Shared Flashcard Set


Midterm 2
Health Care
Undergraduate 2

Additional Health Care Flashcards




IV maintenance:
The nurse’s highest priority during IV infusion therapy is maintaining the patency of the IV access.
IV therapy is used to:
1.replace fluids, electrolytes, calories, or nutrition for clients whose illness has caused a deficit of these subastances

2.provide fluid, electrolytes, calories, or nutrition to maintain homeostasis

3.transfuse blood and blood products

4.administer prescribed medications as needed
Osmotic pressure
amount of hydrostatic pressure (force water places against vessel walls or capillary membranes) required to move particles and fluids in and out of vascular volume
The measure of solute particles
The osmolality of normal human serum or plasma
280 to 295 mOsm/kg.
IV solutions have the same osmolality as body fluids and do not alter plasma osmolality
Isotonic solutions
240 to 340 mOsm/kg and is derived by adding or subtracting 50 from the average serum osmolality of 290 mOsm/kg.

D5W, D5 ¼ NS, NS 0.9, LR
cause fluids to be pulled from the cells into vascular compartments. These are used to increase vascular volume and dehydrate cells causing them to shrink.
Hypertonic IV solutions have an osmolality greater than 340 mOsm/kg and a higher solute concentration than plasma.
Hypertonic: D10W, D5 ½ NS, D5 NS
IV fluids cause fluid to move out of the capillaries and into the cells, which results in cellular swelling.
Hypotonic IV solutions have an osmolality less than 240 mOsm/kg.
Hypotonic: ½ NS, 0.45 NaCl
solutions that increase colloid osmotic pressure (oncotic pressure) by having a greater molecular weight in protein and pull fluids from the cells into vascular spaces.
are solutions that create osmotic pressure by the movement of dissolved ions. These can freely move across the semi permeable membrane of the vessel walls into interstitial spaces, they don’t cross the cellular membranes.
Hydrating solutions
are intravenous fluids used to supply caloric intake, supply nutrients and electrolytes, provide free water for hydration and promote renal function.
The assessment of an IV and IV site
1.The right fluid is infusing.

2.The right fluid for the client. e.g. the nurse should question if a diabetic is getting a solution that has dextrose.

3.Date on the tubing, tubing should be changed every 48-96 hrs, per protocol.

4.The right rate.

5.Absence of kinks in the tubing that could lead to occlusion.

6.Date on the IV drsg, drsg should be change every 48-72 hr

7.Insertion site and vein accessed for pain, redness, warmth, coolness and swelling.
The seven rights of drug medication  
1. right dose

2. right client.

3. right drug.

4. right documentation.

5. right refuse

6. right doctor

7. right route
Complications of intravenous therapy:
Observe clients receiving infusions for infiltration, thrombophlebitis, infection, pain, fluid overload, extravasation, pyrogenic reactions, and tissue necrosis.
Treat infiltration of toxic drugs promptly by discontinuing the infusion and following the institutions procedures for treatment,
Charting the progress of infusions should be done after the initial assessment at the beginning of the shift, hourly each time the infusion is checked, and immediately before leaving the client for the day.
A filter should be used on an IV if TPN is being hung or a solution that has come from an ampule. Filters are used to remove particulate matter thus decreasing the risk for contamination.
The goal of IV therapy
return the client to homeostasis.
Volume to be infused (mL) / time of infusion (min) x drip rate (gtts/mL)=gtts/min
3,000mL of D5W IV over a 24 hr period. IV set is calibrated to deliver 15 drops/mL, how many drops(gtts)/min?

3,000 mL/ 24hr = 125 mL/hr (or 60min)

125 mL/60 min= 2 mL/min

15 gtt/ 1 mL= x gtt/ 2mL (amt needed/min) x= 30 gtt/min
Agents that interfere with nerve conduction and thereby diminish pain and sensation.
General anesthetics- (stage 3 plane 2)
Drugs causing a partial or complete loss of consciousness.
May also produce analgesia and muscle relaxation.
Used when profound muscle relaxation and loss of consciousness are desirable.
It is believed that GA’s inhibit nerve conduction by altering the movement of ions in and out of nerve cells, thereby interfering with the conduction of nerve impulses either along the nerve fiber or across the synaptic space. Administered by inhalation or injection.
Regional anesthetics- (stage 1)
Block nerve conduction only in the area to which they are applied and do not cause a loss of consciousness. (Used during child birth.)
Common types of regional anesthetics: topical, infiltration (local), nerve block, spinal.
Malignant hyperthermia
is an unexpected fever occurring while the client is anesthetized and possibly when exposed to intensive exercise and certain other stressors. It is a life-threatening condition. When succinylcholine or anesthetic agents are administered, the susceptible client rapidly develops muscle rigidity, tachycardia, and elevated temperature (105F/41C or higher). The skin is warm and often mottled, and respiratory and metabolic acidosis develop. If not treated promptly, the client may develop cardiac arrhythmias and vascular collapse and may die. The cause of this condition is apparently a sudden release of calcium by the sarcoplasmic reticulum into contractile muscle causing a high level of intracellular calcium. This, in turn, increases the metabolic rate of muscle cells, increase oxygen consumption, and releases heat. This reaction occurs because of an apparent inherited defect in the membrane of skeletal muscles.

Malignant Hyperthermia Safe Nursing Practice:

1.This is a life-threatening condition requiring immediate treatment.
2.Dantrolene (Dantrium) will be given IV to block the release of calcium. When reconstituting dantrolene, always rotate the vial until the fluid is clear.
3.Monitor vital signs.
4.Take measures to lower the body temperature. (hypothermia blanket, ice packs, chilled IV fluids, and chilled fluids for irrigation of body cavities, such as gastric lavage.)
5.Assist with procedures such as insertion of Foley catheter, irrigation of body cavities with chilled fluids, and administration of medications.
6.Monitor the client’s vital signs carefully for 24-48 hrs. Administer dantrolene as prescribed.
7.Teach the client and family about malignant hyperthermia and the necessity of reporting a family history of this problem.

