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LPN IV Push Medications

LPN IV Push Medications. Part 2 April 2010. Ativan Decadron Digoxin Phenergan. Robinul Solumedrol Valium. Additional IV Push Medications. Ativan (Lorazepam). Class : Benzodiazepine, Anxiolytic

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LPN IV Push Medications

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  1. LPN IV Push Medications Part 2 April 2010

  2. Ativan Decadron Digoxin Phenergan Robinul Solumedrol Valium Additional IV Push Medications

  3. Ativan (Lorazepam) • Class: Benzodiazepine, Anxiolytic • Action: Thought to depress CNS at limbic system and disrupt neurotransmission in reticular activating system • Availability: Injection- 2 mg/ml, 4 mg/ml; Tablets- 0.5 mg, 1 mg, 2 mg

  4. Ativan, cont. • Indications & dosage Anxiety- 2-3 mg PO daily in two or three divided doses. Maximum dosage is 10 mg daily. Insomnia- 2-4 mg PO at bedtime Pre-Op- 0.05 mg/kg not to exceed 4 mg deep IM 2 hours prior to surgery OR 0.044 mg/kg not to exceed 2 mg IV 15-20 min. prior to surgery Status epilepticus- 4 mg IV given slowly- no faster than 2 mg per min., Can repeat if seizures recur after 10-15 min. Don’t exceed 8 mg in 12 hours.

  5. Ativan, cont. • Dosage adjustment required in elderly or debilitated patients • Off label uses: acute alcohol withdrawal syndrome • Contraindications: hypersensitivity to drug, other benzodiazepines, polyethylene or propylene glycol, or benzyl alcohol, acute angle glaucoma, coma, CNS depression, hepatic or renal failure

  6. Ativan, cont. • Precautions: Use cautiously in renal or hepatic impairment, history of suicide attempt, drug abuse, depressive disorder, or psychosis, elderly patients, pregnant or breastfeeding patients • Administration: Dilute IV doses with equal volume of diluent such as NS or D5W. Give each 2 mg dose IV slow push over 2-5 minutes. Don’t exceed rate of 2 mg/min.

  7. Ativan, cont. • Adverse Reactions: amnesia, agitation, ataxia, depression, disorientation, dizziness, drowsiness, headache, incoordination, asthenia, hypotension with too rapid administration IV, bradycardia, tachycardia, apnea, cardiac arrest, blurred vision, diplopia, nystagmus, nausea, abdominal discomfort

  8. Ativan, cont. • Interactions: Drug to drug: additive effects with other benzodiazepines Contraceptives: increased ativan clearance Drug to Herbs: increased CNS depression with chamomile, hops, kava, skullcap, valerian Drug-behaviors: increased CNS depression with alcohol, increased metabolism and decreased efficacy of ativan with smoking

  9. Ativan, cont. • Patient monitoring: During IV administration, monitor EKG/cardiovascular and respiratory status Monitor V.S. closely Evaluate for amnesia Watch closely for CNS depression, signs & symptoms of overdose Monitor LFTs & CBC

  10. Decadron (Dexamethasone) • Class: Glucocorticoid, anti-inflammatory • Action: reduces inflammation by suppressing polymorphonuclear leukocyte migration, reversing increased capillary permeability, and stabilizing leukocyte lysosomal membranes. Also suppresses immune response (by lymphatic activity), stimulate bone marrow, and promotes protein, fat, and carbohydrate metabolism

  11. Decadron, cont. • Availability: Elixir: 0.5mg/5 ml Oral solution: 0.5 mg/5 ml, 1 mg/ml IV: 4 mg/ml, 10 mg/ml, 20 mg/ml, 24 mg/ml Tablets: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

  12. Decadron, cont. • Indications & Dosages: Allergic and inflammatory conditions- 0.75- 9 mg/day PO as a single dose or in divided doses, in severe cases much higher doses may be required Cerebral edema- initially 10 mg IV followed by 4 mg IM every 6 hours, then reduce dosage gradually over 5-7 days Cushing’s syndrome- 1 mg PO at 11 pm or 0.5 mg PO every 6 hours for 48 hours (with urine collection testing as ordered)

  13. Decadron, cont. • Off-label uses: -acute altitude sickness -bacterial meningitis -bronchopulmonary dysplasia in preterm infants -hirsutism -suppression test for detection, diagnosis, or management of depression

  14. Decadron, cont. • Contraindications: Hypersensitivity to drug, benzyl alcohol, bisulfites, EDTA, creatinine, polysorbate 80, or methylparaben Systemic fungal infections

