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Know Your Values  

It is important to note that most of the lab value ranges are not exactly the same. Almost every institution will set its “normal” set of range for a particular lab value, thus, every institution may have varying lab value ranges. But knowing the approximate range of a certain value should help not only in the NCLEX world.

It is important to remember that laboratory results, even in the same institution, may vary from one person to another because of reasons such as race, age, sex, menstrual cycle, problem with collection, handling of the specimen, drugs that affect the outcome, and other factors.  Any result outside the set of normal range should be discussed with a doctor.

 

Below is a list and discussion of common lab values and a table of certain lab values. See link on Home Page for link to Labtestsonline.com for other detailed lab tests.

 

Complete Blood Count (CBC)

The CBC looks at the following cells:

·    White Blood Count (WBC)

Normal range:  4,000 – 11,000

 

Refers to the number of white cells which when elevated is a possible sign of infection and when decreased could be a sign of disease (i.e. bone marrow disease) or due to an enlarged spleen.  High WBC can be a sign of infection. WBC is also increased in certain types of leukemia.

 

Normal range:  4,000 – 11,000

 

·    Hemoglobin (Hgb)  / Hematocrit (Hct)

Refers to the amount of oxygen carrying protein found in red blood cells. And the hematocrit is the percentage of the blood volume occupied by red blood cells. A decrease in values for both is an indication of anemia, living at high altitude, or excessive bone marrow production of blood cells.

 

Normal range:

Hemoglobin (Hgb)       =          Male =  13- 18;                        Female = 12 – 16

Hematocrit (Hct)          =          Male =  40% - 54%;     Female = 38% - 47%

 

·    Mean Corpuscular Volume (MCV)

This helps diagnose a cause of an anemia. A low value may mean iron deficiency, while a high value may mean a deficiency in B12 or Folate, ineffective production in the bone marrow, or when lost blood is replaced with newer and larger cells from the bone marrow.

 

·    Platelet Count (PLT)       

Normal range:  150,000 – 400,000

 

This is the number of cells that “plug” up holes in your blood vessels and prevent bleeding. A high value can appear in a person with bleeding, on one who smokes in excess, or if there is an excess production by the bone marrow. Low values can occur from premature destruction such as in Immune Thrombocytopenia (ITP), acute blood loss, effects of drugs (such as heparin) , infections with sepsis, entrapment of platelets in an enlarged spleen, or bone marrow failure from diseases such as myelofibrosis or leukemia. Low platelets also can occur from clumping of the platelets in a lavender colored tube. You may need to repeat the test with a green top tube in that case.

 

Cardiac Risk Factors

·    C Reactive Protein

It has been used to assess inflammation in response to infection. It is also very sensitive in predicting vascular disease, heart attack or stroke. A patient with an elevated C reactive protein, though not yet definite, is sometimes given statin drugs, niacin and is asked to lose weight, quit smoking, and exercise.

 

·    Homocysteine

Normal value = 4 - 15 micromole/l.

 

It is an amino acid found in small amounts in the blood. Elevated levels are associated with increased risk of heart attack and other vascular diseases. They can be elevated also because of deficiency in folic acid or Vitamin B12 or due to heredity, older age or kidney disease. Men tend to have higher levels.

 

·    CPK

An enzyme which is very useful for diagnosing diseases of the heart and skeletal muscle. This enzyme is the first to be elevated after a heart attack (3 to 4 hours). If CPK is high in the absence of heart muscle injury, this is a strong indication of skeletal muscle disease.

 

Blood Fats

·    Cholesterol

A fat-like substance in the blood which, if elevated has been associated with heart disease.  When the level is elevated, vascular disease can result. A total cholesterol of less than 200, and an LDL Cholesterol of 100 or less is considered optimal.  Increase in cholesterol can lead to artherosclerosis (hardening of the arteries due to cholesterol plaque build up), which in turn can lead to heart attack. If the plaque travels or occurs in the brain, stroke results.

 

Three main types of cholesterol:

(a)     High Density Lipoprotein (HDL)

(b)     Low Density Lipoprotein (LDL)

(c)     Very Low Density Lipoprotein (VLDL)

 

LDL Cholesterol is considered "bad cholesterol" because cholesterol deposits form in the arteries when LDL levels are high. An LDL level of less than 130 is recommended, 100 is optimal, while values greater than 160 are considered high risk.  There are two ways to report LDL. The most common is simply an estimate calculated from the Total Cholesterol, HDL, and triglycerides results. This may say "LDL Calc."  A direct measurement of LDL Cholesterol is usually more accurate but more expensive.

HDL cholesterol is the ‘good cholesterol’ protects against heart disease by helping remove excess cholesterol deposited in the arteries. High levels seem to be associated with low incidence of coronary heart disease.

VLDL (very low density lipoprotein) is another carrier of fat in the blood.

·    Triglyceride

Triglyceride is fat in the blood which, if elevated, has been associated with heart disease, especially if over 500 mg. High triglycerides are also associated with pancreatitis. Triglyceride levels over 150 mg/dl may be associated with problems other than heart disease.

 

Hormones

·    Insulin

Insulin is secreted by the pancreas in response to eating or elevated blood sugar. It is deficient in persons with type 1 diabetes, and present at insufficient levels in persons with type 2 diabetes. The natural evolution of type 2 diabetes     causes insulin levels to fall from high levels to low levels over a course of years. Thus insulin levels in persons with type 1 and type 2 diabetes overlap significantly, and insulin levels are not very useful in determining type 1 vs type 2. Insulin levels vary widely from person to person depending upon an individual’s insulin sensitivity (or conversely, their insulin resistance.) Insulin levels also vary widely according to when the last meal occurred. 

 

·    C-peptide

This is a fragment cleaved off of the precursor of insulin (pro-insulin) when insulin is manufactured in the pancreas. C-peptide levels usually correlate with the insulin levels, except when people take insulin injections. When a patient is hypoglycemic, this test may be useful to determine whether high insulin levels are due to excessive pancreatic release of insulin, or from an injection of insulin.

 

·    Estradiol

This is the most commonly measured type of estrogen measured. In women it varies according to their age, and whether they are having normal menstrual cycles. Hormone levels are also changed when taking birth control pills or estrogen replacement.

 

·    Glucose

Measures the sugar level in your blood and any high value can be due to eating before the test or / and diabetes.

Normal range for a fasting glucose is 60 -109 mg/dl.

 

·    Glycohemoglobin (Hemoglobin A1c or HbA1c):

Measures the amount of glucose attached to red blood cells. The life span of normal red blood cell is about 3 months. Thus this test will indicate the average glucose for the last 6-8 weeks.

 

Waste products:

·    Blood Urea Nitrogen (BUN)

A waste product produced in the liver after breaking down proteins and is excreted by the kidneys. An increase in BUN may indicate that the kidneys are not working as well to be able to excrete this waste product. BUN can also be affected by high protein diets and/or strenuous exercise which raise levels, and by pregnancy which lowers it.

 

BUN                =          (7 - 20 mg / dl)

Normal Bun : Creatinine ratio is 10:1 – a wide ration (example 70:1.8) indicated Pre-renal cause of kidney failure and  narrow ratio (example 45:3.4) indicates Intra-renal cause of kidney failure.

 

·    Creatinine

A waste product largely from muscle breakdown. So, please note that the patient should be advised not to do any kind of exercise prior to prevent abnormal BUN value.

High values, especially with high BUN levels, may indicate problems with the kidneys.

 

Creatinine        =          0.7 -1.4 mg / dL if. If elevated, it can indicate acute or chronic renal failure

Normal Bun : Creatinine ratio is 10:1 – a wide ration (example 70:1.8) indicated Pre-renal cause of kidney failure and  narrow ratio (example 45:3.4) indicates Intra-renal cause of kidney failure.

 

 

·    Uric Acid

Normally excreted in urine. High values are associated with gout, arthritis, kidney problems and the use of some diuretics.

 

 

Enzymes

·    AST, ALT, SGOT, SGPT, and GGT and Alkaline Phosphatase

  These are abbreviations for proteins called enzymes that help all the chemical activities in the cells. As such, any injury to cells will cause a release of these enzymes into the blood. They are found in muscles, the liver and heart.