Malignant hyperthermia does not always occur during surgery. It may occur hours after surgery and may recur up to 3 days after the initial episode. Usually the client receives dantrolene during this period to prevent recurrence.
Post Op nursing interventions:  Nursing care following general anesthesia:
1. Check the client’s airway when received in the postsurgical area.
2. Receive the report from the anesthetist. (Report includes info such as client’s identity, procedure done, type of anesthetic used, any problems encountered, pertinent medical history, and a review of the client’s fluid and electrolyte status. The anesthetist frequently reviews the placement and function of various drainage tubes and equipment with the nurse.)
3. Check the client’s vital signs and wound. Monitor bodily functions.
4. Orient the client and remove the artificial airway when the client becomes conscious.
5. Provide pain relief and warmth as necessary.
6. Monitor oxygen and IV fluid administration as necessary.
7. Place clients who have received ketamine hydrochloride in a quite place and disturb them as little as possible during emergence from anesthesia. (To reduce reactions of delirium, hallucinations, confusion, and excitement that may last for several hours with a possible recurrence of the reaction up to 24 hrs postanethesia.)

The client is usually positioned in a side-lying position, to ensure an adequate airway. Hearing is usually the last sense to fade and the first to return.

Two problems frequently occurring in clients following anesthesia are pain and shivering. Pain meds may be administered as prescribed, provided that the vital signs are stable. Occasionally pain meds are withheld because of hypotension. The nurse should assess the client’s condition carefully because the hypotension could be due to pain. In some instances, the health care provider will approve the administration of less than the full dose of a pain reliever to allow for assessment of its effects on the blood pressure and on the pain experienced.
The second problem, shivering, is due to peripheral vasodilation resulting from the anesthetic, as well as the change from the OR, with its lights and drapes, to the PACU (post anesthesia care unit), with it’s air-conditioning and lightweight covers. Clients who shiver should be provided with a warm blanket and be reassured that the shivering will so pass.
Nursing care following regional (local) anesthesia:
Regional anesthetics applied to the eye are generally short acting, the major nursing responsibility is to see that the eye is not damaged during recovery.
Nursing care for Regional Anesthesia safe nursing practice:
1. Before the use of a regional anesthetic, obtain a history of prior anesthetic exposure, response to local anesthetics, and/or pregnancy status.
2. Check vital signs and provide supportive care.
3. Supervise ambulation after caudal or spinal anesthesia has been used.
4. Report indications of systemic absorption or toxicity when the client is receiving continuous extravascular infusion.

Regional anesthetics can also pass through the placenta, and excessive amounts may produce bradycardia in the fetus.

Before regional anesthetic agents are used, the nurse should ask:
1. If the client has received such agents before;
2. If there have been any adverse responses, including allergic reactions; and
3. If the (female) client is pregnant.

To prevent headaches that follow spinal anesthesia, the client is generally kept in a recumbent position for at least 12 hours and is provided with adequate fluid replacement.

The nurse should stop local anesthesia infusion and report if the client complains of metallic taste, blurred vision, or ringing in the ears.

Also whenever epidural or caudal blocks are sued, the nurse monitors the client for urinary retention, abdominal distention, or fecal incontinence.
used for more than 1000 years, action unknown) Usual dosage: PO- 0.6 mg for acute attack; 0.6mg for prophylaxis. IV- 2 mg initially followed by 0.5 mg q6hr until pain is controlled. Monitor effectiveness of therapy. Monitor for toxicity. Monitor uric acid levels. IV administration can cause phlebitis. Should be taken at the first sign of gout attack. Side effects- Nausea, vomiting, aplastic anemia, agranulocytosis, & diarrhea.
 Allopurinol (Zyloprim
) (long term therapy)
Usual dosage: PO- 200-800 mg/day IV- 200-400 mg/m2/day
Keep urine slightly alkaline to prevent urine acid stones from forming.
IV dose should be given as a single infusion.
Side effects- Pruritic, maculopapular rash, fever, malaise.
Indomethacin (Indocin)    
Usual dosage: PO- 50 mg up to 4 times per day.
Monitor for GI irritation.
Do not crush the sustained release form.
Use smallest effective dose.
- Side effects- CNS symptoms in elderly, and those with preexisting CNS disorders, nausea, vomiting, and abdominal pain.
Naproxen (Aleve)
Usual dosage: PO- 750 mg initially, then 250 mg q8hr.
Should be administered in the morning and in the evening.
Note aspirin or NSAID allergy.
Side effects- GI distress.
Probenicid (Benemid, Benuryl)
Usual dosage: PO- 250 mg twice daily for 1 week, then 500 mg twice a day as maintenance dose- can be increased to 2 g daily.
Should be used with caution in pts with a hx of allergy to sulfa.
Do not start this therapy until acute attack subdues.
Monitor CBC, uric acid, liver, and renal function.
Side effects- Headaches and dizziness.
May increase the blood levels of certain drugs, including antibiotics (penicillins and cephalosporins).Interferes with their normal excretion.
Uricosuric activity may be reduced or abolished if salicylates are administered at the same time.
Care of the client with Gout: (first about gout, and then care of the client with gout)
Gout- A chronic metabolic disease associated with the development of hyperuricemia
The presence of abnormally elevated amounts of uric acid in the blood.
Can result from a genetically transmitted metabolic defect, Obesity, Excessive alcohol consumption, and Therapy with certain diuretic drugs.
4 times more prevalent in men than women and usually appears during middle age.
The accumulation of uric acid causes a problem in the joints and kidneys.
- Kidney stones - Kidney failure - Gouty arthritis - Hyperuricemia

The big toe is a common site for urate crystal deposition.
Acute gouty attacks are very painful and can last for days to weeks.
Attacks should be treated with the first few hours of onset of pain.
NSAIDS used to reduce inflammation and less likely to produce adverse effects.

Care of the client with Gout:
Colchicine is commonly used during an acute attack, particularly with the first one, because it relives pain and confirms the diagnosis of gout. This drug will usually be prescribed orally taken every 1-2 hours. This is continued until the client develops nausea or loose stools. The nurse assesses the client for the development of these two indicators, as therapy is terminated as soon as they occur to avoid development of overwhelming gastroenteritis, diarrhea, or both.
It is generally ture that the earlier treatment begins the easier it is it o abort an acute gouty attack for this reason, clients are usually given a supply of medication to keep at home.

During an acute attack, it is well to advise the client to temporarily avoid red meats, fish, fowl, alcohol, and a large proportion of dietary fats. These foods may aggravate the condition. The client should be encouraged to increase fluid intake, unless there are reasons such as a renal or cardiac disease that would call for restricting or careful monitoring of the fluid intake. To increase the client’s comfort during an acute attack, the nurse can use a bed cradle to keep bed linens off the tender, affected area.

