MedMaster by NURSING.com

Dobutamine

Dobutrex

Short term management of heart failure

Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart.

Inotropic

Beta-adrenergic agonist

• Monitor hemodynamics: hypertension, ↑HR, PVCs • Skin reactions may occur with hypersensitivity • Beta blockers may negate therapeutic effects of dobutamine • Monitor cardiac output • Monitor peripheral pulses before, during, and after therapy • DO NOT confuse dobutamine with dopamine

Divalproex

Depakote

Seizures, manic episodes, prevention of headache

Increases the level of GABA (inhibitory neurotransmitter) in CNS

Anticonvulsant, vascular headache suppressants

None

• May cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis • Increases risk for bleeding with Warfarin • Use caution with MAOIs • Monitor liver function tests

Diphenhydramine

Benadryl

Allergy, anaphylaxis, sedation, motion sickness, antitussive

Antagonizes effects of histamine, CNS depression

Allergy, cold and cough remedy, antihistamine, antitussive

Antihistamine

• May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache • Anticholinergic effects (dry mouth, blurred vision, constipation, sedation) • Assess purpose of medication prior to giving it • Assess allergies, sleep patterns, cough and lung sounds • Patient should avoid other over-the-counter cough and cold remedies

Diltiazem

Cardizem

Hypertension, angina, SVT, AFib, aflutter

Inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodi- latation and decreased blood pressure.

Antianginals, antiarrhythmics, antihypertensive

Ca Channel Blocker (Benzothiazepine)

• Contraindicated in 2nd and 3rd AV block • May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia • Increases digoxin levels • Don't drink grapefruit juice • Assess for signs of CHF • Monitor EKG continuously • Tell patient to change positions slowly • Monitor serum potassium • Instruct pt on how to take blood pressure

Digoxin

Lanoxin

CHF, AFib, A-flutter

Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate.

Antiarrhythmic, inotropics

Digitalis glycosides

• Excreted by kidneys • Assess patient for hypersensitivity • Contraindicated with uncontrolled ventricular arrhythmias • Hypokalemia increase risk for toxicity • Hypercalcemia ↑ risk for toxicity • Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to toxicity • Assess patient for cardiac arrhythmias including bradycardia • Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances) • Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse

Diazepam

Valium

Anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal

Decreases the effects of voltage gated sodium channels to depresses the CNS

Antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relax- ants (centrally acting)

Benzodiazepine

• Contraindicated in hepatic dysfunction • Use caution with renal impairment • Can cause dizziness, drowsiness, lethargy, hypotension, physical depen- dence, tolerance • Instruct patient to take as directed • Caution to avoid alcohol use • Flumazenil (Romazicon) is the reversal agent

Dexamethasone

Decadron

Manage cerebral edema, assess for Cushing's Disease

Suppress inflammation and normal immune response. Used in inflammatory states to decrease inflammation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile • Avoid in active untreated infections • May cause CNS alterations • May cause peptic ulcers • May cause Cushingoid appearance (buffalo hump, moon face) • Weight gain • Osteoporosis • Decrease wound healing • May elevate blood sugars • May increase cholesterol and lipid values

Cyclosporine

Sandimmune

Prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis

Inhibits normal immune response primarily by decreasing the activity of T cells

Immunosuppressant, antirheumatics (DMARD)

Polypeptides (cyclic)

• May cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia • Increases immune suppression with corticosteroids • Avoid grapefruit juice while taking this medications • Assess for signs of organ rejection • Monitor renal panel, liver enzymes • Take medication as directed • Lifelong therapy required for transplant patients • Instruct pt on how to take blood pressure

Cortisone

Cortone

Management of adrenocortical insufficiency (Addison's Disease). Replace cortisol in states of deficiency, suppress inflammation and normal immune response.

The adrenal glands sit on top of the kidneys. The adrenal glands excrete steroid hormones, including cortisol that play a role in increasing blood sugars, immune suppression, and metabolism of fat, protein, and carbohydrates, as well as decreasing bone formation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile • Avoid in active untreated infections • May cause CNS alterations • May cause peptic ulcers • May cause Cushingoid appearance (buffalo hump, moon face) • Weight gain • Osteoporosis • Decrease wound healing • May elevate blood sugars • May increase cholesterol and lipid values

Codeine

Paveral

Management of pain, diarrhea, cough suppressant

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.

Allergy, cold, cough remedy, antitussive, opioid analgesic

Opioid agonist

• May cause alterations in mentation, hypotension, constipation, nausea, vomiting • Assess BP, pulse, and respiratory rate prior to administration and frequently during administration • Use caution if patient is receiving MAO Inhibitors • Narcan (naloxone) is the antidote for opioid agonists