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Module 4 Meds

NameClassMoAAdverse EffectsNursing Implications
Lactulose (Enulose) Osmotic Laxative Colon bacteria metabolize to form lactic acid, formic acid, and acetic acid creating osmotic pressure to draw in water and create soft stools. Also increases excretion of ammonia reducing blood ammonia levels. N/V/D Abdominal cramps Hypernatremia Hypokalemia Effects may nor be seen for 24-48 hrs Monitor Electrolytes Report diarrhea
Levothyroxine (Synthyroid) Thyroid hormone Converts to Ts to produce almost normal levels of both T3 and T4 in the body. Activation of thyroid hormone receptors increases metabolic rate; increases cardiac output, renal blood flow, body temp, blood volume, growth Tachycardia, Angina, Tremor, Nervousness, Insomnia, Hyperthermia, Heat intolerance, Sweating *Thyroid storm *Chronic overdose: Bone loss & a-fib Food v absorption, take on empty stomach 30-60 min before breakfast Avoid iodine rich food Separate from other medications that reduce absorption by 4 hrs. Monitor BP, daily weight Enhances Warfarin and catecholamines ^ need: insulin and Digoxin
Levodopa Dopamine presursor Crosses the blood brain barrier and is converted to dopamine to relieve Parkinson’s symptoms *Nausea Cough Dyskinesia Orthostatic-hypotension Psychosis Darkened sweat/urine May activate malignant melanoma Drug interactions: 1st-gen antipsychotics, MAOI’s, anticholinergics, pyridoxine(B6) Diminished effects over time – neuron degradation Food delays absorption, but helps with N/V protein reduces effect
Carpidopa Decarboxylase inhibitor Inhibits decarboxylation of levodopa in GI to increase levodopa that is available to cross blood-brain barrier No adverse effects alone – no therapeutic effect alone Enhances adverse effects of levodopa Always in combination with levodopa Allows decrease in levodopa dosage (approx. 75%)
Prampexole Dopamine agonist Believed to stimulate dopamine receptors in the striatum Nausea Dyskinesia* Dizziness* Sleep pattern disturbance Hallucinations* First line drug for PD Less effective than Levodopa Combine with levodopa in advanced PD, but adverse effects are elevated
Omeprazole (Prilosec) Proton Pump Inhibitor Reduces gastric secretions by inhibiting pumps that generate gastric acid production Headache GI effects Fracture Pneumonia Acid rebound hypomagnesemia C-Diff risk Gastric Cancer Not for infants Most effective short term Gastric/duodenal ulcers GERD Short half-life
H2 Ranitidine (Zantac) H2 Blocker Gastric Acid Secretion Inhibitotor Blocks both volume of gastric juice and hydrogen ion concentration in parietal cells of stomach Few adverse effects pH increase may increase pneumonia Can be used for infants For short term Gastric and Duodenal ulcers; GERD Lower dose with renal impairment
Milk of Magnesia Antacid *Osmotic Laxative Reduces destruction of gut wall by neutralizing acid; may stimulate prostaglandin production increasing mucus *Poorly absorbed salts draw water into intestinal lumen softening and swelling stool to encourage peristalsis Constipation: Aluminum type *Diarrhea: Magnesium type (laxative) dehydration Sodium loading fluid retention Caution in patients with renal impairment; HPT, HF Interferes with other medications: Cimetidine, Ranitidine, Sucralfate Avoid when abdominal pain is unidentified
Pyllium (Metamucil) Bulk Forming Laxative Nondigestible substance swells with water and creates gel that softens and increases fecal mass. Pressure on intestinal wall stimulates peristalsis Esophageal obstruction Administer in full glass of water Split if difficulty consuming quickly to prevent over thickening Assess ability to swallow 1-3 days
Oxybutinin Atropine Muscarinic Antagonist Competitively blocks the actions of acetylcholine at muscarinic receptors Elevated HR Decreased secretions V GI motility Dilated pupils Loss of accommodation Smooth muscle relaxation-bronchi & bladder Dry mouth (xerostoma) Blurred vision ^ ocular pressure Urinary retention Constipation Anhidrosis Tachycardia Asthma Hyperthermia cause a muscarinic blockade (antihistamines, tricyclic antidepressants, phenothiazine antipsychotics) Not in patients with glaucoma
Docusate Sodium (Colace) Surfactant Laxative May inhibit fluid absorption and stimulate secretion of water and electrolytes into intestines Abnormal taste in mouth Bitter Diarrhea Nausea Muscle cramping Administer with full glass of water 1-3 Days
Bisacodyl Stimulant Laxative Stimulate intestinal motility Increase water and Electrolytes in intestine Abdominal colic Abdominal discomfort Diarrhea (Proctitis w/ suppository) Swallow enteric coated tablets intact Do not take within one hour of milk or antacid 6-12 hrs *suppository 15-60 min
Metformin (Glucophage) Biguanide Lowers blood glucose and improves tolerance in three ways 1)Inhibits glucose production in liver 2)Slightly reduces glucose absorption in gut 3) Makes insulin receptors more sensitive causing an increase in uptake in fat and skeletal muscle. Decreased appetite N/V/D Headache Weakness Dizziness *Lactic Acidosis (Rare) *Thrombocytopenia * Vitamin B12 deficiency Evaluate kidney function prior Discontinue prior to radiocontrast media and check GFR before resuming Alcohol increases risk for Lactic Acidosis; teach patient symptoms (hyperventilation, myalgia, malaise, increased somnolence
Lispro (Humalog) Insulin Short duration/ fast Acting Nearly identical to natural insulin. Stimulates uptake of glucose into skeletal muscle and fat. Also increases protein synthesis Hypoglycemia Hypokalemia Injection site irritation Respiratory infection Monitor blood glucose prior to eating Rotation of injection sites Sings of ketoacidosis: N, Thirst, Dry mouth, vBP, dry flushed skin, Kussmaul respirations, acetone breath Monitor Electrolytes K+ S/Sx of Hyper/Hypo glycemia
Glargine (Lantus) Insulin Long duration/ slow acting SubQ injection forms microprecipitates that dissolve slowly to release small amounts over extended time Nocturnal hypoglycemia Hypokalemia Injection site irritation Monitor blood glucose prior to eating Sings of ketoacidosis: N, Thirst, Dry mouth, vBP, dry flushed skin, Kussmaul respirations, acetone breath Monitor Electrolytes K+ S/Sx of Hyper/Hypo glycemia
Created by: Jennwyo83