Mosby's 2014 Nursing Drug Reference (10 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Antituberculars act by inhibiting RNA or DNA or by interfering with lipid and protein synthesis, thereby decreasing tubercle bacilli replication.
Antituberculars are used for pulmonary tuberculosis.
Persons with severe renal disease or hypersensitivity should not use these products.
Precautions:
Antituberculars should be used with caution with pregnancy, breastfeeding, and hepatic disease.
•
For some of these agents: on empty stomach, 1 hr before meals (only for isoniazid and rifampin) or 2 hr after meals
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Antiemetic if vomiting occurs
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After C&S is completed; monthly to detect resistance
They vary widely among products. Most products can cause nausea, vomiting, anorexia, and rash. Serious adverse reactions include renal failure, nephrotoxicity, ototoxicity, and hepatic necrosis.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
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Risk for infection
[uses]
•
Risk for injury
[adverse reactions]
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Deficient knowledge
[teaching]
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Noncompliance
[teaching]
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Signs of anemia: Hct, Hgb, fatigue
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Hepatic studies weekly: ALT, AST, bilirubin
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Renal status before, monthly: BUN, creatinine, output, specific gravity, urinalysis
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Hepatic status: decreased appetite, jaundice, dark urine, fatigue
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Therapeutic response: decreased symptoms of TB, culture negative
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That compliance with dosage schedule and duration is necessary
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That scheduled appointments must be kept; relapse may occur
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To avoid alcohol while taking product
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To report flulike symptoms: excessive fatigue, anorexia, vomiting, sore throat; unusual bleeding, yellowish discoloration of skin/eyes
Antitussives act by suppressing the cough reflex by direct action on the cough center in the medulla. Expectorants act by liquefying and reducing the viscosity of thick, tenacious secretions.
Antitussives/expectorants are used to treat cough occurring in pneumonia, bronchitis, TB, cystic fibrosis, and emphysema; as an adjunct in atelectasis (expectorants); and nonproductive cough (antitussives).
Some products are contraindicated in hypothyroidism, pregnancy, and breastfeeding.
Precautions:
Some products should be used cautiously in asthmatic, geriatric, and debilitated patients.
•
Decreased dose to geriatric patients; their metabolism may be slowed
The most common side effects are drowsiness, dizziness, and nausea.
Onset, peak, and duration vary widely among products. Some products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
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Ineffective airway clearance
[uses]
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Deficient knowledge
[teaching]
•
Cough: type, frequency, character (including sputum)
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Increased fluids to liquefy secretions
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Humidification of patient’s room
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Therapeutic response: absence of cough
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To avoid driving, other hazardous activities until patient is stabilized on this medication
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To avoid smoking, smoke-filled rooms, perfumes, dust, environmental pollutants, cleaners that increase cough
Antivirals act by interfering with DNA synthesis that is needed for viral replication.
Antivirals are used for mucocutaneous herpes simplex virus, herpes genitalis (HSV-1, HSV-2), varicella infections, herpes zoster, and herpes simplex encephalitis.
Persons with hypersensitivity or immunosuppressed individuals should not use these products.
Precautions:
Antivirals should be used cautiously in renal/hepatic disease, pregnancy, and breastfeeding.
•
Increased fluids to 3 L/day to decrease crystalluria when given IV
The most common side effects are nausea, vomiting, anorexia, headache, and diarrhea. The most serious adverse reactions are nephrotoxicity and blood dyscrasias.
Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.
Interactions vary widely among products. Check individual monographs for specific information.
•
Risk for infection
[uses]
•
Risk for injury
[adverse reactions]
•
Deficient knowledge
[teaching]
•
For signs of infection, anemia
•
Patients with a compromised renal system; because product is excreted slowly in poor renal system function, toxicity may occur rapidly
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Renal studies: urinalysis, BUN, serum creatinine or decreased CCr may indicate nephrotoxicity; I&O ratio; report hematuria, oliguria, fatigue, weakness; check for protein in the urine during treatment
•
C&S before treatment, agent may be taken as soon as culture is taken; repeat C&S after treatment
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, agent should be discontinued
•
Skin reactions: rash, urticaria, itching
•
Hepatic studies: AST, ALT
•
Blood studies: WBC, RBC, Hct, Hgb, bleeding time; blood dyscrasias
•
Storage at room temperature for up to 12 hr after reconstitution
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Therapeutic response: absence or control of infection
•
To report sore throat, fever, fatigue; may indicate superinfection
•
That medication does not prevent infecting others or cure condition but controls symptoms
•
That product must be taken around the clock in equal intervals to maintain blood levels for duration of therapy
•
To notify prescriber of side effects such as bruising, bleeding, fatigue, malaise; may indicate blood dyscrasias
β-Blockers are divided into selective and nonselective blockers. Selective β-blockers competitively block stimulation of β
1
-receptors in cardiac smooth muscle; these products produce chronotropic and inotropic effects. Nonselective blockers produce a fall in blood pressure without reflex tachycardia or reduction in heart rate through a mixture of β-blocking effects; elevated plasma renins are reduced.
