Medicotion worksheet lo//2011

Gener|c Name]8rand Name

lnsullns (8apld AcLlng)
lnsulln Llspro runA orgln/Pumalog
Gener|c Name]8rand Name
Warfarln (warfarln)/Coumadln
Dose] koute] Irequency Crdered
L Speclflc
Is th|s route appropr|ate for pat|ent? ?es /no
Dose] koute] Irequency Crdered
L Speclflc
Is th|s route appropr|ate for pat|ent? ?es /no
n|gh A|ert? es ]No Why? Lrrors can resulL ln pL harm
and deaLh Clarlfy orders uo noL accepL orders uslng u
for unlLs lnsullns are avallable ln dlfferenL Lypes and
sLrengLhs Check Lype dose and exp daLe wlLh anoLher
nurse uo noL lnLerchange lnsullns wlLhouL consulLlng
physlclan or oLher healLh care professlonals
n|gh A|ert? es ]No Why? Lrrors lnvolvlng
anLlcoagulanLs can resulL ln serlous harm or deaLh from
lnLernal or lnLracranlal bleedlng 8efore admlnlsLerlng
evaluaLe recenL ln8 or 1 resulLs and have second
pracLlcloner lndependanLly check orlglnal order 8ecause of
Lhe larger number of medlcaLlons capable of slgnlflcanLly
alLerlng warfarlns effecLs careful monlLorlng ls
recommended when new agenLs are sLarLed or oLher
agenLs are dlsconLlnued lnLeracLlve poLenLlal should be
evaluaLed for all new medlcaLlons (8x C1C and naLural
producLs)
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
AnLldlabeLlcs Pormones/ancreaLlcs
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
AnLlcoagulanLs/Coumarlns
Act|on (therapeut|c effect)
ConLrol of hyperglycemla ln dlabeLlc paLlenLs
Act|on (therapeut|c effect)
revenLlon of Lhromboembollc evenLs
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
ConLrol of hyperglycemla ln paLlenLs wlLh Lype 1 or Lype 2
dlabeLes melllLus
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
rophylaxls and LreaLmenL of venous Lhrombosls
ulmonary embollsm ALrlal flbrlllaLlon wlLh embollzaLlon
ManagemenL of myocardlal lnfarcLlon uecreases rlsk of
deaLh uecreases rlsk of subsequenL Ml uecreases rlsk of
fuLure Lhromboembollc evenLs revenLlon of Lhrombus
formaLlon and embollzaLlon afLer prosLheLlc valve
placemenL
nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)

nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)

(8elow) harmacoklneLlcs
3672 hrs 37 days (aL a consLanL dose) 23 days (afLer
dlsconLlnuaLlon) Llver
harmacok|net|cs (onset peak durat|on metabo||sm)
wlLhln 13 mln 113 hrs 34 hrs Llver spleen kldney
and muscle
harmacok|net|cs (onset peak durat|on metabo||sm)
1extbook Dose kange (for ordered route and |nd|cat|on)
L Speclflc
1extbook Dose kange (for ordered route and |nd|cat|on)
C 23 mg/day for 24 days Lhen ad[usL dally dose by
resulLs of ln8 lnlLlaLe Lherapy wlLh lower doses ln gerlaLrlc
pL or deblllLaLed pL or ln Aslan pL or Lhose wlLh C?2C9*3
alleles or vkC8C1 AA genoLype
Contra|nd|cat|ons]Caut|ous use
Pypoglycemla allergy or hypersenslLlvlLy Lo a parLlcular
Lype of lnsulln preservaLlves or oLher addlLlves/SLress
Contra|nd|cat|ons]Caut|ous use
unconLrolled bleedlng Cpen wounds AcLlve ulcer dlsease
8ecenL braln eye or splnal cord ln[ury or surgery Severe
and lnfecLlon 8enal/PepaLlc dysfuncLlon llver or kldney dlsease unconLrolled
hyperLenslon/Mallgnancy L wlLh hlsLory of ulcer or llver
dlsease PlsLory of poor compllance Women wlLh
chlldbearlng poLenLlal
Adverse keact|on
Common


