NCLEX Pharm: Heparin

Class: Anticoagulant

Indication:

  • Prevention of clotting in arterial and heart surgery
  • Disseminated Intravascular Coagulation (DIC)
  • Atrial fibrillation with embolization
  • DVT and Pulmonary embolism

Side effects:

  • Hematology: Thrombocytopenia, bleeding, bruising, injection-site reactions,
  • Skin: hair loss,
  • GI: liver enzyme changes

Nursing Tips:

  • Heparin is a High Alert Medication
  • Adjust dose based on lab results.
  • Dosage is considered adequate when the activated partial thromboplastin time (APTT) is 1.5 to 2 times normal
  • Give by deep subcutaneous injections; do not give IM.
  • Have protamine sulfate on hand as antidote.
  • Protect clients from injury, report bleeding gums, black or tarry stools, and severe headache.
  • Avoid intramuscular route of administration because of the frequent occurrence of hematoma at the injection site.
  • Always follow facilityโ€™s heparin protocol, whenever working with this medication.

Ref: Roachโ€™s Introductory Clinical Pharmacology

To Your Success!

Rophem ๐Ÿ™‚

NCLEX Pharm: Lunesta

Generic Name: Eszopiclone

Brand Name: Lunesta

Class: Sedative, Hypnotic, Nonbenzodiazepine

Indication: Sleeping pill, Lunesta is used to treat insomnia.

Side effects:ย Confusion, clumsiness or unsteadiness (older adults), daytime anxiety and/or restlessness, difficulty with coordination (older adults), mood or mental changes.

Adverse effects: Headache, chest pain, migraine.

Nursing Tips:

  • Lunesta may be habit-forming.
  • Contraindicated in liver disease; breathing disorder.
  • Contraindicated in History of depression, mental illness, or suicidal thoughts.
  • Contraindicated in history of drug or alcohol addiction.
  • Teach clients to avoid alcohol, it can lead to very serious interactions.

Ref: Roach’s Introductory Clinical Pharmacology

To Your Success!

Rophem ๐Ÿ™‚

Pharm: MAOIs and Tyramine Foods

Monoamine Oxidase Inhibitors (MAOI) are

  • Best known to be powerful anti-depressants.
  • They are effective therapeutic agents for panic disorder and social phobia.
  • MAOIs are tried when other antidepressants don’t work, due to side effects.
  • MAOIs can cause dangerous interactions with foods and beverages that contain Tyramine. See table below.

Tyramine

  • Tyramine is an amino acid that regulates blood pressure
  • It occurs naturally in the body, and it’s found in certain foods.

Important: Clients taking MAOIs will need to avoid foods containing high levels of tyramine.

Common side effects of MAOIs include:

  • Dry mouth, Headache, Drowsiness
  • Nausea, diarrhea or constipation
  • Dizziness or light-headedness
  • Skin reaction at the patch site

Nursing Implications:

  • Monitor for occipital headache, nausea, vomiting, sweating, fever, chest pain.
  • Notify the MD quickly, if client complain of any of the signs above.
  • Monitor for other drug interactions e.g. sedatives, hypnotics, & analgesics.
  • Check if client is taking Herbal products โ€“ St Johnโ€™s wort has a potential for adverse reaction when taken with antidepressants.

To Your Success!

Rophem ๐Ÿ™‚

NCLEX Pharm: Dilantin

Generic name: Phenytoin Sodium. Brand name: Dilantin

Class:ย Antiepileptic, Anticonvulsant, Antiarrhythmic

Indication: Seizures, Cardiac Arrhythmias

Side effects:

  • Hematology: aplastic anemia, hematopoietic complications,
  • Neuro: ataxia, dizziness, drowsiness, insomnia
  • Skin: purpuric dermatitis, Steven-Johnson syndrome.
  • GI: gingival hyperplasia, liver damage

Nursing Tips:

  • Therapeutic serum level 10-20 mcg/ml
  • Do not stop abruptly, to prevent status epilepticus.
  • Stop if rash, depressed blood count, enlarged lymph nodes, hypersensitivity reaction, signs of liver damage develop.
  • Not for use in pregnancy, it will cause fetal hydantoin syndrome; mental & physical birth defects.
  • Phenytoin is occasionally used in the treatment of cardiac arrhythmias, those associated with digitalis intoxication
  • Continually monitor cardiac rhythm; check BP frequently.
  • Dilantin capsules should be taken by mouth, swallowed whole. Do not open or crush medication.
  • Patient should take medication with a full glass (8 ounces) of water unless the doctor directs otherwise.
  • Dilantin should be used regularly and all doses taken on time to keep the serum level constant.
  • Products that contain calcium (e.g., antacids, calcium supplements) and nutritional tube-feeding products may decrease the absorption of phenytoin. Separate liquid nutritional products at least 1 hour before and 1 hour after phenytoin dose.

To your Success!

Rophem ๐Ÿ™‚