NAME Polyethylene glycol ClearLax MiraLax Glycolax FC Osmotic laxative TU STOOL softener USE Constipation DOSAGE Adult PO 17 g a heaping tablespoon in 8 oz of water PT EDUCATION nursing consideration ACTION In solution as an osmotic action drawing H20 into GI lumen increases the number of bowel movements NURSING CONSIDERATIONS Mix powder until fully dissolved in 8ox liquid provide another drink to help wash taste out SIDE EFFECTS abdominal bloating cramping flatulence nausea high doses may produce diarrhea and excessive stool frequency particularly in elderly nursing home pt Pt taking other med containing PEG have occasionally developed urticaria suggestive of an allergic reaction ANTIDOTE CONTRAINDICATION Hypersensitivity GI obstruction megacolon GI perforation NAME furosemide Rx Lasix FC Loop diuretic CC Sulfonamide derivative TU Decreased edema in lung tissue peripherally decreased B P USE Pulmonary edema edema in HF nephrotic syndrome ascites hepatic disease hypertension DOSAGE Edema Adult PO 20 80 mg day in AM may give another dose in 6 hr up to 600 mg day IM IV 20 40 mg increased by 20 mg q2hr until desired response PT EDUCATION Teach patient to take the medication early in the day to prevent nocturia Instruct the patient to take with food or milk if GI symptoms of nausea and anorexia occur Teach patient to maintain a record of weight on a weekly basis and notify physician of weight loss of 5 lb Caution the patient that this product causes a loss of potassium that food rich in potassium should be added to the diet refer to a dietitian for assistance in planning Caution the patient to rise slowly from sitting or reclining positions not to exercise in hot weather or stand for prolonged periods because orthostatic hypotension will be enhanced lie down if dizziness occurs Advise patient to wear protective clothing and sunscreen to prevent photosensitivity Caution patient not to use alcohol or any OTC medications without physician s approval serious product reactions may occur Advise patient to continue taking medication even if feeling better this product controls symptoms but does not cure the condition Advise the patient with hypertension to continue other medical treatment exercise weight loss relaxation techniques cessation of smoking Teach patient to contact prescriber if rash cramps nausea dizziness numbness weakness occur ACTION Acts on the ascending loop of Henle in the kidney inhibiting reabsorption of electrolytes sodium and chloride causing excretion of sodium calcium magnesium chloride water and some potassium decreases reabsorption of sodium and chloride and increases excretion of potassium in the distal tubule of the kidney responsible for slight antihypertensive effect and peripheral vasodilatation SIDE EFFECTS Headache fatigue weakness vertigo paresthesias Orthostatic hypotension chest pain ECG changes circulatory collapse Loss of hearing ear pain tinnitus blurred vision Hypokalemia hypochloremic alkalosis hypomagnesemia hyperuricemia hypocalcemia hyponatremia metabolic alkalosis Hyperglycemia Nausea diarrhea dry mouth vomiting anorexia cramps oral or gastric irritations pancreatitis Polyuria renal failure glycosuria bladder spasms Thrombocytopenia agranulocytosis leukopenia neutropenia anemia Rash pruritus purpura sweating photosensitivity urticaria Cramps stiffness Toxic epidermal necrolysis erythema muliforme Stevens Johnson syndrome NURSING CONSIDERATIONS 1 HF Assess fluid volume status I O ratios and record count or weigh diapers as appropriate weight distended red veins crackles in lung color quality and specific gravity of urine skin turgor adequacy of pulses moist mucous membranes bilateral lung sounds peripheral pitting edema dehydration symptoms of decreasing output thirst hypotension dry mouth and mucous membranes should be reported 2 Monitor electrolytes potassium sodium chloride magnesium also include BUN blood pH ABGs uric acid CBC blood glucose 3 Hypertension Assess B P before and during therapy lying standing and sitting as appropriate orthostatic hypotension can occur rapidly 4 Ototoxicity Assess patient for tinnitus hearing loss ear pain periodic testing of hearing is needed when high doses of this product are given by IV route 5 Hypokalemia acidic urine reduced urine osmolality nocturia polyuria and polydipsia hypotension broad T wave U wave ectopy tachycardia weak pulse muscle weakness altered LOC drowsiness apathy lethargy confusion depression anorexia nausea cramps constipation distention paralytic ileus hypoventilation respiratory muscle weakness 6 Monitor for CV GI neurologic manifestations of hyponatremia increased B P cold clammy skin hypovolemia or hypervolemia anorexia nausea vomiting diarrhea abdominal cramps lethargy increased ICP confusion headache seizures coma fatigue tremors hyperreflexia 7 Monitor for neurologic respiratory manifestations of hyperchloremia weakness lethargy coma deep rapid breathing 8 Beers Use with caution in older adults may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia monitor sodium level closely when changing dose 9 Serious rash Monitor for skin rash often Stevens Johnson syndrome toxic epidermal necrolysis erythema multiforme may occur and is life threatening NAME tamsulosin Rx Flomax NAME fluticasone Rx Flonase Flovent HFA Flovent Diskus FC Selective adrenergic blocker BPH agent CC Sulfamoyl phenethylamine derivative TU Decreased symptoms of benign prostatic hyperplasia BPH USE Symptoms of BPH DOSAGE Adult PO 0 4 mg day increasing to 0 8 mg day if required PT EDUCATION Teach patient not to discontinue product abruptly emphasize the importance of complying with dosage schedule even if feeling better if dose is missed take as soon as remembered take at same time each day Teach patient not to use OTC products cough cold allergy unless directed by prescriber also to avoid large amounts of caffeine Caution patient that product may cause dizziness may occur during 1st few days of therapy to avoid hazardous activities Teach patient to take hr after same meal each day FC Corticosteroids inhalation antiasthmatic TU Decreased severity of asthma USE Prevention of chronic asthma during maintenance treatment in those requiring oral corticosteroids nasal symptoms of seasonal perennial and allergic nonallergic rhinitis DOSAGE Flovent HFA Adult and child 12 yr INH 88 440 mcg bid in those previously taking bronchodilators alone INH 88 220 mcg bid max 440 mcg bid in those