NUR 434V – Med list For CoA- common medications drug list

NUR 434V – Med list For CoA- common medications drug list

Med list For CoA- common medications drug list
 
Acetaminophen (Tylenol)

Adult dose: The FDA limits total daily doses to 4000 mg; however the manufacturer of Tylenol suggests a limit of 3000mg per day pts with liver disease or chronic alcohol consumption are advised not to exceed 2000mg per day.
Class: Nonopioid analgesics
MOA: It blocks peripheral pain impulses by inhibition of prostaglandin synthesis Also lowers febrile body temperatures by acting on the hypothalamus, the structure in the brain that regulates body temperature.
Major side effects: blood disorders or dyscrasias (anemia’s), and nephrotoxicity’s, and hepatotoxicity’s (most serious), more common: skin disorders, N/V
Nursing considerations: allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, and lactation. Skin color, lesions.
Therapeutic monitoring: CBC, renal function and trough levels

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Acetaminophen/Hydrocodone  (Vicodin)

Adult dose: 325mg/2.5mg, 300mg/5mg
Class: Analgesics, Opioid combo
MOA: Acetaminophen- Acts on the hypothalamus to produce antipyresis; inhibits prostaglandin synthesis
Hydrocodone- Opioid analgesic agonist; blocks pain perception in the cerebral cortex; decreases synaptic chemical transmission throughout the CNS, which in turn inhibits pain sensation into higher centers
Major side effects: Hallucinations, bradycardia, confusion, dizziness, drowsiness, fatigue
Nursing considerations: Black box warning for addiction, abuse, and misuse. Long acting hydrocodone exposes pts and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death
Therapeutic effect: HR, CBC, renal and kidney function

 
Amlodipine (370)

Adult dose: 5-10mg a day
Class: Calcium Channel Blocker
MOA: Calcium plays a major role in excitation-contraction of the heart/smooth/skeletal muscles. When blocked this causes relaxation of the muscles and therefore causes coronary arteries to dilate this increases blood flow to the ischemic heart, which in turn increases oxygen supply an helps shift demand ratio back to normal.
Major side effects: Hypotension, palpitations, tachycardia/bradycardia, constipation, nausea, dyspnea, rash, flushing, peripheral edema
Nursing considerations: contraindicated with grapefruit juice also a Look like sound alike drug
Therapeutic monitoring: moniter bp at baseline and then periodically

 
Ampicillin (608)

Adult dose: 1-12g/day divided every 4-6 hours
Class: Aminopenicillin (antibiotic)
MOA: Involves the inhibition of bacterial cell wall synthesis. Once distributed by the pts bloodstream to infected areas, penicillin molecules slide through bacterial cell walls to get to their site of action. Some are too large to pass through openings. Some bacteria make the openings to their cell walls small so penicillin can’t get through to kill them. Once they do get through they bind to appropriate sites (penicillin-binding proteins). The molecules then interfere with normal cell wall synthesis, causing formation if defective cell walls that are unstable and easily broken down.
Major side effects: Anaphylaxis, C. difficile colitis, erythema multiform (Steven Johnson syndrome- life threatening skin reaction), N/V, thrush, yeast infection, rash, eosinophilia
Nursing considerations: Many pts have a drug allergy to this medication and it is important to figure out the type of reaction the pts experience to this medication
Therapeutic monitoring: CBC and renal function

 
Aspirin (420)

Adult dose: 81-325mg once daily
Class: antiplatelet
MOA: Aspirin inhibits cyclooxygenase in the platelet irreversibly so that the platelet cannot regenerate this enzyme. Therefore, the effects of aspirin last the lifespan of a platelet (7 days). This irreversible inhibition of cyclooxygenase in the platelet prevents the formation of TXA2, a substance that causes blood vessels to constrict and platelets to aggregate. Thus, by preventing TXA2 formation, aspirin prevents these actions, which results in the dilation of the blood vessels and prevention of platelets from aggregating or forming a clot.
Major side effects: Drowsiness, dizziness, confusion, flushing, N/V, gastrointestinal bleeding, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, bleeding
Nursing considerations: Do not give to pts with thrombocytopenia, leukemia, active bleeding, traumatic injury GI ulcer, vitamin K deficiency or any pt who has had a recent stroke.
Therapeutic monitoring: CBC, renal and liver function as well as ototoxicity

