For hypotension

Discuss the preadministration assessment for a patient requiring an adrenergic drug for hypotension. 

The nurse can give some of these drug (for example, aminophylline or theophylline) IV, either direct IV or as an IV infusion. When giving theophylline or aminophylline IV, the nurse monitors die patient for hypotension, cardiac arrhythmias, and tachycardia. If a bronchodilator is given IV, the nurse administers it through an infusion pump. The nurse checks die IV infusion site at frequent intervals because these patients may be extremely restless, and extravasation can occur. 

Which of the following drag s, when given with quinidine (Quinidex), would increase Hie risk for hypotension ... 

Monitor blood pressure to evaluate for hypotension caused by drug therapy. 

Risk factors that may increase the potential for hypotension include elderly age, diabetes, autonomic neuropathy, uremia, and cardiac disease.46 The symptoms associated with hypotension during dialysis include dizziness, nausea, vomiting, sweating, and chest pain. 

Best time to take doses At bedtime I m med iate- rel ease anytime during the day however, it is typically given at bedtime Extended-release anytime during the day After meals for best oral absorption On an empty stomach for best oral absorption if taken 30 minutes after a meal, as recommended by the manufacturer, peak absorption time is delayed, thereby further reducing the potential for hypotensive adverse effects20,24... 

If the patient is started on an a-adrenergic antagonist, monitor the patient for hypotension, dizziness, or syncope. If present, assess the severity of each symptom. Reduce the drug dose or discontinue the drug, as necessary. If the patient has malaise or rhinitis, reassure the patient that these are usual, but bothersome, adverse effect, that often improve with continued therapy. 

In the hospital, he receives fluids and metronidazole 500 mg every 8 hours intravenously. Stool was sent for C. difficile toxin assay, which came back positive. The patient continues to have abdominal pain but no bowel movement. On day 3 of hospitalization, his abdomen is distended with diffuse pain. His white blood cell count remains elevated. A CT scan of the abdomen showed colonic dilatation to greater than 6 cm. The patient became febrile and hypotensive, requiring multiple pharmacologic support for hypotension. 

Advise smokers to quit 2 weeks before therapy be judicious in use of IV fluids for hypotension discontinue therapy if requiring greater than 4 L 02 or 40% 02 mask for saturation greater than 95%. 

Hypotension - Orthostatic hypotension with or without syncope can occur, especially during initial titration in association with rapid dose escalation, and may represent a continuing risk in some patients. Garefully watch those undergoing surgery, and those who are on large doses of phenothiazines for hypotensive phenomena. The hypotensive effects may occur after the first injection of the antipsychotic, occasionally after subsequent injections, and rarely after the first oral dose. 

Amifostine (Elhyol) [Antineoplastic/Thiophosphate Cytoprotective] Uses Xerostomia prophylaxis during RT (head, neck, ovarian, NSCLQ -I- renal tox w/ rqjeated cisplatin Action Prodrug, dqjhosphorylated by alkaline phosphatase to active thiol metabohte Dose 910 mg/mVd 15-min IV inf 30 min prior to chemo Caution [C, +/—] CV Dz Disp Inj SE Transient X BP (>60%), NA, flushing w/ hot or cold chills, dizziness, X Ca % somnolence, sneezing Notes Does not -1- effectiveness of cyclophosphamide + cisplatin chemo Interactions T Effects W/ antih5 pertensives EMS Monitor BP for hypotension OD Severe hypotension treat w/IV fluids... 

In patients who have neither hypotension nor respiratory effects, hydrocortisone and chlorphenamine usually suffice. Supportive treatment with oxygen by face-mask, and intravenous fluid for hypotension, may be helpful. Patients who have predominant or recurrent bronchospasm can receive inhaled... 

Plasma brain natriuretic peptide concentrations, plasma aldosterone, heart failure hemodynamic measurements, clinical symptoms of heart failure, routine blood chemistries, blood pressure for hypotension and pulse rate for abnormalities (hypotension is dose-limiting/dose-dependent)... 

Blood pressure for hypotension and pulse rate for tachycardia, especially if the drug dosage has been increased rapidly... 

Blood pressure for hypotension and pulse rate for tachycardia... 

Blood pressure, especially in elderly patients, who are at increased risk for hypotension... 

Doxazosin (Cardura) Potential for hypotension, dry mouth, and urinary problems. Low... 

Short-acting nifedipine (Procardia and Adalat) Potential for hypotension and constipation. High... 

Beta-blockers interact with a large number of other medications. The combination of beta-blockers with calcium antagonists should be avoided, given the risk for hypotension and cardiac arrhythmias. Cimetidine, hydralazine, and alcohol all increase blood levels of beta-blockers, whereas rifampicin decreases their concentrations. Beta-blockers may increase blood levels of phenothiazines and other neuroleptics, clonidine, phen-ytoin, anesthetics, lidocaine, epinephrine, monoamine oxidase inhibitors and other antidepressants, benzodiazepines, and thyroxine. Beta-blockers decrease the effects of insulin and oral hypoglycemic agents. Smoking, oral contraceptives, carbamazepine, and nonsteroidal anti-inflammatory analgesics decrease the effects of beta-blockers (Coffey, 1990). 

Lactic acidosis has been observed, persisting for some hours after deliberate intravenous misuse of 20 mg adrenaline by an addict (SED-12, 308). Six of 19 patients who were given adrenaline for hypotension after undergoing cardiopulmonary bypass developed lactic acidosis, though the ultimate outcome was favorable (SEDA-22,154). 

Kobinger W (1978) Central a adrenergic systems as targets of action for hypotensive drugs. Rev Physiol Biochem Pharmacol 8 40-100... 

Cardiovascular In rodents, lymphohistiocytic infiltrates have been observed in the heart and in the perivascular space in various organs. Tissue macrophages in the heart can contain basophilic granules. In monkeys, no changes in ECG, heart rate, or blood pressure have been observed with numerous oligonucleotides. Under conditions when complement is activated, changes in blood pressure and cardiovascular collapse due to hypotension have been observed [55], but we have shown this to be related to complement activation rather than a direct effect on the cardiovascular system. (Of course, other mechanisms for hypotension could occur with other chemistries. For example, if an oligonucleotide formulation or its metabolic products chelates calcium, reductions in ionizable calcium could also produce a hypotensive crisis.) For most PS ODNs the most likely cause of hypotension is complement activation as demonstrated with complement inhibitors. 

Ketamine has unique properties that make it useful for certain pediatric procedures and for anesthetizing patients who are at risk for hypotension (low blood pressure) or bronchospasm... 

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