What is the nursing role?
- Assessment
- Planning appropriate pharmacotherapy
3.Intervention - Evaluation
Reassess and revise plan if needed
Schedule I drug
Abuse potential: Highest
No currently accepted use
Ex. Heroin, LSD, Marijuana
Schedule II drug
Abuse potential: High
Accepted medical use but severely restricted
Ex. Fentanyl, methadone, morphine.
Schedule III drug
Abuse potential: Moderate
Less stringent control than schedule II drugs.
Ex. Codeine (lower doses compounded with ASA or acetaminophen)
Schedule IV drugs
Abuse potential: low
Similar controls to schedule III drugs
Ex. Benzodiazepines, tramadol, zolpidem
Schedule V drugs
Abuse potential: lowest
Similar controls to schedule III and IV
Ex. Cough medicine with codeine, antidiarrheals with small amnts. of opiods.
Black box warnings
FDA designation, awareness to serious or life-threatening risks.
High-alert medications
Designation by ISMP, medication safety, increased risk for significant harm, increased vigilance in the preparation and administration of the ordered dose and monitoring of the patient.
Fat-soluble vitamins
-ADEK
-Stored in liver and fatty tissue
-Body can synthesize if precursor available
-Need intermittent renewal
Water-soluble vitamins/minerals
-B vitamins and Vitamin C
-Iron and calcium
-Require acidic environment for absorption
-Daily replenishment
-Exception B-12: stored in liver for 3-5 years
Vitamin A
-90% stored in liver
-Formation of visual purple
-formation and maintenance of mucosa and healthy skin
Deficiency–> night blindness, xerophthalmia, keratinization, lowered saliva secretion
Sources:
Preformed vitamin A–> Animal sources
Provitamin A (beta-carotene) –> carrots, cantaloupes, apricots, tomato juice, and spinach
Vitamin D
D3: Cholecalciferol (animal foods) and skin synthesis
D2: Ergocalciferol (plant sources)
Activated vitamin D–>calcitriol
-Develop/maintain strong bones
-calcium and phosphorus absorption
-muscle contraction
Deficiency–> Bone growth retardation (Rickett’s), Low cal–> osteoclast activity–>osteopososis
Dietary sources–> fish, eggs, fortified foods.
Vitamin E
-Destroys free radicals (By-product of normal cell metabolism)
Deficiency
-Hemolytic anemia, disrupts myelin sheath formation
Dietary sources–> vegetable oils, nuts and fortified cereals
Vitamin K
-Initiates liver synthesis of four proteins for clotting–> “Koagulation vitamin”
Antidote: Warfarin
Deficiency: Hemorrhage, higher risk of bleeding.
Sources: Green veggies
Vitamin B-1 (thiamine)
Function:
-supports cellular energy metabolism
-Combines with phosphorus to make thiamine pyrophosphate (TPP) involved with glucose metabolism
deficiency:
-Affects multiple body systems->GI, CNS, CV & MS
-Chronic alcohol abuse interferes with absorption
Sources–> Whole/enriched grains, legumes
Vitamin B9 (Folic acid)
-Also supplements and fortified food products
-coenzyme in DNA synthesis and cell division
Deficiency–> megaloblastic anemia, neural tube defects (spine bifida), alcohol interferes w nutrient absorption.
Sources–> dark leafy greens, OJ, legumes, chicken liver, fortified cereals and grains
-B9 may mask B12 deficiency
Vitamin B12(Cobalamin)
-Amino acid metabolism & heme formation
-Role in synthesis of myelin sheath
-Needs HCL, and intrinsic factor for absorption
Deficiency:
Low gastric acid and lack of IF, macrocytic anemia–> pernicious anemia
Dietary sources: animal origin and fortified foods
Iron
-Stored with ferretin
-Functional part of hgb-> Heme
-hgb delivers O2 to cells
Deficiency: Low gastric acid, malabsorption issues, fatigue, muscle weakness, and pallor
Sources: Liver, meat, fish, chicken, whole grains, fortified foods
Vitamin C
-antioxidant
-Maintains bone matrix cartilage and collagen
-Collagen–>capillary bed walls
-Iron absorption
Deficiency: poor wound healing, weak bones.
Sources: Citrus fruits and juices, tomatoes, bell peppers, strawberries.
Calcium
-99% stored in bones and teeth (1% in blood)
-Ca+ and phosphorus provide strength and rigidity to skeleton
-Clot formation
-Nerve transmission, muscle contraction and relaxation
-Need vitamin D for absorption
Deficiency: Osteoporosis, tetany, muscle spasms, osteoclastic activity, low PTH
Sources: dairy products, dark green veggies, fortified foods
Food label requirements
- Serving size
- Amount of calories
3.Limit these nutrients
4.Get enough of these nutrients
5.% daily value
Antidiarrheals: Adsorbent
Bismuth subsalicylate
-Mild to moderate diarrhea
-adsorbent–> binds to bacteria/toxins
Nursing implications:
-may cause tongue and stools to darken
-May causes d-d interactions w/ aspirin, warfarin, or NSAIDs
Antidiarrheals: Opiates
-Diphenoxylate/atropine (Lomotil)
-Antidiarrheal/anticholinergic
-reduces bowel motility and transit time
-Reduces rectal spasm pain
-Decreases stool frequency and volume
-Diphenoxylate- synthetic opiate agonist
-Slows overactive bowel
-Weak opioid (schedule V)
-AE: Drowsiness, dizziness
-Atropine-anticholinergic
-Discourage recreational use
Antidiarrheal: Opioids
Loperamide (Imodium)
-Synthetic opioid
-Similar to diphenoxylate
-Inhibits peristalsis and prolongs transit time
-Direct effect on the nerves in the intestinal muscle wall
-Lowers fecal volume and frequency
-Available OTC
