Brand: Lantus, Toujeo, Basaglar, Semglee, Rezvoglar
Class: Antidiabetic; long-acting (basal) insulin analog
Indications: Glycemic control in type 1 and type 2 diabetes
Action: Absorbed slowly with no pronounced peak, giving steady basal insulin that lowers glucose
Adverse Effects: Hypoglycemia, hypokalemia, hypersensitivity, lipodystrophy, injection site reactions, weight gain, edema
Contraindications: During hypoglycemia, hypersensitivity to insulin glargine
Interactions: Beta blockers (mask lows); other antidiabetics, alcohol; corticosteroids and thiazides raise glucose; TZDs (fluid retention)
Nursing Considerations: Subcut once daily at the same time; never IV or in a pump; never dilute or mix; in type 1 diabetes never omit basal doses unless ordered
Patient Teaching: Rotate sites within the same region; carry fast-acting glucose; never share a pen, even with a new needle
Glargine is clear like rapid-acting insulin but must never be mixed or given IV, so read the label rather than trusting the look of the vial.
Card 2
insulin lispro
Answer
Brand: Humalog, Admelog
Class: Antidiabetic; rapid-acting (mealtime) insulin analog
Indications: Mealtime glycemic control in type 1 and type 2 diabetes; insulin pump therapy
Action: Absorbed faster than regular insulin to cover the glucose rise after meals
Adverse Effects: Hypoglycemia, hypokalemia, hypersensitivity, lipodystrophy; hyperglycemia and DKA if a pump fails
Contraindications: During hypoglycemia, hypersensitivity to insulin lispro
Interactions: Beta blockers (mask lows); other antidiabetics, alcohol; corticosteroids and thiazides raise glucose; TZDs (fluid retention)
Nursing Considerations: Subcut within 15 min before or right after a meal; confirm food is coming; mix only with NPH, lispro drawn first; IV only U-100, diluted
Patient Teaching: Never move U-200 from pen to syringe or use it in a pump; keep backup pens or syringes in case a pump fails
Lispro starts working fast enough that the meal tray, not the clock, should decide when it is given.
Card 3
regular insulin
Answer
Brand: Humulin R, Novolin R, Myxredlin (premixed IV bag)
Class: Antidiabetic; short-acting human insulin
Indications: Glycemic control in diabetes; the usual insulin for continuous IV infusion in DKA and HHS
Action: Moves glucose and potassium into cells; suppresses liver glucose output
Adverse Effects: Hypoglycemia, hypokalemia (especially IV), hypersensitivity, weight gain
Contraindications: During hypoglycemia, hypersensitivity to human insulin
Interactions: Beta blockers (mask lows); other antidiabetics, alcohol; corticosteroids and thiazides raise glucose
Monitoring: Blood glucose and potassium closely during IV infusion
Nursing Considerations: Subcut about 30 min before meals; check K before an IV drip, as low K is corrected first; double check IV doses; U-500 is not U-100
Patient Teaching: U-100 is sold without a prescription, so confirm the home product; treat lows (sweating, shakiness, confusion) with fast carbs
Regular insulin is the insulin hung in most IV drips, and it pulls potassium into cells along with glucose.
Card 4
metformin
Answer
Brand: None (Glucophage and other brands discontinued); generic
Class: Antidiabetic; biguanide
Indications: Type 2 diabetes, adjunct to diet and exercise
Action: Lowers liver glucose output and intestinal glucose absorption; improves insulin sensitivity
Adverse Effects: Lactic acidosis (boxed warning), diarrhea, nausea, vomiting, flatulence, vitamin B12 deficiency
Contraindications: eGFR below 30, acute or chronic metabolic acidosis including DKA, hypersensitivity
Interactions: Iodinated contrast; topiramate; alcohol; cimetidine, ranolazine, dolutegravir (raise levels)
Monitoring: Renal function before starting and periodically; vitamin B12 periodically
Nursing Considerations: Give with meals; hold for iodinated contrast if eGFR 30 to 60, liver disease, alcoholism, HF or arterial dye; recheck eGFR at 48 h
Patient Teaching: Avoid heavy drinking; report muscle pain, trouble breathing, unusual sleepiness or stomach pain
Metformin rarely causes hypoglycemia on its own; its dangerous edge is lactic acidosis when the kidneys or liver cannot clear lactate.
