Drug Study

Generic Name: nicardipine

Brand Name: Cardene

Classification: calcium channel blocker

antianginal, antihypertensive

Date Ordered: September 15, 2010

Ordered Dose: 2 mg IVTT

10 mg + 90 cc PNSS @ 10cc/hour

increased to 15 cc/hour @ 3:10 PM

increased to 20 cc/hour @ 6:30 PM

120cc/hour / 140 cc/hour @ 6:30 AM (September 17, 2010)

decreased to 15 cc/hour @ 11:00 AM

decreased to 10 cc/hour @ 12:00 PM

decreased to 5 cc/hour @ 5:15 AM (September 18, 2010)

1 g IV slow NOW @ 9:40 PM (September 21, 2010)

10 mg + 90 cc PNSS in a soluset @ 100 cc/hour

increased to 15 cc/hour then increase to 2 cc every 30 minutes to

achieve SBP of less then or equal to 170 mmHg (@ 10:35 AM)

decreased to 20 cc/hour @ 1:45 PM (September 22, 2010)

Suggested Dose: For hypertension: PO 20mg TID initially, may increase after 3

days 9range 20 – 40 mg TID) or 30 mg BID, may increase to 60

mg bid or IV 5 mg/hour, may increase by 2.5mg/hour every 15

minutes, max 15 mg/hour

Mode of Action: Inhibits calcium ion influx across cell membrane during cardiac

depolarization; produces relaxation of coronary vascular smooth

muscle, peripheral vascular smooth muscle; dilates coronary

vascular arteries; increases myocardial oxygen delivery in patients

with vasopastic angina

Indication: chronic stable angina pectoris, hypertension

Contraindication: sick sinus syndrome, 2nd or 3rd degree heartblock, hypersensitivity

Drug Interactions:

Increases the effects of digitalis, neuromuscular blocking agents, theophylline,

other antihypertensives, nitrates, alcohol, quinidine

Increased nicardipine effects: cimetidine

Decreased antihypertensive effect with NSAIDs, rifampin

Increased toxicity risk with cyclosporine, prazosin, cabamazepine, quinidine,

propranolol

Side Effects:

CNS: headache, dizziness, anxiety, depression, confusion, paresthesia,

somnolence

CV: edema, bradycardia, hypotension, palpitations, chest pain, tachycardia,

increased angina

GI: nausea, vomiting, gastric upset, constipation, abdominal cramps

BU: nocturia, polyuria

INTEG: rash, infusion site discomfort

OTHER: blurred vision, flushing, sweating, shortness of breath

Adverse Effects:

CV: pulmonary edema

GI: hepatitis

GU: acute renal failure

Nursing Responsibilities:

Assess:

1. Cardiac status: BP, PR, RR, ECG

2. Potassium, renal hepatic studies, periodically

Administer:

1. IV: dilute each 25 mg/240mL of compatible sol (0.1mg/mL), give slowly

2. Stable at room temperature 24 hours

Evaluate:

1. Therapeutic response: decreased BP

Teach patient / family:

1. To avoid OTC drugs unless directed by prescriber

2. To comply in all areas of medical regimen: diet, exercise, stress reduction,

drug therapy

3. To notify prescriber of irregular heartbeat, shortness of breath, swelling of

feet and hands, hypotension

Treatment of overdose: defibrillation, beta-agonists, IV calcium, diuretics,

vasopressor

Generic Name: mannitol

Brand Name: Mannitol, Osmitrol, Resectisol

Classification: osmotic diuretic


Ordered Dose: 140 cc IVTT now, then 100 cc q4hours

140 cc now then 140 cc q4hours

decreased to 100 cc IV q6hours @ 4:00 PM (September 17, 2010)

decreased to 75 cc IV q6hours @ 12:20 PM (September 19, 2010)

increased to 120 cc IV q4hours @ 1:50 PM (September 22, 2010)

Suggested Dose: For increased ICP: IV 1 ½ - 2 g/kg 15% - 25% solution over ½ - 1

hour

Mode of Action: Acts by increasing osmolarity of glomerular filtrate, which raises

osmotic pressure of fluid in renal tubules; decrease in

reabsorption of water, electrolytes; increase in urinary output,

sodium chloride excretion

Indication: edema, promote systemic diuresis in cerebral edema, decrease

IOP, improve renal function in acute renal failure, chemical

poisoning

Contraindication: active intracranial bleeding, hypersensitivity, anuria, severe

pulmonary congestion, edema, severe dehydration, progressive

heart, renal failure

Drug Interaction:

Decreased effect with lithium

Increases hyperkalemia

Side Effects:

CNS: dizziness, headache, confusion

CV: edema, thrombophlebitis, hypotension, hypertension, angina-like chest

pains, fever, chills

EENT: loss of hearing, blurred vision, nasal congestion, decreased IOP

ELECT: fluid, electrolyte imbalances, acidosis, electrolyte loss, dehydration

GI: nausea, vomiting, dry mouth, diarrhea

GU: marked diuresis, urinary retention

RESP: pulmonary congestion

Adverse Effects:

CNS: convulsions, rebound increased ICP

CV: tachycardia, CHF


Assess:

1. Weight, I&O daily to determine fluid loss; effect of drug may be decreased

if used daily; output qhour prn

2. Rate, depth, rhythm of respiration, effect of exertion

3. BP

4. Electrolytes: potassium, sodium, chloride; include BUN, CBC, serum

creatinine, blood pH, ABGs, CVP, PAP

5. Signs of metabolic acidosis: drowsiness, restlessness

6. Signs of hypokalemia: postural hypotension, malaise, fatigue,

tachycardia, leg cramps, weakness

7. Rashes, temperature daily

8. Confusion; take safety precautions if needed

9. Hydration including skin turgor, thirst, dry mucous membranes

Administer:

1. IV: in 15% - 25% solution with filter; give over ½ - 1 1/2 hours; warm in

hot water and shake to dissolve crystals

Evaluate:

1. Therapeutic response: decreased ICP


1. The reason for and method of treatment

2. To report signs of electrolyte imbalance; confusion

Treatment overdose: discontinue infusion; correct fluid, electrolyte imbalances;

hemodialysis; monitor hydration, CV, renal function

Generic Name: omeprazole

Brand Name: Losec, Prilosec

Classficiation: antiulcer, proton pump inhibitor


Ordered Dose: 40 mg IVTT now

40 mg q8hours (September 16, 2010)

