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1

Wellbutrin (bupropion)

Antidepressant

Works by inhibiting reuptake of Dopamine, norepinephrine and serotonin

Adverse side effects: seizures, suicidal ideation, mania (periods of excessive excitement, euphoria)

*MONITOR BP WITH PATIENT LYING/STANDING, IF SYSTOLIC B/P DROPS 20 MMHG, HOLD PRODUCT*

Asses for increased risk of seizures. If patient has used CNS depressant or stimulants, dosage should not be exceeded

Black box warning: assess MENTAL STATUS, mood, affect, suicidal tendencies. Also risk of seizures is increased if dose is exceeded or patient has seizure disorder

Education:
- therapeutic effects may take 2-3 WEEKS
- use caution in driving or other activities that require alertness due to drowsiness, dizziness and blurred vision
-AVOID RISING QUICKLY FROM SITTING TO STANDING
- avoid alcohol
- report hearing, visual, CNS changes


Black box warning: teach patient that risk of seizures increases when dose is exceeded or if patient has seizure disorder

2

Relafen (nabumetone)

Nonsteroidal anti-inflammatory (NSAID)

Therapeutic outcome: decreased pain and swelling of joints

Give with food or milk to decrease gastric symptoms and sit upright

Adverse effects:
-ulceration, hematuria, ([CHF, MI, stroke: black box warning])

THIS DRUG IS NEPHROTOXIC SO MAKE SURE WE DO LIVER FUNCTION TESTS
BUN, AST, ALT, CREATININE

BLACK BOX WARNING: can cause GI issues- ulceration, bleeding

After meds, make sure you ASSESS FOR PAIN within 30 minutes

Education
-Teach patient to avoid aspirin, alcoholic beverages, NSAIDS and OTC medications unless approved by prescriber
- caution patient to report bleeding, bruising, fatigue, dark stools, change in urine pattern

3

Ranitidine (Zantac)

Acid reducer, H2 histamine receptor antagonist
- prevents gastric acid secretion

therapeutic outcome: prevention/healing of gastric/duodenal ulcers, decrease symptoms of GERD

Adverse effects: tachycardia, bradycardia, hepatotoxicity, pneumonia

HEPATOTOXIC, we want to assess AST, creatinine, ALT, I/O ratio, BUN, creatinine, CBC with differential monthly

*important to assess for GI complains, assess patient with ulcers or suspected ulcers: epigastric/abdominal pain, blood in stools

-Caution patient that impotence may occur and is reversible after treatment is discontinued

**Inform patient to report diarrhea, black tarry stools, sore throat, rash, dizziness, confusion or delirium immediately

4

Prilosec

Antiulcer, proton pump inhibitor

Works by suppressing gastric secretion

Therapeutic outcome: absence of duodenal ulcers, decreased GERD

Monitor hepatic enzymes such as AST, ALT, bilirubin and gastrin

Adverse effects: diarrhea, acid regurgitation, constipation. Can also lead to hepatic failure and pneumonia

Assessment:
- electrolyte imbalances- hyponatremia, hypomagnesemia may occur in those using product 3 months to 1 year, if hypomagnesemia occurs, use of mag supplement may help

Assess GI system: bowel sounds q8hr, abdomen for pain and swelling

Monitor hepatic enzymes: AST, ALT, blood studies

Teach patient to take as directed even if feeling better since prilosec can take up to 4 days for full effect

report severe diarrhea, black tarry stools

avoid alcohol and ibuprofen because it can cause GI irritation

5

Prednisone

Corticosteroid

Decreases inflammation

Used for severe inflammation, MS and skin disorders

**ASSESS FOR ADRENAL INSUFFICIENCY: nausea, vomiting anorexia, confusion, hypotension, weight loss before and during treatment

Medication can also increase cholesterol levels

Monitor potassium, blood glucose, and urine glucose while on long term therapy since hypokalemia and hyperglycemia may occur

Adverse effects: GI hemorrhage, osteoporosis, pancreatitis

Daily weights, notify if weight gain of 5 pounds or more a week

Monitor BP, pulse, notify if pain occurs

Assess for potassium depletion: fatigue, polyuria, dysrhythmias, cardiac symptoms

Education
- ***DO NOT DISCONTINUE ABRUPTLY because adrenal crisis can result
-Teach patient to notify prescriber if pregnancy is planned or suspected; cleft palate, stillbirth, abortion reported

6

Lotensin (Benazepril)

Antihypertensive/Ace inhibitor

TAKE BLOOD PRESSURE AND PULSE BEFORE GIVING

Therapeutic outcome: decreased blood pressure

**THIS MEDICATION MAY IMPAIR RENAL/LIVER FUNCTION SO BASELINES NEED TO BE ESTABLISHED BEFORE THERAPY BEGINS

Adverse side effects
-hepatotoxicity, pancreatitis, increased BUN and creatinine

Assessments
-monitor renal studies: protein, BUN, creatinine, watch for increased levels that may indicate renal failure
- monitor urine fr protein
- monitor renal symptoms: polyuria, oliguiria, frequency, dysuria

