Mosby's 2014 Nursing Drug Reference (6 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Anticonvulsants are divided into the barbiturates, benzodiazepines, hydantoins, succinimides, and miscellaneous products. Barbiturates and benzodiazepines are discussed in separate sections. Hydantoins act by inhibiting the spread of seizure activity in the motor cortex. Succinimides act by inhibiting spike and wave formation; they also decrease amplitude, frequency, duration, and spread of discharge in seizures.
Hydantoins are used in generalized tonic-clonic seizures, status epilepticus, and psychomotor seizures. Succinimides are used for absence (petit mal) seizures. Barbiturates are used in generalized tonic-clonic and cortical focal seizures.
Hypersensitive reactions may occur, and allergies should be identified before these products are given.
Precautions:
Persons with renal/hepatic disease should be watched closely.
•
With food, milk to decrease GI symptoms
Bone marrow depression is the most life-threatening adverse reaction associated with hydantoins or succinimides. The most common side effects are GI symptoms. Other common side effects for hydantoins are gingival hyperplasia and CNS effects such as nystagmus, ataxia, slurred speech, and mental confusion.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine, bile, and feces.
Decreased effects of estrogens, oral contraceptives (hydantoins).
•
Injury, risk for
[uses]
•
Noncompliance
[teaching]
•
Renal studies, including BUN, creatinine, serum uric acid, urine creatinine clearance before and during therapy
•
Blood studies: RBC, Hct, Hgb, reticulocyte counts weekly for 4 wk then monthly
•
Hepatic studies: AST, ALT, bilirubin, creatinine
•
Mental status, including mood, sensorium, affect, behavorial changes; if mental status changes, notify prescriber
•
Eye problems, including need for ophthalmic exam before, during, and after treatment (slit lamp, funduscopy, tonometry)
•
Allergic reactions, including red, raised rash; if this occurs, product should be discontinued
•
Blood dyscrasia, including fever, sore throat, bruising, rash, jaundice
•
Toxicity, including bone marrow depression, nausea, vomiting, ataxia, diplopia, CV collapse, Stevens-Johnson syndrome
•
Good oral hygiene as it is important for hydantoins
•
Therapeutic response: decreased seizure activity; document on patient’s chart
•
To carry emergency ID stating products taken, condition, prescriber’s name, phone number
•
To avoid driving, other activities that require alertness
Antidepressants are divided into the tricyclics, MAOIs, and miscellaneous antidepressants (SSRIs). The tricyclics work by blocking reuptake of norepinephrine and serotonin into nerve endings and increasing action of norepinephrine and serotonin in nerve cells. MAOIs act by increasing concentrations of endogenous EPINEPHrine, norepinephrine, serotonin, and DOPamine in storage sites in CNS by inhibition of MAO; increased concentration reduces depression.
Antidepressants are used for depression and, in some cases, enuresis in children.
The contraindications to antidepressants are seizure disorders, prostatic hypertrophy
and severe renal/hepatic/cardiac disease depending on the type of medication.
Precautions:
Antidepressants should be used cautiously in suicidal patients, severe depression, schizophrenia, hyperactivity, diabetes mellitus, pregnancy, and geriatric patients.
•
Increased fluids if urinary retention occurs, bulk in diet, if constipation occurs
•
With food or milk for GI symptoms
The most serious adverse reactions are paralytic ileus, acute renal failure, hypertension, and hypertensive crisis, depending on the specific product. Common side effects are dizziness, drowsiness, diarrhea, dry mouth, urinary retention, and orthostatic hypotension.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
•
Ineffective coping
[uses]
•
Risk for injury
[uses/adverse reactions]
•
Deficient knowledge
[teaching]
•
B/P (lying, standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take VS q4hr in patients with cardiovascular disease
•
Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy
•
Hepatic studies: AST, ALT, bilirubin, creatinine
•
Weight every wk; appetite may increase with product
•
EPS, primarily in geriatric patients: rigidity, dystonia, akathisia
•
Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms: depression, panic
•
Urinary retention, constipation; constipation is more likely to occur in children, geriatric patients
•
Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness; do not usually occur unless product was discontinued abruptly
•
Alcohol consumption; if alcohol is consumed, hold dose until morning
•
Storage in tight container at room temperature; do not freeze
•
Assistance with ambulation during beginning therapy because drowsiness, dizziness occur
•
Safety measures including side rails primarily in geriatric patients
•
Checking to see PO medication swallowed
•
Gum, hard candy, or frequent sips of water for dry mouth
•
Therapeutic response: decreased depression
•
That therapeutic effects may take 2-3 wk
•
To use caution in driving, other activities requiring alertness because of drowsiness, dizziness, blurred vision
•
To avoid alcohol ingestion, other CNS depressants
•
Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise
•
To wear sunscreen or wide-brimmed hat; photosensitivity may occur
Antidiabetics are divided into the insulins that decrease blood glucose, phosphate, and potassium and increase blood pyruvate and lactate; and oral antidiabetics that cause functioning β-cells in the pancreas to release insulin and improve the effect of endogenous and exogenous insulin.
