Adalimumab HUMIRA
Nursing Considerations
• Use adalimumab cautiously in patients
with recurrent infection or increased risk
of infection, patients who live in regions
where tuberculosis and mycoses are
endemic, and patients with a history of
CNS demyelinating disorders because they
occur, rarely, during adalimumab therapy.
WARNING If patient has evidence of an
active infection when drug is prescribed,
therapy shouldn’t start until infection has
been treated.Monitor all patients for
infection during therapy, especially those
receiving immunosuppressants. If a serious
infection develops, expect prescriber
to stop drug.
•Make sure patient has a tuberculin skin
test before therapy starts. If skin test is
positive, treatment of latent tuberculosis
will start before adalimumab, as prescribed.
• Be aware that the needle cover of the
syringe contains dry rubber. Don’t handle
if you’re allergic to latex.
• To activate the protection device on needles
of prefilled syringes delivered to institutions,
hold the syringe in one hand and,
with the other hand, slide outer protective
shield over exposed needle until it locks
into place.
WARNING Stop adalimumab immediately
and tell prescriber if patient has an allergic
reaction. Expect to provide supportive
care.
•Watch closely for evidence of congestive
heart failure (sudden, unexplained weight
gain; dyspnea; crackles; anxiety), and notify
prescriber if they occur.
•Monitor patient’s CBC, as ordered,
because adalimumab may have adverse
hematologic effects. Notify prescriber
about persistent fever, bruising, bleeding,
or pallor.
• Be aware that adalimumab belongs to a
group of drugs called tumor necrosis factor
(TNF) blockers. Although rare, malignancies,
especially lymphomas and
leukemias, have occurred in patients receiving
TNF blockers, including children.
Patients with rheumatoid arthritis, especially
those with very active disease, are at
greatest risk.Monitor patients closely.
PATIENT TEACHING
vInform patient that the first injection of
adalimumab must take place with a health
care professional present.
• Teach patient or caregiver how to give
adalimumab as a subcutaneous injection
at home, if applicable. Emphasize importance
of injecting the full amount in the
syringe (0.8 ml) to obtain the correct dose
of 40 mg.
• If patient is allergic to latex, explain that
the needle cover contains rubber.
• Caution patient against reusing needles
and syringes. Provide patient or caregiver
with a puncture resistant container for
disposal of needles and syringes at home.
• Instruct patient or caregiver to rotate
injection sites and to avoid injecting in any
area that’s tender, bruised, red, or hard.
• Inform patient that prefilled syringes must
be refrigerated (not frozen), protected
from light, and stored in the original container.
• Urge patient to check expiration dates and
not to use outdated drug.
• Review signs and symptoms of an allergic
reaction (rash, swollen face, difficulty
breathing), and tell patient to seek emergency
care immediately if these occur.
• Inform patient that injection site reactions
(such as redness, rash, swelling, itching,
and bruising) may occur but are usually
mild and transient. Instruct him to apply a
towel soaked with cold water on the injection
site if it hurts or remains swollen. If
reaction does not disappear or seems to
worsen, tell patient to call prescriber
immediately.
• Inform patient that tuberculosis may
occur during adalimumab therapy.
Instruct him to report persistent cough,
wasting or weight loss, and low-grade
fever to prescriber.
• Teach patient to recognize evidence of
infection and bleeding disorders and to
tell prescriber if they occur; drug may
need to be stopped. Advise patient to
avoid people with infections and to have
all prescribed laboratory tests.
• Inform patient that the risk of certain
kinds of cancer, especially lymphomas, is
higher in patients taking adalimumab but
still rare. Emphasize the importance of
follow-up visits and reporting an unusual
or sudden onset of signs or symptoms.
• Caution patient against receiving livevirus
vaccines while taking adalimumab
because doing so may adversely effect the
immune system.
• Inform patient that blood samples may be
needed periodically, but especially around
week 24 of therapy, to check for autoantibody
development. Explain that adalimumab
therapy will need to be stopped if
they’re detected.
• Instruct patient to report lupus-like signs
and symptoms that, although rare, may
occur during therapy, such as chest pain
that doesn’t go away, shortness of breath,
joint pain, or a rash on cheeks or arms
that’s sensitive to the sun. Explain that
drug may be stopped if these occur.
• Advise patient to inform all health care
providers about adalimumab use and to
inform prescriber about any OTC medications
being taken, including herbal remedies
and vitamin and mineral supplements.
Showing posts with label Patient Teaching. Show all posts
Showing posts with label Patient Teaching. Show all posts
Thursday, April 7, 2011
Nursing Consideration Patient Teaching - Acitretin Soriatane
Acitretin Soriatane
Nursing Considerations
WARNING Don’t give acitretin to a pregnant
woman, a woman contemplating pregnancy,
or a woman who may not use reliable
contraception during drug therapy and for
at least 3 years afterward because acitretin
causes major fetal abnormalities.
•Make sure patient has had two negative
urine or serum pregnancy tests with a sensitivity
of at least 25 mIU/ml before
receiving acitretin. First test should be
obtained when decision is made to use
acitretin and second test during first
5 days of the menstrual period just before
acitretin therapy starts. For patients with
amenorrhea, second test should be done at
least 11 days after the last act of unprotected
sexual intercourse (which means
without using two effective forms of contraception
simultaneously).
• Check to make sure female patient of
childbearing age has signed the patient
agreement and informed consent form
before starting acitretin therapy.
•Obtain a lipid profile, as ordered, before
acitretin therapy starts and every 1 to
2 weeks for up to 8 weeks or until lipid
effects are known. In high-risk patients,
such as those with diabetes, obesity, or a
history of alcohol abuse and those taking
acitretin long-term, check lipid profile
periodically throughout therapy.
•Monitor liver function test results, as
ordered. If hepatotoxicity is suspected,
expect to stop drug and investigate cause.
• If patient takes acitretin long-term or she
develops a skeletal disorder, prepare her
for periodic bone radiography because
ossification abnormalities can occur, especially
of the vertebral column, knees, and
ankles.
•Monitor patient’s eyes for abnormalities
throughout therapy. Expect patient to stop
drug and have an ophthalmologic examination
if eye abnormalities occur.
•Monitor patient for evidence of increased
intracranial pressure, such as papilledema,
headache, nausea, vomiting, and visual
disturbances. If papilledema occurs, stop
drug therapy immediately and obtain a
neurologic evaluation, as ordered. Patient
should never receive a tetracycline while
taking acitretin because combined use can
increase intracranial pressure.
• Assess patient for suidical ideation because
depression and other psychiatric symptoms,
including thoughts of self-harm,
may occur with acitretin use. Expect drug
to be discontinued if psychiatric symptoms
develop.
• Significantly lower doses of phototherapy
are needed during acitretin therapy
because drug increases the risk of erythema.
PATIENT TEACHING
WARNING Warn women of childbearing age
that acitretin causes major fetal abnormalities.
• Inform woman of childbearing age that
she must have a pregnancy test before
acitretin therapy starts, every month during
acitretin therapy, and every 3 months
for 3 years after therapy stops.
• Stress to woman of childbearing age that
she must use two effective forms of contraception
simultaneously unless she has
chosen absolute abstinence or has had a
hysterectomy. This must begin at least 1
month before acitretin therapy starts and
continue throughout therapy and for at
least 3 years after therapy ends.
• Caution women taking oral contraceptives
that some prescribed and OTC drugs,
including herbal supplements such as St.
John’s wort, may interfere with oral contraceptives.
Urge her to tell prescriber
about all drugs she takes.
• Caution patient not to consume alcohol or
products that contain alcohol during
acitretin therapy and for 2 months after
therapy ends.
•Warn patient, male or female of any age,
not to donate blood during acitretin therapy
and for at least 3 years after it ends.
• Review acitretin medication guide with
patient, and answer the patient’s questions.
• Inform patient that psoriasis may worsen
during initial treatment and that full
effects of drug may not be seen for up to
3 months.
• Caution patient to avoid hazardous activities
until drug’s CNS and ophthalmic
effects are known.
• Inform patient that tolerance to contact
lenses may decrease during acitretin therapy
and for a period of time after treatment
ends.
• Advise patient not to take more than the
minimum recommended daily allowance
of vitamin A during acitretin therapy
because of the risk of vitamin A toxicity.
• Caution patient not to use sun lamps and
to avoid excessive exposure to sunlight
because the effects of UV light are
enhanced by retinoids such as acitretin.
Nursing Considerations
WARNING Don’t give acitretin to a pregnant
woman, a woman contemplating pregnancy,
or a woman who may not use reliable
contraception during drug therapy and for
at least 3 years afterward because acitretin
causes major fetal abnormalities.
•Make sure patient has had two negative
urine or serum pregnancy tests with a sensitivity
of at least 25 mIU/ml before
receiving acitretin. First test should be
obtained when decision is made to use
acitretin and second test during first
5 days of the menstrual period just before
acitretin therapy starts. For patients with
amenorrhea, second test should be done at
least 11 days after the last act of unprotected
sexual intercourse (which means
without using two effective forms of contraception
simultaneously).
• Check to make sure female patient of
childbearing age has signed the patient
agreement and informed consent form
before starting acitretin therapy.
•Obtain a lipid profile, as ordered, before
acitretin therapy starts and every 1 to
2 weeks for up to 8 weeks or until lipid
effects are known. In high-risk patients,
such as those with diabetes, obesity, or a
history of alcohol abuse and those taking
acitretin long-term, check lipid profile
periodically throughout therapy.
•Monitor liver function test results, as
ordered. If hepatotoxicity is suspected,
expect to stop drug and investigate cause.
• If patient takes acitretin long-term or she
develops a skeletal disorder, prepare her
for periodic bone radiography because
ossification abnormalities can occur, especially
of the vertebral column, knees, and
ankles.
•Monitor patient’s eyes for abnormalities
throughout therapy. Expect patient to stop
drug and have an ophthalmologic examination
if eye abnormalities occur.
•Monitor patient for evidence of increased
intracranial pressure, such as papilledema,
headache, nausea, vomiting, and visual
disturbances. If papilledema occurs, stop
drug therapy immediately and obtain a
neurologic evaluation, as ordered. Patient
should never receive a tetracycline while
taking acitretin because combined use can
increase intracranial pressure.
• Assess patient for suidical ideation because
depression and other psychiatric symptoms,
including thoughts of self-harm,
may occur with acitretin use. Expect drug
to be discontinued if psychiatric symptoms
develop.
• Significantly lower doses of phototherapy
are needed during acitretin therapy
because drug increases the risk of erythema.
PATIENT TEACHING
WARNING Warn women of childbearing age
that acitretin causes major fetal abnormalities.
• Inform woman of childbearing age that
she must have a pregnancy test before
acitretin therapy starts, every month during
acitretin therapy, and every 3 months
for 3 years after therapy stops.
• Stress to woman of childbearing age that
she must use two effective forms of contraception
simultaneously unless she has
chosen absolute abstinence or has had a
hysterectomy. This must begin at least 1
month before acitretin therapy starts and
continue throughout therapy and for at
least 3 years after therapy ends.
• Caution women taking oral contraceptives
that some prescribed and OTC drugs,
including herbal supplements such as St.
John’s wort, may interfere with oral contraceptives.
Urge her to tell prescriber
about all drugs she takes.
• Caution patient not to consume alcohol or
products that contain alcohol during
acitretin therapy and for 2 months after
therapy ends.
•Warn patient, male or female of any age,
not to donate blood during acitretin therapy
and for at least 3 years after it ends.
• Review acitretin medication guide with
patient, and answer the patient’s questions.