The client should avoid aspirin and other salicylates when using Benemid or Anutrane.
Clients receiving drugs for hyperuricemia safe nursing practice:
1. Assess the client taking colchicines for nausea or loose stools.
2. IV infusion is usually limited to acute attacks of gout.
3. Local tissue reactions can occur with infiltration of colchicines.
4. Treatment should be initiated at the first sing of an attack of gout.
5. Factors that may provoke attacks include a high-fat diet, purine-rich foods, thiazide diuretics, liver extracts, nicotinic acid, penicillin, cancer chemotheraputic agents, levodopa, ethambutol, and ergotamine.
6. Asprin is avoided when probenecid or sulfinpyrazone is used.
7. Fluid intake is encouraged during probenecid, sulfinpyrazone, and allopurinol therapy.
8. Notify the prescriber promptly if skin rash occurs during allopurinol therapy.

Some foods high in purines: anchovies, bacon, beer, codfish, goose, haddock, herring, mackerel, mussels, organ meats (liver, kidneys, etc.), salmon, sardines, scallops, smelts, trout, turkey, veal, venison.
Nursing Dx for pts with COPD and airway diseases
Ineffective airway clearance related to respiratory secretions.
Risk for injury related to adverse effects of expectorants and antitussives.
Deficient knowledge related to expectorants and antitussives.
Albuterol Nebulizer page 90 (Accuneb, Airet, albuterol, proventil, salbutamol, ventodisk, ventolin)
FUNCTION CLASS: Adrenergic B-agonist, sympathomimetic, bronchodilator
ACTION: Causes bronchodilation by action on B2 (pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle, produces bronchodilation, CNS< cardiac stimulation, as well as increased dieresis and gastric acid secretion; longer acting than isoproterenol.
USES: Prevention of exercise induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction. UNLABELED USES: Hyperkalemia in dialysis patients.
SIDE EFFECTS: bronchospasm, tremors, anxiety, restlessness
Singulair page 700 (Montelukast)
FUNCTION CLASS: Bronchodilator
CHEMICAL CLASS: Leukotriene antagonist, cysteinyl
ACTION: Inhibits leukotriene (LTD4) formation, leukotrienes exert their effects by increasing neutrophil, eosinophil migration; aggregation of neutrophils, monocytes, smooth muscle contraction, capillary permeability, these actions further lead to bronchoconstriction, inflammation, edema.
USES: Chronic asthma in adults and children; seasonal allergic rhinitis,
SIDE EFFECTS: None in bold, dizziness, fatigue, headache, abdominal pain, influenza, cough
Theophylline page 982   XANTHINE Bronchodilator
FUNCTION CLASS: Bronchodilator
CHEMICAL CLASS: Methylxanthine
ACTION: Relaxes smooth muscle of respiratory system by blockign phosphodiesterase, which incfeases cAMP, exact action unknown
USES: Bronchial asthma, bronchospasm of COPD, chronic bronchitis, emphysema
SIDE EFFECTS: anxiety, restlessness, insomnia, dizziness, palpitations, sinus tachycardia, N/V, anorexia, seizures, dysrhythmias
Tessalon page 177 (Benzonatate)
FUNCTION CLASS: antitussive, nonopioid
USES: Nonproductive cough
Contraindications: hypersensitivity
Benadryl page 372 (Diphenhydramine)
FUNCTION CLASS: Antihistamine (1st generation, nonselective)
CHEMICAL CLASS: Ethanolamine derivative, H1 receptor antagonist
ACTION: Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site; decrfeases allergic response by blocking histamine
USES: Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime dedation, infant colic, nonproductive cough
SIDE EFFECTS: dizziness, drowsiness, retention, seizures, thrombocytopenia, agranulocytosis, hemolytic anemia, anaphylaxis
Guaifensin page 521 (Robitussin, Siltussin)
ACTION: Acts as an expectorant by stimulating a gastric musosal reflex to increase the production of lung mucus
USES: Productive an dnonproductive cough
SIDE EFFECTS: drowsiness, headache, dizziness, anorexia, N/V
Atrovent Page 575 (Ipratropium)
FUNCTION CLASS: Anticholinergic, bronchodilator
CHEMICAL CLASS: Synthetic quaternary ammonium compound
ACTION: Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cGMP and bronchodilation
USES: COPD, rhinorrhea in children 6-11 yr (nasal spray)
SIDE EFFECTS: bronchospasms, anxiety, dizziness, headache, N/V, cramps, cough, worsening of symptoms
Brethine page 975 (Terbutaline) 
FUNCTION CLASS: Selective B2-agonist; bronchodilator
CHEMICAL CLASS: catecholamine
ACTION: relaxes bronchial smooth muscle by direct action on B2-adrenergic receptors through accumulation of cAMP at B-adrenergic receptor sites; bronchodilation, diuresis, CNS, cardiac stimulation occur; relaxes uterine smooth muscle
USES: bronchospasm, hyperkalemia UNLABELED USES: premature labor
SIDE EFFECTS: cardiac arrest, tremors, insomnia, headache, dizziness, anxiety, palpitaions, tachycardia, bradycardia, HTN, dysrhythmias, N/V
Aminophylline page 116  XANTHINE Bronchodilator
FUNCTION CLASS: Bronchodilator, spasmolytic
CHEMICAL CLASS: Methylxanthine
ACTION: exact mechanism unknown, relaxes smooth muscle of respiratory system by blocking phosphodiesterase which increases cAMP; increased cAMP alters intracellular calcium ion movements; produces bronchodilation, increased pulmonary blood flow, relaxation of respiratory tract.
USES: Bronchial asthma, bronchospasm associated with chronic bronchitis, emphysema, bradycardia UNLABELED USES: apnea in infancey for respiratory/myocardial stimulation
SIDE EFFECTS: dizziness, palpitations, sinus tachycardia, N/V, seizures, dysrhythmias
Mucomyst page 79 (Acetylcysteine)
FUNCTION CLASS: Mucolytic; antidote - acetominophen
CHEMICAL CLASS: amino acid l-cysteine
ACTION: decreases viscosityof secretions by breaking disulfide links of mucoproteins; increases hepatic glutathione, which is necessary to inactivate toxic metabolites in acetaminophen overdose
USES: Acetaminophen toxicity; bronchitis; pneumonia; cystic fibrosis; emphysema; atelectasis; TGB; complications of thoracic, cardiovascular surgery; diagnosis in bronchial lab tests UNLABELED USES: prevention of contrast medium nephrotoxicity
SIDE EFFECTS: dizziness, drowsiness, rhinorrhea, nausea, hepatotoxicity, bronchospasm, hemoptysis
FUNCTION CLASS: Opiate analgesic, antitussive
CHEMICAL CLASS: Opiate, phenathrene derivative
ACTION: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors, decreases cough reflex, GI motility
USES: moderate to severe pain, nonproductive cough UNLABELED USES: Diarrhea
SIDE EFFECTS: drowsiness, sedation, N/V, anorexia, constipation, seizures, circulatory collapse, respiratory depression, respiratory paralysis, anaphylaxis
Combo narcotic and nonnarcotic cough agents
Robitussin AC (Guaifenesin and codeine) - combines an expectorant with a narcotic antitussive

