Magnesium Hydroxide (Milk of Magnesia)

Class?

Milk of Magnesia

Action?

Saline laxative that produces an osmotic effect in the small intestine by drawing water into the intestinal lumen.

Milk of Magnesia

Adverse Reactions?

GI: Abdominal Cramping, Diarrhea, Nausea

Metabolic: Fluid and electrolyte disturbances with daily use.

Other: Laxative dependence with long-term or excessive use.

Milk of Magnesia

Nursing Considerations?

• Before giving drug for constipation, determine whether patient has adequate intake, exercise, and diet.
• Monitor electrolyte levels during prolonged use. Magnesium may accumulate if patient has renal insufficiency.
• Drug is recommended for short-term use only.
• Magnesium sulfate is more potent than other saline laxatives.

Psyllium

Brand name(s)?

Metamucil

Generic Name?

Psyllium (Metamucil)

Class?

Psyllium (Metamucil)

Action?

Absorbs liquid in the intestines, swells, and forms a bulky stool, which is easier for the patient to pass.

Psyllium (Metamucil)

Adverse Effects?

Difficulty Breathing, Stomach Pain, Difficulty Swallowing, Skin Rash, Itching, Nausea, and Vomiting.

Psyllium (Metamucil)

Nursing Considerations?

• Do not administer within 3 hours of also administering digoxin (lanoxin), salicylates (aspirin), or nitrofurantoin (macrodantin, furadantin, macrobid).
• Consider patient's fluid intake.

Mineral Oil

Class?

Magnesium Hydroxide

Brand Name(s)?

Concentrated Phillips Milk of Magnesia

Ex-Lax Milk of Magnesia

Milk of Magnesia

Phillips Milk of Magnesia

Milk of Magnesia

Generic Name?

Mineral Oil

Action?

Mineral Oil temporarily coats the intestines, providing a less resistive surface over which stool may pass through the intestines.

Mineral Oil

Adverse Effects?

• Abdominal Cramping, Vomiting, Nausea, Diarrhea
• If aspirated into lungs may cause coughing, shortness of breath, or aspiration pneumonia.
• Can irritate the eyes, nose, and skin.

Mineral Oil

Nursing Considerations?

• Inhibits the body from absorbing fluid and nutrients through the intestinal wall, which can lead to dehydration and electrolyte imbalances.
• Monitor Patient for reaction to exposure.

Senna

Brand Name(s)?

Senna

Senokot

Senokot

Generic Name?

Senna (Senokot)

Class?

Senna (Senokot)

Action?

Increases peristalsis through irritation of the G.I. tract.

Senna (Senokot)

Adverse Effects?

Diarrhea, Nausea, Vomiting, Irritation of the Bowels (Suppositories), and Abdominal Cramping

Senna (Senokot)

Nursing Considerations?

• Monitor Patient for electrolyte imbalances.
• Monitor fluid intake of patient.

Bisacodyl

Brand Name?

Dulcolax

Dulcolax

Generic Name?

Bisacodyl (Dulcolax)

Class?

Laxative (Stimulant)

Bisacodyl (Dulcolax)

Action?

Increases peristalsis by irritating the G.I. Tract.

Bisacodyl

Nursing Considerations?

• Give drug at time that don't interfere with scheduled activities or sleep. Soft, formed stools are usually produced 15 to 60 minutes after rectal use.
• Before giving for constipation, determine whether patient has adequate fluid intake, exercise, and diet.
• Tablets and suppositories are used together to clean the colon before and after surgery and before barium enema.

Simethicone

Brand Name(s)?

Mylicon

Generic Name?

Simethicone (Mylicon)

Classification?

Antiflatulent

Simethicone (Mylicon)

Action?

Disperses or prevents formation of mucus-surrounded gas pockets in the G.I. tract.

Simethicone (Mylicone)

Adverse Reactions?

G.I.: Belching, Flatus

Simethicone (Mylicon)

Nursing Considerations?

• Drug doesn't prevent gas formation.

Sodium Biphosphate

Brand Name?

Fleet

Generic Name?

Sodium Biphosphate (Fleet)

Action?