Card 5
glipizide
Answer
Brand: Glucotrol XL (immediate-release Glucotrol brand discontinued)
Class: Antidiabetic; second-generation sulfonylurea
Indications: Type 2 diabetes, adjunct to diet and exercise
Action: Stimulates insulin release from pancreatic beta cells
Adverse Effects: Hypoglycemia (prolonged in elderly, renal or hepatic impairment), hemolytic anemia (G6PD deficiency), GI upset
Contraindications: Type 1 diabetes, diabetic ketoacidosis, hypersensitivity
Interactions: Fluconazole, oral miconazole, NSAIDs, salicylates (more lows); beta blockers (mask signs); alcohol; colesevelam
Nursing Considerations: Immediate-release 30 min before a meal, XL with breakfast; hold per order if NPO; start low in older adults; give 4 h before colesevelam
Patient Teaching: Do not skip meals after a dose; swallow XL whole (an empty shell in stool is normal); carry fast-acting glucose
Sulfonylureas squeeze insulin out of the pancreas whether or not the patient eats, so a skipped meal can mean a long, stubborn low.
Card 6
empagliflozin
Answer
Brand: Jardiance
Class: Antidiabetic, cardiorenal agent; SGLT2 inhibitor
Indications: Type 2 diabetes, heart failure, CKD at risk of progression, CV death reduction in type 2 diabetes with CV disease
Action: Blocks glucose reabsorption in the proximal renal tubule, causing glucosuria and mild diuresis
Adverse Effects: Ketoacidosis (even with normal glucose), volume depletion, urosepsis, Fournier gangrene, genital yeast infections
Contraindications: Hypersensitivity to empagliflozin
Interactions: Diuretics (volume depletion), insulin and sulfonylureas (hypoglycemia), lithium (levels fall)
Nursing Considerations: Hold at least 3 days before surgery or prolonged fasting as ordered; check ketones if ill or vomiting; assess volume and renal function
Patient Teaching: Report genital pain, swelling or fever, and nausea, vomiting or trouble breathing; urine glucose tests will read positive
SGLT2 inhibitors can cause ketoacidosis with a near-normal glucose, so a sick patient on one needs ketones checked even when the meter looks fine.
Card 7
semaglutide
Answer
Brand: Ozempic, Wegovy (injection, pill), Rybelsus
Class: Antidiabetic, weight management; GLP-1 receptor agonist
Indications: Type 2 diabetes, CV and kidney risk reduction in diabetes, weight management, CV risk reduction in obesity, MASH
Action: Mimics GLP-1: glucose-dependent insulin release, less glucagon, slower gastric emptying, less appetite
Adverse Effects: Thyroid C-cell tumors in rodents (boxed warning), pancreatitis, gallbladder disease, AKI from dehydration, severe GI upset
Contraindications: Personal or family history of medullary thyroid carcinoma or MEN 2, serious hypersensitivity
Interactions: Insulin and sulfonylureas (hypoglycemia); may alter oral drug absorption
Nursing Considerations: Injection once weekly, same day; tablets on waking with up to 4 oz water, wait 30 min for food or meds; tell anesthesia about use
Patient Teaching: Report a neck lump, hoarseness, trouble swallowing or severe abdominal pain; stay hydrated
Slowed gastric emptying explains both the nausea and the aspiration warning for anesthesia and deep sedation.
