Mosby's 2014 Nursing Drug Reference (13 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Nonsteroidal antiinflammatories decrease prostaglandin synthesis by inhibiting an enzyme needed for biosynthesis.
Nonsteroidal antiinflammatories are used to treat mild to moderate pain, osteoarthritis, rheumatoid arthritis, and dysmenorrhea.
Persons with hypersensitivity, asthma, or severe renal/hepatic disease should not use these products.
Precautions:
Caution should be used in pregnancy, breastfeeding, children, geriatric patients, bleeding/GI/cardiac disorders, and hypersensitivity to other antiinflammatory agents.
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With food to decrease GI symptoms; however, best to take on empty stomach to facilitate absorption
The most serious adverse reactions are nephrotoxicity (dysuria, hematuria, oliguria, azotemia), blood dyscrasias, and cholestatic hepatitis. The most common side effects are nausea, abdominal pain, anorexia, dizziness, and drowsiness.
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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Deficient knowledge
[teaching]
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Impaired physical mobility
[uses]
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Noncompliance
[teaching]
•
Chronic pain
[uses]
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Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb, before treatment, periodically thereafter
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Audiometric, ophthalmic examination before, during, and after treatment
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For eye, ear problems: blurred vision, tinnitus; may indicate toxicity
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Storage at room temperature
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Therapeutic response: decreased pain, stiffness in joints; decreased swelling in joints; ability to move more easily
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To report blurred vision, ringing, roaring in ears; may indicate toxicity
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To avoid driving, other hazardous activities if dizziness, drowsiness occur, especially in geriatric patients
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To report change in urine pattern, increased weight, edema, increased pain in joints, fever, blood in urine; indicate nephrotoxicity
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That therapeutic effects may take up to 1 mo
piroxicam
sulindac
Opioid analgesics act by depressing pain impulse transmission at the spinal cord level by interacting with opioid receptors. Products are divided into opiates and nonopiates.
Most opioid analgesics are used to control moderate to severe pain and are used before and after surgery.
Hypersensitive reactions occur frequently. Check for sensitivity before administering. These products should be used cautiously if opiate addiction is suspected.
Precautions:
Caution must be used when these products are given to a person with an addictive personality because the possibility of addiction is so great. Also, they may worsen intracranial pressure. Persons with severe heart disease, hepatic/renal disease, respiratory conditions, or seizure disorders should be monitored closely for worsening condition.
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With antiemetic if nausea or vomiting occurs
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When pain is beginning to return; determine dosage interval by response
GI symptoms, including nausea, vomiting, anorexia, constipation, and cramps, are the most common side effects. Other common side effects include light-headedness, dizziness, and sedation. Serious adverse reactions such as respiratory depression, respiratory arrest, circulatory depression, and increased intracranial pressure may result but are less common and usually dose dependent.
Onset of action is immediate by IV route and rapid by IM and PO routes. Peak occurs from 1-2 hr, depending on route, with a duration of 2-8 hr. These agents cross the placenta and appear in breast milk.
Barbiturates, other opioids, hypnotics, antipsychotics, or alcohol can increase CNS depression when taken with opioids.
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Impaired gas exchange
[adverse reactions]
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Acute pain
[uses]
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I&O ratio; be alert for urinary retention, frequency, and dysuria; product should be discontinued if these occur
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Respiratory dysfunction: respiratory depression, rate, rhythm, character; notify prescriber if respirations are <12/min
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CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
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Allergic reactions: rash, urticaria
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Need for pain medication; use pain scoring
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Assistance with ambulation; patient should not be ambulating during product peak
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Therapeutic response: decrease in pain
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To report any symptoms of CNS changes, allergic reactions, or SOB
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That physical dependency may result when used for extended periods
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That withdrawal symptoms may occur, including nausea, vomiting, cramps, fever, faintness, anorexia
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To avoid alcohol and other CNS depressants
Salicylates have analgesic, antipyretic, and antiinflammatory effects. The analgesic and antiinflammatory activities may be mediated through the inhibition of prostaglandin synthesis. Antipyretic action results from inhibition of the hypothalamic heat-regulating center.
The primary uses of salicylates are relief of mild to moderate pain and fever and in inflammatory conditions such as arthritis, thromboembolic disorders, and rheumatic fever.
Hypersensitivity to salicylates is common. Check for sensitivity before administering. Persons with bleeding disorders, GI bleeding, and vit K deficiency should not use these products; salicylates increase PT. Children should not use these products; salicylates have been associated with Reye’s syndrome.
Precautions:
Caution is needed when salicylates are given to patients with anemia, hepatic/renal disease, and Hodgkin’s disease. Caution should also be exercised in pregnancy and breastfeeding.