Insulins are used for ketoacidosis and diabetes mellitus types 1 and 2; oral antidiabetics are used for stable adult-onset diabetes mellitus type 2.
Hypersensitive reactions may occur, and allergies should be identified before these products are given. Oral antidiabetics should not be used in juvenile or brittle diabetes, diabetic ketoacidosis, or severe renal/hepatic disease.
Precautions:
Oral antidiabetics should be used with caution in the geriatric patient, in cardiac disease, pregnancy, breastfeeding, and in the presence of alcohol.
•
Insulin after warming to room temperature by rotating in palms to prevent lipodystrophy from injecting cold insulin
•
Human insulin to those allergic to beef or pork
•
Oral antidiabetic 30 min before meals
The most common side effect of insulin and oral antidiabetics is hypoglycemia. Other adverse reactions to oral antidiabetics include blood dyscrasias; hepatotoxicity; and, rarely, cholestatic jaundice. Adverse reactions to insulin products include allergic responses and, more rarely, anaphylaxis.
Onset, peak, and duration vary widely among products. Oral antidiabetics are metabolized in the liver, with metabolites excreted in urine, bile, and feces.
Interactions vary widely among products. Check individual monographs for specific information.
•
Imbalanced nutrition: more than body requirements
[uses]
•
Blood, urine glucose levels during treatment to determine diabetes control (oral products)
•
Fasting blood glucose, 2 hr PP (60-100 mg/dl normal fasting level) (70-130 mg/dl normal 2-hr level)
•
Hypoglycemic reaction that can occur during peak time
•
Rotation of inj sites when giving insulin; use abdomen, upper back, thighs, upper arm, buttocks; rotate sites within
one of these regions; keep a record of sites
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia, clear sensorium; absence of dizziness; stable gait
•
To avoid alcohol and salicylates except on advice of prescriber
•
Symptoms of ketoacidosis: nausea, thirst, polyuria, dry mouth, decreased B/P; dry, flushed skin; acetone breath, drowsiness, Kussmaul respiration
•
Symptoms of hypoglycemia: headache, tremors, fatigue, weakness; that candy or sugar should be carried to treat hypoglycemia
•
To test urine for glucose/ketones tid if this product is replacing insulin
•
To continue weight control, dietary restrictions, exercise, hygiene
•
To obtain yearly eye exams
Antidiarrheals work by various actions, including direct action on intestinal muscles to decrease GI peristalsis; by inhibiting prostaglandin synthesis responsible for GI hypermotility; by acting on mucosal receptors responsible for peristalsis; or by decreasing water content of stools.
Antidiarrheals are used for diarrhea of undetermined causes.
Persons with severe ulcerative colitis, pseudomembranous colitis with some products.
Precautions:
Antidiarrheals should be used with caution in the geriatric patient, pregnancy, breastfeeding, children, dehydration.
•
For 48 hr only
The most serious adverse reactions of some products are paralytic ileus, toxic megacolon, and angioneurotic edema. The most common side effects are constipation, nausea, dry mouth, and abdominal pain.
Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
Interactions vary widely among products. Check individual monographs for specific information.
•
Constipation
[adverse reactions]
•
Diarrhea
[uses]
•
Deficient fluid volume
[adverse reactions]
•
Deficient knowledge
[teaching]
•
Electrolytes (K, Na, Cl) if on long-term therapy
•
Bowel pattern before; for rebound constipation after termination of medication
•
Response after 48 hr; if no response, product should be discontinued
•
Dehydration in children
•
Therapeutic response: decreased diarrhea
•
To avoid OTC products
•
Not to exceed recommended dose