Card 8
sitagliptin
Answer
Brand: Januvia, Zituvio
Class: Antidiabetic; DPP-4 inhibitor
Indications: Type 2 diabetes, adjunct to diet and exercise; not for type 1 diabetes
Action: Blocks DPP-4, raising incretins to increase glucose-dependent insulin release and lower glucagon
Adverse Effects: Pancreatitis, heart failure, acute renal failure, anaphylaxis, angioedema, SJS, severe joint pain, bullous pemphigoid
Contraindications: History of serious hypersensitivity to sitagliptin
Interactions: Insulin and sulfonylureas (hypoglycemia; their doses may need lowering)
Nursing Considerations: Check renal function at start and periodically (dose is reduced in renal impairment); stop if pancreatitis is suspected; watch for HF
Patient Teaching: Report severe persistent abdominal pain, blisters, or swelling of the face, lips or throat; take with or without food
DPP-4 inhibitors only boost insulin when glucose is high, so they rarely cause lows unless paired with insulin or a sulfonylurea.
Card 9
pioglitazone
Answer
Brand: Actos
Class: Antidiabetic; thiazolidinedione
Indications: Type 2 diabetes, adjunct to diet and exercise
Action: PPAR-gamma agonist that increases insulin sensitivity in muscle, fat and liver
Adverse Effects: Heart failure (boxed warning), edema, weight gain, fractures, liver injury, bladder cancer risk, macular edema
Contraindications: Starting in NYHA class III or IV heart failure, hypersensitivity
Interactions: Gemfibrozil (raises levels), rifampin (lowers levels), insulin and sulfonylureas (hypoglycemia)
Monitoring: Liver tests before starting and if signs of liver injury appear
Nursing Considerations: Weigh daily; assess for edema, crackles and dyspnea; not for symptomatic HF; avoid in active bladder cancer; ensure regular eye exams
Patient Teaching: Report rapid weight gain, swelling, dyspnea, dark urine, yellow skin or blood in urine; ovulation may resume, so pregnancy is possible
Thiazolidinediones hold onto fluid, which is why the boxed warning is heart failure rather than hypoglycemia.
Card 10
levothyroxine
Answer
Brand: Synthroid, Levoxyl, Unithroid, Euthyrox, Tirosint
Class: Thyroid hormone replacement; synthetic T4
Indications: Hypothyroidism, TSH suppression with surgery and radioiodine in thyroid cancer
Action: Converted to T3, restoring normal metabolic rate
Adverse Effects: Overtreatment: tachycardia, dysrhythmias, angina, tremor, insomnia, heat intolerance, bone loss
Contraindications: Uncorrected adrenal insufficiency; not for obesity or weight loss (boxed warning)
Interactions: Calcium, iron, antacids, bile acid sequestrants, PPIs (less absorption); warfarin effect up; digoxin effect down
Monitoring: TSH periodically (free T4 in central hypothyroidism)
Nursing Considerations: Empty stomach 30 to 60 min before breakfast; separate from calcium, iron and antacids by 4 h; start low in older or cardiac patients
Patient Teaching: Usually lifelong, so do not stop on your own; take it the same way daily; report palpitations or chest pain
Levothyroxine is fussy about absorption, so the same empty-stomach routine every day keeps the TSH stable.
Card 11
methimazole
Answer
Brand: None (Tapazole brand discontinued); generic
Class: Antithyroid agent; thioamide
Indications: Graves disease or toxic multinodular goiter when surgery or radioiodine is not appropriate; preparation for either
Action: Inhibits thyroid hormone synthesis; does not inactivate hormone already made
Adverse Effects: Agranulocytosis, liver injury, ANCA vasculitis, hypothyroidism, birth defects with first-trimester use, rash
Contraindications: Hypersensitivity to methimazole
Interactions: Warfarin (effect up); beta blockers, digoxin, theophylline may need lower doses once euthyroid
Monitoring: TSH and free T4 periodically
Nursing Considerations: Hold and get a CBC with differential for fever or sore throat; liver tests for jaundice or RUQ pain; preferred except in early pregnancy
Patient Teaching: Report fever, sore throat, mouth sores, yellow skin or dark urine at once; tell your provider if pregnant
Fever or sore throat on an antithyroid drug is agranulocytosis until a CBC says otherwise.
