OTC MEDS, Herbal & Dietary Supplements, VITAMINS and MINERALS, ENTERAL and PARENTERAL DRUG ADMINISTRATION

NURS 2411 Elizabeth Pratt, MSN, RNC 2010

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Over the Counter (OTC) Meds

_____ of all medications used in the US Only _____ of the population will consult an MD before using Short-term use only Increases out of pocket expenses
Insurance carriers dont cover the cost if no prescription required .
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Problems with OTC and Alternative Treatments

Mask the signs and symptoms of Interact with prescription drugs . Taken in greater than recommended dose -> Surgery clients should stop taking all herbal supplements 2-3 weeks prior to
If not, bring herbal container for anesthesiologist

Alternative Therapy Drawbacks

Active ingredient not tested by the

Incidental ingredients are unknown

Patients do not always mention these therapies to their health care providers Prescription drug + alternative therapy =

Controls for Alternative Therapy

Herbal medications and alternative therapies are not controlled or tested by the FDA
.

Advertisement is not restricted because they are considered dietary supplements

Off-Label Medications
Definition

The use of a drug for an indication that is not approved by the Occurrence
Commonly takes place in groups of patients for whom there is little premarketing testing Used with
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HERBAL SUPPLEMENTS
Come from leaves, bark, berries, roots, gums, seeds, stems and flowers of plants Breastfeeding increase supply of milk by using
Blessed Thistle Fennel Nettle Leaf

ST JOHNS WORT
Not FDA approved Used to help with depressed moods
Anxiety and/or sleep disorders too

Interacts with anticoagulants and digoxin May make Affects other antidepressants Increases sensitivity to
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 Garlic
interferes with hypoglycemia therapy

Cranberry
decreases renal elimination of drugs

Chamomile
increases risk for bleeding w/ other anticoagulants

BUT I DONT LIKE PILLS

FOODS HAVE VITAMINS!

Carrot - Enhances blood flow to and function of the eyes.

Tomato - antioxidants to benefit heart and fight against certain types of cancers.

Grapes - help heart and blood

Walnut - looks like a little brain; helps develop neuron-transmitters for brain function.

Kidney Beans Heal and help maintain kidney function.

Celery, Bok Choy, Rhubarb contain 23% sodium as do bones; these foods replenish the skeletal needs of the body specifically targeting bone strength

Avocadoes, Eggplant and Pears - target the health and function of the womb and cervix of the female. Woman eating one avocado a week balances hormones sheds unwanted birth weight prevents cervical cancers

Sweet Potatoes - Balances the glycemic index of diabetics.

Figs -Increase the mobility of male sperm and the numbers of sperm to overcome male sterility.

Olives Assist the health and function of the ovaries.

Oranges, Grapefruits, and other Citrus fruits - Assist the health of the breasts

Onions and Garlic - clear waste materials from bodys cells and produce tears.

Vitamins Uses
Treat vitamin deficiency Dietary supplements Specific therapy

Most common adverse effect

GI upset

Assess patients general condition

Vitamin Patient Teaching

Avoid OTC preparations that contain the same vitamins Notify MD if unable to tolerate vitamins due to GI upset Teach patient which medications cannot be taken at the same time with a specific vitamin Recommend dose to be takenotherwise client might guess

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VITAMIN INTERACTIONS
E & K CF patients check with MD prior to use
Antacids reduce absorption of vitamin

B12, B6, & C

Tobacco and alcohol reduce vitamin absorption B6 with oral contraceptives = depression ? PMS

Iron
Alcohol increases iron use Full glass H20 to prevent constipation

C - use cautiously if prone to kidney stones

MEGADOSING
Used for Health promotion/maintenance
Patients with cystic fibrosis

Treating various illnesses

Cancer patients

A drug
B3 in large doses decreases triglycerides

Risk toxic accumulation

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ENTERAL DRUGS
Oral
Sublingual Buccal Liquid Capsules/Tablets Nasogastric or Gastrostomy Tube Rectal

Give on empty or full stomach?

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So before you give

Special assessments
i.e. Lanoxin take 1 minute apical pulse prior to admin.

Swallowing difficulties
Crush one tablet at a time (if it can be)
Exception: Enteric , sustained-release, or long-acting drugs

Mix in small amount soft food (if not NPO) Clean the crushing device Proper position

Excess liquid in cup do not pour back in medication bottle

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 Use calibrated oral syringe for liquid medications Med through tube confirm correct patient position and verify tube placement
If med to be given on empty stomach stop tube feeding for usually 30 minutes prior to administration Amount of fluid for flushing.30 mL

Rectal Meds
Contraindications: rectal bleeding/diarrhea Dont divide dose Left side with privacy/lubrication Pt. can request self-administration (remind patients to remove the wrapper)

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Parenteral Agents
Purposes: - provide replacement fluids, sugars, electrolytes, and nutrients to patients unable to take them orally - provide ready access for administration of drugs in an emergency situation - provide rehydration - restore electrolyte balance ***Remember*** Prior to diluting any drug solution, check drug guide for compatibility to avoid precipitation or inactivation of drug.

 PN contraindications
Patient with known allergies to any of the components

PN cautions
Patients w/ unstable cardiovascular status
May cause cardiac overload

Patients w/ unstable fluid and electrolyte status

Negative reaction to sudden changes

SOLUTIONS
Dextrose
provides calories and fluids

Saline
hydration 0.9% NS to prime blood tubing and dilute medications

Parenteral Nutrition

Use Total Parenteral Nutrition (TPN) to Administer

Essential proteins Amino acids Carbohydrates Vitamins and Minerals Trace elements Lipids Fluids

PN Adverse Effects
IV site irritation or infection Extravasation of fluid in to the tissues Fluid volume overload and vascular problems Electrolyte imbalances Protein aggregation
Pneumothorax, air emboli

Nausea Gallstone development

PN IMPLEMENTATION
Monitor IV or central line
d/c site if signs/symptoms of infection or extravasation occur

TPN Administration guidelines:

Solutions in fridge till ready to use Check for precipitates prior to using Change bag after Use filters

PN Assessment/Evaluation
Insertion site Skin hydration Orientation and Affect Height and Weight Pulse, BP, Respirations CBC w/ diff Glucose levels

PN ADMINISTRATION
Comfort Measures
Tubing under pillow to decrease

Teaching Plan
what to expect adverse effects follow-up tests required notify MD.

D/C PN only after alternate source of nutrition has been established.