MEDICATION AIDE CHAPTERS 33-35

COMMON CONDITIONS OF THE MUSCULOSKELETAL SYSTEM

• Parkinson’s Disease• Osteoarthritis• Rheumatoid arthritis• Gout• Cancer• Cerebral palsy• Muscular dystrophy• Osteoporosis

ANALGESIC

• Used to relieve pain • Common side effects

• Nausea• Dizziness• Abdominal pain• Abdominal pain• Constipation • Confusion

• Nursing precautions• Use pain scale to monitor pain relief• Provide alternative comfort measures

• Examples• Acetaminophen (Tylenol)• Tylenol with codeine• Darvon• Hydrocodone (Lortab, Vicodin)• Ultram

ANTI-INFLAMMATORIES

• Used to relieve pain by relieving swelling, inflammation• Common side effects

• Stomach irritation• Constipation• Dizziness• Drowsiness• Confusion

• Nursing precautions• Observe for GI bleeding• Administer with food• Contraindicated if history of GI bleeding or ulceration

• Examples • Ibuprofen (Motrin)• Naproxen (Naprosyn, Aleve)• Relafen• Daypro• Feldene• Celebrex• Vioxx

CORTICOSTERIODS

• Used to decrease swelling & pain in inflammatory diseases (arthritis)

• Common side effects• Fluid retention (edema)• Weight gain• Electrolyte imbalance• Behavioral change• Elevated blood sugar • GI distress

• Nursing precautions• Watch closely for signs of infection (sore throat, fever, generalized aching,

nausea, vomiting

• Examples • Decdron• Prednisone• Methylprednisolone (Medrol)

ANTISPASMODICS

• Used to relieve muscle spasms • Common side effects• Drowsiness• Dizziness• Fatigue• GI distress

• Nursing precautions• Provide for safety during episodes of alertness

• Examples • Soma (carisoprodol)• Flexeril (cyclobenzaprine)• Skelaxin (metaxalone)• Robaxin (methocararbarnol)• Norflex (orphenadrine citrate)

CONT.

• Direct acting-Dantrium• Same S/E except is very photo sensitive

• Baclofen-used for muscle spasms from MS, spinal cord injury, & other spinal cord diseases• Disintegrates orally, thus is faster acting

ANTI-GOUT

• Used to decrease uric acid in body, preventing or relieving joint pain associated with gout

• Common side effects• Drowsiness• Nausea, vomiting• Diarrhea

• Nursing precautions• Administer Zyloprin and Benemid with food or milk • Maintain fluid intake at 8-12 ounces daily

• Examples• Colchicine• Allopurinol (zyloprim, aloprim) • Probenecid (benemid)

CONT.

• Ist attack is usually the big toe, however can also affect other joints such as the elbows, feet wrists, & knees• Tx. May include lifestyle changes, such as

reduction of foods high in purrine(red meat), stress, alcohol & increased fluids• S/S includes pain• Swelling• Redness• Heat• Stiff joints

DRUGS USED TO TREAT INFECTIONS

• Infection-Results from an invasion & growth of microbes in the body• Local is in a body part• Systemic involves the whole body-germs are transferred thru the

blood• Secondary inf. Is caused by a microbe that follows the 1st inf.

• Bacteria• Often called germs- can cause infection

• Fungi • Yeasts and molds are common fungi- can cause infection

• Viruses • Microbes that grow in living cells. Cause many diseases

COMMON INFECTIONS

• Acquired immunodeficency(Aids)• Healthcare-associated inf.(Nosocomial)• Hepatitis B• Hepatitis C• Herpes Zoster(shingles)• Tuberculosis

AMINO-GLYCOSIDES

• Antibiotics that prevent bacteria from reproducing• Are given by IV or IMK except for Neomycin• Used to tx. UTI’s, Meningitis, Septicemia, Wound

inf.• S/E include Dizziness• Ringing in the ears(can cause hearing damage)• Decreasing urine output(if smoky or bloody-may signify

kidney toxicity)

CEPHALO-SPORINS

• May be used if allergic to penicillin• Used for Uti’s S/E diarrhea-possible dehydration• Respiratory Inf. Bleeding-changes in the platelets• Abd. Inf. Increased conf.• Bacterimia Electrolyte imbalance• Meningititis• Osteo-myelitis• (Meds) Ceclor• Duricef• Ceftin• Keflex• Velosef• Omnicef

KETOLIDES

• Prevents bacteria from forming new proteins-Ketek• Treats-Acute bacterial sinusitis &bronchitis(5

days) Pneumonia(7-10 days)• S/E include • Diarrhea,N/V.• Dizziness• Blurred or double vision-difficulty focussing

MACROLIDES

• Prevents bacteria from multiplying• Used when other classes cannot be used• Resp. inf. Meds includes• GI inf. Zithromax• Soft tissue inf. Biaxin• Skin inf. E-Mycin• STD’s

• S/E Diarrhea, N/V. abnormal taste

PENICILLINS

• 1st true antibiotics-destroys the cell wall• Many bacteria have become resistant to the drug• Used to treat- where drug has been modified• Middle ear inf.• Pneumonia Meds includes• Meningitis Amoxil• Uti’s Geocillin• Syphillis Oxacillin• Pre surgical & dental procedures Penicillin VK• S/E’s are the same• Rheumatic fever Is a secondary inf. from a resp. inf.