-check potassium levels throughout treatment
- assess for allergic reactions: rash, fever, itching

Teaching:

-SWITCH POSITIONS SLOWLY, DON'T EXERCISE IN HOT WEATHER- HYPOTENSION CAN OCCUR. RISE SLOWLY TO SITTING OR STANDING TO AVOID ORTHOSTATIC HYPOTENSION

-DO NOT DC PRODUCT ABRUPTLY

-drug may cause dizziness, fainting, light headedness during first couple days of therapy

Important to notify the prescriber of mouth sores, sore throat, fever, and swelling of hands and feet

7

Lipitor (Atorvastatin)

Anti lipidemic

Decreases cholesterol levels and LDLs and increases HDL'S

Used to prevent cardiovascular disease.

Precautions: (ask patient about past liver disease, alcoholism, electrolyte imbalance because this drug can cause liver dysfunction)

-Ensure that nutritional analysis has been completed by dietitian before treatment


Adverse side effects: liver dysfunction, pancreatitis, abdominal cramps

Assessment
-monitor bowel pattern daily- diarrhea might be a problem
- monitor liver function studies q1-2mo during first year of tx, AST, ALT, liver function tests may be increased


Education
- avoid grapefruit juice
- decreasing risk factors such as high-fat diet, smoking, avoiding alcohol and promote exercise
-notify prescriber if GI symptoms of diarrhea, abdominal pain occur
- advise pt that tx will take several years and blood work and eye exams will be necessary during tx

8

Digoxin

Important assessments:

*CHECK APICAL PULSE TO SEE IF BELOW 60 FOR 1 MINUTE)

*DO NOT GIVE AT SAME TIME AS ANTACIDS OR OTHER PRODUCTS THAT DECREASE ABSORPTION* Check with "pharmacist"

*MONITOR ELECTROLYTES (POTASSIUM, SODIUM, CHLORIDE, MAGNESIUM), RENAL FUNCTION STUDIES: BUN, CREATININE BEFORE TREATMENT
*BLOOD STUDIES: ALT, AST, BILIRUBIN, HCT, HGB BEFORE TX

*PEOPLE ON DIGOXIN ARE USUALLY ON DIURETICS WHICH CAN CAUSE POTASSIUM DEPLETION WHICH CAN INCREASE CHANCE OF DIGOXIN TOXICITY!!!!!

Functional class: antidysrhythmic
- Decreases heart rate
- Decreases AV conduction

Used for ATRIAL FIBRILLATION

Adverse effects
- Confusion, blurred vision
- Yellow-green halos in eyes (DIGOXIN TOXICITY)
- Vomiting

Education
- Teach patient that this med is to regulate heart’s functioning

- Advise patient to not stop abruptly

- Maintain a sodium restricted diet and encourage potassium supplements to prevent toxicity

- Instruct patient to notify prescriber of loss of appetite, lower stomach pain, diarrhea, weakness, yellow-green vision because these are considered TOXIC SYMPTOMS

- Instruct patient to report shortness of breath, difficulty breathing, weight gain, edema, persistent cough (right sided heart failure?)

- Take missed doses within 12 hours and do not double dose

- Teach patient to check and record pulse for 1 minute before taking dose. If there is a change of greater than 15 bpm from usual pulse, notify prescriber

9

Ciprofloxacin (CIPRO)

Broad spectrum anti infective

OBTAIN CULTURE/SENSITIVITY BEFORE USE

treats gram-positive organisms such as staph epidermis and MRSA, gram negative such as e.coli, salmonella

Used for UTI, infectious diarrhea

Black box warning: can lead to tendon pain/rupture, tendonitis

Adverse effects:
- pseumembranous colitis
- abdominal pain
- anaphylaxis

*Avoid taking with corticosteroids because this can increase tendonitis and tendon rupture

Assessment
- check for previous sensitivity reaction
-signs and symptoms of infection
- assess for anaphylaxis(rash, hives, itchiness)
- ID URINE OUTPUT, if decreasing, notify prescriber (may indicate nephrotoxicity) check for increased BUN, creatinine

Teach patient to report tendon pain, chest pain, palpitations

teach patient to notify MD if rash occurs

10

Ceftriaxone sodium

Broad spectrum antibiotic

C/S needed before starting therapy

Adverse effects
-nephrotoxic, renal failure, c.diff

Assess for anaphylaxis (rash, itching, chills, fever, joint pain)

-OBTAIN BASELINE FOR SIGNS/SYMPTOMS OF INFECTION BEFORE AND DURING TX

ID urine output- if decreasing, notify prescriber because this may indicate nephrotoxicity
- check for increased BUN, creatinine

-If on long term therapy- monitor blood studies (AST, ALT, CBC, Hct, bilirubin) and electrolytes (potassium, sodium, chloride)

ASSESS FOR BOWEL PATTERNS DAILY FOR DIARRHEA (C DIFF)

