Learning Plan 7 drugs

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Brand name valproic acid
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Depakene, or Stavzor
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Therapeutic classification of Valproic acid
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anticonvulsants, vascular headache suppressants
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Indications of Valproic acid
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Monotherapy and adjunctive therapy for simple and complex absence seizures., complex partial seizures, adjunctive therapy for multiple seizure types including absence seizures
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Action of Valproic acid
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Increase levels of GABA
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Therapeutic effects of valproic acid
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suppression of seizure activity. Decreased incidence of migraine headaches
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Contraindications of valproic acid
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Hepatic impairment, known/suspected urea cycle disorders
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valproic acid medications to use cautiously
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-may increase risk of suicidal thoughts/behaviors -bleeding disorders -history of liver disease -Organic brain disease -Bone marrow depression -renal impairment -women of childbearing potential -increased risk of adverse effects with geriatric patients -use in pregnancy or lactation is contraindicated can cause birth defects -children under 2 increased risk for potentially fatal hapatotoxicity
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adverse reactions of valproic acid
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-Suicidal thoughts -Hepatotoxicity -pancreatitis -Hyperammonemia -hypothermia
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most common side effects
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-agitation -dizziness -headache -insomnia -sedation -visual disturbances -abdominal pain -anorexia -diarrhea -indigestion -nausea -vomiting -tremors
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adult dosing for valproic acid
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seizures-not to exceed 60 mg/kg/day if over 250 mg then give in divided doses Migraine prevention not to exceed 1000mg daily
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nursing implications for valproic acid
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monitor for seizure location, duration, and characteristics, implement seizure precautions monitor frequency of migrainme headaches assess for suicidal tendencies Monitor for hepatic function and serum ammonia concentrations
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Lab tests for valproic acid
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CBC, platelet count, and bleeding time, may cause leukopenia and thrombocytopenia
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nursing implications for valproic acid
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administer with meals to avoid GI upset do not administer with milk or carbonated beverages may cause premature dissolution
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patient teaching for valproic acid
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take medication as directed notify dr if you have suicidal thoughts or or worsening depression and anxiety, or changes in mood advise dr if anorexia abdominal pain severe nausea and vomiting, jaundice, lethargy, unusual bleeding or bruising, pregnancy, or loss of seizure control
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brand name for captopril
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Capoten
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therapeutic classification for captopril
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antihypertensives
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pharmacologic classification for captopril
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ACE inhibitors
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Indications for Captopril
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-management of HF -reducation of risk or death or development of HF following MI -Decrease progression of diabetic nephropathy
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Action of Captopril
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-block the conversion of angiotensin I to angiotensin II -prevent the degradation of bradykinin and other vasodilatory prostaglandins -increase plasma renin levels -decrease aldosterone levels
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Therapeutic effect of captopril
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-lowering of BP in hypertensive patients -improved symptoms in patients with HF -decrease progression of diabetic nephropathy
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Normal dose range of captopril for adults
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Hypertension-12.5mg-25mg 2-3x daily may be increased at at 1-2 wk intervals up to 150 mg 3x daily maximum dose=450mg/day HF-25 mg 3x daily up to 50 mg 3x/day Post MI- up to 50 mg 3x/day Diabetic nephropathy- 25 mg 3xdaily
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Contraindications of captopril
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-history of angiodema with previos use of ACE inhibitors -Do not use in pregnancy or lactation -renal/hapatic impairment -hyponatremia -hypovolemia
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Adverse side effects of captopril
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-agranulocytosis -angioedema
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most common side effects of captopril