Robitussin DM (Guaifenesin and dextromethorphan HBr) - combines an expectorant with a non-narcotic cough suppressant
Sympathomimetic bronchodilators
are albuterol, ipratropium, epinephrine, isoproterenol, levabuterol, metaproterenol, salmeterol, or terbutaline. Monitor for changes in cardiac function and BP, CNS stimulation, insomnia, nervousness, anxiety, tremor, GI disturbances. Clients on sympathomimetics should not use MAOIs as they can cause HTN crisis.
Xanthine bronchodilators
are aminophylline and theophylline, and caffeine. Also produce diuresis which causes loss of potassium ions. Threat of tachycardia can lead to more severe cardica dysfunction - so administer using a continuous IV infusion pump with rate not to increase 25 mg/min. Monitor HR and rhythm q4 hr. With oral forms, product should be taken with food, if GI upset occurs. Monitor for tachycardia, development of toxicity (i.e., N/V, GI pain, convulsions, restlessness, or irregular heartbeat). client should not consume large amounts of xanthine-containing foods or beverages, e.g., cola drinks, coffee, tea, cocoa, or chocolate. Observe for CNS stimulation, diuresis, changes in cardiac functioning, or convulsive activity. Smokers may require more frequent dosing.
Corticosteroids used for treatment of bronchial asthma
include becomnase, aerobid, advair, and azmacort, nasacort. They should be used only to prevent attacks, not to abort and acute asthmatic attack. At least 1 minute must be allowed to elapse between inhalations. If client Is to use Inhalational bronchodilator as well as Inhalational corticostaroid, bronchodilator should be used several minutes before the corticosteroid to enhance distribution of the corticosteroid in the respiratory tract. Mouth should be rinsed with water or mouthwash after each use to reduce dry mouth and hoarseness. Observe oral cavity for development of fungal infections. Monitor client for signs of systemic adverse effects related to corticosteroid use, e.g., adrenal insufficiency, masking of infection, HTN, and developmental delays.
Nursing interventions with respiratory diagnoses processAssessment:
S/S such as dyspnea; adequacy of gas exchange - such as cyanosis, activity tolerance; Sternal retraction in newborns; lab test resutls including pulmonary function studies and blood gas determinations. Assess for chagnes in cough, ease of respiration, skin and mucous membrane color, nature and quantity of respiratory secretions, activity tolerance, breath sounds, and O2 sat.Also watch for side/adverse effects of drugs.
Ineffective airway clearance and impaired gas exchange R/T bronchoconstriction
Ineffective breathing pattern R/T increased work of breathing
Risk for injury R/T adverse effects of respiratory drugs
Deficient knowledge R/T disease process and medication regimen

Implementation: Assess knowledge of the disease, treatment, therapies, skill of use of treatments (inhalers and postural drainage), recognition and intervention of early s/s that indicate worsening of respiratory state.

Teach pursed lip breathing, use of bronchodilators, oxygen administration, handwashing, avoiding crowds and persons who are infected with cold or flu, avoid common irritants, allergens, smoke, etc. Wear a mask, high fluid intake, room air humidification. Avoid excessive humidification for asthmatic clients who may develop bronchospasms. Conserve energy, rest, and avoid heavy meals.

