Medications Journal ADN

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Potassium

Use Neuromuscular function Normal Value 3.5 to 5.5 mEq/L (minor variation is significant) Regulation Kidneys primarily control balance and also smaller portion by intestines

Hypokalemia

Causes GI Fluid loss, NG suction, Diuretics, prolonged steroid use, Alkalosis, Diet Presentation Cardiac dysrhythmias, flat or inverted T waves, U wave present, Muscle weakness/paresthesias, Anorexia,N/V, Dilute Urine if prolonged

NOTE: Increased potential for digitalis toxicity (Digoxin)

Treatment - diet, K replacement (IV 20-40 mEq/L), Supplements

Nursing Interventions - Serum potassium, ECG, ABGs for Alkalosis, encourage consumption of Potassium rich foods, IV administration Pharmacology - PO when possible. IV required for EKG abnormalities or GI inacessible or serum level <2 mEq/L ⏩ Potassium chloride (KCl): salt substitute ⏩ K-Lyte: powder mix with 4-6 oz juice or water ⏩ Potassium chloride (KCL): IV always dilute 40 mEq/L at most, set rate to 20 mEq/hr or less. Do not IVP Assess - EKG monitoring, Assess renal function Teach -  Burning at injection site

Hyperkalemia

Causes Renal failure, Histological trauma (burns, crush injuries), oversupplementation, severe infection, Acidosis. Presentation ECG changes and dysrhythmias/ Cardiac arrest, Muscle weakness, possible respiratory impairment, Paresthesias, Anxiety, GI Fluid Loss

Treatment - ECG, Limitation of dietary potassium, Dialysis

Nursing Interventions - Serum K, mix IVs containing K+ well, monitor medication affects, dietary potassium restriction/dietary teaching for patients at risk. Hemolysis of blood specimen or drawing of blood above IV site may result in false laboratory result. Salt substitutes, medications may contain potassium Potassium-sparing diuretics may cause elevation of potassium. Should not be used in patients with renal dysfunction Pharmacology:  ⏩ Sodium polystyrene sulfonate (Kayexalate) - cation exchange resin; excreted in feces; used with sorbitol (laxative effect) Administration: PO or Rectal ⏩ Sodium bicarbonate IV - 45 mEq over 5 minutes: rapid movement of K+ into cells ⏩ Calcium gluconate IV - Decrease cardiotoxic effects, Contraindicated if pt on digoxin, Insulin and glucose, Causes K+ to move into cells Assess: ECG

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Hydromorphone

Therapeutic: allergy, cold, and cough remedies (anti-tussives), opioid analgesics Pharmacologic: opioid agonists, opioid agonists/ non-opioidanalgesic combinations AKA: Dilaudid, Dilaudid-HP, Exalgo, Hydromorph Contin, Jurnista Metabolism: Hepatic Receptor:   mu- and delta-opioid

Indications Moderate to severe pain (alone and in combination with non-opioid analgesics); extended release product for opioid-tolerant patients requiring around-the-clock management of persistent moderate-to-severe pain. Antitussive (lower doses). Action Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Suppresses the cough reflex via a direct central action. Therapeutic Effects: Decrease in moderate to severe pain. Suppression of cough.

Antidote: If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing 40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Drug-Drug: Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—initial dose of oxycodone to 25% of usual dose). Additive CNS depression. Administration - Assess type, location, and intensity of pain prior to and 1 hr (peak) after administration. Assess BP, pulse, and respiration before and periodically during administration. If respiratory rate is 10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Stimulant laxatives should be administered routinely if opioid use exceeds 2– 3 days, unless contraindicated. Cough: Assess cough and lung sounds during antitussive use. Common Dose: PO (Adults 50 kg): Immediate-release— 4– 8 mg q 3– 4 hr initially (some patients may respond to doses as small as 2 mg initially); or once 24-hr opioid requirement is determined, convert to extended-release by administering total daily oral dose once daily. PO (Adults and Children 50 kg): 0.06 mg/kg q 3– 4 hr initially, younger children may require smaller initial doses of 0.03 mg/kg. Maximum dose 5 mg. IV, IM, Subcut (Adults 50 kg): 1.5 mg q 3– 4 hr as needed initially; may be+. IV, IM, Subcut (Adults and Children 50 kg): 0.015 mg/kg mg q 3– 4 hr as needed initially; may be+. IV (Adults): Continuous infusion (unlabeled)—0.2– 30 mg/hr depending on previous opioid use. An initial bolus of twice the hourly rate in mg may be given with subsequent breakthrough boluses of 50– 100% of the hourly rate in mg. Rect (Adults): 3 mg q 6– 8 hr initially as needed.  Teach: Advise patient to change positions slowly to minimize orthostatic hypotension

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Tramadol

Therapeutic: opioid analgesics Pharmacologic: opioid agonists, opioid agonists/ non-opioidanalgesic combinations AKA: Conzip, Durela, Ralivia, Tridural, Ultram, Ultram ER, Zytram XL, Hydrocodone/APAP Metabolism: Hepatic Receptor:  mu or μ-opioid receptor

Indications Moderate to moderately severe pain (extended-release formulations indicated for patients who require around-the-clock pain management). Action Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. Therapeutic Effects: Decreased pain.