Sodium Biphosphate (Fleet)

Adverse Effects

• CNS: Headache
• GI: Abdominal Cramping, Nausea, Vomiting, Diarrhea, Peritanal irritation, bloating, flatulence.
• Other: Laxative dependence with long-term or excessive use.

Sodium Biphosphate (Fleet)

Nursing Considerations?

• Before giving drug for constipation, determine whether patient has adequate fluid intake, exercise, and diet.
• Alert: Up to 10% of sodium content of drug may be absorbed.
• Alert: Severe Electrolyte imbalances may occur if recommended dosage is exceeded.

Dulcolax Suppositories

Class?

Dulcolax Suppositories

Action?

• Unknown. Stimulant laxative that increases peristalsis, probably by direct effect on smooth muscle of the intestine, by irritating the muscle or stimulating the colonic intramural plexus. Drug also promotes fluid accumulation in colon and small intestine.

Dulcolax Suppositories

Adverse Reactions?

• CNS: Dizziness, faintness, muscle weakness with excessive use.
• G.I.: Abdominal Cramps, Burning Sensation in Rectum with Suppositories, Nausea, Vomiting, Diarrhea with high doses, Laxative Dependence with long-term or excessive use, protein-losing enteropathy with excessive use.
• Metabolic: Alkalosis, Fluid and Electrolyte Imbalance. Hypokalemia.
• Musculoskeletal: Tetany

Dulcolax Suppositories

Nursing Considerations?

• Give drug at times that don't interfere with with scheduled activities or sleep. Soft, formed stools are usually produced 15 to 60 minutes after rectal use.
• Before giving for constipation, determine whether patient has adequate fluid intake, exercise, and diet.
• Tablets and suppositories are used together to clean the colon before and after surgery and before barium enema.

Glycerin Suppositories

Class?

Laxative (Hyperosmotic)

Glycerin Suppositories

Action?

Draws water from the tissues into the feces, this stimulating evacuation.

Glycerin Suppositories

Adverse Reaction?

• G.I.: Cramping Pain, Hyperemia of rectal mucosa, and rectal discomfort.

Glycerin Suppositories

Nursing Considerations?

• Drug is used mainly to reestablish proper toilet habits in laxative-dependent patients.

Docusate Sodium

Brand Name?

Colace

Generic Name?

Docusate Sodium (Colace)

Class?

Laxative (Stool Softener)

Docusate Sodium (Colace)

Action?

Docusate Sodium (Colace)

Adverse Reactions?

• G.I.: Bitter taste, mild abdominal cramping, diarrhea.
• Other: Laxative dependence with long-term or excessive use.

Docusate Sodium (Colace)

Nursing Considerations?

• Drug isn't used to treat existing constipation but prevents constipation from developing.
• Before giving drug, determine whether patient has adequate fluid intake, exercise, and diet.
• Drug is laxative of choice for patients who shouldn't strain during defecation, including patients recovering from MI or rectal surgery, those with rectal or anal disease that makes passage of stools difficult, and those with postpartum constipation.

Diphenoxylate Atropine Sulfate

Brand Name(s)?

Diphenoxylate Atropine Sulfate

Class?

Diphenoxylate Atropine Sulfate

Action?

Probably increases smooth muscle tone in G.I. tract, inhibits motility and propulsion, and diminishes secretions.

Diphenoxylate Atropine Sulfate

Adverse Reactions?

CNS: Dizziness, Sedation, Confusion, Depression, Drowsiness, Euphoria, Headache, Lethargy, Malaise, Numbness in Limbs, Restlessness

CV: Tachycardia

EENT: Blurred Vision

G.I.: Dry Mouth, Pancreatitis, Paralytic Ileus, Abdominal Discomfort or Distention, Anorexia, Fluid retention in Bowel or Megacolon, Nausea, swollen Gums, Vomiting

G.U.: Urine Retention

Respiratory: Respiratory Depression

Skin: Dry Skin, Pruritis, Rash

Other: Anaphylaxis, Angioedema, Possible physical Dependence with Long-Term Use.

Diphenoxylate Atropine Sulfate

Nursing Considerations?