Education
- educate patient to notify prescriber of diarrhea with blood or pus- may indicate c-diff

11

Cefazolin sodium

broad spectrum antibiotic

Adverse effects
-c.diff, NEPHROTOXICITY, RENAL FAILURE

*MAKE SURE YOU DO C/S BEFORE THERAPY
*OBTAIN BASELINE SIGNS/SYMPTOMS OF INFECTION BEFORE AND DURING TX
*KIDNEY LABS, LIVER FUNCTION LABS

Bun, AST, ALT, creatinine

ASSESS PT FOR PREVIOUS SENSITIVITY REACTIONS TO PENICILLINS OR OTHER CEPHALOSPORINS

Assess for anaphylaxis

URINE OUTPUT- IF DECREASING, NOTIFY MD- MAY INDICATE NEPHROTOXICITY- CHECK FOR INCREASED BUN, CREATININE

ASSESS BOWEL PATTERN DAILY

ASSESS SUPERINFECTION (PERINEAL ITCHING, RASH, DIARRHEA)

Education
-teach patient to report sore throat, bruising, bleeding, joint pain- may indicate blood dyscrasias
- contact prescriber if vaginal itching, loose foul smelling stools, furry tongue occur- may indicate superinfection
- comply with length of time ordered
- advise pt to notify prescriber of diarrhea with blood, pus, mucus

12

Cardizem (diltiazem)

Calcium channel blocker, antianginal, antiarrhythmic, antihypertensive

*CHECK BLOOD PRESSURE*
*CHECK PULSE*
*KIDNEY FUNCTION TESTS*

produces relaxation of coronary vascular smooth muscle, dilates coronary and peripheral arteries, slows SA/AV nodes

therapeutic outcome: decreased angina, dysrhythmias, B/P

Adverse effects
- dysrhythmia, CHF, heart block, acute renal failure

Education:
- avoid hazardous activities such as operating machinery and driving until stabilized on product and dizziness is no longer an issue

- teach patient to continue use even if feeling better and do not discontinue abruptly !!!

- teach patient how to take pulse/BP before taking medication

*CHANGE POSITIONS SLOWLY

- limit caffeine consumption, avoid grapefruit juice, avoid alcohol and OTC products unless instructed by prescriber

- tell patient to comply in all areas of medical regimen, diet, exercise, stress reduction, product therapy

- notify prescriber of irregular heartbeat, shortness of breath, swelling of feet and hands





13

Ampicillin/sulbactam

broad spectrum anti-infective

used for skin infections, cellulitis, UC

C/S BEFORE GIVING MEDICATION
*OBTAIN BASELINE FOR SIGNS/SYMPTOMS OF INFECTION BEFORE BEGINNING THERAPY AND DURING

*ASSESS RENAL STUDIES: URINALYSIS, PROTEIN, BUN, CREATININE

*BLOOD STUDIES/ELECTROLYTES IF ON LONG TERM THERAPY

ASSESS PT FOR PREVIOUS SENSITIVITY REACTION TO PENICILLINS OR CEPHALOSPORINS

Adverse effects
- pseudomembranous colitis, hepatic necrosis/failure, stevens-johnson syndrome

ASSESS FOR ALLERGIC REACTIONS- RASH, ITCHINESS, CHILLS, FEVER

ID URINE OUTPUT- IF DECREASING- NOTIFY PRESCRIBER- MAY INDICATE NEPHROTOXICITY

ASSESS BOWEL PATTERNS DAILY- WATCH FOR C.DIFF.

Education
- advise pt to contact prescriber if vaginal itching, loose foul smelling stools, furry tongue occurs- this could indicate c. diff

-report immediately fever, diarrhea with pus, blood or mucus- may occur up to 4 weeks after tx

14

Clindamycin (cleocin)

Anti-infective

used for infections

can cause pseudomembranous colitis and diarrhea

*ASSESS ANY PT WITH COMPROMISED RENAL SYSTEM- PRODUCT IS EXCRETED SLOWLY IN POOR RENAL SYSTEM FUNCTION AND MAY CAUSE TOXICITY*

*DO C/S BEFORE STARTING TX*

*OBTAIN BASELINE SIGNS/SYMPTOMS OF INFECTION BEFORE AND DURING THERAPY*

black box warning: c.diff, diarrhea

Adverse effects
- diarrhea, weight loss, c.diff

Assess for allergic reactions

*ID URINE OUTPUT- IF DECREASING, NOTIFY PRESCRIBER- MAY INDICATE NEPHROTOXICITY- ALSO LOOK FOR INCREASED BUN AND CREATININE

ASSESS BOWEL PATTERN DAILY

*ASSESS SERIOUS SKIN INFECTIONS: STEVENS JOHNSON SYNDROME

Education
- take with a full glass of water prevent GI upset
- complete entire course of medication to ensure organism death
- advise patient to report sore throat, fever, fatigue- may indicate superinfection

*REPORT DIARRHEA WITH PUS, MUCUS