• Inform patient that psoriasis may worsen
during initial treatment and that full
effects of drug may not be seen for up to
3 months.
• Caution patient to avoid hazardous activities
until drug’s CNS and ophthalmic
effects are known.
• Inform patient that tolerance to contact
lenses may decrease during acitretin therapy
and for a period of time after treatment
ends.
• Advise patient not to take more than the
minimum recommended daily allowance
of vitamin A during acitretin therapy
because of the risk of vitamin A toxicity.
• Caution patient not to use sun lamps and
to avoid excessive exposure to sunlight
because the effects of UV light are
enhanced by retinoids such as acitretin.
Nursing Consideration Patient Teaching - Acetylcysteine Acetadote Mucomyst Mucosil
Acetylcysteine, Acetadote, Mucomyst, Mucosil
Nursing Considerations
• Acetylcysteine should be used cautiously
in patients with asthma or a history of
bronchospasm because drug may adversely
affect respiratory function.
WARNING To avoid fluid overload and possibly
fatal hyponatremia or seizures, adjust
total administered volume, as ordered, for
patients weighing less than 40 kg (88 lb)
and for those who need fluid restriction.
• If needed, dilute 20% instillation or
inhalation solution with normal saline
solution or sterile water. The 10% solution
may be used undiluted.
•When treating acetaminophen overdose,
dilute 20% oral solution with cola or other
soft drink to a concentration of 5%, and
use within 1 hour. Dilute parenteral solution
with D5W or half-normal saline
(0.45% sodium chloride) solution for
injection following manufacturer guidelines
because dilution is based on dosage.
Acetadote may turn from colorless to
slight pink or purple once the stopper is
punctured, but color change has no effect
on product quality.
• Acetylcysteine is most effective if given
within 24 hours of acetaminophen ingestion.
For specific instructions, contact a
regional poison center at 1-800-222-1222
or a special health professional assistance
hotline at 1-800-525-6115.
• If patient vomits loading dose or any
maintenance dose within 1 hour of
administration, repeat dose as prescribed.
• Keep in mind that suicidal patient may
not provide reliable information about
vomiting.Watch such a patient to ensure
that he ingests all of prescribed dosage.
• During treatment for acetaminophen
overdose, watch for signs of hepatotoxicity,
such as prolonged bleeding time,
altered coagulation, and easy bruising.
• Be aware that acetylcysteine may have a
disagreeable odor, which disappears as
treatment progresses.
• Because nebulization causes sticky residue
on face and in mouth, have patient wash
his face and rinse his mouth at the end of
each treatment.
• Be aware that an open vial of solution may
turn light purple but that this doesn’t alter
its effectiveness.
• Refrigerate opened vials and discard after
96 hours.
• Assess type, frequency, and characteristics
of patient’s cough. Particularly note sputum.
If cough doesn’t clear secretions, prepare
to perform mechanical suctioning.
•Monitor patient for tachycardia.
PATIENT TEACHING
• Instruct patient to notify prescriber immediately
about nausea, rash, or vomiting.
•Warn patient about acetylcysteine’s
unpleasant smell; reassure him that it subsides
as treatment progresses.
• To decrease mucus viscosity, urge patient
to consume 2 to 3 L of fluid daily unless
contraindicated by another condition.
Nursing Considerations
• Acetylcysteine should be used cautiously
in patients with asthma or a history of
bronchospasm because drug may adversely
affect respiratory function.
WARNING To avoid fluid overload and possibly
fatal hyponatremia or seizures, adjust
total administered volume, as ordered, for
patients weighing less than 40 kg (88 lb)
and for those who need fluid restriction.
• If needed, dilute 20% instillation or
inhalation solution with normal saline
solution or sterile water. The 10% solution
may be used undiluted.
•When treating acetaminophen overdose,
dilute 20% oral solution with cola or other
soft drink to a concentration of 5%, and
use within 1 hour. Dilute parenteral solution
with D5W or half-normal saline
(0.45% sodium chloride) solution for
injection following manufacturer guidelines
because dilution is based on dosage.
Acetadote may turn from colorless to
slight pink or purple once the stopper is
punctured, but color change has no effect
on product quality.
• Acetylcysteine is most effective if given
within 24 hours of acetaminophen ingestion.
For specific instructions, contact a
regional poison center at 1-800-222-1222
or a special health professional assistance
hotline at 1-800-525-6115.
• If patient vomits loading dose or any
maintenance dose within 1 hour of
administration, repeat dose as prescribed.
• Keep in mind that suicidal patient may
not provide reliable information about
vomiting.Watch such a patient to ensure
that he ingests all of prescribed dosage.
• During treatment for acetaminophen
overdose, watch for signs of hepatotoxicity,
such as prolonged bleeding time,
altered coagulation, and easy bruising.
• Be aware that acetylcysteine may have a
disagreeable odor, which disappears as
treatment progresses.
• Because nebulization causes sticky residue
on face and in mouth, have patient wash
his face and rinse his mouth at the end of
each treatment.
• Be aware that an open vial of solution may
turn light purple but that this doesn’t alter
its effectiveness.
• Refrigerate opened vials and discard after
96 hours.
• Assess type, frequency, and characteristics
of patient’s cough. Particularly note sputum.
If cough doesn’t clear secretions, prepare
to perform mechanical suctioning.
•Monitor patient for tachycardia.
PATIENT TEACHING
• Instruct patient to notify prescriber immediately
about nausea, rash, or vomiting.
•Warn patient about acetylcysteine’s
unpleasant smell; reassure him that it subsides
as treatment progresses.
• To decrease mucus viscosity, urge patient
to consume 2 to 3 L of fluid daily unless
contraindicated by another condition.
Nursing Consideration Patient Teaching - Acetohydroxamic acid Lithostat
Acetohydroxamic acid, Lithostat
Nursing Considerations
• Use acetohydroxamic acid cautiously in
patients with severe chronic renal disease
or anemia and those who’ve had phlebitis
or thrombophlebitis.
• Be aware that risk of adverse psychomotor
effects increases if patient drinks alcohol
or takes drugs that affect alertness and
reflexes, such as antihistamines, tranquilizers,
sedatives, analgesics, and narcotics.
• Administer tablets with food or liquid,
crushing them if needed.
WARNING Acetohydroxamic acid chelates
with dietary iron. If patient has iron deficiency
anemia, expect to administer I.M.
iron as needed during acetohydroxamic
acid therapy.
•Monitor follow-up laboratory tests to
check renal and hepatic function and
urine pH, as ordered.
PATIENT TEACHING
• Instruct patient to take drug at same time
each day, as prescribed.
• Tell patient to take a missed dose up to
2 hours after scheduled time. If more than
2 hours have passed, he should wait for
next scheduled dose and shouldn’t double
that dose.
•Warn patient not to take drug with alcohol
or iron and to consult prescriber
before taking it with any other drug.
• Instruct patient to avoid hazardous activities
during therapy.
Nursing Considerations
• Use acetohydroxamic acid cautiously in
patients with severe chronic renal disease
or anemia and those who’ve had phlebitis
or thrombophlebitis.
• Be aware that risk of adverse psychomotor
effects increases if patient drinks alcohol
or takes drugs that affect alertness and
reflexes, such as antihistamines, tranquilizers,
sedatives, analgesics, and narcotics.
• Administer tablets with food or liquid,
crushing them if needed.
WARNING Acetohydroxamic acid chelates
with dietary iron. If patient has iron deficiency
anemia, expect to administer I.M.
iron as needed during acetohydroxamic
acid therapy.
•Monitor follow-up laboratory tests to
check renal and hepatic function and
urine pH, as ordered.
PATIENT TEACHING
• Instruct patient to take drug at same time
each day, as prescribed.
• Tell patient to take a missed dose up to
2 hours after scheduled time. If more than
2 hours have passed, he should wait for
next scheduled dose and shouldn’t double
that dose.
•Warn patient not to take drug with alcohol
or iron and to consult prescriber
before taking it with any other drug.
• Instruct patient to avoid hazardous activities
during therapy.
Nursing Consideration Patient Teaching - Acetohexamide Dimelor Dymelor
Acetohexamide Dimelor Dymelor
Nursing Considerations
• Use acetohexamide cautiously in elderly
patients and in those with cardiac, hepatic,
or renal disease or thyroid dysfunction.
Drug’s duration of action is prolonged in
patients with renal disease.
• Give acetohexamide 30 minutes before
meals, crushing tablets if desired. If GI
upset occurs, give in divided doses, as prescribed.
•Watch for evidence of hypoglycemia and
hyperglycemia, especially after meals.
• Check blood glucose level often, as ordered.
Provide additional insulin if needed during
stressful periods, as prescribed.
•Monitor liver enzyme levels during therapy;
acetohexamide may increase AST, ALT,
and alkaline phosphatase levels.
• Store acetohexamide in tightly sealed container
in a cool environment.
PATIENT TEACHING
• Stress need to adhere to prescribed drug
regimen, diet, and exercise program.
• Advise patient to take acetohexamide with
food to avoid GI upset.
• Teach patient how to self-monitor blood
glucose level and check urine for glucose
and ketones, as appropriate.
• Teach patient to recognize and report
signs of hypoglycemia and hyperglycemia.
Nursing Considerations
• Use acetohexamide cautiously in elderly
patients and in those with cardiac, hepatic,
or renal disease or thyroid dysfunction.
Drug’s duration of action is prolonged in
patients with renal disease.
• Give acetohexamide 30 minutes before
meals, crushing tablets if desired. If GI
upset occurs, give in divided doses, as prescribed.
•Watch for evidence of hypoglycemia and
hyperglycemia, especially after meals.
• Check blood glucose level often, as ordered.
Provide additional insulin if needed during
stressful periods, as prescribed.
•Monitor liver enzyme levels during therapy;
acetohexamide may increase AST, ALT,
and alkaline phosphatase levels.
• Store acetohexamide in tightly sealed container
in a cool environment.
PATIENT TEACHING
• Stress need to adhere to prescribed drug
regimen, diet, and exercise program.
• Advise patient to take acetohexamide with
food to avoid GI upset.
• Teach patient how to self-monitor blood
glucose level and check urine for glucose
and ketones, as appropriate.
• Teach patient to recognize and report
signs of hypoglycemia and hyperglycemia.
Nursing Consideration Patient Teaching - Acetazolamide Acetazolam Ak-Zol Apo-Acetazolamide Dazamide Diamox Diamox Sequels Storzolamide
Acetazolamide Acetazolam Ak-Zol Apo-Acetazolamide Dazamide Diamox Diamox Sequels Storzolamide
Nursing Considerations
• Use acetazolamide cautiously in patients
with calcium-based renal calculi, diabetes
mellitus, gout, or respiratory impairment.
• Know that acetazolamide may increase
risk of hepatic encephalopathy in patients
with hepatic cirrhosis.
• To avoid painful I.M. injections (caused by
alkaline solution), give acetazolamide by
mouth or I.V. injection if possible.
• Reconstitute each 500-mg vial with at least
5 ml sterile water for injection. Use within
24 hours because drug has no preservative.
•Monitor blood tests during acetazolamide
therapy to detect electrolyte imbalances.
•Monitor fluid intake and output every
8 hours and body weight daily to detect
excessive fluid and weight loss.
PATIENT TEACHING
• Inform patient that acetazolamide tablets
may be crushed and suspended in chocolate
or another sweet syrup. Or, one tablet
may be dissolved in 10 ml hot water and
added to 10 ml honey or syrup.
• Advise patient to avoid hazardous activities
if dizziness or drowsiness occurs.