• Alert: Monitor fluid and electrolyte balance. Correct fluid and electrolyte disturbances before stating drug. Dehydration, especially in young children, may increase risk of delayed toxicity. Fluid retention in bowel or megacolon may occur with drug use and may mask depletion of extracellular fluid and electrolytes, especially in children treated for acute gastroenteritis.
• Stop treatment immediately and notify prescriber if abdominal distention or other signs or symptoms of toxic megacolon develop.
• Don't use for antibiotic-induced diarrhea.
• Drug is unlikely to be effective if no response occurs within 48 hours.

Bismuth Subsalicylate

Brand Name?

Kaopectate

Kaolin / Pectin

Kaopectate

Generic Name?

Bismuth Subsalicylate (Kaopectate)

Class?

Bismuth Subsalicylate (Kaopectate)

Action?

May have antisecretory, antimicrobial, and anti-inflammatory effects against bacterial and viral enteropathogens.

Bismuth Subsalicylate

Adverse Reactions?

G.I.: Temporary darkening of tongue and stools.

Other: Salicylism with high doses.

Bismuth Subsalicylate

Nursing Considerations?

• Avoid use before G.I. radiologic procedures because drug is radiopaque and may interfere with X-Rays.

Loperamide

Brand Name?

Imodium

Generic Name?

Loperamide (Imodium)

Class?

Loperamide (Imodium)

Action?

Inhibits peristalsis

Loperamide (Imodium)

Adverse Reaction?

• CNS: Dizziness, Drowsiness, Fatigue
• G.I.: Constipation, Abdominal Pain, Distention or Discomfort, Dry Mouth, Nausea, Vomiting
• Skin: Hypersensitivity reactions, Rash. 

Loperamide (Imodium)

Nursing Considerations?

• If symptoms don't improve within 48 hours, stop therapy and consider another drug.
• Drug produces anti-diarrheal action similar to that of Diphenoxylate but without as many adverse CNS effects.
• Alert: Monitor children closely for CNS effects, children may be more sensitive to these effects than adults.

Albuterol Sulfate

Brand Name?

Ventolin

Generic Name?

Albuterol Sulfate (Ventolin)

Class?

Albuterol Sulfate (Ventolin)

Action?

Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta₂ receptors.

Albuterol Sulfate (Ventolin)

Adverse Reactions?

• CNS: Tremor, Nervousness, Headache, Hyperactivity, Insomnia, Dizziness, Weakness, CNS Stimulation, Malaise.
• CV: Tachycardia, Palpitations, Hypertension
• EENT: Dry and irritated nose and throat with inhaled form, nasal congestion, epistaxis, hoarseness, conjunctivitis.
• GI: Nausea, Vomiting, Heartburn, Anorexia, Altered taste, Increased Appetite.
• Metabolic: Hypokalemia
• Musculoskeletal: Muscle Cramps
• Respiratory: Bronchospasm, Cough, Wheezing, Dyspnea, Bronchitis, Increased Sputum.
• Other: Hypersensitivity reactions.

Albuterol Sulfate (Ventolin)

Nursing Considerations?

• Drug may decrease sensitivity of spirometry used for diagnosis of asthma.
• Syrup contains no alcohol or sugar and may be taken by children as young as age 2.
• In children, syrup may rarely cause erythema multiforme or Steven-Johnson syndrome.
• The HFA form uses the propellant hydrofluroalkane (HFA) instead of chloroflurocarbons.
• Alert: Patient may use tablets and aerosol together. Monitor these patients closely for signs and symptoms of toxicity.

Ipratropium Bromide

Brand Name?

Atrovent

Generic Name?

Ipratropium Bromide (Atrovent)

Class?

Ipratropium Bromide (Atrovent)

Action?

Inhibits vagally mediated reflexes by antagonizing acetycholine at muscarinic receptors on bronchial smooth muscle.

• CNS: Dizziness, Pain, Headache
• CV: Palpitations, Chest Pain
• EENT: Blurred Vision, Rhinitis, Pharyngitis, Sinusitis, Epistaxis
• GI: Nausea, GI Distress, Dry Mouth
• Musculoskeletal: Back Pain
• Respiratory: Upper Respiratory Tract Infection, Bronchitis, Bronchospasm, Cough, Dyspnea, Increased Sputum
• Skin: Rash
• Other: Flu-like symptoms, Hypersensitivity reactions.

