"I Can't Poop": Medication-Induced Constipation.

One of the challenging side effects of many medications is constipation. When knowledgeable nurses who teach patients about their medications include information about the possibility of constipation, they can then educate patients about how to prevent, reduce, or treat medication-related constipation. Discussion in the following article addresses examples of drugs that have the potential for constipation, why constipation may occur with these medications, and how to safely prevent or reduce medication-induced constipation.

More New Medication Approvals.

In the past year, the Federal Drug Administration (FDA) approved many new drugs for treating a wide variety of patient health problems. In a previous article, examples of approvals for the early part of last year were addressed. In this article, selected new FDA approvals through January 2016 are discussed. Nurses who are knowledgeable and informed about these new drugs will be able to answer patients' questions, clarify misunderstandings, and reduce the potential for medication misadventures.

Catching Up on New Medications: New FDA Approvals.

Despite all efforts of the Federal Drug Administration to release timely and accurate information about new drug approvals, marketing and media announcements about new drugs may be incomplete, misinterpreted, or misunderstood. Informed and knowledgeable nurses are able to educate patients about new medications: they can clarify misunderstandings or misconceptions and significantly reduce the potential for harm. In this article, selected examples of new brand name drugs and first-time generics approved this year are discussed.

Acetaminophen by infusion.

Acetaminophen is a nonsteroidal, nonsalicylate analgesic and antipyretic that is, today, the most common medication ingredient found in oral and rectal over-the-counter and prescription drugs. However, it was not until 2010 that Ofirmev (acetaminophen), an injection form of acetaminophen, was approved for treating mild to moderate pain, as an adjunct to opioids for severe pain, and reduction of fever in those younger than 2 years. Thus, intravenous acetaminophen may be appropriately used in a wide variety of settings and nurses who are knowledgeable and informed about the correct use of intravenous acetaminophen will be able to reduce the potential for medication misadventures. In this article, the uses and cautions for Ofirmev are discussed.

Glaucoma and glaucoma medications.

Glaucoma is an insidious "thief of vision" that affects millions of Americans and is a leading cause of blindness worldwide. The signs of the most common form of glaucoma are incremental and are often not noticed until the vision loss is acute. Nurses, in any practice arena, who are aware and knowledgeable about glaucoma can play a vital role in identifying those at risk for glaucoma before irreversible damage is done. In addition, knowledgeable nurses will be able to educate those diagnosed with glaucoma about their disease and the proper use of their glaucoma medications. In the following discussion, a brief explanation of how glaucoma affects vision is presented and selected medications used to treat glaucoma are identified.

One statin, two statins, three statins, more: similarities and differences of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.

Statin drugs (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are one of the most widely prescribed drugs today. They are considered first-line therapy to lower blood serum cholesterol levels in conjunction with therapeutic lifestyle changes for both primary and secondary prevention of cardiovascular events. In the following discussion, a brief explanation of the background of statins will explain why they are deemed so important today. The similarities and differences between the different statins will be addressed, including a look at dosage, side effects, and cautions for the seven 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors currently available.

What's new? Medication changes 2008-2010.

Every year there are new medications approved by the Federal Food & Drug Administration. Some medications are removed from the market, and new information or warnings about existing medications become available. Some of the information about these changes makes its way into public media and can cause concern among patients and some can be misleading for those without a full understanding of the facts. Nurses who talk to patients about their medications may be faced with questions about medications that patients have heard about from friends or the media. Informed nurses will be prepared to provide accurate information, allay fears or misperceptions, and reduce the potential for harm. In the following discussion, selected examples of information about recent changes will be identified.

Acetaminophen: old friend--new rules.

Acetaminophen is an old and comfortable friend. In its over-the-counter forms (of which there are almost 100), it is used by millions of people for relief of pain and to treat mild fevers. When combined with an opioid as a prescription drug, it is often effective for more severe pain. Generally, for most people, when taken as directed, acetaminophen has proved to be not only effective but also safe with very few adverse effects. However, the relationship between acetaminophen use and acute liver damage is not as well known (despite Federal Drug Administration [FDA] recommendations for changes that relate to both labeling and use). In this article, recent moves by the FDA to make acetaminophen safety are discussed. Nurses who are able to educate their patients about the safety issues related to acetaminophen will be very important in reducing the incidence of overdose-related liver failure.

