Mosby's 2014 Nursing Drug Reference (5 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Benzodiazepines potentiate the action of GABA, including any other inhibitory transmitters in the CNS resulting in decreased anxiety. Most agents cause a decrease in CNS excitability.
Anxiety is relieved in conditions such as generalized anxiety disorder and phobic disorders. Benzodiazepines are also used for acute alcohol withdrawal to prevent delirium tremens, and some products are used for relaxation before surgery.
These products are contraindicated in hypersensitivity, acute closed-angle glaucoma, children <6 mo, hepatic disease (clonazepam), and breastfeeding (diazepam).
Precautions:
Antianxiety agents should be used cautiously in geriatric or debilitated patients. Usually smaller doses are needed because metabolism is slowed.
Persons with renal/hepatic disease may show delayed excretion. ClonazePAM may increase the incidence of seizures.
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With food or milk for GI symptoms; may give crushed if patient is unable to swallow whole (tabs only, no controlled- or sustained-release products)
The most common side effects are dizziness, drowsiness, blurred vision, and orthostatic hypotension. Most adverse reactions are mediated through the CNS. There is the potential for abuse and physical dependence with some products.
Most of these agents are metabolized by the liver and excreted via the kidneys.
Increased CNS depression may occur when given with other CNS depressants. These products should be used together cautiously. Alcohol should not be used, as fatal reactions have occurred. The serum concentration and toxicity may be increased when used with benzodiazepines.
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Anxiety
[uses]
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Risk for injury
[adverse reactions]
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Deficient knowledge
[teaching]
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B/P (lying and standing), pulse; if systolic B/P drops 20 mm Hg, hold product and notify prescriber; orthostatic hypotension can be severe
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Hepatic/renal studies: AST, ALT, bilirubin, creatinine, LDH, alk phos
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Physical dependency and withdrawal with some products, including headache, nausea, vomiting, muscle pain, and weakness after long-term use
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Therapeutic response: decreased anxiety, increased relaxation
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That product should not be used for everyday stress or long-term use; not to take more than prescribed amount because product is habit forming
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To avoid driving and activities that require alertness because drowsiness and dizziness may occur
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To abstain from alcohol, other psychotropic medications unless directed by prescriber
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Not to discontinue abruptly; after extended periods, withdrawal symptoms may occur
Bronchodilators are divided into anticholinergics, α/β-adrenergic agonists, β-adrenergic agonists, and phosphodiesterase inhibitors. Also included in antiasthmatic agents are corticosteroids, leukotriene antagonists, mast cell stabilizers, and monoclonal antibodies. Anticholinergics act by inhibiting interaction of acetylcholine at receptor sites on bronchial smooth muscle. α/β-Adrenergic agonists act by relaxing bronchial smooth muscle and increasing diameter of nasal passages. β-Adrenergic
agonists act by action on β
2
-receptors, which relaxes bronchial smooth muscle. Phosphodiesterase inhibitors act by blocking phosphodiesterase and increasing cAMP, which mediates smooth muscle relaxation in the respiratory system. Corticosteroids act by decreasing inflammation in the bronchial system. Leukotriene receptor antagonists decrease leukotrienes, and mast cell stabilizers decrease histamine; both act to decrease bronchospasm.
Antiasthmatics are used for bronchial asthma; bronchospasm associated with bronchitis, emphysema, or other obstructive pulmonary diseases; Cheyne-Stokes respirations; and prevention of exercise-induced asthma. Some products are used for rhinitis and other allergic reactions.
Persons with hypersensitivity, closed-angle glaucoma, tachydysrhythmias, and severe cardiac disease should not use some of these products.
Precautions:
Antiasthmatics should be used with caution in breastfeeding, pregnancy, hyperthyroidism, hypertension, prostatic hypertrophy, and seizure disorders.
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Inhaled product after shaking; exhale, place mouthpiece in mouth, inhale slowly, hold breath, remove, exhale slowly
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PO product with meals to decrease gastric irritation
The most common side effects are tremors, anxiety, nausea, vomiting, and irritation in the throat. The most serious adverse reactions are bronchospasm and dyspnea.
Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
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Activity intolerance
[uses]
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Ineffective airway clearance
[uses]
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Risk for injury
[adverse reactions]
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Deficient knowledge
[teaching]
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Noncompliance
[teaching]
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Respiratory function: vital capacity, forced expiratory volume, ABGs, lung sounds, heart rate and rhythm, aggravating and alleviating factors
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Storage of inhaled product in light-resistant container; do not expose to temps over 86° F (30° C)
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Gum, small sips of water for dry mouth
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Therapeutic response: decrease severity and number of asthma attacks; absence of dyspnea, wheezing
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To avoid hazardous activities; drowsiness or dizziness may occur with some products
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To obtain blood work as required; some products require blood levels to be drawn
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Avoid all OTC medications unless approved by provider
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To report side effects, including insomnia, heart palpitations, light-headedness; these side effects may occur with some products
cortisone
Anticholinergics inhibit the muscarinic actions of acetylcholine at receptor sites in the autonomic nervous system. Anticholinergics are also known as antimuscarinic products.