QUINOLONES

• Prevents bacteria from reproducing• Used to treat initial & re-current Uti’s• Enc. A high fluid intake(2000 cc)• Meds includes S/E includes• Cipro N/V & diarrhea• Levaquin Dizziness/drowsiness• Avalox Photo-sensitive• Negram Tinnitus• Fioxin Depression• Factive Confusion

SULFONAMIDES

• Prohibits formation of folic acid-needed for cell growth & reproduction• Used for Uti’s, otitis media & if allergic to

penicillin• Enc. Large fluid intake(2000 cc)• Meds include S/E includes• Sulfadiazine N/V, diarrhea• Gantrisen photo-sensitive• Bacrtrim Sore throat, fever(changes

in the• Septra Eryzole white & red cell makeup)• Tinnitus, HA & dizziness

ANTI-TUBULAR AGENTS

• Myambutol-give with food-dosage based on wt.• S/E N/V, diarrhea, Conf., blurred vision/red/green color

changes

• INH-used to prevent if test positive-give on empty stomach-dosage based on wt. • S/E Numbness & tingling, N/V. dizziness, ataxia, anorexia,

jaundice-may signal liver toxicity

• Rifadin given to carriers with no symptoms-1 hr ac or 2 hrs. pc• S/E Reddish-orange secretions, N & V, fever or chills,

muscle or bone pain jaundice(contact physician)

ADDED ANTIBIOTICS

• Cleocin-Broad spectrum ATB• Vancomycin-used only in life threatening inf.• Low urine output with kidney toxicity• Seconary fungal inf. Of the mouth & vagina• Can cause hearing damage

• Flagyl –Trichomoniasis,Gardiasis(traveler’s diarrhea),• amebic dysentery-avoid alcohol & related products• Tindamax-Trichomoniasis, Gardiasis, Amebic dysentery &

Amebic liver abscess• S/E includes severe diarrhea, blood or mucous in the stool• (contact Dr.)• N/V, dizziness• Confusion

ANTIFUNGAL AGENTS

• Used to destroy or inhibit growth of fungi• Common side effects• Burning• Blistering• headache

• Nursing precautions• Report skin irritation athlete’s foot-wear cotton socks• Do not use occlusive dressings avoid eye contact

• Examples • Desenex• Fungizone cream • Mycostatin (nystatin)• Nixoral (ketoconazole)• Tinactin (tolnaftate ointment, powder)• Monistat• Lotrimin

SYSTEMIC ANTIFUNGAL AGENTS

• Diflucan-to tx. Infections of the meninges, mouth & pharynx, esophagus, & vagina• to prevent inf. In bone marrow transplant pts.

With radiation or chemo, HIV, weakened immune systems• S/E N/V, & diarrhea• Anorexia, jaundice(liver toxicity)

CONT.

• Ancoban To tx. Fungal inf. of the blood, ht. urinary tract, meninges, lungs• S/E N/V & diarrhea, low kidney output(bloody or smoky

urine(kidney toxicity), anorexia & jaundice(liver toxicity)

• Fulvicin & Grifulvin To tx. Ringworm of the scalp, body, nails & feet• S/E N & V, abd. Cramps,Conf., secondary inf. of the mouth &

vagina, photo-sensitivity, sore throat fever(changes in red & white cells) low urine output with bloody or smoky urine(kidney toxicity), anorexia & jaundice(liver toxicity)

• Sporanox Treats a variety of fungal inf.• Liver toxicity, dyspnea, chest pain, fatigue, palpitations

[heart failure)

CONT.

• Nizoril to tx. A variety of fungal inf. (Avoid alcoholic beverages & products)• S/E. N & V, Anorexia &jaundice(liver toxicity)

• Lamisil To tx. fungal inf. of the toenails(12 wks.) & fingernails(6 wks.)• S/E low urine output with smoky or bloody urine(kidney

toxicity)• Anorexia, N/ V & jaundice(liver toxicity)

ANTIVIRAL

• Used to destroy DNA of viruses associated with conditions such as AIDS and herpes• Common side effects• Lethargy• Tremors• Sweating• Diarrhea• Nausea, anorexia jaundice(liver toxicity)• Purple discoloration of skin (symmetrel), black discoloration of

fingernails (AZT)• Low urine output-smoky or bloody urine(kidney toxicity)• confusion

• Nursing precautions• Used finger cot when applying topical Zovirax

CONT.

• Zovirex -genital herpes(start @ 1st sign of symptoms)• Initial tx.1000mg. For 10 days• Suppressive 2000 mg./day for up to 12 mo.• Intermittent 1000mg./day for 5 days

• Famvir- for recurrent genital herpes & shingles• Genital-125 mg. bid for 5 days within 6 hrs. • Shingles-500 mg. q 8 hrs. for 7 days within 72 hrs.

