Question

1. Glucose 2. Magnesium Sulfate 3..Milrinone 4..Naloxone 5.Procainamide 6.Sodium Bicarbonate

write down the therapeutic effect , adverse reactions , interactions , precautions ,contraindication and significant nursing activities for each medication

Answer 1

1) glucose

Therapeutic effect : it is used to treat hypoglycemia or low blood sugar level . It is often used in people with diabetes mellitus. It works by increasing the blood glucose level

Adverse reaction: a light headed feeling, fever,swelling in hands or feet,sweating, pale skin, severe shortness of breath ,chest pain

Interactions: the glucose may interact with over the counter medicines, vitamins and herbal products. The common drug that interact with glucose is fludeoxyglucose f18 .

Precautions: use the correct dose prescribed by physicians, Seek medical attention if you still have hypoglycemia symptoms after taking two doses.Store at room temperature away from moisture and heat. Do not refrigerate or freeze. Keep the medicine container tightly closed when not in use.

Contraindication: intracranial hemorrhage , intraspinal hemorrhage, hyperglycemia, dehydrated patients with alcohol withdrawal syndrome, severe dehydration, anuria, hepatic coma

Nursing activities: asess for contraindications and cautions,monitor the blood glucose level every hourly, watch for side effects, monitor vitals, monitor the lab values including urinalysis.

2) magnesium sulfate

Therapeutic effect: it is used to treat low blood magnesium levels.Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy .

Adverse reactions: flushing, increased warmth, sweating ,nausea,vomiting ,headaches, muscle weakness, blurred vision.

Interactions:

• demeclocycline.
• doxycycline.
• eltrombopag.
• lymecycline.
• minocycline.
• oxytetracycline.
• tetracycline.

Precautions: respiratory rate should be atleast 16 breaths/ min , patellar reflexes are present, urinary output must be atleast 30 ml over 4 hrs

Contraindications:.myasthenia gravis, severe renal failure, pulmonary edema, heart block ,cardiac ischemia.

Nursing activities : assess serum magnesium level before administering, cardiac monitor must be connected to the patient, check for reflexes,monitor side effects, monitor the urinary output.

3) milrinone

Therapeutic effect: acute heart failure, pulmonary hypertension, chronic heart failure.

Adverse reactions: ventricular arythmias, headache, hypotension, supraventricular arythmias,chest pain, anaphylaxis,atrial fibrillation.

Interactions: milrinone interact with the following drugs

• amifostine.
• anagrelide.
• diatrizoate.
• Disopyramide
• dobutamine.
• furazolidone.
• Isocarboxazid
• Linezolid

Precautions:

• hypersensitivity (severe allergic reaction).
• congestive heart failure (CHF).
• abnormal heart rate or extra beats (arrhythmia).
• a decline in liver function
• a decline in kidney function
• loss of control of blood sugar.

COntraindications:

• a heart attack.
• narrowing of the pulmonary valve.
• hypertrophic cardiomyopathy.
• abnormal heart rhythm.
• low blood pressure.
• decreased kidney function.

Nursing activities: monitor the daily weight,monitor the intake and output, monitor the side effects, monitor vitals,asess for improving signs.

4)Naloxone

Therapeutic effects : it blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness. An opioid is sometimes called a narcotic. Naloxone injection is used to treat a narcotic overdose  in an emergency situation.

Adverse reactions: These include bodyaches , a fever, sweating, runny nose, sneezing, goose bumps, yawning, weakness, shivering or trembling, nervousness, restlessness , diarrhea, nausea or vomiting, stomach cramps, fast heartbeat, and increased blood pressure.

Interactions : naloxone interact with following drugs.

• Acetylsalicylic Acid (aspirin)
• Adrenalin (epinephrine)
• Ativan (lorazepam)
• Benadryl (diphenhydramine)
• buprenorphine.
• Cymbalta (duloxetine)
• Dextrose (glucose)

Precautions: This medicine should be given immediately after a suspected or known overdose of an opioid or narcotic medicine. This is to prevent a serious condition called respiratory or central nervous system depression.Severe opioid withdrawal symptoms may happen suddenly after receiving this medicine. These include body aches, a fever, sweating, runny nose, sneezing, goose bumps, yawning, weakness, shivering or trembling, nervousness, restlessness or irritability, diarrhea, nausea or vomiting, stomach cramps, fast heartbeat, and increased blood pressure.Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Contraindications: It is contraindicated in patients known to be hypersensitive to it. Use with caution in patients dependent on opioids. Use with caution in patients with cardiac problems or those receiving cardiotoxic drugs.

Nursing activities :

Observe patient closely; duration of action of some narcotics may exceed that of naloxone. Keep physician informed; repeat naloxone dose may be necessary.

May precipitate opiate withdrawal if administered to a patient who is opiate dependent.

Note: Narcotic abstinence symptoms induced by naloxone generally start to diminish 20–40 min after administration and usually disappear within 90 min.

Monitor respirations and other vitals

Monitor surgical and obstetric patients closely for bleeding. Naloxone has been associated with abnormal coagulation test results. Also observe for reversal of analgesia, which may be manifested by nausea, vomiting, sweating, tachycardia.

5)procainamide

Therapeutic effects: Pronestyl (procainamide hydrochloride) is a cardiac antiarrhythmic drug used to help keep the heart beating normally in people with certain heart  rhythm disorders of the ventricles (the lower chambers of the heart  that allow blood to flow out of the heart.