Card 12
propylthiouracil
Answer
Brand: None; generic only
Class: Antithyroid agent; thioamide
Indications: Graves disease or toxic multinodular goiter if methimazole is not tolerated and surgery or radioiodine is not appropriate
Action: Inhibits thyroid hormone synthesis and blocks peripheral conversion of T4 to T3
Adverse Effects: Severe liver injury and acute liver failure (boxed warning), agranulocytosis, ANCA vasculitis, hypothyroidism
Contraindications: Hypersensitivity to propylthiouracil
Interactions: Warfarin (effect up); beta blockers, digoxin, theophylline may need lower doses once euthyroid
Monitoring: TSH and free T4 periodically; signs of liver injury
Nursing Considerations: Reserved for methimazole intolerance or just before and during the first trimester; stop for jaundice or RUQ pain; CBC for fever
Patient Teaching: Report fatigue, poor appetite, yellow skin or dark urine, fever or sore throat right away
PTU's extra block on T4-to-T3 conversion is why it is reached for in thyroid storm, but its boxed liver warning keeps it second line otherwise.
Card 13
prednisone
Answer
Brand: None (Rayos brand discontinued); generic
Class: Anti-inflammatory, immunosuppressant; glucocorticoid
Indications: Asthma and COPD flares, allergic states, rheumatic and autoimmune disorders, adrenal insufficiency (with a mineralocorticoid)
Action: Converted to prednisolone in the liver; suppresses inflammation and immunity
Adverse Effects: Adrenal suppression, infection, hyperglycemia, mood changes or psychosis, fluid retention, hypokalemia, osteoporosis, ulcer
Contraindications: Systemic fungal infections, hypersensitivity; live vaccines at immunosuppressive doses
Interactions: NSAIDs and aspirin (ulcer), K-depleting diuretics, warfarin, antidiabetics, CYP3A4 inducers and inhibitors
Nursing Considerations: Give in the morning with food; taper after prolonged use; monitor glucose, BP, weight and K; infection signs may be masked
Patient Teaching: Never stop suddenly; report fever or infection signs; avoid chickenpox and measles exposure
Long courses shut down the patient's own adrenal output, so stopping abruptly can trigger adrenal crisis.
Card 14
fludrocortisone
Answer
Brand: None (Florinef brand discontinued); generic
Class: Corticosteroid; mineralocorticoid
Indications: Partial replacement in adrenal insufficiency (Addison disease), salt-losing adrenogenital syndrome
Action: Acts on the distal renal tubule to retain sodium and water and excrete potassium
Adverse Effects: Hypertension, edema, heart failure, weight gain, hypokalemia, headache
Contraindications: Systemic fungal infections, hypersensitivity
Interactions: K-wasting diuretics, amphotericin B (hypokalemia); digoxin (toxicity with low K); warfarin; antidiabetics; rifampin
Monitoring: Blood pressure, weight and serum electrolytes periodically
Nursing Considerations: Weigh daily and check BP; assess for edema and crackles; usually paired with a glucocorticoid; stress may need extra steroid coverage
Patient Teaching: Report swelling, rapid weight gain, headache, muscle weakness or cramps; do not stop on your own
Fludrocortisone replaces aldosterone, so its toxicity looks like too much salt: high BP, edema and low potassium.
Card 15
desmopressin
Answer
Brand: DDAVP (tablets, injection)
Class: Antidiuretic hormone; synthetic vasopressin analog
Indications: Central DI, primary nocturnal enuresis (tablets), mild hemophilia A and type 1 von Willebrand disease (injection)
Action: Increases water reabsorption in renal collecting ducts; injection also raises factor VIII and von Willebrand factor
Adverse Effects: Hyponatremia, water intoxication and seizures; headache, nausea, flushing
Contraindications: Hyponatremia or history of it, CrCl below 50 mL/min, hypersensitivity
Interactions: SSRIs, TCAs, opioids, NSAIDs, carbamazepine, lamotrigine (more hyponatremia)
Monitoring: Serum sodium, I&O, urine osmolality, daily weight
Nursing Considerations: Restrict fluids as ordered, especially children and older adults; watch for headache, confusion or seizures; not for nephrogenic DI
Patient Teaching: Drink only the amount you were told; report headache, nausea, confusion or sudden weight gain
Desmopressin makes the kidney hold free water, so the danger is dilutional hyponatremia, not volume overload you can see.
