ࡱ>  @ Cbjbj{{ +k;1aaa8bDVbfefefefefeAfAfAf$ Rr%fAfAfff%fefe:uuuf fefeufuuxxfeZe ܝaqpx#z P0x,":r:"xx" yAfUfucf ofSAfAfAf%%^atuXaMost Commonly Used Drugs In Medical Care By Category CategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsBP AgentsACE Inhibitors CV Captopril Enalapril LisinoprilCapoten Vasotec Prinivil Cough hypotension angioedema agranulocytosis *Obtain BP before administering-hold typically if SBP <90 *Change position slowly-especially with elderly to prevent orthostatic changes *Monitor for decreased WBC count, hyperkalemia as well as liver function, and GFR, creatinine (metabolized by liver-excreted by kidneys)Beta blockers CV Atenolol Metoprolol PropranololTenormin Lopressor Inderal Fatigue, weakness, bradycardia, CHF, pulmonary edema *Obtain BP and HR before administering-hold typically if SBP <90. HR <60 *Change position slowly-especially with elderly to prevent orthostatic changes *Contraindicated in worsening CHF, bradycardia of heart blockuse with caution in diabetes, liver disease Ca+ Channel BlockersCV Amlodipine Diltiazem Nifedipine Verapamil Norvasc Cardizem Procardia Calan peripheral edema, Cardiac arrythmias, CHF*Change position slowly-especially with elderly to prevent orthostatic changes *Measure I&O closely and fluid status due to potential for edema *Monitor liver and kidney function (metabolized in liver-excreted by kidneys) *Obtain BP and HR before administering-hold typically if SBP <90. HR <60CategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital Assessments Vaso-dilatorsCV Hydralazine Isosorbide Nitroglycerine Apresoline Isordil Tridil Dizziness, headache, hypotension, tachycardia*Tolerance common and serious problem with long acting nitrates. Nitrates lose their effectiveness if transdermal patches remain on continually. Patches must be taken off at night and then reapplied in the morning *Contraindicated if client taking any erectile dysfunction meds as these are a similar nitrate that improves blood circulation to the penis-synergistic effect can cause dramatic hypotensionCholesterol Binding AgentsStatinsCV Lovastatin rosuvastatin Simvastin AtorvastatinMevacor Crestor Zocor Lipitor Abd. Cramps, constipation, diarrhea, heartburn, rashes Rhabdomyolosis*give w/wo food *can cause liver injury/damage-watch AST-alk phos, bili levels closely *can cause muscle injury/damage. If CPK elevated DC useHeart Rhythm StabilizersClass III Antiarryth.CV Amiodarone Cordorone Dizziness, fatigue, malaise, ataxia, bradycardia Pulmonary fibrosis*watch for QT prolongation-can lead to VT/VF with IV *assess HR before giving-hold if <60 with IV *can cause pulmonary toxicity with chronic use-assess for crackles, diminished breath sounds, fatigue, pleuritic chest pain *assess for neurotoxicity (ataxia, muscle weakness, tingling in fingers/toes, tremors) *assess for signs of thyroid dysfunction (lethargy, weight gain, edemaHYPOTHYROIDISM or tachycardia, weight loss, nervousness-HYPERTHYROIDISM) *monitor liver labs (AST-ALT-bili) and throid labs (T3-T4) Digitalis CV DigoxinLanoxinFatigue, bradycardia, anorexia, N&V arrythmias*Apical pulse for 1 minute before giving-hold if <60 *increases fall risk for elderly-assess closely *monitor K+, Mg+, Ca+ levels closely-if these are low more likely to become dig. toxic. Elderly also more likely to be dig. toxic *assess serum levels of digoxin (norm 0.5-2.0 ng/ml) *assess for toxicity: abd. pain, anorexia, N&V, bradycardia, visual changesCategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsDiuretics Loop CV Furosemide Lasix Dehydration, hypovolemia, hypokalemia, hyponatremia, hypomagnesemia*Change position slowly-especially with elderly to prevent orthostatic changes *Obtain BP before administering-hold typically if SBP <90 *Monitor sodium and K+ levels closely as well as GFR and creatinine *assess for signs of hypokalemia (weakness-fatigue-increased PVCs on cardiac monitor)K+ sparing Spironlactone Aldactone hyperkalemia*Aldactone and ACE inhibitors can cause resultant hyperkalemia *If on Aldactone-make sure does not use potassium based salt substitutes or foods rich in K+ Thiazides HydrochlorothiazideHCTZhypokalemia*Monitor BP, I&O, daily weight and for presence of edema *If on digoxin, assess closely for signs of dig. Toxicity since they are at higher risk of developing because of the K+ depleting effects of the diuretic Monitor K+, Na+, Mg+, and creatinine levels closelyAnti-CoagulantsAnti-CoagulantBlood Warfarin Coumadin Bleeding (GI) most common*assess for bleeding: tarry black, or maroon stools, nosebleeds, bruising, or hematuria *monitor Hgb, INR (therapeutic range is 2-3 for anticoagulation) *excreted by liver-assess AST/ALT  