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Critical care clinical
wslaught

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Analgesics (4)


  • acetaminophen (Tylenol)
  • hydrocodone & acetaminophen (Norco)
  • morphine sulfate (Morphine)
  • Ketorolac (Toradol)



Drugs for the cardiovascular system (9)


  • aspirin
  • heparin
  • warfarin (Coumadin)
  • hydralazine
  • lisinopril
  • metoprolol
  • enalapril
  • furosemide (Lasix)
  • hydrochlorothiazide



Drugs for glucose (5)


  • metformin
  • aspart
  • NPH
  • lantus
  • regular



Drugs for infection (4)


  • levofloxacin
  • vancomycin
  • metronidazole
  • ceftriaxone



Drugs for the GI tract (4)


  • protonix
  • pepcid
  • zofran
  • reglan



Drugs for the respiratory system (3)


  • albuterol
  • ipratropium
  • flucatisone and salmeterol



Immune modulating drugs (3)


  • prednisone
  • cellcept
  • rapamune



acetaminophen
  • drug class
  • MOA



  • 2nd gen NSAID - analgesic and antipyretic properties
  • inhibits COX in the CNS, which decreases prostaglandin synthesis in CNS



acetaminophen
  • expected main side effects



  • hematologic: hemolytic anemia, thrombocytopenia, neutropenia, leukopenia, pancytopenia
  • hepatic: jaundice, hepatotoxicity
  • skin: rash, urticaria
  • other: hypersensitivity rxn



acetaminophen
  • nursing considerations



  • alcohol use increases risk of hepatotoxicity
  • concurrent use with warfarin may increase risk of bleeding
  • s/s of acute toxicity and overdose are n/v, anorexia, malaise, diaphoresis, RUQ pain or tenderness, elevated bilirubin and hepatic enzyme levels



norco
  • drug class
  • MOA



  • opioid agonist/nonopioid analgesic combo
  • blocks release of inhibitory neurotransmitters, altering perception and emotional response to pain



norco
  • expected main side effects



  • CNS depression: bradycardia, drowsiness, sedation, repsiratory depression, orthostatic hypotension



norco
  • main nursing considerations



  • prolonged use may lead to physical dependence
  • since drug may cause drowsiness, pt should avoid driving and other hazardous activities until CNS effects are known
  • have pt move slowly when sitting or standing up to avoid syncope



morphine
  • drug class
  • MOA



  • opioid analgesic
  • interacts with opioid receptor sites, primarily in the limbic system, thalamus and spinal cord; this interaction alters neurotransmitter release, altering perception of and tolerance for pain



morphine
  • expected main side effects



  • respiratory depression
  • constipation
  • orthostatic hypotension
  • urinary retention
  • cough suppression
  • euphoria



morphine
  • nursing considerations



  • monitor VS - notify MD if RR<10/min
  • monitor I/O - stay alert for urinary retention
  • monitor bowel activity and intervene as appropriate



ketorolac (Toradol)
  • drug class
  • MOA



  • nonaspirin, 1st gen NSAID
  • reversibly inhibits COX and also acts as a potent inhibitor of platelet aggregation



ketorolac (Toradol)
  • expected main side effects



  • gastric ulceration and perforation
  • increased bleeding time
  • renal impairment



ketorolac (Toradol)
  • nursing considerations



  • drug is only meant for short term pain mgmt
  • pt should avoid aspirin products and herbs during therapy
  • monitor pt for adverse rxns, esp prolonged bleeding time and CNS rxns



aspirin
  • drug class
  • MOA



  • 1st gen NSAID
irreversibly inhibits COX-1 & 2, duration of action depends on how long it takes tissues to start synthesizing COX again


aspirin
  • expected main side effects



  • gastric ulceration
  • risk for bleeding
  • renal impairment
  • ototoxicity, tinnitus