Adverse reaction:

dizziness or lightheadedness.
loss of appetite.
upset stomach.
Vomiting.
bitter taste.

Interactions:

If other antiarrhythmic drugs are being used, additive effects on the heart may occur with PA administration, and dosage reduction may be necessary.Anticholinergic drugs administered concurrently with PA may produce additive antivagal effects on A-V nodal conduction, although this is not as well documented for PA as for quinidine.Patients taking PA who require neuromuscular blocking agents such as succinylcholine may require less than usual doses of the latter, due to PA effects on reducing acetylcholine release.

Precautions: It should be used only to treat life-threatening arrhythmias (irregular heartbeats). It may cause a decrease in the number of cells in your bone marrow. It may also cause symptoms of lupus. Keep all appointments with your doctor and the laboratory.

Contraindications:

• high levels of potassium in the blood.
• low amount of potassium in the blood.
• decreased blood platelets.
• very low levels of granulocytes.
• a type of white blood cell.
• myasthenia gravis
• a skeletal muscle disorder
• Heart attack within the last 30 days.

NUrsing activities :

• Check apical radial pulses before each dose during period of adjustment to the oral route.
• Patients with severe heart, liver, or kidney disease and hypotension are at particular risk for adverse effects.
• Monitor the patient's ECG and BP continuously during IV drug administration.
• Discontinue IV drug temporarily when (1) arrhythmia is interrupted, (2) severe toxic effects are present, (3) QRS complex is excessively widened (greater than 50%), (4) PR interval is prolonged, or (5) BP drops 15 mm Hg or more. Obtain rhythm strip and notify physician.
• Ventricular dysrhythmias are usually abolished within a few minutes after IV dose and within an hour after PO or IM administration.
• Report promptly complaints of chest pain, dyspnea, and anxiety. Digitalization may have preceded procainamide in patients with atrial arrhythmias. Cardiotonic glycosides may induce sufficient increase in atrial contraction to dislodge atrial mural emboli, with subsequent pulmonary embolism.
• Therapeutic procainamide blood levels are reached in approximately 24 h if kidney function is normal but are delayed in presence of renal impairment.

6)sodium bicarbonate

Therapeutic effects :Sodium bicarbonate is an antacid used to relieve heartburn and acid indigestion. doctor also may prescribe sodium bicarbonate to make your blood or urine less acidic in certain conditions.

Adverse reactions :

• Aggravated congestive heart failure  (CHF)
• Cerebral hemorrhage.
• Swelling
• High blood sodium levels.
• Low blood ca levels.
• Low blood potassium levels.
• Muscle spasm
• Metabolic alkalosis.

Interactions: it interacts with

• aspirin.
• aspirin rectal.
• aspirin/citric acid
• balsalazide.
• blessed thistle.
• choline magnesium trisalicylate.
• chromium.
• devil's claw

Precautions :

• tell the doctor and pharmacist what prescription and nonprescription medications you are taking, especially other antacids, aspirin or aspirin-like medicines, benzodiazepines, flecainide (Tambocor), iron, ketoconazole (Nizoral), lithium (Eskalith, Lithobid), methenamine (Hiprex, Urex), methotrexate, quinidine, sulfa-containing antibiotics, tetracycline (Sumycin), or vitamins. Take sodium bicarbonate at least 2 hours apart from other medicines.
• Inform doctor if you have or have ever had high blood pressure, congestive heart failure, or kidney disease or if you have recently had bleeding in your stomach or intestine.
• tell the doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking sodium bicarbonate, call your docter.

Contraindications :

• Hypersensitivity, metabolic or respiratory alkalosis, hypocalcemia, excessive chloride (Cl-) loss from vomiting or GI suctioning.
• Patients at risk of developing diuretic-induced hypochloremic alkalosis.
• Hypercarbic acidosis.
• Unknown abdominal pain.

NUrsing activities :

1. Assess the client’s fluid balance throughout the therapy. This assessment includes intake and output, daily weight, edema and lung sounds.
2. Symptoms of fluid overload should be reported such as hypertension, edema, difficulty breathing or dyspnea, rales or crackles and frothy sputum.
3. Sigs of acidosis should be assessed such as disorientation, headache, weakness, dyspnea and hyperventilation.
4. Assess for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered breathing pattern.
5. Hypernatremia clinical manifestations should be assessed and monitored which includes: edema, weight gain, hypertension, tachycardia, fever, flushed skin and mental irritability.
6. Hypokalemia should also be assessed by monitoring signs and symptoms such as: weakness, fatigue, U wave on ECG, arrhythmias, polyuria and polydipsia.
7. IV sites should be observed closely. Extravasation should be avoided as tissue irritation or cellulitis may occur when taking sodium bicarbonate.
8. If infiltration occurs, the physician should be notified immediately. Confer with the doctor or other health care staff regarding warm compresses and infiltration site with lidocaine or hyaluronidase.
9. Monitor the client’s serum calcium, sodium, potassium, bicarbonate concentrations, serum osmolarity, acid-base balance and renal function before and throughout the therapy.
10. Tablets must be taken with a full glass of water.
11. For clients taking the medication as a treatment for peptic ulcers it may be administered 1 and 3 hours after meals and at bedtime.

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