• If patient uses a face mask for a nebulizer, take care to prevent leakage around the mask because of eye pain or temporary blurring of vision may occur.
• Safety and effectiveness of use beyond 4 days in patient with a common cold haven't been established.

Guaifenesin

Brand Name?

Robitussin

Generic Name?

Guaifensin (Robitussin)

Class?

Miscellaneous Respiratory Drug

Expectorant

Guaifensin (Robitussin)

Action?

Guaifensin (Robitussin)

Adverse Reaction?

• CNS: Dizziness, Headache
• GI: Vomiting, Nausea
• Skin: Rash

Guaifensin (Robitussin)

Nursing Considerations?

• Some liquid formulations contain alcohol.
• Drug is used to liquefy thick, tenacious sputum. Evidence suggests that Guaifensin is effective as an expectorant, but no evidence exists to support its role as an antitussive.
• Monitor cough type and frequency.
• Stop use 48 hours before 5-hydroxyindoleacetic acid and vanillylmandelic tests.

Dextromethorphan Hydrobromide

Class?

Miscellaneous Respiratory Drugs

Antitussives

Dextromethorphan Hydrobromide

Action?

Suppresses the cough reflex by direct action on the cough center in the medulla.

Dextromethorphan Hydrobromide

Adverse Reaction?

• CNS: Drowsiness, Dizziness
• GI: Nausea, Vomiting, Stomach Pain

Dextromethorphan Hydrobromide

Nursing Considerations?

• Don't use dextromethorphan when cough is a valuable diagnostic sign or is beneficial (such as after thoracic surgery).
• Dextromethorphan 15 to 30 mg is equivalent to codeine 8 to 15 mg as an antitussive.
• Drug produces no analgesia or addiction and little or no CNS depression.
• Use drug with chest percussion and vibration.
• Monitor cough type and frequency.

Codeine Phosphate

Class?

Codeine Phosphate

Action?

May bind with opioid receptors in the CNS, altering perception of and emotional response to pain. Also suppresses the cough reflex by direct action on the cough center in the medulla.

Codeine Phosphate

Adverse Reaction?

• CNS: Clouded sensorium, sedation, dizziness, euphoria, light-headedness, physical dependence.
• CV: Bradycardia, Flushing, Hypotension.
• GI: Constipation, Dry Mouth, Ileus, Nausea, Vomiting.
• GU: Urine Retention
• Respiratory: Respiratory Depression
• Skin: Diaphoresis, Pruritis

Codeine Phosphate

Nursing Considerations?

• Reassess patient's level of pain at least 15 and 30 minutes after use.
• Codeine and aspirin or acetaminophen are commonly prescribed together to provide enhanced pain relief.
• For full analgesic effect, give drug before patient has intense pain.
• Drug is an antitussive and shouldn't be used when cough is a valuable diagnostic sign or is beneficial (as after thoracic surgery)
• Monitor Cough Type and Frequency
• Monitor Respiratory and Circulatory Status
• Opioids may delay gastric emptying, increase biliary tract pressure from contraction of the sphincter if Oddi, and interfere with hepatobiliary imaging studies.

Calcium Lactate

Class?

Calcium Lactate

Action?

Replaces calcium and maintains calcium level.

• CNS: Tingling Sensations, Sense of Oppression or Heat Waves with IV use, Syncope with Rapid IV use.
• CV: Bradycardia, Arrhythmias, Cardiac Arrest with Rapid IV use, Mild Drop in Blood Pressure, Vasodilation.
• GI: Constipation, Irritation, Chalky Taste, Hemorrhage, Nausea, Vomiting, Thirst, Abdominal Pain
• GU: Polyuria, Renal Calculi
• Metabolic: Hypercalcemia
• Skin: Local Reactions, including burning, necrosis, tissue sloughing cellulitis, soft-tissue calcification with IM use.

• Use all calcium products with extreme caution in digitalized patients and patients with sarcoidosis and renal or cardiac disease. Use calcium chloride cautiously in patients with cor pulmonale, respiratory acidosis, or respiratory failure.
• Monitor calcium levels frequently.