aspirin
  • nursing considerations



  • elderly pts are at increased risk for toxocity
  • should NOT be used to treat fever in children due to Reye's syndrome
  • consider holding if pt is also on anticoagulant therapy



heparin
  • drug class
  • MOA



  • anticoagulant
  • activates antithrombin, which then inactivates thrombin and clotting factor Xa
  • anticoagulant effects develop within minutes of IV administration



heparin
  • expected main side effects



  • hemorrhage
  • thrombocytopenia (reduced platelet counts)
  • hypersensitivity rxns



heparin
  • nursing considerations



  • instruct pt to immediately report chest tightness, dizziness or fever
  • assess I/O to detect dehydration
  • aPTT should fall in range of 60-80 seconds
  • can only be given by injection
  • protamine is "antidote"



warfarin
  • drug class
  • MOA



  • anticoagulant
  • inhibits synthesis of vitamin K dependent clotting factors, including prothrombin and factor X



warfarin
  • expected main side effects



  • hemorrhage
  • teratogenic, so should NOT be given to pregnant women or while breastfeeding



warfarin
  • nursing considerations



  • food sources of vitamin K: mayo, soybean and canola oil, leafy green veggies
  • given orally, will take several days before reachingtherapeutic levels
  • PT ratio used to monitor levels
  • vitamin K is "antidote"



hydralazine
  • drug class
  • MOA



  • vasodilator
  • causes selective dilation of arterioles with little effect on veins; inresponse, peripheral resistance and arterial BP fall...also increases heart rate and contractility



hydralazine
  • expected main side effects



  • hypotension, dizziness, headache, weakness
  • reflex tachycardia and increased O2 demand
  • increased blood volume due to sodium and water retention
  • SLE-like syndrome, s/s: muscle and joint pain, fever, antinuclear antibodies



hydralazine
  • nursing considerations



  • monitor BP, heart rate and regularity and daily weight
  • should be taken with food
  • pt should rise slowly to prevent diziiness
  • to avoid rapid BP drop, taper dosage before discontinuing



lisinopril
  • drug class
  • MOA



  • ACE inhibitor
  • inhibits ACE, therefore inhibiting angiotension II...also increases levels of bradykinin by inhibiting kinase II
  • primarily dilates arterioles and reduces blood volume



lisinopril
  • expected main side effects



  • first-dose hypotension - d/t widespread vasodilation from abrupt lowering of angiotension II levels
  • persistent, dry cough
  • hyperkalemia
  • renal failure



lisinopril
  • nursing considerations



  • concurrent use with diuretics may intensify 1st dose hypotension
  • increased risk for hypokalemia when used with K supplements and K-sparing diuretics (spironolactone)



metoprolol
  • drug class
  • MOA



  • 2nd gen beta blocker
  • selectively blocks beta-1 receptors in the heart (at therapeutic levels) - so should reduce heart rate, force of contraction, and reduces renin secretion by the kidneys



metoprolol
  • expected main side effects



  • bradycardia, reduced cardiac output, AV heart block and rebound tachycardia (following abrput withdrawal) - should be used with caution in pts with heart failure
  • safer for pts with asthma and diabetes



metoprolol
  • nursing considerations



  • monitor BP and pulse rate/rhythm
  • watch for orthostatic hypotension, esp in the elderly
  • drug may s/s of hypoglycemia, so monitor blood glucose levels in diabetic pts
  • may also mask s/s of hyperthyroidism
  • taper drug when discontinuing
  • monitor daily weight in pts in heart failure



enalapril
  • drug class
  • MOA



  • ACE inhibitor
  • inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; inactivates bradykinin and prostaglandins; increases plasma renin and K levels, reduces aldosterone levels - producing systemic vasodilation



enalapril
  • expected main side effects



  • 1st-dose hypotension
  • persistent, dry cough
  • hyperkalemia
  • renal failure
  • angioedema



