NSG124 Pharmacology Drug Card W5., Exams of Nursing

Download NSG124 Pharmacology Drug Card W5. and more Exams Nursing in PDF only on Docsity! NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Hypertension, diabetic nephropathy, heart failure, MI Blocks production of angiotensin II PO Excreted in the urine Peak 1 hr; duration 2-6 hr; half-life <2 hr, increased in renal disease Contraindications Drug & Class How does the nurse know it is working? Pregnancy and Breastfeeding, children, potassium-sparing diuretics 1. Captopril [Capten] 9.1 + 9.4 + 9.5 Angiotensin-Converting Enzyme (ACE) Inhibitor Decrease in B/P, decreased diabetic nephropathy symptoms, Improve hemodynamics in patients with heart failure Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Should be administered 1 hour before meals or 2 hr after meals Do not discontinue product abruptly – adhere to dosage schedule, even if feeling better. Warn patients about the possibility of persistent cough - avoid OTC Hyperkalemia may occur – avoid potassium supplement and potassium- containing salt substitutes Signs and symptoms of angioedema Signs and symptoms of neutropenia Cough – persistent dry, irritating, nonproductive, Neutropenia, Angioedema NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Patients with hypertension, diabetic nephropathy, Blocks the actions of angiotensin II Oral – may be taken with or without food Peak 1 hr; half-life 2 hr; Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity; increased serum creatinine >2 mg/dL (male), >1.8 mg/dL (female); potassium >5.5 mEq/L, type 2 diabetes with microalbuminuria, hepatic disease, CCr <30 mL/min; CCr <50 mL/min in hypertension 1. Eplerenone [Inspra]9.1 + 9.4 + 9.5 • Therapeutic response: decreased B/P Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Assess: • Hypertension: B/P at peak/trough level of product, orthostatic hypotension, syncope when used with diuretic; monitor lithium level in those also taking lithium; those on CYP3A4 inhibitor should monitor potassium at baseline, within first wk, at 1 mo, and more often in diabetes, renal disease • Renal studies: protein, BUN, creatinine; LFTs, uric acid may be increased; contraindicated in CCr <30 mL/min • Potassium levels; hyperkalemia may occur • Pregnancy/breastfeeding: use in pregnancy only if clearly needed; may be excreted in breast milk; do not breastfeed Evaluate: • Therapeutic response: decreased B/P Teach patient/family: • Not to discontinue product abruptly • Not to use OTC products (cough, cold, allergy) unless directed CNS: Headache, dizziness, fatigue CV: Angina, MI GI: Increased GGT, diarrhea, abdominal pain, increased ALT GU: Gynecomastia, mastodynia (males), abnormal vaginal bleeding META: Hyperkalemia, hyponatremia, hypercholesteremia, hypertriglyceridemia, increased uric acid RESP: Cough consulting prescriber • To comply with dosage schedule, even if feeling better • That product may cause dizziness, fainting, light-headedness; may occur during first few days of therapy • How to take B/P; and about normal readings for age group NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Hypertension, alone or in combination with other antihypertensives Renin inhibitor that acts on the renin- angiotensin system (RAS) Poorly absorbed, bioavailability 2.5%, peak 1-3 hr, steady state 7-8 days, 91% excreted unchanged in the feces, half- life 24 hr Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity Black Box Warning: Pregnancy 1. Aliskiren [Tekturna] 9.1 + 9.4 Therapeutic response: decrease in B/P Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Who takes this? How does it work? Pharmacokinetics/How is it given? Courtney Contraindications Drug & Class How does the nurse know it is working? 1. Verapamil [Calan] 9.2 + 9.4 + 10.1 + 10.3 Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Chronic stable angina pectoris, variant angina, hypertension. Inhibits calcium ion influx across cell membrane during cardiac depolarization; relaxes coronary vascular smooth muscle; dilates coronary arteries; increases myocardial oxygen delivery in patients with vasospastic angina; dilates peripheral arteries. Contraindications Drug & Class How does the nurse know it is working? 1. Nifedipine [Adalat] 9.2 + 9.4 hypertensive emergency and urgency direct relaxation duration 2-4hr IV: Onset 5-30 min, peak 10-80min, duration up to 12hr IM: Onset 10-30 min, peak 1 hr, duration 2-6hr. Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity, to hydralazine's, mitral valvular rheumatic heart disease, CAD 9.3 Hydralazine Antihypertensive, direct acting peripheral vasodilator Decreased Blood pressure Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Monitor BP, educate about fall risks Infants Hydralazine is used in infants as young as 1 month for management of hypertensive crisis and chronic hypertension. Sodium nitroprusside is used in heart failure and for management of hypertensive emergency. Children/adolescents Hydralazine and sodium nitroprusside can be used safely in children, just in smaller doses. Side effect profiles are similar to those of adults. Pregnant women Hydralazine, sodium nitroprusside, and minoxidil are classified in U.S. Food and Drug Administration Pregnancy Risk Headache, dizziness, palpitations, tachycardia, nausea, vomiting Category C.a Benefits should outweigh the risks. Breast-feeding women Data are lacking regarding transmission of drug from mother to infant via breast milk. Sodium nitroprusside causes potential adverse effects in the infant. Older adults Monitor for falls, as there is increased risk with polypharmacy and associated orthostatic hypotension. NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Edema, hypertension diuresis Acts on distal tubule and ascending loop of Henle by increasing excretion of water, sodium, chloride, and potassium PO: onset 2hrs, peak 4hrs, duration 6- 12hrs, and half life is 6-15hrs. Contraindications Drug & Class How does the nurse know it is working? Hyperkalemia: don’t use with other potassium-sparing diuretics, potassium supplements, and they should not be used routinely with ACE inhibitors, angiotensin II receptor blockers, or aldosterone antagonists, all of which promote significant hyperkalemia NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Chronic stable angina pectoris, hypertension, supraventricular Nonselective beta-blocker with negative ionotropic, chronotropic, dromotropic properties Metabolized by liver; crosses placenta, blood-brain barrier; Excreted in breast milk; Protein prophylaxis, pheochromocytoma, cyanotic spells related to hypertrophic subaortic stenosis, essential tremor, acute MI, vascular headache enzyme system causes 7% of population to be poor metabolizers Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity to this product; Cardiogenic shock, AV heart block; bronchospastic disease; Sinus Brady cardia; Bronchospasm; Asthma 1. Propranolol [Inderal/Inderal LA] 9.4 + 10.1 + 10.3 Antihypertensive, antianginal, antidysrhythmic (class II) Decreased blood pressure, dysrhythmias Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Teach: not to discontinue abruptly, to avoid OTC products unless approved by prescriber, avoid alcohol, avoid hazardous activities if dizzy, about importance of compliance with medical regimen, monitor blood glucose (may mask symptoms of hypoglycemia), make position changes slowly to prevent fainting, sensitivity to cold may occur, how to take pulse blood pressure Assess: blood pressure, pulse, respirations during beginning therapy, ECG continuously if using as dysrhythmic IV, hepatic enzymes, angina pain, tolerance with long term use, headache, lightheadedness, decreased blood pressure, fluid overload, I&O ratio, pregnancy/breastfeeding (only use if benefits outweigh fetal risk), cautious use in breastfeeding Heart failure, AV block, and sinus arrest. Hypotension can occur secondary to reduced cardiac output. In patients with asthma, blocking beta2 receptors in the lung can cause bronchospasm. NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Fardowsa chloride at proximal and distal tubule and in the loop of Henle. It uses for pulmonary edema; Edema with HE, hepatic disease, nephrotic syndrome ascites, hypertension duration, duration 6-8 hour, absorbed 70% IV: onset 5 min; peak ½ hour duration 2 hours (metabolized by the liver 30%) Contraindications Drug & Class How does the nurse know it is working? Anuria precautions: pregnancy, breastfeeding diabetes mellitus, dehydration, severe renal disease, cirrhosis, ascites, hypersensitivity to sulfonamides/thiazides, infants, hypovolemia, electrolyte 1. Furosemide [Aldactone] 9.5 Sulfonamide Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Assess: HF: weight I&0 daily to determine fluid loss; effect of product may be decreased if used daily. Hypertension/p lying, standing; postural hypotension may occur; assess for full risk in older adults, and implement fall prevention strategies Metabolic alkalosis: drowsiness, restlessness CNS: Headache, fatigue, weakness, vertigo, paresthesia CV: orthostatic