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DRUGS USED TO TREAT DIGESTIVE PROBLEMS Classification: Antidiarrheals DRUG ACTION INDICATION/CONTRAINDICATION NURSING RESPONSIBILITY Difenoxin (Motofen) Diphenoxylate (Lomotil) - Dosage: tablet 2 mg; capsule 2 mg; liquid 1 mg/5 mL or 1 mg/mL - Frequency: PRN for every unformed stool - Route: oral Loperamide (Imodium) - Dosage: tablet 2 mg - Frequency: PRN for every unformed stool; 1-6 cap/day - Route: oral Bismuth subsaliculate (Pepto bismol) Cholestyramine resin (Questran) Attapulgite (Diatabs) Activated charcoal MECHANISM OF ACTION: Decrease the effects of the mesenteric plexus of the intestines Inhibit peristalsis by direct central action on the brain Decrease propulsive contractions Enhance sphincter tone Enhances ileocecal valve tone ADVERSE EFFECTS: Anorexia and nausea (in early stage) Abdominal distention Auscultation of high pitched sounds over the abdomen Eventually, a silent abdomen – absent of bowel sounds Possible percussion of air or fluid over distended abdomen INDICATION: Decrease peristalsis in the intestines by depressing the circular and longitudinal muscles of the small intestine Decrease propulsive contractions throughout the entire colon Diphenoxylate may provide antisecretory effect but little analgesic Loperamide produces less severe CNS effects than difenoxin o diphenoxylate Kaolin and Pectine are locally acting antidiarrheal that are not absorbed; also act as adsorbents 10 Rights 1. Right medication 2. Right dosage 3. Right patient 4. Right route 5. Right time and manner 6. Right client education 7. Right documentation 8. Right to refuse medications 9. Right assessment 10. Right evaluation Obtain an order for antiemetic if patient vomits Identify the use of drugs that may interact with opium Assess bowel pattern Watch for signs of hypoperistalsis (withhold the next dose of the drug) Record I & O

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DRUGS USED TO TREAT DIGESTIVE PROBLEMSClassification: Antidiarrheals

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Difenoxin (Motofen) Diphenoxylate (Lomotil) Dosage: tablet 2 mg; capsule 2 mg; liquid 1 mg/5 mL or 1 mg/mL Frequency: PRN for every unformed stool Route: oral Loperamide (Imodium) Dosage: tablet 2 mg Frequency: PRN for every unformed stool; 1-6 cap/day Route: oral Bismuth subsaliculate (Pepto bismol) Cholestyramine resin (Questran) Attapulgite (Diatabs) Activated charcoal Kaolin & Pectin (Kaopectate)

Loperamide (Imodium)

MECHANISM OF ACTION: Decrease the effects of the mesenteric plexus of the intestines Inhibit peristalsis by direct central action on the brain Decrease propulsive contractions Enhance sphincter tone Enhances ileocecal valve tone

ADVERSE EFFECTS: Anorexia and nausea (in early stage) Abdominal distention Auscultation of high pitched sounds over the abdomen Eventually, a silent abdomen absent of bowel sounds Possible percussion of air or fluid over distended abdomen Absence of flatus Absence of bowel movements Possible vomiting with resultant fluid and electrolyte imbalance

DRUG INTERACTIONS: Can enhance the depressant effects of alcohol, barbiturates, tranquilizers and other CNS Has additive effects when used together with anticholinergicsINDICATION: Decrease peristalsis in the intestines by depressing the circular and longitudinal muscles of the small intestine Decrease propulsive contractions throughout the entire colon Diphenoxylate may provide antisecretory effect but little analgesic Loperamide produces less severe CNS effects than difenoxin o diphenoxylate Kaolin and Pectine are locally acting antidiarrheal that are not absorbed; also act as adsorbents CONTRAINDICATION: Use cautiously with hepatic dysfunction, acute ulcerative colitis, pregnancy and lactation Contraindicated with allergy to any components or to aspirin or other salicylates

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Obtain an order for antiemetic if patient vomits Identify the use of drugs that may interact with opium Assess bowel pattern Watch for signs of hypoperistalsis (withhold the next dose of the drug) Record I & O

Classification: Laxatives (Hyperosmolar laxatives)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Glycerin Dosage: Adults 15-30 mL/day; Children (7-14) 15 mL/day; (1-6) 5-10 mL/day; Infant 5 mL/day Frequency: OD Route: oral or rectal or ophthalmic Lactulose (Duphalac) Dosage: Oral 1-2 g/kg; ophthalmic 1 or 2 drops Frequency: OD Route: oral or rectal Magnesium salts Sodium biphosphate

MECHANISM OF ACTION: Glycerin acts by osmotic fluid pressure shifts; helpful in bowel retraining; introduced into the large intestines and not absorbed systemically Lactulose (Duphalac) site of action is the colon; the unabsorbed lactulose is metabolized by intestinal microflora into lactate (decrease ph) Magnesium salts produce watery stools; evacuation within 1-3 hours Sodium biphosphate causes hypertonicity within the lumen producing osmotic effect

ADVERSE EFFECTS: High sodium level causes tachycardia, hypotension, dehydration High magnesium level muscle weakness, decrease reflexes, paralysis, tachycardia Low calcium level neuromuscular irritability, cardiac arrhythmias Hypovolemic shock

INDICATION: Episiotomy Hemorrhoids/anorectal fissures Cardiovascular diseases Geriatrics Adjunct to anthemintics therapy Presurgery Diagnostic exams Removal of poison Preventing fecal impaction Correcting constipation for bedridden patients

