MedMaster by NURSING.com

MedMaster by NURSING.com

By Jon Haws, RN CCRN AlumnusMedicineHealth & FitnessEducation
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MedMaster by NURSING.com episodes

  • MED: Enalapril
    Enalapril
    Generic Name
    enalapril
    Trade Name
    Vasotec
    Indication
    hypertension, management of CHF
    Action
    block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
    Therapeutic Class
    antihypertensives
    Pharmacologic Class
    ACE Inhibitor
    Nursing Considerations
    can cause neutropenia - check WBCs regularly
    use cautiously with potassium supplements and potassium sparing diuretics.
    use cautiously with diuretic therapy
    administer 1 hour before meals
    monitor blood pressure often
    monitor weight and fluid status
    monitor renal profile
    monitor CBC frequently
    dry cough
    7 min
  • MED: Dobutamine
    Dobutamine
    Generic Name
    dobutamine
    Trade Name
    Dobutrex
    Indication
    short term management of heart failure
    Action
    Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate.  Stimulates Beta1 receptors in the heart.
    Therapeutic Class
    inotropic
    Pharmacologic Class
    beta-adrenergic agonist
    Nursing Considerations
    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
    10 min
  • MED: Divalproex
    Divalproex (valproic acid derivative)
    Generic Name
    divalproex
    Trade Name
    Depakote
    Indication
    seizures, manic episodes, prevention of headache
    Action
    increases the level of GABA in CNS
    Therapeutic Class
    Anticonvulsant, vascular headache suppressants
    Pharmacologic Class
    none
    Nursing Considerations
    may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis
    increases risk for bleeding with Warfarin
    use caution with MAOIs
    monitor liver function tests
    7 min
  • MED: Diphenoxylate/Atropine
    Diphenoxylate/Atropine
    Generic Name
    diphenoxylate/atropine
    Trade Name
    Lomotil
    Indication
    Treatment for diarrhea
    Action
    Inhibits GI motility via anticholinergic effects
    Therapeutic Class
    antidiarrheal
    Pharmacologic Class
    anticholinergic
    Nursing Considerations
    Contraindicated with angle-closure glaucoma, dehydration
    Structurally related to opioids so use caution with patients that have allergies to opioids
    Side effects: constipation, tachycardia, dizziness, ileus
    Monitor liver function as medication is excreted by the liver
    Insure that client is taking medication as prescribed and not double dosing
    7 min
  • MED: Diphenhydramine
    Diphenhydramine
    Generic Name
    diphenhydramine
    Trade Name
    Benadryl
    Indication
    allergy, anaphylaxis, sedation, motion sickness, antitussive
    Action
    antagonizes effects of histamine, CNS depression
    Therapeutic Class
    allergy, cold and cough remedy, antihistamine, antitussive
    Pharmacologic Class
    none
    Nursing Considerations
    may cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache
    anticholinergic effects
    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
    6 min
  • MED: Diltiazem
    Diltiazem
    Generic Name
    diltiazem
    Trade Name
    Cardizem
    Indication
    hypertension, angina, SVT, a-fib, aflutter
    Action
    inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure.
    Therapeutic Class
    antianginals, antiarrhythmics, antihypertensive
    Pharmacologic Class
    Ca Channel Blocker (Bezothiazepine)
    Nursing Considerations
    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
    9 min
  • MED: Digoxin
    Digoxin
    Generic Name
    digoxin
    Trade Name
    Lanoxin
    Indication
    CHF, A-fib, A-flutter
    Action
    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.
    Therapeutic Class
    antiarrhythmic, inotropics
    Pharmacologic Class
    digitalis glycosides
    Nursing Considerations
    Excreted by kidneys
    Assess patient for hypersensitivity
    Contraindicated with uncontrolled ventricular arryhtmias
    Hypokalemia increase risk for toxcicity
    Hypercalcemia ↑ risk for toxicity
    Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to toxicity
    Assess patient for cardiac arrythmias 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 <60)
    7 min
  • MED: Diazepam
    Diazepam
    Generic Name
    diazepam
    Trade Name
    Valium
    Indication
    anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal
    Action
    depresses the CNS
    Therapeutic Class
    antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relaxants (centrally acting)
    Pharmacologic Class
    Benzodiazepine
    Nursing Considerations
    contraindicated in hepatic dysfunction
    use caution with renal impairment
    can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance
    instruct patient to take as directed
    caution to avoid alcohol use
    Romazicon is the reversal agent
    6 min
  • Prioritization #5: Patient Education
    It can be easy to look past patient education because we think we are “too busy” however, I have found that taking the 2-3 minutes to talk with your patient can save you hours later trying to explain why you are doing certain things. In this episode we discuss how and why you should take […]
    10 min
  • MED: Dexamethasone
    Dexamethasone
    Generic Name
    dexamethasone
    Trade Name
    Decadron
    Indication
    Manage cerebral edema, assess for Cushing's Disease
    Action
    Suppress inflammation and normal immune response.  Used in inflammatory states to decrease inflammation.
    Therapeutic Class
    antiasthmatics, corticosteroids
    Pharmacologic Class
    corticosteroids
    Nursing Considerations
    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
    7 min

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