hypotension, chest pain ECG change, circulatory collapse EENT: Loss of hearing, ear pain, NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Heart failure and atrial Inhibits the sodium-potassium ATPase Absorption with digoxin tablets is fibrillation/ flutter pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output; increases force of contractions; decrease heart rate; decrease av conduction speed. Therapeutic response: decrease in heart failure, dysrhythmias; serum digoxin level variable, ranging between 60% and 80%, and can be decreased by certain foods and drugs. The half-life of digoxin is about 1.5 days. Digoxin is available in three formulations: • Tablets—0.125 and 0.25 mg • Pediatric elixir—0.05 mg/mL • Solution for injection—0.1 and 0.25 mg/mL Contraindications Drug & Class How does the nurse know it is working? Cardiac dysrhythmias: most serious adverse effects of digoxin. They result from altering the electrical properties of the heart. Noncardiac adverse effects: Anorexia, nausea, and vomiting are the most common GI side effects. Digoxin rarely causes diarrhea. Fatigue is the most frequent CNS effect. Visual disturbances (e.g., blurred vision, yellow tinge to vision, appearance of halos around dark objects) are also relatively common. NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Shock, increased perfusion, hypotension, cardiogenic septic shock. Unlabeled uses: Bradycardia, cardiac arrest, CPR, acute renal failure, cirrhosis, barbiturate intoxication. Causes increased cardiac outputs. Causing vasoconstriction in blood vessels; low dose causes renal and, mesenteric vasodilation. IV: Onset 5 min; duration <10 min; metabolized in live, kidney, plasma; excreted in urine; half-life 2 min Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity, ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypovolemia. 1. Dopamine (a sympathomimetic) 9.5 Function class: Androgenic Chem class: Catecholamine Therapeutic response: Increased B/P with stabilization; increased urine output. Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Assess: Hypovolemia, oxygenation/perfusion, heart failure, I&O ratio, ECG, B/P, pulse q5min, paresthesia and coldness of the extremities, pregnancy/breastfeeding. Teach patient/family: The reason for product administration, to report immediately when shortness of breath, numbness/tinging of extremities. To report immediately of pain, burning, and redness at IV site. CNS: Headache, anxiety CV: Palpitation, angina, wide QRS complex, peripheral vasoconstriction, hypotension. GI: Nausea, vomiting, diarrhea INTEG: Necrosis, tissue sloughing with extravasation RESP: NSG124 Pharmacology Drug Card Template CNS: Headache, dizziness, involuntary movement, confusion, psychosis, restlessness, irritability, syncope, excitement, depression, ataxia CV: Hypotension, bradycardia, PVCs, heart block, CV collapse, arrest, torsades de pointes, widening QRS complex, ventricular tachycardia EENT: Cinchonism: tinnitus, blurred vision, hearing loss, mydriasis, disturbed color vision GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea, hepatotoxicity HEMA: Thrombocytopenia, hemolytic anemia, agranulocytosis, hypoprothrombinemia INTEG: Rash, urticaria, angioedema, swelling, photosensitivity, flushing with severe pruritus RESP: Dyspnea, respiratory depression NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automaticity Half-life 8 min, 1-2 hr (terminal); metabolized in liver; excreted in urine; crosses placenta IM: Onset 5-15 min, duration 1½ hr IV: Onset 2 min, duration 20 min Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff- Parkinson-White syndrome 1. Lidocaine (Class IB) 10.1 (lye′doe-kane) LidoPen Auto-Injector, Xylocaine, Xylocard Func. class.: Antidysrhythmic (Class Ib) Chem. class.: Aminoacyl amide Therapeutic response: decreased dysrhythmias Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects • ECG continuously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased ventricular ectopic beats, may have to rebolus; B/P • Drug levels: therapeutic level, 1.5-5 mcg/mL • I&O ratio, electrolytes (potassium, sodium, chlorine) • Toxicity: monitor for seizures, confusion, tremors; if these occur, discontinue immediately, notify prescriber; keep emergency equipment nearby • Malignant hyperthermia: tachypnea, tachycardia, changes in B/P, increased temperature • 760Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur with HF; increased respiration, pulse; product should be discontinued • CNS effects: dizziness, confusion, psychosis, paresthesias, convulsions; product should be discontinued • Pregnancy/breastfeeding: use only if clearly needed; use caution in breastfeeding, excreted in breast milk • About the use of automatic lidocaine injection device if ordered for personal use CNS: Headache, dizziness, involuntary movement, confusion, tremor, drowsiness, euphoria, seizures, shivering CV: Hypotension, bradycardia, heart block, CV collapse, arrest EENT: Tinnitus, blurred vision GI: Nausea, vomiting, anorexia HEMA: Methemoglobinemia INTEG: Rash, urticaria, edema, swelling, petechiae, pruritus MISC: Febrile response, phlebitis at inj site RESP: Dyspnea, respiratory depression NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Hemodynamically unstable ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation not controlled by 1st-line agents. Prolongs duration of action potential and effective refractory period, noncompetitive α and β -adrenergic inhabitation; increases PR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance. PO: Onset 1-3 wk, peak 3-7 IV: Onset 2 hr, peak 3-7 hr; half-life 26- 107 days increased in geriatric patients metabolized by liver (an inhibitor of CYP1A2, CYP3A4, CYP2C8, CYP2C9, CYP2C19, CYP2A6, CYP2B6, CYP2D6, P-glycoprotein) CNS: headache, dizziness, involuntary movement, tremors, peripheral neuropathy, malaise, fatigue, ataxia, parethesias, insomnia, confusion, hallucination CV: Hypotension, bradycardia, HF, dysrhythmias EENT: Corneal microdeposits, dry eyes ENDO: Hypo/Hyperthyroidism GI: Nausea, vomiting, diarrhea, abdominal pain, anorexia, constipation, hepatotoxicity, pancreatitis GU: Epididymitis, ED INTEG: Rash, photosensitivity, blue- gray skin discoloration, alopecia, spontaneous ecchymosis, toxic epidermal necrolysis, urticaria, pancreatitis, phlebitis (IV) MISC: Flushing, abnormal taste or smell, edema, abnormal salivation • NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? PSVT, as a diagnostic aid to access myocardial perfusion defects in CAD, Wolff- Parkinson-White syndrome Slows conduction through AV node, can interrupt reentry pathways through AV nodes, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia; decreases cardiac oxygen demand, decreasing hypoxia. Cleared from plasma in <30 sec, half- life 10 sec, converted to inosine/adenosine monophosphate. Given: IV Bolus Contraindications Drug & Class How does the nurse know it is working? RESP: Pulmonary fibrosis/toxicity, ARDS • Beers: Avoid as first-line therapy for atrial fibrillation in older adults unless heart fibrillation in older adults unless heart failure or substantial left ventricular hypertrophy is present Teach patients/family: • To take this product as directed; to avoid missed doses; not to use with grapefruit juice; not to discontinue abrubtly, not to use other drugs, herbs without prescriber approval, many interactions To use sunscreen or stay out of sun to prevent burns; that dark glasses may be needed for photophobia To report side effects immediately; more common at high dose and longer duration • That skin discoloration is usually reversible • To report vision changes, weight change, rash, blistering, numbness, temperature intolerance Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or Hypersensitivity, 2nd- or 3rd degree AV block, sick sinus syndrome, bradycardia 1. Adenosine [Adenocard] 10.1 Adenocard, Adenoscan Therapeutic response: normal sinus rhythm or diagnosis of perfusion defect Contraindications Drug & Class How does the nurse know it is working? Raul 1. Lovastatin [Mevacor]10.2 Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Bile-Acid Sequestrants Contraindications Drug & Class How does the nurse know it is working? Raul 1. Colesevelam [Welchol] 10.2 Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Anginal pain Vasospasms Coronary vasodilators Decreases preload and afterload, which Metabolized by the liver. excreted in urine. half-life 1- are responsible for decreasing left ventricular end diastolic pressure, systemic vascular resistance. Contraindications Drug & Class How does the nurse know it is working? Hypersensitive Severe anemia Intracranial pressure 1. Nitroglycerin 10.3 Decreased prevention of anginal pain Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Assess: chest pain, BP Avoid alcohol. If headaches occur use non opioid analgesics take before stressful activity. Collapse Tachycardia Vomiting NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? People who need rapid onset of anticoagulant effects Heparin suppresses coagulation by helping