Mosby's 2014 Nursing Drug Reference (8 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Antihypertensives are divided into angiotensin-converting enzyme (ACE) inhibitors, β-adrenergic blockers, calcium channel blockers, centrally acting adrenergics, diuretics, peripherally acting antiadrenergics, and vasodilators. β-Blockers, calcium channel blockers, and diuretics are discussed in separate sections. Angiotensin-converting enzyme inhibitors act by selectively suppressing renin-angiotensin I to angiotensin II; dilation of arterial and venous vessels occurs. Centrally acting adrenergics act by inhibiting the sympathetic vasomotor center in the CNS that reduces impulses in the sympathetic nervous system; B/P, pulse rate, and cardiac output decrease. Peripherally acting antiadrenergics inhibit sympathetic vasoconstriction by inhibiting release of norepinephrine and/or depleting norepinephrine stores in adrenergic nerve endings. Vasodilators act on arteriolar smooth muscle by producing direct relaxation or vasodilation; a reduction in B/P, with concomitant increases in heart rate and cardiac output, occurs.
Antihypertensives are used for hypertension. Some products are used for heart failure not responsive to conventional therapy. Some products are used in hypertensive crisis, angina, and for some cardiac dysrhythmias.
Hypersensitive reactions may occur, and allergies should be identified before these products are given. Antihypertensives should not be used in children or in patients with heart block.
Precautions:
Antihypertensives should be used with caution in geriatric and di
alysis patients and in the presence of hypovolemia, leukemia, and electrolyte imbalances.
The most common side effects are hypotension, bradycardia, tachycardia, headache, nausea, and vomiting. Side effects and adverse reactions may vary widely between classes and specific products.
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.
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Decreased cardiac output
[uses]
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Diarrhea
[adverse reactions]
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Impaired gas exchange
[adverse reactions]
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Ineffective cardiac tissue perfusion
[uses]
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Blood studies: neutrophil; decreased platelets occur with many of the products
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Renal studies: protein, BUN, creatinine; watch for increased levels that may indicate nephrotic syndrome; obtain baselines in renal and hepatic function studies before beginning treatment
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Edema in feet and legs daily
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Allergic reaction, including rash, fever, pruritus, urticaria: product should be discontinued if antihistamines fail to help
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Symptoms of congestive heart failure: edema, dyspnea, wet crackles, B/P
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Renal symptoms: polyuria, oliguria, frequency
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Supine or Trendelenburg position for severe hypotension
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Therapeutic response: decrease in B/P in hypotension; decreased B/P, edema, moist crackles in congestive heart failure
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To comply with dosage schedule, even if feeling better
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To rise slowly to sitting or standing position to minimize orthostatic hypotension
Antiinfectives are divided into several groups, which include but are not limited to penicillins, cephalosporins, aminoglycosides, sulfonamides, tetracyclines, monobactam, erythromycins, and quinolones. These products act by inhibiting the growth and replication of susceptible bacterial organisms.
Antiinfectives are used for infections of susceptible organisms. These products are effective against bacterial, rickettsial, and spirochetal infections.
Hypersensitivity reactions may occur. Allergies should be identified before these products are given. Cross-sensitivity can occur between products of different classes (penicillins and cephalosporins). Many persons allergic to penicillins are also allergic to cephalosporins.
Precautions:
Antiinfectives should be used with caution in persons with renal/hepatic disease.
•
For 10-14 days to ensure organism death, prevention of superinfection
•
Product after C&S completed; product may be taken as soon as C&S is drawn
The most common side effects are nausea, vomiting, and diarrhea. Adverse reactions include bone marrow depression and anaphylaxis.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver. Metabolites are excreted in urine, bile, and feces.
Interactions vary widely among products. Check individual monographs for specific information.
•
Diarrhea
[adverse reactions]
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Risk for infection
[uses]
•
Nephrotoxicity: increased BUN, creatinine
•
Blood studies: AST, ALT, CBC, Hct, bilirubin; test monthly if patient is on long-term therapy
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Bowel pattern daily; if severe diarrhea occurs, product should be discontinued
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Urine output; if decreasing, notify prescriber; may indicate nephrotoxicity
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Allergic reaction: rash, fever, pruritus, urticaria; product should be discontinued
•
Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily
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Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
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Therapeutic response, including absence of fever, fatigue, malaise, draining wounds
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To comply with dosage schedule, even if feeling better
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To report sore throat, bruising, bleeding, joint pain; may indicate blood dyscrasias (rare)
oxacillin
Antilipidemics are divided into three categories or subclassifications; HMG-CoA reductase inhibitors (statins), bile acid sequestrants, and miscellaneous products. The HMG-CoA reductase inhibitors work by reduction of an enzyme that is responsible for the beginning step in cholesterol production. Bile acid sequestrants work by binding cholesterol in the GI system. The miscellaneous products work by various actions.