enalapril
  • nursing considerations



  • assess BP prior to administration
  • monitor VS, I/O and daily weight
  • supervise pt during ambulation until effects are known
  • monitor BUN, LFTs, creatinine and electrolyte levels
  • tell pt to report persistent, dry cough with nasal congestion (signs of toxicity)



lasix
  • drug class
  • MOA



high-ceiling (loop) diuretic
acts in the thick segment of ascending limb of Henle's loop to block reabsorption of Na and Cl - which also passively blocks reabsorption of water


lasix
  • expected main side effects



  • hyponatremia, hypochloremia, dehydration
  • hypotension due to lowered blood volume
  • hypokalemia - which can result in fatal dysrythmias
  • ototxicity



lasix
  • nursing considerations



  • assess BP, pulse rate, I/O and daily weight prior to administration
  • monitor blood glucose levels in diabetic pts since effects of drug may increase glucose levels
  • pts can minimize risk of hypokalemia by eating K-rich foods (nuts, dried fruits, spinach, citrus fruits, potatoes, bananas)
  • risk of hearing loss increases when used with other ototoxic drugs (esp aminoglycosides)



HCTZ
  • drug class
  • MOA



  • thiazide diuretic
  • blocks reabsorption of Na and Cl in the early segment of the distal convoluted tubule



HCTZ
  • expected main side effects



  • hyponatremia, hypochloremia, dehydration
  • hypokalemia
  • contraindicated for pregnant women



HCTZ
  • nursing considerations



  • assess BP, I/O and daily weight prior to administration
  • use caution when administering with digoxin - have a higher risk of digoxin toxicity
  • nocturia can be minimized by avoiding dosing in the late afternoon



metformin
  • drug class
  • MOA



  • biguanide (oral antidiabetic)
inhibits glucose production in the liver, slightly reduces glucose absorption in the gut and sensitizes insulin receptors in fat and skeletal muscle (thereby priming those tissues to increase glucose uptake)


metformin
  • expected main side effects



  • decreased appetite and weight loss
  • lactic acidosisn(s/s: hyperventilation, myalgia, malaise)



metformin
  • nursing considerations



  • watch for s/s of hypoglycemia
  • may need to change dose in response to health status (infection or fever may increase metabolic demand and lower glucose levels)



levofloxacin
  • drug class
  • MOA






levofloxacin
  • expected main side effects






levofloxacin
  • nursing considerations






vancomycin
  • drug class
  • MOA






vancomycin
  • expected main side effects






vancomycin
  • nursing considerations






metronidazole
  • drug class
  • MOA






metronidazole
  • expected main side effects






metronidazole
  • nursing considerations






ceftriaxone
  • drug class
  • MOA






ceftriaxone
  • expected side effects






ceftriazone
  • nursing considerations






protonix
  • drug class
  • MOA






protonix
  • expected main side effects






protonix
  • nursing considerations






pepcid
  • drug class
  • MOA






pepcid
  • expected main side effects






pepcid
  • nursing considerations






zofran
  • drug class
  • MOA






zofran
  • expected main side effects






zofran
  • nursing considerations






reglan
  • drug class
  • MOA






reglan
  • expected main side effects






reglan
  • nursing considerations






albuterol
  • drug class
  • MOA






albuterol
  • expected main side effects






albuterol
  • nursing considerations






ipratropium
  • drug class
  • MOA






ipratropium
  • expected main side effects






ipratropium
  • nursing considerations






flucatisone & salmeterol
  • drug class
  • MOA






flucatisone & salmeterol
  • expected main side effects






flucatisone & salmeterol
  • nursing considerations






prednisone
  • drug class
  • MOA






prednisone
  • expected main side effects






prednisone
  • nursing considerations






cellcept
  • drug class
  • MOA






cellcept
  • expected main side effects






cellcept
  • nursing considerations






rapamune
  • drug class
  • MOA






rapamune
  • expected main side effects






rapamune
  • nursing considerations