Drug Brand Name: Synthroid Drug Generic Name: Levothroxine
Classification: Thyroid hormone
Action: Controls protein synthesis; increases metabolic rate, cardiac output, renal blood flow, O2 consumption, body temp, blood volume, froth, development at cellular level via action on thyroid hormone receptors.
Adult Dose: PO 1.7 mcg/kg/day
Side Effect:
Life Threatening: Thyroid storm, cardiac arrest. Common: Anxiety, insomnia, tremors, headache, excitability, tachycardia, palpitations, angina, dysrhythmias, hypertension, nausea, diarrhea, increased or decreased appetite, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, fever, alopecia, decreased bone mineral density.
Contraindication: Adrenal insufficiency, recent MI, thyrotoxicosis, hypersensitivity to beef, alcohol intolerance (injonly)
Nursing Implications (lab value, V/S, ect.):
• Determine if the patient is taking anticoagulants, antidiabetic agents; document on chart,
• Take B/P, pulse before each dose; monitor I&O ratio and weight every day in same clothing, using same scale, at same time of day.
Nursing diagnoses:
• Knowledge, deficient (teaching)
• Noncompliance (teaching)
Patient Education:
• Teaching patient that product is not a cure but controls symptoms and that treatment is long term.
• Instruct patient to report excitability, irritability, anxiety, sweating, heat intolerance, chest pain, palpitations, which indicate overdose.
Drug Brand Name: Metformin (Rx) Drug Generic Name: Glucophage
Classification: Antidiabetic, oral
Action: Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin.
Adult Dose: PO 500 mg bid or 80 mg q day initially, then 500 mg weekly or 850 mg q2wk up to 2000 mg/day in divided doses.
Side Effect:
Life Threatening: Heart failure, lactic acidosis, thrombocytopenia. Common: Headache, weakness, dizziness, drowsiness, tinnitus, fatigue, vertigo, agitation, hypoglycemia, nausea, vomiting, diarrhea, heartburn, anorexia, metallic taste, decreased vit B12 levels, and rash.
Contraindication: Hypersensitivity to this product, or hypersensitivity to chlorobutanol (inj route) asthma, ileus.
Nursing Implications (lab value, V/S, ect.):
• Asses for hypoglycemic reaction (sweating, weakness, dizziness, anxiety, tremors, hunger), hypoglycemia reactions soon after meals; these occur rarely with this product.
Nursing diagnoses:
• Knowledge, deficient (teaching)
Patient Education:
• Teach patient to regularly self-monitor blood glucose using blood glucose meter.
• Teach patient symptoms of hypo/hyperglycemia, what to do about each (rare)
• Teach patient that diabetes is a lifelong illness, that this product controls symptoms, but does not cure the condition.
Drug Brand Name: Insulin Drug Generic Name: Insulin, regular (OTC)
Classification: Antidiabetic, pancreatic hormone.
Action: Decreases blood glucose; by transport of glucose into cells and the conversion glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies)
Adult Dose: SUBCUT dosage individualized, give within15min before or 20 min after starting a meal.
Side Effect:
Life Threatening: Anaphylaxis Common: Blurred vision, dry mouth, flushing, rash, urticarial, warmth, lipodystrophy, lipohypertrophy, swelling, redness, hpypoglycemia, rebound hyperglycemia (somogvi effect 12-75 hr or longer), peripheral edema.
Contraindication: Hypersensitivity to protamine; creosol (aspart)
Nursing Implications (lab value, V/S, ect.):
• Fasting blood glucose, also Hgb Alc may be tested to identify treatment effectiveness q3mo.
• Urine ketones during illness; insulin requirements may increase during stress, illness, surgery.
Nursing diagnoses:
• Injury, risk for (adverse reactions)
• Knowledge, deficient (teaching)
• Noncompliance (teaching)
Patient Education:
• Advise patient that blurred vision occurs; not to change correctives lens until vision is stabilized 1-2 mo.
• Advise patient to keep insulin, equipment available at all times; carry a glucagon kit, candy, or a lump of sugar to treat hypoglycemia.
Drug Brand Name: Insulin Drug Generic Name: Insulin Lispro (Rx)
Classification: Antidiabetic, pancreatic hormone.
Action: Decreases blood glucose; by transport of glucose into cells and the conversion glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies)
Adult Dose: SUBCUT dosage individualized, give within15min before or 20 min after starting a meal.
Side Effect:
Life Threatening: Anaphylaxis Common: Blurred vision, dry mouth, flushing, rash, urticarial, warmth, lipodystrophy, lipohypertrophy, swelling, redness, hpypoglycemia, rebound hyperglycemia (somogvi effect 12-75 hr or longer), peripheral edema.
Contraindication: Hypersensitivity to protamine; creosol (aspart)
Nursing Implications (lab value, V/S, ect.):
• Fasting blood glucose, also Hgb Alc may be tested to identify treatment effectiveness q3mo.
• Urine ketones during illness; insulin requirements may increase during stress, illness, surgery.
Nursing diagnoses:
• Injury, risk for (adverse reactions)
• Knowledge, deficient (teaching)
• Noncompliance (teaching)
Patient Education:
• Advise patient that blurred vision occurs; not to change correctives lens until vision is stabilized 1-2 mo.
• Advise patient to keep insulin, equipment available at all times; carry a glucagon kit, candy, or a lump of sugar to treat hypoglycemia.