Suggested Dose: Gastric ulcer: PO 40 mg daily 4 – 8 weeks

Laryngitis (unlabeled): PO 20 – 40 mg at bedtime x 6 – 24 weeks

or 20 mg BID x 4 – 12 weeks

Mode of Action: Suppresses gastric secretion by inhibiting hydrogen/potassium

ATPase enzyme system in gastric parietal cell; characterized as

gastric acid pump inhibitor, since it blocks final step of acid

production

Indication: gastroesophageal reflux disease (GERD), severe erosive

esophagitis, poorly systemic GERD, pathologic hypersecretory

condictions (Zollinger-Ellison syndrome, systemic mastocytosis,

multiple endocrine adenomas); treatment of active duodenal

ulcers with or without antiinfectives of Helicobacter pylori

Contraindication: hypersensitivity

Drug Interaction:

Increases serum levels of: diazepam, phenytoin, flurazepam, triazolam,

cyclosporine, disulfram, digoxin

Possible increased bleeding with warfarin

Delays absorption of ampicillin, iron salts, digoxin, ketoconazole, and

cyanocobalamin

Side Effects:

CNS: headache, dizziness, asthenia

CV: chest pain, angina, tachycardia, bradycardia, palpitations, peripheral edema

EENT: tinnitus, taste perversion

GI: diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid

regurgitation, abdominal swelling, anorexia, irritable colon, esophageal candidiasis, dry

mouth

GU: UTI, urinary frequency, increased creatinine, testicular pain, glycosuria

HEMA: anemia

INTEG: rash, dry skin, urticaria, pruritus, alopecia

META: hypoglycemia, increased hepatic enzymes, weight gain

MISC: back pain, fever, fatigue, malaise

RESP: upper respiratory infections, cough, epistaxis

Adverse Effects:

GU: proteinuria, hematuria

HEMA: pancytopenia, thrombocytopenia, neutropenia, leukocytosis


Assess:

1. GI system: bowel sounds q8hours, abdomen for pain, swelling, anorexia

2. Hepatic enzymes, AST, ALT, alk phosphatase during treatment

Administer:

1. Capsules may be sprinkled over apple-sauce

2. Do not break, crush or chew

Evaluate:

1. Therapeutic response: absence of epigastric pain, swelling, fullness

Teach patient/family:

1. To report severe diarrhea; drug may have to be discontinued

2. To avoid salicylates, ibuprofen; may cause GI irritation

3. That dizziness may occur

Generic Name: sulperazone

Brand Name: Bacperazone

Classification: cephalosporin antibiotic


Ordered Dose: 1.5 g IVTT q8hours, ANST (discontinued @ 9:45 PM)

g IV q8 (resumed on September 16, 2010)

Suggested Dose: Adult 1:1 ratio (2-4 g Sulperazone, or 1-2 g sulbactam activity, 1-2

g cefoperazone activity) or 1:2 ratio (1.5-3 g Sulperazone, or 0.5-1

g sulbactam activity, 1-2 g cefoperazone activity) 12 hrly in equally

divided doses

Mode of Action: It is a combination of sulbactam and cefoperazone. Cefoperazone

exerts its bactericidal effect by inhibiting the bacterial cell wall

synthesis, and sulbactam acts as a beta-lactamase inhibitor, to

increase the antibacterial activity of cefoperazone against beta-

lactamase producing organisms.

Indication: Resp tract infection, UTI, peritonitis, cholecystitis, cholangitis,

other intra-abdominal infections. Septicemia, meningitis, skin &

soft tissue infections. Pelvic inflammatory disease, endometriosis,

gonorrhea, other genital tract infections.

Contraindication: Hypersensitivity to penicillins, sulbactam or cephalosporins

Drug Interaction:

Increases bleeding risk of anticoagulants, thrombolytics, plicamycin, valproic

acid, and NSAIDs

Decreases absorption of cefdinir: iron

Increases toxicity of aminoglycosides, furosemide, probenecid

Side Effects:

CNS: headache, dizziness, weakness, paresthesia, fever, chills

GI: nausea, vomiting, diarrhea, anorexia, pain, glossitis, increased AST, ALT,

bilirubin, LDH, alk phosphatase, abdominal pain

GU: vaginitis, pruritus, candidiasis, increased BUN

HEMA: anemia

RESP: dyspnea

Adverse Effects:

CNS: seizures

GI: bleeding, pseudomembranous colitis

GU: proteinuria, nephrotoxicity, renal failure

HEMA: leucopenia, thrombocytopenia, agranulocytosis, neutropenia,

lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia

SYST: anaphylaxis, serum sickness


Assess:

1. Sensitivity to penicillin, other cephalosporins

2. Nephrotoxicity: increased BUN, creatinine, urine ouput: if decreasing,

notify prescriber, may indicate nephrotoxicity

http://www.mims.com/Page.aspx?menuid=companionhome&ID=981






http://en.wikipedia.org/wiki/Cell_wall

http://en.wikipedia.org/wiki/Bacterial

http://en.wikipedia.org/wiki/Sulbactam

3. Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phosphatase

4. Bowel pattern daily: if severe diarrhea occurs, drug should be

discontinued; may indicate pseudomembranous colitis

5. IV site for extravasations, phlebitis, change site q72hours

6. Anaphylaxis: rash, urticaria, pruritus, chills, fever, joint pain, angioedema;

may occur few days after therapy begins

7. Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac

8. Overgrowth of infection: perineal itching, fever, malaise, redness, pain,

swelling, drainage, rash, diarrhea, change in cough, sputum

Administer:

1. For 7 – 10 days to ensure organism death and prevention of

superinfection

Evaluate:

1. Therapeutic response: decreased symptoms of infection; negative C&S

2. Teach patient / family:

3. To report sore bruising, bleeding, joint pain; may indicate blood

dyscrasias (rare); diarrhea with mucus, blood may indicate

pseudomembranous colitis

4. To report persistent diarrhea

Treatment of anaphylaxis: Epinephrine, antihistamines; resuscitate if needed

Generic Name: nimodipine

Brand Name: Nimotop



Ordered Dose: 30 mg 2 tabs now then q4hours

Suggested Dose: The oral dose is 60 mg (two 30 mg capsules) every 4 hours for 21

consecutive days, preferably not less than one hour before or two

hours after meals. Oral nimodipine capsules therapy should

commence within 96 hours of the subarachnoid hemorrhage.