Atorvastatin (442)  statin

Adult dose: 10-80mg/day
Class: Antilipemic- HMG-COA reductase inhibitors
MOA: Lower the blood cholesterol level by decreasing the rate of cholesterol production. The liver requires HMG-CoA reductase to produce cholesterol. The statins inhibit this enzyme, thereby decreasing cholesterol. The statins inhibit this enzyme thereby decreasing cholesterol production. When less cholesterol is produced, the liver increases the number of LDL receptors to recycle LDL from the circulation back into the liver where it is needed for the synthesis of other required substances such as steroids, bile acids, and cell membranes.
Major Side Effects: mumyopathy (muscle pain), rhabdomyolysis (breakdown of muscle protein), myoglobinuria (urinary elimination of the muscle protein myoglobin), renal failure, death, headache, dizziness, blurred vision, fatigue, constipation, diarrhea, skin rashes.
Nursing considerations: pregnancy category X drug. Once a day doses usually with the evening meal or at bedtime.
Therapeutic monitoring: cholesterol and triglyceride levels as well as liver function

 
Carvedilol (315)

Adult dose: 6.25- 100mg/day
Class: Adrenergic blocking- Beta Blocker
MOA: Block SNS stimulation of the beta-adrenergic receptors by competing with norepi and epi. It has many effects including acting as a non selective beta blocker, an alpha1 blocker, a calcium channel blocker and even an antioxidant. Used primarily in the treatment of heart failure but also beneficial for hypertension and angina.
Major side effects: MI, rebound hypertension, chest pain, irregular heart beat, difficulty breathing/swallowing, and fainting.
Nursing considerations: do not suddenly discontinue medication. Stand up slowly from sitting or lying
Therapeutic monitoring: BP, HR, kidney function

 
Chlordiazepoxide (253)

Adult dose: 5-10mg (mild-moderate pain) 20-25 for severe anxiety
Class: Benzodiazepine- Anxiolytic
MOA: Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through the GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane
Major side Effects: Memory impairment, muscle weakness, drowsiness, ataxia, sedation, confusion, dizziness
Nursing considerations: Black box warning- concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation
Therapeutic Effects: BP, HR

 
Ciprofloxacin (628)

Adult dose: PO-250-750mg every 12 hr. IV- 200-400mg every 8-12 hr. IV/PO- 250-750 mg once daily
Class: Antibiotic- Fluoroquinolone
MOA: Destroy bacteria by altering their DNA. First broad coverage, potent quinolones to become available. Capable of killing a wide range of gram-negative bacteria. Can kill some anaerobic bacteria as well as atypical organisms such as chlamydia, mycoplasma, and mycobacterium. Also drug of choice for the tx of anthrax.
Major side effects: bacteria overgrowth, prolongation of QT intervals, pins and needles
Nursing considerations: Black box warning for increased tendinitis and tendon rupture with use. Can cause peripheral neuropathy, avoid milk produces and antiacids
Therapeutic monitoring: Liver function, CBC, and renal function

 
Clopidogrel (420) Plavix

Adult dose: 75mg once daily
Class: coagulation modifier (ADP Inhibitor)- Antiplatelet
MOA: It works by altering the platelet membrane so that it can no longer receive the signal to aggravate to form a clot. This signal is in the form of fibrinogen molecules, which attach to glycoprotein receptors on the surface of the platelet. Clopidogrel inhibits the activation of this receptor.
Major side effects: chest pain, edema, flu like symptoms, abdominal pain, headache, dizziness, serious bleeding episode.
Nursing considerations: It must be avoided in patients taking more than 100mg of aspirin daily, It is indicated in pts with acute coronary syndrome. Do not suddenly discontinue. Bruising or bleeding is more common.
Therapeutic monitoring: CBC, liver and kidney function,

 
Dextrose 5% (500/877)

Adult dose: IV- 10-25 g. PO- 4-20g as a single dose
Class:
MOA: Parenteral dextrose is oxidized to carbon dioxide and water, and provides 3.4 cal/g of d-glucose
Major side effects: Hyperosmolality, edema, venous thrombosis, and fever
Nursing considerations: Use with caution in pts with DM
Therapeutic monitoring: glucose levels, monitor electrolytes

 
Docusate Sodium (Colace) (821)