Improving patient safety by improving medication communication.

Any time that information about a patient's medication is communicated, there is a potential for error that occurs because of misinterpretation of abbreviations, acronyms, and dose designations. In the following discussion, corrective approaches for reducing the use of error-prone terms will be reviewed. Terms on the "Do Not Use" list are identified and the rationale for using "Tall Man" letters is addressed.

Treating clients with a deadly poison.

Botulinum toxin (Botox) injections are a highly sought-after elective treatment for temporary relief of some facial lines. Botox is also a highly useful therapeutic agent, approved for use in treating a variety of health conditions. However, Botulinum toxin is a poison responsible for botulism, and, regardless of the purpose for Botox injections, there are serious considerations about safety and adverse effects related to its use that are important for nurses to know. In this article, the relationship between botulism and therapeutic use of Botox is identified. An overview of information about Botox includes particulars related to safe use and Federal Drug Administration warnings and suggestions for patient education.

New medications and medication changes.

When nurses in orthopaedic settings are educating a patient about the medications, they address not just those medications related to the current orthopaedic problem, but all medications the patient is using. During these education sessions, nurses will often be asked about new medications, changes in medications, or medication recalls the patient may have heard about from friends or through media sources. One up-to-date resource for drug information that nurses can readily access is the U.S. Food and Drug Administration Web site. In the following article, selected examples of information available from the Food and Drug Administration includes recently approved drugs, new drug combinations, new formulations of established drugs, and drug alerts or warnings. Informed nurses, able to educate patients with accurate information about all the medications they are using, can reduce the potential for harm and decrease unnecessary stress and anxiety.

Drugs used to treat erectile dysfunction.

Knowledge of the drugs currently approved to treat erectile dysfunction (ED) is important for nurses who care for male patients, especially those men of middle age or older and those who have concurrent health problems or are taking medications that may contribute to ED. This article provides a very basic look at ED and the drugs currently approved and used for treatment. Informed nurses can increase patient understanding of ED, make suggestions for necessary referrals, and help patients and their sexual partners understand the appropriate use and cautions associated with drugs used to treat ED. On the surface, one might question why orthopaedic nurses would need knowledge about drugs currently used to treat ED. However, when one considers that a large proportion of patients in any orthopaedic setting are men, the need for knowledge about the use and safety of these medications becomes a valid component of total patient care. This is an especially important subject today, when media advertising has heightened public awareness of the medications used to treat ED but has not provided much toward a basic understanding about ED or the safe use of the advertised therapeutic agents. Nurses who have some knowledge about ED and the medications used to treat ED are better able to serve as a patient resource for education and referral.

Medicating young or very young patients--Part III.

In Part I of this series, the unique considerations about medicating children at different ages were addressed. In Part II, examples of medications used to treat common short-term illnesses in younger patients were examined. In this part, examples of medications used to treat children with two long-term conditions, asthma and attention-deficit/hyperactivity disorder, are identified. Action, contraindications, and safety concerns for these agents are addressed. The challenges and lifestyle changes that these chronic problems pose for children and their parents are also discussed.

Medicating young or very young patients--part II.

Having a sick child can be stressful for parents, even if the illness is a mild cold or gastrointestinal upset. Part of that stress may be related to uncertainty about when to seek professional help and when to choose an over-the-counter (OTC) medication. When choosing to use an OTC medication, parents are faced with another uncertainty-which agent to use. The variety of available agents, many with pictures of children on the labels or names that indicate "for children" makes a wise choice challenging. Knowledgeable nurses, who interact with sick children and their parents in any setting, can do much to relieve some of this uncertainty and stress by talking to parents about the treatment and medication choices they make. In the following discussion, examples of medications used to treat common problems in younger patients are discussed. Contraindications, safety concerns, potential drug-drug interactions, and safe administration guidelines are identified for each example. Part III of this series will address examples of medications used to treat more complicated childhood problems, such as asthma, allergy, attention-deficit disorders, and obesity.

Medicating young or very young patients--part I.

