DRUG

CALCIUM ACETATE

INDICATION
- Treatment and prevention of hypocalcemia. - Emergency treatment of hyperkalemia and hypermagnesemia and adj nct in cardiac arrest or calci m channel !locking agent to"icity #calci m chloride$ calci m gl conate%. - Control of hyperphosphatemia in end-stage renal disease.

MECHANISM OF ACTION
Increases ser m calci m level thro gh direct effects on !one$ kidney$ and &I tract. 'ecreases osteoclastic osteolysis !y red cing mineral release and collagen !reakdo(n in !one.

ADVERSE REACTION
syncope$ paresthesia CV: mild !lood press re decrease$ bradycardia, arrhythmias, cardiac arrest #(ith rapid I.). injection% GI: na sea$ vomiting$ diarrhea$ constipation$ epigastric pain or discomfort GU: rinary fre* ency$ renal calc li Metab !ic: hypercalcemia M"sc"! s#e!eta!: joint pain$ !ack pain Res$irat ry: dyspnea S#i%: rash

DRUG INTERACTION
Atenolol, fluoroquinolones, tetracycline: decreased !ioavaila!ility of these dr gs Calcium channel blockers: decreased calci m effects Cardiac glycosides: increased risk of cardiac glycoside to"icity Iron salts: decreased iron a!sorption Sodium polystyrene sulfonate: meta!olic alkalosis Verapamil: reversal of verapamil effects

NURSING CONSIDERATION
-Monitor calci m levels fre* ently$ especially in elderly patients. -Instr ct patient to cons me plenty of milk and dairy prod cts d ring therapy. - +efer patient to dietitian for help in meal planning and preparation. - As appropriate$ revie( all other significant and life-threatening adverse reactions and interactions$ especially those related to the dr gs$ tests$ and foods mentioned a!ove.

'o! tamine ,hort-term#-./ doe-by -ta- hr%management of meen heart fail re ca sed !y depressed contractility from organic heart disease or s rgical proced res.

,tim lates !eta0#myocardial%adrenergic receptors (ith relatively effect on heart rate or peripheral !lood vessels. Thera$e"tic E&' kg1min%. &ects: Increased cardiac o tp t (itho t significantly increased heart rate.

CNS: headache. Res$: shortness of !reath. CV: hypertension$ increased heart rate$ premat re ventric lar contractions$ angina pectoris$ arrhythmias$ hypotension$ palpitations. GI: na sea$ vomiting. ( ca!: phle!itis.Misc: hypersensitivity reactions incl ding skin rash$ fever$ !ronchospasm or eosinophilia$ nonanginal chest pain.

Use (ith %itr $r"sside may have a synergistic effect on2cardiac o tp t. )eta b! c#ers may negate the effect of do! tamine. 3igh risk of arrhythmias or hypertension (ith some a%esthetics #cyc! $r $a%e$ ha! tha%e%$MAO i%hibit rs$ *yt cics$ or tricyc!ic a%tide$ressa%ts.

-Monitor !lood press re$ heart rate$ EC&$ p lmonary capillary (edge press re #4C54%$ cardiac o tp t$ C)4$ and rinary o tp t contin o sly d ring the administration. +eport significant changes in vital signs or arrhythmias. Cons lt physician for parameters for p lse$ !lood press re$ or EC& changes for adj sting dose or discontin ing medication -4alpate peripheral p lses and assess appearance of e"tremities ro tinely thro gho t do! tamine administration. 6otify physician if * ality of p lse deteriorates or if e"tremities !ecome cold Lab Test Considerations: Monitor potassi m concentrations d ring therapy7may ca se hypokalemia 8 Monitor electrolytes$ 9U6$ creatinine$ and prothrom!in time (eekly d ring prolonged therapy.

kaye"alate

hyperkalemia

E"changes sodi m ions for potassi m ions in intestine7 potassi m is then eliminated in feces$ (hich decreases ser m potassi m level.

