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

geriatric patients since metabolism is slowed. Also, persons with tachycardia or prostatic hypertrophy should use these products with caution.
    Administer:
    • With food or milk to decrease GI symptoms
    • Parenteral dose with patient recumbent to prevent postural hypotension; give parenteral dose slowly, monitoring vital signs
    SIDE EFFECTS:
    The most common side effects are dryness of the mouth and constipation, which can be prevented by frequent rinsing of the mouth and by increasing water and bulk in the diet.
    PHARMACOKINETICS:
    Onset, peak, and duration vary with route.
    INTERACTIONS:
    Increase in anticholinergic effect occurs when used with opioids, barbiturates, antihistamines, MAOIs, phenothiazines, and amantadine.
    POSSIBLE NURSING DIAGNOSES:
    • Impaired physical mobility
[uses]
    • Chronic pain
[uses]
    NURSING CONSIDERATIONS
    Assess:
    • I&O ratio; be alert for urinary retention, frequency, dysuria; product should be discontinued if these occur
    • Urinary hesitancy, retention; palpate bladder if retention occurs
    • Constipation; increase fluids, bulk, exercise
    • For tolerance over long-term therapy; dose may have to be increased or changed
    • Mental status: affect, mood, CNS depression, worsening of mental symptoms during early therapy
    Perform/provide:
    • Hard candy, gum, frequent rinsing of mouth for dryness
    Evaluate:
    • Therapeutic response: absence of cramps and EPS
    Teach patient/family:
    • To avoid driving, other hazardous activities if drowsiness occurs
    • To avoid concurrent use of cough, cold preparations with alcohol, antihistamines unless directed by prescriber
    • To use with caution in hot weather because medication may increase susceptibility to heat stroke
    SELECTED GENERIC NAMES
    atropine
    benztropine
    glycopyrrolate
    scopolamine
     
    CORTICOSTEROIDS
    ACTION:
    Corticosteroids are divided into glucocorticoids and mineralocorticoids. Glucocorticoids decrease inflammation by the suppression of migration of polymorphonuclear leukocytes, fibroblasts, increased capillary permeability, and lysosomal stabilization. They also have varied metabolic effects and modify the body’s immune responses to many stimuli. Mineralocorticoids act by increasing resorption of sodium by increasing hydrogen and potassium excretion in the distal tubule.
    USES:
    Glucocorticoids are used to decrease inflammation and for immunosuppression. In addition, some products may be given for allergy, adrenal insufficiency, or cerebral edema. Mineralocorticoids are given for adrenal insufficiency or adrenogenital syndrome.
    CONTRAINDICATIONS:
    Hypersensitivity may occur and should be identified before administering. Because these products mask infection, they should not be used in systemic fungal infections or amebiasis. Mothers taking pharmacologic doses of corticosteroids should not breastfeed.
    Precautions: Caution must be used when these products are prescribed for diabetic patients because hyperglycemia may occur. Also, patients with glaucoma, seizure disorders, peptic ulcer, impaired renal function, congestive heart failure, hypertension, ulcerative colitis, or myasthenia gravis should be monitored closely if corticosteroids are given. Use with caution in children, the geriatric patients, and during pregnancy.
    Administer:
    • With food or milk to decrease GI symptoms
    • Take single daily or alternate-day doses in the morning before 9 AM (for replacement therapy)
    SIDE EFFECTS:
    The most common side effects include change in behavior, including insomnia and euphoria; GI irritation, including peptic ulcer; metabolic reactions, including hypokalemia, hyperglycemia, and carbohydrate intolerance; and sodium and fluid retention. Most adverse reactions are dose-dependent.
    PHARMACOKINETICS:
    For oral preparations, the onset of action occurs between 1 and 2 hr, and duration can be up to 2 days, with a half-life of 2-4 days. Pharmacokinetics vary widely among products. These products cross the