Severe
Pypoglycemla and Anaphylaxls

1ox|c|ty s|gns]Cverdose Ant|dote?
Pypoglycemla Mlld hypoglycemla may be LreaLed by
lngesLlon of oral glucose Severe hypoglycemla ls a llfe
LhreaLenlng emergency LreaLmenL conslsLs of lv glucose
glucagon or eplnepherlne Larly slgns of hypoglycemla
may be less pronounced by long duraLlon dlabeLes
dlabeLlc nerve dlsease and use of beLa blockers may
resulL ln loss of consclousness prlor Lo pL awareness of
hypoglycemla
Adverse keact|on
Common


Severe
8leedlng

1ox|c|ty s|gns]Cverdose Ant|dote?
WlLhholdlng 1 or more doses of warfarln ls usually
sufflclenL lf ln8 ls excesslvely elevaLed or lf mlnor bleedlng
occurs lf overdose occurs or anLlcoagulaLlon needs Lo be
lmmedlaLely reversed Lhe anLldoLe ls vl1AMln k
(phyLonadlone AquaMLP?1Cn) AdmlnlsLraLlon of whole
blood or plasma also may be requlred ln severe bleedlng
because of Lhe delayed onseL of vlLamln k
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
SubC May be mlxed wlLh nP lnsulln Mlxed lnsullns
should never be used as lv or pump AdmlnlsLer wlLh 13
mln before or lmmedlaLely afLer sLarLlng a meal
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
AdmlnlsLer aL same Llme each day C MedlcaLlon
requlres 33 days Lo reach effecLlve levels usually begun
whlle pL ls sLlll on heparln uo noL lnLerchange brands
poLencles may noL be equlvalenL ulrecL lv 8econsLlLuLe
each 3mg vlal wlLh 27 mL of sLerlle waLer for ln[ecLlon
8econsLlLuLed soluLlon ls sLable for 4 hr aL room Lemp
ulluLenL no furLher dlluLlon needed before
ConcenLraLlon 2 mg/mL 8aLe AdmlnlsLer over 12 mln
Assessment needed (pre dur|ng and post)
Assess sympLoms of hypglycemla (anxleLy resLlessness
Llngllng ln hands feeL llps or Longue chllls cold sweaLs
confuslon cool pale skln dlfflculLy ln concenLraLlon
drowslness nlghLmares or Lrouble sleeplng excesslve
hunger P/A lrrlLablllLy nausea nervousness Lachycardla
Lremor weakness unsLeady galL) and Pyperglycemla
(confuslon drowslness flushed dry skln frulLllke breaLh
odor rapld deep breaLhlng polyurla loss of appreLlLe
nausea vomlLlng unusual LhlrsL) MonlLor body welghL
Asses for slgns of allerglc reacLlons MonlLor blood glucose
q6h durlng Lherapy
Assessment needed (pre dur|ng and post)
Assess for slgns of bleedlng and hemorrhage (bleedlng
gums nosebleed unusual brulslng Larry black sLools
hemaLurla fall ln hemaLocrlL or blood pressure gualac
poslLlve sLools urlne or nasogasLrlc asplraLe) Assess for
evldence of addlLlonal or lncreased Lhrombosls MonlLor
1 ln8 and oLher cloLLlng facLors frequenLly durlng
Lherapy MonlLor hepaLlc funcLlon and C8C before and
perlodlcally LhroughouL Lherapy MonlLor sLool and urlne
for occulL blood before and perlodlcally durlng Lherapy
keference(s)
uavls urug Culde 721
keference(s)
uavls urug Culde 1293


Medicotion worksheet lo//2011
Gener|c Name]8rand Name
Peparlns (Low Molecular WelghL)
Lnoxaparln (enoxaparln)/Lovenox
Gener|c Name]8rand Name

Dose] koute] Irequency Crdered
L Speclflc
Is th|s route appropr|ate for pat|ent? ?es /no
Dose] koute] Irequency Crdered

Is th|s route appropr|ate for pat|ent? ?es /no
n|gh A|ert? es ]No Why? unlnLended concomlLanL
use of Lwo heparln producLs (unfracLlonaLed heparln and
LMW heparlns) has resulLed ln serlous harm and deaLh
8evlew pL recenL and currenL med admlnlsLraLlon records
before admlnlsLerlng any heparln or LMW heparln prodcuL
n|gh A|ert? es ]No Why?
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
AnLlcoagulanLs/AnLlLhromboLlcs
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)