CONTRAINDICATION: Contraindicated with allergy to lactulose, low-galactose diet Use cautiously with diabetes, pregnancy and lactation10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Do not freeze laxative form. Extremely dark or cloudy syrup may be unsafe, do not use Give laxative syrup orally with fruit juice, water or milk to increase palatability Administer retention enema using a rectal balloon catheter. Do not use cleansing enemas containing soapsuds or other alkaline agents that counteract the effects of lactulose Do not administer other laxatives while using lactulose Monitor serum ammonia levels Monitor with long-term therapy for potential electrolyte and acid-base imbalances Carefully monitor blood glucose levels in diabetic patients

Classification: Laxatives (Bulk forming laxatives)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Methylcellulose (Matsuprex) Polycarbophil (Fibercon) Dosage: Adults 6 g/day; children 3 g/day Frequency: OD or QID Route: oral Psyllium Hydrophilic Mucilloid (Metamucil) Dosage: 1 tsp or packet in cool water or juice Frequency: Children: OD or TID Route: oral MECHANISM OF ACTION: Resembles dietrary fiber Contain natural and semisynthetic polysaccharide and cellulose Increase fecal bulk and water content thereby promoting peristalsis and elimination Ingested but not absorbed Act in the small intestines and colon Fecal softening occurs in 1-3 days

ADVERSE EFFECTS: Excessive bowel activity Perianal irritation Abdominal cramps Weakness Dizziness Cathartic dependence INDICATION: Short-term relief of constipation To prevent straining To evacuate the bowel for diagnostic procedure To remove ingested poisons from the lower GI tract Adjunct in anthelmintic therapy

CONTRAINDICATION: In cases of allergy to these drugs Third trimester of pregnancy Acute abdominal pain10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Should be taken with water Monitor for fecal obstruction Good with irritable bowel syndrome Ensure that patient has sufficient water to completely swallow dose Swallow tablets whole Do not take this drug within 1 hr of any other drugs Report sweating, flushing, muscle cramps, excessive thirst

Classification: Laxatives (Emollient laxatives or surfactant laxatives)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Docusate calcium Docusate potassium Docusate sodium Polyxamer 188

MECHANISM OF ACTION: Decreases surface tension of interfacing liquid bowel contents Promote fluid accumulation in the bowel and softening the stools Easy defecation by emulsifying the fats and water components of feces in the small and large intestines This detergent allows water and lipids to penetrate fecal material producing net accumulation Stimulate electrolyte and fluid secretion from the intestinal mucosal cells Emollients can also be given before rectal cathartics to treat fecal impaction

ADVERSE EFFECTS: Excessive bowel activity Perianal irritation Abdominal cramps Weakness Dizziness Cathartic dependenceINDICATION: Short-term relief of constipation To prevent straining To evacuate the bowel for diagnostic procedure To remove ingested poisons from the lower GI tract Adjunct in anthelmintic therapy

CONTRAINDICATION: In cases of allergy to these drugs Third trimester of pregnancy Acute abdominal pain10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Swallow tablets whole Do not take this drug within 1 hr of any other drugs Report sweating, flushing, muscle cramps, excessive thirst

Classification: Laxatives (Stimulant laxatives)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Bisacodyl (Dulcolax) Dosage: Oral 10-15 mg; Rectal 2.5 g in water via enema Frequency: Route: oral or rectal Phenophthalein (Ex Lax) Cascara Sagrada Dosage: 325-650 mg PO Frequency: Route: oral Senna (Senokot) Dosage: syrup 10-25mL Frequency: 1-8 tab per day at bedtime Route: oral or rectal

MECHANISM OF ACTION: Also known as irritant cathartics Irritate the intestinal mucosa or activate the intramural nerve plexus of the intestinal smooth muscles (increases intestinal motility) Alter fluid and electrolyte Stimulate peristalsis and induce defecation by irritating the intestinal mucosa or stimulating nerve endings of the intestines

ADVERSE EFFECT: Excessive bowel activity Perianal irritation Abdominal cramps Weakness Dizziness Cathartic dependenceINDICATION: Constipation produced by medications Neurologic disorders Irritable bowel Prolonged hospitalization Used before surgeries (sigmoidoscopy, proctoscopic procedure) Short-term relief of constipation To prevent straining To evacuate the bowel for diagnostic procedure To remove ingested poisons from the lower GI tract Adjunct in anthelmintic therapy

CONTRAINDICATION: In cases of allergy to these drugs Third trimester of pregnancyAcute abdominal pain10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Swallow tablets whole Do not take this drug within 1 hr of any other drugs Report sweating, flushing, muscle cramps, excessive thirst Not used in lactating mothers Phenopthalein can cause reddish urine

Classification: Laxative (Lubricant laxatives)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Mineral oil Dosage: 5-45 mL PO Frequency: 1-8 tab per day at bedtime Route: oral or rectal

MECHANISM OF ACTION: Increases water retention in the stool by creating a barrier between the colon wall and feces Prevents colonic reabcorption of fecal water

ADVERSE EFFECT: Excessive bowel activity Perianal irritation Abdominal cramps Weakness DizzinessCathartic dependenceINDICATION: Short-term relief of constipation To prevent straining To evacuate the bowel for diagnostic procedure To remove ingested poisons from the lower GI tract Adjunct in anthelmintic therapy

CONTRAINDICATION: In cases of allergy to these drugs Third trimester of pregnancy Acute abdominal pain10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Swallow tablets whole Do not take this drug within 1 hr of any other drugs Report sweating, flushing, muscle cramps, excessive thirst Advise patient that it may cause nausea, vomiting and abdominal cramping Inspect anal area for irritation

Classification: Anti-peptic ulcer drugs [Histamine (H2) receptor antagonists]