A.     Alkaline phosphatase -  It is an enzyme found primarily in bones and the liver. Expected values are higher for those who are growing (children and pregnant women) or when damage to bones or liver has occurred or with gallstones. Low values are probably not significant.

 

B.     AST/ SGOT / ALT/ SGPT are also liver and muscle enzymes. They may be elevated from liver problems, hepatitis, excess alcohol ingestion, muscle injury and recent heart attack.

Approximate values:      AST and ALT  =    (both 8 - 20 units/ L)

 

·    Bilirubin

A blood by product that is excreted by the liver. Low values are of no concern. If slightly elevated above the expected ranges, but with all other enzymes (LDH, GOT, GPT, GGT) within expected values, it is probably a condition known as Gilbert’s syndrome and is not significant

 Normal range:         Bilirubin    =0.1 - 1.0 mg/dL

·    CPK

An enzyme which is very useful for diagnosing diseases of the heart and skeletal muscle. This enzyme is the first to be elevated after a heart attack (3 to 4 hours). If CPK is high in the absence of 

heart muscle injury, this is a strong indication of skeletal muscle disease.

 

Proteins

·    Albumin and Globulin

Albumin and Globulin measure the amount and type of protein in your blood. They are a general index of overall health and nutrition. Globulin is the "antibody" protein important for fighting disease.

 

Albumin normal is >30 mg/24 hr

 

Other Lab Values

A.     PT, Prothrombin time (8-12 seconds) is for Coumadin, loading dose is 0.5 - 1 divided within 24 hrs; the Maintenance dose is  0.125 - 0.5 / day

B.     INR, also for Coumadin            =          2-3

C.     PTT, Partial Prothrombin Time ( 20 - 45 seconds) is for Heparin. Dosage can be adjusted to the get desired therapy from Heparin

D.     Stomach pH       =          1 – 4

E.      L/S ratio                        =          2 : 1

F.      SaO2 Saturation           =          95% - 100%, below 70% is life threatening. 86% -91% is an emergency

G.     PaO2                 =          80-100

H.     Ammonia level =          80 - 110 g/dL

I.        Amylase                         =          If > 200 units/dL, would indicate Pancreatitis

J.       ICP, Intracranial Pressure       =          4 – 10 mmHg with an upper limit of 15

K.     Blood alcohol concentration = or > 50mg/dL equals loss of coordination; 400 – 600 mg/dL  is associated with respiratory distress, coma and death.

 

Urinalysis

Urine tests are usually evaluated with a reagent strip dipped into a urine sample. The technician reads the colors of each test and compares them with a reference chart. There can be some variation from one sample to another on how the tests are scored.

A.     pH: Measures urine acidity.

 

B.     Specific Gravity (SG):  Measures how dilute urine is. Water has a SG of 1.000.  Most urine is around 1.010, but it can vary greatly depending on when one has taken fluids last, or if the individual is dehydrated.

 

C.     Glucose:  Normally there is no glucose in urine. A positive glucose occurs in diabetes. Any presence of glucose in the urine could indicate diabetes or  glucose intolerance.

 

 

D.     Protein :  Normally there is no protein detectable on a urinalysis strip. Protein may indicate kidney damage, blood in the urine, or an infection. 10% of children can have protein in their urine. Certain diseases require the use of a special, more sensitive (and more expensive) test for protein called a microalbumin test. A microalbumin test is very useful in screening for early damage to the kidneys from diabetes, for instance.

 

E.      Blood:  Normally there is no blood in the urine. Blood can indicate an infection, kidney stones, trauma, or bleeding from a bladder or kidney tumor. The technician may indicate whether it is hemolyzed (dissolved blood) or non-hemolyzed (intact red blood cells). Rarely, muscle injury can cause myoglobin to appear in the urine which also causes the reagent pad to falsely indicate blood.

 

F.      Bilirubin: Normally there is no bilirubin or urobilinogen in the urine. These are pigments that are cleared by the liver. In liver or gallbladder disease they may appear in the urine as well.

 

G.     Nitrate:  Normally negative, this usually indicates a urinary tract infection.

 

H.     Leukocyte esterase: Normally negative. Leukocytes are the white blood cells (or pus cells). White blood cells in the urine suggests a urinary tract infection.

 

Electrolytes: These are your potassium, sodium, chloride, and CO2 levels.

·    Potassium

This is regulated by the kidneys. It is important for the proper functioning of nervies and muscles, especially the heart. A value beyond the expected range, high or low, requires attention. This is especially important if you are taking a diuretic (water pill) or heart pill (Digitalis, Lanoxin, etc.), all of which can lead to hypokalemia.

 

·    Sodium

It is also regulated by the kidneys and adrenal glands. There are numerous causes of high and low sodium levels. Some important causes of low sodium are the use of diuretics, use of certain diabetic drugs, and too much water intake in patients with heart or liver disease.

 

·    Chloride

 

·    CO2

Represents the acid status of your blood. A low CO2 level can be due to either to increased acidity from uncontrolled diabetes, kidney disease, metabolic disorders, or even due to chronic hyperventilation.

 

 Minerals

·    Calcium

Controlled in the blood by the parathyroid glands and the kidneys. Calcium is found mostly in bone and is important for proper blood clotting, nerve, and cell activity. An elevated calcium can be due to medications such as thiazide type diuretics, inherited disorders of calcium handling in the kidneys, or excess parathyroid gland activity or vitamin D. Low calcium can be due to certain metabolic disorders such as insufficient parathyroid hormone; or drugs like Fosamax or furosemide type diuretics.

Calcium is bound to albumin in the blood, so a low albumin level will cause the total calcium level in the blood to drop. You doctor can easily determine if this is significant or not.

·    Phosphorus

Phosphorus is also largely stored in the bone. It is regulated by the kidneys, and high levels may be due to kidney disease. When low levels are seen with high calcium levels it suggests parathyroid disease, however there are other causes. A low phosphorus, in combination with a high calcium, may suggest an overactive parathyroid gland.

Thyroid

There are 2 types of thyroid hormones easily measurable in the blood, thyroxine (T4) and triiodothyronine (T3). For technical reasons, it is easier and less expensive to measure the T4 level, so T3 is usually not measured on screening tests.

NCLEX will not be detailed with Thyroid values but this section could be helpful for RNs and those in the medical field.

Please be clear on which test you are looking at. We continue to see a tremendous amount of confusion among doctors, nurses, lab techs, and patients on which test is which. In particular, the "Total T3", "Free T3" and "T3 Uptake tests" are very confusing, and are not the same test.

·    Thyroxine (T4)

Thyroxine (T4) shows the total amount of the T4. High levels may be due to hyperthyroidism, however technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills or estrogen replacement therapy. A Free T4 (see below) can avoid this interference.

 

·    T3

T3 Resin Uptake or Thyroid Uptake. This is a test that confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein. The method of reporting varies from lab to lab. The proper use of the test is to compute the free thyroxine index.

 

·    Free Thyroxine Index

Free Thyroxine Index (FTI or T7) is a mathematical computation that allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the blood stream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.

 

·    Free T4

Free T4 test directly measures the free T4 in the blood rather than estimating it like the FTI. It is a more reliable , but a little more expensive test. Some labs now do the Free T4 routinely rather than the Total T4.

 

 

·    Total T3

Total T3 is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent and shorter lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3.

 

·    Free T3

    This test measures only the portion of thyroid hormone T3 that is "free", that is, not bound to carrier proteins.

 

·    Thyroid Stimulating Hormone (TSH)

Thyroid Stimulating Hormone (TSH) : This protein hormone is secreted by the pituitary gland and regulates the thyroid gland. A high level suggests your thyroid is underactive, and a low level suggests your thyroid is overactive.