  15. Decadron, cont. • Precautions: Use cautiously in: renal insufficiency, cirrhosis, diabetes, diverticulitis, GI disease, cardiovascular disease, hypoprothrombinemia, hypothyroidism, myasthenia gravis, glaucoma, osteoporosis, infections, underlying immunosuppression, psychotic tendencies, pregnant or breastfeeding patients, children

  16. Decadron, cont. • Administration: Give PO dose with food or milk When giving IM, inject deep into gluteal muscle, rotate sites as needed For IV use may give undiluted as single dose over 1 minute

  17. Decadron, cont. • Adverse reactions: headache, malaise, vertigo, psychiatric disturbances, increased ICP, seizures, hypotension, thrombophlebitis, myocardial rupture after recent MI, thromboembolism, cataracts, nausea, vomiting, abdominal distetion, dry mouth, anorexia, peptic ulcer, bowel perforation, pancreatitis, ulcerative esophagitis, hyperglycemia, cushingoid appearance, fluid retention, adrenal suppression, hypokalemic alkalosis, muscle wasting, muscle pain, osteoporosis, tendon rupture, long bone fractures, diaphoresis, angioedema, erythema, rash, pruritis, acne, decreased wound healing, bruising, fragile skin, weight gain or loss, increased susceptability to infections

  18. Decadron, cont. • Interactions: Drug to drug: barbiturates, phenytoin, rifampin- decreased decadron effects Digoxin- increases risk of dig toxicity Ephedrine- increased decadron clearance Contraceptives- block decadron absorption Fluoroquinolones- increased risk of tendon rupture Ketoconazole, itraconazole- increased decadron level and effects Live-virus vaccines- decreased antibody response to vaccine Loop & thiazide diuretics- additive hypokalemia NSAIDs- increased risk of GI effects Somatrem, somatropin- decreased response to these drugs

  19. Decadron, cont. • Drug-Diagnostic tests- calcium & potassium- levels decreased, cholesterol & glucose- levels increased • Drug-Herbs- echinacea- increased immune-stimulating effect, ginseng= potentiation of immune-modulating response • Drug-behaviors – alcohol use- increased gastric irritation & GI ulcers

  20. Digoxin (lanoxin) • Class: cardiac glycoside, inotrope, antiarrhythmic • Action: increases force and velocity of myocardial contraction and prolongs refractory period of AV node by increasing calcium entry into myocardial cells. Slows conduction through SA and AV nodes and produces antiarrhythmic effects

  21. Digoxin, cont. • Availability: Capsules: 0.05 mg, 0.1 mg, 0.2 mg Tablets: 0.125 mg. 0.25 mg, 0.5 mg Elixir (pediatric): 0.05 mg/ml IV: 0.05 mg/ml, 0.1 mg/ml, 0.25 mg/ml

  22. Digoxin, cont. • Indications and dosage: Heart failure, tachyarrhythmias, atrial fib/flutter, PSAT LPNs will only be giving this drug for maintenance dosing. LPNs will NOT be pushing this drug for initial digitializing of the patient.

  23. Digoxin, cont. • Dosage adjustment: renal impairment, hyperthyroidism, elderly patients • Off-label uses: SVT, intrauterine tachycardias • Contraindications: hypersensitivity to drug, uncontrolled ventricular tachycardias, AV block, idiopathic hypertrophic subaortic stenosis, constrictive pericarditis • Precautions: renal or hepatic impairment, electrolyte imbalances, myocardial infarction, thyroid disorders, obesity, elderly patients, pregnant or breastfeeding patients

  24. Digoxin, cont. • Administration: Measure apical pulse for one full minute before administering. If rate is below 60 bpm, withhold dose and notify provider. Drug has narrow therapeutic index, monitor patient carefully for toxicity

  25. Digoxin, cont. • Adverse reactions: fatigue, headache, asthenia, bradycardia, EKG changes, arrhythmias, blurred or yellow vision, nausea, vomiting, diarrhea, gynecomastia, thrombocytopenia, decreased appetite.

