(Benztropine Mesylate (Cogentin))

Medication Classification: Therapeutic (Anti-Parkinson’s/ Anti-EPS agents), Pharmacological: (Anticholinergics)

Expected Pharmacological Action (s): blocks cholinergic activity in CNS, which is partially responsible for symptoms of Parkinson’s disease. Restores natural balance of neurotransmitters in CNS.

Therapeutic Use: Adjunctive treatment of all forms of Parkinson’s disease including extra pyramidal effects (akinesia, akathisia, rabbit syndrome), and acute dystonic reactions. Doesn’t treat TD

Side/Adverse Effects	Medications/Food Interactions
Blurred Vision

Dry eyes

Constipation

Dry mouth

Arrhythmias

Hypotension

Tardive dyskinesia

No Reported Food Interactions

Additive anticholinergic effects

Antihistamines

Phenothiazines

Quinidine

Disopyramide

Tricyclic antidepressants

Counteracts cholinergic effects of bethanecol

Antacids and antidiarrheals may decrease absorption

Nursing Interventions	Client Education

Monitor I&O

Monitor VS’

Monitor for urinary retention/ and constipation

Assess for tardive dyskinesia

Increase fiber and fluid intake

Taper drug slowly

Take daily dose at bedtime

Teach patient to monitor for S/S of urinary hesitancy and constipation

Treat dry mouth with cool drinks and ice chips

(Divalproex sodium (Depakote))

Medication Classification: Therapeutic (Anti-convulsants), Pharmacological (carboxylic acid derivative)

Expected Pharmacological Action (s): Increases levels of GABA inhibitory neurotransmitter in CNS

Therapeutic Use: monotherapy and adjunctive therapy for simple and complex absence seizures, or complex partial seizures, multiple seizure types, and absence seizure

Side/Adverse Effects	Medications/Food Interactions

Agitation

Dizziness

Headache

Insomnia

Sedation

Visual disturbances

Abdominal pain

Anorexia

Diarrhea

Indigestion

Nausea

Vomiting

Tremors

Increased risk of bleeding with warfarin use

Blood levels and toxicity may be increased by use of

Aspirin

Carbamazepine

Chlorpromazine

Cimetedine

Erythromycin

Felbamate

CNS depression with other CNS depressants

Alcohol

Antihistamines

Antidepressants

Opioid analgesics

MAOI/ Depressants

Sedatives/ hypnotics

Antidepressants may decrease seizure threshold

NO KNOWN FOOD INTERACTIONS

Nursing Interventions	Client Education

Assess mental status

Assess for suicidal thoughts and tendencies

Monitor hepatic function

Serum ammonia concentrations

Therapeutic levels 50-100

Seizure precautions

Avoid alertness required activities until effects known

Abrupt withdrawal can lead to status epilepticus

No alcohol use, CNS depressants, OTC MED, Herbal products

Teach caregiver to assess for suicidal actions

(Venlafaxine hydrochloride (Effexor, Effexor XR))

Medication Classification: Therapeutic: Antidepressants, Anti- Anxiety, Pharmacological: SSNRI

Expected Pharmacological Action(s): inhibits serotonin and norepinephrine reuptake in CNS

Therapeutic Use: Major Depressive illness and relapse, generalized anxiety disorder, social anxiety disorder, PMDD

Side/Adverse Effects	Medications/Food Interactions
SEIZURES

Abnormal dreams

Anxiety

Dizziness

Headache

Insomnia

Nervousness

Weakness

Rhinitis

Visual disturbances

Pain

Altered taste

Anorexia

Constipation

Diarrhea

Dyspepsia

Sexual dysfunction

Paresthesia

Chills

Ecchymoses

FOOD: kava kava, valerian, chamomile, Hops can cause CNS depression

Cimetidine

Lithium

MAOI

Sedatives/ Hypnotics

Opioid analgesics

Trazodone

Triptans

Nursing Interventions	Client Education

Monitor for signs of depression, or suicidal thoughts and tendencies

Monitor BP

Monitor patients weight

Monitor VS

If medication to be stopped inform the client will decreased gradually

Avoid activities that require alertness

Avoid alcohol and OTC drugs

Take with food or water

(Trazodone Hydrochloride (Trazon))

Medication Classification: Therapeutic: Antidepressant, Antixylotic, Pharmacological: Triazolopyridine derivative

Expected Pharmacological Action(s): Blocks serotonin reuptake along the presynaptic neuronal membrane, causing an antidepressant effect. Trazodone exerts an alpha-adrenergic blocking action and produces modest histamine blockade, causing a sedative effect. It also inhibits the vasopressor response to norepinephrine, which reduces blood pressure