Adult dose: 50-300mg/day
Class: Laxitives- Fecal softner, emollient laxative
MOA: Lower the surface tension of GI fluids, so that more water and fat are absorbed into the stool and the intestines. The lubricant type works by lubricating the fecal material and the intestinal wall and preventing absorption of water from the intestines. Instead of being absorbed, this water in the bowel softens and expands the stool. This promotes bowel distention and reflex peristaltic actions, which ultimately lead to defecation.
Major side effects: Electrolyte imbalances, skin rashes, lipid pneumonia, difficulty breathing, and swelling of mouth/face/lips, rash or hives.
Nursing Considerations: caution use in the following: acute surgical abdomen, appendicitis, symptoms such as abdominal pain, nausea and vomiting; fecal impaction, intestinal obstruction and undiagnosed abdominal pain.
Therapeutic Effect: monitor intake and output closely. Type of stool.

 
Enalapril (350)

Adult dose: 2.5-5 mg/day and increase to target dose of 10-40 mg/day as a single does or in two equal doses
Class: Antihypertensive- ACE inhibitor
MOA: Inhibit the angiotensin converting enzyme which converts angio1 to angio2. A2 is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone stimulates sodium and water reabsorption which can raise blood pressure by inhibiting this process, blood pressure is lowered.
Major side effects: fatigue, dizziness, mood changes, headaches, angioedema, and fainting, dry cough
Nursing considerations: Report any signs of fever or a sore throat to your doctor who may carry out further tests to ensure it is not neutropenia (a decrease in white blood cells). Look alike sound alike drug.
Therapeutic effect: Kidney and renal function, CBC, BP, blood sugar if diabetic

 
Enoxaparin Sodium (414/415) levonix-low molecular weight heprin

Adult dose: Subcut: 30 mg/ 12 hr or 40 mg/day
Class: Coagulation modifier- Anticoagulant
MOA: An antithrombotic that inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III
Major side effects: Elevation of serum aminotransferases, Fever, hemorrhage, thrombocytopenia
Nursing considerations: Black box warning for pts receiving epidural or spinal hematoma, Pts should be frequently monitored for signs and symptoms of neurologic impairment (tingling, numbness, muscular weakness)
Therapeutic Effect: Serum aminotransferases, CBC

 
Ferrous Sulfate (864-866)

Adult dose: 3-4 tablets daily
Class: Anemia- Iron
MOA: oxygen carrier in both hemoglobin and myoglobin and is critical for tissue respiration. Corrects iron deficiency symptoms.
Major side effects: N/V, diarrhea, constipation, cramps, stomach pain, temporary discoloration of teeth and eyes.
Nursing considerations: Educate the pt on keeping the medication out of the reach from children considering they look like candy. Take w ascorbic acid (orange juice) aniacids or calcium might cause black, tarey stool
Therapeutic Effect: iron levels

 
Furosemide (455) lasix

Adult dose: IM/IV- 20-40 mg/dose. PO-20-120 mg/day
Class: Loop diuretic
MOA: have renal cardiovascular and metabolic effects. Theses drugs act primarily along the thick ascending limb of the loop of Henle blocking chloride and secondarily sodium resorption. Activate renal prostaglandins, which results in dilation of the blood vessels of the kidneys lugs and rest of the body. Useful in the treatment of edema associated with heart failure hepatic cirrhosis and renal disease.
Major side effects: Hypokalemia, thrombocytopenia, agranulocytosis, leukopenia, and neutropenia, and steven-johnsons syndrome (severe skin disorder)
Nursing considerations: If pt has diabetes this medication may increase serum glucose levels. Stand up slowly.
Therapeutic Effect: CBC, potassium levels, all electrolyte levels, uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase.

Gabapentin 

PO: 900-3600 mg/day
Antiepileptic drugs: Miscellaneous
Mechanism of Action: A chemical analogue of GABA, a neurotransmitter that inhibits brain activity. Exact MOA is not known with certainty, but is believed to work by increasing the synthesis and synaptic accumulation of GABA between neurons.
Major side effects: Dizziness, drowsiness, nausea, visual and speech changes, edema.
Nursing Considerations: Airway maintenance is critical because the tongue relaxes during seizure activity, falling backward and blocking the airway. Intake of alcohol and caffeine are to be avoided, as is smoking.
Close monitoring of dosing is important to attain therapeutic blood levels. For example, if an antiepileptic drug is ordered to be administered every 6 hours, it is crucial to dose the drug so that it is given around the clock to maintain blood levels

 
Glucophage 

PO: IR: 500-1000 mg bid (max dose 2550 mg/day)
Oral Antidiabetic drug: Biguanide
Mechanism of Action: Decreasing glucose production by the liver. It may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity
Major Side Effects: Abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea-especially at the start of therapy.
Nursing Considerations: Metformin with iodinated radiologic contrast media has been associated with both acute renal failure and lactic acidosis. For these reasons, metformin therapy is to be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.
Therapeutic Monitoring: Monitor blood glucose levels.

