Renal failure

Drug Acetylsalicylic acid(Aspirin) Antiplatelets Non opeoid analgesic Increase coagulations studies Decrease serum K Use and dosage Blocks pain impulse in CNS, antipyretic result from vasodilatation of peripheral vessels, inhibit platelets aggregation. Treat TIA, Post MI, Stroke, angina Side effect Increase PT, PTT. Reye’s syndrome (encephalopathy and fatty liver), GI bleed, tinnitus, liver toxicity(dark urine, clay stool, itching, yellowing sclera and skin), visual changes Teaching and labs Take with full glass of water, milk for food to prevent stomach upset Do not crush enteric coated, given 30 min prior to or 2 hrs after meals.

Therapeutic in 2 weeks, do not give children with flu-like symptoms or chickenpox symptoms (Reye syndrome) Binding is irreversible so cathartic such as sorbitol may be added as well. It interrupts enterohepatic circulation of some drugs/toxins and their metabolites. It allows certain drugs/toxins to be drawn out of the blood and bind to charcoal in the intestine a kind of ? gut dialysis? contraindication Do not give children under 12 because of risk of Reye syndrome, children or teenagers with chicken pos or flu like symptoms, pregnancy in 3rd trimester, and decrease effect of ASA with antacid, vit.

K deficiency In ingestion substance that is acid an alkali or a petroleum product. Do not do gastric lavage on pt who swallow caustic agent, convulsions are occurring, high viscosity petroleum products have been ingested, cardiac dysrhythmias are present, or there is emesis of blood Antidote supportive care and preventing aspiration are Activated charcoal (Actidose-Aqua) Given 1gm/kg of body weight Pre mixed with water 12. 5-25 grams Charcoal does not change the stomach PH. Treat poison and overdose following oral ingestion. It binds to poison and prevent its absorption by the GI tract and it eliminate in the feces.

Charcoal must be administered within 60 minutes of ingestion. Ipecac-induce emesis of stomach pups is also used. Charcoal may be given once or twice depending on the level of toxic Incorrect application say into the lungs, results in pulmonary aspiration which can be fatal Page 1 of 64 Study Guide for NLN RN Pharmacology Exam implemented if gastric lavage is not to be performed Do not give during pregnancy, actively bleeding, recent Hx of CVA, Uncontrolled HTN, IM rout is contraindication when using thrombolytics. Alteplase recombinant (Activase) Thrombolytic Streptokinase, urokinase given mostly in emergency situation.

Dissolve or break down clots to reestablish perfusion. Is indicated for clients at risk for developing thrombus with resultant ischemia such as MI, ischemic stroke, arterial thrombosis, DVT, pulmonary embolism an occlusion of catheter shunts. Hemorrhage, N/V, hypotension cardiac dysrhythmias. Dose related is the highest problem Aluminum hydroxide (Amphogel) is Antacid Neutralize gastric acid, antflatulent to alleviate symptoms of gas and bloating Antacid increase gastric pH, decrease absorption of other drugs such as dig, antibiotic, iron supplement. Belching, constipation, flatulence, diarrhea gastric distention.

Acid rebound if given too often. Toxicity cause dementia, Give Amicor for overdose. Given also for excessive bleeding. From cardiac surgery, trauma abruption placenta thrombolytic agent antidote. Monitor VS changes, watch for signs of impending shock ( ). If bleeding is occurring stop treatment and notify doctor. Start on FFP and PRBC. Do not take NSAID and Aspirin because of enhanced bleeding. Given 2 hrs apart from other drugs where drug interaction may occur. Observe for signs and symptoms of altered phosphate levels; anorexia, muscle weakness and malaise.

Increase fluid, exercise and fiber to prevent constipation. In the presence of abd pain, N/V, diarrhea, severe renal dysfunction, fecal impaction, rectal bleeding, colostomy, illeostomy. Severe renal disease, dehydration hypercalcemia andhypercalciuria Page 2 of 64 Study Guide for NLN RN Pharmacology Exam Hypercalcemia, metabolic alkalosis, worsen HTN, heart failure from increase intake. Most common allergic reaction: Skin rash urticaria, purities, angioderma. Purities rash like measles is not a true allergic reaction but develops 7-10 days of therapy and may last for a few days after therapy.