Therapeutic Use: Major depression, insomnia, chronic pain syndrome, diabetic neuropathy, anxiety

Side/Adverse Effects	Medications/Food Interactions
Drowsiness

Hypotension

Dry mouth

Arrythmias

Chest pain

Confusion

Hallucinations

Depression

anticonvulsants: Decreased seizure threshold

antihypertensives: Increased risk of excessive hypotension

anxiolytics, brompheniramine, carbinoxamine, chlorpheniramine, clemastine, dimenhydrinate,

diphenhydramine, doxylamine, general anesthetics, methdilazine, opioid analgesics, phenothiazines, sedative-hypnotics, skeletal muscle relaxants: Increased CNS depression, increased risk of respiratory depression and hypotension

barbiturates: Decreased seizure threshold and barbiturate effects, increased drowsiness

buspirone, selective serotonin-reuptake inhibitors, tricyclic antidepressants: Possibly excessive serotonergic stimulation

carbamazepine: Decreased trazodone level

clonidine: Interference with clonidine’s antihypertensive effect

digoxin: Possibly increased blood digoxin level and risk of digitalis toxicity

erythromycin, indinavir, itraconazole, ketoconazole, nefazodone, protease inhibitors, ritonavir: Possibly increased blood trazodone level with increased risk of adverse effects

MAO inhibitors: Increased serotonin effects

warfarin: Decreased anticoagulation response

alcohol use: Increased CNS depression, risk of respiratory depression and hypotension

Nursing Interventions	Client Education

Give trazodone shortly after the patient has a meal or light snack to reduce nausea.

Give larger portion of daily dose at bedtime if drowsiness occurs.

Because trazadone’s mechanism of action is similar to that of selective serotonin reuptake inhibitors, expect high doses (6 to 8 mg/ kg) to increase blood serotonin level and low doses (0.05 to 1 mg/kg) to decrease blood serotonin level.

Expect most patients who respond to trazodone to do so by the end of the second week of therapy.

Closely monitor depressed patients, including children and teens, for suicidal thoughts and tendencies. Notify prescriber if they occur, and take suicide precautions according to facility policy.

Be aware that adverse CNS reactions usually improve after patient completes a few weeks of therapy.

Urge patient to avoid taking trazodone on an empty stomach because doing so may increase the risk of dizziness or light-headed-ness.

Caution patient to avoid potentially hazardous activities during therapy.

Advise patient not to fast during trazodone therapy because of possible adverse CNS reactions.

Instruct male patient to notify prescriber immediately about priapism.

(Risperidone (Risperdal))

Medication Classification: Therapeutic: Antipsychotic, Pharmacological: Benzisoxazole derivative

Expected Pharmacological Action(s): Selectively blocks serotonin and dopamine receptors in the mesocortical tract of the CNS to suppress psychotic symptoms

Therapeutic Use: Schizophrenia, bipolar mania, autistic disorder in children

Side/Adverse Effects	Medications/Food Interactions
Aggressive behavior

Behavior

Dizziness

Extra pyramidal reactions

Headache

More dreams

Insomnia

Sedation

Pharyngitis

Visual disturbances

Decreased libido

Weight gain

antihypertensives: Increased antihypertensive effects

bromocriptine, levodopa, pergolide: Possibly antagonized effects of these drugs

carbamazepine: Increased risperidone clearance with long-term concurrent use

clozapine: Decreased risperidone clearance with long-term concurrent use

CNS depressants: Additive CNS depression

fluoxetine, paroxetine: Increased plasma risperidone level

alcohol use: Additive CNS depression

Nursing Interventions	Client Education

Use risperidone cautiously in debilitated patients, elderly patients, and patients with hepatic or renal dysfunction or hypotension because of their increased sensitivity to drug. Also use risperidone cautiously in patients with a history of seizures; although rare, seizures may occur in those with schizophrenia.

Be aware that oral risperidone or another antipsychotic should be continued for 3 weeks after long-acting I.M. form of risperidone is first administered to provide an adequate therapeutic plasma level until risperidone release from injection site has begun. If the patient has never received oral risperidone, an oral trial should be prescribed before use of I.M. form to determine patient’s tolerance of the drug.

Remove I.M. form of risperidone from refrigerator and allow it to come to room temperature before reconstitution. Follow manufacturer’s guidelines for reconstitution, using only the diluent supplied in the dose pack.

