Med Check: Routine labs for common meds
Kim McCarron MS, CRNP

Nursing Made Incredibly Easy!
April 2013 
Volume 11  Number 2
Pages 50 - 53
  PDF Version Available!

Medication administration involves many steps and occupies a significant amount of nurses' time. The process of giving medications requires the nurse to have a strong foundation in pharmacology, yet many nursing curricula only provide an introductory course or integrate the information by threading classes of drugs into discussions about specific disorders. This method of instruction leaves many nurses inadequately prepared to handle the vast amount of information required to safely dispense medications.There are guidelines to help nurses decrease medication errors, such as tall man lettering and accepted abbreviations to minimize dosage mistakes, but there's a need for nurses to know how to prevent metabolic injury to the kidneys, liver, heart, thyroid gland, bone marrow, and muscles through the monitoring of routine lab data. By focusing on lab tests that should be obtained before the beginning of drug therapy and then periodically, the emphasis is shifted away from symptom-triggered monitoring.Because the kidneys excrete the majority of medications, it's essential that you know the patient's baseline serum creatinine level and glomerular filtration rate (GFR). These are the most accurate indicators of how effectively the kidneys will eliminate compounds contained in a drug. Medications that can cause adverse renal reactions include nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, and aldosterone antagonists.NSAIDs can cause a potentially harmful decrease in renal blood flow, altering glomerular filtration. Now, add a diuretic and an ACE inhibitor or an ARB to the mix and you've got a triple whammy. The combination of an NSAID, ACE inhibitor or ARB, and a diuretic is extremely detrimental in older patients who have declining glomerular filtration associated with aging, or in patients who have preexisting renal disease.ACE inhibitors and ARBs inhibit efferent arteriolar vasoconstriction

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