Question

Pls complete this 4  drugs used to treat a patient diagnosed with Abdominal aortic aneurysm (AAA) each medication including their

Generic /brand name

Category class

expected Pharmacological Action

Complications

Contraindications/Precautions

Interactions

Medication Administration

Evaluation of Medication Effectiveness

Therapeutic Use

Nursing Interventions

Client Education

1. Epinephrine

2. Norepinephrine

3.Vasopressin

4. Argatroban

Answer 1

1. Generic name:- 1,2-Benzenediol, 4-[(1R)-1-hydroxy-2-(methylamino)ethyl]-, or (-)-3,4-Dihydroxy-α-[2(methylamino)ethyl]benzyl alcohol.

2. Class:- Epinephrine is in a class of medications called alpha- and beta-adrenergic agonists (sympathomimetic agents).

3. Action:- Its action on alpha-1 receptors, epinephrine induces increased vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal sphincter muscle contraction.
Other significant effects include increased heart rate, myocardial contractility, and renin release via beta-1 receptors.

4. Complications:-
•breathing problems
•fast or pounding heartbeats
•pale skin, sweating
•nausea and vomiting
•dizziness
•weakness or tremors
•throbbing headache
•feeling nervous, anxious, or fearful.

5. Contraindication:-
overactive thyroid gland
diabetes
parkinsonism
closed angle glaucoma
high blood pressure
heart attack
angina
chest pain.

6. interaction with epinephrine:-

Ativan (lorazepam)
Benadryl (diphenhydramine)
glucagonglucoselidocainenorepinephrineProAalbuterol
montelukast
acetaminophen
Vitamin B12 (cyanocobalamin)
Vitamin C (ascorbic acid)
Vitamin D3 (cholecalciferol)
Zofran (ondansetron)
Zyrtec (cetirizine


7. Medication administration:-
Adults And Children 30 kg (66 lbs) or more-0.3 to 0.5 mg (0.3 to 0.5 mL). administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh up to a maximum of 0.5 mg (0.5 mL) per injection, repeated every 5 to 10 minutes as necessary.

8. Evaluation:-
●Prevention or relief of bronchospasm.
● Increase in ease of breathing.
● Prevention of bronchospasm or reduction of frequency of acute asthma attacks in
patients with chronic asthma.
● Prevention of exercise-induced asthma.
● Reversal of signs and symptoms of anaphylaxis.
● Increase in cardiac rate and output, when used in cardiac resuscitation.
● Increase in BP, when used as a vasopressor.
● Localization of local anesthetic.
● Decrease in sinus and nasal congestion.

9. Therapeutic use:-
•to relieve respiratory distress due to bronchospasm,
•to provide rapid relief of hypersensitivity (anaphylactic or anaphylactoid) reactions to drugs, animal serums and other allergens,
•to prolong the action of infiltration anesthetics.


10. Nursing Intervention:-
Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately. Keep physician informed of any changes in intake-output ratio. Use cardiac monitor with patient receiving epinephrine IV.


10. Client education:-
● Instruct patient to contact health care professional immediately if shortness of
breath is not relieved by medication or is accompanied by diaphoresis, dizziness,
palpitations, or chest pain.
● Advise patient to consult health care professional before taking any OTC medica-
tions or alcoholic beverages concurrently with this therapy. Caution patient also to
avoid smoking and other respiratory irritants.
● Inhaln: Review correct administration technique (aerosolization, IPPB) with pa-
tient.
● Do not spray inhaler near eyes.
● Advise patients to use bronchodilator first if using other inhalation medications,
and allow 5 min to elapse before administering other inhalant medications, unless
otherwise directed.
● Advise patient to rinse mouth with water after each inhalation dose to minimize dry
mouth.
● Advise patient to maintain adequate fluid intake (2000– 3000 mL/day) to help liquefy tenacious secretions.

1. Generic name:- Noradrenaline
(R)-(–)-Norepinephrine
l-1-(3,4-Dihydroxyphenyl)-2-aminoethanol

2. Class- Noradrenaline acts on both alpha-1 and alpha- 2.

3. Action- Noradrenaline is a vasoconstrictor that predominantly stimulates α1 receptors to cause peripheral vasoconstriction and increase blood pressure. It also has some β1 receptor agonist activity that results in a positive inotropic effect on the heart at higher doses.

4. Complications-
Slow heart rate, High blood pressure (hypertension), Irregular heartbeats (arrhythmias), Confusion, Anxiety, Shortness of breath, with or without respiratory difficulty, Headache, Nausea and vomiting.

5. Contraindication-
high blood pressure
a blood clot
blockage or closing off of blood vessels
an increase of carbon dioxide in the blood
decreased oxygen in the tissues or blood
decreased blood volume.

6. Drug interactions-
Acetylsalicylic Acid (aspirin)
Adrenalin (epinephrine)
Combivent (albuterol / ipratropium)
Dextrose (glucose)
dopamineepinephrineHeparin Sodium (heparin)
Lasix (furosemide)
Paracetamol (acetaminophen)
Precedex (dexmedetomidine)
vancomycinvasopressin
Vitamin C (ascorbic acid)
Vitamin K (phytonadione)

7. Medication administration-
infusion at 8 mcg to 12 mcg per minute. The average maintenance dose is around 2 to 4 mcg per minute. If possible, infusions of norepinephrine should use tubing separate from blood products.