Primary hypercholesterolemia in individuals as an adjunct with other lifestyle changes.
Persons breastfeeding (some products) or those with hypersensitivity to any product or severe hepatic disease should not take these products. Antilipidemics are identified as pregnancy category X on some products.
Precautions:
Some products are identified as pregnancy category C.
•
As directed by health care provider; times will vary with medication used
The most common side effects are headache, dizziness, fatigue, insomnia, peripheral edema, dysrhythmias, sinusitis, pharyngitis, abdominal pain, diarrhea, constipation, flatulence, and back pain.
Pharmacokinetics and pharmacodynamics vary with each product.
Interactions vary widely among products. Check individual monographs for specific information.
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Constipation
[adverse reactions]
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Diarrhea
[adverse reactions]
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Deficient knowledge
[teaching]
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Noncompliance
[teaching]
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Obtain a diet and lifestyle history, including exercise, smoking, alcohol, and stress-related activities
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Protection from sunlight and heat
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Therapeutic response: decrease in triglycerides and LDL cholesterol levels
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All aspects of medication use
•
To combine medication with lifestyle changes, including low-cholesterol diet, decreasing LDL in diet; avoid smoking, alcohol, and sedentary daily routine
Antineoplastics are divided into alkylating agents, antimetabolites, antibiotic agents, hormonal agents, and miscellaneous agents. Alkylating agents act by cross-linking strands of DNA. Antimetabolites act by inhibiting DNA synthesis. Antibiotic agents act by inhibiting RNA synthesis and by delaying or inhibiting mitosis. Hormones alter the effects of androgens, luteinizing hormone, follicle-stimulating hormone, and estrogen by changing the hormonal environment.
Antineoplastics uses vary widely among products and classes of products. They are used to treat leukemia, Hodgkin’s disease, lymphomas, and other tumors throughout the body.
Hypersensitive reactions may occur, and allergies should be identified before these products are given. Also, persons with severe hepatic/renal disease should not use these products unless the benefits outweigh the risks.
Precautions:
Persons with bleeding, severe bone marrow depression, or renal/hepatic disease should be watched closely.
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Checking IV site for irritation; phlebitis
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EPINEPHrine for hypersensitivity reaction
•
Antibiotics for prophylaxis of infection
Most products cause thrombocytopenia, leukopenia, and anemia. If these reactions occur, the product may have to be stopped until the problem is corrected. Other side effects include nausea, vomiting, glossitis, and hair loss. Some products also cause hepatotoxicity, nephrotoxicity, and cardiotoxicity.
Onset, peak, and duration vary widely among
products. Most products cross the placenta and are excreted in breast milk and in urine.
Toxicity may occur when used with other antineoplastics or radiation.
•
Risk for infection
[adverse reactions]
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Imbalanced nutrition: less than body requirements
[adverse reactions]
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Impaired oral mucous membrane
[adverse reactions]
•
CBC, differential, platelet count weekly; withhold product if WBC is <4000/mm
3
or platelet count is <75,000/mm
3
; notify prescriber of results
•
Renal function studies: BUN, creatinine, serum uric acid, and urine CCr before and during therapy
•
I&O ratio; report fall in urine output of 30 ml/hr
•
Monitor temp q4hr (may indicate beginning infection)
•
LFTs before and during therapy (bilirubin, AST, ALT, LDH), monthly, or as needed
•
Bleeding, including hematuria, guaiac, bruising or petechiae, mucosa, or orifices q8hr; obtain prescription for viscous Xylocaine (lidocaine)
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Yellowing of skin, sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
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Edema in feet, joint pain, stomach pain, shaking
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Inflammation of mucosa, breaks in skin
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Strict asepsis, protective isolation if WBC levels are low
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Comprehensive oral hygiene, using careful technique and soft-bristle brush
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Therapeutic response: decreased tumor size
•
To report signs of infection, including increased temp, sore throat, malaise
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To report signs of anemia, including fatigue, headache, faintness, SOB, irritability
•
To report bleeding; to avoid use of razors or commercial mouthwash
chlorambucil
decitabine
nilutamide
alemtuzumab
cabazitaxel
interferon alfa-2b
sipuleucel-T