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Cimetidine (Tagamet) Dosage: tablets 100, 200, 300, 400, 800 mg; liquid 300 mg/5 mL; injection 150 mg/mL, 300 mg/ 2 mL Frequency: Oral HS, QID, BID; IV or IM 6-8 hours Route: oral, IM, IV Ranitidine (Zantac) Famotidine (Pepcid) Ranitidine Bismuth Citrate (Tritec) Nizatidine (Axid) Dosage: capsules 150, 300 mg; OTC tablets 75 mg Frequency: BID or daily Route: oral

MECHANISM OF ACTION: Specifically block the H2 receptors that control the basal and stimulated secretion of hydrochloric acid by the parietal cells Inhibits the action of histamine at the histamine H2 receptor of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, caffeine, insulin, histamine, cholinergic agonists, gastrin and pentagastrin. Total pepsin output also is reduced

ADVERSE EFFECTS: CNS effects include: mental confusion, disorientation, agitation and hallucinations Cimetidine, when given over prolonged period of time may have an antiandrogen (feminizing) effect on men producing gynecomastia, impotence and loss of libido; these effects are not characterisitics of other H2 antagonists

DRUG INTERACTION: They alter absorption of other drugs such as Ketoconazole and Itraconazole (should be taken 2 hours apart)INDICATION: Short-term treatment of active duodenal ulcer Short-term treatment of benign gastric ulcer Treatment of pathologic hypersecretory conditions (Zollinger-Ellison syndrome) Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients Treatment of erosive GERD OTC use: relief of symptoms of heartburn, acid indigestion, sour stomach

CONTRAINDICATION: Contraindicated with allergy to these drugs Use cautiously with impaired renal or hepatic function, lactation10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Give drug with meals and hs Decrease doses in patients with renal and liver dysfunction Administer IM dose undiluted deep into large muscle group Arrange for regular follow-up, including blood tests to evaluate effects

Classification: Anti-peptic ulcer drugs [Proton (acid) pump inhibitors]

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Esomeprazole (Nexium) Dosage: delayed-release capsules 20, 40 mg Frequency: daily for maintenance of healing of erosive esophagitis Route: oral Lansoprazole (Prevacid) Dosage: DR capsules 15, 30 mg; DR granules for oral suspension 15, 30 mg; injection 30 mg/vial Frequency: daily for maintenance of healing of erosive esophagitis Route: oral or IV Omeprazole (Prisolec, Losec) Dosage: DR capsules 10, 20, 40 mg; DR tablets 20 mg (OTC); powder for oral suspension 20 mg/packet Frequency: daily for 4-8 wk for active duodenal ulcer Route: oral Pantoprazole )Protonix) Rabeprazole (AcipHex) MECHANISM OF ACTION: Drugs that block the action of this pump can block acid secretion by the parietal cells Block the enzyme that pumps hydrogen ions (or proton) into the luminal (or secretory) side of the parietal cells of the stomach This enzyme blockade is more effective than histamine-receptor blockade at reducing stomach acid production Often preferred over H2 antagonists More potent than H2 antagonists but are used for the same indications PPIs change the ph of the stomach

ADVERSE EFFECTS: For short term therapy: headache, nausea and vomiting For long term therapy; hypergastrinemia (over production of gastrin)

DRUG INTERACTION: Increased serum levels and potential eincrease in toxicity of benzodiazepines when taken concurrently May interfere with absorption of drugs depende upon presence of acidic environment (eg. Ketoconazole, iron salts, digoxin)INDICATION: Treating severe erosive esophagitis that has not responded to therapy with H2 antagonists Used in the short term treatment of acute peptic ulcer disease (especially when combined with antimicrobial to eradicate Helicobacter Pylori Onset of action within an hour; duration of action is longer and varied from 24 to 72 hours

CONTRAINDICATION: Contraindicated with hypersensitivity to omeprazole , esomeprazole or other proton pump inhibitor Use cautiously with hepatic dysfunction, pregnancy, lactation10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

If administering antacids, they may be administered concomitantly with esomeprazole Ensure that the patient swallows capsule whole, do not crush or chew Patients who have difficulty swallowing may open capsule and sprinkle in applesauce or disperse in tap water, orange or apple juice, or yogurt Obtain baseline liver function tests and monitor periodically during therapy Provide additional comfort measure to alleviate discomfort from GI effects and headache Establish safety precautions if dizziness or other CNS effects occur (use side rails, accompany patient)

Classification: Antacids

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Aluminum Dosage: tablets 300, 500, 600 mg Frequency: 3-6 times per day Route: oral Calcium salts Dosage: tablets 250, 500, 650, 975 mg Frequency: PRN Route: oral Magaldrate Dosage: suspension 540 mg/5 mL; liquid 540mg/5 mL Frequency: PO between meals Route: oral Magnesium salts Sodium bicarbonate Dosage: tablets 325, 520, 650 mg Frequency: QID Route: oral Antagon (ganirelix acetate) Dosage: 250 mcg Frequency: once daily starting on day 2 or 3 of the cycle Route: Subcutaneous injection

MECHANISM OF ACTION: Neutralizes or reduces gastric acidity, resulting in an increase in the pH of the stomach and duodenal bulb and inhibiting the proteolytic activity of pepsin The combination of magnesium (causes diarrhea when administered alone) and aluminum (constipating when administered alone) salts usually minimizes adverse GI effects

ADVERSE EFFECTS:Aluminum: Constipation which can lead to fecal impaction and obstruction When used in patients with renal failure may produce hyperaluminemia, in which aluminum accumulates in bones, lungs and nerve tissues Osteomalacia and dementia may occur Hypophosphatemia may occur with prolonged use of aluminum-containing antacidsMagnesium: Laxation/diarrhea Alkalosis may occur with systemic productsCalcium Carbonate/Sodium Bicarbonate: Constipation is frequent than laxation May cause rebound hyperacidity and milk-alkali syndrome characterized by hypercalcemia, metabolic alkalosis and renal impairment