GI: na sea$ vomiting$ constipation$ fecal impaction$ gastric irritation$ anore"ia Metab !ic: hypokalemia$ sodi m retention$ other electrolyte a!normalities

Antacids, laxatives: systemic alkalosis

dia<epam

An"iety disorders

4rod ces an"iolytic effect and C6, depression !y stim lating gammaamino! tyric acid receptors. +ela"es skeletal m scles of spine !y inhi!iting polysynaptic afferent path(ays. Controls

cardi +asc"!ar c !!a$se !e"# $e%ia$ a,ra%"! cyt sis, and thr mb cyt $e%ia He$atic: he$atic dys&"%cti % res$irat ry de$ressi %

Antidepressants, antihistamines, barbiturates, opioids: additive C6, depression Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isonia id, ketocona ole, metoprolol,

8 Monitor electrolyte levels.5atch for signs and symptoms of electrolyte im!alances$ partic larly sodi m overload. 8 Monitor !o(el movements. Use meas res to prevent or correct constipation or diarrhea$ as needed. 8Tell patient dr g may ca se constipation #or diarrhea$ if given (ith sor!itol%. Instr ct him to report these pro!lems. 8Teach patient a!o t recommended diet #generally$ lo( in sodi m and potassi m%. 8 :or oral se$ instr ct patient to mi" only (ith (ater$ syr p$ or sor!itol; never (ith orange j ice. 8 Advise patient to refrigerate oral sol tion to improve taste. 8 As appropriate$ revie( all other significant adverse reactions and interactions$ especially those related to the dr gs and tests mentioned a!ove. 8 Inform patient he may take dr g (ith or (itho t food7 recommend taking it (ith food if it ca ses stomach pset. 8 Teach caregiver ho( to administer rectal gel system$ if prescri!ed. 8 Ca tion patient to avoid driving and other ha<ardo s activities ntil he kno(s ho( dr g affects

sei< res !y enhancing presynaptic inhi!ition.

propoxyphene, propranolol, valproic acid: decreased meta!olism and enhanced action of dia<epam !igoxin: increased digo"in !lood level$ possi!le to"icity "evodopa: decreased levodopa efficacy #ifampin: increased meta!olism and decreased efficacy of dia<epam $heophylline: decreased sedative effect of dia<epam

concentration and alertness. =Tell patient to notify prescri!er immediately if easy !r ising or !leeding occ rs. 8 Instr ct patient to move slo(ly (hen sitting p or standing$ to avoid di<<iness from !lood press re decrease. Advise him to dangle legs !riefly !efore getting o t of !ed. =Advise patient not to stop taking dr g a!r ptly. 8 Tell female patient not to take dr g if she is pregnant or plans to !reastfeed. 8 As appropriate$ revie( all other significant and life-threatening adverse reactions and interactions$ especially those related to the dr gs$ tests$ her!s$ and !ehaviors mentioned a!ove.

'igo"in

3eart fail re7 tachyarrhythmias7 atrial fi!rillation and fl tter7 paro"ysmal atrial tachycardia

Increases force and velocity of myocardial contraction and prolongs refractory period of atrioventric lar #A)% node !y increasing calci m entry into myocardial cells. ,lo(s cond ction thro gh sinoatrial and A) nodes and prod ces antiarrhythmic effect.

CNS: fatig e$ headache$ asthenia CV: !radycardia$ EC& changes$ arrhythmias EENT: !l rred or yello( vision GI: na sea$ vomiting$ diarrhea GU: gynecomastia Hemat ! ,ic: thr mb cyt $e%ia Other: decreased appetite

Amiodarone, cyclosporine, diclofenac, diltia em, propafenone, quinidine, quinine, verapamil: increased digo"in !lood level$ possi!ly leading to to"icity Amphotericin %, corticosteroids, me locillin, piperacillin, thia ide and loop diuretics, ticarcillin: hypokalemia$ increased risk of digo"in to"icity Antacids, cholestyramine, colestipol, kaolin&pectin: decreased digo"in a!sorption %eta'adrenergic blockers, other antiarrhythmics (including disopyramide, quinidine): additive !radycardia "axatives (excessive use): hypokalemia$ increased risk of digo"in to"icity Spironolactone: red ced digo"in clearance$ increased risk of