 

COMMON LAB VALUES IN TABLE FORMAT

 

Blood Gases

 

Arterial

Venous

pH

7.35 - 7.45

7.32 - 7.42

pCO2

35 - 45

38 – 52

pO2

70 - 100

28 – 48

HCO3

19 - 25

19 – 25

O2 Sat %

90 - 95

40 – 70

BUN

7 - 20 mg/dl

Complete blood count (CBC)  Adults

 

Male

Female

Hemoglobin (g/dl)

13.5 - 16.5

12.0 - 15.0

Hematocrit (%)

41 - 50

36 – 44

RBC's ( x 106 /ml)

4.5 - 5.5

4.0 - 4.9

 

RDW (RBC distribution width)

< 14.5

MCV

80 – 100

MCH

26 – 34

MCHC %

31 – 37

Platelet count

100,000 to 450,000

Creatinine kinase (CK) isoenzymes

CK-BB

0%

CK-MB (cardiac)

0 - 3.9%

CK-MM

96 - 100%

Creatine phosphokinase (CPK)

8 - 150 IU/L

Creatinine (mg/dl)

0.5 - 1.4

WBC + differential

WBC (cells/ml)

4,500 - 10,000

Segmented neutrophils

54 - 62%

Band forms

3 - 5%  (above 8% indicates left shift)

Basophils

0 - 1   (0 - 0.75%)

Eosinophils

0 - 3   (1 - 3%)

lymphocytes

24 - 44  (25 – 33%)

Monocytes

3 - 6   (3 - 7%)

Electrolytes

Calcium

8.8 - 10.3 mg/dL

Calcium, ionized

2.24 - 2.46 meq/L

Chloride

95 - 107 mEq/L

Magnesium

1.6 - 2.4 mEq/L

Phosphate

2.5 - 4.5 mg/dL

Potassium

3.5 - 5.0 mEq/L

Sodium

135 - 147 mEq/L

Ferritin  (ng/ml)

13 – 300

Folate  (ng/dl)

3.6 – 20

Glucose, fasting  (mg/dl)

60 – 110

Glucose (2 hours postprandial)  (mg/dl)

Up to 140

Hemoglobin A1c

6-8

Iron  (mcg/dl)

65 – 150

Lactic acid  (meq/L)

0.7 - 2.1

LDH (lactic dehydrogenase)

56 - 194 IU/L

Lipoproteins and triglycerides

Cholesterol, total

< 200 mg/dl

HDL cholesterol

30 - 70 mg/dl

LDL cholesterol

65 - 180 mg/dl

Triglycerides

45 - 155 mg/dl  (< 160)

Osmolality

289 - 308 mOsm/kg

SGOT (AST)

< 35 IU/L  (20-48)

SGPT (ALT)

<35 IU/L

Urinalysis

Specific Gravity

 

Segmented neutrophils

54 - 62%

Band forms

3 - 5%  (above 8% indicates left shift)

Basophils

0 - 1   (0 - 0.75%)

Eosinophils

0 - 3   (1 - 3%)

lymphocytes

24 - 44  (25 – 33%)

Monocytes

3 - 6   (3 - 7%)

Lipid Profile

Albumin

3.2 - 5 g/dl

Alkaline phosphatase (Adults: 25-60)

33 - 131 IU/L

Adults > 61 yo:

51 - 153 IU/L

Ammonia

20 - 70 mcg/dl

Bilirubin, direct

0 - 0.3 mg/dl

Bilirubin, total

0.1 - 1.2 mg/dl

Thyroid Function tests

Thyroid Function tests

 

Free T3

2.3-4.2 pg/ml

Serum T3

70-200 ng/dl

Free T4

0.5-2.1 ng/dl

Serum T4

4.0-12.0 mcg/dl

TSH

0.25-4.30 microunits/ml

Total iron binding capacity (TIBC)

250 - 420  mcg/dl

Transferrin

> 200 mg/dl

Uric acid    (male)

2.0 - 8.0 mg/dl

(female)

2.0 - 7.5 mg/dl

 

TESTS

 

Sweat Test - to see if PT has cystic fibrosis. Looks at the sodium chloride. If greater than 60

meq/L, it is positive

Guthrie Test - for PKU; must be done on a newborn no more than 7day after birth; Usually done

on 3rd day.

Bulge Test - to determine fluid in knees, legs should be straight

 

 

 

 

 

 

MEDICATIONS

 

When administering any medication the following “rights” must be remembered:

1.         The right patient

2.         The right medicine

3.         The right route

4.         The right dose

5.         The right site

6.         The right time

 

 

·         Synergistic effect – Two or more medications having a greater effect than one of the drugs

alone.

·         Agonist effect -  Two or more medications having the opposite effect.

 

Important Facts

·    Any discrepancies in the count of opiates should be reported to the Board of Nursing

·    Always check for any allergies before administering any type of medication.

 

 

Ways of Medication Administration

1.         Patch medications - its absorption can be increased with heat application; even heat escaping from microwave can heat up the patch.

2.         Oral

3.         Injection – see different types of injections below

4.         IV

5.         Parenteral route

6.         Rectal route

 

Injections

1.         Tuberculin injection – given at 15 degrees.

2.         Intramuscular (IM) – given at 90 degrees; do a Z track injection and a 0.2ml of air is administered after injecting the medication  to allow the medication to be dispersed in the muscle better.

Usually administered at these sites:      Deltoid muscle, Vastus Lateralis muscle, Ventrogluteal muscle

3.         Subcutaneous (SC) – given at 45 degrees.

4.         No injections are given at 30 degree.

 

 

MEASUREMENTS

 

A.     Basic Conversion

 

1 gram (g)                          =    1000 milligrams (mg)

1 kilogram (kg)                              =     1000 grams (g)                                    =         2.2 pounds (lbs)

I milligram (mg)                             =    1000 micrograms (mcg)

1 liter (L)                           =     1000 milliliters (ml)

1 cubic centimeter             =    1 milliliter

one Liter of fluid retained is  =   2 lbs

37.0 C (Centigrade degrees) =  98.6 F (Fahrenheit degrees)

 

1 ml       =        15 drops (gtt)               =          15 or 16 minim

5 ml       =        1 teaspoon (tsp)

=          75 gtt

15 ml     =        1 tablespoon (Tbsp)

240 ml   =        1 measuring cup          =          1 ounce (oz) or 8 fluidrams

500 ml   =        1 pint                           =          16 oz               =        1 pound

1000 ml  =       1 quart                         =          32 oz               =        2 pints

60 or 65 mg                                         =          gr 15 (grain)

 

 

 

 

 

B.     Basic Medical Calculation

1.     Use the ratio and proportion

1 : 2     =         2 : 4

 

2.     To get the drops per minute. There are two ways.

I.    Quick Optional Method

a.    Get the milliter per hour = ml/hr

b.    Determine the drop factor and divide the hourly rate by:

Drop Factor    Divide hourly rate by

10 – macrodrip                        6   (there are six 10 minutes in an hour)

15                                4

20                                3

60 – microdrip             1

 

II.    Using the Formula Method

 

Volume in milliliter      x          drop factor (drop/ml)\  =          drops/minute

Times in Minutes                                                                       (gtts / min)

 

Note: To convert a Hours that is less than 1 hour in minutes  =  multiply by 60

 

 

 

ANTIDOTES

 

Calcium gluconate for magnesium sulfate

VItamin K for Coumadin

Protamine Sulfate - for Heparin

Amicar for Streptokinase

Atropine Sulfate for Tensilon - atropine is given in case of cholinergic crisis

Digiband - fro digitalis overdose

NARCAN - for narcotic overdose Note: Narcan blocks the effect of pain medicatios

Zincecard - for doxorubicin toxicity

Desferal - for iron overdose

 

 

 

 

 

CATEGORIES OF MEDICATIONS

 

It is best to understand what the medication is for rather than memorizing. Listed are just the most commonly used medications.

 

Antiarryhthmics

Xylocaine HCL (Lidocaine)

For ventricular arrhythmia; usually for ventricular tachycardia.

Change in the level of consciousness of patient is a sign of toxicity.

Use IM only if IV administration is not possible like paramedics in a mobile unit.  For IM use only 10% solution in deltoid or thigh muscle.

Lidocaine can increase Digoxin toxicity

 

Procainmide HCL (Pronestyl)

For ventricular arrhythmias.

For IV, use 5% Dextrose

 

Adenosine (Adenocard)

To convert paroxsysmal SVT to sinus rhythm

For IV use only

 

Digoxin (Lanoxin) – see Cardioactive Glycoside section below

Allows more calcium to enter the myocardial cell. Thus increasing contraction.