• Instruct patient who takes high doses of
salicylates to notify prescriber immediately
about evidence of salicylate toxicity, such
as anorexia, tachypnea, and lethargy.
• If patient plans to mountain climb, urge
her to descend mountain gradually and to
seek immediate medical care if symptoms
of mountain sickness occur.
Nursing Considerations
• Use acetazolamide cautiously in patients
with calcium-based renal calculi, diabetes
mellitus, gout, or respiratory impairment.
• Know that acetazolamide may increase
risk of hepatic encephalopathy in patients
with hepatic cirrhosis.
• To avoid painful I.M. injections (caused by
alkaline solution), give acetazolamide by
mouth or I.V. injection if possible.
• Reconstitute each 500-mg vial with at least
5 ml sterile water for injection. Use within
24 hours because drug has no preservative.
•Monitor blood tests during acetazolamide
therapy to detect electrolyte imbalances.
•Monitor fluid intake and output every
8 hours and body weight daily to detect
excessive fluid and weight loss.
PATIENT TEACHING
• Inform patient that acetazolamide tablets
may be crushed and suspended in chocolate
or another sweet syrup. Or, one tablet
may be dissolved in 10 ml hot water and
added to 10 ml honey or syrup.
• Advise patient to avoid hazardous activities
if dizziness or drowsiness occurs.
• Instruct patient who takes high doses of
salicylates to notify prescriber immediately
about evidence of salicylate toxicity, such
as anorexia, tachypnea, and lethargy.
• If patient plans to mountain climb, urge
her to descend mountain gradually and to
seek immediate medical care if symptoms
of mountain sickness occur.
Nursing Consideration Patient Teaching - Acebutolol hydrochloride Monitan Sectral
Acebutolol hydrochloride Monitan Sectral
Nursing Considerations
• Before therapy begins, obtain baseline
renal function tests, as ordered.
• Check apical and radial pulses before giving
acebutolol. Also, frequently monitor
blood pressure and pulse rate, rhythm,
and quality during treatment.
• Give drug with food to prevent GI upset.
• Acebutolol may elevate uric acid, potassium,
triglyceride, lipoprotein, and antinuclear
antibody levels; it also may interfere
with accuracy of glucose tolerance tests.
•Monitor diabetic patient’s blood glucose
level to spot alterations.
• Notify prescriber if you detect a heart rate
below 50 beats/min or signs of heart failure,
such as dyspnea, crackles, unexplained
weight gain, and jugular vein distention.
•Monitor patient for peripheral edema, and
evaluate fluid intake and output.
PATIENT TEACHING
• Tell patient that tablets may be crushed or
swallowed whole.
•Warn against stopping acebutolol abruptly
because doing so could cause angina or
dangerously high blood pressure.
• Instruct patient to take a missed dose as
soon as possible up to 6 hours before next
scheduled dose but not to double the next
dose.
• Advise patient to consult prescriber before
taking OTC drugs that contain alpha agonists,
such as nasal decongestants and cold
preparations.
• Instruct patient to report dizziness, confusion,
and fever immediately.
• Urge patient to maintain diet and lifestyle
changes to help control blood pressure.
Nursing Considerations
• Before therapy begins, obtain baseline
renal function tests, as ordered.
• Check apical and radial pulses before giving
acebutolol. Also, frequently monitor
blood pressure and pulse rate, rhythm,
and quality during treatment.
• Give drug with food to prevent GI upset.
• Acebutolol may elevate uric acid, potassium,
triglyceride, lipoprotein, and antinuclear
antibody levels; it also may interfere
with accuracy of glucose tolerance tests.
•Monitor diabetic patient’s blood glucose
level to spot alterations.
• Notify prescriber if you detect a heart rate
below 50 beats/min or signs of heart failure,
such as dyspnea, crackles, unexplained
weight gain, and jugular vein distention.
•Monitor patient for peripheral edema, and
evaluate fluid intake and output.
PATIENT TEACHING
• Tell patient that tablets may be crushed or
swallowed whole.
•Warn against stopping acebutolol abruptly
because doing so could cause angina or
dangerously high blood pressure.
• Instruct patient to take a missed dose as
soon as possible up to 6 hours before next
scheduled dose but not to double the next
dose.
• Advise patient to consult prescriber before
taking OTC drugs that contain alpha agonists,
such as nasal decongestants and cold
preparations.
• Instruct patient to report dizziness, confusion,
and fever immediately.
• Urge patient to maintain diet and lifestyle
changes to help control blood pressure.
Nursing Consideration Patient Teaching - Acarbose Precose
Acarbose Precose
Nursing Considerations
WARNING Be aware that acarbose isn’t recommended
for patients with significant
renal dysfunction and a serum creatinine
level above 2 mg/dl.
• If patient is receiving acarbose and a sulfonylurea
or insulin to enhance glucose control,
check blood glucose level often, as
appropriate.
• Store drug in sealed container in cool
environment.
• Expect to decrease dosage to control GI
upset.
•Monitor glycosylated hemoglobin level as
ordered every 3 months for first year to
evaluate glucose control and patient compliance.
•Monitor hematocrit and serum AST level
every 3 months during first year of therapy
and periodically thereafter, as ordered,
because acarbose may decrease hematocrit
and increase serum AST level.
PATIENT TEACHING
• Explain importance of self-monitoring
glucose level during acarbose therapy.
• Teach patient to recognize hypoglycemia
and hyperglycemia.
•Warn patient that noncompliance with
treatment can increase risk of diabetic
complications, including neuropathy,
retinopathy, and renal insufficiency.
• Explain that temporary insulin therapy
may be needed if fever, trauma, infection,
illness, surgery, or other stress alters blood
glucose control.
•Warn patient not to take other drugs within
2 hours of acarbose unless specifically
instructed by prescriber.
• Tell him to consult prescriber before taking
OTC drugs during acarbose therapy.
• Advise patient who also takes another
antidiabetic to carry glucose with him at
all times in case hypoglycemia occurs.
Nursing Considerations
WARNING Be aware that acarbose isn’t recommended
for patients with significant
renal dysfunction and a serum creatinine
level above 2 mg/dl.
• If patient is receiving acarbose and a sulfonylurea
or insulin to enhance glucose control,
check blood glucose level often, as
appropriate.
• Store drug in sealed container in cool
environment.
• Expect to decrease dosage to control GI
upset.
•Monitor glycosylated hemoglobin level as
ordered every 3 months for first year to
evaluate glucose control and patient compliance.
•Monitor hematocrit and serum AST level
every 3 months during first year of therapy
and periodically thereafter, as ordered,
because acarbose may decrease hematocrit
and increase serum AST level.
PATIENT TEACHING
• Explain importance of self-monitoring
glucose level during acarbose therapy.
• Teach patient to recognize hypoglycemia
and hyperglycemia.
•Warn patient that noncompliance with
treatment can increase risk of diabetic
complications, including neuropathy,
retinopathy, and renal insufficiency.
• Explain that temporary insulin therapy
may be needed if fever, trauma, infection,
illness, surgery, or other stress alters blood
glucose control.
•Warn patient not to take other drugs within
2 hours of acarbose unless specifically
instructed by prescriber.
• Tell him to consult prescriber before taking
OTC drugs during acarbose therapy.
• Advise patient who also takes another
antidiabetic to carry glucose with him at
all times in case hypoglycemia occurs.
Nursing Consideration Patient Teaching - Acamprosate calcium Campral
Acamprosate calcium Campral
Nursing Considerations
• Acamprosate should start as soon as possible
after patient has undergone alcohol
withdrawal and achieved abstinence.
• Continue to give acamprosate even during
periods of alcohol relapse.
PATIENT TEACHING
• Instruct patient to take acamprosate exactly
as prescribed, even if a relapse occurs,
and to seek help for a relapse.
•Warn patient that acamprosate won’t
reduce symptoms of alcohol withdrawal if
relapse occurs followed by cessation.
• Urge caregivers to monitor patient for evidence
of depression (lack of appetite or
interest in life, fatigue, excessive sleeping,
difficulty concentrating) or suicidal tendencies
because a small number of
patients taking acamprosate have attempted
suicide.
• Advise patient to use caution when performing
hazardous activities until adverse
CNS effects of drug are known.
• Tell female patient to notify prescriber if
she is or intends to become pregnant while
taking acamprosate; the drug may need to
be stopped because fetal risks are
unknown.
Nursing Considerations
• Acamprosate should start as soon as possible
after patient has undergone alcohol
withdrawal and achieved abstinence.
• Continue to give acamprosate even during
periods of alcohol relapse.
PATIENT TEACHING
• Instruct patient to take acamprosate exactly
as prescribed, even if a relapse occurs,
and to seek help for a relapse.
•Warn patient that acamprosate won’t
reduce symptoms of alcohol withdrawal if
relapse occurs followed by cessation.
• Urge caregivers to monitor patient for evidence
of depression (lack of appetite or
interest in life, fatigue, excessive sleeping,
difficulty concentrating) or suicidal tendencies
because a small number of
patients taking acamprosate have attempted
suicide.
• Advise patient to use caution when performing
hazardous activities until adverse
CNS effects of drug are known.
• Tell female patient to notify prescriber if
she is or intends to become pregnant while
taking acamprosate; the drug may need to
be stopped because fetal risks are
unknown.
Nursing Consideration Patient Teaching - Abciximab ReoPro
Abciximab ReoPro
Nursing Considerations
• Know that abciximab may be used with
heparin and aspirin therapy.
• Inspect abciximab for particles; don’t use
if opaque particles are present.
• For continuous I.V. infusion, withdraw
4.5 ml from 2-mg/ml solution and inject
prescribed amount into 250-ml bag of
normal saline solution or D5W using an
in-line sterile, nonpyrogenic, low–proteinbinding
0.2- to 0.22-micron filter. Discard
unused portion.
• Give I.V. bolus with sterile, nonpyrogenic,
low–protein-binding 0.2- to 0.22-micron
filter.
• Avoid I.M. injections, venipunctures, and
use of indwelling urinary catheters, NG
tubes, and automatic blood pressure cuffs
during therapy to prevent bleeding. If
appropriate, insert an intermittent I.V.
access device to obtain blood samples.
•Watch for GI, GU, and retroperitoneal
bleeding and bleeding at puncture sites.
WARNING If hemorrhage occurs, prepare to
stop infusion immediately. Expect to treat
severe thrombocytopenia with platelet
transfusions if needed.
•Monitor patient for hypersensitivity reactions,
such as rash, pruritus, wheezing, and
dysphagia from laryngeal edema. If such
reactions occur, stop infusion and notify
prescriber immediately. If anaphylaxis
occurs, give epinephrine, antihistamines,
and corticosteroids, as prescribed.
•Obtain platelet count 2 to 4 hours after
initial bolus and every 24 hours during
therapy as ordered. Expect platelet function
to return to normal within 48 hours
after therapy ends.
•Monitor vital signs and continuous ECG
tracings during treatment.
PATIENT TEACHING
• Teach about possible adverse reactions,
including bleeding and hypersensitivity
reactions, which may cause rash, urticaria,
and dyspnea.
• Tell patient to prevent injury from falls by
maintaining bed rest and from bleeding by
keeping limb immobile while catheter
sheath is in place.
Nursing Considerations
• Know that abciximab may be used with
heparin and aspirin therapy.
• Inspect abciximab for particles; don’t use
if opaque particles are present.
• For continuous I.V. infusion, withdraw
4.5 ml from 2-mg/ml solution and inject
prescribed amount into 250-ml bag of
normal saline solution or D5W using an
in-line sterile, nonpyrogenic, low–proteinbinding
0.2- to 0.22-micron filter. Discard
unused portion.