DRUG INTERACTION: Within the GIT, they combine chemically with some drugs, notably tetracycline forming complexes that resist digestion and pass unchanged out of the system When administered with enteric coated drugs, they may disintegrate the coating, releasing these drugs prematurely in the stomach Elevation of ph also alter membrane transport of alkaline and acidic compounds, promoting passive diffusion of acidic chemicals and lipid membrane transport of alkaline chemicals. It can alter both absorption and excretion of many systemic drugs Calcium directly augments the ionic stimulation of cardiac contractility thereby mimicking the action of digitalis Magnesium may also potentiate digitalis by depleting potassium store causing hypokalemia secondary to diarrhea

INDICATION: Esophageal reflux Acid indigestion Heartburn Dyspepsia Symptomatic relief of upset stomach associated with hyperacidity Hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity and hiatal hernia

CONTRAINDICATION: Contraindicated with allergy to magnesium or aluminum products Use cautiously with renal insufficiency, gastric outlet obstruction (aluminum salt may inhibit gastric emptying), pregnancy, lactation

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Avoid administering calcium carbonate for long term therapy of peptic ulcer disease because gastric hypersecretion and acid rebound may occur Shake suspensions well Have the patient thoroughly chew any chewable tablets before swallowing and take water Separate the administration of antacids and other enteric-coated drugs by 1 hour because antacids may cause premature release of enteric-coated drugs into the stomach Dont give any other oral medications with 1-2 hrs of antacid administration because antacids impair the absorption of other drugs Reassure the patient that stools may appear speckled or whitish Advise patients on sodium restricted diet to avoid antacids because sodium and fluid retention may occur or increase. Stress the importance of taking antacids exactly as prescribed for maximum effect

Classification: Antiemetic (Serotonin receptor antagonists)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Dolasetron (Anzemet) Dosage: tablets 50, 100 mg; injection 20 mg/mL Frequency: PO within 1 hr before chemotherapy or within 2 hr before surgery Route: oral or IV Granisetron (Kytril) Dosage: tablets 1 mg; injection 1 mg/mL; oral solution 1 mg/5mL Frequency: IV over 5 min starting within 30 min chemotherapy, only on days of chemotherapy; oral PO bid or 2 mg/day, beginning up to 1 hr before chemotherapy and second dose 12 hr after chemotherapy, only on days of chemotherapy Route: Oral or IV Ondansetron (Zofran) Dosage: tablets 4, 8, 24 mg Frequency: TID Route: oral

MECHANISM OF ACTION: Selectively binds to serotonin receptors in the CTZ. Blocking the nausea and vomiting cause by the release of serotonin by mucosal cells during chemotherapy, radiotherapy or surgical invasion (an action that stimulates the CTZ and causes nausea and vomiting)

ADVERSE EFFECTS: Headache Constipation Diarrhea Arrhythmia Bronchospasms

DRUG INTERACTION: Possible cardiac arrhythmias with drugs that cause ECG interval prolongation Potential for severe toxic reaction with high-does anthracycline therapy Decreased levels if combined with rifampinINDICATION: Prevents nausea and vomiting after radiation therapy for cancer or bone marrow transplantation The antineoplastic drugs that are destructive to cells release serotonin from the enterochromaffin cells in the GIT, which causes severe emetic response

CONTRAINDICATION: Contraindicated with allergy to dolasetron or any of its components or these drugs; markedly prolong QTc interval, second-or third-degree AV block Use cautiously in any patient at risk of developing prolongation of cardiac conduction intervals, especially QT interval (congenital QT syndrome, hypokalemia, hypomagnesemia), pregnancy, lactation

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Check for hypersensitivity; may cause anaphylactic reaction If patient is unable to swallow tablets, dilute injection in apple or apple-grape juice; dosage remains the same; solution is stable for 2 hr at room temperature Provide mouth care, sugarless lozenges to suck to help alleviate nausea Obtain baseline ECG and periodically monitor ECG in any patient at risk for QTc prolongation Provide appropriate analgesics for headache

Classification: Antiemetic (Dompamine receptor antagonists)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Chlorpromazine (Thorazine) Dosage: tablets 10, 25, 50, 100, 200 mg; concentrate 100 mg/mL; suppository 100 mg; injection 25mg/mL Frequency: oral q 4-6 hr; rectal q 6-8 h; IM if no hypotension q 3-4 hr Route: oral, rectal, IM Perphenazine (trilafon) Dosage: tablets 2, 4, 8, 16 mg; concentrate 16mg/5 mL; injection 5 mg/mL Frequency: PO daily; give IV when needed to control severe vomiting Route: oral or IV Prochlorperazine (Compazine) Dosage: tablets 5, 10, 25 mg; SR capsules 1-, 15 mg; syrup 5 mg/5 mL; injection 5 mg/mL; suppositories 2.5, 5, 25 mg Frequency: oral TID or QID; IM initially, repeated q 3-4 hr up to 40 mg/day Route: oral or IV

Chlorpromazine (Thorazine)MECHANISM OF ACTION: Mechanism is not fully understood; antipsychotic drugs block postsynaptic dopamine receptors in the braine; depress those parts of the brain involved with wakefulness and emesis; anticholinergic. Antihistaminic (H1), and alpha-adrenergic blocking

ADVERSE EFFECTS: Extrapyramidal reactions (pseudoparkinsonism, dystonia, akathisia, and tardive dyskinesia) Hypotension Sedation