Good for CHF and AFIB

Loading dose of 0.75  - 1.25 PO or 0.125 – 0.25 mg IV

Maintenance dose of 0.125 – 0.25 mg per day PO

Therapeutic level .5 – 2mg/ml

Monitor apical pulse for 1 minute before administration and take pulse at the same time.

Report nausea and vomiting and loss of appetite, swelling of ankles, difficulty breathing.

Overdose:  Have Digiband on standby.

 

Propranolol (Inderal) – See Beta Blocker section below

Beta adrenergic blocker; antihypertensive also

Unlabelled use for recurring GI bleeding in cirrhotic patients

Can cause hypoglycemia

Decreases the effect of Theophyllines and its effect is decreased by NSAIDs

 

Verapamil (Isoptin) – see Calcium Channel Blocker section below

Calcium channel blocker

 

 

Quinidine

 

 

Antihypertensive Medications

A.        Vasodilator / Vasopressors

Nitroglycerin

·    Nitroglycerin is a nitrate. It works by widening blood vessels in the body, which allows more blood to flow more easily through them and reduces the work the heart has to do to pump blood. This reduces the oxygen need of the heart, and helps prevent chest pain.

·    Hypotension is the side effect so keep an eye on the BP and watch for headache; can also lead to cyanide poisoning with sodium nitroprusside use. Can be used prophelactically when engaging in activity that might precipitate angina but should be taken as soon as patient feels chest pain or discomfort.

·    If a patch is used, rotate and wipe of area with just soap and water, doing so helps vasodilate the area for better absorption. There is no need for alcohol use ; can be applied to back and upper arms but not to lower extremities; no need shave the area since the patch may cause an irritation; DO NOT cut the patch since it will cause it to release more of the medication into the system.  One must wear gloves to protect oneself.

 

Prophylaxis of angina.

Must be kept in a brown bottle.  Discard if opened bottle is more than 6 months old.

For PO , for first sign of angina, repeat every 5 minutes but not take more than 3 tablets every 15 minutes.

Do not swallow nor chew medication. It should melt and fizzle in the mouth, not burn.

For IV, use only glass bottles.

Protect from light and extreme temperatures. So,it is not a good idea to store in it in the bathroom medication cabinet.

 

Dopamine HCL (Inotropin)

·    Dopamine is a vasopressor and inotropic agent. It works by increasing the pumping        strength of the heart and the kidney blood supply

 

To increase renal perfusion. To correct hemodynamic imbalance like in shock syndrome due to MI or trauma (heart surgery, renal failure) Note, hypovolemia problem must be restored with fluids.

Only administer via IV

Have Phentolamine on standby in case of extravasation.

 

Isosorbide Dinitrate (Isordil)

Relaxes smooth muscle leading to decrease in venous return and decrease in arterial BP

Antiangina by relaxing smooth muscle leading to decrease in venous return and decrease in arterial BP

Do not swallow nor chew PO med and take in empty stomach

Headache is an early symptom of drug excess

 

 

 

B .        Beta Blockers

·    These group of medicatigons can serve to treat abnormal heart rhythms (cardiac arrhythmias). They are used mainly to prevent abnormally fast heart rates. (tachycardias) or irregular heart rhythms such as premature ventricular beats.

·    Beta  blockers reduce the demand of the heart muscle for oxygen. Chest pain of angina pectoris occurs when the oxygen demand of the heart exceeds the supply, beta blockers can be useful in treating angina. They have also become an important drug in improving survival after a person has had a heart attack.

·    Because of their effect on blood vessels, beta blockers can lower the blood pressure and be of value in the treatment of hypertension

 

Propranolol

A beta blocker that blocks beta adrenergic impulses to bronchial tree resulting in increase bronchoconstriction

 

Timolol (Timpotic)

It is a beta-blocker. So, like other beta-blockers, it can cause bronchospasms, thus, watch out for patients with COPD.

 

C.        Calcium Channel Blocker (CCB)

·    Calcium channel blockers are a class of drugs that block the entry of calcium into the     muscle cells of the heart and the arteries. It is the entry of calcium into these cells that  causes the heart to contract and arteries to narrow. By blocking the entry of calcium, CCB’s        decrease contraction of the heart and dilate (widen) the arteries.

·    Calcium channel blockers should be given with caution to those with Heart Failure (CHF) because they reduce the ability of the heart to pump.

 

Verapamil HCL (Isoptin; Calan)

Same as above

Can lead to decreased white blood cell count; it decreases heart muscle contractility, leads to bradycardia

 

Nifedipine (Procardia)

Antiangina / Anyhypertensive

Withhold if pulse is very low

 

Cardiazem (Diltiazem)

Bolus of 0,.25 mg/kg (about 20mg for average patient) Administer bolus over 2 minutes For continuous infusion, rate should be 10ml/hr.  NO longer than 24 hours

 

D.        Vasodilator

Monoxidil

Minoxidil may cause serious heart problems, including worsening of chest pain. Minoxidil is usually given with beta-blockers to prevent certain heart side effects and with diuretics to prevent serious fluid build-up.

Minoxidil is a vasodilator. It reduces blood pressure by relaxing and dilating (widening) blood vessels. Blood flows more freely and at a lower pressure through dilated blood vessels

Minoxidil may cause dizziness, lightheadedness, or changes in vision.

 

Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms

Weigh yourself daily while you are taking Minoxidil. Check with your doctor if you quickly gain 5 pounds or more or if there is swelling or puffiness of the face, hands, ankles or stomach

 

Hydralazine (apresoline)

Hydralazine works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload

 

D.        Ace Inhibitor

 

Accupril  - an ACE inhibitor, that blocks aldosterone and keeps potasium SO avoid additional potassium

 

 

 

 

E.         Alpha Adrenergic

Clonidine (catapress)

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax (widen) and your heart to beat more slowly and easily.

Clonidine is used to treat hypertension (high blood pressure).

Although not approved by the FDA for these purposes, clonidine has also been used to relieve alcohol withdrawal, as an aid in methadone and opiate detoxification, as an aid in quitting smoking, to treat diabetic diarrhea, to treat Tourette's Syndrome, to reduce menopausal flushing, to treat postherpetic neuralgia, to treat ulcerative colitis, and to diagnose pheochromocytoma

 

Methyldopa (aldomet)

 

 

Cardioactive Glycoside

·    Digoxin is used to treat congestive heart failure and the associated symptoms of shortness of breath when lying flat, wheezing, and ankle swelling. Digoxin is also used to slow heart rate in rapid atrial rhythm disturbances such as atrial fibrillation and atrial flutter.

·    Patients with low blood potassium levels can develop digoxin toxicity even when digoxin levels are not considered elevated. Similarly, high calcium and low magnesium blood levels can increase digoxin toxicity and produce serious heart rhythm disturbances.

·    Watch for side effects such as potentially fatal rhythm disturbances, nausea, vomiting, and diarrhea, blurred or yellow vision; headache; weakness; dizziness; apathy; confusion; and mental disturbances such as anxiety, depression, delirium, and hallucinations.

 

Digoxin (Lanoxin)

Allows more calcium to enter the myocardial cell. Thus increasing contraction. Increasing renal perfusion and decrease heart rate

Good for Heart Failure

Loading dose of 0.75  - 1.25 PO or 0.125 – 0.25 mg IV

Maintenance dose of 0.125 – 0.25 mg per day PO

Therapeutic level is .5 - 2ng/ml

Monitor apical pulse for 1 minute before administration and take pulse at the same time.

If less than 60 DO NOT give. Notify physician if OVER 120 check for toxicity / arryhthmias

Overdose:  Have Digiband on standby.

 

 

Anticoagulant

 

Warfarin (coumadin)

Interferes with vitamin K dependent clotting factors, thus, prolonging clotting times.

To maintain PT to 1.2 – 1.3 or INR of 2 – 3 (3 – 4.5 for those with prosthetic valve)

Encourage patient to take in foods high in fiber to prevent toxicity

Watch for bleeding (hematuria, dark stools, bleeding gums, dark urine)

Overdose: Use Vitamin K So tell patient to watch out for foods high in Vitamin K like green leafy vegetables.