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-cough -hypotension -taste disturbances -neutropenia (captopril only)
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Interactions of captopril
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-use of other diuretics and other antihypertensives may increase the risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists -NSAIDS and selective COX-2 inhibitors my blunt the antihypertensive effect and increase the risk of renal dysfunction -food decreases the absorption take one hour before meals
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Nursing implications of captopril
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-monitor BP -assess patient for signs of angioedema -monitor for s/s of HF -may cause positive ANA titer -may cause false positive test results for urine acetone -monitor CBC with diff prior to initiation of therapy every 2 wk for the first 3 months and periodically for up to 1 yr in patients at risk for neutropenia D/c if neutrophil count less than 1000/mm3
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patient teaching of captopril
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-take 1-2 hours before a meal may be crushed if patient has difficulty swallowing tablets may have sulfurous odor -can be made into an oral solution by crushing a 25 mg tablet and dissolving it ins 25-100mL/water
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trade name for diazepam
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Valium
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therapeutic classification for diazepam
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antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relaxants
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pharmacologic classification for diazepam
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benzodiazepines
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Indications of diazepam
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adjunct in management: Anxiety disorder, Athetosis, anxiety relief prior to cardioversion (injection) Stiffman Syndrome, preoperative sedation, Conscious sedations, treatment of status epilepticus/uncontrolled seizures, skeletal muscle relaxant. Management of the symptoms of alcohol withdrawal
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unlabeled use for diazepam
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-anxiety associated with acute MI, -insomnia
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Action of diazepam
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-depresses the CNS probably by potentiating GABA -produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. -has anticonvulsant properties due to enhance presynaptic inhibition
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Therapeutic effects of diazepam
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-relief of anxiety -sedation -amnesia -skeletal muscle relaxation -decreased seixure activity
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Contraindications for diazepam
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cross-sensitivity with other benzodiazepines may occur comatose patients myasthenia gravis Severe pulmonary impairment sleep apnea severe hepatic dysfunction pre-existing CNS depression uncontrolled severe pain Angle closure glaucoma some products contain alcohol, propylene glycol or tartrazine shoudl be avoided in patients with known hypersensitivity or intolerance Not to be used in pregnancy or lactation or in children less than 6 months old
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side effects for diazepam
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dizziness drowsiness lethargy physical dependence psychological dependence tolerance
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interactions of diazepam
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antidepressants antihistamines opioid analgesics -Cimetidine, hormonal contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metroprolol, propoxyphene, propranolol or valprioc acid may decrease the metabolism of diazepam increasing the actions -may decrease the efficacy of levodopa Rifampin or barbituates may increase the metabolism and decrease the effectiveness of diazepam -sedative effects may be decreased by theophylline -concurrent use or ritonavir is not recommended
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dosage of adults for diazepam
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-Antianxiety- 2-10mg 2-4x daily PO, IV or IM 2-10 mg may repeat in 3-4 hours prn -Status epilepticus/acut seizure activity- IV 5-10 mg may repeat q 10-15 min to a total of 30 mg may repeat regimen again in 2-4 hours larger doses may be required -Precardioversion- IV 5-15 mg 5-10 min precardioversion -Pre-endoscopy-IV 2.5-20 mg IM 5-10 mg 30 minutes pre-endoscopy -skeletal muscle relaxation- PO 2-10 mg 3-4x daily IV IM 5-10 mg may repeat in 2-4 hr may need a larger dose for tetanus
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nursing implications for diazepam
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-monitor VS during IV therapy -assess IV site frequently may cause phlebitis and venous thrombosis -assess mental status and degree of anxiety -keep seizure log intensity, duration, and location; implement seizure precautions -evaluate hapatic and renal function and CBC periodically during prolonged therapy -toxicity and overdose- Flumazenil is adjunct in the management of toxicity or overdose
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patient teaching for diazepam
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-take medications every day and do not take more than prescribed or increase dosage without checking with your doctor -stopping abruptly may cause insomnia, unusual irritability, nervousness, and/or seizures -patients on med for seizure management should wear identification with the condition on it.