DRUG INTERACTION: Precipitate or discoloration may occur when mixed with morphine, meperidine, cresols Decreased hypotension effect with guanethidineINDICATION: Suppress nausea and vomiting by blocking dopamine receptors in the CTZ They also produce blockade of acetylcholine (muscarinic), histamine, and norepinephrine receptors They are often used as antipsychotic drugs Effective in reducing vomiting from antineoplastic and radiation therapy of cancer Control post operative vomiting They do not prevent motion sickness Major drug interaction is a synergistic depression with drugs depressing the CNS particularly, when respiratory depression is involved

CONTRAINDICATION: Contraindicated with allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory collapse, subcortical brain damage, Parkinsons disease, liver damage, cerebral or coronary arteriosclerosis, severe hypotension or hypertension Use cautiously with respiratory disorders; glaucoma; epilepsy or history of epilepsy; peptic ulcer or history of peptic ulcer; decreased renal function; protate hypertrophy; breast cancer; thyrotoxicosis; myelography within 24 hr or scheduled within 48 hr, lactation; exporsure to heat, phosphorous insecticides; children with chicken pox, CNS infections10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Do not change brand names of oral dosage forms or rectal suppositories; bioavailability differs Dilute the oral concentrate just before administration in 60 mL or more of tomato or fruit juice, milk, simple syrup, orange syrup, carbonate beverage, coffee, tea, water or in semisolid foods (soup, puddings) Protect oral concentrate from light Do not give by subcutaneous injection Keep patient recumbent for 30 min after injection to avoid orthostatic hypotension Avoid skin contact with oral concentrates and parenteral drug solutions due to possible contact dermatitis Patient or the patients guardian should be advised about the possibility of tardive dyskinesias

Classification: Antiemetic (Cannabinoids)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Dronabinol (Marinol) Dosage: capsules 2.5, 5, 10 mg Frequency: 4-6 doses a day Route: oral Nabilone (Cesamet)

MECHANISM OF ACTION: The mechanism by which cannabinoids supress nausea and vomiting is unknown They inhibit the emesis center in the brainstem by an action at the CB1 or cannabinoid receptor Used for nausea and vomiting associated with antineoplastic therapy (especially Cisplatin)

ADVERSE EFFECTS: Euphoria or dysphoria Detachment or depersonalization Tachycardia and hypotension

DRUG INTERACTION: Do not give with ritonavir, alcohol, sedatives, hypnotics, other psychotomimetic substances Increased tachycardia, hypertension, drowsiness with anticholinergivs, antihistamines, TCAs Use caution if combined with dofetilideINDICATION: Treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatment Treatment of anorexia associated with weight loss in patients with AIDS

CONTRAINDICATION: Contraindicated to patients with psychiatric disorders Contraindicated with allergy to these drugs or sesame oil vehicle in capsules, nausea and vomiting arising from any cause other than cancer chemotherapy, lactation Use cautiously with hypertension; heart disease, manic, depressive, schizophrenic patients; pregnancy10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Store capsules in refrigerator Limit prescriptions to the minimum necessary for a single cycle of chemotherapy because abuse potential Warn patient about drugs profound effects on mental status and abuse potential before giving drug; patient needs full information regarding the use of this drug Warn patient about drugs potential effects on mood and behavior to prevent panic incase these occur Patient should be supervised by a responsible adult while taking drug; monitor during the first cycle of chemotherapy in which dronabinol is used to determine how long patient will need supervision

Classification: Antiemetic (Muscarinic receptor antagonists)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Scopolamine (pamine, Transderm Scop) Route: transdermal

MECHANISM OF ACTION: Scopolamine is a reversible inhibitor of the actions of acetylcholine at muscarinic receptors Prevents the actions of acetylcholine in the vestibular system Causes additive effects when used with other anticholinergic drugs (antiparkinsons drugs, phenothiazines, tricyclic antidepressants and some antihistamines) Readily absorbed and crosses blood brain barrier

ADVERSE EFFECTS: This medication patch may be harmful if chewed or swallowed. If overdose or swallowing is suspected, remove the patch if possible

DRUG INTERACTION: Causes additive effects when used with other anticholinergic drugs (antiparkinsons drugs, phenothiazines, tricyclic antidepressants and some antihistamines)

INDICATION: Considered the most effective drug available for prophylaxis and treatment of motion sickness and vertigo With some antiemetic action for patients with post operative emesis Also administered as a preanesthetic agent to depress respiratory secretions and salivation

CONTRAINDICATION: Do not share this medication with others Contraindicated to those who are allergic to this drug Use cautiously during pregnancy or lactation Avoid activities that may cause you to overheat (such as doing strenuous work/exercise in hot weather, using hot tubs)

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

For motion sickness, transdermal patch is preferred to decrease adverse effects; patch is applied 4 hrs in advance of travel and delivers scopolamine over 3 days Patch is not advisable for children Store at room temperature When the weather is hot, drink plenty of fluids and dress lightly. If you become overheated, promptly seek cooler shelter and stop exercising Keep all medications away from children and pets Do not flush medications down the toilet or pour them into a drain unless instructed to do so Properly discard this product when it is expired or no longer needed

Classification: Antiemetic (Histamine receptor antagonists)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Dimenhydrinate (Dramamine, Gravol) Diphenhydramine (Benadryl) Hydroxyzine (Vistaril, Iterax, Atarax) Meclizine (Bonamine) Promethazine (Phenergan) Dosage: tablets 12.5, 25, 50 mg; syrup 6.25, 25 mg/mL; suppositories 12.5, 25, 50 mg; injection 25, 50 mg/mL Frequency: oral PRN; rectal q 4-6 hr, IM or IV, not to be repeated frequently than q 4-6 hr Route: oral, rectal, IM or IV

MECHANISM OF ACTION: Help prevent motion sickness and vertigo although the action is unknown Suppression of the stimulation of receptors in the labyrinth of the ear from which signals governing the sense of equilibrium arise Not all antihistamines are effective as antiemetics and there is no correlation between their ability to prevent motion sickness and their potency as antihistamines or anticholinergics