Client experiencees effective cough reflex and diminished adventitious breath sounds.
Client's O2 sat readings from pulse oximetry range from 90-95%.
Client verbalizes improvement in respiratory secretions and ability to remove them.
Client does not experiencee injury due to adverse effects of respiratory drugs.
Client verbalizes understanding of disease process, medication regimen, need for compliance with therapy, and risk factors and how to avoid them.
Safe nursing practice: Expectorants and antitussives:
• Persons with a cough lasting more than 1 week and those with high fever, rash, or persistent headache should be referred to a health care provider
• Assess the nature, duration, frequency, and productivity of cough
• Cough syrups given for their local soothing effect should not be followed immediately by food or water
• Teach clients about environmental modifications that may decrease cough and/or aid in expectoration of respiratory secretions
• Productive coughs should not be suppressed. Clients should be instructed in how to cough productively.
• Sufficient fluid intake is beneficial in aiding the expectoration of respiratory secretions.
• Saturated solution of potassium iodide (SSKI) is measured in drops and can be mixed in fruit juices or beverages to disguise its taste. Do not administer this drug to clients allergic to iodine.
• Teach the client about disposing of secretions properly and preventing respiratory infections.
• As with all meds, these should be kept out of the reach of children. Syrup of ipecac and the number of the local poison control center should be available if a child accidently ingests an overdose.
Increase or decrease the force of contraction of the heart.
Increase or decrease heart rate.
Increase or decrease the conduction of electrical impulses through the myocardium.
Digoxin page 362 (Lanoxicaps, Lanoxin)
FUNCTION CLASS: Cardiac glycoside, inotropic, antidysrhythmic
CHEMICAL CLASS: Digoxin preparation
ACTION: Inhibits the sodium potassium ATPase, which makes more calcium available for contractile proteins, resulting in increased cardiac output (positive inotropic effect); increases force of contraction; decreases heart rate (negative chronotropic effect); decreases AV conduction speed.
USES: Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders.
SIDE EFFECTS: Dysrhythmias, AV blocks, hypotension, headache
Digibind page 365(Digoxin immune)
FUNCTION CLASS: Antidote – digoxin specific
ACTION: Antibody fragments bind to free digoxin or digitoxin to reverse toxicity by not allowing digoxin or digitoxin to bind to site of action.
USES: Life threatening digoxin toxicity
SIDE EFFECTS: CHF, atrial fibrillation, hypokalemia, anaphylaxis, impaired respiratory function, rapid respiratory rate, hypersensitivity
Adenosine page 86 (Adenocard, adenoscan)
FUNCTION CLASS: Antidysrhythmic
CHEMICAL CLASS: Endogenous nucleoside
ACTION: Slows conduction through AV node, can interrupt re-entry pathways through AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT)
USES: SVT, as a diagnostic aid to assess myocardial perfusion defects in CAD
SIDE EFFECTS: facial flushing, nausea, dyspnea, chest pressure, atrial tachydysrhythmias
Tenormin page 158 (Atenolol)
FUNCTION CLASS: Antihypertensive, antianginal
CHEMICAL CLASS: Beta blocker, B1-B2 blocker (high doses)
ACTION: Competitively blocks stimulation of B-adrenergic receptor within vascular smooth muscle; produces negative chronotropic and negative inotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases HR, decreases O2 consumption in myocardium
USES: mild to moderate HTN, prophylaxis of angina pectoris; suspected or known MI (IV use) UNLABELED USES: dysrhythmia, mitral valve prolapse, pheochromocytoma, hypertrophic cardiomyopathy, vascular headaches, thyrotoxicosis, tremors, alcohol withdrawal.
SIDE EFFECTS: Insomnia, fatigue, diziness, mental changes, cold extremities, postural hypotension, 2nd-or 3rd- degree heart block, nausea, diarrhea, profound hypotension, bradycardia, CHF, mesenteric arterial thrombosis, ischemic colitis, agranulocytosis, thrombocytopenia, purpura, bronchospasm
Verapamil SR page 1058/1059 (Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verapamil HCI SR, Verelan PM)
FUNCTION CLASS: Calcium channel blocker, antihypertensive, antianginal.
CHEMICAL CLASS: Diphenylalkylamine
ACTION: Inhibits calcium ion reflux across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases SA/AV node conduction; dilates peripheral arteries.
USES: Chronic stable, vasospastic, unstable angina, dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation UNLABELED USES: Prevention of migraine headaches, ventricular outflow obstruction in hypertrophic cardiomyopathy, recumbent nocturnal leg cramps.
SIDE EFFECTS: CHF, Stevens-Johnson syndrome, headache, drowsiness, nausea, constipation
Propranolol page 863 (Inderal)
FUNCTION CLASS: Anti-hypertensive, antianginal, antidysrhythmic (class II)
CHEMICAL CLASS: B-adrenergic blocker
ACTION: Nonselective B-blocker with negative inotropic, chronotropic, dromotropic properties
USES: Chronic stable angina pectoris, HTN, Supraventricular dysrhythmias, migraine, prophylaxis, MI, pheochromocytoma, essential tremor, cyanotic spells related to hypertrophic subaortic stenosis UNLABELED USES: Anxiety; Parkinson’s tremor, prevention of variceal bleeding caused by portal HTN, akathisia induced by antipsychotics
SIDE EFFECTS: bronchospasm, Bradycardia, CHF, pulmonary edema, dysrhythmias, laryngospasm, agranulocytosis, thrombocytopenia
Norvasc page 123 (Amlodipine)
FUNCTION CLASS: Antianginal antihypertensive, calcium channel blocker
CHEMICAL CLASS: Dihydropyridine
ACTION: Inhibits calcium ion reflux across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary vascular arteries; increases myocardial oxygen delivery in patients with vasospastic angina.
USES: Chronic stable angina pectoris, hypertension, vasospastic angina (Prinzmetal’s angina) may coadminister with other antihypertensives, antianginals