  26. Digoxin, cont. • Interactions: Drug-drug: many drugs result in changes in digoxin blood level possibly leading to toxicity, check nursing drug resources for a complete list; partial list includes amiodarone, cyclosporine, diclofenac, diltiazem, propafenone, quinidine, quinine, verapamil, amphotericin B, corticosteroids, mezlocillin, pipercillin, thiazide and loop diuretics, ticarfillin, antacids, cholestyramine, colestipol, kaolin/pectin, beta blockers, laxatives, spironalactone, thyroid hormones Drug-herb: cocoa seed, coffee seed, cola seed, guarana seed, horsetail, licorice, aloe, yerba mate, may lead to toxicity

  27. Digoxin, cont. • Therapeutic range for digoxin blood levels is 0.5 to 2.0 ng/ml

  28. Phenergan • Promethazine • Nonselective phenothiazine • Antihistamine, antiemetic, sediative-hypnotic • Black box warning: don’t use suppositories in patients under the age of 2 due to potential for fatal respiratory depression

  29. Phenergan, cont. • Action- blocks effects but not release of histamine and exerts strong alpha-adrenergic effects. Inhibits chemoreceptor triggers in the medulla and alters the dopamine effects by indirectly reducing stimulation in CNS • Availability: Injection: 25 mg/ml, 50 mg/ml Suppositories: 12.5 mg, 25 mg, 50 mg Syrup: 6.25/5ml Tablets: 12.5 mg, 25 mg, 50 mg

  30. Phenergan, cont. • Indications: Type 1 hypersensitivity reaction, nausea, motion sickness, sedation • Dosages: Adults- 25-50 mg PO, PR, IM or IV q4-6 hours prn • At City, IV doses are limited to 12.5 mg IV push diluted in 10 ml NS administered through the port farthest from the patient over several minutes. Phenergan should not be administered through a saline lock. IV fluids must be infusing.

  31. Phenergan, cont. • Contraindications: hypersensitivity, previous idiosyncratic reaction to phenothiazines, asthma, COPD, obstructive sleep apnea, coma • Precautions: cardiovascular or hepatic disease, seizures, bone marrow depression, narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal or bladder neck obstruction, CNS depression, pregnant or breastfeeding patients, children under age 2

  32. Phenergan, cont. • Administration: Administer no faster than 25 mg/min or in concentrations greater than 25 mg/ml, inject deep IM into large muscle, don’t give subcutaneously • Adverse reactions: confusion, disorientation, fatigue, drowsiness, sedation, dizziness, extrapyramidal reactions, insomnia, nervousness, neuroleptic malignant syndrome, hypertension, hypotension, brady & tachycardia, blurred vision, tinnitus, constipation, dry mouth, blood dyscrasias, respiratory depression, rash

  33. Phenergan, cont. • Interactions: Drug-drug: additive anticholinergic effects with anticholinergics; CNS depressants: additive CNS depression; Epinephrine: reversal of epi’s vasopressor effects; MAO inhibitors: increased extrapyramidal effects Drug-diagnostic tests: increased glucose levels, false positive or negative pregnancy tests, false negative skin allergan tests Drug-herbs:evening primrose- increased risk seizures, kava- increased risk adverse drug reactions Drug-behavior: additive CNS depression with alcohol, increased risk photosensitivity with sun exposure

  34. Robinul (glycopyrrolate) • Class: anticholinergic, antispasmodic, antimuscarinic, parasympatholytic • Action: inhibits action of acetylcholine on muscarinic receptors that mediate effects of parasympathetic postganglionic impulses. This inhibition relaxes cardiac smooth muscle, inhibits vagal reflexes, and decreases tracheal and bronchial secretions

  35. Robinul, cont. • Availability: IV: 0.2 mg/ml Tablets: 1 mg, 2 mg

  36. Robinul, cont. • Indications and dosage: adjunct in peptic ulcer disorders, to diminish secretions and block cardiac vagal reflexes before or during surgery, to diminish or block cholinergic effects caused by anticholinesterase • 1 mg PO tid to max 8 mg/day OR 0.1-0.2 mg IM or IV tid to qid

  37. Robinul, cont. • Off label uses: sweating • Contraindications: hypersensitivity to drug, arrhythmias, COPD, GI disease, infection, atony, or ileus, myasthenia gravis, glaucoma, obstructive uropathy, severe prostatic hypertrophy • Precautions: cardiovascular disease, heart failure, hypertension, renal or hepatic disease, Down syndrome, hyperthyroidism, hiatal hernia, ulcerative colitis, mild to moderate BPH, autonomic heuropathy, spasticity, suspected brain damage, pregnant or breastfeeding patients

  38. Robinul, cont. • Administration: give oral dose 30-60 minutes before meals • IV administration: either undiluted or diluted with D5W or saline, give each 0.2 mg over 1-2 min. • Keep resuscitation equipment on hand to treat curare-like effects of overdose

  39. Robinul, cont. • Adverse reactions: weakness, nervousness, insomnia, drowsiness, dizziness, headache, confusion, excitement, palpitations, tachycardia, blurred vision, photophobia, mydriasis, increased intraocular pressure, cycloplegia, nausea, vomiting, constipation, abdominal distention, epigastric distress, heartburn, gastroesophageal reflux, dry mouth, paralytic ileus, urinary hesitancy or retention, lactation suppression, erectile dysfunction, urticaria, decreased sweating or anhidrosis, loss of taste, fever, allergic reaction, irritation at IM injection site, anaphylaxis, malignant hyperthermia