 

Heparin

Blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin

Given SC as a prophylaxis

If continuous IV: loading of 5,000 units then 20,000 – 40,000 units / day. Use bottle.

Prohylaxis 5,000 units SC not IM. Apply pressure but NOT massage.

Draw blood for coagulation testing 30 minutes before

Therapeutic range:  PTT 1.5 – 2.5 times control. Normal range is

Check for signs of bleeding

Overdose: Protamine Sulfate 1mg of protamine neutralizes 100 USP heparin units.

 

 

Antimicrobials

·    Most antibiotics are ototoxic and can disrupt the normal flora, leading to superinfection.

·    The great number of diverse antibiotics currently available can be classified in different ways, e.g., by their chemical structure, their microbial origin, or their mode of action. They are also frequently designated by their effective range. Tetracyclines, the most widely used broad-spectrum antibiotics, are effective against both Gram-positive and Gram-negative bacteria, as well as against rickettsias and psittacosis-causing organisms.

·    Ciprofloxacin (Cipro) is another broad-spectrum antibiotic, effective in the treatment of mild infections of the urinary tract and sinuses. The medium-spectrum antibiotics bacitracin, the erythromycins, penicillin, and the cephalosporins are effective primarily against Gram-positive bacteria, although the streptomycin group is effective against some Gram-negative and Gram-positive bacteria. Polymixins are narrow-spectrum antibiotics effective against only a few species of bacteria.

·    Antibiotics are either injected, given orally, or applied to the skin in ointment form. Many, while potent anti-infective agents, also cause toxic side effects. Some, like penicillin, are highly allergenic and can cause skin rashes, shock, and other manifestations of allergic sensitivity. Others, such as the tetracyclines, cause major changes in the intestinal bacterial population and can result in superinfection by fungi and other microorganisms.  Chloramphenicol, which is now restricted in use, produces severe blood diseases, and use of streptomycin can result in ear and kidney damage. Many antibiotics are less effective than formerly because antibiotic-resistant strains of microorganisms have emerged.

 

Gentamicin (Garamycin)

An Aminoglycoside – disrupts the protein synthesis of bacteria, ,destroying its cell membrane

Check for hearing loss (ototoxicity)

Nephrotoxic – check creatinine and BUN

Can be given IM

 

Penicillin G

Side Effect  - Glossitis, stomatitis, Diarrhea, superinfection

Monitor for loose, foul smelling stool and change in tongue

Inhibits synthesis of bacterial cell wall

Unlabelled use for Lyme disease

Don’t mix with Amphotericin B and aminoglycosides

Have epinephrine, vassopressors, in case of hypersensitivity

Can be given IM

 

Vancomycin (Vancocin)

Inhibits synthesis of bacterial cell wall

Usually for C.dif. or staph

Through level is determined by taking blood sample 30 minutes before first dose

Therapeutic level is 10-25mcg/ml

NOT for IM. Give IV. Peaks in  5 minutes and duration is 12-24 hours.

Don’t mix with heparin

Check for “red man Syndrome” (fall in BP, fever, chills erythema of neck and back)

 

Ampicillin (Omnipen)

Similar to Penicillin

Prophylaxis for infection on rape victims and those undergoing cesarean section

PO on an empty stomach with water NO fruit juices or sodas

Can be given IM but not on same site.

 

Amphotericin B

Antifungal like candida, aspergillosis

For IV, do not exceed 1.5mg/kg/day

For IV line, DO NOT use saline, or heparin. Use D5W

For Oral, ask patient to swish  around mouth and retain as long as possible before swallowing

 

Cipro

Drink lots of fluid to prevent crystalluria / stone formation

 

Tetracycline

Dont take with milk, it inhibits absorption; keep an eye on photosensitivity

 

Keflex (cephalexin)

An antibiotic, can alter the normal intestinal flora, so one is encouraged to take yogurt and acidophilus milk

Bactrim

Common side effect is uritcaria

 

 

Narcotic Analgesics

·    The most hazardous potential side effect of most narcotics is respiratory depression (dangerously slow  breathing). So check the respiration before and after administration

 

 

Morphine Sulfate

Unlabelled us for dyspnea associated with acute left ventricular failure and PE

Decreases the preload and after load thus providing relief from anxiety BUT watch for hypotension. If it occurs give DOPAMINE IV

For IV, use D5W

Avoid alcohols, OTC meds, antihistamines

Codeine Sulfate

Same issues as Morphine

 

Meperidine HCL (Demerol)

Check for respiratory distress

Avoid alcohols, OTC meds, antihistamines
            Demerol can mask signs of ICP

 

 

 

 

Non Narcotic Analgesics

Acetaminophen (Tylenol)

Be wary when given with:

(a)   Anticoagulants (eg, warfarin) because the risk of their side effects, including bleeding, may be increased by Acetaminophen

(b)   Isoniazid because the risk of liver problems may be increased

For fever and for those allergic to NSAIDs.

Check for bleeding

Overdose: have Acetylcysteine (Mucomyst)

 

Aspirin

·              Aspirin may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.

·              Aspirin has been linked to a serious illness called Reye syndrome. Do not give Aspirin to a child or teenager who has the flu, chickenpox, or a viral infection.

 

MI prophylaxis; prophylaxis for cataract

Take with food

Watch for Reyes syndrome in children; watch for tinnitus

Watch for bleeding especially when used with heparin, NSAIDs

Overdose: do a gastric lavage,  induce emesis with charboal

Plavix

An antiplatelet.

 

 

NSAID

·    NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.

·    NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke

·    The concurrent use of aspirin and an NSAID does increase the risk of serious GI events

Ibuprofen tablets are contraindicated for the treatment of peri-operative pain in the setting

of coronary artery bypass graft (CABG) surgery.

·    In clinical studies in patients with rheumatoid arthritis, Ibuprofen tablets have been shown to be comparable to Indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal

·    NSAIDS counteract the action of ACE inhibitors and diuretics

 

Indomethacin (Indocin)

For gout, rheumatoid arthritis, osteoarthritis

Serious stomach ulcers or bleeding can occur with the use of Indomethacin Capsules. Taking it in high doses or for a long time, smoking, or drinking alcohol increases       the risk of these side effects

Give with food.

Check for signs of bleeding (tarry stools, diarrhea)

 

Ibuprofen (Motrin)

Same as other NSAID

 

 

 

Barbiturates

·    When stopped it can lead to tachycardia, diarrhea and tacchypnea. Euphoria at withdrawal is not indicated.

 

Phenobarbital (Luminal)

Long acting sedative

For preoperative; for generalized tonic-clonic treatment and emergency acute convulsions.

Give IV doses slowly and monitor P, BP

Check for liver function test

Don’t take the drug more than 2 weeks.

 

Phentobarbital (Nembutal)

Similar to above

 

 

Hypnotics / Sedatives (Benzodiazepine)

·    Gamma-aminobutyric acid (GABA) is a substance produced in the brain which inhibits (slows down) nerves and many of the activities of the brain.Benzodiazepines enhance the effects of GABA and thereby reduce activity in the brain and promote sleep or reduce anxiety like Lorazepam and Valium

·    Anti-Anxiety medication is pharmacologically similar to alcohol. Thus, they can be used effectively as substitute for alcohol in comfortably and safely withdrawing from alcohol dependence.

 

Triazolam (Halcion)

For insomnia

Don’t take with Grapejuice and report any severe dizziness and drowsiness

 

Chloral Hydrate

Sedative / Preoeperative to lessen anxiety / Postoperative to control pain

Check for tartrazine allergy and give with full glass of water

May affect protrhombin level when given with Coumadin

 

Diazempam (Valium)

Antianxiety / antiepileptic

Do not insert in plastic bags or tubing

For IV, Don’t give intra-arterially only into large vein and monitor P, BP

 

Lorazepam (Ativan)

Sedative / antianxiety

Unlabelled use for status epilepticus management

For direct IV injection, dilute with equal amount of compatible solution

For IV, Don’t give intra-arterially only into large vein and monitor P, BP

 

Librium

An antianxiety medication.

 

Versed

Benzodiazepine that produces conscious sedation

 

 

 

Antipsychotic

·    Make sure to watch for over the counter medications that contain diphenhydramine which counteracts the effect of anti-psychotic medications.