8 Assess apical p lse reg larly for 0 f ll min te. If rate is less than >? !eats1 min te$ (ithhold dose and notify prescri!er. 8Monitor for signs and symptoms of dr g to"icity #s ch as na sea$ vomiting$ vis al dist r!ances$ arrhythmias$ and altered mental stat s%. 9e a(are that therape tic digo"in levels range from ?.@ to = ng1ml. 8 Monitor EC& and !lood levels of digo"in$ potassi m$ magnesi m$ calci m$ and creatinine. 8 ,tay alert for hypocalcemia. Ano( that this condition may predispose patient to digo"in to"icity and may decrease digo"in efficacy. 85atch closely for hypokalemia and hypomagnesemia. Ano( that digo"in to"icity may occ r (ith these conditions despite digo"in !lood levels !elo( = ng1ml.

digo"in to"icity $hyroid hormones: decreased digo"in efficacy

Epogen

Anemia associated (ith chronic renal fail re

9inds to erythropoietin$ stim lating mitotic activity of erythroid progenitor cells in !one marro( and ca sing release of retic locytes from !one marro( into !loodstream$ (here they !ecome mat re red !lood cells

CNS: headache$ paresthesia$ fatig e$ di<<iness$ asthenia$ sei-"res CV: hypertension$ increased clotting of arterioveno s grafts GI: na sea$ vomiting$ diarrhea Metab !ic: hyper ricemia$ hyperphosphatemia$ hy$er#a!emia M"sc"! s#e!eta!: joint pain Res$irat ry: co gh$ dyspnea S#i%: rash$ rticaria Other: fever$ edema$ injection site pain

%lood urea nitrogen, creatinine, phosphate, potassium, uric acid: increased levels

8 Monitor vital signs and cardiovasc lar stat s$ especially for hypertension and edema. 8 Assess arterioveno s graft for patency$ !eca se dr g may increase clotting at graft. 8 Monitor electrolyte and ric acid levels. 5atch closely for hyper ricemia$ hyperkalemia$ and hyperphosphatemia. 8 Check temperat re for fever. 8 Monitor ne rologic stat s for signs and symptoms of impending sei< re. 8 Eval ate n tritional stat s and hydration in light of &I adverse effects.

t rsemide 'emade"

Chronic renal fail re 3eart fail re 3ypertension

Inhi!its sodi m and chloride rea!sorption from ascending loop of 3enle and distal renal t ! le7 increases renal e"cretion of (ater$ sodi m$ chloride$ magnesi m$ calci m$ and hydrogen. Also may e"ert renal and peripheral vasodilatory effects. 6et effect is natri retic di resis.

CNS: di<<iness$ headache$ asthenia$ insomnia$ nervo sness$ syncope CV: hypotension$ EC& changes$ chest pain$ vol me depletion$ atria! &ibri!!ati %, +e%tric"!ar tachycardia, sh"%t thr mb sis EENT: rhinitis$ sore throat GI: na sea$ diarrhea$ vomiting$ constipation$ dyspepsia$ anore"ia$ rectal !leeding$ GI hem rrha,e GU: e"cessive rination Metab !ic: hyperglycemia$ hyper ricemia$ hypokalemia M"sc"! s#e!eta!: joint pain$myalgia Res$irat ry: increased co gh S#i%: rash Other: edema

Aminoglycosides, cisplatin: increased risk of ototo"icity Amphotericin %, corticosteroids, me locillin, piperacillin, potassium'*asting diuretics, stimulant laxatives: additive hypokalemia Antihypertensives, nitrates: additive hypotension "ithium: increased lithi m !lood level and to"icity +euromuscular blockers: prolonged ne rom sc lar !lockade +onsteroidal anti' inflammatory drugs, probenecid: inhi!ited di retic response Sulfonylureas: decreased gl cose tolerance$ hyperglycemia in patients (ith previo sly (ellcontrolled dia!etes

8 Monitor vital signs$ especially for hypotension. 8 Assess EC& for arrhythmias and other changes. 8 Monitor (eight and fl id intake and o tp t to assess dr g efficacy. 8 Monitor electrolyte levels$ partic larly potassi m. ,tay alert for signs and symptoms of hypokalemia. 8 Assess hearing for signs and symptoms of ototo"icity. 8 Monitor !lood gl cose level caref lly in dia!etic patient. 8 Advise patient to take in morning (ith or (itho t food. 8 Instr ct patient to move slo(ly (hen sitting p or standing$ to avoid di<<iness from s dden !lood press re drop. 8 Tell patient to monitor (eight and report s dden increases. 8 Instr ct dia!etic patient to monitor !lood gl cose level caref lly. 8 Ca tion patient to avoid alcohol d ring dr g therapy. 8 Advise patient to cons lt prescri!er !efore sing her!s. 8 As appropriate$ revie( all other significant and life-threatening adverse reactions and interactions$ especially those related to the dr gs$ tests$

her!s$ and !ehaviors mentioned a!ove.