Mode of Action: Nimodipine is a calcium channel blocker. The contractile

processes of smooth muscle cells are dependent upon calcium

ions, which enter these cells during depolarization as slow ionic

transmembrane currents. Nimodipine inhibits calcium ion transfer

into these cells and thus inhibits contractions of vascular smooth

muscle. In animal experiments, nimodipine had a greater effect on

cerebral arteries than on arteries elsewhere in the body perhaps

because it is highly lipophilic, allowing it to cross the blood-brain

barrier

Indication: Because it has some selectivity for cerebral vasculature,

nimodipine's main use is in the prevention of cerebral vasospasm

and resultant ischemia, a complication of subarachnoid

hemorrhage, specifically from ruptured intracranial berry

aneurysms irrespective of the patient's post-ictus neurological

condition.

Contraindication: unstable angina, myocardial infarction that is more recent than

one month, intravenous administration of the drug

Drug Interaction:

Enhances cardiovascular actions of other calcium channel blockers

Cimetidine increases the mean peak plasma concentration of nimodipine

Side Effects:

CV: Anemia, decreased platelet count, palpitations, hematoma, hypertension

GI: Vomiting

INTEG: Flushing, diaphoresis, itching, jaundice

RESPI: Wheezing

CNS: Lightheadedness, dizziness

ELEC: hyponatremia

Adverse Effects:

Hemorrhage,

Thrombocytopenia, congestive heart failure, disseminated intravascular

coagulation, deep vein thrombosis

Neurological deterioration

http://en.wikipedia.org/wiki/Subarachnoid_hemorrhage

http://en.wikipedia.org/wiki/Subarachnoid_hemorrhage

http://en.wikipedia.org/wiki/Ischemia

http://en.wikipedia.org/wiki/Vasospasm

http://en.wikipedia.org/wiki/Cerebral_cortex


Assess:

1. Cardiac status: BP, PR, RR, ECG

2. Potassium, renal hepatic studies, periodically

Administer:

1. PO. Never give the drug intravenously or by other parenteral routes. Deaths,

serious life-threatening adverse events including cardiac arrest,

cardiovascular collapse, hypotension and bradycardia have occurred when

the contents have been injected parenterally.

Evaluate:

1. Therapeutic response: absence of cerebral vasospasm and resultant

ischemia, decreased BP



2. To comply in all areas of medical regimen: diet, exercise, stress reduction,

drug therapy

3. To notify prescriber of irregular heartbeat, shortness of breath, swelling of

feet and hands, hypotension

Generic Name: paracetamol

Brand Name: Biogesic, Tylenol, Calpol

Classification: nonopioid analgesic, antipyretic


Ordered Dose: 500 mg 1 tab q4hours PRN for fever

Suggested Dose: 325 – 650 mg q4hours PRN, max 4g/day

Mode of Action: May block pain impulses peripherally that occur in response to

inhibition of prostaglandin synthesis; does not possess anti-

inflammatory properties; antipyretic action results from inhibition of

prostaglandins in the CNS (hypothalamic heat-regulating center)

Indication: mild pain, fever

Contraindication: hypersensitivity, intolerance to tartrazine (yellow dye # 5), alcohol,

table sugar, ssaccharin, depending on product

Drug Interaction:

Decreased effect and increased hepatotoxicity with barbiturates, alcohol,

carbamazepine, hydantoins, rifampin, rifabutin, isoniazid, diflunisal,

sulfinpyrazone

Hypoprothrombinemia with warfarin, long term use, high doses of paracetamol

Bone marrow suppression with zidovudine

Decreased absorption with colestipol, cholestyramine

Renal adverse reaction with NSAIDs, salicylates

Side Effects:

CNS: stimulation, drowsiness

GI: nausea, vomiting, abdominal pain

INTEG: rash, urticaria

SYST: hypersensitivity

Adverse Effects:

GI: hepatotoxicity, hepatic seizure (overdose)

GU: renal failure (high, prolonged doses)

HEMA: leucopenia, neutropenia, hemolytic anemia (long-term use),

thrombocytopenia, pancytopenia

TOXICITY: cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS

stimulation, delirium followed by vascular collapse, convulsions, coma, death


Assess:

1. For fever and pain: type of pain, location, intensity, duration

2. Allergic reactions: rash, urticaria, if these occur, drug may have to be

discontinued

Administer:

1. Crushed, whole; chewable tablets may be chewed; give with full glass of

water

2. With food or milk to decrease gastric symptoms if needed

Evaluate:

1. Therapeutic response: absence of pain or fever


1. Not to exceed recommended dosage; acute poisoning with liver damage

may result

2. That acute toxicity includes symptoms of nausea, vomiting, abdominal

pain; prescriber should be notified immediately

3. To read label on other OTC drugs; many contain paracetamol and may

cause toxicity if taken concurrently

4. To notify prescriber of pain or fever lasting over 3 days

Treatment overdose: drug level, gastric lavage, activated charcoal, administer

oral acetylcysteine to prevent hepatic damage, monitor for bleeding

Generic Name: lansoprazole

Brand Name: Prevacid

Classification: antiulcer,

proton pump inhibitor


Ordered Dose: 30 mg/tab 1 tab/NGT OD

Suggested Dose: NG: use intact granules mixed in 40 ml of apple juice and injected

through NG tube, then flushed with apple juice

Mode of Action: Suppresses gastric secretion by inhibiting hydrogen/potassium

ATPase enzyme system in gastric parietal cell; characterized as

gastric acid pump inhibitor, since it blocks final step of acid

production

Indication: gastroesophageal reflux disease (GERD), severe erosive

esophagitis, poorly responsive GERD, pathologic hypersecretory

conditions (Zollinger-Ellison syndrome, systemic mastocytosis,

multiple endocrine adenomas), possibly effective for treatment of

duodenal, gastric ulcers, maintenance of healed duodenal ulcers


Drug Interaction:

Delayed absorption with sucralfate

Decreases absorption of ketoconazole, itraconazole, ampicillin, iron, digoxin and

theophylline

Side Effect:

CNS: headache, dizziness, confusion, agitation, amnesia, depression

CV: chest pain, angina, tachycardia, bradycardia, palpitations,

hypertension/hypotension, vasodilation

EENT: tinnitus, taste perversion, deafness, eye pain, otitis media

GI: diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid

regurgitation, anorexia, irritable colon

GU: glycosuria, impotence, kidney calculus, breast enlargement

HEMA: anemia

INTEG: rash, urticaria, pruritus, alopecia

META: weight gain/loss, gout

RESP: upper respiratory infections, cough, epistaxis, asthma, bronchitis,

dyspnea

Adverse Effects:

CV: CVA, MI, shock

GU: hematuria

HEMA: hemolysis


Assess:

1. GI system: bowel sounds q8hours, abdomen for pain, swelling, anorexia

2. Hepatic studies: AST, ALT, alk phosphatase during treatment

Administer:

1. Capsules may be opened and mixed with food

Evaluate:

1. Therapeutic response: absence of epigastric pain, swelling, fullness


1. To report severe diarrhea; drug may have to be discontinued

2. To avoid salicylates, ibuprofen; may cause GI irritation

Generic Name: potassium chloride

Brand Name: Kalium durules, K-Sol

Classification: electrolyte, mineral replacement


Ordered Dose: As side drip: PNSS 80 cc + 40 meq

@ 10 cc/hour x 3 cycles

Kalium durules: 1 tab TID x 3 days

IV: 10 mg/liter (September 18, 2010)

Suggested Dose: PO: 40 – 100 meq in divided doses TID or QID

IV: 20 meq/hour when diluted as 40 meq/1000mL,

Not to exceed 150 meq/day

Mode of Action: needed for adequate transmission of nerve impulses and cardiac

contraction, renal function, intracellular ion maintenance

Indication: prevention and treatment of hypokalemia

Contraindication: severe renal disease, severe hemolytic disease, Addison’s

disease, hyperkalemia, acute dehydration, extensive tissue

breakdown

Drug Interaction:

Hyperkalemia with potassium phosphate IV and products containing calcium or

magnesium; potassium-sparing diuretics, or other potassium products, ACE

inhibitors

Side Effects:

CNS: confusion

CV: bradycardia

GI: nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel

GU: oliguria

INTEG: cold extremities, rash

Adverse Effects:

CV: cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and

depressed RST, prolonged P-R interval, widened QRS complex


Assess:

1. ECG for peaking T waves, lowered R, depressed RST, prolonged P-R

interval, widening QRS complex, hyperkalemia; drug should be reduced

or discontinued

2. Potassium level during treatment (3.5 – 5 mg/dl is normal level)

3. I&O ratio: watch for decreased urinary output; notify prescriber

immediately

4. Cardiac status: rate, rhythm, CVP, PWP, PAWP, if being monitored

directly

Administer:

1. If PO: with meal or pc; DO NOT GIVE IM, OR SQ

2. IV route: through large-bore needle to decrease vein inflammation; check

for extravasation

3. IV route: after diluting in large volume of IV solution and give as an

infusion, slowly by IV infusion to prevent toxicity, never give as an IV

bolus or IM

Perform/Provide:

1. Storage at room temperature

Evaluate:

1. Therapeutic response: absence of fatigue, muscle weakness, decreased

thirst and urinary output, cardiac changes


1. To avoid OTC products: antacids, salt substitutes, analgesics, vitamin

preparations, unless specifically directed by prescriber

2. To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea,

vomiting, fainting, decreased output) or continued hypokalemia symptoms

(fatigue, weakness, polyuria, polydipsia, cardiac changes)

3. To dissolve powder or tablet completely in at least 120 mL water or juice

Generic Name: dexamethasone

Brand Name: Decadron, Dexon, Hexadrol

Classification: corticosteroid


Ordered Dose: 10 mg IV now

5 mg q6hours

Shift to 4 mg/tab 1 tab TID (September 19, 2010)

4 mg/tab BID x 2 doses then d/c (September 21, 2010)

Suggested Dose: IV 10 mg, then 4-6 mg IM q6hours x 2-4 days, then taper over 1

week

Mode of Action: decreases inflammation by suppression of migration of

polymorphonuclear leukocytes, fibroblasts, reversal of increased

capillary permeability and lysosomal stabilization

Indication: inflammation, allergies, neoplasms, cerebral edema, septic shock,

collagen disorders

Contraindication: psychosis, hypersensitivity, idiopathic thrombocytopenia, acute

glomerulonephritis, amoebiasis, fungal infections, nonasthmatic

bronchial disease, children <2years old, AIDS, TB

Drug Interaction:

Decreased dexamethasone action with cholestyramine, colestipol, barbiturates,

rifampin, ephedrine, phenytoin, theophylline, antacids

Decreases effects of anticoagulants, anticonvulsants, antidiabetics,

ambenonium, neostigmine, isioniazid, toxoids, vaccines, anticholinesterases,

salicylates, somatrem

Increases side effects of alcohol, salicylates, indomethacin, amphotericin B,

digitalis, cyclosporine, diuretics

Increased dexamethasone action with salicylates, estrogens, indomethacin, oral

contraceptives, ketoconazole, macrolide antiinfectives

Side Effects:

CNS: depression, flushing, sweating, headache, mood changes, euphoria,

psychosis, insomnia

CV: hypertension, tachycardia, edema

EENT: fungal infections, increased intraocular pressure, blurred vision

ENDO: HPA suppression, hyperglycemia, sodium, fluid retention

GI: diarrhea, nausea, abdominal distention, increased appetite

INTEG: acne, poor wound healing, echymosis, petechiae, hirsutism

META: hypokalemia

MS: fractures, osteoporosis, weakness

Adverse Effects:

CNS: seizures

CV: circulatory collapse, thrombophelbitis, embolism

GI: GI hemorrhage, pancreatitis

HEMA: thrombocytopenia

Nursing Responsibilites:

Assess:

1. Potassium, blood, urine glucose; hypokalemia and hypoglycemia

2. Weight daily; notify prescriber of weekly gain >5 lbs

3. BP, q4 hours, pulse; notify prescriber of chest pain

4. I&O ratio; be aler for decreasing urinary output, increasing edema

5. Infection: fever, WBC even after withdrawal of medication; drug masks

infection

6. Potassium depletion: paresthesias, fatigue, nausea, vomiting, depression,

polyuria, dysrhythmias, weakness

7. Edema, hypertension, cardiac symptoms

8. Mental status: affect, mood, behavioral changes, aggression

Administer:

1. Titrated dose; use lowest effective dose

2. In one dose in AM to prevent adrenal suppression; avoid subcutaneous

administration, may damage tissue

3. With food or milk to decrease GI symptoms


1. Not to discontinue abruptly of adrenal crisis may result

2. Symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness,

dyspnea, weakness, joint pain

3. To avoid OTC products: salicylates, cold preparations unless directed by

prescriber

4. To teach patient in all aspects of drug usage, including cushingoid

symptoms; to notify health care provider of infection

5. Avoid exposure to patients with infection

Generic Name: ketorolac

Brand Name: Acular, Ketanov

Classification: nonsteroidal anti-inflammatory

nonopioid analgesic


Ordered Dose: 15 mg (1/2 cc) very slow IV q4hours

Suggested Dose: IV 30 mg; max of 60 mg/day x 5 days

Mode of Action: inhibits prostaglandin synthesis by decreasing an enzyme needed

for biosynthesis; analgesic, anti-inflammatory, antipyretic effects

Indication: mild to moderate pain

Contraindication: hypersensitivity, asthma, severe renal disease, severe hepatic

disease, peptic ulcer disease, lactation, CV bleeding

Drug Interaction:

