Mosby's 2014 Nursing Drug Reference (9 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Antiparkinson agents are divided into cholinergics, DOPamine, and monoamine oxidase type B agonists. Cholinergics work by blocking or competing at central acetylcholine receptors. DOPamine agonists work by decarboxylation to DOPamine or by activation of dopamine receptors. Monoamine oxidase type B inhibitors work by increasing dopamine activity by inhibiting MAO type B activity.
Antiparkinson agents are used alone or in combination for patients with Parkinson’s disease.
Persons with hypersensitivity, closed-angle glaucoma, and undiagnosed skin lesions should not use these products.
Precautions:
Antiparkinson agents should be used with caution in pregnancy, breastfeeding, children, renal/cardiac/hepatic disease, and affective disorder.
•
Product up until NPO before surgery
•
Dosage adjustment depending on patient response
•
With meals; limit protein taken with drug
•
Only after MAOIs have been discontinued for 2 wk
Side effects and adverse reactions vary widely among products. The most common side effects include involuntary movements, headache, numbness, insomnia, nightmares, nausea, vomiting, dry mouth, 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.
•
Risk for injury
[uses]
•
Deficient knowledge
[teaching]
•
Impaired physical mobility
[uses]
•
B/P, respiration
•
Mental status: affect, mood, behavioral
changes, depression, complete suicide assessment
•
Assistance with ambulation, during beginning therapy
•
Testing for diabetes mellitus, acromegaly if on long-term therapy
•
Therapeutic response: decrease in akathisia, increased mood
•
To change positions slowly to prevent orthostatic hypotension
•
To report side effects: twitching, eye spasm; indicate overdose
•
To use product exactly as prescribed; if product is discontinued abruptly, parkinsonian crisis may occur
carbidopa-levodopa
The antiplatelets are divided into the platelet aggregation inhibitors, platelet adhesion inhibitors, and the glycoprotein IIb, IIIa inhibitors. The platelet aggregation inhibitors work by action on thrombin; the platelet adhesion inhibitors work by inhibition of phosphodiesterase; and the glycoprotein IIb, IIIa inhibitors work by preventing fibrin from binding to glycoprotein IIb, IIIa receptors.
Antiplatelets are used to prevent MI and stroke; other products are used for coronary syndromes.
Persons developing hypersensitive reactions should not use these products.
Precautions:
Antiplatelets should be used cautiously in pregnancy, breastfeeding, and bleeding disorders.
•
With heparin or other aspirin (some products)
The most common side effects are headache, dizziness, bleeding, and diarrhea.
Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.
Interactions vary widely among products. Check individual monographs for specific information.
•
Risk for injury
[uses, adverse reactions]
•
Deficient knowledge
[teaching]
•
Reason for use of these products
•
For hypersensitivity reactions with some products
•
For bleeding from orifices, in stool, urine
•
Blood studies: platelets, Hgb, Hct, PT/APTT, and INR
•
Storage at room temperature vial/ampules, oral products
•
Therapeutic response: absence of MI, stroke or other coronary syndromes
•
To avoid hazardous activities if drowsiness, dizziness occurs; to ask for assistance if hospitalized
•
About all aspects of product usage
Antipsychotics/neuroleptics are divided into several subgroups: phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and indolones and other heterocyclic compounds. Although chemically different, these subgroups share many pharmacologic and clinical properties. All antipsychotics work to block postsynaptic dopamine receptors in the brain that are responsible for psychotic behavior, including hallucinations, delusions, and paranoia.
Antipsychotic behavior is decreased in conditions such as schizophrenia, paranoia, and mania. These agents are also effective for severe anxiety, intractable hiccups, nausea, vomiting, behavioral problems in children, and relaxation before surgery.
Persons with hepatic damage, severe hypertension or coronary disease, cerebral arteriosclerosis, blood dyscrasias, bone marrow depression, parkinsonism, severe depression, closed-angle glaucoma, children <12 yr, or persons withdrawing from alcohol or barbiturates should not use antipsychotics until these conditions are corrected.
Precautions:
Caution must be used when antipsychotics are given to geriatric patients because metabolism is slowed, and adverse reactions can occur rapidly. Hepatic/renal disease may cause poor metabolism and excretion of the product. Seizure threshold is decreased with these products; increases in the dose of anticonvulsants may be required. Persons with diabetes mellitus, prostatic hypertrophy, chronic respiratory disease, and peptic ulcer disease should be monitored closely.