antithrombin inactivate clotting IV only Not able to cross membrane, so will not Who takes this? How does it work? Pharmacokinetics/How is it given? prevention of DVT following abdominal surgery, hip replacement surgery, or knee replacement surgery Treatment of established DVT, with or without PE Prevention of ischemic complications in patients with unstable angina, non–Q- wave MI, and ST-elevation MI (STEMI). LMW heparins preferentially inactivate factor Xa, being much less able to inactivate thrombin. SubQ Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity to product, active major bleeding, thrombocytopenic purpura, heparin induced thrombocytopenia Enoxaparin (low-molecular-weight heparin) [Lovenox] Functional Class: Anticoagulant, antithrombotic Prevention of CVT/PE Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Antidote: Protamine Sulphate Monitor bleeding time, any abdominal pain, avoid other injections Bleeding, severe neurological injury, hemorrhage, NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Those at risk of developing blood clots Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K- dependent coagulation factors. PO: onset 12-24hr, peak: 1 ½ -4 days Duration: 3-5 days Metabolized in liver, excreted by the kidneys Contraindications Drug & Class How does the nurse know it is working? Pregnancy, breastfeeding, hypersentivity, hemophilia 1. Warfarin [Coumadin] 10.4 Fun class: anticoagulant Chem class: coumarin derivative Decreased thrombus formation/extention, absence of emboli, postthrombotic effects Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Assess: Stroke, DVT/PE GI, Bleeding , anaphylaxis, angieodema NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Pt at risk for the following: • Ischemic stroke (to reduce the risk of death and nonfatal stroke) • TIAs (to reduce the risk of death and nonfatal stroke) • Chronic stable angina (to reduce the risk of MI and sudden death) • Unstable angina (to reduce the combined risk of death and nonfatal MI) • Coronary stenting (to prevent reocclusion) • Acute MI (to reduce the risk of vascular mortality) • Previous MI (to reduce the combined risk of death and Irreversibly inhibits cyclooxygenase, and thereby blocks synthesis of TXA2. TXA2 is one of the factors that can promote platelet activation. In addition to activating platelets, TXA2 acts on vascular smooth muscle to promote vasoconstriction. Aspirin suppresses both TXA2-mediated vasoconstriction and platelet aggregation, thereby reducing the risk of arterial thrombosis. PO Effects persist 7–10 days after the last dose Metabolized by the liver; excreted by the kidneys; crosses placental barrier; excreted in breast milk Contraindications Drug & Class How does the nurse know it is working? Do not take in 1st trimester 1. Aspirin (cyclooxygenase [COX] Check clotting factors in blood test. Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Blood work is necessary during treatment. Report any unusual bleeding. Take without regard to food. Report rashes, pruritus, hypersensitivity. Notify if you become pregnant. The most common complaints are abdominal pain, dyspepsia, diarrhea, and rash. Like all other antiplatelet drugs, clopidogrel poses a risk of serious bleeding NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Therapeutic Uses: Alteplase has three major indications: (1) acute MI, (2) acute ischemic stroke, and (3) acute massive PE. In all three settings, timely intervention is essential: The sooner alteplase is administered, the better the outcome. Works by: The drug first binds with plasminogen to form an active complex. The alteplase- plasminogen complex then catalyzes the conversion of other plasminogen molecules into plasmin, an enzyme that digests the fibrin meshwork of clots. In addition to digesting fibrin, plasmin degrades fibrinogen and other clotting factors. These actions don't contribute to lysis of thrombi, but they do increase the risk IM standard infusion adult > than 65, 100 milligrams total given over 3 hours as follows 60 milligram given over first hour adult < 65 1.25 milligrams per kilogram over a 3 hour Cleared by the liver, 80% cleared within 10 minutes of product termination, on set immediate, half- life 35 minute, peak one hour Contraindications Drug & Class How does the nurse know it is working? Internal Bleeding history of CVA, severe uncontrolled hypertension, intracranial/ intraspinal, surgery, trauma within three months, aneurysm, brain tumor, platelets less than 100,000 Thrombolytic enzyme: Activase 