Free Mosby's 2014 Nursing Drug Reference by Linda Skidmore-Roth Page A

if still <60 bpm, notify prescriber
    • Electrolytes: K, Na, Cl, Mg; renal function studies, including BUN and creatinine; and blood studies, including AST, ALT, bilirubin
    • I&O ratio, daily weights
    • Monitor therapeutic product levels
    Evaluate:
    • Therapeutic response: decreased weight, edema, pulse, respiration; increased urine output
    Teach patient/family:
    • How to take pulse before taking product; patient should record or graph pulse to identify changes
    • To avoid hazardous activities until stabilized on this product; dizziness commonly occurs
    • About the need for compliance in all areas of medical regimen, including diet, exercise, stress reduction, product therapy
    SELECTED GENERIC NAME
    digoxin
     
    CHOLINERGICS
    ACTION:
    Cholinergics act by preventing destruction of acetylcholine, which increases concentration at sites where acetylcholine is released. This exaggerates the effects of acetylcholine and facilitates transmission of impulses across the myoneural junction. Cholinergics may also act by stimulating receptors for acetylcholine.
    USES:
    Cholinergics are used for myasthenia gravis, as antagonists of nondepolarizing neuromuscular blockade, postoperative bladder distention and urinary distention, and postoperative ileus.
    CONTRAINDICATIONS:
    Persons with obstruction of the intestine or renal system should not use these products.
    Precautions: Caution should be used in patients with bradycardia, hypotension, seizure disorders, bronchial asthma, coronary occlusion, hyperthyroidism, breastfeeding, and in children.
    Administer:
    • Only with atropine sulfate available for cholinergic crisis
    • Only after all other cholinergics have been discontinued
    • Increased doses if tolerance occurs
    • Larger doses after exercise or fatigue
    • On empty stomach for better absorption
    SIDE EFFECTS:
    The most serious adverse reactions are respiratory depression, bronchospasm, constriction, laryngospasm, respiratory arrest, seizures, and paralysis. The most common side effects are nausea, diarrhea, and vomiting.
    PHARMACOKINETICS:
    Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted in urine.
    INTERACTIONS:
    Interactions vary widely among products. Check individual monographs for specific information.
    POSSIBLE NURSING DIAGNOSES:
    • Deficient knowledge
[teaching]
    • Noncompliance
[teaching]
    • Impaired urinary elimination
[uses]
    NURSING CONSIDERATIONS
    Assess:
    • VS, respiration q8hr
    • I&O ratio; check for urinary retention or incontinence
    • Bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, respiratory depression; product should be discontinued if toxicity occurs
    Perform/provide:
    • Storage at room temperature
    Evaluate:
    • Therapeutic response: increased muscle strength, hand grasp; improved muscle gait; absence of labored breathing (if severe)
    Teach patient/family:
    • That product is not a cure; it only relieves symptoms (myasthenia gravis)
    • To carry emergency ID specifying myasthenia gravis, products taken
    SELECTED GENERIC NAMES
    bethanechol
    neostigmine
    physostigmine
    pyridostigmine
     
    CHOLINERGIC BLOCKERS
    ACTION:
    Cholinergic blockers inhibit or block acetylcholine at receptor sites in the autonomic nervous system.
    USES:
    Many cholinergic blockers are used to decrease secretions before surgery, to reverse neuromuscular blockade, and to decrease motility of GI, biliary, urinary tracts. Other products are used for parkinsonian symptoms, including dystonia associated with neuroleptic products.
    CONTRAINDICATIONS:
    Hypersensitivity can occur, and allergies should be identified before administering these products. Persons with GI and GU obstruction should not use these products since constipation and urinary retention may occur. They are also contraindicated in closed-angle glaucoma and myasthenia gravis.
    Precautions: Caution must be used when these products are given to