ADVERSE EFFECTS: Drowsiness and dry mouth Headache and jitters

DRUG INTERACTION: Causes additive depression with the use of CNS depressants (opioids, alcohol, antidepressants, sedative-hypnotics)INDICATION: Antihistamines treat motion sickness and vertigo; 30 minutes before travel and 4-6 hrs after as needed Dimenhydrinate and Hydroxyzine are for motion sickness and vertigo; can be given orally, IM, IV, rectally Promethazine is the most effective drug for motion sickness but with sedating effects Hydroxyzine if given IM reduces post surgical nausea and vomiting Meclizine treats nausea of vestibular disorders such as Menieres disease and LabyrinthitisDiphenhydramine treat dystonic reactions caused by antipsychotic drugs

CONTRAINDICATION: Contraindicated in patients with narrow angle glaucoma; and premature babies Used cautiously in patients with pyloric obstruction, cardiovascular diseases, prostatic hypertrophy, hyperthyroidism10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Do not give tablets or rectal suppositories to children < 2 yr Give IM injections deep into muscle Do not administer subcutaneously; tissue necrosis may occur Avoid using alcohol avoid prolonged exposure to sun, or use a sunscreen or covering garments Maintain fluid intake, and use precautions against heat stroke in hot weather

Classification: Antiemetic (Miscellaneous drugs)

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Benzquinamide (emete-con) given IM because of the risk of arrhythmia Diphenidol (Vontrol) given oral Metoclopramide (PMS metoclopramide, Reglan) well absorbed if given IM or rectally Dosage: tablets 5, 10 mg; syrup 5 mg/5 mL; concentrated solution 10 mg/mL; injection; 5 mg/mL Frequency: oral TID; IM or IV for up to 10 days until symptoms subside Route: oral, IM or IV

MECHANISM OF ACTION: Benzquinamide acts by depressing the CTZ in the brain stem Diphenidol acts on the aural vestibular apparatus to inhibit function and at the CTZ to inhibit nausea and vomiting Metoclopramide blocks dopaminergic (specifically D2) receptors at the CTZ to reduce afferent input; blocks serotonergic receptors It enhances GI motility of smooth muscles from the esophagus to the bowel and accelerates gastric emptying which counteracts the loss of tone in vomiting Distributed to body tissues and fluids and crosses blood brain and placental barrier

ADVERSE EFFECTS: Drowsiness, dizziness, fatigue Transient hypertension Nausea Diarrhea Parkinsonism-like reaction

DRUG INTERACTION: Decreased absorption of digoxin from stomach Increased toxic and immunosuppressive effects of cyclosporineINDICATION: Relief symptoms of acute and recurrent diabetic gastroparesis Short-term therapy (4-12 wk) for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy Porphylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable

CONTRAINDICATION: Contraindicated with allergy to metoclopramide and these drugs; GI hemorrhage, mechanical obstruction or perforation,; pheochromocytoma (may cause hypertensive crisis); epilepsy Use cautiously with previously detected breast cancer 9one third of such tumors are prolactin dependent); pregnancy, lactation10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Monitor BP carefulliy during IV administration Monitor for extrapyramidal reactions and consult physician if they occur Monitor diabetic patients, arrange for alternation in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption

DRUGS TO TREAT RESPIRATORY PROBLEMSClassification: Expectorant

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Guaifensin (Robitussin) Atropine Potassium Iodide (SSKI) Terpin hydrate Ammonium chloride Dosage: tablets 10 mg Frequency: PO (Per Orem) Route: oral

MECHANISM OF ACTION: Enhances the output of respiratory tract fluid by reducing adhesives and surface tension, facilitating the removal of viscous mucus

ADVERSE EFFECTS: CNS: Headache, dizziness Dermatologic: Rash, urticarial GI: Nausea, vomiting, GI Discomfort

DRUG INTERACTIONS: Drug lab test Color interference and false results of 5-HIAA and VMA urinary determinationsINDICATION: Symptomatic relief of respiratory conditions characterized by dry, non-productive cough and when there is mucus in the respiratory tract CONTRAINDICATION: Contraindicated with allergy to guaifenesin Use cautiously with pregnancy, lactation, and persistent coughs10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

History: Allergy to guaifensin, persistent cough due to smoking, asthma or emphysema, very productive cough; pregnancy Physical: Skin lesions, color, orientation, adventitious sounds Interventions Warning: Monitor reaction to drug; persistent cough for longer than 1wk fever rash, or persistent headache may indicate a more serious condition.

Classification: Mucolytics

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Acetylcysteine Hypertonic Saline Dosage: 1-10 mL of 20% solution by nebulization or 2-20 mL of 10% solution q2-6h PRN; Acetamainophen toxicity: initially 140 mg/kg orally, then 70 mg/kg orally q4h for 17 doses (total) Frequency: q 2-6h PRN; q 4h for 17 doses (total) Route: oral or inhalation

MECHANISM OF ACTION: Reduction of viscosityof mucus in acute and chronic bronchopulmonary disease,traccheostomy care, atelectasis due to pulmonary to mucus

ADVERSE EFFECTS: Mucolytic use GI: Nausea, stomatitis Hypersensitivity: Urticaria Respiratory: Bronchospasm, especially in patients with asthma Other: Rhinorrhea Antidotal use Dermatologic: Rash GI: Nausea, vomiting, other GI Problems

INDICATION: To prevent or lessen hepatic injury that may occur after ingestion of potentially hepatotoxic dose of acetaminophen; treatment must start as soon as possible; most effective if administered within 8 hours of ingestion, but can be given within 24 hour or longer after ingestion; IV use approved for this indication CONTRAINDICATION: Mucoytic use Contraindicated with hypersensitivity to acetylceisteine, use caution and discontinue immediately if bronchospasm occur.

