Professional Documents
Culture Documents
REVIEW RESPONSIBILITIES
Misoprostol Action PO BUN, Frequent Baseline assessment
Replaces protective Hematocrit, Abdominal pain Question for possibility of
(Cytotec)
prostaglandins consumed CBC Diarrhea pregnancy before initiating
with prostaglandin- ALT, AST, Occasional therapy (Pregnancy Category X)
inhibiting therapies (e.g., Hgb, Nausea,
Stage 3
NSAIDs). Creatinine Flatulence
(Also used in
Therapeutic Effect: Dyspepsia
first trimester to
Reduces acid secretion Headache
terminate
from gastric parietal cells,
pregnancy)
stimulates bicarbonate
production from
gastric/duodenal mucosa.
Uses
Prevention of NSAID-
induced gastric ulcers and
in pts at high risk for
developing gastric
ulcer/gastric ulcer
complications
Chemical termination of
pregnancy (in conjunction
with mifepristone)
Bicitra Action PO sodium levels Nausea, During pregnancy, this
This medication is used to pH (acidity) vomiting, medication should be used only
(Cytra-2,
make the urine less acidic. of your urine diarrhea, and when clearly needed. This
Liqui-Dual
Citra,
This medication can also blood stomach pain medication may worsen high
Oracit) prevent and treat certain electrolyte blood pressure during pregnancy
GI System metabolic problems bicarbonate (toxemia of pregnancy).
(electrolyte (acidosis) caused by kidney levels
modifier) disease.
Citric acid and citrate salts
Stage 1 (which
(prior to contain potassium and
epidural) sodium)
Methergine Action PO calcium Nausea, uterine Baseline assessment
Stimulates alpha- levels cramping, Determine baseline serum
(Methylergonovine)
adrenergic, serotonin vomiting calcium level, B/P, pulse. Assess
Stage 2 receptors, producing for any evidence of bleeding
(, given after arterial vasoconstriction before administration.
delivery, Causes vasospasm of Intervention/evaluation
rd
shortens 3 coronary arteries Monitor uterine tone, bleeding,
stage of labor) Directly stimulates uterine B/P, pulse q15min until stable
muscle. (about 1–2 hrs)
Assess extremities for color,
warmth, movement, pain.
Report chest pain promptly
Provide support with ambulation
if dizziness occurs.
Magnesium Action IV Mg, Common Baseline assessment
Essential for enzyme IM electrolytes Assess if pt is sensitive to
Sulfate Muscle
activity, nerve conduction, PO magnesium.
(Epsom Salt) muscle contraction Weakness Antacid: Assess GI pain (duration,
Stage 1 Maintains and restores Lack of Energy location, quality, time of
magnesium levels. Blurry Vision occurrence, relief with food,
Anticonvulsant: Slurred Speech causative/excacerbative factors).
Blocks neuromuscular Headache Laxative: Assess for weight loss,
transmission, amount of Nausea and nausea, vomiting, and history of
acetylcholine released at Vomiting recent abdominal surgery.
motor end plate. Flushing Systemic: Assess renal function,
Produces seizure control serum magnesium.
Uses Intervention/evaluation
Treatment/prevention of Antacid: Assess for relief of
hypomagnesemia gastric distress. Monitor renal
Prevention and treatment function (esp. if dosing is long
of seizures in eclampsia; term or frequent).
Torsade de pointes Laxative: Monitor daily pattern of
(atypical ventricular bowel activity, stool consistency.
tachycardia); Maintain adequate fluid intake.
Treatment of arrhythmias Systemic: Monitor renal function,
due to hypomagnesemia magnesium levels, EKG for
(ventricular cardiac function.
tachycardia/ventricular Test patellar reflexes (knee jerk
fibrillation) reflexes) before giving repeat
parenteral doses (used as
indication of CNS depression;
suppressed reflexes may be sign
of impending respiratory arrest).
Patellar reflex must be present,
respiratory rate should be 16/min
or over before each parenteral
dose. Initiate seizure precautions.