Heparin 

Prophylaxis: Subcut: 5000 units every 8-12 hour. Treatment: IV infusion: 80 unit/kg bolus, then 18 units/kg/hr (depending on indication)
Anticoagulant Drug
Mechanism of Action: Heparin works by binding to a substance called anti-thrombin III, which turns off three main activating factors: activated factor II (also called thrombin), activated factor X, and activated factor IX. Of these, thrombin is the most sensitive to the actions of heparin. Anti-thrombin III is the major natural inhibitor of thrombin in the blood. The overall effect of heparin is that it turns off the coagulation pathway and prevents clots from forming.
Major Side Effects: Bleeding is a main complication of anticoagulation therapy. Hematoma, anemia, thrombocytopenia. Heparin induced thrombocytopenia (HIT). There are two types of HIT. Type I is characterized by a more gradual reduction in platelets. In this type, heparin therapy can generally be continued. In contrast, in type II HIT there is an acute fall in the number of platelets. Heparin therapy must be discontinued in patients with type II HIT.
Nursing Considerations: Avoid any area within 2 inches of the umbilicus, open wounds, scars, open or abraded areas, incisions, drainage tubes, stomas, or areas of bruising or oozing. These sites would be at higher risk for further tissue damage with injection of the anticoagulant.
Therapeutic Monitoring: Protamine sulfate for toxicity of heparin. aPTT, PT, and INR. *** aPTT levels are measured with heparin, and PT and INR are measured with warfarin.

Hydromorphone 

IV/IM: 0.25-1mg IV every 4-6hr prn. Oral: 2-4 mg PO every 6 hr prn.
Opioid analgesic
Mechanism of Action: The mechanism of action of hydromorphone is as a Full Opioid Agonist. Hydromorphone is the hydrogenated ketone of morphine, a semi-synthetic opioid with analgesic effects. Hydromorphone selectively binds the mu-opioid receptor which is linked through G-proteins.
Major Side Effects: Hypotension, flushing, bradycardia, sedation, disorientation, euphoria, lightheadedness, nausea, vomiting, constipation, itching, rash, resp. depression, and possible aggravation of asthma. ****MOST serious effect of opioid use is CNS depression, which may lead to respiratory depression.
Nursing Considerations: 7 times more potent than morphine. 1 mg hydromorphone= 7 mg morphine. ABCs. Not to be used with alcohol or other CNS depressants.
Therapeutic Monitoring: Naloxone, naltrexone-reverses analgesia as well as CNS depressant effects, such as respiratory depression.

Ibuprofen 

1200-3200mg/day divided 3-4 times daily
One of the most commonly used NSAID: Propionic acid derivative
Mechanism of Action: Work through inhibition of the leukotriene pathway, or both. More specifically, NSAIDs relieve pain, headache, and inflammation by blocking the chemical activity of the enzyme called cyclooxygenase (COX)
Major Side Effects: GI intolerance, bleeding (often GI bleeding) and renal impairment. May cause anaphylaxis. Therapy should be discontinued after first sign of rash
Therapeutic Monitoring: Monitor renal and liver labs. Patient should avoid using alcohol instruct the patient that these drugs, if in sustained release or enteric coated dosage forms- are NOT to be crushed or chewed

Insulin-rapid action (Insulin lispro) 

Subcut: 0.5-1 unit/kg/day; doses are individualized to desired glycemic control; rapid acting insulins are best given at least 15 min before a meal. May be given per sliding scale or as a basal/bolus; may also be given via continuous subcutaneous infusion pump.
Human recombinant. Rapid-acting insulin analogue
Mechanism of Action: Restores the patients’ ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores.
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Give at least 15 minutes before meals & only after monitoring the patients fasting serum glucose level. Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-short action (Regular Insulin) 

Subcut: Same dosage as insulin lispro; subcut doses of regular insulin are best given 30 mins before a meal. Regular insulin may also be given per sliding scale or basal/bolus and is the insulin usually given IV as continuous infusion
Human recombinant. Short-acting insulin
Mechanism of Action: Restores the patient’s ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major side effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-intermediate action (Insulin isophane suspension (NPH)) 