Antidotal use No contraindications; use caution with esophageal varices, peptic ulcers10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Patients with asthma, older adults, severe hepatic disease, esophageal varices, peptic ulcer disease Patient/family teaching:the patient should be advised to report difficulty with clearing the airway or any other respiratory distress

Classification: Antitussives

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Benzonate (Tessalon) Codeine Dextromethorphan Hydrobromide (Robitussin DM) Diphenhydramine Hch (Bendaryl Lidocaine HCl (Xylocaine) Dosage: 10-20, Doses are low, 1/10 of those needed to relieve pain,: 100 mg Frequency: 10-20 mg 4-6X a day, 100 mg TID Route: oral

Codeine sulfateMECHANISM OF ACTION:Opioid Antitussives: Used frequently for cough suppression Act in the CNS to elevate cough threshhold Decrease frequency and intensity of cough Less risk for physical dependence May suppress respiration

Non Opioid Antitussives: Enhance analgesic effects of opioids (double the analgesic response to 30 mg morphine by adding 30 mg of dextromethorphan) Suppress cough by decreasing the sensitivity of the respiratory tract stretch receptors (components of the cough-reflex pathway)

ADVERSE EFFECTS: Sedation Dizziness constipation

DRUG INTERACTIONS: Concomitant MAOI use may cause hypotension, fever, nausea, myoclonic jerks, and coma avoid this combinationINDICATION: Control of non-productive cough (nonopioid antitussive) CONTRAINDICATION: Contraindicated with hypersensitivity to any component (check label of products for flavorings, vehicles), sensitivity to bromides, cough that persists for more than 1week, tends to recur, is accompanied by excessive secretions high fever Use cautiously with lactation, pregnancy10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Monitor for signs of respiratory depression Avoid concomitant use with MAO inhibitors Increase fluid intake Prolong use of codeine may cause physical dependence Capsules must be swallowed intact, since chewing will anesthetize the mouth and larynx Drug is not given to infants because anesthesia of the mouth may impair swallowing In the event of overdose: give Naloxone (opioid antagonist)

Classification: Decongestants

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Ephedrine Sulfate Dosage: 25 mg capsules, 50 mg/mL injections Frequency: PO Route: oral, IM, slow IV or subcutaneously Phenylpropanolamine (Disudrin)

MECHANISM OF ACTION: Reduce nasal congestion Stimulating alpha adrenergic receptors on nasal blood vessels Causes vasoconstriction Causes shrinkage of swollen membranes followed by nasal drainage Relieve stuffiness Do not reduce rhinorrhea, sneezing or itching Reduce congestion associated with sinusitis and cold

ADVERSE EFFECTS: Restlessness Irritability Anxiety Insomnia Cause widespread vasoconstriction

DRUG INTERACTIONS: Severe hypertension with MAOIs, TCAs, furazolidone, Additive effects and increased risk of toxicity with urinary alkalinizers Decreases hypotensive acon of guanethidine with ephedrineINDICATION: Treatment of hypotensive rate especially those associated with spinal anestheia, strokes-Adams syndrome with complete heart block syndrome with complete heart block, CNS stimulation narcolepsy and depressive states acute bronchospasm. Treatment of allergic disorders such as bronchial asthma, and local treatment of nasal congestion in acute coryza, vasomotor rhinitis, acute sinusitis, hay fever CONTRAINDICATION: Contraindicated with allergy to ephedrine, angle closure glaucoma,anesthesia with cyclopropane or halothane, thyrotoxicosis diabetes, hypertension, CV disorders, women in labor whose P is lower than 130/80 mmHg Use cautiously with angina, arrhythmias, prostatic hypertrophy, unstable vasomotor syndrome, lactation10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Not given together with other sympathomimetics, CNS stimulation may occur Not given before bedtime, may interfere with sleep Limit the use of decongestants for 3-5 days Must not be given to patients with chronic rhinitis

Classification: Xanthines and Xanthine derivatives

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Anhydrous -Theophylline (Theo-Dur) Aminophylline (Aminophylline) Oxtriphylline Dyphylline Dosage: adult: 4.7 mg/kg; child (1-9 years) 6.2 mg/kg; child (9-16 years) 4.7 mg/kg Frequency: adult q 8; child q 6 Route: oral

MECHANISM OF ACTION: inhibits phosphodiesterase, an enzyme responsible for breaking down cyclic AMP produces bronchodilation reduces airway resistance reduces pulmonary hypertension and alveolar CO2 tension Inhibit mass cell degranulation Inhibit the release of histamine and other mediators Impedes enzymatic actions

ADVERSE EFFECTS: Nausea Vomiting Diarrhea Rectal irritation Reactivation of peptic ulcer Irritability especially in children Restlessness Lightheadedness Muscle toxicity Proteinuria

DRUG INTERACTIONS: Accolate (zafirlukast) AccuNeb (albuterol) acebutolol acetaminophen / butalbital acetaminophen / caffeine acetaminophen / codeine acetaminophen / tramadol Acetocot (triamcinolone)INDICATION: This medication is a bronchodilator, prescribed for asthma, bronchitis, and emphysema. It relaxes muscles in lungs, decreases the sensitivity of lungs to allergens and increases the contractions of diaphragm.

