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Medication injuries are most commonly related to a patient's:
Noncompliance with the prescribed regimen
This class of meds lower elevated blood levels of lipids:
This class of meds prevent/inhibit platelets from forming thrombi:
This class of meds correct abnormal cardiac electrophysiologic function
This class of meds prevent conversion of angiotensin I to angiotensin II:
ACE inhibitors
This class of meds lyses/dissolves blood clots:
This class of meds competes with beta-agonists for available receptor sites:
beta blockers
This class of meds inhibits calcium influx across myocardial & vascular smooth muscle cells:
calcium channel blockers
This class of meds blocks the angiotensin II receptor sites in many tissues:
This class of meds prevents blood clots from forming or getting larger. Does NOT dissolve existing clots:
This class of meds dilates veins & arteries:
Aspirin, Ticlid, Plavix, Persantine: platelet aggregation inhibitors (antiplatelets)
Use: prevention of MI or stroke. prolong survival of MI pt. Drug interactions: antiocoagulants & thrombolytics S/E: GI bleeding Labs: hgb, hct, occult blood (stool) Nursing considerations: do not crush EC coated, assess for tarry stools PT teaching: Take as Rx, take w/food, report bleeding, ck otc labels for acetylsalicylic acid
Warfarin, coumadin anticoagulants (PO)
Use: prophylaxis of DVT, PE & MI, A-fib after stent placement Drug interactions: antiplatelets, thrombolytics Food interactions:Vit K, Vit C,green tea S/E: bleeding(gums, stool, urine, nose) Labs:hgb, hct, PT(1.25-2.5x), INR(2-3) Nursing considerations: ck labs, bleeding, >1 cardiac med Teaching: give alone, med bracelet, tell dentist, watch OTC, no valsalva, vit k ANTIDOTE: Vitamin K
Heparin, Lovenox anticoagulants (SC)
Use: DVT prophylaxis & stabilization, PE stabilization Drug interactions: antiplatelets, thrombolytics Food interactions: alcohol >effect S/E: bleeding, thrombocytopenia Labs: hgb, hct, PTT, wt based dosage Nursing consid: 25g 5/8in needle, do NOT aspirate or massage, bleeding Teaching: give alone, med bracelet, otc ANTIDOTE: protamine sulfate
Streptokinase, Urokinase, t-PA, APSAC thrombolytics
Use: dissolves clots in arteries of heart & lungs, leg veins, brain, artificial heartvalve Drug interactions: antiplatelets, anticoagulants S/E: BLEEDING! Labs: hgb, hct, occult blood Nursing consid: BEDREST, avoid: IMs, venous & arterial sticks, assess: hemorrhage, >HR, >BP Teaching: bedrest, report bleeding! ANTIDOTE: Amicar (IV)
atenolol, metoprolol, propamolol, nadolol beta blockers
Use: HTN, angina, prevent future MI Drug inter: >HoTn w/diuretics S/E: weak, drowsy, masks low BS, bradycardia*, constipation, impotence Nursing Consid: BP & RR(asthma & COPD), check AP(1 min) hold if <60
verapamil, nifedipine, diltiazem, nicardipine, amlodipine, nimodipine calcium channel blockers
Use: HTN, angina, arrythmias Drug inter: >HoTN w/ other antihypertensives, "pines" can >digoxin Food INter: grapefruit juice >effect S/E: dependent edema, HoTN, bradycardia, dizziness, arrythmias, change in hepatic & renal fx Labs: LFT, RFT, digoxin level Nursing Consid:edema, BP, I&O, angina Teaching: compliance, orthostatic HoTN, smoking, safety/dizziness
captopril, enelapril, lisinopril, quinapril ACE inhibitors