·    AAdverse reaction of most antipsychotic drugs iis NeUroleptic Malginant Syndrome defined by muscle rigidity and elevated temperature

 

Haloperidol (Haldol)

Also used to control tics and vocalization in Tourettes

May take 6 weeks – 6 months of therapy needed for its full clinical effect

If a patient develops a temperature, it may indicate neuroleptic malignant syndrome (NMS) a potentially lethal side effect of antipsychotic medications especially in high potency drugs such as Haldol

Can ead to akathisia, an extrapyramidal side effect.

 

Risperidone (Risperdal)

Risperidone is used to treat schizophrenia and symptoms of bipolar disorder (manic depression). Risperidone is also used in autistic children to treat symptoms of Irritability.

While you are taking risperidone, you may be more sensitive to temperature extremes such as very hot or cold conditions. Avoid getting too cold, or becoming overheated or dehydrated

 

Chlorpromazine (Thorazine)

Chlorpromazine is used to treat psychotic disorders, nausea and vomiting, chronic hiccups, and acute intermittent porphyria.

Thorazine can cause agranulocytosis, making a patient more vulnerable to infection.

 

Olanzapine (Zypreza)

Olanzapine is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression).

Adverse Reaction is NeUroleptic Malginant SYndrome  defined by muscle rigidity and elevated temperature

 

 

Antidepressants

  • Alcoholic beverages or alcohol-free or reduced-alcohol beer and wine.

 

A.     MAO Inhibitor

·    Avoid taking over the counter cold and hayfever medications that contain pseudoephedrine, which in combination with MAO will increase blood pressure.

·    Avoid food containing tyramine such as aged cheeses beer, wine yogurt, figs, raisins, bananas, avocados, chocolate, soy sauce, liver fish tea pizza with pepperoni and anything with yeast. They can increase blood pressure to dangerous levels.

·    Combining Mao inhibitor with SSRI can result in serotonin syndrome.

·    May take about 2- 4 weeks to take into effect BUT the maximal effect is not until up to 6 months.

·    You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old.

 

Tranylcypromine (Parnate)

 

Nardil (phenelzine)

 

B.      Trycyclic Antidepressant

 

Amitriptyline HCL (Elavil)

Tricyclic antidepressant

Don’t take with grapefruit juice

Do NOT give IV

Suicide risk after 10-14 days due to increase in energy

 

Imipramine (Tofranil)

 

 

C.     Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant

 

·    Avoid MAO inhibitor meds. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal problems, sudden high body temperature, extremely high blood pressure, and severe convulsions. At least 14 days should be       allowed between stopping treatment with an MAO inhibitor and starting treatment with fluoxetine. If you have been taking fluoxetine, at least 5 weeks should be allowed between stopping treatment with fluoxetine and starting treatment    with an MAO inhibitor

 

FLuoxetin HCL (Prozac)

SSRI

May be taken for OCD, bulimia

Effect may not be seen until after 4 weeks

Take in the morning

 

D.        Homeopatic Antidepressant

St John’s Wort

Mimics antidepressant medications. So avoid food high in tyramine (aged chees, chocolate, salami, liver

 

 

Diuretics

·    Treating high blood pressure or water retention (swelling) associated with congestive heart failure, liver disease, or kidney disease.

·    Lasix is a loop diuretic. Loop diuretics make the kidneys eliminate larger amounts of electrolytes (especially sodium and potassium salts) and water than normal (diuretic effect).        Loop diuretics are useful for treating many conditions in          which salt and water retention (eg, edema, swelling) are a problem.

·    Lasix  may cause you to become sunburned more easily.

·    Lasix is a strong diuretic. Using too much of this drug can lead to serious water and mineral loss.

·    Your  doctor may also prescribe a potassium supplement while you take Lasix

·    Give meds in the morning to prevent frequent urination and disturbance of sleep

·    Diuretics that make one loose potassium can increase the toxicity of Digoxin

 

Furosemid (Lasix)

Avoid exposure to light and refrigerate oral solution

Take with food preferably potassium rich diet and weigh self everyday

 

Hydrochlorothiazied (Hydrodiuril; Esidrix)

Take in the afternoon to prevent nocturia

Bronchodilator

Aerosols

·    To dilate the bronchioles

Inhaler

·    Check the contents by dropping in a container with water. If it floats, that means it is      empty. A full inhaler will settle at the bottom of the container

 

Aminophylline (Theophylline)

Drug of choice for acute asthma

Aminophylline will not stop an asthma attack once one has started,  Make sure one has a bronchodilator

10 -20MG/DL is the therapeutic level

Incompatible with most IV solutions.

Take on an empty stomach or 1 hr before or 2 hours after meals

 

Metaproterenol Sulfate (Alupent)

Prophylaxis and treatment of bronchial asthma

 

Albuterol (Proventil)

For prevention of bronchospasm

Unlabelled use for treatment of hyperkalemia in dialysis patients

 

ALBUTEROL versus VANCERIL (beclomethasome)

Vanceril is for maintenance to prevent asthma and is given via inhaler, while albuterol is used during attacks. Albuterol can cause "heart pounding feeling" which can disappear

 

Terbutaline (Brethine)

It can raise blood glucose, so use with caution on diabetics.

 

Cromolyn Sodium (Intal)

Used to prevent the release of histamine and other allergy trigging substance; it’s NOT an antihistamine, nor anti-inflammatory, or a bronchodilator

Doesn’t do anything for a patient on respiratory distress

 

 

Antituberculars

Isonazied (INH)

·    While you are taking Isoniazid , eating foods that contain histamine, such as fish, tuna, sauerkraut, and yeast extract, or foods that contain tyramine, such as Chianti wines, pickled herring, fermented meats, and some cheeses, may cause flushing, chills, headaches, or serious increases in blood pressure

 

For active TB; unlabelled use for tremors of pts with MS

Five on an dempty stomach, 1 hour before or 2 hours after meals

Decrease tyramins containing foods

 

Rifampin (Rifadin)

Rifampin only works against bacteria; it does not treat viral infections (eg, the common cold). Be sure to use Rifampin for the full course of treatment.

An antibiotic used in conjunction with at least one Antituberculous drug

May cause discoloration (reddish orange) of body fluids (tears, sweat, saliva, urine0

 

 

Myambutol

For TB. Adverse reaction is change in visual acuity or color vision.

 

Amphotericin B

Patient’s liver, renal and bone marrow should be monitored since the drug is very toxic to the kidney and liver and can cause bone marrow suppression.

 

 

Anticonvulsant

Phenytoin (Dilantin)

More common side effects may include:
            Decreased coordination, involuntary eye movement, mental confusion, slurred speech

Practicing good dental hygiene minimizes the development of gingival hyperplasia (excessive formation of the gums over the teeth) and its complications.

Abnormal softening of the bones may occur in people taking Dilantin because of Dilantin's interference with vitamin D metabolism

Don’t give with potassium choride

Can change urine color to pink, can lead to gingivitis or hyperplasia of gums overtime; Oral hygiene is necessary every shift

IV Dilantin should not be given more than 50mg per minute and a large vein should be used. Use of smaller veins can lead to “purple syndrome.”

Being constant on Dilantin can cause agranulocytosis or aplastic anemia, thus, a patient has to have frequent CBCs.

 

Tegretol

For seizures; interferes with oral contraceptive n cause photosensitivity.

Depakote

Can cause thrombocytopenia, leuKopenia, bleeding and hepatotoxicity

 

Magnesium Sulfate

An anticonvulsant; also used to regulate heart; also used as a laxative.

Nurse can do the following as a precaution for patients on magnesium sulfate: place a padded tongue blade at bedside, insert a Foley catheter. Darken the room.

 

 

Steroids

·    Patients taking steroids should receive the influenza vaccine annually. A common side effect of steroid is weight gain and increased appetite.

·    Corticosteroid are best taken in the morning; it mimics the body’s natural release of cortisol

 

Dexamethatsone (decadron)

Treating certain conditions associated with decreased adrenal gland function. It is also used to treat severe inflammation due to certain conditions, including severe asthma, severe allergies, rheumatoid arthritis, ulcerative colitis, certain             blood disorders, lupus, multiple sclerosis, and certain eye and skin conditions. It may also be used for other conditions as determined by your doctor.