Anticholinergics are used for a variety of conditions: decreasing involuntary movements in parkinsonism (benztropine, trihexyphenidyl); bradydysrhythmias (atropine); nausea and vomiting (scopolamine); and as cycloplegic mydriatics (atropine, homatropine, scopolamine, cyclopentolate, tropicamide). Gastrointestinal anticholinergics are used to decrease motility (smooth muscle tone) in the GI, biliary, and urinary tracts and for their ability to decrease gastric secretions (propantheline, glycopyrrolate).
Persons with closed-angle glaucoma, myasthenia gravis, or GI/GU obstruction should not use some of these products.
Precautions:
Anticholinergics should be used with caution in patients who are geriatric, pregnant, or breastfeeding or in those with prostatic hypertrophy, congestive heart failure, or hypertension; use with caution in presence of high environmental temperature.
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Parenteral dose with patient recumbent to prevent postural hypotension
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With or after meals to prevent GI upset; may give with fluids other than water
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Parenteral dose slowly; keep in bed for at least 1 hr after dose; monitor vital signs
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After checking dose carefully; even slight overdose can lead to toxicity
The most common side effects are dry mouth, constipation, urinary retention, urinary hesitancy, headache, and dizziness. Also common is paralytic ileus.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Increased anticholinergic effects may occur when used with MAOIs and tricyclics and amantadine. Anticholinergics may cause a decreased effect of phenothiazines and levodopa.
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Decreased cardiac output
[uses]
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Constipation
[adverse reactions]
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Deficient knowledge
[teaching]
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I&O ratio; retention commonly causes decreased urinary output
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Urinary hesitancy, retention; palpate bladder if retention occurs
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Constipation; increase fluids, bulk, exercise if this occurs
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For tolerance over long-term therapy, dose may need to be increased or changed
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Mental status: affect, mood, CNS depression, worsening of mental symptoms during early therapy
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Storage at room temperature
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Hard candy, frequent drinks, sugarless gum to relieve dry mouth
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Therapeutic response: decreased secretions, absence of nausea and vomiting
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To avoid driving or other hazardous activities; drowsiness may occur
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To avoid OTC medication: cough, cold preparations with alcohol, antihistamines unless directed by prescriber
glycopyrrolate
Anticoagulants interfere with blood clotting by preventing clot formation.
Anticoagulants are used for deep venous thrombosis, PE, MI, open-heart surgery, disseminated intravascular clotting syndrome; atrial fibrillation with embolization, transfusion, and dialysis.
Persons with hemophilia and related disorders, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, blood dyscrasias, acute nephritis, and subacute bacterial endocarditis should not use these products.
Precautions:
Anticoagulants should be used with caution in alcoholism, geriatric patients, and pregnancy.
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At same time each day to maintain steady blood levels
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In abdomen between pelvic bone, rotate sites; do not massage area or aspirate when giving SUBCUT injection; do not pull back on plunger, leave in for 10 sec, apply gentle pressure for 1 min
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Without changing needles
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Avoiding all IM inj that may cause bleeding
The most serious adverse reactions are hemorrhage, agranulocytosis, leukopenia, eosinophilia, and thrombocytopenia, depending on the specific product. The most common side effects are diarrhea, rash, and fever.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Salicylates, corticosteroids, and nonsteroidal antiinflammatories will potentiate the action of anticoagulants. Anticoagulants may cause serious effects; check individual monographs.
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Risk for injury
[side effects]
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Deficient knowledge
[teaching]
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Ineffective cardiac tissue perfusion
[uses]
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Blood studies (Hct, platelets, occult blood in stools) q3mo
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Partial PT, which should be 1½-2 × control PPT daily, also APTT, ACT
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B/P; watch for increasing signs of hypertension
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Bleeding gums, petechiae, ecchymosis; black, tarry stools; hematuria
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Fever, skin rash, urticaria
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Needed dosage change q1-2wk
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Storage in tight container
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Therapeutic response: decrease of DVT
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To avoid OTC preparations that may cause serious product interactions unless directed by prescriber
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That product may be held during active bleeding (menstruation), depending on condition
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To use soft-bristle toothbrush to avoid bleeding gums; to avoid contact sports, use electric razor
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To carry emergency ID identifying product taken
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To report any signs of bleeding: gums, under skin, urine, stools
lepirudin