Patient Safety: Medications

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PATIENT SAFETY: MEDICATIONS

6. Antihypertensives

When using vasodilators, if signs and symptoms of SLE occur, then discontinue the drug, contact the prescriber immediately, and continue to closely monitor the patient.

Educate the patient about the delayed onset of action and the bedtime dosing to avoid injury.

Inform patients that any abrupt withdrawal is a serious concern because of the risk for developing rebound hypertension. This places them at risk for cerebrovascular accident or other cerebral or cardiac adverse effects.

Focus nursing goals for antihypertensive therapy on educating the patient, family, and/or caregiver about the critical importance of adequate management to prevent end-organ damage.

5. Anticoagulants

When warfarin is prescribed, therapy is often initiated while the patient is still receiving heparin. Recommendations for overlapping therapy of heparin and warfarin are for at least 5 days. Monitoring results of various clotting studies is still of utmost priority, as is watching for clotting or bleeing problems.

Administer LMWHs by subq injection deep into the injection site using the same techniques as for heparin. Avoid aspiration to prevent hematoma formation.

Knowledge of the proper techniques of administration is crucial for the safe and effective use of heparin and the LMWHs. Heparin may be given subq or by IV, but not IM

Routinely monitor vital signs, heart sounds, peripheral pulses, and neurologic status in all patients before, during, and immediately after anticoagulant therapy.

4. Anti-infectives

Continually monitor for hypersensitivity reactions past the initial assessment phase because immediate reactions may not occur for up to 30 minutes, accelerated reactions may occur after 72 hrs, and delayed responses may occur after 72 hrs.

Give oral antibiotics within the recommended time frames and fluid/foods, as indicated. All medication is to be taken as ordered.

Before the administration of any antibiotic, it is crucial to gather data regarding a history of or symptoms indicative of hypersensitivity or allergic reactions.

3. Diuretics

Before giving your patient any type of diuretic, you must complete a thorough medication history and physical assessment. Take postural BPs because diuretic drug therapy may cause orthostatic hypotension.

Subtopic

Furosemide has a black box warning regarding fluid and electrolyte loss. The correct dose must be given. It is contraindicated in patients with anuria, hypovolemia, or electrolyte depletion.

Contraindicated to the use of these drugs include hyponatremia, hypokalemia, severe renal hepatic dysfunction, and cirrhosis.

2. Narcotics

The most serious adverse effect of narcotic use is CNS depression, which may lead to respiratory depression. When giving narcotics, care must be taken to titrate the dose so that the patient's pain is controlled without affecting respiratory function.

Transdermal fentanyl patches are recommended to be used only by patients who are considered opioid tolerant and they need to be disposed of properly.

Because of associated bruising and bleeding risks related to IM injections, there is now a strong trend in favor of IV, oral, and transdermal routes.

Ongoing assessments are needed for all of the adverse effects so that appropriate measures may be implemented.

1. Anti-Ulcer Agents

Gastric obstruction due to bezoar formation is possible with sucralfate in ICU patients receiving concomitant enteral feeds and in those with delayed gastric emptying.

Carbenoxolone is contraindicated in hypokalemia and should be avoided in children or adults over 75 years old.

Proton pump inhibitors and H2 receptor agonists may mask the symptoms of gastric cancer, so particular care is required in patients with a change in symptoms or who are over 45.

Should be used cautiously in patients with cardiac, hepatic, and/or renal disease.