•
Antiparkinson agent if EPS occur
•
Liquid concentrates mixed in glass of juice or cola because taste is unpleasant; avoid contact with skin when preparing liquid concentrate or parenteral medications
•
Patient should remain lying down for at least 30 min after IM inj
The most common side effects include EPS such as pseudoparkinsonism, akathisia, dystonia, and tardive dyskinesia, which may be controlled by use of antiparkinson agents. Serious adverse reactions such as hypotension, agranulocytosis, cardiac arrest, and laryngospasm have occurred. Other common side effects include dry mouth and photosensitivity.
Onset, peak, and duration vary widely with different products and routes. Products are metabolized by the liver, are excreted in urine as metabolites, are highly bound to plasma proteins, cross the placenta, and enter breast milk. Half-life can be extended over 3 days.
Because other CNS depressants can cause oversedation, these combinations should be used carefully. Anticholinergics may decrease the therapeutic actions of phenothiazines and also cause increased anticholinergic effects.
•
Chronic confusion
[uses]
•
Bilirubin, CBC, hepatic studies monthly because these products are metabolized in the liver and excreted in urine
•
I&O ratio: palpate bladder if low urinary output occurs; urinary retention occurs with many of these products
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
Dizziness, faintness, palpitations, tachycardia on rising
•
B/P (lying and standing); wide fluctuations between lying and standing B/P may require dosage or product change because orthostatic hypotension is occurring
•
EPS, including akathisia, tardive dyskinesia, pseudoparkinsonism
•
Supervised ambulation until stabilized on medication; do not involve in strenuous exercise program because fainting is possible; patient should not stand still for long periods
•
Increased fluids to prevent constipation
•
Sips of water, candy, gum for dry mouth
•
Therapeutic response: decrease in excitement, hallucinations, delusions, paranoia; reorganization of thought patterns, speech
•
To rise from sitting or lying position gradually; fainting may occur
•
To avoid hot tubs, hot showers, or tub baths; hypotension may occur
•
To wear a sunscreen or protective clothing to prevent burns
•
To take extra precautions during hot weather to stay cool; heat stroke can occur
•
To avoid driving, other activities requiring alertness until response to medication is known
•
That drowsiness or impaired mental/motor activity is evident the first 2 wk, but tends to decrease over time
Antipyretics act on the CNS to control fever and also inhibit prostaglandin production.
Antipyretics are used to decrease fever.
Persons developing hypersensitive reactions should not use these products.
Precautions:
Antipyretics should be used cautiously in pregnancy, breastfeeding, hepatic disease, geriatric patients, and those with certain GI disorders.
•
Around the clock to keep fever reduced
The most common side effects are nausea, vomiting, and rash.
Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.
Interactions vary widely among products. Check individual monographs for specific information.
•
Risk for injury
[uses, adverse reactions]
•
Deficient knowledge
[teaching]
•
Temperature frequently
•
For reason for use and expected outcome
•
For hypersensitivity reactions: rash, bronchospasm with some products
•
Storage at room temperature
•
Therapeutic response: absence or decreasing fever after use
•
All aspects of product usage
choline/magnesium salicylates
choline salicylate
magnesium salicylate
salsalate
Antiretrovirals act by blocking DNA synthesis.
Antiretrovirals are used for HIV infections and chronic hepatitis C to slow the progression of the disease.
Persons with hypersensitivity should not use these products.
Precautions:
Antiretrovirals should be used cautiously in renal/hepatic disease, pregnancy, and breastfeeding. Protease inhibitors should be used cautiously in diabetes.
•
In equal intervals around the clock
The most common side effects are nausea, vomiting, anorexia, headache, and diarrhea. The most serious adverse reactions are nephrotoxicity and blood dyscrasias.
Onset, peak, and duration vary widely among products. Most products are metabolized by the liver and excreted by the kidneys.
Interactions vary widely among products. Check individual monographs for specific information.
•
Risk for infection
[uses]
•
Risk for injury
[adverse reactions]
•
Deficient knowledge
[teaching]
•
Noncompliance
[teaching]
•
For signs of HIV infection; increased CD4 counts, decreased viral load; signs of chronic hepatitis C
•
Patients with compromised renal system; because product is excreted slowly in poor renal system function, toxicity may occur rapidly
•
Storage at room temperature
•
Therapeutic response: decreased viral load, increased CD4 count, improvement in the symptoms of HIV/AIDS
•
To report sore throat, fever, fatigue; may indicate superinfection
•
That medication does not cure condition or prevent infecting others but controls symptoms
•
That product must be taken around the clock, in equal intervals, to maintain blood levels for duration of therapy
•
To notify prescriber of side effects such as bruising, bleeding, fatigue, malaise; may indicate blood dyscrasias
amprenavir
saquinavir