SIDE EFFECTS: dysrhythmia, peripheral edema, bradycardia, hypotension, palpitations, syncope, chest pain.
Atropine page 163 (Atropine sulfate, Atro-Pen, Sal-Tropine)
FUNCTION CLASS: antidysrhythmic, anticholinergic parasympatholytic, antimuscarinic
CHEMICAL CLASS: Belladonna alkaloid
ACTION: blocks Ach at parasympathetic neuroeffector sties; increases cardiac output, HR by blocking vagal stimulation in heart; dries secretions by blocking vagus
USES: Bradycardia <40-50 bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU, biliary surgery, bronchodilator
SIDE EFFECTS: tachycardia, paralytic ileus
Epinephrine page 416 (Adrenalin Ana-guard, AsthmaHaler Mist, AsthmaNefrin, ..)
FUNCTION CLASS: Bronchodilator nonselective adrenergic agonist, vasopressor
CHEMICAL CLASS: Catecholamine
ACTION: Beta agonist causing increased levels of cAMP producing bronchodilation, cardiac, and CNS stimulation; high doses cause vasoconstriction via A-receptors; low doses can cause vasodilation via B2-vascular receptors
USES: Acute asthmatic attacks; hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock
SIDE EFFECTS: tremors, anxiety, dizziness, palpitations, tachycardia, dysrhythmias, anorexia, N/V, dyspnea, cerebral hemorrhage
Levophed page 746 (Nor-epinephrine)
CHEMICAL CLASS: Catecholamine
ACTION: Causes increased contractility and HR by acting on B-receptors in heart; also acts on A-receptors, causing vasoconstriction in blood vessels; BP is elevated, coronary blood flow improves, CO increases
USES: Acute hypotension, shock
SIDE EFFECTS: headache, palpitation, tachycardia, HTN, ectopic beats, angina, N/V, gangrene, anaphylaxis
Safe nursing practice: Cardiac Glycosides:
• Always check the client's apical pulse rate for 1 minute before administering these products.
• Withhold these drugs if the pulse rate is less than 60 bpm in adults, less than 90 bpm in infants, and less than 70 bpm in children and adolescents.
• Report bigeminy (if on monitoring) or significant deviations in the client's heart rate or rhythm.
• Assess the client for toxicity by checking the HR and rhythm and observing for neurological signs, such as headache, visual disturbances and changes in color vision, and GI symptoms such as N/V, and anorexia.
• Monitor the digoxin level and report levels equal to or greater than 2 ng/ml.
• Monitor potassium level and report level less than 3.5 mmol/L.
• To minimize pain and possible tissue damage, IM preps must be given deep into a large muscle mass.
• Teach the client and family members how to recognize signs of toxicity and assess HR.
• Monitor for drug-drug and drug-herbal interactions.
Safe nursing practice: Antidysrhythmic agents:
• Assess the client's apical pulse for 1 minute before administration.
• Cleints scheduled to receive lidocaine, tocainide, or procainamide should be questioned about allergy to local anesthetics.
• Monitor BP every 15 minutes for those clients receiving amrinone and nitroprusside.
• Give quinidine at mealtimes to decrease GI upset.
• The client should alwayss be supine when IV quinidine is administered.
• Clients receiving IV lidocaine or procainamide should be supine during administration.
• Check vital signs for all clients following IV administration of antidysrhythmic drugs. Report signs of confusion or convulsions in clients following lidocaine or procainamide use.
• Report evidence of granular deposits on the cornea of clients taking amiodarone.
• Verapamil HCl may cause hypotension and disturbances of cardiac rhythm. Stop IV administration if the systolic bp drops below 90 mmHg and if the pulse drops below 50 bpm.
Safe Nursing practice: Cardiac emergencies and shock:
• Monitor vital signs continuously.
• An IV line is established for the administration of meds and fluids.
• If an IV line cannot be established, drugs may be given through an endotracheal tube.
• Infiltration of dopamine, norepinephrine, or other sympathomimetic drugs may result in tissue necrosis. This is treated with infiltration of the affected area with phentolamine (Regitine).
Diuretics and antihypertensives
In certain illnesses the excretion of sodium may be impaired, thus leading to the accumulation of fluid and sodium within the body. Diuretics are designed to correct this situation by promoting the excretion of sodium by inhibiting its reabsorption. Antihypertensives are employed to lower blood pressure. Diuretics are also used in the treatment of HTN, as they can promote BP reduction while reducing the adverse effects of other antihypertensive drugs.
Loop diuretics (Lasix, Bumex
by inhibiting the reabsorption of Na and Cl in the ascending loop of Henle, therby reducing the ability of the kidneys to concentrate urine. The loop diuretics are more potent than the thiazides in promoting Na and fluid excretion. However, the use of these agents has also been associated with hearing loss, particularly when administered parenterally in high doses.
Potassium sparing diuretics (Spironolactone, Aldactone)
exert action on the distal tubule by inhibiting the action of the hormone aldosterone. These are used in combination with a thiazide or loop diuretic to obtain enhanced diuretic activity and spare potassium to decrease incidence of hypokalemia
Osmotic diuretics (Mannitol, Isosorbide, Urea
are used in the treatment of ICP but also to treat acute renal failure. These agents are capable of being filtered by the glomerulus, but have a limited capability of being reaborbed into the blood stream.
Carbonic Anhydrase inhibitors (Diamox
Carbonic anhydrase is an enzyme that promotes the reabsorption of Na and bicarbonate from the proximal tubule. These agents inhibit carbonic anhydrase activity, promote the excretion of bicarbonate, Na, and water and results ina mild diuretic effect. These agents are used for the reduction of intraocular pressure in glaucoma clients by reducing the rate of production of aqueous humor in the eye.
Antihypertensive agents
HTN is defined as an abnormal incrfease in arterial blood pressure. BP is dependent on 2 factors: cardiac output and peripheral resistance. Virtually all forms of antihypertensive agents affect one of both of these systems either directly or indirectly.

