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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. 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. Patient/Family Teaching 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)