• Give I.V. bolus with sterile, nonpyrogenic,
low–protein-binding 0.2- to 0.22-micron
filter.
• Avoid I.M. injections, venipunctures, and
use of indwelling urinary catheters, NG
tubes, and automatic blood pressure cuffs
during therapy to prevent bleeding. If
appropriate, insert an intermittent I.V.
access device to obtain blood samples.
•Watch for GI, GU, and retroperitoneal
bleeding and bleeding at puncture sites.
WARNING If hemorrhage occurs, prepare to
stop infusion immediately. Expect to treat
severe thrombocytopenia with platelet
transfusions if needed.
•Monitor patient for hypersensitivity reactions,
such as rash, pruritus, wheezing, and
dysphagia from laryngeal edema. If such
reactions occur, stop infusion and notify
prescriber immediately. If anaphylaxis
occurs, give epinephrine, antihistamines,
and corticosteroids, as prescribed.
•Obtain platelet count 2 to 4 hours after
initial bolus and every 24 hours during
therapy as ordered. Expect platelet function
to return to normal within 48 hours
after therapy ends.
•Monitor vital signs and continuous ECG
tracings during treatment.
PATIENT TEACHING
• Teach about possible adverse reactions,
including bleeding and hypersensitivity
reactions, which may cause rash, urticaria,
and dyspnea.
• Tell patient to prevent injury from falls by
maintaining bed rest and from bleeding by
keeping limb immobile while catheter
sheath is in place.
Nursing Consideration Patient Teaching - Abatacept Orencia
Abatacept Orencia
Nursing Considerations
• Screen patient for latent tuberculosis with
a tuberculin skin test before starting abatacept.
If test is positive, expect to provide
treatment, as ordered, before starting abatacept.
Also screen patient for hepatitis B. If
present, expect abatacept to be withdrawn
because anti-rheumatic therapies such as
abatacept may reactivate hepatitis B.
• Review patient’s immunization record,
and make sure all immunizations are current
before therapy starts. Drug may blunt
effectiveness of some vaccines and increase
the risk of infection with live viruses.
• Use cautiously in patients with a history of
recurrent infections, underlying conditions
that may predispose them to infection,
or existing chronic, latent, or localized
infection. They have an increased risk
of infection with abatacept therapy.
• Use cautiously in patients with COPD and
monitor respiratory status closely because
abatacept may worsen COPD and increase
the risk of adverse respiratory reactions.
• Tumor necrosis factor antagonists shouldn’t
be given with abatacept because of an
increased of serious infection.
• Reconsititue each vial with 10 ml of sterile
water for injection. Use only the siliconefree
disposable syringe provided with each
vial because a siliconized syringe may
cause translucent particles to form in solution.
After injecting sterile water into vial,
gently swirl vial until contents are completely
dissolved. To minimize foaming,
don’t shake. Vent the vial with a needle to
dissipate any foam that may be present.
• Further dilute reconstituted solution with
0.9% sodium chloride injection to achieve
a final solution of 100 ml. Slowly add
solution into infusion bag or bottle using
the same silicone-free disposable syringe
provided with each vial.Mix gently. Do
not shake the bag or bottle.
• Give entire dose of fully diluted drug over
30 minutes using an infusion set and a
sterile, nonpyrogenic, low protein-binding
filter with a pore size of 0.2 μm.
• Once fully diluted, solution may be kept
for 24 hours at room temperature or
refrigerated. If reconstituted solution isn’t
used within 24 hours, discard.
• After giving abatacept, monitor patient
closely for evidence of hypersensitivity
reaction such as rash, pruritus, urticaria,
dyspnea, or wheezing. If present, stop drug
immediately, notify prescriber, and provide
emergency care, as ordered.
•Monitor patient closely for evidence of
infection or malignancy because abatacept
inhibits T-cell activation, increasing the
risk of these disorders.
PATIENT TEACHING
• Instruct patient not to receive immunizations
with live vaccines during abatacept
therapy and for 3 months afterward.
• Stress need to report any evidence of
infection or hypersensitivity to prescriber.
• Alert patient that abatacept may increase
the risk of maligancy.
•Warn patient to avoid crowds and people
with infections.
Nursing Considerations
• Screen patient for latent tuberculosis with
a tuberculin skin test before starting abatacept.
If test is positive, expect to provide
treatment, as ordered, before starting abatacept.
Also screen patient for hepatitis B. If
present, expect abatacept to be withdrawn
because anti-rheumatic therapies such as
abatacept may reactivate hepatitis B.
• Review patient’s immunization record,
and make sure all immunizations are current
before therapy starts. Drug may blunt
effectiveness of some vaccines and increase
the risk of infection with live viruses.
• Use cautiously in patients with a history of
recurrent infections, underlying conditions
that may predispose them to infection,
or existing chronic, latent, or localized
infection. They have an increased risk
of infection with abatacept therapy.
• Use cautiously in patients with COPD and
monitor respiratory status closely because
abatacept may worsen COPD and increase
the risk of adverse respiratory reactions.
• Tumor necrosis factor antagonists shouldn’t
be given with abatacept because of an
increased of serious infection.
• Reconsititue each vial with 10 ml of sterile
water for injection. Use only the siliconefree
disposable syringe provided with each
vial because a siliconized syringe may
cause translucent particles to form in solution.
After injecting sterile water into vial,
gently swirl vial until contents are completely
dissolved. To minimize foaming,
don’t shake. Vent the vial with a needle to
dissipate any foam that may be present.
• Further dilute reconstituted solution with
0.9% sodium chloride injection to achieve
a final solution of 100 ml. Slowly add
solution into infusion bag or bottle using
the same silicone-free disposable syringe
provided with each vial.Mix gently. Do
not shake the bag or bottle.
• Give entire dose of fully diluted drug over
30 minutes using an infusion set and a
sterile, nonpyrogenic, low protein-binding
filter with a pore size of 0.2 μm.
• Once fully diluted, solution may be kept
for 24 hours at room temperature or
refrigerated. If reconstituted solution isn’t
used within 24 hours, discard.
• After giving abatacept, monitor patient
closely for evidence of hypersensitivity
reaction such as rash, pruritus, urticaria,
dyspnea, or wheezing. If present, stop drug
immediately, notify prescriber, and provide
emergency care, as ordered.
•Monitor patient closely for evidence of
infection or malignancy because abatacept
inhibits T-cell activation, increasing the
risk of these disorders.
PATIENT TEACHING
• Instruct patient not to receive immunizations
with live vaccines during abatacept
therapy and for 3 months afterward.
• Stress need to report any evidence of
infection or hypersensitivity to prescriber.
• Alert patient that abatacept may increase
the risk of maligancy.
•Warn patient to avoid crowds and people
with infections.
Tuesday, March 15, 2011
Nursing Consideration Patient Teaching - Omeprazole Prilosec OTC Zegerid
omeprazole
Losec (CAN), Prilosec, Zegerid
Nursing Considerations
• Give omeprazole before meals, preferably
in the morning for once-daily dosing. If
needed, also give an antacid, as prescribed.
• If needed, open capsule and sprinkle
enteric-coated granules on applesauce or
yogurt or mix with water or acidic fruit
juice, such as apple or cranberry juice.
Give immediately.
• To give drug via NG tube, mix granules in
acidic juice because enteric coating dissolves
in alkaline pH.
• Because drug can interfere with absorption
of vitamin B12, monitor patient for
macrocytic anemia.
• Be aware that long-term use of omeprazole
may increase the risk of gastric carcinoma.
PATIENT TEACHING
• Tell patient to take drug before eating—
usually before breakfast—and to swallow
delayed-release capsules or tablets whole.
If needed, patient may sprinkle contents of
capsule onto 1 tablespoon of applesauce
and swallow immediately without chewing
pellets. Tell him to follow with a glass of
cool water and not to keep any leftover
mixture.
• If patient takes the oral suspension, tell
him to empty package into a small cup
containing 2 tablespoons of water (no
other beverage should be used), stir the
mixture well, drink it immediately, refill
the cup with water, and drink again.
• Encourage patient to avoid alcohol, aspirin
products, ibuprofen, and foods that may
increase gastric secretions during therapy.
Tell him to notify all prescribers about
prescription drug use.
• Advise patient to notify prescriber immediately
about abdominal pain or diarrhea.
• Urge female patient of childbearing age to
use effective contraception during therapy
and to inform prescriber immediately if
she is or suspects she may be pregnant.
Losec (CAN), Prilosec, Zegerid
Nursing Considerations
• Give omeprazole before meals, preferably
in the morning for once-daily dosing. If
needed, also give an antacid, as prescribed.
• If needed, open capsule and sprinkle
enteric-coated granules on applesauce or
yogurt or mix with water or acidic fruit
juice, such as apple or cranberry juice.
Give immediately.
• To give drug via NG tube, mix granules in
acidic juice because enteric coating dissolves
in alkaline pH.
• Because drug can interfere with absorption
of vitamin B12, monitor patient for
macrocytic anemia.
• Be aware that long-term use of omeprazole
may increase the risk of gastric carcinoma.
PATIENT TEACHING
• Tell patient to take drug before eating—
usually before breakfast—and to swallow
delayed-release capsules or tablets whole.
If needed, patient may sprinkle contents of
capsule onto 1 tablespoon of applesauce
and swallow immediately without chewing
pellets. Tell him to follow with a glass of
cool water and not to keep any leftover
mixture.
• If patient takes the oral suspension, tell
him to empty package into a small cup
containing 2 tablespoons of water (no
other beverage should be used), stir the
mixture well, drink it immediately, refill
the cup with water, and drink again.
• Encourage patient to avoid alcohol, aspirin
products, ibuprofen, and foods that may
increase gastric secretions during therapy.
Tell him to notify all prescribers about
prescription drug use.
• Advise patient to notify prescriber immediately
about abdominal pain or diarrhea.
• Urge female patient of childbearing age to
use effective contraception during therapy
and to inform prescriber immediately if
she is or suspects she may be pregnant.
Nursing Consideration Patient Teaching - Morphine Avinza Kadian MS Contin MSIR Oramorph SR Roxanol
morphine sulfate
Astramorph PF, Avinza, DepoDur,
Duramorph, Epimorph (CAN), Kadian,
M-Eslon (CAN), Morphine Extra-Forte
(CAN), Morphine Forte (CAN), Morphine
H.P. (CAN), Morphitec (CAN), MS Contin,
MSIR, MS/L, MS/L Concentrate, MS/S,
OMS Concentrate, Oramorph SR,
Rescudose, RMS Uniserts, Roxanol,
Roxanol 100, Roxanol UD, Statex (CAN)
Nursing Considerations
• Use cautiously in patients about to undergo
surgery of the biliary tract and patients
with acute pancreatitis secondary to biliary
tract disease because morphine may
cause spasm of the sphincter of Oddi.
• Store morphine at room temperature.
• Before giving morphine, make sure opioid
antagonist and equipment for oxygen
delivery and respiration are available.
• Before therapy, assess patient’s drug use,
including all prescription and OTC drugs.
• Expect prescriber to start patient who has
never received opioids on immediaterelease
form and then switch to E.R. form
if therapy must last longer than a few days.
• Keep in mind that when morphine is
given by epidural route, dosage must be
individualized according to patient’s age,
body mass, physical status, previous experience
with opioids, risk factors for respiratory
depression, and drugs to be coadministered
before or during surgery.
• Give oral form with food or milk to minimize
adverse GI reactions, if needed.
Solution can be mixed with fruit juice to
improve taste.