Prehypertension 120-139/85-89
Stage 1 HTN 140-159/ 90-99
Stage II HTN >160-179/100-109
Stage III HTN >180/110
HCTZ  page  531 (Hydrochlorothiazide)
FUNCTION CLASS: Thiazide diuretic, antihypertensive
CHEMICAL CLASS: Sulfonamide derivative
ACTION: Acts on distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, potassium.
USES: Edeam, HTN, diuresis, CHF, edema in corticosteroid, estrogen, NSAIDs, idiopathic lower extremity edema therapy.
SIDE EFFECTS: dizziness, fatigue, weaknes, hypokalemia, N/V, anorexia, urinary frequency, rash, hyperglycemia, hyperuricemia, hepatitis, uremia, glucosuria, aplastic anemia, hemolytic anemia, leukopenia, agraulocytosis, thrombocytopenia, neutropenia
Lasix page 496 (Furosemide)
FUNCTION CLASS: Loop diuretic.
CHEMICAL CLASS: Sulfonamide derivative.
ACTION: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle.
USES: Pulmonary edema, edema in CHF, hepatic disease, nephritic syndrome, ascites, hypertension. UNLABELED USES: Hypercalcemia in malignancy.
SIDE EFFECTS: Circulatory collapse, loss of hearing, renal failure, thrombocytopenia, agranulocytosis, leucopenia, neutropenia, anemia, Stevens-Johnson syndrome , hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, hyperglycemia, polyuria, rash, prurit
Bumex page 199 (Bumetanide)
FUNCTION CLASS: Loop diuretic, antihypertensive
CHEMICAL CLASS: Sulfonamide derivative
ACTION: Acts on ascending loop of Henle by inhibiting reabsorption of chloride, sodium
USES: Edema in CHF, hepatic disease, renal disease
SIDE EFFECTS: chest pain, circulatory collapse, actue pancreatitis, jaundice, renal failure, thrombocytopenia, leukopenia, granulocytopenia, Stevens-johnson syndrome, loss of hearing, hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, Hyperglycemia, nausea, polyuria, rash, pruritus
Aldactone (Spirinolactone)
FUNCTION CLASS: Potassium sparing diuretic.
CHEMICAL CLASS: Aldosterone antagonist.
ACTIONS: Competes with aldosterone at receptor sites in distal tubule, resulting in excretion of sodium chloride, water, retention of potassium, phosphate.
USES: Edema of CHF, hypertension, diuretic-induced hypokalemia, primary hyperaldosteronism (diagnosis, short term treatment, long term treatment) edema of nephritic syndrome, cirrhosis of the liver with ascites. UNLABELED USES: CHF, acne, hirsutism in women.
SIDE EFFECTS: Hyperkalemia, bleeding, hepatocellular toxicity, agranulocytosis, diarrhea, vomiting, rash, pruritus
Mannitol page 636 (Mannitol, Osmitrol, Resectisol)
FUNCTION CLASS: diuretic, osmotic
CHEMICAL CLASS: Hexahydric alcohol
ACTION: Acts by increasing osmolarity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output.
USES: Edema, promote systemic diuresis in cerebral edema, decrease intraocular pressure, improve renal function in acute renal failure, chemical poisoning.
SIDE EFFECTS: Seizures, rebound increased ICP, Tachycardia, CHF circulatory overload, acidosis, N/V
Capoten page 218 (Captopril)
FUNCTION CLASS: Antihypertensive
ACTION: Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; preventing conversion of angiotensin I to angiotensin II.
USES: HTN, CHF, left ventricular dysfunction after MI, diabetic nephropathy
SIDE EFFECTS: nephrotic syndrome, acute reversible renal failure, neutropenia, agranulocytosis, pancytopenia, thrombocytopenia, angioedema, bronchospam, hypotension, dyspnea, cough
Vasotec page 408 (Enalapril)
FUNCTION CLASS: Antihypertensive
CHEMICAL CLASS: Angiotensin-converting enzyme (ACE) inhibitor
ACTION: Selectively suppresses rennin-angiotensin-aldosterone system; inhibits ACE, prevents conversion of angiotensin I to angiotensin II, dilation of arterial, venous vessels.
USES: Hypertension, CHF, left ventricular dysfunction.
SIDE EFFECTS: Dysrhythmias, MI, proteinuria, renal failure, agranulocytosis, neutropenia, Insomnia, dizziness, hypotension, tinnitus
Cozaar page 628 (Losartan)
FUNCTION CLASS: Antihypertensive
CHEMICAL CLASS: Angiotension II receptor (type AT1)
ACTION: Blocks the vasoconstrictor and aldosterone-secreting effects of Angiotension II; selectively blocks the binding of Angiotension II to the AT1 receptor found in tissues.
USES: Hypertension alone or in combination, nephropathy in type 2 diabetes, hypertension with left ventricular hypertrophy.
SIDE EFFECTS: Cerebrovascular accident, myocardial infarction, renal failure, angioedema, dizziness, insomnia, dysrhythmias, diarrhea, dyspepsia, cough, upper respiratory infection
Hytrin page 973 (Terazosin)
FUNCTION CLASS: Antihypertensive
CHEMICAL CLASS: Alpha-adrenergic blocker
ACTION: Decreases total vascular resistance, which is responsible for a decrease in B/P; this occurs by blockade of alpha adrenoreceptors
USES: HTN, as a single agent or incombination with diuretics or beta-blockers, BPH
SIDE EFFECTS: dizziness, headache, drowsiness
Catapress page 290 (Clondine HCl)
FUNCTION CLASS: Antihypertensive,
CHEMICAL CLASS: Central A-adrenergic agonist.
ACTION: Inhibits sympathetic vasomotor center in CNS, which reduces impulses in sympathetic nervous system, blood pressure, pulse rate, cardiac output decrease, prevents pain signal transmission in CNS by A-adrenergic receptor stimulation of spinal cord.
USES: Mild to moderate hypertension, used alone or in combination; severe pain in cancer patients (epidural) UNLABELED USES: Opioid withdrawal, prevention of vascular headaches, treatment of menopausal symptoms, dysmenorrheal, ADHD, autism, cyclosporine, nephrotoxicity, prophylaxis, diabetic neuropathy, ethanol withdrawal, Tourettes syndrome.
SIDE EFFECTS: CHF, drowsiness, sedation, headache, fatigue, orthostatic hypotension, palpitations, nausea, vomiting, malaise, dry mouth, rash
Safe Nursing Practice: sodium and potassium needs:
• Some clients with HTN benefit from a Na-restricted diet, either mild (1500-2000 mg), moderate (1000mg) or severe (500 mg)
• Clients on Na-restricted diets may experience Na deficit, particularly during hot weather. A temporary increase in Na is recommended
• Muscle cramps, muscle weakness, and change in the pulse may indicate potassium deficit. Potassium is replaced by intake of foods such as fruits and fruit juices.
• Clients on Na-restricted diets must be taught to read the labels on foods and meds to identify sources of Na.
• Clients taking Potassium-sparing diuretics are instructed to avoid salt substitutes containing potassium
The total cholesterol should be less than 200 mg/dL.
LDLs less than 100 mg/dL (<70mg/dL for those individuals at high risk for CAD)
Triglycerides less than 150 mg/dL
HDL levels greater than 40 mg/dL in men and greater than 50 mg/dL in women with a goal of greater than 60 mg/dL.
Lopid page 507 (Gemfibrozil)
CHEMICAL CLASS: Fibric acid derivative.
ACTION: Inhibits biosynthesis of VLDL, decreases triglycerides increases HDL.
USES: Type IIb, IV, V hyperlipidemia as adjunct with diet therapy.
SIDE EFFECTS: Leukopenia, anemia, eosinophilia, thrombocytopenia, dyspepsia, diarrhea, abdominal pain
Tricor page 454 (Fenofibrate, Antara, Lofibra, Triglide)
CHEMICAL CLASS: Fibric acid derivative
ACTION: Increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase, resulting in triglyceride change in size and composition of LDL leading to rapid breakdown of LDL; mobilizes triglycerides from tissue; increases excretion of neutral sterols.
USES: Hypercholesterolemia, types IV, V hyperlipidemia that do not respond to other treatment and are at risk for pancreatitis, Frederickson type IIa, IIb, and hypertriglyceridemia. UNLABELED USES: Polymetabolic syndrome X.
SIDE EFFECTS: dysrhythmias, nausea, myalgias
Lipitor page 161 (Atorvastatin)
FUNCTION CLASS: Antilipidemic
CHEMICAL CLASS: HMG-CoA reductase inhibitor
ACTION: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis.
USES: As an adjunct in primary hypercholesterolemia (types 1a, 1b) dysbetalipoproteinemia, elevated triglycerides levels, prevention of cardiovascular disease by reduction of heart risk in those with mildly elevated cholesterol.
SIDE EFFECTS: liver dysfunction, rhabdomyolysis, abdominal cramps, constipation, diarrhea, flatus, heartburn
Zetia page 446 (Ezetimbe)
FUNCTION CLASS: Antilipemic, cholesterol absorption inhibitor
ACTION: Inhibits absorption of cholesterol by the small intestine
USES: Hypercholesterolemia, homozygous familial hypercholesterolemia ( HoFH) homozygous sitosterolemia
SIDE EFFECTS: none in bold, myalgias, arthralgias
Vytorin page 1163 (Combination of Ezetimibe, page 446 and Simvastatin page 929) Ezetimibe
FUNCTION CLASS: Antilipemic; cholesterol absorption inhibitor
ACTION: Inhibits absorption of cholesterol by the small intestine. USES: Hypercholesterolemia, homozygous familial hypocholesterolemia (HoFH) homozygous sitosterolemia.
SIDE EFFECTS: none in bold, myalgias, arthralgias, fatigue, dizziness, headache, diarrhea, abdominal pain, chest pain, back pain, pharyngitis, sinusitis, cough URI; CONTRAINDICATIONS: Hypersensitivity, severe hepatic disease.
Questran page 267 (Cholestyramine)
CHEMICAL CLASS: Bile acid sequestrant
ACTION: Inhibits multisynaptic reflex arcs causing skeletal muscle relaxation
USES: relieving pain, spasm in musculoskeletal conditions
SIDE EFFECTS: dizziness, drowsiness, nausea, GI bleeding, hepatotoxicity, granulocytopenia, anemia, angioedema anaphylaxis
Crestor page 913 (Rosuvastatin)
FUNCTION CLASS: Antilipemic.
CHEMICAL CLASS: HMG-CoA reductase inhibitor.
ACTION: Inhibits HMG-CoA reductase enzyme which reduces cholesterol synthesis.
USES: As an adjunct in primary hypercholesterolemia (types IIa, IIb) and mixed dyslipidemia elevated serum triglycerides, homozygous familial hypercholesterolemia (FH)
SIDE EFFECTS: kidney failure, liver dysfunction, thrombocytopenia, hemolytic, anemia, leucopenia, myositis, rhabdomyolysis, headache, dizziness, nausea, constipation, abdominal pain, flatus, diarrhea, dyspepsia, heartburn, rash, pruritis, asthenia, muscle cramps, arthritis, arthralgia, myalgia
Niacin page 731 (Nicotinamide, Nicolar, Nicotinex)
FUNCTION CLASS: Vit B3, antihyper-lipidemic
CHEMICAL CLASS: water-soluble vitamin
ACTION: Needed for conversion of fats, protein, carbohydrates, by oxidation reduction; acts directly on vascular smooth muscle, causing vasodilation, reduces LDL, HDL, triglycerides, and lipoprotein A
USES: Pellagra, hyperlipidemias (types 4-5), peripheral vascular disease that presents a risk for pancreatitis
SIDE EFFECTS: jaundice, hepatotoxicity, glycosuria, hypoalbuminemia
Safe Nursing Practice: Clients receiving Tx for Hyperlipidemia:
• Assessment includes taking a personal and family health history, conducting a physical exam, and obtaining lab studies (LFTs, CBC) Ask about exercise, diet, and use of alcohol and tobacco. Measure body weight.
• The Tx of hyperlipidemia is long term. Client compliance is important but may be difficult to obtain. Reinforce with client.
• GI symptoms, such as nausea, may be decreased by giving nicotinic acid with or following meals.
• Cleints prescribed HMG-CoA reductase inhibitors or statins should be tested for liver function before therapy and monitored during therapy in addition to monitoring LDL and HDL levels.
• Administer exchange resins mixed with a noncarbonated beverage, highfluid content soup, or pureed fruit, such as applesauce.
• Other drugs must be taken 1 hr before or 4-6 hrs after exchange resins.
• Exchange resins may produce a deficiency of fat-soluble vitamins. Monitor the client for the development of bleeding tendencies.
Agents used to treat Anemias
Anemias can be caused by excessive RBC destruction (chemotherapy), inadequate RBC production, or by both. Anemic clients often have similar symptoms, no matter what the cause of the anemia. These include pallor, malaise, and lethargy.

