Download Concept: ELIMINATION Time Due (Most often ordered as a daily

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Transcript
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Safe Range
Administration Route
Classification
Action
Reason patient is
receiving this medication
(Most often ordered as a daily dose of
240 mg)
Colace
docusate sodium
Available in multiple dosage strengths: 50 mg, 100 mg, 120 mg, 240 mg, 250 mg tablets or
capsules. Also available in liquid 150 mg/15 ml.
Adults: 5 - 400 mg/day in 1 to 4 divided doses
Children 6-12 yrs: 40 – 150 mg/day in 1-4 divided doses
Children 3 – 6 yrs: 20 – 60 mg/day in 1 – 4 divided doses
Children < 3yrs: 10 – 40 mg/day in 1 – 4 divided doses
PO
Pharmacologic – stool softener
Promotes incorporation of water into stool, resulting in a softer fecal mass. Can impact fluid
and electrolyte loss from the colon
 For relief of constipation
 To prevent constipation in a patient who is immobilized, receiving opioid pain
medications, or sedated
 To avoid straining at bowel movements for a patient at increased risk (unstable
cardiac disease, increased intracranial pressure, intra-abdominal aortic aneurysm)
Pharmacokinetics
O - 24-48 hrs
O - Onset
P - unknown
P - Peak
D - unknown
D - Duration
½ - Half-life
½ - unknown
M - Metabolized
M – direct absorption in the small intestine
Where
E - Excreted How
Major Side Effects and /
or Adverse Reactions
Nursing Implications
E – eliminated in bile
Patient/Family Teaching
Mild abdominal cramps. Skin rash in sensitivities.
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Do not administer within 2 hours of another laxative, especially mineral oil, as it
causes increased absorption.
Administer with a full glass of water or juice.
Administration on an empty stomach promotes more rapid results.
Drug does not stimulate peristalsis.
Instruct patients to used medication only as a short-term intervention. Long-term
use may cause bowel dependence or electrolyte imbalance.
Instruct patients in other forms of bowel regulation, such as increased fiber in the
diet, fluid intake and regular exercise.
Advise patients with cardiac disease to avoid straining at bowel movements, which
can stimulate the Vagal nerve (Valsalva maneuver).
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
Patient/Family Teaching
Imodium
Ioperamide
Adults: 4 mg PO for initial dose, then 2 mg PO after each loose stool. Not to exceed 16
mg/day.
Children 9 – 11 yrs: 2 mg PO initially, the 1 mg PO after each stool. Not to exceed 6
mg/day.
Children 6 – 8 yrs: 1 mg initially, then 1 mg after each loose stool. Not to exceed 4
mg/day.
Adults: 2 to 4 mg PO; maximum of 16 mg/day
Children 9-11 yrs: 1 to 2 mg PO; maximum of 6 mg/day
Children 6 – 8 yrs: 1 mg PO; maximum of 4 mg/day.
PO
Therapeutic: antidiarrheal
Inhibits peristalsis and prolongs transit time in the intestine through a direct effect on
nerves in the intestinal muscle wall. Helps to reduce fecal volume; increases fecal
viscosity and bulk while diminishing loss of fluids and electrolytes.
Relief or control of diarrhea
O–
1 hour
P–
2 ½ to 5 hours
D–
10 hours
½-
10.8 hours
M-
partially by liver
E-
primarily in feces
Use with caution in patients with abdominal pain of unknown cause, especially
associated with fever.
May cause drowsiness, dizziness, constipation, abdominal pain, nausea, vomiting, and
dry mouth.
 Assess frequency and consistency of stools. Assess bowel sounds, abdominal
distention or tenderness. Assess for fluid and electrolyte balance, skin turgor and
daily weight.
 Encourage intake of oral fluids if patient is able to take oral fluids.
 Medication may increase CNS depression when taken with alcohol,
antihistamines, opioid analgesics and sedative/hypnotics.
 Advise patient to avoid driving until the effect of medication can be determined
(may cause dizziness).
 Advise patient to avoid alcohol or other CNS depressants while taking this drug.
 Instruct patient that dry mouth can be managed through frequent oral care,
sugarless gum or hard candy.
 Instruct patient to contact health care professionals if diarrhea persists or fever,
abdominal pain or distention occurs.
Source: Deglin, J. H.; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
Patient/Family Teaching
Adult dose = 2 tablets (5 mg) every 6 to 8 hours
Lomotil
Diphenoxylate/atropine
(Typical adult dose = 5 mg PO 3 or 4 times per day initially, then reduce to 1 dose per
day. )
Each tablet = 25 mg diphenoxylate + 0.025 mg atropine. Safe adult dose is 2 tablets per
dose not to exceed a total of 8 tablets per day.