Increases toxicity of methotrexate, lithium, cyclosporine

Increases bleeding risks of anticoagulants, cefemandole, cefoperazone,

cefotetan, clopidogrel, eptifibatide, plicamycin, salicylates, ticlodipine, tirofiban,

thrombolytics, valproic acid

Decreases effects of antihypertensives, diuretics

Increases renal impairment with ACE inhibitors

Increased ketorolac levels with aspirin, probenacid

Increased GI effects with steroids, alcohol, aspirin, NSAIDs, potassium products

Side Effects:

CNS: dizziness, drowsiness, tremors

CV: hypertension, flushing, syncope, pallor, edema, vasodilation

EENT: tinnitus, hearing loss, blurred vision

GI: nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry

mouth, peptic ulcer, taste change

HEMA: prolonged bleeding

INTEG: purpura, rash, pruritus, sweating

Adverse Effects:

GI: GI bleeding perforation

GU: nephrotoxicity: dysuria, hematuria, oliguria, azotemia

HEMA: blood dyscrasias


Assess:

1. Patients with aspirin sensitivity, asthma; May

2. be more likely to develop hypersensitivity to NSAIDs, monitor for

hypersensitivity

3. For pain: type, location, intensity, ROM before and one hour after

treatment

4. Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hbg before

treatment, periodically thereafter; check for dehydration

5. Bleeding times; check for bruising, bleeding; test for occult blood in urine

6. For eye, ear problems: blurred vision, tinnitus (may indicate toxicity)

7. Hepatic dysfunction: jaundice, yellow sclera and skin, clay-colored stools

8. Audiometric, ophthalmic exam before, during, after treatment

9. GI bleeding: blood in sputum, emesis, stools

Administer:

1. IM/IV for 5 days or less; continue therapy with PO

2. IV route: give undiluted over 15 seconds

Evaluate:

1. Therapeutic response: decreased pain, stiffness, swelling in joints, ability

to move more easily


1. To report changes in urine pattern, weight increase, edema, pain increase

in joints, fever, blood in urine (indicates nephrotoxicity)

2. To avoid other NSAIDs, salicylates, and acetaminophen

Generic Name: sodium bicarbonate

Brand Name: Bellans, Neut

Classification: alkalinizer


Ordered Dose: 100 mg IV bolus now (3:00 PM)

650 mg 1 tab TID

Suggested Dose: Metabolic acidosis: IV INF 2-5 meq/kg over 4-8 hours depending

on CO2, pH

Cardiac arrest: IV BOLUS 1 meq/kg of 7.5% or 8.4% solution,

then 0.5 meq/kg q10 mins, then doses based on ABGs

Antacid: PO 12 – 120 mg/kg/day (1-10 meq/kg)

Mode of Action: orally neutralizes gastric acid, which forms water, NaCl, CO2;

increases plasma bicarbonate, which buffers hydrogen ion

concentration; reverses acidosis IV

Indication: metabolic acidosis, cardiac arrest, systemic or urinary

alkalinization, antacid

Contraindication: hypertension, peptic ulcer, renal disease, hypocalcemia

Drug Interaction:

Increases effects of amphetamines, mecamylamine, quinine, quinidine,

pseudoephedrine, flecainide, anorexiants

Decreases effects of lithium, chlorpropamide, barbiturates, salicylates,

benzodiazepines

Increases sodium and decreases potassium levels when taken with

corticosteroids

Side Effects:

CNS: irritability, headache, confusion, stimulation, tremors, twitching,

hyperreflexia, weakness

CV: irregular pulse, water retention, edema, weight gain

GI: flatulence, belching, distention, acid rebound

GU: calculi

META: alkalosis

RESPI: shallow, slow respirations, cyanosis

Adverse Effects:

CNS: tetany, seizures of alakalosis

CV: cardiac arrest

GI: paralytic ileus

RESP: apnea


Assess:

1. RR, PR, rhythm, depth, lung sounds; notify prescriber of abnormalities

2. Fluid balance (I&O, weight daily, edema); notify prescriber of fluid

overload

3. Electrolytes, blood pH, PO2, HCO-3, during treatment; ABGs frequently

during emergencies

4. Urine pH, output, during beginning treatment

5. Extravasation with IV administration (tissue sloughing, ulceration, and

necrosis)

6. Weight daily with initial therapy

7. Alakalosis: irritability, confusion, twitching, hyperreflexia stimulation, slow

respirations, cyanosis, irregular pulse

8. Milk-alkali syndrome: confusion, headache, nausea, vomiting, anorexia,

urinary stones, hypercalcemia

9. For GI perforation secondary to CO2 in GI tract; may lead to perforation if

ulcer with severe enough

Administer:

1. IV: in prepared solution or diluted in an equal amount of compatible

solution given 2-5 meq/kg over 4-8 hours, not to exceed 50 meq/hour

Evaluate:

1. Therapeutic response: ABGs, electrolytes, blood pH, HCO-3


1. To take medication with 8 ounces of water

2. Not to give with milk or milk-alkali syndrome may result

3. Not to use for more than 2 weeks

4. To notify prescriber if indigestion is accompanied by chest pain, dyspnea,

diarrhea, dark, tarry stools

Generic Name: rebamipide

Brand Name: Mucosta

Classification: antiulcerant, cytoprotective


Ordered Dose: 100 mg TID

Suggested Dose: 1 tab tid, to be taken in the morning, evening & before bedtime

Mode of Action: It works by enhancing mucosal defense, scavenging free radicals,

and temporarily activating genes encoding cyclooxygenase-2

Indication: acute gastritis, acute exacerbation of chronic gastritis, PUD

Contraindication: lactation

Drug Interaction:

1. Rebamipide has shown no remarkable interaction with other drugs

Side Effects:

GI: nausea, vomiting, constipation, diarrhea

INTEG: rash

Adverse Effects:

INTEG: pruritus


Assess:

1. Gastric pH (>5 should be maintained)

2. Blood in stools, Hematemesis

3. Side Effects: n/v, pruritus, constipation, diarrhea; drug may have to be

discontinued

Administer:

1. On an empty stomach, 1 hour before meals and at bedtime

2. Do not crush or chew tablets; it can be broken or dissolved in water; do

not take antacids 30 minutes before or after taking the drug

3. With full glass of water to maintain adequate hydration

Evaluate:

1. Therapeutic response: absence of pain


1. To take on an empty stomach

2. To avoid antacids within ½ hours of taking the drug

http://en.wikipedia.org/wiki/Cyclooxygenase

Generic Name: fluconazole

Brand Name: Diflucan

Classification: systemic antifungal


Ordered Dose: 200 mg 1 tab OD

Suggested Dose: serious fungal infections: PO/IV 50 – 400 mg initially, then 200

mg daily for 4 weeks

oropharyngeal candidiasis: PO/IV 200 mg initially, then 200 mg

daily for 4 weeks

Mode of Action: inhibits ergosterol biosynthesis, causes direct damage to fungal

membrane phospholipids

Indication: oropharyngel candidiasis in AIDS patients, chronic

mucocutaneous candidiasis, systemic, vaginal, urinary

candidiasis, cyptococcal meningitis

Contraindication: hypersensitivity to azoles

Drug Interaction:

Decreases effects of oral contraceptives

Increases anticoagulant effect of warfarin

Increases plasma concentrations of cyclosporine, phenytoin, theophylline,

rifabutin, tacrolimus

Causes hypoglycemia with oral antidiabetics

Increases effect of zidovudine

Side Effects:

CNS: headache

GI: nausea, vomiting, diarrhea, cramping, flatus, increased AST, ALT

Adverse Effects:

GI: hepatotoxicity

INTEG: Steven-Johnson syndrome


Assess:

1. For infection: clearing of CSF and other culture during treatment, obtain

C&S baseline and throughout, drug may be started as soon as culture is

taken

2. For hepatotoxicity: increasing AST, ALT, periodically alk phophatase,

bilirubin

Administer:

1. IV: after diluting according to package directions; run at 200 mg/hour or

less; do not use plastic containers in connections; check bag for leaks

2. Using an infusion pump check for extravasation and necrosis q2hours

3. Do not use if cloudy or precipitated

Perform/provide:

1. Storage protected from moisture and light, diluted solutions is stable for

24 hours, do not freeze

Evaluate:

1. Therapeutic response: decreasing oral candidiasis, fever, malaise, rash


1. That long-term therapy may be needed to clear infection

2. That medication may be taken with food to reduce GI effects

3. To notify prescriber of nausea, vomiting, diarrhea, jaundice, anorexia,

clay-colored stools, dark urine

Generic Name: amlodipine

Brand Name: Norvasc

Classification: antianginal,

Antihypertensive,

Calcium-channel blocker


Ordered Dose: 5 g/tab, 1 tab now (9:40 PM)

Suggested Dose: PO 5-10 mg daily



muscle, peripheral vascular smooth muscle; dilates coronary

vascular arteries; increases myocardial oxygen delivery in patients

with vasospastic angina

Indication: chronic stable angina pectoris, hypertension, vasospastic angina

(Prinzmetal’s angina), may coadminister with other

antihypertensives, antianginals

Contraindication: sick sinus syndrome, 2nd or 3rd degree heart block, hypersensitivity

Drug Interaction:

Increased hypotension risk with alcohol, antihypertensives, nitrates

Neurotoxicity with lithium

Decreased antihypertensive effect with NSAIDs

Side Effects:

CNS: headache, fatigue, dizziness, anxiety, depression, insomnia, somnolence

CV: edema, bradycardia, hypotension, palpitations, syncope

GI: nausea, vomiting, diarrhea, gastric upset, constipation, flatulence, anorexia,

dyspepsia

GU: nocturia, polyuria


OTHER: flushing, muscle cramps, cough, weight gain, epistaxis

Adverse Effects:

CNS: asthenia, depression, paresthesia

CV: dysrhythmia

GI: gingival hyperplasia

INTEG: hair loss

OTHER: altered sexual activity, tinnitus, epistaxis


Assess

1. Cardiac Status: BP, PR, RR, ECG; some patients hav developed aevere

angina, acute MI after calcium channel blockers if obstructive CAD is

severe

2. I&O ratio, weight daily; peripheral edema, dyspnea, jugular vein

distention, crackles that are signs of CHF

Administer:

1. Once a day without regards to meals

Evaluate:

1. Therapeutic response: decreased BP


1. To take drug as prescribed, do not skip or double dose

2. To avoid OTC drugs and grapefruit juice unless directed by prescriber

3. To notify prescriber of irregular heartbeat, swelling of feet and hands,

hypotension

4. To use correct technique in monitoring pulse, to contact prescriber if CR

<50 bpm

5. To continue with good oral hygiene to prevent gingival disease

Treatment of overdose: defibrillation, beta-agonists, IV calcium inotropic agents,

diuretics, atropine for AV block, vasopressor for hypotension

Generic Name: furosemide

Brand Name: Lasix

Classification: loop diuretic


Ordered Dose: incorporate 20 mg with albumin drip

25% or 20% albumin

Suggested Dose: 20-40 mg, increase by 20 mg q2hours

until desired response

Mode of Action: inhibits reabsorption of sodium and chloride at proximal and distal

tubule and in the loop of Henle

Indication: pulmonary edema; edema in CHR, hepatic disease, nephritic

syndrome, ascites, hypertension

Contraindication: hypersensitivity to sulfonamides, anuria, hypovolemia, infants,

lactation, electrolyte depletion

Drug Interaction:

Increases toxicity of lithium, non-depolarizing skeletal muscle relaxants, digitalis

Increases hypotensive action of antihypertensives and nitrates

Increases ototoxicity of aminoglycosides, cisplatin and vancomycin

Side Effects:

CNS: headache, fatigue, weakness, vertigo, paresthesias

CV: orthostatic hypotension, chest pain, ECG changes

EENT: ear pain, blurred vision

ELECT: hypokalemia, hypochloremic alkalosis, hypomagnesaemia,

hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis

ENDO: hyperglycemia

GI: nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, oral, gastric

irritations, pancreatitis

GU: polyuria, glycosuria

INTEG: rash, pruritus, purpura, sweating, photosensitivity, urticaria

MS: cramps, stiffness

Adverse Effects:

CV: circulatory collapse

EENT: loss of hearing

BU: renal failure

HEMA: thrombocytopenia, agranulocytosis, leucopenia, neutropenia, anemia

INTEG: Steven-Johnsons syndrome


Assess:

1. Signs of metabolic alkalosis: drowsiness, restlessness

2. Signs of hypokalemia: postural hypotension, malaise, fatigue,

tachycardia, leg cramps, weakness

3. Rashes, temperature elevation daily

4. Confusion; take safety precautions if needed

5. Weight, I&O daily to determine fluid loss; effect of drug may be decreased

if used daily

6. Electrolytes (K, Na, Cl); include BUN, blood glucose, CBC, serum

creatinine, blood pH, ABGs, uric acid, calcium, magnesium

7. Skin turgor, edema, condition of mucous membranes in mouth and nose

8. Allergies to sulfonamides, thiazides

Administer:

1. Potassium replacement if potassium <3 mg/dl

2. IV: undiluted; may be given through Y-tube or 3-way stopcock; give 20

mg or less/min; may be added to NS or D5W if large doses are required

and given as IV inf, not to exceed 4 mg/min; use infusion pump


1. To discuss the need for a high-potassium diet or potassium replacement

with prescriber

2. To increase fluid intake to 2-3L/day unless contraindicated

3. To take food with milk for GI symptoms

4. To avoid OTC medications unless directed by prescriber

Treatment of overdose: monitor electrolytes; monitor hydration, CV, renal status;

administer dextrose in saline

Generic Name: mebendazole

Brand Name: Antiox, Mebrex

Classification: antihelminthic


Ordered Dose: 50 mg 1tab single dose

Suggested Dose: PO 100 mg as a single dose or bid x 3 days; course may be

repeated in 3 weeks if needed

Mode of Action: inhibits glucose uptake, degeneration of cytoplasmic microtubules

in the cell; interferes with absorption, secretory function

Indication: pinworms, roundworms, hookworms, thread-worms, pork

tapeworms, dwarf tapeworms, beef-tapeworms, hydatid cysts


Drug Interaction:

Decreased mebendazole effect with carbamazepine, hydantoins

Increased drug absorption with high fat meals

Side Effects:

CNS: fever, headache

GI: abdominal pain, nausea, vomiting

Adverse Effects:

CNS: dizziness

GI: transient diarrhea


Assess:

1. Stools during entire treatment; specimens must be sent to lab while still

warm, also 1-3 weeks after treatment is completed

2. For allergic reaction: rash (rare)

3. For diarrhea during expulsion of worms; avoid self-contamination with

patient’s feces

4. For infection in other family members, since infection from person to

person is common

5. Blood studies: AST, ALT, alk phosphatase, BUN; CBC during treatment

Administer:

1. May be crushed, swallowed, chewed or mixed with food

2. After meals to avoid GI symptoms, since absorption is not altered by food

3. Second course after 3 weeks if needed; usually recommended

Evaluate:

1. Therapeutic response: expulsion of worms and 3 negative stool cultures

after completion of treatment


1. Proper hygiene after BM, including hand-washing technique, tell patient to

avoid putting fingers in mouth; clean fingernails

2. That infected person should sleep alone; do not shake bed linen, change

bed linen daily, wash in hot water, change and wash undergarments daily

3. To clean toilet daily with disinfectant

4. The need for compliance with dosage schedule, duration of treatment

5. To wear shoes, wash all fruits and vegetables well before eating; use of

commercial fruit/vegetable cleaner

6. That all members of the family should be treated

Generic Name: phytonadione

Brand Name: Aquamephyton

Classification: vitamin K,

Fat-soluble vitamin


Ordered Dose: 1 drip IV now (5:50 PM)

Suggested Dose: PO/IM/SC 2.5-10 mg, may repeat 12-48 hours after PO dose or 6-

8 hours after SC/IM dose, based on PT

Mode of Action: needed for adequate blood clotting (factors II, VII, IX, X)

Indication: Vitamin K malabsorption, hypoprothrombinemia, prevention of

hypoprothrombinemia caused by oral anticoagulants, prevention

of hemorrhagic disease of the newborn

Contraindication: hypersensitivity, severe hepatic disease, last few weeks of

pregnancy

Drug Interaction:

Decreased phytonadione action with choletyramine, mineral oil

Decreased action of oral anticoagulants

Side Effects:

CNS: headache

GI: nausea, decreased LFTs


Adverse Effects:

CNS: brain damage (in large doses)

HEMA: hemolytic anemia, hemoglobinuria, hyperbilirubinemia


Assess:

1. For bleeding: emesis, stools, urine

2. PT during treatment (2-sec deviation from control time, bleeding time, and

clotting time); monitor for bleeding, PR, and BP

3. Nutritional status

Administer:

1. IV: after diluting with D5NSS 10 mL or more; give 1 mg/min or more

2. IV only when other routes are not possible (deaths have occurred)

Perform/provide:

1. Storage in tight, light-resistant container

Evaluate:

1. Therapeutic response: decreased bleeding tendencies, decreased PT,

decreased clotting time


1. Not to take other supplements unless directed by prescriber

2. To avoid IM injection, use soft toothbrush, do not floss, use electric razor

until coagulation defect corrected

3. To report symptoms of bleeding

4. Not to use OTC medications unless approved by prescriber

5. The importance of frequent lab tests to monitor coagulation factors

Generic Name: tranexamic acid

Brand Name: Lysteda, Transamin

Classification: haemostatic


Ordered Dose: 1 gm now then 500 mg IV q8hours

Decreased to PRN for bleeding (September 23, 2010)

Suggested Dose: IV Short-term management of haemorrhage 0.5-1 g 3 times/day

Mode of Action: Tranexamic acid is an antifibrinolytic agent that competitively

inhibits breakdown of fibrin clots. It blocks binding of plasminogen

and plasmin to fibrin, thereby preventing haemostatic plug

dissolution.

Indication: short-term management of hemorrhage, long-term management

for hereditary angioedema

Contraindication: Severe renal failure, active intravascular clotting, thromboembolic

disease, colour vision disorders, subarachnoid bleeding

Drug Interaction:

Tranexamic acid causes additive toxicity with retinoic acid

Tranexamic acid causes additive toxicity with tretinoin

Tranexamic acid causes additive toxicity with tretinoin tocoferil

Increased risk of thrombus formation with estrogens, Factor IX complex

concentrates or anti-inhibitor coagulant concentrates. Increased risk of fatal

thrombotic complications with tretinoin in acute promyelocytic leukaemia.