The most common form of anemia is iron deficiency anemia – with blood loss as the most common cause, although dietary deficiency may also be a cause. Those at greatest risk for developin iron deficiency anemia are clients with chronic bleeding disorders, menstruating females, frequent blood donors, pregnant women, infants, lactating females and those using drugs that cause blood loss (alcohol, Indocin, NSAIDs, antiplatelet agents, anticoagulants, aspirin, steroids)

The administration of Iron with ascorbid acid (Vit C) may increase the absorption of iron. Other ingredients, such as stool softeners (to prevent iron-induced constipation), antacids (to reduce iron-induced GI upset), trace metals, liver, and vitamins are often combined with iron to reduce the incidence of adverse effects and/or to improve iron absorption.

Most common side effects are GI upsets such as nausea, anorexia, constipation or diarrhea.

Vit B12 deficiency is commonly caused by gastrectomy, pernicious anemia, chronic use of drugs that decrease B12 absorption.

Folic acid deficiency is mostly likely in Pregnant women, alcoholics, nutritionally deprived clients, clients using drugs that may increase the need for folic acid (alcohol, oral contraceptives, Dilantin, pyrimethamine, triamterene, trimethoprim.
Epogen page 420 (Epoetin, Procrit)  (the only agent used in cancer clients prescribed only by Subcut dosing.
FUNCTION CLASS: antianemic, biologic modifier, hormone
CHEMICAL CLASS: Amino acid polypeptide
ACTION: Erythropoietin is one factor controlling rate of red cell production; drug is developed by recombinant DNA technology
USES: Anemia caused by reduced endogenous erythropoietin production, primarily end stage renal disease; to correct hemostatic defect in uremia; anemia due to AZT treatment in HIV patients or chemotherapy; reduction of allogenic blood transfusion in surgery patients. UNLABELED USES: Pruritus; anemia in: premature preterm infants, myelodysplasitic syndrome, chronic inflammatory disorders
SIDE EFFECTS: seizures, hypertensive encephalopathy, HTN
Ferrous Sulfate page 461 (Iron)
CHEMICAL CLASS: Iron preparation
ACTION: replaces iron stores needed for RBC development, energy and O2 transport, utilization; fumarate contains 33% elemental iron; gluconate, 12%; sulfate, 20%; iton, 30%; ferrous sulfate exsiccated.
USES: Iron deficiency anemia, prophylaxis for iron deficiency in pregnancy.
SIDE EFFECTS: N/V, constipation, epigastric pain, black and red tary stools.
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