 

Dexamethasone is a corticosteroid. It works by decreasing or preventing tissues from responding to inflammation. It also modifies the body's response to certain immune stimulation

 

Dexamethasone may lower the ability of your body to fight infection

Dexamethasone may cause an elevation in blood pressure, salt and water retention, and increased potassium loss

Dexamethasone can cause calcium loss and promote the development of osteoporosis. Take adequate calcium and vitamin D supplements

Dexamethasone may affect your blood sugar

COMMON side effects

Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness.

 

 

Methylprednisone (Solumedrol)

Similar to above

 

Prednisone (deltrasone)

Taken with meals; since its a steroid that suppresses the immune system CK for non-healing sores;  this med is gradually increased and decreased.

Side effect include water and Na retention, leading to volume excess and vasodilation of vessels

 

Antihistamine

Claritin (loratatinde)

Causes less sedation than other antihistamine drugs.

 

 

Antilipemics

·    Do a liver function test before starting the medication therapy

·    Medication takes into effect  within a month

·    Report any muscle weakness which could be a sign of rhabdomyositis

 

Lovastatin (Mevacor)

In rare cases, drugs such as Altocor cause rhabdomyolysis, a potentially fatal condition that destroys muscle cells and sometimes causes kidney failure.

Don’t take with grapefruit, which may increase its toxicity.

Give with food; absorption is reduced by 30% on an empty stomach

Better if given at night when cholesterol synthesis ( midnight to 5 am) usually occurs

Check for LFT and eye check up for cataract

 

Cholestyramine (Questran)

Never take Questran in its dry form. Always mix it with water or other liquids before taking it. For Questran, use 2 to 6 ounces of liquid per packet or level scoopful; for Questran Light, use 2 to 3 ounces. Soups or fruits with a high moisture content, such as applesauce or crushed pineapple, can be used in place of beverages.

Binds bile acids in the intestine thus excreted in the feces

Take before meals and mix with liquid but noncarbonated b everage

Interferes with Digoxin absorption and with Hydrochlorothiazide (Esidrix) absoprtion also

 

Emergency Medications

Atropine Sulfate

Anticholinergic – can cause urinary retention. Used for bradycardia

Blocks acetycholine – reliefs of bradycardia, restores cardiac rate and arterial pressure

May cause urinary retention, so ask patient to void before taking medication

Avoid hot environments since pt will be intolerant of heat

Atropine Sulfate for Tensilon - Atropine is given in case of cholinergic crisis

 

Dopamine HCL (Inotropin)

See above

 

Epinephrine HCL (Adrenalin)

Inadvertent IV can be harmful

Always check strength 1:100 only for inhalation and 1:1000 for Parenteral administration (SC or IM)

Isoptroterenol (Iusprel)

Used for heart block ventricular arrhythmias, and bradycardia

 

Lidocaine (Xylocaine)

See above

 

Sodium Bicarbonate

Sodium bicarbonate (SOE-dee-um bye-KAR-boe-nate), also known as baking soda, is used to relieve heartburn, sour stomach, or acid indigestion by neutralizing excess stomach acid. When used for this purpose, it is said to belong to the group of medicines called antacids. It may be used to treat the symptoms of stomach or duodenal ulcers. Sodium bicarbonate is also used to make the blood and urine more alkaline in certain conditions.

Antacids should not be given to young children (up to 6 years of age) unless prescribed by their doctor

 

To treat metabolic acidosis and adjunctive treatment of diarrhea

Counteracts acid but does not prevent ulcer; not used for diabetic acidosis

Minimizes uric acid crystallization in gout; USED to prevent uric acid crystallization

Don’t give with verapamil , calcium, dobutamine

 

Verapamil HCL (Isoptin)

Calcium channel blocker – reduces workload of left ventricle

 

Adenosine (Adenocard)

Adenosine is an antiarrhythmic. It works by slowing the electrical conduction in the heart, slowing heart rate, or normalizing heart rhythm

For rapid IV use only

Antiarrhythmia

 

Bretylium Tosylate (Bretylol)

Antiarrhythmia

 

 

 

Gatrointestinal

 

A.     Antacids

·    They neutralized gastric acids but DO NOT coat the ulcer.

·    Those containing calcium and aluminum can cause constipation

·    Those containing magnesium can cause diarrhea.

·    Best given 1 hour before meals or 1-3 hours after meals since they can interfere with absorption especially  with antiobiotics, INH,

 

Bismuth Subsalicylate (Kaopectate)

Absorbs PO meds so must not be given 1 hour before other meds are given if it needs to be taken first.

Bismuth subsalicylate is an anti-diarrhea medication and antacid. Bismuth subsalicylate is used to treat diarrhea, nausea, heartburn, indigestion, and upset stomach

 

B.     Ulcer Prevention

·    Best if given with meals.

·    Don’t give the antacids.

 

Famotidine (pepcid)

Treating and preventing ulcers. It is also used to treat gastroesophageal reflux disease (GERD), conditions that cause increased acid secretion, and esophagitis. It also may be used for other conditions as determined by your doctor.

Famotidine is an H2 (histamine) blocker. It reduces stomach acid by blocking one of the chemicals (histamine) that stimulates the release of acid into the stomach.

Notify your doctor if you have any symptoms of a bleeding ulcer, such as black, tarry stools or vomit that looks like coffee grounds

 

Cimetidine (tagamet)

Can be taken at bedtime

 

Ranitidine (Zantac)

Taken with meals.

 

C.     Antidiarrhea

Bismuth Subsalicylate (Kaopectate)

Absorbs PO meds so must not be given 1 hour before other meds are given if it needs to be taken first.

Bismuth subsalicylate is an anti-diarrhea medication and antacid. Bismuth subsalicylate is used to treat diarrhea, nausea, heartburn, indigestion, and upset stomach

 

Opium

Opium Tincture is an opiate. It works by decreasing intestinal muscle contractions, which helps to reduce diarrhea

Nausea and vomiting are side effects

Has a sedative effect.

 

 

D.     Laxative

Magnesium Sulfate

An anticonvulsant; also to regulate heart; also a laxative

Nurse can do the following as a precaution for patients on magnesium sulfate: place a padded tongue blade at bedside, insert a Foley catheter. Darken the room.

 

Golytely

Polyethylene glycol electrolyte solution is used to clean the bowel before colonoscopy, a barium x-ray, or other intestinal procedures

Need to taken with 4 liters if liquid. Can be reconstituted with tap water and can only drink water once solution is drank

 

 

 

E.     Antiemesis

Metoclopramide (Reglan)

 

Ondansetron (Zofran)

 

Genitourinary Medications

Finasteride (Proscar)

For Benign Prostatic Hypertophy (BPH).

Should not be handled by a woman who is pregnant or who might be pregnant since this medication is an androgen inhibitor, thus, it can cause damage to the fetus or eventual fetus

 

Phenazopyridine (Pyridium)

Phenazopyridine is a pain reliever that affects the lower part of your urinary tract (bladder and urethra). Phenazopyridine is used to treat pain, burning, increased urination, and increased urge to

Phenazopyridine will treat the symptoms of a urinary tract infection.

It can change the color of urine to orange or red.

 

METHERGINE

A uterine stimulante, it is for postpartum, to treat hemorrhage caused by uterine atony or subinvolution

To help contract the uterus

Preventing and treating bleeding after delivery of a baby.

 

 

Thyroid Replacement Medication

Leyothyroxine (Synthroid)

Synthroid should not be used either alone or with diet pills to treat obesity or for weight loss because serious, even life-threatening, effects could occur. Large doses of Synthroid , especially with diet pills, may cause symptoms of toxicity.