Oxytocin Uses IV electrolytes Occasional: Baseline assessment Assess
Induction of labor at term, Tachycardia, baselines for vital signs, B/P, fetal
(Pitocin,
control of post-partum premature heart rate. Determine frequency,
Syntocinon) bleeding. Adjunct in ventricular duration, strength of
Endocrine management of abortion. contractions, contractions.
system hypotension, Intervention/evaluation
(pituitary drug) nausea, Monitor B/P, pulse, respirations,
vomiting. Rare: fetal heart rate, intrauterine
(Stage 1 & 3) Nasal: pressure, contractions (duration,
Lacrimation/tea strength, frequency) q15min.
ring, nasal Notify physician of contractions
irritation, that last longer than 1 min, occur
rhinorrhea, more frequently than every 2
unexpected min, or stop. Maintain careful
uterine I&O; be alert to potential water
bleeding/contra intoxication. Check for blood loss.
ctions.
Terbutaline Action IV Frequent (38%– Baseline assessment
(Brethine) Stimulates beta2- PO 23%): Bronchospasm: Offer emotional
(Bricanyl) adrenergic receptors, Tremor, anxiety support (high incidence of
resulting in relaxation of Occasional anxiety due to difficulty in
uterine, bronchial smooth (11%–10%): breathing, Sympathomimetics
(CNS system.
muscle Drowsiness, response to drug). Preterm labor:
Stimulant)
Therapeutic Effect: headache, Assess baseline maternal pulse,
Inhibits uterine nausea, B/P, frequency and duration of
(Stage 2)
contractions heartburn, contractions, fetal heart rate.
Relieves bronchospasm, dizziness Intervention/evaluation
reduces airway resistance. Bronchospasm: Monitor rate,
Uses depth, rhythm, type of
Symptomatic relief of respiration; quality, rate of pulse.
reversible bronchospasm Assess lung sounds for rhonchi,
due to bronchial asthma, wheezing, and rales. Monitor
bronchitis, emphysema ABGs. Observe lips, fingernails for
Delays premature labor in cyanosis (blue or dusky color in
pregnancies between 20 light-skinned pts; gray in dark-
and 34 wks skinned pts). Observe for
clavicular retractions, hand
tremor. Evaluate for clinical
improvement (quieter, slower
respirations, relaxed facial
expression, and cessation of
clavicular retractions). Preterm
labor: Monitor for frequency,
duration, strength of
contractions. Diligently monitor
fetal heart rate.
Penicillin Action IM CBC, Occasional: Baseline assessment
Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,
G benzathine
synthesis by binding to one renal dizziness, rash, particularly penicillins,
or more of the penicillin- function pain at injection cephalosporins.
(Stage 2) binding proteins of tests. site. Rare:
bacteria. Therapeutic Seizures,
Effect: interstitial
Bactericidal. Uses nephritis.
Treatment of mild to
moderate severe
infections caused by
organisms susceptible to
low concentrations of
penicillin including
streptococcal (Group A)
upper respiratory
infections, syphilis, yaws.
Prophylaxis of infections
caused by susceptible
organisms (e.g., rheumatic
fever prophylaxis).
Penicillin G Action IV CBC, Occasional: Baseline assessment
Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,
potassium
synthesis by binding to one renal dizziness, rash, particularly penicillins,
or more of the penicillin- function pain at injection cephalosporins.
(Stage 2) binding proteins of tests. site. Rare:
bacteria. Seizures,
Therapeutic Effect: interstitial
Bactericidal. nephritis.
Uses
Treatment of susceptible
infections due to gram-
positive organisms, gram-
negative organisms,
actinomycosis, clostridium,
diphtheria, Listeria, N.
meningitidis, pasteurella
including anthrax,
endocarditis, respiratory
tract infections,
meningitis, neurosyphilis,
skin/skin structure
infections.
Penicillin V Action PO Hgb levels Frequent: Baseline assessment
Inhibits cell wall synthesis Mild Question for history of allergies,
potassium
by binding to bacterial cell hypersensitivity particularly penicillins,
membranes. reaction (chills, cephalosporins.