Give I.M. form using only the needle supplied in the dose pack. Inject entire contents of syringe into the upper outer quadrant of gluteal area within 2 minutes of reconstitution. If drug can’t be given right after reconstitution, shake the upright vial vigorously back and forth until particles are resus-pended. Discard reconstituted drug if not used within 6 hours. Never administer I.M. form intravenously.

Monitor for orthostatic hypotension, especially in patients with cardiac or cerebrovascular disease.

Monitor patient’s blood glucose and lipid levels as ordered because drug increases the risk of hyperglycemia and hypercholesterolemia.

Instruct patient to dilute risperidone oral solution with water, coffee, orange juice, or low-fat milk but not with cola or tea.

Tell patient prescribed orally disintegrating tablets to break open the blister unit with dry hands by peeling the foil back to expose the tablet. Stress the importance of not pushing tablet through the foil because this could damage the tablet. Once patient has removed tablet, she should place immediately on her tongue, where it will dissolve within seconds. Tell patient not to chew orally disintegrating tablet or attempt to spit it out of her mouth.

Urge patient to avoid alcohol because of its additive CNS effects.

Caution diabetic patient to monitor blood glucose level closely because risperidone may increase it

(Albuterol Sulfate (Ventolin, Combivent))

Medication Classification: Therapeutic: bronchodilators, Pharmacological: adrenergic

Expected Pharmacological Action(s): relaxes bronchial and vascular smooth muscle by stimulating beta 2 blockers

Therapeutic Use: COPD, Asthma, Bronchospasm

Side/Adverse Effects	Medications/Food Interactions

Tremor

Nervousness

Hyperactivity

Headache

Tachycardia

bronchospasm

cns stimulants

digoxin

MAOI

Tricyclic antidepressants

Beta blockers

Nursing Interventions	Client Education
Monitor VS

May use tablets and syrup together

Monitor during aersol use

Warn patient to stop use of drug immediately if paradoxical bronchospasm occurs

Proper use of MDI inhaler

Monitor blood glucose level

(Simvistatin (Zocor))

Medication Classification: Therapeutic: Antilipemics, Pharmacological: HMG CoA reductase inhibitor

Expected Pharmacological Action(s): Interferes with the hepatic enzyme hydroxymethylglutaryl-coenzyme A reductase. This action reduces the formation of mevalonic acid, a cholesterol precursor, thus interrupting the pathway necessary for cholesterol synthesis. When the cholesterol level declines in hepatic cells, LDLs are consumed, which in turn reduces the levels of circulating total cholesterol and serum triglycerides

Therapeutic Use: Hyperlipidemia, Hypercholestermia

Side/Adverse Effects	Medications/Food Interactions
Dizziness

Fatigue

headache

Chest pain

Abdominal pain

Constipation

N/V

amiodarone, antiretroviral protease inhibitors (amprenavir, indinavir, nelfinavir, ritonavir, saquinavir), clarithromycin, cyclosporine, danazol, gemfibrozil and other fibrates, itraconazole, ketoconazole, erythromycin, nefazodone, niacin (1 g daily or more), telithromycin, verapamil: Increased risk of myopathy or rhabdomyolysis

azole antifungals, cyclosporine, gemfibrozil, immunosuppressants, macrolide antibiotics (including erythromycin), niacin, verapamil: Increased risk of acute renal failure

bile acid sequestrants, cholestyramine, colestipol: Decreased simvastatin bioavailability

digoxin: Possibly slight elevation in blood digoxin level

diltiazem, verapamil: Possibly increased blood simvastatin level, increased risk of myopathy

oral anticoagulants: Increased bleeding or prolonged PT

grapefruit juice (1 or more quarts daily): Possibly increased blood simvastatin level

Nursing Interventions	Client Education

Use simvastatin cautiously in elderly patients and those with renal or hepatic impairment.

Give drug 1 hour before or 4 hours after giving bile acid sequestrant, cholestyramine, or colestipol.

Expect to monitor liver function test results every 3 to 6 months for abnormal elevations.

Monitor serum lipoprotein levels

Urge patient to take drug in the evening.

Encourage patient to follow a lowfat, cholesterol-lowering diet.

Urge patient to notify prescriber immediately about muscle pain, tenderness, or weakness and other symptoms of myopathy.