CONTRAINDICATION: Patients with peptic ulcer, gastritis and hypersensitivity to the drug

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Monitor ABGs and theophylline levels Monitor vital signs Avoid caffeine derivatives (chocolates, coffee, tea or cola) Monitor heart rate and blood pressure Evaluate the occurrence of tremors Increase fluid intake Avoid smoking

Classification: Ipratropium

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Atrovent Dosage: nasal inhaler 0.03 or 0.06%; oral inhaler (aerosol) 0.021 mg/spray Frequency: BID or TID Route: inhalation Combivent

MECHANISM OF ACTION: Ipratropium bromide is an anticholinergic (parasympatholytic) agent. Anticholinergics prevent the increases in intracellular concentration of Ca++ which is caused by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle

ADVERSE EFFECTS: Dry mouth Irritation to the pharynx May raise IOP to patients with glaucoma

DRUG INTERACTIONS: Hemangeol (propranolol) Hydrochlorothiazide / propranolol AK-Beta (levobunolol ophthalmic) Use with other anticholinergic drugs (for example, atropine) may increase the occurrence of side effects.INDICATION: Allergen-induced asthma Exercise-induced bronchospsms Bronchospasms associated with COPD; use alsoin asthma CONTRAINDICATION: Combivent Inhalation Aerosol is contraindicated in patients with history of hypersensitivity to soya lecithin or related food products such as soybean and peanut. Combivent Inhalation Aerosol is also contraindicated in patients hypersensitive to any other components of the drug product or to atropine or its derivatives

10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia. Have patient void before taking medication to avoid urinary retention Check for allergies Teach patient proper use of inhalator

Classification: Prophylactic asthmatic drugs

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Cromolyn Sodium Nedocromil Dosage: nebulization solution 20 mg; metered dose inhaler: 2 puffs Frequency: nebulization solution QID; metered dose inhaler QID Route: inhalation

MECHANISM OF ACTION: Cromolyn sodium inhibits the degranulation of sensitized mast cells which occurs after exposure to specific antigens. Cromolyn sodium inhibits the release of histamine and SRS-A (the slow-acting substance of anaphylaxis)

ADVERSE EFFECTS: Headache Ocular burning, irritation and stinging Nasal congestion Asthma Conjunctivitis Eye redness Photophobia Rhinitis

INDICATION: Nasalcrom (cromolyn sodium) Nasal Spray is used to prevent and relieve nasal symptoms of hay fever and other nasal allergies Runny/itchy nose Sneezing CONTRAINDICATION: Patients who have shown hypersensitivity to any of the ingredients10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Instruct patient not to share this medication with others. Doing so may cause the spread of germs. Avoid allergens that may be the cause of your allergies

Classification: Corticostreroids

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Beclomethasone -Dipropionate (Baclovent) Dexamethasone Sodium -Phosphate (Decadron Phosphate Dosage: adult 40 mcg/inh or 80 mcg/inh Frequency: BID Route: inhalation

Beclomethasone-Dipropionate (Becotide)MECHANISM OF ACTION: Corticosteroids enhance the beta-adrenergic response to relieve the muscle spasm. They also act by reversing the mucosal edema, decreasing vascular permeability by vasoconstriction, and inhibiting the release of LTC4 and LTD4. Corticosteroids reduce the mucus secretion by inhibiting the release of secretagogue from macrophages. Corticosteroids inhibit the late phase reaction by inhibiting the inflammatory response and interfering with chemotaxis. This action may be due to the inhibition of LTB4 release

ADVERSE EFFECTS: Adrenal suppression Osteoporosis Hyperglycemia Suppression of growth PUD Bone loss (osteoporosis and stunted growth) Adrenal suppression

DRUG INTERACTIONS: Anticonvulsants Anticoagulants Anti-diabetes

INDICATION: Control of bronchial asthma that requires corticosteroids along with Intranasal Relief of symptoms of seasonal or perennial rhinitis that respond poorly to other treatments; prevention of recurrence of nasal polyps following surgical removal

CONTRAINDICATION: Hypersensitivity to any of the ingredients of this preparation contraindicates its use10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluation

Check for allergies Teach patient proper use

DRUGS TO TREAT ENDOCRINE SYSTEMClassification: Anti-diabetic agents

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Regular (Natural) Insulin

Lispro Insulin (Humalog)

Insulin Aspart (Novolog)

Neutral Protamine Hagedorn (NPH) Insulin Lente Insulin and Ultralente Insulin less allergenic than NPH Semilente Insulin Most rapid Amorphous; noncrystalline Small particles of small size Ultralente Insulin Large crystals Dissoleve slowly Long duration of action Lente Insulin 70% ultralente 30% semilente Intermediate duration of action Insulin Glargine (Lantus)

MECHANISM OF ACTION: Unmodified crystalline insulin Rapid onset Short duration Clear solution Only form that can be administered IV Forms aggregates if given SC Given 30-60 minutes AC

Acts faster than Natural Insulin Shorter duration: 3-6 hours Rapid acting: 15-30 minutes Can be given AC and even PC Dispense by prescription Because of its short duration, must be given with Intermediate or Long Acting Insulin

Analog of human insulin Short duration: 3-5 hours Rapid Onset: 10-20 minutes Available in 10 ml vials Given SC eat within 5-10 minutes immediately after administration In combination with Immediate or Long Acting Insulin to provide basal glycemic control between meals and at night Can be mixed with NPH mixing is done just before administration Dispense by prescription

Protamine the solubility of NPH; retards absorption Delayed Onset Extended duration Intermediate acting Protamine is a foreign body watch for allergic reactions

DRUG INTERACTIONS: Hypoglycemic Agents can intensify hypoglycemia caused by insulin Hyperglycemic Agents drugs that increase blood sugar level Beta Blockers- delay awareness of insulin-induced hypoglycemia by masking signs associatedwith SNS stimulation. It impairs glycogenolysis a way for our body to counteract glucose level

INDICATION: Type 1 DM Diabetic Ketoacidosis to allow cells to take up K and lower K level in the blood Treat hyperkalemia