(Stage 3) Therapeutic Effect: fever, rash), Intervention/evaluation
Bactericidal. nausea, Hold medication, promptly report
Uses vomiting, rash (hypersensitivity), diarrhea
Treatment of mild to diarrhea. (with fever, abdominal pain,
moderate infections of Rare: mucus or blood in stool may
respiratory tract, skin/skin Bleeding, indicate antibiotic-associated
structure, otitis media, allergic colitis). Monitor I&O, urinalysis,
necrotizing ulcerative reaction. renal function tests for
gingivitis; prophylaxis for nephrotoxicity. Be alert for
rheumatic fever, dental superinfection: fever, vomiting,
procedures. diarrhea, anal/genital pruritus,
oral mucosal change (ulceration,
pain, and erythema). Review Hgb
levels; check for bleeding (overt
bleeding, ecchymosis, swelling of
tissue).
Betamethasone Action: IM Calcium Frequent: Baseline assessment
Controls rate of protein PO levels, Systemic: Question for hypersensitivity to
(Celestone,
synthesis, depresses TOPICAL Hematocrit, Increased any corticosteroid, sulfite.
Celestone migration of Hgb, RBC, PT, appetite, Obtain baseline values for height,
Phosphate, polymorphonuclear PTT abdominal weight, B/P, serum glucose,
leukocytes/fibroblasts, distention, electrolytes.
Celestone
reverses capillary nervousness, Obtain baseline results of initial
Soluspan) permeability, prevents or insomnia, false tests (tuberculosis [TB] skin test,
(Stage 3) controls inflammation. sense of well- X-rays, EKG).
Therapeutic Effect: being. Intervention/evaluation
Decreases tissue response Topical: Monitor B/P, blood glucose,
to inflammatory process. Burning, electrolytes.
Uses stinging, Apply topical preparation
Systemic: pruritus. sparingly. Do not use on broken
Anti-inflammatory, skin or in areas of infection.
immunosuppressant, Do not apply to wet skin, face,
corticosteroid replacement and inguinal areas.
therapy.
Topical:
Relief of inflammatory and
pruritic dermatoses. Foam:
Relief of inflammation,
itching associated with
dermatosis.
Ropivacaine Action Nerve Hypotension, Baseline assessment
Most local anesthetics fall block bradycardia, Pt should be in recumbent
(Naropin,
into one of two groups: headache, position before drug is
Naropin esters or amides. Both pruritus, administered by parenteral
Polyamp, provide anesthesia and nausea, route. Assess onset, type,
Naropin SDV, analgesia by reversibly vomiting, location, duration of pain. Obtain
binding to and blocking dizziness, vital signs before giving
Naropin sodium (Na) channels. This anxiety, medication. If respirations are
Novaplus) slows the rate of tinnitus, 12/min or less (20/min or less in
depolarization of the nerve dyspnea, children), withhold medication,
action potential; thus, cardiac arrest, contact physician. Effect of
propagation of the arrhythmias, medication is reduced if full pain
electrical impulses needed seizures, recurs before next dose.
for nerve conduction is syncope, chills Intervention/evaluation
prevented. Monitor vital signs 15–30 min
Uses after subcutaneous/IM dose, 5–
Local anesthetics suppress 10 min after IV dose (monitor for
pain by blocking impulses hypotension, change in
along axons. Suppression rate/quality of pulse). Monitor
of pain does not cause pain level, sedation response.
generalized depression of Monitor daily pattern of bowel
the entire nervous system. activity, stool consistency; avoid
Local anesthetics may be constipation. Check for adequate
given topically and by voiding. Initiate deep breathing,
injection (local infiltration, coughing exercises, particularly in
peripheral nerve block pts with pulmonary impairment.
[axillary], IV regional [Bier Therapeutic serum level: 100–550
block], epidural, and spinal). ng/ml; toxic serum level: greater
than 1,000 ng/ml.