 

Take Synthroid on an empty stomach at least 1 hour before or 2 to 3 hours after eating

Take Synthroid 4 hours apart from calcium supplements, iron, antacids (those containing aluminum, calcium, or magnesium), simethicone, cholestyramine, colestipol, sucralfate, or sodium polystyrene sulfonate. These medicines may decrease the absorption of Synthroid into your bloodstream

 

Synthroid (Levothyroxine) -preferably given at breakfast to prevent insomnia; increases metabolic process so should increase urine output and decrease edema AND one ought to check one’s pulse since the medication can cause tachycardia and dysrhythmias

 

 

Minerals / Vitamins / Electrolytes

·    Oral vitamins when taken with OJ is good; it enhances their absorption

 

Ferrous Sulfate (Feosol)

Good for iron-deficient anemia

Best if given with vitamins or orange juice to enhance its absorption.

PT will have to eat more fruits to prevent

CONSTIPATION, a major side effect and stool will become Dark not light.

 

Potassium Chloride (KCL)

Should be given IV and infused at 5 – 10 mEq per hour NOT to exceed 20 mEq/hr.

Main side effect is diarrhea

 

 

Fosomax

Advice patient to drink only with water, no food.

Patient should stay in upright position for at least 30minutes after taking the medication to decrease esophageal irritation.

Must be taken 30 min before anything else (including water) is taken in the morning upon waking up. Food especially those calcium inhibits its absoprtion; should be taken with 8 oz of water; PT ought to sit upright for 30mins afterwards             to decrease esophageal irritiation

 

Accutane

A concentrated Vitamin A, a fat soluble vitamin thus can be hepatotoxic

For acne; made from vitamin A

Should not be used by pregnant patients because of its teratogenic effects.

 

Vitamin B1

For alcoholics

 

Vitamin B6

Usually good for TB patients to prevent peripheral neuropathy.

Often en t from INH and combo of drugs

 

Vitamin B9 (folic acid)

To prevent neural tube defects.

 

Vitamin B12

For pernicous anemia and for problems with peripheral nervous system.

Meat, eggs and dairy products are a good source

 

Alcoholism  Medication

Antabuse

Patients on this medication should avoid anything containing alcohol and vinegar

Check for alcohol use while on the medication. If patient is taking alcohol, he or she may experience nausea & vomiting, tachycardia, severe headache, and chest pain.

 

 

BiPolar Medications

Lithium

Watch for foods that are high in sodium, which can excrete the lithium in an individual.

Lithium is a mood stabilizer and takes about 1 – 2 weeks to take into effect. So, a manic patient may be given at the same time an antipsychotic medication Riseridone.

A salt preparation; level should be 1-1.5

Increased urination and thirst are signs of toxicity

 

AntiParkinson Medication

·    Caused by low level of the dopamine in the brain.

Amantadine (Symmetrel)

Technically an anti-Parkinsonian drug as a substitute for dopamine.

Also given to those with cocaine addiction.

 

Carbidopa-Leodopa (Sinemet)

For Parkinsons, avoid Vitamin B12 since it interferes

Ccan lead to bradykensia

Carbidopa is used with levodopa to prevent the breakdown (metabolism) of levodopa before it can reach the brain and take effect.

Carbidopa is only effective if it is taken with levodopa. It has no effect if it is used alone.

Carbidopa is also used with levodopa to treat the stiffness, tremors, spasms, and poor muscle  control of Parkinson's disease.

 

Benztropine (Cogentin)

For Parkinson Disease

 

Bromocriptine (Parlodel)

Bromocriptine is usually used in adjunct with levodopa for Parkinsons.

It can lower prolactin levels which is a hormone necessary for the production of breast milk and for normal fertility in women.

 

 

Musculoskeletal Medication

Neostigmine (Prostigmine)

For Myasthenia Gravis

 

Dantrolene (Dantrium)

A muscle relaxant. It treats stiffness and spasms caused by conditions such as a spinal cord injury, stroke, cerebral palsy, or multiple sclerosis, mysathenia gravis.

 

Fosomax

Advice patient to drink only with water, no food.

Patient should stay in upright position for at least 30minutes after taking the medication to decrease esophageal irritation.

Must be taken 30 min before anything else (including water) is taken in the morning upon waking up. Food especially those calcium inhibits its absoprtion; should be taken with 8 oz of water; PT ought to sit upright for 30mins afterwards             to decrease esophageal irritiation

 

 

Nervous System Medication

Methyphenidate (Ritalin)

A stimulant than can cause anorxia to a child. So, high caloric food should be offered. Methylphenidate is used to treat attention deficit disorder (ADD), attention deficit. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

Methylphenidate is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy.

 

 

Antineoplastic

·    Most antineoplastic medications have the following side effects:

a.    Bone Marrow suppression, thus, lowers the RBC, causes neutropenia and

thrombocytopenia (low platelets). So, what for nose bleeds and bleeding gums.

b.    GI problems – causes can be anorexic. Have nausea and vomiting since most of

these medications stimulate the vomit center. Patient can also have diarrhea.

c.    Stomatitis – inflammation of the mucous membrane of themouth.

d.    Alopeica – loss of hair.

e.    Infertility – this is a huge issue especially if the patient is childbearing woman.

 

·    Lowers the immune system of the patient. So, tell patient to be careful when in contact with people with colds, flu or other contagious illnesses. Also, tell patient NOT to have and vaccines that contain live strains (ie oral polio vaccine) or  DO NOT come contact who recently were vaccinated with a live virus.

·    When mixing drug medications, it is recommended to wear surgical glove, use Luer lok IV tubings, and use disposable long sleeve gown.

·    Skin exposure to the medications can cause skin irritation. If it happens, rinse well with soap and warm water.

 

Doxorubicin (Adriamycin)

Can cause bone marrow depression,  fever and sore throat.

Can lead to stomatitis 5 - 10 days later.

 

Cyclophosphamide (Cytoxan)

Hair loss occurs within 1- 21 days but grows back abundantly, curlier and coarser

 

Radioactive implants

·    The nurse should carefully monitor the amount of time spent with the patient

 

 

Headache medication

 

Sumatriptan (Imitrex)

Can cause coronoary vasospasms so not good for patients with angina.

For cranial vasoconstriction to reduce pain BUT it can cause vasoconstriction systemically, thus, watch for clients with angina.

 

Diabetic Medications

 

Type of Insulin

Onset

Peak

Duration

Rapid Acting

 

 

 

Lispro

5 - 15 mins

1 hour

3 hours

Apart

5 - 15 mins

40 - 50 mins.

4 - 6 hours

 

 

 

 

Short Acting

 

 

 

Regular

30 - 60 mins

2 - 3 hours

4 - 6 hours

 

 

 

 

Intermediate Acting

 

 

 

NPH

2 - 4 hours

6 - 12 hours

16 - 20 hours

Lente

 

 

 

 

 

 

 

Long Acting

 

 

 

Ultralente

6 - 8 hours

12 - 16 hours

20 - 30  hours

 

 

 

 

Very Long Acting

 

 

 

Glargine

1 hour

No Peak

24 hours

 

·    Regular insulin is the only insulin compatible with IV.

·    IV insulin – insulin molecules can adhere to glass and plastic. So, the IV tubing should be flushed with the IV solution and discard the first 50 ml.

 

 

Precose (Acarbose)

Oral glucose that must be taken with meals

 

Antibacteria /Antifungal

 

Some Topical Medications

 

Silver Nitrate

Will cause dark staining of the surrounding skin

Silvadene

Provides a cooling effect.

 

Betadine

Can alter the function of thyroid.

 

Sulfamylon (Mafenide acetate)

Often used for electrical burns, since it can penetrate the eschar better.

Produces a burning sensation when applied. So, a patient should receive a pain medication when used.

 

Hematopoietic stimulant

Neumega

Stimulates platelet production

 

Epoetin Alfa (Epogen; Procrit)

Epoetin alfa is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, one can develop anemia.

Epoetin alfa is used to treat anemia (a lack of red blood cells in the body).

Check for hypertension; watch for rapid Hematocrit increase by more than 4 points in 2 weeks; may lead to seizures and may need to decrease dose.

 

Filgrastim (Neupogen)

Filgrastim is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection.

Filgrastim is used to treat neutropenia, a lack of certain white blood cells caused by cancer, bone marrow transplant, receiving chemotherapy, or by other conditions.

 

Neulasta

Given to increase WBC

Neulasta is an amino acid. It works by stimulating bone marrow to produce white blood

cells, which fight infection.

 

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