Card 16
alendronate
Answer
Brand: Fosamax, Fosamax Plus D, Binosto
Class: Bone resorption inhibitor; bisphosphonate
Indications: Osteoporosis (postmenopausal treatment and prevention, men, glucocorticoid-induced), Paget disease
Action: Inhibits osteoclast-mediated bone resorption
Adverse Effects: Esophagitis and ulcers, hypocalcemia, severe musculoskeletal pain, jaw osteonecrosis, atypical femur fractures
Contraindications: Esophageal disorders that delay emptying, inability to stay upright 30 min, hypocalcemia; not advised if CrCl below 35
Interactions: Calcium, antacids and other oral drugs (wait at least 30 min); aspirin and NSAIDs (upper GI irritation)
Nursing Considerations: On waking with 6 to 8 oz plain water, 30 min before food, drink or meds; upright 30 min and until first food; correct low calcium first
Patient Teaching: Swallow whole, never at bedtime; report painful swallowing, new heartburn, thigh or groin pain, or jaw pain
Every alendronate rule exists to get the tablet into the stomach fast and keep it out of the esophagus.
Card 17
fluticasone
Answer
Brand: Arnuity Ellipta (furoate); Flovent brand discontinued 2024, now generic (propionate)
Class: Antiasthmatic, anti-inflammatory; inhaled corticosteroid
Indications: Maintenance treatment of asthma; not for acute bronchospasm
Action: Suppresses airway inflammation, edema and mucus
Adverse Effects: Oral candidiasis, hoarseness, paradoxical bronchospasm, adrenal suppression, bone loss, slowed growth in children, cataracts, glaucoma
Contraindications: Primary treatment of status asthmaticus or acute attacks, severe milk protein allergy (dry powder), hypersensitivity
Interactions: Strong CYP3A4 inhibitors such as ritonavir, ketoconazole (systemic steroid effects)
Nursing Considerations: Not a rescue inhaler; have the patient rinse with water and spit after each use; taper oral steroids slowly when switching
Patient Teaching: Use every day even when well; rinse and spit after each dose; keep a rescue inhaler
Inhaled steroids prevent attacks over time; they do nothing for the attack happening now.
Card 18
montelukast
Answer
Brand: Singulair
Class: Antiasthmatic; leukotriene receptor antagonist
Indications: Asthma prophylaxis, exercise-induced bronchoconstriction prevention, allergic rhinitis only if alternatives fail or are not tolerated
Action: Blocks cysteinyl leukotriene receptors, reducing airway edema, bronchoconstriction and mucus
Adverse Effects: Serious neuropsychiatric events (boxed warning): agitation, depression, sleep disturbance, suicidal thinking; eosinophilic vasculitis
Contraindications: Hypersensitivity to montelukast
Interactions: Phenobarbital and rifampin (lower levels; monitor)
Nursing Considerations: Not for acute attacks; screen mood, behavior and sleep; do not abruptly substitute for steroids; give in the evening for asthma
Patient Teaching: Stop and call for mood or behavior changes, nightmares or suicidal thoughts; if aspirin-sensitive, still avoid aspirin and NSAIDs
The boxed warning is about the mind, not the lungs: ask about mood, sleep and behavior at every visit.