Anti-CoagulantHeparin (IV/SQ) Lovenox (SQ)Heparin LovenoxAnemia, thrombocytopenia Bleeding* assess for bleeding: tarry black, or maroon stools, nosebleeds, bruising, or hematuria *administer SQ in abd, NOT proximal to umbilicus *assess for decreased platelets (heparin induced thrombocytopenia-HIT)CategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsAnalgesic Narcotics CNS Hydromorphone Morphine Oxycodone CodeineDilaudid MS Contin Oxycontin CodeineConfusion, sedation, hypotension, constipation Resp. Depression*assess BP-HR-R and LOC closely after giving-especially when drug is peaking. *elderly more sensitive to effects of opiod analgesics and develop SE and resp. complications more frequently *assess bowel function closely due to risk of constipation *tolerance develops w/LT use-will need higher doses to achieve adequate pain reliefCombo CNS oxycodone-acetaminophen hydrocodone-acetaminophen codeine-acetaminophenPercocet Vicodin Tylenol #3Confusion, sedation, hypotension, constipation Resp. Depression*assess pain relief to med 1 hour (PEAK) after giving po *assess BP-HR-R and LOC closely after giving-especially when drug is peaking. *elderly more sensitive to effects of opiod analgesics and develop SE and resp. complications more frequently *assess bowel function closely due to risk of constipation *tolerance develops w/LT use-will need higher doses to achieve adequate pain reliefNon-narcoticCNS Acetaminophen AspirinTylenol ASALiver failure, toxicity w/OD or high doses*max. daily dose is 4000 mg. Liver damage can result if reaches this level or is malnourished or abuse ETOH more likely to be toxic *monitor liver labs (AST-ALT-bili-PT/INR) with Tylenol & Aspirin *Give Aspirin w/food to minimize risk of ulcer/GI bleed Non-steroidal anti-inflammatory (NSAIDSCNS Ibuprofen Indomethacin Naproxsyn KetoralocMotrin/Advil Indocin Aleve Toradol Headache, constipation, N&V GI Bleeding, Hepatitis*give w/food to minimize risk of ulcer/GI bleed * assess for GI bleeding: tarry black, or maroon stools, lightheaded, tachycardia *elderly are at higher risk to develop GI bleeding *monitor liver labs (AST-ALT-bili-PT/INR) *assess response to pain med 1-2 hours after giving *increases bleeding times. Be sure to DC before surgery. Effects last 24 hours after last doseCategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsAnti-anxiety Anti-anxietyCNS Alprazolam Diazepam Lorazepam Xanax Valium AtivanDizziness, drowsiness, lethargy*assess closely for dizziness, drowsiness with first doses *CNS side effects incr. w/elderlyAnti-convulsantAnti-convulsantCNS Carbamazepine Gabapentin Levetiracetam PhenytoinTegretol Neurontin Keppra DilantinDrowsiness, ataxia, weakness*Neurontin commonly used for neuropathic pain or chronic pain syndromesAnti-depressantSelective Serotonin Reuptake Inhibitors (SSRI)CNS Citalopram Fluoxetine ParoxetineCelexa Prozac PaxilDrowsiness, headache, insomnia, nervousness, tremor*requires 2 weeks to have physiologic effects when new medication *assess for increased suicidal tendencies with new therapyAnti-ParkinsonCNSCarbidopa-LevodopaSinemet N&V, involuntary movements*OK to give w/food to minimize GI side effects *assess for Parkinsons effects improving: rigidity, tremors, shuffling gait, droolingAnti-psychoticCNS Quetiapine HaloperidolSeroquel HaldolConstipation, dry mouth, blurred vision, extrapyramidal reactions (EPSE)*OK to give w/food to minimize GI irritation *assess mental status (mood-orientation-behavior) before and after giving *monitor for increased restlessness-agitation after first dose. This is a side effect *monitor for EPSE-these are Parkinson like: difficulty/speaking or swallowing, loss of balance, pill rolling, rigidity, shuffling gait and tremors *monitor for dystonic reaction: muscle spasm, especially in neck causing head to stay fixed on affected side, weakness of extremitiesGastric Acid ReducersProton Pump Inhibitors (PPI)GI Pantoprazole OmeprazoleProtonix PrilosecAbdominal pain*may give w/without regards to food *assess frequently for epigastric/abd pain and blood in stool, emesis Histamine Blockers (H2)GI Cimetadine Famotidine Ranitidine Tagamet Pepcid ZantecConfusion, Arrythmias *give w/food to prolong effects *assess frequently for epigastric/abd pain and blood in stool, emesisCategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsAnti-NauseaGI Ondansetron Prochlorperazine Promethazine Zofran Compazine PhenerganHeadache, constipation, diarrhea, extrapyramidal reactions (compazine)*may develop EPSE.Assess for difficulty/speaking or swallowing, loss of balance, pill rolling, rigidity, shuffling gait and tremors *with Compazine monitor for sedation and dystonic reaction: muscle spasm, especially