Act|on (therapeut|c effect)
revenLlon of Lhrombus formaLlon
Act|on (therapeut|c effect)

Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
1x of acLue S1segmenLelevaLlon Ml (wlLh LhrombolyLlcs
or percuLaneous coronary lnLervenLlon)
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)

nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)

nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)

harmacok|net|cs (onset peak durat|on metabo||sm)
unknown 33 hrs 12 hrs rlmarlly 8enally
harmacok|net|cs (onset peak durat|on metabo||sm)
1extbook Dose kange (for ordered route and |nd|cat|on)
lv SubcuL (AdulLs 73 yr) AdmlnlsLer slngle lv bolus of 30
mg plus 1 mg/kg subcuL dose (max of 100 mg for flrsL 2
doses only) followed by 1 mg/kg subcuL q 12 hr 1he usual
duraLlon of 1x ls 28 days ln pL undergolng percuLaneous
coronary lnLervenLlon lf lasL subcuL dose was 8 hr before
balloon lnflaLlon no addlLlonal doslng needed lf lasL
subcuL does was or equal Lo 8 hr before balloon lnflaLlon
admlnlsLer slngle lv bolus of 03 mg/kg
SubcuL (AdulLs 73 yr) 073 mg/kg every 12 hr (no lv bolus
needed) (max of 73 mg for flrsL 2 doses only no lnLlLlal
bolus) 1he ususaly duraLlon of 1x ls 28 day

1extbook Dose kange (for ordered route and |nd|cat|on)

Contra|nd|cat|ons]Caut|ous use
PypersenslLlvlLy Lo speclflc agenLs or pork producLs cross
senslLlvlLy may occur Some producLs conLaln sulflLes or
benzyl alcohol and should be avolded ln pL wlLh known
hypersenslLlvlLy or lnLolerance AcLlve ma[or bleedlng
PlsLory of heparlnlnduced LhrombocyLopenla
Contra|nd|cat|ons]Caut|ous use

Adverse keact|on
Common
Anemla

Severe
8leedlng

1ox|c|ty s|gns]Cverdose Ant|dote?
roLamlne SulfaLe 1 mg for each mg of Lovenox should be
admlnlsLered by slow lv ln[ecLlon
Adverse keact|on
Common


Severe


1ox|c|ty s|gns]Cverdose Ant|dote?

Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
CannoL be used lnLerchangeably (unlL for unlL) wlLh
unfracLlonaLed heparln or oLher LMW heparlns SubcuL
AdmlnlsLer deep lnLo subcuL Llssue 8oLaLe slLes frequenLly
LefL Lo rlghL of upper and lower abdomen SoluLlon should
be clear lf excesslve brulslng occurs lce cube message of
slLe before admlnlsLraLlon may lessen brulslng 1o avold
Lhe loss of drug do noL expel Lhe alr bubble from Lhe
syrlnge before Lhe ln[ecLlon ulrecL lv use mulLldose vlal
for bolus ln[ecLlons AdmlnlsLer Lhrough a preexlsLlng lv
llne llush llne wlLh 09 naCl or u3W before and afLer
admlnlsLraLlon
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)

Assessment needed (pre dur|ng and post)
Assess for slgns of bleedlng and hemorrhage (bleedlng
gums nosebleeds unusual brulslng black Larry sLools
hemaLurla fall ln hemaLocrlL or blood pressure gualac
poslLlve sLools) bleedlng from surglcal slLe noLlfy healLh
care professlonal lf Lhese occur Assess for evldence of
addlLlonal or lncreased Lhrombosls MonlLor neurologlcal
sLaLus MonlLor for hypersenslLlvlLy reacLlons Cbserve
ln[ecLlon slLes for hemaLomas ecchymosls or
lnflammaLlon MonLlor C8C plaLeleL counL and sLools for
occulL blood perlodlcally durlng Lherapy
Assessment needed (pre dur|ng and post)

keference(s)
uavls urug Culde 637
keference(s)