Nervous System
Bronchodilators
Albuterol: Stimulates the ANS. 10 % of spray with normal route. 20 % with nebulizer. Dilates the bronchial passages, a LOCAL EFFECT. Monitor: HR (will increase)
Ipratropium: Anticholinergics. Bronchodilator, fewer systemic effects than sympathomimetics, less effective but higher HR is OK.
Cardiotonic Medication: Cardiac Glycoside
Cardiac Glycoside: DIGOXIN
How it works: Positive Inotrope (Increase force of contraction w/o putting stress on the heart) Negative chronotrope (Decreases HR).
Therapeutic Range: 0.5-0.8 ng/mL (MUST KNOW)
Toxicity can cause Dysrhythmias, anorexia, N & V, Halo
Binding Site: Competes with Potassium for binding sites. Lower K = More digoxin effect. Higher K = Need more Digoxin.
Increase Renal Perfusion.
MUST KNOW HR, BP, LAB LEVELS, & K +
Beta Blockers. Medications, Uses, reasons to Hold, & side Effects
Uses: Reduces the workload on the heart. Reduces overall force of contraction, thus cardiac muscles need less 02 to function properly. commonly used for HTN & cardiac issues "Two birds one stone"
Monitor: Blood Pressure & Heart Rate (MUST KNOW. HR < 50 [Hold]. BP < 100/50 [Hold]).
Side effects: Mask Hypoglycemia. Orthostatic Hypotension
Remember: "First to give, last to hold"
IM. Gauge, needle length, location.
20-25 G. Length: 1 to 1.5 inches.
Location: Deltoid, up to 1 mL (ALL IMMUNIZATIONS, NO Z TRACK)
Vastus Lateralis, ALL BABIES. 2-3 mL (not baby)
Ventro Gluteal: Most acceptable site 1-3 mL
Dorsal Gluteal: No longer used.
Fast Acting Insulins
Aspart & Lispro (Humalog & Novolog)
Anti-Inflammatories
Budesonide: A Glucocorticoid.
NOT for immediate relief of breathing difficulties. Maintenance Therapy, reduces inflammation.
Side: Rinse to avoid thrush, hyperglycemia, infections
Anticoagulants: Medications, Antidotes, Uses, and things to watch for
Uses: Stops New Clots from forming. Drugs that interrupt some aspect of the clotting cascade.
Heprin: Prevention/treatment of PE, stops clot from growing. Very HIGH risk for complications. Monitor: Platelet & PTT Levels. Antidote: Protamine Sulfate.
Warfarin: Older Class of anticoagulants. Monitor: INR 2.5-3.5 Normal for Warfarin. Antidote: Vitamin K
ACE Inhibitors. Uses, Medications, Side Effects, How it Works, & Things to Monitor
Medication: "PRIL". Most Commonly prescribed Anti-HTN Medication in US.
Uses: Hypertension/HF.
Works: Stops conversation of A1 to A2. A 2 is a vasoconstriction, that stops the process. For HF, a decrease in cardiac remodeling (BNP Test)
Side Effects: Can Develop a long-term cough. Angioedema (SWELLING OF AIRWAY). Harms fetuses.
Monitor: BP & HR
SUB Q. Location, Guage, Common Medications,
Location: Umbilicus ( 1 inch away). Flab of arm fat.
Guage: 25-30 G. Length: 5/8th inch.
Common Medications: Heprin (stops the formation of new clots. Must use TB Syringe. Check Platelets and PTT). Exopin (Heprin cousin, keep air bubble in, prefilled). Insulin (allows the body to store glucose, must use Insulin syringe).
Tests & Ranges for Diabetes
Quick: CBG, Range: 72 - 108
Long: A1C. 3-6 months of blood sugar.
Range: Normal less than 5.7 %
Pre 5.8% to 6.5 %
Diabeto: Greater than 6.5%
Thrombolytics
Uses: BREAKS DOWN EXISTING CLOTS
Medications: Urokinase, Alteplase.
Purpose: Break down existing clots in the moment.
