Mosby's Drug Guide for Nursing Students by Linda Skidmore-Roth RN MSN NP

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Antidysrhythmic— miscellaneous Chem. 9% NaCl (20 ml), then elevate arm • Store at room temperature; sol should be clear; discard unused product ╇ Nurse Alert GI: Nausea, metallic taste RESP: Dyspnea, chest pressure, hyperventilation, bronchospasm (asthmatics) Pharmacokinetics Absorption Complete bioavailability Distribution Erythrocytes, cardiovascular endothelium Metabolism Liver, converted to inosine and adenosine monophosphate Excretion Kidneys Half-life 10 sec Pharmacodynamics Onset Rapid Peak Unknown Duration 1-2 min INTERACTIONS Individual drugs Caffeine, theophylline: decreased effects of adenosine CarBAMazepine: increased heart block Digoxin, verapamil: increased ventricular fibrillation Dipyridamole: increased effects of adenosine Smoking: increased tachycardia Drug/herb Ginger: increased effect Green tea, guarana: decreased effect NURSING CONSIDERATIONS Assessment • Assess cardiopulmonary status: pulse, respiration, ECG intervals (PR, QRS, QT); check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV block) • Assess respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; bilateral crackles may occur in CHF patient; if increased respiration, increased pulse occurs, product should be discontinued Key NCLEX® Drug albumin, human 5% • Assess CNS effects: dizziness, confusion, paresthesias; product should be discontinued Patient/family education • Tell patient to report facial flushing, dizziness, sweating, palpitations, chest pain Evaluation Positive therapeutic outcome • Normal sinus rhythm • Diagnosis of perfusion defect albumin, human 5% (Rx) (al-byoo9min) Albumarc, Albuminar-5, Albutein 5%, Buminate 5%, Plasbumin-5 albumin, human 25% (Rx) Albuminar-25, Albutein 25%, Buminate 25%, Plasbumin-25 Func.

Thrombolytic enzyme Chem. 22) at presentation (increased risk of hemorrhage) Assess for bleeding during first hr of treatment and 24 hr after procedure: hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis, puncture sites; guaiac all body fluids and stools; obtain blood studies (Hct, platelets, PTT, PT, TT, APTT) before starting therapy; PT or APTT must be ,2 times control before starting therapy; TT or PT q3-4hr during treatment; obtain CPK-MB to identify product effectiveness • Assess hypersensitivity: fever, rash, facial swelling, dyspnea, itching, chills; mild reaction may be treated with antihistamines; report to prescriber • Pulmonary embolism: monitor pulse, B/P, ABGs, rate/rhythm of respirations • Occlusion: have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism • Cholesterol embolism: assess for purple toe syndrome, acute renal failure, gangrenous digits, hypertension, livedo reticularis, Key NCLEX® Drug aluminum hydroxide pancreatitis, MI, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, rhabdomyolysis • Myocardial infarction: monitor ECG; on monitor, watch for segment changes, changes in rhythm: sinus bradycardia, ventricular tachycardia, accelerated idioventricular rhythm may occur due to reperfusion, cardiac enzymes, radionuclide myocardial scanning/coronary angiography • Pulmonary embolism: monitor pulse, B/P, ABGs, rate/rhythm of respirations; symptoms include dyspnea, tachypnea, chest pain, cough, hemoptysis • Occlusion: have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism Patient/family education • Teach patient reason for alteplase, signs and symptoms of bleeding, allergic reactions, when to notify prescriber Evaluation Positive therapeutic outcome • Lysis of pulmonary thrombi • Adequate hemodynamic state • Absence of congestive heart failure aluminum hydroxide (OTC) Func.

Aluminum product, phos- phate binder Pregnancy category C ACTION: Neutralizes gastric acidity, binds phosphates in GI tract; these phosphates are excreted Therapeutic outcome: Decreased acidity, healing of ulcers; decreased phosphate levels in chronic renal failure USES: Antacid, adjunct in peptic, gastric, duodenal ulcers; hyperphosphatemia in chronic renal failure; reflux esophagitis, hyperacidity, heartburn, stress ulcer prevention in critically ill, GERD Unlabeled uses: GI bleeding CONTRAINDICATIONS: Hypersensitivity to this product or aluminum products 35 GI obstruction, dehydration, renal disease, sodium-restricted diets DOSAGE AND ROUTES Antacid Adult:╇ ╉SUSP PO 600 mg 1 hr after meals, at bedtime; max 6 times/day Hyperphosphatemia Adult:╇ ╉PO 300-600 mg tid Child:╇ ╉PO 50-150 mg/kg/day in 4-6 divided doses GI bleeding (unlabeled) Infant:╇ ╉PO 2-5 ml/dose q1-2hr Child:╇ ╉PO 5-15 ml/dose q1-2hr Available forms: SUSP 320 mg/5 ml, 600 mg/5 ml Implementation • 2 tsp (10 ml) neutralizes 20 mEq of acid PO route • Give laxatives or stool softeners if constipation occurs, especially geriatric • Give after shaking suspension; follow with water to facilitate passage • Tab may be chewed if patient is unable to swallow, drink 8 oz of water after chewing; or by nasogastric tube if patient unable to swallow • Give with 8 oz of water for hyperphosphatemia unless contraindicated • Give 1 hr before or after other medications to prevent poor absorption • Give 15 ml 30 min after meals and at bedtime (esophagitis) NG tube route • May be given as prescribed q1-2hr and given by gastric tube after diluting with water (peptic ulcer) ADVERSE EFFECTS GI: Constipation, anorexia, obstruction, fecal impaction META: Hypophosphatemia, hypercalciuria Pharmacokinetics Absorption Not usually absorbed Distribution Widely distributed if absorbed; crosses placenta Metabolism Unknown Excretion Feces, kidneys (small amounts), breast milk Half-life Unknown Precautions: Pregnancy C, breastfeeding, geriatric, fluid restriction, decreased GI motility, ╇ Canada only Adverse effects: italics = common; bold = life-threatening A 36 alvimopan Pharmacodynamics Onset 20-40 min Peak ½ hr Duration 1-3 hr used for 4-6 wk after symptoms subside or as prescribed • Instruct patient to separate other medications by 2 hr • Teach patient to notify prescriber of black tarry stools, which may indicate bleeding INTERACTIONS Individual drugs Allopurinol, amprenavir, delavirdine, digoxin, gabapentin, gatifloxacin, isoniazid, ketoconazole, penicillamine, phenytoin, quiNIDine, ticlopidine: decreased effect of each of these drugs Drug classifications Anticholinergics, cephalosporins, corticosteroids, H2 antagonists, iron salts, phenothiazines, quinolones, tetracyclines, thyroid hormones: decreased effect of each of these drug classifications Positive therapeutic outcome • Absence of pain, decreased acidity • Increased pH of gastric secretions • Decreased phosphate levels alvimopan (Rx) (al-vi9moe-pan) Entereg Func.