  40. Robinul, cont. • Interactions: increased anticholinergic effects with amantidine, antihistamines, antiparkinsonians, disopyramide, glutethimide, meperidine, phenothiazines, procainamide, quinidine, tircyclic antidepressants

  41. Solumedrol (methylprednisolone sodium succinate) • Class: glucocorticoid, antiasthmatic, anti-inflammatory (steroidal), immunosuppressant • Action: reduces inflammation and prevents edema by stabilizing membranes and reducing permeability of leukocytic cells. Suppresses immune system by interfering with antigen-antibody interactions of macrophages and T cells

  42. Solumedrol, cont. • Availability: Solution for IV/IM: 40 mg, 125 mg, 500 mg, 1 g, 2 g Suspension for injection: 20 mg/ml, 40 mg/ml, 80 mg/ml Tablets: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg

  43. Solumedrol, cont. • Indications: diseases and disorders of endocrine system, collagen, skin, eye, GI, respiratory, or hematologic system, neoplastic diseases, allergies, multiple sclerosis, tuberculous meningitis, trichinosis, rheumatic disorders, osteoarthritis, bursitis, localized inflammatory lesions

  44. Solumedrol, cont. • Dosages: 4-160 mg PO daily in four divided doses depending on disease or disorder High dose therapy: 30 mg/kg IV over at least 30 min., may be repeated in 4-6 ours for 48 hours.

  45. Solumedrol, cont. • Off label uses: lupus nephritis, pneumocystis jiroveci pneumonia in AIDS patients • Contraindications: hypersensitivity to drug or its component, systemic fungal infections

  46. Solumedrol, cont. • Precautions: cardiovascular, hepatic, renal, or GI disease. Active untreated infections, thromboembolic tendency, idiopathic thrombocytopenia purpura, osteoporosis, myasthenia gravis, hypothyroidism, glaucoma, ocular herpes simplex, vaccinia or varicella, seizure disorders, metastatic cancer, pregnant or breastfeeding patients, children

  47. Solumedrol, cont. • Give prophylactic antacids in patients receiving high doses to prevent peptic ulcers • Methylprednisilone acetate is not for IV use- IM, intra-articular, intralesional or soft tissue injection • Methylprednisilone sodium succinate is for IV or IM use • For IV use, inject 500 mg dose over 2 to 3 min or more

  48. Solumedrol, cont. • Adverse reactions: headache, restlessness, nervousness, depression, euphoria, personality changes, psychoses, vertigo, paresthesias, insomnia, adhesive arachnoiditis, conus medullarus syndrome, increased intracranial pressure, seizures, meningitis, hypotension, hypertension, arrhythmias, heart failure, shock, fat embolism, thrombophlebitis, thromboembolism, cataracts, glaucoma, increased intraoccular pressure, nasal irritation, nasal septum perforation, sneezing, epistaxis, nasopharyngeal or oropharyngeal fungal infection, dysphonia, hoarseness, throat irritation, nausea, vomiting, abdominal distention, rectal bleeding, dry mouth, anorexia, esophageal candidiasis, esophageal ulcer, peptic ulcer, pancreatitis, amenorrhea, irregular menses, cough, wheezing, bronchospasm, decreased growth, hyperglycemia, fluid retention, cushingoid state, hypothalamic-pituitary-adrenal suppresion, adrenal suppression, acute adrenal insufficiency, muscle wasting, tendon rupture, weakness, rash, pruritis, decreased wound healing, fragile skin, skin atrophy, bad taste, weight gain, etc.

  49. Solumedrol, cont. • Interactions: Drug to drug: amphotericin B, mezlocillin, piperacillin, thiazide and loop diuretics, ticarcillin- additive hypokalemai, fluoroquinolones- increased risk of tendon rupture, isoniazid, phenobarbital, phenytoin, rifampin- decreased

  50. Valium • Diazepam • Action: produces anxiolytic effect and CNS depression by stimulating gamma-amniobutyric acid receptors, relaxes skeletal muscles of the spine by inhibiting afferent pathways, controls seizures by enhancing presynaptic inhibition • Availability: Injection: 5 mg/ml Oral solution: 1 mg/ml, 5 mg/5 ml Rectal gel: 2.5 mg, 10 mg, 15 mg, 20 mg Tablets: 2 mg, 5 mg, 10 mg

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