Not seen very often
Lipid Lowering Agents. Medications, Side effects, Nursing timing, & how it works.
Medications: "Statins"
Increases LDL Resorption (Bad). Increases HDL Levels (Good, reduces inflammation).
Side effects: Muscle Aches, can cause Rhandomyolsis. Hard on the liver, must check liver function periodically.
Nursing Tips: Take at bedtime.
"Few indications to hold"
Peg Tube. Location & Steps, & medication issues to monitor for
Location: Stomach, G Tube
Steps: Sit up Semi-Flowers. Flush 30 mL water, medication, Flush 30 mL.
Medication issues: Compatibility. Cannot be crushed (words to watch for, XR, Enteric Coating, Extended Release)
Biguanides
METFORMIN !
1st line of treatment for NEW Type 2
Dose: 500 mg X 2
Benefit: Minimal Risk of Hypoglycemia
New HF Drugs
HCN Blockers: Ivabradine: Prolongs diastole, lowers HR, NO EFFECT CONTRACTILITY. Allows for better Preload.
SGLT2 Inhibitors: Dapagliflozin: Diabetes drug. Excretes sugar & fluid.
Valsartan/Sacubitril: ENTRESTO.
Sacubitril: Tells the body to get rid of the fluid. This medication prolongs the action of the peptides that reduces cardiac stretching.
Valsartan: ARB
Stops Sacubitril from increasing afterload
Diuretics. Medications
HCTZ: 3rd most prescribed anti-HTN medication)
Not the strongest diuretic. Monitor for Hypokalemia (Wastes potassium). Do not give at bedtime.
Loop Diuretics: Lasix/Furosemide.
Stong Diuretic, Waste Potassium. Must know BP & Potassium Level
Peripheral IV: Sites, Sizes, Uses, & Things to monitor
Gauge: Child: 24 G. Adults 20 G.
Sites: Child: Antecubital. Scalp. Feet. Hands.
Adult: AC, avoid areas where pt. needs hands/pulls (If possible).
Uses: Blood Transfusion (16-18G). Medications 20 G. Fluids 20 G.
Caution: MED COMPATIBILITY. SWABBING PORTS (X 3 for 1 medication). FLUSHING (X 2 for 1 Med). Rate (everything that goes in VIA IV has a rate)
Patency of site (infiltration, inflammation)
Hyperglycemia signs & treatment
Signs: 3 P's. Kussmauls Respirations.
BONUS! DKA Type 1 Emergency
HHNK Type 2 Emergency (even higher blood sugar)
Treatment: Bring Blood Sugar Down, DKA Protocol --> DRIP REGULAR INSULIN (FAST ACTING. REGULAR: Only insulin used for DKA (only one that can be dripped)
Squeezers
Dobutamine: Beta 1 agonist. ICU DRUG.
Uses: Gives more contraction to the heart. Minimal effect on HR (limit 02 demand on heart). Helpful for PVD & Dilating Vessels (thus decreasing afterload)
Milrinone: Positive iontrope & Vasodilator. ICU Drug. Increases cardiac output while decreasing afterload.
Calcium Channel Blockers. Medications (2). Uses. Nursing indications.
Uses: HTN. Decrease the force of myocardial contraction. Arterial Dilation. Arrhythmias.
Medications: Amlodipine (Non-Cardiac Anti-HTN. 2nd most prescribed medication)
Diltiazem (Arrhythmias & Cardiac HTN, causes arterial dilation)
Pediatric Injections. Sites, documentation, gauges, nursing tricks.
Sites: Most common: Hand, antecubital, scalp, feet. "Between the brain & pain".
Documentation: Every 1 hour.
Gagues: Under 1 24 G. Under 4 22 G. Above 4 22-20 G.
Tricks: Bee for pain. 1-hour topical for IV. Language (don't say dye, positive wording [keep still], appropriate medical terms [Straw not IV], explain). Holding the child (typically non-caregiver)
This hardly used & cloudy insulin is the ONLY insulin that can be MIXED
NPH
Purpose: To reduce the amount of injections needed daily.