Giving "Most important" meds first - Help ?!

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Hi everyone,

I'm a new nursing student. Tomorrow we are doing a mock drug-pour and we've been instructed that we should always give the "most important" meds first... since our fake pt is elderly, just in case he can't swallow them all, we'd want to get the most important stuff in first. So I have a list of 5 meds which are all related and used for treating HTN and CHF. I have no idea how to decide which are most important?! Any help would be greatly appreciated. Here are the meds:

Digoxin

Persantine

Lasix

Thyroid (armour thyroid)

Potassium Gluconate elixir

I know the dig. is extremely important. And I've heard that elixirs should go last in general, but that's all I can figure out! :icon_roll

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Specializes in Cardiac Telemetry, ED.

I think you're on the right track with the dig. Remember too, though, how important the Lasix would be for this person. And if you're giving Lasix, *especially* since the person is getting digoxin, what would you really want to watch?

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Well, since Dig can be highly toxic and I'm also giving Potassium, I suppose I'm watching the electrolyte balance with the Lasix because hypokalemia would up the risk of Dig toxicity? Is this making sense? I've just started learning about these meds today so I hope I'm on the right track here.

I'm thinking the order would be Dig, then Lasix, then Persantine, then the thyroid and finally the Potassium. Please someone let me know if this sounds crazy, yeah?!

Thanks!

-Kris

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Specializes in Cardiac Telemetry, ED.

Okay. You know you've gotta give the dig, right?

Lasix causes potassium excretion.

Low potassium increases the risk of digoxin toxicity.

So.......what would you want to be sure to give?

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Ah! So I should give the Potassium gluconate elixir after the Dig & Lasix?!

:yeah:

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Specializes in Cardiac Telemetry, ED.

That's what I would do. You could give the dig, Lasix, and potassium IV, but the patient would need IV access. An anticoagulant and a thyroid preparation could be given subcutaneously if needed. So, if I knew I could only get a few of the meds down orally, those are the three I would choose.

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Specializes in ED, ICU, PACU.

The thyroid hormone would be the least important because being a hormone it takes days/weeks to reach the therapeutic concentration and will decrease its levels the same way. It is not as much a time dependent drug as the others; although, if I recall correctly, armour is taken twice a day after meals (instead of once a day in the AM at least one hour before eating, like Synthroid) & therefore, could probably be less bioavailable than Synthroid. Nevertheless, it is still a hormone (an adapated natural version versus synthetic) and its mechanism of action would remain the same (in regards to distribution).

One thing that you should be aware of, that will hold true throughout school, NCLEX and eventually practicing nursing, is the ABC's [airway, breathing, circulation], in that order. If you base your answers and decisions with those priorities, you will usually find yourself doing the correct thing; or, at least, be able to defend your actions/rationale logically to an instructor who may prioritize things differently than you.

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Thanks to both of you! I was thinking the same thing about the thyroid, loricatus, but the ABC's suggestion is excellent.

Thank you thank you thank you! Off to bed, have a great night!:redpinkhe

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