Demerol Action IV plasma Frequent: Baseline assessment
Binds to opioid receptors IM amylase & Sedation, Pt should be in recumbent
(meperidine)
within CNS. Therapeutic PO lipase hypotension position before drug is
(Isonipecaine) Effect: Alters pain concentration (including administered by parenteral
(Pethidine)
perception, emotional orthostatic route. Assess onset, type,
(Neperdine)
response to pain. hypotension), location, duration of pain. Obtain
Uses diaphoresis, vital signs before giving
Analgesic
Relief of moderate to facial flushing, medication. If respirations are
severe pain. dizziness, 12/min or less (20/min or less in
NARCAN
nausea, children), withhold medication,
is vomiting, contact physician. Effect of
antidote
constipation. medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 15–30 min
after subcutaneous/IM dose, 5–
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100–
550 ng/ml; toxic serum level:
greater than 1,000 ng/ml.
Morphine Action IV plasma Ambulatory pts, Baseline assessment
Binds with opioid amylase & that not in Pt should be in recumbent
sulfate
receptors within CNS lipase severe pain position before drug is given by
(Avinza, Kadian, Therapeutic Effect: concentration may experience parenteral route. Assess onset,
Morphine IR, MS Alters pain perception, nausea, type, location, duration of pain.
Contin, MSIR, emotional response to vomiting more Obtain vital signs before giving
pain frequently than medication. If respirations are
Oramorph SR, Uses those in supine 12/min or less (20/min or less in
Roxanol) Relief of moderate to position or who children), withhold medication,
NARCAN severe, acute, or chronic have severe contact physician. Effect of
is pain; analgesia during pain. medication is reduced if full pain
antidote labor Frequent: recurs before next dose.
Drug of choice for pain due Sedation, Intervention/evaluation
to MI, dyspnea from decreased B/P Monitor vital signs 5–10 min after
pulmonary edema not (including IV administration, 15–30 min
resulting from chemical orthostatic after subcutaneous, IM. Be alert
respiratory irritant hypotension), for decreased respirations, B/P.
DepoDur: Epidural diaphoresis, Check for adequate voiding.
(lumbar) single dose facial flushing, Monitor daily pattern of bowel
management of surgical constipation, activity and stool consistency.
pain. Infumorph: Use in dizziness,
devices for managing drowsiness,
intractable chronic pain nausea,
vomiting..
ketorolac Action IV Frequent (17%– Baseline assessment
Inhibits prostaglandin IM BUN, serum 12%): Assess onset, type, location,
(Toradol) synthesis, reduces PO creatine, CBC Headache, duration of pain. Obtain baseline
prostaglandin levels in with diff, nausea, renal/hepatic function tests.
Immune system aqueous humor. electrolytes, abdominal Intervention/evaluation
drug, Anti- Therapeutic Effect: bleeding cramps/pain, Monitor renal/hepatic function
inflammatory & Reduces intensity of pain time, & liver dyspepsia tests, urinary output. Monitor
Disease- stimulus, reduces function (heartburn, daily pattern of bowel activity,
modulating intraocular inflammation. tests indigestion, stool consistency. Observe for
Agent Uses epigastric pain). occult blood loss. Assess for
PO, injection: Short-term therapeutic response: relief of
(5 days or less) relief of pain, stiffness, swelling;
mild to moderate pain. increased joint mobility, reduced
Ophthalmic: Relief of joint tenderness, improved grip
ocular itching due to strength. Be alert to signs of
seasonal allergic bleeding (may also occur with
conjunctivitis. Treatment ophthalmic route due to systemic
postop for inflammation absorption).
following cataract
extraction, pain following
incisional refractive
surgery.