Avoid grapefruit juice

Hydroxyzine HCl (Vistaril/Atarax)

Medication Classification: Therapeutic: antianxiety agents, antihistamines, sedative/hypnotics

Expected Pharmacological Action (s): Depresses CNS at subcortical level, also has anticholinergic, antihistamine, and antiemetic properties, and blocks histamine 1 receptors

Therapeutic Use: Sedation, anxiety relief, decrease N&V, decrease allergic symptoms r/t release of histamines

Side/Adverse Effects	Medications/Food Interactions
Drowsiness

Dry mouth

Pain at IM injection site

Weakness

Constipation

Agitation

Increase CNS depression with alcohol, antidepressants, antihistamines, opioid analgesics, and sedatives/hyponotics

Increases anticholinergic effects with antihistamines, antidepressants, atropine, haloperidol, phenothiazines, quinidine, and disopyramide

Could increase vasopressor effects with epinephrine

FOOD USE: kava-kava, valerian, and chamomile can increase CNS depression

FOOD USE: angel’s trumpet, jimson weed, and scopolia can increase anticholinergic effects

Nursing Interventions	Client Education

Monitor for profound sedation and implement safety precautions

Assess mental status

Monitor for N&V and pruritus

Can cause false positive with skin tests using allergen extracts

Avoid alcohol or other CNS depressants

Avoid driving and other activities requiring alertness until drug response known

Good oral care, mouth rinses, and sugarless gum/candy can decrease dry mouth

Teach other methods to cope with anxiety along with medications

Teach other methods to decrease anxiety such as exercise, support groups, ad relaxation techniques

(Citalopram (Celexa))

Medication Classification: Therapeutic: Antidepressants; Pharmacological: SSRI’s

Expected Pharmacological Action (s): Selectively inhibits reuptake of serotonin in CNS

Therapeutic Use: Depression; Off Label Uses: PMDD, OCD, Panic Disorder, GAD, Post Traumatic Stress Disorder, Social Anxiety Disorder

Side/Adverse Effects	Medications/Food Interactions
Apathy

Confusion

Drowsiness

Insomnia

Weakness

Abdominal Pain

Anorexia

Diarrhea

Dry Mouth

Dyspepsia

Flatulence

Increased Saliva

Nausea

Diaphoresis

Tremor

No Reported Food Interactions

Nursing Interventions	Client Education

Assess for Mood Changes and Suicidal Tendencies

Assess for Serotonin Syndrome

Assess for Sexual Dysfunction

Avoid Driving and other alertness until drug response is known

Change positions slowly to minimize dizziness

Use Sunscreen and wear protective clothing to prevent sun changes

Minimize dry mouth with mouth rinses good oral care, sugarless gum or candy

For Females: Notify Doctor immediately if pregnant or breast feeding to avoid neonatal serotonin syndrome

Follow up to monitor therapy

(spironalactone (aldactone))

Medication Classification: Therapeutic: aldosterone antagonist, antihypertensive, Pharmacological: aldosterone antagonist

Expected Pharmacological Action(s): Spironolactone competes with aldosterone for these receptors, thereby preventing sodium and water reabsorption and causing their excretion through the distal convoluted tubules, as shown below right. Increased urinary excretion of sodium and water reduces blood volume and blood pressure

Therapeutic Use: Edema, hypertension

Side/Adverse Effects	Medications/Food Interactions
Dizziness

Fatigue

headache

vision changes

Abdominal pain

Cough

dyspnea

Hyperkalemia

ACE inhibitors, cyclosporine, other potassium-sparing diuretics, potassium-containing drugs, potassium supplements: Increased risk of hyperkalemia

digoxin: Possibly increased half-life of digoxin

exchange resins (sodium cycle), such as sodium polystyrene sulfonate: Increased risk of hypokalemia and fluid retention

heparin, oral anticoagulants: Decreased anticoagulant effect of these drugs

hypotension-producing drugs: Possibly potentiated antihypertensive or diuretic effect of spironolactone

lithium: Possibly lithium toxicity

NSAIDs, sympathomimetics: Decreased anti-hypertensive effect of spironolactone

Low milk and salt substitutes can increase risk of hyperkalemia

Nursing Interventions	Client Education
Be aware that for children or patients who have trouble swallowing, pharmacist may crush spironolactone tablets, mix with a flavored syrup, and dispense as a suspension. It’s stable for 1 month when refrigerated.

In diagnosing primary aldosteronism, the test is considered positive if patient’s serum potassium level rises when spironolactone is given and falls when it’s discontinued.

Expect to evaluate patient’s serum potassium level 1 week after spiraonolactone therapy begins, after each dosage adjustment, monthly for the first 3 months, quarterly for 1 year, and then every 6 months thereafter or as ordered. Notify prescriber if level exceeds 5 mEq/L or patient’s renal function deteriorates (serum creatinine level exceeding 4 mg/ dl). If patient has severe heart failure, follow closely because hyperkalemia may be fatal in such patients.