Most common side effects: GI, N/V, diarrhea epigastric distress abd pain colitis elevated liver enzymes, taste alteration, sore mouth dark/discolored/sore tongue. Toxicity: treat type 1 toxicity within 230 minutes it is fatal, N/V, urticaria, purities severed dyspnea, stridor, tachycardia, hypotension, red scaly skin Dry mouth, constipation, urinary retention or hesitancy Ampicillin (Ampicin) IV, PO, IM. Treat bacterial infection Shigella, salmonella, Escherichia coli, haemophilus influenza, neisseria gonorrhea, neisseria meningitis, gram positive organism.

Do not give with fruit juice, milk or carbonated beverages because of poor absorption, monitor renal studies, liver enzymes and electrolyte due to hypokalemia. Take on empty stomach. May not necessary to stop treatment if mild diarrhea develops. Give yogurt or buttermilk to restore normal flora. Use absorbent antidarrheal agent Not use in pt with exfoliated dermatitis, Loop diuretic may exacerbate hypokalemia and rash. K sparing diuretic may contribute to hyperkalemia Atropine Sulfate. (antichologenic) for Parkinson. Treat parkinson’s disease, use to increase heart rate.

Monitor dosage of meds carefully, even slight overdose can lead to Increase antichologeneric effect with phenothiazine, Page 3 of 64 Study Guide for NLN RN Pharmacology Exam For ophthalmic use. It decreases involuntary movement and rigidity in parkinsonism. Use for inflammation of the iris and uveal tract. headache,dixxiness Adverse effect/toxicity Paralytic ileus. Assess mental status, Adverse effect when used for the eye Transient stinging, dry mouth, N/V, dry skin, bradycardia, slurred speech, weakness drowsiness, palpitation, tachy, increase IOP, photophonia, urinary hesitancy, heart prostration, decrease sweating toxicity.

Assess for constipation; increase fluids, bulk and exercise, assess bowel sound to rule out paralytic ileus, watch for urinary retention, avoid driving or other hazardous activities, drowsiness may occur. For the Eye Acute glaucoma can be precipitated by papillary dilation; if not recognized and treat, acute glaucoma can result in blindness. Wear dark sunglass and avoid bright light for photophobia, Monitor intraocular pressure and vision should be monitored over the course of the therapy.

Decrease dose if pt is on systematic corticosteroid., assess for impaired bone growth in children receiving inhaled corticosteroid antidepressant, MAO’s amantidine. Contraindicated in pt with narrow angle glaucoma, myasthenia gravis, or GI obstruction should not use.

Systemmatic effect is more pronounced in infant and children with blue eyes and blond hair. Beclomethasone diproprionate (Beclovent) ) inhaled corticosteroid medication Used in bronchial asthma, allergic rhinitis SE: Pharyngeal irritation and sore throat, coughing, dry mouth, oral fungal infections, and sinusitis. Adverse effect/toxicity In children under 2.

Clients with known allergy may adjust dose of antidiabetic agent secondary to potential for elevated blood Page 4 of 64 Study Guide for NLN RN Pharmacology Exam Adrenocortical insufficiency fluid and electrolyte disturbances, nervous system effects and endocrine effects if absorbed systemically. Increase susceptible to infection, dermatologic effects and osteoporosis, diarrhea, N/V, HA, fever, dizziness angioedema rash urticaria and paradoxical bronchospasm, glucose levels with corticosteroids are administered orally. No\t use in bronchospasm or status asthmaticus.

Benztropine mesylate (Cogentin) –Treat Parkinson disease Hypersalivation and SE: dry mouth, urinary retention/hesitancy, HA, Considerations: monitor for huperglycemia,, ask if pt is taking current medication including OTC and history of allergies. Rinse mouth after use for medication because ofopharyngeal candiadiasis and or hoarseness can occur.

