30 medications

[guest042302019, BSN, RN]

As a student nurse, I'm asked to be aware of a great deal of information about medications.

Trade/Generic Name

Therapeutic/Pharmacologic Class

Indications/Uses

Medication Action

Contraindications

Precautions

Interactions

Adverse Reactions

Side Effects

Route

Dosage

Frequency

Assessments

Lab Considerations

Associated Diagnostics

Nursing Diagnoses

Associated Teaching

Evaluation/Desired Outcomes

I can see getting used to trade/generic names over time with exposure. Also, the same with drug class. Indications come easy when one knows class or present/past medical history. Action is easy once one knows the class but of course, within a class there are variation (i.e. alpha vs. beta blockers). Renal/Hepatic impairment always seems to be a contraindication/precaution. But, otherwise, there really isn't that many. Maybe 10-20 per medication. Will I remember that while taking clarithromycin that concurrent pimozide is contraindicated? Or, taking dramamine with a history of seizure disorders or BPH is supposed to be used cautiously? Of course I will. I have an infinite amount of brain space for all these facts I'll use everyday.

Contraindications/precautions are so few that I'm not concerned about causing more harm than good.

Oh by the way, side effects/common side effects/adverse effects/serious effects/life threatening effects. So few and insignificant effects! Let's look at a common medication. Aspirin. It's harmless enough. Everyone takes it. Got a headache? Aspirin. Toothache? Aspirin. 11th finger or extra long tail? Aspirin. Side effects are as follows: tinnitus, GI bleeding, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting, exfoliative dermatitis, steven-johnson's syndrome, toxic epidermal necrolysis, anemia, hemolysis, increased bleeding time, allergic reaction, laryngeal edema, and anaphylaxis.

Me being the rather good student, I'll gladly teach my wonderful patient about side effects. It would go something like this.

"Mr Johnson, here's your aspirin."

"What type of side effects does it have?" He says with intense curiousity.

"Oh not too many," I say while I pull out my handy-dandy nursing drug guide.

"Let's see. Ahh, yes. Here we go."

"I'd like you to report if you have the following: If your ears start hurting or ringing. You may have a small GI hemorrhage and a bit of blood in your stool. Don't worry though we've typed and cross matched you. Your stomach and abdomen may severly hurt but don't worry Aspirin has some pain relieving effects. I'll get the pan when you start vomiting. If you have no appetite, we have TPN. Your liver may stop working BUT I hear transplants are so 2012'. Don't worry if your skin becomes scaly, discolored, and becomes to shed itself from your body. Be positive, with loss of the largest organ in your body, your BMI will drastically decrease. Don't worry when you lose your RBCs because we have oxygen for ya! If you start to bleed out from your orifices, we have super glue. And lastly, if your throat closes and, tell me, we have epinephrine!"

Mr. Johnson, "I'd like tylenol please."

The routes are easy enough. Let's see here. IV, IM, po, rectal, transdermal, eye gtt. Did I miss anything? Ah, the assessments. Generally, with enough medications on board, we could essentially through off just about any lab value. Luckily we give so few medications with so few side effects that it's easy to pinpoint the culprit. Dosages are endless. Look those up every time ideally. Nursing diagnoses. Where to begin with Mr. Johnson above. Maybe, risk for infection, risk for injury, or risk for developing a slew of other stuff simply from Aspirin. I hear that last nursing diagnosis will be in the new NANDA edition. Teaching, "Take as prescribed. Don't ask any questions. Ignorance is bliss."

Lastly, interactions. It's really no big deal once all those medications get in your belly. It'll be a nice therapeutic melting pot. All of our sizzling hydrochloric acid breaks it down and gastric movement will mix it up nice and good. Like a highschool reunion, the beta blockers will be mingling bronchodilators. The GI motility meds will chit-chatting with proton pump inhibitors. Nitroglycerin is gonna take it easy tonight though. He nearly passed out at last year's shin-dig! Too much dilation.

Let's see here. An average medication may have 10-15 side effects. 10-15 side effects X 30 medications? 300-450 on that medication regime. Luckily, I have the time to teach this as well as all my patients are interested in learning and never completely freaked about any of it.

Okay, Mr. Johnson, now let me teach you about the rest your current regime of, "Amlodipine, Brimonidine, Colace, Miralax, Timolol, Isosorbide-Mononitrate, Lisinopril, Pantoprazole, Piperacil, Aluminum Magnesium Hydroxide, Magnesium Hydroxide, Nitroglycerin, Zofran, Levalbuterol, Metoprolol, Multivitamin, Prozac, Lorazepam, Potassium Chloride, Coumadin, Tylenol, Lovenox, Lortab, Bisacodyl, Zithromax, Vitamin D, Calcium Carbonate, Chondroitin-Glucosamine, and Flax Seed Oil."

Oh, by the way Mr. Johnson, your insurance won't cover half of those medications. We'll need a kidney as collateral. Here's your consent form."

Disclaimer: Just trying to point out the medication administration system as it seems to be. Is more medication better? Is this current practice safe for patients and safe for nurses? You be the judge.