β-Blockers are used for hypertension, ventricular dysrhythmias, and prophylaxis of angina pectoris.
Hypersensitive reactions may occur, and allergies should be identified before these products are given. β-Adrenergic blockers should not be used in heart block, congestive heart failure, or cardiogenic shock.
Precautions:
β-Blockers should be used with caution in geriatric patients, or in renal/thyroid disease, COPD, coronary artery disease, diabetes mellitus, pregnancy, and asthma.
•
PO before meals and at bedtime; tabs may be crushed or swallowed whole
•
Reduced dosage in renal dysfunction
The most common side effects are orthostatic hypotension, bradycardia, diarrhea, nausea, and vomiting. Serious adverse reactions include blood dyscrasias, bronchospasm, and congestive heart failure.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver, with metabolites excreted in urine, bile, and feces.
Interactions vary widely among products. Check individual monographs for specific information.
•
Decreased cardiac output
[uses]
•
Diarrhea
[adverse reactions]
•
Impaired gas exchange
[adverse reactions]
•
Ineffective cardiac tissue perfusion
[uses]
•
Renal studies: protein, BUN, creatinine; watch for increased levels that may indicate nephrotic syndrome; obtain baselines in renal/hepatic function studies before beginning treatment
•
I&O, weight daily
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B/P during beginning treatment and periodically thereafter; pulse q4hr, note rate, rhythm, quality
•
Apical/radial pulse before administration; notify prescriber of significant changes
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Edema in feet and legs daily
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Therapeutic response: decrease in B/P in hypertension; decreased B/P, edema, moist crackles in congestive heart failure
•
To comply with dosage schedule even if feeling better
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
•
To report bradycardia, dizziness, confusion, depression, and fever
•
To take pulse at home; advise when to notify prescriber
•
To comply with weight control, dietary adjustment, modified exercise program
•
To wear support hose to minimize effects of orthostatic hypotension
•
Not to discontinue product abruptly; taper over 2 wk; may precipitate angina
β
1
-receptor blockers
acebutolol
nebibolol
β2-receptor blockers
Bone resorption inhibitors are divided into biphosphonates and selective estrogen receptor modulators. Biphosphonates act by absorbing calcium phosphate crystals in bone and may directly block dissolution of hydroxyapatite crystals of bone, inhibiting normal and abnormal bone resorption and mineralization. Selective estrogen receptor modulators act by reducing resorption of bone and decreasing bone turnover; medicated through estrogen receptor binding.
Bone resorption inhibitors are used for prevention and treatment of osteoporosis in postmenopausal women, treatment of Paget’s disease, and treatment of osteoporosis in men.
Persons developing hypersensitive reactions or those with hypocalcemia should not use these products.
Precautions:
Bone resorption inhibitors should be used cautiously in pregnancy, breastfeeding, hepatic/renal disease, geriatric patients, and some GI disorders.
•
For 6 months or more in Paget’s disease
The most common side effects are nausea, vomiting, headache, bone pain, and rash.
Onset, peak, and duration vary widely among products. Most products are taken up by the bones and excreted by the kidneys.
Interactions vary widely among products. Check individual monographs for specific information.
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Risk for injury
[uses, adverse reactions]
•
Deficient knowledge
[teaching]
•
For reason for use and expected outcome
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For bone density test; hormonal status (women) before starting treatment and thereafter
•
For hypercalcemia: paresthesia, twitching, laryngospasm; Chvostek’s, Trousseau’s signs
•
Storage at room temperature
•
Therapeutic response: increase in bone mass, absence of fractures
•
To remain upright for at least 30 min after taking, to prevent esophageal irritation
•
To teach all aspects of product usage
•
To use weight-bearing exercise to increase bone density