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With food or milk to decrease gastric irritation; give 30 min before or 1 hr after meals with a full glass of water
The most common side effects are GI symptoms and rash. Serious blood dyscrasias and hepatotoxicity may result when used for long periods at high doses. Tinnitus or impaired hearing may indicate that blood salicylate levels are reaching or exceeding the upper limit of the therapeutic range.
Onset of action occurs in 15-30 min, with a peak of 1-2 hr and a duration up to 6 hr. These products are metabolized by the liver and excreted by the kidneys.
Increased effects of anticoagulants, insulin, methotrexate, heparin, valproic acid, and oral sulfonylureas may occur when used with salicylates. Aspirin may decrease serum concentrations of nonsteroidal antiinflammatory agents.
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Activity intolerance
[uses]
•
Impaired physical mobility
[uses]
•
Acute pain
[uses]
•
Chronic pain
[uses]
•
Ineffective thermoregulation
[uses]
•
Hepatic/renal studies: AST, ALT, bilirubin, creatinine, LDH, alk phos, BUN if patient is on long-term therapy since these products are metabolized and excreted by the liver and kidneys
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Blood studies: CBC, hematocrit, hemoglobin, and PT if patient is on long-term therapy because these products increase the possibility of bleeding and blood dyscrasias
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Hepatotoxicity: dark urine, clay-colored stools; yellowing of skin, sclera; itching, abdominal pain, fever, diarrhea, which may occur with long-term use
•
Ototoxicity: tinnitus; ringing, roaring in ears; audiometric testing is needed before and after long-term therapy
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Therapeutic response: decreased pain, fever
•
That blood glucose levels should be monitored closely if patient is diabetic
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Not to exceed recommended dosage; acute poisoning may result
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That therapeutic response takes 2 wk in arthritis
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To avoid use of alcohol; GI bleeding may result
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To notify prescriber of ringing in the ears or persistent GI pain
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To take with full glass of water to reduce risk of lodging in esophagus
Sedatives/hypnotics depress the CNS; some products at the cerebral cortex, others inhibit transmitters in the CNS.
Sedatives/hypnotics are used for the treatment of sleep disorders, seizures, muscle spasms, and alcohol withdrawal.
Persons with hypersensitivity reactions should not use these products.
Precautions:
Sedatives/hypnotics should be used cautiously in pregnancy (C) and breastfeeding.
•
Lowest possible dose for therapeutic result; adjust dose to response
The most common side effects are nausea and drowsiness. The most serious side effects are Stevens-Johnson syndrome, blood dyscrasias, and risk of dependency.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted by the kidneys.
Increased CNS depression may occur with other CNS depressants such as alcohol, opiates, antipsychotics, and antidepressants.
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Deficient knowledge
[teaching]
•
Noncompliance
[teaching]
•
Insomnia
[uses]
•
Mental status: affect, mood, behavioral changes, depression, confusion; seizure activity
•
Assistance with ambulation during beginning therapy if dizziness, ataxia occur
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Therapeutic response: ability to sleep throughout the night; absence or decreasing seizure activity
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That these products should only be used for short-term insomnia
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Not to drive or engage in other hazardous activities while taking these products
•
To avoid breastfeeding while taking these products
•
To avoid alcohol or other CNS depressants because drowsiness will increase
•
That some of the products take 2 nights to be effective
•
To report side effects, adverse reactions to health care provider
•
To use exactly as prescribed, at regular intervals
clorazepate
flurazepam
chloral hydrate
dexmedetomidine
Most skeletal muscle relaxants inhibit synaptic responses in the CNS by stimulating receptors and decreasing neurotransmission, decreasing pain and spasticity.
Skeletal muscle relaxants are used for musculoskeletal disorders with pain or spasticity related to spinal cord injuries.
Persons with hypersensitivity should not use these products.
Precautions:
Skeletal muscle relaxants should be used cautiously in pregnancy (C), peptic ulcer, renal/hepatic disease, stroke, seizure disorder, diabetes, breastfeeding, and geriatric patients.
•
When pain is beginning to return, not after pain is severe
The most common side effects are dizziness, weakness, fatigue, drowsiness, and headache. Some products can cause seizures, CV collapse, and severe CNS depression.
Pharmacokinetics vary widely among products. Check individual monographs for specific information.
CNS depressants used with skeletal muscle relaxants may lead to increased CNS depression.
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Risk for injury
[adverse reactions]
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Deficient knowledge
[teaching]
•
Impaired physical mobility
[uses]
•
Acute pain
[uses]
•
Chronic pain
[uses]
•
Pain: character, location, duration, alleviating/aggravating factors
•
Storage in dry area, away from heat and sunlight
•
Therapeutic response: decreased pain or spasticity
•
Not to use with other CNS depressant unless prescriber approved
•
That many products require 1-2 mo of treatment for full effect
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To avoid hazardous activities until response to medication is known
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That most products should not be discontinued quickly but tapered over 1-2 wk