Hydralazine Action PO None Frequent: Baseline assessment
Competes with histamine IM significant Drowsiness, dry Anxiety: Offer emotional support
(Apresoline)
for receptor sites in GI mouth, marked to anxious pt. Assess motor
tract, blood vessels, discomfort with responses (agitation, trembling,
respiratory tract IM injection. tension), autonomic responses
Diminishes vestibular Occasional: (cold/clammy hands,
stimulation, depresses Dizziness, diaphoresis). Antiemetic: Assess
labyrinthine function. ataxia, asthenia for dehydration (poor skin turgor,
Therapeutic Effect: (loss of dry mucous membranes, and
Produces anxiolytic, strength, longitudinal furrows in tongue).
anticholinergic, energy), slurred Intervention/evaluation
antihistaminic, analgesic speech, For those on long-term therapy,
effects; relaxes skeletal headache, hepatic/renal function tests,
muscle; controls nausea, agitation, blood counts should be
vomiting. increased performed periodically. Monitor
Uses anxiety. lung sounds for signs of
Treatment of anxiety, hypersensitivity reaction.
preop sedation, antipruitic Monitor serum electrolytes in pts
with severe vomiting. Assess for
paradoxical reaction, particularly
during early therapy. Assist with
ambulation if drowsiness, light-
headedness occur.
Nubain Action IV plasma Frequent Baseline assessment
Binds with opioid IM amylase & Sedation. Obtain vital signs before giving
(Nalbuphine )
receptors within CNS. May lipase Occasional medication. If respirations are
Short acting displace opioid agonists, concentration Diaphoresis, 12/min or less (20/min or less in
competitively inhibiting cold/clammy children), withhold medication,
their action; may skin, nausea, contact physician. Assess onset,
precipitate withdrawal vomiting, type, location, duration of pain.
symptoms. Therapeutic dizziness, Effect of medication is reduced if
Effect: Alters pain vertigo, dry full pain recurs before next dose.
perception, emotional mouth, Low abuse potential.
response to pain. headache. Intervention/evaluation
Uses Monitor for change in
Relief of moderate to respirations, B/P, rate/quality of
severe pain, preop pulse. Monitor daily pattern of
analgesia, obstetric bowel activity and stool
analgesia, adjunct to consistency. Initiate deep
anesthesia. OFF-LABEL: breathing, coughing exercises,
Opioid-induced pruritus. particularly in pts with pulmonary
impairment. Assess for clinical
improvement, record onset of
relief of pain. Consult physician if
pain relief is not adequate.
Ritodrine Action PO Frequent: Baseline assessment
Inhibits HIV-1 and HIV-2 GI disturbances Pts beginning combination
proteases, rendering these (abdominal therapy with ritonavir and
enzymes incapable of pain, anorexia, nucleosides may promote GI
used to stop processing polypeptide diarrhea, tolerance by beginning ritonavir
premature labor precursors leading to nausea, alone and subsequently adding
production of vomiting), nucleosides before completing 2
noninfectious, immature circumoral and wks of ritonavir monotherapy.
HIV particles. Therapeutic peripheral Obtain baseline laboratory
Effect: Slows HIV paresthesias, testing, esp. serum hepatic
replication, reducing altered taste, function tests, triglycerides
progression of HIV headache, before beginning ritonavir
infection. dizziness, therapy and at periodic intervals
Uses Treatment of HIV fatigue, during therapy. Offer emotional
infection in combination asthenia (loss support to pt/family.
with other antiretroviral of strength, Intervention/evaluation
agents. energy). Closely monitor for evidence of
GI disturbances, neurologic
abnormalities (particularly
paresthesias). Monitor serum
hepatic function tests, serum
glucose, CD4 cell count, plasma
levels of HIV RNA.
Calcium Action: IV electrolytes, Frequent: Baseline assessment Assess
Essential for function, serum Mg, PO: Chalky B/P, EKG and cardiac rhythm,
Gluconate
integrity of nervous, Ph, & K taste. renal function, serum
(Tums) muscular, skeletal systems. concentratio Parenteral: magnesium, phosphate,
Plays an important role in ns Pain, rash, potassium concentrations.