8. Evaluation-
● Increase in BP to normal range.
● Increased tissue perfusion.

9. Therapeutic use-
medication used to treat people with very low blood pressure. It is the typical medication used in sepsis if low blood pressure does not improve following intravenous fluids. It is the same molecule as the hormone and neurotransmitter norepinephrine.

10. Nursing Intervention-
● Monitor BP every 2– 3 min until stabilized and every 5 min.
● ECG should be monitored continuously. CVP, intra-arterial pressure, pulmonary
artery diastolic pressure, pulmonary capillary wedge pressure (PCWP), and car-
diac output may also be monitored.
● Monitor urine output and notify health care professional if it decreases to 30mL/
hr.
● Assess IV site frequently throughout infusion. A large vein should be used to mini-
mize risk of extravasation.

11. Client education-
Your blood pressure, breathing, and other vital signs will be watched closely while you are receiving norepinephrine. Tell your caregivers if you feel any pain, irritation, cold feeling, or other discomfort of your skin or veins where the medicine is injected.

1. Generic name- Pitressin, Vasostrict

2. Drug Class: Gastrointestinal Agents, Other; Vasopressin-Related; Antidiuretics, Hormone Analog

3. Action- AVP acts on renal collecting ducts via V2 receptors to increase water permeability (cAMP-dependent mechanism), which leads to decreased urine formation (hence, the antidiuretic action of "antidiuretic hormone"). This increases blood volume, cardiac output and arterial pressure.

4. complications
slow heartbeats;
pale skin, numbness in your fingers or toes;
stomach pain, gas, nausea, vomiting;
dizziness, headache;
sweating;
rash.

5. contraindication
a migraine headache.high blood pressure.
coronary artery disease.
heart failure.
asthma
an accumulation of toxins in the blood due to kidney failure called uremia
seizures

6. Drug interactions
drugs may decrease the antidiuretic effect of vasopressin when used concurrently: demeclocycline; norepinephrine; lithium; heparin; alcohol.
Ganglionic blocking agents may produce a marked increase in sensitivity to the pressor effects of vasopressin.

7. Medication administration
Vasopressin Injection may be administered IM or subcutaneously. Ten units (0.5 mL) of Vasopressin Injection will usually elicit full physiologic response in adult patients; 5 units (0.25 mL) will be adequate in many cases. Vasopressin Injection should be given IM at three or four hour intervals as needed.

8. Evaluation
● Decrease in urine volume.
● Relief of polydipsia.
● Increased urine osmolality in patients with central diabetes insipidus.
● Resolution of VT/VF.
● Improvement in signs of septic shock.

9. therapeutic use
Vasopressin is used to manage anti-diuretic hormone deficiency. It has off-label uses and is used in the treatment of gastrointestinal bleeding, ventricular tachycardia and ventricular defibrillation. Vasopressin is used to treat diabetes insipidus related to low levels of antidiuretic hormone.

10. Nursing Intervention
● Monitor BP, HR, and ECG periodically throughout therapy and continu-
ously throughout cardiopulmonary resuscitation.
● Diabetes Insipidus: Monitor urine osmolality and urine volume frequently to
determine effects of medication.
● Lab Test Considerations:Monitor urine specific gravity throughout therapy.
● Monitor serum electrolyte concentrations periodically during therapy.

11.Client education
Advise patient to drink 1– 2 glasses of water at time of administration to minimize side effects (blanching of skin, abdominal cramps, nausea). Inform patient that these side effects are not serious and usually disappear in a few minutes. Caution patient to avoid concurrent use of alcohol while taking vasopressin.

1. International- Acova.

2. class- Argatroban is a synthetic direct thrombin inhibitor derived from L-arginine.

3. action
Argatroban exerts its anticoagulant effects by inhibiting thrombin-catalyzed or induced reactions, including fibrin formation; activation of coagulation factors V, VIII, and XIII; protein C; and platelet aggregation.

4. complications
it include gastrointestinal bleeding (2.3%), intracranial bleeding (about 1% in patients receiving both argatroban and thrombolytic therapy), genitourinary bleeding and hematuria (0.9%), decreases in hemoglobin/hematocrit (0.7%), multisystem hemorrhage/DIC.

5. contraindication
Argatroban is contraindicated in: Patients with major bleeding, Patients with a history of hypersensitivity to argatroban.

6. drug interactions
Ativan (lorazepam)
Augmentin (amoxicillin / clavulanate)
bivalirudin
Bumex (bumetanide)
Cardizem (diltiazem)
Coumadin (warfarin)
Diprivan (propofol)
Lasix (furosemide)
Levaquin (levofloxacin)
Plavix (clopidogrel)
Sandostatin (octreotide)
Spiriva (tiotropium)
warfarinXarelto (rivaroxaban)

7. medication administration
Initiate an infusion of Argatroban Injection at 25 mcg/kg/min and administer a bolus of 350 mcg/kg via a large bore intravenous line over 3 to 5 minutes.

8. evaluation
Argatroban is monitored using the activated partial thromboplastin time (aPTT). The goal aPTT in seconds has been defined at UWMC/HMC as 60-80 seconds.

9. therapeutic use
Argatroban Injection is indicated for prophylaxis or treatment of thrombosis in adult patients with heparin-induced thrombocytopenia (HIT).

10. intervention
Argatroban Injection is indicated for prophylaxis or treatment of thrombosis in adult patients with heparin-induced thrombocytopenia (HIT).

Argatroban Injection is indicated as an anticoagulant in adult patients with or at risk for HIT undergoing percutaneous coronary intervention (PCI).

11. client education
You should not use this medicine if you have any major bleeding from a surgery, injury, or other cause.