Education: inhale bronchodilator drug before corticosteroid when both are ordered. Wait prescribe interval between puffs and rinse mouth after use of inhalation device. Do not abruptly stop meds taper over 2 weeks. Be aware of steroids symptomsMoon face, acne increased fat, pads increase edema; notify doctor.

Report weight gain more than 5 pounds in a week. Nurse, Monitor dose Clients with narrowcarefully; angle glaucoma, Page 5 of 64 Study Guide for NLN RN Pharmacology Exam Anticholinergics Treat Parkinson and Extra pyramidal syndrome EPS irregular movement related to Parkinson disease. dizziness. Adverse effect /toxicity paralytic ileus even slight overdose can led to toxicity. Nursing considerations: I&O’s, protect pt form heatlh. Education: Avoid driving, or other hazardous activities; drowsiness may occur. Avoid cough OTC medication unless prescribed.

Use cautiously in pt with impending depression, impaired hepatic or renal function, copd. Give with milk or food to prevent GI upset. Nurse: check BP and pulse before initiation. If bp falls 20 mmHg delay medication and notify dr. Education: avoid alcohol, no OTC unless prescribe, observe for dependency, avoid excessive sunlight. No breastfeed myasthenia gravis, or GI obstruction should not use. Chloradiazepoxide hydrochloride (Librium) CNS agent, sedation-IM & tablet form class: Benzodiazepine sedative-hypnotic Capsules: 5 mg, 10 mg, 25 mg, Injection: 100mg ampules To relieve tension, anxiety, and to manage alcohol withdrawal.

Adverse effect: respiratory distress, drousy, dizziness, lethargy, Peak 1-4 hours po, 15-30 min IM. Half life 5-30hr Nurse Monitor CBC and hepatic enzyme levels in prolonged therapy. • Monitor renal and hepatic studies. • Assess patient for apnea, bradycardia, and hypotension. Suicidal Narrow antgle glaucoma, under 12 year old tendencies may be present and protective measures may be necessary. LABS CBC, Na, K, hepatic enzyme levels in prolonged Page 6 of 64 Study Guide for NLN RN Pharmacology Exam therapy. renal and hepatic studies. Assess patient for apnea, bradycardia, hypotension.

Teach: avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. avoid alcohol during therapy. donot to stop taking drug abruptly Chloramphenicol (Chloromycetin) anti bacterial, anntfungal and antiviral agent for the eye Eye infection for susceptible organisms when less dangerous anti-infective are ineffective. Sty, conjunctivitis, uveitis Adverse effect/toxicity Bone marrow hyperplasia, irritation, burning, itching angioeurotic edema super infection, aplastic anemia. Steven-Johnson syndrome, SE: dermatitis, itching, stinging, swelling.

Chlorothiazide (Diuril) Thiazide diuretic, non Increase urinary excretion sodium and SE: Dizziness, vertigo, HA, weakness, N/V, and Nurse: obtain culture hypersensivitity specimen from eye before initiation of treatment, and remove exudates. Monitor for pain, drainage, redness, selling. Monitor for bleeding or bruising with chlormaphenicol Teaching: tell nurse of photosensitivity, redness swelling, increase drainage, pain or swelling if no improvement in a few days. Consideration: take early Client with anuria. Use in the morning to avoid cautiously in pt with Page 7 of 64.

Study Guide for NLN RN Pharmacology Exam K spearing water by inhibiting sodium reabsorption. Use for HTN and kidney, Inhibit sodium reabsorption in the cortical diluting tubule of kidney, increase urinary excretion, for edema and HTN, CHF, cirrhosis, corticosteroid and estrogen therapy, diabetes insipidus, reduction of osteoporosis pain diarrhea, constipation, frequent urination, electrolyte imbalance, impared glucose tolerance, jaundice, muscle cramps, photosensivitity, impotence hyperuricemia Adverse/toxicity Renal failure, aplastic anemia, agranulocytosis, thrombocytopenia and anaphalytic reaction nocturia.