in neck causing head to stay fixed on affected side, weakness of extremitiesLaxativesGIDocousate Sennosides Psyllium Colace Senakot MetamucilAbd cramps, diarrhea* assess GI system carefully for abd distention, presence of bowel sounds, and color, consistency and amount of stool *hold if has recent pattern of loose stoolsAnti-Asthmatics & COPDBronchial dilatorsResp.Albuterol Albuterol- ipatropiumVentolin Combivent Nervousness, restlessness, tremor, chest pain, palpitations*assess breath sounds, pulse and BP before and after giving. Note amount, color and character of any sputum *inhaled albuterol onsets in 5-15 and peaks in 1 hourBronch. Dilator & Steroid ComboResp.Fluticasone- salmeterolAdvairHeadache, nervousness*assess breath sounds, pulse and BP before and after giving. Note amount, color and character of any sputum Inhaled SteroidsResp.Triamcinalone Fluticasone Azmacort Flovent Headache, pharyngitis, flu like symptoms*monitor resp. status and breath sounds *may cause increased serum and urine glucose levels due to steroid effect-monitor as neededAnti-InfectivesAnti-fungalSystemic Fluconazole Nystatin Diflucan MycostatinLiver toxicity*obtain any specimen cultures before giving first dose but do need results *excreted by the kidneys so monitor renal (creatinine) closely CephalosporinSystemic CephalexinKeflexDiarrhea Colitis, seizures *obtain any specimen cultures before giving first dose but do need results *can give w/wo food *assess for allergic response of any kind (rash-itching-hives-anaphylactic-resp. distress) *determine if has allergy to penicillin, give w/caution as there is risk for cross sensitivity to penicillin *continue to assess for response to infection (temp-appearance of wound-WBC/neutrophils)CategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsPenicillinsSystemic Amoxicillin Ampicillin Amoxil Polycillin Rashes, diarrhea Seizures, allergic reactions, colitis*obtain any specimen cultures before giving first dose but do need results *can give w/wo food *assess for allergic response of any kind (rash-itching-hives-anaphylactic-resp. distress) *determine if has allergy to cephalosporins, give w/caution as there is risk for cross sensitivity to cephalosporins *continue to assess for response to infection (temp-appearance of wound-WBC/neutrophils)SulfonamidesSystemicSulfamethoxazole & trimethoprimBactrimEpigastric pain, N&V, itching, rash*obtain any specimen cultures before giving first dose but do need results *give on empty stomach with full glass of water *given primarily for urinary tract infection-assess response (fever-ongoing painful/burning urination) *assess for allergic response of any kind (rash-itching-hives-anaphylactic-resp. distress) TetracyclinesSystemicDoxycycline Tetracycline Doxy TetracynDiarrhea, N&V, light sensitivity*obtain any specimen cultures before giving first dose but do need results *give on empty stomach with full glass of water *assess for allergic response of any kind (rash-itching-hives-anaphylactic-resp. distress)Steroids Systemic Dexamethasone Hydrocortisone Prednisone Decadron Solu-cortef Deltasone Depression, hypertension, anorexia, nausea, bruising *give orally w/meals to avoid GI irritation *causes hyperglycemia-monitor glucose levels closely especially if diabetic *decreases immune response and WBC count: assess closely for signs of infection *decreases serum K+levels and increases Na+. Monitor these labs closely *assess for signs of adrenal insufficiency that can cause hypotension, weight loss, weakness, N&V, confusion, peripheral edema *monitor I&O and daily weights for these reasonsCategoryClassBody System ImpactedGeneric NameBrand NameMost Common Side Effects SEVERENursing Considerations and Vital AssessmentsThyroid HormoneSystemic LevothyroxineSynthroid Usually seen only when excessive doses cause hyperthyroid symptoms*give on empty stomach in the morning *assess apical pulse and BP prior to giving periodically *monitor thyroid function tests (T3-T4-TSH)Muscle-skeletal AgentsArthritisJoints LeflunomideCerebrexDizziness, drowsiness, rash, ataxia*assess range of motion and degree of swelling and pain in affected joint GoutJoints Allopurinol ColchicineAlloprim Colchicine Rash-Allopurinol Diarrhea, N&V-colchicine*give with meals to minimize gastric irritation *monitor for joint pain and swellingMuscle relaxantsMuscle Cyclobenzaprine methocarbamolFlexeril RobaxinDizziness, drowsiness, dry mouth,*assess for pain, muscle stiffness and range of motion before and periodically throughout therapy *monitor elderly closely for increased sedation and weaknessK+ ReplaceSystemicPotassium ChlorideK-durAbd. 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