MOA: alters permeability of the renal collecting ducts, allowing reabsorption of water. Stimulates muscle of GI tract , acts as vasoconstrictor. Decreases urine output & increases urine osmolality in diabetes Insipidus.
USE: Central diabetes insipidus due to deficiency of ADH.
ADVERSE EFFECTS: dizziness, angina, chest pain, abdominal cramps, diarrhea, n/v, sweating, trembling, fever, water inox w/ high doses.
INTERACTIONS: Antidiuretic effect may be decreased by concurrent admin. of alcohol, lithium, demeclocycline, heparin, or norepinephrine. The antidiuretic effect may be increased by concurrent administration of carbamazepine, chlorpropamide, clofibrate, tricyclic antidepressants, or fludrocortisones. Ganglionic blocking agents may also increase the vasopressor effect.
NURSING INV: Monitor EKG throughout therapy and continuously throughout cardiopulmonary resuscitation. Monitor urine osmolality and volume frequently. Assess for s/s of dehydration. Weigh patient daily, monitor I&O, and assess for edema. Monitor urine specific gravity throughout therapy. Watch for s/s of water intoxication.

USE: used to alkalinize blood and urine (making the blood and urine less acidic) in certain conditions such as metabolic acidosis, and it promotes excretion of certain drugs in overdose situations.
MOA: an alkaline, and a vital component of the body's pH buffering system maintaining acid-base homeostasis. By releasing bicarbonate ions, it acts an alkalinizing agent neutralizing acid. Taken orally, it can neutralize gastric acids.
ADVERSE EFFECTS: Metabolic alkalosis, hypernatremia, hypocalcemia, hypokalemia, sodium and water retention, and edema. PO route may cause flatulence, gastric distention, and N/V. IV route may cause irritation at the intravenous site. INT: increased blood levels of quinidine, amphetamines, flecainide (anti-arrhythmics), and mexiletine (anti-arrhythmics). Do not take enteric-coated products within 1-2 hours of oral administration, it may make the protective coating ineffective. may decrease the absorption of ketoconazole. Burnett's syndrome when taken with Ca (stones). NURSING INV: Assess fluid balance throughout therapy to include daily weights, lung sounds, edema, and strict I's & O's
Assess patietn for s/s of acidosis, alkalosis, hypernatremia, or hypokalemia throughout therapy.
Observe the IV site closely to avoid extravasation, tissue irritation, or cellulitits.
Monitor serum Na+, K+, Ca+, bicarb concentrations, serum osmolarity, acid-base balance, urine pH, and renal function prior to and periodically throughout therapy.
As an antacid, assess patient for epigastric or abdominal pain, frank or occult blood in the stool, emesis, or gastric aspiration.
Advise patient to avoid intake of milk products while taking this med d/t increase risk of milk-alkali syndrome.
Emphasize the importance of regular follow-up exams to monitor serum electrolyte levels, acid-base balance, and to monitor progress.
As an antacid: Instruct patient to take as directed, a missed dose should be taken as soon as possible unless it's almost time for the next dose.
Advise patient to avoid routine use of sodium bicarbonate for indigestion; dypepsia for >2 wks should be evaluated by a physician.
Instruct patient to notify health care professional if indigestion is accompanied with chest pain, difficulty breathing, sweating (diaphoresis), or if stools become dark and tarry.

USE: is a member of a new class of antiarrhythmic drugs that is used for life-threatening recurrent ventricular arrhythmias when other antiarrythmiacs do not work or their side effects are not tolerated. Usually used for v. tach or v. fib. MOA: prolongs the action potential and refractory period. Inhibits adrenergic stimulation. Slows the sinus rate, increases PR intervals and QT intervals, and decreases peripheral vascular resistance (vasodilation). ADVERSE EFFECTS: Adverse reactions are very common in all patients. The most common ones are pulmonary toxicity, exacerbation of arrhythmia, and rare serious liver injury. The most serious ones reported are ARDS (adult respiratory distress syndrome), CHF or worsening of arrhythmias, bradycardia, hypotension, liver function abnormalities, toxic epidermal necrolysis (rare), and corneal microdeposits. Most side effects are dose and length of administration related, many are reversible with med being stopped. The thyroid may be affected (hypo or hyper may occur). Interactions: increases warfarin (coumadin) levels, decrease coumadin dose by 30-50%. There is an increased risk of heart arrythmias, and arrest with beta blockers and calcium channel blockers. Volatile anesthetics can cause increased cardiac depression. Food/drug interaction is noted with grapefruit juice- the drug does not metabolize in the GI tract and becomes toxic. an increase in digoxin levels, so dig. doses should be reduced by 50 %. Interventions: Assess for ARDS! (dyspnea, tachypnea, rales, crackles, infiltrates) Monitor B/P-hypotension usually occurs first few hours-slow rate. Recommend opthalmic exams. Assess for s/s thyroid dysfunction. Monitor labs (liver enzymes, thyroid levels) Always have another nurse double and triple check dosing!! Many fatal med errors have occurred! Assist patient with ambulation to prevent falls. Give through an inline filter. Pts may experience a bluish discoloration of face, neck, and arms with long use. Is usually reversible.

MOA: Increases myocardial contractility. Decreases preload and afterload by a direct dilating effect on vascular smooth muscle. Increased cardiac output (Inotropic effect) IND: Short term treatment of CHF unresponsive to conventional therpy with digoxin, diuretics, and vasodilators. ADV EFF: H/A, ventricular arrhythmias, angina, chest pain, hypotension, skin rash, liver function abnormalities, hypokalemia, thrombocytopenia, INTERACT: None significant INTERVENT: Monitor HR and Bp. If Bp drops excessively stop it. Monitor ECG during infusion because arrhythmias are common.

USE: ventricular arrhythmias MOA: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on heart rate. SE: seizures, confusion, drowsiness, cardiac arrest, stinging, anaphylaxis NURSING INV: Monitor ECG continuously and BP and respiratory status during admin

MOA: Probably acts by suppressing widespread inflammation associated with sepsis. Decrease mortality due to sepsis IND: To reduce mortality in adult pts with sepsis. ADV EFF: Bleeding INTERACT: Antiplatelet agents, anticoagulants, thrombolytic agents, or other agents that may affect coagulation increases risk of serious bleeding. Arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng may increase bleeding. INTERVENT: Assess for signs of bleeding and hemorrhage and infection. Monitor PT, aPTT.