Given with food, allow for two weeks for maximum effect, will not be effective if creatinin clearance Is less than 30ml/min May alter serum electrolyte especially lowering potassium, increase serum urate, glucose, cholesterol triglycerides BUN and createrinin impared renal or hepatic function. Do not use if pregnant. Will increase serium lithium level Nurse: monitor vs, I&O, assess for dehydration; thirst poor skin tugor coated tongue monitor electrolyte levels.

Chlorpromazine hydrochloride (Thorazine) A phenothiazine Antipsychotic medication, Neurologic drug Typical antipsychotic meds to treat positive symptoms but is low potency and can reduce the risk of EPSE Block dopamine receptor in CNS to treat + symptom respond to typical antipsychotic drug, Use for intractable hiccups, treat psychotic disorder (schitzophrenia, bipolar, and other mental illness.

It suppresses acute episode, prevent acute exacerbation and maintain highest possible level of Adverse/toxicity Sedation, orthostatic hypotension, antichologenic effect(dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia) akathisia , liver damage, tremor are two major side effects. (uncontrollable need to move) & Parkinsonism (set of Teach: take early in day to avoid nocturia, take with food or milk, it takes 2-4 wks for antihypertensive effect.

Eat high K food, restrict socium intake, do not use salt substitutes if taking K supplement, change position slowly to avoid dizziness and orthostatic hypotension weigh daily check blood glucose periodically if In pt with narrow angle glaucoma, adynamic ileus prostatic hyperplasia cardiovascular disease, hepatic or renal dysfunction and seizure disorder Drug interaction: may increase for agranulocytosis (low wbc)

Page 8 of 64 Study Guide for NLN RN Pharmacology Exam function symptoms that resembles Parkinson’s disease), photosensivity occurs, clients should take measures to protect eyes exposed to sunlingt, Neuroleptic malignant syndrome (NMS), catatonia, rigidity, stupor, unstable blood prossure profuse sweating, dyspnia It sometimes occurs as Toxic effect and MAY last for 5-10 days after discontinuation of the med.

Cardiac dysrhythmia, diarrhea, dry mouth, constipation Adverse/Toxicity Rare but may include agranulocytosis neutropnia , thrombocytopenia aplastic anemia, anaphylaxis Major toxicities occur in the Hematopoietic, gastrointestinal and diabetic Nurse: get baseline ECG, thorough baseline evaluation lab tests befor treatment. Give bromocripitine (parlodel) and dantolene (dentroim) for NMS. Withdrawal of drug is necessary Cimetidine hydrochloride (Tagamet) GI meds, H2 antagonist Work against histamine, decrease gastric mucosa.

Use short term for duodenal ulcer of benign gastric ulcer, acute upper GI bleed in critically ill clients GERD, heart burn and indigestion Cisplatin (Platinol) Half life 20-30 minutesAntineoplastic Treat ovarian and testicular cancer by interfering with DNA May be given with meals and at bedtime Nurse reduce dose in pt with hepatic or renal impairment Teach: avoid smoking which cause gastric stimulation, avoid antiacid it reduces acidity so use 1 hour of dose Nurse hydrate with oral or iv fluids before and after administration, Hypersensivity to drugs.

Use caution in clients with impared renal or hepatic function, may increase salicylate leavels with high doses of aspirin, may increase coumadin effect Hx of sensivitity to platinum-contaning compounds, impared Page 9 of 64 Study Guide for NLN RN Pharmacology Exam medication, Alkylating agent Major allergic reaction can occur withing first 15 mins of administration. Monitor closely for Signs of anaphylaxis during the first 15 min of infusion. Monitor for decrease Na, K, Ca, mag replication SE/Toxicity Renal and hepatic toxicity, myelosuppression, peripherial neuropathy; neurotoxicity, metallic taste N/V reproductive system.