• Valtrex-shingles & to suppress genital herpes• shingles 1 gm. tid for 7 days• 500 mg. bid for 5 days

• Ziagen & Reyataz-used with other anti-viral’s to slow progression of HIV,reduce frequency of oportunistic inf.(people with weakened immune systems)• Risk factors-diabetes, HIV, Ca, & urinary catheter

CONT.

• Videx-also slows progression of HIV & reduces frequency of opportunistic inf.

• Sustiva-also the same• Comes in multiple forms-taken on empty stomach @ HS • Not taken if pregnant as causes fetal deaths

• Emtriva• Dosage is reduced if impaired kidney function

• Epiver• Also used for hepatitis B

• Zirit• Has multiple dose forms

• Retrovir• Also causes numbness & tingling in hands & feet

CONT.

• Symmetral-Treats influenza A as well as Parkinson’s• Tamiflu-Used to reduce flu S/S• Relenza-Used to reduce flu S/S & prevent 2nd

infection of pneumonia• Inhaled broncho-dilator should be done 1st

• Inhaled like a dry blister pack• Monitor for monitor for broncho-spasms & SOB

• Rebetol-Used with other drugs for tx. Of Hepatitis C• Dosage determined by wt.• S/E fatigue, dizziness, HA, SOB with exertion(changes in

red blood cell production)

NUTRITIONAL AND HERBAL SUPPLEMENT THERAPY

• Nutrition is the process involved in the ingestion, digestion, absorption, and used of foods and fluids by the body. • The MyPyramid is a guide for healthy choices • The kind and amount of flood to eat daily• Gradual improvement• Physical activity (30 minutes moderate activity daily)• Variety• Moderation• Right amount from each food group band

NUTRIENTS

• Protein• Needed for tissue growth and repair

• Carbohydrates• Needed for energy and fiber

• Fats• Provide energy

• Vitamins• Needed for certain body functions A,D,E, K (stored) C, B (not stored)

• Minerals• Needed for bone formation and nerve and function

• Water • Needed for all body processes • 2000-2500 ml daily

MALNUTRITION

• Nutritional needs are not met

• Treatment • Enteral nutrition • NG-tube• Naso-intestinal tube• G-tube• J-tube• PEG tube

Parenteral nutritionTPN & Lipids

VITAMINS & MINERALS

• Used to replace essential vitamins & minerals necessary for human health, growth

• Common side affects• Nausea, vomiting• Abdominal pain• Constipation

• Nursing precautions• Monitor for side effects

• Examples • Multi-vitamins• Calcium• Iron• Folic acid• Vitamins: E, C, D, & K

VITAMINS

• Vitamins- organic chemicals necessary for normal metabolism, tissue growth, healing

• Common side affects • Headache• Heartburn• Nausea• Irritability

• Nursing precautions• Assess dietary intake• Administer with food to promote absorption

• Examples • Vitamins A, D, E, K• Vitamin B group• Vitamin C (ascorbic acid)

MINERALS

• Inorganic substance plays a vital role in regulationg body functions• Common side affects (can be toxic)

• Pallor • Nausea, vomiting• Diarrhea• Blood in emesis• Blood in stools (iron)

• Nursing precautions• Assess for signs of anemia• Stress healthy dietary habits• No iron medication within 1 hour of antacids or milk products

• Examples • Feosol• Zinc• Chromium• Iodine• Copper

HERBAL SUPPLEMENTS

• Used by many to promote & maintain health• The vast majority of beneficial claims are not

proven

NUTRITIONAL SUPPLEMENTS

• Used to treat/provide support to prevent malnutrition• Common side affects• Gastrointestinal intolerance (nausea, vomiting, diarrhea)• Interaction with medications

• Nursing precautions• Monitor for nausea, vomiting• Diarrhea• Monitor weight, I & O

• Examples • Ensure• Vivonex• Sustacal• Boost • Prosure

ELECTROLYTES

• Used to re-establish proper electrolyte balance• Signs of increased electrolyte imbalance• Sodium (fever, weakness, disorientation, oliguria)• Potassium (nausea, vomiting, muscle twitching, cramping pain,

seizures)• Calcium (weakness, fatigue, thirst, anorexia)• Magnesium (nausea, vomiting, diarrhea, colic)

• Signs of decreased electrolyte imbalance• Sodium (anorexia, nausea, vomiting, anuria)• Potassium (muscle weakness & cramping, diminished tendon

reflexes, paralytic ileus, cardiac arrhythmias)• Calcium (abdominal cramps, muscle cramps, tingling of

fingertips, dry skin)• Magnesium (flushing, hypertension)

ELECTROLYTES CONT.

• Common side affects• Diarrhea• Nausea, vomiting• Bleeding & ulceration of stomach• Respiratory depression• Renal calculi• Slow pulse• Clot formation

• Nursing precautions• Monitor vitals• Check skin turgor• Observe for edema

• Examples • Micro-K• Slow-mag• Os-Cal• Slow-sodium• K-Dur• K-Lyte