Card 19
tiotropium
Answer
Brand: Spiriva HandiHaler, Spiriva Respimat
Class: Bronchodilator; long-acting muscarinic antagonist (LAMA)
Indications: COPD maintenance and reduction of exacerbations; asthma maintenance (soft mist inhaler)
Action: Blocks M3 muscarinic receptors in airway smooth muscle, causing long-lasting bronchodilation
Adverse Effects: Dry mouth, paradoxical bronchospasm, angioedema, urinary retention, worsening narrow-angle glaucoma, constipation
Contraindications: Hypersensitivity to tiotropium, ipratropium or any component
Interactions: Other anticholinergic drugs (additive effects)
Nursing Considerations: Once daily maintenance, not rescue; capsules go in the inhaler, never swallowed; watch anticholinergic effects in renal impairment
Patient Teaching: One dose per 24 h; keep powder or mist out of eyes; report eye pain, blurred vision, halos or trouble urinating
Tiotropium is a long-acting cousin of ipratropium, so allergy to either one rules it out.
Card 20
salmeterol
Answer
Brand: Serevent Diskus
Class: Bronchodilator; long-acting beta2 agonist (LABA)
Indications: Asthma only as add-on to an inhaled corticosteroid, exercise-induced bronchospasm prevention, COPD maintenance
Action: Stimulates beta2 receptors to relax bronchial smooth muscle for about 12 h
Adverse Effects: Asthma-related death without an ICS (boxed warning), paradoxical bronchospasm, tachycardia, tremor, hypokalemia
Contraindications: Asthma without an ICS, primary treatment of status asthmaticus or acute attacks, severe milk protein allergy
Interactions: Strong CYP3A4 inhibitors (avoid); MAOIs and TCAs; beta blockers (bronchospasm); non-potassium-sparing diuretics
Nursing Considerations: Never a rescue inhaler; twice daily about 12 h apart; do not add another LABA product; do not start during rapidly worsening asthma
Patient Teaching: Keep a rescue inhaler; one inhalation twice daily, no more; keep using your inhaled steroid
In asthma a LABA is always paired with an inhaled steroid; alone it raises the risk of asthma-related death.
Card 21
pantoprazole
Answer
Brand: Protonix, Protonix I.V.
Class: Antiulcer agent; proton pump inhibitor
Indications: Erosive esophagitis with GERD (healing, maintenance), Zollinger-Ellison and other hypersecretory states
Action: Irreversibly blocks the gastric H+/K+ ATPase (proton pump)
Adverse Effects: C. difficile diarrhea, fractures, low magnesium, low B12, acute interstitial nephritis, lupus, severe skin reactions
Contraindications: Hypersensitivity to substituted benzimidazoles, rilpivirine-containing products
Interactions: Rilpivirine; warfarin (INR up); high-dose methotrexate; less absorption of iron, azoles, mycophenolate; false-positive urine THC
Nursing Considerations: Swallow tablets whole; IV push over at least 2 min or 15 min infusion; check magnesium long term; relief does not rule out cancer
Patient Teaching: Report severe watery diarrhea, muscle cramps or palpitations; use the lowest dose for the shortest time
PPIs shut down the last step of acid secretion, and years of low acid explain the long-term risks: fractures, low magnesium, B12 deficiency.
Card 22
sucralfate
Answer
Brand: Carafate (tablets); suspension now generic only
Class: Antiulcer agent; mucosal protectant
Indications: Short-term treatment of active duodenal ulcer; maintenance after healing (tablets)
Action: Forms a protective barrier over the ulcer base against acid, pepsin and bile
Adverse Effects: Constipation (most common), aluminum accumulation in renal failure, hyperglycemia in diabetes, bezoars
Contraindications: Hypersensitivity to sucralfate
Interactions: Lowers absorption of fluoroquinolones, digoxin, levothyroxine, phenytoin, ketoconazole, theophylline; antacids within 30 min
Nursing Considerations: Empty stomach; give interacting drugs 2 h before; never give IV (fatal emboli); check glucose in diabetes; caution in renal failure
Patient Teaching: Take on an empty stomach and other medicines 2 h earlier; no antacids within 30 min of a dose
Sucralfate is a bandage, not an acid blocker, and it binds other drugs in the gut just as well as it binds the ulcer.