1.Streptokinase / Alteplase (tissue-type plasminogen activator) [tPA] 10.4 *HIGH ALERT* also known as tissue plasminogen activator—is identical to naturally occurring human tPA. The drug is manufactured using Therapeutic response: license of thrombi, adequate hemodynamic state, absent of heart failure, cannula/catheter lack of occlusion Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Alteplase and other thrombolytic drugs must be avoided in patients at high risk for bleeding complications and must be used with great caution in patients at lower risk of bleeding. Absolute and relative contraindications to thrombolytic therapy are shown in The risk of bleeding can be lowered by: • Minimizing physical manipulation of the patient • Avoiding subQ and IM injections • Minimizing invasive procedures • Minimizing concurrent use of anticoagulants (e.g., heparin, warfarin, dabigatran) Ferrous sulfate: is used for iron- deficiency anemia, prophylaxis for iron deficiency in pregnancy, nutritional supplementation. Ferrous sulfate: Replaces iron stores needed for red blood cell production as well as O2 transport and use: fumarate contains 33% elemental iron; gluconate, 12%: sulfate, 20%: iron, 30%: ferrous sulfate exsiccated. Ferrous sulfate; PO; excreted feces, urine, skin, breast milk: enter bloodstream: bound to transferrin: crosses placenta Contraindications Drug & Class How does the nurse know it is working? Ferrous sulfate.Sideroblastic anemia, thalassemia, hemosiderosis/hemochromatosis. 1. Ferrous sulfate [Feosol] 2. Iron dextran [INFeD] 10.6 Ferrous sulfate: you will have enough iron. Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Ferrous sulfate: GI Disturbances such as : Nausea, constipation, epigastric pain, black and red tarry stools, vomiting, diarrhea NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? People who have pernicious anemia deficiancy, vit B12 malabsorption syndrome, Schilling test, increased requirements with pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, renal/hepatic disease, nutritional supplementation Following ingestion, vitamin B12 forms a complex with intrinsic factor. Upon reaching the ileum, the B12–intrinsic factor complex interacts with specific receptors on the intestinal wall, causing the complex to be absorbed. In the absence of intrinsic factor, absorption of vitamin B12 is greatly reduced. However, about 1% of the amount present can still be absorbed by passive diffusion; no intrinsic factor is needed. PO route With fruit juice to disguise taste; immediately after mixing With meals if possible for better absorption; large doses should not be used because most is excreted • Protect from light, heat IM route • By IM inj for pernicious anemia for life unless contraindicated Intranasal Contraindications Drug & Class How does the nurse know it is working? Hypersensitivity to this product, cobalt, benzyl alcohol, optic nerve atrophy Precautions: Pregnancy, breastfeeding, 1. Vitamin B12 – Cyanocobalamin 10.6 Needed for adequate nerve functioning, protein and carbohydrate metabolism, normal growth, RBC development, cell reproduction Hypersensitivity Precautions: Pregnancy, anemias other than megaloblastic/macrocytic anemia, vit B12 deficiency anemia, uncorrected 1. Folic acid 10.6 Needed for erythropoiesis; increases RBC, WBC, platelet formation with megaloblastic anemias Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects Check patients' diet :-(1) poor diet (especially in patients with alcohol use disorder), and (2) malabsorption secondary to intestinal disease. Rarely, certain drugs may cause folate deficiency. Asse intestinal absorption if it is block by sprue. Sprue is an intestinal malabsorption syndrome that decreases folic acid uptake Alcohol use disorder, either acute or chronic, may be the most common cause of folate deficiency. Deficiency results for two reasons: (1) insufficient folic acid in the diet and (2) derangement of enterohepatic recirculation secondary to alcohol-induced injury to the liver. Fortunately, with improved diet and reduced alcohol consumption, alcohol- related folate deficiency will often reverse. -check for megaloblastic anemia Oral folic acid is nontoxic when used short term. Massive dosages (e.g., as much as 15 mg) have been taken with no NSG124 Pharmacology Drug Card Template Who takes this? How does it work? Pharmacokinetics/How is it given? Contraindications Drug & Class How does the nurse know it is working? Nursing Considerations: What is the nurse going to do/teach/assess? Adverse Effects