Nurse Monitor Urine output and urine specific gravity for 4 consecutive hours before therapy initiation and for 24 hour After; report urine < 75 cc/hr it require medical attention. Anaphylactic may occur within minutes of drug initiation. Assess BUN serum uric acid, creatinin, creatinin clearance. Nephrotoxicity occur within 2 wks of therapy. Suspect ototoxicity if client manifest tinnitus or difficulty hearing in the high frequency range given PO on empty stomach; if N/V are severe it may be taken with food; anti-emetic agent should be given before the drug is administered and on a schedule basis throughout the day and night.

Avoid food high in thiamin(beer, wine cheese, brewer’s yeast, chicken liver & banana) may lead to hypertension & intracranial hemorrhage TEACH maintain oral fluid at least 3000 in 24 hr. report reduce UO, anorexia, N/V uncontrolled by antiemetic, fluid retention and weight gain. N/V, anorexia, loss of Nurse check for appetite sedation, sensivity prior to constipation, GI cramps administration, assess urinary retention, oligura, pain,assess respiration purities light headedness and withhold if resp is < dizziness. 12 breaths per minute, assess CNS Adverse/Toxicity renal function and hearing, Hx of gout, urate renal stones.

Incompatible with dextrose and raglan, vancomycin, lasix may increase otoxicity Incompatible with other nephrotoxicity drugs, may increase nephrotoxicity and renal failure. Codeine sulfate Opioids analgesic (agonist) to block opeoid receptors through CNS. Rapid onset if IM or IV. Peak 1-2 hrs, duration up to 7 To treat moderate pain most oral preparations combined with ASA or acetaminophen Do not use if has acute bronchial asthma or upper airway obstruction, ICP, convulsive disorders, pancreatitis, acute ulcerative colitis or Page 10 of 64.

Study Guide for NLN RN Pharmacology Exam hours. Respiratory depression, respiratory arrest, circulatory drpression, ICP. Long term use may cause withdrawl symptoms with termination (N/V cramps fever faintness and anorexia) Vitamin B12 deficiency is more commonly caused by defective gastrointestinal absorption than from B12 are liver, especially lamb’s liver, and kidneys. Eggs, cheese and some species of fish also supply small amounts, but vegetables and fruits are very poor sources. The richest dietary sources of cobalamin are the liver, brain and kidney.

Other sources, include egg yolk, clams, oysters, crabs, sardines, salmon and heart. Lower amounts of cobalamin are found in fish, beef, lamb, pork, chicken changes(LOC), assess allergic reaction TEACH no alcohol, no OTC unless dr order, no smoking driving, without assistance until drug response is known. Report CNS changes, allergic reaction, SOB. Teach; May be taken once per month for life in pt with pernicious anemia . may mixed with fruit juice but give immediately, ascorbic acid affects stability of B12.

For IM give deep SQ by tenting the skin Adverse effect Anaphylactic shock, sudden death, feeling of swelling of body, pulmonary edema, hypokalemia itching rash severe optic nerve atrophy Do not breast feed while giving this drug sever liver or kidney insufficiency.

Combined with MOA may precipitate hypertensive crisis Cyanocobalamin (Vitamin B12) stored in the liver. most potent vitamin a watersoluble vitamin that is stored in the liver. most potent vitamin deficiency result in megaloblastic anemia, dysfunction of spinal cord, with paralysis, GI lesion absorbe in the intestine half life; 6 days most are excreted inurine formation of red blood cells and the maintenence of a healthy nervous system and treats (Addison) pernicious anemia.

Vitamin B12 helps in the formation of red blood cells essential for the proper production of blood platelets and red and white blood cells Page 11 of 64 Study Guide for NLN RN Pharmacology Exam overdose, toxicity, side effects Cyclosporine (Sandimmune) Immunosuppressant medications Inhibit T helper and T suppressor cells. Block production of antibody B cell. Inhibit inflammatory response and block immune response to antigen.

