
• Antioxidant, peripheal vasodilation, and increased blood
flow to CNS. Reduces platelet aggregation.
• Uses: Allergic rhinitis, Alzheimer’s disease,
anxiety/stress, dementia, tinnitus, impotence, and poor
cirulation.
Ginko Continued…
• Avoid use in pregnancy, lactation, children, and
with MAOI’s.
• Drug Interactions: Caution with prescription
anticoagulants. May increase Blood pressure with
thiazide diuretics. Must discontinue two weeks
before surgery.
• Other Herbal Contraindications: Ginger, Garlic, or
feverfew.
• Side Effects/ ADE’s: mild headache, mild gastric
distress
• Toxicity: vomiting, diarrhea, dermatitis, irritability.
St. John’s Wort
St. John’s Wort
• AKA: “Herbal Prozac” because of its use as a “tonic”
for the nervous system.
• Uses: Mood swings, mild to moderate depression,
anxiety, and sleep disorders.
St. John’s Wort Continued…
• When taken with prescription antidepressants,
adverse effect of suicidal ideations.
• Side effects/ Adverse effects: skin photosensitivity,
headache, GI upset, dry mouth, dizziness,
confusion.
• Interactions: avoid with pregnancy, lactation,
prescription antidepressants, MAOI’s, indinavir,
children <2 years.
• Drug interactions: decreased effect of digoxin, use
with amphetamines, trazodone may cause
serotonin syndrome.
• Interferes with absorption of other minerals.
Echinacea
Echinacea (Purple coneflower)
• Is used to enhance the immune system, and for an
antipyretic, antifungal (topical) and antibacterial.
• Increases leukocytes, spleen cells, and activating
granulocytes.
• Leaf preparation: used for respiratory and urinary
tract infections.
• Root extract: for flu-like symptoms
Echinacea Side Effects/ Adverse Effects
and Contraindications
• Temporary tingling of tongue.
• cross-sensitivity in clients allergic to daisy (flower)
family
• GI upset
• Diarrhea
• Contraindicated in: immunosuppressants
(corticosteroids). Persons with systemic disease of
immune system (HIV, AIDS, TB)
Nursing Process
Assessment
• Obtain patient’s baseline info about herbal use and
OTC drug use
• Include dosage, frequency, side effects
Nursing Process
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Diagnoses
Knowledge, deficient about therapeutic regimen
related to use of herbal products
Planning
Herbal Therapy
Prescription and OTC drugs
Interaction between herbal therapy, prescription,
and OTC drugs
Nursing Process
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Interventions
Check client’s response to herbal therapy
Monitor response to prescrip. And OTC drug
therapy
Consult dietician and other specialists necessary
Continue same brand of herbal therapy; notify
health care provider if considering change brands/
preparations
Nursing Process
Client Teaching
• Explain rationale
• Encourage client to read labels and heed
recommended info
• Inform client of storage conditions
Diet
• Teach about food that diminish/enhance the action
of herb
• Foods to avoid
Nursing Process
Evaluation
• Evaluate effectiveness of herbal remedies for
alleviating symptoms.
• Evaluate client’s use of resources
Minerals
Iron
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Vital for hemoglobin regeneration
60% of the iron in the body is found in hemoglobin
Normal diet = 5 to 20 mg per day
Found in liver, lean meats, egg yolks, dried beans,
green vegetables, and fruit
• Foods and antacids slow absorption of iron and
Vitamin C increases iron absorption
• More iron is needed when pregnant, but during the
first trimester megadoses are contraindicated
because of its possible teratogenic effects
Iron
• Dose for infants and children 6 months to 2 years
is 1.5 mg/kg
• Adults is 50 mg/day
• Iron toxicity is a serious cause of poisoning in
children
Copper
• Needed for the formation of RBC’s and connective
tissues
• Cofactor of many enzymes and its function in the
production of the neurotransmitters
norepinephrine and dopamine
• Excess levels may be associated with Wilson’s
disease
• Prolonged deficiency may result in anemia
• Abnormal blood and skin changes caused by
deficiency include a decrease in WBC count, glucose
intolerance, and a decrease in skin and hair
pigmentation. Mental retardation may also occur in
the young
Copper
• RDA for copper is 1.5 to 3 mg/day
• Most adults only consume about 1mg/day
• Foods rich in copper: shellfish, liver, nuts, seeds,
legumes, and cocoa
Zinc
• Important to many enzymatic reactions and is
essential for normal growth and tissue repair,
wound healing, and taste and smell
• Some believe it can alleviate symptoms of the
common cold and shorten its duration
• Intranasal zinc preparations may cause permanent
loss of smell
Zinc
• Up to 200 mg/day can be taken
• RDA for an adult is 12 to 19 mg/day
• Foods rich in zinc: beef, lamb, eggs, and leafy and
root vegetables
• More than 150 mg may cause a copper deficiency
Chromium
• Said to be helpful in control of Type 2 Diabetes
• Thought to help normalize blood glucose by
increasing effects of insulin on the cells
• No RDA
• 50 to 200 mcg/day is considered within the normal
range
• Foods rich in chromium: meats, whole-grain
cereals, and brewer’s yeast
Selenium
• Cofactor for an antioxidant enzyme that protects
protein and nucleic acids from oxidative damage
• Works with Vitamin E
• Thought to have an anticarcinogenic effect, and
doses lower than 200 mcg may reduce the risk of
lung, prostate, and colorectal cancer
• Excess doses greater than 200 mcg may cause
weakness, a loss of hair, dermatitis, nausea,
diarrhea, and abdominal pain, and may also be a
garlic-like odor from the skin and breath
Selenium
• RDA is 40 to 75 mcg (lower dose for women and
higher for men)
• Foods rich in selenium: meats, seafood, eggs, and
dairy products
Iron Assessment
• Obtain a drug history of current drugs and herbs
client is taking.