Use: HTN, heart failure, prolong survival of MI pt, vascular disease Drug inter: >HoTN w/vasodilators, nitrates & diuretics; Hyperkalemia w/K sparing diuretics, >dig levels, NSAIDS> Food inter: alcohol>HoTN, caffeine>effect, watch K+ S/E: hyperkalemia*, cough*, nephrotic syndrome, angioedema, dizziness, neutropenia, fatigue Labs: K+, RFT, dig level, WBC Nursing Consid: K+, I&O, safety/dizziness , infection, cough Teaching: s/s hyperkalemia, safety/dizziness, s/s infections, cough Other:afro-amer & elderly do not respond well, good choice for diabetics
losartan, valsartan, irbesartan ARBS(angiotensin receptor blockers)
Use: HTN, heart failure Drug Inter: same as ACE inhibitors Food inter: same as ACE inhibitors S/E: same as ACE inhibitors NO cough! Labs: K+, RFT, dig level, WBC Nursing consid: change to ARBS if ACE causes cough Teaching: same as ACE inhibitors
procanamide, quinidine, disopryramide, lidocaine Class I Antiarrythmics
Use: correct abnormal cardiac electro-physiologic fx or arrythmias Drug inter: other antiarrythmics(effect Food inter: caffeine S/E: exacerbate other arrythmias, dizzy,lightheaded, drymouth, constip Labs: blood levels of med, K+ Nursing consid: vitals, EKG, labs, arrythmias, hypoK+, hyperK+ Teaching: compliance, s/s toxicity: bradycardia, heart failure, confusion, convulsions
beta blockers (-olol) Class II Antiarrythmics
block cardiac stimulation
Amniodarone, bretylium, ibutilide Class III antiarryhtmics
Use: life threatening arrythmias & when resistant to other meds Drug inter: >dig levels, other antiarryhtmics < CO Food Inter: caffeine S/E: exacerbate other arrythmias, photo-sensitivity, paresthesia, orthostatic HoTN, liver & thyroid disfx Labs: LFT, thyroid fx, K+, dig level prn Nursing Consid: vitals, labs, orthostatic HoTN, arrythmias Teaching: sunblock, change position slowly, report dizziness, s/s toxicity: HTN, HoTN< bradycardia
calcium channel blockers; verapamil & diltiazem Class IV antiarrythmics
do NOT give verapamil & beta blockers IV at the same time or within a few hours
Digoxin, adenosine(rapid IV push) Other
Drug Inter: dig: K+wasting diuretics >chance of dig toxicity S/E: dig: bradycardia Lab: Dig level: 0.8-2.0, adenocard Nursing consid: check AP(1min) hold if <60, Teaching: s/s toxicity: anorexia, nausea, yellow/green halos
atorvastatin(lipitor), simvastatin(zocor) HMG-COA reductase inhibitors (statins)
Use: Reduce LDL cholesterol Drug inter:>blood level of anticoagulants S/E: headache, myalgia, GI & liver probs Labs: cholesterol, triglycerides, PT, INR, LFT Nursing Consid: take w/supper; labs Teaching: 6-8wk to see change
cholestyramine(questran), colestipol bile acid sequestrants
Use: Reduce LDL, Increase HDL Drug inter: delay absorption of many meds, TAKE ALONE Food inter: >fat soluble vitamins S/E: constipation, belching, bloating, headache Nursing Consid: take w/ meals
nicotinic acid, vitamin B3 Niacin
Use:reduce LDL, triglyc & total chol, >HDL S/E: cutaneous flushing*, pruritis, GI distress, glucose intol, liver dysfx Labs: cholesterol, triglycerides, BS, LFT Nursing consid: flushing can be< if ASA is taken 1/2 hr before admin
Lopid, tricor fibric acid derivatives
Use:reduce LDL & triglyceride, >HDL Drug inter: increase blood level of anticoagulants S/E: gallstones, impotence, hematuria, oliguria, UTI< liver probs, alopecia Labs: cholesterol, triglycerides, RFT, urinalysis, LFT Nursing Consid: labs, follow food rules Teaching: meals, hair loss
Ezetimbie(Zetia) cholesterol absorption inhibitor
Use: reduce LDL,total & triglyceride, >HDL Drug inter: fibric acid derivs >level S/E: altered liver fx, gallbladder probs, pancreatitis Labs: cholesterol, triglycerides, LFT*, pancreatic enzymes Nursing Consid: labs, assess for s/s of liver, gallbladder & pancreas probs
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