Mechanism of Action: Restores the patients ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: ***Do not shake NPH (cloudy) and premixed insulin mixtures, but roll them between the hands before administering the prescribed dose. Onset of action of 1-2 hours, so serve meals at least 30-45 mins prior to its administration. Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration. Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Insulin-long action. Insulin glargine 

Subcut only: 0.2 units/kg/day given once or twice daily. (basal dosing)
Human Recombinant long acting insulin analogue
Mechanism of Action: Restores the patients ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores
Major Side Effects: Hypoglycemia resulting from excessive insulin dosing can result in brain damage, shock, and possible death. (MOST SERIOUS ADVERSE EFFECT OF INSULIN) weight gain, lipodystrophy at the site of repeated injections, and in rare cases allergic reactions.
Nursing Considerations: Insulin is to NEVER be administered to an already hypoglycemic patient. Blood glucose must ALWAYS be tested prior to administration Administer subQ at a 90 degree angle, unless the patient is emaciated, in which case you may give the insulin at a 45 degree angle. Rotate sites within the same general location for about 1 week before moving to a new location (e.g. all injections for a week in the upper right thigh before moving a little lower on the right thigh) This technique allows for better insulin absorption.
Therapeutic Monitoring: Blood glucose levels. Fasting blood glucose level of 70 to 130 mg/dL and or higher hemoglobin A1C less than 7% for the diabetic patient

Lactated Ringer’s 

This solution is for intravenous use only. Dosage is to be directed by a physician and is dependent upon age, weight, clinical condition of the patient and laboratory determinations. Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy.
Mechanism of Action: Lactated Ringer’s is a sterile solution for fluid and electrolyte replenishment. It restores fluid and electrolyte balances, produces diuresis, and acts as alkalizing agent (reduces acidity)
Major side effects: chest pain, abnormal heart rate, decreased blood pressure, troubled breathing, cough, sneezing, rash, itching, and headache.
Nursing Considerations: Solutions containing lactate are not for use in the treatment of lactic acidosis. Solutions containing lactate should be used with great care in patients with metabolic
or respiratory alkalosis, and in those conditions in which there is an increased level or an impaired utilization of lactate, such as severe hepatic insufficiency.
Therapeutic Monitoring: Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation. Significant deviations from normal concentrations may require tailoring of the electrolyte pattern, in this or an alternative solution.

Lactulose 

PO: 15-30 ml daily or twice daily
Hyperosmotic laxative
Mechanism of Action: Work by increasing fecal water content, which results in distention, increased peristalsis, and evacuation. Their site of action is limited to the large intestine
Major side effects: Abdominal bloating, rectal irritation, electrolyte imbalances
Nursing Considerations: Contraindicated in patients on a low-lactose diet. May be taken with juice, milk, or water to increase palatability
Therapeutic Monitoring: Assess baseline fluid and electrolyte levels to identify any deficits prior to use.

Lanoxin (Digoxin) 

PO/IV: Loading dose: PO 10-15mcg/kg or IV 8-12 mcg/kg divided into 3 doses; usual oral maintenance dose: 0.125-0.25 mg/day
Digitalis Cardiac Glycoside
Mechanism of Action: The beneficial effect of Dig is thought to be an increase in myocardial contractility-known as positive inotropic effect. This occurs secondarily to the inhibition of the sodium potassium adenosine triphosphate pump. When the action of this enzyme complex is inhibited, the cellular sodium and calcium concentrations increase. The overall result is enhanced myocardial contractility. Enhance cardiac efficiency and output.
Major Side Effects: Bradycardia or tachycardia
Nursing Considerations: Indicated for the treatment of heart failure and atrial fib and flutter. Before administering any dose of Dig, check the serum potassium and mag levels to be sure they are within normal limits to help prevent toxicity. May be administered with meals, but not meals high in fiber because the fiber will bind to the digitalis and lead to altered absorption/bioavailability of the drug.
Therapeutic Monitoring: Low therapeutic index. Dig levels are monitored when the patient first starts taking the drug. 0.5-2 ng/mL (normal therapeutic levels) Frequent monitoring of electrolytes. Toxicity- therapy is digoxin immune Fab.