PO
Therapeutic: antidiarrheal
Pharmacologic: anticholinergic
Decreases GI motility.
Management of diarrhea
O – 45 – 60 min
P – 2 hours
D – 3-4 hours
½ - 2.5 hours
M - liver
E – urine
Dizziness, confusion, drowsiness; headache, nervousness, insomnia; dry mouth, dry eyes,
blurred vision; tachycardia; constipation, nausea, vomiting, urinary retention.
Use in conjunction with other CNS depressants may increase CNS depression (substances
such as alcohol, antihistamines, opioid analgesics, or sedative-hypnotics.
Use in combination with MAO inhibitors may result in hypertensive crisis.
 Monitor fluid and electrolyte balance, skin turgor, bowel sounds, frequency &
consistency of stools.
 Liver function should be assessed in prolonged use of medication.
 Use with caution in patients with narcotic drug dependence; drug is chemically
related to opioids but with analgesic properties.
 Contraindicated in patients with closed-angle glaucoma; severe dehydration;
severe liver disease; patients with pseudomembranous colitis or infectious
diarrhea, such as from Salmonella or Shigella.
 Sound-alike medications – do not confuse Lomotil with Lamisil or Lamictal.
 Instruct patient to take medication as prescribed; do not take more often or
more medication than prescribed. Instruct patient that misuse of drug increases
potential for dependency.
 Instruct patient that medication may cause drowsiness; driving or other activities
requiring mental alertness should not be engaged until response to medication is
known.
 Teach patient strategies to manage the dry mouth response from atropine –
such as frequent oral rinses, chewing gum or using sugarless hard candy.
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Phillips Milk of Magnesia
Magnesium hydroxide (for use as a laxative)
Adults = 30 – 60 ml in a single or 2 divided doses
Children 6 – 12 yrs = 15 – 30 ml in a single or 2 divided doses
Children 2 – 5 yrs 5 – 15 ml in a single ot 2 divided doses
Adult and adolescent males – up to 400 mg/day
Adult and adolescent females – up to 300 mg/day
Children 7 – 10 yrs – up to 170 mg/day
Children 4 – 6 yrs – up to 120 mg/day
Children 0 – 3 yrs – up to 80 mg/day
PO in liquid form – 400 mg/5 mL
PO in chewable tablets – 300 mg/tablet or 600 mg/tablet
Laxative
Magnesium supplement
In smaller doses can be used as an antacid
Draws water into the intestinal space and stimulates peristalsis
Commonly used as an OTC laxative for treatment of constipation
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
O – 3 – 6 hours
P – unknown
D – unknown
½ - unknown
M - unknown
E - kidneys
Diarrhea may result; skin flushing and sweating may also occur.
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Patient/Family Teaching
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Use with caution in patients with renal insufficiency
Patients should take medication on an empty stomach followed by a full glass of
water for best results.
May decrease absorption of fluoroquinolones, natrofurantoin, tetracyclines, and
penicillamine
Assess patient for abdominal distention, bowel sounds, usual bowel habits.
Instruct patient that laxatives should only be used for short-term therapy; long
term use may cause electrolyte imbalance and dependence.
Instruct patient in other forms of bowel regulation, such as increased fiber in the
diet, increased fluid intake and increased activity.
Teach patient to notify health care provider if constipation is unrelieved for more
than 24 hours, or rectal bleeding, muscle cramps, weakness or dizziness occur.
Patients with a history of cardiac disease should be instructed to avoid intense
straining to have a bowel movement.
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
Patient/Family Teaching
Flomax
Tamsulosin
0.4 mg PO daily after a meal;
May increase to 0.8 mg/day after 2 to 4 weeks of therapy
0.4 mg - 0.8 mg per day
PO
Pharmacologic: pheripherally acting antiadrenergics
Decreases contractions in smooth muscle of the prostatic capsule by preferentially
binding to alpha-adrenergic receptors.
Decreases symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia)
O – unknown
P – 2 weeks
D – unknown
½ - 14 hr
M - liver
E - urine
Dizziness, headache.
Rhinitis, orthostatic hypotension, retrograde or diminished ejaculation
 Use with caution with patients with carcinoma of the prostate
 Do not open, crush or chew capsules.
 With initial dose, assess patient for orthostatic hypotension and syncope.
 Monitor intake and output, daily weight and assess for edema.
 Monitor for symptoms of BPH during therapy – urinary hesitancy, incomplete
bladder emptying, straining to urinate, dribbling, urgency.
 If therapy is interrupted for several days, therapy must be restarted with the 0.4
mg dosage
 Instruct patient to change positions slowly to minimize orthostatic hypotension.
 Teach patient to take medication daily as prescribed and to not interrupt
medication schedule, even if feeling well.