Drug Brand Name: Fosamax Drug Generic Name: Alendronate (Rx)
Classification: Bone-resorption inhibitor
Action: Decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone; inhibits osteoclast activity
Adult Dose: PO 10 mg daily or 70 mg qwk
Side Effect:
Life Threatening: Atrial fibrillation, esophageal perforation, esophageal cancer, angioedema, Steven-Johnson syndromes, toxic epidermal necrolysis. Common: Headache, abdominal pain, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia, diarrhea, hypophosphatemia, hypocalcemia, bone pain, osteonecrosis of the jaw, bone fracture.
Contraindication: Hypersensitivity, moderate to severe hepatic impairment, not indicated for use in women or children’s, breastfeeding (but not used in women)
Nursing Implications (lab value, V/S, ect.):
• Asses for serious reactions: angioedema, Steven Johnson syndrome, toxic epidermal necrolysis, atrial fibrillation.
• Asses dental status, regular dental exams should be done; dental extractions (cover with anti-infective) prior to procedures.
Nursing diagnoses:
• Injury, rick for ( uses)
• Knowledge, deficient (teaching)
Patient Education:
• Teach patient to remain upright for 30 min after dose to prevent esophageal irritation; if dose is missed, skip dose, do not double doses or take later in day.
• Teach patient to take in AM, only before food, other meds, to take with 6-8 oz water (not mineral water)
Drug Brand Name: Epogen Drug Generic Name: Epoetin
Classification: Antianemic, biologic modifier, hormone
Action: Erythropoietin is one factor controlling rate of red cell production; product is developed by recombinant DNA technology.
Adult Dose: SUBCUT 150 units/ kg 3 X wk
Side Effect:
Life Threatening: Seizures, hypertensive encephalopathy, CHF, DVT Common: Coldness, sweating, headache, hypertension, edema, pruritus, rash, inj site reaction, iron deficiency, bone pain, coughs.
Contraindication: Hypersensitivity to mammalian cell-derived products or human albumin; uncontrolled hypertension
Nursing Implications (lab value, V/S, ect.):
• Monitor renal studies; urinalysis, protein, blood, BUN, creatinine; I&O; report drop in output to < 50 ml/hr
Nursing diagnoses:
• Activity intolerance (uses)
• Fatigue (uses)
• Knowledge, deficient (teaching)
Patient Education:
• Teach patient how to take B/P
• Advise patient to take iron supplements, vit B12, folic acid as directed.
• Teach patient to avoid driving or hazardous activity during treatment.
Drug Brand Name: Sandimmune Drug Generic Name: CycloSPORINE (Rx)
Classification: Immunosuppressant
Action: Produces immunosuppression by inhibiting T lymphocytes.
Adult Dose: PO mg/kg several hr before surgery, daily for 2 wk, reduces dosage by 2.5 mg/kg/day to 5-10 mg/kg/day.
Side Effect:
Life Threatening: Seizures, hepatotoxicity, albuminuria, hematuria, proteinuria, renal failure Common: Tremors, headaches, confusion, nausea, vomiting, diarrhea, oral candidagum hyperplasia, pancreatitis, rash, acne, hirsutism, pruritus, hyperkalemia, hypomagnesamia, hyperlipidemia, hyperuricema, infection, hypertension.
Contraindication: Hypersensitivity to polyxyethylated castor oil (inj only),psoriasis or rheumatoid arthritis, in renal disease (Neoral/Gengraf), Gengraf/Neoral used with PUV/UVB; methotrexate, coal tar, breastfeeding, ocular infections.
Nursing Implications (lab value, V/S, ect.):
• Encephalopathy: Asses for impaired cognition, seizures, vision changes including blindness, loss of motor function, movement disorder, psychiatric changes; dosage reduction or discontinuation may be needed in severe cases.
• Monitor renal studies: BUN, creainine at least monthly during treatment, 3 mo after treatment
Nursing diagnoses:
• Infection, risk for (uses)
• Knowledge, deficient (teaching)
• Mobility, impaired physical (uses)
Patient Education:
• Advise patient to report fever, rash, severe diarrhea, chills, sore throat, fatigue, since serious infection may occur; also to report clay- colored stools, cramping ( may indicate hepatotoxicity); tremors, bleeding gums, increased B/P
Drug Brand Name: Imuran Drug Generic Name: AzaTHIOprine (Rx)
Classification: Immunosuppressant
Action: Produces immunosuppression by inhibiting purine synthesis in cells
Adult Dose: CCr 10-50 ml/min 75%of dose; CCr< 10ml/min 50% of dose
Side Effect:
Life Threatening: Pancreatitis, hepatotoxicity, jaundice, leukopenia, thrombocytopenia, anemia, pancytopenia, bleeding, serum sickness. Common: Nausea, vomiting, stomatitis, esophagitis, rash, alopecia, Raynaud’s symptom’s, secondary malignancy, infection, Arthralgia, muscle wasting.
Contraindication: Hypersensitivity
Nursing Implications (lab value, V/S, ect.):
• Assess symptoms of rheumatoid arthritis: pain in joints, stiffness, poor range of motion, mobility, inflammation before and during treatment.
• Monitor I&O, weight daily, report decreasing urine output, toxicity many occur.
• Asses for infection: increased temp, WBC; sputum, urine.
Nursing diagnoses:
• Infection, risk for (uses)
• Knowledge, deficient (teaching)
• Mobility, impaired (uses)
Patient Education:
• Teach patient to take as prescribed, do not miss dose; if is missed on daily regimen, skip dose; if on multiple dosing/day, take as soon as remembered.
• Advise patient to use soft-bristled toothbrush to prevent bleeding.