Card 23
misoprostol
Answer
Brand: Cytotec
Class: Antiulcer agent; prostaglandin E1 analog
Indications: Reducing the risk of NSAID-induced gastric ulcers in high-risk patients
Action: Replaces protective prostaglandins, lowering acid secretion and increasing mucus and bicarbonate
Adverse Effects: Abortion, birth defects, premature birth, uterine rupture (boxed warning); dose-related diarrhea, abdominal pain, nausea
Contraindications: Pregnancy (for ulcer prevention), history of allergy to prostaglandins
Interactions: Magnesium-containing antacids (more diarrhea), oxytocin (effect augmented)
Nursing Considerations: If pregnancy possible: negative serum test within 2 weeks, contraception, start day 2 or 3 of next period; give with meals and at bedtime
Patient Teaching: Use effective contraception and never share this drug; diarrhea is usually mild and short-lived
Misoprostol protects the stomach from NSAIDs, but the same prostaglandin effect on the uterus makes pregnancy screening mandatory.
Card 24
lactulose
Answer
Brand: Kristalose (constipation); Enulose and Constulose brands discontinued; mostly generic
Class: Ammonia detoxicant, laxative; osmotic disaccharide
Indications: Prevention and treatment of portal-systemic (hepatic) encephalopathy; constipation (some products)
Action: Colonic bacteria break it into acids that pull water into the bowel and trap ammonia as ammonium
Adverse Effects: Gas, cramping, nausea; excess dosing causes diarrhea with fluid loss, hypokalemia and hypernatremia
Contraindications: Patients who need a low-galactose diet
Interactions: Nonabsorbable antacids, neomycin and other oral anti-infectives (may reduce effect); other laxatives
Nursing Considerations: For encephalopathy, titrate to 2 or 3 soft stools a day as ordered; track mental status, stools, I&O and electrolytes
Patient Teaching: Report diarrhea or weakness; may mix with juice, water or milk; contains galactose, so diabetics monitor glucose
In liver failure, the stool count is the dose check: lactulose works by flushing ammonia out of the colon.
Card 25
loperamide
Answer
Brand: Imodium A-D (OTC)
Class: Antidiarrheal; peripheral opioid agonist
Indications: Acute nonspecific and travelers' diarrhea, chronic IBD diarrhea, reducing ileostomy output
Action: Acts on gut-wall opioid receptors to slow peristalsis and increase absorption
Adverse Effects: QT prolongation, torsades, cardiac arrest at high doses; constipation, ileus, cramps
Contraindications: Age under 2, abdominal pain without diarrhea, bloody diarrhea with fever, acute UC, invasive or antibiotic colitis
Interactions: Itraconazole, ritonavir, quinidine, gemfibrozil (raise levels); QT-prolonging drugs
Antidote: Naloxone for CNS or respiratory depression
Nursing Considerations: Replace fluids and electrolytes; stop for constipation, distention or ileus; reassess at 48 h; suspect misuse in unexplained syncope
Patient Teaching: Never exceed the label dose (heart risk); avoid with bloody or black stools; see a provider if diarrhea lasts over 2 days
Loperamide is an opioid that stays in the gut at normal doses; misuse at very high doses has caused fatal dysrhythmias.
Card 26
docusate
Answer
Brand: Colace
Class: Stool softener; surfactant (emollient) laxative
Indications: Occasional constipation; preventing straining or impaction (after surgery or MI)
Action: Lowers stool surface tension so water and fat penetrate and soften the stool
Adverse Effects: Abdominal cramping, diarrhea; electrolyte imbalance with overuse
Contraindications: Hypersensitivity to docusate
Interactions: Mineral oil (ask a provider before combining)
Nursing Considerations: Give with a full glass of water; ask the provider first if abdominal pain, nausea or vomiting; liquid can be mixed with milk or juice
Patient Teaching: Expect a bowel movement in 12 to 72 h; stop and call for rectal bleeding, no bowel movement, or need beyond 1 week
Docusate softens stool but does not make the bowel move, so it fits patients who must not strain more than those already constipated.