GI Drug, normal cardiac/renal redness, Intervention/evaluation
electrolyte function, respiration, burning at Monitor B/P, EKG, cardiac
modifier blood coagulation, cell injection site, rhythm, serum magnesium,
membrane and capillary flushing, feeling phosphate, potassium, renal
permeability. Assists in of warmth, function. Monitor serum, urine
Therapeutic regulating release/storage nausea, calcium concentrations. Monitor
Effect: of vomiting, for signs of hypercalcemia.
Replaces calcium neurotransmitters/hormo diaphoresis,
in deficiency nes. Neutralizes/reduces hypotension
states; controls gastric acid (increases pH).
hyperphosphate Calcium acetate: Combines
mia in end-stage with dietary phosphate,
renal disease, forming insoluble calcium
relieves phosphate.
heartburn, Uses:
indigestion. Parenteral: Acute
hypocalcemia (e.g.,
neonatal hypocalcemia
tetany, alkalosis),
electrolyte depletion,
cardiac arrest (strengthens
myocardial contractions),
hyperkalemia (reverses
cardiac depression),
Hypermagnesemia (aids in
reversing CNS depression).
Stadol Action IV plasma Frequent: Baseline assessment
Binds to opiate receptor Nasal amylase & Parenteral: Obtain vital signs before giving
(Butorphanol)
sites in CNS. Reduces Spray lipase Drowsiness, medication. If respirations are
Short acting intensity of pain stimuli (Stadol concentration dizziness. 12/min or less (20/min or less in
incoming from sensory NS): Nasal: children), withhold medication,
nerve endings. Therapeutic 10 mg/ml. Nasal contact physician. Assess onset,
Effect: Alters pain congestion type, location, duration of pain.
perception, emotional . Effect of medication is reduced if
response to pain full pain recurs before next dose.
Uses Protect from falls. During labor,
Management of pain assess fetal heart tones, uterine
(including postop pain). contractions.
Nasal: Management of Intervention/evaluation
moderate to severe pain, Monitor for change in
including migraine respirations, B/P, rate/quality of
headache pain. Parenteral: pulse. Initiate deep breathing,
Preop, preanesthetic coughing exercises, particularly in
medication, supplement those with pulmonary
balanced anesthesia, relief impairment. Change pt’s position
of pain during labor. q2–4h. Assess for clinical
improvement, record onset of relief
of pain.
Phytonadione Action IM PT Occasional: Intervention/evaluation
Promotes hepatic IV IR Pain, soreness, Monitor PT, international
Aqua
formation of coagulation PO swelling at IM normalized ratio (INR) routinely
(Vitamin K 1) factors II, VII, IX, X. injection site, in those taking anticoagulants.
stage 2 Therapeutic Effect: pruritic Assess skin for ecchymoses,
First hour after Essential for normal erythema (with petechiae. Assess gums for
clotting of blood. repeated gingival bleeding, erythema.
birth Uses injections), Assess urine for hematuria.
Prevention, treatment of facial flushing, Assess Hct, platelet count,
Cardiovascular hemorrhagic states in altered taste. urine/stool culture for occult
Drug, Affecting neonates; antidote for blood. Assess for decrease in B/P,
coagulation hemorrhage induced by increase in pulse rate, complaint
oral anticoagulants, of abdominal/back pain, severe
Antidote hypoprothrombinemic headache (may be evidence of
for states due to vitamin K hemorrhage). Question for
WARFARIN deficiency. Will not increase in amount of discharge
counteract anticoagulation during menses. Assess peripheral
effect of heparin. pulses. Check for excessive
bleeding from minor cuts,
scratches.
PNV Prenatal vitamins are used PO None Upset stomach; Avoid taking any other
to provide the additional significant headache; or multivitamin product within 2
vitamins needed Unusual or hours before or after you take
during pregnancy. unpleasant your prenatal vitamins. Taking
Minerals may also be taste in your similar vitamin products together
contained in prenatal mouth. at the same time can result in a
multivitamins. vitamin overdose or serious side
effects.
Avoid the regular use of salt
substitutes in your diet if your
multivitamin contains potassium.
If you are on a low-salt diet, ask
your doctor before taking a
vitamin or mineral supplement.