• If needed, open E.R. capsules and sprinkle
contents on applesauce (at room temperature
or cooler) just before giving to
patient. Make sure patient doesn’t chew or
crush capsules or dissolve capsule’s pellets
in his mouth.
• Be aware that E.R. forms of morphine
aren’t interchangeable.
• Discard injection solution that is discolored
or darker than pale yellow or that
contains precipitates that don’t dissolve
with shaking.
WARNING Don’t use highly concentrated
solutions (such as 10 to 25 mg/ml) for single-
dose I.V., I.M., or subcutaneous
administration. These solutions are
intended for use in continuous, controlled
microinfusion devices.
• For direct I.V. injection, dilute appropriate
dose with 4 to 5 ml of sterile water for
injection. Inject 2.5 to 15 mg directly into
tubing of free-flowing I.V. solution over 4
to 5 minutes. Rapid I.V. injection may
increase adverse reactions.
• For continuous I.V. infusion, dilute drug
in D5W and administer with infusioncontrol
device. Adjust dose and rate based
on patient response, as prescribed.
• Avoid I.M. route for long-term therapy
because of injection site irritation.
• During subcutaneous injection, take care
to avoid injecting drug intradermally.
• For intrathecal injection, expect prescriber
to give no more than 2 ml of 0.5-mg/ml
solution or 1 ml of 1-mg/ml solution.
Expect intrathecal dosage to be about onetenth
of epidural dosage.
• If rectal suppository is too soft to insert,
refrigerate for 30 minutes or run wrapped
suppository under cold tap water.
WARNING Monitor respiratory and cardio-
vascular status carefully and frequently
during morphine therapy. Be alert for respiratory
depression and hypotension.
•Monitor patient with seizure disorder for
increased seizure activity because morphine
may worsen the disorder.
•Monitor patient for excessive or persistent
sedation; dosage may need to be adjusted.
• If patient is receiving a continuous morphine
infusion, watch for and notify prescriber
about new neurologic signs or
symptoms. Inflammatory masses (such as
granulomas) have caused serious neurologic
reactions, including paralysis.
• Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body
aches, diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
• If tolerance to morphine develops, expect
prescriber to increase dosage.
•Morphine may have a prolonged duration
and cumulative effect in patients with
impaired hepatic or renal function. It also
may prolong labor by reducing strength,
duration, and frequency of uterine contractions.
•When discontinuing morphine in patients
receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about
one-half for 2 days and then by 25% every
2 days thereafter until total dose reaches
initial amount recommended for patients
who haven’t received opioids (15 to 30 mg
daily). This regimen minimizes the risk of
withdrawal symptoms.
PATIENT TEACHING
• Instruct patient to take morphine exactly
as prescribed and not to change dosage
without consulting prescriber.
• Explain that patient may take tablets or
capsules with food or milk to relieve GI
distress and may mix oral solution with
juice to improve taste.
• Urge patient not to break, chew, or crush
E.R. capsules and tablets to avoid rapid
release and, possibly, toxicity.
• For patient who has difficulty swallowing,
suggest that he open E.R. capsules and
sprinkle contents on food or liquids. Urge
him to take drug immediately and not let
capsule contents dissolve in his mouth.
• Instruct patient to moisten rectal suppository
before inserting it.
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Advise patient to avoid potentially hazardous
activities during morphine therapy.
• Tell patient to change positions slowly to
minimize the orthostatic hypotension.
• Instruct patient to notify prescriber about
worsening or breakthrough pain.
• Explain that morphine may be habitforming.
Urge him to notify prescriber if
he experiences anxiety, decreased appetite,
excessive tearing, irritability, muscle aches
or twitching, rapid heart rate, or yawning.
• Advise female patient to notify prescriber
if she becomes pregnant. Regular morphine
use during pregnancy may cause
physical dependence in fetus and withdrawal
in neonate.
Astramorph PF, Avinza, DepoDur,
Duramorph, Epimorph (CAN), Kadian,
M-Eslon (CAN), Morphine Extra-Forte
(CAN), Morphine Forte (CAN), Morphine
H.P. (CAN), Morphitec (CAN), MS Contin,
MSIR, MS/L, MS/L Concentrate, MS/S,
OMS Concentrate, Oramorph SR,
Rescudose, RMS Uniserts, Roxanol,
Roxanol 100, Roxanol UD, Statex (CAN)
Nursing Considerations
• Use cautiously in patients about to undergo
surgery of the biliary tract and patients
with acute pancreatitis secondary to biliary
tract disease because morphine may
cause spasm of the sphincter of Oddi.
• Store morphine at room temperature.
• Before giving morphine, make sure opioid
antagonist and equipment for oxygen
delivery and respiration are available.
• Before therapy, assess patient’s drug use,
including all prescription and OTC drugs.
• Expect prescriber to start patient who has
never received opioids on immediaterelease
form and then switch to E.R. form
if therapy must last longer than a few days.
• Keep in mind that when morphine is
given by epidural route, dosage must be
individualized according to patient’s age,
body mass, physical status, previous experience
with opioids, risk factors for respiratory
depression, and drugs to be coadministered
before or during surgery.
• Give oral form with food or milk to minimize
adverse GI reactions, if needed.
Solution can be mixed with fruit juice to
improve taste.
• If needed, open E.R. capsules and sprinkle
contents on applesauce (at room temperature
or cooler) just before giving to
patient. Make sure patient doesn’t chew or
crush capsules or dissolve capsule’s pellets
in his mouth.
• Be aware that E.R. forms of morphine
aren’t interchangeable.
• Discard injection solution that is discolored
or darker than pale yellow or that
contains precipitates that don’t dissolve
with shaking.
WARNING Don’t use highly concentrated
solutions (such as 10 to 25 mg/ml) for single-
dose I.V., I.M., or subcutaneous
administration. These solutions are
intended for use in continuous, controlled
microinfusion devices.
• For direct I.V. injection, dilute appropriate
dose with 4 to 5 ml of sterile water for
injection. Inject 2.5 to 15 mg directly into
tubing of free-flowing I.V. solution over 4
to 5 minutes. Rapid I.V. injection may
increase adverse reactions.
• For continuous I.V. infusion, dilute drug
in D5W and administer with infusioncontrol
device. Adjust dose and rate based
on patient response, as prescribed.
• Avoid I.M. route for long-term therapy
because of injection site irritation.
• During subcutaneous injection, take care
to avoid injecting drug intradermally.
• For intrathecal injection, expect prescriber
to give no more than 2 ml of 0.5-mg/ml
solution or 1 ml of 1-mg/ml solution.
Expect intrathecal dosage to be about onetenth
of epidural dosage.
• If rectal suppository is too soft to insert,
refrigerate for 30 minutes or run wrapped
suppository under cold tap water.
WARNING Monitor respiratory and cardio-
vascular status carefully and frequently
during morphine therapy. Be alert for respiratory
depression and hypotension.
•Monitor patient with seizure disorder for
increased seizure activity because morphine
may worsen the disorder.
•Monitor patient for excessive or persistent
sedation; dosage may need to be adjusted.
• If patient is receiving a continuous morphine
infusion, watch for and notify prescriber
about new neurologic signs or
symptoms. Inflammatory masses (such as
granulomas) have caused serious neurologic
reactions, including paralysis.
• Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body
aches, diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
• If tolerance to morphine develops, expect
prescriber to increase dosage.
•Morphine may have a prolonged duration
and cumulative effect in patients with
impaired hepatic or renal function. It also
may prolong labor by reducing strength,
duration, and frequency of uterine contractions.
•When discontinuing morphine in patients
receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about
one-half for 2 days and then by 25% every
2 days thereafter until total dose reaches
initial amount recommended for patients
who haven’t received opioids (15 to 30 mg
daily). This regimen minimizes the risk of
withdrawal symptoms.
PATIENT TEACHING
• Instruct patient to take morphine exactly
as prescribed and not to change dosage
without consulting prescriber.
• Explain that patient may take tablets or
capsules with food or milk to relieve GI
distress and may mix oral solution with
juice to improve taste.
• Urge patient not to break, chew, or crush
E.R. capsules and tablets to avoid rapid
release and, possibly, toxicity.
• For patient who has difficulty swallowing,
suggest that he open E.R. capsules and
sprinkle contents on food or liquids. Urge
him to take drug immediately and not let
capsule contents dissolve in his mouth.
• Instruct patient to moisten rectal suppository
before inserting it.
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Advise patient to avoid potentially hazardous
activities during morphine therapy.
• Tell patient to change positions slowly to
minimize the orthostatic hypotension.
• Instruct patient to notify prescriber about
worsening or breakthrough pain.
• Explain that morphine may be habitforming.
Urge him to notify prescriber if
he experiences anxiety, decreased appetite,
excessive tearing, irritability, muscle aches
or twitching, rapid heart rate, or yawning.
• Advise female patient to notify prescriber
if she becomes pregnant. Regular morphine
use during pregnancy may cause
physical dependence in fetus and withdrawal
in neonate.
Nursing Consideration Patient Teaching - Metoprolol Lopressor Metoprolol Succinate ER Toprol-XL Metoprolol Tartrate
metoprolol
succinate
Toprol-XL
metoprolol tartrate
Apo-Metoprolol (CAN), Betaloc (CAN),
Betaloc Durules (CAN), Lopresor (CAN),
Lopresor SR (CAN), Lopressor,
Novometoprol (CAN)
Nursing Considerations
• Use metoprolol with extreme caution in
patients with bronchospastic disease who
don’t respond to or can’t tolerate other
antihypertensives. Expect to give smaller
doses more often to avoid the higher plasma
levels in longer dosage intervals.
• Use cautiously in patients with hypertension
or angina who have congestive heart
failure because beta blockers such as
metoprolol can further depress myocardial
contractility, worsening heart failure.
• For patient with acute MI who can’t tolerate
initial dosage or who delays treatment,
start with maintenance dosage, as prescribed
and tolerated.
• Before starting therapy for heart failure,
expect to give a diuretic, an ACE inhibitor,
and digoxin to stabilize patient.
• If patient has pheochromocytoma, alpha
blocker therapy should start first, followed
by metoprolol to prevent paradoxical
increase in blood pressure from attenuation
of beta-mediated vasodilation in
skeletal muscle.
• Be aware that metoprolol dosage for heart
failure is highly individualized.Monitor
patient for evidence of worsening heart
failure during dosage increases. If heart
failure worsens, expect to increase diuretic
dosage and possibly decrease metoprolol
dosage or temporarily discontinue drug, as
prescribed.Metoprolol dosage shouldn’t
be increased until worsening heart failure
has been stabilized.
• If patient with heart failure develops
symptomatic bradycardia, expect to
decrease the metoprolol dosage.
WARNING If dosage exceeds 400 mg daily,
monitor patient for bronchospasm and
dyspnea because metoprolol competitively
blocks beta2-adrenergic receptors in
bronchial and vascular smooth muscles.
WARNING When substituting metoprolol for
clonidine, expect to gradually reduce
clonidine and increase metoprolol dosage
over several days. Given together, these
drugs have additive hypotensive effects.
• Patients who take metoprolol may be at
risk for AV block. If AV block results from
depressed AV node conduction, prepare to
give appropriate drug, as ordered, or assist
with insertion of temporary pacemaker.
• Check for signs of poor glucose control in
patient with diabetes mellitus. Metoprolol
may interfere with therapeutic effects of
insulin and oral antidiabetic drugs. It also
may mask evidence of hypoglycemia, such
as palpitations, tachycardia, and tremor.