Children enter an orthopaedic treatment environment for a variety of reasons. Some of these pediatric patients will be seen in practices specializing in pediatric orthopedics. However, many young patients with less demanding problems will be seen in family practice settings and general orthopaedic areas. Medicating these children safely and effectively and educating parents about a child's medications are important aspects of good nursing care. In this first discussion about pediatric medications, the unique considerations about medicating children at different ages are addressed. Adherence considerations are identified, guidelines for talking with children about medications are identified, and improvements in the regulations that are designed to increase knowledge about safety and efficacy in pediatric pharmacology are reviewed. The second part of this discussion addresses examples of drugs used to address selected common health problems in pediatric patients and will be published in the May/June 2007 issue of Orthopaedic Nursing.

Managing insomnia.

Sleep is a vital part of normal health and wellness for everyone. It is also an important factor in recovering from the physiological and emotional stress of any hospitalization or illness. Insomnia--the lack of adequate period of sleep--has a profound impact on society and public health in many ways. Chronic insomnia contributes to injury and illness and may have adverse effects on cognitive functioning, interpersonal relationships, concentration, the ability to handle stress, and productivity. Nurses who are knowledgeable about the possible causes of insomnia, the different types of insomnia, and various therapeutic interventions will be able to identify those who have insomnia or are at risk of insomnia and will be able to counsel these patients about healthy sleep habits and the safe use of pharmacotherapeutic therapies used to treat insomnia.

Diabetes and diabetes medications.

There are more than 20 million people in the United States who have diabetes; 14 million are diagnosed and an estimated 6 million who are unaware that they have diabetes. Thus, nurses in every setting are interacting with patients who have diabetes. Those nurses who are knowledgeable about diabetes can play a major role in reducing the damage that diabetes causes by educating patients and helping them identify the important aspects of managing their disease. In this article, a brief overview addresses the two major types of diabetes and the serious implications of uncontrolled diabetes. A review of selected antidiabetic medications identifies the mechanisms of action and potential side effects pertinent to each medication. Laboratory tests used to identify and monitor diabetes are also addressed.

Unraveling the mystery of HIV medications.

Today, millions of people around the globe are infected with human immunodeficiency virus (HIV). This retrovirus attacks and renders ineffective the human immune system and leads to acquired immunodeficiency syndrome (AIDS), which leaves those with AIDS open to a variety of fatal infections. HIV knows no racial, gender, or age distinctions, and there is, as yet, no cure for HIV. However, after 25 years of research, there are three classes of medication that in various combinations may significantly slow the progress of HIV, thus improving and prolonging the life of infected individuals. Nurses in any practice arena will inevitably care for patients who are infected with HIV. With an understanding of HIV and the therapeutic benefits of antiretroviral medications, informed nurses have the opportunity and responsibility to educate infected persons in the appropriate use of antiretroviral drugs and the importance of preventing transmission of HIV to uninfected persons.

Fighting infection: an ongoing challenge, part 3-antimycobacterials, antifungals, and antivirals.

The first part of this series provided a brief overview of how antimicrobials, the "silver bullets" of modern medicine, are designed to target specific agents of infection. The second part addressed several classes of antibacterials: bacterial cell wall inhibitors (penicillins, cephalosporins), protein synthesis inhibitors (macrolides, tetracyclines, aminoglycosides), and nucleic acid inhibitors (sulfonamides and quinolones). This third section focus on those drugs used to treat mycobacterial infections (Mycobacterium tuberculosis), fungal infections (Candida species, Aspergillus species), and viral infections (herpes, hepatitis, and influenza). Selected agents in each classification are identified, with a look at the specific use, action, and potential for adverse effects. A brief comment about the challenges for future development of antimicrobials is included.

Fighting infection: an ongoing challenge, part 2--antibacterials.

In Part 1 of this three-part series, an overview of how antimicrobials, the "silver bullets" of modern medicine, are designed to target specific agents of infection was given. The worldwide concern regarding antimicrobial resistance and the need for a more judicious approach to using antimicrobials was addressed. In this section, the focus is on those specific antimicrobial agents used to fight bacterial infections. Discussion addresses bacterial cell wall inhibitors (penicillins and cephalosporins), protein synthesis inhibitors (macrolides, tetracyclines, and aminoglycosides), and nucleic acid inhibitors (sulfonamides and quinolones). Examples of agents in each class are identified, with a look at the specific use, action, and potential for adverse effects. A general overview of patient teaching for antibacterial use is included.