$arica!cit ! Bemplar

3yperparathyroidism associated (ith chronic renal fail re

,ynthetic vitamin ' analog7 s ppresses parathyroid hormone in patients (ith chronic renal fail re

6a sea$ vomiting$ dry mo th$ pr rit s$ allergic reaction$ rash$ rticaria$ edema$ lightheadedness$ chills$ fever$ fl like symptoms$ malaise$ palpitations$ pne monia$ GI b!eedi%,, se$sis

a!"mi%"m hydr *ide

Lo(ering of phosphate levels in patients (ith Chronic renal fail re. Adj nctive therapy in the Treatment of peptic$ d odenal$ and gastric lcers. 3yperacidity$ indigestion$ refl "es esophagitis.

9inds phosphate in the &I tract. 6e trali<es gastric acid and inactivates pepsin.

GI: constipation. F a%d E: hypophosphatemia.

GRO0TH HORMONES s matr $i% 1rec mbi%a %t2

&ro(th fail re in children d e to chronic renal ins fficiency. &ro(th fail re in children d e to 'eficiency of gro(th hormone. ,hort stat re associated (ith T rnerCs syndrome. ,hort stat re associated (ith or 6oonanCs syndrome #6orditropin only%. &ro(th hormone deficiency in ad lts #3 matrope$ 6 tropin$ 6orditropin%. ,hort stat re #3 matrope%.

4rod ce gro(th #skeletal and cell lar%. Meta!olic actions incl deD Increased protein synthesis$ Increased car!ohydrate meta!olism$ Lipid Mo!ili<ation$ +etention of sodi m$ phosphor s$ and potassi m. ,omatropin has the same amino lansopra<ole hormone7 somatrem has 0 additional amino Acid. 9oth are prod ced !y recom!inant '6A Techni* es. &ro(th

CV: edema of the hands and feet. E%d : hyperglycemia$hypoth yroidism$ ins lin resistance. ( ca!: pain at injection site. MS: arthralgia7 Serostim only,carpal t nnel syndrome$ m sc loskeletal pain.

A!sorption of tetracyc!i%es ch! r$r ma-i%e$ ir % sa!ts$ is %ia-id$ di, *i%$ or &!" r ."i% ! %esma y !e decreased. Sa!icy!ate !lood levelsmay !e decreased. /"i%idi%e$me*i!eti%e $ and am$hetami%e levelsmay !e increased if eno gh antacid is ingested s ch that rine p3 is Increased. E"cessive c rtic ster id se #e* ivalent to 0?E0@ mg1m= 1day% may2response to somatropin.

8 Assess location$ d ration$ character$ and precipitating factors of gastric pain.. 8 Lab Test Considerations: Monitor ser m phosphate and calci mlevels periodically d ring chronic se of al min m hydro"ide. 8 May ca se increased ser m gastrin and decreased ser m phosphate concentrations. 8 In treatment of severe lcer disease$ g aiac stools$ and emesis$ monitor p3 of gastric secretions. 8 Gr 3th Fai!"re: Monitor !one age ann ally and gro(th rate determinations$ height$ and (eight every FE>mo d ring therapy. 8 Lab Test Considerations: Monitor thyroid f nction prior to and d ring therapy. May decrease T.$ radioactive iodine ptake$ and thyro"ine-!inding capacity. 3ypothyroidism necessitates conc rrent thyroid replacement for gro(th hormone to !e effective. ,er m inorganic phosphor s$ alkaline phosphatase$ and parathyroid hormone increased (ith somatropin therapy. 8 Monitor !lood gl cose periodically d ring therapy. 'ia!etic patients may re* ire increased ins lin dose 8 Monitor for development of

hormone enhances &I tract M cosal transport of (ater$ electrolytes and n trients.

ne trali<ing anti!odies if gro(th rate does not e"ceed =.@ cm1> mos. 8 Monitor alkaline phosphatase closely in patients 5ith ad lt gro(th hormone deficiency.