•Monitor patient with peripheral vascular
disease for evidence of arterial insufficiency
(pain, pallor, and coldness in affected
extremity) Metoprolol can precipitate or
aggravate peripheral vascular disease.
WARNING Expect to taper dosage over 1 to
2 weeks when drug is discontinued; stopping
abruptly can cause myocardial
ischemia, MI, ventricular arrhythmias, or
severe hypertension, especially in patients
with cardiac disease. Abrupt withdrawal
also may cause thyroid storm in a patient
with hyperthyroidism or thyrotoxicosis.
PATIENT TEACHING
• Instruct patient to take metoprolol with
food at the same time each day—once
daily for E.R. tablets. Explain that he may
halve tablets but not chew or crush them.
• Advise patient to notify prescriber if pulse
rate falls below 60 beats/minute or is significantly
lower than usual.
• Urge diabetic patient to check blood glucose
level often during therapy.
• Caution patient not to stop drug abruptly.
succinate
Toprol-XL
metoprolol tartrate
Apo-Metoprolol (CAN), Betaloc (CAN),
Betaloc Durules (CAN), Lopresor (CAN),
Lopresor SR (CAN), Lopressor,
Novometoprol (CAN)
Nursing Considerations
• Use metoprolol with extreme caution in
patients with bronchospastic disease who
don’t respond to or can’t tolerate other
antihypertensives. Expect to give smaller
doses more often to avoid the higher plasma
levels in longer dosage intervals.
• Use cautiously in patients with hypertension
or angina who have congestive heart
failure because beta blockers such as
metoprolol can further depress myocardial
contractility, worsening heart failure.
• For patient with acute MI who can’t tolerate
initial dosage or who delays treatment,
start with maintenance dosage, as prescribed
and tolerated.
• Before starting therapy for heart failure,
expect to give a diuretic, an ACE inhibitor,
and digoxin to stabilize patient.
• If patient has pheochromocytoma, alpha
blocker therapy should start first, followed
by metoprolol to prevent paradoxical
increase in blood pressure from attenuation
of beta-mediated vasodilation in
skeletal muscle.
• Be aware that metoprolol dosage for heart
failure is highly individualized.Monitor
patient for evidence of worsening heart
failure during dosage increases. If heart
failure worsens, expect to increase diuretic
dosage and possibly decrease metoprolol
dosage or temporarily discontinue drug, as
prescribed.Metoprolol dosage shouldn’t
be increased until worsening heart failure
has been stabilized.
• If patient with heart failure develops
symptomatic bradycardia, expect to
decrease the metoprolol dosage.
WARNING If dosage exceeds 400 mg daily,
monitor patient for bronchospasm and
dyspnea because metoprolol competitively
blocks beta2-adrenergic receptors in
bronchial and vascular smooth muscles.
WARNING When substituting metoprolol for
clonidine, expect to gradually reduce
clonidine and increase metoprolol dosage
over several days. Given together, these
drugs have additive hypotensive effects.
• Patients who take metoprolol may be at
risk for AV block. If AV block results from
depressed AV node conduction, prepare to
give appropriate drug, as ordered, or assist
with insertion of temporary pacemaker.
• Check for signs of poor glucose control in
patient with diabetes mellitus. Metoprolol
may interfere with therapeutic effects of
insulin and oral antidiabetic drugs. It also
may mask evidence of hypoglycemia, such
as palpitations, tachycardia, and tremor.
•Monitor patient with peripheral vascular
disease for evidence of arterial insufficiency
(pain, pallor, and coldness in affected
extremity) Metoprolol can precipitate or
aggravate peripheral vascular disease.
WARNING Expect to taper dosage over 1 to
2 weeks when drug is discontinued; stopping
abruptly can cause myocardial
ischemia, MI, ventricular arrhythmias, or
severe hypertension, especially in patients
with cardiac disease. Abrupt withdrawal
also may cause thyroid storm in a patient
with hyperthyroidism or thyrotoxicosis.
PATIENT TEACHING
• Instruct patient to take metoprolol with
food at the same time each day—once
daily for E.R. tablets. Explain that he may
halve tablets but not chew or crush them.
• Advise patient to notify prescriber if pulse
rate falls below 60 beats/minute or is significantly
lower than usual.
• Urge diabetic patient to check blood glucose
level often during therapy.
• Caution patient not to stop drug abruptly.
Nursing Consideration Patient Teaching - Methocarbamol Robaxin
methocarbamol
Carbacot, Robaxin, Robaxin 750, Skelex
Nursing Considerations
• If needed, crush methocarbamol tablets
and mix with water for administration by
NG tube.
• Give I.V. form directly through infusion
line at 3 ml/min. To prepare solution, add
10 ml to no more than 250 ml D5W or
normal saline solution. Infuse at no more
than 300 mg (3 ml)/ min to avoid hypotension
and seizures.
• Keep patient recumbent during I.V.
administration and for at least 15 minutes
afterward. Then have him rise slowly.
•Monitor I.V. site regularly for signs of
phlebitis.
• Inject I.M. form deep into large muscle,
such as the gluteus. Give no more than
5 ml/dose every 8 hours. One dose is usually
adequate.
• Don’t give methocarbamol by subcutaneous
route.
• Keep epinephrine, antihistamines, and
corticosteroids available in case patient
experiences anaphylactic reaction.
• Be aware that the parenteral dosage form
shouldn’t be used in patients with renal
dysfunction because the polyethylene glycol
300 vehicle is nephrotoxic.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
• Advise patient to take drug with food or
milk to avoid nausea.
• Inform patient that urine may turn green,
black, or brown until mehtocarbamol is
discontinued.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient to avoid alcohol and other
CNS depressants during therapy.
Carbacot, Robaxin, Robaxin 750, Skelex
Nursing Considerations
• If needed, crush methocarbamol tablets
and mix with water for administration by
NG tube.
• Give I.V. form directly through infusion
line at 3 ml/min. To prepare solution, add
10 ml to no more than 250 ml D5W or
normal saline solution. Infuse at no more
than 300 mg (3 ml)/ min to avoid hypotension
and seizures.
• Keep patient recumbent during I.V.
administration and for at least 15 minutes
afterward. Then have him rise slowly.
•Monitor I.V. site regularly for signs of
phlebitis.
• Inject I.M. form deep into large muscle,
such as the gluteus. Give no more than
5 ml/dose every 8 hours. One dose is usually
adequate.
• Don’t give methocarbamol by subcutaneous
route.
• Keep epinephrine, antihistamines, and
corticosteroids available in case patient
experiences anaphylactic reaction.
• Be aware that the parenteral dosage form
shouldn’t be used in patients with renal
dysfunction because the polyethylene glycol
300 vehicle is nephrotoxic.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
• Advise patient to take drug with food or
milk to avoid nausea.
• Inform patient that urine may turn green,
black, or brown until mehtocarbamol is
discontinued.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient to avoid alcohol and other
CNS depressants during therapy.
Nursing Consideration Patient Teaching - Methadone Diskets Dolophine Methadose
methadone
hydrochloride
Dolophine, Methadose
Nursing Considerations
• Before giving methadone, make sure opioid
antagonist and equipment for administering
oxygen and controlling respiration
are nearby.
• Before therapy begins, assess patient’s current
drug use, including all prescription
and OTC drugs.
WARNING Give drug cautiously to patients
at risk for a prolonged QT interval, such as
those with cardiac hypertrophy, hypokalemia,
or hypomagnesemia; those with a
history of cardiac conduction abnormalities;
and those taking diuretics or medications
that affect cardiac conduction.
• Dilute oral concentrate with water or
another liquid to volume of at least 30 ml,
but preferably to 90 ml or more, before
administration. Dissolve dispersible tablets
in water or another liquid before giving.
•Monitor patient for expected excessive
drowsiness, unsteadiness, or confusion
during first 3 to 5 days of therapy, and
notify prescriber if effects continue to
worsen or persist beyond this time.
WARNING Monitor respiratory and circulatory
status carefully and often during
methadone therapy because respiratory
depression, circulatory depression, respiratory
arrest, shock, hypotension, and cardiac
arrest are risks. Monitor children
often for respiratory depression and paradoxical
CNS excitation because of their
increased sensitivity to drug. Assess
patient for excessive or persistent sedation;
dosage may need to be adjusted.
•Watch for drug tolerance, especially in
patients with a history of chronic drug
abuse, because methadone can cause physical
and psychological dependence.
•Monitor patient for pain because maintenance
dosage doesn’t provide pain relief;
patients with tolerance to opiate agonists,
including those with chronic cancer pain,
may require a higher dosage.
•Monitor patients who are pregnant or
who have liver or renal impairment for
increased adverse effects from methadone
because drug may have a prolonged duration
and cumulative effect in these
patients. Methadone may prolong labor by
reducing strength, duration, and frequency
of uterine contractions, so expect dosage
to be tapered before third trimester of
pregnancy. Breast-feeding mothers on
maintenance therapy put their infants at
risk of withdrawal symptoms if they
abruptly stop breast-feeding or discontinue
methadone therapy.Methadone also
accumulates in CNS tissue, increasing the
risk of seizures in infants.
• Check plasma amylase and lipase levels in
patients who develop biliary tract spasms
because levels may increase up to 15 times
normal. Notify prescriber immediately of
any significant or sustained increase.
•Monitor patients who have head injuries
or other conditions that may increase
intracranial pressure (ICP) because
methadone may further increase ICP.
• Assess patient for withdrawal symptoms
and tolerance to therapy because physiologic
dependence can occur with longterm
methadone use. Avoid abrupt discontinuation
because withdrawal symptoms
will occur within 3 to 4 days after last
dose.
•Monitor patients, especially the elderly, for
cardiac arrhythmias, hypotension,
hypovolemia, orthostatic hypotension, and
vasovagal syncope because methadone
may produce cholinergic effects in patients
with cardiac disease, resulting in bradycardia
and peripheral vasodilation; dosage
decrease may be indicated.
•Monitor patients with prostatic hypertrophy,
urethral stricture, or renal disease for
urine retention and oliguria because
methadone can increase tension of detrusor
muscle.
• Be prepared to treat patient’s symptoms of
anxiety, and be aware that anxiety may be
confused with symptoms of opioid absti-
nence and that methadone doesn’t have
antianxiety effects.
PATIENT TEACHING
• Instruct patient taking oral concentrate
form of methadone to dilute it with water
or another liquid to a volume of at least 30
ml and preferably to 90 ml or more before
administration.
• Instruct patient to dissolve dispersible
tablets in water or other liquid before
administration.
• Advise patient to notify prescriber of all
other drugs he’s currently taking and to
avoid alcohol and other depressants, such
as sleeping pills and tranquilizers, because
they may increase drug’s CNS depressant
effects.
• Instruct patient to take drug only as prescribed
and not to change dosage without
prescriber approval. Inform patient that
abrupt cessation of methadone therapy
can precipitate withdrawal symptoms.
Urge him to notify prescriber if he develops
any concerns over therapy.
• Urge patient to notify prescriber if he
experiences palpitations, dizziness, lightheadedness,
or syncope, which may be
caused by methadone-induced arrhythmias.
• Instruct patient to avoid potentially hazardous
activities or those that require
mental alertness because methadone therapy
may cause drowsiness or sleepiness.
• Teach patient to change positions slowly to
minimize the effects of orthostatic hypotension.
• Instruct patient to notify prescriber of
worsening or breakthrough pain because
dosage may need to be adjusted.
• Inform parents that a child on methadone
maintenance therapy may become unusually
excited or restless; advise them to
notify prescriber of changes in child’s
behavior.