Metabolize in the liver. Peak 4-5hr, Duration 20-54hrs Half life 19-27hrs Debrox drops ( Carbamide peroxide Otic) An ear drop to dewax Prophylaxis in kidney, liver and heart transplant to protect from rejection. Treat chronic rejection in pt who have received immunosuppressive agent, rheumatoid arthritis, recalcitrant plaque psoriasis is used to soften and loosen ear wax, making it easier to remove. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using carbamide peroxide and call your doctor at once if you Hypertension, tremor is a side effect and is expected. Increase risk of infection, hepatotoxicity, HTN, renal toxicity, N/V, diarrhea, flu like symptoms, hypomagnesaemia, hperkalemia decrease serum bicarbonate hirsutim, nephrotoxicity (olegura Adverse/toxicity Renal toxicity, hepatotoxicity dizziness; ear pain, itching, or other irritation; discharge or bleeding from the ear; or decreased hearing for a prolonged period of time.

Less serious side effects may include: temporary decrease in Nurse labs monitor; AST, ALT, BUN, creat, platelet count, K, TEACH taken with food to reduce GI upset, mix with milk, chocolate milk or orange juice but not with Grapefruit juice Avoid use of live vaccine Prevention of infection and report signs of infections Do not use in Pregnant/lactating mom, Use cautiously in renal and hepatic impairment Antiepileptic medications decrease cyclosporine levels oral contraceptive increase levels NURSE You may hear a bubbling sound inside your ear after using carbamide peroxide ear drops.

This is caused by the foaming action of carbamide peroxide, which helps break up the wax inside your ear TEACH tilt your head with your ear facing upward. Pull back on your ear to open up the if you have a ruptured ear drum. any signs of ear infection or injury, such as pain or other irritation, or drainage, discharge, or bleeding from the ear. Do not use this medication in a child younger than 12 years old without the advice of a doctor.

Page 12 of 64 Study Guide for NLN RN Pharmacology Exam have a serious side effect such as: hearing after using the ear drops; mild feeling of fullness in the ear; or mild itching inside the ear. ear canal. drop the correct number of ear drops into the ear. You may hear a bubbling sound inside your ear after putting in the drops. This is caused by the foaming action of carbamide peroxide, which helps break up the wax After using the ear drops, stay lying down or with your head tilted for at least 5 minutes. You may use a small piece of cotton ball to plug the ear and keep the medicine from draining out.

Do not place the dropper tip into your ear, or allow the tip to touch any surface. It may become contaminated. . Do not wash the dropper tip. Carbamide peroxide may be packaged with a bulb syringe that is used to flush out your ear with water. When filling the bulb syringe, use only warm water that is body temperature (no warmer than 98 degrees F). Do not use hot or cold water. Hold your head sideways with your ear over a sink or bowl. Gently pull your ear lobe back and downward to open up the ear canal. Place the tip of the bulb syringe at the opening of your ear canal.

Do not insert the tip into your ear. Squeeze the bulb syringe gently to release the water into your ear. Do not squirt the water with any force into your ear, or you could damage your ear drum. Remove the syringe and allow the water to drain from your ear into the sink or bowl. Do not use carbamide peroxide for longer than 4 days in a row. Page 13 of 64 Study Guide for NLN RN Pharmacology Exam Diazepam (Valium) CNS agent, Benzodiazepine (have zep and zap in them), they are minor tranquulizersanticonvuls ant, anxolytic skeletal muscle relaxant.

Absorbe from GI, metabolize in liver Onset 30 min IM, 60 PO, 15 IV. Works quickly. MUST not take for more than 2 weeks Peak 1-2hr PO, Duration 15 min to 1hr IV; up to 3 hr PO. Half life 20-50 min Maximum effect will be seen in 1-2 weeks. Can only be take 2-4 wks. It has addictive effect. Digoxin (Lanoxin) Cardiac glucoside/antiarrhythmic drug. Positive intoropic (increase force of contraction and decrease Relieve pain and discomfort form musculoskeletal disorders, manage anxiety, manage acute alcohol withdrawal, But do not use for DT’s because it is major.