• Obtain a history of anemia or health problems that
may lead to anemia.
• Assess client for signs and symptoms of iron
deficiency anemia such as fatigue, malaise, pallor,
shortness of breath, tachycardia, and cardiac
dysrhytmias.
• Assess client’s RBC count, hemoglobin, hematocrit,
iron level, and reticulocyte count before start of
and throughout therapy.
Iron Nursing Diagnoses
• Nutrition, less than/more than body requirements,
imbalanced inadequate intake of food sources of
iron
• Knowledge, deficient of food sources of iron
• Decision-making, readiness for enhanced related to
food choices and vitamin/mineral supplementation
Iron Planning
• Client will name six foods high in iron content
• Client will consume foods rich in iron
• Client with iron deficiency anemia or with low
hemoglobin will take replacement as recommended
by health care provider, resulting in laboratory
results within desired range
• Nursing interventions
• Encourage client to eat a nutritious diet to obtain
sufficient iron.
• Store drug in light-resistant container
• Administer IM injections of iron by Z-track method
Iron Client Teaching
• Instruct client to take the tablet or capsule between
meals with at least 8 ounces of juice or water to
promote absorption. If gastric irritation occurs,
instruct the client to take with food.
• Advise client to swallow the tablet or capsule
whole.
• Instruct the client to maintain upright position for
30 minutes after taking oral iron preparation to
prevent esophageal corrosion from reflux.
• Do not administer the iron tablet within 1 hour of
ingesting antacid, milk, ice cream, or other milk
products such as pudding.
Iron Client Teaching Continued
• Inform client that certain herbal drugs can decrease
absorption of iron and other minerals.
• Advise client to increase fluids, activity, and dietary
bulk to avoid or relieve constipation.
• Instruct adults not to leave iron tablets within
reach of children.
• Encourage client to take on the prescribed amount.
• Be alert that iron content varies among iron salts;
therefore do not substitute one for another.
• Advise client that drug treatment for anemia is
generally less than 6 months.
Iron Diet
• Counsel client to include iron-rich foods in diet:
liver, lean meats, egg yolk, dried beans, green
vegetables, and fruit.
Iron Side Effects
• Advise client taking the liquid iron preparation to
use a straw to prevent discoloration of tooth
enamel.
• Alert client that the drugs turns stools a harmless
black or dark green.
• Instruct client about signs and symptoms of
toxicity, including nausea, vomiting, diarrhea,
pallor, hematemesis, shock, and coma, and report
occurrences to health care provider.
References
• Kee, J. L., Hayes, E. R., McCuistion, L. E., & et al, L. E.
(2012). Pharmacology: a nursing process approach.
(7th ed.). St. Louise, MO: Elsevier.
Quiz
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1. ---------- is an antidote for Warfarin( Coumadin) overdose?
A. Vitamin B
B. Vitamin E
C. Vitamin K
D. Zinc
2. Vitamin E shouldn't be taken with -----------A. Zinc
B. Iron
C. Chromium
D. None of the above
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3. Which type of herbal preparation uses petroleum jelly?
Tea
Syrup
Salve
Exctract
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Echinacea
Ginko
Aloe Vera
St. John’s Wort
4. Which Herb is known as “herbal Prozac?”
• Name 3 foods rich in Iron???
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• What do you instruct a client to do if he has gastric
irritation when taking the tablet/capsule?
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