Evaluate spironolactone’s effectiveness by assessing blood pressure and edema.

Stop drug for several days, as prescribed, before patient undergoes adrenal vein catheterization to measure serum aldosterone level and plasma renin activity.

Instruct patient to take spironolactone with meals or milk.

If patient can’t swallow tablets, mention that pharmacist can crush and mix them with a flavored syrup as a suspension.

Teach patient who takes spironolactone for hypertension how to measure his blood pressure. Urge him to monitor it regularly and report pressure greater than 140 mm Hg systolic or 90 mm Hg diastolic to prescriber.

Caution patient that he may experience dizziness during spironolactone therapy if fluid balance is altered.

(Furosemide (Lasix))

Medication Classification: Therapeutic: antihypertensive, diuretic, Pharmacological: sulfonamide

Expected Pharmacological Action (s): inhibits sodium and water reabsorption in the loop of Henle and increases urine formation. As the body’s plasma volume decreases, aldosterone production increases, which promotes sodium reabsorption and the loss of potassium and hydrogen ions

Therapeutic Use: antihypertensive, edema

Side/Adverse Effects	Medications/Food Interactions

Orthostatic hypotension

Blurred vision

ototoxicity

Hyperglycemia

Abdominal cramps,

Muscle spasms

Hypokalemia

hyponatremia

hypovolemia

restlessness

vertigo

ACE inhibitors: Possibly first-dose hypotension

aminoglycosides, cisplatin: Increased risk of ototoxicity

amiodarone: Increased risk of arrhythmias from hypokalemia

chloral hydrate: Possibly diaphoresis, hot flashes, and hypertension

digoxin: Increased risk of digitalis toxicity related to hypokalemia

insulin, oral antidiabetic drugs: Increased blood glucose level

lithium: Increased risk of lithium toxicity

NSAIDs: Possibly decreased diuresis

phenytoin, probenecid: Possibly decreased therapeutic effects of furosemide

propranolol: Possibly increased blood propranolol level

thiazide diuretics: Possibly profound diuresis and electrolyte imbalances

alcohol use: Possibly increased hypotensive and diuretic effects of furosemide

Nursing Interventions	Client Education

For once-a-day dosing, give drug in the morning so patient’s sleep won’t be interrupted by increased need to urinate.

Prepare drug for infusion with normal saline solution, lactated Ringer’s solution, or D5W.

Administer drug slowly I.V. over 1 to 2 minutes to prevent ototoxicity.

Expect patient to have periodic hearing tests during prolonged or high-dose I.V. therapy.

Monitor blood pressure and hepatic and renal function as well as BUN, blood glucose, and serum creatinine, electrolyte, and uric acid levels, as appropriate.

Be aware that elderly patients are more susceptible to hypotensive and electrolyte-altering effects and thus are at greater risk for shock and thromboembolism.

If patient is at high risk for hypokalemia, give potassium supplements along with furosemide, as prescribed.

Expect to discontinue furosemide at maximum dosage if oliguria persists for more than 24 hours.

Be aware that furosemide may worsen left ventricular hypertrophy and adversely affect glucose tolerance and lipid metabolism.

Notify prescriber if patient experiences hearing loss, vertigo, or ringing, buzzing, or sense of fullness in her ears. Drug may need to be discontinued

Instruct patient to take furosemide at the same time each day to maintain therapeutic effects. Urge her to take it as prescribed, even if she feels well.

Instruct patient to take the last dose of furosemide several hours before bedtime to avoid sleep interruption from diuresis. If patient receives once-daily dosing, advise her to take the dose in the morning to avoid sleep disturbance caused by nocturia.

Advise patient to change position slowly to minimize effects of orthostatic hypotension and to take furosemide with food or milk to reduce GI distress.

Caution patient about drinking alcoholic beverages, standing for prolonged periods, and exercising in hot weather because these actions increase the hypotensive effect of furosemide.

Emphasize the importance of weight and diet control, especially limiting sodium intake.

Unless contraindicated, urge patient to eat more high-potassium foods and to take a potassium supplement, if prescribed, to prevent hypokalemia.

Instruct patient to keep follow-up appointments with prescriber to monitor progress. Urge her to notify prescriber about persistent, severe nausea, vomiting, and diarrhea because they may cause dehydration.

Inform diabetic patient that furosemide may increase blood glucose level, and advise her to check her blood glucose level frequently.

Source: ATI drug guide online (all meds)

(Benztropine Mesylate (Cogentin))

admin

2012-07-11

samantha paris

Firelands Regional Medical Center