treat tetanus, antiepileptic,/Seizure, vented patients prior to surgery, skeletal muscle spasm(involuntary contraction of large muscles) ABCD. Antichologenic (dry mouth), Blurred vision, Constipation, & Drowsiness, cardiovascular collapse, laryngospasm, dizzy, weakness, nausea Adverse/toxicity Erythema multiforme, angioedema, anaphylaxis, dysrhythmia, seizure Nurse watch for CNS effect. Monitor CBC WBC with diff. notify dr. if drop in BP of 20 mmhg Assess for allergic reaction including idiosyncratic reaction, anaphylaxis, rash fever resp distress Teach do not stop abruptly; insomnia, nausea HA, spasticity tachycardia will occur.

Do not drink alcohol while on this drug, it will increase CNS depression. Contraindication: in compromised pulmonary function, active hepatic disease, impaired myocardial function, acute alcohol intoxication, infant < 6 months narrow angle glaucoma, open angle glaucoma, during or within 14 days of MOA Treat CHF and fibrillation, a flutter, paroxymal atrial tachycardia In heart failure it Increase contraction of SE: nausea, HA, loss of usual appetite.

Adverse effect/Toxicity Toxicity my go unrecognized since it presents with same Nurse may give without regard for food, may cruse if desire. IVP over 5 min, do not give IM, it will cause tissue irritation. Monitor apical Contra: avoid in clients with hypersensitivity to dig, do not give full dose if pt receive dig in previous week, Interaction: IV calcium Page 14 of 64 Study Guide for NLN RN Pharmacology Exam heart rate) Therapeutic range: 0. 5-2. 0ng/ml Toxic level > 2 Antidote: digibind (digoxin immune fab If calcium is to be given watch for bradycardia since calcium potentiate the action of dig, influence cardiac contractility. K Level 3.

5-5Meq the heart muscle. In atrial fib, it slows the heart rate Nurse, monitor I&O daily weight especially in pt with renal failure, ausculatate breath sound. Assess for edema because it indicates fluid volume overload symptoms as flu (N/V, anorexia, diarrhea, vomitingvisual disturbance. Blurred green or yellow vision or halo effect. CNS: fatique, muscle weakness, HA, facial neuralgia, depression paresthesia hallucinations, confusion, drowsiness agitation malaise. Dysrhythmia hypotension, AV block, and diaphoresi. In chn early sign of toxicity include cardiac dysrhythmias.

Chn rarely show signs of N/V, diarrhea, visual problem, anorexia SE in the absence of alcohol, disulfiram rarely causes significant effects; drowsiness and skin eruptions may occur during initial drug use but these responses diminish with time. pulse, if 24 hours Onset 1 hr, peak 0. 5 hr meds effect can be seen 1-2 days, substantial improvement takes 2-4 wks Furosemide (Lasix) Loop diuretics, Inhibit NA-K-2Cl symporter in ascending limb. A ? high ceiling? that is dosage can be increase to promote diuresis. Excrete sodium, water, chloride, and K.

With renal it causes vasodilation to provide increase in filtration rate and decrease peripheral resistance Peak 60-70 min PO, 20-60 min IV. Onset 30-60 min PO, 5 min IV, Duration 2 hrs, Half life 30 min reduce and is more favorable is a client need to have long term therapy. Dose should be reduce in the elderly. take measures to protect eyes when exposed to sunlight. incontence. Condition last for 5-10 days after discontinuation of drug. Stop drug and NMS developsTreat with Dantrium andParlodel. se WBC Treat acute pulmonary edema, edema, heart failure, chronic renal impairment, hypertension, hypercalcemia

Ototoxicity Dizziness, HA, light headedness, orthostatic hypotension, weakness, N? V abd pain elevated lipids with decrease HDL dermatitis, urticaria Take with food or milk purities muscle spasm Adverse/Toxicity Hyponatremia, hypochloremia, hypokalemia, hypomagnesaemia hypocalcaemia and hyperuricemia, muscle cramps, tinnitus if administered too rapid renal failure aplastic anemia, anaphylactic reaction, agranulocytosis TEACH eat food high in Nurse, administer IV lasix slowly, hearing loss can occur if injected rapidly. Give over 1-2 minutes to prevent hypotension.