Antidote: If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing 40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Drug-Drug: DO NOT take with acetaminophen. Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—initial dose of oxycodone to 25% of usual dose). Additive CNS depression. Administration - Assess type, location, and intensity of pain prior to and 1 hr (peak) after administration. Assess BP, pulse, and respiration before and periodically during administration. If respiratory rate is 10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Stimulant laxatives should be administered routinely if opioid use exceeds 2– 3 days, unless contraindicated. Common Dose: Rapid titration 50– 100 mg q 4– 6 hr (not to exceed 400 mg/day [300 mg in patients 75 yr]). Gradual titration—25 mg/day initially, 5 mg/day q 3 days to reach dose of 25 mg 4 times daily, then by 50 mg/day q 3 days to reach dose of 50 mg 4 times daily; may then use 50– 100 mg q 4– 6 hr (maximum dose  400 mg/day). Teach: Advise patient to change positions slowly to minimize orthostatic hypotension

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Oxycodone

Therapeutic: opioid analgesics Pharmacologic: opioid agonists, opioid agonists/ non-opioidanalgesic combinations  AKA: Oxycodone/APAP (Percocet) Oxycodone/Acetaminophen (Percocet), Oxecta, OxyCONTIN, Oxy IR, Oxyneo, Roxicodone, Supeudol Metabolism: Hepatic  Indications - Moderate to severe pain; extended release product should be used for patients requiring around-the-clock management of chronic pain. 

Action - Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression. Therapeutic Effects: Decreased pain.Toxicity and Antidote: If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing 40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Drug-Drug: DO NOT take with acetaminophen. Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—initial dose of oxycodone to 25% of usual dose). Additive CNS depression. Administration - Assess type, location, and intensity of pain prior to and 1 hr (peak) after administration.  Assess BP, pulse, and respiration before and periodically during administration. If respiratory rate is 10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Stimulant laxatives should be administered routinely if opioid use exceeds 2– 3 days, unless contraindicated.  Common Dose:  5/325mg PO q 6 hours PRN pain >4 Half-life 2-3 hours

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Heparin Sodium

AKA: Heparin Pharmacologic class: Anticoagulants Therapeutic class: Anticoagulants Indications Thromboprohpylaxis, Full-dose continuous IV / subcutaneous / intermittent IV  therapy for DVT, MI or PE. Fixed low-dose therapy for prevention of venous thrombosis, PE, embolism associated with AF and Post op DVT Actions Accelerates formation of antithrombin III– thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Antidote To treat severe overdose, use protamine sulfate (1% solution), a heparin antagonist. Dosage is based on the dose of heparin, its route of administration, and the time since it was given. Generally, 1 to 1.5 mg of protamine per 100 units of heparin is given if only a few minutes have elapsed; 0.5 to 0.75 mg protamine per 100 units heparin, if 30 to 60 minutes have elapsed; and 0.25 to 0.375 mg protamine per 100 units heparin, if 2 hours or more have elapsed. Don’t give more than 50 mg protamine in a 10-minute period. HIT, a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia and thrombosis (HITT). Drug-drug  Antihistamines, digoxin, nitrates, tetracycline. ASPIRIN Administration draw blood to establish baseline coagulation parameters. Check infusions regularly to ensure correct dose. Place notices for pressure dressings if taking blood. Always draw blood 30 minutes before next dose to avoid false PTT for intermittent. Every 4 hours after continuous. Never use the infused vein. Do not skip doses or try to catch up. Reschedule bolus if necessary and restart. NEVER PIGGYBACK or MIX ANOTHER DRUG IN BOLUS. Check order and vial carefully; heparin comes in various concentrations. Avoid I.M. injections of other drugs Labs ALT, AST, Potassium levels. INR, PT PTT. Regularly inspect patient for bleeding gums, bruises on arms or legs, petechiae, nosebleeds, melena, tarry stools, hematuria, and hematemesis. Teach patient to look and watch for signs of bleeding, family vigilance. Dose Units/ prophylactic and coag Carpuject - 5,000 units SQ q 8 hours

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Aspirin

AKA:  Acetylsalicylic Acid, ASA Pharmacologic class: Salicylates Therapeutic class: NSAIDs Action Thought to produce analgesia and exert its anti-inflammatory effect by inhibiting prostaglandin and other substances that sensitize pain receptors. Drug may relieve fever through central action in the hypothalamic heat-regulating center. In low doses, drug also appears to interfere with clotting by keeping a platelet-aggregating substance from forming. Indications Rheumatoid Arthritis, Osteoarthritis, Mild pain and fever, spondyloarthropathies, Suspected MI, Reduction of Risk for MI/TIAs, CABG, Acute Ischemic Stroke, Certain Artery repair procedures, Polycythemia Vera. Administration crush non-enteric in food for patient with swallowing difficulties. Give liquid immediately after mixing because drug breaks down quickly. Give with food. For MI, have patient chew tablet. Drug-drug ACE inhibitors and Beta blockers, May decrease antihypertensive effects Monitor BP closely. Monitor if used with other anticoagulants! Do NOT - Methrotrexate, Probenecid, Sulfinpyrazone, Valproic Acid. For inflammatory conditions - schedule instead of PRN, enteric coated preferred. Therapeutic level - 150 - 300 mcg/mL During prolonged therapy - Hct, Hb, PT, INR, Renal Clearances. Stop drug 5-7 days before elective surgery Teach - 1 tablet aspirin containts 553 mg sodium. Take with food, water.