• Instruct female patient to notify prescriber
immediately if she becomes pregnant during
methadone therapy because drug may
cause physical dependence in fetus and
withdrawal symptoms in neonate.
• Caution patient who is breast-feeding not
to stop doing so abruptly and not to stop
taking methadone without prescriber’s
approval because infant may experience
withdrawal symptoms.
hydrochloride
Dolophine, Methadose
Nursing Considerations
• Before giving methadone, make sure opioid
antagonist and equipment for administering
oxygen and controlling respiration
are nearby.
• Before therapy begins, assess patient’s current
drug use, including all prescription
and OTC drugs.
WARNING Give drug cautiously to patients
at risk for a prolonged QT interval, such as
those with cardiac hypertrophy, hypokalemia,
or hypomagnesemia; those with a
history of cardiac conduction abnormalities;
and those taking diuretics or medications
that affect cardiac conduction.
• Dilute oral concentrate with water or
another liquid to volume of at least 30 ml,
but preferably to 90 ml or more, before
administration. Dissolve dispersible tablets
in water or another liquid before giving.
•Monitor patient for expected excessive
drowsiness, unsteadiness, or confusion
during first 3 to 5 days of therapy, and
notify prescriber if effects continue to
worsen or persist beyond this time.
WARNING Monitor respiratory and circulatory
status carefully and often during
methadone therapy because respiratory
depression, circulatory depression, respiratory
arrest, shock, hypotension, and cardiac
arrest are risks. Monitor children
often for respiratory depression and paradoxical
CNS excitation because of their
increased sensitivity to drug. Assess
patient for excessive or persistent sedation;
dosage may need to be adjusted.
•Watch for drug tolerance, especially in
patients with a history of chronic drug
abuse, because methadone can cause physical
and psychological dependence.
•Monitor patient for pain because maintenance
dosage doesn’t provide pain relief;
patients with tolerance to opiate agonists,
including those with chronic cancer pain,
may require a higher dosage.
•Monitor patients who are pregnant or
who have liver or renal impairment for
increased adverse effects from methadone
because drug may have a prolonged duration
and cumulative effect in these
patients. Methadone may prolong labor by
reducing strength, duration, and frequency
of uterine contractions, so expect dosage
to be tapered before third trimester of
pregnancy. Breast-feeding mothers on
maintenance therapy put their infants at
risk of withdrawal symptoms if they
abruptly stop breast-feeding or discontinue
methadone therapy.Methadone also
accumulates in CNS tissue, increasing the
risk of seizures in infants.
• Check plasma amylase and lipase levels in
patients who develop biliary tract spasms
because levels may increase up to 15 times
normal. Notify prescriber immediately of
any significant or sustained increase.
•Monitor patients who have head injuries
or other conditions that may increase
intracranial pressure (ICP) because
methadone may further increase ICP.
• Assess patient for withdrawal symptoms
and tolerance to therapy because physiologic
dependence can occur with longterm
methadone use. Avoid abrupt discontinuation
because withdrawal symptoms
will occur within 3 to 4 days after last
dose.
•Monitor patients, especially the elderly, for
cardiac arrhythmias, hypotension,
hypovolemia, orthostatic hypotension, and
vasovagal syncope because methadone
may produce cholinergic effects in patients
with cardiac disease, resulting in bradycardia
and peripheral vasodilation; dosage
decrease may be indicated.
•Monitor patients with prostatic hypertrophy,
urethral stricture, or renal disease for
urine retention and oliguria because
methadone can increase tension of detrusor
muscle.
• Be prepared to treat patient’s symptoms of
anxiety, and be aware that anxiety may be
confused with symptoms of opioid absti-
nence and that methadone doesn’t have
antianxiety effects.
PATIENT TEACHING
• Instruct patient taking oral concentrate
form of methadone to dilute it with water
or another liquid to a volume of at least 30
ml and preferably to 90 ml or more before
administration.
• Instruct patient to dissolve dispersible
tablets in water or other liquid before
administration.
• Advise patient to notify prescriber of all
other drugs he’s currently taking and to
avoid alcohol and other depressants, such
as sleeping pills and tranquilizers, because
they may increase drug’s CNS depressant
effects.
• Instruct patient to take drug only as prescribed
and not to change dosage without
prescriber approval. Inform patient that
abrupt cessation of methadone therapy
can precipitate withdrawal symptoms.
Urge him to notify prescriber if he develops
any concerns over therapy.
• Urge patient to notify prescriber if he
experiences palpitations, dizziness, lightheadedness,
or syncope, which may be
caused by methadone-induced arrhythmias.
• Instruct patient to avoid potentially hazardous
activities or those that require
mental alertness because methadone therapy
may cause drowsiness or sleepiness.
• Teach patient to change positions slowly to
minimize the effects of orthostatic hypotension.
• Instruct patient to notify prescriber of
worsening or breakthrough pain because
dosage may need to be adjusted.
• Inform parents that a child on methadone
maintenance therapy may become unusually
excited or restless; advise them to
notify prescriber of changes in child’s
behavior.
• Instruct female patient to notify prescriber
immediately if she becomes pregnant during
methadone therapy because drug may
cause physical dependence in fetus and
withdrawal symptoms in neonate.
• Caution patient who is breast-feeding not
to stop doing so abruptly and not to stop
taking methadone without prescriber’s
approval because infant may experience
withdrawal symptoms.
Nursing Consideration Patient Teaching - Metformin Fortamet Glucophage Glucophage XR Glumetza, Riomet
metformin
hydrochloride
Fortamet, Gen-Metformin (CAN),
Glucophage, Glucophage XR,
Glumetza, Glycon (CAN), Novo-
Metformin (CAN), Riomet
Nursing Considerations
• Give metformin tablets with food, which
decreases and slightly delays absorption,
thus reducing risk of adverse GI reactions.
Give E.R. tablets with evening meal; don’t
break or crush them.
• Expect prescriber to alter dosage if patient
has a condition that decreases or delays
gastric emptying, such as diarrhea, gastroparesis,
GI obstruction, ileus, or vomiting.
• Expect to assess BUN and serum creatinine
level before and during long-term
therapy in those at increased risk for lactic
acidosis.
•Monitor patient’s hepatic function, as
ordered, because impaired hepatic function
may significantly reduce the liver’s
ability to clear lactate, predisposing the
patient to lactic acidosis.
•Monitor patient’s blood glucose level to
evaluate drug effectiveness. Assess for
hyperglycemia and the need for insulin
during times of increased stress, such as
infection and surgery.
•Withhold drug, as ordered, if patient
becomes dehydrated or develops hypoxemia
or sepsis because these conditions
increase the risk of lactic acidosis.
• Iodinated contrast media used in radiographic
studies increases risk of renal
failure and lactic acidosis during metformin
therapy. Expect to withhold drug
for 48 hours before and after testing.
PATIENT TEACHING
• Instruct patient to take metformin tablet
at breakfast if taking drug once a day or at
breakfast and dinner if taking drug twice a
day. Instruct him to take E.R. tablets once
daily with evening meal and to swallow
them whole without crushing or chewing.
• Direct patient to take drug exactly as prescribed
and not to change the dosage or
frequency unless instructed.
• Stress importance of following prescribed
diet, exercising regularly, controlling
weight, and checking blood glucose level.
• Teach patient how to measure blood glucose
level and recognize hyperglycemia
and hypoglycemia. Urge him to notify prescriber
of abnormal blood glucose level.
• Caution patient to avoid alcohol, which
can increase the risk of hypoglycemia.
• Instruct patient to report early signs of lactic
acidosis, including drowsiness, hyperventilation,
malaise, and muscle pain.
• Advise patient to expect laboratory testing
of glycosylated hemoglobin every
3 months until blood glucose is controlled.
hydrochloride
Fortamet, Gen-Metformin (CAN),
Glucophage, Glucophage XR,
Glumetza, Glycon (CAN), Novo-
Metformin (CAN), Riomet
Nursing Considerations
• Give metformin tablets with food, which
decreases and slightly delays absorption,
thus reducing risk of adverse GI reactions.
Give E.R. tablets with evening meal; don’t
break or crush them.
• Expect prescriber to alter dosage if patient
has a condition that decreases or delays
gastric emptying, such as diarrhea, gastroparesis,
GI obstruction, ileus, or vomiting.
• Expect to assess BUN and serum creatinine
level before and during long-term
therapy in those at increased risk for lactic
acidosis.
•Monitor patient’s hepatic function, as
ordered, because impaired hepatic function
may significantly reduce the liver’s
ability to clear lactate, predisposing the
patient to lactic acidosis.
•Monitor patient’s blood glucose level to
evaluate drug effectiveness. Assess for
hyperglycemia and the need for insulin
during times of increased stress, such as
infection and surgery.
•Withhold drug, as ordered, if patient
becomes dehydrated or develops hypoxemia
or sepsis because these conditions
increase the risk of lactic acidosis.
• Iodinated contrast media used in radiographic
studies increases risk of renal
failure and lactic acidosis during metformin
therapy. Expect to withhold drug
for 48 hours before and after testing.
PATIENT TEACHING
• Instruct patient to take metformin tablet
at breakfast if taking drug once a day or at
breakfast and dinner if taking drug twice a
day. Instruct him to take E.R. tablets once
daily with evening meal and to swallow
them whole without crushing or chewing.
• Direct patient to take drug exactly as prescribed
and not to change the dosage or
frequency unless instructed.
• Stress importance of following prescribed
diet, exercising regularly, controlling
weight, and checking blood glucose level.
• Teach patient how to measure blood glucose
level and recognize hyperglycemia
and hypoglycemia. Urge him to notify prescriber
of abnormal blood glucose level.
• Caution patient to avoid alcohol, which
can increase the risk of hypoglycemia.
• Instruct patient to report early signs of lactic
acidosis, including drowsiness, hyperventilation,
malaise, and muscle pain.
• Advise patient to expect laboratory testing
of glycosylated hemoglobin every
3 months until blood glucose is controlled.
Nursing Consideration Patient Teaching - Lyrica pregabalin
pregabalin
Lyrica
Nursing Considerations
• Pregabalin therapy should be stopped
gradually over at least 1 week to decrease
risk of seizure activity and avoid unpleasant
symptoms such as diarrhea, headache,
insomnia, and nausea.
• If patient has evidence of hypersensitivity
(red skin, urticaria, rash, dyspnea, facial
swelling, wheezing), stop drug at once,
notify prescriber, and give supportive care.
•Monitor patient closely for adverse reactions.
Notify prescriber if significant
adverse reactions persist.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
•Warn against stopping pregabalin abruptly.
• Urge patient to avoid hazardous activities
until she knows how drug affects her.
• Instruct patient to notify prescriber if she
has changes in vision or unexplained muscle
pain, tenderness, or weakness, especially
if these muscle symptoms are accompanied
by malaise or fever.
• Alert patient that drug may cause edema
and weight gain.
• If patient also takes a thiazolidinedione
antidiabetic, tell her these effects may be
intensified. If significant, tell patient to
notify prescriber.
• Inform male patient who plans to father a
child that drug could impair his fertility.
• Instruct diabetic patients to inspect their
skin while taking pregabalin.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes and
to report concerns at once to prescriber.
• Urge woman who becomes pregnant while
taking pregabalin for seizures to enroll in
the North American antiepileptic drug
pregnancy registry by calling 1-888-233-
2334. Explain that the registry is collecting
information about the safety of antiepileptic
drugs during pregnancy
Lyrica
Nursing Considerations
• Pregabalin therapy should be stopped
gradually over at least 1 week to decrease
risk of seizure activity and avoid unpleasant
symptoms such as diarrhea, headache,
insomnia, and nausea.