Monitor VS for hypotension and tachycardia, serum electrolyte calcium and uric acid, monitor body weight and I&O. assess thirst poor skin tugor coated tongue, inadequate tissue perfusion and weakness, decrease muscle strength restlessness, anxiety and agitation. Take meds in the daytime to prevent nocturia. Lab Studies monitor Contraindication; anuria, electrolyte depletion, increasing oleguria, anuria hepatic coma, pregnancy, lactation Interact with digitalis increase induced arrhythmias. Interact with aminglycosides causing ototoxicity.

Page 20 of 64 Study Guide for NLN RN Pharmacology Exam calcium restrict sodium intake, do not use salt substitute if taking K supplement, avoid exposure to intense heat with bath shower and electric blankets. Replace fluid with fruit juice or bouillon if experiencing diarrhea, change position slowly to avoid dizziness and orthostatic hypotension, report ringing in the ear immediately HA, paresthesia, skin rash fever Adverse/toxicity Nephrotoxicity and ototoxicity are two common toxicities associated with aminoglycosides.

Ototoxicity may be irreversible, auditory impairment and vestibular damage, possible to the 8 cranial nerve, risk increase with nephrotoxic drugs, prolong treatment with potassium and sodium. monitor hgb, hct, platelet as these increased due to hemoconcentration Gentamicin (Garamycin) Ophthalmic Aminoglycosides. Bactericidal aminoglucosides Peak level: blood specimen drawn 15-30 min after the infusion is completed to. Peak concentration is 4-10 g/ml determine that toxic level does not occur. If peak is too high, dose may reduce.

Trough level blood specimen drawn kill the bacteria cell affecting protein synthesis. Kill gram negative infections, Use in sterilize bowel prior to surgery Use to treat infection of GI, resp, and urinary, CNS, bone etc. and superficial infection of the eye. Have pt keep eyes closed for 1-2 min after instillation. Tell pt that vision will be blurred Nurse, do not give by mouth, it does not absorbed well from the GI. You may only give by mouth for bowel prep or e-choli . Maintain hydration to protect kidney damage. Fluid intake should be 2,5003000ml/day therapy result should be seen between 48-72 hrs.

give high quality protein food that may LABS WBC to monitor the effectiveness of Contraindications preexisting renal disease, concurrent order for renal toxic agents such as amphotericin B, Vancomycin or loop diuretic. In myasthenia gravis. With oral anticoagulant therapy bleeding may increase because aminoglycoside decrease vit K synthesis in the intestinal tract. Page 21 of 64 Study Guide for NLN RN Pharmacology Exam immediately prior to administering the next IV dose appx 30 min before to assure that therapeutic level of drug is maintained. Trough level is 1-2g/ml between doses.

If level is no sustained, dose may increase or more frequently dose maybe given Peak 30-90 min Half life2-4 hr Glipizide (Glucotrol) oral antidiabetic/hypoglycem ics Sulfonylurease duration12-24 hours Onset 15-30 min Peak 1-2hr Metabolized by the liver Take PO dose on empty stomach Report sore throat, watery stools greater than 4-6 per day, severe nausea or vomiting, indicating possible super infection Signs of ototoxicity include HA, NV unsteady gait, tinnitus, vertigo, high frequency, hearing loss and dizziness Stimulate release of insulin from pancreatic beta cells in the pancreas to secrete insulin.

Pt with impaired renal and hepatic function, adrenal or pituitary insufficiency. Give dose 1-3 time daily may use alone or in combination with insulin aminoglycosides, impaired renal function and other ototoxic drug such as lasix, vanco. Hypersensitivity reactions include prurpura, rash, urticaria, and exfoliative dermatitis. Superinfection a secondary infection caused by eradication of normal flora: Candidiasis, skin and mucous membrane SE; GI distress and neurologic symptoms such as dizziness, drowsiness, or headache.

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