Side Effects:

CNS: giddiness

GI: Diarrhea, nausea, vomiting

CV: hypotension (after rapid IV injection)

Adverse Effects:

CNS: disturbances in color vision

CV: thromboembolic events


Assess:

http://www.mims.com/Page.aspx?menuid=alertr&Druglist=tranexamic+acid**tretinoin**

1. Blood studies

2. I&O, urine color; notify precriber if urine becomes orange, red

3. Bleeding: ankles, knees, elbows, other joints

Evaluate:

1. Therapeutic response: absence of bleeding


1. To report any signs of bleeding: gums, under skin, urine, stools, emesis;

review methods to prevent bleeding

2. To avoid salicylates, NSAIDs (increase bleeding tendencies)

Generic Name: verapamil

Brand Name: Calan, Isoptin


Antihypertensive

Antianginal


Ordered Dose: 5 g IVTT now (11:45 AM)

5 g IVTT now (September 22, 2010)

Suggested Dose: dysrhythmia: IV BOL 5-10 mg over 2 minutes, may repeat 10 mg

½ hour after 1st dose

Hypertension: PO 80 mg TID, may titrate upward



muscle; dilates coronary arteries; decreases SA/AV node

conduction; dilates peripheral arteries

Indication: chronic stable, vasospastic, unstable angina; dysrhythmias,

hypertension, supraventricular tachycardia, atrial flutter or

fibrillation

Contraindication: sick sinus syndrome, 2nd or 3rd degree heart block, hypotension of

<90 mmHg systolic, cardiogenic shock, severe CHF

Drug Interaction:

Increased hypotension with prazosin, quinidine

Increased effects of verapamil with beta-blockers, antihypertensives, cimetidine

Decreased effects of lithium

Increases levels of digoxin, theophylline, cyclosporine, carbamazepine,

nondepolarizing muscle relaxants

Side Effects:

CNS: headache, drowsiness, dizziness, anxiety,depression, weakness,

insomnia, confusion, light-headedness, asthenia, fatigue

CV: edema, bradycardia, hypotension, palpitations, AV block

GI: nausea, diarrhea, gastric upset, constipation

GU: impotence, nocturia, polyuria

INTEG: rash

Adverse Effects:

CV: CHF

SYST: Steven-Johnson syndrome


Assess:

1. Cardiac status: BP, PR, RR, ECG intervals (PR, QRS, QT)

2. I&O ratios, weight daily, CHF: crackles, weight gain, dyspnea,

jugular vein distention

Administer:

1. IV: undiluted through the Y-tube or 3-way stopcock of compatible

solution; giver over 2 minutes, discard unused solution

Evaluate:

1. Therapeutic response: decreased BP, dysrhythmias


1. To increase fluids/fiber to counteract constipation

2. How to take pulse before taking drug; to keep record or graph


Treatment of overdose: defibrillation, atropine for AV block, vasopressor for

hypotension

Generic Name: calcium gluconate

Brand Name: Calcium Gluconate

Classification: mineral replacement –

calcium product


Ordered Dose: 1 amp + 100 cc PNSS slow IVTT

Suggested Dose: 0.5-2g at 0.5mL/min (10% solution); max IV dose of 3 g

Mode of Action: Cation needed for maintenance of nervous, muscular, skeletal

function, enzyme reactions, normal cardiac contractility,

coagulation of blood; affects secretory activity of endocrine,

exocrine glands

Indication: prevention and treatment of hypocalcemia, hypermagnesemia,

hypoparathyroidism, neonatal tetany, cardiac toxicity caused by

hyperkalemia, lead colic, hyperphophatemia, vitamin D deficiency,

osteoporosis prophylaxis, calcium antagonist toxicity (calcium

channel blocker toxicity)

Contraindication: hypercalcemia, digitalis toxicity, ventricular fibrillation, renal calculi

Drug Interaction:

Dysrhythmias with digitalis glycoside

Decreases effects of atenolol, verapamil

Increases toxicity of verapamil

Milk-alkali syndrome with antacids

Decreases absorption of fluoroquinolones, tetracyclines, iron salts

Side Effects:

CV: shortened QT, hypotension, bradycardia

GI: vomiting, nausea, constipation

HYPERCALCEMIA: drowsiness, lethargy, muscle weakness, headache,

constipation, anorexia, nausea, vomiting, polyuria, thirst

INTEG: pain, burning at IV site, severe venous thrombosis, necrosis,

extravasation

Adverse Effects:

CV: heart block, dysrhythmias, cardiac arrest (IV)

HYPERCALCEMIA: coma


Assess:

1. ECG for decreased QT and T wave inversion: hypercalcemia, drug

should be reduced or discontinued, consider cardiac monitoring

2. Calcium levels during treatment (8.5-11.5 g/dL is normal level)

3. Cardiac status: rate, rhythm, CVP (PWP, PAWP if being monitored

directly)

Administer:

1. IV: undiluted or diluted with equal amounts of NSS to a 5% soluction for

injection, give 0.5-1 ml/min

2. Through small-bore needle into large vein; if extravasation occurs,

necrosis will result

Perform/provide:

1. Seizure precautions: padded side rails, decreased stimuli (noise, light);

place airway suction equipment, padded mouth gag if Calcium levels are

low


1. To remain recumbent ½ hour after IV dose

2. To prevent injuries, avoid immobilization

Generic Name: calcium polystyrene sulfonate

Brand Name: Kalimate

Classification: electrolytes


Ordered Dose: 3 sachets TID x 3 doses (4:10)

Suggested Dose: Adult 15-30 g PO bid-tid, or 30 g by rectal route suspended in 100

mL water or 2% methylcellulose soln & left in the intestinal tract for

30 min-1 hr

Mode of Action: After administration of Kalimate via oral or rectal route, calcium ion

of Kalimate is exchanged for potassium ion in the intestinal tract,

particularly around the colon, and Kalimate is excreted as

unchanged polystyrene sulfonate resin into the feces without

digestion and absorption. In consequence, potassium in the

intestinal tract is excreted outside the body

Indication: hyperkalemia from acute or chronic renal failure

Contraindication: patients with intestinal obstruction, stenosis or constipation

Drug Interaction:

Enhanced digitalis intoxication effect

Reduced effect of antacids containing aluminum, magnesium, or calcium

Coadministration with aluminum hydroxide, magnesium hydroxide and

precipitated calcium carbonate can cause systemic alkalosis

Side Effects:

GI: constipation, nausea, anorexia, stomach discomfort

ELEC: hypopotassemia

Adverse Effects:

GI: perforation


Assess:

1. ECG for decreased QT and T wave inversion: hypercalcemia, drug

should be reduced or discontinued, consider cardiac monitoring

2. Calcium levels during treatment (8.5-11.5 g/dL is normal level)

3. For hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea,



Administer:

1. With full glass of water

Perform/provide:

1. Seizure precautions: padded side rails, decreased stimuli (noise, light);

place airway suction equipment, padded mouth gag if Calcium levels are

low


4. To avoid OTC products: antacids, salt substitutes, analgesics, vitamin

preparations, unless specifically directed by prescriber

5. To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea,



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