• If patient has evidence of hypersensitivity
(red skin, urticaria, rash, dyspnea, facial
swelling, wheezing), stop drug at once,
notify prescriber, and give supportive care.
•Monitor patient closely for adverse reactions.
Notify prescriber if significant
adverse reactions persist.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
•Warn against stopping pregabalin abruptly.
• Urge patient to avoid hazardous activities
until she knows how drug affects her.
• Instruct patient to notify prescriber if she
has changes in vision or unexplained muscle
pain, tenderness, or weakness, especially
if these muscle symptoms are accompanied
by malaise or fever.
• Alert patient that drug may cause edema
and weight gain.
• If patient also takes a thiazolidinedione
antidiabetic, tell her these effects may be
intensified. If significant, tell patient to
notify prescriber.
• Inform male patient who plans to father a
child that drug could impair his fertility.
• Instruct diabetic patients to inspect their
skin while taking pregabalin.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes and
to report concerns at once to prescriber.
• Urge woman who becomes pregnant while
taking pregabalin for seizures to enroll in
the North American antiepileptic drug
pregnancy registry by calling 1-888-233-
2334. Explain that the registry is collecting
information about the safety of antiepileptic
drugs during pregnancy
Nursing Consideration Patient Teaching - Lisinopril Prinivil Zestril
lisinopril
Prinivil, Zestril
Nursing Considerations
• Use lisinopril cautiously in patients with
fluid volume deficit, heart failure, impaired
renal function, or sodium depletion.
• To prepare pediatric suspension, add
10 ml purified water to a polyethylene
terephthalate (PET) bottle containing ten
20-mg tablets and shake for at least
1 minute. Add 30 ml of Bicitra diluent and
160 ml of Ora-Sweet SF to concentrate in
PET bottle and shake gently for several
seconds. Refrigerate up to 4 weeks. Shake
suspension before each use.
•Monitor blood pressure often, especially
early in treatment. If excessive hypotension
develops, expect to withhold drug
for several days.
WARNING If angioedema affects face, glottis,
larynx, limbs, lips, mucous mem-
branes, or tongue, notify prescriber immediately
and expect to stop lisinopril and
start appropriate therapy at once. If airway
obstruction threatens, promptly give 0.3 to
0.5 ml of epinephrine 1:1,000 solution
subcutaneously, as prescribed.
•Monitor patient for anaphylaxis, especially
patient being dialyzed with high-flux
membranes and treated with an ACE
inhibitor such as lisinopril. If anaphylaxis
occurs, stop dialysis immediately and treat
aggressively (antihistamines are ineffective
in this situation), as ordered. Anaphylaxis
has also occurred with some patients
undergoing low-density lipoprotein
apheresis with dextran sulfate absorption.
• Notify prescriber if patient has persistent,
nonproductive cough, a common adverse
effect of ACE inhibitors such as lisinopril.
•Monitor for dehydration, which can lead
to hypotension. Be aware that diarrhea
and vomiting can cause dehydration.
•Monitor patient for hepatic dysfunction
because lisinopril, an ACE inhibitor, may
rarely cause a syndrome that starts with
cholestatic jaundice or hepatitis and progresses
to fulminant hepatic necrosis. If
patient develops jaundice or a marked elevation
in liver enzyme levels, withhold
drug and notify prescriber.
• If patient takes insulin or an oral antidiabetic,
monitor blood glucose level closely
because risk of hypoglycemia increases,
especially during first month of therapy.
PATIENT TEACHING
• Explain that lisinopril helps to control but
doesn’t cure hypertension and that patient
may need lifelong therapy.
• Advise patient to take lisinopril at the
same time every day.
• Emphasize need to take drug as ordered,
even if patient feels well; caution her not
to stop drug without consulting prescriber.
• Instruct patient to report dizziness, especially
during first few days of therapy.
• Inform patient that persistent, nonproductive
cough may develop during lisinopril
therapy. Urge her to notify prescriber
immediately if cough becomes difficult to
tolerate.
• Advise patient to drink adequate fluid and
avoid excessive sweating, which can lead to
dehydration and hypotension.Make sure
she understands that diarrhea and vomiting
also can cause hypotension.
• Caution patient not to use salt substitutes
that contain potassium.
• Instruct patient to report signs of infection,
such as fever and sore throat, which
may indicate neutropenia.
• Advise patient to change position slowly to
minimize orthostatic hypotension.
• If patient has diabetes and takes insulin or
an oral antidiabetic, urge her to monitor
her blood glucose level closely and watch
for symptoms of hypoglycemia.
• Caution female patient to notify prescriber
immediately if she is or could be pregnant.
Prinivil, Zestril
Nursing Considerations
• Use lisinopril cautiously in patients with
fluid volume deficit, heart failure, impaired
renal function, or sodium depletion.
• To prepare pediatric suspension, add
10 ml purified water to a polyethylene
terephthalate (PET) bottle containing ten
20-mg tablets and shake for at least
1 minute. Add 30 ml of Bicitra diluent and
160 ml of Ora-Sweet SF to concentrate in
PET bottle and shake gently for several
seconds. Refrigerate up to 4 weeks. Shake
suspension before each use.
•Monitor blood pressure often, especially
early in treatment. If excessive hypotension
develops, expect to withhold drug
for several days.
WARNING If angioedema affects face, glottis,
larynx, limbs, lips, mucous mem-
branes, or tongue, notify prescriber immediately
and expect to stop lisinopril and
start appropriate therapy at once. If airway
obstruction threatens, promptly give 0.3 to
0.5 ml of epinephrine 1:1,000 solution
subcutaneously, as prescribed.
•Monitor patient for anaphylaxis, especially
patient being dialyzed with high-flux
membranes and treated with an ACE
inhibitor such as lisinopril. If anaphylaxis
occurs, stop dialysis immediately and treat
aggressively (antihistamines are ineffective
in this situation), as ordered. Anaphylaxis
has also occurred with some patients
undergoing low-density lipoprotein
apheresis with dextran sulfate absorption.
• Notify prescriber if patient has persistent,
nonproductive cough, a common adverse
effect of ACE inhibitors such as lisinopril.
•Monitor for dehydration, which can lead
to hypotension. Be aware that diarrhea
and vomiting can cause dehydration.
•Monitor patient for hepatic dysfunction
because lisinopril, an ACE inhibitor, may
rarely cause a syndrome that starts with
cholestatic jaundice or hepatitis and progresses
to fulminant hepatic necrosis. If
patient develops jaundice or a marked elevation
in liver enzyme levels, withhold
drug and notify prescriber.
• If patient takes insulin or an oral antidiabetic,
monitor blood glucose level closely
because risk of hypoglycemia increases,
especially during first month of therapy.
PATIENT TEACHING
• Explain that lisinopril helps to control but
doesn’t cure hypertension and that patient
may need lifelong therapy.
• Advise patient to take lisinopril at the
same time every day.
• Emphasize need to take drug as ordered,
even if patient feels well; caution her not
to stop drug without consulting prescriber.
• Instruct patient to report dizziness, especially
during first few days of therapy.
• Inform patient that persistent, nonproductive
cough may develop during lisinopril
therapy. Urge her to notify prescriber
immediately if cough becomes difficult to
tolerate.
• Advise patient to drink adequate fluid and
avoid excessive sweating, which can lead to
dehydration and hypotension.Make sure
she understands that diarrhea and vomiting
also can cause hypotension.
• Caution patient not to use salt substitutes
that contain potassium.
• Instruct patient to report signs of infection,
such as fever and sore throat, which
may indicate neutropenia.
• Advise patient to change position slowly to
minimize orthostatic hypotension.
• If patient has diabetes and takes insulin or
an oral antidiabetic, urge her to monitor
her blood glucose level closely and watch
for symptoms of hypoglycemia.
• Caution female patient to notify prescriber
immediately if she is or could be pregnant.
Nursing Consideration Patient Teaching - Lipitor atorvastatin
atorvastatin calcium
Lipitor
Nursing Considerations
• Atorvastatin is used in patients with
homozygous familial hypercholesterolemia
as an adjunct to other lipid-lowering treatments
or alone only if other treatments
aren’t available.
• Atorvastatin may be used with colestipol
or cholestyramine for additive antihyperlipidemic
effects.
• Expect atorvastatin to be used in patients
without obvious coronary artery disease
(CAD) but with multiple risk factors (such
as age 55 or over, smoker, history of
hypertension or low HDL level, or family
history of early CAD). Drug is used to
reduce risk of MI, angina, and adverse
effects of revascularization procedures.
• Also expect drug to be used in patients
with type 2 diabetes who have no obvious
CAD but multiple risk factors, such as
retinopathy, albuminuria, smoking, or
hypertension. Drug is used in these
patients to reduce risk of MI and stroke.
• Expect liver function tests to be performed
before atorvastatin therapy starts, after
6 and 12 weeks, with each dosage increase,
and every 6 months thereafter.
• Expect to measure lipid levels 2 to 4 weeks
after therapy starts, to adjust dosage as
directed, and to repeat periodically until
lipid levels are within desired range.
PATIENT TEACHING
• Stress that atorvastatin is an adjunct to—
not a substitute for—low-cholesterol diet.
• Tell patient to take drug at the same time
each day to maintain its effects.
• Instruct patient to take a missed dose as
soon as possible. If it’s almost time for his
next dose, he should skip the missed dose.
Tell him not to double the dose.
• Instruct patient to consult prescriber
before taking OTC niacin because of
increased risk of rhabdomyolysis.
• Advise patient to notify prescriber immediately
if he develops unexplained muscle
pain, tenderness, or weakness, especially if
accompanied by fatigue or fever.
• Be aware that atorvastatin is expensive.
Reinforce the benefits of therapy, and urge
patient to comply if possible.
Lipitor
Nursing Considerations
• Atorvastatin is used in patients with
homozygous familial hypercholesterolemia
as an adjunct to other lipid-lowering treatments
or alone only if other treatments
aren’t available.
• Atorvastatin may be used with colestipol
or cholestyramine for additive antihyperlipidemic
effects.
• Expect atorvastatin to be used in patients
without obvious coronary artery disease
(CAD) but with multiple risk factors (such
as age 55 or over, smoker, history of
hypertension or low HDL level, or family
history of early CAD). Drug is used to
reduce risk of MI, angina, and adverse
effects of revascularization procedures.
• Also expect drug to be used in patients
with type 2 diabetes who have no obvious
CAD but multiple risk factors, such as
retinopathy, albuminuria, smoking, or
hypertension. Drug is used in these
patients to reduce risk of MI and stroke.
• Expect liver function tests to be performed
before atorvastatin therapy starts, after
6 and 12 weeks, with each dosage increase,
and every 6 months thereafter.
• Expect to measure lipid levels 2 to 4 weeks
after therapy starts, to adjust dosage as
directed, and to repeat periodically until
lipid levels are within desired range.
PATIENT TEACHING
• Stress that atorvastatin is an adjunct to—
not a substitute for—low-cholesterol diet.
• Tell patient to take drug at the same time
each day to maintain its effects.
• Instruct patient to take a missed dose as
soon as possible. If it’s almost time for his
next dose, he should skip the missed dose.
Tell him not to double the dose.
• Instruct patient to consult prescriber
before taking OTC niacin because of
increased risk of rhabdomyolysis.
• Advise patient to notify prescriber immediately
if he develops unexplained muscle
pain, tenderness, or weakness, especially if
accompanied by fatigue or fever.
• Be aware that atorvastatin is expensive.
Reinforce the benefits of therapy, and urge
patient to comply if possible.
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