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trade name for carvedilol
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Coreg, Coreg CR
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Therapeutic classification of carvedilol
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antianginals, antiarrhythmics, antihypertensives
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pharmacologic classification of carvedilol
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beta blockers (non selective)
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Indications for carvedilol
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HF (ischemic or cardiomyopathic) with other agents, left ventricular dysfunction after MI
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Action of carvedilol
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block stimulation of beta1-adrenergic and beta2-adrenergic receptors sites -have alpha1-adrenergic blocking activity which may result in more orthostatic hypotension
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Therapeutic effects of carvedilol
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-decreased HR and BP -suppression of arrhythmias -increased Cardiac output -decreased risk of death from HF -slowed pregression of HR -prevention of MI
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Contraindications of carvedilol
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-uncompensated HF -pulmonary edema -cardiogenic shotck -bradycardia -sick sinus syndrome -heart block (unless pacemaker present) -severe hepatic impairment -bronchial asthma/bronchospasm
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use cautiosly with carvedilol
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-renal impairment -hepatic impairment -HF (condition may deteriorate after initial therapy) -DM (may mask signs of hypoglycemia) -PVD -Thyrotoxicosis (may mask symptoms) -history of severe allergic reactions -skeletal muscle disease -do not use in pregnancy or lactation -geriatric may have increased sensitivity use lower initial dose and consider decrease in body mass renal/hepatic/cardiac function
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adverse reactions of carvedilol
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-arrhythmias -bradycardia -HF -PE
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most common side effects of carvedilol
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-fatigue -weakness -intraoperative floppy iris syndrome -increase in orthostatic hypotension -erectile dysfunction
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Adult dosage for carvedilol
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hypertension-6.25 mg 2xday may be increased q7-14 days up to 25 mg 2xday or extended release 20 mg 1xday dose may be doubled q7-14 days up to 80 mg 1xday HF-3.125 mg 2xday for 2 weeks, may be increased to 6.25 mg twice daily, dose may be doubled q 2 weeks as tolerated not to exceed 25 mg 2xdayin patients less than 85 kg or 50 mg 2xday in patients over 85 kg -extended release-10 mg 1xday, dose may be double q 2 wks as tolerated up to 80 mg 1xday -left ventricular dysfunction after MI-6.25mg 2xday increased after 3-10 days to 12.5mg 2xdaythen to target dose of 25 mg2xday some patientsf may require lower initial doses and slower titration or extedded release 20 mg 1xday up to 80 mg
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nursing implications for carvedilol
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monitor BP and pulse frequently during dose adjustment and periodically monitor I/O ratios and daily weight assess patient routinely for evidence of fluid overload may cause and increase in BUN, serum lipoprotein, potassium, triglyceride, uric acid levels, may cause in ANA titers may cause increase in blood glucose levels monitor for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, cyanosis, seizures)
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Nursing implementation for carvedilol
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Do not confuse carvedilol with captopril take apical pulse before administering if less than 60 or if arrythmia occurs withhold medication and contact the Dr.
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patient teaching for carvedilol
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take medication as directed every day abrupt withdrawal may precipated life-threatening arrythmias, hypertension and myocardial ischemia -if slow pulse, difficulty breathing wheezing, cold hands and feet, dizziness, confusion, depression, rash fever, sore throat, unusual bleeding or bruising occurs then contact your Dr.
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Brand name for dopamine
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Intropin
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Therapeutic classification of dopamine
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inotropics, vasopressors
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pharmacological classification of dopamine
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adrenergics
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indications of dopamine
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adjunct to standard measures to improve BP, CO, urine output in treatment of shock unresponsive to fluid replacement, increase in renal perfusion
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Action of dopamine
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-small doses (0.5-3mcg/kg/min) stimulate dopaminergic receptors, producing renal vasodilation. -Larger doses (2-10 mcg/kg/min) stimulate dopaminergic and beta1 adrenergic receptors, producing cardiac stimulation and renal vasodilation -doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may cause renal vasoconstriction
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Therapeutic effects of dopamine
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increased CO, increased BP, improved reanal blood flow
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side effects of dopamine
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arrhythmias, hypotension
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Drug-drug interactions with dopamine
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use with MAO inhibitors, ergot alkaloids (ergotamine), doxapram or some antidepressants results in severe hypertension, use with IV phenytoin may cause hypotension and bradycardia. Use with general anesthetics may result and arrhythmias, beta blockers may antagonize cardia effects
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adult dosage for dopamine
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IV dopaminergic (renal vasodilation)-1-5mcg/kg/min IV beta-adrenergic (cardia stimulation) 5-15 mcg/kg/min IV alpha adrenergic (increased peripheral vascular resistance) more than 15 mcg/kg/min infusion rate may be increased as needed
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Nursing implications
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Monitor VS,ECG pulmonary capillary wedge pressure, CO, CVP, and urinary output continuously during administration. – Palpate peripheral pulses and assess appearance of extremities routinely during adminstration -Toxicity and overdose in excessive hypertension occurs rate of infusion should be decreased or temporarily discontinued until BP is decreased Phentolamine may be administered if hypertension continues
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high alert for dopamine
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double check order to ensure accuracy -extra vasation may cause severe irritation, necrosis and sloughing of tissue, administer into a large vein and assess administration site frequently, if extravasation occurs, affected area should be infiltrated liberally with 10-15 mL of 0.9% NaCl containing 5-10 mg of phentoloamine.
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patient/family teaching for dopamine
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have patient inform you immediately if experiencing chest pain, dyspnea, numbness, intgling or burning of extremities, and pain at the adminstration site.

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