 Advise patient to avoid driving until the effect of medication can be determined
(may cause dizziness).
 Reinforce to patient that follow up visits to physician are required to evaluate
effectiveness of therapy.
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
Patient/Family Teaching
Ditropan
Oxybutynin
Adults = 5 mg PO 2 – 3 times/day
Elderly = 2.5 mg PO 2 – 3 times/day
Adults = Extended release tablets – 5 – 10 mg PO once/day – up to maximum dose of 30
mg/day
Children > 5yrs = 5 mg PO 2 – 3 times /day
Children 1 – 5 yrs = 0.2 mg/kg/dose 2-3 times/day
15 – 30 mg/day (adults)
10 – 20 mg/day (children >5 yrs)
PO, transdermal patch, dermal gel
Therapeutic: Urinary tract antispasmodic
Pharmacologic: anticholinergic
Direct spasmolytic action on smooth muscle, including the smoother muscle lining of the GU
tract, without affecting vascular smooth muscle. Increases bladder capacity, reducing urinary
frequency. Decreases urge incontinence, urgency and frequency.
Indicated for “overactive bladder”, urinary urgency, nocturia, urge incontinence, and
neurogenic bladder.
O – 30 – 60 min (oral); 24 hrs (patch); Unknown (gel)
P – 3 – 5 hrs (oral 36 hrs (patch); Unknown (gel)
D – 6 – 10 hrs (oral); 3 – 4 days (patch); 24 hrs (gel)
½ - 7 – 8 hrs (oral and dermal patch); 64 hrs (gel)
M - liver
E - urine
Dizziness, drowsiness, agitation, confusion, headache, blurred vision, tachycardia, constipation,
dry mouth, nausea, abdominal pain, diarrhea, urinary retention, hyperthermia; dermal
application – pruritis.
 Assess voiding patterns, intake and output, palpate lower abdomen for bladder
distention; monitor patient for sedation and weakness from anticholinergic effects.
 Quick-release tabs should be taken on an empty stomach. Extended release tablets
may be taken with or without food. Do not crush or break tablets.
 Contraindicated in uncontrolled closed-angle glaucoma.
 Contraindicated in intestinal obstruction.
 Patch should be applied to hip, abdomen or buttocks, rotating location. Patch is
applied on the same two days of the week – 3 to 4 days apart – and left on until the
next patch is applied.
 Teach patient to take medication daily as prescribed and to not interrupt medication
schedule, even if feeling well.
 Advise patient to avoid driving until the effect of medication can be determined (may
cause dizziness).
 Advise patient to avoid alcohol or other CNS depressants while taking this drug.
 Instruct patient that dry mouth can be managed through frequent oral care, sugarless
gum or hard candy.
 Gel applications should not be near open flame or while smoking; do not swim or
bathe within one hour of gel application
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)
Concept: ELIMINATION
Time Due
Brand Name
Generic Name
Patient Dose
Pyridium
Phenazopyridine
Adults: 200 mg PO 3 times/day x 2 days
Children: 4 mg/kg 3 times/day x 2 days
Adults: 200 mg/dose up to 3 times/day
Children: 4 mg/kg 3 times/day
PO
Therapeutic: nonopioid analgesic
Pharmacologic: urinary tract analgesic
Produces local anesthetic effect on urinary tract mucosa to produce local analgesia
Provides pain relief from symptoms of urinary tract infection or following urologic
procedures.
Safe Range
Administration Route
Classification
Action
Reason this patient is
receiving this medication
Pharmacokinetics
O – Onset
P – Peak
D – Duration
½ - Half-life
M - Metabolized where
E - Excreted how
Major Side Effects and / or
Adverse Reactions
Nursing Implications
Patient/Family Teaching
O – Unknown
P – 5 – 6 hours
D – 6 – 8 hours
½ - Unknown
M - Unknown
E-
Urine
Headache, vertigo, nausea, hepatotoxicity, renal failure, skin rash, hemolytic anemia.
Contraindicated in patients with glomerulonephritis, hepatitis, uremia or renal failure.
 Do not break or crush tablets.
 Administer medication with meals to reduce gastric irritation.
 Assess patient for signs and symptoms associated with urinary tract infection.
 If lab tests are available, monitor renal function during course of therapy.
 Instruct patient that urine color will be bright orange while taking medication.
 Discolored urine may cause staining of clothing or bedding.
 Soft contact lenses can become discolored by use of pyridium.
 Effect of pyridium are short term; patient must continue to take antibiotics used
in conjunction with this drug, for the full duration of the prescription.
Source: Deglin, J. H..; Vallerand, A.H.; and Sanoskii, C. A. (2011) Davis’s drug guide for nurses, 12.ed. Philadelphia, PA:
F.A. Davis Co.
(Must be in APA format)