Levothyroxine sodium 

PO: 25-200 mcg/day. IM/IV: 50% of oral dose. IV: 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary; continue 75-100 mcg/day until changed to oral dosing.
Synthetic thyroid hormone (T4)
Mechanism of Action: At the cellular level, they work to induce changes in the metabolic rate, including the rate of protein, carbohydrate, and lipid metabolism, and to increase oxygen consumption, body temp, blood volume, and overall cellular growth and differentiation. They also stimulate the CV system by increasing the number of myocardial beta-adrenergic receptors. This in turn increases the sensitivity of the heart to catecholamine’s and ultimately increased cardiac output. In addition, thyroid hormones increase renal blood flow and the glomerular filtration rate, which results in diuretic effect.
Major Side Effects: The most significant adverse effect is cardiac dysrhythmia with the risk for life threatening or fatal irregularities. Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, cramps, etc.
Nursing Considerations: Assess levels of T3, T4 and TSH before and during therapy as ordered. When administered, it is important that the drug be given at the same time every day to help maintain consistent blood levels of the drug. ***Extremely important to take in the morning and on an empty stomach, preferably at least 30 mins before breakfast. Avoid taking these drugs with vitamins or supplements containing iron and or calcium within a 4 hour time frame. Antacids and OTC preparations with iodine must also be avoided.
Therapeutic Monitoring: monitoring of serum TSH and free thyroid hormone levels are required to determine the appropriate dose of thyroid replacement drugs Patients need to report the occurrence of excitability, irritability, or palpitations to the prescriber because these symptoms may indicate toxicity.

Lorazepam 

The usual range is 2 to 6 mg/day given in divided doses, the largest dose being taken before bedtime, but the daily dosage may vary from 1 to 10 mg/day.
For anxiety, most patients require an initial dose of 2 to 3 mg/day given b.i.d. or t.i.d.
Antianxiety Agents, Benzos, Anxiolytics, Anticonvulsants.
Mechanism of Action: Lorazepam is a benzodiazepine with anxiolytic, anti-anxiety, anticonvulsant, anti-emetic and sedative properties. Lorazepam enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid on the GABA receptors by binding to a site that is distinct from the GABA binding site in the central nervous system. This leads to an increase in chloride channel opening events, a facilitation of chloride ion conductance, membrane hyperpolarization, and eventually inhibition of the transmission of nerve signals, thereby decreasing nervous excitation. Major Side Effects: Drowsiness, Dizziness, Tiredness, Muscle weakness, Headache, Blurred vision, Sleep problems (insomnia), Loss of balance or coordination, Forgetfulness or amnesia, Difficulty concentrating, Nausea, Vomiting, Constipation, Changes in appetite, Skin rash.
Nursing Considerations: In general, benzodiazepines should be prescribed for short periods only (e.g., 2 to 4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continuous long-term use of product is not recommended. Withdrawal symptoms (e.g., rebound insomnia) can appear following cessation of recommended doses after as little as one week of
Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy. Ativan (lorazepam) is not recommended for use in patients with a primary depressive disorder or psychosis.
Therapeutic Monitoring: Lorazepam should be used with caution in patients with compromised respiratory function (e.g. COPD, sleep apnea syndrome). Elderly or debilitated patients may be more susceptible to the sedative effects of lorazepam. Therefore, these patients should be monitored frequently and have their dosage adjusted carefully according to patient response; the initial dosage should not exceed 2 mg. Some patients on Ativan (lorazepam) have developed leukopenia, and some have had elevations of LDH. As with other benzodiazepines, periodic blood counts and liver function tests are recommended for patients on long-term therapy.

Losartan 

PO: 25-100 mg as a single dose or divided bid
Angiotensin II receptor blocker (ARBs)
Mechanism of Action: The ARBs block the binding of AII to type 1 AII receptors. ARBs affect primarily vascular smooth muscle and the adrenal gland. By selectively blocking the binding of AII to the type 1 AII receptors in these tissues, ARBs block vasoconstriction and the secretion of aldosterone. ***The therapeutic effects of ARBs are related to their potent vasodilating properties.
Major side effects: Chest pain, fatigue, hypoglycemia, diarrhea, UTI, anemia, and weakness. Hyperkalemia and cough are less likely to occur than with the ACE inhibitors.
Nursing Considerations: Used in caution in patients with renal artery stenosis and with renal or hepatic dysfunction. Breastfeeding women must NOT take this drug. Must be taken exactl

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